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V Industrial Hygienists and is published by the American Medical Association m AMA Archives of Industrial Hy giene and Occupational Medicine. In troductory paragraphs define the values as follows: "Values are given in the following tabulation for the maximum average atmospheric concentration of con taminants to which workers may be exposed for an eight-hour working day without injury to health. These values are based on the best available information from indus trial experience, from experimental studies, and, when possible, from a combination of the two. They are not fixed values but are reviewed anauaily by the Committee on Thres hold Limits for changes, revisions, or additions as further information becomes available. Threshold Limits should be used as guides in the con trol of health hazards and should not be regarded as fine lines between safe and dangerous concentrations. They represent conditions only They represent conditions only within which it is felt that workers may be repeatedly exposed, day after day, without their health being ad versely affected. It is felt, at the pres ent time, that workers should not be exposed to a working environment containing any of these substances in excess of the value indicated. These values are not intended for use, or for modification for use, in the evaluation or control of com munity air pollution or air pollution nuisances.'' A few of the materials encountered in the petroleum industry and their Threshold Limits are listed below: Carbca daoixk.......... Cuba* tmsaiarids.. Hrdrocsasalftds..... Nspbtte (pmin). OctAM................. Sulfur dinrirbi........... Tori** 11 5000 100 2ft 500 500 500 10 tna and SLostdfw..ie..a tfniftni nr nt lft 0.1ft Minted inrn-w I foot Dual (tBMM, m (ns ......... ilka kid (iter* *0% tna 8i).......... asteaa k lo irm diOi)......... law fates (5 % (rm 6i0t).......... 50 5 X 50 Nineteen states observe Threshold Limit Values in their laws or regula tions, and more are sure to follow. In dustrial hygienists, as part of their duties, advise management of the ex istence of these requirements in order that precautionary measures may be taken to avoid excessive exposure of personnrI. E-8 J1 Industrial hygienists lindens Irr meas urement of air contaminants for com pliance with states' codes. Even a com mon material like gasoline has a maxi mum safe level which is 500 pans per million. The following are just a few of the hazardous materials that are enonnnrrrrn in petroleum refinery opera tions: teriii by customers. However, this re quires extensive work, knowledge of product, and toxicological information to determine what products must be labeled and how they hpuld be labeled. Prior to 1932, only a handful of per sons were engaged in industrial hy giene procedures. By the end of the next decade, there were industrial by- Brairaurr imtuts AstesM Astaldabyd* Akiaii&a etestes Amaemm Ditsusy botri pan erai DuH payiwtetumiy art, paste Dun MUpnimi ear Dim, bauxna Duneacaim femnrda Fhcridaa Furftm Inhibits* Lint Nitnpaends .Omm Pteal Site 3moka Sulfur dinriri* Wteliac fuasa Toxic Aiifiaa. liquid Anibna, dm Btuoi iBumi Carboa Boasted* ChtnnrsTte hrdroeartx Chnao onpsaMs Cohn oral Hydragta sul&d* Inhibits* Load, coral 0 fans Load. bchart* Lod. utnnurl Usd. soaps Maapmm Many Msthaate ffalinanrm niwi Tobol (Tolas*) XrM (Xrkaa) Sba irntuts And* all kinds ---MBttMDC) Cams* ChfosiBB mha oompoun Cobalt, ami and coaponada Dyta InOibuon NiefcatHla Oik. ohm OUa. hick baliac anoaxic Oik. taaofaabk cuxuna Fhaaol Pitck Salnata Ulkm Wo. Product Labeling One very important function of the industrial hygienist in the petroleum industry concerns precautionary label ing of products. This is receiving more emphasis as state after state passes la beling regulations. One of the most re cent is the State of New York, where on February 26,1954, the Council on Pub lic Health passed labeling regulations which became effective August 26, 1954, as Chapter IX-A of the New York State Sanitary Code. These label ing regulations have the force and effect of law and require precautionary label ing on any product that entails a haz ard in a reasonably anticipated use. A hazard is defined as "the risk of injury or illness which may be en countered during or as a result of any reasonably anticipated type of handling or use of a substance, or during its specified use, if any, by reason of toxicity of the substance through in gestion, inhalation or absorption through the skin, or due to its corro siveness or irritating properties, or be cause of its flammability or explosive ness." Somewhat similar labeling regula tions already exist in California. Illi nois, New Jersey, Oregon, and the Territory of Hawaii and are in the making in many other states, so more can be expected. Most state regulations are guided by recommendations of the Manufacturing Chemists' Association. Inc., and with some exceptions, con formity in one state results in conform ity in other states. It is recognized that, as a rule, label ing of many products is advisable and results in safer handling of the mi- giene divisions in nearly every indus trial state, and in many insurance com panies. Industries themselves, however, have made the greatest expansion in in dustrial hygiene units over the past 22year period. Today, in most large in dustries, industrial hygiene is being con ducted under the guidance of increas ingly well-trained, professional per sonnel. No longer is industrial hygiene seen by industry as an "aimless effort of in tellectuals collecting bottles filled with nothing so that they can prepare long and useless discourses that few read or understand or would know what ac tion to take". Instead, the safeguarding of health is assuming a new signifi cance. It not only saves time, money, and problems for management, but it actually improves employee morale and efficiency by eliminating appre hension in occupational environments. Instead of telling what mistakes have been made and bow to correct them with costly changes, industrial hygien ists now are called in at the bluepnnt stage where their ideas can be incor porated into factories, machines and other installations to accomplish the most good easily and inexpensively. Industrial hygiene at its best in the petroleum industry requires the co operation and skills of industrial physi cians, industrial nurses, toxicologists, chemists, safety men. and industrial hygienists working together as a team. American industry, particularly the oil industry, is aware of the benefits of more and better production derived from environmental control and healthpromotional activities. It needs only to be guided in the application. * * * 002331 THE PETROLEUM- ENGINEER, Moy, 1955 CO O O' CO CO t-- Orandum j'rom T. E. ALLEN. M. D. '` NEW YORK. N. Y. 13 Auaust 1973 D*f.I____________________ Do Dr. H.H. Golz API Dr. Allen has asked me to send the attached to you for your information. Joan DiGanci Dr. Allen's Secretary 002332 183997 /t Memo tr File As noted in a memorandum dated 11 July 1973, a meeting was arranged, following an invitation from Dr. Irving Selikoff, to meet with him at the Mt. Sinai Medical Center. Attending the meeting were: Dr. Harry Hermann - Associate of Dr. Selikoff - NY Dr. W. Nicholson - Associate of Dr. Selikoff - NY Dr. N. Roberts - Assoc. Medical Director, Exxon Corp.-NY Dr. M. Goldman - Ass't. Medical Director, Exxon Corp.-NY Dr. H.A. Sinclaire- Assoc. Medical Director, Mobil-NY Dr. T.E. Allen - Medical Director, Mobil-NY The purpose of the meeting was to present findings that Dr. Selikoff had made following examination of a group of represented Mobil employees (Paulsboro Refinery) on the request of the union at Paulsboro. In addition. Dr. Selikoff hoped that, on discussion of these findings, the group might be able to advise him whether such findings might be considered typical and usual of an average refinery population. The meeting lasted approximately two and one half hours and consisted principally of a presentation of asbestosis as an occupational illness, with major points of same being illustrated by x-rays, statistics, and data gathered on the Mobil population examined. No list of examinees was given, and, at no time, was any data or x-ray identified by a specific name. Initially, Dr. Selikoff gave a brief discussion of the disease, asbestosis. In this coverage, he covered the highlights of work being done here and in U.K. He mentioned historical work done in shipyards in USA and U.K. He made it clear that, during the discussions, he would be talking in terms of "insulators, brick workers, etc. in user companies," rather than in terms of "factory workersM'(where asbestos products, piping, etc. are made such as Johns Manville, etc.). In spite of this, he pointed out that if exposure to asbestos fibers in insulators was enough to produce malignancy, the great exposure normally experienced in factory employees was "excess exposure" as far as cancer was concerned. Graphically shown, this would be as follows: Exposure (Yrs. & Service) FACTORY WORKERS' exposure ^////Z//////////////////- INSULATORS ` Cancer production level T^naaea area represents "wasted" area or exposure) Dr. Selikoff pointed out that the typical x-ray findings in a case of asbestosis were: 002333 1) General thickened pleura (the pleura is the thin, transparent covering of the lungs) 2) Pleural plaques (a concentration of thickening of the pleura in certain specific areas) 3) Reticular fibrosis (intensified marking throughout lung tissue, o------cularly in lower lung fields producing a 183998 4) A shaggy appearance to the heart outline. 5) Blunting or even complete obliteration of the area where the diaphragm touches the rib area. It was emphasized that the above findings were typical of but not pathog nomonic (specifically distinctive or diagnostic) of asbestosis. These findings, along with an extensive work or exposure history, can be considered diagnostic. One does not necessarily need to have positive pulmonary function tests to clinch the diagnosis. The development of asbestosis need not produce death in any person sufficiently exposed, but, there is developed in cases of asbestosis susceptibility to lung cancer, and even to mesothelioma, a specific type of malignancy. In regard to Mobil's employee group at Paulsboro, Dr. Selikoff stated he was requested by the "union" there to examine a group of represented employees. This group of employees was presented by the union to Dr. Selikoff who did not have a voice in the choice and he had no previous knowledge of the examinees* medical, work or social history. He stated emphatically that, as a result, the study was a biased one, but he could not state whether it was biased in favor of a sick, average or well group. The only point on which there was certainty was that all examinees had had at least 20 years of work in the refinery. On several occasions, the size of the examined group was stated to be 137, this is not quite accurate because only 118 were examined. The remaining 19 were those employees who, at an earlier date, had been seen only for a chest x-ray and chest examination and, on whom, the union re quested the company x-rays be forwarded to Dr. Selikoff at his Pate rson, N.J. office. Dr. Selikoff handed out six sheets showing in graph form some of the findings resulting from his examination of. the 118 employees. (It should be noted that the examinations were done by a team of 9 people from Mt. Sinai Medical Center who, with the aid of mobile x-ray unit, completed these examinations during one week-end.) After the charts were handed out, discussion was so continuous that it was not possible to examine these charts thoroughly. Constant re ferences were made to the charts, however, during the discussion. On the days following the conference, when the undersigned was able to thoroughly review these charts, it was evident that there were many errors in calculation, as well as some ambiguity in reporting the population studied and the results found in same. A call was made to Dr. Selikoff's office and some corrections were offered via the phone, and others were made by sending revised charts to replace those in question. Attached are copies of the revised tables issued to us at the meeting. Table VI was not given at the meeting. It was included in a later mailing to the under signed. General comments on the tables, which are self-explanatory, include the. following. It will be immediately obvious from Table I that the medical review was not restricted to "active" employees as was first thought. We are told by Dr. Selikoff's office that the breakdown of the 137 examinees is as 002334 183999 follows: annuitants "active" employees "active" employees 13 105 19 (full medical review) (partial medical review) The 19 employees listed above were employees (no annuitants) who were seen at an earlier date by Dr. Selikoff and on whom only a chest examination and a chest x-ray were done. This was the group of employees on whom the union requested their company x-rays to be sent to Dr. Selikoff. We are not aware in which group, i.e. service, the 13 annuitants fall. We can assume they may be in the 30-39 and 40-49 because it is in this group that ages in excess of normal retirement age are listed. It is possible that some might be in the first service category, 20-29 yrs., if they re tired at an ace younger than 65 years. The remaining tables are self-explainatorv but indicate, among other things, that 1) none of the cases in this series showing classic signs of asbestosis are "serious" cases. There is no doubt that, in x-ray films shown to us (some taken in the mobile unit - some previously in the group of 19) there are some x-ray signs indicative of asbestosis. Unfortunately, we were not given the names of the patients represented in the x-rays shown as samples. Dr. Selikoff feels, from his long experience, that x-rays alone (if not correlated with pulmonary function tests, etc.) tend to "unread" the time picture of asbestosis. 2) Clinical - findings such as bronchitis and positive x-ray findings and pulmonary function tests are higher in "smokers" than "non1 smokers" and higher in "ex smokers" than in the group which has no smoking history. 3) A high percentage of this group are "no hisotry of smoking (28%) and "ex smokers" (39%) making a total group of "non smokers" - 67%. 4) The study is unique in one aspect. With the expected exposure of this group of employees to firebrick, there is no_ indication of silicosis. Firebrick is about 85% quartz in composition. We are not prepared, at this time, to dispute or confirm Table VT_ It is interesting to note that cancer of the lung in this group studied is recorded as 0.8%, The national average of cancer of the lung (males) is 3+%. Probably the most revealing and appropriate chart is Table VII. This shows that of all the categories of workers represented in the study, that of the insulators, masons and bricklayers (13), 81% show positive signs of both 002335 184000 higher than the findings in ail other occupations represented. Again, it was stated by Dr. Sclikoff that although asbestosis is unquestionably established as a diagnosis, these do not represent presently "serious" cases. Attached with the statistical tables is a copy of the recording form used in the analysis of x-rays of patients whose occupation might make them liable to pneumoconioses (chronic fibrous reaction in the lungs to the inhalation of any type of dust) such as asbestos, iron dust, cloth fibers, and silica. It should be noticed that this form and its legend is the official classification established by the I.L.O., and generally accepted as a classification by most pulmonary and occupational health specialists. Dr. Selikoff feels that, in an ideal program of preventive health,, workers with 20 years or more exposure in jobs involving insulating materials, fire brick. and masonary cement, chest x-rays should be done every three months. He also thinks many other preventive procedures to protect their respiratory systems should be instituted. Thus, he advocates the administration of flu vaccine each year for such a group. .-hove all, he urges all workers to stop smoking. Dr. Selikoff was most professional in his conduct during this session. At no time did he mention the company's name and only, as identification of location of the worker studied, was the name Paulsboro used. Furthermore, he feels that the union is unaware of "99% of the great work done by the company medical department." "They only see and talk about the bad things when they happen." He cited a common union complaint that "our men naturally are sick breathing in that contaminated air at the refinery every working day." He quickly referred again to Table V showing that chronic bronchitis, if the union complaint had merit, would be appearing in all represented employees, when actually his statistics show it occurs primarily and predominaely in the "smokers." He urged consideration of a joint management - union study of the asbestos, workers (those who have been exposed during their work life) in at least five refineries, among which should be included the "best" (as far as modern, but not recent construction) and the "worse." Thus assumes more than one company would be so involved. The whole research project should be jointly sponsored developed and each side totally aware of the progress from planning through completion stages. Such a study can be done by any one of many agencies. There is no doubt that it could be done by the federal government - through the agency of NIOSH. If done by them, he feels it would be a fair, well done and complete study. However, NIOSH could and would probably look at such a project only once and not on a continuing basis, and this type of study needs at least a 20-30 year follow-^up since this can be the "incubation" period of asbestosis. The study could be done completely by any outside agency, such as an academic group or a private research group. Needless to say, choice of the group would have to be mutually agreeable. 00232R 184001 The ideal project, in Dr. Selikoff's opinion, is one planned with, guided and suoervised by capable outside experts, but with all the examinations, x-rays, lab. work done by the company inolant medical department. He feels this is the only source of ongoing interested medical supervision available to the men. He does feel that, in Paulsboro's case, it may well take a gigantic effort to get the union and management to mutually trust each other in such an under taking. He does not feel that it is impossible, and he feels every effort should be made to accomplish this goal. Again, he pointed out that, in the general male population of thre USA, there is a 3-4% death rate due to lung cancer. Admittedly, there ar-emultiple etiological factors in development of lung cancer. However, if and when lung cancer occurs in a company worker ex posed to such materials as asbestos, the first and most obvious conclusion is that this is due to a carcinogenic material in the work environment. This is difficult to combat, and admittedly, can be unfair to managements. Research and careful clinical follow-up can establish data that could remove the haziness as to responsibility in all such cases. In summation, Dr. Selikoff presented findings to the group in a most pro fessional and non spectacular fashion. He admitted repeatedly the group studied is an ideal one in many respects. A more ideal study, jointly sponsored by management and union, should be undertaken. Mobil is not the only petroleum company with this problem (cases in Texaco were cited). Dr. Selikoff did not pretend to be an expert on refinery health since he has never had an opportunity to visit a refinery. No commitment was made to him as to follow up to his presentation or suggestions. After the close of the meeting, Dr. Selikoff was asked if he would explain his relationship to either OCAW or independent unions in the petroleum industry. He answered that he has no contract with OCAW or any union. OCAW and independent unions have and do request the Mt. Sinai Medical School - Department of En vironmental Medicine to do projects for them as indicated in this study of some Paulsboro employees. He emphasized his commitment is not unilateral, and both the school and he, as an individual, are free at any time to consider research or consultant capacities with any agency, management, union or government. 002337 184002 - 002338 184003 Ace d is trib u tio n o f by ye a rs s in c e f1i3r7s tr e fin e ry w exposure o rke rs 0 bfi a 0o 03 bo H <& o CO CO CO 00 u in m CO CO 0 > < 0 bfl C in o CO o cd ID i ti r"* o 1 ! CO CO O o* 0 O' in CO bo < o lo LO 2 CO LO z 12 o* 0 in 0r' X* o -* Cl Cl r- Cl u w CO LO- rr CO m r: 1 1 i( S' o c: o CO o CO 'w' tc 0 u oLI 1-^ c Cl c. Cl 03ii CO11 wo o o urt -*j C3 CO o in Cl ii n o* 002339 184004 Table II Work Activities of 137 Production and Maintenance Employees Type of Work Active "Clean Work" (Docks, Case-Can, Auto Shop) "Dusty" Production Work (Bead Plant, Filter Dept.) Fume Exposure (All other production units) Mixed Fumes and Dust "Clean" Maintenance (Carpenters, Machinists, etc. ) Electricians, High Asbestos Exposure (Insulators, Masons, and Bricklayers) Other Maintenance (Pipefitters, '"elders, Boilermakers) and 10 5 28 6 21 13 41 Totals 124 Retirees 1 7 2 3 13 002340 184005 Length o f Number exposure o f T o ta l changes Parenchym al P le u ra l T o ta l p le u ra l P arenchym al CO a to oc c x: u m m n CO in rH CO cc co CO . c* CM in CM N cj U 3 O co tn u TT o O. m CO CM T5 G n CM CO O rr in co !! ! D eg UQJ O -Q O c o u c u o M CJ C3 U) c w c o 5 e u oi c o 0 5s CB 1 X < * 002341 184006 P ulm onary fu n c tio n a b n o rm a litie s in re la tio n to X -ray changes urul s m o k ln " 002343 184007 T a b le IV Xe:l X tn .c 002343 184008 P revalence o f C h ro n ic B ro n c h itis 002344 184009 Table VI History of previous cancer in 11S refinery workers Cancer liunber | of cases Skin 2 1.6% Eiaader j ! 2 1.6% Colon 1 ' 0.% Abdcr.inal 1 o.s% Lung 1 o.s% ID t'- Total cW r 184010 X - r a y IlO B u lts o f R o fin o r y P ro d u c tio . .uid M a in te n a n ce ) E m p lo yo o s o > -wcoOt-- i-l CM T IQ o c. 6^ n C*J CS H o rH a. 03 CM CM O > a o c* o to \ cm t3'-*oo lO V CO V 'C CM rt u o > o Lrt 03 r*- to CO CO ^ o > \ C3 O hfi O 55 CO 03 CO o \o to a to CM tn D. ao OX ow Q 4J r+ t CD O 4-> WO 3 JS -H 4-> -4 J-> C o :3 < v. cu . -u O Dp OS r-4 C o C3 O r-1 O 44 3: C(3 ao a w 4*->* o CO (3 1 w (4 0 U in 3 o Q) CJ 4J u cj o a. r-4 1/1 tn r-t - O >% CJ rt 3 3U T3 C O to 0 uP* T3 CJ X 1 c O O cn c0c aec c 00 4-> c in *4 H rt O 4- 4- COJ -c ~C CJ W a c. 0 urt 44 O 0 0 in 44 m 0) c CJ H O O tl c J* cl O c 0 4-> to u rt c CJ H *r4 rt 4-> O rH r* 44 O CJ a O c. .3 l- *3 a. 3 CD C O r1t0 n 0 a>* to u X. 0a +rt Vi r"H O 3 to W cc 002346 0023</ " 184011 I I (I O c II I il 3 0 u c _ \r. c/: iw -- 11 ! ~I ww 1i ~<v 5w 2 " CCTt. -- " 3 i Cj rt w e ( ~ ~ 1 ,2 - 1 =\PJIQ 1 iii ovicih ; ii j a a3\'uia Tii | 111 i i-.ovjiHdvia i CI3Xld3CI Til i i11 !1i c 4 o -o Wa vc* c-- Si c_ /IR O N M E N T A L S C IE N C E S LA B C O -A 'X T l;i' ..or T S IN A I S C H O O L OF M E D IC IN E OF TH E C IT Y U N IV E R S IT Y OF NEW YO RK 1 fl Q