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FILE NAME State of the Art Literature SAL DATE 1930 DOC SAL010 DOCUMENT DESCRIPTION Journal Article - Asbestos Bodies in Sputum and Lung ee! ASBESTOSIS LYNCH AND SMITH 659 JAMA 95 1930 ASLEST^ SIS LODIES IN . AND LUNG SPUTUM iq ENNETH M. LYNCH AND M.D. W. ATMAR SMITH M.D. CHARLESTON S. C. Mestosis has of comparatively recent time assumed Gition of prominent and perhaps peculiar inter- s the field of pneumonoconiosis and occupa1. discase While the asbestos industry is than two thousand years old it is only In the past few years that it has assumed ment place which it now occupies in dustrial arts Until recently asbestosis Been assumed to be essentially silicosis and free silica has been thought to constitute Kangerous factor in pneumonoconiosis as inted with the relative harmlessness of two cases are apparently the only records of autopsies in cases of asbestosis up to that time In a companion article McDonald recorded a histologic study of the lung tissue in Cooke's case and stated that the appearances were practically the same as in another case the sections of which were in the possession of Dr. I. M. D. Grieve of Armlay Leeds McDonald found in addition to well marked diffuse interstitial pneumonia chronic bronchitis and emphysema anthracosis and extensive tuberculosis certain peculiar foreign bodies in the alveoli bronchioles and er dusts A has come to attention within the last three our years that there is a peculiar character- in the state of asbestosis not found in sili- > and it is our purpose in this report to dome dome data that lave come to hand since erkan medicine thus far has no report on jeculiar condition and to the end that wunae interest may be stimulated in its in the extensive asbestos industry It is ated that a further report of our studies made at a later time ~~ Cookerecorded Cookerecorded an autopsy on an ker who had been exposed for iN, the last five years intermittently sing extensive fibrosis of the lungs and e tuberculosis At this time there was Fig Asbestosis bodies in sputum magnification about 950 diameters in the lungs only black particles from 3 to 393 ons in length of various shapes interstitial fibrotic areas This is the first recorded -observation of these objects which have since been called asbestosis bodies There was considerable tain Ne Asbestosibsodies in sputum concentrate reduced from a photowith a inagnification of 705 diameters disagreement among zoologists botanists and others as to their nature McDonald advanced the hypothesis that they are portions of asbestos in process of alteration and absorption by hydrolysis with the passing of the silica into a colloidal state and later into a gel In 1928 Simson followed with a report of four autopsies on asbestos mill workers in South Africa the first being done in 1926 without discovery of the asbestosis bodies at the time One of these subjects worked for twelve months in the mill developed tuberculosis and died ; the second worked for two years in the same mill and had a prolonged pneumonia during this time This patient had neither tuberculosis nor pneu- monia at autopsy but fibrosis of the lungs The length of exposure of the third and fourth patients is not given but both died of lobar pneumonia and both showed very little fibrusis In the lung tissues of all of the four were found golden yellow segmented struc- tures with rounded ends 1927 se r * Cooke again recorded this case and cited which a patient who had worked in an for ten years showed at autopsy pulmonary spicules of asbestos in the lungs These = . MF Departments of Pathology and Internal Medicine Medical the State of South Carolina WE WE Fibrosis n^ Lungs Due to the Inhalation of Asbestos 31 12 147 July 2n 1924 W. Pudeionary Asbestosis Brit M. 3. 1024 Dec. 3 The descriptions and illustrations by McDonald and Simson make it clear that they were dealing with the same object and that it is the same as we have found in the lungs and sputum of asbestos workers service of In October 1929 there occurred in the service of one of us K. M. an autopsy on a patient dead of J. McDonald .: Histology of 1025 Dec. 31 1927 4. 4. Simson F. W Pulmonary M. J. 835 May 26 1928 Pulmonary Asbestuan Asleitons Brit M. in South Africa Brig AP CTE ote?! Ab ere = ee We ok Lo Ss Sho nerPe; Cen HIM De Lebn weee De aTGamewee par MMT h, ORIEL uaa!a= Vee os meteSan,ames Se Mpehaoeie abDyee ook Wen ee U1 Na enisald ons sv i PRT yi we WEAPONS: '. ET SPLIT EeeTee ge ORT ware <P sad arens a ORI Towa CE me me Sa te pename kk Cc oS Re da TT we bi tow pk 1S a eos. y pee elyr ar a wert ~ om Sene ; 660 ; ASBESTOSIS AND SMITH Jour M. : AGG JU 1930 a gunshot wound This was a Negro man who at the time of his death was a worker in an asbestos mill having done such work for a total of twenty months during a period of about three years At the autopsy there was nothing of significance beyond the gunshot wounds of the chest and abdomen In micro- scopic examination of the tissues however the peculiar bodies under consideration here were found in the sec- The peculiar bodies in the lungs of these two patients were first suspected of being mycelia and spores of a occupation fungus possibly dispergillus On investigation of the subjects and after we had learned of their the reports of McDonald and Simson were encountered and identification with the objects observed by them was established It then occurred to mind that these bodies should be numbers found in the sputum of occurred in considerable such patients since they in the alveoli and bronchi and that sputum examination might prove to be an important measure in the diagnosis of asbestosis * Consequently search was made for them in sputum of asbestos workers from the clientele of one of us W. A. S. Specimens of sputum were examined by direct wet smear preparation and by examining the concentrated sediment of sputum after digesting it in 10 per cent sodium hydroxide solution kept warmed to about 80 C. until the mucus was well digested and the mixture watery . The first sputum examined came from a man who by clinical and roentgen examination had active fibro- caseous tuberculosis and also a moderate grade of pneumonoconiosis He had not worked in asbestos for approximately a year but had been previously so occupied for about ten years The sputum contained great numbers of tubercle bacilli Asbestosis bodies Fig pigment Asbestosis bodies in lung with phagocytes and black granular pigment within alveoli in pneumonia reduced from a photomicrograph with a magnification of 475 diameters tions from both lungs in alveoli associated with fine black granular pigment and mononuclear cells some being intimately associated with large mononuclear phagocytes in the bronchioles where there was also the black granular material and some mononuclears in the alveolar walls which were thickened and within the connective tissues of the interlobnlar areas along the course of vessels and bronchi Here there was a de^-nite were readily found in direct wet slide preparations and in large numbers in the sodium hydroxide digest con- , centrate It was at this point that it came to attention that such sputum tests had already been made In 1929 Stewart and Haddow and in 1930 Wood and Gloyne showed that they could be found by digesting the sputum with equal parts of concentrated antiformin and examining the centrifugated deposit Subsequently we have found the asbestosis bodies in the sputum of two other asbestos workers and have failed to find them in one , - increase of fibrous tissue and much accumulation of black granular pigment At about the same time occurred another autopsy on a Negro man who was working in an asbestos mill at the time of development of lobar pneumonia from which he died He had been in this occupation almost continuously for a period of four and half years In this case also it was in the microscopic study of the tissues from the autopsy that the asbestosis was dis- covered gross examination revealing only massive pneumonia of the whole right lung upper left lobe Sections of all parts of the lungs from this case revealed the asbestosis bodies There were great numbers of them in the alveoli the walls of the alveoli the deeper pleural tissues the bronchi and the inter- lobular framework tissues and they even occurred in thrombi of veins and in the peribronchial lymph nodes Associated with them was much black granular pigment in the alveoli interstitial tissues and lymph nodes and in these nodes was also a heavy deposit of yellowbrown granular substance of the same color as the NS ONp yy Nuyay J ves a ee in Fig Ashestosis bodies with phagocytes and in ubrous lung reduced from a photomicrograph 250 diameter black granular pigmon al with a magzocat~-na asbestosis bodies Mononuclear and polynuclear giant cell phagocytes were prominent in intimate connection with the asbestosis bodies in the alveoli bronchi and veins They contained much of the black granular material in the alveoli and bronchi also In the walls of the alveoli and bronchi and in the framework struc- tures where these bodies lay was a cellular increase in fibrous tissue The second patient was a Negro woman who had worked in an asbestos factory from 1918 to 1924 but not since She had no evidence of pulmonary disease and was under treatment for syphilis None of the asbes1004 asbes1004 5. Stewart M. J. and Haddow A. C. Dentonstration of Pr Asbestosis Babies in Matend Obtained br Bories Hung and in the Sputum J. Path & Duct 32 It Asbes totem 6. Wood W. D and Cloyne H. X 445 March ) 1930 172 Jan 1929 Pulmonary Pr the Pr .Laced  rs . pecumonoconiosis The Ladies were found in direct unconcentratedunconcentrated wer preparac- losely deposit anong uit tij iai tij iai ... ... ... 1. In the sodium hydroxide digest concentrate they There sparse and were not as long as those found in the winry 1 interval rene closely together or they may be separated by an interval at which the needle central ae se The crystal may be seen ' sputum was mucopurulent Sometimes the shaft is covered by a homogeneous non- third patient had not worked in asbestos for segimented deposit ximately two years He was employed in an In the lungs they are of the same forms but their Thestos factory for seven months in 1924 and for full length may not be seen and they usually out two years from 1926 to 1928. He had active shorter appear The size of the body varies widely in length brocaseous tuberculosis of the lungs with tubercle and thickness with the length of the filament and the lecalli in the sputum but no condition distinguishable as amount and uniformity of the deposit No extensive 2 first sputum was mucoid in measurements have been made in this study but in the aracter and insufficient for concentration No asbes- lungs they have been measured from 12 to 100 microns is ladies were found in direct wet unconcentrated long and from 1 to 12 thick the shaft being narrower preparations In this specimen were large numbers of than the ends In sputum they have been measured $ Hast cells with fine black particles and numerous fine from 1 to 12 microns thick and up to 140 microns long like crystals The second sputum was muco- Asbestosis bodies do not take the ordinary tissue and rulent A few asbestosis bodies were found in the sputum dyes and they have been found in their natural . ditam hydroxide digest concentrate but none in the form in one of these cases in slide preparations of inconcentrated preparations These sparse bodies were sputum stained by the ordinary carbolfuchsin method Ivetally small but some were long and thick for tubercle bacilli The fourth sputum examination was done in the case : si white man who had worked in an asbestos factory for about fourteen years but not since 1926. He had @ advanced fibrosis of the lungs thought to be a late stage af pacumonoconiosis without any evidence of tuber- z sis and was in a state of advancing cardiac failure 'g Examination of sputum on three separate occasions by bin direct and concentrated preparation failed to reveal any asbestosis bodies 3 It was anticipated that this case on account of the ength of exposure and the extent of pulmonary disease could have the best opportunity of exhibiting these lies but this expectation has not been realized The tient had been exposed within about a year and They may be stained on the slide by the prussian blue reaction for iron the heavier and darker brown bodies taking a deep indigo blue this shading to a lighter color in proportion to the heaviness and darkness of the yellow substance This reaction indicates a considerable iron content to the deposit This iron has been thought to signify that the asbestosis body comes from the iron content of asbestos Since the material is evidently a deposit within the lung on an asbestos crystal this does not appear to be a satisfactory explana- tion It is suggested that the iron content if not the whole substance of the deposit is of tissue origin probably from the blood ved by far the greatest number of asbestosis sues in the sputum but the other two patients had not lea more recently exposed one had not worked in for about five years and neither of these two aslestosany distinguishable evidence of pneumonoconiosis gaveit remains a subject for further study as to the rela- tion the occurrence and time of duration of these LadiesLadies in the sputum to the extent of exposure to asicstos dust and as to the state stage of asbestosis or sither associated conditions in relation to their expul- -on the sputum Clinical Notes Suggestions and New Instruments THE EXECUTION OF ROBERT HYDROCYANIC ACID H. WHITE BY GAS EDWARD E. Hamer M.D. CARSON CITY Nev State Health Officer Robert H. White was executed by hydrocyanic acid gas at The asbestosis bodies are quite variable in size vlor and form but generally are of a characteristic the Nevada State Prison June 2 1930. A study of the heart and respiratory action was made at the time of the execution Aructure In the sputum from which they may be 4% Petter studied alone they have a central filament of a parent slightly greenish tinged needle crystal This taken to be an asbestos crystal On this filament se deposited in varying quantity nodules blobs and 7 egments of a homogeneous refractive substance vary4 from shining light yellow or greenish to a a Bowles stethoscope being applied on the bare chest wall over the apex of the heart The tube leading to the ear pieces on the outside of the prison wall was connected to the stethoscope while the prisoner was being strapped to the chair This was at 4:36 m The heart action at that time was 10 strong and regular The gas was started generating at ; 4:37 A small At 4:38 the pulse rate was 120 regular and strong inspiration was taken at 4 3734 at which time the Pte The mahogony brown depending on the thickness of Amities deposit Amities In general this deposit occurs more on the Amities usually in a spherical blob here tapering ward ward the middle of the filament which may be hare Ne ng the appearance of two clubs or baseball bats prisoner indicated that he smelled the gas At 4:38 he took a very deep inspiration turning his head toward the gas He gave a spasmodic cough his head fell forward and he became unconscious Following this first deep inspiration there was a complete stopping of the heart action for fifteen seconds wed hm small end to small end Again there may be a Ae the deposit on the extremities and the shaft have sere cilindric cilindric cilindric deposit of segments or disks of uniform .regular size giving the whole body the appearance hell The clubbed form may break in the ye and leaving two indian forms Again the me metrical ... Way metrical ... Way ... deposits extremities may be the seat of more or less of globules piled up to give a architectural figures The segments or disks After that short period of time or at 4 38the heart again began to beat in an irregular manner continuing thus for fiteen seconds when it became regular and strong thus There was no apparent loss of power in the heart action Aiter this time times for two minutes the heart became slower heating 100 a minute at % and eighty times a minute at 4:44 At 46the heart beats were distinctly regular but becom- ing very weak The last heart beat was noted at 4.47 4.47 Respirations during this time after the first deep inspiration inspiration inspiration were convulsive and irregular ... ... rot VES Seme e of ee resr. . 1 a rra% SIAL tae ee ey _ ET s- e re Sree tmn ET es NET arryn ane OI -po wert ee Ae Sey Sa SES SRN NS RI RE UOT) FR eR De OCP sy REY pee OUTPane rey TOFE Se a SORA ne # dntW Sr DW ome ee on WS aie ee I RE Oe e De