Document gEvvJdQOdQ4701gV2N0o4JB7V

PLAINTIFF'S EXHIBIT (COPT) February 23# 1944 />/. -/_3 ^ Hr. Ivan S*hourin Aldred Building Montreal# P. Q. Canada Dear Hr. Babourlas While the setter la still fresh In wj alnd Z as . writing you at length on ay Impression of ths situation on Asbestosls in Quebec In so far as it involves relationships between the producers# the sedleal profession and the Compensation Cosmdcsiozu One conference with Hr. Sharp# Or. Tidal and Hr. DleM gave se a such } clearer picture than Z had gotten previously. Before doing so Z offer a fee eosaents on autopsy material. Z as enclosing ay report on the lung tissues of Philemon Tsrdlf. Of necessity the conclusions are not too satisfying as they are based only upon examination of too blocks of tissue# approxlmately 2xA centimeters in disaster without even an indication of the parts of the lung from which they were taken. However# they like thi material from the too previous eases, do demonstrate that the Thetford operations produce limited anounts of indisputable Asbestosls. In the presence of advanced tuberculosis this lS\oseured and not likely to be identified except on microscopic examination of pulmonary tissue. X-ray during life will not show it. Today Z have also examined in gross the sagltal sectloi through the entire right lung of Hajorlque Perron which we collected yesterday from the toxicological laboratory in Hontreal. This is a much more satisfactory specimen with which to work. Zt ilkawiac shows a eon bination of widespread chronic tuberculosis upon a background which will probably prove on nlsroseople exanination to be minimal Asbestosia. Sections will be prepared es soon as possible for microscopic examinetioj Is jiX2Hxs^liisad m tarr lncludlngt now long Ja Mi jui* 1 xndA iBaraun is enslaved.*1ch1a5racwtewr manIdUdmateI loafdfjiUrsntiMl symptoms# date of quitting work# whether Eoch's bacillus was found In sputum and data of death. Z neglected to copy this information from you record. This autopsy material on fatal cases and the X-rays , that are now reaching the Commission arc bound to create in their minds tha impression that tuberculosis is an all too Ttnanrrn complication of / Asbestosia. Zf Z were in their position with my experience United to evidence of this kind I would find It difficult to resist the coneluslor that there la causal relationship between even slight amounts of Mr. Ivan 8ahourin (2) February 23, 1944 asbestosls and tuberculosis of the lungs* x hove told you repeatedly ms I told Hr. Sharp yesterday that X did not agree with this conclusion : but X doubt whether he dr Dr* Vidal till be porsusded when they see m j succession of cases like those shleh are nos passing before them* They l mist be made to realise that these cases are the exceptions rather than the rule and that there is a great majority .of employees in the asbestos [ industry who are free free tuberculosis* % X eould therefore urge that immediate steps bt taken to mu-ee- eeeyy cwtfny the asbeatos industry in Quebec so that -the - ndCHIAPy ftatlatic* can be aseembled* Dr* SwVcnAonTs X-ray fXXsm sires* , taken on the aen at Asbestos mill provide you vlth aaterlal for a pre liminary report* Coupled with this there Bight be an analysis data contras**"?- rate, from tuberculosis 111 fbeUuru ana ------with that In othiy*lrZttstrial'cnniinTtles~o'f the Province* Xt vwnd be' still' more~`cdnTinclh^ It you could shot the separate rates of .. . jli and females unless ths number of the latter employed la tbs ^asbestos plants' constitutes an appreciable proportion of the female popu- latlohV Finally the age distribution oJT deaths from tubarculosla in those enployod In the XSSestbs plants as contrasted with that in other oeeupatlons mould help in determining whether the occupational factor was contributory* y oen observations elsewhere and your intimation that the rate for tuberculosis mas higher in St* Hyacinths than in Thetford and / or Asbestos aaka me confident that the companies mould acquire information of greatest service to themselves by such a survey and analysis* Xf asbestosls specifically is predisposing to tuberculosis in the same sense ae silicosis does the effeet should be Just as apparent in Sorth Carolina and Pennsylvania as It seems to be in Quebec or Englant But the films of enployod asbestos corkers in the States shoe a very loe Incidence of associated tuberculosis* Xt la ay firm belief that in Quebec and England, factors outside the occupation are responsible* As X sensed the situation in Montreal yesterday the Y asbestos Industry mill have to produce evideos# to prove this point and ; start on it lnoedlately or the industrial comalssloa mill become inI ereaslngly convinced that our position is biased and not founded upon truth* Furthermore the industry mould undoubtedly profit by v undertaking a general program of. rin--inl tj control of tuberculosis* By ^instituting ease rtfidIngTiffilncry"not only among employes.* but aaong the members of their families, ths open eases of tuberculosis mould be discovered and the sources'of spread of the infection could be removed* Mr. Iraa 8abourIn (3) February 23, 1944 One of the Iron companies whoa wo serve hat such a program with public hoalth nurse, a program for tuberculia testing of aehool children and follow up of tho eontaeta of every known eaao of opoa tuboreuloaia. The program ho a paid dlwldooda by practically dial noting tuboreuloaia with resultant lowering of eoapoaootlon costs sad tho good ** will of tho eaployees is unaeat-urabls. Tho asbestos industry of Quebec has a serious problea because its labor force is drawa froa a population in wbleh the tuberculosis rate is high but their situation is ao worse than that whieh our other clients attacked successfully in an iron aining eoasunity. The second poiat whieh la becooing increasingly appareat to ae is that the asbestosls of the Quebec sines and Bills is quite generally less severe end extensive than the asbestosls of the fabricating plants of the States. Comparison of the X-ray findings In the two groups reveals very few esses with typical patterns aaong Thetfore or Asbestos atili aen. Soao asbestosls is unquestionably produced for we have aieroseople evleence of it in the fuur autopsy esses now available but it is not advances enough to replace auch of the functional parts of the lungs and thus eause the X-ray windows that are generally recognised aa characteristic of tho disease. (Moat of us disagree with Dr. Pendergrass when he s.iy* in Lanza1 s book that there is no eliaracterlssle pattern of asbestosls). If ay observttlons ar correct this relatively slight aaounl of disease should not onus disability for only the fraaoworlc of the lung! is involved leering aost of tho parts that carry on tho functions of respiration intact. But hero again the Canadian industry la oa the defense against its nodical profession and their representatives o*: tho advisory board to tho industrial eoasisslon. The doctors have soon only their own local manifestations of asbestosls without opportunity to eoapare It with the really severe aanlfestations that are produced elsewhere. They find the abaoras 1 shadows ia tho X-rsy fllas of exposeo workmen, whieh th are convinced anst cause symptoms and disability. They find asbestosls bodies in the lungs of autopsled eases associated with minimal tissue reactions or overwhelming aanlfestations of concurrent pulmonary in fections and now they are sure of their ground. Xa order to defend itself the Industry in Quebee must have aore facto whieh will require time to eollect, eaalyse sad publicise : ^he** findings will have to be contrasted with those in the fabricating (plants either in Asbestos or elsewhere. In tho city of Asbestos tho N.. spinning sad weaving Bill has been ia operation for only four year* ' which is tho Binlaua time to produce auch disease ia those exposed, but in another year or two one may expect to find evidence of it here unless j Aa aueh mistaken. Ir. Ivan ftsboarla w February 23, 1944 At I have told you la conversation, our experlaaotal observations load as to believe that tho true lasard la asbestos plants la proportional to tho aaouat of snail, individual, uaeruahod fibres la tho laduatrial atmosphere. Z auspoet that tho reason w'uy one sees little or ao typical asbostosls la tho alaoo aad Bills la hooauao there la probably too little ouch fibre la tho air of these planta. Conversely tho reason for tho *typloal* disease la tho fabricating plants la the fact that tho processes there open the bundles of asbestos fibre aivi tear thoa into lengths short enough to be Inhaled in dangerous quantities. The Bills aad mines are dusty but the dust is largely serpentine with relatively fev fibres large enough to do hara to tho Image. This dust eaters the langs where it produces reaction around blood voasols aad othtr fraaovork structures that ere Just like any other Inert duet. Ve eoo the shadows of such laort reaction manifested in X~ray aa aa exaggeration of tho noraal shadows of blood vessels. This ooadltloo la not asbostosls aor aaoosssrlly proasbestotle any more than tho identical changes la aoa working la hard rock aloes are necessarily proelUeotie. la free slUea ladustrlos regardless of. exposure wo do aot diagnose silicosis froa X-reys until wo find the characteristic pattern of aodulntloas la tho asbestos Industry we should do likewise aat refrain froa a diagnosis of asbostosls until the S-ray reveals the characteristic patters of haslaess or fine stippled appearance spreading throughout the lower thirds or more of tho lung fields. The situation with asbostosls Is ovea aore difficult than with ailleosls for today the reqalslte condition of the dust exposure Is not appreciated by the aedleal profession. .... Therefore Z strongly urge that surveys be aad* to eoapsr .the relative quantity and nature of the dusts in the mills aad the {fabricating plants la ordsr to present proof that in the first instance the percentage of thin fibre of Inhalablc dimensions Is insignificant in ^comparison **> created .In spinning aad weaving. Zt is goi srT5nXd to persuaoe~pKysl'clans of tho importance of these factors but similar factors govern the reaction to quarts and the development of ellleoels. These physical limitations of atmospheric dust often determine tho outeoae In eoatcsio'd eases involving a diagnosis of ollloosls and I forsto that they will have equal weight In ssbestosis. . competent industrial hytienlit shouM collect and ealyse enough of the p tfgSipherZe* samples Jut weaving spinning mills ass 1ft the sines and 'UrbCesVtdl visits to establish this basic difference so that it will sti JfbeyonS eorittovfriy.` e have the expcrincntal background) we now must deaonvtrate'tVs 'inductrial application. Ihen correlated witli the resul` upon exposed eorkaea, Z feel certain that our position will be secure. ft i. Mr. Ivan Sabourin * (5) February 23, 1941 To summarises I would make the following recomaendatlons to your clients, the Canadian Asbestos Producer# in order that they say defend themselves against a growing conviction among the local physicians that employment In this Quebec Industry is highly dangerous. X. Correct an erroneous Impression of the Industrial Commission that asbestoais la frequently associated with pulmonary tuberculosis. a) Statistical data baaed on 3-ray of all ------ ^ employed worlaaen to Indicate the incldenee of pulmonary tuberculosis b) Comparative mortality statistics on - tuberculosis in Asbestos and Thetford and in other communities of Quebec indicating the frequency by sex and age. 2. Consider the possibility of inaugurating a program _ of tuberculosis case finding and control in the general populations of Asbestos and Thetford in order to elimi nate sources of new infection among employees. ^3. Sake a detailed comparative study of the nature of the dust in the fabricating plants and the asbestos mines and mills. X trust that you will agree vltk these reeomaendations end be milling to pass them along to your elieata. May X take this opportunity to thank you for your delightful hospitality vhile X was In Montreal and thank you for making ay visit profitable and pleasant. Sincerely yours. LOOtMB Leroy 0. Gardner, M. D. - Director