Document v1G0QEOXZDRQvJVp3zR1LD2eE

FILE NAME State of the Art Literature SAL DATE 1935 Jan DOC SAL022 DOCUMENT DESCRIPTION Public Health Reports - Effects of the Inhalation of Asbestos Dust on the Lungs of Asbestos Workers % . 4 ) Fg kgs COT . ES a rae ane a iS &. it hey a parreame ta er) MR Ve CP UNG *. . oe ath: - a ; Xp EY ok PES OT eat erates Oo eat 84" athe 4 50 OO AF Ce oe POOeE e aet PieUee e aay . Qt am aE Pheerwe Bo rt genese Re ee Bry ponte te Gs ~ orn - ot ak oo 33032 _ te vd OO avy . ; + CastlemDain &* . . PUBLIC HEALTH REPORTS- 1935 | YOL 50 JANUARY 1925 0 _ NOL 1935 B s + THE INHALATION OF ASBESTOS DUST ON EFFECTS OF THE LUNGS OF ASBESTOS WORKERS ' +... 7 at - 4 as 8 y whe Be a me By A. J. Lanza Azzistani Medical Director William McConnma ^ rsiste Frunzz Chemist MstrepoitanLife and Medical DirecatndorJ. WILLIAM . oad de . . . de eet Bg SR ew tows eee INTRODUCTION TAS ees ; - of this hazard and what should be done to prevent or control medical In 1929 the Metropolitan Life Insurance Co. was approached by. officials representing the asbestos industry in the United States who were desirouosf ascertaining whether asbestos dust was an occupse tional hazard in their establishments and if so what was the _ nature tes | COUNTY journals About this time several articles had.appeared had.appeared in EdnugslitshWhile > journals describing a pneumoconiosis due to asbestos instances the occurrencoef this type of pneumo- : -~ r, 5 one or two isolated had been described in American journals the industry itself ; YS fe coniosis uninformed of the existence of any such . [2a appeared to be quite BALTIA ID FOR ocupational hazard silica dust with special reference to the lungs has FLANTIFF'S Te of long been appreciated and great deal of study and research other ID CIRCUITCICIRRCCCUITUIIRT CUIT the COURT industries FLANTIFF'S ' * been applied to the problem in the metal mining and cartain other FLANTIF'S +f in Great Britain the United States the British Do- FLANTIFF'S The nature of the effects of silica & and minions in other countries in the tarm siliconia with the resultant extraor dust expressed tuberculosis is well known dinary predisposition to pulmonary </ dust con- b These effects have been associated with inhalation of Sea | taining free silica in varying amounts The affects upon the pul- tissue of dusts containing combined plicates is mstoilnlaaryfertile field for investigation but evidence accumulating that certain of these dusta produce pathological results quite distinct from '" . ; -* , asbestos dust and will be so used in The name asbestosis has been applied to the pneumoconiosis it this report Cham- caused by of commerces is a hydrated magnesium silicata ically the asbestos silica 44.1 percent mag- consisting primarily of silica combined iron and nesia 43 percent and water 12.9 percent while ferrous nickel are present in small quantities This commercial variety of 101004 1 Cf | LORE oa ae Sind ~ ay Wewn ae? ol d tee yp Oe: ae - . pay wes gee . : eee ; an 8 8 wh Be Ny 2X +4 :s ~ - a Tea Pe Ss ae x a toa. sabestos most commonly encountered is designated as chrysotile andr _ te one of the four varieties of the mineral serpentine in which it > x . ones ^' . ys Ro a Vike ( Bae rv'e| 2 pry, ; ; 7 ge Sttk Lo. xe Py +, AS ie gr 4. od ann anos P er oh "iL ey ca. ana if . Tee ; ; Fe ern . sta Ohh apy aety Dee wa qo" {+ , ee weg: eid - - Beh fa eee? as "seit Sn : [? 3, = ee a -* : 4 ane rate progress . should be bornien mind that silicosis and presumably sabes tosis develope very slowly taking from 5 to 15 and ev 20 e or 2n 5- TS - years to become established This is influenced - * mainly by the dosage of silica which the receive dos- variables amount aga in turn depends upon three of si^flcain the dust the quantity of dust in the air and the length of exposure 3.5 Bol * Be . Le Individual idiosyncrasy might be included as a fourth variabie is however little exposed to dust assumed that would influence known of the variations in It might well be occurrence of asbestosis susceptibility in those similar variables f - Qa Tent the In places where asbestos is mined or fabricated in North America - 4 | such as rock mining may be that the clear clinical there does not appear to be present the picture which is so unescapable in communities with a true silicosis hazard communities It some 20 ot -;*" ~ | asbestos plants of too recent origin for the typical effects of a 3 to are licate dust become manifest but this would not apply to the ie ae older mines to " or all of the fabricating plants + The industrial health service of the Metropolitan Life Insurance Saka vi Co. undertook the following investigation during the period from oe October 1929 to January 1931 which included - oe ke SED 1. study of dust conditions in asbestos mines and mills in Canada and in fabricating plants along the Atlantic Seaboard in the United . States examinations 2. Physical examinations of asbestos workers including ray = = 4 e* < i Pee % a f y - 4 42 evinl Sew ; I. _ 7 fy 7. f ann Fh 7a eo as, ae s 3. A study of dust exhaust systems designed to eliminate asbestos __ , dust ce are in the as A is a Data on the fabricating plants only are included in this study and designated repplo antr s t C D and E. This x preliminary report A more extensive study of the asbestos industry = 4 is now under way we DUST STUDIES - 254 3 ae ioe ast + Ios eo) ae MOSS EX he . AW , ag o OASS a ye | ; it <r i ee : rs a - * : ae { Ti...Apparatus and methods of sampling the impinger 1 and the electric precipitator 2 were used for the collection of samples for dusts at the breathing levels and in close proximity to the workmen - Bothof these forms of apparatus are adapted for this work as ther are transportable easily set up and adjusted for the taking of the air samples at the proper level and are extremely efficient impinging The impinger collects the dust by aspirating the air and then impinging it onto a flat surface covered by a liquid in a container * The liquid used was distilled water containing 50 porcent alconel tu t = + == 7 = oy, 7 x > 4 * eo w~ U fi pet shaq - LJ et we . m= Lal 7 ise rs Hig : 5 ra . ry Rigs 4 74 ts --, i ry Sy 047UA 047UA 047UA - 047UA 047UA i>] prevent the solution particularly which might of some of the dusts any silica present- The impingwears actuabtyeadn electri-' cally driven pump ratht e rae te of air meas wau s mreaesd ured -~ - by means of a resistance type of flow meter with an inclined manome- . : tes measuring the pressure difference Each sample representa theThdeusetleccotlrlieccp ter d fe romcaivp iosli udmet asigoanfet d10uo 0pcr ounbitchefeCsotttorfelaliraparneacipitato> r . principle used for recovering fuam nde fums es commercially This *~ principle depends on electrifying the dust particles by making them pa through an electrostaftieilcd and thus cau ths em ti o sen ttlg e -. out upon a sheet of celluloid The electrostatic field is set up by . means of a transformer operating from the lighting lines on 120 voltz . ' alternating current Air is drawn through the apparatubsy small . rotary fan run a motor the quantity being measured by a flow Samples of dust brushed from beams and pipe lines near the calling also were secured for chemical analysis All samples were shipped to the industrial inboratory of the MetropolitCaon. and the 4 dust counts were made according to the methods accepted by the United States Bureau of Mines and the United States Public Health | Servica I _ Particles in size up to 360 microns in the greatest . ; silica -* Chemical analyses were made for total free and combined according to the accepted standard method of Hillebrand 3 - In the first plant studied A only particles 10 microns and under ' 25"in size were counted It has been demonstrated repeatedly that no- . silica particles exceeding 10 microns a micron equals millionth part of a meter or thousandth part of a millimetar in greatest diameter enter the lung timu;; for this reason the larger particles usually when are not considered determining dust counts Latears it appeared from some of the published articles 4 English that 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 10 microns and under * - Total particles per cubic foot and the of the correspondingweight in dust ` in milligrams were obtained Since no relationship between the weights dust counts and the corresponding weights was found the are not includedin the tabulationsin 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 plaAnat re of particles 10 microns and under " photographs photographs by both the impingur sad the elastie pretplistor were muntad In addition photographs of the dont particles were entered by being projecta~ upon a screen with a lanterns slide projecter the aslarged particles being measured with a ruler Eowing the entire sbargumebn7s actual measurement it was easy to calculate the original particle size D By the t sbargumens Hanebs7 logmilkmis logmilkmis probabuiry paper the logarithms of the formation to be mastered in this cua microm) are placiod 20 tur against the probandilly of cmmmranee os mastered ~- nn, ated iavas route oo hat bbambe rs x B b : 7 Le 7 : ve mnt beene 4 aedopaeheb nr tery : dyfF. ggMt o . + tS + bers Hall ee terte. ae . Se wD nmedae en~~ak P 4 Te . > ayg yy i", i 3 tegesyleaROE: saith -brs ak ea id SORif RE STEa?mareeres th an Bae tee ot oome Rameee , Oe STARS an, 20 Brat : wid as 1 Pd : = aod s AR TESRe> an a meme 7 ~e ~ t . pa a eee o mie Esesaoe mek = ~, \ : $ . oan ea PASoT e aan a MSF an 0 Pd i~ ter s pee e e see oneee S rs er<2Soa e ere =" is Ph : : and in the other plants are for all particles direct comparison is at _ possible as sample taken were the number of particles 10 microus and under less than 94 percent of the whole - cee es m8 : on. + dem DR AL eee o - aera A t 5? $e... T~-naMaximum and minimum dust counts mallion particles Pattee ee ee department et ne we eee TEL eye as a 4 | ' ' t v AAA eee to ee gore sie - .7 oo, Yuats. eae ee Yas : ey . Faso . a i discha discharged into in After lpaed tertd fe ob (yy sci SEE e . . eit fur ead ss aye tem gic ot, > fete] PE | rere; Se arene, | MOO Hane ber af Rdost + ize a Shea 20e Dee |. SS mse | _ aitein onbie | - Leh oie go we beens fet og |Ben baat taken | Pot of tren | feet at foneatt Ssseite2 Tri 18157 PR feenfir pea fiers Pcs fene, |b & "oame wane} _ Pretere7tta) y int, tte Nae ieh To - Card som a Mine fo Mube sane. be ngs =: | TIL oc eae RIK TIL Bhees inguisting 8 f. | do a fosg 2-<a- Sys ae Mace 136 -1 4141 136-10 1 pot ; 15 I oF ~ H wed pee 2 1 TA ae 13544-10 pte1354 -10 $ 10 = a. -_ t. Moi.i - deprapctaicrallty ments oe IEEE erat wet shee ar ee; Anebacias betel awe ESTING. : bee ee - Whereas the dustin the preparation is room all dueto asbestos the contrary is the case in the other departments In the carding spinning and weaving rooms asbestos comprises about 25 i a discharged from is dischargefdrom The - material the in card Se. .-_.- bin in the card ro this conveyor AFS _ -- card room - The ol - of two grades of 1 1 not equipped with marily :.. to emmepi emepi cotton Ster percent of the material used On special jobs the percentage of ~ asbestos may be higher butin general the figurs quotedis approxi- mately correct the other material consisting principally of cotton In the insulating departments of plant A asbestosis but percent nes: ~~ ss ~ weaving Inside amount of death oil at this point diminished to lass of the total material used In the molded lining and clutch division of plant D asbestos comprises about 25 percent the total {= e While minac 2 apparently wES NI indicated material The exposure to asbestos dust thereforeis consid 3 erably less than iin n the dust counts in table 1.- S me, + nts -e> CONDITIONS ET TH S/ PLANTS ' 7 Theprocesses those inthese plants were very similar to in in cotton millsin general For illustration the process in the prepparrateionparation room plant B is here detailed at length These are emptied the floor and of is in bags upon recereci eivv ed ed 1. the asbestosis shoveledinto pug mills and run for about 5 minutes e a? 4 r OS 3 4 in order to crush and open the fibers From there the asbestosis {3 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 materialis discharged into trucks Waste manufacturing material is first run through a garnet machine and 302 . used WES of dust axhausting a plant B dependec machines was ququ vid efficiently which whip buildings tha sci Two pisat 31 31 spinning rooms humidity 73 pares relative dep the twisting the nic nic 69 F. as comparcompar weaving room of . -* m5 e4 anotayeke. eae ETS ovate y pnef s To Sea 4: om Bs ee oh Oates " f | rae7 4 alg N ~ ates sis ista La ve Pe | discharged into trucks which are wheeled to the openers and the materi isafeld into these in the same manner as the new material _ _ - After being discharged from the opener the mate isr on itaola _ viborr shaa kingt sci reennwhg ere the long fibers picked off by @ suction hood and blown into a bin to be used again intextiles a > The short fibers falling through the screen are either soid as such or received = used cotton is in balesopened and also runthrough is trucks from vertical openersIt openersIt discharged into trucks filledthe asbestos- : the vertical.and.horizontal vertical.and.horizontal vertical.and.horizontal openers.containing openers.containingeither - fiber the cotton or the waste matearr e ti aka enl to separate storag.e. binAs s needed these materials are weiagndhdue mpd ed onto the- flooirn proportion to the mixture desired and the resulting mixed - materials are then passed through a mixing picker As this mixtura _ isdischarged from the picker it is sprayed with a light mineroiall- 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 machinies equipped with a suction device which conveys the material to a storage bin in the| eard room The object of the two faciltio ftacailittaete 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- to entrap the small asbestos fibers and hold them enmeshed marily in the cotton fiber the processes of carding spinning and throughout apparent . _ weaving Incidentally it is that it also diminishes the amount of dust The materialis saturated with about 4 percent of oil at this point bu by t the time it res act hes the looms the oil had diminished to less than 1 percent While mineral oil was used in the preparation |room of plant C it apparently was not as efficacious as in plant B. In plEaoin l wt as not used nor was there any attempt at humidification or any system . of dust exhausting Carding machines were by hand In plant ^ 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 exhaust system but it was not efficiently used In plant C carwd as di onn s ing2 buildings 1 of equipped which was with an conditioning system and in both buildings the machines had exhaust equipmentsystem in installations Two plants B and C had artificial humidity in their the spinning rooms In former the temperature was 78 F. relative humidity 78 percent One plant C had a humidification system in the twisting department and alsoin the weaving department where humidity the relative was 78 percent with a bulb temperature of 69"F. as compared with a humidity of 44 percent in weaving room relative room the - soemae of plant A. ose. . ~ owe . Beemer eats Cale8 ae Oe Ne eee TLS RO Ee, eer tS oe ee w 897 See Se ee rene os 8 Re - : -_= : Sneneelicenanen ee EE Seum4m1r08? 8. ay wna oe Gee . Aside from plant E it would appear that the dust hazard was not excessive except in the preparation rooms of plants B and C. The counts are dust interesting too when considered in the light of th- atht e permissible standard for granite dust established by the United States Public Health Service 7 namely about 10 million particies ar 10 microns and under per cubic foot However we are pos justified * - in assuming that because available information suggests that usbes- a mh ' '-> tosis milder disease clinically than silicons the threshold of . 2 .-.2" . permissible dust counts is higher Asbestosis appeurs to be patho- Shug " and the experience so fur does not from silicosis logically different be warrant an attempt to define a standard of dustiness for asbestos . i ara Pd Se fp ret ing ete . a. Oe etre et e dunt oe, these redfuincael the must rest in one Various measures such as oiling humidification and local exhausts : Bo a rr.tended to dust Nevertheless it was evident that ther to control dustiness in on were only partly successful If it is expected upon properly constructed exhaust reliarnelcianece equipment In plant C department an experimental installa-i-nstala- tion was set In spite of some obvious faults this equipment on the basis of comparative dust counts reduced the dust by 50 percent . case such and with further alterations will probably be 75 percent effective a . In this a reduction seemed quite satisfactory It neither practicable nor economically desirable to install such equipment as : 7-} , will make the air entirely dust free The normal defensive mechanism of the body takes care of a fair amount of atmospheric pollution It is when the body is exposed to an excessive amount of dust that this . . - +i defense mechanism breaks down to textile machinery involves considerable The application of exhaust equipment considerable difficulty especially where the construction of the plant _- is such that it is not possible to apply down suction to the looins It is desirable to install exhaust apparatus in any plant on an ex ov +. perimental baxis first and then check its afficiency by dust counts |, This practice will result in saving a needless expenditure of money new ee of phe PHYSICAL EXAMINATIONS bowsd Bee po t reds t xane. EE ag Lettre ta eth an f WO de we sy ak? working ofa F ray films were made of 128 parsons 108 men IS women _ gate - 0 '" in asbestos plants in the United States All but five of these were cers 3 physical examination The cases were selected more or lea zw ge e t giyen those having more than 3 years of empio - wemdMer random from 1 pi" atment the induastmroyng It was soon obvious thas the early diagnosis a. asbestosis tes 121!) must rest to a large extent on ray pictures of the mw, of silicosis the clinical symptoms of shest ' . As in the early stages raaes * apose the asbestos workers were usually indefinits and inconclusive ae a the wi of these films are based on readings of one com- interpretations petent roentgenologist but they have been reviewed by severai Soret _A<vemo? {i600 iY. . eee i Ore. ee ay io Ca ee " _ ee OT ae Se ee rd | ft o | aea dyy fe OM FWA Wa 1 J ... t ot ts @ cent fq . ae sae Saas had ireneed Spy, eh OCT ENEMind Spete ga Eid not Hi the huited ticles sbo sboo ld of hs not bestos lausts It they hess in khaust istalla pat on percent fective neither hent as a. isma It Involves he plant looms an ex- : counts 1 money I working lose were ls or less diagnos employdiagnosis es of the ptoms of ve The lone com several opinion were others experienced in this field The differences of of a minor nature and there was general agreement as to interpretation The films were read conservatively taking into account the physical <7" > =| =. = examination and the age of the individual and were classed as their in pneu positive only when there was no major disagreement . All examiners 5 were guided by experiesinliccoseis and other typeosf tell moconiosca The films classed as negative for asbestonia were further subdivided into doubtful and negative Only time can whether the individuals clumsed as doubtful are progressing toward a definite asbestosis Particular attention was focussed on the presence or absence of indications of tuberculosis and in this respect all the . reviewars of the films were in accord With the unhappy experience in of silicosmiinsd it was felt that a great deal of care shoulbde 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 stage The first stage embraces those who show by my examination definite lung pathology sufficient in extant to warrant a diagnosis of pneumoconiosis but who have no definita` definita` symptoms The second cases exhibit more extensive lung pathology and also definite symptoms All these individuals " were actively engaged in factory work and it was not practicable to make any distinction on the basis of working ability or disability Had any individuals been found who exhibited extensive pulmonary involvement and marked physical disability. or total disability they would have been classified as third stage but no such cases were found Of the total of 128 ray examinations 4 were diagnosed as second asbestosia 63 as first degree 39 as doubtful and 20 as- . negative There is a definite increase in the percentage diagnosed as positive in relation to the years of exposure as shown in table 2. Small numbers make it impossible to determine how far the factor of age . enters into this increase ; * Table Clasrifection of cases by years of exposure Years of exparure Gyver 13 ya O th Sear... ... tn 10 yr Ww. Covrr 3s years... Total ex mira z|x2 43 + 8 | ny 1 Part time 15 astindra astindra worker second states restred of his own to this away but in stal BCGIVE Dous lus 1 not contLONDONKS accord of because old ags 10 years previous eee ee ee ee ee ee ? o 5 er, Sa . f xf A = sb Sh " 4 : Fs a Bh yok ti gMt? eSe a te1 EPA eV 3 bia oe ry. rat . = ..Oe nee ee. e oun ag 93. anZ a NS irs on ler POP ie en Tat ree. 3 oh ee ts eis G =< ment 2 he ae WS anee gc eR SR Keer Lope cee fd ea <74 ye . ey ae ve f . Regen Dike eae Amat 7 . examination and ~ ee PN. coo aoa diagnoseads _ {res |. having positive sabestosis only 8 were entirei free from symptoms rs . while 10 out of 37 with doubtful and 7 out of 20 with negative diag- a es were free from symptoms Dyspaces and cough were the f... symptoms most complained of but none of these cases exhibited the th." urgent or evidteypne t of short wind seen in true silicosia Several -1. _ of those cizmed as negative stated that they were short winded . 4. > and were so recorded but too much emphasis should not be placed wf on statamente of subjective symptome During the progress of the oT. time c E TS wa ishale > {. study physicians who were practicing in the communities where Juani asbestos workers 23 .) lived were questioned and stated that they did not tbe an of ' find unusual amount of tuberculosis among these workers The this state + "+ ay . contrast between affaim and that found in a community " oh with a silicosis hazard is noteworthy in aso 4 aa ; Ro 7 yo 67 examined had less thao employ- The | ' incidenes of tuberculosis based upon ray films is given table 3 40 of the 15 years of = ==> : ; 3 cnn | . oda. . TABLE - Incidenes of tuberculosis Om, raeeee Te t Positive | mawind Negaiive UIAS. plved wot same ? ) A- Pohercedanensv ) Esv . | a | Phe nee eran dineneset as priselb lva sea llvab theley xy findings ORGAO , # = i fj fa bP Tablo 4 gives information as to physienl signs of chest trublo . Andings Table Chest Andings Frattive | Devabthil | New . Hy 2h + s. i re wD T con su adi adi ac pryseStree ooff chaos trwabe pryse LETR . ee in 14 5) aeeeees u MUS MUS 7 ie uw ed o pe wy oe ot rou! | 67 2 at Sams of the red on erience umesark usinntraie 19 these nOT mana At Sams with REMOTEALING with ieniruiee nirl uel with bemas 14 de de 10 AUTOCINA WILD umani eigna od salustenis salustenis . ote What significance if any can be attached to the presence of sabentos corDA on the hands of workers appears doubtful as 18 percent of the positives 12 out of 54 and 15 percent of the others ioe <7 - . doubtful 7 out of 37 negative 2 out of 20 showed such corns _> Each roentgenologist who reviewed the ray films cailed attention * - to the fact that these films indicated a very unusual incidence of enlargement of the licart It is probable that this is a compensatore enlargement due to the additional work put upon the heart in offorts fe Sesunirettoe e vars picahotStete etss aoe te. if { al csitis . a: the ere not Shity > "fa tar 105- pete j= * hues fer . ~ _ et hemi 7 . % ses | ~ I y ; _# | "@ hoe of , 1,8 others 3 fention fention face of , Satory leforts been paid effects pneumoconioses to pump blood through the fibrosed lungs It is posable that not- sufficient attention the the upon the beart Many workers ~ changed from one ate LET and department to another and * a _ from plant to Knother their years of employment in the t asbestos industrySincs only the amounts of dust collected at the sos time of this survey in the various departments are known there is a, no way of knowiavn eragge amount of dust in the atmosphare ' ~~ inhaled by empltho e yeay rs ofm theie r empn loyt ment Conse . quently amounts ooff dduusstt possible exposure individual cases - with definita a - To throwlighlt iEgXhEtURAtNheCErelationship between - asbestosis and Se pulmo- . Fis A Weds nary tubercou f del ath o clais ms ai nd ts otal and per- ne Epes manent disability was made in regard to ~ companies carrying - Nie group insurance and having availabis figures - ; There insurance lives involved with a total exposure of 7,019 life- - years The death claims are so small in number that ratiabis cone 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 Metropolitan . - experience of 1927. However during the latter part of 1928 and the first part of 1929 there was an epidemic of influenza . en ~~ The records one establishment plant B showed that of 36 Ne death claims and 8 of permanent and total disability claims wUE- listed as due to pulmonary tuberculosis This appetoaberae n id n- ordinate amount tuberculosis from this plant However many of the employees were Negroes also tuberculosis claims are genarally high in this section of the country Realthi e dz ifi ficn ulg ty diagnosing pneumoconiosis and the tendency to confuse it with tuberculosis these claims were studied individually The physicians who had treated individuals were interviewed and the hospital and sanatorium records including available investigated with the following results Death claims ray films were * typist A exposed to dust died of pulmonary intestinal tuberculosis and and year 2. Colored male age 27 worked in asbestos I 8 months died of pulmonary tuberculosis following a hemorrhage Wasser- was in sanatorium months Also had a four plus mano No evidence of asbestosis 3. Colored male age 32 workedin asbestos plant 1 year and 7 months died of tuberculosis after 1 month in pulmonary hospital Cavitation both lungs no evidence of asbestoxis as ae ne Sbatpats ~ SD shat soe fae Vapi ett aon SESE Y LEOR + . lisoeel reeledfora See aS hin w~ wae alate Sag Dnaeh + 4 = Py ~ fe + 4 ' m4t- i : oie. x ire * x on fi ee Page TS . racine ( ~ is " : " oF 3 ig eee oe 4. : z eS : 3 5 # 4 . 34 worked 2 ede ook fj -marked - -marke-madrked -In tet +l Total and permanent disability claims His physician parumon it Male employed his **. .s a ag4 "eet . in asbestos yearyeasrs and 4. Colored male age this was case uncom- 6 months His physician believes inmate hospital or sanatorium tuberculosis tuberculosis No information could be obtained on the other two cases ee ee on physician ; 1. employed in asbestos plant 3 yearwisth a "< est" ab- - states that he first came under observation _ 2 after asbestos employ lished case of tuberculosis about years of the kidney and ment started Also had tuberculosis physician aan. glands & tubercle bacilli be subcians physicians treated this man is not Cs Mals employed in in asbestos plant months His physician in Ge nae | states finding of old fibroid tuberculosis with as- Be - No ray available but according physician . as oe sputum bestos bodies were found in sputum Two physicians who an Se 3. Male 10 years employment to believe him rr at different times now -_ investigation nae asbestosis sabescor has a. tuberculous but asbestosis investigation time at time of investigation His 4. White male was re xamined looking good color no incessant s tee . well nourished husky nan physician reports a diminished expansion a -. cyanosis no clubbing of fingers disseminated through both ane - cough ray shows fine mottling Probably a second stage he. evidence of tuberculosis ne lungs No in a WtH: z. aije~ in a ol the basis 8 IChnatteseCrhatpesre = iy *4 pLryecnicaht hs oyA other uncomplicated in asbestos plant Is now sanato- 5. White male 13 years His physician states that hehas ex- gy rium An interesting case tuberculosis cavity in right rt tensive asbestosis and pulmonary with tubercle bacilli and asbestos bodies ~ . _. lung spututbuemrclulooasdiesd long antedated asbestosis This patient is er) Se believes in satisfactory manner mrs a" progressing three of total and ot oh F oo . It was not possible possible to locate the cases having pulmonary permanent disability who had boon diagnosed as obtained the deaths * . t- of the information On uncomplicated tuberculosis Los" tuberculosis to be due to claims cases appear tuberculous at the 7 were Negroes who were probably Ty three of them the asbestos plant commenced ~ time their employment in 1 was uncomplicated tuberculosis oar * Of the 8 disability claim caassbeosstosis who were put on disability es - ra - and 2 were mistaken diagnosis of tuberculosis In this same com- ey because of a of one doath due to uncomplicated asbestosis in an ; wens miunndiivtiyduw ale wkintohwmany years employment in the industry - ok indiente^ imi 4. Asbestos car -marked of fo Jiang Jiang Jiang Se JianJg iang dust center 7. The er ee aes Loge | ye cS coon eR TSE I 4. sabescor SPEC SPEC * ) tabernios =} 3. Gal bak bak le yo sp 1 1 y a a fee ew * + % ploynes Bad gar Inivers gar &... =f, > 17. Burtau Burtau Burtau a wtot Be rie LY 2 vi ice toads AE: 9 4 So ae - oe , CONCLUSIONS sy Sa ayes: fibrosis = to nisbeton dust caused a pulmonary \ _ we 1. Prolonged exposure and doinonstrable on my filows different from siliosum mulder than *D Wt > ae . of a type this study it appear to be of a type from ie Bw c) Clinically .2 Cases of definito enrdine enlargement ware frequently found toss + a.an bebe associated with betoni betoni betoni a] * Hom a> PD Sage ruds ruds * babe COB. gos aug i Pohe ws a Lg 3 oe : - . t ; PORS^ COMAML Mics.com ~ 4 SS Sat: : ban: Te 53 Ath ope? ^' 4 Ee, Tag gy mE ahasfi Ce RM aaron feck Trt Seabee A. ape eset le. ate Be iia oe 3 = neRsaat sail Goat ae eet c . og men te cad } Der _ 4. Asbestosis an observed in this series of cas had notresulteidn re =: 5. It not known how much asbestosis may add to the mortality ~ of pneumonia and scute nontubercpuullmoonaursy infections 6 is not practicable as yet to establish standards for the asbestos 7. amount of dust in the air in the asbestos be substantially reduced rot = bees ce, he. eat il 9 5 = es Tegtay Rakes |<. 2) Sores rep: Teg + eee tt. iaceye RECOMMENDATIONS a 1. That the industry seriously face the probleomf dust control in: a That new 2. employees be examined physically including ray | of examination the chest and rejected for employment if they show - . That employees 3. be examined physically preferably every year at an ray leas leat st every 2 years this examination to include 4. That the indussptonrsoyr studies on known asbeofsatsboesstoisiss as well as studies on effects of asbestosions the hear ant d circulation Vere Av oe ates teen Shae * - en ert ae, 4 ~e ~ oe - ior oe Ne ys ACKNOWLEDGMENTU 2 AES tes The authors wish to express their sincere thanks to all who in this study aided making possible especially the officials and em- ployeeosf the asbestos companies who cooperated to the fullest extent and gave every facility for securing data alts o Do r. Pancoast of the University of Pennsylvania for his interest and valuable advice in .-: interpreting ray films and to Dr. F. V. Meriwether of the United States Public Health Service surgeon in charge of the United States Bureau of Mines Cooperative Clinic in Picher Okla whose inter- this is pretation of all the ray films listed in follofowlle owd ed Ap- =~ . preciation is also expressed to Dr. W. Atmar Smith and Dr. Kenneth Lynch of Charleston S. C. for information and advice particularly as to the pathology of asbestosis * to Dr. W. W. Wild of Charleston ibrosi ibrosis ne eae H. H. S. .; to Dr. Joseph H. Wyatt of Newark N. J. and Dr. Fellows of New York for assisting in interpreting ray films to Dr. Paul O. Snoke of Lancaster Pa to Dr. R. H. Stevenson of Oa Danville Quebec Canada and to Dr. L. U. Gardner and Mr. Donald nae ha E. Cummings of the Saranac Laboratory who have undertaken the 8 study of the pathological effects of the inhalation of asbestos dust APP RS Asba brum ketspu artak m ana d tl ung By M. D. KennLe ynt chh and W. zhat Braith D. ODE Tour Am Med Atm Aug. 30 1900 vol 06 no 1 pp OLL . oe . . ~ ms" ma jaema ere nen 7 rs : vow LP AE Rie va einen os, wm. Arran CET Rares re Bia . te " * rest ; ae, . . ad! : ec , Ramp 12 . ~, - pas rery cesemrn ww hs Te eal Se ro) SRS Peg VA~C~A, hon lal Asal,i eee . a _* ao eget Servet y aioe. ie ve OK 5 Re TPS Fa eu wee Fnay a = ae he be . < wre x ! B . = . - . tngs we oa Metropolitan Insurance Co. Insurance Ste eS mers ome. fee : et . NIIFERENCES NIIFERENCES ii2 NIIFERENCES NIIFERENCES NIIFERENCES eye Mee a . . . aan : tok fk lore . ener RA, reson RE oad . be ^' 1 Greenburg Bloomfield J. .: The implager dust sampling ap- - paratus an...nand by the United States Pabllo Health Service Pub Health a a4 alternating precipitator Jour Ind Hyg vol VII no 6 June 1925 ce current tot precipitator precipitator precitaor Joprecu ipitator Jr our thee 00f .... - + oy wee : SE Bur es RORY W. F4 The analysis of silicate and carbonate rocks Bull 422 , Bee ELS, babceosme mmaal l 451 a Britten SER Sie > wt pBireitrt,en ation pegThompseone |: . . mal Britten R..H R. and CY RL wee Thompson L. Bloomfield J. The : vey o> ith of workers in dusty trades II Exposure to alllesom dust granite : neTwT . -e - e treme rm eee ALABAMA ALABAMA . . Lee : oe as Sn > toys ED - Suey . '@ mee engt , t3 i S77n 3, TRA Te Oe ecg tae] Fe Unie of Senile ADian er Mere +. on Uttar Set ener - nn . Stee een: ; m ode . . By J. N. BAKER D. James G. McAl PhpDe . ar ndn D. G. Grz D. & = 3 2 weilem ot ur gr ence . rer ^' Same eo wwe ere ' eo . 1 [ae iteics --u EFTRODUCTION ee stmme . ook see aee te. ntges 2 oe > Bag its noncontagioua chn that the louss was the of cases appeared azn^> to believe that m^s a Me ].1 . *. fy 3. - - preliminary In a preliminary report made in June this year before Con- ference State and Provincial Health Authoritiheelsd in Wash- the authors discussed of ington the epidemiological aspects endemic typhus as it occurs in southern United States In that report it was noted that there been a rapid increase in this disease in cartain Southern States as is shown in table 1. That other countries have a in :.'., experienced similar rise incidence is evidenced by the figures pc table , $1 @poh- | +; The distinction between epidemic typhus and the endemic typhus was first -" -. of this country " recognized in 1898 by Brill He 1 found wv. in the United States type of fever which resembling typhoid gave negative Widal reaction In further studies he 2 3 demonstrated ', its similarity to typhus but ahowed that it was in milder character and less contagious only case as rule being found in a household repheorreptoretedd that it was most prevda urilngethn e ft all of the year instead of late winter or spring In 1912 Anderson and Goldberger 4 proved that Brill's disease was immunologically identical with Mexican typhus ortabardillo Naturally this led to the belief that . EG. * 7 & E & ae oe cfnocist emphasized the lower strata cfnocist cfnocicfsnoctist recovethes recovethes step was takem ablo to when when when been found in typin Rumreich 7 1531 . in spite of Mezzy's f the probable voctor e and arachnida were : seit vectors were the ipop ras the body louse x25 h itis and the tick an the fact tha Stro dis eS for this reaser.my reaser.my The work of RuzicRukzick PTUeC which are related bot a is endemic typhus wi i x other is Rocky Mount Rocky