Document gao5O8GwDVG32K05gg8EembLa

FILE NAME Household Contact HC DATE 1959 DOC HC048 DOCUMENT DESCRIPTION Book Excerpt - Industrial Carcinogens [ 403] 2 onkontartockortn Sa oki Fn FO Bo oi oft EO IO OE = we Soe st Bry CANCER CANCER CANCER SCROTI SCROTI SCROTI SCROTI SCROTI SCROTI AMAZINI has written a book de R morbis artificumknown the Colic of Poictou is well known diftemper; and every body is acquainted with the diforders to which painters plummers glaziers and the workers in white lead are liable : but there is a dieaaes peculiar to a certain fet of people which has not atleatto my knowledge been publicly noticed I mean the chimney- Iweeper's cancer - It is difeafe which always makes its firt attack on and its firt appearance in the infe- rior part of the crotum; where it produces a fuperficial painful ragged looking fore with hard and rifing edges the trade call it the wart I never faw it under the age VOL II D of MODERN MONOGRAPHS IN Industrial MEDICINE 4 Editor in Chief ANTHONY J. LANZA M.D. Consulting Editor RICHARD II ORR M.D. Industrial Carcinogens Loe By R. E. ECKARDT M.D. Ph.D. F.A.C.P. Director Medical Research Division Esso Research and Engineering Company Linden N. .: Associate Clinical Professor of Industrial Medicine New York University Postgraduate Medical School Instructor in Medicine Cornell University Medical School GRUNE & STRATTON . 1959 NEW YORK AND LONDON 124 INDUSTRIAL CARCINOGENS thickened At the time of the original placement can be instructed by the physician examination the employee be on the nature of the hazard he will working with At this time he can be further educated in unnecessary contacts with the avoiding elements of potentially carcinogenic streams in the personal hygiene such as clean work clothes protective equipment and washing and can be informed to department skin report to the medical any changes which he observes Since some individuals may develop a dermatitis early after initial exposure he can be in- structed to return to the medical department if such viduals who have develops Indi- cancerous changes of the skin should be permitted to work where they contact probably not would include may carcinogens Such changes reddened indurated skin called farmer's skin keratoses hard warts not verrucae vulgaris and other similar lesions The reason for excluding such people from such work is not necessarily because they are more susceptible to cause if they subsequently do develop skin carcinogens but be- as to whether the cancer confusion may exist cancer developed naturally or as a result of the occupation examination of the skin should be performed about one year fol- lowing the initial examination if the worker is still work The purpose of this examination is employed in this to check to see if any derma- titis has occurred which may not have been reported If such has oc- curred it is probably an indication either that the worker is unusually susceptible or that he has not faithfully been observing the protective program If the former is the case the employee should probably be removed from this type work since he is likely to have recurrent dis- abling bouts of dermatitis If the latter is the provided to enforce and case an opportunity is educate the man and the other workers about the protective program From this point on the employee's skin can probably be examined at the time of his regular periodic check In many industries attempts are being made to establish on an annual or annual basis If such check no such program is in force annual examination of the skin should be established after the has been on his job for five At the emplovec years time of these periodic exami- nations the employee should be attention of the encouraged to bring immediately to the physician any persistent skin lesions which the intervals between examinations Persistent lesions develop in defined as those which persist for two weeks or more are arbitrarily The second purpose of a medical examination program is to insure PROTECTIVE PROGRAMS 125 that if any lesions develop they will receive prompt treatment Excision lesion of the with microscopic examination of the tissue ap- removed pears the treatment of choice A representative slide of the tissuc re- moved should be maintained as a part of the employee's individual medi- cal record Considerable debate has occurred as to whether or not an employee who has developed a cancerous or a cancerous lesion should be removed from his work involving carcinogenic exposures and placed elsewhere Those who advise against removal suggest that exposure has already been sufficient and the employee may go on to develop cancer after removal from the work Case 2 Why they ask subject employee to the hazard Those who advise from removal this work are reminded of experimental work in animals a new type of clinical ob- and servations in humans in which precancerous lesions and no disappear new cancers appear once the exposure has been 1 terminated Case The individual industrial physician faced with this decision will un- doubtedly have to base it upon his own best judgment of the He could support either decision although it is likely that the smiatjuoartiitoyn of those who have had to make it have leaned in favor of removal from the carcinogenic exposure BLADDER General Considerations bladder The protective program for individuals potentially exposed to carcinogens is considerably more complicated than one for the skin Of course the basic elements of good housekeeping and hygiene apply here even more so than with skin good personal It carcfiunmoegsens was finely originally believed that the absorption of these carcinogenic amino com- pounds occurred mainly through the inhalation of or divided dusts Present concepts however suggest that the route principle of absorption is directly through the skin This of course considerably complicates the problem of control because once carcinogens escape the from the unit they may contaminate everything in a room or even a whole building leading to subsequent skin absorption in those who brush against the structures or equipment in the room or The building problem of control is so severe that one chemical company had which repackaged benzidine for many years abandoned the operation com- pletely when one of the individuals involved developed a cancer Goldblatt bladder and ? Coldblatt have listed the occupations involved as fol- hows Work in any building where naphthylamine naphthylamine naphthyl- 126 INDUSTRIAL CARCINOGENS amine benzidine or any of their salts or auramine or magenta are produced on a commercial scale To this list should now be added paraaminobiphenyl In addition the use or handling of any of these substances or work in a process in which any of them are used handled or liberated should also qualify for exposure Finally men who maintain or clean any plant or machinery involved in any of the above should be considered exposed Plant Housekeeping plant should be of modern design with floors made of materials which do not absorb the amines either physically or chemically Thus asphalt porous brick or wood floors should be avoided Glazed brick or some other porous material which can easily be cleaned should be used Nooks crevices and other areas which may retain the amines should be eliminated wherever possible Mechani- cal handling should replace manual handling wherever possible If pumps flanges or other areas may leak they should be provided with exhaust ventilation if fumes or dusts are involved if liquids then they should be mounted on catch basins connected with a sewer so that all leaks can be promptly and thoroughly washed down Unnecessary equip ment such as barrels boxes cartons tools or worn equipment should not be left lying around the floor but should be cleaned if necessary and promptly removed so they cannot act as dust catchers As indicated by Hueper The elimination of this type of occupational tumor is not so much a matter of medical concern as it is a task of proper chemical engineering and it might be added good maintenance and housekeeping Although chemical engineering good maintenance and good house keeping may not be matters for primary direct medical concern nonctheless the medical department frequently brings a fresh perspective to these approaches and hence the medical department can contribute in a team approach to a problem of this magnitude and severity Personal Workers in any of these operations should be provided with locker facilities well removed from the area of their work The ideal locker facilities of course would be two separate locker rooms one for work clothes and one for street clothes with a connecting automatic shower room This would insure that street clothes did not become contaminated and also that a shower would be taken at the end of a day's work Work clothes should be laundered regularly at least once a week and the clothing worn next to the skin underwear probably daily Rubberized protective efothing should be worn whenever the possibility of skin contact is high Wooden shoes have also PROTECTIVE PROGRAMS 127 been recommended Although nobody can deny Goldblatt and Gold- industry blatt's statement that The problem before the therefore is to apply every possible method to diagnose the condition as as would appears and to enlist every available means of soon still it would treatment seem that with a disease as serious and as difficult to detect as bladder cancer more intensive efforts al prevention are warranted and that detection far enough early and treatment do not go instruction Worker Education should receive thorough instruction in the necessity keeping the dangers associated with their work and of a clean work place and personal habits of cleanliness It is often main- understand tained that workers do not have the native intelligence to and carry out a protective program as complicated as this That not the case is evidenced by the experience of the pharmaceutical facturers who have trained employees in the production of this is pharmaceutical manu- potent bio- logicals or sterile preparations requiring far more complex procedures to be used by the workers It may be true that the of pro- witheconomics duction do not permit the employment of workers this high a today degree of native intelligence but with the hourly rates prevailing it should precautions be possible to employ workers who will follow the worked out for them To my knowledge the hourly rates paid in the pharma- ceutical industry for this type work are not so much higher as to be who prohibitive There is no justification therefore for the employer maintains that he cannot get workers who will follow the work habits necessary to protect themselves from occupational hazards Medical Program is no intent in the preceding department belittle the important direct role played by the medical the detection and earlyearly treatment of these tumors paragraphs to in Workers in these plants should receive a thorough preplacement examienxaatmiionnatioTnhisThis should include a thorough occupational history and a careful examination examination of urinary the urine particularly for the presence of red cells Any urinary ab- normality should be thoroughly investigated before permitting work in be desirable have one of the exposed occupations It would highly a cystoscopic examination the work entails any risk of to exposure Whether this is practical of course will vary from place to place It particularly the would seem that any urinary abnormality and the of conditions which lead to the presence of red cells in presence would urine type work This be- be justification to exclude a man from this is so cause of the confusion that red cells in the urine might introduce introduce into any control program It would probably also he advisable to have a