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History of Asbestos Related Disease P W J Bartrip 72 Postgrad Med J: first published as 10.1136/pmj.2003.012526 on 17 February 2004. Downloaded from REVIEW History of asbestos related disease P W J Bartrip ............................................................................................................................... Postgrad Med J 2004;80:72–76. doi: 10.1136/pmj.2003.012526 The first medical article on the hazards of asbestos dust companies, such as Johns–Manville, the American giant that dominated the industry for appeared in the British Medical Journal in 1924. Following many years, ran to scores of pages. So asbestos inquiries by Edward Merewether and Charles Price, the had many ‘‘upsides’’. Unfortunately, it also has a British government introduced regulations to control very significant ‘‘downside’’ in that exposure to its dust can cause three fatal diseases: asbestosis, dangerous dust emissions in UK asbestos factories. Until lung cancer, and mesothelioma of the pleura and the 1960s these appeared to have addressed the problem peritoneum. effectively. Only then, with the discoveries that It has long been known that asbestos dust constitutes a danger to health; however, some mesothelioma was an asbestos related disease and that issues, including the relative hazards of different workers other than those employed in the dustiest parts of types of asbestos and whether there is a safe level asbestos factories were at risk, were the nature and scale of of exposure to any of them, remain in scientific dispute.12 Since the 1960s crocidolite has been the hazard reassessed. In Britain, America, and elsewhere regarded as a particular hazard, chiefly because new and increasingly strict regulations were enacted. of its strong association with mesothelioma. ........................................................................... Amosite is widely regarded as scarcely less dangerous. In contrast, some have argued that pure chrysotile ‘‘may present little or no carcino- sbestos is the generic term for a number of genic hazard’’ if uncontaminated by amphiboles. naturally occurring fibrous minerals. As recently as 2000, pure chrysotile was termed ACommercially, the most important of these ‘‘a remarkably safe and valuable natural are the white, blue, and brown varieties, other- resource’’, which could be used to substantial wise known as chrysotile (a serpentine asbestos), public health advantage in the Third World.34 crocidolite, and amosite (both amphiboles). Others dismiss such views and demand an Asbestos is widely distributed, but the largest international ban on all forms of asbestos.5 deposits are found in Canada and Russia. It Such scientific disputes and policy uncertainties possesses amazing characteristics. Uniquely conform to a long standing pattern whereby among minerals, it can be spun into a thread medical knowledge about the health hazards of and then woven into a cloth. Clothes and soft asbestos dust has emerged slowly and sometimes furnishings can be made from asbestos—even falteringly since the early 20th century. As Irving http://pmj.bmj.com/ though it is literally a rock. But why make such J Selikoff, one of the foremost authorities on products out of a mineral except as a curiosity? asbestos related disease in late 20th century The answer lies mainly in the material’s unpar- America, once said, nature long held ‘‘some alleled fireproofing and insulating capabilities. secrets ... rather close to its vest’’.6 However, asbestos possesses other attractive qualities: it is relatively lightweight (an impor- DISCOVERY OF A LINK BETWEEN tant consideration when fireproofing naval ves- ASBESTOS AND DISEASE on September 27, 2021 by guest. Protected copyright. sels), abundant, cheap to mine and process, The sequence of developing knowledge about resistant to water and acids (and hence corro- asbestos and disease has generated historical sion), durable to the point of indestructibility, controversy.7–13 Some even maintain that the electrically non-conductive, and unattractive to health hazards of asbestos dust were appreciated vermin. Finally, it can be put to an enormous in the ancient world; such claims have been number of uses (usually when blended with convincingly refuted.14 Those doyens of occupa- resins, plastics, or other materials). In many tional medicine, Thomas Arlidge and Thomas respects, therefore, asbestos is the perfect mate- Oliver, ignored the hazards of asbestos in the rial for an industrialising and electrifying world late-Victorian and Edwardian periods (though of heat, combustion, and high speed locomotion. Oliver addressed them subsequently).15 16 The Not surprisingly, it came to be viewed, for the ....................... first medical paper on the subject appeared in first two thirds of the 20th century, as the the British Medical Journal in 1924.17 Written by Correspondence to: ‘‘indispensable’’ and even the ‘‘magic’’ mineral. William Cooke of Wigan Infirmary’s department Dr Peter W J Bartrip, By the mid-20th century asbestos was an of pathology, it briefly dealt with the illness and Centre for Socio-Legal Studies, Wolfson College, ingredient in all manner of things, including death from fibrosis of the lungs and tuberculosis Linton Road, Oxford OX2 motor cars (as an ingredient of brakes, clutch of Nellie Kershaw, who had worked in the 6UD, UK; peter. linings, and gaskets), buildings (for insulation spinning room of a Rochdale asbestos factory. [email protected] and fireproofing), warships (also for insulation Following this case report, other papers soon Submitted 11 July 2003 and fireproofing), domestic products (such as appeared. These included articles by Oliver, who Accepted 1 October 2003 ironing boards), and electrical distribution sys- coined the word ‘‘asbestosis’’, though most ....................... tems. The product ranges of the largest asbestos observers have mistakenly attributed the term www.postgradmedj.com History of asbestos related disease 73 Postgrad Med J: first published as 10.1136/pmj.2003.012526 on 17 February 2004. Downloaded from All of these opinions referred to the British experience; for Table 1 Raw asbestos consumption in the years Britain’s efforts to prevent asbestos related disease were USA, 1917–77 (10 year intervals) not replicated elsewhere. In the USA, asbestos was mined, Year Consumption (short tons) manufactured, and used in large quantities (table 1), but, apart from the patchy industrial hygiene measures estab- 1917 135338 1927 226365 lished by some states beginning in the 1930s, little regulation 1937 316263 pre-dated the federal Occupational Safety and Health Act of 1947 616194 1970. By this time scientific and regulatory attitudes towards 1957 723492 asbestos disease had been transformed in several ways. Most 1967 720583 1977 671543 significantly, it had been ascertained that asbestosis was not the only disease associated with exposure to asbestos dust. US Department of Commerce. Bureau of Mines Mineral Yearbook. Consumption peaked at 882 908 tons in 1973. The vast bulk of American consumption (some 96% in 1956) LINK WITH LUNG CANCER consisted of chrysotile (white asbestos). Suspicion that asbestosis might be linked with lung cancer began to emerge in the 1930s.28 29 This link became more persuasive in the 1940s, even though doubts remained.30–34 to Cooke, who used it in a 1927 paper that further explored Then, in 1955, Doll established to the satisfaction of most the Kershaw case.18 19 In 1928, following the discovery of a informed observers that a causal association existed between case of pulmonary fibrosis affecting a Glasgow asbestos asbestosis and lung cancer.24 He believed, however, that the worker, Britain’s factory inspectorate took up the issue. Asbestos Industry Regulations had greatly reduced the risk of Edward Merewether, a medical inspector based in Glasgow, lung cancer for those who worked in Britain’s asbestos was instructed to ascertain ‘‘whether the occurrence of this factories. As he wrote in 1960, ‘‘It seems likely that the risk disease in an asbestos worker was merely a coincidence, or may now be largely eliminated’’.35 evidence of a definite health risk in the [asbestos] indus- At this time, notwithstanding the discovery of a second try’’.20 asbestos related disease, there was every reason to suppose At 36 years of age, Merewether was comparatively young that the asbestos industry could continue to produce the when he embarked upon this task. He was also a newcomer fireproofing, insulation, and friction materials widely to the inspectorate, having taken up his appointment only in regarded as indispensable to modern life, provided that 1927. Merewether’s initial survey was soon followed by a full workers were protected from the heavy and prolonged scale investigation, which he completed in October 1929. He exposures associated with asbestosis and lung cancer. In found that occupational exposure to asbestos dust, particu- 1956, Meiklejohn dismissed the notion of a ban as larly for prolonged periods at high concentrations, consti- ‘‘completely futile and absurd’’.27 Such views remained tuted a ‘‘definite occupational risk among asbestos workers prevalent during the 1970s and even the 1980s. Irving as a class’’.21 The fibrosis of the lungs that could result might Selikoff, along with the editorial pages of the Lancet, BMJ, lead to ‘‘complete disablement’’ and death.21 His report and JAMA and other commentators, emphasised precautions endorsed a view expressed a few months earlier that a ‘‘new’’ over proscription of the mineral.36–39 disease, pulmonary asbestosis,
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