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T ''t. 1009 Smoking and the Coronary Arteries To the Editor:-- Dr. Seltzer's thoughtful and well-documented re view of "Smoking and Coronary Heart Disease" (203:193, 1968) makes no reference to personality factors. Perhaps there are no re search data about personality dif ferences of the cigarette smoker in contrast to the pipe or cigar smoker, but popular attitudes generally sug gest that the pipe or cigar smoker Is more phlegmatic and less likely to'-suffer from tension states. A ' striking difference in the incidence of coronary disease is found be tween the two groups. Apparently ; the Surgeon General's Advisory Committee on Smoking and Health (quoted by Dr. Seltzer) in its list of predisposing factors mentioned only "occupations involving--stress" and ignored individual personality factors basic to psychomatic dis A turbances, which may predispose to coronary heart disease. are Burritt S. Lacy, Jr., MD Manhattan, Kan Asbestos and Mesothelioma 'i57. V Fur- . i 1962. To the Editor:--A recent letter (203:1142, 1968) states that the ictions J Med i problem of mesothelioma formation is "not one that involves the whole ReacTrans- asbestos industry, but only users of crocidolite, and this mineral rep 567-371 resents a relatively small proportion ^fusion, w Eng of total consumption. It has been shown1 that mesothelioma occurs in workers exposed to chrysotile ex ransfuransfu- tensively mined in Canada. We have seen mesothelioma formation nolytic March 111 workers weaving brake lining, which is made from chrysotile. Ex posure was three years as a young uolytic ' Amer adult, and death was caused by a Peritoneal mesothelioma at 43. An n After other case was a 50-year-old man ;d Red who worked in a Canadian asbestos molytic (sfusion 3ept 5) five years and who died of Pleural mesothelioma 15 years after |he first exposure. Analysis of tissue Y x-ray diffraction indicated that :r MaslugA.5) fhrysotile was the only form of as bestos present. Wagner and Skid- of the sfusion. j?rea induced mesotheliomas in `he pleura of rats that inhaled chrysotile, crocidolite, amosite, and silica. Smith (personal communica tion) used chrysotile from Arizona prepared by the Badollet and Gantt method to produce mesotheliomas inhamsters. .............. We obtained similar results with pure chrysotile in mice.3 These findings indicate that asbestos in its various forms can cause meso thelioma in both animals and man. The letter also states Wagner's4 findings that the "time lag between last exposure and tumor formation was always long, averaging 40 to 50 years." However, Kleinfeld3 et al reported the average years from onset of exposure to death was 29.5 years with a range of 15 to 40 years. Our patient, a chrysotile worker, died 23 years after the first three-year exposure. Another pa tient we have seen died of meso thelioma after 15 years of contin uous exposure. We have also seen a young man who died of acute pulmonary edema after a short pe riod of work which entailed blow ing asbestos insulating material into house walls without wearing a mask. We think that inhalation of as bestos fibers in any of its various forms--crocidolite, chrysotile, amo site, or tremolite--carries a certain risk and should be avoided. Melvin C. Godwin, MD George Jagatic, MD Hines, 111 1. Owen, G.W.: Mesothelial Tumors and Ex posure to Asbestos Dust, Ann NY Acad Sci 132: 674-684, 1966. - 2. Wagner, J. C., and Skidmore, J.W.: As bestos Dust Deposition and Retention in Rats, Ann NY Acad Sci 132:77-86, 1965. 3. Jagatic, J., et al: Tissue Response to Intra- pentoneal Asbestos With Preliminary Report of Acute Toxicity of Asbestos in Mice, Environ Res to be published. 4. Wagner, J.C.; Proceedings of the Pneumo coniosis Conference, Johannesburg, A. J. Aren- stein (ed.) London: J. & A. Churchill, Ltd., 1959. 5. Kleinfeld, M.; Messite, J.; and Koojman, O.: Mortality Experience m a Group of Asbestos Workers, Arch Environ Health 15:117-180 (Aug) 1967. Intrauterine Rubella T ransmission To the Editor:--The recent articles by E. B. Buynak et al (204:195, 1968) and others12 demonstrating the feasibility of attenuating rubel la virus in a manner acceptable for vaccine use provides great expecta tion that this disease will soon be controlled. Unfortunately, during the time required to produce suffi cient immunity in the population, many women and their physicians will be faced with the problem of rubella occurring in the first tri mester of pregnancy. Therapeutic abortion is the only means present ly available to prevent the birth of abnormal infants, and this is not legally condoned in most states. One of the major problems in establishing laws regarding abortion in instances where the infant may be bom abnormal is determining the risk of abnormality. A number of studies have been reported in which the risk of congenital abnor malities of infants bom to women with clinical rubella in the first tri mester varies considerably, largely depending on whether the study was conducted during epidemic or nonepidemic years. Since etiologic agents other than rubella can pro duce illnesses resembling rubella, it is likely that the risk figures re-' ported in the past for congenital rubella are low. Current reports emphasize that the etiologic role of in utero rubella infections in cataracts (203:632, 1968) and deaf ness3 is greater than previously rec ognized. In a study described re cently in The Journal (203:627, 1968), we have attempted to es tablish the risk of fetal infection by the use of new laboratory proce dures. Twelve women with clinical rubella in the first trimester of preg nancy were studied and'were proven by laboratory means to have been infected with the vims. Therapeutic abortion was performed in ten in stances, and nine of the ten fetuses were found to be infected with the virus. Two women elected not to have their pregnancies interrupted. Both of these women delivered in fants which appeared normal at birth. Since the time the paper was written, six months have elapsed, and during this interval both infants have developed stigmata of intra uterine rubella infection. In addi tion, another woman who experi enced rubella in the first trimester has come under our observation; upon termination of the pregnancy, the fetus from this woman was in fected with the virus. Thus, in lab oratory-proven maternal rubella, the incidence of fetal infection ex ceeds 92% (12 of 13 cases studied), and malformations occur in a high percent of the fetuses infected in the first trimester. Although abortion for rubella is not legal in most states, it is quite obvious that it is being performed widely. Siegel et al4 in a seven year prospective study of maternal ru bella in New York City reported 331 therapeutic abortions in 763 j*M'A, June 10, 1968 Vol 204, No 11 151