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FILE NAME Brakes BRK DATE 1965 DOC BRK111 DOCUMENT DESCRIPTION Journal Article - Mesothelioma of Pleura and Peritoneum Following Exposure to Asbestos in the London Area Same as 25 000133 SS ee ee sirbely J. L. ad Mitchell of Toluene oncentration our Chemists worth R. L. MESOTHELIOMA OF PLEURAPLEURA AND PERITONEUM FOLLOWING EXPOSUREEXPOSURE TO ASBESTOS IN THE LONDON AREA BY MURIEL L. NEWHOUSE and HILDA THOMPSON From the Department of Occupational Health and Applied Physiology London School of Hygiene and Tropical Medicine RECEIVED FOR PUBLICATION FEBRUARY 11 1965 ane A series of 83 patients from the London Hospital with diagnosis a necropsy or biopsy has been studied for possible possible exposure diagnosis of mesothelioma confirmed by men and 42 women 27. of the patients patients had to asbestos The series consisted of 41 recorded was in 1917 but only 10 of the peritoneal and and 56 pleural tumours The earliest death 1964 series died before before 1950 and 40 48 between 1960 and me In 76 of the series full occupational occupational and residential histories a history history of occupational or domestic domestic living in the same were house obtained Forty 52.6 52.6 gave asbestos compared with nine 11.8 ) out of 76 as an asbestos worker exposure exposure to ae diseases P < 0.001 None of the 17 patients from thethe same hospital suffering from other ae pathological grounds was found to have had suspected cases of mesotheliomamesothelioma rejected on we hood any any exposure to asbestos exposures may be important There was also evidence evidence that neighbour- ete exposures 30-6 of the Among those with no evidence of occupationaloccupational or domestic % mesothelioma lived within half a mile of patients and 6 of the patients with other diseases 5 exposures only an asbestosasbestos factory P < 0.01 10 were in jobs Out Out of the 31 patients with occupational scheduledscheduled under the Asbestos Asbestos Regulations of 1931. The interval b1e6tawneden55first exposure exposure and the development of the terminal illness illness of mesothelioma years ranged between In 47 patients in thethe mesothelioma series lung tissue or Wems In 30 62.5 either asbestosis sputum sputum was available for examination asbestos or asbestos bodies were present wer In recent years the association between to asbestos dust and exposure among the women 25 25 had pleural and 17 cancer of the lung and other tumours peritoneal malignant neoplasms has been the subject of much The aim of research leading article 1964 Wagner Sleggs and this study has been to establish the - Marchand ( 1960 described the occupational histories of these patients and to trace sina ioma of the pleura in those occurrence of meso- any other possible exposure to asbestos There RE: asbestos asbestos in the mining districtseoxfpoSsoeudthto crocidolite were four surviving patients at the outset of the investiga- the has stimulated further studies of tAhferica and tion but these have subsequently died The earliest tion histories of patients suffering from occupathis date of death in the series was 1917 10 died before tumour Oven 1964 Fowler Sloper and Warner 1964 The present investigation 1950 33 between 1950 and 1959 and the remaining 40 in the past four and a half years The youngest ~~ whom mesothelioma had beecnoncerns patients in patient died at the age of 33 and nearly half were e London Hospital during the pastdi5a0gnyoesaerds atAfttehre dead before the age of 55 Table ) examining the necropsy and biopsy specimens held in the pathology pathology department Hourihane Clinical Features 1964 confirmed a diagnosis of mesothelioma in 83 +t of whom 41 were men and 42 patients The ward notes of 65 of the patients were available the women Thirty of Enoite men had pleural tumours and 10 peritoneal and give a picture of a disease disease with a consistent symptomatology Among these PG 261 with pleural The matand matand matand matand _ 202 BRITISH JOURNAL OF INDUSTRIAL MEDICINE TABLE patient the notes had been returned to the local executive council of the National Health Service .. AT DEATH OF BE PATIENTS WITH MESOTHELTAL MESOTHELTAL MESOTHELTAL where they were destroyed within a period of three > TUMOURS TUMOURS TUMOURS Ses 4 : as ss nt Mae SN : . ... ta . .. aa ist laa iad mt Temale ......... 1 / a * . 34 1a8 i14 aio wa years In one of the asbestos factories a file was kept with detailed records of all employces since it started in 1913. The names of all patients were checked with these files Nine men and nine married women after their maiden names had been ascertained from rela- tives were identified without difficulty The exact tumours the commonest presenting symptom was dates of employment of these 18 patients and the jobs they had done were obtained from the records peritoneal the rapid onset of extreme shortness of breath due of the factory alive at the beginning of the to the formation of a massive pleural effusion Pain The four patients feature either described as a dull investigation were interviewed personally A few was a prominent ache sometimes due to invasion of the ribs or relatives were contacted by post but the relatives of interviewed by one of us H.T. at vertebrae or sometimes sharp and radiating sug- 68 patients were > Tumours in the chest their homes situated mostly in the East End of gesting nerve involvement wall were not uncommon occurring either in London Not only was an occupational history of the and daughters and father previous operation scars or by direct invasion of the patient the spouse sons also recorded The chest wall The symptomatology of the taken but past addresses were tumours was more varied In some patients the pre- interviews lasted for at least an hour To recall events senting symptom was pain on defaecation or of 30 or 40 years ago it was often necessary to residential and occupational histories of micturition Diffuse upper abdominal pain was very explore the common and swelling of the abdomen due to ascites all members of the family was always present terminally The methods of treatment included pneumonectomy decortication of the lung deep ray therapy instillation of radioactive gold and cytotoxic drugs They were used alone or in combination but had little effect on the course of the disease Half of the patients suffering from pleural mesothelioma died within one year of the onset of symptoms a further third within two years and only one patient survived for more than three years The course of those with peritoneal tumours appeared to be equally rapid Eight of the patients died within six months of the onset of Exposure to Asbestos in Three Groups of Patients Suffering from Other Diseases For comparison with the mesothelioma patients three further groups of patients suffering from other diseases were investigated The first group was selected from the patients in the medical and surgical wards of the hospital during the early summer of 1964 patient series Each patient in the mesothelioma series who had been traced was matched with an patient of the same sex born in the same year period As there was symptoms a dearth of male patients over 75 years of age in the Sources of Information on Occupation and Residence hospital a sample of six patients of this age and older was taken from a neighbouring geriatric In addition to the ward notes some of which gave good occupational histories there were three other sources of information the patient's general practi- tioner the records of an asbestos factory in the area and personal interviews with patients or their surviving relatives As first step general practitioners were circulated with an explanatory letter asking them to complete a form giving details of the occupations of patients and their immediate relatives Within two months 65 of the doctors had replied In two cases a revealed hitherto unknown exposure to asbestos was in others the name and address of a surviving relative were given but in the majority the doctor was unable to give information because on the death of the hospital The second group were those who had originally been filed in the pathology department of the hospital as cases of mesothelioma but in whom the diagnosis was subsequently rejected on pathological grounds by Hourihane 1964 rejected series As it had proved extremely difficult to locate the relatives of those who died before 1950 attempts were made only to trace the three survivors in this group and the 14 who died after 1950 The patient series already described were all admitted to hospital in 1964. The patients with mesothelioma were admitted to the same hospital over a period of 47 years during which there might have been a substantial change both in the residential date of adinission with the patients j places of residence for comparison wit Details of the series are given in domest about pay available for sever 76 40 52-5 gav compared with on series Table 2 1 2 TYPES OF WITH MESOTHELION | Type of Exposur Employed at one asbe factory Delivered goods to facto Employed at other ashe factories Insulators and laggers Relative worked with asb Dockers handling asbe cargo No history domestic asbestos of work exposureexposure Positive exposures to positive histories in in 2 Seven cases of ex from this table statistically highly 0-001 This result paring the confir mesothelioma gro of the confirmed : This differencediferencedifferencediference mesothelioma of pleura following exposure to asbestos 263 | the local areas and social classes of patients attending the TABLE 3 | * Service 1 of three kept with started in cked with London Hospital Thus a third group of patients was taken from the hospital records matched by date of admission as well as date of birth and sex with the patients in the mesothelioma series Their places of residence and occupations were extracted for comparison with those of the patient series EXPOSURE TO ASBESTOS OF CONFIRMED AND REJECTED CASES OF MESOTHELIOMA SURVIVING AFTER JANUARY Exposure Asbestos to Exposure positive i Diagnosis of Mesothelioma ' Confirmed 36 Rejected ~ 0 nen after rom rela- Results No work or domestic contact : found 35 16 The exact Untraced t t s and the xe records Details of the 83 patients in the mesothelioma series are given in the Appendix No information x? 83.083.0 0001 0 83.01 001 about past domestic and occupational histories was ng of the available for seven patients Among the remaining Mesothelioma Series newe : A few 76 40 52.6 gave a history of exposure to asbestos elatives of compared with only nine 11.8 of the patient Occupational Exposures There are details avati- ewe mate H.T. at * End of series Table 2 The difference in this proportion is able for the 18 mesothelioma patients who had worked at one asbestos factory which used croci- toroyf the and father TABLE 2 dolite asbestos with small amounts of chrysotile and noes first introduced amosite in 1926. Eleven started es ded The TYPES OF EXPOSURE TO ASBESTOS OF 76 PATIENTS work before 1933 the year when the asbestos regula- a Mea call events WITH MESOTHELIOMA 76 PATIENTS WITH OTHER tions controlling the manufacture of asbestos goods AND cessary to DISEASES and the protection of asbestos workers became 0 istories of Mesothelioma patient effective and seven started work between the of Type of Exposure Series Series beginning of 1933 and the end of 1942. The occupa- | No. a No. 6 tions of these workers and the type of asbestos they * Patients _ atients om other patients in rital during ies Each . had been of the same Employed at one asbestos ' factory Delivered goods to factory Employed at other asbestos Factories Insulators and laggers Relative worked with asbestos Dockers hanhdlingandling asbestos | Linke Linke : \ No history of work f | Jomestic exposure to = a hestos i : 18 18 250 250 I 1 4 53 8 . 10 9 118 0 - 5 ': . 16 y 47 1 1 ' ' 3 to. 13 13 $ 3; $ 1' , 2: 26 67 88 used are shown in Table 4. All the 17 for whom details were available had used crocidolite asbestos Five of the occupations listed are not scheduled as TABLE 4 JOBS OF 17 PATIENTS WITH MESOTHELIOMA MESOTHELIOMA AT ONE ASBESTOS FACTORY EMPLOYED Statutory Obligations son Spirung MalMeale " tentiale MaschMaaschlal 4 Crsniouce s there was f age in the is age and g geriatric Positive exposures to asbestos in mesothelioma series versus Carding ! 74 ..e histories in patient series ' 27 11 0001 Subject to Clothing and regulations weaving ' ven cases of mesothelioma could not be traced and are omitted ir this table Disintegrating and opening 2 1 de de VPN Joine " ateve ste ames ames to Choose t l Prysolue anovite anovite d originally eat of the h whom the pathological series fate the rela- templs were a this group ped were all atients hospital there hospital there residential Statically Statically highly significant x - 27-11 Ps Ps 001 ) This result is unlikely to be unduly influenced by e two groups of patients not being matched for yea of admission to hospital since there was no Sp ficant difference either in the areas of residence 15 the occupations ofthe patients admitted in 1964 and those admitted between 1917 and 1964. Com- motheroma parm the confirmed and rejected patients in the motheroma group who died after 1950 36 50 of the confirmed and none of the 17 rejected cases 5 a a history of exposure to asbestos Table 3 The difference is statistically highly significant WE 83 p = 0.001 ilter makarag for ARP masks : Manufacturing Manufacturing of preformed Pipe insula frou 1 Not subject to ManufacturiManunfactguring Manufacturing regulations ro Peake ummings 1 Rubber soPPLY pwinding " Arsenal Arsenal labourer 0 vividuate vividuate 1 RN te 0 ... ve Je ) eR Nett Bon v Employment Employment history not available available for one temale paiment 204 BRITISH JOURNAL OF requiring medical supervision under the Asbestos Regulations 1971 Four patients were working at other factories making all types of asbestos goods One had been employed in a wagon works sawing asbestos sheets INDUSTRIAL MEDICINE TABLE5 DISLASE GROUPS OF PATIENTS SERIES Disease Group IN THE Patients PATIENT No. with Exposureto for partitions Except Except for one a woman employed in insulating electrodes with crocidolite the types of asbestos used in these other factories are not known The eight heating engineers and laggers were all Men Three had been employed in dockyards on ship repairs two in various types types of lagging one in station one installing hospital sterilizing a power equipment and one installing central heating All were consistently employed on this type type of work for 21 mo Cardiovascular 21 mo Metabolic Reticulo including including including 8 ( anaemias intestinal intestinal excluding ) 6 NOM Gastro Respiratory excluding cancers All neoplasms Other 3 NOM 18 NOM 11 NOM Total 76 9 thelioma and the 67 patients in the patient more than 20 years but in some exposure to series who had neither an occupational exposure asbestos was intermittent nor a relative living in the home working with asbestos might have been exposed to asbestos dust - Domestic Exposures The group of nine seven women and two men whose relatives worked with because they lived in the immediate vicinity of an asbestos factory asbestos are of particular interest The most usual One factory where more than fifth of the history was that of the wife who washed her husband's dungarees or work clothes In one instance a relative said that the husband a docker came home mesothelioma patients were employed opened in 1913 having been situated nearer the centre of London for the previous seven years There were white with asbestos every evening for three or four three affected female patients living within half a . years and his wife brushed him down The two men in this group when boys of 8 or 9 years old had sisters who were working at an asbestos factory One of these girls worked as a spinner from 1925 to 1936 In 1946 she died of asbestosis The press report of the inquest states She used to return home from work with dust on her clothes Her brother had apparently no other exposure to asbestos he started work as a shop assistant then became a sawyer of iron girders until 1948 when he worked as a loader of groceries in the docks for five years but never on dusty cargoes and then returned to sawing iron girders He died in 1956 of a pleural mesothelioma patient Series Occupational and Domestic Exposures of this series had worked in asbestos factories and four had been employed as laggers The husband of another was employed at an asbestos factory for three years and two dockers in this group gave histories of handling asbestos cargoes from time to mile of the factory during the time it was in production at its first site When it opened they were children between 5 and 7 years old At the present site there were eight patients living within a halfmile radius of the factory One man was born within . a quarter of a mile of the factory and remained at the same address for 16 years The other seven were women and all except one were children when the factory opened The seventh was 23 years of age and remained in the same house until she died 48 years later She is the only patient who had neither occupational nor household exposure but in whom asbestos bodies were found in the lungs at necropsy Among the patient series one patient lived near the factory at its previous site and four others lived near its present site One patient was 22 years old when she moved into the neighbourhood in 1915 She disliked it and when interviewed complained impartially about the dust from the asbestos factory and the rats in the house TABLE 6 time throughout their working life The diagnoses of these patients have been grouped into seven categories Table 5 The patients with a positive history of exposure are scattered throughout the various diagnostic groups and there is no indica- tion that exposure to asbestos could be related to the disease which had caused their admission RESIDENCE OF PATIENTS WITH NO OCCUPATIONAL OR DOMESTIC EXPOSURE TO ASBESTOS Series Mesothelioma Lived Within Lived More Than | | + mile of Asbestos Factory + mile from Asbestos Factory Total No. % No. % 11 30-6 25 69.4 36 Neighbourhood patient Exposures of Mesothelioma and Series 36 patients with meso- patient S 7.5 62 92-5 67 x = 7.85 < 0.01 MESO Thus among domestic exposu patients in the mi in the patient of an asbestos f difference in the series who lived if had no other ey significant = ! Date of First in Mesothelioma had been exposel lived near the m of exposure varie to over 50 year exposure and de mean 37-5 year workers where e interval was she group living in factories where lowest Table 7 at first exposure : death in each gro RELATION BETWE OF INTERVAL BE ME ee Type of Exposure Factory work Domestic Laggers insulators and Living in neighbouneigrhbour-hood of factory varied between 29 death showed less group of factory years in the othe Asbestos Bodie thelioma Series.- thelioma series examination in f all certified as sufi tissue available ,, revealed the pres Both asbestos bc asbestosis were fo and laggers A fu asbestos bodies c MESOTHELIOMA OF PLEURA FOLLOWING Exposure to asBESTOS 265 * Thus among those with no occupational or Lung tissue was available in only four patients ATTENT domestic exposures to asbestos there are 11 % exposed either through relatives or by living in the patients in the mesothelioma series and five % neighbourhood of asbestos factories In two r in the patient series who lived within half a mile < of an asbestos factory in the area Table 6 The asbestos bodies were present in lung tissue but there was no evidence of asbestosis Me difference in the proportion of patients in the two me. series who lived in the vicinity of the factory and had TABLE 8 ae had no other exposure to asbestos is statistically OO significant x= 85 p < 01 OF ASBESTOS BODIES OR ASBESTOSIS IN EVIDENCEOF MESOTHELIOMA WITH LUNG TISSUE OR CASES e SPUTUM AVAILABLE FOR EXAMINATION ee Date of First Exposure and Interval Before Death oe History of Asbestosis or Asbestos Bodies | in Mesothelioma Series men and women Contact . Lung Tissue | oem had been exposed to asbestos including those who with Asbestos Present Absent ' not Available lived near the main asbestos factory The duration ! of exposure varied widely ranging from two months Positive Negative 22 4 ; 6 23 8 | 13 an to over 50 years The interval between the first Untraced 4 ! 3 | 0 Total e exposure and death varied between 16 and 55 years 30 17 { 36 mean 37-5 years Among the group of factory workers where exposure was probably heaviest the interval was shortest It was longest among the Among the 12 patients in whom no definite contact group living in the neighbourhood of the asbestos with asbestos could be established there was one a e factories where exposure to dust was probably lowest Table 7 shows the mean age of each group at first exposure and the mean of the interval before death in each group Although the length of interval merchant seaman from South Africa whose lungs showed both asbestos bodies and asbestosis he may have had contact either in South Africa or at sea but his early history could not be established There were three others in this group who had asbestos bodies in lung tissue without evidence of asbestosis TABLE 7 EXPOSURE DEATH RELATION BETWEEN TYPE MESOTHELIOMA OF INTERVAL BEFORE DEATH AND LENGTH IN 51 IN SERIESPATIENTS eee Of the seven patients whose histories could not be traced three had asbestos bodies and histological evidence of asbestosis and one had asbestosis alone when the age and . 48 years necropsyd in neither niecropsey nt lived our others years 22 1915 omplainedomplained os factory Type of Exposure | Mean Age at between First 1 No. ' First Exposure | years | i Mean Interval Exposure and Death years Domestic work Domestic 1 200 { ! 2172.-9 5 37.937.9 and ing Lager of insulators =| in neighbourhood factory 200 ' { ot 156 8.5 384 48 aried aried . etween 29-4 and 48-6 years the mean age at gh death .. owed less variation it was 50-6 years in the groguropup -- <2 factory workers and between 55 and 57 j SearsSears the other groups rg TIONAL OR bs ; pan | Total pry os Bodies and Asbestosis in the Meso- thelion & thelion Series the 83 patients in the meso- thelion in xaminon xaminion series lung tissue was available for 4 xaminion in three In four other patients xaminion i all certed as suffering from asbestosis with no lung available queque available examination of sputum during life 36 436 67 s s Poth tite scaler presence of asbestos bodies Table 8 aPsboetsthos apesto's bodies and histological evidence of asbestos were foundin 15 of the 24 factory workers ed ed laggers evidence either A further five showed evidence of either bestos bodies or asbestosis Discussion In the mesothelioma series there are 25 patients in whom no evidence of any exposure to asbestos could be found A chief source of information was a history taken from a surviving relative A surprising amount of information was obtained but in some of those interviewed the memory may have been defective or they may not have known of short periods of exposure during the youth of the deceased For example one of the patients was eventually identified as having worked at a large asbestos factory for two months in 1941. This was before he married and his widow did not know of this episode It is of interest that asbestos bodies in the lungs were found in only four of this group and it seems probable that among the remainder there were those who had had no exposure to asbestos In the mesothelioma series of patients both in- dustrial and industrial exposures were recog recog nized Among the men the exposure was pre- dominantly industrial 22 worked 10 asbestos factories or as laggers two were exposed at home and one lived near the asbestos factors Among the women only 10 worked in asbestos factories and a > gry rans ee: 1 5, I! fae Voy : San #4 a you. as, a8 a wt Ter tur ETO A vrSey ; e . ed. ome BRITISH JOUrnal of inDUSTRIAL Medicine further 17 had industrial exposures seven in the home and 10 living near asbestos factories There is no evidence that the patients with peritoneal tumours differed in their type of exposure from the patients with pleural tumours The propor- tion of positive findings of asbestos bodies or asbestosis was similar in both groups A higher proportion of women particularly among the factory workers was affected by peritoneal tumours but the difference between the sexes was not statistically significant The recent increase in the number of patients diagnosed at the hospital may be partly due to an increased interest in mesothelial tumours and partly to the long interval between first exposure and development of the tumour Those exposed between 1915 and 1925 might be expected to die from about 1950 onwards Asbestos imports to the United Kingdom have mounted steeply since 1932 Leathart 1964 and its uses are more widely diversified in industry The increasing proportion of the population exposed to asbestos during the past 30 years may be expected to give rise to an increasing occurrence of mesothelial tumours The choice of groups for comparison with the mesothelioma series of patients was not ideal The number of patients it was possible to trace in the rejected series proved to be very small The in- patient series although matched for date of birth and sex differed from the mesothelioma series in that all were admitted to hospital during 1964. Neither of these groups could be interviewed without know- ledge of the discase from which they were suffering This could have led to bias with reporting of exposure to asbestos in the patient series However in the patient series the actual patient was interviewed and more detailed and reliable histories were obtained than was possible from the relatives of those who had died of mesothelial tumours There was no evidence that because of their more recent admission to hospital the patient series was less likely than the mesothelioma series to work i tact with asbestos or to live in closer proxin asbestos factories 150to There seems little doubt that the risk of thelioma may arise from both occupation domestic exposures to asbestos Wagner and 1960 described patients with no exposure 50- .nd .ers ner than living as a child in the vicinity of the astos astos mines A high incidence of asbestos plaques at the pleura has been found in the population living near an anthophyllite mine in Finland Kiviluoto 1960 More evidence is required of an increased risk to the population living in the neighbourhood of asbestos factories or other areas such as dockyards where asbestos is used in quantity We should like to thank Dr D O'B Hourihane for his operation and for making the results of his investigations available to us Our thanks are also due to Professor C. Wilson Professor V. W. Div Dr. L. Rushy and Mr G. Flavell F.R.C.S of the London Hospital and Dr. C. P. Silver of St. Matthew's Hospital for permission to interview their patients to the general practitioners who col- laborated in this enquiry to the managements of the asbestos factories for arranging access to their records to Miss Joan Walford for statistical assistance and to Dr. C. Gilson Professor R. Schilling and Dr. W. Smither for their advice and help The contents of this paper were communicated the Conference on the Biological Effects of Asbestos arranged by the New York Academy of Sciences in October 1964 and will be published in shorter form in the proceedings of that conference REFERENCES Fowler P.RS.21S1 loper Cand Cand Warner L. L. cading article 1964 . 2. 202 Hourihane DOB DOB 1984 Theras 19. 264 Kiviluoto 1960 Acta radioi Szeska Szeska Gisa Leathart 194 Hight Hight Owen W. Gisa 1984 Brit med 1.2.214 1.2.214 Suppl 194 16 119 Wagner JC JC Sleggs CA and Marchand ul induste Medd , 17 260 F . ME Case No. | AV ' Section A Fut 8 Plc 19 neur ' Pentine ' 16 Peritoneur Peritoneum Peritoneu Peritoneur Peritoneume Pleura Peritoneum Peritoneum Peritoneuma Pe neura Plo s ... 2" M ... Appendix opposite . - ee 7 i - tte tw te at al Been Tetage ene we apnent oe risk to the f asbestos ds where et mh be - ae te . : MESOTHELIOMA OF PLEURA FOLLOWING Exposure to asbestos wal :3 FARIA oa APPENDIX + | THREE PATIENTS WITH MESOTHELIAL TUMOURS 267 Asbestos Pathological Evidence of As Survival . from Initial Destosis SymptomSs ymptoms in Lung | months Tissue Relevant History Pleura 1901 Peritoneum 19 | Peritoneum | | 1895 1921 1919 18 | Peritoneum | } 24 ' Pleura Peritoneum 14 | Peritoneum | | 16 Peritoneum . = F 1908 | 1925 M | 1880 1928 | F 1893 | 1917 F | 1906 1922 . : an F aad F M F a ro me oe ec are MM, $s. ae aris M . aia F 3 eS iE le _M Ft oar M IN 1 1938 22 | 1941 ~ Necropsy | Positive Positive | Necropsy Positive : | Positive | Positive i | n 1947 Biopsy Positive . A ! 7 sputum !j i : NN 1950 Necropsy | Positive i Negative | | | 2 1951 Necropsy Negative | Negative i| Brake mainly liner ? : coverer asbes 1 tos factory mainly crocidolite ? ; Disintegrator and other jobs asbestos chrysotile amosite cTOCI- delte chrysotile ? { Sectional pipe maker asbestos factory certified asbestotic main- ly crecidoslite 9 Used asbestos boarding in railway carriage construction . ? Asbestos factory job unknown ' 1958 | Biopsy - on a . Positive | A sputum t . | 2 i ! Positive | Positive Positive { A sputum Positive Positive sputum Positive - |A + | Negative | 12 i3 iH 6 5 | 3 * maker Opener and sectional pine asbestos factory certified ashes ttiolte ic amosite crocidolite chryso " Spinner asbestos factory certified : asbestotic mainly crocidolite Sectional | pipe maker asbestos i factory certified asbestotic mainly f crocidolite | Spinner asbestos factory certified asbestotie mainly crocidolite | Disintegrator asbestos factory N a A iS rs Positive as . \ N A t 18 . | 18 re Positive 18 . t ' A A 3, A eof . Negative | Negative 1} amosite crocidolite chrysotrie * Asbestos mixer 1 asbestos factory north England Carder asbestos crocidolite ' factory : mainiy Clothing and weaving asbestos { factory amesite crocidolite chrysotile Filter maker for A.R.P. masks 3 1 asJobienstetos factory mainly croci- Filter maker for A.R.P. masks .- 1 asdboleistetos factory mainly crick Negative | | _f Positive | [ 2 Negative Negative : . ? " Electrode coverer crocidolite Tf Spinner asbestos factory mainly crocidolite | ba Positive . Positive 7 . : Delivered factory chemicals antiwite to asbevos crocidolite Negative . Positive * chrysostile $ ! Spinner asbestos factory mainly crocidolite . ? . whe, i Labourer works and buildings asbestos factory amosHE CROCH dolite chrysotile 3 t Worked in yard of insulating 1 Contractors 6 3: Carder asbestos factory mainly jp crecidohte au a Disintegrator and other with 2p asbestos factory amosite Cli - | Jolite chrysotile Vat ot Punitive + Punitive . NA ai id NA Puitive fae it T Positive ie Antive 12 3$ 9 3s + Worked in close proximity to boiles repairet in dockyards dockyards dockyards + Boiler cleaner and stripper slnko slnko 6 Yards . Boiler coverer and lagget to vartus firmis . Trecting and fitting venital heating Houler cotta Lagares Patio coverer and pipe misulator ling him and Nukei voseret k~ rklis latermurtently T berlager berlager ship Fustaitanen ae omical sturalizing sturalizing ... me ew eee ere Ref a ae oe I, + 268 . : BRITISH JOURNAL OF INDUSTRIAL medicine APPENDIX continued EIGHTY PATIENTS WITH MESOTHELIAL TUMOURS Case No. Site of Primary Tumour Sex Dura- Year | tion Year j| of of First Birth Exposure | of Year Expo- of Exposure Death sure years How Diag nosed Patho- Asbestos || Bodies in Lung logical Evidence of As- Tissue bestosis iTniLsusuneg . Section C Exposure Exposure of relatives Pleura M1912 M1912 1925 11 1956 | Biopsy A A : 34 | Pleura F 38 | Pleura F 2332 | Pleura 2332 | Peritoneum | T 2332 | Pleura 39 | Pleura M 32 | Pleura F 36 | Peritoneum | F . 1913 | 1919 1895 | 1919 | 1905 | 1925 | 1890 | 1921 | 1916 | 1930 : 1919 1928 1900 | 1941 { * 1889 1912 H j \ | ' i 2 | 1957 | Biopsy A 1 ~A 41 + 1960 | Biopsy A NA : ' j 14 [{ 1960 Biopsy |A ; \ NA : 1 21 | 1960 . Necropsy | Positive = Negative . : | 4 1961 . Necropsy Negative ' Negative 2 1961 Biopsy : t 1 n | 1963 Biopsy : ! 18 | 1963 Biopsy : i 1 1 NA ' NA A NA NA ' ' { Survival + from | Initial | SymptomsSymptoms | months 27 ! ' 14 ' 15 3 24 ? 18 18 ... _ Relevant History Elder sister worked as spr asbestos factory died asbestotic certified Elder sister employed as se looked after patient as ch.1 " at +46 aner For several years husband red in ship's engine room close proximity to lagging operations Husband worked as boiler coverer overalls brought home for washing Husband asbestos foreman factory and executive at Husband J docker tre eatly handied white asbestos Elder sister worked as spinner at asbestos factory and suffers from asbestosis asbestosis asbestos Daughter worked in factory for 5 years patient washed bet overally Husband railway carriage alder lined compartments with asbestos sheeting ok hothes ashed at home wee oe Section D Neighbourhood cases 44 | Pleura H 48 | Pleura | ; 42 | Pleura | 50 | Pleura | || 43 Pleura | | 47 Pleura t | 64 | Picura 71 | Pleura + 41 | Pleura | 45 Pleura i 46 | Pleura | F 1905 | i M ; 1922 1913 i 1922 7 1959 161960 1690 161960 Biopsy Biopsy 1 i i | 1 H F 1889 | 1913 48 1961 Biopsy | ' : ' F | 1903 1908 6 1961 Biopsy | i t Fo 190 1913 13 ' } H 1961 Biopsy , F 1917 1917 10 1961 Biopsy ! . + ' F 4 1899 1907 6 4 1962 Biopsy ; F 1899 1907 6 ' 1962 Biopsy t F , 1900 1913 32 1 1962 > Biopsy i 1 F 1900 1913 1 71962 71962 71962 Biopsy , F | 1907 1913 71963 71963 Biopsy t 1 , NA NA Positive NA NA NA Negative ' NA NA NA = NA Section E No history of contact with asbestos 65 | Pleura F 1900 1 1947 Necropsy ' Positive NA NA Negative NA 41 A Negative ' NA NA A Negative 68 Peritoneum F 1902 | |i 49 Pleura /M 1895 (| 7 | } 1 1954 } Necropsy Negative Negative { : 1 ' 1954 Biopsy NA N1 i ; 75 |} Pleura F | 1899 1955 I Biopsy NA NA ! 74 Peritoneum F * ' 1955 Necrops Negative Negative || | | 1904 | 62 Pleura |M 1899 \ ' f] ' 1955 Necropsy Negative Positive ; . : : H { i 1 . 3 17 15 " 4 10 12 .. 7 7 Ae . ? had 38 within Lived m'e ot present site of asbestos factors Lived within p me of present site of asbestos factory Lived within 100 vardsen vardsen vardsen of site of asbestos Fact Lived with mile of and site of asbestos factors Lived within in oe th present site of asbestos facto s Lived within 200 yards site of asbestos factory Lived within asbestos tar i mode tar mode Loved ! me of present mode mode of asbestos 1 Lived within me oe ot asbestos factors Lived gon mit within mit of asbestos fact ... lived with o me et asbestos factory _ Worked is curse mad mad curse typist tried tried lite dates Baker's udsm 1 lapoules pubusan pubusan East End et Lende Munitions work then housewite ... Abbes Usset Ladoress bead and hawa daca Employed Employed is suita suita BEATON B persistent JMPARJMPAR JMPAR de of thest to 192 acute subsegment desmorated chest Mera. tran 8s **** **** **** ** ** ** ** ** ** 1 1 *** *** *** *** *** Sui Sui | A Case No. : t+ 61 P 54 Picasa 76 Pleu 58 Pleura 66 = Pleurs | S7 Periton 2 Pleura 63 Pleura 51 Pieusa 59 | Pie_ : 73 Pleura 70 Pleura 7 Pertone 58 Pie | 00 P eng % Rss 56 P 09 F 7 3 P Section t 3 oP. 3 P. 81 81 r Fr :: 777 777 me Ay es ae.LY bye re ty eG ... MENOTHELIOMA OF PLEURA FOLLOWING EXPOSURE TO ASBESTOS FIGHTY THREE APPENDIN ) continued PATIENTS WITH MESOTHELIAL MESOTHELIAL TUMOURS 269 Nog le logical Survival hive . IN, Symptonis| no definite evidence : 311 Year ......... ... ... ... Year vt cal .. ~ s " Rush First by DYN Sute Death How Wrage nosed Wur Ascarst ...1911 1911 ... a...eraers s Patho + Asbestos Isles in lung Isidence Ar- oo ' Inifttioaml i Lissue oo bestous in Lung Jissue * months i ! History Relevant History ON N'A . 8 Merchant seaman cargoes from S. Africa evidence j of contact with asbestos subse- i quently employed on channel channel eu . - K :: :: POTA 144 1 Nia ...... 1541 t 1898 1930 || BiopBiopssy y 1957 BiopsyBiopsy 1957 BiBiooppssyy . 198 Biopsy : INA !! NA ! NA | z ' A N'A ! : A i; A H ' 1212 ' 19 . o' u : 6 : LaboureLrabourer andand bubiludielrder finallyfinally em- ployed in tunnelling lived in East End of London remaking Employed remaking old sacks in in Bow previous content of sacks not ascertained lived East End of Garage hand Garage chchaauufffeufr eur mechmecahanniic c lived Wolverhampton and Epping Worked as printing machinist before marriage then as housewife : | until death lived East End of :: L VTF | Stereotyper mane) PeritoPenre ituonreur == N 1958 Biopsy Biopsy NA NA | 3 i Stereotyper andand priprnintteerr lliivveed d originally in East London then PleaPleatta a LVTF moved Ipswich Lin . LLVTF Pera M 1800 = 1904 . 1454 BiopBsioypsy 1900 Biopsy NA | | N'A NA NA 12 \ ' 18 H to Van boy regular army cutter and and grinder lived N.E. London and Dagenham Bricklayer cement worker post- man lived East End of London 5. Picara 5. % F.eu . KETON + . Pieza M ... 1910 1911 F 183 1961 1960 ' Necropsy Negative Negative | ' ! Necropsy . Positive Positive t | , 1962 Necropsy Negative i Negative : 18 Fimtotevredantdo Hainault Essex in 1931 turner lived principally 1 in East End of London ? Coloured S. African merchant sea- man stoker at glass factory possible contact with asbestos in S. Africa or at sea 10 Lived until marriage in Wales then 70 P t 1988 " Peren Peren ver) et ... Pieta Pt 00 Per Per } 1898 88 ... 1915 1962 Biopsy ' + Negative |' Negative i , ; 1962 Biopsy NA N ' : i \ 1962 Necropsy Negative | Negative i ! | : 1962 | Necropsy} Negative | Negative ' Hy : ' ' housekeeper in S.W. London 1960 30 Machinist of celluloid collars housewife and canteen worker ! lived East London 10 ; Machinist in hosiery trade Notting- housewife moved to London meat ' 2 Labourer merchant seaman docker carried only meat 54 Apprentice printer barman cook and butcher For 25 years before woes ... Pieu's TR fs Pieta wens F 1897 ... 1912 ' 1963 Biopsy \ 1963 Biopsy t { NA | =| N'A . N'A : A : ' 29 ! 24 death lived East End of London Dressmaker and housewife lived East End of London then Somerset erector Steel erector army steel labourer and porter lived East 69 Petoneum 1 PENT pcewep $30 PI ... EY tag ese Section intrused intrused cases 1401 ... ... | .so1a964 Necropsy Negative | Negative : : 4 1 1 ' : : - 1964 | Necropsy| Positive | : Negative : | " j \ | End of London 42 Employed as packer in pharma- ceutical firm for 12 years then housewife until death lived in Dagenham 24 Fisherman fireman docker 1915- 39 at Tilbury docks fireman and finally storekeeper contact with | asbestos not probable at Tilbury docks lived Tilbury area "EG Weynty 78 Ps 1893 1917 | Necropsy ? Positive 1860 | | | 83 Feu >M } | ' * 1922 Necropsy Negative Negative | t . xan | Negative pe 81 P.3 1877 _ i : 1 1925 | Necropsy Negative | 80 M ! * 1936 | Necropsy Negative Negative ' ' f eap 1900 82 " ' 1893 | 3 ' H 1938 Necropsy Positive Positive *K. | ; || || yTet 77 P. eum 1910 1 1945 {| Necropsy Positive Positive | | | R oF ! 1878 : - * 1955 Necropsy Positive Positive epithades | See, Not traced Not traced | | Not traced Not traced | Not traced Not traced Not traced v \ A - tissue not available