Weller Consultant and Honorary Senior Lecturer Enc Insurance Reinsurance and Underwriting Names Asbestos Related Diseases Liability for Hampstead Health Authority Insurance Reinsurance and Underwriting Names Liability for Asbestos Related Diseases Introduction The association between asbestos fibre inhalation and lung disease has been known for a long time and Pliny the Elder and Strabo described sickness in slaves who worked with asbestos The modern history of the association and the serious cancer complications are outlined Twenty seven years ago encompassing the average latency of five to ten years for asbestosis to develop American legal safeguards based on inadequate sampling procedures specified maximal average levels which were 25 higher than the British during which the peak exposure which is the critical factor could often exceed by official measurements these average levels by over 400 times Scientists and indus- trialists were on record as appreciating that these levels were too high for reasonable safeguard As the term effects became better appreciated with lower exposure levels leading to greater longevity the association with cancers of the lungs the lining of the lungs and the abdomen became apparent Hueper writing in 1951 stressed that the actual connection between asbestosis and lung cancer appears very likely Hueper's views had been expressed earlier Hueper 1943 in a paper that was considered by an executive of the Mandofville Mandofville Corporation now Manville the largest - American asbestosis company Gardner 1946 The same concerns were expressed slightly earlier again in Canada Norway and France and a little later in Italy Desmeules et al 1941 Macklin and Macklin 1940 Wolff 1940 Lecoeur 1942 Mottura and Faggioano 1949 There is evidence that American manufacturers were negligent in failing to protect their workforce from even the specified maximal exposure or to inform them of the gravity of risk to which they were subjected The result has been a flood of litigation claiming damages to compensate victims under the general principles of liability in tort instead of the previously used more limited and modest compensation provisions of the Workmen's Compensation Acts The high cost of litigation results in only 39 of a successful claim eventually being paid to victims who may die before settlement The same issues are repeatedly considered by Courts and the ensuing costs are sharply exemplified by Picher Industries Inc now in bankruptcy proceedings whose litigation and attorneys costs in 1989 for approximately 137,000 claims pending against it were 119.7 million Since 1982 10 other major asbestos companies have filed for bankruptcy due to asbestos claims The Court rulings which cannot be appealed have lead to wide- spread criticism In essence there has been a shift to strict product liability to third parties for a manufacturer once his product has entered the chain of commerce and an opening up of general liability insurance policies many years after they were written to cover claims which at that time had not been contemplated The entire population has become potential claimants critics assert to compensate retrospectively for inadequate protective legislation practice and health care Yet it is impossible to insure the entire population since it is impossible to quantify the risk a prerequisite to setting premium rates The history of the recognition of the problem of asbestosis and associated malignancies and the implementation of protective industrial techniques are informative and relevant to the fact that the global results of Lloyds of London are in heavy deficit and worse is believed to follow British underwriting names have been driven to bankruptcy some having debts of 750,000 on a standard share in one beleaguered syndicate There are central issues to insurers and reinsurers liablity that merit further study Medical Issues Asbestos is a combination of silicates of magnesium and iron It is a versatile substance which is incombustable is capable of being woven into fabrics and can be impregnated with a variety of substances It is used in the manufacture of mattresses brake- linings proofing material electrical insulation jacketing boilers and steam pipes and in building products It was used for heat insulation in 1866 and asbestos cement was introduced a few years later There are three main types of which the blue variety crocidolite is the most toxic All three types are strong with crocidolite being inferior in tensile strength only to steel wire Amosite is a naturally long fibre an important variable in the relative industrial risk whereas white asbestos chrysolite which constitutes some 93 % of the world production is a very short fibre and less dangerous When the insoluble fibres are inhaled they remain in the body and cause progressive damage Asbestosis a term first used in 1924 by Cook in a paper published in the British Medical Journal is a slow insidious progressive replacement of lung tissue by fibrous tissue incited by the destructive asbestos fibres The reserve capacity of the lungs allows the development of the disorder over many years without severe symptoms until the damage is well advanced The pathological changes in the lungs throws a strain on the heart which has to pump blood through the damaged lungs and leads to congestive heart failure 1927 According to Dreesen et al whose ations Public Health Bulletin No. 1938 241 report and influenced recommend- subsequent American legislation in cases uncomplicated by infection asbes- tosis progresses by discernable stages similar to silicosis generally The increasing replacement of functional lung tissue by fibrous tissue results in shortness of breath cough weakness and chest pain which tends to impair working efficiency As the disease progresses further the sufferer does not appear well usually being considerably underweight and appearing tired and listless The surviving functional lung areas generally the apices become distended emphysema and the pathways to them dilated bronchiectasis and brochiolectasis facilitating infection At this stage detection of the condition by the traditional clinical methods of inspection palpation percussion and auscultation is generally possible ray changes are more sensitive to early pathology and progress from an exaggeration of the normal linear markings to granular changes caused by a fine fibrosis within the tissue spaces aptly described by Merewether 1933 as ground glass a term often used subsequently The radiological changes are characteristically more apparent in the bases of the lung unlike the pneumoconioses induced by other silicates with the exception of mica Later workers have emphasised characteristic patches plaques of radiographically opaque material on the lining of lung and thoracic cavity pleural surfaces A dry and non productive cough is common Later severe paroxysms of coughing may produce highly tenacious sputum sometimes streaked with blood There is a blue tinge to the lips cyanosis indicating inadequate oxygenation in the latter stages of the disease Reduced chest expansion and so called clubbing of the finger tips and curving of the finger nails pathognomonic of lung and cardiac disease are present in these cases The asbestos fibres migrate to other tissues where too they exert pathogenic effects particularly the induction of cancers probably at least in part by binding carcinogenic substances such as the products of tobacco smoke so that smokers are at much greater hazard 1 The combined hazard is more than add- itive so that the risk of lung cancer from asbestos exposure uncomplicated by smoking is increased some five times over the expected rate and the increased risk from smoking is probably elevated eleven times but the combined effect of persistent asbestos exposure and smoking is an increased risk of lung cancer 53 times Hammond above the 1966 levels prevailingin the general population ne Stopping smoking can considerably lower the risk of lung cancer among those previously exposed to asbestos and this is an issue that touches on contributory negligence that I believe has been little explored Two asbestos defendants have taken action against the tobacco industry in complaints filled in Bell v Manville Corp.

LEAD ORGANISATION C.

Wear, 158 (1992) 193-211 193 Friction and wear of PTFE - a review S.

Routine dosimetry results for the month were: O O -P" VCM Lead Total Particulates < PEL Nvmfrftir Percent 72 98.6 7 100.0 1 100.0 >_________________________ Number 1 0 0 Iniurv Class Compound Description Minor laceration of right index finger.

The monthly safety meetings were held on shift with each shift supervisor leading discussions focusing on shutdown safety issues and other shift concerns.

Routine dosimetry results for the month were: Chemical <_________________________ Number VCM Lead Total Particulates 72 100.0 4 100.0 2 100.0 Monthly Inlurv Summary > PEL HuBk Egrcepp 00 00 00 FA RWC FA Adm.

Environmental incident resulting in cleanup off site or a fine Event leading to need to evacuate members of general public Properly damage and/or business interruption >$50MM and <$800MM Fire or explosion leading to properly damage off site LEVEL 4 (Unacceptable risk must be reduced to level 3 or less) Multiple fatalities on or off site Permanent environmental damage to an area >5 hectares of a natural habitat off site Properly damage and/or business interruption >$800 MM.

Routine dosimetry results for the month were: Chemical > PEL__________ Number Percent VCH Lead Total Particulates 76 98.7 6 100.0 5 100.0 1 1 0 Both overexposures were with benefit of respiratory protection.

Wear, 158 (1992) 193-211 193 Friction and wear of PTFE - a review S.

Journal of Hazardous Materials, 27 (1991) 111-126 f Elsevier Science Publishers B.V., Amsterdam fiTfi **-. .z 111 p;k Health risk assessment of biodegradable volatile organic chemicals: A case study of PCE, TCE, DCE iand VC H.C.

The ulti mate goal of the new law is to allow Ameri cans with disabilities to lead productive lives by providing, in general, minor accommoda tions to accomplish this goal.

The major obstacle to this procedure has been the need to overcome the extreme immunogenicity of hemoglobin, so that a minor modification by a particular en- vironmental toxicant may not lead to production of antibodies against the adduct, only against hemoglobin.

What are the mechanisms by which reactive metabolites ofbenzene influence bone marrow function leading to aplastic anemia?

New combinations almost certainly will produce astonishing results across the life sciences and lead to solutions for many large, intractable human problems.

UNITED STATES DISTRICT COURT WESTERN DISTRICT OF VIRGINIA ROANOKE DIVISION 1 BARBARA S.