Document NE8rZo3q18mp7Nb9RZ8zeM22p

1 occasion to look at the forest product industry? 2 A. Well, this is from my Oregon experience. When one 3 lives ins the Northwest in Washington, Oregon, you're 4 impressed by the fact that at that time.at least the whole 5 economy was based upon forest product industries, on 6 lumbering and the products from the lumber, including 7 chemicals, and we had known a little bit about their problems 8 before .we got there, but then decided that we w e r e :going to 9 see what the frequency of such problems were, and it was 10 obvious that the forest product industry led all the others 11 in the.-- in the source of the dermititis problems that came 12 before the Workmen's Compensation Commission, so w.e decided 13 to look into the origins of those problems, and we made a 14 variety of extracts of native woods and bark and needles as 15 well as leaves and then attempted to sensitize guinea pigs. 16 Guinea pigs are used to determine whether or not you can 17 produce,, for example, an allergic problem, contact problem, of 18 the skin, and you can do it experimentally in guinea pigs', 19 and we' found that we could do that with certain Northwest .20 wood extracts and then we wanted to find out, well, among the 21 people who ''come, who are referred to us for dermititis, .how 22 many really react to those extracts, and we found that we 23 while we were able to sensitise guinea pigs to western red 24 cedar and several other wood extracts, we w e r e -- when we Oo 1 tested our patients to these materials we, only found that 2 they reacted to Douglas fir, which is the very common wood in 3 the northwest and grand fir, which is the real fir. Douglas 4 fir is really not a fir tree. 5 And we also in looking at the industries 6 themselves, we found that there was a fair number of problems 7 that had nothing to do with the wood. It had to do with the 8 other chemicals that we used in wood processing like the 9 laminating glues that are used in making plywood such as 10 phenol formaldehyde resin, and there were a number of people 11 within the industry, workers in the industry that reacted to 12 formaldehyde and were sensitised in the making of the -- - of 13 the laminated wood. It was really a first step in attempting 14 to clarify some of the issues which we d i d n !t understand as 15 to'what in the forest,what materials from the woods 16 themselves caused skin reactions, 17 Q. This morning, sir, we covered your relationship 18 with the.National Institute of Environmental Health Sciences, 19 and-does that organization have a publication? 20 A. It does. It's. called Perspectives .in Environmental 21 Health.. 22 Q. And have you had papers published, one or more 23 papers published in that particular journal? 24 A. Yes, the one I think that has been probably most oy 1 useful is the one that we talked about this morning, and that 2 is in a task force-..which was organised to develop a 3 description of the needs in environmental health research. 4 One of the committees of that task force addressed the issues 5 of. the problems of specific organ systems like the liver, the 6 pancreas, the nervous system, and I was asked to develop a 7 paper on the state of the science in environmental health 8 with respect to the skin, which we did and also to describe 9 the research needs of that at that time, and the -- as a 10 result of that effort, some of the papers were published in 11 Environmental Health Perspectives, and the one y o u 1re 12 referring to is called The Environment and the Skin and what 13 it does is simply describe the defenses of the skin, the 14 adaptive mechanisms of the skin, physiology and chemistry of 15 the skin as we know it, and some of the major problems of the 16 skin in relation to the physical environment, chemical 17 environment and biologic environment and what some of those 18 needs were for further research. 19 Q. Sir, have you had occasion to v/rite chapters for 20 books? 21 A. Yes. One book,, which is rather extensively used by 22 dermatologists and those ;v/ho want to know something about 23 dermatologic problems in relation to general medicine is a 24 book edited by Dr. Thomas Fitzpatrick of Harvard and his ou J1L staff and Dr. Edward Emmett, w h o 's a resident and. graduate 2 student of mine, and I wrote a chapter on occupational 3 dermatoses, and it has to do with the frequency of the 4 problems, again the defenses, the etiologic aspects of it, 5 how to take.a good history in an occupational skin problem if 6 a problem is suspected of being occupational, the methods of 7 diagnosis and the -- in it, and this is for physicians, we 8 also stress and underscored the importance of-knowing 9 something about the work place, knowing something about the 10 environment and the work place, not just treating the patient 11 in the office, but knowing.what the individual has been or is 12 exposed to, knowing what kind of hygienic practices go on in. 13 the plant or in --- on the farm if it happens to be an 14 agricultural problem, and this chapter was in Dr. 15 Fitzpatrick *s book. 16 Q. . Did .you write 'a chapter in a book that was 17 published by the American Association for the Advancement of 18 Science? 19 A. Yes. I can't remember the exact date, but it's in 20 the sixties, I believe, or late fifties. We 'were asked by 21 the Association for the Advancement of Science to develop a 22 symposium on environmental skin problems, and I was asked to 23 'present a paper on etiologic factors and the- pathogenesis or 24 cause of 'pre-nalignant and malignant lesions of the skin, and O_L 1 we did that by examining all of the data which we, had up to 2 date on the effect of sunlight on the skin and the fact that 3 most skin cancer in man is as a result of exposure to 4 sunlight and plus the characteristics of the skin of the 5 individual, which is a genetic factor, so the pale Caucasians 6 are much more susceptible to the sun burning rays of the skin / and have a much higher frequency of skin cancer than people 8 from the Mediterranean area or from Mexico or blacks. 9 And then we went on to demonstrate that some o the 10 problems of the skin cancer could stem from chemical sources 11 so that things like polycyclic aromatic hydrocarbons -- 12 y o u 'll have to pardon me for using that term, but it* s the 13 chemical component.o f , let's say, coal tar, which we know 14 with frequent exposure the skin can cause skin cancer , and 15 people that handle a lot of coal tar or pitch', and we have \ 16 done some experiments within the lab to show that cer tain 17 chemical agents like benzo-a-pyrene, a polycyclic aromatic 18 hydrocarbon, which is carcinogenic, can be made more 19 carcinogenic by so-called promoting agents, and the promoting 20 agents that we identified in our laboratory with Dr. Whorton 21 happen to be long chain hydrocarbons that are often found in 22 ITti j.I]0 i._Leo For exam pi if sha"Le oil refineries, while the 23 shale itself might not have a lot of polycyclic aromatic 24 hydrocarbons j.n i.fc the shale product s might be very . o/. 1 carcinogenic because of the promoting agents in i,t. 2 It was not only a status report paper, but a paper 3 which actually included some of the work that we had been 4 doing at the Kettering Laboratory. 5 0. What does the terra pre-malignant.mean? 6 A. Pre-malignant means a lesion of the skin, which 7 may, may go on to becoming cancerous, but may not. For 8 example, we know that people of light skin, longstanding 9 exposure to sunlight develop actinic keratosis or these 10 heaped up lesions on the face and the hands. They can, they 11 are pre-malignant, and they can go on to forming cancer, but 12 not necessarily. 13 Q. Nov/, over the years, sir, have you had occasion to 14 give presentations at various conferences? 15 A. Yes, I have. On a number of occasions I've given 16 presentations to meetings, within this country and overseas in 17 Japan and Chile and Great Britain and in Leon for the NIEHS J~iLOO and so on 19 Q. Directing your attention to t h e `MIEEIS conference, I 20 thin k , in 1973 did you give a presentation at that and can 21 you tell us a li-ttl e bit about it? 22 A - T h a t 's a very interesting question, because in 1973 23 the medical and scientific community had become alerted to 24 the fact that there were populations that had been exposed to 65 1 tetrochlorodibenzodioxin, 2,3,7,8-TCDD in the work place in a 2 number of industries throughout the world, and we did not 3 know what the state of the health of those workers were, and 4 we -- they were reported only after.an accident perhaps, but 5 they were never really followed up, and in 1969 with the 6 Vietnam use or the use in'Vietnam of Agent Orange and the 7 study by a laboratory for the government that found that TODD 8 was -- had an effect on the reproductive system in animals, 9 in rats, plus the fact that by that time there was an 10 epidemic of chloracne and other symptoms in Japan caused by II the accidental ingestion of pcb's, with all that in place the 12 scientific community was alerted we ought to do something 13 about these things and study them so we know what the short 14 term or long-term effects are. 15 And the NIEH3 called a meeting in Research Triangle 16 Park, Worth Carolina, and I was asked to present a paper 17 there in 1973 on chloracne and other clinical manifestations 18 of exposure to T C D D , which we did. It was the only paper in 19 that' meeting, I believe, that addressed the clinical issues. 20 The others were about environmental issues, about toxicology, 21 but there were no others that were presented on clinical 22 issues. ' 23 Q. How, in 1975 did you have some connection -with the 24 Japanese society in a conference held there? A . Well? in 1975 I was asked to ta1k to or present a 2 paper on occupational and environmental allergic problems of 3 the skin before the Japanese Society'of Allergology .or. d Congress of Allergology? which has to do with allergy? and tills w a s .m Okayama and presentee' a paper on summarizing wnar w e `knew about new environmental problems which caused skin 1 hypersensitivity, and the paper lists all of the new 8 rnrormar lorn about produc ts tnat.are used in rtagranees anu 9 cosmetics in the v/ork place that may give rise to allergic 10 p 'COQJ. 0FtlS ii We had at the time been doing a study of organic -- of aldehydes? aroma aldehydes used in flavors and cosmetics and fragrances and found that there were certain agents that inhibited in man? certain agents that inhibited the allergy producing characteristics of `these aldehydes, and the paper, also describes some of the new work that we had been doing on these aroma aldehydes and the so-called quenching- effect of agents in guinea p i q s t io Q. Then? in 1978? sir? did y o u `have any participation i. n cl v/o r: [z n 0a. j. 'Ci< y .. l o u p again wi t h FTI BHS a na j:arc ? A. '0 0 / in - a c t u a l "c n e .le WLiS a n jLn t e r Vet. m e e tin g in -L.V7 5, ' A ft 0 U th e ' 73 iiiee t :i.ng t h e r e we S ill sin al _L' iTi.e e t in g in Re;Fee v'c Tl T r j 11Ci ; p a r k c a l 1 ,-n I e 11e'. Qu a i l KOOiit me e t i ng b e c a u s thatwas tns nan 1 people, a handful of people got together to talk about what 2 they were doing. 3 In 1978 the NIEES and the International Association 4 for Research Against Cancer, which is IARC, it's a WHO 5 organisation, felt that it was about time we brought together 6 people from all over the world who knew something about 7 especially the industrial exposure to TCDD and the 8 dibenzofurans which are found in.pcb's, and this was the 9 meeting at which I was asked to give a paper on chloracne and 10 associated problems in the manufacture of 2,4,5-T, of which I 11 believe you have a copy, and what we did in there is simply 12 describe our experiences examining workers that have been 13 exposed to a runaway reaction back in.'1949, following them 14 for three years or four years, and then what we knew about 15 followup. 16 Q. Where did that meeting take place, sir? 17 A. . It took place in Leon, France, where there is the 18 offices of the international association. International 19 Agency for Research against Cancer, which'you referred to as 20 IARC. , . 21 Q. I was just going to ask you what IARC'meant? 22 A. International Agency for Research against Cancer. 2 Q. Now, in 1960, sir, did you participate in a 24 presentation with the National Academy of. Sciences? 1 A. By the time we held the Leon meeting Seveso had 2 occurred. There was this runaway reaction in a plant making 3 trichlorophenols in ICMESA or M a d a , the ICHESA plant in Mada 4 near Milan, and that story is rather 'well-known and by that 5 time the scientists in Italy had already gotten a fair amount, 6 of information about the effects on children, the effects on 7 adults, the effects on the workers themselves, and it was 8 kind of important that they be incorporated also into the 9 IARC meeting, which they were. 10 In 1980 the National Academy of Sciences decided 11 that they should bring in, bring the Italian scientists back 12 to the United States for a three-day conference, 'which was l.} held at the National Academy, and I gave two papers at that14 conference. One I was asked to give a paper on the clinical 15 manifestations of 2,4,5-T exposure, which I did. The Italian 15 scientists and physicians were very anxious to find out what 17 we knew about it, and they shared a lot of their information 18 with us, incomplete at the time, but they did share it. 19 Q. Now, in 1980, sir, did you publish a paper with 20 Judy Zack? 21 A. Yeah. The work on this -- the idea to do a 22 retrospective study, a mortality analysis of a group exposed 23 to TCDD, the idea actually arose earlier, and by the time we 24 went to Leon, this 'work was already going on, and that is o/ 1 that the epidemiologist at Monsanto, and we couldn't have 2 done this without the help of Monsanto records, the 3 epidemiologists at Monsanto and I developed a scheme for 4 identifying who was still alive of those people who were 5 exposed back in 1948, 1948 and '49 who were exposed to the 6 runaway reaction as well as those who were exposed to the 1 7 usual process of making 2,4,5-T, and it was our feeling that b the first thing to do was to do a study of what we regarded 9 as the most heavily exposed population, and the people 10 exposed to the runaway reaction in our view were the most ii heavily exposed, and they were identified and the mortality 12 analysis was about that group. 13 Q. W e 'll be addressing that in more detail later, Dr. 14 Suskind, but I wanted to just mention it. In 1984 did you 15 and Dr. Kerzberg publish a paper? 16 A. Yes. ..In 1979 we returned to the site of the 17 manufacture of 2,4,5-T, which had been discontinued some ten 18 years before, in order to do a study of the populations which IS were exposed to that process, whether they were in the 20 runaway reaction or not and compare that group to the 21 unexposed and see what the long-term effects were, what 22 happened 30 years after they were exposed. We knew What happened right after they were exposed. We knew what 24 happened for four years after they were exposed, but we o o. 1 didn't know what- the state of the health of these, people who 2 were exposed 25 to 30 years afterwards, and that-was the 3 nature of that study published in the Journal of the American 4 Medical Association" in May of 1984. 5 Q. And, sir, we mentioned this morning the Agent 6 Orange publication on behalf of the American Medical 7 Association, you participated in that as well? 8 A. Right. 9 Q. Nov/, did you have occasion, sir, to make a 10 presentation at Michigan State University? 11 A. Y e s , we did. 12 Q. All right. And did you prepare a paper as a result 13 of that presentation? 14 A. That - I was asked by the group at Michigan State 15 that was organising this meeting on the dioxins in the 16 environment, which eventually was published as a book, to 17 give a paper on the health effects of -2,4,5-T and its toxic 18 contaminants. IJhat I did essentially was to recount the IS story from 1949 until the day that I gave the paper to tell 20 them what I knew, about it, including some of the studies that 21 we had done, especially the earlier ones as well as the one 22 back in 1979, and I summarized the findings as I described 23 them in that paper, that is, my findings. 24 (Defendant's Exhibit 1692 marked for 1 identification.) 2 Q. All right. Dr. Suskind, let rne hand you sir what 's 3 been marked as Defendant's Exhibit No. 1692, and I 'd ask you 4 to examine that and identify it for us please. 5 A. This Exhibit 1692 is a reproduction of Chapter 17 6 of the book on dioxin in the.environment, which was the paper 7 which I gave at the meeting in December, 1983 at East 8 Lansing. 9 MR. HEINEMAN: Your Honor, at this time we would 10 move the admission of Defendant's Exhibit -- is that 92? 11 THE COURT: 92. 12 MR. CARR: Is this it, counsel? What is the 13 chapter? We have no objection to it, Your Honor. 14 THE COURT: I t 's admitted without objection. 15 Q. Nov; sir, I -wonder if you would tell the Court and 16 jury briefly what-this presentation is about? 17 A. The presentation, as I indicated, simply describes 18 ray experience with the workers who had been exposed to the 19 making of 2,4,5-T,. including its toxic contaminants, among 20 which was TCDD, and it describes the accident of -- or the 21 runaway reaction of March of 1349, the fact that we were 22 e:d examine our of the most severely effected persons 23 .Lnci nnati, the followup c>n those exami nations in 1950, 24 'chen a further group who were examined in 1953, some of rt O iu 1 whom viere exposed to the runaway reaction, and others simply z exposed to the manufacture of 2,4,5-? itself. 3 We also describe some.work that we did on 4 determining'.how -- how the sebaceous gland reacts to',. 5 chloracnegens. We did that in '53, but we didn't know that 6 this chioracnegen Was. TCDD, and then further we summarise the 7 acute clinical findings and. the subacute or subchronic 8' findings, clinical findings and laboratory findings, and then _G/ finally what we would regard as the long-term effects of TCDD 10 on humans. n 12. Q. Now, did you prepare tables in that paper, sir, discussing those subjects? 13 A. Yes, in this exhibit on Page 238 there are three 14 tables, which-one describes the acute, which follov/ed the 15 runaway reaction of March, 1949 , the subsequent effects or 16 the subacute effects after the acute effects subsided were 17 subchronic effects, the effect that lasted maybe for a year 18 or two and then v/hat we found 30 years afterwards were the 19 long-term human health effects which we believe describes the 20 long-term human health effects of TCDD. 21 (Defendant's Exhibit 1592.A, B, and C marked for 22 identification.) 23 t Q. Dr. Suskind, let me 'and you what's first been 24 marxed as Detenoan'c 's Ahibzt 1692A and ask you to examine. 1 that and identify it for me please. 2 A. This is a reproduction and enlargement of Table 1 3 from that exhibit. 4 Q. Ail right/ sir. And would this Exhibit 1692A ^5 assist you in your testimony? 6 A. Yes, sir, I believe so. 7 Q. All right. Let me get these others identified as UO well. Show you 1S92B, sir? '.9 A. This is a reproduction and enlargement of Table 2 10 of that paper given at Michigan State. 11 Q. All right, sir. I 'm sorry? 12 A. And it's accurate. 13 0. Would this -- would, this assist you in your 14 testimony as w e l l , sir? 15 A. Yes, I believe it wou l d . 16 Q. All right. And again Defendant's Exhibit 1692C, 17 sir. 18 A. This is an enlargement of Table 3 from the same 19 paper listing the long-term human health effects of TCDD. 20 Q. Ail right. Would this assist you inyour 21 testimony? 22 A. Yes, I believe it would. 23 MR. HEINEMAM: 'Your Honor, at this time we would 24 move the admission of 1692A, B, and C. //. 1 MR. CARR: No objection, Your Honor. A THE.COURT: They're all three admitted without 3 objection. f 4 HR. HE INEMAN.: Thank you, sir. 5 Q. Now, Doctor, I wonder if I can put 1692A up here, 6 and if you wouldn't mind stepping down and discussing these 7 exhibits with the jury. 8 A This list of clinical effects, health effects were 9 observed in a variety of accidents, among them the one.that 10 occurred at Nitro, West Virginia, and what happened 11 essentially is that the kettle in which trichlorophenol was 12 being made blew a valve and the material came out in the -- 13 in the plant and some of it outside. People went in to clean 14 it up, and they were exposed in retrospect not only to TCDD, 15 but they were exposed to trichlorophenol and trichlorophenol 16 is very irritating, and what they experienced actually was 17 irritation of the eyes, irritation of the respiratory tract, 18 the nose and throat, and even nausea and vomiting, which is a 19 symptom of gastrointestinal.effect. They experienced headache 20 and ill.at ease, they felt sick. Those people who were in 21 that cleanup operation quickly got out, and they didn't 22 return for a little while, but we feel that these acute 23 effects are probably less due to TCDD than to the irritating 24 chlorinated phenol. J1L 0o All right, sir. 2 A . If I can go on to the next one. May I? 3 Q. Please do. 4 A. After the acute --- o h , 'incidentally the same occurred in Seveso with that toxic material coming out of 6 also a trichlorophenoi kettle. The people who and the 7 children especially who 'were exposed to that toxic cloud, -so na to speak, developed eye irritation, respiratory irritation, 9 and GI symptoms. 10 These effects that I have on Table 2 are those 11 which usually follow these.acute effects, and sometimes there 12 are no -- these acute effects, but it takes a little while 13 after the beginning of the. exposure to TCDD for the features 14 of TCDD toxicity to occur in humans, and what are they? The 15 first thing that occurs is that people develop acne, and the 16 acne usually occurs on the face. In instances 'where the 17 exposure is severe it may occur in other areas' as well, and 18 we can show you pictures of some of those. 19 So that in all instances the effect that was 20 noticed first was acne, and then there are some who we have 21 seen both in OUi own population tnat V70 StUQ .10Ci as well as 22 ot 0 l sw n0 r0 they develop pains in the skeletal iilUyCi.03 ? in 23 th0 a rra0 ai1g the legs, shoulders and the back, 5Liid along v/ith 24 the p a i n s 'in the muscles, whieh is due to a toxi-C effect on 74 1 the peripheral nerves ? the nerves -that supply thse muscles , 2 the voluntary muscles, and that occurs usually well after the 3 acne occurs. In one instance where we did a biopsy of such' a 4 nerve in a leg of one of the first people we examined, we did. 5 find some pathology within that nerve.. 6 We also found that those who were heavily exposed 7. may develop liver function problems, their liver may become b enlarged, it may become tender. It usually d o e s n 't last very 9 long, but an indication that the liver may be affected ana 10 this is in not everybody who develops acne, but only some who 11 are perhaps more heavily exposed, they develop abnormal., 12 laboratory tests for liver function so-called SCOT, GGPT in 13 the day in 1949 these, did not exist for us, they weren't 14 done at the time and the only laboratory test that we had to 15 indicate abnormal'liver function was the so-called 1'O prothrombin time, and the prothrombin time was elevated and 17 the prothrombin concentration 'was decreased, and we also found and others have found -- we d i d n 't find elevated 1.9 t riy1yce rides 'irl our group, but others have found elevated onw t rig1yce rida s in thos 0 wrio nave ciiioracne ano are being' /** exposed to TCI3D,. and they may have elevated liver enzymes. 22 Again this is in the subacute stage. In many instances the skin is also affected by becoming discolored or hvperpiamented. The skin as a. re-suli /j -TL of being exposed to TCDD or associated substances becomes 2 sensitive to sunlight, and the sensitivity to sunlight is 3 shown in the fact that they become dark skinned. They 4 develop hair around the area-where they have their acne along 5 the cheek bone. And we did find, too, that those who had 6 other systemic manifestations may have been irritable, 7 nervous. 8 Now I !m going to '.also talk a little bit about the 9 o t h e r .finding, which is reported, the porphyria. Porphyria 10 by -- when we did this paper, the only thing that we knew 11 about porphyria was that that skin problem called porphyria 12 cutanea tarda, which means blistering of the skin due to 13 exposure to sunlight where the porphyrins are elevated, and 14 that can be determined by examining the urine for porphyrins 15 in a 24 hour sample. There were only two experiences in 16 which porphyria occurred in industry . 'One -was in Spoiana, 17 Czechoslovakia where the -- they were making 2,4-D and 18 pentachlorophenol and 2,4,5-T. The other one was in New 19 Jersey at. the Diamond Alkali plant whe.re they were, making 20 2,4,-D and 2,4,5-T. 2.1 Well, we say that this is rare and only occurs on 22 this chart, say it occurs in mixed .exposures, We now l low 23 frorn recently acquired evidence? matter of fact the 24 Czechos1ova k ian evidence is not so recent, but -that /b 1 hexachlorobenzene, which is a different, chemical'-.agent was 2 used in the Spoiana, Czechoslovakia plant and 3 hexachlorobensene is known to cause porphyria cutanea tarda 4 and disturbance in heme metabolism or porphyrin metabolism.' 5 In the Diamond Alkaliplant it's been recently shown by going 6 back and studying the records, recently shown that these 7 people were also exposed to hexachiorobenzene. If you go 8 back to the original paper by Bleiberg on the Diamond.Alkali o group that had porphyria cutanea tarda, he says in his paper 10 that it -- this eruption was very much like that-which occurs 11 in exposure to hexachiorobenzene, but he d i d n 't know, cause 12 he wasn !.t in a position, he d i d n 't know at the time that the 13 were using hexachlorobensene in that plant. 14 So much for the subacute or subchronic' effects,. In 15 most instances, in all instances that I know of and I have 16 studied severely hundred now, the neuromuscular symptoms, the 17 aches and pains and the neuritis subsides with time'/as does 18 the liver problem as does the hyperpigmentation and as does 19 the nervousness, so that when y o u get to 30 years afterwards 20. and you loo k at the human health effects in a population 21 known, to be exposed to TCDD and who have had a c n e ,.what you 22 -- what you find is that in about over fifty percent of the 23 t)0opiQ Vvno were exposed and who had acne at one time may 24 still have their chloracne, not severe, but they still have 77 1 evidence of it., and you also find that these people have 2 associated with it. changes in the elastic tissue of the'skin 3 like farmers' Skin, and it usually occurs in greater 4 frequency a-round .the chlora.cne, and they still -may have their 5 hairiness of the ;face. 6 We did find also that if one took a medical 7 history, which was only by medical history, that it appeared 8 that among the exposed there was an increased frequency of 9 upper'GI ulcers any time, and we d o n 't-know- why that is.so, 10 but that was one of our suggested findings. We also found 11 that if the individual who was exposed smoked and still 12 smoked, when we examined them, that is, at the time we . ., 13 examined them, that there- Wa-s an -- among the exposed there 14 whs' an abnormal, an increase in abnormal pulmonary function 15 tests, that, is, their lungs functioned.less well if they were 16 exposed and smoked than if they were not exposed and smoked. 17 We also found 'that the high density lipoproteins, 18 there were a greater frequency of abnormal -values of the high 19 density lipoproteins, one. of the blood fats that is rather 20 significant,'among those 'who still had being are acne, who *")1 SC 111 nao acne as compared.to the. 3;cposed who d i d n 't have /./A. acne.. (So Liia'c there may be a iip id disturbance reflected oo .1 w the high cle n s itv lipoproteins among those who still have 24 the! r'"a cn e . 1 Q. ' Dr.. Suskind, I notice in the left hand column of 2 each of those or of the last two boards you have the terms 3 constant and inconstant or common and suggestive. I wonder 4 if you could explain those terras to the jury? 5 A. ` Okay. In our experience people who are exposed to 6 TCDD and have had any kind of health effect the first 7 evidence of health effect is acne. That is constant. And 8 those who develop acne may also if th e y 're exposed to high 9 enough concentrations of TCDD:, and we don't know what those 10 are, by the way, because there are no. have been no human 11 studies to determine the dose response relationship between 12 TCDD and acne or TCDD or any other health effect. 13 The inconstant means that it doesn't occur in 14 everybody who has acne, it only occurs, in some of the people 15 who have acne, that is, the neuromuscular symptoms, enlarged 16 livers, and hyperpigmentation doesn't occur in everybody. It 17 only occurs in some, and irritability and nervousness occurs 18 in some. T h a t 's why we label those as inconstant, but the 19 only constant finding in humans, in humans exposed to TCDD, 20 the first constant, the first and constant finding is 21 chloraene. 22 How, in the long-term health effects vie have that 23 v/hich is a common clinical finding and those v/hich I have 24 regarded as being suggestive. Well, if y o u 're going by /^ 1 history and i t 's not completely verified by hospital records 2 or surgical records or doctors5 records, then you have to oJ say,, v/ell, it can't be absolute, it's only suggestive. 4 That's why we have put, that as a suggestive finding. 5 The abnormal pulmonary function among smokers in 6 the HDL the numbers are relatively small but statistically 7 significant, relatively small but statistically significant, On so that an epidemiologist who would look at this and say, 9 well, you d o n 't have enough numbers to really say it's 10 absolutely so. That's why- we say i t 's suggestive rather than 11 ab S01Ut.6 12 Q. wow, did you find, referring again to Table 2, sir, 13 do the inconstant features and findings occur i n .people who 14 do not have chloracne? 15 A. I have not seen this, not in ray experience. In my 15 experience I have never seen anybody who was exposed to 17 2,4,5-T or TCDD who developed neuromuscular symptoms and IS liver findings, hyperpigmentation and had abnormal laboratory 19 findings without having chloracne. 20 Q. -Thank you, sir. How did there come a time when you 21 participated in an -- in 1984 in an international Congress on 9 9 occupational health? 23 Q. 'A n d 'was there a paper that you published that ar,os< 1 out of that presentation, sir? 2 A. There w a s . 3 (Defendant's Exhibit 1693 marked for 4 identification*) 5 Q. Let rae hand you, sir,, wha't s been marked as 6 Defendant's Exhibit 1693 and ask if you would examine that 7 and identify it for us please. 8 A. This is a paper which I presented at the 9 international Congress on occupational health in October of,. 10 1984 in Dublin, and it was a paper that was requested by the 11 Congress a s -- there were several others, there were two 12 given in any one day over a period of three days, and one of 13 the. issues that they felt should be discussed was chloracne . 14 and dioxin, and I was asked to do that, before a plenary, 15 session, and this paper was the product of that presentation. 16 Q. . All right. Kow did it -come to be published, sir? 17 A. Well, all of the. invited papers were requested for 18 publication in the Scandinavian Journal of Work, Environment 19 and Health, w h i c h 'is published in Finland' in Helsinki by 20 their very distinguished Institute of Occupational Medicine, 21 and the editor of that journal is Sven Hernberg, 22 H-E-R-N-B-S-R-G, and he requested that I submit a manuscript 23 for publication, and T. did that, and it has been publi shed 24 already in the Scandinavian Journal of Work,. Environment, and 1 Health in 1985. 2 Q. All right, sir. And is that what Defendant's. Exhibit 1693 is is that publication? 4 A.. xtl io* 5 HR*' HEINEMAN; All right. Your Honor, at this time 6 we would 'move the admission of Defendant 's Exhibit 1693. 7 MR. CARR: May we approach the bench, Your Honor? THE COURT: Yes, you may. 9 (At this time a conference was had at the bench out 10 of the hearing of the jury.) 11 MR. CARR: ; On' what basis is it being offered? 12 MR. HEINEMAN: It's being offered as his paper that 13 he has produced. What do you mean what basis is it being 14 ortered?. M R .'CARR: I mean just that, on what basis? It deals with a 'lot of different people. . It d o e s n 't deal, 17 particularly on this case. It's a review article of other, 18 articles. I don't know any basis it's admissible into evidence. .- 20 MR. HE INEMAN:. It is. 21 MR.,CARR: It contains hearsay, it contains statements that others have said, it's .self-serving, it's OO argumentative, i t 's -- I see no --- 24 MR. HEINEMAN; It is a recitation of this m a n 's 82 1 opinions. 2 MR. CARR; Yeah. 3 ..MR. HE INEMAN: With respect to chloracne and 4 dioxin. It is a paper he has published. You have the author 5 of the paper present for cross-examination, and, therefore, ., 6 certainly it is not, would not be barred by the hearsay 7 rule. It is information that he has developed, and he's here 8 to be cross-examined upon it. He Vs. the author of this.: 9 document. 10 . MR. CARR; Because he's'the author of the document II doesn't make it admissible. There's no basis that I know of 12 that it's admissible. This is, apparently his testimony in. 13 written form. I certainly object to this. There's no *-- 14 there's arguments in it, it's argumentative, it's -- it's 15 just a self-serving document prepared by a. long-time agent of IS Monsanto, which they 'want, to put into the jury to give their 17 particular views of the evidence, including things about 18 Times Beach that he has no knowledge of, including things 19 about Vietnam veterans,. Ranch Hand that he has no knowledge 20 o1 , a1 x kxnos of things that this man has no knowledge of. 21 MR. HEINEMAN: On the question of whether he has 22 knowledge of it can certainly be gone into in 23 cross-examination, which may go to the weight of the document 24 but certainly not as to its admissibility. 1 before chloracne, but the evidence shows, the population 2 studies show that that usually doesn't occur. 3 Q. Mow, are there any specific incidents that you have 4 reference to when you say you have examined hundreds of 5 people and are there -- what.incident, what are you talking 6 about? 7 A. I'm talking about first exposures-to chloracnegens, 8 and the largest group that we had an opportunity to study is 9 the Nitro group, but we have also looked at and examined 10 others who have developed chloracne and done and have looked 11 at their laboratory findings and find that if they don't.have 12 chloracne, the laboratory findings are usually not abnormal 13 or they don't have other systemic manifestations without the. 14 chloracne. 15 Q. I'm sorry. Go, ahead. I, interrupted you. 16 A. I say they.don'thave other systemic manifestations 17 without the chloracne. 18 0. What is the difference or is there a difference 19 between intoxication and exposure? 20 A., Exposure simply means that'one. is in an atmosphere 21 of a toxic agent, one is in an atmosphere of a toxic agent 22 and may. absorb some of that toxic agent. Intoxication is the. 23 biological, the adverse biological effect of that absorption, 24' whether it comes-through the skin or the respiratory tract or 84 1 think it is. 2 (The following proceedings were had in open Court.) 3 Q. Dr. Suskind, do you have an opinion as to whether 4 or not acne is a hallmark of dioxin intoxication? 5 A. Yes, I do. 6 Q. What is that opinion, sir? 7 A. The opinion is that the first biological effect 8 that one observes in persons who are exposed to TCDD is 9. chioracne, and as such it is the hallmark. Without it you 10 don't have other biological effects. 11 Q'. Nov; -- 12 A. And I think this has been borne out by studies even 13 since that paper was. given. 14 Q. And what' do you -- upon what do you base your 15 opinion with respect to chioracne being the hallmark of 16 dioxin intoxication? 17 A. Well, I myself have made observations on several 18 hundred people -with chioracne, and chlo.racne from .TCDD, IS chioracne from pentachlorophenol, chioracne from the 20 contaminants of dichloraniline, and there are no systemic 21 manifestations in these people, including laboratory 22 disturbances unless there's the chioracne. 23 .H o w , this is not -- there are a number of opinions 24 given that why shouldn't one have laboratory disturbances 2 MR. CARR1; It's hearsay if he has no knowledge of 2 it, counsel. 3 THE COURT: Let me take a look. I haven't seen 4 this. Let me take a.quick look at it. 5 MR. CARR: When was this supposed to have been given 6 to us? I don't recognize ever having seen it before. It 7 doesn't mean that I haven't seen it, but I certainly don't 8 recognise it. When was this given to us? 9 .MR. .HEINEMAN: I can only assume it v/as provided to 10 you with the other materials.'- That' s'my understanding. 11 MR. CARR: It was not included in the other 12 materials that's given to us today. I haven't read it 13 before. The fact that he is the author of this document is 14 not a grounds for its admission. I could use it to 15 cross-examine him on, but. the fact that he's the author 16 doesn't, make it admissible. 17 MR. I-IEINEMAN: It is a written statement of his 18 opinions. 19 M R . CARR: It is, yes. 20 .MR. HEINE MAN: And the facts that he has gleaned, 21 and he j.3 cer ta inly permitted to testify about thes e thing 22 and h e 's here for c ross-examination about them and to that 23 end i believe it's admissible. 24 THE COURT: Okay. Objection sustained. I don't GO 1 the gastrointestinal tract. People become sick, that's 2 intoxication. 3 Q. All right. Nov/, what- is the relationship betv/een 4 chloracne and exposure and intoxication? 5 A. Well, there are any number of people, including 6 many.people in this room who have been exposed to TCDD in: two 7 different ways, one from 1948 to 1969, 2,4,5-T was being used 8 in' lots of gardens and along throfares and railroad 9 rights-of-way to get rid of weeds, and we were exposed to 1 it. I was, you were, and some of us are still being exposed 11 via incineration, and th a t 's exposure. We're not sick, we're, 12 not intoxicated, and we don't have chloracne. 13 So that a level of absorption has to be reached in 14 order for an adverse effect. These, Mr. Heineman,,the simple 15 principles of,toxicology, one does differentiate exposure, 16 absorption, and adverse effects, and usually it takes a level 17 of absorption and a level of body burden to be reached to 18 develop symptoms. For example'., many of us have been exposed 19 to lead from a variety of sources,-but -we-don't have lead 20 poisoning. > ' 21 Q. All right. How,, are you aware,' sir, that Dr. Ellen 22 Silbergeld has testified in this courtroom? 23 A, I was aware that she had. '. 24 Q. And she testified, sir, that --- I 'd like you to oi 1 assume, if you'would, that she testified that 2 MR. CARR: What page, counsel? 3 MR. HEINEMAN:'Page 125 on April 12th. 4. Q. That high dose is required to produce chloracne, 5 and chloracne is not a reliable indicator of exposure. Do 6 you agree with that statement? 7 A. Absolutely not. First of all. Dr. Silbergeld, 8 who's nqt a physician, has had absolutely no experience in g studying populations who have been exposed to chloracnegens, 10 and the 'assumption that she makes is an unproven assumption. 11 and .1 disagree with her completely. There's no sc ientific . J1L1 ha s is for what she says. 13 3. N o w , sir,, in connection with ;-- I'c3 like to pass on 14.. from the publications 'which you have made and talk about 15 government grants a n d .contracts which y o u 've had. Can you 16 tell us --17 THE COURT: Before you get into that, is this a good 18 point for a;break? 19 HR. H E INEMAN: Oh, sure, Judge.' 20 THE COURT: We'll take a short recess at this time 21 and then resume testimony. 22 (At this time, the following proceedings were had in. 23 chambers out of the hearing of the jury..) 24 MR. HE!NEMAN: Want to go back on the record, Judge. bo i THE COURT: Right. 2 MR. HEINEMAN: In connection with the dates problem 3 with Dr. Suskind, I have spoken to him about the Louis 4 Livermore thing. He says that that is a .commitment that, h e 's 5 made to the federal government, it's a U.S. government 6 sponsored thing, and he says that he's just, he's committed 7 to them. He said he just can't go back on that now', and he 8 did give me three, more dates in March that he could make - 9 available. He said he can't be here on the 5th, 6th and 7th, 10 but he could do it on the 10th, llth and 12th of March, he 11 could be back. He's got -- if I go through Friday, that 12 would give with the. present schedule would give Rex eight 13 days to cross-examine him. 14 MR. CARR: I think that w o u l d .-- .I'm not concerned 15 about finishing by then. I think I can -- of course, I don't 16 know wha t he ss saying thus far . .I don !t know what he's going 17 to say, but T can't -- based upon what he's saying right now 18 .1 know I wori- need eight days, but I d o n 't know what y o u 're 1_Q/ going to g o th rough. I .imagine, from what :you 've g iveri me i 20 imagine y o u 're going to go through the K rumm ri.ch plant stody, 21 you're, going to go through the Kfitro study. At a minimum I 22 know y o u 're going to do those things, I assume. I d o n 't khov; 23 what else you're going to do. 24 MR. HEINEMAN:/ We told you in that submission what 1 we were going to do. 2 MR. CARR: That submission is worthless. All it is 3 is broad general statements. 4 MR. HEIMBMAN: Well, they're broad. 5 MR. CARR: And other witnesses have not testified 6 that way. 7 MR. HEINEMAN: Well, I can assure you that he's 8 going to discuss Nitro and Krummrich. ' 9 MR. CARR: Well, it is ray judgment, Your Honor, but 10 I d o n 't know how valid it is that eight days will be adequate II for me to cross-examine this doctor. My objection is to the 12 recess in the middle of the cross-examination, primarily 13 objection, ray primary objeciton is taking these.two 14 additional days off' in the middle of what will be my 1 J- .J cross-examination. 16 THE COURT: Where's he supposed to be the. 5th, 6th 17 and 7th? . - 18 MR. HEINEMAN: I don't know. 19 MR. MASSIF: He's back in Cincinnati for a 20 conference that he's chairing I think is what he said. 21 MR. HEINEMAN:' X d o n 't remember what the 5th, 6th ->o and 7th w a s . 23 HR. MASSIF thought he"was chairing a conference 24 in Cincinnati. U 1 MR. HEINEMAN: T h a t 's right, he said he had to be 2 back on the 5th. 3 MR. HEINE MAN: You know, I don't care about, 4 interrupting my part of it. c; THE COURT: Pardon? 6 MR.'.HEINEMAN: I don't care about interrupting my 7 part of it and bringing him back. ' 8 MR. CARR: I do. I most certainly object to that. 9 That's like having a direct examination all over again. You IQ nave to cross all over again. 11 THE COURT; It's, really not good when that happens. 12 It's something that should be avoided if at all possible. 13 Let's see. Do. you figure on finishing Friday? 14 MR. HEINEMAN: I think so. Judge, yes. 3.5 THE COURT: Umbra.. What did he say the- meeting' 'was 16 about the 2.0th and 21st? 17 MR. -HEINEMAN: It's, the -- 'it* s',a federal 18 government program involved with the Defense Department on 19 the Lawrence Livermore Laboratory, and it is a thing that's 20 been set up by the government, and he has committed to do it, 21 and that's the date that the government selected for it. 'He 22 didn't select the'date..He's committed to do it, and t h e y . 23 said this is when it's going to be. 24 MR. CARR; Well, the government could, you know, >` . - y.i 1 the President's Council on Aging is something set up by the 2 government, it goes on the president, his council on birth 3 control, there's all kinds of things set up by the 4 government.. Just to say that it's a government sponsored' 5 thing is a meaningless statement. T h e r e 's thousands of 6 conferences go on all across the country that are government 7 projects. 8 MR. BE 3ENEMAN: That's certainly true. , .9 MR. CARR: You haven't given us, at least I don't 10 understand there to be anything affecting the defense of the 11 JL country by his ---- I don't undersand' what it is that he's 12 supposed to be there for and what he's supposed to'do. 13 THE COURT: Until get some further information I 'm 14 going to hold to my previous ruling. I'm open to any further 15 information. I don't want to take any more time now. Let's 16 go back in.. 17 (The following proceedings were had in open Court.) 18 Q. Dr. Suskind, if I can direct your attention a 18 moment, again to D.efendant1s .'Exhibit 1593, which you have 20 before you there, how does an author know when h is pape r oi_L peer-reviewed? 22 A V7e _L _l , i think it i . ^ o rathe r obvioiis that one gets 23 irOKi the editorial office of the pub lication comments and 24 requests for either changes or additions or elimination of 1 sections, sentences or whatever. I described earlier how a 2 journal usually asks one to peer review, and when I send in 3 an article for publication or for being considered for 4 publication, I get comments' from unnamed, reviewers, usually 5 two, sometimes just one, describing their appraisal of the 6 paper. 7 Q. T h a t 's forwarded to you by whom? Onr* A. By the editor's office. 9 Q. Of the journal to whom you've submitted the paper? 10 A. Right. 11 Q. Did you receive such comments with respect to 12 Defendant's Exhibit 1693? 13 A. Are you referring to the chloracne hallmark paper? 14 Q . . Y es , s ir . 15 A. Yes, I did, and as a matter of fact, there were 15 some editorial -- 17 MR. CARR: Your Honor, may I approach the bench. 18 THE COURT: Yes, you may. 19 (At this time a conference was had at the bench out 20 of the hearing of the jury.) 21 MR. CARR: Your Honor, t h i s `witness has been 22 instructed that h e 's not to say what others have said, the 23 fact that he's had conversations with others,.peers or 24 otherwise, as to what, as the Court knows we had this -- 1 approached this with this last witness, counsel is supposed 2 to have instructed his witnesses that they are not to come 3 out with these statements that I have discussed this matter 4 with other people and I have been told they agree with me or 5 they disagree with me or what they say, and in addition to 6 that, I want to make sure that this witness has been so 7 instructed. In addition to that, Your Honor, I thought the 8 objection had been sustained. 9 THE COURT: I did sustain the objection on whatever 10 that number is. 11 MR. CARR: 1693. 12 MR. HEINEMAN: Your .Honor, I'm trying to establish 13 that the document was peer reviewed. 14 MR. CARR: I'll stipulate it was peer viewed* 15 THE COURT: Okay. Then it's irrelevant. 16 MR. HEINEMAN: The -- Your Honor, there has been 17 admitted into evidence by Mr. Carr's previous stipulation all 1Oo kinds of documents, all kinds of peer-reviewed papers, which 19 Dr. Silbergeld was questioned about, which Dr. Carnow was 20 questioned about, peer reviewed papers that have been 21 admitted into evidence. 22 MR. CARR: Your Honor, we have had this same 23 discussion so many, times I don't believe counsel is .still 24 doing it. y4 1 THE COURT: You know, almost all these objections 2 are waivable. The fact that either one of you might have 3 waived an objection before does not mean you are foreclosed 4 from asserting that same type of objection on something 5 later. I've been in that position, ybu've been in that 6 position. If he waived a similar objection at a previous 7 point in time, that's his professional judgment just as i t 's 8 been the same with yours. The objection was made, I- have -' 9 sustained the objections The fact that he might have decided 10 to waive it with some other documents is his judgment. 11 (The following proceedings were had in open Court.) 12 Q. Dr. Suskind, we h a d .begun just before the break to J-. O ^ talk about grants and contracts from the government. Would 14 you 'cell the jury what a principal investigator is? 15 A. A principal'investigator'is the responsible 16 person. In this instance, a. .responsible, -scientist who . 17 develops a grant application or a' contract application for 18 the support of his or her research, and the -- if the grant . 19 is awarded, contract: is awarded, th e .principal investigator 20 is the 'responsible, individual. He or she is. in. charge of 21 that study or that program project or that center. 22 Q, All right, Are there such grants as to which you 23 have been principal investigator at the University of 24 Cincinnati? so 1 A. There a r e . 2 Q. ' All right. Would you recite those for the jury 3 please? 4 A. Well? between 1955 and 1962 I was a .5 co-investigator? being a co-principal investigator with Dr. 6 Leon Goldman in a grant that'was given for the study of . 7 occupational skin diseases, and when I left to go to the 8 University of Oregon., I had a similar grant of which I was 9 the principal investigator, which started in about 1964, I 10 believe, and was renewed, and in 1969 I became the principal 11 investigator of the grant for the support of the research 12 center under the sponsorship of NIEHS? National Institute of. 13 Environmental Health Sciences. 14 In 1977 I became the principal investigator in a 15 center grant given for the support of an educational program 16 in the occupational, health disciplines, medicine,, nursing, 17 hygiene, and safety, and I was'principal investigator of 18 these two center grants, one from '69 to '85 and the other 19 from 1977 to 1985 when I retired from. .the', chair. 20 I also was principal investigator for several . 21 studies? some of which are not even, represented here. For 22 example, the -- . we'have a -- have had grants from the 23 American Petroleum Institute that, originally sponsored the 24 cancer research laboratory- at the institute back in 1950, and 9o i it continued to support cancer studies and is currently 2 supporting cancer studies, and I am still a principal in the 3 study of the cancergenic or carcinogenic potential of 4 petroleum fractions, of oil fractions that come as a result 5 of the processing of oil and the products of those 6 processes. 7 I have had a grant from the Goodyear Tire and 8 Rubber Company in the .International Rubber W o r k e r s ' Union for 9 the support of an epidemiologic study of rubber workers, . 10 which was carried out between 1978 and 1985. 11 Q. Who was the sponsor of the second educational 12 center grant that you-- . 13 A. NIOSH. 14 Q. NIQSH? 15 A. Rational Institute of Occupational Safety and IS Health. 17 Q. Okay. Nov; can you tell me about any awards- or 18 honors that y o u 've received in your career? 19 A. Well, .in addition to receiving an award, at" 20. graduation from medical school, which-award was given to the- 21 student who was regarded as the most accomplished in all 22 branches of medicine, flattering.to be sure, but they gave 23 such an award and I was. the awardee.' At the University of . 24 Cincinnati we. have a graduate.fellows award, which is given y/ 1 to scholars.in any field, whether i t 1s_science, humanities or 2 music and so on, who are regarded as having contributed 3 significantly to their field, and in 1972 I was made a fellov; 4 of the graduate school, given a honorary Alpha Omega Alpha, 5 which is the honorary fraternity for medical school,.and I 6 got an award from the American Association of -- the American 7 Occupational Medical Association for achievement in industry l6 for the work that we did in the graduate education program 9 development. And in 1984 I got a Project Hope award, again 10 for service in international education and medical service. 11 And last'year,-two years ago I was made an honorary member of 12 the Society for Investigative Dermatology, and last year I J-L was one of the several Daniel Drake medalists given in -- to 14 commemorate the birth of Daniel Drake, a pioneer physician, 15 and this 'was given for distinguished achievements at the 16. medical school and for international recognition. 17: Q. Mow, I 'd like to ask you, if I may, sir, about a. 18 brief historical, overview of your 'work .with 'industrial .19 problems, at Monsanto Company. From 19.49 until the present 20 who has been your employer and who has paid your salary? 21 A. From 1948 until I retired in 1985 the University of 22 Cincinnati paid ray fui] time salary. 23 Q. And you told us about the Schmidlapp. chair --- 24 A. Right. 3 1 Q. That you had -- tell me, if you would, what 2 payments you've received, what activities you've received 3 payment for by Monsanto Company? ; 4 A. Are you talking about directly? 5 . Q. Yes. 6 A. For services? Before I retired the only two 7 consultations, which I -- for which I had some income, for 8 which I charged, was a visit, one day visit and survey of a 9 process at Mitro making Santocuren N.S., in'which they had 10 some skin problems they wanted me to look at the process, and 11 this was done over the Christmas holiday. 12 Q. What year was that, sir? 13 A. 1981, 1981, I believe, right. 14 Q. All right. 15 A. And several days later I went to the Luling, 16 L-U-L-I-N-G, Louisiana plant also for one day. I couldn't 17 spend more time, looking at people who would have been 18 exposed to a process which made dichloraniline and.they had 19- some chioracne as a result of that exposure, and I got paid 20 for that.. And then subsequently I was', paid for ray expert 21 witnesstestimony at a trial in Charleston and for 22 preparation as well as testifying and 23 O. When was that? 24 A. -- This, trial. 1 Q. I !m sorry? 2 A. That was i n -- it started actually in the winter of 3 '84, but went into the winter and spring o f '''85. It was 4 January, February, and March of '85. 5 Q. And are you being paid for your testimony in this 6 case? 7 A. I hope so. 8 Q. All. right. Mow, with respect to any of the other 9 studies' that y o u 've done, Dr. Suskind, the examinations of 10 Monsanto employees in 1949, '50 and '53 or in '79, have you 11 derived any personal financial gain as a result of any of 12 that work? 13 A. I have not. The full time employees or full time 14 facility at -- in the Department of Environmental Health were 15 truly full time. They were paid a level income for doing 16 whatever work was required of them and 'which was consistent 17 with- their expertise, so that when Monsanto requested that 18 the Kettering Laboratory clinical group do an examination of 19 M'itro. workers,' the Kettering Laboratory was paid for it or 20 the Department of Environmental Health was paid for it, not 21 m e . 22 0. S o 'there have been occasions, have there not, sir, 23 when .Monsanto made payments for these studies? 24 A. . Well, they paid it to the -- to the department and iUU 1 subsequently to the University of Cincinnati, but not, not to 2 me personally. 3 Q. Of that money that went to the University of 4 Cincinnati was any of that money given to you? 5;. A. No, I got my regular salary, which, was paid by the 6 university. 7 Q. Mow, you mentioned in earlier testimony, sir, about LO> an examination that you did of Nitro workers in 1949. Do you 9 recall that, sir? 10 A. Yes, sir, I do. 11 Q. Would you tell' the jury how that came about? 12 A. Well, in, sometime in October of 1949, Dr. Emmett 13 Kelly, who Was then the medical director of Monsanto, called 14 Dr. Robert Kehoe, 'who was the director of the Department of 1C Environmental Health and the Kettering Laboratory and asked 16 him if it would be possible to send -- fiist of.all, he told 17 him about the. runaway reaction, told him about the 18 accident,and he said that there were a number of people who 19 were, affected medically and that he would'like the clinical 20 group at the University of Cincinnati to examine these people 21 in the hospital in Cincinnati. 22 Q. And -- 23 A. And the doctor who was... given the job or the doctor s 24 v/ho were given the job of doing the. examination were. Dr. xu 1 1 William Ash, an internist, who' was head of the clinical unit 2 at the time and myself, and I was this staff dermatologist 3 and a member of the faculty. So he and I actually examined 4 the cases and carried out all of the studies that had to be 5 done. I used some of the biopsy material, as I said 6 previously, for some of our research in addition to wanting 7 to know w h a t -- what chloracne looked like from the 8 trichlorophenol accident exposure, what it looked like 9 microscopically, we used also that material for our studies, 10 but Dr. Ash and I did the -- did the diagnostic work and 11 recommended the treatment. 12 Q. How many people did you see? 13 A. Initially we- saw four people. 14 Q. Wow, were these people admitted to your hospital? 15 A. They were admitted to the Holmes Hospital, which is 16 at that time, was the unit in which private patients were 17 admitted. 10 Q. And to your knowledge, sir, had those.four people 19 been seen by other physicians? 20 A. I don't know if they were seen., all. of these four, 21 but .t:he i;e we re other consultants before we were asked to 22 0XclIII1.ne t he people, \mo had come to riitro to excm i n e the 23 people. They weren't hospitalized, and I don't believe they 24 did any laboratory work. XuX 1 Q. All right. Do you know the identities of the 2 others who had seen those Monsanto employees? 3 A. YeSi- I do. One of them was a Dr. Louis Schwartz, 4 who had been the dermatologist for Public Health Service for 5 some years and had written a book on occupational skin 6 diseases, and he examined, I believe, some of that group on 7 two difference occasions. Subsequently Dr. Donald Birmingham 8 and Cleveland Denton, who were assigned to the unit in 9 Cincinnati, the Public Health Service unit in Cincinnati, and 10 who were two very good dermatologists, they also saw the -- li they examined some, of the cases and they looked at the plant 12 exposure, as well. 13 Q. Now, subsequent to their examinations your unit got 14 involved, is that right? 15 A. Yes. 16 (Defendant's Exhibit 1694 marked for 17 identification.) 18 Q. Now, let me hand you, sir, what's been marked as 19 Defendant's Exhibit No. 1694. Would you examine that and 20 identify it for us please, sir. 21 A. This is the report of the clinical examination that was carried out in 1949 by u:c. Ash and myself and sent to Dr. 23 Ke11 y wno wa s the med i director of Monsanto in St. Lou: 24 dr. Durland, who was the plant manager at Nitro and Dr. I\i 1 Q. All right. Do you know the identities .of the 2 others who had seen those Monsanto employees? 3 A. Yes, I do. One of them' was a Dr. Louis Schwartz, 4 who had been the dermatologist for Public Health Service for 5 some years and had written a book on occupational skin 6 diseases, and he examined, I believe, some of that group on 7 two difference occasions. Subsequently Dr. Donald Birmingham 8 and Cleveland Denton, who were assigned to the unit in ? Cincinnati, the Public Health Service unit in Cincinnati, and 10 who were two very .good dermatologists, they also saw the -- 11 they examined some of. the cases and the*/ looked at the plant 12 exposure as well. 13 Q. How, subsequent to their examinations your unit got 14 involved, is that right? 15 A . Yes. 16 . (Defendant's Exhibit 16.94 marked for 17 identification.) 18 O'. Wow, let me hand you., sir, what's been marked as 19 Defendant's Exhibit no. 1694. ..Would you examine that, and 20 iden 1 1 fy it for us please, sir. 21 A o rphis is the report of the clinical examination that 22 WciS carried out in 1949 by Dr. Ash and myself and sent to Dr. 6r> Kei1Yf 'who v/as the medical.dire ctor of Monsanto in St. Louis, 24 clr. Durland wh o 'was the plant manager- at .Nitro and Dr. J.t/O ft 1 Helson when it was sent out back in 1949 as you can see from 2 the handwriting, notations were made as to who got the *3 report. 4. Q. Now, the date of the report is- what, sir? 5 A. The date of the report, I.believe, is December, if 6 I'm not mistaken. Well, it was sent out in December, 1949, 7 but it is the examination of those who came to us in 8 October. , They were examined in October, but the final repor 9 couldn't be sent out until December, cause we didn't have all 10 the laboratory work back in order to do that. 11 Q. And the last page, sir, does that bear your 12 signature? - 13 .A. Yes, it does. 14 Q. And there's another signature appearing there, and 15 whose is that? IS A., William F. Ash, M.D.. 17 Q. All right. Nov;, at the time that you entered into 18 this project? Dr.. Suskind, what did you-'' know, .what was your 19 understanding about the incident, the .'49'autoclave incident? 20 A. W e l l , we were told by Dr. Kelly that this accident 21 had occurred and that in one building in which 22 trichiorophenol was being made the kettle, five hundred O'*' gallon kettle overheated and the pressure built up and a 24 valve blew and the contents of the kettle came out into the XUhi 1 building. This was Building.41, and some of it out into the 2 surrounding atmosphere. 3 Most of the information, the detailed information 4 about the accident, .and what happened afterwards we got from 5 the workers .themselves, cause the. first, four, -there was. a 6 chief -chemical operator, Paul Willard, and there was a 7 chemical operator, Mr. Hurley, and there were two pipe 8 fitters, one of which entered right after the accident, so he 9 could tell us exactly what he knew about it and what he 10 found , and the third was a pipe fitter -- I mean the fourth 1.1 was a pipe fitter as well, Mr. Stiehl, 'who could also relate 12 the detail s of the runaway reaction. 13 Q. What -was your understanding of the materials that 14 were involved? 15 A. Well, we were given some idea as to what chemicals 16 we used for synthesis of trichlorophenol, and they included 17 tetrachlorobenzene, sodium hydroxide, and-ethanol. Those X were the starting chemicals and the end product was supposed Xyn <'. to be trichlorophenol. 20 Q. Mow, what -- what 'was the material.that was in the 21 building after the eruption? 22 A. Well, it was variously described as a dark brown 23 substance of a black powder depending .upon who you talked to, 24 but whatever the material was when people went to clean it up JL'J-J 1 they became sick. . 2 Q. What -- did anybody identify what that dark 3 substance was? 4 A. Wo. There was --- the Monsanto company had its 5 chemists, and they felt that it wasn't trichlorophenol alone 5 obviously, cause it d i d n 't look like trichlorophenol alone, 7 so that there were impurities in it, and they felt that these S were impurities that came about as a result of. the 9 overheating and the excessive pressure in the kettle, and 10 they were -- there were various ideas that were subsequently 11 suggested as to what might be in that kettle. Some of the 12 chemicals that were talked about was trichloroanisol, another 13 which w a s n 't too far from-what.eventually was found to be the / 14 active toxic agent, somebody suggested it'was a biphenol, 15 oxide, which means that there were two.benzene rings 16 connected by an, oxygen linkage and if they had added another, 17 oxygen linkage, it would -have'been TCDD, but t h a t 's an 18 afterthought. 19 Q. W a s -- 'were you ----- was anybody to your knowledge 20 aware of TCDD at the time of the incident in.-'49? 21 A. No, I d o n 't believe so. 22 0. Or at the time you did your exam? 23 A. -I don't believe 'so. - First .of. -all, :I believe it was 24 the first runaway reaction that had been at least reported to / -L1<JO 1 have occurred in a trichlorcphenol synthesis, so there was no 2 previous experience to ray knowledge. Now* subsequently there 3 was or there were, because there were other incidents of 4 problems-arising from the manufacture of trichlorophenol or 5 the runaway reaction, which occurred in a similar fashion as 6 the one which occurred on March 9th in Nitro. 7 Q. Had the compound TCDD been discovered or identified 8 at that time? 9 A. It had not. ID Q. So I guess the answer to this may be obvious, but 11 was anything known about TCDD toxicity then? 12 A. Ho, the thought that TCDD might be the toxic agent 13 which caused chloracne and the other symptoms was first . 14 published in 1957 by two dermatologists in Homberg named 15 Kinrnig and Schulz, and they got their idea from the fact that 16 at the. Boehringer plant it's B-O-E-H-R-I-H-G-E-R,' I believe 17 Boehringer plant there was a chemist who was working with 18 TCDD. He had actually synthesized it apparently, and he 19 developed severe chloracne and other symptoms and Kernmig and 20 Schulz got the idea from that, incident, and then they got 21 Boehringer material, Boehringer trichiorophenoi and isolated 22 TCDD from that material. But they published their paper in 23 1957, so that in 1949 and !50 and '53 we d i d n 't know- that the 24 chioracneqenic agent was TCDD. X u/ I Q. What clid you -- what information did you have with 2 respect to the exposure of the work force in this Nitro 3 accident? 4 A. Well, the first information that we got was from 5 the -- from the four people who we examined, and then six 6 months later we went to Hitro and examined the four again and 7 two others, one of whom was a foreman, and he was severely 8 affected as well. But we assumed that since there were two 9 different buildings in which the 2,4,5-T was made, one was 10 the trichlorophenol in Building 41, and that was taken to 11 another building where it was then made into 2,4,5-T by 12 acidification with monochloracetic acid, and apparently if 13 there was a chloracnegen in the trichlorophenol, it probably 14 was carried over ,to the -- to the building which was making 15 2,4,5-T, and the esta and.,,subsequently we discovered that, 16 yes, there were people, who 'were involved in 2,4,5-T without 17 having been involved in the accident who also had 18 manifestations of chloracne.. 19 Q. Now., 'with respect to the people'that cleaned up the 20 '49 incident or accident, how.did they -- what was their 21 exposure, what did you learn about that? oo A. W e l l , in 149 we recognised that the people who came 23 to clean up were the -people who were the most severely 24 affected. First, the pipe fitter who- 'went in without any J iu o 1 protection, and he developed a severe headache and nausea and 2 eye irritation, respiratory irritation and so on, and he 3 left, and then he came back several days later with complete 4 protection and by that time others had come in with 5 protective garb and attempted to clean up the inside of the 6 building, and those people who were involved in cleaning up 7 and restoring the process, what they wanted to do was to put 8. it back into shape so they could continue.-to make 9 trichlorophenol, which they did, and those who were involved, 10 including the chief chemical operator eventually developed 11 chloracne. 12 interesting though that Mr Willard, who was 13 the chief chemical operator, d i d n 't develop symptoms until 14 many weeks after, and why he was less susceptible we d o n 't 15 know. Could have been that he used .some rather good 16 protective garb before going in, but he didn't develop his 17 chloracne -- his first of evidence of it was on his leg, as a 18 matter of fact, and then subsequent to that, which was 19 several weeks after he. was. exposed, if, not months after he 20 was exposed, he then developed chloracne and had it not only, 21 on his face, but elsewhere on his. body. 22 0. Doctor, I wonder if you would describe for us 23 chloracne and how it --- how it differs from acne vulgaris, if 24 it does? 1 It v/ould be useful if I had some pictures to show 2 and perhaps -- 3 Q. All right. 4 A, We can do that,. I 'm talking about the clinical 5 photographs. 6 Q. Oh, I'm sorry. 7 (Defendant's Exhibits 1695, 1696, 1697 and 1698 8 marked for Identification.) 9 Q. Let me hand you-, sir, first w h a t 's been marked as 10 Defendant's Exhibit 1696 and ask you to examine that and 11 identify it for the record please. 12 A. This is a photograph of the face of the pipe fitter 13 and mechanic whose experiences I have just described. 14 Q. And Defendant's Exhibit 1697? 15 -A. This is a photograph' of the face of the -- one of 16 the chemical operators' who. also came in to clean .up the mess. 17 Q. And Def endant 's Exhibit 16,95? 18 A. This is an another mechanic and pipe fitter, who IS developed his chloracne when we saw him in October of. 1949 20 when he developed his chloracne months after the incident, 21 a n d .I can describe how he did that. . Q. All right. And Defendant's Exhibit 1698? 23 A. This is the chief chemical operator, who -- this is 24 the face of the chief chemical operator, whom we' examined in XX U 1 1949. 2 MR. CARR; I d i d n 't hear.the last part of your 3 answer, Doctor. I couldn't hear the last of your answer. 4 A. ' `This is -- . 5 MR. CARR; Your voice dropped and I didn't hear. 6 'THE WITNESS; May I repeat, your Honor. 7 THE COURT; Go right ahead. 8 A. This is the face of the chief chemical operator, 9 who we examined.in 1949. 10 MR. CARR: Thank you. 11 MR. HEX NEMAN.; Your Honor, at. this time we -would 12 move the admission of Defendant's Exhibits 1695 through 1698. 13 MR. CARR; We d o n 't object to them. 14 THE COURT:. They're admitted without objection. DT r* MR. HEINEMAN: May we pass them to the jury? 16 THE COURT: Yes, you may. 17 ( Exhibits passed to the jury). 1 ci THE COURT; Mr. Heineman, go ahead. 19 Q. D r * Suskirtd, these photographs, that you have just 20 identified, what is the condition t h a t 's reflected on.the 21 face skin of those men? 22 A. These are photographs of rather severe chloracne, 23 and i t 's characterized by, as you have seen, blackheads on 24 the face, large numbers and these small white- cysts, .which Jlil. 1 are really what we call closed comedones, they d o n 't show 2 their opening, they just show the fact that they are cysts . 3 that are filled with fat or filled with keratin, and this man 4 who was the pipe fitter came in to clean it up. He had it on 5 his face, his scalp, his abdomen, his back, his genitalia. 6 He had a rather severe case of chloracne. 7 Now, if I may go on and explain-what the difference 3 between acne vulgaris is. 9 0. . Please do. 10 A. Physiologic acne or acne of adolescence and 11 sometimes it goes into adult life is usually characterized 12 first by greasy skin, and the first evidence in the 12, 13, 13 14 year old is grease around the nose and blackheads around 14 the nose, and the cheek bones are rarely affected, so the 15 initial locale, the locale, that is the place is very 16 significant where it starts, and in many instances, whether 17 i t 's an exposure to chemical agents like TCDD or 18 pentachlor'ophenol, the first, site is usually the cheek bones 19 and in, front of the ears, in front of the' ears, and 20 subsequently the cysts and blackhead occur on the back of the 21 ears, posterior to the ears as well. 22 In many instances one of the dii:erentiating 23 features i.s that acne vulga ris the glands. are producing too .24 much fat, too much fat, so t h e y 're called hyperplastic XJ. 1 glands, and the skin is greasy, and in the case of the 2 chloracne in most instances, although not all, the skin is 3 usually hyperkeratotic, it feels spiny, hyperkeratotic, it 4 feels spiny, and it's dry. Blackheads, cysts and dry, thick 5 skin, those are the characteristics. 6 These people also had an added feature, and that is 7 they still had as the -- as the report shows,. they even still 8 had the odor of some phenolic substance, and good scrubbing,- 9 by the way, in the hospital cleared that up completely, so 10 that there was a problem that we saw among the first four of 11 hygiene, and"they improved enormously with good.hygiene, as 12 the report showed. They improved enormously.with good 13 hygiene. By the time they left the hospital they had the 14 characteristics of chloracne, the comedones, the cysts,.the 15 dry hyperkeratotic skin. 3.6 In. acne vulgaris it's rare to find lesions, that 17 is, comedones and cysts on the genitalia, but in chloracne as 18 in this case, in this group there were a fairly large number 19 of males that had lesions on the penis and the scrotum, and 20 they had them 30. years, later, "so they d i d n 't go away-, and we 21 would regard those features as the hallmarks .of chloracne, 22 and chloracne being the hallmark of dioxin intoxication, not 23 absorption, but intoxication, the adverse effects. 24 Q. Dr. Suskind, how is it that chloracne develops, how ii j x is itf sir, that it develops? 2 A. Well, we have done some studies to demonstrate -- 3 first of all, you can't demonstrate it in animals, and we 4 have had some human volunteer studies that .go back some 5 years, which we have reported on, in which we have 6 demonstrated that if you take the trichlorophenol from a 7 kettle, and we did this before we knew that it was TCDD and .3 you dilute the material out so that it doesn't irritate the o skin if you apply it to human skin, and then you apply it 10 daily for several'weeks making sure that there are no adverse ii other effects, which we did, you can with repeated biopsies 12 of the skin demonstrate.what the cellular changes are, the 13 progression from the normal sebaceous glands' to the chloracne 14 lesion. I-think we have a series of charts that come from 15 one of ray papers, which demonstrate that, what would be 16 called the cellular kinetics, the cellular pathogenesis of 17 chloracne. .18 (Defendant's Exhibit 1699 marked for 19 identification.) .' 20 Q. Let me,show you,, sir, what's been marked as 21 Defendant's Exhibit 169S and ask you to examine that and ZZ identify it for me please? 23 A. . This is a drawing of the events in human skin when 24 a cbloracnegen is applied to the surface of the skin -LX'i 1 repeatedly over a period of in this instance 12'weeks..' 2 0. All right. Now, what is the source of these 3 drawings? 4 A. I believe it's a paper that.was published in the 5 Scandinavian. W o r k .and Environmental Health, and it was the 6 paper I gave at the international Congress of Occupational 7 Health. o Q. N o w , sir, in the work that you have done, have you 9 done histological examinations? 10 A. Oh, yes, we have. 11 Q. Of'the skin? 12 A. That was the purpose of the study. 13 Q. All right. 14 A. To find out not what was just happening on the 15 surface of the skin, but' .what was happening to the structures 16 under the skin like'the hair follicle and the sebaceous 17 gland ... 18 Q. Have you personally observed the conditions that 19 are rer lected in this chart that I'm holding before you? 20 A. Yes, I was the principal investigator in that 21 study. did the biopsies as well as. read the slides which were 22 prepared by a. pathology, by our own pathology department. 23 Q,, And are these 'drawings or -photographs, I guess -- 24 A. These are drawings of photographs of histological xj 1 sections. 2 Q. Taken from your 3 A. Taken from collection that we have. 4 MR. HEINEMAN: Your Honor, at this time we would, 5 move the admission of Defendant's Exhibit 1699 into evidence. 6 MR. CARR: We have no objection, Your Honor. 7 THE COURT: Admitted without objection. 8 Q. Doctor, i. wonder if you would be so kind as to step 9 down here and explain this exhibit. 10 A. And I wonder if it wouldn't be useful if we turned 11 it in such a way so that the Judge could see it as .well. 12 THE COURT: I'll come down there. That's okay. 'I'd 13 rather the jury see it. Thank you? 14 A. If one -- when you do a 'biopsy, what you do. is to 15 take a segment of a piece of tissue. In this instance it 16 would be a segment of skin, and usually w.e take a punch 17 biopsy.of two or three millimeters in width so we don't cause IS any scars'. Sometimes they're a little larger chan that, but IS they're usually punch biopsies. Some of you may have had 20 such biopsies and if you cut through the skin like s o , you 21 w i11 see f irst the surface of the skin, and this is. called 22 the epidenni. s , this ip Ca ii8G the epidermis. This is normal 23 skin. And then fromthe opening of the hair follicle you 24 find first this fat gland. That's called the sebaceous _L..L 1 gland, and the sebaceous gland is attached to the hair 2 follicle. This is the hair follicle, and these cells produce 3 the hair, these cells here produce 'the- sebum. Everybody has 4 sebum, some more than others, but the sebaceous glands 5 produce this lipid that is a healthy thing,' i t 3s a good thing 6 to have, because of its physiological and biochemical 7 properties. 8 H o w ,. these are cells that are -so-called 9 undifferentiated cells, undifferentiated cells, but they 10 differentiate when they -- they grow, they become cells that 11 produce lipid, so we call them sebaceous cells. These are- 12 the undifferentiated cells, which become sebaceous cells, and 13 as they move upward and outward these cells fill up with fat, 14 and the cell membranes break and the lipid, exudes on- the 15 skin. '. 16 Now, what happens with a chloracnegen like TCDD? 17 The first thing that happens is that you see a thickening of 18 the --- of the membrane , the lining of the sebaceous tjland 19 duc t , a thickening of that 1 i n ing , rJrsL-Uil-a,L 5o the first thing 20 that happens. 'How long doe s it tak e to do that? Six days e 2.1 ten days. We did serial biopsies, so we took biopsies at ten 22 days, biopsies at 14 days. biopsies at two weeks, three weeks 23 and so on up unti 1 12 week;5. If you go -- - if you then QO tO ; 24 let's say, ten to 14 Qay s , you will see that this plug has li. / 1 extended up to the opening of the follicle, and that's the 2 first sign of the blackhead. Sometimes you c a n 't see i t 's so 3 small, but t h a t 's the first sign of it. Then something else 4 happens which is very characteristic of the development of 5 chloracne, and that is something happens to these cells. 5 Instead of producing fat cells they produce cells that 7 produce keratin or horny material, horny material. The 8 .barrier layer on the surface- of the skin is composed of horny 9 material. The nail is composed of horny material, the hair 10 is composed of horny material, and instead of their producing 11 fat cells, they produce keratin cells and what happens is 12 that these are cells that are differentiating from these 13 cells and .instead of producing .fat, they produce a plug like 14 so, and the end product is that blackhead that 'comedon.e and 15 this cyst, and the pictures that you see here, these cysts 16 like so, these cysts is that, t h a t 's the end product. 17 So what you find you will find a mixture, you will 18 find the blackhead, and you will find the comedone and 19 sometimes, t h e y 're large, sometimes they get so large on the 20 back or the genitalia that they require surgical treatment, 21 but th a t 's chloracne, and in contrast ;-- I d o n 't have it 22 here, but in contrast acne vulgaris, while it does also 23 produce blackheads the sebaceous glands become very large, 24 and they produce lots of fat. Kids that have acne have 4-Jl O- 1 greasy skins, and the greasy skin has to come from somewhere 2 and it comes from the enlargement of this gland. Thank you. 3 Q. Doctor, with respect to the examinations that you 4 did in 1949'of these workers, could you tell us specifically 5 what you found in these four men? 6 A. Weil, the first person described in the report is a 7 pipe fitter or steam fitter, who was Mr. HcLanahan. In less 8 than one hour after the accident he went in, got a work order 9 to go into the building and clean it up and repair the 10 damage, and h e .was there for about three hours and developed 11 a burning sensation in his eyes, nose, and throat and on the 12 following day h e .worked In the s a m e .building, and because 13 several hours, after that initial exposure when he worked for 14 those three hours he developed severe headache and nausea and 15 vomiting and dizziness, and that lasted, that is, the 16 headache lasted for about eight' days. 17 Q. Was he able to notice any of the material on him, 18 did he actually get any of it on him that, he noticed? 19 A. Well, I believe that he did, because he didn't wear 20 protective garb, so there was -- he was obviously exposed to 21 the material from the kettle. He also developed itching and 22 severe swelling and redness of the face about less than a 23 week after his exposure, and subsequent to that' he noticed 24 his face developing comedones'- and pustules, and they i.iy J*1L increased in number and involved not only his face, but 2 interestingly enough, it's the first time I've ever seen 3 chloracne in the. scalp. Matter of fact, I think he's the 4 only one I've ever seen who had chloracne in his scalp, and 5 he developed chloracne on his lower extremities and his 6 back . 7 About one month after that he developed aches in 8 the regions of the thighs and the calves, and he -- and this .9 pain, these aches and pains were aggravated by exertion, and 10 he was really unable to walk even short distances. This pain 11 lasted for six weeks, and when he came in, while the pain on 12 exertion was less than he had experienced previously, he had 13 a feeling of weakness and fatigue and nervousness and 14 insomnia. 15 The second individual was a chemical operator,, 16 chief chemical operator, and he told.us that he entered the 17 building several hours after the explosion or the accident 18 and wasn't sure 'whether or not his contact occurred on the 19 following shift or that first occasion', but at any rate he 20 .only developed symptoms a week, several..weeks afterwards, and 21 it was noted that he had some lesions in his -- on the back 22 of his leg behind his knees and also developed a rash on his 23 body, and this again vas followed subsequently by aches and 24 pains, which he had when he came in, and he said that it 2U 1 wasn't until raid August of that same year, whicfr.was several 2 months later that he became aware of the fact that he had a 3 severe case of chloraene, which involved his face, his neck, 4 his back, his abdomen, and his genitalia. 5 He also indicated that the pain was so intense he 6 was unable to walk, he went to the hospital for this, and he 7 was there for about 16 days, was treated with intravenous 8 injections and within one week his pain subsided with 9 treatment. He was admitted to the hospital again, because 10 these complaints recurred, and since that hospitalization, 11 which was in August of the same year, he had no recurrence of 12 the pain in the chest and the neck although he said he did 13 have an ache in the back of his knees. 14 The third man was Jesse Stiehl, who was a pipe 15 fitter, and his contact was interesting. He was asked by his 16 foreman to go to an area in July of that year, the accident 17 occurred in March, in July of that year he went to an area 18 where they had buried some of the pipe fittings, and he was 19 asked to retrieve them, get them out of t h e -- of where they 20 were and clean them up, and in cleaning up these pipes and 21 pipe fittings he developed chloraene. He also developed, 22 subsequently he developed aches and pains and insomnia 23 nervousness, and he had some weight loss since the eruption 24 occurred. This was a patient, who in 1942, which was long 121 1 before the incident, had hepatitis, which lasted"-for about 2 six weeks. 3 The fourth person was Jonathan Hurley, and he was a 4 chemical operator. He was the oldest of the group, he was 56 '5 years old, and we saw him 30 years later, examined him 30 6 years later at age 86. He visited the building a few hours 7 after -- of the accident and six weeks later he was assigned 8 to working there, this time to wash down'the autoclave for 9 inspection. And he said he wore a respirator and goggles and 10 gloves, and two weeks following that assignments he said he 11 noticed a development of chloracne. 12 1 He also had some swelling of the area around the 13 eyes periorbital edema, and this occurred periodically. He 14 also had generalized -- when we examined him he had 15 generalized chloracne, including the face and the neck and 16 the lower legs and the genitalia. 17 So that all of these people had rather severe 18 chloracne, and we found that two out of four of them had 19 tender --- tenderness in the liver area and on palpation on 20 the physical examination for the liver it -- they were 21 enlarged. 22 A third person, who was Mr. Hurley, the liver was 23 barely palpable. However, there was no doubt that in two out 24 of the four they had enlarged tender livers. In Mr. Hurley 122 1 we also found that he had a change in his ability to feel in 2 the -- in the feet, in the skin of the feet, and the others 3 didn't have that, but this change in the sensation, ability 4 to feel made us curious to know whether or not others had the 5 same thing and that wasn't so, but we did take a biopsy of 6 Mr. Hurley's skin of the foot where he was not able to feel 7 very well, that is, he had little in the way of sensory 8 ability, and we did find on biopsy, wp did find there were ! 9 changes in the nerve sheath, the myelin sheath of the nerve, 10 which vas pathological. 11 We found that the total lipids on laboratory the 12 total lipids were increased in at least two and possibly 13 three of the four individuals, and we did find that the 14 prothrombin concentration was decreased, so it was below 15 normal. We wanted to take liver biopsies on these people, 16 cause it was indicated, wanted to find out what the liver 17 really looked like, and vie were told by Dr. Leon Schiff, who 18 was then the chief of the gastroenterological service, that 19 their prothrombin time was low and that there was a danger of 20 bleeding if we took a liver biopsy so vie didn't take any 21 liver biopsies at the time. However, I have to tell you that 22 severely years later Mr. Stiehl, the pipe fitter who d i d n 't 23 have -- had his -- didn't get exposed until three or four 24 months after the incident, he had a biopsy of his liver done 123 1 at the H o l s e r ,Clinic several years later* and it was found to 2 be normal. 3 THE COURT: I think this is a good point to break 4 for the day. Ladies and gentlemen, 'we'll break for the day 5 at this time. As you know, w e 're off tomorrow and Wednesday 6 with this court holiday. We'll resume again Thursday morning 7 at 9:30. 1 would remind you as I do on any overnight break, 8 that you're not to read, listen to or watch anything about 9 this case in particular or the subject matter in general in 10 any of the media. Thank you for your attention and 11 cooperation.. 12 (At this time the jury left the courtroom and the 13 following proceedings were had.) 14 MR. CARR: This witness knows his last statement was 15 completely improper. He brought out the statement that this 15 liver biopsy was completely normal. It has to be hearsay, it 17 has to be something that this witness was told or has read. 18 It was something that was done several years later and not by 19 him. It's improper and he's testified enough, I'm -sure, that .20 he must know that it's improper, and I would ask the witness 21 to be admonished that he should not make statements like that 22 in the future. There wasn't anything in the nature of the 23 question that was even asked that I would know that he was 24 going to make such a statement. I. would like 'when we start 124 1 back with this witness Thursday that the witness'1-- that the 2 jury be instructed that they are to disregard the statement 3 that the.-witness said about this liver biopsy being normal. 4 MR. HEINEMAN: Your Honor, an expert witness such as '5 Dr. Suskind is clearly entitled to testify about the 6 information he has available to him and based upon which he 7 forms his opinions and to my understanding that's a l l he was 8 doing was testifying about the information that he knew about 9 with respect to these people, whom he examined and treated, 10 with respect to their conditions and the conclusions which he 11 is ultimately going to testify about v/ith respect to their 12 conditions and prognosis. 13 MR. CARR: Counsel knows that he cannbt testify as 14 to what somebody else has told him, that's hearsay. We been 15 through this many times before. If it's a medical record of 16 this witness that he knows is authentic and you have a basis 17 for it, and it comes in, that's something else, but the 18 person made that liver biopsy could be cross-examined and 19 could show that"it's not. This is the rankest form of 20 hearsay. He can use information if it's ordinarily reliable, 21 -if it was a medical record for him to arrive at an opinion. 22 He may not relate what that information is. It is hearsay. 23 We have been through this so many times, and the Court has 24 ruled on this point so many times. It's like reading x<io 1 contents of an unadmitted article into evidenced". He may use 2 the articles, he may use authorities to come to an opinion. 3 He may not relates what those authorities say or what those 4 articles say. It's improper, you know it's improper, and he 5 knows i t 's improper. 6 THE COURT: I'm sustaining the objection. I think 7 that's correct. I will admonish the jury Thursday morning. 8 Please remind me at that time about that and I'm ordering you 9 as an officer of the Court to explain that to him, explain 10 what's to be done in the future. 11 12 13 14 15 16 17 18 19 20 21 22 23 24 _L K* 1 STATS OF ILLINOIS ) ) SS. 2 COUNTY OF ST. CLAIR ) ; 3 4 I, MARSHA SCHNIPPER, certify the foregoing to be a 5 true and accurate transcript of the testimony and proceedings 6 in the above-entitled cause 7 Dated this / t day of February, 1986. 8 9 10 n 12 13 14 15 16 17 18 19 20 21 22 23 24 <i / 1 STATE OF ILLINOIS ) ) SS. 2 COUNTY OF ST. CLAIR ) 3 4 5 .If Richard P. Goldenhersh, one of the Judges in and 6 for the Twentieth Judicial Circuit, do hereby certify that 7 the foregoing transcript is a true and correct transcript of 8 the proceedings had in said cause. 9 Dated this day of February, 1986. 10 11 12 13 RICHARD P . GOLDENHERSH, JUDGE 14 15 16 17 18 19 20 21 22 23 24