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Af*RC*METfDONFAOl RMCUESSEIUNMSTIOTUFTHEEOALfTHPAANTDHMOELH^LPOm^c SEVENTH SARANAC SYMPOSIUM THE SARANAC LABORATORY of the Edward L* Trudeau Foundation Saranac Lake, New York Seeaion, Wednesday, September 2k 1952 I U1I5 HlblvJRJCAl ARCHIVES i FlATIONAI. MUSEUM OF HEALTH ANO MEDK3KJ I ARMED FORCES INSTITUTE OF PATHOLOGY two weeks before they cane to the clinic, and they could then be diagnosed as having lung cancer. The clinical symptons and the pathology are no different in the chroru workers, as far as we have been able to determine, than lung cancer of other origins. I think those are the pri: cipal points. 3Y DOCTOR RHOADS: That raises the question. Doctor Baetjer, of a: symptomatic on cancer which simply means no symptoms ref able to the lungs. What brought these patients to the clinic, symptoms to the lung? 3Y DOCTOR BAETJER: No, some came with lung symptoms, pain in the chest. Some of the patients I have read, came with symp toms referable to the metastises. BY DOCTOR RHOADS: Is there further comment on this? BY DOCTOR SMITH; Doctor Lanza, again commented on Doctor Merewether's discussion, asbestosis, and then went on to the chromate situation. I wonder if I may call for a little more discussion of the asbestosis problem. At the and of the morning session, a question brought up as to association of lung cancer with the de, of asbestosis. Shortly before Doctor Glynn's death, I : omuMwam OTIS HISTORICAL ARCHIVES NATIONAL MUSEUM OF HEALTH AND MEDIGNP ARMED FORCES INSTITUTE Of PATHOLOGY ^ 41- an opportunity to visit him and learn somethin*-, of the na terial that he had assembled* He liad seventeen cases in which there had been co-existent carcinoma and acbostocis in tho lungs* In his series, there was no relation that could be detected between the decree of asbestosis and th presence or absence of cancer, or the decree of ashestosi and fight of cancer* How, his series came from a plant that used the Rhodesian blue asbestos which, as Doctor Lansa has pointe out, has osrtain characteristics that are different from the Canadian asbestos* It's a more brittle fiber and, therefore, gives rise to more dust* However, it was my I! understanding that some of the cases described in Great Britain, had had exposure to the Canadian white asbestos* I wonder if any of our colleagues from oversea! who are in the room, night care to comment on that? I would like also, to make one further point ii ji connection with a matter that both Doctor Devan and Doctc 'i ;| Rhoads brought out, and that is the experiment of nature |i where one may vary circumstances and see if that has any< i: i! thing to do with a phenomenal that has been observed* T question of exposure to nickel, which was brought up thi. morning, is something that I have been asked about by se al individuals over the lunch hour* I recently had an opportunity to visit with Do OTIS HISTORICAL ARCHIVES i IDEATIONAL MUSEUM OF HEALTH AND MEDIOM? i ARMED FORCES INSTITUTE Of PATHOLOGY^ Anore who was fomaerly medical officer for the plant In * whore these nasal sinus tumors had been observed, and I e_' visited Doctor Moreen who is the ''edical Officer there at the present time* They both stated that the nan who has developed the nasal sinus tumors were not men who had been employed in the part of the plant where there might be exposure to nickel carbonel, and they were, for that reason, very re luctant to believe that the nickel carbonel was a factor the nasal sinus tumors that had been observed* They further pointed out that the tumors that h occurred were in men who have been exposed to the calcine that is the ores with the - that since 192k, when the cal cinera were redesigned, they have not seen cancer of the nasal sinus in men whose employment in the industry has taken plaee only subsequent to 1921}, so that it would sec that there is an instance which fulfills the stipulation! that were raised this morning as to whether an experiment of nature might be performed which would have bearing on the question of an occupational hasard in the way of a respiratory tract carcinoma* EY DOCTOR RHOADSI Doctor Merewether, would you conwent on these : marksT BY DOCTOR KaRBWSTHER i OT15 HI5IOR!CAl ARCHIVES l tJ&TiONAL MUSEUM OF HEALTH AND MEDJQNF i ARMED FORCES INSTITUTE OF PATHOtCKSY ^ -U9* I couldn't comsnt on sons of then, but I think I can partially answer some of these, sir, and I think Doc tor Knox can answer conclusively one of them* First of all, I think Doctor Lanxa is misinformed about the proportions of asbestos used and where they are used in England, The original cas-js of asbostoeis, fifty years ago, were all Canadian asbestos* The earliest asbes tos work in England was either seventy-eight or eighty-two and there nay have been some crystalline fiber then, but very quickly the asbestos trade concentrated on the white Canadian crystalline* Later on, the Rhodesian asbestos and the Rhodes ian - the South African blue, and the third one which ie , also an iron silica, the emacite, eazae in* Now, of all of these, the amacite is definitely the most brittle* It has short fibers,, it's brown and it's got fibers as long as that (indicating) whereas the best Canadian spinning fibers have only not fibers as long as that (indicating) and the best blue is about that* Well, there is no doubt about the dustiness of th aaacite* That is the brown long fibered stuff, to such an extent that it's very little used today, so it*s at the period where some of these cases are concerned, or where the oases of asbestosis occurred - some of ny old friend Glynn's cases occurred - ther, was a good deal of blue and ! OTIS HISTORICAL ARCHIVES i t^CMIONAL MUSEUM OF HEALTH AND MEDIOKIP < ARMED FORCES INSTITUTE Of PATHOLOGY* -4 a rood deal of amacite used* Now, I think Doctor Knox will be able to tell u in his plant, which is the biggest in the country, what about the types of asbestos they use in that particular f tory, and the - whether they have had any cardnorm of th lung* Now, about the nickel cancer, it is perfectly correct that none of us think that nickel carbon has any thing to do with it as etch for the very simple reason th - well, one reason is that niekel carbon is 60 toxic that we should build a factory in order to get the - in order to get the little cancer, and of course, it might act in ji that proportion, then Z should Imagine a lot more people would have been effected* Doctor Amore or Doctor Morgan and myself feel that the - that the re-building of the old calcinars was the crucial change in the matter, though there was some operation in the constitution of the materials which are shipped from Fort Home in Canada* The difference, as I know, because I saw it before end afterwards, between the old and extremely dusty caloincers and the modern build, is enormous* Therefore, there may be seme hope in the fact that perhaps a lot of dig doaage is necessary to pr( due# some of these cancers* BY DOCTOR RHOADSl "fv ! OTIS HISTORICAL ARCHIVES NATIONAL MUSEUM OF HEALTH AND MEDK3N i ARMED FORCES INSTITUTE Of PATHOLOGY Id Doctor Knox here? Do you care to comment or these remarks? (No response). Apparently not. 3Y DOCTOR MSR5WETHER: Well, I can finish it if he won't. BY DOCTOR RHOADS: Why don't you? BY DOCTOR MEREWETHER: Because all of my information on this is derive from him; he's unduly modest# The fact is that it's mair crysotiles used in that factory# I don't think they use any blue at all, and they've had a number of cases of ca of the lung as one migiht expect# Of course, not all cas of cancer of the lung, even if it is due or associated w: asbestosis, must be included in the list that we have, bi cause there must have been an ordinary occurrence of can of the lung quite irrespective of any factor of asbestos BY DOCTOR LEVIN: It just happens that I talked with Doctor Knox about his data at lunch, and he showed me the data which has# That's the occurrence of dancer of the lung at his plant# Now, from 1932 to 1951 they have had exactly sixteen cases of lung cancer# Unfortunately, Doctor Kno did not as yet have the infomation which would enable either him or anyone else to say whether that was an exc ' MUSEUM OF HEA1TH AND MEDK3NE i ARMED FORCES INSTITUTE Of PATHOLOGY - ______ ^ number of cases. That's the kind of statistics, wr-ich we presented to statisticians, that makes them wish that the;, did have a psychiatrist. 5Y DOCTOR RHOADS: Very proper statement, I'm sure. Is there fur ther comment on our questions of chromate or nickel? (No response). We have dismissed these conclusive topics. We will proveed to the paper by G. Burroughs Mider, Director of Cancer Research, National Cancer Institute. Doctor Mider - on Experimental Pulmonary Cancer. BY DOCTOR MIDER: (Doctor Mider read a prepared paper, which is on file with the Saranac Laboratory). BY DOCTOR RHOADS: Certainly a very comprehensive dissertation on this subject. It is most unfortunate to suspend these ex periments at this stage of medical science. I am most in terested to hear advocated the correlation of clinical ob servation and epidemiological studies. May I ask you the reference to the serial work, which is new to me, I think others might be interested in that since it hasn't appeared yet. BY DOCTOR MIDER: It has appeared in Lithgow & Finkel, Observations AFFIDAVIT WASHINGTON DISTRICT OF COLUMBIA ) ) SS. ) BEFORE ME, the undersigned Notary Public, personally came and appeared MICHAEL RHODE, a person of the full age of majority, being of sound mind and body, who, after being first duly sworn by me, did depose and say: I, MICHAEL RHODE, am an employee of the Armed Forces Institute of Pathology, Washington, D.C. I am custodian of the original archives of Dr. Arthur J. Vorwald. Pages 1 through $ attached hereto are true, correct and authentic copies of documents from Dr. Arthur Vorwald's archives. The pages attached are si's4 Dr. Vorwald was the Director of the Saranac Laboratory of the Trudeau Institute. Upon his death. Dr. Vorwald's archives were donated to the Armed Forces Institute of Pathology by his widow. RHOD.AFF - Page 1 of 2 Dr. Vorwald's archives are in such condition as to raise no suspicion concerning their authenticity; they were received by the Armed Forces Institute of Pathology from Dr. Vorwald's widow after Dr. Vorwald's death; they are presently on file as authorized by law in the National Museum of Health & Medicine, Armed Forces Institute of Pathology, Building 54, Walter Reed Army Medical Center, Washington, D.C. 20306-6000; and the archives have been in existence for 20 (twenty) or more years. MICHAEL RHODE, AFFIANT SWORN TO AND SUBSCRIBED before me, the undersigned Notary Public, on this the day of , 1991. My Commission Expires Nota . , UQ USC 9361 ^ ` _ LARRY D. WILLIAMS LTC, JA, USA LEGAL COUNSEL RHOD.AFF - Page 2 of 2