Elam v. Alcolac, Inc.

TABLE OF CONTENTS

PART ONE

I.The Litigation History. ZD

II.The Alcolac Plant:

A. Its Design and Operation. © ID

B. Startup of Operations — 1978 . LO

C. Plant Operations After WAPORA... C* ID

D. 1. Opinion for the Plaintiffs

The Alcolac Operation: Opinions of the Experts 00

2. Opinion for Alcolac. ©

III. The Chemicals... tO

IV. Residents in the Environs of Alcolac

A. The Plaintiffs-Witnesses. 00

B. The Non-Litigant Witnesses

1. For the Plaintiffs. t-

2. For the Defendant. 00

V.The Medical and Scientific Evidence. 00

A. The Practitioner-Dr. Donald J. Allcorn. 00

B. The 00

*48 VI. A. The Medical Experts and Biological Causation For the Plaintiffs.89

B. The Medical and Causation For the Defendants_ 164

VII. Submissions, Verdicts, 171

PART TWO

The Alcolac Appeal on the Negligence Causes of Action. <N Ci — l

I. Judgment Notwithstanding the Verdicts. CO t> i — l

A.

1. The Issue of Causation in Fact-The Principles. CO t-rH

2. The Issue of Causation in Fact-The Argument. LO ti — I

3. The Issue of Causation in Fact-The Biological Causation Subelement . 1C 00

4. Disposition of the Motion for Judgment Notwithstanding the Verdicts . 00 00 i-H

B. Motion for New Trial

1. Evidence. 00

2. and OS

3. Competency of Medical on “Nonmedical” Causation. OS

4. Undue Limitation of OS

5. Instruction No. 9. O

6. Increased Risk of Cancer. O

7. Miscellaneous Errors. H

a. Conduct of the Trial. i — I

b. Improper Closing Argument. H

c. Errors. H

i-H

II. The Nuisance Causes of Action. H

PART THREE

Appeal of the Plaintiffs.... 219

I. Identical Verdicts as Ground for New Trial

A. Actual Damages. 220

B. Punitive Damages. 222

C. Submissibility of Punitive Damages . 225

PART FOUR

Appellate Judgment. 229

APPENDICES

A — Aerial view of Alcolac plant

B — Aerial view of the locations of residences of plaintiff and non-plaintiff witnesses

C — Foam storm on nearby property

D — Foam carried on Little Shaver creek

E — Resume of testimony given by each plaintiff related to environmental medical diagnosis

F — Official Alcolac memorandum concerning the failure of the liquid incinerator to function

G & H — Official Alcolac memorandum concerning excessive odor emissions

I & J — Material Safety Date Sheets concerning risk of exposure to epichlorohydrin

K — Resumes of evaluations of the immunological systems of each plaintiff by Dr. Stechschulte, an examiner for Alcolac

L-l, L-2, L-3 — Typical SYMPTOMS CHART as completed and validated by expert Dr. Camow as to each plaintiff

M-l, M-2, M-3 — Typical PHYSICAL FINDINGS CHART as completed and validated expert Dr. Camow as to each plaintiff

as to

*49 0-1, 0-2, 0-3 — Typical DIAGNOSIS CHART as validated for each plaintiff by expert Dr. Carnow

P-1 — SUMMARY OF SYMPTOMS by organ systems exhibited in common by the plaintiffs as disclosed by history to Dr. Carnow

P-2 — SUMMARY OF ABNORMAL PHYSICAL FINDINGS exhibited in common by plaintiffs as disclosed upon physical examination by Dr. Carnow

P-3 — SUMMARY OF ABNORMAL LAB TEST VALUES by organ system found in common for plaintiffs

Q-l, Q-2, Q-3 — Typical Alcolac diagnosis charts as validated by Dr. Emmett and Dr. Kirby, examiners for Alcolac

This suit involves thirteen actions brought by thirty-two plaintiffs against Al-colac, Inc. and plant manager Fischer for injury to their persons and property from toxic spills and emissions from a chemical facility in Sedalia, Missouri. The actions, consolidated by order of the trial court, were in four counts and each sought recovery of compensatory and punitive damages. Only two counts were submitted to the jury: One, for the diminished market value of the residences, sounded in nuisance. The other, for injury to the persons, sounded in negligence. The jury, after a trial of more than four months, returned verdicts against Alcolac and awarded to each plaintiff on the claims for personal injury, $200,-000 as compensatory damages and $1,387,-096.70 as punitive damages. The award for property damage varied as to each claim. Alcolac thereafter moved for a judgment notwithstanding the verdict or, alternatively, for a new trial. The trial court denied judgment n.o.v., but granted a new trial as to damages only as to each of the thirty-one 1 personal injury verdicts.

The several plaintiffs appeal the order to set aside the awards for personal injury damages on the negligence count and the grant of a new trial on those issues. Alco-lac appeals the denial of judgment notwithstanding the verdict on both negligence and nuisance counts, the entry of judgment for property damage on the nuisance count, and the entry of judgment of liability on the negligence count.

PART ONE

THE LITIGATION HISTORY

Alcolac commenced its Sedalia operations in May of 1978. In July of 1979 five of the thirteen plaintiff families filed suit in Pettis County with complaints of injury from the Alcolac operations. The five suits were voluntarily dismissed in February of 1981. In December of 1981 the suits were refiled in Jackson County, other suits were commenced, and eventually all were consolidated for trial. Alcolac made answer to the petitions. Alcolac also pleaded a multiple counterclaim. Count I was for Abuse of Process: that the plaintiffs and others in concert maliciously schemed to harass and force Alcolac to cease operations at the Pettis County plant, and to that end commenced an unfounded suit against Alcolac in Pettis County, took no initiative to advance the litigation and later dismissed the suit, but resumed the litigation in Jackson County — not for the redress or remedy of any civil wrong, but for ulterior purposes. Count II was for Civil Conspiracy: that the acts alleged against the plaintiffs in Count I constituted a civil conspiracy. Count III was in Prima Facie Tort: that the acts of the plaintiffs were intentionally done with the purpose to injure Alcolac, and without justification. The counterclaim sought recovery for compensatory and punitive damages as to each cause of action. Alcolac attempted proof of the cause of action *50 through the cross-examination of the several plaintiffs, but without avail. At the conclusion of all the evidence Alcolac dismissed the counterclaim against all the plaintiffs with prejudice. Accordingly, the appeal and cross-appeal are from a final judgment and engage our jurisdiction to review.

What remained was a massive litigation of thirty-one separate causes to action, joined for adjudication through the amenity of consolidation, but tried, submitted and determined by the jury as separate suits. It was a litigation which engaged the jury from August 12, 1985 to December 23, 1985 [four and one-half months] presented one hundred and sixty-five witnesses as well as hundreds of exhibits, and is recorded in ten thousand pages of transcript. The counter-appeals contest not only the validity of the submissions and the verdicts as returned, but also the judgment of the court which validates the proof of the causes of action but nullifies the money amounts returned by each verdict for personal injury and punitive damages. Our review entails the determination of the submissions, the validity of the verdicts, and the propriety of the judgments entered by the court — among the other claims of error.

II

THE ALCOLAC PLANT

A

Its Design and Operation

Alcolac, Inc. manufactures specialty chemical products for industry and commenced such operations in 1950 in the city of Baltimore. It is now an international company. The special chemicals manufactured by Alcolac include surfactants and functional monomers. Surfactants are surface active agents or soaps used in cosmetics and a range of other products. Functional monomers are building-block chemicals used to prepare polymers for adhesives, plastics, textiles, and such. The Alcolac management recognized the dangers to the environment from such production activity and so launched WAPORA, ah environmental management subsidiary, which sells advice on pollution control to industry as well as government.

Alcolac then sought a site in the Midwest for an additional facility, and selected an area contiguous to the city of Sedalia. To deal with the environmental concomitant of the planned facility in Sedalia, in 1975 Dr. Vsevolod Blinoff, founder and chairman of Alcolac, designated the top executives of the company as an ad hoc committee. They included Charles Anderson, Alcolac president, Peter Bouroff, Alcolac vice-president, Dr. Jacob Bregman, president of WA-PORA, and Blinoff, himself. It befell Bregman and WAPORA to design the environmental control system for the Sedalia facility. The design Bregman and Blinoff envisioned was a model of environmental safety — a plant [as described by Bregman] “that could make products that were toxic and hazardous and yet keep them in such a manner that the environment would not be affected.” It was the specific Blinoff instruction that Bregman and WAPORA design and construct “a zero discharge plant” —a state of the art model. Anderson, president of Alcolac and an accountant by training [described by Bregman as “a bottom line kind of guy”], opposed many of the environmental controls as too costly and “a lot of baloney.” The design was drawn and construction began nevertheless.

The composite facility included three production buildings: a building for the manufacture of surfactants or soaps, another for the manufacture of monomers, and an environmental control building. 2 The production from both the surfactant and monomer plants resulted in wastes, both in liquid and vapor form. It was the design of the pollution control processes at the plant to remove the organic chemical contaminants from the wastes, and to expunge their odors, before emission. The design provided for carbon filters and scrubbers to remove the contaminants and odors from the wastes, incinerators to consume the organ *51 ic matter removed from the liquids and vapors, and pipe lines to emit the liquids and stacks to emit the vapors. It was the theory of the design that the pollution control processes would render the otherwise toxic and odorous wastes harmless to the environment.

To dispose of the liquid wastes, underground pipes ran from each of the three structures to four bio-oxidation ponds. There was also an underground pipeline between the monomer plant and the environmental control building. It was the function of the bio-oxidation ponds to degrade the contaminated remnants discharged into them through the conduits from the surfactant building and the environmental control building. The bio-oxidation ponds were designed on the same principle as any municipal sewage treatment lagoon: the ponds were filled with plain water and the bacteria allowed to develop; as the wastewaters [theoretically scrubbed free and filtered of contaminants] are gradually introduced, the bacteria degrade them. Thus, the design, as applied to both the surfactant and the monomer wastes, intends that the organic chemical contaminants be removed before discharge into the bioponds.

In the case of the soap plant, the wastes were to be treated by acid scrubbers to remove the chemical residues and odors from the liquid and vapors. The liquid was then effused into the biopond and the waste vapors, then also cleansed of any acid mist, were emitted through the surfactant stack.

In the case of the monomer plant — where the toxic chemicals were used for production — one liquid waste stream flowed into the environmental control building and over carbon filters for the removal of the organic materials before discharge into the biopond for biodegredation. The other liquid waste, suspensions of undissolved organic particulates, was piped into the liquid incinerator for burning, then through scrubbers to clean the odors, before emission into the atmosphere as vapor. The toxic vapor wastes from the reactors in the monomer production process were filtered through a system of carbon beds in the monomer building and the organic residues burned off in the “fume incinerator” before emission. 3

The design intended, therefore, that the liquid emerge from both the surfactant and monomer plants free of organic matter and then flow into the bioponds as uncontaminated wastewater. It was the theory of the design that the wastewater then biodegrade through a series of four bio-oxidation ponds, each of which retained the wastewa-ter for thirty days before it flowed by gravity into the next pond, and finally collected [after the 120-day cycle] into a sedimentation pond for reuse — either for field irrigation or as washwater for the plant reactors.

This system of controls notwithstanding, both the monomer and environmental control buildings were designed with valves meant to be unlocked only for the release of wash water and storm water to the bioponds. Instead, operators in the monomer and environmental control buildings at times used the valves to bypass the waste treatment features of the facilities and pipe raw, untreated toxic chemical wastes directly into the open air bio-oxidation ponds outside. Also, the wastewater from the monomer process was intended for discharge into biopond one, and that from the *52 surfactant process into biopond two — [presumably, because the soap wastewater was more readily biodegraded than the monomer wastewater]. • Notwithstanding, it was the recurrent practice to emit both the soap wastewater as well as the untreated monomer wastewater into biopond one, with the result that the toxic monomer wastewater intermixed with the soap wastewater and was borne off the Alcolac premises as puffs of foam. Notwithstanding also the sense of the design that the liquid incinerator function as the means of disposal of particulate contaminant wastes from the monomer process, the device malfunctioned from the outset of Alcolac operations and, in mid-1981, was discarded as a means for the disposal of toxic waste.

B

Startup of Operations 1978

Alcolac operates under license of the Missouri Department of Natural Resources [DNR]. That agency has the primary responsibility to enforce environmental compliance. Alcolac is also monitored by the Environmental Protection Agency [EPA] and the Occupational Safety and Health Administrations [OSHA].

Alcolac commenced operations in the Se-daba plant in May of 1978. Some months earlier, in November of 1977, Bregman had circulated to Blinoff, Anderson, Bouroff and Fischer [then plant manager], a memorandum of “comments on the Sedalia plant start-up.” Bregman had recently visited the facility and noted a number of problems he wanted to be certain were corrected before the onset of production. He explained: “They have to do with pollution control systems, and very heavy emphasis on training the plant personnel.” The memorandum recommended, among others, that all the pollution control equipment required for proper operation of the plant be installed and tested before the “first batch” of production; that all plant personnel “go through an intense training session on the use of the pollution control manual” [the Environmental Control Systems Operating Manual devised for the plant by WA-PORA]; that “[a] system of very close checking of the bio-oxidation ponds for odors” be established to ensure that “no noticeable odors from them get anywhere near the property lines or the Alcolac building.” These goals, Bregman concluded, were never met.

Alcolac began production nevertheless some six months later, and almost from the start the liquid incinerator and the bio-oxidation pond systems were sources of complaint. The incinerator emitted vapors and hazes over the environs and the bio-oxidation ponds emitted odors. Alcolac called on WAPORA to allay these problems. Breg-man assigned to David Boies, the engineer who had designed the Alcolac plant, the liquid incinerator concern, and to engineer Dr. Leroy Reid, an expert in the treatment of toxic waste, the bio-oxidation ponds odor concern. Boies and Reid concluded the assignments and reported to Bregman.

Reid completed the first phase of the assignment in July of 1978 and in a memorandum expressed concern that the carbon filter system in the environmental control building was used to overload with the consequence that toxic wastes from the monomer process were allowed to enter the bio-oxidation ponds. A month later Reid resumed the investigation and found the bio-oxidation ponds still toxic as well as odorous. Reid also discovered on that second visit that the drain valves which lead from the monomer building to the bioponds were not locked closed as normal procedure intended. This allowed chemical spills in the monomer building to flow directly into the waste pipes of the environmental control building for discharge into the biopond without any prior cleansing in the liquid incinerator. Dr. Reid not only reported to Alcolac that the ponds were being contaminated with toxic wastes, but that the toxic chemicals lighter than water could attach themselves to the foam created by the aerators in the bioponds and be blown in the air or become vapor — and so present a hazard to the environment. Dr. Reid also recommended that an additional aerator be installed in the bioponds to infuse the water with more oxygen, and so dispel the odors. Reid also reported to WAPORA, by *53 a later memorandum of October 31, 1978, with copies to Anderson and Bouroff at Alcolac, that the chemical data collected indicated that the biopond was receiving loadings of over 18 times design conditions.

Reid continued the investigations into 1979. The increments of chemical wastes from the increased production outstripped the capacity of the bio-ponds to degrade the chemicals so that a sludge accumulated at the bottom of the lagoons. Odors were emitted of the “rotten egg type, which were probably from hydrogen sulfide.” On several occasions Reid experienced “a burning type sensation to the odor coming off the lagoons” to the membranes of the nose. His reports noted also that the acid scrubbers in the surfactant building were not as effective as expected so that soap flowed into the bio-oxidation ponds and put an additional stress on a system already overburdened. Other memoranda reported to Alcolac and plant manager Fischer that the employee who operated in the environmental control building was untrained, and not “capable of doing a proper job.” A memorandum to Anderson at Alcolac in June of 1979 reported other problems: the rupture of a disk [a monomer reactor safety device] which sprayed toxic chemicals into the air. That memorandum also reported that a drain outside the environmental control building discharged untreated chemicals into a ditch and from thence into the atmosphere — among other numerous erratic environmental practices noted as to Alcolac. Reid reported also that strainers on the pumps in the monomer building clogged, so that the pits overfilled with the consequence that the raw untreated chemical waste flowed directly to the bio-oxidation ponds, still toxic. Reid noted also on the occasion of another visit to the Alcolac plant a spill of dodecylbenzene sulfonic acid at the surfactant plant. He commented also that the environmental technician [Le-Maire] was untrained. He noted that the position was very important “as any data he produces must be valid” and urged that LeMaire be trained. Reid urged also that the employees be impressed with the requirement for good environmental control measures. He observed that the plant lacked a “spill response program” — a team trained and equipped to handle spills of corrosive and hazardous chemicals in order to prevent damage to personnel and the environment.

In August of 1979, the Reid memorandum cited evidence of several major chemical spills — which “probably violate either or both Federal or State law.” He commented, “[b]oth were serious and major spills which could pollute either streams or groundwater acquifers.” That memorandum concluded with the summary: “There seems to be new problems developing at the plant each time I visit,” and urged management “to take a highly active role in enforcing the proper conduct of employees to reduce danger to the personnel health and to the environment.” It concluded: “Haphazard handling of chemicals should not be tolerated.”

Reid submitted numerous recommendations to Anderson and the other Alcolac officials on solutions to the bioponds pollution problems — with specifications, design calculations and cost estimates — but every recommendation met resistance or delay in implementation. In addition to the memo-randa, Reid warned the Alcolac officials that the environmental problems would exacerbate. The major concern, as he saw it, was that the chemical waste from the increase in the production schedule “would overcome [the improvement to the bio-ponds] we had planned before it even got installed.” The ultimate resistance to the recommended solutions to the bioponds pollution problem was an economic resistance “clear at the top” — Alcolac president Anderson. Reid had the impression that Alcolac either did not have the money to spend or did not want to spend the money.

Boies also pursued his assignment of June, 1978, to investigate the liquid incinerator and also reported to Bregman. Boies died in 1980, five years before the trial, so Bregman related the results of that phase of the investigation. In the course of the investigation in June of 1978, Boies paid a visit to the woman who complained that the liquid incinerator caused vapor and smoke to drift over her home, and Boies made *54 an apology. Boies composed a detailed memorandum about that incident, gave it to Bregman, and sent a copy to Alcolac. Anderson, irate that Boies should have apologized, demanded that “Boies be pulled off the project and [not] to be put on it anymore.” Blinoff, the founder of Alcolac and champion of “a zero discharge plant” had died by then, and Anderson succeeded him as the dominant figure in Alcolac. Thus, Bregman acceded to the Anderson demand, and removed Boies from the Seda-lia project.

Boies had written other memoranda concerning his investigation of the Sedalia project, but they were missing from the WAPORA files. Bregman still retained a related document, however — a typewritten draft of a proposed memorandum to Alco-lac prepared by Boies and submitted to Bregman, who inscribed his comments. The memorandum in final form — circulated to Anderson and other Alcolac officials— was also missing from the WAPORA files, but Bregman reconstructed its content from the document at hand. The memorandum was a catalog of “things that were remaining to be done” to bring the pollution control systems to proper function. One item commented: “No one person responsible for pollution control.” It meant, Bregman explained, that “Alcolac did not have a trained competent person who looked at the pollution control systems, made sure they operated right.” Another item commented that the “sampling points on the vent absorber units” were not yet installed, and hence “whether stuff was escaping into the air or not and how much or what” could not be determined. Alcolac always responded “they were too busy running the plant to do this.” Another item commented that the major problem as to water pollution control was that “a much higher organic load than had been predicted” was emitted into the bio-oxidation ponds. That is to say, the production of organic compounds at Alcolac exceeded the design level based upon the production prediction provided by Dr. Bouroff. The result was that a much higher organic load wound up in the oxidation ponds than allowed for by the design. Another item commented that the Alcolac employees were not using the record forms supplied by WAPORA to monitor the bio-oxidation ponds.

Another “major basic problem” the Boies memorandum mentioned was from the operation of the liquid incinerator, which generated haze in the atmosphere. Bregman explained that the local residents were restive about that condition of pollution, and the newspaper reported that uneasiness. Bregman assured the citizenry at a meeting that “these things were going to be solved.” That condition apparently came to the attention of the Department of Natural Resources, and the Alcolac officials, Anderson and plant manager Fischer, in the company of Bregman met with the agency in Jefferson City. Bregman and the others disclosed to DNR the plans for air pollution control, and the agency was satisfied. Anderson informed WAPORA shortly after that meeting that Alcolac would “handle all future dealings with the State of Missouri” without “involvement” of WAPORA. The eventual consequence rather was to remove WAPORA as consultant altogether. In the interim, however, Bregman — as requested by Alcolac — met with yet another citizens’ group, an environmental committee, to allay the concerns of the Sedalia citizenry and to assure them that the air pollution problems would be resolved. Bregman then still believed that the recommendations of the Boies memorandum, as well as his own, would be implemented. Anderson refused them, however, because: “[I]t cost too much money.”

Alcolac discharged WAPORA from the Sedalia project in December of 1979. A month or so before, Bregman dispatched a last memorandum to Alcolac president Anderson and vice-president Bouroff, among others. A copy of that memorandum was also missing from the WAPORA files. Bregman, however, retained a sketch, written in his personal hand, from which the formal memorandum was composed. It was a summary of past operational problems at Sedalia, the present state of those problems, and recommended solutions. The memorandum noted once *55 again, as before, the need for a strong and experienced engineer for the maintenance of the expensive and complex pollution control equipment, that the employees be trained in odor detection and control, and that the standard operating procedure delineated in the Environmental Control Systems Operating Manual composed by WA-PORA for the Sedalia plant be observed— all recommendations already made to Alco-lac by WAPORA but not implemented. The memorandum also informed Alcolac, once again, that the monomer plant was producing three times the chemical waste the design capacity of the bio-oxidation ponds allowed. Bregman reported also that the odors were caused by the “sloppy handling” of the chemicals used in the monomer process and could pose a considerable toxic control problem if not handled correctly. It was communicated to Alcolac, also, that a number of the chemicals used in the monomer production had “significant air pollution potential” so that the plant environmental control system needed to be flexible and reliable. Among the chemicals specifically mentioned as environmental hazards were allyl alcohol, dimethyl sulfate, epichlorohydrin, ethyl acrylate, methyl methacrylate and toluene sulfonic acid.

Bregman testified that Anderson refused to implement the recommendations of the last memorandum, as he had the predecessors, as too costly. Bregman deemed the environmental system designed for Alcolac worthy of a national prize, and told Anderson that “if he would fix this up, we would have the best one going” — but to no avail. In December of 1979, Alcolac president Anderson removed WAPORA from the Sedalia project. Bregman cited — as of that date of departure — the continued reluctance by Anderson to spend the funds necessary for these essential pollution controls: $150,000 to install hydrocarbon monitors; another $100,000 or so for an aerator system to facilitate the oxidation of the excess chemical wastes in the ponds due to unforeseen increased production, and about $500,000 to $1,000,000 to redo the liquid incinerator. Bregman reiterated as the “single-most important factor” to a proper system of environmental control “a highly qualified environmental engineer to make sure that the systems work and to give the fellow the authority to make corrections when they don’t work.” It was a recommendation Anderson “strongly opposed,” because of the salary entailed, and because the “corrections” would involve “an ongoing expense.”

Some two years later, after the commencement of suit against Alcolac, Breg-man heard from Anderson once again. As Bregman related the incident, Anderson said that “there were some kooks who filed a lawsuit” and he asked Bregman “to destroy the WAPORA project file on the Se-dalia project.” Bregman refused the request as “unethical, probably illegal and certainly unprofessional.” Of the two files at WAPORA on the Sedalia project, one disappeared altogether.

Alcolac president Anderson was called by the plaintiffs and was examined as an adverse witness. Anderson was a member of the ad hoc committee appointed by Alcolac founder and Chairman, Dr. Vsevolod Bli-noff, and so was involved in the decisions on the design and construction of the Seda-lia plant — the environmental control system, included. Anderson acknowledged that as early as January of 1978, he was aware the Sedalia production process involved many dangerous and highly toxic chemicals. He acknowledged also the numerous WAPORA reports and recommendations, written and spoken, during 1978 and 1979 [the first two years of Sedalia operations] concerning the improvement of the environmental control systems and that Alcolac was not willing to spend money to implement them all.

They did [according to Anderson] use the Environmental Control Systems Operating Manual prepared by WAPORA at the Seda-lia facility. 4 Alcolac did purchase one of the eleven hydrocarbon systems recommended by WAPORA to monitor chemical *56 emissions. That monitor did not function, however, and Alcolac depended on periodic samples taken from the stacks and dispatched to independent testers — “several times over a couple of years” — in lieu of the analytic monitors WAPORA found essential to detect, warn of and control the toxic emissions. The liquid incinerator had not functioned effectively from the outset of production so that in May of 1980 [after the dismission of WAPORA] Alcolac vice-president Bouroff was prompted to report to president Anderson among the items of “Progress As Of May 1980”:

Items 1 & 2: Our liquid incinerator has the poorest performance ever seen. Most of the time it is out of commission due to all kinds of mechanical problems. It is an absolute waste of time and money. We consider it a 100% failure and the most costly operation. Also, part of our environmental problems were/are caused by this piece of equipment. 5

The malfunction notwithstanding, Alcolac continued to use the incinerator as the mode to dispose of the liquid waste. The result was that the waste was only partially incinerated, if at all, so that the residue was vented into the atmosphere still as toxic, or even more so, than before. In 1981, the use of the liquid incinerator was discontinued altogether. The hazardous waste intended for disposal by that method was hauled away thereafter.

Anderson recalled that during one of his periodic sojourns at the Sedalia plant — in 1978 or 1979 — he had occasion to visit Charlotte Phillips [an eventual plaintiff] at her home north of the facility to discuss a complaint of odors. He never knew of any incidents of odors from Alcolac “going beyond the property boundaries” and contested her testimony that on the occasion of that visit the odors were so pronounced “that everyone’s eyes were watering and people were choking,” including Anderson, himself. Nor had Anderson ever seen foam from the bio-oxidation ponds “blow beyond the bounds of the Alcolac property” except for a photograph in evidence which depicted such an accumulation beyond the bournes of Alcolac. He conceded, however, that “[w]e have been cited by the DNR [Department of Natural Resources] for odors that have gone off of our property before.” The numerous complaints of odors from Alcolac made by neighbors of the plant, he said, were personally investigated and never corroborated. The complaints of odors, Anderson said, were unfounded. Anderson conceded that he was advised that the bioponds were regularly being overloaded, but on one occasion only, and then by Dr. Reid. He acknowledged that Alcolac employee Joseph LeMaire was the person Dr. Reid alluded to in his 1979 report as the environmental control technician totally untrained and incompetent for such a position. Anderson was adamant, however, despite even the testimony of Le-Maire to the contrary, that LeMaire functioned as a maintenance worker — not an environmental control technician. Anderson acknowledged that Alcolac officials had met with the DNR some ten times since 1978 concerning the emission and odor problems at the Sedalia facility. He denied any overture to Bregman to destroy the WAPORA files consequent to the initiation of suit by these plaintiffs.

Joseph LeMaire was employed at Alcolac between August of 1977 and January of 1984. His testimony as to his employment function and the regularity of the plant operations was in essential contradiction to that given by Alcolac president Anderson. His service with Alcolac, therefore, encompassed the entire period of the WAPORA presence there — and beyond. LeMaire came to Alcolac at the age of eighteen years as a maintenance worker and groundskeeper. He had dropped out of school at the 10th grade, but later gained the General Equivalency Diploma. That was the extent of his formal education. In the summer of 1979, the employee in charge of the environmental control building was discharged for drunkenness on the job, and [according to LeMaire] without training or even the guidance of an operation manual, LeMaire was placed in charge of environmental control. He was accord *57 ed the title: “environmental control technician.” LeMaire described the process by which the environmental control building devices were designed to function: the liquid waste stream from the monomer plant [where the most toxic chemicals were used] was conducted into a sump pit in the environmental building and from there was filtered over charcoal Calgon units and the liquid, as treated, was then discharged into biopond one.

LeMaire described episodes of repeated chemical spills at the plant. Toxic spills were often “push[ed] down the drain with squeegees.” The valves which controlled the monomer drains were kept open as a matter of course so that the spilled toxic liquid flowed directly into the environmental control sump pit and was allowed to discharge into the biopond without completion of the charcoal decontamination process. Also, on occasion, the environmental control drains would become so overloaded that the waste liquid backed up, and the waste was routed around the environmental control filtration system, still toxic, directly into the biopond. On other occasions, the toxic liquid overflow was simply allowed to drain from the environmental control building to the outdoors, and from thence into Little Shaver Creek. LeMaire could detect the odors of toluene and allyl methacrylate, among other toxic compounds, from these “washdown waters” from the monomer building. LeMaire also described occasional dispersions of chemicals into the atmosphere from explosions in the monomer plant [a phenomenom noticed by the WAPORA report of Dr. Reid to Alcolac president Anderson]. The exposure to these toxic wastes burned the eyes, irritated the throat and impaired the breathing. LeMaire described the odors emitted by biopond one as of “rotten eggs or a bad sewer system,” or sometimes, “a sweet smell, or a sour, bitter, smell,” depending on which untreated chemical wastes were in the pond.

The “washdown from the soap [surfactant] plant” also collected in bio-oxidation pond one. Thus, when the chemical wastes from the monomer building were released directly into the pond uncleansed by filtration, they mixed in that toxic state with the suds from the soap building. Those suds, LeMaire observed, left the Alcolac premises “like a snowstorm” whenever the wind blew, and at times built the suds to a height of “close to 15, 20 feet tall.” Le-maire and the other workers, accoutered in protective gear, attempted to control these occurrences with sprays or other such substances.

LeMaire recounted that during his service at the Alcolac plant, the Department of Natural Resources made periodic inspections. Alcolac received advance notice of the prospective inspections and “cleanup parties” were held to prepare the plant for the inspectors. The agency discontinued the inspections when the plaintiffs commenced these lawsuits, and then “the cleanup parties stopped.” LeMaire was terminated from employment in January of 1984 shortly after he suggested to Alcolac president Anderson and vice-president Bouroff that the Missouri Department of Conservation be summoned to investigate the death of numerous fish in a pond which adjoined the plant. Anderson did not recall the episode, although he acknowledged LeMaire was fired. It was the installation of a twenty-year-old with no training [LeMaire] as environmental control technician which prompted Reid to comment in a WAPORA memorandum to Alcolac that the appointment “made a joke of [the WAPORA] recommendations.”

Paul Faulconer worked at the Alcolac plant and confirmed, and enlarged on, the operational malfunctions described by Le-Maire. He worked there for six months from April of 1979, and so his service was during the WAPORA presence at the plant. Faulconer was not trained for work at a chemical plant when employed, and received no training prior to commencement of work. His function was that of chemical operator in the surfactant plant. Faulconer was assigned one time to the monomer plant with a coworker. There was a spill while he was there from the reactor of about a quart of allyl alcohol. The almost immediate effect was to swell the eyes shut. The maintenance personnel washed *58 down the spill accoutered in self-contained respiratory units. In the process, they opened the doors to vent the allyl alcohol vapors into the atmosphere. Faulconer, some ten feet away outside the building, could feel the effect of the allyl alcohol vapors on his sinuses and eyes.

The operations at the soap plant were plagued by continual breakdowns caused by lack of maintenance: overhead lines ruptured, pumps failed, and other malfunctions resulted. The toxic vapors released from the ruptures were simply vented into the atmosphere. When the sulphur burner in the soap plant broke down, so that sul-phur dioxide fumes filled the building, the employees were instructed to wait until after dark, then open the doors and release the fumes into the atmosphere. At those times, the fumes became so thick that employees in the soap building had to wear respirators. The manufacture of the soap-based products in the surfactant plant involved sulphur and its compounds. Waste from that process included vapors of sul-phuric acid, sulphur trioxide, and other chemical residues. It was a function of the acid scrubbers to cleanse the residues from the wastes before they were emitted, nontoxic and neutral, into the atmosphere through the stack. When the acid scrubbers malfunctioned, but production continued nevertheless [as were the instructions of management], the vapors — still contaminated — and acid mist were emitted from the stack in the form of a plume, and sometimes as soap bubbles. The acid scrubbers malfunctioned 70% of the time. The smell from the plume was “very foul.” When that residue descended, the grass turned brown, and irritated the skin it touched.

There were also repeated chemical spills. They occurred regularly, about once a week, usually at the start-up and shutdown phases of the production process. If the spill was in the plant, it was flushed down the drain and discharged into biopond one. The consequence was “a big pile of soap bubbles floating across the road” mixed with whatever toxic chemicals were in the pond. If the spill was outside the plant, as often occurred when trucks loaded or unloaded the chemicals, the spill was merely covered over with dirt. On one such occasion, some two to three thousand pounds of duodubonicsulfonic acid were released. Other outside spills resulted from the overfill of outside chemical storage tanks of multi-ton capacity. Another source of outside spills was from the storage of the liquid waste products. That residue [presumably because the liquid incinerator continued to malfunction] was placed in several thousands of drums outside the buildings for transport and disposal. Some of the drums leaked so that the contents filtered into Shaver Creek. Others would be smashed by the semi-trailers, and the contents laid open. Other drums exploded in the August sun and spewed the contents.

Faulconer described incidents when trucks came to be loaded to transport the surfactant products, but were refused by the employees because remnants of hazardous chemicals from the prior haul remained in the vans. The truckers simply drove a short distance off the premises, drained off the toxic matter, and returned for loads. It was a practice, Faulconer said, known by Alcolac and tolerated.

There was a logbook used to communicate between the production shifts. It contained instructions by production manager Gibbs as to the chemicals to be produced and the quantity. It was also used to report spills. Faulconer was instructed by Gibbs not to record a spill in the logbook until it was discussed with management first. He testified that only “ten, maybe twenty percent” of the spills he observed at the soap plant were recorded in the log. The spills usually recorded were the “nonhazardous type spills ... five gallons of this, ten gallons of that.” Those spills considered hazardous, Faulconer testified, were never noted in that log, or anywhere else, during his employment at Alcolac.

Faulconer confirmed the LeMaire testimony that Alcolac somehow got two or three days advance warning of Missouri Department of Natural Resources inspections, and that advisement was transmitted to the employees by production manager *59 Gibbs. According to Falconer, the Alcolac management instructed Falconer and the others to “keep your mouth shut, don’t volunteer any information.” Falconer was discharged — he contended — two weeks after he contacted the president of the union at the Alcolac plant in Baltimore [the Seda-lia plant was nonunion] for advice about better maintenance and safety procedures at Sedalia. He took that initiative, Falconer testified, only after he had approached Gibbs about better plant safety and was told “to keep [his] mouth shut.”

C

Plant Operations After WAPORA

Alcolac dismissed WAPORA from the Se-dalia plant project in December of 1979. The urgent WAPORA recommendations— for a trained environmental engineer, employee training in pollution control, a restored liquid incinerator, the installation of eleven hydrocarbon systems to monitor emissions, and an aerator system sufficient to oxidate the increased influx of chemical waste into the bioponds — all remained unfulfilled.

Complaints by residents in the environs of Alcolac [some of them eventual plaintiffs, and others not] of odors, suds, fumes and bodily ailments from those and other emissions were made to Alcolac, to public officials, and then to the Missouri Department of Natural Resources [DNR] almost from the outset of operations. The DNR was drawn into contact with the Alcolac facility in Sedalia by a complaint of odors by Gwendolyn Lawrence, a nearby resident and eventual plaintiff. The response to that first complaint was by Ann Gessley, environmental specialist with the Division of Environmental Quality of the DNR in Jefferson City, Missouri. She arrived in Sedalia a week later to interview Ms. Lawrence — in August of 1978. The investigator on that occasion detected “a slight odor,” and then proceeded to measure the odors around the circumference of the plant by means of a scentometer. That device allows a tester to measure the concentration of an odor by inhalations of comparative volumes of odor-free air [freshened by the carbon filter of the scento-meter] and odorous [unfiltered] air. A dilution ratio of 7 to 1 between the filtered and ambient air constitutes an “excessive emission” according to the standards of the federal Clean Air Act enforced by the DNR. 6 Ms. Gessley then entered Alcolac, informed then plant manager Fischer of the complaint, and was conducted through the facility. She had occasion to inspect the plant several times thereafter but acknowledged that she was qualified to enforce odor regulations, but not as to the “goings on of a chemical plant.” Ms. Gess-ley testified that she never undertook to determine the source of the odors on the occasion of that first complaint, but her written report suggests that “the waste lagoon [biopond] could be the source of the odors.” She doubted, however, that the biopond was the cause of the burning sensations the complaint of Ms. Lawrence described.

The recurrent complaints of odors and bodily discomforts from Alcolac emissions entailed frequent returns to Sedalia by Ms. Gessley and other DNR specialists. They conducted repeated surveillances around the Alcolac perimeter and often detected odors, but no violations — that is, odors diluted in a ratio of 7 to 1 by the scentometer test. Ms. Gressley acknowledged that the elapse of the two hours or so between the receipt of the complaint in Jefferson City and the arrival of DNR personnel in Seda-lia “was why we couldn’t get a violation.” That is to say, whatever odors may have been emitted at the time of the complaint were often dissipated by the time an official test was possible. It was to allay that *60 conundrum that the DNR empowered Seda-lia officials — first the Director of Civilian Defense of Pettis County and then the Se-dalia Police Department — to respond to complaints and to investigate by means of the scentometer. In a memorandum concerning a successive “walk-through” inspection of the Alcolac plant in October of 1978, Gessley did note “foaming problems” in Biopond No. 1, and noted also that the management “plans to reroute discharge [of] sulfactant plant to second and third cells [bioponds].” Gessley concluded her service with the DNR, and hence responsibility for the complaints of the Alcolac operation, at the close of 1979.

The response to the citizen complaints about the Alcolac operation, and the sur-veillances, by the DNR continued through Charles Crawford, a section chief of the air pollution control program, and others of his inspection group. Crawford testified that his division responded to over fifty complaints about Alcolac during his service in that function throughout 1979 and 1980. These responses then still originated from the Jefferson City office of the DNR, and Crawford participated in about fifteen of them. They comprised of surveillances and scentometer measurements. Crawford explained that, as to citizen complaints, because of the lag time between the receipt of the complaints at Sedalia and the arrival of the DNR in response, DNR “pretty much drew a blank on really getting anything to constitute a violation.” He acknowledged on cross-examination, however, that in an official letter to The Seda-lia Democrat, he commented that in the two years which preceded the abatement agreement between Alcolac and the DNR [on May 30, 1980] “we found several violations of the state odor regulation at Alco-lac.” There were also citizen complaints of foam as well as of physical ailments from the Alcolac operations.

Richard Nikkila, chief of the enforcement section of the DNR in 1979, and then in 1980 staff director for the air pollution control program of the agency, first made contact with Alcolac during a “walk-through” inspection of the plant with Ms. Gessley. Such “walk-through” inspections were not to determine compliance, but simply “what is in operation and what [emission] controls are in place.” In 1979 his office inaugurated the. policy of increased surveillance of the plant for excessive odors, which Ms. Gessley and others then implemented. There were occasions when the scentometer measured excessive emissions, and Nikilla recalled that about four notices for such excesses issued to Alcolac from the DNR office from such surveillanc-es. A series of notices of excessive emissions issued to Alcolac on citizens complaints as well.

On March 7, 1980, Nikkila served upon Alcolac a notice of excessive emissions. That investigation was prompted by the complaint of Ms. Lawrence in Sedalia to the DNR in Jefferson City of odors from the Alcolac plant. Nikkila and Hastings, another DNR official, arrived from Jefferson City an hour and a half later. The odors were palpable to them even without the use of a scentometer, and both of them detected successive measurements at the 7 to 1 dilution ratio. They found the source: an exposed portion of the waste stream from the monomer building.

On March 14, 1980, an investigation of another complaint of odors from Alcolac resulted in another “notice of excess emissions.” Alcolac was instructed to “determine the cause of the odor” and to achieve compliance by March 24, 1980. On April 30, 1980, Nikkila received two complaints of dark smoke and odors from the Alcolac surfactant plant. A nearby resident [and former plaintiff now deceased], Ms. Landon, complained that she had been overcome by odors some days before and became unconscious. Mr. Landon [also a plaintiff] complained that the emissions aggravated his emphysema. Nikkila came to Sedalia, took scentometer readings around the Alcolac perimeter and recorded measurements of 7 to 1 — “excess emissions.”

On April 30, 1980, as a result of the investigation of a citizen complaint of dark smoke and odors from the Alcolac plant, Nikkila issued a notice of excess emissions. Nikkila gave notice of excess emissions to the laboratory technician, in the absence of *61 plant manager Sutton. Alcolac interposed a “malfunction plea” against the April 30 notice of excess emissions which was rejected by the DNR after investigation. The official response by Nikkila for the DNR to plant manager Sutton for Alcolac on May 22, 1980 concluded.

Since this is the third notice of excess emissions that you have received and the second which has been upgraded to a notice of violation, we intend to request issuance of an abatement order by the Director, Department of Natural Resources.

Sutton, in turn, issued a memorandum on that very date, May 22, 1980, to all Alcolac employees on the subject: “Odor and Pollution Control.”

During the past three months we have been cited three times by the Air Pollution Enforcement Division of the Department of Natural Resources for excessive odor emissions. These citations are serious and will probably result in further action from the DNR. 7

The memorandum then gave the causes of the citations and complaints as “human error” in the operations which “could have been prevented had proper procedures been followed.” It cautioned that “further operating errors or causes of odors will be very serious [and] could result in additional citations and ultimately the shut down of the plant.”

These episodes prompted the DNR to issue an abatement order which directed Alcolac to cease the emission of odors in excess of the restriction imposed by its regulation. That order of abatement was superseded by an abatement agreement concluded between the DNR and Alcolac on May 30, 1980. Its purpose [according to Nikkila] was to correct what the surveil-lances and investigations determined were the “significant sources of odor.” Alcolac undertook, by its terms, to implement nine projects and procedures:

1. To install a single automatically timed hydrocarbon monitor to sample the emissions from each stack of the vapor incinerator and carbon adsorption system in the monomer building, equipped with a manual noise alarm when the limit for the hydrocarbon concentration is reached. The baseline data for the hydrocarbon concentration cut off limits was to be established by Alcolac and submitted to DNR for approval by December 1, 1980, and the alarm was to be installed thereafter by January 12, 1981.

2. To draft a written plan for the handling and control of the excess hydrocarbon concentration in the vapor incinerator and carbon adsorption system in the monomer building for DNR preliminary approval by November 10, 1980, and for final approval by December 1, 1980.

3. To implement by February 1, 1981 a system to determine on a one time basis the nature and concentrations of the emissions from the stacks of the vapor incinerator and carbon adsorption system for each product manufactured by Alcolac in the monomer building.

4. To install and operate an alkaline scrubber to remove 99.5% of the acrylates in the gaseous waste streams from the monomer building reactors and storage tanks. Alcolac undertook to report a completed and efficient operation of the installation to the DNR by June 30, 1981.

5. To install and operate an alkaline scrubber to remove 99.5% of the acrylates from the liquid waste streams from the hot wells in the vacuum system of the reactors in the monomer building. Alcolac undertook to report a completed and efficient operation of the installation to the DNR by July 15, 1981.

6. To develop and submit to the DNR by November 7, 1980 a plan and procedure for the routine analysis and changing of activated carbon in all *62 carbon adsorption units so that the carbon is replaced before breakthrough of gaseous wastes.

7. To test, by November 24, 1980 and semi-annually thereafter, for emissions of sulfur dioxide and sulfur trioxide acid mist from the surfactant plant stack in accordance with the method approved by agency regulation.

8. To store — immediately—all drummed waste materials in either the monomer building, environmental control building or the warehouse.

9. To develop for DNR approval by November 15, 1980, a plan for the training of employees as to the control of odorous emissions from potential sources at the facility.

The abatement agreement did not prescribe any projects or procedures to further control emissions of odorous matter from the bioponds. Nikkila gave as reasons that the additional infusions of dilution water into the ponds and the installation of a system of aeration led the DNR to conclude that the bioponds “were no longer anaerobic, [s]o in our view, that was not an issue to take up with Alcolac.”

It is the sense of the Nikkila testimony that the terms of the abatement agreement were met, with exceptions. Project 3, the system to determine on a one time basis the nature and concentrations of the emissions from the monomer building stacks, was never completed. Project 1, the hydrocarbon monitor, was installed but reported inoperative by Alcolac on December 8, 1981, and the manual reset alarm for that system was not actually installed until May 22, 1984. Project 8 called for the immediate storage of all drummed waste into one of the designated buildings which were designed to collect odors through the system of activated carbon. Alcolac, however, had adopted a plan to dispose of the physical inventory of 3000 drums at the rate of 500 per week, so that the removals would not be complete until July of 1980. A number of those containers leaked ethyl acrylate and other toxic chemicals so that they were transferred to sound drums. Nikkila could not say how Project 8 was ultimately performed.

The abatement agreement notwithstanding, Nikkila acknowledged, the problem of odorous emissions was not resolved. The chemical spills continued also. The citizen complaints of odors from the Alcolac operation, the official detection of excessive emissions, and the citation for violations persisted. On August 15, 1980, a DNR investigation in response to a citizen complaint resulted in a notice of excess emissions to Alcolac. The Alcolac plea of malfunction was denied, and the emissions officially attributed to Alcolac negligence. In year 1981, the DNR files recorded notices of excessive emissions from a variety of operational incidents: foam off the bio-ponds carried beyond the Alcolac property; chemical spills, and from the malfunction of the carbon bed [and so officially excused]. The complaints of intrusive foam became so recurrent that then plant manager Sutton refused to accept any further notices of excess emissions from the DNR officials. Alcolac called Nikkila on May 14, 1981 to report a spill of allyl glycidil ether residue outside the monomer building to account for odors. An official inspection of the Alcolac plant in 1983 discovered off-premises odors in concentrations in excess of the 31 to 1 ratio. The complaints and official notices of excess emissions to Alco-lac continued throughout 1983 and into 1985 — a short time before the trial began.

In mid-1983, in order to improve the complaint response time, the DNR engaged the local government of Sedalia. Captain [then Sergeant] Rice of the police department performed that function until June of 1985. Rice was instructed in the use of the scentometer, made response to local complaints of odors, and maintained a log of those events. In the course of that two-year duty, Rice compiled 23 memoranda of complaint investigations made by citizens in the environs of odors and resultant physical discomforts. These investigations, conducted night or day as the complaints were received, all led to the Alcolac operations. The odors were palpable to Rice, variously, as “similar to rotten eggs,” “sewer odor,” similar to “a hair permanent solution,” and *63 “foul odor of natural gas” — among other descriptions. The sources of these odors— except for a chemical spill — were the Alco-lac bioponds, and most frequently, biopond one. The scentometer measured the odors on several occasions at the ratio of 31 to 1, and on one occasion, at the ratio of 171 to 1. On these occasions, the Alcolac supervisory personnel attributed the odors to a lack of fresh water in the ponds, the hurried release of soap byproducts, and inability to induce a breakdown of the residue from the production. Of the 23 complaints Rice investigated from June of 1983 to June of 1985, 14 were “excess emissions” as defined by regulation, and hence equivalent to violations unless excused.

Alcolac plant chemist Richardson explained that the natural system employed to degrade the compounds in the bioponds emits a “sulphur-type of odor.” The odors are more recurrent in the early springtime when an “inversion occurs” — when the bacteria become more active and stir from the bottom of the pond to the top. It is a phenomenon which occurs about ten times a year, and sometimes the resultant foam is blown beyond the Alcolac premises. The chemist acknowledged that the ponds are not tested for toxic chemicals. [Nor, as Nikkila testified, was such a test ever undertaken by the DNR.]

Joseph Aid, a plant manager at Alcolac, acknowledged that the odors Captain Rice [investigator under DNR auspices] detected in June of 1983 in response to complaints were “[v]ery definitely from the bioponds.” He attributed them, as well as the foam — as did chemist Richardson — to the soap component of the wastewater and to the natural process of bio-oxidation employed to degrade that waste. He acknowledged at the trial [in late 1985]: “[T]here are still some odor and some foam problems, yes.”

In July of 1980, some months after WA-PORA was discharged from the Sedalia project in December of 1979, and within weeks of the execution of the abatement agreement on May 30, 1980, Alcolac employed Mark Blowers as environmental engineer — -the first to occupy that position. Blowers, a recent graduate school environmental engineering laureate, was then 26 years of age and Alcolac was his first employment as environmental engineer in a chemical plant. He remained with Alcolac for two years — until June of 1982. His resonsibility centered around the environmental control building. Blowers replaced an environmental control technician, McCutcheon — a college graduate, but without other qualification in environmental control matters. His duty was also “to keep an eye on the environmental control building and make sure everything was going okay down there.” Blowers acknowledged that Joseph LeMaire, the maintenance worker, had served as environmental control technician, but then was returned to maintenance work.

It befell Blowers to serve as plant liaison with governmental agencies, such as the DNR and the EPA, and hence to implement the abatement agreement concluded between Alcolac and the DNR just the month before. To that end, Blowers undertook to establish procedures for spill control and clean-up. He also undertook to establish procedures for the treatment and storage of hazardous waste so as to comply with the provisions of the federal Resource Conservation Recovery Act [RCRA], then coming into effect. Blowers was also the official designated to respond to citizen complaints of Alcolac emissions. In those roles, Blowers was in frequent communication with Nikkila and other officials of the DNR. It had been the procedure to maintain the record of spills in the daily reports of the foreman — entries interspersed with other notations on plant operations. Blowers collated these spill notations from the daily reports into a log “strictly for spills” and maintained that system from December of 1980 through December of 1981. Thereafter — for no explained reason — the log was discontinued.

The log reported 111 spills during that year of December, 1980 to December, 1981. The quantity of the spills, as recorded in the log, ranged from one quart to 2900 gallons of the particular compound. Blowers surmised that during the two years he served with Alcolac at Sedalia, “an environ *64 mental concern-type spill, major spill, would [occur] once a month.” The small chemical spills in the environmental control building were rinsed down the drain into the sump pit, and small spills in the monomer building were treated with 3M absorbent cloth. That special cloth functioned to absorb the organic matter from the surface of the waste, and the cloth was then disposed of in drums and discarded as solid waste. Blowers acknowledged that there were occasions when the employees neglected these clean-up procedures, and hence the carbon filter systems were bypassed, so that the spills went directly into biopond one — still untreated and toxic. On other occasions the sumps in the environmental control building would simply overflow from more production of waste in the monomer building than the pumps could accommodate. In such event, the environmental control building operated “in a bypass mode” and diverted the chemical waste into the biopond without filtration. Leaky drums were also a source of chemical spills. These fifty-five gallon metal drums, used to store toxic wastes and stacked on the grounds, were sometimes eaten through so that the liquid exuded. They were also struck by trucks and severely damaged so as also to become “leak-ers.”

Another objective of the abatement agreement Blowers was engaged to implement was that Alcolac install a system of alkaline scrubbers to remove the acrylates from the liquid as well as gaseous waste streams from the monomer reactors. The pujóse of the scrubbers was to expunge those toxic residues, as well as their odors, from vapors and liquids before they were vented to the carbon bed and fume incinerator. Alcolac had operated without such scrubbers for the two years which anteced-ed the abatement agreement. They were installed during his tenure as environmental control engineer, and once in operation — as Blowers described it — they “worked fairly well most of the time.” 8

Another objective of the abatement agreement — the installation of the hydrocarbon monitor on the fume incinerator and carbon bed stacks of the monomer building — was also undertaken during his tenure at Alcolac. The monitor broke down occasionally, but even when the device operated [Blowers said], there was a “major problem [in] trying to determine a meaning to the data [derived] from the hydrocarbon analyzer.” The monitor measured carbon atoms, rather than specific molecules. Thus, although the monitor could identify the carbon content of an organic emission, it could not identify the particular compound emitted. For instance: the detection of four carbon atoms in the emission could signify the presence of epichlorohydrin or any other compound of similar molecular structure, but could not identify which one. It was a delineated objective [¶ 3] of the abatement agreement of May 30,1980, that Alcolac install by February 1, 1981, a system to determine the “nature and concentration of the emissions from the stacks of the vapor incinerator and carbon adsorption system for each product manufactured by Alcolac in the monomer building.” That system was never installed.

Blowers also dealt with the complaints of citizens and of officials concerning the Al-colac operations. The recurrent complaints were of odors and foam from the bioponds. He estimated two dozen such reports during the two years with Alcolac. He explained that the emission of the soap material into the bioponds was an incident of the normal operation of the surfactant plant. The foam — as other Alcolac witnesses also undertook to explain — was the result of the aerator action, and so was not an unexpected occurrence. The foam on occasion built up to a height of 15 to 20 feet on the pond, and when the wind rose, “bl[ew] all about.” He recalled that on about two occasions, he saw the foam on the property *65 of Alcolac neighbors. The foam came into contact with Blowers and other employees at times, but never with deleterious effect —Blowers testified. He acknowledged, however, that during his tenure the bio-ponds were never tested for toxicity, so he could not say whether they were contaminated.

In addition to the continued malfunction of certain pollution control equipment [such as the liquid incinerator at the monomer plant and the acid scrubber at the surfactant plant], the recurrence of chemical spills, and complaints of odors and foam from the bioponds, Blowers encountered two episodes of rupture of the reactor in the monomer plant during his two-year tenure at Alcolac. They involved the blow-out of the rupture disk — a sort of safety release to relieve against excess pressure generated in the reactor tanks during the chemical production process. The rupture disk is a cartridge insert between the reactor and pipeline vent. It is the theory of design that when the pressure in the reactor becomes excessive, the cartridge ruptures and releases the excess gas into the atmosphere through the pipeline. In the early morning of September 25, 1981, a rupture disk blew out, but instead of gas vented into the atmosphere through the pipe, the explosion [as Blowers reported the incident to the DNR], “took the pipe with it and also damaged [the] building.” The report identified the chemical component in the reactor at the time of the incident as diallyl maléate and described that compound as “a mild eye irritant ... toxic only through ingestion.” Blowers continued to reassure the DNR that there was “no reason to expect toxic effect” from the spewed debris. The city officials evacuated the neighbors in the path of the wind direction and the Sedalia Fire Department was called to the site.

The investigation established that the rupture disk blowout not only “took pipe with it” — as described by the Alcolac report — but also a portion of the monomer plant roof as well. Nor was the debris from the explosion confined to the Alcolac premises, but rather was strewn to the north and south onto private property. A number of the firefighters who responded to the call reported skin irritation, and another fell sick. The diallyl maleate in production at the time of the explosion, Alco-lac disclosed, was being made from allyl alcohol and maleic anhydride. Blowers acknowledged that allyl alcohol was toxic and could cause severe irritation to the body and if absorbed through the skin, could cause injury or death. The symptoms displayed by the firemen, the DNR investigation established, “matched the toxicological information given by the [treating] doctor.”

At the time of the explosion of September 25, 1981 Alcolac was without a plant manager. Sutton was gone and Aid, his successor, had not yet arrived. Aid came to Alcolac on October 19, 1981 — a month after the explosion. This suit against Alco-lac had been commenced by then and pended. Among his first initiatives, Aid addressed a memorandum to the supervisors and lead operators of the Sedalia operation concerning the reporting of spills:

I want to emphasize the importance of reporting all spills at the time they occur. Our liquid waste treatment system only has limited flexibility, and slugs of material create serious problems.... If a spill occurs, you must be made aware of it by your operators and a report must be made.

Notwithstanding the hortation of that official memorandum, it was the testimony of lead operator Buckner that spills occurred in the monomer building virtually every day, many of them unreported. The workers found it more convenient to “wash it down than fill out the paperwork.” The clean-up procedures were also discouraged as too costly. The prescribed method for the disposal of most spills was absorption by organic [3M] cloth — but “supervisors complain[ed] it was too expensive and too costly and it was just kind of pushed over.” It became the practice, rather, to wash the spills into the drain to the environmental control building. That occasionally caused the environmental control building sumps to overflow with the consequence that the spills liquid was coursed around the filtra *66 tion system and, still toxic, was pumped directly into biopond one.

Buckner came to Alcolac in September of 1980 and remained there for three years— until September of 1983. Thus, much of his tenure coincided with that of environmental control engineer Blowers. Buckner worked exclusively in the monomer building, where the toxic chemicals were used in production. They included epichlorohydrin, allyl alcohol, methylene chloride, dimethyl sulfate and methyl chloride. He was given no formal training in the use of chemicals, but learned as he went. [Epichlorohydrin, he learned, had no odor and is invisible. “It is just there and it bums you.”] Buckner — as did Blowers — confirmed that the foam in biopond one often reached a height of fifteen feet. Buckner — in contradiction of Blowers — related ten to twelve as the number of rupture disk blowout incidents in the monomer building during his employment there. It was also the practice, Buckner testified, to complete the run of a “batch” of chemicals before the break of daylight so that the toxic vapors generated from that production process could be vented during the dark “so nobody could see it.”

There was the testimony of another chemical operator at the monomer plant-called as a witness by Alcolac — Charles Henderson, who had been employed continuously since production began at Sedalia. He testified to occasional spills in the monomer building — and described a “spill” as “something that would take manpower and maybe, you know, two or three hours to rectify.” Anything less, he considered a “leak.” A leak occurred two or three times a week, and was absorbed by 3M paper or simply washed into the drain. A spill occurred very infrequently — two or three times during his eight-year tenure. They occurred outside the building, and were promptly washed down into the drain connected to the environmental control building. Henderson could not estimate, however, the number of toxic spills of lesser magnitude than those which required several persons to “get it cleaned up rapidly.” The witness considered the 111 spills reported in the 1981 log maintained by Blowers sounded “awfully high but ... possible.” He acknowledged that during those eight years of employment at Alcolac, he had never been shown the environmental control systems operating manual prepared for the Sedalia plant by WAPORA. He had responded to counsel that he suffered from no Alcolac-related health problems, but acknowledged a recent medical examination report which disclosed complaints of numbness or tingling of the hands and feet. The witness conceded an interest in the outcome of the suit in which he gave testimony: “It means my job if they [Alco-lac] lose.”

There was other testimony — through Al-colac witnesses — as to the operation and maintenance of the environmental controls at the Sedalia plant. That evidence was interstitial of the proofs already described and undertook to confirm the defense theme that the internal environmental control procedures were methodically observed and were effective to meet official standards. The responses to cross-examination raised some inferences of contradiction. This spate of testimony, for the most part, related to fragments of the span during which Alcolac operated.

Richardson was plant chemist at the Se-dalia Alcolac for five years [from 1980], He had worked for the Alcolac corporation for twenty years altogether, and suffered no significant health problem as a result of that employment. He worked with monomers in the laboratory, in safety garb. It was his testimony that the odors perceptible in the plant — “sulphur-type”—were not from the chemicals, but from the bioponds, and were the natural incident of the biode-gradation process. The foam on the ponds was a product of the soap plant, and [presumably] not of toxic chemicals. Cross-examination elicited that neither Richardson as plant chemist nor any other employee ever sampled the ponds for toxic chemicals during his stint with Alcolac. He acknowledged that laboratory tests in 1984 disclosed that he had developed a physical condition of abnormal globulins, and that in 1985 abnormal hemoglobin was detected. Richardson conceded “an interest in the *67 outcome of this lawsuit to the extent that [he] would like to see Alcolac win the case.”

Lloyd Goode was the environmental control operator during virtually the entire span of the Alcolac operation in Sedalia. His employment progressed from maintenance, to the surfactant plant, to environmental control building as operator. This progression of duty was without any training. It was his function to run tests and otherwise “take care of the bio-oxidation ponds.” He testified that there were fish in the ponds and other animal life frequented them. He acknowledged on cross-examination that the tests he conducted for the ponds did not include any for toxic chemicals. He, too, admitted an interest that Alcolac win the litigation.

James Wells, a DNR supervisor, performed a hazardous waste management compliance and complaint inspection. Wells testified to an inspection of the Missouri Pacific Railroad installation located somewhat to the south and west of Alcolac. The inspection, conducted on May 31, 1985, was to determine compliance with federal and state hazardous waste management laws and regulations. Missouri Pacific was registered with the federal EPA as a hazardous waste generator, but not with the state DNR. The inspection identified several potentially hazardous wastes and resulted in a notice of violation for the generation and disposal of such wastes without registration with the state DNR. Wells acknowledged that the DNR had received no complaint of any Missouri Pacific activity, and further, that the tests conducted on those premises had not yet been reported. Wells also had occasion to be on the Alco-lac premises — both for routine hazardous waste management inspections to determine compliance with the newly enacted federal Resource Conservation and Recovery Act as well as in response to citizen complaints. The inspections for RCRA compliance were confined to the management and storage of toxic wastes, and did not relate to the condition of the bioponds or emissions from the production process. Wells conducted three such inspections at Alcolac, between June of 1981 and June of 1985. Each of the inspections noted some unsatisfactory feature — among them, the lack of documentation that “personnel training [was] conducted annually” and the storage of corrosive waste in damaged containers. The inspections, nevertheless, found Alcolac in substantial compliance with the RCRA. Wells also dealt with air pollution control at the DNR and responded to six citizens complaints about air pollution — odors and foam — from the Alcolac operations.

Raymond was another DNR official — the chief of technical support of the air pollution control program. It was the function of the technical support group to collect information and surveys from Missouri plants which generate air contaminants and, on the basis of the information furnished by the company, to calculate an “emission inventory” for that particular plant. On the basis of the information furnished by the respective companies, DNR calculated that for year 1983 Alcolac generated two tons of emissions of total hydrocarbons compared with twenty-nine tons of emissions of such compounds generated by the Missouri Pacific Railroad yards nearby. The saliency of that evidence, as the inquiry itself suggests, was to demonstrate the “efficiency of [the Alco-lac] control devices.” The function of the inventory, as the witness repeated with emphasis, was not to “evaluate companies,” but to develop a “monitoring network [in] major areas of high concentration of pollutants.” That national data base, under the aegis of the federal Environmental Protection Agency, depends altogether upon what information the particular company chooses to disclose. The concern of the DNR, in any event, related to emissions of volatile organic compounds, and not to total hydrocarbons, as such. The production processes at Alcolac, the DNR witness acknowledged, generated volatile organic compound emissions. The “emission inventory” of volatile organic compounds for year 1983 did not list Alcolac, the witness agreed, because “Alcolac did not choose to send [DNR] any written information about any volatile organic compounds.”

*68 Hughie Clay came to Sedalia in April of 1985 as plant maintenance engineer at Al-colac. Suit then pended and at the time Clay testified, he had worked at Alcolac for seven months. His work function was to maintain the plant installation and attend to upkeep and repairs. Clay performed no significant duty. Blowers had since left Alcolac, and the plant operated without an environmental control engineer during the period Clay was employed there. The environmental responsibility, rather, reposed in plant manager Aid. The description given by Clay of the production and environmental control processes during his brief span at Alcolac depicted a plant of sophisticated design and virtually flawless operation. Cross-examination elicited, however, the incidence of two fires in the monomer building during his seven-month span of employment. He acknowledged also that he was not informed about past systems malfunction at the plant, and that even the most perfectly designed safety feature could be rendered irrelevant if bypassed.

D.

1.

Opinion for the Plaintiffs

The Alcolac Operation: Opinions of the Experts

The plaintiffs presented Frederick W. Boelter, industrial engineer and staff expert on industrial hygiene with Camow-Connibear Associates, 9 for his opinion on the safeness of the Alcolac operations to the residents of the environs. His opinion rested on numerous evidentiary sources, among them: the WAPORA document; schematic designs of the facility; observations of the physical Alcolac facility; air and water tests conducted on and near the plant premises; analysis of the plant production documents for the past seven years [1978 to 1985]; analysis of the raw materials, production processes and intermediate chemical products; official documents and memoranda between the Missouri Department of Natural Resources; and the internal records of Alcolac. To derive opinion, the witness interrelated the evidence from these sources to the environmental control practices described by the several Alcolac employee witnesses.

Boelter gave opinion that, despite the state of the art design of the environmental controls installed at Alcolac, the neglect of these procedures by the employees as well as the malfunction of the control equipment, has resulted from 1978 in an operation that has not been safe to residents in the environs from exposure to toxic chemicals and compounds.

Boelter elaborated: the lack of trained personnel, the practice of the Alcolac employees to use the bypass equipment to route the monomer toxic liquid waste stream around the filter system so as to discharge directly into biopond one, the practice of the employees to discharge the surfactant liquid waste stream into biopond one [instead of biopond two as the design intended] so that the toxic waste intermixed with the soap waste with the resultant risk that the toxic compound would be borne into the atmosphere, the failure to control emissions inside the buildings and allow the vapors to vent into the atmosphere through open doors, the want of a valid spill control program, the falsification of records, the lack of a standard operating procedure — all bespoke a management “terribly lax in addressing basic plant operation requirements” and were contrary to industry standards.

Boelter also related his opinion of unsafe operation to the log of chemical spills kept for the year 1981 by Blowers during his service at Alcolac as environmental control engineer. The log recorded 111 spills— among them quantities of such extremely toxic chemicals as epichloroydrin, allyl alcohol and allyl methacrylate. The log explained the cause for each recorded spill, *69 and a number of them — as interpreted by Boelter — were the result of a want of standard operating procedure, employee neglect and equipment leaks.

Boelter also determined from the history of equipment malfunction and misuse, that Alcolac was from inception in 1978 an operation unsafe to nearby residents. The incinerator designed as the environmental control for the disposal of the hazardous liquid waste from the monomer process never functioned properly, and was abandoned in 1981. In that interim, the malfunction frequently resulted in incomplete combustion of the waste and hence emission of that, and other, toxic residue into the atmosphere. The fume incinerator used for the combustion of the vapor wastes in the monomer building also did not always function so that toxic wastes were emitted from that source also. The acid scrubbers in the surfactant building often did not function with the consequence that the bioponds were further stressed by the additional soap and their normal biogra-dation function impaired. When the acid scrubber malfunctioned, also, sulphur dioxide, sulphur trioxide and sodium hydroxide —all regulated by law as pollutants — were emitted in the form of a plume of dark smoke. Boelter also rested opinion on the recurrent overload of the bioponds with much higher quantities of organic wastes from the monomer building than the design contemplated [noted by WAPORA as early as 1978], with the consequence that the biodegradation of the chemical wastewater was impaired. These chemicals as well as the surfactant deposits from the faulty acid scrubbers, the evidentiary sources disclosed, produced odors which were never altogether dispelled by the installation of aerators in the bioponds and the use of ammonium nitrate. These sources of evidence also disclosed to Boelter that the bioponds were never monitored for toxicity either of the liquids or vapors.

Boelter rested his opinion that Alcolac was an operation not safe to the nearby residents on yet another ground: the lack of detectors on the stacks and carbon beds to monitor on a “product-to-product” basis to identify the precise hydrocarbon compound — and its toxicity — being emitted from the production of the particular monomer batch. It was a recommendation made early by WAPORA, but rejected by Alcolac as too costly. It was later a subject of the abatement agreement with the DNR in 1980, but never implemented by Alcolac. The documents Boelter reviewed disclosed also that the carbon adsorption systems, both in the monomer building for the vapor wastes and in the environmental control building for the liquid waste, were allowed to become over-saturated so that the excess wastes simply passed through “as though there were no device in place at all.”

The opinion also rested on three tests conducted by Boelter and the Carnow-Con-nibear Associates on and around the Alco-lac premises.

The first was conducted on September 12 through September 14, 1983 at residences of several plaintiffs around the plant. Air samples were taken at those sites for lead, sulfates, methanol and other organic compounds. They determined that Alcolac contributed to the level of sulfates, but were inconclusive as to methanol and the other compounds. Boelter explained that the testers had no real knowledge as to what was in the process of manufacture on those days, therefore the sampling was “essentially blind.”

The second survey was conducted on September 4 through September 7, 1984, and involved both air and water tests. The water at the residences of six of the plaintiffs was tested, as was the ambient air, to determine any detectable level of six specific toxic compounds. The tests of the samples disclosed no significant concentration of any of those six contaminants. Boelter explained that on the days of the tests, the plant was “not operating in a way to determine the level of activity and again, the compounds that were being used and what was being manufactured at the time was unknown to us.”

The third survey was conducted on June 22,1985, on the Alcolac premises under the auspices of a court order. There was no plant activity on that day, and hence air *70 samples, Boelter explained, would have been of no use. [The Alcolac records for that day and the several days before indicate that the reactors were in the process of restoration and otherwise inactive.] Water samples were taken from bioponds one and two. Toluene, a toxic compound, was found in a concentration of 240 parts per billion, as well as other compounds, one known as two-three dichloropropene and another called three-three oxybispropene. The significance of the presence of toluene [although in relatively low concentration], Boelter explained, is that that toxic compound is very volatile and so indicates a more massive recent presence. The significance of two-three dichloropropene is as a “footprint” for epichlorohydrin, a very toxic compound. The chloropropenes, Boelter explained, are a degradation product of epi-chlorohydrin and indicate that epichloroh-ydrin was present. Boelter explained further that it is impossible to sample directly for epichlorohydrin in water since it is so volatile. “It has a very short half life in water” and disappears very quickly either by evaporation into the air or by decomposition into other products such as dichloro-propene. Propene [also known as allyl ether], a toxic organic compound also found n the bioponds water samples, is formed from the reaction between allyl alcohol and sulfuric acid — chemicals used in the Alcolac production process. The tests detected another toxic compound in the biopond waters —a nitrosamine called N-nitrosomorphyo-line, the result of the heavy use of ammonium nitrate in the bioponds to dissipate the odors. The detection of the presence of the morpholine compounds is significant, Boel-ter explained, because they are associated with the manufacture of cosmetic chemicals — the production of the surfactant plant.

Boelter concluded that the presence of these organic compounds in the bioponds was “of particular concern” because the samples were taken under conditions much more favorable than “historical conditions,” 10 and if what was found was any indication “the conditions historically were more than likely much worse than this and with the difficulty in controlling the ponds and the foam that is generated, this could be a very significant contribution to the effects on the surrounding environment.” Boelter observed that only in the chemical and industrial plants of “third world countries” had he seen “this bad of a situation in one place.”

2.

Opinion for Alcolac

Alcolac presented the deposition testimony of Robert B. Jacko, Ph.D., expert in environmental engineering and faculty member of the Purdue School of Civil Engineering. The witness also had! conducted research in the flow of toxic pollutants in chemical and other facilities, but that inquiry did not include health studies.

Dr. Jacko made three visits to the Alco-lac facility. The first two were in the autumn of 1984, and the third was on June 22, 1985, the same date the Carnow-Conni-bear Associates conducted tests on the Al-colac premises. In preparation for these visits, Jacko was furnished with numerous documents and other information — which included the environmental study conducted by the Carnow-Connibear Associates off-premises in the vicinity of the Alcolac plant. Jacko was also furnished the specifications of “all the environmental control systems at Alcolac, as modified by Alcolac employees to update them.” It was on the basis of that information as well as his observations and over-flights of the facility that the Jacko testimony and opinions are based.

It was the opinion of expert Jacko that Alcolac functioned as a closed system for the containment of volatile and organic vapors. That is to say, the environmental control devices operated so that the vapors were not released into the atmosphere until the organic matter had been expunged. In the warehouse building, in case of a chemi *71 cal spill, the building was completely sealed and the fans carried the vapors to the carbon beds for adsorption. In the monomer building, a system of ducts captured the vapors and conducted them to the carbon beds for adsorption, and the vapors are then emitted through the fume incinerator. In the surfactant building, one acid scrubber removes the sulphur dioxide and sulfur trioxide before the vapors are emitted through the stacks, and the other, the solid particulate matter. The emissions from this operation, the witness testified, conformed to the EPA standards. In the environmental control building, the vapors from the monomer liquid collected in the sumps ran through a carbon adsorption system, then through the caustic scrubbers, 11 into the fume incinerator, and then emitted into the atmosphere.

Jacko conducted no tests, either of the ambient air or of the bioponds. He “walked the ponds” with Boelter on the June 22, 1985 occasion, but “perceive[d] no significant odors at that time.” Jacko mentioned two monitors on the bioponds, one to measure biological oxygen demand, and the other to measure dissolved oxygen. He noted no Alcolac procedure or practice to test the bioponds for toxicity. The witness alluded to a sulfur emission test conducted on June 20, 1984 by the Shell Engineering Associates on behalf of Alcolac. The test was for both sulfates and sulfur dioxide, as required by the abatement agreement with the DNR, and certified that the emission rates of both samples were in concentrations lower than the maximum allowed limits. The witness also alluded to the extensive forms submitted by Alcolac for air pollution permits then issued by official agency, presumably as evidence of valid environmental practices.

Jacko mentioned no adverse environmental consequence from the past acknowledged malfunctions of the environmental control system as “updated” — as of the acid scrubbers in the surfactant building and the hydrocarbon monitor installed under the abatement agreement. It is evident that the deposition opinion Jacko rendered — -that Alcolac functioned as a closed environmental system as to volatile or organic vapors — was essentially an appraisal of conditions observed in 1984 and 1985.

Alcolac also presented the testimony of Harvey Shell, chemical engineer and president of Shell Engineering and Associates. Shell Engineering conducted a test of the surfactant stacks at Alcolac on June 20, 1984, and of the monomer fume incinerator stack on June 26, 1984. The surfactant test was undertaken to comply with the term of the abatement agreement that Al-colac would test the surfactant stack semiannually for emissions of sulfur dioxide and sulfur trioxide acid mist. The surfactant tests certified that the emission rates were in concentrations less than the maximum allowed by regulation. Shell acknowledged that the test was for total hydrocarbons, and not for emissions of specific organic compounds. Hence, what the emissions were, or if they were toxic, were not determinable by the test.

Shell took no test of the biopond for toxicity, nor of the foam. Nevertheless, he disagreed with the conclusions of the Car-now-Connibear test that the quantity of toluene measured in the biopond was a significant source of toxic emission. He concluded, rather, that “the ponds are working and doing what they are supposed to do.”

He rendered the opinion — based upon reports submitted by Missouri Pacific to the DNR that it generates twenty-nine tons of *72 emissions per year in total hydrocarbons and in volatile organic compounds — that the Missouri Pacific operation contributed to the ambient emissions in the area of Alcolac. Shell acknowledged he had undertaken no tests of Missouri Pacific emissions.

Ill

THE CHEMICALS

Alcolac produced surfactants and monomers. The surfactant production, for the most part soaps, was a continuous operation. The chemical ingredients as well as the wastes, accordingly, were constant. 12 The monomer production, on the other hand, was custom designed to the needs of the customer, and production depended upon demand. The chemical ingredients of the monomers, therefore, varied according to the order. Many of these chemicals were toxic — as were their wastes. Of these, some were rated as hazardous by the Environmental Protection Agency. 13 Others of the many chemicals used in the monomer production may have been more toxic and hazardous than those identified in the testimony, but have never been tested for toxicity, so that the effects of these agents on the biological system are not known. 14

Among the chemicals regularly used by Alcolac in the monomer production process, and already tested for toxic effect, were epichlorohydrin, allyl alcohol, ethyl acry-late, toluene, glycidyl ether and cyclohex-ene. Of these six chemicals [I)r. Legator testified 15 ], five are designated as hazardous by the EPA, and three are known carcinogens. The effect of a toxic chemical on the human body, Dr. Legator explained, depends upon the concentration of the chemical and duration of the exposure to it. Or, as rendered into a formula: “Concentration times time equals effect.” That equation is subject to variables — among them, the genetic susceptibility of the person to chemicals and the mode of life adopted by the person. The exposure may be chronic — over a prolonged time, or acute —over a short time. The toxic effects may also manifest as chronic or acute. There are diverse portals through which the toxic chemicals gain access to the body. The major routes are through the skin, the mouth or lungs. A toxic chemical may characteristically attack a particular organ or may target multiple organs. When absorbed, toxic chemicals can affect the immune system and, if the dose is high and prolonged enough, can cause mutations in the human body.

Where the exposures are from multiple toxicants [as in the monomer production process], Dr. Legator explained, the combined toxic effects from the interaction may be much greater than the mathematical sum of their individual effects. As toxicologist Schwartz 16 commented, sci *73 ence recognizes chemical interactions where “one and one equal ten.” That effect is known by the technical term synergism. Another means whereby toxic chemicals may become more toxic is by the process of pyrolysis. That term means merely breakdown by heat. Incineration was the form of pyrolysis used by Alcolac to dispose of some toxic wastes. If the incineration is at a heat effective to destroy the chemicals [Dr. Legator explained], the toxic effects are also destroyed. If the incineration is incomplete so that the chemicals are only partially destroyed, the pyrolysis may result in more toxic chemicals than originally and “produce more chemical in the atmosphere.” Dr. Legator gave as opinion — in terms of pyrolysis — that the effect of the operation by Alcolac of the liquid incinerator at low heat levels because of continued malfunction was the discharge of more toxic substances. 17

Dr. Legator then discussed the toxicological role of each of the six chemicals used in the monomer production process at Alco-lac and already tested for toxic effect:

EPICHLOROHYDRIN

Alcolac used some 378,000 pounds of epi-chlorohydrin per year. It is listed by the EPA as a direct carcinogen, a hazardous substance, and a hazardous waste. It is a volatile chemical and enters the human system through inhalation and also the skin. The target organs are the brain and the central nervous system, as well as the kidney and liver, among others. It affects the blood and causes porphyria — a disease of liver metabolism. The chemical is also a mutagen and induces “transmissible genetic damage.” It has also been identified as the cause, even at “very low concentrations,” of chromosome damage in humans —that is, to “[t]he package that holds our DNA.” That is significant, Dr. Legator explained, because “literally every chemical that I know of that causes chromosomal damage also causes cancer.” It is an identification of cause, moreover, borne out by epidemiological studies. Animal studies confirm that epichlorohydrin causes a variety of cancers in different organ sites, breaks down the chromosomes, and affects the reproductive system.

Dr. Bertram Carnow, another expert in toxicology and other sciences, 18 described epichlorohydrin as a direct carcinogen — “an extraordinarily active chemical,” a “grabber” which “grabs onto DNA” and changes it. The chemical also deforms the immune system so that it cannot respond to the attacks on the DNA by cancer cells. Dr. Carnow confirmed that the indication of an earlier epidemiological study that exposure to epichlorohydrin presents a risk of cancer to humans has been “more strongly proven.” The witness considered it significant that Alcolac has used an average of 378,-000 pounds of the chemical in each of the past seven years, since even “[i]n very small quantities, it is extraordinarily toxic.” The volatility of the chemical, moreover, is such that if “put out into water, [i]t will go from water into air.” A test of Alcolac biopond one by the Carnow professional group found “the footprints of epichloroh-ydrin” in the waters.

The toxicologist for Alcolac, Dr. Sorrell Schwartz, agreed that epichlorohydrin can cause damage to multiple organ systems— the liver, the lung, the kidney and other *74 sites. He would not acknowledge it as a “foregone conclusion,” however, that the compound can cause porphyria, but considered it “certainly plausible,” since the chemical “does have a fairly extensive ability to interact with the systems, with the liver.” The witness agreed that epichloroh-ydrin, as an alkylating agent, is a “cell-killer,” but maintained that it has not been demonstrated that the chemical depresses the immune system in humans. Dr. Schwartz agreed that chronic effects may result from exposure to epichlorohydrin in adequate doses and that the chemical is a proven animal carcinogen. He concluded: “It is possible that it can cause it in humans.” Indeed, it was the opinion of Dr. Arthur C. Zahalsky, presented as an expert on immunology by the plaintiffs, that epi-chlorohydrin is not only a carcinogen, but acts adversely on the human immune system.

The opinions of Dr. Edward Anthony Emmett, another expert witness for Alco-lac, 19 were somewhat at variance with those given by Alcolac toxicologist, Dr. Schwartz, as to the toxic effects of epichlo-rohydrin. Dr. Emmett acknowledged that recent publications conclude that exposure to epichlorohydrin presents a risk of cancer to humans. He agreed with the other witnesses that epichlorohydrin, as an alkylat-ing agent, is “dangerous and powerfully reactive to chemicals” and “combines avidly with tissue.” The witness deemed it “certainly possible” that exposure to such a chemical could “depress and destroy the immune system” in humans. Dr. Emmett testified that toxic chemicals cause a form of porphyria called toxic porphyria. He intimated that epichlorohydrin can cause that species of porphyria.

The material safety data sheet 20 issued by Alcolac to the work personnel in compliance with OSHA directive informs that epi-chlorohydrin, in liquid form, “can be fatal if swallowed,” and “[h]igh vapor concentrations can cause death.” It informs also that “the results of a recent epidemiology study have been termed ‘highly suggestive’ that exposure to ECH is a cancer risk to humans.” The data sheet describes as the effects of overexposure: “Vapors severely irritating to the eyes, nose and throat. Repeated or prolonged exposure can cause severe and lasting lung, liver and kidney damage and change in lymphocytes [cells in blood and lymph] ... Cancer suspect agent.” It gives the special precaution: “Notify authorities if any exposure to the general public or environment is threatened by a spill.”

Epichlorohydrin was among the toxic compounds spewed about from blow-outs of ruptured disks [as reported by monomer operator Buckner and environmental control technician Holman.] It was also a component of the 2900 gallon and other spills recorded in the Blowers log for year 1981.

ALLYL ALCOHOL

Alcolac used some 416,000 pounds of al-lyl alcohol per year. It is listed by the EPA as a hazardous waste. It gains entry into the human system by inhalation and is readily absorbed through the skin. Allyl alcohol can have either a chronic or acute effect on humans, according to the concentration of the exposure. The target organs are the liver and kidneys, among other systems, and exposure may cause necrosis. Allyl alcohol also acts as an enzyme and converts other chemicals in the body into even more toxic substances. It has been demonstrated in vitro to alter genetic composition. It was the opinion of Dr. Emmett, Alcolac environmental occupation medicine and toxicology expert, that exposure to allyl alcohol can cause mutagenic effects in humans.

Spills and emissions of allyl alcohol in the monomer building were reported in the evidence. Environmental control tester Holman described an explosion of a monomer reactor which spewed a combine,tion of al-lyl alcohol, epichlorohydrin and stannic *75 acid. The toxic spill log maintained by environmental control engineer Blowers records a spill of 2900 gallons of AGE stripped brine — a fluid composed of allyl alcohol and epichlorohydrin. Monomer and surfactant operator Faulconer described a spill of a quart of allyl alcohol whose vapors were allowed to emit into the atmosphere. Allyl alcohol was also a component of the monomer in production at the time of the explosion of September 25, 1981, which blew off a segment of the factory roof and strewed the debris onto private property. It was an observation of one of the numerous WAPORA reports from Bregman to the Alcolac officials that the habitual “sloppy handling” of allyl alcohol in the monomer production process was a cause of the recurrent odors and posed, as well, an environmental hazard.

The material safety data sheet circulated by Alcolac to the plant workers to comply with OSHA directives describes allyl alcohol as a colorless liquid with a sharp odor. In vapor form, it is “highly irritating to the eyes, lungs and damaging to the liver and kidneys.” It warns: “Onset of eye irritation may be delayed but can be severe ... Absorption through the intact skin can cause injury or death.” The sheet concluded with the special precautions: “Handle as flammable liquid and as a poison ... Notify authorities if any exposure to the general public or environment is threatended by a spill.”

ETHYL ACRYLATE

Alcolac used some 88,000 pounds of ethyl acrylate per year. It is listed by the EPA as a hazardous waste. It is carcinogenic to animals, but present data does not support the expectation that exposure causes cancer in humans. The compound also affects the reproductive process in animals. Dr. Legator, expert in toxicology for the plaintiffs, gave opinion that ethyl acrylate is a mutagenic. The primary portal of entry is inhalation. The chemical is very odorous and extremely irritating. Ethyl acrylate may cause both acute and chronic effects. It is known to cause convulsions, arrythmi-as and other strange manifestations of the heart. It also affects the kidneys, heart, lungs, liver and central nervous system.

The wastes from the monomer production process [as a memorandum by Alcolac vice president Bouroff to president Anderson noted] were “saturated with acrylates.” It was to allay that source of pollution that Alcolac was required by the abatement agreement with the DNR to install alkaline scrubbers to remove the acry-lates from both the liquid and gaseous waste streams from the monomer building reactors. The pronounced odors of ethyl acrylate from the shift in the monomer carbon bed and spills were the subject of report between Alcolac and the DNR.

TOLUENE

Alcolac used some 17,000 pounds of toluene per year. It is an active compound and enters the human system through inhalation and the skin. The compound attacks the respiratory system, central nervous system, the liver, kidneys and heart. It causes arrythmia, tremors, convulsions and other episodes of that ilk. Its effects can be chronic, and — according to Alcolac po-lyexpert Emmett — presents a “potential risk of cancer” in humans. Exposure to the chemical affects reproduction in animals and — according to an authoritative text — also affects human fertility. It was the opinion of Dr. Zahalsky, immunology expert for plaintiffs, that toluene is toxic to the cells and acts on the immune system. Toluene not only attacks the organ systems of humans, but exposure to the chemical by domestic animals induces a range of effects — such as convulsions, loss of motor control, and even death.

It was this chemical, toluene, which — according to environmental control building technician LeMaire — on occasions overflowed from the sump pits to the exterior and into Shaver Creek. It was this chemical also which spilled outside in such quantity as to cover the adjacent irrigation pond to a depth of one-half inch. The test of biopond one by the Camow professional group which found “the footprints of epi-chlorohydrin” in the waters found toluene also. It was the opinion of toxicologist Legator that spills of toluene and related *76 chemicals exposed to the air evaporate and —depending upon atmospheric conditions— “blow around to the surrounding population.”

GLYCIDYL ETHER

Alcolac used some 390,000 pounds of gly-cidyl ether per year. It is a highly reactive chemical and enters the bodily system through inhalation, the skin or through the mouth — if contained in food or water. Gly-cidyl ether affects the liver, the kidneys, the respiratory tract and the central nervous system. It causes peripheral neuropa-thy and manifests in numbness, tingling and leg cramps. Prolonged exposure to the chemical produces chronic effects. Glycidyl ether is known to cause cancer in animals, and, according to Alcolac toxicologist Schwartz, “is possible” as a cause of cancer in humans.

Toxicologist Legator, in response to a hypothesis posed from the evidence of ninety residents within the Alcolac environs that from 50% to 60% of them experience continuous tingling and numbness of the extremities, equated that incidence with “walking down the street and seeing seven people who are eight feet tall.”

CYCLOHEXANE

Alcolac also used cyclohexane in the monomer process. [The evidence does not disclose the quantity.] It is listed as a hazardous waste by the EPA. The portal of entry is inhalation and the target organs are the respiratory and the central nervous systems. It causes erratic blood pressure, sudden nosebleeds, lethargy, depression and vascular disorders.

In addition to the six chemicals already tested for toxic effect — epichlorohydrin, al-lyl alcohol, ethyl acrylate, toluene, glycidyl ether and cyclohexane — as explained by the testimony of toxicologists Legator, Schwartz, Emmett and Carnow, the Alcolac evidence identified other chemicals, also of known effect, involved in the production process. Among them were dimethyl sulfate, hydrogen sulfide, methyl chloride and allyl methacrylate.

DIMETHYL SULFATE

That chemical, Alcolac toxicologists Schwartz and Emmett agreed, enters the bodily system through inhalation and the skin. The kidneys, liver, and the central nervous and respiratory systems are the target organs. If the exposure is persistent enough and the dosage sufficient, the effects of the chemical can be chronic. It is a carcinogen in animals and, according to Dr. Emmett, carries risks of cancer to man. Dimethyl sulfate, immunologist Zahalsky explained, is an alkylating agent: it adds new chemical groups into the compound. As in the case of epichlorohydrin [and some of the other chemicals], absorption into the human system operates to alter the DNA and to kill normal cells. In the terminology of immunologist Zahalsky, dimethyl sulfate attaches to cells and induces the genetic code sequence “to go haywire.” It was an opinion confirmed by Alcolac immunologist Stechschulte.

The material safety data sheet circulated by Alcolac to the plant workers to comply with the requirements of OSHA warned: “Extremely hazardous liquid and vapor. Causes severe burns. Lung injury and burns may be delayed. May cause cancer [based on tests with laboratory animals].”

HYDROGEN SULFIDE

“Hydrogen sulfide is deadlier than cyanide,” Dr. Carnow explained. This compound is absorbed into the bodily system through inhalation and the odor of rotten eggs attends its presence. The odor of rotten eggs was a recurrent emission from the bioponds. The cause of these odors Dr. Carnow attributed to the production of hydrogen sulfide from the overload of the bioponds with toxic chemicals. It was the recurrent rotten egg odor of hydrogen sulfide in the sludge of the overused bioponds that Dr. Reid detected during his tests and examinations for WAPORA. It was also hydrogen sulfide DNR official Nikkila detected during one of his investigations of the bioponds. He attributed that emission to insufficient aerators or to overloaded use.

*77 The organs affected by exposure to this compound are the liver, the kidneys, the respiratory and central nervous systems. It was the opinion of Alcolac toxicologist Schwartz that hydrogen sulfide produces chronic effects if the dosage is adequate of a prolonged exposure. In such circumstances, damage to the liver could result in damage to the porphyrin metabolism. Dr. Camow elaborated: In relatively low concentrations, hydrogen sulfide causes dizziness, vomiting and severe headaches. In higher concentrations, it causes brain damage, respiratory paralysis, and death.

METHYLENE CHLORIDE

It was a chemical found in the biopond waters in the tests performed for the plaintiffs by the Camow professional group. It was among the toxic wastes [according to monomer operator Faulconer] stored in drums, kept along the Alcolac driveway and crashed by track traffic so that the highly volatile compound was permitted to emit into the atmosphere. It was among the toxic waste remnants, according to Faulconer, Alcolac personnel discarded from tankers before replenishing them. Methylene chloride enters the human system through inhalation and the skin. In a sufficient dose it affects the liver [and hence porphyrin metabolism], the heart, and central nervous and respiratory systems. It was the opinion of Alcolac toxicologist Schwartz that in adequate and prolonged dosage, methylene chloride may cause cancer and mutations in humans and depress the immune system.

HYDROCHLORIC ACID

Hydrochloric acid — according to WAPO-RA president Bregman, was a product of the misuse of the liquid incinerator in the environmental control building. Inhalation [in vapor form as hydrogen chloride] is the principal portal of entry. The vapor becomes an acid when dissolved in water and in that form bums through the skin. In large enough dosage, Alcolac toxicologist Schwartz explained, hydrochloric acid can cause damage to multiple organs: the respiratory and central nervous systems, the liver, and the kidneys. It was the opinion of Alcolac toxicologist Emmett [in apparent disagreement with Alcolac toxicologist Schwartz] that the compound can induce chronic effects.

ALLYL METHACRYLATE

Alcolac produced allyl methacrylate in the monomer process. The material safety data sheet circulated by Alcolac to the workers describes the effects of overexposure: “Product may be fatal if inhaled, ingested or absorbed through skin. Irritation of eyes, nose, throat; dermatitis; narcosis.” A spill of 15 gallons of allyl metha-crylate was recorded by Blowers in the log on July 29, 1981, from a tank overflow.

There was evidence [already recounted] that from the virtual onset of the Alcolac operations in 1978, these chemicals or their pyrolysis products were regularly emitted into the atmosphere through the defective liquid incinerator, the vented spills, or discharges — unfiltered and still toxic — into the bioponds which mixed with the soap refuse and in that form were borne away into the ambient air. The function of the liquid incinerator, as explained, was to destroy by heat the organic matter of the toxic chemical waste from the monomer process so that liquid would emerge as wastewater free of contamination and flow into the biopond. When the incinerator malfunctioned, however, the organic matter in the toxic liquid waste remained unconsumed or only partially consumed. When the waste was not consumed, it was emitted into the atmosphere unchanged and still toxic. When the waste was partially consumed, it was emitted as chemical fractions of the toxic waste, often with multiplied toxic effect.

The remnants of these unconsumed wastes retained in the liquid, and their pyrolysis products, moreover, then flowed into the biopond to mix with the toxic wastes periodically pumped around the filtration system and into the biopond. The effect of such a potpourri [in the terminólo-, gy of Dr. Camow] was “a witch’s brew,” a “chemistry set that is unbelievable [of] extraordinarily active chemicals, alkylating agents, like epichlorohydrin. [Y]ou put them all in one place and there is no way of knowing the extraordinary number of toxic *78 agents that you might produce in such a soup.” It was significant, Dr. Carnow explained, that the chemicals used and emitted in the monomer production process— epichlorohydrin, allyl alcohol, ethyl acry-late, toluene, glycidyl ether and cyclohex-ene — attack common organ systems: the liver, the immune system and the central nervous system. He described the mode and effects of concerted assault:

They are extremely active. That’s why they are so irritating to the eyes, and the nose, because they attack protein ... They attack and can even coagulate protein, and when they get into the body, they head for organs, and ... can cause very severe damage, but again in low concentrations, they eat away at an organ. They cause damage, and if you have more than one ... you may have either what we call an additive effect, that’s where one and one is two, or you may have what we call a synergistic effect, and that’s where two chemicals have more than an additive effect. That’s when two and two is six, or ten, or something like that, and that makes it even worse. You have the worst of all possible situations when you have chronic, recurrent exposure, you have multiple chemicals that are highly reactive, you have multiple portals of entry, and you have these chemicals acting together to attack major organ systems.

IV

RESIDENTS IN THE ENVIRONS OF ALCOLAC

A

The Plaintiffs-Witnesses

Alcolac is located on an industrial site northeast of the Sedalia limits in the midst of land still used for agricultural purposes. The industrial area of Sedalia proper lies to the southwest of Alcolac within the city boundary. The thirty-one plaintiffs, composed of twelve family groups, all resided within one and one-half miles of Alcolac— most of them much closer. 21 AH but one of the family groups had established residence there before the advent of Alcolac. 22 The ages of the plaintiffs range from 75 years [Virgil Bradley] to 11 years [Amber Cross]. It was the uniform testimony of all the plaintiffs that the onset of the foul and noxious odors, fumes, smoke, vapors and emissions they experienced coincided with the commencement of operations by Alcolac. Storms of foam from the bio-ponds were borne onto their land 23 and onto Little Shaver Creek and transported through other properties. 24 It was the uniform testimony of the plaintiffs that exposure to these Alcolac emissions caused them symptoms — most commonly and recurrently — eye, nose, throat and skin irritations, nausea, vomiting, numbness and tingling of the limbs, heart irregularity, respiratory difficulty, and other afflictions. The odors were described variously but recurrently as those of rotten eggs, sulphur, lacquer, ammonia, of sweetness, and of other familiar scents. It was the uniform testimony of the plaintiffs also that they had experienced no noticeable emissions or impairment of health from the operations of other enterprises in the locale, in place since before the advent of Alcolac. 25 There were innumerable reports of these annoyances, intrusions and physical effects to Alcolac, the DNR, and governmental officials at every level, but to no avail.

The frequency and intensity of the atmospheric emissions from Alcolac, these witnesses agreed, depended upon the direction *79 or calm of the wind. There was expert meteorological testimony, derived from statistical observations taken at Whiteman Air Force Base near Sedalia, that the wind blows from the south 12.5 percent of the time, blows from the south-southwest 8.5 percent of the time, from the north 8.5 percent of the time and remains calm [that is, blows at less than 1 mile per hour] 13.5 percent of the time. The wind is light and variable 47% of the time. That latter statistic, the expert concluded, indicated “a very excellent opportunity for the people in the vicinity of the plant to detect odors a large percentage of the time.”

The members of each plaintiff family group testified to the recurrent incidences of exposure to the Alcolac emissions and the physical symptoms they induced, to their life modes and habits, and to other personal data which relate to the expert assessment of the etiology and causation of their complaints of environmental injury. This history data was of the same kind elicited from each of the plaintiffs upon clinical examination and, along with the results of physical examination and laboratory tests, were significant elements in the derivation of environmental medicine diagnoses by their physicians as well as those of Alcolac. 26

B

The Non-Litigant Witnesses

1.

For the Plaintiffs

There was testimony, for the plaintiffs, from more than fifty other witnesses, all nonlitigants also resident in the environs, that the Alcolac emissions were causes of annoyance and physical complaint. The locations of their residences ranged from very next to the Alcolac plant to sites more than three miles distant. 27 Their occupations were as diverse as their ages. The current of that testimony comported with the testimony of the plaintiffs: the Alcolac operations gave off emissions in the form of vapors, odors, smoke, fumes, foam and residues which physically affected their persons. The odors and emissions were persistent and recurred day and night. Black smoke belched from the Alcolac stack even in the early mornings. A white residue covered the grass and other vegetation and was an irritation to the skin and exposed areas of the body. Suds and foam from the Alcolac bioponds alighted on then-property, even though several miles distant.

They [as did the plaintiffs] described the odors as scents of rotten eggs, lacquer, sickening sweetness, ammonia, sulphur— and the like. They [as did the plaintiffs] described the consequences of exposure to these discharges as irritations to the nose, throat and eyes, matted eyes, redness and watering of the eyes, kidney infections, skin rashes, headaches, cramps and char-ley horses in the calves and legs, numbness and tingling in the limbs, nausea, fatigue, respiratory difficulty and irregularity of heartbeat. The more youthful females also complained of interrupted and abnormal menstrual cycles. The symptoms, as to most of them, persist. As to several of these nonlitigants who removed from the environs of Alcolac, the symptoms disappeared. They [as did the plaintiffs who kept gardens and animals] complained that the emissions, especially in the form of a white powder residue, afflicted the vegetation so that whole stands of decorative, orchard trees and vegetable plants were stunted. Their domestic animals and pets also died — and unaccountably and without sign of predation. They included cultivated husbandry such as bee swarms, cattle and chickens as well as domestic pets, such as parakeets, dogs and cats. There was also evidence by a non-plaintiff witness that Little Shaver Creek [which traversed the property], the source of the drinking water for the cattle, was so tainted by foam from Alcolac as to kill the *80 fish and cause the cattle meat to stink and become inedible.

It was the testimony of these witnesses [as of the plaintiffs] — a number of whom resided for years adjacent to the Missouri Pacific Railroad yards, Missouri Pressed Metals, DeLong Welding and other plants —that not until Alcolac commenced operations were any odors or other emissions palpable, and not until Alcolac were any ill effects to their persons or plants and animals experienced. A very few of them noticed an occasional odor from Quality Fiberglass, but it was fleeting and of a different quality. The odors and emissions from Alcolac were distinctive and recurrent. It was the testimony of those among them whose employment brought them onto the Alcolac premises for periods of time — such as construction workers — that the odors and emissions they detected from their residences were of the same kind they experienced while in the Alcolac plant. It was the testimony of all these nonlitigant witnesses that their symptoms, complaints and changes of health came on after the Alcolac operations began in May of 1978, and not experienced before.

The nonlitigant witnesses for the plaintiffs also included public officials, some of whom lived within the environs and others who did not, but all of whom frequently— even repeatedly — were called to the vicinity of Alcolac and onto the premises, day and night, in response to citizen complaints of odors and other emissions. The experiences of emissions from Alcolac and the symptoms from those exposures were congruent with those described by the plaintiff witnesses as well as the other nonlitigant witnesses for the plaintiffs. Odors were emitted, smoke from the stack, dense haze, and suds and foam from the bioponds. The odors were described, variously, as “intense,” “terrific,” “bad” — of the sulphur type, of rotten eggs, septic or paint thinner. The odors were the same off the Alcolac premises as they had detected in the plant, and were noticeable from several miles away. The foam and suds from the bioponds came in profusion — a phenomenon Senator Mathewson described as: “[L]ike Lawrence Welk had turned loose the bubble machine.” The vapors sometimes emitted as “a very fine mist” and burned exposed skin. County Court member Jones described the effects to exposure as irritated and watery eyes and headaches. Sgt. Rice of the Sedalia police department [designated by the DNR to respond to citizen complaints] experienced irritation to the mucous membrane from exposure to the Alcolac emissions, as well as irritation to the nose and throat, watering eyes and upset stomach. Environmental Quality Control Commissioner Judy Berenyi suffered headaches, nausea, and a “stinging skin” even from a momentary exposure during the course of her investigations of citizen complaints. The public official witnesses agreed that there had been no citizen complaints of odors or emissions or physical complaints from the operation of the other plants in the vicinity — such as the Missouri Pacific Railroad yards, Missouri Pressed Metal, DeLong Welding.

The plaintiffs presented other nonlitigant witnesses, employees of Alcolac, whose descriptions of the emissions, their odors, as well as the physical symptoms induced by exposure, coincided with those of the plaintiffs and their witnesses. These employee witnesses — Pace, Buckner, Faulconer and LeMaire — identified the recurrent chemical spills, efflux of contaminated wastewater into the bioponds, monomer reactor explosions, liquid incinerator and acid scrubber malfunctions and, simply, careless management of the chemicals as the sources of the Alcolac emissions and odors. The detection of these emissions as odors of sulphur, rotten eggs, sweetness — and a variety of other descriptions — was explained by the characteristics of the chemicals used in the particular phase of production. They testified that exposure to these chemicals and emissions induced in them [as in the plaintiffs and the other witnesses] a burning and watering of the eyes, an irritation to the skin, nose and lungs, cramps in the legs and feet, and numbness and tingling in the extremities.

2.

For the Defendant

Alcolac also presented nonlitigant witnesses, a dozen or so, who resided in the *81 environs or had occasion to come onto the plant premises. They included farmers, businessmen and public officials, as well as employees. A number of them resided adjacent to some of the plaintiffs. Several of the witnesses conducted regular contract work with Alcolac, and a number of the residents had family members employed by Alcolac. Witness Knaus, a farmer, sharecropped Alcolac land. Witness Sneed, also a farmer, cultivated pollen on Alcolac property. There were several among them unrelated to Alcolac by business or personal interest.

There were some who experienced odors on the residence sites, or when they passed by Alcolac, or when they went upon the plant premises. There were some who discerned none. There were some who had seen foam from Alcolac alight on their property. Those who detected odors described them variously: as rotting eggs, pleasantly sweet, or as new plastic. It was the consistent response to inquiry that the emissions caused no ill effect to their persons. Those who kept gardens, crops and livestock all responded that neither the productivity nor the quality was affected. The well-being of their pets was not impaired.

There were other acknowledgments on cross-examination, however. Parmer Reine [who lived near the plaintiffs Turley] answered that some of his cows miscarried for reasons the veterinarian could not explain. He responded also that the children suffer “terrible headaches,” as does the wife, that she experiences arrythmia and palpitations of the heart, has developed cramps on the calves of the legs, and suffers from an irregular menstrual cycle. Pettis County Sheriff Starke responded that exposure to Alcolac odors brought on a headache and a “burning, peppery sensation in back of the throat.” Resident Vicki McFall answered that a drive by the Alco-lac plant “burns your nose.” The regular employment medical examinations, Alcolac chemical operator Henderson acknowledged, cite his complaint of numbness and tingling of the hands or feet. The medical examination reports of Alcolac plant chemist Richardson note the development of abnormal globulins and hemoglobin. The medical examination reports of Alcolac quality control technician Theresa Cecil disclosed two immunity panel abnormalities.

V

THE MEDICAL AND SCIENTIFIC EVIDENCE

A

The Family Practitioner

Dr. Donald J. Allcorn

A number of the plaintiffs consulted Dr. Donald J. Allcorn as personal physician, both for treatment of symptoms they attributed to the Alcolac emissions, and for other reasons of health. Dr. Allcom, board certified in family practice, maintains an office in Sedalia. Two among them — Clarence Elam and Dan Pryor — were treated by Dr. Allcorn for injury from mishaps unrelated to the Alcolac operation. The other seven — Jacqueline Berry, Virgil Bradley, Dorothy Bradley, Betty Elam, Linda Elam Sanders, Joyce Pryor and her daughter Amber Cross — consulted with Dr. Allcorn for complaints attributed to Alcolac chemicals, as well as for other conditions.

Dr. Allcorn was presented by Alcolac. He gave opinion that toxic chemicals can cause many of the conditions and symptoms the several patients displayed, but that they did not — “other than [as to Mr. Bradley, and presumably, the others with like symptoms] those related as possible irritation of his airways due to odors.” He acknowledged both on direct and on cross-examination that exposure to toxic chemicals can cause chest congestion, urinary tract infection, nose and sinus irritation, skin rashes, abdominal pain, tingling limbs, conjunctivitis, fatigue, respiratory infection, sore throat and dizziness — the other symptoms and complaints displayed by these several patients. He concluded, however, that none of these symptoms were the result of toxic chemical poisoning, but could be explained by other causes. In the case of Virgil and Dorothy Bradley [75 years old], he implicitly attributed the complaints to their condition of age. In the *82 case of Betty Elam, he attributed the condition of emphysema to cigarette use. Although the witness attributed the other complaints of the patients to causes other than exposure to toxic chemicals, he did not identify those alternatives.

The opinions rendered by Dr. Allcorn were those of a physician certified in family practice. He readily acknowledged that he had neither special training nor qualification in occupational medicine, preventive medicine, toxicology or immunology. Nor had he dealt with the toxic chemicals used in the monomer production and emission processes — such as epichlorohydrin, allyl alcohol, dimethyl sulfate, toluene and the others.

B

The Immunologists

The testimony and opinions of the immunologists were based on three sets of laboratory procedures performed between August of 1984 and July of 1985, to test the immune system functions of the several plaintiffs. The plaintiffs presented the testimony and opinion of Arthur C. Zahalsky, professor of microbiology and certified research immunologist. Alcolac presented Daniel J. Stechschulte, certified medical internist and certified clinical immunologist.

The first immune panel was conducted by the Bioscience Laboratory in Chicago [August of 1984] as an incident of the clinical examinations and diagnoses of the plaintiffs by the Carnow Associates, their experts. All thirty-one 28 plaintiffs presented themselves for this series. The second immune panel tests were conducted by the Kansas University Internal Medical Center [December of 1984] at the instance of Alco-lac. The protocol for that series of tests— as defined by Alcolac counsel and internal medicine expert Kerby, a professor at the University of Kansas Medical Center — ex-eluded ten of the plaintiffs. 29 It was the surmise of Alcolac expert Stechschulte that the protocol did not encompass the other ten because: “[T]he information that was available ... didn’t dictate that these individuals had abnormalities in their immune systems.” The third immune panel was conducted by the Midwest Organ Bank and Wheeler Laboratory in Kansas City [July of 1985] at the instance of immunologist Zahalsky. He was prompted to that initiative by a deemed inadequacy of the KU Internal Medical laboratory test results and because the pervasive abnormalities disclosed by the Bioscience immune tests suggested the need for more particular information of the cell compartments. He explained that the KU laboratory blood analysis tests were inadequate because they expressed results in percentages rather than as within or without normal range references — as is the common practice — with the consequence that the counts of the various cell populations could not be deter-minated nor the normality of those counts. The KU procedure was all the more wanting, he explained, because that protocol did not include all of the plaintiffs. It was for those reasons that immunologist Zahalsky arranged for the third immune panel procedure at the Midwest Organ Bank and Wheeler Laboratory in July of 1985. Twenty-four of the plaintiffs were tested. Mrs. Landon by then was under a regimen of cobalt treatment for cancer, and so was disqualified for the tests. The six members of the Turley family were unavailable. The evaluation rendered by Zahalsky as to the Turley family members rested on the tests reported by the Biosciences Laboratory in August of 1984. The opinion as to Landon rested on both the Biosciences and the KU immune panel results.

ARTHUR C. ZAHALSKY, PhD

The witness defined immunology as the study of the components of the immune *83 system of man and animals — the cells that compose the system, the appearance of those cells, the origin of those cells, the presence of those cells in the blood, and the balance of those cells. He likened the immune system to “an internal watchdog or searchlight” which surveils the cells and expels those components which are not “okay,” and thus restores the homeostasis —the normal state of immunologic balance. The component extruded from the body by this process, the witness explained, might be the result of a mutational effect caused by the activity of a bacterium, or a virus, or of a toxic chemical. An immune dysfunction, accordingly, is the imbalance and dysfunction of the cells of the blood. The consequence of dysfunction is that the “internal searchlight” becomes dim so that harmful substances may appear in the body which escape recognition, and hence elimination. One resúlt of dysfunction may be neoplastic disease — a condition of cancer. Another result, among the many others, may be the inability of the body to fight infection. The immune system function is determined by the genetic code of the person — none of them exactly alike. The efficiency of the genetic system depends upon the stresses imposed by the mode of life and habits adopted by the person: smoking, the consumption of excessive alcohol, abuse of drugs all stress the immune system. That is to say, they affect how the genetic code expresses itself.

The immunologist noted that the immune systems of the plaintiffs and of those non-litigant residents of the environs of Alcolac shared a common insult: the prolonged exposure to the toxic chemicals in the environment in which they lived. He undertook to explain the consequences of the exposure to the toxic chemicals identified with the Alcolac production process in terms of the function of the human immune system. The immune system is not a specific organ but is distributed in the bone marrow, the thymus, the spleen, and in the lymph nodes throughout the body. In terms of function, the immune system has two divisions. One function is the production of antibody cells which are dumped into the blood and circulate to all parts of the body. These antibodies, called B-cells, derive from the bone marrow and spleen and fight off infection. Another function of the immune system is to “search and destroy,” and is the “cell mediated” arm of the system. Those cells include the T-cells, so-called because they derive from the thymus gland, although they derive also from the lymph nodes and spleen. The T-cells exhibit distinctive characteristics and are of four different types. They remember previous insults and challenges, they live long, and have the capacity to expand. The four types of T-cell populations are the helpers, suppressors, cytotoxic and natural killers. The helpers cooperate with the B-cells to produce antibodies. The suppressors work in balance with the helpers to avoid indiscriminate and undirected responses. The cytotoxic cells are also suppressors and can attack and destroy transformed [neoplastic] cells with or without an antibody. The natural killer cells can also attack and destroy without the help of an antibody.

An imbalance of the helper populations of T-cells [technically designated as T/4], when induced by stresses and insults of toxic chemicals, is a condition of immune system dysfunction properly designated: chemically induced AIDS. In common AIDS, it is the virus [rather than the chemicals] which attacks the helper [T/4] cells and so induces immune system dysfunction. 30 In either case, whether the imbalance is induced by toxic chemicals or by virus, the result is that much of the T/4 cell population is depressed — “functionally wiped out.” Thus, the balance in the bloodstream “just goes completely out of whack” and the production of T-cells cannot keep up with the demand. The consequence, among other dysfunctions, is a progressive erosion in the ability of the person to fight infection. In the case of viral AIDS, the customary course of infection is *84 in the lungs, which eventually leads to respiratory collapse, and death. In the case of chemical AIDS, the progressive erosion of the immune system may induce neoplastic disease — and cancer. Chemically induced AIDS, the witness testified, is a phenomenon supported in the medical and immunological literature, and is a subject of research at the National Institute of Environmental Sciences.

It was the opinion of immunologist Za-halsky that the condition of chemically induced AIDS could be brought on by exposure to the chemicals regularly used and produced in the Alcolac monomer process. Epichlorohydrin, toluene and dimethyl sulfate, among the others, are toxic to cells and act to depress the immune system. Dimethyl sulfate is also an alkylating agent which “sticks” to cells so that the genetic code sequence “goes haywire,” renders the cells toxic and suppresses the immune system. 31 The witness gave opinion that exposure to a “chemical soup” of epi-chlorohydrin, toluene, dimethyl sulfate, among the others emitted into the Alcolac bioponds over a span of seven years and then carried into the air by suds and vapors, could cause a depression of the immune system to persons in the environs. The actions of these chemicals often induce symptoms which mimic actual diseases, the witness explained, so that an untrained local physician will not recognize that the complaints and symptoms actually bespeak a depressed immune system toxically induced.

Zahalsky evaluated the immune system of each of the thirty-one plaintiffs. The witness, a research immunologist but not a clinician, rested the assessments on the laboratory and test data gathered in the immune panel reports from the Bioscience, KU and Midwest/Wheeler laboratories. The witness evaluated the immune system of each plaintiff according to whether the result for each value tested was within or without a normal reference range. 32 Thus, by the self-evident standard adopted by the expert witness, an abnormality is a test value that falls outside the normal reference range. Also, by that self-evident standard, “abnormality is not good.” Hence, the conclusion of the witness: “a laboratory report that fails to list the reference ranges is invalid by definition.” It was, as we note, the perceived unreliability of the KU test results expressed in terms of percentages rather than in terms of reference ranges which prompted witness Za-halsky to recommend that the subjects undergo a third test regimen at the Midwest/Wheeler laboratory.

The summary of test results from the Bioscience Laboratory noted at least one abnormality, and as many as eight, in the immune system of every plaintiff.

The test results for every plaintiff from the KU laboratory, expressed in terms of percentages, were interpolated by the witness through the reference ranges of the *85 Midwest/Wheeler forms into determinations of normal, abnormal and marginal. The KU protocol [as did the Midwest/Wheeler tests] encompassed total T cells, helper cells [T/4], suppressor cells [T/8], natural killer cells and other populations. Zahalsky deemed that the most significant test result components were the helper cell [T/4] and suppressor cell [T/8] counts. The test result associated with the chemical AIDS condition, Zahalsky noted, was an abnormal helper cell [T/4] count. In the case of plaintiff Carl Berry, the KU test disclosed a T/4 count fully five percentage points above the average — an abnormality. In the case of Virgil Bradley, the transposed test results disclosed four abnormalities. Of the twenty-one plaintiffs tested under the KU protocol, the transposed results established that the blood cell population of only one — Joy Sommers, age 15 — displayed no immune system abnormality. The composite tests disclosed 39 abnormalities of the T cells distributed among the 24 persons tested.

The results from the Midwest/Wheeler Laboratory established that 19 of the 24 plaintiffs who presented themselves for tests suffered from dysfunction of the immune system. The witness explained that since the T cell population, as an absolute number, changes with age, to enable valid analysis of dysfunction, he segregated the plaintiffs into three age groups — the young, the intermediates, and the older. The tests of fourteen among the plaintiff groups disclosed the condition of hypo-dysfunction — that is, a depression in the total number of T cells. The tests of five among them disclosed the condition of hyper-dysfunction — that is, an elevation in the total number of T cells. Thus, 79% of the plaintiffs tested by the Midwest/Wheeler Laboratory displayed an immune dysfunction of the T cell compartment. The immunologist deemed the finding “tremendously statistically significant.” To this number the witness then added the six members of the Turley family group who were not available for the Midwest/Wheeler regimen and Mary Landon by then under treatment for cancer. All of them were earlier tested at the Bioscience laboratory and demonstrated immune dysfunctions. Thus, the combined Bioscience-Midwest/Wheeler immune panel tests established that 26 out of the 31 plaintiffs, or 84% of the total number, demonstrated an immune dysfunction. The witness described that statistic “an astounding value.”

The Midwest/Wheeler immune panel tests included a newly available procedure administered at the direction of immunologist Zahalsky. It was for the T cell monoclonal antibody, HNK-1. That antibody not only detects the natural killers of the T/4 population but also suppressors not found in that population. Ten out of the 24 plaintiffs had significantly elevated values in HNK-1, and one person had a reduced count. Four among the plaintiffs tested 33 not only displayed elevated levels of HNK-1, but also elevated levels of T/8 suppressor cells. Those values indicated to the expert a gross distortion in the ratio between the helper cells and the suppressor cells — an indication that the immune system balance is “out of whack.” They already suffer severe immune dysfunction, the condition of chemically induced AIDS. Eight others 34 already suffer moderate immune dysfunction, although not yet the condition of chemically induced AIDS. The changes in the immune system panels, however, are progressive so that the dysfunctions will develop to the AIDS condition “somewhere down the line.”

The dysfunctions of the immune panels as trends in progress were demonstrated by the results from the Bioscience and the Midwest/Wheeler laboratories — the two tests the witness deemed reliable. The Bioscience test conducted in August of 1984 reported one abnormality of the immune system for Arnold Sommers. The Midwest/Wheeler test conducted in July of 1985 listed two abnormalities. The progression for Dorothy Bradley listed by *86 those tests within that interim were from one abnormality to three, and for Virgil Bradley, from one abnormality to five. He noted also that the immune panel of findings of laboratory tests taken of Mary Landon before her cancer condition and cobalt therapy verify that she had a severely depressed immune system. It was the opinion of immunologist Zahalsky, moreover, that the conditions of the other nineteen plaintiffs who then manifested neither severe nor moderate immune system dysfunction would progress into proliferated abnormalities.

Zahalsky concluded with the opinion that all thirty-one plaintiffs were suffering from systemic, progressive chemical intoxication. The witness gave opinion that the condition is the consequence of exposure of the plaintiffs in their home environment to toxic chemicals which have induced changes in their immune system. That injury has dampened the immune system so that the plaintiffs will become subject to a variety of diseases, neoplastic disease [cancer] included. The findings already suggest the possibility of leukemia. The expert would not attempt the clinical prognosis as to “just how sick this group of people is at the present time and is likely to become.” That was a matter for a competent clinician — such as Dr. Camow, an occupational medicine expert. He did conclude, however, that since the condition of dysfunction was progressive, each of the plaintiffs should have annual laboratory tests for the rest of their lives, and bi-annual tests for the four who already exhibit severe dysfunction. The cost for each such laboratory service is $1000 per person, at the current rate.

DANIEL J. STECHSCHULTE, M.D.

Alcolac presented Daniel J. Stechschulte, board certified immunologist and internist, and Director of the Division of Allergy, Clinical Immunology and Rheumatology at the University of Kansas Medical Center. He treats patients at the Medical Center, as well as teaches, but has never treated anyone for a toxic chemical complaint or conducted research on that subject.

The witness described the immune system in the same terms earlier used by Dr. Zahalsky. His response as a physician to a patient who presents a possible immune system problem is to examine the patient, take a history and review the available information. Symptoms and findings of recurrent infections, hypersensitivity reactions or auto-immune diseases 35 suggest immune system dysfunction. A laboratory test may be the adjunct of a more precise evaluation, and the selection of the test depends upon the nature of the symptoms and findings. They help to identify the arm of the immune system involved, and, accordingly, the antibodies of that arm are tested. A test result which does not fall within the reference range — that is to say, an abnormality — does not ipso facto signify immune system disease. The abnormality, rather, may be the effect of a variable exogenous to the immune system — such as the state of nutrition — which stunts its normal operation. Thus, the clinician interrelates the test abnormalities to the age, gender, nutrition, mode of life of the patient, or other variable to determine whether the variables account for the test abnormalities or if some other cause explains the immune system dysfunction. Thus, the witness explained, the end of immunologic evaluation is not a count of cells, but how well the cells function as elements of the immune system, whatever their count.

Viral infections can alter the immune system. Certain toxic chemicals can also alter the immune system. The witness acknowledged the condition called chemically induced immune deregulation. He discountenanced the term chemically induced AIDS to describe that condition of immune dysfunction, however, because “that common usage [AIDS] now refers to individuals that are infected with the human T-cell leukemia virus, Type III.”

Dr. Stechschulte was consulted as to the immunologic tests to be administered to the plaintiffs under the KU protocol. To in *87 form that advice, Dr. Stechschulte reviewed the available test and clinical records of the several plaintiffs from the Carnow clinic, as well as numerous medical records from other sources. The Midwest/Wheeler immune panel tests had not yet been conducted, and so those results were not available to Dr. Stechschulte. He evaluated these sources for findings of hypersensitivity reactions, recurrent infections or auto-immune disease [indicia of immune system dysfunction], but saw no “predominance of symptoms in any of these areas” — except for Mary Landon. He nevertheless advised certain immune panel tests for twenty-one of the plaintiffs. The decision to exclude ten of the plaintiffs from the tests under the protocol was prompted by the results already derived from the tests administered through the Carnow clinic. Dr. Stechschulte accepted those results as “reliable” and “authentic.” The information they yielded, he explained, “didn’t dictate that these individuals had abnormalities in their immune systems,” and hence the need for further tests was discounted. The selection of plaintiffs for tests, Dr. Stechschulte explained, was by random method, and included “patients that were identified as having immune dysfunction” as well as those the records suggested “were perfectly normal.”

The immune panel tests were administered by Dr. Bodensteiner of the Department of Medicine at the University of Kansas Medical Center. The regimen adopted, the witness explained, was to test function and not merely to count cells. 36 The functional test elicits how the immune system responds when it is exposed to a particular antigen or organism. The test, actually conducted in the test tube and not in the human body, simulates the response of the immune system to an infection stimulation. The tests administered through the Carnow clinic, the witness acknowledged, were both functional as well as cell counts and were more numerous than the single function test performed under the KU protocol. 37 The immune deficiency tests conducted by Midwest/Wheeler, on the other hand, were expressed in cell counts but did not measure functional response. Immune deficiency tests measured exclusively by cell counts, the witness suggested, assume a relationship between a normal number of cells and normal function of those cells.

The evaluator of the KU test results— immunologist Stechschulte — was in any event aware of the various reference ranges and undertook, within a reasonable medical certainty, to interpret the KU results as to each of the plaintiffs subject to the protocol. With the exception of Mary Landon, the evaluator concluded, the clinical history of the plaintiffs examined suggested that “their immune system was functioning normally.” There were some, he acknowledged, “that have laboratory tests that fall outside the arbitrarily defined normal ranges.” Others displayed “some subtle changes in their laboratory parameters.” He concluded, nevertheless, that “[e]linically I thought they were normal.” The clinical factors which prompted that conclusion were the ages of some of them [seven among the twenty-one were in the sixties and seventies], and the nutritional deficiency of others suggested by red blood indices abnormalities noted in the Midwest/Wheeler tests. The reference range abnormalities notwithstanding, Stechschulte concluded that basically the immune systems were functioning. He deemed it “highly speculative” to suggest *88 “any prognosis as to where their immune systems might be going.” 38

Dr. Stechschulte explained that a disregulated immune system could result in cancer. The latency period to that endpoint is “highly variable,” and depends on the strain of the cancer — whether induced by virus, by chemicals or by mutagens. It is known that the use of chemotherapeutic drugs [as in the treatment of the auto-immune diseases] over a period of five to ten years can result in an increased incidence of malignancy in the patient population.

The witness reaffirmed on cross-examination that on the basis of the clinical histories of the plaintiffs, none of them [Mary Landon excepted] suffered a functional abnormality of the immune system. He reaffirmed also that one of the indicia of functional abnormality is the recurrent infection syndrome — such as chronic conjunctivitis, chronic- urinary tract infections, chronic rhinitis and chronic pharyngitis. These are conditions, the expert acknowledged, which can be caused by exposure to toxic chemicals. Dr. Stechschulte acknowledged that the histories of the plaintiffs included findings of such chronic symptoms. He responded nevertheless that these conditions, even if recurrent, were not sufficient to suggest a deficient immune system, unless the symptoms were bacterial in origin.

Dr. Stechschulte explained also that although the medical evidence may find that the plaintiffs suffered from conjunctivitis and other chronic conditions caused by continuous exposure to the toxic chemicals over seven years, that would not necessarily suggest an immune system deregulation [a system out of balance], even accompanied by abnormal laboratory test results. He gave as reasons that conjunctivitis, for example, describes “a group of disorders,” some of which may be due to the immune system and others not. Also, he had not come to the diagnosis that these symptoms were recurrent infections. The witness acknowledged that, contrary to his usual clinical procedure, he had not examined any of the plaintiffs — simply because the protocol did not include that procedure.

He acknowledged again that certain toxic chemicals can suppress the immune system. He understood that Alcolac used alk-ylating chemicals in its production processes. The effects of alkylating agents on the new cell formations, the expert explained, is to alter their DNA and can lead “to killing of those cells.” Dr. Stech-schulte agreed that toxic chemicals can cause an increase in the IGA antibody production. That is a condition which may be found in the blood cells of a person who suffers malignancy. The KU protocol did not provide for a test of the IGA levels, and none were made under that regimen. The witness agreed that “there were certainly some [plaintiffs] who have elevated IGA levels.” Virgil Bradley and Dainie Landon were two among them. Dr. Stech-schulte agreed that Bradley and Landon “should be watched and have their IGA levels and other studies done periodically.” He ascribed as the reason, that the IGA “is commonly elevated with chronic inflammation [a]nd chronic inflammation can again be due to a variety of reasons, one of which is malignancy.”

The expert witness agreed that it is good medical practice to test every member of a population with symptoms from exposure to toxic chemicals, especially when the exact immunotoxic chemical is not known. He agreed also that it is possible to have an immuno deficiency syndrome even without present disease, but that disease “may be just later down the road.” The witness acknowledged that the immune system may change from normal to abnormal, and that such a transition was not subject to prediction.

The cross-examination of immunologist Stechschulte concluded with this exchange:

Q. Would you agree that these people I represent, who have been impacted by the Alcolac toxic chemicals, should be watched or monitored to *89 determine when such changes might occur?

A. It is appropriate.

VI

A

The Medical Experts and Biological Causation

For the Plaintiffs

It was the role of Dr. Bertram Camow to posit that the toxic emissions from Alcolac were the cause in fact of the symptoms, biological manifestations and end points of disease exhibited by each of the plaintiffs. The witness rendered those opinions as a physician, expert in the science of environmental medicine. It is the method of environmental medicine that, to come to a determination as to whether a disease is from an external cause, the investigator establish by a high degree of probability that the environmental event — here the installation of the Alcolac chemical plant and the subsequent emissions of toxic odors, fumes, foam and explosions — be related to the pathology or disease.

The process of investigation of external cause and diagnosis of disease involves a compound of factors:

It commences, first, with a related external event — here, the commencement of Alcolac operations and the virtually coincident onset of the emission of fumes, odors and foam discerned by the plaintiffs and other populace in the environs. The related event can be an acute episode — such as an explosion from the monomer reactors, or chronic episodes— emissions over the seven years of Alcolac production.

The second factor in the process of investigation of causation and diagnosis of disease is exposure to the event. The demonstration of that element, in the context of the evidence, is the observations of incidents of smoke, vapors and foam and the detection and inhalation of the odors and emissions — followed by symptoms. The evidence was replete with accounts by the plaintiffs and other nonlitigant witnesses, resident in the environs, of observed plumes and incinera-tions, vapor emissions from Alcolac as well as airborne foam from the bioponds. They described the same composite of odors and assortment of symptoms. The odors, moreover, were characteristic of the toxic compounds involved in the Alco-lac processes — the lacquer odor of the methacrylates, the rotten egg sensation of hydrogen sulfide and the sweetness of toluene — among others.

The third element is an effect from that exposure. It is an effect which follows the external event and stands in a reasonable temporal relationship with it, whether the exposure is acute or chronic or whether the effect is acute or chronic. An acute effect usually follows soon upon acute exposure. A chronic effect usually follows from repeated exposures over a prolonged time. The acute effects displayed by not only the plaintiffs but also the nonlitigant residents, were on the mucous membranes and the sympathetic nervous system, and manifested also as irritation of the eyes, nose and throat, headache and vomiting — among the others. The chronic effects from the repeated exposure over the seven year span of toxic emissions were to the major organ systems which were poisoned by the prolonged exposure. It was the conclusion of the environmental medicine expert, for reasons our discussion delineates, that every plaintiff suffered both acute and chronic effects from the acute and chronic exposures to the Alcolac toxic emissions.

The fourth element is whether the effect —here both acute and chronic — is related to the external event, and therefore expected. In the context of the litigation and evidence, the expectedness of the effects of the chemical emissions was demonstrated by the toxicological profiles of each of the toxic compounds prominently involved in the monomer process. The experts drew the toxicological profiles for epichlorohydrin, allyl alcohol, ethyl acrylate, toluene, gylcidyl ether, cyclohexane, methylene chloride, hydrochloric acid, hydrogen sulfide and *90 allyl methacrylate. The experts agreed that many of these toxic compounds induce common physical manifestations, and hence acute effects: epichlorohydrin, allyl methacrylate, allyl alcohol, and ethyl acrylate cause irritation to the eyes, nose, throat, lungs and skin. Exposure to hydrogen sulfide causes dizziness, headaches and vomiting. Chronic exposure to these and the. other toxic compounds produces chronic effects to the liver, kidneys and other organs, depresses and destroys the immune system, affects the blood, causes porphyria and even cancer. The chronic effects of two of them is to degenerate the human reproductive system. Epichlorohydrin, ethyl acrylate, toluene, cyclohexane and gly-cidyl either all affect the central nervous system. Ethyl acrylate and toluene cause heart arrhythmias or flutters. Cy-clohexane causes lethargy, depression, erratic blood pressure and sudden nosebleeds. The evidence was recurrent — as the details of our discussion relate — that the plaintiffs and others exposed to the Alcolac toxic emissions manifested both these expected acute and chronic effects. The fifth element is to determine if others have been similarly exposed and similarly affected. That component of the causation inquiry, the expert concluded, was readily met by the multiple descriptions of the thirty-one plaintiffs as well as by the sixty nonlitigant witnesses of commonly observed related events— the smoke, vapors, foam and other emissions from Alcolac, the inhalations of the various odors — common episodes of exposure, common incidences of acute and chronic effects as disclosed by the examinations and tests of the plaintiffs and by descriptions given in testimony by the nonlitigants. It was the remarkable statistics of commonality of exposure and effect among not only the thirty-one plaintiffs, but also among the sixty non-litigant residents, which heightened the probability to a reasonable medical certainty that the Alcolac emissions were the cause of the diseases diagnosed in the thirty-one plaintiffs. Thus, although the incidence of numbness and tingling in the extremities is 2% ⅛ the normal population, among the plaintiff and nonliti-gant community, the incidence was between 50% and 60%. That manifestation, as the laboratory tests confirmed, was a symptom of peripheral nervous system abnormality. The laboratory tests of the plaintiffs [as our discussion explains] disclosed that all of the plaintiffs suffer from depressed immune systems and altered cells. They all suffer from abnormal liver metabolism. They all suffer central nervous system damage, except for Lyle Turley, who was not tested because of his youth. The laboratory tests for fertility reported abnormal results for all the seven males who submitted to that procedure. The tests established also that 87% of the plaintiffs suffered some form of porphyria — a very rare disease in the absence of a toxic source. The expert deemed that result “incredible” — and the probability of such incidence in a normal population a quintillion [one billion billion] in the absence of toxic poisoning. It was the unusually high incidence of symptoms, physical manifestations and abnormal laboratory test results of the several bodily organs shared in common by all the plaintiffs which constituted persuasive “markers” for the expert that there was an “extraordinarily strong cause and effect” connection between the offending toxic agente and the manifestations and disease the plaintiffs displayed.

The sixth and final element of the causation inquiry is to determine whether or not the pathology found from the laboratory tests is of the kind expected. The pathology disclosed by the examination of the patients — peripheral neuropa-thy, memory loss, fatigue, and such manifestations — all was of the kind expected from the exposure to the toxic chemical emission agents. The laboratory results of the immune panel studies, the porphy-rin counts, and other test procedures [we presently describe] all confirmed injury and damage to the organ systems expected from chronic exposure to the toxic agents involved in the Alcolac production process.

*91 It is evident that to evolve a diagnosis, environmental medicine' draws upon other sciences and disciplines — among them, occupational medicine, epidemiology, industrial hygiene and bio-statistics. In the case where the point source [the related event] is the operation of a chemical plant, toxicology also impinges. A certification in the environmental and occupational medicine specialty, the expert noted, requires learning and adeptness in each of these cognate disciplines. The expert presented by the plaintiffs to derive causation and diagnosis, Dr. Bertram Camow, was a polymath whose credentials included board certifications in preventive medicine and the occupational medicine subspecialty, in pulmonary medicine and in toxicology. He was an early founder of the environmental medicine subscience, co-chairman of the national certification board for environmental and occupational medicine and conducted numerous epidemiological studies for government, scientific foundations and labor on the effect of chemical and organic pollutants on human populations. 39 His testimony was received by the court as that of an expert in environmental medicine, occupational medicine, internal medicine, preventive medicine, toxicology and epidemiology.

Dr. Bertram Camow and Dr. Ruth Coni-bear [his wife] operate Carnow, Conibear and Associates [CCA], a consultation firm which offers a wide range of occupational and environmental services to government, business and individuals. It maintains a clinic with laboratories, medical equipment and patient facilities. It is supported by a staff of internists, toxicologists, industrial engineers and other professional specialists and consultants. 40 The plaintiffs all presented themselves at CCA in August of 1984 for evaluation over a period of two days by Dr. Camow. [Four of the plaintiffs — Betty Elam, John Lawrence, Gwendolyn Lawrence and Charlotte Phillips— were previously examined at CCA in September of 1983, the year before.] The patient evaluation rested on three components: symptoms, physical findings and laboratory test results.

It is the postulate of environmental medicine, Dr. Camow explained, that cause is a cognate of diagnosis, and therefore a cognate of treatment, as well. It is for that critical reason, he said, that to derive a reliable profile that a disease was from an environmental cause, not only must the environmental factors be validly established [that is, Alcolac as the source of the toxic emissions, the quantities, the toxicity of the agents, how they enter the human body, etc.], but also the risk variables of the particular individual afflicted, and the biological end point. The risk variables relate to an assessment of whether the disease diagnosed was altogether the result of chemical poisons or rather of viral origin or of a genetic predisposition. Thus, a genetic deficiency in alpha: antirypsin predisposes to infections of the lung, as do some toxic chemicals. The risk variables relate also to the mode and habits of life of the person. Thus, a cigarette smoker exposed to acrylates, epichlorohydrin or allyl alcohol is more susceptible to severe reaction and disease than a nonsmoker. The biological end point is the effect the toxic chemical has on the body — whether the organs are diseased. In essence, it is another confirmation of causation.

The process of evaluation at CCA began with an interview of each of the plaintiff-patients. It delved intensively into the family, social, occupational and environmental histories of each, as well as the clinical medical history, present illness, symptoms and complaints. The inquiry *92 probed the environmental factors which the patient related to the symptoms and complaints. The response invariably described the sequence of the commencement of Al-colac operations, the incident of odors, vapors, fumes and other emissions, and physical manifestations of irritation to the eyes, nose, throat, skin, and others. The inquiry probed other environmental factors which the patient related to the Alcolac emissions —the appearance of white residue and foam on plant and animal life with the sequel of blighted vegetation and diseased or dead animals. These environmental phenomena, the expert explained, afford insight into toxicity as well as dose, and of the temporal relationship between event and effect so significant to the determination of causation. Another function of the interview was to enable the examiner to determine the laboratory tests to be administered among the thousands available. That determination was aided by an inventory of the bodily systems most predictably affected by exposure to the toxic chemicals used and produced by Alcolac. In that component of the interview each organ system was “gone through to try to help the patient remember things that he might have forgotten.”

Dr. Camow deemed the history derived from the patient interview and the laboratory tests as the most vital aspects of evaluation, and the physical examination less so. The witness explained: physical examination is most informative where the patient presents acute symptoms — such as bleeding, traumatic injury, or other such palpable manifestation. Physical examination is least informative in cases of chronic exposure to toxic chemicals of the kind used at Alcolac because they induce multiple symptoms which mimic other diseases, and so are more difficult to diagnose in the absence of laboratory tests. In such cases, also, physical examination — which for the most part explores the exterior of the body — is least informative to the diagnosis of disease because the toxic chemicals Alco-lac emitted are systemic, metabolic poisons which attack and degenerate interior organs. Thus, by the time those manifestations of disease are palpable on physical examination [such as enlargement of the liver, spleen, or other organ], the disease is so advanced that virtually no other aid to diagnosis is needed.

The process of patient evaluation at CCA was conducted under protocols defined by Dr. Carnow and delegated to staff physicians, specialists and consultants. The symptoms gathered from the interview of each plaintiff-patient were classified by a nosologist — a specialist who conforms patient responses into a common symptom according to internationally accepted definition. Dr. Carnow then reviewed the found symptoms and, as validated, sanctioned the entry of the symptom as an abnormality of the SYMPTOMS chart of the plaintiff-patient. The chart was devised to reflect the human organs most susceptible to injury from exposure to the chemicals Alcolac used, produced and emitted. 41 Only those symptoms validated by Dr. Carnow as caused by exposure to Alcolac toxic emissions or which represented a severe aggravation of a pre-existent condition were noted under the organ affected. The notation was by an orange dot. That determination of symptom rested on the information derived from the 1984 evaluation process at CCA as supplemented by the trial testimony of plaintiff-patient in 1985. The age and life expectancy of each of the plaintiffs, otherwise proven, were superscribed on each chart.

The physical examinations of the plaintiffs then followed and were conducted under the protocol defined by Dr. Camow and delegated to CCA staff physicians Benjamin and Adamji, board certified internists. The abnormalities the examinations disclosed, again as validated by the expert opinion of Dr. Camow to be effects of the Alcolac emissions, were entered on the PHYSICAL FINDINGS chart of each *93 plaintiff. 42 The chart was designed to reflect the organ systems most likely to manifest physical findings from exposure to toxic chemicals of the Alcolac ilk. They included the eye, ear, nose, throat and the pulmonary, cardiovascular, gastrointestinal, central nervous, peripheral nervous and endocrine systems. A function of the physical examinations, as well as of the derived symptoms, was to enable an informed selection of laboratory tests among the thousands available for the various organs.

The laboratory tests proceeded under a protocol developed to test those organs and organ functions known to be the biological targets of the chemicals used and emitted by Alcolac: epichlorohydrin, allyl alcohol, ethyl acrylate, toluene, glycidyl ether, cy-clohexane, methylene chloride, hydrochloric acid, hydrogen sulfide and allyl methacry-late. The number and kind of laboratory tests administered to a plaintiff were governed by the nature of symptoms, physical findings and related diagnostic incidents of the particular evaluation. A LABORATORY chart listed each organ or organ function for which a test was administered, the description of each test, and noted an abnormal result by an orange dot on the chart of that plaintiff. In some instances, as in the case of the male litigants, a fertility analysis test was offered but not taken. Such incidents of nontest were noted on the LABORATORY chart by a gold star. 43 The tests administered ranged in number from 25 for the youths, Amber Cross and Lyle Turley, to 63 for Carl Berry. The tests were conducted at CCA by staff specialists, others by special consultants, and others by special laboratories. The fertility tests were administered at Cook County Hospital, the porphyrin tests were conducted at the Mayo Clinic by the new high pressure liquid chromatography technique, the immune panels done in 1984 were tested by the Bioscience Laboratory in Chicago, and the immune panels ordered in 1985 by Dr. Zahalsky [in consultation with Dr. Carnow] to delve the startling uniformity of abnormalities reported by Bioscience, were done by the Midwest/Wheeler Laboratories in Kansas City. The normal for each test result was usually expressed as a value within the reference range established for the given test. 44 A test value *94 outside the reference range was deemed outside the range of normal, and hence abnormal. An abnormal laboratory result signifies that the body is out of balance— thus [the expert evaluator commented], “it is reasonable to assume that if a laboratory test is abnormal, whether high or low, that this is not good.” Whether or not the abnormality connotes disease, however, is a matter of medical diagnosis integrated from the history, physical examination and other related data. It was the protocol that an abnormal test result was confirmed by a retest.

The witness reviewed the clinical information amassed from the interview, physical examination and laboratory procedures as to each plaintiff-patient, and rendered opinion on reasonable medical certainty as to those abnormal symptoms, physical findings and laboratory results he deemed to be caused by the Alcolac toxic emissions. 45 That delineation was then evaluated into a diagnosis and prognosis as to each of them. The testimony of Dr. Camow recurrently noted that the chemicals used by Alcolac— epichlorohydrin, allyl alcohol, and the others — are metabolic poisons to the entire bodily system, and hence required test of all the major organs. He prefaced the evaluations of the abnormal results from these tests and the abnormal symptoms and physical findings manifested by the plaintiff-patients by explanations of the target organ and functions of the Alcolac chemicals, the nature of the tests to detect organ function damage, and the significance of the test results.

“EAR

“A number of the chemicals used and produced by Alcolac are toxic to the 8th cranial nerve, the nerve in the brain which controls hearing. The ear is a high energy system — it works unceasingly — and if the nerves are intoxicated, they damage easily and do not regenerate. People hear at several frequencies, but the frequencies at the upper end are those which first become damaged by toxic chemicals. They may also be damaged from severe noise. Thus a person in a very noisy occupation over a period of years may suffer such nerve damage also.

“The hearing or audiometric test is conducted in a soundproof chamber and the subject is exposed to noises at different frequencies — at 500, 1000, 2000, 3000, 4000 and 6000 cycles — to determine which frequency the subject can no longer hear. Since those at the upper end — 3000, 4000 and 6000 cycles — are those which become damaged by toxic chemicals, they are the focus of the tests. Abnormal test results at those levels signify nerve damage. A person with a normal ear hears at about 20 decibels; 30 decibels is marginal, and the apprehension of 3000 cycles at 50 decibels signifies a hearing loss. A decibel represents a volume determination at a given frequency. The decibel count is a logarithmic number, so that a change from 40 to 45 decibels at a given frequency, for instance, is not a loss of 5, but almost a doubled loss.

“To determine whether in any case the test results represented a hearing loss, the conclusions from the audiometer were applied to the Spoor Graph. That diagram represents a composite calculation of average hearing levels at different frequencies *95 at each age — with a different average number for men and women. The results of the audiometric tests administered to the plaintiffs were applied to the averages on the Spoor Graph to determine the acuity of the hearing of the persons tested. That transposition, toxicology and medical expert Emmett for Alcolac acknowledged, were done accurately.

“The test results of twenty among the thirty-one plaintiffs were abnormal. The loss of hearing was attributed to exposure to Alcolac toxic chemicals. Occupation noise or presbycusis [hearing loss incurred by age] were eliminated as a cause in each case.

“PULMONARY SYSTEM

“The test is the spirometer. The spirom-eter measures the volume of their intake and the strength of inhalation. It measures FVC — forced vital capacity — the volume of our intake and the strength of exhalation. The subject blows as hard and fast as possible into a large rubber bag. The bag content is measured and compared with a person of the same age, height and sex. A person with an FVC 80% or more predicted for that age, height and sex is normal. A normal person evacuates 70% to 75% of his air in one second. Any lesser FVC is abnormal and usually attributable to scarring of the lungs. Causes other than toxic chemicals can account for the abnormality. Six of the thirty-one plaintiffs tested abnormally. The abnormalities Dr. Camow diagnosed were all he deemed caused by exposure to Alcolac emissions.

“X-rays were also administered to test the pulmonary system.

“CARDIOVASCULAR SYSTEM

“The test employed was the electrocardiogram — EKG. It tells about the electric pattern of the heart. The toxic chemicals emitted by Alcolac can irritate the nerve bundle of the heart and damage the heart muscle from want of supply of blood. The pattern described by the EKG informs of any such abnormality.

“LIVER METABOLISM FUNCTIONS

“The liver is the largest organ in the body and functions as ‘a big factory.’ It processes proteins, sugars, fats and fatty substances. The liver regulates porphy-rins, iron, enzymes and prothrombin time. It is also the major detoxifying organ in the body. The toxic agents go to the liver to be purified, but because they are so dangerous, they also damage the liver. The liver is the target organ for epichloroh-ydrin, toluene, ethyl acrylate, glycidyl ether and allyl alcohol — among the chemical agents used and produced by Alcolac. The toxic emissions from the Alcolac processes are metabplic poisons which can affect the numerous liver systems and functions. The laboratory procedures administered were selected to determine which major functions of the liver may have been damaged. They include tests for the metabolism and function of the porphyrins, enzymes, iron, prothrombin time, lipids and proteins.

“Porphyrins

“The porphyrins are a small factory within the larger factory — the liver. They are combinations of chemicals which function to produce the heme which then mixes with globin to form the hemoglobin of the red blood cells. Hemoglobin transports oxygen from the lungs to the tissues of the body, and so is critical to life. The heme also goes into the production of the hemiprotein P450 enzymes ‘which run the body.’ The por-phyrins move through the body like a cascade regulated by a series of dams which supplies them to the body as needed. The heme itself is the end product of original eight porphyrins, broken down through the regulation process.

“It is known that epichlorohydrin and some of the other toxic poisons emitted by Alcolac do damage to the system of porphyrin metabolism and the process of regulated flow. Thus, the laboratory test for this liver function was devised to determine any abnormality in the porphy-rin system. Until recently, laboratory tests could measure only uroporphyrins and coproporphyrins. A new high pressure liquid chromatography technique [HPLC] available at the Mayo Clinic, however, enables the test and measurement of the entire cascade of porphyrin *96 flow function. Porphyria is the disease which describes the state of abnormal porphyrin metabolism. It has been known as a rare genetic disease, with an incidence of one in an average population of 100,000. It has become known recently that toxic chemicals can also damage the porphyrin system and cause porphy-ria. Epichlorohydrin can cause porphy-ria — so can PCB and hexachlorobenzene [the latter two not among the Alcolac chemicals used or made].

“Six tests were administered at the Mayo Clinic to the 31 plaintiffs. The tests of four of them disclosed no abnormality. Seven of them exhibited one abnormality, twelve of them two abnormalities, seven of them three abnormalities, and one of them four abnormalities. Thus, the Mayo laboratory results demonstrate that 27 of the 31 plaintiffs [87%] had abnormal porphyrins — some form of porphyria. It was a test finding Dr. Carnow described as ‘just incredible.’ The probability of the incidence of por-phyria in such a percentage had the Se-dalia population not been toxically poisoned — the witness calculated — would be a quintillion [a billion billion]. It was remarkable, as well, he remarked, that 19 of the 31 also had a coproporphia.

“Once the system of abnormal porphy-rin metabolism ‘is turned on’ the witness explained, ‘we don’t know any way to turn it off.’ Animal studies show that it might help to reduce the amount of iron in the body — induce anemia. A consequence of the disease may be porphyria crises which are characterized by severe abdominal pain — which some of the plaintiffs have already experienced. The disease also can affect the central nervous system, cause irritability and induce personality change. It can explain, for instance, the sudden impulse to strike a horse between the ears — as did plaintiff Arnold Sommers.

“The disease may develop into the stage called porphyria cutanea tarda, where any exposure to the sun causes the skin to blister, but none of the plaintiffs are at that stage.

“Enzymes

“The liver also produces other enzymes necessary to carry out vital bodily functions, such as proteins to aid in the coagulation of the blood. This function of the liver, along with the others, are the targets of most of the several toxic chemicals identified in the Alcolac production process. There are enzymes that are normally inside a liver cell. When the liver cell has been damaged from chemical intoxication or otherwise, they are produced in abnormal quantity and leak into the blood. GGTP, SGOT, SGPT and alkaline phosphatase are among the enzymes normally within the liver cell. Thus, an abnormally elevated count of these enzymes denotes inflammation of the liver. An increase in the alkaline phosphatase enzyme denotes chronic liver damage — although it may signify increased bone activity, as during the repair of a fracture or in young, growing children. LDH is also an enzyme, but not specific for liver disease. An abnormally high count of LDH also denotes inflammation — although it is not specific for liver disease, but may appear when there is muscle inflammation or alteration of cell function in other organs.

“Iron Metabolism

“Iron metabolism is usually well regulated, and not many diseases will cause an abnormality of that function. The concern was that since porphyrins use iron in the production of their chemical, abnormal porphyrin metabolism could bring about abnormal iron metabolism. An abnormal test result in iron metabolism, therefore, not only usually reflects abnormal porphyrins, but also an abnormal P450 enzyme system of the liver the porphyrins produce.

“Prothrombin Time

“The test determines the time it takes to stop bleeding. That function is regulated by vitamin K, manufactured in the liver. A disturbance of vitamin K also disturbs prothrombin time and indicates damage to the liver. The test was repeated because of the unusual number of positive results.

*97 “Lipid Metabolism

“ ‘Lipid’ means ‘fat’ and encompasses an entire group of fatty substances which the liver processes. The lipids tested were HDL cholesterol, LDL cholesterol, cholesterol, triglycerides and li-poprotein phenotype. Abnormal findings as to the metabolism of that group is another mark of liver damage. Since the nerve covers are fatty, abnormality in lipid metabolism can relate to peripheral neuropathy — which is damage to the fatty cover of the nerves. Peripheral neu-ropathy was a condition found in 15 of the 31 plaintiffs tested.

“Protein Metabolism

“The liver also regulates protein activity, and so a series of tests were administered to determine whether any toxic chemical damage was done to the protein metabolism function of that organ. The total protein, alpha 2 globulin, gamma globulin and other proteins were tested for metabolism. One test applied was the protein electrophoresis which moves the blood sample in a field and distinguishes among the proteins and counts them. The significance of abnormal test results is that the protein processing function of the liver has been damaged.

“GENITOURINARY

“A number of the Alcolac toxic chemicals target the kidneys and damage them: epi-chlorohydrin, allyl alcohol, ethyl acrylate, toluene, glycidyl ether, dimethyl sulfate and hydrogen sulfide. Kidney damage from a toxic agent produces high uric acid, and the tests were devised to determine that fact as well as the state of the kidney function. The tests included urinalysis, BUN [blood urea nitrogen], which determined whether the kidney is getting rid of poisons, as do the creatinine and uric acid tests. Calcium and phosphorus, potassium and chloride counts also indicate the normality or abnormality of kidney functions, and they were also tested.

“FERTILITY ANALYSIS

“Alcolac chemicals,, epichlorohydrin, and allyl alcohol, can cause severe damage to the reproductive organs. It can cause abnormalities of the sperm count in humans and the destruction of testicles in animals. The tests conducted analyze a fresh sperm specimen to determine the count, type of motion, percent of activity, grade and morphology. A single ejaculation produces a normal sperm count of about 100,000,000. A count of between 40 to 60 million is borderline abnormal and a count below 20 million causes difficulty in the fertilization of an egg, especially if they do not move well or remain active for more than four hours. Those represent the conclusions of the recent Wharton study which was the standard Dr. Carnow adopted as authoritative in his evaluations. The tests administered observed the activity of the sperm at intervals: at the end of 30 minutes 80% should continue to move; at 60 minutes, 70%; at the end of four hours, 60% should continue to move. If less than that number is found, it is abnormal because sperm must live for three days to fertilize an egg. The motion of the sperm is also tested. Normal sperm all move in the same direction at once. Random movement in every direction manifests a poor grade of sperm ‘because that means that they are not going any place.’ The morphology is observed — whether they appear normal. A 20% abnormal morphology among the 100 million sperm is expected. Most abnormal sperm will not fertilize an egg, and if they do, ‘they can cause a damaged product.’

“The fertility analysis was performed on the male plaintiffs amenable to the test. Some of them declined or were not qualified because of prior vasectomy. The seven male plaintiffs tested all displayed at least two abnormal fertility analysis results.

“CENTRAL NERVOUS SYSTEM

“The central nervous system and brain are targets of many of the toxic chemicals used by Alcolac — among them, epichloroh-ydrin, allyl alcohol, toluene, gylcidyl ether, cyclohexane, dimethyl sulfate, methylene chloride and allyl methacrylate. The brain is very fatty tissue, so anything that disturbs the lipid metabolism affects the brain. The brain is a high energy and vigorous organ, so anything that depresses the way the body uses oxygen affects the brain functions. It is for this reason that *98 the health of the porphyrin metabolism system, which produces the heme, is important.

“Certain brain functions are affected by toxic chemicals, and certain abnormalities manifest — such as attentional deficits, memory loss, depression and others. The tests administered were to quantify any such damage done to the central nervous system. They were administered by Drs. Garrón and Wilson, professors of psychology at the Rush Medical Center in Chicago. The tests [30 of them] included the Hal-stead neurobehavioral battery — which evaluates the visual-spatial function, ability to concentrate and other functions of the brain. The results determine what functions of the brain, how much and where, are abnormal. Each test of the Halstead battery was scored according to a reference range of normals devised for different populations — adults or children, range of education, socio-economic status, and other specific standards. The Beck depression inventory test was also administered. Toxic chemicals which deprive the central nervous system of oxygen induce depression, because depression is the way the brain reacts to loss of oxygen. It is for that reason that depression is a very common result of exposure to toxic chemicals. The Zung anxiety scale test was also administered to determine the anxiety caused by the exposure to the Alcolac toxic chemicals.

“PERIPHERAL NERVOUS SYSTEM

“The tests of the peripheral nervous system were prompted, among other considerations, by the common symptoms reported among the litigants as well as nonlitigants of numbness and tingling of the limbs and cramps in the legs. The peripheral nervous system, moreover, is the target organ of several of the Alcolac toxic chemicals already repeatedly enumerated. The tests administered were of two kinds: the sensory and reflex tests performed on physical examination and the EMG and PNVC tests performed thereafter by Dr. Subbaru, a CCA staff neurologist. The PNVC tests measured both the motor nerves and the sensory nerves. The measurements are in milliseconds and when a nerve is damaged the nerve impulse slows. The EMG tests the nerve by insertion of thin needles into the muscle the nerve controls at the motor end plate. If there is damage to the nerve at that site, there will be an abnormal EMG result. That signifies axonal degeneration —that the nerve fiber itself, not only the sheath, is dying. That damage is irreversible. The toxic chemicals which Alcolac emitted are metabolic poisons and cause polyneuropathy — that is, damage to multiple nerves.

“The peripheral nervous system of ten of the thirty-one plaintiffs tested abnormally.

“MUSCULOSKELETAL SYSTEM

“In addition to the EMG, which tested the muscle-nerve relationship, the CPK was administered to determine damage to the muscle. CPK is creatine phosphokinase, an enzyme. ‘It makes muscle go, and sometimes in toxic conditions, CPK. may be abnormally low or abnormally high if there is a specific type of muscle damage.’

“ENDOCRINE SYSTEM

“The toxic chemicals which affect the protein metabolism function of the liver can also affect the thyroid gland of the endocrine system. An abnormality of the P450 enzyme system produced by the por-phyrin metabolism of the liver will result in abnormality of the thyroid binding globulin, a protein, which carries the thyroid hormone.

“The thyroid gland regulates some of the way in which the body uses oxygen. Two tests were administered to test the thyroid function, a T3 uptake and the T4 RIA. One tests the triidothyronine and the other the thyroxine component of the gland. The thyroid and liver functions are so interrelated that when the T3 tests low and the RIA high, it connotes not an abnormality of the thyroid function, but of protein metabolism — the thyroid binding globulin.

“IMMUNE SYSTEM

“The chemicals involved in the Alcolac process — epichlorohydrin, toluene and dimethyl sulfate, among others — are toxic to human cells and act to depress the immune system. The condition of chemically induced immune disregulation — the immunol *99 ogists for the plaintiffs and for Alcolac agreed — may result. The procedures administered by CCA in 1984 and then supplemented by the Midwest/Wheeler laboratory in 1985, were designed to test the T cell and B cell components of the immune system for function and abnormality. 46

“The immune system is separated into the B cell and T cell components. The immunoglobulins are that part of the B cell component which helps protect against common infections. The major globulins, G, A and M were tested. An abnormality in the immune system or in protein metabolism may reflect in abnormality of glob-ulins. An abnormal finding in this group means the immunoglobulins are not functioning.

“Another series of tests of the immune system was the mitogen challenges. The purpose of these tests was to determine whether the body has adequate defenses— whether the body will attack if it sees an enemy. In a normal immune system, the lymphocytes of both the B cell and T cell components attack potentially harmful invaders. They also attack abnormal cells naturally produced by the body as well as those proliferated by toxic agents. A mito-gen challenge is a procedure wherein lymphocytes are taken from the blood and, unstimulated, the energy emitted in counts per minute is tested. That is the unstimulated CPM phase of the mitogen test. Then the unstimulated lymphocytes are presented with an enemy — an antigen — in this case, plant proteins. That should cause the lymphocytes to attack and the counts per minute [CPM] to increase. When the counts increase, that means the lymphocytes are attacking, if they do not increase, that means that they are not attacking. The failure to attack is a test abnormality. The reactions of one type of T cell lymphocyte to the mitogen challenges is reflected in the PHA, CPM and the PHA [phytohemagglutinin] Stimulation Index. The reactions of another type of T cell lymphocyte to the mitogen challenges are reflected in the CON A CPM and CON A CPM Stimulation Index. The B cell lymphocytes were tested by the poke weed mitogen [PWM], another plant protein and the reactions are reflected in the PWM Index. The basic function of the panels administered by Bioscience, therefore, was to test the immune functions of the cells— that is, ‘when they see an enemy, do they attack the enemy?’ It was the unusual findings of T cell abnormalities from these mitogen challenges that prompted Dr. Car-now to confer with immunologist Zahalsky and then to arrange for further tests of the patient-plaintiffs by the Midwest/Wheeler laboratory.

“The supplemental procedure conducted by Midwest/Wheeler in 1985 not only further tested the immune system but also the hematologic [blood] system.

“Other immune system tests administered by CCA and conducted by the Bioscience laboratory in 1984 were to the white cell populations of the patient-clients. They are part of the defense system, and the segs subpopulation increases when infection is present. The tests also counted the total lymphocytes, and eosinophil, mo-nocyte and basophil populations.

“The basic function of the panels administered by Midwest/Wheeler was to further define the subpopulations of the lymphocytes, the T cells and the B cells. The purpose of the tests was to determine the kind of T cells in the lymphocyte populations — the helpers, suppressors, killers or memory T cells, and also whether the relationships are out of balance. These test *100 results inform whether or not there may be suppression in the bone marrow, or whether or not the T cells are unprogrammed when they leave the lymphatic tissue — and other such insights.

“It was the conclusion and opinion of Dr. Carnow that the Midwest/Wheeler tests determined that the patient-plaintiffs exhibited immune system abnormalities in multiple areas, ‘particularly of the T lymphocyte series,’ that the T lymphocytes are ‘one of the major defenses against cancer,’ and that it is known that the T lymphocytes can be damaged by toxic chemicals of the kind used by Alcolac. It was the conclusion of the expert, also, that the Midwest/Wheeler results demonstrate and confirm that ‘the immune systems of most of these Sedalia people were very severely depressed because of damaged organs’ from exposure to the Alcolac emissions.”

The purpose, role and function of each of the laboratory procedures thus elaborated, Dr. Carnow then evaluated the symptoms, physical findings and abnormal laboratory results as to each of the patient-plaintiffs [within the context of a detailed personal, clinical and occupational history of each as augmented by the trial testimony] to derive a diagnosis of the biological pathology and disease caused to each organ or function by the Alcolac toxic chemical emissions. 47 The symptoms, physical findings and abnormal laboratory results found — as well as the diagnosis as to each plaintiff-patient were those evaluated as attributed to the Alcolac operations by a reasonable medical certainty. 48

ETHEL BERRY AGE 73 LIFE EXPECTANCY 13.78 YEARS

DIAGNOSIS: Chronic Systemic Chemical Intoxication caused by the Alcolac toxic chemicals with damage to multiple organ systems, including

1) recurrent conjunctivitis

2) bilateral hearing loss with probable neurosensory 8th cranial nerve damage

3) chronic rhinitis and pharyngitis

4) chronic chemical bronchitis

5) arteriosclerotic heart disease with angina, chronic insufficiency and hypertension

6) liver dysfunction including

a. chemical hepatitis

b. abnormal lipid metabolism

c. porphyria

d. abnormal protein metabolism

7) chronic obstructive uropathy with hypercalcemia

8) depression

9) peripheral neuropathy

10) immune system dysfunction with suppression

11) recurrent chemical contact dermatitis

12) hyperglycemia with early diabetes

PROGNOSIS: Very guarded to poor.

*101 The diagnosis entered by Dr. Carnow as to Ethel Berry — Chronic Systemic Chemical Intoxication caused by the Alcolac toxic chemicals with damage to multiple organ systems — was that determined for each of the thirty-one litigants, although by distinctive manifestations. The witness then explained — in terms of the symptoms, physical findings, laboratory results and environmental history of the litigant — how, as a medical exercise, the subelements of diagnosis were derived:

1) Recurrent conjunctivitis rests on symptoms and history of acute problems with the eyes which recurred every time she was exposed to the Alcolac chemical emissions: redness of the eyes, burning, itching. Although the evaluator considered it more probable that there was residual damage to the eye and so the diagnosis was likely chronic conjunctivitis, the residual damage to the eye was not palpable, therefore, recurrent and not chronic conjunctivitis was attributed.

2) Bilateral hearing loss with probable neurosensory 8th cranial nerve damage rests on the abnormal audiometric tests at the upper frequencies, a sign of bilateral nerve damage to the 8th cranial nerve by the Alcolac chemicals.

3) Chronic rhinitis and pharyngitis rests on physical findings of swollen nose with exudate material within. Rhinitis describes the chronic inflammation of the mucous membrane of the nose. It was a chronic, rather than a recurrent condition, because the swelling and residue were evident even when there was no exposure.

4) Chronic chemical bronchitis rests on findings that the bronchial tubes were chronically inflamed. In response to cross-examination, the expert acknowledged the work history of Ethel Berry — that she worked for 23 years in a broom factory, a very dusty occupation and developed a low grade abnormality from that exposure. It was an abnormality different from the bronchitis and is in the nature of chronic restrictive pulmonary disease, rather than bronchial disease. The restrictive pulmonary disease caused by the dust involves the lung tissue itself. The chronic chemical bronchitis involves the bronchial tubes irritated by the toxic chemicals. The bronchitis was diagnosed from the inflamed bronchia from recurrent episodes of inhalations of obnoxious Alcolac odors, which sometimes bum and irritate and induce nausea. The odors also induce productive coughs. The diagnosis was limited to bronchitis and did not include the restrictive pulmonary disease to the lung tissue because it was attributable to occupation, and not to the Alcolac chemicals.

5) Arteriosclerotic heart disease with angina, chronic insufficiency and hypertension rests on findings of pain on exertion from chronic want of sufficient blood supply to the heart, with the consequence of recently developed high blood pressure. It included the diagnosis that the blood vessels of the heart have been adversely affected by the abnormal fats in the blood developed from the intoxication of the liver. The diagnosis took into account her prior medical episode of hypertension, since for several years Ethel Berry has been free from any such disease. It also took into account that several of her brothers died of heart disease, but discounted that information since heart disease of that kind is not of genetic significance.

6) Liver dysfunction manifested by chemical hepatitis, abnormal lipid metabolism, porphyria and abnormal protein metabolism rests on the abnormal laboratory test results as to porphyrins, enzymes and lipids. The tests for the enzymes GGTP, SGOT and SGPT show abnormal elevations, indications that the liver is acutely inflamed — a condition of hepatitis attributed to the toxic chemicals. In addition the alkaline phosphatase was also abnormal. The lipid metabolism function of the liver was also diseased. The cholesterol was abnormally high at 291, and in addition the lipoprotein phentotype was abnormal and the triglycerides were extremely high at the 407 level [normal, 150]. The inflammation of the liver and the impairment of .the liver function is due to the destruction of cells — a direct action of such toxic chemicals as epichlorohydrin, and the intoxication of the systems of liver metabolism by others. The very abnormal fats in her blood demonstrated by the lipid metab *102 olism tests show very abnormal fats in the blood, developed from the chemical intoxication of the liver. The porphryn metabolism was also diseased. The tests show abnormal heptacarboxylic porphyrins and an abnormal coproporphyrin ratio. The abnormal porphyrins means that the porphy-rin factory and the enzymes which depend on the heme production of the porphyrins are not functioning normally. The abnormal protein metabolism means that the body tissues, the end product of the protein metabolism, are not being properly produced.

7) Chronic obstructive uropathy with hypercalcemia rests on the test result of abnormal levels of calcium in her blood which inflames the genitourinary system and renders urination difficult. It represents an abnormal function of the kidney in this case.

8) Depression rests on not only the Beck depression inventory test, but also on the symptoms, findings and history. It represents a mild abnormality, but nonetheless attributed to the Alcolac chemical activity. There may be some psychogenic overlay but that is the kind of depression manifested by people exposed to toxic agents of the kind emitted. She had some difficulty with some other tests — such as the visual-spatial perception, but the clinical significance of that result was discounted. The expert acknowledged to the cross-examiner that her condition of poor circulation to the brain as well as domestic stress may have combined with the toxic agents to cause the depression. He acknowledged that the Beck inventory was not as definitive as a CAT scan or other such procedures.

9) Peripheral neuropathy rests on the absence of ankle reflex, decreased sensation to pinpricks in sites of the nerves on the left hand, as well as the symptoms of tingling limbs, pains, cramps and physical findings of swelling in the legs.

10) Immune system dysfunction with suppression rests on the “whole host of abnormalities” the 1984 Bioscience and the 1985 Midwest/Wheeler immune panel results disclose. These test abnormalities show that “[h]er whole T cell immune system is depressed,” and a “severe depression of her [immune] system.”

fBioscience Laboratory Test Results, 1984]

Immune system:

Immunoglobulin: slightly abnormal gamma M at 79 [normal, 80 to 310]

Mitogen Challenge: abnormal PHA stimulation net CPM at 41,-800 [normal, over 62,000]

abnormal PHA stimulation index at 92 [normal, over 130]

abnormal CON A stimulation net CPM at 10,334 [normal, over 12,000]

abnormal CON A stimulation index at 24 [normal, over 40]

TMidwest/Wheeler Laboratory Test Results, 19851

Immune system:

Lymphocytes: abnormal elevation of mature B cells at 629 [normal, 50 to 570]

abnormal B cell percentage at 30.3% [normal, 5 to 15%]

abnormal depression of natural killer T cells at 5.4 [normal 8 to 22]

Hematologic system: abnormal ring of distribution [width] of red blood cells

abnormal increase in mean platelet volume

abnormal size of red blood cells [anisocyto-sis]

abnormal lack of red color [hypochromia]

*103 11) Recurrent chemical contact dermatitis rests on symptoms of burning of the skin and abnormal pigmentation of the skin related to the incidents of exposure to the Alcolac emissions.

12) Hyperglycemia mth early diabetes rests on the test result of increased sugar in the blood. Her prior medical history and records indicate a normal level of blood sugar and that she was free of the stigmata of diabetes. A condition of diabetes could account for some elevation of the lipids, but no such condition was suggested from her history.

PROGNOSIS: Very guarded to poor.

The evaluations of the symptoms, physical findings and laboratory results of the other patient plaintiffs, as well as the diagnoses and prognoses derived from them were rendered by Dr. Carnow, in turn. The diagnosis and prognosis of each is re-scripted, as well as the summary of the symptoms, physical findings, laboratory results and other data on which they rest.

CARL C. BERRY AGE 54 LIFE EXPECTANCY 25.51 YEARS

DIAGNOSIS: Chronic Systemic Chemical Intoxication caused by the Alcolac toxic chemicals with damage to multiple organ systems, including:

1) bilateral chronic conjunctivitis

2) bilateral neurosensory hearing loss with 8th cranial nerve damage

3) chronic rhinitis and pharyngitis

4) liver dysfunction including

a. abnormal lipid metabolism

b. abnormal porphyrins with coproporphyinuria and abnormal porpo-bilinogen

5) reproductive system damage

6) cardiac dysfunction with:

a. tachycardia

b. chest pain

c. shortness of breath

7) central nervous system dysfunction with depression

8) severe immune system dysfunction with suppression

9) abnormal muscle metabolism with abnormal CPK PROGNOSIS: Very guarded to poor.

The witness then explained the data on which the sub-elements of diagnosis rest:

1) Bilateral chronic conjunctivitis rests on the symptoms of burned and watery eyes with redness related to the exposure of the vapors, smoke and fumes from Alcolac, as well as on the inflammation of the eyes found on physical examination. These manifestations followed the presence of odors with the smell of lacquer [which the witness identified as the methacrylates] as well as the vapors, smoke and fumes from Alcolac. The conjunctivae are the delicate membranes which cover the eyes. The witness distinguished between recurrent conjunctivitis and chronic conjunctivitis — one condition or the other manifested by every patient-plaintiff. The condition is recurrent when red eyes result upon the repeated exposures but are not present at the time of physical examination. The condition is chronic when the eyes exhibit inflammation upon examination even absent recent exposure, or when there is a history of redness of the eyes *104 “all the time,” or when the eyes are matted in the morning, or gritty.

2)Bilateral neurosensory hearing loss with 8th cranial nerve damage rests on the abnormal results from the audiometric tests. They show bilateral neurosensory hearing loss from the 3000 to the 6000 frequency ranges. Normal hearing apprehends speech between the 500 and 3000 frequency ranges, and sound up to the 6000 frequency. Those toxic chemicals which attack the central nervous system characteristically first cause damage to the 8th cranial nerve at the upper ranges. It was for that reason that the tests were for the 3000 to 6000 frequency ranges. The tests administered to Carl Berry at those ranges gave abnormal results throughout. At the 3000 frequency range, for instance, normal hearing apprehends sound at no higher than 25 decibels. Carl Berry could hear that sound only at 50 decibels. Hearing loss was also evident at 4000 and 6000 cycles. The results demonstrated damage to both 8th cranial nerves — a bilateral neu-rosensory hearing loss from the Alcolac toxic chemicals.

It is damage which does not regenerate, and is irreversible. Hearing loss at those frequency levels may also be the result of occupational noise. Carl Berry was a heavy equipment operator, but never experienced any hearing loss from the practice of that occupation. He was also a signal officer on an aircraft carrier, but he wore ear covers which excluded the noise. His tests for hearing were satisfactory before release from the service. The witness acknowledged also that presbycusis — hearing loss due to age — is a condition that may affect hearing at all frequencies. The loss of hearing due to presbycusis, however, does not “notch,” but increases as the frequency increases. Hearing losses due to chemicals or noise, on the other hand, do “notch.” That was demonstrated in the tests administered to Carl Berry which show that he heard at the 4000 range at 50 decibels and at the 6000 range at 45 decibels — a slight improvement at the higher frequency. The full history and other clinical data led the expert to the conclusion that the hearing loss was not from occupational noise, but from the intoxication caused by the Alcolac emissions. It also excluded presbycusis as a relevant factor in the subdiagnosis of the manifested bilateral hearing loss both on the pattern of “notched” hearing loss, uncharacteristic to presbycusis, but also on the basis of studies which attribute the disease to noisy industrial environments. Carl Berry, rather, lived in the rural environs of Sedalia.

3) Chronic rhinitis and pharyngitis rests on symptoms of irritation to the nose and soreness to the throat from the Alcolac odors and emissions. There was also the physical finding of mucous membrane irritation of the nose. The irritation of the mucous membrane, when chronic, impairs the production of tears, and also renders the person more susceptible to infection. In terms of diagnosis, the irritations are markers of a direct relationship between the discerned vapors, smoke and smells from Alcolac and the manifested symptoms and conditions.

4) Liver dysfunction including abnormal lipid metabolism, abnormal porphy-rins with coproporphyrinuria and abnormal porphobilinogen rests on the normal results of the laboratory tests. The abnormal lipid metabolism dysfunction of the liver was shown by the result of 28 in the HDL cholesterol test with a normal reference range of 29 to 77. The studies show, the witness explained, that although the reference range extends from 29 to 77, a test value below 45 means that the person is “at increasing risk” — therefore, a person at 29 is “at high risk” of cardiac disease. The reference range used by Smith-Kline, the laboratory which conducted the HDL cholesterol test, is based on the Framing-ham epidemiologic study which concludes that an HDL value of 45 in a male and below 55 in a female means the person is “at increasing risk” of heart disease. The test result for Carl Berry demonstrated abnormal metabolism of the fats. The ex *105 pert acknowledged that the discontinuation of smoking will improve the HDL count, but Berry had not smoked since 1969, and so that earlier life habit was not significant to the causation of the manifestation. The porphyrin metabolism function of the liver also tested abnormally. It demonstrated a condition of porphyria, coproporpyrinuria and porphobilinogenuria.

5)Reproductive system damage rests on the abnormal results of the fertility analysis tests. The normal range of count for fertility is between 60 to 200 million sperm per specimen. That represents the conclusions of the recent Wharton study which was the standard Dr. Camow adopted as authoritative in his evaluations. [The witness, himself, conducted some work for the World Health Organization on the subject.] The sperm count Carl Berry produced was above the 60,000,000 level, but there were abnormalities in the morphology and motility of the sperm. The witness explained that there was “good evidence, from the animal data, that there is suppression of sperm production and destruction of testicular tissue by epichloroh-ydrin and allyl alcohol,” among the compounds used in the Alcolac operation.

6) Cardiac dysfunction with tachycardia, chest pain and shortness of breath rests on symptoms and physical findings of abnormal pulse, pain in the chest and, particularly pain in the chest upon walking fast or exertion, and shortness of breath. Those together constitute a syndrome of dysfunction. They suggest that the blood supply to the heart is not sufficient. They suggest a heart which does not compensate well, and a coronary insufficiency.

7) Central nervous system dysfunction with depression rests on the abnormal result of the Beck inventory test of 19 [normal, 0 to 10], as well as on the abnormal digital vigilance test result.

8) Severe immune system dysfunction with depression rests on the abnormal results from both the 1984 Bioscience and the 1985 Midwest/Wheeler tests.

rBioscience Laboratory Test Results, 19841

Immune system:

Immunoglobulin: abnormal gamma M at 50 [normal, 80 to 310]

Mitogen challenge: abnormally decreased PHA stimulation net CPM

abnormally decreased CON A stimulation net CPM

abnormally decreased CON A stimulation index

fMidwest/Wheeler Laboratory Test Results, 1985]

Immune system:

Lymphocytes: abnormal OKT-10 cells at 32.9 [normal, 0 to 15] [OKT-10 are immature, unprogrammed lymphocytes, probably preleukemic cells] abnormally elevated NKH-1 [natural killer] cells at 19.7 [normal, 3.8 to 9.6]

Hematologic system: abnormally shaped red blood cells [poililocy-tosis]

abnormal sizes [anisocytosis]

abnormal color [hypochromia]

9)Abnormal muscle metabolism with abnormal CPK rests on the symptoms of soreness and tingling in the left elbow which weakens the grip on objects and the abnormal CPK test result of the related musculoskeletal system. The symptoms signify both sensory and motor abnormalities of the ulnar nerve. That nerve comes down from the shoulder into the elbow, and *106 the ingestion of metabolic poisons may cause it to swell. That results in pain and loss of the muscular function of the arm. CPK [creatine phosphokinase] is the enzyme which appears in abnormal quantity when there is muscle injury. The test for CPK yielded an abnormal result, which signifies an abnormal muscle metabolism from exposure to the Alcolac chemicals.

JACQUELINE BERRY AGE 55 LIFE EXPECTANCY 28.61 YEARS

DIAGNOSIS: Chronic Systemic Chemical Intoxication caused by the Alcolac toxic chemicals with damage to multiple organ systems, including:

1) recurrent conjunctivitis

2) bilateral neurosensory hearing loss with 8th cranial nerve damage

3) chronic rhinitis and pharyngitis

4) liver dysfunction including:

a. abnormal LDH — possible chemical hepatitis

b. abnormal porphyrin ratio with borderline coproporphyrinuria

c. abnormal protein metabolism

5) central nervous system dysfunction including

a. brain dysfunction

b. depression

6) peripheral polyneuropathy

7) abnormal muscle metabolism

8) recurrent contact dermatitis with probable hypersensitivity state

9) immune system dysfunction with suppression

10)abnormal electrolytes with probable renal dysfunction

The witness then explained the data on which the subelements of diagnosis rest:

1) Recurrent conjunctivitis rests on symptoms and history of irritation, redness and watering of the eyes with blurred vision from exposure to the odors, smoke, haze and other emissions from Alcolac.

2) Bilateral neurosensory hearing loss with 8th cranial nerve damage rests on abnormal audiometry results of the upper frequencies with borderline abnormalities in the lower frequencies. It is a characteristic phenomenon that damage to the 8th cranial nerve from toxic chemicals starts at the high frequencies and spreads to the lower frequencies. The hearing loss to Jacqueline Berry was to both 8th cranial nerves, a bilateral neurosensory hearing loss.

3) Chronic rhinitis and pharyngitis rests on the irritation to the nose and burning in the throat from the Alcolac odors and emissions. Chronic rhinitis rests also on the physical finding of swollen mucous membrane.

4)Liver dysfunction including abnormal LDH [possible chemical hepatitis], abnormal porphyrin ratio with borderline coproporphyrinuria and abnormal protein metabolism rests on the abnormal results of the laboratory tests of the protein and porphyrin metabolism functions of the liver. The LDH enzyme tested at 141, elevated from the 62 to 131 normal. That represents a possible inflammation of the liver, and hence a possible hepatitis. In addition, another liver function, the copro-porphyrin to uroporphyrin ratio, usually 2 to 1 to 6 to 1, was elevated to 7 to 1. Although the other enzymes — the GGTP, SGOT and SGPT — were normal, the other abnormalities found in the liver, the abnormal protein metabolism, as well as the known action of these toxic agents suggest that the abnormal LDH may represent tissue damage as well as alteration of the tissue function. That is why the evaluator termed the manifestation a “possible chemical hepatitis.”

The abnormal protein metabolism was manifested by a T3 uptake deficiency, which, although a part of the endocrine *107 system, did not represent a thyroid deficiency, but an abnormality of the thyroid binding globulin — a protein manufactured in the liver.

The abnormality of the coproporphyrins was termed “borderline” because her co-proporphyrins were at 56 on a scale of 3 to 56. Although, strictly speaking, the count was within the normal range, since it rests precisely at the two standard deviations and about 25 from the mean, the evaluator described the finding as “borderline.” That evaluation was reinforced, moreover, by the phenomenon of the multiple incidences of porphyrin abnormality among those tested, as well as by the known ability of these Alcolac chemicals to cause abnormal porphyrins. The witness was confident in the integrity of the test results as a basis for subdiagnosis because the high power liquid chromatography process used by the Mayo Clinic for that purpose not only measures fractionates and the porphy-rins precisely, but also conducts the test on a reliable sample of urine collected during the bodily 24 hour diurnal cycle, and then repeats abnormals.

5)Central nervous system dysfunction including brain dysfunction and depression rests on a neurobehavioral battery abnormality as well as on an abnormal Beck depression inventory test, and physical findings of abnormality to the 7th and 8th cranial nerves. The history taken by the CCA examiner, Dr. Garrón, notes that Jacqueline Berry used Indural, a drug which on rare occasions causes some depression. It was a datum not clinically significant, however, since the tests administered by Dr. Garrón resulted in several central nervous system abnormalities: the digital learning test, the digital vigilance test, as well as other areas. That represents diffuse brain damage. There was also damage to the cerebellum, the back brain which controls balance and other critical functions. It was the opinion of the evaluator that, given the nature of the toxic chemicals to which she was exposed, as well as the found abnormalities of the 7th and 8th cranial nerves and the neurobeha-vioral test results, the depression was part of her syndrome.

6) Peripheral neuropathy rests on symptoms of sensory abnormalities — muscle cramps, numbness in the hands, aches in the arms, and charley horses in the calves of her legs. The EMG [electromyo-graph] test result [a nerve conduction velocity test] was normal. The witness explained that it would be expected that a person with neuropathy would manifest abnormal reflexes, abnormal pin stick, abnormal EMG and abnormal symptoms. That, however, is usual when the pathology is far advanced. The normal EMG does not rule out abnormalities, but shows only that the EMG test gave a normal result. Multiple teste are done and multiple parameters considered. In this case, the subdiagnosis rests on the symptoms of peripheral neuro-pathy.

7) Abnormal muscle metabolism rests on symptoms and findings of abnormal muscle function as well as on the test which shows the presence of the CPK [creatine phophokinase], the enzyme which shows abnormally when there is pervasive muscle injury.

8) Recurrent contact dermatitis with probable hypersensitivity rests on symptoms of itching, skin rashes and what is known of the Alcolac toxic chemicals to which the patient plaintiff was exposed. The acrylates and methacrylates not only cause severe skin damage on contact, but they also sensitize the skin even in the absence of actual contact. Contact dermatitis relates to the severity of the toxicity of the given chemical according to the degree of contact. When the skin has become hypersensitive a small exposure can cause severe reactions.

9) Immune system dysfunction with suppression rests on the abnormal teste results administered by Bioscience in 1984 and Midwest/Wheeler in 1985.

rBioscience Laboratory Test Results, 19841

Immune system:

Mitogen challenge:

abnormal PHA stimulation net CPM at 44,-288 [normal, over 62,000]

*108 rBioscience Laboratory Test Results, 19841 — Continued

abnormal PHA stimulation index at 118 [normal, over 130]

White blood cells: abnormally depressed total count at 4100 [normal, 4500 to 11,000]

[Midwest/Wheeler Laboratory Test Results, 19851

Immune system:

Lymphocytes: abnormal OKT-4 [helper] cells

abnormal depression of NKH-1 [natural killer] cells

Hematologic System: abnormally increased mean corpuscular hemoglobin

abnormally increased random distribution width

abnormally increased mean platelet volume

10)Abnormal electrolytes with probable renal dysfunction rests on the abnormal genitourinary test results. The electrolytes — the potassium, sodium and chlorides — were abnormal and signified kidney damage. It is the function of the kidney to control the electrolytes, elements critical to life, in a delicate balance. If the electrolytes are too high or too low, the body function becomes imperilled. Some medications — such as high blood pressure pills —can depress the potassium. In her case, however, the potassium as well as the chlorides are abnormally high. These abnormalities represent the abnormal handling of these electrolytes by the kidney, induced by the attack made on that organ by a number of the toxic chemicals generated and emitted by Alcolac.

PROGNOSIS: Very guarded.

VIRGIL BRADLEY AGE 75 LIFE EXPECTANCY 10.67 YEARS

DIAGNOSIS: Chronic Systemic Chemical Intoxication caused by the Alcolac toxic chemicals with damage to multiple organ systems, including:

1) bilateral neurosensory hearing loss with 8th cranial nerve damage

2) chronic conjunctivitis

3) chronic rhinitis and pharyngitis

4) chronic chemical bronchitis — in remission

5) liver dysfunction including:

a. abnormal lipid metabolism

b. abnormal iron metabolism

c. abnormal porphyrin metabolism

6) reproductive system dysfunction

7) diffuse brain damage with dementia

8) peripheral polyneuropathy

9) polyarthralgia and polymyalgia

10) hyperglycemia — rule out diabetes

11) immune system dysfunction

12) renal insufficiency with mild uremia

13) hypertension

14) recurrent chemical dermatitis with probable hypersensitivity component

The witness then explained the data on which these components of subdiagnosis rest.

1) Bilateral neurosensory hearing loss with 8th cranial nerve damage rests on the abnormal audiometric test results *109 throughout the 500 to 6000 frequency ranges — very severe at the higher frequencies and less so at the low frequencies. This represents a course of nerve damage, still spreading. The hearing loss is bilateral and extensive: a 95 decibel loss at the 6000 cycle, a 70 to 75% at 4000 cycle, a 65% loss at the 3000 cycle, and a 30 to 35% loss at the 500 cycle.

2) Chronic conjunctivitis rests on symptoms of irritation, redness and watering of the eyes following exposures to the Alcolac odors and emissions. The inflammation of the eyes remains palpable even without exposure.

3) Chronic rhinitis and pharyngitis rest on the symptoms and findings of an irritated and swollen mucous membrane, sore and swollen throat. These conditions followed exposures to the Alcolac toxic odors and emissions and continued absent exposure.

4) Chronic chemical bronchitis — in remission rests on symptoms and extensive history of severe coughs following exposure to the Alcolac chemical emissions. The symptoms were in remission at the time of physical examination. The coughs were productive of mucus. The witness discounted that the former occupation of the patient plaintiff as a meatpacker bore on that element of diagnosis.

5) Liver dysfunction including abnormal lipid metabolism, abnormal iron metabolism, abnormal porphyrin metabolism rests on the abnormal results of the tests for those functions of the liver. The test of the lipid metabolism function shows triglycerides of 155 with a reference range of 30 to 150. The uroporphyrins of the porphyrin metabolism are at 4 with a reference range of 8 to 44. The iron metabolism was abnormally low. The low serum iron suggests some disturbance of the iron-por-phyrin cycle. The condition of low uropor-phyrins is not as serious as if it were high, but it signifies an abnormality in porphyrin metabolism nonetheless.

6) Reproductive system dysfunction rests on the abnormal results of the fertility analysis. Virgil Bradley was then 75 years of age, but although age is a significant factor as to impotency, it is not as to fertility. The results show a range of abnormalities: the sperm count was abnormally low at 36 million [normal, over 60 million], contained 5% of primitives — a pathological abnormality — only 25% of the sperm were alive after 30 minutes [rather than the normal 80%] and only 15% were alive after 4 hours [rather than the normal 60%].

7) Diffuse brain damage with dementia rests on the abnormal results of the neuro-behavioral battery. Dementia in the context of the subdiagnosis means diffuse brain damage. It represents a “very significant loss of thinking power” — a condition “more serious than diffuse dysfunction.”

8) Peripheral polyneuropathy rests on symptoms of sensory abnormalities, physical findings of absence of deep tendon reflexes and an abnormal result on the PNVC [nerve conduction] test to the upper left extremity.

9) Polyarthralgia and polymyalgia rests on acute and chronic symptoms of joint stiffness or crepitance, joint aches and muscular pains and cramps following exposure to the Alcolac emissions. Arthralgia describes a condition of pain in the joints. Arthritis describes inflammation or swelling in the joints. The subdiagnosis was valid, the expert witness Carnow explained, because there was no evidence of degenerative joint disease, nor of deformity, nor of osteoarthritis. He discounted a medical record of Virgil Bradley, dated March 26, 1982 — from some unidentified source which diagnoses degenerative arthritis — since there was no arthritis present at the time of the examination at CCA.

10) Hyperglycemia — rule out diabetes rests on an abnormal glucose in the endocrine system. The result of that test was 141, with a normal reference range of 70 to 110. The medical history discloses a glucose elevation of 192, with a normal reference range of 80 to 120 used by that laboratory, for that test conducted in 1971. That was the only incidence of abnormal blood sugar in the previous medical record, however, and since there was no indication *110 that it was a fasting blood test, Dr. Carnow could not attribute any significance to that record of abnormality. If that represented a condition of diabetes, the witness observed, Virgil Bradley would be “in very serious trouble by now without any treatment.” The test was never repeated, so the witness concluded it was specious. The abnormally-elevated glucose, the witness determined, demonstrated not diabetes, but suggested a pancreatic abnormality or deficiency.

11)Immune system dysfunction rests on the abnormal results of the Bioscience tests in 1984 and of the Midwest/Wheeler tests in 1985.

rBioscience Laboratory Test Results, 19841

Immune system:

Immunoglobulin: abnormal globulin A

[Midwest/Wheeler Laboratory Test Results, 19851

Immune system:

Lymphocytes: abnormal elevation in OKT-8 [suppressor cells]

abnormal elevation in OKT-IO cells

abnormally depressed T-4/T-8 ratio [an excess of suppressor to helper cells]

abnormally elevated B-l [mature B] cells at 18.4 [normal, 5 to 15]

abnormally elevated natural killer cells at 32 [normal, 8 to 22]

abnormally elevated NKH-1 [killer suppressor] cells at 15.3

[normal, 3.8 to 9.6]

Hematologic system: abnormally elevated mean corpuscular volume

abnormally elevated mean corpuscular hemoglobin

abnormally elevated random distribution abnormal sizes [anisocytosis]

The witness concluded that the test results of six immune system abnormalities in 1985 contrasted to one such abnormality in 1984 suggests a deterioration of the Virgil Bradley immune system. The 1985 test results from Midwest/Wheeler represent “gross abnormalities of the kinds of lymphocytes and the ratios of lymphocytes in the blood” and shows “a profound disturbance of the system.” The mitogen challenge tests which yielded no abnormal result in the 1984 Bioscience tests, however, were not repeated, therefore the current state of that element of the immune system is not known.

12)Renal insufficiency with mild uremia rests on the abnormal results of the creatinine and uric acid tests of the genitourinary system, as well as on symptoms of nocturia and difficulty in urination. The creatinine and uric acid tests were both abnormally elevated. An elevation in crea-tinine is a sign of early kidney failure. The renal insufficiency subdiagnosis means that the kidneys are not getting rid of the poisons as they should. The mild uremia signifies that, although not great at present, the abnormality means a “buildup of poisons in the body.”

13) Hypertension rests on the physical examination. at CCA. The prior medical history confirmed to the witness that the hypertension was a condition which emerged in the 1980s.

14) Recurrent chemical dermatitis with probable hypertensivity component rests on symptoms of skin rash, itching and burning and skin lesions consequent upon *111 the inhalation of odors and other Alcolac emissions.

PROGNOSIS: POOR.

DOROTHY BRADLEY AGE 74 LIFE EXPECTANCY 13.05 YEARS

DIAGNOSIS: Chronic Systemic Chemical Intoxication caused by the Alcolac toxic chemicals with damage to multiple organ systems, including:

1) conjunctival damage with hemorrhage

2) bilateral hearing loss with 8th cranial nerve damage

3) chronic rhinitis

4) liver dysfunction including:

a. abnormal LDH

b. abnormal iron metabolism

c. abnormal porphyrin metabolism

5) early renal insufficiency

6) central nervous system dysfunction including:

a. cerebellar damage

b. diffuse cerebral damage

7) peripheral nervous system dysfunction

8) immune system dysfunction

The witness then explained the data on which these components of subdiagnosis rest.

1) Conjunctival damage with hemorrhage rests on symptoms of irritation of the eyes and soreness in the eyeballs following the exposure to and inhalation of the odors and other Alcolac emissions. That subdiagnosis rests also on the findings at the time of physical examination.

2) Bilateral hearing loss with 8th cranial nerve damage rests on the symptom of loss of hearing acuity as well as on the audiometric test results of loss of hearing throughout the 500 to 6000 range of frequency cycles. The abnormal results represent a neurosensory hearing loss, most severly at the high frequencies with a spread to the lower frequencies.

3) Chronic rhinitis rests on physical findings of mucous membrane irritation following exposure to the Alcolac odors and emissions.

4) Liver dysfunction including abnormal LDH, abnormal iron metabolism, abnormal porphyrin metabolism, rests on abnormal results of the tests of these functions of the liver. The heptacarboxylic por-phyrin [the cascade at the seventh level of porphryn metabolism] was abnormal, and the coproporphyrin to uroporphyrin ratio was slightly abnormal. The LDH enzyme was abnormally elevated, and suggests liver damage. The serum iron was also abnormal. Since the porphyrins use iron in the production of their chemical and in turn produce an enzyme system, an abnormality in serum iron reflects the abnormal porphy-rins and the enzyme system they produce.

5) Early renal insufficiency rests on abnormal laboratory test results. The electrolyte potassium was abnormally low, her uric acid and BUN [blood urea nitrogen] were both elevated. Those conditions represent kidney damage — “the inability of the kidney to get rid of the poisons.” They did not represent uremia, but azotemia, a condition short of uremic poisoning.

6) Central nervous system dysfunction including cerebellar damage, diffuse cerebral damage rests on physical findings of increased deep tendon reflexes and the abnormal results of the laboratory tests. A decrease or absence of the deep tendon reflexes are indications of peripheral nerve damage, but increased reflexes indicates damage to the central nervous system. [Persons afflicted by stroke, for instance, *112 show increased, rather than decreased, reflexes.] Thus, the increased deep tendon reflexes represent some evidence of damage to the central nervous system — the brain. There were also findings of cerebellar damage. The cerebellum relates to balance and other important bodily functions. The tests included the tandem walk, the Romberg, and other procedures to test the balance. The performance of Dorothy Bradley was abnormal. The toxic chemicals emitted by Alcolac, and already identified, affect the central nervous system and the cerebellar function. The neurobeha-vioral battery administered by Dr. Garrón also established abnormality of function and central nervous system dysfunction. The damage is diffuse and affected attention, memory and other components.

The witness, Dr. Camow, discounted the significance to this subdiagnosis of the pri- or medical history of a skeletal imaging study on January 4,1978 at the local hospital of the right parietal bone to explore for possible metastasis. There was concern that there was a tumor, but it was determined, rather, that there was simply a thickening of the parietal bone without pathology. The range of abnormalities found by Dr. Garrón — problems in attention, expressive and receptive language, manual dexterity, memory — have nothing to do with the parietal bone, nor do the cerebellar abnormalities found of poor balance and poor taxia. The brain damage was attributed to the effect of the Alcolac emissions.

7) Peripheral nervous system dysfunction rests on findings of weakness in the left leg nerve. The evidence of neuropathy was a decreased vibration in the left ankle and an abnormal response to pain in the left lower leg — the peroneal area. The subdiagnosis was not related to any condition of degenerative joint disease attributable to age because it was the nerve which was found to be abnormal, and not the joint. The degenerative lesion in the left wrist found on physical examination might be a reflection of age, but neither that nor any other musculoskeletal abnormality was diagnosed as related to her exposure to Alcolac.

8) Immune system dysfunction rests on the abnormal test results of the 1984 Bios-cience immune panel and of the 1985 Midwest/Wheeler immune panel.

[Bioscience Laboratory Test Results, 19841

Immune System:

White Blood Cells: of

FMidwest/Wheeler Laboratory Test Results, 1985]

Immune System:

Lymphocytes: abnormal OKT-4 [helper] cells

abnormally elevated OKT-IO cells at 28.3 [normal, 0 to 15]

abnormally elevated T-4/T-8 ratio [helper to suppressor cells out of balance] at 4.04 [normal, 1.1 to 2.5]

Hematologic System: abnormal cell size [anisocytosis]

abnormal cell shapes [poililocytosis]

These abnormalities of red blood cell production reflect the abnormal porphyrin metabolism which produces the heme for the red blood cells as well as the abnormal serum iron metabolism, also involved in the production of the red blood cells in the body.

PROGNOSIS: Very guarded.

AMBER CROSS AGE 11 LIFE EXPECTANCY 71.06 YEARS

DIAGNOSIS: Chronic Systemic Intoxication caused by the Alcolac toxic chemicals with damage to multiple organ systems including:

1) chronic bilateral conjunctivitis

*113 2) chronic rhinitis and sinusitis

3) chronic bronchitis

4) liver dysfunction including:

a. abnormal porphyrin metabolism

b. probable chemical hepatitis

5) gastrointestinal dysfunction [possible porphyria crisis]

6) chronic genitourinary disease

7) immune system dysfunction

8) central nervous system dysfunction

9) chronic recurrent dermatitis from probable chemical contact with possible hypersensitivity or allergic components

The witness then explained the data on which the sub-elements of diagnosis rest.

1) Chronic bilateral conjunctivitis rests on red, irritated eyes and blurred vision following exposure to the Alcolac odors and emissions and evident on physical examination.

2) Chronic rhinitis and sinusitis rests on symptoms of dry, burning nose over a long period of time and findings of nose irritation and swelling and inflamed sore throats.

3) Chronic bronchitis rests on symptoms of a productive cough, hemoptysis [coughing up blood] from exposure to the Alcolac chemicals and induced by inhalation of the odors and emissions.

4) Liver dysfunction including abnormal porphyrin metabolism, probable chemical hepatitis rests on abnormal results from the porphyrin, enzyme and pro-thrombin time tests of the liver functions. It rests also on the physical finding of tenderness over the right upper quadrant, the site of the liver, which suggested a swollen liver. The coproporphyrin, heptacarboxylic porphyrins and porphobilinogens were abnormal. Two liver enzymes were abnormal — the alkaline phosphatase and the LDH. In a growing person, such as eleven year old Amber Cross, the alkaline phosphatase can be somewhat elevated, but her count was twice that of normal. The chemical exposures accounted for that abnormality. A young person, such as Amber Cross, on the threshold of womanhood and menstruation, who has been exposed to the kind of toxic chemicals which affect the P450 enzymes [as do the Alcolac chemicals already identified] is subject to serious crises. The prothrombin time function of the liver also tested abnormally, 44 as to a normal of in excess of 70. It was retested, once again with abnormal result.

5) Gastrointestinal dysfunction [possible porphyria crisis] rests on symptoms of recurrent vomiting, constipation, stomach inflammation and other abdominal and stomach problems characteristic of porphy-ria crises which occur when porphyrins “go out of whack.” The subdiagnosis was qualified as “possible” because some of these symptoms and manifestations are effects of the nervous system not attributed to the Alcolac emissions. The exposure to the toxic chemicals, however, is the dominant causal factor in her organ dysfunctions.

6) Chronic genitourinary disease rests on the urinalysis result of pus cells in the urine — a manifestation of urinary tract infection. That condition was consistent with the depression of her immune system which renders her more susceptible to viral infection. The prior medical history taken of Amber Cross notes an entry dated February 24, 1978, of dysuria — the difficult or painful discharge of urine. In response to the cross-examination inquiry as to whether that indicated a condition which pre-ex-isted the Alcolac activity, the witness agreed that if Alcolac had emitted no chemical compounds before that date that the genitourinary disease v/ould have to be considered nonattributable to Alcolac. It was the clear evidence, however, that Alcolac undertook test runs as early as 1977 to *114 ensure proper reactor and equipment function when regular production commenced in May of 1978. The medical history of many of the patient plaintiffs [Dr. Carnow observed] disclosed “an abrupt onset of symptoms, some of them early in 1978.” The witness concluded that the chronic genitourinary disease was not “a pre-existing lesion” but rather was caused by the toxic chemicals identified and known to target the human kidneys.

7) Immune system dysfunction rests on the abnormal results of the immune panels administered by Bioscience in 1984 and by Midwest/Wheeler in 1985.

rBioscience Laboratory Test Results, 1984]

Immune system:

White blood cells: abnormally elevated total lymphocytes

abnormally depressed segs [an abnormal ratio since the segs are usually higher than the lymphocytes]

Hematologic System: abnormally elevated platelet count at 485,-000

TMidwest/Wheeler Laboratory Test Results, 1985]

Immune system:

Lymphocytes: abnormal white blood cell count

abnormally elevated OKT-8 [suppressor] cells at 1492 [normal, 140 to 1444]

abnormal — slightly depressed — OKT-4 [helper] cells at 31 [normal 32 to 55]

very abnormal OKT-10 cells at 35.2 [normal, 0 to 15]

abnormal T-4 to T-8 [helper to suppressor] ratio

abnormal elevation in natural killer cells

Hematologic system: abnormally elevated platelet count anisocyto-sis

abnormal random distribution

The abnormalities in the immune system had progressed from two in 1984 to six in 1985. Also the abnormality in the platelet count of the red blood system continued and two other abnormalities were tested.

8) Central nervous system dysfunction rests on the abnormal results of the neuro-behavioral battery administered to her by Dr. Garrón. In that report the examiner rendered the evaluation that the “intellectual and cognitive functioning” of Amber Cross was “unremarkable except for erratic concentration,” a “mild impairment in concentration [which] suggests impulsivity, often associated with delinquency and conduct disorders.” The examiner commented that these “general characteristics seem to reflect familial instability in Amber’s background.” In response to the inquiry of the cross-examiner as to whether the subdiag-nosis of central nervous dysfunction rests on the neuropsychological report of Dr. Garrón, the witness explained that the tester merely conducts the examination and enters a report, but only he — Dr. Carnow— evaluates the report, as he does all others [laboratory, history, and other data as to each of the patient plaintiffs]. Dr. Carnow amplified that neuropsychological tests report other abnormalities: a moderately poor digit span test, and erratic reaction time test, unusual errors of commission on the coding and underlining test. The entire history of the child, her physical symptoms of vomiting and inflammation of the stomach and defections in other organs following exposure to the Alcolac chemicals, her academic decline from a superior student to a below average student — abnormalities and data Dr. Garrón could not have known since he did not have the history informa *115 tion known to Dr. Carnow — require the conclusion that the stress imposed by exposure to the toxic chemicals from Alcolac account for the central nervous system damage found in Amber Cross. That sub-diagnosis remains valid, Dr. Carnow explained, albeit the personal disorders exhibited by Joyce Pryor, the mother of Amber Cross may have induced emotional stress in the child.

9) Chronic recurrent dermatitis from probable chemical contact with possible hypersensitivity or allergic components rests on symptoms and episodes of skin irritations and rashes which develop quickly after exposure to the Alcolac odors, vapors and emissions and then spread over her arms, legs, chest and back.

The evaluator concluded that because of her youth, and because of exposure to Al-colac toxic carcinogens, and given the abnormal immune system dysfunction and the abnormal porphyrin metabolism, the probability that Amber Cross would die from some disease of the organ other than cancer is unlikely.

PROGNOSIS: Very guarded to poor.

CLARENCE ELAM AGE 64 LIFE EXPECTANCY 17.89 YEARS

DIAGNOSIS: Chronic systemic Chemical Intoxication caused by Alcolac toxic chemicals with damage to multiple organ systems, including:

1) chronic chemical conjunctivitis

2) bilateral neurosensory hearing loss with 8th cranial nerve damage

3) chronic rhinitis and sinusitis

4) abnormal liver metabolism with abnormal porphyrins

5) peripheral neuropathy

6) musculoskeletal dysfunction

7) probable renal insufficiency

8) severe immune dysfunction with suppression

9) possible central nervous system damage

The witness then explained the data on which these components of subdiagnosis rest.

1) Chronic chemical conjunctivitis rests on symptoms of reddened, burning and watery eyes following exposure to the Alcolac odors and emissions, with matting of the eyes during sleep at night.

2) Bilateral neurosensory hearing loss with 8th cranial nerve damage rests on symptoms of tinnitus and decreased acuity and on the abnormal results of the audiom-etric test. The right and left ears had a 70 decibel loss at the 3000 frequency cycle and a 50 decibel loss at both the 4000 and 6000 frequency cycles. The neurosensory loss was evaluated as “moderately severe” and very significant.

3) Chronic rhinitis and sinusitis rests on symptoms and findings of mucous membrane irritation and sore throat from the Alcolac odors and emissions.

4) Abnormal liver metabolism with abnormal porphyrins rests on test results of the liver metabolism which disclosed three abnormalities: the coproporphyrins were very elevated at 171 [normal, 10 to 109], the porphobilinogen was abnormal, and the pentacarboxylic [the fifth cascade of por-phyrin metabolism] was abnormally high at 7 [normal, 0 to 4]. These represented “a gross disturbance of porphyrins [which] is very worrisome,” and amounts to a severe breakdown of a major organ.

5) Peripheral neuropathy rests on symptoms of weakness in both arms and the result in the PNVC sensory test which showed an abnormal nerve conduction in the right arm.

6) Musculoskeletal dysfunction rests on symptoms of joint stiffness, leg weakness and joint aches.

7) Probable renal insufficiency rests on symptoms of nocturia and pain in urination and on the abnormally elevated BUN *116 [blood urea nitrogen] and abnormally depressed potassium test results. The BUN, the evaluator explained, is the amount of nitrogenous waste in the body, and when that begins to elevate, it means the body is not getting rid of the waste through the kidneys. It may be a sign of early kidney insufficiency. On cross-examination, the witness was asked to explain the medical history related by Clarence Elam to the examiners under the KU protocol that he has had urgency since childhood due to a small bladder. Dr. Carnow responded that he was given no such history, and in any event, a small bladder might account for urgency, but not nocturia — the abnormal need to empty the bladder. The reason some people have frequency of urination, he explained, is not because the bladder is small or large, but because they do not empty it. Cross-examination noted also a medical record from January of 1971 which indicated a BUN of 21%, with the normal range of 8 to 20%. Dr. Carnow acknowledged that the finding indicated a mildly elevated BUN at that time, but that since the BUN is now 27%, not 21%, the present condition represents a probable renal insufficiency. Dr. Carnow acknowledged that the creatinine was normal when tested, but that means that the kidney is going into failure — a more serious damage than renal insufficiency, the damage the BUN insufficiency connotes. Insufficiency, the witness explained, means the organ does not function as it should, not that “it is in failure or that he is going to die from it.”

8) Severe immune dysfunction rests on the abnormal results of the immune panel tests conducted by Bioscience laboratory in 1984 and the Midwest/Wheeler laboratory in 1985.

TBioscience Laboratory Test Results, 1984]

Immune system:

Immunoglobulin: abnormally depressed at gamma M 61 [normal 80 to 310]

Mitogen challenge: abnormal PHA stimulation net CPM

abnormal PHA stimulation index

abnormal CON A stimulation net CPM

abnormal CON A stimulation index

abnormal PWM stimulation net CPM

abnormal PWM stimulation index

White blood cells: abnormally increased segs

fMidwest/Wheeler Laboratory Test Results, 1985]

Immune system:

Lymphocytes: abnormality [unspecified]

Hematologic system: abnormal sizes [anisocytosis]

abnormal random distribution width abnormal mean corpuscular hemoglobin

These composite tests show that all of the mitogens were abnormal. In addition, the gamma M was quite abnormally depressed. Dr. Carnow concluded that the immune system was “zapped.” The results indicate that an abnormal number of the T cells were not programmed to attack an enemy — and so were useless, “just hanging around.” He attributed that abnormality to damage to the lymphatic tissue caused by the toxic chemicals from Alcolac which are metabolic poisons. He explained that since the memory T cells live for fifteen or twenty years, when they are poorly programmed and have not been educated to recognize an enemy, they remain useless and contribute to the depression of the immune system. The immune system, Dr. Carnow iterated, was “wiped out.”

9) Possible central nervous system damage rests on symptoms of headache, tremor, dizziness and decreased concentration or memory loss.

It was the medical opinion of the expert evaluator that the two severe breakdowns *117 in two major organ systems — porphyrins and the immune system — render Clarence Elam susceptible to pneumonia and many other more serious diseases.

PROGNOSIS: Poor.

BETTY ELAM_AGE 59_LIFE EXPECTANCY 25.10

DIAGNOSIS: Chronic Systemic Chemical Intoxication caused by the Alcolac toxic chemicals with damage to multiple organ systems, including:

1) chronic bilateral conjunctivitis with probable iritis

2) chronic rhinitis

3) neurosensory hearing loss — mild, with 8th cranial nerve damage

4) chronic chemical bronchitis with obstruction and bronchospasm

5) vascular insufficiency

6) liver dysfunction including:

a. abnormal lipid metabolism

b. abnormal protein metabolism — in remission

c. abnormal prothrombin time — in remission

d. abnormal iron metabolism

7) genitourinary dysfunction including

a. possible neurologic deficit

b. abnormal electrolytes

8) central nervous system dysfunction including a. cerebellar dysfunction

b. severe anxiety (aggravated)

c. possible cerebral dysfunction

9) peripheral polyneuropathy with progression

10) polymagia and polyarthralgia

11) immune system dysfunction

12) chronic contact dermatitis with probable hypersensitivity component

13) chronic gastrointestinal dysfunction with neurogenic component

14) hematologic dysfunction, possibly secondary to pulmonary insufficiency

The witness then explained the data on which these components of subdiagnosis rest.

1) Chronic bilateral conjunctivitis with probable iritis rests on symptoms of red, irritated eyes with blurred vision following exposure to the Alcolac odors and emissions.

2) Chronic rhinitis rests on symptoms of nasal congestion, nosebleeds and irritations of the nose following exposure to Alcolac odors and emissions, and also on the physical finding of an irritated mucous membrane.

3) Neurosensory hearing loss — mild, with 8th cranial nerve damage rests on the abnormal audiometric test results which show a hearing loss at the 4000 and 6000 frequencies. This suggests an early hearing loss with some 8th cranial nerve damage.

4)Chronic chemical bronchitis with obstruction and bronchospasm rests on physical findings of hyperresonance [over-inflation] of the lungs — an abnormal difficulty in the expulsion of air from the lungs. The subdiagnosis rests also on symptoms of shortness of breath and hemoptysis [coughing up blood]. The diagnosis of chronic obstructive pulmonary disease from chemical toxicity was entered in the medical records of the Suburban Medical Center in Overland Park, Kansas on September 4, 1981. Dr. Camow agreed with that diagnosis and attributed that evaluation as well as his own to the inhalation of Alcolac emissions. The prior history shows that Betty Elam has smoked a package of cigarettes a day since she was 18 years of age. Although such a personal regimen could contribute to such a condition of obstruction, Betty Elam does not display the symptoms of such an etiology. Chronic *118 smokers are subject to a class sequence of events, symptoms and stigmata. They begin to cough in the morning, usually in the winter months. Then they cough all year round in the morning, and they bring up phlegm. Then they begin to get serial infections, where they bring up yellow matter. Then they develop obstruction. Betty Elam rarely coughs, and then only when she smells the Alcolac fumes.

Nor does her condition represent emphysema — which is a pathologic diagnosis and means the destruction of lung tissue. The x-ray of the lung was normal. Chronic obstructive lung disease, on the other hand, means that the person has difficulty expelling air from the lungs — it is obstructed for some reason. The obstruction can result from irritant chemicals — such as epichlo-rohydrin, the acrylates, the hydrogen sulfide, among the others. The body tries to reject the irritant chemicals, “by closing down.” It may cause a spasm of the air passages or swelling of the air passages. In any event, when the body rejects the chemical irritants, it also rejects oxygen— which is very deleterious to the body functions.

5) Vascular insufficiency rests on physical findings of pallor and diminished peripheral pulses in the lower extremities, her feet. These indicate that the blood vessels were narrowed and that the circulation and blood supply into her legs and feet were abnormal. The designation of the Alcolac chemicals as cause for this vascular insufficiency is interrelated to and explained by the phenomenon that these chemicals interfere with the lipid metabolism and may increase the fats in the body very significantly, and so affect the blood vessels of the body. The laboratory tests of the lipid metabolism, in fact, were abnormal.

6) Liver dysfunction including abnormal lipid metabolism, abnormal protein metabolism [in remission], abnormal prothrombin time [in remission] abnormal iron metabolism rests on the abnormal test results for each of these metabolism functions of the liver. There was an abnormal increase in the heptacarboxylic porphyrins and an abnormal ratio between the coproporphyrins and the uroporphyrins. The abnormal ratio may represent a very early abnormality of the level of the pro-phyrins, thus the disturbance of ratio is significant even in the absence of an abnormal level of one of the porphyrins. The laboratory test disclosed an abnormally depressed iron metabolism, a dysfunction of the enzyme system in which the porphyrins and iron are involved. The prothrombin time was not successfully taken on the first test, and was not repeated on Betty Elam. The lipid metabolism tested abnormally high for cholesterol at 308 [normal, 140 to 270]. She also had an abnormally elevated LDL [low density lipoprotein, that cholesterol which disfavors health, as contradis-tinct from HDL, high density lipoprotein, that cholesterol which favors health]. The LDL result was at 243 [normal, 62 to 185], so as to put Betty Elam at “very high risk to coronary artery disease.” Her abnormal protein metabolism [presumably inferred from the other results of the liver metabolism functions] was not evident as such and was deemed in remission.

7) Genitourinary dysfunction including possible neurologic deficit, abnormal electrolytes rests on symptoms of difficulty in urination and on the abnormal laboratory test results. There was bacteria in the urine, her creatinine was depressed, as was the potassium.

8) Central nervous system dysfunction including cerebellar dysfunction, severe anxiety [aggravated], possible cerebral dysfunction rests on symptoms of dizziness, decreased concentration or memory loss, depression, nervousness, ataxia [poor balance] and headaches on physical findings of poor balance, and on a test result of 54 on the Zung anxiety scale on a normal of 0 to 44.

9) Peripheral polyneuropathy with progression rests on symptoms of weakness and sensory abnormalities of the limbs and on abnormal test results. The PNVC disclosed an abnormal nerve conduction in the lower extremity [which signifies damage to the sheath of the nerve], and the abnormal EMG signifies axonal degeneration — the actual death of the nerve fiber.

*119 10) Polymalgia and polyarthralgia rests on symptoms of joint stiffness and crepitance, joint aches and muscular pains and cramps.

11) Immune system dysfunction rests on the abnormal results of the immune panels administered by Bioscience laboratory in 1984 and Midwest/Wheeler in 1935.

rBioscience Laboratory Test Results, 19841

Immune system:

Immunoglobulins: abnormally increased gamma M at 367 [normal, 80 to 310]

Mitogen challenge: abnormally decreased CON A stimulation index

abnormally decreased CON A net CPM

White blood cells: abnormally depressed eosinophils at 0 [normal, 1 to 5]

[Midwest/Wheeler Laboratory Test Results, 1985]

Immune system:

Lymphocytes: no abnormality shown

Hematologic system: abnormally increased mean corpuscular hemoglobin

abnormally increased mean platelet volume

abnormal cell sizes [anisocytosis]

12) Chronic contact dermatitis with probable hypersensitivity component rests on symptoms of rash, itching, bullae and other skin lesions. The other skin lesions were blisters which means that the chemicals — a number of them alkylating agents, and hence “severe grabbers”— were in such concentration that they literally burned her skin.

13) Chronic gastrointestinal dysfunction with neurogenic component rests on symptoms and history of vomiting, nausea and anorexia.

14)Hematologic dysfunction, possibly secondary to pulmonary insufficiency rests on the symptoms and findings of pulmonary difficulty and lung abnormality and means that some of the changes in her blood supply may be due to the lack of supply of oxygen.

PROGNOSIS: Very guarded to poor.

MALVA GEHLKEN AGE 65 LIFE EXPECTANCY 20.10 YEARS

DIAGNOSIS: Chronic Systemic Chemical Intoxication caused by the Alcolac toxic chemicals with damage to multiple organ systems, including:

1) chronic rhinitis and pharyngitis

2) liver dysfunction including:

a. enlarged, tender liver with probable hepatitis

b. abnormal lipid metabolism

c. abnormal iron metabolism

d. abnormal porphyrin metabolism

e. abnormal protein metabolism

3) central nervous system damage including

a. cranial nerve VII damage

b. cerebellar dysfunction

4) peripheral polyneuropathy

5) immune system dysfunction

*120 The witness then explained the data on which these components of subdiagnosis rest.

1) Chronic rhinitis and pharyngitis rests on symptoms of mucous membrane irritation, swollen nose, soreness and dryness to the throat following exposure to Alcolac vapors and emissions. The chronic pharyngitis rests also on the physical finding of redness to the throat.

2) Liver dysfunction including enlarged, tender liver with probable hepatitis, abnormal lipid metabolism, abnormal iron metabolism, abnormal porphy-rin metabolism, abnormal protein metabolism rests on the physical finding of a tender and enlarged liver as well as on the abnormal results of the tests for the several liver metabolism functions. The porphy-rin metabolism was abnormal: the copro-porphyrins were at 104 [normal, 3 to 56], the porphobilinogen was abnormal, and the coproporphyrin to uroporphyrin ratio was abnormal. The iron metabolism was very low at 47 [normal, 65 to 175], The cholesterol was abnormally elevated as was the low density lipoprotein [LDL]. The sub-diagnosis of abnormal protein metabolism rests on tests of the thyroid which show a depressed T3 uptake and an abnormally depressed free thyroxin [FT] index. These abnormalities, although of the thyroid, indicated not a hypothyroidism — but that “something was happening in the liver.” It signified an abnormality of thyroid binding globulin, a deficiency in the protein metabolism function of the liver.

The examiner, CCA, suggested to Malva Gehlken that the tests be followed up and, in fact, a month later the thyroid panel was tested again by a pathology laboratory in Columbia, Missouri [under whose auspices is not shown]. The results of the successive tests of the thyroid panel were reported as normal. The witness could not explain the disparate results except to observe that exacerbations and remissions are common with chronic diseases. The witness remarked that the Bioscience Laboratory in Chicago, which conducted the first set of tests, “is one of the best labs in the world, and they found these abnormalities.” Bioscience, he emphasized, “repeats every test that they do, and I don’t know why there is a difference between these two tests.” He reaffirmed the subdiagno-sis that the tests show that the protein metabolism function of the liver was abnormal.

3) Central nervous system damage including cranial nerve VII dam,age, cerebellar dysfunction rests on results of the physical examination. The neurobehavioral test results were normal, but the physical findings of the cerebellar function were grossly abnormal: her tandem walk, gait, Rhomberg response, and the other tests of movement and balance were all abnormal. There were also abnormalities of the muscles of the face, indications of damage to the seventh cranial nerve.

4) Peripheral neuropathy rests on the physical finding of decreased deep tendon reflexes, symptoms of sensory loss in the limbs and the laboratory test [PNVC] of abnormal sensory conduction involving multiple nerves.

5) Immune system dysfunction rests on the abnormal results of the immune panel tests administered by Bioscience laboratory in 1984 and Midwest/Wheeler laboratory in 1985.

rBioscience Laboratory Test Results, 19841

Immune system:

White blood cells: abnormally elevated total lymphocytes

abnormally elevated monocytes

abnormally élevated basophils

abnormally depressed segs

abnormally depressed total white cells

fMidwest/Wheeler Laboratory Test Results, 1985]

Immune system:

White blood cells: abnormally depressed total white cells

*121 Lymphocytes: abnormally elevated OKT-8 [suppressor] cells

abnormal T/4 [helper] to T/8 [suppressor] ratio

Hematologic system: slightly abnormal red cell reduction

abnormally elevated hemoglobin

abnormal cell sizes [anisocytosis]

These test results of depressed white cell counts, elevated lymphocytes and depressed segs signify a suppression of the immune system. The diseased liver, the severe disturbance of the porphyrin system, and the suppression of the immune system — particularly—rendered her survival questionable.

PROGNOSIS: Poor.

DAINIE LANDON AGE 74 LIFE EXPECTANCY 11.26 YEARS

DIAGNOSIS: Chronic Systemic Chemical Intoxication caused by the Alcolac toxic chemicals with damage to multiple organ system, including:

1) chronic rhinitis and laryngitis with nasal hemorrhage

2) bilateral neurosensory hearing loss with 8th cranial nerve damage

3) chronic asthmatic bronchitis [aggravated] with chemical component

4) liver dysfunction including:

a. abnormal iron metabolism

b. abnormal porphyrin metabolism

5) genitourinary dysfunction including:

a. abnormal phosphorous metabolism

b. hyperuricemia

6) central nervous system dysfunction

7) peripheral polyneuropathy

8) reproductive system dysfunction

9) immune system dysfunction

The witness then explained the data on which these components of subdiagnosis rest.

1) Chronic rhinitis and laryngitis with nasal hemorrhage rests on symptoms and findings of mucous membrane irritation and swelling to the nose, soreness and burning of the throat following exposure to odors and other Alcolac emissions, and recurrent nosebleeds with spurts of blood.

2) Bilateral neurosensory hearing loss with 8th cranial nerve damage rests on the abnormal audiometric test results which show bilateral hearing loss at the 3000, 4000 and 6000 cycle frequencies. These findings are characteristic of damage to the 8th cranial nerve.

3) Chronic asthmatic bronchitis [aggravated] with chemical component rests on symptoms of shortness of breath and cough and on abnormal test results of the pulmonary function. The forced vital capacity test result was abnormal at 63% of the total instead of the normal, between 70% and 75%. The medical history shows a diagnosis in 1973 for an emphysematous bleb in the upper right lobe. The witness gave opinion, nevertheless, that the diagnosis could not have been accurate since the present x-ray discloses no such irregularity. An emphysemous bleb means destruction of the lung tissue — a condition which does not “go away.” The examination and tests reveal no condition of emphysema at the present time.

4)Liver dysfunction including abnormal iron metabolism, abnormal porphy-rin metabolism rest on the abnormal test results of these functions of the liver. There were two porphyrin abnormalities: *122 the coproporphyrins were quite elevated at 124 [normal, 10 to 109] and the porphobili-nogen was quite elevated at 2.3 [normal, 0 to 1.5]. The iron metabolism was depressed. That abnormality interrelated with the abnormal porphyrin metabolism as well as with the abnormal hematologic findings.

5) Genitourinary dysfunction including abnormal phosphorous metabolism, hyperuricemia [excess uric acid] rest on symptoms of nocturia and abnormal test results. The urinalysis was abnormal, the uric acid was elevated at 9.1 [normal, 4 to 8.5] and the phosphorous was depressed.

6) Central nervous system dysfunction rests on findings of the neurologic examination which indicate damage to the 7th cranial nerve, the nerve which controls the muscles of the face and expression — in his case, a left central facial weakness. There was also an intention tremor, an abnormal neurologic condition. The past history of a “lazy left eye,” Dr. Camow explained, did not impinge on the subdiagnosis that the central nervous system dysfunctions found were caused by exposure to the Alcolac chemicals. The eyes are controlled by the second, third, fourth and sixth cranial nerves. The seventh controls the expressions of the face, and that is the cranial nerve the neurologic examination found damaged.

7) Peripheral neuropathy rests on symptoms of weakness in the limbs, and findings of sensory abnormalities and decreased deep tendon reflexes on physical examination.

8) Reproductive system dysfunction is not explained. The patient plaintiff Dainie Landon could not produce a specimen for fertility analysis, and so there is no basis in the evidence for subelement 8 the DIAGNOSIS delineates.

9) Immune system dysfunction rests on the abnormal results of the immune panels administered by Bioscience laboratory in 1984 and Midwest/Wheeler in 1985.

rBioscience Laboratory Test Results, 1984]

Immune system:

Immunoglobulin: abnormally elevated gamma A globulins

abnormally depressed gamma M globulins

[Midwest/Wheeler Laboratory Test Results, 1985]

Immune system:

Lymphocytes: abnormally elevated OKT-10 [immature lymphocyte] cells

abnormal T/4 [helper] to T/8 [suppressor] cells

very abnormally elevated [HNK--1 natural killer] cells at 19% [normal, 3.8% to 9.6%]

Hematologic system: decreased cell pigment [hypochromasia]

moderately abnormal sizes [anisocytosis]

abnormally elevated mean corpuscular hemoglobin

The abnormal increase in the OKT-10 cells signifies immature lymphocytes which have not been properly programmed. PROGNOSIS: Very guarded to poor.

MARY LANDON_AGE 71_LIFE EXPECTANCY 15.30 YEARS

DIAGNOSIS: Chronic Systemic Chemical Intoxication caused by the Alcolac toxic chemicals with damage to multiple organ systems, including:

1) recurrent conjunctivitis with possible iritis

*123 2) bilateral neurosensory hearing loss with 8th cranial nerve damage

3) chronic chemical bronchitis [asthma by history]

4) cardiac dysfunction

5) abdominal cancer

6) liver damage including:

a. abnormal protein metabolism

b. chemical hepatitis

c. abnormal porphyrin metabolism

7) chronic genitourinary dysfunction with recurrent infection

8) central nervous system damage with cerebral dysfunction

9) peripheral neuropathy

10) recurrent skin damage with acute chemical burns

11) severe immune suppression [aggravated by radiation therapy]

The witness then explained the data on which these components of subdiagnosis rest.

1) Recurrent conjunctivitis with possible iritis rests on symptoms of blurred vision and red, irritated eyes following exposure to the Alcolac odors and emissions.

2) Bilateral neurosensory hearing loss with 8th cranial nerve damage rests on the abnormal results on the audiometric tests at virtually every cycle, increased at the high frequencies. The hearing loss was to both ears. On the right, there was a 55 decibel loss at the 6000 cycle, a 40 decibel loss at the 4000 cycle, a 40 decibel loss at the 3000 cycle, and a 30 decibel loss at the 1000 cycle. On the left, the loss at each frequency was comparable and extended to the 500 cycle where there was a 35 decibel loss.

3) Chronic chemical bronchitis [asthma by history] rests on symptoms of chest heaviness and cough productive of phlegm and blood. The [asthma by history] presumably alludes to a datum from the narrative given by the patient plaintiff during the pre-examination interview, but that parenthesis is not explained.

4) Cardiac dysfunction rests on symptoms of chest pain, arrhythmia and on the physical finding of an abnormal pulse rate.

5) Abdominal cancer rests on a diagnosis of colon cancer on February 15, 1984, and the surgical removal of that malignancy at the Bothwell Memorial Hospital in Sedalia, followed by a regimen of cobalt therapy. The diagnosis and surgery were accomplished when Mary Landon presented herself at the Sedalia hospital with complaints of stomach pain and blood in the stool and changed bowel habits over the past two years. It was the opinion of Dr. Camow, to a reasonable medical certainty, that the exposure to the Alcolac toxicants caused the cancer in Mary Landon. That opinion rests on the carcinogenic qualities of a number of the chemical compounds emitted by Alcolac, the past personal, occupational and environmental history of Mary Landon, and the concentration and duration of the exposures to those toxic substances.

Mary Landon and her husband Dainie lived on a tract immediately west and directly across the road from the entrance to Alcolac. They commenced to notice odors and fumes in the summer of 1978 which gave off the scent of rotten eggs and sul-phur. These odors and emissions were from Alcolac and came regularly. They caused her headaches, stomach upsets, coughs with blood in the sputum, chest aches, a fast heart beat, and a congeries of other immediate physical symptoms and discomforts. They began to keep a diary of the Alcolac emissions with descriptions of the symptoms they induced. They maintained the history until they removed to a mobile home on May 8, 1984, to escape the odors and emissions. They record episodes of foam storms from Alcolac which came onto their property and caused her swelling and blisters upon touch. In April of 1981, she consulted a physician in Columbia for recurrent episodes of nausea, nervousness, and dizziness from which she passed out. He discontinued her numerous medications, *124 except for thyroid, but her symptoms continued and worsened. Many of them were directly related to bad odors. She improved on days when there were no odors from Alcolac. Twice after 1978 she was hospitalized when she passed out.

Her pre-Alcolac medical history included a hospitalization for anemia in 1942. Her spleen was removed and the anemia did not recur. Her father had anemia and an enlarged spleen all his life. Thirteen other members of the family had the spleen removed. It was her understanding, Mary Landon testified on cross-examination, that the anemia represented a condition of pre-leukemia, and that was the reason the spleen was removed. The medical records show, rather — as Dr. Camow explained— that the anemia was a spherocytosis, a genetic abnormality of the red blood cell whereby the cells become damaged as they pass through the spleen. The remedy is to remove the spleen. It was from that congenital anomaly that the condition of anemia was caused, and it was to allay that anomaly that the spleen was removed from Mary Landon — and the other family members, and not to allay leukemia. The congenital anemia, therefore, no more than that two brothers died of cancer, Dr. Car-now explained, could be deemed a contributing cause to the cancer to Mary Landon by the Alcolac carcinogens.

The cancer found and excised in 1984 was in the gastrointestinal tract. A series of x-rays of the lower tract was done in 1981, and no abnormality or cancer was found. The examination in 1984 did disclose a villous adenoma — a noncancerous lesion. It was not known how long that was present or whether that also developed from the exposure to the Alcolac chemicals, or whether the chemicals converted that benign condition into a cancer. The sub-diagnosis of abdominal cancer caused by the Alcolac toxic chemicals did not rest on any such surmise. It rests rather on the carcinogenic properties of epichlorohydrin, glycidyl ether and dimethyl sulfate — toxic compounds used and emitted by Alcolac throughout the period of operations since May of 1978.

6) Liver damage including abnormal protein metabolism, chemical hepatitis, abnormal porphyrin metabolism rests on the abnormal results of laboratory tests of these functions of liver metabolism. The porphyrins were abnormal — a uroporphyria [advanced disease] and coproporphyrin also quite elevated at 98 [normal up to 56]. The enzymes were abnormally elevated — the SGOT, LDH and alkaline phosphatase. These are enzymes seen when the liver is inflamed and damaged. The abnormal increase in the alkaline phosphatase means that the liver damage is more chronic. The condition represents a chemical type of hepatitis. The abnormality in the protein metabolism was manifested by an elevated gamma globulin.

In response to cross-examination, Dr. Carnow acknowledged that the alkaline phosphatase and SGOT values from the laboratory tests of February 21, 1984 conducted at the time of the abdominal cancer surgery were within normal limits. He acknowledged also that the radiation therapy following the surgery “may well have contributed to the enzyme abnormalities,” although not to the other abnormalities of the liver. He concluded, nevertheless, “since the radiation was secondary to a cancer which I feel was caused by exposure to cancer-producing chemicals,” the enzyme abnormalities were a consequence causally related to the exposure.

7) Chronic genitourinary dysfunction with recurrent infection rests on prolonged symptoms of pain on urination, frequency of urination, nocturia, and on the laboratory test results of depressed sodium, depressed potassium and abnormal urinalysis. The symptoms alone suggested renal dysfunction. The witness acknowledged, as before, that the postoperative radiation could account for the abnormal test results, since the pre-radiation laboratory tests of these genitourinary elements were normal. He asserted once again that since the cancer was caused by the Alcolac chemicals, and since the radiation was secondary to that cause, the genitourinary dysfunction — as manifested by the laboratory tests — was a direct conse *125 quence of the exposure. He iterated, that the test results apart, the recurrent and prolonged symptoms alone suggested renal dysfunction.

8)Central nervous system damage with cerebral dysfunction rests on symptoms of dizziness, decreased concentration, nervousness, sleep disorders, tremor and headache, on the physical finding of increased deep tendon reflexes and on the abnormal results of the neurobehavioral battery. The neuropsychological tests disclosed a mild deficit in recent memory — a suggestion of mild, diffuse brain dysfunction.

9) Peripheral neuropathy rests on abnormal results in the PNVC, Motor and PNVC, Sensory tests. They demonstrated a slowing of the motor and sensory nerves in the lower left extremity — the limb measured.

10) Recurrent skin damage with acute chemical bums rests on symptoms of itching, burning to the skin, bullae [blisters] and skin infections following exposure to the Alcolac odors and emissions.

11) Severe immune suppression [aggravated by radiation therapy] rests on the abnormal results of the immune panel tests conducted by Bioscience laboratory in 1984.

fBioscience Laboratory Test Results, 19841

Immune system:

Immunoglobulin: abnormal G globulin

Mitogen challenge: grossly abnormal PHA stimulation net CPM

grossly abnormal PHA stimulation index

grossly abnormal CON A stimulation net CPM

grossly abnormal CON A stimulation index

grossly abnormal PWM stimulation net CPM

grossly abnormal PWM stimulation index

White blood cells: abnormal increase in total lymphocytes

The immune panel test at Bioscience was conducted about six months after Mary Landon concluded the regimen of 40 cobalt treatments post surgery. The results demonstrated grossly abnormal mitogens, as well as the other abnormalities — and manifested as a “very severely depressed” immune system. Dr. Camow deemed it “impossible to say” how much of that manifestation was from exposure to the Alcolac chemicals and how much from the secondary radiation. It was his opinion from the full history, symptoms and test results that exposure to the multiple Alcolac carcinogens depressed the immune function, eventuated in the cancer, and that the radiation further depressed the immune system. Thus, the effects of the radiation are in the sequence of causation. He rendered opinion that given the cancer cells — still subsisted — the chemical hepatitis, abnormal por-phyrin metabolism, and a very severely depressed immune system, “her longevity will be very limited.”

PROGNOSIS: Negative.

Mary Landon died in May of 1986 while the appeal pended.

JOHN LAWRENCE AGE 62 LIFE EXPECTANCY 19.34 YEARS

DIAGNOSIS: Chronic Systemic Chemical Intoxication caused by the Alcolac toxic chemicals with damage to multiple organ systems, including:

1) chronic conjunctivitis

2) severe bilateral neurosensory hearing loss with 8th cranial nerve damage

3) chronic rhinitis

4) cardiac dysfunction

*126 5) liver dysfunction including:

a. abnormal lipid metabolism

b. abnormal protein metabolism

c. abnormal porphyrin metabolism

d. abnormal iron metabolism

6) reproduction system dysfunction with abnormal sperm analysis

7) peripheral polyneuropathy

8) polyarthralgia

9) severe immune system depression

10)chronic chemical dermatitis with probable hypersensitivity state

The witness then explained the data on which these components of subdiagnosis rest.

1) Chronic conjunctivitis rests on symptoms of red, irritated, blurred and watery eyes following exposure to the Alcolac odors and emissions.

2) Severe bilateral neurosensory hearing loss with 8th cranial nerve damage rests on the abnormal results of the au-diometric tests. He was almost totally deaf at a number of frequencies. On the right ear was a 85 decibel loss at 6000 cycles, a 95 decibel loss at 4000 cycles, a 95 decibel loss at 3000 cycles, a 40 decibel loss at 2000 cycles, a 30 decibel loss at 1000 cycles and a 30 decibel loss at 500 cycles. On the left ear, the decibel loss was comparable at each frequency cycle. The findings signify destruction of the 8th cranial nerves, a condition not meliorated by a hearing aid. The hearing loss pattern was characteristic of chemical intoxication of the 8th cranial nerves, and uncharacteristic of loss of hearing due to age [presbycusis].

3) Chronic rhinitis rests on symptoms of irritated nose and sneezing following exposure to the Alcolac odors and emissions and on the physical finding of mucous membrane irritation.

4) Cardiac dysfunction rests on the physical finding of diminished peripheral pulse and an abnormal conduction on an EKG tracing.

5) Liver dysfunction including abnormal lipid metabolism, abnormal protein metabolism, abnormal porphyrin metabolism, abnormal iron metabolism rest on the abnormal results of the tests of these functions of liver metabolism. The lipid metabolism showed an abnormally elevated triglycerides and an abnormal phenotype [hyperprebeta lipoproteinemia, an abnormal pattern of body fats]. The iron metabolism was depressed — which represents an abnormality in the enzyme system.

There was no explanation, by test result or other diagnostic basis, for the abnormal protein metabolism or abnormal porphy-rin metabolism components of the sub-diagnosis — and we assume that entry of those manifestations within the Chronic Systemic Chemical Intoxication diagnosis rendered for John Lawrence was mistaken.

6)Reproduction system dysfunction with abnormal sperm analysis rests on the results of the fertility test. John Lawrence and Gwendolyn Lawrence, along with Betty Elam and Charlotte Phillips were the four among the patient plaintiffs who were examined and tested twice at CCA, once in 1983 and then in 1984. On the 1983 occasion, John Lawrence was not able to produce a specimen, so there was no fertility analysis. On the 1984 occasion, the specimen produced showed a markedly depressed count — a total count of 14.8 million [normal, above 60 million]. Thirty-five percent of the sperm were abnormal, a percentage higher than is normally found. The very low overall count as well as the very high count in abnormal morphology unquestionably constitutes a reproductive system dysfunction, the evaluator concluded. It represents as well, Dr. Camow explained, damage to the testicular function. That derangement of function was explained as the action of epichlorohydrin and some of the other Alcolac toxic chemicals on the P450 enzyme system. That enzyme system is particularly active in the func *127 tions of high energy systems such as the brain, kidney and formation of the sperm. The abnormality of function caused to the P450 enzyme system by these chemicals affects the reproductive function. In addition, chemicals such as epichlorohydrin are alkylating agents which grab tissue — protein — and destroy the cells. Dr. Camow testified that testicular atrophy from these chemicals has been demonstrated in animal studies.

The witness responded to cross-examination that the medical record of July 12, 1977 of a benign prostatic hypertrophy merely indicates an enlarged prostate and has no significance for the reproductive system. The only function of the prostate in reproduction is to secrete an alkaline fluid to nurture the sperm for the three days it takes for the journey to fertilize the egg. The production of the sperm takes place in the testicle, not in the prostate, thus an enlarged prostate does not bear on the subdiagnosis of reproductive system dysfunction.

7)Peripheral polyneuropathy rests on the symptoms of leg cramps and other sensory abnormality as well as on the finding of abnormally decreased deep tendon reflexes upon the second physical examination in 1984. The first examination of the deep tendon reflexes in 1983 was normal, as were the nerve conduction velocity tests [EMG]. The second EMG was also normal, but on the second physical examination, the deep tendon reflexes at both biceps, both triceps and both wrists were abnormal. That suggested that John Lawrence had developed these peripheral neuropathic findings. That the two tests were conducted by two different examiners, the first by an occupational medicine physician and the second by a neurologist, does not bear on the validity of each finding, although different, where the examiners — as here — are both skilled.

8) Polyarthralgia rests on symptoms of recurrent muscle pains after exposure to the Alcolac odors and emissions.

9) Severe immune system depression rests on the abnormal results of the immune panel tests conducted by Bioscience laboratory in 1984 and Midwest/Wheeler laboratory in 1985.

rBioscience Laboratory Test Results 1984]

Immune system:

Immunoglobulin: abnormal gamma M at 76 [normal, 80 to 310]

Mitogen challenge: abnormal PHA stimulation index at 102 [normal, over 130]

abnormal PHA stimulation net CPM at 25,-000 [normal, over 62,000]

abnormal CON A stimulation index at 37 [normal, over 40]

abnormal CON A stimulation net CPM at 9000 [normal, over 12,000]

abnormal PWM stimulation index at 18 [normal, over 20]

abnormal PWM stimulation net CPM at 4400 [normal, over 8000]

White blood cells: abnormal basophils, slightly increased

fMidwest/Wheeler Laboratory Test Results, 19851

Immune system:

Lymphocytes: abnormal increase of NKH-1 [natural killer] cells

Hematologic system: abnormal increase in platelet volume

The first examination at CCA revealed an immune system only “slightly abnormal.” The second examination a year later found the immune system “completely zapped.” The mitogen challenges were all abnormal, the immunoglobulin was abnormal, and additionally, the subsequent Midwest/Wheeler results in 1985 [which tested *128 a different function] disclosed the additional result of an abnormal increase in the natural killer cells of the immune system. That system Dr. Camow described as effectively “wiped out.” The destruction of the immune systems of both John Lawrence and Gwendolyn Lawrence [as we soon note] is explained by the heavy exposure over the period of years to the Alcolac toxic chemicals by persons in the near vicinity.

10) Chronic chemical dermatitis with probable hypersensitivity state rests on symptoms of rash, itch, hives [bullae], skin infections and other skin lesions following exposure to the Alcolac odors and emissions.

The evaluator concluded that the damage to the liver, extensive peripheral neuropa-thy and severe immune system depression suggest continued deterioration and result in a considerably shortened life.

PROGNOSIS: Poor.

GWENDOLYN LAWRENCE AGE 64 LIFE EXPECTANCY 20.92 YEARS

DIAGNOSIS: Chronic Systemic Chemical Intoxication caused by the Alcolac toxic chemicals with damage to multiple organ systems, including:

mucous membrane irritation of the eyes, nose and throat

chronic chemical bronchitis

cardiac dysfunction with arrythmias

chronic gastroenteritis (central nervous system component)

Liver dysfunction including

a. possible chemical hepatitis , with abnormally elevated LDH

b. abnormal iron metabolism

c. probable abnormal porphyrin metabolism

possible obstructive uropathy with episodic bleeding

central nervous system dysfunction including:

a. cerebellar damage

b. cerebral damage with deterioration

c. severe anxiety

peripheral polyneuropathy

hypothyroidism

musculoskeletal dysfunction with myositis

severe suppression with marked deterioration

The witness then explained the data on which these components of subdiagnosis rest.

1) Mucous membrane irritation of the eyes, nose and throat rests on symptoms of red, irritated eyes with blurred vision, irritated nose and nosebleeds with soreness of the nose, burning and irritation of the throat following exposure to the Alcolac odors and emissions.

2) Chronic chemical bronchitis rests on symptoms of shortness of breath, constant hacking cough which produces sputum streaked with blood. As is characteristic of a chronic disease, the intensity of the symptoms as well as of the discharge varied from time to time.

3) Cardiac dysfunction with arrythmia rests on symptoms cf chest pain and ar-rythmia following exposure to the Alcolac odors. It rests also on the physical finding of abnormal heart rhythm, a condition of heart muscle irritation induced by the Alco-lac toxic agents.

4) Chronic gastroenteritis [central nervous system component] rests on symptoms of vomiting and nausea which started in late 1978, became most intense in 1982, and then less frequent during that year. The symptoms followed after the inhalation of the Alcolac odors for several days. That manifestation of gastroenteritis was related — Dr. Carnow concluded — to an autonomic [central] nervous system component which caused her to vomit. In *129 response to the cross-examination that a medical record of 1974 suggests a subsisted hiatal hernia, the witness responded that a vomiting upon the inhalation of a toxic chemical is “a very common reaction when the central nervous system is assaulted by a toxic agent.” It is not a symptom of hiatal hernia, which simulates an ulcer after a person who has one ingests food. It relates neither to smell nor to severe vomiting — the symptoms Gwendolyn Lawrence experienced and described.

5) Liver dysfunction including possible chemical hepatitis with abnormally elevated LDH., abnormal iron metabolism, probable abnormal porphyrin metabolism rests on the abnormal laboratory test results of these functions of the liver. There was one abnormal porphyrin: the heptacarboxylic was depressed at 1 [normal, 3 to 9]. The enzyme LDH was abnormally elevated. The iron metabolism was quite depressed at 38 [normal, 65 to 175],

6) Possible obstructive uropathy with episodic bleeding rests on symptoms of frequent urination in nocturia, foul urine smell and on the abnormal urinalysis.

7) Central nervous system dysfunction including cerebellar damage, cerebral damage with deterioration, severe anxiety rests on symptoms of dizziness, sleep disorders, poor balance [ataxia], and headache and on findings on physical examination and on the abnormal results of the Zung anxiety scale. Gwendolyn Lawrence was among those examined at CCA in 1988. The neurological tests on that occasion disclosed abnormal tandem walk and position sense — cerebellar dysfunctions. The subsequent test in 1984 was normal for those functions, but her symptoms continued. She still staggered when she walked and could no longer ride a bicycle because of imbalance. Her Zung anxiety scale was moderately high at 53 [normal, 0 to 43].

8) Peripheral polyneuropathy rests on symptoms of sensory abnormalities of tingling, numbness, pins and needles in the hands and of weakness, on the finding on physical examination in 1984 at CCA of weakness in the hand, and abnormal nerve conduction tests, both motor and sensory on the lower left [PNVC, motor, PNVC, sensory]. These demonstrated depressed nerve function at the lower extremity. The examinations, symptoms and tests conducted in 1984 demonstrated “a very considerable deterioration of her peripheral nervous system” since the 1983 evaluation.

9) Hypothyroidism rests on abnormal T3 uptake and FT index tests of the thyroid component of the endocrine system. This manifestation represented both a thyroid binding globulin abnormality, but also some hyperthyroidism — as the physical finding of a slightly enlarged thyroid suggests.

10) Musculoskeletal dysfunction with myosis rests on symptoms of muscular cramps, joint stiffness and aches following exposure to the Alcolac odors as well as on an abnormal CPK test result. CPK is an enzyme which becomes abnormal when acute inflammation of the muscle is present. Her CPK was abnormally elevated at 99 [normal, up to 60].

11) Severe immune suppression with marked deterioration rests on the abnormal results from three series of tests, Bios-cience laboratory in 1983, Bioscience laboratory in 1984, Midwest/Wheeler in 1985:

TBioscience Laboratory Test Results, 1983]

Mitogen challenge: abnormally low PHA stimulation net CPM at 30,785 [normal, over 62,000]

abnormally low PHA stimulation index at 71 [normal, over 130]

abnormally low CON A stimulation net CPM at 8532 [normal, over 12,000]

abnormally low CON A stimulation index at 20 [normal, over 40]

abnormally low PWM stimulation net CPM at 7504 [normal over 8000]

abnormally low PWM stimulation index at 18 [normal, over 20]

*130 TBioscience Laboratory Test Results, 19841

Immune system:

Mitogen challenge: abnormally low PHA stimulation net CPM at 1200 ,

abnormally low PHA stimulation index at 6

abnormally low CON A stimulation net CPM at 144

abnormally low CON A stimulation index at 2

abnormally low PWM stimulation net CPM at 359

abnormally low PWM stimulation index at 2

White blood cells: abnormally low total lymphocytes

TMidwest/Wheeler Laboratory Test Results, 19851

Hematologic system: abnormally depressed mean corpuscular hemoglobin

abnormally elevated platelet volume anisocytosis [abnormal shapes] hypochromasia [abnormal color]

Dr. Camow interpreted these laboratory results as an immune system in progressive and “terrible” deterioration, a system in “total suppression” — even worse than that of Mary Landon after the course of radiation for her cancer. The antigens introduced to the immune system cells on the mitogen challenges, Dr. Carnow explained, are expected to be seen as enemies and attacked. The PHA antigen is one that the killer cells attack — so the PHA count suggests a virtually nonexistent killer cell population [at 1200 with the normal over 62,-000]. The poke weed mitogen [PWM] tests the B lymphocytes, and the count of the response to that antigen suggests a lack of function of those cells. CON A generally relates to the helper cells function, and the stimulation net at 144 [normal over 12,000] and stimulation index at 2 [normal, over 40] demonstrates that the entire immune system is irreparably suppressed.

PROGNOSIS: Poor.

GLENN MILLER AGE 54 LIFE EXPECTANCY 25.51 YEARS

DIAGNOSIS: Chronic Systemic Chemical Intoxication caused by the Alcolac toxic chemicals with damage to multiple organ systems, including:

1) chronic bilateral conjunctivitis

2) chronic rhinitis

3) liver dysfunction including:

a. abnormal lipid metabolism

b. abnormal porphyrin metabolism including coproporphyrin and porphobilinogen

4) genitoumiary system dysfunction with infection

5) reproductive system dysfunction

6) central nervous system damage with diffuse brain dysfunction

7) peripheral neuropathy

8) immune system dysfunction with suppression

*131 The witness then explained the data on which these components of subdiagnosis rest.

1) Chronic bilateral conjunctivitis rests on recurrent symptoms of red, irritated eyes following exposure to the odors and fumes from Alcolac, and on reddened conjunctiva on physical examination. The physical findings are indications that the chronic assault of these toxic substances has undermined the power of the body to repair the damage.

2) Chronic rhinitis rests on symptoms of nosebleed and on the findings of reddened, swollen mucosa and of exudate in the nose upon physical examination.

3) Liver dysfunction including abnormal lipid metabolism, abnormal porphy-rin metabolism including coproporphy-rin and porphobilinogen rests on abnormal results of laboratory tests of those liver metabolism functions. There were two abnormal porphyrins: the copropor-phyrin was quite high at 130 [normal, up to 110], and the porpobilinogen was increased at 2.3. The triglycerides test was high and represents an increase in abnormal lipid metabolism.

4) Genitourinary system dysfunction with infection rests on a urinalysis which disclosed pus cells. The test was repeated by a private physician, which also disclosed infection, and Glenn Miller was bedridden and treated.

5) Reproductive system dysfunction rests on the fertility analysis results of multiple abnormalities in sperm count, percent activity and morpholgy. The activity of the sperm after 30 minutes was slightly decreased from 80% to 75%. The count at 39.6 million was low even as compared with the marginal minimum count of 60 million. Also, 45% of the sperm were abnormal — an unduly large count.

6) Central nervous system damage with diffuse brain dysfunction rests on abnormal results of the neurobehavioral battery. It is characteristic of toxic depression of the brain function [although toxic agents can induce a focal lesion] that the damage is not localized. The pattern disclosed by the neurobehavioral battery is of perceptional deficits, attentional deficits, perceptual motor function and problem solving — clinically significant indicia of diffuse brain malfunction.

7) Peripheral neuropathy rests on symptoms of weakness of the limbs and sensory abnormalities — tingling and numbness — and on the findings on physical examination of absent deep tendon reflexes and sensory abnormalities.

8) Immune system dysfunction with suppression rests on the abnormal results of the tests conducted by Bioscience laboratory in 1984 and Midwest/Wheeler in 1985.

rBioscience Laboratory Test Results, 19841

Immune system:

Mitogen challenge: an abnormal PHA stimulation net CPM at 59,000 [normal, over 62,000]

White blood cells: abnormally depressed eosingophil at 0

abnormally depressed white cell count at 4300 [normal, 4500 to 11,000]

fMidwest/Wheeler Laboratory Test Results, 1985]

Immune system:

Lymphocytes: abnormally elevated OKT-10 cells at 27 [normal, 0 to 15]

abnormally elevated NKH-1 cells at 14.9 [normal, up to 9.6]

Hematologic system: abnormally elevated mean corpuscular hemoglobin

abnormally elevated mean platelet volume

*132 The evaluator explained that NKH-1 cells, killer cells, also measure other suppressor cells, as does the OKT-IO, both show marked elevation, and hence present a “very abnormal” immune dysfunction. The patient plaintiff, Glenn Miller, was advised by CCA to avoid further exposure to chemicals, take care about exposure to viral or fungal infections since the low T-lymphocyte function the tests disclosed make him more susceptible to such disease. He was also warned to avoid certain drugs which might precipitate a porphyria attack.

It was elicited on cross-examination that in November of 1980 the patient plaintiff \ Glenn Miller was received at the Bothwell Memorial Hospital in Sedalia with complaints of headache and nausea from the use of bug spray at the school where he worked. A later entry in the medical record book indicated that his sense of well-being was restored when the exposure ceased. Dr. Camow was asked whether the occupational exposure to the bug spray explained or impinged on any of the problems diagnosed for Glenn Miller. The response was that the symptoms described in the hospital records were those from an episode of acute exposure and subsided when the exposure ceased. The bug sprays in the schools serviced by Glenn Miller use pyrethrums or other such substance which, although they may cause headache, are not very toxic. However, the organ damage and disease diagnosed for Glenn Miller — Dr. Camow explained— are not from a single exposure nor from a chemical agent of only mild toxicity. They are from chronic exposures over many nights and for very long periods of time and by agents of severe toxicity — such as epichlorohydrin. The exposure to the school spray — even for a year and a half, as the medical record indicates — could not account for the multiple organ damage found in Glenn Miller. That is so even if the actual spray chemical and the extent of the exposure were known. His medical history and complaints indicate that Glenn Miller has felt no better even after the exposure to the bug spray ceased. He continues to lack energy and vitality that he enjoyed before the Alcolac emissions, and he continues to relate these and other symptoms to the exposure to the Alcolac toxic agents.

PROGNOSIS: Very guarded.

BERNICE MILLER AGE 54 LIFE EXPECTANCY 29.51 YEARS

DIAGNOSIS: Chronic Systemic Chemical Intoxication caused by the Alcolac toxic chemicals with damage to multiple organ systems, including:

1) chronic bilateral conjunctivitis

2) bilateral hearing loss with probable neurosensory component

3)' chronic rhinitis and pharyngitis

4) liver dysfunction including:

a. abnormal porphyrin metabolism including uroporphyrin, copropor-phyrin and porphobilinogen

5) peripheral neuropathy

6) immune system dysfunction

7) hypertension — mild

The witness then explained the data on which these components of subdiagnosis rest.

1) Chronic bilateral conjunctivitis rests on symptoms of red, irritated and blurred eyes following exposure to the Al-colac odors and the physical finding of ede-matous conjunctiva.

2) Bilateral hearing loss with probable neurosensory component rests upon the audiometric test results which were abnormal at every frequency for both ears — except at the 2000 frequency, where the hearing at the right ear was abnormal, but normal at the left ear. The neurosensory loss ranges at 45 decibels at the 3,000, *133 4,000 and 6,000 cycle frequencies, and a 35 decibel loss at the 500, 1,000 and 2,000 cycle frequencies. The results represent neurosensory loss extended to the lower frequencies — an 8th cranial nerve damage.

3) Chronic rhinitis and pharyngitis rests on symptoms of nose irritations and soreness in the throat following exposure to the Alcolac odors. The chronic rhinitis rests also on the findings upon physical examination of irritated, reddened and swollen mucous membrane with exudate material.

4) Liver dysfunction including abnormal porphyrin metabolism including uroporphyrin, corpoporphyrin and por-phobilinogen rests on the multiple abnormal test results of that function of the liver. They show a uroporphyrin at 33 [normal, 4 to 22], a coproporphyrin at 135 [normal, 3 to 56], and a porphobilinogen at 3 [normal, 0 to 1.5] — three abnormalities along the porphyrin cascade. The uropor-phyria signifies a disease somewhat advanced. The iron metabolism, a phenomenon related to the porphyrin abnormalities, was quite depressed at 52 [normal, more than 65].

5) Polyneuropathy rests on symptoms of numbness in both hands and weakness, and on the finding on physical examination of an absent deep tendon reflex in the left ankle.

6) Immune system dysfunction rests on the abnormal results of the tests conducted by Bioscience laboratory in 1984 and Midwest/Wheeler laboratory in 1985.

TBioscience Laboratory Test Results, 1984]

Immune system:

Immunoglobulin: abnormal globulin A

fMidwest/Wheeler Laboratory Test Results, 1985]

Immune system:

Lymphocytes: abnormally depressed OKT-11 [total T] cells

abnormally increased OKT-10 [unpro-grammed lymphocyte] cells

abnormally increased [natural killer] cells

Hematologic system: abnormally increased mean platelet volume

It was the opinion of the evaluator that the test results of abnormal depression of total T cells and abnormally increased natural killer cells signify a suppression of the helper cells, and hence an imbalance between the helpers and suppressors.

7)Hypertension — mild is a subdiagno-sis neither evaluated by the witness nor otherwise explained in the evidence, and— we assume — was mistakenly entered as a diagnosis.

PROGNOSIS: Very guarded to poor.

JOHN PHILLIPS AGE 58 LIFE EXPECTANCY 22.35 YEARS

DIAGNOSIS: Chronic Systemic Chemical Intoxication caused by Alcolac toxic chemicals with damage to multiple organ systems, including:

1) bilateral cataracts with recurrent acute conjunctivitis

2) bilateral neurosensory hearing loss with 8th cranial nerve damage

3) chronic chemical bronchitis with obstruction

4) liver dysfunction including:

a.abnormal porphyrin metabolism

5) central nervous system dysfunction with:

a. damaged cranial nerves

b. cerebellar damage

c. depression

*134 d. anxiety

e. cerebral damage with particular involvement of the right side of the brain

6) severe far-advanced polyneuropathy

The witness then explained the data on which these components of subdiagnosis rest.

1) Bilateral cataracts with recurrent acute conjunctivitis rests on symptoms of blurred vision, red, irritated eyes following exposure to the Alcolac odors and emissions. The cataracts were diagnosed from the neurobehavioral tests which detected that John Phillips tended to neglect the left side of his visual space and displayed a mild deficit in visual perception. A workup the year before disclosed retrolental opacities not amenable to treatment.

2) Bilateral neurosensory hearing loss with 8th cranial nerve damage rests on the abnormal results of the audiometric tests of both ears at the 3000, 4000 and 6000 cycle frequencies. On the right, there is a 65 decibel loss at 3000 cycles, 75 decibel loss at 4000 cycles and 70 decibel loss at 6000 cycles. On the left, there is a 60 decibel loss at 3000 cycles, 80 decibel loss at 4000 cycles and 70 decibel loss at 6000 cycles. The bilateral loss of hearing is quite severe.

3) Chronic chemical bronchitis with obstruction rests on symptoms of shortness of breath upon inhalation of the Alcolac odors and emissions, on findings of wheezing upon physical examination, and on the abnormal result of the pulmonary FEYi/FVC test. The result of that test was a vital capacity of 51% of the total— which is a marked diminution from the normal and signifies a pulmonary obstruction.

In the attribution of cause of the chronic bronchitis with obstruction to the Alcolac chemicals, the evaluator took into account that John Phillips had smoked a pack of cigarettes a day since he was about 16 years of age, but gave up the practice when a physician diagnosed his condition as “bronchial obstructive disease with reversible bronchial irritation.” He has since smoked a pipe infrequently during the day. The earlier diagnosis describes a difficulty in exhalation because of the spasm caused to the lungs by the irritant material [cigarette smoke]. In fact, as the evaluator acknowledged, John Phillips “does give a classic history of an individual who has chronic bronchitis from cigarettes.” It does not, however, show a history of a bronchitis developed into obstructive disease. There was no sputum, no wet coughs, no recurrent infections which mark that progression. He was progressing well until two years of exposure to the Alcolac chemicals, and suddenly is beset with chest problems. The evaluator concluded that although the cigarette use may have contributed to the obstruction, it was not a major factor in the etiology of that disease.

The medical history also reported a complaint to the Veterans Administration Hospital in Columbia on April 24, 1977 of “some shortness of breath on admission.” The occasion for the hospital visit was a complaint of dizziness, weakness and “spinning around.” Dr. Camow surmised that it involved “some kind of an acute problem ... some kind of a Meniere’s syndrome.” Examination, however, found the lungs completely normal — and hence, whatever that episode meant, it did not involve the lung function and hence does not impinge on the subdiagnosis that the pulmonary obstruction was caused by the Alcolac chemicals.

4)Liver dysfunction including abnormal porphyrin metabolism rests! on the abnormal results of the tests of that function of the liver. The coproporphyrins were abnormally elevated at 127 [normal, 10 to 109] and the porphobilinogen is elevated at 1.7 [normal 0 to 1.5]. The liver dysfunction [although not marked on the DIAGNOSIS chart prepared by Dr. Camow prior to testimony] also included a manifestation of abnormal protein metabolism. The globulins were abnormally depressed.

*135 5) Central nervous system dysfunction with damaged cranial nerves, cerebellar damage, depression, anxiety, cerebral damage with particular involvement of the right side of the brain rests on multiple symptoms, physical findings and abnormal test results. The symptoms which aided subdiagnosis were dizziness, loss of appetite, inability to sleep and headaches. The findings on physical examination were abnormality of the 12th cranial nerve and of the 8th cranial nerve as well as of the cerebellar functions of balance and tandem walk. The Zung anxiety scale was very high at 64 and the Beck depression inventory was also quite severe at 31 [normal, 14-16] — a state of agitated depression. The neuro-behavioral battery — a series of 20 procedures which test visual/spatial perceptions and other brain functions — yielded virtually all abnormal results. The neurologist examiner concluded [and Dr. Camow agreed] that the test results suggest “right hemisphere brain dysfunction.” Dr. Car-now commented that the condition of organ depression exhibited by John Phillips [anxiety due to damage to the brain] renders function as to ordinary matters all the more difficult. That tends to explain the persistent marital discord from the insistence by Mrs. Phillips that they move away from the Alcolac disruptions and his refusal to leave the family homestead.

Dr. Camow discounted any prior medical history to explain the etiology of the central nervous system dysfunction and attributed that manifestation of subdiagnosis entirely to exposure to the Alcolac emissions. The cyst suggested by a VA Hospital CAT scan in 1977 — for instance — was on the left side of the brain, and so is unrelated to the damage diagnosed to the right side of the brain from the toxic emissions.

6) Severe far-advanced polyneuropathy rests on symptoms of weakness, tingling and cramps in the limbs, on physical findings of sensory abnormalities and on the abnormal results of the EMG, PNVC, motor and PNVC, sensory tests. The upper right extremity and the contralateral lower left extremity were tested. Every nerve tested in those limbs was abnormal. The results showed not only damage to all the nerves, but axonal degeneration — complete destruction of the nerves.

The immune system also tested abnormally, both on the immune panel administered by Bioscience in 1984 and by Midwest/Wheeler in 1985. Thus, the Bioscience results show a depressed immunoglo-bulin M at 71 [normal, 80 to 310], elevated white blood cell monocytes and elevated basophils. The Midwest/Wheeler 1985 immune panel shows both an abnormal increase in B cells and an abnormal percent of B cells. These abnormalities were not rendered into a subdiagnosis on the DIAGNOSIS chart. It was the opinion of Dr. Zahalsky, immunology expert that all of the thirty-one plaintiffs [John Phillips included] suffer from a “progressive chemical intoxication of the immune system.” That condition of intoxication, he gave as opinion, will subject them to “a variety of diseases, including, but not exclusively neoplastic disease.” The formal DIAGNOSIS chart, for whatever reason, does not enter such a diagnosis for John Phillips.

PROGNOSIS: Poor.

CHARLOTTE PHILLIPS AGE 52 LIFE EXPECTANCY 31.34 YEARS

DIAGNOSIS: Chronic Systemic Chemical Intoxication caused by the Alcolac toxic chemicals with damage to multiple organ systems, including:

1) chronic conjunctivitis

2) borderline hearing loss

3) chronic pharyngitis and bronchitis

4) chronic gastritis — severe

5) liver dysfunction including:

a. abnormal LDH

b. lipid abnormality — aggravated

*136 c. abnormal porphyrins

d. abnormal protein metabolism — possible hypothyroidism

6) chronic esophagitis

7) hypertensive cardiovascular disease with chronic coronary insufficiency

8) genital urinary dysfunction with chronic urinary tract difficulty

9) central nervous system dysfunction with severe anxiety and depression

10) peripheral neuropathy

11) immune system dysfunction

The witness then explained the data on which these components of subdiagnosis rest.

1) Chronic conjunctivitis rests on symptoms of redness, irritation and itchiness of the eyes following exposure to the Alcolac odors and emissions.

2) Borderline hearing loss rests on the abnormal results of the audiometric test administered to Charlotte Phillips by CCA in 1984. [She was one of the four who were examined successively by CCA in 1983 and 1984.] The results were slightly abnormal — a 30 decibel loss — at the 3000, 4000 and 6000 frequency cycles. They nevertheless indicate neurologic damage. In 1983, no audiometry was conducted, but a history of noisy employment was noted. There was some indication of hearing loss at the lower frequencies on that occasion. The eardrums were scarred, which indicated a conduction rather than a nerve defect. The cause of the hearing loss noted in 1984, a borderline effect, was attributed to the chemicals because she had made no previous complaint of hearing loss, had not been tested previously by audiometry and the toxic chemicals emitted by Alcolac do damage the 8th cranial nerve. Neurosensory hearing loss may either be noise or chemical induced, but the probability of nerve damage to one exposed to job noise is markedly increased by exposure to chemicals.

3) Chronic pharyngitis and bronchitis rests on symptoms of burning, sore throat, shortness of breath and cough and on the physical finding of cough. The symptoms followed exposure to the Alcolac odors and emissions.

4)Chronic gastritis — severe rests on prolonged symptoms of stomach cramps with the distress of burning sensations and nausea from the odors and emissions.

She was advised by a physician that these symptoms of gastrointestinal distress were attributed to a hiatal hernia diagnosed in 1979. Also, her gallbladder was removed in 1974, but the problems related to that malady did not recur thereafter. The medical records contained the history of these conditions.

. The medical history of Charlotte Phillips discloses that in 1974 her gallbladder was removed and in 1979, her symptoms of gastrointestinal distress — also nausea and burning sensations in the stomach area— signified a hiatal hernia. The symptoms relating to the gallbladder did not recur after the surgery, and although a hiatal hernia may explain the subsequent gastrointestinal symptoms Charlotte Phillips described, after the removal of the gallbladder in 1974 there were no significant symptoms until after exposure to the Alco-lac chemicals in 1978. The significant array of problems Charlotte Phillips described — epigastric pain, gastroenteritis, nausea, diarrhea, colitis — all began in 1978 after Alcolac commenced to generate the toxic chemicals to which she was exposed. It was also after 1978 that she relates similar reactions from her domestic animals — such as vomiting. It was the opinion of Dr. Carnow, based upon this medical and environmental history, that the distresses already described — epigastric pain and the others — that she did not have before the Alcolac operation in 1978 were attributable to the exposure to those odors and emissions. Dr. Carnow acknowledged *137 that the hiatal hernia itself was not an effect of the Alcolac chemicals.

5) Liver dysfunction including abnormal LDH, lipid abnormality — aggrava ted, abnormal porphyrins, abnormal protein metabolism — possible hypothyroidism rests on the laboratory test of these liver functions. The liver enzyme LDH was somewhat elevated at 133 [normal, 62 to 131] and signified some inflammation of the liver. The lipid metabolism was abnormal: the lipoprotein phenotype was abnormal; the tryglycerides were greatly elevated at 301 [normal, 30 to 135]. Two porphy-rins were abnormal: the uroporphyrins were elevated at 35 [normal, 4 to 22] and the coproporphyrin to uroporphyrin ratio was abnormal. These abnormalities signify a condition of uroporphyrinuria. The abnormal protein metabolism was demonstrated by the results of the thyroid tests of the endocrine system. The T3 uptake was depressed as was the FT index. Dr. Camow concluded that those results may represent a low thyroid [hypothyroidism], but that the underlying pathology nevertheless was the abnormal protein metabolism.

6) Chronic esophagitis rests on the symptoms of inflammation of the esophagus from the recurrent vomiting. This condition was attributed to the effect of the Alcolac odors and emissions and not to the previous condition of hiatal hernia for the same reasons ascribed for the causation of the chronic gastritis subdiagnosis component.

7) Hypertensive cardiovascular disease with chronic coronary insufficiency rests on symptoms of pain in the midchest which radiate to the sides of the chest, and on physical findings of abnormal pulse rate and diminished peripheral pulse.

8) Genitourinary system dysfunction with chronic urinary tract difficulty rests on an abnormal urinalysis, with elevated pus cells and bacteria and recurrent urinary infection.

9) Central nervous system dysfunction with severe anxiety and depression rests on symptoms of dizziness, depression and headache and on the abnormal results of the Zung anxiety scale, neurobehavioral battery and Beck depression inventory. On the neurological tests, she displayed a mildly unreliable concentration, a mildly slow digit vigilance response and a mildly slow bilateral finger-tapping. The anxiety was moderate at 26, on a Beck scale of 0 to 10. The depression was high at 63, on a Zung scale of 0 to 44. These abnormalities, the evaluator interpreted to be manifestations of organic origin interrelated with the chemical component. The hype-rexcitability at the high level of anxiety combined with the state of depression found in Charlotte Phillips was particularly ominous to a restoration of a healthy state.

10) Peripheral neuropathy rests on symptoms of sensory abnormalities as well as cramps and tingling in the limbs, and on the physical finding of the decreased or absent deep tendon reflexes.

11) Immune system dysfunction rests on the abnormal results of the immune panels administered by Bioscience laboratory in 1984 and Midwest/Wheeler laboratory in 1985.

[Bioseience Laboratory Test Results, 1984]

Immune system:

Immunoglobulin: abnormally increased globulin G at 1510 [normal, 700 to 1500]

White blood cells: abnormally elevated monocytes

TMidwest/Wheeler Laboratory Test Results, 1985]

Immune system:

Lymphocytes: abnormally depressed white blood cell count

Hematologic system: abnormally increased mean platelet volume

PROGNOSIS: Very guarded to poor.

*138 DANIEL PRYOR AGE 35 LIFE EXPECTANCY 42.63 YEARS

DIAGNOSIS: Chronic Systemic Chemical Intoxication caused by the Alcolac toxic chemicals with damage to multiple organ systems, including:

1) chronic rhinitis and conjunctivitis

2) chronic chemical bronchitis with restrictive and obstructive defects; and recurrent hemorrhage

3) chronic gastritis

4) liver dysfunction with:

a. abnormal lipid metabolism

b. abnormal protein dysfunction

5) reproductive system dysfunction

6) central nervous system dysfunction, including:

a. cerebral dysfunction

b. depression

c. anxiety

d. possible 8th cranial nerve damage

7) probable peripheral neuropathy

8) immune system dysfunction with suppression

The witness then explained the data on which these components of subdiagnosis rest.

1) Chronic rhinitis and conjunctivitis rests on symptoms of recurrent nasal congestion and on physical finding of mucous membrane irritation and symptoms of red, irritated, burning and watering eyes. Daniel Pryor relates these symptoms and conditions to the Alcolac odors and emissions.

2) Chronic chemical bronchitis with restrictive and obstructive defects and recurrent hemorrhage rests on symptoms of shortness of breath, wheeze, chest heaviness, cough productive of phlegm flecked with blood. The subdiagnosis rests also on physical finding of lung abnormalities of prolonged expiration and wheezing. The subdiagnosis rests also on the laboratory tests for FVC and FECi/FVC which are both abnormally low. There is also decreased volume of the lung and scarring of the lungs — restrictive defects — as well as an obstructive defect, of the kind usual with spasm or inflammation of the air passages. The evaluator attributed these conditions of disease and dysfunction as the chronic effects to the exposure to the Alco-lac emissions.

The personal history given by Daniel Pryor related that he became a regular cigarette smoker at age 18 and continued until age 24 and consumed one and one-half pack per day. He discontinued the habit for ten years, but resumed once again at the same pace about four months prior to examination at CCA. Dr. Carnow ruled out the cigarette consumption as a cause of the chronic chemical bronchitis and pulmonary dysfunction subdiagnosis because Daniel Pryor was free of symptoms when he gave up smoking ten years before the complaints of wheeziness, chest heaviness and shortness of breath began two years ago — before the resumption of the cigarette habit. The productive coughs and the occasional flecks of blood in that sputum commenced about a year ago — and so also predated the resumption of smoking, six months before examination at CCA. His symptoms, rather, all commenced after the onset of the Alcolac productions and the emission of the pollutants. The temporal relationship of the symptoms, therefore, is not to cigarettes but to exposure to the chemicals. Daniel Pryor not only exhibits these many symptoms, however, but also manifests “a lot of wheezing in his lungs, which means that the air passages were swollen and narrowed, all over his lungs.” The lung tests demonstrate a force vital capacity of only 71 percent which means “[h]e had trouble getting air out of his lungs.” These bronchial conditions, he not- *139 , are rather severe, and the cigarettes were “at most, a minimal aggravating factor.”

3) Chronic gastritis rests on symptoms of gastrointestinal distress, nausea, rectal bleeding, anorexia and weight loss.

4) Liver dysfunction with abnormal lipid metabolism and abnormal protein metabolism rests on abnormal test results of those liver functions. The depressed cholesterol and LDL cholesterol represent liver damage. The FT [free thyroxin] index was abnormally low and represents a dysfunction of the protein metabolism function of the liver.

5) Reproductive system dysfunction rests on the fertility analysis which was abnormal through the range of tests. The percent activity showed a 45% of the sperm active at 30 minutes [normal, 80%], and only 45% active at 60 minutes [normal, over 70%], and only 30% active at four hours [normal, over 60%]. Thus, at the end of four hours, only 30% of the sperm remained alive. The grade of motion and type of motion were also abnormal: the sperm were not moving rapidly and were not moving in the same direction. The total sperm count was very low at 29 million [normal, above 60 million]. Also, 23% of the sperm were abnormal. The result, the evaluator concluded, “represents a pretty bad profile.”

6) Central nervous system dysfunction, including cerebral dysfunction, depression, anxiety, possible 8th cranial nerve damage, rests on symptoms of dizziness, decreased concentration and loss of memory, sleep disorders and headache. The sub-diagnosis and their components rest also on the results of the neurobehavioral battery, the Zung anxiety scale and the Beck depression inventory. The neuropsychological examination disclosed a mild attentional deficit and depression, and raised a question as to a somatosensory deficit in the left side of the brain. The severe depression found, however, may impinge to explain that apparent dysfunction. It was unclear to the neurologist whether that manifested a problem of the peripheral nervous system [damage to the nerves out of the cord] or of the central nervous system [damage to the nerves out of the brain]. The Beck depression inventory was 21 [normal, 0 to 10]. The Zung anxiety scale result was 55 [normal, 0 to 44]. Thus, in addition to the test results of a severe depression and abnormal anxiety, the tests demonstrated a nervous system deficit, whether as damage in the brain or in the peripheral nerves.

7) Probable peripheral neuropathy rests on symptoms of numbness in the hands and arms, tingling, and weakness in the legs and grip. The numbness has become recurrent with longer-lasting episodes.

8) Immune system dysfunction with suppression rests on the abnormal results of the immune panels administered by Bios-cience laboratory in 1984 and Midwest/Wheeler in 1985.

rBioscience Laboratory Test Kesults, 19841

Immune system:

White Blood Cells: abnormal depression of the T lymphocytes at 64 [normal, 70 to 84]

abnormal depression of the segs

[Midwest/Wheeler Laboratory Test Results, 19851

Immune system:

Lymphocytes: abnormally elevated OKT-10 [natural killer] cells

Hematologic system: abnormal mean corpuscular hemoglobin

The medical history of Daniel Pryor recorded occasional use of drugs: speed, LSD, downers, but not a present use. Those isolated occasions, in 1976, the evaluator commented, do not impinge on any of *140 the symptoms, findings, laboratory results or subdiagnoses entered for Daniel Pryor. The drug experimentation was occasional only. A chronic drug use, he commented, could explain a liver pathology such as hepatitis, but there was no such condition found. In fact, Daniel Pryor was one of the few among the patient plaintiffs who had no condition of abnormal porphyrin metabolism. The damage found to the lungs, to the immune system and to the central nervous system, are not related or explainable by that occasional use those years ago.

PROGNOSIS: Very guarded.

JOYCE PRYOR_AGE 33_LIFE EXPECTANCY 49.45 YEARS

DIAGNOSIS: Chronic Systemic Chemical Intoxication caused by the Alcolac toxic chemicals with damage to multiple organ systems, including:

1) chronic conjunctivitis

2) chronic rhinitis and pharyngitis

3) vascular insufficiency

4) chronic gastroenteritis (possible porphyrin crisis)

5) liver dysfunction, including:

a. abnormal lipid metabolism

b. abnormal protein metabolism

c. abnormal porphyrin metabolism

6) genitourinary system dysfunction, including:

a. infection with bleeding

b. electrolyte unbalance with hyperchloremia and hyperphosphate-mia

7) central nervous system dysfunction with cerebellar, including:

a. cerebellar damage

b. severe depression

c. severe anxiety

8) mild peripheral neuropathy

9) musculoskeletal dysfunction

10) immune system dysfunction

11) chronic chemical dermatitis

12) endocrine dysfunction

13) reproductive system dysfunction with dysmenorrhea and menorrha-gia

14) hematologic system dysfunction

The witness then explained the data on which these components of subdiagnosis rest.

1) Chronic conjunctivitis rests on symptoms of red, irritated eyes with a swollen feeling following exposure to the Alcolac odors and emissions. It rests also on findings of reddened conjunctiva on physical examination.

2) Chronic rhinitis and pharyngitis rests on symptoms of nose irritation and congestion and on soreness of the throat. It rests also on the finding on physical examination of swollen and irritated mucous membrane with exudate on physical examination.

3) Vascular insufficiency rests on symptoms of chest pain and on physical findings of peripheral abnormalities of an abnormally red color of the legs [rubeosis —which signifies a circulatory deficiency], and diminished peripheral pulse at the feet.

4) Chronic gastroenteritis [possible porphyrin crises] rests on frequent episodes of vomiting accompanied by diarrhea, symptoms of indigestion and gastrointestinal distress, nausea and hemorrhoids. The subdiagnosis rests also on the abnormal porphyrin metabolism test results.

5) Liver dysfunction, including abnormal lipid metabolism, abnormal protein *141 metabolism, abnormal porphyrin metabolism, rests on the results of the tests of those functions of the liver. Her triglycerides were abnormally high at 165 [normal, 30 to 150] in a woman of only 33 years. The abnormally-low FT [free thyroxin] index level of the thyroid signified an abnormal protein metabolism of that function of the liver. The abnormalities of the porphy-rin metabolism function of the liver were also marked, with both a uroporphyria and a coproporphyrinuria. The uroporphyrins were at 33 [normal, 4 to 22] and the copro-porphyrins were at 88 [normal 3 to 56].

6) Genitourinary system dysfunction, including infection with bleeding, electrolyte unbalance with hyperchloremia and hyperphosphatemia, rests on history of recurrent bladder infections and on abnormal laboratory test results. The urinalysis was very abnormal — more than 200 clumps of pus cells and blood in the urine. The chlorides and potassium were both abnormally elevated. The electrolytes tolerate only a narrow range within which the body can live, and so the body regulates the electrolytes with great care. The changes found, Dr. Camow explained, were “very significant.”

7) Central nervous system dysfunction with cerebellar, including cerebellar damage, severe depression, severe anxiety, rests on symptoms of dizziness, nervousness, sleep disorders and headache. They rest also on the findings on physical examination of cerebellar dysfunction and that of the 8th cranial nerve. The result of the 30 [normal 0 to 10] manifested an abnormal depression on the Beck inventory and the 57 [normal, 0 to 44] was an abnormal value on the Zung anxiety scale.

The medical history of Joyce Pryor records an entry by Dr. Allcom, a local Sedalia physician, that she becomes very upset before the monthly menstrual period. The cross-examiner poséd to Dr. Camow whether the premenstrual syndrome was related to the central nervous system manifestations attributed to the Alcolac chemicals. The evaluator acknowledged that the records show a history of nervousness in the early 1970’s for which she consulted a physician, and for which she was given medication. That condition nevertheless exacerbated so that by 1981 it was much worse. The condition of nervousness, in fact, became very severe before her menstrual periods, but Dr. Camow concluded that the condition was related to her absorption of the chemicals. He suggested also that the condition of the nervousness was related to the changes in her porphyrin metabolism. Joyce Pryor was on a regimen of birth control pills, and the ingestion of estrogens exacerbates porphyria. Thus, the estrogens taken before the menstrua-tions may have been a factor in the attendant nervousness — and intensified the intoxication from the Alcolac chemicals acting on her porphyrins.

The neuropsychological findings entered by Dr. William Wilson, neurological examiner for CCA, conclude with the summary: “The results of Mrs. Pryor’s neuropsycho-logical examination suggest a mild to moderate level of depression and distress in an individual with long-standing charactero-logical problems.” The longstanding characterological problems alluded to a history of family abuse, precocious sexual play, early pregnancy at age 16, four marriages, and a pattern of possessiveness and demands for attention from the husband. The records note also episodes of drug use fifteen years before, which included “uppers, downers and heroin,” and the indifference of the husband to that indulgence.

It was posed to Dr. Camow on cross-examination — in light of these examination reports and incidents of prior history — to explain how he arrived at the subdiagnosis that the severe depression was a disease caused by the Alcolac chemicals. Dr. Car-now responded that he relied on the finding of Dr. Wilson of a mild to moderate level of depression, that the occasional drug use was fifteen years before, that the drug episode was prompted by marital discord with her then husband, that she thereafter undertook to repair her life through church activity, but that the chronic exposure to *142 the Alcolac chemicals over the years, superimposed on her tendency to nervousness and depression, made her become progressively more irritable so that by 1984, after a period of domestic discord [this time with husband Daniel Pryor] that marriage ended in dissolution. Dr. Camow acknowledged that the “characterological disorder” and the episode of drug use were “significant components in her depression.” He insisted, however, that a person with her susceptibility to stress is more easily affected by a superimposed stress, such as toxic chemicals. He explained also that her condition of severe porphyria also impinges on central nervous system dysfunction. “It makes people extraordinarily irritable.” In view of the “tremendous amount of evidence that she has been poisoned by the chemicals” as to other organ functions, that intoxication must be deemed to be a component of her depression — “a contributing cause, certainly not the sole cause.”

8) Mild peripheral neuropathy rests on symptoms of tingling of the fingers and limbs, intermittent shooting pains and other sensory abnormalities following exposure to the Alcolac odors and emissions.

9) Musculoskeletal dysfunction rests on muscular pains, cramps and joint pains following exposure to the Alcolac odors and emissions, and on symptoms of weakness in the limbs.

10) Immune system dysfunction rests on the results of the immune panels administered by Bioscience in 1984 and Midwest/Wheeler in 1985.

TBioscience Laboratory Test Results, 1984]

Immune system:

White blood cells: total abnormally elevated at 12,300

T lymphocytes abnormally depressed at 68 fMidwest/Wheeler Laboratory Test Results, 19851

Immune system:

white blood cells total abnormally elevated at 13,300 Lymphocytes:

abnormal increase in OKT-10 [immature lymphocyte] cells

abnormal mean corpuscular hemoglobin Hematologic system:

abnormal mean platelet volume

abnormal shape [anisocytosis]

abnormal color [hypochromasia] from want of sufficient hemoglobin

The evaluator noted the progression in the elevation of the total white blood cells from 12,300 in 1984 to 13,300 in 1985, and recommended — as in the case of the others with found immune system abnormalities— successive, periodic tests. A continued elevated total at that range or beyond would cause concern for an eventual condition of leukemia.

11)Chronic chemical dermatitis rests on symptoms of skin rashes and lesions and progressive increase of facial blemishes and dry splotches on her arms and scalp following exposure to the Alcolac chemicals.

12) Endocrine dysfunction rests on the abnormal FT [free thyroxin] index test result.

13) Reproductive system dysfunction with dysmenorrhea and menorrhagia rests on symptoms of abnormally prolonged menstrual periods, episodes of bleeding, marked by painful discharges and issues of large blood clots.

14) Hematologic system dysfunction rests on the abnormal results of the tests of the hematologic system administered by Midwest/Wheeler.

PROGNOSIS: Very guarded to poor.

*143 LINDA SANDERS AGE 23 LIFE EXPECTANCY 59.23 YEARS

DIAGNOSIS: Chronic Systemic Chemical Intoxication caused by the Alcolac toxic chemicals with damage to multiple organ systems, including:

1) recurrent conjunctivitis

2) possible mild hearing loss

3) chronic rhinitis and laryngitis

4) chronic chemical bronchitis

5) liver dysfunction, including:

a. abnormal enzyme, possible low-grade hepatitis

b. abnormal porphyrin metabolism with porphyria

6) central nervous system dysfunction with depression

7) chronic chemical dermatitis

8) immune system dysfunction

The witness then explained the data on which these components of subdiagnosis rest.

1) Recurrent conjunctivitis rests on symptoms of irritation and burning of the eyes following exposure to the Alcolac odors and emissions.

2) Possible mild, hearing loss rests on symptoms of ear discomfort and the results of the audiometric tests which show a 30 decibel loss bilaterally at the 6000 cycle frequency.

3) Chronic rhinitis and laryngitis rests on symptoms of nose and throat irritation, burning in the nose and throat and recurrent infections of the throat.

4) Chronic chemical bronchitis rests on symptoms of shortness of breath, cough and chest heaviness.

5) Liver dysfunction, including abnormal enzyme, possible low-grade hepatitis, abnormal porphyrin metabolism with porphyria rests on the results of the laboratory tests of those liver functions. The heptacarboxylic porphyrins were depressed and the coproporphyrins were elevated, both abnormalities. The alkaline phopha-tase enzyme was abnormally elevated. That may represent a problem with the liver — a low-grade hepatitis. The globulins were also depressed. She was prescribed drugs to prevent porphyrin crisis.

6) Central nervous system dysfunction with depression rests on symptoms of depression and headache and on the abnormal Beck depression inventory, a 13 on a scale of 0 to 10. The neuropsychological findings conclude, in summary, that the examination results “are within normal limits with the exception of a mild depression whose clinical significance is uncertain given the recent birth of her child.” Dr. Car-now explained that the comments of the neurologist notwithstanding, the examiner was not a clinician and the history does not suggest that Linda Sanders suffered any post-partum depression. The depression, rather, she related to the Alcolac fumes and odors. In view of her youth, he commented, there was no other explainable basis for her depression.

7)Chronic chemical dermatitis rests on symptoms of skin rash following exposure to the Alcolac emissions in 1978. Her prior history notes an episode of allergic dermatitis to detergents at her work. In April of 1977, one episode of rash over her entire body was diagnosed as viral dermatitis. Another entry for that month also notes a rash over the entire body. In November of 1978, she suffered another rash over the body, and the record notes “soap at work.” It was diagnosed by one physician as scabies and by another as contact dermatitis. There was no diagnosis made, however, that the cause was “soap at work.” The rash was recurrent. Dr. Camow entered the diagnosis, on the basis of the history of exposure to the Alcolac chemicals and on *144 the medical history, as a chronic chemical dermatitis.

8)Immune system dysfunction rests on the results of the immune panels administered by Bioscience in 1984 and Midwest/Wheeler in 1985.

FBioscience Laboratory Test Results, 19841

Immune system:

Immunoglobulin: abnormally depressed gamma M at 75 [normal, 80 to 310]

abnormally depressed globulins

White blood cells: abnormally elevated total lymphocytes at 43 [normal, 20 to 40]

abnormally depressed eosinophils at 0

abnormally elevated monocytes

TMidwest/Wheeler Laboratory Test Results, 1985]

Immune system:

Lymphocytes: abnormally elevated OKT-10 [immature lymphocyte] cells

The evaluator concluded that the test results show multiple derangement in various areas of the immune system. Linda Sanders married in 1980 and moved to Texas. Thus, her exposure to the Alcolac chemicals was for a period of one year and nine months. After marriage, she gave birth to three children, all of them healthy. It was the opinion of Dr. Camow that the state of the health of the children notwithstanding, Linda Sanders, because of her youth “may have more problems than other people.” To cross-examination, Dr. Car-now responded that recurrent infections were not necessarily the eventual consequences of an immune system dysfunction as she manifests. Recurrent infection is the consequence of B cell abnormality, since the B system is that arm of the immune mechanism which relates to infections. Her abnormality, as with most of the Alcolac plaintiffs, was to the T cells— and they tend to relate “to very specific types of infections, like tuberculosis and things like that, and they relate more to destroying cancer cells.”

PROGNOSIS: Very guarded to poor.

ARNOLD SOMMERS AGE 42_LIFE EXPECTANCY 36.02 YEARS

DIAGNOSIS: Chronic Systemic Chemical Intoxication caused by the Alcolac toxic chemicals with damage to multiple organ systems, including:

1) chronic conjunctivitis

2) bilateral neurosensory hearing loss with 8th cranial nerve damage

3) chronic rhinitis and pharyngitis with nasal hemorrhage

4) chronic chemical bronchitis

5) acute recurrent gastritis [possible porphyrin crisis]

6) liver dysfunction, including:

a. severe chemical hepatitis

b. abnormal lipid metabolism

c. abnormal porphyrin metabolism

7) genitourinary tract dysfunction with probable renal insufficiency

8) central nervous system dysfunction, including:

a. cerebral damage

b. probable cerebellar damage

9) peripheral polyneuropathy

10) musculoskeletal dysfunction

11) immune system dysfunction

12) hematologic system dysfunction

*145 The witness then explained the data on which these components of subdiagnosis rest.

1) Chronic conjunctivitis rests on symptoms of recurrent eye irritation, itchiness, matting, watering and redness following exposure to the Alcolac odors and emissions. It rests also on finding injected conjunctiva on physical examination.

2) Bilateral neurosensory hearing loss with 8th cranial nerve damage rests on audiometric test results of “classic neuro-sensory loss.” On the right there was a 45 decibel loss at 4000 frequencies and a 55 decibel loss at 6000 frequencies. On the left there was a 45 decibel loss at 3000 frequencies, a 45 decibel loss at 4000 frequencies and a 60 decibel loss at 6000 frequencies.

3) Chronic rhinitis and pharyngitis with nasal hemorrhage rests on symptoms of nasal irritation with gushing nosebleeds and irritation and soreness of throat following exposure to the Alcolac odors and emissions. They rest also on physical findings of reddened throat and reddened and swollen mucosa in the nose.

4) Chronic chemical bronchitis rests on symptoms of shortness of breath and productive cough continuously during the past months. The examiner discounted a chest x-ray finding of granuloma — a residue of a primary tuberculosis endemic to those in this area of the country. It represents a tiny calcification end-result of the healing process. In this case it is “ancient” and of no diagnostic significance. Arnold Som-mers was a smoker for 28 years, but denied any symptoms until exposure to the Alco-lac emissions both from the plant and from the plant run-off into Little Shaver Creek which ran behind his home. The odors from these sources induce his coughs, which have become increasingly frequent and severe. This temporal relationship of the symptoms to the exposure events render the inhalations of these pollutants “the overwhelming cause of his bronchitis,” Dr. Camow concluded.

5) Acute recurrent gastritis [possible porphyria crises] rests on symptoms of nausea, from the Alcolac odors. These effects last for two to three days and then diminish until the next exposure. The medical history shows a diagnosed ulcer of the pylorus in 1976. That condition reacts to the chemical inhalations and he takes medication for the discomfort. It was the opinion of Dr. Camow that the underlying ulcer may have healed, but in any event it was symptomatic only after exposure to the chemicals. When the exposure ceases the symptoms also cease, so even if “some low grade underlying ulcer exists, the symptoms are of a recurrent gastritis.” Dr. Camow noted also that the laboratory test results show porphyria and the symptoms Sommers manifests of severe gastrointestinal pain and disturbance are those common to porphyria.

6) Liver dysfunction, including severe chemical hepatitis, abnormal lipid metabolism, abnormal porphyrin metabolism rests on the abnormal results of the tests of those liver functions. The copro-porphyrins were abnormally elevated at 159 [normal, 10 to 109]. The porphobilino-gen is 1.6 [normal 0 to 1.5] and the copro-porphyrin-uroporphyrin index is abnormal at 6.6 times the copro to the uro. The liver enzymes, GGTP, SGOT, SPGT, alkaline phosphatase and LDH were all abnormal — a sign of severe chemical hepatitis caused by the Alcolac emissions. This pattern of enzyme abnormality shows the full effect of a chronic chemical inflammation of the liver. It is also characteristic of the trae state of the others afflicted by liver dysfunction from the chronic exposure to the Alcolac chemicals, even though they did not all manifest the full spectrum of enzyme test abnormalities. Dr. Camow explained that such is the nature of the enzyme system: “Certain enzymes go up and they go down, and then they may go up again, and then they go into a chronic damage phase, so it depends on when you catch them. [Arnold Sommers] shows evidence of acute damage, and of course, at this point in time, that is a serious prob *146 lem.” It could cause death. The lipid metabolism was also disturbed. The LDL cholesterol was high at 229 [normal upper limit, 185], the triglycerides were very high at 359 [normal upper limit, 150], and he has an abnormal phenotype.

Dr. Carnow discounted as explanation for these multiple liver functions the personal history that Arnold Sommers consumed two six-packs of beer per week. They neither acted synergistically with the Alcolac chemicals to bring about the abnormalities nor were they otherwise significant to diagnosis.

7) Genitourinary tract dysfunction with probable renal insufficiency rests on the test result of an elevated creatinine, which signifies kidney dysfunction — a matter of some concern in a person of only 42 years of age.

8) Central nervous system dysfunction, including cerebral damage, probable cerebellar damage rests on symptoms of dizziness, nervousness, tremor and headache, on physical findings of cerebellar abnormality and 8th cranial nerve damage, and on the results of the neurobehavioral battery. The neurological tests disclosed an attentional deficit — difficulty in concentration — and other abnormalities from which the neurologist derived the diagnosis: “mild diffuse brain dysfunction.” Arnold Sommers described constant and intense headaches from the onset of the Alcolac operations, irritation and loss of temper. He described an episode of rage which induced him to hit his horse between the eyes with such force as to break his hand. Those responses, Dr. Carnow explained, are characteristic of chemical intoxication.

9) Peripheral neuropathy rests on symptoms of sensory abnormalities — such as tingling and numbness of the limbs and members, more pronounced on the left side. The subdiagnosis rests also on findings on physical examination of hand tremors present for more than a year, on continued headaches more severe than before, and on the decreased sensation found over the entire left leg. The subdiagnosis rests also on the results of the EMG, PNVC/motor and PNVC/sensory laboratory tests. There was abnormal motor conduction on the lower left, abnormal sensor/- conduction on the lower left, and abnormal EMG on the lower left — all of which shows axonal degeneration, total destruction of those nerves.

The prior history notes a condition of polio in 1954 and vehicular accidents in 1952, when he fractured the left leg. There was a recovery from the polio, Dr. Carnow concluded, because there was no evidence of a residual paralysis and consequent atrophy of the limb. It was conceivable, Dr. Carnow explained, that the leg fracture may have injured a nerve, but given the development of- numbness and tingling of the toes, hands and feet — so severe that they awaken him from sleep — it is not likely that the 1952 event is related to the conditions of peripheral neuropathy found. In any event, there is nerve damage to the right as well as to the left, so that even if the 1952 event could be said to impinge on the neuropathy to the left, it could not be related to the other damage.

10) Musculoskeletal dysfunction rests on the symptoms and findings of muscular pains and cramps and is interrelated with the symptoms, findings and laboratory results of the peripheral neuropathy manifestation.

11) Immune system dysfunction rests on the results of the immune panels administered by Bioscience in 1984 and Midwest/Wheeler in 1985.

fBioscience Laboratory Test Results, 1984]

Immune system:

White blood cells: abnormally depressed eosinophils at 0

TMidwest/Wheeler Laboratory Test Results, 1985]

Immune system:

Lymphocytes: abnormal OKT-3 [mature T] cells

abnormally elevated NKH-1 [natural killer] cells

*147 rMidwest/Wheeler Laboratory Test Results, 19851 — Continued

Hematologic system: abnormal mean corpuscular volume

abnormal corpuscular hemoglobin

abnormal mean platelet volume

abnormal sizes [anisocytosis]

12) Hematologic system dysfunction rests on the four abnormal findings in that blood system noted in the 1985 Midwest/Wheeler laboratory test results.

PROGNOSIS: Poor to very guarded [that ⅛, closer to poor than very guarded 1.

JOYCE SOMMERS_AGE 38_LIFE EXPECTANCY 44.60 YEARS

DIAGNOSIS: Chronic Systemic Chemical Intoxication caused by the Alcolac toxic chemicals with damage to multiple organ systems, including:

1) chronic conjunctivitis

2) chronic rhinitis and pharyngitis

3) liver dysfunction including:

a. abnormal enzyme [LDH]

b. abnormal protein metabolism

c. abnormal porphyrin metabolism

4) genitourinary system dysfunction

5) central nervous system dysfunction including:

a. depression

b. anxiety

6) abnormal muscle metabolism

7) immune system dysfunction with suppression

8) recurrent chemical dermatitis

The witness then explained the data on which these components of subdiagnosis rest.

1) Chronic conjunctivitis rests on symptoms of reddened, irritated eyes and on the finding of reddened conjunctiva upon physical examination. These conditions follow upon exposure to the Alcolac odors and emissions.

2) Chronic rhinitis and pharyngitis rests on symptoms of nasal congestion, nosebleeds and soreness of the throat following exposure to the Alcolac odors and emissions. Chronic rhinitis rests also on the findings on physical examination of reddened and swollen mucosa with exudate.

3) Liver dysfunction including abnormal enzyme [LDH], abnormal protein metabolism, abnormal porphyrin metabolism rests on the results of the laboratory tests of those liver functions. The LDH enzyme is abnormally elevated and may be evidence of inflammatory changes. The porphyrins are abnormal: the uroporphy-rins are at 33 [normal, 4 to 22]; the pentacarboxylic is at 4 [normal, 0 to 3]; the coproporphyrins are at 171 [normal, 3 to 56]. This represents a gross porphyria.

4) Genitourinary system dysfunction rests on laboratory teste of abnormally elevated chlorides with pus infection.

5) Central nervous system dysfunction including depression, anxiety rests on symptoms of headache and dizziness following exposure to the Alcolac odors and emissions, from the findings on physical examination of dizziness and headaches and from the values on the Zung anxiety scale and the Beck depression inventory. The neurologist examiner found Joyce Sommers “mildly depressed and mildly anxious.” The neurologist noted also a deviation of the tongue to the left, a manifestation of damage to the Xllth cranial nerve.

6) Abnormal muscle metabolism rests on symptoms of pains in the legs and thighs, knotted up legs, muscle twitches and weakness in the knees. This condition *148 has come on within the six months prior to the August, 1984 examination at CCA.

The evaluator considered the medical history that Joyce Sommers in January of 1971 suffered injuries in a vehicular collision, among them dislocation of the hip and multi-fractures of the jaw, which confined her to a wheelchair for a time. The complaints upon which the subdiagnosis of abnormal muscle metabolism rests, however, appeared for the first time in 1984 and do not appear related to the trauma of 1971. In any event, a person with an organ already damaged is more susceptible to exacerbation from toxic chemicals. Moreover, Joyce Sommers made no complaint of the muscular disability during the interval between 1971 and 1984.

7) Immune system dysfunction with suppression rests on the results of the immune panels administered by Bioscience in 1984 and Midwest/Wheeler in 1985.

fBioscience Laboratory Test Results, 19851

Immune system:

Mitogen challenge: abnormal PHA stimulation net CPM at 30,-580 [normal, over 62,000]

abnormal PHA stimulation index at 115 [normal, over 130]

abnormal PWM stimulation net CPM at 6700 [normal, over 6700]

[Midwest/Wheeler Laboratory Test Results, 1985]

Immune system:

Lymphocytes abnormally elevated OKT-10 [immature] cells

Hematologic system: abnormal mean platelet volume

abnormal mean corpuscular hemoglobin

8) Recurrent chemical dermatitis rests on symptoms of skin rash and itch from the Alcolac foam, odors and emissions.

PROGNOSIS: Very guarded to poor.

JOY SOMMERS_AGE 15_LIFE EXPECTANCY 67.11 YEARS

DIAGNOSIS: Chronic Systemic Chemical Intoxication caused by the Alcolac toxic chemicals with damage to multiple organ systems, including:

1) chronic rhinitis with severe nosebleeds

2) liver dysfunction including:

a. abnormal lipid metabolism

b. abnormal porphyrin metabolism

3) peripheral polyneuropathy

4) immune system dysfunction

5) hematologic system dysfunction

The witness then explained the data on which these components of subdiagnosis rest.

1) Chronic rhinitis with severe nosebleeds rests on symptoms of nose irritation and recurrent nosebleeds following intense odors and emissions from Alcolac.

2) Liver dysfunction including abnormal lipid metabolism and abnormal por-phyrin metabolism rests on the results of the laboratory tests of those liver func *149 tions. The abnormal lipid metabolism manifestation rests on the very low triglycerides the test results show [16 on a normal of 30 to 150] and signifies that the liver “is not handling fats normally.” That represents a dysfunction, and whether liver disease will result depends on future tests and symptoms. A finding of high triglycerides [hyperlipidemia], the witness explained, indicates a different kind of disease than low triglycerides [hypolipidemia]. The first indicates “abnormal handling of lipids,” the second an “inappropriate handling of lipids.”

The test results show also an abnormality in the porphyrin metabolism function of the liver: a low heptacarboxylic porphyrin. What that abnormality represents in terms of disease the evaluator could not presently say, but it was a condition found in 8 of the 31 patients examined — a “very unusual” phenomenon. It does not alter the diagnosis of toxic chemical causation because the test result was abnormally low rather than abnormally high. The abnormality of the porphyrin count — whether high or low — depends upon the stage of the porphyria and where the cascade of the stream of porphy-rin metabolism is blocked. The porphyria found in Joy Sommers, the evaluator intimated, is in the incipient stage, and calls for a careful watch because of her youth— 15 years of age.

3) Peripheral polyneuropathy rests on the finding on physical examination of decreased or absent deep tendon reflexes.

4) Immune system dysfunction rests on the results of the immune panels administered by Bioscience in 1984 and Midwest/Wheeler in 1985.

[Bioscience Laboratory Test Results, 1984]

Immune system:

Mitogen challenge: abnormal PHA stimulation net CPM at 60,-700 [normal, over 62,000]

White blood cells: abnormally depressed globulins

abnormally depressed eosinophil at 0

abnormally elevated total lymphocytes at 2540 [normal, 620 to 2410]

TMidwest/Wheeler Laboratory Test Results, 19851

Immune system:

Lymphocytes: abnormally elevated OKT-10 [immature] cells

Hematologic system: abnormal mean corpuscular hemoglobin

abnormally elevated mean platelet volume

5)Hematologic system dysfunction rests on the abnormal results of the hematologic system tests administered by Midwest/Wheeler in 1985.

PROGNOSIS: Very guarded.

TAMMY SOMMERS_AGE 19_LIFE EXPECTANCY 63.16 YEARS

DIAGNOSIS: Chronic Systemic Chemical Intoxication caused by Alcolac toxic chemicals with damage to multiple organ systems, including:

1) chronic rhinitis with nasal hemorrhage

2) chronic chemical bronchitis

3) chronic gastroenteritis [possible porphyria crisis]

4) liver dysfunction including:

a. abnormal lipid metabolism

b. abnormal protein metabolism

c. abnormal porphyrin metabolism

5) probable central nervous system dysfunction with depression

6) immune system dysfunction

7) hematologic system dysfunction

*150 The witness then explained the data on which these components of subdiagnosis rest.

1) Chronic rhinitis with nasal hemorrhage rests on symptoms of nosebleeds and nasal congestion following exposure to the Alcolac odors and emissions. It rests also on the findings on physical examination of reddened and swollen mucosa with exudate.

2) Chronic chemical bronchitis rests on symptoms of recurrent cough productive of mucus.

3) Chronic gastroenteritis [possible porphyria crisis] rests on symptoms of diarrhea, anorexia and gastrointestinal distress and on the laboratory test results of abnormal porphyrin metabolism.

4) Liver dysfunction including abnormal lipid metabolism, abnormal protein metabolism, abnormal porphyrin metabolism rests on the results of the laboratory tests of those liver functions. Tammy Sommers at the time of examination and tests was 19 years of age, five feet three inches in height, and weighed 170 pounds. The triglycerides were elevated at 254 [30 to 154], a very high value for a young woman in the fertile period. The lipopro-tein phenotype, another test for lipid metabolism, was also abnormal. These two abnormalities, when coupled together, represent a “grossly abnormal” metabolism of the lipids “almost never seen.” Her condition of overweight, Dr. Camow commented, might cause some elevation of the triglycerides, but not to the value of 254 as found. The test of the protein metabolism disclosed an abnormal alpha2 globulin and signifies a dysfunction of protein metabolism. The coproporphyrins at 59 [normal, 3 to 56] represents a dysfunction of the por-phyrin metabolism function of the liver and a coproporphinuria in a person so young. These findings of abnormal lipid, protein and porphyrin metabolisms, the evaluator concluded, represent “a very significant abnormality of liver function.”

These multiple findings of dysfunction were explained as the action of the direct toxic agents, such as epichlorohydrin, which come to the liver to be detoxified but are so destructive that they kill liver cells. The liver [as the witness earlier explained] is the organ system with “the most responsibility for working with the P450 enzymes.” These particular enzymes are manufactured in the protein strands of the liver cells called endoplasmic reticulum. When chemicals such as epichlorohydrin [and some of the others emitted by Alcolac] “turn on this endoplasmic reticulum,” they induce an abnormal production of enzymes and the derangements of the protein, lipid, iron and porphyrin metabolism systems are induced. That is because the production of these enzymes needs proteins and iron and involves the system of porphyrin metabolism. The porphyrins, the witness explained, “have a very delicate feedback system” and the unusual demand on that system engendered from the action of the Alcolac toxic chemicals on the endoplasmic reticulum causes the porphyrins to “just go out of whack.” That derangement may affect the enzymes, lipids and proteins. In the case of Tammy Sommers, that derangement was extensive.

5)Probable central nervous system dysfunction with depression rests on symptoms of recurrent and prolonged headaches, on the Beck depression inventory score of “mildly depressed” and on a deficit in neurological function — episodic lapses in attention. The report noted that the depression “seems to reflect situational difficulties” — the divorce of her parents when she was young, an unhappy childhood and uncertainty as to her future. Dr. Car-now concluded that from a clinical point of view, the abnormal depression inventory at 18 [normal, 0 to 10] was significantly abnormal. The episodes of unhappy personal history, he gave as opinion, contributed to her depression, but the temporal relationship between the chemical exposures and her headaches demonstrate that the exposures were an additive to the effect of depression. The two components are not *151 separable as causes of the manifestation of depression.

6)Immune system dysfunction rests on the results of the immune panels administered by Bioscience in 1984 and Midwest/Wheeler in 1985.

fBioscience Laboratory Test Results, 19841

Immune system:

Immunoglobulin: abnormally depressed gamma A at 80 [normal, 90 to 340]

rMidwest/Wheeler Laboratory Test Results, 19851

Immune system:

Lymphocytes: abnormally depressed OKT-11 cells at 847 [normal, 1000 to 3800]

abnormally elevated OKT-IO [immature] cells at 27.7 [normal, 0 to 15]

abnormally depressed NKH-1 [natural killer] cells at 6.7 [normal, 8 to 22]

Hematologic system: abnormal mean corpuscular hemoglobin

abnormal mean platelet volume

anisocytosis

poikilocytosis

7)Hematologic system dysfunction rests on the abnormal results of the hematologic system tests administered by Midwest/ Wheeler in 1985.

PROGNOSIS: Very guarded to poor.

JAMES TURLEY AGE 52 LIFE EXPECTANCY 26.15 YEARS

DIAGNOSIS: Chronic Systemic Chemical Intoxication caused by the Alcolac toxic chemicals with damage to multiple organ systems, including:

1) chronic conjunctivitis

2) bilateral neurosensory hearing loss with 8th cranial nerve damage

3) chronic rhinitis with hemorrhage [chemical and allergic]

4) chronic pharyngitis

5) gastrointestinal dysfunction

6) cardiac dysfunction with possible early congestive heart failure

7) liver dysfunction with abnormal protein metabolism

8) genitouriary dysfunction with obstruction

9) central nervous system dysfunction with depression

10) peripheral polyneuropathy with axonal degeneration

11) musculoskeletal dysfunction with arthralgia and myalgia

12) severe immune dysfunction with suppression

The witness then explained the data on which these components of subdiagnosis rest.

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