Document wKyNqGkzYYGv6NwNXJvb28nVo

* 'tVetXMT.&SIZ ASS ASB2ST0SXS A brier review ef current taevledge sad anilysia . of tuberculosis mortality in the asbestos aiming cesainlty frr'iiiw* " n"t,,rd M'' e"`4` as: / Xeeent developments in Canada have focused attention on tbe question of the relationship between asbestosie and tuberculosis. Aabestosie has been declared a coapensable disease in tbe Province of QCebec, thus increasing medico-ltgal interest in the establishment of this diagnosis and evaluation of any contributing factors. Autopsy of asbestos liners has disclosed evidence of active tuberculosis and asbesiosis 1A2 la tbe ease individuals. In Tbetford Mine a, where a substantial pan of all the asbestos In Canada is produced, the aortallty fres tuberculosis has in the past 16 r years approximately doubled in contrast to a significant decline in the Provincial rate. These, develepaente have materially helped to create the Impression in the ' Province of Queboe that there it a causal relationship between tuberculosis and asbestcais similar to tbe carefully demonstrated and generally accepted relationship betwesn silicosis and tuberculosis. X-* Observations in the United States Previous studies of workers exposed to asbestos dust have mot disclosed a higher incidence of tuberculosis among workers with clinical and Z*ny evidsnea ef asbestosie. Laasa* in 1935 concluded that asbestos dust did not predispose to tuberculosis. In <. examination ef 126 workers in the. industry im the United States, 53.15 were Xocad to have definite X-ray evidence of asbeatosls. Two cases of active tuberculosis were found. Okie of those was a worker with asbestosis. In 1936^ Donnelly reviewed X-rmy film of 151 workers is asbestos mills and found evidence of asbestosis among JA.4S ef the group. So cases, of active tubereuloai were found among workers with asbestosie. On tbe other hafad, in tbe group without fctbcsiosld Do found four active cases of tuberculosis. Two of these active eases * JUH 4 MET-872 Yuca la the asbestos industiy, six tad ta jun respectively. Donnelly C6aeludjd that there was no tendency par as is this type of industrial eeupatlea ' as eaaeerbete old tubsiculosis lssioas* McPbeeters* reported la 1736 aa Z-ray surrey of 210 psraoas expoeed to asbeetoe dust* Us found 25.2* bad sees evidence of asbestosis* Thro# casss of aetivs tuberculosis were fouad. He tuberculosis was found la workers with asbestasis* Tbs three individuals with tuberculosis bad base exposed to asbestos dust 6, 7, and 10 years respectively. Za five cases healed pulxonary tuberculosis and asbsstosis were fouad la association. Tbs average duration of-exposure for tbs 5 was 10.4 years and for the satire group 10*2 years. KePbeeters decided there is ao accelerating offset of tuberculosis oa asbestosis* Za susaatloa of this evidence it caa be said that 2-ray aad ellaieal studios .aaeng asbestos workers in tbs United States dots set reveal a signlfieastly greater asount of tuberculosis than expected ia the routine exaainatiea of workers in any isduati7* Koreover tbs re is ao evidence free these studies to indicate that loag exposure to asbestos dust activates or accelerates the tuberculous proesss. Both these observations are la contrast to findings asoeg workers exposed to free silica*' Canadian Observations These have beta ao published reports of studies aaoag asbestos workers fa Caaada with respset to tho prevalence of asbestosis or of tuboreulosis la tbs osbostes Industry* Za 1930 Pedley and his associates exaained physically and by Z-ray 195 6 oabestos workers In tho towns of Asbestos oad Tbetford Xlaes. The results of thlo . *. 0 survey appear la Table.'1. 4 * o , * * TJLELI 1 t Asbestos Tbetford Klnae . d*r oxsslsed % with sore thaa 10 years ensure . '1* with asbo steals Oil 22 18 54 89.4 24 % with asbo steals 12.7 44.4 Ob* ui* of ictiw tuberculosis vat found aaoag the 19$ iadividusls exaxlssd. e ftis la a vary aatiafaeter7 iaeidtnea of tuberculosis taong an industrial group, ms today. For oxaapla, it apprexlaetss tbs indieoneo Is a survey is 1910 of tho ma gsmsot trad* vhsn 1 aetlvo eaao via found par 165 individuals oaca&iaod. ' Fodloy found that tbo tuberculosis sortallty is Tbotford Xiaoa for tbo ytars 1926, 1927, asd 1928 eesparod favorably vlth tho tuberculosis sortallty for tba ?revise* of Qusboe.. Fleet Qusboe Tbotford TABLZ 2 svs norttiiuv I or All AKI 1926-28 1940-42 t Cbasge 123.6 237.9 78.6 252.1 35 however, siseo this report of Fodloy tbor* baa boos a sharp chaago la tho tuberculosis sortallty rolotlesahip botwees Tbotford Xisss asd tho Froviae* aa a whole. Table 2 .' above that la the Provisos of Quobse tba average rate for the three years 194M2 . * ' has decreased 35J> coapased to tho average rate for.E* years 1926-28. This eorrss- * to experience elsewhere la Canada and the United States. Cb the ether beni, Thctford Mine* fer the corresponding period tuberculosis aortality has increased core than 80S. The obvious existence of a serious tuberculosis problec la Thetford e iaes has led to speeulatlea regarding the influence of asbestos dust. Tuberculosis Hortalltr Study ZX the industrial exposure to asbestos dust is a significant Xaetor in exacer bating or accelerating tuberculosis one would expeet to Xlnd a significant differsace in Bales over 25 /ears of age since, in Tbetford Mines, practically all of this part of the population aet la solitary sendee work in'the asbestos ladustr7. Socio- *ocoaoale factors are also significant in relation to tuberculosis. Therefore, comparison of the tuberculosis aortality rates ia Tbetford Mints with eessuaitiee la the Province of like site, sedical and publie health facilities, socio-ecoacsie fjj* uU aad racial characteristics is iaportant. Dublin has pointed out-uatw -aBcr socio* oeonesie factors were dosiaaat the tuberculosis aortality rates for both husbaads and wives wore slailarly affected; where ladustrial factors played a leading role the standardized aertality rates for the husbands greatly exceeded that of tbe wives.9 Through the courtesy of the Dexographer of the Provincial Ministry of health and Social Welfare, Dr* PaulTParrot, we were furnished the tnxber of deaths free tuberculosis by age and sex for tbe years 1939 to 193'for tbe cities of Tbetford Kina a, Riaousfcl, Chicoutini. Cap do Madeleine, St* Ryaeiatbe, St* Jeaad, and Valleyfield, aa well as for the Province and tbe Dcainloa `as a whole* Of tbe eix communities picked with these cbaracteristies ia Bind, the town of Riaouskl was thought sore nearly to coxpare with Tbetford Xlnes, except instead of asbestos s. niaing its principal industry is* lumbering at* woof finishing (see Table 3, p*la)' TABLE A Show* the Average Morttlity Bet* by Sex for All Age* la Pyovlnee tad la the Seven Selected Cossunitie* 1940-1942 Tuberculosla Death Bate per 100.000 All Age* Hale_____________ fegtle PB07IKCS OF QUEBEC Cap d* la Kadelelaa St.' Hyacinth* St. John Valleyfield Chieoutlai Thetford Klae* Blaouakl 77.5 55.9 84.5 75.1 101.7 141.8 190.1 171.9 80.8 44.5 90.9 109.8 85.3 149.1 223.9 287.3 TABLE 3 jPoeuI Descrictlve Date on Selected Cossunities Industries Health Health Pub.H. ^Private . Batio Phys.tc Officers'** Unit Hurses Pbrsieiens Perdition .ford Klae* 12,000 Asbestos alnlag 1 juski (incl.. 10,000 iburbs) luaberlng, wood finishing 1 Kadalelne 13,000 a rubber afg., * eteel foundry, bag, afg. silk 1 ; Elvers. 45,800 paper, llaea afg., rubber, iron 1 :outisi Hyacinths leyfield '25,000 18,500 20,600 aluaiaua, pulp, 1 paper, iron fdry.j\ clay produets 0 textile afg. . 1. sunitloins, ether war Industries, cotton, silk 1 1. 5 14 .6 12 10 ` 2 3/1000 1/1000 1/6500 1 9 ' 40 1/1150 ` l*e*K~ 10 19 12/4500 (incl. 7 apeea.) 1 ****-V 1/1300 1 *5 10 '3/20C0 rull-tiae health officer* Including 1 dentist . A" including 1 tb. *peeltlit *-**-* Including 2 full-tla* physician* y-bi* 4 It will be acted that three ef the eevea towns for which date #etalned have a tuberculosis sortality which is appreciably higher than the provincial rate, resales la Miaouski have the highest average rate for the years 1940-42, resales'la Thetford Mines have a higher average cortality for'the corree- pendlng period than sales in Thetford Mines who ranked third in this analysis, further analysis by age and sex has been attsspted for tbs ecasualties ef Slsouski and Thetford Hines and the results appear in Table 5. Interpretation' is difficult because of the sasll number ef persons involved In the 4ge. groupe in the two eeesunities. It Is ef interest te note, however, that aaong Thetford nalee the highest sortality rate it recorded in sales egfed 2504. In sales the highest rate is In the group 35 and elder, Thetford fesales aged *25*34 hive / the highest rate in aithar sale or fesale groups, being 519.2 per 100,000, or four tlses the Provincial rate for the seat agree. The rats la tie corresponding age group in ftlaouskl fesales is 446.4 which is nearly three tines the Provincial rate la the ssss age group. Tuberculosis also takes a high tell in Uswsld fesales 35 sal older. Here the rate is four tlses that of Provincial fesales of the ssae ages. TA8LE 5 Tuberculosis Deeths end Death Mates per 100.000 1940-1942 ICE All Ages 0-24 25-34 35* . Pv. of Ouebee Heaths. Hate 3883 1167 803 1918 77.5. 45.2 102.1 .116,2 MAXES Miaoushi Deaths Mate .17 171.9 5 93.3 2 114.4 10 360.9 Thetford Mines Deaths Mate 36 13 10 13 < 190.1 122*3 342,9 245.0 r.. zsiu.of Qusbee Deaths fiats *4019. 1614 1072 1333 0*8 42.7 134.1 83.1 7 nXALSS Jtlaouskl ' Deaths fiats fhetford Kines Deaths fiate .32 287.3 ' 43 '2Z3.S 13 211.9 18 162.5 9 446.4 16 519.8 10 ^ 334.7 9 178.1 HVZa02&SXTAL OBSSfiVATIOKS AT THT27023 Visual inspection of the mills of the three asbestos operators was'made. Dost * cswere sods ot oil important working locations of these properties, end the s Its ore five a in o separate report. There was ao opportunity to personally observe ' conditions, eating and living habits of the population, but this inforsatlea was rted to us by oospetent observers* Several eonditions prevail in the mills vhleh would favor tbs spread of pulmonary . irculosis. The verioen appear to be eareless about epittlng and other personel habits. ardsr to keep warm in cold Mather they huddle in groups in email wooden cabis"Ilia losurea* These measure about 6* z 6'* They usually contain a beach or two aad a ir, with soae heating facilities; a saall tin can oa the floor which la used for aratte butts, spitting, or left-over food. Xa oae mill a tin drinking eup has been use for many years. Xt is obvious that, if there is an employee with tubercle till in hie sputum, these environmental conditions favor the spread of tuberculosis. should be meted that la review of the death claims in the mines insured with the ** a difference in tuberculosis mortality was found* Xa Kins A between 1941-1944, e ;ht deaths wore duo to tuberculosis with a rate of 2,8 per 1,009 employee-years* Xa ae 8 for the oorrespoadiag period there were two tuberculosis deaths with a rata of 4* Xt wos la Mias A that tbs most conspicuous unsanitary practice, the oeomoa inking eup, was found. * .' Home living conditions gre crowded ud it is coaa&oa practice for children asd adults v r>;, beds. Thia la as important factor favoring the traaaaiaaloa of tha disease--apt because It promotea closer human eeataet but, by interfering with adequate rest, the iadlridual,a resistanea to lafaetiea la lowered* Poor eating habits and food selsetlea which prayall also eoatributa to tha lowering of reslataaeo to tuberculosis, . These observatloas oa environmental factors arc admittedly supdrflelal because of tha briaf ties avallabla for laspoetloa and observation* nevertheless, boeauae of their probable 'importance la creating aad maintaining tuberculosis la tha community, further investigation -of them would aaea to bo warranted* . *\ aiseussiCT o It la obvious that tuberculosis mortality is excessive la tha town of Tbatford ines But there la no Indication froa these data that oeeupatloa le a dominant faster because) 1) the mortality is equally bad among females; 2) it la excessive la the age group usdar 21 where there is little or mo Industrial exposure; 3} tuber* eulosis la also a serious problem in Klaouski where there la no asbestos Industry. The age and sex distribution of mortality fren tuberculosis resembles the picture of tuberculosis la a heavily seeded, susceptible population with a lubitu* ;ial proportion of the mortality occurring la both eases under ago 24 and tha majority jf deaths uadar ago 35* Thar* is no evidence, if asbestos dust is a factor, that ** It resembles free allies la Its lafluaaet oa tuberculosis mortality* Careful end ;horough mortality studioa^ameag granite cutters in the state of Vermont revealed .hat they arc subject to an excessive frequency of deaths froa pulmonary tuberculosis, * rot beeeuss of an exceptional risk of contact infection, or because of Inferior ih7*iqu*, or because of uafavorable housing conditions or ether sanitary deficiencies. >ut primarily because of-the occupational exposure* Thin tame conclusion has been 'cached in ovary other study of workers wbe cBntraet eilieosie. %` j^Wnfortunately were unable to calculate expacted deaths based ea the Provincial ^tee beeauee the age grouping* obtained for Thetford Mines and Biaouskl did net correspond to the ate groupings arailable in the eeasus data for the Province, for further insight into the sagaitude ef the tuberculosis problea in these two cossunltlea, it would be desirable not' only to eonatruct such expectancy tables, e hut to cars7 out case-finding studies in these and siailar ce&sunitlse in tbs Province of Quebec. CONCLUSION 1. Baaed on eurrent sertsllty data, tuberculosis in Thetford Kins a. In contrast to aany ccasunitles in the Province as wsll as tbs Province as a whole, has substantially increased* 2. Biaouski, a limbering town, eceparabla to Thetford Kises in aoeio-eeeaesls conditions, aedical and public health resources, has a high tuberculosis sortality comparable to Thetford Mines* 3* Analysis of the tuberculosis mortality by age and sex la Thetford Mines, in the other communities and in the Province shows that both cals a and fscales in Thetford suecuab to tbs disease with approximately tbs seas frequency* This is not the sortality picture seen where there is industrial exposure to fret silica* A* Admittedly cur data la l&adequata for final oeaeluaieas, nevertheless there is no indication frea this sortality study that deaonstrates asbestos mining per ee in Thetford Minos is the cause of the high tuberculosis aortslltyw 5* Purtber sortality studies should ba Bade to construct expectancy tables for' age and sex la Thttford Mines, Biaousld, and perhaps elsewhere in the Province*' ** 4( Tuberculosis- case-finding surveys should be sada both in Thetford Mines and eaparablo communities* * \ Health education concerning prevention of the disease is needed, ae well as gsprored sanitation, particularly is tha plants . George X. Wheatley/ K.D. Assistant Kodieal Director Metropolitan life Insurance Cccpaiy Hr* X. J. Tans; Manager of Occupation Xatings, has contributed to this study by valuable suggestions regarding the handling and interpretation of the data as well as hy caking tbs statistical analysis. Sr. A. J. laasa, Assistant Kodieal Director, has very generously pomitied us to use bis unpublished data secured by Pedley in 1930 on asbestosle and tuberculosis in almrs of Tbatford and Asbestos. Sr. Sanaa has also advised on tbe preparation of the final report. . Sr. X. L. Burnette, Assistant Secretary, eeeuicd for us tbe infercatien ec the seclo-eeenesic conditions of tbo selected eesasitlee. V. > iimmcis 1. Desseules, H., Jtoussotu, L., Giroux, H., tad Siehard P. "Asbestosis tnd Pulaonary Tuberculosis". Linl redieil. Vol. a, March, 1943. p.217. 2. Desaeules, $., tad Giroux, H. 'Asbestosis tad Pulaonary Tuberculotit", Level eedical. Vol. 8, Htreb 1943. p. 227. 3. Lanea, A. J., McConnell, Willies J., tad Fehael, J. WillIts/ "Iffects of the Zahtlttlen of Asbestos Dust on the Lunas of Asbestos Workers." Beprint 1665. froa tbs Public Hctlth Reports. Vol. 50, Vo. 1, Jama*7 4 1935. * * A. Donnelly, J. "Pulsonsry Asbestosis: Jneidenee tad Profaosls". Journal of Industrltl Hygiene tnd Toxicolorv. Vol. 18, Vo. A, April 1936. 5. KePheeters, S. B. "Surrey of t Croup of E^loyees Exposed to Asbestos Dust". Journal of Induatriel Hygiene tnd Toxicolorv. Vol. 18, Vo. A, April 1996. . o 6. Least, A. J., tad Pedloy, Frtak C. Unpublished dttt. '7* Tuberculosis In Industry. Stranee Laboratory Sysposiua, 1941. Published by -the Kttieatl Tuberculotit Association. p. 199. t. Pedlcy, Frtak C. "Asbestosis". Canadian Journal of Publie Health. Vereabcr 1930. 9*' Tuberculosis in Industry. Striate Laboratory Sysposiua, 1941. Published by the Vatloaal Tuberculojic Association, p.50. 10 Keffata, Frederick L. The Problen of Dust Phthisis in the Granite Stor* Industry.^* Bulletin of the U. S. Bureau of Labor Statistics, Vo. 293, May 1922. 'fy'Pt'S /***, m & Cpfc/nMr-/, Q.6: