PARAFFIN NOT PRODUCTIVE OF CANCER HAROLD B. WOOD (Epidemiologist, Pennsylvania Department of Health, Harrisburg) Paraffin has unjustly been accused of .producing cancer. Some writers declare paraffin workers develop cancer of the bladder, while others declare that cancer of the scrotum may be the result of this employment. British writers sometimes use the word paraffin to designate what is more correctly termed paraffin oil, which may be carcinogenic. The name paraffin should be used only for a definite chemical entity, C2,Hb6,and when investigations are made of unrefined, con- taminated, oily or acidulated paraffinoid substances definite declarations should be made of such facts, as it may be the oily, soiled clothing and entire lack of personal cleanliness which lead to skin affections. In experimental work Leitch and Kennaway (1) found that many kinds of petroleum will not produce cancer. They heated the California non-carcinogenic petroleum to 880" C. and produced many aromatic compounds which were not in the original oil and which were actively carcinogenic. The California petroleum has an asphaltic base, the Appalachian oils a paraffin base. Kennaway (2) in his production of experi- mental tar cancer among mice found that high temperature coal tar which gives the greatest proportion of cancers is very poor in paraffins and the tars containing the most paraffins produce no experimental cancers. Leitch (3) produced tumor formations in 30 out of 74 mice which survived the treatment of frequent applications of crude shale oils containing paraffins. Mook and Wander (4) stated however that single injections of paraffin into the subcutaneous tissues of man lead to the pro- duction of tumors. Burrows and Jorstad (5) wrote that paraffin, liquid petrolatum, coal tar, and vegetable and animal oils when introduced into the tissues become encapsulated (as 97 98 HAROLD B. WOOD will any foreign body) and form sarcoidal masses. They believe that these lipoidal solvents induce the development of cancers in which the chief factor is undernourishment. This statement, however, has never been confirmed. Weidman (6) declared the tumors from oil, liquid petrolatum or paraffin injections were not neoplasms but disfiguring foreign body granulomas. Blegvad warns against using paraffin injections for cosmetic purposes, but Dr. George M. Dorrance writes me he has used it for many years with no malignancy resulting. Ehrlich (7) observed five cases of cancer of the scrotum in five years among the employees of a petroleum refining plant in Czechoslovakia, four being in pressmen of the paraffin works, each of whom had worked between 13 to 16 years. Scott (8) in his routine examinations of all workmen in the paraffin departments of the Scottish shale oil industry during four years found various akin lesions in half of the men. The lesions developed a few weeks after beginning work, persisted throughout and ceased at the termination of employment. The lesions varied between erythema, comedones, papules and pustules. He declared that epitheliomas may develop from warts after the man has been working more than twenty years in paraffin. He lists the epithelioma cases going to the Royal Infirmary, 1900 to 1921, finding the distribution of the cases of the paraffin workers as: arms and hands 63 per cent, face 16, scrotum 16 and groin 5 per cent. White (9) stated that Bridge found no evidence of skin affections in paraffin candlemakers. White saw that women and girls working, year after year, bedaubed with refined paraffin wax free from impurities, experienced no detrimental effect whatever from the wax. Most of the reports of paraffin cancer are British, on whose island paraffin is obtained from shale oil which yields olefines with paraffin, whereas in coal shales hydrocarbons of the aromatic benzene group are largely represented, instead of the olefines. Since, in the experimental production of cancer in mice by using coal tar, it seems probable that the high tempera- ture distillate of the aromatic benzenes may be carcinogenic, the apparent contradictory analogy of the Scottish paraffins PARAFFIN NOT PRODUCTIVE OF CANCER 99 perhaps producing cancer and the American being inert is explained by the fact that paraffin contains no benzene com- pounds. The carcinogenic powers of the olefines and also of individual aromatic benzenes need further experimental investigation, though Kennaway has shown that many of them will not produce tumors. Paraffin is melted and used for coating objects, as glassware in preparation for etching by hydrofluoric acid, for making various kinds of corks and stoppers airtight, to render objects non-conductors of electricity and for other purposes. The hot paraffin bath, which is the melted paraffin, gives off a distinct characteristic odor of vaporized paraffin and I have not read that anybody has suggested that the persons working in it develop pulmonary carcinoma. I have examined a considerable number of men who work over paraffin baths and have been unable to determine any damaging effect from this exposure. Davis (10) found wax-boils among the pressmen in a Chicago refinery and said prolonged occupation may produce true epithelioma, but that wax-boils and the subsequent lesions were unknown among the workers in the finished paraffin and among the men who handled the crude oil. He believed paraffinoma was a chronic granuloma due not to paraffin but a long continued action of a low grade chemical irritant. Schamberg wrote that it was not the finished product paraffin which produces cancer but the blackish oily mass from which, during cooling, paraffin separates. Among a total of 8,673 deaths from carcinoma in Pennsyl- vania in 1927 there were 292 deaths from cancer of the bladder, one of which occurred in a man who had worked in paraffin in Philadelphia. There were recorded 2,719 deaths from carci- noma in men for whom the certificates described definite occupations. Only 8 of these men were oil operators, one an oil refiner and one paraffin worker. This prevalence of cancer means one death among approximately 1,000 men of the general population, the same ratio for oil refiners and one death among 4,000 oil field operatives, using the census figures for these 100 HAROLD B. WOOD occupations. These figures do not even suggest any cancer hazard in working in crude oil or its products. Field investigations were undertaken to determine the exist- ence of any carcinomatous conditions among the living paraffin handlers. Trips were made to 15 oil refineries in the 8 principal locations of the Pennsylvania oil field. Ten of these refineries manufacture paraffin wax and employ 76 men who are handling the wax. The labor tqrnover among the wax handlers is very small. Nearly every man had worked at his particular job over five years, many ten, some twenty and others up to forty- one years. Every man was entirely healthy as far as cancer or precancerous symptoms were concerned. In some plants these men strip the sheet of wax off the revolving drum at the final stage of its production and pack it into barrels, their hands and forearms coming into constant contact with the paraffin; in other refineries the paraffin is pressed out in sheets in canvas bags and from them is removed by the men. This second is an exceedingly greasy process and yields the greater amount of the " wax-boils." Local physicians and numerous plant execu- tives all declared they had never known a wax handler to develop cancer. The death records of these same localities showed a total of 124 men who had died of cancer within the past six years. These men were employed in sixty different occupations. Where the death certificate gave no occupation, or said the man had retired or was a laborer definite information as to his previous occupations was obtained from his family or acquaint- ances. The occupational data were obtained for all but three men. Twenty-five men were outdoor laborers and did not work for oil companies. Only 12 of the 124 men were con- nected with the oil business: executives of refining companies 3, oil pumpers 5, and oil driller, oil distributor, oil tester and still- man each one. Not a single man was a paraffin wax handler. The oil refineries visited employed over 1,500 men, and of all the men of these communities dying of cancer within the past six years only the three executives, the oil tester and the still- man worked at the oil refineries. The oil pumpers were among PARAFFIN NOT PRODUCTIVE OF CANCER 101 the hundreds of such men throughout the oil fields who attend the pumps at the oil wells and come into little contact with the crude oil. Cancer of the bladder, which some persons allege follows the handling of paraffin, caused five deaths of the 124 men who died of cancer. These five men were in different occupations; to wit, civil engineer, farmer, painter, railroad engineer and wagon builder. None had anything to do with oil or paraffin. There were no scrota1 cancers in this series and only five skin cancers, on the ear, nose and neck, none of which occurred in a man working in any oil occupation. Paraffin and oil workmen occasionally develop local re- actions upon the skin, what are popularly called " wax-boils." These are furuncles of varying size and number and are very troublesome for some persons, but they produce no adenitis or permanent effect, according to the physicians. The " wax- boils" were much more prevalent in the olden days when less attention was given to personal cleanliness. Some authorities stated the furuncles were more prevalent among the new hands, or among those who did the piping or pumping at the oil wells or among the uncleanly workmen. There were no present cases of this condition at the plants visited. A pustular rash was found on the forearms of a paraffin handler at an oil refinery in Philadelphia, but the pustular rashes come principally in the men coming in contact with the oils, and principally the heavier oils. The paraffin doubtless is effective only by its oleaginous nature, and the saturation by oil of the atmosphere of the workrooms is an added factor. The rash is most apt to appear where the dirty and oily shirt sleeve rubs against the skin. The men who had had it stated it occurred only on the forearms, except one man who had had it upon the front of the thighs. Only a few oil handlers get this eruption. I believe it is due to the oil dissolving the sebum of the skin and opening up opportunities for the intro- duction of infection being rubbed in by a dirty shirt cuff or by the fingers. The rash was more prevalent in former years. Pure paraffin, C2,Hb6,is without doubt inert and in no way deleterious to the health of persons using it. 102 HAROLD B. WOOD

mFERENCES 1. KENNAWAY,E. L.: The Anatomical Distribution of the Occupational Cancers. Jour. Industrial Hygiene, 1926, No. 7, p. 69. 2. KENNAWAY,E. L.: Brit. Med. Jour., 1924, I, 664. 3. L~ITCH,ARCHIBALD: Brit. Med. Jour., 1922,II, 1104. 4. MOOK,W. H., AND WANDER,W. C.: Camphor Tar Tumors. Archiv. Dermat. & Syph., 1920, I, 304. 6. BURROWS,M. T., AND JORSTAD,L. H.: Cause of Growth of Sarcoida or Oil Tumors. J. A. M. A., 1927, lxxxviii, 1460. 0. WEIDMAN,F. D.: J. A. M. A,, 1923, Ixxx, 1761. 7. EHRLICH,H.: Arch. f. klin. Chir., 1918, cx, 327. 8. SCOTT,ALIDXAND~R: Eighth Sci. Report Imperial Cancer Research Fund, 1923, p. 85. 9. WHITE, PROSSER:Occupational Affections of the Skin, p. 143. 10. DAVIS,B. F.: Paraffinoma and Wax Cancer. J. A. M. A,, 1920, lxxv, 1709.