Document 91Z2YDMKM11mMw5jZjg7Q43v5

< f Sciences ritan are fa r from com ience of asbestos expo-.ure pleura and peritoneum as id th a t the association is : asbestosis. In a number one case three months of ial exposure and diagnosis as diagnosed six cases of tients have been followed le's Epidem iological Unit, finite h isto ry of asbe-tos 'essor A. G. H eppleston's ed cases, and evidence of lay has found evidence of st, Tyneside, Merseyside, deside but two cases have The most d istu rb in g fact ncreasing numbers have >sitive, clear evidence im frica, since the majorityasbestos were used. Howas been established in a e chrysotile exposure has Ann. N.Y. A cad, S c i. 132:579-588, l9o5. EPIDEMIOLOGY OF MESOTHELIAL TUMORS IX THE LONDON AREA M uriel L. Nev.-house and Hilda Thompson Department of Occvpvtional Health & Applied Pi ytiology, London School of Hygiene and TTopical Medicine, London, England IXTEODt'CTION In recer.t years, the association between exposure to asbestos dust and cancer of the lung, and other m alignant neoplasms has been the subject of much research ("Brit. Med. Journal. 1954 o W agner. .Siege* ar.d Marc-hand (I960, described the occurrence of mesothelioma of tr.e pleura in those exposed to c-rocidolite asbestos in the m ining d istricts of South A frica, and have stimulated further studies of patients suffering from this tum or (Glyn Owen. 1964; Fow ler et al., 1964'. The present investigation concerns patients in whom a diagnosis of m esothelioma had been made a t the London H ospital. All the post-m ortem and biopsy specimens held in the Pathology D epartm ent in which a diag nosis of mesothelioma had been made in the past 50 years have been re viewed by H ourihane 11965). In 83 cases the diagnosis was confirmed. The series consists of 41 men of whom 31 had pleural and 10 peritoneal tu mors, and 42 women of whom 25 had pleural and 17 peritoneal tum ors. The aim of this study has been to establish the occupational histories of these patients and to trace any other possible exposure to asbestos. T here were, four surviving p atien ts -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 rem ain ing 40 in the past four and a half years. The youngest died at the age of 33 and nearly h alf w ere dead before th e age of 55 (.table 1 >. The w ard notes of 65 of these patients were available: they give a pic ture of a disease w ith a consistent symptomatology. Among those with pleural tum ors, the commonest symptom present was the rapid onset of extreme shortness of breath due to the form ation of a massive pleural effusion. Pain was a prom inent feature, either described as a dull ache, sometimes due to invasion of ribs or vertebrae, or sometimes sharp and radiating, suggesting nerve involvement. Tumors in the chest wall were not uncommon, occurring either in previous operation scars or by direct in vasion of the chest wall. The symptomatology of the peritoneal tum ors was more varied. In some patients the presenting symptom was pain on defe cation or m icturition; diffuse upper abdominal pain was very common and swelling of the abdomen due to ascites was always present terminally. The treatm ent was varied; pneumonectomy, decortication of the lung, deep 579 WI.WBWIBIW MW..- .' ' H|P ......... fi tfMtfti 5S0 Annals New York Academy of Sciences T able 1 Age at Death of P atients with Mesotheual T umors Age Males F em ales <34 35 + 45 + 55 + 65 + 1 ( 2.4%) 9 (21.4%) 12 (29.3%) 11 (26.2%) 8 (19.0%) 1 ( 2.4%) 5 (12.2%) 12 (29.3%) 16 (37.0%) 7 (17.1%) X -ray therapy, instillation of radioactive gold and cytotoxic drugs were used alone or in combination, but appeared to have little effect on the course of the disease. H alf of the patients suffering from pleural meso thelioma died w ithin one year of the onset of symptoms, a fu rth er third w ithin two years and only one survived for more than three years. The course of those w ith peritoneal tum ors appeared to be even more rapid; 14 of th e p a tie n ts died w ith in six m onths of the onset of sym ptom s. Sources of Information In addition to the ward notes, some of which gave good occupational histories, th ere w ere th ree o th er sources of info rm atio n : <1 > the p a tie n t's general practitioner; f2 i the records of a large asbestos factory making textiles, insulating m aterials, and other goods, where it was known that some of th e p atien ts had been em ployed; and <3 ' personal interview s w ith patients or their surviving relatives. As a first step, the general practitioners were contacted with an explana tory letter asking them to complete a form giving details of the patients and th eir im m ediate relatives' occupations. W ithin two months 65 per cent of the doctors h,.d .replied, In two ca-os-a h i'h e rio -unknown ex pc sure -toasbestos was revealed, in others the name and address of a surviving rela tive was given, but in the m ajority the doctor was unable to give inform a tion as. on the d eath of th e p atien t, the notes had been retu rn ed to the local executive council of the National Health Sendee, where they were de stroyed within a period of three years. T he asbestos facto ry keeps a file w ith detailed records of all employees since it started to operate in 1913. The names of all patients w ere checked w ith these files. N ine men w ere identified w ithout difficulty and nine m a r ried women after their maiden names had been ascertained from relatives. The exact dates of em ploym ent of these 13 p atien ts, and th e jobs they had done, w ere obtained from the facto ry files. i i! ! t i Xewhouse & Thot The fo u r patients alive viewed personally. A few tives of 6S patients were mostly in the E ast End c an occupational history oi fa th e r taken, but past ad< for a t least an hour, as to often necessary to explore illnesses and difficulties. A control series of pat portion of in-patients of pected to be exposed at th were selected from the pa hospital d u rin g the early si series who had been trac same sex, born in the sami patients over 75 years of Types of E xposure to A: Type of exposure Employed at one asbestos Delivered goods to factor Employed at other asbesti factories Insulators and laggers Relative worked with asbe Dockers handling asbestot No history of exposure to *7 cases of mesotheliom; table. t Positive exposures to at *Positive histories. X2 = series. mt* wat h .1 . 'is-- ' Sciences HELIAL TCMOKS F em ales 1 ( 2.4%) 5 (12.2%) 12 (29.3%) ' 16 (37.0%) 7 (17.1%) and cytotoxic drugs were p have little effect on the 'erin g from pleural mesoymptoms, a fu rth er third Dre th an th re e years. The :d to be even m ore r a p id ; ; onset of symptoms. t ;h gave good occupational rm ation : (1) th e p a tie n t's e asbestos factory making where it was known that i personal interviews with contacted with an explanaing details of the patients tin two m onths 65 per cent erto unknown exposure to ddress of a surviving relaas unable to give inform a1 been returned to the local ,-ice, w here they w ere de- >d records of all employees f all patients w ere checked tut difficulty and nine m arascertained from relatives. ents. and the jobs they had t ! | : j i ; 1 > j j j ; i i Nev.-house & Thompson: MesotheJial Tum ors in London 581 The four patients alive at the beginning of the investigation were inter viewed personally. A few relatives were contacted by post, but the rela tives of 68 patients were interview ed by or.e o f us a: th e ir homes situated mostly in the E ast End of London, L arking, or Dagenham. Not or..y was an occupational history of the patient, the spouse, sons and daughters and father taken, but past addresses were also recorded. The inter-views lasted for at least an hour, as to recall events of th irty or forty years ago It was often necessary to explore the histories of ail members of the family, th eir illnesses and difficulties. A Control Series A control series of patient? was &!=o examined to determ ine the pro portion of in-patients of the Iw.naon H ospital wno may norm ally be ex pected to be exposed at th eir work or in other ways to asbestos dust. They were selected from the patients in the medical and surgical w ards of the hospital d u rin g th e early sum m er of 1964. Eac-h p atien t in th e m esothelioma series who had been traced -was m atched w ith a control p atien t of the same sex, born in the same five y ear period. As th ere was a d earth of male p atien ts over 75 y ears of age in the hospital, a sample of six p atien ts of Table 2 Types of E xposcp.e to Asbestos o r 76 Patients with Mesothelioma and 76 Contp.ols* Type of exposure M esotheliom a j series! i EmpIoyecLat one asb estos Factory Delivered goods to factory 1 18) j 1) (25.9%) Control series t 1 ( 1-3%) Employed at other asbestos factories 5 ( 6.6%) 1 ( 1-3%) Insulators and laggers Relative worked with asbestos j 7 ( 9-2%) 1 ! 9 (11.8%) ! Dockers handling asb estos cargo j 0 4 ( 5.3%) 1 ( 1-3%) 2 ( 2.6%) i No history of exposure to a sb estos j 36 (47.4%) 67 (88.2%) * 7 ca ses of m esotheliom a could not be traced and are omitted from this table. t Positive exposures to asbestos. t Positive histories. \ 2 = 27.11, P < . 001 for Mesothelioma versus Control series. m imupmiiiiiMu, :?rsnouMniflpppmp mmm w ppp mmm p* 1 v' -nr.rrtfl>MtIttil irfitey 5S2 Annals New York Academy of Sciences Xewhouse & ' this age and older was taken from a neighboring geriatric hospital. The same interview er and techniques were used for the mesothelioma and con trol series but fo r the latter, in which the patient ra th e r than a relative was seen, it was much easier to obtain detailed and accurate histories. Subsequent analysis of the jobs showed that, according to the R egistrar G eneral's classification, th ere was no significant difference in the social classes of the two series. Results Xo inform ation about past domestic and occupational histories was available in seven patients w ith mesothelial tum ors, six of whom had died before 1950. one as early as 1917 and an o th er in 1922. Among the rem ain ing 76. 40 (52.6 p er cent > gave a histo ry of exposure to asbestos, compared w ith only nine (11.8 per cent > of the control series ( table 2 ). This differ ence is statistically highly significant " 27.11, P <.001 ). J obs of 17* Statutory obligations Spi Subject to regulations Ca: Clc w Dis an Occupational Exposures <Mesothelioma Series) Fil Ai T here a re p artic u la rly accurate details available of the 18 mesothelioma patients who had worked at a large asbestos factory. Eleven started work { Mai pr before 1933 (the date when the asbestos regulations controlling the man- j in: ) ufacture of asbestos goods and the protection of asbestos workers became f f effective > and seven later, but none a fte r 1943. This factory originally used crocidolite asbestos w ith small am ounts of chrysotile; am osite was first ' Not subject to regulations Mai br introduced in 1926. Among the nine women the period of employment was usually short, Rut CO varying between six months and two years, w ith only one w orking as long as six years. Among the nine men the period of employment was usually ; s much longer, only three were employed for less than two years, three for ! Gen betw een five and 14 years and th ree fo r more th an 20 years. In one woman it was not possible to verify the actual job. The occupations of the remain- ' "Employment histor- ing 17 employees and th e type of asbestos used a re shown in table 3. All had used crocidolite asbestos. Only the first four occupations-listed arcscheduled as requiring medical supervision under the Asbestos Regulations in this type of work fo was interm itttent. of 1931. ' Exposur Four patients in the mesothelioma series were working at other fac tories, m aking all types of asbestos goods. One patient had been employed in a wagon works sawing asbestos sheets for partitions. Except for one patient, a woman employed in insulating electrodes w ith crocidolite, the types of asbestos used in these factories are not known. The h eatin g engineers and laggers were all m en: five had been employed in dockyards on ship repairs, one in a power station, and one specialized in in stallin g hospital ste rilizin g equipm ent. AH w ere consistently employed .The group of nine, with asbestos, are of p of the wife who washt instance we were told asbestos" every evenit down. The two men in nad sisters who w ere v. series were employed. o f Sciences .ring geriatric hospital. The r the m esotheliom a and con.lien t rather than a relative Led and accurate histories, according to the Registrar ant difference in the social occupational histories was ;m ors. six of whom had died in 1922. Among the rerrainposure to asbestos, compared e rie s (table 2 >. T h is differ1, P < .0 0 1 1. dioma Series) sable o f th e 18 m esotheliom a actory. Eleven started work lations controlling the manof asbestos w orkers became T his factory originally used hrysotile; amosite was first fitoyment was usually short, Lfh only one w orking as long of employment was usually ss th an two years, three for than 20 years. In one woman e occupations of the rem ain ed a re shown in TABLE 3. All fo u r occupations listed are ler the Asbestos Regulations were w o rk in g a t o th e r face patient had been employed r partitions. Except for one rtrodes w ith crocidolite. the not known. m e n : five had been employed station, and one specialized 1w ere consistently employed f !f 1! J i{ f fl i j j i [ { ; ; Newhouse & Thompson : Msothlial Tumors in London 583 Table 3 J obs o r IT* P a t ie n t s E mbloyeu at one A sbestos F actoey Statutory j obligations Job 11 Males 1 Fem ales Material Spinning 0j4 Crocidolite Subject to regulations Carding .. . . Clothing arm weavu* !! i 1j 1 ; j0 1j Disintegrating and opening 12 j 1 Not subject to regulations Filter making for > ARP masks ;i Manufacturing of i preformed pipe j insulation | Manufacturing of brake linings Rubber compounding 2 1 1 0 0 1 0 1 General laborer 1 0 ; j Crocidolite Crocidolite ! Chrysotile | Amosite Crocidolite Chrysotile Amosite Crocidolite Crocidolite Crocidolite Crocidolite Chrysotile Crocidolite Chrysotile A m osite Employment history not available for one fem ale patient. in th is type of work fo r more than 20 years, but th e ir exposure to asbestos was interm itttent. Exposure of Relatives iMesothelioma Series) 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 w ife who washed her husband's dungarees or work clothes. In one instance we were told that the husband, a docker, came home "w hite with asbestos" every evening for three or four years and she brushed him down. The tw o men in th is group, when boys of eight or nine years old. had sisters who were working at the asbestos factory where others of this series w ere employed. One of these girls worked as a sp inner from 1925 m I SB* taifi 584 Annals New York Academy of Sciences to 1936. In 1947 she died of asbestosis. The press report of the inquest sta te s, "she used to re tu rn home from work w ith dust on her clothes." H er brother had no other exposure to asbestos, he started work as a shop as sista n t. then became a saw yer of iron g ird ers until 194S when he worked as a loader of groceries in th e docks for five y ears (but never on dusty cargoes! and then retu rn ed to saw ing iron girders. He died in 1956. Tupes of Exposure of Control Series Two of the control series had worked in asbestos factories; four as laggers; the husband of another was employed at the large asbestos fac tory for three years, and two dockers gave histories of handling asbestos cargoes from time to time throughout their working life. The diagnoses of these patients have been grouped into eight categories (table 4 >. T he p a tie n ts w ith a positive h isto ry of exposure a re scattered throughout the various diagnostic groups. The individual diagnoses of these p atients do not suggest th a t exposure to asbestos could in any way be related to the disease which had caused their admission. T able 4 Disease Groups of P atients in' Control Series D isease group Number of patients Number with exposure to asbestos Cardiovascular disease 21 3 Metabolic disease Reticuloendothelial disease (including anemias) Gastrointestinal disease (excluding cancers) Respiratory disease (excluding cancers) All neoplasms 90 82 62 30 18 | 1 Other d iseases 11 1 Total 76 9 j Xewhouse & Th , Among the 36 affectec who had n eith er an occu , working with asbestos. = posed to asbestos dust 1 I asbestos factory, j The facto ry w here mo t` in 1913. having been sit i seven years. There were j mile of the factory durii site. A t the tim e it open* ' old. At the present site. | radius of the factory. Oi - the factory in 1922 and j other seven were female opened. They rem ained i: | except for one who remi s later. j Among the control se i seven and 14 lived near j and one man who lived ne ; of age when she moved ir > when interviewed, complr ! factory and the rats in the Thus, am ong those wi i bestos th ere a re 11 (30.t . series and five (7.6 p er c [ a mile of the factory at its \ ence in the proportion of j' i } Residence of Patients Category Mesothelioma series Control series X2 , 7-85, P C .O l <0*^ ' of Sciences press report of the inquest th dust on her clothes." H er started work as a shop asuntil 1948 when he worked years Chut never on dusty ders. He died in 1956. -ol S e rie s asbestos factories; four as :d at the large asbestos facstories of handling asbesto.-j corking life. rouped into eig h t categories ry of exposure are scattered ' fhe individual diagnoses of o asbestos could in any way their admission. Control Series (umber of atients Number with exposure to asbestos 21 3 , * ' ; : j : 90 82 62 30 18 1 j 11 1 76 9 Xewhou.se & Thompson : Msothlial Tumors in London 5hr, X fit jh bnrhor/'i K [1'iH n re s Among the 36 affected patients, and the 67 patien ts in the control seiic.who had n eith er an occupational exposure nor a relative living in the hum. w orking w ith asbestos, th ere is a fu rth e r group who could have been c> posed to asbestos dust because they lived in the im m ediate vicinity of an asbestos factory. The factory where more than a fifth of the series were employed opened in 1913. having been situ ated n earer the City of London fo r the previous seven years. There were three affected female patients living within half a mile of the factory d uring the seven v e e r' it was in production at its fir-i site. A t the tim e it opened they were children between five and seven years old. At the present site, th ere w ere eight p atien ts living w ithin a half mile radius of the factory. One. a male, was born w ithin a q u a rte r of a mile of the factory in 1922 and rem ained at the same address fo r 16 years. The other seven w ere fem ales and aged between six and 13 when the factory opened. They rem ained in the area for only between th ree and seven years, except fo r one who rem ained a t the sam e address until she died 48 years later. Among the control series, there is one man who between the ages of seven and 14 lived n ear the factory at its previous site, and th ree women and one man who lived near its present site. One of the women was 22 years of age when she moved into the neighborhood in 1915. She disliked it and, when interviewed, complained im partially about the dust from the asbestos factory and the rats in the house. Thus, among those w ith no occupational or domestic exposures to as bestos th ere a re 11 (30.6 per cent) of the p atien ts in the mesothelioma series and five (7.6 per cent) in the control series who lived w ithin half a mile of th e facto ry at its p resen t and previous sites ( table 5 >. The differ ence in the proportion of the patients in the two series who lived in the Table 5 Residence of P atients with no Occupational or Domestic E xposure to Asbestos Category Mesothelioma series Control series X2 = 7.85, P < .0 1 Lived within 1/2-m ile of a so esto s factory' 11 (30.6%) Lived m ore than 1 ^ -m ile from asbestos factory 25 (69.4%) 5 ( 7.5%) 62 (92.5%) Total 36 67 MuA'iJUHIfN.MnW mmmm mm 586 Annals New York Academy of Sciences vicinity of the factory and had no other exposure to asbestos is statistically significant ( \ - = 7.S5. P < .0 1 ). Including th e 11 p a tie n ts who lived near the asbestos factory th ere are 51 who had been exposed to asbestos. In 39. exposure first occurred before 1930. in th e rem ain in g 12. before 1943. The in terval between first exposure and onset o f sym ptom s varied between 16 and 55 y ears (m ean 37.5). The d u ra tio n o f exposure also varied widely, ran g in g from five weeks to over 50 years. D iscussion Am ong those traced in th e m esotheliom a series th e re are 15 men and 10 women in whom no evidence could be found of an exposure to asbestos. A chief source of inform ation was a history taken from a surviving rela tive. A surprising amount of inform ation 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 de ceased. One of the patients was eventually identified as having worked at th e larg e asbestos fa c to ry fo r five weeks in 1941. but th is w as before he m arried and his widow did not know of this episode. A colored man born in South A frica worked as a m erchant seaman for much of his life; he may have been exposed in the asbestos mines or to cargoes carried at sea, but it was not possible to get any details of his life in South A frica or his work at sea. T here is also evidence th a t some of these 25 patients may have lived close to other asbestos factories in the London area. It is of interest th a t both industrial and nonindustrial exposures were recognized. Among the men the exposure was predominantly industrial: 22 worked in asbestos factories or as laggers, two were exposed at home, and one lived near the asbestos factory; w hereas among the women only 10 w orked in asbestos facto ries and a fu rth e r 17 had n o nindustrial exposures, seven in th e home ar.d 10 living near asbestos factories. In this series there is no evidence th at the patients w ith peritoneal tum ors differed in the type of exposure they experienced from those with pleural tum ors. A higher proportion of women were affected by peritoneal tum ors, but the difference was not statistically significant. The recent increase in the number of cases diagnosed at the hospital may be partly due to m ounting interest in the disease and partly to the long interval between first exposure and development of the tumor. Those exposed betw een 1915 and 1925 m ight fce expected to die from about 1950 onwards. Asbestos im ports in the United Kingdom have mounted steeply since 1932 (L e a th a rt, 1964; and its uses are becoming very diversified in industry. The increasing proportion of the population exposed to asbestos d u rin g the past 30 years may be expected to give rise to an increasing occurrence of mesothelial tum ors. ; j * j j s ; j j ; i - i * Newhouse & There seems little exposure of asbesto other exposure excep A high incidence of population living net More evidence is re in the neighborhood yards, where asbesto The occurrence of strongly suggests th th is disease. T h ere is is known about the < dose-response relatioi Two groups of pat: End of London have b The first consisted r had been confirmed a pational and domestic was peritoneal in ori; 1917, but only 10 o f ti males and 42 per cent between first exposure 16 and 55 y ears (mea The second gro u p co by sex and date o f bir: Of the patients suff exposed to asbestos, as difference in the propo series is highly sig n if exposure w ere recoguiiz tiles, insulating m ateri nsulators; and exposu; asbestos. Eighteen of tl tives were working w it tory opened in 1913 and all those whose records Among the 36 patien tional history and no re there were 11 who lived the control series also 1 t Sciences } Neu'house & Thompson: MesothcJial Tumors in London 587 to asb esto s is sta tistic a lly* fi There seems little doubt of the risk of both occupational and domestic exposure of asbestos. W agner et a!. '"1350; described p atien ts w ith no sbestcs factory there are other exposure except living as a child in the vicinity of the asbestos mines. sure first occurred before * A high incidence of asbestos plaques of the pleura has been found in the -ai betw een first exposure * population living near an anthophyllite mine in Finland fKiviluoto, 1960. y ears fmean 37.5 . The More evidence is required of an increased risk to the population living fro m five weeks to over in the neighborhood of asbestos factories or other areas, such as dock yards, w here asbestos is used in quantity. The occurrence of tum ors a fte r exposure of less than a y e a r's duration th e r e a re 15 m en and 10 an exposure to asbestos, n from a surviving relarbtained. but in some of fective, or they may not I strongly suggests th at personal factors are im portant in the etiology of this disease. There is a need for studies of whole population- where more is known about the duration and type of exposure of all a t risk, so th a t dose-response relationships can be evaluated. Summary ig th e youth of the de Two group>s of p a tien ts who have attended a large hospital in the E ast fied a s h av in g w orked at End of London have been examined to determine their exposure to asbestos. . but th is was before he T he first consisted of 83 p atien ts in whom the diagnosis of mesothelioma ode. A colored man born had been confirmed at autopsy or by biopsy. In all but seven, past occu m uch of his life ; he may pational and domestic histories were obtained. In 22 patients the tum or rgoes carried at sea. but was peritoneal in origin, in 61 pleural. The earliest recorded death was in South A frica or his 1917, b u t only 10 of the series died before 1950. Fifty-five per cent of the F these 25 patients may males and 42 per cent of the females died under the age of 55. The interval * London area, between first exposure and development of term inal illness ranged between d u strial exposures were 16 and 55 y ears (m ean 37.years. edominantly industrial: The second group consisted of 76 patients of the same hospital, matched were exposed a t home, by sex and date of birth w ith those traced in the first series. am ong the women only Of th e p atien ts suffering from m esotheliom ata 52.6 per cent had been 7 had nonindustrial ex- exposed to asbestos, as compared to 11.8 per cent of the control series. The ;stos factories, difference in the proportion of patients with known exposures in the two latients w ith peritoneal series is highly significant = 29.1. P <.001 >. Three m ain types of rieneed from those with exposure w ere recognized: work in factories m anufacturing asbestos tex ~e affected by peritoneal tiles, insulating m aterials, and other products; employment as laggers or gnificant. insulators; and exposure to dust brought home by relatives working w ith agnosed at the hospital sease and partly to the ent of the tum or. Those to die from about 1950 n have mounted steeply s in g very diversified in tion exposed to asbestos e rise to an increasing asbestos. Eighteen of those employed in factory work and four whose rela tives were w orking w ith asbestos were employed at one factory. This fac tory opened in 1913 and was. until recent years, a heavy user of crocidolite; all those whose records could be traced worked w ith this type of asbestos. Am ong th e S6 p atien ts w ith m esotheliom ata, w ith no positive occupa tional history and no relatives living at home who worked with asbestos, th e re w ere 11 who lived w ith in half a mile of an asbestos fa c to ry ; five of the control series also lived in the same area. The difference in the pro- "****> I! I v!ljiBjiJ.!iJU !>.l-mil'iy IhfJ-i j 5S8 Annals New York Academy of Sciences portion of patients in the two series is also statistically ignificant lx2 7.85, P < -01). Acknowledgments O ur th an k s a re due to P ro fesso r C. \ \ ilson. P rofessor \ . W Dix, D r. X. L. Rusby and M r. G. Flavell. F.R.C.S.. of the London H ospital, and D r. C. P. Silver of S t. M atthew 's H ospital fo r perm ission to interview th eir patients; to Dr. W. J. Sm ither for his assistance and for arranging access to records, and to D r. J. C. Gilson and P ro fesso r R. S. F . Schilling for th eir help and encouragement throughout the investigation. References Editorial. 1964. Brit. Med. J. 2: 202. F owler. P. B. S., J. C. Sloper & E. C. Warner. 1964. Brit. Med. J . 2: 211. Glyn Owen. W. 1964. Brit. Med. J. 2:214. Kjvilcoto. R. 1960. Acta Radiologiea. Sup. 194. Hourihane, D. O'B. 1965. This Annal. Leathart, G. L. 1964. Occ. Health 16:119. Wagner, J. C-, C. A. Sleggs & P. Marchand. 1960. Brit. J. Ind. Med. 17: 260. T homas F. Manci Dr. Xewhouse's work out a striking resembl those on beryllium. Ye disease) were identiri mind by recent obser torium in South A irf H ardy observed beryl] Hum workers, and subs in the laundering and i lariy, Dr. Xewhouse 1 the household of asbes The resemblance conti. osis was observed ami of beryllium manufac; Xewhouse and W agner plaques, of residents IP m ining operations. The second point I s Xewhouse and Dr. Waj period between initial < theliomas and lung cai extend to 60 years. Th of employment. In view of these obsei m ortality rates upon a such as recording the o: 25-64. It would be mor least in the L\ S. and t this into consideration In Dr. X ewhouse's s', accomplished by retrcspeven though many year long latent period, mucr will follow a sim ilar appr I should also like to < of asbestos, not ju s t the bestosis, but other relat physema, cor pulmonale out the advisability of health studies of as be? to 1 S'