Document yreL16qJBqnD9pgKkmQbqD77n

FILE NAME: ZD^D/ DATE: DOC#: ^D/ DOCUMENT DESCRIPTION::Z^Z^Z Z^ZKZdZWZ I :;,-- ~j \\ 0 SURVEY OF SOME CURRENT BRITISH AND EUROPEAN STUDIES OF OCCUPATIONAL TUMOR PROBLEMS WILLIAM f SMITH, M D. NEW YORK );' Jl;;\E .2~. \<)50. l ,atll'd tn>111 \:,.,, \11rh. 111tl1 tl1v "liJtct 111 '1-1t111c: I'. O nduab e11,t:,aged in the -twl; "i "Cl 1111at11111;,! tu1111Jr pr1ol1k111' alo111;11l '":" 11- ence gained ir"111 the"" 1bib pr11 1 1 le-' t lie 111arenal 111- th1~ t ('\" 11 l a11d 1J'. !,,~ F resented under tlte fullu11i11g liead111g': 1. Sl,alc Oil I I. Petroleum II I. .\1;be'lu' lV. Dye>tuffs \'. Source,. ol Stali,t1cal l)at,1 II <htup,it111al l.lltr 111 ( 11:ct1 l. 'll.\1.1" UlL Skin ca11cer' l!1 parafti111,1<1rh.n-111 tl1t :-it11tl1-h ,\iak-1;1111111-t.. "nt. ll<Jtec! as lung ago a,, 1~76. 111 \'1.2.\, a detatlt cl -1ud1 .. i Ll11' p111!ilt'111 1111! ' rt t"1r' ui (1_; cases was prepared by Dr ..\\e~arnler :-,,11tt' at tlw nr1ul-t ,,i the -.,,,,tt1-h -kil"-111 industry. Ur. Scott ha" co11ti11uec\ 'itlll' tl1.1t t11111 tr l'l'H' a- 111trl1,.d 1,,11-ult.,11r 1"r the indu~tr} and as 11nrf-s ph1"ic1a11. l had the 111111in~\ "i 11-iti'l'..; !1i111 at tl1e PumpheVi\011 \\"urks in :\lid-Caldn. >ll>ila\1(1. 11l:nl' r al:-IJ kLI the p1e<1-ure lli meeting }.lr. .\l<m .\ndersu11. the \\(irk 111:L1ug-er. l Jr !~. ~1111tl1. t!w ch:ci cl1t1:11"t. and :\[ r. Crom hie. work~ chemi~t. :\Ir. l r"rnlm ;.:a 1e 11,- :L t11ur 11i : 1." 1I.: t. lle stated that oil ,hale, the rnatnial takt11 11ut ,,i the '"tnl1. h r"t"1l,.\ .tl !tl>' 1 t" 1900 F. at four plant~ in Scotland to _11tld naphtha. :11111110111a .u11! r rt1'.c '11. 11ir products are then sent to the J'1unpli1r,\011 \\ .. rk-. \\herl' t!H1 ,,1, 11"'"."''"' 1.. yield ga~ohne. indu~trial naphtha~. paratlin. dit,el 1111, r"h.". a111: .1L1d -ii1dc:" - 1 :.t paraffin i~ obtamcd l1y a pre~~mg operatin11. tu J,e ru11111ll11l<"I "11 1n 1111.c dt'1"1 1 later. Presented at a rnerting ot the Canrn 1'"'"111.. 11 \. ..1111111llcL 111 '\,.,., \ .. ,-k I let l~. J'I'" Dr. Smith is A,sistant Proi""ir, lkp1t111<'11t ,,j l11du-tn.d ~led""'' f',,,1 1,:.1. ld t'.dical Schuo 1!. :\ e11 \'or!, t'niver1h'. Travel c'Xi"'ll'("; lllVtllved II\ the prqu1:ttiu11 oi tJ11, '(II\>) \\lrt lllc'l "-' ~:.l .l' :\nna Fuller ],tncl and from :\'cw Y<>rk l.'ili"'"'t! 1. Scott, .-\.: On the Uccupatiun Canc<'r .. 1 tli, l'.11.dlin an.I I ld \\ 1rkl'1- "' t\1, .,, Shale Oil Industry, British !>.f. J. 2: I lOK-1101> 1 I kc 'l l l'J.22. ! Ill' (Jn 1111.111111 I J, 111.1. , the Parattin \Vorker, of the Scotti-Ii Sl1ak l ld lndu,tl\. \\ill! a llc,a1pt1,.11 "' :! .' ~" AScdioepnttiefdic aInfdrpothrte. IRmepsuelrtisal OChatanic1e1rcdRea,t1ot;hine h!'h,'1.r1i1rndl.icLrnE-d-.<a1l1l.t1,11l1'.!lt.1:.1l1.11P l'011\ .<Tql".''.c.,1,,\,\:, '"<llidi l'1tl1l.:1l- ' 1 Occupation an<l H~alth, J~epnrt No. 21-2, lnternauo11:il l.al1our (Hr"' I ,c11c1 .. !li..:.~ 2. A Brief !)c~cription of the ()perati1111s of the ~cottl'">h ~lull' {)ti lllllu:--t:_\, :---~j 1 tt1-.11 1 ' :- Ltd.. Glasgow, 1948. (32 pp.) Dunn(. l work has 1 he madt l dermai:~. which l s: (,\~[ 1 varyir. g :--iz The eryd,._ CASL ~ in (a5e l. scars, the r :urns and 1_ 30 yean. l CA~f: 3 They were :o year; a.1 CASI:: 4 1 four kerat1 sk111 over tJut Dr 5< irorn an c. iad1n:i; der The !attn ()b<.::rn.:tio1 The) werI the paraft. 11ad dcvel1 th1;, case , tn l).f: en1? ,\\[ 1 almorm: In th1s oil worh or '.trlll~ t1:111or~ The in the 11 renH)\e1 i ~ al\0>1 <;c;i l 1 " paraffin! lal.orer . I ex1stlll~ U!i experit Leei; b ca~e oi large 11 that <l SMITI-l-BRIT!Sll AND EUROPEA.\' 7 IJ.l!()N !'f(()fl!.f:.l!'i 24'J He then covered hi" arm again 11ith the lllliricttin;..'. "ii, li111 tlii- 1i1w rulilwd it ,,ff with cotton soaked in a colurle"::i technical j..'.racle ,,f 11li1t1 1J1l. .\Ji,1"t :tll till' tlw1r1...,1ence \\as thus removed. llllly a little remaininr.; i11 :t 1t'r; i"1 ., .11t r1d li:iir 1,!IH Jt.,. 1)r. Cruickshank stated that he had nnt i"und rln1nat1li- l r1 -:iii 111 J.11111:111 ,Jrn1 ,1ashed reveatedly 1rith \\htte oil. prr11irlerl th<: .J,i11 \\;h l11:dtli; t" -tr .11tl1. ( a,1' ,.f irritation occurred 11 hen the nil 11a, apJlli1rl u11d<..:r drc."111;_;, I 1!rtl" r <11 -n1--1<,11 i \Yays to protect the okin againot "j];., j, c"n\:1imd 111 111:. -ll111tJ1 ti "> 11:1:,. ( Jil" Dr. Cruickshank and l'rrJi. Squire ha1e 1k-cr1L1rl 11-:1rt- tii:1'. 't<'1trr<:I 1,11 Ilic ,kin of 33o/c oi a v,rrJUp nf 1.lo machmt-trJrJI 1,1,erat1,r, 1:-.1,1,-i t -1,1 ::: ., i :1 '1t1t1n;c 11! which they iound capal1lc 1Ji i11rl11c111.i.: ,kin tu11111r, in :11111 .d- I l."1\ :1:1 lJl>"rtunity to examine many excellu1t ph"tngr<qJI.- r;f :Le-< 11 1 ' 1 >1111 .i :l.t 11 "' .were rlat. 11h1te kerair,,t.-. 11tlll:r~ .1ere ra1-erl. n1~1,-r a1 ,\ 1,i_ "1it l I l:-1,,,,~,,1 ! ~ections 5lJ1.wed the ~tte~ VJ lJt jJ<tpil]r,:11a-. ! J1:c :1:1:. L:" :t _, r<,:;,1c:t1:11r. -' 1 J..<,n- <A \\'hich I -aw. Phriti.:ra;,)> rii h, :irrn~ -f11,1 ( 1! !:.::i :t rl,; 1 .1.,:tl! l:l)i1::,. J. \\'. l 1rui. (rp;h. at the l-r~l\r:r .. it~. 11f ( 1hL<!' . ::lt 1 11.!/'!'~ '1) .,.r 1 :. ~' chen11cal nature i tiH: carcin1~t1 1 ... :: tl.,t !J<:tri. :1 1 1i,~ 1 1 1 J r/ r.'! ' i' -1 ;1: r. Dirn1~11:.d~a:1~. l'rii. 111,k \'a:- ;l.-.;:< ir<i;.: <i':~,r_:,i.' t,:i il l l( J :; ' ( ,- ll .f but the \\-crk 1' ac; 1:c.-uiLe11 .' :11,. \, iii ;i .- ::.r:~. I Jr ' (;. ! ~ t j '...'. ,'' Yt:.1..':n1n1 rli::~,l1ati'Jn. chr 1 ,~, 1 ~it1 ~r:;Jh:. 1!1 ;:: 1:'. i ;l; 1. ,I~ 1 n aci<l. tht': h:.:c: j ... ,.1.dt~2 a. c!~r.' ~ 1 : < .' ir.'1 :: i'" '.! '''( J' ' :1 >": ,: .. - s g-e1:eral pri)c1::1Jun: i- :1, t-'-;t~:ilt t!,t ..1.. 1 - d alumira cr:<t::rnb. ;,: l 1.::t;te '":th f"::rr.:eet'!l L11.. J ,', I' '(, .s n~-.tall11:: c"mprJrn~r~-. a- . tt v.;r,e: c: 1-.t .. ,,; ,1_: () "'' 15 ha~ Leen 1 i!Jt~i:11c:1 ill .. Jrr1c:c.::.L ~ E.1iL~: 1., .. , ...:._ g ,- han,J. The1 h::\\ e ";.:le.J tr1 ~:.C: '.::11]'. rt:-:: :S ~1.rn111atics \\'lti1 .:cl!~i:.!r:c c..c~-~ !"t~'-i: 1 :-:.:t : ': . '.r(/ ~--. n rence spenroc:copy Dr. I r-::t::c~. -_.; -:-.., <_ -.~-t:~ :;-- o abn s:-iicl to ban: ::tz~~c'.1e'l ;~.-.:~Cf:-,'.,_::: .. - .;i:~.1:. :s ~'nc at Birn:1:(:h:,:11. I ::.:_ :; .:: 1'.tr -_:_;._._ ;.l ::. t:..n 0f lJenzp:rt::1e .... ~., r'.r:"l 1:-:-.-.-1: '.'J '.": :. .. , 11 .:;f !(t ;11;::;,~..-~ '.a}y :--a:Jr.. ::~ Lt ~- . :.. .~.:~ ;lr ~ .. 1:. : 11e :_;>:'ti.sh Ju:irPl: 1, 1 (,:,:,1. _.,_:; (... ... c.: . ~:.<e5-S 2.~ Ct :r1tc.r.;; 1.: :~--~,--.:.)1:.:: . :1; 1 ..::-. tlr.pb?-~lZt: tLt :.tc'-i :r~:- ~.: 1 rt:- ~'-::.r~.: -: --: ... :-, - _ .. : s. \ .. . . ... ,__ . I. : - :'.._ -- - ial ,Je , <: ,,: "-~~t:~i1-::- >l:.-:- ,_.t!.\.t:" >~:;.-.cc:~_: Us ;.,., whch ~'ha:t: :: : .... ::.':':~:- .:.:. ~ or .\ .11\.l. 11~f t~a:a l .h:i_: ' \ t \~~:.: : :--- ~ :_:-< ~ ------ th(. :_~~10f )~i!:e;-c..: 01:. B:--t. _.. I~~-..:-: :\1-;.. 7:1-~ ~':' 1,, .\n"":i.:11 Rtprir: r_1! t' 1. t-"+-.:c: Ji" -~~c .. ,... ~tajc~~- ~ 5t4t1cnc:-..- u::=i(t'. :'_J..:~. I ~I .. (, L :-] r:~i::: ,) .I 250 INDUSTRIAL HYGIE.\fi .I.VD OCCC!' ..J'/fn.\.1!. .\IF.fJICJ.VF Dr. :derewether referred to th( grner11111e11tal npurt ptdili;..hed in I<J.3() by hi1,, published self and C. \V. Price.17 This n:port sho\\ ed that aLe~to,;i~ devel"perl m !'fJ'; death.' 0 men employed 20 or more years in the industry 17 i. and that in van1Jt1' gri1u1.- ' [11 add workers the percentage in which asliestosb de\eluped varied directly with tlw rl ~. j 169 pers<, ness of the process in which the groups \\ere uigagerl.' 70 These findinc;, :('1 tho~e rnc 1t the adoption of laws requiring ventilatiou of a-.lie.;to;.. wurk rooms in Great Br'.:. (8.3~') (Asbestos Industry Regulations. 193 I;. Detailed speciticat ion~ for ,afet;. er;: gro~, <.r 1 ment are contained in Factory Orders. )<J-P. Jt ~h11uld lie noted that there 1- ; a5be,trtil mining of asbestos in England. Hence. the Briti'h figure-, refer <inly to indirn:: I 1(1 Ill([!, engaged in weaving or other manuiacturing (Jr ha11dl111g J[H:rat1ons tr i!f: ,: :1 A first problem was whether the apparent :1..,..,oc1ation of lung canctr and a'-!,1 incide11c1'. tosis means merely that workrnen'.; eornpe11sati1Jn pr<1cedure~ iun11ck 1! all ':. -,ex rat1r, diseases into one group. Thi~ pos,.ihilit_\ C:lll1H1l ill' ouppurted. li111\e\t r. i1:r ' It \\ t I; such high mcidence of lung cancer has Ileen io1111d Lil ca~es of '"1licu-1-. '' l11cl1 :1: likewise reported to and reYiewed by the l'ncu111uc"11io-,i~ lfoarcl. Ca11cer 1,i th: lum.:, \I ithr,ut ! cr)11V,-,C:::i or the pleura "as noted in only <Jl (1.32~{ 1 (rf t>.l'K.+ ca-c.; "[ ~ilic11.'i~ nc11rde<! ir.-:11 1930 through 19-t(."1 The incidence of ci.nur \\a, thus 10 ti1nL, ,c;n;1t"r i1~ ;1olw- totic lungs than ill silicotic lung~ Data u11 till' a1 crage agl' at deatl1 111 tlu, -.1i:,~nt1c i11r the g found trr group \\ere not gi\en, liut the same rep(Jrt li-tcd :L -l'rie~ r1i l .11.)/ -il:c11t1co whr T \BL.' 1.- died at an average age of 58.2 year:-. c111q1artd '' itb a hr:i11p 11i IUI :1,!,e,t,,t:c- 1ho '. died at an average agr r;f +7.5 year,. Thcr"i11rl" tlw i\:11n1:mt in' .1:;1.-r 111cidt11<:t in the two di~eases cnuld nut lie attril1uted t11 death ,,i ,i11c11t.t- licirt tlw:. rtad1ed tl:e "cancer age"; in iact. the silicotico- 11.,_,1:1,1 ap~war tr.> lian 1iz1d c;na'.er "J1pur tunity by a full decade tn: ield cancer: :-;1111ilarl_1. the ;.11T;1.:..:1 dllr:it;<"1n 11i ern1io;111ent in the"e t\\"n grnnp~ could n1it accuum i11r the di:frre11u- 3-t J 1t:ar, to1 th- IIron P(Jt' silicotic,; again~t 1-+ 'J year~ for the asbestotic,. l,_'r)ul :-:iton :\ measure of the rate at \\ hich lung cancer occ11r,; 111 the general 1" 1puiat11111 or A~be England anrl \\"ale~ can be iound in the l~egi~trar l~eneral's ::it:ttt-ti( al l\e11r\\ ( 19..J.<)). E111ploy111g the data g1\en 011 pai_:c, ,) and 1-+5 11f the l\e11e1 npe c:111 calculate that L3<J;;c of all deaths m tl1e three year, irurn 1~1-+J t11 1cq5 11 r:re rt:p11ned as due to cancer of the lung-, the bronchus. ur the pleura. It is ,,[ intcnq t11 11ote that the percentage oi deaths attributed t" lung cancer in the genn;d P"J"tlati111 is almost identical with the t1gure oi 1.32'./c inr the: fo1ding oi lu11g cancer in a large group of silicotic lungs. Documentation of the ca,e~ Pl cnexbtent lu11g cancer and a-l1e"tu,io- liccca111e 111' nt>xt t>ndeaYor. For this purpN'. I l'isitcd l>r. ~. Rrn1dhn11se 1;J,1:-m :it tile l110-t1 tute for Social ~ledici11e in ( lxiurd. Dr. Clu_, 11e', 'tudic" of the 11,ul.1dn.c:1 ''" de~crihe' thi- elel' continue in his ~c ~cattercd The to~t~ gn tu 1w rt. i:: asbe~tusis are \\"ell known.'' For 111a11; _1car~ lw lia~ rt'<:eiYed 1t111;.:o llr rn in\' c:. matter:, of con1pe11~atiun. I lr. ( ;iu:nl' ;.:c:11non,,J_1 ;.:.11 l' 111e pe11111-~111 t<' cit1 th clata in Table 1, which he ao-~c11il1led iru111 li111;_:-, ti:at he ['tT"1ma!h l'";u111;1nl 111 t1. gros::-. and n11rro~eupirally. 11 i,, tll lie hopt'd th;1t a full an-"u1n ,,i t!ic111 \\ill I li. (a) ).ifercwetht-r, E. H. A., and Pru.:c, l'. \\ : R1.'fhl\ t Pl! Ft!ci.:t-. ut \:-h1.. .. tt1 .. l )tbt 1 11 t' Lungs and Duot Supprc"ion in the :\slll'ol<l> l11du,t1y, l.undun, !fj, ~l:l)C't' , ~t.1::'""''! t lti .. 1930 (summanzed in J. Indmt. Hyg. & T"xic"I. 12: 117. ]<J,1(J, ,111d 111 Tuh,llJ, 15:tN-81. Jr.' ll8, and 152-159, 1933-193-tl: (/1) ibid.. p. HI. T.ihk 3. (I 1h1d. p. l~. T,1hl., ~ 18. Gloyne, S.: The ~orbicl \11atum:- and lli,lulug\ ul \,hc-t<"'' Tnh\'rl' 1<' 14:-l-l.;_.;_: 493-497, and 5.50-.558, 1932-1933 .. \,bc'stthJ>. lll Siill"<>"' and \,hc't"''' trltl<'d In I .1111.t. \ .I New York, Oxford L'niver~ity Pre,,, l9.1P. pp. 225-2-l-l. _.\ .... '.1 - ., . SMITH-BRITISH .i.VD EL.l<OP;:.-1.V 1T.1/0R l'IWHIE\l\' 251 !m- published from a manuscript that was m preparation at the ti111e fli 111-, recent ' of death.19 of In addition to the m:iterial of Table l, Dr. Ciloyne ab11 examined the lungs oi sti- lt_i9 persons without pneumocuniosis but employrd in the '<tlllc '<"t oi irnlustrie:, a-; to rh.i,;e included in Table 1. :\tnong these. he found J.+ who had priman lung cam-er am 1 ~ 3% ). The lungs of 11 asbestos workers whn had n11 a~lll',w-,is (either m the lip- i;::oss or microscopically) were negati\e ior carcin1n11a. The 17 Gl'it''i fif cancer in no ;i,1,estotic lungs (Table 1) were about equally cli,tril111t('r\ lit t11c1n 111111 and \1011ien als 1 : J men, 7 women). whereas 111 the 110rmal populat i011 i11 Fng land the ratin j, said t<~ be 4 men to every woman with cancer oi the !1111g-,. I11 .tdditi"n to thl higher .es- incidence of cancer in ashestotic lungs. Dr. Glo! ne ielt that thi, dilYerl'llce i11 the t> st se'( ratio afforded evidence ior an occuational iactor. no It will be apparent that the lung cancer rate uf ~.3'/c innnd in tlw IIJ'.J 111d11tdttab ue without pneumoconiosis aml the rates of 5.1 to 8.'>'7( in the gnU\'' 1vith p11t't1111u- 1gs rnnioses other than asbestosis are much higher than the rate 1i I.Jr' i e-.t i111ated Jm for the general poptilation on the basis of death certi1icate' and tlil' rat\' of 1.3.Z"i ~s- found from pathological examination of the lan.~e group )i ,jJicf1t1C-. pn1 i11u~ly ,tic ho 1 ABLE l.-!11cide11ce of Prinwr_\' l.tt1lfl (,11Jccr i11 t,i,,11rs;. rift / '11111111 11r.-.i " /'11, '""''' .. 11iosu ho I Data of S. Rot>dft,111s1 (;/,,_,.,,,., !Ce --------------~- - - - - - - - - - - - - - - ,ed )r- Oreupationul Group T11tul :\111lil>tr '\1111tl1' \\ltli P:i11PU\' I.11n'.! ~ .i11t 1t f ', I 'I ( d ~ t' \\llh Piitnat) L1111!! t '11n(t'r Irou and ~rl:'el workers ................. . Pottery workers ............... . Coal miners . . . . ...... oi 8toat:"tlll\SOilS . . . . . Asbesto::, \\ orkPr~ '" ,., :' 'Jh 111 1-li! :.\V an dtscribed. It is thus probable that the higher rate~ retlert cl1 >-.er ,tt1<h I)t,pite ed this elevation of the base line iur compari,,011, the rate 111 the aolil'to't' group .te rnntinued to stand out. Dr. ( ;Ioyne :.tated that of tlw rntal rn1111lier "1 lune: cancers m in his series, 7.So/o were di"covered only on micro"cnptc ('X:t111111attu11 Till''-' \\'ere a 'cattered through the variou" groups. The type of cancer 20 and the degree of asbesto,.is i11 tht' l / ca"e" uf the ashes- 1\.' ti- tf"ii:,, group are given in Table 2. Only one individual I:.\! S ) had evidence of of tulierculosis.. In the 922 ca::ies co111prising the wl1ole of the ]H1eu111"cot1insis ,group \Table 1), 20'/o showed tuberculosis. Dr. Glo: ne made a opl'cial ~earch for pre- eancerous changes in ashe~totic lung::i awl did not detect an;. De-;'lua111atwn oi hrlllirhial epithelium was occasionally seen. but squarnnus cell 111etaplaoia \\a,; not i1,,11u! "ave in the cancers thcm:;elves. It will be noted from 1 al>le 2 that tlit: degree 1'l A brief posthumous publication has appeared ( C;ItJynt:, 5 R . P11et11nul ""'"'i' .\ His- " .d Snrvt:y d Nt>crop'y :\[atcrial in 1.205 Ca'e'. Lancet 1 :810-XU ]<J51: ,,;i, 1' 'I l1rnu~h the c-ourtc'y of Dr. K. F. \V. Hinsnu, of the London C!ie,t I f... p1t,d. ,,e ha'e ' ".' d 1.,Jics fr.,m six lung' of Ur (;Joyne\ serie:.. Tins matenal e-..amincd liv Dr Dougl.1s 1, .\ uidcrland, of Memorial lluspital. :\'ew York. Twu case'i (C. \\'. .incl J \\' 1 das;,1fied as f., '111. "'"u' cell cancer hy Dr Gloync were interpreted as termmal bronchiol,1r ( ":theolar cell") c;,r, 11111ma by lJr. Sundcrlancl :", 252 JNm:sTN!.-l!. l!VC!F.:V!:. . I.Vii UCCU!'.-!Tf()NA!. }/ED/CINE 'z-, "oefxtaesnbseisvtoes"isininevethrye cgarsoeuepxcoefptcaonncee, rowuhserleunitgswawsa"smrieldc.o"rdeTdheasest"immoatdieornatoef" thoer degree of asbestosis was made in every instance hy the same observer i Dr. Gloyne). werTe haesse1m7 bclaesdesovoefr caoepxeirsitoedntoflu2n0g }ceaanrcser( 1a9n2d9 atosb1es9t4o9si)s. sAtulldiheadd btyheDir re. xGpolosyunree itno acsobneisotroms apnrcieor wtoith19g3o2v, etrhnemyeenatr mreogduleartn10enxsh. auTsht evemntaijlaotriiotyn dweevriceesemwpelroeyaeddopatteda ptylpaenst haarendmlionrge l(bhriotdtleesitahnanblCueanaanddiaSnowuthhitAe farsibcaensto(sa.lshoenbcleueg)ivaesbreissteosto. mBootrhe tdhuesste. At least one patient (J. l.), hmH;ver, was stated to ha\'e heen exposed only to Canadian white asbestos. I next 1isittcl Prof. E. J. King at the British Post-Graduate \fedical School in London, where T had tlie opportunity to examine protocols relating to the lungs TABLE ?..-Patlzological Fi11di11!fs in lO llnz and 7 lfo1111'll with .lshcslosis ana' Lung Cancer (nata uf S. Roodhuusc (;1oy11c) P11tfl'nt (~!iilc>11 nei;rl'e of \sl1e~lo'ii.9 1ryt,e of (Jnnecr .\ Ci. \. \\'. p ll. ,) (, .r. r 1; .II E.T ,) \\' (" 11 I p C Ft~ll! :1lt.o1 ' E.\. teasi re E\ttD~l\'f.- \fudera re )JOdt!lUtP- )!od0ra te )!odi>ru te .\lorkrc1te .\lu11t..rate :\lodt~l nte '.llild "Oat Ce.I" "Oat Cell" Squinno11~ Cefl Srzuumulb <1el1 Squamous l'ell Squumou> l'ell SQUlllllOL.~ Cell Squ1:1.111ot. s Cell SquamoLJS Cell "Oat Ce!." fl ~ L. II, :r.;r,. (')" ' _If I" ~ Ii. If Exten~h e S4uamutl'i Cell E'<r1..a..;1\e SqUHll!ou ... l'ell 'f(11lf>ru re Squamuti" L'ell ;I .\luilPI ate s(luamotH Lcll )lod1r .t tt: "Oat ( 'l'l! ){(l\Jer,1 ce "Out l'ell ' )[udt1 a tt .-\dc1wcHr. rnomu ------ ------ - ------ t: "i 11 itHh iduab 11 ho had l1ee11 er11pln)cd 111 a plant using Canadian 11 bite asbesro,. The pathol"g icai de~crip11u1h \\'ere made Ii; Ur nf a:,f,estn'1' 11trc C. \'. Harrison. \ arying degrees tl1(' k ,hlwot1llc noted lll lung,, .\11 8 of these ""at cell" 11 c lung,: there were 3 cancers. all among 111nlc) 11ttli l'.\.t('11,11 (' ancer 11as round in ad1c_"-,tosio; . . \naph-;tic car(lno111;1~ lung-; of one patient patie11b 1 11ml<' J. 111 011c ui wltom the 1rere degree of aslie,to~is was c!escrilied m two moderate; in c <itltcr the ;bill'-,to-,1~ \\':t' 111i11i111al. the The a~l1esthis ranged from extensi,e to rnod- ti erak i11 the 5 rclllai11i11g pat1e11ts in wh0111 thi~; disease \\'a-; not complicated by v. 2l'faJ!lccac.r-,.<s Counitl1ciu1e1xi1i1-,gte1t1l1tc !dttantga coai11lrlcrr. a(n~dio)tatsebesa1t1nd~isJ,>r.thHe adrreigsroene. oofneaslfiicnsdtsostihs atwains ab1 "weax~ten~.q;u;1avne1"ouis11 c5e,ll "im11 oIdIe.ra"toea"t cinell1"3,m a(nJ,d an"mapillad5"ticoriu"m2, inanmdiaal"deninoc2a.rciTnhoem cancer dlet Tlwr" "'"'"' no corn:lil.tion Jietween t qie of cancer and degree oi a asbestosis. in 1. 1'.11gIagJc]d('X1t11 vi1~n1;tuelld1fIa)crt1. 11r1inughe<1r~t1J\e.sVtoy,,erps.rothdeucmtsediricoaml oLflfuiceerasiboerstaoscommipnaendy inin l\E.hnogdleasnida -- .- -- ,, or f the ne). .Jyne sure 1pted at a hese lust. y to ol in ,mgs 1ttcer SMITH-BRITISH .-1.VD E('ROI'E.1N TUJ!OR i'lWJIJE\IS 253 or South Africa. Dr vVyers is the author of a valuable clmical studinyd1o1f,,atrsybeg,,rtoewsis.t0111 ated that asbestosis was recognized in 1900 an<! -1918. lJr. Wyers has that seen the only two deaths from He st major stature in the war asbestosis in people who of 1914 starte(l to work in the indu~try after 1932, the year when exhaust ventilation d(:vices were installed. In contra~!. he had ~een l 15 deaths l ')32. llc ieels that the regulations involving asbestosis in persons employed before safety conditions in the asbestos industry are then.:iure a great triumph in regard to of preventive medicine. The diminution in the severity oileths,eendeid~ea~~ceveinntyterinm~thoei the number of per"ons affected is further borne out hy 1932 the disease was acut(', with death,, ~rJ111etime~ occur- individual cases. Prior rn ring after two years of exposure. The disea5c as it is now ~een i,, much 1nore wa~ cfhoruonndici.n I1n7.thDe r1. 1G7 lcoaysnees eoxf aamsbinesetdostihsesleuenngbsyinDtrh.e\s\e'ye17rscapsreims, aarnydluhnisg pcaatnhcoelor gical diagnoses of the tumoro. have been gi\'en above. dividuals with a~liesto,is and lung cancer were exo,erl beiorc All of the 17 in 1932. According tu Dr. ~fen.\\ether. the a(lditlonal 3 cancer patients -.,t\ldietl h;. ope~ilically i11quirecl of Dr. Dr. Harrison were likewi~e :-.11"sed 11cf11re 1932. l ca~e,, oi c11exi~tn1t lung cancer a11cl a~lieo;tosi~ had been !\[erewcther whether n.ny reported in individuals whose expo.-.ure had taken place n1ly ~i11,:e ten::?. He ~tatcd indu~try that only one such rnse has been reported: case that oi a man empluyed in the might \\ell lw e:-.:\'eltcd a~ !'art of the between 1935 and E1..J.5. This single "normai" incidence of lung cancer in any group as lJ.rge as tl1at enip\uyed in the asbestos industry. In summary, then, I was alile to !ind ~1J111e inforrnati"n 011 a tntal 1,f :?1 persnn~ with coexistent lung caucer and a,,libtl)>l~. <>f wli11111 he 0111; r11 1 c \\'a-, additiuual \(J a man \\'orki11.:: patients mahing uncler conditions now prevailing in the mdustry. T <l in the .\nnual Report of the Chie[ lnspector of Fac- up the total of 31 dbcribe tories for the year 1l)..J.7 had all been exp11~ed prior tu l 1J32 and l did not attCl11)'t to locate autopsy protocols describing tbe111. onsensus of Dr. Gloyne, Dr. \\)er,, and Ur. :\lere\\'ether that the It was the c nature of the disease, asbestosis. as seen in Eng-land ha,, changecl so that H j, le~-, industry hao t:tken cr1mmon and less se\'ere in indivi1\uab whose empli\ nwm in the as the cun,e11sus that a lung t11mor hazard ionnerl\' place only since 1932. existed in this 111dustry lt in w Great 13rita111 lmt that the1e is 11<> evidence to .;how that such a hazard continl!es to exist under the working conditions now pre,ailiug. repnrt 1lr :\lere\1ether ~l1<1\\' It ~houl<l he further noted that in x1,u,1ire of l(i.5 years, tlH'. lfl..J.7 factory with a ran~e of l.5 to -\U y('ar.;. exi!:>ted i11 thl' 1\,at a mean c 1 L\<~ 0 a\he-;to~ 1\lirkcr:-. who snccumlie<I to lung ca1w11. T11diY11luab hC'g irn11ng ,.,;,Jii11g the 111t'a11 age at 1i,,i1 ..n1ploy1m1it 111 1111v.ht lht' 1')30's are tlwreiore only 11u1\ , lie l''-jll'cted to appear The :,izc 0 1 tl.1- i:roul' i, 11, 'L \,11<l\111. ' 1,w]\ t111111ir~ tl11~ fa< t tl1:tl 11 !ia~ th11, hr pnl\idc<\ ollly a srngle GL"L 1 <l\''>j,\('11t 1u11~ c:111n-r 1111\ :,111\ asli,,l1>si~ aq:11<"~ tl1at a11y l1111g tu111or hazard has \iet"11 <J<atl_\ d11111111,hc,J. :tt ~ig11itica111 <111111licr 11i ca='l'~ \\itl1 i1aol i11 1" 1i11t uf tii111-. \Vl1dlw1 tlH'J<' 1<1:ill lie anv d<layed app<:11a11t1 n111.u11:-. 111" to lw ~11. ":-.1'"1 i1111111.il .111clw- 1111 t\1(' ll "I .du111i11a in pi1e1111H1- Pnif. King dhlTilad c0n;o,,cs. In the ca-,,"' '''l't 1i11w11l:d :1'.lw~l"i~. alt1111i11a !1.1<1 1111 \1('llt'licial l'lll'Cl -. . . . ..:.-...(~ ... . ~- -~ ~l~ : ,. "l .:?."4 /.\'fil'STNl.IL fl)'(,ffi\'I: ./\/J UCCI P.-1.110.VAL Jll:IJICl.VE in <1tl1er of l\.1 u 't'rie;. oi tc,h. I o;a111111<'fl hi~tolngical sections oi rat lungs that lrnl recei1ed intratracllt'al i11~tillatio1b 1)i a:-lll'~to~ fibers. Studie~ oi these lungs han hefll puhli,,lwd.'' Proi. l(ing ,,1a1ed that he had found no difference in the re,pnnsf' of rat lungs to Canadian a;, contra!>tecl with l\hodesian fibers, nor had ,u1y epithelial changes lieen evident. :\ iew pulmonary adenoma,, were present in tlie slides ,,hown me. hut these turnors are known to occur spontaneously in rats and cannot he attributed to the imtillation of asbestos fibers. l 11 regard to tile animals chosen ior experimental work, Dr. Gloyne stated that he had found ralihits and guinea pigs more ,;usceptible to asbestosis than rats. He had nr it tested mice. ( ~ee "Abstract tii Discussion .. at end of thi~ paper for further comments on lung cancer i11 relat1011 tcJ aslwsto~is.) rv. DYE:STuFFS In the light oi the ernlence that bladder tumors are cau"erl liy beta-naphthyl- arnine in the d_1 e-1na11uiacturing industry, pr<Hluction nf this chemic-ii wa'> reportedly discontinued as oi _\pril. I<)_';(), l;y lmperial Chemical Industries and by the Clayton Aniline Company, the larg-e'it 13riti~li d) e producers. They are said now to make sulf11ni,- acid,, Ii) 'ulitJnating ill'ta-11aphtlwl a11d aminating it later. thus a voiding the ~tage at 11 hich lieta-naphth) la111i11e is produced This change in the manuiacturing pruce):- ~liould not onl_1 pn t(Tt worker-; 111 the plants lint a!oo remove the potential ha1.;ird 11i rli-;trilnttirn1 t1i irt>e lieta-naphthylamine as a contaminant oi iood d_1 es con~umed h1 the public. The rp1e,tirin 11 !wt her l1e11zidine pre,,rtlts an uccupational tumor hazard has long b('cn rlchated .. \ recrnt paper h) l~;1rsotti :llld \u;liani prc~ents an 1rnpre~si,e series oi ca-;fs of bladder tu11111r<; attrili11tcd tn lienrirline exposure in an Italian dye-works. ft i' cla1111ed that a rnajnrit: oi tlte patients \1acl not Ileen exposed to heta-naphth) ]an1111e. \ tr;rn,bti1lll 1ii thi~ Italian ~t11ck app(':tr' tn an accompa111ing L'aper.' 3 Dr l.\111wtlt l~:ik<'r. i tlil Ua1 tnn .\11ili11e Co111pany, ,\fanc'ie,ter. England, de,crilwrl txper1111e11h ,J1011 in;; that l1e11zirli11e 1helf 1s not carciPo'[enic hut that nwn t'XIH'-td to llrn11di11e txcrct<' i1 their ttrttlt' a h_1 droxylated deri\'ative, JJ 1-dihydrox1--J..-J.'-d1a111i11id1pl1t11: I. a cornpounrl "' illch he rle111nn~trated does enike bladder t1111111rs in rnic1>." ,\[ice 1\-crv g1n:11 rept'ated ,,ubcutaneou~ inject101h oi oli\e-oil ~u,prn,1011;. 11! ll('111H!i1H ur 111 11' ll\drox_, lated derivati1e 3.3 -dihyclrPxy--+,-J.'- d1arni11od1plw11_1 I. .\in(' 1111ct 11 ere :.;in"n tltc h_nlrox_1lated compnund. and bbdder pap11lrm1;h dl'1 ti111Hd 111 ti11 a11d a hladder carci1101na in one. Xo bladder tumors 11t1-c i"unrl 111 till' 1111n ~i1T11 llt'n1.idi11e or in cnntr"I a11in1als gi'.fn injections of oli1T rnl al01w. Dr ( ;crirgian11a 1~1111,..lr. l .ttcl, l 'niversity, Eugland. h.illdly ;umrnarized for 11H tlw curr<'11t 1111rk .,f her blH>rator~. The curious ability oi heta-naphthylamine '" call ltJrth liladdt'r t11111or' i11 111an and i11 dogs lint not in other species has led ttl the 11111 that 1t, carcinogenic aLtion 111ay depend nn so111e n:etabulic change "fl 2tl2ie. 1L'1unn).!g, ' Fol ./ l~:.tll1ll1v1gh,n.T.h/,oarnaxd l1~:acIH. 8\-1' '>:7.Ef]<ftl'4lbt. of .-\;be>lo,, and of .\sbe,tc.s aml ,\lumi111um, 23. Harsotli, .\I ..lllcl Viglia11i, E.: Bladder Le,1011s fr11111 Arlirnatic Am:n{'s, ~led. lavoro <10: l2'J-US I f11r l:t1g/"/1 tra1hl;tt1011 >l'<' .-\ \I .\. r\rch. Indt1>l Hyg., this j,,ue, pp 2.34). 24. l:akn, 1' The ( ;11t1n11ge11ic c"11tr.t <n1cru1n 7tl't. J 1:41i-51, 1950. Act1v1ty of Dihydroxy Benzi<lmc, Acta C mo mternat. 'l"" \ '. 2112 !\/>(~IN/ II /1) (,//!.\'!' ./.\'/) occr:f',/TIONAL .\/F.lJ!CIXE. _I uh. l'150. a rnnfcrcncc v. a~ held at Uxiord dealing- with cancer 111 rP!atio11 ti, :>or1ol"gical ;111d l'll\'Jro11111e11tal iactor:, 1lther than occupation. f'roceedrng~ oi r: i, c011int11c1 ha \e i>cl'n pui>li-,!Jed.'" \HSTRACT OF DISCUSSIO~ DR. P \l L C\Rrn:R, L'Annonciation, Que., Canada: I have been asked to describe our e''" en re at the- Thetford I ndustnal Clinic in Quebec. 11 here 11 e see men engaged in the a,[J, . ' mining industry in Canada. Table 3 pre>ents 1Ltta on eight cases of primary cancer ,,f the :.:1.~ ''hi ch 11 e kt vt tktertl'\l among 4,000 a>be<tn> 11 ork<'rs bdw<'en 19~0 and 1950. In addition to tho'e Ji,tcc! 111 the table, then was a case in which ther<' was quite a de1i1.i1 1 clinical and radi,,Jogital h1,tory of ranrcr of the lu11g but for which, unfortunately. 10 aut"!"' \\a .. perfnnned .\1-..u there \\ere three othe1 cases \\ ith a ~trung su ...pic1on in favor r,i a can1 ~ of tilt lung illlt fur whirh nn su!liurnt tlat.t are a1a1lau!e On anah-,inK tho<' data it oer:m' obnnus that many points \\otild need discussion benrc di!~'"'"' 11 ill he aide to e'tabJi,h a au-al reiatio11,Jiip between the,e patholo16cal fi11ding< "'"' tile d'\be"t' 1-. far tor. L it 1Ht 111or logical tn tl11nk that the ,;.111c causal fal'tur will produce the ,ar11c type "' t11n1i)r, ,tnd, tlitni<,n. "liy do \\C obsif\C ~ud1 a variety nf n1alig11;int tun1ors:. T 1n1.r 1---(-asn of Carci1111111a of t/i, L1wijs Detected . lmong 1,(100 :ls/;es:,;s 11 or!.:as J(}/O-i!J'I) Par!int I \ .\ I J I 1, r I. ,. 1; B \\ ,. Y1111-; c1f f- \}H1-.,l[fl' .in ~ -) ~1 11 I<> '''rie :_..lJ:. 111lh a :it '!1rtc Yt>.11'" in fI11l11 .. tl\' ,ll . !I 17 21, I. 2i..: \J..'!'e n r fJt'il!h ,q -) ~ ;1 .i ,,.Ii'! .-i'.J tj,j D0b;1e11 of .\-.Lf~to:--1~ \linimul .\1mnnal _\d\arnt>i '\Q[l(! -'lir.11nul Xuo1 ~VLt' Type of Tumor Bronchogenir cunwomn Brunchol!ernr carclncmu )lei ii a" t mu I b .11i1ho,.ircoma u1th tH1lmnna1y Int'tct:sta::-l' Bron1.. hvgt'n!(' 1arc1nu n;.u Pll'llf<ll Hlt'"'Utlll'll<Jllltl .. U ronrhogeni<' can:1nc 1iia B ront"hog1lllt' et! remuma (thul JCotorny) PlPural me~uthel1um,1 cases o s.ame cancer, worker great ' only o lioma. Dr. H cmom to exc In ,tiico Pne\11 a rea~ ~crie~ the t1 the L :eco,: D 0f lu l in tr had refe1 tane pho1 mer ...,t.111 1 1.ird .'\<1111trHht11.rP n 1>1 ....1'.l ... , ... und Uperauoo::" pul,\ 1... httl liy tbr \m111t11n :'>fr,l1d A":>uc1nt1un ' ' \ \ \,,.1., '!'111 J'.11:..t~l.,ri i urnp,iri\, 1'11.!} .. ug-~e-,t:-- tlie te1m :111",ottwlial ..;u.rt'o1n:i., Ii t 1 :i "'""" 11t "c: 111a1 a"11111c 111at tilt' a,Jiesto' fibers might produce a hr1mlh11ge111c car- Ltr14 ,flLl lll ,L"'l1e-.tc1lll' !1llJd11_\\l'.., \\1th ..,l)'..!.lliticant t:XpO:::.tlrt', tllcl\ rJtll}- t\\d Cfl',t'S of the ~{ries \\.Uu!<l ': ... l'nt .t ... 1'\Hlt11t~ 'a1at1'-l' till' l:t ... l., tit IllL''L1the!to1na J1r !)rnpho~aruJn1a and ca .... _."' \\tlhout '-"-i'q ... ')i't' cH ',\.tl1 1 it1t .1-..l1t.:-tc1-.,1-- d1J il"t lit1.\l' ri1t' tn11d1tH'lh 1cqu1red \. 1 ::i--.t 1t11111 L. 1t \' ,,p]d :111;.c,11 :lL'Ll."'.,,tr_, t11c1t r111 ..::t,tt'-..tH_; on (>1.._cuuational caicer ot tl( 1tl!'t!, !11 !,l ,11111 ic11\c, .,1111uld 111dll.1lt..' till p1n1"'t' \,1r1c~,:. tir luni.! cancer. \!:< i 111 11<1 \ I.! 1,. \, '' '\ "rk Ti1<' i!1ff, 1Lnce 111 tlw ireqtwncy ,;[lung cancer 111 per'll \l!I. d'JH,l11t1\ ,111~ ... ,i .... ~ 4 111p;1nd \\ll]1 t!1\. L1.n~L ~r()lljl rq- ~:!it..11uc-, p;unckr~ by th_:: Pneumu t'u/lltJ ... , ... ['..,,ii,! . . l t ! l l ' :rnp1L..,..,l\L H11\\V\lT, 11111 rn1i..:11r \\1nder \\liether ~he t\Vu gT(;urs had f)et" l \;tlllltl\ rl !tJ!" \ ti]( l ! \\1th \'ljLJ.il \. .lrl l .till !llljll l'-,-.l'd !iv th~ i.H.:t th:ll \\Len different gruup.-i ul 11111!.!" \\trt. ... t11d11d !)\ t!H .. ~rn11. "!"llVtr, !>1 1.;Jq~11t, the d1Huc11cl::.- in in~quency ot :\lng- canct1 \\Llt' 111wl1 ll.,, !1 \\l' it ... tnct 1i1ir .tttu1t1<111 -.nkl:. t11 l>r (,Joyne':. -.enc::., I an1 nut sure that dH r11 IT I' ["l'lll {"'I ,l: <' ., Ll t I" t ll ~ti!) .., 1l! Ill! H",1 !ll I 1111 \ I I l'.11, \1\\ \urk I 1111111. ! ,, 1111111>1!.11111,, d1,t11J)!tlt'lt lid\\tl'n ct:oe' ,_,f cl1111<,11' n l111~n11,di!t .11Hl 1.11.d ll111g t'.l111.vr. 1111 111h li.111d. ct11d {,l.,t''-' 111 which tl1c d1agnv~1s ')flung cancLr lid-.. IH'v:l 111:1dl a .. 111t1re 111 ll ....... ii ,111 111lHknt.d lind11a.!, :1t .n1t1111'l\', dll the other. T1c En~li~lt lLu111 l!1f .u1 d""''1(1at11111 lwt\\Ull 11111~ L,tncvr and ;i::-iiJc .. t11-.i:.. ha~ hLl'tl b,1~cd, tt seem~ to n1e, en~ t 1L1t.1 1d1t.111,1rl 1111111 lu1JJ!, tl1.1t .t J1.1tliulue1,t h.i- ,c:11cllld with a 1111crnscopP. wond('r huw man1 1 ::.1 ( lltl r<11lt ii11 <;tn(!rc1phicd P,tthfllng.) ;i!lll !)cnH1~:r;iphy ot (J.111.:er. . ' 11:I2/-t,1.l.. l 1FIJ ... I .-. ..._, on to f this 'f'~ri :~tt1s lung tinite rnpsy 1ncer ~fore and SMifH-liRIT!Sll ,-/.\"fJ l:'UklJ!'E.I.\" 11 '\IOI< l'IW!if.l:.\J\ ca,es of lung cancer would bl' found if lung' from any ><>rt .,( i"'P"lat1111 "' tT >itliJ<ct1<l t" tJ,. ><l 111e minute scrutiny? Da. S}!!TH: In regar<l to Dr. Cartitr's query a' to thl' ,ignificancc of rl1ffercnt lYJ<' of ltu1g .an.-er, it may be perti11ent to note that a din:r>it) 11i tumors wa, found 111 t!tl' !t111g' u1 cltr1<m;1tc '"''kers reviewed by Dr. Arma Bactjcr. Expni111cntally. the pol:cyclic hyrlrura11>"11' 1111h;, g: .t variety of tumor types. If asbesto> j, arl'in"g<'nic. I 11<>nld ""t n.pl'c't to 'lt 1t i"""ltt<' .. ,:_: one type of tumor. I am interested in yuur oli>..,rvatl<l11 ui l\\'o ca'L'~ ui pleural rm-.. tlt\li"''"l. Thi> is a ratlwr ran: tumor. In exa111i11tng patlt11l11gical m.itL" ial '""t u-, front E11g!.111rl 11/ !Jr Hin;,on, we found among ,ix cam:ernus asbc,toti< lung' t110 JH'C,l'!llmg alvl'olar L"II .ircin.. rna. These tumors arc often diagno-ed as "pkural mcsothcliurna." l ,!JtJttld \'cry mtllh l1ko t< .-.-.:hange slides with )OU. in reply to ).Ir. Lew and Dr. Lan,.,, it '"" 111~ t1nder-tand>Tw; that till' Engli'h C:'' ui stlw,,.;j,- and their cases oi asbL''tcJ>is \\'ere handled 111 till' ,,m1e ge11cral ia,\:1un tlH1ugh tile 1'11111111on1n1nsis Board ar'U that the lung 1a11ccr r.11<' lJt111d 111 'iliuitiL'> c1111ld tlterd<irt '' n e "' d rea,nnably satisfactory contml for t!te !t1ng cancer '"'te Ill ca'e' ui a,he,tosi, [11 I Ir I ;JJ}!tl', ~cries of Sl cases of lung cancer in tlH' .. ~veral p11l'tirnol't1tl11>~1-, gr{lup.... i.n<l 1n the cuntnil 1.!T1Jt1\1. the tumor was evident 111 the gro in all c:-.npt 11. ::>ume of hi, matcri;d ""' d"'t'"}ecl dm111g tit~ bombing of London. hut hi, rccnllcrtiun \\a, that all ot the cancer' m a l1t,\ ttc' ''ere recognizable in the gruss. Da. JoHx L. P11n1, :\ell' Ynrk HaV< expert1lll'.lttal 'tud1e' tltrn\\'ll a11y l1gltt <Jll tlte 'ill"'t1nn o1f lung cancer in relation to a>h<~>tosis? IJ1c s~nTH; In 19-ll, ::\.. nirnan11 and ::'urgl' 111 ( l'l'lltdn)' claimer! tu 11'1\\" Jll"><llh'l'd 1a11cer iu the lungs of mice b: expo,inf! them 1epea\\'dl) t "'"<'!"' du't Thc11 ,t.,tu11u1\ that can1 er had resulted in 207c ni their exposed ammah i, ou ,1,1<111,tih quterl. .\ctuali). tltetr "211;;" f1Q111 .. reft'rred only tn t\\ u n1tct:, urn.: 1,f which hdd a t: P"-' 11f tunH 1r t!i,1t 1 wcur'."I ('( 11n1nc ltd\ a .... 1 'l1' n- taneous gro\.vth in tnicc. The other tht:) cun .. ickrt'<I tu be ci -.qu~uw1Lh u:ll t.1r,,_'lll1J!!l.i. !iut th--ir photograph does nut 1mprt,,; Ille a' that ,,i ep1dtrn11<1<l ldl'lt1t1111a merely an area of o<qt1amous cell md.ipla<ta. It '''n'' 1;1tlwr tu ,111111 tlOO. aruld out the 10- cn of .er :.he- Uy _er sh