Document QJg8p0ZqkdEQkNDjOjQMvK4n8

'^ - ' ; ' - _' * '^m rnAiM m m ii& i im m tm iullm g ftfn S H JOURNAL Q p 1NPOSTKIAL MDIC1NE fro m b u r m ., . m m P H ENEKG/VIM * * ""* MTOMEtttAZINB CREAM *'" w m i QtsROMomopAMiDm ANTtHISTAINI ANALGESIC ' ANTISEPTIC n ip p u to w c o u a p m u -Euaa o i ta . Be&ffatbtfarmotbn Uaralkteon reqnrit AH KM brand MEDICAL WIODUCT ' M jLM fjuxfriiib t r MAY A BAKER LTD \ btttgm vru y U A R M A C E O T i C A j . S P E C I A L I T I E S <M A Y A B A K E R ) E T P O A O E S W X m T -rjtu m ik ... ........................ T H fti Ts : A S I N f i l g P H Q J ^ Q P Y J M A D g B Y T E :''^ ; : r ;:' -' ' f '*: M ii Brit. / . indus. A M ., 1955 22 S i. MORTALITY FROM LUNG CANCER IN ASBESTOS WORKERS BY ' RICHARD DOLL F rom the S ia iJ titc a l R etearek V ttti, M n S e a l R ete aixh C ou ncil, London (bechvld for publication AUGUST Itfe 1954.) Slxly-cmecares o f lung cancer have been recorded Hueper, 1952) consider that a causa! relationship in pereons with asbestos (Boemke. 1953; Hueper, between asbestos and lung cancer n e ith e r proved 1952) since Lynch and Smith (1935) reported the or is highly probable and the reality o f (he retatton* 6 n t cm*. In vkw o f the infrequency o f asbestosis, ship was agreed a t the recent Intcroatioa&i Sym* tb it large nuraber o f esses suggests--but does not postern on the Endemblogy o f L u n g Cancer prove--that lung cancer is an occupational hazard (Council o f the International OrgaidzatioB* o f erf asbestos wetter*. The strongest evidence (hat U m ay be a hazard has been produced by Mercwether a n d by Gloyac. Mercwether (1949) found that hmg coneer w as reported a t necropsy in 13-3% o f eases Medical Sconces, I9S3J. A m wority, however, remains sceptical (Cartier, I933tt WaTOm, lP f ll, and,according to Hucpcf (1952hLsuva a n d Verw gd, so that ft was thought tfesirabk to wferialte a o f asbestosis 131 out of 235) but in only 1*3% o f fresh tovestigation. ., c o s o o fsilicosis {9} out o f 6,884) and Gtoyne (1951), o n personal examination, found lung cancer in K ccnpy D a ', ^ 14*1% Of necropsies on subjects with asbestos (17 to e n 2 0 a g a to fr9 % fe rilte a tte sf5 S out o f 796). N ekhcr author g am foil details o f (he rex composhioa o f the groups ew mteed, but since women form a higher proportion o f asbestos workers than o f p m o m employed to occupations liable to give rise t o sykosis (coai-mMKfs, stonemasons, pottery workers, fomdrymea, metal grinders) and since long Since 1935, records have b e colteried o fa S A c coroners' necropsies o n person* kaovto to to rn been employed an a large asbestos $ $ & * . logical dtagnes to 105 conreeutiw cares are semmartred to Table t . D e ta il o f lbe a s to Tabu i :: rAUSRS O r Uf-.ATH DIAGNOSE a t ..... VI HSONS EMM.OYCD AT AN ASBESTOS v cancer is kisscommon among women, (he deferences in the proportions o f earner cases cannot be accounted for by d0ferwes to sex distribution, in CMueuTDraih AUenlou* rtetiwn * 4 feet the proportions which a re more properly com* parable with the findings to sificotk subjects are the proportions p f lung cancer found among men with asbestosis, 17*2% to Merewether's scries and 19-6% to Gtoyne's, Aninuaexpertowws aram coadusive. A positive re s t* w asreportedby N ordm anpaad Sorge (tW l) w hofbim d that o i lO rraaw W ch had been exposed t o asbestos d m and survived for 240 days, two developed tong caretooma. Smith 11952), however, considers (hat one a t the nth. in feel, ft exampfc o f stBamous metaphtoa and (hat th e other, an adenocarcinoma, m oy h a w developed spontaaeoBriy from the common mouse adenoma. fS n L w ,-- - Oibir d te n m o r the mpaMrr v a s te r . j AXUtMI .. 8to TJ -f t `t J - r i which twig cancer was found a r e shown to T r ito 2 Ite rin e the first half o f the period tosto deaths occurred to whreh lung cancer was found to asso ciation with asbestos, while to the secnod torff gS the period there were seven s u r i o w to i a ` ` three to which lings canacr was * ** arieatorL T li m arie r of ad employed a t toe works increased sto*rf$ , A negative ressK hasbeen reported fay VorwahJa n d K a rr Q W i* Tfae majority o f w o rk* (cited by 81 PJLPY-Oft RESEARCH IN URLO-E LENDING THF n p . - ^ A k rcasc in the number of June cencer > teenrtled ihwwib the w hole popu lation o f England and Wales over the same period, , therefore, have heen am idpaied that a rarper jtumher o f cares in which the two conditions were associated would have been found fn the last 10 years. Notional sulntions for the control of asteSKM dust were, however, introduced in 1931 (Asbestos Industry Rcuuialions. 1931) end the preeeutions token in prevent dust dissemination in 6ecoB cOberlvc by the end o f the AH the subjects in whom the two found together hod been employed e years under the old conditions, anJ 111 o f th e ttfett end women died within 39 s e n * o r heir Brat esrposure, th e essocialion of Ihe two eottdlliohs has not yet been found in any petsns taken into entploymem during the lasl 3 1 yeara (193.1-53). li is, iherefore, possible th at tire o f the period h that redocedejposore t o d r a has a&eadj^begun t o lessen the incidence and severity Method f Estimation of Rlaic Although the necropsy data shown in Tables I and 2 suggest (f) that some groups o f asbestos workers have suffered an increased rid; o r lung cancer, and (2) that the risk may now have decreased, n is not possible to he certain o f either o f these propositions without a m ore detailed knowledge o f the whole morluhty experience o f the worker*. The first proposition has, therefore, been tested by comparing the mortality experienced by that section o f the mate employees of th e ivories referred to above, who had worked for a t te a t 20 years jo " scheduled areas w hh the morta&y recorded fo r alt men in England and W ales; and the second proposition by comparing the incidence o f lung eanccr am ong men employed tor different periods under the pre-1933 conditions. The investigation w.ts limited to the small group o f menwho had heen employed for at ten* 20 years, since the labour involved i n searching out the individual records o f men employed for shorter periods would be dis proportionately great and, so far as was knows p e r 1,000. T h e from Table 2, would be compaiatively unrewarding. group in the five years 1949-53 The date o f btrth, date o f completing 20 years' 15 years, 15years, 17) years, 19 yean, and 19 work in the " scheduled areas ", and, where applic The number o f deaths expected in the . able, date of ceasing employment and date and cause therefore, estimated to be (15 4-15 + 171 4-19 + of death were obtained, for each man. from the 19) X 2-778/1,000 = 0-238. The total number o f records o f the firm's Personnel Officer. Full details deaths expected from each category o f diseases was were, in most instances, already available for the men obtained by adding the numbers thus calculated for who had ceased employment as well as for the greater each age group for each of the five periods. number who continued to be employed, since some The great majority o f the men ltvedand, when they of those who had left were registered as having died, died in the town in which the works was asbestosis and the attention of the firm had been situated, so that it would have been preferable to drawn to the death o f others, in view of the have based the calculation o f the expected death* on possibi&ty of the cause of death being industrial in the death rate* observed in that town rather than on origin. All the remaining men were successfully the rates for ail England and Wales. These, however, traced and the relevant details obtained. This was were not known in sufficient detail. U tile erro r to not difficult since, by limiting the study to men who the expected number o f deaths from t e a t aw is had been employed in one place for 20 years, few likely to have been introduced on this account since, were found to have changed their job o r to have according to Stocks (1952), th e age-adjusted death moved out of the region. rate for lung cancer among men tat the town con From the data the numbers o f men alive m each cerned was 96" , o f the rale for England and Wales. five-year age group were counted separately for each Stocks's figure was calculated only fo r the period of the years from 1922 (the first m which a man was 1946-49, h u t the proportion is uuflkcty to have recorded as having had 20 years' service) to 1953. A varied greatly over the longer period o f fee investi m an who had completed the 20 years before the begin gation. The expected number o f deaths from H ning of a year and who was alive at the end of it was causes is, however, likely to be somewhat under counted, for that year, as one u n it; a man who estimated since the agc-o$usied deatit rate from 8 completed the period before the begmning o f a year causes for live town is about 25% Idgber &a*t IjElie but who died during it, andam aaw hocom pteied the England and Wales rate ( t r . the excess was 22% to period during a year and who survived to the end of 1950, 28% in 1951, and 22% In 1952), it, wecceachcounicdjor that y ea r, halfa unit; the one m anw ho died the same year as he completed his 2(hyear period ascounted as a quarter o f a u n it Rest* 'i' <>fT' The numbero f men studied was 113 ; The causes o f death were recorded as they were o f man-years lived to each of the to peripd* t e n & given o n the death certificate or, when available, as age group arc shown in Table 3. The (o u t su m te r they were finally determined by necropsy. The causes Table 2 werectassUVcd Infivc categories (seeTable 4), and the numbers in each category were then compared with * by w en w ro t to " KUH M i*** those which m i^n have been expected to occur by ndriplylng the numbers o f men -fllivc in each five - year age group by the corresponding mortality fo r men bv Engl.md and Wales over the same -- Because o f the w a ll numbers, however, the i lion* were not considered separately for each b u t were added together to form live groups in the periods 1922-33,1934-38. 1939-43. 1944-48, an d 1949-33, ami the mortality rates used for each group were three for the years 1931, 1936, 194!, I94& and 1951, The rales for 1931 were used for the period 1922-33. rather than three for the mid-years, '" innately few men were under g the early part o f the period. A i of deaths from afi causes and the m sab ero f dtoto* , observed to each o f to e free d o e eefes<ww*, together with the expected jmmfcer ofdte& *> e . , .......... .. ` . e mortality rate fo r all shown in Table 4 rrom 'T a t o ^ i q p l ^ ^ ^ ^ ' MophutRS other than lung cancer among men in ' '~ i iBMatwto dm* KifEktd U mPPP ^ -- -- - -r -i - - *y g frt- w w w m w K m i t i m M m & n - f r n r iirnii T H f & ^ S ^ S lW ^ r y P ^ J Q ^ p p y f t a A D E : BY t h e N A T IO N A L p & R A R Y OK U lliN fr "y L E N D IN G T H F .Q B !L ^ !^ k WWBHL * tB isfe# if e il ... pi,*,,J the increase ta mortality Uritsaed to tang cancel over th e past 3G yen i> eem tefy due to improve- w e e tt f e d K K a n d I n th e ra p y <ott, 1* 5 8 Cw#nTDli LuB goiw , aasstfjw ss taxorD nU u J f M e f Stpeom t * s rPta*w- < o S cntd tto & i w i S M I (Valu of PJ ^xoconot Even, however, i f i i * * postulated th at th e whofc of die recorded m em se between is d 1SS| was ^ u rio e s and that the real-mm-taSty fawn the dfrra w th re u ^ w it was th at ascribed to i t t a 1951 lift expected number f deaths Is facneased to only j . | atta the observed excess is stta grossly stgeffic*. For ine actual number o f htrtfi Cmasr cases t o he so Buie to excess o f th e expected a t to b e nasoiwbly 1 SS, 14 . * *' 4 s 39 t w y m et } > 0 -} ^casoaD attnbutabfe t o chaw* it would b e nece$$at> t a r the expeetad cases to be 6-3, th a t S * tittm the number ensstctemsmaaeryd otanP)9^5uttraarteetsa, wInionthJ9e5rwi oimrdd*,tfht rwoouugldhb*e* # * piw teM 20 i n g t t w . MB 5 J tow H urt oim sr o f * , t a g m nw jinlaal is nSi, which would mean A m the em a U M wouH hw "> fw*H* ` i d a i o b i e o r dMechon in " i""- ower 2o % o f ah m en a t death. M o o w r ,m * n IN * e w , it would M not account foe the fact ncrensetf mortality from lung o a r , oilier tWPTOWt, J * , g o rtg io v a ^ jJo , j f e a TM ta g * * * astw rraii, tRii t i w tbciT m om lii" lrOTT1other tlircaycs Vinscloro Ii>thol expccleti. ptaram on, o r l)K fading, arc jXKsrtifc ; ( * l n " OKBWfco t a g died n i fong cancer were recorded because o r Menai jo i l * condition, but that some o f the records f other men dying or other thin nil the ra w s o f tong rancor re round in Msocinuon with rabotosft, 11 B, tnerctore, concluded thnt ihc fourth rapianaucni n the most rcororablc oilc and Iht IhcosbMIM workers who had worked for 20 or mm e ycau in the " scheduled .ocas ufored u notably fiiglwr risk item t a l i cancer ihnn lire rest o f the population. To m 8 the rWt in aliraed since (he 193! rcgwWtons were introduced, a ) , not only necessary tm ^tim jw B iqit of the tpeeted number o f demi* -, - s ckMcr * " K O trally and ractrsslrely m p i o K i Bong the tu b e s workers ; (j> thw SSLm*##*1* d sood nmm K W l l M t t e i t i o o f EnglKid r a d W h k ; r (44 o. ^xw! .a<BtVii*rfmTm" yb a"gVetoiln!"eer,.n i d w < 1 tut e*Cs * T * > * `* lTM d <tol I m o o r* o f **. few ^ ,iT Z lr ne^ r KTM*****#*}Mcdncy wms^Fito#ktoiuiwt h* o* iroief fo make nitowonee for duration o r employment before the end of 1932, hot also to allow fo r the nien't ges and for (he total durations o f theiremptoymenl m m e ' scheduled areas '*, since the men employed in the darker periods ra n also have been employed longer and Bred to he eider, On (he other la n d , Itare no oeed w oonrfd foe chtroging incidence otlungraoecr tn foe loud popolatkm o f Cnglaod end W tto sn ra the n m 'ia d a m tl risk has torn shown t o he sm oHtn comparison with Hie industrial one. TheitaMreiioirei1forcontitnfiogflicrisks amongmen emrdoycd i w under 10 yrara, fn r 10 to 14 y e a " , and for 15 y s m aod tas pee-W l conlhbas am n ^ P f o f dcoths Ateo t a Hdion taaelotcd U> WBXf0* the c5*Htnilcd num ber and this a ^ f t y io hve huppemrd unfess the popefetioft had beco sfwnutfid approxiroatcfy correct! d the deains faw i ail cause fully reported, A l| fie dcaltea attributtd ta Itm s cancer en; cnnfirwed by i x o o p y and fmtoJogtcal ewmlnatlon w i the xccss m ontrer cannot be aurifcutcd tt mCI'*1!ec* fiagnosk am eng the o f asbostos workett. Semc Tthe c w m y *fl t * dee te a w t e f e s i ^ i ^ o f t f i c > ^ e c t e d tjca^ f t jjfK3C i)JW o f hews ta Tsble 5, The ages show tsc tae ages & dcafh o f }Jjc &en wha h o w d kd and the ages m mfd* 1^53 ta r live m ee whn arastW . TWecsspected evav tw-fjrjsempiayfnctu group fowta t have ^shcstosls o r oxbestos and tang w a te r an? csf/maied hy mutf/ptying he numbers m each agg, total cmploymcftt. an d p r e - W i cmployrod so i^m u p i&e proportion* o f n a wita asbestosb of with a^*exio^ and lung cancer in the o f p rem pli emptayment cotabtacd. For Naoota. three o ta o f the n ise mensfied X to S t yews whoba * LUNG CANCER IN ASBESTOS WORKERS Taau S SOI^WICO AKfik AND Wt JiOt -sdmtoW umn) m tSvwA UreavofeotareMwMwuy.uuMyi.tHi e-aTm ] to-HYcm } ts+ van M k * m * .* * # * * ' b m t r f f f S t t Man o? i* ^ ^ 1'^1"'**; ^ ret-*> & > Ssi MMoBrrke. tJatAanlt-Mo*to#r.i tS 3 t . Nwr Store s'-taw i I -l f i 1111ya = . *I i t r Sf 1 z -I i i 0i \ 1 1 ' f ~ % 4 % 4 '1 ,' 1 jta 4 j f e !> 70 - a j II] i l-.t 1 4*i 1 1I ' !i avi*a null' sut 1 t Iea-' M+ $<6>S0-*-u9 ! tt 4IiUmp1l&i>ItIOIIWf to & 1tar An* m I 10J i r-- E ir 0 e e i ! *------ z 1t f 7 \1 1 1 I ?.= s 0 1= 0 \# e h t J !' f |-i 1t2 .14 ---W z z !|r *a I ' ! H i1 .' 9 iI ; tt t J 3 9 Yf5'-i*;*1 7 i2 '' i2, ..sft Z ' *7+ 1 l I +J been m fisysA fee 30 ta 24 yean ta tae a n s ta w h * ta < ^ in ^ rtb e c * i* c tf ie asbestos d ta t were Umi ta hast vtimcA andiscansct am* threeiW nh dB iw feidfcruflde/fO ycflram ihcfw e- 1933 badviM tei t a t i d t a 14 yw n M th o had wwhed 1er S <r m ere yeare, ifec specie tMa&er a m ta ca d i o f the P ta t ^ n rota woad la v e beta the su n * , is., I x 3 ^ . o r ! ta tact* the eutabere <rf c a s found tw ree, I.Jtad Z The tela! noreberecxpcctedta each ptc-19J3 ee^taytacw group are obtained by ad<ag the numbers cutentaJed ta r w c h o f tbc use and total em pt^m ent wap* within it. The rcsidfe are as folhn; T h e differences between the numbers o f m en observed am! the numbers expected in e h employ* m em group, had fte taetdeace o f the cenditiooj reraataed th ro t^ to u t. a tatticaBy gni* cata {tatattttatttosu, 0 . E tbffl*). T b ^ o r e h i^ d y w t f the WWW* ~m jWS' ' a r s s s s r x t s s HuMnfm .tifeVolMUV'd MadMwnrMignture/rAnM 8 <* S r Sr U | It - T H fia I S A $1N< I P P H o V o C Q ^ Y M A D g ~ n r l u i f t i F o w H U t t P f v * r k n r < = itt i n v n f t RRir's^FrAa.hcM ^ ) trujQfc " ' y BRITISH JOURNAL OF INDUSTRIAL MEDICINE t i * Wotegfeatiy im portant reduction in the propertkmbctween observed and e je c te d tumfoers as the length of pre-1933 nploym em is reduced, is also taken into consideration, i t is d ea r, therefore, that the inebtencea both o f asbestosu p ad o r king cancer associated with asbestos have b o a ts progressively lest as th e num b1o f y e a n during which men were exposetf to th e pre-1933 conditions h as decreased. t h e d e n t o f the risk o f Jung cancer over ibe whole period among th e meosiudicd appears to have hectf o f the order o f fO times th at experienced by other m e, t h i s agrees well with the data reported h* Merewcther (1949), inn it is somewhat greater thop tftw sagficsted by Ctoyne's data (1951). H ie great reduction in the m e m o f dust producedin b e s t e f t s durfeut foe p e r f e d l been accom panied for ft reduction in the toefcteiKe of fang cancer among th e workmen so th at the risk before 1933 is fikeiy t o have been considerably greater--perhaps 20 times the generalrisk. W hether foespccife industrial risk o f iungcanccrhas yet been completelycSmraated cannot be determined with certainly; (he number of mea M risk, who have bees exposed to th e new One hundred and thirteen men who had wafted for at feast 20 years in places where they were Cable to be exposed to asbestos dust were followed up and tire mortality among them compared with that which would have been expected on th e bosh o f tire mortality experience o f the whole male population. Thtny-nitre death* occurred in th e group where , 15*4 were expected. The excess was entirely doe to excess d ca ite from lung cancer (11 sgofast O'* expected) ad from other respiratory and cardiovascular diseases (22 against 7-6 expected), AD the cases o f lung cancer were confirmed iustologically and ag were associated with the presents o f asbestosis. From the data it can he concluded that lungcancer was a specific industrial hazard of certain asbestos workers and that the average risk among men employed for 20 or more years has been o f the older o f ' d times (hat experienced by the genera! popute- The risk ires become progressively less as the duration o f employment under the old dusty con ditions has decreased. conditions only and w ho h are beret employed for a I would like to ofler my thanks to the management of sufficient length o f lime, is a t present too small for the firm concerned forjpemussioa to carry out this work confidence to he placed fa their experience. It is cfear, however, m at th e risk has for some time been greatly red uced. T he extent o f the reduction is PtuttCufetfr striking when it )* readied that between ami to the Medical Officer and members o f tire staff of the works where the men were employed, who carried out the greater part of the work on which this report is based, 1933 ant) 1943 the incidence o f the disease among men in th e country a t large has In creased sixfold. RxrtMNCES Summary The cause o f death, a s determined at necropsy, is reported for 105 persons w ho had beea employed at one asbestos works. Lung cancer was found in 38 instances, iS times I n association with asbestosis. AS tire spheres tow hom both conditions were found h ad started employment in the industry before 1923 Ashntm Indtnio', Rcuf*ilowM i). Scuumo' Rale*Ami Orders, BuemtIiVc.JFJ.,itMVoJ..hI.MB. tt.MMwJt*.0r,..7L. Tentteft. t nirS. lKP.awItkeSaS.i. A rt*, htcbttlr. tlrg ., $, 2AI tConttlbtjtlon to CouncH rf Hi* IW*rnatfonl OrBsUaiio of Mrdkal Science* ,,DoH,,. HMtfWVJ.JV4&ArVif.*.Wto..AC,mi tJSflZ.K*#. * Mue*prr., MW, .Ct'tnoSSSIXjfc LtfunmuBri,Hi.ttouf tpftkr Sftrwh S m uc Utofiot L. ynch.fiim. M. ,,TaonrrfeSrmwitfikftWM. .A.WJJ, Am*. ACuanw,14,SS. R. A. MW. { * & *rrmj* *r CtoftoOtoor and had worked fa tire saiustry at h ast nine years before tire reg u te tio e sfcr th e control o f dust had 5VSoT2er.aMU,. A A ..V E T - t & Viu'iiJ* - Amtri j Pl1lk^ |4(<, W a rm ,ft(IM Ift O n m M A Brit. J. indurir. M td., 1955,12 87. PRIMARY LUNG CANCER IN SOUTH WALES COAL-WORKER^ . - : WITH PNEUMOCONIOSIS 'J . :.- w , ` ^ 6 i| -' W . U , JAM ES From the Dtporuneni o fPutko&uy and BaeKrhtbfgy, WelshSaitooolSchoolo f M cdfcfot, ffHxQ/t*r ( - , (k e c b v t o f o r p u s u c x n o N o c k m e r 2 8 , tW 4 ) . ^r j\ s ~ m -\ Coat-wocfcm in the soufosm part o f Wales are be m ade t ? foe relative* o f men w ho hove tfoi partteoteriy prone t o pulmonary disease due to the chronic dyspnoea. This shew n k t the h & r mha&tion o f coal dust, in som e men discrete foci incidence o f chronic lesions o f the fuRK O f cardio- o f dost re scattered m ore o r te n uniformly through vasedw system & this series, in m any o f foe r e s out both lungs. This is called simple pneumo prcureocoafo o f varying degrees had been coniosis. In others there occur also one o r more detected radiotogkafiy during life, and compensation huge localized masses o f dust and dense fibrous hod been paid. ,, -. tissue (Fig, I). This manifestation is referred to a s It was considered th at useful information might massive pneumoconiosis o r progressive massive be obtained by studying th e material as fallows ; i l l Observation o f tire ite of th e cancer In The literature contains many references to the relation to the site o f the massive librosw re those coexistence o f classical siticows with primary lung h i whom foe tw o lsions coexisted , (2) comparing cancer, but there are few accounts o f coal-worker's foe cancer cases in foe miners and non-rntfora & ' pneumoconiosis w ith coexistent tumours. In a respect o f foe histotogicai types o f the tum osm , foe reoettt statistical study Keftnaway and Kcunaway spread of mtastass, and the age dHtribubons g l (1953) have shown that primary cancer of the long death ; (3) V studying the reetdenoe o f cancer i s h fern common i n coal-workers than in the general rebifon to foe severity of the dust kion ; (4) for mate population, T heir figures also show that in comparing tire cancer incidence in th e miners wfth the South-Western Division o f the British coalfields, th at found a t necropsy Jo non-miners. where (he incidence o f pneumoconiosis high, foe At n ce ro p y otre o f each p u r o f lungs was incidence o f lung tum our is low relative to (hat in distended by formol-scfounveogtiue solution with a other coalfields. In some cutter British coalfield* view to th e preparation o f a terge m a fay (fan where foe poeirartococtioris incidence is tow ib e technique o f G ough and Wentworth <J94& The tTOOorisdeftre^ioreoal-workers,retotivriybigh. o tte r tong was tt a* tire iw o f tire f t * aril The h fe e ttifth e present irau li? was to obtain after a*fced*cye xannatioa evidence regsf& W th e rcfetikmshipi If any, o f fo r mtcFoscopte study* paeufoocooforis t o lung cancer in South W ak* csfoworitifok . Tbc m areftri w is obtained during tire sib year* 1947 to 1952 during w trifonecrepste were made, in this depKAffitsL oo M 2 7 Bd-workcrs. During tire sam e period poo-m oriem ewmuwfows were O f th e !,827 miners, 967 hod sfatfote pnemtio* confosts o n ) 860 had massive Ofareek. W farenr bu a B er w as found in 49 (S*l%3 o f tit - (is and m 12 ( 1 - 4 % > ^ * 0 W m ade o f 1 ^ 3 i Soulh Wates mates over foe age ________________ n e w . o r l W > p t o B j o f 21 dot concerned with cont-mintog. The patho- hHq, Micar and enexiatrtg to^tsti exaBtiiretions o f she miners were m ade on tire instruction o f coroners who had been told by the relatives (hat they considered death was due wholly o r partly t o dust disease. Tbc symptoms ....... .................. tlw t s te n . o r l o s i h h i s A w o n iris . I |, and i, waa remote from 1 A den in l b , n ite r revel,, If cool dm t ta a i r r a d e a n j w gente cirect il would b , like!, to lead to cancer la o f d ust disease a re wet! known to foe rebut that part o f the lung in .f a c t, lite dote coacaoWltAO cemmuAfi? and requests for necropsy are BfceJy to is greMtet, which M th e rite o f m atelw m i M i i | ^ PHPR PB mm a . c A . i a w ^ , j i t e i , . 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