Document QkXNZmGLEDO8GK00E8ZBnG7M7

*V i t <S . ^ - - ,v - Z :j ( PLAINTIFF'S 4 EXHIBIT IfflVERSITT Of OXU BULLETIN ssfiCCLcr KiDi?-; / o/ //l< AMERICAN SOCIETY FOR THE CONTROL OF CANCER, INC. > 4 "The Drawn Sword" OU 55 JANUARY, 1943 NO. =h* ;t that hither- . I which can ucure of cain-i-:- from cancer. : ;r: from can.-* : .oney ii already it to the cui;ig enough f' i"' ar against c.;-. ,o not have vi r because pi\>ut because ih. >t good enono le to overcome .iiUy inereu.-i^.. the studies one of us g is done, at..: ognize and un now beginnin.: Cancer occur, abnormal chcmitiical comes in : breast and thv one to develop ue of the ortri-.n s the normal ells which muk>ij strangles t-'u>i food and air. tot reeult in tin interferes with irvive they mu?: f and nutrition. - the poison >" In other word?, that they can sicute norm.u t... ' rhjs iv- .come -- touch j r-. ' Mine .lUi tissil The grow.n **: aes cannot hv ay food and -nr are so civd\r.vd In this wav th.tissues and ?> sures of attack then, to preven-. nality by whir chemical com.s found and re search is gome 7*?> Americas Societt for the Control of Cancer S3 But how are we to improve the methods for cure - of the already developed cancer? Since the, tough ' -oeila which compose the cancer cannot be reformed "iato normal civilized and controllable cells, they ost, like our enemies, be destroyed utterly. AU . - tsodern treatment of caneer is based on this prin.`.Qple of killing. We attempt to destroy the caneer 'by the use of x-rays, radium, or surgery. Un fortunately, whereas these methods are very useful, some cancers have progressed to such a stsge when . (he patient first comes under the care of a doctor that no procedure now known can be expected to - be completely effective. Better treatment by new methods is required. How can they be devised? Probably a new and more effective attaek will be -developed, baaed on the fact that tha caneer cell, in - jetting tough, has become dependent on ways of living different from those of the normal eelL It is -; exactly like the criminal drug addict who undtr. ' 'the influence of his drug esn perform extraordinary . feats of daring and strength, and who feels no need '. for food. But even when the drug is removed, the j damage has been done and the addict cannot live a normal life. He is still a menace to society and muat V.be treated accordingly. To kill or to control these criminal eaacer cells, r^we most take advantage of the dependence of can-;.cr on abnormal chemicals or drugs and on tha `abnormal way of living which tha drugs have caused. - We must not only cut off the drug supply, but we * moat find a way to liquidata this lawless member of ^"society, the caneer that has developed. To do so we ./oust find out what the cancer tissue thrives on and . ; how it can be exterminated completely. Experiments of this type are in progress, and although the results .'.'irt.incomplete, it is not impossible that we may be vaaeetssful in the future. y,.At the present time, however, do not forget the "fact that there is no procedure which offers any* .-^tiling to the patient with cancer except the use of ^surgery, x-ray, and radium. You muat not be misled -/...by the published reports of experiments on the Retire of cancer in small animals. Little evidence *xist to prove that cancer in rats or mice is pro* .. duced by the same agents which cause cancer in : \aum. Indeed, it is very unlikely that different species * acquire cancer from the same source. For this res* Y'.MAt.the public should be on its guard and should not accept discoveries reported concerning cancer in animals as applicable to cure or prevention of cancer in patients. The last question is: Whet is the future of cancer research? Success in this field will depend upon two factors: l--adequate financial support, and 2--1the study of cancer in man rather than in animals. Facilities for the intensive study of the disease in human beings are not at hand now, and they are urgently needed. It is not possible to study and treat properly human patients with cancer without an expenditure of at least $500,000 annually; and very possibly more than this sum will be required. This may seem like a Urge amount, hut it is no more than is necessary in view of the enormously com plex, detailed and specialized work required. It represents an outlay of only $1.00 annually for every Individual afflicted with cancer. This money must not be scattered, but should be concentrated in support of closely integrated studies. When a special research organization can be set up and provided with real financial support, it will be possible systematically to study every feature of the chemistry of the invididual with cancer. The resulta of this study should prove that abnormality allows the cancer to oeeur and how it can be rectified. Furthermore, it should be possible to prove in wbat way the cancer tissue differs chem. icaily from tha normal tissue. Once this difference is known precisely, it should be simple by chemical means to attack the cancer at its weak point, to starve or otherwise to destroy it, and leave the normal organs unharmed. ^ This program may seem to be an ambitious one. The fact should be recalled that the policy of ap peasement ean be spplied no more successfully to the cancer problem than to the Japanese and Ger mans. If we wish to win the war against cancer, we must concentrate and intensify our efforts. We must intensify them to any degree which will insure suc cess, and we can be satisfied with nothing short of success. Cancer kills 160,000 individuals annually in the United States, and mutilates 500,000 more. This is an annual lota of life far in excess of that which can bo expected from war. If we can spend unlimited billions to win a war, wo should be able to spend a few millions to finish our fight against caneer. Cancer in Its Relation to Occupation and Environment W. C. HUEPER, M. D.* /.PRINCE the beginning of plant and animal life on this planet environmental factors have + exerted a powerful influence upon the evolu^uen and the cessation of the various species which populate or have populated this earth. Paleontology teaches us that severe changes in the environmental, particularly climatic factors, accompanied am) con ditioned the fundamental and radical alterations in Institute for Therapeutic ftee.*f*h. N,>* Y-irk City. t 64 The Ajixbxcak Socrsrr for the Contsol of Canc** the fauna and flora which took place during the dif ferent earth periods. This control over life, disease and death exerted by the natural environmental fac tors over all living matter has existed without much interference from other sources up to the early part of the nineteenth century, when mankind began to revolutionize its natural inanimate environment by the development of modern industry end the gen eral use of its products in daily life, creating there by a new artificial environment. While we have be come conscious in general of the numerous ad vantages and beneficial effects which the trans formation of the former agricultural civilization into an industrialized one has brought to us. only relatively few have a proper appreciation of the fact that this new artificial environment also pos sesses eminent disease producing properties which act upon its creators and benefteisriea alike. The powerful impact of the rapid rise of modern indus try in all its multifarious ramifications upon the inanimate exogenous environment affects mainly and primarily the industrially employed parts of the present-day population, but extends also to a con siderable degree to practically all other portions of the population and influences all branches of human activity, including personal and public hygiene, medical care, nutrition, clothing, living quarters, communication, transportation, lighting, habits and customs. The numerous new diseases directly attributable to the contact of industrialised man with the new environmental agents involve practically every organ of our body, including the skin, the braiir, the lungs* the heart scd blood vessels, the liver, stom ach, Intestine, blood forming organs, the kidney, the bones, the bladder, etc. This increase in the number and types of industrial and environmental diseases occurring during recent decades is reflected by the appearance of many new special branches in natural sciences and particularly in medicine. In dustrial medicine, aviation medicine and radiology are products typical of this era. Industrial cancers constitute an integral part of the various pathological reactions elicited by a pro longed contact with some speciftc chemical or physi cal factors composing the new and artificial en vironment. Although a few of the occupational can cers have been known or have existed without cor rect recognition prior to the advent of the modern industrial era, the great majority of them appeared after the start of this development. In fact, the overwhelming' number of occupational neoplasms has been placed on record during the last forty years. During this period there was not only a con stant increase in the absolute number of these in dustrial neoplastic diseases but also a marked rise in their organic types and in the exogenous sources. The variations which the numerical and organic incidence of industrial cancers have displayed in recent decades and in different countries and indus tries, reflect, to a certain extent, the general and local growth of modern industrial enterprises with their great variations in tho type of raw prne used, in the methods of production employed, in the kind of finished products manufactured. The medical, medico-legal, sociological, and eatifie significance of occupational eancers exfar beyond the limited importance these diso possess as industrial diseaass. Industrial ca are, at preesnt, with the exception of a few tv of non-oceupational, environmental origin, the cancers in man of which the approximate cat known. They have attained additional impor as the study of these tumors has resulted i discovery and synthesis of a large number of ical carcinogenic substances, some of which fpund to be closely chemically related to subs* occurring normally in the body, such as bile sex hormttBSS, or forming constituents of ou: and our COfls, aueh as cholesterol and vitan The scientific investigation of the causation cupational eancers has furnished the basis fof the greatest advances ever made in the kno* of cancer in general. Occupational cancers are eiieited by a variety of chemical and physical agents s arsenic, chromates, nickel carbonyl, radium, thorium, asbestos, crude mineral oil. pitch, ta paraffin-oil, anthracane oil, creosote, aromatic compounds, such as aniline, naphthylamin benzidine, benzol, ultraviolet rays, roentge and rays of radioactive substances, and certai sitie worms, such as schistosomum hematol dustrially important substances suspected ing carcinogenic properties are iron, lei nitrates. In causal respects occupational are thus closely related to the non-occupatic vironaental tumors which are the result traneous influences of various kinds. Hal responsible for cancer of mouth, lips and cl tobacco smokers and betel nut chewers, or of the skin of the abdominal region in car certain heating appliances such as kangri i mir or kairo in* Japan, and the custom am ored races of decorative scarring is the c. keloida or scarry overgrowths of the skin. ( factors elicit cancers of skin and lips amot pigmented individuals in dry and sunny such as Australis, Argentina and the Mid States. Geological influences are operative production of cancers of the skin among ini of areas in which the wqter supply is cont; by arsenic from arsenic containing ores, si Silesia and Argentina, they account also increased incidence of adenomas and carci the thyroid among the inhabitants of r> which endemic goiter occurs beeausb of i ficiency of the soil, such as Switzerland Great Lakes region. Endemic parasitic i particularly schistosomiasis, are the sourc cer of the bladder, rectum, and liver amot habitants of Egypt, South Africa, China a Additional first cousins of the occupation: are the medicinal cancers which are elicit prn.iu.yort. . !rc<i. an-l .. ' mm v tun:. th* omimport.:d in ''f rhi-- ich w... ile acidour f... ; tamin i> in <!|` r. > for aowU*<i-. a mv..?ucii > m. metar. son ic uniimiine. ar..i gen.rny.. Jin par.v obia. Ir I of havlead ai;.i l eniuvr* :ional on!t of oxabits nr.cheeko if. ->r cnmvr irriers in Hash nong colcauso of ClimatK ong lic^h* rejrioa*. idwesH'f :e in t!-ihabitan: -aminato1 ach ns i for th. nomas o: cffions ii' odine ivanil ti-> nfeetioii* of can j(* the "i nd Japa:. il cancer? ed by the 4 '? The Auzbica.v Socrerr for the Cohteol of Canceq 65 ! ^crapeutie use of certain physical- or chemical and misery, as occupational tumors appear usually | (gents already mentioned in connection with the at the end of a progressive chain of preparatory tis gccQpational cancers, such as arsenic, tar, roentgen* sue changes which are the cause of prolonged dis radio-active substances, and possibly, some of ability and pain. It may also not be amiss to mantion 1 ^e sromatic medicinal benzol derivatives. Exo- in this connection and at this time that the thou I genous agents constituting s part of our new arti- sands of cancer fatalities to be recorded here are ! geji environment thus are responsible for the fol- the victims of a continuous struggle in the economic I hiring three types of environmental esneers: The field of human endeavor, a fight against disease and eeeupstional cancers, the non-oceupational environ- death which is carried on in all industraiized coun Btntal cancers, and the medicinal' cancers. At the tries to varying degrees and for varying lengths of i Resent state of our knowledge one can only specu time, a fight which is leas obvious and spectacular late ss to the number of individuals among the gen than the military wars, but which goes on uninter eral population who contract cancer by contact with ruptedly and sometimes a* ruthlessly as the latter. areinogenie substances of the new environmental Arsenic, a substance extaaaively used in various . assure contained in the food we eat, the air we compounds, as a pigment, parasiticide, pharmaceuti breathe, the tobaceo we smoke, the medicines we cal, war gas, ate* present ae a contaminant in num - take, the water w# drink, the clothes we wear and erous substances, and produced as a waste product, : the cosmetics we use. that is, released, into the atmosphere, in huge - However, it is only to a somewhat less consider* amounts in the smelting of various ores, particu ;. able degree that this uncertainty exists in regard larly copper, Iren, silver and lead, accounts for a ' u tbs incidence figures of the recognised environ- total of approximately 220 recorded cancers of oc 1 mental and particularly occupational cancers. The cupational, medicinal, and environmental origin. The . figures available in this raapect and to be cited later United States has contributed during the last ten .^are baaed on information which is highly dafactive years 24 easts of occupational arsenic caneer to a -I sad. does not redact the actual Incidence even to total of 54 cases and ranks in first plaet among the ~aa approximate degree. The reasons for this lack different countries. This fact deserves special men ,'ttf reliable data on recognited and serious public tion as it has been stated recently by an official of tad industrial health hazards art as follows: Since the Bureau of Dermatoses Investigation, United relstiveiy recent years is some but not in til of the States Public Health Service, that no case of industrialized states and countries laws exist which industrial arsenic cancer has been recorded with ask* the notification of all industrial cancers ebli- this organization during the last six years and that k. fttory with governmental agencies and thus a mat- this malignancy ia formed only when 'arsenic is ,, ter of public record. It cannot be said that such ingested, but not when arsenie is inhaled, the ex . le% are always faithfully observed by the parties posure usually present in industry and agriculture. -concerned nor are they everywhere strictiy enforced It is obvious from the available and well authenti _* or. enforceable, as many of these laws are defective cated data that both oral and respiratory introduc a their wording and supply sufficient loopholes for tion of arsanic may causa caneer.in industrial work -. -.sa evasion of the laws. Industrial concerns art in ers as well as in the general population and may /federal not particularly anxious to have the oc- even affect wild and domesticated animals living ia earrence of occupational cancan among their em- the fume tone of arsenic generating smelters and payees or of environmental caneers among the con- consuming the contaminated vegetation. Mora than semen of their products made a matter of public half, or 125, of the 220 arsenic caneers are of i.. records. Such publicity might refieet unfavorable medicinal origin. The rest are of environmental ;opon their business activities, and oblige them to origin caused mainly by the consumption of drink ^ eadertake extensive and expensive technical and ing water contaminated with arsenic from arsenie v,sanitary changes in their production methods and in containing ores. '4.tbe types of products manufactured. There is. more* The great majority of tha arsenic caneers affect r. aver, the distinct possibility of becoming involved the skin usually after having eaused an arsanic ' la compensation suits with extravagant financial dermatosis with increased pigmentation of tha skin. .- claims by the injured parties. It is, therefore, not sn In eleven cases arsenic cancers ware reported in - .oncommon practice that some pressure is exerted internal organs, four of them affecting the lungs - ^7 the parties financially interested in such matters following inhalation of arsenic dust, five the ali to keep information on the occurrence of industrial mentary tract and two the bladder. cancer well under cover. It is for these reruns that In addition to the arscnicais which occasionally -the statistical data to be presented here concerning have given rise to lung cancers, there are the chrom ' the incidence of occupational cancers as caused by - Jh* different industrial agents represent only those -ade public. ates and nickel carbonyl which when inhaled by workers engaged in their production have eaused the development of cancers of the nasal passages ''*** Before proceeding to the presentation of the and of the lung. It is inter, sting to note in this ..'.*t*tistical information on occupational cancer I connection that the chromate cancers of the lung J *isb to point out that behind these cold numbers have been observed so far only in Germany from ,.*V**r* is hidden an untold mass of human suffering where during the last six years VJ cases were AbfC' r *' '% 2 - **' :.5sE 86 The AwebicaK Sqciett for the Control of Caxceb --qr.- reported affecting individuals 29 to 70 years of ag, engaged la the production of potassium and sodium chromates and of chromate dyes. The nickel carbonyl cancan of the naaal passages and of the loaf, oa the other hand. Have been seen exclusively in Sooth Wales among workers of two nickel refineries. So far there have been placed on record since 1924, when the disease was first recog nised, 34 cases of cancer of the nasal passages and 24 cancers of the lung. Mention may he made of the fact that the nickel ore* and the refining processes used in England are identical with those employed by American factories. So far reports on the oc currence of such tumors smong American workers are nonexisting. Asbestosis cancer of the lung la the moat recent newcomer among the occupational cancers of this organ. First described in 193$, there are now 13 eases of this industrial cancer on record observed among asbestos workers in England, Germany and the United States. The latter contributed five cases. Inasmuch as the asbestos industry Is most extensive ly developed in this country asbestosis esneer of the lung has for us a special hygienic and sociotogic significance. The inhalation of iron and lead dust has been suspected by some observers as sn occupational cause of caneer of the lung. The evidence in support of such claims U still highly defective. An important and extensive source of lung cancer is the exposure to radioactive ores sustained by miners of these ores and by the workers of radium laboratories and caused by the inhalation of radium emanation, thoron and of dust of radioactive ores. These occupational cancers occurring among the miners of the cobalt mines in Schneeberg and of the Uranium-Radium mines in Joachimsthal in Germany are historically the second oldest industrial tumors as they have affected these miners for a period of several centuries, and were known in olden times as "mountain disease" or "miner's phthisis," being confused with pulmonary tuberculosis. Reliable rec ords on the occurrence of lung cancer exist in the Schneeberg district sinee 1869, while they ere of very reeent date (1926) for the Joaehimsthal dis trict. The estimated total number of fatalities from lung caneer among the Schneeberg miners between 1889 and 1939 is approximately 400, that is, three of every four miners died from neoplastic disease of the lung, and are still dying from it. The "radium disease" of the long of the Joaehimsthal miners has claimed so far only 15 cases between 1928 and 193$, that is, SO per cent of the miners dying during this period had cancers of the lung, according to autopsy findings. The miners of the radium mines in the Belgian Congo and at Great Bear Lake in Canada as well as the workers in the radium laboratories refining the ores of these mines in Belgium and in America have so far not shown any signs of this disease, if credence can be given to the existing records snd statements. The name "radium disease" is connected in this country with another cancerous manifestation 'r*' ` lated to an occupational exposure to radioactive substances. I am referring to the epidemic lib.' appearance of frequently fatal diseases among t$* ' female workers of several luminous dial plants'fe* New Jersey and Connecticut in the yean 1923 t*.' 1934. These girls were engaged in painting diais with a luminous paint containing mesothorm*./ and radium. During the first yean of this period some of the girls developed necrosis of the jaw boa and severe anemia resulting in death in 1$ instancy Those who survived these affections sufficiently long showed sarcomas of the bones. The eight osteogeeie sarcomas observed among the dial painten beevwg 1924 and 1934 represent 39 per cent of the total' number of fatalities from radium disease. THe.vie^ tims of this occupation# disease were always r^Isl; tively young (29 to 30 yean), indicating that U.*T age changes are evidently not essential for the pro? duction of cancer whoa a proper carcinogenic stun-, ulus is active. The present day use of radioactive-! luminous paint is much more extensive because'efr' the war, as this paint is employed for numerate' types of military equipment, such as sighting Utt - of trench mortars and guns, instrument boards ef airplanes and submarines, field compasses, etc., sad" many persons are again engaged in this type of-. work in the United States. ' Occupational contact with radioactive substances'* is responsible for two additional types of industrial caneer, those of the skin and leukemia. So far only, two instances of occupational radium cancer of the skin have been placed on record. This figure cor- ' treats sharply with the approximately 12$ cases'of? caneer of the skin elicited by roentgen-rays, a physi cal energy similar to that of the gamma-rays emitted' by the radioactive substances. Occupational radium cancers as well as roentgen-cancers of the skin in observed among radiologists snd physicists and tech nicians manufacturing and handling radioactive substances and roentgen apparatus. The carcino genic properties of this energy are attested more over by the occurrence of several hundred thera peutic roentgen-cancers in persons subjected to treatments with this agent. Again it cannot be said, that the number of known radium and roentgen- cancers of tho skin approximates the actual number. It also cannot be said that modern equipment and precautions mil prevent and have prevented their further occurrence. Chronic roentgen-dermatitis, the precursor to cancer, is still relatively frequent among radiologists snd roentgen-cancers still occur,- ss 1 can state from observations made during the last two years. The malignant condition of the blood, known leukemia, is one of the more recent additions to the list of recognised radium- and roentgen-iniur.ee' There is a total of 21 cases of occupations! actinic leukemia on record affecting both radiologists and. technicians in medical and commercial roentgeo- and radium laboratories. This leukemic reaction to a prolonged exposure to roentgen* and iadiu:n i-ay* radi-i... Jem:,. . amor.:.* >t a'.an-. rs V.-: : itine thii ;i(-' e ji-A' L,-.- OiteoiTv; TS vetw, f :*e e. T/.c \ .. l\Viy< r.' *r.;u : or uer.;- ... rac:-).u-:.. because ' Tiumcr>;;. rhtir.g Hi.. : board.* :' 5, e:e.. is :ypc : substaiuvt ir.dusu-i... So far on'.> ncer of i.*., figure ivr..'5 case* ys. a phvv ay* etnttiv i nal radium he skin an ti and tcvn radtoactnv ) carcinw:sted nior,-ired them.bjected tv no; be s:u.l i roentirvn ;ai r.umbi-r .pment ami euted Uvo.r dermatit:' x frequent still occur during t"i- . known :ivr.i to tin en*injuru-? '.nal actinic logists ar: ront^<-!; reaction i,. odium rus> Tht Aiioica.v Socjxtt for the Coxtool of Caxcm 67 u. ^t-,y* eom somewhat it a surprise, aa these agents 'bad beeome notorious for their hematopoietic tiasue . destroying properties, causing anemia izd decrease . is white blood cells. v. However, similar contrasting effects were oh* served during recent years in connection with the .;occup*tional exposure to benzoL It was blown for ' many yean that the inhalation of benzol vapors by .'chemical workers and others caused a leukopenia - : wd anemia which was not infrequently fatal. , .`. It has become increasingly apparent that such contact may result also, while less often, in leuke* -noid and leukemic reactions, df both the myeloid '.' and lymphoid types. There are at the present time ---approximately 15 cases of occupational benzol ; Jeakemia on record. The most recent additions of 'fire cases have come from the United States and *wtre observed mainly among workers in faat-prea* rotogravure printing plants and shoe factories, .-inasmuch as benzol is used therapeutically in the ' treatment of leukemia, it assumes in regard to the .'^-production of this disease the seme, position which ^ roentgen*ray and radium occupy in regard to the * v treatment and production of skin cancer. With the consideration of benzol as a caneeriJ'genie agent of industrial importance, mention was uaade of the first member of that groBp of careino. `vt*aic agents which are responsible for the over* ^whelming number of known industrial cancers. I ;;am referring to crude mineral oil and coal tar and -their numerous derivative*, aueh as pitch, soot, ''creosote, lubricating and fuel oils, shale oil, paraffin oil, cool oil, anthracene oil and the various aroIVmatic amino-compounds produced in the chemical industry and used particularly in the manufacture yot dyes, pharmaceuticals, explosives, ingredients m I -jjthe manufacture of rubber, dotation vehicles for #6e* | .Vw Occupations! tsr and pitch cancer of the skin was !' 7$$*!** described in 1875. Since that time there have | recorded in continental Europe approximately :. 280 to 200 cases of this neoplasia. Of these 67 cases '-were recorded from Germany, 55 from France, 20 | .from Belgium, 13 from Switseriand, 12 from Italy, i J 7'from Holland, and single eases from a number of | smaller countries. These at beat 200 cases from 1 .^Continental Europe observed sinee 1875 contrast "'Sharply with approximately 1400 cases registered I *ine* 1882 in England and Wales. In the United ! ' States about 65 cases have been placed on record ' .'sinee 1810. The relatively small number of tar .-..cancer* in the United States has been attributed by Heller to the fact that here a nonearcinogenic v'. Petroleum tar is mainly used in place of the coal ;tar employed in other countries. There is, however, -some doubt as to the correctness of this statement ^as well aa to the apparent scarcity of tar cancer in 4 ;'our country. Other countries and continents have ; contributed only a few cases of tar cancer to the ^total number recorded. An exception is Kashmir -%in which the shepherds carry under their cloaks a `.container with hot wooden embers. :be kangri. Neve observed there during a period of 50 years about 2000 ease* of kangri esneer of the sbdominat skin elicited by the tarry combustion products given off by the charcoal. The total of tar and pitch can* cer of the skin of occupational origin placed on record stands at about 3600 cases. To this number of tar cancer* of the skin must be added the tar cancers of the lung, bladder and lip. The only proven cases of tar cancers of the lung were reported from Japan, where 27 cases were observed in workers of generator gas plants who inhaled hot tar fumes. There are nine cases of bladder cancer on record occurring in tar workers with preceding or stmoksneoua tar cancers of the skin in six of them. Henry, Kennaway and Kennaway have shown, moreover, that worker* in ter and pitch exhibit a distinctly increased incidence of bladder cancer, ranging up to 400 per cent end suggesting that tar might produce both cancer of the skin and of the bladder. Tar cancer of the lip ha* been reported in fishermen from this country and England in about a desen esses. Similar conditions exist in regard to worker* coming into oecupetional contact with the various oily and greasy fractionation products of crude mineral oil, shale oil, paraffin oil. lignite, end coal tar. It ia interesting to note in this connection that the different crude petroleums vary greatly in their carcinogenic qualities, thus oil obtained in certain parts of the United States exhibits a small degree of carcinogenicity (Pennsylvania oils), while those from other parts (Midcontinental) possess higher carcinogenic qualities. The first case of oil cancer of the skin was reported from Germany in 1875. Sine# that time 18 additional cases were recorded from that country. Approximately 25 eases were observed among the worker* of the Austrian-Galician oil fields. Ho reliable information ia obtainable from the Rumanian and Russian fields. France eontrib* uted two or three cases of oil cancer of the aids. Hone were seen in Belgium and Holland. In Great Britain, on the other hand, the incidence of oil can* cer among the shale oil workers, paraffin worker*, and particularly mulespinner* runs into very high figures. There ere approximately 150 eases of paraffin oil cancer of the skin on record from Eng land and about 1500 cases of shale oil and lubri* eating oil cancer. These figures contrast sharply with the 60 cases of paraffin oil and 12 lubricating oil cancers reported in the United States. There exists only little evidence indicating that the inhalation of mist of crude paraffin oil or lubricating oil may cause cancer of the lung and of *he stomach in mulespinners and paraffin workers. But some of these workers have died with both cancers of the skin and cancers of the lung and of the stomach. Industrial cancers of the skin elicited by contact with anthracene oil or creosote have been reported in about 40 cases, mainly from England and Germany. Soot, the tarry product of the incomplete com- 68 The Aaiic.\x Society for the Control of Cancm . buation of organic matter, particularly coal and wood, Is a carcinogenic agent which haa boon mainly roaponaiblo for the cancan of the akin of the chim ney sweep* and workers in soot factories. Its causal relation to pulmonary cancer ia controversial. The chimney sweep cancer of the scrotum and of the sldn is a disease which was and still is found almost exclusively in England. There were 107 cases of this disease in England during the period 1911 to 1935. It was much more prevalent among the English cbimney sweeps during the preceding decades and was noted a hundred years ago even in apprentices of this trade who were only 10 to 20 years old when they were afflicted, with this ailment. This occupational tumor wan rarely seen in Ger many, France and Norway. This peculiar geograph ical distribution of the soot cancer in chimney sweept ia attributable to the use of a speciai typo of coal In tho fireplace* in England and to the peculiar structure of the chimneys in English houae* necessitating the enttring of the chimneys by the sweeps, thus bringing about an intimate contact of the skin with the carcinogenic soot. In Continental Europe die cleaning of the ehimneys is done with the help of a broom brush which is lowertd into ths chimney from above. It may be noted that accord ing to statistical data tho caneer mortality of Eng lish chimney sweeps from ail cancers is eight times that of ths general population, indicating that the contact with soot elielts cancer in other organa beside the skin. The last of ths occupational cancsrs elicited by a derivative of tar ia tho bladder cancer of the dye workers. The particular tumor was first observed in German plants la 1896 and has sines been noted among the dye workers in Switxsrland, Austria, Russia, England, United States, Italy and Japan. The total number of reported cases stands at ap proximately 600. These tumors are caused by the inhalation or ingestion of vapors and dust from aniline, aaphthylamine and bensidlne, which are used extensively in the production of dyes and phar maceuticals, in the vulcanisation of rubbor, and in the Rotation of ores. The largest number of these so-called aniline tumors of the bladder were recorded from Germany, i.e., more than 300 eases; an additional 80 eases were reported from Switzer land, some 90 cases from England and at least 100 eases from the United States, and approximately 18 cases from Italy. However, the recorded Ameri can cases were observed in the plants of on* Americae concern, and it is known that bladder cancer ia prevalent among workers of other American chem ical plants. While the total number of aniline can cers among chemical workers is not high, it must be stated that their incidence runs from 20 to 90 par cent for that small group of workers who come in direct and intense contact with these substances. Occasionally these workers show also tumors in the ureter, kidney and other organs. Among the occupational physical agents which cause malignant growths rsferenc* has sires been made to the rays from radioactive substanc and to roentgen rays. Little credence ia given at r present time to the claim that a prolonged exposi to heat rays may cauae cancer, aa such exposa are usually associated with an exposure to soot tarry substances whieh are then the actual caret' genic sgentsf ultraviolet rays as containad in solar rays, on the other hand, are well establisi sources of carcinogenic reactions in tha skin of rr and animals. The physicochemical effects exerted a prolonged and intensive exposure 'of the skin solar rays art commonly apparent in persons outdoor work earned on in sunny, dry ciimste oi regions in which ultraviolet rays are especi; strongly refected as from surfaces of water, sr or white day`soil. The precancerous condition the skin elicited thereby is known as farmer's or sailer's skin and is found in farmers, sailors, / ermen, ranchmen, gardeners, rural mail earn lumbermen, etc. It ia observed almoet exclusive!persons with lightly pigmented skin, that ia, indi uais of tha Nordic strain with blua eyes and bl or reddish hairs. In the United States such dry sunny regions providing a sufficient amount of s exposure are Kansas, Oklahoma, Taxas and : Mexico. The pampas of tho Argentina provide other region fulfilling tha necessary requiremt as do tho sunny regions of Australia and Soot! France. The eutaneous cancers elicited by undue solar exposure are found on the exp parts of the face, hands and forearms. They much more frequent in men than women, as wo usually wear hats with wide brims and more'd try to protect their skin by ths us* of creams, interesting to not* that solar cancer affects the whit* coated cattle in Australia, while cancc the eye is said to be frequent among the light mented strains of cattle about Bogota in Colun Among the various parasitic infections * have been connected with the production of can schistosomiasis has a well established causal tion to the appearance of bladder eancer and a certain connection* with cancer of the rectum liver. The bladder cancer on'the basis of schistos ssis, a worm infection, is observed among the fe in Egypt. It is historically the oldest occupat: cancer known, as the symptoms produced by bladder infection complicated with cancers mentioned by the waiters of the old Egy papyri.The fellahs become infected while cultiv their flooded soil or while bathing in the cam drinking the water of these drainage channels taining the larvae of this worm, which latt develop in the human body and settle in the of the bladder wall eliciting their inflammator necrotic reactions. On the basis of these ch bladder cancers develop in some of the pat The number of known cases is rather small am. between 7.6 to 20 per cent of the patients c< to autopsy in Egypt. Schistosomiasis cancers < V has already e substance-* girts at the ?d exposure eh exposure? e to soot or taal carcino* sined in the .1 established - skin of men cs exerted by ! the skin to ..enons with climate or in ee especially water, snow condition ot fanner's skin . sailors, fish* tail carrier.*, exclusively in at is. Individ es end blond such dry and oust of solar ras and New : provide an* eqeirements. md Southern ted by such the exposed ns. They are en, as women d more often create. It i* - affects also .nie eaneer of the light pig* is Columbia. ctioas which >o of cancers. eausal rela* :er and a le.-** 2 rectum and f schistoaomi* ng the fellahs occupational iuced by thi-* cancers artold Egyptian ile cultivating the canals or channels conoich later on i in the veins -.minatory and ihese chango the patient.*mall and run* tients coming -sneers of the :-C' Th* AUOICAN SOCIgTT for (fl4 CONTSOL f>( CaxCIR <9 -VHver have been observed in Egypt and Brasil. Inas_'^'-*aueh as the present war will favor the infection of l^jtmeriean soldiers with the causative parasites, it sk i* not improbable that similar eases may come to ^observation some years hence in this country. Approximately 8,000 to 0,000 cases of occupa-rational cancers have been placed on record. No definite and reliable data exist in regard to the total number of nonoccupationsi * environmental and .'.".''medicinal cancers. It is obvious that the number A/of the occupational cancers is very small when ^compared with the large figures of eaneer of un* '.s known etiology. HoweveT, as indicated before, this flatter group contains doubtlessly an undetermined V^number of occupational, nonoccupationsi environ* ^jaental, and medicinal caneers which have not beta "properly recognised. An effective control of occupational cancers de pends upon the following measures: l. Plant management, industrial workers and &jaembers of the medical profession must be made ^increasingly conscious of the fact that numerous _^enta of our new artificial environment possess `carcinogenic properties. Physicians, therefore, tf.Vjhould make close inquiries as to the detailed ocCjjfcapotlonal history of every cancer carrier, so ss to ^Sttscover to an enhanced degree cancers of occupaT^^onai origin. Industry should devote considerably more ^..effort than heretofore in determining the caneerous -rrr aoneancerous nature of their numerous products j^whieh may be suspected on general grounds in can* "^.ctrigenic respects. f^'3. Wherever occupational eaneer occurs in indue* >*Vtry, serious and detemiaod efforts should bo mado ;by the plant management to eliminate entirely the iThasardous aspects of the respective operations by technical improvement in the production methods, by the observation of extensivs sanitary measures and the introduction of a dose medical supervision of the endangered workers. 4. All occupational cancers and their preeaneerout conditions should be made notifiable with the state department of industrial hygiene and should bo made a matter of publie record. The state de partment of industrial hygiene should be charged to conduce periodical inspections of such planes by competent persons so as to determine whether ade quate precautionary measures are taken by industry. 5. Industry should make serious attempts to eliminate all potentially cancerigenie agents from further uae by tho development of suitable sub stitute*. 6. Inasmuch as occupational cancers are chance experiments oa eaneer in man conducted by modern industry on a large scale, which render direct reli able and conclusive information as to the cause and mechanism of human cancer, the investigative study of these conditions deserves a great deal more consideration than it has received heretofore. Occupational cancers which involve the young and the old alike are preventable diseases. Their continued occurrence in countries laying claim to an intelligent civilisation represents a challenge to human society which should be mat squarely and determinedly. The experiences gained in occupa tional cancer control by the use of preventive meth ods should prove of great value in the future in fighting cancer in general at its source, i.e., elim inate the causes of cancer. In waging this struggle it should be realised that the fruits of such efforts take a long time to ripen, as the effectiveness of any measures taken cannot be fairly judged before the elapse of 10 to 20 years. Perseverance end deter mination is needed to win this battle, which concerns all of ua that are living in our new and artificial environment. Cancer Prevention Clinic Opened at Women and Children's Hospital LAURA JACKSON* /Tt^ICAGO on May 13, 1943, became the second Si j ***? t*16 nation to have a cancer proven* -jSs-. tion clinic. The clinic, sponsored by the > Women's Field Army of the American Society for T^e Control of Cancer, and directed by an advisory ..^committee of the Chicago Medical Society, is being `-^held weekly, on Thursday evenings, from 6.30 to .^. 9.00 o'clock, at Women and Children's Hospital, .-'rBefore the opening night, appointments had been >.*^eohed through June 10, and the steady stream of :'^*dQ*sts indicates the need for and the interest in such a clinic, and the probability Of its enlargement or extension in tha near future. The new clinic is patterned in essential particu lars after the Strang Memorial Clinics at the New York Infirmary for Women and at Memorial Hos pital in New York City, founded and directed by Or. Elis* S. L'Esperanc*. The former was founded in May, 1037, and-the latter in- March, 1942. Philadel phia haa a somewhat different project in the experi ment at the Women's Medical College of Pennsyl vania started in 1938 by Dr. Catherine Macfarlane '.'S*'$*T*uty Slat** Commander. Illinois, Women s KieM Army ot the American Society for (ha Control of Cancer; Director "t** miblle Relation*. American College of Surgeons.