1987 H. P. Smith award lecture. Eyes for the epidemiologist: the pathologist's role in shaping our understanding of the asbestos-associated diseases

Our plain-English summary of 1987 H. P. Smith award lecture. Eyes for the epidemiologist: the pathologist's role in shaping our understanding of the asbestos-associated diseases, by J.E. Craighead (American Journal of Clinical Pathology, 1988).

The study

• Author: J.E. Craighead
• Journal: American Journal of Clinical Pathology
• Published: 1988;89(2):281-7
• Type of article: Historical article
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000206).

Abstract

Asbestosis was first recognized as an entity at autopsy by a pathologist in 1900. Pathologists also discovered the unique relationship of mesothelioma and bronchogenic carcinoma with exposure to asbestos. The observations of preceding pathologists have provided insights that have served as the basis for epidemiologic studies associating asbestos with disease in humans.

In plain English

This article is the text of the 1987 H. P. Smith Award Lecture. It is a historical review of pathologists' published work on asbestos-related diseases and reports no new data. The author traced how a pathologist, Montague Murray in London, first recognized asbestosis at autopsy in 1900. Pathologists described asbestos bodies in the late 1920s, and as late as 1930 American pathologists apparently confused asbestosis with aspergillosis, a fungal infection. For mesothelioma, the author credited J. C. Wagner's 1960 report of an association with crocidolite (blue) asbestos in a South African mining community, where patients included housewives and white collar workers exposed indirectly. For lung cancer, the author recounted 1935 case reports of carcinoma in patients with asbestosis. The author also cited Wedler's 1943 collection of 92 asbestosis cases, with a 16% prevalence of bronchogenic carcinoma, and Merewether's data showing it in more than 13% of British workers with asbestosis. The author concluded that pathologists were the pioneers who gave modern epidemiologists their original insights. The author noted that pathologists kept contributing over the past two decades but left defining that work to future historians.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Historical review (award lecture) of published literature; no original data
• Who was studied: Published observations by pathologists on asbestos-associated diseases (asbestosis, mesothelioma, bronchogenic carcinoma), mostly from the late 1800s through the 1960s
• Exposure: Asbestos exposure in general, including occupational exposure and, in Wagner's South African work, environmental and indirect exposure to crocidolite (blue) asbestos
• Main results:
  • The author recounts that asbestosis was first recognized at autopsy by a pathologist (Montague Murray, London) in 1900
  • The author describes a 1930 autopsy by Kenneth M. Lynch in which asbestos bodies were mistaken for aspergillus fungus
  • The author credits the 1930 workplace inquiry by Merewether and Price into the effects of asbestos dust on the lungs with awakening the medical community to asbestos health effects
  • In J. C. Wagner and associates' initial report on mesothelioma in a South African asbestos mining community, the patients included miners as well as housewives and white collar workers exposed indirectly
  • The author notes that later epidemiologic studies suggested that fiber length and breadth were probable key factors in mesothelioma causation
  • Lynch and Smith and Gloyne (1935) documented lung carcinomas in patients with asbestosis but did not implicate asbestos as a cause
  • Wedler (1943) collected 92 cases of asbestosis worldwide, with a 16% prevalence of bronchogenic carcinoma
  • Merewether documented bronchogenic carcinoma in more than 13% of asbestosis cases in British workers
• The authors' conclusion: The author concluded that the history of asbestos-associated diseases shows pathologists were the pioneers who provided the original insights for modern epidemiologists
• Limitations the authors state:
  • The author acknowledges that pathologists continued to contribute over the past two decades through postmortem and laboratory studies. The author leaves the task of defining those modern contributions to future historians.

Topics

Medical terms in this study, explained in our Lexicon: Autopsy, Mesothelioma, Bronchogenic Carcinoma.

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