Document G5rB5Y1xrGD1DEYB1r4yXY05Y

ANNALS OF THE NEW YORK ACADEMY OF SCIENCES Volume 132, Abt. 1 Pages 1-766 BIOLOGICAL EFFECTS OF ASBESTOS Conference Cochairmen I. J. Selikoff J. Churg AUTHORS C. G. Addinglby, M. Anspach, H. E. Ayer, M. E. Bader, R. A. Bader, M. S. Badollet, C. Berkley, S. W.'Berliner, H. Bohlig, W. D. Bucha nan, A. Caplan, J. Churg, J. M. G. Davis, R. S. Doll, P. C. Elmes, R. E. Elsasser, P. E. Enterline, J. H. Fanney, W. A. Gantt, R. Gaze, J. C. Gilson, J. Gough, E. C. Hammond, J. S. Hahington, N. W. Hendry, I. D. Hill, D. W. Hills, K. f. W. Hinson, S. Holmes, P. F. Holt, D. O'B. HourIHANE, D. D. HUBERfr'W. C. HUEPflR, R. HUNT, G. JACOB, R. KlVILUOTO, J. F. Knox, A. Laamanen, J. R. Lynch, W. T. E. McCaughey, J. C. McVittie, P. Maranzana, L. Miller, J. Mills, E. T. Miner, S. Moolten, G. Mottura, G. Nagelschmidt, M. L. Newhouse, L, Noro, W. G. Owen, A. Peacock, P. R. Peacock, A. M. Pelzer, B. Pernis, V. Raunio, S. A. Roach, F. J. C. Roe, S. H, Rosen, E. L. Schall, I. J. Selikoff, J. W. Skidmore, G. K. Sluis-Cremer, K. W. Smith, W. E. Smith, W. J. Smither, C. P. Theron, J. G. Thomson, M. L. Thomson, H, Thompson, A. S. Tierstein, V. Timbrbll, E. C. Vigliani, O. L. Wade, J. C. Wagner, I. Webster, D. K. Young Editor Harold E. Whipple l17 NEW YORK PUBLISHED BY THE ACADEMY; December 31,1965 r SCF-FA-5710 P-EXHIBIT-014 1 5 j! . : ' * ' Section IV. Human Exposure to Asbestosi Community Studies OCCUPATIONAL AND NONOCCUPATIONAL EXPOSURES TO ASBESTOS W. C. Hueper National Cancer Institute, Bethesda, Md. Numerous reports by many investigators from various countries estab lish the fact that an occupational or nonoccupational inhalation of dust of different chemical and physical types of asbestos results in the develop ment of asbestosis of the lungs which, depending upon the type of expos ure, may be designated as an occupational, neighborhood or household pneumoconiosis. Since 1935 an increasing amount of epidemiologic, clinical and pathologic evidence, moreover, incriminates this health hazard as one of the environmental sources of cancers of the lung (table 1), and more recently alBO of mesotheliomas of the pleura and peritoneum, although some commercially interested parties and their medical guardians and pro tectors still prefer for their own reasons and motives, to deny the existence of these dangerous and usually fatal sequelae of a respiratory contact with asbestos dust. The obvious fallacy of such allegations is well demonstrated by the remarkable and progressive rise in the number of cases of asbestosis and of cancers of the lung, pleura, and peritoneum reported from various countries during the past two decades. It is shown also by the increase of publications noting the first observations on the occurrence of asbestosis and asbestos cancers from several countries during the past decade (Den mark, Sweden, Belgium, Finland, Japan).1" Both occupational diseases are definitely not as rare and in fact, have become less so in recent times, as has been claimed by several industrial parties.1 There was, for instance, an estimated total of about 700 cases of asbes tosis in Germany in 1946 among a total of approximately 8,000 employees of the asbestos industryWegelius5 found 125 cases of asbestosis of the lung in a roentgenologic examination of 476 asbestos workers of one com pany in Finland. Of 132 asbestos workers examined by B5hme/,u 29 per cent showed radiologic evidence of asbestosis. The morbidity rate of as bestosis in members of this worker group rose, moreover, with the duration of employment, being five per cent in workers exposed to asbestos for less than three years; 56 per cent for those employed for five to ten years, and 79 per cent for those with over 10 years' exposure. A similar morbidity rate of 80 per cent among English asbestos workers with over 20 years of employment, was reported by Merewether and Price1 in 1980. Noro4 noted an asbestosis attack rate of 65 per cent in 167 asbestos workers studied roentgenologically. It is remarkable that no large-scale observations on the incidence, morbidity and mortality rates of asbestosis and asbestos cancers have been published from the giant American asbestos industry. 184 estos: Community Studies TIONAL EXPOSURES eper ite, Bethesda, Md. OT8 from various countries estabonoccupational inhalation of dust of asbestos results in the developlepending upon the type of expoalonal, neighborhood or household r amount of epidemiologic, clinical minates this health hazard as one of the lung (table 1), and more pleura and peritoneum, although (their medical guardians and proand motives, to deny the existence lelae of a respiratory contact with h allegations is well demonstrated i the number of cases of asbestosis mm reported from various 1 . jhown also by the increase >ns un the occurrence of asbestosis ries during the past decade (Den- Both occupational diseases ve become less so in recent times, lagjjgs.' t^lof about 700 cases of asbesof approximately 8,000 employees >und 125 cases of asbestosis of the 476 asbestos workers of one comrs examined by BOhme,"'" 29 per stoats. The morbidity rate of asi rose, moreover, with the duration irkers exposed to asbestos for leas mployed for five to ten years, and V exposure. A similar morbidity estos workers with over 20 years 'ether and Price14 in 1930. Noro4 >er cent in 167 asbestos workers lie that no large-scale observations y rates of asbestosis and asbestos lant American asbestos industry. Hueper: Exposures to Asbestos 185 S 45 R 40 A 19 3 V p CHO 10 t* tn 05 < a. C<D1 N dg d -< r-t 3 iJ 3 16 R 24 A6 HH so as << Cd4 ^ H QQ < i S" a 3 Ml JS 4-16 Av. 11 9-20. Av. 3 0o9 H &H OCH1O Exposure time' Latent period Lag period Site* CO D 7CD j< 14-34 Av. 25 9) ! eH < . 4-40 Av. 28 d. (A T 6-36 Av. 20 M 1-45 Av. 16 7i co* <h5 CdP M U f IA H1 35-71 Av. 52 Age 37-69 Av. 50 gk <n <> s !o 3 S Si Cm n. 4 5 j ST Is 3 Dm a a Cm *** 2 Cm s5 U dto CfCdO1O d *- a 1 (A Ho n0r*0 wnH H CO Ho d M 197 F 41 I 1 I 1 Switzerland .C o u n try Finland 11 I o O i 1 i LL-Low er Lobe; OL-Upper Lobe. fS - Squamous Cell; R - Round Cell; 186 Annals New York Academy of Sciences It is an axiom of sound public health practice that protective and pre ventive control measures, to be rational and effective against environmental health hazards, must be based on adequate information on the sources and types of exposure of the causative agent involved and on the population groups affected. For such an assessment of the potential scope of an en vironmental health hazard of occupational and nonoccupational implica tions, it is necessary to determine the distribution pattern of the agent from the site of its original occurrence and production through the sites and types of its subsequent industrial and commercial uses to the homes of the ultimate consumers. It is, moreover, essential to ascertain the various types of products into which the causative agent might be incorporated and the purposes for which such products might be used. It is important furthermore to investigate the existence and degree of environmental pol lution of the plant area as well as of the plant vicinity and the zones along the routes of transportation of such materials. When some or all of Buch data have become available, a sound factual basis is provided for a com petent epidemiologic investigation of the workers employed in mines and factories producing, using and handling the causative agent, and of the members of various trades and occupations having primary and associated contact with it, as well as of members of the general population sustaining an incidental exposure to it. Past experiences have shown that only through such comprehensive and painstaking epidemiologic procedures are any worthwhile, factual data on the existence and scope of occupational and related environmental health hazards obtained. The continued insistence of some industrial parties that reliable decisions on such aspects can be based on what is called deceptively "sound clinical impression" often merely reflects an objectionable desire to escape from an unpleasant situa tion into a wishful dreamland in which profits are properly protected against just compensation claims. A brief presentation of the sources and types of occupational and non occupational exposures to asbestos and of the various occupational and nonoccupational population groups having Buch contacts, therefore, may furnish a proper foundation for the subsequent discussions of the biologic functional and anatomic effects associated with and produced by the in halation of asbestoB dust. The immediate importance of such data is indi cated by the fact that the world production of asbestos has increased from 600 tons in 1880, to 330,000 tons in 1926, to 446,000 metric tons in 1938, to over 2,000,000 tons in 1968, and that it is still rising (figure 1). The main producing country is Canada, while the principal consuming country is the United States of America, which consequently should have the largest number of individuals exposed for occupational and nonocuppationa! reasons to an inhalation of asbestos dust from an increasing number of sources and from a growing number and variety of products. lemy of Sciences juractice that protective and preIwffective against environmental teiinformation on the sources and it involved and on the population t of the potential scope of an ennal and nonoccupational iroplicadistribution pattern of the agent and production through the sites nd commercial uses to the homes a, essential to ascertain the various tive agent might be incorporated ts might be used. It is important and degree of environmental polplant vicinity and the zones along terials. When some or all of such ttual basis is provided for a coms workers employed in mines and T the causative agent, and of the ns having primary and associated thngeneral population sustaining n ve shown that only through pi jlogic procedures are any ce and scope of occupational and itained. The continued insistence decisions on such aspects can be lound clinical impression'' often flApe from an unpleasant situa- are properly protected id types of occupational and nonof the various occupational and ng such contacts, therefore, may equent discussions of the biologic ed with and produced by the in i Importance of such data is lndion of asbestos has increased from 5, to 446,000 metric tons in 1938, it is still rising (figure 1). The i the principal consuming country nsequently should have the largest :ional and nonocuppational reasons an increasing number of sources of products. yn|)i.D PRODUCTION ASBESTOS I* metric tons Hueper: Exposures to Asbestos 187 NUMBER OF ASBEST0SIS CANCERS OF UR6 REPORTED * -- 60 -- 60 / / - 10 II 1900 1910 1920 19)0 I960 I9S0 I960 1970 YEARS *Lalu! pttM tO /ten Figure 1. World production of asbestos and asbestosis carcinoma of the hmg. Since, of the different types of asbestos, chrysotile represents approxi mately 95 per cent of the total asbestos produced, contact with this type of asbestos furnishes the chief cause of asbestos pneumoconiosis and cancer in most countries, and especially in the U.S.A. which mainly produces, im ports, processes and uses chrysotile.''" Contact with other types of asbestos, particularly amosite and crocidolite, is of comparatively minor and regional importance for occupational reasons because these varieties of asbestos are mainly mined in South Africa and preferably consumed in Great Britain, and represent only a relatively small fraction of the total amount of asbestos produced and used. The exposure data to be given apply, therefore, mainly to chrysotile, although according to Lanza"*" all three types of asbestos elicit' the same kinds of biologic reactions. . Occupational Activities, Processes and Products with Asbestos Hazards Asbestosis and asbestos cancer hazards related to an inhalatory exposure to asbestos exist not only for asbestos workers proper engaged in the direct and* regular production, processing, handling, and using of asbestos-con taining materials, but also for the large number of individuals who may sustain such contacts on an incidental basis. Such persons may be em ployed permanently or temporarily in or near operations where asbestos ahd 'asf*b' ea' tos products are produced or handled and where they inhale, 188 Annals New York Academy of Sciences Table 2 Asbestos Elites of asbestos cancers Exposure stigmata Recognized-Lung Chronic fibrosing pneumonia Involving first lower lobes (asbestosIs), asbestos bodies In sputum, asbestos warts of skin (fingers) Compounds of economic Importance Chrysotlle, amphlbole, amoslte, crocldollte, tremollte containing magne sium, aluminum, calcium, Iron, silica. Operations and products with contact to asbestos for producers, processors, users, consumers, residents Asbestos rock mining, loading, shipping, crushing, milling, asbestos spin ning, weaving, mixing, cutting, pressing, molding, plastering, cementing, spray ing of steel construction, undercoating of automobiles, Insulating pipes, etc., clothes, cloths, sheets, blankets, curtains, brake linings, yarns, cords, ropes, twines, ribbons, artificial snow, filler In rubber goods, plastics and roof coat ings, filter cloths, filter pads, filter paper, artificial wood, tiles, shingles, cardboards, wall boards, partitions, panels, paper, clutch lacings, clapboard, pipe coverings, pipes, Insulation blocks, Insulation jackets, gaskets, pump pack ings, electric wire Insulation, structural heat insulation, facings of acoustical building materials, catalyst supports In sulfuric acid production, putties Population groups with occupational and environmental exposure to asbestos . Occupational groups Nonoccupational groups Asbestos rock miners, loaders, truckers, crushers, millers, asbestos spinners, weavers, electrical ap pliance and wire manufacturers, ma sons, carpenters, heating equipment workers, rubber workers, shingle and tile manufacturers, building material manufacturers, filtering material manufacturers, molders of asbestos products, asbestos-asphalt makers, putty manufacturers, asbestos cement makers, asbestos paper, cardboard and brake-lining producers, asbestos felt insulation workers, asbestos sound Insulation workers, asbestos Insulators, pipe coverers, asbestos tube wrappers, asbestos cork Insula tion workers, construction workers, automobile makers, garage attendants Residents In vicinity of asbestos processing and textile mills Inhaling plant effluents polluted with asbestos dust, and individuals living and work ing along roads on which asbestos is trucked; inhabitants of houses with asbestos insulation. ay of Sciences Bl posure stigmata slug pneumonia Involving first bestosls), asbestos bodies In i warts of skin (fingers) importance te, tremollte containing magne- i asbestos for producers, nrs, residents rushing, milling, asbestos aptnJg, plastering, cementing, sprayomoblles, insulating pipes, etc., ike linings, yarns, cordB, ropes, ir goods, plastics and roof coat- artificial wood, tiles, shingles, taper, clutch facings, clapboard, tt' Vets, gaskets, pump packL on, facings of acoustical rt' <1 production, putties al and environmental itos Nonoccupatlonal groups In vicinity of asbestos and textile mills inhaling i polluted with asbestos ; and Individuals living andworkilong roads on which asbestos is ted; Inhabitants of houses with stos Insulation. Hueper: Exposures to Asbestos 189 therefore, air polluted with asbestos dust (repairmen, maintenance men, engineers, mechanics, laboratory technicians, office workers, medical per sonnel, truckers, railroad workers, yardmen, construction workers, ship yard workers, automobile plant and garage employees, etc.).1**" The total number of individuals in the United States having manifest, suspected and possible, but often unsuspected contact with asbestos, should run between 50,000 and 100,000. The duration and degree of exposure to asbestos in members of this group, however, must vary considerably and their relative liability to asbestosis and asbestos cancer consequently will also show distinct differences. The recent estimate as to the total number of about 50,000 asbestos workers employed in the United States, Canada, England, and several other European countries made by Braun and TruanM must be considered an optimistic understatement which tends to minimize the actual scope of the health hazard associated with work in asbestos. The numerous occupations and products associated with the production and utilization of asbestos provide a vivid illustration of the wide scope of the industrial health problem related to this mineral (table 2). Asbestos Ore Mining and Milling Miners, sorters or dressers of asbestos ore in open pit mines, but partic ularly in underground mines, are-exposed to the inhalation of rock dust containing asbestos. Simitar exposures exist for the loaders of the mined rock and for the truckers and railroad personnel..who haul the material and deliver it to the crushing mill." The crushing and screening of asbestos rocks (comminuation), carried out in the mills for separating the asbestos fibers from the adherent rock, is associated with the production of a great deal of dust and thus entails a heavy exposure to asbestos unless stringent technologic precautionary measures are taken for protecting the workers employed in these mills. The amount of dust produced in these operations and escaping from the mill buildings can, moreover, cause a marked pollu tion of the intraplant and periplant environment with asbestos dust and thereby create not only an intraplant asbestosis hazard for workers em ployed in the yard and-offices located on the premises but also a periplant hazard endangering individual and animals working and living-in the vicin ity of such plants (industrial neighborhood and household hazard)."**1 Reports on the occurrence of asbestosis and asbestos cancer among asbestos miners and millers which are on record from Canada, the United States, and South Africa"*"-5*-*'-"" demonstrate the existence of the typical health hazards associated with these occupations in asbestos. Asbestos Cement Production and Consumption The greatest quantity of asbestos of all grades is used in the manufacture of a variety of asbestos cement and plaster products, such as asbestos cement proper which may be applied like ordinary mortar or plaster, qr t I t i 'i .i s| `! i | 190 Annals New York Academy of Sciences which may be sprayed on walls; insulating material for the covering of1 pipes, boilerB, cables, conduits and ducts; siding shingles, roofing shingles, tiles, flat and corrugated sheets, wallboard, clapboard and automobile undercoatiri.^,', The production, processing and commercial use of these materials often entail for workers engaged in such activities, a distinct exposure to asbestos-containing dust. Reports in the more recent medical literature attest to the existence of distinct occupational health hazards from such exposures by noting the occurrence of asbestosis and asbestos cancers in asbestos cement and plaster makers, mixers, and sprayers, in sulators, laggers and pipe coverers, especially those employed in shipyards, and masons."'su'40'4,'w'4,'*'44'4a',*'4T'4* The circumstances under which asbestos cement products are used in the human economy make it likely that they may create asbestos health hazards of an associated type for other workers as well as in homes where asbestos insulating is used.30'10 Manufacture of Asbestos Textiles Asbestos alone or in combination with other vegetable or animal fibers and synthetic plastics is employed extensively in the manufacture of threads, yarns, wicks, cords, ropes, tapes, clothB, sheets, blankets, and similar products which in turn are used widely in industry (automobile, air craft) as friction materials, brake, linings, fireproof safety clothing, cur tains, life jackets, and similar articles, clutch facings, lagging cloths, and gaskets. During the preparation of the asbestos fibers and.in the fabrica tion process of textiles from asbestos (carding, stripping, mixing, bobbing, spinning, and weaving), the workers become exposed to asbestos dust re leased into the air, although the absolute amounts of this have greatly been reduced during recent years by proper technologic measures in modern textile plants.*0'11 Whether the introduction of such protective procedures has succeeded in totally eliminating asbestotic hazards for the workers employed in such plants, however, rejnainsto be seen because of the often relatively long latent period which mar elapse before asbestosis may be come symptomatically manifest even after workers have left such hazard ous operations.01'04'111 Exposure conditions in the asbestos textile industry until rather recent times, definitely demonstrate that asbestos textile work ers (spinners, carders, weavers) were subject to a distinct asbestosis and asbestos cancer hn Periplant hazards for the population living in the vicinity of such plants may ensue if the effluents of exhaustive ventilation equipment are released into the environmental air without previous removal of their asbestos constituents. Miscellaneous Asbestos Products Asbestos is being made into floor tiles by blending it with other mate rials, such as asphalt, plastics, and similar chemicals. It is used for seals, ly of Sciences g material for the covering of shingles, roofing shingles, Pmpboard and automobile unand commercial use of these d in such activities, a distinct irts in the more recent medical ct occupational health hazards snce of asbestosis and asbestos kers, mixers, and sprayers, in ly those employed in shipyards, instances under which asbestos onomy make it likely that they aociated type for other workers ng is used"-'0 os Textiles ther vegetable or animal fibers isively in the manufacture of i, cloths, Bheets, blankets, and sly in industry (automobile, air , ` -oof safety clothing, curU. ngs, lagging cloths, and iet>. . fibers and. in the fabricatng, stripping, mixing, bobbing, ne exposed to asbestos dust re : amounts of this have greatly technologic measures in modern iflkuch protective procedures hazards for the workers to be seen because of the often apse before asbestosis may beworkers have left such hazardtn the asbestos textile industry trate that asbestos textile workject to a distinct asbestosis and ng in the vicinity of such plants atilation equipment are released lous removal of their asbestos Produets jy blending it with other mate * chemicals. It is used for seals, Hueper: Exposures to Asbestos 191 packing material for pumps and joints, for making paper, filter material, circuit breakers, molds, and many other articles, whose total number Selikoff et al.u have estimated to run at about 8,000 different items. While not all contacts with asbestos and asbestos products are associated with exposures to asbestos dust and thus may result In the development of pneumoconiosis and cancers of the lungs, pleura and peritoneum or less often of asbestos warts of the skin,""*1 there can be little doubt that such health hazards are connected with the production, processing and handling of many of them. Their existence, however, may often not be known, rec ognized and appreciated by members of the medical profession, not ade quately familiar with industrial practices and products. Protection of Asbestos Workers by Workmen's Compensation Laws Asbestos workers of several countries, acquiring as the result and in the course of their regular employment asbestosis of the lung with or without a complicating respiratory cancer, are covered by provisions of workmen's compensation laws. These occupational diseases must moreover, in some countries be reported to governmental agencies (Germany, Great Brltain)."'","'*1-*0 It seems, however, that this type of protection applies in Great Britain to only some types of occupations but not to others. The conditions on this matter differ distinctly in the different states of the United States, where each state has its own compensation acts differing from each other to a considerable degree concerning the type of coverage and the length of the mandatory time-clause. Compensability of asbestosis was denied, for instance, in North Carolina in 1987 in a suit against the Carolina Asbestos Company by the Industrial Commission. In an appeal, thlB decision was confirmed by the Supreme Court of North Carolina. Legal provisions furnishing presumably adequate protection of asbeatoB workers against the health hazards peculiar to their occupation at the present time still leave much to be desired in many states. ' Conclusions (1) The enormous rise in the production and industrial use of asbestos during the past 60 years has resulted in markedly widened exposure to asbestos dust for a greatly increased number and variety of workers. Some of them; moreover, sustain such contacts Incidentally either when being employed in various capacities in operations where asbestos products are processed, used, or handled or when working in plant areas in which an environmental pollution of the air with asbestos exists.**"** . (2). The harmful effects of such growing exposures to asbestos during the past two decades are reflected not only in a growing number of reports on the occurrence of asbestosis and asbestos cancer in a variety of asbestos workers but also in the fact that such reports originate from a rising 192 Annals New York Academy of Sciences number of countries in some of which Buch observations were made only recently for the first time. (8) Information on the number and variety of exposed workers and on the occurrence and incidence of asbestosis and of asbestos cancers among them is most fragmentary in ail countries, especially in the United States and Canada, one being the principal consumer of asbestos and the other the chief producer of this mineral. It is for this reason regrettable that the original plan of having a recent epidemiologic survey on these aspects of asbestos production in Canadian mines and mills to be under taken under the aegis of the National Cancer Institute of Canada was npt adhered to and that this study was carried out as an industry-dominated venture which yielded highly controversial negative results.0-*4'*'"-1 (4) The principal worker groups exposed to respiratory contact with asbestos are employed in the asbestos mining and milling industries, in the production and commercial use of asbestos cement and plaster and their numerous secondary products, in the production and application of asbestos for insulating purposes, and in the processing of asbestos and its manu facture into textiles. ' (6) Because in many countries and states the workmen's compensation laws are defective, the protection.of asbestos workers against occupational health hazards related to respiratory and cutaneous contact with asbestos is inadequate. References 1. Ahlborg, G. A C. J. Hansson. 1966. Asbestosen fttr Sverige ny yrkessukdom. Sven. LKk. Tidn. 53:1876-1388. 2. Wboeuus, C. 1947. Changes in the lungs in 126 cases of asbestosis observed in Finland. Acta; Radiol. 28:189-160. 3. Frost, J., J. Gborg A P. F. Miller. 1966. Asbestosis with pleural calcifica tion among insulation workers. Danish Med. Bull. 3:202-204. 4. Noro, L. 1946. Histology of asbestosis. Acta Path. Microbiol. Scand. 23: 68-69. 6. Clerens. 1960. Occupational asbestosis. J.A.M.A. 143:489. 6. Noramx, N. 1959. Le silicose et l'asbestose pr&liaposants-eUes au cancer pulmonaireT Arch. Belg. Mid. Soc. Hyg. Mid. Trav. Mid. Lig. 17: 86-99. 7. Rosato, D. V. 1969. Asbestos: Its Industrial Applications: 478. Reinhold Publ. Corp. New York, N. Y. 8. Wedler, H. W. 1989. KUnik der Lungenasbestos. Leipzig, Germany. 9. Wedler, H. W. 1943. Asbestos und Lungenkrebs. Deut Med. Wochensehr. 69: 676-576. 10. Baader, E. W. 1989. Asbestos. Deut. Med. Wochensehr. 65: 407-408. 11. Baades, E. W. 1961. Der Lungenkrebs als gewerbemedlzinisches Problem. Proc. 67. Tagg. Deut Ges. Inn. Med. 12. Bohmr, A. 1969. Asbestose und Lungencarcinom. Arch. Gewerbepath. 17: 467-462; 17: 884-896. . 18. Bohmh, A. 1942, Examination of workers in an asbestos factory. Arch. Gewerbepath. 11:488-462. 14. Merewether, E. R. A. A C. W. Price. 1980. Report on Effects of Asbestos Dust on the Lungs and Dust Suppression in the Asbestos Industry. H. M. S. O. London, England. idemy of Sciences Hueper: Exposures to Asbestos 193 wh observations were made only <5 BoWXiES, O. & D. I. March. 1947. Asbestos. Minerals Yearbook 1946 : 1467. ` Washington, D. C. id"variety of exposed workers and 16 Lanza, A. Z. 1936. Asbestosis. J-A..M.A. 106:368-370. 17* Lanza, A. Z. 1988. Silicosis and Asbestosis: 439. Oxford University Press. isbestosis and of asbestos cancers ' London, England. I countries, especially in the United cipal consumer of asbestos and the 18 BoHUC, H. 1966. fiber das Auftreten des Lungenkrebses bei Asbestose. Ber. ' l. Kongress Med.-Wiaa. Ges. Rontgenologic Deut. Demok. Rep. p. 102-106. 19. BoHUO, H., G. JACOB & H. MOller. I960. Die Asbestose der Lungen: 106. al. It is for this reason regrettable *nt epidemiologic survey on these idian mines and mills to be under- Georg Thieme Verlag. Stuttgart, Germany. 20. BoHLic, H., G. Jacob & H. Muller. 1962. Asbestaublunge und Tuberkulose * __neue Gesichtspunkte zur Entschadigungspflicht Internal Arch. Gewer bepath. 19: 434-449. Sancer Institute of Canada was not Tied out as an industry-dominated sial negative resulta.00-'M'80"-"1 ' 21. Bohlig, H. & G. Jacob. 1968. Die HfiuAgkeit des Lungenkrebses bei deut* schen Asbestaibeitem. Dcutach. Gesundheitsw. 13:1101-1108. 21s. Cureton, R. J. R. 1948. Squamous cell carcinoma occurring in asbestosis of the lung. Brit. J. Cancer. 2:249-263. cposed to respiratory contact with lining and milling industries, in the sstos cement and plaster and their : 22. Brugsch, H. G. & H. Bavley. 1961. Asbestosis in a worker engaged in ' automobile undercoating. New England J. Med. 265:879-381. 23. Seltcow, 1. J., J. Churg & E. C. Hammond. 1964. Asbestos exposure and neoplasia. J.A.MA. 188: 22-26. . Auction and application of asbestos ocesaing of asbestos and its manu- .. 24. Braun, D. C. & T. D. Truan. 1958. An epidemiological study of lung cancer in asbestoB miners. Arch. Indust. Health, 17:684-662. 26. Sinclair, W. E. 1969. Asbestos, Its Origin, Production and Utilization: 612. ' 2nd ed. Mining Publications, Ltd. London, England. states the workmen's compensation *sf'v| workers against occupational n<. neous contact with asbestos ; ' \ i 26. Waoler, P., H. MOller & M. Anspach. 1962. Gibt es eine endemische Asbestose T Zeitschr. Ges. Hyg. 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