Document YG3kayGYX5DqzjMN97K6bM94E

PLAINTIFF'S EXHIBIT l General Headquarters, August 29, 1933. Personal & Confidential Mr. A. R. Fisher, Manager, Manville Factory \V QUESTIONS ASKED CR. A. J. LANZA AND HIS ANSWERS VERBAIUM Attached is copy made by Mr. Kottcanp's office of questions asked Dr. A. J. Lanza by our local physician at Waukegan and his answers; also the recamendations by our plant physician. I would like to have you turn this over to someone who could review this correspondence and then go over it yourself and write me your opinion of it. cc - Mr. J. P. Kottcanp Waukegan Factory S. A. WILLIAMS, Vice President QUESTIONS ASKED OR. A. J. LANZA AND HIS ANSWIES VERBKHJM Question Na.l. Among eleven enployees in the Textile department, all exposed to asbestos dust, one only wears a respirator, several on being questioned claim they cannot wear them continuously especially in hot weather. Should all employees be forced to wear these respirators whether subjected to nuch or little asbestos dust? Is any such difficulty experienced at the Manville N.J. J-M plant or other plaoes of which you have knowledge? Answer: Respirators are not satisfactory. It is possible to construct a respirator which will filter out fine dust, but it would offer so much re sistance to respiration that it could not be worn continuously an an eight hour shift. There are on the market small face mask respirators which are equipped with positive pressure and these are both satisfactory, efficient, nd comfortable but they cannot be worn except by a person who stands in one )place as they have to be hooked up with a rubber tube to an air line. I doubt if they would be practical in a textile plant. Questions No.2. Do you agree with my- recamendation that employees definitely be made aware of the fact that, asbestosdust is hazardous to their health? My idea is that a poster be*plaoed.at one or more conspicuous plaoes in the de partment, signed by the- physician^ stating that the dust is injurious, ad vising the continuous use of respirators while at work and cleansing of hands before eating lunch and after work. Your nmiQnfr- on this please and particularly is there any addi tional advice that should be given? Answer: This is partially answered by No.l. I doubt if the hazard is sufficient to justify warning posters as might be used where lead, benzol or carbon monoxide are concerned. This is especially true in view of the extraordinary legal situation. If anything is said at all, it would be better to make a general statement that the Gcnpany is taking steps to control the amount of dust in the air for general health purposes. Any acticn contem plated at Waukegan would probably be influenced by the experience at other lants of the Oarpany. I -2- Qaestian No.3. Do you regard the finding of asbestosis bodies in the sputum as pathogenesis of asbestosis? I have one enployee with x-ray and physical findings pointing toward asbestosis but not sufficiently definite that I can be positive as to whether or not she has asbestos is. However, every ere of four or five speci mens of sputum examined show typical asbestosis bodies. On the other hand, is it possible for a person to have asbestosis and not be able, with careful and thorough search to find asbestosis bodies in the sputum? Answer: The presence of asbestos bodies in the sputum only implies that the individual has been exposed to asbestos dust. I am not certain of the exact pathological significance. My impression is that the presenoe of asbestos bodies in the sputum indicate seme definite lung pathology. I be lieve it is quite possible for an individual to have asbestosis without asbestos bodies in the sputum. Question No.4. Are you of the opinion that the added information derived from stereoscopic films of the-chest justified the procedure of taking a stereo on every case that is to be x-rayed? This is the conclusion I drew from Dr. Pancost's talk in Qiicago. Do you consider it advisable and practical that an x-ray film be taken of every employee in the Waukegan J.M plaint who is exposed to asbestos or silica dust? To date I have x-rayed only those cases suspected, from history or physical findings, of having asbestos is of other lung pathology. Answer: Stereoscopic films are better than single films. They are also more expensive. In our work at the Picher Clinic, we used single films sinply an account of the expense involved. You can diagnose silicosis or any other form of pneumoocmiosis from a single flat film. Cn the cither hand, you can probably get a more cxirplete and accurate idea of the exact condition of any given case frem a stereo. If it is the intention to determine what may be the* extent of pneumoconiosis among aiplcyees, obviously the only thing to do is to x-ray all of them and then correlate your findings with the length of exposure and nature of the job in order that you amy get a fairly accurate idea of what Che hazard is. Question No.5. ( -3 I have made a diagnosis of asbestosis on an enplcyee who has been working in the card roan of the textile department six years, mis place is extremely dusty. He is not disabled. In my judgment the best disposi tion of such a case is to rasove him from the dust and give him a job in sane other part of the plant. Fran your remarks in Chicago I believe this was your advise as to the disposition of such cases. Answer: It is difficult to answer this question. I think it would depend upon the man's age, the nature of his work, his length of service, and other considerations which might have sane bearing. If he is well along in years and shows no disability, it may be just as well to leave him alone. One of the difficulties and vexations in trying to deal with the problems of pneumoconiosis is that ecananic as well as production factors must be balanced against the medical factors. Question No.6. We have what to be an unfortunate situation existing in the fact that the asbestos textile department including loans, twisters, pools, etc. occupies one side or about half the width of a long kxiilding, the other side of which is occupied by the packing, brake lining and ocher J^ departments in which there is very little dust. The card roan, or rest ^ dusty part of the textile department is isolated by partition. Further isolation of the textile department involves considerable expense. Should or would you be guided by the dust counts and ocher observations in these adjoining departments? Answer: I think the answer to the situation outlined in this question is the control of dust in those processes that cause it. Vfren everything possible has been done' to accomplish this result, it may then be necessary to isolate or confine the dusty processes so as to avoid needless exposure of other exrployees not concerned in these processes. This is a situation that occurs in many different types of industrial hazard. It calls for nothing more than the application of careen sense to the problem. I General Headquarters, August 29, 1933. Personal & Confidential Hr. A. R. Fisher, Manager, Manville Factory questions asked cr. a. j. lanza AND HIS ANSWERS VERBATUM Attached is copy by Hr. Rottcanp's offioe of questions asked Dr. A. J. t*"** by our local physician at Waukegan and his answers; also the recenmendations by our plant physician. I would like to have you turn this over to someone who could review this correspondence and then go over it yourself and write ne your opinion of it. oc - Mr. J. P. Xottcanp Waukegan Factory S. A. WTLLIAfS, Vice President i QUESTIONS ASKED ER. A. J. LANZA AND HIS ANSWERS VERBAXUf Questi.cn No.l. Among eleven esployees in the Textile department, all exposed to asbestos dust, one only wears a respirator, several an being questioned claim they cannot wear then continuously especially in hot weather. Should all employees be forced to wear these respirators whether subjected to nuch or little asbestos dust? Is any such difficulty experienced at the Manville N.J. J-M plant or other places of which you have knowledge? Answer: Pocpiral-rre amo r*-&- eat-i It is possible to OOnStTUCt a respirator which will filter cut fine dust, but it would offer so much re sistance to respiration that it oould not be worn continuously on an eight hour shift. There are an the market snail face mask respirators which are quipped with positive pressure and these are both satisfactory, efficient, and comfortable but they cannot be worn except by a person who stands in one place as they have to be hooked up with a rubber tube to an air line. I doubt if they would be practical in a textile plant. Questions No.2. Do you agree with ay reocranendaticn that esployees definitely he made aware of the fact dn^t jg h**rdous to fv*n-h? My idea is that a poster be plaoed at cne or more ocnspicuous places in the de partment, signed by the physician, stating that the dust is injurious, ad vising the continuous use of respirators while at work and cleansing of hands before eating lunch and after work. Your nrMiiwnf cn this please and particularly is there any addi tional advice that should be given? Answer: This is partially answered by No.l. I doubt if the hazard is sufficient to justify warning pnutwa might be used Uiere lead, benzol or carbon monoxide are concerned. This is especially true in view or tne extraordinary legal situation. If anything is said at all, it would be better tp-make a general statement"that the Oanpany is taking steps to control the amount of dust in the avr for general health purposes. Any action oontan'lated at Waukagan would probably be influenced by the experience at other lants of the Cccpany. 030574 S 2 ' I Question No.3. Do you regard the finding of asbestosis bodies in the sputum as pathogenesis of asbestosis? I have one oployee with x-ray and physical findings pointing toward asbestosis but not sufficiently definite that I can be positive as to whether or not she has asbestosis. However, every one of four or five speci mens of sputum examined show typical asbestosis bodies. On the other hand, is it possible for a person to have asbestosis and not be able, with careful and thorough search to find asbestosis bodies in the sputum? Answer: The presence of asbestos bodies in the sputum only implies that the individual has been exposed to asbestos dust. I am not certain of the exact pathological significance. My impression is that the presence of asbestos bodies in the sputum indicate seme definite lung pathology. I be lieve it is quite possible for an individual to have asbestosis without asbestos bodies in the sputum. ) question No. 4. Are you of the opinion that the added information derived free stereoscopic films of the chest justified the procedure of taking a stereo on every case that is to be x-rayed? Hiis is the conclusion I drew free Dr. Pancost's talk in Chicago. Do you consider it advisable and practical that an x-ray film be taken of every employee in the Waukegan J.M plaint who is exposed to asbestos or silica dust? To date I have x-rayed only those cases suspected, from history or physical findings, of having asbestosis of other lung pathology. Answer: Stereoscopic films are better than single films. They are also , more expensive. In our work at the Picher Clinic, we used single films simply on account of the expense involved. You can diagnose silicosis or any other form of pneumoconiosis from a single flat film. On the other hand, you can probably get a more ocnplete and accurate idea of the exact condition of any given case from a stereo. If it is the intention to determine what may be the extent of pneumoconiosis among employees, obviously the only thing to do is to x-ray 'll of them and then correlate ypur findings with the length of exposure and iture of the job in order that you may get a fairly accurate idea of what che hazard is. 030574C 3- Questicn No.5. ( I hove Bade a diagnosis of asbestosis on an cnployee who has been working in the card room of the textile department six years. This place is extremely dusty. He is not disabled. In ay judgment the best disposi tion of such a case is to remove him from the dust and give him a job in same other part of the plant. Fran your remarks in Chicago I believe this was your advise as to-the disposition of such cases. Answer: It is difficult to answer this question. I think it would depend upon the man's age, the nature of his work, his length of service, and other considerations which might have sane bearing. If he is well along in years and shows no disability, it may be just as well to leave him alone. One of the difficulties and vexations in trying to deal with the problems of pneumoconiosis is that economic as well as production factors oust be balanced against the medical factors. Question No.6. He have what seems to be an unfortunate situation existing in he fact that the asbestos textile department including locos, twisters, .pools, etc. occupies one side or about half the width of a long building, the other side of which is occupied by the packing, brake lining and other departments in which there is very little dust. Ihe card roan, or Best dusty part of the textile department is isolated by partition. Further isolation of the textile department involves considerable expense. Should or would you be guided by the dust counts and other observations in these adjoining departments? I think the answer to the situation outlined in this question is the control of dust in those processes that cause it. When everything possible has been done to aaxnplish this result, it may then be necessary to isolate or confine the dusty processes so as to avoid needless exposure of other employees not ocncemed in these processes. This is a situation that occurs in many different types of industrial hazard. It calls for nothing more than the application of ra.nfn.-n sense to the problem. / 030574 D REX^WEKQATiaC OF PLANT R1YSICIAN FOLLOWING EXAMINATION OF EMPIflffiES IN TEXTILE CEEARIMENT AND GCM4ENT BY OR. A. J. IANZA 1. The provision of the best type of dbst oollection and exhaust ventilation equipment. Cement: By all naans. 2. Personal respiratory protection of an adequate and approved type for every enployee in this department. Carment: I do not know. 3. Employees in the textile department should tactfully but definitely be made aware of the fact that work in asbestos dust is hazardous to their health. Every reasonable effort should be made to induce then to war respirators. They should be instructed in the necessity of thoroughly cleansing their hands before eating lurch and after work and provided with adequate facilities for doing this. Cement: I think this is out, at least for the present. Personal cleanliness does not enter into this problem. . I advise rigid adherence to the factory manager's order that no employees je hired or rehired in this department without first being examined and approved by the plant physician and further that no raployee be transferred to this depart ment without first being approved by the physician. Cement: Absolutely correct. 5. I advise re-examination, as indicated, of all workers in asbestos dust and x-rays of any suspected cases. I consider the re-examinations and the continued study of this hazard and its effects of more iaportanoe than the first examination. Ftcn this point of view, the study of some of these cases may be considered ccnplete. Cement: Entirely correct, with the understanding that no examination without an x-ray is worth anything in dealing with Pneumoconiosis. 6. I request, if possible and approved by Mr. Williams, contact with seme authority on asbestosis who has x-ray films showing the condition. This for the purpose of ocaparative study of our suspected cases. Cement: We can probably help you in this if your oenpary is willing. 7. My rejection of Marie Xutenski, made at the time of first examination, stands. Cement: This is outside of my knowledge. 8. I have deferred rejection or classification of Dwain O. Bell, first: be cause of the delicacy of the situation thich might arise in connection with his case, and secondly: because it is generally believed that removal of a worker from the st will not retard or affect the progress of the disease once it is established. ment: Ditto. 030574 E QUESTIONS ASKED ER. A. J. LANZA AND HIS ANSWERS VERBA3UM Question No.l. `. Among eleven employees in the Textile department, all exposed to asbestos dust, one only wears a respirator, several on being questioned claim they cannot wear them continuously especially in hot weather. Should all erplcyees be forced to wear these respirators whether subjected to much or little asbestos dust? Is any*such difficulty experienced at the Marrville N.J. J-M plant or other places of\hich you have knowledge? Answer: Respirators, are not satisfactory. It is possible to construct a respirator which will filter out fine dust, but it would offer so much re sistance to respiration that it could not be worn continuously on an eight' hour shift. There are on the market small face mask respirators which are equipped with positive pressure and these are both satisfactory, efficient, nd comfortable but they cannot be worn except by a person who stands in one ice as they have to be hooked up with a rubber tube to an air line. I ubt if they would be practical in a textile plant. Questions No. 2. Do you agree with my recccoendation that employees definitely be made aware of the fact that asbestos dust is hazardous to their health? My idea is that a be placed at one or more conspicuous places in the de partment, signed by the physician, stating that the dust is injurious, ad vising the continuous use of respirators while at work and cleansing of hands before eating lunch and after work. Your rvinmanfc on this please and particularly is there any addi tional advice that should be given? .Answer: This is partially answered by No.l.' I doubt if the hazard is sufficient to justify warning posters as might be used where lead, benzol or carbon monoxide are ccnoemed. This is especially true in view of the extraordinary legal situation. If anything is said at all, it would be better to make a general statement that the Cccpany is taking steps to ocntrol the amount of dust in the air for general health purposes. Any action contem plated at Waukegan wroijld probably be influenced by the experience at other 'ants of the Cccpany* -2 Question No. 3. Do you regard the finding of asbestosis bodies in the sputum as pathogenesis of asbestosis? I have cne employee with x-ray and physical findings pointing toward asbestosis but not sufficiently definite that I can be positive as to whether or not she has asbestosis. However, every cne of four or five speci mens of sputum examined show typical asbestosis bodies. On the other hand, is it possible for a person to have asbestosis and not be able, with careful and thorough search to find asbestosis bodies in the sputum? The presence of asbestos bodies in the sputum only implies that 'the individual has been exposed to asbestos dust. I am not certain of the exact-pathological significance. Hy impression is that the presence of asbestos bodies in. the sputum indicate sene definite lung pathology. 1 fae.lieve it is quite possible for an individual to have asbestosis without asbestos bodies in the sputum. Question No. 4. Are you of the opinion that the added information derived frm stereoscopic films of the chest justified the procedure of taking a stereo on every case that is to be x-rayed? This is the conclusion I drew from Dr. Pancost's talk in Chicago. - Do you consider it advisable and practical that an x-ray film be taken of every eeployee in the Waukegan J.M plant who is exposed to asbestos or silica dust? To date I have x-rayed only those cases suspected, from history or physical findings, of having asbestosis of other lung pathology. Answer: Stereoscopic films are better than single films. They are also more expensive. In our work at the Picher Clinic, v* used single films simply on account of the expense involved. You can diagnose silicosis or any other form of pneumoconiosis from a single flat film. On the other hand, you can probably get a more complete and accurate idea of the exact condition of any given case from a stereo. If it is the intention to determine what may be the extent of pneumoconiosis among ecplcyees, cbyicusly the only thing to do is to x-ray all of them and then correlate your findings with the length of exposure and mature of the job in order that you nay get a fairly accurate idea of what e hazard is. jesticn No.5 I I have made a diagnosis of asbestosis on an employee who has been working in the card roan of the textile department six years. This place is extremely dusty. He .is not disabled. In sy-jdpnent the best disposi tion of such a case is to xencve his free the dust and give him a job in sane other part of the plant. Rom your remarks in Chicago I believe this was your advise as to the disposition of such cases; .Answer: It is difficult to answer this question. I think it would depend upon the'man's age, the nature of his work, his length of service, and other considerations which might have sane hewing. If he is well along in years and shows no disability, it may he^just as well to leave him alone. One of the difficulties and vexations in trying to deal with the problems of pneumoconiosis is' that mechanic as well as production factors must be balanced against the medical factors. Question No.6. - '' Vie have what seems to be an unfortunate situation existing in 'the fact that the asbestos textile department including loans, twisters, nools, etc. occupies one side or about half the width of a long building, e other side of which is occupied by the packing, brake lining and other -apartments in which there is very little dust. The card roan, or most dusty part of the textile department is isolated by partition. Further isolation of the textile department involves considerable expense. Should or would you be guided by the dust counts and other observations in these adjoining departments? Answer: I think the answer to the situation outlined in this question is the control of dust in those processes that cause it. then everything possible has been dene to accccplish this result, it may then be necessary to isolate or confine the dusty processes so as to avoid needless exposure of other employees not concerned in these processes. This is a situation that occurs in many different types of industrial hazard. It calls for nothing more than the application of catnrn sense to the problem. BEX^mENIAnCKS OF PLANT PHYSICIAN FOLLOWING ECAMINATICN OF EMPLOYEES IN TEXTILE EEPAFSKENT AND OWENT BY DR. A. J. LANZA 1.. Tha_pruvisi.cn of.the.best typeof/dbst_ooUec^cn and exhaust ventilation equipment. Consent; By all means. 2. Personal respiratory protection of an adequate and approved type for every erployee in this department. Comment: -I do not know. ,.V. 3. Employees in the textile department should ttetfully but'definitely be ' made aware of the fact that work in asbestos dust is hazardous to their health. Every reasonable effort should be made to induce them to war respirators. They should be instructed in the necessity of thoroughly cleansing their hands before eating lunch and after work and provided with adequate facilities for doing this. Caroent: I think this is out, at least for the present. Personal cleanliness does not enter into this problem. 4. I advise rigid adherence to the factory manager's order that no enployees a hired or rehired in this department without first being examined and approved ' the plant physician and further that no erployee be transferred to this depart.nt without first being approved by the physician. Ccrrrer.t; Absolutely correct. 5. I advise re-examination, as indicated, of all wsrkers in asbestos dust and x-rays of any suspected cases. I consider the re-examinations and the continued study of this hazard and its effects of more importance than the first examination. From this point of view, the study of seme of these cases may be considered ccrplete. Oonrnent: Entirely correct, with the understanding that no examination without an x-ray is worth anything in dealing with Pneimocxru.csis. 6. I request, if possible and approved by Mr. Williams, contact with sere authority on asbestosis who has x-ray films showing the condition. This for the purpose of cccparative study of our suspected cases. Ccrment: We can probably help you in this if your cerpany is willing. 7. My rejection of Marie Iutenski, made at the time of first examination, stands. Cotinert: This is outside of ny knowledge. 8. I have deferred rejection or classification of Ewain O. Bell, first: be cause of the delicacy of the situation which might arise in connection with his case, and secondly: because it is generally believed that removal of a worker from the dust will not retard or affect the progress of the disease once it is established. Ttment: Ditto. I General Headquarters, August 29, 1933. Personal & Confidential Mr. A. R. Fisher, Manager, Manville Factory QUESTIONS ASKED ER. A. J. LANZA AND HIS ANSWERS VERBATOM Attached is copy aade by Mr. Kottcairp's office of questions asked Dr. A. J. Lanza by our local physician at Waukegan and his answers; also the reccnrerriations by our plant physician. I would like to have you turn this over to someone who could review this correspondence and then go over it yourself and write Toe your opinion of it. cc - Mr. J. P. Kottcanp Waukegan Factory S. A. WIUIM6, Vice President 0 rvrr^ * Tir*?nvy .1^ tr. t. I, fUbr, '- ^rfm*mr ta, lit.', A. /. UIU urtif lb V > : * >. / j* (o qp'jsnca ucs i. uss.i jss zzs gwa Tscuyai BmU tU to toX>to< to (Mto v Uvtl* uto to toa anrHUi *.4. }! to . IU a;M< to WBw>iny to fcn toil to b I to t to- to lU, It tali I S bra of wV<M* WiM m f M> nix tepklXM I I ( . 1 c V, sscssrunoi cr ?un susui fours:a * susaina 9 stvooqi 9 tunu soizrsa ss> vssn ar as. a. . um R3Z JM 5Mt(