Document VjG57LgBp2xyGpEGwaMQMd004

FILE NAME: Uniroyal (UNIR) DATE: 1957-1958 DOC#: UNIR012 DOCUMENT DESCRIPTION: Consultant Report - Report to Asbeston Division US Rubber Co. - Preliminary Resutlts on a 2 Year Study 1957-1958 by Dr. John G. Wells PKU* P O R T TO ASBESTON DIVISION UNITED STATES RUBBER C O . HOGANSVIUJE, G A . PRELIMINARY RESULTS on 2 YEAR STUDY 1957 - 19 JO H N G . W ELLS, M .D NEWNAN, G A . 1. h lata 1956 and early 1957 several Infognai mooting! were hold with Mr. A .C . Link, Mr, John Alexander, and Mr. Jim Guy of the Hogarovllie, Coorgto U . S . Rubber Ccmpony regarding the problem of mbrnto* dlwaoe In the Aibeetan Plant. D VMS toamod that continuino offerta hod boon dtroctad towards Incraatingiy tuec-- fui duro control tinca tho plant* tncoption In 1942- te o polnt whore duro count Information tirowod tavoli in a ll divitioro a l tho plant generclly watt botar throt rocoamiondod and accoptad co sof levali In tho ati*o* Indutiry. Duro count dota, collactad and countad occardlog fa accoptad pro cedure*, ot Intarvali of evary month or toro, fram many itatioro In all rowparimenti af tho plant vara avaltaUa tinca 1942. Check* by lndtpandent agende*, rodi a* th Stata of Georgia Department of Health, Tho Indultial Hyglene Foundation and th New York office of th U . S . Rubber Company, ihowad goed cerretatlon whh th dota collactad by tha plani panorami, B a rra ti cheti x-ray had been takan on all warker and hod been read by a radiologie cenatitoni, ho tobmlttad ht report la th locai office of th conyony. X-royi maro taken fram th beglnnlng of plant operatlon endofferod In alt com i a radtographie htatory ipannlng th occupetianai Ufo htatory of th worker. Cano of pulmonary aobwtoili moro beginning to appear. By tato 1956, Ihoro moro five merkoro with Indbputoblo tig of pulmonary dlpearo thought to bo dro to a o ro c tis. On tho b aili of tho foregoing Information eventi recommendations mere 1. A comptohontivo study dmuid bo undwtokon which vmitid attempt o . tho markon* general health, and In particular,evidence of pulmonary dlroroi duo ta OnKypoormoirtoe ta aAerooi duro b . Roentgenologic flndlngi ^ c . Byti coimt accumulative inpoiura dato miaojrad tn MP9CFY (Million partldai per cubic foot yean) 2 . Conclusion* should be fbrmutatad from theee correlation* 2* Recommendation* tirould bp rod# ta in *** protection of the vmrkett from admito* duct; facilitate prediction and early dotaciIon of dfctad uerkent and preparo guldro far furthar study. Compiate mediati Statarie* were taken on each worker, with particular ettantien being paid ta roptirotary and eartSavaroular lyttaeas. Thorough phytical examlnatlero ware porformed, omitting only tha breati and pelvic examination on females 2* and rectal axantnotlgn on males (In all c o m potlants vrtre adrissd to have thalr family doctors couplet Hits pert of Hilt examination, last subsoguent negative reports to Hww fay me lull thorn Into fatso physical security). tests for 1 1,000) Numerous pertinent laboratory st tuberculosis (Tuberculin and uhtAst#apwtaaarme osis I t 1 mode. those Included (Htstoptaeoiin ,d0c0ln0 ), vft4 cepedty msamxemsnti, urinalyses, end complete hmeograms. Hemograms were iWTfinss'f of white blood cell count and differential exanlnation, and detemlnetlon f rad blood coll count# h-- eglsbln, and hameteerit. Sedimentation rates wore obtained In a ll cans* t * Whore particular side abnormalities wore found, such as pus, blood, sugar or atbwnln In tho urine, or abnormal Wood vulues Recovered, tests were repeated, and if verified, patients ware referred to their family physician for further diagnosis (If necessary) and treatment* Three four-film x-ray vi awbaxas were installed In my office and serial lomiigmiinjneio (In some com dating bock to 1942) wore examined with particular intare# In tho qppeuranca of advaneb* pattern of asbartae dtseam In there who have developed the dlseaoo, and tn the x-ray-dilai corveletten. O r, Eugene r#el#tynra. Chief of Radiology of tho University of Penn sylvania Metioal School end x-ray consultant to the U . S . Rubber Company, kindly m e * ed ey with me at the outses of this study reviewing the radiologic possibilities of pulemnary asbastas cRsaaso* His help was Invaluabla and facilitated this study to a con- stderabia degreo. Du# count data compiled from 1942 through September 1957 were mod# available* Those data warn obtained from analyses made by M r. Jim Guy, Safety supervisor of the HsganovUle cebe#oe plant of the U . S . Rubber Company, and from tfudlas made by the Induetriei Hygiene Foundation of America tn 1930 and the Institute of Indumriet KWdlcIne- Now York Unhmnlty- Bellevue M a ica l Cantor In 1934. According to the statbtlcd analysis of Jew ary 1934 fay the Imtltvte of Industrial Medicine- Now York University- Bellevue Modleel Canter graphs were drawn detailing the overage monrtdy du# counts since 1942 In the vmleus compartment* of the Hogarwrille Asbeston Plont of the U . S . Rubber Company. Du# counts were uniformly high Initially tn 11 comportments and highest In the fallowing decreasing order opening end picking, ea# carding, weaving, spinning, flyer frames, and winding. Uniform downward trends of average monthly counts of mbestos <h* (measured (n MPPCF) were obssrved In a ll areas as du# control meemiras became more efficient* 3 total* Monthly count were than overcgod out and Sown as average yearly micro sloe ha bam hoTlhdetombaxoim3,u0m00o,l0to0v0Ap&aIrsticcolenscepnatrractiuobnicoffoaodtb.otTlohsispaftrpti*cleshoesf 3*10 boloifnethimoled atot tbhoissuoctthpotohuartoawwitohrokuetrd, ewvoerlkoipnigngoa4s0behsotousr wdiosaekasseh.ouTldhobro oisbnUotdoelaabrocrut origin of this figure and It any bo that it U limply a carry over from the figure hold to bo oof* far tho silicon Industries. Ut< this figure os a bads, Tho Now York-Bellswe group formed charts which showed the following} Wlndlnqi More than 5 MPPCF 1942-1944 less than 5 VPPCF 1945-1953 Wvor frmoosi More them 5 MPPCF 1942-1946 Lass than 5 MPPCF 1947-1953 Spinning} More then 5 MPPCF 1942-1946 35MMPPPPCCFF i1n95109-4179-3439,1 than Weaving Mora than 5 MPPCF 1942*1931 Low than 5 MPPCF 1932-1933 6 Cardinal Mora then 5 MPPCF 1942-1949 loss than 5 MPPCF 1950-1953 Ooanina and Picking ~ Mora than 5 MPPCF 1942-1959 Lem Hwn 3 MPPCF 1951-1933 Tho total occumulattvo exposure* In each area hat been least In winding and incrementally incroawd through opening a d picking where the greatest average expoMO has been and still axI#*Tcontfngtng dust date ndws the following figures through September 1937: Wlndlngt 2 .0 -2 .9 MPPCF- deponding an location (Mo# stations average around 2.7] Flyer fr aoen 2 .0 - 2 .6 MPPCF* depend!r on location (Most stations average around 2.6] Spinning} 3.0- 4 .0 MPPCF- depending on location (Mb * stolons average oimd 4,0] Weaving} 2 .0 - 3 .3 MPPCF* depending on location (Mo# Motions average around 2.8 Cardlnoi 2 .T -3 .7 MPPCF- depending on location (Most stations overage around 3.< OeanlnQ and g S g r -- 3 .0 - 3 .7 MPPCF- depending on location (Mo# stations average around 3./ 4. One hundred thirty-bur work*f-patlnt we examined in 1957. Forty- ntn* war whit* mol, and raventy feur w*r whit* femle*. Eight wr colorad al nd three w*r* cobrad female. On* hundred twelve werkar-paHmot* w*ra examined tn 1958. O f thoee, on* hundred oran hod bran pravbudy Momlrad In 1957 ond five wore worked up for th* fla t tim* b 1953* I*ft th* cempnnTyho*r wtw*eranatynbevoernapoaftienbtraecrean. In 1957 but not ra-anoratnad 1 1958 hod btht**tudy. NObv*erhtahv*e1n9o5t7-b1e9e5n8expaamnionneed hbuunt dhroevd*fborrtayn-eIingchltudpeedopInlethw*arJauIdnyclbuedceodme tbhu*rlfoxr-arapyateienndtdwuitthcoduenftindioteteoanrdekanvoawilnabplu*lmfoornarnyommfienraattoiotln., Fwlhvo*hoor*d rbaewenwroartkuerrnaadnodr Irureferred *l*whra before th* atudy began. Thee* bdMAmltcra # . 4 i" * ` ` manrar with th*Wfoolrlkoewrsinwgafrianddiivngide.d Nbyoyaettaerm opft awcoaeraoudieetttvoeseepxparoastuerediIfnFetrhaentfoflolobwing damifleatteni In thia eerie. 0-5 yaott Forty "ran worh t ranging from 2 month t* five yarn In Aabeeton ond with total occumulntlv* expoeura ranging from 0 .3 - 2 .0 MFPCFY. No found. Several other condition w * unraverad- Two potbnt with dtobatra mellltu, on* with probable eergt*nit*l ehelellHib!*, on* with ihewmetb hrart dtseaM, rad thra* with pulmonary hyp*rt*ralonsuopecradon boriof loudiraond pulmonic ta m ii mdaevoral with rather rara onomb umolly *m to menotrhogb rad bedeguete d b t. Tw* patbnt with ementbl hypertension rara db- 6-8 year O f thra* forty-raven, twenty-two were whit* n a ira tw raty-tra were white foralo? two wora colorad mole! andona to colorad fomob. On# woe horn opening and pocking) twelve fro carding; five from flyer frame; four fro* wbdbg? nine from pinning; and thirteen fro weaving. On* potbnt, 46 WM fra* vbovbg with accumulative exporare of 4 M FFCFY hoe o cheat x-ray which I probably normal but which how minimal ewpbtau tigne. aTcWcurmty-uflfavt*ivwe,orekxeprCo*rMraaronafgrionapgnrgfarinobgmgfr5roa.m3dt1po3ic.8k2iynt*oga4rw7iIt.9hnM7yFeFaCro*FnYr1ar.addO4w7ni.et9hMptooPttPbdCnFtY, Sn definite evlden52oe of pulmonaryodmetoel. Five patienthave eqilvocol but 3u9eWgeMitlvofeweainrdlyinegviwdeitnhc6e.o5fypeualrmoonnadry2a2e.b4eeMtoPeFlC.FYTjhee* ora 32 ^ 821v.e8arMFoPnCdF2Y5;.6 MPPCFY? Lob Hurt3t,54W6MWfofowf winidnidnigngwwithith87ye.0aryeoanrdond 3254^M4 MFFFCFFCYFY. ; ond '` . . . 1 defi,ni3t6e. WF of The etphienrnfbivgewmituhst6byemregraarodod with uepbten, ond watched cloraly. 9-10 veers . 5. 5*vwol other conditions were found. Nino potion* ( &ix from winding, *w from pinning, and on from flyer from) hod htstorf* of reeunwnt nuo-trecheo-bronchiris. O nly ono, ihowad any M picton of pulmonary robatfaa dfaooa*. Tam patients with hyparlonal v cordiovoaeular dtaaaaa and c m with hypertensive voacuior diaooa wr found; on with non-tonic nodular getter* an with low grad chronic urinary tract infection* and thro with moderately over anemia (M ow 10.0 gram %) woro found. Patten! wra Informed and odvieod In oil Inatoneoa to eorwdt thlr femlly phyalclono. ' O f thooo thirty-fly, ton woro whit mafea* twenty-three war whit* female* two war cotarad mol. f Two amre from opening and picking* tarn from eardlng* In from flyr fro* five from griming* Ight--n from winding* on from weavl/g*. On patfent with daflnlt orly oabaatoala 1foam opening and pick!*?. O f the with auapiclou sign on ech la from amoving, flyor from, winding, and grinning. Twaiv worker ranging from 8 .5 - 10.0 yoora In oaboaton with total ac cumulative awpoaur ranging from 27.4 to 74.9 MPPCFY. On patfent, _ .. ----- ,, confer, 81 WM with 10 yaan and accmaulathm apeaura of 38.0 MPPCFY hoa daflnlta orly radiologic avidanca of pul"Mnonr rahat ni ll . On othar, , 41 CM of opening and picking with 9 yaan m d 54.1 MPPCFY total accumulative aapaaura has shewn equivocal early radlotogfe signs of pulmonary adwstoeis tagathar with dacraaalng vital capcmlty and rising rad blood cal) count during the past year. Other eandttlans found Included tarn with recurrent bronchitis and bronchiolitis but erith no evidence of rwhestmls* tarn with asymptomatic hypertensive eardfcvaeegiar disease and ono with asaantld hypertension* two potfonts suffered adth racurrant urinary tract Infections and ana gov* a history of poptlc ulcer with hemorrhage. Theee patfent wars appraised of their condition end advised to canadt their family physician for further con O f Hmm twelve worker four ora white mad, seven ora white female, and one fe a colored saai. One U from opening and picking, one from carding, throe from flyer frames, one from ^Inning, two from winding, and four ora fromweaving. The patfent with definite aibeirosit ts from carding* the one with equivocal early change to from opening m d picking. 11-12 years 6 There o k Nranty one woHcew with 11-12 yeaft experience with totd oecumulative date* ranging from 36.0 to 118.3 MPFCFY. O f this group only seven preewt no radiologic evidence of pulmonary asbestosIt and three of these wwan m at bo regarded with aapicJan bo* eotao of tncrootiag rad blood coll vdues, oceiy d o b in g , or changing Intim ity of Hto toBond pulmonic heart sound* O f the roaolning fourteen, eight have unequivocal* and in oovoral caow od rancod cams of pulmonary aabostaelsj four have equivocal oedy chongm and two hovo minimal and qoeetlonoblo early signs* m i v w n graup n m pfirvw vjr M n UiVm vQ m n w v T V i n o n w sections of the Kogamvitle F lin t. Theirs ore the moot odvancod ceeee. They or . ,. _ , 45 WM weaver with 12 yean and 38.2 MPPCFY; , 43 WM carder and fly frame tender with 11 years and 36.0 MPFCFY; . ,, ,6 4 WM with 12 years and 62.6 MPFCFY; , Wf spinner with It yoatsand 118.5 MFFCFY; . .* WF weaver with 12 years and 100 MPFCFY; and. , WF upInner with 12 years and 73.2 MPFCFY* O f the raawlnlng eight, _____ ,, 3? WF weaver, has 11 years and 56.6 MPFCFY and *. ., 42 WM winding md weaving supervisor, 1 11 yeers and 41.5 M PFCFY. O f the early equivocal patients, . ,$ 32 WF weaver , has 12 yeers and 79.3 MPFCFY* 47 CM opener and ptekor, hoe 11 years and 31.7 MPFCFY; , 48 Vif winder, has 12 yean and 42 MFPCFY} and , 45 WM overseer In carding and Spinning Pne 12 yarns md 51.2 M PFCFY. The more oqjhm cd, but early eaptnlnm patients Include j, 42 WF fly frame tsnder with 12 yarns and 42*3 MPFCFY and . ,, 32 WM animont overseer In carding and spinning, 12 yoam and 51.2 M PFCFY. O f the total group few unrelated need!fid condMens were dftcovorad. One patient had asymptomatic Hypertensive cardiovascular im a m one suffers with recurrent bronchiHs (but has no evidence of cebeetosls), one has aethre enoulderlng rheumatoi d arthritis; and ana has hod rend c d c d l since being ie<mvad from the Asboeton Plant. O f the twenty one workers, eight are white male twelve ora white female and one Is a colored mole. ' 13-14 y an 14 41yean 7. On b fan) patting and picking; three or frua carding; f a r or fly from tend*; four art from sparing; four f a winding; five fra wewrlag; fan* am in jporfrfaory eapocltla*. O f the eight patient! with daftnll asbeetaeb tar art f a winding; ana f a weaving; three ftw i spirting; ona from cording; ona b a uparvbor ta weaving and winding. O f tha othorcbg ona ftm opwtfa and picking; ana Is a Ay fa n tandor; ana f a wtaflng; ona f a weaving; and N o a n to ovenodng eapaaiHa* in c crd fa and ip in n fa . Thar ara fourteen workon rotting f a 12.3- 14 yean In feeWen and with accumulative npaan f a 41,4 ta 125.4 MPPCFY. O f thb group van appear fa o of th* fiteou. OF tha maatnlng van. V-f pinner with 13 y m and 125.4 MPPCfY. haa been prevfacly tiam fened. Two other dww unequivocal riyw of pulnonary oabaatoric. They or 34 WM card with 13 yara end 74.0 M fPCFY and . . _ , 35 Vlff iplaw r with 12.3 yaori and 42.1 W K f Y , Four b m e g th o e o l w d ychang H . They am . * 47 vtf weaver with 13.0yaon and 41.4 MWCFY; 51 V/f fa e tender with 13.5 y ta n and 54.7 MP7CFY; . . 43 Wf firana tender with 14.0 yean and 74.4 MPPCFY; and , 42 WM m o vin g wparvlaor with 14.9 yaori and 112.4 M PtC FY. Other condition found lacbdtd two with chronic and recurranT branchilli; coa of who Hoi early fcMpieiou orifatcril . ona with lag vain thro*bephlebltb and napectad recurrent pdmoonry aboil; ona with aewta gloaarvlanephritls# ona with virgin dlabataa weilitus. and ona with hypertandva canBavoccwiar dlaaam. O f thaca faurtaan. four ora ahlta aoiaci tan ora white fanatic; four ara f a n apUmlng; ona f a winding; ana f a n weaving; and ana b on office ecratory. Thera tc ana avarwar f a n weaving end winding. Thara ara nlnaNaa worker* In thb group ranging f a n 14.5 ta 14 yean and with aceuouiativo a^oaura f a 52.5 to 175.0 M fPCPF O f thlc group, aight ora fa a of tha dlaaoea although ona haa oqtfvocal dubbing of flngv noil. O f the remaining doyen. N have draody boon lawcvad fa tha oibnton plant. They ara . 3 ? WM tplnnar and luparvbar with 15 yaon and 175 MPPCFY and . . 43 WM cord with 13.5 yam d 98.4 MPPCFY. O f tha ramoininp nine, four hove u ia p h ocd early pulmonary edbeetodi* They are . yea ana 53.4 MPPCFY; , 54 Wf wind with 13.9 , 34 Y - f weaver with 15 yean and 191.4 MPPCFY; ' _ 44 CM from opening and picking with 15 yean and 128.6 MPFCFY (ha* been removed fare cubeWon); and 3 , 32 WM spinnor with 15 years and 83*8 MPPCFY. Five others with early suspicious changes <we _ , 43 WF with 15 /sort and 63*5 MPPCFY; . 41 WF winder with 15 year and 52*5 MPfC F ft 40 WM carder with 16 years and 71 MPPCFY; . 57 C F w aver and sweeper with 15 yean and 101.4 MPPCFY; and , 33 WM pinner with 15 yean end 83.8 MPPCFY. Other medical condition found Indude ana patient with chronic bronchitis four with hypertensive cordlovaeculor dlteoie and two with assntlai hypertension ana with ssvoro aneetiai and ana with Intermittent dausBcotlon due te paripharal artorlaodorod. O f the twenty-one patient eight are white males; oven are white femoies two are colored mates end two art colored females. in summation; of ana hundred forty eight patients nineteen patients have definite and unequivocal early to advanced pulmonary rafasstaili; sixteen haw equivocal early evidence of die disease) and four have lightly tut* pldous changes. A total of thirty-nine in a il. O f these thirty-nine four ore from opening and picking; four are irate carding) four are from Ayer twisters) ten hem spinning) seven from winding; and five a n from weaving. Two are In wparvlsory capacities in coding and spinning; two In winding end weaving; and ana In carding and fly. Chart f 1 draws a distribution of putienis with varying degrees of oc- cumulated exposure. There are two patients with'? + changes with 21.8 yems and 24.0 MPPCFY; and tea ^ with 22.4 ^ ars and 25.6 MPPCFY; am patient with ana +- changes at 38 MPPCF; one with ? 4- chango at 42 MPPCF; and two with' change at 41 and 42 MPPCFY. There is one with ana changes dT47.9 MPPCFY. The remainder begin to bunch at 5C million particles par cubic foot years and show no particular daw severity ratatiorahtp until 90 MPPCFY is exceeded. Evan hare one is j two ora am ; one it two - j- ; and four ora three Mast of those free winding and opening and pieking who how Involvement do so bol ero they hove a total occueulata exposure o f 60 M PPC FY. Weaving spimlng carding and flyer frames tenders ora strewn out in random fa lle n from an accumulative exposure of 60 MPPCFY on. > Million Portld--PfCubic foot Yan (MPPCFVE CHAW 1 OP - C FFS W WE - Opontng and Picking Carding Flyor Ftann Spinning Winding Weaving 10. Thar* ara patUnti with 3 -- bearcela. Thay ora ai follow Column 1 (Sao. 1957) Colman II Column HI ;<$) 138.7 (FF 1C) 56.0 J . 1950 Jon. 1953 110.7 MPPCFY 44.0 MPPCFY ($) L i b (tv) 100 Jan. 1955 t o * . 1949 45.0 MPPCFY (W) 53.2 Sept. 1956 55.3 MPPCFY (S) 125.6 7 Roview of thalr *-roy* dame that definito 1 4 " hanget oceunad notad ondar Column II. Thalr total aecumuletfve expoouro oorr actad to tha tima of fin i roentgenologic changea la llatad undar C olumn ill. i As con bf readily obanadp tfires of t h w ptHiAtt contlnusd o t r i* for aovare! yaon after lin t definita signa af tha teosa and woraanad rather rapidly. Two patienta wara datactad fairly recently, yet by tha tima of removal 2 and 1 yoan lotor had shown rapid pragroarion of Hit puliaonary lotion, deipite low continuino expooure taina brought about fay tmprovtarant of piont filtering and oxhewat protection. There ora 3 potionta with 2 4* otbaatoah . Thay oro oa follow Column I (Sept. 1957) Column Cdioan HI 74.0 C Jon. 1956 68.0 MPPCFY . 98.6 C Aug. 1953 86.6 MPPCFY ' 53.4 W Jon. 1957 50.7 MPPCFY* A ll patienta with 1 *} <* 4 pulmonary osbestosls have begun to do~ volop pulmonary and'or dliiTcol homatologlc changea within tha peat year 1!. TT . Qiifcussion and Condition Pulmonary bestosb Is a disease of tha lung caused by exposure to and 10 Inhalation of partial of aibaato dust. The particular size h Important and probably vaHo from 3 to micron. Tha finding that potion! In tho winding Mctlon tand to davotop pulmonary tlgn* at lowor acewsulatod exposure rates than workers In othor aoettom (tho total gram exposure rat being roughly eqilvolant) suggests that the dust size at tho winding tfeHens may bo Afferent or perhap that the velocity of scattered dust may be greater with resultant greater pulmonary penetration. Microscopic ttudla Jiawharw hova shewn that tho anatomic ehanga In tho lung consist chiefly of porlvaoeutor fibrosis, interstitial fibre!}, and thickening and widening of tho alveolar capillary berrior. Thor 1odiltlanally o motkod ploura) and poricardlal flbrotlc reaction* Tho d ln lc d course of observed patients with pulmonary osbostotlt ha been inaldoou ond marked fay lowly pregramtva loo of strength, pep, and energy, and ante of well being. Patients tend to develop a dry hocking, wually non-productive, cough with eclated sticky palm acram the lower a re of tiw ch u t both iterlorly, posteriorly, to and In tha axlllo e. Breathing ability become markedly diminished, but usually slowly 1 that patfants almost autaaatledly adfwt to It and usually cemmant that their wind ode* quote if they don't hurry or strain. Thera hove been no Instances of overt right sided heart failure due to increasing pulmonary blood pressure. In several Instone , patients have complained most prominently of In* digestion and epigastric and hypoehondrai discomfort, sub-stomal burning and frequent eructation, but without nausea or vomiting. There lave been no instoncss of pulmonary hemorrhage or spontaneous pneumothorax. Several patients show varying dsgra of dorsal kyphosis end/ kypha-seollotls. Others shew varying degro of pectus excovatum. These anatomies! chest changes have so for diown no relationship to the Individual workers1 susceptibility to pulmonary asbastosls. or bronchogenicSocaforcrinthoemrea have been no either in the suspected or workers with proven ca adm tosls s or of In pulmonary tho with tuberculosis no evidence of tho disease. There Is a relatively high incidence of patients with various camblnIons of slnwo-phofyngo-trochoo-brenehto-bronchtolltis. These patients have not so for shown any evidence of Increased susceptibility to asfaastot disease. On the objective side oil patients with unequivocal pulmonary osbecfom radiographic hcv* dmw vofying dsgreet of changes. (See below.) Those hove occurred dome and no * widely w y jm total occunulartvo dust hove slffilflc * ralottonriilp to to OQ*, MR# or roca. (However, the high colored com rata Is relctad in oil probability the higher dust expoare rata or thotr particular jobs.) A ll poHtartt with pulmonary bM it show significantly diminished vital copoc rougNy fay ( m o ^ McKssran-Scett Vital Copwlty Apparatus). No attempt has been modo Hwa tar to M em timed vital copocitlas, spirogrens, waxlmol breothlr capacities, diffusion oxygon md totaa or carbon dioxide p ran m and saturctlonstudle*. Many patients with pulmonary admettais hovo developed varying degrees of clubbing, the extant of which boors no significant ralotlondilp to the extant of the x-ray changes* In tact. In a few wantan xispiclout early signs of clubbing have occurred wittout faultciieora x-ray changes* While dubbing may oocur congenitally end Binder a variety of other clinical conditions, It must hero certainly be regarded as o suspicious sign end the patlont watched more closely. Sooner or letar, In partants with radiographie ehratgee of osbestasls, ouscultatary signs of pulmonary hypertension develop* that is ta ray, the second pulmonic sauna Increased In intensity and ultimately becomes louder than the second aortic sound. or h Mem instances this finding has (and/or Id occurred without ae yet parallel radiographie changea* As noted ebavo no portent hesaeyet developed sufficiently severe protracted pulmonary hypertension to manifest signs of right tided heert failure; and electrocardiogram have thuo far been significantly innocent of chongm suggesting right sided hemt strain and/or Thera tends to be a parallel Hm in rad blood c e ll, hematocrit, and hemo globin values with development of o moderate secondary poly cythemia. Rod coll counts o a f Hm ta 6 .5 million par emm.j hematocrits to 52-56 volumes %; and hemoglobin from 16-13 grans par cent* With ; regresston ef Hm lung dlssoss Hw m values tand to return towards and In seme Instances go below nonae l* Radiographic changas observed through rite study of serial x-rays on thlrtyntna patients with certain or suspected pulmonary estuatasi! hove diown the dlesow to bo typified by progressiva chonQM Involving the lowor lung vescutor and intontitici itruettros with progressive diminution In lung volume os suggested by deereosa In vertical rfl-- infini of the lung fields and Involvement of the pleura-pericardia! surfaces with eventual oblitrtton ef the camophrentc and cardiophrnie sinuses. Usually ae tlte picture develops ephy^Mtaus changM begin to eppeor in the upper lung fields* The earliest changes Involve elthor the serous surfaces or blood vemois and art meshed by a famine or fag g in e of the pleuropericardta! outlines; or by an eppearanco of thickening hominem and nodularity of the vascular outline In the lower lung fields* Neither lung seems to bo predominately selected and the Involvement may be either medio) or lateral 13. to be a decreaseAtInavbeorutltcotblsluMngm*ditmimenes,ioannsd(o*ns msoemaesuIrnesdtafnrocnetstheveefnirsbtecfoorseto,cthhoenrderablegin* Juncture to o tin* Ktondad from the highest point on tha diaphragm. Tharaaftar tha changes Involve progressive thidcaning of tha voscular deadows with evonfuoi coalescence; froy emiv* thickening ond Irregularity of tha pieuroperfcardial outlines; id progressiva diminution in tha total lung volume at uggatfad by dacraoaa in apled-diaphragmatic dktanea. For tha purpoaa of this study tha following cotagorleol clarification was established; 0 hto avldano# of disease * ' * * -- Equivocal changes suggesting ona f but Insufficient for "" definite statement 1 f Inttld furring or shogglneae of pleural or parlcordiol surfaces or Initial thickening and haziness of voeedar outlines 2 + Combination of vascular and plauraparIcordial change with possible early dacraoaa in vertical cheat dtmaneion 3 f Chongac pravfouriy noted plua development of bockground reticulation or ground glam oppocronce tn lower lung field s coolaaeanca of vascular pattern*, further thickaning of plat*" pericardial outline and greater dacraoaa tn vertical dimension* of cheat* 4 Almost solid appearance of on* or both lower Iwtg fields plus a ll of above change* Nineteen patients were classified 0 having definite pulmonary asbestosis. A ll nineteen have dafinlta and unequivocal radiographic changa* comcotibl* with the criteria previously established. (See page 13.) O f theee nineteen, fifteen hove been personally teen in thft study. O f these fifteen a ll hove diminished vital capacities end twelve of the fifteen dww decreasing vital capacities. Similarly twelve draw some evidence of high or rising rod blood cell values. Eight of theee fifteen patients show varying degrees of clubbing end eight dww evidences of increasing pulmonary blood pressure. Twenty patients hove plus-minus radiographic changes according to the criteria ostobltdmd In this study. Sixteen of those patient* show decreasing vital capacity measurements, thirteen show rising red blood cell values, four reveal Increasing intensity of the second pulmonic sound; and one shows definite early clubbing. 14. A definite diagnosis of pulmonary asbestos* cannot bo mod*, under th* conditions of this study, without radiographic changes. However, tt>e appearance of any combination of dtem w inj vital capacity, riling rod blood cll values, neraosinoJy loud second pul*onlc hear sound or dubbing ihould bo comiderad a Mpietoui sign in any cxfeestae worker; and ho worker should henceforth bo watchod eiosdy for further pulmonary asbostods evidence . That workenfr cm m y aroo within tho Asbestan plan can dovdop pulmonary asbestos!* it ebundsntly door* Chart * 2 (page 15) hows o brook down of workon bytoctlons plotted against yoon ofaaploymont In Asfaaston. 44% of nlno asbestos*. M i chart taggests that workon In opening and picking oro of greatest risk, workon having davolopod olthor doflnito or staple leu sigro of Chart # I taggests moraovorth at these workon oro opt to ckrveloc signs of osbactosit at a lower total occwMviotlvo dbtago thori omployoot In othor division of the plant. Employe* from SPIN N IN G oro next moat frequently Involved. Forty-two % of twenty-six workon havo doflnito or suspicious signs and twenty-seven percent have doflnito osbaatosls. Inspoctlon of Chart * 1 , howaver shows that alt seven women with dsflnlte dtsooM havo a total occumulatlvod ooo of over 60 MPPCFY; ond that oil but one with suspected disease has on accumulative exposure of over 50 MPPCFY. - Empl o y s s from CAEOING art third most frequently Involved percentage wise. Two are cordon with over 70 ond over 90 MPPCFY total doee ond one iso fly frame- cordSng supervisor. One patient, however, has on accumulative dose of only 33 MPPCFY. Tho relatively smell number of workon from tho cording section with asbestos* may well relate to tho fact that this population Is young in regard to working y o n ond total accumula tive dooego. Twenty-four percent of thirty-four workon from Y1NDING have definite or sMpideMS evidence of pulmonary osbestoels. Poor ere definite ond four oro suspect. O f Interest hero however. Is tho fact that six of those eight (three from each group) hove developed signs at somewhat lower total exposure doase than comparable individuals in other sections. Yearly dust studies (See page 3) dm * the winding section to havo one of tho bast dust contra! systems In tho plant- These dote raise o possibility that tho characteristics of tho dust In this section ( e .g . stso, velocity) mey hove a bearing on making tho winding section somewhat more haaordous. WEAVING Is next with twenty-three portent of twenty-nine workers. How ever fifteen workers hove been on the Job lees than five years. Thors Is a wide toread In total acctxnulatlve doses in Involved patients In this section ranging from 40 MPPCFY to over 100 Ml ' In ' Ml 0-5 6-8 9-10 11-12 13-14 C vr 14 Totals 15. Nunbar of Work BY COMPARTMENT GP z -- FF S w WE 2_ 12 5 2 2 6 1 1 3 9 4 15 5 18 1 1 3 3 1 2 5 4 4 5 1 2 3 4 2 1 2 4 2 3 3 4 9 23 24 26 34 2? CHMiT * 2 Supaenravisor Secretory 0 1 0 ------ 47 35 12 0 21 1 14 i I 19 " *m 3 148 Number with Asbottasls i f Workers tsbetfost* 2 3 1 7 4 2 0 19 23% 13% 4% 27% 12% 8% 0 Nwaoer with Sutaoctad Aibwtosls . 2 3 3 4 4 4 0 20 % of Workers with Suspected Asbestosls 22% 13% 13% 15% 12% 17% 0 Nwaoer or Workers with positive or suspected Asbestosls 4 6 4 11 8 6 0 39 % o t Workers with positive or suspected Asbostosls 44% 26% 17% 42% 24% 23% 0 16. C n ly four of twanty-four F lY FRAME TENDERS hova ony vldanea of otbtotii. Howavar, ali of thwa show slgm of tho dtwuso ot total deot undar 70 MPPCrY Ihwo a undar 45 MPPCFY. Thi* saction has ona af tha b*t raoordb Io retard to d * control. Tba avidanca would sueoa* howavar, hot tho wocW* who will davalo? oafaaatoait I thl* saetlon will tand to <b so aorilor thon in mott othor sactions. I c RECOMMENDATIONS Pufmonory asbesteels It on Industrial haalth and preventive medicine problem of the Hr# magnitude. This study iuggntt that tha pcimory and most Important factor in acquiring the dlseate Is tha Individual worker's total oceweulotlve exporare to asbestos A nt. Previous sofa level figures of 3 MPPCF par year must be revised radically downward# the only concession short of an Ideal sere exposure being the minlmax relationship of diminishing returns venue Increaelng effort and expense. alert them net An only active to tha program of education of the danger Inherent in tha fob) workers brt also sthootuhladcboemupnadneyr'tsakefefnortto towards eliminating tha <mbe*ae Amt expoeure hoard workers. This pro*om thould be energetic forthright and and o n ly detection of continuous. It should include not only tha asbestos workers, but their families, the remainder of the working body of the Hoganevllle plont, and the community as a whole. Accumulative dust expoeure figures dwuld be kept current and readily available on a ll workers. Consideration should be given to posting section figures, ^ by the month, In the Involved areas end Inviting workers* suggprtlons regarding methods of lowering the dust hasard. (One who Ison the doily Jab may hove some pretty good practical ideas.) Chest x-rays thould be token* as Is now custonwypn ell new workers and an workers returning from layoffs, tllmmos, and leaves of absence. Otherwise x-rays need only be token at twelve.lntervols until tha worker has reached a total accumulative Arne of 20 MPPCFY. Thereafter, {above 20 MPPCFY) chest x-rays should be token every 6 C linical evaluation dwuld be dona during the first, third, and fifth years of the worker's employment; and thereafter, every year. If would be of peat interest and value If mere extensive studies could be M b * ! * , raprdfo, th . irtv r. f Strafed or suspected osbestosis. The Infarmotion ocqjirtd would be oF both medical and medico-legal significance. If the information we now possess Is propeHy utllixod, no worker need ever process beyond minimal early changes of osbestosis before he Is detected and re moved to a less hazardous environment. 13. should mean thaItfathgeivyeenowrlyorakcecruwmilullabteivoebelexctcoeusrteaydoont1h>eprfoobgrmewucihwllyonlgoewrearnedd,atit lea risk to alt concerned* *