History of mesothelioma

MCDONALD and MCDONALD [1] present a version of the history of mesothelioma that for the sake of scholarship requires amendment. The references to the growth of knowledge of an association between mesothelioma and asbestos exposure are at variance with plain reading of the publications they cited. For example, GLOYNE [2] stated that he considered it worthwhile recording his two cases of squamous carcinoma of the lung occurring in asbestosis, "...not in any attempt to make out a case for an aetiological association of these two diseases, but in order to emphasize certain histological points in which one disease appears to bear upon the other". In each case the malignant lesion was very small, appeared to rise in the wall of a small bronchus and was not recognized in life. Nowhere is the question of mesothelioma referred to. The authors interpret CARTIER [3] as giving his opinion that "...two such rare cancers in a small series of only eight cases suggested an occupational origin...". It is easy to misunderstand this, as the text is unclear. CARTIER [3] was concerned to discount asbestos as a cause of bronchogenic carcinoma, and not to make a case for mesothelioma being occupationally determined. The conference rapporteur reported him as saying: "...it seems obvious that many points would need discussion before anyone will be able to establish a causal relationship between these pathological findings and the asbestos factor. Is it not more logical to think that the same causal factor will produce the same type of tumour, and therefore, why do we observe such a variety of malignant tumours? If for a moment we may assume that the asbestos fibres might produce a bronchogenic carcinoma in asbestos employees with significant exposure , then only two cases (bronchial carcinoma) of the series would serve as evidence because the cases of mesothelioma or lymphosarcoma and cases without exposure or without asbestosis do not have the conditions required". CARTIER [3] listed two workers as having died of pleural mesothelioma, one having worked for 28 yrs in the industry and having had no exposure to asbestos and no asbestosis, and the other having worked for 26 yrs in industry, including 10 yrs of exposure to asbestos, and with minimal asbestosis. The authors refer to a paper by WEDLER [4] as describing two cases of pleural mesothelioma in 1943: apart from these two from his personal experience, he also provided accounts …