Document QkNgK41dQ5r4DQbekdM4Nv5E

FILE NAME Manville JMA DATE 1961 DOC JMA311 DOCUMENT DESCRIPTION Public Health Service Approach to Study Asbestos - Letters Memos & Report OF DEPARTMENT HEALTH EDUCATION AND WELFARE Public health serVICE WASHINGTON 25 D. . BUREAU OF STATE SERVICES Dr. Kenneth W. Smith Medical Director Mansville Corporation 23 East 40th Street New York 16 New York May 5 1961 Refer to OHC Abe i CLS | Dear Dr. Smith Over the past several years a number of articles have appeared in the technical literature relative to clinical findings on individuals exposed to asbestos dust The individual studies however raised a have been number of limited in scope and questions concerning in some instances have the interpretation of the resulting data It seems evident that considerable more information is necessary to assess properly the effects of exposures to asbestos dust I am inviting a limited group to meet with me in Washington at 9:30 a.m. Thursday June 1 1961 HEW South Building Room 2225 to discuss the problem in some detail The objectives of this meeting are to gain a better insight on what is currently known concerning the effects of asbestos dust on health what further research needs to be done to obtain the information for this assessment and the resources and facilities available for conducting the research I hope that you will be able to attend this meeting and participate in the discussions Sincerely yours DHEW DHEW South I OE " OE Harold J Magnuson M.D. Chief Division of Occupational Health DEPARTMENT OF PATHOLOGY MEDICAL COLLEGE OF SOUTH CAROLINA 16 LUCAS STREET CHARLESTON 16 SOUTH CAROLINA 16 May 1961 Kenneth W. Smith M.D. Medical Director Manville Corporation 22 East 40th Street New York 16 New York Dear Doctor Smith This letter is to confirm the fact that I hope to be in New York on Friday 26 May and I shall give your office a call some time fairly early in the morn- ing to find out when I might drop by to see you Sincerely yours FAMCI : pb Forde A. McIver M.D. May 10 1961 Dr. Paul Cartier Thetford Industrial Clinic Thetford Mines Quebec Canada Dear Paul Recently there has been considerable discussion in various groups around this country concerning the relationship of the asbestos fibre and malignancy not only pulmonary but also abdominal Dr. Magnuson has decided to hold an informal meeting to discuss whether or not there is a problem and if there is should the U. S. Public Health Service become interested and conduct a survey This will be a limited group probably composed of Doctors Vorwald and Sander Dr. Lewis J. Cralley of the U. S. Public Health Service Cincinnati Dr. Shaw of the Asbestos Textile Institute and one or two others Because the U. S. Public Health Service is a federal agency Dr. Magnuson feels he cannot invite anyone outside this country He invited me and also asked for names of others to attend I mentioned your name and he indicated that I could invite you as an interested person I do hope that you will give this serious consideration and will attend on June 1 for you have a wealth of knowledge to add to the meeting Please let me know if you can come so that I can advise Dr. Magnuson Sincerely Kenneth W. Smith M.D. Medical Director Saf CLS May 22 1961 Dr. Lewis Cralley Division Special Health Services U. Public Health Service 1014 Broadway Cincinnati 2 Ohio Dear Levist Rei Asbestosis Meeting Washington Washington Following your suggestion I invited Dr. Paul Cartier of Thetford Mines Quebec to attend the meeting He will be there In our recent discussion I stated that Dr. Forde McKiver was the pathologist working with Dr. Kenneth Lynch in Charleston South Carolina I thought that he had left the university but have just learned that he still is there As a matter of fact he will be here in my office next Friday May 26. May I have your permission to see if he has any views on our malignancy problem If he has I shall let you know immediately no that you can advise Dr. Magnuson You may want to transfer the invitation from Dr. Lynch to Dr. McKiver My tentative travel plans are to take the train to Washington arriving about 8 PM Wednesday I shall have to leave on the five o'clock train Thursday afternoon I shall be staying at the Washington Hotel Kenneth W. Smith M.D. Medical Director June 2 1961 Dr. Lewis Cralley Division Special Health Services U. S. Public Health Service 1014 Broadway Cincinnati 2 Ohio Dear Lewis Wednesday night when we were discussing industrial hygiene instruments I questioned the type of instrument best suited for our company needs You kindly offered to contact your Noise Control Group and get their recommendations I would appreciate it very much if you would ask them if the sound survey meter is satisfactory for our survey purposes or if we should have a wave band analy- | zer in addition Perhaps there is an instrument which will serve both purposes ; I think that we had a very interesting and constructive meeting yesterday My only concern is the fact that Tom Mancuso appears to have incriminated the asbestos fibre and consequently the whole asbestos industry in his thinking whether or not the disease works in a pure exposure such as textile or in the multiple exposure occupations such as brake lining asbestos cement shingles or pipe covering Please be honest and let me know if I belabor and am too apprehensive I know that I do not understand biostatistical methods too well and if I m too apprehensive because of this please be frank and let me know I probably shall phone you next week before or after the Asbestos Textile Institute Mesting Sincerely Kenneth W. Smith M.D. Medical Director Thetford Industrial Clinic re Thetford Mines Que June 8 1961 Dr. Kenneth W. Smith Medical Director Manville Corporation New York 16 N.Y. Dear Ken have In the first place I want to tell you that I been greatly impressed by the general atmosphere of the meeting in Washington and I thank you for having given me the opportunity of attending such an informative meeting I agree with you that the conflicting opinions and the confusion which reign among those interested in the various problems of asbestosis justify a thorough survey hoping that such a survey can produce this time solid conclusions scientifically acceptable to the majority of those concerned On the other hand the fact that Dr. Vorwald admits himself that he did not use the proper technique for the Saranac Experimental Study the lungs and also the fact that the conclusions of Industrial Hygiene Foundation are not accepted even on Cancer of the recent by some of the american medical authorities are of nature of rendering any one more least reluctant less enthousiastic about a new project to be very cautious and Fortunate Magnusan seems to want methodic qui this new temptative a Following the past experience I remain slightly apprehens in too many instances a big institution even with a well qualified personnel has not succeeded to accomplish the desired task either because they do not have the same interest as the people living their problems or because they are too busy to give the time and the concentration required for any project of such importance might take in the following On account of the large contribution that Dr. this possible study I am taking the liberty of frank comments or impressions Mancuso giving cont'd Thetford Industrial Clinic Thetford Mines Que -2- I would question the method of investigation used by Dr. Mancuso in his last survey which shows that over 66 of the asbestos workers autopsied have developed a lung cancer it has to be a very selective group or workers exposed to a dangerous mixture of dust The opinion of an increased incidence of brain and peritoneum cancer in the asbestos industry would need further investigation before being accepted Also the fact that Dr. Mancuso persists to consider the results of the comparative study of the death certificates of the County of Megantic where all cases of cancer of the lungs have been detected following a special medical investigation and autopsy with the death certificates of the 2 or 3 surrounding counties without the same medical facilities and no autopsies as a conclusive proof in favor of a positive relationship this fact concurs to make me think that he has already a more or less definite opinion on some of the aspects to be investigated Sincerely yours Paul Cartier M.D. June 19 1961 Dr. Myril C. Shaw Asbestos Textile Institute Schoolhouse Lane Philadelphia 44 Pennsylvania Dear Myril I have reviewed the attached draft of your letter and agree that you have covered the subject very well I note that you have completely omitted the subject of cancer and probably have a very good reason for so doing I wonder if it might not be wise to state quite frankly that the question exists concerning the association of asbestos and cancer and that the U. S. Public Health Service would be able to give factual evidence for or against such a relationship This survey of course would cover all other aspects of health in the asbestos worker in addition to possible cancer Aside from this thought I have that you will receive a favorable vote in ask Dr. Magnuson to draw up the framework no other suggestions I do hope the very near future so that we can for the survey For your information and records and also for Ralph Smith in the Healey Aot became effective January 27 1961. The part text to which I referred is Part 50-204 entitled Safety and Health for Federal Supply Contracts the change of the Standards Sincerely Attach Medical Director . blo. June 19 1961 C. W. Hite Division Managers Meeting June 21 1961 You may wish to discuss the following information at your forthcoming meeting For many years British and South African medical authorities have associated lung cancer with the inhalation of asbestos fibers In recent years American writers have reported numerous cases of cancer not only of the lung but in other parts of the body associating these conditions with asbestosis While we have not had many cases of cancer in our Company these are numerous enough in other companies to osuse Me some concern Two weeks ago a meeting was called in Washington by Dr. Harold Magnuson Chief of the Occupational Health Division U. S. Public Health Service I was invited along with Dr. Paul Cartier Thetford Mines Dr. Arthur Vorwald former head of the Saranac Laboratory and now at Wayne University Dr. A. Sander a specialist in industrial pulmonary diseases in Milwaukee and Dr. Myril Shaw Secretary of the Asbestos Textile Institute Also present were several men from the U. Public Health Service who carried out the Diatomaceous Earth Survey a few years ago It is Dr. Magnuson's responsibility to protect the health of the American worker and he called the meeting because he had become concerned over the asbestos and cancer question The immediate cause for calling the meeting was a report by Dr. Tom Mancuso who under the auspices of the University of Pittsburgh had studied the health of workers in a brake lining plant in Pennsylvania Dr. Mancuso reported that there were 19 cases of lung cancer mong 31 people who had asbestosis This is a phenomenally high incidence In addition the incidence of abdominal cancer was 50 times higher in this group than would be anticipated in the normal population Because it is a recognisfeacdt that inhalation of certain fumes in the dye industrcayn cause cancer in parts of the body other than the lung it was felt that the same night . be trus for inhaled asbestos At the end of cum all day meeting there was an unanimous decision that a problem exists in the me } industry The question of whether or not an association exists betarea a end cancer should be answered preferably by an authorita- tive group suck V. 8. Public Health Service rather than by University workers Althous muson has the authority to investigate any American fi. industry in whhi e fc eelsha health problem exists he would prefer to be invited by the industry to undertake a survey ' Dr. Magnuson indicated that he would set aside two million dollars in his budget poems if he is invited to study our problem There will be no direct expense to industry other than making men and records available to the survey team The whole program would be correlated with studies carried on in other parts of the world where different types of asbestos fiber are used It is expected that a preliminary report could be ready in approximately 5 years 2 Last week Dr. Shaw and I reported the results of the Association meeting to the Asbestos Textile Institute Their Board of Governors voted to invite Dr. Magnuson to survey that part of the asbestos industry Letters have been sent to member companies requesting approval of this action I believe that we should participate in such a survey realizing that if asbestos is incriminated as a cause of cancer it might affect our Company business quite seriously However I feel that it is better to have the question answered by factual evidence rather than by hearsay Certainly we could be no worse off than we are today when many doctors and lawyers quote medical texts associating cancer and asbestos On the other hand if the S. Public Health Service finds that no relationship exists it would be of tremendous value in our future Workmen's Compensation cases and product liability suits Kenneth W. Smith M.D. July 18 1961 Dr. M. C. Shaw Asbestos Textile / Philadelphia Schoolhouse Lane Institute Textile Institute Philadelphia 44 Pa Dear Dr. Shaw 9. Health Education & Welfare Dept. Proposed Survey of the Asbestos Industry ek week. Referring to your request of June 26 regarding the above we are returning herewith our voted ballet on the two questions that you present Unfortunately I was not present when this matter was presented in detail at the last A.T.I. meeting but I have spoken with Mr. B. A. Schuman and had a reflection of Raybestes Manhattan's opinion from Mr. J. A. Bettes As you will note it is our opinion that we want to be very cooperative in having the Asbestos Textile Institute offer every facility they have at their command to assist the Public Health Service in the event that they concernedthere wish to make a specific study of this industry however we do not feel that it is wise to portray to them that are unduly the health conditioo f nthse industry and what has been done in of study and cerrection methods perhaps creating the opinion that have been some deficiencies On the other hafen el thd at a of " Study and thought on the part of all manufacturers have improved con ditions over the years but that if it is deemed adviseable that a study be made then we as representative of the Asbestos Textile Industry should do all in our power to assist It is for this reason that we have studi negative on Question # with the thought that probably our approsoh and opinions to Dr. Magnuson Chief of the Public Health Service could be phrased more in line with the thoughts I have expressed herewith ~~ We have voted affirmatively on question # feeling that if the Public Health Service is to investigate the Asbestos Industry then a subcommittee composed of medical son fully conversant with the problem will offer the greatest assistance in these matters #Stief Sincerely yours 4. 3. HOLOH Blind copies Smith Dr. K. W. Smith C. C. Simoni _ B. A. Sohum Note to Dr. Smith apse Dr. Smith In your absence on vacation I AdvisAdveiseaable Abdvilseaeble that this matter be answered even though I could not check further / youryour own personal opinion I trust that you will a agree with our thinking on the matter and I will J. T. Griffis - H. K. Porter Co. talk with you further when you T. C. McCluskey - Tallman - McCluskey return and any additional opinions J. A. Bettes Raybestes Manhattan that you have can be reflected to the A. T. I. in the event that you do not concur with what I have written S. H. COPY LETTER PROM KEASBEY & MATTISON COMPANY AMBLER PA July 7 1961 Dr. M. Shaw Asbestos Textile Institute Schoolhouse Lane & Henry Ave. Philadelphia 44 Pa Dear Dr. Shaw Your letter of June 26th forwarding a memorandum and letter ballot on the general subject of asbestos as an industrial hazard has been showtno me for comment Since I shall definitely suggest that this Company's vote be no on both propositions as they are now presented I should like to explaimny reasons In the couofra s faie rly short association with this industry I have become convinced that we are subjected to a deal of loose talk and far looser thinking prompted by emotion rather than intelligence inspired by a general feeling of being against sin wrong wrong Using the word asbestosis as their take point articles have been published by officials of the Department of Health speeches have been made by doctors diagnoses have been made by doctors awards have been made by juries and recommendations for the expenditure of huge sums have been made by insurance 7 companies None of these to my knowledge have been able to define asbestosis or give any evidence which can't be torn to shreds as to whether the phenomenon if it exists is gooo r bd ad for the health of any individual information Hehas not informatioinnformation information information Resort is usually made to a discussion of dust without being able to define that Despite my best filtering efforts I am sure I inhale dust in my home car and in the office I walk through an asbestos plant I am sure I inhale dust It seems reasonably possible I would also inhale asbestos I doubt if fibers . Tes se eae Dr. M. Shaw -2- July 7 1961 a half inch in length are classified as dust and I have no ideal whether such half inch fibers would harm or help me if inhaled and I likewise do not know this concerning fibers of any other length Love Further I have yet to see any evidence which cannot be torn to shreds of a method for surely and uniquely measuring the presence of asbestos fibers in any body of air in any definite quantity even if we assumed we know what particular lengths and concentrations we might be looking for Same inley has Despite all this I should welcome a real clarification of ! the matter since I should be most energetically anxious to remedy any situation which was first demonstrably bad and second provably susceptible to remedy am however unalterably opposed to participating in any demonstration of foregone conclusions or searching for a degree of guilt without having first established that there is any guilt The second paragraph of your memorandum states four numbered propositions which I should like to discuss in sequence 1. What constitutes hazardous conditions and how such conditions may be measured and identified " I should prefer a slightly minded approach to this perhaps by the simple amendment to include a search as to what constitutes a hazardous condition I should like to think there is some admission in the minds of possible defamers of this industry that there conceivably could be a non- hazardous condition audioficine audioficine on 2. How much of an association or contact with these conditions serves to identify one as an asbestos worker " Personally I would like to be free to continue considering myself an asbestos Dr. M. Shaw 03- July 7 1981 worker I should dislike being ruled out except on the one condition that I have been sinned against until someone demonstrates that such sinning exists at all let alone in what degree 3. The identification of the type of physical degradation or the establishment of the particular disease resulting from ex- " posure to asbestos dust conditions Being completely uninformed medically I have a most obstinate feeling that any autopsy of myself will reveal a great many foreign bodies in my lungs including asbestos Before anyone starts identifying the type of physical degradation resulting from the asbestos I would appreciate their keeping an open mind as to whether or not there is any such degradation resulting from asbestos or anything else and if there is any I would appreciate their entertaining the thought of the possibility of its emanation from a multitude of other foreign bodies Further before we identify the disease resulting from asbestos I would appreciate_ a slightly open mind as to whether there is any disease resulting from asbestos 4. Whether all asbestiform minerals are equally effective and offensive or whether each one of the group chrysotile crocidolite or amosite may behave differently in attacking body organs or tissues Just an open mind is all I should ask for Could we broaden the inquiry to cover the case of these being equally INoffensive ; Stufed ! ! ! ! Dr. M. Shaw -4- July 7 1961 You say these are a few of the obvious questions and I wholeheartedly disagree they are in the slightest degree obvious on the basis of any evidence I have ever seen However my impression of such statements I have seen put out by officers of the Public Health Service is that these are likely to be the only questions asked that asbestos and the asbestos industry are already condemmed Needless Needless It appears to me that whereas a person many years ago - used most often to die of complications medical ignorance has now been refined to the point where any person at any time employed in the asbestos industry who suffers a spot on his lung or death from cause not too obvious is automatically classed a victim of asbestosis I return to my opening remarks about inability to define what that is etc. I submit as a splendid example of the above a diagnosis of asbestosis given us on a former employee whose total connection with the asbestos industry had been a few years as Office Systems Manager There is extreme doubt in our minds that he was ever closer to asbestos than viewing the material in a showcase Accordingly until there is some clarification as to the approach this proposed investigation might take I shall heartily recommend that this Company vote no to both propositions Yours sincerely aN \ R. Porter cc Mr. Burnett Mr. Rohrbach Mr. Griffis RLL WMD Copy Letter From KEASHEY & MATTISON COMPANI Ambler Pa July 7 1961 Dr. M. Shaw Asbestos Textile Institute Schoolhouse Lane & Henry Ave. Philadelphia 44 Pa Dear Dr. Shawt Your letter of June 26th forwarding a memorandum and letter |i ballot on the general subject of asbestos as an industrial hasard has been shown to me for comment Since I shall definitely suggest that this Company's vote be no on both propositions as they are now presented I should like to explain my reasons In the course of a fairly short association with this industry I have become convinced that we are subjected to a great deal of loose talk and far looser thinking prompted by emotion rather than intelligence inspired by a general feeling of being against sin Using the word asbestosis as their take point articles have been published by officials of the Department of Health speeches have been made by doctors diagnoses have been made by doctors awards have been made by juries and recommendations for the expenditure of huge suns have been made by insurance companies None of these to my knowledge have been able to define asbestosis or give any evidence which can't be torn to shreds as to whether the phenomenon if it exists is good or bad for the health of any individual Resort is to define that dust in my home plant I am sure inhale asbestos usually made to a discussion of dust without being able Despite my best filtering efforts I am sure I inhale in walk an car the the office If I asbesat sbeo sts os I inhale dust It seems reasonable possible I would also I doubt if fibers a half inch in length are classified as dust and I have no idea whether such half inch fibers would harn or help me if inhaled and I likewise do not know this concerning fibers of any other length Further I have yet to see any evidence which cannot be torn to : shreds of a method for surely and uniquely measuring the presence of ; asbestos fibers in any body of air in any definite quantity even if we assumed we know what particular lengths and concentrations we might be looking for Dr. M. Shaw the any Despite all this I should welcome a real matter since I should be most energetically situation which was first demonstrably bad susceptible to remedy clarification of anxious to remedy and second provably I am however unalterably opposed to participating in any demonstration of foregone conclusions or searching for a degree of guilt without having first established that there is any guilt The second paragraph of your memorandum states four numbered propositions which I should like to discuss in sequence 1 What constitutes hasardous conditions and how such conditions may be measured and identified 2 I should prefer a slightly minded approach to this perhaps by the simple amendment to include a search as to what constitutes a hasardous condition I should like to think there is some admission in the minds of possible defamers of this industry that there conceivably could be a hazardous condition How much of an association these conditions serves to an asbestos worker or contact with identify one as 3 Personally I would like to be free to continue considering myself an asbestos worker I should dislike being ruled out except on the one condition that I have been sinned against until someone demonstrates that such sinning exists at all let alone in what degree The identification of the type of physical degradation or the establishment of the particular disease resulting from exposure to asbestos dust conditions Being completely uninformed medically I have a most obstinate feeling that any autopsy of myself will reveal a great many foreign bodies in my lungs including asbestos Before anyone starts identifying the type of physical degradation resulting from the asbestos I would appreciate their keeping an open mind as to whether or not there is any such degradation resulting from asbestos or anything else and if there is any I would appreciate their entertaining the thought of the possibility of its emanation from a multitude of other foreign bodies Further before we identify Dr. M. Shaw -3- July 7 1961 the disease resulting from asbestos I would appreciate a slightly open mind as to whether there is any disease resulting from asbestos 4 Whether all asbestiform minerals are equally effective and offensive or whether each one of the group chrysotile crocidolite or amosite may behave differently in attacking body organs or tissues Just an open mind is all I should ask for we broaden the inquiry to cover the case of being equally INoffensive Could these You say these disagree they are in evidence I have ever have seen put out by are likely to be the industry are already are a few of the obvious questions and I wholeheartedly the slightest degree obvious on the basis of any seen However my impression of such statements I officers of the Public Health Service is that these only questions asked that asbestos and the asbestos condemned It appears to me that whereas a person many years ago used most often to die of complications medical ignorance has now been refined to the point where any person at any time employed in the asbestos industry who suffers a spot on his lung or death from cause not too obvious is automatically classed a victim of asbestosis I return to my opening remarks about inability to define what that is etc. I submit as a splendid example of the above a diagnosis of asbestosia given us on a former employee whose total connection with the asbestos industry had been a few years as Office Systems Manager There is extreme doubt in our minds that he was ever closer to asbestos than viewing the material in a showcase Accordingly until there is some clarification as to the approach proposed investigation might take I shall heartily recommend that this Company vote no to both propositions this Yours sincerely -- -- ---- cc Mr. Burnett Mr. Rohrbach Mr. Griffis RLL R. R. Porter CONFIDENTIAL Bile Division July 3 1961 Headquarters Kenneth W. Smith M.D. Mr. Bettes of Manhattan the attached letter of June 30th just written to Dr. Shaw phoned me about which he has As indicated in the letter they believe it would be preferable to approach Dr. Magnuson along the lines of offering the full cooperation of the A.T.I. membership rather than making an outright invitation to come in and investigate This seems to be a very good thought and inasmuch as Dr. Magnuson's investigation is already a definite proposed project an offer to cooperate should be all that is necessary trust this is in line with your ideas CCS jmt cc W.S. Hough . C. C. SIMONI 9201 COPY MANHATTAN INC Asbestos Textile Division MANHEIM PA 30 June 1961 Dr. M. C. Shaw Sec'y Sec'y Asbestos Textile Institute o Phila College of Textiles & Schoolhouse Lane & Henry Ave. Philadelphia 44 Penna Science Subj U. S. Health Education & Welfare Dept. Public Health Service Division Propesed Survey of the Asbestos Industry Dear Dr. Shaw We have carefully considered your letter 26 June and return our ballot herewith You will note we have voted affirmatively on question 2 much in favor of establishing an A.f.I. Medical We are We would like to nominate Dr. Kenneth Smith Committes of Manville as Chairman So far as I know he is the only man in the asbestos textile industry devoting his fulltime to these problems We have like to tion of not voted yes or no on question 1 We would submit the following comments for the considera- our Board of Governors would be very reluctant to have R A.Ta.Iy. bwreits e t a o les tter INVITING a survey of the industry the Public Health Service Division We feel this by additional problems in the labor would be asking for relations area We would prefer to have you write Dr. Magnuson advising understand the Public Health Service Divisionis we of the asbestos industry As about to make a survey branch of the in- spokesman for the asbestos textile of the A.T.I. dustry we offer the full cooperation factual and enlightening membership in making the survey Page 2 Perhaps we are a bit gun shy but we have reason to be A couple of doctors in our local hospital have given us a considerable amount of unfavorable publicity in recent months Just about the worst possible possible publicity would be for the government to issue a news release saying in effect Asbestos Textile Industry invites Public Health Service Division to investigate relationship between asbestosis and cancer We sincerely want to assist the government in making a factual survey We must carefully avoid pointing the finger of suspicion at ourselves This may be only a matter of wording but in our opinion it's an important difference Sinceraly yours ? ' J. A. BETTES JR - MANAGER oe . ger American Asbestos Textile Co.- A. J. Manville Sim C.oSin moi ni W. S. Hough Keasbey U Mattison - A. 6. Whitfield Semalam McCluskey - I. C. McCluskey U. S. Rubber Co. - S. J. Peale CONFIDENT CONFIDENT LAL Division Headquarters July 13 1961 Kenneth W. Smith M.D. Asbestos Textiles Institute Attached for your information is copy of a letter dated July 7 addressed to Dr. Shaw by Mr. R. R. Porter of the Keasbey & Mattison Company One reading of it should remove all doubt as to Mr. Porter's position on how he thinks the A.T.I. should proceed in connection with the proposed investigation of the Public Health Service We have already forwarded you copy of Mr. Bettes letter giving the suggestions of Manhattan on the same subject It would appear that a certain amount of reconciling will to be done before the Institute can proceed with a united membership front have I assume that you and Bill Hough will do the necessary in consulting with Dr. Shaw and doing whatever is required to straighten out this situation and protect the interests of as well as the Industry M CCS int cc W. S. Hough C. C. SUPERINTENDENT AND MEDICAL DIRECTOR JOSEPH A. SMITH M. F. C. P. State of New Jersey SANATORIUM FOR CHEST DISEASES GLEN GARDNER August 8 1961 KWS | CLS | ext! TELEPHONE HAMPTON 2011 Dr. Kenneth W. Smith Medical Manville Products Corp. 22 East 40th St. New York 16 New York Director Dear Dr. Smith Apropos to our conversation the other day regarding + cancer in asbestos we enclose herewith a report of a meeting and a project proposed at this meeting I do not know whether this is the study you heard about or not However if this new to you it is confidential Yours very truly NEW JERSEY SANATORIUM JAS Joseph Smith M.D. Superintendent Superintendent & Medical Director REPORT OF VISIT TO PATERSON CLINIC Mrs. King and Ann Tolomeo DATE July 26 1961 PARTICIPANTS Irving Selikoff M. D. Jack Churg M. D. pathologist Barnort Memorial Hospital Miriam Sachs M. D. Health Officer Metropolitan Health District B. Lynn Schall Coordinator Occupational Health Programs Mrs. King and Ann Tolomeo NJTHA To discuss pulmonary asbestosis study in Passaic County Review of previous field reports We met for lunch in the library of the Paterson Clinic Dr. Celikoff began the discussion by stating that in a hospital as small as Barnert 125 beds they have had 6 deaths due to pulmonary asbestosis diagnosia by autopsy in the last 10 years Dr. Selikoff has had 21 patients with severe asbestosis of these 2 have died due to cancer of the lungs both cases were diagnosed as asbestosis in 1954 in one lung cancer de- veloped in 158 in the other lung cancer leveloped in 159 Dr. Jelikoff mentioned that Fortune Magazine put out a list of the 500 largest companies 1000-5000 employees in the United States 7 of the asbestos companies were located in New Jersey Dr. Selikoff said there are two things that must be considered - the individual exposure to asbestos and the clinical hazard peculiar to asbestos inhalation which is carcinoma Dr. Selikoff said that in Great Britain there were 49 deaths due to cancer of the lung in 250 asbestosis patients Dr. Tom Mancuso did a study for PHS on diability applicants with asbestosis his findings confirmed the Great Britain finding of intraperitoneal cancer in addition to lung cancer Dr. Selikoff said that he had met with Dr. Harold Magnuson Chief Occupational Health Program PHS about the problem Dr. Magnuson is eager to do some studies in this field He has little literature available on the subject Dr. Magnuson recently met with representatives of the asbestos industries reviewed the literature with them and asked their support and cooperation in undertaking studies in asbestos exposure This group recommended that the asbestos manufacturers display leadership and support these projects As a result asbestos industries throughout the country are now being polled for their reactions Dr. Magnuson assured Dr. Selikoff that if the industries did not support these studies PHS would Dr. Magnuson or his staff members would be willing to come to New Jersey and help with the planning of the study One of his staff Dr. Smith is now in Europe reviewing the studies done there Be, we Selikoff Dr. asked Mr. Schall whet that : project Mr. Schall said that ysould not be of help in th A be wiltolasi sisn t wg ith the. Selikoff how the whether Dr.Sachs \ asked Dr. ; This brought up much discussion as to whether ie silinate a mechanical or chemical irritant mere is no : it just is not known Dr. Sachs mentioned magnesium in tale and the small incidence of talcosis around Both Selikoff and Dr. Churg said that although about 25 of no asbestos is magnesium silicate it may be that this in combi tion with the other materials in asbestos makes asked be. it my be another material in the asbestos Dr. in combi it harmful Sachs Selikoff how he intended to proceed Dr. Selikoff said asked Be. the following at his disposal 1 Dr. Churg to 43 Coleman cultures 2 pulmonary function laboratories Dr. Rubin and himself 4 pathology Selikoff said he would proceed in the following department Se, 1 Work out a list of plants in which asbestos is used in any great quantity these do not have to be confined Passaic County Dr. Selikoff needs help on how to Directory this Schall suggested the Industrial Mr. Directory 2 After thisis reviewed, Dr. Selikoff would tien. participating surveys NJTHA and SDH in of would tial exposure Dr. Sachs thought it would be difficult to and labor unions to cooperate Dr. Selikaff worth exploring Dr. Selikoff stated research neesiga analysis of sputa There vas much discussion back and fortsh tbaedtisBy up asbestosis 3 basic is 2 pulmonary fummation other laboratory stadis oy COMMENDATIONS COMMENDATIONS : OBSERVATIONS . . October 18 1961 C. W. Hite U.S.P.H.S. Survey In previous correspondence on this subject I indicated that Mr. R. R. Porter President of Keasbey and Mattison requested the Asbestos Textile Institute to call another meeting of representative companies to discuss with Dr. Magnuson the proposed survey Invitations were sent to several concerns and Mr. Porter was asked to invite certain representatives from his Asbestos Cement Products Group When the letter of invitation was sent by Dr. Shaw of the Asbestos Textile Institute Mr. Porter telephoned Dr. Shaw vehemently upbraided him for his action and said he would refuse to attend the meeting because the invitation had not been sent by a president of one of the member companies He stated that he refused to talk to anyone not on a presidential level The meeting was held on September 25 and was attended by representatives from Raybestos Manhattan the H. K. Porter Company and Manville The doctor from Keasbey and Mattison was attending another meeting in the same hotel but had been forbidden to attend our meeting Dr. Magnuson outlined the purpose and the method of the proposed survey in the survey Those present felt that we should participate . Subsequently I learned that Mr. Porter has refused to participate and apparently has managed to change the thinking of some people in Raybestos Manhattan Mr. Zimmerman of Raybestos indicated to Dr. Shaw that he should not send a letter of invitation to Dr. Magnuson Therefore the Asbestos Textile Institute has advised Dr. Magnuson that they do not wish to participate in an industry survey but will cooperate if Dr. Magnuson initiates the study himself I believe that this can have serious consequences because surveys of the asbestos industries in Massachusetts and New Jersey definitely are being planned and others in Ohio and Pennsylvania are proposed I would surmise that without the company willingness and cooperation of the Asbestos Textile Group Dr. Magnuson may be forced to devote his funds to various state groups requesting aid I shall learn more about this next week at the Annual Meeting of the Industrial Hygiene Foundation at Pittsburgh Kenneth W. Smith M.D. F Dr. Paul Cartier Thetford Industrial Clinic Thetford Mines Quebec Canada Dear Paul ah Me - * ; Re U.8 Public Health Service Survey - Asbestos Workers You will recall that we met with several others in Dr. Magnuson office in June 1961 to discuss this subject Plans now are well developed for this survey and three of the doctors would like to see some of the Canadian mining operations They propose to visit our mine on September 25 and 26 and wonder if it would be convenient to see Thatford on September 27 and possibly the 28th The purpose of this trip would be for basic knowledge only and is not part of the survey of the U. S. workers fs cr ae Could you please let . i convenient for you At a later . Her other suitable dates me know whether or time I can confirm not these dates would exact travel plans on be these tf oo I probably shall accompany these men so it will be another good opportunity to see you once again Medical Director 8/28 J. O. Eby Jeffrey Mine U. S. Public Health Service Sei Asbestos Workers Some time ago we discussed the possibility of having three doeters from the U. S. Public Health Service visit your location in connection with a survey of asbestos workers which will be undertaken in this country Th noe w hy ave asked me if it would be possible for them to see the mining operation and - discuss certain health topics with Dr. Grainger on September 25 and 26. II these dates are acceptable could you please let me know I can confirm H TO precise travel arrangements at a later time If these dates are not satis- factory please so advise and I shall make other arrangements Following our proposed visit with you they are going to see Dr. Paul Cartier at Thetford I expect to accompany them for the entire trip R. B. Gresham Jeffrey Mine Do you think it would be possible and advisable for Roger to go to Thetford K. W. S. OBJECTIVES AND GENERAL PLAN FOR OCCUPATIONAL HEALTH STUDY OF THE ASBESTOS PRODUCTS INDUSTRY August 21 1962 Division of Occupational Health Public Health Service DEPARTMENT OF HEALTH EDUCATION AND WELFARE OCCUPATIONAL HEALTH STUDY OF THE ASBESTOS INDUSTRY Asbestos is a generic term applied to a number of fibrous crystalline silicate minerals Although chemically they are grouped as hydrated silicates they vary greatly in degree of hydration complex composition of the silicate and physical properties of the crystalline fibrous structure Reference was made to asbestoass early as several centuries B.C. It was not established as a mineral of industrial importance however until around the end of the last century Because of outstanding properties of chemical resistance fibrous structure and incombustibility asbestos has a wide variety of uses in modern industrial technology It is used in the manufacture of textiles felts ropes brake linings roofing and flooring flooring materials asbestos products gaskets insulation mater- ials special papers filters and plastic products These find use in practically every major industry Information from the Bureau of Mines Minerals Yearbook Volume I 1958 shows an apparent consumption of around 685,000 short tons of asbestos in this country in 1958 in the manufacture of asbestos products Chrysotile accounted for around 642,000 tons crocidolite 26,000 tons and amosite 17,000 tons The consumptioonf other types of asbestos in this Country appears negligible Of the above tonnage this Coun- try produced around 41,000 tons of chrysotile the remainder of the chrysotile coming predominantly from Canada The crocidolite was . imported mainly from Bolivia Australia and the Union of South Africa -3- malignancy associated with asbestosis The published data in this regard are based largely on mortality statistics and autopsy records of former employees in asbestos industries While some of the reports strongly suggest that lung cancer is an occupational hazard of asbestos workers the literature in this respect is by no means unanimous and the data are often conflicting Several factors may account for this apparent discrepancy in the technical literature Diagnostic criteria for asbestosis are often poorly defined making valid comparisons of studies difficult if not impossible Conclusions are too frequently applied to classification encompassing all asbestos workers and are not confined to the group under investigation Information on such factors as sex community air pollu- tion personal smoking habits and family history of cancer are absent in the majority of reports Environmental data are scanty No clear attempt is made to define exposures to different asbestiform minerals or associ ated materials Mortality studies often encompass a broad exposure group and do not relate to a specific and single exposure Despite the accumulated knowledge the following questions remain unanswered 1. What is the prevalence of pneumoconiosis in asbestos workers actively employed in the asbestos products industry industry 2. What is the significance of exposure to different sources and forms of asbestos and to other materials commonly employed in this industry in the development of pneumoconiosis 3. What is the role of occupational respiratory disease in the development of the pneumoconiosis 4. Are malignancies occupational risks of the asbestos worker in the products industry If so what are the important etio- logical factors B. Laboratory Studies Laboratory research is necessary to develop sampling and appraisal techniques which will permit a detailed definition of asbestos dust exposures In addition animal studies are needed to evaluate any re- lationship between asbestos fiber exposure and tumor formation plant Environmental Studies The environmental studies will be designed to define the working en- vironment of the various plants Particular emphasis will be placed on levels and nature of exposures asbestos dust Exposures to other air contaminants - silica mineral dusts fumes mists vapors and gases - which may be associated with asbestos or its processing also will be carefully assessed plant Medical Studies The medical studies will be designed to develop specific information relative to the effects of asbestos dust and other associated expo- expo- sures on health They will include medical examinations of a substan- tial portion of the asbestos the asbestos industry ~ and provide a sufficient background for periodic follow medical surveys The medical findings will be related to the various aspects of the environmental exposures C. W. Hite General Headquarters _ ~. U.S.P.H.S. Survey Asbestos Industry On June 19th I wrote to you outlining this proposed survey report since that time Following is a progress I have learned from confidential sources that some states are contemplating health surveys of asbestos workers using their own facilities and ignoring the U.S.P.H.S. plans New Jersey probably will start with a survey in Passaic County Obviously . each state will follow its own ideas in survey methods With no consistency between them there will be as many different reports and opinions as there are states This could be very detrimental to our interests and therefore we are trying to get interested companies to cooperate with Dr. Magnuson in Washington The Board of Governors of the Asbestos Textile Institute agreed to invite the U.S.P.H.S. to make a survey However when the Asbestos Textile Institute membership was polled Mr. R. R. Porter President of Keasbey & Mattison vehemently opposed this survey both vocally and in writing A copy of his letter is attached Reading this carefully you will see that the man is opinionated has not sought information on the subject and has made mumerous irresponsible statements not founded on fact On September 8th at the annual meeting of the A.T.I. Mr. Porter repeated many uncalled for remarks interspersed with personal prejudices Fortunately one else at the meeting appeared to agree with him In an effort to educate Mr. Porter and to show him the seriousness of the situation I have arranged a meeting with Dr. Magnuson in Philadelphia on September 25th In addition to Mr. Porter invitations are going to executives of the following companiest Raybestos Manhattan H. K. Porter U. S. Rubber McCluskey American Asbestos Company Union Asbestos Gatke Corporation Carolina Asbestos National Gypsum Phillip Carey Flintkoto Company I hope that after this meeting everyone will see the necessity for a comprehensive survey carried out by a responsible agency C. W. Hite 2 September 13 1961 You will note that C. B. Burnett received a copy of Mr. Porter's letter I trust that he understands our problem and will try to educate Mr. Porter if the opportunity , arises Attachment Kenneth W. Smith M. D. VIA WESTERN UNION Mattison Ambler Penn HAVE JUST LEARNED YOU ARE NOT PLANNING TO BE PRESENT AT THE MAGNUSON MEETING SEPTEMBER 25th THIS IS VERY DISAPPOINTING AS WE FELT A.T.I. WAS RENDERING A SERVICE BY FOLLOWING THROUGH ON OUR SUGGESTION OF MORE REPRESENTATIVE INDUSTRY MEETING PRIOR TO A FINAL A.T.I. STATEMENT TO MAGNUSON . SOUTHERN ASBESTOS AND I BELIEVE M INTEND TO ATTEND ALONG WITH M THESE FOUR REPRESENT LARGEST COMPANIES IN THE INDUSTRY WONT YOU PLEASE RECONSIDER ATTENDING TO EXPRESS YOUR VIEWS INFORMALLY AND LEARN FIRST HAND WHAT IS FEHXER MAGNUSON'S ATTITUDE REGARDING ENTIRE MATTER W. S. HOUCH MANVILLE bcc C. C. Simoni Dr. Dr.Dr. K. W. Smith - as eal 2nd fl C. W. Hite October 20 1961 Dr. M. C. Shaw Asbestos Textile Institute / Philadelphia Textile Institute Schoolhouse Lane Philadelphia lk Pa Dr. Magnuson's Asbestos Industry Survey Matter Dear Docter Shaws Confirming our telephone conversation will you as possible send out the previously planned / as per your draft letter of October 4 please letter plan just to Dr. H. as soon Magnuson Certain situations as explained to you that have recently taken place in opinion makes the industry my it even more pertinent that our position 5, in the A.T.I. be made known to Dr. Magnusen sen In accordance with the very latest line up of votes in the A.T.Ia.s per Ale information from you it is position understanding that four members have ex- ea pressed an affirmative position and three members have expressed a neg- ative position The three members voting negatively are Keasbey & Mattison Raybestos Manhattan and Tallman Molluskey . Therefore on this basis your | letter should be issued at ones changing of course to the majorvoitetays beingbei ^ n tog3 It is my request to you this Serbv e i givc en e to with a letter of transfmroi m ytoutifayl ou was being sent out by my direction after all factors had been weighed WE: ew W. S. HOUGH DEPARTMENT OF HEALTH EDUCATION AND WELFARE PUBLIC HEALTH SERVICE Occ Health Research & Training Facility Bureau of State Serviens 1014 Broadway ot Cincinnati 1 Ohla - January 8 1962 oO Dr. Kenneth W. Smith Medical Director Manville Corporation 22 East 40th Street New York 16 New York Dear Ken . 1962 am writing to confirm my telephone conversation with you of January 4 If it is convenient I would appreciate your making arrangements for ol. 0 Dr. Philip Enterline Dr. Roy Gibson and me of the Public Health , JSeerrsveiyce and Mr. E. Lynn Schall Chief Occupational Health Program New ~ Health and State Department of to visit your Manville Operations February 14 15 to observe and become better acquainted with industrial processes of asbestos products This is a general follow of our recent visit with you on November 22 to enable us to become more knowledgeable concerning the = asbestos industry If this arrangement is satisfactory we would plan to arrive at your Manville Plant around 10:00 m on February 14. We will be driving from Philadelphia It will be necessary for us to leave around afternoon on the 16th Sincerely yours J. Cralley Scientist Director Assistant Chief Occupational Health Research & Training Facility the learningvarious ba r aspects 7 in wt comerate ^findemonstrating how Asbestos Fibre CONFIDENTIAL | QHQ C. L. Antonson Manville H. Engel Manville K. H. Slater Manville C. L. Stake Manville Proposed Visit U.S. Public Health Service Several months ago the U. S. Public Health Service advised us that it was in- terested in the health of asbestos workers and that a country survey of the asbestos industry would be undertaken Manville has agreed to particiip n ta his t sure vey In order to understand how asbestos fibres are used we have offered to show some members of the Service certain of our Manville operations It would be appreciated if you could arrange to have the following _ people visit your plant on February 14 and 15 Dr. Roy Gibson Dr. Philip Enterline and I shall accompany these men along with a representative of the Manville Industrial Relations Department We expect to arrive about 10 A.M. February 1k and leave abo3uP.t M. the followidnagy During this time we would like to visit the fol owinBgrafkoelloLwiinng ionpgerations Pipe Rigid Shingle Flaxboard Textile Floor Tile and These men will conduct the survey of many different companies in the asbestos industry They are interested only in dust control methods and occupational pulmonary diseason I might state that the U. S. Public Health Service members include many of the group which was so helpful to Manville when the diatomaceous earth industry was surveyed in 1953 ecs D. B. Hillier A. B. Marchant C. C. Simond W. L. Vanderbesk C. H. Grote anville Kenneth W. Smith M.D. ifhy jf January 14 1963 Dr. M. C. Shaw Asbestos Textile Institute / Phila College of Textiles & Sciences Schoolhouse Lane Philadelphia Pa Dear Dr. Shaw U. 8. Public Health Survey Asbestos Textile Industry Unfortunately I have just learned on January 11 that our Dr. Kenneth Smith will be unable to be present at the coming A.T.I. Meeting at which time many of the company doctors will in attendance I am afraid we let the announcement go too long and he has made a previous commitment to be at our sines and the date can't be changed so we have lost th onatht at score Dr. Smith explained to me that be and possibly others will be contacting various Asbestos Textile Industry plants in Engl andaon n td he Continent very soon Dr.Bette of Turner and Newell in England is a key man in the situation and be will undoubtedly meet with the American doctors Dr. Cralley through Dr. Smith would very much like to arrafn orgDe r. Paul Gross Pathologist at Mellen Institute in Pittsburgh to accompany the greep I am advised that a non government employee is not considered proper unless sponsored it is Dr. Cralley and Dr. Smith's request that the A.T.I. appoint and sponsor Dr. Gross as their representative This would be on the basis of no cost to the A.T.I. but it would make Dr. Gross who is an authority on Asbestosis available to the Asbestos Research Council of England Will you be good enough that it is placed on to discuss this matter with Mr. Peele and see agenda for Band of Governor's consideration WASH Yours truly W. S. HOUGH H DEPARTMENT OF HEALTH EDUCATION AND WELFARE Occupational Health Research & Training Facility Bureau of State Services 1014 Broadway Cincinnati 2. Ohio PUBLIC HEALTH SERVICE January 16 1963 a BY eo + ee es . ! AIR MAIL Dr. John Beattle Queens College Cambridge England Dear Dr. Beattle The schedule contained in your letter of January 8 1963 covering our visit in England in excellent and very satisfactory We would be most grateful if you would go ahead and make the hotel reservations To get approval for our trip it is necessary for us to prepare an over schedule of the areas and places we plan to visit I have gone ahead and made some forecasts along the lines of our discussions when we me in t Dr. Smith's off in i NewcYoe rk City This includes spethn e pd erioi d on f Apg ril 12-17 in France visiting Dr. Jean Avr ani d Dl r. Jean Champeix Any detayoi u l wos rk out on this woulbde quite satisfactory Following the outline of our discussions we are also scheduling to fly from Paris to West Germany on April 18 spend April 18-22 in West Germany fly from West Germany to StockonhAporil l 2m3 spend April 24-25 in Stockholm returnintgo New York City on April 26. While in Stockholm we would like to visit the Department of Industrial Health of the National Institute of Public Health as well as some of the industries you suggested Please keep in mind that these dates flexible so that we can fit inte our schedule my Itinerary you suggest It is quite important that we depart for New York no later than the 26th as I must return and prepare for the American Industrial Hygiene Conference to be held in Cincinnati the week of May 6-10 1963 Dr. John Beattie - 1/16/63 Your assistance in helping us also with a schedule of visits in France West Germany and Sweden is deeply appreciated and I shall look forward to your additional suggestions in recommending schedules in these countries Best wishes Sincerely yours Lewis J. Cralley Scientist Director Assistant Chief pr co Paul Gross with copy of incoming letter DKrenneth Smith " " Dr. Enterline " " Dr. Cooper " " QUEENG QOLLUND 7 JAXBLIDE _ 6th January 1963 Dr. Levis J. Gralley Occupational Health and Research Facklity Bureau of State ServicesResarch 1014 BreadWAY Cincinnati 2 Ohio The English section of your visit has been finalised so that I can give you an outline in this letter Later on I hope to be able to give you some details of the French section It has not been possible yet to fix a suitable itinerary for Vest Germany but this I hope can be arranged withina few weeks 31st Karch Leave New York Hotel Brown's Hotel 1st April a.n. Meeting at the Ministry of Pensions and National Insurance to meet Chief Medical Officer- Dr. Watkins Pitchford- and some 2nd April of his staff , ; p.m. Meeting at the Ministry of Labour to meet the Chief Medical Officer Lloyd Davies Dinner at Author's Club Hotel Brown's Ketel , a.B. Visit to an Decupational Health Clinio at a London Hospital . 3rd April Dinner with members of the Asbestosis Research Commeil and their guests Hotel White Hart Sonning All day meeting for Symposium on Asb^ Reading University Laboratorics etosis at Visit to Dr. Helt's Laboratorics to see experimental duct exposures 4th April 5th April Visit to Pneumoconiosie Research Unit , Hotel Queen's Hotel Cardiff a.B. Pneumoconiosis Unit 6th April a.n. Meeting of Association of Industrial Medical 7th April J.B. Queste of the Association Hotel Brown's Hotel Travel to Manchester | | ut Yate. sa ; a ft : Bh cer Rme ame wee nee - . ae se ' + ee en . 8th April ' , Hotel Manchester . Hotel Midland | a.B. Visit to plant of Turner Brothers Asbestos Co. |b at Rochdale B.B. Visit continued at Rochdale Maner as guests of Turner Brothers Ltd. que . axHotel Questo of Brothers Ltd their que Rochdale 9th April 10th April a.a. Travel to Cleckheaton Delting Co. : visit plant of Dus 7 +. a rah, p.a. Continue visit Travel to London by train ; . #: the Barking Kotel Brown's Ketel 6.B. Visit to ( plant of Cape Asbestos opeddodk s:; 11th April a.B. Travel to Cambridge Cambridge ae Demonstration of electron microscopic | seeing in p.n. Hight Cambridg Baner at Queens College Ketel Garden House Hotel , 12th April . a.m. Return to Legies / id ed . p.B. Fly to Paris . of France Arril Medical Officer Nicholia John I am in contact with Company Perede plante and with Medical Officer at the Dw Jech about Nicholia of the & programme visite to the Champoix of Clermont... plant to see this plant a4: the experimental work on , function spate nebout~ nebout~ verkere ,,, ,,, . If you agree with this outline hotel reservations for your ': The travel arrangementwisthin as the some detail later but be it will not necessary United States 8s: o Dr including Paul Or England vill he work Or i8'1/ relaat reirv elaetilvey ly chest} to make any oking prevgy tet pabered. 19 (Am, ap, bens Risdfoor,nJa,e Fas: Teaheey giaay > qd - ete: yal " ,feget:- Shee Shee nw om & 4 Thi OF fever. * oF ~ oe 0 BerDy a hY Lf ., cg DIVISION OF OCCUPATIONAL HEALTH Trip Report NAMES a ; DESTINATIONS Lewis J. Cralley Scientist William S. Lainhart Senior Philip B. Enterline Ph.D. Director Surgeon London Reading England Rochdale Cleckheaton Cambridge Cardiff Wales Paris France Bocum and Dusseldorf and vicinity West Germany Stockholm DATE OF DEPARTURE | March 30 1963 | . DATE OF RETURN April 28 1963 1 April 1 London - To meet with Chief Medical Officers of the Ministry of Pensions and | ; and the Ministry of Labour 2 April 2 Insurance London : To visit an - GS occupational health clinic at a * 3 April 3 Reading - To attend hospital ; i : Council's Symposium on AsbestosisAsb4 estosis Research rk Cardiff - To visit April 4-5 Medical Research Pneumoconiosis Research Unit Council 5 April 6 London - To attend meeting of Association of Industrial | LOofnfdiocners To6visAiptrimlaj7o-r10indRuoscthrdiaelse CleckheaMteodnical a processing asbestos asbestos study 8 April 12-17 Paris - To Medical Officer Ferodo Company of France meet with Ferodo's Normandy Plant 9 April and visit . Dusseldorf and 19-22 Bocum and Lo .. ' Institute vicinity and visit - To meet with Silicosis Research ae es10 April 24-25 industries processing asbestos Stockholm- To fiber - - ca of Industrial Health National confer with Department , and ; visit industries processing Ianssbteisttuotse fofibPeurbl|ic Health | : ce > GREAT BRITAIN April 1 - The Ministry of Pensions and National Insurance of Her Majesty's Government We met with Dr. J. Watkins Pitchford Dr. J. C. McVittie and Dr. Sims The ministry of Pensions and National Insurance is primarily interested in pneumoconiosis from the point of view of compensation There are some 12 or 15 pneumoconiosis medical boards in the British Isles with three primarily interested in asbestosis The latter boards are located in London Manchester and Sheffield Last year there were some 3,600 new cases of pneumoconiosis of all kinds which came to the attention of the boards throughout the country Of these around 2,770 were from coal workers 100 from foundry workers 70 from pottery workers and 40 from asbestos workers The potential number of workers at risk in the asbestos industry approximates 7,000 which would indicate approximately five compensation cases per year per thousand workers at risk This is very close to the figure given for the number of pneumoconiosis cases given in coal workers during the same time period It was also stated that in recent years lung cancer has been found in about 40 percent of the autopsied cases of asbestosis During the period 1955-5391 cases of asbestosis were given compensation among asbestos insulators In Belfast 11 mesotheliomas have been diagnosed of which nine had an industrial asbestos exposure As far as the diagnosis of asbestosis is concerned the medical boards go primarily on 1 exposure to asbestos dust 2 clinical judgment which includes the presence of one or more of the following signs and symptoms rales clubbing diffusion defects with a decreased maximum breathing capacity It was felt that the pulmonary function tests can differentiate a diffusion defect from some other condition which might be confused with asbestosis April 1 Ministry of Labour and National Service of Her Majesty's Government We met with Dr. W. D. Buchanan The factory inspector's responsibility is primarily to enforce the factory inspection law which has to do with the maintenance of good working conditions in factories of Great Britain The medical section is primarily advisory to the factory inspectors One of the early stimuli to the current studies of asbestosis and lung cancer came from a 1947 report of the Chief Inspector of Factories which showed that during the period 1924-46 out of 235 cases of asbestosis which had been autopsied 31 or 13.2 had carcinoma of the lungs 17.2 of males and 8.4 of females In the annual report of the Chief Inspector of Factories for the year 1955 covering the period 1924-54 of 344 asbestotics autopsied 55 or 16.0 showed evidence of lung cancer 20 among males and 10.1 among females There is some current interest in the Ministry of Labour on the effects of nitroglycerin on the health of workers Professor Wayne Department of the - Practice of Medicine at Glasgow University has been working on this problem ~ 3- April 2 - The Department of Applied Physiology London School of Hygiene and " Tropical Medicine We met with Dr. M. L. Thompson and staff and Dr. W. J. Smither Dr. N. L. Thompson has done a great deal of work in pulmonary physiology relating to asbestosio Dr. Thompson outlined some of the problems which are exparently operating in cases of asbestosis which involve primarily a decrease in the inspiratory capacity with a resultant decrease in the vital capecity total lung volume a decreased compliance and diffusion defects Ia esbestosis one finds that the diffusion defect is probably most easily Ieasured Dr. Thompson uses a single carbon monoxide test which involves inhaling the carbon monoxide mixed with 14 helium to test the residual volume and then measuring the amount of carbon monoxide in the expired air after the breath was held ten seconds to allow the diffusion to take place The carbon monoxide diffusion test in Dr. Thompson's laboratory involved the use of ca infrared CO analyzer developed by the Infrared Development Company Limited Welwyn Garden City England The laboratory also used a WatersConley Photoelectric Ear Oximeter in their studies In asbestosis the diffusion or resistance of the alveolar membrane to the passage of gases is decreased presumably due to the development of fibrosis the alveolar walls It was pointed out that one must take into account the in age of the individual for the diffusion gradient falls consistently with age Mr. Hills a statistician in the School of Hygiene stated that when eight doctors experienced in clinical diagnosis and in evaluating disability were interviewed regarding the symptoms most valuable in diagnosis the order ran . dyspnea ray findings rales cyanosis clubbing of fingers exposure to dust cough and sputum and survival The statisticians found a very good multiple linear correlation between cyanosis dyspnea rales and ray findings and percent of disability The level of disability as measured by the pneumoconiosis boards was not correlated with the lung function tests but there is a trend toward correlation with the inspiratory capacitusinyg using Dr. Thompson demonstrated the use of the whole body plethysmograph using esophageal balloon to measure pressure compliance April 2 Department of Epidemiology London School of Hygiene and Tropical Medicine Professor Donald Reid Dr. Enterline met briefly with Dr. Reid Tuesday afternoon to discuss problems relating to the Medical Research Council's questionnaire on chronic bronchitis Dr. Enterline pointed out that when chronic bronchitis is defined as a productive cough the questionnaire did not detect known population differentials in chronic bronchitis Dr. Reid feels that the most important part of the questionnaire deals with repeated attacks of respiratory disease and presented data showing that this has differentiated rather clearly populations in which the prevalence of chronic bronchitis was known to differ He feels that a productive cough represents a chronic bronchitis in its very early stage and that this is aggravated by such things as air pollution to produce repeated attacks He feels that it is at the point that repeated attacks can be detected that observations become of epidemiologic significance ~&e April 3 - Meeting of Asbestosis Research Council Reading University The Asbestosis Research Council sponsored a symposium of speakers from industry Universities of Reading and Cambridge and Pneumoconiosis Research Unit Penarth Clamorgan to discuss problems and current research on the effects of exposure to asbestos dust and fibers A series of papers were presented starting with a background paper by Dr. Gaze describing the properties of the three major types of asbestos used chrysotile crocidolite emosite and the source and commercial use of these minerals Re stated that annually the United States uses about 500,000 tons of chrysotile compared with roughly 100,000 tons in the United Kingdom 10,000 tons of crccidolite compared with 4,500 tons in the United Kingdom 15,000 tons of exosite compared with about the same amount in the United Kingdom The figures he quoted for the United States are somewhat lower than those shown from the Dureau of Mines Minerals Yearbook Volume I 1958 Dr. Pack Turner Brothers Asbestos Company Ltd. spoke of asbestosis from the point of view of the factory medical officer He noted that there seemed to be a correlation between the number of years worked in the factory and the pirocatega of men having asbestosis The shortest exposure reported by Dr. Pack was six months with the disease being recognized 24 years later at cutopsy The microscopic lesions of asbestosis as outlined by Dr. Knox were 1 desquamation of the bronchial membrane 2 endarteritis 3 thickening of the interlobar tissue 4 thickening of the subpleural tissue 5 an increase in the fibroblasts 6 obliteration of some alveoli 7 occasional giant cells 8 amorphous brown pigment and 9 presence of asbestos bodies . Dr. Knex has seen no mesotheliomas in this population He discussed1939-61 provisional figures of a plant population observed for 28 years 1939-61 as - a follow of an earlier study by Dr. Richard Doll indicating that the _- obscrved deaths due to all cancers and due to lung cancer were no more than might be expected in the general population _ Death- all causes all cancers lung cancers Expected 43.6 11.3 4.1 Observed 43 9 4 Men only all caused all neoplasms lung cancer 39.6 35 9.95 31 4.0 31 Females only - all causes all neoplasms lung cancer 4.0 821 1.4 821 0.1 821 It was noted that in compliance with the Factory Inspectors Act of 1933 environmental exposures to asbestos dusts and fibers during the subsequent period were dramatically lower than that of the previous study He felt that the above data reflect the improved dust conditions in the factory The above study is expected to be completed and published in about another four years For this reason the above data are provisional and are not available at this time for publication 5 Professor Holt of the University of Reading discussed research he was doing sponsored by the Asbestosis Research Council One of his findings is that the amount of ferratin which is absorbed onto the asbestos body is several times that of the albumin seen This must mean that the protein is being put out by a cell and is not coming from the plasma itself It was estimated that it takes at least two months to develop an asbestos body for they first find asbestos particles in macrophages then in giant cells then in fibroclasts Work done by Dr. Davis University of Cambridge indicates that a macrophage is some sort of stem cell in the giant cell - fibroblast series Dr. Davis also pointed out that the early lesion in asbestosis is found in cells just under the basement membrane in the alveoli Next there is nodular lesion formation with interstitia fibrosis in the septum which could be termed a type of interstitial pneumonia There are subsequently increasing amounts of lung consolidation Dr. Davis state that in the development of the giant cells a series of microvilli varying in length but about 12 0 units in diameter apparently interdigitate to produce thes cells Asbestos particles are found in macrophages which have migrated to the trachea and lymph glands but apparently there is no development of eshectos eshectos : bodies in these extraneous sites Dr. Smither Cape Asbestos Company outlined the problems of pulzonary function as seen by a factory medical officer He pointed out that the basic pathology involved a stiffening of the lung due to interstitial fibrosis and pleural thickening These processes decrease compliance and also contribute to an alveolar capillary block with a diffusion defect Dr. Smither stated that there is marked disagreement in ray interpretation and that the ray cannot be used- to demonstrate progression Mr. Ross Hunt Pulmonary Function Technician British Belting and Asbestos outlined their program of lung function testing They determine residual capacity obtain an FEV and MBC do diffusion testing helium and an excercise test These pulmonary function tests are done as a part of employment and periodic examinations Company Dr. Beverley Medical Officer at British Belting and Asbestos Company outlined the employment examination he uses with emphasis on medical history to rule out chest and heart conditions and collagen diseases including Caplan's Syndrome He examines the prospective employee by ray as well as by clinical examination and as mentioned before pulmonary function tests are used to provide a baseline Dr. John Cotes of the Pneumoconiosis Research Unit at Penarth outlined some of the problems of standardization of methods relating to pulmonary function testing He stated that they have circulated for comparative purposes a series of aliquots of various gas mixtures to laboratories throughout Great Britain who are doing diffusion tests There are three major sources of error in these tests 1 analytical methods 2 apparatus used 3 differences in terminology The primary source of error was in the analysis of carbon dioxide ne ee es ee I i | > ee a m4 oe ~6-+ presented information on Addingley Belting and Asbestos Company, presented exposures to tr. Addingley Addingley British Belting and Asbestos Company presented presented information methods methods used industry England England enumerate airborne exposures exposures to asbestos asbestos They theusing membrane filter filter collecting airborne airborne this particulates are particulates somewhat company to collectinmg ectollhectiong ds methods counting the particulates particulates differ every however however only company counted counted and this is is used as particulates index In overall exposure exposure A fiber fibers terms terms terms particle particle the width data derived from their on difficulty of comparing derived derived in the De, Addingley commented commented compared difficulty difficulty of comparing comparing data derived from method method counting counting compared with used in Countryparticulates which past past we used impinger distinguishable method of collecting counting and and distinguishable pathologically counting effects of controlling Hill discussed the environmental effects controlling controlling Yr. exposures Bamble and and fibers environmental environmental environmental attention attention given exposures asbestos dust installation factories special fibers mfaiantcentanocre imainetenansce and operations operations attention loss given ventilation recirculate in being able able loss loss 4 summary substantial substantial College Cambridge University gave summary summary of the fr. overall , Queens dust University University gave Asbestosis to asbestos Asbestosis Research Council problem exposure established to fibers as information Asbestosis Council and and resume he develop needed information addition already mentioned facing the group points define asbestosis to stressed that that basic defined defined defined problem problem microscopically microscopically microscopically is how chemically functionally microscopically Research Unit Penarth April 4 = Pneumoconiosis Dr. Cotes Dr. Mr. Skidmore Dr. Wagner Mr. Skidmore and Mr. Clark Research his program program Pneumoconiosis activities activities Glamorgan We met with: Glamorgan We with Unit discussed the overall Wagner of his program data has collected collected relating relating epidemiology of South Africa discussed mesothelioma related relating to epidemiology In series cancer especially reported to 74 were asbestos asbestos exposures Field of 84 cases Wagner Wagner industrial industrial associated with Asbestos Asbestos Field South South Africa had industrial been been exposure asbestos asbestos only of 120 known known exposure series individuals been to something in excess increased reported with with still two individuals exposure without known exposure asbestos asbestos He was years the average average between asbestos exposure exposure development tumor type development that the blue asbestos exposures exposures found In In incriminated in most only which incriminated emosite mesotheliomas mesotheliomasrelated In there exposure exposure emosite had been related large large chrysotile chrysotile case Dr. Wagner raised the question whether whether might expect large the increase increase in cases lung cancer asbestos asbestos that the production this number mineral between 1920 and 1960 to blue considerably increased Special stress this mineral indicating indicating has considerably been been isloated stress was given reports asbestos and 3-4 benzopyrene benzoo pyf reneasbestos asbestos stres^'unmilled unmilled blue not from other forms SCpoectiaels discussed discussed use blue asbestos stated that that exerciser equipment equipment Collis that new treadmill treadmill called and Sons Barry Glamorgan This treadmill has continuous produced Collis continuous speed speed they had been Glamorgan Glamorgan This treadmill continuous continuous and Song of Barry, Glamorgan. a ne nenmt eme me nae eek Det 7 range between 0 and 8 miles per hour with a continuously adjustable incline from 0 to 1 in 6. The length of the table top is 6 feet and the belt width to 60 centimeters Dr. Cotes felt that this treadmill produced more consistent results than the bicycle exerciser Dr. Enterline and Dr. Lainhart presented an outline to the staff of the Pneumoconiosis Research Unit of work being conducted by the Division of Cccupational Health among coal miners and received comments and valuable criticions from them regarding this project Anil - Dr. Enterline and Dr. Lainhart met with Dra Gilson and McKerrow to discuss revision of the IMC chronic bronchitis questionnaire April = Turner Brothers Asbestos Company Ltd. Rochdale We met with Mr. John Waddell Mr. John Pearce Dr. John Knox Dr. Donald Holmes E We discussed the Medical Department's program and the environmental program for OT the control of asbestos dusts and fibers with Dr. Knox and Dr. Holmes and then mada trip through the plant to observe housekeeping maintenance ventilation OR and other programs in use for controlling exposures to asbestos dusts and fibers aes Lhe In addition to the environmental control of asbestos particulates maintains an excellent respirator program for the workers \ the company ' Apmil 9 - British Belting and Asbestos Company We met with Sir William C. Fenton Mr. Frank Pearson Mr. Eric W. Sisman Mr. Richard Barber _ Mr. Charles M. Fenton Mr. D. Michael Pearson Dr. C. Gordon Addingley , Sister M. Preston Dr. W. H. Beverley and Mr. Rose Hunt Dr. Addingley and Mr. Hunt discussed the environmental control prograomf the plant and methods for measuring workers exposure to airborne asbestos fibers A visit was then made through areas of the plant to observe environmental conrol programs instituted for the control of exposures to asbestos particulates A _ visit was also made to the Medical Department to discuss and observe practices in use \ April 10 - Cape Asbestos Company Barking Essex Mr. Mendelle and Dr. Gaze and staff We met with Dr. Smither _ As mentioned previously Dr. Smither felt that one cannot classify asbestosis by the ILO classification rather one must depend on 1 the pleural thickening especially diaphragmatic 2 general loss of translucency in the lung fields 3 increased lung markings and 4 the development of a shaggy heart A part of the discussion involved a problem of whether infection triggers the development of asbestosis Dr. Smither felt that there was some small degree of asbestosis in all patients and that infection of any kind including the chronic bronchitis so prevalent in England might be the trigger mechanism for the development of _' asbestosis Dr. Smither reported a series of asbestos workers who were examined at post mortem between September 1951 and May 1962. Of 41 workers 31 had asbestosis and 10 of the 31 had cancer of the lung in addition - 8 We made a trip through the plant and the MedicavlisDietpeadrtmeInntadtdoitoibsoenrvteo and practices in contrast to the other plants amont of crocidolite chrysotile this plant appeared to use a greater methods April 11 - Queens College Cambridge University , Dr. Davis Dr. Smither and Dr. Avril We met with Dr. Beattie the research work being carried out on asbestos at the Dr. Beattie cutlined on electron microscopy research University of Cambridge with sepcial emphasis mentioned in the as cutlined by Dr. Davis The results of this research were Asbestosis Research Council discussion of the meeting of the April - National Coal Board Dr. John R. Ashford in the visit at Cambridge University Instead Ir Enterline did not participate in the exchange of ray films ae he discussed with Dr. Ashford the current program Ashford said that they have initiated at the time of his visit last year Dr. Cochrane has not been much delayed in reading films and that currently Dr. which was agreed upon completed his conference reaIdtiwngisll tbheey aatlsloeansetedanottohmerakmeonth before they are vo aT at the meeting last year will be able to send the films onto us finished and before they ame aoe - 10- WEST WEST WEST GERMANY April 12 - Dust Research Instituto Bonn Ger Schmidt and staff He ret with Professor Schmidt outlined the functions of the Just Research Institute Professor to characterizing evalueting and controlling which is devoted primarily the Institute conducts on extensive exposures exposures exposures in industry In addition exposures filter and commercial filter testing program respiratory respiratory dust at used for collecting and counting eirborne dust In The Konimeter is compared visually with a set of actual operation the Konimeter field is dust lead where the compla photometric standards tobeelsiteifmattehatthethaiisrbmoertnheod using a great number of for was taken It is their other methods especially since its use is comples is preferoafblteheowve or rk environment with reference to the proper per also uses routine testing of control methods and not for research The Institute forrance airborne dust but weighs the sample membrane filter for collecting silica content of the the instead of doing particle counting In determining determining the airborne dust analysis is made only on that fraction of airborne Germany has about 4,50 cases of dust under 5 microns in size Lest There are 2-5 cases of end about 20 cases of asbestosis silicosis a year The 20 cases of asbestosi lung cancer a year among asbestotics workers risk Roughly 1,50 workers are in the represents cround 2,500and textile renufecture and about 500 in asbestos osbestos brake lining in miscellaneous manufacture of building products and the remainder are has been a big improvement in Dr. Scheidt feels there and recent years asbestos proodfucatssbestos fibers received fror the mines in in the quality been very important in improving environmental conditions that this has for counting are collected by the use of the the plants Dust samples below 200-300 particles per cc with Konimeter and dust levels maintained dust levels from 0.7 to 5.0 microns For asbestos dust sizes ranging for sizes under 1 micron and fiber are kept under 175 particles per cc Plants with low dust below 30 per cc for sizes less than 15 dierons levels are considered examples for others to emulate had recently been established in stated that a Commission dinitrate on the Dr. Schridt to examine the effects of ethlene glycol West Germany of workers Dr. Eberhart Gross is head of this Director Comision Comision of a dynamite health concerned is Dr. Beschz the Medical Directly in Sahlbusch They have had sore deaths recently company and Silicosis Research Marburg 22 - ledical Institute of Hygiene April He met with ^ rAntreiler and Sr. Schiller Institute described the research activities of Dr. Antweiler Chief of the have found that phenylbutazons given the facility He stated that oftheaynimals with any albumin albumin will result in no at the time of sensitization soc and therefore no anaphylactic ilco Bomu antibody production 11 unpublished material was presented on the treatment of phagocytic cells with P called Dusseldorf substance which is chemically polyvinyl G protection against the action pyridine anoxide This substance provides to be some kind of internal cellular of quartz particles There appears protection for if 1 cc of % saline solution is given weekly subcutaneously to a 100-200 gram rat there is protection against quartz perticles introduced intratracheally If the Dusseldorf substance is continued it the animals but when discontinued the animals develop silicosis pInrfootremcattsion was not available on optimum dosage or whether the polyvinyl pyridine anoxide may be stored in the liver or other organs We also met with Dr. Eric Schiller Pathologist at the Institute who presented some evidence showing that vitamins especially vitamins A and E fibrosis in that and pantothenic acid may provide some protemcutlitoinnucalgeaaitnesdt cells and total there is an apparent increase of mitoses number of cells in the epithelial layers of the bronchial tree The next step in his research is to give rats quartz plus vitaming to see if there is any change in the reaction to this foreign body with or without vitamins An additional bit of information provided by Dr. Schiller was that they have had some dogs underground for up to six years day and en in these animals there was hypertrophy of the bronchiolar night epithelium after two to three years within the coal mine There was also cool an increase in the number of goblet cells He believed that pure dust will not produce fibrosis and that fibrosis is due to the silic present by We were show new animal chamber dust feed system constructed by a This instrument is not yet Dr. Palley Gottingen West Germany commercially available In principle the materials to be dispersed are to a hard uniform density and released by gradual contact on the compacted flat surface of a high speed emery wheel The dust passes through e plonum settling chamber and then into the animal dust chamber Automatic control so that of the dust exposures is maintained by the use of a tyndillomater as the dust cloud decreases increased material is fed automatically onto the enery wheel Dust clouds can be maintained uniformly within plus or minus % for prolonged periods | April 22 - Dr. G. Worth Rethany Hospital Moers Dr. Worth has an excellent clinicel ray and pulmonary function unit in the Bethany Hospital He examines from 7,000 to 8,000 miners per year In addition he has been doing some very interesting epidemiologic research Using standard techniques he has found that 1 there is no change in the pulmonary function bafore during and after a 7-1 hour shift in the coal - mines 2 no changa was found following a 3-5 minuto exposuta to concentration of dust about 30 times that which might be found in a mine - - 12 He also found in a group of , 441 iners and 200 iners chosen from the population in and around Noars that the residual significantly increased in miners over niners and volume was that the forced expiratory volume and maximum breathing capacity were significantly decreased in miners as compared with miners Dr. North also made the and due point that it is felt in Germany progressive massive fibrosis are to traces of silica found in the that both coal coal workers pneumoconiosispneumocniosi due to silica The former is dust the latter to massive silica exposure and not necessarily related to tuberculosis As mentioned before the German workers also emphasize the possibility of a triggering mechanism in the form of felt that the most reliable pulmonary infection of any sort Dr. Worth function tests were those for argon or helium using infrared or mass spectrometry The least reliable was the spirometer test the main criticism being that the cooperation of the individual worker was difficult to obtain April 22 - Office of Industrial Medical Council Bocum Dr. Ruckup and Dr. Mapp-- We rat with Dr. Buckup is area referee in workmen's compensation cases and has seen a number of cases of achestosis He said that the workmen's ' compensation law while requiring that interpreted very liberally and implied in the law is not depriving any miners coal miners have silicosi's is that the use of the word silicocis compensation if they were truly entitled to it by that West Germany virtue of their physical condition has very few statistics on cases of We were told mesothelioma but East Germany has reported more in their asbestos workers than in general population We were also told that no pleural plaques were seen in West Germany but were seen in East Germany There was also the report that the East Germans feel that there is some connection between asbestosis and tuberculosis in that asbestosis may predispose and accelerate the development of tuberculosis However the incidence of tuberculosis East Germany was said to be higher than that of West Germany so that major conclusions can be drawn Dr. Buckup pointed out that many of former workers from East Germany were now living in West Germany and in no the that a as result they were having some problems with asbestosis which actually had its origin many years ago elsewhere in Germany We discussed the use of the 1958 ILO classifications for pneumoconiosis and Dr. Buckup while he likes this classification finds it difficult to use work since most of the private physicians in the crea are using the 1930 Sidney classification He feels that it would be very difficult to change In contrast to England filtered air from within the asbestos fectory is permitted to be recirculated in the West Gorman factories SWEDEN April 24 - Svenska Arbets Givaresoreningen Stockholm Dr. Forssman expert responsibilities is consultant to Svenska to encourage industry Arbets soreningen One of his to inaugurate occupational health programs No rining of asbestos is in the logging of ships logging done in Sweden Its primary use in that country is There is one textile and friction eterials plent in the country all of the asbestos operations in Sweden were done in Goteborg Since there enroute to Coperhage the arrangements for us to proceed talk to personnel concerned and to see these operations Goteborg he following made day ; had a death among their orters in the Dr. Forssman stated that they carnis this The nitroglycerin plant and that there was sche concern and they feel skin alicorption alicorption was vorker was exposed only to nitroglycerin Dr. Forssman was also very interested in probably an important factordone in the United States Te nentioned nentioned occupational research being term effects of arsenic exposure especially any information we had on long April 25 National Institute of Public Health of Sweden Stockholm Heelth of the National Institute- Dr. Ahlwerk Chief Department of Occupational activities of Public Health outlined the research their technical services which He gave us a list of 27 project crees on carried out in his department of their time is spent on they are working A considerable portion a broad scope of in fron foundries and iron ines pneumonconiasis problems materials and uses study of the plant investigations decling with hazardous investigation on effects of various industrial solvents on health and some insecticides and pesticides on vagation and enimals Karolinska Hospital Stockholm April 25 - Professor A. Svensson Medicine of the lenical Schinul the Department of Preventive to relation Dr. Svensson is in interest is in asbestos research in of Stockholm His perticular to elucidate the of fibrosis in animals He has attempted the development of different dusts in rats by giving celine suspensions relative fibrogenicity of the lung and intratracheally He then evaluates . icroscopic appearence He also feeling that the weight is a good seasure seasure of changes weighs the lung in the lures which is used as a identifies the amount of hydroxyprolene correlation correlation measure of the amount of collagen production He finds a wood with particles below 3 nicrens between the dosage and the reaction when verking of the lun's end an in size There is a worked progression in the weight when quartz is injected intratracheally intratracheally increrse in the mount of collagienn lung weight and a little increase in collagen There is only small small increase to these chisels in the formation uvhen blue rsbestos b_lor ricrons is given that he had sore trouble with intercurrent started sana tenner Dr. Svensson stated eninals lle felt however that they had infection in his laboratory within each treatment group so that with a sufficiently large group of animals his result He stated stated that he feels the the amount of infection did not influence coal miners is primarily due to that the reactions commonly observed among 14 presence recation and caid of quartz in coal and presented some data which showed a very definite of rats to % quartz Dr. Svensson was also interested in insecticides that Dieldrin had causes some deaths of animals in Southern Sweden April 26 - Laboratory of Clinical Physiology to the Sahlgrenska Hospital Goteborg We met with Dr. J. Bjure and Dr. Eric Lindell Dr. Bjure's primary interests are in byssinosis where he has done work with Dr. Ecuhuys who is presently working at Emory University in Atlanta Georgia In addition to this work in byssinosis Dr. Bjure has been working in the area of pulmonary function with particular interest in the diffusion capacity of the lungs He has also done heart catheterization on all their work groups His major finding is that the diffusion capacity is significantly lowered in asbestosis as compared with workers in glass wool industries He stated that in asbestos there is said to be an alveolar membrane block but he feels that there is also a block in the small arterioles with thickening of the vessel walls They are hoping to do a follow on the men in their study which is to be reported in the magazine Thorax some time in the near future We also talked with Dr. Sven Lindell also a clinical physiologist at the Sahlgrenska Hospital He too was interested in byssinosis and indicated that the incidence in Sweden is increasing In a recent new study brought on by local union pressure using Schilling's questionnaire they found that the incidence was as great in the newest factory as in the oldest There was a decrease in incidence in a factory where rayon was primarily used and very little cotton was handled He also noted that spirometry on a Monday after a two holiday revealed a significant decrease in the pulmonary function Dr. Lindall stated that there is apparently a relationship between smoking and byssinosis If the workers smoke their pulmonary complaints were intensified This causes cotton mill workers to smoke appreciably less than _ the general working population Dr. Lindell is going very soon to the University of Malmo where he will be Chief of the Clinical Physiology Laboratory at the new medical school there April 26 - Mr. Thord Bord Factory Inspector for Department of Labor in Goteborg Sweden Mr. Bor^ took us on an inspection tour which included both a very modern ship- yard and a plant where asbestos lagging was demonstrated In the latter the | asbestos fibers are mixed with water and sprayed impinged onto a metal sheet ' which simulated the structural membrane of a ship The company conducting the ' demonstrations contracts for the insulation of ships using asbestos The supervisor stated that the use of a respirator was mandatory during this operation DENMARK April 27 - Dr. A. Grut Senior Medical Inspector of Factories Copenhagen Denmark Dr. Grut was greatly interested in the occupational health study we have underway of the asbestos products industry in this Country We spent considerable time discussing the scope of our study Dr. Grut has primary interests in factors of the work environment in the factories in Denmark as well as related compensation problems The actual number of asbestos workers in Denmark is not known but there are some 300 in the union designated as insulation workers and 30-40 as lagging workers Some asbestos is used in both weaving and building materials but the number of workers involved is unknown In a study of 35 insulation workers who had been working from 18-45 years with an average experience of 29 showed only lung symptoms There when emosite was years 22 of the 35 had some ray changes nine of the cases changes 19 had pleural changes but only three of the 23 had were also some plaque formation in these insulation workers used Although there have been some compensation cases from exposure to asbestos no lung cancer has been identified but it was recognized there are only small numbers involved If a person is diagnosed as having pneumoconiosis he is advised not to work with asbestos However if he continues to work with any pneumoconiosis dust he is required to wear a respirator The industries in Dermark have an annual ray program with nearly 100 participation as they get paid by the factory to have their chest rays taken In the asbestos factories 30 x 40 cm films are taken as well as 10 x 10 cm The men who read the films find that the small size is more satisfactory for asbestos exposures and Dr. Grut is now tempted to use only the small films for the cebestos workers He is also considering instituting a program of taking . films for silicosis using the small size > ae DEPARTMENT OF HEALTH EDUCATION AND ; WELFARE Occupational Health Research & Training Facility Bureau of State Services PUBLIC HEALTH SERVICE 2/1 2/1 2/1 January 23 1963 Dr. J. C. Gilson Director Ineumoconiosis Research Unit Llandough Hospital Fenarth Glamorgan United Kingdom Dear Dr. Gilson I appreciate very much your letter of January 15 inviting me to visit with you and Dr. Wagner in connection with attendance at the Asbestosis Research Council Rea in Rd eadii ng in n Apg ril Dr. John Beattie Queens College Cambridge is making up a schedule of visits for us during the trip and am sure you will be hearing from him soon Ii t s tentatively planned for us to visit with you April 4 and 5. Dr. William S. Lainhart and Dr. Philip E. Enterline from our Division of Occupational Health and Dr. Paul Gross of the Industrial Hygiene Foundation will also participate in : these visits We are looking forward to meeting with you and Dr. disc anduds iscs ussi inn g tg he research work you are doing on asbestos Sincerely yours Lewis J. Cralley Scientist Director Assistant Chief co with copy of incoming letter Dr. Beattle Dr. Gross Dr. Enterline 3/13 3/13 March 13 1963 Dr. Levis J. Cralley Scientist Director Assistant Chief Occ Health Research & Training Facility Dept. of Health Education and Welfare Public Health Service 101 Broadway Cincinnati 2 Ohio Dear Levies I thought you article in the official that it is an excellent and improved However and the use to which he would be interested in the attached copy of an magazine of the Asbestos Workers Union I think project if the workers health can be protected I fear the report which Dr. Selikoff will make will put the information he is gathering Sincerely Kenneth W. Smith N.D. Medical Director ROSCOE P. KANDLE M. M.P.H. STATE COMMISSIONER OF HEALTH ' MM ALFRED H. FLETCHER S. M.S. DIRECTOR DIVISION OF ENVIRONMENTAL MEALTH \ State of New Jersey DEPARTMENOT F HEALTH BOX 1540 TRENTON 25 April 4 1963 Kenneth W. Smith M.D. Johns Manville Corporation 22 East 40th Street New York 16. New York Dear Doctor Smith Many thanks for your consideration and interest in obtaining for us the service your representative Mr. Walter T. Huber His discussion of products and the knowledge imparted were excellent Attached is a copy of my letter to him which is self explanatory I appreciated receiving your letter dated March 13 1963 and the attachments Doctor Selikoff previously forwarded us the abstract from The Asbestos Worker February 1963 It is interesting to see what may develop from this study With warm personal regards I remain Sincerely yours att jwp E. Lynn Schall Chief Occupational Health Program ica? Le -p Activities a .... DIVISION OF OCCUPATIONAL = 2 Public Health Service Department HEALTH si Education foe 3 See Welfare Departmenotf Health Education and Welfare gt * . No. 2 April 1963 Washington D. C. PROJECT HIGHLIGHTS 9 os Are ANALYTIC METHODS A project to develop separation and concentration pro- cedures for spectrochemical analysis of metallic elements is continuing with me evaluation of methods by radiotracer techniques Work was resumed on the de- velopment of volatization characteristics of beryllium and of internal standard 6 elements which have been found to be most precise for the quantitative spectro- aten graphic analysis of beryllium in biological materials The analytical losses of beryllium during the application of the direct spectrographic method are being evaluated . Recent work has included refinement of the spectrographic method for beryllium indium and antimony development of a quantitative spectrographic method for indium and antimony in human sweat samples and development of a method for the collection of urine samples in field studies and for their transport to the laboratory for gas analysis DUST SAMPLING TECHNIQUES Electron micrographs indicate that the dust cloud produced bya newly constructed device for dispersing dry asbestos dust jm, differs character from that produced by the device for dispersing wet a asbesto underway to determine the effects of density and viscosity of the bed collect Blution and the effect of dust particle densities upon settling time a by Stokes law The mathematical model indicates that wide te oe differences in theoretical settling times in a Dunn cell are possible for the same diameter particles in commonly used collecting media COAL MINE STUDY Medical examinations by mobile field units of both in- active and active coal miners continue in West Virginia In cooperation with mine operators and unions medical examinations have been scheduled for other localities in the State No. 3 July 1963 Washington D. C. PROJECT HIGHLIGHTS COAL MINE STUDY Since the study to diseases among coal miners began January have been given examinations in the hI] determine the prevalence of chest 250 inactive and 500 active miners Division's mobile field unit ^ Pulmonary function and work capacity tests are also being administered to the miners participating in the study to determine any changes in pulmonary function relationship to work capacity and correlation with clinical status Only 20 percent of the men who were retired or otherwise not currently working as coal miners completed the work test riding a stationary bicycle for 12 minutes while over 98 percenotf the active miners completed the tests this is not in itself unexpected in view of age differences and obvious selective factors The data also revealed that oxygen consumption during work on a bi- cycle ergometer is not independent of the body weighotf the rider A single breath nitrogen washout test has been added to the pulmonary function battery The Beckley West Virginia Memorial Hospital has been given contracts as part of the coal miners study Under one contract information was provided on a were cohort of 557 miners working in firas observed 20 percent of i workmen's compensation the year 1937. Within 20 years after they the group were dead and 25 percent had Under the second contract the hospital pulmonary function and work capacity data on a group of 75 miners viously studied 3 years ago itions from the National Vital Statistics Division are being studied to examine the causes of death among coal miners for comparison with the general working population of the United States ASBESTOS INDUSTRY STUDY Work is preliom n i prn eliamir nay ry phases of a comprehensive study of the of asbesat sbeo sts os fibers and dusts on the health of workerisn the asbestos products industry in this country Environmental plant studies are scheduled to begin early this fall and medical studies approximately a year later June 21 1963 Dr. Lewis J. Cralley Scientist Director Assistant Chief Docupational Health Research & Training Facility Department of Health Education & Welfare Public Health Service 1014 Broadway Cincinnati 2 Ohio Dear Lewis Many thanks for letting me read the attached Trip Report I sure wish that I could have been with you I have heard no repercussions whatsoever following the Asbestos Textile Institute Meeting You must have done an excellent job in allaying their fears If I do hear anything in the future I'll let you know Sincerely Attach Kenneth W. Smith M.D. Medical Director DEPARTMENT OF HEALTH EDUCATION AND WELFARE PUBLIC Health sERVICE Occupational Health Research & Training Facility Bureau of State Services 1014 Broadway Cincinnati 2. Ohio June 25 1963 FILE FILE FILE Mr. C. W. Hite Vice President Industrial Relations Manville Products Corporation 22 E. 40th Street New York 16 New York FILE Dear Mr. Hite I am writing in follow of the occupational health study which our Division is undertaking in the asbestos products industry Plans for initiating elements of the study as outlined in the protocol which Dr. Kenneth W. Smith has received are progressing A study of cohort groups employed in the asbestos products industry using social security records is now underway It will be another year however before data from this source can be assembled and analyzed We are ready now to begin the plant study as outlined in the protocol to obtain baseline data for prospective follow Although the environmental and medical phases of the plant study will be conducted independently it is important that we obtain the information available through both these avenues if meaningful correlation of the data is to be made and the objectives of the study are to be achieved We plan to start the environmental work early this fall It would be approximately another year however before the medical phase of the plant study gets underway We believe that information obtained from an environmental and medical study of some of your selected plants as outlined in the protocol would be invaluable in obtaining factual data to achieve our objectives For this reason it is requested that you participate in the environmental and medical plant study We can get together at a subsequent date in discussing specific asbestos products plants which would be suitable for inclusion in the study Other plants in the asbestos products industry also will be requested to participate so that representative and statistically Mr. C. W. Hite --- 6/25/63 meaningful study groups can be constructed We cannot at this time give a specific time for scheduling the start of environmental studies in individual plants which may be selected We will however give a minimal notice of two months and longer if possible so that satisfactory arrangements can be made prior to our arrival We would greatly appreciate early consideration of this request for your participation in the study Sincerely yours & Cral ey Lewis J. Cralley Scientist Director Assistant Chief Research & Technical Services Branch DEPARTMENT OF HEALTH EDUCATION AND WELFARE PUBLIC HEALTH SERVICE Decupational Health Research & Training Facility Bureau of State Services 1014 Broadway Cincinnati 2 Ohio January 20 1964 Mr. R. W. Lane Jr. Manager Manville Corporation Marshville North Carolina Dear Mr. Lane Enclosed are the coples you requested through Dr. W. L. Wilson of our two issuances covering plans for an occupational health study of the Asbestos Products Industry I am looking forward to the opportunity for Dr. these plans in more detail with you Wilson and me to discuss Sincerely yours cc Dr. W. L. Wilson Lewis J. Cralley Scientist Director : Assistant Chief ro Sen ImplementPliannogf Cecupational leaitu study of AsbestosProducts Products industry A pretecel was developed and approved by the Division of Occupational Health Public Health Service August 21 18 covering general plans for a study of occupational health problems in the asbestos produeia manufacturing industry as well as specific plans February 6 1935 for obtaining necessary caviron mental mental and medical plant data Past plant mestical and environmental studies of the Division have been cross- sectional in that health problems of an lacustry were studied by correlating per- timent medical and environmental sata collected through a time approach In those studies all of the medical and environmental dala were collected by official agencies Twy were essentially a one period to tune study with retrospective ata baving minimal meaning due to its sparsity and the inability to confirm ita vaikity With With the rauer massive cavironmental exposures of the past associ atulatul with the occurrence of frank occupational tseases often la epidemia pro- portion this type of study has been very useful in developing information relative to the nature of such diseases and their prevention - However with the increased attention given to the control of plant just ez- posures and to medical programs providing surveillance over employees the effects of exposures have changed from an acute to a chronic type response often requiring periods of a lifetime of employment before the response may be manifest through today's study techniques This response to low levels of exposure over prolonged periods as well as broa.lenad knowledge on the suspect relationship of such exposure to diseases which in the past were considered as entirely nonoccupational in origin invalidates the use of the one time sectional study approach in collecting data in the asbestos products industry for correlating effects of the working environment on health This study will require the establishment of base line data and following this on a prospective plan until an adequate exposure time has been covered In outtl he pli an ofn stude y outld ined in the protocol it is plantonesetad b- lish pnewpdeypen. thet will facilitate the collection of base line data from which ca besn ts can be constar nci u prc ospt ecte ivd a ista to adde thed se cohertihans a: Shentifying bests This entails deifsing the industrial population to be otadiad,: ebtebiag Shentifying and other characterising information on the cohorts and establishing the nature and extent of pertinent plant exposure for each in- dividual throughout als employment in the industry Mortality rate and causes of death will be determined for the cohorts and this data correlated with onvironmental exposure and other information on the coberts Special medical studies as outlined in the protocol will be designed to obtain seeded supplemental data These will be set up as separate studies necesary following plant procedures epidmolgic implementing plan study eee A. Environmental Environmental data characterizing the nature and extent of plant posures will be obtained in each participating plant as outlined in the protocal This data will be collecbty etdhe Public Health Service with assistance when available from state and local occupational healta agencies B. Employes The entire plant employment of each participating plant will be included in the cohorts The following information will be obtained for the Public Health Services on each individual I may be collected on a established basis by trained and competeat personnel of the medical department of the plant or by state or local occupational health agencies or by the Public health Service 1. Lientification data on each employee 2. Occupational history on each employec 3. Job descriptions and classifications on eac~ employee 4. Smoking history on each employee Forma for securing the above information will be provided by the Public Health Service I. Prospective follow on cohorts The base line plant data will be constructed into cohorts to which pro- spective data will be added until twenty to thirty years of retrospective and prospective data on employment experience has been obtained on a signifi- cant number in each cohort Mortality rates and causes of death will be determined for the cohorts and correlated with environmental exposure data and other information on the cohorts supplemental data to the cohoris In establishing and acting A. The Public health Service will maintain a roster of all employees in the cohorts as well an environmental exposure and personal data characterizing each person in the cohort 3 es ae ty . i exposure cinta obtained by management in established a3 monetering programs will be provided to the Service glalalimiball 2 these as necessary with separate environmental studies to assure adequate data on which to characterise exposures of indi, coh ino ther cot hors ts C. Plant management will provide current information throughout the prospective study in changes on any person in the cohorts including III Medical data on emploinyce ohe ors ts Medical studios as covered in the protocol will be done on representative cab ine thercat bers ts Where feasible these studies will be done by plant medical departments and the data given to the Public Houlth Service... "+4. close surveillance maintained to assure uniformity of data These ail mmeenntt tthhaatt ooff tthhee eesstatblaisbheldiccsoohhhooerrttdss AArr rarngaen megntesmffoeorrnttht heess see will | ange bo A. Pulmonary function tests as covered in the protect B. 14 x 17 chest rays C. Medical Misterios D.D. Physical examin date me ervered in pretocal Morbidity records yr. Sgutan tion as covered in press ip will pay for instrumentation films and their development and will instrunem edee d fn or t pula mont aryifuo motn ion | TohfeFaebobverpu8oae1r9t6y 91 will necessitate the following sages the protossi a under Release of Medioni Information page 9 states Mindical data will be released to the physician departments provide the Service with medical data on employees In these instances the Public Health Service Physiwic ll i notabenes x- amining employees and there will be no Public Health Service physiemployee relationship relative to obtaining and possessing medical data on employees Where the plant medical department provides the Service with 14 x 17 chest rays on employees the chest rays provided the Publ Health Service will be duplicates obtained by the plant mediamk dire oe 5s of these individual films by the Public Health Service panel he Sie + 8 : ro The first sentence under Reports page 18 of the protecul states No reports will be issued by the Public Health Service on the study until sufficient information has been collected to permit drawing valid canolusions Since the study will need to cover a period twenty to thirty years of exposure experience progress reports will need to be ismed whenever timely and justified Pkg & Fric Natls Marshville N. C. 1 April 1964 Div Dr. Kenneth Smith - GHQ Today I talked to Dr. W. L. Wilson Chief Occupational Health Section of the North Carolina State Board of Health in regards to the engineering and medical study planned by the Public Health Service This is the matter that you and ir Sheckler discussed with Dr. Wilson during your visit with him last December and were in accord in participating in this survey This survey is tentatively scheduled for the Marshville Plant for the period of May 15 and will be purely an environmental study covering extended dust counts humidity and air flow and the usual annual visit of the mobile ray unit Dr. Wilson pointed out that on this visit the Public Health Survey Unit would not become involved with individual histories of our employees but that this would probably be incorporated in their visit next year RL edt CC E. H. Wells J. L. Stake C. Sheckler DEPARTMENT OF HEALTH EDUCATION AND WELFARE PUBLIC HEALTH SERVICE rational suith Research & Training Facility Bareas of State Services 1914 Broadway Pacinaaty 2. Ohio June 25 1963 Lf Ay , oe / Mr. C. W. Hite Vice President Industrial Relations Manville Products Corporation 22 E. 40th Street New York 16 New York Dear Mr. Hite am writing in follow of the occupational health study which our Division is undertaking in the asbestos products industry Plans for initiating elements of the study as outlined in the protocol which Dr. Kenneth W. Smith has received are progressing A study of cohort groups employed in the asbestos products industry using social security records is now underway It will be another year however before data from this source can be assembled and analyzed We are ready now to begin the plant study as outlined in the protocol to obtain baseline data for prospective follow Although the environmental and medical phases of the plant study will be conducted independently it is important that we obtain the information available through both these avenues if meaningful correlation of the data is to be made and the objectives of the study are to be achieved We plan to start the environmental work early this fall It would be approximately another year however before the medical phase of the plant study gets underway We believe that information obtained from an environmental and medical study of some of your selected plants as outlined in the protocol would be invaluable in obtaining factual data to achieve our objectives For this reason it is requested that you participate in the environmental and medical plant study We can get together at a subsequent date in discussing specific asbestos products plants which would be suitable for inclusion in the study Other plants in the asbestos products industry also will be requested to participate so that representative and statistically Mr. C. W. Hite === 6/25/63 meaningful study groups can be constructed We cannot at this time give a specific time for scheduling the start of environmental studies in individual plants which may be selected We will however give a minimal notice of two months and longer if possible so that satisfactory arrangements can be made prior to our arrival We would greatly appreciate early consideration of this request for your participation in the study Sincerely yours cc Dr. Kenneth W. Smith Lewis J. Cralley Scientist Director Assistant Chief Research & Technical Services Branch