Dr D. Barltrop commented (a) that the mortality data for the population of the most severely effected Turkish village refer only to mesothelioma. Were any other causes of death recognized? (b) The unfavourable conditions in the village must have been operative continuously for many years. Would any change in the population structure be expected and was there any evidence of this?

Professor Elmes replied:

(a) The mortality data for Karain were similar to the other villages except in respect of mesothelioma. There was a fairly high perinatal and infantile mortality, and some deaths due to accidents, but once they had survived adolescence they seemed to live to a ripe old age. The populations of all the villages in the area were too small to give accurate figures but there seemed to be no excess of lung cancer in this area nor was there any suggestion of other cancers associated with the high incidence of mesothelioma in Karain.

(b) The figures in Baris’s paper show that the mean age of death for the mesotheliomas is in the mid-forties and that it is by far the predominant cause of death in the village. Whether it has always been as bad as this is not clear, but the existence of the disease localized to Karain is built in to the folklore and the name of the village. The disease has probably become more obvious as the general standard of living and health of these communities and life expectation has improved in the last

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