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For most workers who joined or were employed in the asbestos industry, there was no indication that they were working with a hazardous material. However, for the minority employed in the ‘scheduled areas’ — in other words, workers engaged in jobs such as crushing, carding, spinning, and mattress-making — the situation was different. They came within the Medical Arrangements Scheme of 1931. They were handed a small booklet, a ‘Worker's Register’, which explained the basics of the medical and compensation scheme and gave them space to enter their job and medical examination details. The text contained no warnings about asbestosis or descriptions of the symptoms of the disease, though it did explain that workers would have to present themselves regularly before a Medical Board. This chapter examines how the Medical Board system operated in practice, drawing on internal documentation from Turner & Newall.

The Asbestos Scheme was introduced in 1931. Like the dust and medical regulations, the legislation applied only to ‘scheduled areas’, in other words, the main preparatory and textile processes; the making of insulation slabs and mattresses; the dry sawing and grinding of asbestos articles; and the cleaning of machinery. Workers such as laggers could theoretically claim compensation, but only if they could prove to the Medical Board that they were unfit — a difficult task when the medical scheme excluded them from periodic examination. Despite the limited nature of the Scheme, the official recognition of asbestos manufacture as a ‘dangerous trade’ was very worrying for the Turner & Newall directors. As regards to compensation, Turner & Newall set up its own Asbestosis Fund and made compensation ‘a purely internal question’ for the board.

The period after the Second World War was the most successful in Turner & Newall's history, when the company emerged as the ‘Asbestos Giant’. In 1949, the company's head office was moved to Manchester and named, appropriately, Asbestos House. However, this expansion was bought at a price. More asbestos meant more dust and continued risk for Turner & Newall staff. It gradually became apparent that the risk included not only asbestosis, but also cancer.

This chapter sheds more light on the central question of this book: why it took so many decades for the full implications of the asbestos health problem to be realized and acted upon. Data disseminated in the annual reports of the Chief Inspector of Factories showed that the Factory Inspectorate did provide important insights into the dangers of asbestos for those who cared to look. However, the culture of the Factory Inspectorate militated against dealing effectively with severe industrial hazards. Matters of health and safety involved a dialogue between the Inspectors and the bosses — a dialogue from which the workers were invariably excluded. Unions were largely ineffective in modifying the provisions of the 1931 legislation and gave health and safety a low priority. Evidence from Turner & Newall also highlights the difficulty trade unions faced in opposing a powerful commercial organization.

In retrospect, it seems remarkable that the asbestos industry should have declined so swiftly. It was the 1960s — especially the mid-1960s — when the tide turned. The first force for change was economic. Turner & Newall's profits hit a peak in the mid-1960s and then dipped as technology and the company's manufacturing profile changed. The other catalyst for change was the rising trend of suspensions and deaths. After 1931 it had been hoped that the suspension rate would fall as less dusty conditions made asbestosis a disease of the past. For a while — in the 1930s and early 1940s — it had seemed as if this might happen: then in the 1950s and early 1960s, the number of new cases of asbestosis in the UK began rising.

The 1969 Regulations had for the first time set a quantitative limit for asbestos dust, yet neither the asbestos industry nor the government felt able to implement or enforce such a threshold immediately. The Factory Inspectorate stepped up its surveillance of asbestos factories and planned a new dust survey of the industry, but the demand for sampling was overwhelming. In industry itself, most of the asbestos textile factories in 1970 were operating over the 2-fibre limit and full compliance would clearly take some time. The situation was dire in Turner & Newall's overseas plants. In 1973, an inspection of the company's Canadian plant showed dangerous and dusty conditions. Of the 166 men exposed to asbestos for fifteen years or more, 91 current employees had asbestosis. The Canadian situation was mirrored in Turner & Newall's extensive African mining and manufacturing interests.

This chapter considers the magnitudes of risk for the development of asbestosis, malignant mesothelioma (MM), and lung cancer (LC) resulting from exposure to different airborne concentrations of asbestos. Information on risk is obtained from epidemiological studies. The risk analysis requires three components: (i) the level of exposure, (ii) cases that have occurred, and (iii) factors that might confound or modify the exposure-response relationship.

Asbestosis can be considered either a clinical disease, which is manifest functionally, and readily demonstrable by radiological means, or a pathological entity of variable degrees of severity, but often as scattered localized lesions in the lungs in the absence of clinically evident respiratory insufficiency. This chapter considers the pathogenesis and pathological features of asbestosis from the perspective of its epidemiology.

This chapter discusses the population characteristics of asbestos-associated diseases in the 20th century and presents a view of these characteristics for the 21st century. It considers the three principal asbestos-associated diseases: malignant mesothelioma (MM), lung cancer (LC), and asbestosis. It describes trends in the asbestos-associated diseases in various countries, including both industrialized and developing countries.

Causes of occupational lung disease

Coal dust exposure (coal mining):

COPD: increased frequency in coal miners.

Pneumoconiosis (simple):

Nodules <1 cm, upper and middle zones on CXR.

Relatively benign disease.

Progressive massive fibrosis (PMF or complicated pneumoconiosis):

Nodules >1 cm, mostly upper zones....

This chapter describes the clinical presentation of commonly-encountered occupational and environmental respiratory disorders, including principles regarding disease recognition and prevention. Where appropriate, clinical cases are included to illustrate specific diseases. The chapter begins with a general introduction to the evaluation of individuals and populations, including important considerations from the history and physical examination as well as common findings on typical diagnostic tests such as chest X-rays and other imaging studies, and pulmonary function testing. Specific disease topics covered include (a) disorders due to irritant exposures (high-, moderate-, and low-solubility irritants); (b) disorders due to nonirritant exposures (carbon monoxide and indoor and ambient air pollution); (c) occupational airways diseases (work-related asthma and occupational chronic obstructive pulmonary disease); (d) hypersensitivity pneumonitis, byssinosis, and other diseases due to organic dust exposure; and (e) pneumoconiosis (including asbestosis, silicosis, and coal workers’ pneuconiosis). Childhood asthma is discussed as a risk factor for occupationally-related lung disease.