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FILE NAME State of the Art Literature SAL DATE 1965 DOC SAL073 DOCUMENT DESCRIPTION Journal Article - The Occurrence of Asbestosis Among Insulation Workers in the United States ~ Py 138 a, Annals New York Academy of Sciences is there that periodical examinations have prevented the development of asbestosis and its sequelae As regards initial examinations the Pen moconiosis Medical Panels have to decide whether new entrants are suitable for employment in the industry The question that should be asked is whether the employment is suitable for the worker In our experience very appreciable improvements in working conditions have been made in some sections of the industry by some employers What some can do others can do Let us remember the answer and the warning given by Merewether 30 years ago When asked whether two years exposure was sufficient th cause asbestosis in young girl he replied Yes if she lives long enough References 1. MURRAY H. MONTAGUE 1907. Report of the Departmental Committee on Compensation for Industrial Diseases Minutes of Evidence Appendices and Index : 127 2. COOKE W. E. 1924. Brit Med 2 147 3. OLIVER T. 1927. J. Indus Hyg 19 4. SEILER H. E. 1928. Brit MedJ. 2 982 5. BURTON Woon W. 1928. Tubercle 10 353 G. ELLMAN P. 1930. Proc Roy Soc Med 7. MCDONALD STUART 1927. Brit Med J. 1025 . 8. STEWART M. 1930. J. Path Bacteriol 33 848 9. GLOYNE S. Roopious 1929. Tubercle 10 404 10. MEREWETHER E. A. & C. W. PRICE 1930. Effects of Asbestos Dust on Lungs and Dust Suppression in the Asbestos Industry H. M. Stationery Office London England 11 WORKMEN'S COMPENSATION Silicosis and Ashestosis ACT 1930 12. SILICOSIS AND ASBESTOSIS Medical Arrangements SCHEME 1931 13. ASBESTOS INDUSTRY REGULATIONS 1931 Na, THE OCCURRENCE OF ASBESTOSIS AMONG INSULATION WORKERS IN THE UNITED STATES I. J. Selikoff J. Churg E. C. Hammond Section on Environmental Health The Mount Sinai Hospital New York N.Y. Information currently available concerning asbestosis has been derived largely from studies of employees of asbestos textile factories and should properly be referred to such individuals It is inadequate to speak now of asbestos workers With the growth of asbestos utilization including rapid multiplication of the number and variety of its applications it would perhaps be more accurate to categorize workmen exposed to asbestos as asbestos textile workers asbestos insulation workers asbestos miners rena. asbestos mill workers asbestos workers etc. The different occupations vary widely in important respects in intimacy intensity and fae duration of exposure in variety and grade of asbestos used in working conditions in concomitant exposure to other dusts or inhalants The im- portance of this distinction and the parallel obligation to evaluate and study the experience of asbestos exposure in other trades is emphasized by the fact that asbestos textile workers are now a minority of those ex- posed during the industrial use of asbestos There were good reasons for the early emphasis on asbestos textile workers The first cases of asbestosis were in textile workers Following the republication of Cooke's case in 1927 with its rapid confirmation by the report of another case by Seiler the Factory Department in Great Britain had to decide whether these were exceptional occurrences or repre- sented a significant health risk in industry Accordingly an investigation into the problem was undertaken during 1928 and 1929. The scope of the study had to be restricted The textile industry was selected for study since only here was there pure or almost pure asbestos exposure Since it was urgent to investigate the effect of this dust limiting the investigation to this branch of the industry avoided the possible complications which might be introduced by the presence of other potentially fibrogenic dusts Moreover in other asbestos trades there were varying portions of asbestos in the dust to which workers were exposed which would have added an- other complicating factor It was accepted that there were considerable numbers of workers exposed to mixed dusts whose risk would not be docu- mented by study of the asbestos textile industry Subsequent surveys similarly designed to study the risk of industrial asbestos exposure were also largely confined to asbestos textile works This study was supported by the Health Research Council of the City of New York - 139 fon /. fj 1.40 Annals New York Academy of Sciences ) VA although some described experiences in asbestos mills asbestos works or factories producing a variety of asbestos products Suci studies had the advantage of having available for investigation sufficiently large numbers of individuals to allow for statistical evaluation of the ob servations made There was the added advantage that in many of the fac tories there were a considerable number of individuals with extended rerey) periods of exposure allowing for analysis of the effect of prolonged exposure Pet An important area of industrial asbestos exposure has been asbestos insulation work The first asbestos factory opened in Great Britain in 1871 + with the expansion of the asbestos textile industry beginning 10 years e later consequent upon the availability of high grade spinning asbestos from Canada Yet asbestos was used for heat insulation in Asbestos cement was introduced as a boiler covering about 1870 and other asbestos tie insulation products were introduced in the next three decades Commercial ete production of asbestos insulation materials was recorded at least in 1871 FS Just as in Great Britain early studies concerning asbestosis in the United States did not mention asbestos insulation workers Neither Pancoast nor Hoffman characterized the asbestos trade in which the work- men referred to by them were engaged The first official claim for compensation associated with asbestos in the U. S. was in 1927 and again the nature of the work was not stated Ellman in 1934 mentioned a case of asbestosis in an insulation worker Other cases were subsequently reported and in the annual report of the Chief Inspector of Factories for the year 1956 lagging or insula tion work was recognized as hazardous Similarly Hervieux in France drew attention in 1962 to the dangers of such end product use as insulation at ention work only large scale survey of asbestos insulation workers was undertaken in the U. by Fleischer et al in 1945. They found only three cases of asbestosis and concluded that asbestos pipe covering of naval vessels is a relatively safe operation Unfortunately 95 per cent of those examined by them had worked for less than 10 years at the trade and as we shall see evaluation of the risk of insulation workers limited to study of men with relatively short durations of exposure may be misleading Asbestos Insulation in the United States Asbestos as a mixture of fiber and sodium silicate was first used as an insulation material in 1866 and as asbestos cement about 1870. Magnesia with asbestos as a binder soon followed and cell covering made with corrugated asbestos paper was introduced in 1898. These materials are still in use with others The first union of insulation workers in the United States was formed in New York City in 1884 under a charter issued by the Knights of Labor fy Selikoff al Asbestosis Among Insulation Salmnder }rs Salmander 141 Salamander predecessor of the American Federation of Labori as Salamander of Association of Boiler and Pipe Felters In 1910 the present union of insulation workers in this country was chartered by the A. F. of L. as International Association of Heat and Frost Insulators and Asbestos Work- ers with the amalgamation of the Salamanders Association of New York and other independent locals through the country The members of this union are insulation workers primarily employed in the building trades doing construction insulation work but also employed as insulation workers in shipyards and powerhouse construction and repair Much of their work is in the open air but it sometimes is as aboard ship in rather tight quar- ters with poor ventilation The men generally work at all parts of the trade few are specialists at one part of it or limit themselves to one material Conditions of work vary from job to job and from company to company Among the 1,117 men we have examined see below fewer than nine per cent of those with 20 years of work experience or more had worked for one employer primarily even after four years of work ex- perience less than half had remained with their original employer Review of work practices with insulation workers from various parts of the United States and with knowledgeable officials of the union and insulation em- ployers indicates that techniques materials and practices are rather the same through the country Similarly data published concerning the work practices in other countries suggest that asbestos exposure in insulation work is approximately the same the world over The asbestos exposure to which insulation workers are subject is limited and intermittent Some of the materials used contain no asbestos Seventy- five years ago the magnesia pipe coverings had shredded rope as a binder with no asbestos Later much work was undertaken with hair wool- felt cork wool In the past three decades fibrous glass products have come into increasing use and these have been supplemented recently with foamed and expanded plastics for certain applications Of the asbestoscontaining products which are widely used by these men magnesia block insulation was and remains perhaps the most important This usually con- tains approximately 15 per cent asbestos While asbestos cement has a varying asbestos content depending upon its manufacture it also generally has 15-20 per cent or less of asbestos Asbestos paper products such as cell have a higher asbestos content but are used in much smaller quantities We have studied the insulation materials with which these men worked in the past in several ways First review of old trade and technical pub lications from the early part of the century to about 1930 indicates that the major containing materials have remained about the same especially insofar as the amount and nature of the asbestos content is concerned As expected from knowledge of sources of U. imports of as- f 112 \ Anals Annals New York Academy of Sciences bestos chrysotile asbestos was largely used This has been confirmed by analyses of magnesia block obtained during repair work In later speci mens so obtained crocidolite has also been found Moreover materials used for ship insulation while containing the same amounts of asbestos as above began in 1934 to have significant amounts of amosite in addition to chryso tile because of the lighter weight of the material Marr has recently brought shipyard insulation experience up to date comparing it with the observations of Fleischer and colleagues and concludes that insula tion materials and work methods have remained essentially the same since 1945 Measurement of dust exposures of insulation workers have been but in- frequently reported and have been hampered by the varied nature of the work As in other asbestos work peak counts are met which are excess sively high but generally counts for asbestos fibers have been within the five mppcf M.P.C. of the A.C.G.I.H. Such counts as have been available made during work engaged in by the men studied by us have shown a range similar to that of published counts Present Investigation We undertook to study the question whether asbestos exposure during insulation work in the U. was associated with the hazard of asbestosis and its complications Our investigations have been concerned with the 1522 members of the insulation workers union in the New York Local 12 New Jersey Local 32 metropolitan area The New York Local of the Union is a direct lineal descendant of the Salamanders Association and is the oldest Union of insulation workers in the U. The 1522 men studied by us include all members of these Locals from 1942 to 1962. On December 31 1942 there were 632 members and 830 men subsequently joined her tween 1912 and December 31 1962. This includes every man who was a member of either of these locals at any time in this period whether or not he remained in the trade as an insulation worker It is believed that the experience of these men fairly represents a cross section of the experience of insulation workers during the history of this trade in the U. Records of the union indicate that these locals had 335 members in 1914 and that 1738 members were admitted to these locals from 1915 to 1963. In the United States as a whole the Insulation Workers Union in 1914 had 1487 members and 28,338 were admitted from 1915 to 1963. The adequacy of our sample can be gauged by reference to these figures see TABLE 14 However our data does not include information concerning nonunion insulation workers maintenance insulation workers insulation work as part of other trades or undertaken by insulation workers in other unions The number of men involved in insulation work in these areas is not known 10 tis at a, 0 0 0 Selikoff et al Asbestosis Among Insulation Worki 113 TABLE 1 STUDY OF ASBESTOS INSULATION WORKERS IN THE UNITED STATES ADEQUACY OF SAMPLE Total U. S. Membership IAHFIAW 1963 14,803 Total NY Membership LAHFLAW 1963 1,258 Examined NY Membership IAHFIAW 1963 1,117 Following insulation workers not studied 1. Nonunion insulation workers a 2. Some maintenance insulation workers ACH 3. Sprayed insulation workers ey 4. Insulation work as part of other trades 5. Insulation workers in other unions alten From January 1 1943 to December 31 1962 264 men died At the start of this study on January 1 1963 1258 men were alive We attempted to locate and examine every man alive on that date whatever his employment status For this purpose invitation for examination was voluntary The cooperation of the union and its membership was freely given Union records were made available and were very valuable The union is a stable one Its members are paid skilled craftsmen with little turnover among these workmen Accurate detailed employment records collected weekly are maintained by the union and from these records it was possible to obtain the entire work history of each man This data was used to supplement the work histories obtained from the men during their examinations see below and was utilized to provide employment data sufficient to establish onset of employment and duration of work experience for those men not examined From the health and welfare records information was available concerning every death among the members of these locals during the period covered by our study and utilizing these records death certificates were obtained facilitating the location of hospital records autopsy protocols histological material etc. Of the 1258 men alive at the start of this study 1086 were active work- a ing members of the union 63 were retired principally because of age 34 were not working because of illness and 75 had withdrawn from the ne union and were no longer engaged as insulation workers but were otherwise employed TABLE 2 One thousand one hundred and seventeen of the 1258 living members 89.9 per cent presented themselves for examination This included 984 of the 1086 of the working members 50 of the 63 retired members 28 of Lay \ 111 \ . \: / Annals New York Academy of Sciences TABLE 2 ASBESTOS WORKERS UNION SURVEY 1963-1964 Years from onset | Deceased Deceased | Retired Retired !! 50+ 25 22 8 40-49 79 35 17 30-39 20-29 107 " 39 6 $ 0 2 10-19 0-9 9 0] 2 5 0 0 264 63 34 Withdrawn Withdrawn Working members 1 5 10 43 22 185 7 75 24 385 11 393 75 1086 Total alive 36 105 218 8+ 411 401 1258 1,522 members January , December 31 1962 the 34 who were ill and 55 of the 75 members who had withdrawn from insulation work TABLE ) TABLE 4 contains an analysis of the 1258 mm according to lapsed time from onset of their employment It will be seer that the very large majority of men in each lapsed time category was examined This inclusiveness of the survey was very gratifying for two reasons First it will be seen from an analysis of TAIILE 2 that a high pro portion of the older members with long work experience and with longer periods of lapsed time from onset of employment are included among the retired ill or withdrawn classifications To have omitted these men would have led to inaccurate selected data It would certainly have mad TABLE 3 ASBESTOS WORKERS UNION N.Y.-N.J. 1943-1962 Status January 1 1963 1,522 members 1. Deceased " 264 2. Alive eee 1,2ees51,8 258 Status No. Examined % Examined Retired III Withdrawn Working 63 34 75 1,086 50 79.3 28 82.4 55 76.4 984 90.6 | 1,258 1,117 89.9 632 Members Dec. 31 1942. 890 admitted Jan. 1 1943 to Dec. 31 1962 Status of men examined during survey 1963-1964 - : Selikoff et al Asbestosis Among Insulation Worke } 145 TABLE 4 EXAMINATION OF ASBESTOS INSULATION WORKERS Onset of exposure Prior to examination yrs 50+ 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 . No. 36 41 64 92 126 18 66 186 225 184 220 1,258 Examined 28 39 54 83 111 16 61 174 91.6 205 154 192 87.6 1,117 Analysis by group according to onset of work exposure difficult the establishment of the effect of a long lapsed period from onset of exposure or the effect of a long duration of exposure Second in addition to data concerning onset of employment information was obtained detailing the actual number of years worked during the period from onset of employment While in many cases the two periods more or less coincided in some cases the number of years worked was significantly less than the elapsed time from onset of exposure The com- parison of such data is of interest when attempting to separate the effect of actual work exposure from the effect of mere passage of time from the initial exposure with inhalation and retention of asbestos fibers Examination of each man included a detailed occupational history Data were recorded concerning onset of employment interruptions for whatever cause number of employers use of protective respirators materials handled and employment in particularly suspect areas of insulation work such as shipyard work and powerhouse construction work Health experience was noted including previous illnesses and hospitalizations as were current symptoms such as dyspnea cough sputum hemoptysis gastrointestinal complaints Smoking habits were recorded in detail including age at onset number of cigarettes smoked and pipe and cigar smoking If the individual was no longer working the reason for this was ascertained Physical examination was particularly directed to the chest but included examination of the skin nose and throat finger clubbing and cyanosis Chest expansion was measured hemoglobin und urine were routinely ex- Annals 116 = Annals New York Academy of Sciences amined Vital capacity was measured in all cases and in many addition measurements such M.E.F.R. TVC and MBC were also made In mat cases sputum sputum was examined for asbestos bodies and in almost half bl . was drawn for special serological studies In selected cases extended p monary function investigations were undertaken including arterial ga studies lung compliance pulmonary airway resistance measurement ventilatory parameters and diffusion studies ray studies were perhaps the most important part of the examination each case a standard posteroanterior film was taken but in addition another posteroanterior film utilizing a slightly more penetrating kilovol age technique was also exposed Our experience indicates that this manes ver is valuable in ray examinations in this disease The standard tech nique is required since penetration may well result in the loss of .. reticular fibrosis and indeed in individuals with relatively brief work histories it is sometimes advantageous to take a third posteroanterifilm with a slightly penetrating technique if such minimal fibrosti is suspected However in the men with longer work experience increase penetration may be required First these men do a good deal of manu labor and are often heavily muscled Second pleural fibrosis is comm and parenchymal fibrosis usually coexists both decreasing radiopenetr bility Third such increased penetration is often required to demonstride calcification especially when it coexists with extensive pleural thickening or is located in such areas as the posterior diaphragmatic sulcus behir the heart in the mediastinal pleura etc. Oblique films in both anterior oblique positions were also routinely taken each case While this has obvious applicability in a disease with >su lower lobe preponderance as asbestosis we have found it particularly va itable in the demonstration of pleural calcification Results Among the asbestos insulation examined by us evidence - pulmonary asbestosis was present almost half the men examined In th evaluation radiological change has been used as the sole criteria TABLE 5. We understand of course that evaluation of the presence and extern of asbestosis limited only to ray findings tends to result underestim underestim tion of the incidence of asbestosis but few instances of disabling disease will so overlooked Analysis of our data indicates that radiologically eva dent pulmonary asbestosis varied directly with the duration of exposure Insulation workers with relatively short periods of exposure have a sig nificantly lower incidence of pulmonary asbestosis and this when present was generally of minimad extent Of 316 men whose exposure had begun less than ten years before exami nation only 36 or 10.1 per cent showed any radiological abnormality In LY a) Selikoff et al Asbestosis Among Insulation Worker wy, 17 TABLE 5 RAY CHANCES IN ASBESTOS INSULATION WORKERS Onset of exposure yrs | | No.No. % % Normal Abnormal Asbestosis grade 1 2 3 40+ 121 5.B own 30.39 194 12.9 20-29 27.2 10-19 379 55.9 0-9 pene}.346 | 89.6 1,117 51.5 94.2 51 28 102 87.1 102 49 18 72.8 35 17 4 44.1 158 9 0 10.4 36 Of 0 48.5 366 126 50 each of these cases the reticular infiltration was minimal in extent and in ' none was there evidence of pleural calcification In only four was pleural fibrosis seen Of 379 men whose exposure had begun from 10 to 19 years before examination more than half still had normal rays Some abnor- mality was seen on ray in 167 of these cases but in only nine was the asbestosis greater than minimal In 35 of these men there was some pleural fibrosis and in five evidence of calcification On the other hand among the 392 men with more than 20 years elapsed from onset of exposure the very large majority had ray evidence of pulmonary asbestosis Among the 77 whose exposure began from 20 to 29 years prior to examination 56 showed abnormal films Among 191 whose examination took place from 30 to 39 years following onset of exposure almost 9 of 10 showed abnormal films while of those with more than 40 years from onset of exposure only one in 20 showed no abnormality Moreover the asbestosis in these cases tended to be considerably more extensive and severe and pleural calcification and fibrosis were commonly seen Pulmonary asbestosis has been called a monosymptomatic disease with dyspnea the essential complaint Analysis of our data concerning this symptom among the men studied by us indicates that it was uncommonly seen in those men with less than 20 years from onset of exposure but was an important symptom after that Thus of 725 men with less than 20 years from onset of exposure only one had significant dyspnea although 32 others complained of minimal dyspnea on exertion TABLE 6 On the other hand of the 392 men with more than 20 years from onset of exposure 134 had dyspnea of some degree 61 of them with disability of greater or lesser extent There was incomplete correlation between the roentgenographic findings considered as parenchymal fibrosis and dyspnea on exertion Two cases were seen with no roentgenographic evidence of parenchymal fibrosis but wo > 118 Annals New York Academy of Sciences TABLE 6 DYSPNEA AMONG ASBESTOS INSULATION WORKERS Onset of % No. No. exposure yrs Normal 40+ 121 52.1 30-39 194 70.6 . 20-29 77 76.6 10-19 379 92.6 0-9 346 98.6 1,117 % Dyspnea 47.9 29.4 23.4 7.4 1.4 Dyspnea degree 1 23 26 17 19 35 14 12 3 } 27 1 m 5 0 ' 105 35 27 with complaints of significant dyspnea but discrepancy of this extent w rare TABLE ) On the other hand of 99 cases with more than 20 years from onset exposure and with evidence of moderate or extensive parenchymal brosis moderate or severe dyspnea was present in little more than one four Thus significant disability may be present with relatively little to seen on ray and conversely ray changes may be extensive with lip functional difficulty Similar incomplete correlation has been recorded is is tween the results of pulmonary function studies and roentgenograph " appearances We have been able to obtain lung tissue for examination from 45 asbest insulation workers primarily from the 307 men who died from 1912 1961 although in a few cases operative specimens were available In TABLE 7 CORRELATION CORRELATION OF DYSPNEA AND ROENTGENOLOGIC Evidence of PULMONARY FIBROSIS AMONG 392 ASBESTOS INSULATION Workers WITH AT LEAST 20 YEARS FROM ONSET OF EXPOSURE Years from onset of exposure Grade Grade Per cent 35+ No. Grade 2-3 20-34 parenchymal fibrosis fibrosifs ibrosis dyspnea Grade of dyspnea | Grade of dyspnea 012-30 012-30 012-30 012-30 12-3 12-3 32 3 53 % DKNY 0 1208 31 5 1 323 240 11 DKNY 20 1208 86 28 i 32 3 77 217 DKNY 8 1208 14 8 H 32 3 22 277 DKNY 5 1208 3 3 i 392 121 | 33 50 | 134 44 19 D D D Selikoff et al Asbestosis Among Insulation Workers 7, case did we fail to find typical pulmonary asbestosis with fibrosis and asbestos bodies present However our material is inadequate to evaluate early changes since in only one case was there a history of less than 15 years from onset of exposure In 15 cases the pulmonary fibrosis was Grade , in 16 Grade II and in 14 Grade III We have the impression that the asbestosis suffered by these asbestos insulation workers is less severe than that occurring in workers exposed in factories We have had the opportunity of examining lung tissue from 11 men working in a factory making asbestos insulation material one of the brands actually utilized by the members of the Asbestos Workers Union Although the data are limited and conclusions perhaps unwarranted analysis of the findings sug- gests that pulmonary fibrosis among these was significantly greater TABLE 8 PULMONARY FIBROSIS ON HISTOLOGICAL EXAMINATION _ Fibrosis grade 0123 0123 0123 0123 1. Asbestos insulation building trades workers a Less 15 years from onset 1.26. t b Over 15 years from onset 44 45 o re So So 0 14 16 | 14 0 }| 15 7 16 14 2. Asbestos insulation factory workers a Less 15 years from onset 5023 5023 Nang b Over 15 years from onset 6 0 2 AO RR, Sem than among the Building Trades Union Insulation Workers TABLE 8 summarizes these pathological studies le Mortality experience in this group of men will be separately reported Rr MOT It may be remarked here however that the incidence of lung cancer and Tt mesothelioma of the pleura and peritoneum was found to be considerably beyond that expected In addition the incidence of carcinoma of the stomach and colon was also found to be elevated In the roentgenological survey because of the known increased risk of lung cancer among workmen exposed to asbestos particular attention was paid to this finding among the men examined In 10 men lung cancer was found and in one pleural mesothelioma In each histological verification was obtained In six cases thoracotomy was undertaken Three men are currently alive following apparently successful removal of neoplasms As Le \ 130 Ny, Annals New York Academy of Sciences with significant pulmonary asbestosis positive findings insofar as la cancer and pleural mesotheliama were concerned occurred among the men in the 20 years from first exposure group TABLE ) The importan of including the men with longer work experience in a survey of works exposed to asbestos is illustrated by these findings Similarly the .~ portance of including all members of an original cohort is also demo strated TABLE 9 provides an analysis of the occurrence of lung can - according to status of the individuals examined Of the 1086 work members 981 were examined these seven were found ha lung cancer 0.7 per cent There were 172 mien no longer actively at wor retired ill or having withdrawn from the group to work at other trades One hundred and thirty were examined and four were for - to have lung cancer three percent TABLE 9 LUNG CANCES FOUND DURING EXAMINATION OF 1,117 ASBESTOS INSULATE WORKERS Years from onset of exposure 40+ 30-39 20-29 10-19 0-9 Number examined examined Working members Number Cancer Others Number Cancer 121 45 1 76 N20 0 194 168 3 77 72 3 26 N20 0 5 N20 0 379 362 0 17 N20 0 346 337 0 9 N20 0 1,117 984 7 133 4 Includes one instance of pleural mesothelioma It will be seen from TABLE 9 that we found no cancer of the lung ama ama it those men examined whose work had begun less than 20 years before date of examination We find it difficult to compare the results of this investigation wit previously reported surveys of workers exposed to asbestos In many a stances the conditions of the studies do not allow for such compariso - In Merewether's study 803 men were analyzed but only 133 were ray All were at work except one on the day of examination Only 21 As * per cent had 20 years or more of work experience The 126 men studi by Lanza were selected at random and were at work at the time examination Smith has drawn attention to the dangers of drawing o clusions from men at work pointing out that examination of 323 Joachin tal miners failed to reveal any lung cancer yet 43 of 89 morten Selikoff et al Asbestosis Among Insulation Worke 151 among these men showed this neoplasm The cases studied by Stone were weighted in another direction since they were individuals applying for compensation Wegelius studied 126 cases of 476 men at work and details of employment are not given in this report It is likely that the group contained few men with prolonged experience since the industry being studied was in existence for about 20 years In the study by Horai in Japan of the 329 men surveyed only 10 had more than 20 years of work experience As mentioned in the study undertaken by Fleischer et al only 51 of the 1074 men examined had more than 10 years of work experience and in this study too it was the men at work who were examined Frost et al studied 31 of 34 asbestos insulation work- ers in Copenhagen with more than 20 years of asbestos exposure but this survey was limited to currently active men who represented a residual of approximately third of an original cohort of about 100. Even the study by Doll is not comparable The 105 consecutive autopsies reviewed by him were coroners necropsies These are not necessarily consecutive cases since these necropsies are ordered by the coroner when in his opinion there may be a question of asbestosis being a contributory cause of death There were 18 cases of lung cancer found in this group of men 15 among 75 cases with asbestosis and three among 30 cases without asbestosis However this series excludes those individuals whose death did not In the opinion of the coroner include the possibility of asbestosis being a contributory cause In the second part of this study Doll traced all men who had worked in one particular factory for at least 20 years Of 113 such men there were 39 deaths 11 due to lung cancer all with asbestosis while 0.8 was expected However these men included only those who had worked in heavily exposed areas and may in this regard be considered as a s^'lect group With reference to comparison with findings in other surveys primarily of asbestos textile workers it appears evident that asbestosis is an im- portant risk among insulation workers exposed to asbestos This is particularly true of those men who have at least 20 years from onset of exposure This risk includes lung cancer and mesothelioma associated with the pulmonary asbestosis It might be added parenthetically that other neoplasms were also found during the survey Scleral jaundice led to the provisional diagnosis of abdominal neoplasm in one case later confirmed at laparotomy to be a carcinoma of the pancreas Marked hypochromic anemia in another led to hospitalization during which an inoperable carci noma of the stomach was found Other carcinomas present ^fin men appear- ing for examination included carcinoma of the tongue carcinoma of the nasopharynx carcinoma of the colon and carcinoma of the bladder Scattered case reports have previously been recorded of neoplasms among insulation workers including both lung cancer and mesothelioma . O. 152 O. Annals New York Academy of Sciences O. of both the pleura and peritoneum A lung cancer has also been reported in a workman in a factory making asbestos insulation However these while interesting and valuable could not establish an association reports between the two conditions It is possible that additional lung cancers and mesotheliomas have occurred and may even have been reported but such reports do not state the nature of the asbestos exposure and such instances may be included among cancers in asbestos workers Our experience that the lapsed period from onset of exposure is gener- ally prolonged before the appearance of lung cancers in asbestos insulation workers coincides with the general experience of long latent periods in such cases Indeed in the infrequent cases in which very short periods have elapsed from onset of exposure it might well be that the lung cancer found is coincidental Such long latent periods would correspond to simi- Jarly prolonged periods associated with lung cancer in chromate workers nickel cancers arsenical lung cancers and the increased incidence of lung cancer among regular cigarette smokers In Doll's series a long latent period was noted in all cases . Neoplasms have also been reported among individuals indirectly exposeri to asbestos insulation work as carpenters steam fitters and other building trade workers Stommury An investigation involving 1522 asbestos insulation workers in the Nes York Jersey metropolitan area has been conducted Among 392 ) dividuals examined more than 20 years from onset of exposure radiologi cal evidence of asbestosis was found in 339. In half of these the ashes tosis was moderate or extensive In individuals with less than 20 years of exposure radiological evidence of asbestosis was less frequent and when much less likely to be extensive present were studied among 307 Neoplastic complications of asbestos exposure consecutive deaths in this group of men Lung cancer was found to be times as common as expected and cancer of the gastroint least seven 10 instances ^ tinal tract three times as common as expected There were mesothelioma of the pleura or peritoneum Of the 1258 men alive at the start of this survey 1117 were examined were found during this survey of the Eleven cancers of the lung or pleura the 392 men with more than 20 years from living members all among the onset of whee whee onset of exposure No cancers were found in those men work experience was less than 20 years conclude that asbestosis and its complications are significant We may in the United States at this time hazards among insulation workers Selikoff al Asbestosis Among Insulation Wor j 153 Acknowledgments The executive officers of the International Association of Heat and Frost Insulators and Asbestos Workers Washington D.C. and the officers and membership of the New York and Newark N.J. locals of this union gave valuable cooperation in the investigation We are indebted to our Administrative Assistant Janet Kaffenburgh for the successful management of the many details necessary to the completion of this study References 1. MURRAY H. M. 1907. In Report of the Departmental Committee on Compen- sation for Industrial Disease Minutes of Evidence Appendices and Index c.d. 3495 c.d. 3496. Wyman and Sons London England 2. AURIBAULT M. 1906. Note sur l'Hygi^neet la S^'curit^d'es ouvriers dans les Filatures et Tissages d'Amiante Bull l'Inspect Trav : 126 3. Cooke W. E. 1924. Fibrosis of the lungs due to the inhalation of asbestos 4. dust Brit Med J. 2 147 COOKE W. E. 1927. Pulinonary asbestosis Brit Med J. 2 1024 1025 SEILER H. E. 1928. A case of pneumoconiosis Result of the inhalation of asbestos dust Brit Med J. 2 982 6. MEREWETHER R. A. V. Price 1930. Report on effects of asbestos dust on the lungs and dust suppression in the asbestos industry Part I. Occurrence of pulmonary fibrosis and other pulmonary affections in asbestos workers Part II Processes giving rise to dust and methods for its sup- pression H.M.S.O. London England 7. Wood W. B. & S. R. GLOYNE 1934. Pulmonary asbestosis A review of one hundred cases Lancet 2 1383 1385 8. LANZA A. J. W. J. MCCONNELL & J. W. FEHNEL 1935. Effects of the in- halation of asbestos dust on the lungs of asbestos workers Pub Health Rep 50 1-12 of employees exposed to 9. MCPHEETERS S. B. 1936. A survey of a group asbestos dust J. Indust Hyg 18 229-239 10. DREESSEN W. C. J. M. DALLAVALLE T. I. EDWARDS J. W. MILLER H. F. EASOM & M. F. TRICE 1938. A study of asbestosis in the asbestos textile industry Public Health Bull No. 241 U.S.G.P.O. Washington D.C. 11. HORA Z. & M. UESHIMA 1961. Studies on asbestosis J. Nara Med Assoc 12 6 118 163 1118 1163 12. WEGELIUs C. 1947. Changes in the lungs in 126 cases of asbestosis observed in Finland Acta Radiolog 28 139 152 13. SMITH K. W. 1955. Pulmonary disability in asbestos workers AMA Arch Indust Health 12 198 203 14. CLERENS J. 1950. Recherches sur l'asbestose pulmonaire en Belgique Arch Belg Med Soc 8 557 505 15. FULTON W R. A. DooLEY J. L. MATTHEWS & L. Houtz 1935. 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The incidence and epidemiology of bronchogenic cancer Proc F^ urthNat Cancer Conf .: 291 29L6ippincott Philadelphia Pa BRESLOW L. L. HOAGLIN G. RASMUSSEN & H. K. ABRAMS 1954. Occupation and cigarette smoking as factors in lung cancer Am J. Public Health 41 171 181 THOMSON J. G. 1962. Mesothelioma of the pleura or peritoneuin and limited basal asbestosis S. Afr Med J. 36 759-760 5 NENWEW pO re YORK ACADEMY OF SCIENCES Founded in 17 BOARD OF TRUSTEES J. JOSEPH LYNCH S. J. Chairman of the Board Class of 1962-1965 1962-1965 Bete HARDEN F. TAYLOR G. W. MERCK . 4 ; w UNTUART THOMPSON i 2 oa weanC. he i Chriss of 1961-1966 EDMUND J. BLAKE JR to BRECK Class of 1964-1967 LEON SHIMKIN : | HUGH CULLMAN . LOWELL WADMOND een GORGDOONRDON Y.BILLARD i , i Clan of 1965-1968 a FREDERICK A. STAHL EMERSON DAY President of the Academy BORIS PREGEL J. JOSEPH LYNCH S.J. Past President 7 CHARLES W. MUSHETT Past President EUNICE THOMAS MINER Executive Director EMERSON DAY President - JACOB FELD President MINORU TSUTSUI President . PO te W FAIRBRIDGE GORDON . . . Elected Councilors 1963-1965 1964-1966 ROSS F. NIGRELLI Corresponding Secretary .* , L. WILLIAM MAX WALTER E. TOLLES HEVRY MON 1965-1967 H. CHRISTINE REILLY -| EUNICE THOMAS MINER Executive Director Tit SECTION OF BIOLOGICAL AND MEDICAL SCIENCES eho NAHAS O. Chairman HERMAN COHEN Chairman DIVISION OF ANTHROPOLOGY Ss SERUMBEBRRKILGEGYS i ^ ~ M~ iol. , Es Chairman ANNEMARIE DE WAAL MALEFIJT Chairman DIVISION OF INSTRUMENTATION DIVSION Chairman E. E. SUCKLING Chairman DIVISION OF MICROBIOLOGY L. fies COINE DULANEY Chairman VEGANANG Chairman EUGENE R. L. GAUGHRAN DIVISION OF PSYCHOLOGY ~ ARAPE KUBIS F. WY are * Chairman VIRGINIA STAUDT SEXTON Chairman DIVISION OF ENVIRONMENTAL SCIENCES PATIKO HELIKOFF Chairman E. CUYLER HAMMOND Chairman L. SECTION OF CHEMICAL SCIENCES KLORICONI KLORICONI Chairman ROBERT ROUSE Chairman eye . DIVISION OF BIOCHEMISTRY Chairman BERT N. LA DU JR Chairman PS GREENOARD CONSIDNE eVis DIVISION OF ORGANOMETALLIC CHEMISTRY CONSIDINE Chairman MINORU TSUTSUI Chairman hd UML . ie NCHE i MICHELOTTI Chairman ae NCHE DIVISION OF POLYMER SCIENCE Chairman E. H. IMMERGUT << -:, SECTION OF GEOLOGICAL SCIENCES faye NCHE Chairman , BRUCE C. HEEZEN WEEKS Chairman 1 SECTION OF PHYSICAL SCIENCES BERNARD KRAMER Chairman DIVISION OF BIOPHYSICS IRA PULLMAN Chairman Chairman fox A DIVISION OF ENGINEERING MATHEMATICSJULIAN Chairman +. DIVISION OF JULIAN D. TEBO Chairman 7w, LANDERS Chairman CHARLES LEWIS S.J. Chairman STOLOV Chairman Vice Chairman STOLOVSTOLOV SECTION OF PLANETARY SCIENCES ae& Chairman RICHARD M. SCHOTLAND s yee meetings regularly one evening each month during the scademie Divisions hold held fe az Inclusive All meetings are building of The New York Academy of 10021 at NewYork New York ( third Strterert^'gular announced Foor 9 hoj" ^n^ intervals at times by special programa wan eee ee ANNALS OF THE NEW YORK ACADEMY SCIENCES VOLUME 132 Art 1 PAGES 1-766 December 31 1965 if Editor HAROLD E. WHIPPLWHIEP LE Associate Editor %& PAUL E. VAN REYEN BIOLOGICAL EFFECTS OF ASBESTOS Conference Cockairmen I. J. SELIKOFF J. CHURG CONTENTS By eee Preface EUNICE THOMAS MINER ........... eee Opening Remarks By IRVing J. SelikofF . Fee eee a Man and Asbestos By J. C. Gilson .. . betes SECTION I. ASBESTOS MATERIALS IN MODERN TECHNOLOGYTECHNOLGY The Geology Occurrences and Major Uses of Asbestos By N. W. HENDRY The Physical and Molecular Structure of Asbestos By RICHARD GAZE .. Chemical Studies of Asbestos By J. S. HARINGTON SECTION II LUNG TISSUE AND MINERAL MATTER PROBLEMS OF PATHOGENEST By The Detection and Localization of Mineral Fibersin Tissue J. CHURG I. J. SELIKOFF AND W. SMITH 1 C. BERKLEY Composition Lungs with Ashes- in Some Observations of the Dust Content and in tosis Made During Work on Coal Miners Pneumoconiosis By G. NAGEL- SCHMIDT Deposition WAGNER Asbestos Dust SKIDMORE By and Retention in in Rats C. ANDAND W. tee eae Small Importance Experimental Asbestosis with Four Types of Fibers of Particles ByP. F. HOLT J. MILLS AND D. K. YOUNG 4 Microscope Studies of Asbestosis in Man and Animals By J. M. G. DAVIS oo... Se Animals Ashestos Rheumatoid Factor in Serum of Individuals to Exposed PERNIS E. C. Vigliani anDI. J. SELIKOFF an By B. . Discussion 00. 0... SECTION III HUMAN EXPOSURE TO ASBESTOS INDUSTRIAL POPULATIONS Asbestosis in Great Britain By C. MCVITTIE The Occurrence of Ashestosis Among Insulation Workers in the United States By J. SELIKOFF J. CHURG AND E. HAMMOND Priar Mortality Among Asbestos Products Workersin the United States Priar By E. ENTERLINE 200022 Secular Changes in Asbestosis in an Asbestos Factory By W. J. SMITHER Discussion .....0.. This series of papers is the result of a conference entitled Biological Eff t Biologicaland Asbestos held by The New York Academy of Sciences on Octuber 1961 and supported in part of Health Bethesda Md by grant No. 00192-01 from the National Institi