Document BJ8q18zVBko18VwME9rnn31J

14 January 1961 1 cases had been cases that had 54, He found that .oma of the Jung r males boing 41 i of fomales). Six isociated with asas mentioned by ichoot.0 A further ,-e were described iod, between first the initial symp- 0 and 60 years. North West Cape such a transitory Evidence of expotailed questioning, ong latent period yment of evidence 1 of occupational taving been found ds and hot in the nay be due to this ion is significant, - in the Cape than ig began comparemined is another e cbrysotiic mines the amosite fibre ailar to the Cape round the Pieters- BLIOMA te age of 40, and Jvo of a primary >m a feeling of . the beginning or creasing dyspnoea it symptom in this f acute respiratory is is accompanied tere is an interval the finding of the iscase, while ultiforms -- either the requiring frequent y quiescent period, srated by tumour; 1 disabled through tally ascites may nses or to cardiac 'ibed as having 3 e of pleurisy and virus or pyogenic re usually successond stage is one of 14 Januarlo 1981 3.A. Tydsxrif vir Qknbbskunde 31 nteural effusion with pleural thickooing; it is then hat Physical Signs ihcnatient is usually admitted to hospital for investigation. Tuberculosis, malignancy, asbestosis and other causes of pleural disease may be considered. Tbe final stage is one obvious thoracic malignancy. In the early stages auscultatory evidence of pleurisy, bronchitis, or consolidation are usual. As Ibe disease pro gresses, respiratory excursions diminish until eventually a frozen chest results, with flattening of the infraclavjcular Age, Sex, Race, Habitat and Occupation Our 34 cases consisted of 24 males and 10 females (Table ]) Six men who had lived all their lives in tbe vicinity of region, 'roof-tiling* of the ribs- and immobility of the chest wall. The chest is then siony-dull to percussion and air entry is grossly impaired. the asbestos mines were the only patients under 40 at the During this late stage of the diseaso, evidence of time nf diagnosis. Four of them had been miners. They secondary spread may appear. Eight cases in our series showed obvious clinical signs of peritoneal involvement TABLE I. AOB AMO RACE DISTRIBUTION OF TH8 34 CASES OF before death. The peritoneum is usually infiltrated by MESOTHELIOMA DESCRIBED Age direct spread through the diaphragm. The liver may be en Totalal rged and nodular, due to perihepatic involvement. Local Race White Sex 30 - 39 40 - 49 SO -59 Over 60 /Male (14) 2-6 3 3\ \ Female() 0 I 3 2/ 20 ized masses due to ihvolvemcht of tbe omentum or para aortic lymph nodes may be felt. In these cases ascites is common. Involvement of the lymph glands of the neck has Coloured /Male (J) \Pemale (3) 2 0 2 0 l.\ . 2 1 0/ * been clinically obvious in 2 cases. Implantation of the tumour in a biopsy scar is not frequent, but it complicated Total /Male (3) 2 \Female (I) 0 6 2 0 13 0 I\ 6. 10/ 87 34 4 thoracotomies and 1 thoracoscopy in our series. Haematogenous spread is unusual and only 2 cases have even tually developed distant metastases. These were predomi were all in their thirties, the youngest being a miner aged nantly subcutaneous but, in 1 instance, numerous small 31. On the other hand, 7 patients were over 60, 5 being deposits appeared in the tongue. men and 2 women. The oldest was a man of 68. Six of Pleural effusions have always developed. Fluid collec Ihese patients had lived for many years in the asbestos tions of 5 6 pints have occurred, but often the pleura) area and 3 of the 5 men had worked for long periods in space is largely obliterated and only small effusions can dose contact with asbestos. One woman died at the age collect. On lapping these effusions, considerable resistance of 60. A9 far as we have been able to ascertain, she had is encountered due to the thickness of the diseased tissue never been in contact with asbestos in her occupation as a (up to 2 cm.) which has to be traversed. Even with the nursing Bister, and had never lived in the North West point inside the cavity, the needle is often so tightly Cape. She is the only patient of the 34 who apparently bad gripped that manipulations are restricted. Usually the fluid no contact whatever with asbestos. is straw-coloured, but blood-staining occurs and may be Tbe remaining 21 patients, 8 women and 13 men, were aged between 40 and 60. The 8 women had either been born in the asbestos district, or had moved there in early childhood. At the time of diagnosis, 3 of these women lived in tbe Transvaal and had never, or only occasionally, visited tbe North West Cape after leaving school. Three women had been engaged in the cobbing of asbestos in their homes. Tbe non-European women mostly lived close to mines in houses where cobbing operations produced much dusl, even when they themselves had done no such work. The European women had been to school near mills or had played on the dumps. heavy, The 13 men aged between 40 and 60 comprised 7 whose work was connected with the mining, milling and trans port of asbestos, 2 who were bom and bred in the district but had not been engaged in the industry (they had ofton watched cobbing' operations in native huts and had played on dumps and in mine shafts on farms), and 4 who worked with asbestos In distant industrial towns. Of these indus trial cases, 2 were boiler makers who had lagged loco motive boilers. Another of these men bad spent the war years manufacturing asbestos protective devices for fightting aircraft fires, and the fourth had worked as a boiler maker in a Cape factory, whose supply of asbestos was obtained from tbe Cape asbestos fields. It is interesting to note that in 1 family both the father and a daughter died of histologically proved mesotheliomas. In 2 other cases a sibling had radiological evidence of asbestosis. Fig, 3, Diffuse pulmonary asbestosis, particular well shown in lower lung zones.