Document 3eZxvBebvevrr8pQd40rNMBKJ

FILE NAME Household Contact HC DATE 1967 DOC HC014 DOCUMENT DESCRIPTION Medical Journal Article - Mesothelioma and Asbestos Exposure trolled animal expo a the literature in part by grant No. ppoirn tparet dby con- : of Air Pollution Ug } Mesothelioma and Asbestos Exposure Gases More Common cory Tract Arch Intern 2 Jan Lieben MD and Harry Pistawka MD Harrisburg Pa ter Effects of Gas Poi- | f totz W.C Permanent n Warfare Amer Rev 4 + 7 Indust Hyg 390 WITHIN the past five years several arti- cles have called attention to the association between mesotheliomas of the pleura and peritoneum with asbestos exposure.,, Wagner et al" studied 33 cases of meso- Sacconi and Coblenz give the incidence of pleural mesotheliomas as 1.1 cases per 1,000 autopsies Campbell reported four cases of pleural mesotheliomas in 3,533 consecutive autopsies.11 cidence of Pulmonary thelioma All but one had probable exposure Mesothelioma occurs primarily in adults Pulmonary re to Vesicant to crocidolite the blue asbestos and is twice as common in males as in fe- ed J 862 1939 4 Asbestos has become a ubiquitous materi- males.10.12 reported fases and Fumes Proc -4 alin our civilization Cauna et al" Pleural mesotheliomas ,, Chronic that asbestos bodies were found in the lung the right and left thoughocWceuirsesqmuaanllyfeeolns Gasesand autopsies 1 , 1954 , smears of 41 of 100 consecutive that pleural mesothelioma University sults of Gassing Med : at Presbyterian at the Presbyterian University Hospital Hospital in occurs on the right more frequently than on the left ine 4 Pittsburgh Similar findings were reported side.12 AccideBrnoot k- ine in | by Thompson".7 in 500 consecutive lung The criteria for diagnosis of pleural meso- nee Some Respiratory and oem mm smears from Capetown South Africa thelioma are presence of a firm pleural mass RespiratoryRespiratory s of Gas 4 t Miami Fla Asbestos bodies were found in encasing the lung histological structure The Long Effects 30 of the men and 20 of the women As- compatible with mesothelioma and absence 8. Amer Rev Reap Dis | bestos has been conclusively associated with of a demonstrable primary malignant neo- gens nic increased incidence of lung cancer and other plasm elsewhere The histologic architecture Pulmonary Insuffi- ES ers Disease Amer J malignancies and an increasing number may be mesenchymal epithelial or 4 of studies associate its presence with malig- ected Studies on the ing New Haven Yale nant mesothelioma of the pleura and perito- neum A complete autopsy is necessary for une- quivocal diagnosis but for the purpose of mting H Pulmonary to Phosgene Amer J Pathology this study criteria were made less rigid in that unautopsied cases were accepted if a dies on Experimental % Path 1037 1947 4 ine Massenvergiftung Deutsch Med Wachr Histopathology Histopathology R.G Histopathology 1 Path 544 1964 V.E and Hatch T q by Phosgene Arch Mesotheliomas of the pleura and perito neum are rare neoplasms Controversy involves histological types nomenclature origin and their very existence Recently mesotheliomas as an entity have become - generally accepted Their morphologic variability makes classification difficult and dif- definite diagnosis of pleural mesothelioma had been made by biopsy and malignancy elsewhere had been excluded clinically chest ray examination bronchoscopy and cytologic studies of sputum or bronchial washing assisted in excluding the presence of bronchial carcinoma Primary tumors of the peritoneum are . ferentiation from other malignancies is often among the rarest of tumors Generally called a problem mesotheliomas they form large spreading masses over the peritoneum and histologi- at be willing to areas and comthe action that haros of Alpha Submitted for publication June 6 1988 accepted Sept 13 e From the Division of Occupational Health Department of Health Harrisburg Pa | Read before the Ninth International Cancer Con- gress Tokyo October 1966 Reprint requests to PO Box 90 Harrisburg Pa 17120 Dr. Lieben cally appear the same as pleural mesothe liomas As with pleural mesotheliomas exclusion of a primary tumor is necessary . This study is an attempt to learn the extent of the relationship of asbestos exposure with mesothelioma diagnosed in southeast- ern Pennsylvania Arch Environ Health 14 April 1967 MESOTHELIOMA_LIEREN & PISTAWKA MESOTHELIOMA One hundred Method Method Tabis 1. Co; ReadCionsultannt gsof Pathologist Pathologist & population of hospitals Table Table One hundred 6% two hospitals serving No. and sixty population population hospitals serving Mesothelioma Goan? ; quested to 6million people diagnosed diagnosed oy Yes report mesotheliomas Not tisue between 1958 and were received received 3-0 tissue Replies records of re- Not Probably ficceptable acceptable not tissue Uissugl tissue from hospitals Hospital records mesothe- Probably tissue ts ewe Yes ported cases reviewed reviewed and mesothe- ay. not Probably liomas confirmed by biopsy au- Probably operation study Forty Forty tissue two Probably Yes not Yes ; tissue Ussue topsy included included included There cas^'s were were meso- Yes satisfied critera critera meso- Yes Probably not tissue tissue tissue 4 theliomas theliomas theliomas eight perito- tissue tissue Not acceptable acceptable tissue neum Among Among pleural the mesotheliomas mesotheliomas tissue tissue tssug acceptable pleural preponderance for occurrence occurrence Nssue | tissue tissue definite definite preponderance on Yes ye: tissue few? the right right side seven occurred pleural pleural meso meso occurred on the side Yes Yes not tissue tissue tissue tissue theliomas only side Probably Probably 25 and two were not stated tissue tissue Yes Probably Sections as many tumors lunge tissue : nes Sections possible and lunge a Yes possible consultant pathologbist opatrhologistropathologist wed reviewed reviewed a Probably PProrbabolybaacbcleypytaebsle No single otheliomas familiar with mes- lung Yes acceptable the instances instances which lung sections Yes Probably sections available available were examined lung tissue tissue not Ne sections presence asbestos bodies examined were Q be Metast Metast reviewed reviewed All glides complete Yes Yes No without history autopsy benefit available complete the lung X acceptable pathologists pathologists autopsy protocol available diagnosis acceptable lung tissue tissue acceptable who the original 4.X acceptable 3 lung tissue tissue Table our Results 33 cases reviewed reviewed Table by 5.X Anaplastic malignancy Probably pathologist pathologist pathologist agreed with outside 6.X not No 88 rejected seven 7.X lung histologically cases MesotheliomaMesothelioma pathologists had No tung tissue must as unacceptable unacceptable unacceptable histologically histologically serious 8.X Probably be proven proven No must doubts doubts nine cases one alide was Yes lung tissue tissue read metastasis metastasis one slide as anaplastic 10.X Yes No lung tissue malignancy and cases slide which lung tis- Yes iden- suemaligwnaancsy malignancy asbestos bodies were Exposure Ten Ten . Patient tified available - Worked With worked 35 department seven between the bestos plant The discrepancies and that of original large large 35 textile department of a than pathological pathological our patholo- 2-0 as. pathological diagnosis illustrate the difficulties Patients 20 gist reported which ytienet ars asbestos asbestos insulaptlanit oannd disagreements disagreements tumor Fwhoicrh are frequent in the tient an insulation pa- diagnosis one year insulation insulation plant only only diagnosis diagnosis diagnoses diagnoses of inclusion in this originally reporting 5-0 worked in i? 20 insulation pl1 ant manu- manu- diagnoses accepted and Patient pathologists pathologists pathologists pathologists ported pathologists cases re- them facturing Jinoleum - ant Sa railroad facturing acoustic boiler maker Jinoleuam investigated ported Efforts were made obtain Patient i ployment ployment and complete em where 25 years years years worked insula- residence yardwhere insula- engines ployment ployment Inquiry was history history each employmade made into employ- on on tion steam steam tion Patient 8-0 engines he ovens which large bakery ment ment history family contacts obtained obtained from individual individual Data fam- amounts of asbestos insulation insulation accountant accountant ily members members alive from fam- Patient Patient was who employers certified Of Of the worked more than accountant of patients patients ten definite asbestos 30 years office who tional exposure exposure asbestos during wloirfkeetirmse textile textile plant plasterer plasterer who came came in three three Patient were contacts contacts 10-0 was eight eight either lived in immeidmmieadtiaeteemnepilgohbyoer-d hood hood asbestos asbestos contact with large amount amount asbestos came in work with a men plants or had patients Of patients 1-0 8-0 10-0 10-0 . pal aes ; ,*r.etarial ve a 1-0 of a 188 or the ; 15 : yea Patient : expi in I expi stos exp! insu lived fo insu the insv worker 5-0 ha Patient worker expo : expo expr street death, hist etreet j Patient f hist from - conection connection fron Patients Patients } con | p thr con in thr plants mesothelio in 8 Patients Patients storage and . asbesto ba asbesto and text is lox Pattientsext Patients Patients text N is q m Mesothe 2-N Exp m, old engineer engineer ' utiliz 1,500 + 1,500 1,500 Patient Patient occup had plant ar worked ar + neighborb neighborb Patient at Patient any asbest worked years Th prior to Arch Environ Health 1967 lent 1-N was a 65- uever had any Vo1l4, April 1967 prior a years. Th prior to 1 s wt ney ne se MESOTHELIOM & pistTAWKA eas eos 561 insulfant Pathologist Asbestos | Bodies tiger. No lunlunggtissue Yes No Jung tissue Yes tissue Yas No lung tisstuisseue Yes No tung tissue tissue No lung No lung tissue No lung tissue No lung tissue No lung tissue No lung tissue No lung tissue J Yes 4 4 lung tissuetissue No No No Yes No lung tissue No lung tissue No lung tissue 4 No 3 No tissue 3 roven No lung tissue No lung tissue Yes Yes Soma Patients Who tient 1-0 worked 35 4 ment of a large as- worked more than ion plants and pa- tion plant for only in plant manu- linoleum taker in a railroad worked on insula- > ens in which large on were used * i 1 accountant who in the office of an rer who came in of asbestos in his 1-0 8-0 and 10-0 itoneum the othesotheliomas ent N was a 65- had any occupa- : 4 f ' : y mal asbestos exposure Her work was always cretarial she was born and lived until the age R 8 in the immediate neighborhood of an asstos textile and friction material plant where atient 1-0 had worked for 35 years From the Fe of 18 she lived for 30 years across the street om the plant where patient 6-0 had worked or 15 years Patient N a clergyman from 1935 until his death in 1961 never had any occupational asbestos exposure Prior to becoming a minister he lived for 19 years within one half of a mile If the insulation plant where patients 3-0 4-0 nd 5-0 had worked as insulation manufactur- Ang workers #. Patient N never had any occupational asbestos exposure except that 20 years prior to this death he had worked for one year across the street from the insulation plant mentioned in the history of patient N Patient N worked for 26 years across the street from the insulation plant mentioned in connection with patients N and N Patients N a nurse and N a meat distributor had no occupational exposure nor family contact with asbestos They both lived - within three fourths of a mile of two asbestos , plants in a town with the greatest incidence of mesotheliomas in this study E Patients N and N were both foremen in a storage battery plant A careful check of the ; plant and their employment records revealed no asbestos exposure past nor present The plant is located less than 1miles from an as- " bestos textile plant The exposure of these two cases is questionable Patients N and N had peritoneal and patients N N N N N and N had pleural mesotheliomas Mesothelioma Patients With Family Con tacts Exposed to Asbestos F a 3year child was the daughter of a ceramic engineer who worked in an insulation plant that utilizes 400 tons of Canadian chrysotile and 1,500 tons of South African amesite annu- ally Patient F a year nurse never had = any occupational asbestos exposure but her father had worked for 35 years in the insulation plant where patients 3-0 4-0 and 5-0 had worked and which was also credited with three neighborhood cases The nurse's brother also had worked in this plant for one year Patient F a year woman never had any asbestos exposure nor had she lived near an asbestos plant She had two sons who worked as insulators in a shipyard for six years These sons lived at home until 15 years prior to their mother's death Patients F and F had peritoneal and patient F pleural mesotheliomaa Mesothelioma Patients With Questionable Asbestos Exposure study of these ten men elicited either a relatively minor or questionable exposure to asbestos Patient Q was a welder for 35 years According to a common reference eight out of 12 welding electrodes contain asbestos which is used as a filler Patient Q was a employed Swiss Swiss cheesemaker A thorough study of the processes of Swiss cheese manufacture revealed no use of asbestos During the study of the manufacturing process a 500 boiler was no- ticed This boiler was covered with a friable asbestos insulation which flaked off on contact Patient Q a year boy with mesothelioma had no occupational contact with asbes- tos nor did any of his family On questioning the boy's father told the authors that his boy had lived with him and had helped him while he had replaced most of the plaster board during extensive remodeling of his house Plaster board contains a high percentage of asbestos Patient Q is employed in industrial sales and never had any occupational asbestos expo- sure Extensive questioning revealed that on two occasions several years before he applied asbestos insulation to boilers in his home mix- ing asbestos cement himself His total exposure during these applications was only a matter of hours Patient Q was a brewery worker for 20 years The brewery was no longer in business when the case was investigated Reviewing the literature of beer production the following paragraph was discovered When ready for packaging the beer is fil- tered through pulp filters consisting essentially of cotton fibers and asbestos After each filtra- tion this FILTERMASS is removed mangled and washed in clear warm water then bleach- ed and sterilized at 160 to 180 F with chlorine The washed pulp then goes directly to a padforming machine where it is compressed at 89 to 90 pounds per square inch to form new filter pads.14 containing pipe insulation is used in breweries Patients Q Q and Q were all steel| workers Patient Q was a crane operator Q a forger and Q a foreman and supervisor In all cases the companies did not recall any asbestos exposure for these men Pipe insulation containing asbestos is extensively utilized by steel companies Patient Q was a spinner in a silk company . Arch Environ Health 14 April 1967 4 x as a . fa aol ety 5s ste or pe- Nt TOS A - Sage AT= a A ROY = ALITY i I i ah ha : RATES NAEPRRL RP AN 562 ste MESOTHELIOMALIEBEN & PISTAWKA PISTAWKA from 1925 to 1938 and later in a plastic fabri- cation plant which utilized fiber glass he also Comment had been a welder for 25 years He has used asbestos but thinks he This study presents could not recall when and a good deal of circum where stantial evidence and Patient 10 a questions many unanswered 4 year man was a maker all his life He worked in two foun- Asbestos is a ubiquitous material dries in one of which asbestos cement is used in much more frequently than is used | | small quantities but according to the plant manager the maker did ized Some uses such as ingetnheerally real- were not brewery tact with this not have any con- previously known to the writers material The son stated that his There are undoubtedly father had used asbestos pipe insulation for pipes in the basement of many others If we assume that asbestos may be the their home several causative or trigger agent for malignant years prior to the onset of his illness and that mesothelioma in some of the he had done some sawing of this pipe insula above we must cases described tion material admit that the minimal All cases in this effect relationship and duration of liomas group had pleural mesothe- latent period are unknown The al occupation- Mesothelioma Patients Without besetxopsosure of the insulation workers or as- Exposure the other Asbestos 11 patients X to 11 textile workers were thousand times higher thancertthaoisnely many X no occupational familial or neighborhood asbestos exposure evidence could be of the neighborhood cases or family contacts Simi- Ten of these patients had elicited lar findings have recently been pleura and mesothelioma of the from England.,, reported one peritoneal mesothelioma The attack rate for mesotheliomas is ex- Clergyman Patient N i ke p Patient N Q- N it === =" be Other Industry Asbestos Plant RE . OT Nurse TP Patient F LE _ Ae _. STREET ~ Mee Occupational neighborhood and family contact TG insulation plant patients with mesothelioma associated with one Arch Environ Health 14 April 1967 ~ . eo F ad deal of circum s material is generally real- { : in the brewery iny others tos may be the : for malignant "cases described 4 at the minimal : 3 1 duration of a The occupation- workers or as- certainly many In those of the c" ontacts Simi- been reported theliomas is ex- MESOTHELIOMA & PISTAWKA 508 emely low Not all mesotheliomas were recorted corted to us by the hospitals but even if we tients no history of asbestos exposure could be obtained Fi ouble the incidence only a minute fraction K the exposed population was affected References here are precedents for this with beryllium isease which acts in a somewhat similar 1. Newhouse M.L. and Thompson H MesotheLioma of the Pleura and Peritoneum Following Ex- attern occupational diseases familial con- facts neighborhood cases plus a very low attack rate and a long latent period be- tween exposure and onset of disease Another question which arises is why pleural pleural pleural mesotheliomas are so much more frequent than peritoneal mesotheliomas The most striking finding of this study was that of the 42 mesotheliomas which came from a geographical area of approxi- mately 30,000 sq mi six were clustered in and around an insulation plant Figure These included two insulation manufactur- ing workers Cases 2-0 and 3-0 three neighborhood cases Cases N N and 4- ( N and one family contact Case -the daughter of an insulation worker Summary posure to Asbestos in the London Area Brit J Industr Med 261-269 1965 2. Hourihane P.O The Pathology of Mesothe- liomata and an Analysis of Their Association With Asbestos Exposure Thorax 268-277 1964 3. Selikoff I.J Churgh .; and Hammond C Exposure to Asbestos and Mesothelioma New Eng J Med 560-563 March 1966 4. Wagner J.C Bleggs C.A and Marchand P Diffuse Pleural Mesothelioma and Asbestos Exposure in N.W. Cape Province Brit J Industr Med 260-271 1960 5. Cauna D Totten R and Gross P Asbestos Bodies in Human Lungs at Autopsies JAMA 371-373 May 3 1963 6. Thompson J.G Kaschula R.O and MacDonald R.R Asbestos as a Modern Urban Hazard S Afr Med J 77-81 Jan 1963 7. Thompson J.G Asbestos and Urban Dweller read before the Conference on Biological Effects of Asbestos New York Oct 19 1964 8. Doll R Mortality From Lung Cancer in bestos Workers Brit J Industr Me~ 12:81 1955 As- Forty cases of mesotheliomas report- ed from 152 hospitals over a year peri- od were studied with regard to exposure to asbestos Survivors or employers or both were questioned regarding the possibility of ; asbestos exposure Ten patients actually worked in asbestos plants eight lived or worked close to an asbestos industry three patients were family members of asbestos workers In ten patients a history of as- F } sumed exposure to asbestos was obtained ' after prolonged questioning In 11 other pa- 9. Lieben .: Asbestos and Malignancy Arch En- viron Health 619-621 Nov 1966 10. Sacconi A. and Coblenz A Endothelioma of the Pleura With Report of Two Cases Amer J Clin Path 186-207 1943 11. Campbell W Pleural Mesothelioma Amer J Path 473-487 1950 12. Weissman H Primary Endothelia of the Fleura Dis Chest 562-570 1946 13. Lyman T. ed Metals Handbook 1. Properties and Selection of Metals ed 8 American Socie- ty of Metals 1961 p 5 14. Modern Chemical Processes New York Rein- hold Publishing Co. 1952 vol 2 p 167 aS s Nurse i Patient F _ d with one DISCOVERY OF QUININE conquistadors quick known in ancient times were apparently apparently discovered by acci Many of the drug sources old South American Indian legend the curative dent For example according to an for malaria was discovered by a sick fe- power of cinchona bark containing quinine his thirst by drinking from a pool of verish Indian lost in the jungle He quenched that it was tainted with the water From the bitter taste of the water he recognizedrecognized from the quina quina tree Although he shared this fictitious belief he drank poison death To his great surprise he recovered completely deeply so as to bring about a quick he told the store of his cure and thereafter cinchona When he returned tomheidsicviinlelagfeor the fever prevalent in that region The Incas later bark was used as a conquistadors that malaria could be cured with cinchona extract. taught the Spanish of Serendipity in Medical Discovery Trans Rossman R.E The History and Significance Call Physicians Phila 104-120 Oct 1965 Arch Environ Health 14 April 1967