Document 2RBpLyoBQNjZb66vjem0297o6

PLAINTIFF'S EXHIBIT ASA-672 -Asbestos Bodies in Human Lungs at Autopsy Dzidra Cauna, AID, Robert S. Totten, MD, and Paul Gross, AID 371 The incidence of asbestos bodies in the lungs was in products such as asbestos roofing, roof tiles, ceil vestigated in 100 autopsies of adults. Lung smears were ings, floor tiles, pipe and electrical insulation, car- taken from the sectioned surfaces of the upper and lower brake linings, cement, etc. Since asbestos is vir lobes of both lungs. The slides were dried and mounted tually indestructible they predicted that the without staining, and approximately 400 low-power fields amount of air-borne asbestos fibers in cities would were examined in each slide. Routine histological sections increase in the future and become a contaminant of of unexpahded lungs were also examined in all cases. As the air. They further suggested that the results of bestos bodies were found in 41% of the subjects. They life-long inhalation of these fibers might lead to were not encountered in persons up to 24 years of age. almost universal basal asbestosis in adults, and a Among males the incidence was 47%, and in females frequency of mesothelioma of pleura or peritoneum 34%. Although significant microscopic pulmonary fibrosis higher than that of bronchial carcinoma today. As was encountered in two positive cases, no instance of bestos has also been implicated as a possible factor classical asbestosis was found. Mesothelioma of the pleura was not encountered. Primary lung carcinoma oc See also page 419. curred in one patient with asbestos bodies and in one in' the development of carcinoma of the lung/ without. According to Doll5 the risk of developing a lung cancer is increased among asbestos 'workers, but Wagner and associates1 reported on the occur this is denied by others."'* rence of diffuse pleural mesothelioma in per As the United States accounts for Toughly over sons from a large asbestos mining area in tohnee third of the world's consumption of asbestos, northwest of Cape Province, South Africa. Since Thomson* initiated an investigation of the fre mesothelioma of the pleura was regarded as an un quency of asbestos bodies in lungs in Miami, Fla, common tumor, and was rarely seen elsewhere in where even higher positive "figures were obtained South Africa, they undertook an investigation of than in Cape Town. these cases. In ten cases, lung tissues were available Pittsburgh and its environs are free of asbestos for microscopic examination and asbestosis was mines, but it is a large industrial center with an found in eight. expanding modem building program. The purpose Thomson* reported seven cases of mesothelioma, of this.investigation, was to obtain -prelihunary' four in the pleura and three in the adjacent perito data on the incidence of asbestos bodies in the neum, encountered over a period of three years in lungs of patients who died at Presbyterian-Univer- the autopsy service of one teaching hospital in sity Hospital. Cape Town. In all seven cases the microscopic pic-, ture was that of pulmonary asbestosjs, with abun Material and Methods dant asbestos bodies and fibrosis in the basal por The work was carried out in the Presbyterian- tions of the lower lobes. Since only one of these University Hospital, which receives patients main seven patients had a history of occupational ex ly from the city of Pittsburgh and the surrounding posure to asbestos, Thomson and his associates' area. The material consisted of 100 routine autopsy undertook an investigation on the frequency of asbestos bodies in the lungs in general population of Cape Town in routine autopsies. Of 500 cases examined, 132 were positive for asbestos bodies. These results suggested that asbestos was becom ing a modem urban hazard. According to Thomson et al,' world consumption of this mineral had in creased from 300,000 tons in 1934 to 2,400,000 tons in 1961. It is used in a wide variety of industrial From the departments of pathology, Presbyterian-Univeraity Hospital and University of Pittsburgh School of Medicine (Dra. Cauna and Totten), and Industrial Hygiene Foundation, Inc., Mellon Institute (Dr. Gross), Pittsburgh. Reprint requests to 230 Lothrop St, Pittsburgh 15213 (Dr, Cauna), 1. Incidence of positive cases relative to age groups. JAMA, May 3, 1965 Vol 192, No 5 . Ill J ASARCO ELP 0002890 ASBESTOS BODIES--CAUNA ET AL * 373 2. Asbestos body intimately related to a macrophage. Unstained lung smear of 65-year-old white scrap-iron dealer (xl,736). 3. Asbestos body intimately related to a macrophage inside an alveolus. Stained lung section of 57-year-old unemployed white male (xl,736). contained coarse orange-brown granules, which also gave a positive iron reaction. Macrophages with these coarse iron-containing granules were also found in smears of six negative cases. In histological sections of lung tissues asbestos bodies were found in only four positive cases, all among the higher counts. These bodies were situ ated within the lumina of alveoli and were usuallypartly enclosed by macrophages as in the smears (Fig 3). Interstitial fibrosis of some significance was observed in only three cases, two of them with asbestos bodies (three and four respectively) in the lung smears, and very few macrophages with coarse granules. In the third case with fibrosis, as bestos bodies were not found, but macrophages with coarse brown granules were seen in smears and his tological sections. No case of classical asbestosis was found and mesothelioma of pleura was not encountered. Primary lung carcinoma occurred in one case with asbestos bodies and one without. The fate of asbestos bodies in the lung is as yet not known. According to Knox and Beattie,10 and Holt et al," the bodies disintegrate after a period of time producing a large number of fragments which are collected in phagocytes. In our material, macrophages frequently contained' coarse brown granules in asbestos positive and also in some nega tive cases. These granules gave a positive iron re action, and judging by their size, they could consti tute fragments of disintegrating asbestos bodies. However, since demonstration of iron in the coarse granules is not a positive identification of fragments of asbestos bodies, the question cannot be settled. On the basis of their experiments `with rats, Holt et al,n suggested that fibrosis of the human lung was not caused by asbestos bodies, but by small asbestos particles, derived from the break-down of these bodies. In our limited material no correlation between the presence of asbestos bodies or macro phages with coarse brown granules and pulmonary fibrosis was determined. The overall incidence in this Pittsburgh series of 41% asbestos positive cases substantially exceeds that of Cape Town with 26.4% and Miami" with 27.9%, the only two localities where this type of information is available for comparison so far. This may merely represent a difference in technique among the three groups or perhaps reflect a real difference in atmospheric pollution among the three cities. In any event the figures from these three widely separated urban- communities indicate that asbestos bodies are commonly encountered in hu man lungs. It is suggested therefore that studies of this modem air contaminant should be extended. This investigation was supported in part by Public Health Service grant HE-06675. References 1. Wagner. J.C.: Sleggs, C.A.: and Marchand. P.: Diffuse Pleural Mesothelioma and Asbestos Exposure in the North West Cape Province, Bril J Industr Med 17:260-271 (Oct) 1960. 2. Thomson, J.G.: Mesothelioma of Pleura or Peritoneum and limited Basal Asbestosis, 5 Ajr Med J 36:759-760 (Sept) 1962. 3. Thomson. J.G.; Kaschula, R.O.CL; and MacDonald, R.R.: Asbestos as Modem Urban Hazard, 5 A/r Med J 37:77-61 (Jan) 1963. 4. Iaseibacher, K. J.; Klaus, H.; and Hardy, H.L.: Asbestosis and Bronchogenic Carcinoma, Amer J Med 15:721-732 (Nov) 1953. 5. Doll. R.: Mortality From Lung Cancer in Asbestos Workers, Brit J Induetr Med 12:81-86 (April) 1955. 6. lama. A.J.: Pneumoconioeie, New York: Grune & Stratton, Inc, 1963, p 24. 7. Braun, D.C.. and Truan, T.D.: Epidemiological Study of Lung Cancer in Asbestos Miners, Arch Indutt Health 17:634-653 (June) 1958. 8. Thomson, J.G.: Asbestos and Urban Dweiler, read before the Conference on Biological Effects of Asbestos, New York, Oct 19, 1964. 9. Vassamillet, L.F.: Personal communication to the authors, Jan 15,1965. 10. Knox, J.F., and Beattie, J.: Distribution of Mineral Parti cles- and Fibers in the Lung After Exposure to Asbestos Dust, Arch Induet Hyt 10:30-36 (July) 1954. 1L Hoit, P.F.; Mills, J.; and Young, D.K.: Early Effects of Chiysotile Asbestos Dust on Rat Lung, J Path Bact 87:15-23 (Jan) 1964. JAMA, May 3, 1965 Vol 192, No 5 3. ASARCO ELP 0002891