Document e7pXbvaME0XVD6N78dR7zwEwE

. '/-1R piG& 1C frUCJ* Miitkopolitax I . 11: Inmukance Company* J ZJZC-OIV ' C( 2-T- d l 7.C7i" ' J ft WTC j M MCC"*'* < *** *o April c, 1963 PLAINTIFF'S EXHIBIT t*<m Toc C**KW*t( I 0*KI ttai Hr. Earl Irieg, Ecployee Relations Manager The Philip Carey Manufacturing Conotuy 320 South Wayne Avenue Clr.cin: ati 15, Ohio Deer Mr. Srieg: * * . . `' ^ Apparently, the job you asked the Hcse Office to do has turned out to be core difficult than at first detirtinsd and the best they are going to be able to get on statistical data will pertain to death claims in the past five years directly attributable to respiratory diseases. It is not considered very likely that tha diagnosis of asbestoais would be shown ca any proof of death forms the c wore subaitted to us and using the "respiratory" approach, they feel thct the field can be .narrowed down end the researcher would be able to determine vcat relationship the death night have had, if any, to asbestoais. The results of this review should be reedy in a week or so. - In the :tcentime, the Hone Office r.ns furnished se with sone referrals to reference work on the disease, along with a copy of a paper prepared by Cr. Smith end Hugh Jackson of the Johns-ilanviile Corporation, and perhaps this information nay be of sose interest. 1 j Very truly.'yours. JRL/ds Enclosures . ccs Mr. E. J. Fasold, Secretary Group Supervisor * / I (tn- .. ii.'.altii cxrciucNCLS amoao am.kstos woniccns 187 \ i The Asdebtos Inoustiit-- Certain Uealhi Experiences Amo.no Abdestos Wonxcnfl *t*i nv JiE.XNKTil W. SMITH, M.D., AND HUGH JACKSON 'Hum . In vi.is presentation I shall try to outline certain health ' \ ' cxpcj-.eiicca which we have seen in asbestos workers, not only ' in my own company but in many other associated companies. While ailwslcsU is a welt recognised occupational disense, ' - - there are relatively few people in tho working populations of ' A the United States and Canada who arc exposed to asbestos dust, and, actually, very few ever develop tho disease. It . . ' '. wiil he shown that tho lives of the asbestos workers nro not '" A shortened by their occupation, and nlso that work in theso .. ' : trades dobs not predispose tho individual to oilier pulmonary . ; ; I diseases f nonoeeupalional nature. ; Tl. <rd "a<bjst.\." is generally used to dcscribo several , \ .'.bromi lar.gncsium .v.licalcs which aio entirely different in their chemical composition and in their physical properties. i There i.ru icvcral types of these fibers. The most important , nro the ehrvsotilc, amositc, and crocidotito. Deposits of theso .: various types of fibers aro found Ihrougliout tho world. Tho - | targes* deposits are in eastern Canada and Africa. .! Tlm.-e asbestos fibers aro highly resistant to heat and somo | j i.ro rcMstant to ai-ids. They have great tensile strength and large urfacc areas. Dccausc of these properties, as well as- .1 their filamcnlcd'structure, the industrial use of tlirso fibers ' .i throughout the world is increasing. The textile industry has ` ' ' used these fibers for generations to produce blaukcts, clothing, ' ` i threads, ropes, tapes, braided tubing, and filters. - In rerent years, however, there has been an increasing uso :j of asbestos in tho insulation, building, and friction material ' ' ' trades. In addition, the fiber can be found, in tvnllboard, . shingles, pipe covering, floor tiles, brake linings and brake . blocks, cements, putties, and extensively in plastics. - Historically the material has been used for many years. Those who are biblical students will recall that in the third ' viiiiplvi- ui Diiuiel the three men, 5'nndrach, Mcshach and ` ' Abednego wero thrown into tho fiery furnace by Kcbuchadncs- - Proceedings - Hone Office Lifa Underwriters Association 1957 1SS iIomc ornce uru uaucuwntTiam aoxociaiiuh *h. k.ng of Rabylon. They emerged from the fire com pletely unharmed, and archeologists today lead us to believe that they were protected from the flame by a blanket of woven asbestos Hirer. Tints we can see that tho mineral lias been used for many centuries, hut it was not until 1927--thirty years ago--that a definite occupational pulmonary disease was associated with the inhalation of this fiber. As previously indicated, the industry is finding many new uses for iho fiber when mixed wilh other materials, ft is an established fact that when asbestos fiber is mixed with silica or diatomaccous earth or other potentially toxic dusts, llto pulmonary changes resulting from tho inhalation of theso mixtures arc not typical of nsbestosis. Tho X-ray pattern is dif..i,ai ; tho clinical course of tho patient is changed, or tho M:->(Cji.ibility to intcrcurrcnt infection Is increased or dc- civasei':. * "i .:, in making a diagnosis of occupational pulmonary rlise.i.w, it is highly important to obtain a detailed occupa tional history; not only the job title, but also a complclo list of raw materials used in the particular job, so that nsbestosis, silicosis, or the mixed pncumonoconioscs can be differentiated. Wo ixTievo that tlicic arc fewer than 15,000 people in the united States and Canada who arc employed today in mines nnd milts where their potential exposure is only to asbestos liber. In this industry the various mining, milling, nnd menufncturing operations create some dusts which arc capable of being inhaled. If asbestos fibers from ten to fifty microns in length arc inhaled continuously and in sufficient quantities over a period of many years, a typical pulmonary fibrosis will develop. It has been demonstrated that this fibrosis is not due to the chemical, but rather to tho mechanical notion ofthe fibers. The fibers arc deposited in tho terminal bronchioles of the lungs. Then tho tissue reacts, coaling tho fiber nnd forming w*hnt is known os tho nsbcslos body. This appears to be a defense mechanism of tho lung. * . Many individuals who have these asbestos bodies in their sputum have had only intermittent exposures to the dust nnd have absolutely no evidence of tho disease. So it seems more appropriate to uso the term "asbestos bodies" rather CtinTAlN HEALTH tiXTEMEKCCS AHOKO ASBESTOS WOnKEIU 189 than "asbc$tosis bodies," signifying an exposure to tbo fiber but not necessarily indicating disease. | If increasing quantities of the fiber are continually inhaled, the tissue reaction progresses and a generalised, diffuse fibrosis or scarring nppenrs throughout the lower lobes of tho lungs. t Willi additional exposure this fibtosis may spread to the other lobes of the lungs, resulting in respiratory embarrassment, . and eventually cardinc'failorc. \l(,,,, The pulmonary fibrosis resulting from prolonged inhalation of the fiber will produce a very typical X-ray pattern which docs not resemble that produced by any of tho other known toxic dusts. (The X-ray picture should never bo used to ' estimate tho prcscnco or extent of an impaired pulmonary function or disability. Many eases with X-ray evidence of advanced nsbestosis have been known to carry on their work and live very comfortable lives for several years. ^ There's no typical clinical picture of asbcslosis. The disease is very slow and insidious in its onset, and very 6lowly pro gressive with continued inhalation of the fiber. The textbook , signs of cyanosis and clubbing of the fingers arc virtually non-( 'existent in the eases of nsbestosis we sea today.. .I'1wr*^- An X-rav survey was made of 703 employees working in an asbestos mill where the ore was dried, crushed, separated and graded, packed and then shipped. Operations in this plant required tho employees to rotate through various jobs, 60 that it was impossible to relate any X-ray changes to a particular job or to a specified dust concentration. At the ' same lime, it could bo assumed that all members of the group had been exposed to varying concentrations of tho dust. Tho X-rays of these employees were divided into three ' groups: c3scntinHy normal; those with exaggerated markings, but not typical of any disease; and those with definite nsbesto- sis. Of the 703 employees studied, 619 or 91 per cent had normal X-rays. This is of interest, because- 201 of tho em ployees, or 29 per cent of the total, had more than ten years of service. Two men actually worked over forty years in varying dust concentrations with absolutely no cvidcnco nf any inrrea<rd markings in their X-rays. . Fifty-two of the 70S employees showed somo increase of nil peribronchial markings although nor.c had any cvidcnco I ISO home ornce un UNucnwiuTens association of ashesLosis. Sixly-nino per cent of this group had more than ten years of scrvico. ' . v Of tho original group of 703, only 7 had developed X-ray uvidcncc which could bo diagnosed positively ns nsbestosis. Theso men exhibited various stages of pulmonary involve ment. AH were working steadily at their jobs with no signs of disability. It is of interest to nolo hero that none of Ilia 0 men developed X-ray evidence of asbcslosis with under twenty 1 years of exposure. '" " Medical literature has given considerable attention to occupational pulmonary disease, but very little has been reported on the occurrence of nonoccupational respiratory disease among employees in the dusty trades. In order to determine tho incidence of nonoccupational disease in o group of 1,561 men and women working in the iir.bcst.os industry, it was decided to study the claims submitted fjf sickness and accident insurance. All employees in tho . survey group participated in the plan operated by an inde pendent insurance company. Indemnification was made only aster the nature of the illness had been certified by the treat ing physician. ' The study included claims submitted over a five-year period for such illnesses as the common cold, sinusitis, pharyngitis, grippe, bronchitis, pneumonia, asthma, and pleurisy. Occu pational pulmonnry diseases such as nsbestosis were excluded from the report. Of tho 1,5GI employees in the survey group, there were Approximately equal numbers in the dusty and nondusly occupations. Of all claims filed for respiratory diseases, only 45 per cent were for employees who had a dust exposure. Not only did this survey show that the incidence of disease over the five-year period was approximately the same in each group; but it also established that there was no Appreciable difference in tho duration of illness in either group. Also clinical observations for many years had given the impression that n dusty occupation in itself would not predispose a person to more nonoccupational respiratory disease lhaa would & dust-free job.' Animal experiments and clinical observations have shown that asbcslosis docs not predispose a person to tho develop- . ' CERTAIN HEALTH EXTEniCKCCS AMOHO AtnCBTOS lYORKKR* 101 . nicnt of pulmonary tuberculosis, nor doc# it aggravate an apparently heated tuberculous lesion. In two isolated one- industry towns in the Province of Quebec whero asbestos was mined and processed, the incidence of tuberculosis over a - ^ period of many years was no greater than that of other isolated , , towns with comparable population, but without a dusty trade. ''t'/In addition, the incidence of tuberculosis among asbestos workers was lower than that in the general population in these mining towns. '< Conflicting opinions and different reports make it extremely difficult to confirm or deny conclusively the causal relationship of asbestosis and carcinoma of the lungs. Too often n common conclusion is drawn from observations and experiences with different racial groups living in different parts of the world, under variable socio-economic conditions and working in <Iivvt*c occupational exposures. To these variables I'd like to add the fact that there arc the various types of asbestos . fibers, which may have different actions on the lungs. Tha Canadian experience with asbestosis has been limited to tho chrysolite fiber. Tho majority of industrial processes in the United States use this fiber, but recently.there has been some increase in the uso of amosite and crocidolile. On the other laud, the Diitisli and other European industries use greater quantities of the harsher fibers, nmosito and crocidolile. Therefore, in trying to clarify the causal relationship of asbestosis in cancer, many variable facts should bo clearly identified, especially tho typo of fiber used apd whether or not other dusts, such as silica or diatomilc, wero present in | f ...aiaM the industrial or environmental atmosphere. J-tf^ i . To amplify this point I'd like to take a few moments to 1 describe the three types of asbestos fibers most commonly ' . used today. . .. j . An electron micrograph of the South African blue or . I crocidolilo fiber would show that it is composed of many short, . . sharp spicules which arc rather brittle. i . Amosite fiber is brownish yellow in appenrnneo and found in _ Africa and Australia. Seen under the electron microscopo at ' ' tho same magnification as above, tho fibers would appear : . longer, less sharp, and they actually aro less brittlo than the crocidolile. , w' 102 home otricc urc UNDr.nvmrEM association . Crude chrysolite fiber fuium aiefly in Canada is greenish while in appearance. Elcclrv; micrographs 6how that this fiber is long, soft and silky. I think that it is reasonable assume that the short, sharp and brittle fibers such as cror ulc and amosite could cause much more extensive damage he lung than could the long, soft, silky chrysolite fiber. T -eforc, I think it is unfair to compare tho experience of so;- of the European operations with our North American ope .ions, using different types of fibers with different actions. To amplify my statement ` i there arc different occupa- tional diseases having dificrci X-ray pictures and different clinical patterns, I would like i describe tho X-ray appear- oiiccs of soma of these disease-' The X-ray in asbestosis sh- a fine, diffuse, infiltration, bilateral in both lower lung fici The heart outline is shaggy or completely obliterated, nodular or conglomerate patterns of other pncumonocoi r. arc not seen in asbestosis. In silicosis the X-ray reveals odular infiltration which is bilateral and appears in .'ill lu fields from apex lu hose, Conglomerate shadows can appe in an> -f tho various lung fields. The homogeneous or g ound ;s nppcarancc of asbestosis is not seen here. The X-ray of diatomitc pncw.nonoc- exaggeration of all linear markings, a granular pattern, and frequent large coal* ly in the apices. sis can show nn - fine nodular or a shadows usual- The X-ray pictures resulting from the lation of a mix- lure of dusts never follow the same palt ad certainly aro not typical of either of the inhaled du In present-day working environments a man might bo ~cd to mixtures of silica and coal, asbestos and silica, 01 ante and silica, Thus you could have many bizarre X-i idows changing from fine granular infiltrations to homi- us and later to coalcsccnt shadows in the samo individu Several years ago, anyone who installc* .alion materials was called an asbestos worker, because as. was practically fcitu viiaj used for this purpcc. day, however, there are mineral fibers, synthetic fibers, . cement, mag- ncsia, and a host of other substances u:. tho insulating CXKTAIN HEALTH EXrEMCKCE* AMO.NO ASBESTOS WOnXEM 193 Imdcj. Tho majority of thcso material* oro relatively non* - toxic, and U i* obviously incorrect to label tho insulation installer today a* an asbestos worker. There arc numerous articles in tho medical litcraturo today reporting the incidcnco of asbes'losis or asbestosis and lung , cancer among asbestos workers. Tho conclusions of tho k authors should not be accepted implicitly unless tho report | clearly indicates thnt tho so-called asbestos worker was expose^ * only to asbestos fibers and not to a mixture of dusts. --' * One company in tho group 1 am reporting has a retirement . plan which has been in ctTccl for sixteen years. They havo a total enrollment of slightly, over 21,000 people; but, of course, this figure has varied slightly through tho years. Since they - started to uso asbestos fibers just about 100 years ago, tho following review of tho pension plan will include employees who liavo had an exposuro to the fiber over a long period . of time. In the past sixteen years there were 1,135 employees who retired under the provisions of tho pension plan. The averago length of employment for this group was 24 years. Although we' are unable to determine specifically.how many of thcso hnd extensive exposures to asbestos fiber, it is reasonable to assumo '. that the majority had, since asbestos is used in nearly all of the product lines. Of tho 1,185 there were 180 who retired for disability before reaching tho ago of 05. Only 0 of thcso hnd asbestosis. ',=r ', 'Tills low incidcnco based on long employment with potential exposuro would seem to indicato that tho asbestos trado is ' not as haxardous as may havo been indicated in tho past. Conelutiont .. 1. Asbestosis is a recognized occupational pulmonary disease, slow and insidious in its onset. It takes many years of exposure to develop, it docs not progress after exposuro censes, and there is very little disability until it is far advanced. 2. There arc relatively few workers exposed only to this dust in industry today. . 104 none orncc urE uxoEnwitiTcn* association 3. Conflicting medical opinions exist concerning asbestos!*. Frequently adequate occupational histories kro not ob tained so that other pneumonoconiosc* aro incorrectly * called asbestosis.'* . 4. Exposure to asbestos fibers docs not shorten tho life of the ' . , worker. . . 5. Inhalation of asbestos docs not predispose tho worker to other puimonnry diseases which will shorten his life. . . G. The asbestos industry has controlled tho exposuro so. that the incidcnco of asbestosis is very low. I f Chaiiiman Lawson: Thank you very much, Dr. Smith, for being with us. It was a very interesting paper. Do any of you gentlemen havo any questions that you would like to ask of Dr. Smith while you have him available? If not, wo will proceed to close. Dave Cartwright, I think, gave us a splendid report on taconito this morning. Tho printed paper, of which you presumably have a copy, covers it in much more detail and has an excellent bibliography if you care to investigate further. We greatly appreciate what Dave has done for us. Morris Pitlcr--thanks ever so much for moderating tho panel. And thanks to you, Chet Barney, Leon Hovey, Paul Shea, and Jack Wilson. .. If there is nothing further to come before tho meeting, wo aland adjourned until 195S. I have been asked by tho secre tary if you will please--please I--leave your badges on tho table as you go out. Thank you all very much! . [The meeting adjourned at 12:10 o'clock.] . ., . ` ti - < I I : i :