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Dr. SAYERS. It might have been, but I cannot tell exactly.

Mr. MARCANTONIO. No; not unless you had performed an autopsy. Autopsies were performed on 10 bodies and in 9 cases the lungs of the deceased showed fibrous growth of silicosis, yet the death certificate said the victims had died of pneumonia. In that case there would be no doubt in your mind but what silicosis was a strong, contributing factor to the deaths caused immediately by pneumonia; is that right?

Dr. SAYERS. I could not tell exactly without seeing the tissue. It would seem that such might have had some effect.

Mr. MARCANTONIO. If you should perform autopsies on 10 men and 9 of them showed silicosis and yet the death certificates said that death was caused by pneumonia, would you not say that the very strong, contributing factor to the pneumonia was silicosis?

Dr. SAYERS. That has been considered as correct. It would depend upon how long silicosis had existed, of course. If it had existed a long time, it is questionable whether it would have any effect upon the pneumonia. We do not know exactly.

Mr. MARCANTONIO. But if it had not existed a long time, if these men had just contracted silicosis

Dr. SAYERS. It seems to be the consensus of opinion that it does. Mr. MARCANTONIO. That it is a strong contributing force?

Dr. SAYERS. They do not usually use the word "strong.” They really do not know how strong it is, but it is a contributing factor.

Mr. MARCANTONIO. Summarizing your testimony, a man exposed for 10 hours a day for several months to a silica condition where the concentration is very heavy, where the rock in which the men are boring contains 97 percent silica, the possibility of that man contracting a serious case of silicosis is very great, is it not?

Dr. SAYERS. There is great possibility of contracting it. Your adjectives are the only things that bother me.

Mr. MARCANTONIO. I think they are important for this reason: Anyway, these men died. We have certain facts that cannot be disputed. A certain number of men died. They were healthy before they went to work in the Hawks Nest tunnel. They died within 2 or 3 years after they went to work there, in fact they died within 1 year after they went to work. Leaving aside those who died as a result of falling rock or as a result of carbon monoxide poisoning, let us consider the autopsies that were performed. We find that 9 of 10 cases had silicosis in the lungs. We also know that the silica rock in which they bored contained 97 percent silica, which is a high concentration. We know that those men worked there 10 hours a day; we know that 16 drills were being operated, 6 of them being wet and boring horizontally and 10 being dry and boring diagonally. These men worked in that tunnel 10 hours a day during several months. Bearing in mind all the conditions I have recited; bearing in mind the facts that these men are dead and that their death certificates state they died of pneumonia, I ask you whether the possibility that these men contracted silicosis as a result of their working in that tunnel, and therefore died, is not very well established.

Dr. SAYERS. You have stated that autopsies showed that 9 of 10 of those men had silica in their lungs. It would seem that your statement is correct under those circumstances. If they had silica on their lungs, and it was shown by autopsies, there is no question about the truth of your statement. So far as it being an incident of pneumonia is concerned, it might be. Silicosis was there and certainly it was a contributing cause of death.

Mr. MARCANTONIO. In the defense at the trial and in the press it was stated that there was an epidemic of pneumonia in that region at the time. First of all, what is an epidemic of pneumonia ?

Dr. SAYERS. Those things are rare.

Mr. MARCANTONIO. An epidemic of pneumonia is a most unusual thing, is it not?

Dr. SAYERS. In some places there is much pneumonia, but we do not have epidemics of pneumonia in this country, generally speaking.

Mr. MARCANTONIO. They have epidemics of pneumonia in, say, Siberia.

Dr. SAYERS. And in many other countries. I do not know whether there was an epidemic of pneumonia in West Virginia at the time. I could only determine that from a study of the vital statistics for the State of West Virginia.

Mr. MARCANTONIO. The vital statistics covering these men would show that they died with pneumonia. In that case the vital statistics would bear out the contention that there was an epidemic of pneumonia.

Dr. SAYERS. Yes. Mr. MARCANTONIO. If you were apprised of the fact that in 9 or 10 cases of autopsies performed silicosis was shown, and then you knew that these men who died were all healthy before they went to work in that tunnel, and you also knew that these men were working at boring rock which had 97 percent silica, that the concentration of dust was so heavy that one could not see 10 feet, that there were 16 drills in operation, 6 of them being wet drills boring horizontally and 10 being dry drills boring diagonally, plus the fact that the ventilator was inadequate and insufficient, and these men worked 10 hours a day under those conditions; in that circumstance would you say that silicosis was a strong contributing factor to the deaths that were said to have been caused by pneumonia ?

Dr. SAYERS. It seems like we are quibbling just a bit. I wish we could be absolutely accurate, but I see the difficulty. It may seem to you gentlemen that I am too careful in making some of my statements. On the other hand, what are the controls? Was there an epidemic of pneumonia and, if there was, was the incidence of pneumonia among those on the surface similar to the incidence of those exposed to silica dust? If we knew it was about the same we might say then that the silica had but little effect on the pneumonia, but if the reverse is true, if the people on the surface did not have pneumonia anything like the incidence rate among those exposed to silica, it would mean probably that those men exposed to silica are more susceptible to pneumonia and tuberculosis. Those men are more susceptible to respiratory infections, especially tuberculosis, than are average individuals.

In the study we have lately carried out and with which I am best acquainted, we found that men exposed to a certain concentration, 50 million particles of this coal dust containing less than 5 percent free silica did not develop anthrosilicosis. They seem to think that such was a safe concentration.

Mr. MARCANTONIO. Assuming the facts as I have given them to be true, you would say that working in the tunnel was a definite factor in the deaths that were allegedly caused by pneumonia ?

Dr. SAYERS. Yes.

Mr. RANDOLPH. Mr. Marcantonio has brought out the alleged fact that these 3,000 workers, more or less, were individuals of splendid health when they went to work in the Hawks Nest tunnel. Is it not a fact that there was no physical examination of these men when they went to work in the tunnel ?

Nr. MARCANTONIO. We do not know that. If there was no physical examination, the fact that they were able to work 10 hours a day in that place indicated that they were, at least so far as their own knowledge was concerned, in good condition so far as any respiratory disease was concerned.

Mr. RANDOLPH. But no physical examinations were made.

Mr. MARCANTONIO. One who is ill with a respiratory disease is not going to work in a tunnel or a mine if he knows it. Those workers came from all over the country, and the testimony we have had here from some of the victims themselves is that they were in good health before they went to work in that tunnel. In the 300 cases that were thrown out of court because of the operation of the statute of limitations, no claim was made by the company that those men were in poor health before they went to work in the tunnel.

And, in the case of the 300 men settled out of court, at no time did the company say those men were in poor health before they went to work in the tunnel or that they had any respiratory disease. The chances are that the percentage of those who went to work in the tunnel when they had respiratory trouble was very small indeed.

Mr. RANDOLPH. The record does not show any physical examination of these men, and you, Doctor, say that examinations should have been made.

Dr. SAYERS. Yes.

Mr. MARCANTONIO. I believe that in every case, especially in mining, that nobody should be permitted to work in a mine unless he is physically all right and, at the same time, no man should be permitted to go into the mine unless the mine is thoroughly equipped with adequate safety devices. Both those precautions should be scrupulously adhered to. From a medical standpoint, we want to prevent any of these diseases.

Dr. SAYERS. We should like to see all these safety devices employed, so as to make conditions ideal for the workers.

Mr. RANDOLPH. There should be a physical examination before the men go to work, would you say?

Dr. SAYERS. Yes; for the proper placement of the men.

Mr. MARCANTONIO. But if a man is found to be perfectly healthy and is sent into a concentration of dust that is poison and where he cannot see 10 feet, where the silica content of the rock with which he is to work is 97 percent, that is not right?

Dr. SAYERS. We are trying to eliminate that. It should, obviously, be eliminated.

Mr. RANDOLPH. The two go hand in hand.
Dr. SAYERS. Yes.

Mr. Dunn of Pennsylvania. There was testimony given not long ago, that the contractors of the tunnel work were informed that the tunnel that they were going to construct contained a great deal of silica stone. Further, they were informed that it would probably take 2 years before there would be any symptoms shown in the men. The contractors obtained that information beforehand; they knew all about it; they were informed what was necessary to keep their workers from contracting this terrible disease; but, according to the witnesses who have testified here before the committee, the contractors did not comply with the law or do what humanity required. There were 16 drills working, 6 of them were wet and 10 were dry. The witnesses have testified that if the contractors had used wet drills, probably few of the workers would have contracted this terrible disease. As I have said, the contractors obtained full information as to the probable effect of the course they had in mind and which they followed, and they knew that if they completed the tunnel within 2 years they could get out of the State and nothing could be done to them by way of litigation; but the men contracted the disease before the end of 2 years. One family alone suffered the loss of 3 boys within 13 months. I refer to the Jones family. In your opinion, assuming the statements I have just made to be correct, was there not negligence on the part of the corporation? A medical commission of 3 members was appointed and that commission exam. ined 309 men and found 137 of them affected by silicosis. Does not that show beyond any doubt that silicosis caused many of the deaths that took place there in connection with that tunnel operation?

Dr. SAYERS. Silicosis may have contributed to the deaths. I think most of those had other infections with it.

Mr. Dunn of Pennsylvania. The company knew all the facts in connection with that operation, and they thought that within 2 years they could complete the job, get out of the State, and thereby avoid all responsibility for the damage they had knowingly caused. The contractors were medically advised that it would take about 2 years before the symptoms would become manifest.

Dr. SAYERS. Ordinarily it requires more than 2 years for the disease to develop. In our experiments with animals we have been able to produce silicosis in 6 months.

Mr. Dunn of Pennsylvania. Therefore the statement made by witnesses that the three young men died within 13 months is reasonable and most probably correct.

Dr. SAYERS. Yes; but I would expect intercurrent disease also.

Mr. Dunn of Pennsylvania. A number of witnesses also testified. that by the way these men breathed one could tell there was something wrong. They maintained that the trouble was caused by silica dust.

Mr. MARCANTONIO. There was a noticeable wheeze when they spoke. Is not that a symptom of silicosis?

Dr. SAYERS. I cannot tell you without seeing the subject.

Mr. MARCANTONIO. Those men were not affecting that wheeze. It was natural, as anybody of experience could see. They were sitting in the chair in which you, Dr. Sayers, are now sitting, and the wheeze could be heard some distance from them.

Dr. SAYERS. Ordinarily when the victims of this disease sit quietly one cannot tell that anything is wrong.

Mr. MARCANTONIO. As those who were here spoke we could hear them wheeze at some distance.

Dr. SAYERS. The shortness of breath is more markedly shown by exercise. One may go along all right when he is quiet, even though he may be in an advanced stage of silicosis, but if he has to exercise, such as walk around or climb steps, he is soon short of breath, and he cannot do it long. For instance, one young man got so that he could no longer swim or go upstairs. He was put in bed on account of a heart condition. On the other hand, let him be quiet, and one would not notice anything being wrong.

Mr. MARCANTONIO. Except for his own suffering.

Dr. SAYERS. There is not any real suffering. This young man had no real pain.

Mr. MARCANTONIO. We had before the committee the photograph of a man who had wasted away until he was nothing more than flesh and bones.

Dr. SAYERS. That usually means that there is a superimposed infection. Even if one has silicosis he does not usually lose weight.

Mr. MARCANTONIO. That infection might be tuberculosis.
Dr. SAYERS. That is possible.
Mr. MARCANTONIO. And the contributing cause would be silicosis.
Dr. SAYERS. Yes.
Mr. MARCANTONIO. Assuming that he had silicosis.
Dr. SAYERS. Yes.

Mr. MARCANTONIO. In all these cases we had to assume a certain state of facts. In the last stages of silicosis is it not a fact that the pain is so great that it is necessary to administer drugs?

Dr. SAYERS. I have not seen anybody administer drugs for silicosis. I have not seen any pain in connection with such a case. When one gets a heart condition, of course, they use digitalis. If you mean morphine as a drug, they do not use it.

Mr. MARCANTONIO. Where they have a heart condition, that is a result of silicosis, is it not? In that case digitalis would be prescribed, would it not?

Dr. SAYERS. It would be by some doctors.
Mr. MARCANTONIO. It all depends upon the degree, does it not?
Dr. SAYERS. Exactly.

Mr. MARCANTONIO. Are there not cases of silicosis in which the person is in pain? Let us take a case wherein a person actually dies from silicosis; the patient suffers pain, does he not?

Dr. SAYERS. I have not seen such a patient in pain. I have not seen a man die actually of silicosis. Asl that I have seen have had an intercurrent infection. have seen a number of men affected by silicosis before they died, and they could not demonstrate any infection in them even by autopsy. They did not have pain when I saw them. I did not actually see one of them die.

Mr. MARCANTONIO. You have not seen anybody die with silicosis except that he had another intercurrent infection?

Dr. SAYERS. I have not seen them die. I have seen them before they have died.

Mr. MARCANTONIO. As I understand, this fibrosis is a fibrous growth in the lungs.

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