Document me3DO8X0xOLN1ZOjowXR4Y90

* \ i'- -yfrs 9V February 2g, 1944* hr. Ivm Sabouria Jlldred Montreal, ?.g., Canada Dear Mr. Sabouria: I her* your 1 Attar of February 22 ulda( for eownents oa the relationship between asbestoeU and susceptibility to tuberculosis, this question cannot be aarwared decisively from a itady of post aorta* aatertal alone. Medical problem of this nature ere usually solved an tat basis of probabilities and it Is this eatter of probabllltlas on which ve need further evidence la the east of tuberculosis associated vita asbestosis. lerewether la his 1--in amlna on JUbtstosls* Tubercle t ' *r tad December, 1933 and .Tannery, 1934) sdalts tast wth* data on .. *ct art neater.* St rtports that of 374 workers while at work, 1 ,, shoved sitns of aetlve tuberculosis sad that the British Silicosis i . beetoe Medical Board la its first periodic rrainstlon of orluf la this Industry found only on* oast of asbestosis and tuberculosis la 1512 examination*. On the other band tha ftigllsh pest norttn **terlal at that tint revealed 35*7$ of the easts complicated by tuberculosis. (Subsequently ht appears to have fowl nert easts If fir. Blddell Is cor rectly informed). In the publication cited Ktrvvether concludes: The eridmse therefor*9 points to ths hypothesis that at present tht_added risk to asbestos workerafron TTj^gTdf^ tr^cuiesis Is limited tad definitely less than in worker* exposed to fret silica; virulent m- sire infections dll as la the general population, cause death; lesser ones vlU result In nore widespread fibrosis then would appear in eases amongst the feaarsl population end light Infections, in eooaen with may other affections, are likely to precipitate death la cases of 4SaS& asbestosis where they wouldn't do so in the (taeral population* the underscoring is but X ac.`ve vita theso views* When Dr. Merwwwther was la this country last year he visited m for several days and we spent aost of our tl,n* discussing theso problem., a* still aowopts our esperinental work which proves that there U uo 1 specific susceptibility to tuberculosis Induced by asbestosis tod he,like ourselves, is anxious to eecuaalate comparative statistics fron various parts of the world to establish the general clinical experience. i I l (2) is I indicated La xy last letter the Quebec experience is not ret analysed; there la only an impression tone seat of the asbestos erkers die of tuberculosis without taking into account tbe exeesslye prevalmce of such infection among the population of the Province* This impression oesds verification hr careful analysis of morbidity end mortality statistics collected from the employee* of tbe asbestos industry, from their families not exposed to asbestos dost and from other ommaltha In tbe Province of Quebec. Such date should then be compared vita similar statistic# for asbestos workers la other countries. If there iJ a specific occupational predisposition to tuber culosis it will becoae apparent on such analysu* just as It has for silicosis. Wherever silicosis Is bein* crested, the high mortality from tuberculosis cannot be hidden. I do not believe that there is mach tuberculosis aam* asbestos workers is the Talted States and suspeet that the exeess mortality free this cause is is probably due to the low living standards of Industrial workers. Possibly selection of eases coming to autopsy has influenced tbe picture. 4*eriean studies have thus far failed to denenstrats enough tuberculosis anon* asbestos workers to eases coneat. The 3. 8. Public Health Service Study of Aabestosls la the iebeetes Textile Industry la forth Carolina, (folletla 211), issued la 1938, hardly mentioned tuberculosis, dismissing the subject with the statensnt * ~t*e 51 that there vers only 2 cases of active, pulmonary tuberculosis froup* (511 employees). Shull, (todlolocj 27, So. 3 279-292* rzasdned 71 of 100 eases discharged from the pleste vhere the ... Sealth Service made Its study 15 month# later sad found 8 eases cosplieated by tuberculosis of alight to moderate extent bat only 2 vers active. These two subsequently died of this cause sad la 2 others the Infection later became active. Shall states la hie endueloos that asbestosls does not predispose to tuberculosis.* Presumably he infers, although he does net say so, that the 4 eases of active disease aaen* 541 wortoen represented accumulated disabilities ta* the enml nation program vas inaugurated. Donnelly (* 2nd. ^r*. and Tax. 18, Vo. 4# 222-228:1938) also axaadned 151 discharged esployees laetadla* the 100 retorted by Shall. Se fives u*re detallj the cases of taberculosims One of then bad worked iar the asbestos industry far S months sad the otr.ars 15 soothe. The remaialh* 2 bad worked a sad 10 years respectively and their infections might have been aggravated by erpoenrs to asbestos dust. Se points eat, however, that an incidence of 2 eases among 151 industrial imal iijmi is ao higher than ia any ether industrial group. , BcPheeters, w* 2nd. 2r*. and Tax., 18, 229-2371 1938) likewise ex- t asiined and reported on thee# cases sad he is ia entire agreement with ' the ether reporters. In his eo&olssions he rtatee, **e activating or 1 aggravating affect of asbestos cast or asbesteels or tuberculosis was observed.* Ptnelly Z believe Z told yon that Z myself# had just rm- j turned from Barth Carolina short I bad reviewed cheat film# of some 100 ' emeloyves of tht local asbestos irdestry asrf sew only one that showed any Laiication of admit type polmonary tubarculools. This was completely j' i Mr. Ivan Sebounn O) ?ebruar7 28, 1944 healed. X consented on the fact to the uxbcrt of the Medical Board of tne State Industrial Cosiisslaa vita vuoa X wa conferring tad the Chairmen, In*. 7e*tal, told ae Uit tuberculosis ms a nr* finning incog asbestos workers although eosaoa enough la other industrial workers la their state. It would therefore, appear that la forth Carolina eabestosis does not favor or predispose to tuberculosis. X bat* jost sow cowpleted a ml** of 125 flins for aa asbestos fabricating plant la aaotbar stata. In th m plant the aaount of severity of the asbestosis on tha first exaalnat .on la 1950 vu vH narked, approximately 40% of tha croup shoving dafinita I-raj evidence of tha disease. lewrthelsss, tha total adult type tuberculosis rata m only 5ii four of these caaaa occurred In paraona vlth asbestosis and 2 of than vara considered probably active* 1 second r 'nineties tu aada upm 67 of tha original group iftir an interval of f years daring which thay renamed at word, lov tha iaeldanea of asbest . had increased to 42$ bat tha tuberculosis rata had fallan to 2+9%. I third areal nation m dona on 57 of tha original group vha still realised la employment aftar a farther iatarral of 5 to 4 tvits; la this group tha incidence of asbestosis was arar 30% but that for tuberculosis only 5.5%. Xa spite of excessive mounts of aararv asbestosis tha tuberculosis rata rvaalaad within tha Halt* uaually found la iaarlcaa indnatrial population*. Tha bahnrlor of tha tuberculosis la thaaa people vaa not unusual. yor exaspl* oaa aaa, a apinaar for 13 yvars, vaa 31 years old vhan first szaainad. la had at that tlaa aa early non-specific dust reaction tad evidence of old tuberculosis la tha top of hi* lungs. Xa tvo succeeding examinations his dust reaction steadily increased to reaeh first stage asbestosis 9 years after ha was first tecs, ftls tuberculosis however, reaalaad apparently uninfluenced. Vast of tha others behaved in tha saae mnner These people had already bean exposed to asbestos dust for periods of 3 to Id or acre years vhaa they vere first examined and. tha three subsequent examinations during tha following 9 years give us a good opportunity to follow vtsat night have developed. lo aaw case of tuberculosis appeared. If it had not by that tine tha cheacwa vere not very peat that they would later. after they left tha asbestos industry ve do aot )ocm vhat happened to naat of thea but on a few there are invarencc records that indicate tha causa of death. Tvo died of tnhorculosis. Qua had had his infection vhan ha was exaadnad in 1930 at taa ago of 50. at that tine ho had a early asboetosls after waving far 10 years and end*nee of associated chronic tuberculosis. Be was advised to leave enieh kw did and died of his infection about 3 years lator. Tha second am aged 32 had bean a weaver for 12 years and had first stage asbestoais but no evidence of tuberculosis at tha tine. Bn Imft his job after tha Mr* Inn Sabourla U) Tebruary 16, 1944 first eta ml nation for rmou not iUtd. fhree years later he ns reported to aare ditd of tuberculosis la a sasitoriua. Such eases could occur anywhere. It la possible that if ee bad folloe-ups oa acre of these cases aftsr they left the asbestos Industry re would fled acre persons rho subsequently contracted tuberculosis sad died of It. Hre arer, the eridenee aow swallable Indicates no sneb tendency. *M eel experiments, contrary to those upon silicosis, disclose no theoretical reesons for suspeetinc that asbestosls creates any special susceptl- bllity to the tubercle bacillus of loch. Z aa beeoalaf aore sad sort oosrlaoed that that the hlh tuberculosis rate# reported la English aatopsy statistics are dae to eaases other thaa occupation* I belitre that the sane aust hold true la Quebec where the aaeuat of sererlty of the asbestos dust reaction is rery mash less thaa it is la the fabricating plants la the Baited States. X beliere X bare corered the other points raised la letter aad nil therefore aot prolca* this discussion farther. Terr truly years, ' Leroy B. Gardner, X. S Director U3C:aa ee to Hr. Taadlrer Broca