Married: Madeline Foeller
Dr. Arthur J. Vorwald was the director of the Saranac Laboratory and research director of the Trudeau Foundation until 1954, when he was appointed Director of the institute of Industrial Hygiene and Occupational Medicine at Wayne University in Detroit. He received his M.D. from the University of Chicago. His other academic degrees included the Ph.D., Sc.D. and LL.D.
He was a World War II veteran.
Adirondack Daily Enterprise, January 13, 1954
VORWALD GOES TO WAYNE UNIV.
The President of Wayne University, Detroit, Michigan, and the Dean of The College of Medicine of the University announce the appointment of Dr. Arthur J. Vorwald, former Director of the Saranac Laboratory and the Trudeau Foundation, as the first professor of Occupational Medicine and Director of the Institute of Industrial Hygiene end Occupational Medicine, on March 1, 1954. In that position. Dr. Vorwald will conduct experimental and clinical studies of problems concerning the health of the industrial worker.
In addition, he will engage in the teaching and training of students in the College of Medicine and in the Post Graduate School who will have unusual opportunity for practical experience in any of the many industries which are affiliated with the Institute. The students will gain clinical experience in the study of patients who are admitted to the University Hospitals which contain approximately five thousand beds. Dr. Vorwald will also engage in consulting practice.
Dr. Vorwald received the Degree of Doctor of Medicine from the University of Chicago, and later the Degree of Doctor of Philosophy from the same University, the Degree of Doctor of Science from Hobart College and the Degree of Doctor of Laws from Loras College.
Upon completion of his studies at the University of Chicago, Dr. Vorwald continued his training at the Presbyterian Hospital, in Chicago, and at the Henry Ford Hospital, in Detroit. Subsequently he spent a year as a Fellow of the National Research Council, at Cambridge University, England. He joined Dr. Leroy Upson Gardner in Saranac Lake in 1934.
His association with the Saranac Laboratory was interrupted by the war years during which time he became a Captain in the Navy and served as Naval Medical Attache to the Embassy, in London. Later he assisted in organizing the office of Naval Research under the Secretary of the Navy, Mr. Forrestal. For three years he was Director of the Medical Sciences Division of that office which supported researches in many universities and other organizations which included the Saranac Lake Rehabilitation Guild and also the Saranac Laboratory, the Departments of Physiology and of Biochemistry, of the Trudeau Foundation.
Upon the death of Dr. Gardner, he was recalled from the Navy to assume the directorship of the Saranac Laboratory and of the Trudeau Foundation. During the past five years, the Laboratory and the Foundation have undertaken many studies involving an annual budget of a third of a million dollars which came from various governmental agencies, foundations and industries outside of Saranac Lake.
Dr. Vorwald is a member of many national and international committees including: the Correspondence Committee on Industrial Hygiene of the International Labor Office, Geneva, Switzerland; the Scientific Committee on Chest Disease of the Industrial-Medicine Association; the Armed Forces Epidemiology Board for the Surgeons General of the Army, Navy and Air Force; Consulting Board of Medical Research and Development for the Office of the Surgeon-General, Department of the Army; special consultant to the Institute of Inter-American Affairs, U. S. Department of State; Consultant to the Oak Ridge National Laboratory, Atomic Energy Commission; special consultant to the Industrial Hygiene Division, U. S. Public Health Service.
He is a past member of the Editorial Board of the American Review of Tuberculosis, past president of the Franklin County Medical Society and of the Saranac Lake Medical Society.
Dr. Vorwald's professional societies include: Diplomate of the American Board of Clinical Pathology; Diplomate of the American Board of Pathological Anatomy; American College of Pathologists; Fellow of the Royal Society of Medicine, England; American Trudeau Society; Association of Military Surgeons; Fellow of the American College of Physicians; Fellow of the American College of Chest Physicians; Fellow of the American Medical Association.
On collecting Dr. Arthur Vorwald's asbestosis records: A Cautionary Tale
by Michael Rhode
"Documenting Adverse Reactions: Doctors, Patients, and Lawyers in the Archives" session
Mid-Atlantic Regional Archives Conference. October 27, 2001
[Note: Emphasis is in the original. Our thanks to Neil Tony Holtzman for bringing this paper to our attention.]
Over a quarter of a century ago, the Armed Forces Institute of Pathology's medical museum (now the National Museum of Health and Medicine) was offered the opportunity to collect pathological records which appeared to have continuing medical research potential. The collection has proved to be of much more interest to lawyers than historians or doctors. Records of Dr. Arthur Vorwald's research centered on industrial medicine and specifically the toxicity of dusts. The research projects of Saranac Laboratory compromise a major part of the collection as do reprints of articles on dust diseases. Asbestos-related records are only a small part of the collection, but have caused the most difficulties. The collection turned out to be far larger than expected and eventually gave rise to a lawsuit arising out of patient privacy concerns. Certainly the Museum did not expect a minor collection of medical records to generate such controversy.
I. Dr. Vorwald
Dr. Arthur Vorwald was a pathologist interested in occupational health and industrial medicine. He researched the toxicity of dusts and concentrated on pneumoconiosis -- diseases of lungs from inhalation to dust leading to difficulty in breathing, including silicosis and asbestosis. Vorwald was born in 1904 in Iowa. In 1931, he received a doctorate in pathology, and in 1932, a second in medicine from the University of Chicago. By 1934, he was working for the Trudeau-Saranac Institute for the Clinical and Experimental Study of Pulmonary Disease which oversaw the Trudeau School, the Saranac Laboratory and the Trudeau Sanitorium. The Foundation, which still exists today as the Trudeau Institute, was founded as the Trudeau Sanitarium to treat and research tuberculosis in 1884. Vorwald worked for each facet of the Foundation before joining the US Navy Reserve during World War II. He served with both the Bureau of Medicine and the Office of Naval Research in Washington, gaining valuable experience and contacts for his return to civilian life. Vorwald returned to the Trudeau Foundation in 1947 as director of research, and was appointed director of the Saranac Laboratory the following year. He continued to consult for the United States government including the National Academy of Sciences, the Atomic Energy Commission, the Public Health Service, the Armed Forces Epidemiological Board, the State Department and the Bureau of lndian Affairs. He also worked with groups like the American Industrial Hygiene Association and the Committee on Threshold Limits of the American Conference of Governmental Industrial Hygienists. In early 1954, Vorwald resigned from the directorship of the Saranac Laboratory and his other positions with the Trudeau-Saranac Institute, possibly at the request of the board. He then became professor and chairman of the department of lndustrial Medicine and Hygiene at Wayne State University in Detroit. While there, he continued his research and consulting work. In 1967, Vorwald suffered a stroke, and although he died in late 1974, his professional career and corresponding creation of records ended when he became incapacitated.
II. The records
As he was leaving Saranac Laboratory in 1954, Vorwald was still conducting research. Pathologist and historian Esmond Long wrote him urging him to finish a project sponsored by the American Trudeau Society. Long's letter implies that Vorwald was resigning under difficult circumstances as he said, "I do not know how much or how little embarrassment there would be for you in finishing it (i.e. the project) up with some such title as research associate or without title, on the Saranac Laboratory staff ... It would certainly save the laboratory significant expense, and would restore the project to the fine standing it had previously with the Committee on Medical Research." (Long to Vorwald, Jan. 15, 1954) Vorwald left the Laboratory in April, but took many of its records with him. Gerrit Schepers, his successor was soon telegraphing and visiting him to request the return of records. By mid summer, Schepers wrote to Vorwald, "Your further retention of this material is seriously hampering the work of the Laboratory" and proposed submitting the issue of ownership of the files to an arbitration board (Schepers to Vorwald, July 20, 1954). Vorwald probably returned the specific files that were requested by Schepers as there were only 48 of them. However he kept hundreds of files including Saranac Lab records including budgets, official correspondence of both his and his predecessor Leroy Gardner, research contracts or grants for corporations and govermnents and their results, patient records including files, photographs, x-rays, and tissue sections in wax (i.e. human remains), and much of Saranac's reprint library. Patient records related to employees in over 100 companies including American Brake Shoe, B.F. Goodrich Co., Bethlehem Steel Co, Chrysler Corp, Corning Glass, Eastman Kodak Co., Ford Motor Co., General Electric, General Motors Co., Georgia Southern Talc, International Pulp Co., Johns Manville, Monsanto Chemical Co., NJ Zinc, Republic Steel, Thomas Edison Co., Thetford Mines of Quebec, Union Asbestos and Rubber, Union Carbide Corp., US Gypsum Co, US Rubber Co., US Steel, and Wyandotte Chemical Co.- a veritable Who's Who of North America's large industry, and all generated health-threatening dusts.
Dr. Eugene Pendergrass, a pathologist who had worked with Vorwald, contacted the Armed Forces Institute of Pathology in January 1975 on behalf of his widow, Madge. Dr. Pendergrass expected Vorwald's records to have continuing medical value and wrote, "It occurred to me, in that Dr. Vorwald was a distinguished pathologist and did a lot of work with pulmonary diseases, especially the Pneumoconioses, that there may be some very important specimens and slides and other material concerned with some of the Pneumoconioses." (Pendergrass to Hansen, Jan 10, 1975). At that time the AFIP and Museum were actively collecting records and memorabilia of pathologists and responded quickly and positively to Mrs. Vorwald. She wrote back offering four footlockers of material from storage and suggested that more material would be in his office at Wayne State. The additional material was thought to be 4 footlockers, and 5 cartons of books for a total of 500 pounds. The next estimate was 4 footlockers, 5 filing cabinets, 30-40 cartons of books and research material and weighed over 12,000 pounds. The deputy curator of the Museum, Chauncey Bly, had known Dr. Vorwald in the late 1940s and may have led Mrs. Vorwald to donate records that she was planning on giving to Wayne State. By March of 1976, 300 cartons of records weighing 8 tons were in the Museum. The Museum's staff, which did not have a professional archivist on staff, transferred many of Vorwald's books to the new Uniformed Services University of the Health Sciences, the military's medical school. Other material including correspondence and journals was discarded in late 1978 by a lawyer, Edward White, who was heading the museum. White soon had cause to regret his actions.
Asbestos is a mineral that is fireproof, yet capable of being woven like cloth and was widely used for fireproofing and brakeshoes. Most buildings built before 1970 contain asbestos. Asbestosis is a disease scarring the lungs that leads to shortening of breath and possibly cancer. The disease is typical of dust diseases, but in 1965 Irving Selikoff linked lung cancer and asbestos. In 1971, the EPA began regulating asbestos and lawsuits over exposure were filed throughout the 1970s and 1980s. So many lawsuits were filed that 20 manufacturers banded together to form the Center for Claims Resolution to pay claims in 1993. By 2001, 24 large companies, most recently W.R. Grace, had filed for bankruptcy protection over asbestos claims. Owens Corning alone had 460,000 asbestos personal injury claims for over $5 billion dollars against it when it filed for bankruptcy in 2000. However, the direct causal link between asbestos and cancer is still debated and as late as 1992, one could find a commentary by Dr. John Craighead in the Archives of Pathology and Laboratory Medicine entitled "Do Silica and Asbestos Cause Lung Cancer?"
Naturally both the defendants, usually the companies, and the plaintiff were eager to find records to bolster their cases. In May 1979, lawyers for Owens-Illinois located Mrs. Vorwald and asked her about her husband's records. They had received permission from Mrs. Vorwald to use the records. Normally, permission would not have been hers to give, but the Museum had neglected to send her a deed of gift, and did not have clear legal title to them. Museum director White tried to remedy this by writing to her in June stating that he was sending a "loan agreement" for the records. Fortunately a deed of gift was sent to her and on the advice of her lawyer, she quickly signed and returned it. Presumably, once he heard that Owens-Illinois was seeking records on their product Kaylo, an insulation with asbestos in it, he wanted to get his client out of the discovery process. Lawyers from Owens-Illinois appear to be contented with reviewing research files that Vorwald had done on Kaylo, but lawyers suing Johns-Manville requested the use of patients' medical records. By September 1981, White was subpoenaed to provide records for Bush, et al. vs. Johns-Manville Sales Corporation. Patient records were held back, but copies of other files were made available for the lawsuit.
A new wrinkle was introduced in March 1983. Robert Hollis of the Department of Justice wrote to the Museum, stating "As you are probably aware the United States is presently a defendant in over 1,300 separate actions arising out of asbestos-exposure. For the most part, these cases involve third-party claims brought against the United States by various manufacturers of asbestos-containing products who have been sued by workers alleging injuries sustained through exposure to asbestos. The litigation raises the prospect of potential Government liability in the billions of dollars. As part of the Government's efforts to present an effective defense to this large-scale, complex litigation, we are in the process of inventorying and microfilming documents held by various federal agencies which provide information relevant to the asbestos issues ... We would, therefore, request an opportunity at this time to microfilm those portions of the Vorwald collection of documents which relate to asbestos disease." Hollis went on to note that microfilming the documents would help to protect the originals. (Hollis to White, March 8, 1983) However, his request for "documents which relate to asbestos disease" would include patient files. In April, David Anderson of the Justice Department's Federal Programs Branch issued a three-page opinion to Hollis stating, " ... to utilize [the records] in the defines of asbestos related lawsuits ... raises the question whether the Privacy Act prohibits the AFIP from releasing these material... The Privacy Act establishes a general prohibition against the disclosure of records maintained by federal agencies pertaining to any individual, without prior written consent from the individual... The medical records which are the subject of your request are governed by the nondisclosure requirements of the Privacy Act."
While the government was prohibiting itself from using records it owned in defending itself, Frederick M. Baron and Associates filed a Freedom of Information Act request to use the patient records. The Army's Office of the Surgeon General denied the request for two reasons. The Office's Robert Chaney cited privacy of medical records, but also stated "The Freedom of Information Act pertains to records that are originated in the normal course of government business. In this instance, the aforementioned collection is library and museum material acquired and preserved solely for medical research reference and is not within the definition of a record as defined in the description of agency records under the Act." (Chaney to Wodka, July 26, 1983). Baron filed an appeal, and the Army, after some internal debate, stood by its definition of the medical records as protected, but agreed that they could be considered agency records. A compromise was sought by sanitizing the records to remove patient names and identifying information. An archives technician, Daniel Bennett was hired to work with the records. Bennett spent ten hours locating and sanitizing four patient files relating to General Motors asbestosis cases. He estimated that there were 100 cases of clear-cut asbestosis, as diagnosed by Vorwald, out of 1200 records. Bennett noted that the sanitizing project would be extremely difficult since even occupations could identify a person. In a deposition for the case, Bennett stated, "For example, in one case history, a patient is identified as a grinder for a particular company. Closer examination of the file reveals that this patient had been the only grinder for that company for a number of years and it was generallmowledge in which plant and building his grinder was located. Thus, revelation of the generic occupation of the patient in some cases would present a high risk that the patient's identity could be determined, for example, through interview of fellow employees and review of public records."
Bennett closed his deposition with another point that speal<s to the archival community and foreshadows the current issue of patient privacy:
If the Army is unable to withhold under the FOIA the identities of and identifying information concerning patients and physicians contained in the Vorwald Collection, I believe that this inability to honor the traditional doctor-patient privilege would deter other medical researchers like Dr. Vorwald from donating or otherwise providing their research and case histories to the Army. Such a development would represent a serious loss to the army medical community and could inhibit progress in ongoing medical research.
Baron and the Army compromised and the United States District Court for the District of Columbia issued an Order of Settlement and Stipulation of Dismissal on April 1, 1985. The Army did not concede that the records were covered by the Freedom of Information Act, but continud to insist they were covered by the Privacy Act. The agreement consisted of 8 points, smnmarized as 1. Barron would get copies of the patient files through 2. microfilming of them by the Army. Baron could only 3. use the files in ongoing litigation, and 4. may only use them if the patient is deceased or has agreed to let them be used. The 5. only reason to contact the patient or family is to ask permission to use the records and 6. the Army could provide copies of the files to anyone who agreed to "be bound by the terms of this order." 7. Compliance with the order would be considered a defense regarding Privacy Act violations and 8. everyone would pay their own costs. To make the use of the collection more practical, Bennett suggested to AFIP's legal counsel that they cease providing copies of the entire collection and only copy material after it was examined and selected by lawyers. This became the standard for use of the patient records. Law firms could request copies of the microfilm from the Department of Justice if they wanted all the records, until 1991 when they wrote to me, "When the Civil Division provided microfilm copies to our adversaries, it was not our intent to become a clearing house of asbestos related documents for private litigants, but instead, it was our intent to quickly resolve issues regarding simultaneous access by multiple parties. This was done so as to relieve the litigation burdens on both the Civil Division and on AFIP. The situation in 1991 is much different, as now private litigants are interested in access, totally apart from any litigation against the United States. In the current situation, when these types of researchers contact the Civil Division, they will be referred to AFIP."
The microfilm is rarely used as it was never adequately indexed and consists of slightly over half of the collection, presumably skipping the non-asbestos-related records. The records themselves continue to be used regularly. Bennett had arranged them by subject, ignoring provenance for expediency, an understandable decision when under a lawsuit in pre-computer days; provenance had probably already been destroyed by White anyway. He wrote a box-level finding aid that we have been refining over the past few years to a folder level, which occasionally descends to item level especially after some new slight pilferage has been discovered. A researcher from American Brake Shoe, now ABEX, asked years ago if we could control the "salting" of the collection by someone adding in documents beneficial to his case. We could not and still cannot, although a comparison to the microfilm might reveal them. Years ago we completed a database of patient records including names, diagnosis, employers and types of records held; it has rarely been used.
The use of the collection has changed too. Lawyers rarely ask for patient records anymore, but still use corporate research such as that conducted for Johns Manville or beryllium research for the Navy. Unpublished proceedings like the Seventh Saranac Symposium which gathered pathologists to discuss the issues of asbestos as a cause of cancer are requested regularly. We've put together as complete a compilation of presented papers as we can and it is 1520 pages long. The reprints get a lot of use now as they provide a fairly comprehensive library on dust diseases from 1900 though 1960. Very few doctors have used the Vorwald collection. In 1982, a research protocol "Histological Criteria for the Diagnosis of Asbestosis" was conducted at the AFIP using fifty cases. This may have been the only large use of the collection for medical research. Historians have not examined the collection much more often than doctors. Barry Castleman used it extensively for his doctoral dissertation and the resulting book Asbestos: Medical and Legal Aspects (2nd ed, Clifton, New Jersey: Law and Business, 1986) which was more of a primer for lawsuits, but contains a lot of history. Historians David Rosner and Gerald Markowitz found the collection just before finishing their book Deadly Dust: Silicosis and the Politics of Occupational Disease in Twentieth-Century America (Princeton University Press, 1991) and used one of Vorwald's patient's record to open the book with human interest. Lynn Snyder used the collection for her doctoral dissertation on the Donora Air Pollution Incident in 1948 when gas from a zinc plant killed 19 people in a town near Pittsburgh.
The collection continues to be mostly consulted by lawyers. I have been deposed several times on the collection, most recently this summer. In 1990 I had a rubber stamp made that reads "Certified True Copy from Otis Historical Archives" with a signature line due to the number of requests for "true" copies. Not many people use the collection each year, but their requests for material are very large. Some statistics on copying might be of interest - from a low under 100 pages in 1998 to a high of over 16,000 pages in 1999. Copies of significant parts of the collection are undoubtedly in courthouses around the country. While the acceptance of the collection brought some legal and administrative problems to the government, I think the records are worth having and preserving. Vorwald was one of the pioneers in the field of industrial medicine. This collection is slowly beginning to be used by historians of industrial medicine and should be of great value for years to come. While the whole story is a cautionary tale, the main point is as political and legal climates change, collections that have been moribund can take on a new social and legal significance, leading to challenges for the archivist and their institutions.
Archivist, Otis Historical Archives
National Museum of Health and Medicine
(202) 782-2212; FAX (202) 782-3573
The opinions or assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the US Department of Defense. This piece is a US government work and, as such, is in the public domain in the United States of America.