trial contamination in Winnipeg, the pollu- independently viewed. In Winnipeg, none of tants are thus readily dispersed. The prevalence of anatomic emphysema in similar age groups was significantly different. Figure 3 shows the prevalence in the two cities. There were practically no cases of emphysema in Winnipeg in subjects under the age of 50. In the late age groups, however, the curves of the two communities approach each other. For convenience, we have divided the cases into three age groups as in Fig 4-20 to 49, 50 to 69, and 70 and over. In the first group, there were seven times as many cases of emphysema in St. Louis as in Winnipeg. In the second group, the ratio of emphysema was two to one, and in the third group, this ratio was 1.5 to 1. The principal difference of the emphysema profile in the two cities rests upon the severity of the disease process. On Fig 5 the extent of anatomic emphysema is shown for the three age groups. In Winnipeg, severe emphysema was uncommon in any age group; whereas, the cases of advanced emphysema were encountered in all age groups in St. Louis. In the older age groups there were six times as many cases of severe emphysema in St. Louis as there were in Winnipeg. Anatomic emphysema in relation to lifetime smoking habits is shown in Fig 6. In nonsmokers there was more emphysema in St. Louis than in Winnipeg although the degree of emphysema in the latter city was not severe. Of the smokers, there were four times as many cases of severe emphysema in St. Louis residents as was observed in Winnipeg. In Fig 7 and 8 the men and women are the female subjects had a moderate or severe degree of emphysema regardless of the smoking habit although more emphysema cases were found in the smokers.6,7 The general trend of the emphysema profile in both cities was a reflection of the characteristic male pattern often recorded in medical literature. Summary There was considerably more emphysema in St. Louis than Winnipeg, and the anatomic emphysema was found much earlier and appeared to progress more rapidly. In neither city were cases of severe emphysema observed in nonsmokers. From these basic observations on these two cities, which have striking differences in the degree of environmental pollution, it appears that smoking is not the only factor concerned in the development of emphysema. The importance of environmental pollution is further strengthened by the fact that the incidence of severe emphysema in comparable groups of cigarette smokers is four times as high in St. Louis as it is in Winnipeg. These findings suggest that the development of emphysema may be related to a synergistic effect of smoking and environmental pollution. The sharp distinction between the emphysema profiles of these two cities further emphasizes the epidemiologic value of correlating various parameters of urban living with patterns of lung pathology. This investigation was made possible through the support of a Medical Research Council of Canada grant 606-7-109 and National Institutes of Health grants H3737 and 2G270. References 1. Thurlbeck, W.M.: The Incidence of Pulmonary Emphysema With Observations on the Relative Incidence and Special Distribution of Various Types of Emphysema, Amer Rev Resp Dis 87:206-215 (Feb) 1963. 2. Heard, B.E., and Izukawa, T.: Pulmonary Emphysema in Fifty Consecutive Male Necropsies in London, J Path Bact 88:423-431 (Oct) 1964. 3. Wyatt, J.P.; Fisher, V.W.; and Sweet, H.C.: The Pathomorphology of the Emphysema Complex, Amer Rev Resp Dis 89:533-560 (April) 1964. 4. Anderson, D.L.: The Effects of Air Contamina tion on Health, Canad Med Assoc J 97:528-536; 585-593; 802-806 (Sept 2, 9, and 23) 1967. 5. Ferris, B.F., Jr., and Whittenberger, J.L.: Environmental Hazards, Effects of Community Air Pollution on Prevalence of Respiratory Disease, New Eng J Med 275:1413-1419 (Dec 22) 1966. 6. Anderson, A.E., Jr., et al: Emphysema in Lung Macrosections Correlated With Smoking Habits, Science 144:1025-1026 (May) 1964. 7. Petty, T.L.; Ryan, S.F.; and Mitchell, R.S.: Cigarette Smoking and the Lungs, Arch Environ Health 14:172-177 (Jan) 1967. Arch Environ Health-Vol 18, April 1969 Senator EAGLETON. Thank you, Dr. Flance. Dr. Flance, I will address this question to you. I direct your attention to your prepared statement which you just read. Have you or your associates made an effort to compile statistics on illness in St. Louis County caused by air pollution? Dr. FLANCE. No, sir; we have no systematized study. Our information is based on our own individual practices and I have included my own experience in this statement. Senator EAGLETON. Would there be any way through the good offices of the great medical institutions such as Washington University for all of the internists and radiologists who deal with lung disorders, to correlate and compile information so that it would be broadened beyond the findings of an individual doctor with his group of patients? I am not quarreling with you or with your patients, but seek to broaden the base of statistical analysis by including other doctors. Is that possible? Dr. FLANCE. It is perfectly possible and feasible. Senator EAGLETON. I know this would take time to do because you have to study a case history over a considerable period of time. But in the months ahead and indeed in the years ahead, I know this committee would be appreciative of such statistical information if it could be made available. Dr. FLANCE. Senator, those studies have been done in Chicago by Dr. Carnow, and that is why Dr. Rockoff made the statement that the same clinical conditions that exist in Chicago exists in St. Louis. And Dr. Carnow in Chicago has been engaged in a long-range study just as you have proposed for the city of St. Louis. Senator EAGLETON. Well, I think the studies in other large metropolitan areas are, of course, directly relevant. They are always subject, as you and Dr. Rockoff pointed out, to the challenge-though I don't think always meritorious-that conditions in Chicago are not identical with conditions in St. Louis. Nothing is identical. I can see where they are roughly analogous and ought to be given merit and weight on that basis. We will have that study made available to us. Let me ask Dr. Rockoff if in your prepared statement in the last full paragraph you discuss, and I will quote: "For instance, there are at present not uniform statutes regarding the emission of trace elements, even though some are known to be hazardous, such as arsenic, beryllium, and cadmium." And I would add, I think, mercury would be in that same category. I take it that, Doctor, you would favor Congress enacting at the very least, if we did nothing else, what might be called a Hazardous Materials Emission Control Act which absolutely and in total prohibited the emission into the atmosphere or the air of arsenic, beryllium, cadmium, mercury, and such others so patently dangerous items as not to be tolerated in even the slightest degree? Dr. ROCKOFF. Absolutely, and not only that but I would like to point out that asbestos, which is commonly used as building material, and certainly is emitted in the burning of debris from any buildng, is known to be a cause of human cancer, there is not question about that any more. In fact, I recently saw a patient, a case of a man with multiple cancers in the lung in the areas of the deposition of just a few asbestos fibers. There is a body of knowledge that appears to believe that it doesn't take much asbestos exposure to predispose one to can cer. Yes, I think that there is good evidence that "hazardous materials" emissions should be controlled now. Senator EAGLETON. May I make one other point? There can be no debate, no rational excuse for a variance from one region to another when you are dealing with lethal items such as these? Dr. ROCKOFF. That is correct. Senator EAGLETON. And medically supported unanimously so? Senator EAGLETON. Let me ask either one or both of you, can either of you doctors identify any direct effects of the August shroud episode in your patients? Dr. FLANCE. Yes, sir, we have had, I have had many calls from people at that time who were complaining of various respiratory symptoms. Senator EAGLETON. To your knowledge, was there any statistical increase in the death rate subsequent to the August shroud episode, that is, an increase over what would be considered the normal death rate? Dr. FLANCE. To my knowledge in the city of St. Louis those statistics are not as yet available, Senator, and I have no such information. I must however again allude to the studies that are done elsewhere where similar studies have been done and an increased death rate has been shown to take place in the city. The city I am referrng to is Chicago. Senator EAGLETON. You both are aware that on November 12 hearings will be held in St. Louis by the Missouri Air Commission to establish emission standards under the 1967 act. 'Have either of you gentlemen been provided with a prospective set of standards so you could give them your analysis and your attention prior to that hearing? Dr. FLANCE. No. Senator EAGLETON. Would it be helpful to you and other doctors, other scientists, other people with professional expertise, if you could have those prospective standards made available to you so you could delve into them in depth and not be hit with them cold on November 12 for instantaneous briefings? Dr. FLANCE. Yes, sir. Senator EAGLETON. We will try to see if we can get them to you so that on November 12 it isn't just a token public hearing and an exercise in futility, so that witnesses with qualified backgrounds can see whether the standards proposed to be adopted in their State are significant, and have teeth in them, or are so lenient and so loose as to be perhaps worse than no standards at all. Thank you. Representative SYMINGTON. Dr. Rockoff, again in your statement you mention the need for international compacts to govern these questions. Are you aware of the U.N. discussion of this question set for about 1971? Dr. ROCKOFF. No, I am not. Representative SYMINGTON. Well, I wasn't either until Friday of last week when it was brought up at the environmental meeting; Senator Hughes was chairing there, and apparently there is to be such a meeting and I am very much hoping that men with your background and expertise can somehow contribute to the work product of such an event and I will try to be in touch with you to that end. I think not only is it necessary for the industrial countries of the world to realize what in concert they are doing together to destroy life peacefully just by more of the same other than by nuclear exchanges, but also provides a rather interesting opportunity for the superpowers to do something useful together and might even get them in the habit. Dr. ROCKOFF. We will welcome the opportunity of assisting in that. Senator EAGLETON. I would like to read into the record at this point, because I think there is some apprehension, and perhaps some of it mistakenly so, that the present Federal act does not contain any authorization for emission standards. I will read from the report filed by the committee in 1967 at the time the act was voted upon, page 29 thereof: The achievement of established ambient quality standards contingent upon the application of meaningful emission controls on the various sources of air pollutions within a given air quality control region. And subsequent to that report the Department of Health, Education, and Welfare, which has the administrative chore so far as the Federal Government is concerned of enforcing this act, has promulgated its guidelines for the development of air quality standards and implementation plans. Page 22 thereof, section 2.30, Implementation Plans, reads in part as follows: Legally enforceable emission standards applicable to sources of that pollutant ordinarily will be a principal element of the emission control strategy but not necessarily the only ones, other elements may include regulations pertaining to fuel use, rules for the location of new industrial plants and other sources of the pollutant, restrictions on open burning, plans for disposal of solid waste materials and so on. I just wanted the record clarified about the present law, with which some people are very dissatisfied. There are some things that ought to be changed in the present law, but I don't want to leave the impression it was so denuded of criteria and standard-setting factors as to be worthless. Thank you both Dr. Rockoff and Dr. Flance, we appreciate it very much. The next witnesses will appear in tandem. They represent the Committee for Environmental Information. Dr. Raymond Slavin, chairman, air pollution committee, director of allergy and immunology, assistant professor of internal medicine, St. Louis University Medical School, and Dr. Robert E. Kohn, member, scientific division, assistant professor of economics, Southern Illinois University, Edwardsville, Ill. While these two gentlemen are taking their seats, I have been informed-I can't see because of the lights that we have present in the audience perhaps the one man who in his time when conditions were even worse than they are now, if you can imagine that, did more than any other one individual to attempt to clean up the air in St. Louis. I am pleased to introduce for recognition the former mayor of St. Louis, the Honorable Raymond Tucker. [Applause.] Dr. Slavin, you may proceed. STATEMENT OF DR. RAYMOND SLAVIN, CHAIRMAN, AIR POLLUTION COMMITTEE, COMMITTEE FOR ENVIRONMENTAL INFORMATION, AND ASSISTANT PROFESSOR OF INTERNAL MEDICINE, ST. LOUIS UNIVERSITY, ST. LOUIS, MO. Dr. SLAVIN. The acute air pollution episode St. Louisans experienced in August was felt throughout the Midwest, from Columbia, Mo., to Cleveland, Ohio, and from north of Chicago to the gulf. Meteorological conditions were similar in the whole area; pollution levels depended on the amount and type of pollutants emitted in the various cities. Lest we think that this was some kind of meteorological freak, a similar weather situation prevailed several days later. The only factor saving us from a new pollution episode was the Labor Day weekend closing of industrial plants. The point was thus brought home that there is nothing inherently dangerous about a weather inversion-the hazard depends on the amount of pollutants waiting to be trapped by an inversion or other stagnant air condition.1 St. Louisans suddenly sat up and took notice. Donora, Pa., London, England, New York City-cities where air pollution disasters have occurred no longer seemed so remote. The point was that it could happen right here in St. Louis. It was at this point that St. Louisans began discussing in newspapers, on radio and television, in their homes, schools, and places of employment, plans for cutting down on emissions of pollutants when weather conditions are unfavorable, and thus avoiding the seemingly inexorable path to an air pollution disaster. There is more than one course of action open to us. We are referring now to different basic approaches to the problem of avoiding an air pollution disaster. One approach would focus on a disaster plan with no other basic change in our current day-to-day air pollution control efforts. Alternatively, we could concentrate on lowering daily pollution to levels where even prolonged unfavorable weather conditions would not produce a disaster. I am not here to recommend either course of action. The purpose of my testimony on behalf of the Committee for Environmental Information is to share with you our evaluation of how much can be accomplished by each of these approaches. Which one is selected depends not only on an evaluation of available data and a knowledge of medical effects of pollution but also on the value citizens and their representatives place on human health; property, materials, plants, and esthetics; how they balance these against the economic values represented by unrestricted industrial operations; how much tax money they are willing to invest in establishing and enforcing controls. When it comes to such decisions we are no more expert than other citizens. 1 Members of the CEI Air Pollution Committee of the Committee for Environmental Information are: Raymond G. Slavin, M.D., chairman, assistant professor of internal medicine, St. Louis University School of Medicine; Stanley C. Becker, M.D., Ph. D., assistant professor of ophthalmology, Washington University School of Medicine; Peter P. Gaspar, Ph. D., associate professor, Washington University Department of Chemistry; Jack Hartstein, M.D., assistant professor of ophthalmology, Washington University School of Medicine Robert Karsh, M.D., assistant professor in internal medicine, Washington University School of Medicine; Robert E. Kohn, Ph. D., assistant professor of economics, Southern Illinois University; Albert J. Pallmann, Ph. D., professor of meteorology, St. Louis University Department of Earth and Atmospheric Sciences; John A. Pierce, M.D., associate professor of medicine, director of division of pulmonary diseases, department of internal medicine, Washington University School of Medicine; and Seymour V. Pollack, M. Ch. E., associate professor of computer science, Washington University. |