In the United States, some transportation industries including railroads never made legal provision for workers compensation. As a result, employees who develop occupational diseases must bring suit against their employers in an appropriate legal forum. In the case of railroad workers, there has been intense exposure to asbestos insulation dust in roundhouses where locomotives were overhauled. The old steam locomotives were equipped with large quantities of asbestos insulation. Severe asbestos exposure in railroad maintenance work is apparently a thing of the past in the United States, with the replacement of steam locomotives by diesels and the substitution of asbestos-free railroad brake shoes. However, the toll of disease from past years is great (T.F. Mancuso. Mesothelioma among Machinists in Railroad and Other Industries, Amer. J. Industrial Med. 4:501-513, 1983).

Medical directors of the railroad companies held annual meetings starting in 1921 under the auspices of the Association of American Railroads. The meetings of the Medical and Surgical Section, as the group was known, or simply the Medical Section in later years, were often concerned with occupational health and safety and proceedings of the working sessions were published and distributed to the membership. The members of various committees and the attendees of each meeting were duly recognized in the proceedings, with each doctor's company affiliation designated.

The following notes of the meetings through 1958 relate to the forseeability of asbestos hazards by the medical officers of the railroad companies. The documents were located in the library of the Interstate Commerce Commission in Washington, D.C. (Proceedings of the Medical and Surgical Section of the Association of American Railroads). Relevant page numbers are noted in parentheses.

1932: Committee on Occupational Diseases and Rehabilitation reported on "Dust as an Industrial Hazard" (60-62), discussing pneumoconiosis at length. It was noted that chest X-rays were diagnostic of fibrous tissue. Many symptoms of pneumoconiosis are cited, hypersusceptibility to infection in the lung is noted. Wetting and ventilation are offered as control methods. Asbestos not explicitly mentioned.

1933: Report of the same committee by same title, recommends respirators in addition to the above measures as controls. Asbestos not mentioned. (72,77).

1935: Report of the same committee now has a subtitle "Pneumoconiosis" (89-90). "Asbestosis is not a common condition but it causes extensive pulmonary fibrosis and takes on a more rapid course than does silicosis." Following, "(A)s railroad surgeons (we) are undoubtedly more interested in silicosis and asbestosis than in the other types." Examinations upon hire were advised to include complete history and physical, with chest X-ray "for diagnosis and future record."

For old employees with a history of working in dust and having the classical clinical symptoms, we suggest

1. To make a change in his occupation.

2. To make an X-ray of his chest for lung tissue.

In the way of prevention it becomes necessary:

1. To educate all concerned.

2. Get rid of dust.

3. Sprinkle the working area with water.

4. Have employees wear inhalers.

5. Have frequent analyses made of the dust content of the air at different times during the working hours.

1937: Discussion of occupational disease compensation and prevention laws enacted in Illinois, with mention of extended statute of limitations for asbestosis and silicosis claims. (19) Concern expressed that state distribution of pamphlets would "create a fear complex" with resulting unjustified workers' compensation claims. (20)

Silica, asbestos, and lead are the principal substances generating toxic dusts to which railway employees may be exposed. (20)

Pre-employment physicals and histories are again recommended, as well as periodic physical examinations of employees "in occupations in which known hazards exist." (21) Control measures discussed include: exhaust ventilation of dusty processes, substitution of safer materials and methods of handling, and use of personal protective equipment such as respirators approved for the intended use by the U.S. Bureau of Mines. (21-22) It is reiterated at the end that asbestosis and silicosis are dust diseases and can be contracted only by breathing asbestos or silica dust. (22)

1951: CDR report section on Pneumoconiosis contains the same 1952 language all three years. Opens with, "The Committee ..." 1953 mentioned "silicosis and asbestosis as forms of the disease most interesting to railroad surgeons." (38 in 1951; 35 in 1952; 34 in 1953) Exam at time of hire to include history and chest X-ray, "particularly in those occupations where unusual quantities of silica or asbestos dust have been encountered or are contemplated as a routine occupational exposure." Periodic exams of such workers also recommended, with X-ray, and those presenting symptoms to be considered for removal and counseling. Indexes in 1952 (42) and 1953 (41) list all years of Medical Section published proceedings in which the Committee previously discussed pneumoconiosis.

1958: The entire Medical Section of the Association of American Railroads hosted Dr. Alton Ochsner, a lung cancer surgeon from New Orleans. He had been affiliated with Illinois Central and Southern Pacific. (81)

There is very good proof that asbestos is a cause of carcinoma. This is seen in individuals working with asbestos, particularly miners. It is also seen among plumbers who work with asbestos, steamfitters particularly. (81)

He said "Heuber" did a study "in which he showed there was a higher incidence of cancer among the operating staffs of the railroads than among the non-operating staffs." Ochsner attributed this finding to a preponderance of males in operations and females in offices (there was a well-recognized difference in incidence of the disease between the sexes).

He said people in these occupations with which an increased risk of cancer has been shown, who develop cancer themselves, are usually heavy smokers, and the smoking is the cause, not occupation. He noted that the only doctors who doubted smoking caused cancer worked for tobacco companies or smoked themselves. (84) Railroad doctors were advised to check smoking histories and tumor cell types of workers filing for compensation for lung cancer.

If they have an adenocarcinoma, it has not been produced by smoking because it is not related to smoking.

Heuber had reported that lung cancer cases were more than three times as numerous among "operating" railroad workers (engineers, firemen, brakemen, conductors, switchmen, and roundhouse personnel) than "non-operating" workers. Yet the former group made up only about 25 percent of the work force. Heuber suspected oil and coal combustion products as a cause of occupational cancers (A Quest Into the Environmental Causes of Cancer of the Lung Washington: Public Health Service Pub. 452, 1955, p. 16).