Document VJRrMVzkZEMzNQ0vLZNvJmeVN

1 OUS niitUK!V_Al AfO-HiVtii I KATKDNAl MUSEUM OF HEALTH AND MEDONE- : JABMFV FORCES INSTITUTE Of PATHOLOGY <c ; SEV3HTH SARAIAC SYMPOSIUM | TBS SAKAIAC LABORATORY Of tfao I Edward L* Trudaau Foundation Saranac Lake* law York j! Saaaioa* Vadnaadayt Saptaobar 2tt 1952 K&LTO1M, oiio niiiUK:v_Ai. ^'-ruco tOvIONAl MUSEUM Of HEALTH AND MEDK3NE- Of PATHOLOGY <c 9100 A. Mj - 100 f. M. 22k* . ij PKEUKOCONIOSIS AND PULMONARY CANDER Chairman! C P. Rhoads, M. D* i; |j Philosophy or Bios tatls tics as Applied to ji Environmental Pulmonary Cancer ij i! Morton L* Levin, M. D* | Discussion I j General Review V. C. Hueper, M. D* Discussion Asbestos Minora Paul Cartier, M* D* Discussion Asbestos Weavers Kenneth H* Lynch, M* D* Discussion, led by E* R A* Merewether, M* D* BY DOCTOR VORWALDl Ladies and gentlemen, it's past time to begin* i We're behind schedule by twenty minutes* We hope that we will proceed in making up this time during the course of the day* Z will admit it's a very tight schedule, but with the leadership of our chairman, Z sat sure that we will ac- j compliah our objective for today* Befora we begin formally, there are just, again, ; a few announcements which I must make* Z call your attention to the banquet tickets for tomorrow and also the: ::_39< ' Sw(OiSlMUSEUM<Of'hEALTH AND MEDIpN^ 1 ikKTITI ITF OF PATHOLOGY ! BY DOCTOR RHOADS: I j Vill the meeting please come to order? You will remember that we were forced by the delay starting this morning, to put over Doctor Merewether>s paper to the first - one on the program this afternoon. It is, therefore, my honor to introduce E. R. A. Merewether, Senior Medical In spector of Factories, Administrator of Labor and Allied Service, London, England. Doctor Merewether. BY DOCTOR MEREWETHER: Doctor Rhoads, Ladies and Gentlemen: I am great ly honored to be invited to attend this erudite meeting which has now, by virtue of the diverse and inspired work of my old friend, the late Doctor LeRoy Gardner,and Doctor Vorwald, become an international event. Now, only a foolhardy criminal would speak after the most stimulating papers of this morning, but I>11 en deavor to do my best, and I shall not detain you long. All I have been able to do in the short time available is to bring up to date our mortality and patho logical data on this matter and lay them before you in the confident hope that if there is an explanation of them, and there are deductions to be drawn from them, I shall obtain them during this conference. Frankly, I>m puzzled and disturbed at the possi bility which may emerge, not only in connection with the | OTIS HISTORICAL ARCHIVES | KATIONAL MUSEUM OF HEALTH AND MEDICINE' ARMED FORCES INSTlMtOf PATHOLOGY ^ | ------------------------------------------------------------39&t- | question of ar. etiological relationship between cancer of the lung and asbestos, but also between canoer of the lung | and other local Illness* In 1948# I made a note of the deaths from aabes- tosls, asbestoals with tuberculosis and either of these with also cancer of the lung, recorded In the United King dom from 1924 to 1947* I placed alongside then for eonparison, the corresponding data we have frost silicosis and canoer of the lung* these were factual data ifoioh speak for tbemselYes insofar as they go, but I attempted to make deductions since I felt the asbestoals deaths were too few for the purpose* I have now brought these figures up to date* the corresponding figures for silicosis deaths auount to several thousands* They were, I think, sufficient ly large to show that there is no etiological relationship between silicosis and cancer of the lung cad in this X*n fortified by the data produced by the South African experts I will not weary you, therefore, with the additions in the last three end a quarter yeare to our slllooels figures* Briefly, therefore, our latest figures are record deaths from asbestoals, asbestesls with tuberculosis, or either complicated with cancer of the lung, with cancer, are 306* X an excluding ten of these where there le also cancer of el tee other than the lunge* Our net figures are. | OTIS HISTORICAL ARCHIVES , t<JATIONAl MUSEUM OF HEALTH AND MEDIQN. .** 1 48MED FORCES INSTITUTE Of PATHOLOGY <c ; 399. : therefore, 296 deaths and of these forty-oi^it or 16.2 percent wore associated with cancer of the lung. This shows an Increase from a 13*2 percent disclosed by our i earlier figures. This means that* as mere deaths from asbestosis corns to hand* the cumulative percentage of j i| !i deaths with complicating cancer of the lung is rising rather Ii than falling. j Sow, where do we go to from here? Are these fig- j ures sufficient to indicate a causal relationship between the retention of asbestos dust in the lungs end subsequent canoer of the lungT the small numbers certainly dictate oantion. leverthaless* they represent the great majority of the deaths from aabeateals which have occurred in the United Kingdom during the past quarter of a century. Nowadays* because of the greatly increased aware ness of workers* dectore and others in the neighborhood of asbestos plants* of the disease* beeause of the duty of Coroners to investigate with autopsy end to ropert to ay de< parteent* deaths suspected to bo duo to occupational dis ease* whatever it may be* the compensation benefits accru ing to oases of pneiaoeonlosls* tho system of factory In spection* our periodical check-up of the death certificates provided by the Registrar General* and for other reasons* it is likely that very few deaths from asbestosis escape notice. ---------------- I OTIS HISTORICAL ARCHIVES | I tdATIONAl MUSEUM OF HEALTH AND MEDICINE; I ARMED FORCES JNSTITUTE OF PATHOLOGY * j 1*03^ Therefore, with confidence, I think we can say that the figures point to the neoeselty for the collection of similar data from other coranunities with an asbestosia hazard, so that by no ana of statiatieal examination of the global figures ao obtained, we oaa settle the question of | whether cancer of the lung ia an additional risk of aabea^ j tos exposures, j Now, I should mention here that the figures in United Kingdom, that these figures include all of them, because they cans to ms, ao that we must not add up excess j i !| j figures end - the X figures and 7 figures and Z figures, and think that they*re all additional eases of asbestosia, with carcinoma of the lung* One can add up, of oourec, different countries, but one must be very oareful adding I up or duplicating the same eases in the same countries* Chare Is another point that waa brought up this morning, that the population risk of aabestoa la small relatively to other industries and It fluatuatea* A war brings a great increase of peoplo, because obviously, there Is a great demand for high class asbestos insulation for use in war ships and other types of work, and them it drops off again, ao that one could never really get a population, for instance, to uhioh one could relate a particular case of aebestoais, assuming that aabestoa ia a factor in this matter* | OTIS HISTORICAL ARCHIVES ( i NATIONAL MUSEUM OF HEALTH AND MEDICINE, ( ARMED-FORCES INSTUiflE.Of PATHOLOGY * j j I !i i i|jQU Now, another thing la tha reverse which I think has got to be brought In mind. Into mind, that whan an# la ij considering a haaard in an Industry and one wants, as tha i| statisticians always do want, something Ilka a world popu- j | latlon before they giro us anything very satisfactory about ; | the matter, that you - you say that, for all purposes, tha j population of an Industry is say two hundred thousand, your j ary risk may be lost In tha mass of tha population. | | | That occurs, for Instance, in coal carbon trade, where I triad a number of years ago, a relatively small portion of people exposed to tar or tarry rapors, and they*r# lost in tha whole population of the trade, but when you limit them to the.people who are exposed to tar and tarry vapors, you find there is six times tha risk of cutaneous oanoer* In other words, tha riak waa lost in tha overall numbers aaaumed to be at riak* And, it is some thing Ilka that in tha asbestos trade. A lot of people don't have much exposure to asbes tos at all* Now, as fer as the rate in asbestos, I haven't got into that yet, but following a remark made this morning, I will try and do so. Then Doctor Lynch did sey, what is tha degree of asbostosis. Now, all these people have been autopsied and all of them died primarily of asbestosis, whether they had tubercle or cancer later. I. I OTIS HISTORICAL ARCHIVES i NATIONAL MUSEUM OF HEALTH AND MEDK3NE- 1 ARMED FORCES INSTITUTE Of PATHOLOGY 75 ! 4-------------------------------------------------------------------------------------------------------------------- How* I won't weary you with the atatlatloal ap proaches* Besides that* I'a vary frightened of statistic al lane* They're going to die if Z find an error in this* ji Not quite as bad as a psychiatrist, of course* I 'a looking ; j for the day when we have a statistical psychiatrist* Well, i | Just another page of this, air, then we'll be ready to throw as out* i | | Of the 296 deaths we are considering, 172 occurred in aales and 126 in feaales* Slghty-two or 27*7 percent, half aales and half females, were associated with pulmonary | tuberculosis* The asan age of death was 4&2 years, with a range of 24. to 73 years for the eases of asbestoals* 39*3 j with a range ef 17 to 66 years, for the eases of asbestosisj for r with tuberoulosls and 534 years with the rang* of 1 1 32 to 77 for the eases ef asbestoais and caneer of the lung^ I The asan duration ef exposure was 15*7 years with! a range ef one to forty-eight for deaths from asbestoais* | Sen# took a Hall of a long tiae to dio -- 11*1 with a rang# | i of 133 - no, X put the wrong one, Ia sorry, 11*1 years, witl ja range of 33 years with asbestosia with tubsrculosia and 19 years with a range of 2 to 49, 2 to 42 years for ashestoaia with cancer of the lunge The mean duration of lift between ceaaation of j i i j exposure and death was 6*5 years with a range of 1 to 32 j for aabestosls, 417 yooro - that Should bo 4*7 yaara with ! I OTIS HISTORICAL ARCHIVES j , NATIONAL MUSEUM OF HEALTH AND MEDICINE- ' 1 ARMED FORCES-INSTITUTE. OF PATHOLOGY [ -- - j | ---------------------- :------------------------------------------------------------------------- --------------------- i; jj rang* of 1 to 21 for asbestoaia with tuberculosis, and 5*8 l' : years with a range of 1 to 26 for aabestoala and eaneer of the lung* You see the ranges ere very vide Indeed, which la of sons Interest* They say with tubercle, you can get tubercle any tine* It can cone on them at any tine and kill} then at any tine* Vow, there are Indlcationa, fron our data, that our preventive regulation whioh cans Into full operations In 1932, twenty years ago, are having an effeot and this nay be the explanation of why the Incidence of complicating cancer of the lung appears to be rising* i j ; J i Today, we do not encounter cases of extreme mass ive fibrosis and gross bvenohleetaals sad oven a sareossa 'nutmeg1 liver with death, and complicated with tuberoulosln or oaneer of the lung at n early age, within five to seven years fron the eomenoenant of exposure* these cases don*t seen to ooeur* the duration of exposure which results la death freai aabestoala is lengthened, the age of death is in creasing and the degree of fibrosis found at autopsy is loss* This means that eases ef aabestoala are United to the eaneer occurring age period, and If - and I say if there la a relationship betwean asbestosis and eanear of tho lung and if Irritation, let us surmise fron the esbeaton fiber la a co-carcinogen with a long exposure period, then II I OTIS HISTORICAL ARCHIVES I tOATiONAL MUSEUM OF HEALTH AND MEDIQNE- I & \ ARMED FORCES INSTITUTE OF PATHOLOGY Tc i I: we would expect an increased incidence of cancer of the :i ! lung over that found in the general population to become jj afterwards* | Regarding these cancer oases, the mean age of death, I said was Tears, so I put this in for - since I found I*d be kicked off if Z didn't* low, the occupations j involved are somewhat interesting* They're always differ* ent, as you know, beoause sometimes two occupations carried out in.the same roam with different dust exposures or with j other different factors, but it is a little interesting to j see that the majority of these fortyeight cases, that the j more dusty the process, of course, it's most fallacious, but still we watch with care, for instance, weaving* Weav- lag is notoriously dusty, one case there with ten of these cancer lung cases, one case also associated with tending and spinning that the man had dene, andone case mixing and sorting, disintegrating and mixing, either - well, eight pipe and boiler eoverers, including mixing! seven, and mattress making, six and all the rest are below that, sad all those are dusty jobs. Hell, what then is the etiological factor, if any heref And, I'd be most grateful for your views* I know that physical irritation as a direct carcinogenic agent has been rather debunked by the oaneer experts, but Z remember that seme recent work by a United States expert, I | II I OTIS HISTORICAL ARCHIVES l MOTIONAL MUSEUM OF HEALTH AND MEDICINE. , ,-!*M ARMED iQRCES JNSTITUIE_ Of PATHOLOGY * I I 'i 405. : | !j Doctor Oppenheimer, has - who has done some experimental i! work with cellophane wrapped around hinges, which may be a j pointer to this factor if it is material. Thank you. 3Y DOCTOR RHOADS: Thank you. Doctor Merewether. Is there a comment about the Merewether discussion? (No response). Doctor Lanza, I think you can make some comment on this BY DOCTOR LANZA; I Mr. Chairman, Ladies and Gentlemen, before going I into this brief statement of mine on chromates, I would like! to make a few comments on Doctor Merewether*s observations. ! I was very much impressed with what Doctor Merewether said, and there is no question but what a very careful, painstaking job has been done in Great Britain on | j | the subject of trying to determine what the hazard might be ! i in the asbestos industry with respect to cancer. | There are just a couple of comments, I*m not say- i ing one way or the other, that it may or may not influence the incidence of cancer. I would raise a couple of points which I think all of us might keep in mind, and which might possibly have some bearing on the situation in England. Now, I have visited, somewhat extensively, I think,, nearly all the asbestos plants of the United States, and the mines and the mills in Canada and have spent quite a lot of AFFIDAVIT WASHINGTON DISTRICT OF COLUMBIA ) ) ss. ) BEFORE ME, the undersigned Notary Public, personally came and appeared MICHAEL RHODE, a person of the full age of majority, being of sound mind and body, who, after being first duly sworn by me, did depose and say: I, MICHAEL RHODE, am an employee of the Armed Forces Institute of Pathology, Washington, D.C. I am custodian of the original archives of Dr. Arthur J. Vorwald. Pages 1 through S/ attached hereto are true, correct and authentic copies of documents from Dr. Arthur Vorwald's archives. The pages attached are -7^^ Dr. Vorwald was the Director of the Saranac Laboratory of the Trudeau Institute. Upon his death, Dr. Vorwald's archives were donated to the Armed Forces Institute of Pathology by his widow. RHOD.AFF - Page 1 of 2 Dr. Vorwald's archives are in such condition as to raise no suspicion concerning their authenticity; they were received by the Armed Forces Institute of Pathology from Dr. Vorwald's widow after Dr. Vorwald's death? they are presently on file as authorized by law in the National Museum of Health & Medicine, Armed Forces Institute of Pathology, Building 54, Walter Reed Army Medical Center, Washington, D.C. 20306-6000; and the archives have been in existence for 20 (twenty) or more years. // / MICHAEL RHODE,^ AFFIANT SWORN TO AND SUBSCRIBED before me, the undersigned Notary Public, on this the day of 1991. My Commission Expires: -w, on, LEGAL COUNSEL RHOD.AFF - Page 2 of 2 '</ `tU iU' CA~~*r * *:VT?^. vhXTUT^^Vt SARA1TAC LAT:ORATORY of the rd L. Trudeau Foundation nac Laho, ow York 1 Session, 'Wednesday, Septanber 2u, 1952  V -------------------- --- --9:00 ji. - i:oo..?. ?i'j~'Ji:2coi:zzzii: a::d ?ul;:c::adi' caudir Chairman:- C. I*, hhoads, K. D. * -- Philosophy or Diostatictics as Applied to Dnvironncntal ruLnenury Cancer Horton I. Levin, D* Discussion C-cr.oral TToviow V.'. C* liueper, II. D. Discussion Asb.octo3 Iliners ' ; 'Paul Cartier,* H. D." Discussion Asbestos Weavers Dcnneth M. Lynch, II. D. Discussion, led by II. A. A. Jlcrcwoth: * # * A* ITi DOC?Dr. VORVALD: * Ladies and entlor.on, tine to be pin. i.'o 'rc behind schodv.lo by tv:snty r.'.lnutoc* Vic ho?o that wc will proceed in ;:*alci:i up this tir.o during the courso of tho day. I \;ill ednit itrs a very tipht schedule, but with the 1 cadcrsliip of our chairman, I are sure that ue will ac complish our objoctive for today* Eeforo we bepin formally, there are -just, Spain, a few announcements `which I must r.slro. I cell your atten tion to tho banquet tickets for. tomorrow..and..also, .the________ .......... 331.- .. rr doctor ~toads: The next taper on_the Fyrjcriun concerns the paper already discussed hy Doctor I{usesr. If va could have littlo cuiet, it would be very helpful for thoco vho cr9 presorting papers. Doctor hue?or he.s eehod to cors-.ent on Doctor Drinhor'c renorbs. I thir.h ve . .u--w us.sr w.. until \;c can ct the papers ur.dor v:ay. I fill, therefore, introduce tho pepbr on asbestos r.ininw by Doctor Cartier. Doctor Cartier. . * V*# * .I. , henberr cf this Tyr.poslur.: hot belnc a statis tician, neither an epider.i.-lo^ist, I don't third: I should, have accepted tc prer.or.t this paper, but I third:, to excuse uycclf, 7. should say that this statistics end ;-.ost of tho papers I an vrceentiny havo been reviewed by your statis tician in Centred arc Doctor Phillips, official-3tatisticiar for National Cancer Institute of Canada in Toronto, so I would liho that tho so two experts tahe tho responsibility of tha atator.er.ts I sifht advance. So I was invitod to present this paper on tho puinoncry cancer in the asbestos rhuirr industry, not on* account of cr.y special codification, only because I happen to be ir charge of a clinic which has, as a prinary func tion, to superviso t::c ?ri::sry condition of four thousand asbestos'minors, such a ^roup of entrants offering on V ........ I worthwhile to cay that the labor turn-over in tho ashes to3 industry is one of the lowest in all the indue try in Cana da, neaninj that "the`stable population is working in our r.ir.o end r.esnin^, also, that in nan7 aspects, it is oasior to ctudy~and nbra'roprc causative. `"Site first slide pleaso. So as 1 uontionod, this Table Ihrtber 1 shove the aj-o rroup distribution of the -- quoup study and I don't think it needs any c omenta-except . to say that the average a,-:a of our enployaee is thirtyfive, about- two years .older than. the. average- for the re nor- . al industrial papulation, and tills t&blo Kill shot? also that 1,577 :aon are included ir. the c.e :roup fron forty to - and over, in the [-roup where .the incidence of cancer is . r.or6 6moral. Second -- n9i;t table, please. This table indi cates the number of years spent in the asbestos "iininr in dustry by the total nunc or of employees surveyed. Of course tills table.is not as significant as would bo a taulo indi cating the specific exposure of tla so onploycoc, but after . many attonpts it has seemed impossible to - to add. together. tho difforent yours spent in difforent concentration of fibors, to which nor t of tho e.uployooo have been exposed, and I think as a remark too, it is worthwhile, to mention that two thousand, two liundrod hnvo aper.t more than ten years in tho asbestos induetrv. 'lent tabic, plcc.se. The following table chows e ciossifIcation of various *e.nposurea in-the asbestos siinins industry. F. cal iso that this classification could be dis cussed for .very hours, ar.d present ueny ruarrols, but. I think: ntrvcsrtkelecs *that-.v<r need, for nany purposes, vs no9d a' job classification, .even for tho exposure aspect or fa? research, so after wo were stationed with our enrinoer, --- - ve took the avoraye of all tho dust survey naae i:i tho :iin- _> In- industry and we decided Just to draw this table, and this tablo has also,. I .con ' t Itnow if it .Is .objective..ad- ' vantage, but has the advcr.tare of correlating with our case of csboctosis. I want to state that ell the cases of acbestosis havo belonged - have worked in shops, under that rule, Ira sorry, in tho louor ^roup,. and our non luvir. r; worked uvea fron two to forty-five years in that kind of exposure, iiaa never aovelopod an csbestosis which was foun d by pataolorists or epidcnlqlojrists or b7 ouperir.ents, to be of any socuonce. any nodical cequenco. Thic tablo, as you nay seo, prosonto r.illion par ticles por cubic foot and tho pore on fiber count. Thi3 is very important, because fron arperlor.co to exper ience, lt.socn.s that tho fiber is tho only pathological a-s.nt, rock duct .not bcinr - not boln.3 reproduced in any concor.su3, puLv.oncry fibrosis. I third:, only thic r.icht ( . 33$.- r.eod sono further explanation, bocr.ure you seo that is not 1 clacr. Tver. this night atsea & little loss cor.contrated, but just the anr.a wo put in this whole group* because an tho ground, dry work and the grizzly men are working longer, thoy ire working in nor2 constant concentration of fibers, and in' tho third place, boenuse we have found a few exceptional cases of asiostools in that group. So, please rener-.ber the categories, 0, 1, 2, 3 4 cn- 5 because rin the--" coning tables, they night help you to understand then* ..'.'Tho following -tailss. intend' to indieato indicehco ' cr prevalence of pulmonary cancer in cliffcron t groups of asbestos 'workers ir. cor.parison to different control groups. Tho task of selecting significant control _roup has boon, in this case, no ovaryiihera, very difficult. ..`0 would hare wished to be able to find a group in the province of fU3tec, a group in any other cooperative - comparable indus trial group, but it wao Lupoc sible for the following reason. '-at in no.other industrial citioo in Province C.uobec, so large a proportion of the adult population is followed nodically so CI020I7, because I think I should non'tion to you that about thirty-three - about thirty percent of tho adult population in Thotford are working in the nines, bo In g the only inerr. try, so wo can't have a vary closo supervisoon cf ths function of tlie - of tlr condition of tho lungs. '..'o triad, with tho r.ass survey, to do tost a con- parsbio survey croup, bvit I ccr.'t third: It was or is poci cible, because In the frdvince of Cuoboc, vary few adults over fifty years of n^o ere tohinc advsntae of tho mss survey. As & matter of fact, the mss survey made in yhotford ninos in .1950 by tho Provincial Department of health, did not detect a single coco of pulmonary cancor, oithcr in tlio ccnsric oporatioa or In fourteen miners who have boeiT ".-rayod, so 2iavin not succoedod in solectiny a .yood con trol croup for tie rocs or. just mentioned, v;e hr.vo decided - to mako comparative studyof.incidence- of tie pulmonary.. ccr.ccr in different groups of asbestos workers, which can bo studied with the car,: methods end which, at the same time, would present sufficient chcractorictics to be mu nificent. C.^ r , pxoase, ibis indicates tho prevalence of pulr.0r.ar7 cancer according to do^rao of length, to decree and length of exposure and by ace. This toblo shovo the prevalence of pulmonary cancer in tho (3roup with sovare exp crura, that's this (yroup, and this is more or less a control y.roup. This, wo havo six cases of pulmonary - of primary pulmonary cancor and four cases, in fact, in tho croup ex posed and this, of c our so, the r.umbor beinc smaller, it Cave us a higher incidence, tut if we also t&ko that, wo havo to admit 'that this difftrar.ee ir. incldenco ic not, has- . -3C7.- no statistical value, toccurs It is not more or equal to twice tlio secondary condition. iext, please, T1J.S table was rado at the sug gestion of Doctor Pratt, who was Interested to know the conpsrativa incidence in group or employee, of employeoc who have boon oxposod to a uiijnlii car.t decree of exposure, ~ Category 3i 4 and S ivon as lees - as one year, and as a control group, tf take the group 01" employees with;any kina of exposure, but of the Categories 1, - 0, 1 and 2, : Doctoiv vratt had'.in .mind,.. In >uy.ccstin that table, that the factor exposure to severe concentration of asbestos Tor any length of tins night bo as significant as i the factor asbostosis itself, moaning that If there is a possible causal relationship, the inhalation of sufficient dosage oi asbestos fibers night be as important as the fac tor asbostosis itsolf and at the scr.e tins, I thirds we hive the two extremes# In the previous slide, wo have ncr. with severe exposure, tho incidonco of cancer, pulmonary cancer in nan with eevero exposure, and in this - In this tchle, vc hova non in tbo group 2 with very light or vory little exposure but with sufficient dosage cf - of dust. I'-unt taolu, ploasu. ' This table indie a do s the prevalence of pulmonary cur.ccr ir. a series of fifty-throe autopsiod asbestos workers. 7;.is analysis, aitr.oagh not as t * # epidemiologist at the saris tins sold no that less than tan percent sro post-mortem citsoc, so this r.Lrht bo not com parable to a larjo extent, but I thinl i there was any r.ijr.iriciir.ee, we should expect to have a birr;cr variation in t;io percentages. , *ta ble, please. Instead oi* ccr.porlrj the annual prevalence on incldenco cl pulmonary cancer in tla population ci Thetrord hires with the incidence in other ,-ucontrol -reuse, lector Phillips iron the '.rational Cane or Institute oi*. Canada has sujjrcotod to vorh- tlJ.a number, . tipis tablo, which ic based or. alio iact that doctor Doming has found in a randen population or ipe, 533 annual inciaence or seven casco ror each hundred thousand or population, rivsii a pear c;rpcctarcy or seventy. On that csic, Thetrord "ir.es, uhich is uvoraje population or 15,000 for tho lact tan years, should :ave ten cases between - tveuty-rivo cases or pulmonary cancer, and the actual prcvalonco for ten years, this ten years, the actual prcvalonco is nino cases* la licrtrcal, with tho ton yours or.zcctahey or sin sin ninety or ain ninety-throe cases, it Las, as you sec. oirht Luudrod riity-cin and I thirl it is ver aide mention that in r.sntrocl, the rato cinco 'U5,` 'k5 the rate per hundred thousand or population w as only .5* 5-9, and in 1950, it has rosebud 11.9. _____ important us that of Doctor hcrcvotier of Great Intel:;, Is based os quite a ci;:iisr basis and I would third: that . ~--T , this croup is loss selective, because that is no section at all. 1`hst1 s all'the cases wo meant to autopsy af tor - from fir teen years ar.d over in the industry. At-fin here, tho differenco is rot as fcir as it Ieohs, beca.se after - urin - usinc the standard there, we cane to c difference-- cf about only .5 tetwoen tha two groups, ther-roup with csoestesis and roup with - without asbestesis* I can not answer why .there is less caaos.of can cer in the ashestotic croup, but I thlnh that if we could hare autopsy on every employee who happens to die, we -i*ht ct either a different picture of nay bo an indirect explan ation. 1`ent table, please. This table was r.cdo for the purpose of Isiowinc if the ratio bctv.'oen she number of can cer deaths -outs;do and the pulmonary cancor deaths was somewhat different from the ratio observed in a few other control croups. First, I thirds it should be mentioned that ninety percent of the cases for the City of I'ontroal ar.d a hundred porcent of tho cases for tho City of That- ford )! ir.es, aro autopsied, * aro post r.ortcn cases, so that is why I say it la difficult to compare, X don't ler.ow in which proportion for tho Frovir.ce cr City of '`..usboch, but for the Province of Cuoboc, the c tat is tic i mm and the  396. Clo responso) Dow, if those of_you v:ko arc in the beck, could you cone forwerd so the t v:c cm re ally -ot t picture* There zero e lot of seato up forward tr.d it will only take a Tow ' ^ S _ .. I nisht cey that the % o to ^ropier will prir.t- these pictures end pou ncy buy ore fran hin if you 00 wish; on the bulletin board outside will be paper: where .you roiC-ht indicate vhethor you went ono cr a do eon# ./ (Photon-aph was taken, after va.ick tho. .no3 tins *. was adjourned* Dossion reconvened at 2:37 f. I'.*). ?::hu:;xj;:iooiD ai:d Ciiro.wate l/orkors caixdr (Continued) 2:33 to > 500 Antu^ny J* Danse, ^* Discussion ~ Ihcpcriricntel rulnsnery Caheer - Densral Review .. U 9 ** 3 *^*3 ***^ j # / # Discussion . Pulnsnery Cencor in Zxporinontal Drposures to, Chror.eta Anna faotjcr, Sc.D* Discussion rursesnary Cencor in Drperir.sntal Daposuros to Derylliusi Arthur J. Vorveld, K. D. Discussion. v h_____ I_________________________ ------- 398.- question or or. etiological rclationsJiip bo t\:eon cancer or tie lun& and asbestos, but also between cancer or tho lung and othor local illnocs* " In 19i;3, I nada & no to or the deaths fron asbostools, asbootools with tuberculosis and either or tbsse with also cancer or tho lunc, rocordod in tha United 71hue " don fron 19'llj. to 194.7 I plccod alongside then ror cora-_ par is on, the correcoondinr data ve have from.silicosis end ^ -- . ^ V' cancer or tho lun. These were factual data which epe ok for themselves.insofar us they 0, but I attempted to na2:e deductions since I felt the as be stools deaths were too few for the purpose * I ;u.vo now brought theca fi.ju.res up to date . The corvesponcinj figures for silicosis deaths ensunt to several thousands. The7 vsro, I think, sufficient ly larje to show that tiioro is no etiological role t ions hip ` between silicosis and cancer of the lunc and in this In fortifiod by tho data produced by tho South African oxperts. I will not v;eary you, therefore, with tho additions in tho last three and a quarter yoars to our silicosis fiures# Lri6fly, therefore, our latoat fijjrea are recorded deaths XV on asbectosis, asuectocis with tuberculosis, or either complicated with career of the lunc, with cancer, are 306. I an onciudinc ten of those where there is also cancor of si tec other than the lunre. Our net fijaras ere, . TOO therefore, 25-6 deaths and or il;uio forty-ciat or i6.2 percont vero associated vita cur.cor of tho lur.r. Tala x-- shout an increase from a 13*2 percent disclosed by our 1 -arliur figures. This noons that, as hore doatlic free asbostosis coma to liana, the cutTolutivo percentage of . deaths uith t: crr.pl i eating cantor of the lur.r Is rising rather taon falling* lieu, vhsro do wo "t to fr or, here? . Are the so fix tures sufficient to indicate s. causal relationship sa tween Lho retention of asbestos dust in tLe Iun,-s and sub socucr.t cancer of the lung? The snail numberscertainly dictate caution, never thole as, they represent the rroat majority cf the deatas from asbectosis which have occurred in the ***? f*A J */ * ' ^ ^ W. -- ('nr,| 'A,* ***.,* X*/w 9 ^ > * !> h ^ W ^* w* W w U U. Mta ^ hcviadayc, because of the greatly incrctcod avuro- r.oas of ..'criers, doctors and others in tho r.e ihborhcod cf asbestos plants, of the uisatre, because of the duty of Coroners to Investigate with autopsy and to report to icy de partment, doaths suspected to be due to occupational dis ease, whatever it ney bo, the compensation tonofits accru ing to casos of pnsunocor.icclE, the systan of factory in spection, our periodical chacU-up of the death certificates provided by tho r.0lstrar Corornl, and for other reasons, it is llholy that very few deaths from asbestesis eocapo notico. \ i. rs 3*. fheroforc, with confidence, I think v:c car cay that tlio figures point to the r.ocoocity Tor the collection i-- or cir.ilor data iron othor communities with an acbestosis haaard, so that by moans of statistical or.nnina.tion of the global figures co obtsinod, vo can settle the question of whether con cor of tho lunr ic an additional risk of aSbCS- tOS OXSOSUTOS. ITow, I should rentier, here th.it the f lyuras in because they cone to :-.c, to'that we rrust not.odd up cxcoos flyuras and - t:ie X fiyuroc and . figures and 2 figures, end third: that they're oil additional coses of ssbestosis, with carcinoma of the iun{> One can add up, .of .course, different countrios, but ono oust bo vary careful adding up or duplicatin' tho sane cases in the sons countries* There i3 another point that was brought up this r-.srr.inr, that the population risk of asbestos is snail relatively to other industrios and it fluctuates. A war brin^t a croat increase of people, because obviously, there ic a crest demand for hifh clasc asbestos insulation fdr use in war ships and othur type3 of work, and. then it drops off Cain, co that cr.o could r.sver really yot a population, for instance, zo which ono could rolsto a particular case cC acbcstosis, cc euni.my that asboctoc is a factor in this matter* c .. 2-.01-- L'ou, another thinr is the reverse which I think has 01 to oe brought in nine, into nind, that when one la considering a hasord in oil`industry and ono wants, as the staticticians always uo wont, soisothinr like a world popu lation before they ive us anythin; very satis factory about tko -.outter, that you - you say that, f or all purposes, the population of on industry is say two hundred thousand, your very risk nay bo lost ir. the rotes of the population. *4*' That occurs, for instance, in coal carbon trade," vhcro I tried a nurdrer of years ay3, a relatively, snail 'portion'of pooplo crporea to tar `or tarry vapors, and they're lost in tho whole population of tho trade, but when you Unit then to the peoplo who aro exposed to tar end tarry vapors, you find there is six tines the risk of cutanoous cancer. In other words, tho risk was loot in tho overall nun'sars ossurtod to be at risk. - And, it is s035 thinz liko that in tho asbestos trccio. A lot of people don't have nuch oxposuro to asbes tos at all. liew, as for as tho rate in asbostoe, I ksvon't rot into that yot, but following a re nark redo this nomine I will try and do co. Thon Doctor Lynch did 507, what is the dopros of osbostooia. -low, all`those pooplo havo been autopsiod and all of thon died pr ir.tr ily of asses tools, whether they had tubercle or cancer la tor. t/ ____ 1^2.-- I How, I \.*o:i11 voary you with tho st-ati sticai Qp- preaches. Besides that, I'.u very frirhtenod of ions. They're oinc to die if I find an error <- t^-- ~4i --* * Hot evito as bad as a psychiatrist, cf course, I'n loolzinc 1 for the day when we have a statistical pcychiatS' is t V 811 , just another pare of this, si:*, then we'll be r"cady to throw I r.3 out. Of the 296 deaths we are cor.sidcrir.r,. 172 occurred ?.in rales and 126 in fend os . Eighty-two or 2 7 percent, ~^;V ! half sides and hdf fend os , t*ere associated with pulnonury tuberculosis. The no an a ,~e of dea'th uas `I4.5.2' yosra , wi th -' a rar.ee of 22j. to 73 years for the cases of asbostosis. 39.3 vith a ran 53 of 17 to 66 years, for the esses of ashes to s is for or vith tuberculosis and S3*h years with the rnnre of 32 to 77 for the cscos of asbostosis end career of the luny. Tho r.san duration of erposuro was 15*7 years vith a ranye of one to forty-ciQht for deaths fron asbostosis. Sorso `took a Mall of a lonr tiro to die -- 11.1 with a ran^o of 133 - no, I put the v.'rcr.- ono, In sorry, 11.1 years, vith a renye of 33 years vith asbostosis with tuberculosis ar.d 19 years with a ranyo of 2 to i|9, 2 to 1^2 years for asbes tos is with cancer of the luny. Ths r.ean duration of life botveen cessation of erpor.uro and death, was 6.5 years vith a rar.^e of 1 to 32 for asbeotosis, ld7 yoars - that should bo I4..7 years with / _____ 14.03* range or 1 to 21 for asbostools with, tuberculosis, ohd 5*3 years with a rango of 1 to 26 Tor acbestosis and csncor of 4 --r tho lung* You see the ranges ora ver7 wide inde. i, which, is of cone interest. They say with tubercle, you can ret tubercle any tiroo. It can cone on then at any tir.o end, hill / then at any tine, Kow, thore oro indications, fro.u our data, that our preventive regulations Tdtich c-cne into lull operations in 1932, twenty years ego, aro having an effect and this ncy bo the explanation or why tho incidence or cor.plleasing cancer or the luhg ' a? pc dr 3 to'bo-rising* Today, vc do not encounter cases of entrene rece ive fibrosi3 and gross branchiae tasia end even c caroor.a 'nutrr.og' liver with doath, and co .plicated with tuberculosis or cancor of ties lung at an early age, vrithin fivo to seven years frer. the comoncoroont or expo euro. Those cases don't seen to occur Tho duration or cnoocure which results In death iron asbootocis is lengthened, the ago or death is in creasing and the degreo of fibrosis found at autopsy is less* This neana that caooB of asbestosls nro lir.ltod to the cancer occurring ago poriod, ana IT - and I say if there is a relationship botwcon asbestoeis and cancer of tho lung and if irritation, lot us surr.ico fren tho asbost os fiber is a co-cercino-en with a long exposure period, then r( vo would o:cpoct on increased incidence of car.ccr or tiia lung over that round in tho_gonercl population to be cons afterwards# Regarding the so cancer cases, the noon ago of death, I said was 53*^ pears, so I put this in for - cinco I found I'd bo hi chad off if I didn't# How, th3 occupations r.volvod are sonowhat interesting* They1 re always differ*- * ent, as you '.nov, because sora tines two occupations carried with. different dus t e;: nocures or with see f- - rs. but it is a little Interesting to of theso forty-eight cases, that the noro dusty the procoss, of course, its nest fallacious, but still wo watch with core, for instance, weaving. VJoavIj irg ic notoriouslp cue ty, one caso there with ter. cf these ccncor lung caoos, or.o caso also associated with tending V end spinning that tho nan had done, ar.dona case nixing sad * sorting, disintegrating and nixing, either - veil, eight pipe and boiler, coverers, including nixing; seven, end nattrese rooking, six and ell the rest are below that, end all thoso are dustp Jobs# Veil, what then is tho otiologicaJL factor, if any here? And, Id be nost grateful for your views. I know that physical irritation as a dir act corcir.o-onic tgen :;ea boon rather debunked by tho ccr.cor oaperts, but I rcrenber'that sc.no rocor.t work by a 'Jnitcd States oxport, (. lj.Ocrj ' ti.-.o were, end havo epont c lot of tins reviewing flirts, end not lonr. aro, spent sovoral days vritk Doctor Kenr.oth Cnith on asbestos, reeding his films. I find it difficult to believe that our cancer incidence anon- asbestos workers could be coir thin; like es lor^c as it scons to be in England, bo ecus a while I'n par- fee tly froe to adroit that ve nay havo missed cancer cases-- which wo should leave not, on tho ether hand, I' don't .think w we could havs :aissod ail of then if they had occurred, into . the :a:o extent that apparently they do in England. I.?ow, that is simply an observation of nine. Of course, it is true that as soon as t'.Ji business of ' the ham ful offects of asbestos ones took hold in the American in dustry, tho7 did start to clean up tiioir slants and, while I wouldn't cay that ell the asbestos plants in the country were .-.arvols of industrial hygiene porfcction, neverthe less jrroat ctrides have been nadc, and particularly, for instance, in the plant in Doctor Dennsth Lynch's town in Charlotte, Couth Carolina, whoro they have done a very beautiful job, so that vrith tho snail number of people in tho industry;, It's obvious that wo are never have tho clinical orporienco with as bcctools that wo have, fcr instanco, with silicosis, because there is r.ot *oinc to be tho natorial to work on. ow, beck of -that, thore is still one .tore quest! ____ l;07* -- That is the nature of the asbestos itself* How, whon 1 first used to 0 to Canada} I used to hoar froquontly that, up thore, that the Canadian asbostos uas loss demurins than the hind they used in IT-inland, I believe, cr.d I have put that cotnont down to what we ni^ht call the national or local patriotism, you know, 11he tho rivalry between towiis, so that you so frequently see, but the fact remains the sssie, that in this country, ve do use the asbostos, nostly,v the asbestoa that we et from Canada, and I bcliove, frea what I hear from. pur Rn^lish friends, that a r re at. deal,...* if not the major part of the asbestos used in Cnrland, is Rhodesian asbestos, uaich is quite dissimilar in its con struction and in its formation, its physical ci-sracteric- tic:, to the hind that cor^s from Thatford and from asbes tos in Canada. How, that nay have ao'dhic to do with it, and up until, two or three years fiqro, I disrtissod that. I thought that was just purile, but sir.co we have in tho last fow years, learned that different typos of silica, for instance, produce entiroly distinct pathological effect, I cm bc^in' nine to wondor if we iiavo not failod to pay sufficient at tention to the type of asboctoa which varies evon, an I am infomod, there is a difforenco between the acbestos that is ninod in tho town of Asbestos and tho kind that is mined' not far away in Thotford, and yot both of these, in turn, <v. ____ _ I4.03.. oro cult tiii'f crcnt fro;-, tho asbestos that cons from Hho- docis, and possibly from csthcr parts of tho world with which not acquainted* And, having in mind tha losson we've learned in tlie silica dust, I think that is aonethiar oerhaos that we should pay none attention to* How, I simply raise that - point, because I think it nay have a great deal none sig-'~ nifieamce than we have beon inclined to rive it* 'tow, I havo summarised - I liars summarised 37 re? .narks. ho.ro. ypry briefly, becsiise tho . topic . of. ,chro. is. .go - ing to bo handled by Doctor Anna Baotjsr, who has dons the experimental work in canons, and has a n.ors intinate know ledge of it from that point of view than I do* Tho arailablo evidence is that chron.ate workors do have an incidence cf cancor cf tho lungs in 27.coss of what night be enpoctod. Beyond this, ve do not as yot know a greet deal*' *-- Intor'cst in chrome as a pcssihlo carcinogoaic agent, with particular respect to lung cancor, is compara tively recant# The officials of one of tho largest chroma producing companies in this country supplied the impetus that started Interest in this subject in the United States, their apprehensions to tangible form, in sotting on foot : the statistical survey conducted by Machlo and Gregorius, and publiahod in the public Health F.oports on August 27th, 1946. -u*. There era sor.o .fi^vros that r.lyht interest you concerning the duration of the enposuro of those people until they cot cancer* l'.ay I chow one elide? This ai^ht interest you to show the distribution .of theso cases by length of exposure* -If you Just focus your attcntion,-i;e- causo wo don't have uuuh tl::o, on tails cdlurut and tho rahjra* you will see that tho avera^o aro is fifty-two years, and v the ranee was fron thirty-one to seventy-two of those casus that have .been rep or tod in the literature. ..... The duration of enposuro is the . into res tine tiling hero, and it varies fron four to forty-coven yiars, These non have been exposed to chroniun, before they developed their cancer. Tiie interval between initial enposuro end tho dittcr.osis of cancer v/ts appronhiatoly the rers, becauso onco it is - about covor.icen, and the rarso is fjur to forty-oovon. Than betv;oon the end of enposuro and the diagno sis of cancer I-s also interesting* It shows that in gosxj casos, tho cancer nay develop isany years after tho. end of tho exposure. The interval betv/eon diagnosis and doath la, as in all cases of Iut.q cancer, an avoroc of a very short period of tine. 'any of tho so casos which wo have had and which vo huvu ctuclicd, have -co:o to o\ir dispone ary cl a inlay that thoir cynpicns, tholr cevero sy.nptorr, didn't bo^in until L. -- U1Q.------- Anore v:ho was fomorly nodical 'officer for the plant in V.'ales i vhoro these nasal sinus tuners had been observed, and I also visited Doctor herein who is the "odicol Officer there r.t the present tine* They both stated that the nan who has developed the nasal sinus tuners were not nen who had been employed in the part of the plant where thero ni^ht bo -exposure to ~ nickel carbonel, and they were, for that reason, vary re-"" . luctaht to bolieve that the nickel carbcnel was a factor in* tho nasal sinus tumors that had boon observed* Tlx7 further pointed out that the tuners that had occurred were in nea who have been opposed to the calciners, `that is the ores with the - that since 1*;2U, \;her. the cal cine r 3 were nodesi^nod, thoy iuve not seen cancer cf the * nasal eir.us in :.:on whose onploynont in tho htch'.stry he3 taken place only subsequent to 1921;, so that it would oeen . that thore is* an instance which fulfills tho stipulations that were raised this norninc as to whether an enperinont of. naturo ni^ht be perfomod which would havo be or in 2 on tho question of an occupational hazard in the way of a respiratory tract carcinoma. ~Y DOCTOR ""PADSI Doctor Ilorowothor, would you co-nnent on these re-- narks ? 3Y DCCTlf: : ( ------ <417. on opportunity to visit him end learn a ana thin,- of the max-- torial that he had assenblod* i!o had seventeen cases in which thero i'-ad boon co-onistcnt carcinoma and csbostosis in tho*. lungs In hie sorios, tixro was no relation that could be de toe tod between the decree of asbostocis end the presence or absence of car.cor, or the degree of asbostosls- and fight of cancer* How, his series cane from a plant that used the' .Khodec ion blue asbestos which, as Doctor Lcr.sa has pointod .* , . .. * . *. . ! / * .............*......* , ' * ' out, has certain charactcristics that are different fraa the Canadian asbostoc. It1 c a more brittle fiber and, therefore, gives rise to noro dust* however, it was my understending that some of the cases described in Greet Britain, had had exposure to the Canadian whito asbestos* I wondor if any of our collea.uos fron.overseas who are in the roou, night caro to corrr.cn t on tint ? t * I would liho also, to :.:abo cno further point in connection with' a natter that both Doctor Devon and Doctor Rhoads brought out, and that Is the experiment of naturo, whore one nay vary circuus tancec end see if that has any thing to do v/ith a phenomenon that has been observed* The question of exposure to nickel, which was brought up this morning, ic something that I have been askod-about by sever al individuals ovor the lunch hour* I recently had an opportunity to vie it with Doctor M -------------1^.9-- I couldn't combat on cone or then, but I tblnk can partially ansver soroo of those, sir, end I think Doc tor Ikion can answer conclusively ono of then* First of all, I tki;jc doctor Lanza is nisinfomed about the proportions of asbestos used or.d whore they are used in Snylsnd. Tl:e original cac^s of asbostosis, fifty* years a^o, wore all Canadian asbestos. The oorlios t- asbostoe work in Ireland was either sovensy-ci'ht or oiyhty-two and- thare nay have boon zone- crystalline ^fiber than,.'but..." very quickly the asbestos trod9 concentrated on tho white Canadian crystalline. La tor on, the Rhodesian asbestos end the Rhodes ian - the South African blue, and the third ono which is also an iron silica, the anacite, cane in# .'row, of all of those, the anacite is definitely the -.ost brittle. It has short fibers, it's brown and it's yot fibors as lonr-as that (indicating:) whoreas the best Canadian spinning fibers have only tot fibers as lor.- as that (indicating) and the bost blue is about that. Well, there is no doubt about the dustinesc of the coecite. Tact is tho brodrn long fiborod stuff, to cuch an oxtent tilat it's very little usod today, so it's at the period v/horo oor.o of these ccsos are concerned, or where tho casoo of asbostosi'o occurrod - sono of :.y old friend Glynn's casos occurred - thcr . was a ^ood deal of blue and  *r * Vo o. a ~ ood d. a cl of enacitc us oi d..-- i!ou, I thinh factor hr.ox will be ablo to toll us, . in his plant, *;i;ich is ti.o bir^ost in tho country*, what about the typos, of asbestos thoy use in that particular fac tory, and ths - v.'ho ther they Lavo laid any carcinona of the I-**:* .a: _ How, about the nickel cancer, it is'perfectly rrect that none of us tni nk tl; do.with it as such for * V f one reason is that * * Vn'2 should build a factory in order to rot the - in order to yet the littlo cancer, and of course, it r.iy.ht act in that proportion, then I should ingt in c a lot --.ore people would havo boen effee tod* toe tor Ar.ore or toe tor /.oryan and nysolf fool that the * that the ro-building of the old calcir.ers was the crucial change in the nattor, though there wac sor.o operation in tho constitution of the natorials which are shipped fr on Tort Hone in Canada* The differohee, as I' know,' because I sew it before and afterwards, between the old and extrcnoly dusty cfilclncero and tho r.odorn build, is enomous. Thorcfore, there nay bo sene hope in the fact that porhapo a lot of tic docaye is necosssry to pro duct) ao:co of tho so cancers* rY DOCTOR F.-3AD2;