Document wgLrR96LQQ2QgOmKdpnmEYX3

FILE NAME: New York State & NY Times (NY) DATE: 1951 Oct DOC#: NY008 DOCUMENT DESCRIPTION: NY Dept of Labor Monthly Review - Occupational Cancer ewYork State Department o/'Labor IONTHLY REVIEW * vision o fIn d u stria lH ygiene & Safety Standards .. 50 O CTOBER, 1951 No. 10 OCCUPATIONAL CANCER* A Challenge to the Physician In the prevention o f occupational diseases we have a e field to which the practicing physican can make a contribution in the course of his regular work. It is e in that the data required cannot be developed in a th laboratory or in a university. It must come from physicians who actually see cancer cases or cases of ccted cancer, either in their own private offices, in er-screening clinics, or in the hospital. It is thus a problem o f extraordinary importance practically to order for the busy practitioner who is willing to e the few extra minutes necessary to take a careful pational history on fcis cancer patients; and report, for r investigation, cases suspected of having been exto carcinogenic agents in industry. T o assist the practicing physician in this matter, the New rk State Occupational Cancer Committee has prepared information. Th e tables provide a few useful clues, uding a list o f the chemical substances and physical found in industry, which are, at the present time, o f having carcinogenic properties, and the types cancer believed to be caused by them. Further study no doubt, add others to this list; some now on the may very well be dropped as new data become available, table o f precancerous lesions together with the occucarcinogens with which experience has associated is in the nature o f a tentative check-list on the basis present information. A copy of the form used by physi os in N ew York State, exclusive o f N ew Y o rk City, for porting cancer cases is also included. - ll recognition o f the possible occupational etiology of cer wtil: give us inform ation as to type of work the patient must a : oid in the future, pro: id: a basis fo r prognosis. make aiailable. under State Compensation Laws, financial assistance to the patient and his family. establish statistical data as to incidence, distribution. and causa::: e agents. -- information now practically non- ZT. r ubhc 5,: tor. : rw York ! - New York Stale Occupation;! Medicai > o t: e: y of the S ta ir o: trr.er.t o f H r Y : i.. N ew Y ork Statt If called upon by any physician interested in cooperating in this program, the N ew York State Occupational Cancer Committee is prepared to follow any suspected case of occupational cancer in N ew Y o rk State into the workroom where it is believed that it had originated, and to make all necessary technical investigations of the environmental fac tors which might have been responsible. Such investigations will include chemical analysis o f materials, radiation meas urements, chemical analysis o f air contaminants in the form o f dusts, gases, fumes, dust counts, or any other techniques as indicated. In thus tracing back the occupational exposures of cancer patients, it is hoped that occupational factors not now suspected of causing cancer w ill thereby be brought to light. In New Y o rk State, the professional staff of the Division o f Industrial Hygiene and Safety Standards may be called upon at all times for consultations and study o f these prob lems in particular plants; the scientific evaluation of any health hazards which may be present, and practical as sistance with control measures. A ll such requests should be addressed to Dr. Leonard Greenburg, Director, Division of Industrial Hygiene and State Department o f Labor, S8a0fetCyenSttraendSatrredest,, New New York York 13, N. Y. The medical profession is well aware of the extent to which lack o f knowledge o f the basic causes o f cancer is responsible for the unsatisfactory state o f our prophylactic and therapeutic approach to this problem. W e do know that a causal relationship has been definitely established between cancer and exposure to certain chemical and physical agents in industry. Thus, exposure of the skin to certain types of oil, tar or pitch are known to cause skin cancer. On the other hand, epitheliomata of the bladder are definitely known to result from exposure to certain of the intermediates in the manufacture o f aniline dyes, such as beta naphthylamine. This small group o f cancer cases for which an occu pational etiology has been established thus offers a rather buanfifqliuneg pdiosienatseo. fTodoeplaitrttluereattefonrtiotnhehafsu, rhthoewrevsetur,dybeeonf ptahiids teonvtihreosnemeoncctaulpatfiaocntoarls carnecseprosn; sitboloe liftotlre tihseikrnopwrnoduocftiothne. An appreciable number of such cases have, no doubt, gone unrTehciosgnisizterude ans1ottoonolcycuopfatoicocnuapl aetitoionlaolgyc.ancer, but of many otothebrelioecvceuptahtaiot noalccduipsaeatisoensalasdwiseelals.esIt hisavae ccoemrtmaionn cflainlliaccayl MONTHLY REVIEW of the Division of Industrial Hygiene and Safety Standards NEW YO RK STATE DEPARTM ENT OF LABOR 80 C enter Street N eu- York 13, N. Y. ED W ARD CORSI Industrial Commissioner 1st THOM AS F. MOORE, J r. Deputy Industrial Commissioner EDW ARD A. NYEGAARD Deputy Industrial Commissioner in Charge The Dnision L eonard H . G reen burg, Direnar M ay R_ M ayers, Medical Bureau WlLUAM J. Burke, Chemical Bureau G eorge P. K eogh, Code Bureau A rthur St e r n , Engineering Bureau L eonard A . Pe r r in , Engineering Unit Building Plans earmarks which immediately suggest an occupational etiol ogy, or even a specific occupational exposure; or that they present medical syndromes so distinctive as to clearly d if ferentiate them from non-occupational diseases. This may occur, but it is relatively rare. Whether one is dealing with cancer or with other systepiic diseases, such as hepatitis, nephrosis or aplastic anenjia, resulting from exposure to toxic agents in industry, is clinical diseases entities, they provide no specific clues as to etiology. In many cases, the occupational etiology is unsuspected. In order to acquire new data as to the environmental factors -- suspected as well as unsuspected -- which are responsible for cancer cases, it is necessary to know pre cisely what the patient's occupational exposure was; what chemical substances he came in contact with; what other environmental factors were present in the workroom. Since cancer w ill usually develop only after a great many years o f exposure, and even many years after exposure to an occupational carcinogen had ceased, the occupational his tory o f the patient must be carefully studied all the way back to his first job. This is difficult. But it will be re warding. At any rate, it is the only way to get the necessan data. Frequently, however, the patient will not know or remember the precise chemical substances, for example, with which he worked. Or he may forget to mention the only exposure which happens to be significant in his case. The names and addresses of the plants where the patient had worked are more readily obtained. This information alone can be a useful guide for a technical investigation of the patient's occupational exposure over the years. The importance of the occupational history' form thus cannot be overemphasized, since a complete occupational history is indispensable to developing any useful data with reference to occupational cancer. History taking, whether it is the clinical history or an occupational history, is very' time-consuming. The occupational history, however, is less familiar to the medical practitioner and so it always seems to present the greater hurdle. For that reason, the suggested Occupational History7 Form has been made as simple as possible. N o matter how carefully and intelligently the case has been worked up, or how accurate the diagnosis, the possi bility' o f an occupational etiology' must not be overlooked. Recognition o f an occupational etiology7, where it exists, will provide invaluable information as to the type of work the patient must avoid in the future; it will provide a basis for prognosis; and it w ill make possible assistance to the patient and his family under the Compensation Laws o f the State in which he lives, providing them with much-needed finan cial assistance during a period of disability. Recognition o f the occupational etiology7 o f cancer cases where it exists, w ill provide statistical data as- to incidence. TOWN VILLAGE CITY____________________________________________ COUNTY_______'_________________ DIST, NO (Lees' Residence of Pattern) PATIENTS NAME:___________________________________________________PRESENT AGE:____________YEAR OF BIRTH: (Piea.sc Print) PATIENTS LEGAL ADDRESS: L'SL'AL *1- Institution Inm ate, Give Previous Legal A ddress; O[>Ca!*CUFPtrAscTIf-OyimNpcorr:TRADE: INDUSTRY: Date of First Visit o f T h is T K T u r n e r to Physician f oRr epTohritsing: SEX: COLOR: MARITAL STATUS: AWnaos t h Pe r r i oPr h yVs iics ii t a n M f a o d r e t t h o is T um or? CLINICAL DIAGNOSIS: PATH. DLVGX05IS: NAME Or PATH. LABORATORY: -STAGE OF "I BWyhePnhyFsiicrisatnDRiaetr;m*: ELoacralv'1 Advanced L-0 " d i s e a s e I SV,) P(TRisIsMueARofYOSrIgTinE): METASTATIC SITE: RInevgoilovneadl Nodes j(__1J ;| MDiesttaasnttasis Recurrent REFERRED BY: REPORTED 5Y: = DF.AET?OERO~ F THIS iNamci 1And-duretut<ionor: Iofi NHoow-oiHranlsjo.ir'ahIzne-td-..tuNtioarn.n TPuatmieonrt Clinic HE.OMAN E. HILEEbOE. M D MALIGNANT NEOPLASMI O iN'KJ 1>KNT1Al- KEIN iRT NH-CaRYKuArEi M(*-Y-.tr LDAr;W.:tnH:-R'.rnUi 'NofTIKuOamL;; Cyoluu-ckwi-ll;ieimf re;>ur 1 ftttfb8wwK^ites^iatag:atfe^i dianburiorc causative agents, etc., now practically non existent. Very few people realize how little reliable infor mation there is, at the present time, as to the incidence of any o f the occupational diseases. Occupational cancers, as a rule, result from prolonged exposure to physical or chemical carcinogenic agents in the working environment. Such exposures may be continuous or intermittent over a period of many years. There may be a iong L i! :: period belore the first evidence of cancer begin to matutes^themselves. During all or part of this period, there may be no contact whatever with the carcinogenic agent originally responsible for the cancer. In the case of ra as d2iu0m-5, 0 f or yea ex rs. a m p l e , this latent period may ' be as lone Individual susceptibility probably plays an important role here as in all other diseases, occupational or non occupational. N o doubt, when more is known about the many metabolic and biochemical factors involved in cancer formation generally, it w ill be found that some of these same factors are operative in cases o f occupational cancer. It is a matter o f great practical importance, for the present purpose, that the industrial environment is essen tially a man-made artificial one peculiarly susceptible o f scientific measurement and medical evaluation from the standpoint ot hazards to health --- including the production of occupational cancer as well as other occupational di seases. O f equal importance is the fact that these environ mental factors in industry responsible for injury to health, once recognized, can be successfully controlled. Fortunately, the techniques fo r the control of the industrial environment and the prevention o f occupational diseases are highly developed at the present time. As a guide to the physician who, for purposes of pre vention. is interested in investigating the role of occupa- iton in cancerous or pre-cantjsrous lesions presented by his patients, Tables I and II are appended; also a selected bibliography o f literature having a direct bearing on these problems. Table I presents a description of selected lesions which have been found, as a result of experience, to be associated kwniothwnagteontbse cinarctihneogoenccicu.pational environment which are Table II lists, alphabetically, for reference purposes, some of the more common substances or conditions in the occu pational environment which are recognized as being cancerproducing or suspect. W ith each such agent the organ or system usually involved, is presented together with a clas seitfiioclaotgioicnalin rtehleatiroignhsht-ihpanids cdooluubmtfnusl, in(CdilcaastsingD )whoertheersttahbe lished (Class E ). woTuhlde gNreeawtly YaoprpkrecSiatattee thOecccuopoapteiroantaioln CoafncperarctCicoimngmpithteyesicians in reporting any information they develop as to the mpoaslsiigbnleanrteloartiobnenoigfn,ocwcuhpicahtiotnheyto fitnhde pinaththoeloirgipcaatlielnetssi.ons, The Keu York Stare Occupational Cancer Committee is an unof ficial agency with the following membership : May R. Mayers, M.D., New York State Department of Labor, AuCshtianirVm.anDeibert, M.D., U.S. Public Health Service KHoanrroaldd FD.obDroinrner,, PMh.DD..,, USl.oSa.n-PKuebtltiecriHngeaIltnhstiStuetrev,icNe ew York City GPa.ulH.R.GGeherrhmaarndnt,, MM..DD..,, NMeawnuYfaocrtkurSintagteCDheempairsttsmeAnstsoocfiaHtioenalth LHeyomnaarnd GGorldeesntebiunr,gP, hH.D.D.,.,NNewew'YYorokrkStSattaeteDeDpeapratrmtmenetntofoHf eLaaltbhor ALerrthoyurS.E.HHouosaeg,, MM.D.D.,., TMuemmobrerC, liAnmicerAicssaonciaPteitornoleoufmthIensSt.tate of New York WLo.uiCs . CH. uKepreesrs,, MM.D.D.,., UR.So.swPeullblPicarHkeMaltehmoSreiravlicIenstitute, Buffalo, N. Y. AnMtheodniycalJ.ScLhoanozl,a,NeMw.DY.,orNk eCwityYork University, Post-Graduate MGeoorrtogne TL.. PLaecvkin, ,MM.D.D.,.,MNeedwicaYl oSrokciSettyateofDtehpearSttmateentofofNHewealYthork ( Continued ht the November, 1951 issue) TABLE II Alphobericol listing of Recognized and Suspected Occupational Cancer Producing Agents, With Sites Characteristically Affected SUCBOSNTADNITCIOESN SOR ORSYGASTNEMOR CLDA*SS rWmu -aie. . . . . . . . . . . . fkan&tErcaeceaoraed, dcerraidveativ...e..s..... kron ur: c o r r s*,~c BSklaindde..r.,....u..r..e..t.e...r.,....k..i..d..n..e..y......... ; D Liver ............................... * D krsemc ............................... SLkiviner .................................................................... '| D R e s p ira to ry system ............ j D E y e lid s ................................ ' k s b e s e s ...................... .. ksj-fcah., a r rififfis* . ............... RS ke sinp i r a...t.o...r.y.....s..y..s.t..e..m................. D ^cnridin e smd d e riv a tiv e s enrol ......................................... EBBvlloaedo dd e..r.f.,.o..ru..m.r..e.i.nt..e.g.r..,...o.k.r.i.g.d..an..n.e..sy.... D Benxol d e riv a tiv e s ............... 3 n m . th e rm ic ...................... SBkloinod ...f..o..r.m....i.n...g.....o..r..g.a..n D C h lo rirarev i h y d r o c a r lto n s . L iv e r .................................... n tn ? z u :e s ................................. .......................... | RS ke si np i r a..t..o..r..y.....s.y..s..t..e..m................. D rreosete ................. ................ . Skin ...... ............... LEiype ................................................... Estrcrer.? rro*-tt::c . Breast (male .. D Skin ......................... i1rmotna r .dcuns.: : nrtu:c LSkuinng ......................................... I) I) Minerai o. . croie Spun and Lip ... L : ; .............................. 1) Respiratore 5w.cn I) Eve ...............'____ B .adder, u r tie r. k viney B.adder, ureter * dnev 'C-- t1:OiC2V C LEAtS S E E E EE E E E EE E Y E SUCBOSNTADNITCIOESN SOR Nickel carbonvl ................ Pitch ...................................... Radio active substances .. Sodium nitrate, crude . . Spindle oils, aromatic . . 1 . Traum a, physical ............. 1 hraviolet r a \ ............... O RSGYAS TNE MO R Respiratory tract ............. LBilpadde..r...................................................... Eye ....................................... SLkuinngs.......................................................................... BBolonoed ..f.o...r.m....i.n..g.....o...r..g...a...n...s.._.._.. BSuloboedpitfhoerlmiailngcoonrngeacntisve. . . Eyteissu.e..s.................................................................. Skin ....................................... BSklaindde..r...................................................................... SRkeisnpir.a..t.o..r..y.....s..y..s..t.e..m............................ EBvloeod ..f..o..r.m....i.n...g....o...r.g...a..n..s............ SBkloinod ..f..o..r.m....i.n...g....o...r.g...a..n..s............ MEveesen.c..h..y..m....a..t.o...u..s.....t.i.s..s..u..e..s...... SEkvien .............................................................................. CLDA*SS D ID) D I) D I1)) 1) ni) in) CLEAtSS EE E EE EE EEE E EE VEE i-; KE N ew ^ t T il * / v i s v OCl f/ fi f) i!t Vol. 30 *-- The chief func agency is to maint; in industry. In ct set forth in the Pu Lin the Labor Law i i Commissioner is c iworkers as follow: "Section 200. Safety of Emplo\ applies shall be s ated and conduct protection to tlje ployed therein. '-T e[ ffeInct ctheretapinrovjuissiiqsc: is rather a pan c and of the Health phere has been lift in a given area -- enforce is well a: W hile the obje tallized and accep that the means o the decision of ti example, in a cer .Industrial Hygien .study and tes:. 1 control. It >s at ti leeway in methoc enforcement of s: a somewhat routi ilto issue the order violation. With r ohbytgaiiennecodrrivecistiioonns a reasonable per: _ mneacyesfsoarrywaerndfotrhcee. % dustrial hygiene rtraonlgionlgafohreacltohmrh T h During the L. subject, .mo aIon. lRiveper,ilnistet d Ali.ds 4 0ewYork State Department o f Labor NTHLY REVIEW division o f'In d u stria lH ygiene & S a fety Standards Y qj_ 30 N O V EM BER, 1951 No- 11 RO LE OF T H E O FF IC IA L A G E N C Y LN IN D U S T R IA L H Y G IE N E L eonard G reenburg, M .D . Director The chief function of the omciai industrial hygiene agencv is :c maintain safe and healthful working conditions in mdusr-.'. In certain states, the ends to be achieved are set forth m the Public Health or Labor Law. For example, the Labor Law of the State o f N ew York, the Industrial dCbmmissioner is charged with the duty of protecting the rkers as follows: "Section 200. General Duty to Protect Health and etv of Employees -- All places to which this chapter plies- shall be so constructed, equipped, arranged, oper and conducted as to provide reasonable and adequate otection to the lives, health and safety1 of persons era- oyed therein. 'The boand shall make rules to carry into ect the provisions o f this section." In certain jurisdictions the charge is not so specific but rather a part of the general police power of the state o f the Health or the Labor Commissioner. In practice re a has been little question given area -- for with foefw theexcpeopstsieosnssi,onthoef authority power to orce is w ell accepted. W hile the objectives o f industrial hygiene are well crys- ,ized and accepted in most areas, it is important to note the m eins of attaining these ends are often left to e decision o f the industrial hygiene administrator. For examrle. m a certain health department, the Division of lusm ai Hvgiene. locates a definite health hazard after dv and test. The problem is to achieve correction and ntroL It is at this point that the enforcing authority has _ leeway Lt method. In general, in labor departments, the X7 ean fsoormoeewnhe antt o f safety rules and regulations is routine fashion. :.t.. the inspector achieved in is required * t o issue the orders immediately on perceiving the so-called " violation. W nh respect to health violations, the industrial 2 hygiene an icons mav. alter ending a violation, move to * obtain ;c:rect:on bv agreement. Not being successful after . a reasonable r'triod, the Division o f Industrial Hygiene - mav forward the papers to the Division of Inspection for necessarr enforcement. The important fact is that the in- dastrial he d e n t division has ronsiderable latitude in ar- icer. U. r. a tre 1 c: _ c:rcph.a.nre scith req u irem en ts to r the ton- .H i E: VCATiON >T iNDf'TRV T-> : in; 2 rears. r.-._l:h has bt.onit a popular a.or.r u ::r. the ir..rva>c or knowledge and in- terest in personal and public health matters, there has gone a corresponding increase in knowledge and interest in the field of industrial health. The work of the universities, the insurance companies, the Industrial Hygiene Founda tion, the National Association of Manufacturers, the Pub lic Health Service and other agencies has served to inform the industrialists of this country about health, and particu larly, health in industry'. This has made the task of what must be done today a relatively simple one. The key to educating industry to appreciate industrial hygiene lies in demonstrating the healthful plant working conditions are the basis o f: ( 1 ) good management; (2 ) 3 good working conditions generally; ( ) good union and 4 worker relationships; ( ) decreased labor turnover and lost time, and ( 5 ) decreased production losses and, there fore, costs of production. In other words, there are so many axiomatic and obvious reasons why healthful working conditions are good for management, that it is only rarely that this direct approach fails. Printed matter has also been o f great aid. Lastly, factory inspectors should be utilized in the education of industry with regard to accident prevention, industrial health and hygiene, and public health. Personnel W ith W hom to D eal At this point, it is well to introduce a fundamental con sideration, namely, the influence of company size on the whTohlee psriozbeleomf tohfe incdoumsptrainayl hayngdienpelanant ddeintedrumsitnrieasl hitesalathd. ministrative organization and the choice of persons with whom the industrial hygienist may deal. In the small plant, one man may make all important decisions-- he may pur chase as well as sell and, at the same time, be factory super intendent. Such an organization leaves little to the choice of the industrial hygienist. He must see the boss of the establishment. At the other extreme, one may find a large organization where function and jurisdiction are limited and well defined. Here, there may be an industrial hygiene department, a medical department, a department tenance, a complete engineering department, a poefrsmonanienl office, a factory manager, a plant superintendent, and one olarrgmeoroenes.aftehteyreenagrienemerasn.y Bgertawdeaetinonthseinsmsaizlle palnadnt inandkinthdes oretpopretrsoisnnoeflt.enThmuasdetheforchothicee iontduthsteriaplerhsoyngietnoiswt hboymthtoe ton.pane organization. The plant manager or tile plant superintendent must he acquainted with the efforts ot the MONTHLY REVIEW of be D ivision of Industrial Hygiene and Safety' Standards NEW YORK STATE DEPARTM ENT OF LABOR SO Center Street N ew York 13, N . Y. EDW ARD CORSI Industrial Commissioner 1st T H O M A S F. M O O RE, JR. Deputy Industrial Commisstoner EDWARD A. NYEGAARD Deputy Industrial Commissioner in Charge The Dilision Leonard H. Greenburg, Director Ma':' R. Mayers, Medical Bureau WlLLLAM 1. Bt-RKE, Chemical Bureau George P. Keogh, Code Bureau A. Arthur Stern, Engineering Bureau L eonard P e r r i n , Engineering Unn Building Plans industrial hygienist. I f industrial hygiene technical per sonnel are a part o f the organization, they w ill be con sulted and the problem explored with them. W ith refer ence to control ventilation techniques, the plant engineer w ill namrally play an important role. Use should be made o f any and all technical services available at the plant, including the plant physcian and the medical department. A s a general rule, no matter whom the industrial hygien ist deals with regarding the details o f the problem at hand, he should start his plant contacts high up in the managerial scale. Management is entitled to this presentation on a high level and. if it is not forthcoming, work at the plant may meet with delays and unnecessary restrictions. A ll of this may easily be avoided by a simple explanation to someone high in authority. T ranslation of Results There are many ways in which industrial hygiene results mav be translated into terms usable by plant personnel. For instance, with reference to exhaust systems, the speed or motors and fans may easily be checked against the origi nal design. Adequate maintenance, a most important fac tor in the operation of exhaust equipment, constitutes a large industrial hygiene area which may be translated into terms usable by plan: personnel. The c-trerence between good and poor housekeeping may be a determining factor in the difference between in dustrial disease due. for example, to solvents, and pro tection item such solvent vapors. Surely, it should be possible to convince plant personnel of the importance of housekeeping in such circumstances. Management is in ti Luger.: enough to know that the use o f a non-toxic solven: a- a sursntate ror a toxic one is good business, and th < ir.uustr-.a. hvciene lesson is beinc translated into usable Ck c n n u l - f .'.e E m p l o y e e E ducation 't :'u vt'.a. -huygiecn.'te.r.eocyuee.anroecneivireosntthtehrmeeaisoorurpcoerst:ion of " mateuai a- u r n to his attention, chieily in p:.n::r.g. iron', itu- on: ci.il agencies. Viewed nom: ce \ u u . the amount or such nute- rial coming into the hands of the average worker must be considered to be rather small and limited in scope. At the present time, it cannot be said that this occupies as large a place in the program as it should. There is, of course, real difficulty in spreading information by this means, and, considering the number of workers in this country, it must' in general, be concluded that this avenue of approach is costly and, perhaps, somewhat inefficient. 2. The second avenue of education is that provided by the labor union. At the present time, this approach is used with great efficiency in certain unions and not at all, in a far greater number. That much can be done, has been demonstrated by those unions which have shown a deep interest in this aspect of the industrial health problem. The union approach has something to recommend it, for a worker usually has confidence in everything that comes to 3him from his own self-supported union. . The third and, perhaps, most important channel of industrial hygiene education is that provided by the em ployer. Here, the education is by word o f mouth and comes from the foreman to the shift boss and directly to the worker. It is clear that the importance o f the foreman and the shift boss cannot be over-estimated. A plant that intends to conduct a good educational program in the field of accident prevention and industrial hygiene can achieve tremendous results by teaching the foreman and shift boss and, in turn, have them teach the individual worker. The instruction obtained in this fashion is usually pertinent to the specific plant and process operation at hand and is of the utmost value in maintaining safety and health in the plant sponsoring the program. It is usually the plant man agement who decides on the instruction the worker shall receive, with, o f course, a certain area devoted to the edu cation by the union. G etting Corrective A ction A ll corrective action must rest on the firm basis of studies which demonstrate a hazard or the existence of conditions which might tend to injure the health of the worker. Obviously, it is not necessary to prove that anyone has actually been injured. The dictates o f public health and preventive medicine make it mandatory that this be so. Nevertheless, if one is to expect to achieve corrective meas ures one must unequivocally demonstrate that there is something that really requires correction. This need must be translated into plain talk comprehensible to lay man agement, if the size o f the plant compels the industrial hygienist to deal with non-technical personnel. Usually, this is not too difficult and, as a rule, can be demonstrated in a simple fashion. This demonstration may be rein forced by quotations from rules or regulations and the uw of medical or industrial hygiene references which earn conviction. In order to achieve control, it is important to demon strate to management why control is to the benefit of both the organization and the worker. This should be made so clear that the self-interest of management should motivate the action desired by the hygienist. Corrective measures should be designed so as to be achieved at the lowest possible cost consistent with the end. There is no reason why management should be asked to spend more mono than absolutely necessary in order to achieve protection. Here, as in all engineering work, the elements of cost .m-economy should be given adequate consideration. Management should be gi\en guidance and assistum deciding what to do and how to do it. This is real. part ot the educational work of the official agence 1 tact, the ottici.il agenev should rarely be called upon to 1 fundamental research, with the important exception ' that type and management tion, 1 migh conducting a mon brick "an as a basis fo: of the state. Manageme for compliar, of extreme h; need the acts sufficient tirr Plant situ: lation does control o f h sary. This is 1 i- which volatil Some diffi presented by mercury in s which mercu one of its m the mercury of local exh: more diffiqu: meta.llic m*et reacting vqss accidental sp: of material < the trouble v mercury dep o f many ye? and floors o Because o inherent diff program was of each pha cates, amon. provide enti changes in j. progressing, carried out of the Divis are kept um It is belie I of this plan: curv exposu. M a x u fac The work ments with : bottle c-levati was conned hose Conner mimeamtelwv a5s0i0d Spillage, : able accumr and in all c of mercurv ' dows closer, showed ext: that type and kind of research which can be used to assist management in achieving control results. In this connec tion. 1 might mention that at the present time, we are conducting a study of dust control in the making of com mon brick and we hope to use the results of this research as a basis for engineering control in all of the brickyards o f the state. Management should be given a sufficient period of time for compliance with recommendations. Only in the case of extreme hazards which may cause death on short notice, need the action be very rapid. For the most part, there is sufficient time for conferences and for the purchase o f necessary equipment, including the usual delays. N o good can come from putting undue pressure on an industry to move with extra rapidity unless there is urgent need for it. Only after all cooperative efforts have failed to produce results, should the law be invoked and legal action taken. In our experience, this is a rare occurrence. American labor and industry' appear to be o f one mind in the im portance o f the subject o f health and health maintenance. In many years of experience, I still have to meet the em ployer who is not himself so interested in health, that he cannot visualize the problem from the point of view of his workers. ` IN D U STRIAL M ERCU RY POISONING ( There w ill be no author) Plant situations arise, from time to time, where venti lation does not provide the conventional answer to the control o f health hazards, and other measures are neces sary. Th is is peculiarly true in the case of metallic mercury which volatilizes at room temperature. Mercury U sed as a Catalyst Some difficult problems in this category were recently presented by the finding of excessive concentrations o f mercury in several buildings o f a large chemical plant in which mercury is used as a catalyst in the manufacture o f one o f its main products. It was possible to take care o f the mercury vapors released from reaction kettles, by means o f local exhaust ventilation. However, other sources were more difficult to controL Am ong these were leaks o f metallic mercury from various pipe fittings, pumps and reacting vessels; overflow of charges from reactors; and accidental spillage of|biercury during the manual handling o f material containing mercury. But the main source o f the trouble was general contamination o f the buildings by mercury deposits that had become lodged, over a period o f many years, in structural members, and in the walls and floors o f the workrooms. Because o f the serious nature o f the hazard and the inherent difficulties involved in its control, a cooperative program was set up with management, for detailed study o f each phase o f the problem. Thus far this study indi cates, among other things, the need in some cases to provide entirely new equipment and to make important changes in plant processes. A s work along these lines is progressing, periodic testing fo r mercury vapor is being carried out at strategic operations by the Chemical Unit o f the D ivision as well as by the plant chemist. Workers are kept under dose medical surveillance. It is believed that the excellent cooperation, on the part o f this plant, w ill make it possible in time to reduce mercurv exposure to within safe limits. the air, ranging from 0.18 mgms. per cubic meter in the office to 0.68 near one o f the work tables. In view o f the above, management was advised as to the type of'ventilation required; procedures for avoiding spillage o f mercury; materials to be used for floors and workbenches; the need to wipe up spilled mercury imme diately; and the critical importance o f plant housekeeping. In addition, the plant was informed as to the legal re quirement in N ew Y ork State that a separate lunchroom be provided completely removed from mercury contami nation. The practice o f eating lunch at workbenches was immediately discontinued. This plant is being kept under continuing surveillance while the necessary changes are being made. Fig. I Signature of worker with chronic mercurialism, illustrating tremor. Kymograph Tracings of Mercurial Tremors in Workers V" a. Control (No Mercury Exposure) Manu facture of Blood Pressure Instruments The work in this plant of filling blood pressure instru ments with metallic mercurv is done by hand from a quart bottie elevated on a stand above the workbench. The bottle was connected to an automatic weighing device, with a hose connection leading to the instrument. Each instru ment was filled with 1 3 lb. mercury, and a total of approx imatin' 5000 lbs. of mercurv were used per vear. S riiiact. in handling the mercury, resulted in consider aanblde :ra.ccauilmcurleavtiiocenss oifn thcreacdkosorasn. d Tthoeprse wofaswvoorlka-tbileinzacthieosn, of mercurv vapor throughout the building. With all w in dshooww- edcloesxetdremate!'.t'hehigthimemeorcrurtvhevaipnovrestciognactieonnt,rataioirnst,esitns 43 O rganic M ercury for T reating Seeds and G rain Treating ot seeds and grain with organic mercury (ethyl mpreervceunryt bplahcokspshmautte,) a wfuansgubseindgiseacsaer.riePdartouotf itnhe ogrrdaeirn stoo i'oTfred*'3* ^ USed ^ Sted' anofher Part was ground In this plant, approximately 20-25 tons of seed were treated during the months o f March, April and May As the seed grams drop from an overhead hopper, through an enclosed chute, prescribed amounts of the mercury comrounu were sifted on it. The dusted grain was then moved. b\ means ot an enclosed conveyor, either to spou,5 for tilling burlap bags, or to a grinding mill. In the hlhng o f the burlap bags, an exhaust system carried oft the dust from the grain and excess mercury compound and deposited it under the floor o f the building. Bagging of the ground material was done from a port in the mixer A ir tests for mercury-, made at strategic plant operations and at the breathing zone o f the workers, were all above permissible concentrations. The plant was advised as to ways and means o f controlling the mercury hazard and is cooperating in carrying out these measures. OCCUPATIONAL CANCER A C h a lle n g e to t h e P h y sic ia n {Continued from the October, 19 5 1 issue) Term and Patholog.col Diagnosis Included* Under "Cancer and Ofher Mcd.gnanf Tumor" and Reportable in Accordance with 25-b, Public Health law SCaarrccoimnoama And EEnpditohtehlieolimoma a of AAsctarnotchyotmoma a CBrhaoirniomTuamors CChbololersotmeaatoma EEptnebnrdyyommoama GGaiinomgliaoneuroma G rfGaniauntloCsaellCeTlul mTourm(oBron(Ce)hary) HHyopdegrknienpshrDomisaea* LLyemukpehmoimaa g! LIaynmitpishoPsalarcstoimcaa (Stomach) M elanoma tahneysetewrmordosf iswhaicpharto.ne MMyenelionmgiaoma MMeesdoutlhloebliloamstaoma MNeiuxreodcyTtoummaor POilnigeaoldoemnda roglioma SSeymncivntoiommaa SSypmonpgaitohbolbaslatostmoma a TTheryamtoommaa WPaiglemt'ss' DTiusmeaosre ((KBirdenaesyt)) EGwraiwngit'zs' TTuummoorr (B(Koniden)ey) T" n' :.-y-.h d1i- n^o:'VCdM1LuNstiTTcHbEuRt EcomISpriDseOs UthBeT grCeaOt NmCaEjoRrNityINoGf tTerHmEs t o k t e d A 'N T -n a t l r e O F a t u m o r , IT SH O U LD BE RE T SJi?a"nc1naCneIt!. ITnucmluodr?ed offorBoSnpeecAiarle SUtusduya.lly Benign, But May Become BIBLIOGRAPHY GENERAL ARTICLES: HuTehpoemra.sW. S.pCri:ngOfieclcdu.paIltliionnosi!s,Tu1m94o2r.s and Allied Diseases. C. C. I1n3d1u:s7t3r8ia.l 19M4a6n. agement and Occupational Cancer -T AMA cSutgpnattpiocnaanlieMoefdI.n. d2u:s1t9ri0a,l 1C9a4n6c.er in the Problem of Cancer' Oc Hartwell. J. I_: rot cararogenic Surrey act:,tty. oFfedCeormalpSoeucnudrsitywhAigcehnchya,reUnbieteedn tSetsatteeds Public Health Service, 1941. ARSENIC: SKIN Montgomery. H.: Arch. Dermat. and Syph., 32:218, 1935. Montgomery. h and W aisman. M.: J.Invest. Dermat. 4:365, GoanedckSeyrpmha..n4n2.:6W40.. H1.94a0n. d W ilhelm, L. F.: Arch Dermat TAHRel--lerP.ITI.:CH.1. --InduAsStrP. HHAyLgT. :12:169, 1930. SXo g io m . W . H.: Arch. Pathol. 2:533 and "?08, 1926. O. ADro.nnovDaenrm. aU:, . an1.d: SByrpith..,J. 19D:5er9m5.at.193229.:215 and 245,' 192*0, H aagensen. C. D Am. J. Cancer. 15:641. 195!. PARAFFINS AND MINERAL OILS: Vc HITE P R : The Dermatcrgoses. London. H. K Lewi- A Co i Vi > * b r f . X K j . A S K E M and St o pio rd . J. S.: Brit. Med J. 2:99.5. Henry. Henry, SS.. AA.. : aAndm.I rJv. i nCea,ncEe.r, D3.:1 : 2J.8 , Hyg. 193 7 3 . 6 : 3 1 0 , 1936. T wort, J. M. and Lyth, R. J .: Hyg. 39:161, 1939. CREOSOTE SOOOTD:onov A an N , D W. AN J.: T HArRchA.CDEeNrEm aOt. ILa:nd Syph 19595, 19-tq. KHeennnrayw, Sa.yA, .E:. ALm.:. JJ.. ICndanucsetrr., H31y:g2.8,7 :16993,7.1925. SOLAR Phill i AN ps. D C : UTLeTxRasA VStIaOteLJE. TMRedA.Y3S6: : 6 1 3 , 1941. SBultutmo,nH, R. .FL.:.:JJ. . NAamt.. CMaendce. rAIsns.st.641::430937,,' 11991450. . * SRUOBESNTTAGNECNE-SR:AYS AND RAYS OF RADIO-ACTIVE Sau11n0d:e2r3s, , 1T93. 8.S. and Montgomery, H.: J. Am. Med. Ass. HLaanzee,n,C.H.GH.: .:J.J.AAmm. .MMeded. .AAssss.. 9957::218868,1,1913903. 1. ASBESTOS: RESPIRATORY SYSTEM LyAnmch. .J.KC. aMnc.e:r J3.6:A5m67., M19e3d9.. Ass. 109:1974' 1937 ARNSoErNdICm:ann, M.: Ztschr. f. Krebsforschg. 47-' 88' 1938' GoaencdkSeyrpmha.,n4n2,:6W40. , H1.94a0n.d W ilhelm, L. F.- Arch Derma- M eforrewth-eetYheearr, E19. 4R3., AH..: MA.nnS.taRtieopn,arCyhOieffficIen,spLeocntodronof 3F8act1o9r4ie4s CHROMATES: ' ' G rKolsins.. EW.:ocAhenngsecwharn. d1t5:C32h3em, i1e9, 365.3:368,' 1940 A lbwepeanths.. W7:.6,9B, a1u93c6k.e, E. C. and J onas. W.: Arch. F Gewer- NICKEL CARBONYL: Britdeagre, 1J9.36C,.:HA. nMn.. SRteapt.ionCahryiefOIffnicspe,ecLtoorndoofn Fa1c9t3o6ries of the T. AKRa:w a h a t a . K.: Gann 32:367, 1938. ' ` RCAODBAIOLATCMTIIVNEES:SUBSTANCES: SCHNEEBERG Ro1s9t3o0s.ki, O. and Saupe. E.: Arch. f. Gewerbepf ath' 1-'75' 1 ' Lorenz. E.: J. Nat. Cancer Inst. 51:1, 1944. RADIOACTIVE SUBSTANCES: JOACHIMSTHAL- URANIUM MINES Pirchan. A., and S i c k l . H.: Am. J. Cancer 16:681, 1932. AROMATIC AMINES: UROGENIC SYSTEM GHeuherpemra.nWn .. GC. :H A:rcJh.A. .MPa.tAh.. 12057:8:15465, 6,1913983.6, BENZOL: HEMATOPOIETIC SYSTEM Erf. L. A. and Rhoads. C. P.: J. Industr. Hyg. 21:421, 1950 ROHEeNnTs hGaEwN.-RPA. YS.S. HAaNwDkinRsA, DJ.IOWAC. TMIVeyEerS.UHB.STLA.. NWCEoSodrui i J and M arshall. 1. F.: J. National Canter Inst. 4:339, 191 , BONES: RADIOACTIVE SUBSTANCES RADIOACTIVE SUBSTANCES: M artlanp. H. s.: Am. J. Canter 15:2435 195 1 .