Document OzO9Ran42ZajdOJxanXXyMgNv

FILE NAME: Metropolitan Life (ML) DATE: 1952 DOC#: ML203 DOCUMENT DESCRIPTION: Dr. Lanza Publications and Presentations Denying that the US Asbestos Industry had an Excess of Cancer in its1Workers / i'b * AW*i4i'Lf-Kiii-' V' X I [ |W - ' 262 INDUSTRIAL HYGIENE AND OCCUPATIONAL MEDICINE July, 1950, a conference was held at Oxford dealing with cancer in relation to sociological and environmental factors other than occupation. Proceedings of this . conference have been published/1 t, v i ABSTRACT OF DISCUSSION /' / Dr. P aul Cartier, L'Annondation, Que., Canada: I have been asked to describe our experi ence at the Thetford Industrial G inic in Quebec, where we see men engaged in the asbestos- ; mining industry in Canada. Table 3 presents data on eight cases of primary cancer of the lung v which we have detected among 4,000 asbestos workers between 1940 and 1950. In addition to those listed in the table, there was a case in which there was quite a definite^ clinical and radiological history of cancer of the lung but for which, unfortunately, no autopsy*.. IjM . 'the asbestos factor, ' v' V i;;.-'. Is it not more logical to think that the same causal factor will produce the same type of P H tumor; and, therefore, why do we observe such a variety of malignant tumors? ' T able 3.-- Cases of Carcinoma of the Lungs Detected Among 4,000 Asbestos ..? .. .W orkers W O r M S O ^ : .^ ; , ... ' MadlaitlMtJymph M 1ii} % fc-t I Ml Z w.c. Son - 5 XOM A^lcnKinttot^^w ^ .'Brootbotenlc _ 'proscbogenle J (thoracotomy)- 'iV&' - :Pteuraf mesottMloina1 *"Standard Nomenclature ot Diseases and Operations" published by the American Medical Association (New York, The Blakiston Company, 1933) suggests (be term "mesothellal sarcoma." - , . "-if* If for a moment we may assume that the asbestos fibers might produce a bronchogenic,car- J ^ ' / s ' cinoina in asbestotic < .serve ,as evidence because ' exposure or without As a last remark, it would appear necessary that any statistics on occupational, cancer. of ^he ^'.i ^ lung, to be conclusive, should indicate.the precise variety of lungcancer. M fr? Sil v; i>*;! ./' .M r. Edward A. Lew, New York i,T h e'T eren c e in. the frequency of lung cancer m persons S ' m 'w ith asbestotic lungs as compared.'with the.iarge group o f silicotics*provided by coniosis Board seems impressive. However, one might wonder whether the two groups fadfaieen examined for cancer with equal care: I am impressed by the fact that when different groups lungs were studied by the same observer, Dr. Gloyne, the differences in frequency of lung cancer - were much less. If we restrict our attention solely to Dr. Gloyne's series, I am not sure that the differences are statistically significant Y - \ Mt'jA- e r ''ili , Dr. A. J. Lanza, New York : I think it is important to distinguish between cases of clinically recognizable and fatal lung cancer; oh onc'hand, and cases in which the diagnosis of lung cancer' has been made as more or less of an incidental finding at autopsy, on the other. The English claim for an association between lung cancer and asbestosis has been based, it seems to me, on data obtained from lungs that a pathologist has searched with a microscope. I wonder how many 51. Conference on Geographical Pathology and Demography of Cancer, J. Xat. Cancer Inst. 11:627-662. 1950. SMITH--BRITISH AXD EUROPEAN TUMOR PROBLEMS 263 cases of lung cancer would be found if lungs from any sort of population were subjected to the same minute scrutiny? ' Dr. S mith : In regard to Dr. Cartier's query as to the significance of different types of lung cancer, it may be pertinent to note that a diversity of tumors was found in the lungs of chromate workers reviewed by Dr. Anna Bactjer. Experimentally, the polycyclic hydrocarbons evoke a great variety os tumor types. If asbestos is carcinogenic, 1 would not expect to see it produce only one type of tumor. I am interested in ypur, observation of two cases of pleural mesothe lioma. This is a rather rare tumor. In examining- pathological material sent us from England by Dr. Hinson, we found among six cancerous asbestotic lungs two presenting alveolar cell car cinoma. These tumors are often diagnosed as "pleural mesothelioma." I should very much like Vi to exchange slides with you. y'M:` In reply to Mr. Lew and Dr. Lanaa. it ^yas my understanding' that the English cases of silicosis and their cases of asbestosis were :handled in th e ; same general fashion through the Pneumoconiosis Board a n d ^ t r t h e l u n g . c a ^ r i r ^ t e ^ serve as _ a .reasonably s a t i s f a c t o ^ i C b i ^ ^ ^ r i ^ c ^ i i ^ ^ ^ ^ ^ l d ^ ^ l ^ i o ^ l ^ i m d ^ I n Dr. Gloyne's ^ :f;s c ric s d f 81 cases of , the'tum or was' evident ifi' the bombing of London, were*, recognizable in the gross. : ^ - ,r:" -I'C' Da. J ohn L. Pool, New Y ork: H ave experimental studiesthrow n any light on the question of lung cancer in relation to asbestos?, V Da. Sm it h : In 1941, Nordmann and Sorge:>vln Germany claimed to have produced cancer - i >re. Li ;#-* A sH mi ?. . -i'i-'rL M i ft S}vSV 'i i tu*/. i SEVENTH SARANAC SYMPOSIUM ~-i:- '**'*>.-* y*r - ' _ *--m :rs? & 3 z ; Ai * IJ zOL V Foreword 4 The Saranac Symposiums, of which this session is -.553 the Seventh, have been organised periodically for the discussion of health problems pertaining to workers exposed by inhalation to industrial substances. The subjects to be discussed at the Seventh Saranac Sym posium will be limited but many have broad applica tion. The topics will not be restricted to individual companies or industries, nor will they concern only a single group such as the employer or the employee, the insurer or the insured. The problems to be considered involve a host o f diverse interests -- engineering, medical, legal, administrative, social. A t the sym posium representatives o f each of those groups and interests will have the opportunity to explore and discuss common problems with the objective that in dustrial health be improved. If that objective is at tained, the symposium will be a successful one. Participants in Program A mbersox, J. Burns, M .D,, Professor of Medicine, Columbia University -- College of P d S, Visiting Physidan-inCharge, Cheat Service, Bellevue Hospital, Member, Board of Chest Consultants, Workman's Compensation Board of New York State, New York, N.Y. A ndrews, Earle T ., Vice-President in Charge of Operations, Pennsylvania Glass Sand Corporation, Hancock, W . Va. Baetjer, A nna M., Sc.D., Associate Professor of Environ mental Medicine, The Johns Hopkins School of Hygiene and Public Health, Baltimore, Md. Barnako, Frank, Manager of Compensation and Safety, Bethlehem Steel Company, BcthUnem, Pa. Braun. Daniel C., M.D. Medical Director, Industrial Hy giene Foundation of America, Pittsburgh, Pa. .Bristol. Leonard J., M .D., Head, Department of Radiology, The Trudeau Foundation, Saranac Lake, N.Y. Cartier, Paul, M.D., Medical Director, Thetford Industrial Clinic, Thetford Mines, Quebec, Canada Connolly, W illiam L., Director of- Bureau of Labor Stand ards, U. S. Department of Labor, Washington, D. C. Donlox. M ary, Chairman, W orkman's Compensation Board of New York S u te, Albany, N.Y. D rinker. P hilip, Sc.D., Professor of Industrial HygieneHarvard University School, of Public Health, Boston, Mas*. Durkak. T homas M., Assistant Director, The Saranac Lab oratory, Saranac Lake, N.Y. Eisenbud, M erril. Director, Health and Safety Division, U. S. Atomic Energy Commission, New York Opera tion's Office, New York. N.Y. Fletcher, C harles M ., M.D., Director, Pneumoconiosis Research Unit, The Medical Research Council, Llandough Hospital, near Penarth, Cardiff, Wales, Senior Lecturer, Postgraduate School of Medicine, University of London, London, England Friedman, Louis, M .D., Friedman Diagnostic Clinic, Bir mingham, Ala. G entholts, A. J., Assistant Counsel, Republic Steel Cor poration, Cleveland, Ohio G reenburc, Leonard. M .D., Director, Division of Industrial Hygiene and Safety Standards, New York State De partment of Labor, New York, N.Y. G recoire, Fernand, M.D., Medical Director, Institute, Montreal, Quebec, Canada C.# j/ . Lavoisier 'TOTO! ^-3 'Sii Hamlin, Lloyd E., M .D , Medical Director, American Brake Shce Company, Chicago, 111. I Hardy, Harriet L., M.D., Associate Physician, Occupational * Medical Clinic, Massachusetts General Hospital, Boston, Masa. H atch. T heodore F., School of Public Health, University of Pittsburgh, and Industrial Hygiene Foundation, Mellon Institute, Pittsburgh, Pa. HlLFINCER, M artin F., President, Associated Industries of New York State, Buffalo, N.Y. H ill, James L., Commissioner, Workmen's Compensation Commission, State of Michigan, Lansing, Mich. \ H ueper. W . C,, M.D., Chief, Cancerigenic Research Studies I Section, Cancer Control Branch, National Cancer Insti tute, National Institutes of Health, Bethesda, Md. H uc h -Jones, P hilip, M.D., Senior Lecturer in Medicine, University College of the W est Indies, Mona St. Andrews, Jamaica, B. W . I. Kalmykow, A ndrew, Assistant Manager, Casualty Depart ment, Association of Casualty and Surety Companies, New York, N.Y. Kuechle. B. E., Vice-President and Claims Manager, Eip- . ployers Mutual Liability Insurance Co. of Wisconsin, Wausau, Wis. Lanza. A nthony J., M.D., Chairman, Institute of Industrial M ediane, New York University, Bellevue Medical Cen ter, New York, N.Y. Levin, M orton L,, M.D., Assistant Commissioner for Medi cal Services, New York State Department of Health, Albany. N.Y. Lynch, Kenneth M., M.D. Professor o f Pathology and Dean, Medical College of the State of South Carolina, Charleston, S. C. McCann, W illiam S , M .D , Professor of M ediane, U ni versity of Rochester, Physician-in-Chief, Strong Memorial Hospital, Rochester, N.Y. McG ee, Lemuel C , M .D , Medical Director, Hercules Powder Company, Wilmington, Del. M ayer. Edcar, M .D , Clinical Professor of Industrial Medi an e , New York University Postgraduate Medical School, Member, Board of Chest Consultants, W orkmen's Com pensation Board of New York State, New York, N.Y. M eredith, G eorce E , Vice-President and General Attorney, New Jersey Manufacturers' Casualty Insurance C o , Trenton, N. J. J M erewether, E. R. A , M .D , H. M. Senior Medical In- l spector of Factories, Ministry of Labour and National Service, St. James Square, London, England Mider, G. Burroughs. M.D., Associate Director in Charge of Research, National Cancer Institute, National Insti tutes of Health, Bethesda, Md. Motley, H urley L.. M.D., Director, Cardio-Respiratory Laboratory, Jefferson Medical College Hospital. Barton Memorial Division, Philadelphia, Pa. O renstein, A. J., M.D., Chief Medical Officer, Rand Mines, Ltd-, Johannesburg. Union of South Africa Pratt, Philip C., M.D., Associate Pathologist, The Saranac Laboratory, Saranac Lake, N.Y. R hoads, C. P,, M.D., Director, Memorial Center for Cancer and Allied Diseases, New York, N.Y. Sabourin, Ivan. Queen's Counsel, Counsel to Quebec Asbes tos Producers Assoa'ation, Montreal, Quebec, Canada Sander. O. A.. M.D., Associate in Media'ne, Marquette University Medical School, Consultant in Industrial Medicine, Milwaukee, Wis. Shaver, C. G., M.D., Superintendent, Niagara Peninsula Sanatorium, St. Catherines, Ontario, Canada Solandt, D onald, M .D , Professor of Physiology and of Physiological Hygiene, Faculty of Medicine, Toronto, Canada T hompson, M. W , Treasurer and General Manager, Hall China Company, East Liverpool, Ohio T rudeau, Francis B , M .D , President, Board of Trustees of the Trudeau Corporation, Saranac Lake, N.Y. Urban, E. C. J , Industrial Hygiene Engineer, The Saranac Laboratory, Saranac Lake, N.Y. V orwald, A rthur J , M .D , Director, The Trudeau Found ation and The Saranac Laboratory, Saranac Lake, N.Y. W acner, Richard, Manager, Casualty Department, Asso ciation of Casualty and Surety Companies, New York, N.Y. W aring, James J , M .D , Professor of Medicine, University of Colorado School of Medicine, Denver, Colo. W aters, T heodore C , Counsel to Industrial Hygiene Foundation, Industrial Counsel, Mullikin, Stockbndge and W aters, Baltimore, Md. W hipple, Edward G , M .D , Consultant Physirian, Strong Memorial Hospital, Member Board of Chest Consult ants, W orkmen's Compensation Board of New York State, Rochester, N.Y. W right, G eorce W ,, M .D , Head, Department of Physi ology, The Trudeau Foundation, Saranac Lake, N.Y. Notes -- Wednesday, September 24 9.00 A.M. -- 1OO P.M. IL. Pneumoconiosis and \I rrtYvdvChonChairman: C. Pulmonary Cancer P. RHOADS, M.D. Philosophy of Biostatistics as Applied to Environmental Pulmonary Cancer Morton L. Levin, M.D. Discussion f i General Review Discussion W . C. Hueper, M.D. ^Asbestos Miners Discussion Paul Cartier, M.D. Asbestos Weavers Kenneth M. Lynch, M.D. Discussion, led by w E. R. A . Merewether, M.D. Group Photograph Wednesday, September 24 j s 2:30 P.M. -- 5:30 P.M. Pneumoconiosis and Pulmonary Cancer (Continued) Chromate Workers Discussion Anthony J. Lanza, M.D. Experimental Pulmonary Cancer -- General Review G. Burroughs Mider, M.D. Discussion Pulmonary Cancer in Experimental Exposures to Chromate Anna Baetjer, ScD . Discussion Pulmonary Cancer in Experimental Exposures to Beryllium Arthur J. Vorwald, M.D. Note * ;> r -r^-S gr'^68* Thursday, September 25 2:30 P.M. -- 5:30 P.M. Workmen's Compensation -- Medical and Legal Aspects Chairman: M. W . T hompson Concepts of Disability Under W o r\m en `s Compensation Statutes Theodore C. Water t Compensation for Disability and Death Re sulting from the Pneumoconioses George W . Wright, M.D. George. E. Meredith Martin. F. Hilfinger Discussion, led by Andrew Kaltnykow 7:30 P.M. Banquet -- Hotel Saranac i Introduction of Guests -- Arthur J. Vorwald, M.D. Remarks -- Pranas B. Trudeau, M.D. Leroy U. Gardner Memorial Lecture Anthony J. Lama, M.D. 5 Thursday, September 25 9:00 A.M. -- 1:00 P.M. Clinical Aspects of Pneumoconiosis Chairman: W illiam S. M cC ann*. M.D. Incidence of Clinically Manifest Diffuse Obstructive Emphysema Leonard J. Bristol, M.D. Discussion Pulmonary Function Studies in Men Exposed for Ten or More Tears to Inhalation of Asbestos Fibers Fernand Grgoire, M.D. Discussion Maximum Ability for Physical Worl^ of Moderate Duration Correlated with Various Tests of Pulmonary Function George W . Wright, M.D. Discussion Cardio-Circulatory Aspects of the Pneumo conioses William S. McCann, M.D. Discussion, led by James J. Waring, M.D. -- Notes -- Friday, 'September 26 9:00 A.M. -- 1:00 P.M. i Viewpoints on Compensation for Pulmonary i ' and Other Occupational Diseases i l Chairman: Hon. M ary D o.v l o x The Functions and Value of Medical Boards , and Medical Examiners in Controverted ! Compensation Cases Lemuel C. McGee, M.D. I 1 Board of Chest Consultant, W orkmen's Compensation Board, Mew York S u te , Edgar Mayer, M.D. J. Bums Amberson, M.D. Edward G. Whipple, M.D. A. J. Gentholts Discussion The Presentation of Medical Evidence in Controverted Compensation Cases Daniel C. Braun, M.D. Frank Bamako Ivan Sabourin Discussion JI Group Photograph  * 9 Friday, September 26 2:00 P.M. -- 5:30 P.M. Administration of Workmen's Compensation Laws as They Relate to the Pneumoconioses Moderator: T heodore C. W aters Panel Members: James L. Hill William L. Connolly B. E. Keuchle ' Earle T. Andrews Lloyd E. Hamlin, M.D. i Summary Workmen's Compensation Sessions Theodore C. Waters 11 Conclusion of the Symposium J Summary of the Medical Sessions and Remarks I Arthur J. Vorwald, M.D. Monday, September 22 9:00 A.M. Registration: John Black Room, The Saranac Laboratory 7 Church Street, Saranac Lake New York Early arrivals are requested to register on Sunday, September 21. 9:45 A.ML Address of Welcome Arthur J. Varwald, M.D. 10:00 A.M. -- 12:00 Noon Definitions and Clarification of Terms Pertaining to Pneumoconiosis Moderator: ARTHUR J. V orwaLD, M .D. Panel Members: Anthony J. Lanza, M.D. Leonard Greenburg, M.D. O. A. Sander, M.D. Richard Wagner Charles M. Fletcher, M.D. fi Discussion, led by A. J. O renstein, M .D . 5e s J-:- . `"--'.- ,'"--*' ~,-w '; * u?;** ir%jtfg *-S*s64C^ ---~., *- ' --'"^.w*r_-iv"*_#**"*:*[*,'~0**<y*J ^VaSS&VBci -- Notes Monday, September 22 2:00 P.M. -- .5:30 PJA. The Inhalation of Certain Industrial Substances Chairman : T heodore F. Hatch Brief Reviews Silica Asbestos Beryllium Bauxite Thomas M. Durkin Arthur J. Vorwald, M.D. [Harriet L. Hardy, M.D. C. G. Shaver, M.D. and Donald Solandc, M.D. Discussion N ew Synthetic Silicas Philip C. Pratt. M.D. The Fate of Inhaled Particulates Merril Eisenbud Discussion, led by Theodore F. Hatch 3 '-S r^ r -^'V-S--''.r~-V.T*>r^y"*i-> --;'_*n-'.'-*--X-'"--%-- -- Notes -- 9:00 A.M. -- 1.00 P.M. Pneumoconiosis in Cool Miners Chairman: P hilip D rinker, Sc.D. Industrial Hygiene Studies of Coal Miners in T w o Geographical Areas in the United States E. C. J. Urban Discussion Radiological Classification Charles M. Fletcher, M.D. Discussion Pathology of Coal Workers' Pneumoconiosis Arthur J. V orrvald, M .D. Discussion Epidemiology of Coal Workers' Pneumo coniosis in W ales Charles M. Fletcher, M D Discussion s J> Pneumoconiosis in Coal Miners (Continued) " i * Chairman: O. A. Sander. M .D. Pneumoconiosis in Coal Miners in Alabama Louis*Friedman, M.D. Discussion Pulmonary Function Studies of Coal Miners in Pennsylvania and W est Virginia Hurley L. Motley, M.D. Pulmonary Function Studies 0/ Coal Miners in Wales Philip Hugh'Jones, M.D. Discussion s BY POSTO? RHOADS ------------------------------------------ : Thank you, Doctor K erev eth er. t 1> S' Is there a comer.t about the Kerewether d isc u ssio n ? (No re sp o n se ). Doctor Lanza, I th in k you car. make sane co m sn t on t h i s . BY D0CT03 LANZA; Mr. Chairman, L adies and G ent.er.en, before goir.r i n t o t h i s b r i e f statem en t of n in e on ch ro n a te s, I would lik e to make a few consents on D octor K erew ether's o b se rT a tio n s I was very rcueh in p re sse d w ith what Doctor Kere- v e th e r s a id , and th e re is no q u estio n b u t what a very c a r e f u l, p a in s ta k in g job has been done in 3 re a t B r ita in or. the su b je c t of try in g to determ ine what the hazard r.igr.t be in the asbestos in d u stry w ith re sp e ct to cancer. There are j u s t a couple of co n sen ts, I 'n not say ing one way or the o th e r, t h a t i t nay or nay not in flu en ce the incidence of cancer. I would ra ise a couple of points which I th in k a l l o f us n ig h t keep in n in e , and which n ig h t p o s s ib ly have eone b e a rin g on the s i t u a t io n in England. Now, I hive v i s i t e d , sonewh&t e x te n s iv e ly , I th in k , nearly a l l the asbestos p lan ts of the Dnited S tates, and the n in es and the m ills in Canada and have spent q u ite a l o t of _____________________________________ RECEIVED F.HJL&S l : - z . DATE: 3 U L 3 t 1975 M.E.M tin e th e re , and hve spent a l o t of tin e review ing film s, and not long ago, spent several cays with doctor Kenneth Smith on asb esto s, reed in g h is filn s * 1 fin d i t d iffic u lt to believe that cur cancer in c id e n c e among asbestos workers could be anything lik e as larg e as i t seens to be in England, because v u ile l*a p e r f e c t l y f r e e to admit t h a t we may have n isse d cancer cases which we should have n o t, on th e other hand, I cor.11 th in k we could have m issed a l l of the* i f they had occurred, in to the sane e s te n t th a t ap p aren tly they do in England* How, th a t i s sim ply an o b serv atio n of nine* Of course, i t is true th a t as soon as the business of the harm f u l e f f e c ts of asb esto s once took h ole in the American i n d u stry , they did s ta r t to clean up th e ir p lan ts and, while I wouldn't sey th a t a l l the asbestos plants- in the country were marvels of in d u s tria l hygiene p e rfe c tio n , neverthe le s s g re a t s tr id e s have been made, and p a r tic u la r ly , fo r in s ta n c e , in the p la n t in D octor Kenneth lynch*a town in C h a rlo tte , South C aro lin a, where they have' done a very b e a u tif u l job, so th a t w ith the sm all number of people in th e in d u s try , i t 's obvious th a t we are never going to have th e c l i n i c a l experience w ith as b e s to s is t h a t we have, f o r in s ta n c e , w ith s i l i c o s i s , because th ere is n o t g'oing to be the m a te ria l to work on* How, back of t h a t , th e re i s s t i l l one more cues t i c M.E.M T hat i s the n a tu re of the asb e sto s i t s e l f . Nov, when I f i r s t u sed to go to Canada, I used to h ea r frequen t l y t h a t up th e re , th a t the Canadian asb esto s vas le s s damaging tha the kind the? used in E ngland,! b e lie v e , and I have put t h a t comment down to v h a t ve n ig h t c e l l the n a tio n a l or lo c a l p a tr io tis m , you know, l i k e the r i v a l r y between towns to th a t you so frequently see, b u t the f a c t remains the san e , th a t in th is co u n try , ve do use the a s b e sto s , m ostly th e a sb e sto s t h a t we g e t from Canada, and 1 b e lie v e , frc n what I hear from our E nglish frie n d s , th a t a g re a t d eal, i f not the major p a rt of the asbestos used in England, is Rhodesian a s b e s to s , *S:ich i s q u ite d is s im ila r in i t s con s tru c tio n and in i t s form ation, i t s physical c h a ra c te ris t i c s , t o the kind th a t comes from T hetford and from a sb e s tos in Canada. Now,, th a t nay have n o th in g to do with i t , and up u n t i l two o r th ree y ea rs ago, I dism issed t h a t . I thought t h a t was j u s t p u r i l e , b u t sin ce we have in the l a s t few years, learned th at d iffe re n t types of s ilic a , for instanc produce e n tir e ly d i s t i n c t p a th o lo g ic a l e f f e c t , I am b e g in n in g to wonder i f we have n o t f a i l e d to pay s u f f i c ie n t a t te n tio n to the type o f asbestos which v a rie s even, as I an inform ed, there is a d ifferen ce between the asbestos th a t i s mined in the town of A sbestos and the kind th a t is mine n o t f a r away in T h etfo rd , and y e t both of th e se , i n tu rn , u t fttlVED F.H.H&S 0 W.t.M a re q u ite d if f e r e n t from the asb esto s th a t case from Rho d esia, and possibly from other p arts of the world with which I'm not acquainted* And, having in mind the le sse n we've learned in the s ilic a dust, 1 think th a t is sor.ething perhaps th at ve should pay more a tte n tio n t o . Now, I simply r a is e th a t p o in t, because X th in k i t nay have a g re a t deal mere s i g n ific a n c e than we have been in c lin e d to give it* Nov, I have summarised - I have s u s ta r ir e d my re marks h ere very b r i e f l y , because the to p ic of chrome is gc in g to be handled by Doctor Anna E a e tje r , who has done the experim ental work in chrome, and has a more in t i n ate know ledge of i t iro n t h a t p o in t of view than I do. The a v a ila b le evidence i s th a t chronate workers do have an incidence of cancer e f the' lungs ir. excess cfv h at n ig h t be expected. Beyond t h i s , we do n o t as y e t kr.o a g reat deal* In te re s t in chrone as a possible carcinogenic agent, w ith p a rtic u la r resp ect to lung cancer, is conparativ e ly r e c e n t. The o f f i c i a l s o f one of the la r g e s t chrone producing companies in th is country supplied the impetus th a t s ta rte d in te re s t in th is su b ject in the United S tates t h e i r apprehensions to ta n g ib le fe n s , in s e ttin g on foot the s t a t i s t i c a l survey conducted by iiachle and C-regorius, and p u b lish ed in the P u b lic H ealth R eports on August 7tn, o- E f f o r ts were nade to reduce exposure in chromium p le a ts and more in te n s iv e m edical se rv ic e ves inaugurated w ith e much ao re fre e use o f X-ray exam ination, end I ven tu re Doctor B a e tje r w ill t e l l you o f her work ir. Bel tin o re w ith ex p eriaen tel animals How, D octor S a e tje r p u b lish ed e comprehensive paper on pulaonery carcinoma in chronace workers in the A rchieves o f I n d u s tr ie ! H istory in 195-'* ad up to now, th e re i s n o t much more to sey th a t ves not s a id in her paper* In e word*, as the saying goes, she covered the sub je c t iron soup to nuts* and as f a r as our question s ta te d along th a t lin e , goes Kov, f o rtu n a te ly , during 195 the D iv isio n of Occupational Health of the United S tates Public Health Service , w ith the assistan ce and cooperation of the in d u stry , conducted a survey of the vacie carene industry Tarough the courtesy of Doctor Seward S. K ille r, in charge of the D ivision of Occupational E ealth, I have been given a copy o f the m edical p o rtio n of th e ir adm irable report Doctor M ille r was kind enough to make th a t a v a ila b le to ce tthen I asked him i f he was going to p re s e n t h is fin d in g s h ere and he s a id no* The r e p o r t, however, i s in the p re ss now, and as i t w ill be p resen tly a v a ila b le , I w ill only fe fe r tc i t in * very b r i e f summary 1 quote from the P ublic Health __________________________________________ F t T .V I& W S erv ice R eport: A ll s p e c if ic causes of m o rta lity in chrome w orkers, the chrome workers had frequency r a te s th a t were mot g r e a tly d if f e r e n t from o th e r w orkers. However, cancer w ith a r a te o f 7*1 compared w ith .7 stan d s out as markedly in excess fo r chromate workers# For cancer of a ll s i t e s , the a c tu a l number of deaths o f chromate w orkers was approx im ately fo u r and a h a lf times the number th a t would have been expected had the cancer r a te fo r a l l males in the United S ta te s p rev ailed # When cancer of the re s p ir a to ry system was observed se p a ra te ly f o r chromate w orkers, n e a rly tw enty-nine times as many d eaths as were expected were found# A ll o th er types of cancer f a i l e d to show an excess among chromate workers# I t is obvious -- t h a t 's the end of the quote -- i t is obvious th a t much re se a rc h and experim entation rem ain to be done b efore we can t a lk w ith more assurance of t h i s situ atio n # In the meantime, the in d u s tria l plants are b e in g clean ed up and in some cases r e - b u i l t w ith the hope and expectation of steadying th is tid e of cancer cases# Before leav in g th is to p ic , I again would lik e to make a p le a f o r the more c a re fu l and p re c is e use and assoc* i a t i o n o f words# The evidence of the r e la tio n s h ip of chror exposure and pulmonary ameer appears c o n c lu siv e . This cancer o f the lungs in chrome workers does not fo llo w , as f a r fts I can a s c e r ta in , does n o t fo llo w , n o r is i t cepende: -WM vl .V' upon ft p r c - e x is tin g pneum onoconiosis.. I n te n tio n th is s th e re may n o t be any f a ls e conclusions drawn ir o n the i i a t i o n o f th ese two terms as they are used in heading i our program* Thank you* BY DOCTOB RHOADS: With very c h a r a c te r is tic p re c is io n , Doctor 1has la id to r e s t any illu s io n s c r queszicr.s th a t .night r a is e d concerning the r e la ti o n of chrome zz pulmonary c 2s th e re a comment on Doctor L an za's preser.zaoior.? BY DOCTO?. RICHAP.DSO": Who were the workers th a t were e ffe c te d in t r . BY DOCTOR LA"2At As f a r as I know now; 2 car.'t t e l l you p o s it u n til 2 have had a chance to d ig e st the Public health : v ice r e p o r t , b u t you know these are s n a il p la n ts and i: s n a il p l a n t s , men s h i f t around, so th a t r.:c only do we mow what p a r tic u la r chrome substance cr v_.ac p a rtic u li process in the manufacture of chrcne is responsible, i i s a c a n c e r, b u t we do n o t know or you c a n 't depend cr. group o f men in th is departm ent or th a t group o f men i t h a t departm ent, u n fo rtu n a te ly , we c a r .'t do it* BY DOCTOR RICHARDS: W eil, could we say when does the exposure tc b egin and when does i t er.d in the p ro cess of tne handl of chrome? E l DOCTOR LA?:ZA: M.E.M ^ V e il, you would have to th e n . Ve had, I th in k , the en g in eerin g p o rtio n of the P ublic H ealth S ervice rep or which w ill give the d e ta ils o i the process, the dust stud ie s , and so fo rth , a t d iffe re n t stages a ll along the lin e , from the tin e they get th e ir ore out u n til i t i s shipped out of the plant* BY DOCTO? P.ICHAP.ES: V eil, then, is th ere any hazard a f te r i t is shipped out of the plant? EY BOCTCP LAYZA: As f a r as I know, th ere has been no com plaint i r any so u rc e , t u t th a t again i s something ve don't know, Y DOCTO?. RHOADS: Doctor Hueper has concent* BY DOCTCP KTZrZB: You asked the ques tio n wnether the na te r ia 1 shipped o u t of the p la n t w ill become c a rc in o g e n ic . There have been re p o rts from Germany t h a t sin e pigment workers have developed carcinogen* The zinc chromate, the yellow d ie w ith which we spray our a irp la n e s and w ith which we spray the o il tanks and o il pipe lin e s , i f you see those b e a u tif u l b r ig h t yellow e o lo rs in the la n e s cap f ur r e f i n e r i e s , t h a t 's zinc chromate* Ve are q u ite a b i t ir.te re to f in d out whether the p a in te rs who sprayed the zinc BY DOCTOR RHOADS: f D octor Mere w eth er, woiald you c o m en t on these r e - ai&rks? BY poCTOR M5R5WST52R : to r Knox can answer co n c lu siv ely one of them* F ir s t of a l l , 1 think Doctor Lanza is misinformed about the proportions of asb esto s used and where they are used in England. The o r ig in a l cases of a s b e s to s is , f i f t y y ears ago, were a l l Canadian asbestos* The e a r l i e s t a sb e s to s work in England was. e i t h e r se v e n ty -e ig h t o r eighty-tw o and th e re nay have been some c r y s t a ll i n e f i b e r th en , b u t very q u ick ly the asb esto s tra d e co n c en trated on the w hite Canadian cry sta llin e* L a te r on, the Rhodesian a sb e sto s and the Rhodes ia n - the South A frican b lu e , anc the th i r d one which i s a ls o an iro n s i l i c a , the am acite, came in* ICov;, of a l l of th ese, the amacite is d e fin ite ly the most b r ittle * I t has s h o rt f i b e r s , i t 's brown and i t 's got f ib e r s as -ong as t h a t (in d ic a tin g ) whereas the b e st Canadian spinning fib ers have only g o t fib e rs as long as th a t (in d ic a tin g ) end the b e s t blue is about that* W ell, th ere i s no doubt about the d u stin ess of the am acite* That is the brown long f ib ere d s t u f f , to such an e x ten t th a t it s very l i t t l e used today, so i t 's a t the p e rio d where some o f these cases are concerned, 'or where the cases of a s b e sto s is occurred - some of my old frie n d Glynn's cases o ccurred - th e rs was a good deal c f blue and a good deal of msacite used* Kow, I th in k d o cto r Knox w ill be ab le to t e l l u s, in h is p la n t, which is the b ig g est in the country, what about the types of asbestos they use in th a t p a rtic u la r fac to ry , and the - v n eth er they have had any carcinoma of the lung* Kow, a b o u t the n ic k e l ca n cer, i t i s p e r f e c tly c o rre c t th a t none of us think th a t n ick el carbon has any th in g to do w ith i t as such f o r the very sim ple reason t h a t - w e ll, one reason i s th a t n ic k e l carbon i s so to x ic th a t we should b u ild a fa c to ry in o rd er to g e t the - in order to g et the l i t t l e cancer, and of course, i t might act in t h a t p ro p o rtio n , then I should imagine a l o t more people would have been effected* D octor Amore or Doctor Morgan and m yself f e e l th a t th e - th a t the re -b u ild in g of the old c a lc in e rs was th e c r u c ia l change in the m a tte r, though th e re was some o p eratio n in the c o n s titu tio n of th e m aterials which are sh ipp ed from P o rt Home in Canada* The d if f e r e n c e , as I know, because I saw i t before and a fte rw a rd s, between the o ld and extrem ely dusty c a lc in c e rs and the modern b u ild , i s enormous# T h e re fo re , th e re may be sane hope in the fa c t th a t perhaps a lo t of big dosage is necessary to pro duce some of these cancers* B Y DOCTOR RHOADS: { CVw C VJV c?y /yT o ii MUMICK FC *fcc no***?# 752 AUtMO< A . J 1--2.0,213 t,tu*. A sb estosis P a p e r read b efore F o u r th C o n fe r e n c e of M cIn tyre R e s e a r c h F o u n d , on S ilic o si eaic. Cc D \zpp [ I OAT* /1 952 AftSlft. CP9.: T we -'`cfiio'' o f .i s b r s ro s i s o n th e b o d y i s b r i e f l y r e v i e w e d . It i s pointed out that a sb e sto sis is regarded much m ore seriou sly in Great Britain th*n in Canada or the United States; the B ritish believe it is w o rse f- t h a n si.1ico.\>i:s ''d o f t e n l e a d s to c a n c e r , w h i l e i n A m e r i c a c a n c e r r e s u l t i n g b from asbestor-is is practically r.on-existent. b a z z0 u /t*o<* OAT* J.TjMAVMliPi UOPO* mew. A*T*aCT UNR row OCMfMAV uf eoM fo. c / eenffli Vt ;-u * lto .R .v ' %r \ asbestosis Kh t Da. A. J. Lamm Quirmaal Institute of Industrial Medicine Now York University Post-Graduate Medical School la opening my discussion of asbestosis I would like to say that while U has been presumably described by Herodotus in 410 B.G, the disease as wo now know it is very new. It w u ftrstlreported In England in 1900 and a comprehensive report was made in that country by Dr. MorewcthSr (duel Medical Inspector of Factories) and Dr. Price in 1940. The lust cases in the United S te p were described by Lynch and Smith of Charlestop, South Carolina in 1940. During 1940 and 1941, Drs. Lanza and McConnell of the Metropolitan* Life Insurance Company conducted the first ftudy of Asbestosis in ths United States and Canada. This study included the mines in Canada and ntariy all the fabricating plants in the United States. The reports of this study wore published by the United States Public Health Service in IMS. Asbestosis, I would like to point out, is the only silicate dust capable of producing disability and death that does so to any marked or appreciable extent. The total number of persona involved in' the industry probably decs not exceed 12^00 sad as far as can bo borne out by clinical experience, tuberculosis is not a factor in this diseasaj Ever since the survey wee started in 1940 the industry has carried on strenuous measures to .contfol the dust in mine, mill and factory with a very marked degree of success. It would seem, therefore!, there will never be available the clinical experirmce of asbestosis that has been a marked feature ef silicosis ip various industries throughout the world. I would also like to point out that the explrieaoe with asbestosis in England appears to differ sharply with that In Cauda and the United State), The authorities in Great Britain regard asbestosis as a very, serious disease, much more so than ail costs, and they seem to be convinced that cancer bf ths * A payer rood Mori tki fourth Coolant* of Mct/iTYM RSARCB FOUNDATION ee SUenh, hold m Norooit, Quote, Jmmry ittk-JOtk, J9if, lungs is a Sequent sequela. This is not the experi ence in either Canada or ip the United Statu A great deal of information is available from the medical departments of the various industries that have for a long time maintained constant roentgenographic examinations of asbestos workers which, coupled with the efforts at dust control, may explain the difference in clinical findings. As far u we have been able to ascertain, there docs act seen to be . any undue prevalency of cancer among asbestos V workers in this country and, u some of the mince * and fabricating plants have been working extensive- *> ty for over thirty years, it would seem that if cancer w u a frequent complication of exposure to as* bestos dust, this fact would have become evident long ago, especially u the medical supervision ef t` asbestos workers is both thorough and comptehenv. slue, I have, within the last couple ef months, spent several days with Dr. Kenneth Smith in Asbestos reviewing a great many films covering a * ; period of a number of years and I understood him ` ' to say that be bad seen only one case of cancer of the lu g s during tbattimn. Dr. Chrtier at Tbcttord b u found only a vary small number of casos of '* cancerof the lungs in the asbestosclinic in Thetford. * I would Uke#to emphasise that none of us can afford to be tod dogmatic in discussing these oc- ,, upational diseases sad because the experience far ooe country indicates one set of results, it does not necessarily fellow that tha same results are to be found, in other countries. There am many dreum* environmental conditions that may diffar markedly and, unless all these divergent factors are known, comparisons can bo mado only with tho greatest of caution. U is quite possible that the asbestos fibers themselves in various parts of the world may differ in their structure and com position and hence produce different pathological results when inhaled. We have recently learned to appreciate the Importance of this phase of dust disease of the lungs in connection with the effects of the inhalation of dJatomnceoui earth. Diato- -*01(04 d k f t l# E T ttt T6. 6B .M 1 T'd t mucous earth is chemically identical with ajysul* producing pulmonary Abroeia will receive further H line allies, but the amorphous form of silica pro* extended study, duces quite different pathology ia the lungs than does crystalline silica. In these dust diseases the Tuberculous does not appear to be a factor ia matter of dosage alto is important and unless the asbestosis and there is general agreement on this seriousness of the exposure is terms of dust in the both in Canada and the United Stales. Certainly inspired air esa be determined with some degree of there is nothing in the clinical observations on accuracy, one cannot compare one set of conditions . asbestos workers comparable to the experience with with another without running the risk of serious tuberculosis seen among industrial workers exposed error, The matter of asbestos as a carcinogenic to x ic a dust. agent deserves, and will receive, continuing extended study both in Canada and the United States. In* duatrial physicians have been alerted to be 01 the Aluminum prophylaxis has not been tried in tha lookout for lung cancer among asbestos work r*. . asbestos Industry. The result oftfas work of Smith, Wootoo and Ring published in THORAX in June Some yean ago the late Dr. Gardner of Sac tnac first ascribed the action of asbestos fibrosis is the lung to the larger particles rather than smaller does. IMi indicates no-amelioration of asbeetosia ia experimental animals as has beta evidenced for silicosis. This ia exactly opposite to the effect of silica where it has been demonstrated that tha smaller | the To summarise: Hand'jn band with continuing particles the more active they are in producing ; efforts to control air born* dust in mine, mill and pulmonary fibrosis. Dr. Gardner was also of] tha ; factory foes a well developed and thorough medical opinion that the action of the asbestos fibers was supervision of asbestos workers, together with a mechanical rather than chemical which again if in research program involving sot only experimental contradistinction to the action of silica. However, i animals, but alio clinical studies including puimoa* some of the persons who have studied asbest sis ary function evaluation tests (Saranac) on selected are not in complete agreement with this and i ; is cases of asbestos workers showing rocatgcao* probable that tha factor of asbestos particle si in graphic evidence of aebcitoiia. V* i i TasntoAdeH.jei^fcL