Document 85rdkpZaJqr3BLmgo2rmxBYyZ

FILE NAME: ZD^D/ DATE: DOC#: ^D/ DOCUMENT DESCRIPTION::ZdZZZZ D 1031 EurrmuALS A:\D A;..;:-;oTATIONS ( ..dlldd, ::'\fl \l. .\~:-- . .r. ~Lly b, UHi~. \ (.l\. 9!! THE CAN ADI AN MEDICAL ASSOCIATION JOURNAL LE JOURNAL DE L'ASSOCIATION MEDI CALE CAN ADIENNE published iceekly by THE CAX.\DIAX l\JEDICAL ASSOCIATIOXL,ASSOCIATIO:\' CAXADJEN:>:E UEDICALE Editor, C.i\!.A. P11/J/ications: DONALD C. GH.\11.\~l, :\l.D., F.R.C.P.[C] A.1wci11te Editors: Gmmo:-.: T. D1r.1o.:1;-.;so:-.:, ;o.1.A., ;o.1.D. Jo11N 0. Comn N, :\1.D., C.:\I., :\I.Sc.( :\kd.) i\!111wgi11g Editor: A. D. KELLY, :\LB., D.Sc., LL.D. Assi.1t1111t Editor: H.oBEHT L. HANDALL Adccrtisi11g .'fa1wgcr: Tmi~rAs L. \\TELLS Editorial Offices: 150 ST. GEORGE ST., Tonor-;To THE ASSOCIATlON OF ASBESTOS sAND i\IALIGNANCY O:\IE 60 y~ars ~ago it was suggested by :\lontague :\forray m England that heavy exposure to asbestos dust could produce fatal pulmonary fibrosis. In those clays men working under uncontrolled conditions de\-cloped asbestosis \\'ithin a few years and died young, often of its complications, pneumonia or tuberculosis. As working conditions improved, together with the control and treatment of pneumoni,1 ,rnd tuberculosis. the onset of ,1sbestos!s was ckl.n t-d and t!ie la~e efft-c~s of fibrosis, such as brm~chiectasis, bronchitis and cor pulmonale, became more common. Still more recently, \Vorkers who have acquired only moderate degrees of asbesto~is have survived long enough to develop an associated bronchial carcinoma. In addition, and unexpectedly, we are at this time seeing the late effects of exposure to certain types of asbestos which were insufficient to produce appreciable lung fibrosis hut which have, after a delay of 40 or more years, led to the development of mcsothclial turnoms in the pleura and elsewhere. The striking feature ill recent years is the new evidence showing that not only is there a high risk of bronchial carcinoma in those with asbestosis, but that other types of tumour develop in exposed pcr~cm-; in thC' ah~C'IH'C of a~bcstosis ill the lungs, ~omctimcs after a small exposure hut always with a long delay. The evidt'nce in man indicates that the type of asbestos fibre to which the indi\'iclual is cxpoi;cd is of great importance in the development of these tumours. The first large series suggesting that the association of asbestos and lung cancer was more than one of simple chance was r<'ported in 1949 by l\forewethcr,1 the Senior ~Iedical Inspector of Factories in Great Britain. The series included 128 males and 107 females whose deaths were clue to asbestosis or in whom tl1c presence of a~besto~is ''as proved at autopsy. Lung cancer was fouml in 2:?. of the males and in nine of the females. i.e. in 1:3'; of this group of persons with asbc~tosis. Since 19-!9 this study has been brought up to date and the proportion of lung cancers has increased to 18 ~~. In 1955, DolF reported a study of 113 workers employed for 20 years or more in the scheduled areas of Britain (i.e. areas in which processes are ~chedulcd by Asbestos Industry Hcgulations of 1931 as being dusty). The observed number of deaths from lung cancer was 11, the expected number \Vas 0.8; and deaths from all cancers numbered 15 as compared \Yith an expected numher of 3.1. Various statistics have been quoted regarding the frequency of association of asbestosis and lung cancer; the Chief Inspector of Factories in Britain lists this figure as 13~;.,, while the Pncumoconiosis Board in London estimates it at 30%. In addition, 11 cases of abdominal tumours associated with exposure to asbestos were <liscovcrccl between 1958 and 1963. A remarkable feature of these cases was the minimal extent of fibrosis found in the lungs. It seems that tliis is yet another clinical condition which must be recognized as part of the asbestosis syndrome. Experimental investigations in South Africa l1a\'c suggested that a particular type of asbestos, crocidolite (Cape Blue), is implicated in the causation of mesothelial tumours. \\1gner3 has reported on 3.'3 cases of diffuse pleural mesothelioma, histologically diagnosed at the Pneumoc011iosis Research Umt of the South _\fric<m Council for Scit'ntific an<l Industrial Research. Tweri':y-e ;L: 0~ :'.1e-se C."'"" L.,d somt' associ,1tion "ith the Cape a~bestos field ancl four had been exposed to asbestos in indmtry. Further, it has been discovered that primitiYc oils and \\'axe's containing ~mall amounts of 3,4-benzpyrene and other cyclic and aromatic hydrocarbons arc naturally absorbed on to this type of aslw~to~. and there is suggestive e,idence that the natuml a~bcstos oils may be supplemented \Yith secondary oils deriYecl either from industrial processing or storage in jute b<1gs. Vny little research has lJCC'n rcportecl with respect to the effects of the \\'hite asbestos fibre, chrysotile, and .'>incc this typP of a'bcstos is mined in Canada, there is considerahlc international interest in any inw'>tigation of tlti~ suhj('cl \\hich ma\' lH' 11nclntaJ..cn in thi, country. Canada is .by far the \\'orld's leading asbcstosproclucing nation and pro\'1cles 4:?.'.'~ of the ,,oriel supply of this product. In 196.3. this amounted to 1.3 million terns, valued tt 135 million dollars. Production is limited to the prminces of Quebec, Ontario, British c;olumbia and Ne\\foundland. Quebec, \\here prficluction has been contin110t1~ since, 1878, contrilmtes 90~; of Canada's output of asbestos fibre. Questions of international concnn which a Canadian stmlv could answer include the following: Is the type .of asbestos important with C..nad. :!\fed. Ass. J. May 8, 19G5, vol. 9~ EDITORIALS A:'\D ANNOTATIONS 1035 respect to the risk of asbestosis, carcinoma of the lung, and mesothelioma and other tumours? Is there any exce<;s risk of bronchial caf1ccr in the absence of asbe:-.toshr ls tl1e1 e a dl'll'clahle stage of asbestosis at wltid1 progression ceases after removal from tl1e dust? In addition, a Canadian study could be expected to assist in obtaining agreement on the minimal clinical, radiological ancl lung function criteria for tl11: diag110-;is of a~bcstosis, and in tlie development of agnlnw11t on thl' typt's of dust measurements which should be made. It is L'ncouraging to he ahlc to add that a Canadian study of this nature is being organized by the Occupational Health Division of the Department of National Health and \Velfare. R1o:FEr:c:-;cEs c .. 1. Great l :ntain, Fae tones. Chief Inspector of; Annual re- pol't of the chief inspector of factories for the year 1949, His )faje~ty's Stationary Office, London, 1951. 2. DOLL, H.: JJnt. J. Inclustr. JI eel., 12: 81, 1955. 3. \\'AG:-; Er:. J. SLEoos, c. A. A:-;o )IAncH.\!'ID, P.: Iu1cl., 17: ~GO, 19GO brothers was a country doctor in Canada and a very keen naturalist. He encouraged his children to observe, to inq11ire and to try. After studying art suhjt~ds al Toronto University both went on lo study nicdicine at Johns Hopkins Hospital. William George l\facCallum, while a student there in 1899, described the sexual part of the life cycle of the malarial parasite. The asexual cycle had been described some time hcForc this. He found male and female gamdl's first iu crow's blood and then in a malarial patil'nt . . . \\'illiam Ccorge ~faeCallurn went 011 to have a long and famous career as a pathologist. II is brother, John Bruce l\IacCallum, died at tlte early age of 30 in 1906. While a student at Johns Hopkins he published work on the development and architectme of the muscular wall of the heart and on the pathology of heart disease." Our Beloved ComJ1anio11s is strongly flavoured with that ambivalence that characterizes the entente between medical students and nurses: Donald Justin Bentley's barbed offering begins as fol!O\VS: THE NATIVES ARE REVOLTI:'.\lG MEDICAL students form a unique subculture in the medical cosmos. :\lore than ever before they are the object of intensive if somewhat baffled scrutiny Ly their seniors, especially those interested in or responsible for the future of medicine. It is easy to be o\erawed, especially if one does not have const,mt contact witlt teaching and students. Theirs i;; a freemasonrv whose ranks remain inviolate becwse no one can for long successfully masquerade ,:, .1 medical student ancl no graduate can cast off . : 1c weight of years and change so as to return to . hat quick-silver state. The great handicap under which student organ::-ations-and student publications in particular. '.ruggle is their impermanence. The student years .tre an inclined plane down which one moves with increasing acceleration until suddenly, almost before he has time to sa\'our the period through which he is passing, it is over. With respect to student medical journals, the ,,.illdifficulties encountered in recruiting suitable ma- terial for publication, seeing it through the various stages of the editorial process and meeting some sort of publishing deadline in such an enYironment perhaps be conceclecl without further elaboration. Ho\\'C\'er, something of interest for everyone is likely to l)e found in these publications, especially if it is a national journal that represents some U,517 students. The British :.Icdical Students' ]oumal appears three times a year: its spring number (Vol. :20, l\o. 1, HJG.5) contains such articles as the follo\\'ing: Student /nr;cstigators: Of "'illiam George ancl John Brnce \L1cCallum, Jean Shortland of \Vestminster Hospital says, 'Thl' fol lil'r of the \IacCalltnn "She wiggled her curvacious body slenderly towards the bed. Fine beams of light, from some far corner of the ward, glimmered through her exotic hair. And a generous odour of Chanel was wafted into the midnight air. Bedside dust, unsettled for decades, began to rise as she propelled her majestic form towards the sick patient. No errant tending the ill eoulcl have moved in a more devoted manner. "'Ave yer done tcith yer bed-pan?" "It was onlv when her cultured tones pierced the absolute hush;1css of the night that I became truly aware of her presence. How guilty we medical students are of taking for granted our nursing colleagues." Voluntary E11tha11asia, by Raanan Gillon, is a carefully researched, well-presented account of the evolution of society's attitudes toward this complex problem. This essay was awarded first prize in the 196-! British :\Iedieal Association Students Essay Competition. Dr. Locwn: or H011.: I Learned to Stop worrying and Lor;e tl1e "'anl Sister will pll?zlc many Canadian readers because the ''locum" referred to seems to have been a short-term clinical clerkship or extermhip. However, Rada Karmi of Bristol University strikes a familiar chord, e~pecially in the following gem: "Al List the feartul d.1y arri\'cs ,1nd you present ~ourself, duly coated <lllcl 'itethoscoped, at the appointed time and the appointed place. The w,ml's in your cha1ge. The p.itil'llh lie in their bed<; as if waiting the momc11t of vour arri\ .ti; the ,i,te1 \ offiee door j, ajar, l)('ckmtingly-. You enter and rclC1\c yo11r fir:.t <;hock. Altl1 ,\ cursory g1cl'li11g you .uc a:.kccl to write a numlwr of presc1iptiun c<ucls. In terror yom 1ealize th,tt \ 011 have forgotte11 lh 11g dosag('S, hut tlwrc is no need Ior panic. Bel 01 t you h.1\'P even 1111scnwecl your pc11, <;1<;ter's \'Dice riug.; out, didatiug fluc11lly drugs