Document oeKokm29ndQkgaw9910ZRbNnE

PUBLIC HEALTH REPORTS VOL. SO - JANUARY 4, 1935 NO. 1 i SQ <c3-bf >3 EFFECTS OF THE INHALATION OF ASEESTOS DUST OX THE LUNGS OF ASBESTOS WORKERS A Preliminary Study By A. J. Laxza, Acsistant Medical Director, William J. McConnell. A inst ant Medical Director, and J. William Fehnel, O.cr-.i.l. .Vcropo.'Ucr. Life iMurance Co. INTRODUCTION ' 1*1 H ^ In 1920 the Metropolitan Life Insurance Co. was approached bv ofEcinls representing the asbestos industry in the United State?, who were desirous of ascertaining whether asbestos dust was an occupa tional hazard in their establishments and, if so, what was the nature of this hazard end what should be done to prevent or control it. About this time several articles had appeared in English medical journal? describing a pneumoconiosis due to asbestos dust. Wilde in one or two isolated instances the occurrence of tliis tvpc of pneumo coniosis had been described in American journals, the industry itlf appeared io be quite uninformed of tSe existence cl cdt suih occupational 'disease.' _ me hazard of silica dust, with special reference to the lungs, has long been appreciated, and a great deal of study and research has - been applied to the problem (in the metal mining and certain other industries) in Great Britain, the United States, the British IXmiaions, and in other countries. The nature of the e5ec1s of silica" dust expressed in the term "silicosis", with the resultant extraor dinary predisposition to ' pulmonary tuberculosis, is well known. These effects have been associated with tiie inhalation of dust con taining free silica in varying amounts. The effects upon the pul monary tissue of dusts containing combined silica--silicate?--are still a fertile field for investigation, but evidence is accumulating tr.st certain of these dusts produce pathological results quite cisrinc; from true silicosis. I . The name "asbestosis" has been applied to the pneumoconiosis caused by asbestos dust and it will lie so used in this report. Chem ically, the asbestos of commerce is a hydrated magnesium silicate consisting primarily of silica (combined silica) 44.1 percent, magDesiu 43 percent, and water 12.9 percent, while ferrous irou and NOT A RECORD OF D`'ckel are present in small quantities. This commercial variety of PPG INWJSTRieS. INC. DID NOT COMEFBOM ITS FILES AND CANNOT BE AUTHENTICATED BY PPG INDUSTRIES, INC. 10,"> GC 15372 t .rn ' Juiiitt t, ism * asbestos most common!}* encountered is designated as ehrysotUe and is one of the four varieties of the mineral serpentine, in which it usually orcurs in seams. It should be borse in mind that silicosis (and presumably1 asbestosis) develops very slowly, taking from 5 to 15 and even 20 or 25 years to become established. This rate of progress is influenced prevent the solution of edi::p of th* which might be present. The iiupiugc tally driven rotary pump and the rule by means of a resistance type of flow m ter for measuring the pressure difi'ere: the dust collected from a volume of If mainly by tbe dosage of silica which the lungs receive, and this dos age, in turn, depends upon three variables--tbe amount of silica in The electric precipitator is designed principle used for recovering dusts an the dust, ice quantity oi dust in the air, and the length of exposure. Individual idiosyncrasy might be included as a fourth variable; however, little is known of the variations in susceptibility in those exposed to dust. It might well be assumed that similar variables would influence the occurrence of asbestosis. In places where asbestos is mined or fabricated in North America there does not appear to be present the clear-cut clinical picture principle depends on electrifying the d pass through an electrostatic field ant out upon a sheet of celluloid. Tbe e means of a transformer operating from alternating current. Air is drawn thrfc rotary fan, run by a motor, the quant meter. which is so unescapable in communities with a true silicosis hazard, Samples of dust brushed from beams such as hard-rock mining communities. It may be that some of the also were secured for chemical analysis, asbestos plants are of too recent origin for the typical effects of a the industrial hygiene Laboratory of ti silicate dust to become manifest, but this would not apply to the dust counts were made according to t older mines or to all of the fabricating plants. C/5 United States Bureau of Mines and the The industrial health service of tbe Metropolitan Life Insurance"^ LU Service (1)/ Particles in size up to Co. undertook the following investigation during the period from " diameter were counted. October 1929 to January 1931, which included: 1. A study of dust conditions in asbestos mines and mills in Canada and in fabricating plants along tbe Atlantic Seaboard in the United , ` States. ., 2. Physicrd examinations of asbestos workers, including X-raV . films. ' 3. A study of dust exhaust systems designed to eliminate asbestos dust. Data on tbe fabricating plants only are included in this study and. . ore designated in tbe report as plants A, B, C, D, and E. This is.a. preliminary report. A more extensive study of the usbestos industry , is now under way. /; Chemical analyses were made for to: .3 according to the accepted steudaru me In the first plant studied (A) only pr in size were counted. It has been der: silica particles exceeding 10 microns part of a meter or one-thousandth par: diameter enter the lung tissu ; for tide usually are not considered when deternd: it appeared from some of the pubibki-d asbestos particles much larger in size wer decided to count all particles and make d JO microns and under.1 DUST STUDIES tTT' OS Apparatus arid methods oj sampling.--Both the impinger (1) esa - tbe electric precipitator (2) were used for the collection of air samples ' for dusts at the breathing levels and in close proximity to the workmen. 1 Both of these forms of apparatus are adapted for this work, ns they ; are transportable, easily set up and adjusted for the taking of tbe air samples at the proper level, and are extremely efficient. ; The impinger collects the dust by aspirating the air and then > impinging it onto a fiat surface covered by a liquid in a container. The liquid used was distilled water, containing 50 percent alcohol to Total particles per cubic foot and the dust in milligrams were obtained. Since dust counts and the corresponding wric are not included in the tabulations in tin Table 1 shows by plants and by den minimum dust counts in million par' Although the counts in plant A arc of pa 1 eollR4*d by both the lnplccrr M tbo ltn nlopphotocroplu of tbe* rimt porticlad vtr* talartM by b< Old* prcxvior. tb* oUrjrd bom* ensured with r fluid BMUi*aDt), it ni wy to atcuiM. nr:iul p tofitubniic probability btprr, tbo lountbm.* of :b function plottoil u tximmZM tbo probability oi ctumsa u . yc it i*be$< 2o e ed i do?10" in * p,,1 rlai-ic; thcs? :i les 1 series, v 'urt / .TU. of the 14 o; a ti the *urr.nc6 d rom. Canada United )>? -A ?>tns \ udy end Ii.1iI .? is a ustrv \i) nnd r samples v kmen. :,i .i they ag of the s 1 then container, alcohol to f ._ 6 Jhouut *. lin prevent the solution of some of the. dusts, particularly any silica which nuihl be present. The hupiuger was actuated by an electrir iih dri <-n ntary pump and the rate of air sampled was measured ty means of a resistance type of flow meter with an inclined manome k r.:-' h /.*. ' TV t ter for me.ts-.'jinir the pressure difference. Each sample represents the dust cciierted from a volume of 100 cubic feet of air. The electric piecipitaior is designed upon the Cottrell precipitator rriuciple u~-d for recovering dusts and fumes commercially/ This principle depends on electrifying the dust particles by making them : , i_- through an electrostatic field and thus causing them to settle cut upon a shret of celluloid: The electrostatic field is set up by rt ' - ` ^: ^ j - - l'?-:- ' ' " TV -* P, ,*?1 Wv-i-.t. . . .' - --V- ' -">u_ K- i.vVt . ir.'-tts of a transformer operatise from the lighting lines on 120 volts, alternating current. Air is drawn through the apparatus by a small rotaiy fan, run by a motor, the quantity being measured by a flow ire: ... meter. Samples of dust brushed from beams and pipe lines near the ceiling also were secured for chemical analysis. All samples were shipped to the industrial hygiene laboratory of the Metropolitan Co., and the dust counts were made according to the methods accepted by the United States Bureau of Mines and the United States Public Health Service (1). Particles in srie up to 360 microns in the greatest !ir<--"` .u** v": "4** > `- \ r< - 'V ....... 4lV> r- . .v.r> :S. * diameter were counted. - Chemical analyses were made for total (free and combined1) silica*.Vv \ according to the accepted standard method of Hillebrand (3). ,< In the first plant studied (A) only particles 10 microns and undet^j^,*^ in size were counted. It has been demonstrated repeatedly that no silica particles exceeding 10 microns (a micron equals one-millionth part of a meter or one-thousandth part of a millimeter) in greatest diameter enter the lung tissu ; for this reason, the larger particles usually are not considered when determining dust counts. Later, 03 it appeared from some of the published articles (4) (English) that Urj,S^.V'-' . ^ - - ,-< asbestos particles much larger in size were found in lung tissue, it was decided to count all particles and make differential counts of all those t * ^ * AA 10 microns and under.1 Total particles per cubic foot and the corresponding weight of the des; in milligrams were obtained. Since no relationship between the dust counts and the corresponding weights was found, the weights are not included in the tabulations in this report. Table 1 shows by plants and by departments the maximum and minimum dust counts in million particles per cubic foot of air. Although the counts in plant A are of particles 10 microns and under, 1 5=plti by both tb* bBplDfT ind tb* oUctrif fr*pir>(t*tor w* coastal. In Addition, tovnpns of tb*t* dad ptnides wer* *xU*rf*d by bticx pro)*ct*d up3n lata wlib i looting *^6* prcjicicr, tb* taJin*d portielot tain* jDaucrtd with a ruler. Xnowiot tb* entire inimrftmtnt (by Ji *u auy to c*lcuJU the orifJaAJ ptrtlO* tiu (5), By tb* tu* of Bitun's (6) bc^-,knc rrubACAIiry piper, the lofinthms of tb# function to bi toeuured (la this cm tzucroru) tr% pltiitd as orJiAtot Afmmst the yrobibllity of oecuntnoe is tW'TTift GG 15374 f'V.r r. :-v.* ^ : .'uutr> 4,1>U .. a. -r ? * \Dfi. PPG f!LS_ and in the other plants are for all particles, direct comparison* is possible, as in no sample taken were the number of particles 10 microns and under less than 94 percent of the whole. Tabu 1.--Mazimum crui minimum du.il count* in million particle* per cubic foot if air, by plant and department Pto A P!ul S FUnl C Flint D Plant E H*prtS>rn: jMClJot W~- v---., M^ns Vu_. MSlmn 1C, ya . "I?" t cutiic Hum- Million put;- kl44 per bmperisno-l jpic l pet tcc: ol cubic Million parti- cits per ruble loot ol Hr tooiol eu mil Prerantloa........ .... Ctrl room..................... P.:r; L-_= M.S24 lyn'r'ict......... FIt>"t.3: :ei sviwiil.tlc;cAi_tav_.i_._.l^._.--._.I.- VS-1`0 *} Vi- s.l---------- -8H li-l+V _........ VW*n--W'.f H--..4.. 3 -43 ------- 3C1 i*lh*--'4i0tV.i is* ....... 1 TJ2O6 --7J6I ' ; 3 t;vj- i 3 itOV--UPl I ] Vi- ; Iziililt-i in Jiicjunt- lnduCta bro*J loom *ta\ mi. Whereas the dust in the preparation room is practically all due to asbestos, the contrary is ;he case in the other departments. In the cardin':, spinning, and wearing rooms asbestos comprises about 25 percent of the material used. On special jobs the percentage of asbestos may be higher, but in general the figure quoted is approxi mately correct, the other material consisting principally of cotton. In the insulating departments of plant A, asbestos is but 5 percent . of the total material used. In the molded brake-lining and clutch division of plant D, asbestos comprises about 25 percent of the total . material. The actual exposure to asbestos dust, therefore, is consid- erably less than is indicated in the dust counts in table 1. -( CONDITIONS IN THE PLANTS * The processes in these plants were very similar to those i*n cotton *v mill* in general. For illustration, the process in the preparation room of plant B is here detailed at length: Asbestos is received in bogs. These are emptied upon the floor and 1 the asbestos is shoveled into pug mills and run for about 5 minutes - in order to crush and open the fibers. From there the asbestos is ; shoveled into trucks and wheeled to hoppers with either horizontal ; or vertical openers, similar to those used in textile mills. After passing ; through the opener, the material is discharged into trucks. Waste T. manufacturing material is first run through a garnet machine and ' ' '3 discharged into trucks, which nro. uh material is fed into these in th*- same j After being discharged from the open, vibrating or shaking screen, where thi a suction liood and blown into a bin The. short fibere falling through tli sc. used in making an asbestos cement. The cotton is received in bales, oi vertical openers. It is discharged into ; the vertical and horizontal openers c fiber, the cotton, or the waste material bins. As needed, these materials are \ floor in proportion to the mixture de; matcrials are then passed through a m is discharged from the picker, it is sp: The material is then taken by a merh: bin in the curd room. Two of these i tliis conveyor system, while, a third suction device which conveys the mat card room. The object of the two systc of two grades of material at the same not equipped with an oil spray. The niarily to entrap the small ushesios fib in the cotton fiber throughout the proc, weaving. Incidentally, it is apparent amount of dust. The material is sutur oil at tliis point; but by the time it rc diminished to less than 1 percent. While mineral oil was used in the jr< apparently was not as efficacious us in not used, nor was there any attempt ut of dust exhausting. Carding machines v, there was a humidifying, ventilating, plant B depended on natural humidit machines were equipped with a dust-ex efficiently used. Iu plant C carding w which was equipped with an air-coud'i buildings the machines had exhaust equ: Two plants, B and C, had artificial h spinning rooms. In the former thp tern humidity 7S percent. One plant, C, ha the twisting department and also in the the relative humidity was 76 percent. \vi f*0 F., as compared with a relative hi: weaving room of plant A. CG 153/5 i Vt%: if f tot ? '<r sA ``i /* to :. .lie :it 25 ten Vital onsid- i -45 r| ton iLjom c and J ites stos is . r:; ' NOTE: THIS DOCUMENT DID A'Vi NOT COME FROM F^LES gv?.V\ discharged into trucks, which are wheeled to the openers, and the material is fed into these iu the smne manner as is the new material. After reia? discharged from the opener, the material is put (into a vibrarir.g or shaking screeu, where the long fibers are picked off by c suction hood and blown into a bin to be used again in textiles. The shc" fibers falling through the screen are either sold as such or ucd in riakini od asbestos cement. The ,'v:ton is received in bnles, opened, and also run through v-'rrical openers. It is discharged into trucks. The filled trucks from tb" vtrrtica] and horizontal openers containing either the asbestos fiber, the cotton, or the waste material are taken to separate storage bins. As needle, these materials are weighed and dumped onto the llocr in proportion to the mixture desired, and the resulting mixed materials are then passed through a mixing picker. As this mixture h discharged from the picker, it is sprayed with a light mineral oil. The material is then taken by a mechanical conveyor to the storage bin in the card room. Two of these mixing pickers discharge onto this conveyor system, while a third machine is equipped with a suction device which conveys the material to a storage bin in the card room. The object of the two systems is to facilitate the handling of two grades of material at the same time. The third machine is not equipped with an oil spray. The object of the oil spray is pri marily to entrap the small asbestos fibers and hold them enmeshed iu the cotton fiber throughout the processes of rarding, spinning, and weaving. Incidentally, it is apparent that it also diminishes the amount of dust. The material is saturated with about 4 percent of oi! at this point; but by the time it reaches the looms, the oil had diminished to less than 1 percent. hiie mineral oil was used in the preparation room of plant C, it apparently was not as efficacious as in plant B. In plant E oil was not used, nor was there any attempt at humidification or any system of dust exhausting. Carding machines were fed by hand. In plant A there was a humidifying, ventilating, and heating system, while plant B depended on natural humidity. In plant E the carding machines were equipped with a dusb-exhaust system, but it was not cfiicieLtly used. In plant C cording was done in 2 buildings, 1 of which was equipped with on air-conditioning system, and in both buildings the machines had exhaust equipment. Two plants, B and C, had artificial humidity installations in their spinning rooms. In the former the temperature was 76 F., relative humidity 78 percent. One plant, C, had a humidification system in the twisting department and also in the weaving department, where the relative humidity was 76 percent with a dry-bulbTemperature of -,c F., as compared with a relative humidity of 44 percent in the weaving room of plant A* . , Ay*"" 1 y i ` ,, fs&v-'vsr;* x = -, r-v- v _ VA *.r $ , * -^5 %,**'. :*,,* nfr*\*d*. 3L ' * #*<W . . Jy.' si. ; ' '&2r .'.'Av. -* % .V *VT-.V,. i **-.** Vf*V m-rnm:- f-T-A . 7-. .y- I *'* a*' ***". N'~ i 4*trVf'Vv'-- * V * vA 4, IW5 6 NOTE: i Aside from plnnt E, it would appear that the dust ha7.arr/4ri*^ nek- vy; excessive except in the preparation rooms of plants B atid C. The dust counts are interesting, too, when considered in the light of the permissible standard for granite dust, established by the United States Public Health Senice (7), namely, about 10 million particles ! 10 microns and under) per cubic foot. However, we are not justified ;a assuming tha; because available information suggests that asbestosis is a milder disease clinically than silicosis, the threshold of permissible dust counts is higher* Asbestosis appears to be patho logically different from silicosis, and the experience so far does not warrant on attempt to define a standard of dustiness for asbestos dust. nrsr control > * Various measures, such as oiling, humidification, and local exhausts, * tended to reduce the dust. Nevertheless, it was evident that they were only partly successful. If it is expected to control dustiness in z these plants, final reliance must rest upon properly constructed exhaust equipment. In plant C in one department an experimental installs- '/ rice was set up. In spite of some obvious faults, this equipment, on the basis of comparative dust counts, reduced the dust by 50 percent and with further alterations will probably be 75 percent effective. In this case such a reduction seemed quite satisfactory. It is neither * practicable r.cr economically desirable to install such equipment ns will make the air entirely dust free. The normal defensive mechanism of the body rakes care of a fair amount of atmospheric pollution. It is when the body is exposed to an excessive amount of dust that this ; defense mechanism breaks down. The application of exhaust equipment to textile machinery involves considerable difficulty, especially where the construction of the plant is such that it is not possible to apply down-draft suction to the looms. * - It is desirable to install exhaust apparatus in any plant on an ex- b' peridental basis first, and then check its efficiency by dust counts. 4 This practice will result in saving a needless e,,xpenditure of money, ~.'`sj. I V-rry PHT5ICAL EXAMINATIONS - i- Tm>de of 126 persons (108 men, 13 women) working '** in asbestos plants in the United States All but live of these were l I ' given physical examination. The cases were selected more or less J* ' at random from among those having more than jTyears of employ- "BlCIlt ill' the lAdustrff it was soon obvious that the early diagnosis t- - of ashestusis iHlsl'THt to a large extent on X-ray pictures jpf the * chest. As in the early stages of silicosis, the clinical symptoms of ^ the asbestos workers were usually indefinite and inconclusive. Tbe - interpretations of these films are based on the readings of one com- petent roentgenologist, but they have been reviewed by several 7 f{leh(-yxpqn^rjcftl| jnjt^s field. The - a minor nature, und there was general a The films were read conservatively, tnl examination and the age of the inti positive only when there was no major were guided by their experience in sili moconioses. The films classed as negat subdivided into doubtful and neg whether the individuals classed as doui definite asbestosis. Particular atteutio or absence of indications of tuberculos reviewers of the films were in accord, of silicosis in mind, it was felt that a devoted to ascertaining, if possible, w disposes to tuberculous infection. The cases of asbestosis were divitlet and second stage. The firat stage ei X-rny examination definite lung path warrant a -diagnosis of pneumoconiosi symptoms. The second-singe cases pathology and also definite symptoms. All these individuals * were, actively it was not practicable to make any disti ability or disability. Had any individ; extensive pulmonary involvement ant or total disability, they would have fc but no such cases were found. Of the total of 120 X-r::y exit min: second-degree asbestosis, OS ns first deg negative. There is a definite increase in the per in relation to the years of exposure, numbers make it impossible to determ: enters into this increase. Table 2.--Clnutijiealion of co: Yon ol axporai* I'm po 5O10iolwoto1155ycToa^nu_.t_....__.__m___._.__.__._.__.__._._.._.._.......-..-..-..--.--.---.--.---.--.---.--.--.-----------.-.---.--.---.--.---.--.---.--.--- l oIfr 5 yi.j.................-- ToUl tvur5n*<!---------...------...------.--------------- Port tint. * Oao t'hottoo orttr (foanol line) m.rei of bi> own ta to Uui muo>, tul it lull min sboui ba iwrtitii.  Tz- --S'.:-*. s * ^ , \ X . ' \ J fr'i' --- in' /. Jouy i, lull others r?;.Tirnreil in this field. The differences of opinion were of i. mimar :s* :re, arid there whs general agreement as to interpretation. Ti.t" '`'ere read conservatively, taking into account the physical rxanimi'Ot; ami the age of the individual, and were classed as posit.'. ? .`iiiy Then there was no major disagreement. All examiners were guiJeu by their experience in silicosis and other types of pneu moconioses. The films classed as negative for asbestosis were further subdivided, ir'o doubtful and negative. Only time can tell the in-fividuals classed as doubtful are progressing toward a uefiilte a-iiestvfls. Particular attention was focussed on the presence or absence of indications of tuberculosis, and in this respect all the reviewers of the films were in accord. With the unhappy experience of silicosis in mind, it was felt that a great deal of care should be devoted to ascertaining, if possible, whether or not asbestosis pre disposes to tuberculous infection. The cases of asbestosis were divided into two classes, first stage and second stnge. The first stage embraces those who show by .yray examination definite lung pathology sufficient in extent' TO' l J *:'.*/* " ' ' A r<: * f.: h4*'i t ' **t-*; ' ' j - - I . * * 9 r>:^\ N- tfe^rV;': - - . ^- efe* ('3 fej; ' ' V*.?-;.-'. ' v*` *****. - --:ffl these individuals ; were actively engaged in factory work, and it wn-t hot practicable to make any distinction on the basis ol working nighty cr disability. Had any individuals been found who exhibited *c.Vttl'i>!ve pulmonary involvement and marked physical disability <>r~ tolill (usamlny, they would have been classified os third stage, bill Pu siien cases were fnnnd-Z ' Of the total of 126 X-ray examinations, 4 were diagnosed as s1 rond-degree asbestosis, G3 ns first degree, 39 ns doubtful, and 20 as i.rgative. There is a definite increase in the percentage diagnosed as positive in relation to the years of exposure, as shown in toble 2. Small t .J -' . , *... i Z&*'*.* *' * Ii; . *4 - _ ... ;,'** *? V' r * ..w .,w*** *'; - numbers make it impossible to determine how far the factor of age v- triers into this increase. Table 2.--Clatnfiealion / com* by year* oj txpotur* V'sri cf tipoeurt Fcwna* potitivft Paiitiv* Kumbrr Doubtful l) Tfin *V hi lj VtjfJ......... ................................ ......... . m to ,v y*itz___ ________________________ l utr s jtia............................................................................ ............ jK 60 <3 n ti 73 10 M 17 w 10 c? * 1 1 li a) > ir*n UT&4. * 1 cot COQtl&UOUi. f*-*cnnl retired nf ha owe ceord, beesutt of old Mt. 10 Tion prtvlouf w *sa,,y, Lai :t Jui! toivc about ha ftrdta. C-G 15378 i kS.*: 4m k M rvr January 4.1MJ 8 sn? p- i- KUl LJir1L* Of the C4 persons given physical examination and diagnosed as having positive asbestosis, only 8 were entirely free from symptoms, while 10 out of 37 with doubtful and 7 out of 20 with negative diag noses were free from symptoms. Dyspnoea and cough were the svnptoms most complained of, but none of these cases exhibited the unrent or evident type of "short wind" seen in true silicosis. Several of those eluded as negative stated that they were "short winded " and were so recorded, but too much emphasis should not be placed "on stAtcriehts of suD'ec.dyp svmntoms. During the progress of the study, physicians who were practicing in the communities where asoestos workers lived were questioned and stated that thev did not nmisnai nmount of tuberculosis among these workers. The contrast between this state of affairs and that found in a community with a silicosis hazard is noteworthy. The incidence of tuberculosis (based upon X-ray films) is given in table 3; 40 of the 67 examined had less than 15 years of employ ment in the industry. 4 Table 3.--Incidence of tuberculosis T'jVrruVk'l* TOad. i1. PttitiTt Daubiful Kefrititt ........................................ -......... - * h1 ********--*******"-**4k*-****4-****"***<*-1-' 7 1 67 1 0 3V 2 I 30 1 This e*K diumwod ti pmh,Kr si live on tbs x*r,y ftnJir.fi. Table 4 gives information r.s to physical signs of chest trouble. Table 4.--Chest findings > PojitlT* Doubtful Nontivo t % Phyjiw.l *icx* r; troab)*--________________________________... No Ddyvrn! --.............--...---------------------......--------------------- Motiux.u,i______ - ------- ------------------------------------- >31 31 3- 67 ** 2$ 3 *9 \\ z 0* 30 t < At Inst f of :Lt taowri so o-ridenr* imociatod with nbwtojii. > S of t*.A* noi w::t arui, jiidj found with Aibtsuxi*. t of 10*90 not uuutad witn anui *iyu of ubrotosii. 2 'What significance, if any, can be attached to the presence of "asbestos corns" on the hands of workers appears doubtful, os 18 percent of the positives (12 out of 64) and 15 percent of the others (doubtful, 7 out of 37, negative, 2 out of 20) showed such corns. ' Each roentgenologist who reviewed the X-ray films called attention to the fact that these films indicated a very unusual incidence of enlargement of the heart. It is probable that .this is a compensatory enlargement due to the additional work put upon the heart in efforts 010 FILES,", r\ ii jiVl rru 9 to pump blood through thu fibroid 1 sufficient attention has b^en paid tu th upon the heart. Many workers had changed from o from one plant to another during the asbestos industry. Since ouly the an time of this survey in the various dc no way of knowing the average amo inhaled by these people over the years quently, it is not possible to correlate amounts of dust exposure. . insurance c To throw light on the relationship nary tuberculosis, an analysis of det mnuent disability claims was made ir group insurance and having available There were 2,099 lives involved, wit years. The death claims are so sma elusions cannot be reached from any s same is true of the sickness claims number of claims for respiratory diser studied but low for the others, ns co experience of 1927. However, during first part of 1929 there was un epidemi The records of one establishment death claims and S of 10 permanent i listed as due to pulmonary tuWcuIos ordinate amount of tuberculosis from the employees were XcgToes, and alsc nlly high iu this section of the count diagnosing pneumoconiosis and the tuberculosis, these claims were studiec who hod treated the individuals wer< and sanatorium records, including investigated, with the following result Death claims: 1. A typist, not exposed to intestinal tuberculosis. 2. Colored male, age 27; wor months; died of pulmonary tuber wns in sanatorium 10 months, niann. No evidence of nsbestosi 3. Colored male, age 32; workt 7 months; died of pidinonary hospital. Cavitation both lungs; GC I53rq * .3 I J> *> i; .. the 16 .* J wd" .v-d e here . r.ot ' ie r' ID H. 1 fw --1 1 20 l i : cv of ntioa of '-try efforts ; - V NOT 001iZ to pumo through the fibrosed lungs. It is possible that not suffiti-.T* '.;;-'ni.ion bus been paid to the efforts of the pneumoconioses upon Many - 'ir.it*rs had changed from one department to another and from rlan; to another during their years of employment in the fc=b~t*> 'ucustry. Since oulv the amounts of dust collected at the tin? cj :his surrey in the various departments are known, there is l:> way of sr.0r.in2 the average amount of dust in the atmosphere izLilc-i by :bese people orer the years of their employment. Conse quently, h is not possible to correlate individual cases with definite a.v.turr of dust exposure. . INSCE-OTCE CLAIMS To throw light on the relationship between asbestosis and pulmo nary tuberculosis, an analysis of death claims and total and per manent disability claims was made in regard to companies carrying group insurance and having available figures. There were 2,099 lives involved, with a total exposure of 7,019 lifeyr.irs. The death claims are so small in number that reliable con clusions cannot be reached from any subdivision of the figures. The same is true of the sickness claims under health insurance. The number of claims for respiratory diseases is high in two of the plants studied but low for the others, as compared with the Metropolitan experience of 1927. However, during the latter part of 192S and the first part of 1929 there was an epidemic of influenza. The records of one establishment (plant B) showed that 6 of 06 death claims and 8 of 10 permanent and total disability claims were listed as due to pulmonary tuberculosis. This appeared to be an in ordinate amount of tuberculosis from this plant. However, many of the employees were Negroes, and also tuberculosis claims are gener ally Ugh in this section of the country. Realizing the difficulty in diagnosing pneumoconiosis and the tendency to confuse it with tuberculosis, these claims were studied individually. The physicians who had treated the individuals were interviewed, and the hospital and sanatorium records, including available X-ray films, were investigated, with the following results: Death c/ain,.?: 1. A typist, cot exposed to dust; died of pulmonary and intestinal tuberculosis. 2. Colored male, age 27; worked in asbestos 1 year and S months; died of pulmonary tuberculosis following a hemorrhage; was in sanatorium 10 months. Also had a four plus "Wnsser- mann. No evidence of asbestosis. -- 3. Colored mole, nge 32; worked in asbestos plant 1 year and 7 months: died of pulmonary tuberculosis after 1 month in hospitai. Cavitation both lungs; no evidence of asbestosis. GG 13360 1; )< i. "i ur fr l&r.y v* .* - v t ,ft.:.. :;.\V i iT . ' . i,:*i**%*. J ' . t*; y. y-x.: v* 7 S'* % * / y ' ; -*V - , J_ri J . ki_. '* .% * *. H. I. v.'.w* * e-r* - s* SSCrr*; , -r. sym+.+> * * 11 - v* . - * *: <- lomury 4, U33 -; * ,-A ---* * W ,,, ?-r.J 10 a,1* ,r 4. Colored male, age 34; worked in asbestos jr.&ii 2 yft&K C mouths. Kis physician believes this was a ease of uncom plicated tuberculosis. Was not inmate of hospital or sanatorium. No information could be obtained on the other two cases. Total and permanent disability claims: 1. Male, employed in asbestos plant 3 years. His physician states that be firs: came under his observation with an old estab lished ca*e of tunerculosis about 2 years after asbestos employ- . men: started. Also had tuberculosis pf the kidney and cervical glands. 2. Male, employed in asbestos plant S months. His physician states dmting of old fibroid tuberculosis with tubercle bacilli in sputum. No X-ray available; but according to physician, as bestos bodies were found in sputum. 3. Mate, 10 years' employment. Two physicians w*ho treated hint at different times are now inclined to believe this man is not tuberculous, but has asbestosis. 4. White male, was reexamined at time of investigation. His physician reports well nourished, busltv looking, good color, no cyunosis: no clubbing of fingers; diminished expansion: incessant cough; X-ray shows fine mottling disseminated through both lungs. No evidence of tuberculosis. Probably a second stage asbestosis. _ 5. White male, 13 years in asbestos plant. Is now in sanato rium. An interesting case. His physician states that he has ex tensive asbestosis and pulmonary tuberculosis; cavity in right lung: sputum loaded with tubercle bacilli and asbestos bodies; believes tuberculosis long antedated asbestosis. Tliis patient is progressing in a satisfactory manner. It was not possible to locate the other three cases of total and permanent disability who had been diagnosed as having pulmonary tuberculosis. On the basis of the information obtained, the deaths in death-claims cases appear to be due to uncomplicated tuberculosis; three of them were Negroes, who were probably tuberculous at the time their employment in the asbestos plant commenced. Of the S disability claim cases, 1 was uncomplicated tuberculosis and 2 were uncomplicated asbestosis who were put on disability because of a mistaken diagnosis of tuberculosis. In this same com munity we know* of one death due to uncomplicated asbestosis in on individual with many years' employment in the-industry.* COKCLCSIOXS 11. Prolonged exposure to asbestos dust caused a pulmonary fibrosis of a type different from silicosis and demonstrable on X-ray films. Clinically, from this study, it appears to be of a type milder than silicosis. mt 2. Coses of definite cardiac enlargement were frequently found to be associated with asbestosis. * Pmmil eeaouinleiUoG. .. DID 11 * ' 3. f predisposition to tuberculous < indicated in this study. 4. Asbestosis as observed in this M?ri< marked disability in any cone. 5. It is not known how much asbestc of pneumonia and acute nontuherculov. G. It is not practicable a.- yet to estub dust content of air. 7. The amount of dust in the air in It be substantially reduced. * . - ' KECOMXIEXDA.T It is recommended-- 1. That the industry seriously face t": asbestos plants. 2. That new employees be examined examination of the chest, and rejected tuberculosis or pneumoconiosis. 3. That employees b? examined phys but nt least eveiy 2 years, this exam examination of the chest. 4. That the industry sponsor studies os well ns studies on effects of asbestosis acknowledgm: The authors wish to express their sin aided in making this study possible, es; ployees of the asbestos companies who cc and gave every facility for securing data University of Pennsylvania, for his int interpreting X-ray films, and to Dr. F. ^ States Public Health Service, surgeon ir. Bureau of Mines Cooperative Clinic ir. pretation of all the X-ray films listed in predation is also expressed to Dr. W. At: Lynch, of Charleston, S. C., for inform!1. s to the pathology of asbestosis; * to Dr K. C.; to Dr. Joseph H. Wyatt, of Xe Fellows, of New York, for assisting in Dr. Paul 0. Snoke, of Lancaster, Pa.; Danville, Quebec, Canada; and to Dr. L. E. Cummings, of the Saranac Laborator study of the pathological effects of the Ailmtosii butlittiniputum udlaaj, Bt EnD:h M. 1 Jfcur. Am. ul, iuoc. AOK. SO, 1930, to). BA so. 0, pp, f,? *M 4 and - f: ft 1* * ii i. *\ un -i >ulnvV'rel f ,* * _ i k. n `.Hi in -; cs- . * *.*. ?d v ^ not tr-*S_ . T tlO . *. l.u>:h s 6 ` a* i- .naio- a? exi nt 1 cd oimry biht ~n.isn; ::i :bc J5I5 H.ity rom T an 11 0S13 ` i ins. r than u I to MP'. 31 1'"1? - 3 iV Ojq... tt 'W t i ; j-- -v fTTt,3jr1LhS C. A predisposition to tuberculosis due to asbestos dust wus not indicated in this study. 4. J.?'.'-;vs observed in this series of cases bad not resulted ip marked iis.ihuity in any case. I i ! 'tKt' --nr J* j JL-i known bow muclTasbestosis muy add to the mortality vf and acute nontuberculous pulmonary infections. 0. I: ii practicable as yet to establish standards for the asbestos cu.: co"en: c' air. 7. Tie ai'-Oii*: of dust in the air in the asbestos plants studied can la j-.ostaz.ua_y reduced. .v RECOMMENDATIONS It is recommended-- 1. That the industry seriously face the problem of dust control in asbestos plants. 2. That new employees be examined physically, including X-ray examination of the chest, and rejected for employment if they show tuberculosis or pneumocouiosis. 3. That employees be examined physically, preferably every year, but at least every 2 years, this examination to include an X-ray examination of the chest. 4. That the industry sponsor studies on known cases of asbestosis, as well ns studies on effects of asbestosis on the heart and circulation. 'v'w.aU -(k'-.'- J .... k v___ : - r, : ACKNOWLEDGMENTS The authors wish to express their sincere thanks to all those who aided in making this study possible, especially the officials nnd em ployees of the asbestos companies who cooperated to the fullest extent and pave every facility for securing data; alo to Dr. Panconst, of the University of Pennsylvania, for his interest and valuable advice in interpreting X-ray films, and to Dr. F. V. Meriwether, of the United Slates Public Health Service, 6wrgeon in charge of the United States Bureau of Mines Cooperative Clinic in Picher, Okla., whose inter polation of all the X-ray films listed in this report is followed. Ap preciation is also expressed to Dr. W. Atmar Smith, and Dr. Kenneth Lynch, of Charleston, S. C., for information and advice, particularly r.s to the pathology of asbestosis; * to Dr. TV. TV. Wild, of Charleston, !\ C.: to Dr. Joseph H. Wyatt, of Newark, N. J., and Dr. H. H. Fellows, of New York, for assisting in interpreting X-ray films; to Dr. Paul O. Snoke, of Lancaster, Pa.; to Dr. R. H. Stevenson, of Danville, Quebec, Canada; and to Dr. L. U. Gardner and Mr. Donald K. Cummings, of the Saranac Laboratory, who bave_undertaken the stu(ly of the pathological effects of the inhalation of asbestos dust 4 boUi*> la 5-u`um tad luct- l*j Ktaatlh M. Ljaeh, M. D-. tod W. Atmti Smith. XI.T>. i-~- Asl M*d. Aboc.. Ant. SO, 1K0. Tel SI. ao. S. pp. WP-Wl. C-G f'-v n JJ y:C L-'; if Ihs--, ' V * ->- ' {*&-. ' ** " V -* .* .V.' 1 ;i* ^ -ury-.:. :/ ' .**VV.-.-