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Dr. SAYERS. It will bring death in a much shorter time than otherwise. I have seen only one case that occurred in less than 2 years in the last 10 years. That man had a peculiar situation, and he was exposed.

Mr. RANDOLPH. I believe you have stated here that most men who have silicosis do not die with it.

Dr. SAYERS. They do not die of silicosis; they die of some intercurrent infection.

Mr. MARCANTONIO. Let us consider a diabetic. One having diabetes suffers from an infection, an amputation takes place, the amputation refuses to heal, and the man dies. The real cause of death might be a poisoning, but at the same time the underlying cause, is the diabetes. Is not that analogous to silicosis?

Dr. SAYERS. Yes.

Mr. RANDOLPH. You have stated that out of 1,000 workers, we will say, exposed to breathing of silica dust approximately 100 would be affected out of each 1,000; is that correct?

Dr. SAYERS. No; I do not remember such a figure as that. In the study that I have given you on the anthracite industry we examined 2,711 men, and 616 of those men were affected. We examined only men in three mines.

Mr. RANDOLPH. About 2,000 workers were exposed to silicosis dust at the Gauley Bridge tunnel; what percentage of those 2,000 would you say were affected?

Dr. ŠAYERS. That is a very difficult question to answer.

Mr. MARCANTONIO. That would depend first of all upon the amount of concentration of silica, the length and continuity of the exposure would it not?

Dr. SAYERS. That is correct. There is a very interesting figure that comes to light in most of our studies. This is a chronic disease in some instances. Of all those who work the percentage having the disease in some stage or other is close to 25 percent. That is shown wherever we have happened to make a study. The growth that we examined in the tri-State district shows that. Wherever you examined all these men 25 percent will show that they are affected.

You will notice also in this study that most of those men in an early stage have no marked symptoms, symptoms that have been brought only by a physician. There are 106 out of the 616 that had marked symptoms and had decreased capacity for work.

The real problem, then, is the prevention of the disease by con-trol of dust and through physical examinations to prevent further infection.

Again, from a compensation standpoint, probably the men you would want to take out of the industry, if at all, would be those with infections; and those who have a marked decreased capacity for work would probably want compensation. The others would probably want to continue to work rather than accept compensation.

Mr. MARCANTONIO. During the trial of several hundred cases at Fayetteville, W. Va., a commission of three doctors was appointed by the court to make an examination to determine just how many of the plaintiffs or how many of the claimants had silicosis. Those doctors examined 309 persons, and they found 137 had silicosis. That commission of doctors was an impartial commission appointed by the court. This examination took place about 2 years after the last exposure to silica dust. Would you say that of the remaining number of those who were found not to have silicosis at that particular time, at the time of exposure, there is a possibility that silicosis might have developed or appeared subsequently?

Dr. SAYERS. It might have done so, but I would not expect it. That is possible but not probable.

Mr. MARCANTONIO. To be in a good position to answer that question, we would have to have a knowledge of the character of the examination conducted at the time.

Dr. SAYERS. Yes.

Mr. Dunn of Pennsylvania. Suppose a hundred men are working in a tunnel, and all are exposed to the same amount of dust; is it possible for all of them to contract silicosis?

Dr. SAYERS. Do you mean that all are exposed to the same amount of dust and for the same length of time?

Mr. Dunn of Pennsylvania. Yes.
Dr. SAYERS. Yes.

Mr. Dunn of Pennsylvania. Would there be any escape; if so, why would some escape and not all escape?

Dr. SAYERS. After a time probably all of them would get it, that is, if they are exposed to the same amount of dust for the same length of time.

Referring to this anthracite group study, the first 15 years, or less, only 2 percent of them have it, even in an early stage. After 25 or more years 90 percent of them have it. It would look as if the exposure was the controlling factor and that the other factors that we might describe are incidental.

Mr. MARCANTONIO. In dealing with the arrest or cure of this disease the probability of a cure or an arrest is very slight or remote where the patient is living under conditions where he has to subsist on a small allotment of food and where shelter is not any too good. In other words, he would have to live under more or less decent conditions to stand any chance. That is very necessary, is it not, Doctor?

Let us consider one family that appeared here, consisting of five or six people. They were getting $2 a week from the relief authorities in West Virginia. Certainly a man having silicosis could not on the amount of food that could be bought for $2 a week live properly at any time, especially when he had silicosis. Living that way would certainly not be conducive to his cure, would it?

Dr. SAYERS. If his susceptibility to infection is increased over the average individual, he will not be bettered by not having sufficient food; but after he has been out for a time it seems to come to an arrested condition. This is what happens if we want to take the effect of the dust in the lungs or other body tissues, The dust goes into the lungs, a portion of it is breathed out or is expelled by various mechanisms. That which stays there is taken up by the cells called phagocytes. Then they gather in the tissues of the lungs and cause proliferation or an increase in the body cells, espefibrous tissue cells.

degeneration takes place and some matty tissue comes. Fibrosis dust becomes scar tissue.

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This is followed by a deposition of calcium carbonate, lime salts. Then calcification takes place. When that takes place that stays there indefinitely for a period of years. The fibrous tissue, scar tissue, also stays for a period of years. I would not expect that man to be more susceptible to infection, and I would expect him to be able to withstand the diminished supply of food the same as any individual would, if the former were not beyond the early stage.

Mr. MARCANTONIO. But if he is beyond the early stage, he could not withstand it. He would need proper food and shelter, would he not? I have the legal description of silicosis that I should like to read. It says:

In general terms, this process (silicosis) may be stated in an untechnical way as follows: The fine particles of dust when inhaled, lodge on the moist surface of the interior of the lungs

make their way through the lining membrane of the air spaces into surrounding lymph channels Eventually in progressive cases, many of the original essential structures of the air and circulatory channels are damaged beyond repair and replaced by scar tissue, medically known as fibrosis

and there is then loss of elasticity, diminution of effective lung surface and impeded blood circulation through the parts, all combining to produce shortness of breath and labored heart action, which may be sufficient in the end to cause death. Together with these direct effect of the silica particles, the changes they initiate interfere with protective mechanisms against micro-organisms and thus favor the development of infections, especially bronchitis, pneumonia, and tuberculosis.

Depending upon the duration and intensity of the exposure to the dust, the size of the particles, the intercurrence of infections, and the like, the disease may develop within a compartively few months or may take many years and may even manifest itself only after the lapse of several years following cessation of employment. In its manifestations it may simulate heart disease or other varieties of lung disease, and in earlier stages it may present but few and ill-defined signs in the stethoscope and the X-ray examination. Under these circumstances it is natural therefore that the disease should be frequently overlooked, not only by the sufferer himself but also by his physicians.

Mr. MARCANTONIO. What is your opinion of that statement?

Dr. SAYERS. There are a number of controversial statements in it. It is, generally speaking, probably correct; but there are, as I have just stated, a number of controversial statements in it. I could express an intelligent opinion of it only by taking each portion of the statement and answering it.

Mr. MARCANTONIO. Summarizing your opinion of this situation, Doctor, first of all the chances of contracting silicosis depend a great deal on the amount of concentration of the silica dust that is present; is that correct?

Dr. SAYERS. Yes. Mr. MARCANTONIO. So that a person exposed to silica dust of a content amounting to 97 percent runs a greater risk of contracting silicosis on account of the high percentage of silica dust present; is that true?

Dr. SAYERS. It is, if we are considering the same concentration and the same length of exposure.

Mr. MARCANTONIO. Take those as a basis.
Dr. SAYERS. Then you are correct.

Mr. MARCANTONIO. If one contracts silicosis by working in a high concentration of silica dust during a period of continuous exposure for 10 hours a day for several months, which conditions make one very susceptible to the disease, he is in a more dangerous condition than if the silica dust had been of a less concentration; is that not true?

Dr. SAYERS. He would be in a more dangerous condition than hie would be if there were less silica.

Mr. MARCANTONIO. The probabilities of his dying sooner, because of having been exposed to that particular condition that I have described, would be greater.

Dr. SAYERS. Providing that concentration causes disability in the length of time.

Mr. MARCANTONIO. You could place a person in a tunnel which has a silica dust concentration of 97 percent, which is a very high concentration,

Dr. SAYERS. Yes; that is a high concentration.

Mr. MARCANTONIO. And if one is in such a place for several months 10 hours a day, certainly the chances of that person contracting a serious case of silicosis are very high?

Dr. Sayers. That would depend not only on the silica but upon the concentration of dust particles in the air.

Mr. MARCANTONIO. Let us take the description given by the men who have testified here. They have told us that at times the dust was so heavy that they could not see 10 feet. Would you consider that a high concentration ?

Dr. SAYERS. Yes; I would. Mr. MARCANTONIO. Even with electric lights illuminating the whole place they could not see 10 feet.

Dr. SAYERS. Did that continue? Mr. MARCANTONIO. It continued as long as the drilling was taking place.

Dr. SAYERS. How long did they drill, 10 hours a day?

Mr. MARCANTONIO. They were going all at one time. There were 16 drills. Six of those drills were running wet, boring horizontally, and ten of them were dry, boring vertically or diagonally. As I have said, the men have testified that they could not see 10 feet; that when they left the tunnel their clothes were white, as if they had been working in a flour mill, with dust; that they beat the dust from their clothes by beating the clothes against tree stumps. Would you call that a heavy concentration of silica dust?

Dr. SAYERS. Where one cannot see a light 10 feet, there is a very high concentration of dust.

Mr. MARCANTONIO. That being the case, what would be the chances for a person escaping a serious silicosis condition if he worked 10 hours a day, and several months, in that tunnel?

Dr. SAYERS. Of course, I do not know what the concentration was.

Mr. MARCANTONIO. Assuming that the concentration I have described to you is accurate. Then what is your answer?

Dr. SAYERS. Assuming that description to be correct, a man would probably suffer some effects of that dust, which would mean silicosis.

Mr. MARCANTONIO. The fact that this medical commission examined 309 men within 2 years after their last exposure to silica dust and found 137 of them to be affected by silicosis certainly shows the high concentration under which these men were working; otherwise, according to your own figures, it is about 25 percent, and that is rather high.

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Dr. SAYERS. Those were men who claimed to have symptoms instead of all those who worked there?

Mr. MARCANTONIO. There is no question that these men worked there.

Dr. SAYERS. But you have a special group that think they have the disease and therefore you have a higher pereentage than if we took everybody who worked in the tunnel.

Mr. MARCANTONIO. In this tunnel were more than 3,000 men working due to changes in various shifts.

Dr. SAYERS. Yes.

Mr. MARCANTONIO. So that when you get a percentage of more than one-third of those who claimed to have the symptoms, that more or less indicates the percentage of people who have contracted silicosis due to exposure to silica dust.

Dr. SAYERS. In 1914 Dr. Lanza found that 433 miners out of 720 examined in the Joplin, Mo., district had silicosis. That is much more than 25 percent. That is where persons who had symptoms and who presented themselves voluntarily for examination, and your percentage does not hold so far as that particular industry is concerned. We would not have found more than 25 percent if we had examined all.

Mr. MARCANTONIO. Let us consider the Hawks Nest tunnel at Gauley Bridge, W. Va. If you had been a doctor there representing the United States Public Health Service, would you have advised these men to work under conditions that I have just described?

Dr. ŞAYERS. I would advise them to correct the condition you have described.

Mr. MARCANTONIO. And that correction would have been to drill wet, which would have eliminated the dust.

Dr. SAYERS. I would have eliminated the dust.

Mr. MARCANTONIO. Let us take into consideration another element that came into play, namely, the use of gasoline motors in the tunnel. That certainly would not be considered as anything but detrimental to the health of those exposed to the fumes.

Dr. SAYERS. Insofar as it stirred up other dust.
Mr. MARCANTONIO. And the carbon monoxide has to be considered.

Dr. SAYERS. That is entirely a different hazard, and would not have much to do with silicosis.

Mr. MARCANTONIO. But it would have had something to do with some deaths there.

Dr. SAYERS. Such deaths are usually very sudden.

Mr. MARCANTONIO. If a man having silicosis is subjected to carbon monoxide, what would be his possibility of withstanding that carbon monoxide compared to a person who did not have silicosis?

Dr. SAYERS. It would probably not have much effect upon men who were willing to work under those conditions. That is especially true if it were in the early stages.

Mr. MARCANTONIO. In making out the death certificates incident to the burial of those victims the certificates showed that these men had died of pneumonia. All of these men had been exposed to the condition I have just described, while the immediate cause of death might have been pneumonia. Do you think, Doctor, that the silicous condition to which they had been exposed was contributory to the deaths, was a contributory factor to the deaths ?

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