Document nKwd6XL22Dr56DmvjGV5mKEz

FILE NAME: Texaco (TEX) DATE: 1966 Nov DOC#: TEX003 DOCUMENT DESCRIPTION: Journal Article - Malignancies in Asbestos Workers ure to nt im>ease. H ealth 1H H D a Kane, oratory. y Flow Dis 90: monary Amer a City: 1 Fune s Co., -lemical aneous 960. dosis, iecker, > Dis M.H., th Bii Mea 619 Malignancies in Asbestos Workers JA N 1..1E1SEN, MI), URK 1SBU RG , PA m T H IN recent years and months a con siderable amount of evidence has appeared in the literature which indicates that asbes tos; s is directly related to the incidence of Oialignant tumors arid Cancer.1-3 As early as ten years ago a Pennsylvania pathologist reported that he had seen at ijtitopsies many cancer cases in persons who tlso suffered from asbestosis. The pathol ogist is on the staff of a hospital which re ceives most of the patients from a narby town where a large asbestos producing plant Its located. The findings of the pathologist have created concern in the asbestos industry and it was felt appropriate for the Pennsyl v a n ia Health Department to review the prob- pn. Exposures in the Plant fl: The following information was obtained Ilium the files of the health department which has studied environmental exposures of workers in this plant oil several occasions in the past 30 years. During this time there %as been a tremendous improvement in dust Conditions in all operations and dustiness f|ia s been held close to or below the present Threshold limit. t i t The textile department used chrysotile, primarily, for many years. It was not un common for the milled fiber received by the textile plants to contain 30% or more of fines The fiber of today is very much clearer than that received prior to 1050. The use of light oil in the bl.hdibg department began around 1955. This was helpful in improving conditions and minimizing dust. Prior to 1950 amosite was processed in small quanti ties for making thermal blankets. Although the processing of amosit never exceeded one card and the operations were at times intermittent, this operation was much dustier than from cards processing chrysotile. Crocklolite has never Teen handled iii the textile department. f. In the friction products operations ex tensive changes iii (he formulations have Submitted for publication June 6, 1966; accepted July 1 : . . From Division of Occupational Health, Department of Health, Harrisburg, Pa. ' : Reprint requests to Division of Occupational Health, Department of Health, PO. Box 90, Harrisburg, Pa 17120 taken place over the past 30 years. Prior to 1945, coal tars and pitches were com monly used as impregnums in making brake linings, clutch facings, and packing materials. Since 1945, these have been essentially re placed by resins and other materials so that: at present only a very small amount of tar and pitch is used in packing materials. A small amount of crocidolite is still used in making some packings. The Study Since asbestosis is a disease which, once established, progresses even after exposure to dust ceases, it was decided not to ask plant management for cases known to them. Instead, the record rooms of six hospitals which draw their patients from the area of the asbestos plant were checked for cases of asbestosis. Admissions only for the period between 1956 and 1964 were included. Seventy-five hospital records coded as as bestosis were located. Asbestosis was diag nosed in these people on admission, by x-ray, or at autopsy, or asbestosis was men tioned in the differential diagnosis. After obtaining the 75 records, medical, occupational, and smoking histories wore obtained for all these former patients. Many were deceased and their survivors had to be contacted. Other data were obtained from plant management. Seven either Had not worked at the asbestos plant under study or the diagnosis had been changed. This left 68 asbestos workers who had worked at one time in the above-mentioned textile and friction materials plant. Further study of. the records showed that 21 of these not only had evidence of asbestosis but also had suf fered from malignancy. By the time of the T able 1.--Number of Cases and Duration of .. Occupational Asbestos Exposure by Deportments v.: Exuostire D u ratio n Leas than . 10 years 10-20 years 20 30 years SO-f ye) Textile D eparatm _ent . .: F riction Textile Xijnknpn;^': aiid - ' ; FriY.tioi* : Arch Environ Health---Voi 13, Nov 1966 -t _ 620 MALIGNANCIES--LIEEEN T able 2.-- Summary of Cases Studied Case Birth 1 1911 2 1906 8 1898 4 1907 6 1896 8 1901 T 1901 8 1896 9 1897 10 1906 11 1896 12 1903 13 1907 14 1901 16 1894 16 1884 :17 1901 18 1888 19 1877 20 3896 21 1894 D eath 1962 1959 1958 1961 1961 1966 1957 1966 1968 1961 I960 1056 1961 1961 1966 1959 1962 1964 1960 1958 1967 Type of Tumor Length of E m ploym ent in Asbestos Type of Employment Bronchogenic carcinoma, histologic type unspecified Squamous cell bronchogenic carcinoma Squam ous cell bronchogenic carcinoma Oat cell bronchogenic carcinom a Squam ous cell bronchogenic carcinoma Bronchogenic adenocarcinom a Anaplastic bronchogenic carcinoma 1936-1967 1929-1969 1918-1928 1927-1967 1947-1961 Only 6 mo 1919 3 mo only in 1928 Bronchogenic carcinoma, histologic type unspecified Squamous cell bronchogenic carcinoma Alveolar cell carcinom a of the lung Carcinoma of the lung, origin and type unknown Lung tumor, x-ray diagnosis 1926-1937 1922-1964 1960-1960 1926-1960 1919-1966 Anaplastic bronchogenic carcinoma 1028-1961 Intra-abdom inal adenocarcinoma, origin unknown 1984-1942 Carcinom a of the colon Lymphatic leukemia, chronicity unknown 1922-1966 6 mo only 1941 M alignant lymphoma Chronic lymphatic leukemia 1926-1942 1938-1947 Acute leukemia, type unknown Carcinom a of throat, origin and type unknown M ultiple myeloma Carcinoma of prostate, m etastatic 1922-1949 1986-1967 Carcinom a of bladder 1917-1987 Yarn twisting 1984-1962 W eaver 1929-1969 Breakline weaver 1918-1828 Weaving and later loom fixer Laborer sweeper, picker house Weaver--later lath foundry worker Area unknown, later hotel operator 1928-1957 Linotype operator 1921-1923 Carding room, gardening for 19 yr th e re a fte r W eaver 1022-1954 Friction materials, laborer on lathe Inside driver in weaving room Loom fixer, machine shop foreman, toolmaker General foreman-- spinning before last job Most of the time in friction products, spinning 1922-1937, later upholsterer Weaver Sweeper and laborer Ju n e 12, 1941 Mechanics helper for 46 years for trucking company Carding room supervisor La borer--ban dtruck er --supplied weavers with spools; farm er till 1937, sexton a t church till death Shipping room only W eaver--loom fixer, textile foreman 1986.1947, packing mil] 1947-1967 Supervigor friction mil) 20 years 1917-1037, Ice cream m aker 20 years 1987-1967 Smoking 12-15 cigarettes 1 pack/day No cigarettes No cigarettes 1 pack-{-/day Cigars Only No cigarettes 1 pack/day Lees th an 10 cigarcttes/day Unknown No cigarettes 2-3 cigarettes/day No 1 pack/day 6-10 cigarettes/day No No cigarettes, little pipe Very few cigars only 5-10 cigarettes/day Pipe only 1 pack -f-/d ay Remarks 80 yr foundry ;i work : Also cirrhosis of liver : Probably ju>t to asbestos :j Probably 7i<jt / asbeaton Diagnosis from hospital record; no autopsy Probably not du</ to asbestos - 3 coronaries ? asbeatosis study all 21 had died. Ten of these cases paper which appeared in Cancer in August have also been reported by O 'Donnell in a 1966.4 Thirteen of these had lung cancer Arch Environ Health-- Vol 13, N ov 1966 ......Material may be protected by copyright law (Title 17, U.S. Code) mark foundry : rk ' M bly notdti<*3 lUstoa ftosla August : cancer MALIGNANCIES--LIEBEN 621 lifti$ht had various other growths which }V*>jfldcd two abdominal cancers, one bladder ixpanJ'- two lymphatic leukemias, one acute fc'tfhuJHi', one lymphoblastoma, and one ft ntiifde myeloma. N o cases of mesothelioma ><!'!'}<' 1 this group. There were four cases ,n {miner plant employees but these em- illlfftfes had been admitted to hospitals either jp b r to 1956 or after 1964 and because of r( are not included in this study. Illiliid : diagnosis of the condition of these 21 I f i l l l l i s had been established in 13 by au- in four by operation, in two by biopsy, ! | | | | n two by x-ray only. death certificates of all 21 were ob| | | i | i The malignancy diagnosis was re ported on 15 death certificates. Six were lillp c d out as follow s: two as cardiac failure, v- as coronary disease, and three as as'1<! sfosis If death certificates alone had been Iflffli&ed in this study, these six cases of :||il|ifh a n cy would have been missed. The smoking history of the 13 lung cancer f l i p s revealed that five had never smoked, smoked, and in one case no smoking "hidory was obtainable. Of the eight pa tients with other malignancies, three were IllH irette smokers, two never smoked, and lif t e d were cigar smokers only. ! |li|f the 21 patients witli cancer, 13 had l l l M e d in the textile department of the plant it:liy- for a sum total of 301 years. Four iiiikdd in the friction materials department illf : - a total of 48 years. The department Ifllip fe one man had worked remains utlillptyh and three others worked at various Jobs which included both textiles and friction ^||l||t|'ials (Table 1). 0 Two of the 13 lung cancer and one of the _ lymphoblastoma patients had wmrked in the 1 ;-p<bfcsto.s plant for a period of less than six twnths each, which is a rather short ex ' posure One wonders if this short exposure lliir a have contributed towards their dis- ||$fih Eighteen of these 21 patients had si aided work in the plant prior to 1940 and 12 had started work prior to 1920. Of the 21 patients with cancer 9 were between 50 and 60 and 12 were over 60 Years of age {Table 2). ' Comments and Conclusions The incidence of malignancy in this sek-tdc'd group of hospital admissions with ft\l)estosis was very high-- 21 out of 68. This is eight times higher than in the general population 45 years of age and over, for the eight years of the study period.5 The incidence of 19% (or 16% if we do not consider exposures of less than one year) of lung cancer in this group of work ers with asbestosis is comparable to that reported by Isselbacher1 who summarized data of various authors and reported that of 603 persons with asbestosis, lung cancer was found in 83 (13.8% ). It is also close to that reported in the literature review by Behrens8 who collected 44 cases of lung cancer (14% ) in 309 patients with asbesto sis. Only three patients with these malig nancies had their first exposure after 1940, when dust conditions had been much im proved. A repeat study in the future may clarify whether this reduction of cancer occurrence in more recent employees is due to a latent period, to the age factor, or to the dust control measures instituted by the plant. The patients with lung cancer were gen erally younger than those with cancers of other organs. Eight of those in the lung cancer group were under 60 and all eight of those in the other group were over 60 (Table 2). Summary A study of 68 hospital admissions with asbestosis from an asbestos textile and fric tion materials plant included 21 malignancies -- 13 of these were carcinoma of the lung and eight carcinomas of other organs. Eigh teen of the patients had exposures to as bestos in their occupational environment for a period of 10 to 36 years. Only three pa tients had their first exposure after 1940. Extensive dust control measures have been instituted by the plant. REFERENCES 1. Jsselbacher, K.J.; Klaus, H.; and Hardy, H.L.: Asbestosis and Bronchogenic Carcinoma: Report of One Autopsied Case and Review of Available Litera ture, Arr^er J Med 15:721-722 (Nov) 1953. 2. Doll, R.: Mortality from Lung Cancer in Asbestos Workers, Brit J Industr Med 12:81-86 (April) 1955. 3. Hueper, W.C.: Environmental Causes of Cancer of the Lung Other Than Tobacco Smoke, Do- Chest 30:141-159 (Aug) 19,56. 4. O'Donnell, W.M.: Mesothelioma Associated With Asbestosis: A Report of Three Cases, Cdticer 19:521 (Aug) 1966. 5. Cancer Mortality and Morbidity, Harrisburg, Pa; Pennsylvania Department of Health, 1964. 6. Behrens, W., it.: The Clinics! Picture and Pa thology of Asbestosis, Z Unfiiltnied, BerUfikr 45:129, 1952. Arch Environ Health--y ol 13, Nov 1966 Material may be protected by copyright law (Title 17, U.S. Code)...  t. 1 animal expoa tne-literature, pported in part by conl in part by grant Ho. 1 of Air Pollution, US 559 Mesothelioma and Asbestos Exposure More Common Gases' itory Tract, Arch Intern iter Effects of Gas Poi- ijotz, W.C.: Permanent in Warfare, Amer Rev .ion of Irritant Gases :t, J Indust Hyg 5:390, incidence of Pulmonary ure to Vesicant and 1led J 2:862, 1933. Gases and Fumes, Proc ar Gases and Chronic t 1:510, 1954. esults of Gassing, Med jrine Accident in Brook17. on Some Respiratory ges of Gas Poisoning, J : ong-term Effects ne er Rev Resp Dis ronic Pulmonary Insuffi?illers Disease, Amer J otlected Studies on the oning, New Haven: Yale Bunting, H.: Pulmonary re to Phosgene, Amer J Studies on Experimental J Path 23:1037, 1947. eine Massenvergiftung urg, Deutsch Med Wschr ng. R.G.: Histopathology rch Path 78:544, 1964. W.E.; and Hatch, T.: sed by Phosgene, Arch 5. t, but be willing to ad areas and com ike the action that Pharos of Alpha I Jan Lieben, MD, and Harry Pistawka, MD, Harrisburg, Pa | W I T H I N the past five years several artiI cles have called attention to the association between mesotheliomas of the pleura and peritoneum with asbestos exposure.18 Wagner et al4 studied 33 cases of meso thelioma. All but one had probable exposure to crocidolite, the blue asbestos. I Asbestos has become a ubiquitous materi1 al in our civilization. Cauna et al5 reported :i that asbestos bodies were found in the lung smears of 41% of 100 consecutive autopsies at the Presbyterian University Hospital in I Pittsburgh. Similar findings were reported by Thompson6-7 in 500 consecutive lung smears from Capetown, South Africa, and 1 Miami, Fla. Asbestos bodies were found in 30% of the men and 20% of the women. As bestos has been conclusively associated with increased incidence of lung cancer and other malignancies8'9 and an increasing number of studies associate its presence with malig nant mesothelioma of the pleura and perito neum. Pathology Mesotheliomas of the pleura and perito neum are rare neoplasms. Controversy in| volves histological types, nomenclature, ori,4 fin, and their very existence. Recently, ( inesotheliomas as an entity have become ||enerally accepted. Their morphologic vari ability makes classification difficult and difSerentiation from other malignancies is often , |a problem. H/Submitted for publication June 6, 1966; accepted fSept 13. .From the Division of Occupational Health, De partment of Health, Harrisburg, Pa. fe Read before the Ninth International Cancer ConSfess, Tokyo, October 1966. Reprint requests to PO Box 90, Harrisburg, Pa |7l20 (Dr. Lieben). Sacconi and Coblenz10 give the incidence of pleural mesotheliomas as 1.1 cases per 1,000 autopsies. Campbell reported four cases of pleural mesotheliomas in 3,533 con secutive autopsies.11 . Mesothelioma occurs primarily in adults and is twice as common in males as in fe males.10*12 Pleural mesotheliomas occur equally on the right and left though Weissman feels that pleural mesothelioma occurs on the right more frequently than on the left side.12 The criteria for diagnosis of pleural meso thelioma are presence of a firm pleural mass encasing the lung, histological structure compatible with mesothelioma, and absence of a demonstrable primary malignant neo plasm elsewhere. The histologic architecture may be mesenchymal, "epithelial," or mixed. A complete autopsy is necessary for une quivocal diagnosis, but for the purpose of this study, criteria were made less rigid in that unautopsied cases were accepted if a definite diagnosis of pleural mesothelioma had been made by biopsy, and malignancy elsewhere had been excluded clinically; chest x-ray examination, bronchoscopy, and cytologic studies of sputum or bronchial washing assisted in excluding the presence of bronchial carcinoma. Primary tumors of the peritoneum are among the rarest of tumors. Generally called mesotheliomas, they form large spreading masses over the peritoneum and histologi cally appear the same as pleural mesothe liomas. As with pleural mesotheliomas, ex clusion of a primary tumor is necessary. This study is an attempt to learn the ex tent of the relationship of asbestos exposure with mesothelioma diagnosed in southeast ern Pennsylvania. Arch Environ Health--Voi 14, April 1967 560 MESOTHELIOMA--LIEBEN & PISTAWKA Method One hundred and sixty-two hospitals serving a population of 6% million people were re quested to report all mesotheliomas diagnosed between 1958 and 1963. Replies were received from 162 hospitals. Hospital records of 62 re ported cases were reviewed and only mesothe liomas confirmed by operation, biopsy, or au topsy were included in the study. Forty-two cases satisfied our critera. There were 34 meso theliomas of the pleura and eight of the perito neum. Among the pleural mesotheliomas there was a definite preponderance for occurrence on the right side of the chest. Of 34 pleural meso theliomas only seven occurred on the left side, 25 on the right side, and two were not stated. Sections of as many of the tumors and lungs as possible were borrowed and reviewed by a single consultant pathologist familiar with mes otheliomas. In the 15 instances in which lung sections were available, they were examined for the presence of asbestos bodies. All slides were reviewed without the benefit of the complete history and autopsy protocol available to the pathologists who made the original diagnosis. Results of the 33 cases reviewed (Table) by our pathologist agreed with those of the outside pathologists in 17 cases; he rejected seven cases as unacceptable histologically, had serious doubts in nine cases (of these one slide was read as metastasis and one slide as anaplastic m alignancy). Of the 15 cases in which lung tis sue was available, asbestos bodies were iden tified in seven. The discrepancies between the original pathological diagnosis and that of our patholo gist are reported to illustrate the difficulties and disagreements which are so frequent in the diagnosis of this tumor. For inclusion in this study the diagnoses of the originally reporting pathologists have been accepted and cases re ported by them were investigated. Efforts were made to obtain a complete em ployment and residence history for each pa tient. Inquiry was also made into the employ ment history of family contacts. Data were obtained from the individual if alive, from fam ily members, or employers. Of the 42 patients, ten had definite occupa tional exposure to asbestos during lifetime, three were family contacts of asbestos workers, eight either lived in the immediate neighbor hood of asbestos plants or had been employed next to an asbestos plant. Ten patients had a questionable asbestos exposure and, in the oth er 11 patients, either no asbestos exposure could be elicited on direct questioning or no survivor could be located. Table 1.--Readings of Consultant Pathologist Case No. M esothelio m a A sb e sto s B odies 1 -0 3 -0 4 -0 5 -0 6 -0 9 -0 1 0 -0 2-N 3-N 4-N 6-N 1-F 2-F 3 -F 1-Q 2-Q 4-Q 5-Q 6-Q 7-Q 8-Q 9-Q 10-Q 1-X 2 -X 3 -X 4-X 5-X 6-X 7-X 8-X 9-X 10-X Yes Not acceptable Pro b a b ly not Yes P ro bably not Pro b a b ly not Yes Yes Pro bably not Not accep tab le Yes Yes Yes Yes P ro b a b ly not Yes Yes Pro b a b ly ye s Not acceptable Yes Yes P ro b a b ly not May be M etast Yes . Yes Not accep tab le Not accep tab le A n a p la stic m align a n cy P ro b ab ly not No epith elial cells M eso th elio m a m u st be P ro b a b ly not Yes Yes proven N o lu n g t is s Ue Yes N o lu n g tissue Yes Yes No lu n g tissue Yes No lung No lung No lung No lung No lung No lung No lung No lung Yes tissue tissue t is s u e tissue tissue tissue t is s u e tissue No No No N o lung tissue No No No Yes No lu n g tissue No lu n g tissue No lu n g tissue No No No lu n g tissue No lu n g tissue No lu n g tissue Yes Exposure of Ten Mesothelioma Patients Who Worked With Asbestos.--Patient 1-0 worked 35 years in the textile department of a large as bestos plant. Patients 2-0, 3-0, and 4-0 worked more than 20 years in asbestos insulation plants and pa tient 5-0 worked in an insulation plant for only one year. Patient 6-0 worked 15 years in a plant manu facturing acoustic tile and linoleum. Patient 7-0 was a boiler maker in a railroad yard where, for 25 years, he worked on insula tion of steam engines. Patient 8-0 built bakery ovens in which large amounts of asbestos insulation were used. Patient 9-0 was a certified accountant who worked more than 30 years in the office of an asbestos textile plant. Patient 10-0 was a plasterer who came in contact with a large amount of asbestos in his work. Of these ten men, patients 1-0, 8-0, and 10 0 had mesotheliomas of the peritoneum; the oth er seven men had pleural mesotheliomas. Neighborhood Cases.-- Patient 1-N was a 55year-old woman who never had any occupa- Arch Environ Health-- Vol 14, April 1967 MESOTHELIOMA--LIEBEN & PISTAWKA 561 'onal asbestos exposure. Her work was always Secretarial; she was born and lived until the age gt in the immediate neighborhood of an asstos textile and friction material plant where jgtient 1-0 had worked for 35 years. From the fge of 18 she lived for 30 years across the street Irom the Pi011*- where patient 6-0 had worked fcor 15 years. f Patient 2-N, a clergyman from 1935 until his "eath in 1961, never had any occupational asCestos exposure. Prior to becoming a minister ;e lived for 19 years within one half of a mile y the insulation plant where patients 3-0, 4-0, nd 5-0 had worked as insulation manufactur-g workers. ' Patient 3-N never had any occupational asestos exposure except that, 20 years prior to iis death, he had worked for one year across |h e street from the insulation plant mentioned the history of patient 2-N. J Patient 4-N worked for 26 years across the jtreet from the insulation plant mentioned in Connection with patients 2-N and 3-N. Patients 5-N, a nurse, and 6-N, a meat dis tributor, had no occupational exposure nor ifamily contact with asbestos. They both lived iyvithin three fourths of a mile of two asbestos 'plants in a town with the greatest incidence of .mesotheliomas in this study, f Patients 7-N and 8-N were both foremen in a torage battery plant. A careful check of the "plant and their employment records revealed '.'no asbestos exposure, past nor present. The {plant is located less than IV2 miles from an as bestos textile plant. The exposure of these two Cases is questionable. Patients 1-N and 4-N had peritoneal and pa tients 2-N, 3-N, 5-N, 6-N, 7-N, and 8-N had leural mesotheliomas. Mesothelioma Patients With Family Con Tacts Exposed to Asbestos.--Patient 1-F, a 3,year-old child, was the daughter of a ceramic 'engineer who worked in an insulation plant -that utilizes 400 tons of Canadian chrysotile and 1,500 tons of South African amesite annu ally. Patient 2-F, a 40-year-old nurse, never had .any occupational asbestos exposure, but her fa th er had worked for 35 years in the insulation Splant where patients 3-0, 4-0, and 5-0 had orked and which was also credited with three neighborhood cases. T he nurse's brother also bad worked in this plant for one year. Patient 3-F, a 67-year-old woman, never had any asbestos exposure nor had she lived near n asbestos plant. She had two sons who worked as insulators in a shipyard for six years. These sons lived at home until 15 years ^Prior to their mother's death. Patients 1-F and 3-F had peritoneal and pa tient 2-F pleural mesotheliomas. Mesothelioma Patients With Questionable Asbestos Exposure.--A study of these ten men elicited either a relatively minor or question able exposure to asbestos. Patient 1-Q was a welder for 35 years. Ac cording to a common reference,13 eight out of 12 welding electrodes contain asbestos, which is used as a filler. Patient 2-Q was a self-employed Swiss-born Swiss cheesemaker. A thorough study of the processes of Swiss cheese manufacture revealed no use of asbestos. During the study of the manufacturing process a 500-gal boiler was no ticed. This boiler was covered with a friable as bestos insulation which flaked off on contact. Patient 3-Q, a 14-year-old boy with mesothe lioma, had no occupational contact with asbes tos nor did any of his family. On questioning, the boy's father told the authors that his boy had lived with him and had helped him while he had replaced most of the plaster board dur ing extensive remodeling of his house. Plaster board contains a high percentage of asbestos. . Patient 4-Q is employed in industrial sales and never had any occupational asbestos expo sure. Extensive questioning revealed that, on two occasions several years before, he applied asbestos insulation to boilers in his home, mix ing asbestos cement himself. His total exposure during these applications was only a matter of hours. Patient 5-Q was a brewery worker for 20 years. The brewery was no longer in business when the case was investigated. Reviewing the literature of beer production the following paragraph was discovered: "When ready for packaging the beer is fil tered through pulp filters consisting essentially of cotton fibers and asbestos. After each filtra tion this `FILTER M A SS' is removed, mangled, and washed in clear, warm water, then bleach ed and sterilized at 160 to 180 F with chlorine. The washed pulp then goes directly to a pad forming machine where it is compressed at 89 to 90 pounds per square inch to form new filter pads.14" Asbestos-containing pipe insulation is used in breweries. Patients 6-Q, 7-Q, and 8-Q were all steel workers. Patient 6-Q was a crane operator; 7-Q a forger; and 8-Q a foreman and supervisor. In all cases the companies did not recall any as bestos exposure for these men. Pipe insulation containing asbestos is extensively utilized by steel companies. Patient 9-Q was a spinner in a silk company Arch Environ Health--Vol 14, April 1967 t 562 MESOTHELIOMA--LIEBEN & PISTAWKA from 1925 to 1938, and later in a plastic fabri cation plant which utilized fiber glass; he also had been a welder for 25 years. He thinks he has used asbestos but could not recall when and where. Patient 10-Q, a 63-year-old man, was a core-maker all his life. He worked in two foun dries in one of which asbestos cement is used in small quantities but, according to the plant manager, the core-maker did not have any con tact with this material. T h e son stated that his father had used asbestos pipe insulation for pipes in the basement of their home several years prior to the onset of his illness and that he had done some sawing of this pipe insula tion material. All cases in this group had pleural mesothe liomas. Mesothelioma Patients Without Asbestos Exposure.--In the other 11 patients (1-X to 11X ) no occupational, familial or neighborhood asbestos exposure evidence could be elicited. Ten of these patients had mesothelioma of the pleura and one peritoneal mesothelioma. Comment This study presents a good deal of circum. stantial evidence and many unanswered questions. Asbestos is a ubiquitous material used much more frequently than is generally real ized. Some uses, such as in the brewery were not previously known to the writers. There are undoubtedly many others. If we assume that asbestos may be the causative or trigger agent for malignant mesothelioma in some of the cases described above, we must admit that the minimal dose-effect relationship and duration of a latent period are unknown. The occupation al exposure of the insulation workers or as bestos textile workers were certainly many thousand times higher than those of the neighborhood cases or family contacts. Simi lar findings have recently been reported from England.1 The attack rate for mesotheliomas is ex- Clergyman Patient 2-N Patient 3-N4-N Occupational, neighborhood, and family contact patients with mesothelioma associated with one insulation plant. Arch Environ Health--Vol 14, April 1967 KA Cc ,4ent snts a good deal of circum. and many imanswered ubiquitous material used ntly than is generally real such as in the brewery sly known to the writers' btedly many others, that asbestos may be the ger agent for malignant ome of the cases described admit that the minimal nship and duration of a mknown. The occupation s insulation workers or as kers were certainly many higher than those of the is or family contacts. Simi3 recently been reported 3 for mesotheliomas is ex- Clergyman Patient 2-N MESOTHELIOMA--LIEBEN & PISTAW KA 508 tremely low. Not all mesotheliomas were re ported to us by the hospitals, but, even if we double the incidence, only a minute fraction of the exposed population was affected. There are precedents for this with beryllium disease which acts in a somewhat similar pattern; occupational diseases, familial con tacts, neighborhood cases plus a very low attack rate, and a long latent period be tween exposure and onset of disease. Another question which arises is why pleural m esotheliom as are so much more frequent than peritoneal m esotheliom as. The most striking finding of this study was that of the 42 mesotheliomas which came from a geographical area of approxi mately 30,000 sq mi, six were clustered in and around an insulation plant (Figure). These included two insulation manufactur ing workers (Cases 2-0 and 3-0), three neighborhood cases (Cases 2-N, 3-N, and 4N) and one family contact (Case 2-F)--the daughter of an insulation worker. Summary Forty-two cases of mesotheliomas report ed from 152 hospitals over a five-year peri od, were studied with regard to exposure to asbestos. Survivors or employers, or both, | were questioned regarding the possibility of | asbestos exposure. Ten patients actually p worked in asbestos plants; eight lived or | worked close to an asbestos industry; three i patients were family members of asbestos ||; workers. In ten patients a history of as B . sumed exposure to asbestos was obtained ' after prolonged questioning. In 11 other pa tients no history of asbestos exposure could be obtained. R eferen ces 1. Newhouse, M.L., and Thompson, H.: Mesothe lioma o the Pleura and Peritoneum Following g x_ posure to Asbestos in the London Area, Brit J Jn. dustr Med 22:261-269, 1965. 2. Hourihane, P.O.: The Pathology of Mesothe- liomata and an Analysis of Their Association With Asbestos Exposure, Thorax 19:268-277, 1964. 3. Selikof, I.J.; Churgh, J.; and Hammond C: Exposure to Asbestos and Mesothelioma, New Eng J Med 272:560-563 (March) 1965. 4. Wagner, J.C.; Sleggs, C.A.; and Marchand P.: Diffuse Pleural Mesothelioma and Asbestos Expo sure in N.W. Cape Province, Brit J Induatr Meg 17:260-271, 1960. 5. Cauna, D.; Totten, R.; and Gross, P.: Asbestos Bodies in Human Lungs at Autopsies, JAMA 192:371-373 (May 3) 1963. 6. Thompson, J.G.; Kaschula, R.O.; and MacDon ald, R.R.: Asbestos as a Modem Urban Hazar(j g Afr Med J 37:77-81 (Jan) 1963. ' 7. Thompson, J.G.: Asbestos and Urban Dwe]]er read before the Conference on Biological Effect 0j Asbestos, New York, Oct 19, 1964. 8. Doll, R.: Mortality From Lung Cancer in As bestos Workers, Brit J Industr Med 12:81, 1955, 9. Lieben, J.: Asbestos and Malignancy, Arch En viron Health 13:619-621 (Nov) 1966. 10. Sacconi, A., and Coblenz, A.: Endotheli0ma 0f the Pleura, With Report of Two Cases, Amer J Clin Path 13:186-207, 1943. 11. Campbell, W.: Pleural Mesothelioma, Amer J Path 26:473-487, 1950. 12. Weissman, H.: Primary Endothlia 0f Pleura, Die Chest 12:562-570, 1946. 13. Lyman, T. (ed.): Metals Handbook: x, Prop erties and Selection of Metals, ed 8, American Socie ty of Metals, 1961, p 5. 14. Modern Chemical Processes, New York: Rein hold Publishing Co., 1952, vol 2, p 167. Nurse Patient 2-F IT liorna associated with one DISCOVERY OF QUININE Msrny of the drug sources known in ancient times were apparently discovered by acci dent. For example, according to an old South American Indian legend, the curative power of cinchona bark (containing quinine) for malaria was discovered by a sick, fe_ verish Indian lost in the jungle. H e quenched his thirst by drinking from a pool 0f water. From the bitter taste of the water, he recognized that it was tainted with the poison from the quina-quina tree. Although he shared this fictitious belief, he drank deeply so as to bring about a quick death. To his great surprise, he recovered completely. When he returned to his village, he told the store of his cure and thereafter cinchona bark was used as a medicine for the fever prevalent in that region. The Incas later taught the Spanish conquistadors that malaria could be cured with cinchona extract-- Rossman, R.E.: The History and Significance of Serendipity in Medical Discovery, Trans Coll Physicians Phila 33:104-120 (Oct) 1965. . Arch Environ Health--Vol 14, April 1967