The doctors and the dockers

Our plain-English summary of The doctors and the dockers, by M. Greenberg (American Journal of Industrial Medicine, 2004).

The study

• Author: M. Greenberg
• Journal: American Journal of Industrial Medicine
• Published: 2004;45(6):573-81
• Type of article: Historical article
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: London Dockers unloading a dusty asbestos cargo in 1965, consulted an eminent Occupational Health physician, Dr. Donald Hunter who informed them that they had been at serious risk. A second, opinion provided jointly by a Consultant Chest Physician, the Port Medical Officer, and the Medical Advisor to the Trades Union Congress, declared that they knew of no disease affecting dockers, and stated that intermittent exposure to asbestos constituted an inconsiderable risk that with certain precautions would be eradicated.

Methods: Archival material have been obtained to supplement limited published material and eyewitness accounts of the event, to provide a clearer picture of the issues.

Results: Reassured by the Chest Physician, the Port Medical Officer, and the Medical Advisor to the Trades Union Congress that they had little to fear, London dockers resumed unloading asbestos. From time to time dockers at other ports were to express concern and interrupt work, only to be similarly reassured.

Conclusions: Had the medical troika in 1965 considered the available health statistics, they would have had reason to take a less sanguine attitude to the cancer mortality of dockers. An analysis of data for 16 selected occupations for the years 1900-1902, showed dockers to have an unhealthy job, with deaths from 'All Cancers' of 1.09 per 1,000 years of life (the fourth highest). The Registrar General's occupational mortality report for 1951, noted excess tumors of the lung and stomach for dockers. Elevated Standardized Mortality Ratios for lung cancer had consistently been calculated by the Registrar General for the 20-64 age group of dockers; in 1931 (183), 1951 (149), and 1961 (169): by 1971 it would be 182. A total of 266 dockers were to be registered in the UK by 1999 as having died of malignant mesotheliomas, proving that Donald Hunter's concern for dockers had not been excessive.

Copyright 2004 Wiley-Liss, Inc.

In plain English

This article was a historical account, not a new study of disease rates. The author reviewed published sources, eyewitness accounts and industry documents obtained through legal discovery about London dockers who consulted Dr. Donald Hunter in 1965 about a dusty asbestos cargo. Hunter advised masks for all the men and vacuum suction on the cargo. Industry then had three physicians review the matter. Reassured by them, the London dockers resumed unloading. An industry memorandum said Murray was to meet dockers before the physicians' report was signed and published, hoping to get them to recommence handling white asbestos. That report, in 1967, said they had found no case of injury to a Port of London dock worker's health from asbestos cargoes. The author argued this reassurance lacked support from the evidence available. From other published sources, the author cited raised lung cancer Standardized Mortality Ratios for dockers aged 20 to 64 in England and Wales (183 in 1931, 149 in 1951, 169 in 1961, 182 in 1971). The author also noted 266 mesothelioma deaths in dock-worker occupations by 1999. The author concluded that Hunter's concern had not been excessive.

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 perspective: a review of archival industry documents, published material and eyewitness accounts. It is not an original epidemiological study; the disease figures come from other published sources.
• Who was studied: Dockers in the Port of London who raised concerns in 1965, the physicians who advised them, and dockers at other UK ports through the late 1960s
• Exposure: Unloading bagged asbestos cargoes by hand. White asbestos (chrysotile), crocidolite and amosite are all discussed; the author states that all varieties were present in commercial cargoes at the time.
• Main results:
  • Hunter advised that all the men use the Siebe Gorman Mk 4 mask, in the hold and in the barges, and that vacuum suction be used on the cargo during unloading.
  • Reassured by the three physicians (Perry, Murray and Lawrence-Smith), the London dockers resumed unloading asbestos cargoes.
  • An industry memorandum stated that, before the physicians' report was signed and published, Murray was to attend a meeting of dockers at the West India Docks, where he hoped to get them to recommence handling white asbestos.
  • The three physicians finally reported in 1967 that they had found no case of injury to the health of a Port of London dock worker that could have resulted from asbestos cargoes.
  • The author judged several claims in the reassurance to be unfounded. One example: asbestosis had not been shown to be a necessary precursor to mesothelioma.
  • About 10 weeks after an August 1965 meeting, the Ministry of Labour told employers that the 5 mppcf level had been exceeded when unlined hessian sacks were used at a normal work rate.
  • In a 1969 letter, an industry correspondent reported that most dust counts during manual discharge exceeded 4 fcc, and that about six exceeded 12 fcc.
  • An earlier analysis of 16 selected occupations (Collis and Greenwood, 1921) gave dockers a death rate from 'All Cancers' of 1.09 per 1,000 years of life, the fourth highest.
  • The Registrar General (1957) recorded 144 observed 'All Cancers' deaths among wharfingers and stevedores where 101 were expected. The excesses included lung (59 observed, 37 expected, SMR 159) and stomach (29 observed, 18 expected, SMR 156).
  • Lung cancer SMRs for dockers aged 20 to 64 in England and Wales (Logan, 1982) were 183 in 1931, 149 in 1951, 169 in 1961 and 182 in 1971.
  • In social-class-standardized data for stevedores and dock laborers (Fox, 1978), 1,365 deaths from all causes were registered where 1,291 were expected. Proportional Mortality Ratios were significantly raised for cancers of the stomach, larynx and lung, and for bronchitis, emphysema and asthma.
  • For 1979 to 1980 and 1982 to 1990 (Coggon et al., 1995), 36 dockers and goods porters died of pleural mesothelioma, 7 of peritoneal mesothelioma and 4 of asbestosis.
  • Another analysis of those years (Hutchings et al., 1995) reported 57 stevedores and dockers dying of mesothelioma, with a P.M.R. of 293.3 (95% confidence interval 226.6 to 358.8).
  • By 1999, the cumulative total of mesothelioma deaths in occupations corresponding with dock worker was 266 (Hodgson and Darnton, 2000).
• The authors' conclusion: The author concluded that the 266 dockers registered in the UK by 1999 as having died of malignant mesothelioma showed that Hunter's concern for dockers had not been excessive.
• Limitations the authors state:
  • The author acknowledged that the excess cancer deaths among dockers might reflect lifestyle, such as smoking and drinking, rather than dock work. The author noted that social class adjustment would have accounted for much of this.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma, Shipyards and maritime work.

Medical terms in this study, explained in our Lexicon: standardized mortality ratio (SMR), Lung Cancer, Malignant Mesothelioma.

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