Document omd0vz7p66BQQgXQJDoxVp5OE

.>mjvcc 12th larch, 195a. fir. H. R, Elpfaick* Medical Superintendent* State Sanatoria** WOOBOLO?. /c**. n.y*S*<l Dear Sob* Z m most interested In.the patient who* e discussed laat night* Z hare leaked up nr notee as asbeatoals and the reat of the letter *111 really ooselet of extraete front these aetep-rmlewt to this partisular eases Pathology - Kenneth X. Ind. la the A.R.1* Archives of Industrial Health* 1955* Toll11, P*l85. -- "Pathology of Asbestoais" describes t grads** Xa the flre^enall numbers of asbestosls bodies are found la the alveoli*, this, he says* is an incidental finding. Zn later stages* asbeatosle bodlea are found with definite change* la the lung tissue* Clinical Asbestosls -- In the A.1UA* Archives of Industrial Health, 195>, voi.1t, P.204, Paul Cartier naka* a surrey of 4000 asbestos workers In Qxebee* Between 1945 and 1953, 128 cases of asbestoais were discovered* 40 of show died* Of the 126, 121 were diagnosed by x-ray and the other 7 cn peth^ logical study only, i.e. diagnosis was not Bade tan the fllss, where changes, if present at all* were - Of the 40 deaths, 6 were due to bronchogenic carclnona* It is of interest, that in the other 3,000 odd,eaployees, only 7 died of broncho genic eardnooa* Of the 88 survivors with asbestoais, 55 were able to work without disoonfort* Of the rewainlag 29, no good correlation between the degree of asbestoais and the dlnleal status was found* However, la an article la the Post-Graduate Journal of Medicine by H* tyere, 1949, Tol*35, P.635, la a survey of cases of asbestoais, dyspnoea is quoted as a universal oon plaint. The author also nentlcns that aputun may be occasionally blood-specked (tills Is the only nentlon of hassoptysis that I have cone across)* In this survey,tlfe average exposure to asbestos wass - ^ l6 2 females 7.3 ) M c*ae* 10*4 ?**** In a survey of 53 eases, 29 were found to have finger clubbing. (Also 33 of the 53 had an sccentuated pulmanary 2nd sound. Cn the other hand, Kenneth V. Smith, In the 4-k.A. Archives of Industrial Health, 1955, ?ol*12* P.196, states tr.it there are no typical clinical feature of asbestoels and clubbing of the fingers la a rare finding. He statee that asbestos workers are not predisposed to Intercurrent ^laonary infections. "However, when an acute pneumonitis develops In the presence of an established a9bestotie fibrosis, the infection is slow to heal, relapses are frequent and the ritient nay be sore susceptible to subsequent ptilrxmarj ir. fee tiona. " In an article -"Silicosis ?.nd Asbeatosis" - American  *t 4. 2. Journal of Surgery, 1955* Tol.90, P.118, Sander*-,:.referring to asbestoals, state* that radlollgically it needs to be distinguished from chronic passive congestion, bronohieotasis, polycythaeais and Infiltrating malignant aetastlsls froa tbs lbs heat description of x-rays that Z have read, as jet, is by I J. Bristol, A.B.X. Archives of industrial Health, 1955, Tol.11, P.193# 1& which ho desl^atea 3 stages^ Bis description Infers sfcthcr than states that th* *<Mft tends to folios a bilateral syaastrloal ecnflgaratloa. Bie Relationship of Canoer of the ia.- Bdltorlalt-Aaerloen Journal of pathology, 1999, Tol.29* P.1388.- the relationship spyeara.-to be trtaWlsTisd sad there appear* to be ^n*^rslty~oX hjatologloal-types. Asbestoals cancer of the lung Is a ooapensahla occupational disease la Gsrnsny. Zt 4Po/appear tMhlnorsassd liability toceanoer of the lung ha5~lisited the presoaee of asbestoals of the lung and doea not extend to exposure to aabeotos without the oristsnoe of a jneuaoeo&losls resulting therefros* In the British Journal of Industrial fedldae, 1999, Tol.12, P.81, by Blchard Boll, gives various percentages of lung cancer in cases of asbestoslsi 1949 * Herewether 31 out of 239 - 13*. 1951 - Clyone 17 121 - 14*. In Merewether's figures, 17* of sen and In dyone'a figures, 19.9* of sen with asbestoals had carcinoma of the lung. All of the subjects In who two diseases were associated, had at least 9 years In conditions In which control of dost did not have to be undertaken, i.e. prior to 1931 In &gland. Re states that the association of the 2 conditions has not been found In any person taken into employment since that date, fills point Is aore significant when It Is realised that between 1933 end 1953* incidences of lung cancer aaong men In the country at large# Increased sir fold. Apart from the clinical urgency, it la Important to establish whether or not this patient has a carcincwa of the lxrng. By this X mean that the shadow In the Isf^.nld zone, l.e. a slowly resolving Infection, could be due to carcinoma of the lung and he got the clubbing of the fingers. Share seeas to be evidence that the latter la of fairly recent origin and probably of fairly rapid progress. I rather tend to tbs opinion that this rapidity would be aore In keeping with clubbing due to a carcinoma of the lung than th3t due to -eil^etreia.'. If this patient has carcinoma of the lung, we are loft with the asbestos bodies and the Inconclusive shadow at the right base, to establish a claim for asbestosls. It certainly night be well worth-while going ahead with the claim under these circumstances but If we are certain that there Is 710 carcinoma, then we have a ruch sounder case for asbestosls. I wonder if it would be of help if you could get a specimen of sputum -".d if you could send It down to Professor ionaelden with * view so having a search for carcinoma cells.' to you i atlor: you for I do hope that these notea will be of assistance I I would like to hear the outcome of 7our Invest- :`-`f I an iringiag vry this inti proo. .roenntseod indJ1e0i.d.C*3in-. this *patient. Thank Tours sincerely. 1