Document b5pmpnMGGkVa6zQMvbwE8eXGg

FILE NAME: Asbestos Mining (ASMI) DATE: 1931 DOC#: ASMI005 DOCUMENT DESCRIPTION: Journal Article - Asbestosis Bodies in the Sputum: A Study of Specimens from Fifty Workers in an Asbestos Mill >1 a u c jo u rn a l o r T h e O ffic ia l J o u r rial o f the Pathological Society of Great Britain and Ireland FO P...'' -?Y A. K. B O Y C O T T M. J. STEW A R T - -T V'. W .-C 'tO P L E Y f o u n d e d i.\ f i r o r . suis 'roovnc.in VOLUME THIRTY-FOUR--PART I P aces 1 -400 r \ e*. r: ^ EdinburgOh : Oliver and London ;3 Paternoster Row f; . The Journal of Pathology and Bacteriology V ol. X X X IV ., N o. i 616.24--003. 656.6 : 6 1 3 . 633 ASBESTOSIS B O D IE S IX T H E bP U T U M : A STU D Y ,, . . O F S P E C IM E N b '"D O SI F IF T Y W O R K E R S I N "a n a s b e s t o s m il l . F. W. Siwsr - nt'.-I The Department r f / 'th'C, y g the .South A frican Institu te fo r Medical ll, A, Joha.-intshurr?. ESChe following comr.iv.n'caiii n i? based on the examination of the of fifty workers. ir. an asbestos mill, some of lvliom bad also exposed to asbestos dm t in other occupations. The atmosphere All-he mill was at times so overcharged with dust that it was impossible "^distinguish large objects at :> distance even of Id or 20 feet. Since .eoaeentration of dust is one of the main factors in the production ueEpulmonary changes, under the wording conditions of the mill any t'tyaetion would be likely 10 occ-ui rapidly. The coses examined .Tjjgpnaed five europeans ami furty-fxve natives ; it is among the latter that the greatest exposure to dust occurs. The examinations were curried out in the South African Institute Tiff Medical liesearch from material supplied by Hr 0. F. Slade, and as the mine was several Lundveil miies distant, specimen-* were -un.et'mes toot received until uftci lapse of two or three days. In spite of this it was possible to oonmi LYU1''. lluiu the asbestosis bedim void intracellular m praetie div I*' Li V <'<lSO. A difficulty was eiiem oiteu'd ia the collection of speed 'v U.A i/OLi natives. Tie1 ideal ti:ll ior collection v m the morning . *.7LCD, ;1S cl result of the overnight <e(_'11*vi L the cib'ifeil epithclhii . (U ( 1 0 1v;uicLi, jimii.o jrom the ]o\vor Respiratory trad has been 1Mageht ui'. I 1 1 11ns miu'i.s dies! ( lIl.b Cdll usually be uemon-urated. e ! rvlls, 1hei e woe-", euoiiiious 1 the late pre -am,aidy dm ivin few of th e spa 1 -... ji-, o , 1 1 ..a iiu'-t el s of asb esto s j f i e e s ; , n<! C M s f i d g ii. the lode v h 1h sC(UepirH'.- tli,a here, iliic s'.as apparent'.' V na tive nov filling the- so.lam rceeptaeics in ihe m .ww, -oee>;. or iv.rn. vc . coming mi the d e f t , liMO r2 F. W. S1M S0N AN D A. S. STRACH AN when the mouth and nasopharynx were loaded with dust. Fortunately it was possible to duplicate these samples, and a satisfactory specimen was obtained in all but two cases. Technique. Two series of films were made from each sample. In the first thick films of the mucoid portion were made and dried in a paraffin oven at 54"C. These were fixed with saturated mercuric chloride solution, one set being stained with hsematoxylm and eosin, the other for tubercle bacilli. The second series was made from the centrifuged deposit after digestion with antiformin, as recommended by Stewart (1929). We found however that it was as easy to demonstrate asbestosis bodies in the direct films as in the antiformin treated specimens, and the former method had the advantage of showing both the cytology of the specimens and the intracellular development of the asbestosis bodies. Result.$ o f sputum examination. Burton Wood and Gloyne (1930) describe the sputum in pulmonary asbestosis as " thick and mucoid--frequently so thick as to resemble semi-coagulated egg albumen. In the latest stages small nummules of pus appear." In practically all our specimens there was a mucoid element, usually thin and watery, occasionally very thick. Pus cells were present in all specimens, but only a few contained obvious pus. The colour varied from grey to brown according to the amount of free asbestos and lode dust present. The free dust sometimes separated out as a deposit on standing. In all films asbestos fibres, small crystals of various types and colours, and amorphous debris both brownish and black were present, some of it intracellular. Pus cells, dust cells and epithelial squames were present in all specimens which contained bodies, but their proportions varied. Always the bodies were seen to be lying within dust cells. Many of the asbestos masses present were disintegrating into their constituent fibres. Asbestosis bodies were present in 48 of the 50 eases examined. They show great variety in size and shape. Some are long and thin, much longer than the normal diameter of a dust cell, so that the ends are bent and tend to project on either side, where they are covered by cytoplasmic prolongatic s. The extremities show a bulbous enlargement and commencing segmentation is often seen. The colour is greenish- or golden-yellow. In the middle portion of the ore slender bodies the fibre forming the core is very thinly coaled with the golden-yellow material. Many of the bodies are sharply angled, suggesting incipient fraeluie. Should complete separation take place at this point it will give rise to two bodies of " crustacean " type, with bulbous heads, segmented bodies and tapevjng tails. Analysis of cases. The age of the workers ranged from 17 to 50, two-thirds of them falling within the 30 to 45 age-period. Ail but 10 had worked in the asbestos mill for consecutively in mill <md mine) for periods ranging PULMONARY ASBESTOSIS A " q 3 to 9 years. In the others the period of service ranged from months to 2 years. 18 of them had also corked underground in the "gold mines. Cough was present in every case, dyspnoea in all but 10 and mss of weight in all but 21. These symptoms naturally varied ...-in severity, but they showed fairly close parallelism in individual cases. ^Examination of the sputum for tubercle bacilli was negative in every .-instance. As already mentioned asbestosis bodies were present in 48 out of 50 cases examined. In 9 the antiformin method was negative i'awhsadirect smears gave a positive result.; in 11 the converse obtained. Pjf-Jgjg two cases which gave negative results with both methods had been Siemployed in the asbestos mill for 7 months and 2 years respectively. mfie shortest exposure to be followed by the appearance of the bodies iypite five months, and another ease was positive after four months in the llp&ill and three months underground. We are informed, however, that ag jjy -atmospheric conditions in the mine are not such as are likely to be S'ssBoeiated with asbestosis. c Simson (1929) has recorded the presence of asbestosis bodies in a l liuman lung from a case with a history of only two months' exposure J|$c dust, and Stewart (1930) in the lungs of guinea-pigs after three to months' exposure in an asbestos factory. The bodies in Simson's ; ioaec were well formed, and it would appear that the time necessary 'for their development must be even less than this.- Discussion,. It is obvious that the presence of asbestosis bodies in the sputum 'ydoea not necessarily imply the existence of pulmonary fibrosis, although lytrs are of the opinion ihut they indicate a reaction on the part of the alveolar epithelium. McCrae (1913) has shown that in silicosis most of the inhaled particles which reach the alveoli are of a size comparable with that of ordinary bacteiia. In the case of asbestos dust the litres which ultimately go to form the core of the asbestosis bodies (Burton Wood and Gloyue, 1930) may be 00, or more in length, and must therefore enter the alveoli lengthwise. Here they become ISL phagoeyted by dust cells (Simson, 1928) and we are of the- opinion that it is m these or in sdnihir phagocytes elsewhere that the changes i}V&tSef.&i ' which go to the foimaiiou of the bodies take place. 'There an: several observations which seem to support this view. In carefully prepared riv-k direct films of sputum the bodies are always intracellular, and we have W- noted appearances which v, e would interpret as stages in their develop ment. Briefly them n'-e .m follows The fibre becomes ended with a V-dv greenish-yidiuw ur gulden-yellow .-mb&tunci pvmg dm p mma n I S blue reaction. This coaling may be uniform except at the extremuics, g ^hcre there is a buihom enlargement. The deposited material incieases m amount and with Uio increase segmentation appeals m most of the bodies T ,,,, uui ,i, i11,1,.~i 1..-.i.i.:.i.-.t.i.i...i.'..t i `i i iI l: , II ! I l f > i d i Ytji; Ct' liij)]t. I p fracture of the fibre may occur with formation of the " crustacean" * type of body. The latter may continue developing, the tail again becoming slightly bulbous. We believe that the alveolar phagocyte j| and not merely the body fluid is the source of the material which goes h to form the asbestosis body. - Asbestos fibre is not the only inorganic substance which, in the luug, becomes coated with material giving the prussian blue reaction. Mavrogordato (1922) has observed in the case of experimental quartzite 1 inhalation that there may be associated with this substance intracellular ' yellow or red granules and sometimes yellowish plates, some of which 1 give the' iron reaction. In some of the dust cells in specimens which we have examined, both in silicosis and in asbestosis, we have noted granules such as Mavrogordato has described. Simso i (1929) has observed, after 3 months, similar iton-reacting material around asbestos fibres injected subcutaneously, and Stewart (1930) has been able to produce typical iron-reacting asbestosis bodies by the subcutaneous inoculation of a suspension of asbestos dust. 1 Summary. The inhalation of asbestos dust in high concentrations leads to the appearance of asbestosis bodies in the sputum in a large percentage of the workers exposed thereto. They were present in 48 out of 50 workers examined. Asbestosis bodies were as easily demonstrated by direct thick films as by the antiformin method. The sputum wras always mucoid in character when there were no bronchial complications. I t may resemble egg albumen. In none of the sputa were tubercle bacilli demonstrated. Study of the intracellular asbestosis bodies in these cases suggests that they are formed by' the deposition on the asbestos fibre of an iron-containing substance elaborated by the cell. We wish, to tender our acknowledgments to Dr Slade for the opportunity of carrying out this work, for the collection of the material and for the clinical data which he supplied. McCttAE, J. . . M avrogordato, A. Simson, F. W. . 55 Stew art, M. J ..................... 5) * Stewart,M .J.,andH addow, A. C. W ood, W. Burton, and GLOYNE, S. ltoODHOUSE REFERENCES. Publications o f the South African Institute fo r Medical Research, 1913, i. 122. Ibid., 1922, xv. 161. B rit. Med. Journ., 1928. i. 8S5. Annual llcj)ort o f the South African Institute for Medical Research, 1929, p. 6!. B rit. Med. Journ.. 1929, ii. 5S1. this Journal, 1930, xxxiii. c46. this Journal, 1929, xxxii. 172. Lancet, 1930, i. 445. I#; ........ 5 4 7 . 9 1 2 + 6 16 -- 006 + 61 6 -- 0 0 2 . 4 + 6 16 -- 004 - r e x p e r im e n t a l l iv e r n e c r o sis fr o m SH A LE OIL. Si,: _ _ Cyril J. P olson. tm ike Department of Pathology and Bacteriology, University of Leeds. ( P lates I. a k d II.) LtlDBOK (1923, 1925) observed that carcinogenic tar caused liver osigs!=in .rabbits. The carcinogenic action of shale oil and its lyes, is .widely recognised (Scott, 1923; Southam and Wilson, Seitch, 1922; Twort, C. C. and J. M., 1929 and Eoussy, 1929). IH^JCfirthat its action on the liver has hitherto escaped notice. No Ions were observed in man (Scott, 1930). Experim ental Procedure. I|33ie:oiI used was shale oil No. 8(2), the carcinogenic action of which was 1 by C. C. and J. M. Twort in 1929. Dr C. C. Twort also sent a sample n-carcinogenic residue No. 8 (2) CHIt5, an oily substance having similar icalproperties to the original oil. he preliminary experiment on six rabbits, each animal received a daily f'6 c.c. of undiluted oil per vaginam for three days. Within the week two rabbits had died from acute liver necrosis: the remainder were killed at nd of a fortnight. A fresh series of thirty-one rabbits was then used to "ate this liver damage. With one exception, each of the new rabbits i the oil intraperitoneally. In the longer experiments, additional doses K*iministered intrapleurally or subcutaneously. The dosage ranged from to 10 c.c. and the experiments lasted from three days to several months. In longerexperiments the oil was diluted from 1/2 to 1/20 with liquid paraffin(B.P.). 'Jifjgtder to exclude, as far as possible, vitiation of the experiments by naturally pCoonirruig disease twenty of the rabbits were subjected to laparotomy and biopsy of the liver at the commencement or during the course of the treatment. Tins procedure was adopted both in the long experiments and in the controls, lu addition three rabbits were used to control the effects of laparotomy followed , i>ythe intraperitoneal administration of liquid paraffin alone. Twelve mice, four guinea-pigs and eight rats were also given oil. Dilution of the oil and the effects of its subjection to heating were also tested. Tha non-carcinogenic residue of the oil was administered intraperitoneally in doses of 10 c.c. to each of six rabbits and in 3 c.c. doses to each of four rats. Twelve rabbits received an intraperitoneal dose of a 10 per cent, solution of scharlacli II in olive oil, six had doses of 10 c.c. and six, of 5 c.c. 1. F in d in g s in rabbits. One of the three control rabbits given liquid pai alSi: a I laparotomy A tWa8 killed three weeks later and the other two at the end of seven --s ,^ JOUaK. OF P A T H .-- VOL. X X X IV . A 2 PJf+