Document M4x7Y0pn9GOvN3n3boVy9wqq9

PERITONEAL TUMOURS IN ASBESTOSIS 21 whatever cause are referred for necropsy. One of us is usually present at the examination or is immedi ately informed of the circumstances. Ten of the cases described were discovered in this way. The surviving patient is an asbestotic whose complaint of dyspepsia led to investigation in the light of previous experience. Type of Exposure There are three commercially important types of asbestos: chrysotile, crocidolite, and amosite. The latter two are grouped as amphibole asbestos. They differ in geological formation, in chemical composi tion, in crystalline form, in fibre size, and in many other respects. Wagner et al. (1960) have reported primary mesothelial tumours associated with expo sure to crocidolite. In North America primary peritoneal tumours have been reported by Cartier (personal communication) and by Mancuso (Mancuso and Coulter, 1963 and personal communica tion) in workers exposed to chrysotile. So far there have been no cases reported where the exposure was only to amosite. Cowing (personal communication), in a report not yet published, has found no cases in his experience of workers exposed for many years solely to amosite in South Africa. The cases in this series had all been exposed at the same factory to dust from all three types of asbestos. It has proved impossible to ascertain the degree of exposure to any one type. It cannot be too strongly emphasized that the amount of exposure to asbestos was often small. The exposures and histories are outlined in Table 1. They are presented in order of the length of exposure. Clinical Features All the cases presented with abdominal pain, discomfort or ascites (Table 2). The time from the first exposure to the onset of symptoms was always long, from 20 to 46 years. In the majority of cases the illness ran a course of less than six months. In four of the cases pulmonary asbestosis had not been diagnosed or certified previously; in one case the diagnosis of asbestosis was not submitted for certi fication in deference to the patient's wishes, and in one case the patient died before the diagnosis of pulmonary asbestosis could be confirmed and certified by the Pneumoconiosis Medical Board. None of the cases was severely affected by pulmonary asbestosis. Disability is assessed by the Pneumo coniosis Medical Board according to regulations made under the National Insurance (Industrial Injuries) Act 1946 which came into force in 1948. This is expressed as a percentage except in the cases of two females whose disability was certified as `total'. Such `total' disability is the only alternative No. and Hospital Reference Sex IF Queen Mary's 26655 2F Not admitted to hospital 3M London 190984 4F King George's 98753 SM London 141164 6M London 40336/47 7M King George's 49534 8M Harold Wood 55085 9M London Clinic 2117/61 10M London 27245/56 (Keal, 1960) 1 M Hammersmith 227252 (Heard and Williams, 1961) Table 1 Age at Death Years of Exposure Length of Exposure 44 1935 10 months 67 1916-1919 3 years 52 1930-1934 4} years 61 1916-1924 8 years Alive 38 78 1937-1940 1945-1955 1939-1942 1946-1960 1942-1962 13 years 16} years 20 years 47 1929-1954 25 years 57 1921-1948 27 years 50 1931-1935 31 years 1937-1954 47 1927-1959 32 years Diagnosis of Pulmonary Asbestosis Not diagnosed Year of Death 1961 Survival after First Exposure (yr.) 25 Certified Disability Not certified 1946 1962 46 `Total' 1963 1963 33 Not certified 1956 1962 46 `Total' 1955 1954 Biopsy 1962 1961 (Alive) 26 22 30 y. 20% Not diagnosed 1962 20 Not certified Not diagnosed 1959 30 Not certified 1948 1961 40 Not certified 1954 1958 27 10% Not diagnosed 1959 32 Not certified