Document daveX2x6g2RMVkqXe25DKg24R

MANUFACTURING CHEMISTS ASSOCIATION 183b CONNECTICUT AVENUE. N.W. WASHINGTON, O.C. 20009 (2021 483-6126 I January 3, JAN 7 197,: TO: Technical Task Group on Vinyl Chloride Research M. SMITH SUBJECT: -Third Bi-monthly Progress Report of TabershawCooper Associates -Future Meeting Plans Gentlemen: i Distributed herewith is the subject progress report. The next progress report is scheduled to be an oral summary report to be delivered at a meeting of the Task Group on Wednesday, February 20. 1974f at a Chicago, airport motel to be selected. The Research Coordinators will meat the previous afternoon or evening at the motel. Please note this cnange of daue from t'ne 19'th^ as stated in the minutes of the last meeting, to the 20th. Sincerely, KDJ:mb Enclosure cc: Dr. D. P. Duffield Mr. D. M. Elliott Dr. Tiziano Garlanda Technical Task Group on Vinyl Chloride Research AP000I5662 I MANUFACTURING CHEMISTS ASSOCIATION VCM EPIDEMIOLOGICAL STUDY PROGRESS REPORT December 19, 1973 [! L L i V D IUS-ARCH & OEVELOPM-`; JAN 7 1974 W. M. SMITH Prepared by Tabershaw-Cooper Associates, Inc, 2180 Milvia Street Berkeley, California 94704 AP00015663 Manufacturing Chemists Association VCM Epidemiological Study Progress Report Progress to Date Data are now in hand from 28 plants, and are in the process of being obtained from 5 more. The remainder of the plants in the study i population have not yet been contacted, since it appeared to be a I matter of higher priority to establish the various follow-up activities described below as quickly as possible, before adding new data. Among the 5 plants which have been contacted and for which data are not yet in hand, there are some large establishments whose records include, in the same file, data for both vinyl chloride workers and workers in other activities involving no vinyl chloride exposure. These plants have themselves undertaken the lengthy task of searching their files for workers with vinyl chloride exposure. Without this co operation , the identification of- a study population in these plants alone would have taken over a month. The study population as of this date consists of 3952 workers. Data cards have been punched for 3037 of these. The latter group, ex cept for final information on vital status, is ready for analysis. Follow-up Different plants have favored different methods of follow-up. Depending on the wishes of plant management, one of the following four procedures is currently being used for each plant. I 3 dates for each. Each job was given a score of 1,2 or 3 according to whether the estimated exposure was low, medium or high. Jobs with no exposure were not included, but were used in the calculation of total duration of employment, as distinct from exposure. From those data it is possible to classify the study population by time weighted average exposure, maximum exposure, duration of exposure, and several other similar variables. Table 2, for example, shows the distribution by time weighted average for those workers for whom data cards have been punched. Only 27 percent of the workers had an average exposure of medium or greater. However, all of those with average exposures above 2.0, and most likely some of those with lower average values, must have had at least one high exposure job during their employment. Table 3 shows the distribution of duration of exposure by date of birth. It is helpful in getting some idea of the proportion of the study population which is in the older ages and has also had a relatively long exposure. This group is of particular interest for assessing chronic effects. Unfortunately, the fact that most plants are relatively new is reflected in the fact that only about 17 percent of the present group was born before 1930 and had 10 or more years exposure. Table 4, which shows the distribution of duration of exposure by the year in which exposure began, gives a similar picture. Those, for example, who had 10 years or more of exposure beginning approximately 20 or more years ago constitute slightly less than 3 percent of the study AP00015666 4 population. This picture will improve as soma older plants are added to the group and, in addition, the groups with longer exposure may contribute a disproportionately large share' of the ultimate experience in the study. Nevertheless, older workers with long exposures beginning some years ago will be in the minority. Mortality Death certificates have been received for 56 of the 105 workers known to have died. Table 5 is a listing of the causes of death from these certificates. This listing is presented for general . information purposes, but cannot be interpreted in terms of risk of death for two reasons. First, the number of cases is too small to provide any firm information about specific causes. Second, without the calculation of person-years of observation which will subsequently be made,' there is no basis for deciding how many deaths should be expected in this population. It is of course true that if the majority of these deaths had been from a cause known to be rare in the general male population seme interpretation might be justified, but such a deviation from the typical cause distribution is not apparent at the present time# Future Plans The follow-up will be continued and the remaining plants in corporated into the study. As soon as it appears feasible to do so. i APOOOf 5667 5 mortality rate calculations will be' made for the earliest plants to enter the study, for which follow-up will be completed first.- I APOOO15668 T TABLE I FOLLOW-UP STATUS OF VCM STUDY POPULATION BY DATA PROCESSING STATUS Statue Total Total___ 3952 Cards PunchedCards Not Punched 3037 915 Alive Dead Unknown 2972 105 875 2341 76 620 631 - 29 255 APOOO15669 TABLE 2 DISTRIBUTION BY TIME WEIGHTED AVERAGE EXPOSURE OF 2996 VCM WORKERS' 2 TWA Total 1 No. of Workers 2996 < i.o 1.0-1.4. : 1 3 1985 1.5-1.9 191 2.0-2.4 533 2.5-2.9 86 3.0 193 1. Exposure unknown for 41 workers. 2. The numbers 1,2 and 3 represent low, medium and high exposures. _ 0 i N APOOO15670 TABLE 3 DISTRIBUTION OF DURATION OF EXPOSURE IN YEARS BY BIRTKDATE, FOR 2996 VCM WORKERS* Birthdate Total Z. 1900 1900-1909 1910-1919 1920-1929 1930-1-939 1940-1949 1950-1954 Total ,2996 6 72 300 623 862 1093 40 Duration in Years L 5 5-9 10-14 1465 825 258 32 21 16 70 65 183 141 376 2-85 772 316 40 1 14 42 89 107 5 15-19 300 10 71 134 85 ^Exposure unknown for 41 workers. 20+ 148 11 52 76 9 i APOOO15671 T TABLE 4* DISTRIBUTION OF DURATION OF EXPOSURE IN YEARS BY DATE AT WHICH EXPOSURE BEGAN, FOR 2996 VCK WORKERS* Exposure Began Total . Total 2996 t Duration in years <5 ' 5-9 1465 825 10-14 258 15-19 300 1940-1949 1950-1959 1960-1969 1970-1971 126 757 1765 348 26 16 5 9 127 89 172 291 964 720 81 348 *Exposure unknown for 41-workers. 20+ 148 70 78 APOOOf 5672 TABLE 5' CAUSE OF DEATH AND ICD NUMBER* FOR 56 DEATH CERTIFXCATS OF VCM WORKERS Cause and ICD No. No. of cases All Causes 56 Malignant Neoplasms <140-205) 11 Malignant Neoplasm of The Lip (140) 1 Malignant Neoplasm of Large Intestine (153) 2 Malignant Neoplasm of Liver (Secondary) (156) 1 Malignant Neoplasm of Lung, (unspecified) (163) 2 Malignant Neoplasm of Mediastinum (164) 1 Malignant Neoplasm of Kidney (180) 1 Malignant Melanoma of Skin (190) i Malignant Neoplasm of Brain. -Xervcus -System (193) 1 Leukemia and Aleukemia (204) 1 Diabetes Mellitus (260) Subarachnoid Hemorrhage (330) * Arteriosclerotic Heart Disease (420) Bronchopneunomla (491) Pneumonia, other and unspecified (493) Other Diseases of Lung and Pleural Cavity (527) Other and unspecified congenital Malformations (759) Motor Vehicle Accidents (810 - 825) 1 2 23 1 1 1 1 8 i AP00015673 Water Transport Accident (850 - 85S) Accidental Fall (900 - 904) Other Accidents (910 - 936) * International Classification of Diseases, 1955 Revision. 12/15/73 1 1 5 APOOOI5674 J for l&ans under tills auiiourio*..vici'it muffi be mod r.ot later t;:;uj March DL1974. Dated: January 18.1374. Thomas 3. Klcpfe. Administrator. [TR Dce.7t-2373 Filed 1-23-74:9:45 am[ ViiTti<7.'>3 Aix:.ii^i31 n.'tT.C/'J ADVISORY CDULllTfEE ON STRUCTURAL cai-tty o.- yltlra.'.d ad:/.;:<::svr,v vic;i "AC.ir.*;z3 . Kccc ofttastlns The Veterans Administration elves no tice pursuant to Public Law 92-4G3 that c ir.cctir.st c' ifc Advisory Cocnraittce oa L.rucluiVil L-fli-ty of Veterans Adminis tration Facilities will be hold In Room 412 at the Veterans Administration Con trol Office, Oil Vermont Avenue, NW,, Washington, DC on February 23,'1974, at 10 am. TSis committee members v/tU review Veterans Administration con struction standards and criteria'relating to fire, cartiiQuabe. and other disaster resistant construction. The mooting will be open to the public up to the seating capacity of the room. Because of -he limited scatlorr capacity it will fcc ncccwnry Tor those wishing to attend to contact Mr. Jarr.es Leiter, Di rector. Civil 'Engineering Service, Office of Construction, VA Central Office (phone 202-Z6O-2SC3), prior to Febru ary 19, 1974. Dated: January 22,1974. Dy direction of the Administrator. CsealI It-c-us H. Wilson, Associate Deputy Administrator. ]FR Doc.7*-*4-*.8 Filed 1-23-74:8:45 em] DSPA.TTUZNT OF LABOR Cfnea of the Secretary POSSIBLE HAZARDS OF VINYL CHLORIDE MANUFACTURE AND USE Request for information and Notice of Fact-Finding Hearing Notice is hereby given that the Oc cupational Safety and Health Admin istration is requesting information on possible hazards associated with tho manufacture and/or use of vinyl chlo ride (chloroctbcne. Chemical Abstracts Service ItojjLsSry Number 75014). The Administration requests informa tion including, but not necessarily lim ited to: (1) The toxicity of vinyl chloride; (2) The toxicity of other chemicals In volved in the manufacture and use of vinyl chloride; (3) The teciinolo:;ics involved in tho production and use of vinyl chloride; (4) Employee populations potentially or actually exposed to vinyl chloride or other chemicals, suul involved in the pro duction and/or use of vinyl cliloridc; <S> K|>iticmiolo`dcal studies of eirceLs of vinyl chlor-uo ;..J other chemicals ic ed ir. the iva.--ui\c.;:/c or uro of vinyl chloride populations, employee or otherwise; auc* <C) V.T.cthcr Uv.' available ; . ;cr. P'.v.-h*.iu7 ofr.rer shall ecrtliy the record .virrai.ls the : :::j..r.,'.o of :.n ILr.ci'ae.t;./ vh^ivof vo the .'.r.ii. .n;;5 Seerotary of Temporary ih.-ndard. cr (lie commcnci;- Labor for Occt:,n.Ao:;al Safety and me:\t of a rt-ulr.r rulemaffinrc uncle? sec KeffiUu tion v'b) of the Occupational Safety and Health Act. V;.ter. cLr.li nay be ma/.ad or ffi-'.iv- Signed at Washington, D.C., this; 2Sth day of January 1974. ored jo t!'.a Ch.'.ee r,f Standards. Attn.: JnrtN II. S--s-o-j?.. Docket OSH-23. Occupational Safety Assfs'c:: Secretary o/ Labor. and ricr.ith Air;!ni.~rmlon. Room 2C2. 1T23 J Street N\v.. v/jshin.jton, D.C. 2i*.210. net later than February 2.7. 1974. [7R Doc. Tl--2C0-4 Filed 1-29-74:8:43 Rrn] T..e ihla \-`iU ba avffiL.blo fi.r puohc in- a;-action and coyyhi:; v.i tho OftflA 1'ublio Heading Room. Doom 203. 17ul l-Z Street NW., Washington. D.C. 20213. Oral presentation of data v.dli also be [Notice No. 434] ASSIGNMENT O" KEARINSS received by an administrative i,v Judge at an informal fact-flndins hearing be ginning at 10 a.m., e.d.t., on Friday. Fcb. ;:ary 15, 197-). Conference Room 13. De- JANTJAHY23,1974. Cases assigned for healing, por.tponemcr.t, cancellation or oral argument ap tncntal Auditorium, Constitution Avelvarmtental Auditorium, Constitution Avenue N'.V., between. 12th oncl L4th Streets, V/a^iiington, D.C. pear below and will be published only once. Tills list contains prospective as signments only and decs not include cases previously assigned hearing dates. Persvhs desiring to appear at the hear ing must file with J. Goode:!. Attn: Duck et OSH-23, Office of Standards. Occupa Tiro bearings will bo on the irsv.es as prCxlutly i-ftlccteu in the Official D.mlcct of the Commission. An attempt v.ili bo tional Safety and Health Administration, Room 203, 1723 hi street NW.. Washlncffon, D.C. 20210. a written notlco of in tention to appear, in triplicate. Notice made to publish notices of cancellation of heariuf's as promptly as possible, but Interested pnrtioK should taka spproi'ri- atc atrps io insure tiiat they arc :iou'ii.\l should be filed as soon as possible, but .of cancellation or postpanoments ol hear will be accepted by the Management Offi ings in which they are inceraslcd. No cer at the hearing until the pro-hearing conference begins. The notice should state: The name and address of the person wishing to appear; the capacity amendments will be cntcrtainccl after January 30.1974. MC-tGC77 Sub to. I',\*v/j\ T.*r.:i*jvort Cpi-;)., c.yMC 130153 Sub 2. Tnicklnr' Co.. i:u\, in which he will appear; and the approx imate amount of time rewired for the presentation. The notice should also in-- MC 13C3H5 Cub 3. iioiubrrit IhiitIkiicm, nc,, MC luu.nl.i;*. Cur;*-, nnw u 1071, \v;ll !>a ;..t, v|,,i ti:irr.iu..'.ij wurc. M:;:vh 13. ii... chide, or bo accompanied b.v, r. brief IJowilUJU-n, 175 l'lcilnu'IU Atelilli:, statement of the presentation to l>o G.i. made. w-bl Sul)-5s.'>. a, :.te.MV.!.tiT I.inp, Dcgirminff at 9:20 a.m.. e d.t.. on February 15. 1074, the oi-cfidiag Adiv.inltraiive Law Judge will hold a prc-hcarlug conference In order to establish the order and time for the presentations, and in order to scale any other matter relat Inc., ft W--157 i:uh-.'f<v. 0, jicAi:i:,i,'f I lie,. n.,tv l^einruitry 4, }074. ac Now V..r:t. N.Y., i-i esuicdlcd sitw (erred to MimuioU 1'rwednrc. MC-C1055. CcatrniK.il iqvaiisl'cr Co., Tne.. nr.v/ {(.signed Ptbrnnr- 0. JiKN. i-.i j,.R.r.:,ii Cuy, >ta. is cancelled n:.<i rcx.-.l-'iifid r.i- ing to tho proceadin-w. UfV C. J!)7J. In Iln..in iW. I'.nierr.J The oral proceedings shall bo reported PM :., :)tl Walnut, m.im, i:,i verbatim. The vt'e of prepared statement* by witnesses Is encouraged. All documents that, are intended to !>c submitted should be submitted in triplicate (original and two copies). No. 25717. SniiLliem 7t:illw:.y C'.n.fi:.:vl 1. tlr.n f.ir IMcli.vnU.ry Orcl.-r. I.-.717 "nlj 1. J.iiul::villi und N:tf.Uvillw ia.llrr-n-l CJniu- j>wiy--Petition Air lu<-l:r:t>.ry o.-'i'-r-- itn- I'und llnli:-- Aj.rufM.m .. r.,n> 11nUdd to Mitivli Id. 1074, at tins Oirsc-;. ol Tho administrative law Judge shall (.lift TiiU:r,.Into C'nn/nnp'ft Oonl.'il have all tho powers nece.sj-ary or appro- W:vMi)ni;loil, II.C. prisde to coaduet a fair and full Informal M(J :IR7U .`lob l(i. Plum r:ll.y 'IVni l-.li.;; hearing. Including tho powers; (n) To regulate tlic course of Lhelicur- ing: Cb> To dispose of procedural requests, objections, and comparable matters; (o) To confine the presentations to matters pertinent to tlio requested In jp.tuy, lull., m.w i<i.:ii|*,i.'l I'l Pini'.ry 4. JtiYI, nt (JlilonJJf*, III., t'l [iii'.I l;r"I.','.Iilli'.y, MC 22(iu Null 447, TeiiriOwny Ii.rt., rmw lucilitiied Puiiruury !:>71. u:, t.'li-w'lru.ii, (iMu, is caiicellnd mid llio a'lpllcni.li/ii ir, (ltiiiiibud. (seal] rUillMIT Ii. O.iV/Al.n, formation; Srv.rr.t.ary. (d) To regulate the conduct of thoae JtTl Dac.74*2451) ldli d 1 'SO -74;l];.ir, moj present at the hearlnc by appioprlato means: (o) In hlfl dlsicrctlon. to qucKtlon aiul permit qi:c:.Lionlng of any witness; nml FOURTH SECTION APFL1CATSON Idle RELIEF (D inlib'i UUwvtlun. Ui V.vi-p Uu: rvinl ,Unpav >.&, I'./iA. 01'il for a ivn.-.oiialili- :.ti;i'C<l Hum Uj in- An :L|...ll< al.'..ii, u-. eelVO v/VALi-n unt.k inmi -:>/ v. h<j hmi !,< i u IP. d ivirn.v.t:i J'.-.n* i.mi Liirs ji..rtii:l|iiii.-d m tile oral :.rocui..ii:i:;, j-^<,i,Jr< ;u.:i.L.-i of j.i.-bi-nt ! fl l-'ollowi.ii; lllo citAie of U'.c ho...'iOo'. tho slate Commerce A.* to jicr.r..; commoa FC2At B2CISTCR, VOL 39, NO. 21--W&NKOAV,. JANUA2T 30. 19/4 AP00015675  73-12-^7 i Deutsche Medizinische V/ochenschrift, 08 (43) > P* 2034-2037, 1973 "On the So-called Vinylchloride Disease" By S, Jllhe, G. E. Lange, G. Stein, and G, Veltman University Skin Clinic of Bonn Director: Prof. Dr, *Leinbrock Since 1958, when the first information on the hazardous health aspects to workers in the vinylchloride manufacturing industries was found, and especially since 1963, when the sane 'effects were found affecting workers in the polyvinylchloride industry (PVC), and through further reports on this subject 13, 4, 7, 8, 12, 28), attention has been drawn to this branch of the chemical industry. This deals with a disease similar to a skin and bone affecting scleroderma, but a disease un explainable in etiology and pathogenesis. The main symp toms of this have been the Raynaud syndrome, nodular to large area dense skin alterations and band-like osteolysis in the finger phalanges. We could report our first observations on this,disease type in Germany in 1972 (15, 16, 17), As the clinical picture was at first comparable to a specialised fora of progressive scleroderma, we submitted all employees to a painstaking AP00015676 2 internal examination to determine if visceral participation was also present. Recently, we reported completely (18) on the results found up until the end of 1972. These reveal new aspects to be used in the judgement of this disease and, as we believe, also may give new suggestions in the research* The 13 workers examined in the April-December 1972 time period were 29 to 52 years old (average age: 39 years), and had worked at least two, and at most 18 years (average period: 7 years) in a PVC-manufacturing plant at alternating jobs, although mainly as autoclave cleaners. The first disease symptoms appeared one and one-half to three and one-half years after first working there in eleven patients, and in two cases seven and eleven years after first working. .1 Symptoms and Findings ir. The most frequent initial symptoms of the anamnetical details are increasing sensity to coldness in the hands and feet, a feeling of deafness, and crawling parletosis. In addition, pressure pain in single fingers, a thickening of the end finger joints and weakening of the nails as well as general complaints of excessive tiredness, forgetfulness and slowing down, syncopal dizziness, nauseau during work. Increased perspiration and upper abdominal pain* A major role in the diagnosis of this disease is played by the alteration of the skin: Seven patients proved to have drumstick-like (clubbed) thickened finger end phalanges (club procurements and, shortening, watch-glass nails, shortening of APOOO15677 3 the nail plate). We saw scleroderma-like skin alterations in 6 patients; small knots or more spread out; very coarse and relatively sharply defined, usually covering the surface akin projecting infiltrate on the outstretched hands, the distal third of the arms under the elbow, and the area of the cheeks. Three patients had no clinical skin alterations. The histology findings of the excision specimens (from the left or right hands) of all patients were relatively.uni^ . form. Besides hyperorthocytosis and epidermidosis, there va6 an expansion and increase of capillaries in the upper cutis. An increase, widening and homogenation of the collagen bundle and a clear rarefaction and fragmentation of the elastic fibers was evident. The same findings in the epi dermis and the fibers of the upper cutis were proven to exist in the patients without clinical skin alterations. The histology alterations in the epidermis1 and the collagen connective tissues are similar to the edematosis to.infiltra tive stage of progressive scleroderma. Here, however, a clearly defined border is seen between that of possible but to some extent considerable injury of-the elastic fibers and the vessel alterations. So far, circulation disturbances are the most common symptoms: Nine of thirteen patients complained of this, and in fact eight, of them gave this complaint as their first symptom. The degree of complaint ranged from increased sensitivity to the cold and "akrozyanose" to the Sayn&ud APOOO15678 4 syndrome (four patients). The circulation obstruction could be judged objectively with the aid of temperature measure ments, determination of the time required to rewarm after exposure to the cold, capillary microscopy, and arm-hand -arteriography. In no case did oscillography and plethysmo graphy result in a certain pathological prognosis. From this, one can ascertain that the origin of the circulation obstruction is in the periphery and not in immediate range. of the large blood vessels. This consideration is supported by the angiographic and capillary microscopy results. Four patients with sensitivity to the cold were proven to have `ampule-like widenings of the capillaries in the nail joints -just as described in the Raynaud syndrome (14)* All seven patients who underwent arteriography showed pathological vessel images. The alterations ranged from a slight narrow ing of the Aa. digitales palmares propriae et communes with Single segmentary localized closure^ to a high degree of stenosis and segmentary closures, and even to the extent of he loss of contents by the arteries in the entire length `of the finger and clear stenosis of the entire hand joints. After the examination until this point, it appeared that a direct relationship existed between the length of exposure and the amount of vessel damage. The most obvious x-ray results of this disease were the band-llke osteolysis between Processul unguicularis and the phalangen on single or all fingers in six of the patients. AP00015679 5 In' addition, fragmentation and border defects of the Pro cessus unguiculares could be found in six patients. It is also possible to determine different degress of bone alter ation: in light cases only a small lytic zone is visible, and in the advanced stage the phalange is almost fully de stroyed and the Processus unguiculares mounts onto the basis of the phalanx cap-like. A full restitution of the bone is not to be expected based upon the' facts at this time (23,24). Remarkable herein is the solid correlation of acroosteolysis and the cluh-like expansion of the end phalanges. Thus, the 'drumstick fingers11 are an expression of the lytic bone process and not of an internal disease. An examination of the blood building system and coagu lation draws our attention to this remarkable finding-:' all 'thirteen patients showed light to serious thrombopeny. The :thrombozytic count lay repeatedly between 30,000 and '119*GC0^ulJI (under a normal limit of 150,000^0. ,In.-a sternal puncture given to six patients in search for an `explanation, there resulted in no case a reference to the Obstruction of the ^hrombosytopoese", osteomyelofibrosis, or osteomyelcsclerose. The other examinations showed, no deviations from the 'norm, except for a slight reticuiocis in eight patients (between 16 and 26 %), and a slight leu kopenia in five patients (2350 to 3950 leudocytes/^Jt ). Reticulosis and leukopenia may be caused by the splenomegaly in the twelve patients. At this time, it is not clear if AP00015680 6 the thrombopeny is also so caused, but It Is probable that it deals with a turnover disturbance or an increase in disin tegration in the periphery. It was observed in the anamnese that three patients re ported recidivisic pain in the left upper abdomen and one patient reported pain in the right upper abdomen and a feel ing of fullness, as earlier diseases of "Leber and Milz," yet long-time intake of medicines or extreme alcoholism were not * discerned* However, three patients without the scleroderalike skin condition and acroosteolysis had record histories pointing to a chronic liver ailment (Esophagus varices bleed ing, splenoral anastomosis;portal hypertonus; esophagus varices, splenomegaly*) The bromosulfaline retention was clearly increased, but by comparison the values for serumtransaminase and-phosphates were for the most part nothing out of the ordinary. This discrepancy could also be proven in the other ten patients. Four patients had esophagus varices, and In twelve cases splenomegaly was proven scintallgraphically. The laparoscopic and liver biopsy results of five patients, which were available to us at the end of 1972, showed remarkable agreement: surface area of the liver clearly or finely waved, capsule fibrosis, increased bloodand lymph-vessels, histologicaly a slight to clear fibrosis of the portal system and.indifidual cell necrosis, and slight coarse fat droplets. The result, that we could further ver ify at this time let us express the follov/ing theory: =Excent APOOOf5681 i 7 for the slightly toxic alterations of the liver cells, this results from the expansion of the connective tissues in the. portal system into the diffuse circulation in the liver. In advanced stages this leads to an interhepatic block (most like ly because of the hinderances in the height of the portal system, possibly similar to a sinusoidal block), with esophagus varices. It remains to be found if the splenomegaly is only is a secondary condition or if this primarily the direct .result . Of toxic changes. .t Of nine patients examined in the lung functions (anamnese, x-rays, .spirometry, entire body plethysmography, and blood gas analysis) after references pointed to mainly restrictive alterations, eight of these patients showed partial insuffi ciencies. Further research must be undertaken to determine *I if these disturbances can be traced back to the fhct that similar changes occur in the lungs as in the collagen and elastic supporting tissues of. the skin, that is, that a beginning diffuse lung fibrosis is the cause of these dis turbances. The Initiating Factor -- This paper is concerned with an industry-caused.disease, in which the symptoms include (arranged in order of most common occurrence) thrcmbopeny,.splenomegaly, toxic liver dsuoage, ventilation bleckage, circulation obstruction, and skin and 4 bone alteration. This complex of symptoms has not yet been ( AP00015682 8 been assigned to a known syndrome. It is unexplained etiologically and pathogenically. Ie it possible to obtain a certain insight in the etiology and pathogenesis by a comparison of. our results with, those previously recorded in literature? Y/hat is then possible to be the initiating factor? At a simultaneous pressure and temperature Increase, liquid vinylchloride is polymerized to polyvinylchloride with ^ the addition of water and various additives, depending upon i the different properties desired. In different countries, independent of the additive type, the Raynaud syndrome and acroosteolysis was present in workers cleaning autoclaves. The symptoms appear so characteristic that it lead in the past year to the disease designation of "occupationallyconditioned acroosteolysis" and was advanced to a diagnosis position (28). It is not assumed that the additives, differ ing by type, country of production and methods, play an import ant role, but the harmful combination of these with the vinylphloride can not be completely excluded. Therefore vinylchloride, the substance present in the largest amount, be comes the main point of our interests. The monomer vinylchloride is pumped over a closed system of an autoclave. The exit possibilities of tho gas - and thus the inhalation possibilities - consist then in more places within the pro duction process: 1. Permeability of the autoclaves (intake and offtake) -KiC AP00015683 9 during polymerisation and recovery processes* 2. In the discharging and opening of the autoclaves as well as in the drying process of the finished polyvinylchloride. The residual gas consists of up to 9096 vinylchloride (6) and often leads to leaden tiredness and short-lasting disorientation in the employees. 3* From the polymer precipitation on the walls of the kettles. Therefore, from the technical viewpoint,' it is completely possible that vinylchloride initiates the hereby described disease. ^ *< Some facts are already known about the effect of vinylchloride on human and animal organisms. The narcotic effects have long been recognized (22). Since. 1.958, reports have re peatedly been made concerning the angioneurotic obstructions and the Raynaud syndrome in workers (1, 10, 21). In the literature one finds single references.to the Intoxication of vinylchloride, wherein a reversible dizziness, light to very noticeable giddiness* disorientation, skin appearing as a 2-degree burn, and lessened blood coagulation have been e determined symptoms (6, 9> tl). One worker died as a re sult of poisoning. With the use of experiments involving animals, lung -% odem, blood congestion in the lung% liver, and kidneys, as well as decreasing blood coagulation could be proven (20). In long term experiments it was possible to produce centro- lobular degeneration in the liver and necrosis with foamy vacuolization as well as periportal cellular infiltration (26). AP00015684 10 Recently, reports were made concerning skin, lung, and bone tumors and obstructions in the bone structure (27)* These results, based on animal experiments, lead again in 1970 to a depression of the MAK (maximum occupation concentration) to 100 ppm (13)* It is not yet known to us the regulations concerning gas concentrations at the occupational site* The symptoms related in the framework of this disease (Raynaud syndrome, toxic liver changes, obstruction in the . ' bone compositions and prenarcotic syndrome) may then be pro duced by vinylchloride. Thus, in the knowledge of the occu pational site we can express the conjecture that long term exposure to vinylchloride is at least a, if not even the disease-initiating factor* The fact that the name "occu pationally-caused acroosteolysis" hints only at a not necessarily determining symptom shows that a new name should be coined* Y/e have proposed the designation "so-called vinylchloride disease" for this syndrome because this disease,h influenced by the participation of numerous organs, obtains the character of a system disease* Pathogenesis The pathogenesis is, as before, unexplained* On : the basis of our research we discussed the theory that the disease as a pathogenetic principle in the furthest sense is caused by an obstruction on the connective tissue or the vessel connective tissue. In-addition, as our theory shows that the toxic agent is effective not only per inhalationem, but 1 AP00015685 u Also perkutan, the fact exists that only uncovered main arteries exhibit scleroderma-like coatings and that the band-like os teolysis is only found on the finger phalanges. We saw sclerOderma-like skin alterations as well as acroosteolytosis only in workers who had worked a long period with the cleaning of autoclaves. This can perhaps be explained by the fact that 600-1000 ppm of vinylchloride could be measured in the area of the autoclave walls (5)* As an indication based upon the obstruction of the connective tissues, we saw the qualitative and quantitative alterations of the skin and the multipli cation of collagenic fibers in the portal system of the liver* The increase and expansion of the capillaries was visible by capillary microscopy and histology in the upper cutis, in addition, to the peripheral circulation obstruction proved 'clinically, angiographically, and thermographically; Even the alteration of the bone (osteolysis as a result of trophic obstruction by damage to the vasa nutricia) and the lung (restrictive and obstrictive ventilation blockage) can be synonomously explained. The prognosis of the disease judged quite optimistically by earlier literature-appears quite serious to us, especially with respect to thrombopeny, Teplenomegaly, and portal hypertension According to our observations of alterations in the bone, this disease should be judged with reserve. Consequences for the Practice The triassic formation of this disease system, serious AP00015686 12 prognosis and relatively high mortality (from our investigation certainly more than 10%) has led prevailingly youn men to sol icit us to place the following suggestions: 1, Execution of epidemologic and preventative medical experi mental tests* In our opinion, it is not sufficient any more to search for only Raynaud syndromes and knotty skin alter ations because these symptoms , as characteristic as they are, already show the advanced stage of disease. Perhaps more t - important, controls to determine the thrombozytic count in regular tine periods should he given to all employees of PVC- producing industries. This should take workers with a con stant thrombopeny out of this branch of the industry, as this appears to be the first objective symptom, before further and more serious internal damage occurs. 2* No employment given to those with liver diseases or circu latory problems. 5* Regular gas concentration measurements in different work sites to avoid exceeding the MAK limit. Experienced tech nical Improvement with the goal of greatest possible automation, andimprovement of the ventilation conditions to reduce the possibilities of gas inhalation to the lowest amount possible. if. Compensation to diseased workers and recognition of this disease as liable to indemnity by inclusion in the list of BKVO. y, 5. More research, especially with animals, using vinylchloride with special consideration to the skin, bones, lungs, liver, and spleen. ft APOOO15687 13 BIBLIOGRAPHY Uteratu^ (1) AnpheU'-u. M. Otniu. E. (luhrj* itewi, L. C Dohfm.wu. V. Gatca: Contnlcrstti clinKP-pamjenit' j-up'i J.mcnwln Raynaud li m-noH-ru din tndu'itca pglieloruni de '.nil. Mid. interna (Sue.) 21 [1941). 4?). (2] $M>Un. A. V.. A. N. Vjin. A. C. Kochetkov: Os ihe pnihjtreait of changes deacloptnt due < * Iwi'n- term eapuvare tu the o< cir.yl- Aland*. G.R. Tr. prof. Zabul. li tl|. 24. <2| Chalcisln, A., f. Monlkifti lln syndrome d'Kmtul|!( d'un^nc professions Its (I de conwrtinn fiuiiveile M France-. J. RadiuL tkcrcvl. <1 (1917), 277. (<) Cordier, J. M., C. Firm, M. J. Lefevre, A- ievrim AcutiatcotyM et (kaons cutances aaaocieea ehee Jure oi**riera affectft an nertoyjpe d'auincUvct. Cih. Med. Travail 4 llJiA), ). Ifl Cook, . A., f. SI. Clever, . D. Dinman, H. J. Msjr.utont QcojpjtHjral OCfooMtolysai. 11. An indgireial hapten* study. Ards, environra, Hith 22 (Will, 74. (i) DsAlijrf, H.i Accidental potroning by vinyl chloride. Caoad. med. Aoc. J. U (WfOy. *21. . <7) Dinrnan, B. D., W, a. Cook. V. M. VOi.tehou*, 21. i. MitmituAi Occupational semnt*ol>*:i. 1. An eptdcmtoloEiuJ indy. Ard). enmvnm. HI* 22 (1971). <1. (I) Dodson, V. X., 6. D. Dinman, V. M. Whttehouie, A. X. M. Nur. H.J. Mspnuacnt Occupational acrov* teelyaii, ID. A clinical study. Arch, curironm. HI* 22 (1971). 91. 9) Dublin. L. J., R. J. Vane: occupa tional huacdl >ed diagnostic science. Bulletin No. JU (WJ). Bulletin No. 41 (1741), U.S.A, Dcpe. Libor; niitrr int Daniitxr (0* tiituliMii, fott^>un<thrt^.t< dea Lan. dts XorJrheln-'Ac'tfalm. Sr. 15)1 (^'citdeur.Jier VciUg, Kgln 1H4)> 115) Juhc. 5., C. Vcitmtn. Zur Klimk dcr au|. Vtnyl.!ilnnJ.kra*'>.v.r>t I. Inter* n.imrulvt Stmpvivum der 'SerLainte d.f d:unu(dun InJuiine, 27. a. 1977. (10 J-ih S., C.-E. Lavgei S'e'eruJarmt*anito Hauaversnderun ten. Raynaud* Syndrom und Akroot'colvien bei Arbeitcm dvr 2 VC-hmuUendcn Induwri*. DitJa. mul. U'ichr. 97 11971;. 1922. (17) Juhe S., C.-E. Lint*. C. Saein, C. Velrrnant Zur Klimk dr to|. Vinylriilorid-Ktankhcir. Jahrcatsfont Dcundbo Crwliichaft (ii/ A(bei:tncd3ui It. (0. 1972. (It) Lanfe, C.-C , S. Juh*. C. Snrin. C. Veltmaii: Die sab. VinyldaloridKnnklicit - one bcruiabccarfre Sytteiia* aklert'iO Int. Arch. Arbeitsacd., in Dfuek. (191 Lint*, C.-t,, S. Jdhe. VI. J. Mar* rte|lcr, k. Mslier. C. Veltc-jr.t LeVcrtditdrn itn Rshaien der lop Vinyl* dilocid-Knnkhcit. Jshtmafint Dcui* ache CctcIlKhiit fur AfbcittnrditaB II. S. I7J- (20) btaimimsneo, Z., A. Mi Fiahcr, H. Chriatie. H. Danaieer. Acosinha* lation toxicity < vanyi thior.de to lahoriiory snimalt. Amer. ind-tif., Hyf. Ava. J. Jl [IJoOj 294; aidert In: Malien. K. E.. R. L. ZieLh-cia led.): InduMrisI Toaiculoev and Dvraiatolegy In tnr FroJuction and ?fOCfSlif4 ol PUtcia (Elaevicr. AmiK/daan 1944). (21) O'Conner, 1, B.: A nev occupido* nil dunw it bon. J. occup. .Mrd. 12 119791. 224. (22} Peoples, A- S., C. D. Leakei Tfco aneaahefic anion of virily etkxvle. J. Pharmacol, cap. Thcr. 4| (1921), 2*4. (2J; kcein, C., 5. Juhe. C.-E. Lante, C. Veltmam Bsndfnripitc Oncolyien in den Endphsianeen del Hacdvkeient. fonadtr. Rbotfcnstr. Ill il)73), 40. (10) Filatova, V. S., L. J. Balakhonovs, i. S, Gcoaabettt Hyjicr.K conditions in * * production of vmvl dilonde. Cip. Tr. prof. Zaboi I [I959i. <: aificn in Public Health Enpn. Abler, 44 (1)40) N* , P. * (111 Harris, D. K.t Health problems in das nuulactun and wm oi plait.ci, Bek. J. industry Med. 10 [195J], b'S: ririert int Mil.ro. K. C.. A. L. Zielhuia (ed.k Itwitulml Toxivolury and Derma tology is the Production and Prucr.in of Pban* (Elsevier: Amsterdam irn>, Ut. (IS Harris. P. r,, V. C. F. Adamn Acro-oitenlym occurring in men encaged to the polymrr.iatiun oi vinyl diluuJe. Brit. med. f. IFaM, 712. (IF! Hcnidilcr. H. (Hnj ] Ctsutid* beiutchsdbJie Arbciisttnre. Tu\ikul,> litA-jrbe Kmed t.n.Khe Ergfunuui** von O Che/nj. hcia )>72). (14) Jacoby. H.: Ptnphrrr DutchbluIM"(akrjrk>'f'ieai i.n C; ree> J<r KliVio. (24) Stria, G,, S. Juhe. C.-E. LanSi, C. Vrlimafl: SVe1(trre/i.,idcr*ar|eB hei Jet ao(. VinyliAlorid-Kunkiteit. RoncgeAprixn, am Drudt. (251 Sucao, I., J. Dreitnas, M. Vjljtkai: Corainbuiii la atudtul imholnivinlor praduae de elorura tie viml. Med. interns (Sued ti [U*)i, SET. (2*} Torkelson, T. R.. F. Ojen. V. K. ko*(: The rusKiay of vinyl dilaridt it determined by repeated eapwwrr tv lihnrj-ory animal* Aittf. isdutir. H)g. A;a. ]. 2211941). 3J7i utwrc ma Mtlicn. X. E.. R. L. Zaeihait IcJ.lt (nduafrial Tviitvluyv and Dermsrolofy in the Ptuduirinn and Protruine uf Platlivs (Eiipvieri AtnticrdtD 19*4), [27T ViuIj, P. I_, A. Bipocti, A. CaputO: On.vtrntc mponae of tat tkia. lunta, and tuner to vmri chlonde. Cancer Rtl. 21 11971). JK. i:tl ||M, R. H,. W. E. SU-Corrw.it. C. F.Tatum. J. L. Creech: Cc.mpjtujnal actnc-itcolyaia. J. Am<r. rned. Ais. 201 (V9*71, 977. Dr. Susanne TiiSe. Dr. C.-E. LsnRe.Or. G. Stein, ?to(. Dr. 0. VtUman Ur.svf*!tao-Ha:kiinik 33 Bonn I, Vcnu/berg . ' ` . `* < 1 AP00015688 CONFIDENTIAL. Copied by MCA. January 30, 1974 Translations Unit/?n.l2.897b/-3irB/V3 8 January 1974 PVC GAS: 40 HEN TAKEN ILL Doctors say: "Very serious" Reference: Kttlner Stadt.-Anzeiger, 14.12.73 EB Troisdorf - More than 40 workers at the Dynamit-Nobel Works in Troisdorf bei Siegburg have been attacked by a severe illness which is brought on by gases released during the production of the plastic polyvenyl (sit) chloride (PVC). Doctors at the Bonner UniversitAtskliniken (Bonn University Teaching Hospitals), who have been studying the PVC-sickness for some time, describe it as very serious. It can, in severe cases, prove fatal, particularly in younger men. The most serious symptoms are said to be sensations of giddiness and cold, headaches, swollen finger joints, bone atrophy, difficulties in breathing, reduced blood clotting capacity and liver damage. (Gee Panorama) Circulation Mr G J Sleddon, DS0-J20 Dr D Winter, F-11 Translations Unit, R-J/G AP00015689 Copied by MCA. January 30, 1974 Ref; Weser-Kurier, Wo. 300. 20.12 1973, p. 11 Insidious Disease Chemical Workers threatened by Hideous Disease due to PVC Gas Poisoning Bonn Ministry sets up Special Committee of Enquiry Bonn (our own correspondent). Chemical workers directly engaged in PVC autoclave production in large chemical factories are threatened by a new and serious disease. At least 40 employees of a Troisdorf factory are reported to be poisoned by dangerous vinyl chloride gas. "A serious prognosis" for the victims, according to the Bonn skin specialist Professor Gunther Veltmann. Mortality from PVC gas poisoning is reported to be "relatively high" and particularly serious in young male workers. According to the medical specialists the frightening consequences of the gas poisoning are reflected in the softening of the bones in hands and feet, enlargement of liver and spleen, severe effects to blood formation and coagulation, and as sociated grave lung disorders. The victims have increasing difficulty with breathing, and varicose veins can form in the esophagus. This previously unknown disease, according to Professor Veltmann, is "irreversible," i.e. incurable. No remedy has so far been discovered, and the only thing that can be treated is the defective organ. The victim can only look forward to in creasing disablement and insidious encroachment of the disease. Experiments on animals are now being commenced to study the causes arid course of the illness and to find antidotes. This evil disease is not even recognized yet as an occupational illness. As a result of the alarming medical reports, Federal Labour Minister Arendt has set up a special committee to in vestigate and report back. The more seriously affected victims are now claiming disablement pensions. However, they have as yet no entitlement to a pension, since this particular illness is not yet officially recognized as an occupational disease by the health authorities. The Committee for Dangerous Raw Materials of the Federal Labour Ministry considers that regular medical inspection of workers engaged in plastics production is essential. Guidelines t AP00015690 2- - for technical countermeasures in respect of health hazards are also being drawn up. Local factory inspectors have already ordered individual firms to introduce appropriate safeguards. Meanwhile, the Troisdorf workers-have levelled the serious accusation that they were used as guinea-pigs. One employee, aged 39, a sufferer for some 18 months, is reported to have swollen hands and feet with no more feeling left in them, and is afraid to venture on the street because of dizziness. He first became aware of the unusual symptoms when cleaning out a PVC autoclave three years ago. Another 47-year-old chemical worker attributes his chronic liver trouble to the poison. According to Professor Veltmann, the effects of the gas on the liver resemble the Liver complaints suffered by chronic alcoholics. The 160 workers on the Troisdorf autoclaves have become particularly uneasy about the situation. However, both manage ment and works council have emphasized that the employees directly involved are not really worried, in view of the fact that none has accepted the offer of transfer to other work on the site. A different explanation, on the other hand, is that these same workers are the top earners in the industry. It is they who are responsible for producing the material which is subsequently processed by their other 2,500 colleagues. PVC is one of the most widely used - plastics, with countless applications in the home and in industry. However, medical specialists emphasize that nobody can suffer ill effects due to contact with PVC products. -The only people at risk are the workers directly engaged on the plants in which the colorless vinyl chloride gas obtained from petroleum is liquefied under pressure and converted into powder in large reactor. The danger arises from the gas, which can escape during the process either as a result of leaks, carelessness, or during the cleaning of the reactors. The maximum permissible concentrations of such leakage gases have repeatedly been reduced by the responsible authorities. According to the Troisdorf works, "nobody has yet died and production has not been irresponsibly pursued at the expense of workers' health or safety; moreover, no efforts have been spared to safeguard the interests of their employees." Hans Wullenweber AP00015691 t Copied bv MCA January 30, L974 Translations Unifc/TR. 12-897a/EMS/VS 4 January 1974 PVC DISEASE TO BE INVESTIGATED References Frankfurter Allgemeine Zeitung, 20.12.73 Bonn/Troisdorf 19 December ^ p\ Many cases of illness among persons employed in the PVC plant at Dynamit Nobel AG in Troisdorf have caused concern among the local population* As Dynamit Nobel AG confirmed on Wednesday, 43 workers so far have shown symptoms of the mystery illness, which is known only as "PVC disease" at present. Two foreign workers are said to have become completely incapable of working already. PVC (polyvinyl chloride) is a widely used plastic that is produced by a number of other chemical companies apart from Dynamit Nobel AG. How seriously the situation- is regarded is apparent from a statement issued by the West German Minister of Labour on Wednesday to the effect that the government had instructed investigations to be carried out into the hitherto unknown causes of the disease. Details are to be laid down in January by a panel of experts. According to the Ministry of Labour, the relevant employers* association is working on the assumption that the disease is caused by vinyl chloride. It was stated that the Ministry of Labour Committee considers that operatives working in the neighbourhood of PVC autoclaves must be medically examined. 'When the various cases of illness became known local factory inspectorates ordered steps to be taken to provide increased health safeguards on the plant. The symptoms of the condition are unconsciousness, attacks of dizziness, changes in the hands and feet, headache and nausea. According to a report from the works in question, the first cases of physical damage to workers in the PVC plants were observed in Germany in the Spring of 1972. Dynamit Nobel have been producing PVC since 1951. The Press Section at the Troisdorf works stated that: The government industrial medical officer, in agreement with the Chemical Industry Employers' Association, has instructed Professor Rudolf Gross, who holds the chair of Medecine at the University of Cologne to examine some of the affected persons and to produce a report. 6 patients from the PVC plant have now been examined by Professor Gross at the university teaching hospital. A report on some of his findings will be issued in December. - AP00015692 TR 12902 Translation from Der Spiegel No 50/1973 Copied by MCA January 30, 1974 MEDICINE Dangerous Plastic A new and deadly occupational disease has been discovered by Medical Specialists in Bonn: workers engaged in the production of F7C rick incurable diseases of the liver. Pipes and Venetian blinds, curtains and films and whole host of articles in common use are made from PVC, a hard, durable plastic which can be moulded into almost any product, German producers alone have distributod almost a million tonnes of polyvinyl chloride over the country in the last year, PVC has so far been responsible for the death of as yot unknown numbers of chemical workers. For the production of this much desired material, wiich can be combined in so many different ways with plasticisers, fillers and pigments that it has become one of the leading products of the plastics age within the last twenty years, is apparently very much more dangerous than had been previously been assumed. Medical specialists of the Bonn University Clinics have this year diagnosed a "vinyl chloride disease" in at least 4-0 of the 120 PVC workers in a labouring chemical factory. However, the number of cases is probably considerably higher than this. According to preliminary comments made by the doctors this newly discovered "occupational illness" is characterised by a "serious prognosis and a relatively high- mcrrtaxrty rate in--men-of predominantly younger age groups". According to Prof, Giinther Veltman writing in the "Deutsche Kediainische Wochenschrlft" : "Certainly more than 10# as revealed by our enquiries", lPh-t occupational disease first came to the notice of dermatologist Veltaan and his team in the form of characteristic changes to the skin, particularly in the fingers. However, they were soon forced to the conclusion that still worse was to be revealed by this already well-known PVC symptom : vinyl chloride harms blood and blood vessels, bones, nerves, liver and lungs. As summed up by Veltman : "A disease of the system". This plastics material apparently places at risk only those individuals actually present when the colourless vinyl chloride gas, obtained from mineral oils, is liquefied under pressure and compressed to form powder in the large reactors known as "autoclaves". This "polymerisation process" is necessary to' produce the PVC which is then sold as "Hostalit" (Farbwerke Hoechst) or "Vinoflex" (BASF): Products which are not toxic as far as the end consumer is concerned, unless, in the words of plastics experts, "Plasticisers migrate from them". Those cases in which these toxic substances have been liberated from such materials have indeed been reported for a considerable period of time. On the other hand, the "closed system" of the autoclaves gives rise tc dangerous leakages. The Bonn Medical Specialists have been investigating "possibilities of gas leakages and associated inhalation risks" at numerous points ir the production process. VC-gas escapes when the reactors are discharged r.nd opened as well as through "leal:s in the autoclaves", For cany years doctors have been aware of the toxic nature of the gas and its narcotic effect. Almost without exception personnel engaged on the cleaning of autoclaves complain of feeling "dopey", giddiness and headaches. For this reason the "maximum allow;,ble concentration" ("MAK") of the VC gas has been, repeatedly reduced. According to Veltman, however, "we have so far not been aware of regular gas concentration measurements being carried out on production sites," AP00015693 2 Personnel responsible for cleaning the autoclaves - such as the majority- of the diseased chemical workers apparently inhale many times the quantity of the acceptable tolerable dose of the toxic substances. Industrial doctors in America have repeatedly measured gas concentrations of 1,000 ppm in the neighbourhood of PVC autoclave vails, which is ten times the MAK value* The symptoms suffered by the diseased Eonn workers show that the air in German chemical factories is not very much better. The following changes in bodily organs has frequently been observed after only 18 months employment : Enlargement of liver and spleen with lasting destruction to the structure and function of their cells - collective tissues proliferate in the organs. Reduced circulation in the hands due to diseased narrowing of the arterial vessels* I Finger bones gradually deteriorate, and were almost completely destroyed in cases of advanced disease* Blood formation and coagulation were affected and breathing was found to become increasingly difficult. The majority of these illness-induced changes are considered non-curable by reason of the fact that the increase in connective tissues in all vital organs is 11 irreversible" Specialists in internal diseases accordingly hope at the most for a "defective healing" in diseased livers.. The chemical workers are left with a thick-skinned and deformed organ such as that found in chronic alcoholics after cany years over-indulgence in alcohol. According to Prof* Veltraan, the necessary `'consequence" is "compensation for j11 diseased workers" and the recognition of the illness as an occupational disease. Neither he nor his colleagues have so far ventured to estimate the numbers of the victims of the PVC disease. Basic research into the medical problems of VC is also badly lagging. In the 100 year after the ability of vihyl chloride to polymerise was first discovered in 1878 - the doctors in Bonn are now demanding "experimental investigations in animals on the effects of the vinyl chloride with particular reference to skin, bone, lungs, liver and spleen". PPM s abbreviation for parts per million s parts (by volume) per million : a measurement unit used to indicate the quantity of trace substances eg in a gas mixture. Circulation: Mr G J Sleddon Dr D Winter Translations Unit ACH/ttMB 9 Jan 74 AP00015694 Translation: Refs Copied by MCA TR,12,917 January 30, 1974 Frankfurter AUgcmcinc, Zcitung, ?. Jan 74 LIVER DAMAGE IN PVC PRODUCTION In spite of abundant warning signs no adequate supervision Like many other occupational diseases, the damage incurred during the production of polyvinyl chloride* or PVC, is only now, more than 30 years after the start of industrial PVC production, being fully realised. The scale of the health hazard involved in PVC production was first exposed in a publication by doctors of Bonn University Teaching Hospital (Universittitsklinik Bonn), who found skin damage, changes in the ends of fingers and toes, as well as liver and spleen damage, in 45 workers at Dynamit Nobel AG*o PVC plant in Troisdorf* According to reports by H J Marsteller of the Medical Klinik and Susanna Juhe of the Skin Klinik in the "Deutschen Medisinischen Wochenschrift'* (Vol# 98, p 2311), 45 of tho 120 workers in this plant have so far been exhaustively examined in Bonn, Some of these patients were suffering from skin changes, in others the examination was carried out on prophylactic grounds* Most of these workers were found to be suffering from various types of liver damage of obscure origin# In addition to enlargement of the liver, biochemical malfunctions of the liver were detected# Histological tissue changes were finally established# Since, in spite of the diversity of the liver changes all the patients had been engage! in PVC production for 1*S to 21 years# This can only be an occupational disease involving FVC* In 1963 circulatory disorders, inflammation and hardening of the skin, thyroid deficiency and enclargement of the liver in PVC workers were reported for tho first time in Roumania* It was only after re-publication of this work in 196? that similar observations were reported in Germany, France, England and the United States# But here the emphasis was on changes to fingers and toes. This led, according to the Marsteller and Jtlhe report, to "attention being directed to the liver damage first noted in PVC production in the Soviet Union in 1949" The scientists are making no statements about tho prognosis of the FVC liver damage# Even the frequency of this illness among other PVC producer:* is unknown. Possibly the threat to personnel is heavily dependent on local working conditions# Since the morphological picture of those liver changes corresponds to chronic toxemia, such as also occurs from contact with chlorinated hydrocarbons, eg chloroform, the health risk could be determined by the concentration of the gaseous initial product, vinyl chloride, in the atmosphere. Since such a hazard was certainly not unforseej^ble, and must indeed have been expected in view of tho existing publications, the question arises as to whether either the v'.nyl chloride concentration or the health of the workers were properly supervised in these plants# AP00015695 crfot 'fiicdtcfc- atu C/temiea& WC. VCL ANALYSES BY 8. F, GOODRICH AT CALVERT CITY Two Transfers Water HC1 50 PPM 0 76 0 Iron 00 Ethylene 0,1 1.2 Propylene 4.1 1.6 Acetylene 0.8 1.1 Butadiene 7.0 4.2 Monovinyl Acetylene 0 0 Total Unsaturates 12.4 8.9 Vinyl Chloride % 99.998 99.999 CONOCO ANALYSES OF TANK CARS DELIVERED TO PACE Water HC1 Non-Volatiles Iron Acetylene Butadiene Methyl Chloride 26 0 0 .1 <.l 4.7 90 22 0 0 .1 <' 8.5 73 WET ANALYSES MADE AT PACE ON NEW MONOMER Phenol Peroxides Iron Non-Volatiles Aldehyde Acetylene HC1 .16 .45 .09 9.2 .21 .08 1.0 0-.43 0-5.0 .01-.69 1-75 0-.85 0-.11 .1-4.0 - "'"`T APOOOf 5696