Document jmw13BpDNQ0zzDqr9zBMYq5jR

FILE NAME: Asbestos Sacks and Bags (ASB) DATE: 2004 DOC#: ASB089 DOCUMENT DESCRIPTION: Journal Article - The Doctors and the Dockers AMERICAN! JOURNAL OF INDUSTRIAL MEDICINE 45:573-581 (2004) Historical Perspective T he Doctors and the Dockers Morris Greenberg* Background London Dockers unloading a dusty' asbestos cargo in 1965, consulted an eminent Occupational Health physician, Dr, Donald Hunter who informed them that they had been at serious risk. A second, opinion provided jointly by a Consultant Chest Physician, the Port Medical Officer, and the Medical. Advisor to the Trades Union Congress, declared that they knew o f no disease affecting dockers, and stated that intermittent exposure to asbestos constituted an inconsiderable risk that with certain precautions would he eradicated. Methods A rchival material have been obtained to supplement limited published material and eyewitness accounts o f the event, to provide a clearerpicture o f the issues. R esults Reassured by the Chest Physician, the Port Medical Officer, and the Medical Advisor to the Trades Union Congress that they had little tofear, London dockers resumed unloading asbestos. From time to time dockers at other ports were to express concern and interrupt work, only to be similarly reassured, Conclusions Had the medical troika in 1965 considered the available health statistics, they would have had reason to take a less sanguine attitude to the cancer mortality o f dockers. An analysis o f datafo r 16 selected occupationsfa r the years 1900-1902, showed dockers to have an unhealthyjob, with deathsfrom 'All Cancers'o f1.09per 1,000years of life (thefourth highest). The Registrar General's occupational mortality reportfo r 1951, noted excess tumors o fthe lung and stomachfo r dockers. Elevated Standardized Mortality Ratios fo r lung cancer had consistently been calculated by the Registrar Generalfo r the 20--64 age group o fdockers; in 1931 (183), 1951 (149), and 1961 (169): by 1971 it would be 182. A total o f 266 dockers were to be registered in the UK by 1999 as having died o f malignant mesotheliomas, proving that Donald Hunter's concernfo r dockers had not been excessive. Am. 3. lad. Med. 45:573--581, 2004. ffi 2004 Witey-Uss, Inc. KEY WORDS: Britain; dockers; doctors; asbestos; lung cancer; malignant mesothelioma; occupational health IN T R O D U C T IO N 74,NorthBid Road,London,United Kingdom Contract grantsponsor.TheJoseph RowntreeCharitabieTrust 'Correspondenceto:Dr.Morris Greenberg,74,NorthEnd Road,London,NW117SY.UK. E-maii: gillmems.gteenberg @ btintemet.com Accepted 18 February 2004 DOi 10.10Q2iapm.200U.Publishedonline inWileyInterScience (ww/wifl.iinttaerr&sro*iiePn.ncre.e.wwilteayu.ncnomml) While all physicians are presumed to have the best interests of their patients at heart, in the matter of giving advice on the hazards arising from occupation, an adversarial situation can arise in which physicians advising workers, industry. Under these circumstances it requires more than scientific acumen to distinguish between the physician as `Attorney of the Poor' or as `Enemy of the People.' in 1.965, a group of dockers in the Port of London, consulted D.r. Donald Hunter about the hazard to their health 2004 Wiiey-Liss, Inc. 574 Greenberg from unloading dusty asbestos cargoes. His opinion was that the inquiring dockers had been at serious risk, and recommended ways of reducing it in the future [Hunter, 1965], Industry considered that his alarm was excessive, and presumably because no individual could be identified o f sufficient authority to refute him, they appointed three physicians to review die problem. They were dismissive of the risks of die dockers' intermittent exposures to high levels of asbestos, reserving the use of respirators and protective clothing in the event of substantial spills [Perry' et a!., 1967], Reassured, the London dockers resumed unloading asbestos cargoes. Published and internal industry records have been reviewed to dirow light on the roles played by the physicians who became involved in die incident, the belter to equip the reader to decide where Virchow's and Ibsen's epidiets are best fitted to the physicians involved in the controversy. A BRIEF RESUME OF THE AWARE MESS OF ASBESTOS AS A HUMAN HEALTH H AZARD BY 1965 tuberculosis mortality rates at Thetford Mines, either that inhalation of asbestos dust pre-disposes to and aggravates pulmonary tuberculosis, or that many deaths certified at Thetford Mines as having been due to pulmonary tubercu losis were inaccurately diagnosed, and in reality were due to asbestosis. It was not for some time that the health hazard of miners and millers was acknowledged [Cartier, 1955]. When a causal association between asbestos exposure and excess lung cancer was confirmed [Doll, 1955], it was denied that it applied to Canadian miners [Braun and Truan, 1958], International consensus had earlier been reached about fire carcinogenicity of asbestos [Anonymous, 1953], hut at the landmark New York Academy of Sciences meeting on Asbestos in [Whipple and van Reyen, 1965], industry continued to question the causal association between asbestos exposure and excess cancers, and iterated the traditional claims that improved conditions had consigned asbestos diseases to history. The emergence of malignant mesothelioma as an as bestos associated hazard [Wagner et al., i960], added a further dimension to the problem. Commercial mining for chrysolile asbestos started in Quebec in die late 1870s, and in 1898 it was reported in die UK to be one of the four most hazardous occupational dusts [Deane, 1899]. Shortly after, a London asbestos textile worker in his earl}' 30s, die last survivor of ten men who had been employed together in an asbestos process 14 years previously, died from `fibroid phthisis' [Murray, 1907], Further alarming reports of respiratory disease and death in asbestos workers followed from France [Auribaull. 1907], from Italy [Scarpa, 19Q8j, and again from England [Collis, 1911]. A few years later, American and Canadian insur ance companies generally declined to accept asbestos workers [Hoffman, 1918], and the clinical picture and abnormalities in the chest radiographs of 15 American asbestos workers were reported [Pancoast et ah, 1918]. By 1924, when the first detailed clinico-pathological case report o f asbestosis was published [Cooke, 1924], physicians in towns with asbes tos factories were already familiar with the condition [Joss, 1924; Grieve, 1927]. In 1930, an H.M. Factory Inspec torate survey revealed the extent of asbestosis that prevailed in the manufacturing industry [Merewether and Price, 1930]. Miners and millers of Canadian chrysotile had repeat edly been given a clean bill o f health by government and industry [Department of Labour, 1912; Pedley, 1930; Stevenson, 1940], though the actuaries knew better [Hoff man, 1918; Fitzhugh. 1935], A dissenting medical opinion asserted that all the facts essential to the welfare of people exposed to the hazards o f asbestos dust had been well-known in North American mining and medical circles [LeDoux, 1949]. After comparing tuberculosis rates of Thetford Mines, with inhabitants of Sorel and Granby who were not exposed to asbestos, Ledoux concluded from the abnormally high PHYSICIANS INVOLVED IN ASSESSING THE HEALTH RISKS TO DOCKERS FROM ASBESTOS Dr. D sw ald Hunter Dr. Donald Hunter's interest in Occupational Health developed after a research assistantship in 1926 at Harvard, and continued on his return to The London Hospital as Assistant Physician. In 1943 he was invited to be FounderDirector of the Medical Research Council's (MRC) Depart ment for Research in Industrial Medicine at The London Hospital. As Founder-Editor of the British Journal of Industrial Medicine and author of a singular book on `Health in Industry,' he received international acclaim. Of humble origins, born son of a Post Office worker and brought up in the East End of London, he metamorphosed into a Censor and Senior Fellow of the Royal College of Physicians, and Commander of the British Empire, nevertheless he rallied promptly to the call from the East End dockers. Dr. Robert M urray Dr. Robert Murray joined HM Inspectorate o f Factories in 1947, and being based in Manchester would have gained valuable experience from the inspection o f regional asbestos factories. One of them, Acre Mill, would return to haunt [Parliamentary Commissioner for Administration, 1976]. He moved to the International Labour Organisation (1LO) Occupational Safety and Health division, returning to the UK in 1961 as Medical Advisor to the Trades Union Congress (TUC), which he was to leave in 1974. Like Hunter London Dockers 575 he was of modest origins, and achieved honors including an award of the Order of the British Empire. After the TUC he established a thriving national and international consultancy practice, receiving commissions from industry and from a number of unions. He continued to be involved in the control of asbestos after leaving the TUC, both as a consultant to industry and by his influence at the ILO. Sr. Kenneth Perry Dr. Kenneth Perry was a Consultant Physician at The London Hospital, who like Hunter had `been to America' as a research fellow, a rite of passage for promising young physicians, and had worked for the MRC during the Second World War investigating occupational diseases. His obituary in the British Medical Journal (6th October 1984) described him as having a critical eye for both medical and political scenes about which he held strong views: this might have influenced his choice as an opinion to counter Hunter's. anybody there who knew about asbestos. At which a more experienced and now eminent Hunter came out of a meeting to talk to them, a consultation for which he requested a plebeian fee of a beer and a sandwich. A graphic account has been given by a docker of the process of transferring asbestos from Hie hold of a ship to a lighter in the South West India Docks (London). Four hundred to five hundred tons of asbestos were stowed in sacks in a ship's compartment measuring 18 feet square and 5 0 70 feet deep, that was entered at the top through a 9 feet square entrance [Slower, 1985]. The docker descended vertically into the hold mid emerged by means of steel rungs welded to the wall. The physical effort of the work combined with the physiological stress arising from the temperature in the hold which was proximal to the boiler room, would have limited the ability to tolerate for long, adequately protective clothing and respirators had they been provided. After inspecting the unloading process in the ship concerned, Hunter wrote to the dockers' representative: Dr. A.ML Lawrence-Smith Dr. A.M. Lawrence-Smith, was Principal Medical Officer to the Port of London Authority, and would be expected to have had a more extensive and intimate knowledge of the work practices of dockers and stevedores and of their health experience than the text books betrayed. Dr. Donald Hunter on A sb e s to s The young Dr. Hunter's opinion on the dangers o f asbestos was presented on 10th January 1934 at a meeting in Manchester in an address entitled: `Industrial Toxicology of Today.' A postscript to a letter addressed to the inventor of the Asbestos Spray process by an industry' colleague noted: `It is my considered opinion that the Siebe Gorman m ask Mk 4, must be used by all the men, both in the hold and in the barges, in spite of the fact that the breathing resistance creates a difficulty'. I realize that it will take much longer to unload a given cargo but if their health is damaged by asbestos, the process is irreversible. Further, I take the view that vacuum suction must be used on the cargo itself during the whole period of unloading, for whenever a bag breaks, the dangerous powder is scattered around and must be removed so that it cannot escape into the working environment [Hunter, 1965]. INDUSTRY'S RESPONSE T O HUNTER `As a m atter o f interest, we have ju st learned that a Dr. Hunter o f London has recently given a paper in Manchester to both the Medical Society and Chemical Society on this subject, during which, I understand he referred to the Dolbey process as " murderous" [Anonymous, 1934].' (There was no occasion for the owners of the patent to be alarmed; sprayers were to continue to work throughout the world for some 40 years and die quietly.) in 1965, the story as related in a personal communication by the late Alan Dalton, who interviewed some survivors a number o f years later to obtain evidence in his defense of a suit for defamation brought by Robert Murray. One day a number of East End dockers, troubled by a particularly dusty asbestos cargo that they were unloading, set out for The London Hospital and on arriving asked whether there was The Shipowners' Joint Industrial Body responsible for working conditions within the Ocean Trades of the Port of London, claimed that Hunter's precautions would have a grave effect on the importing of asbestos through the Port of London. They commissioned what they called a Consultant Biochemist to examine the dust count in the atmosphere o f a ship's hold during the discharge of various kinds of bags, though they had doubts that: \ . .the men will accept the conclusions reached, in face of the opinion held by Dr. Hunter.. The "Consultant Biochemist" laboratory being situated conveniently dose to Harley and Wimpole Streets, served their medical practitioners as well as conducting a more general Public Analyst service. The Secretary of the Shipowners' Joint Industrial Body wrote to Turner and Newall: `.. .it would assist me greatly if you could advise me of an eminent Doctor, who might even in the face o f Dr. Hunter's views, give an opinion on the 576 Greenberg Biochemist's report' [Bennett, 1965]. The inference being that a physician could be found who was more favorablydisposed to asbestos and whose opinions and recommenda tions would not prove so restrictive. This question was passed to Turners Asbestos Fibres Ltd., who in turn passed it to Turner and Newall (T & N) their Manchester based bolding company, with the comment that: We have been singularly fortunate so far in that our difficulties with the dockers have not been ventilated publicly, especially as they would make excellent material for a feature on radio, television or in the p ress.. .it is only a matter of time before publicity overtakes us, especially if a reporter gets hold of Dr. Donald Hunter [Fell, 1965], T & N consulted Dr. Knox, medical officer to Turner Brothers Asbestos (TBA) Rochdale who referred the mat ter to his Manager, who agreed with the suggestion that Dr. Walter Smither, medical officer to Cape Asbestos at Barking, whose raw material arrived at the West India Docks, would be able to advise the London Group of Shipowners [Waddell, 1965], Cape Asbestos, Barking had been estab lished in 1913, and from 1929 onwards its disabled workers were to find their way in increasing numbers to the local Medical Officer of Health's Tuberculosis Clinic, The London Hospital, and the City of London Hospital for Diseases of the Heart and Lungs, Victoria Park East. Smither had been recruited from general practice, but in following tip Cape employees at clinics and at Coroners' autopsies, in a short period should have gained considerable experience of diseases associated with asbestos. On receiving the preliminary report dated 3rd August 1965 from the Chemical Analytical Laboratory' of airborne asbestos during unloading [Milton, 1965], a letter was sent out on 5th August by the Joint Secretary' of foe industrial Committee for a meeting of Employers on the 9th, accom panied by a copy of the Environmental Analyst's interim report. The impression from an overall look at foe interim report indicates that foe analyst was unfamiliar with best practice for measuring the exposure of individuals to asbestos, let alone airborne dusts. The characteristics of the sampling instrument were not given, but the environmental measure ment was of "background" airborne dust in terms of milli grams per cubic foot. The analyst's study of foe literature persuaded him that the harmful fraction of asbestos was contained in particles from 10 to 50 microns. Based on the US Public Health Service's tentative suggestion for a hygiene standard in 1938, which he assumed to be a safe level, he calculated 5 million particles per cubic foot to be equivalent to 2.5 mg per cubic foot by weight. (The full report issued 12 months later, while still sanguine about foe health pros pects of dockers on the whole, was more guarded as to the safety of 5 mppcf). Three air samples were stated to contain 1.3, 1.4, and 1.5 mg/cu. ft. which were deemed safe. At a meeting held on 12th August 1965 at the Ministry' of Labour, HM Chief Inspector o f Factories and his officials met with a Commercial Councillor in the High Commission for Canada, and a representative of UK Asbestos Producers and Merchants. Prior to foe meeting, a representative of the Board of Trade had written to the Ministry of Labourexpressing fears that if imports of asbestos were banned, the vital motor industry and building trades would cease, and many thousands of workers would be laid off and vital export trade would be lost. In the event, the meeting resolved nothing other than that HM Factory Inspectorate would investigate the handling of asbestos in the docks. The Ministry of Labour wrote to foe employers some 10 weeks later to foe effect that the 5 mppcf level had been exceeded when unlined hessian sacks were used and foe work rate was normal. PHYSICIANS ON THE HAZARD OF UNLOADING ASBESTOS CARGOES A summary account of problems with foe Dockers as seen from an Industry viewpoint was given in a memorandum from TBA to its holding Company. In reference to this impending report the author o f the memorandum wrote: " .. .1 know Dr. M urray well personally and I have been in touch with him three times in the last few days. He told me that Dr. LawrenceSmith and Dr. Perry and him self had prepared a report designed to allay the fears of the dockers. .. .Where the hags are broken they recommend respirators, which means slow handling and special rates, but otherwise they do not think that there would be any objection by the dockers to unloading white asbestos ,. .Before signing and publishing this report, however, Dr. Murray was asked to attend a big meeting o f dockers, along with Trade Union officials, at the West India D ocks.. when he hoped to get them to agree to recommence handling white asbestos.. .Dr. M ur ray also told me that he had been instrumental in settling two stoppages of work in Glasgow-- one on the Q4 with `M arinite' and one on a building site with Asbestolux." Interest was aroused in the National Press by the dockers, and the Press in turn attracted foe dockers' interest. An article in Tire Sunday Times of 31st October 1965 headed, `Scientists track down a killer dust disease,' which largely dealt with malignant mesotheliomas, drew attention to the London Dockers 57? series of cases identified by Dr. Muriel Newhouse in The London Hospital files, one of which included a docker's wife of whom it was said that her husband came home with his work clothes covered in asbestos, which she brushed down [Newhouse and Thompson, 1965]. Under the headline, `Dockers fear health peril from asbestos,' on 30th October 1966 The Sunday Times, reported that Dr. Lawrenee-Smith had made: `.. . a controversial attempt to assuage their (dockers') fears.. and had circu lated a signed statement among the men which stated that: .. .the M inistry o f Labour arranged scientific investigations which excluded the lung disease o f "asbestosis" as a risk to dock laborers, that the development of the tumor associated with asbestos-known as mesothelioma-requires simi lar circumstances to those causing asbestosis, and that the tumor only occurs where a particular variety and grade of dust, not found in com mercial cargo, is released into the air.. .He has an assurance from HM Medical Inspectorate that the gangs run no risk of mesothelioma or as bestosis in handling such cargoes. The three doctors finally reported in 1967 with the conclusion: Our inquiries have found no case of injuiy to the health of a dock worker in the Port of London that could have resulted from employment there with asbestos cargoes; and we have no knowl edge o f any cases of Asbestosis occurring in the Docks Industry in the country, as a result of Dock work [Perry et ak, 1967]. Dockers nationwide were informed: We are fully satisfied as far as the Docks Industry is concerned, that no unacceptable risk at present exists and that provided the currently approved methods of work are followed, Dockers may proceed with confidence in the handling of asbestos cargoes... The categorical statement:1. . .our inquiries have found no case of injury to die health of a dock worker in the Port of London that could have resulted from employment there with asbestos cargoes.. would seem to have been accepted in the absence of supporting evidence. The assertion: `That no unacceptable risk exists at present in the Docks Industry,' begged the question of what risk was acceptable, and was not evidence based. In the absence of demonstration that a threshold dose of asbestos existed below which it had no carcinogenic effect, the claim that: `Asbestos can only be a risk if substantial amounts are inhaled and that it is perfectly safe to handle otherwise.. was unjustified. Similarly the three `facts' included in the statement: (1) `Scientific investigations had excluded "asbestosis" as a risk to dock laborers;' (2) `...mesothelioma occurs with as bestosis. . ( 3 ) . . .(mesothelioma) results from a particular variety and grade of dust not found in commercial cargoes; were unfounded. No scientific investigation addressed to asbestosis had been conducted, asbestosis had not been demonstrated to be a necessary precursor to mesothelioma or to bronchial carcinoma for that matter, and all varieties of asbestos were to be found in commercial cargoes at that time. The Dock Industry newspaper, under the banner head line: `The facts about asbestos,' included several sub-texts [The Port, 1967]. Prominently, under the headline: `A new statement signed by all sides: No unacceptable risk exists,' there was the lull report of the three-doctor inquiry without critical comment. Separately, the views of Dr, Robert Murray and of Dr. Lawrenee-Smith were reported. Dr. Murray was presented as largely attacking crocidolite, insisting that it was so dangerous that it would be wrong to stand the chance of the slightest amount of the dust getting into the atmos phere, and going so far as to declare that he would not be entirely happy until there was a total ban on its import. As for amosite and chrysotile, he saw it legitimate for dockers to handle palletised impermeable bags, provided masks were available in case of spillage, until containerisation was instituted. Dr. Lawrenee-Smith was quoted as describing the risks to dockers as negligible, though adding the caveat: `we have to take precautions and keep our eye on the matter.' EVIDENCE FOR AN EXCESS CANCER MORTALITY RISK FOR DOCKERS The statement that: `Dockers are no more likely to get lung cancer than anybody else' was not supported by evidence readily available at that time. An earlier analysis o f British mortality data for 16 selected occupations, showed dockers to have experienced a rate of deaths from `All Cancers' of 1.09 per 1,000 years of life, which as fourth highest should have been of concern, though specific sites were not mentioned [Coilis and Greenwood, 1921]. Another analysis of national mortality data had observed (O) 144 `Wharfingers and stevedores'to have died from `All Cancers' where 101 were expected (E): among the excess tumors were, lung ( 0 --59, E --37 Standardized Mortality Ratio (SM R )= 159), and stomach ( 0 --29, E --18 S MR --156) (Registrar General, 1957). In an analysis of mortality tor the 2 0 -6 4 age group of dockers in England and Wales, elevated SMRs for lung cancer mortality were found consistently over the course o f 40 years: 1931 (183); 1951 (149); 1961 (169); 1971 (182) [Logan, 1982). 578 Greenberg It could be argued Shat these findings did not necessarily represent the direct effects of dock work, and might merely he a reflection of life style; in the case of dockers Are facile explanation would be to attribute it to their smoking and drinking habits. In a later analysis by the Office o f Population Censuses and Surveys of data for Stevedores and dock laborers, social class standardization was applied, and where 1,365 deaths from ail causes were registered 1,291 would have been expected. Proportional Mortality' Ratios were significantly raised for cancers of stomach, larynx, and lung and for bronchitis, emphysema, and asthma: the excess lung cancer mortality was confirmed by cancer registration data for the years 1966-1967 and 1968-1969 [Fox, 1978J. Although the commentator did not consider that the excesses clearly represented the direct effects of work, as social class adjustment would have taken account of much of the potential effects of tire cigarette and alcohol variables it would have been prudent not to dismiss the potential contribution of work. In the period 1967-1968, in Britain four dockers were registered as dying of mesothelioma [Greenberg and Lloyd Davies, 1973], and the incidence of asbestos-associated deaths registered for male dockers was to rise subsequently. In the years 1979-1980, 1982-1990, in one analysis, 36 dockers and goods porters were found to have died of mesothelioma of the pleura, 7 o f mesothelioma of Ate peri toneum, and 4 of asbestosis [Coggon et al., 1995]. Another analysis of data for those years, reported 57 Stevedores and dockers to have died of mesotheliomas (PM.R. --293.3,95% Confidence Interval = 226.6-358,8) [Hutchings et al., 1995]. By 1999, the cumulative total of deaths from mesothelioma in occupations corresponding with dock worker, had risen to 266 [Hodgson and Darnton, 2000], (When Murray was to offer to conduct a preliminary study for the asbestos industry, . .to show that people like dockers who have had intennittent and quite high exposure to asbestos have nonetheless not suffered from asbestos related disease to any extent' [Murray, 1984], Industry acknowl edged that the 1,000 fee requested was reasonable but with prescience declined the offer in case the conclusions proved positive [Hardie, 1984].) PUBLIC RELATIONS AN D TH E DOCKERS about 200 cases of lung cancer (mesothelioma) associated with asbestos in Great Britain. This compares with the present level of 26,000 cases of lung cancer (which presumably refers to bronchial carcinoma) from all causes [Hill and Knowlton International, 1967].' In the absence of proof for Arc existence of an amount of this carcinogen below which it is `perfectly safe,' the claim that only `substantial amounts' are harmful may be perceived as self-defining or deceptive. The leaflet posed the question: `Is asbestos safe to handle?' to which it answered: `Yes, provided shippers pack it in a way that dust is not emitted' (begging Ate question of whether this had yet been achieved). To tiie further question: `Suppose some bags are damaged?' it replied that: `A tew torn bags are no cause for concern because they will not release large quantities of airborne dust.' If large numbers were damaged it suggested: . .respirators and overalls may be desirable.. In current practice, bags were not handled with delicacy and the resultant spillage was dealt with by dry-sweeping, by which exposure was enhanced. The figure quoted o f 200 cases o f mesothelioma over the course o f 50 years was an imperfect statistic, and its juxtaposition with 26,000 cases of "lung cancer" a year was calculated to minimize it further. While the number of asbestos workers at risk of mesothelioma amounted to thousands, the 26,000 cases of "lung cancer" a year related to the tens of millions of males and females in the general population. Although mesotheliomas are rare in the general population they are far from rare in asbestos-exposed popu lations. This document not only m inimized the importance o f mesothelioma as a risk to asbestos workers, but omitted to take into consideration the substantial additional risk of associated " lung cancer." A PR company is not on oath when preparing a brief for its client, and its staff may not appreciate the niceties of a scientific case, however, industry's expert scientists and physicians should have been able to identify their errors and omissions. THE DOCKERS' RESPONSE TO REASSURANCE The PR consultants to the asbestos industry prepared a leaflet for the Doekworkers that included the following statements: \ . .(asbestos) can only be a risk if you inhale substantial amounts o f airborne dust. It is perfectly safe to handle otherwise.. `. . .Cancer associated with asbestos is extrem ely rare (this presumably refers to malignant mesothelioma). In 50 years there have been only The three-doctor reassurance to the dockers was supported by a Labour Minister who informed Parliament, that he knew of: *.. .no recorded ease o f a docker contracting asbestosis from his work, and dockers are therefore no more likely to get lung cancer than anybody else [Gunter, 1967], Notwithstanding, 2 years later Glasgow dockers were to inform Clydeside Stevedores of their refusal to handle further shipments o f asbestos [Scott, 1969]. The ship ping company attributed this to a television program the London Dockers 579 previous week that suggested that the inhalation of white fiber (chrysotile) might be dangerous. A letter cited the earlier opinions of Dr. Murray and of the Minister ofLabor, as well as the Code of Practice issued by the Asbestosis Research Council, declaring the safety of the process where proper precautions are taken [Genimell, 1969a], (Despite its title, The Asbestosis Research Council was an industry agency with a public relations function [Tweedale, 2000j). The author of the reassuring letter of 12th August 1969 could write the same day to Bell Asbestos Mines in Canada, owning frankly to excessive dust counts having been measured during manual discharge of container loads of Bell fiber packed in both Clupak and multiwall paper [Genimell, 1969b]. `You will note that the great majority of the counts taken at the various operations exceed the level at which our (government) inspectors would require improvements to be made (above 4 fee) and that in approximately six instances they would have required operations to stop until respirator}' protection had been provided (above 12 fe e ).. .There is one further point about dust counts which ought, i think, be looked at, i.e., how it comes about that so much dust is generated although the bags are impermeable and undamaged.' He suggested that in the case of Clupac: `...it is possible that loose fiber is picked up by the hessian in the mill.. , and as for the impermeable paper sacks, he observed: . .loose fibre dinging on the outsides was negligible, but from my own observation a good deal of dust is emitted from the bag closure during handling.' The author observed the filling of multiwall paper sacks: this was carried out by means of a hopper under less than efficient containment, following which the neck was machine stitched. If was then tipped over and trampled to flatten it to facilitate stacking, during which process dust could be seen being expelled through the gaps between the stitches. Over the next few years, despite intermittent concern by dockers for their health, asbestos continued to be imported, unloaded and delivered to the factories. After a Port of London disturbance, following a television program that suggested that the inhalation of chrysotile asbestos might also be dangerous, Glasgow dockers who had initially been concerned about crocidolite, declined for a time to unload that too. At various stages, by way o f temporizing, arrangements were made for the diversion of asbestos to more accommodating UK ports [Cablegrams, 1969], though from time to time even they, for example Manchester [Howe, 1969] and Avonmouth [Hope, 1969], came to be troubled abou t asbestos. In one incident, when a cargo arriving at Manchester was noted to have been marked in South Africa as intended for Glasgow, local Union officials agreed to keep quiet about it and any similar cargoes en route [Howe, 1969], while industry arranged that in future South Africa would not mark the port of destination on cargoes. EPITAPHS Their work was necessary, bard, physically hazardous and dirty, the process of hiring was degrading, and their stereotyping was as a vulgar and violent group, but the guild like conditions for admission to the labor pool and the specialized nature o f the work were those o f an elite. The movement of port activity downstream to tire Medway put paid to London's docks and containerization would create redundancies. East London's docklands are to be remem bered locally by street and pub names, dockers are com memorated by their entries in the National Mesothelioma Register, and Hunter is honored on bookshelves worldwide. ACKNOWLEDGMENTS The author is thankful to Michael A. O 'Connor, Esq., and his staff at ihe Chase Manhattan Bank who provided copies of documents obtained by legal discovery. In addition to Christopher .1. Hunt, Director trad University Librarian, The John Rylands Library, Manchester who disinterred the Manchester Medical Society information, 1 am thankful to Richard Jones and Ben Davis of the BMA Library Archives and to Dr. R. Owen for biographical information, and to Mrs. Laurie Kazan-Alien and the late Alan Dalton for supplementary material. REFERENCES (Where possible, cited documents obtained by legal discovery in the archives of Turner and Nevvalls and photographed in the- case of: The Chase Manhattan Bank. N.A. against T & N pic.. United States District Court, Southern District o f New York. 87 Civ. 4435 (VLB) (KAR), are identified by their 12-figure film-frame reference numbers). Anonymous. 1934. A letter addressed to Mr. N.L. Dolbey (inventor of the Asbestos Spray process circa 1931 )a t J.R. Roberts Ltd., Leeds, dated 8th February 1934, author uncertain [0000 0038 0274]. Anonymous. 1953. The endetniology o f cancer o f the lung. Editorial to the proceedings of a syraposum convened by the Council of the Intternational Organisations of the Medical Sciencesat Louvain. July 21 24,1952. Acta Unio list Contra Cancrum 9:437-439. Auribauit M. 1907. `Health and safety o f spinners and weavers of asbestos textiles.' In, Annual Report of the French Labour Inspectorate for 1906 (Paris, Imprimerie- Nationals) (in French), Bennett DL. 1965. Letter from the Secretary to the Ocean Shipowners' Group Joint Committee, addressed to Turner and Newali Ltd., dated 29 July 1965. headed `Asbestos in bags.' [0000 0035 1236-1237]. Braun DC, Truan TD. 1958. An epidemiological study of lung cancer in asbestos miners. Arch Indust Med 17:634-653. 580 Greenberg Cablegrams. 1969. Addressed to; OSEAGRAM MR B VULBESTON MCHR Manchesterfrom Johannesburg]. `1234 COAST ADVISED BY UNION CASTLE THAT GLASGOW STEVEDORES WILL NOT HANDLE GLASGOW ORDERS BOOKED CLAN MACNAIR ADVISE URGENT AM IANTE-1-1234' [0000 0027 1983], The reply dated 12th August 1969, read: `YOUR 1234 DIVERT GLASGOW ODERS RST4 TOTAL! TNG 110 TONS BOOKED CLAN MACNAIR TO OFFLOAD AT MANCHESTER.. . ' [0000 0027 1979]. Cartier P. 1955. Some clinical observations o f asbestosis in miners and mill workers. Arch Ind Health 11:204-207. Coggon D, Inskip H, Winter P, Pannet B. 1995. Occupational mortality by cause o f death. Table (6.17, page 70). In: DreverF, editor. Occupational health. The Registrar General's Decennial Supplement for England and Wales. Series DS No, 10. London: HMSO. Collis E, 1911. Annual Report of HM Chief Inspector of Factories for 1910. London: HMSO. p 118. Collis EL, Greenwood M, editors. 1921. The health o f the industrial worker. London: J & A. Churchill, p 177. Cooke WE. 1924. Fibrosis of the lungs due to the inhalation o f asbestos dust. Brit Med J 2:147. Deane L. 1899. `Report on the health o f workers in asbestos and other dusty trades' In: HM Chief Inspector of Factories and Workshops. Annual Report for 1898 (London, HMSO), 171-172. Department of Labour. 1912. Labour Gazette, 12 February 1912. Doll R. 1955. Mortality from hum cancer in asbestos workers. Brit J fnd Med 12:81-86. Fell JCT. 1965. Memorandum from Turners Asbestos Fibres Ltd., to A.D.N. Jones of Turner and Newall Ltd., dated I August and headed `Dust-proof bags' [0000 0057 illegible]. Pitzkugh GW. 1935. Memorandum of the Supervisor. Actuarial Division, Group Life and Health Section, to Dr. McDonnell, 1935. Cited by Castleman, B.1.1996 In: Asbestos: M edical and Legal Aspects. Frederick, Aspen Law & Business. 4th edn. Fox AJ. 1978. Office of Population Censuses and Surveys. Occupational Mortality 1970-1972. Decennial Supplement. Series BS No I . London. HMSO. Gemmell JM. 1969a. Letter to Mr. Montgomery (John Scott & Co. Shipping), dated 12th August [0000 007 1978]. Gemmell JM. 1969b. Letter to F.P. Smith, Bell Asbestos Mines L tddated 12 August, headed `PRIVATE AND CONFIDENTIAL.' 0000 0027 1974-1975], Greenberg M, Lloyd Davies TA. 1973. Mesothelioma register 19671968. Brit J Ind Med 31:91 -104. Grieve LV1D. 1927. Asbestosis (unpublished MD thesis, University o f Edinburgh, 1927). Gunter J. 1967. Statement 17 April 1967 in reply to a question from Mrs. Joyce Butler. Hansard [HLj , 1966- 67, Vol. 745, cols 19-20. Hardie HDS. 1984. Letter to Sir Neville Stack, dated 10 December, headed `Asbestos Disease in Dockers' [0060 058 0990]. Hill and Knowlton International, 1967. Asbestos and your Health. Leaflet prepared for the information of dock workers, under the authority of the Asbestosis Information Committee (two pages). Hodgson .1, Damian A. 2000. Mesothelioma in Great Britain-- 196880,82-99. Data provided to the author by courtesy of the Epidemiology and Statistics Unit, Health & Safely Executive. Hoffman FML. 1918. `Mortality from respiratory diseases in tire dust trades (inorganic dusts)' Statistics Bulletin, No 231. Washington, DC: US Bureau o f Labor. Hope AS. 1969. Letter from Cayzer, Irvine & Co. Ltd., to Cape Asbestos Fibres Ltd., Uxbridge, dated 31 December, headed `Asbestos to Avonmouth.' [0000 0027 1895]. Howe MR 1969. Letter to Mr. W. Scott, Cape Asbestos Fibres L tddated 23 September, headed `Private and Confidential: Amosiie Fibres on the "Clan Macnair" [00000027 1917-1918]). Hunter D. 1965. Letter addressed to J. Beach (Port o f London dockers' representative) from The Middlesex Hospital Medical School, dated 9th July 1965 [0000 0009 0017]. Hutchings S, Jones J, Hodgson J. 1995. Chapter 9: Asbestos related diseases. (Table 9.14, page 136). In: Drever F, editor. Occupational, health. The Registrar General's Decennial Supplement for England and Wales. Series DS No, 10. London: HMSO, Joss WJ. 1924. Written statement to E.N. Molesworih, HM Coroner Rochdale, in relation to an inquest on Mrs. Nellie Kershaw (The `Cooke case'). An extensive report o f the resumed inquest of April 1,1924, was reported on page 8 o f the Rochdale Times, 2 April 1924. LeDoux B. 1949. Asbestosis, East Broughton, Province of Quebec, Canada. Logan WPD. 1982. IARC, 1982. Cancer mortality by occupation and social class .1851-1971. IARC Scientific Publications No. 36. Lyon. Internationa! Agency for Research o s Cancer. Tabic 12E, p 246. Merewether ERA, Price CW. 1930. Report on the effects o f asbestos dust on the lungs and dust suppression in the asbestos industry. Itondon: HMSO. Milton R. 1965. Copy of typescript preliminary report dated 3rd August, headed: Tire discharge of asbestos in bags in the London docks. Addressed to The Ocean Shipowners' Group Joint Committee. Murray HM. 1907. In: Report o f the Departmental Committee on Compensation for Industrial Diseases (London, HMSO) (Cd. 3495), paras 4076-4104. Murray R. 1984. Letter to Sir Neville Stack, Asbestos International Association dated 29 November. [0060 0158 0992], Accompanied by a document headed: `Asbestos disease in dockers, proposal for research'. [00) 0158 0993-0995], Newhouse M L Thompson II. 1965. Mesothelioma of pleura and peritoneum following exposure to asbestos in the London area. Brit J Ind Mod 22:261 2 . Pancoast HK, Miller TG, Landis HRM. 1918. A roentgenologic study of the effects o f dust inhalation upon the lungs. Am J Roenlfienoi 5: j 29 138. Parliamentary Commissioner for Administration, 1976. Third report of the session 1975-76. Supplement: Department o f employment C.253I V. London: HMSO. Pedley FG. 1930. Asbestosis. J Caad Med Assoc 2:253 -254. Perry K, Murray R, Lawrence-Smith AM. 1967. `Inquiry and conclusions on the medical aspects of working cargoes o f asbestos by dockers of the port of London.' A printed sheet consisting of 27 lines of text with, a 3 line postscript by Murray [0000 0068 0045). Registrar General. 1957. Decennial supplement. England and Wales 1951 occupational mortality part II, volume 2. Tables. London: HMSO. p 181. Scarpa L, 1908. T h e asbestos industry and tuberculosis' In: Proceed ings o f the 18th Conference on Internal Medicine. Rome. October 1908. (Rome, 1.909)358-359. Scott J. 1969. Letter to Turners Asbestos Cement Co, Traffbrd Park, Manchester, headed, `Importation o f Asbestos Fibre ar Glasgow'. dated 12 August 1969 [00000027 1973], London Dockers 581 Stevenson RH. 1940. Typescript headed: "Asbestosis" [0000 0009 1643-1650). Slower M. 1985. Dockworkers land asbestos-related diseases. Health & safety at work. April 1985. 36-38. This includes an inset on pages 36 and 37 entitled: `A day in the life of Ben Morris, dockworker.' The Port. 1967. `The facts about asbestosis' (bannerheadline), issue 17 May. [Sub-headlines include: `A new statement signed by all sides-no unacceptable risk exists'; `Asbestos load is rejected'; `Medical officers give their views'; `How stall began': `W hat the figures show'). Tweedale G. 2000. Science or public relatons? The inside story o f the Asbestosis Research Council, 1957-190. Am J Ind Med 38:723-734. Waddell j. 1965. Minute dated 12 August to A.D.N. Jones (Turner & Newalt), headed `Asbestos in Bags.' [00000057 1303). Waddell J. 1967. Minute dated 13th March to K. Neve (Turner & Newail), headed `Asbestos and Health- Docks.' [00800081 0627)33. Wagner JC, Sieggs CA, Marchand P. 3960. Diffuse pleural mesothe lioma and asbestos exposure in the North. Western Cape Province. Br J Ind Med 17:260-271. Whipple HE, van Reyen PE, editors. 1965. Biological effects of asbestos. Proceedings o f a conference held in New York, October 1 9 21,1964. Ami NY Acad Sci 132:1- 766.