Document 5DGxKkqEyGxkV4QwK0YmjBmJV

FILE NAME: Asbestos Mining (ASMI) DATE: 1955 DOC#: ASMI026 DOCUMENT DESCRIPTION: Published Presentation from Workmen's Compensation Problems 1954 - Occupational Cancer Hazards  ] I f PROCEEDINGS-- iOth A n n u a l C onvention o f th e International Association of Industrial Accident Boards and C om m issionsQ uebec, Canada, O ctober 3-7, 1954 Workmen's Problems 1954 B U L L E T IN 130 UNITED STATES I) FPARTMENT OF LABOR Jam es P. M itchell, Secretary ; ' BUREAU OF LABOR STANDARDS . P a u l ii# C u rsk c D ire c to r ANNUAL 7iiEETlNGS AND OFFICERS OF THE INTERNATIONAL ASSO CIATION OF INDUSTRIAL ACCIDENT BOARDS AND COMMISSIONS Annual meetings Xy. Date Place President Secretary-Treasurer 1 Apr. 14, 15, 1814................ Lansing, M ich____ ____ John E . K innane______ Richard L. Drake. .Tan. 12, 13, 1915 .............. Chicago, III....................... ____ do................................... Do 2 Sept. 30-0ct. 2, 1915____ Seattle, W ash-................. .........d o ............................. Do, ? Apr. 25-28, 1916............. Columbus, Ohio_______ /F lo y d L. D aggett______ \W ailace D . Yanle______ }L. A, Tarrell. Aug. 21-25, 1817................ Boston, M ass................... D udley M . Holm an____ *Royal Meeker. r> Sept. 24-27, 1918............... Madison. W is ................. F. M . W ilcox................ . Do. 0 Si-pt. 23-26, 1919..,____ Toronto, Ontario............. George A. Kingston____ Do. Som. 20 -24, 1820............. San Francisco, Calif___ W ill J. F r e n c h ............... Charles H . \V n ilk Sept. 19-23, 1921............... Chicago, i l l . , _________ Charles S. Andrus........... Ethelburt S tew u i. J Oct. 9-13, 1922................... Baltimore, M d................. Robert E. Lee___ _____ Do. !(' Scot 24-26, 1 0 2 3 ............ St. Paul, M inn................ F. A, D uxbury................. Do. n Aur\ 26-28, 1024................ Halifax, N ova Scotia___ Fred W. Armstrong........ Do. 12 Aug. 17-20, 1925_______ Salt Lake City, U t a h ... O. F. M cShane................ Do 13 Sop. 14-17, 1926............... Hartford, Conn________ F. M . W illiam s________ j Do. 14 Sopt. 27-29, 1027............... Atlanta, Ga............. ......... H . M . Stanley_________ Do. 15 Sept 11-14, 192S............... Pateison, N . J .................. Andrew F. M cBride___ \ Do. 11 Oct. 8-11, 1920................. Buffalo, N. Y ................... Frances Perkins................j Do. r, Sept 22-26. 1930............... Wilmington. D el______ Dr. Walter O. Stack___ Do. is Oct. 5-a, 1931......... ........... Richmond, Va________ Parke P. D e a n s ...............! Do. 19 t>cpt. 20-29. 1032.......... Columbus. Ohio_______ W. T . Leonard_________i Do. 2(1 Sept. 11-14, 1953_______ Chicago, 111....................... II. E. Wenzel........... CliaS. E. Baldwin 21 Sept. 24-28, 1934............... Boston. Mass________ Joseph A . Parks................j Do r>. sept. 3o~Oa 3, 1935....... Asheville. N. C _______ J J. D ew ey D orselt........._J Verne A. Zimmer. 23 s u ll. 21-24, 1816............... Topeka. Kans....... ...........j G. C lay B aker_________ i Do. j ui. IN-Juiy 2, 1937........ York Harbor, Maine___ D . D . Garoelon................ j Do. 25 Sept. 26-2*, 1938............... Charleston, W. Va_____ A. G. M athew s.................| Do. 2d Sept. 25-2S 1939............... Milwaukee, W is.............. V oyta W ra b etz............... i D o. 27 9-12, 1940................ Richmond, Va________ W.*H. N ickels, Jr.............{ Do. 23 S.-pt. S -l!, 3041................ Winnipeg, M anitoba___ C. K. N ew com be______ _ Do. 2'J Oct. 25-2: 1943................. Harrisburg, Pa................. W m. H , C h e sn u t.......... Do. 30 Sept 11-14, 1944............... Boston, Mass.......... ......... Em m a S. T ousant.........._! Do. 31 N ov. 26-29, 1945............... Winston-Salem, N . C .. . T . A. W ilson......................! Do. 32 Aug. 25-29. 1946................ Portland. Oreg................. L. O. Arens........................ ! Du. 53 Sept. 28-Oct. 3. 1947........ Toronto, Outano_____ D . J. Galbraith................. ! Marshall Dawson. Sunt. 13-10, 94S_______ N ew York, N . Y ......... M ary D onlon.................... : Do. ' Oci. 3-6, 1949......... .......... St Louis, M o_________ Spencer H . G iv e n s .___ ' Do. U Sept 25-28,1950.......... Milwaukee, W is.............. Harry A. N elson.............. Wui L. Connolly A. Oct. 1-5, 1951.................. Detroit. M H s ................ Jame* L. H ill.....................j Do. 3S Ne v. 10-20, 1952............... Miami Beech, Fla_____ ; Raym ond E. Barnes___ : Do. Oct 4-8, 1953............. ....... Coionado, ('alii................' S, \Y. M acdonald.............i Do. 40 Oct. j~1, 1 9 5 4 . .. .. .. .. .. . Quebec, Canada_______ Joachim Grc-mer, Q. C ..i 1 Special meeting. IV Contents O C TO B E R 4--M O R N IN G S E S S IO N J o a c h im G r e n i e r , Q . C., President, 1 A IA B C , Presiding P re s id e n t's Address,. Jo a c h im G ren ier, Q. O., P re s id e n t, Q uebec V ork- m e n 's C o m p en satio n C o m m issio n ---------------------------------------------------------- 1 T h e F u tu r e of W o rk m e n 's C o m p en satio n , A rth u r L arso n , U n d er Secre ta r y , TJ. 8. D e p a rtm e n t of L a b o r______________________________________ 5 R ep o rt of th e S ecretary-T reasurer, Pau! E. G urske, D irector, B ureau of L a b o r S ta n d a rd s, Lb S. D e p a rtm e n t of L a b o r__________________________ 33 A n n o u n c e m e n t of C o m m itte e s------------------------------------------------------------------ 16 O C T O B E R 4-- A F T E R N O O N S E S S IO N E u g e n e E . S p a r r o w , Chairman, Ontario Workmen's Compensation Board, Presiding R eport of R ehabilitation Com m ittee, E lm er H . K ennedy, Supervisor or R ehabilitation, W ashington State D epartm ent of Labor and Industrie 17 Panel-- R ehabilitation of injured W orkers, Chris. W. Pritchard, Com m issioner, B ritish C olum bia W o rk m e n 's C o m pensation B oard, M o d e ra to r----- -------------- 31 Alexander P. A itken, M. D ., Chairm an, Subcom m ittee on Industrial R e la tio n s, A m erican College o f S u rg eo n s____________________________ 31 W illis C. G o rth y , D ire c to r, I n s titu te fo r th e C rip p led And D isab led , N ew Y ork, N , Y -- ---------- 35 Chris. W. P ritchard, Commissioner, B ritish Colum bia W orkm en's C o m p en satio n B o a rd ________________________________________________ -13 D r. G . G in g ras, M edical D irecto r, R e h a b ilita tio n I n s titu te of Monfcrs `tf_ 49 D is c u s s io n ______________________________________________________ 74 D e m o n stra tio n of b a sk e tb a ll g a m e b y gro u p of p a ra p le g ic s______________ 76 OCTOBER 5-- M O RNING SE SSIO N J o h n M o u l in , Commissioner. Illinois Industrial Commission, Fie* President, !A t ABC. Piesiding Report of L egislation C o m m ittee, Joseph P . M iller, C h a im a n , T id 'a n a In d u s tria l B oard . __________________________ _______________ __ __ 77 7 TI CONTENTS R eport of Subcom m ittee on S eco n d -In ju ry F unds, S. J. H olderm an, C hairm an, Illinois In d u s tria l C o m m issio n ______________________ Problems and M ethods of H andling Small Risks and Excluded E m ployees W ho M ay W ant V o luntary Coverage, W . S. M cC orm ick, A ssistant S ecretary, A etn a C a su a lty & S u re ty Co_____________________ P anel-- A dequacy of W o rk m en 's C o m p en satio n , H a rry A. N elson, D i recto r, W isconsin In d u s tria l C om m ission, M o d e ra to r________________ Jaco b d a y m a n , S ecre ta ry -T re a su re r, Ohio C IO C ouncil_______________ William H. Zucker, D irector of Studies, Comm erce and In d u stry Asso ciai ion of N ew York, I n c ______ ______ ______ ______________________ E arl F. Cheit, A ssistant Professor of Business A dm inistration, School of C om m erce a n d Finance, St. L ouis U n iv e rsity _____________________ .Discussion_____ ______________________________________________________ O C T O B E R 5-- A F T E R N O O N S E S S IO N A drive to She. A nne de B eau p re a s p la n n e d for th e delegates O C T O B E R 6-- M O R N IN G S E S S IO N J\M es T. VociiLLE. Chairman, Florida Industrial Commission. Presiding R eport of Statistics Commit tee, D av id M. W alker, Secretary, Pennsyl v an ia D e p a rtm e n t of L a b o r a n d I n d u s tr y _____________________________ O ccupational Cancer Ilazau is, W. i) . llu ep er, M. D , Chief, E n v iro n m ental Cancer Section, Cancer In stitu te. U, S. Public H ealth Service, W ashington, D . C __________________________________ A ccident P rev en tio n A ssociation U n d e r th e Q uebec W orkm en's C o m p en sation Lave, L. K . T. Clegg, P re sid e n t, Quebec A ssociation fo r th e P revention of In d u stria l A ccid en ts_____________________________________ R eport of A dm inistration and Procedure Comm ittee, M ary D oulon, C h airm an, N ew Y orkW o rk m e n 'sC o m p en satio n B o a rd ________________ The Safety Procram U nder the A lberta W orkm en's Compensation Law, 0 . M. M acleod, Q. C\, C h a irm a n , A lb e rta W orkm en's C o m p en satio n B o ard _____ _____________________________________________ Pse 84 87 95 97 102 110 119 122 120 144 153 103 O C TO B E R 6-- A F T E R N O O N S E S S IO N Artiu r LkcpeuC. M. D.. Chief, Medical Officer, Quebec Workmen's Compensation Commission, Presiding R eport of M edical C om m ittee, E. C. Steele, M. 1).. Com m issioner, On- lario W orkm en's CorxpensirJo'.. B o a rd _________ ______ ____ I"'* Film -- "T eam P la y in At lio n " ___________________________________________ 1"4 H eart Disease an d em ploym ent, Leonard J . G olT xater, M. D.. N ational Chairm an, C ardiae-in-Industry Commit,fee, American H eart Asso c ia tio n ________________________ ______________ - ------------------- - CONTENTS P a n e l--Noise in In d u s try , M a ry D o n lo n , C h a irm a n , N ew Y ork W o rk m en's C o m p en satio n H oard, M o d e r a to r_____________________________ Frank Tame), International R epresentative, International B rother hood of B oilerm akers, iro n Ship Builders, Blacksm iths, Forgers and H elpers of th e A m erican F e d e ra tio n of L a b o r_______________________ D aniel Spair, D irecto r, D iv isio n of W o rk m e n 's C om p en satio n , N ew Jersey D e p a rtm e n t of L a b o r a n d I n d u s tr y _________________________ - L. R. L eppard. P h . D ., P h y sic ist, D iv isio n of In d u s tria l H yg ien e, O ntario D e p a rtm e n t of H e a h h ______________________________________ D iscussion______________ R ep o rt of N om inating. C o m m itte e a n d E le c tio n of N ew Officers_________ O C T O B E R 7-- M O R N IN G S E S S IO N (tIj n x L. (iousLEY, Q. C ,, Chairman. Manitoba W'orkmm's Com pensation Board, Presiding R eport of (safety C om m ittee, A dam Bell, C hairm an, B ritish C olum bia W orkm en's C o m p en satio n B o a rd ______________________________________ R eport of A m erican B ar A ssociation Proposal for Uniform E x traterri torial Provision, As'rlcy St. C lair, Counsel, L iberty M utual Insurance Co., Boston, M a s s_____________________________________________________ Panel-- Principles and M ethod, of E xpediting H earings and Settlem ent of C laim s m C o n te s.e d C ases, Ja m e s J. R eid, T ice C hairm an, S o u th C arolina In d u s tria l C o m m ission, M o d e ra to r_________________________ S. W. M acdonald, C h a irm a n , C alifo rn ia In d u s tria l A ccident Com m ission_____________ ________________________________________________ ; T heodore P. I,v a n , C n a lrm a n , M ichigan W o rk m e n 's C om p en satio n C om m ission_______________ William B . Nickels, J jC o m m is s io n e r , V irginia In dustrial Com m is s i o n _________________________________________________________________ Presentation of Film "T h ree To M ake R eady" by In stitu te for Crippled a n d D isab led __________________________________________________________ O C TO BER 7-- A F T E R N O O N SE SSIO N J o \ chim iJHDMKR, President, lA E iB C , Presiding R eport of A ud ting C o m m itte e , W iniam M cC au ley , U. S. D e p a rtm e n t of f,ab o r_________ ___ ___________ ____ . _ ___ _______________________ R eport of R esolutions C om m ittee, Jam es J. R eid, Vice C hairm an, South C arolina In d u st rial C o m m issio n _____________ P resen tatio n of P re s id e n t's P la q u e , W illiam II . N ickels, Jr., C om m is sioner. V irginia In d u s tria l C o m m issio n _____ . _ ____ . P resen tatio n of S e c re ta ry -T ie a s u re r's P laq u e, P re sid e n t G ren ier_________ A ppendix A --O fficers .m il M em b ers of th e A ssociation for 1954-55______ Appendix B-- C ons'itution of th e International Association of Im iustriai 'e e id e n t !'n e rd s em 1 C o n u e b rio " _____ ____ _____ ____ _ _. ______ A ppendix C - tifiiei"! V Jon dan ce "J, th e F o ifie th A nnual M e e tin g ,. .. __ . VH Pas* 181 181 186 190 198 199 201 202 205 205 208 212 215 216 219 221 221 222 226 228 126- 1954 M EETING OF IAIABC O ccupational C ancer H azards W. D. H uepeii, M. D., Chief, Environmental Cancer Section, Cancer Institute, U. S . Public Health Service, Washington, D. C. A. Scope Occupational cancer hazards have plagued mankind for thousands of years. Undue exposure to agents of our n atu ra l environm ent such as solar radiation or infections with the worm, Schistosoma liematobium, have doubtlessly been responsible for the occurrence of cancers of the exposed skin among outdoor workers an .I of cancer of the bladder among farmers of the Mile valley even during prehistoric times. However, it was not until the advent of modern industrialism some 150 years ago that, occupational and indnstry-rolated agents have attained a preeminent position in the hum an cancer problem. Not only are occupational carcinogens the only well defined known causes of human cancers, but their num ber and variety have steadily increased since P o tt in 1775 first related th e occurrence of `.cental cancer among chimney sweeps to their exposure to soot. O ur real knowledge and appreciation of occupational cancer <mdueuig agents as phenom ena of modern industrialism dates hack some tnw&VtKtgr&ii C " -J* >\ *v. *. 4 j: ^ ^ ' Xv f vc ** J*? >* ** > O * * * / / << ,, v W*", - '''Aw ... - d*-v - * yy'kCoA.--. .,ogv a- ; *" - " fc r Q - . '* '3 . ' 1 < , , . - * - `4 - - - ' nay;-- 1'IG U liE 1. O C T O B E R 6-- M O R N IN G S E S S IO N 127 75 years wit 1 the discovery of the rela tio n betw een th e occurrence of skin cancer and an occupational exposure to coal t a r (fig. 1). T h e d a t a given in the following tables (1 and l a ) briefly sum m arize th e salien t additions to the information on occupational cancer hazards m ade since that time. They list the various chemical and physical agents so far recognized or strongly suspected as causes of cancer in man. T hey show, moreover, the different organs and tissues representing the target organs of these agents and the num ber of occupational cancer cases placed on record or known to have been recognized as caused by them. T a b l e I.-- Occupational Cancers Recorded m the United States and Foreign Countries u p to l i t rid Agent Sites of c inn-r XuiiltHT Of X t i m l n r n Mpci'i ( 'IM?S (di'icvr cim` 111 . S .A . m E u reno T -.riil A rsenic______________________________ C oal ta r , p it c h ____________ . _ ______ P e tr o le u m _____________ _____________ Shale o ils_______________________ ____ L ig n ite ta r a n d p a ra ffin ___ __________ C reosote o il____ ____________________ A n th ra c e n e oil___ . . ________________ S o o t-carb o n b la c k ___________________ A rom atic a m in e s____________ ________ R o en tg en - an d ra d iu m -r a d ia tio n ___ A rsen ic___ Asbestos-.. Chrom ates X ickel C oal e . r , p i i t i t ___ ____________ P e tro le u m __________. . . ______ B e n z o l - .------------------------------ Is o p ro p y l____________________ R ad io activ e c h em icals_______ S k i n _______ . . d o ________ ___d o . _______ _ . d o ______ ___d o . _______ _ . d o ________ - _doA __ - d o ___ ___ B l a d d e r ____ Skin _. __ j Lenke ma 1. b u n g ____ _ Lung-- __ d o ________ __ d o _______ ! - d o ________ -al oav- !i.Ne a! tn; i; M i n s Lung_____ ___ di) ______ _ Leukem ia--. [Lung j L a ry n x ____ IXasa! sin u s. Id . ^ Xa~ai sin u s. 7 no 70 7 i i i o - ;oo Ch i r> . 7 22 75 ! o i! 0 ~ ' U ! ! ' 4 1 / j 7 ! T ' o i 3. 150 20 j , 900 1 4 0 20 100 i. 2 0 0 ' >> (.00 10 03 65 ; 81 51 5:5 33 31 0 0 0 0 0 32 3, 2fi0 99 J. 007 ]-l 41 20 101 1, 000 (?) 27 050 23 So 140 84 51 oS 40 42 1 1 6 9 :i T o ta l___ _______ ___ > 7 5 0 ! 7, f)40 8, 400 1 App'ovtmate. 128 1954 M E E TIN G OF IAIABC T abus 1a.--- Time Table of Discoveries of Occupational Cancers Name of agent Date Discoverer Organs affected Nature of exposure Chemicals--Organic: 3 775 1876 Coal tar (bituminous)----- 1892 1910 1936 3920 1908 Pam {fin oil (shale oil)__ 1876 1890 Petroleum paraffin oil___ 1910 1930 3910 Benzol.......... ..............--. . 3028 Aromatic amines (five 1895 interim diates). Isopropyl uil....................... 1952 Chemicals--Inorganic3822 1887 1 >U0 N ickel__ ______________ -;,32 Din>u*P .'rent* U':;avioler radiation. 1 1S94 Korr'iccn-raduitien_____ P102 I90( 1 '11 Radioactive substances.. 1579 1923 1929 1931 But! m ............ ................. ____ do.............................. Bell ..................... .do ................. .. monpre-z Sehamberg_________ _ Delorc & Borgomano. B ohn................................ Wc:I, Sm yth & Nale._ ___do...... ..................... . . . d o - .......................... Blood-forming tissues. B udder, meter, kidney. Nasal sinuses, luiynx. lung Occupational. Do. Do. Do. Do. Do. Do. Do. Do Do. Do. Do. Do. Do. Do. S k in ........................... : >G. Medicinal Saupe____________ _ L u n g .................... ......... Occupation:!!. ____du.................... ......... Do. Pieii ...................... ____dn________ ______ Do. G ie n r o ll.___ _ . Nasal cavity and si- Do. nuses, lung. \ D ona............................... \ Do. Environment u. Y rieben ....................... ____do__________ . Occupational. \\ _______________ ____do________ ______ Medicinal Von J no, Schwai Iz A Blood-forming tissue'. Occupational von Mcbenroek Haerting A Hesse___ McXoal, Ward and W illis L o ev v v ........................... M uttland ...................... Lung................................ S k m ................................ Blood-forming tissues. Bone.............................. Oecupa; tonal. Do. Do. Do. lo'.vHTr, ,,n iiuii'ifriminaH* '''i-pt;incc of those figures a? i-o-ilo-*.*!ij>jj: the acuml scop' of the occupational cancer hazards would seriously Le midr-ading for the. following reasons. The presence of occupational cancel hazards has so far been established for only a few worker groups having contact with one or several of the carcinogenic agents listed While, for instance, it is generally known th a t workers e m ployed in gas works and coal tar distilleries or engaged in the cleaning of petroleum still- and having skin and respiratory contact w ith coal and petroleum pitch and ta r show an excessive liability to cancer of the skin, and apparen tly also, of th e lung, tlie.ro does no t exist any official record of similar cancerous complications among electrode workers in alum inum production plants where an. exposure to I'noms OCTOBER 6-- M O RNING SESSION 129 from the electrodes consisting of a mixture of coal tar, pitch, and petroleum coke exists. Reliable information, however, is on hand t h a t these wm-kors suffer from cancers of th e skin and, possibly, also the respiratory tract. The extent of this exposure hazard m ay be estimated by the fact that approximately two-thirds of a pound of electrode carbon is consumed for each pound of metallic alum inum produced, of which 800,000 short tons were consumed in the U nited S tates in 1945. I t is equally significant t h a t agents which have boon re p o rte d to have caused occupational cancers among workers of an in d u stry of one country, do not seem to have the same effect upon the workers of an identical industry of another country, if the available d ata would be accepted ;u their face value. Since carcinogens behave in their fundamental disease-producing properties like pathogenic micro organisms, there is no sound reason to assume that, carcinogens m ake any distinctions in their activity or effectiveness for any national reasons. In fact, it can be shown that such scientifically incom prehensible discrepancies are mainly due to local differences of report ing of occupational cancer cases. T h e existence of an excessive liability of gas house re to rt an d coke, oven workers to cancer of the king has been reported from -Japan. Canada, and England, but not from any other country despite the fact that the exposure conditions for workers employed in such opera tions are identic id. T h e occurrence of an appreciable n u m b e r oi ae-eric cancers of the skin among Gorman users of arsenical in secticide-, was placed on record during recent years. If full credence would be given to reports on arsenic cancers observed in the United States, one would be led to believe th a t arsenioals in our part of tie world are carcinogenic for almost exclusively medicinal reasons. Again, it is hard to assume th a t arsenicals would m ake such dis tinctions. A similar situation seems to exist concerning the car cinogenicity of lubricating oils obtain ed from petroleum in different parts of i he world. Although there were placed on record by English investigators during recent years, several hundred cases of skin can cers due to occupational contact with lubricating oils, practically nothing is officially known as to the existence of such industrial disea-e*- from the countries on ibis side of the Atlantic. One seems to he content with attributing here the English observations to the carcinogenic action of shale oils, the large-scale industrial use of which was discontinued during the 1920's, and therefore, cannot account for the, more, recent English cancer cases observed am ong spinners, mechaiues, engineers and other workers having had exclusive con tact with lubrieul ing and cooling oils of petroleum derivation. 130 fr 1054 M EETIN G O F IAIABC I t is w orth noting in this connection th a t during the last 20 years, there has been mi almost complete lack of published additions to the list of occupational coal tar, pitch and creosote oil cancers of the skin from the United States, althougn such cancers have been observed and are recorded as such in industrial records, and despite the fact that the animal reports of the Chief Inspector of Factories of England and Wales have regularly listed notifications of such lesions to the extent of from 100 to 250 cases per year. One m a y also reflect, on th e fact th a t th e la.si published figures on occupational cancers in American dye workers appeared in 1908 and listed less tiran 100 cases, all occurring am ong employees of one com pany. D u rin g the intervening 15 years, the total n u m b e r of such cases has risen several fold and no official d a la have become avadahie from any of the otlior companies producing and handling carcinogenic aromatic amines used in the product ion of decs and rubber anti oxidants. In contrast, recent reports by English investigators sup ported by the. English chemical industries have supplied adequate figures on the number, incidence rate, and attack risks of bladder cancer among English dye and rubber woikrrs who had been exposed to the same carcinogenic aromatic amines with which the correspond ing worker groups in this country have occupational contact. Finally, some coin deration m ust be g ven to the fact t h a t the general population lias varying degi oes of com act. with some oi the carcinogenic agents through, their presence m industrial wastes released into the environmental air and bodies of water, and entering subsequently the soil and the fauna and llora living in such a polluted ern ironmem a n d list'd in p art lor nutritional purposes. I n the past, claims as to the occurrence of so-called "neighborhood" cases of cancer have rarely been made. The well established former occurrence of arsenic cancers among inhabit ants of a German region in which tiie drinking w ater supply was polluted with arsenic from mine, slag heaps represents tlie first occurrence of this t \ pc. Following the disem cry ol bladder cancer Hazards am ong G eim an dye workers, it was asserted dial an environmental plant contanim a tion with carcinogenic around ir amine' v n responsible for the production of bladder cancer's among persons living in the vicinity of this plant While the actual existence of such conditions was denied at that time by other investigators, the recent demonstration of " neighborhood Cdc"v" of her;, Iliosb n v k - tiaim s up peat as noi unreasonable possibilities since a. highly potent carcinogen, such as beta-rsaphihylamim', is involved which might have produced such result's if the waste disposal and housekeeping methods of the plant were inadequate. Il is probablt that the future occurrence of caneej'-. of tlie lung and bone among individuals who lived near beryiiium- producing or processing plants might iv rn b h additional evidence of OCTOBER 6-- M O RN IN G SE SSIO N 131 cancer hazards rein led t.o o u d ro m n e n la l plant pollution if beryllium and its compounds arc not only carcinogenic for rats and rabbits but also for m an. Similar conditions of industrial atmospheric pollution exist around arsenic: smclu-rs. chrom ate producing planls, carbon black factories and oil refineries, as weii as u ra n iu m ore' mills. The recent compensation chums advanced on the basis of an alleged, existence between cigarette, smoking and lung cancer also point to the possibility of a greater fm ure import anee of the compensation aspects connected \\ith the occurrence of cancel's from industry-related sour: "s, such as exposure to carcinogens contained in the exhaust fumes from diesel and gasoline engine, or present as additive and contam inants in foodstuffs. It appears from these considerations tlnu there can be no doubt th a t the- actual n u m o e r of oecupationai cancers is considerably higher th a n the n u m b e r of cases pi.at ed on record. It is of some1in te r e s t, m oreover, that tiut n u m b -r of cases recorded m medical journals is appreciably higher th an the num ber of occupational cancers which during the last 20 years have conn- for decision before com pensation boards be cause compensation chums in m any such cases have been settled o u t of court. \\ ith a few exceptions, such as the incidence of lung cancer among American chromate manufacturer', and among German and Czechoslovakian radioactive ore miners, of nasal sinus, larynx and lung tumor-- among Ameiicau isoprop\ 1 ak-ohol manufacturers, and of skin canew among English ro d ta; manufacturers and processors, no reliable m fort mi don i a vail a IT -on ihe incidence rare- of occupai ionai cancers c>f ilm vaiteus types among dilferein occupatiom d p opulation groups. H. S p ecia l A sjtccts o f O ccu p a tio n a l C ancers A fair and competent adjudication of com pensation claims for cancers allegedly caused by occupational ag nts or conditions requires an ad e q u ate knouledge, of the. special a,spe. t-.- re lated to the production and de \ eloj nient of tlu'-e Pm -m - and <! the c i t e r i a hy winds th ey m a y be dist liu.-ii-ht-d t n n nuh-oecimaiiomil environm ent ni (medi cinal. diet ary. eo,mcii< . luduiualj as veil a- "sp o n ta n eo u s ' c.Liteera. 1. i )(' fi it ii toh ui iio I tr //S "fiet '/pen a .' t ( fiiiy\ -1 - J ha term --oc cupational cancer'' is applied t(. nialiuna!.. tu m o rs oi iginating in individuals during the course, and or a- 'he n - n k of die regular and nsm dh prolonged exerei e of rrrl am occupational aciirities emailing contact v ith sonic (-xogi-nons, p b w r . d , .'iii-anral or pnra.otic agent acting in proper imeiisitv. Occupe* icmd cancers iSws are caused by specific agents or m loiegirally ich.ied to well defined occupational coitdil io'ts vrhiih form, an ;.ccg--i pa:t o* d.o ord in ary workine.u\irm -inent. Tiny ditfci ih ro u ih d e w a-;,,. c(s Irom i he. arm, iei 11v1 o n u pal mi la i eaneers wl.idi result Irom or f o ik u upon some eviaiur- 132 1954 M E E TIN G OF IA1ABC dinary, unforeseen, accidental injury sustained at. w o.k and being of a nonspecific nature. 2. Types and N ature of Occupational Carcinogens.-- O ccupational agents which are known or strongly suspected as having caused cancers of various organs in workers who became exposed to them are largely chemicals. Some of these chemicals are well defined, others consist of variable mixtures of a large number of chemical com pounds, a few of which possess carcinogenic properties. A second group of occupational carcinogens is composed of agents characterized by their ionizing or nonionizing radiation. A third group b repre sented by environm ental agents and conditions which sometimes: have an occupations!,! association, and which m ay be related to certain infections or several specific climatic, geologic, dietary, and n u tri tional conditions, an d which in part, have more, or less indirect relations to carcinogenesis (tabic 2). T able 2 .-- Occupational Carcinogens-- Their Route of Exposure and l' heir Target Organs General type Specific type i Route of exposure i Chemical carcinogens. O rganic c h e m i- B e n z o l........................................ Cutaneous, rc-spira- cals--aromatic, polycyclic, het i ton,. i erocyclic Beta-ria-phthylammc, hi jui- . Respiratory, curano line, l-amlnodiphonylmLinj- ous, iliumm.iry. mine magenta '.*) dolui- di.'K ') Coal tar, pitch, scop asphalt, C utaiioom .................... tar oil, creosote oil, anthr.v- Ucspiratus e.................. cone oil lain]) black, lignite tar and paraffin oil. Synthetic coal oil and tar Cutaneous ................... (Bergius). ' Shale oil and paraffin o f _____ ___d o .................. ........... R esm ram rv... ___ . Petroleum fuel oil, diesel oil, Cutaneous____ ______ lubricating oil and grease, R cspnarorv... ............ cutting oil, carbon black, asphalt, tar, coke, c>ode i i.iraffin oil. Target oi. an Blood-forming o r g a n s (leukemia, lyrnphosarcoma, myeloma';. Viogonous oigan (binddel, meter, knlne\). skin, Rang. SKin no. Larynx. Lung Inorganic chemicals. Physical carcinogens: ionizing radiation. A rsenic.......................... .............. Cutaneous, ingest ivo.. Respiratoi y................... N ickel............................... ............. ....... d o ............................. C h r o m iu m ....... .......................... . . . . d o . ______ _____ A sbestos...................................... . . . . d o ............................ ,.s Transcutaneous______ Radioactive radiation (alpha-, beta, and eainmr,-radiation; C utan eou s... . _____ Transcutaneous__ ___ R e sp ira t o ry ................... Skin Lung. Nasal cavil y, nasal sinus. lung. Lung. Do. Connective tissue, bone, Mood-formmg o>gans. .Skin. C onnects e ti.-sue, blood- formmg organs. Nasal siuuj Incest,iw._ ................. Parasitic carcinogens.. SUthdosoiiiu hematobium ___ CutaiKOus................. Bono Bladder. O CTO BER 6---M O RN IN G SESSIO N 133 In addition to those established occupational carcinogens there are a number of potential hum an carcinogens which have been shown to elicit cancers in experimental animals and to which workers become exposed hiring their regular occupational activities. These po tential agents which also must be considered in the adjudication of com pensation claims, are listed in tables 3 and 4. T able 3.-- Potential Environmental H uman Carcinogens Agent Site of tum or Type of e\- posuio T \p v ' of himiua contacts? E s tr o g e n s ..-________ ! Breast_____ ____ Parenteral.. Natural.....................I Lym ph n o d e s ...' Cutaneous. S y n th etic........... U terus........................ Oral______ ! H y p o p h y s is __ ;____________ Carbon Tetrachloride.. Liver..................... O r a l............ Chloroform. Oial____ Barentei al. D D T (r.j.i-Bistp-cilo- .......do r o p h e n %1-1,1,1-t r ichloroethnne). Tannic acu__________ ;____ do .. O ral. __ Parent'rai T hiourea an d dea .'va- 1........do . tn eu Tiiyr-jui p-Pu nel >luron ( i )ul- , L uer fin,1 i D ietlp huit' pd\col. . . . Bladder . Orni_ MOb-dateu napnf Skin. C utaneous__ _ Berg!us coal oils and . .do ............' Cutane-ms tar. I M ih ci'taiieou s iheertteial ! truie. Fish*............ ...J ; b on-.. tar-', UIM'.s, . gra. s Mouse... lin t........... Ivubhit-- . CjU pii Mou e . . .J..nnJ:ioTutu Ihciai > addui\e. Cosmetic ingredient. P '-litsi n \1 sedvenr IVer using tijrnt 1)i \ -elo.uu;iti agent 1 nv-' \uiig.-sbiLig age nt. Mol1of.-onii t , Pioducnun of ficon 'Sr tin fumigant F 'lia i 11vc of -tils. Manufacture. A n.-'tlK't to > o h 'b l and F \P \icfive of oiP tcm'a . runbot. waxes, iodine, alktdaids, ' li'aicdiei't oi lacquer, floor ' polish cK iirm i fluid. 1';itint:oil of artificial silk, vlisics Maniifn lin e. m-e< tic hie1. Ff'Oil curt ur.mani. lianrdj-'iu of foodstuffs (miits, \m iio, coiTee, and ; tea). ?.I,d - ina.1 am ni Ta<initig igvut. iihat ftiescivotive. Mouse Hot Pul Mu-erenr.g agent. AMifrr in: on. <h,i` e in i -.possve no onfuettb.. St ,fr .ai uf hf'Q!!. -r inks, vmu.1 .-?an-' One, textile, hi mrc Pun d'-baevo). Vc 'ode oi imcet Hides. M il"lf let U! O. ; iii t fiubtKanis. J'l.' n ` mod Ktb'J). . Vm,, H-b.a .ii. V uruf.Vn! Pue! Lubricant. Id ti,,r 0 nut al * 134 T able 3 1954 M E E T IN G O F IAIA BC Potential Environmental H um an Carcinogens---Continued Agent Site of tumor Type of ex posure Species Types of human contacts Light green SF bril- S u b cu ta n eo u s Iiant blue F C F fast tissue. Parenteral........... R at________ Textile dyes. Food and cosmetic dyes. green FC F . M ouse........... Food dye (orient). R at_____ _ Gasoline dye. Flare color. Cellophane, polvethylene, polyamide (nyIon), K.kehte teflon polym ethyl methae- Subcutaneous,. Parenteral___ _ ___ do_______ Film , fiber, plastic-industrial manufacture and uses. VTrippim.r motor" d. M edicinal agent. rylate. Berryllium. _________ Bone ................. Parenteral___ _ Rabbit . . . . M etal alloy, X-ray tube, Respiratory___ R ut________ phosphor irmnufac* m<*. Refractory vessels Atomic energy production. Selenium.. _ _ ............... Liver, thyroid .. Dial . .................. . . . _do... . . . Soil contaminant. ' j I ' Coloring matter of glass, ; 1 > ceramics, paint, rubber ] j 1 Metal alloys 1 j ` Rubber accelerator, j ; Photoelectric apparatus ' Decoloi izer. - 1 Fireproofing agent, i , |Medicinal agent Cobalt...............................1 S u b c u ta n e o u s , Parenteral______ ......... d o ........ I Metal alloys and plating. tissue I |Coloring matter o? ela'-s ' ' i cot arnica, paint, rubber. Me iH'r'u] agent T a b l e 4.-- Carcinogenic Chemicals Eliminated as Environmental Human Carcinogens Agent 1 Site of Cducer PUryl 4TJ......... _____ S u b cu ta n eo u s t isMie. 2- \o'~yainino-iin .<i>ris.1 Su nei: f..noons 1 tr-me , Bladder___ . ie v ir _________ Brain Tb\rmd. 1 Acoustic duct. Breast ; Leukemia. 1 kidney 1 Lung. T>ppoesuorfeex J Species j Intended use Pareutc r<il....... Oral _______ I' .enter , ] __ 1 __] M ouse........ ; _ J ____d o____ . K ,u___ _ D og______ ._ Foni . 1 i j Trypanocidal 1 Ir.se- i cidc i agent. ] i i 3. lii n id fittoit oj lnleiuui.-- For ilio establishm ent oi onusal irllion^s b et we e n an exposure to t he se agoiits and t h e s ubs eque nt d e v e l o p ment of a canoar of an occupai ional genesis and therefore e ompe nsnble intuire, tin; following prerequisites m ust U fulfilled: OCTOBER 6-- M ORNING SESSION U /U (a,) Definite evidence m u s t bo available indicating that, 1he c laim an t had occupational contact with any one of the various agents listed, th a t this contact was either of prolonged nature extending as a rule over periods of at least 6 months, and was of adequate, intensity for eliciting a cancerous response, according to any previous experience which might he available on this point. Single exposures may be considered to be effective if the casual agent consists of external ionizing radiation or the exposure mechanism favors the production of a carcinogenic depot, in the tissues from which a prolonged exposure of th e host, organism m ay ensue. (6) T h e route of exposure to or introduction of die carcinogenic agent in addition to its specific chemical properties and metabolic peculiarities determine the site of the organ or tissues in which a cancer is elicited. Therefore, n o t any cancer, b u t only cancers of specific sites are related to any particular carcinogenic agent. (c) T h e type- of exposure does n o t need to be co ntinuous or extend up to the time of appearance of the cancer, but m ay be interm ittent, in fact, any contact, with the occupational carcinogenic agent m ay have ceased many months to years or, occasionally, even decades before, the cancer becomes manifest. Effective carcinogenic exposures m ay be sustained not only by the ordinary operators employed in opt rations with occupational carcinogenic hazards, but also by workers entering such operations on a transitory basis, such as supervisors, maintenance personnel, repairmen, truckers, loaders, yardmen, and v orders employed in rooms and buildings near the hazardous bperatio m , if housekeeping and exhaust disposal m e th o d s are inadequate and environmental contaminations result. (d) Occupational Medical Stigm ata.-- F o r the estab lish m en t of causal relations between occupational exposures to carcinogens and sub sequently appearing cancers, it is of distinct value to analyze the medical history uf the, affected persons for functional or anatom ic disease manifestations characteristic of a pathogenic action of the parts ular carcinogen allegedly involved. Such noiu-unci-ro'is and often preparatory or precaneerous symptoms of etiulogie specified}' uU as 'limn a la or biologic linger prim s supporting not, only the actuality of a previously sustained specilic exposure, hut also its causal relationship to the cancer present. Symptomatic manifesta tions possessing such a significance are, for instance, chronic radiob e r m r !:!:, lu-mec i-.u- derm atitis, arsenic derm atosis, chronic solar derm aliiis, chronic radiation periostitis, asbostosh of the lung, and leukemoid reactions after exposure to benzol and ionizing, radiation. Cdieinieai a n a h s e s of tissues for the in crim in atod ehemi( a! uho m ay somethin s be of assistance in establishing previous contact witii any specific occupational c a m .ogees, .such as arsenic, ciuem ium nickel, ra d io a rm e snLstuncis, and benzol. 136 1954 M EETIN G OF IAIABC I t is important., however, to note th a t both these procedures are not applicable for all occupational cancers. Some of the carcinogens do not produce any etiologically characteristic symptoms, in fact, they may not elicit any preliminary toxic or other disease phenomena despite a persistent and prolonged carcinogenic exposure. Thus, cancers of the bladder in dye and rubber workers m ay develop in the absence of any preliminary local or general warning sym ptoms after more than one or two decades of continuous, interm ittent, or dis continued exposure to certain carcinogenic aromatic amines. There also does not. exist an y parallelism betw een th e toxic and/or irritative properties of any chemical and its potential carcinogenic qualities, nor, is there a relationship between the degree of toxicity of any particular carcinogen and its relative carcinogenic potency. (e) Extensive experience w ith occupational cancers indicates t h a t there usually elapses a laten t pejiod of years, if not decades, between the onset of exposures to a carcinogenic agent and the appearance of the resulting cancer (table 5). It is lor this reason most unlikely that occupational cancers become manifest, within the first year following the inception of contact with a carcinogenic agent. In fact, all cancers which m ake their appearance during the. first three years of occupation in a carcinogenic environment should be subjected to severe scrutiny for a more probable nonoccupational origin before they m ay be considered from ant occupational viewpoint. T a b u . 5.-- Latent Periods of Occupational Cancers Organ and astern Skin Arsenic: M edicinal________________ O ccupational____________ T a r ___________________________ Creosol e o il .______ ___________ M ineral oil_________________ . ('ru d e paiailin oil_____________ Solar ra d ia tio n ________________ X -radial ion___________________ Lung A sbestos______________________ C h ro m ates_________________ . Nickel carb o n y l_______________ T a r fum es____________________ Ionizing ra d ia tio n _____________ Aromatic amines. Bladder Average latent Ranee of ; period , latent peuod j i ! Years Years -\ 18 3-40 -i 25 4-40 20-24 1-50 ! 25 15-40 j 50-54 4-75 j 15-18 S~`d5 i 20-30 15-40 l ^ 1-12 5 ! 22 1 ] j i I I 11-15 15-21 (.-30 9 23 7-50 2-40 OCTOBER 6-- M ORNING SESSION 137 (/) A successful p ro d u c tio n of cancers in experim ental anim als l>y the administration of any particular chemical or occupational agent supplies weighty support to a claim that such a factor may hare- an identical effect upon m an, especially if the lout-e of exposure, the physiochemical status of the agent, during com act, and the cancer produced in (experimental anim als arc, identical with the corresponding aspects in hum an experience. However, because of the pronounced species specificity of axogenous carcinogenic agents, even positive experimental evidence provides merely strongly suggestive but not entirely conclusive evidence as to the cxi.-keme of carcinogenic, proper ties of such agents for man. Only human experience gives a definite and irrefutable answer in such m atters. (</) Pathologic and histologic evidence is in general of only limited importance in the establi-dunent of the occupational causation of cancers, since neither the clinical behavior nor the gross appearance and histologic structure of cancers arc etiology specific. However, in some occupational cancers histologically or histocheinieallv d em on strable manifestations ore present which give conclusive or suggestive evidence as to their nartioular etiology. The presence, of asbestos bodies and asbcslosis in a lung- affectcd by cancer provides practical and scientific proof as to the arix-dotic origin of such a pulm onary carcinoma Of similar causal significance would he the dem onstration of chromite dust by Lidochomical methods and by incineration of sections of the lung of an individual with pulm onary carcinoma. The Lislochemicu] dem onstration of arsenic in the skin ailedcd by a carcinoma represents another illustration of the value of histologic studios m thi` doterminai ion of the etiology of a cancer. Likewise the presence of extensive endartcritic, changes in a fibrosed s u b c u ta neous tissue containing a carcinoma or sarcoma would arouse the sus picion that X-rays or radioactive energy was causally responsible for the malignant lesion It appears from iliose conribt rat ions that a com pered and critical e valu at tun o 111a entire o\ its -iv ` i el a l ed to the ex postin' ui 1lie m d i\ n 1-- uai (lit; sym p to m a tic main ie-t at ions of the preparat ory period, th e iengrii of the la te n t period, 1lie site of the cancer, some histologic o r hisloehemieal characterisl ios and the existence of corresponding o b servations on cancer production in experimental animals aside from pertinent epidemiologic, d ata represents the scientific basis essential for medicolegal decisions in lirigatiims of alleged occupational cancers. ('. C om pen sation Latos W orkmen's compensa! ion laws cintel ed in various countries and staits reveal a remarkable lack of uniformity as to the types oi oc cupations! carcinogenic agents', industrial operations uni; carcinogenic ;;so.-.sS - -- i o i 1>1 lVXiHIl<XAi\Vjr U I 1A1AJ3L hazards, and occupational cancers covered. As of O ctober 1, 1954, full ('.overage laws applying to all kinds of occupational diseases in cluding cancers had been passed m 26 S ta tes of the United States and the, D istrict of Columbia; schedule coverage laws not always covering occupational cancers, or all types, were in force in 20 States and no occupational disease laws had been enacted at th at time in 2 States (Mississippi and Wyoming). While w orkm en's com pensation laws based on the- principle of schedule coverage may provide some degree of compensation against disability and injuries resulting from occupational cancer hazards, such legal provisions designed for the protection of workers are totalh inadequate, if not obsolete, ill an era of a rapidly changing and in creasing occupational disease panorama. Such static laws reflect a legal and sociologie, state of m ind which is m aladjusted to the dynam ic state of modern industry. However, even the, blanket or general coverage com pensation law which is sufficiently flexible, to include n o t only the present but also any future occupational cancer hazards, usually has a s ta tu te of lim ita tions which is inadquat,e for providing fair protection under eenain and not too unusual circumstances met with ip occupational cancer Since occupational cancers m ay become manifest m any years aftei cessation of exposure to occupational carcinogenic agents, a statu to ry time clause of from 6 months to 6 years may be too hort for omunlionai cancers which may a])pear after a ionger period, it is a<l\isid>le for ibis reason to adjust all existing laws in such a way that Mich eventualities are properly covered. In the workmen's compenst ion laws existing m m o st Siaies. eenain groups of winkers or employees, such as especially farm labor and domestic, servants, re excluded from coverage b\ the law. Since farming as well as housework have become and are increasingly be coming occupations having extensive contact with industrial produeifpes! ieides. herbicides, synthetic fen bizers. anlisprouling agents, hormonal fattening agents of livestock, lubrican ts and fuel of h u m machinery, rr-iduul oils lor smudge puts, soil n n p io \c rs . nuiiuoi u>, detergents, waxes, polishes, di y cleaning agents), there is no sound scientific, reason for excluding m em bers <>f such occupations from coverage by the, w orkm en's compensation laws and from adequate, protection against cancel's arising from exposure to potential and actual occupational carcinogenic agents. O C T O B E R 6----M O R N IN G S E S S IO N idy I). L abor Codas a n d S ta n d a rd s Any attem pt toward achieving an adequate compensation by finan cial m eans for a cancerous condition acquired th ro u g h contact, w ith occupational agents not only present considerable economic dif ficulties but is aho of questionable h u m a n e m erit. W hile such a procedure is evidently th e best t h a t can be, done after an occupational cancer has become an accomplished fact, the wiser, more rational, and in the long run, more economical approach to a reasonable con trol of occupational cancer hazards lies obviously in their prevention w herever this is possible. This goal can he achieved to a large degree by the enforcement of proper work conditions in operations in which cancer hazards exist, so that cither any contact of workers with such agents is eliminated or reduced to an ineffective level As to the fu n d a m e n t a! step for accomplishing such a control of occupational cancer hazards, it would he advisable to have all factories, workshops, laboratories and other establishments producing, handling or using known or suspected carcinogenic materials to register with State public health and labor agemies. 'Phis information would provide the basis for establishing the supervision of plants by health and labor agencies and would create the proper machinery for familial zing managers of such opera tions with the potential carcinogenic properties of the substances and devices list'd in their establishments and with the m eth o d s and pro cedure-. by which they might be controlled or .voided. Tie- iciutive eli'evli, eness of a n y m e d v a h -a i.itup. and technologic com ro! measures to he adoptod can best he determined b y nseen lining the changes in the occupational cancel incidence among the total population at risk occurring during seme 10 to :'0 years a lte r ilieir introduction. It is therefore desirable that provisions he made, for rout miy recording all cancer cases occurring among w orker groups expo-ed to occupational ememogehs. All procanem uis and cancerous lesions observed among m em bers oi su< li grottos should for this reason he m ade notifiable with the S ta le health ag< ney. All peivons having knowledge of these cancers should hi' held u snonsiOle lor such report ing. T he adopiion of such measures repj e.-ent s an im portanl -top from a pubiic health viewpoint, because there is a growing urgency o deteim ine the environment id causes responsible for significant changes in the incidence rates of se\ end cancers. \ giei deni of eiremnstinitial and direct, evidence incriminates recent changes in the, indust ry-related environmental factors for (he -i art ling and progressive increase in 1he i ung cancer frequency observed Id U 1954 M EETIN G OP IAIABC iu all industrialized countries during the past 50 years (graph 1). A similar, while n o t as m arked, rise in mort alit y rates has been observed dming the last two decades for cancers of the blood forming tissues, especially leukemias, for which the crude m ortality rate increased from 1.0 per 100,000 of the population in 1900 to 4.3 per 100,000 in 1944. This development coincides with a m arked increased use oi ionizing radiation as well as with a widespread industrial and medicinal employment of chemicals having distinct homatotoxic effects. O CTO BER 6-- M ORNING SESSIO N 141 it, also m ay bo of significance tliat the age-specific, total and agoadjusted m ortality rates per 100,000 population for skin cancer in white males and white females in the United States have shown between 1930 a n d 19.">0 a m ark e d shift in favor of t h e younger age groups (table 6). W h e th e r such changes in the ago, d is trib u tio n of skin cancers for b oth sexes m ay have resulted from the m odern habit of sun bathing or a more intense environmental, occupational and dietary co n tac t of t h e general population w ith arsenical*, or with products of the coal tar and petroleum industry, remains at present a m utter ol speculation. F o r determining tlio possible causal signifi cance of such factors in this development, it would be necessary to ascertain data on occupational, dietary, environmental and habitual contacts of the affected individuals, their eomplexioii and race, and T abub 6.-- Age-specific, Total, and Age-adjusted Mortality Rates P r 100,000 Population for Skin, Cancer in White Males and While Peinales. T~''iicd States, 1930, 1345, and 1950 White males k Percent Age i charities ! ! 19P | 1950 ; 193-50 0-, t 1 l1 11 1 Fueler 13- 15- 1________ 2 5 -3 4 ____ 3 5 -1 4 ________ 5 5 -0 4 . _ ____ C5-71, _ . 75-84-_ _ . 85 ami o v e r__ All aces- _ Ago adjusted 1 ____ 0. 0(5 0. 08 0. 03 ____ . 12 . u . 34 ____ .2 2 . 46 ; . SI - . .75 . 85 : 1. 4 ____ 2. 5 2. 1 : 2. 7 ____ 8. 0 5. 3 | 5. 9 ____ 23. 7 16.0 ; 12. 8 . . - 1 68.2 52. 3 : 32. 6 19 4.2 i 172. 4 i 77. 5 _. . ! 3. 3 I 3. 2 2. 9 . . . 4. 7 3 fi i 2 f< --62 4 209 ' 4-76 + 65 + 2y + 11 -2 0 -3 8 -5 5 White females U nder 15 - 1 5 -2 4 .- . 2 5 -3 1 - ______ 3 5 -4 4 ________ 45-54. . . . . 55-01 _ 7 5 - * 1 . ______ _ S3 r _________ \!f ^ adi usual P ____ .... , ____ ____ -, ' 0 07 . 06 .2 3 . r-3 1. 5 O ____ l i . 4 ____! 4. 6 ____1 162. 7 2 ____ 2 il 0. 07 ! . 13 . 23 ! . 55 | 1.0 ! >4 > 8. 7 1 26. 3 ! 132. 7 i 90 1 2. 1 0. 02 . 3t . 72 1. 2 1. 8 3. 0. 8 18. 8 OS 5 2. 0 I. V -- 71 + 138 + 213 4 US -!- 80 4 24 _22 -- - hc- _____ ! &c I A djured ior vo total popnUt iort of tlio United States, 1950. 1954 M EETIN G OF IAIABC on the location of the cancers in the exposed or unexposed parts of the skin (site distribution). All such d a ta could readily be obtained for occupational factors if all occupational cancers would be m ade notifiable. At the same time this measure would be instrum ental in ascertaining to a m uch greater degree than heretofore the scope of occupational cancer hazards ami of the cancers resulting therefrom. The effectiveness of this pro cedure is strikingly illustrated by a graph (graph 2) published several CUTANEOUS CANCER IN RELATION TO OCCUPATION CrfcAPH SHOWING THE HUMBER OF CASES OF CUTANEOUS CARCINOMA !N U A i e * * FEM ALES IN ENGLAND, WALES S SCOTLAND NOTIFIED ANNUALLY FROM 1911- 1949 INCLUSIVE. fc'SKAOWR';* THE DOTTED POTT-ON OF THE GRAPH DENOTES THE NUMBER OF CASES C O w ntau tEB s v s h a l e c ,l a minera . o il o n ly . GHai':l 2. O C T O B E R fi-- M O R N IN G S E S S IO N 143 yours ago i>v I len ry in v Inch he showed the striking rise in the n um ber of cases of cutaneous carcinoma in males and females in England, Wales and Scotland attributable to occupational exposures to coal tar, pitch, shale oil and miner;.; oil alter s t a i u t o i y notification went into effect, in 1920. Conclusions 1. T h e rapid de\ elopmeni of m o d e rn industrialism has been asso ciated with tin' ap pearance of m an y new occupational health hazards of which those causing cancers occupy an im portant position. 2. T h e increasing ra te at which occupational carcinogens have been discovered during recent decades suggests that only a fraction of the actually existing industrial carcinogens is known and th a t here tofore unknow n and new occupational carcinogens m ay be added (o the present industrial environment through the development, and use of new chemicals and production methods. 3. Tlien- is a great deal of evidence indicating that only a relatively small fraction of the cancers produced through contact with occu pational -'arcinogens has been recognized and /o r placed on record. Because of the established widespread industrial contact of large worker groups with known occupational ctucinogens, the potential scope of the occupational cancer problem evidently is much larger than apparent from the reported n u m b e r of oeeupalional cancer crises and hazardous industrial operation-.. 4. Medicolegal decisions in co m pensatiou procedures of occupational cancer claims should be bused on a com petent and critical ('valuation of the entire evidence ielated to the exposure conditions of the claim ant, th(> presence or absence and the ty p e of a n y etiology, specific symptomatic manifesiations observed during the latent, and develop m ental period <>i th e cancer, th e le n g th of the la te n t period, th e site of the cancer, any specific, histologic and histocliemieid characteristics, the production of corresponding cancers tu experimental animals by the incriminated agent, and perl merit epidemiologic data. a Schedule coverage laws ar" inadetjuate for providing proper protection against occupational cancer haz ard s because of the, dynamic, slate of modern industry resulting in the constant addition of new ehomicais and production methods winch may' entail heretofore unknown occupations! o i n o r b-v>i',l--. 'The t a l u k (if limitations contained in the general coverag< laws represents its main defect tit the fair and equitable application of tin- ty p e of workm en's com pensation law to n c 'upai ional cancer hazards. (i. Since the prevention of occupational r.inoet h a z a rd ; and not financial compensation for established o ee u p a1hmal cancels appears lo he tin1 more m nsdue and hum ane m ethod of oceupnt !>nal cancer i a o a JU i,jSTi:,TG O F IA IA B C control, labor codes should be properly adjusted and enforced so as 1o eliminate or reasonably contain occupational cancer hazards in mod ern industries. 7. F o r ascertaining the ac tu a l scope of the occupational cancer problem and for the institution of adequate control measures, it is essential that occupational cancers and preeancerous conditions are made notifiable with local and State health and labor authorities. 8. A comprehensive s tu d y of occupational cancer h az ard s will provide a sound basis for an equally urgent investigation of the apparent extension of industiy-related cancer hazards to large parts af the general population. Bib l io g r a p h y 1. H u ep.br, W . C., O ccupational T u m o rs an d Allied D iseases. C. ('. T h o m as, Springfield, 111., 1942, p. 897. Recent. D ev elo p m en ts in E n v iro n m e n ta l C an e ', A. R eview . Arch. P ath o l. In press. A M ethodology fo r E n v iro n m e n ta l a n d O ccupational C an cer S urveys. I 'ubl. H e a lth T ech. M onograph No. I. U. S. P u b lic H e a lth Service, D e p a rt m en t of H ealth, E d ucation and W elfare, 1950, p. 37. . T hasko, V. M ., O ccupational D isease R ep o rtin g . U. S. D e p a rtm e n t of H ealth, E ducation and W elfare, Pubi. H ealth Service Publ. No. 2S8, 1953, p. 80. Stein e r , L. K ., R ecent T ren d s in O ccupalional DEea.se Legislation. Univ. Illinois Hull. 48; No. 69, 1951, p. 30. M orgis, G. G., a n d B av ex i-ort, S. J., S ta te C o m p en sato ry P ro v isio n s to r O ccupational D iseases. B ureau of Mine In fo rm a tio n C irc u la r 7650, U. S. D e p a rtm e n t of th e In te rio r, 1952, p. 125. W a t e r s , T h ., In d u s tria l P h y sician a n d W o rk m en 's C om pensation---C u rre n t Trends in Com pensation Legislation. J. Indu-t. Pvg. and Toxicol. 31: 251-255, 1949. Sun committee o x L egislation P r in c ip l e r , A R a tio n a l A p p ro a c h to .Air Pollution Legislation. M anufacturing C hem ists' Assoc., 1952, p. 23. T ouranoeau, F . J ., H e a lth of W o rkm en: A p p reciatio n of Risk to W hich H ealth of W orkm en Are Exposed in In d u stry in Pvo\mc,e of Quebec. C anad. M. A. J. 54: 352, 1916. The A eeident Prevention A ssociations U nder the Q uebec W orkm en's C om pensation Law if. T. Clegg, President, Quebec Association fo r the Prevention of Industrial Accidentsi i the, absence of M r. Clegg, his statement was read hv Arm nun }h -> r ;CL 'president, Quebec Association fo r the Vrcvent-'Qu, of Accidents] i will outline briefly the setup of tho various safety associations, and or, being m ore familiar w ith the, organization which i repieseut. shall endeavour to elaborate, on a few of its m ajor promotional O C T O B E R 6----M O R N IN G S E S S IO N 145 P reveit tir e isso ria 1io n s As you arc? no doubt, aware, Section 110 of the Q uebec W o r k m e n 's C om pensation Act, stip u la te s that, industries included in any of th e classes u n d er schedule. 1, m a y form themselves into an association for accident prevention and may formulate rules for that, purpose. F u rth e r, th e W o r k m e n 's C om pensation Commission, if satisfied t h a t an association so formed, sufficiently represents the employers in the industries included in the class, may make a special grant toward the expenses of any such association. It is under these provision that, the vaiious sa fe ty associations were organized and are functioning in the Province of Quebec. I t m ight he well to m ention here th a t there are 24 Hasses of industries u n d e r schedule 1, w ith 5 se p a ra te Accident P revention Associations operatin g w ith and for th e m --4 of these associations each cover Angle classes, nam ely: 1, 2, 5, and 22, while flic fifth association serve all th e rem ain ing 20 classes. T h e la tte r are am algam ated and operate u n d e r the nam e of ih e Q uebec Association for the Proven lion ot i n d u s tria l Accidents, Incorporated. It should bo pointed out that, schedule 1 embraces the industries therein mentioned and that the employers in these industries contrib ute to the accident fund by v ay of assessments on their behalf. In schedule 2 are the businesses of railway, suoet railway, express, telegraph, Dominion telephone companies, navigation, owing, opera tion of vessels and m a rin e wrecking, bridge on- radon, th e G o v e rn ment of Canada, the Governmen! of the Province, municipalities, commissions and school boards. Employers under schedule 2 are individually liable to pay the com pensation provided lor by the act. T h e first, of t h e five associations I have referred to earlier is The Quebec L um berm en's A ccident Prevention Association, Inc. This asso ciation serves industries in class 1, m ade up of sawmills, lum bering, and veneer. 'They have approxim ately 2.o00 m em ber-, of v, hi< h about 900 are sawmill operarets. The second is The Quebec P u lp and P u jx i Saf<h/ .E w e ,'re He. h e . This association servos industries in class 2 eom prbing some 000 members engaged in paper mill operations and culling pulpwood. These two groups, while separate, operate from one offer, here in Quebec City, as the general n atu re of thi ir on-ralion lend themselves to such a combination. Of real interest to me is the Hot th a t both those associations are functioning with a merit ruling yen m. Mach of th ese gro u p s lies its own boirnt of d i r - ' ,e,m. hcparato tccoimung, and e;<Hi receives s opnr u' e <>re:ns rom dm <'o nu ni m' o n. C o m b i n e d , t h e y h a v e c r / h t i nspector a ho are sent to \ at ous s w t i o n s of the Pro unco with a specified sHwnn.e of inspect ions to be made.