Pulmonary Asbestosis Ii: Including The Report Of A Pure Case

Our plain-English summary of Pulmonary Asbestosis Ii: Including The Report Of A Pure Case, by K.M. Lynch, W.A. Smith (1931).

The study

• Authors: K.M. Lynch, W.A. Smith
• Published: American Review Of Tuberculosis 23:643-660 (1931)
• Type of article: Journal article
• Our copy: from Johns-Manville's own medical library, J-M no. 003066. The article is still under copyright, so we describe it here rather than post it.

In plain English

This article reviewed published reports of pulmonary asbestosis and described one Charleston, South Carolina, patient. He was a white man, 46 when first seen at Roper Hospital's chest clinic in November 1925. He began as a carder at a local asbestos plant in 1911 or 1912 and worked there with interruptions for approximately 11 years through May 1925; the scan garbles a fraction after the 11. He then returned to the plant for several months in 1926. The authors said the plant had extremely poor ventilation and no dust removal. His physician diagnosed pulmonary tuberculosis, but his sputum never showed tubercle bacilli. He died of congestive heart failure in 1930. At autopsy his lungs showed extreme fibrosis but no evidence of tuberculosis. Numerous asbestosis bodies were found in fluid pressed from the lungs, though none in his sputum. The authors concluded this was a pure case of long-standing asbestosis ending in slow heart failure. As far as they knew, it was the first such case to reach autopsy in the United States. Their review collected 172 published cases. Of these, 27 were confirmed by finding asbestosis bodies, and 18 had come to autopsy.

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 report (one patient examined at autopsy) combined with a review of previously published cases of pulmonary asbestosis
• Who was studied: One white male patient, aged 46 when first seen at the chest clinic of Roper Hospital, Charleston, South Carolina, in November 1925; he died in Roper Hospital in 1930. The review covered 172 cases from the published literature.
• Exposure: Work in a local asbestos plant, beginning in 1911 or 1912 as a carder. Employment was interrupted and totaled approximately 11 years (plus a fraction garbled in the scan) through May 1925. He returned to the plant for several months in 1926. The authors state ventilation was extremely poor and there was no provision for dust removal. No fiber type is named; the article refers to asbestos dust.
• Main results:
  • The patient's physician had diagnosed pulmonary tuberculosis, and he was sent to a sanatorium, but sputum tests for tubercle bacilli were negative.
  • In his final illness his sputum was negative for tubercle bacilli and for asbestosis bodies on four examinations.
  • He died of congestive heart failure about three weeks after admission to Roper Hospital in April 1930.
  • At autopsy the lungs showed an extreme grade of hyalinizing fibrosis, both pleural sacs were obliterated by old adhesions, and the right heart was enlarged.
  • Fluid pressed from the lungs contained numerous asbestosis bodies. No evidence of tuberculosis was found.
  • The cavities suspected on X-ray were not found at autopsy. The authors attributed them to groups of very large emphysematous bullae, with one small pneumothorax.
  • The authors noted in the lungs the laminated hyaline fibrous nodule previously described as characteristic of silicosis.
  • The literature review collected 172 cases of pulmonary asbestosis.
  • Of the 172 reviewed cases, 27 were confirmed by finding asbestosis bodies in sputum, in lung juice obtained by puncture, or at necropsy.
  • Of the 172 reviewed cases, 18 had come to necropsy.
  • Among the reviewed cases there were 4 necropsy records of uncomplicated pulmonary asbestosis, including Murray's case of 1900.
• The authors' conclusion: The authors concluded that this was a pure case of long-standing asbestosis. In their view, it led through extreme lung fibrosis and right heart strain to death from slow cardiac failure, which they called the natural end result of uncomplicated lung disease of this extent. They described it as the first such case to come to necropsy in the United States, so far as they could ascertain. They also suggested that in late cases sputum examination for asbestosis bodies may be less useful than in earlier stages.
• Limitations the authors state:
  • The body had been embalmed before autopsy, which the authors suggest may have interfered with observing cyanosis.
  • In the reviewed literature, the diagnosis in most cases rested entirely on clinical and X-ray findings, and in four cases from Wood's series it was doubtful.
  • Lung puncture to look for asbestosis bodies was not attempted in this patient.

Topics

Medical terms in this study, explained in our Lexicon: Asbestosis, Sputum, Autopsy, Fibrosis, Standing.

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