Document RjNLKYYVn3omye6YR7OazbXdE

Wr,c1 2j July 1904 gPirk, Lusdin:: Articles ub-* . ; i.:s part that controversy has played" ir.'thcsc developments first exposure to asbestos arid the development of the tumour, escape notice. Controversy raged when blood transfusion was ar.d seven of the eleven patients had been exposed for more first introduced, and though to-day all but the eccentric or than ten years, though one worker had been exposed for only religiously biased would acclaim this great therapeutic 10 months. Similar tumours associated with asbestosis have advance debate will continue, profitably, on the details of :s application. When 29 years ago Professor A. H. Burgess, beep described by others,'*'1 and at p. 214 ar.d p. 211 in this week's B.iU.7. Dr. Giyn Owen and Dr. P. 15. S. Fowler nrofessor of clinical surgery at Manchester University and and his colleagues describe more patients with diffuse meso honorary surgeon to the Manchester Royal Infirmary, pave his Presidential Address to the Association,' on " Tltc Debt thelioma of the pleura who had a history of exposure to asbestos but with no evidence of asbestosis. In a group of of Modem Surgery to the Ancillary Sciences," he also paid 632 insulation workers in the building trade followed for 2Q tribute to blood transfusion. In this context he mentioned years by I. J. Scliko/T and his colleagues'* cancer of the lung " immuno-transfusion," in which patients with pyogenic infec occurred seven times more frequently and cancer of me tions were given blood from a donor who himself had first stomach, coion, and rectum three tunes more often than was been actively immunized, and commented- that this treatment expected. In addition, three mesotheliomas of the pleura .vas on trial and had met with some. success. Though this and one of the peritoneum w-erc found. While some of the controversial treatment did not survive in its crude form, we workers in this survey may have worked in very dusty condi have to-day, descended from it, for example, the use of hyper tions others had been exposed only intermittently to materials immune scrum in generalized vaccinia or tetanus. containing asbestos. J. C Wagner ar.d his co-workers" During the last thirry-fivc years there have been remarkable Advances in curative medicine. This is undoubted, and well mown to the public as well as to doctors. On television and radio, as Dr. Gerrard wryly remarked, curative medicine is ` entertainment in quite a big way." We join with him in --.inking, however, that a change of emphasis towards preventive medicine is r.ow overdue. Pills and potions, those -.oderr. counterparts of the mediaeval talisman, arc swallowed .-naming, noon, and night by the faithful. But how much described 47 patients with diffuse pleural mesotheliomas, all but one of whom had probably been exposed to crocidalitc. Many of these patients were born on the South African asbestos fields, !d gone to school near ashestes mines, or iir.d played or. asbestos dumps as children. Only eight of them had confirmed asbestosis. Since then mere eases have been collected and 120 were reported by Wagner in 1963.'* Primary diffuse tumours of the pleura ar.d of the peritoneum are rare, ar.d their possible origin from menu- .-.ealthicr they would be if, instead, they took a little more thelial cells has been the subject of argument. .Many ciifuse -zeroise, ate sensibly, and smoked less l It is our duty as pleural rumours have in the past been shown to oe secondary to doctors--.teachers--to say this, loudly and repeatedly. Dr. Garrard is right when he reminds us of the importance of riese things. bronchial carcinoma, ar.d this condition should be excluded''before a diagnosis of mesothelioma is made. Or.iy four of 33 cases described as pleural mesothelioma by Wegner and his colleagues were confirmed a; necropsy : in the rest rX - jOoo - the authors had to rely on clinical and mdiclcgica! examina tion to exclude other primary sites of malignancy. P.miek.-.ap ar.d Smithcr did no; describe the peritoneal tumours wh-.eh Asbestos and Malignancy they studied as mesotheliomas, but instead preferred to u>c the term " peritoneal rumour of asbeatosis." They ccscnhea imee K. AG Lynch and W. A. Smith1 described a ease of ur.g cancer in association with asbestosis there has been mcrcasing evidence connecting the two diseases.' More recently other malignant neoplasms have been associated not riy with asbestosis but even with exposure to asbestos dust, v R. Gloync5 found that 14% of a series of eases of asbestosis only peritoneal tumours, while Wagner ar.o nis colleagues described mainly pleural tumours and others have described predominantly bronchial carcinomata. The difficult-.- in identifying the difTusc rumours may be in part responsible for the differences in reported incidence, and the origin of this tumour may become clearer as more eases are described. `..:d carcinoma of the bronchus. Ke thought this all the more tiling as 41% of the patients with cancer were women, -.-.ile at that time primary carcinoma of the lung was distri cted among males and females in the ratio of 4.4 to l. i DolF calculated the average risk of lung cancer's dcvcloo:g in workers exposed to asbestos dust for 20 year: or more "< be ten times that in the general population. D. C Braun -me T. D. Truer,` in Canada, failed to show an association etween lung cancer ar.d asbestosis, but in Great Britain two 1 Ernen, H. M., and Smith, M7. A.. Am*?. J. 1933* Zi, 36. . CUyfne, S. X, U*xrt, I93i, &tO. * Doil. 0_. tint. J. iAduttr. Af.-i.. 1935. 12. 31. * Qraun, O- C-, and Tfuan. T- D., Atth, ItftM, 1933, 17, 63-i `Annual Rcfen nf the Ov.ef (r.?<ctor of Fieronci fot,,;rve jei; 9i7. Gnnd 7621, 10-J9, K.M.S.O., Lonuon. * Annual fle^ort of the Chief Inij'estor n on T.nduitrul Heim far the year 1933. Grind 311. 1939, H.M-3 0 , uana^n. 1 EnneUrun, ]. D , and Smuher, 9T. 156-1, 2!IA I Jinn**?, C*. M.. riuldi, J. ;r>53. zz, ;:s. and Stewite, M. J., /!**. J. Vn. . ;n.-.u.-.l reports oi the Chief Inspector of Factories'* have lawr. a high incidence of lung cancer in necropsies on ;. '.fichu with asbestosis. * Recently the story of asbestos and malignant discaae lias -ter. taken a stage further. J. B. Enticknap and W. J. .-rntther' have described eleven eases of peritoneal rumours in * !\ui. c. c., i960, z. ::i i. ** J.. w-- ,*1960, In, 139 II Manc%io, T. ind Gautier, E. J., *.963, C/310,`51 i SehknfT. I. J., 0.ur;# and Hamswwid. E. C.J- .tmtt, isi. ZZ. A:t.t 199*;. 11 Wiener, J. C.. Slcj^. C A., end 'tjrc.'usJ, I9o0. IT, CuQ. Jn:. J. ,# -- 1 ;<h !n;<ma;:on3* Cjntrest ja Ccc%3j:.Annl Xsa:;.*.. 1963 -tsestos workers, all of whom showed histological evidence - asbestosis. At least twenty years had elapsed between the *------ Mur.div. 0. E.. :.nd Har;.-.c:on, J. % ,J. S-i , 1962.'.3-.\n ** Huunhane, D. 0'3.f r*V*sr. 19. 23*. %t S.tiiihcr, *37. J., C.liOn, J. C- m4 Vsjr.er-y. C-. 2r.t. 3 ',92. 2. * Jnr. m*,1. 196*. 2, I7S. U5- 11 WJ - . T. E-, -- ide, 0. L-, aA/y jH. ? C-. ibi4., 192, . -9,. * Ibid. 196*, 177. * lb*d. 1929; 2. Ul. * S.< (Ljn.`.3, i962, '* *7agncr, j. C., iU*d., 1962, 153, .*0. *.25 July 1964 J^- Leading Arriclcs D. O'U. Hourihar.e** has reviewed ill the cases recorded os primary diifuse tumours of the pleura or peritoneum in the necropsy files of the London Hospital between 1917 and 1962 irrespective of exposure to asbestos. He accepted as mesothclio.r.ata 17 out of 3S pleural tumours and 17 out of 55 peritoneal tumours with characteristics which clearly distin guished them from primary carcinomata of the lung or other viscera. There sppenri to be no correlation- between the degree of severity of asbestosis and the occurrence of pleural or peritoneal tumours, and in some eases the exposure to asbestos dust seems to have been slight. Information is being collected1' to determine what proportion of these uncommon tumours occur in people who have been exposed at some time to asbestos dust. W. T. E. McCaughcy and his colleagues,'* reviewing 15 patients with mesothelioma of the pleura, found asbestos bodies in the lung in 12, most of whom were likely to have had some industrial exposure to asbestos. Asbestos bodies should certainly be looked for in the lungs of patients 'with mcsothcliomata. However, it is difficult to assess the significance of this finding as long as the incidence of asbestos bodies in lur.gs without accompanying mcsothcliomata is unknown. Hourihane found a significant incidence of asbestos bodies and fibres in the lung in his eases with mcsothcliomata compared with consecutive necropsy eases of carcinoma or the lung and consecutive cases without a tumour . in the chest. Onwnac does the probable carcinogenic action of asbestos depend ? -The members of the series of fibrous silicates to which the term ssbestos is applied have diiTarsr.t physical properties and chemical compositors. Chrysotile is a magnesium silicate with long, strong fibres suitable for spinning. Crocidolire and amositc are iron-containing sili cates w-.th shorter fibres. Many of the tumours reported so far have been associated with crocidolitc, and some with cnrysotilc. I; only certain varieties of isbestes arc found tobe associated with malignant disease a valuable clue might be provided. It has been suggested that because of its physical properties the asbestos fibre gives rise to chronic irritation and eventually to malignant change. J. S. Harington". extracted from erocidolite, and to a lesser Extent from amositc, small amounts of fluorescent oils containing 3:4 benzpyrene and other polycyclic aromatic hydrocarbons which he though: had been produced by the primitive organisms present when the asb:os-cor.:ainir.g rock system was deposited. The possible role of iron in the carcinogenic action of asbestos is also being investigated. Little experi mental work on the carcinogenic ctTccts of asbestos has beer, published. Wagner** obtained three mcsothcliomata in 50 rets injected incrapicurally with asbestos, but he also obtained one similar rumour in a group of ten injected in the same way with silica. There arc many uses for the 2J mijlion ran* of asbestos now being produced annually, and- though the number of certified eases of asbestosis is decreasing morg people may be inhaling a smaller concentration of the fibres, not only in industry but possibly also as a result of the eontamiaation of the environment. If only certain varieties of asbestos arc carcinogenic others could be substituted for them. Until we know the answers to some of the questions posed by the recent findings all exposure to asbestos dust s.'touid be considered as hazardous, and supervision should be extended to insulation workers in ships, factories, and domestic buildings who may be intermittently but nevertheless VI IV ~St+r mA ..* - J Computers in Medicine It is often said that medicine is applied oicicgy. Hut i>" recently the idea that medicine might also become an imp1 tone focusing point for mathematics and computer seiu: would, have seemed strange to most people. A recent lend: article in these columns on automation in hospitals cal', attention to the fact that a time far revaluations is at ban New methods arc claiming a place in the traditional fran work of medical research and practice. Nothing could have given sharper emphasis to this in the conference held in Oxford a fortnight ago on Mat item.*.: and Computer Selene: in Biology and Medicine, organic jointly by the Medical Research Council and the Mims: of Health. The topics ranged from the latest rnethe developed in America for cor,ipute:-.'.iead processing hospital records to the abstract logical and m.a;hcmaii< problems underlying automatic classification, whether diseases for diagnostic purposes, of organisms for taxonnn or of documents in systems of information retrieval. A sen of distinguished speakers strove cheerfully, and on die wh. successfully, to communicate at leas; in outline flic math nuiics involved in the analysis of clcetrooitcephni-egrr.r.-.-. a. electrocardiograms, in devising and testing models epidemiological processes, sue ir. interpreting cl--ng-v. state in living tissues. There sre few in biology and medicine to-day who -Jo recognize that the new methozs have come to stay and the medical man must learn both to live with them art..exploit them for his own use. Yet most of us w.-.tri. ; advance of the computer with some apprehension. There in addition a widespread belief that i:t order to use a car.:;-.;:, effectively one must, first, be very clever aitd, secondly, hamathematics at one's finger-tips. Though perhaps v.-.fib the early days of computers, these beliefs and apprcficm..r.. are now increasingly based on fallacy. In this center.; ; contributions to the Oxford conference may be picked a as opening doors to the use of computers as sophisticate rcseoreh tools without the need for any special training e the par: of the user beyond the capacity to ihir.k elea.-iy. R. S. Ledlcy, of the National Biometrical Reset:.*: Foundation, Maryland, U.S.A., described to the Conferee., a system for using the computer in the scanning snd imerp: _lotion of photomicrographs of humor, chromosome prep-..tio.ns. Tine system has several man-years of higrtly spec...11... progromming ctfor: behind it. 3u: new that the work :beer, done ar.y cynologist may use the system or even m..-:;. and extend it by employing methods which can be learn: . an hour or so. A further stage i.n the " spoon-feeding " of the ucr by maer.inc was illustrated in a dramatic demcr.r.trctie.-. by 'Rilkes, director of the Mathematical Laboratory, C-r.:.>: . University. From a lecture had ;.n Oxford he co::u::.:.-.i----with an iil.M 7094 computer m the Massachusetts lust.in. of Technology using G-P.O. Telex equipment. i'y tv -h an appropriate message into me teleprinter lie cttv.u,..: programme In the M.I.T. programme library wiuen pr-.-.t. out its own operating instructions, ir.terragr.tir.g anu gu... the user at every step. A mcm.ccr of the aucwnce wes able :o CXCCtlk z complicated mat.hematic:! case having ro use a.r,th.ng beyond p;e u.-.Zi.:.*fc;:urc of the M .I.T. instillation, remark::!: by astindir:is. is that dozens of user; can plug m to :