Document ppO52QpoQvrEoezy2GJN3BRNa

f.r.1 SSr Archive's of Industrial Hygiene and Occupational Medicine Volume-2 SEPTEMBER 1950 Corriisar, 1950, by the Amebicax Medical Assocutiox SYMPOSIUM ON PREPAYMENT HEALTH PLANS FOR INDUSTRIAL WORKERS MEDICAL CARE FOR INDUSTRIAL EMPLOYEES THOMAS A. McGOLDRlCK, M.D. Member of Council on Mcdienl Service, American Me<ticol Axsectatioa BROOKLYN t IT IS WITH great interest that the American Medical Association through this correlating committee of its Council on Medical Service awaits the proceedings of this meeting. Medical care that can be obtained by the worker through his industry has been available for a compara tively small number of years, and its extent is not fully recognized by all die people. Yet, there are more than 18,000 plants in this country where health plans are in operation, and more than 2,000,000 employees par ticipate in their benefits. All the medical bureaus are not alike in the land or the amount of service rendered. Some protect the employees from the hazards of disease arising in their occupations, recognizing and eliminating any causative factors and providing individual workers with protective devices and medical treatment. Some provide early care of injuries in first aid stations with an attending physician and nurse, while for necessarily longer care and rehabilitation the injured employee is assured of some benefits through the more or less limited workmen's compensation laws in 48 states of the Union. Some medical care bureaus have in-plant clinics equipped with laboratory facilities and may have hospitals of their own or are affiliated with nearby institutions where needed hospital service may be obtained. The extent of medical service available to employees differs widely in industries and localities. Some give advice and treatment, aided by complete diagnostic laboratories, to ambulant patients and, when pos sible, laboratory aid and supervision to patients confined to bed and home. Many employees, however, do not or cannot obtain all the benefits of the well conducted bureaus of our large industries. Fortunately for them, there are other means and places for obtaining medical care and for easing the financial burden of full hospital, laboratory, nursing and medical service. The voluntary prepayment plans of the Blue Cross and the Blue Shield and of the lay and medical society-sponsored groups in 40 states This paper is the first in a "Symposium on Prepayment Health Plans for Industrial Workers" held at the Tenth Annual Congress on Industrial Health, sponsored by the American Medical Association, New York, Feb. 20, 1950. 2*15 . ENVIRONMENTAL CANCER HAZARDS CAUSED BY INDUSTRIAL AIR POLLUTION Introductory Comment to the Discussion W. C. HUEPER, M.D. Chief, Concerigenie Studies Section, National Cancer Institute SETKESDA, MO. AN APPRECIABLE number of recognized or suspected occupational cancers are probably caused by inhalation o certain cancerigenic chemicals in dust, fumes, vapors, mists or gases (figs. 1 and 2). Many of these industrial agents are also introduced into the air while they are being used or released as waste products. Because the minimal effective cancerigenic dose of almost every one of these agents is yet to be estab lished, the possible, even the probable, existence of cancer hazards resulting from pollution of the environmental air by chemicals represents an appropriate subject for those taking part in this conference to consider. With the exception of soot as a possible cause of cancer of the lung and cancer of the scrotum, cancer-producing factors polluting the environmental air have only rarely been considered or investigated in connection with cancer in man. Studies of this problem which render valid evidence are difficult, complex and time-consuming. There is small wonder, therefore, that at present all available data on this matter have suggestive value at best, and most are mere speculation. Some years ago Green alleged that the sulfur dioxide released during the burning of coal and the smelting of ores is the cause ot an excessive incidence of cancer among population groups exposed to the fumes. On the other hand, Stephens blamed carbon monoxide, which was introduced into the atmosphere from domestic and industrial sources, for causing cancer in certain workers and the general population. These claims have little, if any, basis in fact. Much more substantial, however, is the evidence in regard to other industrial products (table). There can be no doubt that products of the combustion and fractionation of coal, such as soot containing cancer igenic tar, tar fumes, pitch and tar dust are polluting the environmental air from various sources and at many places. Similarly, combustion products and processed fractions of mineral oils, shale oils and natural gas are released into the air as domestic or commercial soots and fumes. Read at the United States Technical Conference on Air Pollution. Mav 3 to 5. 1950. ' 325 20 IXtHXTKI.il. IIVulHXli .tXI> OCCiP. ITlt >X.-U. MlinU'IXIi _ ' ', _... . > . ' , ^ vl>i . .. .. 'i -'i`'**** ..** * ** - * * f. ; ^PHYSICAL' V maasreV- foRGAWC AGFucum)MVj)-:^cvicjiL PROfEsstoiw7-^;*:;K\ (MOflGANlC : i 'parasitic ' ,; ; V' . - . # y. . SINUSES LARYNX THYROID BRONCHI IUNB . ' ' ; OVER : ' # KIDNEY >; .'BUOOER 'ORETEff ^SCROTUM . 'BONE MARKOV .. fI.]' /'''.V' BOM'" - ..; -- skih ' Fill. 1.--The cnvirnimieuial cancer sjjcarum. Environmental Cancerigenic Agents and Sites of Cancer Cancerigenic Agent Erpe ot Contact Site of Cancer Benzene Aromatic amines Beta napbthylamlDe Benzidine Coal tar, pitch, asphalt, soot, bitumen, creosote ' oil, anthracene oil (3,4-benzpyrese) Shale oQ ' Lubricating oils Grade paraffin oils Lignite oils Lubricating oils Crude paraffin oils Tar oDs Petroleum and petroleum products Lubricating oils . Crude paraffin oils Enel oils Commercial soots Aromatic Organic Chemicals Cutaneous Respiratory Cutaneous Respirator? Cutaneous Respirator? (lumes) Leukemia lymphosarcoma? HjtlODt! * Carcinoma of bladder, ureter, renal pelvis Carcinoma of skin Carcinoma of lung Cutaneous Carcinoma of skin Cutaneous Cutaneous Respiratory (Mist-Dust) Carcinoma of akin Carcinoma of skin Carcinoma of lung! Isopropyl olIT % Anenlcals Inorganic and organic! Aliphatic Organic Chemicals Respiratory Inorganic Chemicals Cutaneous Alimentary Respirator? Chromates 2)tckd carbonyl? Asbestos Respirator? Respirator? Respirator? Carcinoma of nasal sinuses and lung? Carcinoma of skin Carcinoma of lung! Carcinoma of alimentary tract! Carcinoma of bladder! Carcinoma of lung Carcinoma of natal sinuses and lung Carcinoma of lung Ionizing radiation of electromagnetic (gamma) and corpus cular types (alpha, beta) from radloactlre chemleali Ionizing radiation from x-ray tubes Ultraviolet radiation solar radiation Cancerigenic Agent Physical Agents Cutaneous Respirator? Alimentary Genera) bod? Parenteral Cutaneous General bod? Cutaneous Site ot Cancer . ,, Carcinoma and (atcoma of skin Carcinoma ofhur Oardnoma of nasal sinuses Sarcoma ot bones ' Leukemia, lymphosarcoma Carcinoma of liver! Carcinoma of skin Sarcoma of connective tissues and bones Leukemia, lymphosarcoma Carcinoma otskln 8pedes Potential Environmental Cancerigenic Agents and Caneer Sites Aromatie amino eompoands o-amlnoazotoluene Liver o-smJooazobenzene Bladder L,3-azoto!uese * o,ni-dlethy|.p-amlno- azobenzene 4-dlmethyl-amlno- benzenM-asonapth- . thakne 4-oxy-i:S-dImetbyl- - azobenzene 5-aeetylamlnoflnorene . 2-amlnofluorene . Dlbenzocarbazole 4-dlmetbyI-amlno- azobenzene Estrogenic compounds Breast Stilbestrol Uterus Aliphatic compounds Hemopoietic tissue Chlorinated hydrocarbons Liver Chloroform Carbon tetrachloride Dletbylene glycol Carbamate derivatives Bladder V. Lung Thiourea derivatives Beryllium Selenium Thyroid gland! Bane Liver Rat Mouse Mouse Rat Guinea pig Mouse Mouse Rat Mouse Rat Mouse Rabbit Rat 327 a; Hi / -3: 328 INDUSTRIAL HYGIENE AND OCCUPATIONAL MEDICINE or may cover mineral particles escaping from cracking towers, thereby- becoming a part of the constituents of smogs. Whenever production and waste disposal methods in aromatic amine operations are inadequate, dust, fumes and vapors of beta or alpha naphthylamine and benzidine may enter the air of the factory fume zone. The large scale use of arsenical dusts as pesticides and the long-continued and formerly uncon trolled release of arsenicals with the waste fumes of metal ore smelters may have created potential cancer hazards in many regions. It may be wise to consider the possible existence of similar conditions for the population living near chromate factories, beryllium operations and asbes tos mills. In recent years the potentiality of cancerigenic air pollution hazards in connection with many establishments in which radioactive material is produced, used or handled has become an important factor in their operations. . Cancerigenic agents polluting the air may enter the human body by inhalation, cutaneous contact or ingestion. Exposure of the population to cancerigenic air pollutants, especially those of stable nature, may result from their subsequent incorporation into and contamination of drinking water, foodstuffs and soil. Cancers caused by cancerigenic air pollutants may affect not only parts of the respiratory tract, such as the lung or the nasal sinuses, but, depending on the nature of the agent and the type of exposure, may affect other organs, such as skin, bones, bone marrow and bladder. The future control of these potential hazards depends, first, on the i chable qualitative and quantitative demonstration of cancerigenic agents in the air around establishments producing or handling recognized or suspected cancerigenic agents; second, on thorough epidemiologic studies of cancer incidence in the population living in the fume or waste disposal zone of such plants; and third, on the subsequent institution of effective measures preventing further release of cancerigenic agents into the environmental air. To cope properly and speedily with this new health hazard from air pollution in the modern industrial environment, it is essential that*indus trial management, public health agencies and the medical profession be alerted to the problem and that they work together harmoniously in trying to solve it.