Document rey7z2REmQX708O4q3d7zBL5e

K. ;<iopt) ,February 23 1944 PLAINTIFF'S EXHIBIT Mr. Iran Sabourin Aldred Building Montreal, Q* Canada -- Dear Mr. Sabourin* While the matter la still fresh In mgr mind I aa . writing you at length on ay Impress Ion of the situation on Asbestosla in Quebec in so far as it involves relationsixips between the producers, the medical profession and the Compensation Commission. One conference with Mr. Sharp, Dr. Vidal and Mr. Dick gave me a much clearer picture than I had gotten previously. Before doing so 1 offer a few comments on autopsy material. I am enclosing my report on the lung tissues of Philemon Tardlf. Of necessity the conclusions are not too satisfying as they are based only upon examination of two blocks of tissue, ap proximately 2x4 centimeters in diameter without even an indication of the parts of the lung from which they were taken. However, they like the material from the two previous cases, do demonstrate that the Thetford operations produce United amounts of indisputable Aabestosla. In the presence of advanced tuberculosis this isvjpscured and not likely to be identified except on microscopic examination of pulmonary tissue. X-ray during life will not show it. Today 1 have also examined In gross the sagltal section through the entire right lung of Majorlque Perron which we collected yesterday from the toxicological laboratory In Montreal. This is a much more satisfactory specimen with which to work. Zt likewise shows a com bination of widespread chronic tuberculosis upon a background which will probably prove on microscopic examination to be minimal Asbestosla. Sections will be prepared as soon as possible for microscopic examination. Ig mflar l&Jateg assort complete in this case. X would appreciate it if xoa would Mend me m brief summary of the occupational and eiAnieai history including! How long employed, character and date of first symptoms, date of quitting work, whether Koch's hmmtnnm was found in sputum and date of death. X neglected to copy this information from your record. This autopsy asterlal on fatal cases and the X-rays that are now reaching the Commission are bound to create In their mine, the impression that tuberculosis Is an all too common complication of < Asbestoais. If I were in their position with my experience limited to evidence of this kind I would find it difficult to resist the conclusion that there is causal relationship batween even slight amounts of 0699 I l Mr* Ivan Babourin (2) February 23, 1944 asbestos Is and--tuberculosis of the lungs* X have told you repeatedly as I told Mr* Sharp, yesterday that X did not agree with this conclusion but I doubt whether he or Dr* Vidal will be persuaded when they see a i succession of cases like those which are now passing before then* They i must be made to realise that these cases are the exceptions rather than ; the rule and that there is a great majority of employees in the asbestos i industry who are free from tuberculosis* X would therefore urge that immediate steps be taken to surra: every employee in the asbestos industry in Quebec so that the neVftlS&PV 'Vtatlstics can be assembled* D*sr dteverisori**' X-ray films already falcon on the sen at Asbestos will provide you with asterial for s pre liminary report* Coupled with this there night be an analysis of awytsiit* data contrasting the total death rate from tuberculo*iA~Hf^Thetrord AM - -^"XsMTstaSi1 with that inotheyingDatrial `communitieswof the FrdvXdce* It W5UI3 be still moire''convinetrig if you could- shod the separate rates of jmles and females unless the nunber of the latter employed in tbs ^asbestos plants constitutes' an appreciable proportion of the female popu lation* Finally the age distribution of deaths fron tuberculosis In those employed in the 'SsTjesib# plants as contrasted with that in other occupations would help in determining whether the occupational factor waa contributory* *y own observations elsewhere and your intlMation that the rate for tuberculosis was higher in St* Hyaclnthe than in Ihetford and / or Asbestos make me confident that the companies would acquire information of greatest service to themselves by such s survey and analysis* If asbestosls specifically is predisposing to tuberculosis in the sane sense as siiieosis does the effect should be just as apparent in North Carolina and Pennsylvania as it seems to be in Quebec or England* But the films of employed asbestos worksrs in the States show a very low incidence of associated tuberculosis* It is my firm belief that in Quebec and England, factors outside the occupation arc responsible* As X sensed the situation in Montreal yesterday the asbestos Industry will have to produce evidence to prove this point and start on it immediately or the industrial commission will become inI creaslngly convinced that our position is biased and not founded upon . truth. Furthermore the industry would undoubtedly profit by v undertaking a general program Qf community control of tuberculosis* By instituting case'flnflng osTSfiinery not only among employes* but among the members of their families, the open esses of tuberculosis would be discovered and the sources' of spread of the infection could be removed* Mr. Ivan SabourIn (3) February 23, 1944 Oaa of the Iron aIn lug companies whoa wa serve has such a program with a public health-nurso,_a program for tuberculin tasting of school children and follow up of tha contacts of every Known case of open tuberculosis. Tha program has paid dividends by practically eliminating __v tuberculosis with resultant lowering of compensation costs and the good ^ will of the employees Is unmeasursble. The asbestos Industry of Quebec has a serious problem because Its labor force is drawn from a population In which the tuberculosis rata is high but their situation is no worse than that which our other clients attacked successfully In an iron mining community. The second point which Is becoming increasingly apparent to me Is that the asbestosls of the Quebec mines and mills is quite generally less severe and extensive than the asbestosls of the fabricating plants of the States. Comparison of tha X-ray findings In the two groups reveals very few cases with typical 'patterns among Thatford or Asbestos mill men. Some asbestosls is unquestionably produced for we have microscopic evidence of It in the four autopsy cases now available but It is not advanced enough to replace much of the functional parts of the lungs and thus cause the X-ray aiimdovs that are generally recognised, as characteristic of the disease. (Most of us disagree with Dr. Pendergrass when he snvs in Lanza's book that there Is no characteristic pattern of asbestosls). If my observations are correct this relatively slight amount of disease should not cans disability for only the framework of the lungs Is Involved leaving most of the parts that carry on the functions of respiration intact. But here again the Canadian Industry la on the defense against its medical profession and their representatives on the advisory board to the industrial comnission. The doctors have seen only their own local manifestations of asbestosls without opportunity to compare it with the really severe manifestations that are produced elsewhere. They find the abnormal shadows In the X-ray films or exposed workmen, which they are convinced must cause symptoms and disability. They find asbestosls bodies in the lungs of autopsled cases associated with minlmal tissue reactions or overwhelming manifestations of concurrent pulmonary In fections and now they are sure of their ground. In order to defend itself the Industry in Quabec must have more facts which will require tlae to collect, analyse and publicise. : These findings will have to be contrasted with those In the fabricating (plants either In Asbestos or elsswhsre. In the city of Asbestos the X. spinning and weaving Mill has been in operation for only four years ' which is the minimum time to produce much disease in those exposed, but in another year or two one may expect to find evidence of It hare unless X Am much mistaken. 0701 ( Mr. Ivan tebourln (4) February 23, 1944 Ai 1 have told you in conversation, our experimental observations load ao to balleve that th# trua haaard in asbestos plants Is proportional to tha amount of snail, individual, uncrushed fibras in tbs industrial atmosphere. Z suspaet that tha ramson why one sots littla or as typloal asbastosis in tha ninas and Mills is because thara is probably too littla suoh flbra in tha air of thesa plants. Conversely tha raason for tha "typloal* dlsaasa in tha fabricating plants is tha fast that tha proeassas thara opan tha bundlas of aabastos flbra and taar than into lengths short anough to ba lnhalad in dangerous quantities. The sills and ninas ara dusty but tha dust is largely ssrpantlas with relatively faw fibras large anough to do hara to tha lungs, this dust antars tha lungs whara it producas reaction around blood vassols and othor framework strueturas that ara just Ilka any othar , Inart dust. Vs saa tha shadows of such inart raaotlon aanlfastsd in ' X-ray as an axaggaratlon of tha nornal shadows of blood vassals, this eoadltlon in not asbostosis nor noeossarlly proasbastotle any aora than tha idantloal ohangas in nan working in hard rock alnos ara nacsssarlly praallieotio. In fraa silica industries regardless of exposure we do not diagnose silicosis froa X-rays until we find the characteristic pattern of modulation; in tha asbestos Industry ws should do llkswlst and refrain froa a diagnosis of asbastosis until tha X-ray reveals tha characteristie pattern of haslnasa or fine stippled appearance spreading throughout the lower thirds or sure of tha lung fields. The situation with asbastosis is even aora difficult than with silicosis for today tha requisite condition of tha dust exposure Is not appreciated by tha aedieal profession. " . ,v... X Therefore Z strongly urge that surveys ba oade to coapara /the relative quantity and nature of tha dusts in tha mills and the i fabricating plants in order to present proof that in the first instance -> \ tha percentage of thin flbra of inhalable dimensions is insignificant in ^ comparison with *,fty quantltj created.in, spinning and weaving. Zt is going tSoenard to persuade physicians of the importance of these factors but siallar factors govern the reaction to quarts and the development of alllooeis. These physical limitations of atmospheric dust often determine the outcome in contested cases involving a diagnosis of sllieosis and Z forsoo that they will have equal weight in asbestosis. A _ competent industrial hvaleni.pt shouj^ collect and anlyce enough of the stewspner16* ij^Jles.J^nwefi^lng Aaiflpinnihg mills 'antf ih the mines and 1'nrbi^slfrd^'plahTs' to. establish, this basic difference so that it will stand /beyond `66titr6rfty,' V# have the experimental background j we now must ^ deVOfi*trtt$'lVs'lMuetriEl application. When correlated with the results upon exposed workmen, Z feel certain that our position will be secure. 0702 Mr. Ivan Sabourln (5) February 23, 1944 ~Xe summarizes I would make the following recommends tlons to your clients, tbo Canadian Asbestos Producers in order that they nay defend themselves against a growing conviction among the local physicians that employment in this Quebec industry is highly dangerous. 1. Correct an erroneous lnpression of the Industrial Commission that asbestosia la frequently associated with pulmonary tuberculosis. a) Statistical data based on 3-ray of all -------- ^ employed workmen to Indicate the Incidence of pulmonary tuberculosis b) Comparetire mortality statistics on _________ tuberculosis In Asbestos and Thetford and In other communities of Quebec indicating the frequency by sex and age. 2. Consider the possibility of Inaugurating a program _ of tuberculosis case finding and control In the general populations of Asbestos and Thetford In order to elimi nate sources of new infection among employees. ^3. Hake a detailed comparative study of the nature of the duat In tha fabricating plants and the asbestos sines end mills. Z trust that you will agree with these reconoendatlons and be willing to-pass them along to your olieats. May Z take this opportunity to thank you for your delightful hospitality while 1 woe la Montreal and thank you for making my visit profitable and pleasant. Sincerely yours. LOOsSB Leroy 0. Gardner, II. 0. Dlreotor 0703