Pulmonary Asbestosis: Radiographic Apprearances In Skiagrams Of The Chests Of Workers In Asbestos

Our plain-English summary of Pulmonary Asbestosis: Radiographic Apprearances In Skiagrams Of The Chests Of Workers In Asbestos, by W.B. Wood (1929).

The study

• Author: W.B. Wood
• Published: Tubercle 10:353-363, May (1929)
• Type of article: Journal article
• Our copy: from Johns-Manville's own medical library, J-M no. 003106.

In plain English

This 1929 article was a case series describing chest X-rays (then called skiagrams) of people who had worked with asbestos. The author collected fifteen chest X-rays of asbestos workers seen at a local tuberculosis dispensary in Barking and at the Victoria Park Chest Hospital, with brief case notes. An X-ray of a South African gold miner was included for comparison. Exposure to asbestos dust ranged from one year to fourteen years. The author reported that X-rays of those exposed longest showed shadows suggesting diffuse scarring (fibrosis), mainly in the lower two-thirds of the lungs. The author also described a 'ground glass' look with fine mottling, signs of pleurisy at the lung bases, and thickening of the pleura at the lung tops. In general, the density and extent of the shadows were proportional to the length of exposure. Three patients died. Lung sections from one showed numerous unusual bodies. The author judged a diagnosis of pulmonary asbestosis justified in most cases, but cautioned that the series was small, follow-up was short, and tuberculosis could not be ruled out.

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 notes and chest X-ray (skiagram) descriptions of individual asbestos workers
• Who was studied: Fifteen asbestos workers seen at a local dispensary in Barking and at the Victoria Park Chest Hospital (in-patients and out-patients), described in case notes I to XV. Case XVI was a comparison case: a man who had worked eleven years in South African gold mines.
• Exposure: Asbestos dust in asbestos factories and works. Jobs named in the case notes include grinding crude asbestos into fibre, spinning, work in a disintegration department, and store-keeping. Duration of work ranged from one year (Case IX) to fourteen years (Case II). The article does not say which asbestos fiber type these workers handled.
• Main results:
  • In workers exposed longest to asbestos dust, the most noticeable X-ray feature was shadows suggesting diffuse fibrosis, chiefly in the lower two-thirds of the lungs.
  • Some cases showed a 'ground glass' appearance, with fine mottling on close inspection. Where mottling was more definite, it lacked the coarse quality described in X-rays of other pneumoconiosis.
  • Other features were evidence of basal pleurisy, often with an obliterated costophrenic angle, and, in many cases, thickening of the apical pleural cap.
  • Ring-shaped shadows suggesting possible cavities were seen in only three cases. Tubercle bacilli had been found in the sputum of only one of these three.
  • In general, the density and extent of the lung shadows were proportional to the duration of exposure to dust.
  • Some patients complained of breathing symptoms only some time after they had stopped work (Cases I and X).
  • Three patients in the series died within a few months, and one autopsy was obtained. Lung sections from Case 7 showed numerous yellowish bodies similar to those reported by earlier writers. No similar forms were found in samples of raw asbestos or in workers' sputum.
• The authors' conclusion: The author concluded that a diagnosis of pulmonary asbestosis seemed justified in most of the cases. In the author's view, the probable diagnosis was indicated by: a dusky complexion, extreme breathlessness, wasting out of proportion to the physical signs, dry crackling sounds, no tubercle bacilli in the sputum, and a history of prolonged exposure to asbestos dust. The author called the prognosis grave once the disease was established.
• Limitations the authors state:
  • The series of X-ray films was small, so deductions had to be made with caution.
  • Most cases had been observed only for short periods. Negative or absent sputum tests on one or two occasions did not rule out tuberculosis.
  • The diagnosis lacked the final proof that only post-mortem examination can supply.
  • Reduced size and difficulties of reproduction prevented some details seen in the original films from being shown convincingly.

Topics

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

Browse return to medical research.