Document zdLvLM5O9BLmEVjQN2zG8exV7

A \' MET-239 BEPOHT OF THE PHYSICAL EXAMIMTIOHS AHD X-EAY EXAlfflHATIOHS OP ASBESTOS WOEKEBS IB ASBESTOS AHD THETPOHD HIHES. QUEBEC. :x // / I The report herewith presented deals with the examinetioh ;,,of 141 employees of the Canadian Johns-Manville Co Asbestos, Que- and 54 employees of the Asbestos Corporation of Canada, the Zeesby-Hattison Co. and John son's Mine, all of Thetford Mines, One. 40 of the men of the Canadian Johns-ttanrllle Co. were examined by Dr. B. H. Stevenson and Dr. Joseph Wyatt, who performed the physical examinations and I-ray examinations respectively. The other examinations were all performed by me, except the X-ray examinations. Actually, Dra. Stevenson and Wyatt examined 57 men; bnt slnoe 17 of these men were re-examined by me I am including them In my list. Drs. Stevenson and Wyatt carried on their work in Sovember 1929. Hy examina tions were done in July 1950 in Asbestos, and in September 1950 in Thetford Mines. The Asbestos and Thetford grasps are very dis similar with respect to age distribution and length of service in the aabeetoB industry, but racially and econ omically. the two groups are much alike. Table I gives the sge distribution cf the men and Table II the distribution according to length of servlee .in the asbestos industry* r* I vv X f. M 2 TABLE I. Age krou ~T - ASB--PISTBIBPTIOB OF ASBESTOS WQBEBBS .' Asbestos Thetford Hines i* Humber. 1 Percentage Humber Percentage 15 - 19 3 2.1 20 - 24 24 17.0 2 3.7 25 - 29 24 17.0 5 9.3 SO - 34 26 18.5 6 11.1 35 - 59 25 17*7 4 7.4 40-44 45 - 49 18 _ 14 12.8 10.0 13 24.1 7 12.9 50 - 54 Z 2.1 6 11.1 55 - 59 1 0.7 4 7.4 60--64 0.7 6 11.1 66 - 69 .1 0.7 1 1.9 Hot stated i 0.7 TOTAL 141 100.00 54 100.0 1065 TAB LB II 0 0w 11 is Years of serrloe. 0- 4 S- 9 10 - 14 IB - 19 20 - 24 2B - 29 ZB - 39 TOTAL IBBOTH OF SERVICE IH ASBESTOS INDUSTRY . Asbestos Thetford Hines Rtunber Percentage Number Percentage 44 31.2 1 1.86 68 46.1 8 14.8 11 7.8 8 14.8 10 7.1 16 29.6 6 4.Z 9 16.7 2 1.4 9 16.7 2 1.4 1 1.85 - 1 .7 2 3.7 141 100.0 54 100.0 It will be noted that vhlle 8 percent of the men in Thetford Hines were over 40 years of age only 28 percent of the men in Asbestos were over 40. And for* ther with respect to length of service 82.4 percent of the men examined in Thetford UineB had worked in the as bestos indnstzy for 10 years or more, bat in Asbestos only 22 percent had worked for more th$n ten years* Table XII shows the disposition of the sen in various parts of the industry. Since the numbers are 1066 email 'broad occupational groupings are used. In Asbestos the occupations are divided into 3 groups - mill, pit ana factory; in Thetford Mines only the first two occupational groups are used, einoe no aabeetde Bhufaotaring is carried on there. All the men of the Thetford Mines group oould he so class ified, but 6 men were excluded from the Asbestos group sines they did not appear to be exposed to an unusual amount of dust. T A B 1 E III <7 [EHOTH 07 SERVICE Iff PIFFEBEKT 00CUBATI0K3 III ASBESTOS IHJUBY ASBESTOS THBTFOHD MINES Years of Mill service 0- 4 14 Prilling pit 7 Factory 24 Hill 1 Drilling pit 9 36 8 16 3 5 10-14 6 6 71 16-10 7 5 12 4 BO-24 3 1 81 26-29 1 1 81 30-64 1 1 1 35-39 1 40-44 2 TOTAL 9 27 40 40 14 The past occupational history in industries other than the asbestos industry was significant only in 5 cases. Of these one had been a grain inspector 1067 5 tor 6 year8 and so exposed to very dusty conditions, one had been an underground copper miner for 18 years, one a oopper miner for_2 years*, a fourth had worked in a cement plant for 9 years, and the fifth had operated a drill in an iron mine. TBis last individual showed X-ray evidence of pneumoconiosis, the others did not have pneumoconiosis* In Table IV are given observations of weight in relation to ^J.ght by age* The average weights are taken from the figures compiled by the Association of life Insurance Medical Directors and the Actuarial Sooie^r of America. TABLE IT. WEIGHTS AM) HEIGHTS ACCORDING TO AGE Pofmds Under average pounds over average - 20-39 10-19 5-9 -4 to 44 5-9 10-19 20-39 ASBESTOS 9c* 21 28 19 24 16 19 9 4> 16.0 20*0 13*6 17.1 11*4 13.6 6.4 THETPOHD So. 9 STBSs" . 16.7 Group. of 10,000 mal 9 Industrial workers is 11 20.4 18 8 14.8 11 9 16*7 3 5.6 21 -IJ9 6 11.1 14 7 12*9 10 404 4 2*9 1 1.8 3 The group of 10,000 male industrial workers re ferred to in the above table was studied by the United States Public Health Service f see Public Health Bulletin 1068 Bo. 162). It will be noted that there is very little distinction between this large group and the group of asbestos workers so far as degrees of overweight or underweight are oohoerned. In the consideration of individual defects some interesting facts have been found. In this study only the 101 men at Asbestos and the 54 men at Thetford Mines are considered, since the records of the men ex amined by Dr* Stevenson are not strictly comparable with mine* TEBTH*Dividing the men into two groups aooording to whether the teeth did or did not need attention, of the Asbestos group 49 .^required attention, and of the Thet ford Mines group 51.8 $o. HEARING Acuity of hearing was tested by means of a watch. fMy own hearing, which las been tested by an audiometer, was considered nofmal, and used as a standard) The watch test is admittedly very rough. In noisy occu pations impaired hearing is frequently found in the older employees. Of the 101 men at Asbestos 10 showed definite hearing loss. This is not an excess proportion since any 106 V group of adults will show a similar picture. In Thetford Hines 28 of the 54 men suffered from well marked hearing loss. This is a very high percent age, and comparable to what may be found in weaving sheds and holler shops. All these meht except,two, had been exposed to loud noise in their work for 10 years or more, and it is reasonable to suppose that noise played a psrt in their hearing, disability. The number of men with infected TOUSIIS was 27 in Asbestos and 13 in Thetford Hinas, and al most lndetloal ratio to the total in both groups* Defects of the THYROID were rare. 4 men in Asbestos and 1 in Thetford Hines had enlarged thyroids. BIPOD PRESSURE Readings were recorded In all men over 40 years of age. Except in exceptional circumstances the blood pressure was not taken in the younger men. Consequently although the groups examined In Thetford Hines was smaller than that in Asbestos more blood pressure readings were taken there. 2 men in Asbestos had blood pressures of over 150 and 2 blood pressures under 100 m*m of mercury* B men in Thetford Hines had blood pressures of over 150 and 2 blood pressures under 100. 1070 8 The incidence of HEBSIA is of interest from the oompsnsatlon standpoint. In Asbestos all new emp loyees must pass a physical examination before employ ment. There were 4 cases of inguinal hernia discovered among the 101 men examined there. In addition to these 5 men had been operated upon for this condition In Thetford Mines physical examination is not required before employment. There were 5 oases of In-, guinel hernia among the 54 men examined and 2 oases which had been operated upon. Some Interest has arisen in connection with the occurrence of the so-called ASBESTOS COM3. These are usually pin head sited elevations of the skin* some what like minute warts. Hone of these were detected in the Asbestos men probably due to my ignoranoe of their appearance. B of the Thetford Mines men had these growths on their hands and several others reported having had them, at one time or another. ion 9 I IT B G S ___ Of the 101 men examined by me at Asbestos only 4 suffered from definite first stage pneumocon iosis* These frill not be considered on account of the doubtful diagnosis* Of the 40 men examined by Drs* Stevenson and Wyatt 14 were diagnosed as first stage pneumocon iosis (asbestosis 1) (l am including the 17 men ex amined by Drs* Stevenson and Wyatt and subsequently are-examined by me in my group of 101). The muoh lesser incidence of pneumoconiosis in my group of men may seem surprising, but it must be remembered that the X-ray negatives were not read by the same men* In my group the X-ray diagnoses were made by Dr* fieriwether of Ditcher, Oklahoma, and in the other group- the lnterpretatlona were by Drs* Wyatt and Donoopot* Further the A' gra&p examined by Drs. Stevenson and Wyatt were* in gen eral* older than those In my group* Of the S4 men examined at Thetford fiines 24 were diagnosed by X-ray as suffering from pneumoconiosis (asbestosis), of these 4- were diagnosed as probably first stage asbestosis* f> as early stage, ? as definite first stage and 3 as second stage* the pertinent faeie regarding the deflate eaees of asbestosis are given in tables 7 and 71. 1072 10 Table V Exam* DiagHo. Hoele Afi* Occupational history Symptoms _ Asbestos Group. Sims. 66 A.l 71 A.1 36 A.1 ?4 A.l 2C00 A.1 3? Screen & oyclons 10 years 47 general operator ftftftkt foreman 54 years 42 loading ears in mill & foreman 9k ye-irs 50 l driller 7 years 41 Millwright M years cough,dyspnea deficient expansion loss of otrenglth 000, crepitations 17ft apex. cough, dyspnea poor expansion, pore- frequent colds ussion diminished left cheat, crepitations all over both lungs. no cymptome no abnormal signs. no symptoms dyppnea,cough no abnormal signs. no abnormal eigne 2301 A.1 2002 A.1 r motor attendant no symptoms for it years 35 millwright 14 years no symptoms faint moiet raise 3 & 4 rib in front. no abnormal signs 200? A.1 ?c labourer & watch man in mill 5 years no symptoms 2015 A.1? 23 labourer top floor mill, 2 years no symptoms 2020 A.1 47 in mill 16 years no symptoms 2021 A.l 52 millwright JO years no symptoms 2025 A.l 2:27 A.l 20^2 A.1 2055 A.l 20J4 A.l 20J6 A.1 20*72 A.l 63 mason in alii 26 years no symptoms 43 mine (work not stated) no symptoms 1? yearB 4.3 driller 4 years no symptoms 41 driller 2? years no symptoms 60 driller 4 years no symptoms ajiareman f years foreman 2J years 57 driller 5 years trackman 4 years no symptoms 22 pipe corarer no symptoms (factory) 4 years alight dullness right base,left chest expands more than rignt. breath sounds et apioee harsh do abnormal signs expansion slightly limited expansion limited no abnormal signs no abnormal eigne no abnormal signs absent vocal fnitus bronchial rales left Bide no abnormal signs. 1073 Table VI Exam. DiagNo. nosie Ak'b Occupational hintory Symptoms Tbetford Mines Group Signs. t A.l 42 filling bage ( yerae no symptoms coarse slicks above heart * ; oiler--1C years foreman 4 years & at both baseo behind. 5 A.1 43 driller 25 years no symptoms no abnormal signs 6 A.l . 3? cleaner In mill 3 yre. dyspnea no abnormal signs (probably' . flllingg bags 4 yrs. 11 A.2 52 millwright 27 years dyspnea no abnormal signs 12 AO. A? sweeper 1C* years (early) cough & exp ectoration, coarse crepitations left apex behind Ooc, blood in sputum,dyspnea loss of weight 1.3 A.l 52 millwright 21 years cough is exp- dry rales over rt,oheat ectoration, behind, expansion deficient dyspnea, loss of weight a. strength A.1 47 millwright 21 yoars cough occasional dry rales at (probably) left base iii A.1 2'`> 1? A.1 4? (early) driller 11 years driller 17 years no symptoms history of pleurisy, no ab.-iormal signs noabnoraal eigne sister died 21 A.1 52 ^millwright years of t,b,o. dyspnea no abnormal signs (early) 2? A.l e-62 driller 40 years (early) No symptoms many crepitations right base. 26 A.1 2? driller 6 years No symptoms no abnormal signs (early) general work in pit 4 years 2& A.1 44 filling bags 1 year history of no abnormal signs dust shed C years 50 A.1 25 in mill $ years hemoptysis cough, dyspnea no abnormal signs (early) in tunnel feeding crusher 3 years suspected t,b.c in 1S23 A A.l 53 orueherll years no symptoms no abnormal signs (early) sweeper in mill 4 yrs. oiler in nill 3 yerae 5.5 A.l 56 loading boxes in pit sister died a Showers of fine oropitattns 25 years, feeding of t.b.c. both lunge behind from 4 the mill 5 years vertebra down,percussion ?s> A.1 3? (early) 5 miiiwrigit Idjjcnatb foreman 26 years dyspnea note diminished no abnormal signs 4o A.l 62 feeding crusher to year dyspnea cleaning in mill 15 yrs,B crepitations in rt.axilla & 1. base behind. 4l A.1 46 feeding orpsher in mill no symptoms no abnormal signs (probably) 6 y^arBg driers lyear, foreoan In mill ^ yearn 1074 Table VI (continued) Exam. Slag-. No. Qoelg Age Occupational history Fyaptoas Signs Thetford Kines Group (cont'd) ^ A.l Cearly) 51 A.l *51 (probably) 33. A.l 5c A." 4? 2? A.l Vi (lato) - loading boxes in pit yrs. driller ( yrs. operator in mill C yrB., millwright 10 years oiler in mill 10 ywe* foreman mill ? yrs. Laill repairs t J yrs. mill foreman 1' yrs. Foreman mill V} yra. millwright 7 yrs. no symptoms no abnormal signs. no symptoms percussion leso resonant over right lung, showers crapitat.ons right side front i> bank/-, over left U;.ar lobe front & basic. son died fe.b.C. expansion poor, many daughter has crepitations 1. apex & tuberculosis. in r. axilla, crepitations r.l 1. upper lobes behind ' at both baoes. cough,dyspnea expansion poor,percuesion poor nt a;, feces. no rales. no symptoms no abnormal eigne. 1075 *5 Zt will be noted that of the 14) men examined at Aebeetoe 17 were diag nosed as first stage asbestosis, while of the J4 em.ii.ned at Thetford mass ST were diagnosed as first stage aebettoels and 5 as second stage asbestosis. This Is not to be interpreted as indicating an excess hazard in Thetford Mines* The increased inoi^enoe of pnaumonooonioeis j,n Thetford mines is simply a reflection of the different distribution with respect to age and length of service. Reference to tables 1 and - will reoall the great differ eneee in these two things. In the great majority of eases the length of service in dusty work was more than 0 years os indicated in thefollowing table1 length of ssrvioe Number Of oases Numbar of men examined. 0-4 yrs. 3-9 10 - 14 1** 6 over Total f> *n 7 41 44 75 1? 5? ... ....... . ____ VI,___ ____ Prom this table one would conclude that asbootoeis is not likely to develops with an exjxjaure of less than 3 years, but that with exposure of more than 1? years there is a great possibility of it developing. Zt Is, however, of interest to remember thatomy men with long periods of ejqoeuro do not develops any signs of asbestosis. As to occurstlons of 41 drillers 15 were cases of asbeBtosis, of 10? mill workers 07 were oasee of asbesteais and of 4o workers in the factory only 1 ease showed x-ray evidence of the disease. Evidently there is little difference in the hazard in mill workers and drillers. The mill workers appear to be exposed to far greater diet con centralions than the drillers and it is rather difficult to undsrstdnd ter the high incidence of asbestosis among the drillers. However, It may ar may not be of interest tox note that 1076 14 that the drillers are occasionally exposed to granite dust Bgrnr of.tbe-^eases of asbestosis a; peered to suffer from disabling symptoms. Perhaps the most, common symptom was shortness of breath, but losa'ttian half the oases complained ofthis symptom (U of the 4l oases). As to Physical siCTS I won unable to find any pathognomonic signs which would enable one to mahe a diagoeia in the al-oence of the x-ray picture. Inspection of the lungs was of little value since it wio difficult to evaluate the degree of diaphragmatic excursion And sometimes expansion a.-.care* to be deficient when actually it was not. If a respiration tank had been available some quantitative Idea of vital capacity might have boen attained; the measurement of sheit expansion by a ta^e measure was given up after the firnt 1examinations. Since there ie not standard pithh of percussion note and no standard intensity of tactile fremitus or vocal resonance one has to compare one side of the chest with the other to detect abnormalities. But asbestosis ie essentially a symmetrical lesion and in tills diseaso the comparison of the two sides of the chest is of little help. The same observations apply to the quality of the breath sounds. The most frequently found abnormality was the presence of rales, p rtioularly crepitant rales. In many of the more severe cases showers of these rales occurred throughout both Aides of the ohest,particularly on coughing, but in two of the three cases of second stage asbestosis these rales were not heard, so that evidently thejra are not a constant sign of the diseas*. On clinical examination two or three of the oases with large numbers of orepitant rales at tbapiees were thought to be tuberoulous but the x-ray examination did not confirm this impression 1077 Tuberculosis did not play an important part 1 the study. Rone of the oases of aabestosls appeared tft be complicated with this disease. Indeed the incidence of definite tuberoulosis in the too groups of individuals was very low. There were several suspected oases on clinical examination which were not confirmed by x-ray and several suspected caseB by x-ray which showed no real evidence in the way ofaignB and symptoms. Only one case in tne groups can be considered as activity tuberculous. It was difficult to obtain sputum from most of the men since very few of the?t were coughing. About 12 sputa were examined for tubercle bacilli and asbestos bodies* No tuberole bacilli were found but one case did ehow several asbestos bodies. This case was diagnosed by X-ray as probably asbeetosls (first stage) but is not included in the number of asbestoeis oases since the x-ray film was not oatlsfao4ory. Conversation with physician? and Aine managers in the asbestos regions^' indicated that no hazard to health was suspected in connection with work ' in the asbestos mining and milling industry. In general it may be said that the hazard of pneumonoconioais in the asbestos mining and milling industry hue been demonstrated! but evidently the disease does not incapacitate to any great degree and apparently it is not particularly associated with tuberculosis. 1078