Document Grpzka8y7r3LKObRM1rY1Q7Y
4 Jrh. 3. faduur. Med., I960, 17. 260.
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DIFFUSE PLEURAL MESOTHELIOMA AND ASBESTOS EXPOSURE IN THE
NORTH WESTERN CAPE PROVINCE
BY
J. C. WAGNER. C. A. StEGGS. and PAUL MARCHAND
From the Perhelegy QM.tbit, Ptsrameranirtiis Rrstaeth Unit of ihe Ca/wif for Srkntifie end
Industrial fUuwrh, JohemeThurg, Hess EndHospital^ Fbthftjrx* oud ihk'. -JUT*- , Drpo'lmfoi of tto*orit Siwgrry, IWiw/ij /ihr U'iixairrs'endead Johanntfhur^ Crnrrel Hespiiat
' (fticiivio o* K'8uc*hon Ann. 54, I960)
u. \
Primary malignant tumours of the pleura are uncommon, Thirty-three caves <22 mate*. II females, ages 31 to 6> of diffuse pleural mesothelioma are described: all but one have a probable exposure to eroeidolilc asbestos (Cape blue}. In a majority this exposure was in the
Asbestos Hilh which lie to the west of Kimberley in the north west of Ope Province. The tumour is rarely teen elsewhere in South Africa.
S' KMt4c
Mesothelioma of the pleura is regarded ai an uncommon tumour. In the last four years u* have
seen 33 htstologlcaHy proven eases; 2$ of these had some association with the Cape asbestos fold and four easel had been exposed to asbestos in industry,
The tumour Is rarely encountered elsewhere in South Afrfea. During the past five years, wsth the exception of the present series, no neoplasm of this nature has been diagnosed amongst 10.000 lungs examined at the Pneumoconiosis Bureau in
Johannesburg, or in the Pathology Department of
the South African Institute far Medical Research. Higgmson and Oettle (1937) 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.
Ow first necropsy specimen of pleural meso thelioma wHh asbeslosi* was examined at the
Pneumoconiosis Research Unit in February. 1926 (Case 1). During the early months of that year,
one of us <CA.S.) in the Nonhem Cape, treated six patients with gross pleural thickening, Pleural biopsies from two of them showed the features of mesothelioma. !n the ensuing two years, etghi
funher cases were found from this region and five from elsewhere in the "Union. Touring ihrt period
GA.S. had become perturbed at the number of these unusual tumours occurring amongst hit patients, and stimulated as investigation. At this stage ihtrc were two masons to suggest that asbesios
might be implicated. First, asbestos was found In
the lungs of the first case (Case !>, and secondly.
10 of the cases came from a hospital to which
suspected cases of tuberculosis wtrt referred from a
large asbestos mining area. This hypoihwis could
not be supported at once from the original histories
obtained from the patients, for they included house
wives. domestic servants, cattle herders, fanners, a
water bailiff, an insurance agent, and an accountant,
none of whom we working on the asbestos mines
at the time. We therefore undertook a detailed
investigation of their past occupation and place of
residence, end the tssodBiien with
ex
posure was discovered. The oases are summarised
in Tabk 3. Previous biopsy specimens ware re
examined, and new* eases diagnosed. iucUiding
asbestos* miners. In only one case do the relatives
deny that the patient either veiled the asbestos
mines or was exposed to asbestos.
This is a preliminary* publication and the problem
is being intensively investigated.
Y* V*;',
The Asbestos Am of the North*West Ope According to Hall (1930} asbestos was discovered
- S4
by* Uchenstein near Prieska during his travels (<*
and ISOS. Since then it has been >* i established that the asbestos deposits exited from
20 milts south of Priest*, northwards through the
western part of the magisterial district of Hay. to
the eastern portion of the magisterial district of
Postmaaburg and finally, to the western area of the
'
WV-004281
DIFFUSE PLEURAL MESQTHEUOXtA
261
district of Rumman (fig. i). 7b* deposiw occur
b> the slopes of a range of H|U covering as area of
approximately $.000 square mite*. Known as the
"Atbtftw Mountain*". these fefll* extend more or
less longiiudinafty between 22-50" and 21* E, The
whoU area U terni-arid, sparsely populated, ted. apart from mining, cauls ranching iy the only
important occupation. In (he Kuruman area severs]
large tracts of land inorabutting on these mountains
have been reserved for the aboriginal inhabitant*
and here whites may only reside in the immediate
vanity of the mines.
The type of asbestos Bused throughout this area
is crc*2do>w, better knows M Cape Blue Asbestos. The chemical analysts ofthe fibre U given is Table 1.
Ootidoiiie is the fibres form of r&bcckte ac<aS
sugrt of transformsuon from a massive riebedite rock ^ou^ 'ismeto -ricbeaite to -aabestitom
erocldofite occur in this ngfojx* Mejpe
frequently associated with the croddohte (Vermaas,
19S2L '
.*
, Mining of asbestos first began in the Prtcsia
district in 1893 and gradually .spread northwards.
- *3' Vs'*.
Is 1906 production bad begun to the Kurumas dis trict. Between 1916 end 1918 a Urge number of cfaimt were tabsa up. 7his aonbward trend ba* coBU&ued and in about 1950 mining started at femfre* near the Becbuanala&d border (Tabu2).
Initially the ore was quarried in numerous small open cast workings. This was followed gradually
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CHfittICAl ANALYSES or CROCflWLrtT ANO AMOOTE
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VOFUtATiOK OF THE MAGISTERIAL plSraHTTS W WHICH ?Hf ASBESTOS FIELDS ARE SITUATED nikn i#n IMm CoHgt l(JI. nfl l?lli
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by a type of shallow mining; radioed *hafi3ng be* today the eon-whi* prates to v m cW m
came more common after 1930.
possible, and the children play on the dumps from
Acco.ding to Frood <}9J5), The quarrying was a the mine and Bull.
family aFair undertaken by the local inhabitants.
TTie men quarried the roc*, which was sorted and then hand sobbed t*y~ihe women and children.
Hand cobbing cotnim of separatist the fibit from (he banded ironstone by striking the rock cob with a small MiMict. As the mathta is selective, a
Case Hfeferies
The foBovmg eight au hfttetit* fihmreu sariois aspects ofthe disease and the different ryj** of capetur* to atbestos dtm.
rotary sieve was sometime* used to grade the fibre
C*m I.--B.F,, a Biots male, 34 years of age (bon
and tVuntaste (be small particles of dust. After 2P30X was a udne bbourar, and > the first cas*.
grading, it was bagged and weighed. The asbestos was then transported by donkey wagon to the nearest rafl*head. Before the establishment of the saltway in this area between 1923 and 1920. such a journey could last as long at 13 days. TW* transport eras
generally undertaken fay white youth* ffarmers' sons) under contract; The fehc inhabitants played very
frtile pan in actual recovery ofthe fibre, being nearly always employed us tfee role of managers or over* seers, issuing floras and supervising the grading end weighing of the fibres. Farming activities were and
are still carried out round the mines. Since the 1939*1945 nr, the demand for crocuSo-
file has enormously increased. The. lucrative e!aist& have been bought by registered companies. others
bftvg bon ataivtafttd. As foeptr and richer
deposits have been found, vertical shafts ate being sunk. However, the mines with large shallow deposits ere still using the inclined shah and tunned and quarrying Is still used by the few remaining
smaller producers. With the building of more mUH. band cobbing has diminished. In 1915 the first crushing miS was established at Keefe* m the sooth.
This was foUowtd by a large miff at Kurvman
dia^soudas a eteseiheUama w'hhevUtncwofwAotoda. He was bore in the Kurcman district bur h is not knows whether he worked cn the ukttm vt&ntx. He was
employed oe the Wrtvwtmandgold-tnbiet underground for two years and bi (he change toon* for a further It years.
A radiograph taken si a cafoe boephal os Agoe 3V 1955 showed a manhe rtfu-sided pleura! effusion, and 3,000ml, ofthud net withdrawn. Ha wetadmitted lo Um Whwitencraod Karri* Labour Aasodatlos Hospital on August 24. 195$, sad two days iutt aspira
tion yielded 1,000 ml of thick gelatinous pus *Vhkh could be pulled otd in threads". He w%* trend whh frequent aspirations and Instillation of varidu* bet without ftnprcvemsa. sod be 4U4 a Febrwer* 15. 3956(hfanlrty. im
At autopsy the right thoracic cavity was eteupled by a large ge&tiaoua tumour which die?bad the mediartk flura and compmied the left king. The tweo bad' Mfihrated the pericardium, The right Jung was com* pkitfy compressed by MOflauie tissue <Fi* 2) bm the right bronchial tree did not p' any evidence of a
primary bronchogenic carcworaa. Hiatokgreal rattiora of the pleural growth showed a papillary mesothelioma (Fig. 3). Thera was evidence of atbevetis In both lungs <Fr*. 4>.
(operated between 1926 and 1931) wferc U was a' Cbs* 6--K,H.. a hi<e female. 56 ye*** of age (bom
situated within 300 yards of the main street, close 1891k wit a social worker, who could only havt bid %
to which cobbing was aUo dot* for a few years short exposure so asbestonra* a child and probably a *
(1927*1930). This was followed by a mill at PriesU further slight exposure as a young omtti Sbt.snry
is 5950. which was completely rebuilt .in J93J. have jakl-aciera? abort vrm to the mines with her 43rlquaNwti'had* tmaa mill In 192S, The practice , husband at a later period.
today is for one mill to serve several mines in the immediate vicinity.
She was bom in Oriqusrown where she tried until * s&e was 5 years of age. Her tm$r then moved
lUmbertey where from 1914 to 1922 she sorted as a
to the early days the manager and labourers lived clerk in aa tsfeesiot warehouse. Her fau&scd oada
within * few* yards of tfeh place f work, and even . asbestos mine from 2933*1940.
DIFFUSE PLEURAL MESQTHEUOMA
263
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She Y.%* referred to the West rwj Hospital, Kimberley, o July 19. 1954, because f dyspnoea *nd right chest discomfort of scute onset. The chest radiograph showed a iocul-tcd pleural c&auon at the right base. Straw-coloured fluid was aspirated. which or eaamins* tioo was found u> be negative far M. UtbtrtuJatit but
contained mesothelul cells arranged ha acini. At thoracoscopy in Johannesburg on August I?. J954 tumour ooduies werewen on she parietal pleura. Histo* logical evandnutoa of the biopey specimen showed a mesothelioma. Deep therapy and radio-active gold buuUaiioa in September. 1955 caused initial regression pf both the pleura! fluid and nodules bui did noi arrest the progress of the disease. She received a further course of *-ray therapy without improvement and died in January. 1957. The liver was enlarged and nodular before death but no necropsy was done. <Figs. 5, fi. 7. sad S show the radiological development of the tumour io this case,)
* Oue
,B*wo' male. > yean of ageTbora
39!f). was ao asbestos miner, He was born in the
Korumafl dairies and as t child often played on the
asbestos dump near an asbestos mine. He subsequently
worked with asbestos for several yean, being employed
at an asbestos mine weighing fibre from I9JS-U. In
J943 he *cried on a tVbw&tmraad gold mine bul
returned to the Kuruman district io 390 where be worked as a farm labourer until his Anal pines*.
He-w*sadmittedtothe West EndHospital oo March 9, 2959. He had been well until July, SMS when he became awart of pains in the righi aide of his chest, in addition he bad a slightly productive cough and short ness of breath oa earnies. Chest radiograph on March 9, 3959 showed obliteration of the right lung fleld. Asbestos bodies were found m she sputum. Headk biopsy *hwtd hissbitguaV features toounc&t with a mesoihcliorna.
AvrorsY.--7he right chest wW occupied by a huge whitish tumour which infihraied the mediastinum, mending through the diaphragm onto (he superior surface of the Iter. A straw<loured cflusioo was present in the left pleural sac but the left lung was cot effected. The mediastinal, cervical, and pva-aonk abdominal lymph glands to the level ofthe renal arteries ware tafiUrattd whfcuwwt.
1b Che right lung fe was food that the tumour mas* had ia&hrated along the interlobar fissures. The lobe* of the hag were compressed huo three small aegmsou (Fig. 9), On histological section a papillary type of pleura! mesoihcliorna was sees (Fig. JO) which had infiltrated into the tens parenchyma in some area*. There was marked lymphaik spread throughout the
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BRITISH JOURNAL OF INDUSTRIAL MEDICINE
lung substance. Numerous ashrsfcw bodies '-ere present haemoptysis, H* w**% nfrmd jo_p JehsnMiWg .
v*. ibt %\t spaces and occasional bodies and fibre* were General Hospital for rniTStigjitioft, 'The ebest tag**. '
teen ft the fmemftiat tissue. The ten*
graph showed frost pteural thickening with a ban?
markedly atetectr'.ie. Evidence of nsbenesis * pleural effuskm osto kfl tidt. He .was afimlfled to*8*-
>b?veS in j>* kfr Jung.
hospital and on June 10, (957.a thoracoscopic pkutat biopsy was taVrt. Thu*showed the features of a meso
Cim IS.--S.S.V.. a white female, 42 years of age thelioma, On June 24.1911 m> asumps w dccorticsUoo <berm W6), is a heusevite. w*o l^wd cm a mine near was made. The left epprfr lobe was gripped easily bu
Johannesburg and t( treated tc* uxbemateei skurny the grossly ihkgeaed pleura was so adherent to the
for aia months, it was only after the histological low lobe that the attempt wasabandoned. Sections of
diagnosis of a masoOuBnma had Hen made that her the pleura confirmed the diagnosis of roesoihcSecm.
previous history wit obttteud. \t> addition, h i' He died on December 13.1937.
subsequently karat that her father (Case 2?) had been horn on Ox asbestos field and had a long miotng history.
The pattern was bom vet the Ov*wato*ri disiiirt and
win* to school jj.Kstrwnan, She spent most of her
Case It--A.N V,, whitem*k-S0 yyaraj>favaw4bmw 1909). was a farmer, who vrisporn at Criqimtowa and were to vtUag* tcbocJ naas * asbestos mine. From
yooth in the asbestos belt. She hat lived nearJohannes* I9/4-J6 he transported asbestos In donkey waggons ft<o
burg for 20 years.
Hay to Frleska. During theseJourneys h* often skpt on
In March. J9Jf this patient developed righi chest pain asbestos bags. Ip 19U he wmbed an asbestos mlae
and rapidly increasing shortness of breath. She w foe a month.
admitted to hospital and 2.50ft ml, oT slightly blood' The partem became it? in December, 195! with vag
stained Arid was removed from (he right chess. A JirMterTXi? pace* and dv^mtea, A Vft*ded pkora?
thoracoscopic examination i> earned out on July 27, effusion was tStagnosed and hr was referred to Mr, I, K.
when a small biopsy %v wt*f bar \>n\ tenanted of Brcmmcr la Pretoria. There was no evidence ofrraj^.''
fibrous tissue, flronefeoseepy was normal and no nancy tn broesdeal and scakae biopsies. Some splcil
neoplastic eeBs were obsmid In the bronchi*? washings. pkyral thictenh^ and a dense homogeneous opaey *t _
M, raikrrt-Ajttt was not ensured ftom maneraui specs* flse base cf the lefi tung was sees In the radiograpb oa
mens of sputa, pVurs! Ihrid nor from she bronchial August 3, 1939. Thoracotomy {Mr. Fremmrr) lo ; washings. She was admitted to a Joha&nestorg nursing February, 1937 revealed a thkkentd aodalar pteara *'
home os October if. I9$t.
Hfh a largemassem theleft diaphragm. A mesothelioma
Radiographs then showed ma?* tfekJceninc of the was seen or. hhtole^cal section.
right pleura u ith fluid m the right chest. At thoracotomy In ApnX J939 be wj examined b> Me. J. D, Vis,*v in
(Mr. Dennis Putter) the p*i*mt pleor? wi 2 cm. thick,
"ba*d as rock"and stripped wrtfe great difficulty frora the Chest w*B. The visceral peel stripped thirty easily from the uppet fabe tot separation became more iiffeuh over
Klmbertey who found small notates Id the subcutaneous , v'tt tv*? vhe neck and ghe^. A large firm maw was
found hi thr thoracotomy wound and a m*uaspmatA in the tefi hypochondrium. There was generalized
(he lower lobe where the peel was thither. During the IsmrpbadenopMhy ted numereus nodubs ware present '
deconication i necrotic mass was found in the paran* on the tongue. OveMrwedgrarttAowndttUftpJsmal chyma ofthe teft l^ver lobe. At she Wb fioftflwdl udth cavity to be obliterated. He v*at onefd few eases to
thr diaphragm and perhaps the srsjgattinum.wis * hard develop vridaspiead tnetaytasea
craggy mass which could not be removed. Histological A biopsy of one of the subcutaneous che Bod4e aectiost of \M sperimta mealed eo adenoid form of showed a similar appearsnee to (Hose seen In the original
tubular mesothelioma. Subsequently throe syeormm, specimen fn ihe pkun. The pstletK died on May 22,
of sputum wire examined for asbestos bodies bin none 1939. No neerow wa\per(Merit4. were found.
The patient is stiff alive (April, !0|, but her condition m Case 34,--'D.O, a white mate, 32 years of age (bom
> deteriorating.
1922). by prfrfesttenanaeccunUav.wwvtomin IngJanfl
but came to South Africa as an hvfanr. He spent fas
Os* 23.--0.AA, a white male.<6 ?wtof sft, and a aarly childhood in Kurumsn and teft althe age erf 7. He farmer. was the father ofthe previous patient, Athough later qualified ti a chanewd ascowmom in Klnfirerlcy. diagnosis of pleural meaoihrSpma was nude In In 1944, at theageof22,hehad been dfeefcargedmedically
January, *93? it was not umH July. 1959 that dett&t of unfit (torn the mty because of a kfl plsura) effut^n.
Ms exposure to asbestos was obtained.
Neither (hen not oa many oJ^tfwa.occ*r*iorft"ms
Me was bom m GHqoatowis and went lo school these. . ^aeid^teai'bitcISIbund, cither In Ipulum or pleural fluid.
He worked.la Kunirrum. PmumSfrurg end Gr>Qutto*m HH only subsequent contact with ashesins was the
until the age of d Between 1911 and 1932 h* worked auditing of the bonis of an tmosht mine In the .
at an evb*es miner underground and was mostly In Transvaal.
Charge <4blasting. fetwweo 1922 end 1944 be armed to In September, 2933 he eompbiocd of kft.slded cb* )V'
{he district but returned to asbestos mWng from 1943 peiru and shrnnmofbreath, A radiograph of the &ta ;
to 1932.
showed flattening of the diaphragm on (he ten side with ^..
In January. 1991 (be patient csmeuHed W* doctor be* obhteration pi The eOMophrcnfc anpte and thifikepin* of *'
cause of fcft.sidcd chest palu with cough and slight the ebSque Sucre. He w*tsaeftewsuttctous occasion* ./' *
DIFFUSE FUUFAL AfESOTHEUOhU
267
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FAM-Ot&wnWUatW.
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Iron 2953 to 1957. A radiograph tikes t*rly m I9S6 and these have revealed that during the refewu periods
tluM<d the ttesttopmci* *rf * left superior mediastinal Cape erocidoliie **s eselutlwly in use.
lhado* whi4* enlarged progressively (Rp J I) and Uur He eras first seen on Match 14, 1939 complaining of
; the <U Iopmc of dilute noduktf plcurd U&ksi&g serous,pan the right dhesi and recent oraei of breath*
on the left. During 1937 tinker bul few markedchanges fewness. .Three pints of fluid had beers espiraled from
*ebpd on the fight side (fig. J2>. He consented to the pleura and cytclt*e*i eusUnutotv showed the
b'`an*> in June, 3957. end. at operation, a diffuse pleural presence of malignant Bt The radiograph showed
malignant* was present.
marked pleural thickening and hydro-pneumothoraa.
Sealant of the parietal pku'ft only oweremoved and Os March 17, J939, * ihoracoioopy wo* done. The
the feftiologieai gppearaacci **tt thou of roeso- pleura fek thickened and the lung was coJfepsed and
theftcmi. He died on October 6,1937, A necropsy vat immobile. Several twepsfe* wm taken. These Shewed
** net peifonnetfr
the presence of a nuwtheUomt. The underlying lung
Case M-Cf,, a white cutfe*, SO yun of age (ben
l909j, is a storekeeper, with 4 Muruy of industrial exposure. He hat nr\Tf been near the Cape Asbestos F*td.
showed the presence ofasbcsto&it. He was ucaud with
nitrogen rmaurd bura-pleorally and his condition
fcrepeeanly Improved. When fast examined he cent. pfenr*d erf increased brewhfestnest.
He was bom in South West Africa and lived there until the ape of 22. From the age of 21 to 2b be worked In a
tfaceiBta
factory ia she Cape as a bo&r-nuilter end finer. He volunteered the information that he had worked con tinuously iih atbrsios. lagging pipes and bciferi. He
remarked that the removal ofasbestos lagging from old pipetcreated* very dutiy aunospbeit and that he would wwgb a lot at sueh work. Between X and 32 years of age.he^ortnsdrfn a Acro*r fo /onaswestwsg te % similar capacity hut was not exposed to such heasy dust con centrations. For the past 20 yean he had not been in o*v with asbestos. Enquiries were made from the factory in ihe Cape as to the nature ofthe asbestos toed
In 2924 Robertson denied the eaistence of
primary natignan* tumoan of the pleura and con sidered them to be secondary in origin. Since then, on the one Hand. Wtttti (194$, 19S5!> 7id Smart and
Hmsea U93?) have suj^ofled Aohcuos's views, while on the other haodv primixy nwpUwM of vtu* nature have been described by many author* in recent years. These Include Tobia&tea (1935) ia Sweden, Bdloni and 9ovo (1957) in Italy, Godwin (193?) in the United States, and McOaghey (1938)
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m Rrita'm. L't&nre m junv't* ol \bt mcwilwha? .1 He anKHjm rt_nimchonsetk sub^nt
origin of th< lumour* can he found In thf rif<ir iiinymn ha varied *<*/*abU
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appreciated the solubility rf* hyaluronic 4C^
The variegated hfctologieaf pattern of tumours,. aqueous media and (he majority of tbne tumour*
arising from (he frtesethelium of the pleura. was were fi\cd in 10% formal-saline. Further.
remarked on by K femperer and Rabin 0931). Such 0953} states that the mctachrcmasia of hyiforanii
e variation.1* appttrialed when the irrrinpoienttshty acid Is optimal at a concentration of I<10.000 are
of the ceils lining coelomte caplin are considered. gradually decreases at higher levels. When the
Maximov fi( demonstrated ihn feature frt 1927. . concentration* shat Meyer and Chafe*
tfcfl,
htorak (f9AJ> staled that (he mucosa of *U pans of focmd in tteir tumours are considered, this variation
the MGIIcrian canal and the. germinal epithelium in metachromatle properties seemf to here }<~
were derived from these cells. Ktasbe? 11941) . psfttolly,aa|damed.^'tr>^bdHk>flr''fltir^ pu`-<
showed (hat ki the embryo, the mesonephros, differences in tht histology of the various femora, (j j
rtwisnephros, Wolffian body, genital ridge, and all would be logic;'1 to expect certain tumours (& %i
dependent Urogenital structures are derived from marfced adenoid appearance to secrete more lij-
the moothelium,
those with an essentially non-glandular structure
Campbell (1950) considered Ore presence of both Three of the five autopsies performed ihe;j
epithelial and mesenchymal elements a major evidence ofperiioneaf mettsta&es. }n (he otherrc.I
diagnostic feature, in dcscr&mg the histology of lntra*thorriespread was observed. in oneOir to dr i
\1 ofthese tamcow MrCaugheytWl>demonstrated other lung and chest wall, and in the second to dr
that either ihe epithelial or the mesenchymalclement mediastinal lymph glands and pericardium. Bmp*?*
might predominate. He riasffied his cases into the evidence of meuscases has been obtained in Pee*
following four groups: Tumours of epithelial cases, one from the omentum and the other fromthe
character; tumours of mesenchymal type; tumours subcutaneous tissue ofthe chest wall: while a third!
ofmixed type; and tumoursofanaplastictype.
patient developed an implantation nodule tn fir!
Using McCBught?** classification on our series thoracotomy scar which should a similar apparent -j*5r
oftumours, the majority arc, as in Campbell's senes, to that of the previous biopsy specimen.
of the mixed type. Of the remainder, a few showed The first recorded case of carcinoma of the k: the papillary gubuTar structure of the "tumours of associated with asbestos was described by Lyref
epithelial character", and then wxre several of the SLbd Smith <I95S). By 195$. *eto>dtng to DoS, t
anapksdc type. One case had the appearances ofa total of 61 eases had been reported- Included it
"tumour ofmesenchymal type** but even in (bis case these cases was one mesothelioma. Cirtie? <1952*
primitive tubular structures wtre mn.
mentioned two cases ofdiffuse mcsoihcliom* from*
Apan front the origin*! as* *11 the histotcgrcal Canadian chrysotile mine. .A further three cash
diagnoses were made on biopsy material. 7hr of were described by van dw Schoot <!95f).
these biopsy findings were confirmed at necropsy. fortunte)y no indication fs given ie the Stcrsiarr l....... la the remainder, w have had to rely on clinical regarding the type of asbestos o which the majority 7^^':
and tadfatogteal examination to exclude that of recorded case* of carcinoma were exposed. v*`,`1
primary sites of malignancy,
Howerer. discussion with management and medial;
Following the worfc of Meyer and Chaffee (1939. officers of two of the factories, in which the Kusom;
394DJ, the possibility of demonstrating hyaluronic of the cases reported In Britain were employed,
arid in these tumours both chemically and hfoo* suggests that most of these verier* were handling
chemically has been considered u a diagoouk aid. chrysotUt asbestos (Vfogner, 195t>. Tl poslbOity'
Both these investigarioa* are still m an early stage that tome of these people may also hax been
(Harington. 1959).
exposed to croddolite dust cannot be excluded.
Ffthrntnary results of Ote hlsiochemtcal experi
Attempts to produce tumour* in experimental
ments show that there is ractachromatNr substance .Animalsfey<c*pgnmsttyrrrto asbestos dust ha't bsstt
in borh rhe stroma and glandular structures of the made, Vorwald and \n 11932$ were `ansuccsahab
tumours. This metichromatta can be reversed by Lynch, Mclvei, and Cain (1957) succeeded ui pro*
incubation with testicular hyafcirortidase. 'This during tumours in mice, but lung neoplasms m hb
material tufa* strongly vrtth Hale's\1946) ccftoidal control animals were far too numerous for the
' iron method. The periodic add Sefalff technique result* to bo considered significant On the otbef
has given variable reactions. These muhi ere not hand SehmShl (1951) voc)dg tn OntffcstyH specific for hyaluronic acid but ere Wrongly laboratory has been able to produce rawmas te
suggestive of Its presence.
rats. This has occurred
subcutaneous *od
*'...
. ~.i4. a-t.vr.Ai. ajt.yJltiLHOHA
if#
,r>nap<fjtOT>cj| inoculation of both asbestos fibres (Table 3). Eighteen of these 29 cases were bom in
and dust. He stale* that '`mineral aibetiot" was the vteu&y of she mines and two arrived in the
uid bui does not njm (he variety.
district as infants. Of-theae tg people-)) admit
Jo our series of mesothelioma(a, ftmologieaJ definite Childhood exposure*to the dust and two
vvSence of sb\w,ij has been observed in eight others were exposed industrially in later lift. In
of Ihe 10 cases in which lung parenchyma was in- addition two patients with childhood exposure later
eluded in (he specimen examined. No lung tissue worked in tM asbestos mines. Three cdtet arrived
was proem in the biopsies from the remaining in the regionatan older age but wereemployedeither
2i cases. It was only in the four cases that came 10 on the mines or in transporting asbestos. A further
necropsy that Urge sections of the lung, muse were three of these IS caves Wave bad industrial exposure,
available far examination. In all of these specimens sod in only one case do the relatives deny any
evidence of asbcsiosls was found.
exposure to asbestos dust.
M 6n* ta was thought that the presence of The four industrial cates are significant Two
numerous asbestos bodies, fragments of fibre, and of the patients were lagging locomotive boilers and
du*t immediately below the pleural elastic laminae one was lagging swam pipes. A man, who was an
in these specimens, might have been significant m upholder by uade, was employed io making
the pathogenesis of the tumours. However, jt is fire-proof clothing from I?39*jjbl5. Avfttft can
more ptobabfc that this dmributkm.K a rctuh of the be ascertained "these pedj>sr'*irrp never in the
marled aftkedsts, Similar features have been Griquabnd district. Thete findings tend to add
observed in airieeutie lungs of asbestos miners in support to asbestos being the common factor &t the
u'hicb no mesoihefiomas have been observed.
development of these tumours, and to counter the
Pleural fibrosis has been a common finding in suggestion that there may be some other environ
cases of asbestos!* and to. some caae& teg* pkmxt mental cause v> the region of GriquaUnd Wat.
pLquex measuring up to 2 0 cm. in thickness have
If asbestos dust is a factor in the occurrence of
bech seen. These plaques, which werefirst described these tumour*, similar cases might have been ex
by Ooynr 09}}}, have been observed following pected from the neighbourhood of the Transvaal
exposure to both amostie and crodidoKM asbestos asbestos mines in the Fjetersburg and Lydenburg
dusts. In these cases of benign pleural thickening districts, where ceoededta and amoriia asbmtn Vs *
no evidence of stromal cnetachromasia has been mined. According to Vemaas (I9S2J, crccidolhe
observed. *
and acnosite occur in the same aearns In the ffietea-
, in aft the V^ologvcai sections of pleura examined burg district. Aa can be s&n from Table I, amosiie
in the cases of these mesotheliomas and in more b similar in composition to croddoliu, Xo ehe past
than 100 cases of asbestos*, no asbestos bodies, four years she liras* of 2d cases of asfeettotU from
fragments of fibres, of dust have bees observed the Lydenburg district have been examined. In
beyond the pleural elastic laminae.
this material two cates of adeoo-carciaoma have
Three pa&n*& from the Kvnxman fifetfUa, writh been observed. The one.was m a white miner with
clinical and radiological features consistent with 19 years' service, who had an adcoo-cardnoma
those ofdiffuse pleural mesothelioma had markedly arising from a bronchus. The other cue at *
abnormal crib |n the pleural fluid. These cells JSamu miner who Had t peripheral tumour Ho
showed no specific features to distinguish them from service record was obtainable in this case. Only
cells originating' in seconder? malignant pleural one save of asbeaom has been received from the
deposits aw from the grossly atypical cells some Pftsctsburg area. All of these men ware actually
times seen in nozwnalifnant pleural effusions, As employed on the mines at tbe time of death, the
nobiopsy or autopsy examinations were obtained in majority having bad a relatively short seme*. Our >
these eases they have been excluded from the scries. findings suggest that mesothelioma occurs 20 to 40j
The pathological evidence for associating these year* snore after exposure to dust. Until com-'
tumours with asbestos exposure h pot conclusive. parativtly recently the mining tn the Transvaal
As previously stated, only tn eight of the y cases has has beep on a small scale, and there were no settle-
evidence o(asbestos been demonstrated. 01 these, menu in the vicinity of the mines.
six had a definite mining history* and one Had been The lungs of 20 asbestos miners from the Cape
exposed to asbestos^while lagging steam pipes. The Asbestos Fwld have been examined, & whom other ease was bom in the Kuaimsn district and mesothelioma wasobserved- One autopsy specimen
Editing cbe b fattwa.of.fejja,.i*o*i2fe'arrival %< combiing of three fragments of Jung showed
'*Wjiwaunraad goW-roiot at the age of IS. la the asbestosis sod an adenocarcinoma. Radiological
remaining 75 cases we can only present circum features of asbettorij haw been observed in many
stantial evidence of exposure to asbestos dust miners from ibis region, without any suggestion of
270 BRITISH JOURNAL OF INDUSTRIAL MEDICINE
Tu 5
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titionen of the Grfooeland Wed Dutria feed the * *'
DiffUSE FLEURAt MES03HLU0MA
271
> hot?cie surpeon* and piihok>g>it> m Johannesburg, Prtfptw, and Durban, WY thank ihe Secretary of Health for jxrnujm'n to pubhh ihrt jwoer.
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By *h nd ef June-$60. a twaH^^TaSff'oT" mwhcliom8 had been identified. In 4S of time a poisible association whh eiposure io crocidoJiie hu been esubltshed. Jn one gau * mesothelioma of the peritoneum was present.
-alif*63.
THE JULY (1960) ISSUE
The July f1960} issue contains the following papers:---
S * '<*'
-'A V <;.; **oKbd%s
Decorspression Skfcness during Coostmclioa of the Danford Tes1- By F. Campbell CoUing. P. Griffiths, H. V. Hempteman, W. D. M. Patoa. and D. N, Walder,
A Cwspanwn ef ate M High-altkede *' and ** High-pressure " Syttdromes ef Deeenpressien Sickness. By M. de G. Cribble.
Phosgene Po&miBg Dutcd by rtrf Use ef Qaeaiieal Painf Remoms Comafnisg Metfitfriw Chloride to IlhtemiUtcd Rooms Heated by Kerosene Stott*. By W. B. Gerritsen and G H. BuKhmann.
A Study on the Acute Touch)1 of (be Trl-aryl Phosphates Used at Plasticizer*. By H. F. Bon4y, E. J. Field, A. K Worden, and 3. P. W. Hughes.
AcrcncA }nha^tion of CaNBjE-D.T-A. (MosstS) by WoAers Constaafiy Exposed to Vead Poisoning. By U- Peucnf, M. Siankovk, M. Savieevid, and D. Polets.
A Biochcotka! Study of the UHaaf}' Protein ef Men Exposed to Meta&ie Mercury. By J. C. Smirb and
Agnes R. Wells.
__
A Simplifn-d Method for the Estimation of Nickel in Urine. By J. Gwynne Morgan.
' CUmcak Bronchoitraphie, Radiological, and Physiological Observations to Ten Gises of Asbeno&is. By G- L. Lcathart.
Tbe Mea&urem4 of Occupational Mortality4, F. D. K. Uddcll.
Observations on the Occupatkmal Life Hhlory of the Coal Face Worker at To ColUerla, By O. P. Edmonds and D. S. Kerr.
The Assessment ef Bectro^icephaiogrBphk Changes and Memory Disturbances (n Acute Inlexicadons 7tb lodossial Poisons. By B. Qiahipa.Synkovi. and M. Sev&ik.
Book Rcrien*.
A number of copies an stPl available and may be obtained from the Publishiag Manager, British Medical Association, Tavistock Square. W.C.1, price Vs. 6<f.
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