Document 4JokaeOr5JwZ5aj8mOOanmaRV
FILE NAME Brakes BRK
DATE 1965
DOC BRK025
DOCUMENT DESCRIPTION Journal Article - Mesothelioma of Pleura and
Peritoneum Following Exposure to Asbestos in the London Area - British
Journal of Industrial Medicine
B. J. industr Med 1965 22 261
2. D. Svirhely 11 11 Jer PJ and Mitche 1 Dangers of Toluce missible missiblmiessibcloencentrate concentrate concentrate
J. Oil Colour Chemi
,
. 38 129
Hollingsworth R.L
14,387 14,387
*
Thuis )
MESOTHELIOMA OF PLEURA AND PERITONEUM FOLLOWING EXPOSURE 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
whendn
from the London Hospital with a diagnosisdiagnosis of mesothelioma confirmed by
A series of 83 patients
to asbestosasbestos The series consisted of 41
Anad, necropsy or biopsy has been studied forhapodsspiebrlietoenxepalosaunrde 56 pleural pleural tumours The earliest death
men and 42 women 27 of the pa1t0ieonftsthe series died before 1950 1950 and 40 48 between 1960 , and
recorded recorded was in 1917 but only
oes
1964 ARE
occupational and residential histories were obtained Forty 52.6 gave
In 76 of the series full occupational
to
EAL a history of occupational or domestic domestic living in the same house as an asbestos worker exposure
asbestos compared with with nine 11 % out of 76 patients from the same hospital suffering from other
diseases P < 0.001 None of of the 17 suspected cases of mesothelioma rejected on pathological .
found to have had any exposure to asbestos There was also evidence that neighbour-
grounds was hood exposures may be important
Among those with no evidence of occupational or domestic
with other diseases
30 %
of
the
mesothelioma
patients patients
and
7.6 %
of
the
patients
elixvpeodswuirtehsin half a mile of an asbestos factory ( P < 0.01 Out of the 31 patieonfts19w3i1t.h oTchceupaitntieornvaall
exposures only 10 were inin jobs scheduled under the AsbestiollsneRssegouflmaetsioontshelioma ranged between
of between first exposure andand the development the terminal
16 and 55 years
was available for examination
In 47 patients in the mesothelioma mesothelioma series lung tissue or sputum
^'
In 30 62.5 % either asbestosis or asbestos bodies were present
In recent years the association between exposure among the women 25 had pleural and 17 peritoneal
to asbestos dust and cancer of the lung and other malignant neoplasms has been the subject of much research leading article 1964 Wagner Sleggs and
cee Marchand 1960 described the occurrence of mesothelioma of the pleura in those exposed to crocidolite
(tence asbestos in the mining districts of South Africa and this has stimulated further studies of the occupa-
aed tional histories of patients suffering from this tumour
rene Owen 1964 Fowler Sloper and Warner 1964
The present investigation concerns patients in
en whom mesothelioma had been diagnosed at the
me London Hospital during the past 50 years After
i examining the necropsy and biopsy specimens held
i
tumours
The aim of this study has been to establish the occupational histories of these patients and to trace any other possible exposure to asbestos There were four surviving patients at the outset of the investigation but these have subsequently died The earliest date of death in the series was 1917 10 died before 1950 33 between 1950 and 1959 and the remaining 40 in the past four and a half years The youngest patient died at the age of 33 and nearly half were dead before the ave of 55 Table )
Clinical Features
;
+
in the pathology department Hourihane 1964 con-
available
firmed a diagnosis of mesothelioma in 83 patients
The ward notes of 65 of the patients were
and 42 women Thirty of and give a picture of a disease with a consistent
of whom 41 were men
the men had pleural tumours and 10 peritoneal
symptomatology symptomatology
Among those with pleural
"
ore
seamen
see
petty
SEXO opt meee~
as
ed
eaten
E
* .-
5 e2
aehe
Pe
qs F
3,7
4
a
ca
arp
woe
corges
262
BRITISH JOURNAL JOURNAL OF INDUSTRIAL MEDICINE
fee
ened,
St
thsethan
Mb
wid
corti
' .
ws
Dantes
s,
TABLE 1
AGE AF
DEATH
OF 83 PATIENTS WITH TUMOURS
MESOTHELIAL
i Age yr |
No.
a
+134
2
35-
7
45 |
15
| 55
10
65 ! 7
Male
|
1 i
|
| a
| % _
49 17
|
366 |
2 17 4
i
Female
No.
! 6 9 18 8
j
|
n
_
\
24
14
21
| 429 19
i
gM patient the notes had been returned to the local sant
executive council of the National Health Service wale aLroenasdoannt| where they were destroyed within a period of three OEEE was take
years
deg date of a
In one of the asbestos factories a file was kept with
with the
pee _ detailed records of all employees since it started in
r
places of
1913. The names of all patients were checked with
SN these files Nine men and nine married
for comp
women after
their maiden names had been ascertained from rela-
Ctr tives were identified without difficulty The exact
naka
tumours the commonest
dates of employment of these 18 patients and the ANE Details
ete
presenting symptom was jobs they had done were obtained from the
the rapid onset of extreme shortness of breath due
records
series are
a hee
to the formation of massive pleural effusion Pain of the factory
ATA
about pas
DE was a prominent feature either described as a dull The four patients alive at the beginning of the available
motte ache sometimes due to invasion of the ribs
investigation were interviewed personally A few
6,40 52
vertebrae or sometimes
or relatives were contacted by post but the relatives of
rete, sharp and radiating sugSan gesting nerve involvement
68 patients were interviewed by one of us H.T. at
_ compared Sane series
Bacoshe wall were not uncommon Tuomccouurrrsingin etihtehecrhesitn their homes situated mostly in the East End of T
of a
previous operation scars or by direct invasion of the London Not only was an occupational history the nee
op
ER
chest wall The symptomatology of the peritoneal patient the spouse sons and daughters and father
ve
tumours was more varied In
taken but past addresses were also recorded
The ne
Rene Y
some patients the pre- interviews lasted for at least an hour To recall
TYPES OF
see
senting symptom was pain on defaccation or of 30 or 40
events
WITH MESS
micturition Diffuse upper abdominal pain was
years ago it was often necessary to
Pie
G,
very explore the residential and
act
common and swelling of the abdomen due to ascites
occupational histories of
EDM *
all members of the family
Type
e n was always present terminally The methods of gy
pneumonectomy 7
treatment included
decortication
pteA
of the lung deep ray therapy instillation of
Exposure to Asbestos in Three Groups of Patients
Employed
Sat active gold and cytotoxic drugs They wereraudsieod- Suffering from Other Diseases Defiancvteorreyd g-
.
Bn AERO Ae alone or in combination but had little effect on the
For comparison with the
course of the disease Half of the patients suffering from pleural mesothelioma died within
mesothelioma patients
three further groups of patients suffering from other
Employed
factories
one year of diseases were investigated
Insulators f
oe cea, the onset of symptoms a further third within two
The first group was selected from the patients in
Relative wo
ytheraeres and onlTyhoene patient survived for more than the medical and surgical wards of the hospital during Nena Dockers >.
meal years
course of those with peritoneal the carly summer of 1964 patient series Each
Cargo
hak
tumours appeared to be equally rapid Eight of the patient in the mesothelioma series who had been
No history
F ate spaytmiepnttos msdied within six months of the onset of traced was matched with an patient of the same daosmbeessttioc
ap
sex born in the same year period As there was
ean
Sources of Information
a dearth of male patients over 75 years of age in the
Positive . his
aet k on Occupation and Residence hospital a sample of six patients of this age and
positive
FN
older was taken from a
In addition to the ward notes some of which gave hospital
neighbouring geriatric
Seven cu from this t
Shairemece good occupational historics there were three other
The second
a
sources of information the patient's general practi- been filed
group were those who had originally
tioner the records of an asbestos factory in the
in the pathology department of the
statistica
wnet
and personal interviews with
area hospital as cases of mesothelioma but in whom the
0-001 1
surviving relatives
patients or their diagnosis was subsequently rejected on pathological
by the tw
As first
grounds by Hourihane 1964 rejected series As
of
step general practitioners were circulated it had proved extremely difficult to locate the rela-
year
with an explanatory letter asking them to complete tives of those who died before
significar
a form giving details of the occupations of patients made only to trace the three
1950 attempts were
or in the
1
and their immediate relatives Within two
survivors in this group
and thos
months and the 14 who died after 1950
eS 65 of the doctors had replied In two cases a
The patient series already described
ace paring t
all
tee
hitherto unknown exposure to asbestos was revealed admitted to hospital in 1964. The
were
mesothel
a in others the name and address of surviving relative mesothelioma
patients with
of the c
a were given but in the majority the doctor was unable
were admitted to the same hospital over a period of 47 years during which there might
gave h This dif
to give information because on the death of the have been a substantial change both in the residential
h
x 11
tae
beat wee
A VAS
perake
to the local Wealth Service period of three
was kept with
ce it started in ^ checked with d women after ned from relaty The exact ients and the m the records
inning of the nally A few
he relatives of
us H.T. at
East End of
Thistory of the
rs and father ccorded The recall events
necessary to al histories of
is of Patients
Nt
oma patients
ag from other
he patients in ospital during series Each
ho had been of the same As there was
of age in the This age and
ang geriatric
nd originally
ment of the in whom the
| pathological I series As
ate the relatempts were in this group
hed were all Patients with
ame hospital there might
he residential
te MESOTHELIOMA OF PLEURA PLEURA FOLLOWING FOLLOWING EXPOSURE TO ASBESTOS 263
te
areas and social classes of patients attending the London Hospital Thus a third group of patients was taken from the hospital records matched by
Table 3
EXPOSURE TO ASBESTOS OF CONFIRMED AND REJECTED REJECTED CASES OF MESOTHELIOMA SURVIVING SURVIVING AFTER JANUARY
1950
- date of admission as well as date of birth and sex
nk with the patients in the mesothelioma series Their nweee places of residence and occupations were extracted te for comparison with those of the patient series
te
Results
Sem Details of the 83 patients in the mesothelioma
series are given in the Appendix No information about past domestic and occupational histories was water available for seven patients Among the remaining
76 40 52.6 gave a history of exposure to asbestos compared with only nine 11-8 of the patient
series Table 2 The difference in this proportion is
| Exposure to Asbestos
i
Exposure positive
i
On
ee
No work or domestic contact |
found
|
Untraced
|
Diagnosis of Mesothelioma
Confirmed
i
36
'
H
{
35
i
I
H
Rejected
0
16 1
= 1183 P - 001
Mesothelioma Series
Occupational Exposures are details available for the 18 mesothelioma patients who had
worked at one asbestos factory which used croci-
dolite asbestos with small amounts of chrysotile and
TABLE 2
TYPES OF EXPOSURE TO ASBESTOS OF 76 PATIENTS WITH MESOTHELIOMA AND 76 PATIENTS PATIENTS WITH OTHER
ate
DISEASES
Hk
diene
Type of Exposure
{
Miche . "
at
i OE Employed at one asbestos s
tae
factory
he Delivered goods to factory
a
re Employed at other Jactories
Ae
Mesothelioma Series
No jf
! 19
Py
H
|
+
H
% 25
patient
Series
No.
%
.
| {
1.3 1.3
first introduced amosite in 1926 Eleven started
work before 1933 the year when the asbestos regula-
tions controlling the manufacture of asbestos goods and the protection of asbestos workers became effective and seven started work between the beginning of 1933 and the end of 1942. The occupations of these workers and the type of asbestos they
used are shown in Table 4. All of the 17 for whom details were available had used crocidolite asbestos
Five of the occupations listed are not scheduled as
Insulators and laggers
!
8
10 |
4
53
TABLE 4
Relative worked with asbestos
" ' ris |
I
13
Dockers cargo
handling
asbestos
i
0i
H
|2
| 4
26
_
\
|
No history of work or
| | domestic exposure to | }
asbestos
1
30
, 47
67
i 882
|
Positive exposures to asbestos in mesothelioma series Versus
e positive histories in patient series 12-27 12-27 11 < 0.001
een * Seven cases of mesothelioma could not be traced and are omitted from this table
JOBS OF 17 PATIENTS WITH MESOTHELIOMA EMPLOYED AT ONE ASBESTOS FACTORY
Statutory
Obligations
Subject to regulations
;
7
|
Joh
| MaleMale
| Spinning
0
;\
Carding
Carding Carding
t
1
1
| Clothing and
\
weaving
1
t
; Disintegrating
Yo
and opening
2
| '
I
.
7
|
Female Female
Female
\
MaterMatierialal
t
i 4 |H Crocidolite
' 1
Crocidolite
Crocidolite
| :
Crocidolite
|
| 0 ,
chrysotile
amosite
1
|
| | I
Crocidolite chrysoule
'
ama osite mosite
statistically highly significant ( > 27-11 <
0001 This result unlikely to be unduly influenced by the two groups of patients not being matched for year of admission to hospital since there was no significant difference either in the areas of residence or in the occupations of the patients admitted in 1964 and those admitted between 1917 and 1964. Comparing the confirmed and rejected patients in the mesothelioma group who died after 1950 36 50
of the confirmed and none of the 17 rejected cases
gave a history of exposure to asbestos Table 3 This difference is statistically highly significant
x 83 p 0.001
} Filter making
| For
ARP ARP
| { jo
masks
i
2
i
0
Crocidolite
|
i Manufacturing
ot preformed |
pipe insula
t
j tion
|i
j
}
1
| Crocidolite
Not subject to Manufacturing
regulations
of
brake
bnings
|
i
|1
{ Rubber com- |
pounding |
0
|
General
i
labourer
|
t
{
i
|
0
Crocidolite
Crocidolite
i
chrysotile
Crecidolite
0
;
chrysotile
amosite
'
!
Employment Employment history not available for one female patient
recsavon
Oe ss
iar
feces
eT hand
TREhe!
yePee
eroainteyyVelngy a
va
yt
aCSLE
tae
act PLASyon
I
e rie
aR
Bee
*
wh
Ip
ctsnever
Aas
Tart
EE
ars
Fk
CPR F
Spt
satis
Me
264
BRITISH JOURNAL T INDUSTRIAL MEDICINE
HMS
VM
requiring medical supervision under the Asbestos
Regulations 1931
Four patients were working at other factories making all types of asbestos goods One had been employed in a wagon works sawing asbestos sheets for partitions 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 of lagging one in a power station one installing hospital sterilizing equipment and one installing central heating All
DISEASE
GROUPS
OF
TABLE 5
PAINTS SERIES
Disease Group
Cardiovascular Cardiovascular Metabolic
endothelial including
anaemias
intestinal excluding cancers
Respiratory excluding cancers
All neoplasms Other
Total
IN THE
No
Patients
21 9 8 6 3
18
76
9,
PANM PATIENT No with ae
Exposure to Mt
Asbestos
NL
;
03 PEE
|
22 AN
0 i
i ASE
9
ON
were consistently employed on this type of work for more than 20 years but in some exposure to asbestos was intermittent
cerns thelioma and the 67 patients in the patient
NE series who had neither an occupational exposure
Domestic Exposures group of nine seven
nor a relative living in the home working with Oa asbestos might have been exposed to asbestos dust Fe
women and two men whose relatives worked with
asbestos are of particular interest The most usual
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
*
white with asbestos every evening for three or four
because they lived in the immediate vicinity of an OP
asbestos factory
ee
One factory where more than fifth of the
mesothelioma patients were employed opened in cceean ge
ee 1913 having been situated nearer the centre of
London for the previous seven years There were oL
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
three affected female patients living within half a
eapie mile of the factory during the time it was in produc-
tion at its first site
SL
When it opened they were
children between 5 and 7 years old At the present OEE
site there were eight patients living within a half-
mile radius ofthe factory One man was born within
INEM a quarter of a mile of the factory and remained at 9
mn, the same address for 16 years The other seven were
women and all except one were children when the
canted iron girders until 1948 when he worked as a loader factory opened The seventh was 23 years of age and
of groceries in the docks for five years but never on remained in the same house until she died 48 years A
dusty cargoes and then returned to sawing iron
a Tier girders He died in 1956 of pleural mesothelioma
later She is the only patient who had neither occupational nor household exposure but in whom
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
asbestos bodies were found in the lungs at necropsy eae
ei, Among the patient series one patient lived
near the factory at its previous site and four others
Ee 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
MOR) impartially about the dust from the asbestos factory
and the rats in the house
AMA
time throughout their working life
Att The diagnoses of these patients have been grouped pe into seven categories Table 5 The patients with a
TABLE 6 RESIDENCE OF PATIENTS WITH NO OCCUPATIONAL OR
DOMESTIC EXPOSURE TO ASBESTOS
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
Series
Lived Within
sg 1 mile of
| | Bien Asbestos Factory
Lived More Than |
mile from
| Asbestos Factory
tAsbestos
-
No.
.
Total
Neighbourhood Exposures of Mesothelioma and
Mesothelioma
-
a
patient
! 25
69
36
+
| [ene
.
62
925
67
patient Series 36 patients with meso-
785 001
MES
Thus amor domestic expos
patients in the in the patier
of an asbestos difference in u series who live had no other
significant x
Date of First in Mesotheliom had been exp lived near the of ex osure var to over 50 yor exposure and d
mean 37.5 yet workers where
interval was si group living i factories whe lowest Table at first exposur death in each g
*
RELATION BET OF INTERVAL
Type of Exposa
Factory work Domestic Laggers and insulate Living in neighbo
hood of fictory
varied between death showed group of facto years in the o
Asbestos B. thelioma Series thelioma series examination in all certified as tissue available revealed the pr Both asbestos
*
asbestosis were
and laggers A
asbestos bodies
ons
ee
Fhe
ot Saha ES RR Te
PATIENT
yt
No
No
Exposureser
1
Asbettes
|H
1
;
:
:
2
j
0
1
.
4
i
in
patient
patient
al exposure
orking with
bestos dustdust
cinity of
_
difth of the opened in centre of There were
thin half a in produc-
they were
the present in a half born within emained at
seven weTC
when the
of age and 48 years
ad neither
i in whom
necropsy tient lived
our others is 22 years od 1915
omplained zos factory
IONAL OR
:
a i
{ 36
1,7
Sanne
those with no occupational or
Thus among
to asbestos there are 11 30-6
restic expthoesumreessothelioma series series and five %
Sents in
series who lived lived within half a mile
patient
in the area Table 6 The
an asbestos factory
of patients in the two
ference in the proportion of the factory and had
ses who lived in the vicinity
to asbestos is statistically
no other exposure
alficant
alficant
P xx77 .. 88 55
< 001
tissue was available in Oty BASAET |the
Lung
by living in the
exposed either through relatives relatives or
In two
neighbourhood of asbestos factories
neighbourhood
present in lung tissue but there
asbestos bodies were present
was no evidence of asbestosis
TABLETABLE 8
BODIES OR ASBESTOSIS
EVIDENCE OF ASBESTOS
WITH LUNG TISSUE
CASES
OF
MESOTHELIOMA
FOR
EXAMINATION
SPUTUM AVAILABLE
IN OR
First ESxeporsiuerse and Asbestos | | Available Mesothelioma : Date of
Interval Before Death Fifty men and women
exposed been
to asbestos including those who duration duration
History of
Asbestosis or Asbestos Bodies
Lung
Contact
Present Present
Absent
not Available
-
A
a
633
pn
23
main
| The duration Positive main
factory
The
factory
22
ed asbestos factory | 4 633 13 . near thethe main
from two months Untraced
'
varied widely ranging
Untraced
| exposure
The interval between the first -
| 17 36
30
| 2 over 50 years
Total
t
and death varied between and 55 years
posure
37.5
Among the group of factory
mean 37.5 years
was probably heaviest the
definite
Among the 12 patipatients ents iin n whom no definite contacta
workers where exposure
the
shortest It was longest among
with asbestos could be established there was one
probably Gervalliw viansg in the neighbourhood neighbourhood of the asbestos
from South Africa whose lungs merchant seaman
bodies and asbestosis he may
youp
to dust was
actories
actories
where
exposure
showed both asbestos
at sea
Table 7 shows the mean age of each group , have had contact either in South Africa or
west
and the mean of of the interval before but his early history could not be established There
first exposure
the the length of interval
three others in this group who had asbestos
Although asbestosis ath in each group
were
bodies in lung tissue without evidence of could not be
rea Of the seven patients whose histories
histological nr
TABLE 7
traced three had asbestos bodies and
EXPOSURE AND LENGTH
of asbestosis and one had asbestosis alone
BETWEEN
RELATION BETWEEN
TYPE
IN 51 PATIENTS IN
evidence
a OF INTERVAL BEFORE
BEFORE DEATH SERIES
MESOTHELIOMA MESOTHELIOMA
Discussion
q
| | Type of Exposure
| Factory work
| Domestic work
and neighbour- Laggers | | hood of factory
| Mean Age at
Exposure No. \ First years
|
23 225
23 |
179
156
By
nN
85
:
Mean Interval
between First and
Exposure
years
294 37
38 4
48 6
29-4 and 48-6 years the mean age at
saried between
it was 50 6 years in the
death showed lessless wvoarrikaetrisonand between 55 and 57
group of factory
' years in the other groups
with nw
Bodies and Asbestosis in the Meso-
Asbestos
Series Of the 83 patients in the meso-
- thelioma
available for
thehoma
thehoma
series
series
lung
tissue
was
In four other patients
examination in forty
" all certified as suffering from asbestosis no lung
examination of sputum during life
tissue available available
bodies Table )
revealed the presence of asbhistologeical hsitsotoslogical evidence of
* Both asbestos bodies and in 15 of the 24 factory workers
asbestosis were found
A further five showed evidence either
and laggers
in patients
25 In thethe
series mesothelioma
series
are
25
there are
patients in
could
mesothelioma asbestos whom no evidence evidence
any exposure to
of a
information found A chief source of
was
be A
relative surprising history taken from surwvaivsinogbtained but in some of
of
amount information interviewed the memory may have been defec-
those
short periods of
tive or they may not have known of
during the youth of the deceased For
exposure
was eventually identified
example one of the patients
factory for two
as having worked at large asbestos before he married and
months in 1941. This was
It is of
his widow did not know of this episode
were found
interest that asbestos bodies in the lungs
four of this group and it seems probable that
in only
those who had had
among the remainder there were
no exposure to asbestos
both in-
In the mesothelioma series of patients
dustrial and industrial exposures were recog-
nized Among the men the exposure was pre-
dominantly industrial 22 worked in asbestos
two were exposed at home
factories or as laggers
the
and one lived near the asbestos factory Among
women only 10 worked in asbestos factories and a
asbestos bodies or asbestosis
1
.
a
we
&
Ri?
,
^'
.
Paces
: gt
Ee teme Sy an
aE?
ates Se
oe
rd
-. --
.
5
es Ste Ah bea 2 : :
266
BRITISH OURNAL OF
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 proportion 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 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 inpatient 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 disease 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 rehable histories
were obtained than was possible from the relatives
ofthose who had died of mesothelial tumours There
was no evidence that because of their more recent
admission to hospital the patient series was less
oR
INDUSTRIAL MEDICINE
RAE
RM likely than the mesothelioma series to work in con-
tact with asbestos or to live in closer proximity to
ATER asbestos factories There seems little doubt that the risk of meso- a
thelioma may arise from both occupational and et Ue
domestic exposures to asbestos Wagner and others
aA 1960 described patients with no exposure other
than living as a child in the vicinity of the asbestos bet
STN mines A high incidence of asbestos plaques of the he
pleura has been found in the population living near
an anthophyllite mine in Finland Kiviluoto 1960 a
TO 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 ae asbestos is used in quantity
are
We should like to thank Dr. D. O'B Hourihane for eo his operation and for making the results of his +
investigations available to us
earned Our thanks are also due to Professor C.
Professor V. W. Dix Dr. N. Rusby and
Wilson Mr. G.
Gee Flavell F.R.C.S. of the London Hospital and Dr. C. P.
Silver of St. Matthew's Hospital for permission to inter- view their patients to the general practitioners who col- ae
laborated in this enquiry to the managements of the
ne asbestos factories for arranging access to their records
to Miss Joan Walford for statistical assistance and to Dr. C. Gilson Professor R. F. Schilling and Dr. W. Smither for their advice and help
The contents of this paper were communicated to the
Conference on the Biological Effects of Asbestos
arranged by the New York Academy of Sciences in a
October 1964 and will be published in a shorter form
in the proceedings of that conference
Fowler 211 Pe REFERENCES
PBS PBS , Sloper C. and Warner E. C. 1964
,
,
211
Brit med
Leading article 1964 Thud , 2. 202
Hourihane D. O'B 1964 Thor ix 19 268
Kiviluoto
1960 Acta ruched Stockh } Suppl 194
Death G L. 1969 O ap Hin and ) 16 119
Fel Owen W. Glyn 1964 med J. 2 214
Wagner J. C. Sleggs CA. and Marchand P. 1960
Brit J.
industr Med . 17 260
I
eng
MESOT
Case No.
i
Site of Primary Tumour
|
|s
Section A Factor wor
;.
8
Pleura
>
19
Peritoneum
' t
18 Peritoneum | i I'
24 | Pleura
14
Puttoreum
|
i
16 | Peritoneum
'
13
Peritoneum
'
i
= | Pertereum !
\ \.
1 t '
15 [ Peritoneum
9 { Peritoneum
:
Pleura
1 Peritoneum
t
5 | Peritoreum
j
| \
7 Peritoneum
' .
:
2
Pleura
20
Peritoneum7
17
Pleura
6 i Pleura
10
Peritoneum
I
Pleura
23 Pleura
'
3 | Peritoneum |
4 | Peritoneum
Appendix opposite
MN
Section B Laggers and 25 Pleura
'
28
Pleura
ah
Maer 22
Pieura
Uo
30
Pleura
Sago
27
Peritoneum
OR
|
'
26
Peritoneum
1 31
Pleura
on
PT 29
Picura
AM
3
g
3
a
4
iS
Te cn 4 TOE
ERMINE
I
IL I eT TT OT ee A TE ee
Ns
in
rk in con-
Oxanty fa
APPENDIX
APPENDIX
APPENDIX
EIGHTY THREE PATIENTS WITH MESOTHELIAL TUMOURS
of mesomesos s ional and and and others are other other asbestos
\
|
'
| Dura-
|
Pathe |
|{ BirBthirYetahr |years | in | Symptoms 10 in | ||| 7150
Site of Primary Tumour
1 Year
Year | tion
of ft of
Year
Sex
First Expo- of Birth Expo- sure Death \
| ! sure
i
i
i
i
|
How Dingnosed
1 Asbestos
Jogical | Survival
Bodies
Evidence |
from
| in Lung i of As- i Initial i
Tissue | bestosis Symptoms
Lung
months ;
|
Tissue j
A
|:
_
Relevant History
on A Factory workers
ues ues
\ ues
ofof the the
Pleura
|M
1901
| | ing near
| 1960 to ,
1960
219) Peritoneum
{
M
1895
t
1921
17
1919 4 22
usk to the the f f asbestos ds ds where where
uhane for uhane its of has
i i \
{ 18 | Peritoneum } F 1908
1925 ,
5
i; i
1
.
i
H
| | 24 Pleura
M
1880 1928 12
;
| 1906 ! . : 11889933 14 Peritorium ,
F 1893
{
H
1917
?
16 | Peritoneum
F 1906 1922
7
t
i
,
i
\
|
i
1938 ; | Necropsy Positive
Positive |
H
1941
|
| Necropsy Positive '
Positive |
|
:
1
1947 | Biopsy
j Positive | A
| | ,
1 sputum
:
|
, 1950 Necropsy| Positive
Negative |
:
1951
|\
|
Necropsy Negative
Negative
|
|
{
...
951 Biopsy
| Positive | NA
|
i
sputum
|
,
WilsoWnilson
Mr
Dr.
C.
P
a to inter-
> whwho o col who ofof its
1 the records
'
| j
> W300 Peritoneum
:
| I
Peritoneum
||
i
\ 15 Peritoneum |
H{
9 -
Peritoneum Peritoneum Peritoneum
| :
21 | Pleura
1
| 4
2 12
t
Peritoneum ;
F|
|
F
:
!
M F
1894 1894 1895
1901
1897
1897
|
H
H
' 1 1915
i
5
'
| 1917 | |
i
{
H
{
H
7 1918 | 141
\ 11991199 bo,
!
1955 | Necropsy
H
1955 | Biopsy |
i
Positive
Positive sputum
1955 |
{ 1956 1956 A 1956
Biopsy
Positive
sputum
NeNecropcsy ropsy , PosPiotisvietive
1893 |
}
>
1918
,
1923
1937
i
1957 Biopsy
i
2 1958 ! Biopsy
N A
Positive
Positive
A
A
Negative Negative
NNeegagtiavetive
A N {
,
| Brake liner boiler coverer asbes-
Tox Tactory ; mainly crocidolite
?
Disintegrator and otner jobs
asbestos factory amosite croci-
' dolite chrysotile
Sectional pipe maker asbestos
1 Sectionalfactory certified asbestotic mainly crocidolite
9
Used asbestos boarding in railway
| carriage construction
j ?
Asbestos factory job unknown
9
{ Opener and sectional pipe maker
1 asbestos factory certified ashes-
tolic
amosite crocidolite
chiyso- chiysochiyso-
tile certified
12
Sapsibnensetrotiacsbemsutnolsyfaccrtoocriydochetretified
3
' Sectional pipe maker asbestos
factory.certified factory.certified asbestotic mainly
crocidolite
6
Spinner asbestos factory certified
asbestotic mainly crocidolite
;
amositeamosite crocidolite chrysotile 3
Disintegrator
asbestos
amosite
amosite
crocidolite
;
chrysotile
18
Asbestos mixer north England
asbestos factory
18
Carder asbestos factory mainly
c
and to id Dr. W
ted
ted to the Asbestos Asbestos
fences in
ster form
3
{
| | i | | | \ 5
Peritoneum
M 1908 1927 30 1958 11958 Necropsy Positive
Positive
18
!
:
*
1
'
j
| * | Peritoneum
| | 4) 1940 z 7 | Peritoneum
{
M 1925
4 + 1958 Biopsy
A
A
3
t
i
: 2 | Picura
:
| -
!
|| 1
'
\
| | | M | 1925 1941 1,6 1 1959 Biopsy
| Negative Negative
1
| ' i
:
4
t
}
{
'
;
| | j 20
Peritoneum 1 F
1907 | 1921 10
1959 Necropsy Negative Negative
?
i | 17 Pleura
t
:
}
:
\
i ok 1908 1924 , - 1962 0 Biopsy | Positive | Negative i{ ?
i
'
6 | Pleura
!
|
t
!
i
'
j
| | J M 1907 | 1942 3
1962 Necropsy Positive
Positive
|
2
j
'
j
i
|
}
i
1
|
1
i
i
{i|
crocidobte
Clothing and weaving asbestos
factory amusite weaving crocidolite
i chrysotile Friter maker for A R.P
masks
asbestos factory mainly croci-
dolite
Filter maker for A.R.P masks
1
asbestos U dohte
factory mainly croci-
\ Electrode coverer crocidolite
t
... Spinner asbestos + crocidolite
factory
mainly
| Delivered factorfacytory
chemicals amosite ,
to asbestos crocidolite
1 chrysotile
Brut mort BBrere
10 F | Peritoneum
!
|!
Pleura
| MPT
23 |
|
20}
:
Plear Peritoncu
4 | Peritoneum
i
M
M {
M
!
| 1899 | 1923
| 1899
:
:
1936 |
|
\
1908 | 1925
{
{
:
| 911 1930
' j
o 1917
1937
:
'
t
.
)
.
} , 1963 Biopsy
! Positive
;
\
'
26
1963 Necropsy Positive
| |'
:
|
{
1963 Necropsy Positive
|
2
1963 | Necropsy | Positive
:
3
27
1964 i Necropsy Positise
i
|
\
| Negative |
i
| Positive
'
\
| Negative
\
I
Positive
|
' ;
Positive |
|
5
| Spinner asbestos factory mainly
crocidolite
?
j Labourer works and buildings
| asbestos factory amosite crocIchrysotile dolite 1
insulating
S
Worked 301 yard of insulating
f Contractors mainly
6
! Carder asbestos factory mainly
+ crocidohte
24
i Disintegrator and other jobs
1 asbestos factory amosite croci-
dolite chrysotile
|
Section Baggers Baggers and insulators
2 *
1
~
25 i Pleura
28
:
22
Pleura Pleura
M
M H
'
M
1874
1885
:
1893
.
1910
1921 , 1937
53
1935 Necropsy
H
B
1955 + Biopsy
1959 Necropsy
Negative A
9 Negative
;
NA
!
'
Positive 1 Positive |
1
i
| 30
Pleura
:
1
M
1908 | 1922
39
1961 Biopsy
N'A
A
'
i
|
!
.
1
1
27 Peritoneum i M
1908 | 1922
36 ' 1961 Necropsy Positive | Positive
|'
'
26
Peritoneum
M
1911
1927
34
,
1961 Necropsy
Positive
, Positive |
'
:
{
31 Pleura
- M
1897
1915 41
1962 Bropsy
NA
A
}
>
.
29 Pleura
iM
191219121927
34
1962 Biopsy
NA
.
NA
12 24
16 25 12 13
8 10
: Worked in close proximity to boiler
repairer in dockyards Boiler cleaner and stripper dock-
|
i yards Boiler coverer and lagger to various
firms
| Erecting and fitting central heating
t
+ Boiler coverer and pipe insulator ' contracting firm ! Lagger and boiler coverer various
firms
1 Intermittently boiler lagger ship
repairs Installation of hospital sterilizing
equipment
continued
5
i
3
F
<
if
p
, ;
.
H
i
!
'
:
ae sae)
:
=
pon
-&
;
so
1
\
ay
:
ae eergist TSatei
-
By
ae
3
2 ae
4
of
4 4
oe
7
"4
L e
o
.
q a
a a
7
~
8
a ar
ze
i. i
*
ae
a
I +
&
4
4
_
ig
}
2 _ok
on
mi a
4
i
3
i
t
g f
} iaT
4
7
y
:
z
{
; a
4
-q
i
: t
3 5 ^'
2
i
t
3
'
i
3
i
om
savna 268
BRITISH JOUR AL OF INDUSTRIAL MEDICINE
APPENDIX continued
a
q
EIGHTY LENTS WITH MESOTHELIAL TUMOURS
4
!
\
I
|
t
5
| .
Dura-
H
Patho-
'
\
.
i
Year
tion
:
4
| Hi Asbestos Case
Site of
1 Year
of
of | Year
How
Bodies
logical | Survival
i
| ' No. Primary
Sex
of
First Lapo- of f Diag-
Evidence 7
from
H
i
g
Tumour
) | History {
i Birth Expo- sure Death
nosed
in Lung | Tissue
of As-
Initial
:
Relevant
{
i
bestosis Symptoms
i
! | years | | |
sure
:
'
in Lung { months
en
H
Tissue
ee
} | | { Section
C>
of
1
Exposure of relatives
i
i
:
| :] 40
Pleura
M
:
1912 ! 1925
i
|
i
1956 ; Biopsy
A
/
.
27
1 Elder sister worked as spinner at
34
Pleura
;
38 | Pleura
F
{oF
i
{
| | 1913 1919 | 2
|
H
1895 1919 41
i
'
1957 Biopsy
1960 Biopsy
NA A
A N
| 14
15
1
'
.
27 Pleura i oF 1905 | 1925 14 | 1960 Biopsy N A 3
|
i
t
| 35 | Peritoneum , F 1890 | 1921 21 1960 Necropsy Positive Negative 24
i
33
Pleura
{
F
|
|
| | '
1916 1930 4
1961 , Necropsy Negative Negative +
?
:
! 39 | Pleura
i
i
|
M
1919 1 1928 |
'
'
2
1961 Biopsy
A
A
18
!
H
fl
i
\
'
|
| 32 Pleura '| F 19001941 19041 19001941 5 1963 |+ Biopsy A A 18
i
:
|
36 Peritoneum | F
t
|'
:
1889 | 1912
18
1963 , Biopsy
A
A
|
1
15
|!
|
:
\
4
t
~
H
:
Section D Neighbourhood cases
asbestos factory
certified asbestotic
died
1946
i
Elder sister employed as spinna
4
looked after patient as child
} For several years husband worked + in ship's engine room close } proximity to lagging operations
i Husband worked as boiler coverer
overalls brought home for washing
Husband foreman and executive at asbestos factory
:
j Husband 7 docker frequently handled white asbestos
Elder sister worked as spinner at
asbestos factory and suffers from
^' +
asbestosis
3
in Daughter worked asbestos
{ for 5 years patient washed her
overalls i
Husband railway carriage builder
lined compartments with asbestos
{ sheeting work clothes washed at
home 3
Case
No.
P
T
6611 Pe
54 Pi
76 | Ple
58
Pl Pl
66 | PlPle e
57
PePerr
52 4 PlPele 63 | PiPeie
44 j Pleura
|
| i
48 | Pleura i
'
F
1905 | 1913
7
|
M
1922 1922
16
1
42 | Pleura j
|F
1889 ! 1913
48
!
50 Pieura
'
i j
43 Pleura H
|i
47 I Pleura H
F
|
1903
1908
6
F|
F
1905 | 1913
13
H
F
1917 ; 1917
10
'
!
| 64 |
Pleura
E
1899 | 1907
6
! F
71 Pizura
|
F
1899 * 1907
6
I | .
41 Pleura H
F
1900 | 1913
32
'
45 {| Pleura
}
| F
1900 j 1913
7
| 40
Pleura
:
;
F
| 1907 \ 1913 7
j
H
'
Section L. No history of contact with asbestos asbestos
1959 |
' 1960 !
:
Biopsy Biopsy
|
1961 Biopsy
1961 | Biopsy t
1961 Biopsy
'
{
\ 1961 Biopsy
i
1962 , Bropsy
| 1962 Biopsy
| 1962 ' Biopsy
.
1962 | Biopsy
:
1963 | Biopsy
!
A
A
Positive !
|A
1
|A
\
|A
i
| Negative
|
|
N
A
'
I
A
H
i Negative !
!
A
:
i
|A
'
|
i
N'A
:
i
|
| Negative |
H
A
:
'
I A
A
|
,
A
A
i
A
A |
8
17
15 13
t 16
S 12 29
] 7
| Lived within 1 mile of present site
, of asbestos factory
|| Lived within } mile of pres .t site
of asbestos factory
| Lived within 100 yards of present
i site of asbestos factory { Lived within 1 mile of old site of
j asbestos factory Lived within } mile of present site of asbestos factory
Lived within 200 yards of present site of asbestos factory
i Lived within } mule of old site of
} asbestos factory
j Lived within } male of old site of ' asbestos factory
Lived within to mile of present site ofasbestos factory
Lived within $ mule of present site of asbestos factory
Lived within } mile of present site
ofasbestos factory
i ... Ple
g
| P...l
{3
i
73 | =
t3
70
Ple
;
{
72
P.
;
;
1
55
Ple
i
>
f .60 | Pe
I 67 | Ple
jJ
56
Pic
.
|
|
i 65
Pleura
Foo: 1900 :
!
1
1947 Necropsy
Positive
Negative
7
Worked
69
P-
!
3
c
!
i
!
}
as nursemaid to manager
3
; } | \ 68
Do.
j|
'
'
of gas works in East London London
'
| Peritoneum
i
I ,
1902 !
:
1954
Necropsy Negative
{
'
Negate
1 asbestos insulation used in works
typist | :
i
i
:
|
S
| Shorthand and housewile H
53.
PlPlee
| | } | 49 | Pleura = 1895 } ' | 1954 i Biopsy A
lved Ilford area
|
Hl t
:
|
5
i
H
:
A
?
1 Baker's roundsman army general
,
I
; !
io.
!
t
labourer publican for 30
i 75 | Pleura
;
#
1899
{
i
:
1955 |
years
:
East End of London
i
i
| | '
|
i
Biopsy i A
N
H
?
Munitions work before
marriage I t
|
;
i
t
i
{
:
|
:
' then housewife lived Waltham
x
Section Section
i
| H 74 Peritoneum IF
1904
{ 1955 | Necropsy
H
Abbey Essex
i
78
Plet
I | | F
H
:
' Negative Negative
27
| Tailoress and housewife in East
62
Pleura
| | | {:
M
1899
|
i 1955 | Necropsy | Negative
End of London
83
Ple
H
| | H
'
i
i
Positive 1 28
1
y
Employed as luteman and greaser
4
i | | |
Beckton gas works 36 years
81
Pic
\ | i
.
| i
i
1 persistent discharging sinus R.
4
i | | j
;
'
:
:
i
i
;
side of chest following empyema
.
80
Pleu
| i
!i \
{
i
i
1925 acute chest infection 1953
| from | '
i
i
!
' '
!
i
|
subsequent thoracoplasty but
82
Ple
deteriorated from this date i
i" 77 Perit
: 79 4 Pl
s
continued
s
x
i
.
APPENDIX continued continued
.
. .
EIGHTY PATIENTS WITH MESOTHELIAL MESOTHELIAL TUMOURS
t
r
T
, ||Exposure Death | || | HistHoisrtoryy
aT !
7
7
,
Dura- !
i
Year
V|
Year | tion
.
S Sii tetoef
ise
Year
| Year of
of
Year
How
Primary
Sex '
of
First Expo-
of
|
Diag-
Tumour
Birth Exposure Exposure Death nosed
i
sure years
.
| | :
t
i
1
SI
Peritoneum | M
1913
|
}
1.
1955 | Biopsy
i \ definite :
| | as spinner at
died 1946
|| 1| | ed as spinner
as child
by i
Pleura Pleura
!
'
'
fl
|
;
| | MM
191904 04
1919556 6 Biopsy
t'
s
usband worked
| | | | room clo
*
Pleura Pleura
!
F F 1916
{
;
1957 Biopsy
| | | g operations
\ | \ ascertained poiler Loverer
i
t
| :
'
me executive washina | | | Garage ' 5
|
Biopsy
executive at
553 3
PlPleeura ura
,M
18198191
1957 Biopsy
' | er
| F | | ;
frequently frequenftrequenltly y
Pleura
F
'
1898
i
1958
i
Biopsy
Destos \ before death \ i ; ' H ' London H
nd sullers at | | , Peritoneum !
;
: Peritoneum
| 57 1879 Biopsy Peritoneum M : 57 factory
Biopsy
1
1958
asbestos factory | originally Ipswich nt washed her
H; '
| | \ boy Ipswich builder uage Dagenham s with asbestos
| thes washed at
3 M | lived Hainault -
; 1 | | i Fitter and turner of present site
| | | Positive of present site
52
Pleura
t
i St
$9
j
2
PleurPa leura
PlPeleura ura Pleura
=
i
M
1
1890
1890
1904
4
!
{
:
H
'
i M \ 1910
:
t
H M
1911
:
to
1959 Biopsy
119690 60
.
Biopsy
H
1960
Necropsy
Necropsy
1960 |
1
Necropsy
| possible rds of present
| | | ' Lived ory
>
:
73
Picura Picura
|
1887
1887
j | housekeeper of old site of
| | ; and P | PiPicucra ura
i housewife and of present site '
!
18881888
:
i-
i
:
| i | in | F
4
1898
:
ids of present
+
7272
i PePeritoneum ritoneum
F
1898
present
|
1960 orv
|
19621962
NecropsyNecropsy Necropsy
1962 | Biopsy
{
1 1962
j
BiopsyBiopsy
i
\
Asbestos Bodies in Lung Tissue
A
/
A
A
N
A
N
A
Pathological 7 4 Lvidence of As-
L bestosis in Lung
Tissue
(at eee ee
|A \
{ i |A i
'
/
i
/
A
A
:
Survival |
from Initial
Relevant History
Symptoms {| months |
' |
H
|
8
| Merchant seaman cargoes from S.
|
1 Africa 1930-32 no
evidence
| '- of contact with asbestos subse-
|
{ quently employed on channel
|
|
boats
12
Labourer and builder finally em-
H
ployed in tunnelling lived in East
:
i End of London
19
Employed remaking old sacks in
Bow previous content of sacks not
{
lived East End of
London
11
hand chauffeur mechanic
;
lived Wolverhampton and Epping
6
| Worked as printing machinist
marriage then as housewife
death lived East End of
NA
NA
:
A
i
N
:A
i
A
London
3 \
i
.
Stereotyper
moved to
and printer East London
Ipswich
lived then
12
Van
cutter and
army
1
grinder lived NN..EE.. London and
!
.
A
A
Negative Negative
Negative
Negative
Negative
Positive
Positive
;
Negative
Negative
|
Negative
Negative
Negative
Negative
Negative
Negative
Negative
Negative
A
/
'
A
|
18
Bricklayer cement worker post-
;
man
End of London
moved to Hainault Essex in 1931
18
lived principally
+ in East End of London
?
Coloured S. African merchant sea-
man |
stoker at glass factory contact with asbestos in
S. Africa or at sea
10
marriage in Wales then
housekeeper in SW London
30
Machinist of celluloid collars
|
1
lived
East
canteen ondon
worker
10
Machinist hosiery trade Notting-
housewife moved to London
.
1960
| | \ Labourer merchant of old site of
Si Si
PPlleeuurraa
M M
'
11888888 |
11996622
NecNe rcorpop ss yy
H
Negative
Negative
! Negative
Negative +
:
2
docker
seaman only meat
carried of old site of
| | 1 | death butcher of present site | | of present sistiete presnt | Dressmaker of present site
i
|
1915
i
,
t
1962
1962
Negative Necropsy Negative
Negative
Negative |
54
Apprentice printer barman cook
50
PePerriittoonneeuum m
M
11915
| 50
i
25 years before
For i
\
'
|
H
death lived East End of London
:
Biopsy |
6767
Pleura Pleura
1897
F
1897
| 3
11963963
Biopsy
A
NA
NA
j
NE
and housewife lived
{
East End of London then Somerset
;
|
' 56
Pleura
'
1
1912
1912
11 9613963 Biopsy
N
A
N
A
24
Steel erector army steel erector
and porter lived East
;
| | { | labourerLondon _
i | | | ) | as to
manager
| F F 69 | Peritoneum Peritoneum
'
1901
\
'
:
1964
Necropsy Necropsy
Negative
Negative
{
Negative
Negative |
'
42
End of London Employed packer in pharma
ceutical firm for 12 years then
housewife until death lived in
ast manager London
'
'
'
.
Dagenham
| asaseed d in works
| !{ Tilbury d housewife
{
53
PleurPaleura
! MM
H
18198922
19614964 Necropsy Positive
Negative ,
24
'
:
Fisherman fireman docker 1915-
39 at
docks fireman and
finally storekeeper contact with
years : aros general
For 30 years in
\
:
i
:
:
'
:
. ;
:
'
;
j| i
H '
asbestos not probable at Tilbury docks lived Tilbury area
1
;
re
re
sed
marriage Waltham
wife in Last
and greaser
> 36
years
Og Sinus
ing empyema
Section F Untraced cases
S
F
78
78
| PPlleeuurra a
F
83 | PiePuriaeura
|M
81
PlPleeura ura
| 3030
PlPleeuraura
M
| Z Z
1893
1893 1860 1877 1900
Positive
Necropsy
'
1917
,
Necropsy |
?
1 Positive +
|
| | 1922
Necropsy
Necropsy
Negative
Negative
Negative
Negative
| | 1
H
1925
Negative
Negative
Negative
Negative
Negative Negative
,
{ Necropsy | | Negative
Negative
|
1936
| Necropsy| Negative Necropsy
Necropsy
Negative
| Negative
;
fection fection 195
oplasty
bbutut
date
| Necropsy 8282
PlPleuera ura
i
M
1893
1893
1
'
t
Necropsy
:
1938
Positive
Positive
Positive |
|
| | ; | !
t
H |
1
Peritoneum
17
Peritoneum
FF
... 1910 1910
1915
Necropy
Positive | Positive
: | <
\
| ' yt Pleura
.
1878
I
1878
Necropsy
:
Positive
| : : i 1955 Necropsy Positive
Positive
i
Not traced Not traced ,
Not traced
\ Not traced
' Not traced
y Not traced
Not traced
.
continued
A -- tissue not available
1
ete
Fay
ge. set
aes
ppt
,
Epa fete Si
Eweet;
eon
i