Document 7RGLG54vVbw3nZO96pzw8o6O8
FILE NAME Household Contact HC
DATE 1965 DOC HC013
DOCUMENT DESCRIPTION Medical Journal Article - Mesothelioma of Pleura and
Peritoneum Following Exposure to Asbestos in the London Area
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Brit J. industr Med 1965 22 261
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MESOTHELIOMA OF PLEURA AND PERITONEUM
. FOLLOWING EXPOSURE TO ASBESTOS IN THE
pe
LONDON AREA
BY
7
we
ft.
Se
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
.
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 56 pleural tumours The carliest death recorded was in 1917 but only 10 of the series died before 1950 and 40 48 between 1960 and
1964 - In 76 of the series full occupational and residential histories were obtained Forty 52.6 gave
a history of occupational or domestic living in the same house as an asbestos worker exposure to 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 - grounds was found to have had any exposure to asbestos There was also evidence that neighbourhood exposures may be important Among those with no evidence of occupational or domestic
_
exposures 30 of the mesothelioma patients and 7.6 of the patients with other diseases lived within half a mile of an asbestos factory P < 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 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 Marchand 1960 described the occurrence of mesothelioma 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
.40
Owen 1964 Fowler Sloper and Warner 1964 The present investigation concerns patients in
whoin mesothelioma had been diagnosed the
tumours
The aim of this study has been to establish the
occupational histories of these patients and ttorace
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 Bead before the age of 55 Table )
London Hospital during the past 50 years After examining the necropsy and biopsy specimens held in the pathology department Hourihane 1964 confirmed a diagnosis of mesothelioma in 83 patients of whom 41 were men and 42 women Thirty of
the men had pleural tumours and 10 peritoncal;
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
261
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ad
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FEES er Ras raed htined ann AERTS A RLS RGRAY oA SAY CRESSee SEt Re S
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Dyes
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262
BRITISH JOURNAL OF INDUSTRIAL MEDICINE
TADEL 1
age at deATH OF
83 PATIENTS WITH TUMOURS
MESOTHELIAL
patient the notes had been returned to the local executive council of the National Health Service where they were destroyed within a period of three
Age yr
35-
| 45
55 | 65 i
Male
%
No.
%
171
15
36
10
24
?
17-1
Female
~
No. No.
:
i
24
9
21
18
429
8
19
tumours the commonest presenting symptom was the rapid onset of extreme shortness of breath due to the formation of a massive pleural effusion Pain was a prominent feature either described as a dull ache sometimes due to invasion of the ribs or vertebrae or sometimes sharp and radiating suggesting nerve involvement Tumours in the chest wall were not uncommon occurring either in previous operation scars or by direct invasion of the chest wall The symptomatology of the peritoneal tumours was more varied In some patients the presenting symptom was pain on defaecation or micturition Diffuse upper abdominal pain was very common and swelling of the abdomen due to ascites was always present terminally The methods of treatment included pneumonectomy decortication
of the lung deep ray therapy instillation of radio
active gold and cytotoxic drugs They were used
alone or in combination but had little effect on the
course of the disease Half of the patients suffering from pleural mesothelioma died within one year of
the onset of symptoms a further third within two
years and only one patient survived for more than three years The course of those with peritoneal tumours appeared to be equally rapid Eight of the patients died within six months of the onset of
symptoms
Sources of Information on Occupation and Residence
In addition the ward notes some of which gave
good occupational histories there were three other
sources of information the patient's general practitioner the records of an asbestos factory in the area and personal interviews with patients or their surviving relatives
As first step general practitioners were circulated with an explanatory letter asking them to complete a form giving details of the occupations of patients
and their immediate relatives Within two months 65 of the doctors had replied In two cases a
hitherto unknown exposure to asbestos was revealed; in others the name and address ofa surviving relative
were given but the majority the doctor was unable
to give information because on the death of the
years factories
with
In one of the asbestos factories a file was kept with
detailed records of all employees since it started in
1913. The names of all patients were checked with
these files Nine men and nine married women after
ascertained
their
maiden
their maiden names had been ascertained from rela-
tives were identified without difficulty The exact
dates of employment of these 18 patients and the
jobs they had done were obtained from the records
of the factory
.
The four patients alive at the beginning of the
investigation were interviewed personally A few
relatives were contacted by post but the relatives of
68 patients were interviewed by one of us H.T. at
their homes situated mostly in the East End of
London Not only was an occupational history ofthe
patient the spouse sons and daughters and father
taken but past addresses were also recorded The interviews lasted for at least an hour To recall events
of 30 or 40 years ago it was often necessary to
explore the residential and occupational histories of all members of the family
Exposure to Asbestos in Three Groups of Patients Suffering from Other Diseases
For comparison with the mesothelioma patients three further groups of patients suffering from other discases were investigated
The first group was selected from the patients in the medical and surgical wards of the hospital during the early summer of 1964 patient series Each patient in the mesothelioma series who had been traced was matched with an patient of the same sex born in the same year period As there was a dearth of male patients over 75 years of age in the hospital a sample of six patients of this age and older was taken from a neighbouring geriatric
hospital The second group were those who had originally
been filed in the pathology department of the hospital as cases of mesothelioma but in whom the diagnosis was subsequently rejected on pathological grounds by Hourihane 1964 rejected series As it had proved extremely difficult to locate the relatives of those who died before 1950 attempts were made only to trace the three survivors in this group
and the 14 who died after 1950
The patient series already described were all admitted to hospital in 1964. The patients with mesothelioma were admitted to the same hospi.a over a period of 47 years during which there might have been a substantial change both in the residential
MESOTHELIC res . : an
an
a
2 social a classes
areas and social classes
> London Hospital Thus was taken from the hos
K date of admission as well
in HM
with the patients the bi
places of residence ando
for comparison with those
ee
ae
t ann {>
rd
ze
.
.
tga
.
'
ee
Res ae
tant
Bin Geol
tes .
an
.
of series Details the 83 pati
% series are given the
F' about past domestic and
availablefor seven patier
76 40 52 gave a hist
: compared with only nine
series Table 2 The diff
:
cad
',
ao
a
roy
P
T^'
TYPES OF EXPOSURE TO
. WITH MESOTHELIOMA AND
i Leanne
q| Type of Exposure
*.
ry
bestos nN Re
Employed at one
factory
*
Delivered goods to factory
Employed iy
at other asbestos
iy factories }
i
*
i
Insulators and laggers
sg
4 * Relative worked with asbestos
,
t
2 Dockers handling asbestos
cargo
>
No history of work
= it domestic
a+sbestos
exposure
ar by
a 2A
es
Positive positive exposures to y
patient R
positive histories in
&
xy? = 2k
>
mesotheliom S<even cases of
from this table
.
te
Ae
*
statistically highly sign
0.001 This result is un
by the two groups of pe
. year of admission to b
significant difference eith
or in the occupations oft and those admitted bety
paring the confirmed
mesothelioma group wh of the confirmed and a gave a history of expos This difference is stat
x= 83 < 001
MESOTHELIOMA OF PLEURA FOLLOWING EXPOSURE TO ASBESTOS
263
gethere wasi, in in the :
age and ;
geriatriocus
whom the +:
thological , rles As
F the rela2 3
ripts were
his group ;
md
were all
cats with
hospital*
might Pe
csidential -
areas and social classes of patients attending the London Hospital Thus a third group of patients was taken from the hospital records matched by date of admission as well as date of birth and sex with the patients in the mesothelioma series Their places of residence and occupations were extracted for comparison with those of the patient scries
Results
Details of the 83 patients in the mesothelioma series are given in the Appendix No information about past domestic and occupational histories was available for seven patients Among the remaining 76 40 52 gave a history of exposure to asbestos compared with only nine % of the patient series Table 2 The difference in this proportion is
TABLE 2
TYPES OF EXPOSURE TO ASBESTOS OF 76 PATIENTS WITH MESOTHELIOMA AND 76 PATIENTS WITH OTHER
DISEASES
Type of Exposure
Fimployed at one asbestos
factory
Delivered goods to factory
Employed at other asbestos
factories
ss
Insulators and taggers
Relative worked with asbestos
Mesothelioma Scries
No. %
} 18 18 18
250
4
3.3
8
10-5
9
11.8
patient Series
No. | %
|
!
i
i 4 {
13
13 $ 1.3
Dockers handling asbestos
cargo
D
_-
2
No history of work of
domestic exposure to
asbestos
36
47
67
26 882 882
Positive exposures to asbestos in positive histories in patient series
mesothelioma
series
versus
X - 27-11 P < 0.001
Seven cases of mesotheliorna could not be traced and are omitted from this table
es
ate
statistically highly significant x = 27.11 <
0-001 This result is 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 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 gave a history of exposure to asbestos Table 3 This difference is statistically highly significant
x== 83 r < 0,001
o
.
y .
TABLE 3
EXPOSURE TO ASBESTOS OF CONFIRMED AND REJECTED
SURVIVING CASES OF MESOTHELIOMA
AFTER JANUARY
Exposure to Ashesina Exposure positive
Diagnosis of Mesothelioma
i
er eS en
|
Confirmed
Rejected
'
36
,
No work or domestic contact
found
JS
16
Untraced
H
1
i
= 1183P < 0.001
Mesothelioma Series
Occupational Exposures are details avail able for the 18 mesothelioma patients who had worked at one asbestos factory which used crocidolite asbestos with small amounts of chrysotile and first introduced amosite in 1926. Eleven started work before 1933 the year when the asbestos regulations 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 occujations 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
TABLE 4
JOBS OF 7 PATIENTS WITH MESOTHELIOMA EMPLOYED EMPLOYED AT ONE ASBESTOS FACTORY
Statutory Obligations Subject to regulations
-
t
'
Job
~... Male
Female
Material Material Material
+ Spinning
0
4
Crocidolite
Carding
I
t
l
Crocidolite
. Clothing and
| Crocidolite
=
weaving
i
i]
:
j
chrysot .e
amosite
1 Disintegrating
Crocidolite
a
and opening
:
t
chrysolue
amosite
| Filter making !
| { for A.R.P I
\
1
masks
-
3
@
| Crocidolite
1
H
+ Manufacturing
preformed
| I
pipe insula-
H
Lisan
i
i Crocidatite
Not subject to regulations
| Alanul icturIOictuNrION
=; of brake
p Jiangs
'
u
1 Crocidobte
t
|
Rubber usm
Crocidolite
|
pounding .
0
1
| | ! General .
Chrysotile Crecidolite
' labourer ! 1
{
:
t
Chrysobie
iniosit^'
Employment history not available for one female patient
fey .
afes
4
Ef.
y
*
Nias 3 cord TREE
f
;Prt
yy
wrt
Saha Se es
3 BS
ERD sae HOE A aUbs 4
BAER a
ledytcl ged
ae
> <2
gy.
fs
Sod
5
tet
}
& ap
a,
e
ang
of
GR
Lr
.
a
Owe
z
ere Be gg
Oe egy
.
7
2 Sf ade
n x
-
. SSonyv
264
BRITISH JOURNAL OF INDUSTRIAL MEDICINE )oj'"
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 -- --T hree had been employed in dockyards on ship repairs two in various types of lagging one in a power station one installing hospita 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 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
years and his wife brushed him down The two men
in this group when boys of 8 or 9 years old had sisters who were working at an asbestos factory One of these girls worked as a spinner from 1925 to 1936 In 1946 she died of asbestosis The press report of the inquest states She used to return home from work with dust on her clothes Her brother had apparently no other exposure to asbestos he started work as a shop assistant then became a sawyer of iron girders until 1948 when he worked as a loader of groceries in the docks for five years but never on dusty cargoes and then returned to sawing iron girders He died in 1956 of a pleural mesothelioma
patient Series
Occupational and Domestic Exposures of this series had worked in asbestos factories and four had been employed as laggers The husband of another was employed at an asbestos factory for
three years and two dockers in this group gave histories of handling asbestos cargoes from time to
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 indication that exposure to asbestos could be related to the disease which had caused their admission
Neighbourhood Exposures of Mesothelioma and patient Series 36 patients with meso-
TABLE 5
a
ioe.
THE PATIENT DISEASE GROUPS OF PATIENTS IN SERIES j
Disease Group
}
Patients ad
'
No. of |
No. with
Exposure 10
Asbestos
Cardiovascular
Metabolic
oa
endothelial including
anaemias
excluding
Gastro ) intestinal
excluding
Respiratory excluding cancers
All neoplasms
Other
Total
21
a oa
oa, a
a
bed
7 0
et ed
6 5
, 2
Jor[ty a
18
a
Ol
?
ye
76
a
ar
uw
thelioma and the 67 patients in the patient series 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 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 affected 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 half-
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 years
later She is the only patient who had neither
occupational nor household exposure but in whom
asbestos bodies were found in the lungs at necropsy
Among the patient series one patient lived
near the factory at its previous site and four others
lived near its present site One patient was 22 years
old when she moved into the neighbourhood in 1915
She disliked it and when interviewed complained
impartially about the dust from the asbestos factory
and the rats in the house
;
TABLE 6
RESIDENCE OF PATIENTS WITH NO OCCUPATIONAL OR DOMESTIC EXPOSURE TO ASBESTOS
Series
Mesothelioma
patient
Lived Within } mile of
Asbestos Factory
No. 1
%
30-6
S
75
;
Lived More Than
Asbestos mile from Asbestos Factory
Total
No.
*%
25
69
36
62
92
07
** 7-85 < 0.01
.: Nari
. nee yl SM
t
: . Thus among those
domestic exposures to as
. patients in the mesotheli
In the patient seriesw
- of an asbestos factory in
.. difference in the proport
- series who lived in the yc
fr ~ had no other exposure
be. significant x.7.85 .7.85 ,
rity
. co on %
: in Date of First Exposure
- in Mesothelioma Series
had been exposetdo asb 3 lived near the main asbes
M., of exposure varied widel B to over 50 years . The
R exposure and death vark
B . mean 37-5 years Ad
. workers where exposure
. interval was shortest exposure
group living in the neig
factories where exposu
e.. lowest Table 7 showst
at first exposure and the
=i death in each group
RELATION BETWEEN TYF^
OF INTERVAL BEFORE 7
-
MESOTHE
4
; a
.
os Type of Exposure
oR ag
No.
Factory work
Bf Domestic
FS} * Laggers and insulators
*fi
Living in neighbour-
hood of factory
$ . x
:
ui]
an?
.
oh 2 $ can
varied between 29.4 and
death showed less variat
group of factory worka
++ years in the other groff
Asbestos Bodies ar
thelioma SerieOs f`th
'
thelioma series lung
examination in forty-
all certified as suffering
tissue available examin
revealed the presence
Both asbestos bodies in asbestosis were found in
and laggers A further
asbestos bodies or asbel
*y,
f
Eee ns
Nee
iy?
3
MESOTHELIOMA OF PLEURA FOLLOWING EXPOSURE TO ASBESTOS
265
-
Thus among those with no occupational or
Lung tissue was available in only four patients
HE PATIENT -@ domestic exposures to asbestos there are 11 30-6 exposed either through relatives or by living in the
:
. 2 patients in the mesothelioma series and five % neighbourhood of asbestos factories In two
of | No. with
49 in the patient series who lived within half a mile asbestos bodies were present in lung tissue but there
rae
Exposure 44 44 a,
of an asbestos factory in the area Table 6 The difference in the proportion of patients in the two
was no evidence of asbestosis
o
|.
series who lived in the vicinity of the factory and had
TABLE 8
2 /
had no other exposure to asbestos is statistically
@
z
significant x= 7-85 P < 0.01
EVIDENCE OF ASBESTOS RODIES OR ASBESTOSIS IN 47 CASES OF MESOTHELIOMA WITH Lung Tissue or
ache
A
SPUTUM AVAILABLE FOR EXAMINATION
a
a:
M in Date of First Exposure and Interval Before Death
in Mesothelioma Series men and women
had been exposed to asbestos including those who
History of
Contact
with
Asbestos
Asbestosis or Asbestos Bodies
Present
Absent
Lung Tissue not Available
The patient
person tional exposure working with {D asbestos dust ERM,
oe
of an
vicinity
Sg
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
mean 37.5 years Among the group of factory workers where exposure was probably heaviest the
fifth i of the , opened in
interval was shortest It was longest among the
^'
group living in the neighbourhood of the asbestos
the centre of factories where exposure to dust was probably
. There were a lowest Table 7 shows the mean age of each group
fiwithin half a
was in produc-
4 at first exposure and the mean of the interval before
death in each group Although the length of interval
ped they were
At the present 'of :
TABLE 7
within a half-
was born within
4 RELATION BETWEEN TYPE OF EXPOSURE AND LENGTH S$ OF INTERVAL BEFORE DEATH IN 51 PATIENTS IN-
and remained at - 28
MESOTHELIOMA SERIES
other seven were
^...ldrenwhen the rt years of age and . .
Type of Exposure
Mean Interval
Mean Age at
between First
No. | First Exposure | Exposure and
years
Death
he died 48 years i
years
had neither vA Factory work
23
bo but in whom
Domestic
9
Laggers and insulators
8
tr" pgs at necropsy
Living in neighbour-
Be patient lived 4 hood of factory
tl
/
22 17 156
.
8.5
29.4 37.9 38.4
48
and four others
i; ent was 22 years
ourhood in 1915
fed complained
;
asbestos factory, 4
rh
Fea a
3
:
e
ya
OR
CCSUBPESATOTSIONAL . ?
Vore Than de from
on Factory
%
fo
' |*
Total
.
.
. 69.4 ase
.
36
r, 92
A
67 A]
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
Asbestos Bodies and Asbestosis in the Meso-
thelioma Series the 83 patients in the mesothelioma series lung tissue was available for examination in three In four other patients all certified as suffering from asbestosis with no lung tissue available examination of sputum during life revealed the presence of asbestos bodies Table 8 Both asbestos bodies and histological evidence of asbestosis were found in 15 of the 24 factory workers and laggers A further five showed evidence of either
nD oe
+.
.*
.
asbestos bodies or asbestosis
Pourive
22
Negative
*
Untraced
4
h
23
"
13
3
0
Total
30
i
17
36
Among 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 early history could not be established There were three others in this group who had asbestos bodies in lung tissue without evidence of asbestosis
Of the seven patients whose histories could not be
traced three had asbestos bodies and histological
evidence of asbestosis and one had asbestosis alone
Discussion
In the mesothelioma series there are 25 patients in
whom no evidence of any exposure to asbestos could
be found A chief source of information was a
history taken from a surviving relative A surprising amount of information was obtained but in some of
those interviewed the memory may have been defective or they may not have known of short periods of exposure during the youth of the deceased For example one of the patients was eventually identified
as having worked at a large asbestos factory for two
months in 1941. This was before he married and
his widow did not know of this episode It is of interest that asbestos bodies in the lungs were found
in only four of this group and it seems probable that
- among the remainder there were those who had had
no exposure to asbestos
|
In the mesothelioma series of patients both in-
dustrial and industrial exposures were recog
nized
Among the men the exposure was pre-
dominantly industrial 22 worked in asbestos
factories or as laggers two were exposed at home and one lived near the asbestos factory Among the women only 10 worked in asbestos factories and a
:
3
S
oy me
SO
A
ee
Ie
e354
2 a aeeley Lae
CAEPe ee la ie ad HES NG
frangtonl ON Phat ee TS REESE IE
Re saint eo
wR
os
areata
Mite
Dar Ti
mi
ty,
266
BRITISH JOURNAL OF INDUSTRIAL MEDICINE
further 17 had industrial exposures seven in the home and 10 living near asbestos factories
There is no evidence that the patients with peritoneal tumours differed in their type of exposure from patients with pleural tumours The proportion of positive findings of asbestos bodies or asbestosis was similar in both groups A higher propartion of women particularly among the factory workers was affected by peritoneal tumours but the difference between the sexes was not statistically significant
The recent increase in the number of patients diagnosed at the hospital may be partly due to an increased interest in mesothelial tumours and partly to the long interval between first exposure and development of the tumour Those exposed between 1915 and 1925 might be expected to die from about 1950 onwards Asbestos imports to the United Kingdom have mounted steeply since 1932 Leathart 1964 and its uses are more widely diversified in industry The increasing proportion of the population exposed to asbestos during the past 30 years may be expected to give rise to an increasing
occurrence of mesothelial tumours
The choice of groups for comparison with the mesothelioma series of patients was not ideal The number of patients it was possible to trace in the rejected series proved to be very small The 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 knowledge 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 reliable histories were obtained than was possible from the relatives
of those who had died ofmesothelial tumours There
was no evidence that because of their more recent
admission to hospital the patient series was less
likely than the mesothelioma series to work in con-
tact with asbestos or to live in closer proximity to
asbestos factories
.
i
There seems little doubt that the risk of meso-
thelioma 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 been found in the population living near an anthophyllite mine in Finland Kiviluoto 1960
More evidence is required of an increased risk to the
population living in the neighbourhood of asbestos
factories or other areas such as dockyards where
asbestos is used in quantity
where
We should like to thank Dr. D. O'B Hourihane for
his operation and for making the results of his investigations available to us
Our thanks are also due to Professor C. Wilson Professor V. W. Dix Dr. N. L. Rusby and Mr. G. Flavell F.R.C.S. of the London Hospital and Dr. C. ^ Silver of St. Matthew's Hospital for permission to interview their patients to the general practitioners who collaborated in this enquiry to the managements of the asbestos factories for arranging access to their records to Miss Joan Walford for statistical assistance and to Dr. 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
Fowler P. B. S. Sloper J. C. and Warner E. C. 1964 Brit med
Leading article 1964 Ibid 2 202 Hourihane D. O'B 1964 Thorax 19 268 Kiviluoto R. 1960 Acta radiol Stockh Suppl 194 Leathart G. L. 1964 Occup Ilth Lond , 16 119 Owen W. Glyn 1964 Brit med J. 2 214 Wagner J. C. Sleggs C. A. and Marchand P. 1960 Brit
industr Med 17 260
.
f
MESOTHELIO
4
3 t : oy
hana
beet
No.Casa Casa
fe
.
. .
.
:
% -
ws
an
t?
Sito
Sito of
Prudery Tumour
yf
.
.
of
| -
*
kab
an
2
Sex
ac
ve
4
| Year
| of | Birth
in
t
Section A workers | |
38Pleura"jy M 190 18
19 | Peritoneum tot |
N wo ah
ay
.
- BE {Y8 | Peritoneum | F
:
{
Peritoneum >
{fi | Peritoneum
J} | Peritoneum 11 | Peritoneum
Yas . a)
-9 |
re dy]
.
ws Ja|
Peritoneum eye
| Peritoneum P &
Pleura
M
Periconeum |
A F
,
H
| | > Peritoneum M I e
1
Pentoneum }. Mer is
Pleura
.
4 8 :
MTD
ore
| W Peritoneum
F
.
ol
Pleura Picura
Peritoneum
F B
M iD
+
ES,
Pa. ee
| F [Us
Pleura
bh
23
Pleura
M
at 4
"
$ 3 | Peritoneum | M
ps 4 | PeritoneumTS | M , AveY a
Section B Laggers and insulah
25 | Pleura
M. yt
Appendix opposite
29 | Pleura
|
22
Pleura
.
30
27
.
. ca 26
31
'29
: Pleura
' Peritoneum Peritoneum
| Pleura
| Pleura
M,Tr a3 Pa~e)nae 5
M
<r
Sxsx ais
ova
Y t
Raute s ew
ae FKLe
oy
y
a
re
ce a "ca ato s ae
aps
a
Baie
tk
if
Y,
ataite es
Tage
G ]
1%
Niget
2G ToSANgeri
"1
Svcs
.
yg
a,
Fey yo
}
work in con-
i proximity to ,
Trisk
Trisk of meso- 3
cupational cupcuapattioinaol nal and and
cupational
Qty
and others
xposure
4
xposure other #4
of the asbestos :
Ae plaques of the living :
non living near
Kviluoto 1960 & fased risk to the the
^ ad of asbestos
MESOTHELIOMA OF PLEURA FOLLOWING EXPOSURE TO ASBESTOS
267
EIGH - TY THree patients patpieanttsients APPEwNDiItXh MESOTHELIALMESOTMESOTHELIH AL ELIAL TUMTUOMUORURSS
| Case
No.
Dura- Site | Site of | | Primary
| | || Tumour
Sex
Year
of
Birth
Year
of
First Expo-
sure
tion ur
Expo
sure
years
Year of
Death
How
Diag nosed
Patho-
Asbestos
| | Bodies | in Lung | Symptoms Tissue
logical Evidence
Survival from
of AS-
Initial
bestosis Symptoms
in Lung | months
Tissue
Relevant History
Section A Factory workers
3 | Pleura
j 1901 | 1921
iy | Peritoneum | | 1995 1919
Peritoneum
18 | Peritoneum | F
1908 1925
24 (| Pleura 14 ] Peritoneum
1880 | 1923 1893 | 1917
17 | 1938 | Necropsy | Positive 1 Positive
22 | 1941 | Necropsy | Positive | Positive
:
S | 1947 | Biopsy
Positive | A
sputum
12
1950 | Necropsy { Positive
Negative
?
1951 | Necropsy } Negative ; Negative
hoiler crocidolite asbes- Brake 7
liner
tos factory mainly crocidolite
| 7
Disintegrator and other jobs
asbestos factory amosite croci-
dolite chrysotile
?
Sectional pipe maker asbestos
asbestolic main-
factory certified
9
Used asbestos boarding in railway
carriage construction
?
Asbestos factory job unknown
Wilson
C.C. Wilson On
by and Mr. On
Dr. C. and
mission
P. P. C.
mission to inter-
titioners
.
Esist, ance to sy ,
W. Shiling Shilling and Dr.
.
:
vee
16 | Peritoneum | F
1906 | 1922
7 | 1951 | Biopsy
Positive | A
sputum
3 | Peritoneum | F
11 | Peritoneunt | F
.
1894 | 1913 1895 | 1917
(S|
Peritoneum | F
1901 | 1918
9 |} Peritoneum | F
1897 | 1919
21 | Pleura
M | 1893 | 1928
12 | Peritoneum | F
1918 | 1937
| | | | 3
Peritoneum
M
1908 1927
.
:
- Peritoneura {| j 1925 | 1940
" | 1955 | Necropsy | Positive | Positive
I | 1955 | Biopsy
Positive | A
sputum
} | 1955 ' Biopsy
Positive | A
sputum
1 | 1956 1 Necropsy | Positive | Negative
I
1957 | Biopsy
A
A
z | 1958 | Biopsy
A
A
30 | 1938 | NecropsNecyropsy | PositiPovsitivee
4 | 1958 | Biopsy
A
Positive A
2 { Pleura
M | 1925 | 1941
.
20 | Peritoneum | F
1907 | 1921
1/6 | 1959 | Biopsy
Negative | Negative
10 | 1959 | Necropsy | Negative | Negative
?
Opener and sectional pipe maker
asbestos factory certified asbes-
toti~ amosite crocidolite chryso-
tilc
12
Spinner asbestos factory certified
asbestotic mainly crocidolite
m
Sectional pipe maker asbestos
factory certified asbestotic mainly
crocidolite
6
Spinner asbestos factory certified
asbestolic mainly crocidolite
3
asbestos factory Disintegrator amosite crocidolite chrysotile
factory 18
Asbestos
north England
asbestos factory
18
Ccarrodciedrolaitsebestos factory mainly
18
Clothing and weaving asbestos
factory chrysotile amosite crocidolite
3
Filter maker for A.R.P. masks
asbestos factory mainly croci-
dolite
it
i
asbestos maker asbestos
for factory
A.mRa.iPn.ly
masks
croci-
dolite
?
Electrode coverer crocidolite
17
Pleura
6 | Pleura
F
1908 | 1924
i}
1962 | Biopsy
Positive | Negative
,
M | 1907 | 1942 | 10 | 1962 | Necropsy } Positive | Positive
?
|
|
10 ] Peritoneum | F
1899 | 1923
It | 1963 | Biopsy
Positive | Negative
S
Spinner asbestos crocidalite
factory mainly
Deflaicvteorreyd
chaemmoisciatles
crocidolite to crocidolite
chrysotile
Spinner asbestos crocidolite
factory mainly
| Pleura
M | 1899 | 1936 | 26 | 1963 | Necropsy | Positive | Positive
23
Pleura
| 1908 | 1925
3}
Peritoneum | | 1911 | 1930
31
2 |
1963 1963
| Necropsy | Positive
Positive
| Necropsy | Positive
} Negative | Positive
4 | Peritoneum | | 1947 1937 | 23 | 1964 | Necropsy | Positive , Positive
asbestos asbestos ffaaccttoorryy
and buildings
amosite croci
doltic chrysolike
Worked 8
in yard of insulating
contractcontractors ors
mainly
6
Carder asbestos crocidalite factory mainly
24
Disintegrator und other Jons
asbestos factory amosite croci
:
| :
$
.
{
| dolite chrysolile
o rteay A.
S503 aa TON
thie a ave
> .
.
wer ey
$
Section B Laggers and Insulators
.
| 1 | 1935 ) 25
Pleura tj
M
1874 1888
53
11935 Necropsy Negative Negative |
12
a
to Worked in close proximity proximity boiler repairer in duckward duckward
| 2285859
Pleura -
t
| Pleure
'
Pleura
M |} 1893 | 1910 2 | 1955 | Biopsy
A
M
1921 | 1937 | 2 | 1959 ] Necropsy | Positive
Positive
M
1908 | 1922
2
1961 | Biopsy
A
A
Positive
1 A
Boiler 24
!
cleaner and stripper dock-
yards
9
Boiler coverer firms
and
lagger
to
various
25
Erecting and fitting central heating
1908 | ' Peritoneum
\
1922
2
1961 - Necropsy Positive ' Positive
\ | | |j H
Peritoneuin
1911 | 1927
2
1961 Necropsy Positive
Positive |
12
| Boiler coverer aid pipe insulator
contracting hem
13
L^ggerand boiler coverer various
bemy
{ Picura
} i Pleura
i
M
|
1897 | 1916
=
1912 | 1927 | X
1962 | Biopsy 1962 | Biopsy
A A
A A
K
Intermittently boder lugger s up
repities
10
Installation of hospital sterilizing
1
equipment
continued
ega
Soclheyerona 8
Te 2
~
Pete Fa .
me.
aaa
-
AI
ewe
web
me
KB
wewe oY
~
ae)
en
he ew
tw.
-
id a}
F228
ons 3360
Pe,
me
>
os poe? RAL
pecan?
268
BRITISH JOURNAL OF INDUSTRIAL MEDICINE
APPENDIX continued EIGHTY patients with mesoTHELIAL TUMOURS
Dura
.
Patho-
Case No.
Sue
Sue of
Primary
Sex
| Year
| or |
Year of
First
tion
of Expo Year
Expo ol
How Ding-
Asbestos
| } Dodies | in Lung
logical Evidence
of As-
Survival
[|
from
Initial
'
.
Relevant History
.
Tumour
Birth
Expo- sure DeathDeath
sure years
nosed
Tissue
bestosia Symptoms Symptoms
| In Lung Tissue
months
Section C. Exposure of relatief
40 | Pleura
M 7 1912 1925
11
1936 | Biopsy
A
34
Pleura
38 Pleura
F
1983 | 1919
2 | 1957 | Diansy | A
F
1895 | 1919
41
1960 | Biopsy
A
A
A A
27
.
14 15
7339 | Pleura
F
1905 | 1925
14 | 1960 Biopsy
A
A
3
7339 | Peritoneum { F
1890 1921 1 21
1960 | NecropsNecyropsy | Positive | Negative
24
7339 | Pleura
7339 | Picura
F
19th { 1930
4 | 1961 ] NecropsNecyropsy | NegNegaative tive | Negative
1
F
5 | 1919 1928
2 | 1961 Biopsy | A
A
EB
32 | Pleura
F | 1900 | 19st
n | 1963 | Biopsy
A
A
18
36 | Peritoneum | F | 1889 | 1942 18 | 1963 | Biopsy | A
A
"
.
Section D Neighbourhood cases
| | 71959 | 44
Pleura
F
1905 1913
71959
71959 Biopsy
A
A
a
.
48 | Pleura 42 | Pleura
M | 1922 1922
16 1960 Biopsy
A
A
17
:
F
1889 1913 | 48 | 1961 | Biopsy
Positive | Negative
15
50
Pleura
F
1903 | 1908
6 | 1961 | Biopsy
A
A
13
43 | Pleura
F
1905 | 1913 | 131961 13961 131961 | Biopsy
A
A
4
47 | Pleura
F
1917 | 1917 | 10 | 1961 | Biopsy
A
A
16
64 | Picura
F
1899 |: 1907
6 } 1962 | Diopsy
Negative | Negative
S
71
Pleura
F
1899 | 1907
6
1962 | Biopsy
A
A
12
41 | Pleura
F
1900 | 1913 | 32 | 1962 | Biopsy
A
A
29
| | | 45 Pleura
F
1900 1913
7
1962 Biopsy
A
A
9
i
46 | Pleura
the
1907 | 1913
7
1963 | Biopsy
A
A
7
f
Section E. No history of contact with ashestos
65 | Pleura
|
F
|
i
68 =| Peritoneum
F
49 | Pleura
M
1900
| |
1902 ,
1
1895
1947 | Necropsy; Positive
Negative
7
1954 | Necropsy | Negative | Negative
s
1954 | Biopsy
A
A
?
1
75
Pleura
F
1899
!
i
1955 | BiopBsioypsy
A /
A /
74 Peritoneum F
|
a
i
62 | Pleura
M
1904 |
1899 |
|
1955 | Necropsy | Negative | Negative
27
1955 | Necropsy | Negative | Positive
28
| t '
j t
| '
!
|
| | :
i
1
.
.
Elder sister worked as spinner at asbestos factory died 1946
certified asbestotic Elder sister employed as spinner
looked after patient as child worked
For several years itusband worked
in ship's engine room close
proximity to lagging operatiotis
Husband worked as boiler covercr
Husband Husband
brought foreman
haonmd e
for
washing executive at
asHbuessbtaonds
factory a
docdockekr er
frequentlyfrequently frequently
handled white asbestos spinner
Elder sister worked as spinner at
asbestos factory and sulfers from
asbestosis
in
asbestos Daughter worked
factory
for 5 years patient washed her
overalls
Husband railway carriago builder
lined with asbestos compartments sheeting work
sheeting
clothes washed at
ge ag? i
%
an
,
Pleura 58
s
:
.
are
66. | Pleura .s
an
of
oe
ea
-b
ci
:
PeriPtoeneruria toneura
fog
2 .
M F
.
a
Pleura Pleura
...
.o
-
4
x,
Lived
within
i
Lived within i milo of present site
of asbestos factory Lived within ^ nule of present site
of asbestos factory of
Lived within 100 yards of present
site of asbestos factory
site
Lived within ^ mile of old site of
asbestos factory mile
Lived within mile of present site
of asbestos factory
Lived within 200 yards of present
site of asbestos factory
site
Lived within 1 mile of old site of
asbestos factory
site
Lived within 1 mile of old site of
asbestos factory Lived within mule of present site
of asbestos factory sita
Lived within { mile of present sita
of asbestos factory
Lived within & mile of present sile
of asbestos factory
Worked as nursemaid to manager of gas works in East London
asbestos insulation used in works
Shorthand lived
and housewife
lord area
Baker's roundsman army general
labourer publican for 30 years in
Munitions London End of Munitions work
before marriage
then housewife lived Waltham
Abbey Essex in
Tailoress and housewife in East
End of London
Employed as luteman and greaser
Beckton g35 works 36 years persistent discharging unus R.
side of chest following empyema - 1925 acute chest infection 195
subsequent thoracoplasty but deteriorated from this date
/ Pleura /
} / Pic ura /per
;
av,
. 73
vs
Pleura
q *+ ; oY 77 TM 8d +
i)
wh.
4
i 70 | Pleura
72
ar .
| Peritoneum
+
' B
am)
.
$3
Pleura
A,|
rye
60 | Peritoneum i, B
e
1 _: 67 | Pleura z
| N
56
oa
Pleura
o2 a
.
Hy
1 +
>
@, | Peritoneum
%PD
.,
ag
:
ty
| +
53
Pa
ines
Pleura
,
y fe
' *
Ar
~ ae os?
$
F Section F UUnnttrracaecded Untraced ~ ae
_
Untraced
) ie. 78
. &
Pleura
| <a
.
:
&
&
= + go
83 | Pleura
81 | Pleura
.
80 | Picura
: y
st
ve
3
b ,
fF 82 Pleura
uM
a
GA
| } & Be
77
Peritoneum
3
a
;
79 | Pleura
Pleura Kos
continued
we:
0
ee
eee Yet
ora ide EN Rte he
mani
x
etek Meg ites Ltt
SEN
OAT
se.
a
EN
bee ne
LOS
0
Sa ANT EAR CRIP ELS TOS Db
Rad
ae
ORea
OOF
4
eee: Parti
ONE Lig Phe
sake wshhs fa
fee
ett.
yes
+E
MESOTHELIOMA OF PLEURA FOLLOWING EXPOSURE TO ASBESTOS
APPENDIX continued
EIGHTY PATIENTS WITH MESOTHELIAL TUMOURS
269
Site of
Primary Tumour
Dura-
tion
or
of
First
Birth
Expo-
Exposure years
.
How Diag
nosed
Patho
Asbestos
togical
| Bodies
in Lung
Evidence of As-
Survival from Initial
Tissue
bestosis
in Lung
Tissue
|| Symptoms months
|
Relevant History
Peritoneum
Picura
Pleura
F
Pleura
Pleura
Peritoneum
Picura
.
Pleura
Pleura
Pleura
Pleura
F
Pleuts
Peritoneum
1
,
~
Pleura
X
| Peritoneum
'
i
| Pleura
! Pleura
Peritoneum
4
Pleura
M
-
Po
q
Section 1: UntencedUntenced
Pleura <
1893
Biopsy
A
A
|
A
Merchant scamun cargoes froin S Africa 1930-32 no definite evidence of contact with asbestos subsc quently employed on channel boats
Biopsy
A
Labourer and builder finally emplayed in tunnelling lived East End of London
Biopsy
A
Employed remaking old sacks in Bow previous content of sacks not ascertained lived East End of
London
Biopsy
A
t
Biopsy
A
Garage hand chauffeur mechanic
'
lived Wolverhampton and Epping
Worked J printing machinist before marriage then as housewife until death lived East End of London
Biopsy Biopsy Biopsy
A A A
A A
Stereotyper and printer Inved originally in East London then moved to Ipswich
Van boy regular army cutter and grinder lived N.E. London and Dagenham
Bricklayer cement worker postman lived Last End of London moved to Hainault Essex in 1911
Necropsy | Negative | Negative
Fitter and Turner lived principally in East End of London
| | i
Necropsy Positive
Positive
?
Coloured S. African merchant sea-
man stoker at glass factors
possible contact with asbestos in
5. Africa or at sea
Necropsy | Negative | Negative
Lived until marriage in Wales then housekeeper in 5.W. London
Biopsy
Negative | Negative
Machinist housewife
of celluloid and canteen
collars worker
lived East London
Biopsy
A
A
1962 | Necropsy { Negative ; Negative
Negative
Necropsy | Negative | Negative
Machinist in hosiery trade Nolting-
1960 1960 housewife moved to London
Labourer
merchant
scaman
docker carried only meat
Apprentice punter barman cook and butcher For 25 years before
Biopsy Biopsy
A A
A A
death lived East End of London Dressmaker and housewife lived
I East End of ondon then Somerset
Steel erector army steel erector labourer and porter lived East
End of London
Necropsy | Negative | Negative
Employed as packer in pharmaceutical firm for 12 years then
housewife until death ined in
Necropsy | Positive
Negative
.
Dagenham Fisherman fireman docker 1915-
39 at Tilbury docks fireman and finally storekeeper contact with
asbestos not probable at Tilbury docks lived Tilbury area
Necropsy
..
Positive
.
Not traced
Pleura
Necropsy | Negative | Negative
Not traced
Pleura
X
i
Pleurs
1023 Necropsy } Negative | Negative Necropsy | Negalne | Negative
Not traced
Not traced
Menta
1938
Necropsy | Positive | Positive
Not traced
Peritoneum
1 79 Pleura
| . ee
Necropsy | Positive | Positive
| | |
Necropsy Positive
Positive
Not traced Not traced
A = tissue not available
oe = sii ts aneia afae