Document VqxBR17M5gYe4JkxEM7KnQrN

FILE NAME Manville JMA DATE 1955-1956 DOC JMA212 DOCUMENT DESCRIPTION Memos RE Proposed Epidemiological Study at the Quebec Mining Association ~ INDUSTRIAL HYGIENE FOUNDATIOONF AMERICA.INC Memorandum To C. Richard Walmer M. From Daniel C. Braun M.D. Date December 19 1955 I met with Ken Smith and Hugh M. Jackson in New York on Thursday December 15 1955. The subject under discussion was a proposed study by the Foundation for the Quebec Asbestos Mining Association relative to the incidence of lung cancer in asbestos workers As result of our discussion a proposal will be made to the Association by Mr. Fisher that such a study be undertaken A brief memorandum will be prepared for Dr. Smith by January 15 at which time he will have the Association's reply to Mr. Fisher's proposal Dr. Smith and I will visit Montreal Dr. Vidal Quebec City Dr. Parrot the government statistician Thetford Mines Dr. Cartier and Asbestos This visit will be for an optical survey to permit an evaluation of the study and its ~ cost Expenses will be borne by the Association and if the project is approved the fee for the original visit will be included in the total amount Otherwise a fee of 500.00 was quoted for the initial visit The study will be epidemiological and statistical in nature and will cover a period of a year during which approximately half time will be devoted to the study I discussed the statistical phase of the study briefly with Dr. Gafaerin Washington on Friday At the same time we visit Thetford Mines and the clinic at Asbestos we will engage in a separate study relating to a medical survey of these facilities This venture would be separate and distinct from the cancer study and would be charged for separately The study would be financed by M and the Association 3 A third subject discussed was the possibility of a total medical survey for the Manville Corp. covering its 20,000 employees in 65 locations Dr. Smith will visit us in Pittsburgh on February 8 and 9 in order that we may familiarize him with the reports of previous surveys aid him in developing a company policy toward the medical program and discuss further the possibility of a company medical survey PRODUCED PRODUCED PRODUCED 21 3 3 4 : as 3 DCB 0454 ee eee com + Notes on Dr. Braun's Trip to Canada re Lung Cancer Survey for Manville Corporation . +e ae 2 February 28 1956 . of J M and Dr. Sunday Feb. 19 1956 conference with Dr. Kenneth Smith Mr. Ivan Sabourin Dr. Vidal Dr. Gui Dr. Roger Granger Paul Cartier at Mr. Sabourin's home Mr. Sabourin presented a broad outline of the need for an epidemiological study the interest of the Quebec Mining Association in such a study and the facilities of IHF Monday Feb. 20 conference with Dr. Groulx City Health Officer from Montreal with Dr. Smith and Mr. Sabourin General prob- lem outlined for Dr. Groulx Dr. Maille statistician for the Montreal Health Dept. brought into conference cooperation pointed out that death certificates were unreliable Nevertheless we were shown figures for deaths from cancer including a category for primary cancer of lung see : Lunch at the Mount Steven Club with Mr. Sabourin Dr. Smith and Dr. Valois City Health Officer for Verdun and formerly in Dr.Maille's position Dr. Valois is closely associated with the National Cancer Institute He suggested conference with Dr. Phillips statistician in Toronto for the National Cancer Institute Dr. John T. Marshall and Dr. Kohn who are statisticians for the Dominian Government at Ottawa Dr. Valois also thought that all cases of lung cancer diagnosed and treated in Montreal could be obtained from three sources Dr. O. Dufresne at the Institute du Radium Dr. Simard at Notre Dame Hospital and Dr. Morton at the Royal Victoria Hospital ou After lunch Sabourin Smith and proceeded to Radium Institute g for a conference with Dr. Origin DufresnHee suggested writing to each i 4 hospital either in Montreal or the entire province for cases diagnosed over the past 10 years His own records are very complete as regards cases diagnosed Surgical cases are referred elsewhere He does not believe his cases together with those at the Royal Victoria Hospital would represent all cases in Montreal He admits that to canvass the hospitals might duplicate many cases PRODUCED JM - 83 . 0447 Se mr ema eee, am? Om ~ eres Tuesday Feb. 21 conference with Dr. Gregoire Minister of Health Province of Quebec Dr. Smith and Mr. Deputy Dr. Gregoire opposes law to require reporting of cancer Sabourin He feels only chance of getting a control group is to be found in Montreal he feels outlying centers such as Chicoutimi are too recently in operation and certificates of death are too inaccurate He thinks there are too many cancer detection centers in the Province of Quebec and they are not located where needed Conference with Dr. Paul Parrot statistician for the Provincial Health Department This was the most productive conference to date Dr. Parrot is a conscientious and competent statistician His records would be adequate providing we deal only with mortality His death certificates are available he follows up with the physician when the death certificate is questionable he corrects the cause of death when inquiry or subsequent autopsy so indicates of Parrot's figures are as follows Limitations on the usability ) Only the immediate cause of death is used in the published reports although secondary cause considered in the figures kept in the office es 2 The code number for cancer of lung in Parrot's statistics covers neoplastic disease of lung or bronchi undifferentiated as to primary or secondary a 3 Previous to 1941 deaths were compiled as to place of occurrence although since that time they are compiled as to : place of residence 4 Confining ourselves to mortality data death certificates we would miss all presently diagnosed cases not yet dead 5 Every case reported as dying of Ca of lung could be followed although many are not confirmed by operation or autopsy But it would be impossible to follow all cases certified as dying some other cause which may actually have been Ca of lung Furthermore an individual who may have actually died of another cause might also have had Ca of the lung Statistics from Dr. Parrot s, Population of the Province of Quebec - 4,500,000 4,500,000 approximately Total deaths in Province in 1954 = 3,169 3,169 Deaths from all types of cancer in Province in 1954 - 5,037 5,037 Deaths from lung cancer in Province in 1954 - 131 of which 108 were males Mean ag age e at death was between 65 and 70 PRODUCED PRODUCED PRODUCED PRODUCED JM - 83 Neoc e Fa e eo ete fen ee Lees Dee adil . Selitay . arene Dr. Parrot stated therate was 116.2 per 100,000 If have this figure correct I cannot reconcile it with the above figures | 5037 divided by 45 equals 111.9 and 131 divided by 45 equals 2.9 oe Dr. Parrot gave us population figures as follows | -* Megantic County - 47,016 in 1954 Thetford Mines is in Megantic County Richmond County - 36 285 Asbestos is located in Richmond County County Other localities having about the same population as Megantic Portneuf - 45,000 Levis - 45,000 . One locality with population comparable to Richmond County was Arthabaska with 39,000 39,000 , Best statistics in the Dominian of Canada are British Columbia Ontario and Quebec _' obtainable from Later on Feb. 20 visited Dr. Bertrand Bellemare who is the physician connected with the Workmen's Compensation Board and =~ directly representing the Ministeorf Labor Dr. Bellemare's attitude was one of resistance and defensiveness although he finally expressed a willingness to cooperate It is Dr. Bellemare who is most troublesome to the industry ; Left by car for Thetford Mines afternoon of Feb. 20 . u Soe o Bie gers , . - _ 4 DUDED DUDED DUDED f DUDED DUDED DUDED DUDED JM.- JM.- 83 0449 . . oN . en+ e r Oe eee te ee-e we = eee mere wv.ess ~ meee eee oe ee ce eee - . Feb. 22 Thetford Mines Dr. Cartier's Clinic Population of the city of Thetford Mines is estimated by Dr. Cartier and Dr. Smith as 19,000 personnel man of Asbestos Corp estimates it at 18,000 18,000 Smith and Cartier estimate the population of the area at 26,000 the adult males at 7,500 and the workers in the asbestos industry at about 4,000 4,000 The latter is very stable and has a low turnover Dr. Cartier has the impression that primary lung cancer incidence is higher in Thetford Mines than anywhere else in the Province except Montreal He is con- cerned about the influence of autopsies on incidence figures and points out that there are three times as many cases of lung cancer in Montreal as there are in Quebec city and that the number of autopsies performed in is Montreal exactly three times the number I copied tables on the incidence of lung cancer office Do performed in Quebec city from slides in Dr. Cartier's The Clinic serves employees as follows - Flintkote - 300 Asbestos Corp. - 1740 Johnsons - 625 Bell Asbestos - 450 Quebec Asbestos at East Broughton O 450 Lake Asbestos UN Asbestos - 200 not a producing company Total - 3765 probably hourly employees only Drs Smith and Cartier think salaried workers would bring total to about 4000. The McCloud Foundry with 120 employees is also serviced by the Clinic A chest ray is made on each employee every year Except for certain executives all persons on the payroll get these rays employment examinations are also made at the Clinic and a complete folder is maintained on each worker Content of this folder is noted in my handwritten notes and I have copies of forms used to record results of examinations and to report to the companies Drs Cartier and Smith agree that about 75 of the people in the _ asbestos industry may have sufficient exposure to differentiate them from general population They include for example supervisors and product ie 5 control men who have occasional exposure to the fiber or dust They rate bere, exposures in five categories On this basis 3000 people at the Thetford + Mines would constitute the population of the study There is a question as to whether or not the entire population of the community should be used or all employees of the asbestos industry or only those with at least this mini- mal exposure This contact with fiber or dust is not to be confused with exposure in the sense of acquiring asbestosis -_-- _ ww me- Dr. Cartier states that there are now known living 128 caseosf asbestosis of any degree He believes there are perhaps 300 additional who have less than radiological changes Smith does not agree and at best this must be only a guess on Cartier's part Dr. Cartier estimates an additional 40 may have died having some degree of or asbestosis ~ retired or been compensated There are therefore 166 possible cases of radiologic asbestosis wat ag z 18 cases of lung cancer are known to Dr. Cartier on the basis of post mortem confirmation over a period of 20 years Of these one was later proved to be metastatic from kidney 4 others he considers questionable because 2 were without post mortem and 2 were simply reported as cancer of lung on the death certificate Of the 13 remaining cases all were proven by autopsies as being primary in lung Four had advanced asbestosis 7 had minimal or questionable asbestosis negative for asbestosis on ray and 2 had no evidence of asbestosis at autopsy One of these cases occurred in 1946 one in 1940 and the remainder in the period 1946 to 1955 inclusive They represent all of the cases in the Province of Quebec except two occurring at Asbestos Evening of Feb. 22 dinner meeting with Dr. Phillips of the Canadian Cancer Society and Dr. Simard Past President of the Society at the Mount Steven Club Others present were Mr. Sabourin Dr. Smith Dr. Cartier Dr. Gui and Dr. Vidal This was to explore the possibility of obtaining from the Cancer Society statistics and figures relating to incidence in the Province My impression that Dr. Phillips and Dr. Simard did not understand what was wanted and proceeded on the theory that the Cancer Society would set up and plan a study to be financed by the QAMA and Mellon Institute Nate, "Mite + woe mp - we em ee 1 EP COOTER + February 23 at Asbestos with Dr. Granger The Clinic serves 3000 workers all M and in addition does periodic rays on 135 to 140 Norbestos Company workers 2577 periodic rays made in 1955. As of 1955 there were 17 cases of radiologically diagnosable asbestosis The reading is sufficiently alike at Asbestos and Thetford so that the discrepancy cannot be accounted for on this basis The dustiness is considered to be lower at Asbestos than at Thetford Mines No additional cases of asbestosis could at first be recalled but later we found one compensated in 1946 2 dead one with asbestosis and cancer making a total of 21 cases of asbestosis Note 168 cases out of 4000 at Thetford and 21 cases out of 2500 at Asbestosis would indicate an incidence of asbestosis at Thetford 5 times that at Asbestos Total known cases of cancer of lung at Asbestos is 2. Detailed information on each in my handwritten notes One of these cases had asbestosis the other had no asbestosis The latter was not autopsied M has compulsory retirement at age of 65 Thetford has not _ - There is good follow of retired employees aided by the fact that all local medical facilities are acutely aware of asbestosis It is my impression that the industrial hygiene at M must be very much better than at Thetford . \ M transfers men when periodic ray first indicates fibrosis They also rotate men in the course of normal employment No such ro- - tation or transfer occurs at Thetford The age of the two workings is similar The average of M workers is lower than at Thetford Smith and Granger think as much as 10 years Discussion with the personnel man at M in Asbestos discloses that the bulk of the M employees live within a radius of 15 miles of Asbestos There are 2360 employees on hourly rate of which 375 work in the factory 590 salaried employees make up the total to 2950. McGow states that there is a low labor turnover but not quite as low as at Thetford Asbestos is a industry town the labor force comes mainly from Richmond and Arthabaska Counties The population of Asbestos is approximately 10,000 Danville has 2500 to 3000 Richmond has 4000 to 5000 and there are County./ a few small factories including shoe textile and foundries in Richmond County./ The Travelers Insurance Company covers sickness accident and death benefits Diagnoses and causes of death are available from their records Insurance is continued after retirement of the employee Serious illnesses are for the most part treated in hospitals Sherbrook and Arthabaska draw the major portion of the population but some go as far as Montreal or Quebec Mr. On Friday February 24 we a summarizing meeting with Sabourin at the Windsor Hotel after which we visited Dr. Simard at Notre Dame Hospital to clear up a point which Mr. Sabourin had missed at the Wednesday evening dinner meeting We wished to make certain that Dr. Simard had taken the position Wednesday night that ~ the Canadian Cancer Society would undertake plan and execute the study and that they would expect to be paid therefore In this latter discussion it was obvious that this was his thinking ** - + wa wow a Neate. Sre SEDUCED SEDUCED SEDUCED SEDUCED SEDUCED SEDUCED SEDUCED SEDUCED SEDUCED SEDUCED EXPOULIVI EXPOULIVI OFFICES MaxVILLE GORPORATION EWENTY .... ... KORZETETI STREKE STREKE NEW YORK 16 11 October 10 1956 Dr. Paul Gross Industrial Hygiene Foundation of America Mellon Institute - 4400 Fifth Avenue Pittsburgh 13 Pennsylvania Inc. Dear Paul Unfortunately we do not have any section or tissue material available here Actually the several cases which we have forwarded Sararac for study have either been cases which we did not feel were asbestosis or cases which were primarily silicosis with a minimum exposure to asbestos Saranac has of course studied a number of asbestosis te cases forwarder them by the Thetford group To the best of our if you should want some doors knowledge to review this this case material is still at data I am sure we can at Saranac and least open . The only Quebec symposium of which we have knowledge is one which was held in Montreal in October 1945. This Symposium on Specific Pneumoconioses was held under the auspices of La Societe de Phtisiologie de Montreal and as far as we have been able to ascertain there have been no minutes of the meeting or copies of the paper published I have attached copy of the program of this meeting for your review and sime Ken was in attendance he may be able to recall some of the essence of the papers You are familiar I am sure with the papers appearing in the A. M. ARCHIVES OF INDUSTRIAL HEALTH March 1955 which were read at the Symposium on Occupational Diseases of the Lungs held in Boston in October 1953 and sponsored by the Massachusetts Medical Society and interely yours i wi ye: M. Jackson Manager Industrial Health Program PRODUCED JM - 83 0118 =, MEDICAL PROGRAM PROGRAM Thursday October 25 1945 Introductory Romarks 1 neumoconioses as an Industrial Problom 2. Etiology of the Pneumoconioses - b b Eenign specific Silicosis forms c Asbestosia Dr. F. Herbert Dr. F. J. Tourangeau Dr. A. R. Riddell Dr. L. U. Gardner 3. Silicosis - Pathological Anatory - 4. Fadiolaical Picture Diagnosis - Classification Classification and Technique 5. Clinical Ficture 6. Tunchean G. Dr. G. Manseau Dr. Hugh Burke Lecturer On Discussion Dr. A. Fobert Lecturer Dr. H Lacharite Discussion Dr. J. 1. Vinal Lecturer Br Louis oussen Dr. B. CuddihCuddyihy oussen Discussion 7. Physiological Consideration and Froblem of istimatin- Disability in pecific Pneumoconioses 8. Asbestosis Patholerical Anatomy Anatomy - 9. Asbestosia Pay and Clinical Picture lagal Aspect Prevention and Treatment of Specific Pneumoconioses 12. Closing Femarks and Summary 13. The ks Will Be Extended By G. Dr. Dr. G. Wright C. Frouha Lecturer On Discussion Dr. L. 1. Gardner Lecturer Dr. M. Giroux On Discussion Dr. T. Vastal ^ TC. R. Mavis Dr. Stevenson Lecturer Lecturer On Discussion k Dolois 1. Sabourin Lecturer On Discussion Dr. L. U. Lecturer Dr. J. W. C. Hannon On Discuss- , . ion Dr. Wright On Discussion Discussion Dr. A. J. Lanza Dr. J. A. Jarry Symposium on Specific Pneumoconioses held under the auspices of La Societe de Phtisiologie de Montreal at Sacred Heart Hospital Cartierville Montreal 0119 PRODUCED 16 07