Document KG6KyrY7R7MDpaEzL53zEdqBo

FILE NAME: Metropolitan Life (ML) DATE: 1944 DOC#: ML225 DOCUMENT DESCRIPTION: Letters from Dr. Gardner to Mr. Sabourin Asbestosis & Tuberculosis at Asbestos Mines February 23, 1944 Mr. Iran Sabourln Aldred Building Montreal, P. Q. Canada Deer Ir. Sebourint While tha aattar la till fresh la my mlixi I am . writing you at length on ay lapresslon of tha situation oa Asbestosls in (uabac in fo far as It involves relationships between tha producers, tha aadlcal profession and the Compensation Commission One conference with Mr. Sharp, Dr Vidal and Mr* Dick fare ms e much clearer picture than Z had gotten preciously Before doing so X offer a few consents on autopsy aaterlal Z aa enclosing ay report on the lung tissues of Philemon Tardif Of necessity the conclusions arc not too satisfying as they arc based only upon examination of tso blocks of tissue, * p T proxlnately 2 x 4 centimeters In diameter without eren en Indication of the parts of the lung iron which they were taken However, they like the material froa the two previous esses, do demonstrate that the Tbetford operations produce Halted amounts of Indisputable Aabestosls In tha presence of advanced tuberculosis this lSs)pseured sad not likely to be identified exeept on microscopic examination of pulmonary tissue X-rar during life will not show it* ^ Today I have else examined In gross the eegltal section through the entire right lung of Majoriqus Perron which as collected yesterday froa the toxicological laboratory la Montreal This Is a much more satisfactory specimen with which to work Zt likewise shows e com bination pf wideepreed chronic tuberculosis upon e background which will probably prove on microscopic examination to be minimal Asbestosls Sections will be prepared as soon as possible for microscopic examination * TM .o^ hl>torr inclodings How long u S a , character end date of*flSSSt** symptoms, date of quitting work, whether Xoch*s bacillus was found la sputum and date of death X neglected to copy this Information from your reeord This autopsy aaterlal on fetal eases end the X-raya I that are now reaehlng the Commission ere bound to create la their alads .the impression that tuberculosis Is an ell too common complication of } Asbestosls If I were la their position with ay experience limited to evidence of this kind X would find it difficult to resist the conclusion that there le causel relationship between even slight amounts of Hr Ivan Sabourin (2) February 23, 1 9 M ,asbestosis^and tuberculosis of the lungs* Z have told you ** I told Ur Sharp, yesterday that I did not aero* with this conclusion !hut Z doubt whsther ha or Dr* Vidal will ba persuaded whan they aaa a l aueeatslon of caaas Ilka thoaa which ara now pasting bafora than They (mist ba aada to raallsa that thasa casas ara tha exception* rather than the rule and that there Is a great majority of eaployees in tha asbestos jIndustry who ara free from tuberculosis Z would therefore urge that lanedlate steps ba taken t X Industry in Qucbcc so that tha -> ncglllllV Itatittlcs can be assenbled Dr; SWVehifonTI X-ray fXZns alra faEan on the een at Asbestos will prorlda you with notarial for a pre- wstclH still ore''convincing if you *could show the separata rates of _ facsala pop la those eaployed in tha IZbastos plants as contrasted with that in other occupations would help in determining whether tha occupational factor wai contributory By own observations elsewhere and your Induction that the rate for tuberculosis was higher in St* Hyacinth* than In Shetferd and / or Asbestos make me confident that the companies would acquire Information of greatest service to themselves by such a survey and analysis* Zf asbestosls specifically is predisposing to tuberculosis In the sane sense as silicosis docs the effect should be just as apparent In Sorth Carolina and Pennsylvania at it scent to be in Quebec or England But the fllas of caploycd asbestos workers in tha States show a wary low Incidence of associated tuberculosis* Zt is ay firm belief that In Quebec and England* factors outside the occupation arc responsible* >.. .-- As Z sensed the situation In lontreal yesterday the asbestos Industry w i n have to produce evidence to prow# this point end ; start on it lmedlately or the Industrial eoaeisslon will become ln- ) creasingly convinced that our position la biased and not founded upon \ truth* Furthermore the Industry would undoubtedly profit by __ v undertaking a general program q, .co-- tnlty oontnol of tuberculosis* By Instituting eas'd"TXfiSlS'ttiSSinery not only eaong Cnployv.fS..but anong the aenbers of their fsallies, the open asset of ^Otberctflpsls would-be discovered and the sources'of spread of the infection could be removed* Xr. Ivan 8*bourin (3) February 23, 1 9 U On of the iron mining companies boa serve has such program vitn a public health nurse, a program for tuberculin testing of school children and follow up of the contacts of eery Known ease of open tuberculosis. The program has paid dividends by practically eliminating Cs tuberculosis with resultant lovering of coapensatlon costs and the good ** ill of the employees is unmeasurable. The asbestos industry of Quebec has a serious problem because its later force is drawn from a population in which the tuberculosis rste is high but their situation is mo worse than that >hlch our other clients ettacced successfully in an iron mining community. The second point which is becoming increasingly apparent to me is that the .'bestosIs of the Cuebee mines end mills is quite generally less sevsre and extensive than the asbestosls of tbs fabricating plants of the States. Comparison of the 2-ray findings In the two groups reveals very few esses with typical 'patterns among Thetf&rd or Asbestos mi LI men. o*e asbestosls is unquestionably produced for we have microscopic eviuence of it in tbc four autopsy cases now available but it is r.at advances enough to replace much of the functional parts of the lungs and thus cause the X-ray nmdows that are generally recognised as characteristic of the disease. (Most of us disagree with Dr. Pendergrass when he soy* in Lanza's booh that there la no characteristic pattern of asbestosls) If my observetions ar correct this relatively slight amount of disease should not caus * disability for only the framework of the lungs is Involved leaving most of the parts that carry on the functions of respiration intact. But here again the Canadian industry is on the defense against its medical profession and thslr representatives o; the edvieory board to t-tie industrial consist ion. The doctors have seen only tbelr own Local manifestations of asbestosls without opportunity to compare It with the really severe manifestations that are produced elsewhere. They find the abnormal shadows in the Z-rsy films of exposed workmen, which they ere convinced must cause symptoms and disability. They find asbestosls bodies in the lungs of autopslod cases associated with minimal tiasue reactions or overwhelming manifestations of concurrent pulmonary In fections and now they ar* sure of their ground. Xn order to defend Itself the industry in Quebec must have more facts which will require time to collect, analyse and publlelsa. These findings ill have to be contrasted with those In the fabricating (plants either in Asbestos or elsewhere. Xn the city of Asbestos the v spinning and saving mill has teen in operation for only four years 'which is the minimum time to produce much disease in those exposed, tet in another year or two one may expect to find evidence of it here unless X am much lataken. Mx, Zvan iabourla (4) February 23, 1944 A I have told you la conversation, our experimental observations load m to believe that bo truo hasard la asbostoo plants 1# proportional to tho aaouat of nail, Individual, uaoruatood flbroa la tho laduatrial atmosphere Z auapoet that tho reesan why oao aooa little or me typlaal asboatosla la tho alno and alUs la booauao thoro la probably too llttlo such fibra la tho air of thoso pianti Coavorsoly tho roaaon for tho typical* disease la tho fabrlestlag plant is the fast that tho processes boro opea tho bundles of asbestos fibre and tear thea lato loafthe short enough to be Inhaled la dangerous quantities The all and nines art dusty but the dust is largely serpeatlae with relatively few fibres large enough to do hara to the luags This dust eaters the lungs where It produces reaction around blood vessels and other frostwork structures that are Just like any other Inert dust, fa tee the shadows of such Inert reaetloa aanlfestcd la X-rty as an exaggeration of the aoraal shadows of blood vessels. This condition lx not asbestosls nor necessarily preasbestotlc any acre than the Identical changes la non working la hard rock aloes are necessarily presllleotlc. la free silica Industries regardless of exposure we do not- diagnose silicosis froa X-rays until we find the characteristic patter of modulation} la the asbestos industry we should do likewise and refrain froa a diagnosis of asbostosls until ths X-ray reveals ths eharacteristlo pattern of heslaees or fine etlppled appearance spreading throughout the lower thirds or acre of the lung fields The situation with asbestosls Is oven acre difficult than with silicosis for today the requisite condition of tho dust exposure Is not appreciated by the editai profession M-ooei44S9 ..... XTherefore X strongly urge that surveys bt aade te coapare /the relative quantity end nature of the dusts la the alUs and the ^ i fabricating pleats la order to present proof that In the first Instance \ the percentage of thin fibre of Inhalabas dlaenslons Is insignificant in ^ <cowpajlon quantity created .la. spianine and weaving Zt Is going 15"n4 hard to pcrsuaae^ptffilelans of tbo importance of those factors but stallar faotora govern the reaction to quarts and tho developaent of sll&eosle Those physical limitations of atmospheric dust often determine the outcome In contested esses Involving a diagnosis of silicosis and Z forse# that they will have equal weight la asbestosls. A ____________ _____ _____ stand 'CofitjbVfr i j r \ .... ___________ demonstrate its industrial application. When correlated with the results upon exposed workmen, Z feel certain that our position will *'*'ir* Mr, Ivan 5ahourla (5) February 23, 1944 To summarises X would u k the following reeommeadatloaa to jour clients, tho Csnadien Asbestos Producers in order that thsy aay defend themselves against e growing coavletion song th local physicians that caploymat la thla Quebec Incur try it highly dangerous* X* Correct an erroneous impression or the Industrial Commission that ashestosia la frequently associated with pulmonary tuberculosis* a) Statistical data based on -ray of all --- s enployed workmen to Indicate the incidence of pulmonary tuberculosis b) Comparative mortality statistics 00 _____ _ tuberculosis la Asbestos sad Thetford mad la other communities of Quebec indicating the frequency by sex and age* 2* Consider the possibility of inaugurating a program * of tuberculosis east finding and control la the general populations of Asbestos and Thetford in order to elimi nate sources of new infection among employees* ^3. Make a detailed comparative study of tho nature of the .dust la the fabrlestlag plants end tbs asbestos mines sad mills* X trust that you mill agree with these recomosadstions sad be milling to- pass them along to your ellants* lay X taka this opportunity to thank you for your delightful hospitality vhlle X mat la Montreal and thank you for making my visit profitable and pleasant* Sincerely yours* Leasts Leroy O* Qardaor* I* 0* Director 7abruary 2, 19AA* Daar Mr. Sabourini Z har yoor lattar of far eoavanta a -- tha ralatlonahip batvaan aabaatoala ad auaeaptlblllty to tubareulosls* ffals quaatlon aasoot ba ansvarad dacialrly fra* a atudy of poat aorta matarial alena* Badleal problaoa of thla natura ara osually aolvad eo tha basi of probabilltlaa and it la this sattar af probabiltiac aa ahieh va naad furthar arldanea la tha aaaa af tabarauloala aaaaa&atad with aabaatoala* aravathar la bla *laaaraadoa aa Aabaatoala* fabarela foraabar and Daeanbar# 1933 and Janaarr 1934) adnlta that *tba data aa tha aubjaet ara naafar.* Ha raparta that of 374 vorkara whlla at aork* anly A ahovad ilcni of aetlva tabarauloala aad that tha Britleh HUlaoala and Aabaataa Hadleal Board la Ita flrat parlodla axaalaatlon of vorkara In thle laduatry foond oaly aaa aaaa af aabaatoala and tabaraolaala la ,1512 exaaiaatlORa. Or tha othar hand tha Bacllah poat nortaa aatarlal /at that U n a ravaalad 35*7J( af tha aaaaa aoapUaatad by tabaraolaala* (tabaatuaatly ha appaara ta bava foond Rara aaaaa 1f Kr* klddall la a< ractly lafaroad)* Za tha pobllaatlan altad Barravatbar aanoladaas *Sha avidanaa tharafara* palata ta tha bypothaala that ihan la vorkara axpoaad ta fraa allieaj viral iva lafaatlona vili aa la tha fanaral papalatloa aaaaa daathi laaaar aaaa vili raaolt la aera vldaapraad flbreala thaa vaold appear la aaaaa aaoocat tha finirai Epopolatlaa aad allfht infaetleoa, la a n a m vlth acy tbar affaetloaa, ara Ukalj ta praolpltata death la atta af advapva aabaatoala obera thay vooldn't da aa la tha fonorai ^o^ialatlon** tha oadaraoorlac la bat Z acraa viti aa alava* khan Or* Maravathar vaa la thla aoustry laat yaar ha vlaltad . a far aavaral daya and va apaat aoat af aor tino dlaeoaalac thaaa problaau .-Ha stili aaaapta aor oxparlaaatal varie vhleh prora that thara la na ! apaelfla aoaeaptlblllty a tabaraolaala Indoaad ty aabaatoala ad b*,llka .`aorsalraa* la anzlona ta aaeoaolata aaaparatlra atatiatiaa froo torlooa liparta af tha varlA ta aatabllah tha faoaral allwlaal axparlaooa* J As X Indicated la my last latter the Quebecexperience is not yet analysed] there le only an impression that most. T'Xhm I, asbestos corkers die of tnbereulosls without into eeebuat the { excessive prerralestee of such infection' among the' population of the V Province* Thie impression needs verification by careful analyeie of aorHdlty end Mortality statistics collected froa the employees of the asbestos industry* fron their fsailies not exposed to asbestos dost and free other eoaauahtha in the Province of Quebec* Such date should then be coapared with similar statietiee for asbestos corkers in other countries* If there le a specific occupational predisposition to tabor- : culoele it ill become apparent on sueh enalysus just ae it.has for 1 slllcosle* Wherever slliconis* is being created* the hlfh mortality froa `.tuberculosis esnnot be hidden* X do not believe that there is aueh tubercolosle /asbestos corkers in the United States end suspect that the excess mortality | from this eaase in England is probably due to the low llTlaf jtaaiards ) o t industrial corkers* Possibly ieSeilaT'oT easer doming io autopsy uas"influenced the platers* American atudlea have thu far failed to demonstreto onoufh tuberouloele among asbestos corkers to eeuso ooamemt* The U. S* Public health Service Study of isbestosls in the Asbestos Textile industry la forth Carolina, (Bulletin 2U), iwsuod in 1938* hardly mentioned tuberculosis, dismissing the subject with the statement on page 91 that "there vers only 2 oeeoe of eetlve* pulmonary tubereulealm in the group" (541 employees) Shull, (Badlology 27* Vo* 3* 279-292S 193.6) examined 71 mf 100 oases discharged from the plants here the Public Health Service made Ita study 15 months later end found 8 cases complicated by tuberculosis of alight to moderate extent but only 2 rare active* These tee subsequently died of this cause id la 2 others the infection later became active* Shull states in his conclusions that ."ashestosla .does not predispose to tuberculosis* Presuaubly bo infers* although be does not say so* that the A oases of active disease among 541 workmen represented accuaulated disabilities when tbs examination program css inaugurated* Donnelly (J, Xad* Arc. and Pox. 18* So* V * 222-2281936J~also examined 151 discharged employees InOludlng the100 reported by Shull* Be gives more details on the ossos of tuberculosis* One of thorn had corked in the asbestos industry for 5 months and the othsr* 15 months* The r-- fwlng 2 ted worked 4 end 10 years respectively aad their infestlame might term boom aggravated by exposure to.asbestos dust* la points cut* however* that on Incidence of 2 oeees among 151 industrial employeas is no higher than in any oUxer industrial greup* IcPheeters* (J. Xad. lyg. and Tex.* 18* 229-2391 1936) likeeias ex amined and reported on these eases and be la in entire agreement with the other reporters* Xa hie conclusions he states* "Is estivating or aggravating offset of asbestos dust or asbestosis or tuberculosis was 'Observed." finally X believe X told you that X reelf, bed just re turned from Vorth Oscollaa where X had reviewed Seat films of some 100 employees of the local asbestos industry and saw enly one that showed any indication of adult typo pulmonary tuberculosis* This haalad. x coaaantad on tha faet to th aaabars of th Kadleal Board f th* 8tata Xnduatrlal Coaalssloa wlth ho X as confarrinf and tha Chalraan, Or Tostai told a that tubaroulosla vai a rara flndiaf on* asbaatoa vorktra althoufh coaaon anou*h la othar Induatrlal orkars la thalr stata. Xt would tharafora appaar that la lorth Carolina aabastosls dosa not favor or pradlsposa to tubareulosls X bava Just aov eoaplatad a rasria of 125 fila for aa asbaatoa fabrleatln* plant la aaothar stata la this plant tha aaouat of aevarity of tha aabastosls on tha flrst axaalaatloa In 1930 as all aarkad, approxlnataly iOJ of tha froup sbornia* daflaita X-rsy avldanea of tha dlsaasa -Savarthaltssr-tha-total-adult-typaubareulosls rata ss only four of thasa tassa oaeurrad la ptrsoas Ith aabastosls aad 2 of thaa ara eonaldar'ad probably attiva A saeond xaalnatloa as aada upon 67 of th orltlaal roup aftar aa latrval of 5 yaars durisi hleh thay ranalnad at vork o tha Ineldaoea of asbtstos had Ineraasad to 42JC ut tha tubarculosls rata had fallon to 2.9. A thlrd xaalnatloa as dono Oh $7 of tho orlflnal *roup ho stili raaalaed la aaployaant aftar a furthar. l&tarval of 3 to a yaaraj la thls *roup tha laoldaaea of aabastosls as ovor *0* but that fo tubareulosls only 35J(. Xa splto of xoasslva amounta of savara aaba&tosls tha tubareulosls rata raaalnad vlthln tha llalts usually found In Aaarlean Industriai populatloas Tha babatlor of th tubareulosls In thasa paopla as not unusual*. For zampi# ooa asa a spianar for 13 yaars as 31 yaars old ban flrat axaalnad Ha had t that tino an aarly non-spaclfle dust raaetlon and avldanea of old tubareulosls In th top of hls lune. In tvo suecaadln* axanlnatlons hls dust raaetlon staadUy Ineraasad to raaeh flrat stasa adbastosls 9 yaars aftar ha as flrst saaa Bis tubareulosls hovavar raoalnad apparantly unlnfluanead. Best of th othars bahavad In tha sana oannar Thasa poopl had alraady baan axpoaad to asbastos dust for parlods of 3 to 1S or sor yaars han thay ara flrst axsmlnad ad tha thraa subsaquant axanlnatlons aurini tha follovina 9 yaars Iva us a cood opportunlty to follo hat alfht nave davalopad. lo a essa of tubareulosls appaarad Xf it had not by that tino tha ehaneas vara not vary iraat that thay ould latar, Aftar thay loft tha asbastos ladustry a do not knov hat frappane! to aost of thaa but on a fa tbara ara lnsuranea racords that Indicata th ausa of daath to dlad of tubareulosls On had had hls lnfaetlon han ha as oxaalnad in 1930 at tha aia of 50 At that tlaa ha had aa aarly aabastosls aftar svini for IO yaars and avldanea of assoelstad enronle tubareulosls* la as advlsad to laava hleh ha dld aad dlad of hls lnfaetlon about 3 yaars latar. Tha saeond aan id 32 had baan a aver for 12 yaars and had flrst stai# aabastosls but no avldanea of tubareulosls at tha tlaa Sa loft hls Job aftar tha first examination for reasons not stated. Three yuri lator he v u reported to have dlad of tuberculosis In a aanltorlua. Such eaaaa could occur anywhere* Zt is possible that if we had follow-ups on aora of thasa casas after they left the asbestos Industry we would find aora persona vbo subsequently contracted tuberculosis and died of it How ever* the evidence now available indicates no such tendency* ,experiments* contrary to those upon silicosis* disclose no theoretical /reasons for suspecting that asbestosls creates any special susoeptlf billty to the tubercle bacillus of Eoeh* X aa bccoalng nore and more convinced that that the hieh tuberculosis rates reported la Baalish autopsy statistics are due j -to causes other than occupation* Z believe that the sane aust hold < true In Quebec where the aaouat of severity of the asbestos dust reaction I 'is very such less than it Is In the fabricating plants In the Halted j 'States* 1 believe Z have covered the other points raised In your letter and will therefore not prolong this discussion further* Very truly yours* Leroy 0 Gardner* M* C* Director LHOtBE ce to Hr* Vandiver Brown t