Document Ed9DxyVk58mMO59RxjdnLO0pj

FILE NAME: Metropolitan Life (ML) DATE: 1926 DOC#: ML314 DOCUMENT DESCRIPTION: Asbestosis in Mine Workers rACU^Y or Mtotcim orfici or Tu* oan. M c G ill U n i v e r s i t y , ^ M ontreal. ju ro m Ni&otoonth 1 9 2 6. Augurtuo 8. M.P. Madicul P i r o o t b r X Metropolitan Lif Inaurunco Co., MI V TO Rju/ u I T I . - ySL 21 4 4 it i I i 1 -< *4 i Pour Dr, Knight, I bar* Jyat returned fro California, and find your good lrttar of January 7th awaiting m o . It a oxtroMly good of you to write mo ouoh 0 aio# not, aui Z qu iti understand vyour position, Wo aro or# than dolight od ' at tbo g eaem ity of tbo Board of Piroctoro ia appropriating tho aoaoy for our ourroy, aad Will look forward with a groat' deal of iatoroot to ouoh work ao wo oaa oarry out. I hope i t w ill ho tho soatu of *Yor mr* aid aoro pieaoant relation* hotwooa tho Canadian nodlot 1work aad tho Metropolitan U fa Im rune* Ooapaay, . With orory good wiah for tho Mow Toar and ronowod thank for your Jdadaooo^jtollov* *. . ~ " ' ... UUM. p f \C P u> * .a r I v M tV0<394 Dr.Charlo F. lfcrtia 6C0 Cfcarbrtsakt trart ItaairtajL CMdA JftMMUy 1 , mt liy dacr D ttitr to rti r*r qvdt# i 1M( tltt# X iH rlJw l it mj laikUltj i* k*t Ui vrnrtml yr*nwU t t t a t I atad* i* yt* whoa y m ara k* i* my frie , twaly, that X **14 try i t o ll yt* dark Um ( U m M a**k k i r Ctaiptay ** lit o ly i l M Lik r i a r m i i tk i t ^ w ir K U li t k t top*i f i r . I m LUmt fW |it MT it a B tttor M ito ai m U i t k t X noi c t M ite r f ite r a la t in i17 oihlac W 1 m ! 4 r 4mm I ito * tlM X aa tmrjr r ito t t U H jm *v( t o m m y ito * ImiJNm N / t i ra titi ym*+ ratntia torftajarmartttffrWtordty-itolkKtorto* Wltototr I tila Caimay taytm*M* Il000 yaar far fiat yt ftt tto prtyttto Mtratf it k taM totaUm W i m a*d canditia** li tk Mtditad f Um MMimtUItt ' / X k M Otaikt th at ym tm j t lr m t j kam k a rd Wat t ih U tkf*u*k Um laiiaar t t o t tmr Pamidtari wrt# ta t i r J rtto r t* to rri* rm U H ay, t o i a iv a rik ia a a I U t k / iL U k k i i i a tr i M i jm a k a i it* Vh klndtti fiaai*l rafrd# jm ad truitln ikai yaa adii, n m ta m m a towaaaac ym an tort I 9m tari.Z mb Ttur vary indy* ! n o i e AL K tt C I W ,,,,^.ir.nD s /c /m /m s It 1 euggeeted that ea approeoh the Dean of the faculty of hedislne of MaOlll Onivereity with e proposal that upon tb* establishment of an adequate Department of Industrial Hygiene in the Uctiill Medical School the Metropolitan enter into u agreement with McGill to secure for the Go*pony certain services and information re lating to the health of industrial workera in Cattide* With the establishment of a Canadian Hon* Office and tho extension of the Coupany'e operation in the Dominion it bacon increasingly important that the Company her s e c a n t knowledge of condition attendlr ioduetrial activity in Canada. It 1, further, moat dirabla that tha Company* program for tlm betterment of tha health of industrial sorters and their families ba advanced In Canada where industrial Iqrgleno as a chase of public health sort is notably backward* spacLfic It would ba of great value to tha Company to Imva Information rtgarding euch mattare asi 1. Tha distribution of indurtrisl establishment*, mlxMHS ad lumbering operatlene with data eomcaaw log tha noabar of employeeo in aaah o r U b H ehnw* and dirtrlcrU 2* Studia* of hasardou* prooaasaas % Studi** of worbldity and mortallty in relatlca to tha major Industriai poreuita* 4* studio of eoteot and aharactor of medicai aerioa availobi* in tha 'unergcmtsad territaiy* wharwin ara coaduetad tha graat mlning and lmberltg operatlons* Si Citadrrwattano rwgtrdlng apyurtunltles for adusaU o o a l ork tgr tim Compaqy* '~D ~0 oa OC.7 cn.. To aacoro mah information directly would ba d ifficu lt and vary erpemsita. I f I t could bo obtained from department of 1*durtrial hutlane in Qamda'e leading university in rmturu for a noder- 40 mttml AM U* Oonpuf ould wntowMmdlj benefit, I f tha Cntpety oooii im iio d iD y through its relation with tha Ootvoraity oxtend ita W la d liw * In the field of public health the benefit would bo til l I t would amen an adheronoo to th* Compasy'S eatabliahed policy of u tilisin g when possible Oanadlan personnel and operati** through Canadian wgeaaio*. I t would bring the Ooepaay and its activ ities in eoataot with many highly influential lndivldvale and industrial groat* Though legal obstaalsm may stand In the way of a eomtrlb- ution by the 'Vmipsity to an educational institution they are not eoftaarn- ad with the plan proposed, Suah a plan involve# a definite quid par quo. paymattta specifically ooadlttoned,upon a comaenam a i s return, the ade quacy of euch rotar to be determined tgr the Fruitomi. ar theme to bea he may dilagate the daelslon. -a- c m m u . _ 7 7 ~ *" prop(Hnl bt taLdi W tiki OdttpMflT ti tli Dal U LVI ^ ^ U l optnltlonji than H w o u l d ^ *" *" & jrUeip*tioi to bo oollclt^, , , i* 4* accordingly reconowadod that with oroDsr iri IS S S S /S 0l',,U" fulflU" lrt of uiuh^ omimL fQj'iki'j ,, z m r s a ? ! . * ,m , * 1* * "*** w * * m r **W> tn0w,*0ii dollar* annually during period of )w \. faudo bright t 0397 to?. 4, 1$>. Deer Doctor Xnighti Z do cot know whether or not the President 1 ettll lnieraated la eeteblalhlng oca* *ort of relation with HcOill or not* Neither an I re11 Juet hon the Ottawa coroer-aton le/*lot take* place but If that event ia till In the offing it would be a grand tie to do the graceful and announce our proposed relation* wlthathe Univeraity* nlthia th pa*t to eeeiu or ao there Imre tee turo imporUat and rgent cella for i**lp fron CanodUn fifa* Om La th (Hit eative ef th klf pepar ooepanJLee, fron th standpolni of labor relation* and eoa of tbe ver/ lergojrU Thoy aro fin a li/ tartlag on an ertene1ve reorgaalaatloa of t hI r ehole ndiesi procrea lth perielio annual peleala , a t tho rocoonoadatton of th* twUo oapl/ee*. Xhl le tbe Spenleh ftivar Pulp and Paper Coaptty* The ether wtflt 1* a p rlo tii* plani near Montreal vhlch 1* launchi z * vlld eh** te oratine ererybedy lo tb elr eoplcy uod alee th aembezo of th Na ti tee of eapleyeea* Patii th** groupe noed elee aatchlng ani e le t of belp. l i 1 aork which ee eaa de *0/ with d if f i c il i/ and great oxpeoee ani m ie ehiah a Oeaadlan ceuld do b atter thea ae euld* On neh a job th* oooteapUiei dapertamt a f U dii*trial hyglene a i XoOlll *U be abl* te render moti re i nabla oanrioo* 11 jett thlnk veli of oontlonlng th* Dottore Mr ftraar* oeetid gip* yen all dotali** A /ou know 1 did not poca** tbe attor of th Mei'* relatloio oith *r*iU wlth Hr. finre, lottlog tbe baie queetl* roet bare &t on on Mr Mele*'* rlalt bere* Xf /ea viah to oca** further Infornatioa fren *r* omero ploae* ioli kUt of th plot at th Une of Or KarUa'a vlelt for he fcnoea nethln* f IU , 31no*rel/ year* f * C.J ^ "TH E THING I W ANT YOU TO TAKE HOME AND THINK ABOUT" Business Session of the Managers' Annual Convention, January 29, 1925 H aley F iske, President My dear friends, I have left for myself but a very few minutes to sav^ something to you at the conclusion of this exhibit of the year's business. I don't like merely to read this record and dismiss you. I won t see yu again to be able to talk to you for another year, except as I hope to be able to meet many of you in the Field during the current year. (Applause.) I don't count Saturday night, because in making way for other speeches, I cut my own down to the shortest possible limit, and what I shall have to say there will not be directed entirely to you, but also to the listeners-in, who, this year, will be millions and millions of people. I understand that we have engaged all the systems for a certain length of time, and that everybody who -has any kind of a radio at all, will be under the necessity of hearing me speak and have the delight of hearing the other speakers. I like to confine my remarks sometimes to a text. I don't know but that before I get through today I may preach a sermon. I am very much stirred up. The Reverend Father Bull is one of the most dis tinguished men in England. He is a member of the Community of the Resurrection. That Community consists of learned men whose occupation is writing books and preaching sermons and also doing mission work. Father Bull is known all over the world. One of the vows of the Community, as in other religious orders, is poverty. When a man enters a religious order, he has a vow not only of chastity, of obedience, but of poverty. All that he has is surrendered, and thereafter he lives the Community life. Father Bull's Visit to Home Office Father Bull was in this country delivering a course of lectures at the General Theological Seminary. He became much beloved. I was privileged to meet him. He came to the Home Office. Later, he had a conversation with my daughter which was rather illuminating. With that notion of poverty and that idea that this material life of ours is temporary and that eternal, life is the only thing worth con sidering, he said he never liked to meet or know rich men or the officers of rich corporations. You can see his idea. He was good enough to add to my daughter that he made an exception in my case. And why ? It was no merit of mine; He came here to the Home Office. He lunched. Then we showed him around. I thought he would never get through. He said he thought he had walked ten 439 440 M a n a g er s' A n n u a l B a n q u e t , 1925 visitS'to yo1 i / S t T a notef saying: thoroughly enjoyed my Of the lufman race in eS- f r USC in His Kin?dom- as a uniof Cooperation Our Mission (he w'ni'T r ' 1 r1akint.g ?urselves instruments of good, carrying out o ; r ; t t a ? T t a V ' , 1?TM',"'ot hi. oT k t , z and that is the thinir T f * want to say a word or two about, The thini h n f 1 ant yU t0 take home and thinl< about, but a a Ei , r rUPOn US' not as a life insurance company, of the o r 1 CT Pa0y Wh,Ch- HaS, ne-fifth of the Population who m akeVOOOoSS ' SC SyS`T mvolves weekl-v visits of agents, who n c d h S r ? ? ' 0r.!!,OT Cal!s a year in the homes of people tunity and Z a v t Z 'S the SIt,uatlon; II develops at once Oppor- engaged in 1 m tZ ^ be.IonSin? to a great corporation and I s ^ f that human l! b l? T "* ' " puts uPn us Responsibility, and o S t into Z iaS ng? \-UC^ S yU, and yoUr agents are- can't afford r(ppi"SLp)w ""r l"m,an beings and "eel" 1 (al tau1!? k f,or &ranted that I am addressing a body of men L mereaSmsemf the age"tS 0 thS ComPany whom I lovef.who are have Gon'?gH?!m f Z insuurance company, but human beings. They rehL^h.-nc rea omh E 5 '^ d them' The-V have, as human beings, human Z C mPa^ creates for them an abounding human m lC E fo T 'n e o V ' SJ Y m " 0 WCekIy contact with millions and and Z loL and 1 ?aVJ hat no man who has the fearof God ttuiitipif E ft, h mamt,y !n h'S veins can possibly meet thoseoppor- claZs It be, . mere.,rIeIat.1onship of premium collections and death human i 1PSSIhle, it seems tome, for a human being with a h 1Cart t0g ar U"d a"d niake thcse visits and not do all the which f h i r n0t contentlng himself with simply keeping the contracts " h,ch the Company has made for him. The Home Office Furnishes the Means at the'HnmJhnfrbe S ' ." Z can, we do? What we have been doing which vlE ffic! `f t0 i urtllsb -vou the plan and the material by is niiMini Ca,!f Tu* those GoD-given opportunities. First, of course, not i n i Z Ai? htfVe ta ked t0 you about that so often that I am c t a i Z Z w u a k .ab/0Ut 11 today' excePt to say that I can not under holder who !ieedas anueagent " neglecting any sick Industrial policy- w a n T ^ 'c,1 3m .alHng out hterature year after year, and I don't " H i about that. But, gentlemen, if you yourselves read the literature that we issue, you must be impressed with the fact that very, very instructive and helpful. I am persuaded that it has Address by H aley F iske 441 been largely circulated where it would do the most good. I do hope that you will continue to see that it is distributed where it will do the most good and in the manner in which it will do the most good. And the manner in which it will do the most good is by consultation over the pieces of literature between the agent and the family. For thirty years I have been preaching that this Company of ours is a family. I am rejoiced now to think, at the end of a generation, . that everybody feels it to be a family. After all, we are members of a great human family, and it is that feeling of a human relationship which I want men to cultivate. It is curious how the heart-touch of human sympathy will enter into men's breasts on the slightest occasion. I was reading the other day, a letter from one of our districts. It was a story to me extraordinary which illustrates the feeling of how yearning people are, how aching people are to have human friend ship and sympathy. One of our men called with an assistant or another agent at a house which he understood was uninsured. He knocked at the door. The door was slightly opened and then a bar thrust across, and the man said: "What do you want?" "I want to present to you the subject of insurance." "I don't want to hear you. I have considered it, and I won't take any, and I don't believe in it. and you can go away." He said: "Well, I think I might say something to you that would be interesting at least to your family and yourself, if you wouldn't mind letting me in for a few minutes." The man's face softened, and he said, "Well, come in." The agent opened the subject of insuring the father and the mother and the chil dren, and he made no headway. The man got up in a kind of disgust, left the room and went out into the kitchen to shave. Of course, the agent kept on talking to the wife. The Christmas Message She hadn't any power to sign an application, but on a chance the ' agent said: "I wonder if you would like to listen to a Christmas address made by the P resident of my Company to the men and policy holders; because if you would, it happens that I have a disc in my car outside and a little phonograph, and I can put it on and let you hear it." Well of course curiosity got the bfetter of the woman, and she said: "Bring it in." He put on the disc and repeated that Christmas message of a year or two ago. which went all over the country to agents and to policy holders. There was a listener-in from the kitchen. He finally burst into the room and said: "I missed part of that. Do it over again. It was done over again, and the agent left with the application of father and mother and every one of the children. (Applause.) Of course, you know that story isn't told for the purpose of any exaltation of myself. It is done for the illustration of what I am insisting is true: that the hearts of working, people are yearning for sympathy and human relationship; and as soon as that man found MANAGERS A n n u a l B a n q u et, 1925 while to deliver to him aChristmas * 2 ? 5se, heaci thght it wort a member of the corporation whose p CSS? P ' "I want to b the welfare of all hiT policyholders ^ resJdent th,nks at Christmas o Do you see? Can you get that* T ^ to be "e- was in the man's mind* That f E t ' P u l s e tha people, whether they admit it or not. g " 'he m'nds f a 1 wofkin.! The Meaning Reaches and Touches Men Who Work reaching out to those^men 7 n '^ m a t t e r " rfnd"striaI insurance, i: because it involves a cooneratinn Unt atterL of human relationships The system th? .e,mP.lo-ver a"d employe mutual contributions ties un in a t. 6 w llc '> ln effect, ties up in the employe, and ties them up in a f iS T e n s e ^ T b ^ emi?loyer ana ship in business, and they are in n 2 L u" TLhey are m P^tner- ownership, that mutuality which is fhe S v 'n f T b ^ M fsense,.of joint binding together of millions of people or m. tm i P 1,tan' that beautiful thing in the world Tt i cf L * Mutual support, the most the employe that he andhi boss J --that s ike great n efi ' that|J * w ameliorate and T, " tre to am^ ' co?scl"sness on the Part of M" rol ,to"familv "C.e<l.Ey I"f"TM e. ft Capital and Labor, the employer and employe'*'The,,fnSlT b'u" " n mg it to your attention because I leel a t 'this r TM ,,, T ' 1 am btrlnS- ness which we are doinir doimr to ' i " G p Insuran busi- small extent as com ired 2 H\ - r ? e e?tent- bl,t to such a valuable things from a public ooint nfP ^ , b l u*St . ,S one of the most b= engaged in that is interested at all in M 'fa ta `n e i" rPOn`,i0" f -inking E m p lo y e m d Em thyc! Bonds of Mutual Interest come to any company the defpnsp Cy tbe power that would any company that has on its hnnL- a^ainst assault that would come to this country masses of oponl* S fosses of the population of s s k e w 's A ddress by H aley Imske 443 Group Insurance is the study of hygiene of the worker. Did you hear me read that list of forty different things that Dr. W ade W right is doing in his division ? Can you see that he is reaching down into all the hazards of employment; that his purpose is to bring home to the emp oyer his responsibility for the health, the welfare, the lives of his employes? Can you fancy this Metropolitan entering into all the employments of this country and going down to the working man through the employer, or independent of the employer, and looking after his health, his domestic conditions, his methods of carrying on his employment, the things provided for him in the place of emjiloy- ment. And this hygienic investigation and survey of Dr. W right is to go down into the homes of the working people and see what they arej at home, what can be done there in the domestic way to advance their welfare and health, 1 Do you see now this human relationship extended to the nth degree, this Metropolitan center stretching out its tentacles in every possible direction to reach the domestic and the working conditions of working people? And then do you see that it is the sweetest of all things, the tender human relationships, the heart touch of crowds who will say, as you go on in this work, that you are marked men in th communities in which you live? The working people will look up to you as their friend and their advisor. Employers will be seeking you to know what more they can do. Capital and labor will lose their strife, and. as God's people under the one roof, whether they be capitalists or laboring men, they may be brothers, and you and your agents, as you walk, will walk, in and out as brothers to humanity, as friends of cverv man and as servants of God. (Long applause and cheers.) c o p t /* BBPOBT OF THB ACTIVITIES OF THE IHDUSTBIAL CLIBIC, UONTBEAL GENEBAL HOSPITAL, FOB THB T B A B S B P T S M B B B 1, 1928. to AUGtTST 3 1 , 1 9 2 ? ^ CLINICAL (A) The investigation of occupational diseases among the Out Patients of the Hospital has progressed this year in the same manner as the previous year. The number of cases for in vestigation does not appear to be increasing, and I am of the o p i n i o n t h a t t h i s a s p e c t of the work, w h i l e v a l u a b l e f r o m a re*, s e a r c h s t a n d p o i n t , is less I m p o r t a n t t h a n s ome of the other \ activities of the Clinic. A ctually there were 523 cases r e f e r r e d / to the Industrial Clinic during the period. Among these 30 cases of active Lead Poisoning, 3 cases of chronic arsenic \ poisoning. Three cases of carbon monoxide poisoning were seen in the H o s p i t a l wards, but t h e s e w e r e n o t I n d u s t r i a l cases. . ./ (B) The e x a m i n a t i o n of F o o d H a n d l e r s r e f e r r e d to t h e .. . Hospital for certificates has been continued. Actually ther< ` have been 275 of these examined. (C) 3 83 I n d u s t r i a l a c c i d e n t e a s e o w e r e q u e s t i o n e d regard to the oausation. The figures for this study are in the p r o c e s s of oo pilation, a n d ca n n o t b e giv e n . The d i f f i c u l t i e s of a study of this type from hospital records becomes apparent as soon as it is undertaken, for one has no assurance that all accident oase g of a given company come to the Hospital for trea - m ent. . FIELD ACTIVITIES. PRODUCED $/C/fofM (A) The Plant Uedleal Departments whieh wers established the first year of the operation of this Clinio have atisfactor11t . and have handled a tremendous volume of work, j . in h php.lo.l . . I ' . .... t * . Statistical statements only d e s o r i b e the _ D e p a r t m e n t s in part. I believe there is o* the part of the various plant managers in T ^ M n w r i TM i ' ......... - .p n r t n . n t o . * . . f t i . . . t i J I * ! 8 S B s l * I P 5oga.d * th . fo rm atio n of Madienl . , . 1. d u rin g t h . . h i . n o . Of t h . p h y .lo la n ` . " J " * * ' Anoth.r largo plant manufaotnrlng oompanj .otahlloh.d a Baalth S ert 1e . . otlmttlatod I h.ll.T. hr thl. Cllnlo, hnt th. C U n l e ... not consulted as to its organisation. 2 (3} Xhe Id ef co-operative Health Sercie to small plants, whieh w a r sponsored by the Canadian Uanufaetarers Association, has made no-progress this year* (0) T hera have b een several calls for i n v e s t i g a t i o n of plant conditions, A fairly extensive study was made in one bronse foundry. 1 number of air analyses for lead were carried through. The r e s u l t s of t h e s e - 'stu d i e s f o r m the b a s i s of a p a p e r to be r e a d at the annual m e e t i n g of the American Public H e a l t h A s s o c i a t i o n this fall. A study of the carbon monoxide hasard in a large garage was commenced last winter, but was discontinued for lack of apparatus. The p u r c h a s e of suitable a p p a r a t u s is c o n t e m p l a t e d and it is h o p e d to c o n t i n u e this study d u r i n g ' t h e c o m i n g year. EDUCATIONAL. (A) L e c t u r e s In I n d u s t r i a l H y g i e n e h a v e b e e n g i v e n to t h e . third year students, the students in architecture, the School o f/ Graduate N u r s e s , the Sc h o o l of Social W o r k and the p u pil nurses. - . of the Montreal General Hospital. . *' ;r 'v v (B) A s p e c i a l c o u r s e of 12 l e o t u r e s w i t h f i e l d visith,.jral(E;: \ r - g i v e n to- the P u b l i c H e a l t h N u r s e s in the S c h o o l of Gradu%C-i|fci`M&-.^ (C) 6 P o p u l a r l e o t u r e s have b e e n d e l i v e r e d at v a r i o u s clubs and societies in Montreal, and one in Toronto. MISCELLANEOUS. PRODUCED S/C/M/Ms (A) A n I n d u s t r i a l Dent a l C l i n i o w a s o p e n e d i n D e c e m b e r 1928. The Clinie is self-supporting so far as running expenses are con cerned, but the Hospital donates the use of the spaoe without charge for rent, light, heat and laundry. At this Clinic 182 oases have been treated. There has been a total of 785 treatments given. In the o r g a n i s a t i o n of this Clinio two firns d o n a t e d # 3 5 0 . 0 0 to purchase the necessary equipment. A total of #1780.46 has been ree:elY.e*tfl#|te^J8 B | t r i a l Dental Clinio, of whieh the sun of # 1 4 | F | ^ | B H U K K ^ H H K d for salaries and supplies, leaving a balance of acknowledge here w i t h t h a n k s the servloes of the who have spent their tine at this Clinie with.-/ r e m u n e r a t i o n , a n d to the n u r s e s , w h o volnistianlKiKEj^^Knlr time to assisting ths dentists. (B) The s t a f f o / the C l i n i e a s s i s t e d i n t h e p r o d u c t i o n the perlodlo Health Examination Film of the Canadian Medical tion. This ocoupied a very considerable amount of time, but considered well worth the time spent. 4 of Associa was (C) The i n d u s t r i a l M e d i c a l A s s o c i a t i o n of the P r o v i n c e of 3uebeo conducted a successful year. A union of the French and English Associations took place, and this united Association in collaboration with other organisations was able to render co n siderable serv i o e to the `J o r k m e n 's C o m p e n s a t i o n . 0459 C o m m i s s i o n of the Several general ting were held daring the y**i and a vary s u c c e s s f u l d i n n e r m a t t i n g at the a nnual m a t t i n g of tha C a n a d i a n Medical* la toe fit ian. (D) A n e f fort haa b e e n made to o b t a i n p a r m i a a i o n to atudy the affect of aebeetoe fibre on the h e alth of workers. Two large eompaniee were approached in thia regard. The fir* one, poaaibly on account of financial d i f f i c u l t i e e , waa unwilling to aponaer auch a atudy. The a e o o n d haa d e c i d e d to u n d e r t a k e an i n v e s t i g a t i o n for i t a e l f w i t h our a a a i a t a n o e a nd adv i c e . It is to be h o p e d that i n f o r m a t i o n of s c i e n t i f i c t a l u e w i l l be f o rth coming from thia. (E) The d i r e c t o r of the I n d u s t r i a l C l i n i o a t t e n d e d A conventions during the gear under review. Respeotfully submitted, (Signed) F r a n k C. Pedley, t The Industrial Clinic. i o H tff \ - PRODUCED 8/C/M/Ms COPT / ``f U l N T l F F 'c ' EXHIBIT Hio3r_ B I POET 0? THE ACTIVITIES OP THE IIDUSTHIAL CLISIC, HONTBZAL GEHBBAL HOSPITAL, POB THE T1A3 SKPTEM3EB 1 , 1929 to AUGUST 31, 193Q. pK intiff's EXHIBIT CLIHICAL M V 535^_ The clinical work in the H o s p i t a l as distinguished from that d o n e in the field has c o n t i n u e d as in the past, and an a d d i t i o n a l d u t y has b e e n assumed, n a m e l y the supervision of the health of the Bospltal employees. This was undertaken as a s e r v i c e to the Hospital, a n d has little value from the University standpoint. The n e w a o t i v i t j calls for an e x a m i n a t i o n of all new e m p l o y e e s of the Hospital, and r e q u i r e ! that all cases of i l l n e s s a m o n g the H o s p i t a l e m p l o y e e s be r e p o r t e d to the In** d u s t r i a l Cli n i c . Duri n g the year 80 p r e-employment examinations and 38 perlod'io re-examinations were performed. 410 siok f e m p l o y e e s of the Bospltal were seen a nd followed until the. t e r m i n a t i o n of their illness. T h i s system, as it operates a^>p r e s e n t , is not e n t i r e l y s a t i s f a c t o r y on a c c o u n t of the nus'frfr of departments whioh engage their own personnel, and a considerable number of new employees are being engaged with no examination. However, It is hoped that as the value of this examination b e c o m e s a p p r e c i a t e d all d e p a r t m e n t s w i l l take advantage of it. The study of occupational diseases among the Out-patients of the H o s p i t a l continues. Some results of this work are now appearing. One concern, which formerly contributed a large n u m b e r of oases of lead p o isoning to this Clinic, has established a new factory, partly on account of the severe lead haiard which existed in the old plant, and another firm has installed a fume removal system which should reduce the hasard very considerably. 22 cases of aotlve lead poisoning were treated and investigated. Two. of t h e * * f a r e ^ o f speoial i n t e r e s t , a n d have been wri t t e n up report, ene In the Journal of Industrial tore the M o n t r e a l M e d i o o - C h i r u r g i o a l Associa- Lng was one of the p r i n o i p a l diseases seen, : Jjtases of occupational skin diseases were in- . s connection an arrangement was made between L'f i i V t u W r ^ a n d the S k i n D e p a r t m e n t of this Hospital to u n d e r ta k e an i n v e s t i g a t i o n of a d e r m a t i t i s caused by a certain lotion of his. This investigation was oarried through 4o a very satis factory c o n c l u s i v e l y the Skin Department. It m a y be >'VsUt.MdJt-)ed here that the l e g a l a a p e o t of occupational dise ases is in^a^jj.ry u n s atisfactory c o ndition in this Province, s i n c e no p r o.v i i'g n ^ s made for c o m p e n s a t i o n t h r o u g h the W o r k m e n 'e CoapenBe'iiq'n7.Act. This m a t t e r was b r o u g h t to the a t t e n t i o n of the P r o v i n c e of'Quebec Safety League, and a committee * f o r m ed to investigate it, but so far, u n f o r t u n a t e l y remittee has been very inactive 0454 * ' ^ - 2- The Industrial Dental Clinic has had a very satisfactory y e ar. It c l i e n t e l e lncreaeed, and c o n s e q u s n t l y an increase of *taff a* neceeeary. 268 new patient were treated and 904 t r e a t m e n t given. I b e l i e v e this Cli n i c le of real value to the oommwjaity. I n d u s t r i a l worker can get goq d dental eerrice t a l o w cost, and since the Cli n i c 1 o p e r a t e d at night, they need not loae time fnom their work. The financial etata* of the I n d u s t r i a l D e n t a l C l i n i c i satisfactory, the fees from the patiente being'sufficient to pay the operating cost. FIELD ACTIVITIES . The plant Medical Department haT continued to carry on their work, a n d h a r e g i v e n general s a t i s f a c t i o n o far a c a n lie d e t e r m i n e d . It 1 our pra c t i c e to end to e ach plant m a n a g e r a m o n t h l y r e p o r t c o v e r i n g the a c t i v i t i e e of vis M e d i c a l D e p a r t m e n t , a n d i n d i c a t i n g the state of h e a l t h of hi* employees. F r equently suggestion are made a to improvement in his plant from the standpoint of health. These suggestions are always gladly received, and usually followed. In *kese Medical Department 1056 physical examinations were made during the past year, 15,605 urgioal treatment and 6336 sickaesaxf' t r eatment were given, and 889 nursing visit made to th M > e * / . of the employees/ . y 1 n u m b e r of f i r m h a v e b e e n a p p r o a e h e d in r e g a r d to establishing medical department, but no ucees. ha ` J**nd*J e f f o r t s this year. I b e l i e v e there is no d o u b t that the services already e s t a b l i s h e d have given satisfaction, but the idea has not sold itself, and.we have had very few unsolicited request for information and advioa about the organisation of medical se r v i c e . It is p o s s i b l e that the general i n d u s t r i a l d e p r e s s i o n has been responsible for this. _ CO Four new activities were proposed during the year: study of asbestos workers. O udy of a large group of workers by X-ray termine the incidenoe ef tubereulosis. Ifeetudy of psychological tests for automobile rs wit h the view to decreasing aooidents- The organisation of an Occupational Therapy Workshop and an Industrial Workshop for hand CO Q L J O rj oo^ cc CL icap p e d i nd i t idu.e l*s.. t * t i 9 r~. (1) The asbestos s t o ^ r i s nearing completion. io z i n d i v i d u a l , w e r e e x a m i n e d ei*ttir.cally and by X - r a y at the plnt of the C a n a d i a n Johns-UanviilejtfJ.o. in Asbestos, P.Q. in July 1930. Other gr o u p s we r e e x a m i n e d at Thetford Mines in P t e m b e r 1930, b u t t h e s e do not come with i n the p u r v i e w of rep o r t . This study is b e i n g c a r r i e d on w i t h .the oo-oper ' ' ' .C 0 4 5 5  -n ^ * f  - 3- of the M e t r o p o l i t a n Lift I n s u r a n c e Co., tnd it is expected that v a l u a b l e information on tht subjeot of asbestosis will be f o r t h c o m i n g . It is hoped that p e r m i s s i o n to publish the results will he obtained. (2) The Tuberculosis Surrey will probably be commenced d u r i n g the c o m i n g .year in c o - o p e r a t i o n with the Canadian T u b e r c u l o s i s A s s o c i a t i o n , ,the Sun Life Insurance Co. and other b o d i e s S ince t u b e r c u l o s i s is such an i m p o rtant disease in the ProTince of Quebec, p a r t i c u l a r l y a m o n g i n d u s t r i a l w o rkers, it is e x pected that results of real value will accrue from this study. {3} The p s y c h o l o g i c a l study of automobile driTers was d i s c u s s e d in c o m m i t t e e and then p r o p o s e d to the Insurance Casualty Underwriters Association, but they did not show sufficient interest to warrant continuing the natter. (4) The o r g a n i s a t i o n of the O c c u p a t i o n a l Therapy and the I n d u s t r i a l W o r k s h o p s for h a n d i c a p p e d i n d i v i d u a l s is still mooted, and will, it is hoped, be acco m p l i s h e d in the future* In that conn e o t i o n the Direotor of the Industrial C l i n i s h m s - s e r v e d as P r e s i d e n t of the A s s o c i a t i o n of Oooupational The r a p y a n d has v i s i t e d a n u m b e r of w o r k s h o p s in other cities to', aoquaint himself with their organisation and operation. BDCATIOIAL. L e o t u r e s have b een g i r e n at the U n i v e r s i t y in the fac u l t y of Medioine, the Sohool of Sooial fork, the Sohool of Graduate Hursei and the Department of Architecture. Several addresses hare been giren to elubs and societies in Montreal and elsewhere. A paper, "Lead Poisoning in Brass and Bronse Industries* was read b e f o r e the Industrial H ygiene Se o t i o n of the American Public H e a l t h Association at its Annual Meeting in Minneapolis in Oa.tabi er, "The Inoidenoe ef Occupational Deafness .,,ts P r o v e n tion", was read b e f o r e the 11th .irt. the Amer lean A s s o c i a t i o n of Organisations for ring in Hew fork in June 1930. '' f Through the Prorino e of Quebeo Safety League and the M ontreal C e u n e il Of Sooial A g e n c i e s r e p r e s e n t a t i o n was made to the Provi n c i a l Department of Public forks and Labour on behalf of h a n d i c a p p e d w o r k m e n who are d i s c r i m i n a t e d 'a g a i n s t by the 7 orkmen* a C omp e n satlon Aot . In this connection the Direotor of the Industrial C linie was asked to read a paper before the International A s s o c i a t i o n of Industrial Accidents Board and C o m m i s s i o n s at its Annu a l M e e t i n g in f i l m i n g t o n , Del. in^ Sj>t 1930. 0456 4-/ LV I - 4 - ' Th D i r e c y o of tha Industrial Clinic served as Chairman of the Industrial and Economic Section of th 2nd C a n a d i a n Confertno of Social York held in Toronto in May 1930. The I n d a a t r i a l M e d i c a l A s s o c i a t i o n of the Province of Quebec haa held fire regular meeting during the year. The attendance at these meetings has been between 20 and 35. The members regularly.attending the meetings appear to enjoy them, and I believe the organisation of this Association has been well w o r t h while. It plans during the coming year to send l e c t u r e r s to d i f f e r e n t parts of the P r o v i n c e and so extend the influence of the Association more widely. The Director of the Industrial Clinic attended six n a t i o n a l or i n t e r n a t i o n a l me e t i n g s d u r i n g the y e a r as follows: The Annual Meeting of the National Safety Council, the Annual M e e t i n g of the A m e r i c a n P u b l i c E e a l t h A s s o c i a t i o n , the Second Canadian Conference of Social York, the American Association of Organisations for the Hard of He a r i n g and two meeting* of the Conference Board of Physicians in Industry. * - *rA a In ,-v In r e s i g n i n g the p o s i t i o n of D i r e c t o r of the IadajsVriel:*~r Clinic I w i s h to say that it is my b e l i e f that the Industrial Clinle should be oontinued along the lines already established. A l t h o u g h n u m e r i c a l l y the n u m b e r of c a ses s e e n and treated is n o t large, the location of the Clinio and its activities have served the useful purpose of gaining contaot w i t h industry, and it seems l i k e l y that as ^ime goes on the fifcld of u s e f u l n e s s of the Clinic will be enlarged* It was my hope at first that more use oould be made of the olinioal material passing through the Compensation Clinio, but so far no method has be e n found to handle this material in a useful way. A study was carried on last year of the accident oases of several large firms, hht sino these firms did not send s l X A J u *ll:***jftV tf the C l i n i c a p r o p e r s t a t i s t i c a l b a c k g r o u n d mined and the result of the study were of no `J H that the present change in personnel affords BKBflKSS' f V the r e - o r g a n i s a t i o n of the Industrial B y g i e n W ^ S w - r V W i i * 7 T h e r e is n e e d in t his p art o f the country for a well trained ohemist in the field of Industrial Hygiene, and it Is my b e l i e f tha t one should b e e n g a g e d . The spaoe is a v a i l able in the Department of Public H e a l t h and Preventive Medicine, and many problems await n man Q u a li fie d in this field. At the present time Industrial Hygiene activities at XeOlll University are severely hampered by the absenoe of skilled assistance in ohemistry. Respectfully submitted, . 0457 (Signed) F r a n k G. Ped l e y , The Industrial Clinic PRODUCID S/C/M/Ms e DEPARTMENT OF PUBLIC HEALTH AND PREVENTIVE MEDICINE . M---c-G--I-L-L--U--N--I-V-E--R-S-I-T7Y MONTREAL, October 11, 1932. N.L. Burnette, Esq., Metropolitan Life Insurance Co . , Ottawa, Cnt. Dear Mr. Burnette: You have asked me to let you hare a statement regarding in dustrial hygiene at McGill in time for the American public Health Association meeting this month. As you know, I came to Montreal in August, 1927 to take charge of the Industrial hygiene work at McGill. The first aotlvlty was the creation of the Industrial Clinic at the Montreal General Hospital. It was thought at the time that the best point of contact with Industry was through a clinic to which cases of occupational disease might be sent for investigation and treat ment. A considerable number of such cases were directed to the Clinic, particu larly cases of lead poisoning, and contaot was made with the industries from which they came. One plant with an exceptionally severe lead hazard actually erec ted a new building, partly, I believe, on our reeemendation, and several plants have Improved their working conditions, by installing various ventilating devices -- to carry away poisonous dusts and fumes. Several papers have been published on the subject of lead poisoning, copies of which are enclosed* The occupational pdsonlng work has been considered a less important activity than others, particularly on account of the fact that the num ber of cases of occupational poisoning is small compared with other diseases which affect industrial workers. All evidence points to the fact that industrial work- \ \ era suffer in the main from the same diseases which affect the general population, \ / and that preventive medicine far industrial workers should be directed tomrds / those diseases and not especially towards the so-called occupational diseases. ' For this reason, it was thought that a valuable service oould be rendered Industry p / in particular, and the e o m m n l t y in general, if Industrial health services oould \ be established in the larger industries, so that the health of the workers could i be brought under the 1m e d i a t e supervision of a doctor and a morse* A good deal of time was devoted to making contact with in dustries which, it was thought, would be interested in a scheme of this nature. Considerable suooess was ao^leved at first and five plants created health depart ments immediately under our supervision, while four or five other concerns were stimulated to establish medical departments. These medical departments have all given satisfaction and are still operating, but the industrial depression during the last three years has made progress in this work very difficult. Industrial Dental Clinic o r n \) 0 6 In connection with the work of the industrial health services, M b F 0357 2 on Industrial dental clinic ata eetabliahed, the aotivitlee of which are recorded in an attaohed re-print. This clinio hae iteelf entirely and is having a certain amount of difficulty now in making both ends meet. Industrial Medical Association of the Province of Quebeo la an outcome of the industrial hygiene work, the Industrial Medical Asso ciation, P.Q., was established in 1928. This is a bilingual Association which carries on Independent activities, and is also considered a branch of the Province of <uebec Medical Association. Doctors, Fennoyer, Mercier, St. Jaquee, and Tees, have been the successive presidents, and Dr. Ward and I have served as secretary. The organization took an active part at the request of the Workmen's Compensation Comnission, in R a fting the tariff of the 1928 Workmen's Compensation Law, and has held meetings approximately bi-monthly since its organization. Montreal Health Survey The Industrial Hygiene Department co-operated with the Montreal Health Survey Committee and prepared the industrial hygiene section of the report. Study of Asbeetosls In co-operation with the Metropolitan Life Insurance Company, a survey of two companies mining and milling asbestos, m s made in July and September, 1930. Physical examination of some 150 men was made, together with chest X-rays, and am interesting state of affairs was disclosed, which was reported to Dr. A.4. Ianaa of the Metropolitan Life Insurance Company, but to date permission has not been se- f cured to publish the results of the study. ^ ^ -.-Lectures at McGill . Courses of lectures on industrial hygiene have been given every year to ^ the third year medical etudents and graduate nurses, social workers and architects. General Publicity A number of public addresses have been given on the subjeot of industrial hygiene. Various papers have been prepared for publication or presentation at scientific meetings, moat of which are enclosed* I h a w beer e m i t t i n g revlewsand editorials to the Canadlal Medical Asso ciation Joumah,C|Uf W i also acted as Joint editor with Dr. Cunningham of the Industrial Hygiatm-Seetloa of the Canadian Public Health Association Journal. sw , _ , A representation favouring the oreation of Division of Industrial Hygiene in the Provincial Health Department, has been made to the Social I n t e n s e Cooinis.ion and the Province of Quebec, end this Coowaission has reccomended such a Division to tha Provincial Government. ' PRODUCED n. a ..we Present ictlrlti.ee The Industrial Clinic has bean moved to the University under the inmediata dlreotlon of Dr. Tanoe Ward. The eupervieion of the plant medical department! eon- ^ tinuee, and in addition, two new activities have been started and ara now in operation. (1 ) a study of mercury poisoning and (2) an industrial health eurvey, tt 0358 Our attention waa drawn a year or ao ago to ha aarcury haxard In ona of tha (1) plant outIda tha City, and alao to tha .faot. that a ralatlTaly email amount of aiparimantal work had been dona on induatrial marcury poisoning. Tha co operation of tha Department of Pharmacology at McGill waa obtained and an ex perimental atudy with doga ia now in progreaa to aaoartain tha minimum per- mlaaable concentration of mercury in air. It ia anticipated that a publication of thia atudy will ahortly bo ready. Thla atudy ia being finanoad entirely from the Induatrial Hygiene fxuida.(^~^. *** (2) In co-operation with the Canadian Tuberculoaia Association, the Provincial Heal Department, and the Department of Induatrial Hygiene at McGill, a etudy has been started with particular reference to tuberculoaia in induatrial workera, but also with reference to general health. Some 2,000 worker in three companies have already received a complete phyaical examination, with cheat * "r**B ' _ it ia hoped to continue thia survey ao aa to include 5,000 employee in differ ent occupation. Thia survey has been under way for a year, and .a being fi nanced,partly by theSrovincial Health Department, partly by the induatriea con cerned, and partly byA>ur selves. The $25,000 promised by the Metropolitan U f e Insurance haa all been paid, and some $4,000 ia left to carry on the work. le are J*** t h B "T? ry atudy can be completed within thia appropriation, but it will not be poseible to finish the induatrial health aurvey unleaa additional fund are forthcoming. in activity which ww h a m been endeavouring to establish far some year, ia a co-operative health service to planta too small to provide a complete -service of their own. in endeavour was made to get thia aervloe under by the companies themaelvea, but various difficulties presented, chief tf whichwa the scepticism of the employers of its practicability. Since this scheme ha successful in Philadelphia and Hud on County, Hew Jersey, it eeems likely ******* better times return, i f a demonstration were made perhapa in co-operation _with the Royal gdward Institute, employer might be convinced of the desirability scheme. We-feel thia would be of value to the ocunnnity in general, and to - duatriea affeoted in particular, and might be of actual occmoaio value to your own. company. Theaa. the wmin facts in connection with the induatrial hygiene eork at McGill University^- : . V ... Tour very truly, FGP/IM. a* 'fir1 Frank O. Pedley, M.D. Assistant l*rcf0f , liidUiWill'Hygiene. ,n iV' 0359 sjc*r'Mi^sj~e r < -- RTtEvP.OmmRTT O-F T-H--E PHYSICAL EXAMINATIONS EXAMINATC ONS OF ASBESTOS WORKERS HI / ? , x- " AND THETEORD MMRS, QUEBEC The report herewith presented deals with the examination of -1*11 mmployees of the Canadian Johns-Man- ville Co., Asbestos, Que. and 5*1 employees of the Asbestos Corporation^of Canada,, the Keasby-Mattison Co. and John son's Mine, all of Thetford Mines, Que. .'I0 of the men of the Canadiam Johns-Manville Co. were examinacd by Dr. D. M. Stevenson and Dr. Joseph Wyatt, who performed the physical examinations and X-ray examinations respectively. The other examinations were all performed by me, except the X-ray examinations. Actually, Drs. Stevenson and Wyatt examined 57 men; but since 17 of these men were re-examined by me I am including them in my l i s t . Drs. Stevenson and Wyatt carried on their wok in November 1929. My exami nations were done, in July 1930 in Asbestos, and in September 1930 in Thetford Mines. The Asbestos andThetford groups are very dis similar, with, respect to age distribution and length of service in the asbestos in.dustry, but racially and econ omically the two groups' aret much alike. Table I gives the age distribution of the men and Table II the distribution according to length o f 'servicg in the^adbestoe industry, * * 1 p -r1 *i' .....* *i->.*-> .-r , *' ' " rW i Tho report herewith yr.: tonto *o-lc v ith r>f 1*11 employcoo of tho Cun: Jm : :.*u. - ^ -- d.-- 3wl 0 , >VU C f'.- Dft O .JV'l t*yoC3 O 7 tj`>0 / 'JoTporr t i oi: o f C- oi.C: , tho r o o r b ;.-:> U in o n Co. f ;;; 'i*. . .-..iiiCt fi.13 of >,0trCor y.ir.rr, *.uo. 40 of .ti.* ; ' *. . C. i m vOiu*r-.r-iivil; o Co. v.oro o;:r*inij.o 1y i'r. *. `ii,,V0;;TM nn i r . Josoum > H , Hso yorforco tho y\v*St-i ou.vMj j.-tiono ar.il rr-r.-y c-'Uiir,atiene rorj-.cctiviOy. y;-.... " !'or ,}'r,rttiono '"oro r.ll , crfor..iOil by not r^cc-it iv. -r:*y crtniic;/ Lior.. />c vUi.l.V-, ire. Stver.sor. tu.il *. y. ors-wi nof, 57 con; but pji:c.; 17 o f t: oso IiJ0, roru V0. 0.:; ... V;' no 1 ,m i'02uJiiR t.o., ir, >y U s t . lrr.. Stev'-..?;- tk crrrleil.o n th o ir rov.*; in ro vo 'bor l'JCi?. . c .....; U `,,,; voro ojio in July ItTO in Auuostou, n.rt 3, ;*v ;, 3. O i . O.oo txOi*(*i t ' ' xao Aebonton ou S'hotfrS :v:uv*c rrn vf:`*v C i,` - pJiilur vrltli rooroot to 0/50 d ir tr lb u tio n tmrt 3o;:-.!;h oX `irTioo ln tho asbeotoo iramntry, but r c o in lly cru oo-u.- omlonlly tho tt*o groups.nro ir.uoh r.lifco. , * ' ! - j Tu.hle 1 rlvo o the np.o d is tr ib u tio n o f tho mar. fi:* nlilo i l tho die t r i b u t i or oocordinr, to lonrth o f n\r:)r in tho nobocton industry* ' OO244 /5 c4 / /'/' a/ * *s or *J'/TlA?# * w'I tl <J lV# ta ;.m7o *?'" i:i .3 " *I1 >#*71 .i S1 , *wi Tho roport hoiv.vith yr:;Lor.tcO. *o~3.c vif. :,*. 0-v~-..ir.-!i\>* n i 1-il crs/loyeoo o " tho Cl;: Jt i* J..*>.:-;./ . ville C o .t /:*;rato c*t -vUC. . Di o..yl<oc3 o7 tho / s :.. J?" ,o r .'Vi oj: C- r.'.Z: , t `i:> '.~or!;. -I.j 11 i no;; O . i y.,\ .- 1-. : . : i h C , f13 ;f ThotrCorC '"ir.rr, ..\io . 40 o f i '-o r.'-. ..h C: ;:'ion ohu::-'/.) .-;vil3 e Co. v.or& o;rr;:ii.\cC b** r. h. J liivo.'uvtr, r.;; Jr. Joso'oi' Vyr-tl, -ho yorforr.io tho jhy;-j '. f U1orio or.a c~'u;ir.atiwnc ror/cc tiviOy. *"0r C"?\"ir.nlione --oro rii ,crior..o t*;' ;ao, r:-cec:t cr:o iin.v li or.t. /*c l*.i;.3.3./, Ctc'vrr.sor. o.j.f *,;; i1 o::;i.:3aon 07 rzon; but r-3r.c; 17 of tho co mor. voro rc---.--.: *"; sin 1 j ii.ciuJi.r. tio.i ir. U st. rrr. Stcv- *. ' t l c - r r i n<l or t h o ir vor'; 3* Vovo.-hr l'JCv?. i. !* v':ro ')<;o ir. %jh;iy HT.O it Aijboclon, 3 '.i 3. J '0 IxC '(i J..JO:* o .... *? ;*!. . Tho- Aobonton oufl V h o tfo ri ; .-.tuyc rrrs vv*;; C5: i*5j;i51nr r i t h r^ o ro o t to 0^,0 i:* t r i b u t i on r.r.rt 3oj:-.i;li o l ir^rriio in tho a s b e s t o s iruYiintyy b u t r a c i a l l y :r no :.- a o.T.lcnlly tho two groupa nro injieh r .lilio . * Table. I rfvo s the rip.o d is tr ib u tio n o f tho me. * * / r-.O Table I I tho d ie tr itm tio r : o-ocordir/* to lonr.th o f reijvjr ' i in tho f.Db^cton industry* * \ 00244 c/t/,* //. 46 ti A B L T. 11 r - Xr.IlGTU OP SKSV1CS IB ASBESTOS r T W T H Y *iO*-1*0 of rorrloo. 0-4 fi - 10 - 14 15 - 10 >*/ * n / 25 - 29 ro-r-4 Asbesto 8 I JJirnber i ?orcontn":o! 44 SI .8 I 65 46.1 11 7.0 10 7.1 4.3 1.4 1.4 Thotforfl Vinon Tfrinber `Porcont'-r.o 1.05 14.0 14.0 16 29.0 1G.7 10.7 1.05 ~ R? - '*V'} m/**O.ipi -mArt" ! U > t!i T0TA 1 141 -.7 100.0 _n n_n_B_B_B 2a i 54 i 5.7 I H I I 100.0 I t w i l l bo noted th at vrhilo CO porcont o i tho mon in Thetford UinoB wore over 40 years o f ego only 20 percent o f the men in Asbestos v?ero over 40. And fu r ther with roopoot to l e n g t h o f cervice GS.4 poroont o f * the men exnminod in Thelford Hinop had worked in the ao bestos industry fo r 10 yonro or Bore, but in Ashoetoo i . . only 22 percent had vrorkod fo r moro than ton yoaro * . : - i . . Table III shows tho disposition of the maxi in , various parts of the1industry Sinoe tho numbers are nrnill Vrotid ouoiimiionri c *'> viivfi. |,t Anbontoo tho occupations nro divided in to 0 Crou)-a - m i l . p i t and fa c to r y ; in Thotiord Kinou o n l y tho f i r r t tr.-o occupational croupo nro uood. oinoo no nobontoe nanufnoturins i s orrriod on th e re . ' A l l tho non o f tho Thetford L'lnos croup oould bo eo oiroo- I flo d . but 5 mon nero o lu d o d iron tho Aobooton croup einoo they did not apjoar to bo erpocod to an unuouol cmount of d u st. V. A B I E HI r . .. ' ! ; n >0 past ooeupntionnl h isto ry in industrion 1 other than tbs asbestos lnduotry w t sicnifioont only ' in 8 oases. Of these ons had boon a croin inspootor 00244 for 6 years nnO so eupoood to vory Cuoty oonditiojin, nr.* h-fi bon nn undorcround ooppor rainor fo r 18 yor.ro, one o ooppor nlnor fo r 2 y e r r s , n fourth had t;ox');g & in o ooznont plnnt fo r 9 yor.rn, ond tho f i f t h had operatod a d r i l l in nn iron mine. . * Tl/io l a s t in d ivid u a l shoved ~-rr.y oviCor.oo o f pnouuoconiooiu, tho othoro did not havo pnomoconionis. Ir. T a b l e I V a r o p i v o n o b c o r v a t i o . n o o f v o i g h t i n r e l a t i o n to h o i p h t b y ap,. T h o nvori'p,c vralfthto a r o t;Cion f r o m t h o f i g u r e e oo.-npilod b y t h o 'noooinLioii o f L i f e jnuunvi.no 7 D i roctoro and tho Aotuarial Society of Anorioa. j .?? J A B1 TV J * j ! / T>r, [ > . ' ..... y ,t n . i -1 -- _ .....__ ' 11. .i. JO, (VO >w* Tnoilt r i ali v ??;/.o"n ! <* e i g h t s a: j> 3! :io'i'p.z .w r:i> i:.;o to /.r-. Perniin Unflor n vorr-o Pour.fln ovov w ^ p -n . no-no 01 ir.o 0 . 1C.7 ~ io -io ! 20 2 0 .0 f 11 ! I 2 0 .4 ' 10 n-o - 4 to id ! c -o ! i o - i o i s o `-ro' /- n j i 10 1 PA ! 1C 19 * 1 0 j A ! j < ! ir..c 17.1 I 11.4 1 i n .6 ! ' ,, ! ! 0 0 | ! f. : 7 ' 1 I 14.0 ! 11 . . 1C.7 ! 5.C i 11.1 ! 1 2 .0 3 .* ! 1 1 21 : 0 I . i* ,I 14 i i o : r# i - ... j ; forxjod : St?too T h e g r o u p o f 1 0 , 0 0 0 rac.lo i n d u s t r i a l r o r k o r s r o i to in th e sb o v o jtsh lo too stu d im i by th o U ni tod i * . Publio Health Service ( ooo Publio Health B u llo tin i no. 162). I t w ill be notoa that thoro io very l i t t l e d is tin c tio n between th is large group and the group o f aBb08t0B workers eo fa r .a s degrees o f overweight or underweight aro concerned. * - In the consideration of individual dofoots b o o o In te r e s tin g f a c t s have beon found. In th is study only the 101 men a t Asbestos and tho 54 men a t Thotford Hines aro considered, since the records o f the men ex amined by Dr. Stevenson aro not s t r i c t l y comparable with mine TEETH- . D ivid in g tho.non in to two groups aooordir.g to whether the teeth did or did not nood a tte n tio n , o f the . AobOBtos group 49. 5^roquirod atton tio n , and o f the Thetford Mines group 61.8 . ITE/'H I K O ;- ' Aouity o f hearing was tostod by means o f a watch. (Uy om h e a r in g ,' whioh hx s been tontod by an ' * . 4 audiometer, was considered nofra^l, and used as a otondard) The watoh to s t i s admittedly vory rough. In noisy ooou- rations impaired hearing is frequently found in the oldor employees. Of the 101 men a t Aobestoe 10 showed definito hearing loss. i 00244 This is not on exoees proportion sinoe on.-. . . 1: * r*rou-" o f adu lte v .lll show,a cirailar p ic tu r e . In hetford llinee 20 o f tho 54 men suffered from Troll marked hearing l o s s . . This i s a very high poroont- 0.30, ond oomparable to TJhat nay bo found in wspvinp: ehods and b o ile r shops. A l l thoso men, exoept.tvo, had boon exposed to loud noine in th e ir work fo r 10 yoars or more, and i t i s reasonable to suppose that noise played a part in thoir hearing d is a b ilit y . ' Tho numbor o f mon v lth infeoted TONSILS ttsb 27 in Asbostoo end 13 in Thotford ninoo, and a l most in d e tic a l r a tio to tho t o ta l in both groups. D ofeots o f tho THYROID tvoro raro. 4 mon in Asbootos and 1 in Thetford Ilinos had enlcrgod thyroids. . bipod rK sssura- - ` .Bondings noro rooordod in nil mon ovor 40 years of ago. JSroopt in orcoptional oircunotnoos the blood prosjure m u not taken in the younger mon. Consequently although the groups oxrained in Thotford 2*ines Tvas smaller than that in Asbestos more blood prosruro readings m r o taken thore. 2 men in Asbontos ......................................., tinier 100 n ja . o f moroury. 8 Eion in Ihotford ainoo hod Mood prossnroi of oror 160 end 2 Mood proBourse under 100 # 00244 . ' The inoidonco o f Hr.K??TA in o f in te re n t from tho compensation standpoint. In ABbontoB n il now oraployoos must pass a phycieal examination before employ ment. There were 4 canon, o f inguinal hornin dinooverod among tho 101 non oxaminod thoro. In -addition to thoao 5 men had been oporatod upon fo r th is condition In Tholford iinoo phyoical examination i s not roquirod bofore employment. There woro 5 oaeon o f in guinal hernia onong the 54 men examined and 2 o o b o b rhich hod beon operated upon. ' Some in te r e s t hoB arioon in connootion with tho oocurronoo o f tho oo-callod ASBESTOS C0ft:,'3 . Thene are uounlly pin bond oizod olovr.tior.B o f tho akin, pomorliat lilco minute w arts. ***>no o f thooe wore detected . in the Aobootoo mon probably duo to my ignoranoo o f th o ir rpponranoe. 8 o f tho Thotford nin es mon hod thono grorthn on th o ir hondo and Bovoral others reported having had thorn a t ono timo or anothor.* *. ) I Of the 101 mon examined by me a t Aobostoo only 4 suffered from d e fin ite f i r s t , s t a g e pneumocon i o s i s . These Trill not ho oonsiderod on aooount of tho doubtful d iagn o sis. Of the 40 men oxaminofi by Drs. Stovcncon and T.'ytt 14 T7ro diagnosod rs f i r s t stage pneumocon i o s i s (nsbestoois 1) (I ma including the 17 mon ex amined by D rs. Stevenson and V/yatt and subsequently ro-exorainod by me in my group of. 10 1). * The much losoor incidenoe of pneumoconiosis in my group of mon moy sooia Bnrjrioing, but it nust be ronomborod thnt tho X-rr.y ngatives rere not rond by tho came mea. In my group tho. T-rny diagnoses were made by Dr. Korivothor of P itc h e r , Oklahoma, and in tho othor group tho intorpro?tntionB were by D rs. Wyatt and rv.nooo a t. . Further tho gasaup oxaminod by D rs. Stovonson and T,'ystt voro, in gen e r a l, older than thoso in my group. Of the 54 men examinod a t Thotfor Uinn 24 rere dingnoeed by X-ray as suffering from pnownooonioois (r.nbostosin), of thoso 4* wore diagnosed as probnbly f i r s t stago asbestobb, 0 as early stago, f as definite f ir s t stage and S as sooond otage. j The p ertin en t fAote r e g a r d e the doflifite onooo of ' *beotele are giren In tableo V and T l. 19 Table V I!;'Or.n# iior.ii Ar.e Occu-ntlonnl hi''tor:* fi** ..% f Aon.?.-,ton Crou:. w ' A.i 71* A.l / A.I A.l n ** A.l * i A.l t.% A.l Serena cyclone <* yonrs c; *o` rtoricient or;u n i o n loou or str*ii.,th oce, ere, it* U n tie l /t a.-ait. *7 C/rioral o^oritor Kr.aiit Caro'in yo-irn cau-h, V^i 9na frov'ont coldo ' c '.o a t, cr *. i t - t l vi a l 1 ov-ir W-ilt 1t.*i lnniin;; can In n ny:.,*10.40 n* nl.nor-rtl elii'in. :.ili *. fore-.an SlV yo *rn I driller 7 yo.iro no o.T.,*t`.. no a ' nor.vil r l ,nn. M r.ill^rl.^ht '* yoirn 0;p.iiea,couJi no ohnor ml o i;rin T ::at'r ntlo.'iivit no ry for 11 yo re V* .iillori5*it 1' yeuro n. ny... V.*n f a i n t :j*.'l o t r ;1 *:*.* * '< rii* In fr-Mit. no at nor^.il nlj.iip n * A.l 5** Iniouror * wateliman in mill T yorn no ry:,t.'ji v n A.l * **A l^Moror to,* floor 1 yoarc no *, ts..n . A.l '7 in riill 1^' year no n : m A.l * .ilwrfsht y j.\rn no s-ya4*t***..-n . A.l ' 7 A.l A.l ^ e1 A.l - y. A.l A .i i ' A.i r.' .on In niil T.f yo rn no ny;.:,*t*j..p i* mine not etatol) no uy.;to-n 1 * yo rn A 1 drillor ' yoirn A 1 driller **. yo.iro rrt drillor *; ynrn_ no ov -, t '..n no ry.*.tu..r. no "i-.t n it irnain yorn f.irn :m .`IJ y rro *7 d r i l l e r ^ yonra tru e '*:van * y o iro 1*1pe eovorer no no oyuyta -9 'fir-tory) * yo^ro nJi.M lullnon- ri**.ut . In-.*.,left rVi*t .*,y*t*/ inra i:*ii ri,; 't. ' 1 lire**Hi i:i*ido Mt 1) *.rrh r.o ftlw ir-'U ni 'ion oli;;*iUy . 11 .MIit'iMI'jii 15 _.U " l . . n*i nl't* v1 r**,*ii . - . 'v. ' O V``. no i *v*i` 'il :1r; . . r; no il.io r./il t*J i ii* * . ; i v u lr o .it i i c - 1 f*4U*w v; ^ *'*-&&* * W onciiinl m l*n - lari nl-i* ' ;;, no o lm o n o l n ijin o * ;]'; " \ . , .M. J*v ir;-.-* . .* -J . 00244 o.n j. wile Vi. n >nl - A"i >1 A .I `i-i .*' ** /..i n . A. 1 : h *1 : ` A . I v* (1* x-.nlilyi* 11 A .: n.* 1.' A4 . _0ofiu^ntl3n ) lit*t.*>v Tbotford ::i;i^nr,7: -Irna. olJor^yiari y0r<tt> no *vn"luo "orern yearn driller -n ynaro . ' ... oaarpo olio:. i9v ;, ,rt * nt batii boron le^ln.-l. o**nnor i u n i l l *. -m. 00 1a b o o r *,i *lf,ia filUn5 l:.:* A yro ' ~ nn al'nr*<ni nlltvrlgiit :i? yvarp *o?Mer 1 ' y Vn r a no nbrion.al nl*nn c - f ' n " V i lUon. woe, blo.-lS tin lc>it .* * * l 'c.h l " * * 1 A. / n 31 years or' o.' *sniJit ia . A .I `tf V; `o b iM y ) 1: A .I */: 1/ A.I An (airly) nil.right *| yaro drill or 11 yearn d r i v e r 17 years *t A .I n* (.* *A*r.I3y ) f ! r. A.I (*iriy) A. 1 V, 'UiwrlC!t H y;nro drill or Ar. years driller C years C v ier.il trar;: in ; ,i t ya m nilin,; b.a;.. 1 y,nr . W . u S r dy.'i, ai, looa o r wc:,ia . ntr-jrifjtu coa/.N n* .. t j ;a liii or T'Oiriny, o i * W 'Uol * t*b,o, Ayr; .no.a -Mind, ;,-Vunmu'ori Wirl-,| occa -lnml dry ml.on \ i lu< l l.aco no al* .ar..i ei*;s,a n o a b n o r n l ri.;0 no `iliioniai nl;.ne m o *y*. !.*:.;e *' *V ;/ta,,.n w n y ere, ittl* ;n n r i '.L bnoo. ' no nhnor.iM nl.-no A.I (irly) A.I f,1 (owly) A.I V. A. I *rly) A.I f- A.I \e (.irolrjl'l/) rbo 1 *' yc-ira I**Z.Jv.''VZ..P'iyu " ,Unvr nl in ''l j& y<*re W.i.;;,, dyC|,.:# |J0 nJ in t-.innoi Too line oran::er 1 y:aro miD.-ootoJ t,b.c in 1. '* 0 cr.iohori 1 yoarn no oy.,rt.IMO n9 n,ayr(.a tl n# *0.0.w i n illi A yro. "Hr in nill 5 jroma . * * Joa ling lio.aoa lo pit T yoaro, fool in*; Uio n ill * yoarn * *.u.0. 1. ... lfc,U, I,9,|ln1 f r 9 i .. ortal.ra dowi,. rouo^lon. a*Uiurir; t jt'lyoaro forvjan f 00UnC V yoaro oruobor tr y . atr ddyynnjl,,wl0o.1a loanlue in n il! 1^>yro* fo o lln r. c rp e ^ e r In n i i l 00 o-- Lo. driero tyaar, *' ^ f-roian in ill yw s noto dlulninh^l no nbnoraal einnn t ,oropltaUom -in rl.nxll]i t }l\. rao-: ibo0l5.*1i"nl1,* bno-.nl oi^n ` _ Toule VI (continuel]) To, noni* A TM Ocnu. nti'jml hlrtary ry.i t>rr TteiforO r.rau,. (coni'*)' * . /.i y (*irly) *>t _ A.l ni A.l T T*' . V li A.l A* (lto) . 1anting by.to* in ;-lt Vrn. <1rill*;r f yro. o.[orator in-.111 .* yjjn., aiilnri;;:.l 1 i yearn , oli*sr ir. .uill i:> ra. fare a h ulll ;* yre. -ili re, aire 1 ' yrn. ".111 foro .no 1' yrn. Forooin .ili m yr.# Blllwricht 7.yre. no cy.jta-.o . no nlAorn.l cl. un. .O nan 01 o t.V.. *i-i>:',Mt-r .'an lu'.orculonin. ecaijJ,Oyr.. nco no nyu/toi m ;|t`rc.:!> irrr r :-- :it over ri'-Jil lu:rt, ero. lia 'e ri., t i*rj .1 Ino , **vyr 1 u..or lo!* fr **t *'.*.. O t,.A .ni H 'r, r orc/it ti un J, iti r. n>.l(.;<, ci*-*,i*.1-1- r.' 1, u ;or !:*'. ***11* * nv h^tn i** !*, o i. .;"or .y r. :! loar 't i'cr'O. no r*-*. no i!>norr>il ri;,-n, . I . i i iI f .. libili )> note*) timi of ti, ` r* ' m an6d rrJaio o r i;,o n , , `'Cn...! .. firoV ftta-0 '^Z'I......^ .. ^ T"<'l'""r'' ;ii- TM * * " ,l J . t a r ^ i u . ' i ; U u i ^ ` ! ** * "''V J *n.xeiUns n oseonn JmnM in - , l""* Ti" ln.ro,,,t ` . ln *"*.**'*t , oo o* noni .onooonioeii t - --, , - 1 *;ly n roflootlon or thD ,)** * . Bino- 1 *.f oorvico n N Wii" r**>acl *'* '***** t.'iooo t v . 1 r 0aU t:,'J n t UJT.o-- i:w ia 10 ^ * ,l .r. ri o r ..... * --1 . - ~ M *` U , > U .' ln -- - __ _ of " . in tow,, ..J-i: v,. xr . vu;. 5`3r o tsin i i - W ... L,oro lo * t;ro,t ;,,Cili|)Uu J.> t. 1 l t -' M" .n n iir i r or intoroot to ro.,o ;.r ** * not ,,volo . ,,ny 1^ ^ ^ ^ n WU`*1#M* `8rUt1? * o, * * #i* of nH>ontoolot . * Ao ntlqno of At drilloro , t Ili workoro 7 Woro o '- ^ *"*0 f * . 7 1roro ' of Hf.;nt83lo no ) of hv w of i . . ^ >-* 4 i r r r M l( lQ Ul,, l m n r i ln o i u l<r to 1* ox.a .i 4- j _ ' ln l'- ^ *" u - r . i. m u , oro un) ,, r i 1oro* ' Tho n i n . I 4filJii_wor. orr 1 - v-j : ...... ... v .. ..,..v - ***-ft rtld B9t J*1*/ on li.;rrtvit 2*rt/l'\vUip;olti<?# Hi* r tir >#V# '**'1f^'i*^'`'* * ' ' > 1 '_7**,,*1.1 .' '..*,<*;' ' , ( -j1.... of an!nntal *'*-i'-oa---ol* MaUi*-- o*:v U-Hli'_oj/':_..^.^..'`'..IS .J>V \ h '>& ' SK;r- _ .. . tfulacH onco of doflilnliitaU UbveiaoMola r , 1" grbj-b of 'w*v- .-^K . :....3 . gr &&& ,; . - * `-H" ' - -v'i'< '5'---l-' i;. - " ifc.Iffife'*?.*--V9r* l0 ir* TJ,er* wpro * **ral o u r y o e to l oao* on e U n U a l ^ v . i n i U v i '.-. * . . ' ' *<.'*".. ">' "'' `.1C.'"-*' .'.'Vi- . ' . sfe'**: w*r# B0* onfi'ir-*^ *y x-ray up novoml: oaft>c8lo.l ca*HU* *-rai- ^ ' : ::-uvi i; . ; ...,<.'&"*? ` ' . '. :; i' ^ 9 \ " r * a *v l 1*n e in * v O f r l- n a o n l o y a / t ^ . . Only on* ear* i , , $:?$****** nn.fco Mor*! no notify UO-orealouo. ^ ' , ' ` ' *1 V ' . . . ; ) ' * ?; , ' / - V ' . , . iiSSS 11 ,,irflowU 10 oUaiH ::utuM frau aoiitiof li, a vyr- jv, i ^i#gjK';. >''? I % " .$:-i . . .: .,.: - * .-: '.' . rTVr;,091^ " ^ Aoout*1.*} o.Vita w-vo oxa^ino^fur lui-orci- l.-ciill % - : r .^ *. * , . <{<: 'Oii^ anhent'isbo.n1. Ml.. U.nu .-h''': - . ': h ' ..-:.; ... ; . ...... .. . , 1v^V-1i-V81i.*^-. , : -til fe:v" 00 ,n*iirrt 10 h^ t^ ^ ,ii^.;ip3ii o > ?nnoeiif.n t i U i ^ r : : : : W ; / ; : 3 | | finWatoo nloAns .ao-1 n liiliij iiPustr;*.' ' '' : * ' v '' v TUSeT&UMSIS AND ASBSSTOSIS A brief review of current knowledge and analysis of tuberculosis mortality in the asbestos mining community . ' of Thetford Mines, P.Q., Canada fie$ent developments in Canada have focused attention on the question of the f relationship between asbestosis and tuberculosis. Asbestosis has been declared a compensable disease in the Province of Quebec, thus increasing medico-legal interest in the establishment of this diagnosis and evaluation of any contributing factors. . 0 Autopsy of asbestos miners has disclosed evidence of active tuberculosis and asbestosis 1&2 in the same individuals. In Thetford Mines, where a substantial part of all the asbestos in Canada is produced, the mortality from tuberculosis has in the past 16 years approximately doubled in contrast to a significant decline in the Provincial rate. These, developments have materially helped to create the impression in the I ^ Province of Quebec that there is a causal relationship between tuberculosis and asbestosis similar to the carefully demonstrated and generally accepted relationship between silicosis and tuberculosis. Observations in the United States - Previous studies of workers exposed to asbestos dust have not disclosed a higher incidence of tuberculosis among workers with clinical and X-ray evidence of asbestosis Lanza^ in 1935 concluded that asbestos dust did not predispose to tuberculosis. In his examination of 126 workers in the.industry in the United States, 53.l wer^Tound___ to have definite X-ray evidence of asbestosis. Two cases of active tuberculosis were found. One of these was a worker with asbestosis. ' . In 1936** Donnelly reviewed X-ray film of 151 workers in asbestos mills ang-- -------- found evidence of asbestosis among 3k*& of the group. No cases, of active tuV^eisitnil wore found among workers with asbestosis. On the other hand, in the group without hsbestosio he found four active cases of tuberculosis. Two of these active cases' . 2 . - ucn in the asbestos industry, six and ten years iNspectively. Donnelly cp&cludjd th a t there was no tendency per se in. this type of industrial occupation to e x a c e r b a te old tuberculosis lesions, _ ' ' Iv'. HcPbeeters*' reported in 1936 an X-ray survey of 21,0 persons exposed to asbestos .dust. He found 25,2$ had some evidence of asbestosis* Three cases of a c tiv e tuberculosis were found. No tuberculosis was found in workers with aebestosis. The three individuals with tuberculosis had been exposed to asbestos dust 6, 91 and 10 years respectively. In five cases healed pulmonary tuberculosis and asbestosis were found in association. The average duration of-exposure for the 5 was 10,4 years and for the entire group 10,2 years, McPheeters decided there is no accelerating effect of tuberculosis on asbestosis* . I ' . In summation of this evidence it can be said that X-ray and clinical studies .among asbestos workers in the United States does not reveal a significantly greater smount of tuberculosis than expected in the routine examination of workers in any industry. Moreover there is no evidence from these studies to indicate that long exposure to asbestos dust activates or accelerates the tuberculous process. Both these observations are in contrast to findings among workers exposed to free silica* - Canadian Observations These have been no published reports of studies among asbestos workers fa Canada with respect to the prevalence of asbestosis or of tuberculosis in the asbestos industry. In 1930 Pedley and his associates examined physically and by X-ray 19%^* ' 6 asbestos workers in the towns of Asbestos and Thetford Mines. . . . . survey appear in Table.1 * The results of this ' \ TABLE 1 Asbestos Thetford Mineg rf- examined i % with more than 10 years ; exposure " 141 22 54 . 83.4 y* with asbestosis % with asbestosis 18 12.7 24 44.4 One case of active tuberculosis as found among the 195 individual, examined. This is a very satisfactory incidence of tuberculosis among an industrial group, even today. For example, it approximates the indlcenc. in a survey in 1W> of th.^ garment trap, when 1 active case was found per 165 individual, examined. Pedl.y found that the tuberculosis mortality in Thetford Mines for the years 1926, 1927, d '192s compared favorably with the tuberculosis mortality for the Province of Quebec. . `. .. . TABLE 2 ' Tuberculosis Mortall y for All Ages per lOOyOOO Place 1926-28 1940-42 % Change ' .. ' . Quebec Thetford 123.6 137.9 78.6 252.1 35 83 + However, since this report of Pedley there has been a sharp change in the tuberculosis mortality relationship between Thetford Mines and the Province a. a whole. Table 2 show, that in the Province of Quebec the average rate for the three year. 1 9 M K 8 ha. decreased 35* compared to the average rate for. i'he year. 1926-23. This corses- >  . . . ' - 4- ' . to experience elsewhere in Canada and the United States, On the other hand, Thetford. Mines for the corresponding period tuberculosis mortality has increase 1 1 m more than 8Go, The obvious existence of a serious tuberculosis problem in Thetfc Mines has lied to speculation regarding the influence of asbestos dust. * Tuberculosis Mortality Study If the industrial exposure to asbestos dust is a significant factor in exacer bating or accelerating tuberculosis one would expect to find a significant difference - * in males over 25 years of age since, in Thetford Mines, practically all of this part of the population not in military service work in'the asbestos industry, Socio- . economic factors are also significant in relation to tuberculosis. Therefore, comparison of the tuberculosis mortality rates in Thetford Mines with communities in the Province of like size, medical and public health facilities, socio-economic and racial characteristics is important, Dublin has pointed out-^^^eli#sie* socio economic factors were dominant the tuberculosis mortality rates for both husbands and wives were similarly affectedj where industrial factors played a leading role the standardized mortality rates for the husbands greatly exceeded that of the wives,^ Through the courtesy of the Demographer of the Provincial Ministry of Health ' and Social Welfare, Dr, PaulI'Parrot, we were furnished the number of deaths from tuberculosis by age and sex for the years 1939 to 1943 for the cities of Thetford Mines, Rimouski, Chicoutimi, Cap de Madeleine, St. Hyacinthe, St, Jeand, and Valleyfield, as well as for the Province and the Dominion "as a whole. Of the six communities picked with these characteristics in mind, the town of Rimouski was r thought more nearly to compare with Thetford Mines, except instead of asbestos principal industry is lumbering and wocd'finishing (see Table 3 , P4a)` 5 ' . TABLE 4 Shows the Average Mortality Rate by Sex for All Ages in ' Province and in the Seven Selected Communities \ \ . 1940-1942 ' Tuberculosis Death Rate per 100,000 ' All Ages Male__________ Female PROVINCE OF QUEBEC Cap de la'Madeleine St; Hyacinthe St. John Valleyfield Chicoutimi Thetford Mines . Rimouski 77.5 55.9 84.5 75.1 101.7 141.8 190.1 171.9 80.8 44.5 90.9 109.8 85.3 149.1 223.9 287.3 TABLE 3 Population Descriptive Date on Selected Communities Industries Health Health Pub.H. ^Private . Officers"'" Unit Nurses Physicians Ratio Phys.to Population letford Mines 12,000 Asbestos 1 mining Lmouski (incl,. 10,000 suburbs) lumbering, wood 1 finishing ' ip Madeleine 13,000 . rubber mfg., 1 ' steel foundry, bag, mfg. silk hree Rivers ' 45,800 paper, linen 1 mfg., rubber, iron . hieout3mi t. Hyacinthe 25,000 18,500 aluminum, pulp, 1 paper, iron fdry. 9 clay products / textile mfg. 1. alleyfield . 20,600 munitions, other 1 . war industries, cotton, silk 1 . 5 1 4 1** . 6 12 10 ' 2 1/1000 1/6500 1 9 40 1/1150 10 19 :a/4500 (incl. 7 specs.) 14 1/1300 ' 1 ` -5 10 '1/2000 T*-full-time health officers including 1 dentist . including 1 tb. specialist including 2 full-time physicians i t t Table 4 it will be noted that three of the seven towns for which data obtained have a tuberculosis mortality which is appreciably higher than the. provincial rate. Females in Bimouski have the highest average rate for the years . 1940-42. Females in Thetford Mines have a higher average mortality for the corres ponding period than males in Thetford Mine^ who ranked third in this analysis. 1 Further analysis by age and sex has been attempted for the communities of Bimouski and Thetford Mines and the results appear in Table 5. Interpretation is difficult .because of the small number of persons involved in the age. groups in the two communities. It is of interest to note, however, that among Thetford males ` the highest mortality rate is recorded in males agj^ed 25-34. In Bimouski males the highest rate is in the group 35 and older. Thetford females aged `25-34 have the highest rate in either male or female groups, being 519.8 per 100,000, or four ' tames the provincial rate for the same agres. The rate in the corresponding age group in Bimouski females is 446.4 which is nearly three times the Provincial rate in the sams age group. Tuberculosis also takes a high toll in Bimouski females 35 and older. Here the rate is four times that of Provincial females of the same ages; ... TABLE 5 . Tuberculosis Deaths and Death Rates per 100.000 . 1940-1942 AGE .Prov. of Ouebec * Deaths. Bate All Ages ' 0-24 25-34 35 4- 3883 1167 803 1918 77.5. 45.2 102.1 .116.2 MALES Bimouski Deaths Bate .17 5 2 10 l 171.9 93.3 114.4 360.9 Thetford Mines Deaths Bate 36 13 10 13 , 190.1 121.3 342.9 245.0 * - 7 - ACE" All Ages 0-24 . 25*34 35 ^ Prov. of Quebec Deaths Rate j ! 4019. ` . 1614 1072 ; 1333 80.8 62.7 134.1 83.1 FEMALES Riraouskl Deaths Rate 32 287.3 13 211.9 9 446.4 10 334.7 Thetford Mines Deaths Rate 43 18 16 9 : ENVIRONMENTAL observations at thetford . Visual inspection of the mills of the three asbestos operators was made* Dust count, were made at all Important working locations of thus, properties, and the . . ,,suits a given in a separate report. There was no opportunity to personally observe h0me conditions, eating and living habits of the potation, but this information was reported to us by. competent observers. several conditions prevail in the mills which would favor the spread of pulmonary . tuberculosis. The workmen appear to be careless about spitting and other personal habits. Iu order to keep warn in cold weather they huddle in groups in small wooden c.bin-lik. enclosures. These measure about 6- x 6'. They usually contain a bench or two and a Chair, with so heating facilities; a small tin can on the floor which is used for Cigarette butts, spitting, or left-over food. In one mill a tin drinking cup ha. been in ose for many years. It is obvious that, if there is an employee with tubercle bacilli in .his sputum, these environmental conditions favor the spread of tuberculosis. ' It should be noted that in review of the death claims in the mines insured Company a difference in tuberculosis mortality was found. In Mine A between V > * + .i6ht deaths were due to tuberculosis with a rate of 2.8 per 1,000 employee-^.. In Mine B for the corresponding period there were two tuberculosis deaths with a rate of l . A . It was in Mine A that the most conspicuous unsanitary practice, the common . . * % drinking cup, was found. - Home living conditions gre crowded and it is common practice for children and a V beds, `This is an important factor favoring the transmission of the disease-- npt 'y because it promotes closer human contact but, by interfering with adequate rest, rtbe individual*s resistance to infection is lowered. Poor eating habits and food .. selection which prevail also contribute to the lowering of resistance to tuberculosis, 1 ` t ' These observations on environmental factors are admittedly superficial because of the brief time available for inspection and observation. Nevertheless, because of their probable'importance in creating and maintaining tuberculosis in the community, further investigation of them would seem to be warranted. ' DISCUSSION It is obvious that tuberculosis mortality is excessive in the town of Thetfoxd Mines, But there is no indication from these data that occupation is a dominant factor because: 1 ) the mortality is equally bad among females; 2) it is excessive in the age group under 24 where there is little or no industrial exposure; 3) tuber- . culosis is also a serious problem in Rimouski where there is no asbestos industry. . The age and sax distribution of mortality from tuberculosis resembles the picture of tuberculosis in a heavily seeded, susceptible population with a substan tial proportion of the mortality occurring in both sexes under age 24 and the majority of deaths under age 35 There is no evidence, if asbestos dust is a factor, that it resembles free silica in its influence on tuberculosis mortality. Careful and thorough mortality studies^among granite cutters in the state of Vermont revealed that they are subject to an excessive frequency of deaths from pulmonary tuberculosis, not because of an exceptional risk of contact infection, or because of inferior physique, or because of unfavorable housing conditions or other sanitary deficiencies, t'. but primarily because of-the occupational exposure. This same conclusion has been reached in every other study of workers who cSntract silicosis. . Unfortunately we were unable to calculate expected deaths based on the Provincial r,t0, because the age groupings obtained for Thetford Mines and Rlmouski did not correspond to the age groupings available in the census data for the Province. For further iijsight into the magnitude of the tuberculosis problem in these two communities, it would be desirable not only to construct such expectancy tables, but to carry' out case-finding studies in these and similar communities in the Province of Quebeci - . : . CONCLUSION ' 1. Based on current mortality data, tuberculosis in Thetford Mines, in con to many communities in the Province as well as the Province as a whole, has substantially increased. . 2. Rimouskl, a lumbering town, comparable to Thetford Mines in socio-economic conditions, medical and public health resources, has a hlgh tuberculosis mortality comparable to Thetford Mines. 3. Analysis of the tuberculosis mortality by age and sex in Thetford Mines, in the other communities and in the Province shows that both males and females in Thetford succumb to the disease with approximately the same frequency. This is not the mortality picture seen where there is industrial exposure to free silica. 4. Admittedly our data is Inadequate for final conclusions, nevertheless there ia no indication from this mortality study that demonstrates asbestos mining pe in Thetford Mines is the cause of the high tuberculosis mortality ' 5. Further mortality studies should be made to construct expectancy tables for age and sex in Thetford Mines, Rimouskl, and perhaps elsewhere in the Province. 6. T u b e r c u l o s i s , case-finding surveys should be mado both in Thetford Mines and com p arab le c o su n u n itie s . . : p?ni^, TJ" f - 10 - 7. Health education concerning prevention of the disease is needed, as well aB improved sanitation, particularly in the plants* j I George M. Wheatley, M.D, Assistant Medical Director Metropolitan Life Insurance Company Mr. R. J. Vane,' Manager of Occupation Ratings, has contributed to this study by valuable suggestions regarding the handling and interpretation of the data as well as by making the statistical analysis. 0 ' ' _ Dr. A. J. Lartza, Assistant Medical Director, has very generously permitted us to use his unpublished data secured by Pedley in 1930 on asbestosis and tuberculosis in miners of Thetford and Asbestos, Dr. Lanza has also . advised on the preparation of the final report, ., Dr. N. L. Burnette, Assistant. Secretary, secured for us the information on. the socio-economic conditions of the selected communities. REFERENCES 1 , Desmeules, R., Rousseau, L., Giroux> M.$ and Richard P "Asbestosis and . ` Pulmonary Tuberculosis". Laval medical. Vol. 6, March, 1943. p.217. . . ------- - 2. Desmeules, R., and Giroux, M. "Asbestosis and Pulmonary Tuberculosis". Laval medical. Vol. 8, March 1 9 4 3 p. 227. i . t ' '. 3. Lanza, A. J., McConnell, William J., and Fehnel, J. William. 'Effects of the Inhalation of. Asbestos Dust .on the Lungs of Asbestos Workers." Reprint 1665, from the Public Health Reports. Vol. 50, No. 1, 'January 4, 1935. ' 4. ..Donnelly, J. "Pulmonary Asbestosis: Incidence and Prognosis". Journal of . Industrial Hygiene and Toxicology. Vol. 18, No. 4, April 1936. . ' / 5. McPheeters, S. B. "Survey of a Group of Employees Exposed to Asbestos Dust". * Journal of Industrial Hygiene and Toxicology. Vol. 18, No. 4, April 1936, , , 1" * 6. Lanza, A. J,, and Pedley, Frank G. Unpublished data. 7. Tuberculosis in Industry. Saranac Laboratory Symposium, 1941. Published by the National Tuberculosis Association. .p. 199. " * 8. Pedley, Frank G. "Asbestosis". Canadian Journal of Public Health. November 1930. 9. ' Tuberculosis in Industry. Saranac Laboratory Symposium, 1941. .Published by the National Tuberculosis Association. p.50, 10 Hoffman, Frederick L. The Problem of Dust Phthisis in the Granite Stone Industry. ' Bulletin of the U. S. Bureau of Labor Statistics, No. 293, May 1922. . . f f jrrrvf y I VAN1 SABOURIN ' . , Q.C. V : ' - ' . ; ALD RED BUILDING, MONTREAL. ! ` 1 MEMO This Tuberculo&ls-Asbestasis 1944 Survey conducted b y 1 Metropolitan Life (Dr. George Wheatley then Assistant Medical . Director of Metropolitan Life in New York) might be of Interest to yen. At the time this study was communicated to the officers at ^ Quebec such as Workmen' s Compensation Board, departmental heads and also to the members of the Pneumoconiosis Committee of the Workmen's Compensation Board and also to the then pulmonary experts in the Province. .. --------- The attached copy was made out of the baste rep of Dr. Wheatley which I have in my files. In connection with Cancer, the same prejudice ii rampant now, as you know, which was rampant before 1944 as Tuberculosis. The Metropolitan survey dispelled that prejudl At that time we also had test cases conducted (the hearings tx attended by the leading experts of the continent) to prove that asbestosla exposure did not invite T . B. n/ia^! \ I |\/1/V ^ As to Cancer - exposure to asbestos incidence, th Pittsburg survey took place in the 60*s (Dr. Daniel Braun - his was also published) which survey's conclusions, just as in the a asbestosls, concluded that there Is not seemingly any relations*^ between dost exposure and cancer. j/; " /f?7 Dr. Braun ( together with Dr. Grgoire, Professor Beattie of Cambridge, Professor Kushner of New York University -- an expert in the pathology of cancer tumors -- Is a member of the scientific *\> committee of our proposed Institute raider the chairmanship cf Dr. Wright, * April 29th, 1966. I.S.  I I V A N S A B O U R I N ,1.t . O i t U d u L ' T y ^ t c C i ^ p , ADVOCATE LiU ijf^cX T> -Q -* j I Mo n tr ea l. MEMO * This T uberculosis-A sbestosis 1944 Survey conduct ed by Metropolitan L ife (Dr. George Wheatley then Assistant Medical D irector of Metropolitan L ife in New York) might be of interest to you.- At the tim e this study was communicated to the off icers at Quebec such as Workmen' s Compensation Board, departmental heads and also to the members of the Pneumoconiosis Committee of the Workmen's Compensation Board and also to the then pulmonary 'experts in the Province. The attached copy was made out of the basic report of Dr. Wheatley which I have in my f ile s . In connection with Cancer, the same prejudice is rampant now, as you know, which was rampant before 1944 as to Tuberculosis. The Metropolitan survey dispelled that prejudice. At that time we also had test cases conductd (th e hearings being attended by the leading experts of the continent) to prove that asbestosis exposure did not in v ite T .B . As to Cancer - exposure to asbestos incidence, the -Pittsburg survey took place in the 50's (Dr. Daniel Braun - his study was also published) which survey' s conclusions, just as in the case of asbestosis, concluded that there i s not seemingly any R elationship between dust exposure and cancer. Dr. Braun (together with Dr. Grgoire, Professor Beattie of Cambridge, Professor Kushner of New York University an expert in the pathalogy of cancer t umors --) i s a member of the s c ie n tific committee of our proposed in stitu te under the chairmanship of Dr, Wright. April 29th, 1966. I.S. OS HON 16:52 FAX 410 685 7155 CiOUUlANjrSlQiJEN .WA imbre 1947 3 'axiome de '.esticule gui J a confronti 'J 1 cancer du! .dra que te '; lentement, s andis que ta',* une surface' tardivement''! aort en deuij une tumeur! euse, elle 61 m d e c in e in d u s t r ie l l e TUBERCULOSE ET AMIANTOSE <iT - f U w t des connaissances actuelles sur l'association amianto-tuberculj' '5 et analyse de la mortalit par tuberculose Tbctford-les-Mtnes, Qubec, I ' Canada, centre minier d'amiante. iothrapie. que possibili vasculaire ttj laires ine y, les lment nent sensible GNE, i' Urologia t-Saeremn"'a Certains incidents rcents ont attir l'attention sur la dation qui r ' iw* pourrait exister entre la tuberculose e t l'am iantose. D e plus, le fart que cette dernire vient d'tre reconnue comme maladie industrielle parle gouvernement de la province de Qubec a accru l'intrt mdico-lgal " _. 1 .> t . f ___ _____l ' A l f i S 1U je et de tuberculose (1 et 2). t" A Thetford-Ies-Mines, centre minier d'amiante le plus considrab e J au Canada, le taux de m ortalit par tuberculose a approximativement doubl durant ces dernires annes, tandis que dans la province e {Qubec en gnral, il a sensiblement diminu. Cette constatation a I contribu objectivement crer dans Qubec l'impression qu il existe j une relation de cause effet entre l'amiantose e t la tuberculose, relation \la i serait semblable celle dj solidement tablie et gnralement accepte qui existe entre la silicose e t tuberculose. w l/.l*. l \ . l ' QV. \ 44H .U 'fe. t i.& 05/22/95 16:53 TX/RX NO.1824 P.001 03/22/85 MON 18:87 FAZ 410 685 7185 _G0U>1IAN, SKBEN, VA 1090 L aval M dical Novembre 1947 Malheureusement, il nous a t impossible de calculer les < morts probables bases sur les taux provinciaux, parce que les groupes d'ge obtenus pour Thetford et Rimouski ne correspondaient pas aux groupes d'ge que nous fournit le recensement de la province. Pour rendre possible une tude plus approfondie du problme de la tuberculose dans ces deux villes de Thetford et Rimouski, il semblerait souhaitable de prparer, non seulement de semblables tableaux de probabilits, mais aussi de faire des enqutes de dpistage dans ces villes e t dans plusieurs autres villes de la province de Qubec. C onclusions 1. D 'aprs les statistiques dmographiques, surtout celleB de6 dcs, la tuberculose Thetford-les-M ines, contrairement ce qui *e produit dans plusieurs autres villes et dans la province en gnral, a augment su b stan tiellem en t. 2. Rimouski, ville dont l'industrie principale est le commerce du bois de construction et qui jouit de conditions sociales et conomiques, d'organisations mdicales e t d'hygine ressemblant celles de Thetford, montre aussi un taux lev de mortalit par tuberculose. 3. L'analyse de la m ortalit par tuberculose par groupes d'ge et par sexe, Thetford, dans les autres villes et dans la province, dmontre que la frquence de la tuberculose est peu prs la mme chez les hommes et les femmes. T outes les fois que la poussire de silice devient un facteur de mortalit^ le taux de mortalit change notablement. 4. Nous adm ettons que plusieurs donnes nous manquent pour nous permettre de conclure de faon dfinitive j nanmoins, dans cette tude, rien ne dmontre que l'industrie de l'amiante soit le facteur causal qui pourrait expliquer le taux lev de mortalit par tuberculose qui existe Thetford. 5. D'autres tudes dmographiques devraient tre faites afin de pouvoir tablir l 'incidenc probable de la tuberculose suivant l 'ge e t le sexe Thetford-les-M ines, Rimouski et ailleurs dans la province. 6. D es campagnes de dpistage devraient tre organises Thetford e t dans d'autres villes industrielles. Noven I. D 05/22/95 16:53 TX/RX N0.1824 P.010 05/22/95 MON 16:57 FAX 410 655 7155 GOLDMAN.SKEEN,WA M7 res ' !des ` gne- pne m 4ous 1 pro- 3 rieux 1 * icher a cupe U J m ies ' >ir de : `/ tasse. verte T? 3 irions avons 'i qui i mini. j ruber- Dans '1 s, soit i a moins 1 ,,fonts tvoirise :parce % Novembre 1W7 L aval Mm c a l 1089 eu h au sommeil et. indirectement, diminue la rsistance M W f e l u maladie. Une mauvaise hygine alim entare, assez TM in de la population ouvrire, contribue aussi diminuer U rsurtan ` " d'toH,o. H . m m P6c*to ,, m U t o r . d u ife. NanmojM. k Ucteur |-4wd. de I* TM> rleimportent .1y **" de oembrm avantages pousser plus loin une enqute de ce genre. D iscussion H est vident que la mortalit par tuberculose est trop leve Thetford. Cependant, il est difficile, d'aprs les faits que TM us venons d'numrer, de conclure que le travail mme soit un facteur causal domi nant parce que la m ortalit est aussi leve chez les femmes . p a r TM -dlT t r. M o u c E I* individu. H t . d . o .~ . d . 24 . . . chez qui n'y a pas d'histoire de maladie professionnelle et parce que t X c u l o J constitue un problme aussi srieux A R * o .1 n'existe pas d'industrie d'amiante ni aucune industrie minire. La dissmination de la tuberculose d'aprs l'Age et le sexe des individus morts de tuberculose, semble bien tre celle qm " une population fortement contamine et partimUrement l'infection. En effet, une forte proportion des dcs surviennen dessujetsdesdeuxsexesquin'ontpas encore 34ans et la grande mamrt^ des dU arrivent avant l'ge de 33 ans. Il ne semble pas d'aprs les faits relevs, que la poussire d'amiante inH,lence autant que > librela mortalit par tuberculose et qu'elle en soit un facteur causal. tL .pprofaodc d. I. - M W d h - - * ' granit de l'Etat du Vermont ont rvl une frquente trs levee de la ^ p" -- o r ^ i 1" de contamination plus m a * TM non pas cause d un tat physique infrieur des employs, de logements malsain* ou d au b es c0^ 1. hyginique* dficientes, mais bien cause du mtier mme de ces o La^nme conclusion s'est impose aprs toutes les enqutes i les ouvriers exposs la silice libre- '-M fi V. M 05/22/95 16:53 TX/RX NO.1824 P.009 05/22/95 HON 16:59 FAZ 410 685 7155 __ GOLDMAN, SKEEN. ffA 1068 L aval M dica l Novembre 1947 Novem observ dans toute la province de Qubec pour tous les sujets du mme fig A Rimouski, le tau* chez les femmes ayant 25 34 ans, est de 446.4, soit trois foi* le tau* officiel pour la province de Qubec. La tuberculose est aussi trs rpandue Rimouski, chez les femmes de 35 ans e t plus, et le tau* de la morbidit par tuberculose est chez celles-ci, quatre fora plus lev que celui de toute la province de Qubec. C onditions hyginiques a T hetfokd % La surveillance hyginique des moulins de trois compagnies minires a t faite. Des chantillons d'air ont t prlevs k divers endroits des usines et les particules de poussire y ont t comptes. Les renseigne ments concernant l'hygine alimentaire, l'hygine personnelle et l'hygine de l'habitation nous ont t transmis par des gens dignes de foi. Nous n'avons pas pu faire nous-mme cette enqute. II existe dans l'usine plusieurs causes qui peuvent favoriser la pro pagation de la tuberculose pulmonaire. Les ouvriers sont peu soucieux de leur hygine personnelle et plusieurs ont mme l'habitude de cracher (.4 sur le plancher. En hiver, pour se protger contre le froid, on se groupe dans de petites cabines de bois ayant six pieds par six pieds, garnies d'un petit pole, d'un banc, d'une couple de chaises et d'un crachoir de fortune. Dans le moulin, les ouvriers boivent tous la mme tasse. Dans ces conditions, il semble vident qu'un cas de tuberculose ouverte devient un-rel danger de contamination. En tudiant les rclamations lors du dcs des ouvriers ayant une police d'assurance, nous avons constat dans le taux de mortalit par tuberculose, une diffrence qui serait en rapport avec les conditions hyginiques des diffrents moulins. A la mine A, de 1941 1944, huit morts ont t causes par la tuber culose, ce qui donne un taux de 2.8 par 1,000 employs-annes. Dans la mine B , pour la priode correspondante, il n'y a eu que 2 morts, soit un taux de 1.4. La mine A avait des conditions hyginiques moins satisfaisantes. Les habitations sont encombres et, assez frquemment, les enfants et les adultes partagent le mme lit. C et tat de choses anormal favorise la contagion, non seulem ent &cause de la promiscuit, mais aussi parce Ili", 05/22/95 16:53 TX/RX N0.1824 P.008 05//05 MON 168.:-556 FAXZ 410 685 7155______ GOLDMAN. SKEEN, WA 05/22/95 16:53 TX/RX NO.1824 P.007 wAs imrtTtftiitk DOTtOOtOOO '05/22/35 HON 16;55 FAX 410 685 7155 GOLDMAN,SKEEN,ffA 1086 L avai. M edicai. Novembre 1947 Rimoski qui est le centre industriel le plus comparable, bien qu' Rimoski, l'industrie principale oit le bois, et qu' Thetford. ce soit l'amiante (voir tableau 3), TABLEAU 4 - - P - * -- - - u s n a c t s 1 *' D4cAs p ar tuberculose---T o u x p a r 100,000 tous les Igea PHOVINCE PB QSBC. Cap-dc-hrMadeleine.. Saint-Hyacinthe......... Saint-Jean.................. VjJteyfceld . ................. Chicoutimi. . . . . ThetfortHes-Min. . . Rimoski.................... 77. J 55.9 85.4 75.1 10.7 141.8 190.1 171.9 Femmes 80.8 44.5 90.9 109.8 85.3 149.1 223.9 287.3 Le tableau 4 nous indique que trois des sept villes choisies pour tablir la comparaison ont un taux de mortalit par tuberculose sensiblc- ment plus lev que celui de toute U province de Qubec. A Rimoski, durant la priode 1940-42, le taux moyen chez les femmes est le plus lev et, Thetford, le taux, durant la priode correspondante, est aussi plus lev chez les femmes que chez les hommes. Ceux-ci occupent e troisime rang dans cette analyse. , Une analyse supplmentaire par groupes d'ge et par sexe a t faite Rimoski et Thetford et a fourni les rsultats inscrits dans le tableau 5. A cause du petit nombre de personnes comprises dans chaque groupe d'g pour ces deux villes, il est difficile de donner une interprtation satisfaisante des faits. Tout de mme, il est intressant de rcmsxquer qu' Thetford, le taux le plus lev chez les hommes, est en registr chez des individus gs de 25 34 ans, tandis que, Rimoueki. le taux le plus lev est observ chez ceux qui ont 35 ans et plus. ^ Thetford, les femmes ges de 25 34 ans fournissent un taux plus que edui des hommes : 519.8 pour 100,000. soit quatre fois le taux > Novemb * 05/22/95 16:53 TX/RX N0.1824 P.006 05/22/95 16:53 TX/RX NO.1824 P.005 05/22/95 16:53 TX/RX NO.1824 P.004 '05/22/95 MON 16:54 FAI 410 6855 7155 ________GOLDMAN, SHEEN,WA 1084 Lavai. M dical Novembre 1947 Novei D epuis la partition de ce rapport de Pedley. il s'est produit un chan gement trs apprciable entre les taux de m ortalit par tuberculose Ttetford-Ies-M ines et les taux de la province de Qubec. Le ^ < * 2 indique que le taux moyen de la province de Qubec a diminu de 35% s l'on compare la priode 1940-42 U priode 1926-28. C ette constata tion est sensiblement la mme ailleurs, tant au Canada qu aux E Unis. M ais Thetford, pour ica priodes correspondantes, il existe une augm entation de 80 p. cent. Or. le fait que U tuberculose sort Thetford un problme dominant, a fait natre des hypothses sur le rle que peut avoir la poussire d'amiante dans la production d'une telle situation. R ' T U D fi DX LA MORTALIT TAH LA TUBERCULOSE TABLEAU 3 Si l'inhalation de la poussire d'amiante peut rellement accentuer ou acclrer l'volution de la tuberculose, l'on peut vraisemblablement S'attendre de trouver Thetford un plus grand nombre de tuberculeux chez les hommes de 25 ans e t plus, puisque la majeure partoe de ces individus qui ne font pas partie de l'arme, travaillent dans I industrie de l'amiante. Le rle des conditions sociales et conomiques est im portant dans l'tude de la tuberculose. C est pourquoi, avan td e com parer les taux de la mortalit par la tuberculose dans 1a ville de Thetfordles-M ines avec ceux d'autres centres, il est ncessaire d'en tudier les conditions sociales et conomiques, les conditions hyginiques, or ganisme* d'hygine publique e t les caractres raciaux de la population. Dublin fait remarquer que lorsque les facteurs sociaux e t conomiques sont vidents. les taux de la m ortalit par tuberculose chez les maris comme chez les pouse* sont identiques ; et quand ce sont les facteurs industriels qui prdominent, les taux standardiss de la mortalit sont plus levs chez les hommes que chez les femmes. U Dr Paul Parrot. dmographe de la province de Qubec, a eu 1- a m a b i l i t d e nous fournir les sta tistiq u e s de m ortalit P ^ b ^ u f o s e . suivant l'ge et le sexe, de 1939 1943, pour les cits de Thetford-lesMines. Rimouski, Chicoutimi, Cap-de-la-Madeleine^ Saint-H jm cinthe. Saint-Jean, Valleyficld, la province de Qubec e t le Canada. es p villes qui ont t choisies cause de nombreuses ressemblances, 05/22/95 16:53 TX/RX NO.1824 P.004 05/22/95 MON 15.53 FAX 410 685 7155 GOLDMAN.SKEEN.WA 1003 ,re 1947 amiante cz ceux ose. Et pas la natria de aient des ^ ient une a l ouvriers in ouvrier r ailleurs, fl trouva l'am iante n depouscien foyer ifete radio- 15.5% pr&- x a de ceux tutre ct, y d'amiante tvidus, il Aprs cette jdiflaix pas les ouvriers est pas plu ustries. Et l'inhalation veiller ou ,t diffrentes Novembre 1947 L a v a i. M d ic a l O .s M W .T io m recueillies au C anada 1083 A . P P '* 614 ouvriers de l'amiante au l'amiantose dans l'industrie ^ pedley et ses collaborateur Tout de mme, en 1930. clinique et radiologique Thetford-Ies-Mme et de 195 ouvriers de g t a n t de cette enqute. Asbestos (6). Le tableau 1 donne 1er tableau i Axbaloi Tbol/ord-lrs-Mmcr 141 54 Nombre d'employte, ^ i ' jv personn.e-s e x " am m r e *s - Mi n ^ r ^ i groupe" industriiel, puis1qu;H* berculose trs satiafa ^ aprs enqute dans l- dustric de la confection^ D a tuberculose active a t trou ? l# 1 W ndividus examin (7)tuberculose, Thetford, de la province de Qubec. * -----Endroit TPbroevttionrcde-Idees-QMumbe8c*. -- -- TABLEAU 2 - - *~ J926-28 125.6 137.9 940-42 75.6 252.1 ?N M il f 05/22/95 16:53 TX/RX N0.1824 P.003 1 Dr. McConnell Welfare Division In d u strial Health Section Re* A3-G-2 - Johnson1a Co., Thetford Mines West, Quebec We issued this p o U c y in 1929, and to date ve have premiums of 133,000 against Death claims of $28,500 1a1nad DDiissaabbiilliittyy cCxlaaiimmas of $3,000. Thepreexapleurmisenacmeouinstivnegryto of $1 ,000. . An auelysls of the cU Iju .hoes e prepoudersnce of lung disorders manufacturing o f e s e > ^ T,,,,1H ^ hare you or H r^rehnel^loepeet^tbe Pia n ts of this co .i.n y e t your cowenience. l i i A e k a ^ 4fl it,. <*1a4a na.lTaiS, Way 27, 1935 GWy/DB Q.W. > i > ^ h ^ u p e r r i s o r Actuarial Division Group L ife 6 Health Section i 59^ PRODUCED S/C/M/Ms Dr. McConnell, Welfare Division, In d u stria l Health Section Res Johnson's Company, T hetford Hines West, Quebec We cover the employees of the above company for group life insurance, and to date the claims amount to 83% of the premiums. Several years ago the experience was unfavorable, and we referred the group to you because there was*a substantial number of claims for lung diseases. There has been an improvement in the experience in recent years and the coverage has shown a profit since 1935. In 1936 the question of offering this company Accident & Health benefits was considered and we asked you to make an inspection of the properties. Tou reported that the employees were French Canadians and looked undernourished and that in your opinion the claim experience would not be very good. On the basis of this report, we decided not to offer Accident & Health coverage. Our representative has again raised the question of Accident & Health coverage and advises us that the company has appropriated a considerable sum of money for mine improvements. Possibly this will im prove the group as a risk for group coverage. We would appreciate a further inspection of this company's properties and a report from you at your convenience. The group is not large enough to justify the expense of a special trip for this inspection, but possibly you will have someone in the vicinity soon and can have him make a report. In advising us whether you consider this company an acceptable risk for Accident & Health coverage, you will want to take into consideration that for this industry (asbestos mines) we load our standard rates 10%. In other words, if you think the clai rate will be less than U+Q% of the claim rate in a non-hazardous industry, our normal rate should be adequate. Of course, the plan we will offer will not/jjrovide benefits for occupational accidents. <05/22/55 MON 1653 FAX 410 665 7155 __ __OLDMAN,SKEEN,WA 1082 Laval M dical Novembre 1047 i O b s e r v a t i o n * faites a u x t a t s -Unis Les enqutes faites chez les ouvriers dans l'industrie de 1 amiante ' n'ont pas dmontr que la tuberculose tait plus frquente chez ceux qui prsentaient des signes cliniques et radiologiques d'amiantose. Et Lanza (?) concluait, en 1935, que l'amiantose ne prdispose pas U tuberculose. L'examen mdical de 126 employs dans l'industrie de l'amiante aux tats-Unis a dmontr que 53.1% de ceux-ci avaient des signes radiologiques d'amiantose, et que deux ouvriers avaient une tuberculose en activit dont l'un tait aussi amiantosque. En 1936, Donnelty (4) faisait l'examen radiologique de 151 ouvriers de l'amiante et dpistait 34.4% de cas d'amiantose, mais aucun ouvrier de ce dernier groupe ne faisait une tuberculose active. Par ailleurs, parmi les cas qui ne prsentaient aucune image d'amiantose, il trouva quatre cas de tuberculose active, dont 2 travaillaient dans l'amiante depuis 6 e t 10 ans. Alors, Donnelly concluait que l'inhalation dpous sire d'amiante per st, n'tait pas de nature rveiller un ancien foyer de tuberculose. McPhecters (5), en 1936, publiait le rapport de son enqute radio logique sur 210 ouvriers de l'amiante dans lequel il d it que 25.5% pr sentaient des signes radiologique* d'amiantose, mais qu'aucun de ceux qui souffraient d'amiantose n'tait tuberculeux. D 'un autre ct, 3 ouvriers aprs 6, 9 et 10 ans d'exposition 4 la poussire d'amiante prsentaient une image de tuberculose active. Chez 5 individus, 1 y avait association d'une tuberculose gurie et d'amiantose. Aprs cette enqute McPheeters concluait que la tuberculose ne modifiait pas l'volution de l'amiantose- En rsum, les enqutes faites aux tats-Unis chez les ouvriers de l'amiante indiquent que la frquence de la tuberculose n'est pas plus leve dans l'industrie de l'amiante que dans les autres industries. Et mme plus, qu'il n'existe aucun fait qui prouverait que l'nhalatiou prolonge de la poussire de l'amiante serait de nature rveiller ou i stimuler un processus,tuberculeux. Conclusions totalem ent diffrentes de celles qui ont t obtenues dans l'industrie de la silice libre. Nov Non Pou Nor Pou 05/22/95 16:53 TX/RX N0.1824 P.002 io/oy/90 11:49 * IVAN SAB O U R I N MOHTRKAU. JUb? so**, 1945. George, li. 1 teatley 3sq., M.D., Aeelfttan\ V CJ-Preaident, Welfare Metropolita tLife Ingrano Company, S2V YORK ai , H .Y . U.3.. V '-i, . % Dear George 18tb inai. I b.g to ctoiml.dg. of * o n T * o t * Contani. hT. . a not4. ! hav. no .u o ...d .4 1 n t norie t I h t f o r $ J ^ a t e l Y mad orna ebangea *sbii. r*U *t * . i, itintuzl) fo t th f * ithleh .t-ttP V ^ L ^ L f o r m d a th i^ B o u T l.r coming SttimM I hT. Jbfoic" * . ; # u ttT , 0f y fCost nd gnf dyW o a rMa . morning. Dr% l? I n *"* . A tAttaI B o u tl,t t h i ` , I h t. . fe n end h. .111 j . r t aXY J ? J T n Z t t W H o . ` C b 8T o ^ ? C l . l Bod f t J T t . * . .:<vtt*. t h , ? . hHii .. .. iril-- y.rt.rdw d M d . S T * ! *.7 bri-sTvO. H ** bu tlon ., 1 * ^ f i - ' *h M d ie l e x p o rt* . S i . , * *.' * " by . - -v '-_ - d.-tv,. A*_*fttJdi.v oA#f' t4hKft l a t t a r mritten fhank yotiiior th PY f a l l y olaaredL up. h r t . .Ibi Sl* i * *< * 01 t u . i *aonel regarde. . 3.3 ( ( i il **** H .. <w tel W * w ' ^ '2 ? * K ? W " ' c m ^W 5 >2 su s r* * & s <w ? 5 ^ 4 y s r s s .? v r * V 5 R U T 2 ^ . s . p s ^ 2 . * " MX ' W- * * ! " V . .mn.. 1 - rfv ^ \ >* : PLAINTIFFS ' EXHIBIT . Ilio**** Q& C' ' f / & / ' 7C7 a 15',3!M9 . nu u m * . . ^ rgutlac io U uditoli* jroW ll aatt cCoonntwac*t* lan Q**~*c---r--*-A*w *- .. #- - V . . i n A U rad B o ild ia i# Sonto**! (8** JL*- 1 . T . ih o n ia * U ** _ - ,, i t u e t e i lo tte * ' * f w W f *< y g J r i , . . t r i p f TTM to *#4 35 O'^ - SfbSaxtfor tred S t AS*U**toT* ,S 2 *ty*#te TU lU ^^n^t. R(M' i / Uljn/ fS ^ St e Lt i SS .- i i m rr+ . u c t .. t a t t . * y f r t & * L Jt. (o % ^ " ^ i l ^ t t S u S u U ti b ^ ^ ,* ^ 1 i 1w l - * ^ 2 0 * S S . " 111" u* Tatbar f"0 * Bouri*r, 8.J tractw^ _ wt^i and probably d _.__ ? i to taro M* >**. ___ ^ p., lacattoi Corti. 3 . i t ttotfort raffi tic* tte te T" * " * ttt py"ill*'lic*1 *>ir*t^ .^ , .umiiii<i Cf* [* y * ,!1`L ^ w v m for th ' U . Th^ Xaaltb Copart^t. U m * * % * * th^SBlBB ^ baja** Scorar a l* t * 014 S 5 5 T ^ * * S IE * . 4 S la oo*p*a*abla JMJ to dtTolop** * *,#lth f f P S,! for ocnditton* U ~ ^ V * * * ^ t o S S S to f i j l o ^ y g y g S a t iUX credit and ibtir *j*f Boee. I L T *S f^*7 AwM dm ljP s r is & s r u s S & - * * . B . laprora&ant cf b**l (- . u ctaranaon tibe ba* i. Ton oxbt to iod rt . . J " ten ? tti 'B tw U r !fU * * W X ! S ? J S teS*W - S e Sa tbe 8UU* r lataraitad ! * " * s - = S S K ? A " . WWWe . , * , . , , fo^aas** * * * * * 5. I n . * ttet L ^ 1`S S S OE T m* " toTr,W W P n - "- u S/C/M/Ms, Ample toilet facilities sre provided and kept clean. Drinking r:?ter is scrolled by bubbler type fountains. Heated rooms or cabanas are located on each floor of the mill building- ` o . fflMCLUSIONS AND ECO:/ilENDATIONS ~ The concentrations of dust found at the time of this survey are much lower than those found in 1930. This may be due to the mill not operating to capacity and improvement in the housekeeping. Covering of conveyors is, no doubt, a contributing factor also. Tvhsn the samples ~ere tf-*.sn, the ..-ndors- ..e open and the day res clears . It is recommended that efforts be made to further reduce t(2he) duet con- centrations. According to the United States Public Health Service, five millio particles per cubic foot may be regarded as the maximum allowable concentration of asbestos dust. . HEALTH HAZARDS . . ' There are attached reprints of two studies which may be of interest in connection with the hazard of asbestos dusts . "Effects of the Inhalation of Asbestos Dust on the Lungs of Asbestos Workers" "Asbestosis" (r^U.S. Public Health Service, Public Health Bulletin No. T'l, "A Study of 11-bestoais in the Asby.tos Textile Industry", l?33. * \> - KING MINE " ASBESTOS CORPORATION . Thetford Mines. Quebec, Can. ' * * *_ A recheck survey o f th e d u st conditions in the m ill of t h is company 772s mfd.e by the Industrial Health Section of the Metropolitan Life Insurance Conraeny on October 26, 1944* A orevious study hsd been made in June, 1930. . INSTITUTE OF OCCUPATIONAL /NO ENVIRONMENTAL HEALTH MONTREAL, CANADA A M E M O R A N D U M :- 70: Cr. Wheatley FROM: Miss R e illy CATE: June 1? , 19LL A tta c h ^ a r t copies o f the survey , * * % '' k . ^ d u s f " n " '' Company mines and m ills in t J e allowable concentration of five m illion " t ^ u s ^ d . p a r t a e n t and t o . screening department were t i l l too high. Anon* s U . .. p h y s ic a lly axaninad two showed f i r s t degree a a b e sto s.s but non. of the oen appeared to have tub ercu lo sis. The s a n ita ry c o n d itio n s V * * f . r L ^ h ^ o y ^ s p U t L ^ n l h . t h a t th e re was an unusual degree o f carelessines ^ n g ^ P i5nCe the war th e m ills ^ . o r ^ l ^ S ' C a ^ thr >iacieo f T s t , W S Z S S Z fa e r iS z s s s s r ^ - -- f " s ls - I f I t i s a d v isa b le H r. Tehnel can stra n g e to gof l 0^ i b i e ? i f S ig h t" .h c b e u m y o f th e Johnson* s Company p r o p e r tie s , i r p o ssio a e , M gPTM ^ . ^ f t n o l i ^ Y s u r v ereyjr wo*f l iv in g n d l tl o n . o f .p lo y ees. (^ > ............. 85 S* 4 \ I i Mi iu u p o ' tan I.jiu n .sh u .nnV i-; (Y>m ,,any Iriimmkk .44^ Ijiov A.Lini oi*. rov J - i -- w< A s*rt. uMDim. KIAV VttMK n rv r b r a a r y l o , IV.2 Yr. ltanfrd Soadltch, D lrtetor D lviiion e f O o c u p ttla v l X/ln 23 Joy S tro fi Im U s , Uu>. fr lL,nfrd 1 h*T your l t t t a r of Ih* l^ th . 1 tMr.fc l t 1< p o itib la th e t tM* un moy ha > b ito tit. A* yu ino*, f ir n our e i* ri #tj-i;b:to ii In tho*c ho-fabrleat* t i W i t s t and not In th o tt aoo^aln l t . Zt bkTf found vidt.ict of l t in *n ho t r i s a ib tsto s pi}* Aololn, i .M t t l i t , and o lh ir a t t r i t i of t i l t cu tu r , a l t i a povir u i . Of court, t i you xnav, tb t f t c t tS it a u n &>; br a c o a y f tc t rs m t* ( t 'o l s c l t t 1 not o rti a b u rrai la diufno*ia t i l t t>p of f i l a uni. h bu ics sparlino. ?h acoapttnt r M a tc tn a lo c Iit" , partieui>ely i f fc 1 T8 sp ari, v i l i la o it invkriably r*d a lo t of ja tialo cy la ti f i l a of aa *Trr| b ialtb y c i a i t . P*j tha th td i of ir K*tt. I vould ru (t* * t to tha, LT tbr 1* Any deubt la th a n t l t r , t i a t thy Mnd ti a f i l a to K r Saapion fo r rifle a tlo n . h, \y O L iO C V i U M O ^ > * . /{*>* . . f f .. -/ / . 2/16/42 I have your letter of the 13th. I think it is possible that this ma n may have asbestos is. As you know, we find our cases of asbestosis in those who fabricate asbestos and not in those who mine it. We have found evidence of it in men who trim asbestos pipe moldings, shingles, and other material of this nature, with a power saw. K Letter from A.J. Lanza, M.D. to Manfred Bosditch, Director Division of Occupational Hygiene/ 1420 - INDUSTRIAL DUST HAZARD (Continued from Page 1417) ' error, nevertheless it is interesting to ob serve that they were quite uniformly high for copper .miners, gold and silver miners, and lead and zinc miners. The situation as regards iron miners is interesting because it was thougnt for a long time that they had little or no exposure to .silica. More recent studies show that there is. actually a moderate degree of silica hazard w hich'. produces silicosis in upwards of twenty years. However,; in both insurance studies there were too few deaths from respi ratory tuberculosis to permit definite quan titative conclusions therefrom. A great many-workers in mining occupa tions, it must be borne in mind, are common laborers-among'ythora we should expect a much higher, mortality from tuberculosis thin among standard ordinary policyholders. From the limited data available for unskilled workers, from-these studies it would appear that the tuberculosis' death rate for this class of workers runs between two and three times the. rate of standard ordinary business. Thus it is clear that even when-allowance is made for-the important factor of social-economic class; the death rates.for the metal miners are extremely; high. I'"Goal, miners' in. different sections of the country present an' interesting contrast. Among the bituminous miners, exclusive of the Pennsylvania miners, the mortality from tuberculosis was over i l/ t -times that on standard ordinary miners, a low ratio for this-type of worker. .Pennsylvania miners, on-'the-other .hand,'most, of whom were em ployed in 'th e anthracite field, had a very high"-ratio-of: actual' to expected deaths-- 'well over 300 per cent. Anthracite miners, as we have stated, are exposed to an appre ciable amount of' silica dust, which accounts for. their relatively unfavorable position. No dusty trade has received more careful Underwriters, .. 1 agency managers, I . home-office men: Tor .the first time, the whole subject of safeguarding life insurance proceeds has been reduced to readable form and . substance for easy assimilation and . practical application. - . Safeguarding .; . . LIFE INSURANCE PROCEEDS By W.' J. TFheeler and T. L. Todd .. Here. - in simple fashion, are ex plained the desirable: objectives to be .attained by safeguarding life insurance estates; as well as approved practical ' plans of distribution-of insurance pro- 1 ceeds. '. t - la lk U urw l ! UHrr, *mmmy r*k- lata Wu tiiaila fr + p k tm mtUmme klttk wpUla tk laiap i a payaMl, Mardkatl f.p*U* tl--Ott. a c t. a ulakaak. . It U pk*4 4tk pr<ai Ulaf IdaM for ***rf u ^ irrrliir ta ak*rk lata kla aaJaa S2.S0 PoitpoM Vp)t ESttfelp '5HniiErtoritrr ' 80 Maiden Lane ` , New York i 'ne W eekly Underwriter study in the United Ctates titan that of granite cutting. Long rcccgr.izcd as a dan gerous trade, it Has beer, tour.d time and again to take a heavy toll in deaths from tuberculosis. The amount ot free silica in the dust breathed by these workers is very large. In the years 1925 to 1936, the mor tality frem tubercuiosis among granite and sandstone cutters was the highest recorded for any ot the -groups of insured lives studied. There were more than 25 times as many deaths from tuberculosis as expected; is indicated by the higher mortality tubcrculos-.s among exposed workers . ' age 45. About ail that car. be said c point irem the ii-.nited Ar.-.criczr. life , ancc company experience, is that the ttu~cuiosis death rates t'er grinders, metal pciiskers, ar.a butters who arc exposed to tcorganic ctests, most of which co net cectax a large percentage o: silica, are net high, having in mir.d the ccor.omic suras of thatworkers as compared with the average ordi nary policyholder. Lime, cement, aac artii- whereas in the earner years, there were nearly ten times as many deaths as expected, based on a small exposure. Marble and lime eiai stor.e workers had a quite favoraiit mortality. The very high ratio for march and limestone cutters, however, may be sug stone cutters did not show anything like as gestive of some untoward infiuer.ee. Dr. high a ratio as the granite and sandstone cut L. U. Gardner a: Saranac Lake, found tau ters. There were ten deaths where one was animals dusted with marble dust by inhala expected in the years 1925 to 1936. It can be but regretted that there are so few mortality statistics ior occupations ex posed to dusts other than silica. Grinders tion, developed little reaction,. but bemmt temporarily more susceptible to inftcdcc with tuberculosis. The increased susceptibil ity was not marked. of metals, most of whom for many years The three occupations in which there is have been using composition wheels in place exposure to organic dust had from two to of the old sandstone wheels, and consequently two and or.e-'nalf times the number of tuber have had a little or no exposure to free culosis deaths expected.. Even allowing ter silica, experienced a relatively low extra mortality from tuberculosis in both studies, based, however, on a small exposure. An the economic position ot these groups as compared with ordinary policyholders gen erally, the mortality is nigh. It is dimed: interesting point to be noted here is that this occupation also offers exposure to- metallic dust. It would appear that neither the dust from the composition wheels ncr the meed dust has produced excessively high death rates- from tuberculosis. Buffers and pol ishers, a somewhat similar group, also ap peared to have a low extra mortality from tuberculosis in the years 191S to 19215. .. Cement and Lime W orkers to see in the light o: present clinical knowl edge, how it is possible to account for the excess mortality on the score of damage a the lungs caused by such dust. Mortality findings, then, are still cot a complete harmony with clinical and labora tory findings. But from a practical under* writing sand point, it may be said th?*_z,bt only dust which of itself might s-. the total mortality, by increasing Cement, lime,- and.artificial stone workers dence of tuberculosis, as to require an ':J - i 'were reported upon in both the Joint Occu premium charge for life insurance, is free pation Study and the Occupational Study, silica. We have no mortality data for as but the number of deaths from tuberculosis ' bestos workers but, it may well be that ex was in each instance less than the number posure to asbestos dust m large quanutim required for separate tabulation. This fact in itself is significant, although it does not mean-necessarily that the death rate from tuberculosis was. below the average.. Never will also be found to produce a high mor tality. theless, from the facts presented, in these studies, it is quite evident that the tuber culosis death rate for'this occupational class was comparatively low. . N ew Baldwins 1 Y ork In su r a n c e A nnotated ' La w Three groups of male workers exposed to organic dusts are included in the table-- upholsterers, cotton- mill operatives, and "Perpetual Revision Edition" is the one authority on New York woolen mill operatives. The ratios for all Insurance Law. of these classes run about 2CO-per cent, based on small exposures. It must be admitted that these occupational It contains: The Insurance Law mortality, statistics are meagre and do not permit of very definite conclusions regarding the effects of -specific dusts. So far as they go, they fully substantiate clinical and labora tory findings regarding the injurious char acter of silica dust. The death rates from respiratory tuberculosis for men in occupa All miscellaneous statutes relating to Insurance ' Exhaustive annotations Insurance Departm ent Tulings Attorney General opinions " Common-Sense" index tions where there is a serious exposure to silica dust are so high as to leave no room Kept to date for doubt that silica is the offending agency. Price S20" 'Contrary to clinical and laboratory find Including -1940 Supplement ings, however, the mortality statistics, pre sented by Cottis and Yule, suggest that long continued exposure to non-siliceous inorganic dust has an-injurious effect on the lungs as <Efje (HSeEfelP tSnbcrir^;^ 80 Maiden Lane new- *.*<: 0! sy ijl iit J? g "s V 205 3| ?3 *og <5J 2lJ 39 003.1 33V ;0: >t giurie-8," 1940 . 'SURPLUS FUNDS o lan ............ n tiill ............... York L ire......... ble. N. Y......... iancock............ acu* Life .. IIIPena Mutual ML Mutual BeneAc ......... frU.`W jtem & Southern. CUt'Uaaa. M utual ........... RlC Pforidene M utual . . . Ili tfc-w En f Und M utual |IC U ic In a. Co. oi V a.. BjfcA scr. Nt'L T e x .... 11 Coon. C e n e r a i ........... /IfrC ona. M u t u a l ............. &2L Union Central L ife. 9t.' Bankern Life. l a . . . . {t2L*:Katioaai Life. V l . . . gf- M * 4 * s S 1 U .S 0 1 .6 2 0 c o n ti n tn t y re- Xauonai Life & A cs... Lincoln N a tio n a l......... Equitable Life. l a .... State M utual ............... Phoenix M utuai ( ......... Southwestern Life . . . K a n u s City L ife......... Fidelity M utual ......... Jefferson Standard . . . Bankers Lite. N eb .... Paciftc M utuai .a........... Northwestern National Guardian Life ............. Reliance Life. l*a........ Great Southern #........... Monumentai Lite . . . . Home Life. N. Y .... Occidental. C alif.... Life St CCasausuaalty........... Continenta1}1.. 1IH; .. Central L.ifce. -l-a--..-.-.-...... Columbian National Acacia M utual ........... .Calif. Western Slates. ` provident Life & Ace. , M utual T ru st ............. *.o.43uro 3.941.163 3,777.602 3.6 25.331 7.344.962 7.340.000 7.205.934 .463.639 6.300.000 .457.913 .269.459 a .171.696 4,733.020 4.569.137 4.300.635 4.152.034 4.077.235 3.922.443 3.373.551 3.529.063 3.412.797 3.295.000 3.233.576 J .231.713 49. Wash. N a tio n a l........... 50. Minnesca M utual . . . 51. Sun Life. M d............... 52. Cliioiobs M utual, O .. 53. Ohio National ............. >4. Guarantee M utual . . . $5. Midland M utual ......... 56. Amer. United. I n d . .. . 57. North Amer. R ca u u r. 33. Commonweal ........... 59. W estern Lite. M o n t... 60. Home Beneficiai . . . . 61. Continental Amer. . . . 62. Mass. Sav. Dank......... 63. Pilot Lite. N . C-......... 64. Pan*American L i f e .. . 65. Generai A merican . . . 66. Old Line. W is............... 67. Baltimore L ife ^ ........... 63. Ohio State L ife............ 69. Presbyterian NLicv. . . . 70. Alliance Life ......... . 71. Berkshire L i f e .............. 72. Farm ers & B a n k e rs ... 73. Business M en's. M o ... 74. New W orld L it.............. 93.596 35.976 75. Air.er. Mutuai. I........ 76. Coomat L.:e ............... 77. Industriai L. \ I:.. Ca. 7S. Protective Life. A ia... 79. Country L::e. I '.I.......... SO. American tannare . . . 31. Indunauoiis Life . . . . 32. Armcaoie Life ............. 33.41.. Paul Revere Life......... FranUir. L.:. I.:........ S3. Casual L:e. Caio........ 36. Union La sor L i f e .. .. 37. Oreson Mutual S3. Monarch Life. M a u .. 39. Loyal Protective . . . . . 90. Soutaund lu:e ........... 91. National Reserve . . . . 92. Illinois Bankers ......... 93. Volunteer qta:e ......... 94. Atlantic Lite. V a _ .... 95. Girard Life. ? J ............. 9fw Greac Anier., T ex as.. 97. United Life A c s... 93. Northern Life ............. 99. Mass. Protettive ......... tOO. Lutheran Mutual . . . . 1417 :.7;/.',95 l.iil.iz* :i7 I . i l l . 223 :. c !. : - j :.*;;.225 1.512.2C6 1.490.457 1.440.425 I.T9.902 lii i.j'.s.n: i.iOl.iOf :.:3 i.:s; ;.:co.3;r :;5 i.-Ti.n; 1.391.11; 11..333633..590I10 INDUSTRIAL DUST HAZARD {Continued from-Page 1413) ; rarely seen now and the clinical picture tas changed with the .progress of dustconl *trol measures. The' trend is towards a /lessened incidence of"new cases of silicosis. '.This improvement- depends upon the mainitenance of constant vigilance in detecting unisjuspected hazards and in supervising the efficiency of dust control methods after they have `been put into effect. It cannot be ex * eted that this improvement will be reflected insurance mortality until a considerable Tperiod of time has elapsed. ---- ---------------./..The conclusion seems warranted from ^.clinical and laboratory experience, then, that the only dusts which of themselves might have sufficient effect on the mortality of 'workers exposed to them, so great as to re ,,quire an extra premium charge for life in : surance, arc silica and possibly, asbestos. Life insurance men naturally will turn to "'ortality statistics for-confirmation of a ag so at variance-with the common be-lief, -long held, that exposure to all kinds of .-dusts is productive of a.high incidence of respiratory tuberculosis. To .thcTayroan it "seems only reasonable to suppose that the ":diffieulty in breathing he experiences when texposed to large quantities of dust must pirn some way affect his health, and that filling j,;the lungs "with foreign particles' must have `Injurious effects on them. The writings of 'eminent students of occupational mortality ^statistics have served to strengthen this be"Tiei.. Nearly all such statistics, show the immortality from respiratory tuberculosis among "iiworkers exposed to a wide variety of dusts to be well above the average for all workers 'included in the study. But, when these figlures are refined so far as is practicable to V'make allowance for. factors other than dust, /'which may influence the - mortality from `tuberculosis of men employed in these oecu_ "potions, the importance of many, dusts as .. .causative factors becomes less evident. '-.There is-a surprisingly large number of -'.factors, other than dust,, any one of which .may be responsible for the high mortality `from tuberculosis among men in dusty trades. 'Some dusty occupations are carried on by `men recruited from the lower income classes, -among whom it is now known that apart enV' :tirely from exposure to a specific occupW4;y` -tibnal hazard,"the death rate from tuber culosis,- is considerably higher than among persons in the higher income groups. The selection of certain kinds of work by the less robust workers is reflected in the high mor tality from tuberculosis of men in other callings. Racial and nationality groups tend to enter certain occupations, with the result that the peculiar susceptibility or relative immunity to tuberculosis of these stocks, colors the mortality picture of men in such occupations. These arc but a few of the many circumstances for which allowance must be made before conclusions can be drawn as to whether a particular dust is or -is not the responsible agent in the high mor tality found among men in a dusty trade. ` Unfortunately there is, for the United States, no considerable body of mortality statistics sufficiently detailed to permit of evaluating separately some of even the most important-conditions affecting the mortality of men. in. specific occupations. Perhaps the best statistical demonstration of the effect of different, types of dust on mortality from `tuberculosis is supplied .by two British a!u'thoritics. Dr. Edgar-L. Collis and G. Udbey Yule. These authors selected for study, from the occupations reported upon in `the -Registrar:.General .of England and Wales', report on Occupational Mortality covering the years 1921-1923, two groups of occupa tions--one exposed to silica dust, and the other to non-silica inorganic dust. The groups were so chosen that each had, as far `as possible, the same amount of dust ex"posure, physical effort, exposure to heat or to weather, or any underground environment. Part of the authors' comment on the reSuits as regards respiratory tuberculosis is quoted: "For all ages (20.to 65) the comparative mortality figure (this figure is denned as the number of deaths that would have occurred in the Standard Population at the rates rul ing in the occupation) of the Silica Group is no less than 5922 against 163.5 for the Standard Population, i. e., the mortality is more than three and a half times the normal. For the- Non-silica- Group, the Comparative Mortality Figure, although actually slightly higher than normal, at first sight hardly seems to differ significantly from the normal; nor would one's judgment be much affected it, instead of making comparison with the S ta n d a rd P opulation, one h ad used the Social Groups III and IV, for which the re spective Comparative Mortality Figures are 159.8 and 164.2. But the summary figures conceal interesting changes with age. A glance at the figures (shown on Table 4 of their study), shows that in the Silica Group the ratio of mortality to the normal, though greater than unity even in the lowest age group, rapidly increases as age advances. In the Non-silica Group, the comparative mor tality is actually below normal up to age 35: it rises just above normal in the following age group: but as ages over 45. it is con spicuously above normal." ' The facts regarding tuberculosis were nor published in this report for each of the six silica occupational classes included in the study. We have, however, determined by reference to the report of the Registrar Gen eral, that each of the silica occupations had over twice1the expected number of deaths. The extraordinary high ratio of 1.150 per cent was recorded for tin and copper miners, while sandstone masons, cutters, and dressers had a ratio of 441 per cent. On the other hand, only the limestone masons, cutters, and dressers of the five o c a nations considered in the non-siiica group exhibited a high ratio. 191 per cent. Like the English tin and copper miners. American- metal miners are exposed to a: serious silica hazard and have an inordinate mortality from respirator/ tuberculosis as will be seen by reference to Table 1. In this table are given the ratios of actual to ex pected deaths from tuberculosis for a num ber of occupations exposed to dust and re ported upon in the Joint Occupation Study. 1928, and in the Occupational Study, 1937. ' both published by the Actuarial Society of America and the Association of Life Insur ance Medical Directors. In the period 1913 1926, the number of deaths from respirator/ tuberculosis among metal miners was over eight times the number expected on the basis of death rates by ages prevailing among standard ordinary lives in the same years. In the latter study covering the years 1923 tc 1936. the ratios were even higher--over 11 times' as' many deaths were recorded for metal miners as were expected on the basis of death rates among standard lives in these years. . While the actual number of -deaths for each separate metal mining class was rather small in both investigations, ar.d consequently the ratios are subject to a large margin of ( C o n t i n u e d o n P a g t 1420) -June-8, 1940 i -t I J mental animals nor co workmen exposed to asbestosis. but most ot the iaiai cases have though eases wiii be seen occasionally that these dusts show any clinical symptoms or been complicated by other disease such as I'rccced to a fatal tcrrr.tnation without ir. tec- X-ray appearances suggestive oi silicosis. cancer and diabetes so that the extent to tier.. which the asbestosis was responsible for Exposure to moderate amounts ot silica Silicates death is not clear. dust where the parttcie counts are in excess A considerable number oi silicate, dusts The pathology ar.d X-ray appearance of oi ten million docs not occur frequently a: have been studied and their effects upon ex asbestosis are entirely different from silicosis the present time, though it is cniy in the as: perimental animals, both by inhalation and and in the absence oi a definite history of few years that siiica industries have en injection, noted. They produce little or no exposure over a considerable period of time deavored to cope with their dust problem and reaction in the body tissues and what little . to asbestos dust, the diagnosis is difficult. A effectively reduce the amount. Such ex reaction some ot them do produce does not great deal ot success has been attained in posures produce definitely disease in from tend to progress. An exception should be controlling dusts in the plants where asbestos eight or ten to twenty or more years, in pro noted here regarding asbestos, which is con is fabricated so that it is not likely that as portion to the actual quantity of dust. The sidered separately. bestosis will ever become an important in incidence of tuberculosis is high and of those N or is occupational exposure to silicate dustrial disease, as far as the number of who die of their puimonary condition, 7a per dusts accompanied by any such clinical pic cases is concerned. ~ . cent are tuberculous. ture ot disability and death as is. found in siliea dust exposures. The Public Health Service studied some talc mines in 193S. Only 66 men were exposed. Tuberculosis morbidity and mortality rates were very high in the county where the mines were located and the dust exposure was.'exceedingly se vere, running into hundreds of millions of particles. Eight men showed advanced pneu moconiosis but tuberculosis was also present in most of them. It is conceivable that ex posure to tremendous quantities of any min eral dust, regardless of silica content, might so overwhelm" the lungs that they could r.ot deal with the invading substance. Irrita tion, inflammation, and probably infection would follow with disability in proportion. Such isolated instances do not invalidate the conclusions stated in the previous paragraph. Asbestos The scarcity of clinical data on asbestosis makes the prognosis doubtful. We have had a small group of cases under observation for about ten years ar.d.some of these show a definite but slow progression, as far as can be judged from the X-ray films. However, what the outcome may be remains to be seen. These men are all working and showing no ' signs of any disability. Silicosis It may be said that there is a very general, accord among the leading investigators and . research authorities in the opinions and con clusions presented in the international con ferences on silicosis. Such differences of opinion as .may be expressed, from time to ' time do not seriously affect the general agreement on the basic factors affecting the cause, incidence, effects, and prognosis of silicosis. It is also possible to find degrees of silica exposure which, white producing definite siiicosis evident on X-rays, will r.ot produce dis ability or death in an average working life time. Mortality statistics are not broken down by industry to an extent sufficient to make available definite figures by degree of exposure. We must rely then on the clinical results obtained in industrial investigations which are conclusive enough for those indus tries studied. Our own impression -is that even where the silica hazard is of a miid type, the incidence of tuberculosis wiil be higher than the average. It has been stated that where siiica dust contains caustic alkalies also, the action of the silica is intensified very considerably. The evidence here is meager. ' Other substances apparently have some inhibiting effect upon the action of silica, affecting the pathological as wcil as the clinical picture. * Asbestos is the only dust of combined The effect of silica upon the lungs depends silica which is known to cause a definite on the nature and extent of exposure. That Prognosis pulmonary fibrosis which may result in dis ability and death. Most of the asbestos fab ricated in the United States comes from the is to say, upon the quantity* of dust in the air breathed by workmen, the amount of free or uncombined silica in the dust, the size The prognosis is fair for a silicotic whose lungs are not extensively damaged and who is free of infection. Such persons have an mines, in Quebec Asbestosis. however, is _ of the dust particles; the presence of other ' n ot`found among asbestos miners, most ot_ . substances in the dust, which may modify whdtn work" in dbea uiam es or pits, nor the action of silica, and the length of time increased susceptibility to infection and if brought into intimate contact with a case of tuberculosis arc very apt to become tuber among^ men engined in mining operations or duration of exposure. ' The individual culous also. The outlook for the tuberculo- whereby* the asbestos is prepared for ship ment and bagged, but among workers _in fabricating plants. Only recently has an ex . plaiuitimi beui uileietl 141 tills anomaly. It would appear that not only is asbestos an himself must also be considered. Previously silicotic is poor. Many cases are essentially existing disease of the lungs, especially a chronic and may live for years. Others show ' tubercle infection, will influence his reaction .. rapid, progression and die in from one to two to inhaled silica.. There may be other phases years--aiter-their- infection becomes active. of susceptibility about which we know little The importance of tuberculous infection exception in that it diners from other sili or nothing but in the main, it may be stated among persons exposed to silica dust brings cate dusts in its ability to cause- structural that individual susceptibility to the action of up a very important underwriting considera changes in the lungs but its action appears to silica dust is an acquired rather than a con tion, that is, where the worker in a siiica be mechanical and not chemical like the ac genital condition. . , occupation is in contact in his home with an tion of silica. If asbestos is crushed to fine In industry we find different types of silica open case of tuberculosis. particles, it will not cause asbestosis in cx- hazards. The severity of a silica hazard is The question is frequently asked whether p -vin u n ra l am a w ln B ir will asbestos produce estimated on the amount, of dust in the air men who had worked ir. silica dust at cr.e any readtlatl clsewBtfe*than in the lungs.- If and this is expressed in millions of particles time but later changed to a job in which its action wu i ill OCT nature ot sdica. the per cubic foot. The particles counted, are there was no exposure to silica might be effect would be more pronounced with smaller those under ten microns in size, though the considered, standard risks for life insurance particle sizes. Consequently, Gardner con present opinion is that it is the particle ,be if they passed the usual insurance physical cludes that the relatively.long spicules of as tween one-half a micron and three microns examination. While there are no insurance bestos produce their effect because the lungs that is mostly responsible for causing the statistics to prove the point one way or the are never at rest and the constant.movement disease. ' - - other, there is every reason to believe that 3 ' provokes the fibrous reaction. Exposure to excessive quantities of pure a group of such men will not give a stand Like silicosis, asbestosis develops slowly, silica dust, that is, where the dust count is ard mortality. Tne usual type of physical presenting the characteristic .symptom of in the hlindrcds of millions of particles per examination will not detect silicosis. Tne shortness of- breath. The number of cases cubic foot, is now rare. Isolated instances only way to be sure is to secure X-rays of -PJ of asbestosis.that have come! to autopsy is may be found as. in the case of a sand the lungs of such applicants and have them ' small but there are several cases on record blaster improperly protected. Such exposure interpreted by some one who has specialized in which death .was due entirely to the as produces a severe type of silicosis in upwards in reading films of this kind. . bestos and not to any associated infection or of five years, even sooner in extreme cases. Silicosis is gradually coming under control. other condition! There does not seem to be With such extensive silica- damage to the 'T h e a g g rav ated cases seen tw enty y e a rs ag o any pronounced tendency to tuberculosis in lungs, tubercle infection is almost inevitable. ( Continued on Page 1417) Life JZ& - 1412 e W eekly Underwriter Insurance Department JUNE 8, 19-10 Underwriting Aspects of the Industrial lite Dust Hazard - . By A . J . Lanza, M.D.; A ssistant Medical Director, and R. J . Vane, Statistical Bureau, ' . M etropolitan Life AddressBefore Medical Section of American Life Convention, Colorado Springs, Colo., June 6 OUR knowledge of health hazards re sulting from exposure to various -kinds of dust"in industrial .'occupa tions is based, on .observation and clinical studies of workmen exposed to these dusts, wool, silk, sugar, flour, starch, wood, tobacco, -and leather. .' It is true that some occupations in which is involved exposure to organic dusts mani fest a tuberculosis mortality .rate higher, quality. Their lungs bccotrfc pigmented ireta coal dust but they do not develop a true, fibrosis. For anthracite miners, the pictsre is quite different and the reason is that an- thracite mining includes exposure not coir -- and upon noting .the'results of the acdon of than the average. Formerly, it was thought to coal dust but also to silica. Disabling these same dusts upon experimentalanimals. that this undue prevalence of tuberculosis miner's asthma was shown by the Unites The former me'thod goes back for centuries was due to the occupational dusts but the States Public Health Service study of 1935 -and our earliest'conceptions of the harmful dust studies of recent years have demon- to be a type of silicosis, to -which the'term, properties of dust .were based, on first hand vstrated that, mosdy, organic particles are too anthraco-silicosis is properly applied. A=th- 'observation. . ' large to penetrate' to the pulmonary, tissue racite seams are often found in country rode . Many pi these conceptions were erroneous. and when they do, they are absorbed without which' contains a considerable'amount of It is only in the past twenty, years that any producing any specific inflammatory reaction. free silica and, as in other silica dust ex-' thing like a comprehensive knowledge of Nor is much credence given nowadays to the posures, the development of pulmonary dust diseases has been attained-^-due first to idea that organic dust particles convey tub fibrosis was found to -be proportionate to tlx the perfection of the -X-ray as a means of ercle bacilli -to the lungs and thus, cause amount of silica m the coal dust and the diagnosis, and the development of successful tuberculosis. . ' laboratory technique for conducting tests on M etallic'D usts * length of exposure The incidence of tuber- - . culosis among anthracite miners is very high. experimental animals. . . . ... 1Now we have arrived at a point where in tensive studies, both clinical _ and experi mental, conducted in this :country and in other countries, have resulted in a crystaliza- tion of our ideas. In the English speaking world, the outstanding contributions to our knowledge have come from the South African .Institute for Medical Research-.and the Miner's Phthisis Prevention Committee in.Johannesburg; from various official agen cies in England and Australia,. in Ontario, . Canada, and in this country, especially the H ere the situation is not unlike that of , Qinical .pulmonary tuberculosis was found in. .J organic dusts. The prevalence of pulmonary IS per cent of those with early anthraca-- disease among workers in certain occupa silicosis and in 43 per cent of those with tions exposed to metallic dusts gave rise to advanced anthraco-silicosis. Service upwards the theory that metallic dust was a fruitful of twenty to twenty-five years was asso- 'souree of tuberculosis. Such diseases as ciated with a tuberculosis rate of 14 per tent * "grinder's rot" were recognized clinically, . -among regular miners and 37 per cent among long before the era of modem diagnosis and those with a number of years as rock work-, laboratory research. Metallic particles in ers. Animal experimentation, with both the form of fumes may cause such reactions bituminous and anthracite coal dust, free as zinc chills or brass founder's ague, which from associated silica, produced no specific are more in the nature of an allergic reac reaction. ' tion. The .-pulmonary disease which afflicts Non-Siliceous Minerals United States Public Health .Service, the grinders and- buffers is silicosis and not in - United States- -Bureau, of Mines, and the any way a result of exposure to metallic .Saranac Laboratory. . ' / / . . '' dust Metallic dust particles are mostly large There is no evidence that non-stliceous minerals produce any pulmonary if i'w v . Gardner, at the Saranac Laboratory, tested In presenting this discussion of industrial and heavy (that is, comparatively speaking), upon animals such substances as diamond, dusts, their effects oh workmen'exposed to consequently do not penetrate to the lung, aluminum oxide, rutile, marble, gypsum, ga-> them, and the bearing that this subject has in many.instances, and when they do they are lena, chalcopyrite. iron sulphide, zinc sul on life insurance underwriting, we. have at either absorbed or -remain fixed and inert in phate, fluorite, and dolomite. The sulphides tempted to summarize what should be the ,. the tissues. From' an underwriting stand and doiomite proved toxic but this affect is insurance attitude, based on the present state point then, the hazard of'metal dust is the outside of our present discussion. Non-silice- of our knowledge.. Briefly, the present con hazard of- such silica dust as may be asso .ous minerals proved inactive in animals and cept regarding-industrial dust'hazards-is'as ciated with i t . there is no clinical evidence of specific dis follows: Orjranic dusts, of which the dust . . . Coal ease among workers exposed to this tvpe of arising in textile operation* is an .mramnle. For many-years there has been a belief dust . ' do not cause'any-IpiCillfi pulmonary disease. that coal miners had less, tuberculosis than . - . Artificial Abrasives . There is no clinical 'n o r. ikpiflfHeilCST evi the average for wage, earners and, on the . Experiments with artificial abrasives dence to the contrary. Winds- u Sufor- other hand, miner's asthma has been recog demonstrated the incorrectness of earlier gamcTU&SUnu,' is considered in connection nized as an occupational disease of coal ideas that dust caused injury to the lungs, with mineral dusts.. Organic dusts at times miners. Here again, recent studies have proportionate to the hardness and sharpness' may cause an allergic reaction and also irrita clarified the situation to a considerable' ex of -the particles. Artificial abrasives, ire- tion of the upper air passages. They do not cause protracted disability nor death. In tent. ' Bitum inous o r soft coal m iners do not have among the hardest substances known. Neither silicon carbide nor alum inum oxide produced this classification may be included cotton, an occuptional pneumoconiosis of a disabling any reaction resembling silicosis in experi- fri- *tu 25 Toc Sc far Svt > 1er '*sc *-ti f*Cl "Vt . K Sl & pr. LF r.D 1 *p `.ne c ' 'c ~ t "i?t r-: ri-T 1 j. i 1 7 'i ? c : i>j PLAINTIFF'S EXHIBIT S & U k ). w .i iTt.f. :v ..i-!a-t*.-*- 'U'I :3:: -'iri.HT l_av. cooF' tu ta - t* * . N. i. fy lilAm i-Vf.A. J : V 4 !4 ; ; US UKDEAWTUTIXC 1STECTS - DUST HAZAIO the same physician, tbit ft was rnpoasible to come lo any definite cbo^elusion and jay, "tins man ded of asbestosis," when bis' previous disability certificates showed flat be bad myocarditis or high blood pressure or cancer or diabetes or pulmonary.tuberculosis. Tbe pathology and X-ray appearance of asbestosis are entirely different from ailicosis and in fle>absence of a definite history of ex * considerable pend of time to asbestos durt. the diag. # -OuftCtfiLl A great dtai oi nicest k u been ttliincd in cox>* ollinj; dusts 'the plants wiere asbestos is fabricated so that It is pot likely that asbestosis will ever become an important industrial ^isease, as far as tbe number tf cases is concerned. ' scaroiy of clinical data on isbestorji mafcft tbp p^g*1**^*" doubtful. TVe have bad a xma2 group of cases under observation for about ten yean -- there were iginally, I think, some sixty odd men in ibis group and we 'sull ban fifty of them where we can get at them-- and some of these sior a definite but slow progression as far as can be judged from tbe X<ay films. However, what the outcome may be remains to be seem These men are all working and show no signs of any disability. * In the meantime tbt plana have been cleaned up so that these men are not exposed now to nordinale quantities of asbestos dust, jo it is difficult to say what tmuld have bee: -the progress of their disease bad their working conduoas remained the same. SIU COSTS . It may be said that them Is a very general accord among the lading investigators and t a c i n h authorities in tbe opinions and e=n- elusions presented at the inltrmuonal.conieiocts on silicosiu (Jobaa' pesburg, August,^1930, Geneva,`'August,and-;Srptember, 193SJ Such difftrrocex of*opinion as may ce expressed from U'rr.e to time do not jeriouxly affect the general acrement css the basic factors affecting the cause, incidence, effects, a il prognosis of ftlir.n-t The effect of jUica upon the lunp depends on the nature ir.d - extent of exposure. That is to say, upon the quantity of dust in the air breathed by workmen, the amount of free or uncombined silica . in (he dust, the site of the durt particles, the presence of other sub stances in the*'dust which may modify the action of silica, aad the length of time or duration of erposure. The individual himself must also be considered. Previously existing disease of the lungs, especially a tubercle infection, will infiurare his reaction to inhaled silica. There * may be other phases of susceptipily about which we know little or ^UPUIUP ryit rm V ' I , .* I * 1)1 UNnKnWIUTWO ASPECTS-DUST hazard font patllclri of one fo two and tWce microns In their larferot diameter, that those partlelrs had no physic! characteristics In the ordinary true In which we opply them. Artificial abrasives are among the hardest tnlnlanrrs known, Neither lilicoa carbide nor aluminum oxide pro durrd any reaction resembling silicosis In experimental animals nor do troikmen exposed to these dusts .show any clinical symptoms or X-ray appearances suggestive ol silicosis. t ` / SILICATES A considerable number of silicate dusls bare been aludled and their efleets upon experimental animals, both by Inhalation and Injec* lion, noted. They prodncelinle nr no reaction In ll*e body tissues and what little reaction some of them lo produce does not tend to process. An exception should be noted here regarding asbestos, which Is con* siderrd separately. Nor Is occupational exposure. 1 silicate dusts accompanied by any . such clinical picture of disability and death as Is found In silica 'dust exf>osurrs. The Public Ilraltlr Service studied some talc mines In I9JS. Only 66 men were e*|K>seil. Tuheriulnds morbidity and mortality rates were very high In the county where the mines were located and the ilust exposure was exceedingly sevrre, running into hundreds of miliums nf partirles. Eight men showed advanced pnnimoconlosls hut tuberculosis was nlxo present In most of them. It Is conceivable that expo,re to tremendous quantities f any mineral ilust, regardless of silica-content, might so overwhelm Ihr lungs that they could not deal with the Invading tubstnnee. Irritation, Inflammation, and probably Infection would follow with disnlHlilv In projKwtlun. Such Isolated Instance} do not Invalidate the roorhislnni slated In the previous paragraph. ASBESTOS Asbestos It the only duit of combined (lira which Is known to cause a definite pulmonary fibrosis which may result In disability and death. Let me make that point clear. When we talk of silicosis nod the types f dust that produce Mlimsls, we mean dusls (hat contain silica In a free or rinconddnrd stale, SIOi. IVhrn the silica Is In die foror n| silicon carbide <<f magnesium silicate or Iron silicate Shat Is `what we mean by rmnbliwd rllira. The combined silicate klusls, at I have Just mentioned, do not produce any pulmonary disra-r, with one exception, and that one e.xcrpllmi ll asbestos, which It hxdrateil maem'sium silicate mixture, with a little Iron In It. Moil of (lie *?lrflot fabricated In the t/nllnl 5la<cs comet from the mlnct In A. J . LAKZA, MD. A ft.J. VAUK QurWc Asbestosls, however^ ts wot found rung a.d>cstot m h.-n, most f *Hbm work In open quarries or m u . or among mm w agerf-ftf mtHtfff operation wlttr cby the asbestos 1 prepared for shlpmcnT anil lJ**t nnwmg workers in fabricating plants. Fabrication, you rvill tmrtmtand, being In Ihe nature of a textile process. Only recently has in explanation l>ccn offered for this anomaly. It would appear that lint only* Is sslieslos in exception In that It dilfrrs from ulhrr sili cate dusts In Its ability to cans? structural changes In the bines but Its action appears'to be mechanical and not chemical like the action o( silica. II asbestos Is crushed to Hire particles, It will not cause ashes* tttds In caterlnicntal animals nor will nMxstns produce any reaction elsewhere than in the lungs. II its action were in the nature nl .iticr., Ihe ftirct would be more pronounced with smaller particle sires. In oilier words, Gardner established that the Intensity of a silica reaction upon animals depended upon Ihe smallness nf the silica particles, lxeautr, In sum it up IMrfly, the finer Ihe silica particles, the greater Is Ihe surface exposure which ads tijion the pulmonary tissue.* Aslrestos particles, below a certain sire, do not produce any effect tin e*|terinienlal animals. Furthermore, you can prndure a silicotic /faction, the typical silicotic nodule, In any organ by Injecting pre*. pared silica. Ymi cai) gel silicosis of tlie liver or of the spleen or elsewhcte. Flirt you cannot pnwlurr any reaction In animals with asbestos anywhere earepl In Ihe bines, and then only If ymir partides are sufficiently .large. Consequently, Gardner concbulrs that the relatively long spicules of asbestos produce tlieir effect because the lungs are never at rest and the tonslanl movement provokes the fibrous reaction. Like silicosis, asbeslosls develops slowly, presenting the charac teristic symptom of shortness of breath. The number of cases of ashes* tosls that have come lo autopsy Is small .but there are several cases on record In which death was due entirely to the asbestos and not lo any associated Infcdlnn or other condition. There dors not seem lo be any pronounced tendency to tulrereulosls In asbeslosls, but mcit of Ihe lalal cases have been complicated by other disease such as cancer and dial>ctes so that the extent lo which Ihe aslreslosis war responsible for dcxlh Is not dear. ( made a mlbrr exhaustive study I few years ago of all ihe Insurance certificates that I could find In which aslw-stns was given as Ihe cause of death and then followed up Ihe previous history of these people and got their rnrclicnl certificates when they were on dbjbiiily. T Ik- diagnosis given on th e disability certlfiratei was usually so at variance wilh ihe diagnosis given on (he dcalli ccrllfi'stM, ultrn by y ,r -' Vs PROCEEDINGS i OF THE THIRTIETH ANNUAL MEETING of the , . MEDICAL SECTION # ' Of TOE lMERICAN LIFE, CONVENTION ` 1940 OFFICERS ' MEDICAL SECTION O tatrm an-D x. A. J. RontssoN, Medical Director. Connecticut General Life Insurance Company, Hanford, Connecticut,_________ _ airman--D*- W. T. Blaccto*d. Medical Director, Commonuealth Life Insurance Com pany, Louisville, Kentucky. . , . Sccracrj-- D^ B. F. Brxc, K edical Director, National Life &. Accident Insurance Company, Nashville, Tennessee.' ^ Member of Board of Managers--D *.T . H. Dickson, Medical Director, Minnesota Mutual Life Insur ance Company, S - FauL Minnesota. ' Proram CpiirEnh^-Da. p TrL^,*rrroN. Medical Directed, Medial Life'Assurance Go. of Canada, f fi'mrrloo.-Gfyirio. . pr t,.- ! DDAqy Li- lt Liii/ii KilJKTOllTIS II;: ca *V f i* .T .* ** 1 1 V 3 i.% 4. f * :/ l , V If h : K . n. > u (V- * F l. . / i: I - i- - . h* PLAINTIFFS EXHIBIT | S S T n 0 X 438 A. J. LANZA AND R. J. VANE 1 (28) Iron foundry workers show highest percentage of deaths from pneumonia, Statistical Bulletin, Metropolitan Life Insurance Co., March, 1928, 9 ,3 . (29) Bloomtield, J. J.: Engineering aspects of industrial epidemiology, Indust. Med., 1938, 7,7 . . (30) K ib b e y , C. H.: Pneumonia and tuberculosis among industrial workers, Am. J. Pub. Health, 1937, 27, 6. (31) H aythorn, S. R., and Meller, H. B.: Pneumonia, Ibid., 1938, 2 8 ,483. (32) T hompson, L. R., Brundage, D. K ., R ussell, A. E ., and Bloomtield, J. J.: The health of workers in dusty trades. I. Health of workers in a Portland Cement Plant, Pub. Health Bull. 176, U. S. Pub. Health Service, April, 1928. (33) R ussell, A. E., Britten, R . H., T hompson, L. R ., and Bloomtield, J. J.: T he health of workers in dusty trades. II. Exposure to siliceous dust (granite industry), Pub. Health Bull. 187, U. S. Pub. Health Service, July, 1929. fl 'fits iv. a fry Ii.:v i l- INDUSTRIAL DUSTS 437 (4) Whitney, J essamine S.: Death rates by occupation, Natl. Tuberc. Assn., June, 1934. (5; Registrar-General's Decennial Supplement: England and Wales 1921, Part II. Occupa tional mortality, H. M. Stat. Off., London, 1927. (6) Joint. Occupation Study, Actuarial Society of America and The Association of Life Insurance Medical Directors, 1929. . (7) Occupation Study, Actuarial Society of America and The Association of Life Insurance Medical Directors; 1938. ~ (8) Sayers, R. R., Chairman: Report of the Committee on the Prevention of Silicosis through Medical Control, U. S. Dept. Lab., November, 1936. (9) Sayers, R. R., Bloomfield, J. J., D allavalle, J. M;, J ones, R. R., D reessen, W. C Brundage, D. K., and Britten, R. H .: Anthraco-silicosis among hard coal . m,ners- Pub- Health BulL 221, U. S. Pub. Health Service, 1936, p. 85. (10) National Tuberculosis Association: Framingham community health and tuberculosis demonstration, Framingham Monograph No. 10, July, 1924, p. 69. (11) Stoenstricker, E., and Britten, R. H .: The physical impairments of adult life, Am. J. Hyg., 1930,11,89,100. (12) Britten, R. H., and T hompson, L. R.: A health study of ten thousand male industrial workers, Pub. Health Bull. 162,1926, p. 161. . . (13) Gardner, L. U.: Reaction of the living body to different types of mineral dusts with and without complicating infection, Tech. Pub. No. 929, Am. Inst. Min. & Met Eng., May, 1938. . (14) P edley, F. G.: Asbestosis, Canad. J. Pub. Health, November, 1930. (15) M iller, J . W., and Sayers, R. R.: The physiological responses of the peritoneal tissue to dusts introduced as foreign bodies, Pub. Health Repts. 49, January 19,1934. (16) Collis, E. L., and Yule, G. U.: The mortality experience of an occupational group exposed' to silica dust, compared with that of the general population and an occupational group exposed to dust not containing silica, J. Indust. Hyg., 1933,' (17) M acklin, E. L., and M iddleton, E. L.: Report on the grinding of metals and cleaning of castings with special reference to the effects of dust inhalation upon the workers. U. K. Home Off., H. M. Stat. Off., 1923. (18) Collis, E. L.: Industrial pneumoconiosis with special reference to dust phthisis, Milroy Lectures, 1915; reprinted by H. M. Stat; Off., 1919. (19) D rinker, P.: Causation of pneumoconiosis, Harvard School of Public Health, 1937. (20) Carleton, H. M.: The effects produced by the inhalation of hematite and iron dusts in guinea pigs, J. Hyg., 1927, 26, 227. (21) Health protection in welding, Industrial Health Section, Metropolitan Life Insurance Co., (b) 513 LAV. (22) Doio, A. T., and McL aughlin, A. I. G.:. X-ray appearances of the lungs of electric arc welders, Lancet, London, 1936,230, 771. (23) E nzer, N., and Sander, O. A.: Chronic lung changes in electric arc welders, J. Indust. Hyg. & Toxicol., 1938, 2 0 ,337. (24) Landis, H. R. M.: The relation of organic dust to pneumokoniosis, J. Indust. Hyg., 1925^ /) ! (25) Sayers, R. R., and M eriwether, F. V.: Miliary calcifications of the lungs due to unknown cause, Reprint 1431 from Pub. Health Repts. 45, December, 1930. (26) F awcitt, R.: Fungoid conditions of the lung, Part I, Brit. J. Radiol., New Series No. 99, March, 1936; Part II, Brit. J. Radiol., New Series No. 102, June, 1936. (27) D ickson, E. C.: Coccidioides infection, Arch. Int. Med., 1937, SO, 1029. 436 A. J. LANZA AND R. J. VANE far exceed those found for men in other pursuits, as to leave little room for doubt that silica is implicated. With regard to silicate and other inorganic dusts not containing free silica, American mortality, data are very meagre. The relatively low death rate from tuberculosis among grinders in the small American insur ance experience suggests that the effects of aluminum oxide, silicon car bide and other substances used in manufactured wheels are slight. British data, much more complete, show lower than average tuberculosis mor tality up to age thirty-five, but substantially higher mortality after age forty-five for a group of men exposed to inorganic dusts other than silica dust. Whether this unfavorable situation later in life is due to the cummulative effect of such dusts with duration of exposure or whether it is due to the inclusion in these occupational groups of a substantial number of men who had been exposed also to silica dust, is not clear. There are no mortality data for men exposed solely to metallic dusts. Recent statistical studies, like the earlier ones, show higher than aver age death rates from tuberculosis among men employed in certain occupations or industries in which organic dust is generated. In no in stance, however, does the rate for a group of this kind approach in mag nitude the extremely high rates found among men employed in some of the occupations in which there is exposure to silica A1 f~ of clinical knowedge, is.it possible to account for the excessv|Sy on the score of damage to the lung tissue caused by Hue. The relationship between dust inhalation, and ftriif* remains a field for further investigation. A splendid contribution to our knowledge of this subject has already been made by the United States Public Health Service in their bulletins on The Health of Workers in Efusty Trades (32, 33). A greater volume of data of this kind and more detailed studies of occupational mortality are vitally needed to guide the work of industrial physicians and hygienists in this field. ' REFERENCES (1) H offman, F. L.: The mortality from consumption in the dusty trades, Bull. 79, U. S. Bur. Lab., November, 1908. (2) H offman, F. L.: The mortality from respiratory diseases in the dusty trades, Bull. 231, U. S. Bur. Lab. Stat., 1918. (3) H offman, F. L., Chairman: Preliminary report of Committee on Mortality from Tuberculosis in Dusty Trades, Working Conditions Service, U. S. Dept. Lab., 1919. Second preliminary report of Committee on Mortality from Tuberculosis in Dusty . Trades, Natl. Tuberc. Assn., 1919. INDUSTRIAL DUSTS 435 an unusually high mortality from pneumonia (28) and the same is true of certain occupations in the steel industry (29, 30). Exposure to dust is associated with some of these occupations and usually extremes of temperature are also encountered with such other conditions as would tend to cause dampness and chilling. So far as silica is concerned, a high mortality from pneumonia is associated with the silica trades, both in this country and abroad. Whether silica acts as a predisposing cause of pneumonia or due to the accompanying lung damage the prognosis is more unfavorable, cannot be shown from the figures available. For some years, a series of interesting studies has been carried on in Pittsburgh by Haythom and Meller and their associates in an endeavor to establish any possible connection between the prevailing high mor tality rate from pneumonia in th a t city and atmospheric pollution. These reports are interesting and suggestive but not entirely conclusive. The following quotation is from a recently published report of these authors (31). ... It is further seen . . . that during the years from 1932 to 1935 when the de pression was at its height, when air pollution from industrial flues was greatly decreased and when economic and living conditions were at their worst, there was a great decrease in the number of deaths from pneumonia. However, the decrease occurred in females as well as males so that the change cannot be attributed to conditions within the plants, such as overheating and rapid chilling of the employees. SUMMARY Early occupational mortality studies focussed attention on the im portance of dust as a cause'of respiratory diseases. Virtually all kinds of dusts were implicated. Present day clinical and laboratory studies point to the serious damage, to the lung tissue caused by a few dusts, notably silica and asbestos, and to the relatively little damage to the lung tissue caused by many other dusts. The most complete recent mortality studies have been examined in the light of this clinical and laboratory knowledge. These mortality data, while yielding highly suggestive information, are very incomplete and permit only quali fied general conclusions regarding the effects of dust exposure on the incidence, of respiratory diseases for even the broad classes of dust with one exception--silica dust. The death rates from tuberculosis among men in occupations in which there is exposure to free silica so 434 A. J . LANZA AND R. J . VANE In the American insurance experience, covering the years 1915-- 1926 (6), also, the ratio of actual to expected deaths was above average for several occupational groups exposed to organic dust. The ratios of actual to expected deaths for the more important of these were: cotton mill operatives, 176 per cent; woolen mill operatives, 134 per cent; upholsterers, 225 per cent; cigar makers and tobacco factory operatives, 174 per cent. The occupations discussed here have been traditionally classified among the dusty trades. One may well question, however, the inclusion in such a list of boot and shoe and of tobacco factory workers. The great bulk of workers in these industries cannot be said to be exposed to appreciable quantities of dust. But taking the list as it stands, there is obviously no resemblance between the tuberculosis ratios for these oc cupations and the very high ratios for occupations with exposure to silica dust. Some condition connected with the work of persons in these trades obviously is associated with the above-average incidence of tuber culosis. I t may be that the less robust workers are attracted to them. Whatever may be the explanation, clinical findings would suggelf dust is not an important factor in the high incidence of tuberculosis in these trades. . . - FTTNGTIS DISEASES OE THE LUNGS Dust may convey to the respiratory tract various types of fungi. Some of these apparently have no clinical significance. Others are pathogenic and may produce either acute or chronic disease. The constantly increasing use of the roentgen-ray in diagnosis and in routine physical examinations has served to awaken interest in fungoid diseases about which too little is known and which are not uncommonly diagnosed as tuberculosis (25). Our knowledge of the subject is very incomplete but it is recognized that these fungus diseases are frequently occupational in origin and associated with dust inhalation and may result fatally. Mortality statistics are entirely lacking, but the reports of Fawcitt (26) . and the recent studies of coccidioidal infection in California (27) indicate that such pulmonary diseases may be quite important. . PNEUMONIA The effect of dust inhalation upon the incidence of and mortality from pneumonia has been the subject of much study without any clear-cut picture of the rle of dust resulting (32, 33). The foundry industry has INDUSTRIAL DUSTS 433 of textile plants and he stated that there was no evidence of organic dust causing pulmonary diseases (24). The mortality picture as regards organic dust and tuberculosis is confused. In the Registrar-General's Report (5), out of thirteen classes of textile workers, six had above average death rates from tuberculosis but in only one class--wool, worsted, card, comb or frame (not spinning frame) tenters--was-the rate as much as 59 per cent above average. No . TABLE 4 Standardised mortality (comparative mortality figures) from respiratory tuberculosis af males ages 20 la 65 years in occupations exposed to organic dust compared with that of all occupied and- retired civilian males taken as 1,000, England and Wales, 1921-1923* O C C U PA T IO N 1IO XTALITY RATIO All occupied and retired civilian males........................................... Wool sorters......................................................................................... Cotton blow room operatives--skilled......................... ................... Rag grinders, wool willowers, etc...................................................... Cotton-card and frame (not spinning frame) tenters..................... Wool, worsted card, comb, or frame (not spinning frame) tenters Cotton strippers and grinders and card room jobbers.................... Cotton spinners and piecers.. . ......................................... ........... .. Wool and worsted spinnera and piece............................................ Cotton--double, windera, warpers, beamers, etc.......................... Wool and wonted--double, windera, warpers, beamers, etc....... Cotton weave................................................................................... Woolen and worsted weave............................................. Weavers of other textiles.......................................................... .... Boot and shoe clickera and cu tte ..................................................... Skilled boot and shoe operatives, not clickers or c u tte ............... Bakers and pastry cooks.................................................................... Tobacco factory operatives....... ...................................................... '. Upholsterers, coach trimmers, and bedding m ake......................... Draftere and brush m ake................................................................ 1,000 1,065 750 1,093 1,057 1,591 796 1,072 898 869 510 1,162 904 1,820 1,821 1,016 2,002 1,262 2,376 * Compiled from Registrar-General's Decennial Supplement, England and Wales, 1921, F art II. Occupational Mortality. other class showed more than 16 per cent excess, while in several classes the rate was quite low. On the other hand, boot and shoe factory workers showed an 82 per cent excess; tobacco factory operatives had 100 per cent excess mortality, and brush makers and drafters, 138 per cent excess. The rate for upholsterers, coach trimmers, bedding makers was 26 per cent above the average. Table 4 gives the Standardized Mortality for the principal occupations exposed to organic dust. 32 A. J. LANZA AND R. J- VANE t a t was injected into the peritoneal cavity of animals, the reaction was In th e process of w elding, m etals R eports have and inhaled into the lungs 1 / ? been made of roentgen-ray films, taken dur g physical examination P V bU filte oi welders, which ^ " " " ^ r ^ e r s i U c o s i s might silicosis. T h is has given n although all these cases were symp- be contracted from welding (21, 22), aitnougn t0Oneof the cases reported;by accidental death. No ^ ^ ^ ^ J ^ a u s e i by collections of iron and the nodular shadows on the film were ^ sec L D^co carbon pigment in the lymph channelof the No satisfactory statistics are a v a d a b le ^ th e m o r ^ y ^ ^ ^ posed solely to metallic dust. _ P nther process and the comments character thrown off in grinding asm y P polishers, given regarding the. mortality of gnndenumd ufjtfO fe under inorganic dust, are per men seem t0 have producedmm dusts from the composition w e with those where, tality rates from tuberculosis comparable m any way the silica hazard is severe. . . . ORGANIC DUSTS Until the action of subject of processes,werecansriredt resulting from the extensive the possible action of size of the particles an ^ concentration of inorganic The presence of organic dust and associate industrial tuberculosis. Knowledge P ^ ^ ^ M mimmlze. acc0unt of the large average compared with the nartides found in various industries, P structural change caused by demonstrated wi m ^ in connection with in- which could be compared wit"h th a tj-st^0ia U wi^^s^^ ^ The late Doctor Landis of Philadelpm* . ofppichtyusrie. tuberculosis danS His^studies included employees of a number INDUSTRIAL DUSTS 431 might have been expected and 18 deaths from influenza and pneumonia where 11 were expected. In the 1925-1936 study (7) there were 10 deaths from tuberculosis among limestone and marble cutters where one was expected. Here again, as in the case of the British limestone masons, cutters and dressers, the question is raised as to whether some of these men had not worked on granite and other stones as well. Granite and sandstone cutters in the American insurance experience, as we have shown, had more than twenty-six times as many deaths from tuberculosis as expected. American iron miners apparently have a different type of exposure from the British. We have included them in table 1, somewhat ar bitrarily, with the occupations exposed to silica dust. There were 12 deaths from tuberculosis among them where only 1.4 were expected, or a ratio of 857 per cent. This very high ratio suggests that, in some Amer-_ ican mines, there may be a greater silica hazard than had been thought. The number of deaths was small, however, and the result cannot be considered conclusive. METALLIC DUSTS . Hoffman (2), in Bulletin 231, emphasized the danger of exposure to metallic dusts (pages 51-161), but the experience of recent years has not borne out his conclusions. There has not been defined in the various industries in which exposure to metallic dust occurs any definite or specific pulmonary disease resulting therefrom. All the indications are that, where pulmonary disease has been described in conjunction with metallic dust, the blame must be placed.on coincidental exposure to silica dust. Macklin and Middleton (17), reporting in 1923, point out that silicosis is associated with the use of natural grindstones and not artificial grindstones and make no mention of ill effects from metal dust. Collis (18) had stated the same general conclusion in his well known Milroy Lecture in 1915 and stated further that the percentage of free silica is the index of harmfulness. Drinker (19) states that there are no data to indicate that iron in the absence of silica caused pathology in any way comparable to silicosis. Carleton (20) states that hematite is relatively harmless compared with flint and other silica dusts; if inhaled over long periods of time, it might cause fibrosis and tuberculosis but further evidence is needed. Under experimental conditions, it is a. relatively harmless dust. In a series of experiments by Miller and Sayers (15), when iron oxide h i?. J .V . 430 A. J . LANZA AND B.. J . VANE deaths. The t ^ a n l y fOT t o and had a ratio of M l P " " h U ^ "` ^ ^ " e s tt other i i n d , only the limestone ta the ,,,,silica group exhibited a high -- - - " d' consequently, had been f ^ sed^ f " n" a dust are concerned, as we S o far as the occupations exposed to silica dust u ^ W e mentioned, these finings are in agreem occupations exposed experience. Unfortunately them to inorganic dust, other than included in the American entirely free from complicating expo ^ 'siliI and coal dust, - e and none of these is the 1915-1926 ^ inders of metals had Medico-Actuarial Study ( ), a sm tuherculosis, while in a some- twice the expected number o e 1936 ^ the number of deaths what larger exposure in the period 1925 1936 W ^ expected. fIna r-ecent years, sandstone g E , . " j tfs*a*fabir~ass*umipt*ioni;? by composition wheels throug ou pxoosed t0 dust from composy therefore, that most of the gnnders wem eiqmsed to n wheels, silicon carbide, ^ ^ t o n e to e d s are still in # some grinders were emp oy J t varianCe with the result for This comparatively favorab e t.. w i a ratio of actual to expected deaths of 368 per cent. That st" <ly 21 to 1923, wheda may have been . " d f X ^ t e t r ^ e S r a n c e experience. The report in the cutlery industry, where e s We ],ave determined a much higher m o r t a ^ l o n g the cutlery grinders from the facts presented t e e were over seven and a h a M many deaths from respiratory grinders ^ deaths tuberculosis as expected, whereas among J ,,ere somewhat fewer than three tunes _I0Up, ,,ere repre- Buffers'and polishers of metal, a som 17_000 life sented m the 1915-1926 j - aths from tuberculosis where 7 years of exposure. There were 10 deaths from t INDUSTRIAL DUSTS 429 rapidly increases as age advances. In the Non-silica Group, the comparative mortality is actually below normal up to age 35; it rises just above normal in the following age-group; but at ages over 45, it is conspicuously above normal. The report does not give the facts regarding the mortality from re spiratory tuberculosis separately for each of the eleven occupations in cluded in either the silica or the nonsilica group. Because of our special TABLE 3 Ratio of actual to expected deathsfrom respiratory tuberculosis among males ages-20 to 65 years, exposed to specified hinds of dusts, England and Wales, 1921-1923* ' O C C U PA T IO N ACTUAL DEATHS EXPECTED DEATHS 2A T I0 PEE CENT Silica Dust All selected occupations........................................................ 654 179 Tin and copper mine--underground workers, not super- intending staff........................................................................ 92 8 Potters' mill workers; slip makers; potters............................ 105 37 Earthenware, china, etc., kiln and oven men, and kiln set- ters and placers................... ; ................................................ 50 23 Metal grinders...................................................................... .. 221 60 Sandstone miners and quartiere.............................................. 36 17 Sandstone masons, cutters, and dressers................................ 150 34 365 1,150 284 217 368 212 441 . Nonsilica Dust- All selected occupations............................................................ 162 150.3 108 Brick and plain, tile makers, moulders, etc., furnace and crucible pot makers,............................................................. 34 33.7 101 Brick, tile, etc., kiln and oven men......................................... 15 22 68 Iron ore mine--underground workers, not superintending staff (Staffordshire and North Riding of Yorkshire)......... 13 24 54 Limestone miners and quartiere............................................ . 39 38.6 101 Limestone masons, cutters; and dressers................................ 61 32 191 * Compiled from: Registrar-General's Decennial Supplement, England and Wales, 1921, P art II. Occupational Mortality. interest in the facts for this particular disease, we have calculated, from the original report of the Registrar-General (5), for each of the selected occupations, the number of deaths from respiratory tuberculosis which might have been expected on the basis of death rates prevailing among all occupied and retired civilian males between the ages of twenty and sixty-five. These results, together with the numbers of deaths which actually occurred, are presented in table 3. Each of the silica occupations had over twice the average number of A. J. LANZA AND R. J. VANE INORGANIC DUSTS OTHER THAN SILICA, ASBESTOS AND COAL DUST Many industrial dusts contain silicain combined form, as distinguished from free silica, such as combinations with magnesium, iron and alum inum. The effect of silicate dusts upon the lungs, with one exception (asbestos), is problematical. Where exposure to silicate dusts occurs in industrial establishments, under circumstances which might be though hazardous, one does not see the clinical picture which is presented where free silica is involved nor is there evidence of disabihty and tendency to infection. Extensive animal experimentation with silicates, both by inhalation and intraperitoneal injection (15), fails to produce anydisease akin to silicosis or other evidence of definite, disease. I t is doubtful whether there is a definite disease to which the term siltcatosts^can be applied, although such a term has been devised. Certainly, the last word has not been said with respect to silicate dusts. , Similarly the dusts of aluminum oxide and some other artificial abra sives, of.hematite, and of other inorganic dusts have not been shown to be the cause of marked pulmonary damage. Mortality statisri^len d o emphasize the distinction between the effects of dusts containing i and other inorganic dusts. This is very strikingly brought o u t j study, based on the occupational mortality data of the.R ^siSE ^*^ of England and Wales (5), by Coffis and Yule (16). Jhese autf selected for study two groups of occupations-one exposed to sdica d and the other to nonsilica--so chosen th at each had as far. as possible t same amount of dust exposure, physical effort, exposure to heat or to weather, or any underground environment. Part of the authors com ment on the results as regards respiratory tuberculosis is quoted. For all ages (20 to 65) the C.M.F. of the Silica Group is no less than 592.2 against f<53 5 for the Standard Population, Le., the mortality is m o re n three and a half times the normal. For the Non-sihca Group, the C.M F although actually slightly higher than normal, at first sight hardy seems differ sienificantly from the normal; nor would ones judgment be much a fcted, if instead of making comparison with the Standard p PulaTM ' a used the Social Groups III and IV, for which the respective C.M.F. s are 159 8 and 164.2. But the summary figures conceal interesting changes with aee A glance at the figures shows that in the Silica Group, the ratio of m tali'ty toie normal, though greater than unity even in the lowest age-group, Pnmnarative Mortality Figure: This figure is defined as the number of deaths that would have occurred in the Standard Population a t the rates ruling m the occupation. INDUSTRIAL DUSTS 427 employees; at ages 45 to 54, in 10 per centjand at ages 55 to 64, in 20 per cent. No such rise with age occurred in any general population group for which com parable data are available. The prevalence of tuberculosis was greatest among the rock workers. The next to the highest rate occurred among anthracite workers who had changed more than five years previously from very dusty to relatively non-dusty oc cupations in the industry. The third highest rate was exhibited among per sons who had had appreciable exposure to harmful dusts in other industries. Among the regular miners working at the face, the rate was definitely higher than in the control group (men whose dust exposure averaged less than 5 million particles per cubic foot) which showed a prevalence rate of less than 1 percent. . When the term of service exceeded 20 years, more than 2 or 3 of which in volved exposure to-heavy concentrations of rock dust, about 37 per cent of such employees [classified as rock workers] showed evidence of pulmonary tuberculosis. Service of 25 to 34 years was associated with a. tuberculosis rate of 8 per cent among non-rock workers employed in the haulageways, of 14 per cent among the regular miners, but with a rate under 2 per cent among men exposed to less than 5 million dust particles per cubic foot of air. Asbestos: Exposure to asbestos dust may produce a pulmonary fibrosis which, like silicosis, may cause disability and death but which does not appear to carry with it a predisposition to tubercle infection and which has a pathology quite distinct from silicosis. The circumstances under which asbestosis will occur are not too clearly defined and undoubtedly there has been a tendency to classify as asbestosis cases in which the causal relationship of asbestos to the condition present has been assumed rather than proved. _ Our knowledge of asbestosis is based on individual reported cases. The actual number of fatal cases of asbestosis, supported by postmortem examination, is too few to have any statistical weight but the disease itself and its pathology have been clearly demonstrated. Gardner (13) believes that the action of asbestos dust, unlike silica, may be mechanical and not chemical. If this is so, it would well explain some of the con fusing aspects of this disease. The cases described have originated in textile and other asbestos fabricating plants and not in connection with the mining of asbestos. Pedley (14) found that the tuberculosis mor tality rate in Thetford Mines (whence 80 per cent of the asbestos used in the United States is derived) did not differ materially from the rate of the Province of Quebec as a whole. 426 A. J. LANZA AND R. J. VANE ard lives. Compared with the death rate for laboring groups generally, therefore the tuberculosis rate for bituminous miners is quite wherea^the rate for anthracite miners is as high, if not ectudly higher i i the average for this class of workers. The number of deatts and the ratio of actual to expected deaths for coal miners is given in t a b l e . The following quotation from the Public Health Service report (9 previously r e f e ^ to, is of interest in showing the incidence of clinical tuberculosis among anthracite miners. Several surveys have shown that tubercutais of 2\ per cent of the general adult white male population of the country TABLE 2 * ffwl Miners O C C U PA T IO N Actual deatba Operatives not underground 14 Operatives underground 125 Pennsylvania (mostly anthracite) t Other localities (bituminous)............... ....................t- Ratio . per cent actual to expected 159 157 . -- -- . --------------------- ----------------- f Data not available. W0S i g the anthracite work. . . -- pT INDUSTRIAL DUSTS 425 high among certain groups of miners while among others the death rate from tuberculosis has been consistently low. Recent investigations have cleared up many points about the hazard of coal dust and have indicated certain differences between anthracite coal and bituminous coal. I t is desirable, therefore, in studying the effects of coal dust to consider these two types of exposure separately. In 1934, the Public Health Service (9) made a report on an investiga tion of pulmonary disease among anthracite miners. This report stated what had previously been suspected, namely, that anthracite mining had, under certain conditions, a silica hazard and many anthracite miners were exposed to the effects of coal and silica dust. The evidence tends to show that disabling miners' asthma is, in effect, silicosis, a silicosis modified by coal dust but nevertheless a silicosis. " ' ....... Turning to the mortality record of coal miners, we find that the Medico-Actuarial Occupation Study (7) shows for the Pennsylvania miners (nearly all anthracite) the following figures, based on 144,535 life years, for the twelve-year period 1925-1936: There were 1,699 actual deaths where 613 were expected, giving a ratio of actual to expected deaths of 277 per cent. Of this excess, 37 per cent was due to accidents; and 63 per cent to disease. The pneumonia and influenza death rate was five times the normal; tuberculosis, over three times the normal; and accidents, five times the normal. - .. Miners elsewhere (bituminous) presented the following figures: There were 52,522 life years and 330 actual deaths against 187 expected, a mortality ratio of. 176 per cent, but of this excess mortality, 84 per cent was due to accidents hnd 16 per cent to disease. The death rate from accidents was five times the normal; the pneumonia death rate was normal; and the tuberculosis death rate, 61 per cent in excess of normal. In the insurance occupation study (6, 7), as we have pointed out, the death rates for each occupation are compared with the rate for standard ordinary policy holders, a rigorous standard as compared with the rate for all occupied males. When considering the mortality of men employed in mining operations many of which are carried on by unskilled workers, it is especially necessary to bear this fact in mind. Apart from any specific occupational influence conducive to a high incidence of tubercu losis, we should expect a greater than average mortality from tuberc- culosis among them because of their economic status. Insured common laborers outside of the mining industry, it should be mentioned, have a death rate from tuberculosis about three times as great as that of Stand- 424 A. J . LANZA AND R. J. VANE miners, but in the earlier study (6), covering the years 1915-1926, there were 11 deaths from tuberculosis in this group or eighteen times as many as expected. The ratio for iron miners, 857 per cent, is unexpectedly high inasmuch as it is thought that most of these workers are exposed to only moderate amounts of silica dust, except for a limited number who are working in hard rock. I t might have been expected that their mor tality would more closely approximate that of coal miners. The number of deaths is small,, however, and the difference may be more apparent than real. . ,, j ^ c_ Among cutters of granite and sandstone, there were 38 deaths from tuberculosis in an exposure of 5,944 life years, compared with 1.4 ex pected, or more than twenty-six times as many as the expected number of deaths. Chippers of. metal (exclusive of ship chippers) had 16 deaths from tuberculosis where only one was expected. I t will be observed that the ratio of actual to expected deaths from tuberculosis for each of the silica occupations is higher in the period 1925-1936 than in the period 1915-1926. The reason for this apparent y lies in the difference in the trend of the death rates for men in these oc cupations and the rate for insured persons generally. While the figures are too small on which to base broad conclusions, they sugg ^ in silica occupations have not shared in the general decline in rate from tuberculosis. . I t may be that there was actual l y ^ in the rates for the period 1925-1936 over that for th period 191^ Interesting confirmation of these high ratios by English data is pre sented in table 3. English tin and copper miners had a death rate from tuberculosis eleven and one-half times the average; sandstone masons, cutters and dressers, nearly four and one-half times the average; and metal grinders, about three and two-thirds times the average. Ratios such as these cannot be explained away on the ground of differing social classes or the selection of the occupation by physically weaker types of This evidence is in agreement with reports of silicosis studies from South Africa, Australia, Canada, and Great Britain as well as the United States and is supported by clinical experience of physicians in many parts of the world whose practice has been among workers exposed to silica Coal dust: I t has long been known that coal miners are subject to chronic pulmonary disease characterized by dyspnoea and usually terme "miners' asthma," also that the death rate from respiratory diseases is INDUSTRIAL DUSTS 423 No useful purpose would be served by quoting extensively from the impressive volume of mortality data available to show the influence of silica dust on the incidence of tuberculosis. Virtually every one of the many studies is in agreement in showing extraordinarily high mortality rates from tuberculosis for industries and occupations m which large numbers of men are known to be exposed to a real silica hazard. These rates are so high, in fact, as to leave no room for doubt of the causeand-effect relationship between the hazard and the high mortality. A few figures from the insurance investigations (6, 7) may be quoted. Table 1 shows the ratio of actual to expected deaths for the chief occupa- tions exposed to silica dust. TABLE 1 Number of deaths and ratio of actual to expected deathsfrom tuberculosis of the respiratory system Ordinary Department Mortality Experience o! American Life Insurance Companies a ____ i!___ f/%tilira dust Stonecutters--granite and sandstone.. Chippers of metal--(not shipbuilding) Mine operatives--underground Copper mine operatives, Gold and silver mine operatives.............. Iron mine operatives............................... Lead and zinc mine operatives.... ntv.n. anri nnf nerified mine oneratives Actual deaths 16 24 per cent actual to expected 976 615 Actual deaths 38 16 Ratio per cent actual to expected 2,639 1,667 913 - :29. . , t , 3 8 L ^ s f Data not available. 42 A. J. LANZA AND R. J . VANE These are the Registrar-General's Decennial Supplement for England and Wales (5) and two studies made jointly by the Actuarial Society of America and the Association of Life Insurance Medical Directors (6, 7). In the English study, the tuberculosis death rate for men in a given occupation, ages 20 to 65 years, is compared with that for all occupied and retired civilian males of'the same ages. . The method of analysis employed in the insurance studies was to compare the actual number of deaths which occurred among men engaged in a specific occupation with the expected number of deaths calculated on the basis of death rates by ages prevailing among standard lives, that is, persons who buy insurance on an annual basis in amounts of $1000 or more and who are not em ployed in hazardous occupations. Thus the insurance standard is a more rigorous one than that of "occupied males in the general popula tion since those in the lowest social-economic class are excluded, as are men who are employed in occupations where there is a Serious exposure to dust, accident or other hazards. This should be kept in mind in interpreting the figures presented for insured lives in the following discussions. INORGANIC DUSTS Silica: Silica in the form of dust produces a defin disease of the lungs, namely silicosis, a progressive f ib r o s is ^ ^ ^ ^ S itself, may cause disability and death and which carries disposition to tuberculous infection.,. Silicosis m sulfs^from ^the^^^Bra of dust containing free or uncombined silica. Its pathology has been extensively studied, both clinically and in the experimental laboratory. I t has been established that silica particles which penetrate the lungs ar under ten miera in their largest diameter and are mostly from one to three miera. Not only must the silica dust be in a state of such fine subdivision, but the particles must be present in large amounts and the exposure of the individual must be prolonged. When such conditions are fulfilled the natural defenses of the body against inhaled dust break down and silicosis results. The precise nature of the action of silica dust upon body tissues is not definitely known but it appears to be a protoplasmic poison and pro duces its effect chemically and not mechanically. A given dust is dan gerous in proportion to the amount of free silica which it contains. The nature of the relationship between silicosis and tubercle infection has not been determined, but the fact of such relationship is attested by overwhelming evidence both clinical and statistical (8). INDUSTRIAL DUSTS 421 There are reasons, obvious to us to-day, why these mortality studies have not been an entirely accurate guide. For one thing, students of mortality did not have the benefit of the clinical and laboratory knowl edge regarding dusts now available and, consequently, had to make their own classifications of dusts on a somewhat arbitrary basis. They were handicapped, too, by the fact that the existing occupational codes often brought together all the men in a whole industry. This did not permit of detailed studies of the mortality of men exposed to a single type of dust. Occupational mortality statistics still lose much, of their value because of this same lack of refinement in methods of classifying occupa tions. Then again, factors other than dust, which have a marked in fluence upon the incidence of tuberculosis among men engaged in differ ent occupations, were not as well understood and were not given due consideration in interpreting the results of mortality studies. There are pitfalls in reasoning from cause to effect, especially where tuberculosis is concerned, and the error of post hoc ergo propter hoc is particularly to be guarded against. A high incidence of tuberculosis or other respiratory disease among men in a given occupation does not necessarily indicate the existence in that occupation of a definite oc cupational hazard. It is well established that people of the poorer economic classes, whether in industry or out of it, have a higher incidence ` of respiratory tuberculosis than do people better off financially. In Miss Whitney's (4) study of Death Rates by Occupation in Ten States in 1930, the standardized death rate for tuberculosis was .over .twice .as high among, unskilled workers as among all occupied males while in the Registrar-General of England and Wales' study (5), 1921-1923, the rate for unskilled workers was about two-fifths higher than the rate for all occupied and retired civilian males. Certain occupations, too, are more suited to the physically weak and are selected by them as a means of earning a livelihood. When the followers of an occupation are recruited from the ranks of either of these classes, it is to be expected that a high r incidence of tuberculosis mortality will be found among them. Failure to take cognizance of these factors as possible explanations of a high tuberculosis incidence in certain callings has led to much misinterpreta tion of the significance of mortality findings. ^ I t is not our purpose to reassess the older statistical material to which reference has been made. We shall limit our discussion of statistics mainly to the results of the three most recent investigations in which tuberculosis death rates are obtainable for a number of occupations. 420 A. J . LANZA AND R. J. VANE In 1908, Dr. Frederick Hoffman (1) wrote an article on the mortality from consumption in. the dusty trades. Ten years later, he produced the well known Bulletin 231, The Mortality from Respiratory Diseases in the Dusty Trades (2), an important milestone in the hygiene of industry. In 1919, appeared the first and second preliminary reports of the Com mittee on Mortality from Tuberculosis in the Dusty Trades (3), of which Committee, Doctor Hoffman was Chairman. An indefatigable worker in many fields of public health, Doctor Hoffman's name is thus linked to the early authoritative publications in this country dealing with dust and pulmonary disease. The various reports of Governmental Com missions in South Africa, Australia, Great Britain and other countries have also stimulated industrial studies and laboratory research into the effects of many kinds of industrial dusts, especially those containing silica* ,* . . .......* ' ' At the present time, while no one would state that we have adequate information about the effects of the inhalation of industrial dusts, we do know a great deal more than we did twenty years ago. Both clinical and laboratory studies have given us some knowledge of what kinds of dusts are dangerous, the circumstances under which they are dangerous, and the nature of their action upon the pulmonary tissue. We h a v ^ _ learned a great deal about the prevention and control of the dust hazard by engineering methods. But when we seek evidence of the effects of dust inhalation in mortality and morbidity^ecords, w e;find^thafethc statistical demonstration of mortality and morbidity due to the inhala tion of dusts is anything but satisfactory or complete. This situation is the more regrettable because comprehensive mortali y and morbidity statistics would be of the greatest value in clearing up ` many doubtful points regarding the effects of specific dusts and would bring to light occupations in which there might be a real, but unsuspected, exposure to injurious dusts. Early occupational mortality studies, it must be admitted, gave the first broad clues to the extent of the dust hazard in industry and to the kinds of dust which are most injurious. These earlier mortality studies, valuable as they were, however, were in many instances misleading. Virtually all kinds of dusts were shown to be productive of tuberculosis rates higher than average, whereas recent clinical and laboratory experience points to the very considerable damage to the lung tissue produced by a few dusts, notably silica and asbestos, and to the relatively little evidence of harm done to the lung tissue by organic and many inorganic dusts. INDUSTRIAL DUSTS AND THE MORTALITY FROM PULMONARY DISEASE1 A. J. LANZA AND R. J. VANE* Air and water are the two immediate vital necessities of our lives. We take extraordinary precautions to guarantee for ourselves not only an ample supply of water but one of defined purity, and vast engineering water-supply projects, costing many millions of dollars, are an accepted and commonplace fact in our times. ' With respect to the air we breathe, we are more complaisant. Dust arising from industrial processes pollutes the atmosphere of working places, in mine, factory and mill, and the products of combustion, both industrial and nonindustrial, are liberated into the atmosphere of our communities with little restraint. In recent years, particularly, in dustrial dusts have received much attention and much effort has been put forth by industrial firms of all kinds to control dusty processes in their establishments. Fortunately, nature has furnished us with a respiratory system which has not only a large margin of safety, but a fairly efficient protective, mechanism. When that protective mechanism is subjected to severe stress for a sufficiently long period of time, it may fail. The extent to which such failure may be reflected in mortality experience is, within certain limitations, the subject of this discussion. We are concerned here with industrial dusts other than those commonly recognized as poisonous. Lead, mercury, arsenic, manganese and other systemic poisons are excluded,, together with the chemical poisons. Those dusts with which we are concerned are both organic and inorganic, and the latter, in turn, may be subdivided into metallic and nonmetallic. There are many possible subdivisions of these three classifications but for our purpose extensive subdivision, is unnecessary. Indeed, it is difficult to get sufficiently ample statistical material to give us definite information under the general headings. 1Read as part of the Symposium on Tuberculosis in Industry at the joint session of the Pathological, Clinical, Social \york and Administrative Sections at the 34th annual meeting of the National Tuberculosis Association, Los Angeles, California, June 23,1938. . * Me ropolitan Life Insurance Company, New York City. Ur. Korean hurnette October 25, 19 through the B*ai Office or vnvldiyBouWhIicshh yuesu ttoiidnoV shoc?>uM ** in^teerree.stteead Kfcile T an at RCl in Canada I net IY. rgufmon Kr M e f V l W Per l.OObl e c ^ l S ' t o u ^ i e f t b ^ T T ? ^ ' f r a U r v * w i " frr "W t , M c h < E -r. t h a o u l m , * , *ig T? c'?* does not beliere that tvse t 'ala. m r* el i''#**? ; *57 -- *** *** particularly critieni r *w '* * for legitimate 11 .ness* Be is R S3. ^ 7 f t Se a r t pla7ad by the Company kedical Examiners sa.2prx.rirjsns ss-ss.ss-isk r 2 a f lnf ** The T'r*d:,aln" t diagnoses are neurasthenia, vuVness * ** * occur ci-ng the fenale emrln?eep, Particularl" in tvr reri*r assembly department, hich has about 93 Percent f e ^ . . ' ** * u.j i A sbestos I*. terenso:-., ho is the Jehns-Kenrille t*Tr1c<eni is S 3 !dl3J' fr,r the Company. Be mentioned that employees were :S2 patients*' S S ^ S - J i * ' U l k f I S ! loC&1 ^ i c U ^ T t h e l r r. eXCUSe i8 that th*-v are accommodating the in bole letters rn^the E S put. * . t th. Insurance u ^ c^VisCE i v L 3 ^ t h S dt.Sa^ th* f''5?" 7 prlnt S -1^V u z toSTtf;ssuiis l: " "' 1 Sincerely yours, George K. Wheatley, K.E. Assistant Kedic&l director I i___ October 25, 19IZ Dr. Norman L Burnette . A?'Iftent Secretary Canadian Head O ffic e Dear S-raani * ~ w :uest!^nnaire regarding coarunity health aerrices and liv'ng . c-nditi^ns, which you planned to send tr the Burses J.n cos-:unitiee in which we are making the tuberculoris n-rUlity study, reached me today. I think it cowers everything we talked about Saturday and f!.*uld give us the necessary information. If it aeeos necessary and we arc in doubt ab-ut conciti-ns it may be o->ssi"le "or ne t- make an insoecti-h visit later on. I a?sure fro**- your lettfr that y u can secure the ln'*nrnation fres a trusted s*urce known t*' you in Pimouski. If you are in doubt a K t a source 1?. Asbestos, I believe t can secure this I2.frm.it `on through Dr. Smith, the assi tont to Dr. Stevenson at Canadian Johns-^anville in Asbestos. I have several quest1ons which I did n^ttake up with you on Ssturday which relate to r.y visit. (1) tr. Graham Rose, Medical director of National Breweries, Voctretl, was intere sted in cur indurttial health material. He has afcvjt 25 physicians in his professional organisation which he and Dr. Pildfell, Medical !Mrector *f Aluminum Coauany of Canada, are organising. He e-uld use 5 conies of aopropriate literature for these men. Do you have s i miles of our Industrial Health 'tries and do y-u wish to sup-ly Dr. Men'vitv then? (2) Mr. C. K. McGaw, in charge of Industrial Relations of Canadian J^hns-Manville, Asbestos, Cue., is Interested in having health education material for educational work with their 'employees in Asbestos. They have become quite active in safety education anc nov went to turn to health education. Be wanted to be eurrlied * *itb the health education material which we have aval.able. Do you have literaturt you can send hint If not, what dc you wish done? I right*also mention that iTr. HcGa* raised the quest'on ab-ut nursing service. He said that the ixnrersi rn had been g 'ven then that they would have nursing service when the insurance wup purchased. I explained that we provide nursing service where it is available and thot would not necessarily follow the contract. Iou perhaps know the background of t' \ i and you may aiah to say something to him. f In connection with the nursing service, I gave Kiss (b'ess the names of the Biearer* of the two nines we insure in Thetford, Mr. 0. C. Smith of the Bell Mines, anc Mr. Andre Johnson, of Johnson's Mine. She is planning to call on them this week. (3) Mr. Ivan Sabourin is also interested in Metropolitan health l'ter- ature. I shall arrange to nut hit on the 'tatlstlcal Bulletin mailing list, but am in doubt as to hat you nrefer t-> do about other health literature, ould 144 Dr. N e m a n L Burnette A?latent Secretary CaneS 1-, Head Office Dear x-'raani October 25, 194Z are takinr the tuberculous rorUlitT C52':unlti*R in hieh *e covers erer^hlnr we talked I b S 1 P 7 ' " *,ched Be *>dy. I think 1t lnforsut* ->n. I r it s.CBa w v t y anc f..^uld five us the necessary u L V 'UH * ? * ^ letter that y u can secure the ir.'nrBat^?^** * a?SUR!e f r v ' * 0VT secure this ` ^ c* *J I believe r Jan Canarian Johns-Kanvllle in Asbestos.' * *' *** * SC* ttnt 40 Cr* steTcnon at I h&ve s e v e r a l suer t 'o r ? wv<rf\ I j i* .. . . , which r e la te to rv v i s i t m k, r " . _ n t ^ k e up w ith you on Saturday e t 'Ut 25 ohvticitns in H i _Ur ln?UEJ*ia^ health Deterill. Be bee Bcdickl rirectW " f n ^ i L - C ^ S rI5 S ' * ^ he " * Cr- ' e U . ennies of eojroprUte " u t r S u ^ ' e i f ! ! d '`l m " e * l t t o E. Ke enuld m Industrial Hetltv *er*ea aod .* *!!*** Bea* y?u have w h i l e s of our A.sb*e.stos, Cues. 1 w S 4t^u Lu TMi1,?*?'""^8 rff Ctaen'aodiia#n,%Jwohtn`s-tkha"n?ville<,*> * . work with their `ennloyees ir AbcetoaRfi Th*1**! eduf9tlr,n " terial for educational education ,, g nor h`TM * * * qit. active In safety "if. the health education T u t T J 2 *> * BUrT'l1ed t-.u I-,. i i c S , i2it.ili h . r ?lah"?' 1 u , ls o r e t s l ? n had l*tri fr:Tcr. th e - th * t th r ^ T ^ k fe r7 ` c 1 H* I d t h a t th e Insurance ._ r o u rc h . J ! fc* " `` " f m e . . b e t th e is ll.hl. .,,d th:.t .duld nit n i c ^ s ^ r v ? - n n 3 *i `" " i "* ''h *he" U ben. th, f e c u n d of f i d ood h u " ''" * * * th . W .-.S u" t h , o . . ,, <f ature TTM Sa^ urln 18 6 1 9 0 interested In etroooliten hetdth l'ter- 05/23/05 MOW 10;50 FAI 410 685 7155 GOLDMAN,SKEEN.WA icfe. odut nent ce du ques, rtford, ge et contre aunes 'acteur afin de ge e t le iCC. fhetford N ovem bre 1947 L avai- MfemCAL 1091 et une amlioration de* conditions hygI usines s'imposent. bibliographie T r i TM M . e t R ichard, R - 1. DE3MEXU.ES, R -, R ousseau, j 'la va l Mdical, 8 : 217. Amiantose et tuberculose pulmonaire, i* {mars) 1 9 * . M ., Am iantose et tuberculose pul- 2. D ksm eu Si R -p 1043 moMitre. L *I M i '. 1 JJ 1. Wli.n>, J. L anza. A J . EItt workers,Tir partn looa , r H U RtpnrU, .Ci**" ) , ,,SL,, a. Journalai group .1 em p lo iTM j> Med " a > 7. Tuberculosis m J^ / * / Tbe^ loSi8Association,p. 199. , f j prf>ti6 p .r T 1W- phtM , fa the p eeh e * " Z Z Z Z Z * I/- S- -- * I-- " . ,, J . G -S G eorge M . W haat. . . v. M. o., Assistant Medical LKrictor, Metropolitan Ltf* insurance Company- &:W M >$l Agi I ` 05/22/95 16:53 TX/RX N0.1824 P.011