Document jB7yJoNYgbQ0ZXrvkDEno3EGk

a REPORT OP THE PHYSICAL EXAlIlJM'lUfla AIJJJ .''.-HAY EXAMINATIONS OP ASBESTOS v;QR7JiRS IN AABESTOS AXD THETPOHL MIRES. QUEBEC. The report horowith presented deals with the examination of 141 employeeo of tho Canadian Johns-MQnvillo Co., Asbestos, Que. and 54 employees of tho Auboatoo Corporation of Canada, the Zoesby-IIattison Co. and John son's nine, all of Thetford Minos, ^ue. 40 of the men of tho Canadian Johns-Ltanville Co. were examined by Dr. R. II. Stevenson and Dr. Joseph Wyatt, who performed the physical examinations and X-ray examinations respectively. The other examinations were all performed by me, except tho X-ray examinations. Actually, Drs. Stevenson and Tyatt examined 5? men; but sinoo 17 of these men were re-oxominod by rao I am including them in my li3t. Drs. StevonBon and i Wyatt carried on their work in November 1929. iiy'examina tions wore done in July 1930 in Asbestos, and in Soptombor 1930 in Thetford Minos. The Asbestos and Thetford groups are very dis . similar with respeot to age distribution and length of service in the aabostos industry, but raoially^and econ omically the two groups are muoh alike. ; Table I gives the ago distribution of the men and Table II the distribution. according to length of service in the asbestos industry. TABLE I i i ico* iitr rfw A no p.roup ! 15 - 19 ::0 - 24 25 - 29 20 - 24 I'.b - 59 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 : not ntotod 'total AGE DISTRIBUTION OF A8b0 8tQB______________ ! Number 1* 1 Poreontune ASBESTOS V-.'ORI'EPS __________Thetforfl Vinos Number Feroontcrce , i 2.1 24 17.0 2 2.7 24 17.0 5 9.3 26 18.5 6 11.1 2f 17 .7 4 7.4 10 12.8 14 10.0 13 24.1 7 12.9 3 2.1 6 11.1 1 0.7 4 7.4 1 0.7 6 11.1 1 0.7 1 1,9 1 0.7 141 100.00 54 100.0 T A B L E ' II Years of service. 0-4 6-9 10 - 14 15 - 19 20 - 24 26 - 29 30 - 34 35 - 39 40 - 44 TOTAL LENGTH OP SERVICE IN ASBESTOS INDUSTRY Asbestos Number i ! 44 Percentage 31.2 Thetford I.Iinos l Number i Percentage 1 1.86 66 46.1 8 14.8 11 7.8 8 14.0 10 7.1 16 29.6 6 4.3 9 16.7 2 1.4 9 16.7 2 1.4 1 1.85 1 -.7 2 3.7 141 100.0 54 100.0 It will be noted that while 68 percent of the men in Thetford Mines were over 40 years of age only 28 percent of the men in Asbestos were over 40* And fur ther with respect to length of service 83.4 percent of the men examined in Thetford Mines had worked in the as bestos Industry for 10 years or more, but in Asbestos only 22 percent hod worked for more th%n ten years. Table III shows the disposition of the men in various parts of the' industry. Sinoe the numbers are omnll "brona ooouvai/ionol nrottpin/jii m tio8& In Asbestos tho occupations ere divided into 3 groups - mill, pit and faotory; in Thetford Minos only tho first two occupational groups arc used, sinoo no asbestos manufaoturing is carried on there. All tho men' of tho Thetford Minos group oould bo so class ified, but 5 men wore exoluded from the Asbestos group Binoe they did not appear to be exposed to an unusual amount of dust.. TABLE III LENGTH 01? SERVICE IN DIFFERENT OCCUPATIONS IN AS3E3T0S INJURY ASBESTOS Years of Mill service 0- 4 14 Drilling pit 7 Faotory 24 THETFORD MINES l Mill i ' Drilling pit ii 6- 9 36 8 16 3 5 10-14 6 6 I 16-19 7 3 12 4 20-24 3 1 81 26-29 1 1 81 60-34 35-39 40-44 1 1 ! 1 i i 1 i ____________ 1____________ 2 _ TOTAL 69 27 40 40 14 Tho past oooupational history in industries othor than tho asbestos industry was significant only in 5 oases. Of those ono had been a grain inspector .J for 6 years and so exposed to vory dusty conditions, one had boon an underground oopper minor for 18 years, one a copper minor for 3 years, a fourth had workod in a oement plant for 9 years, and tho fifth had operated a drill in an iron mine. This last individual showed X-ray evidence of pneumoconiosis, the others did not have pneumoconiosis. In Table IV are given observations of v/oight in relation to jho^ght by age. The average weights are taken from the figures compiled by tho Association of Life Insurance Medical Direotors and the Actuarial Society of America. T A B L E_____ IV. WEIGHTS AI1D HEIGHTS ACCORDING TO AGE Pounds Under average pounds over average 30-39 10-19 5-9 -4 to 44 6-9 10-19 20-39 ASBESTOS [Jo. 31 38 19 34 16 19 9 <% 15.0 30.0 13 .6 17.1 11.4 13.6 C .4 TJIETTOHD iJo. uIHKS & Group ) 10,000 anal 0 Industrial rorkora $ 9 16.7 13 11 30.4 18 8 14.8 11 9 16.7 3 5.6 21 19 6 11.1 14 7 12.9 10 40| 4 3.9 1 1.0 3 The group of 10,000 male industrial workers re ferred to in the above tablo was studied by the Uni tod States Public Hoalth Service ( eoo Public Health Bulletin i No. 162). ' It will be noted that thero ia very little distinction between this large group and the group of asbestots workers so far as degrees of overweight or underweight are oonoerned. In the consideration of individual defeots some interesting faots have been found. In this study only the 101 men at Asbestos and the 64 men at Thetford Mines are considered, since the records of the men ex amined by Dr. Stevenson are not striotly oomparable with mine. TEETH't- Dividing the men into tv/o groups according to whether the teeth did or did not need attention, of the Asbestos group 49.^required attention, and of the Thet ford Mines group 61.6 ~ HEARING:Acuity of hearing was tested by means of a watch. (My own hearing, which has been tested by an audiometer, was considered nofinal, and used as a standard) The watch test Is ..admittedly very rough. In noisy oooupations impaired hearing is frequently found in the older employees. Of the 101 men at Asbestos 10 showed definite hearing loss. This is not an exoess proportion ainoe an;, nroav of adulta will show a similar picture. In Thatford Hinas 28 of tho 54 men suffered from well marked hearing loss. This is a very high percent age, and oanrparable to what may bo found in weaving sheds and boiler shops. All these men, except.tro, had boon exposed to loud noice in their work for 10 years or more, sad it la reasonable to suppose that nolee played a part in thoir hearing disability. ' The cumber of men with infected TOUSIIS was 27 in Asbestos end IS in Thatford Hines, and al most indetioal ratio to the total in both groups. Defeats of the THYEOID were rare. 4 men in Asbestos and 1 in Thatford Minos had enlarged thyroids. BLOOD PSSSSUHE Boadlngs were recorded in all men over 40 years of age. Bxoept in exceptional oiroumst*noos the blood proesure was not token in the younger non. Consequently although the groups examined in Thotford nines was smaller than that in Asbestos more blood proseure readinga were token there. 2 man in Asbestos had blood proeeures of ovor 150 and 2 blood pressures under 100 s;a of msroury. 8 mon in Thatford Mines had hlood pressures of over 150 and 2 blood pressures under 100. The inoidonco of 55FJTIA 'la of interest from the compensation standpoint. In Asbestos all new emp loyees must pass a physical examination before employ ment. Thore were 4 on.bos of Inguinal hernia discovered among the 101 men examined there. In addition to these 5 men had been operated upon for this oonditlon In TheLford 13.noa physical examination 1b not required before employment. There wore 5 oases of in guinal hernia among the 54 man examined and S oases whioh had beon operated upon. Some interest has arisen in connection with tho ooourrenoe of the so-oallod ASBESTOS COftflS. These are usually pin head sized derations of tho skin, some what like minute warts. J'nno of these were da tec tod in the Asbestos men probably duo to my ignoranoe of their pppearanoe. 8 of the Thotford Hines men had those growths on tholr hands and sevoral others reported having had them at one time or another. 9 LUNGS Of the 101 non examined >>7 me at lebestoa only 4 saffared from definite first stage pneumocon iosis* These will not he considered on aaoount of the doubtful diagnosis* Of the 40 men examined by Srs* Stevenson and Wyatt 14 wero diagnosed rs first stage pneumooonioois (oebeatosis 1) (I am inoluding the 17 men ex amined by Ore. Stevenson and Wyatt and subsequently re-examined by me in my group of 101)* ' The muoh lessor inoidenoe of pneumoooniosis in my group of men may seem ear prising, but it must be remembered that the X-roy negatives were not read by the same men. In my group the X-ray diagnoses were made by Dr* Herirrother of Pitoher, Oklahoma, and in tho othor group the interpretntions were by Srs* Wyatt and gwaeeaed. Further the geaup examinod by Srs* Stovenson and Wyatt were, in gen eral, older than those in my group. Of the 64 men examined at Thetford Uinos 24 were diagnosed by X-ray as suffering from pneumooonioois (flnbestosis), of these 4> were diognoeed as probobly first etap.e aabeetosls, 6 as early atage, f as definite first stage and 8 as aooond stage. The pertinent faeta regarding the deflate otioeo of eelieeteale ore given in tnblaa 7 and 71. 10 , .. J Table V Euan# Ding/7o. liosls Ano Oooupntlonal history S.'/r.-iPtons Gir.no. Aobentos Group. 66 A.l 71- A.l M ' A.l rA A.l A.l n * f) f A.l A.l n A.l r;o A.l? f2\ 20 A.l i 'i A.l r. -15 A.l ? :'7 A.l A.l *3; A.l 1 >JA" A.l A.l i a A.l y? Gorenn ^ oyclons 10 yeara *7 General operator filtnlcfc foroman ' JA years Ai loading car# in :nill ^ foreman Hfr yoirs ,0i grille? 7 years Al wdllwight 'll yoara cough,dyspnoa deficient expansion looo of otrongith occ, crepitations 1 -ft apex. cough, dyspnea poor oxpa*iulon, pore- frequent colds uorion dlminlsho! left ohast, oroplt'tlona all ovor both lun/;o. flu symptoms no abnormal signs. no symptoms dyppnoa,oough no abnormal signs. no abnormal signs T motor attendant no symptoms for 11 yoire 3? millwright 1A years no symptoms faint moist ralco A A A rib in front. no nl/noraal signs jo labourer b watch man in mill 3 yearn no symptoms labourer to;) floor mill, fi yoare no symptoms <>7 in mill 16 years no symptoms 9* millwright years no oymptoan (Id nnron in mill 36 yoiro no symptoms W. . mine (woric not stated) no symptoms 1'.' yoaro 0.3 drill or '1 yoaro no symptoms Al driller "13 years (!o driller A yoaro no symptoms no nympto-.io sparoman f years foronan .15 yeira ?7 drillor ? years no symptoms tradfjan A yoars *2 pipe covoror no symptoms (factory) A yoaro slight dullness right ba3o,left chest expands mors than rlcht. breath sounds at aploos harsh no abnormal signa expansion slightly 11mi tod expansion limited no abnormal signs no abnormal signs no abnormal signs absent vocal fmituo bronchial rales loft side no abnormal olgno. TabLe VI Exam, Diag* iiO noni3 Age Occupation'1 history rynutono Thetford Liinon Group -61608. ......................... 1 A.l 42 filling bags 6 yerao no symptoms oonroo olioho alovt hvirt ollor to years to at both banoo behind. foroman 4 years 3 A.l 4} driller 73 yoaro no nynptono no abnormal nlgns 6 A.l 3? oloanor iu mill yro. dyspnea no abnormal signs (probably) fillings bags 4 yro. 11 A.i y millwright 27 yonre dynpnoa no abnormal signs P owoopor 16 yoara oough oxp- oonroo cropiti lions C early) octjration, loft apex bohind Ooc, blood in nputurn,dyopnoa looo Of Weight n A.l 51 millwright 21 yoaro oough T.> ex|>* dry rales ovor rt,ohout ectoration, bohind, expansion doficioat dyopnoa, looo of weight (0 strength 3 A.l 4? millwright 11 yoaro cough ocea'lo'ml dry ralos at (probably) left baoo t:! A.l 16 drill or 11 yonrs no symptoms no nb-iorowl slgno 1/ a.i 4;> driller 17 years him tory of noabno ruu1 n1gn 0 (oirly) plearioy, olotor diod 7 ( a.i 97 millwright 111 yoaro (early) of t,b,o. dyopnoa no nlmorual oigno A.l 6.1 driller 40 yoaro (oarly) fj0 nyraploue many crepitations right base. .16 A.l 2? driller 6 yoaro (oarly) general work in pit Ho symptoms no abnorunl signs ^ ! ' A.i 44 4 yoaro filling bags 1 yoar hi 0 to ry of no abnormal oigno duet oho-l yoaro homoytyola ?'> A.l 33 in mill .5 years (oarly) in tunnel fooling oouj'h, dyepno.i no abnormal signs ouapooted t,b. 13 oruohor ^ yoaro in 1?2> 57 A.l 53 oruahorl 1 yoaro no syuptoiao no abnormal signs (oarly) Bwooj.or in mill 4 yro. oiler in nill A yoraa A.i % . loading boxen in pit olotor diod a Shono's of fine oropltatine 79 yoaro, fooding of t.b.o. 1EJ6P both lungn bohind from 4 U10 mill 5 yearn vortobra domi,percussion 3 note dlralnisliod ?:> A.l (oarly) milivrrig t *6yanro fore nan *6 yearo dyopnoa no abnormal signs A;' A.l 6.7 fooding oruohor U' yoar dyopnoa orapitatlone in rt,axilla oioaning in mill 13 yro A 1. baoo bohind, 4 i A.l 46 feeding orpeher in nill no symptoms no abnormal oigno (probably) ynr'e, drioro lyoar, J ____________ Table VI (continued) _____________ r<a. Diag- i.'o, noolg Ap,9 Occupational history fy.-iptonooii^neu 'O A.l :>h (oarly) A.l <51 (probably) M A.l 5 A. ^ At' 7.7 A.l A h (lata) Thotford `.'.inn:' Group (contM! loading bc;coa In pit fyro., drillnr (. yro. Ojjorator in mill 6 yjp., alllirright 1'i yearn ollor in mill 10 yro* fore.oan mill 7 yra. mill repairs 1 yrn. mill foreman 1" yro. Foreman mill H yrs. millwright 7 yro. no flymptomo no abnornnl eigne. no eynptoma llorcuueion lenr r romnt over right lung, ohi.iorn cropltat ono rigit uldo fro.it '> bnol:,- ovor left up. or lolio front b.aolc. oon diet t.b.C, oxpaioicni |><v>r, n:\ny daughter hnn cropLtntlono 1. nj.e:< b tuborculonie. in r, axilla, crepitations r.l 1. upper lobou beltin'.] * at both haooi?. oaughjdyojnea tar Lon poor,percup elan poor nt a;fcceo, no rnior, no symptoms no abnormal clgns. It will be notod that of tho t ^ t : 5T examined at Aebootoo 17 were dLcu/- nosod as first etnge asbostoois, while of tho J4 exn.ilnod at Thotford Minos HI wers diagnosed as first stage a3bc6toole and 3 ao second otige asbostonlBi This is not to be interpreted no indicating an oxooos hazard Ln Thotford Minos* The incroasol inoi'enoe of pnoiinonoconiooiB in Thotford minon is Dimply a rofleotion of tho different distribution with rosj eot to age and length of service. Reference to tables 1 and will rooall tho groat differ ences in these two things. In tho great majority of oasoo tlvo longth of sorvice in duoty work woo inoro tlian 9 yoare as indicatol in thofollowing tablet length of sorvice iiuabor Qf oaeoa number of non axa-'.lnod. 0 - 4 yrs. J - 9 Id - t4 V* <* over Total < 7 4l 44 7? V t?') Prom this table one would ooocludo that asbootoflio fn not likely to dovsiopo with an oxpoauro of loos than H yoare, but that with expoouro of more than T' yoare there is a great poosibiilty of it dovolaplng. It is, however, of intorest to remember the tinny nan with long period of exiopuro do not develops any eigne of asbo3toelo. Ae to occupations of 4t drilloro 1,* wore oases of aBbootosie, of 1?'' mill workore -7 woro caeoe of aobooteoia and of 40 workoro In tho factory ly 1 case showed x-ray evidoaoe of the dioeaso, Evidently thnre 1b littte dlfforenoe in tho hazard in mill workers and drilloro, ; Tho mill workoro h.peir to be expoael to far groator d4r>t concentration!) than tho drillers aid it in rathor diffloult to undorotdnd tho high ^ncidonoo of asloptonla anong tho drilloro, Howevor, it mny or may not be of intorent to* note thru t ( 14 i i that tho drillera are occasionally exposed to granite dust. Hone ot f the oases of anb'-Btosio a: poured to suffer from disabling symptoms. Perhnpe tho moot coiiaon oyaptom wao ohortneou of kroath, but fe !. ! loon than half tlia. oasoo ooaplairio:l ofthia nyn; toa ( 11 of tho 4l cares). Ao to physical slr.ns I wao unnbio to find any pathognomonic oigns which -would enable ono to nnhe a diagooio in tho atoonco of tho x-ray ploturo. Inn: ootlon of tho lunge wnn of littlo value elnco It -ao difficult to evaluate the degree of diaphr igaatlo oxcuraian and aoiiotLiios expansion a,, oare* to bo deficient when aotuilly It .me not. If a roei irntlon tnn'< hv? boon available ooao quantitativo idea.of vital ORiaolty might Itave boon attained) the moaounomont of ahott exjaholon by a tnt o monoure vrae givon up after the firnt examlnatlono. Slnoe thare ie no* standard pitfall of percussion noto and no st'indurd intenaity of taotilo frauitus or vocal rooonaaco one has to ooai aro ono aide of tho shoot with the other to deteot abnormalities. But aobootooia is essentially a symmetrical lee Lon and in thio disoaoo tho comparison of tho two al'eo of tho cheat ie of littlo help. The arune oboorvationa apply to the quality of tho breath eounde. The moat frequently found abnormality was tho prnaunco of rnloo, p rtioulnrly crepitant ralea. In many of the more oovere canoe ehowoyn of those rales ooourrod throughout both didee of the oheat,particularly on coughing, but in teo of tho tliroo cuocp of second stage anbeatoeia theca rales wore not hoard, ao that ovidontjy thoys aro not a oonet&rit eign of tho Unease, On clinical examination t*:o or throe of thn caueo witl) largo numbers of oropltant mien at thapicoo woro thought to be tuberoulouc but the x-ray examination did not oonfiru tills improsnion Tuberculosis did not play an inparrtant part, in ths study, Kane of tho oriaoa of anboatosis appeared t9 be coopllcntod irith tlilo dieenno, Indeed tho incidence of definite tuborculoolo la the too groups of 1'H individuals 0 was very low. Thera wore several oucpeotod oaaes on ollnlcnl examination which were not confirmed by x-ray and novoral suspootod oases by x-ray which showed no real evidence In tho way ofalgng and eyaptoos, Only one caso irt tas groups can bo c moidorod as activity tuberculous. It was dlffioult to obtain oputuci frow most of Lho mon since vary few of th"'i were coughing* About bT sputa wore examined for tuberolo bacilli and anbootua bodies. No tuborolo bnoilli wore found bub one onoe did show HdV'jr'i bbjlapj Hii3 panp 1703 d5.n/:nosot Jy ns J'P'H.nlliy nnl.eotooia (first stage) but la not inoludod in the number of aobootuaie 0*300 since tho x-ray film wan not satisfactory. Con vernation with phyelcinnr' and iiine aanagoro in tho nsfcostoo regions ln-Uoated that no hazard to hoalth was suepooted in connection with work Ln the asbestos mining and milling Industry, In general it may be said tliat the hazard of pnoitionoconlusLo In tho asbentoe mining and milling industry Ino boon demonstrated, but ovl 'ently tbo disease doeo not Incapacitate to any groat degree and apparently it is not particularly associated with tuberouloeis.