Document ba10dDY6VVbmNnqVyNZ7qzbgD

.,:ts!r. Mr. 1965, 22. 26). 1l 1ESOTHEUOMA OF PLEURA AI\TI> PERITONEUM FOLLOWING EXPOSURE TO ASBESTOS IN THE i LONDON AREA BY MURIEL L. NEWHOUSE and HILDA THOMPSON From the Department of Occupational Health and Applied Physiology, London School of Hygiene and Tropical Medicine (kecii'.to fo.'t j*UBLirAT ion fhhkoary 11, 1965) . .erics of S3 patients from the London Hospital with a diagnosis of mesothelioma confirmed by p;y or biopsy has been studied for possible exposure to asbestos. The series consisted of 41 and 42 women; 27 of the patients had peritoneal and 56 pleural tumours. The earliest death - ted was in 1917, but only 10 of the series died before 1950 and 40 (48%) between 1960 and \ ~6 of the series full occupational and residential histories were obtained. Forty (52-6%) gave lory of occupational or domestic (living in the same house as an asbestos worker) exposure to . 'os compared with nine (11*S%) out of 76 patients from the same hospital suffering from other .-ses (p < 0 001). None of the 17 suspected cases of mesothelioma, rejected on pathological -r.-Js, was found to have had any exposure to asbestos. There was also evidence that neighbour1 exposures may be important. Among those with no evidence of occupational or domestic wires, 30 e % of the mesothelioma patients and 7 6% of the in-patients with other diseases 2 within half a mile of an asbestos factory (p < 0-0J). Out of the 31 patients with occupational sores only 10 were in jobs scheduled under the Asbestos Regulations of 1931. The interval ecu first exposure and the development of the terminal illness of mesothelioma ranged between .-r.d 55 years. r 47 patients in the mesothelioma scries, lung tissue or sputum was available for examination. ') (62-5%), cither asbestosis or asbestos bodies were present. rat years, `.he association between exposure os dost a-.d cancer of the lung and other neoplasms has been the subject of much leading r.-ricle, 1964). Wagner, Sleggs, and '.i (1960; described the occurrence of meso- of the pleura in those exposed to crocidolite in the mi .ing districts of South Africa, and stimulated further studies or the occupa'.orics of patients suffering from this tumour 964; Fo-' ler, Sloper, and Warner, 1964). ; 'csent investigation concerns patients in .'.esotheliotna had been diagnosed at the Hospital duiing the past 50 years. After vg the necropsy and biopsy specimens held hology department, Hourihane (1964) condiagnosis of mesothelioma in S3 patients, 41 were rven and 42 women. Thirty-one of had pVeral tumours and 10 peritoneal; among the women, 25 had pleural and 17 peritoneal tumours. The aim of this study has been to establish the occupational histories of these patients and to trace any other possible exposure to asbestos. There were four surviving patients at the outset of the investiga tion, but these have subsequently died. The earliest date of death in the series was 1917; l(t died before 1950, 33 between 1950 and 1959, and the remaining 40 in the past four and a half years. The joungest patient died at the age of 33, and nearly half were dead before the age or 55 (Table 1). Clinical Features The ward notes of 65 of the patients were available and give a picture of a disease with a consistent symptomatology. Among those with pleural >t I t i r ! I BB 0005742 j MUTISM JOUR\AL O'. n'Dl 'STIU M. MEDICINE MI Taiili. 1 At.: XT DLATM OH SJ VAT1UNTS WITH MhfOTHnivt TUMOURS Aprr.-r.) * 4 -1555*5 - Male No* 2 7 15 10 7 k 4*9 17*1 7C.6 24*4 171 Tcrxik** Nd. I 6 V 12 R 24 US 1**`> turours, the commonest presenting symptom was the rapid onset of extreme shortness of breath due to the formation of a massive pleura! effusion. Pain was a prominent feature, either described as a dull adie, sometimes due to invasion of the ribs or vertebrae, or sometimes sharp and radiating, sug gesting nerve involvement. Tumours in the chest wall were not uncommon, occurring cither in previous operation scars or by direct invasion of the chest wall. The symptomatology of the peritoneal t.mouts was more varied. In some pr.;ients> the pre senting symptom was pain on defuecr.tion or micturition. Diffuse upper abdominal pain was very' common, and swelling of the abdomen due to ascites vas always present terminally. The methods of treatment included pneumonectomy, decortication of the lung, deep x-ray therapy, instillation of radio active gold, and cytotoxic drugs. They were used alone or in combination but had little effect on the course of the disease. Half of the patients mi hermg from pleural mesothelioma died within one year of the onset of symptoms, a further thitd within two years, and only one patient survived for more than three y<. s. The course of those with peritoneal tumours appeared to be equally'rapid. Light of the patients died within six months of the onset of symptoms. Sources of information on Occupation and T!cMik-nce In addition to the ward notes, some of which gave good occupational histories, there were three other sources of information: the patient's general practi tioner; the records of an asbestos factory in the area; and personal interviews with patients or their surviving relatives. As a first step, general practitioners wete circulated with an explanatory letter asking them to complete a form giving details of the occupations of patients and their immediate relatives. Within two months 65% of the doctors had replied. In two cases a hitherto unknown exposure to asbestos was revealed; in others the name and address of a stu vising relative were given, but in the majority the doctor was unable to give information because, on the death of the patient, the notes had been returned to the 1.^... executive, council of the National Health Ser,*.. where they were destroyed within a period or th:,: years. In one of the asbestos factories a flic was kept -.v\ detailed records of all employees since it started , 1913. The names of all patients were checked \>,these flics. Nine men and nine married women (an. r their maiden names had been ascertained from re!; lives) were identified without difficulty. The co;_~ dates of employment of these 18 patients and t.-jobs they had done were obtained from the reo re. of the factory. The Tour patients alive at the beginning of ir. investigation were interviewed personally. - A fi-. relatives were contacted by post, but the relative,.: 68 patients were interviewed by one of ux (11. ! .;;; their homes situated mostly in the East End London. Not only was an occupational history of tiv paticut, the spouse, sons and daughters, and fig be taken, but past addresses were also recorded. J `,interviews lasted for at least an hour. To recall eve-./, of 30 or 40 years ago it was often necessary . explore the residential and occupational historic.; all members of the family. Exposure to Asbestos in Three Croups of Eattv::. Suffering from Other Diseases For comparison with the mesothelioma patter . three further gr --.tps of patients suffering from o,;-.diseases were ! stigated. The first pro.. was selected- from the patient.. the medical and surgical wards of the hospital durm tire early summer of 1964 ('in-patient' series). I;:-.! patient in the mesothelioma scries who had Ivv traced was matched with an in-patient of the s.t: - sex born in the same five-year period. As there v. ia dearth of male patients over 75 years of age in n hospital, a sample of six patients of this age a;..: older was taken from a neighbouring gcriat:..hospital. The second group were those who had original': been filed in the pathology department of t; hospital as cases of mesothelioma but in whom t!: diagnosis was subsequently rejected on pathologic, grounds by Hourjhanc (1964) ('rejected series'). Ait had proved extremely difficult to locate the trees of those who died before 1950, attempts we., made only to trace the three survivors in (his pc'--: and the 14 who died after 1950. The in-patient scries, already described, wete '' admitted to hospital in 1964. The patients v.r mesothelioma were admitted to the same hospi' over a period of 47 years during which there mT have been a substantial change both in the resident:' .. ..i- and so t < nion Hosp taken a. of adiid .. :;i tile j>ativ n'.-.e' of rev; v; compart-'.-'. t retails of i '.-vs are give -out past do; ..'table for > 10152-6",. ipared v. i; " vs { fable : I S OF IS lit MI.SOI1 i>i*t .s' i l 3? *-*vsJ ; * ui < : utof ivta M J.itoi* u;J ! 'jllU'WOfk hit. V- IfiHO,-) i;\e hixi> mi thi> ci.i 'U.tixtica `>001). ' b> the t'ear of vignifiev >*: in th and tlu paring Riesotl >: the gave : 1 hii NOTE: THIS DOCUMENT DID GO \vy NOT COME FROM PPG FILES .. if. wir.j MESOTHELIOMA OF PLEURA FOLLOWING EXPOSURE TO ASBESTOS 263 ,! social classes of patients unending the . Hospital. Thus, a third group of patients . en from the hospital records matched by admission as well us date of birth and sex . patients in the mesothelioma series. Their -if residence and occupations were extracted .parisen with those of the in-patient series. f Results cds of the S3, patients in the mesothelioma arc given in the Appendix. No information past domestic and occupational histories was :ive for seven patients. Among the lemaining *52-6%) gave a history of exposure to asbestos -.red with or.h nine (IT8%) of the `in-patient' Table 2). The difference in this proportion is 2Tabu OF EXPOSURE TO ASBESTOS OF 76* TATIENTS itSOTHELIOM A AND 7S IX-l'ATIENTS WITH O) HER DISEASES .. pc of Exposure rj | one asbestos v to f;;c*ry -ej at other fc.^sios *> and -orked j-bestos ' hamllrng ;-*Ve*to tory of v wi, of .-'.ic to Mesothelioma Sfrirt No. X 18 1/ ISO 4 53 8 10-5 9 US 0-- 36 47 4 Mivpalicnt* Seric* No. V 1 13 1 13 4 5-3 i 1-3 2 26 67 : i' ; exposure* to rsbcMos in mesothelioma series versus >.;*lie* is m-paticnt senes; i ~ 27*11, * < 0 001 .'a cases of .`r.rxnthelromi could not be traced and arc omitted -.* table. :iica!l> highly significant (^l = 27-11; v < .). This reiult is unlikely to be unduly influenced vc two groups of patients not being matched for of adn.';sion to hospital, since there was no ficant dir.rcnce either in the areas of residence the occupations of the patients admitted in 1964 those ad:../.ted between 1917 and 1964. Com et the confirmed and rejected patients in the -thclioma group who died after 1950, 36 (50%) ;c confirmed and none of the 17 rejected cases a histor> of exposure to asbestos (Table 3). difference is statist.cally highly significant 11 S3; v < 0 001). Table 3 EXPOSURE TO ASRBSIOS OF CONFIRMED AND REJECTED cases or mesothelioma surviving after. January 1950 Exposure to Asbestos Exposure positive No work or domestic contact found Untraced Diagnosis of Mco`hcUoma Confiaii'J 36 j 1 Rejected !35 ,, i| i r* 11 S3, r < 0 001 Mesothelioma Series Occupational Exposures.--There are details avail able for the 18 mesothelioma patients who had worked at one asbestos factory which used crocidolite asbestos with small amounts of chrysotile and first introduced amosite in 1926. Eleven started work before 1933 (the year when the asbestos regula tions controlling the manufacture of asbestos goods and tite protection of asbestos workers became effective), and seven started work between the beginning of 1933 and the end of 1942. The occupa tions of these workers and the type or asbestos they used are shown in Table 4. All of the 17 for whom details were available had used crocidclite asbestos. Five of the occupations listed are not. scheduled as Table 4 JOBS OF 17* PATIENTS WITH MESOTHELIOMA EMPLOYED AT ONE ASHES EOS FACTORY Statutory Obligations Subject to regulation* Not subject to regulations Job Male Spinning Carding Clothing and v> easing Disintegrating and opening 0 1 ) 2 Filter nukine for A.lt.r. masks Manufacturing ofrreforir.cd pipe insula* tion Manufacturing of brake lining* Rubber com pounding General labourer i 0 1 Femalt Material 4 Crocidclite 1 CrocidoHte CrocidoHlc, 0 chr>sotilct amosite Crocidohte, 1 chrysotile* amositc 0 Crocidolite Crocitlokie 0 Crncidohte Oocidclile* chrysotile Crocidolite, 0 chrysotile. amoxitc Employment history not available for one female patient. rr J NOT 'COMt ittUtvi kfU NLfcS i i I i I I t 1 i i \ i1 i 1 i i i i O' r , o; i Bfl rtn np ,iivU-> V* T'DU hisj VUi 1' :.'\ i 1~>r ISRITISlt JOURNAL OF INDUSTRIAL MEDICINE recjnmg : .cdical supervision under the Asbestos " egulatiom. {!93t). our paSents ;>vcre working at other factories r -king ali types of asbestos goods. One had been err.ployed ia a wagon works sawing asbestos sheets fo" parti lit.Tts. Except for one, a woman employed ir: insulating dectfodes with crocidolite, the types of as: estos Usc,-J in these other factories arc not known. Toe eight healing engineers and laggers were all men. Th;-^ had been employed in dockyards on sh:p repaid, two in various types of lagging, one in a power station, one installing hospital sterilizing ts'-ipnient, and one installing central heating. All were consistently employed on this type of work for more than 20 years, but, in some, exposure to asbestos w.--s intermittent. Doiuswtir /{.xrw'zi-s.--The group of nine, seven women nn-J two men, whose relatives worked with as^j-ios, are of particular interest. The most usual .'..o,ory v..i, that of the wife who washed her hus- c'-ttd's dm.farces or work clothes. In one instance a rdalive said that the husband, a docker, came home with asbestos' every evening for three or four years and h:s wife brushed him down. The two men ir. ibis group, when boys of 8 or 9 years old, had sti'.ers w ho were w orking at an asbestos factory. One of these gitts worked as a spinner from 1925 to 1936. In 1946 sii'j died of asbes-osis. The press report of trr inqv.e.i states: `She used to return home from V'orwith dust on her clothes'. Her brother had ar rarently no other exposure to asbestos; he started as a shop assistant, then became a sawyer of i'O.n girdei-. until 1948 when he worked as a loader o: groc-enes in the docks for five years (but never on d-.'o.y cargoes! and then returned to sawing iron girders. 1 l-v- d`ed in 1956 of a pleuial mesothelioma. In-patient Series O;tmid Doincsiic Lxposwr.t.--Two of series li.'di v' urked in asbestos factories and four J- i'-'fi employed as luggers. The husband of - - "-;ter was employed at an asbestos factory for ree >eni\, an,| two dockers in this group gave t,orie> ol li. asbestos cargoes fiom time to - tilloui-b.'y* their working life. Tue di.:> nt'ws of these patients have been grouped I : :o se-.on categories (Table 5). The patients with a P- tive lu\i.> \ of exposuse arc scattered throughout thtr : V3r:o;i'. d,.-.gnostic groups, and there is no indica"! t...:t exp,.sure to asbestos could be related to tr e wis.'.iM- wl-.rh had caused their admission. Nc!CM ."uIk .1, Exposures of Mesothelioma and Jn-p.it-.ai s,, v,--The 36 patients with meso- Table 5 DISEASE UROL}US OF PATIENTS IN THE IN-PATIENT SERIES Disease Group CGRMaaeearttn.diatcarioobue*vomlioanliiestca<cns*u)Mdlaoirtrhile(leiaxlc`luddeilnugdicnagncers) RAOHethsenprciroaptol.ruyim(rxdudsng cancers) Tout FNaoiic. notrs 219 f8t n1j8 76 hxNApsoob.scuvsrtoc;tbv;.x i3t 2201i 9 thclioma and the 67 patients in the `in-patient' series, who had neither an occupational exposure nor a relative living in the home working with asbestos, might have been exposed to asbestos dust because they lived in the immediate vicinity of an asbestos factory. One factojy, where more than one-fifth of the mesothelioma patients were employed, opened in 1913, having been situated nearer the centre of London for the previous seven years. There were three affected female patients living within half a mile of the factory during the time it was in produc tion at its first site. When it opened they were children between 5 and 7 years old. At the preset.! site, there were eight patients living within a halfmile radius of the factory. One man was born within a quarter of a mile of the factory* and remained :v the same address for 16 years. The other seven wen* women, and all except one were children when the factory opened. The seventh was 23 years of age and remained in the same house until she died 4S years later. She is the only patient who had ncithc I occupational nor household exposure but in whom asbestos bodies were found in tire lungs at necropsy Among the `in-patient' scries, one patient lived near the facioiy at its previous site and four other:, lived near its present site. One patient was 22 yearold when she moved into the neighbourhood in 1915. She disliked it and, when interviewed, complained impaitially about the dust from the asbestos facn-iy and the rats in the house. Table 6 KisiDENct or rat11:nis with no occdpationai r- domestic exposure to asbestos went'* Mesoibcbpma In-patient hived Within J mile of Aibcsios Factory No. % 11 30 6 5 7-5 l.i\eJ Mrc 1 han i m>*e horn 1 Jxlurj No. | % 25 ' 1 62 | a* 92 5 7 oi**I X1 -- 7 S5, r < 0 01 MES Thus, amoi domestic expo paiR-ms in the m the `in-patie (I an asbestos Jiu'ercnce in t ei ies who live had no other significant (^" l>ate of Kirs in Mesotlieliom had been expo lived near the of exposure va to over 50 yc exposure and <. mean 37-5 yc winkers, when interval was S gmup living it Ilirtorics, wlic In.rest. Table ai tirst exposur death in each g in i vtion ultv- 'i interval i 1 >PC of tiry WvrS; hi rKM^bbsiu h mJ of fjciury ai:ed between d-.'th showed I nncp of fa etc vea .1 in the ol Asbestos Co di'.-aonia Scrie* helnima seric 'v.imination in 'li certified as s tKMie available 'wealed the pr hn'.h asbestos --v-UosK were ait! luggers..A olvnos bodies I BB 0005745 1 -1 7- ;U. S* U sHLCi MESOTHELIOMA OF PLEURA FOLLOWING EXPOSURE TO ASBESTOS 265 ihu>, among those with no occupational or c_ r..;s".ic exposures to asbestos, there arc 11 (30-6%) r-"ents in the mesothelioma series and five (7-6%) r fin-patient' series tv ho lived within half a mile ,: an asbestos factory in the area (Tabic 6). The c V.-rence in the proportion of patients in the two ^ ies who liv ed in the vicinity of the factory and had r,' no other exposure to asbestos is statistically : y rneant (** = 7-85; r < 0 01). 4 Date of First Exposure and Interval Before Death i \lesotheliuma Series.--Fifty-one men and women red been exposed to asbestos, including those who i-.ed near the main asbestos factory. The duration cf exposure varied widely, ranging from two months t. over 50 years. The interval between the first sure and death varied between 16 and 55 years -.an 37-5 years). Among the group of factory .-'-ers, where exposure was probably heaviest, the -:.-v = l was shoTtest. It was longest among the g-c-cp living in the neighbourhood of the asbestos -.cries, where exposure to dust was probably . .si. Table 7 shows the mean age of each group : r.-t exposure and the mean of the inlerval before in each group. Although the length of interval T.vm.r 7 --TTON BETWEEN TYPE OF EXPOSURE AND LENGTH ;->TERYaL BEFORE DEATH IN SI PATIENTS IN MESOTHELIOMA SERIES lN ',- of Exposure I No. 1 ? 7 - ry feurk. _i .'-i insulators i1 ! j9j s * "; tf*ffsncelisghrybour- ! 11 FMiresa(tynExArpstoe)suarle 2127--59 15-6 8-S hbM'eKetpwa(oDenyseeeuInaaricritI*hO)htaivrnsMdt 233987*M-94 4S6 j-'ed between 29-4 and 4S-6 years, the mean age at showed less variation; it was 50-6 years in the of factory workers and between 55 and 57 - " in the other groups. ' rAstu> Bodies and Asbestosis in the Meso1 " ;cn Series.-- Of the S3 patients in the meso- c.na series, lung tissue was available for v 'ination in forty-three. In four other patients, - , .TtifieJ as suffering from asbestosis, with no lung .- available, examination of sputum during life . -led the presence of asbestos bodies (Table 8). B : asbvdos bodies and histological evidence of -v . tc-sis were found in 15 of the 24 factory workers - ' sgeers. A further five sho wed evidence of cither - vos bodies or asbestosis. Lung tissue was available in only four patients exposed either through relatives or by living in the neighbourhood of asbestos factories. In two, asbestos bodies were present in lung tissue but there was no evidence of asbestosis. Table 8 EVIDENCE or ASBESTOS BODIES OR ASBESTOSIS IN 47 CASES OF MESOTHELIOMA WITH LUNG TISSUE OK SPUTUM AVAILABLE FOR EXAMINATION History of Contact with Asbestos Positive Negative Untraced Total Asbestosis or Asbestos Bodies Rresent Absent 22 6 48 43 30 17 Lunc TUsuV ' not Available 23 13 0 36 Among the 12 patients in whom no definite contact with asbestos could be established, there was one, a merchant seaman from South Africa, whose lungs showed both asbestos bodies and asbestosis; he may have had contact either in South Africa or at sea, but his early history could not be established. There were three others in this group who had asbestos bodies in lung tissue without evidence of asbestosis. Of the seven patients whose histories could not be traced, three had asbestos bodies and histological evidence of asbestosis and one had asbestosis alone. Discussion In the mesothelioma scries there are 25 patients in whom no evidence of any exposure to asbestos could be found. A chief source of information was a history' taken from a surviving relative. A surprising amount of information was obtained, but in some of those interviewed the memory may have been defec tive or they may not have known of short periods of exposure during the youth of the deceased. For example, one of the patients was eventually identified as having worked at a large asbestos factory for two months in 1941. This was before he married, arid his widow did not know of this episode. It is of interest that asbestos bodies in the lungs were found in only four of this group, am! it seems probable that among the remainder there were those who had had no exposure to asbestos. In the mesothelioma series of patients, both in dustrial and non-industrial exposures were recog nized. Among the men the exposure was pre dominantly industrial; 22 worked in asbestos factories or as laggers, two were exposed at home, and one Jived near the asbestos factory. Among the women only 10 worked in asbestos factories, and a 'r ve0 2_BB 0005746 [ o further 17 had ron-mdustrial exposures, seven in the likely than the mesothelioma scries to work in con S h'"i ar.d 10 living near asbestos factories. tact wills asbestos or to live in closer proximity to There is no c\ i-.lcncc that the patients with asbestos factories. prrhoneal tumours differed in their type of exposure , There seems little doubt tlrat the risk or meso t\ fro.-', the patients with pleural tumours. The pi opor- thelioma may arise from both' occupational and tior of positive findings of asbestos bodies or domestic exposures to asbestos. Wagner and others astxstosis was similar in both groups. A higher pro (1960) described patients with no exposure other portion of women, particularly among the factory than living as a child in the vicinity of the asbestos workers, was affected by peritoneal tumours, but the mines, A high incidence of asbestos plaques of the difference between the sexes was not statistically pleura lias been found in the population living neat-, significant. an anthophyliite mine in Finland (Kiviluoto, 1960), 1 The recent increase in the number of patients More evidence is required of an increased risk to the diagnosed at the hospital may be partly due to an population living in tne neighbourhood of asbestoi ! increased interest in mesothclial tumours and partly factories or other areas, such as dockyards, where * to the long interval between first exposure and asbestos is used in quantity. de- elopment of the tumour. Those exposed between 1 Vi 5 and 1925 might be expected to die from about .. Wc should like to thank Dr. D. O'B, Hourilvaiic for f 1950 onwards. Asbestos imports to the United K:".cdor: have mounted steeply since 1932 (Lcathurt, ISoi) and its u^ss are more widely diversified in industry. The increasing proportion of the popula tion exposed to asbestos duiing the past 30 years r e;, be expected to give rise to an increasing occurrence of mesothclial tumours. his co-operation and for making the results of !fi> investigations available to us. Our thanks are abo due to Professor C. Wil-.o.'i, Professor V. W. Dix, Dr. N. L. P.usby, and Mr. G Flavell, l-'.R.C.S., of the London Hospital and Dr. C. 1'. Silver of Si. Matthew's Hospital for permission to inter view their patients; to the general practitioners who c.:1 laborated in this cnquiiy; to the managements of ill. i j ( ; Tree choice of groups for comparison with the asbestos factories Tor arranging access to their rccouN; rr-:-;othelioma series of patients was not ideal. The number of patients it was possible to trace in the 'rejected* scries proved to be very small. The `inp-iient' series, although matched for date of biith ar.d sex, difieied from the mesothelioma series in that ah were admitted to hospital during 1964. Neither of these groups could be interviewed without know ledge of the disease from which they were suffering. Tr.:> could have led to bias with under-reporting of c posurc to asbestos in the in-patient scries. How to Miss Joan Wulfoid for statistical assistance, and i;> Dr. J. C. Gilson, Profcvtor It. S. 1:. Schilling, and Dr. V, Smither for their advice and help. The contents of this paper were communicated to the Conference on the Biological Effects of Asbesm-.. arranged by the New York Academy or Sciences n; October 1964, and will Ire published in a shorter foie, in the proceeding; of that conference. RfclPREIViCLS ; i \ f ; i { 1 ever, in the `in-patient' scries the actual patient was interviewed, and more detailed and reliable histories were obtained thrn was possible from the relatives of those who had died of mesothclial tumours. There v.n r.o evidence that, because of their mote recent cr.v.iision toJcospital, the in-patient scries was less I p, B. S., Sluper, J. C,, and Warner, C. C. (1964), J.,1, 211. Pending article (1961), l/'id., 2, 202. Hourihtuic, II. O'D. (I9M). Thorax, 19. 2C.S. Kiviluoto, R-(I9G0|, ArUi rud.ol. (Sliol h.). S-jppl. 194. Lealh-tn. G, L. (luG-l), Oi. op. nrd.1, 16, 119. Ov.cn, v\ , C.l>n (1904). Jirii. ntori. J.. 2.214. Warner, J. C., S!ct`i;c, C A., and Murvhnr.d, P. (1960). mthtrrr. 'f.A . 17* 2.V0. uvC Ihii. J C ,i'-c Si*. Stic of Primary Tumour i tintf A; Fuctorjr Pleura 19 rcfituicup '* Fcfitofteui. Pleura it Fcrilowur IS Ptrhoncui 11 Fcrfeortew: i J iVriiorcib I* FcrHomiut 9 :i Pleura 12 Fcri|f>iwui 5 Pvrii<**ieu > Pleura Fcriu'trvu n ricurj l Pleura iu Pcrijoreu i Pleura Pleura \ Pcriinnuii ' rcriituvcu Appendix opposite tnui H: Ijtzw 2*0 J'lftir* 2* PllUfeJ 22 Ml Flrtirj 27 PeritoixN * I'liiitoni.-i *\ Pleura 2'* Pleura *rV' | *i i_J^000574 7~] l I MESOTHELIOMA OF PLEURA FOLLOWING EXPOSURE TO ASBESTOS 267 APPENDIX EIGHTY-THKEU PATIENTS WITH MESOTMbLlAL TUMOUKS S-.'.c c* Prii-- 1 ' Facto ry *-orkrrs Vr C.r;6>5 Dura* Year lion of of Year First Expo- of Lpo- sure 'Death jure .(iCurj* 1 How Dnicnosed Asbestos Bodies in Idling Tissue Kithological Evidence of Asbc>tosis in Luna Tissue Survival from Initial Svmptomi (months) Relevant History rr^i-ri M 1>01 ' 1921 17 1936 Necropsy Positive roaiin-e 1 Per'dortuni M 1695 1 1919 22 1941 Necropsy Positive Positive \r,;picu.Tk F 1925 5 1947 Biopsy Positive N/A (sputum) * /'sa: - ifcaO 1926 12 1950 Necropsy Positive Negative :-en:c7*aa> r : sfi;,-nsu:n r - 1917 lf`0o 1922 7 1951 Necropsy Negative Negative 7 1951 Biopsy Positive n:a (sputum) ^-r :`<*rvturn f 1594 1915 * 1955 Necropsy Positive Positive :'erriorum b I 1995 1917 1 1955 Biopsy Positive n/a (sputum) P.:ri:*>r;cum : H Peril cr.sgm F 1901 191S ir>7 1919 I* 1955 Biopsy Positive n/a (sputum) 1 1956 Necropsy Positive Negative Kcj'i M * I3 19--fi 1 1957 Biopsy N/A N/A rk(l;w,cun F 191S 1937 1 2 195S Biopvv n/a N/A r'-T::o^eum ! ' ) 1503 1927 30 1958 Necropsy Positive Positive i 1l M 1525 1540 4 1959 Biopsy N/A N/A i ii T.^wra ; M ` 1925 1941 1,6 1959 Biopsy Negative Negative i i - P_:itor^u.Ti . r ! 1/07 ,92. ,, 1959 Necropsy Negative Ntgali'c J Pi.'-:* Pft*.. * `F 1905 j M , 1707 {i 1924 1942 1 1962 10 1962 I Biopsy Necropsy Poxitte Positive Negative Positive : f j ii9v 1923 | 11 1963 Bopsy 1 Positive Negative i` tut* : M ! 1 TO ,936 26 ^ 1963 Necropsy Positive Positive P^_?i :m M T*r' -o-:- ;90s 1911 1917 1925 19?0 1937 1963 NecrO|S) Positive ,963 Nevropjy Positive 27 , 1964 i , Necropsy Positive Nvgm*'e Positive Positive 7 Brake liner, boiler coveror. ashestos factory; mainly trocuMitc 7 Disintegrator end other jobs. axticsto* factory; amojite, citcidoliie, chrysolite Sectional pipe maker, asbestos factory, certified ashesiolic; main ly crocidolite 9 Used asbestos boarding in railway carriage constructor* 7 Asbestos factory, job unknown 7 Opener and sectional pipe maker, asbestos factory', certified nsbe.stntic; nmositc, crocidolitc, chi>*otiic 12 Spinner, iKhc-do* factory, certified mbestotie; mainly vro;idolitc 3 Sectional pipe maker, asbestos factory, certified asbe>totic; mamly crocidolitc 6 Spinner, ashbiloi factory, certified ftxhcstotie; mainly crowdoJi'e 3 Disintegrator, a*hc>;ox factory; omositc, crocidolife, chrysotilc IS Asbestos mixer, north England asbestos fuctoo IS Carder, asbestos "factory; mainly crocidolitc IS Clothing and weaving, asbestos factory*; amositv, crocidolitc. chrysotile 3 I ilicr maker for A.R,P. masks. asbestos factory; mainly croci- n Filter maker for A,R.P, masks. asbestos factory; mainly crocitlolite 7 Electrode covcrer; crocidolitc Si'innur. BitnrHor. fiCoiy: m.iinly crocidoliie t Delivered chemical to asbestos factory; amour, crocidolitc, chrysolile 5 Spinner, asbestos factory; mainly crocid4*litc 7 1 Labourer, works and buildings. vl>c>u>i factory; amowte, croci- fi ilol/ic, chrysolile Worked in >ard of insulating contractors 6 C arder, ^bcotns Tactor>; mainly crocidolitc 24 DNimacruior and other jobs, asbestos factor), amosite, crocidohtc, chr>*>\li'k '> L ??-ert >\` P!r_.-S 1 i iC-Ti M D74 1553 53 1935 Necropsy i Negative iI j Negative i 12 1 Workevl in close proximity lf> boiler j rcpnirci indockv.,rJs M 15W 1910 1955 Uiopsv S/A N/A 1 24 Boiler cleaner and stripper, dock- l i1 M !*2l 1937 22 1959 Necropsy Positive j Positive | y.irtU 9 i Boiler coverer and lugger lo various M IvOS 1922 * 3 ! 1961 Biopsy | n/a ! N/A j 25 i firms j Erecting and fitting central heating I'v-vit-ae jm M )9C3 1922 ! 36 ,961 Nccrop>> Positive Positive ! Boiler coverer and pipe insul.itor, i contracting f m re; no,.;um M 1911 1927 34 1961 Necrop>y Positive Positive 1 13 1 1 agger and boder coverer, various 1 J 1 f,rm* i'.-Lrj M 1*97 1916 i 41 1 1962 , Biopsy N/A N/A ! F j Intermittent!) boiler Jaggv'r, ship J j repairs M 1912 1927 34 . 1962 Biopsy N/A N/A 10 1 lnsi.iltativvi of hospital sterilising ciicupmeiif Icnnfimti'J} | BB 0005748 | -. NOTE: THIS DOCUMENT DID NOT COME FROM PPG FILES 26S BRITISH JOURNAL OF INDUSTRIAL MEDICINE APPKNDJ.V {uoAiin'u-fO EIGHTY-THKHE PAT1KXTS WITH MESOTtIF.UAL TUMOURS \ i Ces* Nj- i iit 1 Site of T uroour . Scettvz C: A-' 1 Pleura i W i Pleura ! ' Six 1 Year or Birth o/rzluh*rs M l l F 1912 1912 1 Piegra 1 37 i Jkrgra ^F i F IS95 1005 is__! Pcr::_r,riun * ;i 1 Wrere i t * Pleura F F NS 1890 1916 1919 DuraYear tion or ot Year bust r.\pc- or Expo- Sure Death sure 1925 11 1956 1919 1919 2 41 1957 19i.O 1925 14 1960 I92J 2j I960 1950 4 1961 1928 2 061 How Di.Snosed Biopsy Biopsy Biopsy Biopsy Necropsy Necropsy Iliupy Asbcsto* Bodies in Luny T issue N/A N/A n/a N/A Positive Negative N/A 3i ; Pleuca F 1900 1941 s J '*6.1 biopsy N'/A 36 Peril >: <unt F 1SS& 1912 U : St cfr. AA t PlcU."j i 4 > j Hi.." -^ T'tVT+* > *0 . PievT-J * G Pie-ra l 47 1 Pieurj ! i 1 t i i ! j | ..... r 190? 190 7 M 1922 1922 16 F j9 1913 48 F 190.1 190$ 6 F 1j05 1913 13 F 1917 1917 10 1-4 PUufr j F 1599 1907 6 1 71 ' Pieu- a F 1S99 1907 6 j41 Plrvri F 1900 1913 32 45 r:;gri F 1900 1913 7 i 4^ ; PIei-'a ) F 1907 190 7 i : ,Yc> hiitor. f'f contact i* ith usbcilai C? Kcrifa F 1900 ires Btupoy N/A 1939 Oiopii* I960 Biopsy 1931 1961 U:opiy lliopsy 1961 Biopsy 1951 n.cp'y 1962 Biopsy 1362 Biopsy 1962 Bfop>y )9C: Riops) 1963 Dmpvy N/A N/A Positive N/A N/A N/A Negative N/A N/A N/A N/A 1947 N>v ropsy Po*it\C S JVriJeOeun: F 1902 At PUcra 1 M ISO? r 1*99 rJ'erjtorrum 1904 h_ Fir'-.'.. M loc*9 19? 4 1934 Necrupsj Uiop*y Ner.ttiw N;A 1535 U>opsy N/A 1955 1935 Neerop'-y Negative Necropsy NY`i',.itiv e i t i! Kuho- logical Fv.dcr.ce of Asbc*tosis in Lons Tissue Survival from Inmal Symptom* (months) Relevant History - N/A 27 Elder sister worked as sninn.-r v asbcv.oi factory* died 19*:-. certified rsbtslouc N/A J 4 Elder vvter employed as spinne. looked after patient a* child n/a 15 For several years husband worked in ship's engine room, ci?*e proximity to lagging operatin':* N/A 3 Hnsbard worked as boiler cover o\*r*JN brouphl home tor Negative 24 Husband foreman and extcuiiv,: ,t; Negative sb-?us factory > I1u*b;,j:d a docker; frce\\mn-.i/ haa/lcd *h:tc' atbcstns n/a 18 FJtlcr v'j'.er Vt'orJceJ a* spinner j* ash-.*s`o> factory ;md xufiers n o"; a^lv.1 :o,:> N/A 18 Dau^^u-r worked inflibodosf/temr. for 5 years; patient washed k*r N/a IS IltisKanJ leibvay cjffi.ipe huii.r,*r: h;ed Ci? ' pan nenus with * sIks'ii;^, work clothes v.2>!h.-<1 home t * \ ! 1 \ i 1 1 i ( \ \ * 1 ) N/A N/A Nvgalixc n/a N/a N'A Negative N'A n/a n/a N'A Necili'.e Negative N/a N/a Negative PojUive * 8 LmJ .ithV, i mt! cf p'oscnt 5 `- of aiV**i*"'* factory 17 Live! wp.lan 1 mile of piescnt sit-' of aibe'1.^ factory 15 Lived lOrt yard* of pres*. *. i silo of ,-o :vti2 factory 13 I-ivlU # mile of old *:tc i asbrstos f.ctery 4 Lived within 1 inile Ol present #: ; i of asbe*t>> factory t 16 5 Lived v'j'L.n 200 yards of pre*--*. site of a'*?rtos factory Lived wjthia J ntile of old site t t t 12 nslxsios factory Lived vir.'-/t 1 mile ol old vie *! ale*Os iavtury i \ ' 29 Lived } inila of present s:ic of ashes'os factory 9 Lived withA mile of present *,rt i of u\K`:c#s factory ' 7 Lived wiLLti i mile of present v-: of factory : / | 7 NVi.,?.*d i. Ruremald to r.;anac. oT works in Last l^vt. la *' { asbest,' i.vt.Li(ioii u..ed in v.o:`> 5 Sho.*th.ir.J-:.pisl and hotsr.`*. I\vd J ?tv'.i Bakery ro.'.atsnnn, rfntv, gerer * laho .rcr. pahtuan f<*r 3d >cr< .? Fast LnJ or Loiuton -1 Mumi'-'T' v,9*rk \tefore m iTi'V'i I hi.", h- a,'Wife; h\ed \\alia-'1 . Ahb.'N. 1 i 27 '1 aiJor.in housevvife ia f.'t 1 nd of I."-d-n I ?S fli*i;'k>ej ?s latentan and rrta*`',r. l>eCktor i'lS woik ?(* ! * perG*t-`*tt d:M.harpinj; Mn"> I*s'de of skrtt followi'tp, cn'pvi*!''-1 ; 1925, Slu'c ehes-t infection Is*'1 sub'.f^ue"*; th:'r;te<`pla>' - deteM^ra* d from tins dale 1 { ME. f v,o. She <r Pri.tuO Ttunocir | Peritoncur 1 1 .I rirui^ Tf. PIsura Fleurs Plctif* a Puritoncv: fl;urj , * ' rieor* >1 Plnir.1 "'1 Pleuia 7, 1 I Plvura ti l'K*ura i 7- Petitooctim i i *' t Mcurj % ,iJ | Peritoneum r*7 { rk-un ! 1 Pleura f ' reiitoiwtin ! PL'uia i V Kfm<t /; t /UfuCrJ T" 1 l*Jcvir j '< I Pleura -1 i i'leuta -9 j Pleura Ptoura " i A'ruoncum - | lixifj _____ ___ _______ ________ pfL | BB 0005749 | t r- MESOTHELIOMA OF PLEURA FOLLOWING EXPOSURE TO ASBESTOS APPENDIX {cmt(tnuvd) 269 i j ! EICYITV-TIlKlib PATIENTS WITH MESOflli-LlAL TUMOURS \ >.* o: i vfr/r.r |i 1 1 \( \ ; Dura* ! \ cur non l Yvr of . of Year 1 . S-\ of ! First , Ltpo H-.rth E\po-| sure r Death ! ! sure :{ycars) 1; i1 11:53!K*se J l 1 1 Asbestos Iti.Jici 1 in Luns Tr-suc Pal ho- logical Lvidcnc" of Asbestows m Lung J iSlUV Survival ft om lniti..l Symptoms (months) Rflcviot History !/.-.concur.; ; m j ion , ii < \ j i Psrufa j M j 19<W Pl.-.-rj 1* vjfa fr-jra 1' j F | ID 16 1t j ; m j 1891 ! r ; is9s i! * :_'a ; M ! 1 STD * } M J IS9Q r f" 7:rj j v. ; 1904 i 1 M j 1910 M ; i9ii r' r^-j r j.c'i :f ! j IM7 1R3>; ! I.'-;-.,-' : y 1 1 SOP i 1' ; M : isss r *ri !M i F 1915 1397 F , M 1912 1 i*-r ~ A F i j jM 1 ! 1901 1392 i t i i , ; . * : ! 1; i i 1^55 j;n*MA n/a N/A S Merchant sea -tail, cts'joc* from S. Africa 1930-32, no dvfvnUc evidence of contact with asbestos: sttbse- qneolly employed on cros^-chauncl boats 1950 Hiops> N/A n/a 12 labourer and builder, finally em- ployed in tunnelling; Jived in East End of London 1957 C.opsy NVA N/A 19 Employed remaking old sacks in How* previous content oi wick* not ascertained; lived East End of 1957 Biopsy N/A N/A London 11 Garage hand, chauffeur* mechanic; 1958 iLopjy n;a n/a lived Wolverhampton nod Epping 6 Wotted as rrintits" machinist before marriage, then as hoim-wife until death; Jived lLa$t End of la>nd<ctft 1953 Htop> N'A n;a 3 Sisreoiyncr and printer; lived originally in East London, then moved to Ijsn i;h 1959 Hiop.y NVA N/A 12 Van boy, regular army* cutter and grinder; Jived N.CL. l.njidon and I960 Hioi i> N,`A N/A IT.irenham 13 Bricklayer* cement v-erker, po^t- man; llvrd East Fuel of I-ondon. 1900 Necr^r v Negative Negative moved to Hninault, Esscx in 1931 IS l-iiier and turv.-r; Lved principally 1960 Necropsy Positive Positive in End of London 7 CAdoured Sk African merchant sea* man, stoker at plan* factory; possible contact with asbestos in 1962 Nccropry Necatue Negative S. Africa or nt sea 10 Lived until marriage in Wales, then 19G2 . l>lopi> Ncyatni Negative 30 hototckcepcr in S.W. Lornlou MnabirvM of celluloid collars. honscvtiic and canteen worker; 1962 Biopsj N/A N/A lived Fast London 10 Machinist in hosiery trade, Notttiig- Jiain, hotzsewjfc; moved |o London 1962 Nccroj -y Negative Negative IVt^O 2 Labourer, merchant teaman, docker, carried only meat 1962 Nicrcp^y Negative Nc^tive 54 Apprentice printer, barman, cook. end butcher. ] tm 25 ycais before 196J ii. .pi} N/A N/A death lived East End ol J-ondo/i Dressmaker and hoo-cife; lived 1963 B:op*> N/A n/a Last End of Lor,dun theft Somerset 24 Steel erector, oimy, steel erector. labourer and porter; lived East F,nd of London 1964 Ni.-nv'iy Negative Negative 42 Lmploved as racket ir, pharma- ccuiical firm for 12 jeurs* then houscwiTc until lived >i Dager.ham 1964 Necropsy Positive Negative 24 Fisherman, fireman, di-eker, 1915- 39 at Tilbury dtKk.-, f*reman and finally storekeeper; rootacl with asbestos not probable at Tilbury docks; lived Tilbury rea AO- . C3 CA ~r UJ ca __j h~- 11 _ fl CD : ' a OTM j. m cS "J* o-- --* -m 9* r\ L,, or^o*___ j i * - C37** L#- *. p 1393 i 1917 Nccrer*;-' Positive a* -- * J i M IS 00 1922 Necrop-y Negative Negative M 1S77 1925 Nc^ror^y Negative Negative 1 ' -J M v/oo 1936 Necropsy Negative Negative M 1893 j 1933 Necropsy Positive Positive ' '--"-I r 1010 1 1945 Necropsy Positive Positive F 137S i 1955 Nccrn7S> Positive Positive N/A not available. Not traced Not tracej Not traLxxl Not traced Not traced Not traced Not traced GG 1- n{ 4- ___ ^ __ | BB 000575 I