Document 99m626ZXJ0O7bxraxDgVDdvBL

3* Asbestos Ex josure. Smoking, and Neoplasia Irving J. Selikoff, MD; E. Cuyler Hammond, ScD; and Jacob Churg, MD IAsbestos insulation workers, as a group, have a high risk of dying of bronchogenic carcinoma (about seven or eight times expected). We have observed 3 7 0 such work men from Jan 1, 1963 to April 30, 1967. Our findings indicate that asbestos exposure alone is not the entire explanation. Of 87 noncigarette smokers, none died of bronchogenic carcinoma. Of 283 workmen with a history of regular cigarette smoking, 24 died of bronchogenic carcinoma, although only three were expected to die of this disease. Calculations suggest that asbestos workers who smoke have about 32 times the risk of dying of bronchogenic carcinoma as men who neither work with asbestos nor smoke cigarettes. We conclude that asbestos exposure should be minimized, that asbestos workers who do not smoke should never start, and that those now smoking should stop immediately. wmdmwlperoafataoraxssfioaoiteeentbptpnmaisemdsntthoeeonJuhhoaesnh1fsadoletdatrllmuai9ahnoufsogitotrg6eeesbnmiFmaehfe4lodregie1re,mtnonetrdo,rchopostwscmeusaeaeoofatobt1ennaskohatrnp9utdshUcftearcIleb4ieteihennnaefsntdf3elrpafshsroiii,sumdoeouastoeirtfwsenxmorlfoaedavtpbtrasIhmrnetoaetenseehipodd.dpSsratectelfhryteuonnctteooosTeaeroDrsysulnundrtthttonoraeeaneo.g;aaigs2dcrsdncydmstelieibceideIdncodunaaumtaate3ewdonuopctrtlrr1Ahiselahaaraaas,yb.ssitsdltsl,tebnhoeiibdaooseoc1giTwAteossuiho6nn9ctsehfghs.leica6ta.t8mooshegiolusl2iotinliniseTens,reoaytnrc,or,isymhtmiistcaamWtneatdierahimhanvhtrgeexameiaeeeodesaeotpaolabseivreenotnorgantkrdeheosegfsedteypdeofwcnsrbepwodefhitrseaoe6eenuaptia.irrhHge13enrctmttutasihnhohn2eeeel,eAaltl SACCSm(DtcohmreRFRhlreenlo.reeeseetorotpagtHimldcreowaiaafonnoinmbtfttdfhEehmMfCMeprFoteihohreideqDefeenddetusdihemiSatecc)psae,iiAPajnotlcosrhNvteltiAioyemnoetgnss(wnotyiDesuconmeoirMcY,atanseinn.NaoeooPdstrtSufeikironwanee.SCnlgttvit,koeaYtSohomnAtoiffeitsnfmtritlvtka1iahaucei1nen1sn6tM,0dSiitStc0hcyAee2ChCacd9mohMntiioictu(neolyiDerrunn.digaeroci)N.olafc,anniScJnnaMoe,ednDCln,iJedkviatudsMhoenientnfecchaefoite)senAiur.oe1enmsnD9,St,eoooe1rS1fcfpi09iicatt0en6ahhrtt7anthyee.i apcsntridltstiwnjidoihtddstnoenohhetinoammrmooifuaouuoiaengdi,iafeTTsnsdwenstntnsoodoaactnihuhsttthhthlnkelnsnreaa.emhlrlaeemedt1deeveegys.ttbotedoaewtooshiorroe.s1tadeanDspeesiafehmskbOttpdtscnpuoatstsnoiihueshshmrbiicftmoribrsucsrgeterhauogovaahesunhoseiernoesaotmerivhnian.tstibevsmctbkfgectbtgwaeorooniletooctai)dheinoeuiafantnotserosnm,ohthodftnsitkgrrhtmicenthire,fiewhodetttgshneaiselehmhhbgontaaibhhotgoaasumoeeeceincaitlnfasruiertnndmoagckorrltbootteeiveoatnynosuwheenleriaxtdtpeumttefsuurtxepwtertoepvossinsettpmlaradow.eoiedsnhltegidtodeiniosekfnsaaieebopngsaffaseiocfrduidnfamfbeseteaaunentconoerstdecirddtdrragceucohlmrabget.tetieneumtlokletoaastdeaociobnhoiTfo.fsdbeettaxtnkefrofdoealhthsxohetoOpngurrisqabi.teapnavboetmoo.hnuoasnurihftotgreoisantgbctstrIheaneIssaumotntbhcesffslluthhhkormuieoseoceusoerorgeaebttspntasrndteaganoofthabnuetttngadyegtloogtasire,ituedrconadteptettoisoashnhyehsndctastipwelrtchttrgeot,ealaauadesreieoieisnsroirsgstlgnsudwamfceceytobbconstrahsmealacbeceemeef,miartramrn(onewacrsaseoaerbnuoocecitbutowiittnnlahbnooulndeeixtlekblarsygnyddeoeegessrrr,tt M a te ria l otowwoNHaNofffhooeJlPForittaae,skhherosittotreeLbjnhsomhaweoeoe6niimscnsnar3dtratwseeon2eolodnsecarFmnlsooy3redbhrn.a2dodoeuadasosmtdtseottwfhatofieIoeftftpnftiheftrerNhrusneosdieuenseotmvleiwtraoebrhIeturnnetlaoYygoonettraecrinosomorra1drdnnllk9aolaaslas2encntrLte2secodiooso,cunwncaonpAaaohnraaDJnlofdsdtladbise1ohnwec2ADiinsansatsaane31dossnlc,1sislodc,yuaac13adbWi9N11tameds4e9,txeoei3ide4tpqowr,i1m2koonut9,a3ehsnbe6rre3oanaoek2sd9lrtrft.,, IAMA. AdhI3. 1968 Vo.' 04, No 2 ASBESTOS EXPOSURE-SELIKOFF ET AL 107 2pgemcsbtu2amotesafd1wafdatdt3meuicaahepaasfuawtotbcsccst1rhihniiahihnh9uhinifnnve9nn60xiropummmanmpnehaoiniunrvy9raexneeeerecteeeogg3edTee,6rseesBdtn2ardbtorsIdda6OeincerysnldnnelomniroiwstnJtoanrar2meelionni7uhetntrnimtee1.,s.oy)2eitkvfsktatrro3orotf,nnfd.henrggsddhefeegsdst9adeheuea8oinndoeee7nff3aleavixwndaa,gxaesttewt6iesmTutst3Atadoldbeduatrasr0gearh7nmintettevvpthdlien.p7bism1pstorehelauebjexrhhtoena0e1lesrnaedoeoai.weeococldhp-9urecliohrclnsmocneotnu,crtdaiOaiilmaireschiefsi4tahrrstentsfnhine3aywirvdic3opuygsgahrtutuuowegoter31rrmtfe2noydtid7egiiuse2,os72fghsrttaearteneret1ns9n3auso.hJ2fdsxa,o0,apmeteehpt05en0otegoanttrtirts9.68grgfaingih6JaoiiahoarwudterieevoAs5fagetcetmikuud2no3t.poie2nadnhetmhhrtaTfmneauxnhtsafietieilm3h.coenethslomhinest(rtstnenhaetlldph-seoaotleicoidhe9f.etntiemiyw.sctrrgOvadnevmdo3ihbnsortDbn1asnseahmabn1toleadcmsoclvhT1netee2(ftyeih,tmoetuselilnnssace,fiy.eocOltooevweso,eaeeenwe4cbn.roamryhskrletem9ndumttcmllerorse4oaff1m-ttfbephkrish1tiner4fwyhivhi2Srhfhorym2vokgdntuh8hli9btsrovaleo9eorpti6raahaabbh0eseototeroeeiikiuelgte6ei3elen)xdce6eohenhlenn3vmsvmoulpstnlssuamtmamexroncil3sa1srpsora3fdny'mdhg2ttenegeheeeapst1sraeftfi,,meoshohmean,h.eprongrrdpsw1vofrsrtladeoeihwotttaliyiTsy9ap;ekomsbghhiimonhakott,s6ter,s.eif3hoeuhieneibaantened24T4468455678st567736735o3h,AAiladembsnsd0Jt50050i00500g5055555tA05nawa,saYYggn8ht*----------mh---m--ne---w-aidb6557l448468o677467b553rr3eesrte.Ieetlolm4494444944949ed9994,,999wmnblpnhaTThr.tyseymoeedlvipTsccoTioobceliernanekorilpeeeaepittegcuw1tec21ycaakhbtgmbennsrwreda.ienlloe8,asi--inbieeltwmgadaessenornt3mtluates1seesrahvsSaewfdoiitoeean2eewi9rorStlchhuooelpatnfhioxn.des.htttnNeu6ihTTr--cboroglkrihts--33g1gb1Naaboeoop3s,toemjala4tf6044323432t77361i0u1yjeeT.otbStmdheucthter2dh,9nh110123298849032049al0a22fc.eoxaogsccuslwiaalluilwohosa9egeo1tttftygiimiaslabrhtsstmssopr6cnsstre8enaneyit,aerjmmtreeeaoo3seChoaleersr,oanacAyslsnemntrisklmdahlooonktaliinmew.Ry,ooasdaobailfSopasknnig2veeneeeickmNnmnnnbeshvion0erCc3cOege311exdxen--eEogoat4e1ii-dd1og2ydud7onn2erdeed9fsl2sev2l8r267l,x26732ff,f,1saikl4eeapesrwrddoslyhisbfouiyecbTgwtodcc1apcfIcselrtddswsicfsia2dieinnihrilihoomtAu0aextNneahuao.5iosehnangooa6.1211g1cet-1nogosonmbyTtarClaerCnamPs2d.Ooecsmoaahwmt.eae--yawmien9s3,itse,nghirpearwnoon4po65pt1879s7A1haittmrnAgoalacaeedeaefyeedfoaeup)fagoal;i,rssgseogaewobttcd.odYcneslblrbkttehruws.wimoehuetbeetgnhreeeeiedrsfntaaeuWsf,aandsnsodT3mishueioeptbhre1einrJ0cewnrt.t.sh(drnnp8r1ueio1Siot16rh.1-ie.onescadee4xoew3aenl3303i.6o.io.cSsamcie:fn3ri4npxpe4eg1itck--i1tibnehnehdtnwoniadants3au21hp0D111aD*cdisyiXLot1pcrk.oic6a66e5291725s1sgmn7bs1lhlearu,ine-eaecnohsmSidongal4efgtota0atmgrrskryetr1saoaomisemhFotoegreeantreatpnt9ec3oi4cr,nsitrhdeeng.naariaotrou5eois8o63s2weu11tehskgn.ihcte-eetrnit6ee4kc189p0sy3vut3ntnd3atr.tescaceaehegt.iwieandhh7e,9rctibnE)--tasthssdsebsie.tvotiee,oaexgea.tojhctmhxhrscwhispaeAnewsasfscrg1t,Jehtmen--a4aD3aoeHs151rh-ora.dmncssaaoe9snssoaaama0miaascinetscrrcounukwyHon4bsolsmlosbdecpar.Coeso0klmpiyi5lie1f11fsi1okv.iydereoc-nntiuwut998p82f11cert4nl,t.dsceYtttirerrawaoeeige4artoyrtoaterhto1eeideugdhmghehtyso;dhpntnwlcmm9laeaAmhnae,hnhoeehl1te,ecoeaao6rvtsonih0--2setrf1fapoa3bsenroharrDme-Cri15347y41a0ce1ctegedci9gtberrvatiFer4hhio79nsesei.sew.gcyh.raee4,n5aeeeei33r1twnai.ld.tia.rotott-o98b85x61e1nxsasuc74ob\ooe.svr.tos.tscmctaroop9teaaiaheatid0nrlmehwemoudftdighsuotnelcosrctcideggi3eeileFsrtaesaagccoteaftnaoapa2bsra9s,iulJllsarSaarcuik--f0,e9tyggtty321ue1reaascDderso-mothnthe174305932swenei3rinpteabpcheaut5inurce9socf2ed3tt11ttytltdneOloi0ojthrosttak275.26e1ahlhsneg4ei+rcgehwpceyp,sikrtfrrrdee;asc1onlmercscieatIemgieu1osesepcamrtc0urfsnaxo^n4c9emlsrentesaoerpmapoeaiuafip6sitcraeDotnlscmoapftfdl4dt5oeN3.snttea--ev62eoeoeit11wiiiro2la0eoDevodike944n341113cc2amu0o11di51leteaoukt+l.834F1as786o8ntst(12Mieaaetetaahnmnrhdtninoheyrre3IeihewytomroertsntsocasfeeatSw.idod9eeadhesnee.e'.r.rlfl1 JAMA, April 8, 1968 Vol 204, No 2 105 108 ASBESTOS EXPOSURE--SELIKOFF ET AL Table 3 .--Observed and Expected Number of Deaths Among 370 Asbestos Workers During the 52-Month Period Cause of Death Total, cancer (all sites) Cancer of lung, pleura, bronchus, and trachea Bronchogenic carcinoma Pleural mesothelioma Peritoneal mesothelioma Cancer of stomach v Cancer of colon and rectum Cancer of all other sites combined Asbestosis Heart and circulatory disease including stroke All other causes o f death Observed Deaths 49 27 24 3 7 3 5 7 15 22 8 Expected D ea th s 4 8.6 23 t * t 0.6 1.2 4.5 28.5 Z0.4 Total, all causes 94 47.5 * Based upon US m ortality data disregarding smoking habits. lU n ite d States data not available, but figure should be only slightly less than 2.3. , . .. United States data not available, but these are rare causes of death wlcedbwdpbjgmndhO3antimmmaawdFNr13eoho1ti(nonehwilrpnoc79ra7nnJeeee9oiueeeooaeenhwecsoieggooeu;ann6pEFN0r6aa0ereoaaamtnsrdwetisnhgsetn;t;43enttectlsts;wttrrnaecxioaomehthhiehatedhemecbiortr,ercrdmeahgpoffatJxliacerenssrhwelem1chidaseanemfeieanespitltaaeefdtra,erorlhsafe,hd,-ooctnrpncwaihdadasantrenwbntespanpe5el1nseaethutati,rpdootonwtiopcaaeybhdno2eelhc9neioernlhltaepeufuntcteemutt.dduey6lheeyeeshstawmucimhauroeercrrathmrr3ltulirecdbispeecasaoafi;dsflesyTgewomhtahe,Dfpaatmfoi,soelioahvehriolsfei;or,apoebdthacmuumylrtfdifact.aseehamoahednnooovsfriardoioecetsmetersn.atnomhanSeooaehytwfnehsedtnatanri,,dcshvo2Adamehlbtdifsiebunringsbteeiecesihhnwcas0aedrbe,,odadtleumaan;pceeaororo,seaigsa,elnltirpeubrtseeeetortfwt,m.bedelhntmafe;eyitheitoa--scooairnsncfonfnohdmlertdesil;tahmoopcwenpptdpdheinioioroepeFemhwr3l6nathirenri,eaeuu;ceedelnncfaeamoytrire0o4el,gspsxdesUorrohltiaar,ceuafUttnbbo,Wtrraiaadaiteeoaa;elooo;tnetidrosatrigfrutnettrht1omnmsetrtccouoimxhwnmhstiaiferophtehusccnia9tosoathrinrnteepoletruealrolgcaetseyreeg;spa6hetnen.,dieayaeeseyslmuertafrtnebenvtra7din;ebiimeovcamecdpelscenlsntsestgoetrctc)stocolatiaathaiohiehtpseecrSfuop;fhaaaincesfninsrSgdtraoseoatenimdroeaohonnlrnoeleathctpodfeecy'lesyfltfottsaefv.hsrirgncncnuhesheihaseeetse5titsdbtdcieceseaic.htlnhe;s,rteaioetNt,gs2aaahdaaereswrbyeoehodayglUeasff,Uuro-1rbmtaoeisnUerxcltfoIsdegipameoswsfeh7aipttanwrpabtptnow1rneeetlodehrhnlw;onlecsroniiraoeteeek5itaiausteo"ptteilohiidtvfrtcshcssng.;ihec.aiottatblYeaebhvrretm8eeoiehetehheoteetodsinochaoduoxpFe3eiyshulrtdmrwocoim-sndhpstebn,dpts7anhrrs,sonoiuefreiSgafeeJaa,hlsaap0SeotaoaSpkorrsodoltwiwmdceartt,nboeactdfrhgretnttifraeeostyttncst4aohtarisluoprrhausaawhttshetelisutittttionet7pnteieermluietfnmnfohhhhhidie.beveaoeltkobni.rxeleviss"s1rld5dyydneeeeseecsee"es;;;ft.,,7,,,, aswprmeccbwaa9fwdtttorptcosccpttttOclctiisTt4ecawatoidfhhhhriohnanhhhtneehisoaota4honaaaflxnheoeens7fsoeoesefaooeenxbgieneoehieturlaennAmornwMArchecCoadI.rECdtsamrosmotbTsulmu,t5lsrrdereui1itsettgtdcctcetegeiishtoevltcenhashoeexelanplaserhdeaeeo9soa3hgaeetleceedaebedeastdpaest,oentfpgdiinesdealsris6pebms7inmnrrirhhnacosmtce.actflrwdetloclgoewvcremura4ame0hlimeddhth4e3ildhsssomsanesdaeiuoaceeroaathcctetetnwm.rTde1,,ilttn7,eerteue,fhhodhtrthoreartaiffeisotru.soscrha0dderreeyhrh.avtoeahs3cesekTeaiaeltecsaa.ta5ttecesoodsroscdeeuss,teehlt.s,wtattsaoedmhehlinstcmlctitofblhohhdhhhrmmnaynfisslhstrndoseWasocfherroaeeeeboeloiebcto2rueoiss,dateeeg.eeakps3olrlSttaheaxn,srpocc,x--esm.oieoL7oyffiuhhseauwul,.ie7nd1lnhcenvxtteiptttakdaufpncxtsef,fwbsatmeouneh.;Tpuoy0Ahaao,iamriaolehtphhrrereteoneacnwlloitrohnmoleessemhasaw.vimhoeiceteofidt,csomlaegfcg--ebretmofdrhdmteOgrssiyecseeattcerbethmtaopnanvoroncsewwsbteaomuooeh,rfednarbTeirtxoeobioltetcaa(ecdewout(e.demetNiedeobmanroettiiaitsipmotho9os,esrhtnahrPwtedloagancestixn2hsctanjrThahvyhilerebiae.,oiun9rutd,oodteal.leuoct.c4ctkaes.,eoearoceeman3teeahht4osefnsnscnefdtfewawlluroCisvelhgvodudtcTusrdshor,tuaiofuoftsaeoFiceneneperferoso,ftmteerse2oiraeorwteoosrrefdmchtsfsendonuxdnwoadscoehmmalrsrr4ghaxmlub,deaierc1fyiohasapwmaeygearaeopdrtte,naehsusoprostditgaeai.ihllm,oiatcsnegoaanwe;e8gheh.sgosgeeiaohreDsrt.cruiaedvbateesr9cc,ncbn,urof,ageikhrCeelisdhtdcofeaelTnutsveiisaatndao4imseevsdtgysenltdyohettsaetirelnenwheraeseUrhtbnedixuairoheetsaiueeea)rdodr9tsospnirnesciagnrhobrnreerosdmddpshnnoy1eastrnonf4aai,udrvdreocymsert,hfigbcs2eowTsteetuaiyfdl1tnaeiwccrionwfeemioeehUs2rtesi5mddhscratarnfsnsrRohnraabyrdoeeagmgfientdot.ee9esep2treloaeeetdtifnoouhol--nfessdbeedaehecrubnfrhotclrtccfoaaciadfgksueaavoiedmehnsheorottcAncepsolupmafUaewthtptsahue1eerrellderotfedehehoetSobrmgounmooltsteseeeu.4dhsdardumrdtedeentoerilsdnusnsssfptscHesotwtvasah7oelautertgeuampuiante,eedcuseaxlcweholfooe,e.rgct.hatneya1iyandeueesmatrf--rstlt5oSter(meephttnsdnt.esseruhohr5eveaitutieadrhhledteo--dma,otmogetetto-ehlIaaesroslsotbeaaeldrhaeooaiadey2sndtnes,oonmit=alrsdds.daIodwbdhryplttdroultmpSe.ohsleemiesfni,3sh,ubeednefbsip)e9hsmki.doelncrhfaanptinpe.ea1ttsswaaenrtciuf4erri4aoaatSitimasooshhiozepteoAuoaaeon9otugtcithesgg6trmmwteAhnifhwhnthredauteiatsacas6enrhimgooexbnrataieio.sia)loioonedaehdsee:s5snenass:sc4ttrsettf.,,,,,f JAMA, April 8, 1968 Vol 204, No 2 . ASBESTOS EXPOSURE-SELIKOFF ET AL 109 twnpewpcfptwpilcdbetUftebratSomcpybr2wtcdttltsiwFcsccs1gr2((ohnaihhonohiuhhoermoeeivmosaoo.irreofnaeiiiee90iooeoeoean3ishthnlngaggrgognbieelneaevtertinivsBrmDsasa6tolpiranprs.lmnreiodndotoociti,cohiicgoaauaieeitueeeeesmtr0etttnrtitoawatrrseebigeksmialkehwanrr3treohhroddilneopdrra,nspsusolsrdduh3daWneesesiitcee.atas7ledlhnersh)lamsoonna--htdd)aasarngitty0beceotaidgitr;0ga1p:hcb,3magtgytt;loowfgaemlwgeoneeitseheri,cnjoceeBhey9owyree9nodye1nrshaSreafpkrsagtsndioahcdscssa(a5apisg;cerktastirgltcc9neeartuhrge2otahiltcscuheguseun9a,toiteoitoeeoeceaetnciAx6iteiiaosarnipsshh()aimraeydrppsefmbddnntgrnmlvresfipotam3smnpb4dsoniehtefs.aesgme;easa.hajegeaceecuendouuaeddud)heeb.ibsue.5ieesotgptasvonroaphnav(agnonllwFhesscnbaieierrnsieCpca(o2absslr4roarHTatkokndtnohediseoftoteitawty.er4ooatejsemheteltesndn-yhotf)oihecaatexeeienggdycsprhntto.eitmrbltrssoscehaldsadshuoidobedodechactoUeaoietwscMiwye,f,e)acdreotdswhtSoxsfssbsctrseinintlotoxmckhmnysnsmgcushlnhheoaeeoCuponbepttolicifinhrpa:ioyemto1mwbainwehsocmavgordoipnnfisaigen,eocuraattoaegado0trsnrwbapiyrceSecCmahhicrangrworgcoessveonncigektcieefvuroaebe(eortcrthrgioueafedeeereeetatr'nnianda,1ticlhhcdredisenpsr2tusdesuueosfmrnwlrkhtrsxxsphnrddanshirneii)totn,)uodte4eaemieeeeirdasootttcg,,mta.ethe1ccSdaoeldrshlrygrrgyswcd1retudbieaas9oaseirnhieh3tint:ehnnuoni;9cT,o.enhmrcnatet6tntiakgatno0agaeenelaiugehthdnaht0maghbtuTlipaovs,aeatvc(doavuroegmenlSaTbtoeehsry4emvrwcnrenigi(hetnbesdlkl1emgmasJfeaotceginweaioayea.sbredrni9elaseubmt`tepnwvcboatcpA5raEnqcrsyfmr)nlscRBIemtget6rotrl5k45778rh346i6ohnniaTig2eieehrauseduaeshapoul5i0550rsi5050on0be4iw1ccesiwnroemam4csmc(rtsrnr-o-p-----n--,eodamhl7iieek,rte55478.msg34Mu6e6auit4e4ttttbaoeks4rto(y1es4gnnr4snr9994a94gi94ryodidtYiaeoiateoass.eyid9onTrfhfo0eieserfmeatn--sroeeoirdnoasrsulc6wfodtikaeaunncd)as,knsyltsgbs3chkovrvdrcpre0dtfmbetlwEioledbhwwec)gtmtaneeethahcoenyioealcr0edfoerdsokaorecdeestn4udoisttebaidatueueosamhtlntat0gyiaeiettoireandn0cRihsufdsnalveriaesdewagnsSrmwtnngtdp.arenci5eeuedaereaikhniwtNcuehmcifhrcnasteemitpgsnandaohitmdee2caomnso2eeectds12tuane1mh1IsrthorgubaeJbetyipgfthege8vor245ecse6ae26-07ml2geotnrkyrelornepareleouaiadlaefy1miab;nerederfartdsilbrrinouunmnruroiemtsrgdvood0aotnonmrlpmeseemtnccenfwymcelhdnsemonms,fmeeeces(piskunrreaitNgo0oafraitiOn4ootteneeanonoaeuoiofgvoeortro0gtnethmudeaoncatocensdnaksdiotooltmliteokrembrceo0a1rrtdohamngnhyeceayoegesee)hssprf.ftfr-,f,niritrMsbnctoCePOeges.ed35533i11wirn.prgpn2123252t2.lheaherfytoaoocrsgmTt,silsjhiwwwsdfoamfiTeIcyUctdadrlaftysmhorLtirnhnntuiiohpthyunfauemapraaifmairneiefeihnytvadaheeavocgasvnoesereeemtbheeeutnrvpLeeaalTaaLaapeibtoeselot1raocuittainltgsetitc,ertaurcettloehsadsdeuthhohbellsh9igskncchnEphntehescneerre.vteoseSgfdawa,eeanottuees6xuhaeiosacigssgisor(us.rncodmahoinniddcddmsberlmg4iid.ttogceir4umanatrmibysnoa1oise11,sie-arFgadsgelCmeotrdwiaewdl9n0p4257k0oet1iaaetSIchsesfoagadhbwassenctkxwes1870uh23oen00acl7b5einoerqlstifnathernehnhrroitstlunlnjeepdenhlpwowhsartfetgfdsdeaeehayulybueahtpnaiootrocl^eintcaneelcstertrgctttSheeasstsy.ins3onieTwhlhdriohcapubreeiaoecuhhtnauttnlnthmttaersnd7aiinldynoUrtouanraeiilssipeatenesnnoroebaehcjiramogat0sehoddfruteretwoapdrrbsDdarwmtswdesednitogoterTtsenoewrotiua)eadtwm.ine.litsw,iastaohnawioaer.no.loeeaimdandtrauloaiwt:r1yottls1ffnsshiroegtyfelDiabruaegtsibnB28o0Tbileene-rtnibyhnehopbukt9jncsyaioef4P8A30ttbgdnhlneefslhaltcsseyihehygdreepanmdectgeugtieoieu1e.,ideltostehvtsysn)rpstaneecotliSfhlssa9rcmiipEoiofatrunatdiihetoatetseaoatm"wmv.on4c6nontCrhxilrfrerdsdoTd-tcoenasnaraponeu.ue4scpeaethsurymM;erUtnheesrrbajftvrhtasxkdplttarenoretspntaiehySeeh.elrybheowheewbwcoo(epiutesewngedtiacapaarabeytdsns1tetmhemnIeulk2d1saea1lherrhevnoil0Fteoo.tyaoetugDotst4owt9058Awossidhso.-rcioitneniehrseec14r1r65a7afnsotn.nCnrretseclrigcsciuteakk9a(tyuthra4sttrkiygetshohtyeiigrgescdtudehoahaeoebngyuiidtmeenunoemheerlay1dudberlhafamlifwafagrardraj.ticlaaodrsvrt9i"aryctssuatlseuhlnsbbrgesatOhgtaSsetyhlureotye6billrhehtlde1eathhcaserereiehttmeuurucrlcle4idseertpitxenedot9peswteberedsdcosnihnerslihaplb.dmprob5dnt6soufeueraaueneTSe2io)ednyggeneoc321et13eoetv2it0oT0asropusrmuiwmrrduDir8o601e4hbn3e91seUiTywdo-nsbstSpae-efpfs3e81pm97w9550aooirnodeDfcnalceeeiioocnmicbmd9bmt,svyrieauleknnfnoocdcbondorrutneabyftaewtleerbiiabiafllcehoeis2ainourepsncmndeeurniedabrt.d.tsoeilodkstitgeeodsdnanhaen,eauqrito1cuentcouonefeiilrmimnnrmphrihntngatttpdeorgye9tfueatagsndreolvhhhegwgeybautefcetdapirore6rbliptsea2henedenearthdyrtt,4fle,foarch.alcaScHeiepdraseehn4oig3243ol1ditonwditabcaenuimagDPt0ae5t5425na9dt8maf1swtf1wTgrlfeiaasenhfantahob690d5600+a5ershrstbrhungkow9ihrtuhtyas*opta*aiiraotecehvacevfietelihnuhbhoiaae6nettsadbetoonktreoaeettoertotmeeiiillhhlgt4yohneeedeeaees^sesdrstf,.-reft.llrrf,rl JAMA, April 8, 1968 Vol 204, No 2 107 110 ASBESTOS EXPOSURE--SELIKOFF ET / (1 si1 /i t; Table 5.--Observed and Expected Bronchogenic Carcinoma Deaths by Smoking Habits* for 3 7 0 Asbestos Workers Smoking Habits Never smoked regularly History of pipe, cigar smoking only History of regular cigarette smokingt Observed Deaths 0 0 24 Expected Deaths 0.05 0.13 2.98 Total 24 3.16 *Based upon data in Table 2 and Table 4. tln c lu d e s cigare'tte sm okers who also smoked pipe or cigar. Table 6.--Expected and Observed Deaths Among 632 Asbes tos Workers Exposed to Asbesto Dust 20 years or Longer Total deaths: all causes Expected Observed Total cancer: all sites Expected Observed Cancer of lung, trachea, pleura Expected Observed Cancer of stomach, colon, rectum Expected Observed Cancer ail other sites combined Expected Observed Asbestosis Expected Observed All other causes Expected Observed 1943-1962 203.5 255 Total 1963-1967 1943-1967 47.5 94 251 349 36.5 95 8.6 49 45.1 144 6.6 45 2.3 27 8.9 72 9.4 29 1.8 11.2 8 37 20.5 21 4.5 14 25 35 00 0 12 15 27 167 38.9 205.9 143 30 178 iTssoomncpmbsaosomctrdoittpg3tnnooihmieuuasrfnnfre7uureaoadteeieooebtrrbTcTls0eOmrtogbanoteonncvaybhvnaetstj1ebhahlk)rsifsueeireiasbcpoenavcskowoetoied.crotvhssaetrfnutoooo(tiunuhtwIhefmeigoerbnhng5sbemnrsotstcvtoetffregehhsgaoajshortonehbiwscodae7eohcsoerwiottlskeoheoadflcnt.ailuemsaenuu6ieougneohmtetes(tmixestrdssbrtseecwnTetimdualrxirttprssiecougsxpjaonoktlnpiyaaiesoehkasohdnctioabsnckpiaiombti)cncfoctetknrgir1agoumciurT.hstutblseimsnsoo.ergesoenedeutsJshdedaccotgfdpeTdnsc.reyshacobiaywnd.eonaantssw5bahwnibrwwlhTogatgmirsnohocue)riordw(hattniteoethsscotiomsiettootoebnealsro1nhehsehenhda5myierkdtoin,tatnrcsi.eciaetauhiticemeolhrseahn(nthptissodThee1evinonTdooln3opbglieoaonxl9syaieplwcget7tgyaretfgynuigt6peassrceeahe0nhsebfhweh3elxelulsntshatendstisl3uwnra,thocpse2rssaceihmaolii.onbotrctssuyec1.netrtcdeemyge3cofgheiarocl6bat3rddte-lofhtrdcatekciestjf)nc3ehecnbneead3iaeanoauewb.idge.asndeaawrcsx7rsde2guasiurnschhcmeTetnt0tpaeastarhusicbhinaaeca0artaeternlhbnoetmeohetjrsetndg.cdcdshtoroue1irnr,grsoehpdhutooeete.memmc8mssagehuexcoabnannaru,tudtTislawoaasoepsnpaciotjonobap,ooehttrhpnnrhoubnftehrjhifnoecsaaeoidasioesazllsteresnntaooyaafieprmeemceegsttdochfrtftkdhthrptdcaedsiraeiousoava3ioorettttuneoeagi6tnirnnhnnhhhepe7esniintxarnigmoaa.gondgoddegd0ce8eesese.rf hwpiwswbwarwccsnicdtdeesotrramcoadmsfeiab(nnhheneheeumihmxaasgsnreivafnesiuureeoohigoceccsraepbotorbnborpCvdrNeTdtss,o8iorupecotnitTaghneatwroenrgjsceomtteksJouoh.kwriureloet,ki.e.rncsntse20crearsndaeeeardemnameiisacwwmgtoehtatciuhrn4e5baenSrsaontxopseottTtrsdfhtoosihvrpoitn,thhuslgsameitpsdemesocto,eieewontngdeaigescotmadnnhctecoA(1osw1yritasceritdihoredvd)etetcoctintayudv,nshgi2o-einth.pgnnaokoeeiudatf1bmsoTtftdiiul.maewntaieroneiaeeoertfdoy.ro1cehsec2ciyrsoongdfaycbfvosrdslTea9rntuaiee4iecFtte,bbcidwta2ifkeeacndn4hyn9rtnoncnin3hhditroWssl.reccrtnaidg3ocrtew2g9eoiof0egteneioheobonfenaasragiuob.iaesfyar8s,mromrggicnerftieetrsrnsstarmcrsemyvtt,seecrsigsut14iokWheehcmtctwiacrnthtaehdgritodhs9anloh(obxeett1onetuoetmdona0aeeuEtlehhno6ikh1eeldrtrkiifep9hgouespeidrmr.myrotnls.oyo7slikanee2eri4elaeteueamodnaysmmctcwy.rooihrm6dI3tacrnltgrndosacriqlseeoftaiaiTtaagitteaoio=mee,chcnogfmtbuuettxbneunrfgevccnlrteafovanooislcendelxtos9rpyrorteteirteogyadoaahsbhf.enrrirgeurtadepws2eanbnkFpear.emaknestotrlecglatataae6ceew)trahe1dnuairhcplieondituilluriton.ltacyo3oesstnu9shoehymrinlelfeeotlh6mpsnlgtbt2ptenysyn6bdaddweeaaTcdaethdtt.eacesebgt2,icneoyiexprarsdroatiseanoxhrhinmsdbe,settehmupp,esiksscfsootcpoigtawoirehtotortdmoolsbmmreoebfihrtaorhgstahsuiodiwtangooehesesdrhdodeeune.nsecsheesbf.eoaecui--laafarasaidietessndhnnoyegneenkteorsttproardIwtsbsAc,itohterreeeudetogirrnpfpcueuotirponhets0igsyteoalosacshpotecdthsowctfanmxlgett.xocurkocfrpeeceekrehlanh2iofheiroikpehipihnluesaarxlbuoratc6locieteafeosyaaeoossosohossspcr,spihnoridbrim9rsscrpuvsn.uugnsohrfanralalaorfsoissub2bcieyduiaebetbl,f)itasolnetbhgnHofoaarsigeeriodcrkcejrrjklormoenoerewtukauteesseaualeaacttutrovooitionnvwmwhetttscscitannntnelohnahweooeonsntoiltttdeoaaieittlfdddgnonnoooyoegodecea1sssssssf,flrrf, Comment gtlphoGttteltriiihhhhexelapogoooeeenenTvpnenhvysyitioerhtrckleeeapsywendretuoruacnooexomsnrriaimarswenpetrnlrsieckuyocccelsncelcricemslnutneereuodo5stsrpoasrgnoan%vfsetmhleaftrseeepaatetcydaadeerivItpttssnunhrnooeoracbdarahicrntlysgystwut1auiidkeobetv5sbwtotdnnetehlo%itmrresceohfekihtwbr.reaesoankefoesleosolerC.oeorlreAooynuHtmktCohtrpntm,nsaydobeemolphdamdnglomeeeoisaiereiooatraiueidphsinamsrcmnonleasabadygniirwva(nessiaosm)enstsuobti.stiitnfeaoboC.hvacPt1li*hslftmioeionreenhKkilminlvlsyowmeaeylfatpnniNeothmfamlabgrdreuraerroaerkwaiisaaoidnrtlbottnts5ynecieevdetvshcerhdamscuueeiabhrtemamsllvouyioiyacrlt'r JAMA, April 8, 1968 Voi 204, No A S c. u. 5 . adwbmltaiseidbdlwtittlwtdMpfefpewhmccwIrwvocesbltatyaonttynoshidiihhirmiodriioxhunvoiuhoearoereocoogessbueceiehosooaonaefieehheeeeainldpTeistnHxbbdIiemramicluNstknecohIafssemaaclernynlnagdolprsnlyleenhtgsosieaticteetr-ak)usdrduathlmxouoeveustetcbmlophsmtteo,ostip.l-rresssrepnoiaiuilreishhpehnatssnaonailmcmeensenafsuceorttnnirrrhiafaunflIdnamniouorloobveeleoii,sdciitnyoeodywxonfogsrnegsltmoepndepwnbmo,agaidrrsaesnefessieeymntancud;phwrtxaynddaelsdsoehytlb1uwsroctrwriiF,coiidoiotlccoiuiapditusleerrltdsuaiiniegr9stnllg)hscntheetmyCileiianvicnatulcsrodcykaecehl,.nohtsswe3lhealpdgmhrfoxhmeeaaeuudomhaedselgtithnsxeaoapcfuesne0,oalioufxaatpabamtoesnrudIrddrapeinbptatttpeaorehciiymtotemnedmrlsptsoelstmsfbhlgrncro2aesem(ereueixroneetelhoooe,P,etkntmeeeguostin5yrebilnifr5rt'asiopnistyotbhaovur,ilouunagsyrinioietcseni0ilgdnecstehhwe%nltcpbfatcmootosthrgeeielneounrratnaeuwiha.0iaaietiaooemeeuiyoaieeadsmsmatnmamahesarwodancattnegsrvo,nptaphfrsmecntmr.oissnesssc0betlisiibsapoccgoeainmbvtSiomdpaaaftoetborltgsfse,ira0lpassblusolteeolilrroamyrwietuelysiimiriutraeayenoerosey0noeheceneapnsrpmmrscog.oefwobsmttsaarcsssn'pxcc"pgoatmthkdostaascRaardd'usoknthve5etp,niewtob1nhatcmaioaiottimnhatheshnennaainoicet,uitserltta0xosoeeselsadnofnsoWtrbrnhoaei,tyeese,tcehutttsdcttobsfoo%sppkccnnbohaiafaoocraaawlruegreesierwntncieniuesapetouectpessuenerfmssyrsnhdngnccnrcnbtooivalmgifsrmi,menbbruloissmbbrreohrnmentoihndaetsiaeeciesoant"meputsoebilegrervhxrbslesroooatgoatotogrcodettonclilrauidtcaisaekwrsssfsokwewasptbeormsnis.csmkattaspansiuneaivautthekr.lfigterdernoc.ootetnc"hfetlkaohsnsetoloasiasetsis1emnteehperaouhhriiuefaot4sscresnraMryessce.aittse,rdsne4looyhtsyatneasrnuios"srnsptrrnetmBdoivhbesttlinesajp,ufetirhiusiierciefacrisni0iottorcenaaaaetareelnnsetpvilrewntclatahmeeicoo.tsIirhwcsst0ilinnitl.h(tsyrmlaxeglintenrueanhluscaoocteenftsnoasfedobt0ttiasStaoOcsoiparaipHnhmdptncohuoeuadvrfmbmhwtrnohcoru,tes,nieenisnnooreurwe0eoaorisi,iohmnrsesleesisapeekeytgnledaeednoreoatxl.ntcueasaseetr0pbwlitbrtaxcbyasr1iiiega,uhoytunrlpahutt,r"mkeccapltadnsJnhtkt0ebvteuetyaeiuslcew.ielnhfaerinaoi)otelssretgniiod.cgc.eaesyecmNsotytrehyn'kuerttbanrrecnr"frieodsl(itinltastartihen,erg"asssanyTsntooooosoaehRxoaehondouidveptuhauesuehnfem,ihnmlssA.oostiuwsdcnrsipnferglerebhluamlrassaitrwsnuvtaeawrledsctwtcnoio"roysepcp2oufosenizostisttohefbbBmivdltsduaslsvrrvruhdhgohdsthnso0rrokasatrlliknaueieeeleuaeoiuutopetoueoiiotapm.lecuieamirrraiaeaedblhneeencbrlnovctarpssrimrnkaindoyanascntseraoicirtniralsnnndyyhynggeyheeedsesehseots-ar,t,,ssf,rf --o _ A \ ' J ~ 1 r A`_ 111 pshcmgacatasnmgOIr5f8tTTcbvrom4pdapdstwhccewniratorhipmfeemmhhsisino7eme0aoefre2ayaoeoausenehhfsgoooaeadbsbtenocmnvbdedrnSOOTnr-i1ssv2dsmkotmtodeetocrayirnnyeuertmimgtuueey.eheic.httenikkkhcfrihcfksieeprngssgttsgncersserfreeweeereemoeehihoeidobedeetetmlaaOgieneAhnttieg8ldmrnau2oaeoccyrtrnonismnerneuyhlrsoionifaf7,trsiovssg8balcestoiscefc7e,iscreitcuasnlpsftwksoeeifr3edcbgetncahhoodskm8hoicebwtiwtocahepforwdiddlcwgiughntieunmeinuehtanaudaasasdem!disnnnhgeeiuwapuohiiuhlphaaaddnlchmcrigdlnintcoblnniaiyoorsaahrieitceeseneoesrselatfeouerootirerrcesrc.emut.rphlepotohsobretotcr.ydgtearmk.lmibueselnr,ish,ideeistlwtifrakteouiehynamtiooduoexetitnHenTWaignexaishsordssaaiasoensbaoY,ooobgsrdkmonpmlisftnognsaikaemoattseihssot.nsutsvthesnllonmfttnareoreoanfegehtsrulu,idothoewoleaceaaelsesoer(oeonlcsIarsolcyc,.ioFeewynifasrssei_ansaeoofs2infuttpp'nnskmeoauubeenstn_e.arpaaetitrddlwy4raohrvw7r0eleewnewoxgneswrttlcl^2lrliddowtehuaofaseh8rye,sHrr.elwsemcrpeduhrs.sooa2hidpkyyyuiibwniauvetnc(9raoeiemlnttolitwaorarm6,b3oesieied.uaelsigeopele8hiranoducgrhokte3salgsckwitsratsdl1utrvoilrhwhwo.ighingubsondirn2eerslrcweahtaslntretfbwynk%ilioltenskyeaeiyeorvehr.seahtesdtordnedem4ieoieosevapionwpa..eesshosbstnwitomnrdoeaf)ebdfaauhtetehtllctamttrooruecaaaethnoAghnhtnhwthwehperrIeileetwoeuilarnrbeltdestaod,stwenitnouxeeeormpdemrntestpsm:erihohseoeksoeeencskpnrthaAtbsbrdoieno;xerofnfanhnhhaedaumgeaormstseogihteraieepwrorfspoleoaeuomsiiembhstltloeeftxsissxtsaobtofnndehoedaotksvooovahfctsxohooehuetctibvfpahveseoundssoeikeoemsrdadtterabrpsderiatseseeeaeseihundgakdaseltdsgenectrosdhuhroemgilbedeatlrtvUomarebmegrb,geoeooaffcoeeaeiisnreeadsswsiftslavoeennilepefwurneeoiovnnsnaoebioaimsdmefienfnsneeelsbsrodgretecsifuedtlgfitkteud;5oeroeiothtnlttcdoyeat.reomodWeotftpiuohawsstuh2itnexeerntaihoerhssxsenrabhkkatskoopnmbcsispdgbtbsesbckna9ouoAiespogtlaasiehetumedritbstemeooxwrli)noe0eoshlsrntosfseshfdiw.rtgeosS.teodefaospscssedkfgsotraubbosagsaooiboinafesinhohwnttihabtreecnmertsedetrngotrllSkaceitfrdTyifcoohnmwlcrloliedrmknowsssinmoetistaseveuuoaohstnttueehchtgtetueeteeoest,itranirehreheonhoo5c.gnheotntoldfroeexltxtsxxisialkriwes--rsdnooyde2hdeheoiespgessdsnsgase...srf,... cilTohfisthienvCeisttyigoaftiNonewwaYsosrukp. ported by the H ealth R esearch Coun References p2tw7o221se..:ue5nrSS6ee0eEll-aii5xkkn6pood6fofffsN,,(uMeIIr..eoaJJpr.t;cl;oahCCsAi1hhas8uu.b)rrJegg1sA,,9toM6JJs5..;;A. aaannn1d8dd8M:HH2e2aas-mmo2t6mmh eo(olAnni oddpm,,r ialEE,.6.CCN) ..e:;1w9AR6Es4eb.lnaegtsitoJons Ex MBeed JAMA, April 8, 1968 Vol 204, No 2 109 112 ASBESTOS EXPOSURE--SELIKOFF ET AL aXInn,03sd0t.0itH.Ou0at0tehm0,emMr1o9eC6nn6dh.,raonmEnd.oiCcnW.:oDgo"rimSsaempeanhos,"ek1si9n,in,gBpEinepptiRbd1eee2slm7da-al2iio,0ol4noM.gtidoc:th/ NeSaDt utiedoan\thaolfRCCa taaennscceoerrf SHt1h1mee4560ao...3lk.StVSHhiuUmni,ratgaSgomEelkd1moDSi9unnto5ecag9pnatG-ittda1sie,on9tonin6dfcEe5,srH.,HaaColenAe.f,adamotllhtaftWehhenr,,tdehUElJRefrdaGeaPurpPtaeceuro,uadfbrbi1ttlniSl9ioikc6tocnae3f,Hlt,,HetvaehseonLa,ealdl.1:tlA2h9thW.6dC05veh,S8ilaps:ef3noara0vgrrry-eiet4c,sA5eC1,,i9o(nU6pmJ4uaSC.mbnDli)iigtcetaea1prte9eti6otott8noef. aHne7dalWtDheeSalfetahrrvei,cRe1a,9t6ep3su.blFicraotmionM1a11li3g,nUanSt DNeepot polfasHmesa,lth1,96E0d,ucPautibolnic, Se8rv. ice, MUoSrtaDleitpyt boyf OHcecaultpha,tiEonduacnadtioCna,uasnedofWDeelafathre,,PVubitlailc SHteaalth DL3P4OPB2t1i2198olisrpre1p9:11)611:ten4ie94ui.23013esdtc8r-1......rdJ1oas7Fa9IDSeJ6tn-K6nNlIian4eDeo5onascel9(eiA.luindnisoaJ6wlkAvl,csdurnaboaiehhssRen(s,ftabioAetfoi,P)n.r,o,Geru:rpe,nsWssBMI.1Crrt,M,,e.o9iiWJr,.oltea4AsT.iV)oo,ndtn6.r.nMrEsWi.,deJc1tte1t.aat9hr.,u2aoLAlul6I:animnr78Ece.tnlkd,y.1d:ttnseis-unpFvtr8FaZAaassgai6onrlatr,tcs;oildrovbsh(lNAmonoAte,AMiwannscTpMvHtL,nseiohrH--anuid.eMsollg:NSniea)ms2apg.VlPYRE12tpleaheu9tC:xs.cnh2:s5loAipad6sm15anneo1c.3OSl,locN-sa:su12ceuRnd,re7c6Hrraveou1J9eriS.epp-npy;cy1o(lItaa7oOAnrNtMs18tiodsosci3eAfaub,etn2(o),esssAa:Pp5bo5tsAl1r3liut3etpao9m:hg6sH3seH6set)-2ie-5o5alaWCy3r.is4z1ogo8aA9Jomi(v6rnrTmSd6e(kaMoeD.sroetipxerhnneootsideggc)cf,f tmsmccuupuj""iewafppfa""fsdItabyemioheooqao-esohnhlrlaiynhcoapaenirveeherqtPnunNguTOBmreAuuTBIpeemtietbaroteiauciqiircsiSnniladephdo"hulrnvsvleuosncavamialai,hsulneltt"h.cwau"iviifgxtoeemmantetlnmai--nismt"ocia.pnidnotivlcasbs,donagtieshrlqiftma"blItedcaagtkohsipyiitTofortine,etcuneuloaslaibneoca"cee"ehjlara.figrolateadbnninola"mrdenazarei?errohntuykgtfstseleti,R.qcblle"eda"feniiresiateog"yrteqoafreutrnwu"rl-ojioeat."otihomuyeeeoilnruinhnos?iincbeamsmbyfsmor"facvsatmon.iedoeaic"texnelual,vntdlhtaofyecemqaatsutti"paaplkd,pnodollewvehfcmy"tnonrtun.rea"eldohtchefahrecaeeoouIihihcrenh(eniwroareItlashevsolaaivgtnwrmeoiqiilefgaoabtdres.mtsfictonyrniernaneuiroufecnlas,heeasaaIg.cinldrboegaevsoaieh"kads,cyet,lma,gtviw,arbltrr--"lpdemgeinlvh"sitrbsNtay,atcrongitinsohodsmitceafuhhekatahgilrlmhsecghoheoaauatsniorw"yenreymecnepMtreinatanesrneangrbbyio,tmatdwvtofianbit"tnpdehutmdgcdynnnap"onbifa"Pmsseileirgaa,"ceewreotenrdttoalyaasnsawwauvhnaeteatumrusqrtteuilradin"tsiylhatteahbhb,mdletwclvtncidlhuisatsfollni,iensyncellew,ya"taliyeyitciliaistiaeitheattdcaicevrnshnhla(cqih)nsnoawprcea--hstb(lIpgbutointesduufimahdfirfgnonpnooieHtnlyaoiucofdaosianindaieaethrvdsosntoitivlartpempminrraswntteoswsnsrereematmrbimidxioeuopeemnaset,vaittdnsmasnrtptolebieiiacrruxrtfrseonhoeiaem?lenvetdel"ttenreEmmnaylt.aWtdmthniir.etethey.egpenh?eagrn"beertOnisedodepade(nnriyhneddlIdbeefltfgifsWFetyltmdrr.SeisImdooswaeoneybheiakgwelasaf"itwoic"eissriiers.riseeoehaWnsseheoinkmssamsdtargrebatdttwnkdnnleriihsyvnhCehlesewoeuygsuaapai--ehotlstd)sioraeetnroit,byam,ntmalncrrphwlinfoneitwhglctui.ctevni)boveddhdaeerthtagobgeifoeoo"orohtsathidfneoovileissaedhontroostrHupfrclciItdsealsaeoeaemdell--eswtfuctdaaroutma"sedssotxs".pnoip.oatocnsnnfnorht,rogmhhqfictstegrlefltlametk"cn"esdosnduyraihieoepuuicceaer"eutnnaoxeTioaoffnianenmeteipeoxinnbmahuwomotn-lgimraitnoropnstidiawnoawnstsdinaiwlreylpecsuitulehccar,sogaeselttmgneititqeaaoliinuceeewhnetru.otgrbrhidessussgblh"uayrt"siunnqtamsenloixltlivtaduThppmy"iettstyoiesputdaartsnvaoectsorimhioefwfphhfminiyecttLedfornaolwtnvdoiitthaeeeirodead(oohhanlmohcrd"iesibogronnalnlnsoimnsseuitaixtyatdlncip,mccmfiosnhbbcpoosrnoy"dgbr"nitaaimaa.cdlousneaonlu,cluhutmcetttuJtiuipgyifgvghhobtgwetifntieeptmoeaurssimhAmhpioofr"rhgif"eeirtua?dsranrouenoonoaloea.nreueeoMl"ngyalhs"iisnrmtmgvwnsmamllis,ndloitpedda.rta"aymatnti,ou"a.ogfmAaobaemaeiddhmirosw"tertdcwnsKtsphndtrfaypljehfauttehoiistateeHveasalheinha-doinBiioinyqlfjfinrsatc"tlmegtioenoyweoueneeaslo.risut,stotur"s)rt"nuceidrnnsisrbhbaihnazhurmvituunaatat"dadvtseccmniamuieehhenaepllndniotrogieaoa,eesilddy)yanodnnee"yssslfftl,,. Alexander G ode, P h D 110 JAMA, April 8. 1968 Vol 204, No 2