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FILE NAME Manville JMA DATE 1934-1935 DOC JMA274 DOCUMENT DESCRIPTION Disability Correspondence - E.R.A. Merewether ! 0022 : 0022 Merewether we H.K.Kedical Inspector of Empire House 159 Gt.Charles St. Birmingham 3 Pactories 4th Dec. 1934 | { . : }. Dear Dr. McPheeters As promised I have thought over the points raised in your tter of the 15th October and have endeavoured to discuss them in the following pages In view of the official post I hold I must however state that the opinions expressed are only my own personal ones and not necessarily in accordance with the opinions of others competent to judge nor assented to by the Home Office Before one can discuss profitably questions relating to the establishment of any compensation scheme it is essential for us to agree on one or two fundamental points the first of these is With what aim is compensation to be paid 1.6 a Kerely a payment to a worker or his next of kin as some recompense for having had the misfortune to contract an secupational disease in this case asbestosis - or b As an effort to recompense a worker and those strictly dependent on him for actual financial loss directly occasioned by the effects of the disease is being quality notice less filmed of it is clear the document due than to the this _ FACTORIES MISC ANUALBOX FACTORIESS 194,47 RPT1944,47 ASB CHIEF M INSP OF In the first case the solution is easy since as soon as disease is diagnosed definitely a payment can be made to the or to his estate and the matter is finished the worker In the second case the problems raised are much more complisated but payment of compensation on this principle is more just in its application and probably less expensive In other words in the first case payment is made irrespective of the presence or not of any disability due to the disease and in the second case the presence of disability or of death from the disease is essential and the extent of the disability material in assessing the amount of compensation to be paid Now it is necessary to decide 1 what is disability and 2 whether any particular worker has the disease and is in fact dis- abled by it 1 Disability is a function of offert or work - If can is disabled he cannot work so well - and vages are a function of work done therefore disability is shortly inability to earn ordinary wages Obviously if we apply the term in this sense although am affected worker's VCW044 VCW04 tTf if f | ee to E E it we. aed : i -- Korfzether - page 2 -_- . ~~_ physical condition may remain exactly the same his disability will vary with the type of work to which he is put This as you will agree is material in the case of asbestosis since one man with developed asbestosis can continue to earn his ordinary wages in the absence of some intercurrent employed infection if narrow band weaving in one process whereas he could e.g. not if employed in some other process e.g.transport- ing sacks of asbestos shovelling and mixing If therefore method b above is adopted as the basis of compensation it follows that the amount of compensation to be paid does not depend only on the presence and extent of the disease but also on the type of work of which he is how capable of doing whether such work can be found for him and the proportion the wages he can earn at the new kind of work beare to that which he earned at the old work Apart from such questions as adjustment of compensation in relation to number of dependants a further subsidiary question has to be considered that of the procedure where it is dangerous for the workman although not totally disabled to continue work in the processes on quality is quality j being notice qualitnyotice less filmed filmed the than | document | document this document & . FACTORIES ANNUAL MISC FACTORIES ; FACTORIES ANNUAL ANNUAL FACTORIES 1 RPT RPT RPT 1944,47 1944,47 CHIEF CHIEF INSP 2 Whether any particular worker has is in fact disabled by it the disease and As just mentioned the other factor in the assessment of disablement from asbestosia of a worker is the presence and extent of the disease and this is where as Pancoast has BO lucidly explained we all come up against & considerable 50E You will agree that it is easy enough after consideration of the clinical and radiolog- ical features and the industrial history to come to a correct decision in the majority of cases of advanced asbestosis but is quite to say in particular case mia asbestosis and never will have if another matter can has not got he has no more exposure to the dust Not only to my mind are there no definitely recognisable stages of asbestosis but the earliest definitely recognisable signs of asbestosis are of ominous import VCW04 point of workers Let view like us put it this way From the practical one can consider ^ series of asbestos those you have examined and divide . ~ -_ --- wm Nortwether - = page S ws - moe Pe ene te them up with fair ease into 1. Cases of advanced asbestosis with dis- ability in the sense we have just considered 2. Cases of developed asbestcais a with disability b without disability is NOTICE beingquality notice less filmed clear of it If is the the tduoe thanfilm document the thisimage -FACTORIES 3. Cases of diagnosable asteatosis with no appreciable disability 4. The remainder I am leaving out for the moment any cuses complicated with tuberculosis It is Group 4 which is so very difficult to sort out Prom the practical point of view of group compensation it is not really important to do so but is necessary for any resson to make a diagnosis and a prognosis in each individual cise then one does realise the complexity of the business MISC -FACTORIES 1 MISC BOX -FACTORIES AN UAL S RPT 194,47 1; 94,47CHIEF Let us consider what types one will find in this Group 4 firstly from the clinical and radiological point of view Ass INSP t M OF a The apparently perfectly normal fine physical specimens with no thermal clinical signs in the chest and no suspicious radiological features at all b The same but with an extremely slight general impairment of percussion note to very light percussion and possibly a fox scattered sticky pleural like crepitations at teses and zones no suspicious radiclical features c The at in same as b but with very slight the bases or in the zonei 17. the sones in ozen hazing zen or These three classes Eay be considered together Have asbestosis Will they ever have it if they have no further posure to dust they ex- VCW04 You will agree that there is no definitely diagnosable degree of asbestosis present yet c represents the earliest recognisable changes That than will happen to these people tan sih no fure exposure The reply in the 18 is Amnesebble to amster this question without definite knowledge ofnta heture of the work on which they have been engaged engaged its dustiness and the length of OXTCSUFO pte Ean mye Herfwetler - page 4 exposure In other words Have these workers trapped in their lungs the producing amount of dust and if this question is answered in the affirmative Eas 6 maturatient period sufficiently long to permit of the development of a diagnosable degree of asbestosis elapsed These two points are discussed slightly in sections VI VIII and X of my Memorandum Now it is possible with precise knowledge of the process individually on which engaged its dustiness and the length of exposure to consider individually the workers in classes a b and c and make a very accurate forecast of what will happen to them sooner or later Some will never develop & disabling degree of Estestosis some will be dead from it in three or four years The importance of this method cases is that with its aid one can apparently healthy all capable of insurance examination into of attack in these difficult separate these workers ail passing the strictest life 1 Those which will develop definite asbestosis within a comparatively short space of time and should be examined at intervals of six months 2 Those which one need not concern oneself about for a very varying ani indefinite peried In parenthesis one may note here another advantage It is the above Group I of cases of rapidly developing steatosis due to shert exposure to dense concentrations of dust which are liable to discredit an organised system of examination by State experts for compensation purposes For example such a case Lay be examined by the experts and clinically and redielegically nothing definite is found during the next year the worker develope tubercle further examination discloses a radical radical picture which is conclusive only as regards the tubercle the worker Cies within the next 19 months or so and morter not only much tuberculosis is revealed but eist extensive actestcais The question ther raised is why did not the expert discover the Gatestosis the explanation being of course that at the time of the first exam- ination although the worker had in his lungs & producing amount of dust the fibrosis had not had time to mature it did go on meturing steedily however until death but at the time of the second examination the tuberculosis obscured and prevented nition of what would have been radiologically & definitely able degree of asbestosis in the absence of tuberculosis recog- diagnos- Obviously therefore the history of exposure and the concentration of dust to which exposed is always important and in some cases supremely important if mistakes are to be roided Also whether there is or has been exposure to other dusts the nature of them and amount of exposure is also important cdification of the radiographic picture owing to the resulting Incidentally I have seer one or two definite cases of combined silicosis and asbestosia being notice is NOTICE NOTICE filmed the due due tthhe an document image image image : - FACTORIES FACTORIANENUSAL FACTORIES FACTORIES FACTORIES RPT 1944,47 CHIEF 1944,47 CHIEF ASB INSP ASB INSP M OF OF VCW04 =<. _ ! Kerfaether page 5 the two types of fibrosis in one case which came to autopag occurring typically and independently - To revert to classes b and c page 3 the significance of the very slight general impairment of note less in degree than that one seen in definite asbestosis and the sticky crepi- tations is of interest I think that in workers who have only a short history of exposure and in whom there has been no time for the maturation of any appreciable degree of fibrosis these signs indicate very recent or present exposure to dense concentrations of dust I suppose they actually reflect mechanical blocking up of bronchioles with dust Similar crepitations appear from time to time in cases of developed or advanced asbestosis due to other causes as well developed developed advanced advanced points because when present in such cases as we are considering they are suggestive of exposure to much dust d Workers with existing pulmonary disease or sequela-i these of course may have had very verying lengths and degrees of exposure with short ex- posure the principles outlined above are helpful with longer exposures although the clinical signa of asbestosis such as they are may be totally or partially obscured the radiological appearances are however as a rule sufficiently evident somewhere in the film especially if taken in con- junction with the history of exposure In this connection I mus say how impressed I am with the inevitability of asbestosis I have yet to come acress convincing evidence that of two men working side by side at the same dusty process for the sime length of ti the will be taker and the other left Per centre i silicosis as you will agree this does oproer to secur At the risk of wearying you I would repeat that with a history of a certair length of exposure exposure to & cartain con- centraticr of dust one can sip without fear of ^,rrerthat a particular worker List have an easily recognisable degree of asbestosis if we could take out his lungs and examine them a with concurrent pulmonary disease apart from tuber- culosis here of course until the scute or subacute condition clear up nothing much can be done other than to consider from the industrial history amount of exposure to asbestcs etc. whether it is possible for the worker to have developed a recognisable degree of asbestosis Large hearts with associated congestive pheno- men and pregnancy may produce misleading t= appearances the radiographic appearances being is being quality notice less filmed of it is clear the document due than to the this " Misc FACTORIESANUALMisc on Box S RPT 194,47CHIEF ASB M INSP OF VCW04 mother page 6 f with Tuberculosis I with existing fibroid type Apart from the rediographic appearances at the bases and of the other lung if unaffected or less affected the slight impairment of note at the bases as compared with the normal together with the history of amount of exposure to asbestos are helpful 2 With concurrent acute or subacute infection Admittedly you will agree the diagnosis of the asbestosis element is often extremely difficult One type has already been mentioned on page 4 Another type is where the tuberculosis supervenes on a definite degree of asbestosis The tubercular infection appears to have a pronounced effect on the radiographic appearances of asbestosis remote from the air site of the tubercular lesion and diagnosis may be very difficult if the worker is seen then for the first time However as a rule clinical examination of the chest does disclose some evidence of asbestosis the remainder of the lungs As I have the uniformity of the signs found which are mentioned elsewhere it is alightly abnormal physical so suggestive of the diffuse Abrosis of asbestosis Intersction of Asbestosis and Tuberculozis This erect is being most actively discussed at the moment Some points are discussed in Section IX of my Hentrandum To attem t to examine the question critically is beyond the limits of a letter but it may be worth mentioning a few ites which strike me &8 the question is so important from the compensation point of view These arese 1 The number of verified deaths from asbestosis or asbestosis with tuberculosis in which full particulars available is #ill far too small to make any dogmatic assertions 8 Kany writers have assumed that necessarily the relationship of asbestosis and tuberculosis should be the same as that which is accepted to exist between silicosis and tuberculosis there is no reason why this must be so since the diseases differ in several fundamental ways 3 The figures extant relating to silicosis are compiled almost entirely from male deaths a very large female element is employed in the asbestos trade no account has been taken of this or of the pronenes of adoles- cent females to tubercle quality quality quality quality filmed the due dtochumaenntthan . document | document this document ' " FACTORIES AN UALMISC FACTORIES FACTORIES FACTORIES FACTORIES RPT BOXS 1944,47 194 ,47 1944,47 1; 94 ,;47 CHIEF INSPAs8 M of VCW04 L Keriwether Fage 7 4 No effort has been made by writers to separate out from the deaths which have occurred from asbestosis with tuberculosis those deaths which inevitably would have occurred from tubercle and which so for as one can judge have not been accelerated by the preser of asbestosis 5 At the present moment including all cases in which full particulars are available of the total deaths in this country from asbestosis and asbestosis with tuberculosis 39 per cent had tuberculosis and of the total deaths in this country from silicosis or silicosia with tuberculosis 56 per cent had tuber- culosis 6 Therefore emphasising that the figures for asbestos and asbestosis with berculosis deaths are far too draw small to any conclusions all one can say is that so far there is no evidence that the risk of tuberculosis supervening is so pronounced in asbestosis as in silicosis If in addition one takes into account the factors mentioned in 4 above and in my Memorandum the difference as to tubercle risk in the two diseases becomes more pronounced Still it is certainly no uss arguing this point until we have sufficient statistics The position is still paper I think exactly as giver on page 21 of my That there is a relationship between asbestosis and tuberculosis must be taken inte account in any scheme of compensation and knowledge is too slender at present to do otherwise then to Bey that compensation sho ldbe paid where death takes palce from pulmonary tuberculosis and a recognisable degree of asbestosis is also found p.in. and that workers with tuberculosis should not be remitted remitted to work in processes involving a risk of asbestosis Now with regard to your specific questions you will have observed from the foregoing discussion and from the tenour of Dr. Pancoast's answers that both he and I hold the view that it would be impossible in the present state of mowledge to evolve a scheme of Compensation for asbestosis based on the identification identification of a series of stages of the dise All one car do is to decide whether workers 1 Have a recognisable degree of the disease 2 Have or have not mary tuberculosis in addition *** disstled a *** 3 Are or are not disstled Totally b Partially Question 1. Question 5. The minimal asbestosis lesion Is asbestosis a progressive #sesse etc Since amount of I hold the views I de de de concerning concerning the Fibrosis producing 23 asbestos dust page 23 my leftrandum the answer to is SALOU beingquality notice less filmed clear of it is the BIS tduoe than mit document the thisaftomi " FACTORIESMISC ANUAL BOX S RPT 194,47CHIEF AMss INSP OF VCW04 Merewether page 8 Question 5 in my view is Yes and moreover when the earliest recognisable radiographic appearances which can only be identified with a reasonable degree of certainty by comparison of the particular case in all its aspects with other cases - of which all the details including radiograms and results of post- m^rtenexamination are known - in one's library of cases appear that amount of fibrosis is a present risk to the worker as there is more fibrosis present than is reflected in the radiographic recovery appearances and sufficient to militate against his from say an attack of pneumonia How far that minimal amount of fibrosis will progress depends on the amount of new fibrous tissue which will be laid down which in turn depends on : : the amount of asbestos dust rrapped whether the maturation period has last exposure to asbestos in the lungs elapsed since the my and Of course the maturation of the fibrous tissue involves also production in severe cases of local emphysematous bullae which repture causing partial pneumothorax and of local retractions contractions and strangulation resulting in bronchiectasia and tubercular cavitation At the asbestosis moment lesion therefore I think one can say that the minimal is more of academic interest rather than of medico- legal importance and really can only be thought of in the living worker as the opinion of a particular expert with considerable experience of the disease and with a large library of ouses and films for comparison purposes on a particular case A post- Horton standard of a minimel asbestosic lesion could I suppose be laid down . 2.2 Supposing a man otherwise here here here here one and he had this miniral nitesteris lusion and reilly minimal i.e. the earliest degree reasonably recognisable en wilita0d extent # above then I think the prognosis of the case is tad although vary exceptionally no inevitably so One tul have to consider the amount and extent of exposure and how far maturation had pro- Fressed and on these apart from complicssions complicssions and the question of What further exposure to dust there dll to Covends whether the mez will live for years or die in a comparatively short space of time The minimal lesien therefore signs and radiographic appearances life probably length of life & vrbs as recessed in terms of clinical is if expressed in terms of vrbs Questions 3 24 / Tisse have already been ented cn. Tene are no definite stages of asbestosis roughly tts could grade them into early developed and advanced and thate with intercls but such a grading would neither Recessarily be arouse arouse of the disability nor of the prognosis beingbeing quality notice filmed of it is the due to document the FACTORIESMISC ANUAL BOX S RPT 194,7CHIEF M INSP OF VCW04 Herewether page 9 Question 6 This I have endeavoured to answer on page 7 have that I think that now I have come to the and of the points raised in your letter Forgive me if I have appeared is only because I have been trying to give you my own on the subject you dognatic feelings I afraid this is a very long letter but I have endeavoured am also other subsidiary questions which you would have to answer been face to face instead of probably wished to discuss if we had conducting the matter by correspondence for one moment that you will agree with all I I don't suppose have said on this very difficult subject ? shou's like to know with me and also ang any points with which you are at variance other points which you would like to discuss woh 20. One last word - Compensation however generous is at the best for Frevention and this sstrtikers ikes mle very but a oruel recompense with asbestosis and silicosis Tete ars forcibly in connection deadly diseases are the not and the cut some is so indr For masa two very to the avitable granted sufficient exposure without endoting and reasons since the provision of compensation of dust in the stringent mesures mesures directed at the suppression " straine expected obusative industrial processes is 2ietle ce it is compensation compensation on the financial structure of the compensation compensation she she it very time desirable to attack the problem Men both compensation of the same given It the pleasure me and ome @aa . awe a4 you have m^ ised m^ ised Clo & at. 8. erg moore oves 2 er 2 ppooiinntts s with kind regards being beinNg OTICE ean quality NOTICE Pe filmed the due document than film ImagIe mage Image . -FACTORIES -FACTORIES -FACTORIES ANNUAL 58-0F8ACTORIES -FACTORIES RPT 1944,471944,47 CHIEF INSP _ INSP M OF OF OO ... MM e e ee 3tl.4P VCW04 -~ _ FACTORY DEPARTMENT OFFICE s H.M. MEDICAL INSPECTOR of Factories kermal eneanened kermal _- ON Cae EMPIRE HOUSE Gt Charles STREET kermal | : Leroy U. Gardner Esq M.D. BIRMINGHAM 3 6th November 1935 Director The Saranac Laboratory for the study o sis Tuberculo of The Edward L. Tradeau Foundation Post Office Box 661 7. Church Street Baranac Lake NEW YORK U.B.A. Dear Dr. Gardner In continuation of my letter of the 18th August I have now with the courtesy of Captain J. G. Ross Manager of the Asbestos Corporation Ltd. Canada and W. V. A. Janitch representative of the Corporation in this country obtained some accurate information as to King's Floats This I enclo and you will see that only about 10 of it is non- fibrous material The percentage of fibre is higher than 1 expected expected You will see however that in test 4 after mahing material had passed through a 200 mesh sieve only 8.65 of fibrous material was obtained Of course one might argue that this method of amlysis is not sufficiently delicate to settle NOTICE NOTICE NOTICE filmed filmed is clear the document film document to than film document image ANNUAL {| ANNUAL ANNUAL FACTORIES AN UAL FACTORIES ANNUAL 1 FACTORIES RPT RPT RPT 1944,47 CHIEF 1944,47 CHIEF INSP INSP M OF . r eee ok oe the question you raised in your letter of 25/7/35 but it seems to me that if with this test only 8.65 of the material which passed through the 200 mesh sieve was fibrous any samples of floats you used for your experimental work would contain quite a high enough - percentage of fibre provided it was well mixed I have the small boxes of samples referred to in the test if you would like to further examine them yourself ir. Janitch very kindly maid that I could aake what use I liked of the facts in this test so I an enabled to send on to you I am not sure whether I mentioned it to you before or mot but I am being led to a conclusion of the immense amount of importance of the fibrous nature of asbestos dust this because 1 have been making a little enquiry into the effect of French Chalk which is nonfibrous and I have come to the conclusion that it certainly does not have the effects of asbestos on the +o lungs judging by the results of my examinations of workers eto and it seems to me that the reason for this is the different physical characters of Franch Chalk and chrysotile asbestos although they are practically identical chemically is aD NOTICE beingquality notice less eats filmed clear of it is IfGa the due the GED to than film GED document the thisimageGED > -FACTORIES MISC -FACTORIES MISC ANUALBOX -FACTORIES1945 RPT 1944 ASB CHIEF M INSP OF VCW04 0 0 0 9 9 9 8 8 ~ l In this connection the Canadian asbestos interests are inclined to think that Canadian chrysotile is less harmful than other varieties of asbestos on account of the fact that they feel certain that Asbestosis would have made itself so very much more evident amongst their workers at Thetford and elsewhere in Canada than it has done This suggestion I have only heard in the last few days but coming to my notice as it does after a considerable period of cogitating on the French Chalk problem there may be something of truth in the suggestion although of course nobody has yet produced any concrete evidence on the matter It would however fit in with my theory as to the importance of the fibrous character of asbestos dust and of the fibrous character of French Chalk as an explanation of the different effects of these two dusts when inhaled into the lungs Canadian chrysotile as compared with chrysotile from other sources certainly is more talcy or slippery to the feel I enclose you two extracts from the Annual Report of the Chief Inspector of Factories for the years 1933 and 1934. On pages 63 65 of the 1933 ane OD Ge =D quality NOTICE NOTICE being NOTICE quality NOTICE filmed clear clear If the due due film film document film this image document image image ne ANUALMISC MISC FACTORIE- BORFACTORIE- S RPT 194,47CHIEF Asb INSP M OF VCW04 Te ~] | ifI y ! n I> | _ ] 2 NOT IfICthEe ee ee ee NOTICE If the film image is less clear than this notice it is due to the quality of the document being filmed - INSP ANNUAL RPT CHIEF INSP OF FACTORIES 1944,47 1944,47 ASB MISC Box VCW044 VCW04VCW044 VCW044VCW04 VCW04 VCW04 a find this wil of sincerly you result report the of 1934 regads synopis kindest 4 the some very of of 15 With Yours page mine and short of report very enquiry