To the Editor:
The index case had worked from 1964 to 1993 as maintenance fitter in an asbestos factory. He dusted down machines, repaired them, and swept up afterwards. He worked all over the factory, "Asbestos dust lay thick everywhere" was his comment. Danger from asbestos produced no concern to the 1960s, in that no factory precautions were taken. Thus, no masks or caps were worn, machines were not washed down, and there were no extractor fans. There was asbestos laden white dust outside the showers and changing reruns. A shower would be like "taking a dust bath," he said. Following legislation in the early 1970s, working conditions at the factory had improved, and the firm began phasing out asbestos products. The fitter was then provided with a cap and mask, but recalls no warning being given to avoid contamination with any dust about the factory, and no one was told that the dust was dangerous. In May 1993, he became ill and has not worked since then. Symptoms and findings confirmed the diagnosis of asbestosis, following employment in the asbestos factory from 1964 to 1993, and he began drawing compensation backdated to 1987.
The special interest arises out of people who were not employed at the factory but who had contact with the index case and coworkers. The fitter took his overalls home, where his daughter shook them free from dust and laundered them. Twenty years later, she was said to have been found to have pleural plaques, presumed related to asbestos exposure. He knew of several men at the factory whose wives had laundered their overalls at home anti had had "chest trouble," but he knew no details.
However, the indirect exposure associated with the most serious consequence related to the barber. Men from the factory often went to the village barber during the lunch break, for a haircut. The barber had worked over forty years locally until retirement in 1987 at the age of 63 years. An account from his assistant employed for his final 18 years said, "The men write often covered with dust, you combed it out of their hair, you worked at hair level, and shook the cloth afterwards." At no time had the barber worked inside the asbestos factory premises, and (as far as could be determined) any asbestos exposure arose only in his barber shop. He died in hospital in 1992 of pneumonia and mesothelioma (of the left lung), which the coroner decided was asbestos related. The case illustrates the potential for serious asbestos exposure in people (such as the barber) closely associated with workers who were themselves exposed when control measures and risk awareness were largely nonexistent.
John P. V. Rigby, BM
Guy's Hospital
London, UK
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (e-mail: permissions@chestnet.org).
Correspondence to: John P. V. Rigby BM, Huntsmoor Weir, Old Mill Lane, Cowley, Uxbridge, United Kingdom UB8 2JH
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