Document Z4Y5217RgMaaeQyEk2XYKbn4L

FILE NAME Quebec Asbestos Mining Association QAMA DATE 1944 DOC QAMA003 DOCUMENT DESCRIPTION Unpublished Report - Tuberculosis and Asbestosis with 1966 Cover Memo IVAN SABOURIN Q.C. ADVOCATE ADVOCATE Building aldred Building Montreal Montreal Montreal Montreal P.Q MONTREAL MEMO This Tuberculosis Asbestosis 1944 Survey conducted conducted by Metropolitan Metropolitan Life Dr. George George George Wheatley then Assistant Medical Director of Metropolitan Life in New York might be of interest to you At time study was communicated the officers at Quebec such as Compensation Board department department heads and so to the members of the Pneumoconiosis Committee of the Workmen's Compensation Board and also to the then pulmonary pulmonary experts the Province The attached copy was made out of the basic report of Dr. Wheatley which I have in my files In connection with Cancer the same prejudice is rampant now as you know which was rampant before 1944 as to Tuberculosis The Metropolitan survey dispelled that prejudice At that time we also had test cases conducted the hearings being attended by the leading experts of the continent to prove that asbestosis exposure did not invite T.B. As to Cancer - exposure to asbestos incidence the Pittsburg survey took place in the 50's Dr. Daniel Braun , his study was also published which survey's conclusions just as in the case of asbestosis concluded that there is not seemingly any _relationship between dust exposure and cancer Dr. Braun together of Cambridge Professor Kushner expert in the pathalogy of cancer scientific committee of our proposed of Dr. Wright together with Dr. Gr^'goire Professor Beattie Kushner of New York University -- an cancer tumors -- is a member of the proposed institute under the chairmanship April 29th 1966 I.S. ~ 7 of t } _ TUBERCULOSIC AND ASBESTOSIS Asst it eel) Asst Med DirecT DirecT 2578 Neation Neation Neation NeaNteiaontionNeation Kant A brief review of current knowledge and analysis of tuberculosis mortality in the asbestes mining community of Thetford Mines P.Q. Canada 2578 2578 75 75 75 KanKtant Kant Recent developments in Canada have focused attention on the question of the relationship between asbestosis and tuberculosis Asbestosis has been declared a compensable disease in the Province of Quebec thus increasing medico interest in the establishment of this diagnosis and evaluation of any contributing factors Autopsy of asbestos miners has disclosed evidence of active tuberculosis and & in the same individuals In Thetford Mines where a substantial part of asbestosis all the asbestos in Canada is produced the mortality from tuberculosis has in the past 16 years approximately doubled in contrast to significant decline in the Provincial rate These developments have materially helped to create the impression in the Province of Quebec that there is a causal relationship between tuberculosis and asbestosis similar to the carefully demonstrated and generally accepted relationship between silicosis and tuberculosis Observations in the United States Previous studies of workers exposed to asbestos dust have not disclosed a higher incidence of tuberculosis among workers with clinical and ray evidence of asbestosis Lanza in in 1935 concluded that asbestos dust did not predispose to tuberculosis In his examination of 126 workers in the industry in the United States 53.1 were found to have definite ray evidence of asbestosis Two cases of active tuberculosis were found One of these was a worker with asbestosis In 19364 Donnelly reviewed ray film of 151 workers in asbestos mills and found evidence of asbestosis among 34.4 of the group No caseosf active tuberculosis were found tsbestosia tsbestosia among workers with asbestosis On the other hand in the he found four active cases of tuberculosis Two of these group without active cases` TABLE 1 # examined % with more than 10 years exposure # with asbestosis % with asbestosis Asbestos 141 22 ; 18 12.7 Thetford Mines 54 83.4 24 4404 One case of active tuberculosis was found among the 195 individuals examined This is a very satisfactory incidence of tuberculosis among an industrial group even today For example it approximates indicence in a survey in 1940 of the 7 garment trade when 1 active case was found per 165 individuals examined Pedley found that the tuberculosis mortality in Thetford Mines for the years 1926 1927 and 1928 compared favorably with the tuberculosis for the Province of Quebec TABLE2 Average Tuberculosis Mortality for All Ages per 100,000 Place 1926-28 1940-42 * Change ; Quebec Thetford 123.6 137.9 78.6 252.1 35 83 + However since this report of Pedley there has been a sharp change in the tuberculosis mortality relationship between Thetford Mines and the Province as a whole Table 2 shows that in the Province of Quebec the average rate for the three years 1940 42 has decreased 35 compared to the average rate for the years 1926-28 This corres- onds to experience elsewhere in Canada and the United States On the other hand in Thetford Mines for the corresponding periodperiod period tuberculosis mortality has increased more than 80 The obvious existence of a serious tuberculosis problem in Thetford Mines has led to speculation regarding the influence of asbestos dust Tuberculosis Mortality Study If the industrial exposure to asbestos dust is a significant factor in exacer bating or accelerating tuberculosis one would would expect to find a significant difference in males over 25 years of age since in Thetford Thetford Mines practically all of this part of the population not in military service workwork the asbestos industry Socioeconomic factors are also significant in relation relation to tuberculosis Therefore comparison of the tuberculosis mortality rates rates in Thetford Mines with communities in the Province of like size medical and public public health facilities economic and racial characteristics is important Dublin Dublin has pointed out wher socio- economic factors were dominant the tuberculosis tuberculosis mortality rates for both husbands and wives were similarly affected where industrial industrial factors played a leading role the standardized mortality rates for the husbands greatly exceeded that of the wives.9 Through the courtesy of the Demographer of the Provincial Ministry of Health and Social Welfare Dr. Paul Parrot we were furnished the number of deaths from tuberculosis by age and sex for the years 1939 1939 to 1943 for the cities of Thetford Mines Rimouski Chicoutimi Cap de MadeleineMadeleine St. Hyacinthe St. Jeand and Valleyfield as well as for the Province and the Dominion a whole Of the six communities picked with these characteristics characteristics in mind the town of Rimouski was thought more nearly to compare with Thetford Mines except instead of asbestos mining it's principal industry is lumbering andand wood finishing see Table 3 p.4a , -5. TABLE 4 Rate Shows the Average Mortality by Sex for All Ages in Province and in the Seven Selected Communities 1940-1942 PROVINCE OF QUEBEC Cap de la Madeleine St. Hyacinthe St. John Valleyfield Chicoutimi Thetford Mines Rimouski Tuberculosis Death Rate per 100,000 All Ages Male Female 77.5 55.9 84.5 75.1 101.7 141.8 190.1 171.9 80.8 44.5 90.9 109.8 85.3 149.1 223.9 287.3 TABLE 3 Population DescriptDaitevoen Selected Communities Industries = Health Health Officers Unit Pub.H. #Private Nurses Physicians Ratio Phys.to Population netford Mines 12,000 imouski incl suburbs ) 10,000 Asbestos 1 mining lumbering wood 1 finishing sp Madeleine 13,000 rubber mfg H ' steel foundry bag mfg silk 1. 5 1 ** ** 4 . 6 12 1/1000 10 = 1/1000 2 1/6500 . Gree Rivers 45,800 paper linen 1 1 9 40 1/1150 mfg rubber iron cicoutimi 1. Hyacinthe Alleyfield 25,000 18,500 20,600 aluminum pulp 1 paper iron fdry clay products textile mfg 1 munitions other 1 war industries cotton silk 1 10 19 11/4500 incl 7 specs **** . 14 1/1300 1 5 10 11/2000 " -full health officers including 1 dentist . *** *** including 1 tb specialist **** including 2 full physicians From Table 4 it will be noted that three three of the seven towns for which data was obtained have a tuberculosis mortality whichwhich is appreciably higher than the Provincial rate Females in Rimouski have the the highest average rate for the years 1940-42 Females in Thetford Mines have a higherhigher average mortality for the corre ponding period than males in Thetford Mines who ranked third in this analysis Further analysis by age and sex has been been attempted for the communities of Rimouski and Thetford Mines and the results appear in Table 5. Interpretation is difficult because of the small number of persons persons involved in the age groups in the two communities It is of interest to note however that among Thetford males the highest mortality rate is recorded in malesmales agred 25-34 In Rimouski males the highest rate is in the group 35 and older older Thetford females aged 25-34 have highest the rate in either male or female groups groups being 519.8 per 100,000 or four times the Provincial rate for the same agres . The in Rimouski females is 446.4 which is nearly three rate in the corresponding times the Provincial rate age group in the same age group Tuberculosis also takes a highhigh tall in Rimouski females 35 and older the Here the rate is four times that of ProvincialProvincial females of same ages TABLE 5 Tuberculosis Deaths and Death Rates per 100,000 1940-1942 MALES AGE AGE . All Ages 0-24 25-34 35 + Prov of Quebec Deaths Rate 3888 1167 803 1918 77.5 45.2 102.1 116.2 Rimouski Deaths Rate 17 171.9 2320 93.3 2320 114.4 2320 360.9 Thetford Mines Deaths Rate 2727 2727 10 13 - 190.1 121.3 342.9 245.0 AGE All Ages 0-24 35 Prov of Quebec Deaths Rate 4019 1614 80.8 62.7 2333 83.1 FEMALES Rimouski Deaths Rate 287.3 211.9 446.4 33407 Thetford Mines Deaths Rate 72209 223.9 72209 162.5 72209 519.8 72209 178.1 ENVIRONMENTAL OBSERVATIONSOBSERVATIONS AT THETFORD Visual inspection of the mills of the three asbestos operators was made Dust counts were made at all important working locationslocations of these properties and the results are given in a separate report There There was no opportunity to personally observe home conditions eating and living habits of the population but this information was reported to us by competent observers Several conditions prevail in the mills which would favor the spread of pulmonary tuberculosis The workmen appear to be carelesscareless about spitting and other personal habits In order to keep warm in cold weather they huddle in groups in small wooden cabin enclosures These measure about 6 x 6 TheyThey usually contain a bench or two and a chair with some heating facilities a small tin can on the floor which is used for cigarette butts spitting or over food In one mill a tin drinking cup has been in use for many years It is obvious that if there is an employee with tubercle bacilli in his sputum these environmental conditions conditions favor the spread of tuberculosis It should be noted that in review of the deathdeath claims in the mines insured with the Company a difference in tuberculosis mortality mortality was found In Mine A between 1941-1944 eight deaths were due to tuberculosis with a rate of 2.5 per 1,000 employee In Mine B for the corresponding period there were were two tuberculosis deaths with a rate of 1.4 It was in Mine A that the most conspicuous conspicuous unsanitary practice , the common drinking cup was found Home living conditions are crowded and it is common practice for children and adults  8 beds share This is an important factor favoringfavoring the transmission of the disease only because it promotes closer human contact but by interfering with adequate rest the individual's resistance to infection is lowered lowered Poor eating habits and food selection which prevail These observations also contribute to the lowering of resistance to tuberculosis on environmental factors factors are admittedly superficial because of the brief time available for inspection and observation observation Nevertheless because of their probable importance in creating and maintaining maintaining tuberculosis in the community further investigation of them would seem to be warranted warranted DISCUSSION It is obvious that tuberculosis mortality is excessive in the town of Thetford Mines But there is no indication from these datadata that occupation is a dominant factor because 1 the mortality is equally badbad among females 2 it is excessive in the age group under 24 where there is little or no industrial exposure 3 tuber- culosis is also a serious problem in Rimouski where where there is no asbestos industry The age and sex distribution of mortality from tuberculosis resembles the picture of tuberculosis in a heavily seeded susceptible susceptible population with a substan- tial proportion of deaths under of the mortality occurring in both both sexes under age age 35. There is no evidence if asbestos dust is 24 and the majority a factor that it resembles free silica in its influence on tuberculosis tuberculosis mortality Careful and studies thorough mortality granite cutterscutters in the state of Vermont revealed that they are subject to an excessive not because of an exceptional risk of frequency of deaths from pulmonary tuberculosis contact infectioninfection or because of inferior physique or because of unfavorable housing conditionsconditions or but primarily because of the occupational exposure exposure This other sanitary deficiencies same conclusion has been reached in every other study of workers who contractcontract silicosis Unfortunately we were unable to calculate expected deaths baseodn the Provincial rates because the age groupings obtained for Thetford Mines and Rimouski did not correspond to the age groupings available in the census data for the Province For further insight into the magnitude of the tuberculosis problem in these two communities it would be desirable not only to construct such expectancy tables but to carry out finding studies in these and similar communities in the Province of Quebec CONCLUSION 1. Based on current mortality data tuberculosis in Thetford Mines in contrast to many communities in the Province as well as the Province as a whole has substantially increased 2. Rimouski a lumbering town comparable to Thetford Mines in economic conditions medical and public health resources has a high tuberculosis mortality | comparable to Thetford Mines ; 3. Analysis of the tuberculosis mortality by age and sex in Thetford Mines in the other communities and in the Province shows that both males and females in Thetford succumb to the disease with approximately the same frequency This is not the mortality picture seen where there is industrial exposure to free silica 40 Admittedly our data is inadequate for final conclusions nevertheless there is no indication from this mortality study demonstrates asbestos mining per se in Thetford Mines is the cause of the tuberculosis mortalityi 5. Further mortality studies should be made to construct expectancy tables for age and sex in Thetford Mines Rimouski and perhaps elsewhere in the Province 6. Tuberculosis finding surveys should be made both in Thetford Mines and comparable communities , . 10 7. Health education concerning prevention of the disease is needed as well as improved sanitation particularly in the plants George M. Wheatley M.D. Assistant Medical Director Metropolitan Life Insurance Company Mr. R. J. Vane Manager of Occupation has contributed to this study by valuable suggestions regarding the handling and interpretation of the data as well as by making the statistical analysis Dr. A. J. Lanza Assistant Medical Director has us to use his unpublished data secured by Pedley tuberculosis in miners of Thetford Asbestos advised on the preparation of the final report very generously permitted in 1930 on asbestosis and Dr. Lanza has also Dr. N. L. Burnette Assistant Secretary secured for us the information on the economic conditions of the selected communities jl. REFERENCES 1. Desmeules R. Rousseau L. Giroux M. and Richard P. Asbestosis and Pulmonary Tuberculosis Laval medical Vol 8 March 1943. p.217 2. Desmeules R. and Giroux M. Asbestosis and Pulmonary Tuberculosis Laval medical Vol 8 March 1943. p 227 3. Lanza A. J. McConnell William J. and Fehnel J. William Effects of the Inhalation of Asbestos Dust on the Lungs of Asbestos Workers from Reprint 1665 the Public Health Reports Vol 50 No. 1 January 4 1935 4. Donnelly J. Pulmonary Asbestosis Incidence and Prognosis Journal of Industrial Hygiene and Toxicology Vol 18 No. 4 April 1936 5. McPheeters S. B. Journal Survey of a Group of Employees Exposed to Asbestos Dust of Industrial Hygiene and Toxicology Vol 18 No. 4 April 1936 6. Lanza A. J. and Pedley Frank G. Unpublished data 7. Tuberculosis in Industry Saranac Laboratory Symposium 1941. Published the National Tuberculosis Association p 199 by 8. . 10 Pedley Frank G. Asbestosis Canadian Journal of Public Health November 1930 Tuberculosis in Industry Saranac Laboratory Symposium 1941. the National Tuberculosis Association P.50 Published by Hoffman Frederick L. The Problem of DustPhthisis Bulletin of the U. S. Bureau of Labor Statistics Statistics in the Granite Stone No. 293 May 1922 Industry . FROM fyles fyles of Ivan Sabourin Sabourin 0.6