Arthur J. Vorwald and Kenneth W. Smith on Lung Cancer Among Canadian J-M Workers (1950)

Two letters. On January 3, 1950, Dr. Arthur J. Vorwald, director of the Saranac Laboratory, asked Dr. Kenneth W. Smith of Canadian Johns-Manville at Asbestos, Quebec, five questions to plan "the proposed roentgenographic study of your cases for evidence of pulmonary malignancy in asbestosis": how many cases were in Smith's files, how many showed asbestosis, how many had shadows suspicious for cancer, and how many cancers had been proven, including by autopsy. Smith replied on January 25 that the company's X-ray library held about 6,500 files going back to 1935, that there were "at least 11 cases with x-ray evidence of asbestosis," and that he had seen no shadows suggesting cancer and no proven cases.

What it shows

Smith explained that the doctor before him, Dr. Stevenson, "did not keep any regular file of the results of the x-ray examinations," and that he had spent the past year trying to survey all 6,500 files. A proper study, he wrote, would mean "reading over 100,000 x-ray films." This exchange follows Vorwald's October 1949 request for the X-rays (Vorwald to Smith, 1949). Smith's answer that he knew of no lung cancer among the men at Asbestos was written while the Saranac Laboratory's own autopsy records already included asbestosis cases with lung cancer (the Saranac autopsy index).

In Johns-Manville's chronology

Johns-Manville's own chronology of what the company knew describes this document as follows:

Dr. Vorwald writes to Dr. Smith, 1/3/50, asking if Dr. Smith has seen pulmonary malignancies associated with asbestosis among J-M employees. Dr. Smith responds on 1/25/50 that he has seen no such cases but has seen at least eleven cases of asbestosis. Dr. Smith states that he is in the process of organizing and reviewing the medical files at the mine/mill and that what needs to be done is a thorough study of all films.