Document Yr5bO4rXLRLQeNMNQ8akeGOrN

FILE NAME Insurance Industry INS DATE 1957 DOC INS065 DOCUMENT DESCRIPTION Published Conference Presentation - The Asbestos Industry Health Experiences Among Asbestos Workers ee Fe . . 2 * i, . . - 1957-3 ma . %e, e 2 *fi . a en SZ . Cee. *. . 5 i . va . 1957-3 _ . 1957-3 1957-3 1957-3 ; : . - * eae - 2 187 CENTAUR MRALTI EXPERIENCES AMONG ashestos worKERS 187 nae | hoo, : THE ASBESTOS INDUSTRY-- INDUSTRY-- Se, CERTAIN HEALTH EXPERIENCES AMONO ASBESTOS WORKERS "0 , BY KENNETH W. SMITH M.D. AND HUGH JACKSON - . Fo 7 '. . In this presentation I shall try to outline certain health 5% exper.ences which we have seen in asbestos workers not only - -.- in my own company but in many other associated + I While asbestosis is a well companies 2.7 recognized occupational disease <r |} there are relatively few people in the working populations of -+-. oo the United States and Canada who are exposed to asbestos dust and actually very few ever develop the disease It will be shown that the lives of the asbestos workers are not shortened by their occupation and also that work in these trades does not predispose the individual to other pulmonary - v *"O "_ diseases of nonoccupational nature Cote woe Tl word nghestos is generally used to describe several brous magnesium silicates which are wig ve #3 their chemical entirely different in - + '! (pees | composition and in their physical properties , There are several types of these fibers The most . are the chrysotile amosite and crocidolite Depositismpofortthaenste 7 at" various types of fibers are found throughout the world argest deposits are in Tho :::mo eastern Canada and Africa sete These asbestos fibers are highly resistant to heat and Sete % are resistant to acids some They have great tensile strength and : oe .:*- large surface areas their Because of these properties as well as filamented structure the industrial use of these fibers throughout the world is increasing The textile industry has used these fibers for generations to produce blankets clothing threads ropes tapes braided tubing and filters In recent years however there has been an use tofraadsebsestIons in the insulation building and friictnicorneamsaitngeruiasl ea" addition the fiber can be found in wallboard >x: shingles pipe covering floor tiles brake linings and brake blocks cements putties and extensively in plastics reg years i Historically the material has been used for many years *--' Those who are biblical students will recall that in the third - | hapter of Daniel the three men Shadrach Meshach and (r0v7.2 0: Abednego were thrown into the fiery furnace by Nebuchadnez- . Proceedings - Home Office Life Underwriters -- * : - 7 Association 1957 - oly ut , veyed ISS HOME OFFIice life UNDERWRITERS . ABSOCIATION zar the king of Babylon They emerged from the fire com- . , pletely unharmed and archeologists today lead us to believe ~ that they were protected from the flame by a blanket of woven . asbestos fiber Thus we can see that the mineral has been ; . used for many centuries but it was not until thirty years that a definite occupational pulmonary diseaso - was associated with the inhalation of this fiber As previously indicated the industry is finding many new uses for the fiber when mixed with other materials It is an established fact that when asbestos fiber is mixed with silica * or diatomaceous earth or other potentially toxic dusts tha | pulmonary changes resulting from the inhalation of these - mixtures are not typical of asbestosis The ray pattern is different the clinical course of the patient is changed or the susceptibility to intercurrent infection is increased or de + creaser ' sin sin making a diagnosis of occupational pulmonary ae e Oe Se a. Ne gs. ... lee .oa ' eo disease it is highly important to obtain a detailed occupational history not only the job title but also a complete list of raw materials used in the particular job so that asbestosis _-. se .* | . el, inte silicosis or the mixed pneumonoconioses can be differentiated 2 United We believe that there are fewer than 15,000 people in the -w ;oe . United States and Canada who are employed today in mines and mills where their potential exposure is only to asbestos erwne:tee a nee fiber In this industry the various mining milling and manu- . _ facturing operations create some dusts which are capable of -. + being inhaled If asbestos fibers from ten to fifty microns in t.3 04% length are inhaled continuously and in sufficient quantities \., a over a period of many years a typical pulmonary fibrosis will fibrosis - develop It has been demonstrated that this is not : due to the chemical but rather to the mechanical action of ? the fibers - : . , eeoe wf rey loss The fibers are deposited in the terminal bronchioles of the i oo lungs Then the tissue reacts coating the fiber and forming . a what is known as the asbestos body This appears to be a ~ defense mechanism of the lung .. . oo loss Zz an loss Many individuals who have these asbestos bodies in their their / / sputum have had only intermittent exposures to the dust k bv and have absolutely no evidence of the disease So it seems Than T more appropriate to use the term asbestos bodies rather - .f , + -- ee he I Peg WR wae a oan Cs a oe ry) Ty se oo . - . : wee A ow re * ce ee 189 CERTAIN HEALTH EXPERIENCES AMONO ASBESTOS wonxens ve we . 4 ae . Pe te . mtd bodies signifying than asbestosis " signifying anan exposure to the fiber ~ but not necessarily indicating discase .- ' rane ahn am.* teta. If increasing quantities of the fiber are continually inhaled at ee De the tissue reaction progresses and a generalized diffuse fibrosis Card Soe te : or scarring appears throughout the lower lobes of the lungs st . With additional exposure this fibrosis may spread to the other - lobes of the lungs resulting in respiratory embarrassment -- ee and eventually cardiac failure \ prolongedprolonged The pulmonary fibrosis resulting resulting from prolonged inhalation inhalation inhalation ne a Se of the fiber will produce a very typical ray pattern which we does not resemble that produced by any any of the other known ~ toxic dusts The ray picture should never be used to estimate the presence or extent of an impaired pulmonary pulmonary function or disability Many cases with ray evidence evidence of advanced asbestosis have been known to carry on their work - and live very comfortable lives for several years "+ There's no typical clinical picture of asbestosis 2" The diseas~e is very slow and insidious in its onset and very slowly pro- -. gressive with continued inhalation of the fiber The textbook - signs of cyanosis and clubbing of the fingers are virtually non- o Existent in the cases of asbestosis we see today ..- ; aw An ray survey was made of 708 employees working an 0. 275. asbestos mill where the ore was dried crushed separated and 0.2.7 graded packed and then shipped Operations in this plant "7 required the employees to rotate through various that it was impossible to relate any ray changes to a particular job or to a specified dust concentration same time it could be assumed that all members of the had been exposed to varying concentrations of the group dust dust v +. The rays of these employees were divided into three three groups essentially normal ; those with exaggerated markings 2." but not typical of any disease and those with definite asbestosis * sis Of the 708 employees studied 649 or 91 per cent had -. ws normal rays This is of interest, because 204 of the em- | a ployees or 29 per cent of the total had more than ten years of service Two men actually worked over forty years in varying dust concentrations with absolutely no evidence of any increased markingsmarkings in their rays .. Fifty of the 708 employees showed some increase of WO STETT. all peribronchial markings although none had any evidenco i e . . fos eee us F ee erg . Tt ge ae . . . Be . . . of e ue . ,? e . e . which ar es Se which io " : S . : * 100 100 nique office liye undeNWNITERS ASSOCIATION , ,, ,, , . ? ft of asbestosis Sixty per cent of this grou . had more " than ten years of service only & Of the original group of 703 only 7 had developed atLy ray : evidence which could be diagnosed positively as asbestosis +. * * These men exhibited various stages of pulmonary involve- ment All were working steadily at their jobs with no signs o's": " of disability It is of interest to note here that none of the Diese men developed ray evidence of asbestosis with under twenty . ! " years of exposure . _ . attention Medical literature has given considerable attention occupational to pulmonary disease but very little has been 4 : reported on the occurrence of nonoccupational respiratory ** disease among employees in the dusty trades . 71, In order to determine the incidence of Tt - i disease in a of nonoccupationa =s_ sf oy asbestos indugsrtoruypit was 1,d5e6c1idmeedntoasntdudwyotmheenclwaoirmskisnugbmiintttehde a7 for sickness and accident insurance All employees in the ~::-. survey group participated in the plan operated by an inde- . ; pendent insurance company Indemnification was made only after the nature of the illness had been certified by the treat- ing physician . . ost. claims we The study included claims submitted over a year period . . ON,4 for such inesses as the common cold sinusitis pharyngitis ' grippe bronchitis pneumonia asthma and pleurisy 2: : Occu- are pationa pulmonary diseases such as asbestosis were excluded -7 ; report 5 W wre >. te, Of the 1,561 employees in the surv; ey group there were .i 0/0:approximately a equal numbers in the dusty and nondusty oe occupations Of all claims filed for respiratory diseases only * ' _ 15 per cent were for employees who had a dust exposure Not ce "* only did this survey show that the incidence of disease soa the year period was approximately the same in eoavcherhfey rs e group but it also established that there was no appreciable = ... difference in the duration of illness in either clinical observations for many years had given thgeriomuppresAsilosno >. i that a dusty occupation in itself would not predispose a person v. : job .. to more nonoccupational respiratory disease than would _ a dust to __ Animal experiments and clinical observationobsservatihonsave shown S~.E that asbestosis does not predispose a person to the develop- . **+.-" . oo . ett ares . . ^' aw, . ee o- % :. e @e e~t; : we feo. . 2 : ve S 20, | ie ors Mette ate Se!Patit eet:seat See eats . ee: Me OY : > 191 tuberculosis it andestos WORKERS . HEALTH CERTAIN - * EXPERIENCES AMONg pulmonary aggravate Sorsear does _ pe ment of nor it . an _ , . . apparently healed tuberculous lesion In two isolated one- industry towns in the Province of Quebec where asbestos was - -*. mined and processed the incidence of tuberculosis over a . = yer period of many years was no greater than that of other isolated e greater LL towns with comparable population but without a dusty trade Tye In the incidence of tuberculosis among asbestos - . addition " workers was lower than thatin the * populationin general these mining towns different -.. , Conflicting opinions and make it confirm reports extremely difficult to or conclusively the causal relationship deny 3 of asbestosis and carcinoma of the lungs Too often ; a - common conclusionis drawn from observations at and experiences with , _, different racial groups livingin different parts of the world a working 7ie : under variable economic conditions and in at a diverse occupational exposures To these variables I'd like = we. to add the fact that there are the various types of asbestos Cot % P fibers which may have different actions on the lungs The * wel: Canadian experience with asbestosis has been limited s. -- =, .. " =E " . to the chrysotile fiber The majority of industrial processes *. in the United States use this fiber but recently there has been 771 = some increase in the use of amosite and crocidolite On the -2 *, other hand the British and other European industries use ane quantities greater of the harsher fibers amosite and crocidolitte Therefore in trying to clarify the causal relationship of asbestosisin cancer many variable facts should be clearly Reo .. , identified especially the of fiber used and whether or type --"-- ---- -- not other dusts such as silica or diatomite were present in --"-- the industrial or environmental atmosphere ~~~. --"o--t%--e?-- -- 3S ---- . To amplify this point I'd like to take a few moments to *- describe the three types fibers mostcommonly t of used today * micrographof South African "! An electron yy asbestos the blue ; aes ere or ae : short of crocidolite fiber would show that it is composed many ah brittle . sharp spicules which are -~ rather oom Amosite fiberis brownish yellow in appearance and foundin ~: _ Africa and Australia Seen the . same magnification as longer less crocidolite sharp and they actually than . under the electron microscope at ia : above the fibers would appear ts:- Ped are less brittle the . . : -- cee 192 ae HOME UNDERWRITERS OFFICE LIFE _ ASSOCIATION Crude fiber greenish chrysotile found chieflyin Canadais - whitein appearance Electron micrographs show that win this I fiberis long soft silky sharp and I think that it is reasonable to assume that the short sharp i could Ray : and brittle fibers such as crocidolite and amosite ; . cause --* or ; much more extensive damage to the lung than could the long 7, * ; . .. .. chrysotile soft silky fiber Therefore I think it is unfair to | : compare the experience ofsome of the European operations on with our North American operations using different types of fibers with different actions 7 ve d. fi. ++ To amplify my statement that there are different occupa- *.3 *, tional diseases having different ray pictures and different would clinical patterns I like to describe the ray . 7 appear- ances of some of these diseases . ot ae The inin asbestosis shows a fine diffuse infiltration ray : . vt ,. bilateralin both lowerlung fields The heart outlineis shaggy ee or completely obliterated The nodular or conglomerate- + , patterns of other pneumonoconioses are not seen in asbestosis | * | * * - In silicosis the ray reveals a nodular infiltration which is -- bilateral and appears in alllung fields from apex to base te - Conglomerate shadows can appear in any of the various lung appearance fields The homogeneous or ground glass . _ asbest siiss not seen here of . Daa of pneumonoconiosis diatomite The ray of can show an ios t exaggeration of all linear markings a very fine nodular or large usual- att granular pattern and frequent , lyin the apices coalescent shadows . a ;- ray Batt ot resulting from + The ray pictures the inhalation of a mix- : ture of dusts never follow the same pattern and certainly are a might , _t,7,/ + 0+ changing Pane ~ not typical of either of the inhaled dusts In present : working environments a man be exposed to mixture-s. have + of silica and coal asbestos and silica or diatomite and silica ,. Thus you could many bizarre ray shadows _ shadows individual to from fine granular infiltrations to homogeneous and later coalescent iin n the same asbestos materials :: Several years ago anyone who installed insulation was called an _ worker because asbestos was practically : Voom, the only material used for this purpose Today however rues there are mineral fibers synthetic fibers clays cement mag- " nesia and a host of other substances used in the insulating eset win > B tS a : CERTAIN ote? HEALTH EXPERIENCES EXPERIENCES AMONG Asbestos ee . . . . . , oe oe WORKERS . 193 -- - of these materials are relatively non- - . trades The majority to label the insulation h"e> toxic and it is obviously incorrect if installer today as an asbestos worker in the medical literature today |: ?7:! , There are numerous articles t asbestosis and lung . the incidence incidence of asbestosis or $25 reporting asbestos workers The conclusions of the \: |. : cancer among not be accepted implicitly unless the report : authors should the called asbestos worker was exposed Siffre . clearly indicates that mixture of dusts - Silfian to asbestos fibers and not to a ~~. only in the group am reporting has a retirement One company They have a plan which has beofensliinghetflfyecotvefror21si,x0t0e0enpeyoepalres but of course .: total enrollment varied slightly through the years Since they this figure has about 100 years ago the , started to use asbestos fibers just - will include employees * 7. following review of the pensitoon tphleanfiber over a long period ve" who have had an exposure S Nete 6 : eee uaee |. i time there were 1,185 employees who In the past sixteen years of the pension plan The average we retired under the provisions _ 24 Although ' + length of employment for this group was years of these had how unable to determine specifically many *: 2we are to asbestos fiber it is reasonable to assume -* extensive exposures had since asbestos is used in nearly all of . L that the majority there were 186 who retired for: , ~ the product lines Of the 1,185 6 of these had 3 disability before reaching the age of 65. Only i et cpr oe tr ential asbestosis 7 2 empl1 oyment on employment with potential \ 47: . This low incidence based long asbestos trade is J} would seem to indicate that the om _. exposure have been indicated in the past 0 not as hazardous may* as _, ned . s @ . to ee 2 tad ter recognized until disease little oe te SV . . STE ages ty on a. ot, NO pulmonary pulmonary * wes Ae recognized - , |. NNamhe - 1. Asbestosisiinssiadious in its oocncsueptatiIotnatlakpeuslmmonaanryy years of 7% slow and to develop it does not progress after exposure {3 ae exposure and there is very disability it is far #22 ceases wer eae advanced -.%-- eRe et d.isability . . 2. There are relatively few workers exposed only ties in industry today : . Ee Or Sars) ee . wie . . unNDENWNITENS HOME or--celive ASSOCIATION * rio 3. . 1, 4. " , . 5. Conflicting medical opinions exist concerning asbestosis - Frequently adequate occupational histories are not ob-* tained so that other are incorrectly _* pneumonoconioses called asbestosis ' +. +, . the life the asbestos Exposure to fibers ' worker 273 does not shorten be .. of *. Lore? Inhalation of asbestos does not predispose the worker to other pulmonary diseases which will shorten his life > . | . 6. The asbestos industry has controlled the exposure very theincidence of asbestosis isis - low . - . . : *. coe oe ' . ee es . : . . ad 8 2 Pn to on.d on . - so that oo . . aad waxe>s I as . b beat. +e r . oo sty - an Chairman LawSONLawSON Thank you very much Dr. Smith for a ce me . being with us It was a very interesting paper : __ ;areal oe Do any of yougentlemen have any questions that him available - would like to ask ofDr. Smith while you have *. If not we will proceed to close . Dave splendid report 4 Cartwright I think gave us a i taconite this morning The printed paper of which you on you ihe aeipem : pererey A wewe : ry -oe .+.* copy presumably have covers it in much more detail and has excellent bibliography if you care to investigate further - ' Chet Leon HoveyPaul zt -* *We greatly appreciate what Dave has done for us ~~ son wee Morris thanks ever so much for moderating tho are o7erapes ans panel And thanks to you Barney Shea and Jack Wilsonfurther - betes total Awad to before meeting eo4 If there is nothing further come the wo o nd stand adjourned until 1958. I have been asked by the scere-.-i.4.4: ; tary if you will please please -leave table as you go out _ adjourned 12:10o'clock 2 inceting The 12:10 - Thank you all very much . at o'clock your badges on the arn . re the m ee ie "kaye PIFe OF ASD. . ad ae to Ae pent Nee,