Document ajo1eKRGkxNnBxJkvgo6zMdM

FILE NAME: Metropolitan Life (ML) DATE: 1924- 1966 DOC#: ML015 DOCUMENT DESCRIPTION: Collection of Documents - Letters, Book Excerpts, Reports, Meeting Minutes & Other Relevant Documents l/-- ' A ssurin g Life ^ : b t j fr-- Insuring Lives ASSURING LIFE BY INSURING LIVES THE THETFORD MINES EXPERIMENT theTChoemhpigahnyr,atine o1f9i2n1f,atnot umnodretratlaiktyeian dFeremnocnhstCraatnioandaincacuhsieldd wneeeldfaleress.intAenftdeerda tcoarepfruolvseurtvheayt, tthhiestowwansteofoTfhcehtfilodrdliMfeinweass, saenlecatsebdesatossthmeinsienagt coefntthere ienxpthereimPernotv.incAe ForfenQcuhe-sbpeeca, kwinags npularcseedwinithcehxartegnesiavnedexapsseirgiennecdeainsmtafafteornfittwy oceontthererwForrkenwchasCgiavnenadsipaencinalutrrsaeisnianngdinlaNteerw aYoprhkyCsiictiya.n, all of whom were rateAisnaTrehseutflot rodf tMheintehsrehea-syebaereenxrpeedruimceedntf,rothme 3in38fapnetrd1e0a0th0 to 9A6.n4optheerr1g,0ra0t0if.ying outcome ofthe experiment has been that bveinccaiuasleGoofvtehrenmreesnutltos foQbutaeibneecd hians TahpeptrfooprdriaMteidne$s5,0t0h,0e0P0rtoo bpreouvsinedced.uring the next five years in child welfare work in the THE INFLUENZA COMMISSION th e Binefclauuesnezaofetphideeemniocrsmoofus19lo18ss aonfdlif1e91th9,a tthoeccMurerterdopdoulriitnang ulinttdleeritsokonkotwonf.inAanccoemamstiussdioynocfotmhpisosdeidseoafsefi,vaeboofutthwe lheiacdhinsgo sCaonmitaprainanyswoasf othrgeanciozuendt.ryAallnodf tthweorerseeparrecshenwtaotrikveosn ifnroflmuenthzea bcoeminmg icsasriorine.d on in the country to-day is mobilized under this butTehnucsofuarragthinegcraeussueltosf hinafvlueenbzeaenhaosbntaoitnbedeenindestteurdmieisneodf, W s COPT) February 23, 19M Mr. Ivan Sabourln Aldrcd Building Montreal, P. Q* Canada Dear Mr. Sabourln* Vhils tha natter la atill fraah in wj I an writing you at length on ay iapraaalon of tha altuatlon on Asbestosis in Quebec in ao far aa it inwolTas relationship# between the produeera, the nodical profeaaion and tha Coapensatlan Commission. 1 One conference with Mr Sharp Dr* Vidal and Mr* Dick gawa aa a such clearer picture than I had gotten previously* Before doing ao offer a few comments on autopay notarial* Z aa encloalng ay report on the lung tlwanes of Philenon Tardif Of neceaaity the concluaIona are not too satisfying 1 as they are baaed only upon era nation of two M ocks of tissue, ap 2 1 proximately x centimeters in disaster without area aa indication of the parts of the lung froa which they were taken* However they like thi notarial from the two previous cases* do deaonatrete that the Thetforg operations produce Halted aaounta or indisputable Asbestosis In the presence of advanced tuberculosis this is vgbscured sad not likely to bs identified except on sleroseopie exsalnotion of pulnonary tissue* X-ray during life will not show it* Today Z have also exaalned In gross the asgital oeetlon through the entire right lung of Bajoriqus Perron which we collected yesterday froe the toxicological laboratory la Montreal* This is a nueh ore satisfactory speclean with which to work It likewise sheers a oon bination of widespread chronic tubereuloala upon a background which will probably prove on sleroseopie examination to be siniaal Isbestoais* Sections will be prepared as soon as possible for microscopic exeat nation In this M H * I would appreciate It _______ of t S omenamtioaei anc alinimml long eapXayed o b a n c t a n O i t a of first syaptoas, date of quitting work, whether Koch's hast 11ns was foaad la PRODUCE] sputua and date of death* I negleeted to copy thla inforaatloa froa your record* s/c/M/a This autopsy saterial on fatal mikM !that are now reaching the Coaalssloa are bound to create in their Binds >the impression that tuberculosis is aa all too nnwain eoaplieatioa of /Asbestosis* If I were in tbelr position with wy experience Halted to evidence of this kind I would find it difficult to resist the conclusion that there is causal relationship between even slight aaouatsof^ Mr. Ivan Sabourin (2) February 23 1944 asbestosls and tubareuloila of the lung a Z have told you repeatedly j c a a a a ba aaa a 'aa Z told Mr* Sharp yesterday that Z did not agree with this conclusion < tut Z doubt bather ha or Dr* Vidal ill parauadad when they fueceaalon of like those which are now passing before than* They | must ba made to raaliaa that thaaa caaaa are the exception rather than j the rule and that there la a treat majority of eaployees in the aabastoa Industry ho are free froa tuberculoaia* Z ould therefora urge that immdiats atapa ba taken to rurre:' eve -> e_lri tha aabeatoa lnduatry in Quabaa ao that ttm stics ean be assemble*- Dri'EtiehsT X-ray n X a a alread on th a n at fsbslos v i H provide you vlth aatarlal for a prm llelnary report Coupled with thia thera might ba an analysis of aortalit data eopeyikting, th tot*i daath rata fron tubarculoald ld Tuaiiora M~ T BBdtff wlth that n oihSF^itgttatrial coaaunltiea of* lha PrYla" Xt W H be stillmorc convineing lf you cuia rhdV~the dparata ratai of ala and foetales unie the nomber of tha lattar. employai ii ttn ^ asbestos plants.'constitute*' an appreciable proportion of tha ration' Finally tha age distribution of deaths fFoa tubareuloaia la ^ those employed in tha aabastoa plants aa'contrasted with that in other occupations would help in determining whether tha occupational factor was contributory My ova observations elsewhere and your intimation that tha rata for tubareuloaia was higher in St Hyacinthe than in Zhetford and / or Asbestos make aa confidant that tha coapanles would aaquira information of greatest service to thaaaalvaa by such a survey and analysis Zf asbestosls apacifically la predisposing to tuberculosis la the same sans aa silicosis does tha offset should ba just aa apparsst In forth Carolina and Pennsylvania as It seems to ba in Quebec or England But tha films of employed asbestos workers In tha Stata# shorn a very lost incidence of associated tuberculosis. Zt la ay firm belief that la Quebec and England factors outside the occupation are responsible 111 As Z sensed the situation in Montreal yesterday the Y asbestos Industry have to produce avideos# to prove thla point and ; start on it Immediately or the Industrial comaiasloa will become la* I creasingly convinced that our position is biased and not founded upon t i ruth* ; PRODUCED S/C/M/Ms Furthermore the industry would undoubtedly profit by >1 undertaking a general program of. rn-- inltar < of tuberculosis By 6 7 Instituting castf'TTWIng * Tu!ner ~not 'only among but the members of their families the open eases or' sis discovered sad the sources'of spread of the infection could be Hr. Ivan 8abourin (3) February 23, 1944 Ob* of tha iron alalng companies boa wa serve baa aueh a D M t M a ?urs* *-Ppo*r*JI for tuberculin testing of tebool *?* toH OW ttp of th* cntacta of every known eaaa of open wtulbUcroouflot ihi.s.WplTilohhayr,pspuo1g.ur, *aiunotbMaloat.vpuarriitdnbild*l0.v/lTdeaohoa.dpitnbbMyot,otioornactClniMcdiutlJ.ltviraTdo f c j e fin" which tho tu b o re u lo si, r tto Ui*s Ih"ig*h bruotretoh o1l*r driatwu antlforon1, Spoo mm upluo n mtnianningth caot m>^iu;inchityour other c lie n ts attack ed su ccessfu lly in an Iron Tba aacond point which la becoming increasingly apparant to me is that the asbestosls of tba Quebec mines and mills la quite ganaraily leas severe and extensive than tha asbestosls of tba fabrlcatlnt plants of tha States. Comparison of the-X-ray findings In tha two groups reveals very fee cases with typical'patterns among Thatford or Asbestos 111 nan. Some asbestosls Is unquestionably produced for ve have .microscopic evidence of it in tba four autopsy cases now available but it Is not advonceu enough to replace such of the functional parts of the lungs and thus cause the X-ray nmdows that are generally recognised as characteristic of the disease. (Host of us disagree 1th Dr. Pendergrass hen he says in Lanza's book that there la no characteristic pattern of asbestosls) of disease shouIlfdnynotobscerruvsatidoinssabiarleitycorfrorectonlthyistherelfartaimveewloryksolfighttheamloutnogr; is involved leaving most of the parts that carry on the functions of respiration intact. But here again the Canadian Industry Is on the defense against its medical profession and their representatives o-; the advisory board to the industrial omission. The doctors have seen only their own local manifestations of asbestosls without opportunity to coapare It with the really severe manifestations that are produced elsewhere. They find the abnormal shadows in the X-ray fllaa of exposed workmen, which th are convinced aust cause syaptoaa and disability. They find asbestosls bodies in the lungs of sutopslsd cases assoolstsd with minimal tissue reactions or ovsrwhslalng manifestations of coneurrsnt pulmonary in fections and now they are sure of their ground. In order to defend Itself the Hust have more facts which will require time to collect, analyse and publicise These findings will have to be contrasted with thosa In the fabricating ( plants either in Asbestos or elsewhere. In the city of Asbestos the spinning and weaving mill has been in operation for only four years which is the minimum time to produce such disease In those exposed, but in another year or two one may expect to find evidence of It here unless 1 am much elstaken. Ir. Iran gabourln U) February 23, 19U Aa X bava told you in conversation, our exparimontai observations load ma to believe that the tra# tnaard in asbestos pianti il proportional to tho amount of amali, individuai, unoruahod fibraa in tbo induatrial atmosphere. X luapoct that tho reason why ono iota llttlo or no typloal aaboatoala in tho minai and miIla la booauaa thora la probably too llttlo such fibra in tha air of thasa pianta. Convaraaly tho roaaom for tho typical dlaaaaa in tho fabricating pianta la tha faot that tha proooaaoa thoro opan tha bundloa of aaboatoa fibra ani taar thom lato langtha abort enough to bo lnhalad in danforoua quantici*. Tho milla and mlnaa ora duaty but tha duat la largely aarpantima with rolatlvaly few flbraa lorga onough to do harm to tha lmmga* Thil duat antora tho Imago whara it produeao ratetion around blood vaoaolo and othar framework otruetmroo that aro juat Ilka any othar inort duat. ffo too tho shadows of ouch lnort raaotlon manifaatod in ooadltiom IS X-?cy aa an ozaggaratlon of tho normal ahadova of blood vassals. Thia not aaboatoala nor natoaaarlly proaaboatotle any n o n than tho idontloal ohangoa in man working in hard rock mlnaa a n noetaaarlly proalliootlo. Xm from allloa induatrloa rogardloaa of exposure wo do not diagmoao alliooala from Z-rara until wo find tho eharaetorlatlo pattorn of modulation} in tho aaooatoa lnduatry wo should do llkawlao and nfraim from a dlagnoala of aaboatoala until tho Xray nvoala tho Ohanotorlatlo pattorn of hasinoaa or fin# atlpplod appoaranoo aproadlng throughout tho lower thlrda or moro of tho lung fields. Tho aituatlon with aaboatoala la ovoa moro difficult than with alllcoala for today tho requisite condition of tho duat exposure la not approclatod by tho madloml profession. ^ ___ J [ t h o n f o n X strongly urgo that sufViy'd'baratfd',W ' 0apere /tho rolotlvo quantity and SSiSCl th* dusts In tha milla and tha ifabricating planta In ordar to praaant proof that In tho first lnatanca }tha perearn*age of thin flbro of lnhalablo dlaonalona la insignificant la oomwarlaon tin quantity created in pinning, ami saving. Xt is goia Cl BlTTlfd to perauaae~tfflysl'cians of tho importance of thoao factors but similar factors govern tho reaction to quarts and tho development of allleoola. Thoao physical limitation of atmospheric duat often determine tho outcome in contested cates involving a dlagnoala of silicosis and Z foraoo that they will have equal weight in asbestosls. A ompotont industrial hyalu l a t should oolloct and onlyit onough of tho OTirftphtrry iflpift in *" T M 'f^g^v^ ~ nnVhf mills and ih tho mlnaa and U fo le W lt fr jiliS t Y to establish thia basic difforanca so that it will itanc l/bayond contrbtpriy.' FS have tha experlmsntal background} we now must *dedenitPiti' Its 'Indus trial application, than corralstad with tha result* m m Axooaed workman. X faol certain that our position will be secure. Mr. Ivan Sabourin 0) February 23* 1944 To summarisei 1 would aaki the following rteotMidttloos to your clients, the Canadian Asbo* to* Producers in order that they may dsfoad themselves against growing conviction among the local physicians that employment In this Quebec Industry la highly dangerous. 1. Correct an erroneous Impressloo of the Industrial Commission that aabestosls is frequently associated with pulmonary tuberculosis. a) Statistical data based on J-ray of all -- . ? employed workmen to indicate the incidence of pulmonary tuberculosis b) Comparative mortality statistics on _____ - tuberculosis in Isbestos and Thatford mad in other communities of Quebec indicating the frequency by sen and age* 2. Consider the possibility of inaugurating a program ' of tubersulosis caaa finding and oontrol in tho ganoral populations of Asbestos and fhetford in order to elimi nate aotveea of now infmotion among employeta. ,J* lake a detailed cooperative study of tho nature of the duet in the fabricating plants and the asbestos mines tad mills Z trust that you will agree with these reeowntndations and be willing to. pass them along to your clients lay Z take this opportunity to thank you for your delightful hospitality while Z woe la Montreal mad thank you for making ny visit profitable sod pleasant finoeraly youra, PRODUCI :r> .u o >\rj'!/*ivin/r-vi<> Leroy 9 Gardner, 1 0 Director LOOfU oro 3 February 2$ , 1944- Dear 1r* Sabourini I hare your 1 attar of XftbouuxJ22 f* aosnta on -- the relationship between asbestosls and susceptibility to tuberculosis* This question cannot ba answered decisively fron a study of post aorta atariel aLena. Bodies! problens of this nature ara usually solved on tha baala of probabilities and It la thla attar of prebebllltlee on which wa naad furthar aridanca in tha case of tuberculosis associated with asbestosls* Karawathar in his *Henoreadn on Isbastosis Tubercle Meranbar and December, 1933 and January, 1934) admita that tha data on tha tubjact ara safer* Ha reports that of 374 workers while at work, only 4 showed clgna of aotlra tuberculosis sad that tha British SUlooala and Asbestos Hedies! Board in Its first periodic examination of orkars in this Industry f o w d only one ease of asbestosls sad tuberculosis In ,1512 examinations. On ths other hand the Hagllah post nsrtan material /st that tine rawaalad 35*7jf of tha eases oompUeatad by tubereulocis. ' (Bubseqoently ha appears to hawa found nora aasoa if Dr. Klddall is oes reatly informed)* In ths publiostion eitsd Horaeitbsr asnallist The aridanca therefere. points to tha hypothesis that IS g g f o f f iR t present thf llflfd-rif* t4 nlMBMrr ^ ___ ,, 3 _ ,, than in workers exposed to freo silica| rlralsnt sire lnfaatlona will as In tha ftTM* cause dasth| leaser ones will result in nsra widespread flbrosla than would appear in eases snonfst the faneral population and slight infactions, in mommon with many other affections, ara likely to precipitate death In licaaes of ssbastosis share they wouldn't do so in tha general population* tha underscoring Is nine tat x M t a wltfc tb... n m . PRODUCED S/C/f//Ms When Dr. lerewether was la this ootastry last year ho na for sareral days and we spent nest of our tine discusslag tl He still accepts our experimental weak which proros that there ls. no speclfle susceptibility to tubereuloals Induced by asbestosls an# he,like ourssires, is anxious to aeeunolate oenparutive stallatlas fron ' parts of the world to establish the general oliniaal (2) , Is wot yet Aas n I a l yins de dic; a tt eh d e r e i n i s a y las only t a n l e it mt eprr etshseio n Q uebec that metxjpfXe rQl eTn~oX&e e [, eaxsebeeSsatloYswwporrkmer*l sdmie ooff tsuubchercinufloasclt*io. nw istmh-omugt tthaek ifnogpinnUtotlOanswdwfm~tthethe l maPsroobretb^siBtdogistjiy,inandTduhsimstroyimr, tpafrrloeitmsysiotshntaentiiersetdfiu*eUnvLelsreoisflilcenaoottteiodenxpfrbooysmedctahtroae fauesnlbpslenasetroelystwe dioeufsottfh e atchnoedumnf rbtoremie csoo. mthpIeefrr e dtrhnewmriewthi l I tsst mima iislnpa retchsietfai cPt irsootcriiccnuscpaaftooi or f naQaslubepebsreetcod. sl s p8wouocsrhlkt ledor s am t a l a t s o ho ottuhubelder r * cuLocIa i t w ill become apparent on such analysus Ju st as i t has fo r silicosis. Wherever silicosis is being created, the high mortality from tuberculosis cannot be hidden. I do not ballere that there is much tuberculosis asbestos workers in the United States m A suspect that the at mortality of industrial work BAs'Influenced the demonstrate enough tubrculoais among asbestos workers to The 0. 8. Public Sealth 5err1.ee Study of Asbestosls in the Textile Industry in Vorth Carolina, (Bulletin 241), issued in 1939 hjaordpalgyeme51ntitohnaetd"tthuebreercwuelorseiso,nldyis2micsassiensgotfhesatsiurbej,ecptuwlmiotnhartyhe* __ in the group* (541 employees) Shall, (Radiology 27. Be. 3, 279--292* 193.6) examined 71 of 100 eases discharged from the plaits where Public Health Serrlee made its study 15 months later mad found ft complicated by tuberculosis of alight to moderate externt tmt smly 2 aotlre. Those two subsequently died of this cause and in 2 Infection later beeems satire. **1 states in his conclusion* "asbestosls does not predispose te tuberculosis.* Presumably h `although he docs not say so-, that the 4 cases of satire dl 541 workman represented accumulated disabilities chan the pregrem was inaugurated. Donnelly (J. lad. ftyg. aad Tsol. 1ft, 222-225*1936) also examined 151 discharged reported by flhnll. Kc gives mere details on the ea One of then bed worked lm the asbastes industry for 5 others 15 msntha. The ranalMwg 2 bed eartost 6 amt 10 aad their Infections might hare been aggravated by srpsenrs te ssbeetee dust, fte points cut, hewersr, that an lmcldsnoe of 2 eases ameng 151 Industrial stmlsysse is no higher then la any otter Industrial gxsny ePhoetare, (J. led. ftyg. aad Tux., 1ft, 229-239 1936) Ukevlse cm*i-- d aad reported on these ease* aad he is la entire agreemsmt with the other reporters. Za his conclusions he states, "Be aetlratiag er observed." Finally I bellere Z told yon that Z *rsalf, had lust re turned fren Barth Carolina where Z bed rerlemed cheat filme of seme 100 any indleatlem ef adult type pul manary tuberculosis. This tms senplete P R O D U C E D S/C/M/MSq y o 5 , Ivan aabourin (3) February 28, 1944 healed. I contacted on the fact to the members of the Medical Board of the State Industrial Commission with whoa I wai conferring and the Chairman, Dr. Ye.tal, told ae that tuberculosis was a r * * ? ^ * ? r. among asbestos workers although coaaon enough in Jth*J worktr# in their state. It would therefore, appear that in forth Carolina asbestosls does not favor or predispose to tuberculosis. t have Just now completed a review of 1-25 films for an asbestos fabricating plant in another state. In this ]f>iSni930#wasweil of severity of the asbestosis on the flr*t Sense was only 5*j four of these cases occurred in persons with asbestosis and 2 of them were considered probably active. A second examination was made upon 67 of group after an internal of 5 years during J^J^^J^L^^fJe^uberouloeia low the incidence of asbestos had increased to 62* but rate had fallen to 2.9*. A third ~ ; 4 S V ? J t h 2 r interral original group who still remained in employment OTr 80* 3 to 4 yearsj in this group the incidenceof asbestos!SLiLia of X that for tuberculosis only 3.5*. la ***??.!* the limits usuall serere asbestosis the tuberculosis rate remained within the limits usuaui, found in American industrial populations. The behavior of the tuberculosis in unusual. For example one man, a spinner for 13 yee** ***_?-. duet when first examined. He had at that time an reaction and evidence of old tuberculosis in lururs In two ?S*ri*ch succeeding examination* his dust reaction *t;*diy Hla tuberculosis first stage asbestosis 9 years after he was first 05J!r5 # 2 however, remained apparently uninfluenced. Mott iSoeed to asbestos in the same manner. These people had already dust for periods of 3 to and the three subsequent 1e8xaomrinmaotrieonsyeadrusriwnghent htehef oylwleorweingfir9sty *J" are V# . . good opportunity to follow .h.t * ^ td* - ch e ~ r . of tuberculosis appeared. If it had not by that time tne not very greet thst they would later. After they left the asbestos industry we do what happened to most of them but on a . One had that Indicate the cause of death. Two died of f 50. At had his infection when he was examined In 1930 J* ^ that time he had an early aabestosis ^ m r w e a w l n ^ o r 10 year evidence of associated chronic tuberculosis. B *** *#eond bm^uhnticnahogehdeevid3di2denhcaaednd obdfeieentduaboefrwcehuailvsoesr iIsnfofraetct12itoh^en aatribamoeu.atnd}H^e lert ^Itase^ aabestthos. is nus J P R O D U C E D S / C / M / M S A r , c 0 ro 6 r Iran Sebourin (4) February 28, 1944 first at nation for reasons not stated. Three years latar ha was reported to havs died of tuberculosis in a sanitoriua. Such caaas eould oacur anywhere. It is possible that if we had follow-ups on more of thasa easas after they laft tha asbestos industry va would find aora parsona who subaaquantly contractad tubaroulosis and diad of it. How ever, tha evidence now available indicates no such tandancy. Ualaal .experiments, contrary to thosa upon silicosis, dlsclosa no thaoratical Jraasons for suspecting that asbastosis craatas any spacial susceptlI bility to tha tubarcla bacillus of Koch. I aa becoming aora and aora convinced that that tha ,high tubaroulosis ratas reported in English autopsy statistics ara due to causes other than occupation. I believe that the same aust hold / true in Quebec where the amount of severity of tha asbestos dust reaction I'is vary much lass than it is in tha fabricating plants In tha United 'States. I believe Z have covered the other points raised in your letter and will therefore not prolong this discussion further. Yery truly yours. Leroy U. Oardner, M. 0. Director LOOtRH ee to Hr. Yendiver Brown M b .'.i 0 R N D U '.T i fl j.-a : Dr. Wheatley FROM: Miss Reilly ri- hf_R: June 19, 19L U Attached are copies of the surveys nude by Mr. Fennel of the Johnson's Company nines and mills in 1939 and of the new mill in March 1931- The dust conc-n ire.Lions found vre?'e much higher than the allowable concentration of fiv million our tides per cubic foot as established by the U.o. Public Health Service for oust In asbestos mills. Although there was an improvement in the new mill, the concentration: in the crusher department and the screening department v^re stilt ton h irh . .Among six men physically examined two showed first degree asb*Tt. 'mi none of the men 'appeared to have tuboT~cuLosis. The sanitary conditions in the plant were rather poor ord it was m v' thd. t-iere was an unusual degree of caredsun-'r.r among the employees in spit1:in-* ou flv o . Housing conditions In Thetford Mines were also poor, fine*? the war the '<i1 end mi nos have been ooa>*atlng 7 hours a dr-v. Tup increased wor\c causing a corn ding increase in the production of duct, end the lack of rest may produce a doerret (.stance amon^ the employees which may Influence the incidence of tubercules Is. If it is advisable Mr. Fehnel r^u arrange to go to ThetfoH Mir 'S -, \r .'i . rech cch survey of the Johnson's Company properties. Tf por s.IM e , It :rM 'h t--'- ""'ll to include a survey of living conditions of employees. DR. ARMSTRONG: MEMORANDUM July 3, 19U The Actuarial Division has asked ua to study the Johnson's Mine Company on which we have Group Life coverage, because in the last three years we have paid 28 claims of which 13 deaths were due to tuberculosis. The Group is increasing the premium on the company as of July 1, 19LX* Johnson's Mine Company quarries and manufactures asbestos and is located in Thetford Mines. Several industrial hygiene surveys have been made at Johnson's Mines in past years-- the first was in June 1930 in connection with the study of an asbestos industry in Canada. Another study was made in March 1931. As you will probably recall the conclusion reached in the asbestos study was that asbestosis did not predispose' to tuberculosis. Very high dust counts were found at Johnson's Mines with 99*25^ of the particles of less than 10 microns:: Workers were very careless about expectorating on the floors; drinking water was supplied in bucket* and common drinking cups were in use. A number of recommenda tions were made to improve general.operating conditions of this mine. No subsequent study has been made. I have Suggested, inasmuch as Mr Tehnel is planning to visit Canada on other business, that he include Johnson's Mine in his trip with & view to a recheck survey of the Johnso Company properties and & survey, if possible, of the living conditions of employees. If you think it feasible, I might be able to arrange to go along 6n this trip also. It seems to me regardless of whether asbestosis contributes to tuberculosis, there is a tuberculosis problem, not only in Johnson's Mines but in Thetford Mines. The latest mortality-^ figures that I could secure show that Thetford Mines in 1941 had a tuber-g culosis mortality of 259 per 100,000; in Quebec 80 per 100,000; and in Canada 51 per 100,000. I have written to Dr. Gardner in Saranac to ask his advice about the present status of asbestosis in relation to tuber- Q culbsis and also for any suggaations as to the approach to this problem CO in Canada. I discussed the matter briefly with Dr. Burnette when he was getting in touch with Dr. Turgeon, Director _____ ___________ _______ ial Hygiene in Quebec City. I plan to write .y to Dp. T^rgeon far more up-to-date figures on tuberculosis mortality /7i and a breakdown by male age groups*. If.X went to Canada I could discuss q the problem fore freely than I could by mail. Before plunging into this,: c however#-1. should like to have your advice as to the proper lines of - procedure so as to avoid crossing any administrative lines or stirring up trouble without leading to any constructive result. I might add that the Actuarial Division has askad Dr. McConnell about the health conditions in Johnson'8 Mine from time to time. Dr. McConnell's opinion was that the employees were French-CanadIans and looked- undernourished and that, in his opinion, the claim experience would not be very good. It has been for this reason that M S has not been sold. fVcrre V. w.u. DR. FEi KQOFJ-NDtJM J u l y 3, 1944 I think it would be highly desirable, if you can arrange it,to go rith Hr. Fehnel to Thetford Hines. ou could mateiially supplement his observerions by paying some attention to general sani tation, bousing, medical supervision,- if any, etc. 7>neu is Kr. Fehnel visiting Canada anc what contacts is hen-king? Si. Baxreit sp-oke to me about this, but I do nox have a record of the detailed plans. Sr. Eariett said he would clear F e h n e l 's contacts with Ur. KcDonald, by sending him a note regarding them, and by sending copies of the same to Dr. Burnette and to me. The simplest procedure would be to discuss thin tiih Lb .Barrett ano have him include a reference to the Thetford M ines contact in his memo to Hr. McDonald. If you have an opportunity before the visit to discuss it further r/itli Dr. Burnette when he is n e x t in the Home Office that would be desirable. It would no doubt be desirable to write to Dr. Turgeon. I assui.ie he is Director of the Provincial Division of Industrial Hygiene. One other important issue remains and that is the attitude of the Johnson Mine Company. Are they at all aware of their uxifavorable tuberculosis record? I suppose they are, as their rate is being increased. Have they asked the Company to make a study? If not, their cooperation or at least acquiescence should be s e e m e d before we visit the p l a c e '. H i . ho re croft might know about this factor, though I expect it may have to be cleared through Kr. Barrett or the Group Division. Third Vice-President. fScarr.aLnaecrolyab9orCateordrnieasr, Plrertor 8nue, fv Zrt j Star Dr Gardners relationship, ifCmodyld, byoetuvegainveaasabejaotuorslpsraondanttooWpirneiuonloaflbftoutXthkaaov pthroadtlapprorrr>lcutoa tsutubdolramc laopspiaea, r ltaoatmaiylcraotemthtaotxspsebraleseteooslcihwaaogueldd tnhoits pexopinertimofenvtiainutTnRetofceerndtllyinTthaaarntdhaadotactohaatltontabtoerlsouolkosslosalraavtxhraaalahliaaf tchaauspeoopful*aetaiotfne,asOaf aov3-1aai,naIahrottafolirtdy wiaith roapoet 2a tthoatuabttearrcuhlaonsdis, for as ftharesheaackiaaus w19it5h1,laaatabaaeraafoofpnedrao9o9naAp5?raotftjthhoigaha dduusstt poaursttlclalaa aaoarae of rlolosnsaothvanap1r0oammitcarotnhsa, tyVpeeaoref vlaoerkllaaradtoartthdinekalitnhgat1ththe acnladiaidanxpoat raallaittotlde toa rwtorakliangsaelyru. diBtieofnorse, gSeettvienrgeri,toa iatr,c pZlawnonuilndgatpoprsoteuidaytothis yiaouar padrorblelaeuIndlraopopUroyachr'amlagtotdhitsopwroorhklainag, elooagdalrtidolatass, oitf iahattbhorrietuhillay afielrdobliansC1acnatdhaavocuenldtrbaal aoofattuiinbtoarrcaualotoadia,mdthhoeilapftuhlolapdsbtulideyhinegalathnd dot ( aoaathine abowtthlat otudlaa la mm Voaf th1o11pplareobtaabtlhyaatskva7boahrs#elatcocensaskatoaonnde nXoar#s daloasot tfroyrinXghottoforadocburyoagoeugtrotuubpasrfctuplosaTlahastoforrtda,lltQyuefbigeuc,raaandfothraoBovopnalnrllsoosaa f Canada, Xf you have any data Xvonld appreciate having thm, Hth kindest ragarda. Sincerely jvura, Assistant Btdleal Blraetor produced s/emu The Saranac Lasoratory FOR THE STUDY OF TUIERCULOSIS OfTMIBWAIO L.TtUOtAU FOUNDATION Saaanac La o ,N.Y. Ju ly 6, 1944 1 * \b% //-j-iy Pr. Ceorge X. VheetTey Adltant XedlcelIDirector Metropolitan Life'Insurance Company Uew Tork, Kev York J R T- Pr: Pear Pr. Vheatley: Your letter of the 3rd arrived at a most opportune nonent as 2 an just planning to go up to the asbestos mines next veek to review again the situation there. I as bringing Pr. Vestal of the Korth Carolina Board with me because he has had so mush experience with the real aabestosis that they see in his vicinity. The filss that 2 have^reviewed from Quebec generally fail to show characteristic shadow patterns ana 2 have reached the eon elusion that the disease which they have is nlnlnal and quite different fros the changes produced by Inhaling fibre in the fabricating sills. Most* of the Quebec cases show little sore than non-specific, linear exaggeration which 2 believe is due to particulate serpentine and other non-fibrous slllcetee. 2 have had three or four autopsies fron the Thetford region; all of then cocpllcated by advanced tuberculosis. Microscopic exaclnatlon revealed sinical anounts of asbeetosls but the change was not sufficiently narked to be diagnosable on gross inspection. 2 have tfelt however, that the infection vat incidental and not a specific resu2 ' Of occupational dust! ~ This opinion is strengthened by the faet that in Korth Carolina the incidence of* tuberculosis is lower in the asbestos - employees than in the population at large. 2f a predisposition were involved it should operate with equal effect in every part of the world 2 would think that cortallty oheeks such as you pro pose collecting would be extrenely valuable. 2n fact 2 have urged the Canadian group to obtain figures tor utVTtn Thetford and in Asbestos at well as other communities of the Province. Ve know that the tuberculoi rate is excessive everywhere up there but reliable figures on the com parative mortality in and out of the industries are not available. 2f you can get any data 2 an sura it would be most helpful. 2 an in oorrespondenee with Fehnel about the matter collecting more dust samples to determine ths relative number of fibre and particles in elr-borce dust. The former, 2 believe, are the only ones capable of producing fibrosis and up to new we have based our estimate of the kasard on the total dust count. 2f we ean get a more refined standard it should bs of practical significance. Vith best wishes, ^PROuUCcD S/C/M/Ms *krmjte('4<x* cua} & - `3Ua*~c+^ d tiuL / $ U f C o '1u*Ujt_CL+^ef JAAsd&O 1 /^ ~ lri* d ra a ~7*-A*Ll t i C& 1^4 & t iP 'TkkUaJL. s6Q CL-fUck/ljuJ0* % cuuj "2u a ^C . U^c OstujoCLU***, '^<*0 r ~ t< d'VtluJL ^Cu. 04ajl ^ 7A^^ fix xJ&tuju*u* idiyutxjL^ A^70*80r28255* , PRODUCED S/C/M/Ms Jaly 26, 19U HBrl*alPftarayl hofrrBoata,ltEetaaodgra8pmhwU 1 Welfare fQmoralbieteaCeetttyB, uCllttoiattdga* Otar Br* Barrett 'i.. M tiai te lehZjeveoUerIelkgoodteaatheaacnfkc ytaeagninyaan1ek yfaerwthlaettUefra* oflfgw/alya a2itthtaterTaaawUHalanratiwmtelialtymaaaylflufaacpalltye imtbtuatge aaasfrteaa - DR. WHEATLEY * "tee -w -- '* ^PRODUCED S/C/M/Ms fAirs,si*st,aILnt, BSeucrrnecttat*ry Canedita Had Sffics ths probit of tuX^eruculiolsiirle&ulTl hesatfyoorudr. lafisnter itshi&i tIHdaisteo1sshsmd uitdhyvu ffuorrthmertfisnTveitftlitgeTthio*tnforodf fthltiporolbiit loadft1r1st-focuaUadschaaaslroralUoevaorotffcthhs ilo Jsoithinsmtir'af VthiasrI,r. Bpc.fvttryal ulnr-,lusXthrei*f!irbsjtfieraart lrnumJuynot 1h9a3r0 bhoocac MBrd.U1su rAattthots-t.dlrimlaec rthecryahebie*btdosusitnddu-usatrtsy.eAronoftofuainrdstluadJyorhanssoona'dsol'1Ibnal,ardloirk19o3r1s* rsaurprlriotdryinabrurelVtserteajbtoouatsenspdercitaekralatglngeuopbs rtti*rfluosoodr*sj dArninukaibnegr ooflororeooasSsoadeusbtleoenouse%ntrs*tuadayishato bIxacparosrue igse,neAradijacoarnktlntog Jcoohodasltolao'assMoifath1lBa*lUso. Mtailsletsy, raaltt-eaoGrrroupthpollaicsythfoolrd*trf.eaIr,haarni aIhadofoolieooraionsgristoaalloofotbhereirtboorwd lof,fldorerreiee* ti'a*vaeorrrtaielitt.f?u,rth%erlslnaaryesatldgtbtlconst,abtolsthticoaflBly*lsliganadifiJcoahnnosobn1ot Kls. thmt tu'arculosisAxltzh.scunfo?.t. fara. oUxrre.ctttodhadeocaopnlcileuadloiodatnfrzo.nhtlhldblosaotaossS,tulndy rteir,rGoafrdtnhelrinorpSaorralsnnaccctolnfiJnodhnoouoctTAs aBtlabsslXpfrooflainaiaorrpainatioodn llao ,wrBlotinbgoato Mpodta*atoicnerreolaeot&iml sshtulpdieard, bl oothplcustaiuearUUca asvnlidslnncK* oIrnlhdiCcaatroo*li,nalaobf iIsholapinion, thrart ,absbetdhovat irfilidtehca*tacdosppirriatliivpeKa--e rl ittilelt ys iliacdo smi*or--b>ildoitytubleurdciuolsosoifs,tuUbesro* coulhleorsispraonrldBCa?arb*sntou*lli*hIer.rTorh/etvfoorrdtbaadl.iolth,orfoclolonvciaaictioairirloQiuoebQecusabnsde last laeeflcb.stbfeorbdarisjunsottaritttteesntaat*i*thbautt,tulabebricsuolopsiinsi.on, th* outstaadlac fsaturo thougbt Xould pBialnaeloBfotllaftatthact.isaleatpUlaaboa,lagibaistrip* eloxpCsseatadilai lbsoo,thXo vgoetsilnorfllSaotplotonashcfroUr tuhs,1-tBriilsl iBi aJrorhonttsoins'erarnadnbgolalgi ,Vthinraoui,ghthKerr,ePaerrsryl,aluo doothssirrabl&lodfuooriruilsl blos&alnthi*caonlitoa.ete that Kr, Barry saaas lo IblnM i l veald bo Blaes Ihle probloc ln Xbolford npooars lo bo largoly no af ltoubseirscuAlsossociis,al!Itoao*cddpunbileiclbesnllotah afogreinldlaosfliealdCanfaodra,thXCvaonaudlidabnoTuIbnetrocru- ested ln prebica, etiag both in th th Pprooopvlinethaaaldyoiua tthhialDcoaoiauilodnb,arXfaathslynlaorrooliallaoricbsilsod ia sabine an atlaeV en th prorlsa, o alght bo feo posilion lo giro thsa .som lechnlcal sad Statistical bslp and portaos pronola th latarssl of aaasgsasnt la Ibis disaasa, ^ Xa rlov af Ibis psadiag trip, othsr adiritit or poials af ^PRODUCED S/C/U'M flaorterafttolaloorkelaitt! toonfeitsbeoru*r lelfert woA a*j era* to ye* as pertlMSt George K. Iheetle;, S. A5l*Unt Befiiehl Glrecter PRODUCED S/C/M/Ms Th Sa r a n a c La oratory FOR. YH STUDY F TUttftCULOSiS OF TMt COWARD L.TRUDEAU FOUNDATION SARANAC U, N.Y. September 28, 1944 SEP. 29 RM. :;*Pr* George M. Wheatley / Medicai Director \y, Metropolitan Life Insurance ;Mew York, Mew York Company \ -V'" car Dr* Wheatley: * I have recently been in connunlcation with Mr* Vandiver Brown-and the local attorneys of the Canadian Asbestos interests regarding the natter of your proposed investigation of the is ,, -Incidence of tuberculosis in the Province of Quebec. I have assured f these gentlemen that it would be coat desirable from every standpoint ` if 'one could obtain sore accurate information on the incidence of . tuberculosis in this section of Canada, The local dootore appreciate .-that they have a problem but I am not sure that they realise how " serious it is. From the claim standpoint in the asbestos industry I think there is a tendency to attribute much of this infection to H .exposure to asbestos dust. I d o n 't believe that this^opinion can be 'substantiated because in other sections of this country where there is much more asbestosis than there is in Quebec, the tuberculosis rates are not excessive. In faot in North Carolina there is lees tub? -roloal in those exposed to asbestos dust than in all the other induotri :#. I believe it would be moat deeir&ble if your organization could establish both male and female rates in the com munities of Thstford and Asbestos and also as controls determine rates d n other industrial towns of similar sits* This would afford the information which is badly needed on the tuberculosis rates among those exposed to asbestos and provide adequate controls. I would b very much surprised if you found any,excess of tuberculosis in the exposed male population of the community where asbestos.is mined and milled. A bulletin published by the Metropolitan setting forth these findings would do much to clarify the local opinions on this natter. We have completed our counts on Mr, Fennel's samples of the duet taken at Manvllle and find that the total concentrations are apparently low. Most of the sample contain appreciable amounts of asbestos fibre ana we are looking forward to making a oompar&tive study of the material that he. will collect in Quebec in the coming weeks. T * With best regards, 0886 Sincerely yours, LUCkP.H cc to Mr. Brown Leroy U. Gardner Director I N D U C E D S/C/M/Ms .TRIP TO MMTBEAL, ASBESTOS, THETPORD HUES, QOOEC 10/16/-10/21/U ^=P /? To explora,,the high tuberculosis eortality rat in fhetford Vines} to v*ss the .asbesto* laduftqrjsegardAng health w iy w a in Thetford.Mines; ib visit Group policyholders in Montreal^, CB**a *.c U * d U * i S r r'* M b Hv*t cm* **ScLmaSL taeh-- *eateio and Ggrroupaa 'Wl aWi t e d ^ ^~*** w ^ . e^tUiMa m.. ..Ui. > October 16, 1911 & X Radlo Corporation of Canada Mr. Deacon, the new President, Mr. McCallta, Personnel Director; Dr. Kaufman, Medical Director, Mr> Ronaseau, Safety Director. Charles Proaat Co,, pharmaceutical manufacturers* President, Eliot 3. Prosst; Mr. Sheen, the Plant Manager; and Dr. Lozinsky Director of Research. October 17, .1911 J * * * A*>Zm.U**a- nSp^*"t CiijA^ / **u *~ . Mr. Robert^Steele, President dr Asbestoe Corporatlon^cDr Jacques Cartier of u e Montreal ^ntltuberesloals TieMf; 20 physleisas doing industrial nedldne , in Mcctreah. who- are neabers of the Congress of. Industrial Physicians, ahaseg.id t W a president e Br. Grahaa Rosa, Medical Director of Katlonal Breweries- The aeltt% was held in the projection roon of the Aluminum Coepaur p Canada, whose Medical Director ie Dr^eMMrt4A-ftaest at the neetinc was Drv'Tourasgeae, Director of industrial *yfiene>Frovincial Health Department of Quebec. -- ''Tv-- ^Sk . .,, - ,, October 1H, 1911 # ^tvStaeA aUedteP -- JisUlsg w y m Mr. Iran Sabourin, lawyer, through, who* Mr* Prank Roe arranged . fer our visite t o Asbestos sad Thetfoni Minee.-- Afcoflainnnin is the I*CAL repre- tfk^peentative forthe Asbestos Producers Association, wf Canada This laeludss not aely* is three eparatore in Thetford, bet J o h a s e m M / t a ^ r i ^ A U Asbestos Mr Saboeria las been ^H t i t--ir*11~g the conpensetion eases arising out of the asbestos industry*. I % h a s else been folding the prodecere> et Thetford lines-in the setting up of the health. clinhaHkh-thap-as'4fcasged"4p4e^gMne^ Mr. Sabourln ie interested l*.Mcarlngall the help and guidanee possible, not only as the estabUdkmfceff. ehealtb clinic but in e itudpln the problee of asbestos!*? and, lndlreSBXteharcelasls Severe! cases have cam before the CoepeaseSieS* ConisslonOBistfbrd Base since the disease has beecee epensable The prevailing^f(inl. opinin in the Province is that ufebaetaal* contribute* td tubercnlosM^5brthszMre, there is enough confusion about the subject in the ninds of the dilators that celas are being filed for asbestoeie sham the cause of dset eay bo due to kidney or heart disease shanths x-ray pietaee.slso reveals sea* degree of hbustoils. There is also no sgrssMet on the type of x-ray fils which should be takm to properly*reveal asbestosis Meeting with Mr.^Shery&lf Manager of the Johas^rA>--- Pleat in Asbestos The Meting was attended by boat a doten of the executives ef Asbestos, including J L # a r ff841 Dr. Stevenson, ledieel Director, and Dr. Snith, hie assistant, -and Mr. C. - McGaw, in charge of Industrial Halations Visited the asbestos will end weaving plant in Asbestos, also the hospital there. Jt Ito. ^C-b sue, 0UU |>^ t>hf>fwUm e *1 we C U isrbAlU AaeUA OAM. wtt'JL* <*> e ^ U e dW*H*J* SvLrwv^t % + v^ooacED-m.ms October 19, 19U In Thetford, conference with Mr. 0. C. Shith, President of Bell Mires; Mr. Andrew Johnson, President of JohnsonsMine; Mr. Alfred Penhale, Meneger of Asbestos Corporation Mine In Thetford. Inspected the Bell, Johnsons, aad Asbestos Corporation mills. Visited the Thetford Mines Hospital. Conferred with Dr> Sirou, practicing physician in T/ftdtford Mines who specialize in tuberculosis and has charge of the tuberculosis service at the hospital; and Miss Chess, Metropolitan Murse in Thetford. October 20 , 1944 Conference with Dy. ^Parrott in Quebec, the statistician for the Provincial Health Department; Dr.?oley, Epidemiologist, Dr. Gregoire, Deputy Minister at Health; and Dr. Gilbert, Director of Health Education. October 2 1 , 1944. Conference with Dr. Burnette. Results RCA claim rate, as analyzed by Mr. McCalluu sad Mr. Ihnxssiau, is running currently 40 per 1000. It reached a pea^k during August of this year. I do not believe that all these claine are legitiaate illness. Ihe bulk of the claims and the highest disbursements srs In the radio department white employes about 90 pereenfe females. Predominant diagnoses are neurasthnie, weakness, anemia, etc. Dr. Kaufman tes.very critical, of the Company?* claim administration, especially the part played by the Medical Examiner. He said they were poorly trained and did not halp in controlling malingering. He sede a point of the fact that Examiners', examination was no nor# revealing of the patient's physical conditioa than the patient's own physician. He complained about ths -Company's failurt to usa laboratory procedures sueh as blood tests, x-rays, etc., to check up on vague diagnoses submitted by attending physicians. He was bitter ebomt one case which the Company permitted to have 13 weeks1 disability because our Medical Examiner agreed with the attending physician, although Dr* Kaufman believed the worker was malingering On.the other hand, on- case t e a he knew the facte and thought that tha worker needed,a rest the claim was turned down. t The Radio Department was inspected and new vsntilatlng hoods to taka off soldering fmes warm observed. These follwed Mr. Fahnal' s prviens study of ths plant. Ha will make a check of tbsa working conditions cm this trip.' Charles Frosst. Company is planning a health-service for its 200 employeef. Mr. Fahnel and I Inspected the plant, made suggestions gaxdlng ths health service, and we will sand Dr. Lozinsky infcreation. on tha medical setup for a small plant. Several marking locationa In the plant raised the question of possible hazard from drugs. Mr. Fehnel will make a aurvay nf in these working locations an this trip. . 0842 PRODUCED S/C/M/Ms - 3- Ob October 17th at 3t30 at tha Aluminum Company of Canada, Mr. Fehnel and I spoke on industrial hygiene. Dr. Boas presided. I daacribad tha organization and pnrpese of tha Industrial Hygiene Bureau of tha Company, and than discussed briefly tha reason for our visit, with soaa discussion about tuberculosis and asbastosis* Also discussed tha rola of industrial medical service in the problem of rehabilitation of veterans returning to industry and recant developments in tha control of respiratory infections. Also saw a very interesting color file on nutrition produced by Squibb & Co. It is a 16 -mm. film,- runs about AO minutes, and-is called "Modern nutrition". A copy can be obtained from W. B. IcHargue, Chief of tha Vutrltion Department of Squibb in Rev lo^k. Mr. Stoddart vas their Canadian representative. This film is Intended for a medical audience. Dr. Boss vould like copies of our industrial hygiene material to distribute to physicians in his group-- about 25 copies of any material vould bo appropriate. Dr. fourangeau vas very much interested in our proposed visit to Asbestos and Thetford Mines. He said that he vas hopeful of asking some dust studies there himself. Ve promised to try to secure the approval of the Asbestos operators in Thetford for Dr. Tourangeau'a laboratory Aan to vork in Thetford with Mr. Fehnel the following week. On October 18th, conference with Mr. Sabourin, Mr. Smith, Mr. Johnson, Mr. Penhale, and Mr. Fehnel, and myself. The health clinic vas discussed. Mxx. lalfch The three operators have agreed to tha establishment of tha clinic and era prepared to. spend ska between $50,000 and $$0,000 to establish it. They vent the heat x-ray equipment possible are ready to employ m full-time physleiaa. Dy. Cartier vas the-physician that*they have considered. 2a lot knowing this, but knowing ha was interested in the problem of tuberculosis, I had called cm him the previous day at Dr. Burnette's suggestion. Dr. Cartier has had very good training in the field of medicine and especially tuberculosis. He la seriously considering the offer to go to Thetford Mines. Z urged him to accept it if it were offered. At the meeting of the nine operators, I recoMended him and it was agreed to offer him a position. I also suggested that the doctor be put on the Management Committee for the health clinic A i e h is composed d the three mine operators. The health clinic will be established for preplacemaat medical examinations and subsequent fullaw-up examinations and health supervieicn of tha vorksrs in thn three companies. It Is intended tv employ one or more nurses, as neeassary, and a technician for x-ray and othsr laboratory purpose It was thought that the plan comld be initiated at once if fir. Cartier could accept. They would permit him to'determine his own leads and give him sufficienttime to stttfy the. local situation and visit other place# lm order to bacon fairly val^oriented*with his problem. A specified yearly sub will ha available to him for^tmraX. amft'poat-greduate study. in Thm The Ptftarlseial Health Department will send me mortality data on tuberculosis the Prorinee^ tuberculosis mortality rate at Thetford lines is high, But it is else high lm a number of other Provinces in tha ccwuaity. lo breakdown has been made which will ahov whether there is am excess male mortality from tuberculosis in Thetford. If ahbaatosia contribute to tuberculosis, one would eppeet a higher mortality among males in Thatfcrd lines since practically no woman era employed in the industry In Thetford. Dr. Parrott promised to send in two or three weeks age-specific mortality rates for males and females in the Dominion, in the Province of Quebee, end in Thetford lines, Asbestos, Falleyfleld, Bimouakl, St. Hyacinths, St. Jean, Cap da Madeleine, and Chicoutimi. He will 'C 0843 p r o d u c e d s/c/mis - A - H* will likewise send infant mortality for thaaa communities. W vara intereatad in securing a deaeriptlon of tha conomie and llrinf condltiona of these aama communities.for comparison with Thatfrd Minas. Dr. Parrott said that tha Dominion census had secured this information but fin it had not been analyzed. Therefore, it is not available. *hen I met Dr. Burnette on Saturday, I discussed this with him and ha thought It would be possible for our Burses to secure this information. In discussing with Mr. Sabourin what further steps might be taken to clarify this problem of asbestosia and tuberculosis, ve agreed that there vas need to educate the physicians in the Province regarding asbestosia. Thera was also urgent need far agreement among physicians and roentgenologists and others who were being called upon to act as experts in this disease on standards of x-ray examination and diagnosis. To this and, Hr. Sabourin thought it would ba possible to do two things! (1) to invite a medical commission to review and agree upon standards of diagnosis; (2) to arrange a clinical symposium on asbestosia. He thought that the Asbestos Association might pay half of die expenses to bring doctors in the Province to this clinical aympoaim* \ \ 0844 kffioo TRIP TO CAIAD1 Monday Visited RC1 In sorntnf. Oct. 16th. Conferred with Mr. McCallon, In charge of personnel; Ir. R o u m i in charge of safety. Reviewed their cliim high rate in radio department. When 90^S female claina are for neurasthenia, weakness, etc. Or. Kaufman - good nan - critical of medical procedure In claim administration. Medical Examiners poor lot. Lack training in their job. One case whs permitted 11 weeks when it was nalingering. Another we turned down when it was legitimate. Inspected plant. Blind man was assembling. Fehnal will cheek, especially soldaring hoods In bat not parfoct. Lunch with Mr. Deacon and Mr. McCallua, Parry, Fehnel. Afternoon. Charles 2. Frosst & 60. pharmaceuticals. 200 employees. Health Barrie#? Dr. I. Losinsky, director < Resaarch - M.D. in iriwg dept, housekeeping left something te be desired. Fehnel will visit to make survey. Tuesday Visited Group Office. Mr. Robert Steele, Prealdmt, Asbestos Corporation. Mr. Sabourim, lagal represantative for Asbestos- Product# Aseoclatlom.. Health clinic by law - govaramamt or industry - industry has chsnce to do it. Teat all help ihaa can get. Lunch with Dr. Boss* let Dr. Cartier. Meeting with Congress of Canada. Qzm Rosa, Health Department. ^ of Industrial Bilifelf; Dr. Physicians et Aluninm Company Tcmxungoaw, of Provincial Ind. Hyg. setup Rehabilitation The. and aabestosin Reap, imfso. . Dinner with Ross, Tonrangeam, Billfald, Fahnal, Perry. Ross would like eopios of indnstrlnl hygiene material. Tourmngeam'e lab. ana was intorestsd to work with Fehnel. Wednesday. Drove to Asbestos. Lonch with Mr. Sherrod, MMUger; Dr. Stevenson, Dr. Smith, end others. *lsited plant, hospltel, and doctors. Stevensos - Co.- should emphasise on farm seat to claimant that it Is not for vacation, ate. Good health program for yearc - ctrpngpposition in vies of developments in compensation field. - 2- Smith - mobile unit* of Health Department aot- very good poor equipment. Vo safety shots* Tuberculosis In woman in tht weaving mill. 15% try dusty. Pratty ntw rantils,ting wquipmant is* Electrostatic precipitation only about because now being overloaded. Vast to enlarge hospital. Takes care of surrounding country to capacity but tuns away many. Mr. McGaw said they'd like nursing service - thought they'd have it; wants outline of health education material. Evening. Met Mr. Smith of Bell, Johnson of Johnson's, and Penhale of Asbestos Corporation. Discussed plans for clinic. Doctor - x-ray - $50,000- 3$60,000. $700 ($1,000 for managers (doctor also) travel) Doctor, nurse, Managing Committee-- Local doctors be interested - Dr. Sirou? Manager agreed to invite Health Department man to works. Fehnal agreed to ask Cartier. Thursday Bell - older sea Asbeatom Johnscm'W - tin cupe. toilet on 1st floor off 4 story mill. Afternoon - Hospital. 150 beds - 75 tbo. 1930 rum by Sisters. Sister think tbc. due to dost, but malms do not predominate. Excellent, modern equipment, except x-ray.machine (20 years old 100 millianperea) lo EES. Dr. Siron in charge of tbc. service on outskirts of city (800 acre farmers) Miss Chasm - III Verse since Oct. 1st. Ho m s ere better than ones she visited im Qeebee. Mostly maternity - familiee not large that she hae visited. Advised her to call om Mr. flhith and Mr. Johnson Dr. Siron (semrotfcer noise) Prlday \ Saturday Dr*. Dr** Dr. Dra Dr. Burnette' rV 0846- m Or. Sirou In charge of the work for Health Depnrtmant and at hospital. Obaolata equipment - 20 yrs. odd - 100 milllampe. Slatar la technician. Excellent other equipment. Ballerea the canaed by aabeatoa. ^ 6 canea (he haa twice written otherwlae) akaptieal of Gardner uaea Lanxa. Chicoutimi Cap^b de Madeleine St. Jean St* Hyacinth# Rinouski Valleyfiald Asbestos Thetford Dr. Foley - Epidemiology - County health ada. Thetford $15,000 budget for health. County paya 10& of local health budget. 5 part-time nuraea, 1 full-time Health Officer, Dr. Blais, But for every known open case probably 10 caaea (not open) Follow-up poor. Fursea poorly trained far the. Didn't know compensation law had made aabeatoais compensable. Thought industry was. iuneooperative. lo information on 1 anyth a t occupation. (Sabourln peat 5-6 yrs. if they asked they would have gotten ttyfrom industry) ede only 1 attempt to getLanza* a report (doubt If he knew * a t report vaa migration of minors (not so) *o the. director (of hoepitale) else Dr. Parrot - 2-3 weak mill send information on age-speeifle 5 towns comparable In geography, economic statue, industry, desceiptioB of aedieal aarvlee* aim infant mortality, geogrpghy econonid statan Dr. Gregolr^ - . Pittttretfr `Vl all hyglane meeting with Sabowrlm, Lansa, Gardner Standards of x-rnye, ate. Clinical mautlng to ednoat doetorm. Check am lab. eqmipnamk. Clinical session Symp. and diagnosis Pathology bray 0847 .PRODUCED S/C/M/Ms V Octotr >5 19U CIrh*rrlftCL*alIasm;ttZ4lrCtci*or af Ssa:jrch, ua, CB*dt. lavr Lr* lotlsAgri jair ?1`a t aXii.t oi eMear*rdJrs?h#orliftfcX e-*ur JlpauelMtorcleatrl*rant aiara*IdyatttOvo.tiaelfaerylo kab;ofla vbis\ril?ta?dl larr(tlUataatoiUccjdtvoi etov:rb ?this fuyeodwir hs~f altaferptrrrnicla*ttlfoaar wl.thlaUyatira.ssW!rhat ifaoalolalarylaa?sm***hklcfpa yau aa bit* ffat viBtMl porp a: aa la*vctriol nrri* i U i l t h iaUntai o iba aarkin., forea, or praaaotioa af tflntit and LoJury tbraa-b ardex1 Bparrltlai t aucntlan. 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Uxrs;la>S`rtf r K : M k>4 lot **':'t U l r nliif. Xi ta Mise ta;* ; f.'MUvi Titrlteii r f ^ l a l v la la-u. tri'l tosici* in'. bjc** b thosif bt fiera sa ozsorttibl'p te ^i|fr ir-ttv* er ts ir itf m i ij\ilgr are af. sane of lac rsfrtrtrr* belfif *ll 9** l* k l * rnij-et ^ arcletl csllipr a: orbital tr.ravb- it tb< e^aelTj. licore a *T.arietlu#fse^liUnlMlala4nM*iroibliUlortelitbr iatif olictziJtticrrlccela'tSMpslrcbiilpsl,irptneeMt.'aivr.#b*fa#r a f.t.ta t tlta?r*iBiturt inm.*ljfaamr pt easficai*o'alerella!.:tritfta*r.1Ih(*'bfaot'aiciiu*Iileoefwaytrfvtteloliote), bb.out lIm; -frrla'tler#ap!a cbi*ltfllilttmp ouct, tiartlVasc1r7t,rClrclvacil or. Xn :trialr*ltlItoda,thihiietl er*ismb h z itti ciacUUoc, 5?5 bartb l^trarrs ttraci, Cblctjp, HI* fir etar oifuXUa:r;trsitoi-eItrariitritv, iKetlal:c.rtrycrirflrItttailetthocsaasliSbofsl'1 Tfr.lf1i*, tT, aPariirili,is:i,it Stilista:;, acbtc. l ;v ii: ttuu :ofWl i bjbafris*jtlil fearfkbycllitU i lafar*c!liIntitc*ti1ro1>:;b*a.rd4hacr}*lottei.li.*lataitiiX!-r.>7rta.*3.at tp, rotatv- idloycs*alsb,ol.p.*itKlrant*rrtiolsneltl-t?oBtr'*tirreoas\?a?, tftbraleaie:t-yl htiir-rleearalaio^1la.s;>7a-?rl'jtloauar.vreptt 1 b la Clrj. #p et cbZloncruiprc.mrlatr.ofne-arIaliloas:tI*r iliels.co*floloropf Utrttliefalart es-Iel-iMplt?r:*t wIasplreanasnerrltrst 1fa7r elf alai/ pai*aantiAltt*t*l.eeuta>l~in*a?*rIjte,rb*il Iba ph>.lei<B s*oalf b* gl** a ebtaet la anaroet ltloas* T<r.l1t:elaa*kciatrib, eUalttiIr-tibrt :fletrarteif*oipe-ta*bac beasri#baara"crarparaiaeftl-aslstprlrjeafatati .t*a4.>-irnle*aaeo:`ptticalptrof, s:arUetod. Iacniratsi-ltoa**rtal,. ixTfatapfralnaaeltploilapaaarthliietf tacaoiicl lIeta*b*let tit*eara fjrrto-a^lll7.*ebrauri !?d tieeslioesotlcliteyty a: t li lactl aorca' rgrcliallaa, alaet id ir ii r.rj 1 aliartei,btasl;laetitri:Inlarbaleab:.vt.atlr.s:nta*tiryofnthiea mefnpjltuttirat*eitipe>illaaetrav:ilcafIr?ifrttlttlosata la*ttMu rOt0Ul*i<a.cKd br7ofrt*rltttrrtel<itiI*r U t iptr af lia*artriti ileal ar-olaet arst&aaed 7- aule lHi,att,ftptir7a0obrilne l|pa*natetir tl.lt ritriti, fK*a t 7 *Ue lefor* Ila ferjr trulp toots. 1efriltairttfat iI*IrV ltciiiltltiljrirlcteUr Sovember 11-th, 1944 Vandiver Brown, Eaq., General Attorney, Executive Offices, Johns-lianville Corporation., 22 East 40th Street, Ife* York City- Dear Vandivers - RE: C U K I C A THETFOKD (ASBESTOS COBPCRATIOli LDLTDj BELL ASEfcSTGS IKES LIMITED AHD JOEKSGiPS Ct/liPAKYJ__________ Dr-Cartier, whoa fefc you know was highly recommended by Dr.Gardner and aloo by Dr.fhe&tley of /ievr York has finally accepted the appointment aa of thie date and it hae -occured to n* that it would be im mensely helpful fcr him to attend the Pittsburg Air Hygiene Conference if arrangement* could be made ac cordinly. I wonder, therefore, if without putting you oat too much en invitation could be arranged Cor Dr.Cartier. . ^ i Your faithfully, I: 33 C.F. Dr.Wheatley k r .Sherry P/AK SABOT1HIP / J.O E (f u 7%. KING MINE ASBESTOS CORPORATION Thetford Mines. Quebec. Can. * * *_ A recheck: survey of the dust conditions in the mill o? this company vras made by the Industrial Health Section of the Metropolitan life Insurance Company on October 26, 1944 A previous study had been made in June, 1930 * * * INSTITUTE OF OCCUPATIONAL /.NO ENVIRONMENTAL HEALTH MONTREAL, CANADA MANUFACTURING 0?FRATI0vS No changes hsve been msae in the ".ill on^rrtions s-'nce the first survey. The only effort at dust suppression consisted in covering some conveyor ' riETHOi'S OF A.,[?LIWvi AND ANALYSIS The sarnies rere collected end rnalyzed bv the r.ethod devised (1) end used by the United States Public Health .Service. The folio-tying table shor;s the concentre tions of dust found at the time of this survey. m ^f'jr r\ ^ ..; v - <.1 ACIA/AO JL--- ' (l)U.S. Public Health Service, Public Health Bulletin =?17, Peterrdnrtion and Control of Industrial Dust, J.J Bloor.fielc and J.M. Dallavalls, 1935 /  Kins Mine '7 Asbestos Corporation Thetford Mines. Quebec. Can. Sample No. Location Date of Sampling Cu. Ft Air SamDled Millions of Dust Particles per cu. ft. air Type of Dust Remarks 1 Crusher house, 10/26/44 15.0 picking belts on primary crusher 2 Mill Bldg, th floor U (frms and collectors) 3 Mill Bldg. 3rd floor fibre screening -4 Mill Bldg. 2nd floor h rock screening ,Mill Bldg. 1st floor II bagging 20.0 15.0 15.0 15.0 11.6 14.3 17.0 26.6 18.1 Asbestos talc u It II Test made on specie! run of small quant ity of roc). Clecr day. Not full pro duction. Brick building, wooden floors. Windows open. Clear day. Wooden floor, win dows open. Clear da; . II Concrete floor, windows and doors open. Clear day. . : irlurmnrrriu iin urn .a u m itn ^ i m A nninn u n nimniwwiTinmi-mnu l r n m r r 'iiii:":.f:!...i:fi,'it -A- r~ r~ ?B?gQ/AL FACILITIES Ample toilet facilities are provided end kept clean. Drinkin? rater is sup-plied by bubbler type fountains. Heated rooms or cabanas are located on oach floor of the mill building CONCLUSIONS AND ?C0:.'iJENDATI0NS The concentrations of dust found at the time of this survey are much lower than those found in 1930 This mey be due to the mill not- operating to capacity and improvement in the housekeeping. Covering of conveyors is, no .coubt, a contributing factor also. When the samples -ere taken, the rindorS'rer open and the day res clears (2) It is recommended that efforts be made to further reduce the dust con-- centr3.tions. According to the United States Public Health Service, five million ^articles per cubic foot may be regarded, as the maximum allorable concentration of asbestos dust. HEALTH HAZARDS There are attached reprints of tro studies which may be of interest in connection with the hazard of asbestos dust: "Effects of the Inhalation of Asbestos Dust on the Lungs of Asbestos Workers" "Asbestosis" (f)TJ.C. Public Health Service, Public Health Bulletin No. f'l, "A Study of ;'~beato'rls in the Asba'tos Textile Industry", 1?33. ___ (10) October 31 1944 r* 507 PIwlaacae Cde'bAorunrelss MCeenaatdreel va(| Deer lr. Sebooriai not tela oblTehtlo g1etaocfofseownhoattedteolayyeode loeototeorer. enHdowZewoefrf,erZ hsyeraepboeleogieeesryfobroay eatching up with whet hae bees bappemiag while Z wee la Canada hoar sale halfIkewphliaobaelatreipeaeteidawtraeedweeextofoeUl eaaatdUwneeerriAwpeedlaialeLt aaOeeatrhdeie*iaywietfor tthheiehioaspsoitaaaliteyaaalhlioahsiylaeraeexattenledaedstteehBera. fyeoheaeeelaeeadtoalee,w lZohsotp. e that X esa yeten had aa epportTahaeitdyetlaoytaialkwwrlittklagIrt.oeyeedaarhdas hCaodlaeaaasleUaadawaasataadgefsir*hOeaaarwdeaeerZ. hTawhae lraeyttaerrt otwfeodarroappaetdiwliatitaeathaIelfaflicdethoeanFtrhidaatythaeidreXweeaaAoalaapteaeepiibrailitthyatthaatwaereblailaiaal dhieaaaratsialyieaiaoffmaarh.aatCaaoilaonbeyl Lreeaaesfeadiaieddaaestptehritnakwhaes oeooealtdieppalirtetidcpaaedtetheehyilawahrna biaoth fsirtilOl airadatehraAirdaythheantcheaaewaefaldthhaadaifvfalailaabltlye,eafadgehtatinwgeatlldaasaoggffeeftarlawswtotbiaaf Oaeretfieaagt.s! BCohtheinCaoaloesfalthLeeaBseerathadCfierrolQlaesrdlaeedrlethaoluBgheatrdtheaft itht ewfetaaldtebZeaadwseeatnritarleCateiasealtasolewaeta hbe*rsetoaslanoasthltetyeeertaa peaUtaaballiiaghtoatahaadaartdathaflsaraXa-trlaiyi aexfatnhiaaalatidaassatradiadlialyytaiasaaiaa oFfeauad>stlea iianafaittttasmbeprMphb, aftafc'araNBWavBeaheril1l5haaa*hlare caXddaararhetaisfe XtaehsaawaeayheaaistehaataCaaoalaonaefl eLtehaeser darlaf tha aaalhr*ead hsaadatastfldaaa athfastoahrasshadwraarayeiswasehd iaatlaartteesrtadfrelaa yheaatrwepeohratltagteaeasr wialt ead dfeldh eawared tha pelate that X aeatloaat the trip Z cZa aedrdaseeadt!eallgyly Zlaeteareelesteeedeiaeerthbaoapelespaytaeneaeatarbisliiashg aayheehaeltehrwealtilaeaiea alaf tthheatfgerrwdwpdtlaheasneafdetsshtaalrltebdepiSe*htoapefiywoee yhaewaeblleetaheaaaadawaaieaafapleieaeihglaattllaafhfeirlpinCgartiar fir* Oardaer poke wary faworehly aboat hia oa Friday industrial aodSlacaal saeeerdwilnage ywebaiebshZorbtleyllaemweotahteliagaroaapf tahteIhpetrfpoecsde Baaldassseewpillaffiaada bclpfel perhaps ia wieesllslag the klad ef progrea that they are leoklag forward ta. MlDUCED S/C/M/MS Tphhyratenlaia'a fpetotUoat t iltI 1oandairaatooo*dctlahaart haaboeiotnllad bcoanaaxapnatelotaadvtltehdothaprhnaaaapltlhoyaaat aedleaalaoaxtiaoanlaaat tltohaaat a i1thaha;ralaN*aito titnroealta oTaebaaptfaotrlotntahlailoiaapclao*yeeMa iblarej vthj fairIro*va pthhayaiaiepiareaalaaioacmtb*aotfthoaeeUaptatilpomoaIlIiamjorthyaatadthalUaaaapaloay.aatraahmoahldibaaxtprlaaaataatiioabyZbplai I**repeehlyaieieiiathaaaaiadprsaeatabloyathaai AeoobpearaloyapthhyaatieaialaloeZeuaptahtllaoaianltaArlpinmeatataloada eiaojrnrraientaf aforandtratahtaatdthbay ethaaateeeafpatraiytaptihnyealodeaeauap.atiloanaalaallylnpaUaaeeaaadlalathjaaryStlaateaenietli hlaaaabahaaaa dona by tha eeapaay phyaieiaa aad tha tnality of ara ia vaaally battar ahieh tha fOrrorGlaarddaaalrlalaaitlhaaOblaBpjarftoaroraatrdhaatoparoanaiiaagadthalaaarratiatalirtaytaddataayeaaiatahbiaarevloaia btealrittiinethlaat eltoavaoaaalldtlabaa doantaairldaabiathataababaraaatotoablaardeuaalotrayia ZT-rhaayfraonvrpraeyaithudexap,aprlraaafaaarably OlardCaiaargtiathrlaiaiaftutfhtyainMgotautrbaarlcnAloaBtll-aTiaabaTrbeaatlofosriat*SoBealaetyoaalaidaplnaorhaaptalUthsaaythailfiaaailli ietolaaaanaoiftiathaathleaattroanbiaAvaatpi-iTtntafeiarioenrictoblaa aSooerltaatlyltylaataMiylt aarraya ia aoaa of tha othsr Z-ray filaBiahtihehCellaoaaalaaLaalalyaaaaaaii Ofarr Gtaahraiaraernltohaaiaa^aiatrtrhayaat vthoaal5i5aaoat*haaaaiatthlaafa4atbayry5* fcaoar lIi-rbaaynlaafnivfaarriartheaia(onthoaraaiabpaoaptoaala.t.ioaladiaaaZtrhyetfaTrhtaHy athtaoaa^aiti Athabaata4toatf b5*atfltlhaaat rtaencaaiaopriaailoaaniahfialaa#Z oiliaafhcatctaacihaaonaaanoiffathropeirkatartalo.alZptrholaaakdatrhaaatlaOra*aCrrayritaiafrohnatiaatheha a aarray aa a had ia alai* aad ili bZa (aUbodltahad(lraismi toyohaookaaeyatypqonaetaaitloeaasththoaptraogaryaaacriao#f*thoZ hproaaalathaaatlhiaaltoZ aSoaaitlbdelalaarnaaajyoaeaagaggacsatlaataasththarravalagha*yoa rathar thaa ritiac direatly ta Ir 0* C* Z a aaelaaihi taa reprint* oa aabeatoala ahiah yoa aay flad latorertiaf trip aa plUaeta*aatita1icrt igaria aai thaaka nenia far yoar aaaiataaaa la aakiag oor fcry aiaoarely yonrs, Oaorga feeatlay l0* . Aaalataat lailaal Olraatar Copy to t>r. Burnette cm% I P R O D U C E D B.'Gifil'i'i'S Xv.+ f VV* x u Buxxrmu rx.ac.x. VETROPOL1TAN IlEE INSURANCE COMPANY . F*xdfxjcx H.Ecxrx. war A. Lotcom. CtXOXTDTUAMWAB. OU tSH AoIUm s -Octobar 31, 1944 /^ 7/ / Dr. George Uheatley Assistant Medicei Director tin York Bo m Orfica. S mut George,- )v7 if I &a not to have tba pleasure of seeing you on the 2nd, it seems sdrisable that I answer your letter. 'Tith reference to. the Company's Industrial Health material,- our distribution in Canada is not, and I do -not think ewer will be, sufficiently large to warrant the expanse of printing In this country* From time to time we requisition on Home Office for such moderate quantities as will fill our normal requirements. Because of your eery recent contact with Dr. Graham Roas-and Dr. Billfeld I think you might send these men the publications direct from your office; you will probably want to write'to them. The general welfare pamphlets are another matter. They are printed in Canada,- wary often with necessary changes, and we print in both official languages. For these reasons it stems advisable that you should not send this type of material from Hew York. I will it send a set to Hr. HcGaw and also to Ur. Sabourin. // v V s? % I am not going to comment on the statements of Dr. Foffman of R.C.l. or Dr. Stevenson our medical examiner in Asbestos, except to refer you to studies of the claims of the International Nickel Company made by me back in September, 1943. Neither the state ments of Do. Aoffman and Stevenson nor ths findings of the various Home Office expeditions to Croups in Cansda have added one iota to ay original analysis. If you have any ideas as td how to improve the situation which, be it remembered, is wide-sprtad among Qroups in general, then I think you ought to discuss this with Vice-President Campbell.'*'" Sincerely yours, ds P R O D U C E D S /C /W iS MINISTRE DE U SANTE ET DU BIEN-TRE SOCIAL HTEL OU GOUVERNEMENT DIVISION DE LA DEMOGRAPHIE QUEBEC MINISTRY OF HEALTH AND SOCIAL WELFARE PARLIAMENT BUILDINGS OP DEMOGRAPHY QUHJBC, Roveaber 25th 1344 Doc to George H. Wheatley, Assistant Medical Director, UetropbMtan Life Insurance Company, 1 M a d i M n Avenue, NEW LORE CITY. Dear Dr. Wheatleys In reply to your conunicatLon of the 20th instant, I vtsh to apologlse for havlng oaitted to inelude in the tablee I forvarded to you the data on infant aortality in the Province and the listad cities. Dhder this cover I aa encloalng a ne table providing these data and I do faope that you 111 flnd saae satiafactory. As it as mderstood, copy of tbose data vas sent to Kr. Yvon Sabourla, Aldred Building, Montreal City. If you can help ae in providing the full address of Mr. Sabourin, I 111 appredate your assistance because the letter shich as addressed to tala has bean r e t u n e d to ae as m d a l a e d . P?/*T. lours truly, the Demographer, PAUL PARB0.1.D. PRODUCED S/C/M/Ms *orabi> 28, 19U Dsra. iRsteannatnSLaa. rBatuamryatta Canadlaa Baad Office Dht leraaii port <mhTefaealtnbk 70ad0 wlirrlyn cauacohnfd-nltrtoanaaadllaactha*a ttohnannarfaoera* *rahcladiiravda tthroa aaolsrotagUattytl&flcfuaroaretaflrtotya Dflrf*urFaner*rotV,obhuatrraata *ta1b1l1aaaawadtU70haaaracotopybaaacos0a0a0truaoatathdayfroaaratharlaaldlaabtala*aad a Sbwartlj jeara Aaalataat ladlaal D&raater la m b ir 39, 1944 DDriT. iPaaieunl PoferDreoato,grDaepabojrjrapber Mlolatry of Baelth and Social Malfare Parllaaent Bulldlnga 9-- bea, Qua, Canada Deer Or. Perroti addr--a, as vaTbhaavnak lytou, vlaerythaaneAtoldfraedr Bttoaftlddaltaaf- MIro*ntrIeva--l, QSaubao,uaraiad'ai laaitboaevaala,aQo--ther aIdbdaraiasatoabbleehaijoeacaaialtge*batcrkyf.a...*VafetrPalaIcnafodr'niramti--ee,, bai voaul--otoialdfabra mtbay toaanateolfataarbaoaritaod# qlaai btbaavlaaacatabbaaacoiartaaalljtoyufrbaava-taflbvea*a* lfaorathcao--alarltcyn--of laitnit#e#--aaadliaTrheatfla--rdalaldaelaa*baXrdrlyaaololaaapatrbaabtlalatbaaataa vTlheaatfaorhdlcbU maslia*tadlevfoerrthaefloao--d,mlaaajvyi--earafattbAa albaadU--otariaLl--bacaaltrblonaaa#to aa thalr aortallty figaro# far tabareaiaatoa aad^i&sa diIlHar^.-operato-- la IhTabtafbarldl!lipmtrfaearpeaclaatllaytaoraagaagtaadd BtarteJa--oq--tbeatCtebratia--d alfe?", --cndtlrreaaalt,--teaofbtobaabaladd--a--tralilaalmbtaparltvbpaarlaiatlotaa latolttaebtabraogrolaoraalaaattaabalUm)a-- llaimg alaoggdnatat ttttoeaCb bvtatdttrorvjialairbaaugtetattflrnt--f. nlaoiboote atte jroo, aa I Aedetaat Itotiaal Dir--t-- 0822 ' R O D U C E D S/C/M/Ms MINISTRE DE LA SANT ET DU BIEN-ETRE SOCIAL HTEL DU GOUVERNEMENT DIVISION DE LA DMOGRAPHIE QUEBEC MINISTRY OF HEALTH AND SOCIAL WELFARE PARLIAMENT BUILDINGS DIVISION or DEMOGRAPHY QUEBEC, December 2nd 1944. Dr. George M e tro p o li The 1 Madison A' heatley, Assistant Medical Director, Life Insurance Company, us, ' r f NEW YORK Cl Dear Doctor Wheatley: In reply to your letter of November the 28th, I wish to thank you for providing the address of Mr* Ivon Sabourln. As regard your demand for statistics identical to those already supplied, but for the t o m of Asbestos, I have to state that our usual' tabulation is not made for that City because it falls into the group w d e r 4,000 population To obtain the data you mould like to know mould request a numerical count of all the forms and at this time of the year I cannot foresee this oould be done mithout considerable disturbance in our mork. I am Lad to know that Doctor Jacques Cartier has been engaged by the Company of Thetford U n a s . I personal ly know Dr Cartier and 1 am sura that he mill be able to handle the situation properly. lours very truly, the Daaographer, PAUL PARBDT.M.D. January 19, 1915 > SDerr.anLaaeroyLa0borGataerrdynar, Diraotor Saranae Laka, lav Tork Daar Dr. Oardaeri atlutdoy, olaf TcohuortftorI,dauVtttlyeaaeeetltoteayorlaugyrouaIdrceoatip*gyhlaot fthathdaabcotou--dybeearttc.utlhoIlaotitraopoiloritratr.laiteyof erygraat balpXthaaattyotoa ftaakvao atholltaovooearakllen*gotoutththaaltkyouudyt.erXthroagrat hthaaadtlclatpplaadaboataaaaaatabothraaugahorataalltayvdoualtda kvhalratbllDkra*dF1a%rr. otVaavaatrua 3anasbfeocr. d1iffearlatontdaldgoagortourepcealtvhaaafrthcaa hcalanttahtadaastpaooratanpeo#puolaataloaaaalaay yaaaaorape^aaGhvfatahdadjaholaptaod tthoafolotvaaVtlagvaatriothaaleatatt,hXlahaohpaalathpaatrotbhllaaa abayy ba oetotthaothrraa. uCphrthtlaarrai .a llalatry o lXtobatovaDaraaTt oaurrdtbngpafatna,-tDfriraSoatobrooorflalafodra f Health of tha Frorlact. Xtara aahad aptartlatilnHe yogalana hla'to thoa bhaaiikvtoadcotephrylatthotoaDrrohpoForatirtraotto*fuOrXtrh*baSarvbdaalraartlarttoiibutetAaloatayoo1oth1op1ayrbtsaouvfDgaolrco.otaBloauadra.aatthtaatayoo*m Vitti kladart partoaal ragardt. Slacerely youra, or. Aatiataat Vadleal Diraotor [PR O D U CED S/C/M/M? January 19 1945 Dr. H. L. Burnett* H#ad Office Assistant Secretary Canadian Deer lament mortality XinaTnheeatfcolrodeinlign eesc.opIyfotefrthyoeusthuedvye roefviteuwbeedrcIutl,osXiswould ayopuprrescuiagtgeesytoiounr Xsewndriontge tIot Dtor.DWr.hWerrheetrtreetbtofuotrthbiiss psirgohblts.ft'nAnttf hperosvuingcgeesotefdDsuoewbsooi.mpZortthainntkc,otnhteersetsfofroer, wtheattohneawboouwldhihleeviennthe liongpliecnaelnitnstaenreesotfinthtehriosnnrwepnsonrdteetinednenight be in e position to gtheveet in oehItnwgentthtios yon eeoured on lttihrveiipnnkgfryeounuidtefhlueeloa, ltefhosprfeatchcieailloliytthietehsrehInieelpftohmteheoettthloyenoru ccoounasmelsitit#he,t lyeotuuhraevlleytoI wsaokueldoenptphreeerleepteormt.y suggestione end Sincerely yours, Assistant Medicei Dlreotor P R O D U CED S/C/M/M X Jnoary 19-1919 DDriviPsiaoanl Mlnlstry PooffarHDroa#at*,olfthBraaparabodygraSpohci?al Valfaro PQauarblloaoaaQotuoBulCldalaaacda Daar Dp f lv a k t 1 rhtaarlltJyurttaidtaythtoiebBraToaraafan aaooothpay obafatita ottoufbBotbrroooTfliectoaviratoao|*nbUTbhjaota aaaofckadiabdllayfobraUaalartaiwaoudolfa*haXtamaycloiptiUoaf oyofuthXraaopuolrdt atbalaoteaXahyaorutraevoaalolaobatlao,aatod aabacagraaahtlleaaoapyftovrltkyoi bar bad aa opportaalty to rarloa tbo raport tbo aatorial AavfaalialabXiolatob atoatbaalr yoa for yoor bolp la aahiat Slneoraly yourr. AaalaUat adlaal Piraotor [fRODUCED S ,.,, January 19 195 DDriv. ifsi.onJ.oTf oIunrdaaugseteruia, lDHiryegcietonre MQuinebisetcr,yQonfs.H eCaaltnhadaaad Social Welfare Deer Dr Tourangeaui analysis oXdsob enclothsaingdostscofuprynoisfhethdethtruobuegrhcuthloosisseuasrrtstsaylitoyf DtorataekaolaFfteimr fgiro. ainoXg nooveorldthspispraosctiestrolaalnayadroowsnaitdaaylooet slaityet1o* hnaovaebeyrouofshcooptieth* iasardepthoartt tioe sDhry tXersocreat*skinXghyaorue otoalyshoor1eloytotuerds with Dr* Parrot Fatati aadXmweaooat tthoethoacaclaisyioono foofroyueratrrcipootroteQsyueobsetcc*adoVdithte Ir kindest regards* Sincerely yours issistsat Medicai Streeter PR O D U CED S/C/M/Ms V J January 19, 1915 r. Ivaa Sebourin AIlkdaretmd Siut ilF.dlQng, Dm t Iv u i study MieIlimleeentclloesisntgoaoecpolpstyod, thXebteulibeevreeuIlheeetleDMr*rCteaUrttiejr stoi l tlakbee itnhteerIensitteidatilvaeIt1scleasrerybinegleoatthseeoesseeeft l et t e! person the rsisansadstlMOi no doubt Isebeesdchthaonugeghltavyeovuorepldlansesebyeoeuobcceurrerebdef,ore ctheristainbleyt appreecfiayteedarybouenrtbveodaegrhttfhnelaseeeoev*la IsetnrdMinigndaeedtheee CoXfbrthlsetavesest heaorsspitable sack that B ill ead Xsajoyod olth yea* the data IfreeeleochsicpkertohneiaetaeetloheeedaesetiestdayBeneeeynenedOgaivenetehlaklasedeeuerting regarde* Sincerely yours, n*. vr/.^ATlTf Assistant Medi cal Mrectar PRODUCED S/G/M/Ms C83Q The Saranac Laboratory POR THE STUDY OP TUBERCULOSIS OfTHIWSAaIraDnUacT1UUDnK.ANU.PYO.UMDATION January 22, 1945 Dr. George ta. Aheatley Mtropolitain Life Znsuranoe Company Sew Tori W n T fork Dear Dr. Vheatley: Z as tremendously interested in the report b 00' on the tubereulotIs situation at Thetford and in the Provlnoe of Quebec. Z hare not had opportunity to do more than aean it but it would oertaInly appear that the data thus far eollected do not tend to incriminate the asbestos exposure as the primary oause of the smesse of infection in Thetford. Dr. Cartier is coming down here at the end of the month and by that time Z shall hare digested it and will discuss the situation with him. Z also hope to be seeing Dr. Lansa in Chicago shortly. For the moment Z do not know of anyone else who should receive a copy. Ve may be pretty sure that Xr. Sabourin will stake certain of its wide-spread dissemination. Z deeply appreciate your collaboration in this program and believe that by following through ve are going to develop information which will be of scientific and practical value to everyone. Xou vili be hearing from me anon Sincerely t o u t s * 2JJG:XB Leroy D. Gardner* X. D. Direotor Otf IVAN SABOURIN ADVOCATE Mo n trea l. January 22nd, 1945* Dr. George II. Y/haatley, Assistant Lled\cal Director, . * Hetropolitan lare Hew York City Insurance Company, Dear George*- RE: Q.A.P.A. (TUBERCULOSIS STUDY) I acknowledge yours of the 19th instant. Contents have been noted with a deep interest. I am tricing this matter up directly with Dr.Cartier and shall keep you duly informed. I agree, of course, fully with you when you say that Dr .Cartier would be the man to carry out these recommendations properly. I expected to be in Hew Y8rk before this date. I shall be there shortly, however, and will 'get in touch with you. Best personal regards. ISiBS Yours faithfully, rm SABO /S. A L D R E D B l'I L D IN O C8I5 PRODUCED S/C/M/Ms W tL T A U DIVISION N. L. BAUjtRt.NT EsTcTrtEtm. rDy. Sc. S. Metropolitan Life Insurance Company Frederick H.Eck e r . Le r o y A.Lincoln.m m January 24, 1945. CANOATDTIAAWN AH,ECAADNAODFATICI Dr. George M J ffae a tly, A ssista n t Medkoal Director, Metropolitan U f e In s. Co., New York Home^Office. Dear George, me the p r iv ile g e o f in Thetford Mines. to Dr. iliherrett. Thank you very much indeed fo r allow ing seeing the study of Tuberculosis m ortality As suggested by you, I am p a ssin g t h is on Sincerely yours, AP PRo du /n iS p b o d uW January 25, 1945 t Dr. Burnette Asais-sau Secretary Catuulau 'teud Of'lca Dear Som a n t Thank you for your uota regarding receipt of the tuberculosis mortality study and far sending it on to &r* Therritt. Just had a noto fron Jin Canpboll oh son thti report and ha said ho assunod that McDonald is joint to see It. Shea It coaas back fron Dr ffhnrrett you nay h a m an opportunity bo pass It along for Mr. KeDoaald'a infomation Sincerely your, Assistant Medical Director PRODUCED S/UiVi/iVi3 Canadian tuberculosis Association Hm n rjfmiint His Prvidn* TEO. RLO. NRTOU.DODNYT.. PmiJtnfrEtu or o r Cx c o a c n o t th c P iomt Hon o u m aclc T h c Ca u l At h lo n c . ico- a o vin N o n -a cN iS M . Canada OTTAWA PLAZA aUILD IN O CANADA C o l . j . D . A D A M B O N , S.A.. M.o,, M.R.C.*. i o . r.R.c.R. toi. WINNIRCS. MAN. Hn tr * n Vm-Pnn i n n > Thc U cutcnant-So vcsn css o r a u . thc Provinccs H n trtr j TmuarwE. A. STEPH EN . OTTAWA. ONT. E xttatht Stm try . J . W H E R R E T T . M .O. M.ILO.P. February 13, 1945. Dr. George M. Wheatly, As si atanby Mdical Director, Metropolitan Life Insurance Wew York City, U.S.A. Company, Dear Dr. Wheatly Dr* Burnette has passed along to me a copy of the very in teresting study of tuberculosis mortality in Thetford Mines, P.^., which you have recently made* I think this is a very excellent report. This should tend to clear up any tendency to blame the high death rate for tuberculosis in-this area on the asbestos industry. The report Kill also be helpful in focussing attention on that locality and I am -wondering if it would be possible to interest the provincial group to undertake a community survey there* ~ With kind regards, GJW/S* H*D*, kutive Secretary r:\ * '* 1 5 i i'tfiti 5 1l MINISTRY OF HEALTH AND SOCIAL DIVISION or INDUSTRIAL HYGIENE QUEBEC WELFARE January 25, 1945. Dr. George M. Wheatley, Assistant Medical Director, Metropolitan Life Insurance New York City, U.S.A. Company, JAN 29 ?.. Dear Doctor Wheatley, 4^" I beg to acknowledge receipt of your letter of January 19th, together with a copy of the tuberculosis morta lity analysis made from the data furnished to you by Dr. Paul Parrot. I hare read it with great attention and found it highly interesting. Your conclusions seem to me Tory logical considering the small figures you had to deal with. I hare suggested to Dr. Parrot to make some comments to explain why the mortality rate for tuberculosis in the mining region of Abitibi and Temiscaminguejwhere the silica hazard exists in the mi nes, is much lower than at That ford-Mines, Riaouski and Chicoutimi. Cbe factor, which probably explains partly such condition is that the process of education is slower, in the regions showing a high rate, from the point of view of family hygiene. Another*''^***' big factor according to Dr. Parrot is that the Abitibi and Temiacaaingue'*'^ regions are new regions and that most of its population is younger anywhere else and more rigorous. I wish to congratulate you for this rery interesting study It will clarify many points which were hitherto:far from being clear. Very sincerely yours, FJT/H. F.J.Tourangeau, M.D., Director of the Division [PRODU cr?89 fttooary 20, iva Dr* 0* J Wtoarratft SXMUtlVO SvOTOtary FC(HaUoatumdaB,nuOiflnadtbino,groCualnoasdias issonlatloa Door Br. ihorrott 13th relativoThtaoaktoyouthovarytodamychfcfiachr ynouorneaodooMofaltahoatlotaaboafraFaolfoaarolanry aIoarntoglliatdy athfaIthfotforrdaiallaadoothaangdamaamtloaothabroaetotahanapioUauoiblallitthyaoFfiMa laaa aeonaunaadanitrytakianrgray Slat T1h1a1tfadradygnimi, ahaaaIratrh,inokn tha mo htlaoo1! latakrliynag ftohra lsaarli*k btloaotntvaopytfoeiaataadrrlyodItlatahlraBatgrhaatoArnoyfouthnaalyatkfamatr,iafiBr*BJaaanltghuda iCaalrtlaforrhathna labtaurhloaaraaaplaoraalataraarrinoyIahothtrfoourg*hllhaioaaaaafoira*atClaanrtolaitrhbtahaahiaMd ftaryaaarllmaa iaitflttaadhyoirfaehlaoaalaraLaayapgaraoaahaIdthlaZkthhiankrayoida baaaallndtakraaattab*at!taardtahtaan Zaaah fnegauthaoartfaamphohlyllathoaraplarnvoaflaoraagtoaranoydoahlodaldbaapooraoaamr aanaahUvaattaodyoakIathaitnakdr than at aoy Una In tha pant* Zadaatrial lyXglmonaot aafoothyay faTfotrhionarloaploBratatlothBpr*oyTnnrtanraanagtaau,#DathroouootdarIotfto BitrtopafrerotFttliany*hXrovnioattiOanl BWanoagyroaykhoonr,XbaaaftnXladaQaaanbtohaatanIihsahtahlalrahroitokintaand mBry fhaawlfaayeamrnnthoIrngayggfamrftathparotphoasafleathratthathraaPyarro*vitnonicarl*BmaaaltyhDatphainrtm' nt Tuimtski a Mampgty survoy, if this sama toa boat nrthsl af haring tha Or Bonattofh11o1y Xi tka1o1*1, tboao pjuoaotoibalnlnfatorrayavtaodtoafsamllariaatyhathaaualaltamnat.laonad ill aft ta aoeyarato in say ay that la poaalhla Slth hladaat rogarn Copy, to Dr. Burnette (COPT) IVAN SABOORIN Advocate Montreal May 14, 1945 N. Lt Burpette*/2s()ay DSc.,S, Assistant Vice-President, Welfare Aivfsion, . UetropoAj^an Life Insurance Co., Ottawa, Ontario Dear Mr. Burnette,* I acknowledge yours of the 30th ultimo* Contents have been noted. This letter is indeed of deep interest to ms. I shall take up the matter with the Thetford people at an early date and shall keep you duly informed. I indeed appreciate that kind, helpful thought of Dr. Wheatley and yourself. Believe me, Tours sincerely, (Signed) Ivan Sabourin U J U U U U U U U L U ? 25, 1915 M. L1HZ1 SDBJBCTi lSaubrera*tyce,f CO&snaabdala,alaJn?hn9,i 1M91n3itmaa *O?pa1r7a,tl1o9a1a5.ah I laar&sd, m o b aftar rrlral, that thr* n r t sight w m i , olaiaing wk*toiJ, filad lth tha Industrial CoaaisaioB of QaabM. S m m e u i t origiattad la both tha fsctoxy od Bill Xr Shorr?, 8aarel Aiparintandant is 111 and hospitalisad la Kentraal. Ib Lia plana thara ha bata aat up a Haas Staarinf fliaaittaa haaded by ttr L* Fostsr as Chalman, Thla Goadttsa diotataa tha paliis of tha ina and all, Alia Kr I f Gkrdmsr, fuparlstamdaBt o tha flotar?, cuidas tha poliaiaa f tha faetaxy* By tkla aat up f -- c-- t control, tha alas aad Bill fuastLaa taabiloaVl? m aaa usdt *dla tha fhateay parata aa a aparata aatarpriss. Oa *ridarv 1w U 1 W , Mr* Trata 1-- Md k t M i a * Mfe Fatrieh aad |a ta a diana aaati| at tha Xraaoofta k M Irtartoii k i k V1 Gaopar, _ia atarfa ai -- litan f alaaa, KBailf Pt X k 1 I* fcUb, aad Ir* 0* I, adaaiperwwaaal dtrastar, ara ala praaaat* la t a p m o U t t n of tha factor? attaadad tkia aaatiai. Mattara diaaaaaad aarac 1 n dflaahilltp f tahfag.partidla du* M pHi 3. fha traala* af rf fte taklag dat arpia aa* Lttaa ppadatad -ha #4*d aad tha ili*iktii a ddMlh that ap ta tha la lorfc tttlaap,- 1 0* Cktardhyi fc? 1?, A lia aa alead Ir* BUsJfe. ratrtatraa* aa ta hara la-- h alth hlm luaah ha aahai a 11 m aawld rramfa ta.aaat alth hla ftanaoa at 3i30i& tha aoafaraaaa rasa at tha faateayv ftittXdi| attaadad tha aasfaraaaa oa Tuaadapp Mi? I3i lh 1.X* Vthcafc Thartildtiac SHEUnar, Tal-- torPla, Gavilla, W . p, J* % , Titead Ib*-- triol djvi-- -- baaatoip aa* liald tarrioaa, MLie. k d* I M U i , fHtaiiln at t o n a Ir* F* d* Patria*, Matrapalitaa Ufa 1 ppvOO 0679 2 DDrr* III** BV* S8mtealtnhn#eoiana#iaXt*andtDtoetefirr* S^twrmllM "t*Jafcne-lesvllle* MMrr*. 2*. hs.. Tloleatoenr#, ADeanaairattmananitfiIamto4ry fcparlBtandont* MMrr** Wt*. JX** MMoerdriaienoin#' Baeppearrttmmaaastt HHeeaadd*. rr** 2B** 8L** GOailrbdenratr#, fBaocptaorrtyoaAaqt pBeeradn*tandent* r* 4* K* HeOav# Faraonnal fiirtotor* na i t thlaphoaaaaaatlng ceoanTtorsoeldfaay#r pMor*taGn&tird!sahreaatlfehtahdatahaartdshianhtahddplaleannsiaed t itk and h a t T harai oaIagstrseda i t hoofapl linnioynotrhitaito i n n s #la eaknde aflaabeatldo nte t a e ocrorna etrt otlhathaaeae eoonuddiitiiioennae,aaa dna tehii th 1 * The linaoakraaaisedhaplprafdoaartjiaonniatnedr raiamraaniedeaf tha frodaotion Bepartsent. 2* 3 tha laaoxnldtyitioesfathaaanireaoraetodnainnagp--roevsitamteo traakpaardtea#tian te aerraet th i* th pafpitpieraedsiarr!abnyateheaaBaxaye tfoarrtioOubffnicltetlag th piane and thair- fiater n.teKi afvciradrkIasrtetathtadntghdativthraaaettvaaraenf efiheatfoferyraniaanaagaamremnta*ae#M.broiGaaerrnear ereeoneroinadprtohbalatehaenfdatthiatthmatethdnegtaenoaadtlxesellaabnrdaaBltaesreniaTtaiemaparfaatriotoheahtami aeeeen# he ftchraonraadakoadsefaeroaaenitataeeettieeseonatelitsee hanede tghuliadeptrhogriansdeaaeetrlllableheaerltrhiadproagsriam*X la tehoaggfaaaetatedrythaats#i tfhi n si iel if baall#aveheIllteteidotfertehenMotairmialieftartepetraaerefaatrinbluasagnliadabneeteh vinaindeattehreeaieaimagatnehreitableorintiathre aeaeareaae! pari^miieeitrreateefhseeaelrthfhhetaearaerds Xefalee seggratei tthhatptlhalsat aHhaeot ldahbeeelrtabpearkteadpt1vampatrteiadtaotye#teo stihO HMsretlemlaHterrccailaaehrmmgtUhtstInsgteth o y in * 1 eh thay ore te be sai* enly oaka tthha deereaatmdeereremra#tiatraafeteiatehleaoamgpolaea#lamdonkesttrhiaalbmyogtUa#adbaotiAeeontolirnailieseet laamiilnlaoidtimaletlrnidannadtrtltaelreheeeaaltshleptreiabhlanmlsan,e#Tahalda pahereemalot babeaunlddebrethmeedlilrgereeutnded teeapthervmUetdeiotaei*tehet M.aIttneair!Mtnragetieii*iaaaTahije hteysgtleentUe tomldnilnd btteagommetlaeaheleAa leie biulneaalivaadhaimn iedtnryetteetotsaa#ttiigrlaleolynseit*#mbifinlealieesetmtsetse#eeamtptgar e fa ti" te"aAhseifttamsarftta ll faehriAthlaet maleisnf ;lisbtee namtoldllbo*e kteepdinleot taroaminrtilnagg btiyA*a*lipiat.h binai omstlag 9oA 1 ventilationTheenignindeuesrtraisaslighnyegdiatsaladtoaahigmaidadatlua ltlatlliaacoraroeecpteirvaet*mweaitshurtehsefor hthlaeacsolfntaroitlhaat lhlepalitahsihaoapaarrdaat*ioaaIbaandledaaleaarleDadirielyotdeor this wiftahatihlaarolsoeoperetion of tha industrial hygienist* Dr* Sadth,Tahnlda lprl*anleatmfcageebn,d! orDserd* SjateapohdenlistoanlyahtaytairdthGaatrdhnaera,laDar*aaSatepimhefnesvoenr, ofofronth#acKomadiltotaeleD, iirfecftaorr htoo coothopererraatoaafoosllthya.n ltao autattaddovtahtahtai ftlateeoaescoeassaitatrayaa taharaairprleangnueldarhaaaaaotlanlcdanormally hare to apand foor half days a aonth In attaadinf eration poZteanlntiaalshugeagletshtedhaatharadtathenadetohnaailrtteeelimahinoualtdionno, thountlya*htoauklda ninaktoa acoantsoiddy aoafasaaofetltoyadhataharadtat*heTrehaaasaafaetygrpoarodeaddeuarlaoafinfoothliangfacatnodrhyoarnsdepslaiylltaaornaglatxh*a It pemarptlaoyaeneds*bellatke-asnhdiftthaguraaridaa haaarrealabsaaasppilliancgedaafastporcokteacntdionnaftoarrlacelartaininthneoring faatozy* isles and p u n y a y i ara aftas blocked eitk natarlala and truck* lr* fosterBseofdaarthleaavaitnstgaaAasobtesthtoast, hona aTahurasbdaley,toKasyr1it7lrX *assadinnrfdamiaadlavthDatash ethmaaLidteteaaa*f Itetaamra--nrtttateemdtheaitththteina imaa*adngaapclaldeeltalaadnanatdaaoaaatniatag saaflatiraeeaacnhd nenoetrngye*easBoaorayt tia--aalficnagpaalrelnoattas ilhlaackrt abfetaaoasorlathtLaoaaahtaeatthfahuprrettitsao*aaaadyiatasla1 otirodserintathaavaslilal ltaaathdafhaeftfatsayt*af seasonal saathcr changue a tha dust aenaantrw PROD?r, .... ^ rVwJ:c1u.<nhi# ^ 0681 .'otx.r.sx rxxxr- xxxac Aisietant Vice-President, Malfare June 12, 1915 Mr* Ivan Sabourln Aldred Building Montreal, *;ue., Canada Dear Irani Minaa* Ona or Our good go two racant developments prompt ma to writ# you friand, Bill Fehnsl, juat before leaving to again up to about Thetford Canada again told aa of tha rary wondarful cert that you took of hi and Mr. Patrick on thair laat riait* I cartainly envied thair opportunity of being with you* Dr* Borsette of our Canadian Office vhoa 70U hare at, 1 bexieve, id dova harm today with Father Edile Bouvier of tha University of Montreal to giva the latter an opportunity of eating eoae of tha people in our health and welfare cervice* X had a chance to to you that 0ne a work talk with Father Bouvier and laarned that tha euggeatioa had of Father's Sourier* studente who did some laat summer bean ado at Asbsstos would be available again this lunar* I think if you could persuada tha ina opera tor group in Thetford to invite this young im o to Thetford to study the living end working condition* it would be constructive thing to do* A you know* fro the study we sede of tubero losis mortality in Thetford, we drew the conclusion that tha problem waa a co-- unity one but we had practically no evldeno which described the social and econ omic conditions of the comaunlty. Such data la Important not only for correlation with the mortality study that we haws mad but also in connection with any morbidity or case-finding which fir* Cartier will undertake* Moreover, the information to be gained by such c survey of the environment end habit of tha community is essential for a health education progran which X think eventually must be undertaken if the tuber culosis probi-- is to be successfully attacked in Thetford* X would certainly think it to the advantage of the asbestos operators to sponsor this study which could be done under the aegis of ths University of Kontrsal* The spense involved in underwriting X this would be negligible* aspect for tho two or three nonths it night be at the reto of $25 or $30 ft -- *1 It mould coca to mo thet no small outcome of such a survey might thm rapport be to further between industry tnd the community l o a d such as the clergy, physician, sad later leader since part of tho study would necessarily involve inter views with each indiwidmmls* I expect that Dr. Lanas will be visiting Canada the end of the aonth In con nection with soee industrial hygioas problemi of the Canadian Army* He expects to bo in Montreal for a day or two* X hope that ho can too you and poaeibly get down to Thetford line* and see Dr* Cartier end the other# there that you would feel he should sa. X as s u that he could give some very valuable advice concerning soaj >f the problems that Dr Cartiar moat be feeing* lith kindest regards* Sincerely youra, k A l 0 7 Assistant Vice-President, Welfare T xxr-sr- '-- r- -oc i333taat Vic-President, Welfare Jun* 15, 19A3 Dr* G* J* Vharrett Executive Secretary Canadian Tuberculosis Plaaa Building Ottawa, Oat*, Canada Association Dear tr* Asrrettt X hat just been going o n r sows correspondence relating to the tuberculosis prablse the letter X received through Dr. P, in J. from Thetftard Vine and thought Touraageea Er* Palsy eight interest you, because in your letter of February 20th te ee you said that yon hoped the Provincial Health Dspartnent raid undertake a tuberculosis survey of the ooseonity of Tfcetford U s e s * Sr* Foley states "It is eztreeely 'asirable that -ray study A ould be undertaken anoog the population of Thetford Sines. The preeeaee of Dr* Cartier on the spot mould be of. greet assistance to us* However, it Is so difficult to obtain tbs necessary material that X doubt A e t h e r this important work oould be vndertaken sad brought to a successful finish.1 Very sincerely yours, Assistant TicePrsidgit, Velfare r Assistant Vice-rreiilenl, rel"are June 15 1945 Vary P.everaod Father ZhdLI# Douviar Zcole da Service Social da 1'Olivers!te da 2ioatreal 1961 Rus Rachel Iat "cr.trcal, Qua*, Canada Soar Father Bouviort Thera ill ba a delay in getting a oopy of the The tford Hines study to you because X an trying to get copise sad X *111 sand it to you as s o o t as copies ara available Sincerely yours Assistant Vlc-- Preslrtut Welfare (P $r . TX~.r~:r~rr'- '-JCTXZZ Aaalatast 7icaPraldaot, Walfara Jur 13, 1943 Kr Ivan Sabotarla Aldrad Building !8ontraal, Qua, Canada Daar Irani that thIinakn vvaariyl oglfadthatoabrraarnagyaoauarntntoota aorfaJuthnaa 1yo4vthnganndantoiroknnar rtahllaaaltUypholaiuraSaarraaalLtayaanoatafoItckamnloltawraatahaiatgthoyaottonhlaahravattilfloaiordkarinKhrgitvafaabarlavtbarflaodntaaotatanfior*trhTa eaInottraala %lagaaohfaJugnoaa24to%fcanndtrvaailli bBaathaaxrpaaomta ttlal tbhaainarIabnnlntgraoafl tthhaa 22t7ttfhc alandlo2n9ttrtuaalBa ia pIlwanulgnggaattathgaatt ylaontodrrcohp wbliathayonnota#nahdirtlaoinrfrlhralal of Lthaanaaaoaaatiade,oaroadniXaaqtuoatayta*IrfmIagrnoittiotiaawbaiathtoyaomu donIhhaiatfoarrtrflrZatlaagOtiria dthaartvtovpialilacatrhray aaroaormtrhaaatvlaanakaanvdlthbMutrIBvabileiarblaa*gorarnad by wbmt Parrot vhloIhama amvratroaattnhag aqaoaoaptyioonfyaonlarattiaaardZaroaoocaarirnaidngfronTofpiration of daatha by ratidanaio 11th kiadaat raguda n S/C/M/M Canadiarr'Jubercuosis-%VX Associati-.njggTBfr on PrmJtnU Mis Ex c e l l e n c y thk Rioht Ho n o u r a ble T h e Ea e l OP ATHLONK. K.O. BOVCRNOR-SENERAL OP CANADA PrtjUtMM TEO. RLO. NRTOU .DODNYT.. Pm iJnl-Eittt- CO l_ J . D . A D A M S OWNI,NBN.IAP.C. OM,.DM..AMN..R.C.R. (O . P.R.C.P. (Cl. OTTAWA p l a z a b u i l o i n o CANADA H m p i Vio-PrtsJtwt*- THK UCUTCNANT-BOVERNORB OP AU. THK P ROVINCCB Hmtrmt Tnaan* E. A. S TE P H EN S . OTTAWA. ONT. ti. J. WHEExtRaRuhETUT.n tMa.nD.. M.R.C.P. June 20, 1945 Dr* G e o r g e If* W h e a t l e y , Assistant ViceKBresident, Welfare, Metropolitan Life Insurance Company, Me Yo r k City, 'u.S.A* Dear Dr* Wheatley Th a n k you very m u c h for y o u r letter of June sending m e the information you have recel red from Dr* regarding the tuberculosis problem in Thetford Wines. this further ith Dr* Woley the next time I see him* 15th and for Tourangeau I sill discuss I think that, a s he says, the presence the spot should be^rery helpful in improving the of the t h i n g s a s a o u l d like to do m a y be c a r r i e d -direction* of Dr* Cartier on situation and many out under his , ci !c:M/Wis IVAN SABOURIN ADVOCATE Mo n t r e a l . J u h S 1945. George il. Assistan Metropoli' NEW YORK U.3.A. atley, Esq., M.D., ce-^resident, Welfare, Life Insurance Company, N.Y. Dear George, I beg to acknowledge receipt of youra of t 18th inat. Contents have been, noted* I have not succeeded in having young Sthier work at Thetford this summer aa the operators there had lately made soma changes in their "publie relation a* set up which set-up they did not wish to disturb for the coming 3ummer* I have informed father Bouvier accordingly and Father Bouvier appeared appreciative of my efforts and of youra. Dr. Lanza ia meeting Father Bouvier this morning. I have spent part of the day yesterday with Dr. Lanza and he will be spending the week-end. at my home. He met the Doctors of the i^uebee Workmen'* Medical Board yesterday and made a deep impression on them. His contri bution, X an sure, will prove to be very helpful in the proper appreciation by the medical experts, here, aa regards our asbe stasis-tuberculosis incidence. Thank you for the copy of the letter written by Dr. Parrot. This point is now fully cleared up. ALDRKD BULDXNG yxcnxxrrcrrr'r'xx Assistant 71-*e-?r93::.ent, .'elfare July 10, 19A5 Dr, F, J, Tourangeau, Director DiTiLon of Tadustrial Hygiene ' 'tialatry of Health and Social 'elfare Quebec, ;ue., ;.aiwuia Dear Dr* Tourangeau! . I as rery {laU to hear fro* Or* Lana* hat an enjoyable meting be had dfe you recently In Quebec, Be telle no that the subject of *y paper on tuberculosis and asbestoels c m e up for discussion end that yru pi cased aone lntereet la haring it published X think thle le rery H a d of yea and X should be rery pleased to hero you do so. Bo doubt, you could risk to hare It translated Inte French, Should thle be Incanrenient for you J, no doubt, can sake arringanewto to hare It translated, If you aid to publish it I sa enclosing a copy of the paper* sincerely yours, Assistant Vice-President, Welfare i O/ 'w// \ MINISTRY OF HEALTH AND SOCIAL DIVISION OF INDUSTRIAL HYGIENE QUEBEC WELFARE August 6, 1945 Dr. George M. Wheatley, Assistant Vice-President, Welfare, Metropolitan Life Insurance Company, New York City, U. S. A. Dear Doctor Wheatley, office, your Following a letter of July as prolonged aheenea fron y 10th was handed to together with a copy of your paper on tuberculosis and aabeetoaie. I intend to send it to the Canadian Public Health Journal for publication, unleaa you prefer ta have it published in a French Journal. Sincerely yours, fjt/ h. - Director of the Division Ffctruary 17, 194 Kr. H. 1 & d t h Ball Asbesto Mina Thatfard Minai, Quebae Canada Dm r S a lti i Tour lattar to our Canadlaa afflce.haa baae rafarrad to m far rapir* I aa aaolaaiaf a eopy tf tha \ \. Bafliab tranalation of tba artlela bini appaarad la Lrral Ifadioal* Sia crifinal report, howarar, la auch loagar and u aoos u copiai ara agallatila, taarvlll ba >/^ aaat to you* Tou aey ala ba lntaraatad te aaa a copy of a lattar aaat to Kr Laasari of tha FOdaration Satinoala daa fiBpleyaa da L'Xaduatrla Klnlara* Sinearaly youra, Gaor*a H. Ibaatlacr, I.D* Aaalataat Yice*PraaidV -u G [a U L O'-`-w ^ IVAN S A B O tR IX f 4- t . ADVOCATE atcou tu /WW Montreal. V -Q .* MEMO This Tubercuiosis-Asbestosis 1944 Survey conducted by Metropolitan Lif e (Dr. George Wheatley then Assistant Medical Director of Metropolitan Life in N e w York) might be of interest to you. At the t i m e this study w a s c o m m u n i c a t e d to the officers at Quebec such as W o r k m e n 's Compensation Board, departmental heads and also to the m e m b e r s of the Pneumoconiosis C o m m i t t e e of the W o r k m e n 's Compensation Board and also to the then pulmonary experts in the Province. T h e attached copy w a s m a d e out of the basic report of Dr. W h e a t l e y which I have in m y files. In connection with Cancer, the s a m e prejudice is rampant now, as you know, which was rampant before 1944 as to Tuberculosis. T h e Metropolitan survey dispelled that prejudice. At that time w e 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. A s 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 with Dr. Grgoire, Professor Beattie of Cambridge, Professor Kushner of N e w Y o r k University -- an expert in the pathalogy of cancer t u m o r s -- ) is a m e m b e r of the scientific c o m m i t t e e of our proposed institute under the chairmanship of Dr. Wright. April 29th, 1966 I.S. u Gq. t 7} Q , 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-legal interest in the establishment of this diagnosis and evaluation of any contributing factors. Autopsy of asbestos miners has disclosed evidence of active tuberculosis and asbestosis in the same individuals. In Thetford Mines, where a substantial part of all the asbestos in Canada is produced, the mortality from tuberculosis has in the past 16 years approximately doubled in contrast to a 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 hot disclosed a higher incidence ef tuberculosis mri"e workers with clinical and X-ray evidence of asbestosis. (C) Lanza in-1935 concluded that asbestos dust did not predispose to tuberculosis. In his examination of 126 workers in the industry in the United States, 53.13 ere found to have definite X-ray evidence of asbestosis. Two cases of active tuberculosis were found. One of these was a worker with asbestosis. (j>)ln 1936 Donnelly reviewed X-ray film of 151 workers in asbestos Mills and found evidence of asbestosis aaong 34 *1 $ of the group. 80 cases of aotive tuberculosis were found among workers with asbestosis. On the other hand, in the group with^asbestosia he found A active cases of tuberculosis. Two of these active cases had been in the asbestos industry, 6 and 10 years respectively. Donnelly concluded that there was no tendency per in this type of industrial occupation to exacerbate old tuberculous lesions. (3 ) McPheeters reported in 1936 an X-ray survey of 210 persons exposed to asbestos dust. He found 25.2^ had some evidence of asbestosis. \ \ Three cases of active tuberculosis were C831 fbiWSEEDd sS/Cc/mais -2 - found. No tuberculosis was found in workers with asbeatosis. The three individuals with tuberculosis had been exposed to asbestos dust 6, 9 and 10 years respectively. In five cases healed pulmonary tuberculosis and asbestosis were found in association. The average duration of exposure for the 5 was 10.1 years and for the entire group 10.2 year8. McPheeters decided there is no accelerating effect of tuberculosis on asbeatosis. \ In summation of this evidence it can be said that X-ray and clinical studies among asbestos workers in the United States does not reveal a significantly greater amount of tuberculosis than found in the routine examination of workers in any industry. Moreover there is no evidence from these studies to indicate that long exposure to asbestos dust activates or accelerates the tuberculous process. Both these observations are in contrast to findings among workers exposed to free silica. Canadian Observations There have been no published reports of studies aaong asbestos workers in Canada with respect to the prevalence of asbestosis or of tuberculosis in ths asbestos industry. In 1930 Fedley and his associates examined physically and by X-ray 195 asbestos worlcsrs in Asbestos and Thetford Mines^S-^ tauci* Asbestos Thetford Mines # examined HI 54 % with more than. 10 years dptm.** 22 83H # with asbestosis % with asbestosis 18 12.7 .24 11.4 One case of active tuberculosis was found among the 195 individuals . examined ^ J This is a very satisfactory incidence of tuberculosis aaong an industrial group, in a surgey in 19 10 of the garment trade when an Inoirw 1 case was found in 200 individuals examined. Pedley id^jej found that the tuberculosis mortality in Thetford Hines for the years 1926, 1927 and 1928 compared favorably with the tuberculosis mortality for the Province of Quebec. PRCDUCED'S/<$ikls" Tabi* 2 Ararat* Tubrculos1* Mortality far All At* p*r 100,000 Place 1926-28 1910-12 * Change Quebec 123.6 78.6 35 - - I s t o r i __ i r . 9 -- 2 X -1 ____ k^wmJ*in*c'** tills rt-o rt of Pedley there has fc**n a harp chant* In ttHIerelatio n en lp batan Thatfonl Mines and the Province a* hole. Tbl* 2 shows that lh the Provine# of Quebec the average rate for the three years 1910-12 ha* decreased 35* corered to the average rate for the vears 1926-23. This corresponds to experience elsewhere in Ceida and the United States On the other hand, In Tbetford Mines for the corresoonding period tuberculosis ao rtality has Increased more than 30*. The obvious existence of a serious tubereuloils preblea In 1 n u i 'jy*ha* speculation regarding the influence of asbesto* dust. y V If the indu*tr ia l exptousuarIeir'/ifsrta.tsoilgl,nnj3ifica(ntfMacuto'Vrlinn.eoxyacerbating or cccelerating tubereuloils on* would expect to find a significant difference in male* over 25 year* cf age aince, in Thetford Mines ,^this part of th# population^ae1e.*aiml*leaoa*muiua# y u frf-- Irrilwidea lii llamai*nr i laoa Socio-eoononie factor* ara also signifleant in relation to tubarculoaij^ cooparlson of the tuberculosis a o rtality ratea in Thetford Minea with communities in th* Province of libs sire, medical and public health fa c ilitie s, aoclo-econoaie and racial characteristic 1 important,ffrihUn hag oolntad out that where socio-economic factors ware dominant tha tubarculoslM ao rtality rate* for both husbands and wives war* sim ilarly affected; ehere industrial factors playsd a leading rolethe standardised ao rtality rates for th* husbands greatly exceeded that of th* wives. (p. 50, Tuberculosis in Industry - Saranac Laboratory Symposium. 1911) Through tha eourtasy of th*^Provincial jfaa1^ ^na^agg^H jiy a i ^ e ^my^P r.^ arro t, were furnished the nunber of deaths fro* tuberculosis by ago end sax for th* year* 1939 to 1913 for the c itie s of Thstford Mines, Riaouaki, Chiooutlnl, Cap da Madelaina, St. Hyacinth*, S t. Jean, and Vallayfiald, as mall as fo r the Provino* and th* boatinice as a A ola. Of th* six coemmities picked with these characteristics in alad, the tom oitfa Rprlimnciop'a"ula^int.d^urLs*trluyy*i^salumbering , Thetford Minea, except Instead and wood~finishl2kv*~r^ ^Z. 'wi ** of aabastoa Mining *t+o- Shows thsrSoxtallty Bats byNSex fo/m A,ges Prorinoe ri tfr.Se_ve_n_f_tt_aa_fc_e__1*1` in th* X Tubrculoais DAealtlhARgeaste per 100,000 PROVIMCK OP QUEBEC M77a.l5a Pe8n0a.l8* CSatp. dHayalcainMthaedeleine St. John 8515..59 75.1 1910..59 109.8 1 CVhallcleoyuftilealid H10I1..78 18159..31 - RTihneotfuosrkdl Mines 117910..91 222837..93 Proa-Table Z~it w ill be noted that three or the seven towns for wniw dal* was obtained have a tuberculosis mortality which is appreciably higher than the Provincial ra ta . Females in Rlmouskl have th* highest average jrata for the years 1910-12. Pernales in Thetford "toes have a higher average aortality for tha corresponding period than males in Thetford inee who ranked third fftO S tfC E D S/C/MAV.s Furtbtr analy*l* by age and tax baa baan attaxuted for tba cossuaitle* of Riaouaki and Thetford kinea and tha rasulta appear In Tabla 5. Interpretation la d iffic u lt becsusa of tha snail nuaber of person* Inwolwad Is tha age fro upa tn tha two conaunltlaa. It Is of Intarast to nota, however, that among Thatford -talas tha highest m ortality rata Is recordad In salas ajad 25-31. la P.laouskl salas tha highest rata Is In the group 75 and older. Thetford famalas aged 25-31 have tha highest rata In either sale or female groups, being 519.8 par 100,000, or four Usas the rovinclal rata for tha same eges. The rata In tha corresponding age grouo In Rinouskl female* Is 16.1 which Is nearly three tines tha Provincial rata In tha saaa age group. Tuberculosis also - takes a high to ll In Rianuskl females 35 and older. Rare tha rata Is four timesl6tb!**V -- I"v P)iij 1aiiiT~sKau1s1safaisJ,Wi wju 3. .a * Tubarculopaalsr 1D0e0a,t0h0*0and Death Rates 1910-1912______________ Bale* age ?Dreoarth, sof Rat* Quebao DRlenaothusskRl ate TDheeatthfosrd HEinaets 01-211Age* 25-a*35 f 13186878 7175..52 157 19731..39 1336 112910..31 1981038 111062..21 102 316101..91 1103 231125,.9C Jill age* 0235-52v+131 PDreoawth,*of ORimabtaeo 11061191 8602..87 11303732 18331..11 esaLs DRiaaaothuaakRi ata TDheaetthfo*rd UlRnaata 3123 228171..39 1138 9 16 212632..59 519.8 10 131361..71 9 178.1 a*at**>'" j * TT* Mw Cac^w *aT SO c a x i ^ v n a j Thetford Unas Population 12,000 Industrie* OHffeicaelthl. HUenailtth KPuurha.aH*. ph#y^PMriEvm. a Asbesto* 1 1 5 12 Phy#.R*tio 1/1000 Blssuobuurkbi*Inel. 10,000 limfibneirsihnign,gwood 1 1 1 10 1/1000 Cap nadelelr* 13,000 rsutebabel rfoaufgn.dry. 1 1** 6 2 1/6500 bag,afg. silh r Three Biwar* 15,800 pruabpbeer,r,liinroenn 1 1 9 10 1/U50 * Chiceutlnl 25,000 .plaipieirl,wir.bnDifldlsr.y,1 1*** 10 (in cl1. 97 specs) 1/1500 i S t. Hyacinth* clay products 18,500 tex tile afg. 1 1**** 6 U 1/130G Vallayfiald 20,600 waruniintide*s*. ,cootthtoenr 1 1 5 10 1/2000 ilk. **f uinlol lutidnin*gh1* adltehn toi sfft ic e r* including 12tbfu. lla-ptianeialpiahtysician* 083 ` hhhs PRODUCED S/C/M/Ms - 5- DISCUSSION It'.is obvious that tuberculosis mortality is excessive In Thetford Nines But there is no indication from these data that occupation is a dominant factor, because! 1 ) the mortality is equally bad among females; 2) It is excessive in the age group under 2 1 where there is little or no industrial exposure; 3 ) tuberculosis is also a serious problem in Rimouski where there is no asbestos industry. The age and sex distribution of mottality from tuberculosis resembles the oicture of tuberculosis in a heavily seeded, susceptible population with a substantial pro portion of the mortality occurring in both sexes under age 2 1 and the majority cf deaths under age 35- There is no evidence, if asbestos dust is a factor, that it resembles free silica in its influence on tuberculosis mortality. Careful and thorough mortality studie^among granite cutters in the state of Vermont revealed that they are subject to an excessive frequency of deaths from pulmonary tuberculosis, not because of an exceptional risk of contact infection, or because of inferior physique, or because of unfavorable housing conditions or other sanitary deficiencies, but primarily because < the occupational exposure. This same conclusion has teen reached in every other study of workers who contract silicosis. Unfortunately we were unable to calculate expected deaths based on the Provincial rates because the age groupings obtained for Thetford Hines and Rimouski did not correspond to the age groupings available in the census data for the Province. Far further insight into the magnitude of the tuberculosis problem in these two communities, /Jr. it would be desirable to construct such expectancy table3s w X.j, ,, i V A> . CONCLUSION w 1 1. Based on current mortality data, tuberculosis in Thetford Hines, in contrast to 0835 many communities in thm Province as well as the Province as a whole, has substantially increased. 2. Rimouski, a lumbering town, comparable to Thetford mines in socio-economic conditions, medical and public health resources, has a high tuberculosis mortality comparable to Thetford Mines. p r o d u c e d s /c v w m . - 5- DISCUSSION It'is obvious that tuberculosis mortality is excessive in Thetford Minei But there is no indication from these data that occupation is a dominant factor, because: 1) the mortality is equally bad among females; 2) It is excessive in the age group under 2^-where there is little or no industrial exposure; 3 ) tuberculosis is also a serious problem in Pimouski where there is no asbestos industry. The age and sex distribution cf mottality from tuberculosis resembles the oicture of tuberculosis in a heavily seeded, susceptible population with a substantial pro portion of the mortality occurring in both sexes under age 2L and the majority cf deaths under age 35* There is no evidence, if asbestos dust is a factor, that it resembles \ R free silica in its influence on tuberculosis mortality. Careful and thorough mortality studies~amcng granite cutters in the state of Vermont revealed that they are subject to an exeessive frequency of deaths from pulmonaiy tuberculosis, not because of an exceptional risk of contact infection, or because of inferior physique, or because of unfavorable housing conditions or other sanitary deficiencies, but primarily because cf the occupational exposure. This same conclusion has teen reached in every other study of workers who contract silicosis. Unfortunately we were unable to calculate expected deaths based on the Provincial rates because the age groupings obtained for Thetford Vines and Rimouski did not correspond to the age groupings available in the census data for the Province. Far further insight into, the magnitude of the tuberculosis problem in these two communities, it would be desirable to construct such expectancy tables^ 4Ua di^ui f l J t*t*w*A*ZbM ^ CONCLUSION 4 o JC&***y '?***<# n0*m . 1. Based on current mortality data, tuberculosis in Thetford Vines, in contrast to 0835 nanv communities in the Province as well as the Province as a whole, has substantially increased. 2. Pimourki. z lumbering town, comparable to Thetford mines in socio-economic c^ndit,i'>ns, medical and -ublic health resources. has a high tuberculosis mortality comparable to Thetford 'fines. [PRODUCED S/C/M/M: - 6 - '"1 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. L. Admittedly our data is inadequate for final conclusions, nevertheless there is.no indication from this mortality study that demonstrates asbestos mining per se in Tnetford Mines is the cause of the high tuberculosis mortality. 5. Further mortality studies shoull be made to construct expectancy tables for age and sex in Thetford Mines, P.imouski, and perhaps elsewhere in the Province. 6 . Tuberculosis case-finding surveys should be made both in Thetford Mines and comparable communities. - t n ---- ' s ^ v-- - \ u / * & * - / < L s j ^ h f - - , l f i j o , * ^ ^ 4 (ipi. U U^> * "Xj^ e" 1 J . * *- ^ ^ J 6 ^ -3 \ ^ / f U s 3. ? t/. ^ -- 2 - 7 * o^ I J Zj,i* *,<fit \ X f ^ ju-\a r -> - Yf-s) J'T- . - v ~ - 7 W A d ,u /: fl> - / ? < f i f t l k ^ J K t ^ J L t. ^.J, T W , iCfiojSiL \ ^ . ^ l u f c >r> tJ t p , J* - 0837 PRODUCED S/C/M/Ms \ *Zj L \ L-rruAC % *k--- iee d ^ ^ nay sfyy C039 PBODUOicD S/C/M/Ms DRIFT EBYIROnfZITlL OBSJHVATIOHS AT ZERSORD Visual inspection of the Bills of the three asbestos operators was Bade. Dust counts were Bade at all iaportant working locations of these properties, and the results are given in a separate report* There was no opportunity to personally observe hone conditions, eating-and living habits of the population, but this information was reported to us by competent observers. Several conditions prevail in the Bills which would favor the spread of pulmonary tuberculosis. The workman appear to be careless about spitting and other personal habits. In order to keep want in cold weather they huddle in groups In snail wooden cabin-like enclosures. These aaasure about 6* x6*. They usually contain a bench or two and a chair, with some Heating facilities) a small tin cam on the floor which la used for cigarett butts, spitting, or left-over food In-., one Bill a tin drinking cup has beam s in use for aaay years* It is obvious that, if there is an eaployee with tuberoula bacn 1 in his sputum, thsse environmental - conditions favor the spread of tuhareulosls* It should be noted that In review of the death clalna in the mines' insured with the Company a^fepfc difference In tuber culosis mortality was found* /Hine A between 1941-44 $ deeth^dus to tuberculosis with a rate of 2*8 pew 1,OOP employee years* In M n e B for tha oorraspending period there were @ tuberculosis- deaths wi s by a rats a f 1*4* It was in U n a A that fee most conspicuous ussanitary practice, ths cosmos drinking cup-, was food* Hons liviai conditions are crowded and it is comeos practice for children and adults to share beds This is am importest factor favorlag^fes transmission < ths disease-- not emly because it promotes Loser husam edataot but,'by interfering with adequate rest, fea iadirlduaBi resisUbce to infeetiom la lowered* Poor eating habits and food saleetlon which prevail also contribute to the lowering of resistance to tuberculosis/jpThese observations am environments! feetors are admittedly superficial because of the brief time available far inspection and observation. Veverlhelass, because of tb^r^importaace~ln creating and -- twtainiwg tubereoloais in the coj-- unity, further investigatioa of them would seem to be warranted* L |^ 0839 PROD|dWs/C/M/Ms] "1 - 8- Lanza, A. J., McConnell, William J., and Fehnel, J. WiUlas. "Effects of the Inhalation of Asbestos Dust on the Lungs of Asbestos Workers". Reprint #1665, from the Public Health Reports. Vol. 50, No. 1, January A, 1935. Donnelly, J. "Pulmonary Asbestosis* Incidence and Prognosis". Journal of Industrial Hygiene and Toxicology. Vol. 18, No. A, April 1936. / UcPheeters, S. B. "Surrey of a Group of Employees Exposed to Asbestos Dust". Journal of Industrial Hygiene and Toxicology. Vol. is, No. A, April 1936. I Lanza, A. J., and Pedley, Frank G. Unpublished data. Tuberculosis in Industry. Saranac Laboratory Symposium, 19A1 the National Tuberculosis Association, p. 199. Published by xb. Pedley, Frank G. "Asbestosis". Canadian Journal of Public Health. November 1930. P p. 576. f, Tuberculosis in Industry. Saranac Laboratory Symposium, 19A1. Published by the National Tuberculosis Association, p. 50. Hoffman, Frederick L. The Problem of Dust Phthisis in the Granite Stone Industry.- *7 Bulletin of the U. S. Bureau of Labor Statistics No. 293, May 1922. ft,C*****/v " d jo Z f t* r fiU i*s****i & \ V U irtJ U *.f, f ' * `7- _ p ^ y t^ p S j A < u u A / f ^ P y y 7 0840 % PRODUCED S/0/WMsj TUBERCULOSIS AKD ASBESTOSIS A brief review of current knowledge and analyst! of- tuberculosis mortality in the asbestos mining community of Thetford Mines, P.Q., Canada Recent developments in Canada have focused attention on the question of the relationship between asbestoqis and tuberculosis* Asbestosts has been declared a comoensabie disease in the rovines of 'uebec, thus increasing redico-legal interest in the establishment of this diagnosis and evaluation of any contributing factors* Autopsy of asbestos insrs has disclosed evidence of active tuberciosis and asfcestosis in the same Individualsi'^In Thetford Mines* where a substantial part of all the asbestos in Canada is produced, the anrtality from tuberculosis has in the past 16 years approximately doubled in contrast to a significant decline In the Provincial rate* These developments have materially helped to create the impression in tba Province of Quebec that there is a causal relationship between tuberculosis and asbestosis similar to tha carefully demonstrated and generally accepted relationship between silicosis and tuberculosis* Observations in the United State! Previous studies of workers exposed to asbestos dust have not disclosed e higher incidence of tuberculosis among workers with clinical and X-ray evidence of asbestosis* Lanaa^ la 1935 concluded that asbestos dust did not predispose to tuberculosis* In his examination of 126 worker In the Industry in the United States, 5 3 *1 ? ere found ' to have definite X-ray evldanoe of asbestosis* Two cases of active tuberculosia were found. One of these was a worker with asbestosis* r- -- --r> /p- /ft1 <* ~ ~ o/wwi/m In 1936^ Denoally reviewed X-ray fils of 151 workers in asbestos sills and found evidence of asbestosis among } i,l% of the group* Bo cases of active tuberculosis ere found among workers with asbestosis On the other hand, in the group without asbestosis hs found four active sses of tuberculosis* V of these active cases had been In the asbestos industry, six and tec yetrs respectively* Donnelly concluded that there wee no tendency per se in this tyoe of Indujsttrriiaall^^cj^^^ - 2- to exacerbate old tebtreulosls lai*ns. Mc?heeter*3 re-crt*d in 19 3 6 an 7-ray survey of 2 10 persons exposed to asbestos oust. He found 25*2$ had .'a.e evidence of asbestosis. Three case of active tuberculosis were found. So tuberculosis was found In worker with asbestos!. The three individuals with tuberculosis had teen exposed t*' asbestos dust 6 , 9, nd 10 years respectively. In five cases healed oulconary tuberculosi and asbestosis were found in us sedation. The average duration of exposure for the 5 was 1 0 . 1 years no for the entire .roun 1 0 . 2 years. McPheetars decided there is no accelerating effect of tuberculosis on asbestosis. In sup-aution of this evidence it can be sate that X-ray and clinical studies among asbestos workers in the United T-t^tes does not reveal a significantly greater amount of tuberculosis than experts!in the routine examination of workers In any industry. Moreover there is no evidence fi"a these studies to Indicate that long exposure to asbestos dust activate or accelerates the tuberculous process. Both these observitl-ns are in contrast to findings acong workers exposed to free silica. Canadian Observation* There have been no published reports of studies among asbestos workers in Canada with respect to the prevalence of asbestosis or of tuberculosis in the asbestos industry. In 1930 Pedlsy and his associates examined physically and by X-ray 199 asbestos worker In the tons of Asbestos and Thetford liines.^ The result of this survey sppear in Table 1 * TABLE 1 ,,--- 'J b/G/iWMs Agbeijpt Thetford Sines # examined % with tore than 1 0 years exposure # with asbestosis % with asbestosis U1 22 18 12.7 5A 83. A 0749 U.i - 3- 7ne case of active tuberculosis as found among the 195 individuals examined. This is a very satisfactory incidence of tuberculosis among an industrial groan, even today, ^or example, it approximates the incidence in a survey in 19Z0 of the active garment trace hen Incase as i>und jJer-J.6-5 individuals examined.*^ Fedley found that the tuberculosis .mortality in Thetford Mines for the years 1926, 1927, and 172? compared favorably with the tuberculosis mortality for the Province "f Quebec. TABL 2 `veruge Tuberculosis Mortality for All Ages per 100.000 lace___________ 1926-23 1940-12______ % Change Quebec 123.6 78.6 35 - Thetford 137.9 252.1 83 4 However, since this report of Pedley there has been a sharp change in the tuberculosis aortality relationship between Thetford Mines and the Province as a whole. Table 2 shows thtt in the Province of Quebec the average rate for the three years 1940-42 has decreased 25% coo-ared to the average rate for the years 1926-28. This corres- oonds to experience elsewhere in Canada and the United States. On the other hand, in Thetford Mines for the corresponding period tuberculosis mortality has Increased more than BO%. The obvious existence of a serious tuberculosis problem In Thetford Mines h&s led to speculatloa regarding the influence of asbestos dust. Tuberculosis Mortality Study If the industrial sxposurs to asbestos dust is a significant factor in exacer bating or accelerating tuberculosis ons would expect to find a significant difference in males over 25 years of age since, in Thetford Mines, practically all of this part of the population not in military service work in the asbestos industry. Soelo- P-\ i"Vw 1 l'- -A - ec^molo factors are Iso significant 'n relation to tuberculosis* Therefore comparison of the tuberculosis mortality rates la Thetford Mines with communities in the Province of like site, medical and nubile health facilities, socio-economic and reeial characteristics 19 .important* Dublin has tx>inted out that share socio economic factors were d-ninant the tuberculosis mortality rates for both husbands .nd wives were similarly affected; where industrial factors played a leading role the standardized nortality rates for the husbands greetly exceeded thut of the 9 wives. Through the courtesy of the Demographer of the Provincial Ministry of Health anc Social Up 1 fare, rr. Paul Parrot, we were furnished the nueber of deaths from tuberculosis by age and sex for the years 1939 to 1913 for the cities of Thetford Mines, Piaouski, Chicoutimi, Cap de Madeleine St* Byacinthe, St* Jean, and VRIleyfield, as sail as for the Province and the Dominion aa e whole* Of the six communities picked with these characteristics in mind the town of Riaouskl was thought more nearly to compare with Thetford Mines except instead of asbestos mining its principal industry is lumbering and wood finishing (see Table 3',g>. la) TABLE A Shows the Average Mortality Rate by Sex for All Agee in/'v'r - Province and in tha Seven Selected Communltiea `^ - 1910-1912 PR0TT5CI Of QUEBEC Cap de la Madeleine St. Hyaclnthe St. John V.lleyfield Chicoutimi Thetford Mines P.imouski Tuberculosis Death Rate per 100,000 All Agee J^i Female 77.5 55.9 81.5 75.1 101.7 1 1 1 .8 190.1 171.9 80.8 11.5 90.9 109.8 85.3 U9.1 223.9 237.3 0751 - la - TABLE ? Eeserially Data on gelected Cocaunltles 'ooulation Industries Health Health Pub.H. 0 Private Ratio Phv: Officer# Unit Nurses Physicians Ponul&tioi Tbatford Sin 12 ,0 0 0 riacuski (ind.. 10 ,0 0 0 suburbs) Can '.'adeleine 13,O X Three Rivers 15,800 Chicoutiei 2 5 ,0 0 0 St Hyacinth Valleyfield IS,500 20,600 asbestos 1 aining lunberine, wood 1 finishing rubber afg., 1 steel foundry, bag, afg, silk paper, linen 1 afg., rubber, iron aluainua, pulp, 1 paper, iron ftky, clay products textile cfg. 1 aunitions, other 1 war Industries, cotton, silk 1 5 1 1 1 * 6 12 1/10 0 0 10 1 /100-0 2 1/^500 1 9 10 1/1150 !#* 10 19 1A500 (incl 7 specs.) l***e 6 1 5 U 1/13 0 0 10 1/2000 full-tiae health officers Including 1 dentist Including 1 tb. specialist Including 2 full-tin* physicians ** 0752 r ' :U iw* kVi<* - 5- From Table 1 It ill be noted that three of the seven town* for which data as obtained have a tuberculosis mortality which is ap-'reciably higher than the Provincial rate. Female* in Risoueki have the highest average rate for the years 1910-12* "oaales in * Thetford Mines A have a higher average mortality for the corres- ponding period than males in Thetford iiines ho ranked third in this analysis* Further analysis by age and sex has been attempted for the communities of Rioouskl and Thetford Vines and the results appear in Table 5. Interpretation is difficult because of the small number nT persons Involved in the age grours in the two coamunities. It is of interest to note, however, that asong Thetford males the highest mortality rate is recorded in males aged 25-31 In Risouski sales the highest rate is in the group 35 and older Thetford females aged 25-31 have the highest rate in either sale or female groups, being 519.8 per 100,000, or four times the **rovindal rats for the sane ages The rate in the corresponding age group in Risouski resales is 116.1 which is nearly three tines the Provincial rate in the sane aga group* Tuberculosis also takes a high toll in Risouski females 35 and older* Here the rate is four tiaes that of Provincial females of the same ages* AGI All Agee 0-21 25-31 35 r AGE All Agee 0-21 25-31 35 + TABLE 5 Tuberculosis Deaths and Death Rates oer 100.00Q 1910-1912 r MALE8 ' So /C/M/Ms groTt-Of_2Sbg deaths Rate Risouski Deaths Rate Thetford Mine Death Rate 388* 77.5 17 1167 15.2 5 303 102.1 2 1918 116*2 10 171.9 36 93.3 13 111.1 10 360.9 13 190.1 121.3 312.9 215.0 SBHALZS Prov, of Guabafe Deaths Rate 1019 1611 1072 1333 80.8 62.7 131.1 83.1 Risouski Deaths Fate 32 287.3 13 211.9 9 116 .1 10 331.7 Thetford Vine* Deaths Rate 13 223.9 18 162.5 16 519.1 9 178.1 0713 5 i.ViHOKMfJffAL OBSERVATIONS AT THLTEORD Visual inspection of the mills of the three asbestos operators whs tads. Dust counts were sa.ce at all im^'-rtant working locations of these properties, ana the results are given !.n a separate report. There was no opportunity to personally observe hone concitl'.0 ?, tatin;.' ^nd living habits of the population, cut this information was reoTted to us by competent observers. Several conditions prevail in the (Bills which would favor the spread of ^ulmon&ry tuberculosis. The workmen appear to be careless about spitting and other personal hacits. In oraer to keep warm in cold weather they huddle in groups in small sooder. catir.-liVce enclosures. These measure about 6 * z 6 '. hey usually contain a bench or two and a chair, with sons heating facilities; a small tin con on the floor which is used for cigarette butts, spitting, or left-over food. In one mill a tin drinking cup has been In use for many years. Tt is obvious that, if there is an employee with tubercle bacilli in his s>utum, these environmental conditions favor the spread of tuberculosis* It should he noted that in review of the death claims in the mines Insured with the Company a difference in tuberculosis mortality was found* In Mine A between 19A1-194Z, eight deaths were due to tuberculosis with a rate of 2.8 per 1,000 employee-years. In 'line B for the corresponding period there were two tuberculosis deaths with a rate of 1*1* It was in Vine A that the most conspicuous unsanitary practice, the common drinking cup, was found* Home living conditions are crowded and it is common practice for children and adults to share beds* This Is an important factor favoring the transmission of the disease-- not ony because it promotes closer human contact but, by Interfering with adequate rest, the individual's resistance to infection is lowered* Poor eating habits and food 3electi n which prevail also contribute to the lowering of resistance to tuberculosis* These observations on environmental factors are admittedly superficial because of the brief time available for inspection and observation. Nevertheless, because of their probable importance in creating and maintaining tuberculosis In the community further investigation of them would seem to be warramted* - 6 - LI2CU35I0N It Is 'bvioua that tuberculosis mortality is excessive in the town of 7hetf~rd Allies. 5ut there Is no Indication from these data that occuneti^c Is a dominant factor because* 1 ) the mortality is cually bad among females; 2 ) it is excessive in the t:;e roup under Zi, here there is little or no incustrial exposure; 3 ) tuber culosis is also a seri'us nroblem in r.iaruski here there is uo asbestos industry. The age and sex distribution of aortaiity from tuberculosis, resembles the Picture of tuberculosis In a heavily seeded, susceptible ponulatl^n ith a substan tial orooortion of the aortallty occurring in both sexes under age ZL -nd the majority of deaths under t>ge 35 There is no evidence. If asbestos dust is a factor, that it reseables free silica to its influence on tuberculosis aortality. Careful and thorough nortality atudkee^aaong granite cutters in the state -f Vermont revealed / that they are subject to an excessive frequency of deaths from pulmonary tuberculosis, noV~because ~f an exceptional risk of contact infect*on, or because of inferior ohysique, or because of unfavorable housing conditions other sanitary deficiencies, but primarily because of the occupational exposure* This same conclusion has bee* reached in every other study of workers dio contract silicosis Unfortunately e were unable to calculate expected deaths based on the Provincial rate? because the age groupings obtained for Thetford Ulnae and Rimouskl did not correspond to the age groupings available in the census duta for the Province. For further insight into the segnitude of the tuberculosle problem in these two communities, it would be desirable not only to construct such expectancy tables, but to carry out case-finding studies in these end similar communities in the Province of Quebec. CISCLUSIOM 0755 1* Based on currant mortality data, tuberculosis In Thetford vines, In contrast - 7- to many communities la the Province as vail as tbs Province as a whole, has substantially increased* 2 * Kimouski, a limbering town, comparable to Thatford lines 1 :; socio-economic conditions, medical And publiAci health resources, has a high tuberculosis mortality c^"-arablfc to Thctford Mines* 3. Analysis of the tuberculosis mortality by age and sex in Thetford Vines, in the other communities and in the Province shows that both sales 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 slilea. 4. Admittedly our data is inace:uate for final conclusions, nevertheless there is no indication from tfcls mortality study that demonstrates asbestos mining per se la Twetford *ines is the cause of the high tuberculosis mortality* 5 * further mortality studies tficuld be made to construct expectancy tables for age and sex in Thetford Mines, r.imouski, and perhaps elsewhere in the Province* 6 . Tuberculosis case-finding surveys should be cade both in Thetford Mines and comparable communities* 7. Health education concerning prevention of the disease is needed* as well as improved sanitation, particularly in the plants. George I. Wheatley, I.D* , ^ Assistant Medical Director 7 : Metropolitan Life Insurance Company Mr. R. J* Tame, Senager occupation Ratings, has contributed to this study by valuable suggestions regarding the handling and Interpretation of the deta as well as by making the statistical analysis* Cu+uo Dr* A. J. Lanza, Assi S'tsirt Medical Director, has very generously permitted ua to use his unpublished data secured by Pedley in 1930 on asbestosis and tuberculosis in miners of Thetford and Asbestos!.'. Dr. Lanza has also advised on the preparati on of the final report* , . V ,P Lr. N. L. Burnette, Assistant ceeretery, secured for us the information on tne socio-economic conditions of the selected conaunities* 1Wl i\ ii \*\ C 7 3 6 n - 8 - R E ? I P. E X C E S 1 De'taeuiea, R., r->.s?re&u, L., Ciroux, K., and Richard, P. -Sjksbaafcosis and ^laonary Tuberculosis" Laval aedlcal. Vol. 8 , V-rch 1913. p. 2 1 7 , 2, L'esaeules, .r.d Gir->uxf U. "Arbestosis and Pulrconary Tuberculosis". Laval aedlcil. Vol. 8, 'tfarch 1913. P. 227, 3. Lanaa, A. T., i'cConnell, fn.ii.Ji J.. ^nd -Vhnel, .T, iliiam. "iffects of the Inhalation of she9tos Duet on the Lungs of Asbestos aorkers". Renr'.nt ^1^5 frrs the ufc-i.lc Health be----rts. Vol. 50, No. 1, January 1, 1935 1. D'rmelly, J, "Pulaonary Asbestn.lsi Incidence anc Prognosis". Journal of Incustrial Hygiene and roxicoloL7 . Vol. 1 8 , No. 1, April 1936. 5. KcPheeters, 7, B. "Survey 'f a Grour. of En.rlryees 'rx-'-sed to Asbestos Dust". formal ~f yn'-u3 tri-xL y iene and Toxicology. Vol. 18, So. 1, April 1936. Lanaa, A. J., <mc Pedley, ''rank G. Unpublished data. 7. Tuberculosis In Inauatr7 . Saranac 4*aboratory Svrcresiua, 1911. Published by tha National Tuberculosis Association, p. 139. 8 . Pedley, Trank G. "Asbestosis". Canadian Journal of Public Health, N0vecter 1930. p. 576. 9. -- Tuberculosis in Industry. Saranac Laboratory Synpoaiun, 1911. Published by the National Tuberculosis Association. 0. 50. 10. Hoffman, Frederick L. The Problem of fust Phthisis in the Granite Stone Industry, bulletin of the 0. 3. Bureau of Labor Statistics, No. 293, May 1922. 0757 kt> jr/, el/zuf!e--'--- ,i A ; , f" TUBiP..U^C3IJ a n d a s b e s t o s i s V Asst A brief review of current knowledge and analysis of tuberculosis mortality in the as'oestes raining community .. a of Thetford Mines, P.Q., Canada /> 2^7 / " 75" accent developments in Canada have focused attention on the question of the relationship between asbestosis and tuberculosis. Aobestosie has been declared & compensable disease in the Province of Quebec, thus increasing medico-legal interest in the establishment of this diagnosis and evaluation of any contributing factors. Autopsy of asbestos miners has disclosed evidence of active tuberculosis and asbestosis 1& 2 in the same individuals. In Thetford Mines, where a substantial part of all the asbestos in Canada is produced, the mortality from tuberculosis has in the past 16 years approximately doubled in contrast to a 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 Stat8 3 Previous studies of workers exposed to asbestos dust have not disclosed a higher incidence of tuberculosis among workers with clinical and X-ray evidence of asbestosis. Lanza^ in 1935 concluded that asbestos dust did not predispose to tuberculosis. In his examination of 126 workers in th e .industry in the United States, 53.1^ *ere found to have definite X-ray evidence of asbestosis. Two cases of active tuberculosis were found. Ona of these was a worker with asbestosis. In 1936^ Donnelly reviewed X-ray film of 151 workers in asbestos mills and found evidence of asbestosis among 3 4 . of the group. No cases of active tuberculosis were found among workers with asbestosis. On the other hand, in the group without Lsbectosia h* found four active cases of tuberculosis. Two of these active cases'1 *d been in the asbestos industry, six and ten years respectively. Donnelly cpncluded that there was no tendency per se in this type of industrial occupation to exacerbate old tuberculosis lesions. McPbeeters^ reported in 1936 an I-ray survey of 23,0 persons exposed to asbestos dust. He found 25.2^ had some evidence of asbestosis. Three cases of active tuberculosis were found. No tuberculosis was found in workers with asbestosis. The three individuals with tuberculosis had been exposed to asbestos dust 6, 9, and 10 years respectively. In five cases healed pulmonary tuberculosis and asbestosis were found in association. The average duration of-exposure for the 5 was 10.4 years and for the entire group 1C,2 years. McPheeters decided there is no accelerating effect of tuberculosis on asbestosis. In summation of this evidence it can be said that X-ray and clinical studies among asbestos workers in the United States does not reveal a significantly greater amount of tuberculosis than expected in the routine examination of workers in any industry. Moreover there is no evidence from these studies to indicate that long exposure to asbestos dust activates or accelerates the tuberculous process. Both these observations are in contrast to findings among workers exposed to free silica, Canadian Observations These have been no published reports of studies among asbestos workers n Canada with respect to the prevalence of asbestosis or of tuberculosis in the asbestos industry. In 1930 Pedley and his associates examined physically and by X-ray 195 6 asbestos workers in the towns of Asbestos and Tbetford Mines. The results of this survey appear in Table.1. \ TABLE 1 Asbestos Thetford Mines ff examined 141 54 % with more than 10 years exposure 22 83.4 t? with asbestosis 18 24 % with asbestosis 12.7 44.4 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 the indicence in a survey in 1940 of the garment trade when 1 active case was found per 165 individuals examined. V' Pedley8 found that the tuberculosis mortality in Thetford Mines for the years 1926, 1927,and 1923 compared favorably with the tuberculosis mortality for the Province of Quebec, TABLE 2 Average Tuberculosis Mortality for All Ages per 100.000 Place 1926-23 1940-42 % Change Quebec 123.6 78.6 35 - Thetford 137.9 252.1 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.-^ha years 1926-28. This corres- ' / / to experience elsewhere in Canada and the United States. On the other hand, /jTietford Mines for the corresponding period tuberculosis mortality has increased / 3rd than 8 C. The obvious existence of a serious tuberculosis problem in Thetford y.LD*6 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 expect to find a significant difference in males over 25 years of age since, in Thetford Mines, practically all of this part of the population not in military service work in'the asbestos industry. Socio economic factors are also significant in relation to tuberculosis. Therefore, comparison of the tuberculosis mortality rates in Thetford Mines with communities in the Province of like size, medical and public health facilities, socio-economic and racial characteristics is important. Dublin has pointed economic factors were dominant the tuberculosis mortality rates for both husbands and wives were similarly affected; where industrial factors played a leading role the standardized mortality rates for the husbands greatly exceeded that of the Through the courtesy of the Demographer of the Provincial Ministry of Health and Social Welfare, Dr. Paull'Parrot, we were furnished the number of deaths from tuberculosis by age and sex for the years 1939 to 19^3 for the cities of Thetford Mines, Rimouski, Chicoutimi, Cap de Madeleine, St, Hyacinthe, St. Jeand, and Valleyfield, as well as for the Province and the Dominion'as a whole. Of the six communities picked with these characteristics in mind, the town of Rimouski was thought more nearly to compare with Thetford Mines, except instead of asbestos mining its principal industry is lumbering and wood' finishing (see Table 3> p.4a)' ^ 5 TABLE 4 Shows the Average Mortality Rate by Sex for All Ages In Province and in the Seven Selected Communities 1940-1942 Tuberculosis Death Rate per 100,000 A H Ages ______Male___________ Fecale PROVINCE OF QUEBEC Cap de la Madeleine St. Hyacinthe St. John Valleyfield Chic outimi Thetford Mines Rinouski 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 Descriptive Date on Selected Communities Industries Health Off'leers Health Pub.H. tr?rivate * Ratio Phys.to Unit Nurses Physicians Populate uetford Mines 12,000 Asbestos 1 mining Lmouski (incl. 10,000 suburbs) lumbering, wood 1 finishing ip Madeleine 13,000 rubber mfg., 1 ' steel foundry, bag, mfg. silk :r<e River3 45,800 paper, linen 1 mfg., rubber, iron ;icoutimi 25,000 aluminum, pulp, 1 paper, iron fdry., clay products ;. Hyacinthe alleyiield 18,500 textile mfg. 1 . 20,600 munitions, other 1 war industries, cotton, silk 1 . 5 12 1/1000 1 4 10 i/iooo 2 1/6500 1 9 40 1/1150 l " * 10 19 0/4500 (incl. 7 apcs.) l* * * * -i- 14 1/1300 1 -5 10 `1/2000 -- full-tine health officers T including 1 dentist including 1 tb. specialist including 2 full-time physicians /roa Tcble 4 it will be noted that three of the seven towns for which data obtained have a tuberculosis mortality which is appreciably higher than the provincial rate. Females in Rimouski have the highest average rate for the years . 194042. Females in Thetford Mines have a higher average mortality for the corres ponding period than males in Thetford Mines who ranked third in this analysis. Further analysis by age and sex has been attempted for the communities of Rimouski and Thetford Mines and the results appear in Table 5. Interpretation is difficult because of the tmal1 number of 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 males agred 25-34. In Rimouski males the highest rate is in the group 35 and older. Thetford females aged `25-34 have the highest rate in either male or female groups, being 519.8 per ICO,OCO, or four times the Provincial rate for the same agres. The rate in the corresponding age group in Rimouski females is 446.4 which is nearly three times the Provincial rate in the same age group. Tuberculosis also takes a: high toll in Rimouski females 35 and older, mere the rate is four times that of Provincial females of the same ages; TABLE 5 Tuberculosis Deaths and Death Rates oer 100.000 1940-1942 AUw - All Ages 0-24 25-34 35 r Prov. of Quebec Deaths Rate 33S3 116? 803 1918 77.5. 45.2 102.1 .116.2 KALES Rimouski Deaths Rate .17 171.9 5 93.3 2 114.4 10 360.9 Thetford Mines Deaths Rate 36 13 10 13 190.1 121.3 342.9 245.0 /*&' All Ages 0-24 25-34 35 Prov. of Quebec Deaths Rate 4019 1614 1072 1333 80.S 62.7 134.1 83.1 FEMALES Rlraouski Deaths Rate 32 287.3 13 211.9 9 446.4 10 334.7 Thctford Mines Deaths Rate 43 223.9 18 162.5 16 519.3 9 178.1 ENVIRONMENTAL OBSERVATIONS AT THETFORD Visual inspection of the mills of the three asbestos operators was made. Dust counts were made at all important working locations of these properties, and the results are given in a separate report. 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 careless about spitting and other personal habits In order to keep warm in cold weather they'huddle in groups in small wooden cabin-like enclosures. These measure about 6* x 6 f, They 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 left-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 favor the spread of tuberculosis. It should be noted that in review of the death claims in the mines insured with the Company a difference in tuberculosis mortality was found. In Mine A between 1941-1944, eight deaths were due to tuberculosis with a rate of 2,3 per 1,000 employee-years. In Mine B for the corresponding period there were two tuberculosis deaths with a rate of 1.4. It was in Mine A that the most conspicuous unsanitary practice, the common drinking cup, was found, . Home living conditions gre crowded and it is common practice for children and adults O /are beds. This is an important factor favoring the transmission of the disease-- npt j_y because it promotes closer human contact but, by interfering with adequate rest, tne individual's resistance to infection is lowered. Poor eating habits and food selection which prevail also contribute to the lowering of resistance to tuberculosis. These observations on environmental factors are admittedly superficial because of the brief time available for inspection and observation. Nevertheless, because of their probable 'importance in creating and maintaining tuberculosis in the community, further investigation of them would seem to be warranted. DISCUSSION It is obvious that tuberculosis mortality is excessive in the town of Thetford Mines. But there is no indication from these data that occupation is a dominant factor because: l) the mortality is equally bad 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 Kimouski 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 population with a substan tial proportion of the mortality occurring in both sexes under age 24 and the majority of deaths under age 35. There is no evidence, if asbestos dust i3 a factor, that it resembles free silica in its influence on tuberculosis mortality. Careful and thorough mortality studies^among granite cutters in the state of Vermont revealed that they are suhject to an excessive frequency of deaths from pulmonary tuberculosis, not because of an exceptional risk of contact infection, or because of inferior physique, or because of unfavorable housing conditions or other sanitary deficiencies, but primarily because of-the occupational exposure. This same conclusion has been reached in every other study of workers who c6ntract silicosis. Unfortunately we were unable to calculate expected deaths based on the Provincial ^cet because the age groupings obtained for Thetford Mines and Rimouski did not correspond to the ago groupings available in the census data for the Province, For urther insight into the magnitude of the tuberculosis problem in these two communities, it would be desirablo not' only to construct such expectancy tables, but to carry out case-finding studies in these and similar communities in the Province of Quebec, CONCLUSION 1. 3asad 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 socio-economic conditions, medical and public health resources, ha3 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, L. Admittedly our data is inadequate for final conclusions, nevertheless there i3 no indication from this mortality study that demonstrates asbestos mining per se in Thetford Mines is the cause of the high tuberculosis mortality. 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- case-finding surveys should be made both in Thetford Mines and comparable communities, ' 7. H ealth education concerning prevention of the disease is needed, as w ell as ^proved sanitation, particularly in the plants. George M. Wheatley, M.D. Assistant Medical Director Metropolitan Life Insurance Company Hr. R. J. Vane, Manager of Occupation Ratings, has contributed to this study by valuable suggestions regarding the handling and interpretation of the data as well as hy making the statistical analysis. Dr. A. J. Lanza, Assistant Medical Director, has vary generously permitted us to use his unpublished data secured by Pedley in 1930 on asbestosis and tuberculosis in miners of Thetford and Asbestos. Dr. Lanza has also advised on the preparation of the final report. Dr. N. L. Burnette, Assistant Secretary, secured for us the information on the socio-economic conditions of the selected communities. - 11 REFERENCES 1 . Desmeules, R., Rousseau, L., Giroux, M., and Richard P. "Asbestosis and Pulmonary Tuberculosis". Laval medical. Vol. 8, March, 1943. p.217. 2. Desneules, R., and Giroux, M. "Asbestosis and Pulmonary Tuberculosis". Laval medical. Vol. 8, March 1943. p. 227. 3. Lanza, A. J., McConnell, William J., and Fehnol, J. William. "Effects of the Inhalation of Asbestos Dust on the Lungs of Asbestos Workers." Reprint 1665, from 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, Np. 4, April 1936. 5. McPheeters, S. B. "Survey of a Group of Employees Exposed to Asbestos Dust". Journal 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 by the National Tuberculosis Association, p. 199. 8. Pedley, Frank G. "Asbestosis". Canadian Journal of Public Health. November 1930. 9. Tuberculosis in Industry. Saranac Laboratory Symposium, 1941. Published by the National Tuberculosis Association. p.50. 10 Hoffman, Frederick L. The Problem of Dust Phthisis in the Granite Stone Industry. Bulletin of the U. S. Bureau of Labor Statistics, No. 293., May 1922. / / 6 IVAN S A B O U R 1N , Q.C. ALORCO SUILOINO, M O NTREAL. MEMO Metropolitan TLhiifse T(Dubr.erGcueloorsgise-AWsbheeasttloesylsth1e9n44.ASsusirsrteayntcoMnedduicctaeld by yDoiar.ectoArt tohfe MtimetreoptohliistanstuLdiyfewinasNceowmmYournki)camteidghtto bteheofofIfnlteeerresstatto Qanudebaelcsosutochthaes mWeomrkbmeresn'osf CthoempPennesuamtiooncoBnoioasrids, Cdoempamrittmteeentoafl thheeads "exWpoerrktms einn'sthCeomPrpoevnisnactieo,n Board and also to the then pulmonary of Dr. WheatTlehye wahttiachchIedhcaovpey,Inwamsymfaildees.oat af the basic report rampant now,Inascoynonuecktnioonw,wiwthhiCchanwcaesr,ratmhepasnatmbeefporreeju1d94ic4e aiss to TAut btheartcutilmoseis.we Tahlseo Mhaedtrotpesotlitcaansessurcvoenydudcitsepdell(ethdethhaetarpinregjsudbiecien.g aatstheensdleode Lbayetxhpeosluearedindgidexnpoterintsviotef Tth.eB c. ontinent) to prove that Pittsburg survAesytotooCkapnlcaecre -inexthpeos5u0r'es t(oD ar.sbDesatnoiselInBcriadoennc-e,hitshestody wasabseasltsoosisp,ubcloisnhceludd) edwhtihcaht stuhrevreeyi'ss cnoontcslueesmioninsg, lyjusatnaysrienlatthioencsahsipe of between dost exposure and cancer. of CambridgeD, rP. rBofreasusnor( tKogueatimheerr wofithNeDwr.YoGrkrUgoniirvee,rsPitryof--essaonr eBxepaetrttie ^ v Icnomthme ipttaetehoolfogoyuorf pcraonpcoesredtuimnsotritsut--e _unldaear mtheemcbhearirmofanthsehipscoiefntific Dr. Wright. April 29th, 1966 X.S.