Asbestosis: A Roentgenologic Review Of 71 Cases

Our plain-English summary of Asbestosis: A Roentgenologic Review Of 71 Cases, by J.R. Shull (1936).

The study

• Author: J.R. Shull
• Published: Radiology 27(3):279-292, September (1936)
• Type of article: Journal article
• Our copy: from Johns-Manville's own medical library, J-M no. 002984. The article is still under copyright, so we describe it here rather than post it.

In plain English

This 1936 article by a Charlotte, North Carolina physician reviewed chest X-rays of 71 of 100 workers dismissed from local asbestos plants. These workers had been found physically disabled and referred for X-ray study, and were examined from late 1934 into January 1935. There were 56 white males, six white females and nine negro males. Average age was 34.4 years, and exposure ranged from 16 months to 21 years. The author grouped cases by extent of lung scarring (fibrosis): 16 slightly, 35 moderately and 20 markedly advanced. Eight (11.3 per cent) had tuberculosis. Five patients later died. Autopsies on two markedly advanced patients found lung fibrosis containing asbestos. One had died of acute fulminating tuberculosis, the other of asbestosis. Twenty-one patients were re-examined. Lung X-rays improved in five of nine slightly and three of seven moderately advanced cases. Three of five markedly advanced cases showed more fibrosis. The author concluded that asbestosis differs from silicosis, does not predispose to tuberculosis, and is not primarily progressive. The author cautioned that the re-examined group was too small, and follow-up perhaps too short, for definite conclusions about progression on X-rays.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Radiologic (X-ray) case series of disabled asbestos workers, with follow-up X-rays on some patients and two autopsy reports
• Who was studied: 71 of 100 workers dismissed from local asbestos plants near Charlotte, North Carolina: 56 white males, six white females and nine negro males, average age 34.4 years. The author places the examinations in the latter part of 1934, and figure captions show examination dates up to January 7, 1935.
• Exposure: Work in asbestos plants, with inhalation of asbestos dust and fiber, for 16 months to 21 years. No fiber type is named. The author states that the degree of exposure (type and amount of dust) could not be determined.
• Main results:
  • Examinations shown in the figure captions include one dated January 7, 1935, so not all examinations fell in late 1934
  • Cases were classified by extent of fibrosis: 16 slightly advanced, 35 moderately advanced and 20 markedly advanced
  • Markedly advanced group (20 patients): average age 37.1 years, average exposure 8.7 years, all males (16 white, four colored). Only one lacked X-ray evidence of right-sided heart enlargement.
  • Eight recognized cases of tuberculosis (11.3 per cent) in the entire series; only two appeared active
  • Five patients died after examination. Autopsy was performed on two, and 21 of the remaining 66 patients were re-examined.
  • On re-examination, five of nine slightly advanced cases showed improvement in the lung picture and only one showed increased fibrosis
  • Of seven re-examined moderately advanced cases, three showed improvement in the lung picture and two a definite spread of disease
  • Of five re-examined markedly advanced cases, one showed no change and three showed more fibrosis; clinically, four showed no improvement
  • Two markedly advanced patients had autopsies. S. G. died three months after examination of acute fulminating tuberculosis, which had shown no X-ray evidence. That autopsy found fibrosis containing fine asbestos shreds, along with tuberculous areas.
  • The other autopsied patient, P. J. V., died one month after examination of asbestosis. That autopsy found extensive fibrosis with numerous asbestos spicules and a dilated right ventricle. No tuberculosis was found.
  • Only six patients in the entire series showed slight displacement of the trachea, and three of these had X-ray evidence of tuberculosis
  • The article reports that, after a North Carolina court case, the State Legislature of 1935 amended the Compensation Act to include 25 occupational diseases, including asbestosis
• The authors' conclusion: The author concluded that asbestosis is a definite disease distinct from silicosis, and that a fair percentage of slightly and moderately advanced cases tend to improve when removed from asbestos dust. The author also concluded that asbestosis does not predispose to tuberculosis and is not primarily a progressive disease.
• Limitations the authors state:
  • The re-examined group was too small, and perhaps too little time had passed, to draw definite conclusions about the progress of the disease on X-rays
  • The degree of exposure (type and amount of dust inhaled) could not be determined
  • X-ray findings in early cases are not diagnostic without a history of exposure

Topics

Medical terms in this study, explained in our Lexicon: Chest X-Ray, Fibrosis, Silicosis.

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