Document Byzbr5QOn91Yz48OdQnDyyxDo

<v i 6/5/61 REPORT TO 0. 3. RUBBER C(HPANY, A2EESTON PLANT, HCGANSVTLLE, CSCRGIA, REGARDING ASBESTOSES IN E-^LOIEZS AT THE ASSESTON PLANT, FCR THE " ASBESTOS TEXTILE INSTITUTE t-ZETING PLAINTIFF'S EXHIBIT John G; Wells, K. D, Kiwua, Georgia Th* Asbeston Plant* of the U, S, Rubber Company started operations in 1910, Proa its inception, there was cognisance of the potential aadico-industrial hazard in working with asbestoa fibers. Several factors militated against ths possession of satisfactozy knowledge regarding the nature, degree and extent of this danger. Ccnnazdcations between different companies working with this fiber were handicapped by ths requisite need for secrscy inherent in a highly competitive system of frss enterprise. Adequate studies regarding the epidemiology, radiographic, elinicopathology changes and functional or physiologic had not yet in many instances been undertaken; marked the "**"* by which particularly the latter could be* accomplished even being developed. More over, as will be Indicated later, and as has been suggested by others in the United States and England, there is reason to believe that not only has the nature of asbestos disease changed in the past eighty jeers; but also is probably different in varying places at present, because of such factors as type with location of operation within a given plant and the type of asbestos fiber predominantly used. Awareness that*there was a potential problem motivated the U. 3, Rubber Co. in Hoganaville, Georgia, to start routine annual chest X-rays on all personnel working in ths Asbeston plant at the inception of its operations in 1910. Additionally, detailed dust count studies at many stations within the plant have been continually performed over its twenty-one years of operation. Information adduced from these data and films have subsequently proven in valuable in yielding some estimate of the approximate accumulative exposure to asbestos dust and its relation to the production of asbestos lung disease. . Examination of sarial roentgenograms of individuals has moreover enabled us to describe the radiographic picture of asbestos lung disease as it occurs at our plant sad places us in a position of greater confidence in detecting early changes at a tine when we hope removal of the worker from risk will prevent development of a pulmonary cripple and keep a trained worker on the labor market* The present program was inaugurated in the Asbeston plant in Hogansville in 195?t its goal was to develop all the information possible regarding the general nature of the asbestosis problem as it occurs at our plant and to detail. Insofar as possible, the specific alterations in the individuals at risk. To this end all workers receive comprehensive annual examinations which include a detailed history and physical examination. (Male workers are advised to consult their family physicians for rectal examinations, ard f-rui9 woik6rs are requested to consult their personal doctors for breast and peavic examinations); a hemogram which includes whita 'with differential' count; ; DEFENDANT'S | EXHIBIT mo '' . 4 U ^ Roport to 'J - , .r__ cr Company -3- hemoglobin, hematocrit and red blood call count. A sedimentation rata and urinalysis art also performed. Vital capacity has baen measured by the HcKessca-Scott apparatus.and yearly skin teat for tuberculosis and histo plasmosis bar* batm dona* In selected cases, sputa are collected Tor tubercle bacillus culture and about six patients hare received bilateral bronchograns -`with negative findings. Cheat measurements at inspiration ` and expiration, height and weight and the routine vital signs are recorded* Our effort then, is to see the patient as an individual and a whole, with emphasis upon the changes - if any - wrought on his poysical and eaoticnal being by occupational exposure to asbestos dust; to quantitate that eicposure in dust count dosage and resultant radiographic alterations; and to more recently measure pulmonary physologic performance. Nvnerous factors seemed apparent in an initial report in 1950, and the' passage of time has done little to alter initial tentative conclusions. Oust exposure in our plant lessened more-or-lssa steadily with the passage of the years, following continuing efforts by responsible plant personnel to ' entrap, divert and exhaust the asbestos dust from the work ares atmosphere. Review and study of serial chest X-rays of workers who were beginning to develop pulmonary asbestosis in HogansvlUe demonstrated a more-or-less orderly progression of radiographic maturation frea normal lung to diseased lung. This comparative study was particularly valuable In that it rendered more easily apparent the detection of the earliest radiographic changes of pulmonary asbestosis in this plant. Ths logical sequel of course, is early discovery of affected workers in order that they may be removed from risk before advanced and irreversible pulmonary changes have occurred. 0 In this connection, it seems pertinent to note that the progression of radiologio changes seems so far to be unique'for this plant. Ve were prlviledged to consult with Or. Kenneth E. Smith, Medical Director, Johns-^anvUls Company and Dr. John F. Knox, Medical Director of Turner Brothers Asbestos, Ltd., Rochdale, England who shoved me X-rays of their workers with pulmonary asbestosis* Ths radiographic patterns of their asbestosis patients seemed to be of a far coarser and further advanced nature than cur patients at comparable clinical levels of disease. The type and source of the involved asbestos fibers, dust sise, sad possibly dust velocity at time of Inhalation may be some of ths factors involved in the differsacs. As a local ocBvenienoe and method of utilizing available information relating dust count date and accumulative exposure, we developed the term MPPC7T meaning million particles (of asbestos dust) per cubic foot-year, ^e found the greatest exposure density of workers affected by pulmonary asbestosis to be around 50-60 MPPCTT* s * A curve plotting asbestosis against MPPCFT shows a slow h r.m pfdnfc and a tendency for asbestosis to become mors predictably certain with increasing exposure. In order to keep a trainee* worker on the Job, the conclusion seems inescapable then that at least cne vital step involves as near <pnplete eradication of the dust as is possible* Report to U. 1, n.er Ceraany -> Certain stations, such as weaving and winding, seem more at risk la our plant, but th* changing work population and insufficient number of worker* hare prevented, so far, any valid statistical and predictive evaluations furthermore* certain type* of workersj namely supervisory personnel, have seemed more susceptible to the disease and the attrition among these valuable people hae been relatively high* Speculation leads one to wonder whether the very attributes which drive certain workers to excell and become supervisors may have at the ease tics encouraged them to taka greater risks, show core disregard of the dust hazard, and ultimately become casualitiss* In regard to hazard and risk we have adapted the policy that knowledge of the risk and awareness that we are doing everything possible to minimize it and remove the worker from danger should he become an incipient victim 1* the most prudent course to follow, from a laboratory standpoint, patient* who develop the disease have tended generally to show rising value* of hemoglobin, hematocrit and red blood counts, Thera hava been no signlgicant alteration* in white blood count or differential value* unless there ha* been a complicating infection* * Vital capacities^, as measured by the KcSeason-Seott vital capacity apparatus, have shown universal from a clinical standpoint the- cardinal feature* have bean onset of chronic low grad** non-productive cough, occasional sub-sternal and epigastric iny digestion, and an insidious onset with progressive lessening of strength, pep and energy and a stealthily increasing shortness of breath on exertisn. No on* haT'ccmplained of orthopne* or paroxysmal nocturnal smothering* 'Chest pain, except for fleeting and hard to describe almost neurltio symptoms, has bean largely absent* Some patients with fairly well advanced pulmonary disease complain occasionally of difAcuity in getting air into their chests* This symptom may be part of the hyperventilation syndrom*, end subsequent respiratory studies have indicated that these patients almost uniformly have an increased minute vclm* of nr>f Those with pulmonary asbestosis In our plant have Invariably shown diminished. chest and di uph-repcatiQ excursion,, fairly normal respiratory murmur* except for a tendency for th* development of bronchove^yjiffyli^ sounds over the _ baits posteriorly and laterally; the typical finger changes of hypertrophic pulmonary oeteoariSropaihy without tenderness along the shafts of the lung golfo*! ariTIhcreaelng intensity of the second pulxonio sound suggesting rising tension in th* pulmonary circuit. So far, none who show even moderately advanced pulmonary aabestods (with one poeslble exception who waa not observed by a*} have demonstrated cor pulmonale manifested by right heart failure, radiologic change In hilar vessels or eiectrocardiogrephlo chargee of right sided strain* This stems somawhaV strange but perhaps time will throw more light on this particular problem* In order to learn more regarding the chyotoloslo alterations of pulmonary asbestosis and to provide a aerwoi--less quantitative method of following these alterations we started about twe years a<;o to study the volumes of the various physiologic lung compartmentsj their ventilation} th* distri bution of inspired gas as measured by the pulmonary nitrogen emptying rate Report to 0* d. ^'-or Company 5 (Tain te*t) cod pulmonary nitrogen washout eurves) tad the character of the recorded spirogram. More lately w hare begun to study in theee patients of vsntilaticm-perfusicn relationships and the diffusing capacity of the lungs for oxygen by the method of Rilay and Cournand using two different levels of inspired oxygen concentration. The partial pressures of c^rgen and carbon dio3d.de in arterial blood at these two levels are determined by the direct bubble method of Riley, Proeasnel and Franks. The arterial blood content of 07"gen and carbon dioxide and various gas analysis are msasured in the Van Slyhe mancaetilc apparatus and arterial ?HTs are determined with the 3eckmaa PH meter. There are appended to this ropert three pages in tabular fora showing in seme detail the results of our studies on several patients with pulmonary asbestosla. AH have radiographic changes of varying degree, uniformly involving the lower lung fields and, as the disease progresses, the serosal surfaces of heart ar.d lung. All have evidence of decreased chest excursion and many show "decreased descent of lung bases to percussion. Breath sounds over the inferior portions of the lungs, usually .posteriorly and often laterally and anteriorly are normal to bronchoveslcular and frequently reveal fins to medium end-of-inspiratory sticky ralss and occasional faint rhonchii. Vhere the second aortic heart sound is louder then the second pulmonic, serial observations over several years have tended to reveal a changing relationship with decreasing aortic second and increasing pulaonio second sounds. 4* The majority have clubbing of varying degree acme pronounced, end some minimal, and there appears to be little correlation with the severity of the process. Uniformly, there is some dyspnea on slid to moderate exertion and a general loss aanaa of well being and usual strength and energy. . Vital capacities age almost uniformly decreased. Residual volumes tend to be slightly increased and total lung capacities, so" far have tended to remain close to predicted normals. This may be because of increases in residual volumes, for the directly measurable inspiratory capacities and expiratory reserve voliass art uniformly decreased. Minute voloMS'are almost uniformly increased and arterial CO* pressures tend to bs low. Almost all have increased ventilatory equivalents for oxygen. Maximal breathing capacities are uniformly decreased, although the figures given osy be somewhat lower than the patients1 full ability because the test has been performed in the seedrecumbent position. There is little evidence of airway obstruction arid the pulmonary nitrogen emptying rates have been almost uniformly normal. Timed vital capacities have tended to show some lag at one second but normal emptying at two and three seconds. Arterial oxygen saturations has been normal as have arterial partial pressures of oxygen at 21 percent oxygen in the ambient air. Diffusing rapacities for cxygen at reat have varied in four patients measured from 10.8 to 16,0 oc/m/na. L-^s.y n-cn^ \!a\< ^ V V <^C. Sr SV_ Cjt