Document qaYRYrDVD82RK2wk4z2w7NMGE

6/5/61 REPORT TO 5* 3* RUS3ES COffAHT, ASBESTCN PLANT, HCGtfSnLLS, CECRGlA, RCAR0Hf0 AS3STOSIS IK CLOTHS AT 3iS AS3Z2TCN PLANT, rCR TKS B ggTIKQ 't-* PiAMTIFPS Jota G; VeUe, K, 9, HcvniOj Georgia r>Exfwr D!R*5a The Aebestaj Plant' of the 9 S, tebber Company started operations in 19ic, Pros it# inception, there vu cognisance of the potential sedieo-indus triU hazard in woridng *ith ubstoi fiber*, Several factor# nutated against the possession of satisfactory taewlodge regarding the nature, d|n and extent of thia danger. Cnamni cation# between different copsenie* vortdng nth thi fiber ware handicapped by the requisite need for secrecy inherent in a highly ccnpetlti-re ystsa of free enterprise, Adequate studies regarding the epidemiology, radiographic, alinieepatheiegy changes and functional or physiologic had not yet in aaay instances been undertaken; narked the seen# by *4ttch particularly the latter could be' accomplished eras being developed, test- over, as will be Indicated later, end at bee been suggested by others in the United States end Ingland, there is reason to believe that not only has the nature of aabeetos disease changed is the peat eighty years; but also is probably different in varying places at pretest, because of such factors ee type with location of operation within a given plant aad the type of aebeetoe fiber predominantly used, ^ Awareness that*there was a potential problem activated the U, 3, Rubber Co, in HogsnsviUe, Georgia, to start routine annual cheat X-rays on all perscnr.al working in the Asbestos plant at the inception of ita operations in 1940, Additionally, detailed dust count studies at sacy stations within the plant have been continually performed over its twenty-one years of operation, . Information adduced from these data aad fllss have subsequently proven in valuable in yielding sons satinets of the appmri mate accusal atirs exposure to asbestos dust and its relation to the production of asbestos lung disease, .Xxasdnatlcft of serial roestgcaogrtsa of individuals bee sereovsr enabled us to describe the radiographic picture of asbestos lung disease as it occurs at our plant 'cad places us la e position of greeter confidence in detecting early changes at a tins when we hope rvaeval of the worker from risk viil prevent devalofswat of a pulaonery cripple end keep a trained worker on the labor Market, The present progren was inaugurated in the Asbestos plant in HogansvUle in 195? t_ Its goal wee to develop all the information possible regarding the general nature of the asbestosis problem as it occurs at our plant and to detail, insofar as possible, the specific alterations is the individuals at risk. To this end all workers receive cosprehcasive annual tranlnations vr.i:h include a detailed history and physical iei nation, (Kale workers are advised to consult their fasLly physicians for rectal cosh nations, and f'--* workers are requested to consult their personal doctors for breast and pelvic enirtnations); a heaograa which includes white with differential' count; Report to *J, ' r__5r Ccapany hmgloblA, hMteertt and red blood eall eount, A sedimentation rate ted urinalysis are Also performed* Vital capacity has been measured by the KcKesscn-doott apparatus;and yearly skin tact Tor tuberculosis and histo plasmosis bare been dose* la salactad cases, sputa are collected for tubercle bacillus culture and about six patients hare received bilateral breaebegrs&s `with negative findings# Chest osasureaaats at inspiration * and expiration, height and weight and- th# routiae vital signs are recorded* Oir effort then, is to see the patient as aa individual and a whole, with - esphasls upca the changes - if wrought on his pnyeical and emotional being .by occupational exposure to asbestos dist; to quantitate that exposure in dust eount dosage and resultant radiographic alterations; are! to acre recently aeasure pulannary physclogic performance* 4 Kroerous factors seed apparent la an initial report in 195$, and the' passage of Une has done little to alter initial tentative conclusions. Dust ensure la our plant lessened nore-crless steadily with the passage of the years, following continuing efforts by responsible plant personnel to ` entrap, divert and exhaust the asbestos dust fro* the work arse ataoepher*, Review and study of serial chest X-rays of workers who were bsgiadng to develop ptlaenary asbeetoeis ia Hegsasvillt densastrated a mere-er-leso orderly progreasioa of radiogrsphio maturation froa normal lung to diseased lung# This cooperative study was particularly valuable ia that it rendered acre easily apparent the detection of the earliest radiographic changes of pulaonary asbeatesU la this plant* the logical seqoel of course, ia early discovery of affected workers ia order that they oay be moved iron risk before advaaeed and irreversible pulaonary changee have occurred* # la this eet&sctlen, it ambs pertinent to note that the progression of radiologic changes asm so far to be unique* for this plant* V# were privlledged to consult with Or* Kenneth E* faith, Medical Director, Jehna-KanvUIe Co^any and On John f Knox, Medical Olreetor of Tumor Brothers Asbestos, ltd*, Rochdale, England who showed at X-rays of their workers with pulnenuy aebeetoeie, the radiogrsphio patterns of their asbeetoeis patients eeened to be of a far coarser and further advanced nature than our patients at. cccparrbie clinical levels of disease, the type end source of the involved asbestos fibers, duet else, end possibly dust velocity at tine of Inhalation say be sons of the factors involved in the difference* As a local ooBveadense and aethod of utilizing available information relating dust eevt date and accumulative coosurt, wo developed the term HPPCTf meaning alllion particles (of asbestos dust; per coble foot-year* found the greeteet exposure density of workers affected by pulmonary aebeetoeie to be eroued 50*60 *-??CTT*3, A curve plotting asbestos!* against MPPCfT shows a slow rice prior to this point and a tendency for aebeatesls to becoas sere predictably certain with increasing exposure* In order to keep a trainee worker on the job, the conclusion seems inescapable then that at least cne vital step involves as near e eradication of the dust aa is possible> . Report to y. Ccraany as certain stations, such as weaving and winding, sees sort at rick la our plant, but tha changing work population and insufficient amber of workers have prevented, so far, any valid statistical and predictive evaluations* 4 tf furtherttare, certain typo* of workers; naaely supervisory personnel, haw eee&ed aors susceptible to the disease end the attrition e&ong these valuable people has been relatively high* Speculation leads cos to wonder whether the very attributes which drive certain workers to end beec&e supervisors aay have at the ease tics e&eeurtted then to take greater risks, show sort disregard of the dust hazard, ani ultimately beccae casual!ties, la regard to hazard and risk we have adapted the policy that tacwledge of the risk and awareness that we are doing everything possible to cirri size it and reoove tbs tarfcer frea danger should b# beeo&e sa incipient victia is the most prudent course to follow, ( froa a laboratory standpoint, patients who develop the disease hare tended * generally to show rising values of beaoglobtn, hesatocrit and red blood chests* there have bean no slprigicaat alteration* lawnite oiooa count or differential values unless there has been a eoaplicatisg infection* Vital capacities^ as asasursd by the Kcleseca-Scott vital capacity apparatus, hava shown universal decrease. , frua a clinical standpoint tbs* cardinal features have bean onset of chronic low grade`non-productive cough* occasional sub-sternal and epigastric iny and an insidious onset with prorrteaivs lessening of strength. Sep sad energy and a stealthily Increasing shortness of breath on exertisn. o cos hae explained of orthopnsa or parsons*! nocturnal soothering* `Cheet pain, except for fleeting and hard to describe al&ost neuritis eynpte&s, has been largely abcest* Sosa patients with fairly wall advanced pd&onary disease crmpleln occasionally of difficulty in getting air into their chests* This syaptca aay be part of the hyperventilation syndroas, end subsequent respiratory studies have indicated that these patients al&ost unlfcn&ly have an increased adauts ' Those with pulmnary aebestoale in our plant have invariably shew dialnished Chfst and diatthreigetla gg*eir faiyl-e neml respiratory ssumtrt except for a tender^ for the dervtlop&eat of bronchovtiyyf ri^T f*'"**4* ,, baste posteriorly and laterally; the typieal finger changes of hypertrophic puiannary oeteoarlEffspsthr without tenderness along the shafts of the lung ,gosssi eanbereaeins intensity of the second pulaonie sound suggesting rising tension in the pulacnary circuit* So far, none who show even aoderttely advanced pnlamaiy aebestods (with one possible exception who was not observed by &e) have ds&onstrsted cor pul&onale asnifeeted by right heart failure, radiologic change in hilar vessels or electrocardiographic changes of right sided strain* This sees* ecae^at strange but perhaps tlse will throw sore light on this particular probieo* la order to learn acre regarding the thwloloslc alteration* of pulaonaiy aebcstosls sad to provide a aorv-crl*s* quantitative aetbod of following these alterations we started about two veers ago to study the volumes of the various physiologic~iurig ccepartnentSj their ventilation; the-distri bution of inspired gas as seasoned by the pulmonary nitrogen e&ptying rate Seport to fl* 2, SLlber Cs^4ar (Tala Mi) d puZaanary nitrogen without comi) d tilt character of the recorded splrogna* Kort lately we hm begun to study in thHt patisnts of vmtilatioe-perfusicn relationships tad tho diffusing capacity of the lungs for coQrgea by tht method of Riley and Coumaad using two different levels of Inspired cjygen ' concentration, Tht partial pressures of eaygen and carbon dioxide ia arterial blood 4t these M levels art determined by tht direct bubble aethed of ?d127, ?roDl tad Frank*, The arterial bleed content of or~gen tad carbcn cicada tad various gss analysis trt asasured la the Via Slyhs saaeastrie apfparatus tad arterial ?H*$ ct determined with ths Seciman FH aster# There are appended to this report thro# pages la tabular fora showing la scat * dattll tba results of our studies oa several patient* with pultannery asbeatoeis, AH htrt radiographic changes of varying degree, uaiforaly involving tha lew itmg Helds .and, as tha dittos* progresses* tht serosal surfaces of heart and lung# All have trldt&et of decreesad chest exeysioa aad"aa5r snow q*crea*3 ieeeent of lug bun to percussion, Breath sound* rtt tho inferior portions of tht lungs, usually .posteriorly tod often laterally tad anteriorly era r.oratl to brcnehovesicular tad frequently rtreal flat to ntdixa end-of-inspiratcry* sticky rule* tad occasional ftiat rhonehil* bhoro the second tortlo heart sound it louder than the second pulaotde, serial obterrttie&fl error several year* here tended to meal a changing relationship with dtortasiag eortlo second and pnlaania second sounds* 4 a The oajorlty hart dubbins of retying days sms pronounced, and seat aiaisal, tad there appears to be little correlation with the eeeerity of the process. ttetfonaly, there is seat dyepnea on slid to eodareta' exertion sad a general loss sene* of vail bains art usual"strength and energy* - Vital capadtieo are alaoet urdforaly decreased* Residual roliaes tend to be slightly increased sad total lung capacities, so far here tended to resain dose to predicted normals* This nay be because cf increases la residual volussa, for the directly aeaeurshle inspiratory capacities sad expiratory reserve valve* are uniformly decreased* Minute valve* are alaoet uniformly increased and arterial C02 preeeures ' taad to be lev* Alaoet all hate increased restllatory equivalents for caygto. 4 Martas! breathing capacities are uniformly decreased, although the figures given say be sooeidiat lower than the patlsat*1 full ability beeaoee the test has been perfomsd in the sertrocumbeot poeltlcn* There is little evidence of airway obstruction sad the pulmonary nitrogen eaptying rates have been alaoet uniformly ncrasl* Timed vital capacities have tended to show acne lag at o&e second but normal eaptyiag at two and three seconds* Arterial oxygen saturations has been nomal as have arterial partial pressures of e^gen at 21 percent oxygen in the aabieot air* Diffusing capacities fer wygea at reet h*ve varied la four patients aaaeursl from 10,8 to 16*0 oe/on/ea* o-3*^--^ .C-^v . 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