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Stats of the Art Asbestos-Related Diseases of the Lung and Other Organs: TheirUpidemiology and Implications for Clinical Practice' * taARCA?=T R. OECKLAKE1 Contents In'nnii: .nun 1 l.i- \ :iMim-i.iN v -.,f'li.t' ,;i in iii . a nil I tin ; T\ pi'-'. ' W-cMm > at Ri.-k ii,,!,i^ii (IWm 'i.r. Ni .iilxi; !!. f.u \ iI > .1;: n'Ol.i*) I`.11 ':! \ I'.-f !li V'Ol M> l .liiiK.il 1 rnuif, K.l.llu*;:.., [.ii ( t-> f .111 k 1 '1 >HMi- 'll l>Mt,n t ; .! :i'ii|., ,. tun:; i Vi*!.*.*i M:u..c".r I lif ! .. .Ml'l }'.l|*'ttv lulul'd I'.* Iliil I I- j'l * I !i I 11" l I M I'f!::; 1) ( ii .u.mkv l\a Kelt m:'.''!, i)- .ri itmciaii. .m.-t Mu'.';! 1/. .11 i)(. L ; u;:ii *1 tv.:i:n,i l!i< I m ; l.u:r . I i!ifi> ') :r r iltk.!' Iii ;.-;in.i'hij> n< ni*.*;:-,;.; Ri-j-uii-i' 5>i A'lc-l-> 1..-mi: >:n i "f l`mu.it 1.1 ,iint ( <mi- `| tl*i> :n Quitt.! Man-ml Hi.ii'..! 5 i.u|ii'*%. tU.iliii'- *; CaUiiuti I i,.. niii^ u( ilte l'.*iif/t.'l (! iM.it f.,-i , Vy 1 }.;! minlogf amt IVtlio;;ri;r\i$ (.Unit.,il ami R.ti|it'lii~ic M;un(f't.tlimi Filirotic *..'" Mfii'inii 1 Hi infill Dttlt:fntti .titial I'nlmu'i.iry l ilroM> Dili 1: 'Ii.tti the IVjHnltm-iiik of l|.iili ami Hi jltti. amt of FApemnnuat Medicine. MtCill Uni* tci-al'.. and from the Drpaitihcttt of Mi tllr inv. Royal Victoria Hospital. Montreal. Om.-lm, C.inail.i. Ri j . .'> for n [inis slimiM ! .il<iiiM<il to He- p.-it'n->! KpiiJt minliyv .mil Htaltli. t ni- ui.-i'i, v<j L imei'ily iticct, Muntual. Quclnc. C .tu.n!.i 3 A .-uii.it** of tin.- Medical RiM.iuh C nnm.il u( CAua la. M.*i:^i!'-:L Mi *' ! -;:i.i i t'n* 1'lvitr.t .'mil IVin (mu ::i I1.".: . :.-y 1 f 1:.1 - . . .itiiii uitli tAmj.-uw t 'n-.s.'l 1'.. In is .'N.! i '.'a: : C.itiii. 0'' {'. I 1 i Nj'U.MM \ - . i,; .-.* u:ilt A-licvi r, o-tiu A''* -lu- Ki i il ( ... ii;; 'i hi' ?!.:! m- e:'!:' 1 i 1 .!;! lh: N. 'iiu- of K\- jm.o-r ,!.i t'.i.i! r C!iti< ii implst f. '{ ii;- I j-; Iftn.i'iu^i'. Hmlii ",, Introduction ,\Sllu* i 't llu lif ij' ;!'.' > f a*t>iiU" li.ivc ! . n 1 v< *.:.: it >ii> 1 .1. ifi; i niii > . '.'i. iU iDUiim 11 i.1! 1 it.i!Ilmi '.v.i. i:i.i.!c'i; until ll;c J.UI'I ; ni of tin mmi : tr'i 1 : .;M.;.1' ii toult <! tin' 11:1!.i'ii i.i! it \u;ii>: 1, ill.; ti-.'vl ill mm '.> ilcurl'*1,' t!.i- uui.iA' i( ii.'ui.i'.iin tin: s-r.im '.Tioii.i,' (`2} l hi; iii'f ':i\ in 15*77 r.r.J m;|}jii. tit il* u iu: mem in ti:c !'<**> >f llu; f\- Utt'io: tinv'*vtiIi* t'.cj'i-it> '.:t f.iuttu Ouchir w;i\ |(tl!`t`.M.'4 lv fnuln.r i-so'v.i. o-'ii i.l tlic .it- r*';u!y Lsntun atrl in litc Ci.tl iiw.uK.iim tit U.u-ii.1 and t-f tin- tu-nt timi'cl i!,.|'ii';i' in I'.ilv ,1 r -i (Aju.i-- (J. I l:c \ i'M I*. 1' i -'n \jt. <i. <1-11 in tin C.ijn' (Stmlli \lt:i.t) "a ruin.ihi! in tlii* iradv i*i:t:- VIFRKAN Rt.VHVV Of Kt'I'iK.X lOKI IMM \Sf.. Vitl. Ml ill. f-M \VT ASBESTOS IflFORMATIOH ASSOCIATION/ x North America 1335 K oirefit, N. W. Suite 402 jVas^ington, 0- C. 20006 oi- I3 makcauft r.vce: ski: teenth century. hilt l. u .'C scab- tie willy be- g in in the pa*: slrrat ;. An.c.iice. I'ico-.-inJ in 11.- Ti-utsvaal i. i I'.i tT . fir.; iYVm h.'ly ( V tt:-.net! in lyuS \liilin; < .; .: fdnr to re- h..-'- it the* i'nr; . usU.d*; 1dm. the tain'-. |:s- r-r. .. ... <'. f w r n vti 1..' ; ' 1 n ' e\pw*-ud t.. the f.-.;: .-i;s i ! :. .s i:u11; %; i 1 ut'd. in I"''---: l-.r bru. i;n. i .'her tin c' .). - s.uritr i'S. a? ` th- ri.-iNAr-:-. 1 : 7 -w.;'. '. of --.ad me of thii : i;t 7 d n:v d- .-.vm h-u;e I I:: v..iy tha: liiiv'* r!!i:v : - tor v.m Id... !. applet reti'a. of it-. !-ai i.;. i! :! to h- 11!t; ;urv 2 t*.<"f" the i'Aniry rl 1 iwCsUpii..\-n rd its health c!lsc;> in ! v!.u- 1.) 1.1: * i' <:i .cm: .1 exploit.!- ti;.:t of t* i::l: J .1.. Th I.-.:--.- (IfeeC* U' J.-'u;i o'a.- tls.i in t -Jy lb am! fm f;:>or;v ia. !'.' T a ti.l 1: i ; it..-.v ceci-^a'rc.l s`=sp-e ;* :* s-W. u. iv ! *- il;" v*"'--*- 1-iqic. lit 'on. ' y v*f 1 in table 1. '< ;.>c imlm.lc hhl 0>iS of \ar\:*'* J k'd ! - and \ d. '-Mi'e of tf.-t luuy- und. plea: :>ri.l i> -nis of the lung. p!*:i::a. t> i dot .> 1 ;.. | g:s.* 1 m l M : vi'ircal traet (5 h;. at-.d. po-i;,ly. ti .e 1 . ry;.. . (`l-M), o*a;y (l.'d. and breast (Ito Ds pi-: iv; i i.u.i'.c actum aitrmd a*. *,n . t.g 1 en!!:' t.ivcts in Eu- io:- and N*. `.n-e:: io ..a >, p. d*- h-;-ri:>-.:i ode"'. ea.-h 1; c-1 ui-rfd to he re- po: :sd. !: t:. ...he. :os : 1 1 ;i -ease ha* bint C.dl- -.1 "! *' UM \ .<>:i j;dm - - of the O' l ." a dost;ip- *\. at o re' b-eis t!,.- e-xretcl of cur- tent jvttbl,!. (Of!C'*tn for this l le.drh ha/.etd (i). Ah:.oi:;h rcn-umtion of thr :-.-.oci.uion be tween asbw-'* ts pnsttr* and the s.ariom health li-t-.d is- n-.ble 1 wm ni.alc initially by shrewd di.-dc.iJ. p-crho'e-jpc. and epidemiologic o'<vrv.i:i..:;. txptmution of the. nature of the association *vc':h ;obes!o cxt*o>tire has sub>e- spr.-ntly been ttnvle by epulenh.dp.ic studies, luv.i';, ;,i SMi.'. studies arc frequently found in jottnnh n{ epid-.-mioloyy, public health. 5-ul cttvironmcnul health, r.vher than in rlinual journals, ami in report* of ifrrnitiuu.-d con ferences not cosotcd by tfic um:.-.! rlit;ical tefer* cure system*, stub u* the C'uu-.-.d.uise Index (5-9). The published piocccdcug' of the*e con- ferenre*. all iruvruation.itiy suppor-oil. in keep ing with ;m iutetn.itinn.'.l nature .if d*e.=;o* u-*.\ provide cwilcnt sniiuc mate;!.! to whitli ex- tensive rch teuco is made in this rc%ir*.*. for this reason. the rroiceding* of each conference are cited indy once, in references 5 to 9. Individual presentation* are subsequently identified in the text by the name of the first author ansi page number. *ta#-# -i it vitt A S*C5 * M< | * U t* ** I --------- 1 V t L' - n,. Vi-e J. p'l.na 5iM.th>T ft'.: u-j.-.i:.!<; 1-y perrci:'*-*i <-f pu'K>he:.| Ws-o..; v.i- h mbad sad -.vhe:-.' it i'i .I Tlii' he-uv was ti.iss it net sviirltt o.*ti*n:s-r>- ti-m f<i- l`Y7l\ -iii< o.d at !' tn.:. Ta- lap u:.' fm ImT. - ;::i-.vvit at 5.11*0 .<.-''1 tn:.;. \.i;h Km-ian ; \np.ijj;j the jv Me.* non of tl*e w. s(* r.i Nc'cilhe!- .. ;1 . piatthing pV.,'ici:Ki is often the litst Miii.s' -d u'Cvlis.i! lulp fo- the c-xpo-ed person who .a hr.hh i alls tied. p*rt;cul,*vly if tin* r\p*>smv : t-hitnl t> the w--.\ rather titan production of. :a1h-\|i* pto-.hts.t>. r if cvpourv is notiostup.tti'-tul. i.c.. by tt*,ic;hhr.rho*-:! j? tiousehoUl C"n:.!<f. U has hern '.rid by UYb* (17) tift; "the c'itt- i.ian >ve\ the 'i<s .iryu::*: '.! tciiiiori*: (.1 isnlit iilu.ils v. ::h a siuul.ir foit-tclhitioit of ab- iiojin.ilities half-htiris t! in hi* apperceptive li'sbutouml ;.! in tel.ttion to v.hat h- tcfa'U fi nit the Ji ci.ttti:.. usnalfy wiitren by peer* v.idt the same <:r .11 In Id -'f \;sit>n" ami that tic "fotmlv:% irtt-t e: touron* syncUidov.s because In- hulks only at thv prop!; (li'Ci.tly iu fro tit o.f liiu.." I'.y rontra?. t'1-- ej hU-uMMli *-*c* "the stcV. pa tten' as an isr.tvt'iMt.d n:ti: in trlacion to a popn- l.nional ttnivvt -e" and "uiU-.e-. a rrtttl; Vccaur it i> lunivd iti a m.i*' of du.i" '.'ciltr.ps the.v. remarks aiml) only :o th - !..] rlittician and the b.til epideittiolo^ist. Nc*'nhclcss. the slidvrcnrci in approach, seem to he iuHith.-ni to merit a tc- \i.-w that attempts to bridge the gap; thus, the Oi u Zj c AMU-ll *>' Mi V ; M 1 r. ,. J.000 I '1 y i.cao i00 u2a l-T U. t)i.i>jr.*niM5:iii: pi-c- . illation <-! llu: .;unvil in id l lit* .C .O lt'.'ll <! ' '1 '|K s.m''. ! SlCj i.M.-d.i-----------i*K-.d.i. 1 a' ill-lu' si. I'-11 l'...... *>C tliv | : ch nt le* i :-'.v is to ev:d ll.UC cur'< in ii .ol it-.,;; ion, nartui il.'t-:!/ tls.it Oilti; iued Ii .'in i }iii!emit|nf:ic studii > . if. l;;;hl of t l>rt ;, upli- t.iiioi.s i>f tliis kiumh'di'.e f-r t.'.iui; .ii pi:;. tics:. The Asb?sla Minanis rhytinl Ch'Htu t*nUw> (..*!:/ 1'iOcr 7 }'.. j i l>' |>J.7 -.it :.;;i :tuy v.; II qs: m Mi; the > .nice nf ih j'iis:.i<.s chctiti'`ty the .ohe.'U.s min* i!' in :!;* \t.ue o hi' a.i. The anv.vvr i\ con- 11:i*d i:i Ci!*n\ 'mun.ii: / of the ll-o-t New N.-ik ConhiMKc on th. "Uinl'tjtua* Kff'us ol \viio:"'' in which he idetiiiiicd one of the <|H'* ftu tlicr "Is sin- i;.k !l''..>i;fu, and mhei t'.n.ior'f" Jieeau.w "iLv quem lu\>: '';.;rn..d that tins is so (see l.-ii-r in this I'.vi.v.). knov. !e'. * a.hiNii's m whi\.ii a person L.is Ls.cn exposed should pi.de i h I'dlillf- . ictiun.; in t'Cah* .md e-tiiMiitiisj; x [iros-. A .i)i sls>' i> !i..*ra! ic!'!i; tp-.'en to a .-{'v.r- cl iiiir.ei.th th.>: sist.ml to hit*h IdnuUs in il- u.^tcr art-', re* pcrarurcs. ,5. tv.o qj;d. *v *u which their i:. l.c:ii.! i.m. depends. The -'i impoirant ouumeui.ii hheri ^diowsi in ts-dde TA&Le 1 PATHOLOGIC EFFECTS OF Asaesroc EXPOSURE IN Vh; Organ fteer $ \ irt Caryns S jnjt Perifonaom C -.:roint*;inaI t^set 0 i' * Qrvsit A-.tinstos corns Carcin.-vn# 'A*hosto'* bodies anj/cr tibars OiHusa intartt<t<ai (ibrosii tasb*stosi': C.ireino'na (:>*r-nehiat) Hvellnn plsouai jnij calciUcation Malignant masotbatiomo Plaural atlusinn Malignant n ajothalioma NaoDiasia Carcinoma Carcinoma 'Association ttioueiit to b* causal, nxeept v/'-ors indicated, t Association, not causa.'astablishad. ASSOCIJtiCil vVittl Ast>*s:02 c'S'OSiir.i* Estai'U'^ad Po'.si'.'la EstabU'.nad Established Cofnctor v.-ith cigarauas Estabiishon Establish*;!* Possibl* Est.iblishnd* Established RcmotaW ccssibln Ramoraiy possiMa R-jMratsce 0 1 1 14 s-r- 5-9 50 5-9 5-3 10 r-i 5- 9 15 10 01-0206253 M-MtCUll 1 111 C t.l \r.l j, .ut chrysolite (a white. usually loon. silky ft hinadlv into tt-stiles. aslmstox (vini-nf and otln-r ij'i). irorMolite (a hardier blue fil*;N). .ittmxjti imi'iniitioii pioduUx. p.tjM-r produits. (tit lion il.roun mid hard)). mid authnphyllue. <hic*ll uiatetia!'. and insulation pioduns. ft is uko nmiI mined and Used in Fin land. In addition. snm in the ihemii.il and plaMiis indu'tiiv'. where c>t tK-'C fibroin minerals also ot cm in die bean it' binding ptopetties fin patti< ul.n. die po*j . k m mine-' ili.'M'lupetl primal il'. tor die ex pled- live ihatge of ihtvxotile) enhance' i:s union t iuo >} oilni mioi-r.dx. such as talc. miia (l? , with fill- i ami pigment (1 .indell. 7. p X!'l, .! i;oh. .1'. lor wimple, in the itoti mines it Oih im.jipiM.iud into ntaniif.iCHucd umus. the hr.i<l of l ..tin Superior ami in Labrador. the liber is relatively well bound and is time- I li'ti'rentes in the physiol [!>;t-tties of die hue less lilclv u> po>e a health lia/aid to t!>e \ .<...is fihei s iLienninc their pai :n ul.ir Com- many wotket' v.!m u-e the newly m.im.C.ietiirvd j s-i! itu .`uI:h ". I Juts, for <'. m.pb-. cJhvxo- piodiKix I'lT S <.Jijd.ij I'xi-v, i.ihle ?), so iv. hi, h (oii'i't' of loir.', it mini v p'i:ilI`- libers as die [>ioduct is not sawn, disrupted, or <u; i.i ,i 't!i1 jiioerV'sixciv imo hmi lihiil'. kud% ii am. way; however, axhrxio. fibers air viiiwdly 'd I-) iinoi p'-- it inn into textiles. wh-teax dot i- indi-'iruifihle *1 hcmp'.'ii. f>, p. l!H) apiiy dr- .!. !'e m*l mtodte. w!iiih ate nrne and t-\tx 'iiihes this .;s a `"nall-lilc it an infiiuiy of t -in. ar-"' of pai ocular value for mat i tie invida- yeai'." 'Hie fiin-tx may b- irie.i'ed intu die at Mo:- (.tilaiii .I'hextox lenient piodmi-, may he mosphere - in wheti the migin.il product is ir- it.- :!<' fmni )! uis /*f ihrv.ofile .mil .iino-hc moved. iep! .ed. or de.xio\ed, ax mav occur in .end or irc>tid-lm- The'e dilfeietues in rlu ihe ionsiiucimu am! 'hipSi.-.Ming in.lusui;x. ph.sh.il properties of the libn> (ami in couv- in imimitiotj with demolition, repair, and/ ipnnce. in their anodytumic; bvh.r* im > may ac- ot tefitung. F.\po>mes ol this sort, particularly romu for ditfetei.ies in the hc..lth riiect' of ex- il they occur in a contained environment, such rosi.it-; indeed. it lux hrm argued ih.o ''only h\ a< the h.dd ol a ship undergoing refitting, rnat icl 'ting experimental hiologn ev idvitce with the invoice w.jikcts wIk.so primary ).>!> ha> nmlt- i.ririoii' in physical v/r and b>ito . . . t.m we ing to do with asbestos, c.g., welders nr tna^i.n. i:mn ly aviive at valid medio! (oncltisioiv.'* lud-ed, failtt:c* to appreciate tlicse sourtes of cv Jliis ipustioit is (listn-.v.-d iti a later set- poxine in I ; 1-. imisirurtion and shipbuihh:'.^ i: ;e. of the piea.in review. indaxtrics i!9. ! 'i probably accounts fm the te-emergem e a.l.exui' ii laicd slixe.'tsr in -!.r If'iiOs. There a..peats to be no direct infc.n.i tion on t'--- :uiieix of w-'ikcrs at risk it: i'ifs of '/om; ()r< u`hitintis nt Ilittk ditlmutt coi.nt ies. other than an estimate of World prodm lion and use of asbestos have 'rown greatly since the late nineii* nth century; between IS77 and 19l7. axlnr-lOx production and n*e incieased from 5H toiix to l.lHMi.ntiu tons jr.ii.tHKt pci**nix [o. the Kuitcd States in HOi (JIV The ieas,xn for itieludfitg the inlorm-.uion *r the oceiipationx at risk (cable j) in a clinical pc: yeai. an sn.CVm.fold jmreaxe. For industriali/vd icittntties. such as Britain ami tlx: United XMt'.x. the imr.-oe in asbestos n<e betw-rn 19h1 and 197b wax 7-fold (1$, I9h l his jelhit' in crease* >u volume of manufactured goods ax well as In the variety of iim-x developed for the ma terial. These arc outlined broadly ht table `.h Appreciation of (be wide variety of mes of asbestos important to the physician ami serves as an indicator of the many occupation' poten tially at risk from exposuic (table ty. These occupations include ad>etos mining, milling, and handling itt preparation for its um\ either directly (as. for immure, in sptayiug when mixed with oil) or for its incorporation into the manufacture of a great variety of asirestos-con* tev few is t** oiler the physician an overview l the uses of th* mineral, so that when faced with hi individual with an iliucss that may he axhexto.' related, lie tan fotinul.uc u >v''.ci:it.c entjuirv into the petxn'x occupational h.isiuty 'Fhe physician should thus cover pos,ible c\r bines in mining, milling, and maoufactuiing. at well as in die application of m.wiuC irtt.rcil prosUtcts containing axln^tox, directly, or a; the time of demolition or rephicem.'ist (19. U11. *Jt). *!'lie phyxici.in must not only seek the <b tails ol the put it nr'x *>w n job', p.t't .mil pr c *. nt hut must also U'ltfrt.tiu whether ritix woek j* i.irrird out at flic side of other woikus wliv-c jobs invidwd t!iv hamUmg of .i-i" 'ici' ptailtan or materials, put tiiui.ii ly il hi a t loved or p-ua laining products. The latter may he classified ventilated euvironuietU. 01 - 320 . 'HI I l M. him v I -sI 5 9 a *,, o>r > i I'-li TABLE 2 o } 0 ;> ;3 6* =1 o 2h o 2 < Cfl UJ So 2 c O' 2 %; o o " <J O .ai i* ;" 2o fl IL It I M 3L w i 5I I S C =2O U0 o o[ 2c vi \ S o z <~ ft i 9 nO O 0o- & G O >' --> zb 11 !5 12 t2 i- !'S 1w rii "^ -- U i. K c tra c to iy tiles Pressure pipes C ctncm products t-e ltt to r plastics 35 oI 0 0 3a *.2 Is oC -- 9-- 99 | fl 9 2oe if, <-- Z a- uff. 53? 0Ooi >^2o*0ft..>x*w-2o 22 2 59 ? s -2 2 2 2 1 2 u 3 5 5 .2 | ? 3 2 3 jas,j;S>2::S2c S>03~353;^"< c </j s w < u o zIT 2E I8 o a -> * S * S*t o* a ~ 9 ; 4 " 3 0" ac I1 O u. * U 41 1 2 J h it < h I II In su la tio n * * "P a ve r" products W <> jo ft I a 3 -*` 35 s; ill?? iI?f*>oi;! i 5 = n* 'a 1 - C 2 0 6 2 = 1V2 m\r<;\ r 111 ( Lf.AKt 1 occupations r risk po*; milling. MANUrACTUH 515 3 cxpos'.**? i.\ .mining, J -*;*J SECONDAtlY 'JS=S` PfOJCII -> - --" P'O'JUUO.' M ,tunj Willing Handling -- - PfOOur Vnu or Jsj -------- ---- - . .... . Prunjty >>'** in Sorey ii*J I'suon Ftlttir nob grouting Manufacturing o* TaxtiUS Cement prortuC's "Paper" product* Friction material* ln*uiat<oo orc-Titt* Application Comtn-.-ron New construction HtCftir. Semotition Shipbuilding fleoatf, r*t* Spray Of firter mined win O'l Cloth, curtjm*. i.igum; .:ectve e'of-.ng, m.siibags. ri.cp.ng, corvlyor belt* Sheet*. pipe*, roofing gutters, ventilation >(:, lower sots Millboard. roofmg fni* juality tsstricai Popart, flooring tiller* Automotive prod ictt. Oas%*t* .-.lute* plate*, brake Immj* Pipe a''d bo>l*r inv.ji.it-n. _ju.na.vj lining* for ships Boards and puttie*. <-i Paint*. lOint filter*; product* (tiles, pip**, ShIio?. 5"' '5 ; Insulation materials |n*nUt.pn materials f.i? ,i *. matf*se*. ctothl fp* r-; null, decks, (ageing pf vent-;**, js en.i water pipes, cables tnsui it.r>n mainiais. a* -'Mit'ioad (or 'construction'' Automotive industry Memjfecture n*pir Gasket*, brake lining*, underrating Gaskets, brake 'inings, j -cy-coating . ,. . Jobs Pnti-nti.siiv at Hut ... __ __ * - flock mining, losing, trucking Crush.ng. milling Transport worker*, dickers, loaoert. nose who uny.sen jut* tacks {recently replaced with Vicks that do nor permit tibei* to escape) S.'-av i.niul.itors (construction, ship bui'dmg) O'enrtmg. c.i'oing, spuming, twist :ng winding. hrai-linn, weaving. *:.i-ry timing, ijit- isating. mnii'iloryinq 3'e'vt.ng, slurry preparation, toiling, pressing, p.;>* cutring 1 <.-*t v. carpenters, l.iggers. painters t ;> Myers, insulation wO'kers, ."Ci-t nut.il and heating .'Quip-i'O 't ..pi M'll. rrirfSOU*. ItHi-l-CUV all Othi'1 .-.-o*sors on constriction sites, s : at i.*--fs. sveiiiwrf, etectnci.u. 0*,- sut.t"< sv<ukeS for all of these Lest-*'*., ifilters. srr>pprs. StAitni soiimaxers. joiners, ship vi* ,`.i s. engine titters, masons, p i nter*. .voSdar*, c.tulkars 0 reedy. vil jh-ow iO0* on refits, dry CPvk, a'i orhm repairs onar.sti-'n* inuiiiv "y. m nntim nice fitters anrl tap}- m,.n, electricians, plumber*. wj'dars. carpenters Inst lii.i'.aii of brake lining*, gaskets. and so on Service i/.<*'i, tt'ake repairmen, uodv r*pjirnii'n, auto mechanics * Information collated by Or. Graham GiOOi from r*ra-.ees 2. 3, 13-20. and 22-2;. Indirect Exposure (Domestic, Xcighborhoodt Environmental) ExjHjsure to asbestos fiber is a*>t conkucd to the place o work (27): the search for exposure in the background of {i.iticno with mesothelioma il. `-.'Wjl) has bi-m^ht trt lijjhi toverd futim of indirect t up.aiuiijl t-xposure. 'I lie oc currence of m Mtil.elioiuu in the family incut* i-ors of asbestos w.ukris led to the revmuuiou of indirect dotmv.ii, i;sjnmirc: the source here 01 AMOMos RH i I) I.UM- l|sr \sts vxs i> pnrsuincti lO Ik.* die dust brought home in 11 of the . 'pir.univ tiacl they enter, and the pai tsoikct's oveiails (H), 31). Likewise. the associ- nt n ul bleaching that carries the panicles. `I he ri<-it between icsideticc near a mine, mill, .iciinlyiiatmi licbas mi .`I p.mules is a function U;m\ jml the occurrence nf mcMHheliom nninly of diameter, bui .dv> of si/e, shape, ami I-! n light 11 tv important!* <f neii'lilxu hool density. I he v.uyim; < h.u .u irt isucs f.l (.mutter- i ('-'TV Such ucighhuitiood exposure ' ciailv um.nI avlu .(os libei make it obvious that .'I'u j in account for occmtcnce ol pier the cnviiontm-nt m whiilt asbestos Winker* are ml plaques and/or cakiftcation in lesitkms H exposed will L>mt.iu p.utitles having gte.tl u.o mining ;nca of Finland Iheur.-I vati.ilion In si/e ami compu.iiion. These include ; .Hj.irs have also been desci il*i ;l in .i;;i i- .iuu .u ftheis ('(i-c.ille-.t il their length h at least times ]* jmLitioii'* (aS-.Vd: in some instances. they tbeit tli.'.mcieri, whiih mas be long (as long as i'.nc been .mtibun-d to the Hoiking cil' soil that `Job /on) or short, lit addition, a vvoikiug en contains asbestos fibers, c.g., in Bulgaria (J3. t vironment iv likely tn include a range of smaller parukles author fibev> released Irom tlic break Ik1 suiprisingly high prevalence of asbestos down and disruption of the primary filter, .is i-idii.' (as evidence ul exposure) in tontine ;iu- web as those due u* any other uoii.isIk-sso* par |Mjdes indicates .in cuviummcutal exposin': ticles added by the mining or industrial pro l"i the loi'feui.' of mo'i ni rlu* huger cities of cess. die world; however, the .imom.is in dm gcnei.it Inhaled asbestos patlieivs fallow the moving 'j)here are small \jh), ami these autopsy luv!- airsue.uns with eaeit inspiratiim. .nut. once they ia;' shciuhl probably he regatded more as an make contact with any p.ut of the surface of the index of exposure rather than of disease potest- ail wavs or aitsp.ut-s. ate ut texuxpemb d in the ti.il. I he Advisory Committee teporr that fob expiratory aitsucam* (II, IJ). Deposition of the l-*'-'cd flu: l.ymi Coiitciemc ^7) concluded tli.it latger inhaled panicles (more than h miu in <li- "dim* is ar pic-sent no evidence of lung damage time ter) occurs mainly iti die nose (assuming !-. a'hvsidS to the genctal public." ami "die iitoc breathing; and tu.ijni .diways, owing to n:;:ui of asbestos in *.ke lungs of members of inertial impaciion .<ud sedimentation. Because the genet a I public is very small compared to of llmwnuitt mov- -ucut. deposition uf die small ih..'- ih cupationally exposed." er particles (less ikau l ,<m in diameter) occurs Finally, .-mention has recently been directed mainly in the mo;-- peripheral airways and .tit- toward the widespread occurrence of asbestos spaces. 'litis ilcpo'iiiou profile is smuntari/ed in fiU'ts in certain natural water sources (37-40). figure J. An event that brought this to the notice of the Oejjosition patterns can he profoundly modi- gvm-tal public was the discharge of mine tail* fted In hrcaiftiug patterns; nose breathing i .uim-s hi-' containing fiber into Lake Supviior. a source a high retention rate, men of small ftlx-ts, nl dtinkitig water to many cities in the center widiin the nose* (-11. IJ). However, under work nf the North American continent (3^). It is ing conditions, including beat and exertional now also recognized that filters also occur in stress, most wmkrrs iv,it to mouth breathing, t::.mv natural waters, particularly in mining re beeper, slower tespit.itiom lawn- a more esett gions; however, the Advisoty Cotmntttee repott distribioion of impited air. and, dins, a more minuting ftom the Lyon Coufcictuc i'7) even distribution of inhaled particles. Lung judged there to be no evidence at piocnr of volume also iniluctues disuibiuion and. poi- "jii increased cancer ri>k resulting from asbestos fibers present in water, beverages or food or in die Uuicto used for the administration of drugs " blv, tetcmioii patterns, p.mitulariv if breathing occurs at less than die normal ltuu tioii.il rcsnlual capacity (FRO in the range ot aitvvav clo 'I he question must, however, remain under close sure (43. p- W|. Likewise, there is mimic evidence wiuiiny. tliat die siate of the aiivvays in smokeis is jiuh that inhaled pat tides will peneiraio less deeply The Fat* and Biologie Effects of Inhaled Asbestos Particles Lk'jtosilinn in thn t.ung into the bronchial nee and thus tend to be de]K)sitcd more centrally than in tumsmokers (14). Whether or not inhaled asbestos fibers will lie Pulmonary Clrnrunee deposited in the lung depends on the aerody (llcatance of panicles deposited on the mu- namic behavior of the particles, the dimensions cmi.s blanket is brisk, with half-times of minutes Q\"C ' ' \'M MARGAKf ; HI CM AKK dial .1 system of it* tcioph.igu iccruitment meets oud.nights of Itri iibiiN .mil.<n p.u tides. Sh-.ii fibers (< a i>mi .ippe.it to be readily and. com pletely pliagot v t*>.. d. Int; 11hit* Jiheis ,nc n<. c\rn win it at:.'iked bv mote ih.ot c>m- m...|o phage, wliiih iilav '.t-.id to i-U fu>>o.t *'AiIi-.t'i. 7, p. S(n. C-le.irame ol inha'wd pattieh'S by these iiiecb.mi-.no i. believed to be moie dim '*> per cent effective !.*r trn-st deposited parti:!.-, iISj. l'nu'tr>iUn't, /,',,** !ii\t> d'li'tou. r.iti! Mubiliinitnit <<{ (, >i< n.;i, ,1 . Idnu/.o f'-o *u'U'\ uniiiin tfsc /.tote 'I he use of electron miuovopv lias revealed l ig. [l mm Hi.iin .itiil \'.tM*< ;i2): reprinted 1v pc-rmivdnn of publisher: copyright 10?:. Aipctica:'. Medical A'socistUm.) Aeiovol deposition in u.-pn.iloiy tr.Kt. I he pen i mage aerosol di-pcond wav C.lUul.ikd [io'ii die ,1'Mimpimm in the moil-1 r> fciiob u jImhc for .1 (itl.il volume of 1.1*0 ml mm j futjiM-mv of 1 *> hii-.iili< jiff min. I lie piolde of th.po sition >! .hi uiiO'til is infinurc i >1 In its effect:'*s .Uiotlsiumit tiikavim (h.i; (miuv the diMiiluitio:; ; m;*s% for many .micm.I., n log normal) n.iv !> millicit tis tin* in.-ts uuili.in diameter of the avitanti its g -oimtiic M.uidard deviation. In this Ir.;:::;. per cent rn-rn-.nl di-podicd is related diintlv to tin mass median di.-mt-nr, uheu-as th**2 lines icfviim; in each Imp' />in- tu\. N P. T il. .nul I', ri speeds''!-, indicate (he di!:;:-nccs in |ht tent dcjHJdtioii :!ut would ifsuit d the gvumittic tand;ml deviation {' the mass median diameter varied ftmu l 2 to 4..* ^ N l1 =* nasophaiMe-jeal -uniatc; T ll = ciliated to, cluolmnnchial miiI.iic; l* mmciUateU ptilim'iniy sllll.ltC. to limits. Mucus ami cells fmm mmcili.tted aitways iiv.itiny; invested panicles from the major aiiwuys .tsc clearitl to the pharynx: the* mateti .! uap|H.'d in the nosr is also cleared to the plur. :tx. Herr, pulmonary and nasal debris mix with saliva am! arc swallowed or expectorated [\2>. This phase of clearance docs not appear to be aliened by the presence of asbestos lung disease (!!!) and. under certain circumstances, the ef fects of smoking in producing bronchitis tti.is ev iMi sp* i d this phase of eh'.trance ('-If*. -IT). Particles deposited in the nmiciiiated regions may be cl**ucd tclaiivelv uipidly if tl.ev ii iuji:. on the sutf.icc (with a half-time of 2-1 hours;, hue once they penetrate fixed tissues, deaianc*' is slowed, with half-times ranging from days to thousands of days (-IS). It has also been sug gested that macrophages decrease the likelihood of fibers penetrating the alveolar walls (T--s. and tlic presence ol irmiy, male, 'uiiimaonOpic, me coated asbestos l!*cis .otd IilniN in the lung suli-.:.im,e of die cxp'md worker, f.ir mine t!). :t was ever imagined when the lung liber popula tion was evaluated by light microscopy alone eHl-til!. ft is also now evident that die pi->portion of muo.iied to coated fiueis (i.C., those tint fmm die owe of an .idetns body; is votv huge, of tin* oidvr of 7o per cent (Hb. an ob*.rv.itiiiii that suggest' a \c-iv lii:-,h penetration ird retention tatc tor die wthmictosenpiv parti- k* tele.e-ed into ; v.oihiiig enviionmou .Mu: natively, the*. :.:.dl lilien and or putuh* might lepii*: - the breakdown piodmts vvltat were i:d-. !1. I.u.prr fda-rs that had pvt.e ti.cit'd tin' aivt .. pit's id the lung. A M-.i-::d reason feu un<h : *ri::i:u ion of tfu* amoi.nt nS :.siiesios fiI*c i let.iimd in die fun., is tie.- dii'-.ruhv emouiiteied in its rixoveiv from lungs at a :topsv. (ompated U tii.it -*t -nlict pneuir.osOtlie >i-pu<diKing din's (Nagi'l'chtuiill. 5. p. filV 'I hr chili, id;y in tuown applies more i.* chrysolite than to other f.hets, ptesmuajiy 1-e i.him.' of its gu.uei solubilitv (m igncwititii. i;t p.uiicutar. unds n> '< lc.uiieil out) and. hei'-ce, its tend'-nev to luc d: down chemically and physicalh aitet piol uigecl i- sidencc (*l). Within the tc-ug. ll'.etv appeus to he a iciv demy for fihcts to accumulate in the periph eral regions of the lower /ones as indicated !the early appearance of ftbrutic reactions in these areas I hi-. .11 ,ii ibuitnn has been at*riot:'.ol to posture and gtavity elfect, (Thomson. [> i:wi. afci't ttmouted p.u tic lev that hive penetrated, the lung tissue app'ar likely to remain v-.h. ie they are. p.u titulai Iv if they are intracellular, sonic* clearaiue chics occur via lymph channel; to hilar and mediastinal nodes, where coated ami muoated p.uiklcs ate seen ^Houriham*. 5, p. 017). although this appears to be less than ^ 1 ' 0 k G o AMV*'* . KH 'HI' t I'M; IHNf A'ts l`)5 ii die ease of oilier fibrogettu dmiv m j> sil standitit; o| the l.utois mult ily mg the pathogen* ica. Thu dillerenrc in clearance attri icti to trsis ol mevulichunu. the greater cytotoxic eilett >{ sil'na, whi t tends, thctrloie. to maiut.im an ov.r.iceiluui peniuou (.t>atril .-/motor / th< i* \ .l Oudirs) t.'ii). in.i' I'xjjl.iin win Itil.ir node nil gi-tra'iti i* .1 m'ie'(or;sis;t'!U fuid:;.g in .isvocia:i-.Mi with silica th.ui in asMiciaticnt with A.btsuys exposure (5-). l he to.mi I .fin ,:os fiber w is letugui/ed c.ulv in die Iiet.itise of its churauet istie ap pearance under light muio'eopy (35). L is usu- allv .i rod-shaped smietuie wjdi riuhbed ends, Less is knots'll about the ptuetra* 0'i oi in* olcen beaded .dong iis length. is yellow to gestvd fiber* dui.ogh the wall ot the i;.is:n>* blown in color, ranges in length ftom 10 to iiitcsttn.il ti.ict, although aiiin; il stnoies suggest hd <<m and in thickness U\m l to G Min, and iii.it this doc* not oemi' (r<?). except in tin* Uc has a <ciiti.il. paler imc. The coating, mmisdng ot a heavy lo.nl Oe'u ered directly in*..-* the o( lerritin gt.mules and an anvnphous uu* s'-.rnach (I*1). What relevance ibis has n* linuuu tevial, probably protein, varies in thickness from disease, vult as peritoneal mesothelioma, ic- verv tliin in5i-nt (^*>-37). mtin* to bo dctrrrruMed. Once it hi* penetrated the lung, the dust On the bash of animal srmiics. coating is now believed to be an intivn eilidar process and fol appears to irmain lixed. hut mu*. he tein">i!i/.d. low* die engulfing of particle' by macrophages .ij j>.irejmIv even lii':u dust macules or s< at?. the to which they adhere (*><). he \rial maunphagc* <vpciiitisc wv;thani>m pethaps being epi'-dt< of may fuse to engulf large fibers It is while the pulmonary edema ami'or inJeuiou (-IS). 1c is ithers are smrouuded by partial:-; fused un- helies'd that smh tetiiohiii/atioo ot dn>t tuny iiopli.iges ilia; mating begins (W*. 'I'he fdier Jesuit in its eviction, a phenomenon that dien liri.umt-s imnipomted into intracyto. louM e\n!.<in dm t.ne event. <>t apjiau-ut te- pi.ivmiv v.\calv, and the first coating material gjr'si'Mi of radiologic change' in the worker appears io l>c some hum ol acid tniuopoiys.ic- uinovcd {i'\n e\p<ome (.vfanfieda, V.- l'r,p;d. (haiide c'tiv lion i-i iiie foim of heuio^nlcriti hshid data). Alternatively, it r.rtv bct';..e re- dien at itottuhn * in die i\t"pl.i'iu of the ma- seipirsuried and tnurrihuic to the extension of cropluge. Iron u.i. -. lies, possible derived Clout dia-rue in the face of no further exposure. breakdown id hcu.agioihti, invome subsC(|;ictu- Uespite the (act that pleural teacthms (eliu- o inoupurato! titc phagosomes, and turnl sion, fibrosis, and/or calcification and nst* u> coueeturatv .nound the fiK-v; esentualls. plasm) ate common manitesi.ttimis of asbesm* theic is clearing *f gtotiiitl substance (57). It is cxpoMiie, there is little direct evidence as to of interest that the pvtac^s appeal', to be a priw how the adjoin* gains access to the pleura, which gressive one, with the mtiiitig increasing with pH'sumahty must hapj>t*ii to explain the pleural time .on! uumaicd hbets ijecoming coatcxl teat (ions. Ashcsto* L**dics are rarely seen in the moutbs oi years alter instillation (fnij; how* \i>tei\tl pleura and have never been reported in esei. bnati'C die propottioti of unroaU'd to pla.-ptfs iotated in the parietal pleura of ex mated fibets in human lungs appears to remain posed persons. rvc*u though they may he readily (oii.ian: widi dme (if*, ah'), dicic must also he Uvuml in the imerstitial tissue of the same lung a parallel process ol aging and dissolution of (.si). Hy contrast, asbestos fragments have been die coated fiber. I here i> some evidence that the found in mesotheliomas even without evt* coating of a fdar tendeis it noulmrogenic. Why dense of adxrstosis or coated fibers in (he lung vmiC particles become coated and other* do (Mottrilune. 5, p. 617). Thu has led to the not is not understood; however, sire may be suggestion that fibers that become coated in the important, with die tvpical a'L-estos body cievrl- lung arc less mobile and le>s susceptible to oping oiiiv o:i huge particles (greatet dun 5 lymph trie clearance than untoatnl fibcis Thus, ^tu) that r.imiot be completed engttHed bv one election microscopic studies may reveal moty maciophage (5S). (note uiHo.tted fditiv in the plcuta than antici It must also be i tuph.i'i/.e*! due not all coated pated ftom the senriity of mated fibers. Alter* fiber* seen in the lung have an asbestos core, natively, any fibers that ate denied to subpleur.il and die puuevi of mating is apparently used hy lymphatics may undergo dissolution more de lung in rc*i*nw: to -i variety of other fibers readily here than elsewhcte in the lung. In any emounicrcd in the environment- These include event, information that would sited light on this glass and cotton (diets, dinumuiemis earth, talc, paradox might well lead to improved under* giaphitc, and carltortimUim particles (10, 55). 01 -02 \% MARGARET R. HI I \JtE Fnr tliis reason, the noncommittal tcuu, "Ccr- tui;ii:nii\'' : i\ foil), h.s been suggest'd as a mi"1.' cviu de'cription in the absence of posi* i.sc iderue :t <.l ilie I,her one. Although ivi'iti't- : ! .'I'.^nion is now possible *:-.:ti; u-i I.:. :',..c* lie' clmom beam, i.i't'i mi- crnjM--l.es. ..*onic. dicin icy ration, and masi *pcc t!.*c:.:a. tltt-sc (c*. 1 >ni<ftics aic cxpcit- 'h' nt tit..-. .*;:d money .:ml ^?H lent.iiti reiich io.-'s : .r while /L.uu-ci, ?, p. lllh As '-.nil. huv-e-i.. dies base htought i.j light tef lon i:trvte': i'.!:% Ftn- instance. it ha* luijj >!u`V. n tli.if ..hi alt fiber types may become i-Mted in !:ii..iitoiy animal (AO), in ta.m t1. i> the am:*..it.ole fiber that is found nmie fte- (jiic-uiA as :1 v ( >ic- of a Ic'rugimms bods dnn ui<- < up s.iii.-r :: <er (i`>. even xvhen both (\p<s i,( sr- t filler ate seen in llic lung li'ylev 7. :.Ji. The significance of this ol>- s(i\.ttt.ni to tie determined: it m.iy sim ply lu.ii-M-iK the relatively high solubility of tlntsoiiiv in relation to the mher asbestos libers. Cyliuilr F.fJ'rls N\ ith.cr 11 w original iliem v that ihe ftbin p.nit tiled -.f .1 w-. i ii it-1 s .mil p.iiticles was tine to pltS'-t-d nrit.i:t in not dm $n!tib:!ii\ thews, alitibuung r it : ;ion to le.w bed-out metal ions a:..! >! one:* .u.l. (,nt satisfactorily explain id ol the t-s;r -.ii:-.;. nial and c'.'aiis.d o'omuvam sns ;U ay tier. n'.d ,. 'I his lead* to lfit* hvp.uh.*- sis t! at !>%: tactors, in p.iititular the immune 'itni. might be impoitanr. either bvtau*c <d :'"C ptoductioa r Int.di/ation of abnormal globulin* in al.eolar phagocytes or librobbists. or bct-uise of auto.intih-.Klics developing in reSpott f (o ). sis o! phagocyte* Th'- me nt tis-..ic and cell culture techniques I. < haidu: ;:*.,,t! umI tmclcr*:am(ii:g of the hin- logic etTects oi adicstm at the cellular level (Alhum, 7, |. sfn. Potential tatget colls in man arc the macrophages (which are tesponsihlc for phagocytosis-, nirsnchclial cells, ahcolar epithelial cell* (which may undergo ntalignattt transformation), and fibroblasts (which partici pate in the fmrogetiic teaction). Two types of o'ogynic ciiceti base hern detected, an calls one attributed to the interaction of asbestos v-idi the t'.n.ii.ir men.Inane, increasing perme ability (a tcictinn chat is inhibited Uy setuut and other ib >h-gU niacromolcttdcs), and a late reaction attributed n> imcr-reaction of the al ready i;gc*ted particles with the membranes around the `stoiidary lysosomes. Because of the findings of similar direct cytotoxic effect* on III ' '[- i.*'.;' - ami me * {in' ila! (HI*. lnt( t! uu h i- n -(> [hr td i...Ida it i* I>e|i(-Cl-|d iIm( hi n-'-.-u my UlclC/.iitC be esokl'd tl:tiettgi* d. t:: :i. i oph.igi- 11 *p -use. ll* addition, 1ft C .-i di.fereiK'.s < ii i hi \.ui.*n* .isle *to* e.;O' * III their c \ t'ltoN t .1 ii*.. h; i *nt:le i1 it. ; i t it i p- 'lent <': 'i< its Kid t.: j >.n h\ 1 be ir l\ -ix id-.iu UMinviie mice u.d nlhc. i i: ...i * .:: th<- Ol'C : 11 h sc i al j >1 c Millie- [ :o ic- M li... a the :ii:tnU : > of f li* im n|s cd. t! *i:e* of th*:i; ivii;;m:!;::i.iil . :;l.e 1: lldu'll i \ for m i. t'fj*" i.to au.;t etratf in pel d'lOiU i'lol ir 1-. 111- 'H*i. and d'e c .ue.*.'. .uis v flleUi n ( ii'U- (ii incti asvmit from iidi.d cd ft lift - a.*d V ai (icei * It ia itoi known whe: lie: lhe th vein ::ent of Sl.c il changes i* dvr el mined pi tin wily !.v (iu: a: lio-:!f <>t du*t at cun uri'Uc,\1 u : the luui* s' n be d- 1 in detail i aider 1 > >*< l'cl.iii<M<%hip) -i whet lies il dep mi * to an imj-oif.UH IS'O O' ' i ;c: '"ii-* bed r^'C *'ilM l pniitlity. I '.\ poii:h ;i;> ::i anituai' .nvl cpi'h miolu^ic <ia::t in m.M 'ui'g'.'M that ais important. The iHe xane, eviden.c wii: b- c-iushlcfcd separats-U uu- let the curious a'best-." icLu '.d lung diseases. Doss I'vdalioiish ;! of Biological Respont.s to Ar-bestos Sxpo^u.<- 1 !U! < .iitfj'? -hi;- J l-'..: -!irp (if ........... .. to st::i::.,i;,. ,il k ;a'::ili.:r in ph.u utautii.g-, v..> i:.u-..hi.v.l U i -''' it* an vth*ri ;! >>' iigl 1 on ti s n.:, ;;t- <: iu- ..pparent \aria- l; -n in i! i- l*I-.*->^it p.-m-.i- ;< iuli.tlid *lu>t- AVh\ i one- pc:.d ec's*! and not the tn-ut w icsnle 1.If* impoMattcc is ibt- only a> i t.-.l Uir rspbiitritg variation* in liioiii^ic b it t *r the \e:y piactird that inlutein t:i - *!>- urluionsltip lie- [!- inf'.rm {>: : t --.did and sii'.m- ti!c h'-is mi which * c*::d h li the uitetia for euvicittiiuem.d c'UW.'-.il. M*u*i' ei. vcithuttt such a t. !ai ioii'hip. the .i*-n. i.irini: b-. tweeu du*e and ic*non>c-i* jitoh.d>l> i c.r-.-ai Hatch's concept dh.*tr.:ted in figure b takes int'i .ucmiiit the p-i*f dilleretues in ii-vj.unsAeMC'S betwmn p;-:*'*rs (or he- tween pipul.itiim. bv i::i;<.dui:ig tin: third di- tucttiion. 1 he implication :* tbit a given dc^- trspouie curse i.m l>e d-. \ clnped for a given prison for population'-, but that it will be 3p pUcable only i. ntuulu r pet-*u \r population) of the ' ime "ttmepti nlit* " J:i this ccmtext. jus- ct-ptibiiitv might l;e tdio l : any nl sc-ceva! biologic characteristic*, t.i hot mce. the elhcieucv of clearance luech.iui*?:'* in the lung, the anatomic characteristic* cd th.e lung/airsvjy sys- ASM X 1 O'- ' > \.K\ V 1 liSC UIXVVSFS 107 expet itm-mal conditions in which animals ;.m l*e raised throughout liie in etn uomsu-tm witii (liHort-nt, bur known ami dost <>m* (cmiatiiun. Vu Ii studies have, in genci.J, shown dose nla! i ii i'l 11 j n I in a il U .11111 <*1 f: bn oil ami can- m ti-k iti'Jj. In .iiMiiitiii, it ir<-jm pusbbh that ui.iiUematit,d computation. i.Aing into account inienniucncy and pulse expo-mrcs (!_j. may enable tun.ic- studies u> make even better cui- mates of dose. In epidemiologic studies, estitnalC' uf the have lead to he much more nude, being based im the number nl years >f serv ice in an indu-ury (fj-Gd): the number of years since first expo- sine (K.1, 6b. 7U); or the total yean of exposure, together with an i-siim.ue of the dustiness of a worker's job t7l-7b); or (itouihuivc dust ex fig. 1. (M<**ltfn-d turn* l (:-,< U (lily. t;-pwnv:*l b\ per- misiiott of poMi-lur: copy tight ISijn. .'mcriran Miilicj! .\><>oiiaiu>ii.} l)<we K.p-'i>- tor j pupil- I In: curie {he lummnt.tl plane p<*r li.iis tin* d-'- ii'pome relation-.hip (or a population of 'ii.sCi such liial *u per mil t(s|<o <U to tin- ilo'f imlu.iied by the ilotli.il line, if on'v If'* per tent wive Hsjnn-.sisc m that <l<w. the uii*>: would he Me1' ilbpl.KV;! dmtmvaid (n-.vaitt the il.-sc ,.\n; if 7' per tent weiv lespumiu. it would Ik- appiopi i.U'.'ly tlbpi.ircd upw.ud. posure calculated from dewt cmweturatiotis for given jobs. Doses miy be t.dculatrd for each individual uoiker on the basis of his or her work hivtois (SO-D.ij. or for gtoups <( w<.liters in given j.bs in a given industty (95-!)S). In all oi these studies, thou; has bcv the pioblem of rainilaiing the d',o for tsvnkers whose c\{w>* sure ustiailv extended into the remote p i-*'., v.hh iiil"ima{io;i ,(!,.;( dti'l t<luccniralionv being at best mmuiv d incomplete and in most in-, stances mmvsiso-.it. U-m, 4*r the physical fitness of ific person (less fit pervuiv ventilate more fur a given work Untti). Alu.t natively. susceptibility might. be con Despite tlu.-.d. uir.ut-.ings of the meth'-ds tor estimating ih-se. .. relationship of estimated dom lo rcs|Hinse has. nevertheless, luvu a consistent finding (table -*b Tim consistency has been sidered in the immunologic some, A major problem, however, in applying the true wtils c-XfH.anes encountered in mining, manufacturing. .md secoudary usage, including Uosc-rct{H>ttsc concept to the study of asbestos* removal of old .obisttw insulation. Furthermore, tclutrd ili-e.MC in anhiiuK and ni.m lies in the nw-m.ifa^iu "( dose. I'rciumahly, the relevant it appliul to all of the resj*on.ses examined, i.e., lung libi*'i, as .!h i ieil ly ivinptonis 77. d<;'e fin li.itth'i terms, the dose d< liveied at the bJj. long Imiihon (dV. 7t*. S!. h7; amt ra*'.io- critical site in the body) is the amount ol asbes giaphic changes ;d*, u\>. xS. Uj-.. ;u*d h.ng can tos dust and liber retained in the lung, i.e.. die cer. as uiiecied in nwualitv statistics (fill. Gii- amount inhaled less the amount exhded and/ 0!-!. 71, 7-1, 77. 7b--Kl. K'i. b.J). Foi mcs-.*(heiii>i:ta, or clean'd from the lung. Although estimates of in vviiich inudi less exposure seems to be capable the amount inhaled can be derived fsvnn direct of producing a icspoitse in certain circumstances measurements of dust and filter in tin winking environment and from- ventilation volume, there tv no practical way to measuic the (see neighborhood and domestic expovure'i. there is also some evidence for :s dose effect us ing liber counts in the Jungs at autopsy as a amount of dust exhaled and/or cleared from me.ir-ur" ol expusure. A more complete disci:*- the bang, cither in the lab`*.noty animal or in sion ol dosc-icspoivse rel.triotisiups follows in the m.m. TIu-s at heir, it js possible to measure (of estimate) only the first our half u.r tlir dose ctpia- set lions devoted to various asbrsto*-; elate-\ lung di.scasCV. tion, i.e., the concentration and amount of dun U must Ik* j*oin;c`d out that although di>e- inspired (in Hatch's terms, the magnitude iespouse rclatiotidiips arc evident to a greater or of exposure to external conditions that give rise lesser extent for all ses{H>nvc, the tlegrce of cor to stress). relation is surprisingly low, perhaps became This shortcoming is perhaps less crucial under one seldom, if evet, finds uuue than a 50 per cent 0j -06266 m MARI. \k(. r MTkl li.) rr|jou%c i.ue. even in ihov; cxj'u'cd to the he.'.', irst Times. In addition, the lopuust' i> u?*.d!v the icmiIi ol past. i.hIut (h.m iiuicn'. *\poturw l Uiv jxvov cotrtd.itmn has led to tin- cur.et.t int<Trvt in ` suM.e}j<H'iIity." i.c.. luitois .ictn-.in: ini' U>r liciwevn-sulijm dilleiencCs in u-'j. -r.a-. Xlu- toikvj>t *C the il>ie-t'e'pMi%e reLurju ship. insofai ;r> it applies to exposed workers. < hi In ( Njiinnil only ly studies th.it me cpiduui'-tn.^ir uchniijiios and tend.lei ;li of i:;'.io `l list Ol uh.it n !i .i:ire is i!sir ^iuc|-t nf <'>': knj.oi!v; t<* a plivsici.i'i ih'iiing with the pinhlcms of an individual j* isiftit? In the f:r* I'l.u e. hinm Udice of do-serc-ponsc rcl.uiun'iiipin:n pi-nide the answer in win a p.u titular pa tient u.is at ri<k: seuuid, ciiis information ::inv .iktt tire phwri.iu in die p.iiauti.il i i'k in o; woikers; third, if may hme import.ittc: it* establishing pio{'ii<nis and dnennininj' a^ftnem. '1 hu*. in th>* d-u.iilcd descriptions of tiiC v.i* i.us asbeMo'.M.hued lun diseases that tal low. then iclntinti.ship to exposure dose, r.r.d possih!.-- di:. t'UCvs ill fi e i!o*.."-ii'|ion\r r-.-h(Kinships oi f..c s.tiious hl-ei p.pcs will ho d,iHissed afu! ' -n.ntai i/cd m t iir- !:n.d o,ii/n in tenm nl t.t i::i:r minus n, the oln iici.ni. Significance of Coated and Uncoated Fiber* in Clinical Material '1 In- <1 lei 1 ir*;i Hi an bodies ;s <.i|hd ill dus a.'-a... ' i a ;t-<: positicr r.U ntd'iealmil * [ [ I'v Mu: i ; . ' n n m !< 11 < u . u >ul. .i Is w of the i-.icnt uiahc-t or io.o.i'I fibers in hinhibit n. utri'i derised Imm pv:,.nis v.ho art (M tujj.tt i - -n exposed *11 ad esnn hat loi'a bv. n [etnifiti/f-d a- h.ilitn.uol i'\i>iv.me (Vi 1 heir pie<-nee in routine autopsy n.utetid. Iiur re:.", loan Cape lyui. Vmiii \U>>. > {'*!). !i' - . [tii. n; !. litin roidirnti-d in t/umiii* 'ilnunmi mul comnmtutio. h. ail jiaifi v v.c.iriti, in fact, wlicncvei > i'lv .-.I'-inv ivmts to imrt i.e wi;b t'.ic vi"i>r of t.: '..Htlt nfd iliocnds on the animuu 1AtL= 4 L15 TI.<3 Of-' SruiVed* ' SMO'.V A C.r: -i .. A riO\bH;i* B?Td.6N s y rif.tATr.D Xr'OS'Ji-;= ` AiHS- fi*;:l L'lOLOoK: POhSc Oo-.i* o'.''-. Me.-}iii^U by v Yrors if S'lJftij'i1 YiMrl jasr^ first OeeubAtion Ocl:unp|r'c., end (I.KStlCII F ibi osn tu4 ' O'-r'-l C.ujfj' *'f a/ ii131 Sit*.'. Cn'iim iho) ZpiIim it ol t /?) SnltkOff rt jl (G4> Regjn Ct jt '70) Mj...us <*f Ol (/*>) Sarw) T^spieto'i (7o) s ; f -r /( (04) H.'"- !i f ,7r,j S*.'r jr-.j : o"'b's:o: (?' ViMifMifl ft jl (775 Cai.vim anti MeCuNavjn (7S> C-U><0 Luaif .*** .1' ini' I v: u'-.t; '*>.i:l Ct a' l 7 7| j>; .j. ; Sr*n Ol f iff f7 (**) Plin.rA Vjahj.a- "f 3? 'AO) '.a.v'lrj.is# l.?o. /1 j . v : .tt rn: ,ri."isi) ..! 6l Al(.ii ,v,i ` Ouff.ji' *f .1.' .77? Ff.tCfr.l * {".! Kendrick (79! Snt^ri.*,- (SOi 'll 'rlrr.i* Hnndrsen (31) Ntf.vhOH'ft * 7t* CumuiJiwi dust tKpoiur* Jo*ti;in (rf.//iH.t| McOoajtO ft ol (8b) BucklaW* ft ol (07) Ros*nr ft at (Kb) Weill t'f Jl (94. 95) F ibr count in parPoingic n'oiorul (electron n'icrocooy) P; ef J/(S3' ri rrf.-i.ru nt jt (82. 83) V .'Donaid c: i5* Pooler. F O (7). 0. 2.-2 * Identified by refarence number in perentnetet. tMintng (68). mining and milling tlM-88. 92), i->s..f.icturing (29. 33. 64. 94. Obi. jnJ tecond.iry ute including removal of old asbestos mtulat.on <84, 05. 75, 76l. 0 1 -Q 20 N x o .b u f o f autopsies in w h ic h search to r M f.'u o ln o u * bo dies was m ode. t Y .;jr o f p u u iic a iio ii was u s u a lly w .tiu n ) to 2 y e * fi I th e y e ar in w h ic h th e u u a y w as c a rrie d o u t N o t* m a t fo r N e w Y o rk and L o n u o d a ta a t t!>o e n d o f th e i*r> ie . tr.a a ctu a l year o f the study isy-ven. AMU M OS l I ' A U I) MM. o o in o no oo oa 2 ^ i- a -vo0- ~ o 2a o- ------ --o- a - a fi ,s n n wA o' a - - * -- a= "- o w3 O 'n3 -no o- j*i r^* wi <oj f(S -oJ 3.t c'f o ; .i a r j -.' o o o o ? f z- a '">r3* 0O " ii 3O -a3 coo o. r Ci ; 109 wt <; i<ras,-vvt 3 E5 = H : ; = S vi (,> tn o (/i o> {/ ti vs W OS VS a r a a ai a -- . -- Z i V a y y; i/i J) ii </> < ~i O a ^ i iii c i n .i a o v o r* 2* - ~ ,4 ~ ^ 1 - 1 ^ - vs s 3. s 0a 5! 2 {<) ^ one i n -o! o: | 3! 5 ce . 2 . iu ! Si o o o ci a o >1 n q o a o s o o' i r* o a 6 -- in o Q 9 o e r i*' > -- o ; ? s o O 9 sees* o n -?' or.' .I 2 Ui J I <t >i li I . .ci*o-oooc*?oor>oo 0^*0 o . O I,9>nNof<fl-*9a<> ailcIIoN1oo(oV > ^flofl o* e o-- y-- --c - f - i S 4 S * <2 1 _ 23 >n oc i5 "< S US 3 3? th%y! 33 <2 i <-j uC i3 - ~ 0 Z. 3 . >u ?C S a -- <A ll <v S < *w I z >'S- ias f i 2 IIsu?iU.jaglfloH^ 2oI2nil2 z - _ ?U - >n:i MARCAKE ( " Mil kLAKE nf tissue examined <n if lung jtiUc is ex I ix,tn the (linu ian`% pnim of view, this inf amined. the vigoi with which it is extracted. in.Hu.ii. based .'ii rpLIctiiuhogit studies, i.on"\ When digested I uni; tissue is cxuuiiud, preva die me.sage that tire piesotuc: of .i.l.t.: . leme approaches lOi) per uni (ll". IN:. U i- fiixiv c-.Hcd or UIW O.l I <11. ill blUp-V III I * <'t :. not likely tli.it rlwse figuirs have lift';; utuch in- .iuit,:>v. m.iteti.d. m, for di.it tn.Htc:, spuf.: . liiien: cd 1<\ die pievou e of met t .'..besios-relatet' 11 J 7 -: i1 * . which afiei ad. only te'ivtis luu; disease, uhich was iisnabs sneulicaiiv ex luti;;.' > ducm, is an indie.umn of past or r.;t- (liuhd tiniu (in; autopsy ,cries examined ^ 1 It tint f.xnoMHC to asl.c'io. ipiusided (he r.b'.T . i*v was found l" 1 <* minima!. peiliaps .i 'iiuit sin.;!-- aiea of o is.ii (ibiosis (h', *.dl). p-Ail i\:!. iiirjti ilu cl). l! tiie hbet is tu-t j r itivels i'ii mihed. espawiu to asbestos low; I'opire she f.m (h it ferruginous bodies mm the I'Ut i-.jc the only. explanation. (! not oa;:iiu .hi ;t.b< s(o> tnie. if i probable (hat eu a l.i'i.iiv ol ocfupirioii.il rx.p><smc ;> a.l(.;- most oj dm>c hiiiud in the lungs id many cii- tew. the phvsiri.m i% utthkils to t'.apiin- posiriv.? dwellers do (riuiitevdt, 7. p. SOi. Thus, pirvu- hbet Llentihc ai ion foi ins clinic.d pnip.os lent** nl (ft t ugiunus bodies mav loasnn.ddv In ih- absence of histoiy of asbestos c.\pn-.u:v. he legurd'-d ,is a uilcction of community ex- Midi idemi(w.uiou might l>e usoUd, inn m mo;> [losiiie. In keeping with this is the ruial-nrh.m impo: nte would be ..n exhaustr-v n-view ..; giudi*. ttt. evident in tabic which lists the data ail o| paiietn's previous o< pupations lor tu.-.. h\ inueasitt" pievaieuo.'. Thus, rural areas and e'er lu.et a petiod ol time, as well as iiiscxib' : small cities lad at (he beginning of the tah'e, lion >! (!.e possibilid ol noiioccup.uioiial C\- luge iiulusjiiali/rd urban centers, at the end. posine. A similar i ui .d-ui )>.m gradient was semi in an other sesit s in with Ii counting methods were stand.n di/ed (Oldham. 7. p. '2:'.l). I'revaleme was also tnie:;.tendy higher atn-mg tr.cn than women, l.i addition. ii imte.'.ed with age (l'*, 111), and when witltin-city distribution was examined, as in die .study nl London, r.ngl.md, hif*l;-r pivt.detnfs v.ete loctnd among (hose v ho litccl tloo.-st to (Ik- thicks and. or the iiwlussii.il ht.m of cast loi thm, among those engaged in heavy manual vonk, and among those whmc nunpati'ins wete in shipping, transport, anti en gineering (Ifli. In addition, there is the hirer- csring observation that prevalence increased with time to l Mb) in Iaimlon. England, hut not in New York (see table 5). Ferruginous IhhHcs have been found on tare occasions in the hilar mules in persons believed to have been heavily exposed (120). and more raids, beyond the limits of the thoracic cavity, c.g., in spleen, sinuses; tonsils (54). am! by. aline User pLujues (?>b). Further, in autopsy Pleural Plaques, Hyaline or Calcified yfibrotie Thickening of the Parietal Pleura) l w i'pw ol pU ur.d u.Kiiou are seen in asoliatiou wi;b a'beao. ixposure; (!} an exudatiie ..'ini, uMi.dii v. dhspread. iitvol1. bo;!i ; . -i and viwcr.il pleura md uu.d. t!.e im. netu In m.t, wit;, oblite; , ;i -n of plvtu.i! s; "c; a;nl (2) a discrete tc.ulion, *:: soliiiv; pitiiial pie;;:.:, usually in m-.;.lb.Hi o:;v 1 -..ition. .-ml leferied to as a ph-in 1 pl.ujuv (I'd"!. 'I he lust i associated svith syivtms and ailciis l;.!u.ti('ii fldl) nt;d will he <o;-sidiMi! Liter in tltis tesitsv together ssitlt pub mouaiy fibiosis. Tlif stxond. usuallv a taJ-sgtaphis diagnosis in all othctwise healthy petsi*tt. wilt be* ioils! leti."I in tin: ptesi'itt section lS.*th tea.(ions may. of rnurse. occur together in ii... suite peisoti; Iviocr. the tliniial p: m m.nioti s likely to be dominated by the exte: : of tin- cxudatiic leactiou. I'-illmU'.'; material obtained from rases with a.sbesiu*-r*`- onrop.'e i(/>/*''.(anr`.. I'letlial plaques lated lung disease, fiber count appeared to be cur as 'Ijsercte. i.ai.cd, giey-white lesions r.n some reflection of dose (54, 59. 120). inner surhue .f the ri> i;tge arid on the <!., As already mentioned, the ratio of coated to plnagm. In a series ol patients who had piet.: n mu nail'd libers within the lung appears to be pl.ivjllfs devft'iiifd At tlios i'.o.sopv. M Utvn .. faitlv ioiiM.tiu at 10 to !W pet cent (19. 5!*). Uiug.pist (121) ununii,:iinl that "despite t! ; Thus, although a count of coated fibers under umfusitm of dillYient si/is .uni shipss. '.>;> - represents the total liber foment of the lung, times sm gesimg an aul-.ipefago, the pattern it should, ncveithelevs, reflect reasonably accu the pU'|tte> is ticvei ihtless monotonous: a ll.u rately trends with res(>ect to age, sex, residence, slightlv uneven sutlace. white and shiny 1 amt occupation. synovia or uiotluT-ohpcarU steep edges rising Oi *206 e9 ASQESTGj-ftfL ' F.l) l LN; OliHASIS 201 abruptly from the surrounding normal plan . ij'-'i. 121). With electron mufintop-.. r i> .q,. here aikl there rounded mound* vvnh overhaul, p.ir'-tii ih.it uio.t plaques loiu.rin n>a;,. ing algo. The consistency was tlut of cartilage '..hu-.tintojiic lihtiv It is <>f inti-ico bi.it d.i>e (he diiiribiuion of pleural plaques l> ivregubt; ,i;'iioie v'Hiceuu.r'ed tu the udv.uicd than they tend to he more marked over the iuv.-- r 1!i tlii- !iS;hii> amic* (1.' Bouf;..o(, 7 p. "i'.i, li*-', ;u.i\ lojl.rw or cross rib lines, iii.iv he CO ! ten11 nctl in the posterior, luteal. or atueri >r ift<l voifacc*, hut mu the caiulaginou.' portion* (31), li.v association bcr.-.K'u plfutal p'.iqm-s The diaphragm is iimsuJv involved, fretiucmlv ;.iul ..vb.-'i.>v exp.iMue. "rij'in.iHy u; ;v.*.jed c-n in (he atea of the cemv.il r-imni; (r>W I hey do cuau.i! a:;d epideuiioln;;!,- mound*. :.a* h,.-:t not occur in the costophrenic angles or over the apices. Mediastinal pia.pies have not been ohserved (120), hut the pleural surface of the ;< rii.iulium is not iufieque-ntiy involved, particu ample ouifirtned by n ptd.tiion studi*r., vd.edi ct ''.pi**;! vn occupational 'r ur-i.-tCC-ipaiiou.l. In occup.ui-ju.iliv exposed g;m::v. sir.h .i> ii.i::v:> (8*S| and \hqnard win ket * 1 <3. 7fu. larly in the advanced case (o k). the picv.denec of pleural changes'on t'. j ch:t i'laquc humanon appears to occur in ar*as iM'lti'ur.'ij.h lias lueti shown to incuu-v in u-ia- fieC of adhesions, and iii* same person might turn in vs.iitinted dove M a ! .^co*. alth.i'. is have unilateral ohliteratirm of the pleura in one ili'T.; >:!r m discnt.iii.Jv .i;,;v hm! :x m.i5^- ts. hcmithuiax and abundant plaque* iti the other, All v.irietio * fiber h-oc t>een impii:.. -.J. liu: with uufused pleural sut fares (fii). Alict native. higl.e.t rates occurring with anthvjhvllae lv, plaque-* nuqht im<ilu` m;c pait of die hemi- (|ikh-n. 7. p. 2Id). In audition, f.iuoi. a-vici-u- thotax; adhesions, .mother p.ut. Occasionally, cil .uh die mu- ,md n.vunv v-t the i1*-- ...it ap- plaques ate found under a-ltu-siun-* ('!). Their- j -.mi to he important; lot instance, in (.mjicc, tliiikness varies greatly. ("-.ilnlkation appear* to p:ev,deiii.fx of c.iln'.u ition diiferetl by a- much he more u>ninton in plaques situated in relation a. Ij-loid in 2 adjacent mining areas, u--.iki.ig to the anterolateral poiiiou ,if the upper tihs: it ti.e '.nne fiber in the- same geologic dep tines tiot appear to relate in any way to tiie In those mi' .K.-;ip:uioii.i!!v cx[o-ed. : -.a; :i\ ii- llmAnev. of a. plaque (' I). l.iib in i'uii.r :. civetC > vnmi- evidenf: -... s::k,. Microifn^ic *r. The plaques con gt-- that piCi.-.. ri'l.itc. chv pruX; ,.u:.V >.l sist of coilageuous connetrise tis.ur, oil-poor, with few nhrocyiic nuclei, arranged in undtilit- plavc* ot ii'.'- : te to mining arc;:' ;. 5;Situ.'! .:ly, tin i i .m inc i .v in the `..iciUO ing fashion iti a < oars*-. basket-weave pattern, of pleura! dm;,-es on the i.-diograt It i,i: some and umtai'iing only fetv tTm-waKed capillaries .* V- i* uliur.il popui.'tionx in which the soil con. (.VI, 121). Elastic staining shows intact lamellae triiis ashC'tifoi::* mineral t3:l. Jl). hvneath the plaque In continuity with the sur l'.i>eti this ii'x-ii.iioit i.etueen e\p..>i;:e and rounding noriuil parietal pleural connective pleural plaque', houevii. no satisfactory thmiy tissue. suggesting that placptcs are extrapleural h i' iiceti tlesclopcd to explain how p.,; ieta: p'.cu- and develop between the hitter ami its covering i d re.Kti-.ms develop in response to the inn.da- layer of ni'wntheiial rciU (51). Some calcium ti*n i>l fiheis and panicles and tin :r de.M*'ideposition is pn-.:tu in a high ptoponion ok tion iti the lung, which ns.iv itsel: sh. >u- re- plaques, and ocruts us granules along the course action to the d*:.:. luiLuhimC, until reta.-ntly, of the collagen fibers, ceasing abruptly where tiie picjun.ed c;m:-.uivc agent, namely, the as- the connective tissue changes into normal pleu li-.-sfs fiber or particle, had only cards l-ccn d:t- ral tissue (54). Cuboidal mcsothelial cells may tetK'vl at the >itc of the reaction, that i*. in die occur at the edge of the plaque (51), occasion- ph-uial platpie usiiig ciectroit microscopy as in ally witH metaplastic changes (121. 122). Ai;ocia- dicated abas'*. turn with bronchial cancer is discussed subse One UypotUtsis that pleural plaip.es vesub. quently. from trauni.uicatiim ot the parietal pleat a din Although coated asbestos fibers have nut U*en reported in relation to pleural plaques, even in the cuenvive series of 172 sections ex amined by Meurmau (51) under polarized light, examination of ashed tissue has revealed die presence of uncoated fibers in many cases ing brc-.nliiug by ',h.;p adieMo* spicule-' p-rnedating the plcut.i. litis tr.innn is believe.! :> produce hciit'Tih.i-j;-: and vahv-.quent o.'ia-iTation of the biod clot in a nmune:' comp irah'e to the process seen in huge hcmotliorac.-. (33. 123). Against tl's theory is the failure to dem- ov 2u2 MARCAKiT K. BH .Akh on>lrjte-iiill.imm.no!)- exudates. and the imtvpirtmus absence of adhesions in ;i'sn< union wih pleural plaques. AIno, imt.tccHuiar tr.uispmiation via pultnonan ivitiphaucv and (lieu tettogi.nlc 'jii'.ad via the durst wall |\mphaucs t.1*u* r>> I* mas* igmg .niiiin of die K'spit.u.vn niiKflr-% i!- um vvetn likely in the absence of lul.ir and *n media*;tub Istuph nude enlargement. neidier u which has ''0011 found in awe liutimi v. ir!i pivotal pla-piei {1-1. 12a). 'I he {h'.pniuoftii.n br-tween ihe tuatked parietal [dental lespmoe and tlxr* -mad amnnm of eti.i- agent led n> \[<cculati<>tt about individual eii'invit* as a factm, a h\puihesi* fur v.hidi thete i> *upnoir in ><>me `todies, Itn not in othci. Aslxwt'as-cxposcil wotkeis wit!* plaques have higher comvnn.ttion* ni g.unnuglobiii (120;, hur similar tom mirations of circulating tlu.uniati'u! fac<'.- ami .nitimidcaf antibodies (127). contpaifd t- pet >.an* nut exposed tu asbestos. 1 honisnt; oi. p, l"Si suggests the following vqueme id event*: Fibeis, partiitdatIv lung uni-', tend to inmc toward the lung pet iphci v; '"Mi'- lease ihe lung am! teaih the p.uietal pleu ra and'or the ili.iplu.igtn. and those that ate he'd up by 'he i ilis <>i tet.<* hunts pat t uf the dia pht.ient cliti; a reaction in tlu- stthmesoibclia! tissue* that eventual!', leads to the formation n; a pie-:; ai plaque. C..diif:i a t imi. when it or cut s, is es*rn:i.i'h. -.1 a dystt.iphii. type in aielluiat ami degt ti'-r.i;ed collagen. It is ptubal*!', ni'.iit; realistir, however. u ;uicpt die >i.elusion of Junes am! Sheers (7. p. 2 hi) rli.it the path.sis of pleural jvl.Kpu that incur in association with asbestos exp-.me is unknown. For this icv.vitt. and het.uise the d-*sc relationship only partly explains the ob* n atioiis. airs fut:her light that could he thrown on the pathogenesis ut pleural plaques might in i'm- an important contribution to the understamlinK of how asbestos produces its biologic eliects, and eventually, how thes might he con trolled. Clinicnl nnit UntUolo^ic Mitnifntiitiniti Pleural plaques. hyaline or calcified, in the absence of obliterative pleura! lesions and pul. motKicy fibrosis, ate rarely associated with res* piiatorv symptoms, including dyspnea (12$',-. '! Itis is i:i keeping with die fact that their effect on function, although detectable in popuiition studies (12$), is modest anil is mainly seen as small reductions in lung volumes (120). By contrast, radiologic changes may be very striking, particularly in the presence of calcili* f.;b . I (valine plaques. howntT, nuv he dilli- i;d n set; wi'li.mt spetial oblicpic and v. i; ' c* del ct led lx**t by high k V If * hniipiCs, i.t\. I;1 -> I-Hi k V, witeieas t ah tire 1 pL- pu > .ue hi ts r d' tiioiistr.ited by lower k\' 'leihiiiques (lit) tu k Vj t I'.uhlig and (iis.m, 7, p. g Vj. did.t'd plaques aie ustt.diy seen ut: ;!>< [.: to.mu'tiot lilin as it regul.u outlines ul mi- cm u density; thev {.ut easily he mt"ed in n.er- i.-.lialt d films, [taiiivuiaily il dies uscihe m'I'n' iI c.ittilago (10). N'uacalt ifxb plaque., n-'i.iiiv ouU win o:i the postuo.oue; i' it' lihu if d ey lie in the lateral costal repott*. > c., at iig!o aa ;'c.\ the .Stay beam, appear as ill deliaed up uics along the costal margins. Oblique film. :.! he ncccss.irv to visualize plaqius that ate i.u.u.'.d antett'Miv or posteriorly. K-mtiii'' t.- ileigt.'.pin. however, can ajq*.o iu!' .'.`.i t utd' a -mdl piopoitum of pl.uptes idenutied at ;u.- t pw; in one scries, oniv Ij per rent wete d- - and detect;'u was t.mlmcd to the most h-..:s ilv i.iicilicsl pi a-, pie* (121). The most usual clinical pre*i-ntarinu i. .o an i.o iden'.d radiologic finding in an :ts\ mptiV". it- ie patient. '! his should aletl th<` phv .iiiau to b.:- p-osihihi;. of CM-i-atie if tltis is not ahead' kim'.-n; in the ..''i'ittcc of oCi'tip.iiiiin.il e\p s iC. ntighboti ut iKimt-oi- '\p.isme sianod i:s `"gin. \li;;c'o`;h ti teseuce of hyaline plcm d ['. xp.vs alot.i- < not appear to cause sym : of uis.iln'.: . tltrre is smile evidetwc t*-:t t5,cv ;dli*t progm !*. Thu;, in ><me series weio .isaui.it.d wiilt a hiv,h; t-llatt-e\[`'*i.ti 1 rnideme ul lum.-bial i.unnomi (S tiitlt, $, n 277 . v hi re i> in iiuelnv t hiyMitil. a;;.! r tiheis. tiiis was not *' (f'2! M..l.gt:r.;t mrvjdv.h'-Htta lias also hi eti n posted a* d.vel.vpiug i;t ;. i: mev-'.helial i-.:!s at the eilqv of the* plaque ', Pieural Effjsion (Benign) Lsud.uivc plcu: ;i ic.u (ions, which may occur in a.sixi.ition with all ol the :isheso>-iCi.'*U'd 'oig diseases, in.q. also oecu as the primary, or i'. least the must prmiiitn-to. clinical :t:.i;t* [..i'n il.'*l-lu3`', pw:sc;i;itr' as an "idiojudut phur.il effusion" :i;H); luiite, die justidic.ttin. t-o (nsidi'iing this diugno.i\ scp.uateiy in a iliuir.d levies* uf the asbesiu'-tel.i'.ed lirngihcues. The prcMiu tlestripn-ui i. based on tl* It1 cases >* las juibhshed (la-l); Imwevcr, picatal cilushm m.iy well be a mote frequent m;*aitcsution of asImsios csposioe than this uu.dvM number suggests, particularly il it were subw- OX-0201271 4 A'limo m.athi n.Nc iusfaxm li()3 (piciiUv diuwti to be a phase in the (' 'lop mail of other plaual changes. Pr.thoUfgy. C>ri iti.n.r<(Oj ie %.ituiu.it' u at t:iuf.it"UCims, `cural sot laces -how ;: .u tiv* v.duiv-' (It.ii actu i/cd l>v inert.. "I \as- v' t:.. . an:i v.iiylivds. Associated t-ieui.d (do ; appear to lx .t U'.tuur. Miiro- 'topic examination dimes v.ui.dilu pleura1 thick- v.i:!, j!-- ::i 1 diii: nl carbon mt1 o:lu*r dus' 'i:it' :: : dti\c gtamilf-" (!"><>. Oth er t" :;t' 1- icgvut'ratiii'j trienheiium an-.' \;t-:*>iiir c-.!!.uer.:! circulation (l.'l), .uul ii . or.'.' : ;! of grar ..! uni {!:lh. i he r >i:s_j l.i.V' ibwte show- car-Sug debtee's of MirM i*. i:i:on::i, .a trihl , 11 V- gi.nl*' ::iUa:::un.v.i< . to ..3.11.:. .1 intersti t:..l fi '|*'S.V. in v. l.nh .,d i-'diCs a::* 1 aie u .uai <v, L-U : : ' U '. !;, to111:d. L iniul-'-.'opic .in.il* 'i >1 ued fiber, h iiievu i .p.-it- ed i* ; ........... n . : i C of Case, but i: Call 1'. a.s -iinicd u ;!.! t''` touttd. /- * l i .uMi.d pie- ut it ion is :tc j\ if idfudon unknown t*1''-, ' *ai-.U die'-' p.un (I 'I he el- fu-:,.;i m.* 1. o'iSa'f d, l.d i'.cial. i.: one -si lc t::p Mi-'.v *!:' ..;h'.T in seipxncc. "M": pieseu- tatix may he ..cute, wi:h lever. kmkoi \tn`is. jin! :.n i; '.* c.Iime::u:lna vi clnuaic, tv:-!; ini-.:.. I -v'-tciim: reaction. 'll.e li-.-id i> f:- !!> .! st.lined fivs! i.io-.d cell C.:::;s r: :.0;::. !i nil *>.00*1 to jh.tfiu ieu*. per ::.nv, an.;, in ;:i.<*. eaves. :* exudate. The I c -i e tie* tuna tb.it of a benign .uni 'Cif-'in.iiii.;' (IH2, l.ttl t' the develop- -f cfir.-.n-. pleural thickening that re- j iif vW.<>itU...;on (131/. The patient's asso- v.i;!. i-'.s-.os may he entreat. <* mure lien us.i) ! *w beeu brief atul in the remote Uii'i-;rfn:::.i The d; ignoMs o* a be nign -isbe-tcs pleural effusion should i*c (mi- ddeicd a eh .gnosis only hy exclusion. The chief alternative ; . he excluded is malign.mt meso thelioma, on-,- of the manifestations of asbestos c\p.sne that may am develop until mane >c u .ft'.r the first exposure. The pleural effusions mat common!*. complicate the h.ttcr tmnur may precede In mouths or years the definitive iliag- i.u-'v of the ' :u\.ir. Iticleet!1, otie con'd, aiguo .i^iln-t acceptir--* the diagnosis of benign ad'es- toe ph-e.-'I eii-niou unril all of the piecut re ported. c.iv-.n a.t followed to death, au-l death n sh-jwn f he a?{ iluitahlc neither to c.uiinuuu of the lung nor to mesothelioma. However, ai follow-up becomes longer (!3l), the justiftc i- lion lor this diagnosis iiiu'eatm. am! .i.hestos (\po\u-'1 t.m ii'acmahly lie added I * j: long list of causes <J heuigu, returicm p!cui d effu sion. Differs? Interstitial Pulmonary Fibrosis (Asbestosis) jy?fimtiort Diffuse micr.titial fihioiis of the lung as.cu-i.ued with ashectov c\:smc Ss.is h Ci.i.i.'cd in the earls years of tlx twentieth returns, the first .isbcsuis-icl.i'i'd. divcasc to 1-. m> rei>>gui/cd (1); lio-.vcsi-r. the term "aslu'iojis" to deseiihc th.it ['KUiti'Koniosis w.i> not su;:^cvied until 19117. sshen C.ooke used it to describe the c,.se of a lunate asbestos textile w*n It is usual to in-, fade fibrosis of the .is*-ci:teJ s iwt ral pleu ra under this term, but mu that o( the puici.d pleiua (Id'. Theie is merit in m.imtair.it:g this spetiJU its.ii;e in line with the isadclv acrepteil ux of the trim pneumoconiosis (1 !>/*), i.uhcr than to use t!ie term hisbestosis" in 2 genetic sense to '.-'siithc all asliestos-related diseises of the lung and p lent a, even neoplasm* (10.. Atrf.-'/ogv .\(iumu-`hu ptrnr/.'H; r. The main p.rth*logic featmes tluu had bee:: d<'scrihed wi-ii *c b\ the Ih.lOs i,. iudisidual ca'* repoits (1US, lati) wire im: >.e*l In Hoiuil.ane am! Me( auglus (lit*} in the iighr of tlicir nun patho logic material, bavd oil ti'.t cases of eliim-i av he stosis t xaunuet! at the l.oudou Hospital. M.irrosi-ipie changes ranged fr- m small area* of bas.it .fibrosis (ii sullniently lo-.-li/'d, these may 'cape lecogtiiiion be the ur.ktd eye) to the fully developed tasc ol a diltuw.. line lduc-sis :'dfenit*g hv'th lungs. I .urn; >i.'^ tends to relloct the extent of the fibrosis; when tins i. dilute, the lungs tend to he Mii.d!. Can surface 'hows the fine, grey-toloted fibm-is that generally ap pears to alien sulspleuial areas first, often cpiite CNtensivly. Iieloo* adv.nuittg into mliei lobrs with the extension of the disease ptoccs*. l.owci lobes tend to be affected first, then midrlic l d es, and eventually, upper l-'-bes (10. llo, l l*1} Small honeycomb cysts may be ieen. in tl*e hnver lobes paiticuiatls, and fibiosis and h mcycouihiitg also tend to be coneerUFatcd subplenrally (I lit), l-.mphysema. cctmilobular or buiimi-. is. (rctpicntly found, with characteristics C'semial!v du* same as iu emphysema not associated with asliestosu (HO. HI). The pleural surface in re lation to the film-sis is invariably involved iu 01~0236272 2\)\ \fAR(. \!0 r tlu- hbrotie process. either mildly, ^iv. it\< the ap salts (III)). 1 hi* |>r-..cn<- of ffrru;>,!:i<".is holies peal a me of :t mdkv covering t<> t!<c Itbio-uv, <u s io ! c\|ici u,l. and r!et :>m niiviO'iop-. i. with widespread fihiosis and syntpb-.-* bki.lv (> iv'c.il \ei\ i uge r:..ud:.Ts of n.ivoaied I l')i. I lie hilar hittph undo a;e i*"t u'u.iih jii ; vets line pum u-d libris (1*J} l In* c nlatge.l 01 Olherw he alh c ted (l <5. I i J . pad. douit foulimiv ill k: : s < \poscd to .hum- La>:i';!<mik i .ne l--.ioii..-i massive |ibu>s.v, < sot .iii.l < l. *v id->1 u- base ..ieu shown i.i ' -v imi d-'!' in the pt ii 'i c"iv e nuis>h e fdnon><t coal ' n:i.ill) sinnl.ii n. am i.ued wad. ciuy- w-oikei'. oil in i:! the nbsemc of tuberrulosis so; tie r.jiM-tiK (V\ a.p if., f. p JT't). i. p. but ;;.? i.hc, unit - the ev I- Mi;r lias b* C:i :r> ntised dust :m'..dh: ; '..be /'-.uv.^r.v-b l i l. i ij; siilt.1 MU, 1 l ! ). Ill ,.<!d h T>. the a U'-yi-is appear :> luic a p;cdili i linn fut lower lobes (!JJ. Ml), unlike other hvu.s u; I'c.uiio;i. at die ivi lev'! hoc .: 1; s 1 v 1 < -:. di-.ii.>ed, and at t:;- ih^.m l\ 1 are presj./ed IO i via I e to tin 111;;; >! - t >! i.lis ica.iing, wiinli pngti'sshe music'- lihtnsis. I lie occasion.;! s<!it:>t y binotic it'U'.n is seen, for which the icrm is*, lorn is believed to ula;c to the retained "d 's.-" ol as'--st:/^ dost and. or fiber. Tbi aj' a l.vst'iui.t has been used (1 la). N`i i lobim;c nodules associated wuh rheumatoid disease (s.mdar m lli'i'C seen with (kipl.tus' dis-M*',- in umI "orkeis) .no sieti (llfi-H'J). Imt oidv r.ncly pens to h*; true for ntihl and inodviaie libvusi'. tesp* cti'i lv, in ani::;i*s .oJ: as wcU a> in man. in whom d'e :e.p-ha. la *. u i ei ut\! jo '.'.-e" u ' linesi, as u';h\ is * bv < om c nu ation of cs'.rcd {Hi;. .'I'd itiii'Mied |ian;..! ' ;u :?* lung lissnc is ;m- i:!>:>t.'intiticcs. Iii .iiiim.d studio. Calls dust tc.inious include a dr.|ti.i:!iaiivc a!- ti'piy (dn; howto- du-:. 1 *>*'s nut appear ta be turther pi-`->ri'.i -n h *u. moslcrato to nsei:* \i-d.ir response (Webster, *d, p. 117). a :o'c;:-.o f:;.assoi i.ovi! w::h an incie.ise in ti<*sc (M, dr it :uay ha* 0 it' cunntetpal. in in us Ml 1 '"K I'J . it IS. uivH'ini! . : so;!.-:-d that die proxies I n add it nm. dna e is ist: ca>e tepnrt id clt*. jua'.uaii'.s 1111es'-1 i. I pii'-imioui.n ssitb .v!.:--: : n!- si.in lawn mtHiet.m ? > f\c>e libtosis is di;e io tt f.s<toM, <>;.. : *.:i':. intlair.ma:i'.'.i. as if> i.i t!:e bin;; (i Vi.. ;>;.<I die view h -> ! I: cv ' ..s vd bv A.1 .: .:r. 1 I ii [ijilsMmi (!`h o: pifisei' dial list', is one end. of a sp.:;-.- d. i: p- * * i.1 i *. in \r:!-{ > 111 i * . host tfspo:! .. .' end- null libiohng .:!\e'I:iis An Me*. f s; ^gvr-h. d b\ l a. i W'.i:-.. r.k ,'l t!). Thus, h the a Kim tu.ditins in the eoly staler of :de. (anus hum .-s..::ii :.i!io:i of biopsy tn.uei id, a s>:i !>t. r uli'viva'. auMainibodtes. < i: : i:'m -mg.ini. <.. im ..:!! . ::iii:t.!.ir amdn-1- alis soupbt m <'tnbhh ;; di 'g.iosis id .'.botniis ie> v W \i. ms::; . . h .mb .!i.,brls greater fre- (IjI, lb')). '1 he early reaction in die itster'isu.d <pavncy in cxjkiv ;. cui.p.vjs-s\ tv tt-ttvsyA'.-.sl. tissue I'-sembb's th.ii of other forms of iuo.rsti* pcrs.su> in ti'*c !.-. ual ps.-puli iimt. and with rial p!Jcn;uort, with mixed leukocvte infiltra in esposetl popibab"'. wib: gts'atci ficijncttcv tion of the alveolar walls, moderate numbers of in those wih ili.de d di-' --f than dioe with- phagotytrs in the alveoli, and varying devices o-.u /l'dt-!.Vd, Vu: net -V.'.i! wi: ['.ropvwi 5 that of otgattir.ition with fihtosis (!"l. 1 l*.. In some ANA .u t' as .in tt > vl*. r -:or uu c* the I'd1*0:- ha< t,rsts. die e.'tlv .Innges .ii-.* canr.ciiti.itu! at d : l--;i ii.ii i.m d b-. .1 ..jair re .".y'nt (Ti.rtici A\'ar- i` \e! of tlic trspiai,.iv bronchiole, when' tvtiesi- 7, p Jr<S|. .Si..-. ! 1 i\l daii.il ioli wot;;si fit bit hbeiv itt.ntopSuraux, ami dust particles sul lb- clinical ohser. a tv <n h. / .'.sbesu'sis m:v- ..p- len flO, lit*;, leading subsequently to what ha. pear lor die N;>f dr'.e -u;.l piogicss l.*n;.*, i'"i been termed die basic lesion of asbestosis, name xpiisiir*- ! ilnsf h o ic:is*-d. HiC pivcsiliiluv (Ita; ly. a jsctilsTOtxchtoUtr ftbroMS (IHi;. Fn.m Sw-ie. genetic la. tots in;: i. ik.i- tb1' respou-e to Vsj( the proem extends outward to involve the sur sine i' suggested in one st. <! in which tl.c ! i .-A rounding alveoli, leading to dilluse alscolar wall ICr occurred with f,f:.;.t> r b e ptrncy in asbewO'i thickening, with peiihionciiiolrii and perivasci:- rases tompated to :!;e geuei.il populaticiii tiaC). t,<r lihrnsis (116). (u an occasional c.v-e, the fd.:li 'I tv.-rc* is aho a pro<!e"i.'* dctrc.ij? ut the '.o'.d sts i mu. ins almost exclusively pci ihronthiol.u IvmphcKyti! uitmt with ash uuing fihro*i*. a:tii (l-l-l. figure 5), but the more usual pir.tuic is the suggestion has been made that the ivlhiltf that of j <!ilfu>e fihtosis. involving the intei imiiuuie uu-chanistn i> disturbed in asbcsi.no Milium, fvetjstvi'.tlv associated with ateas of solid (1.77). fibrosis, whete laminated tollagen may iepl:>t*; li;c ptogressiou tjom riiihiv.* interstitial lihrrs- the entire parenchyma. Such areas may alo show sis to conglomerate fih:.-si may, in the past, alveolar cell hyperplasia and sdcro.is of vessel have been associated with tuberculosis (1-a). 1 01-C2G* Adornos tu ttu I.UNO OibKAShs 'J05 bat tiirs is tate :<k!:iv in the l!u.;<d St.r i laaerlintf, 5, p. 156) amt in iUinin (Smith , 5. |> I6u). Nor d->c> mth progression appeal u) ui.icc n> a "rUvum.ifiUi" dwthe-is (9<>). Ou ''C <n`iir baud. ibeminnml disease des eloping in v a-bes;o worl-.-r is liable to 1 e aww.ii'vd : V . i p; v :i .iiu <( lung changes of unusual and r.it'.ier :r..vkcd <.' ir.actcr. 1 In- u!-i;i.sti'i.ip if emphysema t<> a-Jicstos ! .-I c\noui;v ft.:n.ains *o be elucidated. VU\?i'- i<i;u su.iliC' 'a.aiill.a .liiw.u ub\ti u< fion is i-.-.nriiui;; in the Kv'riU'C f>[ fiijro>t%, pupuul.iilv this is |'i.TMi'.(.;.k liio|.ii in Incatimi. ii. would -tr. ic-isuimble f ribe it to the dint ). >ad. In absence o! dye: fdmisi.. and gisr-ii the i 11 : of dn- >"; Aim* habit. it is mote difhodt in determine the r->1 e of a dust load in the d-.- i! -piiiCtH '{ curby-cna. To dare, there has 1 : mi sS'tem.ctic autnp>v study it; which tue I : v derice id ceij'hvse/nn and/or chronic br'-n- iin w.i;'sO:s i \ pi wed to asbewos was com- j ard with ti.e prevalence in nouexposed j* r- i.v smIt .i> of !lvder atul associates (!*) ;a coal uniker*. a s'te.l) that dearly showed ilte tstcv* of i 'C.i'i.i iii co.tl tuiiivts. An Open i.iin.l should he Kept mi the *uhjcrt until lur- ll.Ci evidence is v.-.il thlc. (prs'cs, 111e\ i.'-iuine tiioii' v.idespiead atul orcupy a grv uvr p.ut ol itis|'iratioi;. I hey are ititibutcd to tltc "sudden opening of atuvass in dellated tettitories of the iutig" (I5y). an cxpl.iualioii Mip|>m;'d t.\ tin* f.ut that they siri11 l) the gt ,i\ i'.itiu.uHv lowei lobes with changes in posture (lUS) and have been diowit to !>e consistently detei t..!le a gnen transpuhuona.'v picssuiC (I'liVi. i)ih;'i .iiivenlilious sounds, sin,; as wi.Avrs and rhonihi, ate less common. Air i mi v atul chest exti.-.nsiou ate Kkeh to be ,;ih v.tcd in propm cimt to .issoeiatci! pleural cbatigi.s. Clubbing of the fingers .uni toes said { be ptescut in most ca>es (lOi, aitbou-'h by t;o mean., is tiiI alw.r.s line (101). This sign does not necessarily imiir.it;? advanced disease, be cause it is alat *-poited in men who are still .dic to work (9b. lift). Tin* lack of correlation with of libtosr. i> seen pauicut.uly s*lit'j\ the chibbiiip evaluated systCimdcaUv Irom casts of rligits to al!<w measimunciK c*l tin h', pouvchial angle (Me5, lift) by the method of Regan and ass.`ri.it.s (K.'J,. it is of interest that sniukiug also appear, to pho a part in the develop* trent of this sign (U.mics, 7. p. I9. an ass-uia* t.ion detected in epidemiologic studies, the si.p nilicar.ee of which is unknown. CIinic.il l he s>. up; and signs of dilfuse mretsihh.l f.ht.o'i ys ,id,-s;os exposure ate :;>> dillerent [mm thou* % dl other hums of diiiuse inter- >utial fibrous. TV. ;*, th." most prominent symp* t-'itt is hfc.it'uivs`;:ess. f.st noted under the stress ellort, then, at rest, as the large working re* i'i\c of the h.r.g becomes progtessivcly re duce.!. Clough, either dry or with sputum, not js ior.sisi";:tlv pf.sent as dypsnc.s, tnay he se wn, with tli'i;1 j-iitg paroxysms (10). Although ^i.u.illy aniiiitr.cd to aitway, ratlier than to h'u-tstiiial. lung disease, this symptom occirs wuh gieater fi'cipuciiry iu the ashestos-expo-rd nlcr than in Ins uoucxpmcd counterpart (Ho. '(7. HU) and often cannot he attrihuted to dif- k-reocn in smoking habits, suggesting that tin's wmptom also relates to asbestos exposure. Chest piitt, not a frequent complaint. Iras been artri- bund to muscle athes, because it appears to he p.oent only when dyspnea is severe (10). Tlie iinwt Iiatacteiistir physical sign is the prc ericc o[ ucpita'iom. which are described as lining a "crisp, clc.m, quality" and or<lining late in iospintixM. usu.illy over tire lower or middle lung roues (10). A deep inspiration may be necessaiy to elicit them. As fibrosis pro* Ji- v/i/*{t `*/i/i.; hi cotisideri* ;!:c* c'n.st radiograph of ti;e in dividual c:ov f ' <h.ig:t.e.tie pui|.)sC> (l<. llil'). evaluation c*f :b-. pulii;'r*nary parenchyma *`:c*ul-.l I*.-- based ott the lollowiuj' f -atuii's: small, irreg ular. and or round opacities, scored for she or length, pr-dashm, and number of ioe.es af fected; hairline ring (honeycomb) shadows: .1 d'lfnse ha/e or ground-glass appearance not oh* sinri'ly due to p.le-.ira! shadows; short Ut-t'/outal vptal lit.vs or Kerley H-lines, believed to represent lymphatic obstruction (Mi), and occasional longer hairline shadows. I'leuni1. changes are likely to he present as well (in more titan one half of the rases iu one scries > contpenvtti-ni board material), whereas in '-> per tent of cases, thes w-ete present svithetu par enchymal changes (I6d). Rounded opacities are mote evident when the: occupational exi>,-.;;.chas included silica (93). These finding* are hi gcttci.d agreement with previous repotts (lri.11*59). Thus, it can ho seer, that the rudiol.'g.c features of asbestosi* arc no ciilfereut fiom tho'e t>f all other forms ot iutvi'iittal bbrous, except for tle prominence of associated pleural chang es, in particular, calcification, which should 27^ 02^b 0^- 20(i MARCAR R. IdCkt \KK ,duais i all attention to the possible assoriaii* with a>hfMn exposure. iu,; m dvH'iitiii.'.- <'vjMicuir tfspnriN*' relationships has |.'ii.mod mk:c:uis to he ih'awri A sssimutie tl.issilicatiou of dm tadioh" n ab'at tails t.luts id adas.-os oil tie imr-'. m changes as '.'siaittl with asbestos exposure v - I oi niaiion (hi: n. -s i.Iu.imkT. !ia. e con- eh i Me l-'dl.Ug Tl. o -. "1 die fe.uuri s diMiil.ed, togeti pi.u'ii.d laiim in tii'Us o! the v.ockci's la. v. ah ;d...i.d changes, was developed fui c-i- |lii- is.;;- d hb((lM. .I's; .. :.-.;fci c-. idi d; ; a'l".- . a : Tpo.es. fust as the nClb'Ciut Cspn.Wil l;> *;.>s is v,v:m:a!:\ l". lieled :<| i.a:i < atatioi. (fd7). later adop''.d as ;.'a i ;! wt.\. cf;c ir i i\at..! ".T.col.u 11.0 c r ': as'-Uitation (IfiSp Jls f.-ainies elude a i hng sheet, an extended !C-oo;-:t tapillns !!>.'., j>-;it'ius ul pubnoeais (.mili-m. s!i;;i!ar i- din - :i s-. i: j i die in'-i-.-m ! scale- to ^1 . paieiuhs ni.il chang.,s, and. s*-:idan! Idtr.s : iissi.t in tIsc c;\alnatinu of pieiu .1 and [< ;U n.!. in.d (iianges (obtainable liom ; k"loMS f. -in uiln i.. rs i I'.ci si e. 7, o. ?; t hai .h u-t i-a it '> 'mm of die .-tal !n-'d v.ie i'..idi iliniiai air1.'or i.i<!u-.;i. phie cieUm : of Intel nasi : ;.d labour Oflite. Occupational ha'-- di-.e.ise) .ne: ;:e;.eiai n stvn tion of lung s! tv and If;: .!! h !*.;.! licit. Cdl Hill (irnn.i _J. V.v | * /fl I.' 1 V !. ih ii Sw l-'rauis `.'.'>(1 A l In- uu ol ui'irs. p.nlit ui irlv sh.i! f.ip:nit\ (VC), with. iileit mi te-id . b c.dinue; denease in tt. vs. tins cl - i -hoo. b\ iiinnoviug pictision su.h as l-stt !..<! \ !diatf.is vedunn- (.1'!''.','.. pio.b.nd-. toiiip.ira.bjlit'. bertiecti i. in j " i o;. .- in V{!. > ilia; ;a. lias 'riunrai d. the s ir. ;> die X iav as an . ;d- ratio of t'VA', t i loin.! \iu: tape.s'i'v (l-'V'x:. i, s1.--mnd" . '"o! (l-;r>). Thus, it enaiiles a lief-r i datively nrd pi;M-;s--d: decieisc in di!'.;.vt:-.; plait: --i die r.lui in dm nudddum-nsif" ! lap.uiiv. ;i!;:i:.u\b>le m part to (he detan. "coiumu.nr.: which extends hunt rou.pletc ' :u- long *.uluu;t ;i7o>. although deftei-'-d nu*m n: 11it\* a* 'r,v cii-l to th'! most sever dvgic*. of In.me tiaumi and itdioniogrueitv of irgiond ainiO! m..:k ty at ti.o fii^h.cT" (Hohiig 7. p. li'V in \ ntil i;ion ; .mmi 11 l.ti:on-,!ups v. in:in the panic.d. i. In. pvallotted tin- '-\phu uio- long ondnid.'vd.. < "iirrihiuc To die impaited gas the c\p..-- * d< si- i cl.ii tonship> f'lsing dm c!. .t liansf -: ! :, >. luip.iuiurnt .:* ej.is CX- [a'li--: : t* iv.-.isuu' ie-p 'ii'<-. in i-.oi' i '.g popida.': : fn addirj.m. nh.h i!..sifuatie-.-j 1 ; th.iiige r.'p-ld .: v. liflv'Tcd in arteri:.! dm* ;t::ja li -'i. inn:: ' -he "i.iJ-.t.'ieii.il I'.w y.i.idi, ;>, b'.tU d..t! i d ! a. it.:upon .alion !> i.u ds in sv ! ami h\ pc-i .'.'toil, in.iv at fust l<>* esib-.; C'iiiii!: ; i . i improve condscenci in the tead.-.g .d\ unde; i-'c-uisc. hut UMin ul i! t r.-.-st t.uliogvaph and .shov'.d :-c .L is'1 t * .ih.ue-.e is not U-u.nly allet 1st!. ioed ui - ; ns er thii evaluation ot a petsotds id.a- and ai:u..' 1 tv..' ".rt.x: is not lio.d.U a lea* tmist hi i- laddered cclative Co d*os<* of other- It niii'iif ilic r d died i ,tse. must be t :..p!-..tsi/ed. howcsCt. that this tla- : Vdnmgh !,:; is imeiuhiue ( suggest. fh.t cation i- d e-.riptive and not diagnostic; fimi.er- f'fn .unis dun {., tin\in- is anv diitnr- nt mote. .!:? ugli ratUoJooic change- so deicrd Csl (ha' due to '!.: I libel'. "ilf t'pi.tt'miol*n'e Hnlv tclate r. < rnddy well to lung function change' vgyests t! 't d'.eie ii!.ii he gK'itor '''rr-m* i". in .::in studies (H7, 95), their rtd.t;t*.iship to d i .f-iiitv, which is likely to vary n.u- fom lion Ini r>j uvdcp: ( .nuialed c.\p*a::'' to ti"ido!iir fe-o.'icd *" i lirvs.'iilc rdr), ,t cl it- sidet.dd;. :-. nt subject to subject, has not hieti fi'ieiun th;o . aM !- spl.din-d h\ gu-ac" ie- widely stu lieJ. lemion ol ct t!':"",e con.pared io <.:i:y>otiU; i-n Z.tmg Function t'i|ni\ il. m s.ini.ti'."' espusuie: b n-.'.-o t. in dm lighi of ilie: p-'On-ial ami. indeed, hit". t.ddr Lung function tests have bun applied >> dm i.i.ni in ai its *!.: i>e el all einuts (a ts.d'iaie study ot .sIk-siosic since their general i lion to cltitit.il inedit luc in the 1910s. In g n- itnioie past da-r e-.po>;ur*. in amount anti W natme of the !d n. this inceicsiiiig n,'<;'i\.i'.; >i, rial, tin re :ue 4 clinical areas of applh .'-:u:i reijuiif' Imtl.ei toudu uiaiiou bdots u. i (H'j; fiw. ` > ami :ivcssmem <! dj. siniii.il 11:;i' diiteicn* ld>ei< hast tliiferc'H fib:'-'- ability; h' j'h!. (or following the evolution of genii, potet;::..'. man. disna.-* with tinm: third, lor the uirvcillan.c *>t It is lin'd.\ liaiu'isl mat airv::-.\ obaim:..':' hcahl'i ..'tkfis with a view to detecting early is not a feature of ;isb* slo a> flib i.ul.d., rh.mge'>. and fourth, for pteemploiiueut t-x.itu- hovsC'U'i'. a iistev. of published, case (l" illation to screen the "susceptible" person. most with unoipiisot.d [i.m'u.fi'.m.d lad.a'i'git In ad.ti:ion. information gained from cpith-mi. changes, iiulita'.ed lha' a consider.ihu* muidiei of ologit studies using pultnonaty function test- patients ii.nl air.'.ty uhstruction (11 ptr cent 01-020 ASBtjlO- I.L M. imtAif.S 207 <nitt|Kirctl ut SI> per cent wiili a tesmetiv t-ir- c.ub' or late in the development of his disejsc. tern), whereas in 18 per cent, the iuttctiou im- '{ins dhuep.incy between function and ivtnp. p.iitrnent suggested a mixed phturc- ot nbstnn- toms is .dvo found in some epidemiologic und tiou ami restriction. In addition. suutioy uf ies (172. ITS, 17'). but not others ('Jo. y7). epiilcminlngic studies in working p<pw; ''< 1 n Th-: iinp'ittun? cnnelnsion fordir.ic.d practice is (i.e.. studies th by their nature. exilud*- the th.it in the individuil rase, disability cannot disabled atid : 11 ' it .1 lew. of ih'sC with iadi > . b_ predicted with icihliilUy bom svmptoins. logit, <!i'C.i*e) insatiably sUuvvx a sueaMe tuani- i: '.ii, ti>ii, o\ tadmgo.phle changes. It should her ( persons with cvMcncc ot .tiiw.is nbstrm- tl.C.'Ctott be cvalua'td bv apiuopt i.iie e:\crci.-: tiuu (fi), 72. 17'1, 171~l 7jh However, llcie is tv't'. it ne-e's.itv at 111*te than om- load. u,r no cf: t evident** showing an i-x.ess ol anwr. e..-`h ctt'C individuadv (Hot klake. 7. p. 3). filivti uctiim i.: .:>b*Movexp,,'Cd popular i<ns E: e/.-.-otget u-itii time. Serial me.i- (ompaicd m i.-<>*t cm so exposed p.'ii. IT.'i, surer.lents of lung '.unction in individual ri.o .'i .l there is no ck-.n evidence that within ex- -I'hisiosis wi;U time suggest that deteti'uatunt post d populations. t!te pi ev alcm e of nbs.ruv i' -n-"t closely jeflectcd in VC (,0b 75. 18')', and, iiit imrcMM-s with it.creasing exposure (I 72). jo-u-dy, maximal volunt.nv vvntii mioii. "Hie `I he icsltictive patterns of lung function -dto ilvifs not. show in increased ptevuiente in rela d.--.tusing capacity 'A the kmg for CO (l^cc). otigH.allv p;op*%e<l on ilumictie gr-v-nds :i> -veil tion *o exposure 1I72). .-s <>!* the ha>i> of some iimit.d obs;*tv,.;ii,us To tliis time, therefore, epidemiologic studies < [ 7h-. may urn i>e as useful (12S). fil Im-.; hinetii.n have not been ai>le ; cluti- Support for then* cuucltisi-ons ab. ;oi:i' > from date the relationship heiwren airway ol>;:iuc- f-pid' Tnii,logic su.d*ex ot exposed working popu- tion and asbestos exposme. >r the part ['hoed la i-iis in \vi:i;h doueu'c ill \'C, in p.ntiiul.tr hy the cigarette hal.it (additive *r synergistic). the 1C component of-VCl, sliowcj a cioer rda- In (onsetpu in*:, even in the presence uf radio- li-'ud'ip to estimated dust exposure than did Ica-ie there is usually hesitation in at Inc's, measured eidn-r by the sing'.c-hrcnth or tributing tin* obstructive eviupon-.-m of a voih- ;!: - ''. ai'--state : ui<p:i- (S7. f) l,. Other s i-r's disease to usl>',-i'siJ, despite the tact that tieueas*tl -oihI'.k in. i: has i.-e; .shown in mhri tu..: .-iiowed a : :.-<ion,!iip to exposure i'l v'j ;.>7) aid ...\iinil mid-ex pit atot y do'.v forms of hiler-tithd lung disease (177). With however. .i:l .studies of a:t epidettuo- out radiologic. hinges, thete ts ev-n grettvr ! .-:ie ii-.tute fi . .. tollmving flnu^'i in a v.hok t?!iii';imc to attribute the <.L>tiucttoit to ache;- ' nl.in-g p ipu!rattier titan in a few se toe exposme. N' venliebrss, thent H enough in lected subjects* .nutId pros Me more p.ecbc it.- ditett evidence to suggest that in rtspouv tv f..:::iati'in on this p..int. best>s vxj>osvm\ the chancn v of the function '.r.ty; /f- tt- tt-'**- This implies detect*on of dim impairment may be obstructive in a terrain cifects in a pii-.on hr fnrc he or she perceives number of rases (1"j); until further evidence them as v.iupt-Mn'. IVis-ms shuwing these early is available, an open mind should be kept in ilianges are mote likely t<> be found in a-work iki* icgnrd. ing population than in a clinic population, he- /fueyon.r.it of disability. The relationships e-i'ise clinic ntlond.une pievupposes symptoms. between organ malfunction (as reflected in what Furthermore, wiciun a working population, it may be called descriptive measurements of the is reasonable t*> suppnu* that svmptoms v.iil oc lung. i.e.. its size or lung volumes, and in the cur more frequently iit those with heavier ex- measurements related to its mechanical proper postttrs. In one cjmlcmioh'gic stinly coufmetl ties), organ failure, generally considered to he to e\|*osel pet sn* v\ itlt.ntt clinical or rad Miotic present only when gas exchange hmi-ion is ividetu*' of divea-r. and svitu iiMimd loutitie impaired (-13, p. -H2), and dunbiUtx (binmui- lung lum.tton, it was possible to detect changes li.m of perfoimalice as perceived bv the subject in tie In tigs' met hank al p.ropertles (sticcirical- t'imsclf) aie not straiglulorsvatd. Thus, consid b. a dt'uease in compliance anti an incense erable amount) of oigan malfunction (i.e., ab i.i calculated ujotieam tc-'ittauce) in tlmsc widi normalities of lung function test,) tan he heavier ik'-st cxj-'ute (8i). These changes sug prevent without organ failure (i.e., abnormal gesting a dust eifeet at the small airway level blood g.;es). even under th** sttess o* c-llort. Likewise, disabi'ity in the form of unusual would be c nnpaiible with pcribrondiioU-.r fibro sis (I Hi). Similar results were obtained in a sub breathlessness raav be perceive*! by the subject sequent study of a larger number of subjects. 0l-<SJS<.7t> . uk rJDS MAii'.AKKT f uckiw\kfc 'I>>1 K<! in" ptcdiminaiv hum (ISIj. ir.ing (In- id'cu [ile.iral di.case, and iung (unction im- jIi.nuij; volume tC't. At pics'/nt. these ol-scrv.t- `i in Pieiit of alH soit (in, hii, !I7. I72p If ad ' iii ii\ have iii pt.itiial signifKinu', 1 Cause* it uueii.i aic present, (l;1- ili`"po.is wouhl genn- icni.nio tii 1)C 'L'imi (/) tli:t >h.ii is deterred aLv he iottsidet*. d i siaidishcd fo, i.roi ion.pen- i'. i.i fur. tin. I > ginning of a plows* that will -iii.ui 1 Kaids. \V:;h Iruei ui"'!ia, thvie is les* nhim u.! . L vl : * asbeunsis, ami (3) that a.tiv u itaints. imei\cnii- n. ninos.il fmm exposure, In the ali'cpi:- of m cxjjosiue hisu.rv, or it ' ni[(l pieveru t':f ultimate (level' jenei't of dis. I'lruu v.h u s 1><--1 i.iifl ahi..;: pad .up- d'e PNjKouic I i-:- iv i' v; odc'vd too short u. a. .out Im tlie mnt of divasc prej' i:t. a tis- eh*. howevet. i; t'ueau 'li.it m i:> ca lie:' s;.ig'-x ot ties lojuu- 'he fbuosis of a,!> >-,.-i-. .<j*- sue h .;.no'i, i.: o 3 <v- < 111; ! foi. p u ri, nl u !' in , ot,*p,i:Mtiiii i . 1 > r ,r iS.ut ;hi!it\ i* i ii -v tu i tel. 'V. to ilu-it .Kiurai.! anti in -hmlii. In s,"L i: u.i! cuts, an .ii.i-ii hintf Liop i!>< rcfoie. hv ioi.-ji-.-.itiutt, removal (iota expo- 'i il-lfj) is pielcirdne to a needle i.ioj-sy f 18J>. mi:.- !j\ [i.cv<1111:* t'u'ixr atiuinuia*. ui mi^ht p n'-- id u !\ if m-diogr.tpliic i ! a i ;ue md'ii- s'o-.. tit** I ::",e finding,, ;!:m Lave i:i;d. P.LM sv ;lira : d shouid * c (; hicallv e.xam- potential arvpi: r.i:: m in t!;.- tuture. im d hv ] gilt nu-.rosi opy lar p .uhoiogie ft; itmcs. iu'HUn". : m:;. i rho^nj'ltw r'i'll:<>!' :( t'.c (>ii! v i/'\Y( r.'-r. !>, ii,it(. .Several '.t!'- clini im iudinc I'1 1. s: i ; o! toa'.e d idr.-r.. aiad by i 1 oil HIM t .,S.., ;>- 1 a' the pH u-'W of Vian - mi- cal an lies. \->mr ha veil on small nutuhes of sub- id h fsi -: ; opri ite extiaaiou pun C- pa ts. suggest, d th a tn ad.eitosis shames in tune- ihill'. .p, *>!< ;. 7. '.`1;. \lsn.. .<c o'o'ialtv. tii" t:- - n pieced:d (...m-graphic < h l'df*. p:e>e iK; of a d..s; s bodies in the sputum VII7- IT'i). I lie Ji.iii luticiioti I'knului! uric : i`h tnav at* r: ti >< pits si< i.Ht 0 die pos dhilitv in V(. (Li. Pl^t am! I'l-co ilT'id S i : ipient d e'..postirv and u suit >n an apprc>;>ri:i;it!y C\- epidemiologic s;..dim suggest that at a* far '..mo i\ <;u pai:-. ll'V; d tlie suiiee of l X- ;i' these isvo (-> of funct'ou v eu' ihmv: tied, 5 <ost i t c. C ala! rd u he** aie, of rotif.e, cisuunotdv thev v.nc no n >* sen'iii'.e than i .fli'docn: loinid unde: tiii.'.i;: i.i- f hc..vy ami current ili.uii;ci ?, It mum In- emj h iu ;l that expo-ure. lie latter i mu !';:on were lv`0'1 on bi'wccti- group rompa: i . of (la.vihcil Lv duo expo.-uo, fo: v h'-.h i leittihiMiiou ol .ti:uj>*;* pi.i! . :?**/ M-'di' ul me "tiorm.il" -i.n d.ttds is .uiv I'-tcc' ing aimiHiii:,lin in the individual rase **.rer* The out!....-. . ; ,i;p pel' u wide a'hestosis has t.iiniy is amum: iinitei, bit.mse i*bs r?ip;iies umhudnedis- im; >ved fiusidt during th*r irfeteme 'i n. ! :N of uoimnlity, ultir'o for p.,i fo se. is. ho:!, in t.m- pc p7? and in North hoth i.Mli-,o|..p: .. studies -u ! tests ol (unction Atonic.i (<V>|, vi:h age at death, vvao of tv have (ai.ly wide ;:-n"'_*j. Periodic tympar.ttive posoit* until tit .' !*!,. ami ve>:s o' survival dust tadiogrephs or l,.."'i *ii texts. are lively to er diagnosis jncf.vsing ivioipidi.-u-ly in itio-.t iiit|io`. c the ihan.c of detecting v.uly almntmrdi- lountries. Also, tt h ot nrptn.ttiit-.* t: : th dun to ii- % in a ^iu'ii [p;:oti. h must l>e home in mind, i.iimf tt'spii Ho:\ ili-ea*"' seem- to In' e`*u.r:ii'd however. tli.u t- t.uliologic (h.uijtps are invarr u* thosewith high dust cxp'inoes (MclHm.iLl. ,iJly of a iuii>;v.riiic natuie, similar to tho*- 7. |>p. 1'" -I 7,'i. ocumitig svith ac'inji o: the cigarette h.thj: (I82j: Perhaps ia ian-. of tin- iotp.'-:r smvtval perio-.l. hence, the opinion that in an individual c.;.e Vsoikcrs with iisi.r-o>-is ; ;e now snrvivui" i;uo they teflert early fthrosis houll he guarded. the lung rnn\.< r age pdap an-.l deaths from this cause ate assuming a tom.h greater impori.uuc /hVrgnojtv (MdUmald. 7. pp. l^-i-`J'7i. hi addition, it should be imted that lung Miner is htcomiug a llicuitiii.i t-ir diagnosis of ashcsiosis depend moic (ommou cut. .e of death in the geuei.il on the put pose f. .| vi hich iliamtusis will he lived, population. .up.! the dupes* ol u'ttaiiuv reijaiicd. A '.soil., Medical m.in.'ig-.'m'iii of .ishest si-, is tc-.triv.c- inj* i!itii<;i! di.v.';;.nis can he UMfhed on the ha- ;d to the svittpcutii nil i.oe given to suhjefts vis ol an e\pn::tc hivtoiv (piC'fnl. p;is(, or with inierstiti.i'. i.i.sosis. v.i; .icvt r the cause. I he temote p.ami the presence o{ one or mote me ol crticostet'livls is t.nt eilvocatcd, hcv.iuse of the following: effort dsspuca. havtl crepita- the agent, ashotos, is. as far ;is is knovstt, fixed in tinm. radiographic chaugci of parenthvmal the lung tissue. Appiopti.it; treatment of inter- Ol 0206: ' - ASUtS'l O* ' '..LA 11 i) LL'NO UtSt.SSfcS 200 lurictit infections mav bo p.umtil.ivly not* i tut i:i view of the suggestion lli.il uon- uiu inflammation may contribute to [`tuples m ot f !<>'is (A.sbcmtt. 7. p. 2:bi). Thcte is i real C'hUiue t.> iu;;4e' that the oti`v possibl elfet- t i \ i- ill!.; .incut .. .tv : fin i-'ii. tiiiuvlv, to le- imo'C the petson I;.' u vsposme. h:i. any 'fa! in- fhicinc on tho oun-'me >( (he use One : 'mutes tli.it removal might halt Umber pi<'"'res'iu:i. a li^..vhosis >1*1 w:. -ch (:umo is son-c cvihcu' e It ri knou-n. however, th.it disease cun both jio.ir ,imi piugn** many v:-m> after icmnv.il (roin ex[yi>ute thus, ivseatxh .should be directed at j-.xitb'e vm ut determinipvvii.it I'-, tors determine this inune progression .nut wnetiter it is pn.sii.-e to d-.tme the stage m level >>f svtvvtu! at whii.ii removal might tie ati edec- w\ j.: e.'et't>* ' ru- -sin e. Pro emnhivn.oric cvalmition of long f Diction m scicen out hi.'h-ri-k pcv>nti> i*. in them-., (lie i;io%t important o/ futtne hculih r>ro- teu:*in: vet. this i* .!*< :!ic* mra in whirl* 'here is i.o systematic evidence to iiulh..itc wli.u type of pvt>oii to s, in oi screen out. At'e.trioii has been diitie.:- 1 toward itic prc-euip'.uv men' dcivcd->n of >!' trttchv.' hmg disease. acute or chronic. on lh-.: ("sumption that surlt per son ;if hrg'.-ri*k .>! developing a>b'-s?-;sis ^Hunt, . u,. The `tliokiug habit, c: rtuiulv the greatest rid. t utor f-u hi.iu.l"'g<mit t.uwr. d-".- nut usually cr.nuitu'.r grotuiv'; fov u-lus- ieg a tt'trnit. Its r> in the development of fihr>> sis i> lew elc.tr. 'here being some evidence t** ugi>et ;i synergistic effect witJi dust (165), ami some evidence to the contrary. An imcresriitg possibility, as yet completely unexpluvj. is that (cr'.ain physiologic rhar.ic* lerptit'. tor instance, the relative sire of aiiways to .hi sprues (1J*i. may constitute ri!U fuums at;;! might. for example, be the basis for exclu sion of certain types from dust hanrd. Final* ly. it is ixiutible that pie-cmptoymcni and an* nual measurements of lung function, particu* laxly FVC. might also prove t>> be a u>ct'.d tool in die health care of the worker (37): however, this, too, should be introduced only in a way that permits a critical evaluation of the effec tiveness at such a procedure. Malignant Mesothelioma of the Pleura and Psrilonaum Primary malignant mesotheliomas arise from the pturipoteutial nicsotitcHal cells (of the pleura, peritoneum, u<l pericardium) and in couse* ipuncc. may pii-scm with widely vaning histo* h'gic fcattiio*. \cveitfu !:'%, tiny iiave been t,n* vivieted a pathologic entity (H), ISS), albeit ure, for .me time, their av*ociati*u with asbestos r\p,>M.ii- v..js nirntioucd ns e;nly as hi au iiulivi.iu.d i,im` icpiut (10). This a-.sociatiou was v!i .iiu.it ii .illy b;>mglii to the attention of die cu'dii.d public by Wagt.er and colleagues (':?) in a report ct arises with occupation.d and/or cm ioimo.i;!.:! aiul/or douic'-tic cxpos-irc in the Clot i o.lite mining aica *f die Xmtliwrst (.ipe, South Africa, the ;t>soiiation witli asl^cs- t*>s exp;.vutc has now been con firmed fioin many par.s of the world (table 6). Pathology . A characteristic feature of the macroscopic appcai.ime n{ the nialtguant vuriciv is the ten* dene) to spre.Hl along serosal inctubraues (13t). emasiug the lung bs ,< bulky, lobidaied iiiiii that usually invades the Insures. Areas of neero* si> within die tumor may give rise to cystic spaces (died with glutinous fluul. a distinctive feature of this tumor, although tun necessarily a specific one. heca.f.c ft r ,*ho seen in adenocarcinoma (10). Lot. nictaxases to clu sf wall, mediasti num. and pciuafti a;:, rithet than remote i.ieia't:i*i.`.. declare m.:;./.:tancv of the tumor; how ever. mci.ista-V'. t- ! dav and abdominal lymph e.ode* are not u;.... ;.imnn, and, occasiimaily, moie vu-iaii: sites, s-ah as liver, thyrmM, adre nals. riot:v; and Inain urn involved (10. li-0). It has been c:r.;>!i.>i/el. ho'vev.'i, that the diag nosis Is eiu- nt exclusion. :ttu! that alt |>otcutol sites for primar) grosvth (particularly lung, pnm ucis. iutestine. and ovavs) must be exam ined: r-visidvr.itiou must also he given to till possibility that the prinv.it v minor has already been icmoved \.\UCaughe\, 5, p. 603). The peritonea!, tumors present similar appearance, but do nut tend to engulf tin* abdominal Oig.ins to the '.ime extent as the pleural tmoots. Ckuinous ascitic fluid, however, is a common feature (!;. Prtniars pericardial tumors <lo /tot ap* pear to be u>siciated with asbestos cx|x>ure. Microscvipii.dly, 1 varieties are recognired jc- cording to ti'.e dominant cell types (1?;(>, 137). EpithfI:*!, or tubulopupilhiry, nunois are char acterised by branching acini, lined by colum nar or cuboid >L cells, often containing mucin and having a tendency to spread. .We.trnc/iymnl, or sarcomatous, tumors range in appearance from cellular fasciculated fibiosatcoma to myx oma, with the amount of associated collagen in the tumor varying considerably. The undifferen- 01-C2Q6Z73 210 I I MARI- * i' K. 1U'( Ki AKF o- I4 7. < < <3 2 < *) i -- ^ |i3 j l.' As U* S J K T. V : 1S : 2o nn *:i i n sa in n mn S.II > . ! CC I S2 sO O .n 3. Oj 2c o< 2 Wc W3o I e. . *? J= *1 ? 21 5 ?5 C : v o 3 ik O X r -.3 a rj c r*- co 'r 3 -j r. Nv t- *3 j> * o -o 0 N* ft a 01 ASatSTOi I l !.ATEO LUNG Ulst.ASES ?.U ti'itrd, or polygonal. type h liy compO' ' of solid iliCCtt of cells with abundant cosmop'ulic cwoplaaui. which mav look remarkably ign. The mixed t>per comprises all of the char." tert'lio pic'Hi'i'h de-vrthed. Svaic h;!;e\e th ( a!! U'iihm. would turn out to he of the mixed car- ict> il sniTtcicnt number of sections were *ak- en (!'. .meydt. p. fc:o. A v.trp; I !;;* and not m:- 'i niim (m.'ittg is the posi-nco of only ant tumor element in the ujetast.(10). Although ferruginous bodies ..ic usualis I'.u.'td i:i the inn"* in eases of asbcsms-as'oo.tted lutsoihcliouia (1 ioui i!..uu:, 5, p p|T'. it is unovi.il to hud parenchymal hiir<*'i* (i.as- imst-isis) ill au\ decree when the tumor ari-cs u: the pleura; on the o-her hand, in peritoneal p.union.ns fibtoxi' ::i." hr a \y. ominent I* mire, giving rise to the iiyp.itheds ot oburuc- ti-m to the thoiacic lyrfiph.de drainage and letcograde b mphatic spread of the .Vsbvsto* fiijcr u the abdominal [emphatic system. IVrit'me.il uutu-rs. rvptes.-nting perhaps 10 per cent of ca ses, appear ,r< occur mote Crcnuvr.t'v in v.-nie 'plies (30; than in others (-'). atvl one study sh*>-..-, a sex (Inference it: :!;r pr-puwh.-int in- not 'itc, piticonc.d tumor-. be.ttg more fro- pa nt in w'aavi; d';0i ho'.'vvci, n.: b'jnc.'l tu tu..js pre-.h : ..'u.tte in wsrti cil-m.*.1: series (Sell- Wn. 7, p. -'d*; Kjiu!eir:o!ft^\; .1 uon-:!:jte.f/i .Ti/cntm Ex[tenure (Newiu.mc, M. 1~: Pct*ou:iI rentmunk.uioa). Un like' lirotu iiial (inter, smoking doe' not play a stuergistie nde in the development of u.e o- theliomas. 1 he mmt <!iv<one:ting aspect the tel. .ion- 'hip between malignant mc thcliouia ; as bestos exposure ts its document-d ns,- ion '''li app.ii cmlv low k % t 1. .t C\p> .'lire. . i l.i- uvel\ bikt peiio'ls in the ten >te from ;.<-;glilv.| lio.ul d*.UK1'tic 'Outs'.' ilcsc: died (27. "<*. jI). I lie Cu:i.:i:iiiHst doo.i.'utnted nci0;.h-u- hyod e\poMite is tii.it id sliihhou piasirut in tiie streets within <>:,e-half mile ot a factory (jr mine, nsnallv for 'eseral '- ars in cnr'.v chik'- iii.otl. although >nc tantiut usually he certain tit:n t!ie\ did not also plav in the v.-tu.' and, or the tailings. Hot'Cvcr, neigiihoi'i'.ood i.M-i';-r;s seem teuain to base Ijcru :CS> than th.e-: to which woik:rs timtii'cHes were exposed, im:-ly- itig lack (i[ a dose relationship t cxpeomc. On the other hand, in ccaain oth.er occupat'on-d groups, s ieh as ti'.e woikcrs in cite London as- l.vstos textile l.utoiy >tud:-.l hy Nc'.shous': arid a.sOiiates ("0'.. a dose cltetr on risk c.<u )<e dis cerned. Innthermoi'e, when do-c is lueM'tu- 1 by i.umhev ot a-! .: -s bodies nnd.V-r fiber' ii: .!ii- o!-'.:k ir;,teri.. '7. Ir*^. 107.. thi-. is fom:.'. to i.e highc: th . in the nu.il population, ah though Imv.i ; ..n usu .Uv seen ;:i relation to puimona'\ ft..;.'-; Despite their being rare tumor*, estimated to have a:> incidence of the ord'T of l p er 1 .(.n'O.Gun per atrmtin in the general population, the as sociation of mcvitlieliouta v.ith asbestos :\po'tire has l>cen consistent itt all part* of rite wo: M (table *h. Although all commercial 'ihi rs except anthophsllite (77). but including talc, have been implicated, there are important betwecn-filicr dillercnces in mesothelioma ivk, be ing greatest with crctidblite. loss with amoMtc, and apparently even lc* with chrysmils. With antosite and chrysolite, there appear5 to be a higher risk in manufacturing than in mining at.-I milling. These were the conclusion* reached by the Advixjiy Committee on Aih**>toc C-uucrs m liu- l.yoti meeting (7. p all) anil are based on published epidemiologic. xtudhs. including piospetii'C and ictrospective nn.itality studies. In addition, mesothelioma rate' 'vent. in gen ual. to he increased in cities that have ship building or ship repair industries (2d-), and in vune woiVing j.Hipulitions may approath 10 per cent, particularly if exposed to crocidolite Animal expet iaicii!' iudir.ua tiiat, svhen Rivcti ititrapleutaily. .all tsjx*s of ad-essos fiber, a*, svcll a cet min ivpes of filaxs f.ber, ate capable of pt (hiriii* ti.alieiiant inrsiuhclud tuumrs. and ri.k appe.it' to mie.i'- svith l*: (Wagner, 7, p. 2s5y. hihal.oh.n experiments, on the od'.er hand, tend to pr-dnce cancel'*. I his ha led to ti:e liy potl'.esis chat all tvpes of fiber, once tie1; n'ach tile plema. cxetcise "bi.di.gic activity." There is some < vid-nn e, however, that tins ar- ti'.tv is 'i/o dependent, til^ets !.>> dun in diameter or between in and im m h ng'h being p.irticul.u !y eilfctsse at tiuiin.g mcsuil.e- lial giossihs (.Stanton. 7. p. For these rea sons. opinion is moving av-.iy fiom tile ' iew that the gradient of biologic activity shown in Ulan, at lean with leg.ud to ri'k of deveh ;mig mesothelial tuiuors, ix due to ehenucal .hth.r- cnees between ftbeis, and t>v\ai\l tnc view tliat it is due to [itiysic.d diilcrences between liber*. Thus, it is believed that the determinants of pudiogemuty of a liber ate die degree to whicJi it penetrates and settles in deep lung spate5, and f c\ MAiXAU It. I'.;-.'. M.\*E this, in turn, is controlled I>y i;s ..crodyn.m i i; -us an al ! o .? and rt i u< :eme of tfu' fttrtio:-. properties (Tiniiue!!. 7, p. ri .jr. i :iv vh. ! umw, 7. p 2tt ,, l hmr is only o:.;1 In addition, it must be pointed oat tint ma rrpwit of !. :. durmia in a""iiatioi; unit ph u- lignant ines.iiliciii'iii.i is nm uimpiely as.mini u til in,wi:!.. i.uii (2"i); the .: >s.u iaiior. ina) with 'sIi'-m-'s rvposiiie. jim) .1 s'i::Il number of i!i-'uf..ii' ! -.ken as iti uliuua!. I lie misnit- < . (. > wiih- .c: mu'. a hist.-; y .,i seen in in I svi i- *: inis propOl t;Aii ;. UM. illy -a-.all. 1,',; h is K.i'.i -; d in.; 'vans vi'. . Uvi itniu.'.l tuiuor. ate mv.u i.i!.!\ l: tid .in.' v . hi;: ;, ioiii !kar iv.n ; iiuhulu p;..- ocr Sn per t'iv (I')'). AJwO'hch.'i tumor' .-#.* ti.il oni.:;; ' ititcst.hi.il ohsti m fton. in;; in the pci hmciimn have r<o;. been linked to a-Kwios. 'll. - (li.-i . in lac is us--.ill', one of r. I * pio'U*dn:. : r ] lem,il tnuio., the asct .r- l>cspiie the :.-jw a'acmed i i.**:: -u >( m.; i..' 1 time : -t o':v i <( s\ rupioms is aj.-pioNi lignum mesothelioma nidi asbc;.,!* expo-ete in ^ i- t.-i p-'ii'anMl mam.s. I't t;> die pat'u-vr.u-M* of tJ:i* unnnr i' lar tm-n 1 i ni (!r:.* i' is \ .:i ii-s. tv.'.vcs . i, ant! in our 'e. dear. I'tcsuiu.ii/iy, it is only b\ m: .mined ie- ti.s. i7 p-.r . ,ii \w:rc ah-r after i5 ye.n (hsT). '"at\li. ti'iug auiiti.il models, ..ml looking hu- \-m : ':>* mom hridgn the romse. t'-r lisk laftois in exposed populations. that an im- nunc like!', '.hat ll'.e pal hole* ;{ i husific.i'i'U d.iTstninlio-^ \.n. esvniu.dls he tcnl.rd vl tie: >1 ion I.! hr : -r.l t> h-'uign mesothelioma (2n.V. mechanisms mr1 lying ii> dL.i-loptnent. la thed. s.uir 1- rln'iiKii-''!} <A the m.;1 *.> j r/ rt.' T t ship of tin's tumor to cxpujiuv >o !u: '! v u>.>.; important ar^.i for name lev !i. and the k'.y l i e ii'..:cn : ran h-.- dcfmitels m.kIc isah In li'stie r\.'Vhcic ait! a nuruhir <,f usv to ur.dvritandit.; the inn!i uidm h\ which ev ' a.; win ! i iiila i.lf n n; ikr a positivr I'.i.ier.-'- posuts* to (202). produces its elicits in ..:.;ti so of *hii . T..'n dutin^ life, cu-n when adc- <j'i oe 1 :tvri,il is as iil.th'e. Tl'C'C in- Ch^Urt ;$ duds' :iiv ..ixlc variety of ct-II t\pr> wi-ho-. n t. -j i ids iit< s<e of ihc mi\s-d ispe. I'lenrel tumors inv:t:i.i*.puo.-ut with dull an I r!:e r.-..' ; \rln.h- primars ftnoi . t'hv chest i>i sluMi'dir pain, of imiM.ius ou'e:. hut wii'.'r -v i; i\ slainui* that divim. Siuwly l.vcnmi...; juid-ariii i i;oe;-h (r> ; 11't' r f; t ' 'is 'U l-l : '. ria1 o.i t-c :s>ui-ttf in seith ship .Time-, 7, p. 2b7.. In * mu' c howcv.;r. the p in m.iv he v,".-ie .md pbudii.. <.o/ '51 i, thr ' : p. t'.iT-. I" ad.liti--ii. } *h;,'ioi* .rnettnen: Hicathlcssne**. eni.Mv ulitvd to .o(nuudation Is.'. !l p .. 0-1 !; v doeir ch.lt.w'' :t of pletird i!".id. v.,e?,!it lo.;, 11 e I ;it>>. and (Mv Cm . 7. p. .'Si. a diliuuhs rciivitri1 ! \ cough follow. As mentl-ned i>- evi-udy. dime il. vela m tlesi number of ca.-es, less than may also he a hi'voty of p:v\ious pieiu.d etfu- at' rci ;:t vine s* ; is s ("hrV. M.iisetpirut'v sinus (2<'A;. *i he pic-atinnl sequence <4 *-s-:its s'-nutruril ! . un.*tin liosu.t tvsiew panel'. Thh is as follows; s- ions effusion, pethups developin'; did*! nh' he trv. in;po: la*it in i linii at nirrli- in association with plaque*. possibly clvatim' sh.r. in w` i .i t!:r h.ipoiMn; durtruumn is he- later, to iccnr with Mood M'liniug. imrea-im' in twcsti a :,i: and a maliu.n.iiit omioi. :h.rn in amount as the tm.nov develop-.; imadm*. and epit'.rmi- ! . o,.dh s J-.n M**'k to iiisc*'i;.at; rhickeui.'ig of parietal and liuttal piciut. .T"'*fi a hAtois *' asiiC'fos s-yja'snre. eventually leading to the lung's hceoming im in whii :i s..:, iafni'v of di . ;no'tic uits'ri.i in ex prisoned. with retraction and inim.bi!iMiioit of po xcd and . i.cxp '-I p.miip' is .ill impou.m-.. the chest cage on the affected idc (MI). Thu UeCaiiM' 'f i!it* l'0:wi-eu-:iiiii>`ir ami Ssithin-tu presenting symptom of a peritoneal tumor i> mor fit';.-!-v.iriatmu menti\i:;cd pirsini:v also usually dull pain, later followed by swelling Iv. nisi ti: ' ::<*t iulrr.j'iv-nt s'evrh pinmi of the and weight loss. The physical dgm will depend on the stage at which the patient fust present*: nsnally. pain grov.ih ij; :':.c tr.wk ol die biopsy needle. o:b-vi me:'.v>ds i f ev.mhi.u.io-i h. nr hv<*n rsr 1 in in crease.' n r;..;:i;v of dia>;noas Thus, die ; n s- precedes systemic symptoms and th.o pm-ettee tf ri.ee >'t !.' iaiotiii add in the pleurd :invl clear physical jigns hy wa ck> oi mouths. Apart (2`i7) C'i' i'-' '.aii i-1 it a; aii*)ti in I'.im^r ;iss.e hy from die Jiniral tijjni nf the e/Tusion ;j:id/t*r l!jsiocliv,n;.`.',.l te*. imi'MHw may ht- nf some plcnral invasion, cluhbing f the fttup'r' is om* value ii: d is'.ingnishing between raOViihelioma tnon; asute arhrop;tthy which may also be a and sccond.ii*. carcinoma, tmt i> not the ih hui- feature sC associated asbestosis (20!) has Isceu tivc test i: was nt initially helieved to he (COT), reported, with regression mut reappearanre, aft- (.iyiologie .xaniiuation of pleural fluids, by lij<m Ql-020628i 'll AsMsios KM \ n i t.; .lint electron miernwopy. may offer use ful run t'-i i.d fi aim moie dun I ,(*nn , .!<<* ,.f p;; *ou- iributory evidence. A series *'t ]'.ip<-ts under di- n.'A published m I!*'.I p.'llV :hee, i; gi-nei.d title 'Assessment of Methods i'-ed ir appealed ihat -ixbcxtosiv w.i> associated with a die Studies ni tlie biological Elfett ut Ashcsi** t<> !'. (7, p t. rS-81) provides a ten' tin.t!i hi;.;h:i lung (.men rid. titan other pneutuotmiiobs, with 1.7 to 20 per cent of men re- (.ii.\; r.u n; ;-,.d tip-iod.uc Mimmary of tins n'ld-.il as having adi-.-vusi-, dvltM f4..-*> tp.is dieir precision, and genet al appli. c uiv.-. This ibk wi. tcj.oited to have fei'k-r in- *!'.ty. uriKi1. ctm%ider.ddy in I'lhaiu by p'-oj (t'v/, Tl:e radi..! gif appearances vary according n .-mu a vimihu inrnv-* in king tamer : kk duiii: - ii:e '(.>,;< to which the di-.ase has progressed. the saint decides has been tepoi.cd h -m Gti- C- y(i>:nofi fra'iue* ..re the piewtHe >! .1 plcurd many (facoh, ">, p. fiilfi). The emergence of i.ia- cilu.um. 'cihul.vt'.d tumor masses that may In* camev 3S an impAitaiu threat to the hJ.iith ot ':whie only .<tfci ttiru'vai of toe pleural fluid, asbestos workers is attributed ;o t!;e impioei;i-. ,r. ihc*? wall in sr.feUife imuj lesions, am!, oc in dusi (oiiditions, with !e-v mortality from asl;e>- casional! >. Iisdn.-pneumothorax In a revie'A treatments (16. p. 277") tin;-:-, tovis occutring after longer periods of cxpr*uie uni. tliert-fore, survival of wotker> tinough t:;o pointcil or.; that there is no cifecthe dilative Jong hn-tn period of lung cancer (alb. (>,lent, bih-'Ojjh sui;;ie-.l excision, hx.d .V.ib>e.|m:i!t epidemic-lo^ie snulie. ha.e nnj.l\ .:ul;o: s'.i'etnic cytotoxic therapy, and radio- t on fit med dte .iss.'vi.iiiuti !*rtvves*n a-iri.ii, cx- tin-1 ,ija hate ;-ii lec n tried. He a!-o pointed out posutc am! Sung t.nnvr, mottahtv c\:'"iicm: several fca'm-.s tint surest ;i vunsideiuhtc con tribution of (h- body's defense nitthaitism. ba*U in ii:c foiinat'o;) of abuc'imal tissue and in die sh.-paio oj irs rliiiir.il (n-itv.'. R-duive to rm: fust point is the apparently low doo of exposure ripnlA* of ehsiriii;; a response; i-dativc to the being the (hief method c*f study (uj, 67. S2); lmv'?vcr. table 7 iml.'oms that despite die con* si.teudy itutea-.-xl ichtive risk in these reports, there ,'ic c msiderabie between-studv I'.id^reuces i- ;-i is degice. Sotnc of the.se difieienrei must eertainly be ,s- ibfd to '.etwe-en-study clrv:*re `'-Olid i' the not infictpieni ixtiar.avt' <t che-t injuries and in!e< - i<.uc at the onset >>f the in tiie viveth-.Used t<' v?.!cu\;ue* ri-k (`.'.'l?), p.irtioda; is lartoi s av composition c f the thnital {o'i!,i>, am! die sometimes rap'd dHseui- risk gt>up v::: terms of age, ve.iis of cxprouic. inarion, :p;i irut'y pim.oV.cd hy treatments, * and leuglli i : .lhw upi. and :f'c tutu of the such as r.vUasi n or cytotoxic drugs. For the e tiii.liol or re`- i- me gi.iup, v.h.icn eo't'.d be cith r'MSi.ns, !: believes that litis tumor may eventn- er a l.ivvexpos.ste group wiihiu d;e w-inking ally iut;i out to be controllable through improv ing body dctritM.-v Tims, it is not surprising that jj-.pu!atii*n, or :itt appropt iate reference popis* i.uion derived tiom it..:i.ir.ae staiistice In add1'* the me o{ p.CC. vaccine in treatment is a tu.mcf lieu, most studies deal with relatively sn ail of gtcat cmnm interest. with, as yet. no dcfmi* m.inliCi' of deaths ;!css than 1011 in .id but 2 live evidence on which to ban* clittu d action. ot die studies). So that r.uculatio;i would inevt- Meanwhile, therapy is symptomatic, and disg l.d)lv he influenced by the addition r.r loss of noetic mt-asutr-s should he kept to a miuinuuu. om: ta-e. Finally, diUerence* in exposure dose H^tnovrd of fluid for diagnostic examiiu -ion ami vumking habits are inker lelevau: faaots and to relieve brcathlesvnes, should be done as for which stand.'rdi/.ition is seldom poniblc. As infrequently as |>ov.ibIc. Indeed, as Klmes notes, U .igt:er and assi-ci.lies point out. however, "an the establishment of a precise diagnosis in life, additional lesson to be learnt from the apj-ar* given the absence of a potentially dilative treat* cut conflict *.*f evidence i. die need to pay m:t tnent, is an academic, rather than a clinically aticntiuti (( the type t.f asbestos and to the useful, exercise. pbvsit.d state of the respirable taction of the dt!<i" (213). ami the evidence ih.it there uc real diffeicnces in risk asswiiated with d;c diif- Carcinoma of the Lung Associated with Asbestos Exposure etent Tiber types, as wdl'.ij the different types of exposure to the Same is becoming move An association between asbestosis and broo- convincing. Such dillerenccs. however, have a chial carcinoma, suspected in the IfrfOs on tin* gicatcv sigtiincame in the hold of envitomn'rit* basis of individual case reports (21U), was sub* tal control a.id safety standards than in the prac sequentN confirmed in two Hritidi reports one tice of clinical medi* ine. by the Chief Inspector of lactones, issued in The interaction of cigarettes and aibestos cx- 1017, and die second, an analysis of autopsy m.v posuie as risk factors, clarified to some extent by Ol 'J 1 MARCAKtT I ,'U>' I. \XI. e-pu!eniir>lti{ic studies, is, however, of v'iv real >d i' ofo ii not diii-... :::l*. piv'ti'vt." The epi- or.;'i t.rm.c in <litMC.il practise Car-wvmi.i of i miniutpr e\ iden.* i/rd :.r-iv ;:.s- t:t* him; appears to develop one, v.iy t itelv ill lei hues tin: inipor .tr. of < >t..hlidiin ; thi. M- ii iniis:nnler <-\;>o\i't to .e.heNto; (*i"S. ?j) ' >t i i; m. ' (:'!> i-h .1'>.k i.itcil wu11 e\pov,1. c to !(itli Is V * * * 1 i-.-M.in :: i!; in .iduii iv v, a :,.i prcli.t- Other Asbcstcs-Rcdn^d Cancer* hi' | l itivt . 73. mu). 1 ' V. .. . ot i;.;i n.iitv hcliescd tliat c: c o a:o: was a - .: (. ' :k< i . h o :'* i*f i'' f.Miiv lot. ui'-n 1 * * l A t f. '' ll'. : fit <i i >s:s :: u;!- ...he t Ted l '- i.nnai ii.it.'i.- ' 11 .pOK (1 .,. ilVj . i. ('-1 > l law,-, .-i, alii.** ii.illy l :i.l i n In: >, .. hi. Ii ::ithe scat Mi I'll H`>i> ,* " . t>. th i* i> not altvats v ( i 1.1 Si'S in ion :i;.m: ditv s i ! .im.oIi ; r-. User is .1 j;-. r-.lli'! \pecu d ns's f.. r .-ii t" t r : t.ii.-V 7;. f an. ':.c-.T -hows i;u: Zl<' - i. I.r \ I- 1 i'N. tv. . 1 .. t a :u e: . >f (. I'll.:! (la. t. "1 he . st-" c*l .;a-iro: it; o;:: < . H;.'h i. r-. it'ent i:; . . . >>: it . " !' r tin : t : c>:.- i population u-; l v. oh ui.ite sAoect-. 1 iniin I*ei o! dead:.. - : i si. plitii.,, v.i::.:- c a; ... !-v ;i ie:. tied i:i as.neiatioi; with rel.v W.`l h ; i s expose.! i:- .hephviii;. til:-: ms; :i;d f; hi . rirl O'.ci'i'Mialls i:i thi : l ills p: e'iun.thU i> fu :l.;-r c\ivl'-iice f the d it- v.: r ! fdueI--K h-`:n;. Snv.il,illy, akh. h Cants Ut'.-! if in the hiolop' t ellceis ,f the tlid at . .! .i.! >; t i! i :d*.e!) m 'he:s (h *. dl'ti. . t;. j-.t-s TI'mii- i- .. - 'ii.e i ' nie .t e to *. ; . !. :.'in' evill.-f.tc to surest t:- :.t the: dio tiia' c*.. iioii-:.-... ..i e'.p on: o 1:. a > i^c of l: in id c i; r. ,e- i* tlilh'Mti' Ittvin :ha: seen imp. ill s:t e ill ;a>tr-.i.:: l otf.a 1 tatiKCV ; . iii. in Oti.ds'.U' v ith-* . t c:;j-v.miin-i.jic'.; . a atcah-r VO 1 . '! 1 VlMJ. ->i ''h.n.Kai ciin.ina 'H-.h !w addition to [: >.u er, .'.'.it', is ; IK.-cad i.4> -Mill. ut v that -inIk--.: ^ %: - * : . .t ; .lied wi p. !i . ! -i It* ; !. r .tliesis th.-t ihe cars :is in ,... , i - kv , h.e.c l> 11 t'."!i\s : 111 v' I'm J i : * i , :i;.h ...ii : "ions t f thv i.r-a: >. 1. i ; u: !. *. V i i.' :; kt-t p.itt'c!v. t'ij. \ . all . V * 1., . l!l! ^KMtcr pi-p'-:. ' . of t 'in el of the l,u v :;x : ' -1 hike 11!: 1 ;d t'.UiC ihi. taut rr aho !:.% .. ion;.' latent i..d .; a ml c i"ai te sniovli.; .' a v.ell-iec ).:' had - .... Ci.ih (1 :; -V fa; tut. .':: Mia ir,: i iti.-iij v.-'tii a ... lu:: -U d ! i ! 1 . i vm vti, an.l ;! e .( Ii tc- It l hut i1 pc; *.. ii.'ea:. ;: it ; 1 : ' i h: .e -fi if*, the j : t-'i-r: : of ph-i- i Y-`.. Ti- td i he .is.'.n.i:: ,! v. in a 1 ! ct l;T r ti. (.i :j'i::;, <. inter . ),, i. '1 .ll * . . *t | ns |- tll.tr 1:1** piv'ftHf. of 5... ap>r> u *:....:i"ii :!.;n Ittj ; An ; c.v... i.iii t an.; l. v ..f : i.lii tiiiiit a! .i , .i ..--hi e\; . WO ' .. 1 .1 *:i: 1 on h .:ii;i'ia! .no i i'- r J *;' .^Ij ; vlh'U a l ^i'er < * >v;* t* dose. has not. in tfit: vi.w : tin- Adsisoi-v ClilUf lit- >: i- p.i 'attrnis, site> iii.n'% ... dhi 'tent ire . \shi.-'t.i. 1 .a: . . rs M. o. al2. I.i-fti cot: i; : r.j i-s. v .:I'.i hten ! scribed in ul aliou (. r k; StOs t > . ( :m 11! in ?he (h .r * i loiiaiit-. sur.cv cf -..a r*:t : wmkt'. p. -Ii'al i t l.vh- .f;.* The tiiiiit il pi< f.tie, jjmt'nosi-.. an. l uc.nnifiii : n did.- -ni i tom those scut in the p flsOTI that tin- eiitiit.d i : iehudiy hclir \"*<l to he ova:: i..t: itmiiX'S s..: ' .Ill llic..*'! : li-ntli.i, ..f ! : i .. d 1 s* t'l a a.estos. except i<>. a rl.:* ' f )* :s ; limit the tiax.ii.a ,t o. io!i>. l he (:i i it-'m'-am ii`:. \ u in i>a: 1 . .p.n,,.; ( : , ii' Mcv to, and ;. flp m. tjiuttiiv; m i: 'Kin K me <1. ii !y Cv eu iiioii11 it>i|H*rtaiu lo: the v,4; k . r is. ; -.l iv th*: lun^ i t 11. iu.Kiia i.f (he ! .-I ad--vfos 1 diCi :: 1 ili w.i.ici: ii.is ** v 1: pr.scd to asbestos tli.ill his or her tin: ' p .ed com K-j . :ivl in .:ie s..;.l . n.na l ondm: . Ml..4:.. i:,'. panion, and a conceited cllort at worker c.filia a studs (ha:. : . *t.-1\:. m . .. d:.l u.d w tion mijjlit pmvc worthwhile. i!... same thiuty ;.n ciiiwiua o! the hr Another practical problem vonc.:i:i. comp n- . (it:t i atn t:i> v.. :th su'je.'-.i'.-ih ! ...t mo :.`r* s'liou. in p.uticul.ii, the tpicstien ct asttibu- st imi.v.ed, .i.'ociati- . % %**!* .* >t ** -: rc i,.' ilir. of iung cancer to o>;pos.n-.t: in the .iif It tiK.-uiia. nut! .-' t.r.ch'i.i l. am 1 of -.hpnftc.ini fiin'.'ii'. Some compensation h; id;, .wti"^ on the d..-t. n l.iiionsi'.ip in(.n*t i ' i ri i tn\ nmcto^ityln 1 iiicmia (l'1; Tc.'.'s- aft' in.'i niomil lu te. : to a: a J: ; pk n. or lion, aw..!,! the benefit ni the doeht iC ex- their path ills, hut ! > nn.h.'i lui-; th-; |j--itc hr; hern considerable in a u.M.nitnkcr. the a.vK iatitiu h .sets a>li(-.i..s itul .ir.v MitnlL, as lu bcn emphasised elsewhere human cain.cis. iv: . jttai'i i.nur. t ho .15A ;2'2d, 22.-), the "occupational hisiory may not tion calls he.' ciiui. al iclitm. well th it; :c seem important in patient* with catrinouu to.lins to he pro'. -. d v. i..:her a.l.Cilo* l`.? it Iv (Iv: 01-0206"S3 r .o i i v n t < o l ih <v'? J /j > & . ; n u m p i o f d e a l-, A llV I: HUiK 0 I ; CA\*C' H I O il M A I F ASHr'l'.IO S 'A O ilK .1 A^HES'ICVS Rtl.Al tUNC. "in awlW*l -- -- -- v r. .* 2.. n* ' aa ~ - S I 13 7 z _ . 2 ' " ;i = u o jj 5 a2 2 22 r-- - -v i ~ t-- Vi' . c :* C w --_ - u> . o 0) -- ~- _ c3 4C 62 ; 3 4 I i^ nr? -- o n X _i : r* c r ~ a u ri -- r. tj ; - Cl o rj O-- -- m n fi <? n -- J 44 O I Mil! 2'3| ,,I Jo O2 r- O O C--D .r*i m *-- -- ri O ..1 i O v ri On 'SZ' r"> a -.* 7>i} " -- \--? O-- n <u ? Ou'. U-. t? -- -- . ;? r<,r sj , 3! _ mt es Il 25 203 >6 6 o o iff s> C J S r? Cl t ?j -i Z-- >o i" o = . 8S2* e >- *- p 5 3o 22 a WCSl OIN . 3- ~J --E * .l3 3s. v . -Z! .? r N t V 3 > > >: r? r I C* is -- . 8> 5* S> aa e o o y y :< s< 3e 2"-- 0 f3O" 5 5 5 1 S0 3- c:> 551 22u 03 22 * M 1 * o4 ^n u- -> .' h- V uU h j a <2 ~eoZ - C n3 ao 3V sy *= 03 gu 33 30 ?O aa 3O *3 O aa >> S 5 w<< 3 so s * *> i j " ii rsr 'C o rn y u r iconc vn>ru m a d e v*th a p p io p f.jt.' n n . o n jl s n s .n ic v u'<;> p t v.hocn in-.c ti t ln to m .il c o m p jm 'jn o f lo .v - a n d h .< ;-i-rr p o '. u 'ii g ro u ,, t. * * l i c i t ., O n u in o f r c u t iv c iik lo r In n ) c jr.C i-r v .a i 0 0 u u n g a>l>cr rriC tn o d i. t tin c lu il-'-; i'a n :c f o f tlic pleura and lu ry ii*. * * E ng.igud in vuin- v ji ic ty o f to o *. 01-0 2 0623!+ A' I G MAiU; w n. J'M KLAfch Eutiii.m 'TCi. ..' n. >.r a cotar.itnjoi'u. anti potentiator >{ u^nrctti; >:v.uie iiml.'or mb r i.iCflJt'. The inf!v-nc t'f Fib'sr T)pa and th.* M-.ture Eip*'v..v > n Rt'.ponor* At:. :i !' . 'mu Vn' f.tjtil j.'nre :! I K.G -V:. ; no t[> on e.nWL't mgcd stsu A uC ";i." : ` i ' [ 'i d.. d., (jm !udi \* ....... .. ' 'inr m exposure) a: i tic.* lull'. . -1 '.rc of th** I > 'li:' f in'' : _ ,.r:( ip.mi of ' . 11 'iv. - '! i a:,d . r < r\." In r;'.-.. V- .M .!,. " ::. ' i-` .-'a t-.*iV ! i-igo-ut fide* 11 .- ;: f'> ' '*.<-r !. rI.'i r i< j r.>.. * j.. \ bjt'V' (*i; am! I""it t C l: . . n ! : csvsI'iiMi i:< ;: --. tlir- cot.;;- :: i'. ! pA . d: ! tie of tin* il m-. Ain'CtS 1!' ' 'Vp-AlP-nTim. In the r:: } 1 i s; a: >, - i-- ihruti;*!! >:; v ' !, vi d ilo i in pmt of i.i : i>*, 1 ii'sj>.ji;sf; r(.! na;:v;!y. tii.tt a do ? f><:` all >1 ill*.- *i_ SpOllsCS : . -! i 'O'-.i'. c . : I:ii v> c.f t'u. h'!;,' other j >r> i :.*; |\. i.ippiiiuoii'ia 1- ut 'I t-: p.imv. j.r all tN'-v* "f a.. * {<.< . `! ;ijc> : vjM'.::?'' :-!V'Vv., od. '1 ii" : ili-iu.e !. i I : .ivt.l; .inaoii/n! in tal.l- It 1. ! i' mv t ir:-.;-*tip:HC si 11 >il !:- . - A. tn.it . v' ion .m.I ji!n tv! st.is. : ' i of i: ip--. i:( t' i-- o :?< . ' . < .in t!. 1 - ir : :s *' c* 'oniopi-c-u t*f spoil.*.- : I -: fih.'it, ir (or d . N.niiC f:A\ v : : rotif t.Apo.nic o'mdit5 ` c- 1 :ai'!iiu; rnpoaird to nt.m if.;;* toring. JA*.:. . vnn.d o.vli.i in \v!ii* !i <"tj *:*': can be rcl >i- well co:;.: -l!'-l .rc in. a:.;..- site ab-n.' t! ^iativc f'tbity* *ni;ity of tli.'i*. tit; . fil..*; t ;< - .. -2 :i!:!'.n-. .'.'t'l-cncts it* r :r- i iiio.;tr.> p .-.-ntial Lava l.tx-n ihown i'2'M . miuU*?i i.i in (litfcicn: <-. Cupationsi.% v\pos>:d gioupj * dili'-t.'-tn- between fii .mil ip "wen expivat:*-., in torn* o the :: c.nrdr.Oj'en:-. Ijntii f.r htttg cancer table G> ami f*`*r tm:s,*tleliot:M (224); bowev a:, it is Usually inipo'dldn t> '.> tnbli.di to wl. extent can he t.xpiair. 1 bv dilFeronc*s in. ;-xp*i>*irc: A ' "U air! .1 v.f iatcvl ` ;C- t'lts, Uf\ .1-* d;;aiettPs ;.;n! vrner cn-itaoi-o.. .'ns. Turt:. .tvs re, e\pouri.> to mm fd>:r t>|.<- , tare t';ts*i.-i.it: ttilnii:;;*. mO'! JM-i'IlK! . n wotAcr* !or.* ini>el oxji-j'tnr> (22 i). i*m i "mcc. t ible S >iunmari/es tx <t t collected in Quebec asbestos votltcrs, exposed only t*> clit; ;Ic fibers. Even in ;he;e results. v.iiali sbov. a : . .If:,: if.r >Ii :i-s|.oip*'i, ilrur ..I 1 V(V. ; ' 1. ,i If 1 !il;cu-.i.i-> 1 -.u in ul.i* 1, for 1 il ii ill i^iC ib it: . A- ::v 1. ..f he s.m.c -.roib .-.pa! swm kitiy tl>'- ' :i. ;.! ;. k C .iin! v. i-1- \- posurc l.lli ;! itv. \ 'in' ' 'III': is j.- ,.| ( i\ CM ilu. 1." : - - r- , <*::h. iC:w c , fo v.lu.t ex- i Ml. if a;;'.. ;1 ; "it e curse; :>n pAe.ib:" ti... 1.. I.i:. . 1 'ic.n- Cait<tii . -.n;> it..bii.; i '';ni:e ti.at b*.:!: :! i ii* * a* 1 bo !-: .I'll, ! in | oi..ii.it f:,;* . ...1 ib ; i ;*<!.lorn ........ j.at -'ii !i.* . ' m. `ii.;.. \ . !. ri .>' i ii is .dc.-ady 1 vi >.. !o i;. !i- . :!..i t < \ -.n il tin- C.:,l 2 um :, :; m. ;. CU.: il is Am.wi! ab la; .: . >u: :i.ij' I'm 'in.; i ; tili: 1.rv, tu;.,b ; * iu ; . is ji- -Mibio t. up- ; sure ihcm in - : .tite. i :ii' virn:.ii i'.m at- : in|itil '. i' i.i.. ' ' *' 1. . a tin*! ;.:!i:x s . .-sa-ued by f :v.. ; ifior'..!/ i T.. it i-. i: < poS'.iiAa to (!n':i..v t: oin iItit > /tui lo-m .vise;! .it, indeed, ibeie i. eater ri | . id::.; :<>it . or*..-;, {i-.up iit il m 'liners i veil .\ttrii*i't.dde to diilereiui' it: :!. > n ' re - c the e\[V'SiP n hi ii.u fj'i'.t iA-i.- : r wi.uii t'..no is little sc. A lie j'iNtilu..i;i rt. ..r Ao-cli' . i ;i's is < rniij nab'.-: to: ! -''ll .. ini', t'.v s,:. ` ng (ftg'sre In.-.:- pm.-I' tv.; .ii- i i< >' : i.ra: . Ija. meat. IV.iiiti: : v.nnn/s i... in A-iti;; bp:. . .i- 'to. A 1 omp . . <:. . in ! . r.j.t i g. -!. :.! Inv.l it. a <" 1 ;. - r la. K\.-isdi.-M : ' .. ..i,.' o; ^ iA .a: nm. ;7, ;.l|: U i. b. 1i--\! :. .'-'i- ;m.- 'ii,iu tit*, i.'a tbc ;; >>;:. :.p :. 'I i;.|-e (;v- n . - ':i , > i V all'l * r.vdj Uv attd > - . r to M-.-t AAp ;; . V itb , ill .*.* t i:!i antis*-;.!:.!- .|| <' r. fm .m.-e-ii-'. ^oatv.t in *: m .s . c- 'i pat-d i .;p net A. l .i aib: *.i [j T .*4* { :*. t to. i'dit*. id tiie d'.ilv.vi't : . ; " v!* !, ! :;.-v iso !.- j'les.'ni;. v.'i'b i 1 r-u:!- A -. . a.ii- .* ; '' U:.o. w lt-.lc.lv ;;; * .! ins iii i ... ; .: -r r '* t i.iv '.a m->;e fi.o -b irl.l'.r- 1 l lA1 :vuv -.ii die i"-.j--" no. v itb ni-.ii!ti' tim* l-.a. A r.i.i.in' . at L'aXI fuC tile. To slate, t!n best e t:'*s f.i :he*c g. -di- ciu in I'i'v ,n .-unn l i . cl;:.: (K-xelopo*.; Timbivii v7. [/.. `,*0:. :;.ir is. Aivt idoaigiv a- tiviiv tei. te* f* t'.e .U :r i of ; o:ie;r.r.ion and !jn\ii i.-ii -. inti;: I -. V ai*.. n ...irv <>). *l*!.ii'. ilu* f;rea:n n;-.- iicii- *.p * ; umrini of (.o, i '.e- To ssmtp.iH '. : an . ai"!'."i !.- dii". .ii> '. duxsvtilv, i".:'. 1 ! e slue :* its smaller fib": si.c ami its other ae r. .A paniii. ; .iv.j-.pi ties, *.v11'b per tuit greater ju-s*. air.nion pr.. * v* v |>o>i * ion. Sin'ii.ir* 01-C2Qo ASBFSroS RtLATI Lli.NO I'DKAbES 217 EXPOSURE RESPONSE RELATIONSHIPS IN QUEDEC CHRYSOTH.E A336STOS MINERS A N D M ILLE R S v. ' i i !i 0 1z ,* -- 20 -- e-- O's vN SN\ O ^ 1 c; ,, .> O - O 0*0 ZiZ i 5 wl T-. Ci -5 oCS !I o - C' <*v f r a s pn/ip<pDuO> H iS '.iu p u c a 0 v ,4 riaip< i u c u -v'-V i j aI l 1IiI 2Vvr *<2Sn 3 10 3 r2 H S0 a,, "c CA ill III 5 l ! tA c 11s :ii Q v l 31 * v . s* 11 eufo3 5o I <c ca_> s = we i *" 2 t 3_ 0.. J- si --(ai sz-oa o.-i 5*. < ^ .55_ i a _ O Sg > UuJ. Q ; sa *g e2 < G1-0206236 A>Mf W v;.(. \ki ri ( (Apa<*<(j *0 a'J d *9' I.. I' mtttrci n.i M.tin limn .1; < ^ ^. ....... i -MiMtJi'l *>: ..iiinsitc in m 1 ' I ' 'i ; m min jiarCtl iu miilili;:. f.mli! :v .'(Mil- c-i.l ;o ihc emitter p irtule I"! .hi I.u i:i a j : i <i 11:t i:phi:.? C-.uipatVii t-. tiwl \r I- . d p( > nv iniimic-:-. tut .. r<. ii"i. i<. -hnpi.>, I f.v c in. i"K' ! " ' ! I., ill.' l ),, i i ; ,[ Ml : S. (i r.c .i * a i, 11. ; i j ; ' me:' !> mn*;.;,. i'.v, it u,.n l...i> ;m',' i 'ell 1. i' r.'.nc than 1 set.: ri.-k of .ho.-.'. . : .i 11 \, 'i (*.*, in a '*'1 \ . v ' Iim. I- v *- ili.it this v.Y>;.i! alo f- 1 l!1: *' ll-tv .>1 !; '.'tlljr i.MlilT A' (h*- tilin'. ;!. I'.lii.ib ( )> f ii.n *! I I * ;;n't: * S ,1 il'iy v..:S which.Hi. lii.it :.(!.ii.!% In; '!;:* : f:T : i^ t 11..-v' "i> .i11iii' ^y, n< ' |:r- ; -1 ;'u s.iinc ' an.t.ir.l' ! : . in.. .ic ; 2 'I.I. .( ' Iiwt.iill hi lirwes ir .U- s;ih:'W'-;:l KH <im i* ' -227' `a .is j.'. willii^ :< ! !. si 11.1' nt ic; i .. i..ti, Fm itn ; ::n >ir. In'Mi'C ah *'iin'..'ii; '1 .:!! t",` u-n ir. 1. .I in ir i : . .|C ( ,i t:i i \ wi. n- i .-I :;t ")' ; i'ii. ;,i ;i'i;iir : i" if in ch -:.-(jnn'' T-- ru..|Pi i l.wiiim 1!;h. they ...1J ah.v'.n-. !*- K'VK V.'ci! in il:c li .i;'. of w;;.. :CMt i;\ isle:: It.is \..i i!.mc in f -i .nut no clwnice w,i> ictointuemtoil In too l nircii S\iti tint Osai|>.ui!!i.:i 11 < -1:!i .mil 5,i i i -.' A.! win is't .itioti [.:*' i : i.'' ueil a stati' ! .i;i ...I' ;- 1 :vi > per i in 11*7 '2. : . icAiiu-:! n li p ... end in I'mG i.'.llh. ,'IWi till'* f H.l .'. .'.lent j.jo i'.in,,! to io'-o-f funlu-r ll 'Mnii.ud to ' *> r.im.N pci end ',,!i..;.n its ,im!\ mail fibci ISJX.N. These Uese.iiiii sli-. -,.hl i imti.i '.t in nn hutw'c jo r.!.tx111s mute j. ieii' the :t.'.s fo.' betv.iTn- in 11 i!i:u icin n in bioh* cd Ct ?. bci.in.f a bi;:-.T umhT'i.. ;ulin: *l ..'.it iletifininv' tl'.e I.- > ;ii re'j'in; *.N .1 this .ii.> r.il cen owls it-' snii in h'* lii'ii! ,.sv 1-; unu'.wric.l nn-i-'r .. ii; ii.n ih.i'; !c..i.lh of the <>.: we el leiri'.fis i.foiat ker. <* v.::> .,( i.-, ':j}i t.. V il-mm , :epm?.\ 'i\ ret ii: .'f i 'li \ > i- rv'J*. om' n i i;,- n -h. ' fu; .4 tw. Iii-i-.i,:.. an' I-.:.; 'H..; .'.v,. .1* ; u. a:- n! Mill .i..'.<! i.', p. If'. <!. <.;i,nn>? i1 ns- "li!" -'IX'Jio m;ii..-:n (!!: >cakj. rii.tl tho-e >4 1*?i- I'Mline and assmuas .<2. S">. `Umril hr? jr.Mnt lion wurkcri sralcj. In MsUon-i! !' 'hiti. mor- t.ilitv waCNpi'< <! as iquivaU-n* .m i .,*' d ;I; wre * (s.. 1*2) to enable a Kiihm*fK>;':ii .(tun *.<.! 11. ipm l.*turt'ii men uiih low ami hiyiivi :pi*t :-.\p..--.i';. '{In: data of Ftuetlii.e *ml :>nni.cI:i:.--n 11r i<. j'..iil as 'i.iiid,...Ii/ii! ti.oi i.ilii \ v,!,l.!i ii'.d l.r ij;:iti the itn-'i i i'*i-l*v em- i ..ii IMim i in l.oili 'imll;'. in >iiuii.it f,.-*i!*>: i.rnl is- in ih'IImk j- iriii lv< p:i [>i'*-v*-.\i% .'.'vh >:*. I'M. lh- sett'.* ill .if; niji;i >f> lli.U j:i vijuiva. I- ni ,i\rrapp ilc.itli i ne of 20 i> <|iu:f*t \i'!i a >i.ui- it mlirett nmti tlity r?.'ir> 4 200 in the pativl and 1*" in iJ: p.'tul, liith ii-sish' ii. t.ili siatj of ilal.i i.i) the s.ijnc siiiviv l.npi'e:it r.iih niolcyi-; e; V- \ .0 3% l ui.! v.ith .i p ; A ; , .`.ni:i the i!i -.gnosis *)f ..ii-,- o! the sli * 1.:d il: : i.. n lias been to...'.-. i i-.. filt >nin .l ,:u l.iny.N .> I ' pleoi.'.. or r in the lm*c '*.! c.t ; !**.!t .i. it may he im- Ji.ll Mill (1* I'M-' ii.!-, u!i,: i it- :! i ji.nti.ui.n i * the ili.- ' i' ..shm;."n f '.iivl. If ti.e | t- i: i.i U :!. k;:o'.'. :ii he expo i >h :hi i. i. pu 'em' . . I*, no!, a .vwMti ... .vv i' i .iiU . 1 : . .mil s!m..!.{ imimie all 1:is iV Iut [wevim ;n inciiioiii'tiN tinclr.ilit:4 >!i.nt- <*i;.i jolis. 'iiiTiii.er job'. :.mt x on., .in w.ll .in of Itis of !:rv w(.;l. c.'hv ip'KS .itnl f miilv r.. mficrs. In .i;iiiiti*s:i. p.'.ar'sof rtsi*.?etnc iu.- noli\!. } ic:i-.-.I.i:v i.r tin* .'.i.i^r. hi i--. mc*i.. tl-vlioiiia mu' **t p!-.:vt! ni wj'.'i-n lie tiisiov- s:v of ;isl*ir*tt'S f:i eis. lo.-.ie'i! ': -...nc it'-I. in l.i.>I*i;;ii iii.iltri.il v ir I :y or lii.itcn.i!; icfniirts sj>* iimtion. ii not aii'-nty ( i`icnt Iioin the iii-tms. Lst.iiiliNl.inent (<f .iii as'oriathui witii ashs-Nl*> lias ittij-oi twine if -it- M iiKitahility is inif'tionvil tin c.ics of cortpcn- s.nioii), as well as lor other wurkets it the risk h.u! mu ptcvioa'lv t>e<*n rcco^t;i7ed. TIiC dose ii l.itionsliip, p.irticul.nly t>{ fibrosis. 02Qo2fi7 ASUESTOS-KEL.UT' '.l*NO DlSS.\>tj CROC1DOL1TE AMOSJTV. 210 ANTH0?HYLL1TE CMRYSOTILE lOfwn Jig. f. [From Tjtnhrell. V.: Physhnl factors ;*>. ctinloj-ic mtchiimssus. in lUoi'ifi'Cti! Kffreit of .{stM'SfOj, IAJsC. Scientific Publication No. S. bum. llJ?3, p. '!!':*; unit! iv pvumsMiMi of ptthlUh*r. Eketron micrographs oi croculnliu* (ii.-ith western Gi|h* Pro. ::mh. atinwit*? .1 miuujIi. anthophsllire (Finland), chrysolite (Canada) at '.!:* .wine t> iTi'o. Franno to note are (/) th>* rtctiiincar shape of die amphiboly h.wis computed with the unved .uni fsi.sud mur- p!irt|r..;\ of rhnotilc fibers; (J) the outer of th diauut* i of the .uuphihote hb-ox'-WT-ted hs iictai-nnu ivtrron liiit ingiapiitc examination* ..f thro? lilx-i* from die 3 uuus. crocidoliti* < amosite < antlmpittlhie: |i> tin* ^(buutuuil fragmentation of the thv-..iulc and the small diameter (about 0.U3 ^m) i,i the ultimate fibril.*. to exposure should always he home in mind, airtl the patient in whom disease develops after a relatively short period (for example, less than 2` \e.ii-s) must be taken as ;m indicator of ancnisf.ittory past aml/or present working condi tions, requiring foitcful collective action. The cc:..* juimrle should he takeu toward the per son in whom Iihiois is believed to be ptesent in its early atjyes or development, cither on clini cal, radiologic, or functional evidence. Any claim that this is not so because the "environmutual levels'* to which die person was exposed were "safe" is incorrect; levels were dearly not Safe" for the particular jktsou concerned, cither because of guMicr-ih.in-sUspccted dose, or giirater-tbitn-avtTagt: susceptibility. k must be emphasized that die clinician's job is not only to recogntee the ca.*c of avhestos-rtfUicd disease, but also to see that r. is bum ;h' to the aueutimi of the appropriate executive .iiuh.uiiy (in many areas, the Workmen's Com pensation Committee, which informs the com* pany concerned). This tecngtuiicm and re ferral lias social implications at 2 levels. For the pcfvm. the implication i> appropiiate compen sation, society's fumbling liest to make up for his 0 220 mam;.- 1 K. KLAkt or her loss of health. At the si-nuid hwt oaurrctuc ot an nsbrsto'i-icl.md ilinv'.t is >[lo.jfhul a* ;i l.trinre .f i-mu-d in- -t> ires, ni w-v'is t> itiu.it!> the point -*f f-.il. -o so v'-it i <.-c. !. ukcii -r^i *'. i'ic m w generation o' v.orktis ;;be ilitii'n it and \c*tit;*jt*j (o!iiv;i,-- 'ndav's vie- vvlto m;o. cuv.un'.) er.tv:`.,5 the in tlt-o.y. Nowhcic is t'n-, w.-ue esi'.-iu with the lo.ilin;.'of .t i.io,."r: w i-h rt. mf-sojiflio- i::.i who-e only -,.,0,ih-o coiu.n.i wr.;. '.t's'VSii 1 i o:!. 1 <1 f. rh;.,. ,,!i n-'ijJ.ih i<i-! .0 don: lit exp-ivor. (-"`w hj,; ,;v of ;,vit;hlioti"-o-1; t\[osi.u\ si;.mi!'! ibr f .;:.iis ;n irr%t loi the >.ikr ill us tneMhci'' Pi -babiv .tot. I..i .-U'f 1 lu* l.n ^ [.' ol r!i h :;;:;trr tri A r, u inoi- Id el) 1)1.a they have .dread'. received ao\ f\}ni',iri* teiev::; to the 'ntiitt; *!> p- nu ll* of movj'li-. : Should ti-.-.v f.-miiies mo-. in* into the tli'riitj i-s .ohi-ed .i~oo't r:us, un it-.s 11!ft0 ti::, been t!-;-i<-j>ri:tce .olio;- for en vironment.d lo:io,,| w-, tT j,f tv i-.i-.i years? An uu.'it >wn aide oni'-tio;;. (liven :t hi.'-' of d>- l.oslit cspo-nm . ilo; ci.i.iti1!. t!;t h*;i.: i.-.- .inh: to .is.uit the n..; i;, uhies th;it w-rk l:f end:'. rov in.At iln; vo:k < lut'nC* lire it- -t taken Iuune to be J-.'j.n-d. F.ii-'-.i wish .1 j-.-n-'i: with a li.^wn e\po-..n<s iik. wh;u i.u.lh.:; c.*tu he to pro- tot hi> --t her htahi.? .`-adiy, it i:,si' ho milted th.-.t ihvi-' Tit; none, o-causc cJectiv-r health jiinU'i ti ;* ]-.-s in elieimo cmirw.vnuittnl c-uicol, .mil tmdiv.d sat vciHafUC is probabiy lontelK. mn'ideied .i form of hio`or;tj n*oui- toiiiif' su;j|'!i menury to environtnenu! ntoiiiloving ('.hi',). Tints, go*-A work nt.'Ctites Mu', (juittiti" tefrsijsiiii;^ sninking r*r; the (vse 'mesiit..il n-::.sotss" tor the in'"vi-`.u.si vooket; l`owc.01, tl*. CNionhi.ition implied hv medical suivoiil.nice cun I'towdo otUcr servievs. iud;;T inji case detection mul otlmr forms of hrr>ith care. As knowledge im^ov?s, jr ts (hu medical surveiltancc will hv able to fidful its iiopcddor role, namely, the d;ifC(ion of health tflects in a j>cr'on at a stage when `oms a:im (lor isist.nicc, iciuoval from c\jj->une) nuy.Ut jirevu'i e\etmul disablement. Giv'-n the ''impcrffi t" t.Ttc of the art. it is, at {uvsctu. believed tii.it mrdical surveillance should rulmlc a ciinica! i v.ituiii'uivn (entjilu- si> on l<.tvd uej-itaiious), an annual d.e>t i ttlio- jjr.iph, and a im.ismemcnt of h-:t^ lumtion, jMobably the most useful being die forced ex* piratory volume test, and possibly die difiusiug 1 i|i.i<i'\ v.h.it |.i:;it hi tiis.e cb.i;u;es hi one <-i r:i-'ie <>i li.r'o: 1 no:; -ti .f cs.iminaihoi call !-ji .itiioii is::. iiu> to be eo-iblMtcd. ''-i the ruru'iiih. t-.pr-'-al woikcr. U'-iuti. in tills asca u rt.oid. ;;a> tb :ac.->t rel."v..;,;.e, in l-.uihnl.il'. n tiiiod. i>; iih'iiii::4 if.*- j.-.is.u;, in whom the dis-'.iM- v-'dl j.r.-'jr'-!-.,. .-divdi.-r >v: ii'it r; sp'-sun' \inm;d v. li'.i' itiul: ,iu' il f: * * r : c\|>--'Vic sa... s! j>-f,. v.ir'V.oa b'd;. ant', in the ab'-:i;e -d lU-f-uiiisv d.it>. this :n-:s* .d-o h .`ssuisie-.l 10 occur in tu.m. With >v;*.v .1 uu v .nki.T. ii ;'Cr.;.'ins l>i hr wh-.-d;': :!it- at id{d* ri.k ca-t idemif. .<! I'-.d ' e enuy into uu' ind.H- t:\. Mr.ur.1 lie. ih< is- im.-uis lo he tr.etit it: d<r plosi-ig Vi:-into niainiainin^AnrTetu'v pm- st.md.ti 1 is * I "i. i c c ii:*!. . :n the tv.vuib.-h it-uii.iy. Ie>cH h oc r-*.1 u xei. hecau*-' '.he .isbgj- i--s v.'urkct's i'eahli l-.'caiue a matter of public c 'tK-.'i'it. Had the `{.tadmls been more sssiem i- h.dly luh'.eM.'.i 10. it i' lik-dv tii.Tt the asbestos- r-. laied diseases would itot have rc-v-.i'.'.gfd as 11 < "oscup.-tioiial iih;rs> of the C1''." > i w'i- :;cu;\ 10 the workii; ; . nd 'tiins of die previ-> j 1!. ^.u!e. I' i- : !.<,, !.>:.vd :r rarrn! i' ti.u>-I.-.is - rlie-i,.;; .ntiou for ti.e wvrk- i-.tcc ciui-.u.i teiiu^' :!iv iiuluitty. ./- >1 lie- s. 1 it..r - - :* {!-*. r u-ry :? ..j-j-it .i..tl -n Ur Pi. > ! Iill'i : t -f li.-4 TlliVfS'-il;- .1/ t! V 1 i.ti;1. fun 0 ai;:. .Sniuli .Mn-.j. i.-t- aid-? help in tin- ii.'-ruu:-- .;i!i 1. !.n. I rl.N review; I-* Pi |. (!, M. P.-i i!.;, ihret:-':. a; J all m* tuheis of the M.l'i'l llMVnv.", *lp n1CV:r*.il ir.u lb-; In altii elf** t< of .-!- -.*. . .t.i<* JViri, in uc- of thvii .*lii:i . ..;.ii'; * .-i1 -` i-Mfu -Uni-:' ti:i j.n--il. is-cd-iu-: t: : in-ms fh-- :>..d of the j-i- i it* ton;.; ii iv it Cm. ( ii.unnt.ii, 1 l-uil. f-. P. k. I i.: (. (-IV.-.. ,,::d lr. Nf \riiiiii of li'-- P.-pu tun :u of I- u: act lU-.dth. Mit.iU Piu'.s-iids, .o il Pr. M. Net*loose ol tl.c 1 >>ii(lo;i 'tii'.iioi o: .\f.ilisi::-; ami !!-. ehiie (o; vaU...l-.v c-h'.orv.-.l s< -.-.uuvm. t- Ur. M. Pi Irir.v. of the lii't.-.c i i-f I'l.cup.iMonil .i:i ! liini ii.iiiiH'iinl fLallh. C.)u!.-*c Asbcsio- Mie.i'ij A's*-i: i- tii-u. h-r au-' { li:.- Iintmiii'i i-u-.'ihi'.f Kb-.-ss *< ii-piiois .uol f -r hi- nht":: d ii'wmi'rt: an-l 'o Puu.r 1 . (.InuiiiT. Jai;-.- Ho . V;!- M.ma.i, and I'h-.j 1 (o|>kiti>oii f-*r tlu-ii' -.sub: ;; help i*t preptuati;. ol lh References 1. ll.uiulo-n. \ . an-1 M.uilv. It.: fi..!u-o. ;l to\i mloxs. cl. Pub: hin;; Sricmcs f.u-iip Inr. .Won, M.vs., Iv74 j 5-1. 2. OiUon. J. C.. A.b-.s'Os tatner: Past ami future ASBtS'lOS KK.V1VP I NC PLEASES 2*1 hazards, Fruc R .Vx Med. 1173. <**. i'^i. 3. 2 mwttsn. j.: AsIksU..; Naim-' and hi'Miy, Rev Ci1w-<Hajjy. 1972. i.:i. t. MnilllCT. \V. Avhe'fm .nid .IvIhmiimv. Aiki Oti itjt Hvj*. 19*6. /), 3. '* Umlo'sh-d e"- i' nt .du-di'V I- J S.-UkolV, ;u-.d J. CL.nir. i.>-< i.-.i: I'r<" eediugi of 4 roe- tru1'!'- I.ild at (I. Vie \ntl, At.ulvm) M Sii- fine', Hit. |>! Cl. 1 l, Aim N V Acad vi, pifi*., Ml?. pp. I n lii.'ii'j'u.tl of .rlV'tos, M. Ampruh, Cli.iirm.in. Di-til'. !: . /r-Mdaliusiifi fm Ai- InalCi -i!: < h.ifl fui Albeit'hygiene mill A i In iiw 1. j * r in dir DDR, Iir-Mtiii. Aptil 22 25. I9'tt.pp. 1 -3'2. 7. biological elietfs oi ad .do', P th.-guvAi. [. C. Cdon. V. 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Tl, Mi iiitn.iii, J..: \sl>. ((H bodies jtul j>l ..:al |>li<{ues in a Finnish series of autopsy Acta Pattud Mi. I'.biol Stand, Il'tit*, ('tip;*1-. ment 181, p. S;. (iniskt, K. A and Addiiif.ttui. W. \\`: As h< sitis ni fiiiu^moiis IhaIus. l-ir.u s.s*. (s. Ftu'l J Med, To Su/tiki. N' and C lung. J r I'u: niatiun t,f tie* as. hestos ho-i,: A coutjvii.-.tive study v.iili iin.i- i < j-e* "f .;!>' 'ios. Km i; on K' ., I" A, I h7. j?. s'l.u'-:, . an-l (.Ion*;. J: sti t:i i me ,.n! i< |opm-::- ,.f the a-:n -ti-s lusiy. Ailin' | I'.i::. .'. p; i. *;u h.iii-. J M Fnuhci ohi'.isatioiis on (!:e i.:ti.i- -li Hi I ,i, linl ilKl'd-it' <! the fm Ui.il i. !| ..f ad.s.-o* I i-l,-'.. I'an Mol Path'1!. IPTh. I J. .'hi. 1*. n <. t: tti.. - . A. ami iJi's'i'-nh *. j.. \ !is tris l".'iis 1 lih. is ii- l:::4 iissii.s. I'.e.'i.or. Health P- ispii t, luTl.v. I iT. H'. (.ms., P. h'-rroillr. R. T. P.. and Halle.. M. 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If., tv.. . ti'pack. C., ami Hailey. VV.: Radiographic I p!i\nolO`'it patterns amui;, : uoikcrs o;ga:;-..i in tnauufat ttire of cement puiin.i'. j Occup Mol, 1979, IS, 2i>. pi*. Muiphv, R. t.. li.. Verrit*. H..U.. Htngcs>. V,'. A., tVorcoter, J.. ami Gacmter, E. A.; F.ifcrts of Imv I'mientutioiis <*f a>he,to: filinital. em vironim ni.d. rasliologic and cpidemiulogie oh- vetvations in >hipyatl pijn? twrini ami eon* tioh.N Engl J Med. 1971,2.. 1271. *.*?. I'Yirts, |i. (., Kan;u!ive, M. V., Peters, J. M., Minphy. R. 1.. H.. Uuigtss. \V. A, ami 1'emlcr- jj11. I*.: I'm *.ah me of chronic le.pitatory disease: Asbotusi. iu ship iepo.it workers, Arch Ktiviti.u Health, 17*71.2K Jll). h.-s. rhoms.ni. f. CL. and Graves, W. M., Jr.: Ash's- <>s as an uiluii ait romamimtut, Auh Patl.ui, If'dd.*?/, 1'3. f*1). I'humsoii, J, fI., K.isthtdu, R. O. C... and M e* Donald, R. it.: Asbestos ;u a modern urban haraid. 5 Afr .'ted J. 19H3. 17. 77. 100. Peacssek, P. R., luanciiioii, C., and Di;cci:>reUi, E.: Exaniination of lung smeau tot aslieitos bodie* in 109 comccmivc necropsies iu l'erugia, Eur j C:tu<-r, I*, Ija. 101. iliiRcr.traud, I., and Seifert. Jt.: Adx'tos lad ies ami pleuiul platptvs in human Im.gN at necropsy, Acta Pathol Microbiol S*.aud [A}, 1^73. a7d, 437. 102. l)icke, T. E., and Naylor, h.: Prevalence of a*- Pi 221 MARCAKf dflC.kLAKF bcstus bt*Ues in human lungs at necropsy. Hi; Che*. HHK. 122. 10.1. AdlOufl, T.: Asbestos bodies in routine uc cropwe* on Tyneside: A p.uheli'gii.al and s.i.i' murfy.Br Med J. low. 1,H14. 101. Ktmc*. T. MvCaugltry. IV. T. E,, ami W'.tle. (). J..: Di'i'mc tm'lUh'.'liOnu of th-.- pleura am' .i-lv.-s: . B: Me : J. i.f.jo. I'l'l. : A, G. if.: Ad>estos bodies in lun^t a: lurioptv . J rii;i Pathol. I0C7,2v, S70. Sun. Pvdliack. A.. u.d s.u>s. M. 1.: 1'ievaiCHfc c,f aOn-stm hod:; ' in b...,ai luuj smears, iu J M-'d s< i. J"0*. j; 107. r-ii.t. it, i Atu. P. S.. arui Gii"-, l*.: lot !n-*!ii.< in Imnnii lunj-* at .Hr.'.-p^y. J.\s|.\. iivi'i. r>:. luV Xipell. I M . : i. l rdt.uii.d, P. H.: AdK->('>s -.J i*-\ in li:.:,- ; Mi AuMialiai, ii-por;, P.idioh"',. 10.;n 7, ;V.;, lO'i. I'l.euim^rii;..>i' K'/'c-utii Cousstil fnr Sc tfni: fit :d industrial Rt-eartii, Annual P.e pm t. P.'iG il 1 . I'itL' Report So. 2lt>r. Johannes* lung. S. \iiit no. Anjihil. 1... ind VliuiloeiV., W. M.: The in i- diiii'C i>? ;t>-^ Im-dies in [|ii. lung, -t :.i:i ilmn nt, rj -i et in Moutical. Can Mai \<s^.e J. u:: in. t.li*v/i, 'd 'In.ni. C.. and P.ucctt. lf.: Ins lic-di. . ::i id. l.mg; <>f ndial.iUiii' <! Milan. Med !'-'7..hC 22J. 112. [ini. ti-i I.- V c.J (In ,;-.-rd...: lu::d in a-l . to: bod:- b ugs in Li.-.dmi lf,:i." -I.:;, Hr Mvd j. i n. 2,21S. t 1.1 1 'tidji -n. Nt. i).. f.rn P.. aiiil PeTiv'd', P.. J . 1'.: 1. in ir. 1 ..d>--. m lnru;i:i inn*;,. Atth 1 u-.:ri-: - iladdi. 1 ;r.*27. l i 1 ll'igii.,1,. ] . I .ru. J.. Ivuinaid. 0.. Jauuud. M. C.. ... aid Pitu non, M. C : Intuit ute <>( piilnvm.nv h:i:. pitfU:. bodies in l-mwe. P.nxitmi l*'.-. ;v >, ISO. ir.. I'irfjm n .. V . Pdida. 11.. Kahvie, M.t MatxiuA. /... 5<:.d.. i.. `fld /tgvr-\'i;Iovit. Z: !tHid::!-f of ad 1'lies in ha.al I'.ing >mtar. Acta M-d I::,- iv;!. 3f. 327. ! 1-1. } Icinli I O B,, and MiC inpii.n, \V. T. 5' . P?rlin!;'gii..: ii tls of a'l;n'i*. P*-<fgi.nl M i! j. /:. 117. Sdimphim. {.: rjiislfinicdogv of nieS'.>thdi ':n ott IValchercn Maud, id J 1m! Med. l`J7l. 2-'. 5fc nit. U'allacr. IV F. M., I-iuglands. J.: in -ida- (ion tvoikers iti Belfast. 1. Cimip iri^ui of a ran- dot*! Vllep'.f svuii a uuuuil psspulatiou, Ui J l.-.tl .Mnl. 107 i..* v,2tl. no. 1 iitgkuiiU. j. U. M.. W..ll.ue. W. P. M.. and Siinp%.ni. M J. C.: hiMiiutimi -..ul.crs in Bel- {.I-.1, 2. Mod i.!.:s. in men Mill at uuik, I'.r ] l:u! Mid. i^Tl. ?J'. 217. 120. N'avc.itil, M.. and Pobias. j.: Ik-vclnpincm of pleural hy..ltm>sis in lougieim studies of pet- '<>** v\ps**eil lit a*>lws!it" tluM, Kin nun U .. ftf>. ;*; 1.1. M.uim'!1, *. !t . and ltii>iu|\iir. T.: l*| *s. ; plaque, aiid i vpii-iiK in aiu-.ini, S<..iml | Uv pir I>:s. I'iTu . N:'pp!et.;( m p. ). -2. 1 i n iu-i-!;n. 1 i. t : l ull m.digii.:;; 1 dm. 1 del! | - [ jdeq.. , ,11:.' In .; -.:e.-. i '.p "Uit. i j>e ie;nc. I'.: 1 l>ix C.n-.I. 107 1. is':. r:i. l- -. II 1 lie |*.<tf:<(- js !' p .iivta!;-! i.l! plaques. J l i P.uhol. 1'-t;.2/, ! Id. 1 - '. ........ . i l > H . i.i-,. f. I... :ii-l fl .irds.m, j*. C..: Hv.iiuic r.ii.: m l pi-:; plaques ;n ...i index nt cvp'>-.uu ' > A unity i.f i..dw-I. gd,ii and . :*'.:oh p.ieal fe..i"tir< o' I1.*) i.r- - ;v;;i; i >U'iii<'iaiit'u of epa! ru:oi eg) . lit Mul J. l-vn. /. li\50. i_*. kui'V. ( I-., un.1 IK.uuc. Mmet.d cental. id the lungs after expo.me to .sbt : is diH, Audi iml H>g. i*'*> t.: \ 2:> ik-. X.ivi/iil. M.: Plcuial ,,.i!.1:,<.iiiun rite; t- iii'ins expo'iue compared nidi iriev.li.I fi::d iug, in '.lie n.>n-'x{*i\rd p>pu!:itions, in In- i:-tleti Pn: -;./ r.tpmn . ///. IV. H- 'A ahi.n. <'tl.. I'u'ci e.hng' i-l trie British Ottup.Ui--.:..; Il'.gieue ' ...el> Simp '-iutn. l.oinlcn, pn'l. L'n- iv.n, < lid V. i. - in ? P.7, xt ui'ln 1 n.. .: lid Kd'e-.-. |. k.: ("ittn'.lt'n'g i le is ui ,i:. l-.I f... and niuittucicvr antiln in diijn -rd .. difNiOs ; inkers niiSi pl-ut.;! phiri;-:.. I'.r [ ?:; .1. P>7 i.c.s-. 1 < : Pi.ilniu::ti i f:net:o: U'S in ..-.l-e.i.i , i . . 1 i.in, V* Oeniji .Med. i. >. n. .: . M.-tU-.ke, v : . I'mind.'i-'.hive'., G. 1... Mr- M J < ' sni.t [,. and R.i- .in . ('. I'.: f.umj ! giapl.i-- av.Hull r.;7. ii in re!..ii.vii l. ;!:: t i. in Om-'iii t,.i '.. .1 Re.jiif id'.-'. VKv.ln-r. I'. M.- A s:i.-.v-diy ol ship?-.id noiket-. i.d: pi tnuI Br J In' M-d 1172. .''Mid. I '!. t-.u'inlt i. F \ . and Uapl.in. A. 1.: A'U-oi-. j-h nr d i.-nm !.?, Ann ten i n Med, Hi.' 1. '!, K 1.2 ! 11. i> ; I*s tn;*p'r'i:: .. JAMA. i d*,. "T. M'.V 1-1. piv mt.ri:, II. I*.. Pleuial r!i ir.i-evx in .* v)-* . S. N I'c.gi J Mr.', 1071. 102*. i ' ( ii.iiiun n, l'.. A... r.igium, {.. i>., Parii site, Vt.. Btm.irt, C., ami ChuG'n, j.. I e pleoredi ;nSt>t<;jues r.otitumora!'.'. 11. v Kr Mat Ri p:r. 1 *:', 7,5. l.dt. {.enien.^ev. J l1.. and lc IVv .ui.u-.t. I..: I'leti.i 'te ?..Vf'ti*iijuei non-ttituurali s: ,\ pu*j'\ U ! olnen.iiuHi', I a Nomell'- I'u- e M.-.1, *:*. t. MAS. i ' v Cis-Ve. W. I'.: Kulmoii.uy a>lte',A>.*i,,, i*'- M->> J. l'.'27.:. l'*2l. 1.17. iWcfclnltc, M. R.: Rrspiraion' discft'e: Section 7: 1'lnsical ami ciumscal irriums. in Ccctt Lct^ AMiFsros iu vrrn u/nc otaSAaKS Tcxthuok uf Medicine, cd. If. W. Sauiul- is. Philadelphia. 1971!. p. 8**4. I.'.v (doync. S. R..: Morbid .ui.tmti) *.ul lustuiojp u( adiotosis. Tubvtdc. I*t33.1I. I15. FI*1. F^bert, O. $.: Pulmonary ashcstusw. Am l.ev Tuberc. 193*,. i/.aj. I i A.fii. U. J. . and William.;, R.: Tlvt j>u: `t ol y <( v* t: Ii n. fttvuee 10 King fi.i. Thm.ix. P'dl. In. 2M. t'l. C.nfirr. P.. (auitribuiioii a ITtudc de I'.uni'n r:>>e, Aw ii Mil P.-of, PH'J, 10, IN. lij `ihnmn. V. ("H in-in, IP. Wvli.t.*r. 1., and v'iin C.ii iih::', K.: M.i"ivr hi;ww% in jid'r.to. vA. E;: iwn tic*. 1971, /. -p!0. I ij. ( ti*i*M, R. \. ami Di:iitlu'ff, J) \| ,..:ve ViiaWT'.'.l upper Inilff tihrnd' *f\'Mtd..iy i-i ) c\w. C1k.i, 1^7 [. /<*, IIP I mm r-Waii ii k, M.: A pci 'prnive view on v-U!> iMihi-.mwm Kr Med J. P'M. :.i7i. IT- (..n li'U'i. F. V. l.au tii'jNin, CP IP. C.Mitu. R F . 1 mn.wi.wt. A.. MwKm.ux, l .. .md Vmii-,, \ Pailudngt. 11, physioli'iiw al, .nui i.iiinilogL.d <.: - i; ti,,* pncinuptonio'c'. Aim A Y Ac.xl s* i, 1972, 971. **fi P.iika"k. A. ami halted. C-. M.. RIi.>;'"i l-ii.l lung dunces a*<! iaird with .win. ,5..i%, I . pos,:i. iKj. 117. ii, W. G.: Rheumatoid [nvu.ii'': (Capl.iiiA 'M.!wiiiv) in adeu< uTtki-w. 'lit**. u\. I'.i'il, If-. 372. 1Mihjj.*;;, \\ k. Rli'-um.ipii,; jnn u.d-.i, n> sis in f>. 1.13. i i;jt>fi with ashevtusi', 'niw;v, P,;iJ, 1 Ms. U : 'vmltome in .t*t*.i.* with .i h, hi>.is. ,Vamt J kv'jiir Di, J.'Tl, 195. '. <onti. It. .md Purr, A. P.: KlriltOii mil to . iu .IcMptamamc interstitial jin.'it. mourn a'.od.drd with a.bcMos Thotax, 1972. 77.3*1. l`-i .v.ultlii.,;. J. (.. amt Mm.**:*. K. V. \V.: DiP.usc nlvndtti; (dilfn.sc mtersutial fibto.m ( ;!n- I'iiJjj'k I ii'wix. 191(7,22.2f| I Iw. Miliii, l.an^iT, A. M., Ticnlcin, A. S., and VitAoll. I. J.: '*N(Mi>jctiric" iuci'tii.il juih.m- tr.ity Itbiiwia; AaWKiation iv tIt a.dn-itov fibers (Jitittitl 1>> dpcttoti miuox.opy. N Find j .Mcil. 1975.292.91. 153. Tiimcr-U'arukk, M., and Ha^laia, Ami Imdics in wmc chronic rtbro.iui; iun^ ]. Non-ii'^atiu N|*ccitic auti)amiU<dii-'. Cilia AlkrSy. 1971. / , 81. I'd. 1 iiimTAYarvvitk. M., H.wlam. I*., and WrcV*. AmilwxJirv in 'Otnc chumic fihriwln^ lunij diw.'.m-'. 11. Imttiunnthmri''(;nit studitj. Clin \97l. 1.209. T'trm l AVativick, M., and I'aikrs, R.: Calculat ing ihcum.uuid ami antinmU-jr f.vtort iu as* bt* w<irkc;\, Rt Md J. 1070. 3.102. I ". Mi rdiitu. J. A., klmi.Ia, I*. T., .Stmiar, C. I'.wki', \V. P... 1 .r.vli r, 'i. t>,, ami Tinnu VV.i; wi<2. M.: I In. til. A >y'ivr.i iu .wL.d.w \voik* ris, r.i \:.d j. !>:*., /. i.-.i 1*>7. k.a:^. k-Y.. Sua, Y.. Okuchi, T.. and Y.r;u- tmiTA, Y.: I'-iywphmMvs iu .idn-'Ujdv, N rti^i J M'.d. 197 l. ; 7 ;5. 1 .*>'. Rvi i, u, j. (~i:ii;-i)( !1. H. .'::d (.ou^h. (.: I'mjjJiv-v'an in cnadviukciv' -i.. iiKM-aioMs. |5 M -i! J. I'dii. 7. si. Il'<'ij;.i'. A. !<l.t.ng f.'.inid>. 2i J ki> Cui't, !.tPJ. !.>. 1. Ii^i. Vain, A. R., ,.m! f.jil. L. U.: tmpir.iiory iri-kii' ami hk\Ii.iii;, ,1 ouih ot la.adiin;. `1 hor.ix. |*i7 1. till*. IM 1 lu.'.v. I*, k.. Cla.l. M.. Ciiov. S. F., Mi;'i:;:n:i-;- i.vu. !. M. }.. Ch.m. .. f u.w. Ci. Nij. Y. k., and (iamlrvi.i. U.- A'lu >m< walkers ::i sita'a- j'i'W : A dinival. ium.:: .nal and radiological Mifiry. \r<:li Knvii.m n,,:tlth. l`.*7 >. .V-, 2 Yi. I"2. Ki.v;an. (i. M.. `I It.. :.in! Tliyiiwmi, M. 1..: Sxii nn;> ill a*id uh'jettivc r.u.wuw mem vt iir^et ituhl>in>i, l ai.cet, I*>7, /. .">3*i. Il'it. Si'tit:; i, A.. Sitmai. arvl TuitierAVaiwirk. M : The ladio'o .<( a.'Ui s;o*>imhiv.,ad v'.kcasc ut the iung', Itr I IPs (iin -.t, 1971. <$, '.ij. I(il. vh!iiiiii'.ii, A.: The r.adi-.'k^v of -iSi,.;oi4. S .\?r M.d j. 19;>. n. 8;;. Ui.'i. Hmivit/. M.: Ro.-iUj.c.W'Icgi'. *sjie<i (d adm t \;n j i'.- ;im|, I''hi. o'T 2i ti. Kid. I.i-.uhail. C i Chtiic'ii, hw.nt liogr ipliii. i.i (!:'A-"ii.ii a: . . .'ohia.i.il o!wr'..i;.>* ;> >. h Ip'.'' of avl>' - ' i'-i j li d Med. 1; v'1. 1. , 21 !. In/. CtCiCCi:ui:. <la'-i`iuui.n of tin- e;.ij>liii ajijs- in.*'' uf {.h.cn.iioe'onin.o Cir.'U jv.*,T. ItIM. Inu 'nation.d l.a!n-ur Ol!u*-: If.O U,C * Irt* latiou .f widti'fci.snh. u! ip.e (mrtum*o :ii.:.t 1971. Ouujiativnal lU*..l:h :uui` S.tUl) S. tii . N<>. 22, intern uwiial L.dxmt Oihcv. Ovm'.a, 1972. K9. Weill. II.: Tin* rluM incmgcnggr.'im a\ an i.pi- deiMiolnj,i. Ripoit cf ; Wmkviii'j* vj*.<it- vfieil lv tin' l*lvof 1 'mg Ui.ea^ <. y.aU.u,.-; Hear; ;;nd I.ur.g P.i.`*i. '). 4 Arch Enviion Heaith. 170. lUiklakt, Nf. R.: l'liuiiiiiM'iiiiw, in fhitul h.H>k uf l'h\Muii>: \. >. v a, Ht vn!. N. \Y. O, l eitti ami 11. Kaiwi, e.!., A met i* an Ph\*i- ologiud s-.ivietv. W.i'l'iii^mn. 0.(1., I?**'*. 171. Woinm iu, 11. J.: Pa riillittic A'!)r'tstaiiiivxj.,'>i- lion imd nli'tsiikti.e Vvmi'.itum.toriin^eu, lm Aich A*lritMn'vl, !97n, 27.211. 172. .Muipliv. R. L. H.. Giendet. t. A., Redding. R, A.. Iti Ueau. R.. Ke-i.m, P. J, .smith. A. (h'lf, A. M., .uni Feui, IV G.t I "".v i-xp'-'iue to adustm: Ga> txehungv in ship p:|h.' uneu rs anti lo.muli. Aich Enviion Health, 1072, 25, 255. 173. Vimiuicr-Mavc>, (V., and Ikcklakc, M. R..: Pul* 94 iriliJ MAKCAP4TR I ' KIwMCi intMiaty fmutkm jnol.!<'> in Om-lm. ad.i-'V * KiHkh. Hull kC'j-ir (Wiihaj, iws. ii,vk 171. Mukiixm. B C .ami 1 mini \Y.h iik. \l.: I i:-.;,; hint non %:u.!ic% in .idji i\ workas, Ur J Jh viun.I->. rii. !?' l'il.it. I U.ll.i.ii. 1'.., t ;.ili-i:i. O.. T< :i!i'i H. (-i iit ii, A. \l.uni Aon.to!*- .(.u, R.: (\>u Uihtuuiu .i 1 clinli- ia . oi rr!;ui>;j< ti.in-.i. .IS|H'I l' l.lll. ' c [it ', < hi..Itn.f .. <-t M IH iinfliii 1 i <.*[ I .*! *t j * . V. \ .r.l.t .i.i.t.. M .d t .i .in. I:*7! rt*,. 7'i. W illi.iin*. 1Ii , n i i 1 lloiiii !' f'. l' . 1 lie >ip'n:h art i t-f !, .. r* Ut;i:...ii c!i::: in I'h'.'tti'i'. n...i\..'.. ! . O -l; o" . It ...... ii *!.; llltl^t d-.' -,|< i 5, lll'I. 1 ;t \ 1 >:.l II...: .. K . M.: R. >i't m< t>.u o,-' a itli d Iiijm- iiiHTiH'.'al \T - RtA IV. '[ u I't'. I J7 3. 7/i. Klciidfld. M , M..'.I:,-. J. , Knovrnan. O., .no! 'i.iit.i'i. J : l IM ( -d ..A- iii'i iiili.il tit r on lim^ Inn. r ii *M . Aidi F iii ii `..it H- .;lth. l!!:o. /2.7II. i :. Kit uiifl-`. U. . Ms -in. J..:au-i Mupit <>, (.: CJij; it.il. i.idi..] -a i-,,| and idr. -ioli !:n Mnjs i:: :i'li?--.ii*.i., . \u 1. luii'i it M<-J, ;-j|''.. if,7. "Ill 1 *'!. I*1 .4M<|. A :.l. 1; : d IIIOM.! 1 ) !u: ii;.. ui in .t'l'-'.;. .. fl'll'WOtkl >' \ l! ; :rf 't lj O'S l 'Hnli. Ai.i Rx'. Rf'jii i 1 / of SJJ. l.'l iI'-'H '. . |f !!.. Wh in 5 .. an* ! B.-iVd.d*.. M. R.: f ! u i.. : j/.ii'i. i[> 1.- .1ivfirn <.io'iut' mill . h.;i.I. . ! i *.' ll. -t . x; ``ll-' f i V* 'J*.1* i). C If i-.::,. i; W. i". \Y.. ( c Mr- .on !-. iiv t .-ml | : 1!;i" .111; I fain : - < -: h'-.iuii. 1; :1 fj i ' i'-"H. \l: .* . f il.i. finiii-.. i>:;. i>. Mini, j ;> 'ii1 It-l-.f. r. l lit* dl.lwHI'd* i - ;im* a|*u .t i;. P> t ( 71 , 1 . />''. *|1. < l , M., l-.i 1. J.. and Tiiiiin, J.. M.: Y.isi.i IlililV id n; x r 'n,m c n liil.: ii-tv floti-vi'lun.a i Hit* J \ i'J:: .\'td. r'71. * 7. *>7. Irt. 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'1 I.. \ i ;> lu.ft <f v.'isc: from , ui a OestVii Ik | Iiu! ' i i\ ' l( t S|t!U>`:'ll, M I tviiiki'i* i a ii.'frt v Maiukiv Via lf">, iiv jk,\ Vaa 5. '.vh. l *:inn, J ... :hi<: \\\ a . j. r. mi cr " of uu 1 pKiiiji .i'oit.ti i U jk > f.'.!. '..*! [..OS jvt !; A: : j 'is!mc Ik.l!: U i a-.i'i. ' , 1 ?o'i. Vl:V<.:l l . }.. flii'-J'id. I'. . and C!v.h T. J : C ; iiu .V i'.fil. of aniM'i-L- a l- Ardi En- \iio:t J V `h. ' Ti.2i. l-:5. K< a! l *: ' , F..: F- 'itii.ik 1:1. rt-V.t in *!..tll(' a! ki-il-h rl'.ci. of A- Art R- - R. .j-.n li ./;. it:-. U -ii- r. i. . Giki.i*. T. C.. it In. 11, V.: ri'.<a ::iii.(.. v of a \[ a rrt i ,ii'.':n, Tli .\r- .11- . i-vi,::\:t. V liK-'l . I. J . i f.ii.ii.i'ii ! F c:., .a.'.I Ciu.-t;. j ' v>- < \ j u: , smw : a-l n.T.j'LiMH. J \M 1! VI !s.i'.IO'.'!>li:tl, Nf,, ai'tl v',.`'i> J r.iiUidugy of i .hi in. :n ; .( 1:i.a !'in}{ as-.* K i ..III Is il ll JS 1,. .a . ^ vjihmii C a.i < i. i'.iT.'. *. 1 1 A'f N. . W. I... at, l W a:, f. r - v t tiu'i .* .! .all <r||i!-i,-lri in u s! j- ;.p, .. .i! k.'. .. ik 1 i ,.i \f..L "i,. 'J J*. ni.T.ti :: i-.. \ Min.' ;- M 1 .. u ii. 1 ! - n K V an.!' Ila- li'.s a .1 tv li.ii^ t.iii. i l l V. ' '] rl N M J: .if.-i t 1 A.'* l .i. ill li.-- f ti.: nl Km :.!.mn,,, j la-u : i Vii'l 0..; ; -..V. V . k"-'.i-. U f... t.t.l -. \ '* . i . A.! a-.>. i % j ''a.- ,.n 1 in..! v TIlOlx. \a: is', t is. ai; Ik, 1 -T , I'l. isl iiif''].l, \r.: Uiat< r.ii. 1 ta kit.- t :iii!i.iiM i t ...ia-'ti-., J (1.1 M. *! '.'.:7a. 1 \ J*.'*. l'a ifi.'i (vt hi Mlk'SMl n. k** i'f s.-`l.-y: C---r. aiiaro ..ii ll..^i: 'ir Slai> ;.j; l`s- ft ;i't:i- a.-n il.'.uis far iii.'; a*i ill- .is!-.-:tils .'.at. .Ana iD-.im. Jkia>!- .- ;,am! 1 A'l\ r .v i ii Cr- Tr*m l< i'ii 11\ >;u iIlf Sc.ll'-l.;., r % 1 k .'ir j'n i.; .. * fat .litl'miu miasiic :is!v.S.*f> s ill.St . Am; t ' i n%r. n:::. 1. it* i **_ ,\slt stc-s Ki'i;`il;Hi'!i ' ( ii- :Ti S.f. r.i No. r.'ia. ii';'ii 11 lull'll. <VI>1 Ikil.-h i i,paii..mil li'.;-;ii :ic xa* i .-r.: i. : u::: il i,v a:. H-.-.-i. f,.- an!.a. [- Pkticiv of i, ! *: ! i v At:':.i. 1 Im ii. i.. : 'if. to* i!1:. *. \ = U5 out.;, n-*:. : 'I r S. I).-;- ai-m of l..-:Si i* : 1 tiltr.-.l . .a. r. s. !v. .a l,t of 1 .1 !*r : V-aJ. p ai K- n ' i?;;.. > 2il. S'lillit , . *: 1-.: (ku.p.i; 01\ ,:! Ik' ikh .-.-U!......A..,. l-.iii-laa. 1- i; > ` ; -i.la .a . . Qi-02062 ?6 rul'-`-o*~.ry Diitixit iecUon l 7C0 r><'*l:Jo TULA N E i; X I E il 5 IT Y Sc'-O'.'i ".v'.-.ci'.e Nil - 0^' aN>, L.A. *J 1: J une 1 O' Mr. E.. H. Mareness, Executive Director Asbestos Information Association IS35 K Street ;\W - Suite 402 Washington, D. C, 20006 Dear Lob: I suggest for your consideration the following : ue-stions a ns wer s to be supplied later) to be iucludvd in a bvoer.u e on As s to 3 Heal :h E-Tecta for distribution to the general public Whac is asbestos? Who uses asbestos? Arc there different type* cf ashes:. .> ? What makes asbestos so difficult to replace? Does asbestos fiber present an occupational health hazard; What influences the extent to which asbestos is an occupational health problem? Is asbestos a major air pollutant? Do brake linings emit asbestos into the air / Does asbestos present a risk to the general public? Co'aid the use of asbestos products by the general public cause disease ? Cnee asbestos enters the lung, does all of it remain there forever? 01-0206297 t v Can asbestos b"2 safely v.sd in ths -.voi''cpls.ce ? What about substitutes for asbestos? What is being done about the problem? Hov/ c:;i. we summarize the faces at present? cti*cv--at jd questions lor cer.'.:v-. or aclo.it von y to pr-oaro a draft of answers? a: tho r.e::t step, With kindest regards. Sincerely your;:. Hans Wei t * Oi-020629^ St2-':3 of the Art Asbestos-Related Diseases us the Lur/' cud Cine: Their Epidemiology and implications for Clinical Practice' 1 \!ARGA?5T R. QECKLAKE* ns: Contents Iiiiro^hi ,;i.o 1 > ' :<% \(iiici.1!' f*!i.ii i i ;i n aiu! t i!h i T ;;i*< I'm. ' \ >! `O'.(."> ` '( .'ti| .>( I',.:* ... ,V. - :!'.. F.i. \ i u. m.i'i i'.il I'.iilu m* t*lum..i t v.'tuii-s K.i.li'is.-:.., !.; t I.ot-j; ' tin.ii--i M: if, i l .......... . ( -- . ' .. 1 V M.,i.. -. Ii.. >i:<i 15:. V;i'..f Iu`:L' .* i. i'.- ... i . || i . | | ; || 1'":::: 1 y ( n a: atV.'tJ I'm ' ' -ti. lil'tc ::/*>!, 1)- -t <n JI, ! Mu'.jii i/. ii 'j(. C ;.i\mh ; i'*:()<,!. x.'.Uii.i tin I m - (tun . ::t I' .- . : ;y h i'. . < 'M-.J.-l l, ' lt|. --i * - . j";vi >.ii!i . t V:V ' l-.NO.t.tU'.. C*ir r Uv". > i \ i ,.iitv ?.;:! -G--- .> '.-.V-t . ......... . . ` * I.Ki rial -l .i.m! ( o.n* ! K;i> t :ti iiliai- IK.ihif ny fi.i\;:u-il 'fibrolic Ti... V* ntit,; i*{ ittf l'.`t vul t'Ji 'ti.it tf'lo^\ ami iVt!nr,;rt:ms C.JTm* ji .;:ui R.FmU<~ c rii.itt.-i ' :f;i,ii)it 0:111;-- (nui'.iitial I'utmoo.m t-'i'ro*i tAiW'iosiFi t)i > Fi -.tt the |VjMttni:t;l of } imli nu-'I'V' airj lUaitii. amt of FApetimi-mat Medium:. MiCill Uni* amt from the iVparmw-m of Mt-dit iu. llio.al Vicria Hospital. Mmitrral. Oni.-tm. ' Ki j a .u for tt (ints 'hoiilil In- .t ltitt to l>v (i.'ifi- : oi V,|iiii mii'lojv .mti Hiali'i. '.ftGil! I ri- *i.i*i'v. J77j T.mvct'iiy Jtifvt. Mont;<.ai. c. c uw.:- t A it! tif :liv Mci!i'.l! !Uh.:..!i C MU'Kti I.i Cm.', '.j. ,N Rt.VUW i !- Rl 1 OR t 11 i'll \sf. \.'l Calx ii >*' ti.-. I ; \ i i.i: ... w -tlt ,\-*;c'! i \j'-t-'iTi OtU- K- . ! | ...> Thr *i.: -ojt > i ,.-.i i*-:>: Clint* it imjtlit i:. . ::-i tf*-- N ' i:i>. of l.\- ii * i tii*. ! [-;.U o-.oii-^f. Hmlit y. Introduction .Mill'* :;il lilt iV'ts:.i 'i' S' * .U:it.- li.n. : it i;( it^:.: . i! *n' ; j . if;: ,-iii ' !. il t iii: iii.- ;i > ,!i . s;- i."Stoii ' n t:Mi;i Lit i' i ; 111 of t.ii : . v -. ..v n ' .. K'Mllt tit** ll;w .imi i.i 1 tt In:.-.;.. it ffl .ilUM ;.t il-.-.cio-. i!.o ir i -f i' -1 u.i; r 1 ii>i. 'f.'Ut to t !:i. ii'o : t% itt IF77 ;'.It-,'. Mtl.W'j lit lit i; ! ; utcnc in (t :c i it ilic t \- tt'IIMV : < iitv.>f iic 11 > : t I'.h.t t It C)'tt ht <* was to tV f'lit titt-r t-'ll' jii ;:-** i.l liic .! V !!-mn lit- ! c s:i- ; iv i. >!. .......... .it t*K f * 1 .s I l.l* ;Jf t *. I a IS n IXi: ;.i . tstl'.-f ii.f u: .it liittrt 1 '. : .1i i-1:% ,i* -i f s ii: ,i . . J. '> f hr vi..-.I...........i .- r... C-i-. 'S*iit:i \::m.u u.i tun; .1 i.i tin- '.A .W i lj<2a asscc!ATio:i/ tj.'.i...>*t) 't 2S 0. C. T.J 2v.CCo 01 0 P 0 6 m <.r?; y< v. tevnth ictitnry. > m; L:.-c T.d" ti: * in' y.m !! the .h .'.a`.v. 1 to'..>.! in i 'ir a*\f.; -s r. i .hv \ U ,\r'.x;{ i;t ] *i* 2}. >- It ill . 1 f.h;.: ;o f". !- i; r\' :1 v . ..* th,- . .' 1 . .c i i. . }vr*i;j- brit.itn. >'z ureas m ' ! *;<;trd .S.'.tfv*. . - ur ii l. i 'i i..,u?5tr:"'. 1;'? this 1-1 of ntv.du: 'hv. and use of .uv s'- an fi.-uu- ! in -i way thrt; i;irv!,-r!ii':?v ini -.suild... I-; ct titrt of it; ;U ?.; i! d :..;j i> Ir. altb: far- 2 tia-*e> the r\;.->ry ri :.i .h;..:! i.cu.ynh' <: its health In '.vl.K.-wi to th- I'lH irt: hd exploita tion of t* Th::., eifectJ I ..!:?! 'AVI'.- oh.< :\.d ir * ;r [ v i':'.*; f-rs? i-V-'T:-.- i:i !'. 7 .md i- is ivcn -.!r;d a zfi'Vifti.'.i tr.u.: (3 !;. ru'.ct. ; o'<;*>*y. the l.ryx.. {`1-14). ovary (l.**. and breast {In; !;; i actio:; aitr.j: r^n:: :hr i ..?!*' ::;ects In Eu- to:* mv* N"--::.. '.me: in 3. ;>. -.dr:*). !::rri:,::\ 'tT-.;:; ; !;.!*; o-i do-n-d ;j be re po: :-.d. !:-d.i ;i ..-.iv; ha* l-.tJ: f.."- ( m i i- >sj i!b.i * of the l' : dev;:; that n te-'-cts ti-- extent of ct.r- !<?;? coac-'tM f^r 'I*?* 1;-;.h.i/.ai*. (t). AIt:.or*h of tls* r.s.iciation l>*:* tv.o-.-r* an*t th;- variotw health c!t c-. I-s-.i it* ?r.Me l v;a nt.tdc iuitUHv l.y 'hre-...! :*nrS:o!c!'ic a:ttl c*.*UlemiolOst^ o!<-vr\.v.i <\p!iti;mnii of the of the .'i-'oetatto:* v.i:h ,i>).'*s'o* tsno>;;r*j tia^ $ub*s- ijo-.-Mtiy I r.-n 'tt.vfs bv :;:c sttul'C'. o; i*u:. ruilut arc fottttd in of r it'-.-ttttoloyy. hvahh. .vul cnvironmenul iif.-alth. ra'iv.-r than ir> clinic.'.' journah. ad in r*rjxm of i**nn itr.nul con ferences noe covctc<' by the ttMs.ti c!ii;ioi tt-urenre syuetns, utrlt as i:l;e Cmtr.d.itUc In*U*x (.>-9). The pufdithcd pt { tiw>c coa fcrences. all htv.-niath'n i !i-. s-.ip;.o- l'd. in keep- in^ irh dto int-.-tn.ni.n..*. ! nat-.-re- :i d.-::oii:-r. provitlft ' v-:- :``?tu tnu:..':' d u n hii Ii ex- t>::tive r :f- t.-;.oc is made it: ftps re . t or ihi i reo'.vn. the t ro'f:*.bt!^' of each rc .-/--.tifC :.re cited once, in refer..:u vi 3 :o 9. Indi.iau.jl pre>enta::.-n are vuh-.c'j vrn:!> :d. a:::"e.l in tiie text by t!ie n.itr.e of t; firs; auiitvr and page nurr.ber. Ki-a I. i? r r.i -.i:.:-ii i-y pern. if .............. . i: U ir-.::-.! :.:r` dx-t-: it i- H-i-.l Tlti iia'itc a:is h.'-.ii! i-u uorht v-'tnnirp. ti>*n (.f i^TO. tin- .it "..( .',''0 irt.:. T-t- lt*- uti- fn 1 *>7 *r - -:::i Vnt .vf Ivii'-iuti i-;.-.!. ! : -v* s.ii p,...na pr ol ti*e >* 't :.i '! Noctil-vi j- the ii>'t . tncdii.i! Ji! i th- vx-jo-e.f |icrw*:i vs7*> *- :sr..I:h i- iititir;1. piv/Tuleriy if i!i<* r\j-v*itr : ; >1 m tin: vritiu-f than |mxitntion of. :-dioK** pto-.hiu*. **c if cvj-n*tifv i< tionmi np.it-ntir.l. i.-.-.. by t?c It ini'. l:- < :> b;. '.W l<\ (17^ ti--: "\u? c'i'r i<.i.iti >':* t!:-.' 'I's '*; r:f ;*~.iir^: !.! ntiuioriv* cl :51 j 'itnil.ir ron-tci- .:ic-i: of ab- nt*i:uil:tie> imritil ia his n:.pc;-'-eptiv? b nk^totutd in tci.ii'oa to v.h::t itr rt-fu'U from the ii:t-i ,u*;t.. ihu:-.;!-. .: ittan :<v peers with the Mine :*. .!! Ii;lv! -t \:-*i<tt" aud ::u: he "fcunilers e: :ott-ar< load-.: "*r:< hce.a:tr he KhvIcs only at ti -; (! ct.tiy its front -**f l.iin." lb.- rotitraf. t' e:-hh-i th in as an : : r-. -- t* . at --c* "ti: e tick pa : a poj... l.ui.mal t.a it : " n. "iiiis-.c. :t trat' it ii hint-.-..: ai a .,f dis.. - ,\i; ...-n tt-ntarl-i :*l\ oniy to b.'-l .-`.inicia l-.id e;>i',.-.a: d*.df ;:.it X e-.'ailieU ss. :!* the in antiro.icih. ri .ta tn ::.v ::t to i r.crit a r-:- view that .ttctnjttv to biid.;;c the ; th-a. th. n- ~i - j ~ \Mt 1 i . ;N! : \ ; M l*r \ ' > * tiij. 2. i.i>;r.uuiR:i(it; mpriinrunon of the jjmwil* of iltc iiuiit'Uy r.mi the ti-co;: of hn* .'CmU'iI :oo'i'i;.i cil> <;I lie 1 'Mix*, mi* - I* i in in ate the \v :ih '. .in j.:;t [* ' f f i - : m( if. h-w i. it; ev::lu.;:~ u:r- '< ut jnriii ol.-iiy tii.tt vh:..itte:l i. .`in < {MiLrr.nW-i^ic (*;:.* .. i:i <A the luio;.' this .itit*InIt^i: <. 1 n:-I 7ho Asbestos Vinsrai* i'h'ytiul Ch-:r!:t.l<m!:c. r.n:( I'ibfr V'y'* I h: [>l.-.s;i.i.i.. :.iy m t;ri- the i: !iv. nice of ilv j.-iiftci chemi -xv .'* the min- ;S :!. { hi< a,:. Yl:e an.-w-r n on- :o;i-.f i:t <ut"::'i.ii / i.f the ll-h Nettf \.-ii. ('on}*-;, :-.vV on Kif'tis ol XmonV* py, itt whith he iikniiiieil one of else < I * i* :< ;t % uiinii iu^ fniti.er i tr. "Is ;: v ot .i-h-v--' .;u i::in*>rt.*nc Lcior i i the s * ot h. o;t>.hi.ti L..rci:t'iir.:;. me-iothe* .mi! othet t >f' ? '* JYfiUve i':ln Cjttem iu\: that. ;;>!> is s-i ('Cl I.-u-r in this ievi.-.v). it::Ov.-le !-e oi the t;.;ie of ;fl>!-Mu% m nhi.h .i person h:ei Lttn f.V'0->eU '.tiunkt ^ui.Se lif jsiv*i<.;-,n in e-taio Ihhiijo . ,.;u; litim.iciuj; ^ pros A-.ix iutiiI term i:i:t m ;; .-roup i! . . ;il:i>. i> hi : if....:-`T ! re- \i-t.mt tu .:** t*a;:'. <m whit It their i.ntti.i! im. i.lepeM.N. 1 he .. i:tt{H)itn:tt Liimmctvi.il fibers ipho*!! itt tu'.iie TABLE I PA'HOcOCtC eFFGCTS OF ASSESTOU CXPOSUnS I.'* .V-` t Organ Effect $ < irt I4'yn '.vfli)t *!* ^torisn^om G *-.!i 0. t'act Arnnvoi corn* Co.-iinR-n* ''Ahettot" ood!t tnA-st tiottt Oiffui* mtemni** (ioroAU (4ttt*ttSJit; Cjteino'ni (?*rnehnlj Hv^On* and Mlcifieition Mati^.ianc n<*tocRl>oma Pleural atlutinn Malignant ntaiot^aiioma NyjOlMia Carcinoma Carcinoma 'Arnif.i.i.on ttisuQot to at u.U, nxceot v/Oofj iniiic*<*d. : Atwiii*tio. not o,iuw.'t4bi*ta. AweutiOi> V..M1 Py.si?le Estaaii'.nnd Eita6ii***0 CofcctOf with ci5ar*f. 6>taoonen Paawm* E*t iblttnudf F*tHU*in<J flnnotuv rc't'1.'1" namo'aiy oossit><* Pj.-^ryoc* 5h 11 -t< s-r- 5-9 5-5 5-9 5-5 10 r--i 5- -j is * 0* 0* 0650 1: 1 m \u<; \:;i >>.11 1 ,1 1. .iiv ihrysoule (a wiiii'x H'U.div -.iikv I. ni-MiU'i lltfll : xide*. .V..!-x tfi' t ii;: in a.: a.! ,'T i jim idolitt* ,\i harsher .i:uosi:i 1 v'Ciwtt and har>h;, .iml .1111.<*jj 1 ii 1.t c iv>1 l 'YW* * l*l ' ion pi oj.icis . p.lp'T j'foduc i. liikl- on i-r.itei i.d '. .m-ii i;!'al. 'i oil 1)1 ir< it .h'O >> . ,1 .ml and used m riiiKintl. In add::;,m. \nm m die > :-..'t:ti > n and p!.,'i :< -n-.l no,lie*. .TV </ fiiirnm umi'.'T.iK '/> in :i.i- . ; i. : i anted '..-i 11 i U>r ; lie f' m!c 1 i . ! ollu ; ::u:,.::i sue' `. :i:iu t * . ' ! 1:011. .!>. .`or .'.ample. 1:1 the it..n mines 'l in .nl of Mi'wrtor and in (.. br.idoi. bidt-rence* iv t!>c phyb<-d ji*'jt-rcio "I1 the s.n.yit ftlji'i' determine* their pittiiid.it coni- no lidm-w I hio. tor r\t:ui.. chiy**'- ii' i lofn;:n-. -ui p.::n- d.o .......... T i I'.r < ha tire - jf < hi yi nm) iiiii.ii. r , :.ia of. u ii, Id! - p-wi.iv: 1 1; n.h :i.: 1 , On. a ii.'co. m-t.itc J into 1 :f; :C 1; itc'.! 1 -IS. '.lie libel is rclativeiy well hound at:id is die iC- fme lev, hlch to |m>.>e a health ha;aid to 1.Ilf in,Iliv Wi irxCt 1 w ho tk.< die ficwie m.; m.factored plliillUIV Ihi Xr^.iildal' I'sin, t.ilde 2). \y :. iv Ii it Ii 1 yf luit^. it mild'.' i''i:ibl'' fibers the product is not sawn. di>rup*.ed. or r..i in .r v.11 * jnmi/,-C'iveh in'o liner hud* ii :ur. way; liywe'-rr. axhesio* fdivis ate vimn'i^ to hum p-*<r iti<ui into textiles. whme.t* tun i- iinhwiruitilde. 'i iniiu|--'U. .*>. p. 1'itij .v.niv do- u..'i:e and width ,ih' urur and red* 'ctihes this .1 ''li.dhUtv of an infinity of 1 ::i. af-' of pniiicular value for ttutine muda- }v:n''* I fie ii'ivis i'i y l'-. lefe.'.'eii inui tile at- u*:- (.cri.iiu ,nl'i s(i,s tnmni o*.ox.lt;iuuy he ntiwpherc a-dn wlien ilte mi-in.1! product is to 1.. . !r fi.ua Ii; iu% <>f 1 lit-. ;<iitie mil m-a.viie n-mid. iopl..kcal. or dcM-ovcd. .i> mav occur iti . in' Th-*e ddhnn-'-' in >!u too i-i 1'Itnc:i"ii -ml dup'ii>e ; |oa! 111c ti'iii' iiii'ii 10 Cm.---- i;. 1 msuci t imt widi lonadit i- m. vcp ii.-. an-l/ ill l I'v:...'toiU it.mb: u nvr. u ot n iittiM-. l',\;>...nic'.% u. litis uiit. partunL.lv M-mt for -;'tfx :vt..v> in the 1.r *i'1 niect' of '"X- it thev ore-.:' In a vkiutaincd environme:;'. micIi : indeed. u has hrm ai'4-.t-.! i1' ' "o:d% l>\ the h.*ld '>! .1 drip muU-r-'oin- refitting. Rtav | ici 'tine I'Xperiuieiual hinio/w e'idviie'* v.-i;ii the i.;::i'irn in j>l vt/f .ttul pom .. . e.,n ur iusnlsc w.nVcis wlwe.t* prhnarv j.<!.* h.i.' i;`Kh- 1 iu- to d.i widi asliesto'. c welders <>r ntawMs [ dirnv.'iy .111 im' ?t vtilitl mi.klk.il conclusion.'' Ind-rih f.iiiiue to appreciate dies*' sources of e\- | !-.. 1 his (jiiiktion is di'<ie.v.b i:>. .1 l.uci **<,. po'ine in .-'iistrunion and `idpl.koliU;:^ [ !: of '.iic |i:i- etr review. imluMrit's >'*>. pr.!i.ihh accounts ho tl-.e j ic-eiuer-wu o ..'hes<n> trl.ucd di'Ca'1' in d.r l l'1..;)'. T!:e:v .. -UN to he u-i kiu-.-et stttorv!i ti\n "<i :! --uci' f :i.x ta * I ii'\ <f f>h- ot Hitk di:U':i:i: h-.. other :!im us cstiiuu'* ef j World |.f'.ir.k lion and ik* of .idv'U** I' iu* ;ro'.m jrer.'U since the Luc nineti-* ntii lemurs; between 1*7? tool t%7. nslieHO* production and iim' iiKu..wt! frntti 5*1 ton* *0 pv: yc-t. -11 '*'*0'iu.SoUl inire.tvtf. I'or imUiMji.il- :/r-.l ;oi:u:!u., mdi as Urit.iin uid tint loiitw'1 "t.ites. tile imr i*c in u: l*;*ji*',n I*'*(* iml w.* 7-foUl (l*. lid. llii* iriUttk in Ueuxc* in volume of manuf.uturcil "mihU :* well a in tUe variety of iwx dvvtl<>pv;l fur the nu- teri.il. TUcveareoutliueti bruadly in raidvl!. Appreciation of the wide variety of uwi of n>bc<toi U important to the physician .it'd m.tvvi as an ndimtor of the many occupation^ poten tijl'.y at rivk from expOMiie (table S)- These occupation' include .i'l'rto< mining, niiili:'" and Itamliit:^ it: preparation fur its ir<-. tidier diief'ty i'.r. for inMaure. in xjit.ivini; when mixed with oil) or for its ircoiyotation into the maimh.cture of n t^e.11 variety .>f .vhi .los-t'ot* loiiiii;- product}. The Jaticr may lie classified ^'>},ntm ,||V jo, the t 'uitCtl Stales in I'.'T'J . (`ii' | riur u-.it.sn tor imitiditt** the intorniatimi >*a ' the ocvupattom at risk (c ibie 5) in a chairs! leskw is <* oiler die physiei.m an oveisict* .{ ' the ttsv* **f tf** mineral, so iliac when fac^l with in ii`.r, i..'u;d v.i.Ji art iiinc'J* (h it mo K' ashe'Uj.k 1 cl.i'vii. he o-i irntmit;.-.'.- a >iwttmit.t viKjuifv tu:o ttic |*er,HM'' occupational '-isn.ty The phvsici.m siiotdd tints cover <*csjle cvp/- suits in miuin;. millincf. and maniitacutiin,*-3t ; well As iu tit'? application *; tiiaULf.iti.rvd i products enuuimni; adutsto*. disectiv. nr at tfw time of deuudiiicm ot lepl.icemett'. (1. -h.*- Util. The phydci.m 11m41 um only <eci; itn i.v tails oi t!v pat ii ii*'* "W n joh*. p *iu: -is: hut must ..on .I'.ert.un wlietlie; thi' woik i.ittit'd at at '!* Mkle ',4 ' ae; w.>;'>.-;s w::a*r ;-iis ;iiviiv> I h .oooue a! ....... ' o' of v.r. ' or ui.iieii.iN. p um ui.:: !v 11 .n a 1 !o*ed p* vi-iiulutcd eu.i: munciu. 01-0206TC2 lI i' \>.1; > i o'-KH Ml 1^ a>X > 2 i'.ll ! _ ! ! <I S* "y : 111 =1 o i 3 * - ** 0 32;.u SnU C. U. I .*< 55s 2 I 5d _0 2 : . io =2 < .1 a s <~ aa 0 o3 ='< er ~ 11 2i u 33^W 8a a1c! S: 3 5-- w i S5 J _ a < --: * (A 3 ia 3 3> 33 2 ,a :s i- ;a M olrji to iy Ittei fr'r.ivw iu pipe* r V3 S1. " ri'm c n i to-luai I dle* Ig r lly'.ln.s Intwiniion * * p 'O ilu tU .Si = (5 Io z* M fi- 03 " 3 3 o" O 1 k>?_ Oo0>* 3aa3<irt02O a } .2 5 3 33 3: >O c i C 11 5 ^ J 4. >* !I 0- 1s ; 52 Cy jgj s g 1s 2 O 3 I * aa.3eo _ s2g _ a -3 3j : J 3 - 1 J a_ 3= 3 2 aa 2 j: 31 030^ 0 3 1<I> M \X\. \ r ;u xi , \> OOCvlPA DCVtS -> ^ f-'.fK cn;. eAl'O^'.'-r >'. iiSt\"J. MILLn\o. .V-:.vP*-.CTUi J -VI. SE-jyr-wAT- JiiS* P'O'j tsno'* Miffing Milling Hnilling -It** :n $ftay w. filiwr and {rooting .\t>nofn?u,riAg o* Tatil* C inAt .v:s..v> Pjoor" TfOOust* Pnet.un mat*r:i inui4tion prc^'.stt Apr-li' toon Corv.r* an f.*w cr-;:.*'-,*?io> 7**0ir. aemotmon Sniriiu-.a.-j Conttrwron ^aif. rant* Aatomom* mcuittv Manufacture noair *otv.>- "v ot ;; Spray of Un^t miaett w.sn n Clotn, curtamt, i.icion*. a: a;*st`V e'3'n.ng, nvnloij, eonvtvor inlet S-rsu. t 'noting i-. ntVt. ot Wtbatrcj. roofing fm* ` "4 ,;,.alilv Us:r.C3l PAC-M. McO'-n-; *, .:i.v* A'itomotiv* pr<Ki irr*. gaivtt :tvtcn plat**, orwn Hip* and bO*r initial **1 (Airgs for tnios Soarot anj t"C; *i . 0mt. fOnt fii*i*M. ;.'5-.*.on <!:. iis*t. <Kiig. }" '} *: an marariait invitation matnruu |nrn -i. matt'wMe* elntni o* t"; -<4. ijgomg p* *nv. t * an.i vvatar piant, npii lnu> ir-nn m)tniii, at -?.;," 1 for `conttroci'cin " Qatkatt. brek* lining*. ndrreoa>"fl Gataatt. brs* lining*. .'s?- :pating Jon it H I< aOev mining, loading. uo<'*,ng C'on.ng. milling Trntpprt worrar*. oockcrt, ipaoart. t>io*n .vho uno.icK it iackt (rpcont'y replaced witn *.ie*>* mat do not permit M>is to etcsuo) s.'-ay .isolator* (eonttruenon. m-o bviifiJi'tg) a'4'*n,.n,y A.irmnn. sr.iinmj, t>yitt nr; win.lmg. nrai iinj, ivtivmt, mmr.j. -j.i natin;, mouM ; .i'Vi'4 ? -- : ^5. smfv iirera'jtio , 'Oiiii*;. p'ttimg. p.; t Cjtlmj I / . >-,jni**it. 1 i.nr.i" 1 .f }:.'at ,r>n /o- in, . T.Ji.M ,J<KJ n.,n-7 .Oa.jj.*-' .-.a- %. rnatcri. iiMri*tegi an ot*" . o' sort on can*T't.et'On $:, a. :ii.. .tv kvtliln<t, .................... 3" '<-.t.on for tt of tpn w.*a '*.. -tiur'i, ttn.im .iiinas*t*. loinrrt, jn.; , 1. *"flit ttiitt, 3 1 n\vt. .vaioP'*. C rjlkgra 1 ( 5 '* t'v. all if 'tv lOPi 41 rat' r. ^r-, 3d* ami otnt rcgairt orritinnt my ira: . in i*nt***i nc* it it.'l!' m..,,, l*At*-C`*nf, piur.tth..' <%?'*, 4*rr"-nt#ri , int: !' r-an of I'r.ik* umngt, an to on Sivi.'* ".**, ti'atn Mo<(riM, u-ppv tvji'"ii,nl .Vito m.rn3ni' * information co to'i by Or. o'anjm Qioa< fonn r*'*"ea 2. 2. '3-20. in 22-ZA. [rtUirifc: F.x;iov.ae (Domestic, Xe^kboThav-l, nvion:nvntatj Ex|n>-.ire 10 iiibeiio* fiber b .>t roniiiicti w the place >( work the v:.irch tor e':pnure in the- background of p.iticnt\ with mc'iothciioRiu III. ll' b:-'*l^!lt f' li-^li. iOCT:' {i.iCCtt &i ui'lirCCf I1i;i.. ..ji.iiiunul v\:.o.re. i he <>v.fiencc of u. Mii'.' iin.u.i in the b.miii Ui::ij-orA of .i>be>;i.' iikt-is !ed to ilc rv.'np.itmit /.f inclireu itosm >:i-- i'\pimrc: the 'mrce i':re .J 01 0 20^ s.nu \Ml)sM" Rt | : 11 ! I'M. I>|\f \N| s i* pi mimed lo lie die dust brought home iti th <( the Miiiamn nail ihev enter, and tire pat- ''1X1.1 > ovcialls (10. :$]). l.iXovi'e. the .i'hiu. mu >>! hieachmg iii.it carries die p.iuu'e,. 1 ho In'twiTii icsulence near a mine, mill, < .inikI\u.uiuc bebavnn > p.ii.uh's i> .1 litnrt.on :.: 1 !\ jitd (In* ocrutrencc <( mesoflieiinm mainly of diameter, but also ot ii/e. sh.ipe, ami I.....r^i,i iu light I In; mijw>t tanr e of neighbor boo l density. I lie \.ii\in*; 1 h.nartenstus r,; (.mutter- >; -ms {`J7V i 1 iinghbotlinofl exposute ciaJly u's.l .Ivin itlicis rn.ike if. obviortj that .! vmimciI to account for occuucuce of pier the cnvimmnetu n* uhiih asbestos worker* are nil |'..Kjuo uml'or (.deification in icsidcms H exposed will ouii.iin p.uiicies having great <hc mining atca of Finland (3-). I'ieurtd variation in size and compeuiuon. 'Chesc intluvle :es have also been described in ,ij;i j< ;.Umar fibers fso-called il their length is at least 3 times (33-3*A: in some instance*. thev ihcit diameter), whidi mav be long (as long as ! nc l>ein attributed 10 the working of soil that Jt'b Min) or short. In addition, a woiking on* contains asbestos fibers, eg., in Bulgaria (33. \ irounictit i* likely 10 include a range of smaller particles and,or liber* released trotu the break M e surprisingly high prevalence of asbestos down ami disruption of the primary filxr. .n (.it evidence ut exposure) in loutine an- well as those due to any other uonasbestos par injiiit'S indicate* an environmental cx{>ovuie ticles added by the mining or industrial pro* l-'i the icvideut.* of mr>*t of flu1 huger rides of revs. ibt v\oihl; however, the amount* ill the general Inhaled asbestos pat tide* fi>iimv the moving .uvosphete are small ami these autopsy hud- airsucams witii each inspir.ilioti. and. once thev i:*' should probably he rcgaidfd more as an make contact with anv pate of the smlace of the index of exposure rather titan of disease *><nen* ail wavs or aitsp.ufs, ,nc u-.t tesuspep,;. <1 iu the I he Advisory Committee report that fob expiratory aitsueam* (U, Ui. l)c]>>sitioi, of the 'e..-..i...m...e. i.)ou umtttettLC f ........................... huger inhaled punicU' (mure than a mn in di "dim* is at ptesrnt no evidence of lung damage ameter) occurs mainly in the nose (assuming !* asbestos t* the genetul public," and "the nose iireathinn, .uni majoi aiiways, osving to .fia.iiitu o.l^hcMo* in -.;.e lungs of members r'i inertial impac.icn ..ud sediment.uimi. Hecauve small t<> of Hiownian m*>*. neut. deposition of the small er partidcs (les* 1 nau l am in diameter) occurs Kindly, attention has icicutly been ditetied mainly iu the mm- peripheial airways amt ait- louard the widespread occurrence nf asbestos spaces, litis dcpo*tm>n prolilc is sumnuii/ed iu Inns in certain natural water souico (37--40). figure 3. An i vent that brought this to the notice of the ne|H)sttion patterns can 1w profoumlly modi genetal public was the cUsehatgC of mine tail* fied In breathing panel ns: uo*e Ine uhing 1 .him-s n>es containing fiber into Lake Super ior. a source ;t high rcteitlinti rue. even of small filieiv, o( di inking water to many cities hi the center within the nose (-11. l.h However, under work uf the North American continent (3^;. It is ing tnrniitions, indudii:- hear amt exer'.imial nw also retogui/cal that filter* also ocvur in stress, inoM wotkers tes*nt to mouth breathing, i::.iav natural waters, particularly iu mining rc- livelier, slower le'pti.'tioms lavor a more evCU cions; however, the Advivoty Committee repent dmribmioM of inspit'.*<l air. and, tiiu.. a more < it. mating fium the L>ou Conference t'7) even distribution of inhaled iiarticies. Lung judged there to be no evidence at piescnt of "411 increased earner ri*k resulting from avbe>u M-er* present in water, beverages or food or in volume also intluemes distribittiou and. lilv, tetcmioii jiam tns. patlicid.ulv if nre.ithitio occurs at less than (he ttuimal himtion.d resid 1he Uukb user! (or tiie administration of drugs" ual capacity il'tH.o iu the range ot airwav clo I lie question must, however, renuiu under close sure (43, p. **$). Ukcsvise, there is some evidence RIUCMiy. that the state of the aiiwavs in smokers is sm.lt that inhaled pat tides will penetrate less deeply The Fate and Biologic Effects of Inhaled Ataoslos Particles Dt'ltosidnn in the t.uit' into the hrouchi.d nee and thus tend to l<c drpo'iied more centrally man iu nousmokers III). Whether or not inhaled asbestos fibers will be Pulmonary (Armmice deposited in the lung depends on the aerody t'.le.uance of particles deposited on ciie mu namic behavior of the particles, the dimensionsOl cous blanket is brisk, with half-times of minutes Ol"006 marc :u : u >Ky ::'.jt a s,.'ti:n uf t.:<>;...'4 iciriattiient >u-.a U'4.'.:' Oi in i .-.ii ..in! .h , !:herx ; an i u :< h; reaiiiv .i;,.'. (, .. I'lcleiv j.;- 14>i< m-'. .! .ii' a>ir; !;liii, .uc .i.'im.l i. .i',.r . 'i .mi. ;.;i r;*'. '.nil, . im.:'- ' u' .1 1 . . \.li 7 j). xfH. t-li.iniiiv im iiiluit\l patti;l,i i\ iiu' e HiedtaiHMiis i. In-!ie\ed tf> he unite tii.m per cettt elective !. :tust tirpnsiivd parti; h'* CIS,. w.* wve ~ l'V ' Ho-in ili'n; Kill .tI!< r. printed jx,n*ir%inn of cops right I07j. Aipci i< a:: Mi-iliill |>i!.iin\ 11 i: t 't he d'.p"-i'i'm m :i. ::**.- .uun*ni Ji pr-in t! as CtlhidaUd liiV'l [in' ,i' 1111 i ; 11' r i ^ ,n Hie mini-l r, fin<*! m a'K>\c f.ii a iiil.il \o!i::n.' nf 1.1'fl ini an.', .i ft. niuiifN of I*, '-ivaih* [>. i nun. I he jnotde tf <!.}* iitiuii .it jn aviO'ol is intuiciKi.l lv tu ei7-c;:-.i. .U'lixUlUlim tiih.iVKK that iMiUr ll'.L (list t llnit ; m;i> fur mans ..<iosn|> ix h-;normaI) i*' i\ ho d-- xt tilled hv the m ,sv m.d. in ''-..uiun v *> tin acts* -: and i*\ g-mnetiir *t-indard drsi.itintt !* ;h:x lip; , per cent uti'-'.i .t! o rrl.:iril I'.nads to < t.s.svv ntrihau ,p tv.: (. r. " ii. i- .. th- hue' u..'- ; .. ; n> !i I ii to; h o.. N I' T il. .'.ml p, v 'pi i d. imiua:v the <!::.:-r.s-rs m per ant cio|iu>uuiii ths: \<ouUi ic'uii if tin- gemuttm Maud.iul ihvi.uimi tin* tutus mediai. dunu trr uriml fitmi 1 - to t.a m N l* " na'.ph.i:,ii-4val tman': T H s ciliated p.. clteobiouchi.tl 'i.il.u,;-; I* - uimciliatcii pulmcn.ux nutate. in hnuix. Mutt:' .uni te!N flout noueiliiU-.l wn\s heat hi" ingested panicles from the mi -r ,iii svasx ,:!c < irt.n il to the phtu vu\: the main i .! tt.HHH.il in the ntiM* i alsocleared to the ph.tr.:t\. Herr. pulmnn.us and n.ixn! ilthiis t:u\ -ndi i.diva and are swallowed or expectorated (tl.. This phase of rlc.trauce docs not appear :-i I.-.averted by the presence of asbestos lung disease {!*>) ami. tinder rertttin tircumstanrcs. the ef fects of 'iuoi.i:ii' in piodming hrnitthiii' m..x e\en xo- id ihis phase of; h-.iraitrc (id. 17). ihit ti< deposited in the uoiitilitual region' Ml.l) b<- C h' *. ed tci.iuvi 1\ l.ipilllv if ti.CV II (Ii;;,;, on the Mil f.iCe (with .t half-time of -! Ii-m:*-. lut ocico tlies penetrate fixed ti'sues. tie-.n.*nc** is >U>sved, witii h.uf-titnes ranging from d i>s to tUoiivunh of i!.i)s {12j. It has aUo hcett s..;>j. pestcil that utacropii:i(;t*s decrease the likel:!o..d of fibers pettctr.itint; the alieohir walls (1`J;, .n:d 1`rticir'itifiri. /,*, n!!-'/, I>i\h rm! i.( (. >;< u..i, ,1 . li'u-ituv f'-'.i 'n ;'fs nu(/ii;t d.v f.ini<>& The use of electron mitroxsope !ut resettled tin? ptfxetice of iv. ittv, mair. 'uimuaowojMc, tin- lO.ued axlu'xtos ii*>vT' .ot<l liiitilx in the luutT s'.;1 .tame uf t;.e cxp"x.l ssuiker. far tame ::: a n.ix cser ;n;h n:uu ti e hie^ ;...pu..i- (ion was cs ha. '-.al hv light microvrom ib-i-e iiV->|i. Il ix ,uvi i,;.n esuleii! tliat ti c pi >- portion of ii iu o..u;l to eo.'.tul f.ueis vi C., t!i"-e f!; tt foim tin- C"ie >' an .out-nos l.<x.i\ ix vet- l.ii^e. of the outer of *.*> pi.t cent (ihi. an .!. rsattoii that xu'faextx a veis lu.-.u pencii.iiiou it-v! retention t.ae l-.r the xubuuuosc'piv parti-h> P.le.ixed into v.oi'sine. euvttontSK. '.t natisei). tin- atail libcis- and Of putu.'.* might tepu the bre.-Ml-uv n piodin'* -I -.vh.it were : .A ' ;. ix t'-.a 1... 1 p -. ti.iltd ih*- aiv . . :ai> <-; ;;ic lung A ' .. ...1 retr-on foi nini. . 1:.ott >.f t'a- .= ;*.c-n: ot ... hex|*x f.lsi :et.:i:nd 111 tin- Iti*_, ix tin. dirt.-uiu vm-niptei evl in its rceovvis from l-.m-.-.s it topxs. nmiiuii.ii tv> tii.it ->r <*;het piteuntoc.iO'' i..po,.lining 1 1 il >* S i\a;gi'i'shmidi. 5, p. tie. The sh.li- .:ity ill leios iis apj'lii's t> vi-rsxucile that! u 'sthet '.i-eis. piexitiiiahis : * i.tU'e "t itx 1 net M'iii i'liits ; --I -yp-.e'inm. 1; 1 pal iikld.il. n-11. I. to \f k ,n hxd out) iml. hence. its ieiitl>'iu\ > Im 11, ilo-.vn sitemiv-lil^ >..vl phssnail-- a::et pt 0! .u,et!1 f-sivlence Uhtitin t!tC :!;-.-te .topeus t" he a ilcmv fur fiiieix to arcum.tlaie tti tit'* pe-.iph- oral rejions of t!ic u*wet /ones :s ttulirmcii h' rite c.'tris* appeir.ince of ftbrutic fcawtiot'-' in these areas ! htx .!. -t; ihntion hax hvi ii .ifu;-1 ! m poxtiae and "tastts vifect* ^I'hotmuu. p 1 ro*. uiutMii-.l pi.'.nii* n.-.e ;h,- lung tixxiic ,'pp'Mi h-.eo ;o t-.ai.nn .......... tt.es ,n, p.itticukuiy if they me intrzceiiu some ileatative -.ho iiu.n s ia lymph or...--a-- to hilar tun! ntcvliasttnal nedes. sxiterc coato. ami uiuoaied p..nitlc> aie 'Celt Hourih. a, p. til"), litiion-gh this appears to be le> ii...... 01 0236 AMUs AM \ 1 HM l M. DIM \s*s in die Case of other hbrogenic hosts. m .. mi- 'i itnliiu; ui t!;e I.icums umiuain^ the p..lho;;en- ua. This dith-rencc in clear.-'me at:n ted to i.'ms ol mcvithchoina. tJ.u- neater cyto.n\ic eib-tt m!k.i, win tends, thcrrloic, to maintain .ni oxtr.ic'-i!c;t. position (.imir.l !.- >,vi / ,!n ij ... i. /J,f h-i y Ki.i' evphi.n wbv iiti.u 110 .grn.iii: l .e Ci*i>i 11 . >i - :>' I u >. i' -.vis i.( i^ii i/c.,! i. .i i iv i' i <ur:i\;cii: uncling i': .issociah m with oiif.i ct:c tit.m m association wub I'bCstos exposure (5U). less i-* known about tin.' penetration of in* in the i'HM'. bi'catise ut its cL.ivi'.eic.is'.ie uopi-.-.r.mcc under liglu mitimcopy (ja). It ;s uualls a rod-shaped juncture nidi etybbeu ei\U, olti'u lu-;uhd .dong us lengih. is yellow tu incited fiber* thwmgh the wall o: the g.isiro- blown in color, langet iu length from 10 to intestinal true:. althoughat\iiv..d studies suggest f/U *m ami in ihitkmss li'mti 1 to 0 >ui, and but thisiloCi not ocutr {*?). except in :i:>' face has a re tit i a I. pah r cme. The coating, consisting ol a heavy load deli ered dircctiv in'.* tire ot lerritin gi.m.dcs and an am-nphous ma stomach (}('). U'luic relevance du> has to limiutt terial. probably protein, varies in thickness from disease, 'uli as peritoneal mesothelioma, re very thin to '..m (--371. mains 10 be determined. On the basis of animal studies, coating i> now Oikc it ii <> penetrated the lung, the dim beliesesl ;<> b-i ,m inuai eduiar process and lob .'.yiMO to iffii.im lived. hut nr.r. he icmnbdl;.d, low' die eiigtilung oi paitich-' !>' m.ui'ojib.ig-.-s .:;(* ircinU cm it mu dii't mac.lies or s.cr.e m tvliuii they .uihefc" ^*')- h*. vetai ui.ieiopli.i^vs .penalise- irieth.iuiwn pvilups being epi<odc< '< may fe-e tu cti.;uif I.-.rge bbers it is winie the p-.hinoiiuty edema and'or ii.;/;a;on i; is idiers are 'in rounded by partiaii v fused nta- U-hevd ;h.u >ui'.i temohi'i/.uif.u *-l dust 11;v tioph.ig-s tiiat coating begins (_*>. T!ie filter K nli in its tr\i ictton, .a phenomenon that men b-i.ii:nes iu.ut pcicated into intracyto- ii'uht c\p!.on the tare event ol appau ttt re- pi.oniK vaciKtlcs, and thr first coating material si'-'i'iii o( tacUologic ('r.atiges in the worker appeals to be some lotm oi acid muiopolssac- teiiUAfd !..! i-\-io,iirc (M.ttdied.i. V.: I'nptib- (li.unlc- lion in ;iic foiin of beuumderiu hsiieil data). Alternatively, it may btc->:..C re- du n .u c uimd.itc s I i: die cy iopiawn of the ma- c<pc\icicvl and contribute to d*e vMeuvlan ol Clnphugo. Iron t:.. uii'v, pi'ssib;-. tlvrivc'd front di .'.-v.c in die f.ice of no further exposure. loeakdoiv ii <>t in .gi ..bin, income viibse-p-.cui. hc'spiie the fact i<..it pic.inn -eacti-.-i-' leitu- h inco; por itc-i in: tiie piia<UH>"-.es, ami fi".i 'i'lti. fihrosis, and,oi calcification and ncm so umcentrau- ......uml the fiber: esemuafrs. pi..-.in) ate common utaniies.iuoiis of a<bcs(r-s du-ie is cicMiini; of gi*-.-aiid nbst:mce (j7). It i c'.pnsmr, there is little diiect evidence a* to of inu-iesi that the piraess appcaiv :<> l>c a pn- hrstv ilc .r.ltoms gains access to die pleura, which gressise umj, ssith the u'mins; increasing with jU'umal>ty must haptx'ti to explain the pleural time ..ml nucoatrsl Id.'fis becoming coated tcMttiotis. .\sl>c$:o h-alics are raiely scett iti ihc months oi vc.irs aher instillation hew. si'ier.il pleura ..nil have never been repotted its esei-. beiatw tU-." prop.iliut *>f .uuoaicd to ;d::.|ucs io< tiled i:i the paHet.il pleura <? e\- coaled l*b'-;v in human lungs a;spears t*> remain pev.-d per'onv evert though they may he readily (.iu.M.in; -.si;n utnc (if*, .'in, iheie must also be loutiti iu die irucnttti.il tissue of t!:r same lung a p.irailei process *[ aging and dissuht'ioti oi lit). By contrast, avhestos fragments have been the coaicd filK.-r. I iietc i\ some evidence th^c tire (mind in mesotheliomas even without evi coating of 1 fiber lenhvis it nuitttV-rogenic. \Miv dence ol athestosis or coated fibers in the lung some paicuU' become coated and uth-rs do (Ih'urilunc. 5, p. 6-17). This has led to the not is nut underwood: howc-.cr. sire uuiv he >*mge*tuiu that filters that become coated in the importum. with ;l;c typical nd.-c-stc*' body devt-b lung are lest mobile and is susceptible to 'ping onis on large policies (givatet tiun 5 Um;.h tiit clearance than uncoat'-ti filter * Thus, ^:u tiiat cannot !.c c`iiu[leteiv engulfed by one election uMeioscopic studies may veve.d m my nuciopha.ge la.s;. inure utno.ited fiber' ;:i the plewn than amici- It must alio be i uiph.i'i/r.I ti: it :n : all coated |i-ted ftc-ni the statute- of coated ;ii--er>. Alter- libers sfeti in the lung have an asbestos core, itatitcly, .mv f-bers that ate cieaicd to Mib.heur.d and die pcocvss of coating is app.ceiulv used ivy lymphatics may undergo dissolution more the lung in response t-> i v.oietv of oilier fibers readily here than ehewhete in the lung. Iu any encountered in the euviioamenu These include event, information that would slu'd light on this glass and cotton libejs. diatom.neons card'., talc, paradox might well lead to improved under- gi.ipiiite. and cat hoi itmUttn partictes ^K`, 53). 01 -020i:;o ') m v.?r ,Rrr ?. m A* For ,;n% rc.'v'in, the uomuiirmt'.:! i, : m;.m < 1 j; .. i Vi<- m I : . > : ` - ' i : - 1 , i . i ,; t r::i:n r. ,n : c .doenc;' C'':. : < .nr \ ...in. i- . . i.-.u c : :ns r ,>Sm i/in . in he-im. mi s.ruj n.i.c v :.,'C'iiit ti:*mtii;ition, anil mass 'put!(hoc if.iniicpu.s .nc e\:>cti- ''v in .'.mi monc; ami will icra.shi re- >'..uc:i :<<11 s : r .. whit-.' (Lamer. 7, p. !!'>' As i.'i ; i . `i , : hi i: 1 < s : \ ;< i v i:, t: . ;.i ,e I . .' i.. hi .msi'.re . \ c. !.;c. t the .ne .:. :m i ;>u M.iiiod it- li...n ihe .-f in\--Ki.(:, i! M;o '.ah. :u.m t.. ms imp hiji.ght in huh; ter- cl i.,.;:; i i.iti'.i !.i; i. i;t . u <: t-udenis (ci ran m FuJ mst.iuie. it h.-. h.eti nil i'i-i.-to (. .n n: : : n;u ! i.. i ,ill types tiiav beeline ifi.'its.. ,ii wl d'e 111 n ....< i ; ; .on- I '.unl iii !:(>! unrv animal (*jo). in nun li.MiCil dS'i'.it fli'til Itiiudid (diet' ..'.l p.nti- i% the i.-.!e fiber tir.u t\ found ntou; fre- (jueri'l; . :: . i ol .i U ; rugi wins limh dim d." i:: i -mi.-' i ! `1. even '.\ben h.'di ei.-' il o hoi kiio'.mi s\ln- ci-: 'he Ji .vim o' o . ii 1.1: mi^'.'S i- !. :m innu-.' i , i!v !>\ ' ... .Ai't .u i. m'. ' .* .one > l- i'-j"' <' . ! : : f t <een i:: 1,..^ .1 "r ' i:: t.: t! r i 1 'd .: i- S.' : I'j-.ns 7. : __ lie ji.n'tuc.ince ot ' t \ a:; m : ,c.. v be ..c'':: nuiied. n m . L-- .ra < O : .. a .% i j . im; .nr -s. .:< .. p` . t. . \ . i \ ^: i pe i..,a ; - iciuiee!'. yi'.iLmiv of r:. .. il ;iit..:. . ' - ,' ' ' '1 i- ;' e ' .m u.i ;' i!c in relation lim other asbestos libers. m.u i"''1 in-. :nrt. Tl.e C. iiulM i'.fj-rts N< iih.tr :i;v m iunui tl;."i s ilut the tili'> ;.me '.me v \\il. i" i i n *lvi the '..iri'Mi'.i'i'CM' i ; _ s; ;r:ii. !. nil- u I.-n^ -.ioeases s '.eu f ..-....... and p.mific> v;.n <'.>*v to . hss.ii .ir.n.nm u.>! the S'd.cn-s, Ouc; Ho'.ahonv- o: 3lolcgt^ni Ar-besr-is espe-.:. to .i t' it.n.a.vl-oni mend !>: n. ' . tm s.r:o ntur.lv .'.p: ::: i-- Cl, n.S : \{ . . i | ;cvi v...!.i..il Oi>M'i MS Vy (_-i. * li.-s k-.ui> to th.f !r-p.- :s tl.it tift'in, in p.uttcuiai' u*c in'iiUti;*.' - 'ie:ii. m.pi ir:>j*it.mt. eititer iitc ...-c <i ; c i'i',jd.:t;;.j:i -r Iru. di/nion of .rb-unrttul i: n i:i oisib-iis : ; 'I'o u,'.. ih ! .iui /.*.! . i' p;: .;i e.rsd . m! ui.ii the :c u .. . i. i, mL I :n::'.! incc : oi.i iu ji.iriLr pii..','OC>tcs or hbrohi.isti. o.ii, j' t-.-.i lor r-\:.i iiu;n\j s ir:.i:i.ni or !.ctiit?o of i..:".intih-i!ies develupiti^ in rvs(.o;i *c in !...... .a ic-poc-.-, ' :t i: t sets' praciii i T:*-' irt "t n -. -e .nui leil cuimie irtiwiipnes i. > iuc'u : !.:.i - I uiiilcr'i.imliut' of h;n. -,-iTcts of .i-'iesos .it the ceil'd.ir level ( \i- *;. 7. p. iViicntinl tsr^et s''h' m am :ifc tiie in.icroph.TcjM (which are icspomihie for phg^ocr'.nii*'.. mi-M'tlicii.nl ceils, .dwolir epitlieii.d eeili '>!n'ch nuy undergo nuliijti.uu ir.miforttuiioni. .>nd fibsolii.isti (ssiiidi ;/ r*n i- it'*, d :*; *t ;'! if: t ; . < .; :n i .. rn; i:be [:< -n ssiinfi . . i' ' ii ;he eiicu.i tor : :n .;.:;:eu: .d v nr ; n. N [..>. i. a .;h.out sticii i t. iioi;c t!.': ........... ; ! tr..,eu slje ..n-.l il iiiDii'i i> pa>i`-i.- . .. .: i|.i;-.!:' mtaept r>i . d. nr. '.-.d in fiji.r.* ). takes *i:'-' iscf,*-n; ;1 < : i.::s uf ;iitleicne" in oscnc'X ber-.n.'*' p-.:..>n* (or he- [ .-le it: the :'i'ro,'c:nc ic.iction). Tuo t'.-n*' r>t f-'o^vu'C v::rtt !>.ise heeti ilctecte^l. .ut c.a;> 0'itr to me iuict.u tion .I'hes'.os ts.e'.'n p.'oi;:..;i"M>. os :;..n.o :i"P insrd !i- ite.'tiM.'U. i .inoi..,.: ..'ii ;s ; .I : me:: m- tf'|.......... . s 0 ...i ... :l ;r.r .. K,.e'- v oil ........ A- uivti.b. me. tiuic isiii( pmnif- i;. .r cop:. ..... : ;< 111 i.e .1. .ii !:{. (.i e::<:t i' iitmiuted l>\ iCIim:i .:u'! oib-.r i., tn:ictt>ntietid,>*;, am! .i i.nt: c;i. ..iih- t- m . o ;nn.;.n, oi do* 'line epi; .:;.is " In l;i:i ^ooiO\i. 'us- rt.ieuou .'ttrih\> nuer-renction of tiic .u- tf.niv !i.itiiclc> svitii the nu.iniir.Tnes jiuuttd -v. .udjtv Ivsosonaes. Bec:uitf of t!; upiiii.i1' i.ue.' i 1 i ;- ; `. nis o| v ^e: . hioiogic ,'i: r letCi'i'cC'. let .n: <i<o. ct;e euieie::- cv of .ie.a'nre i n. ' in tiie hnrp. ;aC fn.dittos > i;i...Lr daect r\toto\ic e*.fec;> "tx .m.'vijiiuc cl,^r.i<`tcr:'i..e\ c.'.e .uf.s *s sss- t | i i 01 -020*3C3 WH M <> ' M \ I M j It \C. UiSV \Sf 107 Cxiifi i:ii' ;:;,n tmid.f la.: * in ill a: bt raised ihrnu^hiuit hie in en* nonmenrs v.;di (|ili('le:il. bur klioui1 k ii.,\;i!>< 0 or i i cim al :imi< v n i, ,(i:d:.'s .n'l', ni *; nri . i. d-.u.it l- <se i i i.il " >.*'i i; i i >i .i i il> it:11 ( i ! ; .[:>.<, a:I 4....i- irr ii A Iii .uMuiun. it sfi'ios pvjsii.h iitadieinatu.ii computation. faking into .iremint inteniHiicney ami pulse exposures {''-), mav enable tutiwe 'tudivs u> make esen hotter (Mi niates of dose. la cpulctuiulo^ie studies, estimates of dose Dk'. i ti.itu il.r.iii rrpimu'l *i\ m r tmv.-ou cf pnbh.bi.cor. v i > f ID-A. t'.uri( *n \'0( ijlmii 1 l)n*c Im j pO(i- ll:i cnr*,.- c.:i :he i.oiloeu.-d pi. nr p.u- tl.ivs ilu- ii'i-tiw rc l.u uni ship tin' j. jmpM latum of -me* [-I ihi i: l v Midi Unit *'D per i 'tit h.-sjxi *0 to Uir U"v iinla.uvvl by vhe dotted bin-. 1! o:dv l`'> per sent iuU' u-'iMMitixc ;o that (lose. die uu1'* would ! ]ti i`;-r i iMi.ul ' ili'pi.io d <lm* mv.ird town:'! the d.'Se ..Xls, if 7a jit ! U'tlC M'H' le'puUMVc. U Would Im- at'jiifj'it.it displaced upvs.ud. nun, or rh? pirsi'Al rd trie person (less fit p*.rs-<us ',-:;tilAtc more fur a given work iojii). Alim natively. jos* ephbilby might be ton- sidtml in the immunologic tense. A major probit-m. however, in applying tire U/>c-rcv|n>tsc concept to die study of asbestos- tcl.ncd die.-.u: in itnim-tU and man in the nvMt tt m-nt of doxc. Presumably. the relevant d(jr fin ll.uchb term1-, die tlue di livcieti at dir ctideul site m the body) is die .iHiiwm nl asbes tos iliiii and fiber ret.uncd in tin* lung, i.e.. ti:o amount inhaled less the amount cxhrled and' or ciearrti Irom the lung. Ahhm`U cuiuuu.es of die amount inhaled can be derived hum direct measurements of dust and fiber in the Hoiking environment and fzom- ventilation volume, there is no practical way to mersuic du* amount of dust exhaled auU/or cleared from the long. C:;her in the lalx'i.uoiy animal or in n*.in. T!.:1'. .it hev. it is p-"ii>io to un-ourc (ur estimate; only the fir-t one hall of the dose eiputimi. i.C., the concentration and amount of dun inspired (in Hatth's tertns, die magnitude of exposure to external eomlitionj that give rise to stress). This shortcoming is perhaps leu crucial under have it.id to be much nmre nude, being h.ued on die number nt year* <>t service in an h.duviry (fij-Od); the number of years since first expo- sine (ti.l, 6`j, 7tl); ur the total' years of exposure, together nidi an esiiin.ite of the dustines* of i worker's job (7l-7'h; or cuiuiLuve a-st ex posure ealvul.a-tti limit dust cone :n:r*`..uns for it i sen jobs. } loses mo be < aicuiated an e'tii iiulivjduaJ umker on die of ins .-sr her work hisim* (SU-lta*. fur giot.ps . ; -..ikerv in given jobs in a given inth,:*;i> In all c>! these suulies. tiieu- has been die ni.ii-ietu of < alriil.iiing die do,c for vmkrrs wu*5? expo sure usuailx extended into tlie remote past. v. id; hi1' a mat ion jb, -t oust rmcen iratinns i c;. i;; at hot sf.inis . ...I iiivomplc'e and in m->st in- stunves uuuexis'. Despite ch. nti-.iiungs <>f die met! a-, tor e*;.mating d<-sr. . lela-;!i.ip of : tim.i.^d de<e t.i rexjHm^e !u>, uever'.iveiess, Iwen a eviViisu:i*t (uiditi'J (table lb Ibis consistency has been true nidi cxfM.oncx vucrumierctl iu mining. iii.iuuf.il tm iirg. and s to,jd.trx uvu'r, inUudiitg icmoval of ofi! a-lustos insulation, r urihertnort. it .tppliul t*-* aH of the responses examined, i.e, Itirig fibiosh, .is 'i.fli iox! i<> St .npU'Ui', U'-t. 77. h-i. lung buit bon p'--. 7.':. >.7^ .i;id r.olio* giaphic wh.luges vti'>. s>, 'b . and h..:g i_aii. Cer. as rcJiected iu muitaii:v sritisthj nb- !;b, 71. 7-1. 77. 7b *-.>. S'*, ujj. J--,., mi.s.i{i:0!ioi:i.i, in which much less exposure seems to be ..;pabie of prosiuctug a tespoiise in teri.uu eircunist.tnces (>ce itcigfibotbfHJtl atid domestic exposure . there is Also some evidence fur : dose effect .u- iug fiber counts itt the !iu:gs At .lutopss as a me.eui'* oi extiu.uvc. A nn-ie toitip'Ve di-su-- sum ut dosC-iespoi.se tel.v.i>ms':.ips fe-'.'.k. ..} m tiie set lions slescuesi to Sariije, '.(O,.relate in:.' sliseasts. U must lie jwsiirted out th a AUh>*o.'.h dose- lespoioe rcl.it:tm.hips ;nc evident tu A g.'C.tcc.' u.* lesser extent Im- all s*po*ev the dsgree nt Cut- relation iv surprisingly low. p-.-duus beenue one seldom, it cvi. itnds mo.e than a 30 per cent 0^ -C 0^ I'.1 vlV*i.\Ai i ' V '< M \ . ir-jKiiisc i..tv. even in %:tj V*. 1. ' tilt. . ; 'f . \ I - ..Oiitio- x i : if.*.- umiIi ni i *: ri' i f i. i. i -n 11'111. 'nri '. 1 !ii% i>ri'ii (oji! i itlOff h.e ' ;.l 111 ' : c-.r. -... i; i: m . ;i ;i j,1 r . ., *; >. ik. :... ;n -.7: - ; 11 -- ' " ' '-1 1 '-1 r v uif s; :. gIm (. 'I ... . .... ;!: : * v .- if!... 'll. | r m if ; .1* i; .11 [) j 1 c ^ \ tiiJ'Cd Wi'l 75. ( in < \|>Jo:(..1 onh li\ s. C> tii.it u'e- wj>* 1.11.1 m * :vt iiiin jur- * Mid U-ll* iilev ;di of t:;:.'f i i'i; t )t u [i.i{ rv U :litre iv il.ir ioncc'i! i.i i` i i '[.c. : :o a jiliv>ici i i <ic mu" wiat the l. j.'1i'Mviii' " -in liuln l(!:i .1 ( ;!; fitt> in the |>l,i. v. k i;< >\v .cil^y u( iJo.'- !'( ,.)u'C it. !.ii toil'..;;} i:t;\ |.i.jv n!c ;iic .iiim . C l- f:: ti'n -i j>.u tuui.n ;.;i i;cnc ",is ;ic ri*'s: >ct< in<i. liiis i nform.ition :::i- .ill!! t! if j 1 i. s * f ** t: l l<> tlic j-.K.-i; 'i.i! i; n o: ; ?int f!. if u..i. it.i\ o ;u:; ^r:.it- I';..:.Ml ! .!( tinnrnM^ j-.; ii 1 ! iU . 11 t, i;- . J .. r : . < i -y . - < : ll.C...- ..'b-.-'M-.-i i It: -1 11. f 1 r.'t i't. : 1; i.ii i'M'. f!. c.-! X ! ci'tloll >|. ;t) to t-v'.)1.'>ufe :.o >. ` ' . )\s;/ ; *r M | *]. . * l tl u d r s,*: * r , \ , * 1.1 % .1 : . .vi ' r r' . v> : ; ... .: - ;. ... i (! c11 S'ymi'Ca 735 s` Coated end U rtco.v.a^ riL-vrs Ciimc2! i'Jo:.-:! -iii, -c lit 1 i:;s .. i.it; : < : -n te 1111i11 11 M'l C.ii'i ji'Kit; .. "tll'.C.ttUHl - ' ..i.v11 un. i i; n . i; .'in. ,i !; ul -(fit ;; - . . 4 f n: .f.i! if . r .'j.. v i . Mnin'flf -i Jitiu.; 1; i ; i ;wiis -.> ;;o .i of -. m>.i:. t .,. c\ 1 lOjCll 'll 1 ' I..,. retd'^ii:/.- d .; li.iiini .l'v >J . r\nr.-niic ("i- ihc-ix : iC''':'.',.- it', routine .!1 :f r..y-.or. hi't r-.'j i >. ... i-.nti CJti-e i ^ -.ii. Nmii. \l: i""'. ' i .- T.r.:*v..:. *.11 . (.'Kind >< 1 4-V! .4. .di J - *, .-.! -...40'---. VI 4. ; ^l. li.it- 1 i.i :; . <. 'i> . IV.HV '. 'i . ."'!- .. t", of. itv.iu. L,3ri- j'Jc3l'vjL':ci' S^T.'.gc^ v>ru-,^TE3 T>- 4 >N 'itiSi r~: .-. r:C-' Do'--i .vs" . \!eiMi'-..! yy ,, T j/t i l ' -i:.- - Lu`i g F ito< o*'* Y*ir\ n*f QOVJf! OceviMnO' * i^<t il-if *:f - ?I S*M3tr ! ]i <.t4) Rfjyti Ct .v ' 70V Mjr *t .1/ ( /r,| Snr% yfl Ti 7d) V.Oiiff'ijn *7 Jl {" 7'. C-VO-i*' son VcCintOyn .*) 5- * * ` -'f /* i y * l i -v > ;si S'--*'* i-. Jr ' Of i *; ; ...'. Sr---- Vlt iff .1' '*11 n. . . *. / 1 I , i. \*vfiO'.- t Cgmuhi.. oust **oo*yf* *?.// c.-i.:) McOo.' Wi it .< (Six) Sw-sca** f -i: -.0/'. Rgi(" >'f 0/ ' Hdl VWiH C-: Jl 04 IS; f 11>-*' o->n* .n y-mi-vogit tOlySVO'* 'V;fOr~yy) V iff . l3fl> S< A;i : ' 4j<i- ii' -/ : c-;c.... .. . 771 "'1' = -- 'SCi S -X ! * .|.*| H**'o*'io-. \C ' t .,,* -, .3; 53) j j.i.ii.i c:. O 5 - 9~3"'. . ' '7 t?' a. l<X*nti'i*0 fy n-im0r iO o-.r.intf***'!*. t.Mrrtirj -ri<5'. mining jr\-j mining 'fV-3>i. Tt! *1' . f .1: t v> x.n,7 09, Z (ivy ut* ?itiovi of okj asoiMto* in tot a: o- -54. OF. 7 5. 7-5.. r-l. 94. Co;, j J i*eon Oi-020o3i0 im r fjo iw l'i. ) i lo ' U c v . V o 'k s o il lu n d o n U jc a a* IS j c m ) o< <.r i* i> 'e tf. 'MU ' ! m I ' \ l M- l I'M. ii,<u 1 1 ? O '2 5 ` 5 - 3 -3__ . ~ - C 3-C- C> ? - - - - a n .u -- ,i ,i 3 5 ; - * r ; j c j - -5 * ? 9 a ?s e 5 a <r* <co.* c'3J> .e?*. <--r ,:a->i a-ra i`Vl UJ I i; Si : \ 2 is> -J\ i,* .t Xi i o C\ -si : 3 s ;i y y% 4 }. 'l <o /: ir <2 05 ; V5 D O. O. 3i e. 2- o! Ul | Z1 3. <i >i 4 . wi ?. r - - O .1 J v s'* --N a in * .*. r> n 1 1 --5; 7j'oon3e-fr^<ao.ic-cio<3e3 oo*** csas1 >_ *#sana J'lasi-fifi*-! u-- *--'1 " 1 * Y J>* <"* r< <"* n rt tf ? * -- *f o ^ .3 .3.. 3s~i^Oa--Co3a--aa4Wr?<->Of.-o?3**oO*'va--a*<"-ja0,-j oo_ o* 5 i:? EE = * rji< n .i, .i (.1 ji. io p '. iu i in M h ic h u i i ' d i i<>' i i h o ^ iiu iu i t o u - i <jv <n<>dci I Y ..J ( o > p x o l'C j l i a n w j I n t u . ilt y s v . ilim 1 u > y v *. 0 * lu y J u f m i w h ic h th e n u i i y * * * i .ii.i v c .i o l l''c U u lly it y iv t'n . j 4 . >C ? 1< > 'J 0 ~m j z <5 M? -4 S :* ; ? 1 hi 5 :< 1 3; >3 s : r 3 i? ?0 ?* 2 \- j< ^a y 3 0 2 " ~ o l -- < 3 *'4~ r a 5 5 a 2 3; a = i "1 --.J :5 2 >o 2 0l~^C.6- , M \HC \x.t i of nwi' in i'h ri.i '"l . im .[ \. .- e i' I : - 1 1(ill'll - ' n m| , - --'a . -'-A .. .uinned. :"c -.idi which i? ; t n t: ac:-... V\ lii-n iti^C'K-l iiit " ,j c' i.r-.". i ', ii- ... ' "\' ...i^-,- r' 11 ; .- ; n^m.- r linn- i:' < ft k 1. es I ">i per (.i. at i i !i^ :m`n V.---.. mom 'a i u : !. "' f'.'t '. i : :c:. n ... ; i ' ... ,.(>. m tr of m OK .. a-i s;o i '.da'.-.i' < ini-, -.nIiuIi a.IS .in'I.iI,-. mei.lhta! A CN '-'acia. i* an mdu.i.mu : -- ,.i r..' < Itul1d Iiiati :li>: u'!op>, .cries was found i<> b<- 'iiininuf. j-vthaps sinci'' .iiu 'if n iN.il nO;ns;s ^'."A L'O). v!;.. : i u; :> *mm c to .in! *i m i>. p: < i \ id:-d ' *n- ! ! ..imi!. i'.ic;i!ilit ilV i! tiie li'u-: is ; *. , O'ch r!. ikdild. iNposn;, t,> :in!,.n ua;.->: lU'piir the (,m diK (crniqimniN 'iodi(X nt.v. t'.e !:k-i>. hut n-'C du- i*:d'., CNpiauatioit. C, ix't u:i;;ii; .in ,il>< siu> tore, if A probable Mi.il v11 a ol ocoipitinu.d (.'no-'niiiC :o ,i%l <. - m*>c oi e1 in the limps ([ mam* li:. to. d>'* -divd'-i.m IN -.ildikl IN !o tv-j.iio- ;,;>n,;i-. : dwellers do \i'i.iin<NJt. 7. p. SO'i. Thus. [nn.i. fih'.i id'-n: ii.i anon fm anv il,!i:i..'. pnTp'N lint*- nl {niajinmi-. bud it-. tna\ iea.snu.ihi', In 11: ali'sHir' of Imtoiy of ;;si>i .;.i% C\.n*i:s be le^ard'd .in .t rclleciiou of 1'iinuni.iicv Niufi ; leu t disali* >n lUI-'n I.- unc.o;. 'our <; tnoo jiiin*;ic. la Kicjiin" with this j-, the nil al-arb ut i i it : :' oue i'.t i\d;l he . t e\i i i'.: ' r . i.-.ic-. V m. vi :.!<!: in ; d>io nnI'.uii lots the I.:a ... i *! v pa net tf A pi C' n.o.A i ni' : ! A- iiiui on.- ui-.. 1 ini', n.'.ii areas 'i-i.di ii'ii-s ! di ,,-t da; i ^it'.urn,' id die r e\ i.-r 1 :.' : a i ii*d ol t::;ie, as w. !; n '-. (;. posjihdn\ r.l r.ouoce.;*>( \ In-. ntdi!:i :..\.-ed i.i!..,a .u tliC end. J On..; A m.iiiLi i .n -i-nr!-in -i.alient v.,i\ m. -m m .m niliri MiiiN [a whi.h muntiiv.; methods ".veic M.md.H di/- d ,Oldham. 7. [>. T'd). I'n.-vnlia-.c was ,i|nii mu higher :im.*i'* men dim VNoincii. i.t i*idii..in, ii im:rv *'! v.idi age (I-*. Ill}, .nid ith.n-euy disuibuiir.n was cn.i: liiad. .in in i!:; studs ol London, IV.,,;|,im1, III*;!.- r I'1'.'I.mi.IHIn .. "I e I - 'M.-ld .irililii'dlf'Nl' 'ill laid i *. : !* . d.-.i'ks .nsd ni tlic indue*': b I" n; o; v in l -n d-.i:, am.-nr' ;:<%; in Iic.ivn in.ini .d vojK. :tnr{ ammig those wi-D-.e o<Ni!|i.i;i-MN in civ m shipping, transport, attd cn- ginecrint: fin, In addition, there is the imer- C'tittR i'h'.i\.ition that prevalence increased with tinn- {I'l.lti to I {."in) in London. England, hut not in New YorL (see ul>k a). I cmi^iiiouN 1'have heeu found on lartr incasioiii in die !d!.ir nodes in persons helicuU it* li.oe tii-eu heavily e\poetl (!-')). .inti n**ie r.i*K, iieioud die Simas of the thoracic c.ivi;y, e.*'., in Njdeen. sinus; lousiL aH). and Itv. aline liter piarjnes (*l'V Further, in nuiopsy Pieurai Plapnes, Hyaiimr o* Calcified vKibrcnt Thicken.ir.j oi ins Parietal P!r?*ara) I \n * <d jd<nr if u.uiioii at'- ',v:i .i".'- u..ru'ii to-. : liodi '1 .in'h'.Iio n :.p'.ole: a.i: C\r.`:- iimi do ..h.-'p: tad. i:i\ol ! .T d -i..i-i',d olein.- -ad ........ !. do I.:. ']-,:'i !v. uirl. nhlif'.' .i-C . nl- nr.- a,id (2) a Nii'et'e1 o. i.ii.:;. i.d\ . , |- nii :.d u. m . . it.iui. 11 :ert eu t" :i. i.. .. .- p. -... pi.up.v l fe lust ;> a-'oci.utd 'n:ai .-t*. - ti.in *od a.A-irs mod fi'lh :u.d 'vdl : ninIi-i.'. :*;i-v in d-.is *e\uw rottirilirr '.sitlt iii"ii.,a fdit..os. The Nt-N'ind. um( !lv .1 ta.l:'1S*t.>t*!>:v diagii.isls i.t .ui o:he* w isn h-'althv }>e: m*u. i-.;!l h.e i-ui>. !;; ' ;u tipivN- i;; '.rctimi ;ca.A--us fi.-.. ot i"-..r-c. .'.CCni ..* hi d". s h-c cli.d.ai ;. m in.. ; ui in I: - e!\ : i .* d- i.n-.iiaieu tiie c'.'.;. ol no- cvad.iin e : e..t dor !' .Jr> o .v material ohtainetl Ir.jtu qwn tvith aNhesr-.u-re* M.it ><M.-<i}:c *'/-/' (I'.'ffH'.' I'iem.il pir..j-.:r latctl lung disease, fiber count appeared to be Cm .is d.Ai-rctC. i.d.cd. ^re\nvhite ledotis '-n ' some reflection of dose (34, S9. 120b inrirr mu'kc of tire rn> i.'ee on ti.i As already mentioned, the ruin of coated > piitaTm In a series ol j.-mvAtj -dm V.:-.d '.-.a- ' unuuinl tiheis uiihm tile hinj' .uiMC.ir' to in* pi I,, es -!esr: ii.rd at dim ps. i i;: . i laiilv t >iiNi.m; .u 10 to `Id |>rt rent (i'h 3'1} l !;;in. .dthi-.i:;!: a <o;::ir o', i vited fii>Ci' .auln Is : i is-' . >' ( I 2 i i n-lum-ru* *i 'dial "d'-,p 'V ' ' i on I..-.-hi .A d.; ol 'i/' ' ..ud te|inse:nN the totd filler inntctu <d tin: lung, it should, iicncj theiess. ictlect reasonably ruxu- u(ire-. ... u:; an ax' . j*. :a.; :i..- _ t>'c p..i , is tn.\ c; d.iexess :n'ii>i<*u"i. . r;ttcly trends with respect to age, sex. lesidettce. and occupation. s!i-itfiv one-eo sntiai.e. '-.aiie and :.i.r 1 . ssiiovia or .notlK-t-olp'Cari. steep x - ;v n...; 0 I - o -*. _ ci> ; '-"-r, u:.:iA5xs 201 .ihinptlv from 1)1? surrounding uoriri! ;>;-.--n i.-'. '..'h. Wit'ii t.; c v niunmn!,., i> ,n>. here and (here mumlcd :,.uu'<;> wini : -r-:s; a i.to-t cm.taui i:-,.: mg elites. '1'he consistency was that of carting*- *..;u. .. i oi.n: nr i.in i n it ;. mu u, * , l he uLstribul inn of phi.ran urvgul : ........ ... . i u.'c.-;:;..'-. u . .n miuIivu / '.. * :i::: tt ill-.' tend to hr more marked owr the h:.. r i:t ;h; 111 ; i ' i. /on.. i''>u.;..n;, ~ . n1'. i. toii jw Oi etO'S :; i j hue'. he CC : ccnti oed iu the posterior, l.ne'.d, or antvn-r F. ^ . }' f.-n .. ; smbut mu the cartilaginous portions ij lj The diaphragm is usuailv involved, fretiucnhv in the att-a of the central 'tuiim () A. The <U* t i.e .osuci.jtion iivf..ti'n pleu'.il ; .i.mu v .mi.I in.tcvir's cxp.oiuc. ovit'in.illv '"Utteccd on euuii.il arwi epnluniolo;u: ^!oun.t>, h.'o -i not occur in the costophrer.ic angles or over the itnplv ^ >ufinned bv p-/.;[.uion stu'.ti*--, i.l.ct!:- apices. Mediastinal plaques have not men ob ei ,x:a.;n- wu> occupational 'c .cc-ip:-.- served but the pleural surface of the ; < > i- uulmm A not im'iequentiy involved, patutAi- [.u !> in the advanced ease (5-1). IMaipie tm nution appears to occur in ar'-us tion.d. In ocettpatiyuaii'. exposed gn.unv su.h a\ i.iii'.us iS.Hj atul \iiipsard woike:> ,'3. 70*. tin- pievalem'h of pleural tisanges'on .e rlnuc r.nu<-,'riph has been viimn (o iuctea*.- in ni.v five of adhesions, and the same person might tu>ri :<> ';s.-uiatcd do-e <[ aid p have unilateral obliteration of the pleun iu one *1 r... , l: (it tiiseu I at. a-, H'<1 ,.\1 >< 11*; hc::ii(Uoi.i\ and abundant ptaqu-w ;n ihe nth?i. ,\.i ' inenes '-1 nPer iioc live;: .. 'b.: 'Aitli uulii'rrl pietnal {>) \heiu..;e Iii^' -- .t rates eecm in-' wi*! a .e lv. plaques might involve one p-ut of tiie he:m- i fOiu '. 7, p. 2i.b. In tiiion. lact'i- .*'.-ei *t- adhesion'. aunii iT pm O.'t ''ion.ills', ed .lilt Mie .oid ii.v.-.ue ot tit? *'--( 'it ap- plaques ate found tinder a ili'-simo (j||, Their peat ** he itup.taut; .*>i itutaiue, hi '.pi-bd. thiikncss varies great!*,. Clalriluation appear* to jite-....eut?s ol cilc: n uion 'i..fereil by tuuch be more common in plaques wanted in relation a> la-uud in 2 ;ulj.icent mining areas. ^ikiur* 10 the amc::nlateral poi iiini of the upper i ibs: it i!.e 'jtne- fiber iu the same geologic .. does not appear to relate iu any way to the In those ito: '.ip.innu.dlv expo--. .. r. :'u n- ihickno-*' of plaque (' V*. l.uh in Futia- . th.Cic i' 'Oittf evident". op,- MictO.'fnpic appear.;"- n. Tltt' plaque; con- yi-- . :> tin- pr *\; d.-. --i mm of i '/llagenous tin.nv;;jve t:\.i.'bpuor. p..i.- o: ' -.e to .inning are.;- with fev. fliito.;ytic nuclei, air.tngid iu umlulit- si:::.i . .., dr:; :. an ia >in rnr : : m inji fashion in a to.n-se, b.oket-weave nauern. ol pieiirai that.,-.-' on ;he i.-`iiogrta !i iu `Ou:c and ttmtui'img only feu* t!iiu-svaKetl capillaries a r:i. duir.'d j->pni.,tiim\ in which the i.ul Cv::- 121). Elastic staining shows intact lamellae ttutts .'sbe-ulciui titiuera! 31). beneath the plaque in coiuinuity with tits stir- I'.i.ui this n"ovi..nr.i. betwetn exp.oii: . and tonmling normtl parietal pleural connective tdcu'.a! phupow'. Liowvvm. no vatisfiitar.' themy tissue, suggesting tint placptcs are extrapleural I: u uivii ih-vebipcd to exi*i.*.i:i !*<sw' :>. :;.t: oleu- and dc'-elop |t.vcen the latter attd its covering t d te.'vii 'tt' develop iu te'p.msc to in....!.:- laser of ni^'Otlielial cells (5l). Some calcium tioii oi ish?t% ami ri.o:ie*es and t.uir .i. tlrpodiimi is pfe-eut in a high ptoportimt of ttr*n in cue Ir.tnj. w.uch in.o its?!; s;-. re- plaques. and ocrui* as granules along the Course ..ctt'-tl t*> tin* I uih.^nuoic. cn11:1 rcv.utiy, of the collagen fibers, ceasing abruptly where the piesiin.cd Cau:-.;tr.e agent, uatttsi.. t.-C ..< Ue connective tissue changes into normal pleu h.-siov ftiier or pat iicie*. u.u.1 uni) rufeb he.n !.? ral tissue (54). Cuhoidal niCwxhelial t-11 may tecied .it the me of the ivaetion, that i;. ir. the occur st the edge of the plaque (51). occasion ph utai plaque using electron fttic.'us..*i as in ally with metapiastic changes (121. 122). Ai'octa- die tied iilov-.*. nun with bronchial cancer is dheum'd utbse- Or:e iopothesis i> that picurai pia.u.es :'<v-i-. ipie'-tlv. from trautu.uic.iiI*m ol the patina! p.e. * . dtu- Although coated asbestos (diets have not :ug l-fc..tiling bv ,.i.:,p i.l.e-ios si-h ..C' ' "no- !*cen reported in relation to pleural plaques, tta'ing the [lieu: i ! u. * i. t-.i.e.r-i ' - even m the extensive series of 172 <cuu>m ex prodUvC i ic: a:. ! vans -p. amined lv Mcurrnan (a 1) under polarired light, ' lamination o( ashed tixue has revealed attutt of '.he !>..(.:! n> v .r'.'.uue: -'c to the process s*.-en m l.ugc hnuotl.or.v .. the presence of uncoated fibers in many coses 123). Agahu: this theory is the fuutue tv -itu:- 0 1-02 36 c- MAkCAki r :< Oiiiit.iie itJ!.>Ji'.m;ifo:a CM-daiis, and f,:e iAii- s: drn<>irs .ih'tnt e of .i<m- .i-'A* ta11".i v. 11 |licit'.)I |.i.u|ucv Also. .\.ct !ui.;" Hans- ; i " ! mi \..1 j n11ii'oii.i| \ ties and t ci. i. i !c i ,i'l \ i.i > hi t i i :i: >: u;u v.. i ----- - :i ' i the : c'nt: t - >. \ m.i'Ch ' Iiii.ir .uni "I 'com iA'... i:i rise .dictwc of io.ii I'.imiii nolle enlarge merit, uviiiiir o( which has lecn found m assoc.iii-'ii wnh ji.eui.il ol.i'juci (121. 125). 'the (i:>jim;.'r;lmi hr-twe^n dm marked parietal pdetiiai us*........ mj di** .m.tll .miouuc of eu.- logic agent ied ;o >pCCul.i!e ui about irv.lividu i! ici>'** i\ i:v .t> n f nini. .i ir. !! (thesis for v.i.mi iheie is mpnot: iu some s;nd:e', hut not ill nth- cue AsIk's<otcn hosed wotkets with ;.|,njuC' have higher imiri.vi o.ioii' of gauint.iginiiin (I 2d/, hm sirnb.it (on', .idot;' of luiu! uiii thrun:.iO':d lie r .:! .m'.in.u r: . .uii/O.iiv' `,127). c inip u t- ., ' in . noi <;v ooieb !u a'btf'lOs. 'Ihoimm: m si-ggens the lollww ::g M.'jiumiC 'f i.-. n;\ i'lheis, | ...l (h nl.u h l.eg mu', ii'i.i! : m.i'.c coward 'I e long pet i j 11-1 \; -"tn" lease !: and tenth th*; panetal r.i .md nr the diaphtagm. ami those that .irf ill 'll II11 I r. 'I b IS (,1 I*. I ' Ij).i n ,f d .e l!!.! [hi .'em idic: ,i H'li'ii-iii .u cr:r sii!,uiesothc.n.'d i1 'mu - I1-..i i .i mind1, leads tn :ht fution ot .i >i!":: .1 pi o i.*. C..ilii:`i.itn>u. when uotctU'. In C " < I ; : . .1 'I I I : lilil IS or 111 .'(eihb'pl .nid di o.-i. i . ( <o',,. s.e:i. ll I' [.iim.,;'l. mo;-; r'nlist.e. !mwe*.er, in -u tept die mi e!ii'!:11 OI [oiu's ,md >iieer> (7. p 2i:n did < i ;i ohus nr pleural ;.!aip('. iii.it occur in "'Oeinmin with .iiIkiI"' cs|ouie i unknown |..r dii* ic.tsoii. mid hct.iU'C the d we ki.1(1.111X0!ji ouh partly e\pi.im> du* ob- ' u.i::ui!'. .m ' I-,.i lueht that could !>e throw n "i the .-.iiC'iv ot pleural piiijucs tntyh.i i:> d i ii i;.c^otritMitimi to the und'.*:- '! uiilini; <; u.o'.v .I'liCitiA [ii.kU:Clw itj inolv'uie tiiecti. .ind e\ c.au.ilU, l;H' the*, he i.nn- tlolldl. Clinical "d /J/j/ft/i.`ii;u: .'J t/n/riidtjoiit I'lcunl trhttjucs. hyaline or calcified, in the .ili'Ctm* ot o.iltterativc pleui.d !c<ion> and pul- in.itiap' fihi'.ois, no r.irelv associated with res- j ii itiiii v.tv:ii.i::i., i;it!udi:iy, dyspnea (12s;. I iui .i .:i hM't\ ;:,e t .c. :t..u d\vi; c`.7ccf mi I .;:u r i ?j. ilcicet.iiiie ill poptd i- t:o;i >n.i'.;e> \lis umdeit anil is :n.ii:dy seen .t> 'in.:1! red .u" ions ;t: lung sotmacs (I2?i. By contrast, r.uliyiogic changes may be very unking, particularly in the presence of caic.it- i 1 ( ..! 1111 ;..`.,i,w:'s. iiij'.w;;, e i . m e ''. i1 ii. n:.' '' iC I. -: i i ,..i;\ i. , e lit :c V 11 d ill-'- h*. in c') A i. i it' t V. v.: :n (:>' i .. .1 ; in i : | m ' . ;. ;. - i ' ; ::c.: . v -ov. er k V n ... o . l | -A il d i-; i m; t.. i ' u. . . .. ^ 1 ..u.i'.i |>i.umes .ne .cmi. i.'. n ' I'utiU'tioi him as it re>*sti.: null,;........ . ...: C 1 n density, diev c.itt easdv he m.i in >.. t *. ; e: t .it i d filin'. p.nmuniiiS it :.m ..." e .i: -.i i c.iiul.iyces ^Oi Noncait i Tv e'. pl.n..u V'lid'.v cuds set is ts:s the '.oia d :hi lie in the lateral costal . e , uti^h1 .:a; c> (> the \-iiy iie.im. -ippi'.a .m iii oj- ii ;tie> .dong the tosral mnr>;ni' < >Mn;t;c films '.id he ncccssaiv i(> visnaii/e pi.iuiris dt.u 'u l.'t.i'.'.d .'iiui'ti-sfiv or posttrun 1,. Is iiitiiH' dn i i'\. iui-.veser. can a; i o r.< n : .n-. .. i ,;: * pen t t.m of ;'h'.::::eo uU'utuivd .w . . in 'frit-' -nos' pr i m.;.; v..re u-:. ind d'.ri'C.'o eotiiitud to ::.e tn.-t :v i.diifie'l p':1. ine- cdl' Tl.C :u.-'t usti.d clinical pr>''.'iit.itiou ,s i..' ii'. n d r.;.iiuh*-rie finding it: an :i>s c. u - n is' [>..;h'ih. *1 Ins >hmild a let t tin- pi>v det.m i-uiiil.;', of c\i . if tin' ij not ki, in tiu `'mis' "l "'M.p.ui.in.d ' in;1: in'i; i I.U ih'ttie -' i \ j 'I ; e " \n..o- ;'i d po. si-no of j;'. iliue ;d.'U! . j a' s no' .<r to C-uS' . >ii ti.'.iiiid . i,;c:c it 'iiiin- i"/iils:\s t. : d'e- .tile, t pt*g:. ds. l int i. - >t.je sei :l< t . ini:- as.ot r..I '..uli .i *i-e i nidetue ol him. dm i.itriumn t> :i;d!. >. ;> 277 . '. hi;*' s in (lueht'i ein -swiih ::m ri u... r ddet'. ::u. wu* nut *' '*`2. e.: nie'.t 'i-iiu.l il.ls .d'O h. I n 11 : .'.d a* d. ' : ' '.'ll'g S! . : me' ii.ii t.-!s a*, t;-.: vii".. I the ; Pieural Effjiion i^oeni^n) ksud.itivc plot;: si it.K tiuns. nliisii !it." . in .i'S.v ;.uiots ui*!t all ot i.-.e .i'hcso>-tel'-tf! ling ilisea.es, ina*, also uc'c'ii a> (in* print.ip. or i*. a.aSt ti:C nv^st pi nin.int ;, ciintca. .i ui i 1 1 -1 i. pti''s;i;.ng as an in; j i > i e!t ns'. >'i ` i ,i). i h ; .i c. .. it ,,s; : , or.sin-'ti.'ig ::.i. vita'.. u u at ..i.t tcsie'-' v'. '.s---'. 0 i ;c: the j re.'* it t * .e *t > _ ' . cases (a; om'h'iie*: ; > : --.m j-- " i ;. C r. g :.d ''d.i'ixUi v.-eh i'e a ueue ;i'>t.!Mia ot ,i'iit'm eNpn'i.ie t!...;; '; u;.. nuniijcr suggests, ji.utieul.niy d it v.."e ' e.-'e 'O? 06:: * un i : f i \'i> " ::..sc .ns? \v -I.ovmi ;.j be a jti-im c;tb -1**j mm tm ;!.i. ui.r'iii-'i' irum;. .. a;.,! !.,,>;)$ ii ntner ^ P:::u u>g\ ('; i v -.! ' t i. clung"* !ii m. i mi o; v.iiiiin.ii -MO'* !..u .it t<; i/Ci! 1 men... : at I \ .is- c\; ,i;m i - (_.i ii I.- imi'I.. i,'. ! i. ...i ; list i*t caused m' lieu.an. te-.eiu 'H'U. ; ^ !ei. ! c:;,.- x.. ;* ; .ii t - xic, ; ^. i - -i s. A i u: rm..l :ijjI to ! <i .i lemie Micro- *to;-it: ex.mtm.iu.m mows v.u.abit: [Mem.:1 thick- <nr:^. i;I, "[! >:;tl chut ot carbon uu1 other die a.id ( am: giamhc*" (ljl>. Oth er f :: 1; icge-ncnting mesotheimm .itv.' mcmos c-.hhiterm circulation (l.'li. and , of.v : ;r -:f gramhuin The r:; iug !.nv; '.bum shot* > \ ar\ ii:g electees of d y .i-umonitis, p nulii. hu* giadc hilijimn.-uti . m tug.;;.;. .-1 iu:emui..l ........ . bi v.hnh m-diCs a::d "hit' a,e u.cully. Lot ;. ' ;i .m.ih.b* !'. tom:'1.. LHct:on mm..'[bi. :nl I'.her. ' : .p-m- f! ii `>.,t C.iU asximcd b it t- loi.m! C .. ..." ; "I u*m.l p:-:- t;t tnrt is Is.' .b .. 'g Mt <' t ''. s' I' 11 s' ' t'.! i i!:v>' j/.m (I . I he ct- ,i h uni2`-- '1, 1.:! I'.ei.ii, t-: (me >i.le 0hhi5? Interstitial Pulmonary F;b.*s;i$ (Asbests&is) Dffinitio't Ih^ii'C mtct'tiiial fihiciis of tttc hm^ :.s>tJe..ited limit jshC'(o> e\;'"'me u.'.s n co.'imcd in ttte onto ycart oi tf c tucntietii fcntmv. :he fitst .inInMus-iel *. >i disease m i . '> res-igtii/cd (l); lims'C'cr. the term "ashistosis" to dOKtii.e thii imiimi'itoninsis w.is nM. mud tihtT. uhen (ioiike uiod it to describe the c.*>e of a lemale asiiestns ir\ti!e nmi.'... It t> UMiai to iT\ ' ;;ie fii>rosis ot ttie as'- >'i,.:ed \ is..,1 :lve:- i t under tl'.U ;e;n. h;.t da; li.e ^I j'tf.ua (111', liiete i> met:: ut this Jt'i'iilu in ime ''id.: do '.vniele .u:i-[>teil Hm' of t!:e pucuuioi-'rdmls - i. .* i. i.itltcr f!;.u: t" Use :!.e te:m ' i'i>v>;.-.Md' ,i> ^.uetic tcit'C to !i'sc;:'*c ill a diCsfu-rol.'! :eJ e! i %i: *-t. * of the lung and jdem.i. C\eu neo;/*ai* ( 15 r:: .' f-. hv.-; ; 11;? in >etj ;'.:u.C. `1pu.sMti- l.ftfM t m: ay ..cute, t.itl t h. er. h.-U/siM y ro- is. -ud .n .. :. u.bmerrt;1111.' i i ft shioule. , m. mi- ] ; -iei:iu re .u'f ;< m. '1 i.e : lenrnl T.;d s r- :. i , > s. : ,n .: h> '! mil c ...:. ; s r <* h .m '.ini't t.j A>' vei * '# :r* n'" d. m : a---", cn-.es. Ml exudate . The line. ! < c lies 11 > m.i tb..; of a bent.; tl and seibh lot:a.-' i 1S:i*' it ;IHC. ::S3s t'> the develop- nmiu of tflO'.l a [deur.il thickening th at re- | iif S v!r..*> C U , .nn (131;. T:ae (nsiiMH''s asw* V ;i. t ' .' *tos inav be tmrent. ot more tter. may 1* i*.: hi-eu brief runl in the temote Attf.idogy Mut oh.- nn:The main ;>.ui>- lm;:e fcatmes ;h. t I;.1rl iiee:; ti''sc:i:n-d v. idi . m c i.s tin' . . iiidiitdu.d rfj-ott' [!: i d<* >> uric -.'ed * s \ fl. ;::d,atc ansi Me- ( .imjj'hi t fl lii; in :hr li'i';: ot t'.e;r oivtt n.uho* logic tn.iterial. havtl on to case* of rlinii..: is- histosis is.itninnl at the l.-sml-xt Ifij*i:.d. Ma- cross.ehang'.-x raut;.'d If. .u >:n.dl area* of i-asu tiinusis dl iniluientU lOs-.U/'d, tim'O may t-'i-iue lecuguition In the naked eytd to the (idly ile'Cl'meil ; a sc ul a diui.'e. hue l;lnr.'is aifi'it.ng bx'di lur.is. I mu; t.-' tend* to teilect Ihl'r.mi::-.: .s*:roti. The h; i.,Uoms ot .1 nigu .til.e'.'-r* .mural effusi-m should i*e cm- .idetctl a ti: .:^nis onlv iv cxeiu'ion. The chiet aUcrn.itivc !<c excluded ix mtiiizti.mc t::evititeiiomti, if.. -. rA the tnauift'itniotK of e\;..'<uc th-i r.i.iy not develop until tnaui se in dt-.r the ftrit cxpo+tire. The [deuni cd.idor.s hi:-'. tomnitMih. eotnjdiv.ue the '...ttcr tutnnr may [jr\r-y'r- hv 'ttotithi or \e.u5 '.'. i def.tiitive dinj- i.11 n ot the ' mm.if. Indeed, one tooM .tt;;t.c .g ih.-t ' ; :'.e di.i^ne-'ii ot henign .i!'es. iMMii-.H utt'il ;dl <<' ;Tt* [MO'tnt rc- ported fi''.'' .r.; f'dloued t" r'.'Mth, icl deuh m t" ho .u:i MM.f.n.lo neither to e rujiuniii { i;:e luu^ nor to nteioththtoma. However, r.i follow-uj) i.ecotnej Umijer the ji> tifi. : t!ie ex'ent of the i:ht`<>'is; u!ti-n tiiis m:;n.sC. tite lungs tend to lie siti.dl. (.ait unfate dimes the line. grev-e*lmel Iiou.i" th.u generally .tj[>Cat* to atlcet 'a:lii'eut ai are.'.s hfst. nftTft (|uili e\tensiv'-i[., iuMoi>* adraming ium nther i.<irs '.*ith die extcuaimi the dhea^c jnocess. i.ov.ci lobe* tend to in: atlveted fas;, then inuddie ! >bes, and esentuaily. u[p?r ! t.es (Id. !>o. I h'v Small hotiev. omb > -.sts mav bo er:t. in the l rver lubes pal tieulaiis, .md fd>to>.> and h .m:\ccmihmg also tend to he .m.ecmi-.ttc t '..b[r.n:r .l!v dim. lunjiityscm.i. s.<mu ii. d;d u- ->t Imiim.-. :* eutlv linmd, v.itii *h.;r::e;er:>*icj Coemnib hv du- same as ;u emph'. snma n-n. ..*sO t.uevl *>*.t:i asbestose, (IHh HI). Tire pieutni iuitacJ in rel.itisiu to the f:.b'M>is is invariably involved m .v C' ? ' r\ \ . - r ; >1 .1 HIi:. ^ - uni':;";; ' c >v v .desptead njiO'it md \rr:. .0 0 -.i.i r.i : V . .. .1. . . ..c ;:ii.ir , :\\t 1:1 .;t *.. :n i: . : 1.. . < : \ . *. I 1 i. ,, ; 0: uih- rw ,-e .nil 1 u .1 if. ! ........... m. .m\; ! . ,, s % ....... I-'.: , . i ' '- : ... w: ' ...1 , lu ;?ic *\ 7 1. ' ' * r : u. n > *. c 1 .i1 * > 1 -1 I >. I.I. ....... ...... 'loi w .; . . W. I* 1 . i>l' II! in ilr.vnu' of .llo-o >ol i or. ,U...o ; > j . ,. j. i>. M "m. 1**11 .1; ; 1.11 c, uui ' n !C V\u m<< ; ( !i.n hi e: 1 ;o 1111 ml Just :m 'in ,,,s r y, nn. i tj; n; sou .1 11 lit;, in .11U::: :f>n. ::;t . if-inn* penr V> h..\i- ;i ;j;<\l':li c f inn h>v t'-o- i(>Wi' f* loi.lt t! 1 J. Iiii, unlike other inn ..; 1*' M" "ii e 0; i< m>. 1 110 oci i >1. .11.; 1 .oil. nn 1; iiltitic if-; *n 11 seen, for v-hiii: the icrr:: 1:,.e.,.ci!c>:i . .1; the .-I lev : : 1 \c .hi..fi' n, m ill -V ;i ml .( 11 : - 01 - -. 1 .in* i-ietui. f *15 to 1:; i :i! ; : v * !.!' U\ . : " : .. ..;.n : v.'.tiii-4. ^ k !i 11\ nun 1 -. lll-'.ll.' .* U) 1 v i lie '.o the ionnucil ol . i-.!' '..,> .! lol : .or fi'ocr. I hi> .1 hm;. lil.l li.1i b'.lll U'ftl (1 i3i. Ni 1 !> i;n >i :i :-c :u> l" he true lur : nii'i .. mi i.i'jiiei re fib: > injilnn>.' .1 'iniin[..ii wall rhi:iin\.i;m<; oi'-.mm: fl-IU- lr > lilM'l xCV !1 With ( i.i: i!.;ii>' o'; \ . > . U Iff:* s t i \ < \ V . in .mi:". j ..s ..cii .0 n ;:. *1 M wii'-iu e : C'''' * 5 l . ' .. .u v: it<..'. " i- w.,f kt 15) lie >1 Cn ( i ! 1*1 -1 l'J). ho' 0:11V r 11 e i r ;< , . . nu.nm 0; -. .. ; tu. ,: u . : t..\ , . t . ' . 1. Mu 0\('.: , :cn. In .n;;:.. > 111V '. .-X . 0 .. ' 4 \ 1 ,Kt\ .to Ci-!-. .!i|'l 1 :`.u 11. > 1' if-J.id? 1 Jl .i|ll.i1oC 1 ; 1 .; - : .0 r- \ ; ! .1: ! j::-o i/N i-i/uer. l1. ; 11 7). : e r*ci: :i [' It 1: :.iv h.i* .10 fomitet [i in in 1:1 u: :; . 1 '.ii fl. 1.00 IS.. l-u i: i. ; ill'IO.'" .nt.-.. e in 1 tot il. ;;:. . 0.. I 11 .il1' iui.iii. rin it it "in; 1 .-c !i'|>''rt ii.-';[i...iii* ' 1* 11 f:..m ........ ... .0 V. < 1 >1 os; J 0 ' : :u .u r. v uici i | .nmiu. -,i i.i wiili .1; . > ! If' 1.. lire 1-n:; . 1'0., ,u.. i :!n: V i .-, ii 0 ! . .;. o.. oh' : 1 :t! - , ; ' .'ni i :; 'i 1 ; 1 ' 1 li.UIIUl.i: i .- 1 .0 i. ; ;.!, .loll | J l ^ '\:i; t'..i.- n.. - i'.'..'. o`. .. si.., <. ! i' i * n.h hi.iv .1115 (Ini). ' ii 0 ' '>::.......is .. . m ;! . ... it .0. , 1! ( ll .It! . ; :i ;u in. ['<'. ;....;u 1 1 r 1 .* S ,* , s ! .1 t... .0 h- i.: *<. 1 \ * ' r 11.1 . - Viiu- * .: - .1 ; ... . i I .. ' nn -.-yin 1 oh .; di o.i'iM, :' 1 . -r ie- ,\\\. . ..V I : r: .. "IV.:-C- ! i u i. l ?j). *i he uMction in the i;::e: ii <! i .T.I.V III es;.v . I.,:..! ;,,! n ri"ur : 'AfnthL-t rh.t of otlur form' ui i. U' I SCi- :-.>*> in. c *. ni ..... ,.i, 1.>(l. .uui ' u.. ml j .rtc*nii"ni.1, v.itit uiiMtl !itikni\:e iir.t.ltra- in e\;- mi11 [.oiu;...:. " -.itet in:./..1 *tc ii<i!i ot the .lilt 0I..C vv.tlU. uVKleriile uutr.l ers '( in 'if v .vol; v. .i .0- r .ii.m tlui'C u:... [ilnt;' i<)te\ in the fKfoli, ami wir.'ruj; < 1; ^-.CC' O... / 1 *1 r iV<!. Vn: in t V. that of nr;;:int7.iii<>n a j!i J'lnti-.is H ``.l. 1 I /.. ii N.\ nt' .1' m ! r : me the ..-i.;. !r.; c.<. ihe r ' i\ .it*: to:it.fnt:.i:v 1 It .! . ii- 1:i lit '! i.. . .1* l nt ,_T . ni (he in; .i 1 ..iv bronchiole. v.h ie r..ti\.i s V s . V, t > UJ'. Ni .: 1.1 wmii. 1 in iill 1' '/`.is. iii.n 1i.ijiii.i^c"., ami ilutf |i .ni" i.. ohU 1 10. 111.;, le.itiiit'4 juhwqoentiy n> l if il.: bfCtl termed tilt Imic lesion of adjcMr-vis. n .ic- I.i - liiilii.:;i fo'i.T'. ' ``A ' . '.ieit:"i' m.v " V 1 ' v.r I:n 1 he i.i ! '. : * v 1; i-'ueiv:' : l' ! i \ i.uir- - . O'- 1 ['he j i.i'..ii.ii'A u.i; lv. 1 jiciihronchinhir f;iir<ms (1111. * a. : (he process extends oimvard to involve t he >ur rounding alveoli. leading ?n <iiiluw .nv.ol-ir A.ih A :iuiv 1. Mi' Ul.' . * V` l te'U'.'U c t , . 1 ' V. :c is sn'4 -'fa >* - i,; V j i. * i. in wnic.i the i i i . . . h uccu: rvil 'with - V : uicticy in .*'1.;.sO ill ii i. rnutl', ni1:h ici iinoncliioiat mi', peri', .imi1 l. !'C' (Ont;nntct! h : '! i- t.ii r)ti,.ul..:io'i , I.T liiirosis t !!>;. !n jn occasional eve. '.*0 > 1 c-.ie i' t \ -"V'-i. Jet re.oC u '.!iv MS t >-:i. 1 iiii . no-t t\< hiMVtly |>e: 'in th.--: 1: i-. :v \ r'lii;' . III. . .--u i::>rv-..i (i :*i H >. r ; y. but the more uuul pii th n. .f a .i:;hu.e fii.toM'. in\.. inj; tin. 1' : MiUn1' \tif'u h ir Vll - tii.u l:-; i.i: :* 1: l:.l II t M 1: if ro-iv '(ill*.nn. ftc'un- oil;, o'.'ci.-tel with .f ...:.! 4 hhrnvi-.. w'nee hiinin.itril in.;-; . -* 1 ,.c Ikc'-.v.i :; M:i m:cr* the entire ..rent itym.. Such arc.is rr..i\ ;.l>o sim-w n to;H^i..mer'*e ftf-: -- in -he Alvtoi.ir ceil In j-.erpiasia and <cicrnns of .tael have been .1 ivViutetl : 1.. :.iocrcul-ai 01-0206316 \'0> S I o.' itf l ill I.LM OlS>.AS>j -'Or. a :!uv. i' ime : 1.iv in :uC ` mo.il v.r i.-.t'.-r line. 5, ;j ! and in <Sir.;ti' V w 16.ii. N-*r li'-vi <ui!i po .'t'Mnii . ppe'.ii >') i*c to A "iheunut 'ill" dnihe-is din). Qu i. .'XT baud. Vk! deveh.p.Ug Ml . '.or* .r ts ii.ibic to ha .iweia -d 'w . p; . id sh.mge, of unusual iti-i r.t titer ::: . > kc .1 i -trader. 1 hv relation.!.ip .if emphysema to ashosios m e\]'Owi'.' remains '0 b<: elucidated. Physio- io;n sii.J ic' ui.:l .mu.i'; oh\tre.i cion is I'l'.i'niuii; in the ii.aunirc of fibrosis. particularly J this is piTm:<>...liirvj.n in loc.iiion. it would ' -m ic.isciii.iui> m riinr it to liic <iu>t load. In 'v absence of `hi.; ftl'i.uj,. ami gi\f*u the mi- ;i"t of dm j.". 'Mil-; ha hu. it is more difficult :>j determine tin: rut- -if i dt-.t lo.ul in tiie d- v!-j.iiiCtu -( cm; Ir.scin.v To dare. '.here mas (! m.;?:i.i,., ;vil<'P.v sm.lv ii. which me i . i'.C'CC ;:. '-ema and or t.f;:' ni* br'-n- i .. u; s^'.'ci; o is w.u (out- j .r'<: u:;;: ia t;o:ir\posed , `.s. siul' is ;[ Ruler .mil 1'Ui uo (l'>j <.si.il v.iMvin. tiiat (.ieaily showed tlie ssccss i.f te.'i.i in toal. minvis. An open min.' v..);!.! be . pi ..a the subject until fur- ti.Ci cv.cle;:./: is v- ,il lble. gt< i-cs. :;a i..'1'.nir >u' nit*-. ;< v ; jr.d ..c- unis i erv :lv:` [Mil ol inspiration i lu;v am ritidnued ; -x... <h lli.U'd tet i urn ios i-t ;;;{- iiin^" ;iag). an c\- pl.iit.111-ui '.ii'ixu.id l-s tii*- hut ih.u tho I i :hi' gi .r.. ' ... i ,i 11\ on. t `..,ues nit.; .s in I'l'-i.iu1 .iiu! li.tsc LiiCit '..own :i.i he con 'istemh dctci t dv ... a go va tr.in-jn.huuoa. . jiicssuiC (I'hi'i. Oitiei .nisentuious vhmuA. sin .. uliff/cs ami r'tnuthi, ate less wnmio::. A:r lull' and ihrst etsn.-.n-um atv lAcls to he auiut- cd in propm lion to a^s.sciated picit.al duit;g :s. Cliuhliiiig of t!ic f;:(..*<mu and toes is s.url t.-, be piescut in most t;.vs MOi, aitltouph hv no iiiO.uij is tlii. alsva.s tine (IGi). Vhis -igu doc> not necessarily indicate advanced disease, be cause tt is .dvi Ti-poited in men who are `till able to work (/*<'. 1 l!h. The l.u--. <;t correlation uiu: 'cwu:'. <>t i,i>;,i) i^eii p.uucuiaiiv i.iien the il.iidnU'' i- evaluated s\ >cc::ts.;C;'.!:.v iroi'.i ea;s of dig.tv to a!!.* v tiu'.i:i. uteni ol ih. I. . ,iuv chial angle fi;.'. 1 l*i> h\ the method uf I'.ve.ui ami ass..fi.(I'--, it is of iritetssl that stiiM'. ing also apnea:. (> p! n a part in die Jes'Mop- t!'C:U of tliis sign (Haines. u. Ifn. an as>*>via- t.ion detected in '. pnietuiologic studies, die sig nificance of tvlm h is unktu*u n. CUr.ic.it I'fiitUiKi The i -i'' mi am! .1 gts .if di'hisc intet stitird '; ;> . .I.- -.' expoutr- itc :;o cf :ft f >m il.O'i' v .11 hunts of dittuse int-u - siui.il iidro-.i. Tims, th" most prominent sytnpi-.tn is bre.uiiitisutesc. fit .1 noted under the stress f vltovt, then nt rest. as the large working re"t'e of the U.u; becomes progressively redntei. Cough, either dry or svit'a sputum. not js .or -i:-'t::l' n:-.e:u as dwssr.c.1, inav l'C vrt*t/. uirh d.t: s'Utg parmsttttis (!fl). Althiru'U ,.;'u.d(v .i 11 i.t.iA-tl ts aitu.iv. r.uhT tft.ui to .i-tciMiiial. lung disease, this symptitm ncfirs uU m'Mtcr fretj'tf!t(\ in the asiiesfusa-xpoMil *n*cr than in !is uoticxposcl imuuerpat't *7. lift) and often (.autint i>e nttriintted n> dif- krenen in smoking itnliits. suggestini' that this svmptom alo relates to asliestos e\po>uic. Chest [tin. not a frequent eontplaim. has been attri- luuid to muscle .uiifs. u'.*eause it ai>t>e.us to he tt.ucmonls ul.cn sf-tpnea is sesere (10). The un-t >l..i:.it!etistic piss deal sign is ih.c |.i- r.-:ice >-f unions, ul.iwh are deicvdied as linin' a `cris;. rlc.m, qiulitv" in.I oriurtiiig l.uc in in-pir.n..-u. tuw.dly o-.cr th-: lower or middle lung m.ni (10). A deep iu-oiratiou i;u>' be iieecst-.y to elicit tliem. As Tihrosis pro- x<:il)hic i./t'./i :*f In C'-ns'dr: r :':c id vt r.nhogt t:dl C-' c!;:- i'..dividual {-: f ' ' .:g-M 'R pmp.i'.U (in. I'..'., esaht.atiuu v>f :h ,.i:!ii;*;:.ity p.trciiehs'Vo'U.l h" based on the `adboving f atuu'w: small, ur.'jutar, and or mum! opacities, 'coie'tl for '/* or IcMtgtli. [tr 'fusion, tr.d number yf zy.es aff`c.U*d; ii.iitiioe ring fhone-'CC:d>\ shadows: a define lu:/** >>r gtound gla" ippearsncT not ohviotolv dttg to ldoura! vo.-i'i.ws; *!-yrt lu-i'amt:il '"ptal iit.ev us Keriey H-h`n?s. bciie.cJ to leptocnc Nuipiiaiii oh.'.nniiyu (bir). and. otcasiou.il lom/er hdriiii'.' shadows. Pleura; cimngvs aie likely ; s he present as ueil (in more than one it.ill of the cases in one scries eompermtion hoard tnatesial). whereas in -t> per cent of cases, thes were present witlicut t-.*aemhvm.d changes (IGi). Rounded opacities are moie evident when die occfp.itiou.d ts;-.......e fi.is included silica (^si. 7'i;:sC findict^i ate genual agvrrmem with pre\;ou* rcpotts !bh. Tiuo. it can 1"' vcr. '.Its', the fa ft- uures of a-hetosu an: ; > diife:u:t '.ho:.i ' ~ of all other forms ot uitustitial va-r.-ns. *.\cept for tlie proiniiu ttre uf associated pleuird vi'*.t:gOs, in particular, calcification, uhidt si.ou.U 0 1 - 00 6 7 i V \K0 \4 : \ - I \> i ,v \ , i, 1 ;ittc.itmn to t.iC i;t .C * " *C i i. I '1 ' . ibi a*!'?>:.u ........ . A 111 r . 1 ; s';; . ' a n f :! ,1- 1 .. .; c ' m ' . -; . a - *' ml ' M. ' (_' ..ii ;C' ii'tcd :!! -s /'.ro. .!- . " ... m. .' ' ..: . I 1 fc a - d. :....... : a. ; i ... 1 .d . *.c. cii. ; .1 ...i v ih ' ) a.. .. : :.i f.ut ... ' X; C.;.. . < . ......... : . S : 1 n - ' ;. .... nr.i : iti.,1. 01'")- * net' -hI' .1 as a............ ! v... ,: *s : *i i r in v . . _ ' (\ t. v u.u v r r i.is'i'ic.'Minn (Iri.s. Jt,. fc.ttnics r ,.i|.ill..r." id.. . -. n ; ; . 1 ' 1 ' vi [ ll d .i; v l.ii't clinic .. slice;, an rxccu :!cd tC nnr't t'"ii. 'Miii'.ii : t;t 'i " a '- ;:it ;l'v a aa-' i scale to ,i. |>aick'i' iiiai and m :i- lain.MS fi . idlfl . ' is la t si d. S'. 7. P. , dan! ti;n> : i ii'.i.t m tlir cs.du.tti mi o( iiicu: d t ; i.i i .tc1 vi i- i :s < "tu.t s nt d-c it^.. . .mm! i.m: inai ci;ai|X'-s (oliiaiu d !<. i emu ; till c 1 i 11K ai air! Pi' i.a'a ;i.ft; .v:,, i ;uci n.... i l .id-mr (.iffiu'. Occm [Mticilial .'s.v- d : case, i .-:,c; ai n s:: i< t; ni nf !m , tv :iml i'; d!i i* t a licit. Cdl Mill (.cum a ,1 iii'ir"'. j>.u lit . >r.v vr.d f.ip.tsitv (\'C,. i.;.. v.< r /n i. i d. i'l it Siv |'i;:m ^ 'J jn -1 l ! 1 : Use |>I i ll. i! mi is . . t: \. d a pi-, . deft i'll, ir !! v. . t1. i> li ' C :iou. la ;ir.ai.>v;:i^ :[uciivi''" : I Ml. .1 IS ! '< . .. d ' 1 ..!<'. v vji iM . !:". i; ; ! .. -dm v! .;.i i' ( a.. .i. `a.irar ..In'i:be; '.seen nad s I i-.;;' \ lav X ta a. mi ,i r ' ' . Tl.t.s, cu . .;v .1 - * f. T. 1 i *; [> {`f * *;. |l*( MM* '% ! ti a .Mt'i .1. U.-t:: -. - a- ..................... ... la a- 1 '. i \ 1 .. . . It l-if-; dm.. ; * ni \ (!. iii.t.* : . ' . ....Mid .' I'V . ".. 1 * (. 1 ' * * . S . .. . . dr a ; m. a, . . s -dr - : ..mu n. dir. M I .. ! '.ii t i. ! IlliSst .1 ' ill.Ills' tl.ll;.. aiu.O* a; ;> !i.~i vr". v?s.jlii. :. ;> v ' till' 'til'll ! " it 'rid' i"\ , . ... ;;? r..;tn.d . I; . .a. i ;.:ed tnc < ' i'inia-in- d . ,;1!^ * 1>( *'1:*. * ................. !'.r m i:v d^ * d- :ci.itiiiii'iii;- d I'ltia li.i- t.' .. [,..i*nf ; m'' u: tm'u; \ cv r..li. rr. ' i :1 1:t c i C', 'ii'i- ill v.< i ` . ,v ti.a.-l.c f';- :'. 'a. 'C-.i at t"i i d ! .1 avlvlirl.m. lias > la iir .ilii'i! i : i. i i' i ' s. d.n - r 'sri.d !'.r .. \ i 11 d 1 i -..it i-.ii !, . .,uM" .o and 'in... r'.av a: fit st i ' s co' tut: W'l pH b Vs rri.r-a... i.-iavn' . d I *;;.!: ! ..!*: ; . r ;. it ...- : . ^ * *l . 11 ., ...I *'.T 1 ... " - 'i i s. in.; d .i, c .. ;i = !. r i. r . r, .. i. in is' be . ; . dilt :! irr. c >u ;; > ai .iiiai' it I'.IIV `U dll' in.i't V. . at lliis cl ' \: !l .M.;d . i. :: n id. :.. c 1.1 s ^ "rs; tjtii.ti * .'* . 'ini i VI; ..tti'i ;;rs- fUa^ll:'*lic; futi.r.' .si.. st.'M" .!.- , tjc :s ..iiv b a!:! ;g!i rtuiioinxic th.uip . s' ilcJiTiI ?.l dial .!1;; t-. I.i ni.c . ai"' >. pis!- titiid..-'. ,i.;d ic'au. r M-. -..(.II lung (unction chat.,-.' l-'i : <n studies (*7, 95', tl.c-ir tc! ; drj, m d. bits. '.vhk.U is iikd;v to v.iiy i- s (U d".;c ;i'a> i'V ' n-'ja it dim ......... n t . d'. i :i> d t sr ' ...: ' a t ; : I-ii :if s ! r ' ' ;d." 1 i . dit- >IU*t 'i uu]c-:f to sutij'.'i.i.. lia> not widciy r. .Cvl. !; r f J i '.I i". ' si ' ....""! in ; ;n t ii i.i c: . i.. >d'v fi r.. .'vi f* car . Limg Function s'i""'i\ d. :r Ir. ' .su: i" . -v. . r :il r)ia ll-Ul nl ii.S ".a:;."id tin!, md'.-cs!, ip.-, n d..- Lung fuinciinn li.iv* bvcU ajiisticil '* l.;:; Mmly il njskc tltcir stent:.l hip i.i.<s s in ,.i is' ; ..i < pi cifiu s ; < s. . i.:...- :v*u*iv j'.ljC i--r in tiU'-'U:; a:..! 'r tiou lo iiiuii.il medic dr.: in ilu* PJIUs tu naime >>( *'.e '' <. tins intcic-'1 m-.-. ""'>" 111 iftil. :e :!? -t clinical .irea of Tj>|>ii" "i >"i irtjisi: C" l s":d. :i' i >. j-nir.- : - \ I u i. fu -:. ", i k,'. : .m- *(. am! I's^-sius:;".; ' ( mu: : U ; ` a: lia' e t .dull;;.. , md, f->r t die evnittn m -.~i ; ili--- i Ui.,- ; i;:i: U-:' ;..c 'm vr i!! . i. v . ; [( i f ' 1 i>. . s. ..v ill, \,: v. m <\"ec ting r ix'* i > change-. fnu.'iU. !"i j'?i1 j*i<u rtit'ii i; f.v*. vi i. : m ; >. ;' ... . iti.;! co 's'Ccn (ho !<'* pe'.Si'u. mr-t widi d miicr, \u;al I n .*:! information gained ham j ,,! mi- emu tv,*ii`-1\.. tril -i ` .. otogu. Pv.dis' nMirg i>uimotMi\ (uncCOti mute.Us i. . ..t".. u > bst; nr:mu .,1 ; . 01 Q 2 0 - 'r \Si'.is i O ' l \ ! c J i i. ''i' iiliiAi". > T)7 lomp.ired m M jicr cent mbi ' ic>? iJ:i\' , ' iern\. wberens in 1$ per (.> >;. h _ luiud uaument sJjyjJCMCi! j :it>s.c<- mi OUT m n. tion .mil resit union. hi a.h.ition. u.iii". yt epidemiologic studies in iv<i*.;.i; mmx .1 v.. 'tubus til r. liicir imih'i1, cxibib.- ill'.":``i! .i u .! it.'.. >: 'V.sC '.'11:1 in^n. 1`(-.i<) ;n\.111 jiilj 'Iiiavv .1 si/cable aum- bet u( permits vsuli evidcaee <>< i.hsum- (inii (l>5, 7*-. I7T !71-I7tj- However, t' fit? is 1*0 eVar 1? v i<if f 11 r; sbowiiii; an ol a:;w,i'. nbsti uciion i:: populations C< >111 [ iv [ in i.msc urn *,i e\|"nd i'.'n. ! 71';, and there i* i.i) cic.ii evidence dial union w- posttl populations. tin: |ju-\,ilnuc of nbxiruc- ii-->n imrcjM-- nidi increasing r*\posiiie (172). I he ICStiiui.e p.iumais of lung frtrn.tn 1 <j ally 'Inc** mu. show m ,';ie:Cav;d p;e\ aiem e in rein* tiiMi fo exposi.: :* (! ",l\. To this time, therefore, i-ptclemicb'gic s. 1 <; t.> ! itn-.; Inri'T; m have- Uoi n,,?u able' .<. unu- date the ;cl.iti'Mixii .p Iroiniin o''::. uc- l;n:i .mu'. H'Iw.ios exposute. -r ci 1 c put O.L In t!'*.* cigarette habit (ad(ilise "f " nerci'-de, lu comctj'u ui*:, cxeu in pr.xvnee at r.'-Uu- logic changes. there is mu.illv Ittsitarion in at tributing obstructive tvmp<..r;nl of a w >:h- tt's tU'xca>v t" --> .1`iv.j, despite .!>; lac-, that de ur.-nvil a'liil'.i' in. <: li.ii !;,.no ui infills of iMeruid.u lung T'ense (177). U'uU* Out : ih iiu.rvs, the:-; is 1 tmr.r icliuMino to ntirib.iie* the c.b'Ui:,.iioti tc- tot sxpn'uiv. N-.-vorihelr xs, h- rnoi-'I: i>. duett cvulciKe tn su^gtrM tVi.it in rc'pnov t>sis Justus v\postilc, t! >: charactu if tiic liusction iinpaijutcnt any tjc nl>strncf.;v in a .rtain nuuiJaf nf cjv.-s (!7ii); until rurtUct* e*.iilcncc is available, .m tins u-garci. mind sinmhl ue l:c;H in sitwf'-nr/tt of ilisr.bilily. '[`he rrlaiijnjliips Lsivscrn <>'*' ! 'niilftmction 'as roiict'.vii in tvba: may l* v.nlcil lcrripi:ve mcasuretr.ems n{ the lunff. i.e.. its si^e or lung soiuuus. md in the measurements related to its mechanic.".! iie<), organ failure, generally vonsuirretl to he jiresetu only when gas csich.in>;c Ituu-ion is impaired (J3, j>. 152), aiui nimiimi- li.n of pcrftuitunce as perici.sil tiy u-.c soi'je. t Mni-c!!) jie nu sirahluim u.-u!. lints, umsii1.cr.iMc .atiM.nii, of oijptt malfmctivn (i.e.. 'ii- ii'jiuun.aes T 5;-.;iJ5 hi'ie'i'Ui tV't'j < m l:y* preu-ttt without urgan failure e.. abtiorma! blood s-'cs). even under th- suc> o( cdurt. LiLcwive, disabi1 ity in lift ;>-m c>{ unuua! breatldessnest r.iav be percent"l hi the subject : or i.uc 1:. uCirloiimetil :! !.;s '< n.-x ecu U.uc'u-: *.: ; ; I' -:i>o ii: ji-itic cpidertia.oj:.' 1*2. i*' ! 7'',*. hut in#; or: v; * t . < >. u*-.. 1 : hn:v::.:M: c.'r.'.:i;\Hi:; f<r clir.ic.d '.rrict;<-c ;s ' in ;i.e . !u. i.is-:. du:.l-'' 1 r.-uu.-i ; r-"!ic:cd v:.:i iCu dniiis i-om mi. 1 :n-:->n1 ui [ ! i->;i : j>;> if di.ui^rs l; >.,,jiu! :1 c-etore he C'-aiua'iil bv ap;>;o]Hi.uc exert.-: il iifC's.uv .a ......if than om- io.ul. u>r C-hi c.'i'C imbvidii.iils ;'Uc< klake, 7. [3. 3N. F.-. .1;cA-.i'i^ct au/zi tune. .Scrub mc.i- MUfaeir.' "i lung Lunction i:t indii iuu.u ci.es >'hesin'is n;;h ante hii;i;i,'( dial ue:e: :> : .itum is .I'-'xt c:o>els u-'leelCil in VC 1 (Gl. 75, ISO1, .uul, ti'tvni.d H'iim'.us sendiunm. The mug c.i[>.ici;v die lung for CO 1.*J: c0V- J- iv.u.dS mi iiu'nedi. 'nS is '-.Ju ' !>' :!`0 bas.i of sous; b.'.uu.sl oi.s .1 -..'.'.iu .s i 7.' . a:;' 11^1 i'v > usefxd 025). S To: hi.'u (e'ici;: >:-.>ns ,;! '.- nu.,'.>*;e mi.,'.' a i>l expose.! a '.*'nii'T \ c.m* ui \-.hi,!i deiif.-'e in \ <2, :n [>: u ..iar li.v !C toinpoiuMit ef '.'Ci, showed a eiuit'r rd.t- 1 'ul:ij- '.v fsiirn.ii.d limt CM.osure' c.u! h`:,-s. i-iC.r-nrvd e:du':* by ti;e single-bread' or ,K'. . i;ii|iu' (S7. fU 0:l;e: ..;i!. e-.1. .1 - - i .> n .hi j* to C\:'Osuri' ' .'*** J'l '.'j ..'"i ,1:: ; . 1 11 uiid-evo:; 0; J * V ,:'l , I.iiiiei'Cr, :-*! 'Uidiis : a:t eya leicdo- 1 c; ui.-- . ill ,. \ ;.,!< i.tbmf rfian r.\ a i'.;. -c- ixLied '.:b;et:'i ..!.u'tl provide m ac j .eti'c [ : ::<a:iuii y:i i'-!' p--int. Fi:i`! it. tThu in:,dies detect ;on nf <.bt wifecii in a |j; f.on b? {me he or 'he ju'iceivcs i'.iim .i> v.iup: nn. i'l-rvuis .in.wi.ig these early .h.inges are more lil.fi;. '.> be toned in a v.od.- i*.g pojniiation tli.tii in a clinic !.{ 1 i'iv: tiude .i:toul..nn: j>:e'uppo'cs -t,-, I' irdiernuaS. within a `..inking popuiaC:.'-., it i> reasr.iiaoie to s.i`I1;"*..< t! l.lt V, lllvK Mils V. l.,! occur more fieu.i : I y in t'. :uC wid: hsa`.:c r e:.- i.I.,;; fx. Ill rule' ;. 1 Vmiob-gic su:d.\ c :: fu.eti u* <\ pet %nx . i :i:.Hii cliuicn: or rad;,. logic 1 . itietit 1* 0! disea f. arid wiiit nuMti.d i;>;atute ;::: i_ liuu.lion. it ' pl|S' :h|tf to detect e: mjc.*, h; b. e U:u'.;s` r.;ei U.ir ,; aueTl'Cv a-;.:',. Vi:eae in 1.' i:r.tpli. uu.e atni an a:. cr. -c . c . u i*': :*:.i . 1 1 e i.C.inct:, 1:: tit iev >U u. t:<i-'r' \*. ti \ ^ Is. 1 .Cm* C. ..u''. '.si: ng .1 dust e.:Vet Mi...:; a:rv. > s. ,.-.vi "O;.. d be e nu:'.it. bie with periiiioncitioiar 1. -TO l in;. Nun,'.,.ir : ei. sits -- Cie oiitr.i'.'.ed n .l ; j. sequent siuils yf a larger number ot r.d jecti. Ol '0206 -i V.! A *i ; . ..{ in , . v ui'.u:;-.* h.o <*!'. -i. . . av A'. ; i:. rh''--.- ot -c:".a- . c ii '> ' :: A m u i f r-.! . 1. ::: . ; u- :o:. i ,.i ; :if' i.'.n it *.%, :ui T> , ;i'- iin0! \ 'v .1; .!*;; u\;,..u.:o. > n.i.i ;; ultimate ticvc!- |.;iio:u of iii'- Vinni v.h -t ;> In --n .11 ; ;.ci. v/it- v.m '."'.vm'i. A . ;.<v t 'h;a m iti C-t in..* st.i^-s i>: uv' ii'i'fin.fh'.is.s </ 7. !).;. 1. . t j. I ". II.him 1.1 - 11 \ .11 -s 1 -., . 11 ' s' i-xpH'iut.- ! iv -. <.. -1IC ' -.. i ::h) slu.rt 1.1 1. 1 -u 1:t lor i.-.c 1 uui of iin i'.o i'ro.'f ui. a lis- S'.iO ' ' ............ 1. - v A.- ( 1 lit- ' ff>i. 1 11 i. l | I ; '.V U' i - 'tu j u u 1 f i>: 1 . ;.>r .1 : -.1: < .1,1 ii'.i ;A i' .i> n> '. rci ;n Just .ii.m.u.! ; ami ill !< into. ! U si" ' u . i< hi 1 : 1 hiliC !i.u,t 1 i''. rt'i".-i`*v !-, irmo'..'.! f:ou; c\i.o- .V . ! (') is ;-,ic:< -?>;<: 1.1 .i ui.-eui" 1-. sptv fl.-jj.. !). |. c' On: !;; ,1-im.i- rn < 11 :ti. 1;: f 1 nu^it; s'uv. ;>" v" S .c litre 1111.4.. 'j.I.jve p 1. : u: 11 !* :' "i.li'/Or.i:i 1:0 < 1 ' >"*. alt uiyi; <i.i:.!. !`-iijis\ iim:i-:: .| sliouitl f.e :i:ir:Uv cr:: - irnii.i! ;im u; tuturc. poMcr,; 1 !i, '**\: .*.'.! :-i r1..- i iu t M iv I-.; !: ui.i ; .s.ii|.v inc f i;iif';.i.,i\- fc;,H;iis. u:.'i:ic!:;.o ' in- i:r- ui o-.i -. l ;. i. -: .. a:-! iiy 1 .. . " hi :n i> : is.. . - : t t i.c -c of 1:; -.> 1 . J ; > t ;s. >u.;--s: . < - : :! v:r 1 , v'i.1. v. : i ! n i'i'M-;'.- . ha. <: x I'.!*, i 7 0 . I 1:0 1.' . ... in t>:i -.\ f: e v v o; ! n l< 1. .s- i Ail' in VI d>. i.' .in.! ! h <. > v ! ;; i::n: fv ;"A 11 an 1' ; r- .-..| i.nol - c\- at ... fur .is ilu-.i' 1 * . < 1 !. of f-..n;;r<ui i-cj:: 1 r veil. :iu*v v.oic ii ' n .if sfU'.ii o than r vlv v '..lii'.- s . It MUM in- inn: h i4'/ : hat ' 'iv- ( tu:: > :0\. A liu' . i si* (M ' '.. *s 1.1 - *. ('.nan-1. x ;.k', ut f.'H-r.o. i.f-u'u'.si'.''. All Hit I'l'l!;; t 'Hi-'. 1-. I-C . V ;. (..I c.i.-u: <:\";>'uro. lie latter ........ Ina -.if'-: !;.i'0`l -.-tt hi'n-csnet1 '11 j> f'>: 1.1 . ..! s-nr . i !. ..ilirii 'n ilu : ..... . . ......... : ; /! no "u u :!. i .'i !'(. i1 , >U'U ;u hi .n li *. in.! . (- i-.iv <:!- 1 iiii:v is ..:**( - : ui.ttei. Ihi.iu';' t'-A itu'Uirs t < fri 1 ui > ;'si.':.is -t jku ssimu C^r flic . ... - 5-s ts "l Mi umi--inii fi.v j:;:. ..<! s -r* h ::: I.-.:: ;o .`.OS'.,.is :; ituiin^ Mi" |j. N, Inut: 1 iili-^i...'! . .'u-li-s .1: ! n-sts ot functiem Auiriivi V..;.. .u'O ,u i'.o'u!n v.jrs ot < \- have *-v. c I'-.t"'>;iic <j:nj<ar.itive 1 In st i;,i!in;;r:'[' - ot i.u: arc lil'-Iy t-5 :i.i.;i!r rtnul v!; . nut vru suivii.it t:r <it.*i;uc.>sis lot: siu^ 1 -u-n n.> -!v in ciijuif c t!u| li-.ii'i 1 iu^ imiI1, .iiumninii- 1-lO'll lirs. A!,.. VI,' c u .- A A v kn ir - ui .1 ;-\v-f.i,. h rmiM lie l>;rric in tniiul. {I'-t I x- t . J '............ .. In Uf I'll! r :u -.1 1.. 1vt. l!.--' t: t cl..*ny*,s .ue im.tri- l<. tliOsc v.-'-i : :-j clast r .'"sni -:s (MiUnti.iUi. .liiiy i*f .1 . c il.t ii.iuiic, siujil.if to ;.pp. 1 "-i occmtinj5 v.itli o: tile atcuc Iii-titc. llie o|}ini<i(i 1 hat in ,ir, ii.iiivutu.it c...v rori'aj'S t ri.ni.. of :!v iv.iikois with .x'.u -".i. . suivivat .s;.i--i. ;,.n-. surviving ivn they reflect car!;, nf-ioiis sfioufi.; `*e .1 led. t'u- iuttvj carioc r ..,0 -"I'i (toa: .s irotti tins cause aic .assuinin^ a iui`'.:i ^roaicr inu' -f;.iiK< f'.ti [><malvi. 7. i"'. t>-)-7!7i. in "lUiuina. .: sivuiiil ho uutO'.1. '.till iua ; f.i.i-o; :x '.loinuut.e .' l lie si t"':: 1 t * 'ii.ifjtiiisis .vf .1 siicsi 1 .sis :i...o I'UViU".'. s... -.'.o.i'.li :u :!k 4i:i,:..,i on ;!>e n-u;..-- - ' ; wlurh liia^n.-sis *.s:M no -1 ui! ti>< A. si'iuuir- i-.i. .mil. \ %'s!. ; . ; .1 it .ill'll, *.[ --lit.ii n.a.r ; '-trlvt m;*_ > !iui<:I:V". .-is can !>: : 1 .if i-.O't on tin: !< s<s III ,t! fvji'.s ; <_ hen,I I , [( O's'ilt. |`tii. <>) iojiic.it: past', . i.-'. '!if jmstu.t: r>( -imc or :uous of the fotinisiiM t.Tnrt 1!siiiio.i has.it tropita- limii, r.u! i..s t!niu;v.> of irom iv. .u..i ;o '.he .1::.: > .-:o yi'.ii to s s 1 i 1 ' > ' ,-'.i i/rervla '..s. 1 . ,v. f ;... cnov 'l... U-C ot l'l I till ! .Ills .S I..11 .Vi If ... I V.. .svallV- >!. 'out. nshe-f tin: ii.>uo. <s. as f..t .-s r. k.;;j-.sn. ::: pv'pii..:- of into; 01 ^- ^ '-'<6 A5:;f.sio- i. si; ij;^t.A4ti -Q9 infections ui3v be p.n inni.u ;>! ' i' lUl. lUc'CHl lv Hit '.viilvi, V.llSUlg hlSUl. ::; view of the sii^'.-M"Mi d.-.i i.< a ...m 1 "4ic ", :hu 1;. i' i; i.ui. . fl-vuin.iUon mav contribute to |um;;o -n ot : i \ > 11 c i o t c, 7. (i. '.'.bp. `iiit'v o i red i a :'.itiui;o;aiC entity (!>>, i'j'1. ahjot :j;v, )*!' uie time, uenr .'\>.'.i.i.ttii ri i '- 'ibevov , ..; a r ' i -it < : . :t'C miv u. ><m1e:! ec us r : !r. .r ..: . .vi. :. .viv , > l . \|r* v. laraa'nn i: eai .-' as m in ;1 .im- n pot: .10^ '1 h.> .< lOvi.iti.'.i move the pctsoi; n *\poine. !i ;inv o.i 1 ;;t- 'i:i> d; .1:11.11 ii .tA I.: .nil'll to til'- alien t ic" i wf 'he HiiCiiic 'Hi the I'lili-'mc of ill!.' ease. Oil" . '.mues that removal might lie.lt further ptrM'res'.oti. .a lo no thesis for -%! .:ch diettf i> uni": eviuco' e />-) !' I; .dsn known, however, tlA.it disease can both appear .uni pfugre" mam Mil' afier it:n vii fr-m c\jHt>urc thus, icvearc'.i sbouicl he uiediwa! public by Warner and coiieagucs [[') in a rep.-rt ul l>:i ta^cs with occupational and/or eiu MOiinieut.:! .md/or domestic exiuonre in die ci'ot i a.htc iniiung .nca of die Noithwrrt (ape. 5o;:th Al'iica. I he avtOiiation witii asbes tos exji.ouie i,.,s now been conhr.v.ed fiom directed at pw"-o'e wav* of dctcrminii*; nli.tt many parts of tiie world (table 6). f -i ton determine tins iutute progression .mil imi'iiiiT k i* pmsihit ;r> ii;tme the- stage t>\ level /`cii/m/ocv of jvv'Wic :it ..hn.ii removal might he an edec- A cb.ir. ctet istic feature of the macroscopic : . e.ruth e >u: C. appc.it.uKi- of the M.di'tu.uu '.irieis ii the ten Pr-T i-mdm n.i*ti: cv.dilation of b'";; f :m.t:on dency to v're.t.l .-.lot.2 screoa'i mcmjr ;".es (led), f* ;ci<.en ml ht.*: ,-t i... iiir..)ii> i-.. in cia.i'ing ! hmg If .; iuiiv\. lokwl.ucd mats tin? :: '"I iui[.mra of futtne heaib1 "-ro* :iic uv.a.'.v iri.nlcs fte itntues. Areas of nccru- .`.'.f'O: ct. `Jus > .il-i ;he :ti vvh.- h 'here m'> w it bin ibr :i;:nuriti.iv gv. e : f.-c '.o cs'tic 'p-ice- is i.^ astcrnai:-. evidence to itid.i.,ue ni..it type filled w:;l'. i,'iuti:!'His :Uii\i. a elisticceti-c feat ire cf pC'l'oO (O i;\ Oi 'Cl(?n <Ult. A:ViV.i'Ul of t':is tum.iif. .'.tii.m.pt uni nece" uilv a spetific hi. hct.it dite.Vv.i toward tl.c prc-euiptuy ii'.cit: one. iiet.i.::e ft c> .d'O seen in adenocarcinoma net hi o( :ri:c:ii r Ini';; diefnv-. acute (10). L"C..l nietasiii'cs to ch; >t wail. or ci.roti:o, mi dm :i">ii;uptiou tb >*. su.h per nutn. and pciii.iid:'- i idnei than remote m-:- son- :it high-n-k ,>f d-. . clopii: / .i ji-i l.*'tac.. drwlare tu.:.. .mincv <f the tumor: liow- (Mum, ). h . The smoking iu.hit. c rttiiulv e'er. me;..'ta.v< t- ' d.ic and .d;d.>i.tit\'d lymph i! . Z'.f ilC'l rid- *. ; ;x.i f.<i bn.mb- grille i.u'.s. T. Unde, are tv't if. ..nun::, .iud. oc;..:in:;a'dy. t1"-.' not tcMi.iili ii.nuita'.o fm tiais- mote situs, -. ill as ii'.ei, thyroid, a-.h-.'- a icirmi. It*. ;>*. in the dir*.i '.o|incm of Eiir.. nab. ijouv. and in dn an* invoked (10. id".;. Ui ii km -!c:tr. kciiij *ote cvj.itfntc t> >i:^- ic>t .i v:u;r?;i*;U' cttect with ciust (155). :uul soaic If has keen cmpiia-i.eil. lH*wev.':, tli.tr th.C diatp imsis i> e'lif ot rsi iusiou. and that all poiciuial inidctuc to the contrary. sites for ptimaty growth (particularly lung, pan- An inrrrC'>rtu t*oii!ility, as yet c:*m;>lctriy u:u.-\jn i\ that terrain plty.ii.logic tluiac- lei;.lit', h'f iii'raticc. tllC vel.ukC Si/C of to oh 'jia^cs (tJ'ii. r.uy comtititte ri;t t.iams utfis. iniestittv. and ovary) must be exam ined: consideration must also be given to ;!v* possibility that the pimuy tumor has already been iemoved (M.CAuahes. a, p. d')j). The -ii:.! ttiilu. i.if i;ile. i.'C il'.C liasts for exrltt- >iiti of certain from dust harml. final ly. it is [M>v>iiie ttut ptc-ent|i[i/ymcnt and an nuel measurements of lung function, particu- Uily FVC. might also prove t' lie a ti.ehil tool in die health care of the worker (37); however. t!iis. too. shottid be introduced only in a way perittmiM:. t'Uuors present simd...* appearance, but do uvt tend to engulf tin* ul.-lwuntun otgans to tlie ...i.ie extent as tiie piev.ral ".:tiims. C*!;;dnous ascitic fmid, however, is a cntunv>n feature {10',. Prcuarv i-ericaulnil tumors do not ap pear to ke associated with a>besos cxpoiure. Microsc>pii.i!*>. * vatieues are reuoijuired .-C' that ['crmits a critical evaluation of the effec tiveness of mcli a proceduie. eordinc: to tite dotniuant tell types b'T). Eptlht'!^'., of nibtuopapiU.irv. Mimm are cl.ir- acteiirod by btar.ihing acini, lim'd by coiutti- nar or cub-'-sid ceils, often containing uiut.u Malignant Mesothelioma of the Ptaura end Peritoneum and having ^ ..r.d-.n'.'W to 'pread. .'.ct.o-nenymei, uv '.ircom.itoui. ttimois range in appearance Primary malignant mesotheliomas arise from the jih.-ripotencial mesotiielial cells (of the pleura, peritoneum. ml pericardium) and in couse* front cellular lasdculatccl fibios.ucotna to myx oma. with the amount of associated coKagfn in the tumor varying considerably. The :inii{]irsn- G 1-0206v" M.\=U \ St 5C < < 5 z i 3 i -02C r-~2- 1. r u j '. i H l - i l " i . ` U J M I, ;i'v .M l J 4 i. c d I , / in * : i- , c , /. ,i!|.- i .-.Ik ' i i i i i i ' . i , . I . , . i ............. i 1,1. . I l lj - ,i , 1 ` .. .. u . i f i ^ .j : i o n >1 o n -1 i i ,n > , < j.., ,,i ,.,,.11 j-. ,i ,i r .o iid ASQtSTOi i I A7FJ Li. NO Cmr.AVis n , :hiti ,1, or poisgou ii. i>ptr :. mu.bl'. compo- T solid sheets of ccii with ..but.dam -eo'iuu, 'ahc osophism. wbuh ini'. !o.,k m m.. rk.bl : T'.-.C tyo comprises ,.U n: Tur tim- i'i a > pi e' it'11' <1:. - v rthc.l. .. lies e t : dl Uutii-i' i>nul.l turn out to !>e c>; t-u rv.txesi taricty if i sufficient mjjr.ber of secti.no were 'k.- rn (I'l.utcydt. a. p. bin. A surpti Mi 5 .end imt ........ ... 'tiiun finding is ;;>c pr-sr-rtce c-f oniy act tuinf.-r vi^jitcnt irt the tuet.ut.nes (! 0). Although i riiginous bodies atC tiunils bmnd i:i the 1 tin^% in oases of asbcs:os-.iS'Pv.i.ued me soihclioma i i lot.* if..tie, .i, p AIT . it is : uas'i.ii to find parenciunui fibrosis (i.*.. as- i)csi"sis) of an\ decree when the twinor .iri'Cs II! t!he ph.mr a: on die -."her It:.ml. in peritoneal .Mtu '1 s, nun.a . fdjiosi' ;tv v hi a p of. i''uu I. .1 tre, gi'-ing me t" the ir r. ti.e-hi -... ittttC- :i a to th'1 tlifuactc lymph, t.v. ( ii; -ge :::d tetriagiade!- ..tphatic spre.tvi o:f the a, a.iiui fii.cr to ' !.e i''' v,oini:i.i| M mphattc 'f '-mm. th-:".; meal rail. -.-rs. r-.pt es-*!tttng perl-..tjs 10 p or cent >f ca- SC SI . pucar o' occ.r v.w.te CsV.V. r.t in iw)' hail in others (Ti'>- .. i - . one ''Pte slv .. a sex (inference ii: thr 1 i.lvt. :at ta- tt.til--l 'it-:, p t :i;ong.il n-n" he.: mot'i. fro- .[ill ;.t in -< uiivit d':i); hots-.", VI. iionc A tt:- I'-ol s prr-h u.a.T.j. >.. :c ill some cl! ; j,erics i Seli- *v: . fstot u.\`.ri Exposure Ns is lu.:isr*. M. Ji'vt 'cua 1 '' * :nr.:;''.i,. L .. [ike hioin.ii.il tMC<.r. -i'u.s.. v d.e' not ;-!.v i ''.uergntu. i-de !.i the ot ;... >. .v ! u >i:i.is T lie i':rn; ui .>...((: i if. ^ ,.s; v( t .. ` ;;.e : :i. ...i s"ip !>etS'CCM :is.i!;gii.i;u u.es. ;..,;a ,s- l.estos lApovnrc is its dncuiv.e.:;-<1 i.. l.,;j V. 'll ap|i.iiCli11v low It \ i .t exposure. : l.i- us.'lv hii-.f pciiovls i:l il.e ue iron ..'igliooi hood <u domestic 'Cuvet;' vLC'Ci .as''. \Z1. ;n. ^l). fhc i!r>.'.::utnted iei;,!.h.ir- I'oou exju'siiie is that of AbMteu niasi:-.;: m the streets within one-half mile ot a t.teturv or mine, usuailv for several yars ii: ca:h cl-ik1- :;..od. .dihoug!i one cum.it usu.ulv hr certain tii.il lht\ dill 'lui ,i!so plav iit ti e vm-i; .:;r.l or il.e tailings. If *so-.c r. neig:-.'>.s,v.>v.! s seem u'ttun to h.oe hev'i :1 to uii.'ch woik-Ts 'i:ern-s 1 se-s v.-:re exnv.se 1. hu* !_ ii"; i.itk ol d.,se icl.iiii'iish;: to e\n. s'.;e. On ti'.c other In*.mi. in certain oc.n.T ocei.pat;on d ` upi. ' ish as the woiV.r.rs tit ei'.C Lon-toi: as'..-.s'.rss textile i.utory suit'.;--I `>y Nealnuo'- and -'Os i.ltf' J dose r-lu,.f -;n ;-iik C.t.1 h.- di,- ccrnctl. l-`imh<:r^.rie, when dote is n.ea'.u 1 l-.y monher ot a- : .: -e [.odies a:ui o. fiber > d.- ol >-.:tC I'litef. .1 [''!. j-e. I?"-, thi-- :> to.m.l ;n K1 iiighe: . in tin- ;.; ne:.d p mel..:! ,d- tl-oiigh !- v.e: .u uso .lie <mn :u re: it;..,; to pnltmuia' . f:-... -1.. /'.u/mjjfr-rtj I'cspite their being rare ttunnrs, estimated (> have an incidence of the ordvr of I s.r 1 th-T.Ouu per annum in the general population, jhe a- smialioii of m<;v>tliclioma v.-;h .vdn *tos expo sure has l>cc:: consistent in jl! parts of the w:!d ii.;!ic ).. Although all commercial :ivr v-Hcpt imih'jphsJlire (t~). hut incitwlinc taic. hue* implicated. there are important he- tvseen-fiher difleieuccs in rTfodieiicuni ri--., Iv ina greatest with crcciaolite. Lcx v-idi am "v.v. and apparently even lc*s with chrssmili. U'ith .imosite ami chrysnule. there appear* to he a higher risk in manufacturing than in mining .u. i milling. These were the w.'nch.si- :t reached bv the \tivjso:'; C.uinmiuce on ATe-,-.-,; Canters -.t on- l.yon ru-cung t?. p Mi!) and arc h is.-i mi poidi-!..<I -.-ptdemitdugu. slit.;'- >. :11cl uiu.g p;osj>i-i live and iet!'s*'pcrt:\e mm'.-ditv 'invite*. In addition, mesothelioma rates `vc:::. hi g-m- end. to he uu teased in cities I'-.a have `hip budding or *Uip repair imliotries n>l in vane -soikiug jiptd itiniis ui.u a pin ::u h in per cent, particularly if exposed to crocb'.etl;; \i imil cxpcMniems iiidi--.iti ;/.at. svhen given inuapleutaov. ;dl 'ajh-' of .id esr.,s fiber, a* weil as in tniu types of glass fiber, are fonhi.- of p: si'ticit"' ti.alicn.uil m^so-.hcl-i.i tu:tf>rs, and ri.k app<-.:: lo :u. v.itli d.-s * AVagu.-r, 7. p. LSliy. oiii.il.'O'.n expefimenr-.. vti the o'her hand, tend to ;'!'.U:Ce came.a. This h.< lc;i fo t:-e hypothesis that a!' tvpes of fih-r, once* tlu-- i.'acii tt'.v pleura, cxi isisv ''hi ..-g-c aetu. tty." There is "'*.uv sv-v-me. ,ao-.vv<yr, this af- tis Itv is dependent, abets it;..n ...7 yn in diattivttr nr hetwr'rn Mi .n:d >' r.i in h ng'h ln-iiig p.'.rticul.u i-- uiaiiu1 :it i:miu:.7 nvesw1.1..- h.n gtj.vth '.xttuttAu. 7. :>. her t;.i.se rea sons, m-iuiof is i-aosiuT -r- r* uom :i. iw*.v th.:; tiu.' gradient oi i'ioio'--o n.M'. its i .u ut.u.i. at !eact '-vi.h o-g,;d risk ,..g tr.e't'ihe.i.U tu.;u,ri. is due to da u'..c.a cn-.es heiss.-eu hi e;s, win t e.: 1 ..e i.v.s tl.at it ij due to physic..! uiuuetictj bett.'ven a.-ets. Thus, it ii believed th it tne tietrrmtnants of p.:diogv:*iv.itv >>( -. liner a'? th.r disgrcs to v-.ti.it it penetrates ami Settle' die-.-p lu..g o'-ac.-. t.i-. ^ 1" 0 20632 'I ;I i'. i;i U;r:i. a i o:ir rolled I"-' m "Tca cm. ..v i I'.',?:<<c.'i. 7. p IP i.i audition, '; u:u\t be p-.Mi.tc.i ; : . . n-in i is mu i,n<:1 r. ; a . ' 'I >'-m t >- \ ) m: : .i i, ! ,i i: . i, i n ! i tnis pr-'pm : .c-1 o.cr ;(> per a. ...]. ; 1, > ;..........i .wvjCfheii.'u ;'.in;i`.r- . ii,- im; in Lite pciLauii.im h.nc r*o: teen linked to a-hestos. Jkspite the :.>w acu'tncd .av..m i.-.i:m m.; li~ti;uu >ti.t-'.:with .liLiwtv. exp-wi.: i:i 'lie t:1'vf.'is u( :hi> tumor a (if 11 c'C.ir. I'lC.-mii.i.iiv, it i. i.niy ir. ^t: *r liti :v '\uv!t. ming .; mili.il in...i;-N. Km.Kir.- f'V- risk uct.ns in et posed iK>p;.':u:'>ut, that .m tin- drrstaniiii.g `i. e-Vf.ui.hls he :cn! e;i ...f fie ii 'ch.miMm . i. b.hing u> (!..i>rtrer11. 1,i- r\ fm. .. 51.i j> /. :i b . : .r ,< ....>.i; I : important . Ar f. iii'.dv::: . r..'.; ; iv- .;>.! :!:: km 1 . w::th w 10 .i'i.'v-'... ;i: nl'i.;'' .Is in v=02). firil/.': ;! i'Scuri'l t r' in\a; i.i'..- pi.-vnc !;' C-iCst ' >i s'.:.odder p A:. i. :.f ill-;''".:* of-et. In'' $,i.v.|\ l.e< ^ ;,, : aho; 1" ii.'. * f- i" with si; _ r v.'. . 7. -.>7 ,,u* c >. I".; - li.-lor*. [IIVM m.n- h r. i' . . ni nr;.. 17 r \ i.. liu'te 'ike! ' 1III (At. :i ,i i ol v;, i n ; |c,,;. . .... i. -.e ii u .1 < ::C* of .........I : | let;:..! imi-.io. .. tl.v '.-.er.ip; .ri ocs-.i <{ iwi;j :"iut ii --ir.i tntu'i.s, 1". to a \;.:ies, h* '.vc\.i. 'irt! :li >}.; i: v.-'-e ic e ..fti-r ') ve.io faT) :>e i,r*te h-'c.'-rt ;|>c fouiv.'. r v .! .;{ the p.itlioio^ir J.ioihc.it: "1 tu h- iu^n ,ne:ulieii.--i.t.i I: : :>'l - \ i;-i If': ! . {lu.h* : 1. ; the * ^ >k > *} ' r* - .* I u i . k! ^; . 7^1' . : ;x ....... v.. r ; v v :;; X ,,, mv v'. ; / ^ a>C, r* . n .a;-!.V. A c, :,ie 1 ;;> .hr \ .iriet' . t' I! A [' ' t% i,; i i i Ici.M . 1 i:t ' ' \ ye. : \. 11-. 1. y-itM ;1 \ t.mi"! cl-- s it tl. i:md th.it tl. ....... BiO^.'iviv'.nr.:, . ,!!v i.im . :o . : ni'.i of pleurb .1 '.! v.v:,;l i p*i..i;n*. -tn-1 cough follow. As -n.'l p imi'I'.. th* ;e m.iy al'o r.: a. Iiamiv <>f p: c. !>:, p i -i1 cif.i* *ins "ii!: |iiv-ttmril sti'.uoiif'.* <A is as fsill*s. -.'i-js s !Tii>:iiU. I'viu.'ps ilev0i`>j-ii in ;:;* pu.iKi?'. | N-iK\ tiv.rin;' inter. O' ;u"r ir!\ l-losut in:m Kit'MKU ns the C itti.ir i;:i.<,h,i: -.i-i tliickeniis^ o: parietal .no! vi^ciil peril, eventually Iratliiij' to th* luo- s hsAoinini; im- prisouctl. with retraction ami iiiiiu.'hni/i'.in.t the chew cage on the affected nde (il.'y The presentint r.tnpiom of a peritoneal tumor i also UAimllv dull pain, later followed by ami weight loss. Ti'.C pii'.Aie.. l *i^ns will ilepe n.l nu ti e at which the ; .tieitl first pn-M-n t; ia.i.'i'a . .-..ii;i precede, v.v :::`.iC S'/UiptOlVS .rtl1 t!'.- p: eve live ff clear pins.. ? > 1\ h. o ir .;.ti`' \p_rt front lire e'.ini >`?l !>!, ti e effusion ifd'or p`C'1 ral im .ah eitihhilit' -( the f.r i. e-m- moii; a. .it'* ?i''iu.ap.uhv which t.l.lv ah-) ic.: a feature ui 'ici.iteti ashewom (dPU has hceu reported, with regression ami ;.`i:i:.;.;nmtf, aft- tl. :v! *'' ; -.1 .. ! ili.i'i *ihv :: ti...'. iVM-in . ill A !> I i. . ieu .i..d Uec-uo'' irmr i:i;. h. amt tu tr.A.ili itn tre.v.!- ci.ft i hiNeacl..-:-. t.i!"C .tml s.-f ,r. me V'i C-'.tul.^- a -: 11. ..if. : ,i !.'. a .c,., .,:ire. i'T'ti V c- ..-*fic til l'::.. Ir: CX- > .; t,i "ic. is I. iif.noi; ..... .he i.,"-'s .:i-:i..i-i..' ;;rul tiiiiiiM.i- \ \ .< ti-.: io: i it'f.etl i'i."...'n ; *. i:ilrf>;'i. -.; d?s;ut rhe ' ;r.,,.! me '>i..pi ifje.i.t (".!'{ ' .: 11 V Oi ci.''. !..a - ..niH'i '..:il m the '..It'tir ! -M ;.:i f.>. I A I.- i.i- . i .. * :.. . '!' - m>:i:-. .i'ij:nht,I'.::;.. t'v. -hf-hoi.; t ; t.-r.iiimn.i. In:t % r."t ti.e d ... i ..i> ..ii-itt:;li> Relieved m he .iminmiim r.; ph-.uai h\ im; Ol 20 4 A < \',M lit !!<.-{ V ttn 1 rlciiron tr:icr->sff j.^. :ua\ -v'vr iii-f.d r.>n ;i muter) fviilvnu'. A sere.' > t ; pm . unh i i;i !.' j..ildl-il'.'. i 111 I .-.i'. \- gellS'l-ll title "A sUS'llle'IK of Ml';!:ihis L * 1 il :;'l ;!nt ..m <%(.>-o ' n | ,) me she Immige. ! L.'f.,i ... A-.!j(.'i-. iiu.N.. In;.;, t.; l-.m; 1 .i;.v. : ;; f\,u !' .'' 7. _;> '.S-i'i} j.i'.vults a l.:oc..:;;ous, will. 1* 1^ i; ( .t i.. . up o-'i.uc >'i:n;:i..t v of >'1(1. d .lN [i.iV.ll^ '.I".. I.'h r 1. ; ;.-.N f*.. vAvir piceison, ami grnei.u apuli. .ihti.iy v t.;v . 'I ins i isk u\;, ic^m'tcd ty c ucased cim>ii:-r.:t.iy in I'.iii.uu l*;, --r m(l<\i. The r.u!e.i>gic appearances vary adorning is lee '{' to which me1 di>..ase h.t% progressed. (./itunon fea'uies arc the presence of a plcui u lift.-..ou. loi'ui.iv.d tumor masses that tn.iy he ' mhle ntiiy c: te;ru"-.H of the ideurtl il;;id, ihest tv.ill m.! .... satellite iiing Irsinns, .uul, yecasio.i.di*. h\du,pneumothorax (2i.h). In ,i re, sew of treatments (IJ. p. 277) Llua." .'rul a simil.u- iMcre.-'-' in lung c.u.ccr ;'-.k dun:: the same decides l:.:s lit'en repni.ed tr ua Cti- ir.any (Jacob, h. p. The emergence ot cancer as an imp.siijnt threat to tli* I'.r.uth .u AnIk >tos 'vyt kerj :> attributed to t:;e ii.ipro*e::..' .it in uut conditions, with le-s ui.irc.tlit) trc:u .ubca- tosis occutrinc after longer periotls of csposuie md. therefore, survtsal oi worker* th:ou?,l'. ;:.e pointed that the-e is no cnecthe enrunv mumt. single..! tHiiion. loi ai ml <>: i'.:v:n!. e.tm.xic therapm .uul radio- ti.i-i.ij x e 'hi !>;;. t; in.!. ri-. a I -o pointed out long la.cut period nf lung can. er ' 's*.11*joi;t1:; epi,e::'.:.d.'Ti. 'i'\!i.'. med ;:-v iv 'tia::. n an/.!-, .... p.'N.uc ami ia.:a ...uni', uMtt.d.ts C.:-1. :;T.* <: 'frv>.-r.:! h.-mi-.-. y.m.^xt .i eOn.si-.hu.thh* tors- "d-eiion i.f t;.hudyA <!eiV::s; metiunism. U'.'h i:i u-.e fyi ui.i'.'.-.a oi atmeu'o.il thse.e and in the nii <>1 . iuii/.ii (''ut'C. Il-dativc to 'Ue lust point is the r>:.:::nv11:*y low ;Ioh' of expumi!* copabV oi emuing a t'c^point*; i-:Ia;ive to li e "."mtl i> the not inftctjt.eiu I'uiar.itu' ot choc it:;r;rtt-N and .i mlct-i'-us .u tin; ncisc; of tin* tlmic.d an/' the sometimes rapid clixsna* iituioti, -p --.-utlv j t<>\.>vv.I lo tteatineMf., Muii jn rad;..si a or cytotoxic ilui^N. For ;hc-v r*MS.,ns, !:>. f chvM-i that t:;:rumor may pututti. l.eu'g the i hit i r.i; thoil uf stutly piJ, o7, ^ lj: Imwescr. ;ai it 7 uui.cfo dc'pi:.- .ae con- si-te:.;-; iiwi;-.,-.--d. i-.-lvn-.e ri'k in tites** rep--rts, (here ."0 c .iiM.U-;: lav h.:iwi-en-s;'..r'.v di r`v a.ves a- ; iis ifg;ee. Sviue uf these dine:rr.3 itvist certain,v !*v - ilu-ii 10 hetwe'-n Nimly d,.v. us die meth. unc-s! <r!cul..ie ti s (A 17M p.irtit id.i: l. i. far: i. 3 .mompod:: n 1 f die ri*k gioup p.. :-.*r:nj i>f ve.sii of imiomu*.. .uul . .. 1. . j.'. :1 V .[ ivii.iioi ia i ' . me ip.mp, n -.id. el' a !.w w; wT.ti:: ti;e king aU*; turn on: !.c controllable ikrntigh impuls ing lioii', U tortNi.-,. Thti5, it is not sm jn ising tint the u: oj p.cc. vjuiuc in treatment is a mutter p-.pul.itiufi, .-.v .1:1 .ipprnpi iate reforcir. c .o-..,;. l.uii"t denied Ihuu u..;:->u.ii statistics. In a;'..!'lira, most studies deal wuii u:!.Uicf) m ail of g:c.>t rutuiu interest, with, as yet. no definilive wid-mcc on which to hast* clinit i! action. Meanwhile, herapy is ivmp.ioiitatic. ami tli-ig rtoN'ic I'.aMnai N sliould he kept to a miuimuta. K'-rnsi-l of Uuhl for tiiagmi'-tie Cxamin; loa iiiuiihct n <[ deuihs ;iiss than 100 in .ol im; 2 ot du: studies). Se* that r.dcnl.uion v.- oiel fue-vi- t.ibh he* indue..^C.i h;. t:-." .tdditmn l"-.> ui out; ca e. Finally, dilierrme. in e\p<d.,N.- and sirmkuig : .tI ic* are nd.'.r teles.u;t lattoi* anti to rf,lii;e tirc:uhlenfN should he done as inttctpnrntU as pov.ihlc- Indeed, as Khues r.utcs, tlic establid-.rrtem of a precise diagnosis in liF?;. for whieh stand.'t'di/ation i' '*Uloni p.si.i'ne. An W.i'toe: and as^-ei ii.es point out. howesef, ":m aihlilion.ii lesson io he lea.nt from the appar given the absence of a potentially < mauve treat ment, is an academic, rather titan a clinically ent lOiiliiet (' esulcnee : d'.e ueeel : > - m..;c atle'iuion to the ope :d a'ieste.s ami to tits useful, exercise. phs'K.d state ol the rcspir.dde tanioti of il.c dun'* (21S). ami die* evidence that d'.sr.- :e re'.'.l ihlfeieiue. in rise as*.,, i.ile'd with, the* rl. r- Carcinoma cf ih# Lung Associated with Asbestos Cxposor* cteiic hi>er t*. .:rs. as will a, die uiavrsm ;; p-.t ot I'vpiMrc t. ;i:e i.aiif 1 ;*,*r, is ' viOim-.g ;r.ai; An a<sotiati.sn liof-vcfn ushcstusiN and hrp. COusiucuia. Sneh tliilereuee\ h.-uvC' er, have a chi.tl rartinom.i, suspected in die I'.hlhs on tit-.- gifiitci signif.eams 111 the lu.'ld <H ctiva.am.- n- basis of individual case reports (210), w.i tub- tal lontt.d a..el safety staitilards than in b.v prac se-.piemlv confirmed in two HrhMi report', one tice i*{ cliule-d medix ins. by tl;e C.iiief Inspector of l-acu>ries. issued in cite interecii'Ui ol eiga'.vttcs .ml a>n*sioS cx- 1017, anti the second, an anjls us of autopsy ma- posiue as risk tav.ors, ei.'.i-i f,d `.orr.e smtnt uy Ql-OZOk 1.: \<( nT i . TIq1siiiu is. iiov cv: "' n.'l " mkc ill ( iif'ir li prana1 ' ' i <' ! .114 : -> ':V'"M - 1 "1 .....................11 ''i' - : : - .. Ur .:-.!u 1; t........: . 1 1 1 - Olhi ^jcstcs-Ti. l.r :x' 11 (:;.. 1; o v 'i.'. 73. J t!'). I. ! ' ... 01 ryin.dii l.clics Cii :!t it J n.tror 'mo a t!.ci* 1' .1 r.11 :-t7. -i ivcu 11 r>'s :-.r /': . -. 1; t in1 1. lv< t if 1 ri <n:;;iv '<<_.11! 11 > r* a!,'c 7 . I in. '\nr Ino.'- t,w; - 1:. 1 !* ' s ' - *. > i t-71;. lu fii it 1 !*:> :t 1 u!11 1.. . e 1 :'s. n-i i- >i-.. ' .. u:m \;; i :iv:i I t'cprrii.itri.' 01C it> '.mi.:! (i.ni. 'I !.i ot t - : 5 r.roc. r.: :! .1 :n j; 1 .1 > ('-J i I-ow. .t. a ill,a 1 .an: * 1 r . idi. v r : 1'-. >. :i- i 1 i!nv xc.n j: f'i-to C" < poon; icin': ; - c 1 tai> i> i:n( iliv.iis so 1. t..isrs umi'.ln'i n( civ. 1'!:.. i*. 1:. !>*..! I'C'.i i:i jsa.n'i.icioi! '.vid; red.".- N.i-ix.is t'\p*'v.! i.- ....,.[`'.1d; !":.i:\; .77 :.:int f::; ' 1 10! Ot.C'to.ia.ilA 1:1 tin; 11 * I1;;' (i: <. 'luu.mls . r........r .H:m;:ui. r * birv.il.it'is. .1!:!' r dt C" -.'S r . f . I :' 1 - ........... * .i r. to a .t di-- 1 : -a ! : 1. a . . ;a.a a ; .-1 c i.i .or s,, 1 i.:. .. ;;i.i'.r [. ..*! `o -m o ! 1 !i.. .Ii.mi il\r C'li'i ; . ..Av- ; 1 i'.c a-'cai '.i .'li v< d > do- ; i_ ! .< : *r,::> f ri;? i.r ' ' - -'i' ;t ;i .t tic >!: .. -.c./tcr ; t-v-- ; ;r. ' ' " - ::i : i, s i-:. .Mil >: tv : -.1:.,. 'M- 'to, d-: ; ........ : . in .1 ti'i ill' 1 .: ", . : 01.! c ...hi ::c Mil'" C: it '! . -V. f.;; Mt I . -i.s. *i. '.i ti: 1 i-- . :`v.: !'i. ; 1.. ; a:1.; : f-1: t : .1 .[s 1!,.1 r U"r > ... o f ; i .a ;'vl!-'u t c;\: cUf si.tr- . il'..'irn( . v .'!.> l*tcu dt'sritivd lu '..i.tiiou .<!.i;'!i>'i \i- . ' *2-7d'. 1 ::tr tiitiii -i J'i fitO, . 'Ui.t Ui.MttliViU ; (li.i" . tit :r*m tii'OV a.cil in f 1: C ..I i -d:;*.;os. t* x 0 mh!i. < :... iiatit thr c:it. icv to, in. ijtattitvj -it: 's,i^ .<:c c:. illy C'tMl mr.f it.ipoil.iiu lo: tlv v j,Mi'il to ur'CMii* tii.tu :iis or t:vr mi; .>v.! nn. ant . cotitaicil ctrou a: -..oi vci c.'.tit.t- lion tnitjlu piovc iiorthwliilc. Another ructi#..il pfoMeto *.*:. i:. c .r.| a- i:t p.n u;.d..i, tin; ij>u c.` :i* i; .I.i of i r.iacs:: ;o c\;>............ r-i.: i.r'atT:. n' ! i'.i S'i..n* .i ".rct1:i ' ;1.. .u:!...;* i' .!.. t'. 'i.iiio': :a : :uv. i 1 ;-i,' r-i tdc it C\* j:- i-iic; 1. i. i.cri cr;;.;i.l. r ;dii` .: i; >1 t'. l-i11a11.. l..i. !.;Cti c:na;;;tii:cd .*1:-.r^li-rtts iJj'1. 22';. :'.i' ' ai-.torv any tun import mi", i.i aati':';:'. wait c;:iit:oiaj f ....1 1 ll . 5 iinf. iii :!m s : \-lsiv.:" Ci...;: .1 t; i ta -i.c f":: ..0'i-iiMi u.il. *. t' :* - 11 t li'i o\. : . r. i .i.v s .i< ; i ; it .:.i . \i: .- ir- d- !i: > I c -I .;. l\; .1 > .:.,a :n i.;:r i!'> .i .an!'. iit.a .t. i -.i . ' ; J I-, sat'u- tiii.rf t* -1* i c : i* < :* ol :: , "... i ( >.rc,.M,'r: > .rs; s:iji: .toil, ... at.i . St > 11 t v.,1, ..**.! :: 'x.''' .. '-a .in '; v..!;;i.i. a;.:i . - i i. V. .. -ii' tiiA tu.U'.o^!' i i :1 I atiom <1 . c. ' ' ' t!.-m jv.oic.iii. '/ n- '.a. tl.c i ii ni .vn.t.i 1 l.n-a.iu i'..n..i.;s. !. i .-.u.:'' t. > lirrn ;:dh f..:' '-.aM. aa t.i !>v p: a a o -n-c.. <1 ia--t i> : El -02 Cl : ic:o;v , c T!:-i cp- > 1: ' r.zi -i ;ht: --.are .r I K L. of - : C- -iin (Jiv i '>tr . !` 'lie :l. ! !, :i,;i U.M.i, J ' ............... ' fL'I.i'i'jr.j.--;.' i'^.t a. COi..' - ' Alices t . i- l:i t. o; t' a.-:;' : 'J` ; . : '< ' o;!u.r i : .. : 1- ut '! v: t:v -vv. tm f j.Ci ill' 1 K w 1. 1 it . .. .-.rit : . ro [' on i..i!i'c: -ii>cn- . 1 p i i!. v i-i i im in. 11 : 1 <i:.r eop.mir';, n: ml p........ -i fin.1 o( fh*' f;. > ` , ; at innm of : . i a. 's." in r; . ' . '.i .:*:*! ` . , ijvtit me ; . ' ....... r w i . : c\ ; ;mi.! . ; 1 : : o' il-.ali 1 c:l ! . ! ; ; . 1 a ; : nf ii. pi :>' i ! r : :a . of t;t, 1 - , j>r-'a I : * :i! i.u'u.(.lioi:-e.l ..f fii -r m i t if. ou; r.r - Cam ii . ... i( ' V*U>k . i:. .t i Mj-'il : r r flat 11 '.nm*". ,i'.- :11 >:l.r \. in.-.y :l jure in ; n>]Keil i. - i . t.. ` nn ,v: r . i M; f I ; ' ` - i * ** ic: * '<'. jjr iMf:!' lv._ i t .ii. ii.-o::-. * i.unC t- . :"*v. ti:ri:^. I '...a a tie <-\p ><1: i.'i:ini:; 1 :.:i - : ".ji"i t' m.hi t.m I-r zr>:- !!'*! ..a: i.i. .a.:..- r Ii1 ; : >' i iu< .^t. r..' 2.. .' ' . 1 . .acini . : ' in - ! x-:: ^liov.n .J'l: Kpu!'": ' . 'ti.iil':? !;i (!id.a:n: ' . vv-oval yt-j... . ' tu between niif.-s. ap1 :r-u-.ip. Lii-vonr-. i:. tftrru of {{.:: c.'.rc;r. ii'ttci.l t.. lung cancer table O' .f! fin (221); bowet . it is itiuiliy '.j- cnlili..fi to vs'.-,; :-:tci.t 'it-.o c;.:j be cxulnif. 1 'r.v diifvro'.i-u .A:.-o.irr l.'.o!; n- i.r.i 'l ! cotv ^ r.irtcrs . .-rr. ; \p-i (; iiii; f.;- r t\iu- i-vl : -i c i :tti>: p: !n. . ,u U'ojkt iu. -.nee. : ? >iM'ifv.t i/;< : C-Wlcctitl :r 0ui.ioc -.nf'Ci'j oTert. exa-e*-.! otr.y t<> ..'c fti.rrt. m :!ie c remi... v ; i . ; " I ; .'Till * ut% in . i ii"' I i . :! i n'f tile. Tl) ii -fP. ''>:> in l.i l : UlUi *. 11 _ . ; ; i: v i ei. 'i'"'1- : ' i i. i!i:' .`.'Jile. i ill-.i :T cm ^rc.itcr v v v. i*" . Ml i : ' ' ' i r. > .. jlno.i,-'. ;i a O' :;i ii .i: u. .' ii.)i ii: i. a ut: : in;; ' a :; . to i:i-- . ivirtr. u i: .i: 1 . mo; . -; . i-- is! i;.:> l.i in: in. :: . ; I. fi 'u .o-c : : i ;i. lv . i i.v . i ,t .U r : - 0^ 9 AiRh'ifUi ' l:.m; . i' r, a i i j - .I 1 i 7. < <: ^* nr> pi -i <A C 3 y: (/I O3 . UJ 01 :>> <; U< P O V) > aI UJ w " 'i ; w 'i .% - - Ul a0 2 w; T ttl 2 O < u; at J o k a IN -- I ~ ri I 3 *. .* .** 3 3 5 >| f | JI>JJlcll/U ll A 0 1 -G?.GgZ29 f. L \ I\ i ! . ,u >.. . i C-. .... i. i* :n.i 1 !pr i , r".i '>. , ,.t i ). . . l.. ,.. i; - I Ip i ] i F.'i. i- . .'i < ru .i ..1 r- t i -1 . - ' I-. {! I'.' ; I ),, ,.j. ;| i ,1 !!\ ,< . . ,C .i i i i : i x id.'.- over :nm:;;'nt. it u .i > I.* ' v i.F ! t:n >:f; ; i > ; cci.: riA <( ;:i .1 v ,. .: V *, he i-v t .it titis v..'::. ji } i : j / 'll Fill l i I . i r. h; ` : it-..' : ii ,, ;. ' . .1!.* I'C ip4 ir-.n .! j ' M>> : . r<* : ::i . - : > ( Fro ,i\,m ! !i ,! >. hr... ip'.- rl< n:i lai.vc .ir.V.u' ....Pm C'lii'*:: ;cvu'V.'.;! iJ<n i. 'A 11 ..:t <{ in ; t .. i .uni no uu> it.'i.ousc.x.'uii'u! .J" In ti.o l ciitti ''.P?. UiC Oti7V[j.if;:>u.:i S!-1;! .:inl ^.i e A.'.uv.nix-i cion CO 'H *.' i.'coi .1 slim-1 r;i of '> ;-.r i in i'.*A. .c . i:( p:S : i .iifix ; . f.i;1 in '' 7;> " .. v. .' r.u-in j.i r>. . ...; v, i .... r AiA.-: '' ; -i!m t.i: .1 -o " ' t'A...x . - Cl U ' ' 1. . :.... {< Mill,! . . A, -1 x lii' ;i r'ni:i -. ; :. ;i .:. :> i..::i:r. ipii:c : i .( < I v ;! v n.' fo ' '..n:' 'i r. 11 < i i'i.c. 11-:i ; in. iiion ,'t 1 -c lc. I'.U' iuuUt''.. .niii'-' '! rntiuv' l:- . * .-i i!: ' 'Ui.- r.il C. n .c 'sit ic i:n Is.1:.- I Fi : .mini i:i' i!:..: r c.-V'r:'-. i.n: ! i i/l . n A. j* -i ! i i* t-iif v., ; :: f . * 'l .: ': 4 ; ` i ' ` ! - . .'I . . Ir '.-T'tStl*. t 1 r.. - !m 11 : !' ; .. : ; f> i. .i:- n! '!; I' j-:)*>.,, ii..i-,. , j I y* >! i' !' ftlinr mil iM'-vun- .'2. ?>? n: i.nn ivorkeri *<*::cj. In Mt D-'. .1 ''.s'j. mt>r (.,i{v u-3* .n t tumuli'::' .:\t i .^i :: u;!i r.-. rs*>. iti cnaUli- a uivn tuon utth luw ami 111^:i>. t .;!. ,x;u. [ i'i; urn.i tif F:.:.*s I:ii<:l iw:< ii ;< i< il i mil. ..!i,i ! ijipi i t:>.! ! I >.* p 'i-ni.-i !:ii- i'i-v-n i ...i ; 7 :;l i...............'.'.i. iMtx; i ,, ........ . in !..n' . ... i.. i.-..i.1:. ` i :.i..: * I':--- -I :* *: l: i I ;*' I- I..I ,.i I'!. ' ' t l I-.- M it ( * t-. ,i cut j:i n:;i' 1 ! i. i:: i itc <{ 'j*' is , * ->l :'1' .1 s-' .n "il:.1iii.'i* tie, rv:f* *-f i'- ' t 4* ' in ii.i. i j t t . iii-.lt ; :* I.. j'S't -:`i m ;, oi .>! :... .c xci'i' 1 ixtF -i ( : ... .! n: * i n.. f;!*l >m . *! !..!!., ! , *1 v nr f t'. i :!'. it :u.iv i c i::i- ' r. ,i iii ix. ' i;... a `i, : i * :. ;. ; ;v:i;n n i . tiif ill i ,.xi' ; x ! iti. I. :? :..-j | i i,., i. i . :, .1 '..: . I: n - ;. ,i . . , > r ... -I " i> .i : :. ,:ikI ' 1 ' i:: .'..t.-j .`F. V icr ii- ' i * cn:; :=' ii'.cir..l;i:^ xi: >< r- 'r..! ji it ix. x`,n:: -.-r jnl'x >< c,.i , --.'I '. x- c.f liix r.r !'vr 'a'i.x v'.'''. .::m! f i:ti!\ r.ii'xVS. Ii: .i.,.iiiti*'>!i. r' .^> of r.xi'.i'.'rnc 'Li-iF,! i>w ivies!. j> .I.;:!. :! !; .li.<-i : ns:"-- tl'-.'liocu r.:ir v,t p`. i; -| ..[pi-x l !: F.;>t..V- --I :i;.(. ! x. (c .uF ... .. a- .! :ii ;, 1.1 i.; i r Ili.ilxr: F: . .:-.;ll..:: '] 'll v.iP^it:'.'. i.s.iitr:..!. i i i .C .*. *; n.'t f. :".i-:it nun: <'..c i.i-;n:'. F -i.i:;c::: .... i X.. ( hi .'.x. v ... > i. :i. .i. i*.:: :: it f: uft'-ilif. i> ;'.v'*ioin..in i.-i'Ci i'i c-.r'C'-'n- '.ci.>c). r.s '.vr; i c.ii i-t'".'.-: `.. j ; V. C r S ii Fvj rnx k.:F iiiil inevio;;!*. U-<-n rCCj;::i?;U. T!,C ilvixn t 1 iiix.'m;). :..irricui..il'.' ni :F)C)'ix. o -azo^~ - ASMiilOi tCSLA'iS" '...'-0 UiltAst. croc!DOl:t a.mosj rt ANTHO?HYLUTE CHRYSOTILi iOfitn Hr. f. Troni Timhrcll. V.: r!iysi*..il faciuis a>. rtinionic :m chuiU'niv ir. f\;[eet> af iil' MOt, 1ARC. Scientific Publication No. $. I.son. i'.CU. j>. -I5'*; -s |*-_. ; m of publi-h-r.) Ehcrron micrograph' oi crotuInUtc(tunth tvesiciu Cajn- 1*t; - :.ci. am'>*ttr. I '.ui'V.ul'. aiuhpj.i*.vUit 'Finlatnl), cliTy'>o;U* tC.mad;i> at '.imv maynif;:. ui. o i.r tTi,i uu' arc f!) th>- rrculincar 'liapc of the auipiuh'ilc- `i.< i\ cuiitpautt ^ it lx the uiuol .'..*! f'-v.iim>i- j'lio|r._;% of rhr.oiiIc fibeis; (?) the outer *f :i dt.n.u t-1 of the .t-ophihole 'i. .rron inir-ioriapiuc i-xjnmi.ui. i- i tiu-e liin-i* ir*m the :S nci-v-.-phu.d ..u:iv croii<lc>(it>' < a.":oiu- < aiitliopfulliic. ti tin ! .-^icuttiiul fta^'iicsttatoiii of .!u!e 4<ul the vto&U diameter (about Q.03 Mu.) the ..'.innate hbm> t* exposure should always be borne in mind, at:*.! tlie patient in whom di>e.i>c develops after a relatively short ntriml (for example, less than -r> sc.ns) must be nkn as ,m imlicntnr of jn- vui'f \ jiaM .1 mi <>r ptesent working cotivit* U"tts, re ',;j collective action. The v- ifittide s'--., .id !,o taken toward titer per- >>n ... s*l.\*:u dbr-.si is believed to (jc jueseru in it* e.'fly Kta^cs or development. cither on clini- tai. radiologic, uc functional evidence. Any cl.inn that this is not so because the "environ- nt-'nul levels" to windi the ptron was exposed Here "safe" U incorrect; level* were dearly not -afe" for the particular per-nii concerned, .liber because of 'u-:iti:rtluii'U>pi.-cted Jo'C. of ^te:tttr-;h;m-averuse snscepiibijitv. it must h.r c*mpUasi/ed tit.xt the dinicitr.'* job i> nui onl^ to rc`i.*ojiire the c.oc of l.iietl <li'e.ic-. but .1K0 it* see t'ut i: is hum ;,: to die attention of the 'p;,r-'P*^:'-'- executive .(licit-<ity (ut titans are.;', d:e '.'.'..rkmetib (.on;* pomatum C'*nm:ttre. v.iiuii itifotu;, the enut- p.nis concerned'!. This tnoijtiitinn vml re- let rai has social '.iupdrat;on- at "1 levels, for the person, the implic.itiou i* ..unopiiatc eotuvett- i.ttiuii, suciftv's >iisicor heft U t:;a!<e 1:0 ior his Ql-02 D.t ; \.1 <. i ti*r 1'.-)^ i'f !<? ntli. . ><ctifri'tHc ui .in : i--; is n-atlntl .in I . --'lift , i; I \ . ; f ; oi:.( : . i 0 -r 1 ; n tf> n ........ . 1 " C iii v. :i :i . , ..,*r: i!11li!11 11 .i`u[ vuiii.^r; t-"`i!<*.. *i.> . t>. 'v s '*ic- niii'i. uiio i!>; \ !, t.ir;c;:il-, vruivig ti.c in t!i \. N'luluir A i h i > r.,.ic t:\in wins tlvr liiiiiiii'^ in . ii.ni.j :: ..;[! r* i.".: ri'-C'*>ii:f*t: .I wlia-s. i.u'a A- C'lilMU n;:h i.-cl.M-ti. ......' ,fv` .!; <. (it CX|l->S"|l\ f., ill,; V t.f C\ |>i I'UC, si 1 [i' I -n ir-V!. hi! !IC i.A* ill i:< ' . i ." >'< ''n- 1-m ,, ' !'i -n.ibiv .au. ; v-r :n t ... ,.cc, | l M. '..Uii'. i. -. Ii.imi. .< ;i; m niiom il.o tii'--.i'i- i.r.i'*r**.s, >-iiet!n'r n'>t riii'Kur" v...o;' s.i.W'V' iimr M itiui: .in-il i;i... \1 j>-r,. ^'.vnuin ..til1. :i- t.:' ni ik'-nin-.v i. .i: miN :i. .I 1 ><';:i.cl to I'ct.u ;.f ^ i n.i < it ; ; .I;; . >1 b r. ii ; ci::. -111 s t- - f)f t!rir* rtii n .*- i .-.iv.-i; ;!iC [icrt'.H at tiA c i*i f < xlc '*:T: *c i-:it;y into ;;i'- .'.ItJitw tin ic j. |n-.:r.n :*i: :i.i:.) n ns io fit :r>'nt in i.m: i :*i: r, \ . i fri.-:! 1 't ui.I .:,U 'l ... ti. . ' . ,.,c . .ha i-'.; i. !iu-i!f - if r:io- :!; ii, mt > 'lit i.i-::..; ;u . i,,\. -'.w .. . fi-. ;.-'ri.i'js it:- a mis, - .1 . L" ' i ' i 1 II n > .r.a - v.i'.-..'. - i'.- .. i:-..v.t.`i` .-i .n'/n . u. il'.ii ;i.t ' .. !.:;< .itca n.niv us1.!.;,; .tii.. 1.1 .ni.:i.-i: i ij. 1A- .y -mt jl.t .ul.t.;'.'*- I. s bcv i >ri::tc .* ; >r a- v )! .n::it in'.! kjiif.ii i,-. tr i. |n f-;i.ii,(,: An i; i mu tii'.i.i'tN ..i-.r.i as lii\i r ot ti'.c t5''- nti- nn.'r: iin'iiii t..i lit c .......... of '! t |:.i .r i.. :.. 'Ia :o if'.t ...u-'.ii: ; .-ul 'i-nis C.t tilt d. I' f - :t i.Mltl.t i11'(* '> >cililt ; niiit' th u n c't. j-: .(. (: r .A? i!.. .r-. t ( nj'.iiC' .ITt (!( !.i',.i;ii '.i.-ir.i' In* u-.1 f,i j >. ; i - V, nil.:; i,;< : c.'n - . `.A . lef'ltA r iit I; in* : K\. muted lii.'A tfiv:-- iit- irf, <i.c !i:- i!:h j.n *;.- ti : < in ::{,, itA : ti'A liw.*. coit.'ot, .m<2 iiK'ii.v.ii <>i; i', rniin^ oi}j|'!s icfTtarv c-i -tniirofiineru i! num;- .. tt.i;--'. 1 I-.:.:- Aii'....... .icni l./V '. nerk- I -' . I I.;.f. r -. n !*: v iiinn. i : ...-rv mvv. .. U .;. 1.1 .ns* ' ; :;, - ;i-r. *.:!!( 1 Mf.'.j, r'.'i ;:i ! :n tfi- !. f.u. t ;*.! nm.-n; i.. I t J. t . \.i J:* !.!. iiir.-tt '. -n -J til :n r <;f \{. ' * uiv.-i'.'. i.:>'<'1 < id" rvii .(-.! U' .iltii *-li.. in .i*' 1 n;- t- J >.' '.x.n'a. '.i .mu'; <|iiii:iti" -r tcfi.-*in;i-' fu-".-. :::Jit:^ .TC t!.c li-'.-.'.Siin " tn' an* ir:Ui 1 ts.:i wiakvi; i--.nc.tr, t!:c CNiiiuiintioa 'i--' tr.ctlii.tl tmveill.iuic Cm |>ro'. u*0 *?[.< r <vr-. ittJ. intlnJ- in^ case detcai(i ami otl;r ;orm <>C hr~ih fare. As knowledge iu)(MOvc<. i is {*'.'.`v tna* medical surveillance nilf a file to moCUI i>. liopcddor role, unmvlv. ci*e m' lc:d*!t l-.ni. i-. I) S. ; :.. . c. t.i'.-.-,. .. tir M \riinn <'t Vi-- ] H 1.1 Hn i' on. . Jf.l f i: 1 . Mi( Mi; I ';ir.i.-;>! i'r. Net. rii i .>111 lu;t ^u-,.h>1 t;-.-.:-.-; v n t'mc tor v;i! 1....i c-'-.ti-.I i-.Mm-m. t- i)r. .'-f. !'.!n:u, -( tin- Iti.t.tu n t'lnui-vtiuii lir.v. ;. luinntrif iU-llii. 'Am! "C A'M.'i... tllccts in a *. a sra;c wl.cn `oir.c .miuo iior imt.icnnt.il lrorr. n.i.lic j.revc-'f v\ criuul di i utern:. 0;v'-:i :I.e ":r'i|trT'--> :! .* it i>. at jn -.ftiJ. stirveilhnte Irpi M'(' 1 -r '..I I 1 nu. -.. j-. ' i |> jA.f.v'i r t: .av i-1 in ..'."t t't. *.. t; .If;-! > i ; .. V.i f M.-.v...* Ii-'p p r i r- "i: r-. " >1 :,,{!mlt .( tiinml i \ .;.i.i: trivn ^cnijiU..- si> n l..n .1 .:i .mil...... Ct.-.'-t i di-)- iv ijdt, .in.I ,k iiu .Miti'U'tii; '! I-..;-: ituuli-m, jiit-vabS tin- mo^t .'\t-n.i `.erttg :;:c ioiccil e\- [iirnti.sy \o'.n;..c nnc. :;ttd pns-.."'.2 <ii:i ^ R*!etenc*s I. i l.-imit-- \ ... ! *.. U. I iiiio-MS. ol. . i'l.!'. S.'in-.o f.i>-:i !tn . At*!. . I1 ;> j. C.. ..i:--.\'f' r.l>t aa.l inii-t." ci 02 Oo \SUi.-a i 0> :<r i. VI !' I Ni- : akasss I,a,.mis. IToc ft. V* Med. ITT'. AA "'5 ' / n*inuti. j : *M>. S.uit: ' ami i..'nv Kev io7i. r. .a I ''tuithvr. \\* j . \d.w<-* -ml .via \11 tV ,.p I'M-.). ' .1 '"< ; i [ le-.mt. !. f Vli'fft. .i; ,i! |. :: ij. t I. -i. |*c'. < nl.n ,, , (.; a f(.c> h-11 <-1<- ..ctii .i! I..-, '(Ik Ai .dem* *f fmo, Oit l`i-21, I'.-rti, Aim S' Y Arad vi. l'ir.5. f 52. ;-p. \ 7i'.** llioioipiul ilTed of .vbe'OV*.M. Antpaili. Chairman. l)eni*<!:-* /mruliiwit'u fut \i hei(*<nedi/;:i: f<i*ii!\<.hafl fll Arbt'it>h>;'ieiie mul AiUeii'SJlot:: e.i -L*v iittR. Ji--. April 7. hmlojpial cfu'ti* of .i*l.e<'.(>'. l'. <. j. C. V. `I tmhicA. and J. C. Wr.;net. ed. Pro- fril.i>c> of a rcnfncnir it [AlUA l.v- on, Ouoljcr 2-f>. l.VMC S-Mi-ncihc Pubii- C iiiiui--, Vo. ,i. [ ! **7i. ;'* l -fll S. I`..n'."du"p of i- fVv.mm-onir*'. C iti'cfrr.c,-1 j.i!i.li:nr\liu;i;. VeA. 1. Ef-inii-. AJ -d.. j. and A. Ciun.i.iii ltd.. I oiidi a. 1'V). j*:. i .-i, II Pm-umuioiin.o.. H. \. Sh.ij>iiO. id. l'.<V:ed- lll^* '>f till' il.iro' :'l.n il ( "oliiei Ct-lC. f !l ,IT1 !nn>j. Sindh \l::i.. ir-;p, u-O'iii lty Pu>-. t .ip.- l oi*i. 1* 7a. pi> ,"i i'J. l`,iii*<.A. V*'. P. : A*i.*?.? I.itcil di.-nrier*, Hr | lh,CU<;. 107.V*. 2 a. i I. *-. il. 1*. M.. mid v..i.dl, T.: AO .'(*> mid Isr- )nil',,l i.mii.n... i. ilw.A ! !o. 12. N ,-.i Iioum*. *!, I... a: A A>f. '-jt and !.n \n...` ? i rjriMioia.-. ! .-.netrA I`.*77, 7. bl5. i,'. I ib-dtiAA 15. 1., V-Si. V. \tld:w>a. \V., anti Southard. M. AMicstOi anti caret- iHxm of tlitr linn*. J ' MA. 11*71.2Z*. 1571. II. (iuidotti. T. L.. AUuluin. J. L., ."ml IVNcr. 1*. It.; AMcjttrt <\poiitc and ciuccr of t`.o: Ian n't. WY* J M. t. H*7S. 122.75. 15. ( t.di.nit, J, ami Graham. K.: Ovarian cancer and Ktnir.-ti lies, !P;>7.1. 115. ! Mt-ikt.iclt. J.. Sv.eir.-'dt.im, K. V,, arul ifathorn, M. K. S; |`i..vairjKi: of ,i*.*'M05 in nvo!'y in K.i't loii`!on: ,\-:>`<taitt.vi with div-JM.-. n-.'.u;>;ui(>ti. ami dmmcdiary ad- tlrvn. Ur J 1ml Med. 1575. 77. IG. 17. VYcitf, W.: Clinical cpidttmiolujty. Arch Environ llcaUfa. 1970. 20.5. li*. Sprii, S.. and l^tnewcher. J. 1'.: Atbejtm miner- aU in modem tecimoln^y. Environ Rci. 1PW. uv>. I'1. Wright. (5. 5\ .; .'.*5>v;ot and health in I'jd'.i. Am Re* Kivptr i>i*. lr-'d>i*. 2-'. Il,i'r-.*.. 1'. Cd: ' tin-: toiKt-mrattom in >lny. u patfit'S- S at Heal appro-n '.v t>* -tv.p-.ov li'sivi.'* in v.jvai dotls)j.'ds, Ann Ofvnp Hv^. J,*7I. If.'iU. 21. Ke<pirat'jiy Di't.Ta'l* Forc-j r.'port on Pioljlenit. IXvtearch Appicacliet, Nceu*. Tnc I :i l`; i -k': : in, \ it ..<> t; ;:: j...; (,ut;.- it.*;:- n -i.; : ' 7., I i ; f:. A.i,;;.. I ilm..\V ei; r ~ J. i i[ ....... I s.m 1 :t. I J.. *>!< 1 - i Al- id t, i: :i -i-i.i'i..! t.- d...- . - r' x p.-u:.,:..i ......... I. \ ;*, ;i ui. !' .. P'-Tl, . d> ri-m. J ( . ! !ix. : 1 A . -l.d ; A.i.u.*, S V dus( :t\ v.uiii. '. ;u budding-, `.ui'u.- pt'i.umtf i -i. > Iiu'l -ii.- lof i J** m lf ; r con- 'ini'.'.mn, \i;u l)xi 11; 12. 17i. 21. (..ivtdJni^. M ; Ad. n> i-o fiotn luueiv ltt*\c<. lt:;i II'" 1.-7 1. .' ", Z'<. 15>.l,it!i. \) V,, .-ml A S. 1... C:.: ;o aNlicvio* diiri'i;: hi 'se t.i.id.t- ti.i:;.-;, Ann fJc.up Htj. I7<*. I J. IT. 2d. Mnrplit. 1. t.. II.. trvi-ro. W . Alb.t::::. E. IahiU. J. J . .M.d U-'.'.'-i *\ . A fv-f-T *il- 'i;>:alli(irn .'.t a ion,*- '.in K:"- Id*. !'*!. />7r. '* v.,-sme. -7. M.-a.-r, j C ;>.'lu,e jd-. f . \ . i.d Si.rc;u< 1" .* *.* -it.-; v' . . ' V \ ; III N...:i. 'A. *t C3 ;> i'JOs vC, i*i J 1ml Mid. 1' - '. A'. 2 - 1 2"i Sen isi'i. c, M I... a:u! Tl I't. t"'- A il ; Mt>u. C'l-liom.i . < .>ta .fid i`\ jiiLiMi1 ; . a*' ie* '< in -r;\ <u . n, f.i'I >s. '.t.'nc'ti area . a. j ittd M-'d. 1 . v ". td. 2.1. St V. 1|.'ti.- M I : \ *:iui. f >4 1 il. mm t.j !;. v Of \* o i V: ; * .:: .*hv*;.;.t . *^i J Ii. ' Aai. :$n. S'e.. a*m*. . he..;.. (; \, * i- c and Ti..-..l*. M. \ *ii..,y ot ; w * .' . .- in.tie ,!*<-. > . ,.i ' . i'.: i i- d 7 A-i. ;:- *2. 2*> i;.v. :i'.. (iii.i'tij'ii'it. v Tun t.i*v> of Itul 4na:;t Itt- to thetiintia jfle; i,:;-Min- ; .* *! Cut. A: ll Kev Hiv K'T!. i Jm. Kiviutov*. K.i I'loural if!.. vli-.v 3-> llvi-V.l- ' !' ii'.'Si-is * ' l :*'..d I.IM amii'.pbtiiiii ,.Ki-.iii>:. t;.-. d;. dot v- 1C kil), -.'aj ; 1 lit-.;:. ; . !.. :>S. /otwv.r. r.iii; a-.*, r.. i t- .d*-. i;tl .i*iv *`ti'i* i ti , fte. id 'h ;;d 1. iju.,.-. ilutttSot. r... :{ Mivl,...:.i * .i. 1... \*.io. a\ (fit tif ti:n' wd ami cf-S >i>. K.nviir n R* *. IbTO. }. 4 : pi-****: i * *oe<u;- 35. IvO!f. V.. ami Sti!d.-it. J.: Ac tiiic^y cf piiiuni platjuf*. Tl.or; v. 27i' 3d. Stiikolf. I ) S.eh. w. j a:ml La.- V. M.: A'lx*(ut air p,,A;it.<i.i. \rti. c.atron ! Ic.iUn. i.-72.;.= . 1. iv m.. t-i.*-. k. a.;.: j u.. Av<M!i-,i"i .... ,.i..!'. and im..'Uien't tit t . -- '.: ; .u idcipat u.-:e: *or*( In.-*. . i i. l> *s. Rotii'd rite unrUl: A-'- 'o* :.i ' .wr. I 1573.:, 1250. SO. Muwu.T. J.. McHv. i. V... -ud MdAr. A. W.; 01-0*C M \ . Aihrstos like H:>< ' in Drniitri w itf; J : 10 ear.ier !;:>: t.d: it. J \ M !' ' ' UllO <0. 1`i.uli 'f l. It . :u! LuiiiiiiV-'"'1'. H u.ition "f (In.- ' '! Mm !' ! . K IV vU ..i.i'ivi- : liiiiii j m i: irh .. ui (.i:nn,il h M. f I' Mmv, ul.. WdV.un IK. ~ in.mu Mrtlu il Hooks I td . I ondmi. UiTl!. j* I I'J. Hi-ii". j. !>. :iml VultuTg. I* A.: Med-.H Imill r< irmiou lined on JCRp T.:-k Ore-.::* Ri |;inf. At ti Kmui-n Health, tOTI. '.v, I VV Half' l> V.. M.nkkm, 1*. T., anil Chiinie. ?.. \ i\` .pil iloi, Him tlPlt ui niw,..!- ci! 'J. IV Vunnkis ( o . i'!ulailcljhi.i. f'>71. II. * uhis. j., \t.. Ch.ilincn It, .1 Si-v. imu.r. M, T.: Kcfcoinal ciiMriluite.a i:.<. Iim^ , ir:n;i|i r m. . !>.- <ii - ms in sntoke! < ini'Ai r>, in '.`t1,.!,-I J'rtrfi. VV Wil'.t. i.l . I .->. .1 !.:>ii t -I . Old WoVm-. I-;-'.. . I'.'-.-p hi. Ci I liiiiii..'::, M I .(ii,l xiifiii. M 1). i.ii i foe : 1-mi i:; ;|;|i. <'ironic ub'li .C:. -' ...' ti.it ill-..-i..I sbeslfisis, | Vppi l\. I'l-.n. V. In. I in'iiiMin, I .. 4ml Pa via. D : C p- 11.Kton ;..d , iiMsjji- r in il;? human A :!i !. i * iioii I It il*li. i'?*. J1*. I". 1. 17. \!)ict r J>. y . IV:, mm. H. T.. Jlol.nm f. 1- and I. [ j in i>m M.- vh'.-r* ti.-im .. irMC strir-ki-ii;;hjomlM.i: (hatnncv in' ! n<. Ai. 1 I v. (!*. l-.IT*. ii'J. ';< l> t.i- ". ! , . ml i'l r;rv:!in, R. T. r.: I h- . i .is -it t:!-.<! ./im.iiii a^ainii in.iuin . t' ; liKUol'. \n- i'rv Re*pr Ois. l<`<\ d- V I*' Alii{r. I'.,ami A C, : To.: p tn.il ,anl ri. < turn mi;.,<opie UittfHimia.i*-" pnl'imnaiv a-hi't< fihre voncrnfnin vu I trl itioii u hum m jiatliolo-^ical reaction. J t* *0 r r'l-v . l>: K!i.i!itni;itrf*nn5*c diavi'c: u, of i iIt.-|:iI liiivxitiii; j'lKStio tilm, i.' J i'tii Mert. i'':?.:/. i in. a t. I :ic r. A. '`Iiktilf. I. J.. .im! S.i-'ic. ( hrNvotik nslx-wo' in thf* lungs of (m-uv::* *i New York City, Auh Environ Hnitli. i Cl. 5 IS. .Y2. Crmv ?.. Daviv J. M. (i., Harkv. K. A.. :r..! nvTre%il!e. R. T. J*.: Lymphatic tr-np*'T: Aluum dti't from the lungs. | Orei.p '! !. it':.--. /.V M. t. i o\*. f . Hai li-v, R. A.. Swiitinni.':. 5.. M.. T . i is, J M. G..-ii'.L W. H : In ;< *'ul ta-. -r- al oh. <* 'ii.i!.. . ; 'Ottvatr'i'ur'-r Cl. \lll| Eruuoi. l!:-.l!t!. !`V;i.:\atl. ,'t. Ar 1 n l ill.ill, 1 .' ,,>l-r';ni i)>>Ill's [' pi i<|ias -.n a EniriiAi 'nts of autopi'* Acta !'iiioi ; 1 .ini Vatni, I'.'oo. ment 181, p. h. \ .ii-i A. i.miao.i '.i ' . _ .m .j . !i v j Vi V ii-'i V hum-, j ' i " na:i i(i <.f A ...... . l-n\. ....I'.'' 1 ' . \mi i ti '. .'? IViu . [ '! Pmihei oioi.ia:.wiis on ;in- i. ,. >iiu,.i.. liuO'i'tii "I C i- fu,n,.,:-i 'i , v.i* lull's. (' s t Moi I'.i: in-i. !: 70. . 2 lii. I'..n.i in . i, a . 11vl iv j '. Vi. Ixi.'i. Mi l.-:. ; I lihi ir i .;.v. i. i"Ti v. ; s. l.wi.ai: r-'. (.n.'-. i*. I i-cmI:. . R. T. I'. mil if.'Hc., M. N . i'i:V'i''ti.i: i ht ruL'inoo* !><x! > m r;:. du-1' -tv \ik.i f mium Health, !?'', ;. C i 1)1 ll.iilii ! i- ; '>is:h:i. ..Ill diiiii.il: ,'U. I,: (h:- i.ii.,. i no .:i dii'V i.ii. !.. r*.i\ He |V.*S VA'. \t' i: ` ! '... \\ I . I . 'k.d.. | '-.`I V : T. I V' .:.i- ; o' sCiko'i. i j . ti.i.vr. R, \ it.idcr. '{, K.. (Inn!. I.. in..: I i.u' u. 'id. V . (!. t.inliMi Hu! m-o.'' .d i. \i.i | Med. 1C-''7. : (. t It i, A! 1' . ii.id i. R V , Ti.-i *:. iS.. Md'-.-r. '...and < ;f. I . s ;...i.i,iidi: di .nif > : .. t-.ii ::ig d... . mi i \i,, < <'. s, ..(!. \ ' d. d 1 : . . . r -- ,i '' i Ko ' i I' '. i!: . ; :j Mi.. iui..! ti'-.v-r ..".ll oi!.. ' i.i'.-.i . .i.iikei' i;; a.!.-; u-i .. '.'i: n.. It: J M.d. i K. tiT lloU R M.ii'. i.lt flom linn; iMum ill t." Hr j Hid Nod 1' i;.;i. i>5. Kit m.:\ ! ;. \; . J. and ii-.-.m:.:, t.' Mu.-..:: i\: .-:iii.-..' i.i ' , ;t *( uoiV. :v \. !':n,v,i Hi.'' i.l. IV.'. M. 1 - t. .. j. c.. V.'.. Mtt;: ..atl V. : r . M M : M :. a di-T--.- > iiu.i'.i.si d.u.ft in .'.f'.di Im or . .11 ,` 1 .. n :i. i/- .ivd P. <- Arad. i:c Pro Yo:k. ! 1C t\l i. Hi. ( . VI. . T.-.et. is.. .1.11 1 alfoid. Tlwimo-t. M. I..: -1 :.c a.:,.; i-.<- imp clii: . r..d: ..;,a.i. Itlli *. ii:iii...t: tii.it .*; s tit ..i.l-.!'/.? a. . - .1,'iV * C : n s. ,, id*. >:. . V ...... M. I \,i.. ... i ;.m . ,;:nl :h:- e"r..iui::'i:v. \.;u OsCt-p H - d.C;, / A:. -'i,i. G . Ci..-'/;. I-. an-: etciii E- I.otl ' i'iit;. ':-'!l ill tci.Ulv-'i fO r id....),,_..:i 01-020637^ .i<uks i os-wlla: :-'j lii.in^ei in asbf'lus soiku-.. R> 'I'ii.H.i.o. I'j'J. in | ;:w Ihriv. (.. Si -.'iuiii'i'. M. 1. .. a-.ui i'ur..*, M.: (''inhiiii d elbiis -'i \ :o, v\ ji.m: . .,:;J 'iiii'kiii'^ on mr::.:in. b'-o: i ii'^ am.', r :n : -.e- i"r\ % >i kerv i aw t. i .-72, 7, 17G. i...i. !!. y r.; \:i it. \. a.. N ' ' | * \ l 7! v in ^ Cut..a: of ..v.ioUv, iro:,?, nr. w . j OwCUp ^4*. w, 7,`j. Hatm-s, i'. C.. M.wkeit'i.-. K. A. t'.. Sheers, C , X.*`ntj>. J. It.. Oliver, T. 1'., a,id Wtighc. D. S.; Kadiidno't.d \urw\ ,,f f.rn c-sp.>.rd m a'bes- in naval dcukyaidv Rv j Uvl Med. iOT", yt. 271 Tfi. Mim', G.. and A. R.: Effects of .1-In .(os in <i'sk).crd woi.-sci', I5f M>-ci j, p'dS. J.'>74. 77. \l. iiiinuti. J.. o. KiviU't<u>, R.. and Makanva, M.: Mmubiu mcihiiUtv .inning the work* ma f'jni!i:ii.u .iniiiu.,i:v!li;,' .idu-im nii.icis in f inland. Pr J In.! I n7 i, 7.', i0.'>. Ts*. l'll.am, N.. l, Ii..,,m. S. V.: Viu! p.mty and mi" .(.'/.'ul (-rd espu.voiy ciinc in Vii'Ci.i'i.m M.iiv ,ibr*n ccnuiil v.e:-k- i'. Amt lUrup Ify.f. l:J7*i, !.*. M.l. 7'* 4 irir:inu- 1* 1......nvi kenbriik, ,M. A,. \ dii'i rvjinuui at vun'iii Kids .iul n..,rt:iI2cy, An li Em irm. t.YakU. i'A-T. ,'f. isl. HO. f`invfi"u-, I*. .*'a-u.ii:y among aibcHos pn-.fu..; v.>.ike > in ;in i.':d:cd Si..ui, Ann N Y Arad vci. 1)2, HI. En;-.".liin\ '\ i... .ui.l HctnU'i'on, V.: T;po of adn-kw aa l i-'pitutory earner ii the zdvestoi mdii'li). Auii vi:.hi Health,. 19711, 27, *11'. s.' Kitci luce*. P. T.. 1;. .nid'.e, !\. ;.;! Il>*'ulcr-i*ii, V.: it.-jm.n*- i imi'f in r I.ri.ni lo 'uenpa- c\j-iu'* > .iiiii'ii^ ntin.d .tslvMoi work* u', Hr J Jml Mol. I`*T:S, >0. Jlid. -vt Fittrciinr, P. K., Ihvvntlc, P., and Henderson, V,: Modality m rda.inn to occupational c\* j-t'iin- in the u.bcstts .miustiy, j Orcup Mot. //.S.'T. S*. |ih!(>:ii. Q-. Gibbs. G. \V,, Mackleflj. ?. T.. Me- I'!..i.i. |. ..ml Ik\.khkr, M. R.: Earl*. rl!- rtt of .i*1, ,'* on Innjj fmi turn. A KiipiT Jo*. 52a. H*. MclNmaUl, J. C.. McDonald, A. D., C.ihbs, G. U\, sicmiaiytki. J., and K'*icr. C. E.: M`*r- entity in the chrytotilc uibc*co uiinci and mitts <( (^ici>cc. Arch Environ Heatdi, 1071. 22. i>77. W. MciVinald, j. C, Bvtklakc. M, R., Tournicr- MavNcy. C.. iml Rentier, C. E.: Retaliatory v>(iipit>ms in chrwxile j'hotov mine and mill of Otiehtc, Ar.Ii Environ Hcalih, 1272. 2). :>?*. >7. K. tVt.vki', M. R., 1 uiir'V'T-M.!"). C., ROiiiter, C. E.. ?c*l .MiUunalvl, j. G.: l.uu^ tuoction in cln y-'CiIr ..>oi'.!0> tnine amrt m.il v.r>ciii,rs <if Ouclu'C. Anil Env itim rtejltls, 1072.2!, 401. R.iicr, C. t'.ri-'tol. L. j.. Gartier. P. H.. (.i'.'ii. {. (... l.i-imin'r. t . R.. Slim-C.i; ::nv. k. ,111.1 .Mrhoi;.,;.:, j. t:.; - i sc 111 iiic > iii i ii; \ i. `i >;o ;.lie - ,; i.i.,; "Ik'.; Viaejee A.cii .i. v.,. r II. ,1:1.. t'7*_.>.i (. ,ii;.J I,... ...ukc. M.. Du'f rrp,'tire ni ;ke v!:. >'"i.ie .i;'H"'> .ni.i . ii.i> e. < >n-.!)cc. \i t W finv mm I it It. V-J~2. 2f. I.*, i. h". Ul.ict. I- St., .swift, j.. -imt 1A.-kiAe. M. R.: lUirtun.iCic Cuuipiauav and yuUuon.ivy re'pov. n> diryioCiIe ilust iniuiacioci in d'C mim , .nul mill of Quebec;. Can Med Af.iO< J. 1971. yt. C-ihuv. G. \V,, aeui L.uliance. M.: Dust-fiber rc* lati.msliip. in ti.e Qvu'lieC ir.ausiry. Aiclt Environ tfejtui, 197-1. 2S,00. 92. McDimaM. J. C.. Recki.ike. M. R.. C.ib;., C. M\. MeDou.ild. a. D.. amt Rmjicer. C. cl.; Tlie IwnUli of cinv'otiio a'lnwcos im:u and cin'1 of Quebec. Arch Environ fle.cvliv. i"7t.;.v >!. b". Si ii.n iilcrui.in, M. A: DijfCsciie S;-tc-n r:.nce.f .uur-iijj ^H'r.-.j mbjrifv'! Cu OCCcipr.linliJi .:i- bal.iuvn of aA'C>!0' \>,.uidcs: A Ut-rature re- vn.iv nub liiipiij'i' o:i i'i'`<.' fcvjK>u<c, vium Hv-ltli Pet.pect. 197-t.797. I. \v nil. t (.. / I'siini, M. M,. \\ aiffeci'p.ii k. C-. .lo t Rir*'U :r, C. F..: l.ang ftnictioct tocuroticnc';. .( i(u>i espi'>utv in a'bv'.'.iu cnm ni v.i..nniac:ui ini plan:Arc!; Environ Health, l'JT'i, }>). ci-'?. I'i. S'.'eill. H.. W.. . ii'paik. C... and Uiilny. . Radiograph:'.:- phv >iolo*:it p.uti-rnv a:nu.., ; mukesv ei.^j-;- . m nenwtai. of .iihe-.c -> ceunut pi-.'lm. . j 0<viip M*.''. is, 21>. f!n. .Mitiphv. k. t.. ti . Ferris. It. t. Uui^e'-j, *V. A.. Uurcoter. J.. ami Gacnstrr. L. A.; F.,ceit< uf Imv I'lnuncutiuii' >;' Ocnual, vnoniiii ni.-l. radcotnjjiC and i p.ih tniiii>pi fb- s<;Ivatioit> ut >tu\u:>ut pij*^ ci>wv*--,s and vv-n- tuh,.N Engl J Mod. t'.':t.:?,11271. 1*7. Kncis. Ii. G.. Ranaiiive. M. V'.. Put. J Sf., M'ciplH. K. 1.. It.. Rui^t'. W. A. ami Pender- H. I1.. V" '--i. .i.e oi ttus.'cnc c-.pi:.;;ufv di-ease: m -hip ceput wv-ikecs, Aveh Knviii.it Heil'b. 1971. 2 22J. h-s. l ln-nii'.ii. [. 0.. and Graves. M.. Jr : Aw-"'- t.n an intuit .ut crim.ainii::n::. Auli i'.Hbvi. I1'*. TlnmiM'ti. J. (J.. K.iutiida, R. O. ' . ami V <.Donald. R. R.: Asbestos ,u a modern urban lia.aui. S Aft Med J, t9Ri. >7. 77. K)0. r.-.HuV. P. R., Riancnioii. C.. and BucciAfeiii. L.: Exancinitwvn of Urn-* snieau tor a*be?ios bodies in 10-? e-mjetuU'C neerop'i-5 in i'eru^ia. Em- J C.u.vi r, iOtii1, f. l.Yr. HU. li.igcf'iraml, t.. n/f Strfen. R : A-newOs '-'dut ami pli.iiial piuipus in lunnart necrops.. .Veil Pithul Siscrooiol $.ami [ S^. '/til. d/.t, t.77, ll**2. Dcckc, T. E.. and Naylor. Ii.: Prevalence of . . _ - -nruv .'fL.il.\K .*' !>vto, : i< iiumau iun^j .`..'ffL-riv. i;i; l .lime, 1 Do'*. < . 11*5. ini. Adiuoft. T.: Asliosios 1:1 roiiii;.. i;e on Twimidc: A pap.'-n'yie.ai ami .> >:n<l). f.r Mid J. I^.;,0!4. I'M. Pimm. r. c...'. i.Caayllt^. W T. T.-. a.l' O. 1 iV:'' -C onu >:f lb: pleura . 1.. '-V : ."i' 1'.-.. . .;<. G f : A`: lui>3't it lirCH)|\. | Cii:a i'.ihol, Hill. r..ih.uk. A.. ..i-l M. 1.: fitAalcnrc o' jOrckim fcodir. in biiai iuu^ >::)can, I-.i J Nfe-.. S/|. p'rJ. :4 M7. riirlM. n . 1., ::u;. R. S.. and Gii'S., 1'.: lo, lic'U< aiann liitij.. ai .:i'-/%y. f\MA. r>:. W* V.i-.-U, i M.. Hd.iliul. V. 5.- VlH-.f? '' -:A K's ill . viivliali.iii KporV im;o t Ifi-i. I'i.i. nun..-: V:i in.:.. pi.ii, ( ;; ' r'..>c.nch l im: fi-r : ..iluij 1 :al Ri-i.ireii, Ann:.'.! Re i Roper: N-..'! * V JoiiiM.i. 1 !* \n:. i... i... ic-W. t. 1 ..... :r. ; 11 1 C i- dies in ii:i.^. I ;a ; li'iiu iiv- r- p.. > in Monueai. Can Meu A;'-j. >*, , i*--. 111. 1! J. ' . M-. in. Cr.. ami R.CfCU. l:.; UK 111..!;.- . .1 j ... I.lli^ 1 '( III M;|:i 11. Mel I .-urn.- ! 1 * ?, *3, uiJ. 1. in. l. i I. r,i {li. . lu :. in ' : . tr; L."!.- - ! : i.i l.o-..lui' H-.l*. ^i-.. Sir MvH ;. : = .; ii5 i i. 1,: -i Mr:. at.il P.-Tik . !' . J. i-.- 1 ... .. i'.in,..a i.-i'Cv Anil l ii- :;-t. 1 Wifi........ .. ).. U -.n-nia. G.. jam,i1:'!, M C.. l/df. .. : i 1`iif. lion. '1. C Inuii- neo -f [UiliH"'i.'.r. :..Uo.'.im m Vram':. Vti M*. Ri* i . J. <30. IMaid'. :i.. IV. >i!:i . H.. Kai:eii. NI.. MaiVi*'. ,e. /.. v:-!.. 1.. :vl j;vfA'iiVivic. /: Imid**" 0 of .>: .. . . ' jo Iia jl lun4 .nieaf, .*< t-n . -; si J ^ %. 4 ' ! V O it.. ;w,d M.C itt;:V. k W.T. ' 1v.'fh> -' t-{ of.,!I*, M. j. It". Mittnphim. J.: F pitlemHiv of uus>'t1 !e-'ii u > on W'aicl.Sffn Kauri. )i. j Ind .`.Jnl. 5*. IIS. Wallace*. 'V f, >L. and J.: in-u.i- lion uoik.-ri id tleSf:i,(. !. Oap 11 1!> of .1 fan* dof.i \.n* pV 3 uutt: >1 popuiiiioii. Hi j I..u Mod. I!1"1, i .iij:.hii n j ;i. M . \V.,::.ur. V'.'. I M.. aid 'imp*. .1, 'd |. '... .......................... ia `.11 ::.e:i '(ill *1 ioii\. R.r ] 11 Mii. >?;i..-j.,;r. I'-P. Nv.t.ul, M . p'diia,, j.: lt'-'ei.ipms.-n: nS pUitf .l lr...i.;i*<n ;;i lonRietm ti.dic ol pel* '1 (\ ;r u A ; i > ,.v . N 1 : ii-i _____ , ; , ' 1 ...... j-1 . . .. [If 1 l;. : ' ' i - -. !. . . 1; ( ' d . * . C ' !(' -1 , . ... . ...- : ) 'If t > ;.. 1 r 1 ;h ; :i! 1 .-N ,. .*i ull p!.-a-uv<. J l ! m I'.'.' 'km, 1' ".a. .... i I'.it; 1) 1 1 H . I.e-- I.. a.-. ":. .1 r:l.ni. !>. r . Hv,ii;n<- .;iid IVU./i: 1 [il.if|Ui- .i.i 1: *.!. \ 01 C"- ; III. K- . \ 'UkU i f 1...! 1 r. ^'<.11 and i* ':eal u*-ii.- m I:> i.'v., ;Vii,f; .i rin%:ut`i 3111*11 '{ Cp.c O' i'o.r-i .'v.i;. [ G. / I.MiO. i*. Kiu>\, | i .. .ml iu . 1 : Mitlfl.'l f.-IKslU <* :iii* iiuiif' a:ier c1 \ju.*iu<- 1C .I'vi' l Sml Hvj. I**"' 1. ; dil*k, \l.dl : N ;\r:.ui. Af1' leiir ii . ai.uivn d.*e t > In rx v'i >*: m .;U * :.es*,i . r. :v.%\ <. 1 }\- : .) a Ov . ; p ptii.i;:.-'-!;.. . , U . IMv-'m- ' t.K* V- ; ..in, Oi....: . .. . e *. M -.j :. 1 in, ian, .* * *. i : a. 1:. 1 >: ! V.- * I'- ' i-'. v ;.. n . ..Uu fX^.. i K ni irn.i.. ,i :mt :;n ::;:i'c:e.*r .ml.:* ' m '`up* r*l i'v.,a> 1. :l.orN .. iii; pVa.m:. Ur j ' c... a. im 5, * I .1.; . < PiilriKii:, . * f :i:ctU r.: , `i UO' N. . C'eo'ip M--d. . /.\ 1 ' ft. ml A- V . T :f . *:.......... k.. 0 . v- n.'rvM : ' s ii<M ; ..* 1 it,. . 1* V I.ri: : 11 Til t* S . ltd* U'-'t*' G-..' . iii * ... ^ ,,.l *...,, . .. Jil. ii i l-.l.l t\ 7. K -:>u N ;:c). i. . Hil.imr- I*. 1G: di: iti-Gv cf ,.*: urtlli J1 m-i Hr ] Si: M ' l !7a..'v ' 1!. 1 ..u u*i 1. F \ am* !.,; i n. \ I : \-V. . -. . { \ma. ; ?i-i i ' j i'- it-.;. IV, .... N l j a .1.. . :>!, 0'J*. in ; ( (i.'iiii:i :i. i>:ii!i. niunoii. J.. 0., I'.veunlt, R.. O.. am*. j.. 1 _> plc.rmi* r.nntuuicr.'.:*.,. i. Vr M.:l I*- ;>.r. *.S. '. I I'M..;,. . J !\.' i.v .i. i',, nut I c !-> l..' IVvn. . ' ' ; \ii...i|in-. 1,1;;..rr.!. ; V pi.i\ iIhm:-.. I .1 N.diwii*' i ; m.m I'*;. ' , iV.Imoi. , A- j. I''-':.:. '.AT. H.'rtlukc. M 9..: S.C'-pitaioiA ddeve: Scii:;; *: t'iii'ical a::u irtiumv in C'eiiL:*1' / G1-0-2C6:. 7i .\<;>FS r;n r.> ixr.r. oucvjri ul <r^i. l 1, \V. '.taud >5, riti!4tit!|'h;.T 107". i' ` I *.v Mouw, v R.: Morbid a.i*I ImtotJG u: X'ljt';ois. Tubercle. Im4j. .'/. Uj. T,;bcrt, 0. i.: Tulnionary ad>cu>i. An: TlibtTC !' *. ;! . 2'. 1 . 11 I. :i"i V.'i I! i * :n Tiv: [>j: li ,,! ' ;y 't ` < , ii . f(.r life to l;,uy I. Thni .1 \, !''ol. "li 1. IM. r.ictifr. ?*.: (Amnbtition a IVtisdc dc Tarni.'n tnxc.Aitii M.d Prof, LUO,/(>. ?* 11. Gnl-Lutti, il.. Wchuvr. 1., . ;i;i V.iA Cn liter. G, k.: ltl;iu*f* ul a-H'-iu- Mi. E;r. iion i'.ct. 197!, 4, -J;?0. Iij. Gtc*'n. R, V. atul niui'.hrff. !> G..: lui.iii r::i ;}*<.t lobe Iihrod* (\<'uii..ry ;o t'bee\|'"mie Gltcii. 1^71, < *, *i'7. Timi':AVitv>n, Ni.: A |.iei<p< ciivc nov on u ill' o|u ititiKoti.it v fnuoMv Hr Met! j. i" .171. ' t o it'lt i, I . V, 11 tu^<)ii. G. II . Gout u. k r , I fill.IM..11, A.. H-ilfni.1.1, { . .met v>(t.. \ \ I' ltiin... it, j iiviu.'li'fu.it, .tnil i.uiif;,i^. u l Mm.o f; pncuniftomo'C'. Aim A V Ac."I i. '"72. >, `jl i. Hi' \ (...and H.,nett G. M.. P. A. <- t i-u.l U.u,; injures j*:i i.ttr-.l wi;!i -n, I lun..\. : i. i?.V !!- 1 ell** i. \v. C,.: lUictiPi.iia.il pncit.itf -Ls (G;i|il.iu 'Mu'ifiHc) i:t .i\l>c>U`< wt'ikcr*. "I n- ra*c. t'. !l. sr:. I !s' Mo.**:.. `A K. G.: K!i>'iini.u*><d jtui u.i.m. u..*- SI*. ,:i ' i : i.;t,'| ;;j> iv(u't*. 'HlOil^. 11 "*> 7. /v. I ' M.iii'-fu, * ii . C.'.', u.u\ .v.'.diotv.c in ttoii muIi ..!-in.i^. >v..iiil J kc'jiir l)i, i '71. <7. i:*3. I'*' i irtMH. ll . v.nl 1'nfi-. A. ll.: KltUirot titino 'vV|>it t;afo . !i-i|iiai;umc iiinmittal |m:ti- nituua ;:',tni..;al with a.i/CMos, Thorax, IV7*. :7.>*v. I - i. > .! !;!.t.^. J. (. . .uni K. T. M .: 1 lift .uc tti:*iM!; ::Uci.liiii (.iliifntC iuuisUttii fiHtmij ( :l.f l't.I i,.if ix, 1*0,7. li'u ! :. Militt. '... I.iiijj.r, A. M.. I'icHtcitt. A. S.. .',t:tl v ityt'ii. I. J.. ''N'om^iKxiftc" tutci'titi.il it- naty libuiM,. A%<Hiaiiou ivitli a.-lioio^ fi1 t-rj titicvuti lt\ clrcitim N Kmrl j Ifcil. 113. Turner Waruick, M.. atul 1*.: Anti bodicj in >tttc rltrnttic fiiro,u;^ lmij> I. Non-o'^atm ^pcciiic aui<.,utibivli' '. Chu At- IvfS).197;.:,8.1. i`l. 1 m;t: r-V\ at .via., '1.. Hadatn. IV. anil 'v>. J.: Amil-odo-' in Qnu- cHtonic fihro--ns do'.M*'*. It. I;i,iminQi!u:i:t''>v.'ui lU.dii,. Ci.rt ir<7t. ;."09. IV.. T'lim t-W.iiwivs, M.. anti I'.nWcs. R.-. G..vC-itl ii:^ thi'tuu.uoi'l uni aminnUcif fa- rors in as* bntos wr>r*c., Rr Mi d J, 107(1, /. {*_*. !> i1 ii .in. {. ' .. kin';.:.., T. T.. Nik; r:, ( . \ w . r. . i .-o .. > v.., iv.ii.. ; i If ;u. \ St.;.IK ... , .u,;. , r:v til \t, -.1 f. t'V- 1 I'7. i.-M-e. 1\-V.. S*.: a. V Gi.eciii. cr..l V.' :i::r i. \ . I |iiri;i;'i" -.io .it .it. ....... \ , . j i'-rV. i K .... . Ii . 1 '....... , j' 1i' . i *: | 1 ! 1 . : i1 . C-va^U. 1 ..tu a in e" mi*xt oios.'. ! ir ,\r -it J ; ;.<i A. 1It.: Li. <7ii ?, ^1. ouniis. Ht j I'"'1'Coot, Ltrl. c;. . U-i ''.Till . A. R... all>! r"`i U. L. U.: ! tomr.itory t r i. k !u and :ni\fi .lllie. .1 ouiii ol In.- n; 1111 i 7, 'i nor.ix. t'.C!.. *> tiH'i. it ; ( tn m.. T K.. Ci.i.i. M , I'iic.v. V l .. Su f t:::u:i : i .'<." l. i. M. j.. Ch..n,. U .. Ottoi C. H,,. n`s... v. k.. .Util G.imlfVt.i. Ii ' A-lii. '.in. WOlklli, ;.i j'Otl A liirtt-.al. 1'urn.: i-tv.l ar.d r :ji!.i It'xii'.il Mil VI \. \ri'li T11 . ; 111K 1 i 111. l .'7 .. 7 A t. l"j. ii.. ; att.G 7.(,. '1 1'. . a::.; Tlton; ..'.t Vh i a ..ji1 u: . Ill': 1.' 'jrt tUCII1. < t i. r i itv.tV1. ., , 1 t. 1 "*7 . ,i .;it iV'. ! : 1 A . ,'Utt'' : . ` Tutu.- r-U :: V, M : lit.' i.t. l.lf Ml it [lie i;tu_i;. Hr | L> 'iC'i . ;< J`i * ; . .A -cave - Jj. l'i. ''lot :t< it, A.: The :ad..- iC*) H L b.; ;oi. t. S ,Vfr M< -l j. 1'i.i`i. u.;.. >i'ivun/, M. : t.ii i . olt :-ii"i. i .... . \m J T : i< ( t "li i. . V::d. Lid. l.i .t: iitut. < ; (. 1 Urn, t't. Ik. If ]IllJJ : ;> id., i.. It'''.- ten-it at i.e-d o ;.m v'..'.: i ... < tt n-. of .-.-I.. i'.. j 11 d l;it. 1. i.'. 7! . lit/. (17 :' < i:ii.: t tt.i- ::. tjd-.K j'i ' nv r ;.n;. tniT, Wit . JtiM. In:. tia;.oi).ii |.j!.iir (W.if: III') U(r'i*. n- <..iti.ui ..f t.itUutl .* iim j'.ncHtt***, i -u,. ll'Tl. <Ut<i[>:uiw.:.A i'tnt 5. t.. . N". J.. imcfti :;;ctiul Labour Olhcc. Lent`.a. lt'7". l!il/. V.\ii!. H.: The rluxt .*.it iIei"!Ql.,^ c t'-fi; RtjHiii ff Vv fit. .;, >|'..t- ,'n.ii b t ;:c 1 lit; I M'o t>. e ' !. . 11<..tv: :.;;<i Lur.; I:-.<l::t.*e. Er.V!;.-ut ii.-,-:;;;.. I'C-t./v. -tt'-t. ,70. Hi <,!-.!.<ki. '!- R.: I'm. un.oi.fU:.<~.v ia h.hi/i `ihx.\ruii>.`.'>. ' <. /'t up. 'Ql. U. U . O. I'cntt at'.U II. R.'.Hn, c.l., Autct .salt THvtt- oiojiK.il v.H.icf. .1' w'ii.,:.i:i,rH:,|li:;i 171. Wot ton 111, 11. JH'Tiilliclif Ad)'-i'.(;.i;l.vxj >..i. non tt::i! oli>t: v. nr.I.m\.nlv:oriii:,,w". lu: Aich \: It>,'ifmini'll, l*'7n. 77. 2 i i7'7. K. L. H. G:0"k:. ii. A, !\. R. \.. Us Uc.<;t. R Rv I', j, .'.min. A. Gi-if. A. M.. ..ml r-.'in. !'. C. : l--' to ;i.ln*ti: C*.1 > e'.ell.ii y'. i'l 'iiijt i;jc w.'*et. r. am', ii/imoh, Auli Ltixiiun Ucat'.h, lv77, 7,'. 171. l-municr-Mm*:), (7., and Rcc'slakc, M. R.i Tul- 01 C206?.?- MAKC.tSi r * TIii>iu>> fiiiHtmii jt^ i t tin. i-'i : 1*1. lun lii" i, Hull l'li\`u , ..' a *1 i":.v v. MuMii'il 11 (. . iH.i t iiiui Kc';-u i'..iiiu:, \1 I i ?"!M ' ' II .....................' AO.-/.11C: j I * - r. m . . . i. \ r, t. \ i . . . i ' i !., ;. l'' r : : I . i ... i > T> < . t> .. A M . uni \i ft. I'..- ' . :t tfil.in.tin .i i elude i,i > hi ri Lt:i.i. i .ispatx I ,i.! u >! >; utli.lii.v'. ` t (''|h;i.i'|.|.; iV'|>ii.ite>tlf> ili. 1 ,i\) k'U/'C, Mu', l.r.niii. IVT. i"'*. 1 Ti*. \V:l|i.uii'. il , mid 1 | huh-|* iri'v I*, lilt >!' riilK.H'fi n( .,,,i; iiia'-:.,,n cli:::-. vx ie i- *i*.i*i. ( l.oi.is. s. K>'. 77. (Ixi.mi, :> . I'i ., il It.e.x i in ui...:.. U M : R. >;x: p.s:- :;r. aitli <:-.iu:>e iiiixTiiif^. liiii}; .1-x \: Uv\ K. .^.i Ui', I'.iT'*. : * Z- 7 Ixivinlal'l M. '(, |., riiKjxfnan. 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