Document nkrpdpejM8DQBqx1Ya3OJRR7m
FILE NAME Cape Asbestos CAPE
DATE 1965 DOC CAPE008
DOCUMENT DESCRIPTION Medical Journal Article - Mesothelioma of Pleura and
Peritoneum Following Exposure to Asbestos in the London Area
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MESOTHELIOMA OF PLEURA AND PERITONEUM
FOLLOWING FOLLOWING EXPOSURE TO ASBESTOS IN THE
pe
. LONDON AREA
a
.
7
BY
MURIEL L. NEWHOUSE and HILDA THOMPSON
_ From the Department of Occupational Health and Applied Physiology London School of Hygiene and Tropical Medicine
a
RECEIVED FOR PUBLICATION FEBRUARY 11 1965
.
A series of 83 patients from the London Hospital with a diagnosis of mesothelioma confirmed by necropsy or biopsy has been studied for possible exposure to asbestos The series consisted of 41 men and 42 women 27 of the patients had peritoneal and 56 pleural tumours The earliest death recorded was in 1917 but only 10 of the series died before 1950 and 40 48 % between 1960 and
1964 In 76 of the series full occupational and residential histories were obtained Forty 52.6 % gave
a history of occupational or domestic living in the same house as an asbestos worker exposure to asbestos compared with nine 11-8 % out of 76 patients from the same hospital suffering from other diseases P < 0.001 None of the 17 suspected cases of mesothelioma rejected on pathological - grounds was found to have had any exposure to asbestos There was also evidence that neighbourhood exposures may be important Among those with no evidence of occupational or domestic
_
exposures 30.6 of the mesothelioma patients and 7.6 of the patients with other diseases lived within half a mile of an asbestos factory P < 0.01 Out of the 31 patients with occupational exposures only 10 were in jobs scheduled under the Asbestos Regulations of 1931. The interval between first exposure and the development of the terminal illness of mesothelioma ranged between
16 and 55 years
In 47 patients in the mesothelioma serics lung tissue or sputum was available for examination In 30 62.5 either asbestosis or asbestos bodies were present
In recent years the association between exposure among the women 25 had pleural and 17 peritoneal
to asbestos dust and cancer of the lung and other
malignant neoplasms has been the subject of much research leading article 1964 Wagner Sleggs and Marchand 1960 described the occurrence of mesothelioma of the pleura in those exposed to crocidolite asbestos in the mining districts of South Africa and
this has stimulated further studies of the occupa-
tional histories of patients suffering from tumour
Owen 1964 Fowler Sloper and Warner 1964 The present investigation concerns patients in
whom mesothelioma had been diagnosed the London Hospital during the past 50 years After examining the necropsy and biopsy specimens held in the pathology department Hourihane 1964 con-
firmed a diagnosis of mesothelioma in 83 patients
of whom 41 were men and 42 women Thirty of
the men had pleural tumours and 10 peritoneal
tumours
The aim of this study has been to establish the
occupational histories of these patients and ttorace
any other possible exposure to asbestos There were four surviving patients at the outset of the investigation but these have subsequently died The earliest date of death in the series was 1917 10 died before 1950 33 between 1950 and 1959 and the remaining 40 in the past four and a half years The youngest patient died at the age of 33 and nearly half were
dead before the age of 55 Table )
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
261
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262
BRITISH JOURNAL OF INDUSTRIAL MEDICINE
TABEL 1
AGE AT DEATH OF
83 PATIENTS WITH TUMOURS
MESOTHELIAL
Age yr
34
35- |
45 |
55 | 65
No.
2 7 15 10 7
Male
%
49 171 366 24 17.1
Female
No.
.
I
24
6
14
4
21
18
42
8
190
tumours the commonest presenting symptom was
the rapid onset of extreme shortness of breath due
to the formation ofa massive pleural effusion Pain
was a prominent feature either described as a dull
ache 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 either in
previous operation scars or by direct invasion of the
chest wall The symptomatology of the peritoneal
tumours was more varied In some patients the pre-
senting symptom was pain on defaecation or
micturition Diffuse upper abdominal pain was very
common and swelling of the abdomen due to ascites
was always present terminally The methods of
treatment included pneumonectomy decortication
of the lung deep x ray therapy instillation of radio-
gold active
andcytotoxic drugs They were used
alone or in combination but had little effect on the
course of the disease Half of the patients suffering from pleural mesothelioma died within one year of the onset of symptoms a further third within two years and only one patient survived for more than three years The course of those with peritoneal tumours appeared to be equally rapid Eight of the patients died within six months of the onset of
symptoms
Sources of Information on Occupation and Residence
In addition the ward notes some of which gave
good occupational histories there were three other
sources of information the patient's general practitioner the records of an asbestos factory in the area and personal interviews with patients or their surviving relatives
As first step general practitioners were 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 ofa surviving 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 local executive council of the National Health Service where they were destroyed within a period of three
1
years
In one of the asbestos factories a file was kept with detailed records of all employees since it started in 1913. The names of all patients were checked with these files Nine men and nine married women after
their maiden names had been ascertained from rela-
tives were identified without difficulty The exact dates of employment of these 18 patients and the jobs they had done were obtained from the
records of the factory the The four patients alive at the beginning of
investigation were interviewed personally A few relatives were contacted by post but the relatives of 68 patients were interviewed by one of us H.T. at their homes situated mostly in the East End of London Not only was an occupational history of the patient the spouse sons and daughters and father taken but past addresses were also recorded The
interviews lasted for at least an hour To recall events
of 30 or 40 years ago it was often necessary to
explore the residential and occupational histories of all members of the family
Exposure to Asbestos in Three Groups of Patients Suffering from Other Diseases
For comparison with the mesothelioma patients three further groups of patients suffering from other
discases were investigated The first group was selected from the patients in
the medical and surgical wards of the hospital during the early summer of 1964 patient series Each patient in the mesothelioma series who had been traced was matched with an patient of the same sex born in the same year period As there was a dearth of male patients over 75 years of age in the hospital a sample of six patients of this age and older was taken from a neighbouring geriatric
hospital The second group were those who had originally
been filed in the pathology department of the hospital as cases of mesothelioma but in whom the diagnosis was subsequently rejected on pathological grounds by Hourihane 1964 rejected series As it had proved extremely difficult to locate the relatives of those who died before 1950 attempts were made only to trace the three survivors in this group
and the 14 who died after 1950 The patient series already described were all
admitted to hospital in 1964. The patients with mesothelioma were admitted to the same hospi.al over a period of 47 years during which there might have been a substantial change both in the residential
MESOTHELIC social -
4
,
_,
r areasand
HELIC
i"n, London Hospital Thus was taken from hos
date of admission as wel with the patients in theni
places of residence andof
for comparison with tho"c
compae rison tt hs
a>
Details oe
_
of the 83 pati
series are given the
' about past domestic and
available for seven patier
76 40 52.6 % gave a hist
compared with only nine
series Table 2The dit
ey .
i . te
cat
1
1
TYPES OF EXPOSURE TO
WITH MESOTHELIOMA AND A
t
y
a
Type of Exposure |
ribestosribestos . Employed at one factory " Delivered goods to factory
Employed at other asbest06
factories
?
.
: Insulators and laggers
ied
Relative worked with asbestos N
2Dockers handling asbestos 34
No history c? domestic
** asbestos
of work exposure
or 19
asbay
f
Positive exposures to asbay
a positive histories in patient.
3
-Z
from mesotheliom J Seven cases of this table
mesotheliom
i,
statistically siygsn highly
0.001 This resultis unj
by the two groups of pa
. year of admission to bk
significant difference eith
or in the occupations of
and those admitted bety paring the confirmed
mesothelioma group who
of the confirmed and of
gave a history of expos
This difference is stat
x= 11.83 00 P < 0
aw
Soe Persiy
a swine pp tater
ra
Lweee eyeee ae
asSoSa Pag beys
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eo,
a PM
Dt
ey
eee
ad ary
Sri Soe
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(Aa,
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et ARR Bit
Aa oe
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Sita fees n
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ee
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Mesothelioma of pleura folloWING EXPOSURE TO ASBESTOS
263
kept
Started in
ked with
4
den after
from
7)
-
from rela- a
areas and social classes of patients attending the London Hospital Thus a third group of patients was taken from the hospital records matched by date of admission as well as date of birth and sex with the patients in the mesothelioma series Their places of residence and occupations were extracted for comparison with those of the patient series
:
Results Results
Details of the 83 patients in the mesothelioma series are given in the Appendix information about past domestic and occupational histories was available for seven patients Among the remaining 76 40 52 % gave a history of exposure to asbestos compared with only nine 11 % of the patient
series Table 2 The in difference this proportion is
C4
BY
TABLE 2
TYPES OF EXPOSURE TO ASBESTOS OF 76 PATIENTS
MESOTHELIOMA WITH
AND 76 PATIENTS WITH OTHER DISEASES
of Type Type Exposure Exposure
7 Fmployed at one asbestos
Delivered goods to factory
Employed at other asbestos
factoric
"
'
MesothSeerilesioma
No.
%
18
4
250 5.3 5.3
patient Series
No.
%
1
13
13
atients a " in
atients in 4 during
7
during + ;
Each a
had been a an
td
same
the a there was
ge iinn tthehe:
a
if
age and 4
geriatric 3
Insulators and laggers
8
10-5
4
Relative worked with asbestos
9
11.8
1
iar
DockersDockers hanhdalnidngling asbestos asbestos
0
-
226
history No domestic
of work or
exposure
to
asbestos
36
47
67
53 1.3 226
88
Positive exposures to asbestos in Positive histories in patient series
mesothelioma
series
versus
X = 27-11 P < 0.001
.
Seven cases of mesothelioma could not be traced and are omitted from this table
originaly
ae
originally 4 ne of the 4 whom the 7
aw statistically
statistically highly significant x = 27-11 < 0-001 This result is unlikely to be unduly influenced
thological v4. by the two groups of patients not being matched for
rles As
year of admission to hospital since there was no
the rela2 4A significant difference either in the areas of residence
ripts were 3 or in the occupations of the patients admitted in 1964
his group
and those admitted between 1917 and 1964. Com-
were
all >
were all 9
cats with 2
hospital hospital | cats
hospital
;
might wa
paring the confirmed and rejected patients in the mesothelioma group who died after 1950 36 50
of the confirmed and none of the 17 rejected cases
history
gave a history of exposure to asbestosasbestos Table 3
This difference is statistically highly significant
csidential y x== 83 p < 0,001
Ley
,
,
TABLE3
EXPOSURE TO ASBESTOS OF CONFIRMED AND REJECTED CASES OF MESOTHELIOMA SURVIVING AFTER JANUARY
1950
'
Exposure to Ashestos
|
Exposure positive
I
No work or domestic contact found found
Diagnosis of Mesothelioma
-
Confirmed
Rejected
36
,
35
16
Untraced
1
1
-
x
1183 P < 0.001
Mesothelioma Series
Occupational Exposures are details available 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 regulations controlling the manufacture of asbestos goods
protection
and the protection of asbestos workers became effective and seven started work between the
beginning of 1933 and the end of 1942. The occupations of these workers and the type of asbestos they
used are shown in Table 4. All of the 17 for whom details were available had used crocidolite asbestos
Five of the occupations listed are not scheduled as
TABLE 4
JOBS OF 17 PATIENTS WITH MESOTHELIOMA EMPLOYED EMPLOYED AT ONE ASBESTOS FAF CTORA Y CTORY
Obligations Obligations
regulatiroegunlastions
-
Not subject to regulations
Job
|
| Male Female
Material
'
Spinning
:
Carding
:
Clothing
i
1 Disintegrating
i
and opening
:
0
4
Crocidolite
:
t
t
1
Crocidolite
|
fg,
;+
,
:
t
i
Crocidolite
amosite Crocidolite
chrysotne amosite
Filter making |
|
masks
/
| Manufacturing
|1 ptrieofnormed|
| Manul icturing
Innings brake
1 Innings
;
4
34
|
1}
'
;
.
1 Rubber pounding
General
General
og |
|
:
1 labourer
|
: :
|
0
| Crocidolite
,
gL Crocidolite
;
U Crocidobite
Crocidolite
po Crocidolite
Crecidolite Crecidolite
Chrysotile Chrysotile
,
imosite
Employment history not available for one female patent
|
!
4
.
t B oo uae
:
ey 3
Ta
FS
aes
| Bat?
iz am
ar.
i
ect
i Ea
5.
:
.
ee eae 14:
264
British Journal of Industrial medicine oe pis 2
requiring medical supervision under Asbestos Regulations 1931
Four patients were working at other factories making all types of asbestos goods One had been employed in a wagon works sawing asbestos sheets for partitions Except for one a woman employed in insulating electrodes with crocidolite the types of
asbestos used in these other factories are not known
The eight heating engineers and laggers were all men Three had been employed in dockyards on ship repairs two in various types of lagging one in a power station one installing hospital sterilizing equipment 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 was intermittent
Domestic Exposures group of nine seven
women and two men whose relatives worked with
asbestos are of particular interest The most usual history was that of the wife who washed her husband's dungarees or work clothes In one instance a relative said that the husband a docker came home white with asbestos every evening for three or four
years and his wife brushed him down The two men
in this group when boys of 8 or 9 years old had sisters who were working at an asbestos factory One of these girls worked as a spinner from 1925 to 1936 In 1946 she died of asbestosis The press report of the inquest states She used to return home from work with dust on her clothes Her brother had
apparently no other exposure to asbestos he started work as a shop assistant then became a sawyer of iron girders until 1948 when he worked as a loader of groceries in the docks for five years but never on dusty cargoes and then returned to sawing iron girders He died in 1956 of a pleural mesothelioma
patient Series
Occupational and Domestic Exposures of
this series had worked in asbestos factories and four
had been employed as laggers The husband of another was employed at an asbestos factory for
three years and two dockers in this group gave histories of handling asbestos cargoes from time to
time throughout their working life The diagnoses of these patients have been grouped
into seven categories Table 5 The patients with a positive history of exposure are scattered throughout the various diagnostic groups and there is no indica-
tion that exposure to asbestos could be related to the disease which had caused their admission
Neighbourhood Exposures patient Series 36
of Mesothelioma and patients with meso-
TABLE . |?
THE PATIENT DISEASE GROUPS OF PATIENTS IN
SERIES
,
Discase Group
}
Patients a
'
No. of -
No. with
Exposure to
Asbestos =
Cardiovascular
Metabolic
tT
endothelial including
anaemias
intestinal excluding cancers
Respiratory excluding cancers All neoplasms
Other
Total
21 ott
s
7 6:
3a 18
well
76
fs
3
TB. 9
\'
18
2 . 0 fe
ae
|
fod
2 rn
we on
thelioma and the 67 patients in the 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 factory where more than 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 production at its first site When it opened they were
children between 5 and 7 years old At the present
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 at
the same address for 16 years The other seven were 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 48 years later She is the only patient who had neither occupational nor household exposure but in whom asbestos bodies were found in the lungs at necropsy
Among the patient series one patient lived near the factory at its previous site and four others lived near its present site One patient was 22 years old when she moved into the neighbourhood in 1915 She disliked it and when interviewed complained impartially about the dust from the asbestos factory
and the rats in the house
TABLE 6
RESIDENCE OF PATIENTS WITH NO OCCUPATIONAL OR DOMESTIC EXPOSURE TO ASBESTOS
Series
Mesothelioma
patient
Lived Within Asbestos mile of
Asbestos Factory
No. 11
% 30-6
S
75
Lived More Than + mile from
Asbestos Factory
No.
%
25
694
62
92
x = 7.85 < 001
Total
36 67
MESOTHELI 2 7
+
-
ia are
a Ay 4
domestic : Thus among those
*
exposures to ast
' patients in the mesotheli
In the patient series
proport factory > of an asbestos
in
. differencein the
- series who livedin the
vic - had no other exposure
be
4 _ significant
Date
=7.85 *
riein. a
First in Date of
Exposure
in Mesothelioma Series
to m . had been exposed asb 3 lived near the main asbes
B-. of exposure varied widel
to over 50 years , The
exposure and death
.
mean
37-5
years
Ad
. workers where exposure
. interval was shortest .
group livingin the neig
factories where exposu
. lowest Table7. showst
^' , at first exposure and the
group RELATION gyi
death x
a ey":
~vp
in each
no wha aPe)4 .
.
at
..
va
BETWEEN TYPE
po. OF INTERVAL BEFOMREESOTHE
2
ae
a>=ne
Type of Exposure | No.
iei
:
anh
Factory work
#, Domestic
Bi '4 Laggers and insulators
Living in neighbour-
hood of factory
ar
aC
|
iff
varied between 29.4 and death showed less variat
group of factory worke
grop years in the other
Asbestos Bodies an
thelioma Series th
thelioma = series lung
examination in forty
all certified as suffering
exami tissue available
revealed the presence
Both asbestos bodies
asbestosis were found in
and laggers A further asbes
asbestos bodies or
asbes ! tt
rd
Sate a
oped
SA
A
nate Ren cS coGeo
oee ei
Bea sicresinen
eahie
> ah om
ge
Pade
MESOTHELIOMA OF Pleura following exPOSURE TO ASBESTOS
265
.
.
;:
Thus among those with no occupational or
Lung tissue was available in only four patients
THE PATIENT eee)
domestic exposures to asbestos there are 11 30.6 % patients in the mesothelioma series and five %
exposed either through relatives or by living in the
neighbourhood of asbestos factories
In two
| Ne rae of
No. with
Exposure to
degen
Asbestos + ner
ee
=
in the patient series who lived within half a mile of an asbestos factory in the area Table 6 The difference in the proportion of patients in the two
asbestos bodies were present in lung tissue but there was no evidence of asbestosis
3
series who lived in the vicinity of the factory and had
TABLE 8
had no other exposure to asbestos is statistically
OWN
significant x= 7-85 P < 0.01
EVIDENCE OF ASBESTOS BODIES OR ASBESTOSIS 47 CASES OF MESOTHELIOMA WITH LUNG Tissue
SPUTUM AVAILABLE FOR EXAMINATION
IN or
pr
~~
Pax)
The patient
tional exposure ; working with
6 asbestos dust
vicinity of an
At
me
fifth of the .
yed
, opened in
the centre of
; There were
yy: within half @
was in produc a:
nAetd tthheepyrewseenrt e~ wd B-3 owithin a half- ese
. was born within
Bon and remained at : ede
other seven were
Legace ^...ldrenwhen the cS
.*
years of age and
he died 48 years Ten
ho had neither "
re but in whom
ings at necropsy to
De patient lived | and and four others
ent was 22 years
ourhood in 1915
fed complained asbestos factory , +z.
Bey
Fetee
>
OR
CSCBUEPSTAOTSIONAL v
More More Than
de from os Factory
eo
Total
:
%
%
64.4
Le 925 | 67
Bas rere
pe
Date of First Exposure and Interval Before Death in Mesothelioma Series men and women had been exposed to asbestos including those who lived near the main asbestos factory The duration of exposure varied widely ranging from two months to over 50 years The interval between the first
exposure and death varied between 16 and 55 years
mean 37.5 years Among the group of factory workers where exposure was probably heaviest the interval was shortest It was longest among the group living in the neighbourhood of the asbestos factories where exposure to dust was probably lowest Table 7 shows the mean age of each group
at first exposure and the mean of the interval before
death in each group Although the length of interval
TABLE 7
RELATION BETWEEN TYPE OF EXPOSURE AND LENGTH OF INTERVAL BEFORE DEATH IN 51 PATIENTS IN
MESOTHELIOMA SERIES
History of
Contact
with Asbestos
Positive Negative
Untraced
Total
Asbestosis or Asbestos Bodies
Present
Absent
22
6
*
/" /
4
3
30
17
Lung Tissue 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
Type of Exposure
No.
Mean Age at First Exposure
years
Mean Interval between First Exposure and
Death
years
Discussion
In the mesothelioma series there are 25 patients in
whom no evidence of any exposure to asbestos could
Factory work
23
Domestic
9
Laggers and insulators
8
Living in neighbour-
hood of factory
ul
22.5 170 156
8.5
29.4 37.9 38.4
48 6
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
varied between 29.4 and 48-6 years the mean age at death showed less variation it was 50-6 years in the
exposure during the youth of the deceased For example one of the patients was eventually identified
group of factory workers and between 55 and 57 years in the other groups
as having worked at a large asbestos factory for two
months in 1941. This was before he married and his widow did not know of this episode It is of
Asbestos Bodies and Asbestosis in the Meso- interest that asbestos bodies in the lungs were found
thelioma Series the 83 patients in the meso- in only four ofthis group and it seems probable that
thelioma series lung tissue was available for - among the remainder there were those who had had
examination in three In four other patients no exposure to asbestos .
all certified as suffering from asbestosis with no lung tissue available examination of sputum during life
In the mesothelioma series of patients both in-
dustrial and industrial exposures were recog-
revealed the presence of asbestos bodies Table 8 Both asbestos bodies and histological evidence of
nized
Among the men the exposure was pre-
dominantly industrial 22 worked in asbestos
asbestosis were found in 15 of the 24 factory workers factories or as laggers two were exposed at home
and laggers A further five showed evidence of either asbestos bodies or asbestosis
and one lived near the asbestos factory Among the women only 10 worked in asbestos factories and a
Saat
einnetie EsSeKeIMO i qcetay be hy pk ie
ane
Suber
RTA 4 tel ae
bare
266
BRITISH JOURNAL OF INDUSTRIAL MEDICINE
further 17 had industrial exposures seven in the home and 10 living near asbestos factories
There is no evidence that the patients with peritoneal tumours differed in their type of exposure from patients with pleural tumours The proportion of positive findings of asbestos bodies or asbestosis was similar in both groups A higher proportion of women particularly among the factory workers was affected by peritoneal tumours but the difference between the sexes was not statistically significant
The recent increase in the number of patients diagnosed at the hospital may be partly due to an increased interest in mesothelial tumours and partly to the long interval between first exposure and development of the tumour Those exposed between 1915 and 1925 might be expected to die from about 1950 onwards Asbestos imports to the United Kingdom have mounted steeply since 1932 Leathart 1964 and its uses are more widely diversified in industry The increasing proportion of the population exposed to asbestos during the past 30 years may be expected to give rise to an increasing
occurrence of mesothelial tumours
The choice of groups for comparison with the mesothelioma series of patients was not ideal The number of patients it was possible to trace in the rejected series proved to be very small The inpatient series although matched for date of birth and sex differed from the mesothelioma series in that all were admitted to hospital during 1964. Neither of these groups could be interviewed without knowledge of the disease from which they were suffering This could have led to bias with reporting of exposure to asbestos in the patient series However in the patient series the actual patient was interviewed and more detailed and reliable histories were obtained than was possible from the relatives of those who had died of mesothelial tumours There
was no evidence that because of their more recent
admission to hospital the patient series was less
likely than the mesothelioma series to work in con-
tact with asbestos or to live in closer proximity to
asbestos factories
.
-
There seems little doubt that the risk of meso-
thelioma may arise from both occupational and
domestic exposures to asbestos Wagner and others
1960 described patients with no exposure other
than living as a child in the vicinity of the asbestos
mines A high incidence of asbestos plaques of the
pleura has been found in the population living near
an anthophyllite mine in Finland Kiviluoto 1960 More evidence is required of an increased risk to the
population living in the neighbourhood of asbestos
factories or other areas such as dockyards where
asbestos is used in quantity
mo,
We should like to thank Dr. D. O'B Hourihane for
his operation and for making the results of his investigations available to us
Our thanks are also due to Professor C. Wilson Professor V. W. Dix Dr. N. L. Rusby and Mr. G. Flavell F.R.C.S. of the London Hospital and Dr. C. P Silver of St. Matthew's Hospital for permission to interview their patients to the general practitioners who collaborated in this enquiry to the managements of the asbestos factories for arranging access to their records to Miss Joan Walford for statistical assistance and to Dr. J. C. Gilson Professor R. S. F. Schilling and Dr. W. Smither for their advice and help
The contents of this paper were communicated to the
Conference on the Biological Effects of Asbestos arranged by the New York Academy of Sciences in October 1964 and will be published in a shorter form in the proceedings of that conference -
REFERENCES
P.
Fowler
B.
Sloper
J.
C.
and
Warner
E.
C.
1964
cading article 1964 Ibid 2 202
Brit med
Hourihane D. O'B 1964 Thorax 19 268
Kiviluoto R. 1960 Acta radiol Stockh Suppl 194
Leathart G. L. 1964 Occup Hlth Lond ) 16 119
Owen W. Glyn 1964 Brit med J. 2 214
Wagner J. C. Sleggs C. A. and Marchand P. 1960 Brit J.
industr Med 17 260
Ni
| Sito of yfr
Primary - Sex
*
Tumour
yas
ay
; i Section A Factory
uN}4,
8
,|
0
\ 4419 |
wPes
||
Pleura M 1901
Peritoneum
i
hd
Peritoneum 9f- 189
}', |a s a nee
1Y8 Peritoneum | | 190
34 Pleura + | | | a, 188)
Peritoneum FR *: 169
Peritoneum | F
|
Peritoneum | F
I
Sat| Peritoneum F | AE
y
JS t
ay
i9
va
at,440041
.
i 12
are
| Peritoneum |"
2
Peritoneum
| | Peritoneum
ao
ft
*
Pleura
| | Peritoneum .
Fe: ag
.
F
*
M
1 A
a
Stoe
F
| | 3) Peritoneur M 1
1
aor
Wi
"7 | Peritoneum }- Adr
sors
:
i 20 | Peritoneum | F
*, 17 | Pleura
,6 | Pleura
mM
| > 10
MW
Peritoneum
aN. 1 | Pleura
23 | Pleura
a3
Peritoneum
4
Peritoneum
a
My
Appendix opposite
Section B Laggers and
25 | Pleura
*
28
Pleura
|
22
Pleura
,
30 | Pleura
:
yr
27
Y 26
31
'29
| Peritoneum
1
| Peritoneum
| Pleura
| Pleura
oe Rees pSaars
eS
SRE
< oe
rates
Sen
ak
?
a
Oseerage
:
oy
ee
; 1%
atch,
pit
Easeae
ite PURER
CS
spares
ue
i; Ki. meee
:
PASEO MONIC,
Ae
Py ae
a RA
.
atte
,
tn
AU
RE peat!
Ya) 3
re eat
reae aly
.' 4
.
.
Py work in con-
-proximity to
oy
risk
risk of
aan
*
meso-
cupational and
cupational
and others
xposure
xposureother
of the asbestos
plaques of the
og living near
Reviluoto 1960 risk risk to the
pod of asbestos
Kyards where so :
4
Ad
a
&
xt 42
Ps
#4 b
-4
i
+
"e
3
i
4
4
.
MESOTHELIOMA OF PLEURA FOLLOWING EXPOSURE TO ASBESTOS
267
APPENDIX EIGHTY patiENTS WITH MESOTHELIAL TUMOURS
Case No.
Site
Site of
Primary
Tumour
Sex
DuraYear | tion
Year
of
| Expo- of
First
of
Expo-
Year of
Birth | Expo- sure Death
sure ( years
How
Diagnosed
Asbestos
| Bodies
in Lung
Tissue
Pathological Evidence of As-
ibnestoLsuinsg
Tissue
Survival
| from Initial
Symmopnttohmss
Section A Factory workers
8 | Picura
M | 1901 | 1921
17 | 1938 | Necropsy | Positive {| Positive
?
Peritoneum
19 | Peritoneum | M | 1895 | 1919 | 22 | 1941 | Necropsy | Positive | Positive
?
.
Peritoneum
18 | Peritoneum | F
1908 | 1925
S
1947 | Biopsy
Positive | A
?
sputum
24 | Pleura
M
1880 | 1928
12
1950 | Necropsy | Positive
Negative
9
14 Peritoneum F
1893 | 1917
?
1951 | Necropsy | Negative | Negative
?
Relevant History
Brake tos
liner boiler coverer asbes factory mainly crocidolite
Disintegrator and other jobs
asbestos dolite lactory chrysotile amosite croci-
Sectional pipe maker asbestos
factory certified asbestotic maincrocidalite
Used asbestos boarding in railway
carriage construction
Asbestos factory job unknown
4
mg
:
ok 4
.
Co
ve
itd
.
& anes
ys
8 .
4
.
:
Hourihane
>
HHouroihanue rihane for
Hourihane
his
results of his 2
[
results
16 | Peritoneum | F
1906 | 1922
7 | 1951 | Biopsy
Positive | A
( sputum
?
Opener and sectional pipe maker
asbestos asbestos factory certified asbes- asbes-
ttioltcic amosite crocidolite chryso-
4
,
2
FI , .t
Mr. C.C.
by and
Wilson WilsoWinlson -
! G Mr. +
$3.) Peritoneum | F | 1894 1915
11 | Peritoneum | F
:
1895 | 1917
n | 1955 | Necropsy | Positive | Positive
t | 1955 | Biopsy
Positive | A
sputum
12
certified Spinner asbestos factory asbestotic mainly crocidolite
3
Sectional pipe maker asbestos
factory certified asbestotic mainly
wo
: .
^'
_
4
and Dr. C. P. aE
mission
inter-
mission to inter- .
titioners who col
singements
singements
z
singements of the the F
sistance andrecordsto to their records . ,
Ft filling and Dr. W.
.
.
Ammunicated to the +;
Asbestos of
of Sciences in
of
in
a shorter form
fey rn ,
oe
Peritoneum
15
Peritoneum
1
1901 } 1918
Peritoneum
9 | Peritoneum | T
1897 | 1919
21 | Pleura
X | 1893 | 1928
12 | Peritoneum | F
1918 | 1937
Peritoneum
3 Peritoneum M | 1908 1927
:
7 | Peritoneum | M = j 1925 | 1940
t} | 1|
1955 1956 |
Biopsy
Biopsy
Necropsy |
Positive
Positive
sputum
Positive |
A Negative
1 j 1957 Biopsy
. Biopsy
2 | 1958 | Biopsy
|A
A
A A
30 | 1958 | Necropsy | Positive | Positive
4 | 1958 | Biopsy
A
N
2 | Pleura
| 1925 | 1941 | == | 1959 | Biopsy
,
Negative | Negative
20 | Peritoneum | F
1907 | 1921
10 | 1959 | Necropsy | Negative | Negative
crocidolite
6
Spinner asbestos factory certified
asbestotic mainly crocidolite
3
Disintegrator asbestos factory
amosite crocidolite chrysotile
factory 18
Asbestos
north England
asbestos factory mainly
18
Carder asbestos crocidolite factory mainly
18
Clothing and weaving asbestos
amosite crocidolite
chrysotile
Fcihlrtyesrotile 3
for
masks
maker A.R.P. asbestos asbestos
facfactorty ory ; mainly croci-croci-
maker A.R.P. masks 11
Filter
for
asbestos factory mainly croci
dolite
2
Electrode coverer crocidolite
oe t;
,, f
J+
.
2
4
' :
.
.
'
4
te
ye | | | Positive - Nth,
17
Pleura
K<
1908 1924
1
1962 Biopsy
Negative
2
Spinner asbestos factory mainly
i
boteb
ye
crocidolite
me | | | | | | | w
4
6
Pleura
M
1907 1942
10
1962 Necropsy Positive
Positive
?
Delivered chemicals to asbestos
"
8
au,
~
factory
amosite
crocidolite
,
Ue, if
a
Z
chrysotile
..
vet. |] | | | | | 10
Peritoneum
F
1899 1923
1} 1963 Biopsy
Positive
Negative
S i
factory mainly
ippl1916494196r4aBrit. SLpaibnonuerrerasbestos aa || || || | || | || |j| 119Son
My
ut
crocidolite
eae
se"
1
Pleura
M
1899 1936
26
1963 Necropsy Positive
Positive
?
works and buildings
{
asbestos factory amosite croci- ,
.
.
ve
dolite chrysotile
16.
23
Pleura
1908 1925
A 1963 Necropsy Positive
Negative
8
Worked in yard of insulating
;
1960
Positive contractors
1960 1960
hbre.. Hs *, ey
vy - ia
7S Syme,
ape
is WWae
we ;
maeyg Vt
ae La wy ioe
ye tin"St be
A's ^' ^'"
eit te"i., a"
beyea ree rots Lig.
3 | Peritoneum | M | 1911 | 1930 4 | Peritoneum | M (| 1917 1937 |
2 | 1963 | Necropsy } Positive 27 | 1964 | Necropsy | Positive
| Positive | Positive
|
.
6
Carder asbestos factory mainly
crocidolite
24
Disintegrator and other Jons
asbestos chrysotile dolite chrysotile amosite croci-
Section B Laggers and Insulators
.
25
Pleura .cj
M
1874 1 1888
32283 | 1935 | Necropsy Negative | Negative |
12
sh
Worked in close prox nity to boiler
repairer in dockyards dockyards
| j | | 222NA-
Pleura >
M
1893 1910
32283
1955 Biopsy
A
!A
24
Boiler cleaner and stripper dock-
.
yards
| | | | | 222NA-
Pleura
M
1921 1937
32283
1959 Necropsy Positive
Positive
9
coverer and lagger to various
| | | | | | BEorielcetring 222NA-
Pleura
M
1908 1922
32283
1961 Biopsy
A
A
2
and fitting central heating
222NA- | Peritoneum
M
1908 { 1922
32283
1961 . Necropsy | Positive
Positive i
!
222NA-
'
222NA-
Peritoncuin
'
1911 | 1927
2
1961 | Necropsy | Positive | Positive
12
Boiler coverer and pipe insulator
contracting firm
13
Lagger and boiler coverer various
firmy
.
222NA- Pleura
% 1 Pleura
!
M {| 1897
1912
1916 | 3 | 1962 | Biopsy
1927
3 | 1962 | Biopsy
A A
A A
H
t Intermittently boiler lugger ship
| repairs
10
Installation of hospital sterilizing
equipment
continued
:
:
1
.
aif
. *
mo
4
ra
os
"t
<
+
_ Pee
}
g1
rsa
5
Avs,
268
BRITISH JOURNAL OF IndustriaL MEDICINE
APPENDIX continued EIGHTY PATIENTS WITH MESOTHELIAL TUMOURS
Dura-
.
Patho-
Case No.
Site of
Primary Tumour
Sex
Year | tion
Year
of
of | First
| of
Expo-
Year ot
Birth
| Exposure Exposure Death sure years
How Dingnosed
| | Asbestos
logical
Survival
|
| Bodies
in Lung
Evidence of As-
from Initial
Tissue
bestosis in Lung
Tissue
| Symptoms | months
cy,
History
'
Relevant History
pot
wy an 'e
ht
t
. a ay
. ee arn 7%
be he hag
eerie
-_
"F
*
mn
of foe
J Site of oy)
Primary '.
Tumour AS
moe
ay
thy die
Section C. Exposure of relatives
.
40 | Pleura
M | 1912 | 1925 | 11 | 1956 | Biopsy
A
A
27
Elder sister worked as spinner at
asbestos factory died 1946
34 | Pleura 38 | Picura
F
1913 | 1919
2 | 1957 | BioBpiospsyy
A /
F
1895 | 1919 41 | 1960 | Biopsy
A
A A
37 | Picura
35 | Peritoneum | F
1905 | 1925 | 14 | 1960 | Biopsy
A
A
1890 | 1921
21
1960 | Necropsy | Positive | Negative
33 | Pleura 39 | Pleura
F
1916 | 1930
M {|
}1928
+
1961 | NecropsNecyropsy | NegNegaative tive | Negative
.
2 | 1961 | Biopsy
A
A
32 | Pleura
F
1900 | 1941
S | 1963 | Biopsy
A
N
36 | Peritoneum | F
1889 | 1912
18 | 1963 | Biopsy
.
A
A
14 14
asbestotic certified Elder sister employedemployed as spinner
looked after patient as child
15
For several years husband worked
in ship's engine room close
proximity to lagging operations
3
Husband worked as boiler coverer
overalls brought home for washing
24
Husband foreman and executive at
?
asbestos Husband faactorydocdockker er frequentlyfrequently frequently
handled white asbestos spinner
18
Elder sister worked as spinner at
asbestos factory and suffers from
in asbestosis
in
18
Daughter asbesastbeo sts os factory
for 5 years patient washed her
overalls builder
15
Husband railway carriage builder
sheeting with compartments sheeting work clothes waasshbeesdtoast
home
Peritoneum
ls aye
Cote ae
|-
M
de 4
,
Pleura M i sony!
.
we R Pleura
F
" Pleura ot T a) S8
.
aeSete
Pleura ,
NM
Pleura
ar
Pleura
F
7
.
of,
PerPitoenerumitoneum |
PlouraPloura
bd
, x,
Pleura
M
Section D Neighbourhood cases
44 | Pleura
F
1905 | 1913
7
48 | Picura
|
1922 | 1922 | 16
1959 | Biopsy
.
1960 | Biopsy
42 | Pleura
F
1889 | 1913 | 48
1961 | Biopsy
50 | Pleura
F
1903 | 1908
6 | 1961 | Biopsy
43
Pleura
F
1905 | 1913
13
1961 | Biopsy
47 | Pleura
F
1917 | 1917
10 | 1961 Biopsy
64 | Pleura
F
1899 | 1907
6 | 1962 | Biopsy
71
Pleura
F
1899 | 1907
6 | 1962 | Biopsy
41
Pleura
F
1900 | 1913 | 32 | 1962 | Biopsy
45 | Pleura
F
1900 | 1913
7 | 1962 Biopsy
46 {| Pleura
F
1907 | 1913
7 | 1963 | Biopsy
A
A
A
A
Positive | Negative
A
A
A
A
A
A
Negative | Negative
A
N
A
A
A
A
A
A
Section E. No history of contact with asbestos
65 | Pleura
F
|
1900
68
Peritoneum
F
|
1902
49 | Pleura
M
|
1895
75 | Pleura
F
74
Peritoneum
F
|| |
62 | Pleura
M
|
1899
i
'
1904 | 1899 |
|
|
'
\
i
1947 | Necropsy| Positive
Negative
1954 | Necropsy | Negative | Negative
1954 | Biopsy
A
A
1955 ! BiopBsioypsy
A /
A /
1955 | Necropsy | Negative | Negative 1955 | Necropsy | Negative | Positive
~
8
Lived within ^ mile of present site
of asbestos factory
17
Lived within mile of present site
of asbestos factory
15
Lived within 100 yards of present
site of asbestos factory
site
13
Lived within } mile of old site of
,
;
ri.
73
uo
Pleura
*:
Pleura
77
wr
rn
Pleura
?
tM
+
| re ek. .B
| asbestos factory mile
{ 70
Pleura
4
Lived within + mile of present site
e
of asbestos factory
:
16
Lived within 200 yards of present
site of asbestos factory site
S
Lived within 4 mile of old site of
asbestos factory
site
12
Lived within | mile of old site of
72
. e
$5
aa
| Peritoneum
.
| Pleura
{'
B
D
mM
asbestos factory
29
Lived within } mile of present site
60 Peritoneum /B
| | z of asbestos factory site
9
Lived within mile of present site
:
67
Pleura
.
_:
of asbestos factory
we
. | 7
Lived within } mile of present site
& 56
Pleura
of asbestos factory
.
oa <
.
Bt
| | +, &, Peritoneumn
i 7
Worked as nursemaid to manager
.y
8 of gas works in East London
&
asbestos insulation used in works
| 33
Pleura Pleura
S
Shorthand and housewife
aawe
ay
MY lived lord area
.
ik d
?
Baker's roundsman army general
labourer publican for 30 years in
% '
on
East End of
,
London ?
Munitions work
before marriage
Untraced
Untraced then housewife lived Waltham
Section F
_
~ a es Abbey Essex
78
Pleura
in
<i 27
Tailoress and housewife in East -
t
~ a es
~ a es
End of London
28
Employed as luteman and greaser
Beckton gas works 36 years
persistent discharging nus R.
83 | Pleura
81
Pleura
"
8
re
igh
ve
side of chest following empyema + 1925 acute chest infection 1953
subsequent thoracoplasty but deteriorated from this date
80 | Plcura
* 82
Pleura
a.
b
M
TA
77 | Peritoneum raFiJ
79 | Pleura
&
continued
ii4
! ney
rey: el
adoie
nA
ad Cis
i
May hese
~ ext; tio
an
Dake
LaCie
RL al
Eee
Mngt Sah aaa aa
oe 344!
GORE Da paths
pte
it i See
ne5
05
bX
20 ae ig
os
Vi
Seated
Sa
CORLEHeRe pe aaae ERS BF ee ee Pee Thee ek SSAA > Sis
ps
es taian aa a9 we AF Sea Caer
ary
5
Fas ohn Mita tetc
thera
eS :
ed ea
PR
tnt c a She i Breaa d neA s
MESOTHELIOMA OF Pleura folLOWING EXPOSURE TO ASBESTOS APPENDIX continued
EIGHTY PATIENTS WITH MESOTHELIAL TUMOURS
269
1
4
Case No.
;
|
Site of
Primary
Tumour
Sex
Year of
Birth
Dura-
Year | tion
of
of Expo- Year
First Expo- of
ExposureExposure Exposure Deathi
sure years
.
How
Diag nosed
Asbestos Bodies
in Lung Tissue
Patho-
logical Evidence
Survival from
of As-
Initial
bestosis | Symptoms in Lung | months
Tissue
Relevant History
Peritoneum | 1913
Pleura
| 1904
1955 | Biopsy
A
1956 | Biopsy
A
A
!
8
A
N
-
12
Merchant seaman cargoes from S Africa 1930-32 no definite evidence of contact with asbestos suose-
quently boats employed on channel
Labourer and builder finally employed in tunnelling lived East End of London
Pleura
Pleura
Pleura
F
1916
M
1891
F
1898
1957 | Biopsy
A
1957 | Biopsy 1958 | Biopsy
A A
A
A A
19
Employed remaking old sacks in
Bow previous content of sacks not
! ascertained lived East End of
London
,
it
' Garage hand chauffeur mechanic
lived Wolverhampton and Epping
6
Worked S printing machinist
before marriage then as housewife
until death lived East End of
London
Peritoneum | | 1879
Pleura M 1890
Pleura
|
M 1904
1958 | Biopsy 1959 | Biopsy 1960 | Biopsy
A A A
A A A
3
Stereotyper and printer lived
originally in East London then
moved to Ipswich
12
Van boy regular army cutter and
grinder lived N.E. London and
Dagenham
18
Bricklayer cement worker post-
man lived Last End of London
moved to Hainault Essex in 1911
Pleura Pleura
.
Pleura Pleura
1910
|
i
| 1911
1887
F
1888
1960 | Necropsy | Negative | Negative 1960 | Necropsy | Positive | Positive
1962 | Necropsy | Negative | Negative
1962 | Biopsy
Negative | Negative
18
Fitter and turner lived principally
in East End of London
?
Coloured S. African merchant sea-
man stoker at glass tactory possible contact with asbestos in S. Africa or at sea
10
Lived until marriage in Wales then
housekeeper in S.W. London
30
Machinist of celluloid collars
housewife and canteen worker
lived East London
Peritoneum +1
1898
1
'
~
Pleura
XX
1888
1962 | Biopsy
A
A
1962 | Necropsy | Negative | Negative
10
Machinist in hosiery trade Notting-
1960 1960 housewife moved to London
2
Labourer
merchant
scaman
docker carried only meat
| ! Peritoneum
XX
'
1915
1962 | Necropsy | Negative | Negative
54
Apprentice printer barman cook
and butcher For 25 years betore
|
i
67
| Pleura
F
{
1897
16 \ Pleura ;
M
1912
1963 | Biopsy 1963 | Biopsy
A A
A A
death lived East End of London
29
Dressmaker and housewife lived
East End ofLondon London then Somerset
24
Steel erector army steel erector
labourer and porter lived East
End of London
69 | Peritoneum | 11+
1901
1964 | Necropsy | Negative | Negative
42
Employed as packer in pharma-
ceutical firm for 12 years then
housewife until death lived in
{
53 Picura
.
ro
. f
M 1892
1964 | Necropsy | Positive
Negative
Dagenham
24
Fisherman fireman docker 1915-
39 at Tilbury docks fireman and
finally storekeeper contact with
asbestos not probable at Tilbury
docks lived Tilbury area
Section 1 Untraced cases
18 Pleura
F | 1893
h Pleura
X
1860
UY!
Pleurs
X
1877
fo Pleura 1
X 1900
Qt Pleura
1
X | 1893
| i Peritoneum
F
4
|
| 19 Pleura
F
k
Sener
1910 1878
1917 | Necropsy
?
Positive
1922 | Necropsy | Negative | Negative
1925 | Necropsy | Negative | Negative
1936 | Necropsy | Negative | Negative
1938 | Necropsy | Positive
1945 | Necropsy | Positive
| Positive
Positive
1955 | Necropsy | Positive
Positive
:
Not traced Not traced Not traced Not traced Not traced Not traced Not traced
A = tissue not available
on del
hierar
fe Rass:
ee ee ee
ie Be
ma
PORT
<
rep NB,
eee
2
xpeea TR
ed
we teG
Oat
$ 4 3
ea
iy
4 at
TT
Y,
Soe
wwe
Soler
malarianrere <