Pulmonary asbestosis with special reference to an epidemic at Hebden Bridge. The Milroy lecture, 1978

Our plain-English summary of Pulmonary asbestosis with special reference to an epidemic at Hebden Bridge. The Milroy lecture, 1978, by B. Mann (Journal of the Royal College of Physicians of London, 1978).

The study

• Author: B. Mann
• Journal: Journal of the Royal College of Physicians of London
• Published: 1978;12(4):297-307
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Free full text

In plain English

This 1978 lecture described asbestos disease at Acre Mill, Hebden Bridge, a factory operating 1939 to 1970 that employed about 2,200 workers and used chrysotile, crocidolite and amosite. The author reported that 262 workers (12 per cent) developed asbestosis of the thorax (lung or pleura), though clinicians might differ on some diagnoses; 77 of them had died. Of those 77 deaths, 44 were from lung cancer or mesothelioma. Among 100 consecutive cases, 11 were workers who never handled asbestos. Symptoms began on average 17.6 years after first exposure. Four workers had asbestosis with normal chest X-rays, confirmed by biopsy. At least three patients with pleural asbestosis later died of mesothelioma. Four nearby residents who never worked with asbestos had pleural thickening. Soil from a waste tip near a primary school contained crocidolite and/or amosite; air sampling, 15 years after dumping stopped, detected no fibres by optical microscopy. The author concluded that workers not directly handling asbestos also faced a real hazard. The author noted that emigrant workers could not be followed and that soil tests used only optical microscopy.

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: Lecture describing the author's clinical case series of asbestosis among workers at one factory, with soil and air sampling near the site; it also discusses other published studies
• Who was studied: Workers at Acre Mill, Hebden Bridge, near Halifax, England (open 1939 to 1970, about 2,200 workers employed), including 262 who developed thoracic asbestosis and a detailed series of 100 consecutive cases (69 males, 31 females); also four local residents and soil and air near the factory and an asbestos tip
• Exposure: Chrysotile (white), crocidolite (blue) and amosite (brown) asbestos used in asbestos textile manufacture, pipes, ropes, respirator filters and insulation material; also environmental exposure from living near the factory
• Main results:
  • 262 workers, 12 per cent of the Acre Mill labour force, developed asbestosis of the thorax (lung or pleura)
  • By comparison, 1.05 per cent of all workers in the same company's UK factories had been certified with asbestosis
  • Of the 262 workers with thoracic asbestosis, 77 died of asbestosis or a complication of it
  • Of the 77 deaths, 44 (57 per cent) were from lung cancer or mesothelioma and 18 (24 per cent) from heart failure, cor pulmonale or pulmonary thromboembolism
  • 11 of the 100 consecutive cases were 'other workers' who did not handle asbestos (gardeners, office workers, painters, lorry drivers, canteen workers)
  • This 'para-occupational' group had worked twice as long as the workers who developed asbestosis while handling asbestos fibre closely
  • The average interval from first exposure to first symptoms was 17.6 years, with wide variation
  • 37 per cent of cases had pleural damage only on X-ray
  • 41 per cent of cases had mixed pleural and pulmonary asbestosis, the commonest X-ray pattern
  • Four workers had asbestosis with normal chest X-rays, all confirmed by biopsy
  • At least three patients with pleural asbestosis later developed mesothelioma and died
  • One worker (Mr K. G.) who stacked asbestos materials for only nine weeks, starting at age 35, died of mesothelioma at age 48
  • Four Hebden Bridge residents who never worked with asbestos, and who lived or worked within two miles of the factory for over 25 years, had pleural thickening
  • Six soil samples from a footpath over Asbestos Tip No. 3, 150 metres from a primary school, all contained crocidolite and/or amosite
  • Of 13 soil samples from two fields next to the factory, eight had no asbestos fibres and five had a few short fibres
  • Air sampling at five points between the tip and the school playground, 15 years after dumping had ceased, detected no asbestos fibres by optical microscopy
• The authors' conclusion: The author concluded that there is a real hazard of asbestosis among 'para-occupational' workers who do not directly handle asbestos
• Limitations the authors state:
  • Workers who emigrated or returned abroad could not be followed up, so the figures probably underestimate the true situation
  • Clinicians may differ in their opinion on some of the 262 diagnoses
  • Soil testing used optical microscopy only, not X-ray diffraction or electron microscopy, so the findings must be interpreted with caution
  • Hundreds of local residents had X-rays showing no abnormalities that could have been caused by asbestosis

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis.

Medical terms in this study, explained in our Lexicon: Asbestosis.

Related studies

• Neoplasia among insulation workers in the United States with special reference to intra-abdominal neoplasia — E.C. Hammond, I.J. Selikoff, et al. (1965)
• Radiotherapy in the treatment of malignant mesothelioma of the pleura, with special reference to its use in palliation — S.R. Davis, L. Tan, et al. (1994)
• Evaluation of pleural disease using MR and CT. With special reference to malignant pleural mesothelioma — A. Knuuttila, L. Kivisaari, et al. (2001)
• Clinical study of asbestos-related lung cancer in Japan with special reference to occupational history — T. Kishimoto, K. Gemba, et al. (2010)
• A case-control study of lung cancer with special reference to asbestos exposure — M. Minowa, S. Hatano, et al. (1991)
• Malignant pleural mesothelioma: clinicopathology of 16 extrapleural pneumonectomy patients with special reference to early stage features — K. Hiroshima, T. Yusa, et al. (2009)

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