Pulmonary Asbestosis

Our plain-English summary of Pulmonary Asbestosis, by W.B. Wood, S.R. Gloyne (1930).

The study

• Authors: W.B. Wood, S.R. Gloyne
• Published: Lancet 1:445-448, March 1 (1930)
• Type of article: Journal article
• Our copy: from Johns-Manville's own medical library, J-M no. 003094. The article is still under copyright, so we describe it here rather than post it.

In plain English

This 1930 article described the symptoms, signs, X-ray findings and post-mortem lung changes of pulmonary asbestosis, caused by inhaling asbestos dust. The authors drew on 37 cases examined at Victoria Park, including 4 asbestos workers with doubtful diagnosis, and four post-mortem records. The main symptoms were breathlessness and cough. Lung scarring (fibrosis) was found mostly at the bases of the lungs. In advanced, uncomplicated cases they regarded the chest X-ray as distinctive. They listed 'asbestosis bodies' as a distinctive microscopic finding. Of 15 cases reported in 1929, three had died: two of broncho-pneumonia, one of pulmonary tuberculosis. The authors proposed three stages. The first was asbestos fibres in the nose or mouth, showing exposure but not necessarily disease. The second was asbestosis bodies, which they accepted as a sign of disease. The third was typical clinical evidence of the disease. They called symptomatic treatment disappointing and saw preventing fibre inhalation as the only hope for asbestos workers. They reported that once asbestosis bodies appeared in sputum the disease seemed progressively downward. Stopping exposure did not appear to check it, and death ultimately came from broncho-pneumonia or tuberculosis.

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: case series: clinical, radiological and post-mortem description of the authors' own cases
• Who was studied: 37 cases examined at Victoria Park (London), including 4 asbestos workers with doubtful diagnosis, together with four post-mortem records; this builds on an earlier report of 15 cases with radiograms published in 1929
• Exposure: Asbestos dust made of fine asbestos fibres produced in industrial processes. The article does not name specific fiber types.
• Main results:
  • The main symptoms were breathlessness (dyspnoea) and cough
  • Physical signs were those of lung fibrosis limited to, or mostly at, the lung bases; at post-mortem the fibrosis was most marked at the bases
  • In an advanced and uncomplicated case, the authors considered the X-ray picture distinctive (pathognomonic)
  • Of the 15 cases reported in 1929, three had died: two of broncho-pneumonia and one of pulmonary tuberculosis
  • In three of the authors' cases, it seemed probable that tuberculosis had developed in lungs that were already damaged
  • Asbestosis bodies were listed among the post-mortem lung changes and were described as pathognomonic
  • Asbestos fibres were also found in the tear fluid (lacrymal secretion) of one patient
  • Once asbestosis bodies appeared in the sputum, the course of the disease seemed to be progressively downward
  • Stopping further exposure did not appear to check the spread of the disease
  • The authors stated that death ultimately ensued from broncho-pneumonia or tuberculosis
• The authors' conclusion: The authors proposed three stages. Stage 1 is fibres in nasal secretion or the mouth, showing exposure but not necessarily disease. Stage 2 is asbestosis bodies, which they accepted as a sign that disease is present. Stage 3 is typical evidence of the disease. They described symptomatic treatment as disappointing and concluded that the only hope for asbestos workers lay in proper means of preventing inhalation of the fibres.
• Limitations the authors state:
  • The authors stated it was too early in the study of the disease to say something about its prognosis; the rest of the sentence is lost in the OCR
  • In the earlier stages of the disease, a definite diagnosis may be impossible
  • The authors could not decide whether the disease reactivates quiescent tuberculosis or whether tuberculosis develops on top of asbestosis as a terminal event

Topics

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

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