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PLAINTIFF'S EXHIBIT DUP-933 i ' -Tlie American Journal of Medicine VOLUMI; U APRIL 1947 numie* Editorial Asbestosis and Neoplasia X ii 'nil one fourth ot th adults w ho die I in urban areas in the United Ststes and still n assumption, an extrapolation from lha observed data tinea we do not know at thi* time other indimriaiiaed countries asbestos bodies whether or not the small amounts inhaled ai the ire found in the luugs [ 7-d). Thit observation result of aibcstot air pollution have an effect 'oat led to the recognition of ashesto-relaied comparable to the much larger amounts inhaled dieaic ai a potential icriaua modern urban hat* in industrial or intimate environmental cir aid (7-JJ. cumstances- The question will not be resolved for Indeed, Thomwe (3J haa predicted that tome time becaum of the long latent period aabvetu-induced neoplaamt will rival cigarette* iftduc4 5unj c*ncr in th next xcverftl deJdt between initial eontaet and the appearance of clinical rfitcase. Although there are variations This prediction it bated upon five obvrrvatioftt bated upon individual idiosynerity, intimacy, and one atiumption. The known data may b* duration and continuity of exposure, and per nmirariatd u foilowe: (t) Asbestos inhaled haps alio upon such factors at the varied' of i.-der tndu<triai condition! will prudtice o <er>oua , -tevfflocon otia (pulmonary atbestosis) I !0] tbcrtos u-ed icltrytottie, amostte, croeidoiite, stuhophylite, tremolite) and the presence of "on with relatively light exposure f771. (2) other concomitant dusts, by and large it may be U nder timiUr eottdiiiuns of heavy (72( or light .aid that disease canted by asbestos is rarely i'JJ induttiiaj exposure, workmen die of neo* manifested in lets than ten to twenty tears from oioirnt xotc frequently than expected. (3) onset of exposures '"detpread contamination of the environment f5| nay oceur both froniinduwgial totircea (tueb u aibeataxontainiij^duM from con- rULwexaav atttciTotia itructicn tiles) and from dijtaUfagyatian or uea of The cate report which gave the disease its stfceitos products (tueli ajRm containing name [21] was of a woman asbestos textile r tiles and brake litur^T [id). (*) Soda operator who had begun this work twenty year* 'nvironmtntai contamination may reault is before. Alerted by this and similar cases, a dapread . nhalation and retention of tmafl survey of British factories was undertaken; umbers of the mineral libers (7-dJ. (!) Under evidence of asbeetoeia wit found to be common, strain condition* (for example, residence witliin but oesiy m those whaet occupational exposure half.mile el aa aibeteae (severe or in the house* to asbestos had begun many years before [70). <2d of an ubena* worker) environmental Similar experiences were oen recorded in the vposure haa been shown to produce ienoue United States [72). The ioumerpart of acute tdi* i'eaac [77-33). The prediction that widespread coeis was almost never observed, except perhaps westos contamination of cits- air will he awocU under tht most unusual cireumssancvs 123). d with widespread neoplasia, however, ia This tituition still obtains. In a recent study rl I I I o I >o M W ,vj v-7 t.;` t DU 037111 T.wix i* KOt.Nietv w>K.te auscu it i>u.vu*w sv^Mhut* Oth Ctpomir* "(sr.) 4:i^ * 20-21 10-0 0-f NV 121 t?4 ? yj J4A 1.U7 Pur cent Normal SS Kt--.1n 5i 5 Dt al 5 Per c*m Abiwrmw U2 IT 1 7: i Ms 10 4 4 S 1 ?5 \*l jJ ` jOu i1 51 * :,si 17 4 9o J0 io" * Scitlrtf et a*. \11\. of over 1,1'JO sslseitus insulation workers. ehust roentgenograms disclosed abnormalities in only 10 per cent of those whOK exposure to asbestu* began less ihnn ten years before and in only U pr cent of those who had hetn Arte exposed to asbewat from ten to nineteen years before. Moreover, these abnormalities (roentgeno- logically evident parenchymal fibrosis end/or pleural fibrosis and calcification) tended to lie minimal in extent. On the other hand, in those with onset ot exposure to asbestos from twenty to twenty.ninc yean before, chest roentgeno grams showed abnormalities in 72 per cent of the older workmen and in over 90 per cent of those with mtne than tiiirtv yean from onset of ex- f poem (Tablei) [If]. Tire explanation is iwofuid. first, asbestus rarriv prove4c an actna ittllainntatefy rtaciMMi in the lung. Rather, the fibrosis which remits it i siowlv ptotttetsive. The athestos Alien remain ix rite where inhaled but the tissue rrspunsc to them is indolent, albeit progressive and appar ently irreversible. This course of events is wen both in human and experimental asbestusia (2J-i7J. Second, asbcstotic fibrosis is of the rtifitisr interstitial variety, which may nos be readily apjixrrnr on roentgenograms in iu i. earlier age l3| and sometime* not even when . extensive (3)j. There is a tendency, tlterefore, i i m*:n nnderrttiiaate the presence and extent of EEL" elisucal disrtxse, Bj ___ Pulmonary asbestnsis has bests aptly char- aCtasriesd as a inooosvmpuwnatie disease, with dyspswa itt cardinal clinical finding. Vet this feature, and the physiolejia and marphoiogte changes responsible for it, are not early findings. In the asbcstOM (bund atnotsg ineniation workers in the United States, dyspnea waa preseat in only I per cans of thorn *ttth last than ten yean l* of work experience, and was minimal id each i case [//]. Even in iho with ten to nine.--;: years from onset uf exoQsuic, cait-paints ji livspnea were recorded only In tueniy.c.ght J|' 379 men examined anu these were minimal in ail but one instance. In contrast, of 111 men with mure than forty t ears from unset of expo, sure almusc half had dyspnea, mart oiien than not inudcrait or tcvert in decree, ringer club bing. cyanosis and extensive fine basal rales ad tend to dcvciop only after a long time ftotn the onset of indietrial asbestus exposure. Tilt pulmonary phonological defect in as bestoses is associated with the pattern characterotic of the ilveolar.eapiilary block lyndrosra- (.5(l|. with minced vital enpnetty. fairly wen pre*rxcil maximum briMihina capacity, hyper- trntiiation at rest and particularly on excrete, tleervaerd dithisimr eaijactty of the .1]|, un* paired nxygesation of the aiterial blood ml rrriucrrl pulitttnusy compliance. None of the |kirameters shows significant ch.mue eaiiv m thr emuse of lire disease, nut earn nui caoncuv. which hat Iscrn deitiuniiraietl to be pcrha-.- the mod sritsuive index uf provreiMOn ul tnr disease In newt instances, therefore, the term '`earl1, aslsesiosis'* is uf 'tneertaut mejnme. If it .- intended to dciiarutc ciimcxi atbestosii miniiiui or limited extent anti severity, con siderable time will hav clapwd, pernaps onr or two decades before nian.festatiuna h.w become evident, in a lesser period from oux1 of exposure it is likeiy that few or no charge indicative of clinical disease will be present, even though histologic changes will be gmedv underway [JJ|. lvsc cuveta In 1933 Lynch [jd] reported a case of ium. cancer in a man with asbestos!*. The asiociaiic. astsicss jsuisst er a t a i e ' 1 OUP 0935703 DU 037112 490 Editorial deaths from 1951 to 1964 only eleven were due the latent period it over thirty years. Also as to pulmonary insufficiency. Death front pul monary tsbatotis occurred at an average of 25.7 yean from omat of exposure whereas the latent period between oniet of exposure and death from lung cancer ti 30.7 yean. With improvement in induitriai eonditione, and leia with lun* eaneer. there t> no re-ular correlation between the severity of asbcstecis and the occur rence of mesothelioma, end many instances occur in subjects in whom there is Utile or no roentgenologic evidence of ubestotit. The Droden experience may be recalled in this cornice- exposure to asbestos, Dresden asbestos workers lion, too. During the period when eiriy death survived lonj eneufh to reach the period in from cor pulmonale was common no meso which'lung cancer occurred! theliomas were seen, but m the later period, SltJOTHIUOXA when severe asbestests was no longer u com mon, 19.4 per eem of all thoracic tumon were Scattered reports of neoplasms of the meso- primary in the pleura. The litem pened from theiiai surfaces of the pleural and peritoneal onset of exposure in these cases averaged jl.J cavities in stioctstion with ssbestotis have been years. available for over thirty vein. Weia [42] suggested an etiologic relationship in 1955 but such proposals faced tha difficulty of in frequency of reported cases and the absence of population and epidemiologic studies. The poaibility of a causal relationship was greatly strengthened by the report of Wagner and associates in 1960 (4J| of thirty-three cases of diffiisc pleural mesothelioma in South Africa, thirty-two of the thirty-three patients having had at least suggestive evidence of potential exposure to asbestos. Other large collections of easts of mesothelioma of the pleura or peri toneum associated with exposure to asbestos have appeared, including these of McCaughey, Wide ' and Elines [44], Owen [45], Hourihane (46), othxx ncoslasus The neoplastic potential of asbestos may not be limited to the lung end mesothelisl surfaces. Other tumors may be related to asbestos ex posure, although the evidence for this is nor as well deBncd at this time iJSJIj. Cancers of the stomach and cotea seem to be significantly in creased among asbestos workers, la two studies in which the initial exposure to asbestos could be dated, the cancan of the stomach and colon occurred after the tame long latent period chir. aetertstie of lung eaneer and mesothelioma (57,52). rvausual c-vuctrsovTio-v . Scattered instances of calcification of the Churg, Rosen and Mooitcn [47], Webster [4J], pleura, ehicAy of the parietal pleura, were re Enriekr.ap and Smither (4J|. This tumor now ported in the 1950`s hut their frequency and follows lung cancer as an important cau uf importance as a roentgenologic urn of aosrtte* death among asbestoe workers. In fifty-sia exposure were not appreciated until the report consecutive autopsies of workers in one asbestos by Jacob and Bohlig [551 in 1955 who found factory, nineteen cases of peritoneal meso such calcification in approximately 5 per era thelioma were found [40 k In a series of 525 of 545 Dresden asbestos workers. Ths stgmn- consecutive deaths (194J to 1966) among as cance of this characteristic .t-rsv finding was bestos insulation workers, seventeen were due emphasiard by Kiviluoto't report in 1960 [74]. to mesothelioma of 'the pleura or peritoneum Recent studies have nos only confirmed the [50), * eatreoedinarily high incidence (ap4_ peosimately $ per cent) for a tuinoe otherwise frequency of pleural calcification among work men exposed to Asbestos but have Also demon .J r`se rare; the prevalence in tha general papulation strated that this finding too is strongly deper-desi S' at this time hae been calculated to bit approxi upon e long latent period fret a onset of ex mately I hi 10,000 deaths [Jf ]. The association of posure. Ai can be seen in Table it, roentgens mesothelioma with exposure to asbotoe is so striking u to suggest that a history of exposure to tsbestse bo sought whenever the histologic noeis of mesothelioma is made, nee again, these ii a striking latency. As with lung cancer,1 it is unusual to Bud meso thelioma assoc:aled with asbestos in less than twenty years from onset of exposure; generally, logically apparent pleural calcification is ram within twenty year* from onset of exposure, ody five instances having been found among '24 asbestos insulation workem in this categoryOnes the ewency year point is patted, however. visible pleural calcification becomes much mere common and is found in more than half "e man in whom more than forty years have AMisitAS jsism or * * *1 * *.* * DUP 0935704 DU 037113 ,V ' > 4. 'Jh . Eaitortai r A T*ta a* ruufUfc CA^dnCAno* amo *toi tMVL*rie ~oiuu m OMtt < */: ` 40+ '* '.*7' Jiv 1 c:K a>- -;VT` tlM ibL.." /*** ' N*. lit 194 7T S7 34 UtT cn 42.1 45 4 114 71.9 100 0 ' Ptr rtnt Calciftcjun ST.f 34 5 10.4 1.1 a.a * Extent a/ CeJaftcju** (frW) JT 20 11 44 15 4 t00 >00 00 a H 11 If Meicff. Li. [UU t'jp*d line* the cruet 0f exposure fJJj. These dau ihtuid be interpreted in tlie light of knowi ngs thu pleural calcification of limited extent tnd radiobenfirv it usually not viftlik in the i.nv film fJ|. It is likely that parietal pleuril chances with hyaline arid sometimes calcified plaques ill occur in all asbestoa workers, if they ins Ion] enough. rooeatntffic or asiutos oistvu HITU01.T coxTmto txrvtCits Knowledge concerning the latent period of asbestos- related disease has been derived pri marily from obiervattona of industrially exposed ''population groups, although epidemiologic erudite of random instances of such discern, specially mesotheliomas, have given similar results tro.JJ). These and other epidemiologic rudies have demonstrated that aUx-'tot-reiated ditcisc thay occur without continued exposure from industrial sources. The explanation for this presumably is as follows: The iflxtstoo fibers inhaied initially largely remain in place, al though tome may be removed in the bronchial eeretioh* for many decades after cessation of exposure and others may gradually Its clitsoivsd is body fiuida (iJ; this last possibility has nos bceo diiniiiveiv established As a result, thaue reaction to the retainedJLbgra com on, svest hi the attract of inhalatio^Vi^d^totial amount*. Thus a workman w h^jSlhens contjjiuslly cxpoicd to asbestoa forJfcua soy, twenty-five tears carries within himTCompeaib* biological effect. The initial burden of inhaled filters is uaociatcd with a tweney-fiv* year esfeet, then inhaled, twenty yean before an experiencing a 'wsaty-ycar edict and oaw the fiber* but recently inhaled adding the effect associated with ntwly depedted material. Tlie clinical rsnitunt ia the summation of ail these sifeesa. 'a. *1, trstt tsar t Tltis analysis explains the relnclattec of many plpuciant to advise asbestos workers with many years of experience but in good health to leave their employment, once their ultimate fate may be determined set by their current exposure but by their exposure many years before. The same situation holds in many cases of minimal silicosis or respiratory disease associated with coal mining. axrcaiwctvTAL sinnas Reference has already been made to the lowly progressive fibrous in experimental asbestoeis. counterpart of the latency in the human disease. Similar findings are observed in experimental studies of neoplasia sssociatcd with asbestos. V/agncr fddf produced utcaotheliomas ia rata by a tingle intrapleural in jection of several varitties of asbestos but these tumors did not appear for fifteen to twenty-three months, a considerable portion of tlie life spaas of the animal. Smith produced pleural meso theliomas with asbestos in the hamster but, again, these did not appear until 244 days after injection [J7j. Pleural disease has also been found in hamsters following the intratracheal instillation of asbestos but the same requirement of a long latent period hat been observed (1). DMCKOttt or AtaaiToa otscaw It ia clear that a painstaking occupational history it essential in thorn clinical circumstances ' in which the possibility of asbestos-related dis ease is being considered in differential diagnoaaa This ia particularly true ia injuncts of (1) interstitial pulmonary fibroris of undetermined origin. (2) pleural calcification (either unilateral or bilateral), (J) pleural or peritoneal meso* thelioma, (4) aheolar-eaptllary block syndrom* (even in U absence of rsdkdogieally evident ; ik MB'LS< !: li i. !* 9 c o w W1 o cn . DU 037114 *?2 Editorial 1 ei'ff m a brake hmi^ betyry far Atv four ntMilu m l*j$, wtife nm utMr^urni N?our ta .uUdviat. .Vate ihju (He ftbroiie ftrw bream* vukm w fWHfiwurmn m IfftS. v r.ii > *14 / :r* * * *.. :?; 3sSl. ;jW< f3 ; '.*' !: i T-f: ! Is^sh^-T-- interstitial fibrosis), (5) luiif cancer and (6) fibrotic pleural plaque* (unilateral or bilateral), ta such caM* the recent occupational history ia at lc imerat than the work the patient did twenty, thirty or mere years before (Fif. 2). y The exposure may have been brief--a matter of t&^C a fine months or lets--and the occupation not ' oecanarily one ordinarily thati|ht of at related to aebewes. Of the individuate industrially exposed only a minority are atbettoe textile and asbestos products worker*. There are, for ex ample, mote asbestos insulation workers than asbestos weaver*. Over 3.000 vies for asbestos are currently known (90), raufinf from Alters uaad in the manufacture of beer to repair cements for home furnaces, from re-entry r.oie cone* for our space vehicles to certain valve packings and weldinj electrodes. The construc tion industry uses a (teat many material* eontaininf asbestos; for example, a carpenttr stay repeatedly saw asbestos buildinf board, a plumber and sttanvfitttr freqviently uses asbestos rovinfl for joints, an electrician it no sne|cr to asbestos-covered wire and cable. In the shipbuildinf industry, asbestos finds msny usa and. because of tifht quarters and clove uerkinf conditions, indirect occupational exposure (for example, a welder inhaiinj the asbestos butt derived from aa insulator einta by) may be usefully explored in the occupational hutory. * M ft !e A K J O V & * * b ? 111 ieia( UUP 0935706 v*.weesi-v.1-.'viWali-.id-n.-Vr.'p Yj~. DU 037115 5 . Editorial Y- 493 < M imo <M km <u m im *a iin <tw no moo too ton yeah Fie J. A prujcctieo ef the potential incidence at ncoptaia duo to iihenaa. The cjrv, diowo m I'lfufa l hat lMe (wparimpatee an l*v) of aeld ptnouauon at attontoa h*wa to the arOk nan*. The nrepfatia ll-eeirlrd HUh greater tiuJUauu* at wkwtat anil not fee in evidence until tlta tOOTt. Tht tluattaO ataaa Indiana iha tna which Kata hecaaw manifer*. ih# uiuhrOrU 1'tM rtpra* cm paianuai aaa Indirect oidupafibnal expoeurc may alto lx Important m tlia building trtdoc altd in many outer at ytt incompletely investigated occupa tion* A complete litt of potential direct and indirect occupational expoaurct to arhettoa ia -jmfiitlv impossible here, but peehapt enough baa been laid to indicate that a bit of detective nark during the occupational hitiorv, etpectally ">th retpeet to work two, thret or four decade* before, may be diagnoriieallynew-ardinf. Although many intuncealSve been recorded, lata arc net available to ch^jpcriac completely - t effect ol cessation of uptenlhiti external 'curcee, lime large groups of]atbcstaa worker* " box esporurt hat been discontinued have not been observed and compared with other* whh the ume exposure who have continued at their "* Such data at are avaSa&c (5J] would uggest that both eiapiad time u'nce lint ex* cuture and total ton of exposure are of iin* wranea. Thera are no epidemiologic data, 'i. 1, trait t7 tueh at are available for cigarette trucking [dOh which indicate that coration of expornre it aixxdaied with a subsequent dtercaied ritk of lung cancer. Smoking data, moreover, should not necessarily be trampeacd to aibertot npoture, in view of the retention of inhaled atbettet libert which hat no clear counterpart in the cigarette problem. Definitive diagnosis of asbestos diieau de pend* upon the finding of albertor, cither in the form of asbestos fiber* or asbestos bodice in effected timier. However, their discovery in routine postmortem tnidiea ie (imply evidence that tt ut nmf ashotor fiber* have bees inhaled, without indicating when tueh inhalation oc curred. The connotation would be different in each caw >ince. aa we have wen, disease cuuld he anticipated only a* a result of inhale* u'on that had occurred a considerable time before. Therefore, we sjtotild perhap* take little comfort from the circumstance that, in moat * 9s V-/ V'.* _kl . Vi{** c |I Sg&l dli- "It :;J S#1 v,J V./TV* ^ ?5^3'^5 .**<*>5 *: ? ,*f m Vii 494 Editorial insfoiicej, neither pitl/nonan* filjruis nor neo- piatia ii associated with the tuiioiu* currently being (bund postmortem. . It it ileiv that mote asovstus now being dis covered postmortem in pcisous * ho have not been industrially exposed haa been of rectal deposition. The basis for thia assertion lies in the economic data concerning aahcatoe. Until 1370 asbeatoa was an exotic rariiv. The unuataJ qualities of theae mineral fibers--fireproof, waterproof, wear- and ehemical-teatitam--were toon found to have important uses in our rapidly expanding industrial civilisation, and altnoat each year saw a rapid incse-ite m the world production of thia mineral. Truth SO tons per year ninety year* ago, was id production hat now reached aimou 4,000,000 tons per veer. As Gilson haa pointed out (d/J, aabeatoe can truly be called the twentieth century mineral, tince its output haa increased over a thousand fold in sixty yean compared with a mere fifty fold for oil, an industry often regarded as the symbol of industrial growth. The asbeatoa brought to the surface of the earth inertsm year by year, and the total it a cumulative one. As has been aptly said [ f) the fiber hat ``a half life of infinity" to that each year's production adds to the cumulative total of all that has been produced before. The frequency, nature and extent of disease due to asbestos la a matter fur fntmt observation. A graphic picture of thia potential problem is given in Ftjure } in which the curve of the latent period of cancer of the lung and pleura is super- imposed upon the production treords ofaideso*. The neoplasms now encoumcnxl ussociatad both (rich industry and environiurut are consequent upou inhalation of aa-uviuicd with the limited asbestos production uf asm* thirty year* ago. The neoplasm* aiwciitcd with current utilixatinn and exposure to osbrxo* will not be evident until the lOWa. 7~J5tt < be resolved are uch important questions as whether diCetent kinds of fibers a.- exert the same biological eiTeeta. the nature of the dotediscern reiitiocihip. source* and extant ef asvironnaaetal conubauuthm. the range of industrial exposure (Inadequately doeumented at this lime), the range ef neopixoie effects os* aabettas exponjie. standardisation of roentgenologic and physioiogie studies, and even whether asbestos bodies Buy not auineumes be the result of inhaiatioa of minrral fibers other than asbestos fdJJ. fa our own laboratory, data arc aceumulauior to sutgeat an important eo-carcinoucaic e.Tect of ciqarette sinneintj m asbestos workers [All possibly .due to adsorptxn of careinogenie substances onto the asbestos fiber, but possibly also due to histologic or other changes induced in the affected lung. cava.t.'okxe xcuauks Asbestos is s most valuable material, essenttal in our industrial soetetv. W'e recognise and imay its dangers to that we may devise means of minimising or avoiding them. Diligent, in genious and often expensive improvements in industrial hygient practice ,'d-l| rav help to eliminate heavy or unnecessary expoaure. A., are nas* of the potential risks of environmental contamination is also necessary at this time, at least until the future tells us whether Thom son's assumption is right or wrong. Ixvrxo S. Stuxorr, u.a. Ricsuxo A. Basis, u.a. Moaroixa E. Baoss, u.a. Jacos Cmuso, itj. end E. Ctrirua HaMsiomo. sc.8. Dtpatuntnit af Mtiitint and Caaammitj Mdicn* Pw Msnnf Sixes Hsipiul and tht Manat Sinai Schaai >/ Mtjitiat iVna Tori, A`n* Yatk asrsatxcts 1. Tvnvaow. J. C,, Kascvuca. It O. C and V.e. OdOAse. B. R. ililnm ,n a ntourrn urstit hjusrrt Sant . I/'V-A M. J,, IT ;t, ,!*} I. Cacva. 0., Torres. R. S. and Geuti. ? Amntosis boons Is human lungs as ..unapt*. J A.M .t., t:5: 371, 17*3. J. Clue*. P. C, McC-vcvrv, tv T. E. anil w.ae, O. t- Otigttn mnodtctiumo at the p-c-jra ami ssbeuos. ha. M. J., I: 3W. 17SS. 4. Tiiu--om. J. G. and G* I, W. M. Vuniu at so urban aw crioutniiunc. A'tk. /sis, SI. -IS, trad. 5. MsueuAX, t_ Aibntw boUm And pkural plsqua in Flnnoh nries uf lunpsy ram. .ere pais, n maratmL uaahaat.. Ill (uipp.): I, IPSO, i. HevatKAxe. O. O. I. Lxitor, l_ and Ricx-aova-, A C Hyalin and csJeaSrd ptruraj yUgim a- an indon of wpoiiiro to ssbniot. A uudy of rstli* logical and patholefical Citium of 100 coaoi -`A s considwsuoo of ep^mology. Ini. .U. .Is I0*. ISM. T. tdkonoJ. .tsbniosit snd malignant disuse. .' Vw fqiwf J. .tfrdt. Vi. SM. less. A Editorial. Hnnltb hssards of uUuos Lama, 11130. toss. S. tdasrial Asbwroiii is urbso yopulaaooe. /-f.Af-119*: 73A IMS. 10. Manewcmeo. C. *. A. A metnwdfldum an sal toon. Tatmta, IS: t*. IOC. 1SL 1733-1*34. 11. Sdunorr, I. C-rveo, J. and H--wa-e. A C Tbs aalitSAS joriaAi or usotetes O. id - <ufl --' DU 037117 ajguiim. -*<-......i3....1'liiliil.ii. K^U. iiliililiiiiii.ini mlimi Editoriil I 4C5 . ,. occurrence of ubmicaie amonf imuLtieii arkn ' ' . t9 Jit L'ancd Sutfli Am. Xm Ymk Aug. St* Knil mu m a tonf*irm proepoetne ftudy. Am. Xmt Ymk .ini. St* 132: 391, lHi. 132: 139, HIS. tl, 9eu R MvuIit Ha Ignf tancm in ubwtoa - Art. /. /adur. if*., 12: II. I93S. 12. SeuM9ftf l. 3* Ono. J. aad HaeuOKp. . C . Abates mpeaure u< acepiaaie. Jmi-Atu* 114: 22, 1944. 14. Kn^wor*. R. P!evrJ ealoAtiiioa u rocmfena* lofit sift af aoe^eeupasienei snOcmw tnU*m pk* Ilite--aadwow. Atu uditi* 194 fiupp.): lv 32. Huxt, R. Routine iunf funcuon ttudiss an 130 cnpioyeoi la ao uboiu proesninf factory. Am Km Yttk Aud. St., 132: *04. 1945. 33. Hoaai, Z* Tujmcro, Oaawtu*. M.. Hisa. imuOaw*. M. Sams. HL, C'iia, i. Kak*ta, H. a no Cro. H. Studies -- ubteos. v. Applica* 'ion sf necok biopsy of ths iunft for Uis dufnods of mbmtmm. J. AVo At. A* U: 719, 1940. 34. Lvnew. K. K(. and Surra, W. A. Pulmonary iifcoM mo. tS LiAMkNSm A., Noeo, L and Rauato, V. Olnsrva- uett ea atmospheric air pellutiee cause* by torn. m. Carcinoma of ths iunf in iiQmto tiiieorifc Am. J. Gmut, 24: 54, 193S. 35. Annual Report of the Chid Inspector cf factorial umutes. Ann JV4 Aug. &, 132: 240. 1945. for the year 1947, p. 79. London, 1949. Her If, Hv*:a W. C Occupational and nonoceupatiunal (\9wra to abaiau dee. Aw Yt*i Ami. St* XfajoKy's Siauotfwv Office. 34. Annual Report of <ht Out/ tnpncter of factorisi 122: 144, 1945. 17. Hao***. A. C la: Report of annual mtctiitf of Untied MtdtaiJ Aitanitwo MsacJteasr, 1929. Li*f 2: 230, 1929. if. W*eua, F . MOutt, H. and Amracii, M. Cid tm endstadebo AiHawd //ee4r. jis. AVf , I; 144, 1912. If. Siaci. P. C and Watt, O. L. Reiatiooslup beiwesa sapaure to mbrntm and pleural malignancy in bti/uet. Am. AV Ymk Aud. St* 132; 349, 1941. 20. NV^momi, M. L. and Tuonrso*. H. Afaeshefionui * of f>ieuro and pertfaneum fsllmAinf saposuw to nUe lit tho LanOon arts. inr. J. M*. Sltd* 22: 241, ini. 3. Cooes. W. t AiiMMVf ntnowit Jnr. At. J* 2: 1024, 1927. \22 Oacu&ur, \V. CL, Dauavaua J. M.. Chaim, T. I-, Xtaixm, 2. \V., Camu, H. F. and Tates, VL F. A Study of Aibateue to the Aideuoo Tau tilo tnOusfry. Public Hcafcfc Hllnin No. !. WaiMofton. O. C* 1914. U. S. Coomnm for the Year 19U. p. 20*. London, 1934. Majorty`1 Stationery Office. 37. lueMAflAM, W. 0. AsfccKOM and primary intro* thoraete nooplatfw. 4no. Aw )w4 Aud. St* 132. S07, 1949. 31. Saifeorr, !. Cxuso. 3. and Ham*ooo Z. C Relation between npoaure to adtsaios and mow* thefioma. AV Eaglmd J. AM* 272 : 3*0, 1945. 39. MeVtTTV, J. C Oieui**on. Am. Xtm Ymk Aud. St* 132: 112. 1943. 40. Somuo, H. and Jaeao, G. New Gmfchtspwnkto uhor den Lmqsnhrodi dor AilwiurOoitor. Duutit AM. H*tkmM* It: 231, 1994. 41. Jacob, G. and AnsoaeH, M. Pulmonary neopladd amoof Dresden ubota werksre. Am Xmm )V4 AM. St* 02:534,19M. 42. Wots, A. Pfeurakrcds dei Lunoeoshmto>o. io viva morpholofiseh |khcrt. >fdinaur4r, p. 93, 1993. 43. Waoncs. J. C* Siceos, C A. and Maaoitaoo, P. Di5uU pleural tin wnhriooui and ubo oiya* lure in Nnrth Wwcrn Gape Province, drm. J. Pncuaf Office. S. Auaiotuvr, XC Note mat rSygicnc t U <2uotf 4m ouM'ioro dans lee iUrurm t mufaa d'amtaato. Sdl, ritspttL Ttm* 121,190*. 24. Guowe, S. R. The merdid anatonw and hioolofy ti a.>0oiwta. HHvdr. 14: 44$, 49*, 5SO, 1932. 25. Couetf. J OifTorcimai dia^nouo in the patlwilopy of idutad. Atm. Xm Ym* Ami. St* 132: 344, * 1944. 24. Ctao'tta. L, V. and Ojuaqm--, V. L Studies tm saptnenui pnouTtiocnoinufc \i. lafealatioii of aUrtos dun: ciTecti upon pmury tutavolM iakrriOMi J. Mwm. 13:97,193L 27. WAcwto, J. C Athoyflm'isoioiniil ammod. Smtf J. tngrnm. AM* 28j_1, IHl 3. Isnit, H-, J iboo, C. itoUquii. H. DioMkm toco 4m Luiif. Gowofy kfiidu Rflncfonota|y. Stutican, 19*0. GiveTMom 29. WOajca, H. CW irtwoi foils 4m Adotua To: Dio IisuMoofsnwfcfahunpSM, mi. 3, p. Ml. ZMiH 9y iORta, 1C. W. add KtaiorMmr, W. Darrasaadu 1990. StsMopC. 38. Iau, xc t* Iam, R. A. and Scucsrr, 1. 3. Fulpmnaiy Mmim Id ardiwis af the ki^; alvsotsr lipfoy Wood lyndroyo, Ao. J. AM* 30t 23S, 19*1# 31. loo, 34, t, OadCd, R. Tnosrcta, A. S. and VwTdry, t, J. Foteonorr Oinetton t Mwc. AM, 17: 210.19A u. MeC.ua.cv, W. T. W.m. O. L. >nA Eu. T. C Ezpw< ( Cm <*, dilTu*. plnnl RMmhcJiama. Corr.poodncc, 3rk. M. J* 2: I.J7, I72. >1. Ouw, W. C. Dilfm mnaUi.tom* end aM.* < ubata. duu in Uw Mcncpid. irtt Ar*. M. J* J: 214, IM4. *. Mkiihuc a.' O. *. Tht puthmiaft M ih.li.nui. end cn iiuivii. af the 'it. I'b^tat cvpour. 7Mac. 1J: 2U, IH*. 7. Onjca, }., %'Atx. S. H. ind Maotrc, S. Hina- laficcJ chcrMeriftio t( inaailwKaM iMaeacicd oiih iitam. .<. AM M. St., 122: 11*1 17.L Wiktu, I. NlM>hUaauiaut tunwn in Snh .Mrica, h.lhoMv uid upvutcm.I r*a.lq]r, AM 1M AM. St.. 122: 2. IMS. *. bhoutf. J. I. end JuiTurc, W. J. FwUmocI nimon in MbMOtif, Ann J. /Mm .Vd, 21: 20, 17,4. JO. Cmum. J. d Jcuvor, I J. Cneraphic jMUier of m.Mw!iM. of ih hin^ 1* poc J!. L C. Jaucocr, L J. tad Omm, J. N'nda .m*. iimlciiM worlioc in (. LniMd N Stem with ipm.i reCefcnet t, l.u*..b<jocmB.l r.a.I.lR't, .An. AM 1M Mtt. St., 122: II* 1M2. (t. 43, amu I 947 "7 r.-r: ^TT; itv*. 'ttzg * v i;' SSi ra : * A? e vO Cd CA *a a DU 037118 Tjr 3` i 494 Editorial S3. Maxcvia. T. F OitONuM. .<. AW iV4 ,4rW. Xr,, 132: S90. 19*1. 53. J*eoo. C. and bonuc. K. Rocnternutoitvai com* piirMtona in pulmonary .uMiouii Amr*r. G*i. Afa/;mrofcW *3: MS. 19SJ. 54. Scuxorr. t. J. The ucturrciKo of 9toif.1l caiciAca* tian atiw< aibatos imwiaoon woi-koro. J. AW Fr4 .4rerf. 133: 3S1, IMS. S). N*iucr. 0. Some obvfvntwm of the duu contem and campcoKioo m lun* uh nhnowv Am. AW IV* .U*1. St.. 132: U. 19*). j*. lv*c*to. J. C Eaperunemal production of ntoo tltcHai nimoun of Hit pleura by imptaatauon of duM io laboratory oiummU. AVorr, 19b: ISO, 19*3. ST. Sm, IV. E MlUil. L. Gtvae. 1. ami Souaorr. I, J. MnoilugOMtoo iu Haiiwun feiiowinj iiura* pleural inj-eunm of .ubntac. y. ,1/1. 32: 1, 19*S. SI. S*m, W. C.'UnpubUdfd dace SI. Rocato. V A*b*ow*. Iu ImJiAtriaJ Aflpticattynv pi 4?|. Nov York. >V59 Kemhotd FuOibOtnr Co. 10. HawuO>. E. tvidrnco on iho *freu of ctvtnf up ^vi wnolcmf. .im. J, A*. H**iUk. S3: 442. 19*5. *1. Guuo*. J. C Moo amt aibwtoc. Aa. AW Tmk Wed. *.132: 9. 19*J. *2. Report and rocomowiwadom of the nr*i grout on itiNMt and cancer. In: Kicieftcai E5rca ef AiheOQC. .4m. AW * 4rod. St , 132: T0. 19ft). I). Scuoorr. L J., IIamuOao. L. C and CrfVic, J. VApvbUabcd data* *4. Hiua, 0. W, Economici of duet control. Am. A<* fart .trod. *,, 132: 322. 19*1. yr TT?TSr! liine pvi^il Of o 1 o 1 e 11 r DU 037119