Document DD6xdZ3X2RnkBV2ZwQZxez5jB

FILE NAME Colonial Sugar Refinery CSR DATE 1960 DOC CSR237 DOCUMENT DESCRIPTION Journal Article - Diffuse Pleural Mesothelioma and Asbestos Exposure in the North Western Cape Province Brit J. industr Med 1960 17 260 apender appender DIFFUSE PLEURAL MESOTHELIOMA AND ASBESTOS EXPOSURE IN THE NORTH WESTERN CAPE PROVINCE BY . J. C. WAGNER C. A. SLEGGS SLEGGS and PAUL MARCHAND From the Pathology Division Pneumoconiosis Research Unit of the Council for Scientific and Industrial Research Johannesburg West End Hospital Kimberley and the Department of Thoracic Surgery University of the Witwatersrand and Johannesburg General Hospital 4 RECTIVED FOR PUBLICATION april 24 1960 Primary malignant tumours of the pleura are uncommon Thirty cases 22 males 11 females ages 31 to % of diffuse pleural mesothelioma are described all but one have a probable exposure to crocidolite asbestos Cape blue In a majority this exposure was in the Asbestos Hills which lie to the west of Kimberley in the north west of Cape Province The tumour is rarely seen elsewhere in South Africa Mesothelioma of the pleura is regarded as an uncommon tumour In the last four years we have seen 33 histologically proven cases 28 of these had the lungs of the first case Case 11. and secondly -.. 10 of the cases came from a hospital to which suspected cases of tuberculosis were referred from a some association with the Cape asbestos field and four cases had been exposed to asbestos in industry The tumour is rarely encountered elsewhere in South Africa During the past five years with the exception of the present series no neoplasm of this nature has been diagnosed amongst 10,000 lungs examined at the Pneumoconiosis Bureau in large asbestos mining area This hypothesis could not be supported at once from the original histories :- obtained from the patients for they included house- * |: wives domestic servants cattle herders farmers a water bailifan insurance agent and an accountant none of whom were working on the asbestos mines at the time We therefore undertook a detailed - . Johannesburg or in the Pathology Department of the South African Institute for Medical Research Higginson and Oettle 1957 did not observe a single case in their survey of malignant tumours occurring in the Bantu and Cape Coloured population of Johannesburg and the North Eastern Transvaal Our first necropsy specimen of pleural meso- investigation of their past occupation and place of residence and the association with asbestos ex- . posure was discovered The cases are summarized in Table 3. Previous biopsy specimens were re- examined and new cases diagnosed including asbestos miners In only one case do the relatives deny that the patient either visited the asbestos thelioma with asbestosis was examined at the mines or was exposed to asbestos Pneumoconiosis Research Unit in February 1956 Case ) During the early months of that year one of us C.A.S. in the Northern Cape treated six This is a preliminary publication and the problem is being intensively investigated patients with gross pleural thickening Pleural biopsies from two of them showed the features of The Asbestos Area of the North Cape mesothelioma In the ensuing two years eight further cases were found from this region and five from elsewhere in the Union During this period C.A.S. had become perturbed at the number of these unusual tumours occurring amongst his patients and stimulated an investigation At this stage there were two reasons to suggest that asbestos might be implicated First asbestos was found in According to Hall 1930 asbestos was discovered by Lichenstein near Prieska during his travels be- tween 1803 and 1806. Since then it has been 2 established that the asbestos deposits extend from 3 20 miles south of Prieska northwards through the - western part of the magisterial district of Hay to 4 the eastern portion of the magisterial district of ': Postmasburg and finally to the western area of the r : 260 PLAINTIFF'S 105370 DIFFUSE PLEURAL MESOTHELIOMA 261 ASBESTOS KRIS oe oo mo tevt~e ~ FIG Map of Griqualand West asbestos fields district of Kuruman Fig ) These deposits occur In 1908 production had begun in the Kuruman dis- trict Between 1916 and 1918 a large number of in the slopes of a range of hills covering an area of claims_were claims_were Known as the taken up This northward trend has approximately 8,000 square miles Mountains these hills extend more or continued and in about 1950 mining started at the Bechuanaland border Table 2 Asbestos less longitudinally between 22-30 and 23 E. The Pomfret near the ore was quarried in numerous small whole area is semi sparsely populated and Initially This was followed gradually from mining cattle ranching is the only open cast workings apart occupation In the Kuruman area several important these mountains TABLE 1 s, large tracts of land in or abutting on OF CROCIDOLITE AND AMOSITE py, enS have been reserved for the aboriginal inhabitants CHEMICAL ANALYSES from Vermaas 1952 earn a Om m6 and here whites may only reside in the immediate . vicinity of the mines 5144 The type of asbestos mined throughout this area AlhiDs 108.6240 is crocidolite better known as Cape Blue Asbestos The chemical analysis of the fibre is given in Table 1 Mg0 Crocidolite is the fibrous form of riebeckite and all Ns,0 004 Pe stages of transformation from a massive riebeckite , H,o- Le rock through lamellar riebeckite to asbestiform er Pre crocidolite occur in this region Magnetite is wt frequently associated with the crocidolite Vermaas : 4 Crocidolite , 31, i Fe,0, Feb C0 Ke Hee ed : 19-39 3.37 . : 0.19 ; 6-07 | 0.31 2-58 = 49-47 0-63 4-15 3343 637 O52 00? 020 007 . 333, 041 ets woe . . ; ein first Prieska 1952 _ in the asbestos Mining of began in 1893 and graduallygradualy spread northwards . district SH a ae od et wed ate Total it 100-73 300-46 Or rc oe ore . o2 BRITISH JOURNAL OF INDUSTRIAL MEDICINE INDUSTRIAL INDUSTRIAL POPULATION OF THE MAGISTERIAL TABLE IN WHICH (taken TABLE TABLE WHICH THE ASBTESTHOS EASBEASTSOSBESTOS ARE SITUATED SITUATED THE POPULATION THE i Population Pricska District { 8,399 Hay | Br1r2ae.3i8tt9s Prieska Union Union CensCenusus s } 1951 Whites 0931 1921 i Whites Toral { Population i whites - whites : Non shites Whites : Whites Toul Jour 16.698 8.309 3.361 : 10.847 14.206 3.430 4.879 3.361 10.847 4.816 4 { 16.648 16.648 theHay 212.1.44771 113.383 44,,88118 2.787 293.429M9 RTs) Store , ' . type With The lucrativtehe mills Joru1fin9ggt5ashhAs6etyFpeMiebcparlgtoeraunrscatlhtrpTiileauhnlhrsalbeyreornecehogmesothileiomvanmaipcroivdnemicedandrdcteiccanrcionvaeommaasiednechainrsctccoriieneesomaasbiaesltloanssuibsseasyttsrosabisteHeissttoloogiscailassbestoisisbnaowdtfurmhtht, ersaieictthnictonsehd producers Kuw rurcmlaa aaiilnmwss ay the Witwatersrand rooms . ~ by a type of shallow ese, came type mining: inclined Sh2fting be. the non shallow mining inclined white to live close shafting of shallow shallow 1930 inclined quarrying was the the children play on dumps dumps close as as came more Frood 1915 the quarrying possible and mill children from from Acco.ding Acco.ding undertaken undertaken by local family affair undertaken rock rock inhabitants inhabitants . - The quarried cobbed the which sorted and Histories then hand consists women and children children following following case Hand cobbing of separating separating the fibre from a eight types various different the different . small hammer ironstone striking striking rock with a exposure exposure exposure " small hammer the market was selective selective fibre sieve was sometimes used grade the 1. B.P.1. B.P.Bantu male 36 years sotary eliminate eliminate small particles particles dust fibre - 1920 a mine labourer labourer was of first case ... grading grading bagged bagged weighed weighed The asbestoas sbestos diagnosed mesothelioma mesothelioma the asbestosis asbestosis ... diagnosed in evidence evidence grading : - transported transported donkey to the nearest born whether the Kuruman Kuruman but mines known Witwatersrand rail rail head Before establishment establishment establishment the railway railway worked employed the Witwatersrand underground the asbestos mines underground underground in this area between between 1923 and 1930 employed for two and in was further could long as days This transport was years sons generally undertaken undertaken transport the change change | rooms roomsfor afurther a * under under contract contract white youths played very 1955 showed radiograph taken a mine hospital pleural effusion white inhabitants inhabitants inhabitants being nearly and showed massive massive withdrawn admittedeffusion 18" > 3,000 of little part actual recovery recovery the fluid fluid withdrawn always employed employed in managers or over- to the Witwatersrand Labour Association Association Association =: + seers issuing issuing stores supervising the grading and Hospital Hospital August August 1955 Native two days aspiasrpiraa- - t . weighing weighing weighing supervising activities were and yielded tion yielded 1,000 thick gelatinous gelatinous pus which : threads Pa are are still fibres fibres Farming mines could be pulled aspirationtshreaandds threads wawas s treated with lite Since carried war the demand for crocicrocido- do- frequent aspirations anidnstillation of varidase varidase with | 3 enormously increased lite has without andindsitedillao tionnFebruary February but. have been enormously enormously increased companies others ~ died on occupied 15, have bought have been registered deeper and richer _ abandoned found As vertical shafts are being gelatinous which At tumour autopsy displaced tumourtumour which mediasti- a large gelatinous the displaced lung mediasti- byby deposits have been mines with being num and pericardium pericardium The The tumour com- sunk deposits However However using inclined large shallow and deposits still using shaft and tunnel infiltrated compressed neoplastic right lung com- comtissue tissue evidence but a and used used the few remaining With building building primary bronchogenic bronchogenic carcinoma Histological evidence sections mesothelioma smaller smaller producers diminished hand crushing mill established established more Ip 1915 the first Histological mesothelioma mesothelioma a south This crushing followed Koegas Koegas the Jungs we followed by large mill mill . 4). oats tn by husband was born period Griquatown today operated situated within 300 yards of main social social worker who could to situated cobbing cobbing was also done street close short exposure exposure exposure asbestos asbestos and probably probably a 1927-1930 1927-1930 This followed for few Prieska further slight exposure exposure child woman She may = in in 1930 which followed a mill Prieska have paid several short young the mines with nat . Griquatown Griquatown had hadcosmmpallletely rebuilt The practice visits tGriqo uatown mines lived may today today mill in 1928. mines the for one mill to several mines mines in where she lived until age 1922 immediate immediate worked Wo . Kimberley where from from to 1922husband owned an _ In In the early days manager manager labourers labourers .,, within within within few yards of their place of work aevnedn . clerk asbestos asbestos 1933-1940 1933-1940 fe asbestos asbestos asbestos mine 1933-1940 Her she worked as a eee , asbestos mine from 1933-1940, Her husband owned an = - week tose . TOMER raat ae eee o e sy TA . . nan ; oes sete mee DIFFUSE PLEURAL MESOTHELIOMA sem. Fig lRunig gsuhbsttalnucngelung of Case I showing a tumour compressing the Haematoxylin Fx Cellular structure of tumour of Case 1. and eosin ^ 40 FIG Sections of lung lung from Case 3 showing asbestos bodies ^ 40 Hacmst^,xylinand eosin t ome ees oe e to am w es ee sos if 264 BRITISH JOURNAL OF INDUSTRIAL MEDICINE ~ . # x . > re af ee let : wa ee, Ce Se . _ . _ " # ~ May Fig OnO Mr arch 3 1956. we . ; * . FIG . On July 3 1956 . : Fios 7 of tumour in 4 11 _ 5 and 2. Radiographs showing development ot ustt zo . a rr can ad . Case - . oe . . .. 2 . wom Ss . . ; : <) ar i -2: : * <= < ay a + i - Ex Bee ore aS _ @ - J DIFFUSE PLEURAL MESOTHELIOMA At 265 os ew oe ptr mena 645 Ys ULL A: y yin TNS BOL ory. OP A, ad i, i fa, iss He ey Ms Ob pie ne Laef yee me ae AE ay FIG Right lung of Case 14 ae rp Sea oa ~ wf &e Py 8 OE> 6 whewae mean aif lierdDwyeRae . ad me SO Poe ai nes wetADrtAdUD oy id a ra TO oF or ROR FIG Histological sections of Haematoxylin and eosin from Case 14. . x 24 She was referred to the West End Hospital Kimberley on July 19 1954 because of dyspnoea and right chest returned to the Kuruman district in 1943 where he worked as a farm labourer until discomfort of acute onset The chest his final illness . radiograph showed a loculated pleural effusion at the right base was admitted to the West End Hospital on March 3 1959. He had been well until July 1958 when he coloured fluid was aspirated which on examina- tion became aware of pains in the right side of his chest In was found to be negative for M. tuberculosis but a contained mesothelial cells arranged in acini At addition he had slightly productive cough and short- ness of breath on exertion Chest thoracoscopy in Johannesburg on August 11 1954 radiograph on March 9 1959 showed obliteration of the tumour nodules were seen on the parietal pleura Histological examination of the biopsy specimen showed a right lung field Asbestos bodies were found in the sputum Needle mesothelioma Deep therapy and active gold biopsy showed histological features consistent with a mesothelioma instillation in September 1955 caused initial regression of both the pleural fluid and nodules but did not arrest the AUTOPSY right chest was occupied by a huge progress of the disease She received a further course of whitish tumour which infiltrated the mediastinum ray therapy without improvement and died in extending through the diaphragm onto the superior January 1957. The liver was enlarged and nodular surface of the liver A coloured effusion was before death but no necropsy was done Figs 5 6 7 present in the left pleural sac but the left lung was not and 8 show the radiological development of the tumour affected The mediastinal cervical and aortic in this case abdominal lymph glands to the level of the renal arteries were infiltrated with tumour Case 14. S.Sa. Bantu male 40 years of age bora In the right lung it was found that the 1918 was an asbestos miner He was born in the tumour mass had infiltrated along the interlobar fissures The ' Kuruman district and as a child often played on the of the lung were compressed into three small lobes asbestos dump near an asbestos mine He subsequently worked with asbestos for several years being employed segments .. Fig 9 On histological section a papillary type of pleural mesothelioma at an asbestos mine weighing fibre from 1938 41In 1942 he worked on a Witwatersrand gold mine but was seen Fig 10 which had - infiltrated into the lung parenchyma in some areas There was marked lymphatic spread throughout the ' 7 % wre te wee ae od seen substance substance Numerous asbestos bodies the spaces interstitial interstitiaolccasitonail ssuebodies and were present General fibres graph observed atelectatic markedly markedly pleural . white female, 42 the left a lung who 42 years Of biopsy 15.-S.S.V. Case 1916 15.-S.S.V. white female female years of age thelioma years is was near showed gross pleural thickening thickening effusion on thickening 54 == the left side thoracoscopic pleural and June 10 a thoracoscopic admitted admitted taken This showed showed the thelioma June 24 1957 attempt decortication decortication easily = Pleura} decortication made The upper grossly thickened thickened pleura wawsaas bandonedadherent adherent the to the Sections lobe that attempt diagnosis of of pleura confirmed confirmed mesothelioma mesothelioma | confirmed diagnosis diagnosis mesothelioma went to school at youth the asbestos belt She lived Tight chest Hay 16. A.N.V.16. A.N.Vma.ke make who 16. A.N.V.16. A.N.V. farmer (bom years of age bom was born Griquatown Griquatown and and was village village school near and village village transported asbestos asbestos mine From Fr 1914-16 Prieska transported donkey donkey wagg^nsfrom Prieska In these journeys often slept mine from 1914 worked worked an asbestos slept on asbestos month month asbestos mine Mine neoplastic neoplastic tuberculosis not cultured mens sputa from numerous numerous mens washings She pleurawl apsleadumirttaedl nor nor Johannesburg bronchial Ene PretoriaThere There wasno biopsies evidence SomeSomeapical apical F natie b found the thoracotomy a mass present present was hypochondrium in the lymphadenopathy There was was generalized generalized present numerous nodules were lymphadenopathy radiographs radiographs the pleural obliterated obliterated was develop widespread widespread widespread metastases cases to the few cases to widespread develop . subcutaneous chest nodules nodules to sections showed biopsy similar appearance appsearaunce bapcpeaurantce aneous Subsequently those three mesothelioma of tubular showed from from pleura May 22 mesothelioma of sputum mesothelioma examined asbestos bodies but specimen necropsy necropsy was patient patient died on May 22 none 1959. No performed . died on . 24. D.G. were found found is still white male May 22, April deteriorating is 1960 but her condition 1922 but profession came an accountant accountant infant He spent 22. D.A.B. Case 2. D.A.B. white white male South Africa spent his early childhood childhood and the age of I He farmer farmer was the father of years years age Although Although pleural 8 farmer diagnosis previous patient Although in later qualified as Kuruman and accountant accountant In chartered been discharged discharged discharged January January 1957 1957 mesothelioma 1959 details details the age of because medically medically medically He was effusion his exposure exposure asbestos not until obtained 1959 details details pleural pleural ' asbestos obtained He He worked until until Kuruman Postmasburg and @$ the age age Between Between underground worked an an asbestos underground and was and mostly charge charge charge Between Between 1944 farmed farmed the the district returned returned asbestos asbestos mining from 1945 to to asbestos asbestos from 1945 In In January 1957 cause cause left chest sided chest pain pain cough and slight cough and slight acid bacilli subsequent subsequent contact i His subsequent subsequent with contact was the : an amosite auditing auditing of mine mine the 4 Transvaal books Transvaal September contact with left chest chest 1953 complained complained September complained sided chest chest . { pains flattening of the showed showed flattening costophrenic diaphragm costophrenic obliteration oblique fissure He oblique fissure fissure was ; the oblique fissure, costophrenie He angle and thickening of te7 * was seen on numerous oecasions | - ji i, oy - : 24: . Fics. 1Nm OSneprember 11, 1956. . Fio August August . ets September September 11 1956 Radiographs showing showing deszlopment tumour tumour Case 34 24. 1957 from 1953 to + A ** taken early in 1956 1957. 1953 1956 and these have revealed during during relevant development relevant let superior 11 mediastinal later Cape crocidolite exclusively exclusively use complaining periods clopment diffuse 'Nthe de which enlargedoef nlarged progressively pleural thickening nodular nodular marked changes He was first seen March March recent onset cough pain the the right chest recent been asbpirrateed afrotm fhr-oomf lessness the Three pints fluid fluid examination bi psyJune right side operation , diffuse pleural pleura and cytological radiograph showed 1957 presence of malignant cells the hydro pneumothorax pneumothorax malignancy malignancy was present pleura only were removed and marked pleural thickening thoracoscopy the Sections done the parietalparietal pleura those of a On March thickened 1959 and and thoracoscopy and histological histological appearances appearances October were 1957. those meso- pleura felt thickened biopsies were collapsed collapsed NOt thelioma necropsy was immobile Several mesothelioma taken These showed showed the presence of mesothelioma The underlying lung presence not performed 30. G.F. white . Case 1909), male male years years age born asbestosis showed the presence intraintra pleurally He treated with Case Case 30. improved 1909 is G.F.white with history history of industrial industrial ninittrrogeon gen mustard improved pleurally pleurally When and his condition condition exposure storekeeper storekeeper neverbeen near near Cape Asbestos temporarily increased breathlessness last examined examined com- Fields plained of increased breathlessness examined he com- breathlessness the Fields . born South South Africa Africa lived there the He was born From the age of 21 to 26 until in the age of the Cape as boiler worked in denied factory in maker fitter He primary primary information malignant volunteered volunteered information that he worked con- asbestos lagging lagging of pleura and considered themto secondary pipes boilers He sidered one hand hand in origin Since Since and Hinson Hinson Hinson 1957 haWviellis 1953 and Smart views Between Between 26 and years similar suchfactory while primary neoplasms factory the other supported Robertson's Robertson's views this in age capacity but Johannesburg Johanesburg in similar nature nature have been described centrations centrations was exposed exposed to such heavy been recent years described Tobiassen 1955 These include in contact contact For the past 20 years he made from been Sweden Tobiassen Italy Godwin with McCaughey factory factory factory Enquiries Enquiries were asbestas used the Cape Cape as the nature of asbestas asbestas Belloni and Bovo Godwin 1957 the United States and McCaughey McCaughey1958 ) 1958 1957 in the United States, and McCaughey (1958) Ferg SHOE; VA tts al aS74 s $2a 282@, esof. i les ers eee et TNO) eee 4%. SERRE SORTS SStTE > o Tomes 268 BRITISH JOURNAL OF INDUSTRIAL MEDICINE in Britain Evidence in support the of of origin of these tumours can be found mesothelial in The amount metachromatic experience cillut cillut experience experience at Stort bad Wings 1t8h6e 7t5issue substance tumours has varied considerably Sano Weiss and Gauli 1950 appreciated EN considerably considerably gee aa The variegated histological pattern of appreciated the solubility of hyaluronic arising from the mesothelium of the tumours remarked on by Klemperer and Rabin tumours pleura w'as aqueous media and the majority of these were fixed in % formol is a variation appreciated when the 1931 Such 1953 states that the Further Lisor metachromasia multipolentiality of the cells lining coelomic cavities acid is optimal at a of hyaluronic -. concentration of Maximow first demonstrated this are considered gradually decreases at higher levels 10,000 and Novak 1931 feature in 1927 . concentrations that When the higt 1940 the M^...llerianstated that the mucosa of all parts of found in their Meyer and Chaffee 1939 canal and the germinal epithelium in tumours are considered this variation variation swheorewedderived from these cells Keasbey ( 1947 partmiealtlaychromatic properties seems to have been that in the embryo the mesonephros metanephros Wolffian body , genital ridge and all explained In addition with the differences in the histology of the various great would lesions it dependent urogenital structures are derived from be logical to expect certain tumours with the mesothelium marked adenoid appearance to a Campbell 1950 considered the those with an secrete more than essentially glandular epithelial and presence of both structure mesenchymal diagnostic feature elements a major In describing the histology of thoracic spread 11 of these tumours McCaughey 1958 that either demonstrated other lung and chest was observed in one case to the the epithelial or the mesenchymal element might predominate He classified his cases into the mediastinal wall and in the second to the lymph glands and pericardium Biopsy evidence of metastases has following four groups character Tumours of epithelial cases from the been obtained in two tumours of mesenchymal ; tumours omentum and the other from | t> [2 of mixed type and tumours of anaplastic type subcutaneous tissue of the chest wall while a third Using McCaughey's classification on our series patient developed an implantation nodul^' in the of of tumours the majority are as in Campbell's series thoracetomy scar which showed a similar to that of appearanc - the mixed type Of the remainder a few showed the previous biopsy specimen : the papillary tubular structure of the tumours of The first recorded case of carcinoma of the lung epithelial character and there were several of the associated with asbestos was described by Lynch anaplastic type One case had the appearances of a tumour of mesenchymal type but even in this taontdal Somfit6h1 1ca9s3es5haBdybe1e9n55 according to Doll reported Included it primitive tubular structures were seen case these cases was one mesothelioma Cartier FF: Apart from the original case all the mentioned two cases of diffuse mesothelioma 1952 histological diagnoses were made on biopsy material Three of these biopsy findings were confirmed Canadian chrysotile mine . A further from : were described by van der three cast 9 Schoot In the remainder we have had at necropsy fortunately no indication is given in 1th9e 58 Un and to rely on clinical radiological examination to exclude other literature regarding the type of asbestos to which the of recorded cases of majority primary sites of malignancy carcinoma were exposed Following the work of Meyer and Chaffee However discussion with management and medical 1940 the possibility of demonstrating 1939 hyaluronic officers of two of the factories in which the majority acid in these tumours both of the cases reported in Britain chemically and histochemically has been considered suggests that most of these workerswere employed Both these investigations are stialls ian dainagenaorsltyicstaaigde chrysotile asbestos were handling Wagner 1958 The possibility F that some of these people may also have Harington 1959 been Preliminary results of the histochemical exposed to crocidolite dust cannot be excluded ments show that there is metachromatic subesxtpaenrcie- In both the stroma and glandular structures of Attempts to produce tumours in experimental animals by exposing them to asbestos dust have been the tumours This metachromasia can be reversed incubation with testicular by Lynch made Vorwald and Karr 1938 were unsuccessful Melver and Cain hyaluronidase This material stains strongly with Hale's 1946 colloidal ducing tumours in 1957 succeeded in pro- mice but lung neoplasms in his control animals were far iron method The periodic acid Schiff bas given variable technique results to be considered too numerous for the specific for reactions These results are not hand Schm^/hi significant On the other working hyaluronic suggestive of its acid but are strongly 1958 laboratory has been presence able . rals This has occurred we DIFFUSE PLEURAL MESOTHELIOMA ; shoracic surgeons and pathologists in Johannesburg Offr^ Ass et Pretoria and Durban Maminy 1986 Proc Trans Mine med Offr^ Mazimow A. 1927 Arch exf Zellfanch Offr^ 271 Ass 35 63 We thank the Secretary publish this paper of Health for permission to McCaughey W. T. 1955 J. Path Burk 96 212 Meyer K. and Chaffer E. 1939 Proc Soc ( 42. 797 exp Biol N.Y. aa Novak 1940 J biol Chem 133 83 References Belloni G. and Boso G. 1957 Ariu med pajor 17 367 Campbell W. 1950 Anier S. Path 26. 473 Carier 1952 Arch industr Hyg 5 262. discussion.J Contribution to the Doll 1955 Bris J. Induur Ate~ 11. 81 Frond G. 1915 Armorandum on the Asbestos Industry in she Cupe Province Report of the Government Mining Engineer Union of South Africa pp 76 82 Gloyne S. R. 19331 Tuberrie Lond 14 493 Godwin M. 1987 Concer Philad 1. 10. 298 Hale C. W. 1986 Nuture Lond 157 802 Hall A. L. 1930 Asbestos in the Union of South Africa Memo randum no 12. Geological Survey of South Africa Harington J. S. 1984 Personal communication Higginson J. and Oenie G. 1957 Acio Un int Centr 13 949 Hurwitz M. 1959 Proceedings of International Conference of Lapere on Parumu omissus Johannesburg Feb. 1959 Churchill London In the press Novak E. 1931 Amer J. Obstet Gynec 12 826 Robertson H. E. 1924 J. Cancer Res 8 319 Sano M. M. 763 Wens E. and Gault S 1990 thorac Surg Schm^/hl1958 Z. Krebsforsch 61 361 D. . , Smart J. and Hinson K. F. W. 1957 Brir J. Tuberc 319 Stout A. P. and Murray R. 1942 Arch Puth Chicago 34. 931 Tobias0.s198 en0.198 G. . 1955 Acta pash microbiul stand Suppl 105 van der School H. M. 19581. Ned T. Geneesk 102 1124. - S. Vermaas F. H.S 1952 Trons prod Soc Afr 5 199 Vorwald A. J. and Kan J. W. 1938 Amer J. Path 14 49 Wagner J. C. 1958 Memorandurn su Parumonorious Parumonorious Europe Submitted in the C.S.I.R. Research in Willo R. 1948. 1st ed and 1953 Butterworth London Pashology of Tumours Addendum Keasbey L. 1947 Amer J. Push 23 671 Klemperer P. and Rabin C. B. 1931 Arch Push Chicapu Chicapu Enon .. 3483 Histgebinie es CytochimieCytochimie Animales pp 332-337 Gauthi rok allats Paris Lynch K. M. and Smith W. A. 1935 Anier J. Cancer 24 56 - Melver F. A. and Cain J. R. 1957 A.M.A. Arch industr Hith 15. 207 By the end of June 1960 a total of 47 cases of mesothelioma had been identified In 45 of these a possible association with exposure to crocidolite has been established In one case a mesothelioma of the peritoneum was present OP , THE JULY 1960 ISSUE The July 1960 issue contains the following papers . . DecomHp.rVe.ssHieonmpSilceknmeasns dWu.riDn.g CMo.nstPrautcotnioannodf tDh.e ND.arWtafolrddeTrunnel By F. Campbell Golding P. Griffiths A Comparison of the " " altitude and " pressure " Syndromes of Decompression Sickness M. de G. Gribble ' By ! i Phosgene Poisoning Caused by the Use of Chemical Paint Removers Containing Methylene Chloride 1 ventilated Rooms Heated by Kerosene Stoves By W. B. Gerritsen and C. H. in Buschmann i A StAu.dyNo.n WthoerAdceunteaTnodxiJc.itPy. oWf.thHe uagrheysl Phosphates Used as Plasticizers By H. F. Bondy E. J. Field ce .* . Aerosol Inhalation of CaNaE.D.T.AMosatil by Workers Constantly Exposed to Lead LJ Petrovi~ M. Stankovi~ M. Savi~ evi~and D. Poleti Poisoning By _ A Biochemical Study of the Urinary Protein of Men Exposed to Metallic Mercury Agnes R. Wells By C. Smith and | \ ' i t 2 r] * on ; } } i a, A Simplified Method for the Estimation of Nickel in Urine By J. Gwynne Morgan ee ; * CliniGc.alL.BrLoenacthhoagrrtaphic Radiological and Physiological Observations in Ten Cases of Asbestosis By i The Measurement of Occupational Mortality F. D. K. Liddell of ObseravnadtiDo.nsSo.nKtehre rOccupational Life History the Coal Face Worker at Two Collieries By O. P. Edmonds . The Assessment of Electroencephalographic Changes and Memory Disturbances in Acute Intoxications Industrial Poisons By B. Chalupa J. Synkov^and M. ev~ ^>k with Book Reviews MediA calnuAmssboecriaotfiocnopTieasviasrteocsktilSlqauvaarileabWl.e Ca.n1d pmraicye b1e7sob6tdained from the Publishing Manager British ig. : i 4. . i : |i : Pe a |