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* Shore Med of the luman le and motor I, eds. uional icaiion ry and servad Med 'n and : Per- rganic Viarch curity New ovan- New ovan- Alto: Rich- venc- s bet- robemen- Thc 1987. rieval 4;24: losed m of tnois: ental ( and >logy n vs Mot st of Skills tees. Inc, 1 on Iria, 187. teal British Journal of Industrial Medicine 1991;48:427-432 42? FORUM Forum is a new feature of the Journal which is intended to allow space for the expression ofhypotheses, opinion, or speculation in a form that is not necessarily suited for the standard scientific paper. Also, correspondents may deal with matters arising from material published in the Journal at greater length than would normally be permitted in the correspondence columns. Authors whose papers are being commented upon will be given the opportunity to respond and they too will be permitted more space that they would enjoy in the normal course of events. Ifreferences are included in pieces intended for Forum they should follow our normal style; they should be kept to a minimum as should any accompanying tables or figures. Forum begins with an exchange of views on asbestos and the asbestos industry between Castleman and Murray; it is hoped that it will stimulate others to submit material for inclusion in this section. Letter to the editor, British Jour nal of Industrial Medicine. Asbestos and cancer: history and public policy Sir,--Murray has now twice stated in the pages of this journal that, "There was no knowledge of lung cancer or mesothelioma" attributable to asbes tos during the second world war. He goes on to allude to the suppression of cancer findings by asbestos industry sponsored researchers at Saranac Lake, New York, commenting that this was not as reprehensible as some (including me) have said.'2 The lessons we draw from asbestos for public policy and professional eth ics would be few if Murray's picture of mere ignorance in the forties and hygienic practices worldwide today was accurate. We owe it to ourselves, the public, and the many workers who are dying from asbestos diseases to learn from this tragic history, lest it be repeated. Because history, like latency, has no statute of limitations, let us first consider what was recorded, and then turn to what was suppressed during the years at issue. Following the publication of case reports of asbestosis in combination with lung cancer in the American Journal of Cancer, Tubercle, and the American Review of Tuberculosis, Nordmann in Germany published a paper entitled "The Occupational Cancer of Asbestos Workers," in 1938.2" Nordmann emphasised cer tain aspects of the two cases he had seen, along with those reported previously by British and American pathologists. He observed that in Ger many, as in Britain, there were 12 recorded autopsied cases of asbestosis, in two of which there was associated lung cancer. In all six cases of lung cancer/asbestosis known to Nord mann, the period from onset of exposure until death was between 15 and 21 years. These and other features of Nordmann's clinical epidemiology analysis satisfied others, including such authorities as Ludwig Teleky, who wrote abstracts of the papers by Nordmann and his colleague Homig, published in the United States in 1938."" In Germany, the view that asbestos was carcinogenic was supported by many and challenged by none after 1938. Leading German authorities such as Koelsch and Baader weighed in before 1940, with Baader announc ing that German compensation auth orities were treating lung cancer even in combination with "light" asbestosis as an occupational disease.1"" The federal government in Germany adop ted this in legislation early in 1943.12 By 1943, additional cases had been reported, and these writers and revi ewers in Germany all agreed that lung cancer was an occupational hazard of asbestos workers.11"21 The German reports were carefully noted in Britain all through the war. The leading British authority on the pathology of asbestos disease, SR Gloyne, published abstracts of papers by Welz and Wedler in the Bulletin of Hygiene.2223 Wedler was the first to report primary cancers ofthe pleura as well as lung cancer in patients with asbestosis and assert that they were all occupational tumours. These abs tracts by Gloyne were reprinted, with others on asbestosis and lung cancer, in the United States in the Journal of Industrial Hygiene and Toxicology and the Industrial Hygiene Digest. The latter was sent monthly to firms hold ing membership in the Industrial Hygiene Foundation, including Johns-Manville and a number ofother asbestos companies. The senior medical inspector offac tories reported that there were 12 cases of lung cancer among 103 autopsied cases in which asbestosis was present (11-6%), as of 1938, when lung cancer was seen in less than 1% of autopsies in the United Kingdom.2* Gloyne and Merewether raised the possibility ofa cancer hazard from asbestos in a sup plement to the International Labour Office Encyclopaedia, Occupation and Health.a Sparks meanwhile informed readers of the British Journal of Radiology that lung cancer was one of the complications seen in patients with asbestosis.26 Meanwhile, strikingly high rates of lung cancer among patients with asbestosis were consistently reported by pathologists in the United States.27"2" For Kenneth Lynch, who was des cribed by the president of RaybestosManhattan as "the doctor in charge of our spinning plant in North Charles ton," this was the second such report' in the American Journal of Cancer.21 x Not only were five more new cases reported in the American Journal of Pathology, but historical publications from around the world were also revi ewed and tabulated in 1942 and 1943 a Hueper's Occupational Tumors and Allied Diseases reviewed the inter national publications, enumerating the common factors pointing to an occupational relation between asbes tosis and lung cancer.'1 In 1943, Hueper wrote that asbestos was unquestionably carcinogenic, and urged the substitution of carcinogens in industry with safer materials.12 This article soon found its way to an executive at Johns-Manville Corpora tion, the largest American asbestos company, who loaned his copy to Dr Leroy Gardner, Director of the Saranac Laboratory." More on them later. Other United States authors wrote ofthe mounting evidence that asbestos caused cancer, in publications includ ing the New England Journal of medicine and the American Journal of Public Health.1*"K Writers in Canada, Norway, Italy, and France also expressed concern over evidence ofthe carcinogenicity ofasbestos in the early 1940s.""11 Editorials in the Journal of the American Medical Association in 1944 and 1949 named asbestos among the known and suspected causes of occupational cancer.*2*' The second editorial was entirely devoted to asbes- HWBUI0001125 428 Forum tos, and featured powerful evidence his corporate sponsors precluded him companies, including Keasbey and published by Merewether in the from publishing anything about his Mattison, asking them all to, "Treat it Annual Report ofthe ChiefInspector of findings without their approval. with the utmost confidence." Johns- Factories for the Year 1947.** By then, Originally hired to do experiments on Manville's Vandiver Brown warned the Factory Inspectorate was aware of asbestosis that Raybestos-Manhat- "It is obviously undesirable that the 235 deaths in which asbestosis had tan's president said might prove useful report in its present form receive any been found at autopsy, in 31 (13-2%) to the companies in combating claims distribution or publicity outside a of which there was also cancer of the for compensation, Gardner was limited number of people in our res lung or pleura. admonished about his vow of secrecy pective organisations.'"1 Attorney More recently, Becklake has con after he mentioned his studies in Brown's most prominent concern was cluded that the relation between publications in the late 1930s. Gard getting Vorwald to delete his exposure to asbestos and lung cancer ner informed his sponsors in 1943 statements about the tumours, and he attained the state of "probable" in the that, "The question of cancer suscep wrote that if Vorwald's report was early 1940s.45 tibility now seems more significant confined to the animal studies, "Our Gardner, writing for a United than I had previously imagined."* In right to criticise and suggest changes States government grant to study the his enclosed report, Gardner charac before publication, or even to forbid asbestos-cancer question experimen terised both the published human data publication, is unquestionable."52 tally in March 1943, wrote that and his unpublished experimental On 11 November 1948, executives "Gloyne, Merewether, and other studies as, "suggestive but not con representing eightofthenine sponsor English observers contend that asbes clusive" in demonstrating carcinogen ing companies met in the Boardroom tos has a specific carcinogenic icity. He said he would defer publish of Johns-Manville, and the decision action."" He had evidently learned ing his experimental findings, in the was unanimous to strike all references this from Merewether during the visit hope that he would be able to get a to cancer and tumours. Reporting to to the United States by the Factory government grant to repeat the work. the vice president ofone company who Inspectorate's leading asbestos expert "Of 11 mice inhaling long fibre had not been able to attend. Brown that winter. asbestos for 15 to 24 months, 8 urged that a copy ofthe draft report be So, it is beyond dispute that the developed malignant tumours in their retrieved from that firm's medical carcinogenicity ofasbestos was widely lungs.. . The incidence rate 8T8% is director (Lloyd Hamlin), saying that, noted in prominent medical publica excessivehe wrote. "Of 22 mice "Everyone thought it would be most tions and English language abstracts inhaling short fibre asbestos for not unwise to have any copies ofthe draft by the early 1940s, and that concern longer than 12 months, only 3 report outstanding if the final report was expressed within official circles in developed lung tumors. Rate I3 6%." is to be different in any substantial Britain and internationally. More Gardner concluded, "Thus the respect. The feeling of the complete accounting of the published incidence of lung cancer in the long representatives was very emphatic on (and unpublished) record may be fibre asbestos mice was over 16 times this point."53 found in my book, now in its third the average for mice inhaling other The asbestos companies communi edition, which has never been revi dusts for comparable periods and over cated their orders to Vorwald through ewed in this journal.'" I believe that 3 times the maximum for any other Dr A J Lanza, who had established a Murray wrote a rather churlish review group. Mice exposed to the practically very dose relation with asbestos com ofthe second edition which was rejec inert short fibre asbestos showed fewer panies during his career with ted for publication--so his failure to lung tumors although 7 times more Metropolitan Life Insurance Com recall that this body of knowledge than those in short exposures to other pany." Lanza began by telling Vor existed is particularly unfortunate. dusts."" wald the sponsors wanted him to omit Two early experimental studies Although there were certainly ways all references to cancer and tumours were suppressed, at least one of which in which this study could have been from the report.55 He also requested had produced positive findings that improved upon, it still represented the the insertion of a statement in the inhalation ofasbestos caused lung can most extensive experimental inves conclusions about the non-progressive cer. The first ofthese was reported in a tigation of the cancer aspect that had character of asbestosis. Lanza's cover letter and an attached outline of been done up to that time. And in his favours for asbestos companies span a monograph on asbestosis that Gard plea to the United States govern ned decades, and in some cases went ner sent to Johns-Manville executive ment's cancer advisory committee, beyond any ethical duty, but there Vandiver Brown in 1943." This and Gardner said he was "startled" to have is not space to retell that story here. related correspondence were dis obtained such results." A tearful (It has been told to New York Univer covered, through legal proceedings, in Gardner confided to Harriet Hardy sity, which has so far resisted renam the files of Turner and Newall and shortly before his death in 1946 that ing its Anthony J Lanza Research Johns-Manville (now Manville) in the Johns-Manville would not allow him Laboratories") 1980s. One of the companies that had to publish his findings." Vorwald did as he was told, and his sponsored Gardner's research on After Gardner died, Johns-Man report published in January 1951 did asbestos in the United States was the ville officials renewed their pressure not include the word cancer or any of T and N subsidiary, Keasbey and on the Saranac Laboratory to come up its synonyms.55 Vandiver Brown sent Mattison Company, whose president with a report. And finally, in 1948, reprints to all the sponsors, saying, "I sent Gardner's material on to his Gardner's successor, Arthur Vorwald, think we are entitled to condude that counterpart at Rochdale on 8 March sent a draft to Johns-Manville. Copies the project was worth while."56 Vor 1943* were circulated to presidents and vice wald was rewarded with a contract for Gardner's research agreement with presidents at each of the sponsoring another confidential study of asbestos Font card also and \ dy b initia Vorv Quel a Jol Lam It lead' find: mail the asbe com publ idty ford be fc reinf insul The. ofoc. abou As indu: tion. torie foots by tl party tent pract and Whe and haza expe M tion unav of tl man that 1930 corp igno Lyn. man: colle of t have clog; victi outr misc dam not Llo> shen loss ced. thou asm HWBUI0001126 \ um hat the ical :, is and lOUt the k is hile t of is a >ulthe but osis sent diss in is a dis use the en906 ikes ury t in /ere om ing. the The so the t in nately ven rot, :ase 918 fest in ary the ia 50s isis oal tey rds ene tese iinfor sto ire. the his and has His Forum 431 enthusiasm betrays him on several occasions into telescoping time. For example he refers to Sir Thomas Legge, who had questioned Montague Murray in 1906, as soon afterwards lamenting, "looking back in the light of present knowledge it is impossible not to feel that opportunities for dis covery and prevention were badly missed". Mr Castleman gives the date of that quotation as 1934 which is not exactly soon after 1906. Actually Sir Thomas Legge said it beforehand in 1928 which was sooner but not much. This is one ofthe few references which Mr Castleman does not have, but it illustrates the perils of hindsight. It is very easy to be wise. . . . even for such an expert as Sir Thomas. How much more so for the non-expen Mr Cas tleman. It would be tedious to enumerate the many examples of selection, bias and emotionalism throughout the book. Even though he recognises that what is written does not suddenly become common knowledge (p 134) he continually makes the assumption that it does. He does not appreciate the gradual accretion of medical and hygiene knowledge, though at one point he recognises that scepticism is a tradition in science. He selects references which suit his arguments and ignores those that do not. He sneers at industrial doctors and hygienists, some of whom he names. He did not know any of them, individually or corporately, but he is liberal with his insults. He has his favourites and his "betes noires". Some people are favourites when he quotes them in favour of his arguments, but villains when they do not conform. He uses discredited information like the infamous Califano document, but not the more recent information by Doll. He praises the ILO for having raised the problem in the 1930s, but criticises it for its Code of Practice in 1984. He does not refer to Convention 162 and Recommenda tion 172 of 1986. He might be forgiven for not having the final text of the Convention and Recommendation, but he ought to have known that an international instrument, debated by a tripartite body, was in prospect. The most damning indictment of the fanaticism of the book is the absence of any reference to smoking. Cancer of the lung was a relatively rare disease until the epidemiological study of Sir Richard Doll in the United Kingdom in 1947. The evidence, even of his favourite Dr Selikoff, is that there is a synergistic action so far as bronchogenic carcinoma is concerned, between asbestos and smoking. Yet Mr Castleman does not mention it. He does not appear to recognise that there is no relation between mesothelioma and smoking because this too is not mentioned, probably because it might dilute his argument. Perhaps the most ludicrous chapter is that concerning brake linings. First of all he confuses the manufacture of brake linings with their repair and maintenance. Of all the references he quotes there is only one which refers specifically to garage mechanics and even there the effects are speculative. He does not find it surprising that the millions of people who have been exposed to asbestos from brake linings since the beginning of the century have suffered rarely if at all from asbestos related disease. He refers (p 611) to his own exposure and that ofhis younger sister and his mother; he does not say if his mother is dead and if she died of an asbestos-related disease. He admits (p 619) that some people die of causes unrelated to their asbestos exposure but he brings them in as well. He does have the grace to publish the statement of Francis May at Appendix 2 pages 655-680 without comment. In contrast to the rest ofthe book it is not a diatribe but a sober, competent, well balanced statement about the background of asbestos related disease and the responsibility of employers." Dr Robert Murray 15.7.88 I see no reason to change my opin ion, and his letter to you, containing more references than my article, is further evidence of his paranoia about asbestos. I paid tribute, in my review, albeit left bandedly, to his delving into past publications and I accept, as I said in my article, that there were indica tions from German and Czech papers about lung cancer in relation to asbestosis. I said that it was these that had alerted my old chief, Merewether, and given rise to the investigation of 1947 which was not published until 1949. But these were anecdotes, numerators without denominators, and not a basis for action. Even in the light of his discoveries, Merewether did not con duct a campaign against the asbestos industry in the United Kingdom He believed, as he persuaded me to believe, that the duty of a doctor in industry, as I said in my article, was to point out the potential dangers. So, if he wants to accuse me, unjus tly, of not recognising that there were some articles on asbestos and lung cancer before the war, I accuse him, justly, of drawing the long bow about cases in ancient times. Kevin Browne and I have made it dear that there were no references to asbestos related disease in ancient times.' There has been no riposte about this. Let him produce the evidence. In any case, do you listen to every oracular statement about every disease? If ever Alz heimer's disease is associated with aluminium, all the Cassandras of the world will jump up and down like Castleman and say, "I told you so". But 1 was there at the time, which Castleman was not, and the main problems, so far as cancer was concer ned, were the bladder cancers in the chemical industry and skin cancer in the cotton industry, both of which have been brought under control. (We did some things right in the 1940s and 50s, though it has taken until now to appreciate it.) Lung cancer was a rare disease outside smoking. Even Doll, when he did his study, published in 1955, thought that the controls introduced by the 1931 regulations (the first regulations in any country to tackle the problem of asbestos) would prevent future cases of lung cancer. Dust problems in the 1950s were primarily those ofcoal miners. Maybe this was because of the small numbers in the asbestos using industries, but there have to be priorities when resources are scarce, as they undoub tedly were. How long did it take the United States Surgeon General to accept the evidence about smoking? And how long did it take the United States to accept the evidence about coal workers' pneumoconiosis? There can be no doubt that 1960 was the Rubicon so far as asbestos and cancer were concerned. Hot even Cas tleman can assert that mesothelioma was known to be associated with asbestos before 1960, even though Merewether had referred to lung and pleural cancer. I remember having seen a mesothelioma in about 1950 in the postmortem room of the hospital in Bury, Lancashire. I had never seen such a white cuirass of a tumour, but the Home Office pathologist who was doing the postmortem examination said, "Asbestos", as though he had seen it before. I was too young and \ \ HWBUI0001127 ** vrum ' and eat it ihnsimed t the : any de a resiraey t was his id he was `Our nges >rbid tives isor oom ision nces ig to who own rtbe iical that, nost draft port ntial the c on uni>ugh ed a omwith om'/or>mit ours sted the sive za's anent lere ere. jeramarch 1 his did .y of sent !,"I that /ortfor stos Forum 429 carcinogenicity in mice, which appears that could have been prevented and 23 Gloyne SR. Abstract ofref19 in Bulletin also to have yielded positive results, and which was never disclosed publi cly by Vorwald.57 That research was initiated at the end of 1950, after was not. BARRY I CASTLEMAN / 722 Linden Ave, Baltimore MD 21217, USA of Hygiene 1944;19:362. 24 Annual report of the chief inspector of factories for the year 1938. London: HMSO, 1939:81. 25 Gloyne SR, Merewether ERA. Asbes Vorwald hosted the lawyer for the tos. In Occupation and health: ency Quebec Asbestos Mining Association, a lohns-Manville executive, and Dr Lanza at Saranac.58 1 Murray R. Asbestos: a chronology of its origins and health effects. Br J Ind clopedia of hygiene, pathology, and social welfare. Geneva: International Labour Office, 1938:1-15 (suppl). 26 Sparks JV. Asbestosis. Br J Radiol It is reprehensible that industry leaders and scientists suppressed such findings, enabling a controversy to be Med 1990;47:361-5. 2 Murray R. Author's reply. Br J Ind Med 1990;47:845-6. 3 Lynch KM, Smith WA. Pulmonary 19383:371-7. 27 Lynch KM, Smith WA. Pulmonary asbestosis V: a report of bronchial carcinoma and epithelial metaplasia. maintained in scientific circles beyond asbestosis III: carcinoma of the lung American Journal of Cancer the 1940s. United States and British asbestos mining and manufacturing in asbesto-silicosis. American Journal of Cancer 1935;24:56-64. 4 Gloyne SR. Two cases of squamous 193936:567-74. 28 Holleb HB, Angrist A. Bronchiogenic carcinoma in association with pul companies meanwhile profited from carcinoma of the lung occurring in monary asbestosis Am J Pathol public ignorance about carcinogen icity ofasbestos and were able to delay for decades the time when they would asbestosis. Tubercle 1935;17:4-10. 5 Gloyne SR. A case ofoat cell carcinoma of the lung occurring in asbestosis. Tubercle 1936;18:100-1. 1942;18:123-31. 29 Hamburger F. The co-incidence of primary carcinoma of the lungs and pulmonary asbestosis. Am J Pathol be forced to eliminate asbestos as a 6 Egbert DS, Geiger Aj. Pulmonary 1943;19:797-807. reinforcing agent in their thermal insulation and in many other products. asbestosis and carcinoma. American Review of Tuberculosis 193634: 143-50. 30 Simpson S. Letter to LU Gardner. 17 May 1938. 31 Hueper WC. Occupational tumours and The direct consequence is an epidemic 7 Nordmann M. The occupational cancer allied diseases. Springfield, IL: ofoccupational cancer that is only now about to reach its peak. As to conditions in the asbestos of asbestos workers. Z Krebsforsch 1938;47:288-302. 8 Teleky L. Abstract ofref 7 {Nordmann). Abstracts of Literature on Industrial Charles C Thomas, 1942:399-405. 32 Hueper WC. Cancer in its relation to occupation and environment. Bulletin of the American Societyfor the Control industry of today, Murray's descrip Hygiene fsuppl to Journal of Industrial of Cancer 194335:63-9. tion of "model" asbestos-cement fac tories is a far cry from the shocking footage in a 1988 documentary filmed Hygiene and Toxicology) 1938;20:184. 9 Teleky L. Abstract of ref 14 (Horaig). Abstracts of Literature on Industrial Hygiene (suppl to Journal of Industrial 33 Gardner LU. Letter to JP Woodward. 8 May, 1946. 34 Tabershaw IR, Bowditch M. Industrial hygiene in 1944. N Engl J Med by the Canadian Broadcasting Com pany in Thailand.59 It is also inconsis tent with recently reported Egyptian Hygieneand Toxicology) 193830:184. 10 Koelsch F. Lung cancer andoccupation. Acta Unio Intemationalis Contra Cancrum 1938;3:243-51. 19443231:706-10. 35 Levin ML. The epidemiology ofcancer. Am J Public Health 1944;34:611-20. 36 Davis E. Chemical carcinogenesis: practices of emptying asbestos bales 11 Baader EW. Asbestosis. Deutsche drugs, dyes, remedies, and cosmetics and mixing with cement manually.60 Wherever information, regulation, and compensation are not in force, Medizinische Wochenschrift 1939; 65:407-8. 12 Fourth schedule of extension of com pensation for industrial accidents and with particular reference to bladder tumours. J Urol 1943;49:14-27. 37 Desmeules R, Rousseau L, Giroux M, Sirois A. Asbestosis and pulmonary hazards from use of asbestos are to be expected. Murray is wrong. His bland asser diseases. Reichsgesetzblatt Part 1, No 14,29 January 1943. 13 Teleky L. Occupational cancer of the lung. Acta Unio Intemationalis Con cancers. Laval Med 1941;6:97-108. 38 MadcUn MT, Macklin CC. Does chronic irritation cause primary car cinomaofthe human lung? Archives of tion that the asbestos companies were tra Cancrum 1938;3:253-75. Pathology 1940;30:924-55. unaware of the carcinogenic potential of their products cannot erase the 14 Horaig F. Clinical considerations on the question of industrial cancer ofasbes tos workers. Z Krebsforsch 1938; 39 Wolff A. Pulmonary asbestosis. Nordhk Hygienisk Tidskrift 1940;21:1-40. 40 Lecoeur J. The study of occupational many scientific and medical studies 47:281-7. cancer. Presse Medicate I942;50: that pointed to the contrary in the 1930s and 1940s, nor dispute that corporate leaders in the industry 15 Ehrhardt P. Today's position in the fight against asbestosis. Arbeitschutz 1940;7:191-3. 16 Linzbach AJ, Wedler HW. Observa 415-18. 41 Mottura G, Faggiano E. Pathological anatomy and pathogenesis of asbes tosis. Ross Med Ind 1940;11:233-84. ignored the cautions and warnings of tions on occupational cancer ofasbes 42 Environmental cancer (editorial). Lynch, Gloyne, Merewether, Nordmann, Gardner, Hueper, and their tos workers. Virchows Archiv fur Patkologische Anatomie 1941 ;3D7: 387-409. JAMA I944;126:836. 43 Asbestosis and cancer of the lung (editorial). JAMA 1949;140:1219-20. colleagues and were caught in the trap 17 Nordmann M, Sorge A. Lung cancer 44 Annual report of the chief inspector of of their deceit. Giant corporations have become bankrupt, courts are clogged with tens of thousands of from asbestos dust in animal experiments. Z Krebsforsch 1941;51:168-82. 18 Welz A. Further observations of factories for the year 1947. London: HMSO, 1949:79-81. 45 Becklake MR. State of the art/asbestos- related diseases of the lung and other victims seeking redress. Jurists, occupational carcinoma in asbestos organs: their epidemiology and outraged by evidence of "outrageous misconduct," pass verdicts ofpunitive workers. Arch Gewerbepath Gewerbehyg 1942;11:536-50. 19 Wedler HW. Lung cancer in asbestosis implications for clinical practice. Am Rev Respir Dis 1976;114:187-227. 46 Gardner LU. Letter to L Hektoen damages--punitive, so that this will patients. Deutsches Archiv fur Klinis- (Committee on cancer research of the not happen again. Insurers, such as Lloyds of London, agree that the shenanigans will lead to the greatest chen Medizin 1943;191:189-209. 20 Wedler HW. Asbestosis and lung can cer. Deutsche Medizinische Wochen schrift 1943;69:575-6. National Cancer Institute, US) 15 March, 1943. 47 Castleraan BI. Asbestos: medical and legal aspects Englewood Cliffs, NJ: loss burden they have ever experien 21 Boemke F. Asbestosis and lung carcin Prentice Hall Law & Business, 1990. ced. But worst ofall, the fate of tens of thousands of innocent victims stands oma. Frankfurter Zeitschriftfiir Path ologic 1943;57:569-77. 22 Gloyne SR. Abstract ofref 17 in Bulletin 48 Gardner LU. Letter to V Brown and attached outline of proposed mono graph on asbestosis. 24 February, as mute, terrible evidence ofa tragedy ofHygiene 1943;18:651. 1943. I j I | HWBUI0001128 430 Forum Fort 49 Muehleck E. Letter to WWF Sheperd (Turner and Newall). 8 March, 1943. 50 Hardy HL. Personal communications, 1982,1989. bles paranoia. In the fully developed form of this psychosis the individual adopts a false premise and then uses asbestos, so that the statement that the disease was "discovered by the ancients," while adding historical enth occa exar 51 Brown V. Letter to E Muehleck (Keas- every device of selection and bias to colour and apparent verisimilitude, is Leg bey & Mattison Co) and JFD Rohrbach (Raybestos-Manhattan). 22 October, 1948. 52 Brown V. Letter to sponsors (Amer support it. In the case ofa person who thinks he is Napoleon or she is the Virgin Mary it is easy to recognise the manifest nonsense. This temptation to dramatise and emotionalise is apparent throughout Mui lami of p Brake Shoe, Gatke Corp, Keasbey and Mattison, Raybestos-Manhattan, Therrnoid Corp, Union Asbestos and Rubber Co, Russell Manufacturing false premise. It is less easy with a subject which has been ventilated in the media over the last 25 years to such the whole book. I have not counted the emotional adjectives but the book is liberally besprinkled with them while not cov. mi: Co, United States Gypsum Co). 27 an extent that the average man in the the author flogs himselfinto a lather of of 1 October 1948. ____ 53 Brown V. Letter to W 1 Kelly (Amer Brake Shoe). 12 November, 1948. 54 Lanza AJ. Letter to AJ Vorwald. 14 street tends to agree with the premise or something very like it--that asbes tos has been an unmitigated disaster indignation. One early example is a reference to the "devastating" pul monary disease at the beginning of the exa Th 19: December, 1948. 55 Vorwald AJ, Durkan TM, Pratt PC. Experimental studies of asbestosis. Arch Ind Hyg Occup Med 1951 ;3: and that it should be banned. In support of his hypothesis Mr Castleman has combed the world century. There mas such a disease, but it was called pulmonary tuberculosis and this was such an ever present Th Mi illu 1-43. literature in a remarkable way. It is a disease that when Dr Murray dis very 56 Brown V. Letter to sponsoring compan ies (see ref 54). 21 March, 1951. 57 Vorwald AJ. First interim reportjasbes- pity that a book which has been so painstakingly researched should start covered the first case of asbestosis in 1899 he did not publish it, even as a an e mor losis and pulmonary cancer (to Quebec with a false premise and arrive at medical curiosity. He must have dis i tlen Asbestos Mining Assn) Saranac Lake, entirely the wrong conclusions. It is cussed it with his colleagues because I It NY: Saranac Laboratory, 7 May, 1952. Vorwald archives. Armed For ces Institute of Pathology, Washing characteristic of paranoia that the arguments are logical and well presen he was invited to give evidence to the Department Committee on Compen the and ton, DC. ted. It is the conclusion that is wrong, sation for Industrial Diseases in 1906 bool 58 Woodward JP (Johns-Manviile). Min utes of discussions held at Saranac Lake on 7 November, 1950-14 November, 1950. Vorwald archives. because it is arrived at in advance of the evidence and derives from emotion rather than scientific balanced to which Mr Castleman makes reference. At the beginning of the century wha beet corn 59 For export only. Canadian Broadcasting Company; broadcast 4 October, 1988. 60 Kamal AAM, Sayed GM, Hassan MH, Massoud AA. Usage of personal appraisal. The difficulty is that he is not entirely wrong. Asbestos is a dan there was a great deal of interest in industrial disease. The priorities were lead and mercury poisoning from it d grac hyg protective devices among Egyptian gerous material which has killed many which people were obviously dying, poir industrial workers. Am J Ind Med 1988;13:707-16. people and will continue to do so, though less and less as our knowledge and phossy jaw, which destroyed the beauty of young women. The trad refe Reply by Murray Sir,--Castleman chooses to criticise my account ofthe chronology ofasbes tos and its effects. I don't mind him doing this, for none of us is perfect. After all, I criticised his book, "Asbes tos: Medical and Legal Aspects." Contrary to what he says, however, my review was not rejected for publica tion. It was never submitted. I was asked my opinion ofthe book by one of my colleagues in the London School of Hygiene and, having an unexpected weekend to spare, I read it and wrote what I thought. The book was publi shed in 1986 and I wrote what I did in July 1988 so, even ifI had wanted to, it was a bit late for a review. To put the record straight and to let your readers determine whether it was "churlish" ornot, this is what I wrote. increases. Our main problem is that the effects of exposure are delayed up to 40 years, during which time our expectations are increasing and our diagnostic methods are improving so that we have to run fast to stay in the same place. Moreover, medicine has always had its priorities. Some subjects take the centre of the stage according to social demands of medical advances. What Mr Cas tleman does is to turn the spotlight, the blinding light of hindsight, on what was a very obscure problem and over illuminate it as though it had occupied centre stage for the greater part of this century. At the very beginning he starts to bend the facts to suit his argument. Pliny did not recommend bladders as a protection against asbestos but against vermilion which caused acute mercury occupational chest diseases were so obscured by tuberculosis that the Departmental Committee of 1907 in the United Kingdom found itselfuna ble to define these diseases adequately for compensation purposes even though the existence of potters rot, grinders asthma and ganister disease were well known. It was not until 1918 that the role of silica became manifest and this became the priority in research into occupational pulmonary disease to such an extent as to limit the study of asbestos because it was a silicate. This was true until the 1950s when coal workers pneumoconiosis took over centre stage. Silica and coal dust are still as fibrogenic as they always were but Mr Castleman awards no medals to the medicine and hygiene professions forhavingcontrolled these problems. and snet hyg He indi libe favc Son quo argi not info doe info ILC the of P to C tion for Con but "Asbestos: Medical and Legal poisoning. It may be that some people Instead he concentrates single min- inte Aspens. Second Edition BI Cas in ancient times were affected by dedly on his subject and accurately, for trip. tleman, Law and Business Inc 1986. asbestos, just as our stone age ances the most part, records the references to T Mr Castleman does not like asbestos. tors may have been affected by silica asbestosis in the medical literature. He does not like the people who mine from the manufacture or use of flint What he lacks is a broad view of the the absc it, process it and adapt its products for tools, but there is no evidence for Mr developing subject. He approaches his Can sale. His dislike has grown into an Castieman's comments about Roman task with the enthusiasm and dise obsession and his obsession into single slaves. None of the Greek or Roman intolerance ofthe new convert who has of ; issue fanaticism which closely resem- physicians described the effects of discovered the secret of salvation. His Kin HWBUI0001129