Document k9g3Q5mONn8DLOD7LXyq6d2OV

FILE NAME: German Articles - Some with English Translation (GER) DATE: 1943 DOC#: GER035 DOCUMENT DESCRIPTION: Medical Journal Article - Asbestosis and Lung Cancer English with No German Original & Handwritten and Typed Additions by Dr. WC Hueper Ba.ry 5. Castleman EN VIRO N M EN TA L CONSULTANT ! 1738 Riggs Place, North West, Washington, D.C, 20009/202 3 8 7 .7 5 9 5 Wedler's Paper in 19^+3 ~~ a key reference Wedler was the first to publish reports'of pleural mesothelioma with asbestosis, but he refers -to other findings cf pleural cancer by his British colleague Gloyne (1 ease in 1933)* Wedler found 2 pleural tumors in autopsies of 29 persons who died tilth as bestosis. There were also 9 bronchial cancers in this series of 29. In a review of the literature, in particular that of Germany, England, and the United States, Wedler was able to total 92 dissections from case reports, in which 1-4 lung and pleural cancers were found. This review, at least for the British cases, included unpublished as well as published reports. This 16 percent incidence of lung and pleural cancer was con trasted with a normal expectancy for lung cancers of approximately 2-6 percent. Further observations on asbestotic cancer were: it occurs as commonly among females as among male patients -- lung cancer is usually 3-4 times as .prevalent among men; the cancer victims include relatively young patients, between the ages of 35-41 and the tumors are localized in the lower portions of the lung, where the lungs also have the highest accumulation of asbestos fibers, Wedler reported that the lapsed period from onset of exposure and development of cancer was 12-'42 years for all patients. Wedler concluded that the cancers among asbestos workers were clearly connected with occupation. Ke said that cancer of the lung in asbestosis is a legally justified dis ease for insurance claims. By this he clearly meant to include pleural cancer as a subgroup of lung cancer. Wedler also noted that Nornmann and Sorge had conducted experiments on animals, apparer.ily producing cancer of the lungs frcm asbestos exposure. & Translation: German-English 26 October 1976 ZITTA, D.M. DEUTSCHE MEDIZINISCHE WOCHENSCHRIFT 1943 pp.575 - 576 GERMAN MEDICAL WEEKLY ASBESTOSIS AND LUNG CANCER by H.-W.Wedler Chief Clinician of the Clinical Dept. Asbestos induced lung disease has long been recognized as a clinical .phenomenon in those working with asbestos. Extensive research done to- date would preclude substantial new findings. However, further studies are indicated with regard to the pathogenesis and its combination with other lung diseases. On the basis of extensive studies the author was able to show that, for example, associated tubercular lung disease is less frequent than in silicosis. Asbestos has no substantive influence on the frequency and the development of tuberculosis in lungs. An entirely v r*Ctuhfa ~CLy*-> different picture presents itself when dealing with.cancer of the lung 'btv& pz V u i Ccrutiom * which appears relatively often in eerrj-gnc l puXsano.US^.aXkaJ^&d&. . . fykridJ! particular instance, we are dealing with a new type of occupational Mfah? | u+kt'R.l-{ Qf common clinical interest, aside from the question of its eligibility for workman's compensation claims. ' -"tLoc 5 The following studies published to->date in world literature are wentined briefly. The first observation of asbestos-induced pleural carcinoma was made by Gloyne in 1933. In 1935 he recorded 2 new related cases followed by another one in 1936. Two years later and, after 50 dissections on patients with asbestos disease, he found 6 of them to have cancer of the lungs. Further, related single obse'rvational C j-vvvh & J L * - / / X h C '& 'y M <Nf h-f- V, L a & a *'* /-J :f ^ ,A^ w "< CH^-t^vU ^^ *} ^ L ^ -tL m J b t & n - i f a y "t# A a * W - ' & ( e /fc Iv W L^wv-|r iC jB M mZ s i\ t i, // studies were published between 1935-1941 by Lynch and Smith; Egoert and Geiger; Nordman; Wedler and Wedler; and- Linzbach. The most recant discovery of two malignant tumors rwas*"made by TeutschlHnder, Alwens and Fischer-Wasels in Germany. Malignant lung- and pleural tumors in asbestosxs have been established on the basis of dissections performed. For example, in Germany out of 29 dissections performed 4 revealed bronchial cancer and 2 malignant tumors of the pleura. On a percentage basis this amounts to approximately 20%. In England, data gathered from dissections involving cases of as bestos -- though less reliable than ours -- show those performed by Gloyne to be 12%. The published American data show 2 bronchial cancers in 13 dissections performed. Italian, French and other literatures contribute no further positive studies to the related field. All together 92 dis sections were carried out on patients with asbestos disease which revealed 14 malignant lung- and pleural tumors, corresponding'to 16% on a percentage basis. S' ' In order to categorize cancer of the lung as an occupational disease the statistical frequency in this certain disease must he demonstrated, - preferably by reproductibility in experimental studies in animals and especially the behaviour deriving from the basic disease, including the attempt of an pathogenic explanation. characteristics^ Statistical data showing increased frequency of occur rences of lung cancer in patients with asbestosis are given above. Based on broad, statistically, obtained data from dissections performed^ the average of 16%, as mentioned above, far exceeds the normal expectancy for lung cancers which is approximately 2-6%. Experiments on animals were, carried out by Nordmann and Sorge with positive results. Further studies are still pending. Studies of asbestotic cancer reveal the following peculiarities: statistical data show female patients to be relatively as often afflicted with the disease as are the male patients. The usual ratio of 3-4:1 shifts unfavorably toward the female population since'they comprise the greater working force in asbestos factories. Among those afflicted with cancer are relatively young patients, between the ages of 35-41. The tumor is localized in the lower portions 6f the lung -appearing most often where changes in asbestos levels have highest concentration. a The histological characteristics of cancers of the predominantly it . /. 0/^-X -" a lamellar-epithelial type carcinoma vary significantly from the -eei: fentviQv**. f ctM. `il-4 , -s-teuet-uie--in- lung cancers ftauh^hmo^g':a^i:^spnnrdng.-n'umbfei: ,.of pa-tieht-S""''' ^with 'caiieer d'f the 'lung .. The formation of cancer in an asbestotic lung always implies a ^ long period of exposure to the dust. Here, duration and intensity to pcK.tc_j A ( & * . y w \ exposure eer&spond' to a certain degree. One frequently encounters Z -t period^ of dust-free intervals between the actual asbestoswork and the 0* VZJEA-.J>jffcvyX onset of lung cancer^-. The period between first exposure to dust and actual evidence of cancer was for all patients 12-42 years. The con- nectior^-tog-occupational cancer^-is clearly evident. The understanding for the increased frequency of lung cancer in asbestosis derives from the following aspects 1 The mechanical and, probably also chemical reactions of asbestos are seen to cause general proliferation of lung tissues and multiplication of the connective Q-l. tissues-- -- There is epithelial disquamation and 11 modification^/ ^crfl 0 ^5macrophagia-, giant foreign-body cell 4 - .-- -- ~formation and epithelial meta- plasia of the bronchial mucous membrane. The which disturbs the function of h^igt-fty tissues is never severe enough to destroy the cellar""'Rather, the development of cancer must be attributed to the metaplasia of the bronchial mucous membrane and the accompanying inflammatory reaction, (--- L- As in all occupational cancers, here too, -the patriant-ls general C & h H & S ^[pliy-^icA-i] iwell^beinf,^disposition),' must be considered^ beca u s e ^ only a certain percentage of asbestotic patients succumbs to cancer. +vU. ~UL4E,-j-e_ '9ef`3<jrMcoi -Qtv the. basisc of the foregone studies it can be concluded,that^, cancer of the lung in asbestosis is a legally justified, disease for . . _ . insurance claims. Q*kaA$L J \ / References and more detailed studies can be found in,the author's js>Ce Cx)`fV'tbex, , jmaisf publication^ "On Cancer in Asbestosjs", [in A r c h i v e of Clinical Medicine,. (Arch.klin.Med. ) . The author's address: Heidelberg, Bergheimer Str.58, University Med ical Clinic.