mesothelioma andperitoneum ...to the formation ofamassive pleural effusion. pain was a prominent...

Brit. J. industr. Med., 1965, 22, 261.

MESOTHELIOMA OF PLEURA AND PERITONEUMFOLLOWING EXPOSURE TO ASBESTOS IN THE

LONDON AREABY

MURIEL L. NEWHOUSE and HILDA THOMPSON

From the Department of Occupational Health and Applied Physiology,London School of Hygiene and Tropical Medicine

(RECEIVED FOR PUBLICATION FEBRUARY 11, 1965)

A series of 83 patients from the London Hospital with a diagnosis of mesothelioma confirmed bynecropsy or biopsy has been studied for possible exposure to asbestos. The series consisted of 41men and 42 women; 27 of the patients had peritoneal and 56 pleural tumours. The earliest deathrecorded was in 1917, but only 10 of the series died before 1950 and 40 (48%) between 1960 and1964.In 76 of the series full occupational and residential histories were obtained. Forty (52-6 %) gave

a history of occupational or domestic (living in the same house as an asbestos worker) exposure toasbestos compared with nine (11-88.) out of 76 patients from the same hospital suffering from otherdiseases (p < 0-001). None of the 17 suspected cases of mesothelioma, rejected on pathologicalgrounds, was found to have had any exposure to asbestos. There was also evidence that neighbour-hood exposures may be important. Among those with no evidence of occupational or domesticexposures, 30-6% of the mesothelioma patients and 7-6% of the in-patients with other diseaseslived within half a mile of an asbestos factory (p < 0'01). Out of the 31 patients with occupationalexposures only 10 were in jobs scheduled under the Asbestos Regulations of 1931. The intervalbetween first exposure and the development of the terminal illness of mesothelioma ranged between16 and 55 years.In 47 patients in the mesothelioma series, lung tissue or sputum was available for examination.

In 30 (62 5%), either asbestosis or asbestos bodies were present.

In recent years, the association between exposureto asbestos dust and cancer of the lung and othermalignant neoplasms has been the subject of muchresearch (leading article, 1964). Wagner, Sleggs, andMarchand (1960) described the occurrence of meso-thelioma of the pleura in those exposed to crocidoliteasbestos in the mining districts of South Africa, andthis has stimulated further studies of the occupa-tional histories of patients suffering from this tumour(Owen, 1964; Fowler, Sloper, and Warner, 1964).The present investigation concerns patients in

whom mesothelioma had been diagnosed at theLondon Hospital during the past 50 years. Afterexamining the necropsy and biopsy specimens heldin the pathology department, Hourihane (1964) con-firmed a diagnosis of mesothelioma in 83 patients,of whom 41 were men and 42 women. Thirty-one ofthe men had pleural tumours and 10 peritoneal;

among the women, 25 had pleural and 17 peritonealtumours.The aim of this study has been to establish the

occupational histories of these patients and to traceany other possible exposure to asbestos. There werefour surviving patients at the outset of the investiga-tion, but these have subsequently died. The earliestdate of death in the series was 1917; 10 died before1950, 33 between 1950 and 1959, and the remaining40 in the past four and a half years. The youngestpatient died at the age of 33, and nearly half weredead before the age of 55 (Table 1).

Clinical Features

The ward notes of 65 of the patients were availableand give a picture of a disease with a consistentsymptomatology. Among those with pleural

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BRITISH JOURNAL OF INDUSTRIAL MEDICINE

TABLE I

AGE AT DEATH OF 83 PATIENTS WITH MESOTHELIALTUMOURS

Male FemaleAge (yr.)

No. % No. %< 34 2 4-9 1 2-435- 7 17-1 6 14 345- 15 36-6 9 21 455- 10 24-4 1 8 42-965+ 7 171 8 190

tumours, the commonest presenting symptom wasthe rapid onset of extreme shortness of breath dueto the formation of a massive pleural effusion. Painwas a prominent feature, either described as a dullache, sometimes due to invasion of the ribs orvertebrae, or sometimes sharp and radiating, sug-gesting nerve involvement. Tumours in the chestwall were not uncommon, occurring either inprevious operation scars or by direct invasion of thechest wall. The symptomatology of the peritonealtumours was more varied. In some patients the pre-senting symptom was pain on defaecation ormicturition. Diffuse upper abdominal pain was verycommon, and swelling of the abdomen due to asciteswas always present terminally. The methods oftreatment included pneumonectomy, decorticationof the lung, deep x-ray therapy, instillation of radio-active gold, and cytotoxic drugs. They were usedalone or in combination but had little effect on thecourse of the disease. Half of the patients sufferingfrom pleural mesothelioma died within one year ofthe onset of symptoms, a further third within twoyears, and only one patient survived for more thanthree years. The course of those with peritonealtumours appeared to be equally rapid. Eight of thepatients died within six months of the onset ofsymptoms.

Sources of Information on Occupation and Residence

In addition to the ward notes, some of which gavegood occupational histories, there were three othersources of information: the patient's general practi-tioner; the records of an asbestos factory in the area;and personal interviews with patients or theirsurviving relatives.As a first step, general practitioners were circulated

with an explanatory letter asking them to completea form giving details of the occupations of patientsand their immediate relatives. Within two months65% of the doctors had replied. In two cases ahitherto unknown exposure to asbestos was revealed;in others the name and address of a surviving relativewere given, but in the majority the doctor was unableto give information because, on the death of the

patient, the notes had been returned to the localexecutive council of the National Health Service,where they were destroyed within a period of threeyears.

In one of the asbestos factories a file was kept withdetailed records of all employees since it started in1913. The names of all patients were checked withthese files. Nine men and nine married women (aftertheir maiden names had been ascertained from rela-tives) were identified without difficulty. The exactdates of employment of these 18 patients and thejobs they had done were obtained from the recordsof the factory.The four patients alive at the beginning of the

investigation were interviewed personally. A fewrelatives were contacted by post, but the relatives of68 patients were interviewed by one of us (H.T.) attheir homes situated mostly in the East End ofLondon. Not only was an occupational history of thepatient, the spouse, sons and daughters, and fathertaken, but past addresses were also recorded. Theinterviews lasted for at least an hour. To recall eventsof 30 or 40 years ago it was often necessary toexplore the residential and occupational histories ofall members of the family.

Exposure to Asbestos in Three Groups of PatientsSuffering from Other Diseases

For comparison with the mesothelioma patients,three further groups of patients suffering from otherdiseases were investigated.The first group was selected from the patients in

the medical and surgical wards of the hospital duringthe early summer of 1964 ('in-patient' series). Eachpatient in the mesothelioma series who had beentraced was matched with an in-patient of the samesex born in the same five-year period. As there wasa dearth of male patients over 75 years of age in thehospital, a sample of six patients of this age andolder was taken from a neighbouring geriatrichospital.The second group were those who had originally

been filed in the pathology department of thehospital as cases of mesothelioma but in whom thediagnosis was subsequently rejected on pathologicalgrounds by Hourihane (1964) ('rejected series'). Asit had proved extremely difficult to locate the rela-tives of those who died before 1950, attempts weremade only to trace the three survivors in this groupand the 14 who died after 1950.The in-patient series, already described, were all

admitted to hospital in 1964. The patients withmesothelioma were admitted to the same hospitalover a period of 47 years during which there mighthave been a substantial change both in the residential

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areas and social classes of patients attending theLondon Hospital. Thus, a third group of patientswas taken from the hospital records matched bydate of admission as well as date of birth and sexwith the patients in the mesothelioma series. Theirplaces of residence and occupations were extractedfor comparison with those of the in-patient series.

Results

Details of the 83 patients in the mesotheliomaseries are given in the Appendix. No informationabout past domestic and occupational histories wasavailable for seven patients. Among the remaining76, 40 (52-6 %) gave a history of exposure to asbestoscompared with only nine (11 8 %) of the 'in-patient'series (Table 2). The difference in this proportion is

TABLE 2

TYPES OF EXPOSURE TO ASBESTOS OF 76* PATIENTSWITH MESOTHELIOMA AND 76 IN-PATIENTS WITH OTHER

DISEASES

Mesothelioma 'In-patient'Type of Exposure Series Series

No. % No. %Employed at one asbestos 1

Delivered goods to factory 1 25 0 1 13

Employed at other asbestosfactories 4 5 3 1 1-3

Insulators and laggers 8 105 45|3

Relative worked with asbestos 9 118 I 1-3

Dockers handling asbestoscargo 0 - 2 2 6

No histor) of work ordomestic exposure toasbestos 36 47-4 67 88*2

Positi%e exposures to asbestos inpositie histories in in-patient series:

mesothelioma series versus

X= 27-11, P <0001

*Se%en cases of mesothelioma could not be traced and are omittedfrom this table.

statistically highly significant (x2 = 27- 11; P <0 001). This result is unlikely to be unduly influencedby the two groups of patients not being matched foryear of admission to hospital, since there was nosignificant difference either in the areas of residenceor in the occupations of the patients admitted in 1964and those admitted between 1917 and 1964. Com-paring the confirmed and rejected patients in themesothelioma group who died after 1950, 36 (50%)of the confirmed and none of the 17 rejected casesgave a history of exposure to asbestos (Table 3).This difference is statistically highly significant(X2 = 1183; p < 0001).

263

TABLE 3

EXPOSURE TO ASBESTOS OF CONFIRMED AND REJECTEDCASES OF MESOTHELIOMA SURVIVING AFTER JANUARY

1950

Diagnosis of MesotheliomaExposure to Asbestos

Confirmed Rejected

Exposure positive 36 0

No work or domestic contactfound 35 16

Untraced 1 1

x' = 1183, r < 0001

Mesothelioma Series

Occupational Exposures.-There are details avail-able for the 18 mesothelioma patients who hadworked at one asbestos factory which used croci-dolite asbestos with small amounts of chrysotile andfirst introduced amnosite in 1926. Eleven startedwork before 1933 (the year when the asbestos regula-tions controlling the manufacture of asbestos goodsand the protection of asbestos workers becameeffective), and seven started work between thebeginning of 1933 and the end of 1942. The occupa-tions of these workers and the type of asbestos theyused are shown in Table 4. All of the 17 for whomdetails were available had used crocidolite asbestos.Five of the occupations listed are not scheduled as

TABLE 4

JOBS OF 17* PATIENTS WITH MESOTHELIOMA EMPLOYEDAT ONE ASBESTOS FACTORY

Statutory Job Male Female MaterialObligations

Spinning 0 4 Crocidolite

Carding 1 1 Crocidolite

Subject to Clothing and Crocidolite,regulations weaving 0 chrysotile,

amositeDisintegrating Crocidolite,and opening 2 1 chrysotile,

amosite

Filter makingfor A.R.P.masks 2 0 Crocidolite

Manufacturingofpreformedpipe insula-tion 1 1 Crocidolite

Not subject to Manufacturingregulations of brake

linings 1 0 Crocidolite

Rubber com- Crocidolite,pounding 0 1 chrysotile

General Crocidolite,labourer 1 0 chrysotile,

amosite

*Employment history not available for one female patient.

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requiring medical supervision under the AsbestosRegulations (1931).Four patients were working at other factories

making all types of asbestos goods. One had beenemployed in a wagon works sawing asbestos sheetsfor partitions. Except for one, a woman employedin insulating electrodes with crocidolite, the types ofasbestos used in these other factories are not known.The eight heating engineers and laggers were all

men. Three had been employed in dockyards onship repairs, two in various types of lagging, one ina power station, one installing hospital sterilizingequipment, and one installing central heating. Allwere consistently employed on this type of work formore than 20 years, but, in some, exposure toasbestos was intermittent.

Domestic Exposures.-The group of nine, sevenwomen and two men, whose relatives worked withasbestos, are of particular interest. The most usualhistory was that of the wife who washed her hus-band's dungarees or work clothes. In one instance arelative said that the husband, a docker, came home'white with asbestos' every evening for three or fouryears and his wife brushed him down. The two menin this group, when boys of 8 or 9 years old, hadsisters who were working at an asbestos factory. Oneof these girls worked as a spinner from 1925 to 1936.In 1946 she died of asbestosis. The press report ofthe inquest states: 'She used to return home fromwork with dust on her clothes'. Her brother hadapparently no other exposure to asbestos; he startedwork as a shop assistant, then became a sawyer ofiron girders until 1948 when he worked as a loaderof groceries in the docks for five years (but never ondusty cargoes) and then returned to sawing irongirders. He died in 1956 of a pleural mesothelioma.

In-patient Series

Occupational and Domestic Exposures.-Two ofthis series had worked in asbestos factories and fourhad been employed as laggers. The husband ofanother was employed at an asbestos factory forthree years, and two dockers in this group gavehistories of handling asbestos cargoes from time totime throughout their working life.The diagnoses of these patients have been grouped

into seven categories (Table 5). The patients with apositive history of exposure are scattered throughoutthe various diagnostic groups, and there is no indica-tion that exposure to asbestos could be related tothe disease which had caused their admission.

Neighbourhood Exposures of Mesothelioma andIn-patient Series.-The 36 patients with meso-

TABLE 5DISEASE GROUPS OF PATIENTS

SERIESIN THE IN-PATIENT

N of No. withDisease Group Paticnts Exposure to

Asbestos

Cardiovascular 21 3Metabolic 9 0Reticulo-endothelial (including

anaemias) 8 2Gastro-intestinal (excluding cancers) 6 2Respiratory (excluding cancers) 3 0All neoplasms 18 1Other 11

Total 76 9

thelioma and the 67 patients in the 'in-patient'series, who had neither an occupational exposurenor a relative living in the home working withasbestos, might have been exposed to asbestos dustbecause they lived in the immediate vicinity of anasbestos factory.One factory, where more than one-fifth of the

mesothelioma patients were employed, opened in1913, having been situated nearer the centre ofLondon for the previous seven years. There werethree affected female patients living within half amile of the factory during the time it was in produc-tion at its first site. When it opened they werechildren between 5 and 7 years old. At the presentsite, there were eight patients living within a half-mile radius of the factory. One man was born withina quarter of a mile of the factory and remained atthe same address for 16 years. The other seven werewomen, and all except one were children when thefactory opened. The seventh was 23 years of age andremained in the same house until she died 48 yearslater. She is the only patient who had neitheroccupational nor household exposure but in whomasbestos bodies were found in the lungs at necropsy.Among the 'in-patient' series, one patient lived

near the factory at its previous site and four otherslived near its present site. One patient was 22 yearsold when she moved into the neighbourhood in 1915.She disliked it and, when interviewed, complainedimpartially about the dust from the asbestos factoryand the rats in the house.

TABLE 6RESIDENCE OF PATIENTS WITH NO OCCUPATIONAL OR

DOMESTIC EXPOSURE TO ASBESTOS

Lived Within Lived More Thanj mile of j mile from

Series Asbestos Factory Asbestos Factory Total

No. % No. %Mesothelioma 11 30-6 25 69-4 36

In-patient 5 7-5 62 92 5 67

x' = 7 85, p < 0-01

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MESOTHELIOMA OF PLEURA FOLLOWING EXPOSURE TO ASBESTOS

Thus, among those with no occupational ordomestic exposures to asbestos, there are 1 1 (30-6 %)patients in the mesothelioma series and five (7 6%)in the 'in-patient' series who lived within half a mileof an asbestos factory in the area (Table 6). Thedifference in the proportion of patients in the twoseries who lived in the vicinity of the factory and hadhad no other exposure to asbestos is statisticallysignificant (x2 = 7-8S; p < 001).

Date of First Exposure and Interval Before DeathIn Mesothelioma Series.-Fifty-one men and womenhad been exposed to asbestos, including those wholived near the main asbestos factory. The durationof exposure varied widely, ranging from two monthsto over 50 years. The interval between the firstexposure and death varied between 16 and 55 years(mean 37-5 years). Among the group of factoryworkers, where exposure was probably heaviest, theinterval was shortest. It was longest among thegroup living in the neighbourhood of the asbestosfactories, where exposure to dust was probablylowest. Table 7 shows the mean age of each groupat first exposure and the mean of the interval beforedeath in each group. Although the length of interval

TABLE 7

RELATION BETWEEN TYPE OF EXPOSURE AND LENGTHOF INTERVAL BEFORE DEATH IN 51 PATIENTS IN

MESOTHELIOMA SERIES

Mean IntervalMean Age at between First

Type of Exposure No. First Exposure Exposure and(years) Death

(years)Factory work 23 22 S 29-4Domestic 9 17 9 37-9Laggers and insulators 8 15-6 38-4Living in neighbour-hood of factory 11 8 5 48-6

varied between 29-4 and 48-6 years, the mean age atdeath showed less variation; it was 50-6 years in thegroup of factory workers and between 55 and 57years in the other groups.

Asbestos Bodies and Asbestosis in the Meso-thelioma Series.-Of the 83 patients in the meso-thelioma series, lung tissue was available forexamination in forty-three. In four other patients,all certified as suffering from asbestosis, with no lungtissue available, examination of sputum during liferevealed the presence of asbestos bodies (Table 8).BEth asbestos bodies and histological evidence ofasbestosis were found in 15 of the 24 factory workersand laggers. A further five showed evidence of eitherasbestos bodies or asbestosis.

Lung tissue was available in only four patientsexposed either through relatives or by living in theneighbourhood of asbestos factories. In two,asbestos bodies were present in lung tissue but therewas no evidence of asbestosis.

TABLE 8EVIDENCE OF ASBESTOS BODIES OR ASBESTOSIS IN47 CASES OF MESOTHELIOMA WITH LUNG TISSUE OR

SPUTUM AVAILABLE FOR EXAMINATION

History ofContactwith

Asbestos

PositiveNegativeUntraced

Total

Asbestosis or Asbestos Bodies

Present AbsentLung Tissuenot Available

Among the 12 patients in whom no definite contactwith asbestos could be established, there was one, amerchant seaman from South Africa, whose lungsshowed both asbestos bodies and asbestosis; he mayhave had contact either in South Africa or at sea,but his early history could not be established. Therewere three others in this group who had asbestosbodies in lung tissue without evidence of asbestosis.Of the seven patients whose histories could not be

traced, three had asbestos bodies and histologicalevidence of asbestosis and one had asbestosis alone.

Discussion

In the mesothelioma series there are 25 patients inwhom no evidence of any exposure to asbestos couldbe found. A chief source of information was ahistory taken from a surviving relative. A surprisingamount of information was obtained, but in some ofthose interviewed the memory may have been defec-tive or they may not have known of short periods ofexposure during the youth of the deceased. Forexample, one of the patients was eventually identifiedas having worked at a large asbestos factory for twomonths in 1941. This was before he married, andhis widow did not know of this episode. It is ofinterest that asbestos bodies in the lungs were foundin only four of this group, and it seems probable thatamong the remainder there were those who had hadno exposure to asbestos.

In the mesothelioma series of patients, both in-dustrial and non-industrial exposures were recog-nized. Among the men the exposure was pre-dominantly industrial; 22 worked in asbestosfactories or as laggers, two were exposed at home,and one lived near the asbestos factory. Among thewomen only 10 worked in asbestos factories, and a

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further 17 had non-industrial exposures, seven in thehome and 10 living near asbestos factories.There is no evidence that the patients with

peritoneal tumours differed in their type of exposurefrom the patients with pleural tumours. The propor-tion of positive findings of asbestos bodies orasbestosis was similar in both groups. A higher pro-portion of women, particularly among the factoryworkers, was affected by peritoneal tumours, but thedifference between the sexes was not statisticallysignificant.The recent increase in the number of patients

diagnosed at the hospital may be partly due to anincreased interest in mesothelial tumours and partlyto the long interval between first exposure anddevelopment of the tumour. Those exposed between1915 and 1925 might be expected to die from about1950 onwards. Asbestos imports to the UnitedKingdom have mounted steeply since 1932 (Leathart,1964) and its uses are more widely diversified inindustry. The increasing proportion of the popula-tion exposed to asbestos during the past 30 yearsmay be expected to give rise to an increasingoccurrence of mesothelial tumours.The choice of groups for comparison with the

mesothelioma series of patients was not ideal. Thenumber of patients it was possible to trace in the'rejected' series proved to be very small. The 'in-patient' series, although matched for date of birthand sex, differed from the mesothelioma series in thatall were admitted to hospital during 1964. Neitherof these groups could be interviewed without know-ledge of the disease from which they were suffering.This could have led to bias with under-reporting ofexposure to asbestos in the in-patient series. How-ever, in the 'in-patient' series the actual patient wasinterviewed, and more detailed and reliable historieswere obtained than was possible from the relativesof those who had died of mesothelial tumours. Therewas no evidence that, because of their more recentadmission to hospital, the in-patient series was less

likely than the mesothelioma series to work in con-tact with asbestos or to live in closer proximity toasbestos factories.There seems little doubt that the risk of meso-

thelioma may arise from both occupational anddomestic exposures to asbestos. Wagner and others(1960) described patients with no exposure otherthan living as a child in the vicinity of the asbestosmines. A high incidence of asbestos plaques of thepleura has been found in the population living nearan anthophyllite mine in Finland (Kiviluoto, 1960).More evidence is required of an increased risk to thepopulation living in the neighbourhood of asbestosfactories or other areas, such as dockyards, whereasbestos is used in quantity.

We should like to thank Dr. D. O'B. Hourihane forhis co-operation and for making the results of hisinvestigations available to us.Our thanks are also due to Professor C. Wilson,

Professor V. W. Dix, Dr. N. L. Rusby, and Mr. G.Flavell, F.R.C.S., of the London Hospital and Dr. C. P.Silver of St. Matthew's Hospital for permission to inter-view their patients; to the general practitioners who col-laborated in this enquiry; to the managements of theasbestos factories for arranging access to their records;to Miss Joan Walford for statistical assistance, and toDr. J. C. Gilson, Professor R. S. F. Schilling, and Dr. W.Smither for their advice and help.The contents of this paper were communicated to the

Conference on the Biological Effects of Asbestos,arranged by the New York Academy of Sciences inOctober 1964, and will be published in a shorter formin the proceedings of that conference.

REFERENCES

Fowler, P. B. S., Sloper, J. C., and Warner, E. C. (1964). Brit. med.J., 2, 211.

Leading article (1964). Ibid., 2, 202.Hourihane, D. O'B. (1964). Thorax, 19, 268.Kiviluoto, R. (1960). Acta radiol. (Stockh.), Suppl. 194.Leathart, G. L. (1964). Occup. Hlth, (Lond.), 16, 119.Owen, W. Glyn (1964). Brit. med. J., 2, 214.Wagner, J. C., Sleggs, C. A., and Marchand, P. (1960). Brit. J.

indusir. Med., 17, 260.

Appendix opposite

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MESOTHELIOMA OF PLEURA FOLLOWING EXPOSURE TO ASBESTOS 267

APPENDIXEIGHTY-THREE PATIENTS WITH MESOTHELIAL TUMOURS

Dura- Patho-Year tion Asbestos logical Survival

Case Site of Year of of Year How Bodies Evidence fromNo. Primary Sex of First Expo- of Diag- in Lung of As- Initial Relevant History

Tumour Birth Expo- sure Death nosed Tissue bestosis Symptomssure (years) in Lung (months)

Tissue

Section A: Factory workers8 Pleura M

19 Peritoneum M

l8 Peritoneum

4 Pleura

14 Peritoneum

16 Peritoneum

13 Peritoneum

II Peritoneum

IS Peritoneum

9 Peritoneum

21 Pleura

12 Peritoneum

5 Peritoneum

7 !Peritoneum

2 Pleura

Peritoneum

Pleura

Pleura

Peritoneum

Pleura

Pleura

Peritoneum

Peritoneum

F

M

F

F

F

F

F

F

M

F

M

M

M

F

F

M

F

M

M

M

M

Section B: Laggers and insul25 Pleura M

28 Pleura M

22 Pleura M

30 Pleura M

27 Peritoneum M

26 Peritoneum M

31 Pleura M

29 Pleura M

I 1901 1921

11895 1919

1908 11925

1880

1893

1906

1928

1917

1922

1894 1915

1895 1917

1901

1897

1893

1918

1908

1925

1918

1919

1928

1937

1927

1940

1925 1941

1907

1908

1907

1921

1924

1942

1899 1923

1899 1936

1908

1911

1917

1925

1930

1937

tlators1874 1888,

1893 1910

1921 1937

1908 1922

1908 1922

1911 1927

1897 1916

1912 1927 .

-1-

17

22

S

12

7

S

11

2

30

4

116

10

10

lj

26

2

27

53

22

22

39

36

34

41

34

1938 Necropsy Positive Positive


1947

1950

1951

1951

1955

1955

1955

1956

1957

1958

1958

1958

1959

1959

1962

1962

1963

1963

1963

1963

1964

Biopsy

Necropsy

Necropsy

Biopsy

Necropsy

Biopsy

Biopsy

Necropsy

Biopsy

Biopsy

Necropsy

Biopsy

Biopsy

Necropsy

Biopsy

Necropsy

Biopsy

Necropsy

Necropsy

Necropsy

Necropsy

1935 Necropsy

1955 Biopsy

1959 Necropsy

1961 Biopsy

1961 Necropsy

1961 Necropsy

1962 Biopsy1962 Biopsy

Positive(sputum)

Positive

Negative

Positive(sputum)

Positive

Positive(sputum)

Positive(sputum)Positive

N/A

N/A

Positive

N/A

Negative

Negative

Positive

Positive

Positive

Positive

Positive

Positive

Positive

Negative

N/A

Positive

N/A

Positive

Positive

N/A

N/A

N/A

Negative

Negative

N/A

Positive

N/A

N/A

Negative

N/A

N/A

Positive

N/A

Negative

Negative

Negative

Positive

Negative

Positive

NegativePositive

Positive

Negative

N/A

Positive

iN/APositive

Positive

N/A

N/A

7

?

9

?

12

3

6

3

18

18

18

3

11

7

8

6

24

12

24

9

25

12

13

8

10

Brake liner, boiler coverer, asbes-tos factory; mainly crocidolite

Disintegrator and other jobs,asbestos factory; amosite, croci-dolite, chrysotile

Sectional pipe maker, asbestosfactory, certified asbestotic; main-ly crocidoliteUsed asbestos boarding in railwaycarriage construction

Asbestos factory, job unknown

Opener and sectional pipe maker,asbestos factory, certified asbes-totic; amosite, crocidolite, chryso-tile

Spinner, asbestos factory, certifiedasbestotic; mainly crocidolite

Sectional pipe maker, asbestosfactory, certified asbestotic; mainlycrocidolite

Spinner, asbestos factory, certifiedasbestotic; mainly crocidolite

Disintegrator, asbestos factory;amosite, crocidolite, chrysotile

Asbestos mixer, north Englandasbestos factory

Carder, asbestos factory; mainlycrocidolite

Clothing and weaving, asbestosfactory; amosite, crocidolite,chrysotile

Filter maker for A.R.P. masks,asbestos factory; mainly croci-dolite

Filter maker for A.R.P. masks,asbestos factory; mainly croci-dolite

Electrode coverer; crocidolite

Spinner, asbestos factory; mainlycrocidoliteDelivered chemicals to asbestosfactory; amosite, crocidolite,chrysotile

Spinner, asbestos factory; mainlycrocidoliteLabourer, works and buildings,asbestos factory; amosite, croci-dolite, chrysotileWorked in yard of insulatingcontractorsCarder, asbestos factory; mainlycrocidoliteDisintegrator and other jobs,asbestos factory; amosite, croci-dolite, chrysotile

Worked in close proximity to boilerrepairer in dockyards

Boiler cleaner and stripper, dock-yards

Boiler coverer and lagger to variousfirms

Erecting and fitting central heating

Boiler coverer and pipe insulator,contracting firmLagger and boiler coverer, variousfirms

Intermittently boiler lagger, shiprepairs

Installation of hospital sterilizingo,nainmont

(continued)

20

17

6

10

23

3

4

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BRITISH JOURNAL OF INDUSTRIAL MEDICINEAPPENDIX (continued)

EIGHTY-THREE PATIENTS WITH MESOTHELIAL TUMOURS

Dura- Patho-Year tion Asbestos logial Survival



1. _______ Tissue

Section C: Exposure of relatives40 Pleura M 1912 1925 11 1956 Biopsy N/A N/A 27 Elder sister worked as spinner at

asbestos factory, died 1946,certified asbestotic

34 Pleura F 1913 1919 2 1957 Biopsy N/A N/A 14 Elder sister employed as spinner,looked after patient as child

38 Pleura F 1895 1919 41 1960 Biopsy N/A N/A 15 For several years husband workedin ship's engine room, closeproximity to lagging operations

37 Pleura F 1905 1925 14 1960 Biopsy N/A N/A 3 Iusband worked as boiler coverer;overalls brought home for washing

35 Peritoneum F 1890 1921 21 1960 Necropsy Positive Negative 24 Husband foreman and executive atasbestos factory

33 Pleura F 1916 1930 4 1961 Necropsy Negative Negative ? Husband a docker; frequentlyhandled 'white' asbestos

39 Pleura M 1919 1928 2 1961 Biopsy N/A N/A 18 Elder sister worked as spinner atasbestos factory and suffers fromasbestosis

32 Pleura F 1900 1941 5 1963 Biopsy N/A N/A 18 Daughter worked in asbestos factoryfor 5 years; patient washed heroveralls

36 Peritoneum F 1889 1912 18 1963 Biopsy N/A N/A 15 Husband railway carriage builder;lined compartments with asbestossheeting; work clothes washed athome

Section D: Neighbourhood cases44 Pleura F 1905 1913 7 1959 Biopsy N/A N/A 8 Lived within I mile of present site

of asbestos factory48 Pleura M 1922 1922 16 1960 Biopsy N/A N/A 17 Lived within * mile of present site

of asbestos factory42 Pleura F 1889 1913 48 1961 Biopsy Positive Negative 15 Lived within 100 yards of present

site of asbestos factory50 Pleura F 1903 1908 6 1961 Biopsy N/A N/A 13 Lived within I mile of old site of

asbestos factory43 Pleura F 1905 1913 13 1961 Biopsy N/A N/A 4 Lived within I mile of present site

of asbestos factory47 Pleura F 1917 1917 10 1961 Biopsy N/A N/A 16 Lived within 200 yards of present

site of asbestos factory64 Pleura F 1899 1907 6 1962 Biopsy Negative Negative 5 Lived within I mile of old site of

asbestos factory71 Pleura F 1899 1907 6 1962 Biopsy N/A N/A 12 Lived within I mile of old site of

asbestos factory41 Pleura F 1900 1913 32 1962 Biopsy N/A N/A 29 Lived within j mile of present site

of asbestos factory45 Pleura F 1900 1913 7 1962 Biopsy N/A N/A 9 Lived within * mile of present siteof asbestos factory

46 Pleura F 1907 1913 7 1963 Biopsy N/A N/A 7 Lived within I mile of present siteof asbestos factory

Section E: No history of contact with asbestos65 Pleura F 1900 1947 Necropsy Positive Negative 7 Worked as nursemaid to manager

of gas works in East London;asbestos insulation used in works

68 Peritoneum F 1902 1954 Necropsy Negative Negative 5 Shorthand-typist and housewife;lived Ilford area

49 Pleura M 1895 1954 Biopsy N/A N/A ? Baker's roundsman, army, generallabourer, publican for 30 years inEast End of London

75 Pleura F 1899 1955 Biopsy N/A N/A ? Munitions work before marriage,then housewife; lived WalthamAbbey, Essex

74 Peritoneum F 1904 1955 Necropsy Negative Negative 27 Tailoress and housewife in EastEnd of London

62 Pleura M 1899 1955 Necropsy Negative Positive 28 Employed as luteman and greaser,Beckton gas works 36 years;persistent discharging sinus R.side of chest following empyema1925, acute chest infection 1953,subsequent thoracoplasty but

-l-l-I-l - I______ l______ l______- ________ - deteriorated from this date

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MESOTHELIOMA OF PLEURA FOLLOWING EXPOSURE TO ASBESTOSAPPENDIX (continued)

EIGHTY-THREE PATIENTS WITH MESOTHELIAL TUMOURS

Dura- Patho-Year tion Asbestos logical Survival



Tissue

Peritoneum

Pleura

Pleura

Pleura

Pleura

Peritoneum

Pleura

Pleura

Pleura

Pleura

Pleura

Pleura

Peritoneum

Pleura

Peritoneum

Pleura

Pleura

Peritoneum

Pleura

M

M

F

M

F

M

M

M

M

M

F

F

M

F

M

F

M

1913

1904

1916

1891

1898

1879

1890

1904

1910

1911

1887

1888

1898

1888

1915

1897

1912

1901

1892

1955

1956 1

1957

1957

1958

Biopsy

Biopsy

Biopsy

Biopsy

Biopsy

1958 Biopsy

1959 Biopsy

1960 | Biopsy

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

1960 Necropsy Negative Negative


1962

1962

1962

Necropsy Negative Negative

Biopsy Negative Negative

Biopsy

1962 Necropsy

1962 Necropsy

1963 Biopsy

1963 Biopsy

N/A

Negative

Negative

N/A

N/A

N/A

Negative

Negative

N/A

N/A

1964 Necropsy INegative INegative

1964 Necropsy Positive Negative

8

12

19

11

6

3

12

18

18

?

10

30

10

2

54

29

24

42

24

Merchant seaman, cargoes from S.Africa 1930-32, no definite evidenceof contact with asbestos; subse-quently employed on cross-channelboatsLabourer and builder, finally em-ployed in tunnelling; lived in EastEnd of LondonEmployed remaking old sacks inBow, previous content ofsacks notascertained; lived East End ofLondonGarage hand, chauffeur, mechanic;lived Wolverhampton and EppingWorked as printing machinistbefore marriage, then as housewifeuntil death; lived East End ofLondon

Stereotyper and printer; livedoriginally in East London, thenmoved to IpswichVan boy, regular army, cutter andgrinder; lived N.E. London andDagenham

Bricklayer, cement worker, post-man; lived East End of London,moved to Hainault, Essex in 1931

Fitter and turner; lived principallyin East End of London

Coloured S. African merchant sea-man, stoker at glass factory;possible contact with asbestos inS. Africa or at sea

Lived until marriage in Wales, thenhousekeeper in S.W. London

Machinist of celluloid collars,housewife and canteen worker;lived East LondonMachinist in hosiery trade, Notting-ham, housewife; moved to London1960

Labourer, merchant seaman,docker, carried only meat

Apprentice printer, barman, cook,and butcher. For 25 years beforedeath lived East End of LondonDressmaker and housewife; livedEast End of London then Somerset

Steel erector, army, steel erector,labourer and porter; lived EastEnd of LondonEmployed as packer in pharma-ceutical firm for 12 years, thenhousewife until death; lived inDagenhamFisherman, fireman, docker, 1915-39 at Tilbury docks, fireman andfinally storekeeper; contact withasbestos not probable at Tilburydocks; lived Tilbury area

Section F: Untraced cases78 Pleura F 1893 1917 Necropsy ? Positive Not traced

83 Pleura M 1860 1922 Necropsy Negative Negative Not traced



82 Pleura M 1893 1938 Necropsy Positive Positive Not traced

77 Peritoneum F 1910 1945 Necropsy Positive Positive Not traced

79 Pleura F 1878 1955 Necropsy Positive Positive Not traced

N/A = tissue not available.

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58

66

57

52

63

51

59

73

70

72

55

60

67

56

69

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mesothelioma andperitoneum ...to the formation ofamassive pleural effusion. pain was a prominent...

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