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FILE NAME Cape Asbestos CAPE DATE 1960 DOCH CAPE151 DOCUMENT DESCRIPTION Journal Article - Diffuse Pleural Mesothelioma & Asbestos Exposure in the North Western Cape Province Legal - Tibbs Case Exhibit 49 Brit J. industr Med 1960 17 260 ELCTRONIAY DIFFUSE PLEURAL MESOTHELIOMA AND ASBESTOS EXPOSURE IN THE FILED - NORTH WESTERN CAPE PROVINCE BY 2023 J. C. WAGNER C. A. SLEGGS and PAUL MARCHAND Oct From the Pathology Division Pneumoconiosis Research Unit of the Council for Scientific and 18 Industrial Research Johannesburg West End Hospital Kimberley and the 12:13 Department of Thoracic Surgery University of the Witwatersrand and Johannesburg General Hospital RECEIVED FOR PUBLICATION APRIL 24 1960 PM Primary malignant tumours of the pleura are uncommon Thirty cases 22 males - 11 females ages 31 to 68 of diffuse pleural mesothelioma are described all but one have a probable exposure to crocidolite asbestos Cape blue In a majority this exposure was in the RICHLAND Asbestos Hills which lie to the west of Kimberley in the north west of Cape Province is rarely seen elsewhere in South Africa The tumour Mesothelioma of the pleura is regarded as an the lungs of the first case Case ) and secondly - uncommon tumour In the last four years we have 10 of the cases came from a hospital to which seen 33 histologically proven cases 28 of these had suspected cases of tuberculosis were referred from a COM ON some association with the Cape asbestos field and four cases had been exposed to asbestos in industry The tumour is rarely encountered elsewhere in large asbestos mining area This hypothesis could not be supported at once from the original histories obtained from the patients for they included house- South Africa During the past five years with the wives domestic servants cattle herders farmers a PLEAS PLEAS exception of the present series no neoplasm of this nature has been diagnosed amongst 10,000 lungs water bailiff an insurance agent and an accountant none of whom were working on the asbestos mines examined at the Pneumoconiosis Bureau in at the time We therefore undertook a detailed - Johannesburg or in the Pathology Department of investigation of their past occupation and place of the South African Institute for Medical Research residence and the association with asbestos ex- Higginson and Oettle 1957 did not observe a single posure was discovered The cases are summarized case in their survey of malignant tumours occurring in Table 3. Previous biopsy specimens were re- in the Bantu and Cape Coloured population of examined and new cases diagnosed including Johannesburg and the North Eastern Transvaal asbestos miners In only one case do the relatives 203CP41759 Our first necropsy specimen of pleural meso- thelioma with asbestosis was examined at the Pneumoconiosis Research Unit in February 1956 Case ) During the early months of that year one of us C.A.S. in the Northern Cape treated six deny that the patient either visited the asbestos mines or was exposed to asbestos This is a preliminary publication and the problem is being intensively investigated patients with gross pleural thickening Pleural biopsies from two of them showed the features of The Asbestos Area of the North Cape mesothelioma In the ensuing two years eight According to Hall 1930 asbestos was discovered further cases were found from this region and five by Lichenstein near Prieska during his travels be- from elsewhere in the Union During this period tween 1803 and 1806. Since then it has been C.A.S. had become perturbed at the number of established that the asbestos deposits extend from these unusual tumours occurring amongst his 20 miles south of Prieska northwards through the patients and stimulated an investigation At this western part of the magisterial district of Hay to stage there were two reasons to suggest that asbestos the eastern portion of the magisterial district of might be implicated First asbestos was found in Postmasburg and finally to the western area of the 260 DIFFUSE PLEURAL MESOTHELIOMA 261 ELCTRONIAY FILED - 2023 Oct 18 12:13 PM - RIC-HLAND COM ON FIG Map of Griqualand West asbestos fields PLEAS PLEAS district of Kuruman Fig ) These deposits occur In 1908 production had begun in the Kuruman dis- - in the slopes of a range of hills covering an area of trict Between 1916 and 1918 a large number of approximately 8,000 square miles Known as the claims were taken up This northward trend has Asbestos Mountains these hills extend more or less longitudinally between 22-30 and 23 E. The continued and in about 1950 mining started at Pomfret near the Bechuanaland border Table 2 whole area is semi sparsely populated and Initially the ore was quarried in numerous small apart from mining cattle ranching is the only open cast workings This was followed gradually important occupation In the Kuruman area several 203CP41759 large tracts ofland in or abutting on these mountains have been reserved for the aboriginal inhabitants and here whites may only reside in the immediate vicinity of the mines The type of asbestos mined throughout this area is crocidolite better known as Cape Blue Asbestos TABLE 1 CHEMICAL ANALYSES OF CROCIDOLITE AND AMOSITE from Vermaas 1952 Sio A1,0 Crocidolite 51.94 ' 0-20 Amosite 49.47 0.63 The chemical analysis of the fibre is given in Table 1 Fe 0 FCO 18-64 19.39 4.15 35-63 Crocidolite is the fibrous form of riebeckite and all stages of transformation from a massive riebeckite Mg0 Ca0 Na 1.37 0.19 6-07 6.57 0-52 0.02 rock through lamellar riebeckite to asbestiform K 0- 0.04 0.31 0.20 0.07 crocidolite occur in this region Magnetite is frequently associated with the crocidolite Vermaas 1952 H 0 Tio Mno F 2.58 ' _ | _ _ 2.33 0-25 0.61 0.01 Mining of asbestos first began in the Prieska district in 1893 and gradually spread northwards Total 100-73 \ 100-46 262 British Journal of industrial medicine ELCTRONIAY TABLE 2 POPULATION OF THE MAGISTERIAL DISTRICTS IN WHICH THE ASBESTOS FIELDS ARE SITUATED taken from Union Census 1921 and 1951 District Population 1921 Population 1951 Whites | whites Total Whites whites Total Prieska Kuruman Hay Postmasburg FILED 3,430 4,713 4,499 ' 4,879 16,698 8,814 8,309 21,411 13,313 3,361 4,818 2,757 10.847 23,779 9,631 14,208 28,597 12,388 Included in the Hay District 4,887 21,019 25,906 - 2023 by a type of shallow mining inclined shafting be- today the white prefers to live as close as came more common after 1930 possible and the children play on the dumps from Oct According to Frood 1915 the quarrying was a the mine and mill 18 family affair undertaken by the local inhabitants The men quarried the rock which was sorted and then hand cobbed by the women and children 12:13 Hand cobbing consists of separating the fibre from PM the banded ironstone by striking the rock cob with a Case Histories The following eight case histories illustrate various aspects of the disease and the different types of exposure to asbestos dust small hammer As the market was selective a - rotary sieve was sometimes used to grade the fibre Case 1.-B.P. a Bantu male 36 years of age born and eliminate the small particles of dust After 1920 was a mine labourer and was the first case RICHLAND grading it was bagged and weighed The asbestos diagnosed as a mesothelioma with evidence of asbestosis was then transported by donkey wagon to the nearest He was born in the Kuruman district but it is not known head Before the establishment of the railway whether he worked in the asbestos mines He was in this area between 1923 and 1930 such a journey employed on the Witwatersrand mines underground - for two years and in the change rooms for a further could last as long as 10 days This transport was 11 years COM ON generally undertaken by white youths farmers sons under contract The white inhabitants played very little part in actual recovery of the fibre being nearly always employed in the role of managers or over- A radiograph taken at a mine hospital on August 18 1955 showed a massive sided pleural effusion and 3,000 ml of fluid was withdrawn He was admitted to the Witwatersrand Native Labour Association seers issuing stores and supervising the grading and Hospital on August 24 1955 and two days later aspira- PLEAS PLEAS weighing of the fibres Farming activities were and are still carried out round the mines tion yielded 1,000 ml of thick gelatinous pus which could be pulled out in threads He was treated with Since the 1939-1945 war the demand for crocido- frequent aspirations and instillation of varidase but without improvement and he died on February 15 lite has enormously increased The lucrative claims 1956 Martiny 1956 have been bought by registered companies others At autopsy the right thoracic cavity was occupied by have been abandoned As deeper and_ richer a large gelatinous tumour which displaced the mediasti- deposits have been found vertical shafts are being num and compressed the left lung The tumour had sunk However the mines with large shallow infiltrated the pericardium The right lung was com- deposits are still using the inclined shaft and tunnel pletely compressed by neoplastic tissue Fig 2 but the 203CP41759 and quarrying is still used by the few remaining smaller producers With the building of more mills hand cobbing has diminished In 1915 the first crushing mill was established at Koegas in the south This was followed by a large mill at Kuruman right bronchial tree did not show any evidence of a primary bronchogenic carcinoma Histological sections of the pleural growth showed a papillary mesothelioma Fig 3 There was evidence of asbestosis in both lungs Fig 4 operated between 1926 and 1931 where it was situated within 300 yards of the main street close Case 4. K.Ha. white female 56 years of age born 1898 was a social worker who could only have had a to which cobbing was also done for a few years 1927-1930 This was followed by a mill at Prieska in 1930 which was completely rebuilt in 1957 Griquatown had a small mill in 1928. The practice today is for one mill to serve several mines in the immediate vicinity In the early days the manager and labourers lived within a few yards of their place of work and even short exposure to asbestos as a child and probably a further slight exposure as a young woman She may have paid several short visits to the mines with her husband at a later period She was born in Griquatown where she lived until she was 5 years of age Her family then moved to Kimberley where from 1916 to 1922 she worked as a clerk in an asbestos warehouse Her husband owned an asbestos mine from 1933-1940 diffuse pleural MESOTHELIOMA ELCTRONIALY FILED - 2023 Oct 18 12:13 PM - RIC-HLAND COMON PLEAS - FIG 2 FIG Right lung of Case 1 showing a tumour compressingcompressing the lung substance 203CP41759 FIG Cellular structure oftumour ofCase 1. and cosin ^ 40 Haematoxylin FIG Sections of lung from Case 1 showing asbestos bodies ^ 40 Haematoxylin and eosin 264 BRITISH JOurnal of INDUSTRIAL medicine ELCTRONIAY FILED - 2023 Oct 18 12:13 PM - FIG On July 21 1954 RICHLAND FIG On July 7 1955 - COMON PLEAS PLEAS - 203CP41759 FIG On March 3 1956 FIG On July 3 1956 FIGS 5 6 7 and Radiographs showing development of tumour in Case 4 ELECTRONICAL Y diffuse pLEURAL MESOTHELIOMA ELECTRONICALY ELCTRONIALY FILED - 2023 Oct 18 12:13 PM - RIC-HLAND FIG Right lung of Case 14 FIG Histological sections of tumour from Case 14 Haematoxylin and eosin ^ 24 COMON She was referred to the West End Hospital Kimberley returned to the Kuruman district in 1943 where he PLEAS on July 19 1954 because of dyspnoea and right chest worked as a farm labourer until his final illness discomfort of acute onset The chest radiograph He was admitted to the West End Hospital on March 3 showed a loculated pleural effusion at the right base 1959. He had been well until July 1958 when he - coloured fluid was aspirated which on examina- became aware of pains in the right side of his chest In tion was found to be negative for M. tuberculosis but addition he had a slightly productive cough and short- contained mesothelial cells arranged in acini At ness of breath on exertion Chest radiograph on thoracoscopy in Johannesburg on August 11 1954 March 9 1959 showed obliteration of the right lung tumour nodules were seen on the parietal pleura Histo- field Asbestos bodies were found in the sputum 203CP41759 logical examination of the biopsy specimen showed a mesothelioma Deep therapy and active gold instillation in September 1955 caused initial regression of both the pleural fluid and nodules but did not arrest the progress of the disease She received a further course of Needle biopsy showed histological features consistent with a mesothelioma AUTOPSY right chest was occupied by a huge whitish tumour which infiltrated the mediastinum 203CP401759 ray therapy without improvement and died in January 1957. The liver was enlarged and nodular before death but no necropsy was done Figs 5 6 7 and 8 show the radiological development of the tumour in this case extending through the diaphragm onto the superior surface of the liver A coloured effusion was present in the left pleural sac but the left lung was not affected The mediastinal cervical and aortic abdominal lymph glands to the level of the renal arteries were infiltrated with tumour Case 14.-S.S. a Bantu male 40 years of age born 1918 was an asbestos miner He was born in the Kuruman district and as a child often played on the asbestos dump near an asbestos mine He subsequently worked with asbestos for several years being employed at an asbestos mine weighing fibre from 1938 41 In 1942 he worked on a Witwatersrand gold mine but In the right lung it was found that the tumour mass had infiltrated along the interlobar fissures The lobes of the lung were compressed into three small segments Fig 9 On histological section a papillary type of pleural mesothelioma was seen Fig 10 which had infiltrated into the lung parenchyma in some areas There was marked lymphatic spread throughout the 266 BRITISH Journal of industrial mediCINE lung substance Numerous asbestos bodies were present haemoptysis He was referred to the Johannesburg ELCTRONIAY in the air spaces and occasional bodies and fibres were seen in the interstitial tissue The lung itself was markedly atelectatic Evidence of asbestosis was observed in the left lung General Hospital for investigation The chest radiograph showed gross pleural thickening with a basal pleural effusion on the left side He was admitted to hospital and on June 10 1957 a thoracoscopic pleural biopsy was taken This showed the features of a meso- Case 15.-S.S.V. a white female 42 years of age thelioma On June 24 1957 an attempt at decortication FILED born 1916 is a housewife who lived on a mine near was made The left upper lobe was stripped easily but Johannesburg and was treated for tuberculous pleurisy the grossly thickened pleura was so adherent to the for six months It was only after the histological lower lobe that the attempt was abandoned Sections of - diagnosis of a mesothelioma had been made that her the pleura confirmed the diagnosis of mesothelioma 2023 previous history was obtained In addition it was subsequently learnt that her father Case 22 had been He died on December 13 1957 Oct born on the asbestos field and had a long mining history The patient was born in the Griquatown district and Case 16. A.N.Va. white male 50 years of age born 1906 was a farmer who was born at Griquatown and went to school at Kuruman She spent most of her went to a village school near an asbestos mine From 18 youth in the asbestos belt She has lived near Johannes- 1914-16 he transported asbestos in donkey waggons from 12:13 burg for 20 years . In March 1958 this patient developed right chest pain and rapidly increasing shortness of breath She was Hay to Prieska During these journeys he often slept on asbestos bags In 1914 he worked in an asbestos mine for a month PM admitted to hospital and 2,500 ml of slightly blood- The patient became ill in December 1955 with vague stained fluid was removed from the right chest A substernal pain and dyspnoea A sided pleural - thoracoscopic examination was carried out on July 27 effusion was diagnosed and he was referred to Mr. J. K. when a small biopsy was taken but this consisted of Bremmer in Pretoria There was no evidence of malig- fibrous tissue Bronchoscopy was normal and no nancy in bronchial and scalene biopsies Some apical RICHLAND neoplastic cells were observed in the bronchial washings pleural thickening and a dense homogeneous opacity at M. tuberculosis was not cultured from numerous speci- the base of the left lung was seen in the radiograph on mens of sputa pleural fluid nor from the bronchial August 3 1956. Thoracotomy Mr. Bremmer in washings She was admitted to a Johannesburg nursing February 1957 revealed a thickened nodular pleura - home on October 16 1958 with a large mass on the left diaphragm A mesothelioma Radiographs then showed massive thickening of the was seen on histological section COM ON right pleura with fluid in the right chest At thoracotomy Mr. Dennis Fuller the parietal pleura was 2 cm thick hard as rock and stripped with great difficulty from the chest wall The visceral peel stripped fairly easily from In April 1959 he was examined by Mr. J. D. Visser in Kimberley who found small nodules in the subcutaneous tissue over the neck and chest A large firm mass was found in the thoracotomy wound and a mass was present the upper lobe but separation became more difficult over in the left hypochondrium There was generalized PLEAS PLEAS the lower lobe where the peel was thicker During the decortication a necrotic mass was found in the paren- lymphadenopathy and numerous nodules were present on the tongue Chest radiographs showed the left pleural chyma of the left lower lobe At the base confluent with cavity to be obliterated He was one of the few cases to - the diaphragm and perhaps the mediastinum was a hard develop widespread metastases craggy mass which could not be removed Histological A biopsy of one of the subcutaneous chest nodules sections of the specimen revealed an adenoid form of showed a similar appearance to those seen in the original tubular mesothelioma Subsequently three specimens specimen from the pleura The patient died on May 22 of sputum were examined for asbestos bodies but none 1959. No necropsy was performed were found The patient is still alive April 1960 but her condition Case 24.-D.G. a white male 32 years of age born 203CP41759 is deteriorating Case 22.-D.A.B. a white male 68 years of age and a farmer was the father of the previous patient Although a diagnosis of pleural mesothelioma was made in 1922 by profession an accountant was born in England but came to South Africa as an infant He spent his early childhood in Kuruman and left at the age of 7. He later qualified as a chartered accountant in Kimberley In 1944 at the age of 22 he had been discharged medically January 1957 it was not until July 1959 that details of unfit from the army because of a left pleural effusion his exposure to asbestos was obtained Neither then nor on many subsequent occasions were He was born in Griquatown and went to school there acid bacilli found either in sputum or pleural fluid He worked in Kuruman Postmasburg and Griquatown His only subsequent contact with asbestos was the until the age of 62. Between 1918 and 1932 he worked auditing of the books of an amosite mine in the as an asbestos miner underground and was mostly in Transvaal charge of blasting Between 1932 and 1944 he farmed in In September 1953 he complained of sided chest the district but returned to asbestos mining from 1945 pains and shortness of breath A radiograph of the chest to 1952 showed flattening of the diaphragm on the left side with In January 1957 the patient consulted his doctor be- obliteration of the costophrenic angle and thickening of cause of sided chest pain with cough and slight the oblique fissure He was seen on numerous occasions diffuse pleural mesothelioma ELECTRONICAL Y 267 ELCTRONIALY FILED - 2023 Oct 18 12:13 PM - FIG On September 11 1956 RICHLAND FIG On August 23 1957 - FIGS 11 and Radiographs showing development of tumour in Case 24 COM ON from 1953 to 1957. A radiograph taken early in 1956 showed the development of a left superior mediastinal shadow which enlarged progressively Fig 11 and later and these have revealed that during the relevant periods Cape crocidolite was exclusively in use He was first seen on March 14 1959 complaining of the development of diffuse nodular pleural thickening cough pain in the right chest and recent onset of breath- PLEAS on the left During 1957 similar but less marked changes lessness Three pints of fluid had been aspirated from developed on the right side Fig 12 He consented to the pleura and cytological examination showed the biopsy in June 1957 and at operation a diffuse pleural presence of malignant cells The radiograph showed - malignancy was present Sections of the parietal pleura only were removed and the histological appearances were those of a mesothelioma He died on October 6 1957. A necropsy was not performed marked pleural thickening and pneumothorax On March 17 1959 a thoracoscopy was done The pleura felt thickened and the lung was collapsed and immobile Several biopsies were taken These showed the presence of a mesothelioma The underlying lung 203CP41759 Case 30.-G.F. a white male 50 years of age born 1909 is a storekeeper with a history of industrial exposure He has never been near the Cape Asbestos Fields He was born in South West Africa and lived there until showed the presence of asbestosis He was treated with nitrogen mustard pleurally and his condition temporarily improved When last examined he complained of increased breathlessness the age of 21. From the age of 21 to 26 he worked in a factory in the Cape as a maker and fitter He Discussion In 1924 Robertson denied the existence of 203CP401759 volunteered the information that he had worked con- tinuously with asbestos lagging pipes and boilers He remarked that the removal of asbestos lagging from old pipes created a very dusty atmosphere and that he would cough a lot at such work Between 26 and 32 years of age he worked in a factory in Johannesburg in a similar capacity but was not exposed to such heavy dust con- centrations For the past 20 years he had not been in contact with asbestos Enquiries were made from the factory in the Cape as to the nature of the asbestos used primary malignant tumours of the pleura and considered them to be secondary in origin Since then on the one hand Willis 1948 1953 and Smart and Hinson 1957 have supported Robertson's views while on the other hand primary neoplasms of this nature have been described by many authors in recent years These include Tobiassen 1955 in Sweden Belloni and Bovo 1957 in Italy Godwin 1957 in the United States and McCaughey 1958 3 268 BRITISH Journal of Industrial mediCINE ELCTRONIAY in Britain Evidence in support of the mesothelial origin of these tumours can be found in the tissue culture experiments of Stout and Murray 1942 and Sano Weiss and Gault 1950 The variegated histological pattern of tumours The amount of metachromatic substance in these tumours has varied considerably This we think is partly due to the fact that until recently we had not appreciated the solubility of hyaluronic acid in aqueous media and the majority of these tumours arising from the mesothelium of the pleura was were fixed in 10 formol Further Lison remarked on by Klemperer and Rabin 1931 Such a variation is appreciated when the multipotentiality 1953 states that the metachromasia of hyaluronic acid is optimal at a concentration of 10,000 and FILED of the cells lining coelomic cavities are considered gradually decreases at higher levels When the high - 2023 Maximow first demonstrated this feature in 1927 Novak 1931 stated that the mucosa of all parts of concentrations that Meyer and Chaffee 1939 1940 found in their tumours are considered this variation Oct the M^...llerian canal and the germinal epithelium were derived from these cells Keasbey 1947 in metachromatic properties seems to have been partially explained In addition with the great showed that in the embryo the mesonephros differences in the histology of the various lesions it 18 metanephros Wolffian body genital ridge and all would be logical to expect certain tumours with a dependent urogenital structures are derived from the mesothelium marked adenoid appearance to secrete more than those with an essentially glandular structure 12:13 Campbell 1950 considered the presence of both Three of the five autopsies performed showed epithelial and mesenchymal elements a major evidence of peritoneal metastases In the other two PM diagnostic feature In describing the histology of thoracic spread was observed in one case to the - 11 of these tumours McCaughey 1958 demonstrated other lung and chest wall and in the second to the that either the epithelial or the mesenchymal element mediastinal lymph glands and pericardium Biopsy RICHLAND might predominate He classified his cases into the following four groups Tumours of epithelial character tumours of mesenchymal type tumours evidence of metastases has been obtained in two cases one from the omentum and the other from the subcutaneous tissue of the chest wall while a third of mixed type and tumours of anaplastic type patient developed an implantation nodule in the - Using McCaughey's classification on our series thoracotomy scar which showed a similar appearance COM ON of tumours the majority are as in Campbell's series of the mixed type Of the remainder a few showed the papillary tubular structure of the tumours of epithelial character and there were several of the to that of the previous biopsy specimen The first recorded case of carcinoma of the lung associated with asbestos was described by Lynch and Smith 1935 By 1955 according to Doll a anaplastic type One case had the appearances of a total of 61 cases had been reported Included in PLEAS PLEAS tumour of mesenchymal type but even in this case primitive tubular structures were seen these cases was one mesothelioma Cartier 1952 mentioned two cases of diffuse mesothelioma from a Apart from the original case all the histological Canadian chrysotile mine A further three cases - diagnoses were made on biopsy material Three of were described by van der Schoot 1958 Un- these biopsy findings were confirmed at necropsy fortunately no indication is given in the literature In the remainder we have had to rely on clinical regarding the type of asbestos to which the majority and radiological examination to exclude other of recorded cases of carcinoma were exposed primary sites of malignancy However discussion with management and medical Following the work of Meyer and Chaffee 1939 officers of two of the factories in which the majority 203CP41759 1940 the possibility of demonstrating hyaluronic acid in these tumours both chemically and histochemically has been considered as a diagnostic aid Both these investigations are still in an early stage Harington 1959 of the cases reported in Britain were employed suggests that most of these workers were handling chrysotile asbestos Wagner 1958 The possibility that some of these people may also have been exposed to crocidolite dust cannot be excluded Preliminary results of the histochemical experi- Attempts to produce tumours in experimental ments show that there is metachromatic substance animals by exposing them to asbestos dust have been in both the stroma and glandular structures of the made Vorwald and Karr 1938 were unsuccessful tumours This metachromasia can be reversed by Lynch McIver and Cain 1957 succeeded in pro- incubation with testicular hyaluronidase This ducing tumours in mice but lung neoplasms in his material stains strongly with Hale's 1946 colloidal control animals were far too numerous for the iron method The periodic acid Schiff technique results to be considered significant On the other has given variable reactions These results are not hand Schm^/hl 1958 working in Druckrey's specific for hyaluronic acid but are strongly laboratory has been able to produce sarcomas in suggestive of its presence rats This has occurred after subcutaneous and diffuse pleural MESOTHELIOMA 269 ELCTRONIAY intraperitoneal inoculation of both asbestos fibres and dust He states that mineral asbestos was used but does not name the variety In our series of mesotheliomata histological evidence of asbestosis has been observed in eight Table 3 Eighteen of these 25 cases were born in the vicinity of the mines and two arrived in the district as infants Of these 18 people 11 admit definite childhood exposure to the dust and two others were exposed industrially in later life In of the 10 cases in which lung parenchyma was in- addition two patients with childhood exposure later FILED cluded in the specimen examined No lung tissue was present in the biopsies from the remaining worked in the asbestos mines Three cases arrived in the region at an older age but were employed either - 23 cases It was only in the four cases that came to on the mines or in transporting asbestos A further 2023 necropsy that large sections of the lung tissue were available for examination In all of these specimens three of these 25 cases have had industrial exposure and in only one case do the relatives deny any Oct evidence of asbestosis was found At first it was thought that the presence of exposure to asbestos dust The four industrial cases are significant Two numerous asbestos bodies fragments of fibre and of the patients were lagging locomotive boilers and 18 dust immediately below the pleural elastic laminae one was lagging steam pipes A man who was an in these specimens might have been significant in the pathogenesis of the tumours However it is upholsterer by trade was employed in making proof clothing from 1939-1945 As far as can 12:13 PM more probable that this distribution is a result of the marked atelectasis Similar features have been be ascertained these people were never in the Griqualand district These findings tend to add - observed in atelectatic lungs of asbestos miners in support to asbestos being the common factor in the which no mesotheliomas have been observed development of these tumours and to counter the RICHLAND Pleural fibrosis has been a common finding in cases of asbestosis and in some cases large pleural plaques measuring up to 1-0 cm in thickness have been seen These plaques which were first described suggestion that there may be some other environmental cause in the region of Griqualand West If asbestos dust is a factor in the occurrence of these tumours similar cases might have been ex- - by Gloyne 1933 have been observed following pected from the neighbourhood of the Transvaal exposure to both amosite and crocidolite asbestos asbestos mines in the Pietersburg and Lydenburg COM ON dusts In these cases of benign pleural thickening no evidence of stromal metachromasia has been observed In all the histological sections of pleura examined districts where crocidolite and amosite asbestos is mined According to Vermaas 1952 crocidolite and amosite occur in the same seams in the Pieters- burg district As can be seen from Table 1 amosite in the cases of these mesotheliomas and in more is similar in composition to crocidolite In the past PLEAS PLEAS than 100 cases of asbestosis no asbestos bodies fragments of fibres or dust have been observed four years the lungs of 24 cases of asbestosis from the Lydenburg district have been examined In beyond the pleural elastic laminae - this material two cases of carcinoma have Three patients from the Kuruman district with been observed The one was in a white miner with clinical and radiological features consistent with 19 years service who had an carcinoma those of diffuse pleural mesothelioma had markedly arising from a bronchus The other case was a abnormal cells in the pleural fluid These cells Bantu miner who had a peripheral tumour No showed no specific features to distinguish them from service record was obtainable in this case Only cells originating in secondary malignant pleural one case of asbestosis has been received from the 203CP41759 deposits nor from the grossly atypical cells some- times seen in malignant pleural effusions As no biopsy or autopsy examinations were obtained in these cases they have been excluded from the series The pathological evidence for associating these Pietersburg area All of these men were actually employed on the mines at the time of death the majority having had a relatively short service Our findings suggest that mesothelioma occurs 20 to 40 years or more after exposure to dust Until com- tumours with asbestos exposure is not conclusive As previously stated only in eight of the 33 cases has paratively recently the mining in the Transvaal has been on a small scale and there were no settle- evidence of asbestos been demonstrated Of these six had a definite mining history and one had been ments in the vicinity of the mines The lungs of 20 asbestos miners from the Cape exposed to asbestos while lagging steam pipes The Asbestos Field have been examined in whom no other case was born in the Kuruman district and mesothelioma was observed One autopsy specimen nothing else is known of him until his arrival at a consisting of three fragments of lung showed Witwatersrand mine at the age of 23. In the asbestosis and an carcinoma Radiological remaining 25 cases we can only present circum- features of asbestosis have been observed in many stantial evidence of exposure to asbestos dust miners from this region without any suggestion of 270 BRITISH JOURNAL OF INDUSTRIAL MEDICINE 1 Case No. 2 3 Year of Birth Age at | Diagnosis TABLE 3 DIFFUSE PLEURAL MESOTHELIOMA ASSOCIATION WITH ASBESTOS 4 5 6 : Born on | | | Fields Race Sex Asbestos | 7 Asbestos Exposure 1 8 Diagnosed on Biopsy 1 1920 K B + 2 1913 +42 MXD + 1902 SA ** + 4 1896 w ** + 567 1925 www *** | +++ 567 1903 www *** +++ 567 1920 www *** +++ 8 1894 a MXD F + 9 1905 29 MXD M ++ 10 1909 49 W M ++ 12 1898 808 MXD M +++ 12 1910 808 B XXL +++ 13 1909 808 W XXL +++ 14 1918 40 * M + 15 1916 42 * & + 16 1896 8 * M + 17 1911 48 MXD F + 18 1920 38 B + j 282222 1922 53 MXD + 20 1906 53 W + 282222 1912 - * + ! 282222 1889 8 = + 282222 1895 63 = | + 24 1922 38 = M - 25 1899 26 1895 2 1904 * 1899 38 1913 38 : 1909 = 1913 23 1908 38 W F _ i | : * > | = ! i 8 ;> M = 8 > - . 44 >> - 8 >> = | 44 > G i 9 > - 23 1890 | 59 > - Other history unknown until came to the Witwatersrand at the age of 23 Mined asbestos from 1930-33 left area at the age of 27 Lived whole life in a location near an asbestos mill Lived on asbestos fields until the age of 5 worked in asbestos warehouse 1916-20 Spent all his working life in the vicinity of mines Lived all her life in the vicinity of mines Lived all his life in the vicinity of mines worked as a miner From the age of 24 lived in a village serving local mines often visited mines watched cobbing outside houses Whole life spent near mines digging wells Lived at the mine from age 7-17 years played on dumps and in mine as a boy returned to assist from age 21-25 Whole life spent near mines miner 1931-33 Lived near mines until the age of 17 miner 1927 Lived near mine until the age of 21 played with fibre as a child Whole life spent near mines miner 1938 41 played on dumps as a child until Daughter of Case 22 lived at mine until age of 20 went to school near cobbing sheds Went to school near mines transported asbestos 1914-16 till Lived on major wagon route till age of 15 several subsequent visits mines miner Whole life in the vicinity of the mines miner 1945-58 Family lived at mine miner 1938-1959 Spent whole life in village on wagon route to Kimberley mines until Lived in the vicinity of mines until the age of 16 dumps often on as a child mines miner Whole life in the vicinity of the mines miner 1913-32 and 1945-52 Lived in the vicinity of the mines until the age of Lived in the vicinity of a mill from the age of 1-7 played on the dumps as a child Lived in a mining area from the age of 10 to 18 years after 1918 spent whole life in same town as Case 24 Mined and transported asbestos from 1929-33 as overseer Born in North West Cape transported asbestos from 1920-24 Lived whole life on farm in mining area from the age of 12 transported asbestos 1916-21 Maintaining locomotive boilers 1931-45 Maintaining steam pipes in explosive factories 1930-40 Worked as fitter on railways maintaining locomotive boilers dates unknown Making asbestos blankets for the Air Force 1939-45 No history of exposure to asbestos - - + +1+ +1+ ! +1+ + | ++ : ++ +++ +++ +++ + + + + + ++ ++ + + + + -- + + + ++ ++ + + + + KEYS Column 4 Race W ==== White MXD = Mixed Coloured B ===== Bantu Column 6 + = Born on asbestos fields = Not born on asbestos fields 0 == Unknown Column 9- + == Necropsy done = Necropsy not done * = Only small fragments of parietal pleura submitted at autopsy for histological examination 9 10 11 Survival Histological from Necropsy | Evidence of Symptoms Symptoms Initial Asbestosis (Symptoms in months + + 8 +* I 8 _ _ = -~ - SE +* - 11 - - 5 = + 24 1 55 1od f 55 | 1+ 13 12 + 1+ | 1+ Still alive - I ? + - = : i - + - 0 - 9 alive Still alive 42 3 + + 22 - + Still alive - ! ~ 8 f -~ _ 16 i - 12 _ - : - _ 48 i Still alive - - Still alive ; ! _ I | 13 : - o H 15 | alive _ - alive ; - _ 7 : alive - + ; Still alive : - - 60 _ - 78 - - 78 Column 10 + = Positive histological evidence of asbestosis = No lung tissue submitted O Small fragments of lung tissue but no evidence of asbestosis ELCTRONIAY FILED - 2023 Oct 18 12:13 PM - RIC-HLAND COMON PLEAS PLEAS - 203CP41759 tumour formation However pleural involvement has been a common finding in these cases Hurwitz 1959 It is possible that there has not been a sufficient lapse of time after exposure for tumour development in these cases Further the factor of individual susceptibility must also be con- sidered We wish to record the great assistance that we have received in this investigation from the medical prac- titioners of the Griqualand West District and the diffuse pleural mesothelioma 271 thoracic surgeons and pathologists in Johannesburg Pretoria and Durban Martiny O. Proc Transv Mine med 1956 Offrs Maximow A.1927 Arch 76 McCaughey W. T. 1958 exp Zellforsch J. Path Bact Ass 35 63 517 Chaffee We thank the Secretary of Health for permission to Meyer K. and publish this paper Gynec1950 ELCTRONIAY Robertson1940 Obstet 317 REFERENCES 1939 Proc Soc exp Biol N.Y. 42 , Novak E. Sano J. biol Chem 133 83 1931 Amer J. H. E. 1924 J. Cancer Res 317317 Weiss E. and Gault E. S. 826 J. thorac Surg M. 783 Belloni G. and Bovo G. 1957 Acta med patav 17 367 Krebsforsch Brit Campbell W. N. 1950 Amer J. Path 26 473 FILED P. 5 Cartier 1952 Arch industr Hyg 262. Contribution to the Schm^/hlD. 1958 Z. 62 Smart J. and Hinson K. F. W. 1957 Stout A. and Murray M. R. 1942 J. Tuberc 51 319 Arch Path Chicago 34,951 discussion 34,951 - Doll R. 1955 Brit J. industr Med 12 81 Frood G. E. B. 1915 Memorandum on the Asbestos Industry in the Tobdiearssen Cape Province Report of the Government Mining Engineer Union of South Africa pp 76 82 1938 2023 Gloyne S. R. 1933 Tubercle Lond 14493 J. Path Research Godwin M. C. 1957 Cancer Philad 10 298 802 Wagner Europe 1958 Hale C. W. 1946 Nature Lond 157 Africa Europe Oct Hall A. L. 1930 Asbestos in the Union of South Africa Memo- 1955 Acta path microbiol scand Suppl 105 198 van Schoot H. C. M. 1958 Ned T. Geneesk 102 1124 Vermaas F. H. S. 1952 Trans Soc S. Afr 55 199 Vorwald A.C.J.1958 195K8 arMemorrandum J. W. 193o 8n Amer Pneumoconiosis 49 Research in Europe Submitted to the C.S.I.R. Willis A. 1948 1st ed and 1953 Pathology of Tumours randum no 12. Geological Survey of South Africa Harington J. S. 1959 Personal communication Butterworth London 18 HigginsoJn. and OettleA.G. 1957 Acta Un int Caner 13 949 Conference Hurwitz M. 1959 Proceedings of International of Experts on Pneumoconiosis Johannesburg Feb. 1959 Churchill London In the press 12:13 Keasbey L. E. 1947 Amer C. Path Arch Klemperer P. and Rabin C. 23 871 B. 1931 Path Chicago Addendum By the end of June 1960 a total of 47 cases of 11. 385 mesothelioma had been identified In 45 of these PM Lison, Vilars et Cytochimie Animales pp 332-337 a possible association with exposure to crocidolite - Gauthier SHimsittochhimie Mclver Lynch K. M. and W. A. 1935 Amer J. Cance2r4 56 , F. A. and Cain J. R. 1957 A.M.A. Arch industr has been established peritoneum In one case a mesothelioma Hith 15 207 of the peritoneum was present RICH- LAND THE JULY 1960 ISSUE COM ON The July 1960 issue contains the following papers Decompression Sickness during Construction of the Dartford Tunnel H. V. Hempleman W. D. M. Paton and D. N. Walder By F. Campbell Golding P. Griffiths A Comparison of the " altitude " and " " pressure Syndromes of Decompression Sickness By PLEAS M. de G. Gribble PLEAS Phosgene Poisoning Caused by the Use of Chemical Paint Removers Containing Methylene Chloride in - ventilated Rooms Heated by Kerosene Stoves By W. B. Gerritsen and C. H. Buschmann A Study on the Acute Toxicity of the aryl Phosphates Used as Plasticizers A. N. Worden and J. P. W. Hughes By H. F. Bondy E. J. Field Aerosol Inhalation of CaNa E.D.T.MAosatil by Workers Constantly Exposed to Lead Poisoning By LJ Petrovi~ M. Stankovi~ M. Savi~ evi~and D. Poleti A Biochemical Study of the Urinary Protein of Men Exposed to Metallic Mercury By J. C. Smith and 203CP41759 Agnes R. Wells A Simplified Method for the Estimation of Nickel in Urine By J. Gwynne Morgan Clinical Bronchographic Radiological and Physiological Observations in Ten Cases of Asbestosis By G. L. Leathart The Measurement of Occupational Mortality F. D. K. Liddell Observations on the Occupational Life History of the Coal Face Worker at Two Collieries and D. S. Kerr By O. P. Edmonds The Assessment of Electroencephalographic Changes and Memory Disturbances in Acute Intoxications with Industrial Poisons By B. Chalupa J. Synkov^and M. ev~ ^>k Book Reviews A number of copies are still available and may be obtained from the Publishing Manager British Medical Association Tavistock Square W.C.1 price 17s 6d