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FILE NAME State of the Art Literature SAL DATE 1943 Jan DOC SAL037 DOCUMENT DESCRIPTION Bulletin of the American Society for the Control of Cancer Inc. - Cancer in Its Relation to Occupation and Environment Lional Lional Lional Aw BULLETIN1943 of the UNIVERSITYUNIVERSIOTY F OKLARDOKLARD _ AMERICAN SOCIETY FOR THE CONTROL OF CANCER INC UNIV UNIV UNIV med med of of School . The Drawn Sword , JANUARY 1943 Ea AOFM P-aF ant naneaoeeiae cirh chad tet Schaal ad bit AE x: e *. nn ee ORO OMRON ae attphstictnlnaLomdaina _ nile id isin thre SST st eats peed se Lett , . e . ee , on a : : i . The AMERICAN SOCIETY for Control the Control of Cancer Cancer 63 : that hither which can be sure of cancer rom cancer : it from cancer ney is already - to the con enough even ir against can - not have et because proit because the good enouri e to overcome ily increasing se studies dies one of us who is done and ognize and unnow beginning Cancer occurs normal chem- oe pies in d the re evelop e of the organ ts the normal Ils which make d strangles the * food and air ot result in the interferes with wvive they must and nutrition the poison or In other words that they can xicate normid wae ot this res Comme 84 tough the cont ling mal tissti + ot The growth of 123 cannot t iy food and ar are so civdized this way the tissues and se sures of attack hen to prevent nality by which chemical com and re- NK going , But how are we to improve the methods for cure not accept discoveries reported concerning cancer of the already developed cancer Since the tough Peells which compose the cancer cannot be reformed in animals as applicable to cure or prevention of a cancer in patients Tinto normal civilized and controllable cells they must like our enemies be destroyed utterly All modern treatment of cancer is based on this prin-ciple of killing We attempt to destroy the cancer by the use of rays radium or surgery Un- The last question is What is the future of cancer research Succesisn this field will depend upon two factors adequate financial support and the study of cancer in man rather than in animals Facilities for the intensive study of the disease in .- fortunately whereas these methods are very useful - some cancers have progressed to such a stage when sthe 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 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 large amount but it is no more Probably a new and more effective attack will be than is necessary in view of the enormously com- > developed based on the fact that the cancer ceil in plex detailed and specialized work required It .! getting tough has become dependent on ways of represents an outlay of only 1.00 annually for living different from those of the normal cell It is - every individual afflicted with cancer exactly like the criminal drug addict who under - she influence of his drug can perform extraordinary . feats of daring and strength and who feels no need 2 for food But even when the drug is removed the 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 dxamage has been done and the addict cannot live a it will be possible systematically to study every normal life He is still a menace to society and must feature of the chemistry of the invididual with -& be treated accordingly To kill or to control these criminal cancer cells cancer The results of this study should prove that . abnormality allows the cancer to occur and how it we must take advantage the dependence of can- cer on abnormal chemicals or drugs and on the abnormal way of living which the drugs have caused can be rectified Furthermore it should be possible to prove in what way the cancer tissue differs chem- ically from the normal tissue Once this difference is We must not only cut off the drug supply but we must find a way to liquidate this lawless member of society the cancer that has developed To do so we must find out what the cancer tissue thrives on and how it can be exterminated completely Experiments known means starve normal This precisely it should be simple by chemical to attack the cancer at its weak point to or otherwise to destroy it and organs unharmed vO leave the , program may seem to be an ambitious one : of this type are in progress and although the results are incomplete it is not impossible that we may be +successful in the future At the present time however do not forget the fact that there is no procedure which offers any- 7? thing to the patient with cancer except the use of ta surgery ray and radium You must not be misled by the published reports of experiments on the cure of cancer in small animals Little evidence " The fact should be recalled that the policy of ap- peasement can be applied no more successfully to the cancer problem than to the Japanese and Germans 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 exists to prove that cancer in rats or mice is produced by the same agents which cause cancer in man Indeed it is very unlikely that different species acquire cancer from the same source For this rea- son the public should be on its guard and should This is an annual loss of life far in excess of that | which can be expected from war If we can spend untimited billions to win a war we should be able to spend a few millions to finish our fight against cancer : Cancer in Its Relation to Occupation and Environment W. C. HUEPER M. D. INCE the beginning of plant and animal life on this planet environmental factors have ~yo exerted a powerful influence upon the evolu- tion and the cessation of the various species which V...arner Varner Institute for Therapeutic Research New York City populate or have populated this earth Paleontology teaches us that severe changes in the environmental particularly climatic factors accompanied and con- ditioned the fundamental and radical alterations in Abean ape ree] had, sare . bt te Sinebs et A Ls seepy: oe. sme iae er 2a oneSOgn Pe Inttee Cd ey ceop 2 i the CONTROL of Cancer 68 The AMERICAN SOCIETY for ~~ the dif- their great variations in the type of raw produ an the fauna and flora which took place during used in the methods of production employed -ferent earth periods This control over life disease __ environmental fac- an in the kind of finished products manufactured and death exerted by the natural The medical medico sociological and se extend tors over all living matter has existed without much entific significance of occupational cancers disorder interference from other sources up to the early part far beyond the limited importance these cancer of the nineteenth century when mankind began to as industrial diseases Industrial revolutionize its natural inanimate environment by possess are at preesnt with the exception of a few tunior the development of modern industry and the gen- of occupational environmental origin the onl eral use of its products in daily life creating there- in man of which the approximate cause a by a new artificial environment While we have be- ad- cancers known They have attained additional importane come conscious in general of the numerous as the study of these tumors has resulted in the vantages and beneficial effects which agricultural the transcivilization discovery and synthesis of a large number of chem of which formation of the former industrialized one has brought to us only ical carcinogenic substances some wer into an found to be closely chemically related to substance relatively few have a proper appreciation of the occurring normally in the body such as bile aci~ a fact that this new artificial environment also posproperties which sex hormones or forming constituents of our for sesses eminent disease producing and our cells such as cholesterol and vitamin I act upon its creators and beneficiaries alike The of the causation of powerful impact of the rapid rise of modern indus- The scientific investigation the basis for in all its multifarious ramifications upon the cupational cancers has furnished or try of the greatest advances ever made in the knowled inanimate exogenous environment affects mainly the industrially employed parts of the of cancer in general and primarily population but extends also to a con- Occupational cancers are elicited by a gres of chemical and physical agents such : present siderable degree to practically all other portions of variety and influences all branches of human arsenic chromates nickel carbonyl radium mes the population thorium asbestos crude mineral oil pitch tar soo activity including personal and public hygiene paraffin anthracene oil creosote aromatic anir medical care nutrition clothing living quarters habits and compounds such as aniline naphthylamine ar communication transportation lighting benzidine benzol ultraviolet rays roentgen customs diseases directly attributable and rays of radioactive substances and certain par I The numerous new sitic worms such as schistosomum hematobia to the contact of industrialized man with the new dustrially important substances suspected of ha environmental agents involve practically every body including the skin the brain the ing carcinogenic properties arc iron lead a organ of our nitrates In causal respects occupational caner lungs the heart and blood vessels the liver stom- thus closely related to the occupational ,, kidney ach intestine blood forming organs the are which the result of the bones the bladder etc. This increase in the vironmental tumors are traneous influences of various kinds Habits : environmental number and types of industrial and responsible for cancer of mouth lips and cheeks reflected diseases occurring during recent decades is tobacco smokers and betel nut chewers or can by the appearance of many new special branches in of the skin of the abdominal region in carriers natural sciences and particularly in medicine In- certain heating appliances such as kangri in K dustrial medicine aviation medicine and radiology mir or kairo in Japan and the custom . among are products typical of this era Industrial cancers constitute an integral part of ored races of decorative scarring is the cause keloids or scarry overgrowths of the skin Clim the various pathological reactions elicited by a pro- longed contact with some specific chemical or physi- factors elicit cancers of skin and lips among 1 cal factors composing the new and artificial en- pigmented individuals in dry and sunny regi vironment Although a few of the occupational can- such as Australia Argentina and the Midwest cers have been known or have existed without cor- States Geological influences are operative in rect recognition prior to the advent of the modern production of cancers of the skin among inhabit industrial era the great majority of them appeared of areas in which the water supply is contamin after the start of this development In fact the by arsenic from arsenic containing ores such * overwhelming number of occupational neoplasms Silesia and Argentina they account also for has been placed on record during the last forty increased incidence of adenomas and carcinoma years During this period there was not only a con- the thyroid among the inhabitants of region which endemic goiter occurs because of iodine stant increase in the absolute number of these in- dustrial neoplastic diseases but also a marked rise ficiency of the soil such as Switzerland and in their organie types and in the exogenous sources Great Lakes region Endemic parasitic infect The variations which the numerical and organie particularly schistosomiasis are the source of incidence of industrial cancers have displayed in cer of the bladder rectum and liver among t and J. recent decades and in different countries and indus- - habitanta of Egypt South Africa China tries reflect to a certain extent the general and Additional first cousins of the occupational ca local growth of modern industrial enterprises with are the medicinal cancers which are elicited b Pa CRE NN re ~ mo gSreekR, Aean ve a, aa by Pes plea : :. red an red and set extend isorier isorier cancer ie tunt ... the m ae cause : Cortan in th of chem ch were astances le acids ^ ur .; amin 1 of for ase owledogwledg a great such a 1.0 1.0 ar sout Le in paraibia In of hav ead and cance onal enof cs bits are heeks in r camer riers of in Kush ong col cause of Climatic ng light regions western e in the abitantminated as for th tomas of gions in dine des d Japan ,, cancers d by the See The AMERICAN SOCIETY for the CONTROL of CANCER 65 weet, re? therapeutic use of certain physical or chemical agents already mentioned in connection with the : occupational cancers such as arsenic tar roentgen- and misery as occupational tumors appear usually at the end of a progressive chain of preparatory tissue changes which are the cause of prolonged dis- rays active substances and possibly some of ability and pain It may also not be amiss to mention The aromatic medicinal benzol derivatives Exo- in this connection and at this time that the thou- ~ genous agents constituting a part of our new arti- cial environment thus are responsible for the fol- sands of cancer fatalities to be recorded here are the victims of a continuous struggle in the economic ~~ lowing three types of environmental cancers The field of human endeavor a fight against disease and > occupational cancers the occupational environ- death which is carried on in all industralized coun- mental cancers and the medicinal` cancers At the tries to varying degrees and for varying lengths of present state of our knowledge one can only specu- time a fight which is less obvious and spectacular Late as to the number of individuals among the g",,n- than the military wars but which goes on uninter- . eral population who contract cancer by contact with ruptedly and sometimes as ruthlessly as the latter arcinogenic substances of the new environmental nature contained in the food we eat the air we Arsenic a substance extensively used in various compounds as a pigment parasiticide pharmaceuti- take breathe the tobacco we smoke the medicines we the water we drink the clothes we wear and the cosmetics we use cal war gas etc. present as a contaminant in numerous substances and produced as a waste product that is released into the atmosphere in huge However it is only to a somewhat less consider- able degree that this uncertainty exists in regard to the incidence figures of the recognized environ- amounts in the smelting of various ores particularly copper iron silver and lead accounts for a total of approximately 220 recorded cancers of oc- mental and particularly occupational cancers The cupational medicinal and environmental origin The ~.. figures available in this respect and to be cited later . United States has contributed during the last ten are based on information which is highly defective - years 24 cases of occupational arsenic cancer to a and tet does not reflect the actual incidence even to total of 54 cases and ranks in first place among the - an approximate degree The reasons for this lack different countries This fact deserves special men- reliable data on recognized and serious public tion as it has been stated recently by an official of and industrial health hazards are as follows Since the Bureau of Dermatoses Investigation United relatively recent years in some but not in all of the States Public Health Service that no case of . industrialized states and countries laws exist which industrial arsenic cancer has been recorded with make the notification of all industrial cancers obligatory with governmental agencies and thus a mat- ter of public record It cannot be said that such _ this organization during the last six years and that this malignancy is formed only when arsenic is ingested but not when arsenic is inhaled the ex- _ laws are always faithfully observed by the parties posure usually present in industry and agriculture concerned nor are they everywhere strictly enforced 2 or.enforceable or.enforceable as many of these laws are defective _-mtheir wording and supply sufficient loopholes for an evasion of the laws Industrial concerns are in | general not particularly anxious to have the oc- of occupational cancers among their em- = plcouryreeensce - or of environmental cancers among the con- sumers of their products made a matter of public i. records Such publicity might reflect unfavorable upon their business activities and oblige them to undertake extensive and expensive technical and s=anitary changes in their production methods and in the types of products manufactured There over the distinct possibility of becoming e< in compensation suits with extravagant is moreinvolved financial +. claims by the injured parties Itis therefore not an uncommon practice that some pressure is exerted 2.; by the parties financially interested in such matters to keep information on the occurrence of industrial " cancer well under cover It is for these reasons that the statistical data to be presented here concerning 2 the incidence of occupational cancers as caused by the the different industrial agents represent only those : _ public Smtaadtiestical 2. Before proceeding to the presentation of the information on occupational cancer I 22 wish to point out that behind these cold numbers therte here is hidden an untold mass of human suffering It is obvious from the available and well authenti- eated data that both oral and respiratory introduc- tion of arsenic may cause cancer.in industrial work ers as well as in the general population and may even affect wild and domesticated animals living in the fume zone of arsenic generating smelters and consuming the contaminated vegetation More than half or 125 of the 220 arsenic cancers are of medicinal origin The rest are of environmental origin caused mainly by the consumption of drink- ing water contaminated with arsenic from arsenic containing ores The great majority of the arsenic cancers affect the skin usually after having caused an arsenic dermatosis with increased pigmentation of the skin In eleven cases arsenic cancers were reported in internal organs four of them affecting the lungs following inhalation of arsenic dust tive the ali- mentary tract and two the bladder In addition to the arsenicais which occasionally have given rise to lung cancers there are the chrom- ates and nickel carbonyl which when inhaled by workers engaged in their production have caused the development of cancers of the nasal passages and of the lung It is interesting to note in this connection that the chromate cancers of the have been observed so far only in Germany where during the last six years 39 cases lung from were . eee o on ee oem The AMERICAN SOCIETY for the CONTROL of CANCER reported affecting individuals 29 to 70 years of age engaged in the production of potassium and sodium chromates and of chromate dyes The nickel carbonyl cancers of the nasal passages and of the lung on the other hand have been seen exclusively in South Wales among workers of two nickel refineries So far there have been placed on record since 1924 when the disease was first recognized 34 cases of cancer of the nasal passages and 24 cancers of the lung Mention may be made of the fact that the nickel ores and the refining processes used in England are identical with those employed by American factories So far reports on the oc- workers currence of such tumors among American are nonexisting Asbestosis cancer of the lung is the most recent newcomer among the occupational cancers of this organ First described in 1935 there are now 18 cases 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 extensively developed in this country asbestosis cancer of the lung has for us special hygienic and sociologic significance The inhalation of iron and lead dust has been suspected by some observers as an occupational cause of cancer of the lung The evidence in support of such claims is 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 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 records on the occurrence of lung cancer exist in the Schneeberg district since 1869 while they are of very recent date 1926 for the Joachimsthal district The estimated total number of fatalities from lung cancer among the Schneeberg miners between 1869 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 lung of the Joachinisthal miners has claimed so far only 15 cases between 1926 and 1935 that is 50 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 and statements . The name radium disease is connected in this country with another cancerous manifestationre radioactive lated to an occupational exposure to substances I am referring to the epidemic like appearance of frequently fatal diseases among the female workers of several luminous dial plants in New Jersey and Connecticut in the years 1923 to 1934. These girls were engaged in painting watchi - dials with a luminous paint containing mesothoriam and radium During the first years of this period some of the girls developed necrosis of the jaw bone instances and severe anemia resultingin deathin 15 | Those who survived these affections sufficiently long showed sarcomas of the bones The eight osteogenic - sarcomas observed among the dial painters between- totalt 1924 and 1934 represent 30 per cent of the : number of fatalities from radium disease The vie tims of this occupational disease were always rels- : old tively young 20 to 30 years indicating that age changes are evidently not essential for the pro duction of cancer when a proper carcinogenic stim ulus is active The present day use of radioactive 7 luminous paint is much more extensive becauseof the war as this paint is employed for numerous. types of military equipment such as sighting lines of trench mortars and guns instrument boards of airplanes and submarines field compasses etc. and many persons are again engaged in this type of workin the United States S. substances Occupational contact with radioactive is responsible for two additional types of industrial cancer 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 con- trasts sharply with the approximately 125 cases of cancer of the skin elicited by roentgen a physimb cal energy similar to that of the gamma emitted by the radioactive substances Occupational radium cancers as well as roentgen of the skin are observed among radiologists and 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 in persons subjected to treatments with this agent Again it cannot be said that the number of known radium and roentgen cancers of the skin approximates the actual number It also cannot be said that modern equipment and precautions will prevent and have prevented their further occurrence Chronic dermatitis the precursor to cancer is still relatively frequent among radiologists and roentgen still occur as I can state from last two years observations made during the wo. The malignant condition of the blood known 2 leukemia is one of the more recent additions to the injuries-- list of recognized There is a total of radium21 cases and of occupational actinie leukemia on record affecting both radiologists and technicians in medical and commercial roentge/ and radium laboratories This leukemic leukemic reaction to a prolonged exposure to roentgen- and radium rays has co itul be destro destro in whi Ilu served sceup many chemi und at Is contat moid and ly appro louket tive were ratog Inasi treath produ fvent treats Wi venic made genie whel am re their cred il c matic sudus of dy the : res 0 first been 180 were from . fre Smal Cont shart -inec State since vane petri tar Sunli 1 air VAILL Tuta in cont ECT INP ently ently lun st^'oget- s betwee betwee ecause of numero numero numero ting lineboards of etc. and 3 Exp : Exp far only ser of the gure cons i cases of a physi *emitted al radium e skin are and teen- adioactive a careinu ted more red thera- jected to ot be sail Foentgen A number ment and ated their dermatiti frequent still occur Juring the Anown as uns to LBC Thes eaction to idicat rays The AMERICAN SOCIETY for the CONTROL of CANCER 67 has agents come somewhat as a surprise asthese .had become notorious for their hematopoietic tissue destroying properties causing anemia azd decrease in white blood cells * HoweverHowever similar contrasting effects were ob- served during recent years in connection with the Coccupational exposure to benzol It was known for many years that the inhalation of benzol vapors by <3 chemical workers and others caused a leukopenia and anemia which was not infrequently fatal It has become increasingly apparent that such contact may result also while less often in leuke- moid and leukemic reactions of both the myeloid and lymphoid types There are at the present time approximately 15 cases of occupational benzol ; Jeukemia on record The most recent additions of five cases have come from the United States and Awere observed mainly among workers in press rotogravure printing plants and shoe factories Inasmuch as benzol is used therapeutically in the E treatment of leukemia it assumes in regard to the production of this disease the same position which E roentgen and radium occupy in regard to the treatment and production of skin cancer z With the consideration of benzol as a canceri- genic agent of industrial importance mention was made of the first member of that group of carcino- genic agents which are responsible for the over- whelming number of known industrial cancers I tam referring to crude mineral oil and coal tar and their - numerous derivatives such as pitch soot ? creosote lubricating and fuel oils shale oil pars~-lin oil coal oil anthracene oil and the various aro- compounds produced in the chemical -miantdiusctry al and used particularly in the manufacture of dyes pharmaceuticals explosives ingredients in the manufacture of rubber flotation vehicles for Occupational tar and pitch cancer of the skin was firstfirst described in 1875. Since that time there have been recorded in continental Europe approximately 1180 80 to 200 cases of this neoplasia Of these 67 cases were recorded from Germany 55 from France 20 from Belgium 13 from Switzerland 12 from Italy 17 from Holland and single cases from a number of smaller countries These at best 200 cases from Continental Europe observed since 1575 contrast ssharphly arply with approximately 1400 cases registered "S since 1892 in England and Wales In the United States about 65 cases have been placed on record since 1910. The relatively small number of tar ~ cancers in the United States has been attributed Heller to the fact that here a noncarcinogenic bypetroleum tar is mainly used in place of the coal Atar employed in other countries There is however some _ doubt as to the correctness of this statement as well as to the apparent scarcity of tar cancer in Four country Other countries contributed only a few cases and continents have of tar cancer to the ws total number recorded An exception is Kashmir 7in which the shepherds carry under their cloaks a container with hot wooden embers the kangri Neve observed there during a period of 50 years about 2000 cases of kangri cancer of the abdominal skin elicited by the tarry combustion products given off by the charcoal The total of tar and cer of the skin of occupational origin record stands at about 3600 cases pitch can- on placed To this number of tar cancers 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 simultaneous tar cancers of the skin in six of them Henry Kennaway and Kenna- way have shown moreover that workers in tar and pitch exhibit a bladder cancer distinctly increased incidence of ranging up to 400 per cent and suggesting that tar might produce both cancer of the skin and of the bladder Tar cancer of the lip has been reported in fishermen from this country and England in about a dozen cases Similar conditions exist in regard to workers coming into occupational contact with the various oily and greasy fractionation products of crude mineral oil shale oil paraffin oil lignite and coal tar It is 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. Since that time 18 additional cases were recorded from that country Approximately 25 cases were observed among the workers of the Austrian oil fields No reliable information is obtainable from the Rumanian and Russian fields France contributed two or three cases of oil cancer of the skin None were seen in Belgium and Holland In Great Britain on the other hand the incidence of oil cancer among the shale oil workers paraffin workers and particularly mulespinners runs into very high figures There are approximately 150 cases of paraffin oil cancer of the skin on record from England and about 1500 cases of shale oil and lubricating oil cancer These figures contrast sharply with the 60 cases of paratiin oil and 12 lubricating oil cancers reported in the United States There exists only little evidence indicating that the inhalation of mist of crude parafin oil -- -- lubricating oil may cause cancer of the lung and of the 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 in about 40 cases mainly from been reported England and Germany Sout the tarry product of the incomplete com- ee ee a ae en 2 = ten er r ee ene a Lower A eT eae pen nl wade eeeKor a: tied ake tisPi5 er aA bt aces 7% ay RYSASG AN aoe: pest ia}tLyat 8 seetabhey13 68 . The AMERICAN SOCIETY for the CONTROL of CANCER , .bustion of organic matter particularly coal and wood is a carcinogenic agent which has been mainly responsible for the cancers of the skin of the chimney sweeps and workers in soot factories Its causal cause malignant growths reference has already been made to the rays from radioactive substances and to roentgen rays Little credence is given at the present time to the claim that a prolonged exposure relation to pulmonary cancer is controversial The chimney sweep cancer of the scrotum and of the to heat rays may cause cancer as such exposures are usually associated with an exposure to soot or . skin is a disease which was and still is found alnost tarry substances which are then the actual carcino exclusively in England There were 107 cases of this disease in England during the period 1911 to genic agents Ultraviolet rays as contained in the solar rays on the other hand are well established 1935. It was much more prevalent among the sources of carcinogenic reactions in the skin of men English chimney sweeps during the preceding and animals The physicochemical effects exerted by decades and was noted a hundred years ago even in a prolonged and intensive exposure of the skin to apprentices of this trade who were only 10 to 20 solar rays are commonly apparent in persons with years old when they were afflicted with this ailment outdoor work carried on in sunny dry climate or in This occupational tumor was rarely seen in Ger- regions in which ultraviolet rays are especially many France and Norway This peculiar geograph- strongly reflected as from surfaces of water snow ical distribution of the soot cancer in chimney or white clay The precancerous condition of sweeps is attributable to the use of a special type the skin elicited thereby is known as farmer's skin of coal in the fireplaces in England and to the or sailor's skin and is found in farmers sailors fish peculiar structure of the chimneys in English houses ermen ranchmen gardeners rural mail carriers necessitating the entering of the chimneys by the lumbermen etc. It is observed almost exclusively in sweeps thus bringing about an intimate contact persons with lightly pigmented skin that is individ of the skin with the carcinogenic soot In Continental uals of the Nordic strain with blue eyes and blond Europe the cleaning of the chimneys is done with the help of a broom brush which is lowered into the chimney from above It may be noted that according to statistical data the cancer mortality of English chimney sweeps from all cancers is eight times thaotf the general population indicating that the contact with soot elicits cancer in other organs or reddish hairs In the United States such dry and sunny regions providing a sufficient amount of solar exposure are Kansas Oklahoma Texas and New Mexico The pampas of the Argentine provide an- other region fulfilling the necessary requirements: as do the sunny regions of Australia and Southern France The cutaneous cancers elicited by such beside the skin undue solar exposure are found on the exposed The last of the occupational cancers elicited by a derivative of tar is the bladder cancer of the dye workers The particular tumor was first observed in German plants in 1895 and has since been noted among the dye workers in Switzerland 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 parts of the face hands and forearms They are much more frequent in men than women as women usually wear hats with wide brims and more try to protect their skin by the use of creams It is interesting to note that solar cancer affects also the white coated cattle in Australia while cancer of the eye is said to be frequent among the light pigmented strains of cattle about Bogota in Columbia _ inhalation or ingestion of vapors and dust from Among the various parasitic infections which aniline naphthylamine and benzidine which are have been connected with the production of cancers - used extensively in the production of dyes and phar- schistosomiasis has a well established causal rela- maceuticals in the vulcanization of rubber and in the flotation of ores The largest number of ' tion to the appearance of bladder cancer and a less certain connection with cancer of the rectum and these called aniline tumors of the bladder were recorded from Germany i.e. more than 300 cases an additional 80 cases were reported from Switzerland some 90 cases from England and at least 100 cases from the United States and approximately 15 cases from Italy However the recorded American cases were observed in the plants of one Ameri- can concern and it is known that bladder cancer is prevalent among workers of other American chemical plants While the total number of aniline cancers among chemical workers is not high it must be stated that their incidence runs from 20 to 90 per cent for that small group of workers who come liver The bladder cancer on the basis of schistosomi- asis a worm infection is observed among the fellahs in Egypt It is historically the oldest occupational cancer known as the symptoms produced by the bladder infection complicated with cancers 38 mentioned by the writers of the old Egyptia papyri.The fellahs become infected while cultivating their flooded soil or while bathing in the canals of drinking the water of these drainage channels containing the larvae of this worm which later of develop in the human hody and settle in the veils of the bladder wall eliciting their inflammatory and necrotic reactions On the basis of these change in direct and Occasionally intense contact these workers with these show also substances tumors in bladder cancers develop in some of the patients The number of known cases is rather small and rune the ureter kidney and other organs o between 7.6 to 20 per cent of the patients comme Among the occupational physical agents which to autopsy in Egypt Schistosomiasis cancers of the pantanpical " ws ao + BLE EE aS hah votrendepaaradbicten emanerevererirres wtqm. . The AMERICAN SOCIETY for the CONTROL of CANCER 69 D}- Substances Substances iren at the d exposure exposures to soot or al carcinoned in the established kin of inen exerted by be skin to rsons with Quate or in especially ater snow ondition of mer's skin ailors fishil carriers clusively in is individ- and blond ch dry and int of solar 3 and New provide an quirements a ern be be . sed sed They are 1. 33 Women more often reams It is afects also le cancer of e light pig- n Columbia which which tions which of cancers causal rela- and a less rectum and schistosomig the fellahs ccupational ced by this Cancers are d Egyptian e cultivating he canals ur nanncis conIch later on in the veins mmatory and sese changes ints ints jentoming jentoming jentoming jentoming ancers of the liver been . have observedin Egypt and Brazil Inas- on eB much as the present war will favor the infection of a American soldiers with the causative parasites it 2 Oeimsis not improbable that similar cases may come to ~~ observation some years hence in this country Approximately 8,000 to 9,000 cases of occupa- tional cancers have been placed on record No ' definite and reliable data exist in regard to the total number of nonoccupational environmental and medicinal cancers It is obvious that the number compared of the occupational cancers is very small when with the large figures of cancer of un- known etiology However as indicated before this flatterflatter group contains doubtlessly an undetermined number of occupational nonoccupational environ- ay beer XiXmenitalmental and medicinal cancers which have not properly recognized 4 An effective control of occupational cancers de- upon the following measures pends industrial members 1. Plant management workers and members of the medical profession must be made cinncreasingly conscious of the fact that numerous peagents of our new artificial environment possess carcinogenic . carcinogenic properties Physicians therefore should make close inquiries as to the detailed oc- cupational history of every cancer carrier so as to discover to an enhanced degree cancers of occupa- tional origin effort 2. Industry should devote considerably more effort than heretofore in determining the cancerous For noncancerous nature of their numerous products which may be suspected on general grounds in can- Zo c^'rigenicrespects oc. 3. Wherever occupational cancer occurs in indus- try serious and determined efforts should be made by the plant management to eliminate entirely the hazardous aspects of the respective operations by technical improvement in the production methods by the observation of extensive sanitary measures and the introduction of a close medical supervision of the endangered workers 4. All occupational cancers and their precancerous conditions should be made notifiable with the state department of industrial hygiene and should be made a matter of public record The state de- partment of industrial hygiene should be charged to conduct periodical inspections of such plants 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 cancerigenic agents from further use by the development of suitable sub- stitutes 6. Inasmuch experiments on as occupational cancers are chance cancer 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 civilization represents a challenge to human society which should be met squarely and determinedly The experiences gained in occupational cancer control by the use of preventive methods should prove of great value in the future in fighting cancer in general at its source i.e. eliminate the causes of cancer In waging this struggle it should be realized 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 clapse of 10 to 20 years Perseverance and determination is needed to win this battle which concerns all of us that are living in our new and artificial environment Cancer Prevention Clinic Opened at Women and Children's Hospital - LAURA JACKSON | the on May 13 1943 became second wy HICAGO city in the nation to have a cancer preven- C . tion clinic The clinic sponsored by the 77Women's Women's Field Army of the American Society for aa the Control of Cancer and directed by an advisory committee 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 Before = the opening night appointments had been booked through June 10 and the steady stream of requests indicates the need for and the interest in such a clinic and the probability of its enlargement or extension in the near future The new clinic is patterned in essential particulars after the Strang Memorial Clinics at the New York Infirmary for Women and at Memorial Hospital in New York City founded and directed by Dr. Elise S. L'Esperance The former was founded in May 1937 and the latter in March 1942. Philadel- phia has a somewhat different project in the experi- ment at the Women's Medical College of Pennsylvania started in 1938 by Dr. Catherine Macfarlane State Commander nals Women's Field ofDPeupbluitcy Relations American College of Surgeons Army of the American Society for the Control of Cancer Divector