Of the 760 cases in the registry, 215 are acute cases meaning the illness began abruptly at the time of exposure, 490 suffer the more serious chronic disease often occurring some years after the patient has left the beryllium-using industry, and 210 of the 760 patents (27.5 percent) are dead.

TABLE 5.-Delay in onset-Chronic disease

These numbers give some perspective to the problem but the registry lacks some knowledge that would be useful in answering the questions you are likely to ask. Such missing facts are (1) How many workers were similarly exposed and did not become ill? (2) How many became ill and were either sick only briefly or beryllium was not recognized as the cause of the illness and, (3) to what beryllium compounds were the sick workers exposed, how much, and for how long?

It is useful to repeat the fact that until 1949 no attempt was made to reduce or control in any way beryllium exposures in the United States, which helps to account for the size of the problem. The registry, used very little by industry, has helped teach doctors the character of beryllium disease. In addition its data have brought to light certain facts as to which industrial exposure caused the highest death rate, the value of treatment, how to make an accurate diagnosis, and the effect of certain control measures.

Of greatest interest to you are the 60 cases in the registry of illness in individuals who never went in the plant. Thirty-one of these patients are dead. In 27 cases the only exposure was to work clothes contaminated with beryllium; in 13, work clothes and air containing beryllium were thought causative; in 17, air alone was felt responsible. In two no data of value is at hand but beryllium was found in tissue and the illness was characteristic of the recognized worker cases.

TABLE 7

HAZARD OF CONTAMINATED CLOTHING:

Breslin & Harris, clothes put into machine, 40 micrograms/m3

Eisenbud et al, home laundering, 17 micrograms per day

Viles et al, shaking apron, 7.7 micrograms/m3; prior contamination (apron) 150-200 parts per million; after shaking, 70-100 parts per million

Accurate data on how much beryllium these patients might have inhaled is lacking. There are three published studies of work clothes contaminated with beryllium. One reports that putting such clothes in a washing machine results in 40 micrograms per cubic meter of air, another author estimates home laundering produced 17 micrograms per day.

A third author doing an experiment showed that 7.7 micrograms per cubic meter is produced by shaking a worker's dirty apron. It is impossible to say from these observations, however, precisely how much beryllium from work clothes did cause illness.

The out-of-plant or nonoccupational so called tolerable level now in use is 200 times less that used for workers. This level is based upon the work of Eisenbud and his associates (1949) which included studies performed in 1947 in the area surrounding a beryllium extraction facility. Of the 11 persons with nonoccupational chronic beryllium disease discovered in this area, 10 resided within 0.75 mile of the plant. Effluent from extraction operations was discharged through one 185foot stack and a series of roof stacks approximately 33 feet above ground level. Curves based on the Sosanquet-Pearson and Sutton equations were prepared to show the theoretical fall off for equal amounts of effluent originating at each of the stack heights and the average concentrations at ground level downwind from the source.

A definite relationship was observed between case distribution and ground level concentration of effluent from the 33-foot level. Actual data obtained by sampling down wind at various distances from the source were compared to the theoretical curves, and good agreement was observed.

Allowing for greater production and higher beryllium concentrations in roof effluents in previous years, the earlier air contamination was believed to have been higher by a factor of less than 10. Because so many of the neighborhood cases appear to have been caused by the fact that the patients were exposed to beryllium contaminated clothes it is difficult to be certain of the levels of beryllium in neighborhood air which actually did cause disease.

I want to conclude my statement to you by discussing what has happened in the United States in the past 20 years to prevent the occurrence of new cases of beryllium disease now that the hazard has been recognized. Of first importance was the 1949 decision by the three fluorescent lighting manufacturers because of the hazard to remove beryllium from the phosphors (powders). In 1948, Eisenbud, work

ing with the AEC, proposed a certain safe level of beryllium exposure to prevent the acute worker disease and this was widely and successfully adopted. In that same year, the AEC formed a committee to consider safe levels for prevention of the more serious chronic diseases. I was chairman of this committee which met annually until 1958. Certain levels were suggested in 1949 for AEC use only by this committee but have ben adopted generally by industry. Use of recognized industrial hygiene controls has led to impressive reduction in number of both workers and neighbor cases, almost to the vanishing point. This means that beryllium poisoning is like other industrial intoxication caused by the inhalation within certain limits (though presently unknown precisely) of definite quantities of beryllium. Since this is true, beryllium disease can be controlled within industrial establish

ments.

Some students of beryllium poisoning believe that this is a disease of hypersensitivity. By this is meant that in some exposed individuals an unusual response to the presence of beryllium in the body leads to disease. This concept was introduced by Sterner in 1951 and is still under study. If this theory proves to be true, the task of setting safe exposure limits is increased because of the presence of unknown numbers of those peculiarly sensitive to harmful beryllium effect in any population in an industry or in a community. The general population contains people who are young, old, and those ill of many causes. An example of this aspect of neighborhood disease is the illness of a girl of 15, diagnosed in 1965 as a case of chronic beryllium poisoning. Born in 1951 she lived near a beryllium industry not practicing control of beryllium allowed to go into community air during her early years.

Recent discussion of the possible use of beryllium in rocket firing has come to my attention. If my information is correct the amounts of beryllium proposed for such use are very great. It is difficult to see how accidental overexposure of people and contamination of soil here or in other parts of the world could be prevented. Weather changes are unpredictable and absolute control of intricate equipment impossible.

One cannot but recall the serious problem involving human illness that followed U.S. testing of nuclear devices even though carefully planned and held far off on a Pacific island.

I can summarize my knowledge and opinion as follows:

1. Contrary to published prediction in the United States, beryllium proved to be a hazard to humans when used by industry.

2. Beryllium and all of its compounds except the ore beryl have caused illness.

3. Beryllium disease carries a serious threat-35 percent mortality in its chronic form; 50 percent in the neighborhood cases.

At a recent symposium of physicians it was agreed by those studying the disease that no one has ever recovered from beryllium poisoning. 4. From what is known in 1966 the industrially incurred disease can be controlled by conventional industrial hygiene engineering. In most industries such control is practiced. Where cases have occurred in recent years ignorance of the hazard or carelessness explain occurrences of illness.

5. The use of beryllium in large quantities in rocket firing is in my opinion unwise. My opinion is based on the impossibility of control

of weather and likelihood of technical accident. In addition, the risk of exposing a general population is an entirely different matter from the risk of exposing healthy workers who can accept controls.

6. There are not at present adequate data to support setting so-called air quality control levels for beryllium. Whatever their error, the levels now in use, have as far as is known, prevented new cases of beryllium disease in worker and neighbor.

Thank you.

Senator MUSKIE. Thank you very much, Dr. Hardy.

I would like to focus attention on some of the conclusions contained in your summary, for emphasis and perhaps for clarification.

First of all, it is my impression from your conclusions that industrial control of beryllium is now adequate?

Dr. HARDY. We certainly have not seen workers cases where industrial hygiene controls are in operation. We are seeing new cases because of the subcontracting to small companies where there is not knowledge of the hazard or where controls are not in use.

Senator MUSKIE. That is what you mean by the sentence which reads "In most industries such control is practiced."

Dr. HARDY. That is right.

Senator MUSKIE. This is a voluntary kind of control. This is not a control imposed by governmental regulations?

Dr. HARDY. The States vary enormously in how much activity of an enforcement character they use in implementing these so-called safeguards, safe standards. I think as far as the beryllium hazard is concerned in the industrial worker, the compensation costs and the publicity given the general problem, at the moment at least most beryllium using industries hesitate not to use industrial hygiene control out of enlightened self-interest.

Enforcement of safe industrial practice regulations varies a great deal in the United States. In Massachusetts, for example, the regulations are simply promulgated as recommendations. Enforcement is very difficult because the local courts have not upheld, not in the case of the beryllium problem but other industrially related situations that have been brought to their attention. But some States move right in very quickly.

Senator MUSKIE. So that as to those areas of industrial activity which are not now covered and which you described, is it your impression that it would be sufficient simply to intensify State activity to bring the problem to the attention of affected industries or do you think we ought to be considering something more drastic here than that?

Dr. HARDY. For the in-plant situation it seems likely that the hazard could be controlled if the States used what regulatory power they already have. Someone from my university, non-Government agency position gets the impression that for a number of different reasons the enabling legislation that is available is not used at least in most situations that I know of.

Senator MUSKIE. Is there State regulation or State legislation in every State where beryllium is used in the process of manufacture?

Dr. HARDY. I think that would be hard to say. Some of the States are so recently industrialized. For example, when I worked at Los Alamos in New Mexico there were no laws whatsoever. The Government was very keen to see that right steps were taken in case of injury.

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The device of sending the worker to California was used because Los Alamos was a University of California contract. More recently I am reasonably certain New Mexico has developed its own legislation.

Senator MUSKIE. You make no effort to monitor the efforts of the States?

Dr. HARDY. No. I am on the clinical side. What I know of enforcement is a mattor of my interest and general knowledge and for use in teaching.

Senator MUSKIE. Do you know whether the public health service gets involved in this at all?

Dr. HARDY. No. I think the Public Health Service has been involved purely from the standpoint of doing toxicological experiments within its own laboratories. But it has not, so far as I know, been involved in trving to see that these so-called safe limits are used wherever beryllium is in use.

Senator MUSKIE. There are two other questions as to exposure which I think are pertinent. One is exposure in the neighborhood of manufacturing activities. You have already covered that in your statement. Is it your feeling that we ought to be considering any additional public policy or legislation to give protection as to this problem or as to this exposure area?

Dr. HARDY. This is of course an extremely difficult matter to answer. Categorically, I think from the evidence we have, if by any chance beryllium is being airborne where there were houses close together we have exactly the same problem that we did in producing these 60 identified cases.

So it would seem appropriate to me to make absolutely certain that there is air sampling in the neighborhood of beryllium-using operations. I think one can put it that way.

Now how to make certain about this? I suppose some agency must make certain that each State considers monitoring air for beryllium is important, (a) and is actually taking samples, (b) this is a protective device that can assure freedom from risk with confidence because people don't get sick below air concentrations so far as we now know. Senator MUSKIE. Is it possible that there could be an impact upon health which does not come to your attention?

Dr. HARDY. This is the one that we worry about. This is why the registry is carried on from year to year with support from the Atomic Energy Commission. That is, in small animals, and now in monkeys, beryllium produces malignancies, malignancy of the bone in rabbits and of the lungs in rats and monkeys.

The worry is that those people who carry a smaller burden of beryllium in their tissues somewhere may at a much later date prove to have a significant increase in the amount of malignancy over what they might have had without beryllium exposure.

Perhaps you know that the same worry is going on now with asbestos exposure. I am sure it has come to your attention that asbestos is a lung disease of industry and was controlled by reducing the level of asbestos in the air.

With lower asbestos exposure-this is chiefly British evidence-the kind of cancer which comes with cigarette smoking appeared in that industry and at what are believed to be still lower doses a very rare and lethal malignancy appeared. I think it is quite correct to say that we have a parallel worry with the beryllium situation because we do not