Document DGVKX7RxbybOmQ2NGr87XLpXa

>. O. '-"r. D . S-.rU T l.MMm, M. Oa'Wi Xa 1j-^. J. industr. Afed., 1965, 22, 261. PLAINTIFF'S EXHIBIT A.J,, U. :> o. Moi^re -<*m. t- L. * k tk, 14. sn. ^ ct. j<j , i % I MESOTHELIOMA OF PLEURA AND PERITONEUM FOLLOWING EXPOSURE TO ASBESTOS IN THE LONDON AREA BY MURIEL L. NEWHOUSE and HILDA THOMPSON f ront the Department of Occupational Health and Applied Ph\notary. London School of Hvjttenc and Tropical MedUine (RECEIVED FOR rUSUCATION FEIRUARV II. 1965) ST02792I6 A series of 8.1 patients from the London Hospital with a diagnosis of mesothelioma confirmed by 1 necropsy or biopsy has been studied for possible exposure to asbestos. The series consisted of 41 J men and 42 women; 27 of the patients had peritoneal and 36 pleural tumours. The earliest death J recorded was in 1917, but only 10 of the series died before 1930 and 40 (48%) between I960 and 1 1964. In 76 of the series full occupational and residential histories were obtained. Forty (32 6%) gave a history of occupational or domestic (living in the same house as an asbestos worker) exposure to asbestos compared with nine (11-8%) out of 76 patients from the same hospital suffering from other diseases (p < 0001). None of the 17 suspected cases of mesothelioma, rejected on pathological grounds, was found to have had any exposure to asbestos. There was also evidence that neighbour hood evposurcs may be important. Among those with no evidence of occupational or domestic exposures. 30-6% of the mesothelioma patients and 7-6% of the in-patients with other diseases lived within half a mile of an asbestos factory (r < 0-01). Out of the 31 patients with occupational exposures only 10 were in jobs scheduled under the Asbestos Regulations of 1931. The interval between first exposure and the development of the terminal illness of mesothelioma ranged between 16 and 35 years. In 47 patients in the mesothelioma series, lung tissue or sputum was available for examination. In 30 (62 5%), either asbestosis or asbestos bodies were present. lo recent vears, the association between exposure among the women. 25 had pleural and 17 peritoneal asbestos dust and cancer of the lung and other tumours. ralignant neoplasms has been the subject of much The aim of this study has been to establish the research (leading article, 1964). Wagner, Sleggs, and occupational histories of these patients and to trace vlarrhand < 1960) described the occurrence of meso any other possible exposure to asbestos. There were * thelioma of the pleura in those exposed to croddolite four surviving patients at the outset of the investiga tsbestos in the mining districts of South Africa, and tion, but these have subsequently died. The earliest \ cis has stimulated further studies of the occupa- date of death in the scries was 1917; 10 died before -IX oonal histories of patients suffering from this tumour 1930, 33 between 1950 and 1959, and the remaining lOwen, 1964; Fowler, Sloper, and Warner, 1964). 40 in the past four and a half years. The youngest The present investigation concerns patients in patient died at the age of 33, and nearly half were 7 shorn mesothelioma had been diagnosed at the dead before the ege of 55 (Table 1). London Hospital during the past 50 years. After i- examining the necropsy and biopsy specimens held Clinical Features -.t the patroloev department, Hourihane (1964) con- -rrr.cd a c-aciiosis of mesothelioma in 83 patients, The ward notes of 65 of the patients were available ;f w horn -! were men and 42 women. Thirty-one of and give a picture of a disease with a consistent ,-ic men hac pleural tumours and 10 peritoneal; symptomatology Among those with pleural f BRITISH JOURNAL OF INDUSTRIAL MEDICINE MESOTHU / Tu I *<>* -" o;a:h or *: ^at:csts vmth mesotheljal TL MCLRS Mi 4 No U *4f * j" 4^ :i i - :>i44 1m F*m*k No. 1 961 j 24 2u14) It !| 412990 irr. :ur-. ne commonest presenting s>7nptom was re -a pi c ns*.! of extreme shortness of breath due r .- f .rrr-jiien of a massive pleural effusion. Pain -ax a p-or-::nenl feature, either described as a dull a:hc. s:rw. due to invasion ef the ribs or 'trievrc. cr sometimes sharp and radiating, sug- gr>u-g -.er-e .nvolvement. Tumours in the chest wail *re no: uncommon, occurring either in p:."' 'u; op-rranon scars or by direct invasion of the C"e: The symptomatology of the peritoneal tLT'c jrs wij rare varied. In some patients the pre- ve~.:i:-g svi-ptom was pain on defaecation or rr- t_ -- 11 'n. D.fiuse upper abdominal pain was very co-pi- or. ar-d spelling of the abdomen due to ascites ;. ;:vkivs present terminally. The methods of trrat- cr' i.-.-'liJcd pneumonectomy, decortication j: !_'#. deep jr-ray therapy, instillation of radio- zc. grid. ani cytotoxic drugs. They were used al;pc or - oor.biaation but had little effect on the o the dxasc. Half of the patients suffering irc'.i -le.ra mesothelioma died withio one year of :n: i ' -e of sv.r.ptoms. a further third within two a.-s. zr.t o' iv one patiert survived for more lhan three ec-v. T. e course of those with peritoneal lurou -v epp c oed to be equally rapid. Eight of the pa <rrt> oev. - thin six months of the onset of r pir rn*. Sources of inr,.rtEjrion on Occupation and Residence I: i :d. .(' tc "ie ward rotes, some of which gave . cc.ra Til histories, there were three other -ource- o' in '--jiicn: the patient's genera! practi: or;- :heri. rc> of an asbestos factory in the area; and perv na i-.ter.Sew-s with patients or their sjoivi.-.p relavves. A> a hrv s:ep. general practitioners were circulated with ar explanatory letter aslung them to complete a fern ct'-ng details of the occupations of patients and the-p ..-n.TJtdiate relatives. Within two months f?*, of ire oners had replied. In two cases a - :h:rv l.-vn.:exposure to asbestos was revealed; t cr.c'i t/e na-ie and address of a surviving relative v-ert ci rn. ru: in the majority the doctor was unable t; g.r f'tT'jiion because, on the death of the patient, the notes had been relumed to the local executive council of the National Health Service, where the) were destroyed within a pcrunl of three years. In one of the asbestos factories a file wav kept with detailed records of all employees since it started in 1913. The names of all patients were checked with these files. Nine men and nine married women (After their maiden names had been ascertained from rela tives) were identified without difficulty. The exact dates of employment of these 18 patients and the jobs they had done were obtained from the records of the factory. The four patients alive at the beginning of the investigation were interviewed personally A few relatives were contacted by post, but the relatives of 68 patients were interviewed by one of us (H.T.) at their homes situated mostly in the East End of London. Not only was an occupational history of the patient, the spouse, sons and daughters, and father taken, but past addresses were also recorded. The interviews lasted for at least an hour. To recall events of 30 or 40 years ago it was often necessary to explore the residential and occupational histories of all members of the family. Exposure to Asbestos In Three Groups uf Patients Suffering from Other Diseases For comparison with the mesothelioma salients, three further groups of patients suffering from other diseases were investigated. The first group was selected from the patients in the medical and surgical wards of the hospital during the early summer of 1964 ("in-patient" series). Each patient in the mesothelioma scries who had been traced was matched with an in-patient of the same sex born in the same five-year period. As ihere w a dearth of male patients over 75 years of ace in the hospital, a sample of six patients of th is ace and older was taken from a neighbouring eeriatric hospital. The second group were those who had originally been filed in the pathology department of the hospital as cases of mesothelioma but in w hom the diagnosis was subsequently rejected on pathological grounds by Hourihane (1964) (`rejected series'). As it had proved extremely difficult to locate the rela tives of those who died before 1950, attempts were made only to trace the thrte survivors in this group and (he 14 who died after 1950. The in-patient series, already described, were all admitted to hospital in 1964. The patients with mesothelioma were admitted to the same hospital over a period of 47 years during which there might have been a substantial change both in the residential ' areas and social claxw London Hospital. Tl- I was taken from the ' date of admission nv :. with the patients in thi ' Places ol residence r-:u for comparison urlt'h. I "S Detail. of the 83 pi v series are given in the F about past domestic ji I available for seven p:n > f 76, 40 <52-6 %) gave a hi * compared with only mn. * series (Table 2). The d j LI26L201S t types or EXPOSE WITH SII NOtHE.Lin Tmx -r EDmcftbpewltoory<rsr0J ji 'n ^`0' io f*ci< Emfacpttoiend. * InvwiilOfi .*ihJ luMtu Rfljti'd ked 'th k^*'*'*''* Docket lumlltnf *vhcsi" c>>,lt ___ _ SO TllAI" ' O* *' . dumctiA npouitf Potiine routiNC h 'ii'ffc'i n m-pji'.'1' 'Sawn of mrv'lhv from htx ,jhit. statistically highly mci0 001). Thix result is u.i by the two groups of p. year of admission to ' significant dilferente i r or in the occupations . and those admiued b.-t. Paring the confirmcvl i mesothelioma group > of the confirmed and n ft *ave a history of exp This difference i' -t > (* = II 83; P 0 f<H I _JL_ MESOTHELIOMA OF PLEURA FOLLOWING EXPOSURE TO ASBESTOS 263 re:.mcd the local . <--jl HcJ:.' Service, ...it-. * pe-.o- of three , : cv i file ' it *JX with .. oc- since .lined is ,ar it *ere c-.ec*ed with . rferried > 3~<en rafter a-certa-ne; f-em reU- Ji~.cult> Trie exact ,, < it patir-.'.s and the , -.ci (Vox (hr records :iw beiir.-.ra of the ,0 p>:nenii;. A few . hji she rc.miies of - . one of .s H.T.) at ,n tne Exit End of . -.at anal h .ic -y of the lighters, ar i fatta .-c n'.yo reerrded. The . rou. To rrCiT events often recosary to .. ..patior.a! '.ir.nries of -ix Croups of Patients ;i.*r Diseases i-eas and social classes of patients attending the luruon Hospnal. Thus, a third group of patients ,v> ul.en from the hospital records matched by ii'.c of admission as well as dale of birth and sex a ih (he pal tend in (he mesothelioma series. Their . jee> of residence and occupations were extracted ir comparison with those of the in-paliem series. Results Details of (he 83 patients in the mesothelioma v-ies are giicr. in the Appendix. No information ;r.'ut past Jumo'ic anJ occupational histories waj imlahle for scion patients. Among the remaining \-. 40 (?2h*..i gjie a history of exposure to asbestos -mpared unit only nine (II 8*.i of the `in-patient' ^ir> iTable 2) The difference in this proportion is Tabu I -, fTtH>MOtsl OISIllFtLOIOSl'RIAt ATNODA7S6 IIENS-FTAOTSIEONFTS7W6'ITFHATO1TEHNETRS DISEASES 7 v fH ( t vp< ujff ! |-ed at JwtocMfH 1 Wt No I i 11 '! I * :s< Unm No. | X ! \i .'I' hci.or-a salients, 'uferng-ro-n other -*. . rd at t tet *hr>4f>\ 1 ' at*. ` *' -/a -*.vi ' aBH 1 1 4 5J 1 l to s Ij *i )) JJ ::.-u the pa .ems in , I ti-.chos: ti during - jih.nt' ssx.en . Eaeii wrir> vh. h_d been .-p;-.ier.i c' ire same por td. A-. ir rre was *5 >rars o' acx in the of ihi i;e and . .ah-ocrir; i-triatric ,vrj - (tft wbhrsiA'* j fAxCr-x f .*vi .J't \ h At............. wviet ; "rifylh f'Nwgff t. **a' 1 (te | to j ' 9 1 III 1 0 I i 1 i 1) :i ! 24 *7 it: p.>. sc jyv .gits io ttbettot m metotbelioma wrics ttrut h.- .TrOi u hCTXS X* - 2VII. r < 0-001 *><1 r*i ,i><\ i-> 1rir (4Mi fres.rthel.omj could noe be trcod and are ofhind " o hac or pirally Jo.-jnnri of the 13 nut ir. *r om the .iico or. puhologjcal ro riied srries'). As io loca-e t-.e rela* i*hl. atimp-.s were - . i JrS ir. :n: group r;. v ere aO I e ra.or.. with i:.e sire hospital . . --.oh fere might :: ntne-i*. ier.tial X I .uUiiically highly significant (y* = 2711; F < I c-00l i. This result is unlikely to be unduly influenced t five mo groups of patients not being matched for .ear of admission to hospital, since there was no smificam difference either in the areas of residence .-.in i he occupations of the patients admitted in 1964 i.-.d those admitted between 1917 and 1964. Com- 1 -irirj the confirmed and rejected patients in the ,-escthtlioma group who died after 1950, 36 (50*) c: t>c confirmed and none of the 17 rejected cases j pie a history of exposure to asbestos (Table 3). This deference is statistically highly significant ,v- - II 83; f < 0 001). T*au J EXFOSl'RF. TO ASBESTOS or CONFIRMED AND REJECTFII i*secases of mesothelioma surviving after January Eiiwiin io Asktfiot Etpnourc pout*** No ork oi lomo^k cooioet Umraccd Dugnotit of M%cihdM*rru CoUnntd i Rejected Mi 0 .)5 ; t * - 11 . r < 0 flOt Mesotheliooa Series Occupational Exposures.--There arc details aud ible for the 18 mesothelioma patients who had worked at one asbestos factory which used crocidolite asbestos with small amounts of chrysotile and first introduced amositc in 1926. Eleven started work before 1933 (the year when the asbestos regula tions controlling the manufacture of asbestos goods and the protection of asbestos workers became effective), and seven started work between the beginning of 1933 and the end of 1942. The occupa tions of these workers and the type of asbestos they used are shown in Table 4. Ail of the 17 for whom details were available had used crocidolite asbestos. Five of the occupacions listed are not scheduled as Tasle 4 JOBS OF If FATIESTS WITH MESOTHELIOMA fcMI'LOl I l> AT ONE ASBESTOS FACTORS SikuiW) OMt|iiioM Subject to reguliiiofu. Not MbfOCI IO rvutoioa Job Male Spuming Cer4in| Oothmg end coving Di*n<egratin| ad opening 2 Filcer making foe A R.P. Milt Manufacturing ofpreformed prpe inauUtMm Manufacturing of brake lining* Rubber com* pounding General labourer 2 0 l-emale Material 4 Crnctiloliu . CtocialoJiie Cfocidolue. 0 chrxjotik. arfw*9>ie Crocidi|iic, chryaoiik. a marine 0 Crocidolnc Crocidolite 0 Crocidolnc Crocidolite. chryanuW Crocidolite. 0 cbrysottle, amofttc `Employment kaaoey not available Tor on reflate patient. ST0279 2 18 n THE l^-fATieVT Citirn n * *. Mjk V flJ !I . i. in the '.n-patiem' jpatienjl exposure . .-.sire wording with - ;n-cd to asbestos dust . mediate vicinity of an c t.-.an one-fu'th of the t employed, opened in .c ntarer ihe centre of -_.cr >eart. There were , -i> .ntng within half a i - ; t.me it was in producr.n opened they were vejrsold. At ihe present , *.t ivi.-ig wii.nin a half ' >-ic iu.n was horn within . tjst.cy and remained at . - '"he other seven were At e children when the - ; 23 .'ears of age and u-iit she died 48 years ^tieni who had neither - c'pos-ire but in whom , 11 :-.i lures ai necropsy. one pjiient lived . ,.u. site and four others >jr; patient wjs 22 years . n; ghbourhood in 1915, .nurxiiwed. complained . . -n- the istsMos factory >< -.o oect r vtional o* I TO ASSESTOS Iti M r i.rcai *' *. o> Total 1 MESOTHELIOMA OF PLEURA FOLLOWirmINGu EXP, O--S--U---RE TO ASBESTOS 265 Thus, among those with no occupational or LLuunngg ttiissssuuee wwaass aavvaaiillaabbllee iinn oonnllyy ffoouurr patients domestic exposure* to asbestos, there are 11 (30-6%) exposed either t"hr-o--u--g>h -re*>lati*v;e* or bvy liviing in the neighbourhood of asbestos factories. In two, pstiems in the mesothelioma series and five (7 4%) asbestos bodies were present in lung tissue but there m the "in-patient' series who lived within half a mile was tso evidence of asbestosis. of an asbestos factory in the area (Table 6). The CO difference in the proportion of patients in the two s series w ho lived in the vicinity of the factory and had had no other exposure to asbestos is statistically signif-i-c-a-n-t. (,,Xs " 7-85; r < 0-01). Oa of First Exposure and Interval Before Death la Mesothelioma Series.--Fifty-one men and women had been exposed to asbestos, including those who Uaul q EVIDENCE OF ASBESTOS bodies or asiestosis IN f\3 <t casessrtomfjMmaevsaoitlahbelleiomfoarweitxhalmuinnagtTiiosnsue or a,.J ----------------------------- vO Arimiii ****--** J Ln*Tiy* |\> ' i 4'w*M ' wH AM* , lived near the main asbestos factory. The duration of exposure varied w idely, ranging from two months to O'er 50 .'ears. The interval between the first evpoiurc and death varied between 16 and $$ years (mean 37 5 years). Among the group of factory wMien, where exposure was probably heaviest, the interval was shortest. It was longest among the group living in the neighbourhood of the asbestos factories, where exposure to dust was probably lowest. Table 7 shows the mean age of each group at first exposure and the mean of the interval before death ir each group. Although the length of interval Among the 12 patients in whom no definite conUct with asbestos could be established, there was one, a merchant seaman from South Africa, whose lungs showed both asbestos bodies and asbestosis; he may have had contact either in South Africa or at sea, but his early history could not be established. There were three others in this group who had asbestos bodies in lung (issue without evidence of asbestosis. Of the seven patients whose histories could not be traced, three had asbestos bodies and histological Table 7 evidence of asbestosis and one had asbestosis alone. RlLxT'.ax 8CTWEEV TYFE OF EXPOSURE AND LENGTH or ivTi HVAL Herone death in si fatients in MESOTHELIOMA SERIES Discussion In the mesothelioma series there arc 25 patients in whom no evidence of any exposure to asbestos could be found. A chief source of information was a history taken from a survit mg relative. A surprising amount of information was obtained, but in some of those interviewed the memory may have been defec tive or they may not have known of short periods of exposure during the youth of the deceased. For J between 39 4 and 4! 6 years, the mean age at example, one ofthe patients was evenlually identified 'jn;-i showed less variation; it was 30-6 years in the as having worked at a large asbestos factory for two --at :p of factory workers and between 55 and 57 erfvcirv m the other groups. months in 1941. This was before he married, and his widow did not know of this episode. It is of interesi that asbestos bodies in the lungs were found Asbestos Bodies and Asbestosis In the Meso in only four of this group, and it seems probable thai thelioma Series.--Of the 83 patients in the meso among the remainder there were those who had hat thelioma series, lung tissue was available for examination in forty-three. In four other patieats, noJenxpthoesumreetsooathsebleiosmtosa. scries of paiicnts, both in all certified as suffering from asbestosis. with no lung dustrial and non-industrial exposures were recoi uc available, examination of sputum during life nixed. Among the men the exposure was pn ti ealed the presence of asbestos bodies (Table Sj. dominantly industrial; 22 worked in asbesu rneo- th asbestos bodies and histological evidence of factories or as laggers, two were exposed at horn Batobtehstosis were found in 15 of the 24 factory workers and one lived near the asbestos factory. Among ll aar.td loggers. A further five showed evidence ofeither women only 10 worked in asbestos factories, and asbestos bodies or asbestosis. ' I2Z6UG1S BRITISH JOURNAL OF INDUSTRIAL MEDICINE funner 17 hid non-indusmal exposures, seven in the hjrre a-d 10 l:v ing near asbestos factories. There is na c'-idcnce that the patients with pern rr.es! t_maur> differed in their type of exposure from :ht pai.er.a with pleura! tumours. The propor tion o' pc-viti.e findings of asbestos bodies or a-:os i was similar in both groups. A higher pro p -; n if -o-ier.. particularly among the factory v* jf^erv was afected by peritoneal tumours, but the d 'erenc; between the sexes was not statistically sumr'ca::. The recer.t increase in the number of patients d'-ie'-. n-cc a: the h-ospttal may be partly due to an irpci-cc interest m mesothelial tumours and partly to the !;.ng ir.terval between first exposure and de ei. p~en: of the tumour. Those exposed between IItI? in5 I9Z5 might be expected to die from about 19:0 or.arcs. Asbestos imports to the United K.nyc nr h.a : mounted steeply since 1932 (Leathart. 19--tj ji-: i - lw. are more widely diversified in injj-t-j The increasing proportion of the popula tion c.pence to jnnestos dunng the past 30 years me;, be expecit-J to give nse to an increasing occurrence o' mesochelial turrours. The chiice of groups for comparison with the -nc-othel.cma series of patients was not ideal. The -lu.-ihrr of patients it was possible to trace in the reected' series proved to be very small. The `inoaiient" serie*. although matched for dale of birth ind sex, cLfened from the mesothelioma series in that all were admitted to hospital during 1964. Neither of these groups could be intentewed without know ledge c! the disease from which they were suffering. Thi; could ha-e fed to bias with under-reporting of exposure to asbestos in the in-patient series. How ever. in the 'in-patient' series the actual patient was interviewed, and more detailed and reliable histories were obtabed than was passible from the relatives of those who had died of mesotheliai tumours. There was no evidence that, because of their more recent admission to hospital, the in-patient series was less likely than the mesothelioma series to work in con tact with asbestos or to live in closer proximity to asbestos factories. There seems little doubt that the risk of meso thelioma may arise from both occupational and domestic exposures lo asbestos. Wagner and others (1960) described patients with no exposure other than living as a child in (he x icinity of the asbestos mines. A high incidence of asbestos plaques of the pleura has been found in (he population living near an anthophyllile mine in Finland (Kiviluoto. I960). More evidence is required of an increased risk to the population living in the neighbourhood of asbestos factories or other areas, such as dockyards, where asbestos is used in quantity. We should like to thank Dr. D. O'B Hcurihanc fot his co-operation and for making the results of his Investigations available lo us. Our thanks are also due to Professor C. w.I.-on. Professor V. W. Dix. Dr. N. L. Rush;., .md Mr. G Flavell, F.RC.S., of the London Hospiul anj l>r. C. P. Silver of St. Matthew's Hospiul for permission to inter view their patients; to the general practitioners who col laborated in this enquiry; to the managements of the asbestos factories for arranging access to their records: to Miss Joan Watford for statistical iSM-tance. and to Dr. J. C. Gilson, Professor R. S. F. Schill ng. and Dr. W. Smiihcr for (heir advice and help. The contents of this paper were communicated to the Conference on the Biological Effects of Asbestos, arranged by the New York Academy of Sciences in October 1964, and will be published in a shorter form in (he proceedings of that conference. Retcxencxx Fewtar. P. . S.. Soper. J. C . end Werner, E. C.II9MI)).. BfU. > A, 1,211. Leadkia ankle (1964). HM..U301. Uoenkane. D. O'B. (1964). Three. 19. 261. Kixiluaco, k. (I960). Acts rMKW. iSioekA.u Suppt. t**. UalHArteO. L. (1964), Octxp. HHkALm^X 16. 119. 0*n. W. Clin (1964). Bru. m*4. 2. 214. Wafner. J. C,, Steffi. C. A., tnd Mtrchlo^. P. flttO). But. /. imdsstc. A/rW.. 17, 2*0. Appendix opposite MESOTHEl I Com Sue t>( No. j fP' mar> Serfka 4 f.len w*rr. s Pleura !M 10 P**ilffl<WD , M It Pc-iK-rxettm r 24 1 Pleura m 14 feruonetjm . f 16 Peritoneum ! K 13 1', j II Pc'K*neum ' 15 P-.fiumeum 9 P.'fiux*um 21 Pleura 12 p.-fiti*reum 5 P.fllltMUIfl 7 , peritoneum Pleura j 30 . Pcfitenflifi' 17 ricura ! 4| ' I- 10 rern<vmim ; I : Pleura , 23 IMcut j 3 9rtuivnxjm Vr,i,*<seum SrtfJrm tl J stnrr \ usd i* 2} Pleura N1 21 Pleura 22 Pleura JO Pleura M M M 27 Peritoneum M ' 26 I'firtcnewi'' M 21 Pkurj i 29 picui j r L MESOTHELIOMA OF PLEURA FOLLOWISC EXPOSURE TO ASBESTOS 267 V ;nk icrio 10 orit in con- ,.e in ciorr ^rotimity lo '..at iht r.jk of idoo b;ch o=y;jitionl and v. fctnc-*jsd othen -c- tjo CTpcxt^e other ic ctnr.v ' * ubeuot ir asrc.3 rlijue* of tbe - p??cau>r. Iking near I'.itrd (Ki 'lu.^to, I960). ; -r, rvcrexrisk to the ufjCKiI cf atbestot .. i o.ci.i.-is, when :) OB. >: .hi.Te for i, :rc :;.o :n of hb < t*- "dS<>t C WUon, r jsrry. me Mr. C. If fJ Ur. C. P, - crr-'ns...n *.o inter- _ ><..'.itjanrs "hoeot- . ->...-.a*xrer"- of the . .c- tr ihtrr .-scottb; ff'lave and to .. f.c Or. W. `o the V *CMo c` S; e-^n (n * `h'rre- fo-m -M i *. ;. APPENDIX EIGHTY.THEE FATJEVTS WITH MESOTHEUAl. TUMOUES . ; ; j~ IUkil Hi>ior> t Brake liner, hosier go*vrr, nbn* \ZZ* a | PlBl* ipoi ; It 1 11 i |WJ t*l* 1 a l 1 Necropsy Km<~* l<Mt Neeropey Porilh. j *** | toe factory; mainly craodoliit ) PitumpMOf end other jobs. sob--ot factory: amotite. ernci- I dolhc. chrysoitk Ssniosit pipe maker, l<M7 j 1 '1 19S0 1 1951 l 1931 Biopsy Necropsy NncropsT Bopsy foHiv< | HIA (tpuuiml fo*Ui N-i ; Potilix H * (^tuun) , 1 factory, cetufiej svKcx^tiv . 1 ly croodoHie ( Used asbestos feoardinf m r-Uj> j CSirup construction | Aibmst factory, iob enfcfHi**. : Opener and sactnmat ptpe m^kvr, ul--nt factcry, certified avbr>> task; amoeac. efucido^itc, cferyw- 1955 fimcroiny Pouuvt BMtpajr Pmiiivc j N"A j (9Muifl> } 1I95J j Biopsy 1 Po**t*** f N A t I < p*rtutnl 1954 j Necropsy 1 Poshtw Nsfi*'*1** 1957 I BiW 1951 1 Biopsy N*A N/A NA KA 1951 J NCrW P-- poktU U j! Stpitienner, aebestot factory. certiHcd , tibauxk: mainly ctockJoIhc > Sactianal pipe maker, asbestos 3 ) factory.centAcd asbetmt*c; mainly ,, Scproinanaedra,Hatasbestos fb.'io*y, ccriitied 6 ubcMtk. mainly crocnloluc 3 OttitMfWaf. asbestos factory; amwtr, erocdoliK. chrysotdr 1* AsbCUOS rr.tvcr, north EntiUnd It Ciathrdcear.oiafsabctvoi4rys facinry . mjinly |* Ortotrhd<vfiitrand a>brvtn<< It fsciory; amt*sfte, rioodi'lttv. Petmv-e.im 1 M )4i5 1 1940 l i 19?f ] Biopsy I > I 1959 : Biopsy i N7A NA i; Negative J Npau> : 2 II FchUvyrsmmifaeker lur A R.P. m-skA. avbcaJea factory; m*inV cioo- FJinltelure maker for A.R.P. avhotos tacior); numiy pfuf j 1 ! i . :i St t925 1941 ! 1 t ) j 1959 j Nocrofn) j Negative ( Negative j ? d<4itc Liectrode c>cr. Aroodolttr 1 )V07 1921 j 1 , 1942 | Biopsy | Positive ] Negative J * Spinner, a^bestot factory. mainly crocidolitc y\ plrjia f l^OK 1924 ' ^ Poailivc ( M |'K)7 1942 Il 0 ' 1942 N'ectopry f Positive U j 194) ! 9*opy ! Positive I NcgMl"* \ Pe'U**k'*<r' p 1^99 1923 j i6 ' 1962 j Neeropt) ! Positive positive 1 ? Dclivetcd cbemtcAli to / factory: amnsiic, crnCHit'int. 5 1 SpciHnrnyesre, ttaletbritu* factorym.nniy ? }. Lcarbcooudroetrn. c *erki and building, i asbestos factory: amositc. v'iki* Pku'A M 11-99 1936 ! j |J1963 j Nsorops) j Positivej Negative { 1. PIfu * J si 1*K. 1925 1 Z 1963 j Necropsy j Positive Positive Pc*ii*nfum M l<a11 1930 1 27 1944 1 Necropsy J Positive Positive M (917 1937 t 1; Wdoorikiue,dchirnysoytaikrd of in*wl.>i>ng 6 Ccaorndterar,ctoesrsbcuos factory; manly . croodohie 24 Dmmefirator and otb.-r | asbestos factory; anvmtc. crocu ! dolitn, ebrysmik r^ur- to M | $74 tlU 23 1935 Necropsy ' Negative ,< > M 1910 22 : I9JJ Biopsy N/A lull '19.17 22 t 1959 Necropsy Positive NA Positive Vieu'J - 1901 l 1922 1 " 1 1961 M 1| 19*1 ' 4jr N/A ' N.A Posmve '' p.Mi-'.vum SI M 1901 1922 1411 1927 34 1961 Nacrepn j Po*tti' Positive Na * P<<at - y 1547 I91A , 41 | w: Biopsy M 1912 1927 34 1962 ! Rmimi VA N) A SA Worked in dose prt#*mn> r hokr * repairer in dockvardr 24 9 ' Boikr ckner and stripper. ByoairkdrsCoirfer and Ug^tr v> wtu.uv - (Efirramcstmf and fining cent'.*) h^^nrg 25 12 Boiler coierer ji J pr< inhuiatof, conttaciirg firm n ' Lagprr end borkr crsrre*, t to ImfiremtnstiucrtiK ho*kr Ufgc', ii:.p InrenpaalliArsliktr -f fio-tf*!*! ,icilu*ng 2226L201S 268 BRITISH JOURNAL OF INDUSTRIAL MEDICINE APPENDIX ImW) EIGKTY-TKREE PATIENTS WITH MESOTHELIAL TUMOURS ave S x . ' <- '> k - , 1 Dvr** i Vo,* *>on >CM of ^f Year c ' First Expo- of B tpo- urc Death tgrr <>ctr*i Ho* Diasnoted i . i.m " f. T.-ur* *f refa- 4*i *U-J M IB.2 1*23 11 1*56 Biapfir * P.lho- Asbestos i logical | Bodies Evidence tit Lung ! of Aj. Tissue , bcsiosls (a Lung ; Tomm N-A N/A U rCu-4 3* Peura F i*:) 1*1* 2 l*J7 *o|y F IW 1*1* 41 1*60 tiomr n;a NVA N/A N/A JT fjua F 1*05 1*25 14 1*60 Biopsy Six N/A 3? ^riiomeur F ir-o 1921 21 1*60 Nsetopty Positive Negative 33 P.U."W F 1*16 It JO 4 1*61 Necropsy NapsUva Negative J* fnn M i*i* 1931 2 1*61 Olay N/A N/A j: Pcurw F 1*00 1*41 1*63 May N/A N/A m Peri4./*wew. F i II** 1*12 It 1*6) i _ ow N/A N/A Survival front Initial Symptoms {moetktl i Reievur.; H .i.rv 27 Elder sister oul u spinner it asbestos died 1*46. carlifted nbruote 14 Elder sister cmr`*o)Vd aa specter. looked after patient i child 1) For several years hesostad sorted iq ship's engine room, d0* proximity to lagging operations J Husband worked at boiler tod*: overalls brought home for washing 24 Husband foreman and executive asbcsiot faoory i Husband a docker; frequently handled 'whhe* asbestos n Elder abler worked aa srnnr f< ubestos factory and suffers from ssbestosb It Daughter worked tn avbauotfactory for S years; patient washed h** overalls IS Husband rat)a* carnage buddrr; lined compartment! with asbmtc* sheeting; work clothes washed at home 44 PWwrw 41 Prwra 43 nur JO - Hewra 43 Prvr 4* Newra M P-ru-a 41 P.evrw 4* PuD 4* *tu% F 19C5 1*1) 7 , 1*5* fay M im 1*22 14 i 1*60 Biopty F IM9 1913 41 . 1*61 *oy 1 F l*C3 1*00 * 1*61 iop>y F 1*03 i*i) 1) 1*61 Blopty F !*;? 1*17 10 1*61 ioyiy F IF** 1*07 4 1*62 Biopay F It*9 1*07 4 i*i Biopay F 1*00 1*1) 31 ;1 1*62 Biopsy F l* 1*1) ^ i 1*62 Biopiy F 1*73 1*1) 1*63 Biopay N/A N/A Positive N/A N/A N/A Negative N/A N/A N7A n;a N/A N/A Negative N/A N/A ' N/A Negative N/A N/A N/A N/A 1 17 IS 1) 4 16 5 12 2* * 7 w. ,r .V* iJ'W' r/rn. act i / eahrrfm A Pea.* i * 1*00 1*47 Necrort> Positive Negative 7 V H-.t 4 I'eu-. " /e-v 1*"I M IV5 L 1*-^ 4 It--t *r>e -- l*'4 t. Pe.n M ir 1 *M 1*54 Necroni) Negative Biopsy VA Negative N/A 1*55 Biopsy SA N/A 1*73 Necropsy Negative 1*55 Necropsy Negative Negative Positive 3 n 21 Lived withia f mile of pisteat me of asbestos facto*'- Lived vain | mJe of pi asset site of asbestos Ctctorv Lived withui 100 yards of proem site of asbestos factory , Lived wuhio 1 mile of old arte of asbestos fsaory Lived witbw 1 m:le of froon of asbestos factory Lived within 200 >ads of ptmeel tile of asbestos factor) , Lived within f mile of old sne of asbestos facwo , Lived within | mile of old *t* of asbestos factorv Lived within l m.U of present vte of asbestos factory . Lived wiih's 1 m.k of present use of asbestos factor' Lived wiihm i tr. lc of prevent **w of asbotos factory Worked as nurs<-n.i^ iv maniger of gav workv n l.t Uf'h`n* asbcviin inuljti *n ir*r</ m v**r> Shorihand-i'p*'* lived lllofd area Baker's rotr.dvr*in. h.ncJ<. graetn labourer. puhl*,jr. !.* H' jeo East End f* Lc* J-'" Munitions *ork he* re nurrags. then hou'c*ifc. i.-ed Ni al*fcam Abbey. Eaves Tailorcst and h u'T- f< m E-tt End of London Empl<'^ied * lu'rT'.a- and greaKr. Beckton pu w.rw 36 >"" permient dvcK. m-% `g smut R tide of chest tA'c- u rtg eTy-enta 1*23. acute che : -.iec:*on 1*3>. tubvequem ir *... rlj't' deicnoralrJ f..-- i- . MESOTHELh ST0279223 Case No. S ic of P 'IMM 7. mour 1 Scv 1 i P 61 Ptf iiircum 1 M . I- 54 PWut j 74 Pleura 51 Pleura 66 Ple-jra 1M .F il i jM jF 57 Peritoneum | M | 32 ritjrj 1 1 6) Plrjf. | 31 Pleura 3* i PUwia ! 7) . Pleura 70 Pleura 1 72 Peritoneum 33 Pleur^ 60 * Pe'itoneum v< M 67 ; Pleura 36 PU-ura 69 Pe'irneum F M F 33 P-eurj M f 1 nttjrrd 71 ( Pl.-Jfi ;l 1) 1 PUura |M II .l Ptcurs |M 0 '. Pirura Pleura 11 !'i M St i' 1 r |- Ti Peril.>eiim * 1 7* Pleura 1* : i i\i; : EMa * nr. A '-'ten - -er Ucury, <i~ m*. w '** w*r<tyt; u - *J *.'tr jva- *r.: . , ^ jtj- y-: ** * * \m ~ U Uq:'< rr- t' -.;"it- a*r0. ffc*i: <t - ile fir valuing r,, .ircauj * \cretr* ar - 'jCSt^ >t. a dicsr' l*qrm<ly v.wcr *of^ -*u immt m <* f'a, or> ani tuSma {< *orktd n 4. * 'an; pa^ea: T.p4.imeu r-ib i nt *ork cot<ii*t *a*fc*< m _ . `Ill IT> .iS " vcov CaCUTV . m :`.im i mic c,r v UJKry ; - -."lift }Oti >ar-y <jf : aibeu.:* Lcto*-* . >AC* t wi ynat* t'< ^ He ef f OUC s.` pim r*cu'~y . *.un 20.' of : .lOCSCS* fluToP" k . *.*' .mjCiLS|TXmx a! ok I of . *: *.'A t **< a * 9< 7, . > iA.v> - --*.m y *tu p-a p| f<wCU^* ;'! t true c*` prk rev i . <vi;n rme o* 'fVwt t*CtCT< l r ora r. L > **--atur w-stf i.-Vl he ' I'ti rwr.^t f * K; . : Lor.^tr ' " <jr\c tc:' ?*r<` X* k^C . Inc; * -nd b.iin Lx ndem at l_u*nar .ursd ft.: <L*cb.-|<'4 l*Mn i . x*e>: '* - f ewgju-- __e cars x:i<ai Itf X, . T- *S*v ba* MESOTHELIOMA OF PLEURA FOLLOWING EXPOSURE TO ASBESTOS APPENIKX (awM) EIGHTY.THREE PAT1ENT1 WITH MESOTMCUAL TUMOURS 269 ^ s or ^ Pnmar* e Pentorvam *. fir.: a > Pie.- Ple.-rf - Ple.j - Pemonc.m Fk.-a Ptes.'a Vle^ j e rie.'a Plrjfj - Pkc'j 7 Per cone _m r Ptc_'- ! Pcf .J'-MVc ;m Plr-rj Pka*j PeT-TCfW-ffl r Pk^j t/ l -f-- Pkw c Pie./a * Plr--'a . . Pk.-j - Pcr.t.'nc .n *4 Pk-^j ' Dura* Year tioo ; Year of of Year Sea First ipo of | link Eapo* sure Death sure (years ! How Dapnoaad M 1913 1931 *r " AabaHaa Bodies m Laa# Tana N/A 1 M 1904 1 1916 1956 lir 1957 Biopsy NA N' A M 119) 1 1K94 1957 Biopsy 195* Biopsy NA NA M 1179 M 1(90 M 1904 M 1910 M 1911 1951 k>W S'A 1959 Biofnr NA 1960 iopey NA I960 Necropsy Kfun 1960 fimaottf Poaitive F HIT 1962 Ncr<w Ncgilne F 1tags 1962 R*of< Negatrea F 1191 1962 BMpiy NA M 1181 M 1915 1962 Necropsy Negative 1962 Nacropey Swim F 1*97 M 1912 i 1965 B,op*1 196) (<o|I NA NA F 1901 1964 Ncropjr Nagstire i M 1(92 1964 Necropsy Positive PlBo* tlEL of Aa* in Law# Taaun N/A N. A NA N7A N,*A N/A Si a N/A Neprnw fouiw Ncpthc Ncpthe N/A HlplM Naps tore N/A N/A Ncsptrve Negaiive SuMvsl from Initial Symptoms (moothe) Kttrrmi Hmofy i< Africa 19)^32, no dcflnhi evidence of COWm with asbestos; subse quently employed ne cross-channel boati Labourer and builder. AnuU> em ployed in tunnelling; lived m F.jvt End of London 19 Employed rem.ikiny r'd vack* in i Bow, prcvHitix cofiunl v-ickv ih*i ascertained; I ju Cud of London ; i ClleieradmWhl|a|vncd*,llcAhmjurilifMcut '..IImrrIMI 'kfthfMjnfluK', 6 forked av pinttng nuwhmtM before marriage. (hen j tie until death: toed Cni End of London 5 Stereotyper and printer, lived ortfinatty in Eau London, then moed to Ipawieh 12 Van boy, regular army, cutter and Kndcr; lived S.E. London and >penbam IK Bricklayer, cement wucker. p"vt- iam; lived Eait End of London. moved lo Hainault. Esaev in |HI II Fitter and turner: lnd principally V in East End of London Cotourad S. African merchant tea* man. stoker at plau factory; taible contact vith asbeviov in rAfrica or at tea 10 : Lived until numaie in Walct. then housekeeper in S.W. London 50 Machinist of celluloid colUiv. 1 houtnift and canteen i>fkr; lived East London 10 ' Machinist in hosiery trade, Netting* ham, housewife; moved to London 1900 j ; Labourer, merchant vejm.it>, docker, carried only meal 54 |I Apprentice printer, barman, cook, and butcher, lor 25 years before death lived East End of l-endon 1 1 Dressmaker and house* tfe; lived East End of London then Somerset 24 <i Steel erector, army, steel erector, 1 labourer and porter; lived East 1 End of London !| Employed os packer m pharma* 42 eoutical Arm for 12 years, then housewife until death; lived m Dagenham 24 Fisherman. Areman, docker. 1915 59 at Tilbury docks, firemen and Anally storekeeper; contact iih asbestos not probable si Tilbury docks; lived Tilbury area F 1,93 i M 1160 j i M 1*77 j M 1900 | VI 1*95 1 j F 19)0 | jF ; i*7* i 1917 Nacropey i 1922 Nacropey Sedative 1925 Necropsy Negative 1956 Necropsy Negative 195* Necropsy Positive 1945 Necropsy Positive 1955 Necropsy Positive Posjctvc ( Nrkm i . 1 N<po | Negative Posnvc Powtivc ( POVD ve ' Not traced Not traced Not traced N.h traced Not traced Not traced Not traced N'A tiuue not available. ST0279224