Document 4vpwEm6XM1a52q6VVgEDX2Kk1

l7'y;nvr-,--^P(_.,i,i,(. _ I965 Newhouse *gr,,.,' .. i.~ ,,. ".lCf,'nySs^-i"''' Irii.J. industr. Med., 1965, 22, 261. '',"'-'J" , lll5 rr , ... ^.S*****' , - ..,rrt^ ^ ^ 90 ~t th,"haa u* ^ i* bfafeM i t*Umm ' (AIMt |1 , . I . w;, wi i<'r"f-* 1C*.*!."*.***** .^-rf^*** e***1 ` wi**** 4iS** 5-11 MESOTHELIOMA OF PLEURA AND PERITONEUM FOLLOWING EXPOSURE TO ASBESTOS IN THE LONDON AREA * BY . * MURIEL L. NEWHOUSE and HILDA THOMPSON From the Department of Oeeupational Health oat) AppHeti Physiology,. London School of Hygiene ami Tropica! MetHeine , (RECEIVED FOR PUBLICATION FEBRUARY ]1, 1963) A series of 83 patients from the London Hospital with a diagnosis of mesothelioma confirmed by necropsy or biopsy has been studied for possible exposure to asbestos. The series consisted of 41 men and 42 women; 27 of the patients had peritoneal and 36 pleural tumours. The earliest death recorded was in 1917, but only 10 of the series died before 195Q and 40 (48%) between 1960 and f 1964. i In 76 of the series full occupational and residential histories were obtained. Forty (52-6%) gave i a history of occupational or domestic (living in the same house as an asbestos worker) exposure to i asbestos compared with nine (11-8%) out of 76 patients from the same hospital suffering from other diseases (p < 0 001). None of the 17 suspected cases of mesothelioma, rejected on pathological i grounds, was found to have had any exposure to asbestos. There was also evidence that neighbour hood exposures may be important. Among those with no evidence of occupational or domestic exposures. 30-6% of the mesothelioma patients and 7-6% of the in-patients with other diseases lived within half a rniie of an asbestos factory (r < 0-01). Out of the 31 patients with occupational exposures only 10 were in jobs scheduled under the Asbestos Regulations of 1931. The interval between first exposure and the development of the terminal illness of mesothelioma ranged between 16 and 55 years. In 47 patients in the mesothelioma series, lung tissue or sputum was available for examination. In 30 (62 5%), either asbestosis or asbestos bodies were present. In recent years, the association between exposure 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 Marchand (1960) described the occurrence of meso i thelioma of the pleura in those exposed to crocidolite asbestos in the mining districts of South Africa, and this has stimulated further studies of the occupa tional histories of patients suffering from this tumour (Owen, 1964: Fowler. Sloper, and Warner, 1964). The present investigation concerns patients in whom mesothelioma had been diagnosed at the London Hospital during the past 50 years. After examining the necropsy and biopsy specimens held in the pathology department, Hourihane (1964) con firmed a diagnosis of mesothelioma in S3 patients, of whom 41 were men and 42 w omen. Thirty-one of the men had pleural tumours and 10 peritoneal; i among lhe women, 25 had pleural and 17 peritoneal 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 investiga tion, but these have subsequently died. The earliest date of death in the scries 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 age of 55 (Table I). Clinical Features The ward notes of 65 of the patients were available and give a. picture of a disease with a consistent symptomatology. Among those with pleural f. mfrV* - I r &- I j MESOTHELIOMA OF PLEURA FOLLOWING EXPOSURE TO ASBESTOS 263, local :rvice. ' three t with ted in I with (after i relawait id the icords 3f the 4 few of the father . The event* iry to ri-- of atientv tientx, i other :ms in during Each in the :e and riatrie finally y *hc le logical .') As c rela* were Sroup ere all s with nspitai might dcntial `ras and social classes of patients attending the j London Hospital. Thus, a third group of patients ns taken from the hospital records matched by tiite of admission as well as date of birth and sex | iiih the patients in the mesothelioma series. Their paces of residence and occupations were extracted hr comparison with those of the in-patient series. ' Results ! Details of the 83 patients in the mesothelioma J wies arc given in the Appendix, No information | ibout past domestic and occupational histories was ' nailable for seven patients. Among the remaining * `6,40(52-6%) gave a history of exposure to asbestos : compared with only nine (11-8%) of- the `in-patient' ies (Table 2). The dilterence in this proportion is Table 2 nrrts oh i.xposure to asbestos of ja* patients * 1TH MESOTHELIOMA AMI 7fi IN-PATIENTS WITH OTHER 1 DISEASES ' Mesothelioma | 'Iniraiiem* Type o Eapoiure 1 Scrira i - Series . ! No* y. | no. V. tuplpvvU at one asbestos factory Otfcvcted goods to factory . 1-3 fuNoytd at other asbestos i factnne* | 4 J..V 1 1-3 Iwdaiors and laggcry jS 10-J 1 3-3 fttbirveworkvd with asbestos ] 9 US 1 1-3 Deckers handling aabcum -! 7 carte 0 IS No history of ock nr domettie capoxurc to iibewos 47-4 67 111 * Positive exposures to asbestos in mesothelioma series versus ponmc histories in- in-fiiicni series- [ x* * 27-11.* < 0 001 I *Socn cases of mnoihtiicxM could not be traced and ar* omitted 7 from this table, | statistically highly significant (x1 = 27-11: p < * 0-001). This result is unlikely to be unduly influenced I 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. Com paring 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 pave a history of exposure to asbestos (Table 3). ! This difference is statistically highly significant . [f = 11-83; p < 0001). ` ,. iI tI Table 3 exposure to asbestos of confirmed and rejected CASES OF MESOTHELIOMAIWSUORVIVING AFTER JANUARY Diagnosis of Mesothelioma Confirmed Aelected Htpmure positive No work or domestic contact round - 3S 0 ft 16 . Untraecd i i* 11-10. r 0 001 Mesothelioma Series Occupational Exposures.--There are details avail able for the 18 mesothelioma patients who had worked at one asbestos factory which used crocidolite asbestos with small amounts of chrysolite and first introduced amositc 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 occupa tions 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 Tabu 4 jobs of 17* patients with mesothelioma employed at one asbestos factory OSbtlaigtuattoioryn* Sdrbejegcutlattoions Noret fuuitbajteiocnt sto Job Mil* Spttflidf Carding Clothing and weaving Dftiiucvraiing and opening 1 Filter making fmoarskAs.R.F. Maonfpurfeafcotrumriendg ptioiro^ insuia- Maonf ufacbtruarkineg11 Hniop Rubber com* pounding General labourer 1 1 1 Q 1 Female Material 4 Crocidolite t Crocidolite Crocidolite, .0 Creaohmcriodyssoioltiettiele., 1 eahmroysvimteile, 0 Crocidolite 1 Cftscidoiitc 0 Crocidolite Crnctdolite. 1 ehrysotilc 0 Crocidolite, eahnruymsmtetle. *fiinpioymnl history net available for on* female (unenu % 6? *? S* * tf ; M-.:. W^ %>:&IUr .- *X' .2 . bst;few- - 264 BRITISH JOURNAL OF INDUSTRIAL MEDICINE 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 crocidolitc. the types of asbestos used in these other factories arc not known. The eight heating engineers and laggers were all men. Three had been employed in dockyards onship repairs, two in various types of lagging; one in a power station, one installing hospital sterilizing equipment, and one installing central heating. All were consistently employed on this type of work for more than 20 years, but, in some, exposure to asbestos was intermittent. Domestic Exposures.--The group of nine, seven 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 hus band'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 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. In-patient Series Occupational and Domestic Exposures.--Two 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 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. Neighbourhood Exposures of Mesothelioma and In-patient Scries.--The 36 patients with meso- Table 5 DISEASE CROUPS OF PATIENTS IN THE IN-PATIENT SERIES Dimit Group Cardiovascular Meiahok Reticuloendothelial (mcJudinc piaeinuil Gistro-Hmrmnjl (eieiudtnc cancan) RaptraiQn* (eiudia( cancers) Ail neoplasms Older * Tola} No. of Patients 21 9 t 6 3 It 11 76 No, wild Exposure to Aiteta 3 9 2 2 0 1 1 9' thclioma and the 67 patients in the `in-paiicni' scries, who had neither an occupational exposure nor a relative living in the home working with asbestos, might have been exposed to asbestos dust because they lived in the immediate vicinity of an asbestos factory. - One factory, where more than one-fifth of the mesothelioma patients were employed, opened in 1913, having been situated nearer the centre of London for the previous seven years. There were three alTcctcd female patients living within half a mile of the factory during the time it was in produc tion 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 hair- mile 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 yean 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 `in-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 RESIDENCE OF PATIENTS WITH NO OCCUPATIONAL OR DOMESTIC EXPOSURE TO ASBESTOS Series Mmothdioma In-patient' Lived Within | mile of Asbestos Factory no. | ;; 11 30-6 3 7-3 Lived More Than J ) mile from < Asbestos Factory 1 Total no. | 23 | l 694 i 36 62 | 92-3 | 67 - 7-13, r < 0-01 t., MESOTHELIOMA OF PLEURA FOLLOWING EXPOSURE TO ASBESTOS 265 iN^ATir.M [ Nrt, with I %pmure ip * Atbcitn* i az I I * 'in-patient' 1 exposure r<ing with sestos dust iniiy of an There were thin half a in produe* they were the present hin a half ** -ithin ei. cd at seven were t when the of age and' :d 48 years ad neither n in whom t necropsy. itieni lived four others ;tos factory TlONAl OR \ .* | Total Thus, among those with no occupational or Lung tissue was available in only four patients domestic exposures to asbestos, there arc 11 (30-6%) patients in the mesothelioma series and five (7-6%) ! in the `in-patient' series who lived within half a miic of an asbestos factory, in the area (Table 6). The exposed either through relatives or by living in the neighbourhood of asbestos factories. In two, asbestos bodies were present in lung tissue but there was no evidence of asbestosis. difference in the proportion of patients in the two senes who lived in the vicinity of the factory and had bad no other exposure to asbestos is statistically significant (Xs TM 7-85; p < 001). . Table 3 EVIDENCE OF ASBESTOS BODIES OR ASBESTOSIS IN at Cases of mesothelioma with lung tissue or SPUTUM AVAILABLE TOR EXAMINATION Date of First Exposure and Interval Before Death a Mesothelioma Series.--Fifty-one men and women had been exposed to asbestos, including those who ( lived near the main asbestos factory. The duration of exposure varied widely, ranging from two months ` to over 50 years. The interval between the first exposure and death varied between 16 and 55 years HCisowtonitrthaycot f Asbestos Positive Nceauve Uniraced Total Asbestosis or Asbestos Bodies Protot Absent 242 ,, 4 30 4 8 3 17 Lunt Tissue not Available 23 13 0 36 ' (mean 37-5 years). Among the group of factory t workers, where exposure was probably heaviest, the interval was shortest. It was longest among the group living in the neighbourhood of the asbestos factories, where exposure to dust was probably , lowest. Table 7 shows the mean age of each group I at first exposure and the mean of the interval before death in each group. Although the length of interval Amons the 12 patients in whom no definite contact with asbestos could be established, there was one, a 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 cariy 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 j RELATION BETWEEN TYPE OF EXPOSURE AND LENGTH OF INTERVAL BEFORE DEATH IN 31 PATIENTS IN 1 MESOTHELIOMA SERIES Of the seven patients whose histories could not be traced, three had asbestos bodies and histological evidence of asbestosis and one had asbestosis alone. 1 ] I Type of Exposure ! ' Fmwy work j I j OULifvnlmtnttfnuiienantni einttshublaotuorr*s hood o( factory No. 23 98 11 Mein A#e tC First Earoitir* tyorik 2127*59 4 15-4 1*5 Mean Interval between First ExpoDseuareth and (yosra) 29*4 331**-94 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 defec tive or they may not have known of short periods of varied between 29-4 and 48-6 years, the mean age at death showed less variation;-it was 50-6 years in the group of factory workers and between 55 and 57 years in the other groups. 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 befotc he married, and his widow did not know of this episode. It is of Asbestos Bodies and Asbestosis in the Meso interest that asbestos bodies in the lungs were found thelioma Series.--Of the 83 patients in the meso in only four of this group, and it seems probable that thelioma scries, lung tissue was available for among the remainder there w-ere those who had had examination in forty-three. In four other patients, no exposure to asbestos. - all certified as suffering from asbestosis, with no lung In the mesothelioma scries of patients, both in tissue available, examination of sputum during life dustrial and non-industrial exposures were recog revealed the presence of asbestos bodies (Table 8). nized. Among the men the exposure was pre 1 Both asbestos bodies and histological evidence of dominantly industrial; 22 worked in asbestos asbestosis were found in 15 of the 24 factory workers factories or as laggcrs, two were exposed at home, and laggcrs. A- further five showed evidence of either and one lived near the asbestos factory. Among the asbestos bodies or asbestosis. women only 10 worked in asbestos factories, and a I r. t fr & l  I I I r\ f.: & 266 BRITISH JOURNAL OF INDUSTRIAL MEDICINE further 17 hud non-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 pro portion 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 mcsotbclial tumours and partly to the long interval between first exposure and development of the tumour. Those exposed between 1915 and 1915 might be expected to die from about I9J0 onwards. Asbestos imports to the United K ingdom have moun ted steeply since 193 2 (Lcathart, 1964) and its uses are more widely diversified in industry. The increasing proportion of the popula tion exposed to asbestos during the past 30 years may be expected to give rise to an increasing occurrence of mcsotbclial tumours. The choice of groups for comparison with the mesothelioma scries of patients was not ideal. The number of patients it was possible to trace in the `rejected' senes 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 disease from which they were suffering. This could have led to bias with under-reporting of exposure to asbestos in the in-patient series. How ever, in the `in-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 mesotheiial tumours. There was no evidence that, because of their more recent admission to hospital, the in-patient series was less likely than the mesothelioma series to work in con tact with asbestos or to live in closer proximity to asbestos factories. There seems little doubt that the risk of mesothclioma may arise from both occupational and domestic exposures to asbestos. Wagner and others (1960) described patients with no exposure other than living as a child in the vicinity of the asbestos mines. A high incidence of asbestos plaques of the pleura has bycn found in the population living near an a'nthophyllitc mine in Finland (Kiviluoio, 19601. More evident^ 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 IV. 17. O'H. Ilouriiinnc for his co-operation and fur making the revolts of his investigations available to us. Our thanks arc also due to Professor C. Wilson, Professor V. W. Dix, Dr. N. l_ Rusby. and Mr. G. Flavell, F.R.C.S-. of the London Hospital and Dr. C P. Silver of Sl Matthew's Hospital for permission to interview.thcir 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 Watford for statistical assistance, and to Dr. J. C. Gilson, Professor R. S. 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 October 1964, and will be published in a shorter form in the proceedings of that conference. References Foster. P. 3. S., Simper, J. C_ and Warner. _ C. (1964). Brit. rtr4y.. i. 211. Leading article (19*4). lhid,m L, 202. Hinjfthanc. P- O'B. (|4i4). Thnwx, 19.. 26S, Ktvtiuoto, R,, (19*01. Atta radio/. (SittrkhA. Suppl. 194. Leaihan, C. C (19*4), Orcup. HUh, {LondA* 16, 119. Oven. W. GWrt (1964). Brit, tried. J.% 2. 214. Wagner. J. C,, Slcfgs. C- A., and Marctiand, ?. (i960). Brit-J* . imrtutir. .Wed.. 17. 260. rt' h Cl t Appendix opposite ti h- 1? c ii "! tin----- '"`'r--inr* i *v-`i MESOTHELIOMA OF PLEURA FOLLOWING EXPOSURE TO ASBESTOS 261 APPENDIX EIGHTY-TIIRF.E PATIENTS WITH MESOTIIEUAL TUMOURS csoamJ l-.-rs ihcr stos the war )). the Him we for hn Case ho. Site of Primary Tumour Dura- Year firm Year or of Year Set of First Expo of Birth Exp^ sure Death (years; Strtio* A: Ferrary orkm t Pleura M i Peritoneum M _______ 1901 1895 1921 1919 17 193* 1941 IS Peritoneum F 1908 9IS > 1947 : Pleura M 14 Peritoneum 1' r Peritoneum F litJtf) 192* DPI* 1917 !90h 1922 12 1950 * l**5l 7 I9SI Ml. D Peritoneum F 1894 1913 5 1933 C. ii P. !ter* 1 Mi 9 llie I 21 Ue; Peritoneum Peritoneum Peritoneum Pleura F F F M 1897 I9IT 1901 1897 1893 1918 1919 1928 1 1933 M 1955 1 1956 1 1957 ' i> 12 Peritoneum F 1911 1937 195* w 5 Peritoneum M 1908 1952 JO 1958 1 ilM, 7 Peritoneum M 1923 1940 4 1958 in 2 Pleura M 1923 1941 1/6 1939 9 Peritoneum F 1907 1921 10 |9?9 17 Pleura . F 1908 1924 1 (962 Pleura M 1907 1942 10 1962 10 Pentcmcum F 1899 1923 1) 1963 1 Pleura M 1899 1936 26 1963 23 Pleura M 190* 1923 i 1963. 3- Peritoneum M 1911 1930 2 1963 4 Peritoneum M 1917 1937 27 1964 Sfrtkm 8: LtffgfM omi immiainrs A 33 | Pleura % 2S 1 Plcun vv ! Pleura hi 1 1174 IIM > 53 1933 M | 1893 1910 i vw .933 M | 1921 1937 ! ' 1939 4 30 ! Ptm M * 1908 1922 39 l 1961 27 1 Peritoneum M ; 1908 ! 1941 1922 | 36 36 ! Peritoneum \ M ; 1911 1927 1 J4 1961 31 Flcwa S M 1897 1916 j 4| | 1962 29 flturm M ( 1912 1927 ` 34 (962 How Diag nosed Necropsy Necropsy Biopsy Necropsy Ncernjwy Biopsy Necropsy Biow Biopsy Necropsy Biopsy Biopsy Necropsy Biepiy Biopjy Necropsy Biopsy Necropsy Biopiy Necropsy Necropsy Necropsy Ncoopsy Noctopsy Biopy Necropsy Biopsy Necropsy Necropsy Biopsy Biopsy Asbestos Bodies in Lunf Tiue logical Evidence of As- bcsiosis in Lung Tissue Positive Positive Positive Positive Positive N/a (spuium) Positive Negative Negative Negative Positive N/A (sputum) Positive Positive Positive 'N/A (sputum) Positive (sputum) Positive n/a Negative n/a N/A n/a N/A Positive Positive N/A N/A Ncpiivt Negative Negative Positive Positive Negative Negative Positive Positive Positive Negative Positive Positive Positive POwlI'* Negative Positive Positive Negative Negative N/A N/a Positive Positive N/a n/a POJIIIY, Positive Positive N/a n,a Positive n/a n/a Survival * from Initial Symptoms (months) RelcvaiH HKiory V Brake liner, boiler cot^rer. #<be9 V in* factory; mainly croeidolite Disintegrator and other job*, asbestos factory; amyne, croci* V doiiie. chryiotik Sectional pipe maker, asbestos factory, temfinj asbesmtie; main ly cmcidotiic 9 Used asbeMm hoarding in railway * AC^ahrroiaimge clanvm'tmtriy,cinji**iht , unknown * Opener-and ^vIhhuI mpe maker, asbestos factory, certified ashes* (Otic; amosiic. crocidoliie. ehryv*tile 12 Spinner. isMmih factory. cernAcd attasradc; rntmir eroodolitc 3 Sectional ppe maker, asbestos factory, certified asocstotic: mainly erocidolite . 6 Spinner, asbestos factory, certified asheMiMic; nunniv crocidoliie 3 DiiinKPamr. laciory; anwnitc. crncidnhlc. chry^imlc 18 Asbestos mi\er, north England asbestos factory IS Carder, asbestos factory; mainly erocidolite IS Clothing and weaving, asbestos factory; amosde, erocidolite. ' chrysoidc 3 Filter maker for A.R.P. masks, asbestos factory; mainly croct- dolitc II Filler maker for A.R.P. masks, asbestos factory; mainly croci- dolite 7 Electrode eoverer; erocidolite 7 Spinner, asbestos factory; mainly 7 erocidolite Delivered chemicals to asbestos factory: inmite, erocidolite. ebrysonic s Spinner, asbestos factory; mainly cfnciduliic " 7 Labourer, orks and buildings, asbestos factory; amositc. crocu doiiie. chrysonlc I Worked in yard of insulating contractors 6 Carder, asbestos faetory; mainly eroeidolite 24 Disintegrator and other jobs, asbestos factory; amosite* croci* dolite. chrysolite 12 Worked in close proximity to boiler repairer in dockyards 24 Boiler cleaner and stripper, dock* yards 9 Boiler coiotr and latter to various Arms Erecting and fitting central heating .2 Boiler centre? and pipe insulator, contracting firm >3 Laggcr and boiler coverer. various firms * Intermittently' boiler lagger, ship repairs Inesqtuailplamtioennt_o_f_h_o_s_pital sterilizing fcV: L^, * ^1* . * s~rt' - s.~ I- 5** !* v ' -. ' Pi. Pf' t ( ---........ .......................... -- 1 `<"7*<' .*iU ------ --------------- ?* ': ** m l '~i " j ^ * r .*_'.*.._y. -XV^V, 268 BRITISH JOURNAL OF INDUSTRIAL MEDICINE APPENDIX (emiifiw^) E1CHTY.THREE PATIENTS WITH MliSOTllCLIAL TUMOURS No. Site of Primary Tumour 3gr*> Year lion Year of of Year Sea of FlMl :ih of Binh Eipo*) lure Death sure |(years) How Dtagneutl <k(m C-` Exposure/" relatives 40 Ptcon M 1912 1923 It 1956 Biomy 34 Pleura. 3* Pteur* f 1913 1919 2 1957 Biopsy ? 1t95 1919 41 1940 Biorvr 37 Pleura F 1905 1925 14 1*160 Uoroy 35 Peritoneum F 1190 1921 ;i 1940 Necropsy 31 Pleura F 1916 1930 4 1961 Neeiofwy 39 Pleura * M 1919 1928 2 1961 Biopsy 32 Pteur* F 1900 1941 3 1963 Biopsy K Peritoneum F 1999 1912 IS 1963 Biopsy Asbestos Bodies in Lung Tissue N/A N/A N/A N/A Positive N.cativ* N/A N/A N/A Palho* logical Evidence of Aif ScilPMt in Lung Tissue Survival from Initial Svmptoms (months) ' N/A . 27 N'A N/A. 14 15 N'A Negative ` Negative N/A 24 18 N/A IS N/A IS Relevant History Elder sister worked a* spinner r asbestos factors*, aied certified asbestottc Elder sister employed JS spinrtr. looked after patient as child For several years husband *ou:. in ship s engine nwnt. etc;; prosimny to Ij lifting operanmflusb.ind worked u hmter emer; overalls hriMight home hw w.ia.h Husband foreman and cvccum; asbestos factory Husband a docker; frequent handled 'white asbotos EJder sister worked as sf*mner : asbestos factory and suffers (rasbestosis Daughter worked in asbestos fjr.rfor 5 years; patient warned overalls Husband railway carnage Hinkle* lined compartment* with jnjW'. sheeting; work clothes wasne* . home 5wH-- 0: AVifhdofAtfob com; 44 Pleur* F 1903 1913 7 1959 Btoftljr N/A 4* Pleura M 1922 1922 1 1960 Biopsy N/A 42 Pteura F 1189 "1913 48 1961 Biopsy Positive , 30 PWara F 1903 1908 6 1961 Biopsy N/A 43 Flair* ' F 1903 1913 13 1961 Biopsy N/A 47 Pleura F 1917 1917 10 1961 Biopsy N/A 64 Pleura F 1399 1907 6 1962 Biopsy Negative 71 Pleura F 1899 1907 6 1962 Biopsy N/A 41 Pltm F 1900 1913 32 1962 Siopiy N/A 43 Plcora F .1900 1913 7 1962 Biopsy N/A. 4 Flam F 1907 1913 7 Sfrtiom ; So hintwj of eotvrerr *v<4 asbeaot 5 Pleura F 1900 j 1943 Biopsy i i 1947 Necropsy n/a Positive N/A N/A Negative N/A N/A N/A Negative N/A N/A N/A N/A Negative 61 Peritoneum F 1902 49 Pleura 73 Flam M 1893 * F 1899 I9M Necropsy Negative 1934 Blow N/A Negative N/A 1955 Biopsy N/A N/A 74 Peritoneum F 1904 (2 Pleura t M 1899 1953 1935 i Necropsy Negative Nioo*r Negative Negative Positive i 8 Lived within 1 mile of present s of asbestos factory 17 Lived withm 1 mile of preseri > of asbestos factory 15 Lived withm 1(X) yards of pres; sue of asbestos factory 13 Lived within } mile of old me asbestos factory 4 Lived withm l mile of presen: of asbestos factory 16 Lived withm 200 yards of pr.' site of asbestos factory 5 Lived within 1 mile of old . asbestos factory 12 Lived within V mile of old asbestos factory 29 Lived wSihirt l mile of prvser? of asbestos factory 9 Lived within } mile of present of asbestos factor* 7 Lived within t mile of presenof asbestos factory 7 1 Worked as nursemaid tn rr-.ir Of gas works in East L. - asbestn* insulation used tr. - 3 Shorthand-tvpist and hou^: lived Ilford area V Baker's roundsman, armv. ; labourer, publican for 30 \ East End of London Munitions work before mr*- then housewife; lived Abbe>-. Esses 27 Tailoress and housewife m End of London 1 23 Employed as luteman and 'Beckton gas works Jo I persistent discharging s side of chest rollgmg c- 1 1925. acute chcM jnt.sr. subsequem ihorjcor<i> deteriorated from this Jj. . | r;!; ' 6 --*v. -*' `*"`r'' 1 . .y` 11~, .,i.-*',`V. ,,*'4-f'2-"* * . -%* * .v- t '*'*. r - `-T - - , '' --J!. '* ' _' J" '* ,, 1 gjr ' ^ MESOTHELIOMA OF PLEURA FOLLOWING EXPOSURE TO ASBESTOS APPENDIX frwwiANri/) EIGHTY-THREE PATIENTS WITH MESOTMELJAL TUMOURS 269 Cm Site of Row Primary Tumour * 1 1 Peritoneum M * Pleura 1 it Pleura . a Ftntra <t \ PWura Sea M M F M F sr Peritoneum ,19 1 Plmre M M u Pleura 1 6 51 a 1 t 1 # I n ; 55 to 1 17 6 1 11 Rests Pleura Pleura n Peritoneum fVura Peritoneum Pleura Pkufi Peritoneum Moira M Ki M F F F M M F M F M i frtffru f: L'ntrotfH coses n 1 Pleura F 13 ' Pleura M t | neura M 10 ; Pleura M i: PWura *7 Peritoneum M F IT* *wv Year of Birth Dura Year tion of of Yer First Expo of Expo sure Death sure (years) How Diag nosed Asbestos Undies in Lung Tissue 1913 190* 1916 1 t i i 1953 Biopsy N/A 1954 Biopsy 1957 Biopsy N/A NIK 1191 iwt irr* 1190 1904 1910 1911 isr7 itss 1191 I8S 1915 1197 1912 1901 IS93 i 1937 0*> N/A i 1938 0rjr N/A i' 1931 Bujtny N/A 1939 Bnpty n/a i 1960 Biopsy N(A I960 Necropsy Negative I960 Nwnspiy Positive i 1962 Necropsy Nttuin I 1962 Bpt Negative i i 1962 Bisvty N/A 1962 1962 Necropsy Ncqopsy Negative Negative j i j i i i 1963 1963 Biopsy Biotuy N/A N,'A 1966 Necropsy Negative 1964 WlBCPH Positive Patho logical Ex idcnce of As* bcsiosis in Lung Tissue Survival from Initial Symptoms (months) Reievam Hivory n/a N/A N/A N/A N/A N/A nia n/a Negative Positive Negative. Negative N/A Negative Negative n/a n/a Negative Negative 1 Merchant Kamjn, cargnes from S. Africa 1931X32. no definite evidence of contact with svbcsiro; sulgxe- qbovacmts ly employed on crmKhan- nel 12 Labourer and builder, Anally em ployed in tunnelling; lived in I3fct End of London 19 Employed remaking old sacks m Bow. previous comem of sacks not ascertained: lived East End of London II Career hand, ch.-tnilcur. mechanic; liini NVoUethatn|X*u and 1 ppmg A WtirLd a- priming rtMiliinm before marriage, (hen as housewife until death; lived Eau End of London 3 Slertotypcf and primer: lived originally in East London, then moved to Ipswich- 12 Van boy. regular army, cutter and * grinder: toed N,. London and Dagenham It Bricklayer, cemem worker, p**M- man; lived Ljm |;nd of London, moved to llamault, Lssci in 1931 !S Filter and turner; lived principally V in East End of LondonColoured S. African merchant sea man. stoker at glass factory; possible contact im asbestos m S. Africa or at sea 10 Lived until marriage in Wales, then housekeeper in 5.W. London 30 Machinist of celluloid collars, housewife and canteen worker; lived East London 10 Machinist in hosiery trade, Notting ham, housewife; moved io London - I960 2 Labourer. merchant seaman, docker, carried omy meat 54 Apprentice primer, barman, cook, and butcher, for Z* years before death lived East End of London 29 Dressmaker and housewif_; lived East End of London then Somerset 24 Steel erector, army, steel erector, labourer and porter; lived East End of London 42 Employed as packer in pharma ceutical firm for (2 years, then housewife until death: lived m Dagenham _ ' 24 Fisherman, fireman, docker, 1915 39 at Tilbury docks, fireman and Anally storekeeper; contact with asbestos not probable at Tiibury docks; lived Tilbury area 1893 I860 1877 1900 1893 1910 1878 1 1 1. 1* j1 1917 Necropsy V 1922 Necropsy Negative 1923 Necropsy Ntcilivc 1934 Necropsy Negative 1938 1943 Necropsy Positive Necropsy Positive 1455 Necnrpsy pnvitvc Positive Negative Negative Negaiho Positive Ptwiivl Positive Not traced Not traced Not trace} Not traced Not traced Not traced Not truod ' N/A ~ tissue nos available. r FT '"! ^*1; t? * ` - -v- * V--i.*'s, I** *b * .4f .* * u pit''- Ift- - ` TM P- \ rT-v [v* > V. k*'rVwAbT.-'.- iV-i.'-tV . ri> *Kv-jrr; - & r* 4 .