know how many people carry around a beryllium burden that is unmeasured because of the earlier exposure that no one was recognizing as potentially hazardous. Senator MUSKIE. What you appear to be saying, Dr. Hardy, is that the clinical case tends to come to your attention. What you are now discussing is low-level exposure which does not result in clinical cases Dr. HARDY. That is right. Senator MUSKIE (continuing). And which you can't monitor or observe. Dr. HARDY. We can't identify this beryllium exposed population, to return to your original question, it would seem to be the part of prudence to be absolultely certain that the levels of beryllium are held within or close to these low levels that have been so tested now for 17 years, from 1949 when first introduced. This begins to be a rather impressive control period. One would expect that we would see disease and perhaps malignancy within this 17-year period. The individuals we worry about especially are those who were in the industry and received higher doses, are not now ill but retain beryllium in the body. Senator MUSKIE. Would you say this kind of low-level exposure which you can't identify or measure will go on in the public at large as compared to neighborhood exposure? Dr. HARDY. No, apparently not. This was the only reason for bringing up the rocket firing. If these turned out to be an accidental overexposure of a huge quantity, that is another sort of problem much like the Nevada testing of nuclear devices. Senator MUSKIE. So that the risky exposure which concerns you are (1) in uncontrolled plant industrial exposure; (2) neighborhood, then. Dr. HARDY. Neighborhoods near beryllium using operations. Senator MUSKIE. Near neighoborhoods; and (3) possibly exposure from such things as the rocket or missile firing? Dr. HARDY. Right. I suppose I should add within the industrial group the hazard to workers in the small industries where there is either ignorance or workers in a place where nobody is considering control of the risk. In Massachusetts we have many small foundries for example, and some of their workers exposed to beryllium have gotten ill, since the knowledge was available, because nobody goes around to have a look at them. The law says, I think, that if there are below eight workers the State agency is not responsible for hazard control. I suppose it is a matter of shortage of manpower or something of this sort. At MIT, if we subcontract, we actually send along a written warning. Senator MUSKIE. Would you suggest perhaps that the Public Health Service ought to more thoroughly poll the unsupervised area of the industrial activity in order to identify it? Dr. HARDY. Yes. As a mattor of fact the Public Health Service is constantly worrying about what is called the small plant health service. This would come under that heading. I think they are thinking more in general terms. However I find it hard to believe the Public Health Service does have beryllium on their list. Senator MUSKIE. In addition we ought to be doing something about examining low-level exposure in industrial neighborhoods. Dr. HARDY. Certainly epidemiologist should be asked to design prospective studies. In order to record air levels and correlate them with the health of the beryllium exposed workers in that area this would avoid much of the guessing now necessary. Senator MUSKIE. Let me ask you about this missile firing or rocket firing. What is the beryllium being used for? Dr. HARDY. It gives it an extra push. Thrust, I believe is the word. It has a tremendous bang that is attractive to the research people. Senator MUSKIE. It is a fuel? Dr. HARDY. There are so many new words. I think it is a fuel, propellant, solid fuel. It is still in the experimental stage. Senator MUSKIE. Do you know whether the Department of Defense has given attention to this possible fallout from the use of beryllium? Dr. HARDY. They certainly have been harassed by people like Harriet Hardy. I don't know how seriously they have taken it. Senator MUSKIE. You have harassed them? Dr. HARDY. As best I could. Senator MUSKIE. That is good, Have you had any response from them? Dr. HARDY. Well, a few long-distance telephone calls. Dr. HARDY. Not yet, no. I keep hoping. Dr. HARDY. Harassing? Senator MUSKIE. Yes. Dr. HARDY. My friends in the audience know that I have always been harassing so to answer you is easy-20 years ago when I first began work in the field more specific harassment on beryllium as a propellant began when two young men from one of the explosives industries came to me and said they wanted to use this material experimentally and what did I think. So I began rudely showing them specimens of dead people and asking them if they had wives and children and being just as difficult as possible. In a week I had a letter from one of the companies that produced beryllium suggesting that if I didn't stop talking that way I would be in serious trouble in a lawsuit. So I have been busily harassing for a long time. Senator MUSKIE. It has not had any observable effect on you. Senator MUSKIE. Would it be helpful if we joined you in seeking some answers from the Department of Defense? Dr. HARDY. I think it would be most helpful. My conclusion from talking to various groups responsible that those who make the policy have not had the information put to them for their ultimate decision. I think this is part of the warp and woof of our life and maybe not a whole lot of it can be prevented. But endless people meet and know bits and pieces of the problem. When it gets to the people who are going to have to make a policy it has a very odd look indeed. That has been my observation. Senator MUSKIE. We will see if we can't get the problem in better perspective for the benefit of policymakers in the Department of Defense. Dr. Hardy, you have given us some excellent testimony. I can't conceive of a clearer presentation to an uninformed and uneducated layman on this problem than you have given us this morning. Dr. HARDY. Thank you. Senator MUSKIE. Senator Randolph. Senator RANDOLPH. Dr. Hardy, I want to digress for a moment because of your knowledge in the fields of occupational disease in many types of industries and ask you if you have any comment on silicosis? Dr. HARDY. Well, I can keep you here until the afternoon. What part would you like to hear? Senator RANDOLPH. I would like to know what we have been doing to diminish this problem in industry. In West Virginia we had many deaths, I will not go into the background. We think we have seen an improvement. I just wondered if you could comment on this particular occupational disease. Dr. HARDY. Yes, indeed. Let me put it this way that some of the most distinguished work in the whole world was done by our Public Health Service in the early thirties when Dr. Sayers and Dr. Miller and others made that original study. This has been imitated by the British medical research council for their very extensive pneumoconiosis studies that you probably know of. It is my view that a lot has been done to curtail both the severity of the hazard, numbers of people involved. I studied some of your West Virginia coal miners at one time, brought them to Boston to do some studies. Senator RANDOLPH. Was that in the early thirties? Dr. HARDY. No; this was in 1957, 1958, and 1959. Senator RANDOLPH. Why should I associate you with the thirties anyway? Dr. HARDY. I appreciate your compliment. Senator RANDOLPH. Dr. Hardy, I did not mean to interrupt. Dr. HARDY. That is quite all right. Senator RANDOLPH. I think we all agree that silicosis was very prevalent in West Virginia in the thirties. Dr. HARDY. That is right. Senator RANDOLPH. It was a tragic situation, especially in the area of Gully Bridge, South Charlestown. Dr. HARDY. That was very dramatic and very important. The only consolation from it is that a great deal was learned and was used in prevention. I should say that the problem was in large measure under control in the foundries because they can and do use other compounds than silica. From my studies of the underground mining situation is by no means completely straightened out because of the difficulties in the industry and mechanization. In some cases at least the silica hazard has been increased by reducing the size of the particles so the men get sick with smaller doses. There are many problems that still remain. I think that with the combination of the Public Health Service and some of the State agencies, some very exciting work is going on down in your part of the world, it seems likely that we are going to make a real impression on silicosis within your and my lifetime. Senator RANDOLPH. Thank you for your comments. Dr. HARDY. You are welcome. Senator MUSKIE. I have one further question, Dr. Hardy. I understand that you participated in a symposium on environmental lead contamination. Dr. HARDY. Yes, I did. Senator MUSKIE. Yesterday we heard from representatives of the Public Health Service who expressed concern about lead in the atmosphere. I wondered if you might care to make some comments with regard to the cumulative effect on the increasing amounts of lead in our air environment. Dr. HARDY. It seems to me that this subject has just barely been opened up and some of us interested met in an exploratory meeting in Washington following questions that have been raised by Professor Patterson. So that I for one must say that there are many, many questions. As, for example, lead can do so many different things in the body that toxic lead effect at low levels would be difficult to identify without some pretty carefully worked out plans. There are many new studies that suggest that this is going to be possible as time goes on. I think some of what I reported in my discussion of the beryllium problem hears on this. The question of a toxic exposure of a healthy worker is one thing. But exposure, and this is what I discussed at the December meeting-of sick people, babies, old people, pregnant women, is a quite different matter and calls for a whole new way of thinking when it is not possible to identify on the one hand a low level effect, and when there are a combination of insults, operating some of which might arise from neither industry or environmental pollution. For example, disease might arise, be due to a particular infectious disease epidemic that had somewhat similar signs and symptoms of disease as those of lead poisoning. Another example of the effect of lead on a chronic illness we all know about, that has been studied, is the evidence that an alcoholic with liver disease will store lead iron in the liver in excess of nonalcoholics. This raises the question, as to whether this lead is harmful. Is it simply retained or is it part of the disease process. This is what I mean by a mixture of insults and low level effects having to be explored before anybody can say directly that one thought that such and such a level in the air would absolutely assure no harmful effect on a general population as differing from rich to healthy workers. I think the most significant fact is that we have had very little data. on lead in air until the Tri-City survey of recent date. I think that a lot much more data should and will be collected. I would hate to see any decision made now on the basis of presently available air data and presently held clinical opinion and knowledge. Senator MUSKIE. Is it accurate to describe your reaction that our knowledge is too fragmentary? Dr. HARDY. This is my view. In going through considerable lead toxicity literature as I did, for the December meeting it is striking that nothing but harm has been reported as a lead effect either from industrial exposure or in experimental study. In contrast to many metals found in nature which are beneficial at certain levels, harmful at others. No useful effect has ever been ascribed to lead. However, to make what is now known useful there is a world of work ahead. I don't think it is too difficult. It can be encompassed. Senator MUSKIE. Are your people at MIT working in this field? Dr. HARDY. Yes, we are. Senator MUSKIE. Do you have any accumulative data that we might usefully include in the record? Dr. HARDY. We have just begun. It is a 5-year NIH grant on trying to find out the influence of environmental lead on children and whether or not it explains the fact that they are not doing too well in school. We have only studied four cases to date. It is not easy to do. Dr. HARDY. You are welcome. Senator MUSKIE. I want to include in the record two papers which you and Dr. Tepper have written. One by yourself and one by you and Dr. Tepper in the field of beryllium poisoning. I will also ask the staff to request the Public Health Service and the Defense Department to respond to your testimony here this morning. Dr. HARDY. That will fascinate me. (See p. 443 for response of the Defense Department.) Senator MUSKIE. Thank you very much, Doctor. (The papers referred to follow :) [Reprinted from the New England Journal of Medicine, 273: 1188-1199, Nov. 25, 1965] BERYLLIUM POISONING LESSONS IN CONTROL OF MAN-MADE DISEASE* (Harriet L. Hardy, M.D.,† Boston) The accidents of my birth date and choice of work have led to the responsibility of honoring my senior colleague, Dr. Alice Hamilton, whose unusual contributions inspired the inauguration of this lectureship. Many in this audience, too young to know just why Dr. Hamilton deserves our praise and thanks, will want a little background. After a rich and varied education here and in Europe, Dr. Hamilton chose to live at Hull House in Chicago, one of the first and greatest settlement houses in this country. Here, people of privilege, under the leadership of Miss Jane Addams, learned of the wretched living conditions in the slums. In this setting, "Dr. Alice," as I am privileged to call her, lived and worked. While she was living at Hull House, working in bacteriologic research, the chance came in 1910 to investigate hazardous trades in Illinois. She called it "a voyage of exploration" because nobody knew where to make such investigations except in a few lead-using industries. Dr. Alice writes, "American medical authorities had never taken industrial diseases seriously, the American Medical Association had never held a meeting on the subject, and while European journals were full of articles on industrial poisoning, the number published in American medical journals up to 1910 could be counted on one's fingers." From 1910 her time and energy were spent in search for occupational dangers and study of their character to the end that workmen might be protected. To achieve her purpose, she worked for state and federal governments and for industrialists. In 1919 Dr. Alice came to Boston to give three Cutter lectures. Dr. David Edsall, then dean of the Harvard Medical School, sponsored these lectures and The Alice Hamilton Lecture, delivered at Harvard School of Public Health, May 27.1965. Supported in part by a grant (AT [30–1] 2629) from the United States Atomic Energy Commission. Associate physician, Massachusetts General Hospital; lecturer on medicine. Harvard Medical School: assistant medical director in charge of Occupational Medical Service, Massachusetts Institute of Technology. Hamilton, A. Exploring the Dangerous Trades: The autobiography of Alice Hamil ton, M.D. Boston Little, Brown, 1943. P. 3. 433 pp. |