INTERNATIONAL LABOUR
OFFICE

Studies and Reports
Serie* 2C^"/ /, _.

GENEVA

C

Vi February 1921.

-Oí-,

Cancer of the Bladder Among Workers
in Aniline Factories.
SUMMARY.
Introduction — Frequency — Aetiology — Technical Survey— Pathogeny—
Pathological Anatomy — Symptoms — Diagnosis — Prognosis —
Treatment — Prophylaxis — Legislation—Conclusions —Bibliography.

INTRODUCTION.
The problem of tumours among certain classes of workers
is undoubtedly one of the most interesting questions of labour
pathology.
It had long been known that tumours existed among
chimney-sweeps, petrol refiners, workers handling tar, paraffin
pitch, and many other occupations. Some years ago attention
was also drawn to the frequency of tumours among the miners
of Schneeberg, who were exposed to inhalation of dust
containing cobalt and arsenic.
I t was in 1895 that Rehn reported to the Surgical Congress
3 cases of tumour of the bladder which the medical officers
of an aniline factory at Frankfort-on-Main had sent to him
for surgical treatment. In a short time observations of a
similar character multiplied. The tumours, however, were
of different natures, due to different products.
I t was
impossible as yet to determine exactly the industrial origin of
the tumours, but the Directors of the factories, disturbed by
the frequency and the gravity of the tumours noted, placed at
the disposal of the experts and technicians all the material
necessary for studying the problem and discovering prophylactic
measures.
The Serological Section of the Höchste Farbwerke took
up the question, but the experimental researches carried on
for two years did not yield appreciable results. The first
cases of tumour were reported among the workers engaged

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— 2 —

in the preparation of fuchsine and aniline. Efforts were made
to secure the completest possible protection in this branch, but
the danger was not eliminated.
The Surgical Congress of 1904 again dealt with the question
of tumours of the bladder due to industrial causes and instructed
Rehn to collect material relating to cancer of the bladder
among the workers in aniline factories. The enquiry was
carried on in 18 factories, but the cases observed only concerned
7 factories.
The study of the question, the work of
documentation, and the treatment in hospital of the patients,
were entrusted to the Samaritenhaus of Heidelberg; but the
results were not very encouraging.
The reports published, however, had indicated that other
products were capable of engendering tumours of the bladder,
and that among those benzidine and naphthylamine occupied
the most prominent place.
The cases observed were all in the zone of Frankfort, and
the question was raised whether the phenomenon might not
admit of a different explanation.
In 1912, however,
Leuenberger published a very interesting study dealing with
18 cases observed among the workers at Basle handling aniline dyes. From that moment the existence of a very close
connection between the manipulation of aromatic bases (1)
and tumours of the bladder among workers was proved.
The question was again brought before the Congress of
Factory Physicians of the chemical industry (6th May 1920),
which appointed a Commission for the study of the question.
The Commission comprises the representatives of the
Commission of the Association of the Chemical Industry, of
the medical practitioners of Frankfort engaged in the study
of cancer, of the Government, the Province, the manufacturers,
and the workers. The Secretary, Dr. Curschmann, in a recent
pamphlet, has published a questionnaire to be answered, for
the purpose of arriving at the most exact statistics possible.
He points out that the total number of cases of tumours of the
bladder since 1913 cannot be more than 28.
Considering the gravity of the question, especially in the
case of malignant tumours, and considering the fact that the
industry of aromatic bases has undergone a very considerable
development in recent years in countries not perhaps
(1) Organic chemistry is the chemistry of carbon compounds, which
are commonly classified in two groups — compounds of the aliphatic
series, or derivatives of methane, and compounds of the aromatic series,
which have received that name because many of them possess an
agreeable smell. These are also called benzene compounds, because they
are derived from a hydrocarbon C6 H„ known as benzene.
Benzene and its homologues, toluene (C6 H 3 (CHj)) and xylene
(C6 Hj (CH3) s ), form the starting point of a great number of compounds.
Among the characteristics of the aromatic compounds may be mentioned
the fact that they easüy react in combination with azotic acid, in forming
nitrate derivatives, and with concentrated sulphuric acid in producing sulphonic acids.

.— 3 —

sufficiently informed in regard to the ill effects of these
products, a clear presentation of the problem is desirable,
especially in view of the fact that the specific action of aminocompounds (1) is only explicable after a long period of contact.
Frequency.
A certain number of authors do not admit any direct
connection between poisoning by aniline and its derivatives
and tumours of the bladder. Grandhomme has repeatedly
insisted on the fact that no case was noted from 1883 up to
1896 among 493 workers exposed to aniline poisoning, and
that during the same period not a single case was reported
among the workers (4,000), at Offenbach or Fechenheim.
He concluded that aniline may irritate the mucous membrane
of the bladder and produce troubles in passing water, pains,
etc., but that it has no connection with the production of
tumours.
The observations of LeicMenstem and Schwerin have
completely disproved the conclusion of Grandhomme, and the
analysis of published works is very conclusive on this subject :
1895.
1898.
1898.
1900.

1904.
1904.

Behn. Three cases, two of fibrop apillo ma and one of
sarcoma, among workers in contact with fuchsine
and aniline.
Bachfeld (of Offenbach) reports 63 cases of poisoning
by aniline, toluidine or nitro-benzene, among which
16 exhibited troubles in passing water (strangury). .
LeicMenstem : 1 case of sarcoma due to naphthylamine
and one case (not clearly characterised from the
histological point of view) due to toluidine.
Wendel gives the histological examination of the
cases of Eehn and Leichtenstern and reports 3 cases
of cancer, of which 2 are due to aniline and one to
naphthylamine.
Rehn repofts on 20 cases submitted to him for surgical
treatment; 8 are cases of carcinoma; 5 of papilloma
and 7 without particulars.
Posner studies one case of cancer due to naphthol
(or naphthylamine).

(1) By reducing the nitrate derivatives of benzene and its homologues,
we obtain the corresponding amines of the aromatic series. Thes
form rather feeble bases. They are distinguished as p r i m a r a ^ S
tertiary, etc. The chemical properties of the amines ôUffj^^prfSÎaeraDry'yJ^
from those of the amides, which may be considered as interrfeiiate products
^
in the transformation of nitriles into acids. The c a r b / ^ ^ group may
*7
undergo changes when substitutions by other elemenj^pr groups are
__
introduced : thus derivatives of fatty acids are obtained i y modDEcation of
.. '
the carboxyl.
I '
"*• i , . fì
^ ,

V

_

1904.
1904.
1905.
1905.
1906.

1907.
1909.
1909.
1911.
1912.

1913.

1919.
1920.

4 —

Strauss. Publishes one case of cancer due to toluidine
and benzidine.
Bardenlieure. Two cases, one of cancer and one of
papilloma.
Rehn. One case of cancer of the bladder, ureter and
kidney, due to aniline.
Schedler. Two cases due to aniline, one of malignant
polypus and one of sarcoma.
Report on the enquiry made by Rehn.
In 7 factories out of 18 in which the enquiry was
held, 38 cases due to aniline and aromatic bases
were observed. They were cases of malignant
tumours, of which 18 were fatal; operations were
performed in 17 cases ; 11 of these were still living,
but three had already shown symptoms of relapse.
Seyberth reports 5 cases, 3 of papilloma, one of
adenocarcinoma and one of cancer due to aniline.
From the reports of the Labour Inspectors one case is
known of papilloma due to aniline and toluidine.
(This case was reported under the year 1910).
The same source gives one case due to benzidine,
without, however, giving the diagnosis.
Cesabianchi publishes one case of adenocarcinoma due
to fuchsine, and 2 cases of adenocarcinoma of the
gall bladder.
Leuenberger studies in his thesis 18 cases, 9 of carcinoma, 4 of papilloma, one of sarcoma, one of
Sarcocarcinoma, one of cancer of the bladder and
kidney, and 2 not specified.
Schwerin, who brings into the discussion the fruits of
his 21 years practice as a factory physician, collected
for the Conference of Medical Officers of Chemical
Factories, 117 cases, which he reduced to 100, as 17
were doubtful. During his long practice he had
observed 38 cases of tumour of the bladder' of
industrial origin, as against one which had no such
origin; but no case of carcinoma.
• Nassauer studies in his thesis 32 of the most recent
cases of tumours.
Curschmann reports on the cases of tumours since 1913,
the total of which amounts to 58, of which one
is badly described and not counted and 17 have
been previously reported. Among the 40 which
remain, 11 are not cases of tumours, but only of
more or less serious troubles of the bladder, and
one is a case of cancer of the kidney. Altogether
the cases observed since 1913 are reduced to 28.

— 5 —
According to Curschmann, the total number of cases of
tumour reported from the time of the first cases reported
by Eehn is 177. The cases of Fehr are doubtful, and those
reported by Israel and Casper in Berlin (Urologische
Gesellschaft 1913) require closer study before it is possible
to decide whether they have an industrial origin. But it
seems to us very difficult to accept Curschmann's conclusion,
since it is impossible to obtain precise information on the
cases prior to the report of Eehn in 1906, inasmuch as the
statistics were based on the figures of the Sickness Insurance
Funds, and it might easily have happened that the same
cases were counted twice. Thus, of the 38 cases of Eehn,
24 had been previously reported and four are doubtful; so
that up to the time of the thesis of Leuenberger the total
number of cases would be 41; and as it is impossible to say
whether or not the 32 cases of Nassauer include cases
previously reported, the total up to 1919 would probably be
only 87 ; that is, 41 plus the 18 cases of Leuenberger and the
28 cases of Curschmann.
The opinion that these tumours were only found in the
district of Frankfort-on-Main has been refuted by Leuenberger,
who proved the existence of tumours in the district of Basle,
among workers handling aniline dyes (dyers). The diagnosis
was verified by autopsy in 47 per cent of the cases reported
by Leuenberger.
" The examination of the question whether the development
of aniline dye factories has been parallel with the occurence
of more numerous cases of tumour of the bladder in the whole
of the population of Basle City has not produced exact results.
It has, however, been possible to prove that the number of
deaths due to tumour of the bladder was 0.007 % of the
average population of Basle City for the period 1871-1880
and that it rose to 0.02 % during the period 1901-1910.
" The comparison of the number of deaths recorded
among the workers in aniline dye factories due to tumour
of the bladder, with the deaths due to the same disease among
the rest of the population of Basle has given the following
results :—
" According to information supplied by the factories in
question, the number of workers employed during the period
1901-1910 in the factories producing aniline dyes and aromatic
derivatives in Basle City, was 840. In the same period,
according to the Office of Statistics, the whole male population
of Basle City amounted approximately to 56,500 workers.
From 1901 to 1910 six workers employed in aniline dye
factories died in Basle City as a result of tumours of the bladder.
During the same period, the physicians recorded 12 fatal cases
due to the same affection among the rest of the male
population of Basle City.
" From these calculations, therefore, it appears that in
Basle City during the period 1901-1910, the deaths due to

— 6 —

tumour of the bladder recorded among the workers in
factories producing aniline dves and aromatic substances
were 33 times more numerous than the fatal cases recorded
for the same number of individuals and for the same disease
among the rest of the male population, including old men and
children." (Leuenberger).
The data of Leuenberger are in fact even more striking,
inasmuch as the statistics taken from the Surgical Clinic
of Basle give figures proving the gr'eater morbidity of the
aniline workers :
Period.

¡
!
I
¡

Before the
development
of the Chemical
* Industry
After the
development
of the Chemical
Industry

•

Number Tumours ! A ...
I
¡
of
of the workers : ° y e r s !
Patients Bladder W o r k e r s
]
!

I

i

I

1861-1870
2600
\ 1871-1880 ¡ 3450 I —
i 1881-1890 i 4250 , 1
1891-1900
5500 i 4
/iqm
\xyui

1Qin
Iyiu

16

9650

10

I

Tumours of the bladder among men amounted in the
period 1901-1910 in Basle City to 16 out of 570 cases of tumour,
thus, 7.8 %. At Vienna, according to Gürtel, out of 16,673
tumours only 66 affected the bladder, or 0.39 %. Other
authors give the figure as 0.25 % and 0.76 %. At Frankfort,
on the other hand, tumours of the bladder, which appeared in
the same percentage among the population generally, amounted
to from 25 % to 30 % in a period of 23 years among workers
of the class with which we are concerned.
I t is certainly not necessary to accept the extreme
conclusions of Nassauer, who says that all workers in the
factories are exposed to the danger of tumour of the bladder ;
it is a proposition which may be true in theory, but which
fortunately is not so in practice. But the fact remains,
although it only affects a minority even among the workers
exposed to contact with aniline and similer substances.
A percentage would be difficult to arrive at in default
of a census of workers in the past. The percentage would
in any case be very remarkable, even if we accept the figure
of 177 cases given by Cursclimann, out of an average of 80,000
to 10,0000 workers.
A classification of the cases reported by different
physicians over the period 1895 to 1920 according to types
of tumour, age of patients, and period of contact with the
poisonous products, would give the following figures :—

„
, m
Types of Tumour.

i No. of Cases
¡
reported-

Papilloma
Fibroma
! Carcinoma
¡ Sarcoma
i Sarcocarcinoma
Cancer of the Bladder, Kidney, etc
!
Total
j Reported as Benign Tumours
' Reported as Malignant Tumours
Total

I
|

. . .

-.j
24
4I
4
6I
I 51
12
15
27 !

. . .

Tumours without specification
Grand Total

Types of Tumour.

¡ 10
. . .

88

i' Age of Patients.
30-40 41-50: Over 50

Begnign
Malignant
Xot specified

4
i 3
. 1
Total
Grand Total

10
4

11
ii
5

14

23
45

Although a tumour which is due to industrial causes
generally appears at a precocious period of life (before 40
years : Chimney-Sweeps, Miners etc.,) it must be admitted
that among workers in contact with aniline, tumours appear
especially after the age of 40. But it would be well to
remember in this connection that in such cases the action of
the poison develops very slowly and after a very long period.
It is more difficult to reply to the question what is the
lapse of time necessary for the appearence of the first symptoms
of tumour of the bladder. The data are very different and
contradictory. Most important of all, the date of the
engagement of the workers is not precisely known, and
indications given by the workers themselves have to be
accepted.
In many cases, especially in the past, the diagnosis was
made at a very late stage, as the worker had often had no
remarkable symptoms. Thus the following data are given
in regard to 52 Cases :—

Types of Tumour.

First Symptoms of
arnong \ v oiKers alter
2-5
6-10 11-15
li 2
•| years years years years
,i

1

Malignant
. . . .
Mixed
Not specified .
Totals . .

1
2

1
1

1

5
5

1

3
13

1
.>o

Tumour
wonting
16-30 Over 30
years years
i

5 |

2

1 1 —
17 1 3
23 | 5

In six cases it has been impossible to determine the period
of latent duration of the tumour.
As regards tumours there is no case which had not at least
10 years' incubation (in one case even 35 years); but on the
other hand there are cases which develop very early, especially
among those caused by benzidine (less than 3 years : Schwerin,
but other physicians say 8 and 12 years.) The period is
also very brief in the case of naphthylamine (5 years). 12 years
is indicated in the case of rubine and longer in the case
of fuchsine and of work in the acid-bottle department.
Equally interesting in practice is the question of the
diagnosis of tumour of the bladder among workers who
have left aniline factories. Although the number of such
cases is very limited, observations are nevertheless recorded
of tumours among workers who had been sent to other department or other factories because they had exhibited vesical
phenomena (cystitis). These workers have in most cases
come to the doctor for haematuria from two to eight years
afterwards, and some have had to be operated on.
In order to secure the most exact information possible
in the future, it will be necessary to make use of the following
Questionnaire prepared by Cursciimann : —

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.

QUESTIONXAIBE :
Christian Name and Surname.
Date of Birth.
Address.
Married or unmarried.
Cases of Carcinoma in the family.
Former illnesses.
Alcoholism.
Venereal diseases.
Previous poisonings.
Career (Nature and duration of occupations since
entering the Factory).
Date of entry into the Factory.
Department and period of employment.
With what substances has the patient worked ?

— 9 —
14. How many workers (that is, individual workers and
not the total number of workers at any one time)
have been employed in the Department during the
last 10 years ?
15. Duration of working day. •
16. Overtime.
17. Examination of Urine, result (Proof of colour).
18. Periodical Medical Examination.
19. Examination of Blood, and with what result.
20. Clinical History : First symptoms.
21. Evolution.
22. Diagnosis.
23. Treatment.
24. Operation ; Operator (Eeferring to any publications
of the Surgeon).
25. Seat and macroscopic description of the tumours.
26. Histology of the tumour.
27. Anatomical and Pathological Diagnosis.
28. Metastases.
29. Has the patient been able to resume his occupation ?
30. AThere and with what materials has the patient been
subsequently employed Ì
31. Relapse.
32. n a s this Eelapse been the subject of an operation ?
33. Did the Relapse shew any deviations from the original
tumour !
34. Have any Metastases been observed ?
35. Termination.
Date
Signature.
36. Remarks on the actual state of the disease and on its
subsequent evolution. Address ..

Aetiology.
AVhat are the products capable of engendering the morbid
form indicated ? The reply is not so simple as one might
think. As far as we know, it might be said that almost all
the products listed below, or at least the majority of them,
may he the cause of tumour of the bladder.
I t must be remembered that the worker is not always
exposed to the action of a single poisonous compound, even
in a single department of the factory, and that unfortunately
the details of the cases published do not furnish us with very
precise information on this subject.
In effect, the reporters limit themselves to citing the raw
material or final product without giving us exact information
as to the compounds handled by the worker.

— 10 —
' The result is that products well knoAvn to be inoffensive,
such as naphthol, have been, reported as causing malignant
diseases, whereas the origin should be attributed to intermediate or accessory products.
The following is a list Of the products which, either singly
or in association with other products, may cause tumour of
the bladder, according to the studies of different observers :
Mtrobenzene (Reim), nitrotoluene (Behn), aniline (Eehn,
Wendel,
Schedler.
Seyberth),
aniline
and
toluidine
(anonymous), aniline and naphthol (Eehn), aniline, benzol and
toluol (Lewin), aniline dyes (Bardenheure, Bard, Behn,
Seyberth, Leuenberger), fuchsine, rubine (Behn, Cesabianchi),
benzidine (Behn, anonymous), toluidine (Behn, Leichtenstern),
toluidine and benzidine (Strauss), naphthylamine (Behn,
Wendel, Schedler, Leichtenstern),
naphthol
(Posner),
naphthylamine and diphenylamine (Behn), phenylnaphthylamine (Behn), xylidine (Behn), cumidine (Behn). Mtro-dyes,
triphenylmethane, diphenylnaphthylmethane, acridine, ozazine
and thiobenzil have also been indicated.
If the enquiry of Reim limited itself to the indication
of fuchsine and naphthylamine only, Wendel in 1900 definitely
established that the suspected products, such as aniline,
toluidine, naphthylamine, etc., all belong to the aminocompounds, thus excluding the nitro-compounds.
Poisoning by the latter must be distinguished from
poisoning due to amino-compounds, inasmuch as the nitrocompounds are generally more poisonous in proportion as
the number of the nitro groups in the nucleus increases.
The researches of Leuenberger among workers handlinganiline dyes (Basle City) do not make it possible to give an
exact list of the products capable of provoking tumour.
I t seems however that the following may be the probable
cause :—
Safranine, dianisidine, dehydrothioxüine, Congo red, and
benzo-purpurine.
Experience proves that there is no immunity, and that
predisposition plays a great part. There are many factors
favourable to poisoning — lack of cleanliness, mal-nutrition,
alcoholism, excesses of every kind, damp weather, excessive
perspiration, etc.
Workers new to the trade, and
consequently working without precautions, with whom
large skin surfaces come in contact with the poisonous products,
are special hable. On other hand, workers remaining a long
time in the workshops are more exposed to the danger of
introducing by deglutition the products floating in the air.
Although the permeability of the skin by the products in
question is remarkable, it is certain that the older workers,
who are accustomed to take great care of their skins, show
a smaller number of cases of poisoning.

— 11 —

Technical Survey.
Let us examine more closely the nature and characteristics
of the products which have been indicated as the most probable
causes of the injuries reported.
Among the products of the illuminating gas industry, tar
is undoubtedly of great importance, and a still greater
importance has recently been acquired by its derivatives.
By means of distillation, coal forms two great classes of
products; light oils and heavy oils. From the light oils
proceed the benzols which, treated in columnar apparatus,
give the hydrocarbons of the aromatic series (benzene, toluene,
xylene, etc.).
Each of these bodies represents, in its turn, the starting
point of a series of bodies extensively used as raw materials,
especially in the dyeing industry. By nitration and reduction
of the above-mentionned carbides the amino-derivatives
(aniline, toluidine, xylidine) are obtained.
Benzene is transformed into nitrobenzene in cast-iron
apparatus, by the addition of a mixture of sulphuric acid and
nitric acid. The introduction of the same mixture in the
corresponding aromatic compounds produces nitrotoluene,
nitroxylene, etc. .
In order to transform the nitro-compounds into aminoderivatives, the aromatic compound is placed in .contact with
the hydrogen obtained by the reaction of a small quantity
of chlorhydric acid on iron shavings.
The simplest of the aromatic bases, aniline, may be
considered as derived either from benzol by substitution
of the amino group plus one atom of H (amiùobenzene), or
from ammoniac by exchange of one atom of H against the
phenyl group Cell-, (phenylamine). Since 1864, aniline
(amidobenzene, phenylamine CoHr.AzEb) has been prepared
by reduction of nitrobenzene in a columnar apparatus, with
cooling, etc., carefully avoiding a too powerful reaction, iron
shavings and 5 % chlorhydric acid being present. When the
reduction is complete, the aniline is distilled under steam,
and the reaction being accomplished, the product is alkalinized
by means of lime.
Toluidine and xylidine are obtained from nitrotoluene
and nitroxylene by an analogous process.
Among the homologues of aniline must be mentioned
the three toluidines CeH-^CHsXAzX») obtained by reduction
of the three nitrotoluenes : monoamines: toluidines (xylidines,
nitranilines, benzylamines, etc.) : diamines (phenylendiamine,
etc.).
Fuchsine was first prepared industrially in 1859. The
dyes of the rosaniline series are derived either from triphenylmethane, or from metolyldiphenylmethane. The first are
described as "para compounds" and are prepared by

— 12 —
oxydising a mixture of aniline and paratoluidine, or by
heating a mixture of nitrobenzene, aniline and toluidine,
with the addition of iron filings and chlorhydric acid. One
of the salts of pararosaniline and rosaniline is fuchsine
C20H20AZ3CI.

Formerly, the poisoning might have been attributed to
arsenic, in view of the method of preparation, for a mixture
of aniline and toluidine (Rotöl) was heated with an extremely
concentrated solution of arsenic acid. It is now prepared by
treating the aniline with formalin.
Naphthaline CioHs is a carbide discovered in 1820,
also obtained from coal tar and separated from the fractions
of the latter substance which reach a temperature of 180°200°. The products of substitution of naphthaline may be
mono, bi, etc. substituted derivatives.
The monosubstituted derivatives always exist in two isomeric forms
distinguished by the letters a and ?. The « naphtylamine
CioH;(AzH2) is obtained by heating « naphthol with
ammoniacal chloride of calcium or by reduction of the «
nitronaphthaline.
Isomeric ß CIOHTAZII» is
produced
by heating naphthol ¡i Avith ammonium sulphide in a current
of ammoniac, or in presence of ammoniacal chloride of zinc
Diphenyl, like benzene, is the fundamental carbide of an
important series of derivatives. By reduction of nitrobenzene
by means of iron, caustic soda being present, and passing
through the .intermediate products, azobenzol, etc., benzidine
is obtained.
Pathogeny.
The channels by which the poisonous products enter the
body are the respiratory organs (volatile products, for example
aniline), the alimentary canal (solid products, for example,
the paranitraniline), and the skin and mucous membrane
which are very permeable, even by the non-volatile aminocompounds. It is no doubt a question of small quantities
of the poisonous product, which must moreover apply their
action during a number of years and thus constitute in the
organism a quantity sufficient (accumulation ?) to engender the
tumour.
The local irritant action of these products is proved by
the frequent declarations of the workers, who often complain
of pains (strangury), and especially by the presence of ulcers
on the gland and prepuce. The alterations observed on the
skin (tumours) following on contact with the same products
must have a pathogeny analogous to that of the tumours
of the bladder, since they must be the consequence of the
excretion of the products in question through the skin along
with the perspiration {Brat Hirt).
I t is not possible at present to give the toxic equivalent
of these products. Experience has proved that certain

— 13 —
products in small doses under certain conditions give rise to
very grave lesions; others, even in strong doses, do not produce
any lesion. I t has in fact been known for a considerable time
that many workers, although exposed to the , action of
aniline and other products eliminated through the urinary
organs, have not shown any signs of vesical lesions. Other
substances must therefore be in question.
The toxicity of dyes derived from coal tar is also a very
complicated question. It is, in fact, often very difficult to
judge of the toxicity of dyes, especially as they are not
always pure, while experiments on animals are not decisive
and individual reaction is very different.
Pending positive results, it is desirable to establish very
exact statistics, which, as has been said, presents serious
difficulties. " Thus, for example, the hypothesis of Rehn that
tumours are more frequent in the preparation of fuchsine and
rubine, is not accepted, any more than the hypothesis which
indicates aniline as a very frequent cause of tumour of the
bladder. .
Leuenberger has arrived at the conclusion that the tumours
are due more especially to the action of the aromatic aminocompounds with one or more hydroxylated nucleii. I t is
therefore the intermediate products of the amino-compounds
which must be incriminated. During the passage through
the organism the amino-compounds must undergo a
hydrolysation, an indispensable condition for rendering the
products of excretion favourable to the production of tumours
in the urinary system.
Ktichenbecher has endeavoured to ascertain whether the
suspected products (aniline and its homologues, benzidine
and other derivatives of diamidophenol, naphthylamine a
and (3) really give rise to hydroxylated aromatic aminocompounds.
As the result of these researches Kuchenbecker
concluded that aniline and its homologues in free para position
give rise to hydroxylated aromatic amino-compounds, which
may, however, reach the bladder without dangerous action,
owing to their being combined with sulphuric acid.
In
the case of benzidine and naphthylamine (« and ß), on the
other hand, there is no production of hydroxylated aminocompounds. The hypothesis, therefore, that tumours of
the bladder are due to these products is only valid in certain
cases.
It is easy to prove that the products with which we are
concerned follow a law in their transformations within the
organism. This law holds good for the transformation of
nitro- into amino-compounds; but it is not yet proved as
regards other products. Although experiments in this matter
have given excellent results, the question is still open. A fairly
considerable part of these amino-compounds, and even aniline
itself, do not undergo oxydation in the organism, and are
eliminated without modification either through the urine or

— 14 —
through the respiratory organs (aniline). For this reason,
in cases of poisoning by aniline and nitrobenzene, analogous
final products — that is to say, ,? amidophenols — may be
distinguished in the urine. Intermediate products are also
partially distinguished. The toxic product is in both cases
the same — quinonimine. In the case of nitrobenzene, one
must also take into account the action of nitrophenol.
The intermediate products which may be distinguished
in the urine have been studied by KuclcenbecTcer, who has
also given a practical procedure for diagnosis (see page 18).
If he is confirmed, we shall be able to say :
1. What is the toxic substance.
2. What are the alterations produced in the organism.
3. What are the channels of entry into .the system.
Eesearches are still in progress with a view to ascertaining
whether, 'besides the hydrolysed products of excretion, the
final and intermediate' products of oxidation may also
engender tumours. It is certain that this holds good as
regards the toxic action, and especially as regards the action
exercised on the haemoglobin by the nitro-compounds of the
group hydroxylated in the organism before being rendered innocuous by etherification.
It follows that the position of the hydroxyl group is very
important.in the amino group and in the formation of the
bivalent phenols (introduction of the two
hydroxylated
groups) etc., inasmuch as the possibility of obtaining
compounds capable of producing quiñones and quinonimines
depends upon such position.
What becomes of the aromatic carbides is therefore still a
problem full of obscure points. This is the case, for example,
with the naphthylamine ß. The researches on this point will
be carried as far as possible. Very interesting also are the
experiments of Curschmann on phenylendiamine, tohiendiamine and paranitraniline, which produce alterations of the
vesical mucous membrane which disappear very quickly,
without leaving appreciable traces and without giving rise
to tumours.
Pathological Anatomy.
Only the tumours of the bladder due to aniline, the
tumours of the lung among the miners of Schneeberg, and
those caused by the X-Kays are properly neoplastic formations.
The other industrial lesions observed among chimneysweeps and workers handling tar, paraffin, pitch etc., on the
contrary, have no title to the qualification of tumours. They
are in fact tegumentary proliferations, which sometimes
appear as excrescences in which the cellular- elements never
lose their normal morphological character or their normal
disposition.

— 15 —
There are very few autopsies or histological examinations
of cases of aniline tumours which are complete and which
make it possible to classify the observations collected. The
anatomo-pathological or histological diagnosis is sometimes
so uncertain that a precise classification of the tumours is
impossible.
Their classification as malignant and benign is too simple.
As has been seen, the malignant are very much more
frequent than the benign tumours.
Out of 88 cases
studied, 28 benign tumours have been distinguished, as
against 50 malignant and 10 not specified.
The seat of the tumours is very different : on the posterior
or anterior segment of the bladder, or in the neck of the
bladder, most often on the inferior segment and preferably
near the neck, so that the urethra is sometimes obliteratedThe tumour rarely has its seat below the meatus of the ureter.
Cases have been reported in which the Avhole of the bladder
was occupied by neoplastic masses (Papillomatosis).
The papillomata do not sensibly alter the mucous
membrane. They are very liable to relapse, do not produce
metastases, and are not always fatal so long as they retain
their original character. If they extend, they may prevent
the emmission of the urine, with all its well-known consequences.
In consequence of the fragility of the vessels and the form
of their villosities the tumour readily bleeds, whence the
serious and dangerous haemorrhages well-known among
aniline workers.
Carcinoma (or adenocarcinoma) generally takes the form
of a flattened mass, infiltrating the walls, extending over a
greater or lesser segment of the bladder wall, and affecting
also the mucous membrane and muscular tissues. Very often
the cancer is superimposed on a microscopic or macroscopic
papillomatosis of the vesical mucous membrane, and there
has been much discussion for and against the metaplasia of
the papilloma into a carcinoma.
It is a question, therefore, either of typical epithelial tumours (papillary tumours and adenoma), or of atypical tumours
(epithelioma). The papillary form is frequently observed,
but it is not always a benign form of local evolution capable
of transforming itself into atypical epithelioma.
Proofs of metaplasia are rare, but it cannot be excluded,
at least in certain cases. There are numerous cases, however,
especially since the introduction of the periodical examination
of workers (cystoscopy 3 ), of papilloma allowing of early
treatment.
(1 ) Cystoscopy is the examination by the eye of the interior of the bladder
which is not normally visible without the assistance of special instruments.
The first attempts of Bozzini in 1805 were carried to completion by Nitze
(1875), who invented the cystoscope with interior lighting. A tube carried
iuto the bladder through the urethra enables the eye of the physician t o

— 16 —
The tumours, especially the epithelial tumours, are accompanied at an early stage by cystitis and nephritis, often causing
death before the tumour has had time to reach the
neighbouring parts and to become general. In these cases,
metastases are found, into the lymphatic vessels, and even
into the wall of the abdomen. Only one case is known of
metastasis to the liver and lungs (examination, however,
proved that the vesical mucous membrane was intact).
ÎJesabianchi reports also two cases of adenocarcinoma of the
gall bladder in two workmen in contact with fuchsine (primary
tumours?)
I t is certain, therefore, that in the whole of the urinary
system the constant action over a number of years
of hydroxylated aromatic amino-compounds, exercised on the
conjunctive tissue or the epithelium, is capable of exciting
proliferation developing as infiltration of the urinary passages
by an atypical growth of the epithelium of the mucous membrane, with formation of microscopic and macroscopic papilloma, the development of granulated tumours, true carcinoma, adenocarcinoma, sarcoma, etc.
The majority of the tumours have an extraordinary
polymorphism, but it may be admitted that all the tumours
arise from alterations of pre-cancerous tissue, as is observed
in the case of tumours due to X-rays, etc.
Other authors consider that the histogenesis is still obscure,
and that the relationship admitted in clinical practice (aniline
poisoning = inflammation = tumour of the bladder) is not
yet established.
Practice has proved that tumours often appear several
years after the cessation of work. The same fact has been
observed in the case of tumours and dermatitis caused by
X-rays, and it would appear that in such cases the tumours
are formed by a processus of inflammation and chronic
dégénérescence in the sub-epithelial conjunctive tissue (Bibbet).
Symptoms.
There is very little information on this subject, but it
may be said that the clinical symptoms are the well recognized
symptoms of tumour of the bladder.
The cases already known without symptoms necessitate
the regular practice of cystoscopy, so as to permit of an early
diagnosis, among the workers in the suspected occupations.
In all cases of haematuria, it will be absolutely necessary
to subject the worker to a very careful interrogation in order
receive the luminous rays proceeding from the cavity by means of a system
of mirrors, lenses or prisms. The interior of the cavity is lighted by special
systems of illumination placed in the tube introduced into the cavity and
utilising either an exterior or an artificial (electric) source of light.
Although the optical systems of cystoscopes with interior lighting are
somewhat different, it may, nevertheless, be said that all the apparatus
is based on the same principle.

— 17 —
to make sure that he has not been in contact in the past with
amino-compounds. This is necessitated by the fact that cases
of haematuria among workers who had left the factory two or
even five years previously have been subjected to a systematic
treatment due to an erroneous diagnosis of stone in the bladder,
urogenital tuberculosis, etc.
If the practitioner carefully interrogates the worker he
will easily be able to establish whether he has suffered from
haematuria in the past.
Generally, the disease shows itself by hcematuria, which
comes on suddenly without premonitory symptoms. The
haematuria is very capricious and may even appear once
only. It is accompanied by other symptoms, varying
according to the seat of the tumour in the bladder. Pains
are rare, more often the patient consults the practitioner
for trouble in passing water : dysuria and stranguria.
Formerly patients usually called in the practitioner when
the tumour was already in a very advanced stage, and
treatment was almost impossible.
Before proceeding further, it should be stated that bladder
irritation, although it is a characteristic of this form of
industrial disease, is not always a premonitory symptom of
the tumours. It is prudent and desirable, however, to follow
it with attention. Bladder irritation which precedes by a
considerable time the more serious alterations due to the
action of amino-compounds, may appear, disappear and reappear, and even be cured without leaving noticeable traces.
In other cases, the tumour develops without the slightest
symptom, and the attention of the relations or comrades of
the patient may only be attracted by the anaemia or cachexy
accompanying the tumour in an advanced state of development.
Cystoscopical examination now enables early diagnosis
to be made and treatment given, so that it is almost
impossible for serious cases to escape detection. It is only
in the case of widely extended tumours or metastases that
complications may arise, which characterise the final stage
of the disease.
Diagnosis.
It is absolutely necessary to use all the means at the
disposal of practitioners for making early diagnosis,
especially in cases where symptoms are absent. It is
necessary also to obtain information on the past of the worker
in order to trace a haematuria or the slightest symptoms of
cystitis. Many extremely slight irritations of the bladder
have been discovered by means of cystoscopical examination.
In the case of workers AVIIO have ceased to be in contact
with aniline for a long time, it is necessary to be prudent
before diagnosing vesical calculus, haematuria or urogenital
tuberculosis.

— 18 —
An early diagnosis is facilitated by the periodical
examination of the Avorkers (urine, cystoscopy). Cystoscopy
should be practised with every worker who shows suspicious
symptoms, and even repeated several times a month as long
as these symptoms persist. It may be thought that such an
examination Avili produce a bad impression on the workers;
experience shows that this fear is without foundation,
especially as the test is free and not compulsory, although
strongly recommended by the industrial physician to workers
already informed of the danger which threatens them.
The examination of urine will be made on the water last
passed in the presence of the doctor, and its object will
be the microscopic search for the presence of red globules
(terminal haematuria). This is not a specific symptom, but
it is certain that red globules appear in the urine at a very
early period, even when the tumour is not yet capable of
diagnosis by the cystoscope.
Schwerin has sought to demonstrate the presence of
substances capable of engendering tumours, particularly
among workers engaged in handling acid-bottles. The
results obtained are truly striking, the more so as the quantity
of products introduced into the organism is so small that
the urine cannot possibly contain perceptible traces of the
products of transformation. Kuchenbecker, following an
indirect line, has sought for a substance derived from the
amino-aromatic group, the action of which as a colouring
agent would make it possible to discover the amino-compound
present in the urine. By combining the amino-diazotised
compound with a derivative of amino-naphthol-sulphate
2-5-7 (phenylic acid 2-5-7) he has obtained a colour which
tints cotton with the shades characteristic of each incriminated
substance. According to the intensity of the shades it is
possible to judge the greater or lesser quantity of the substances present in the urine. It is necessary in order to avoid
mistakes that the phenylic acid 2-5-7 should not contain any
non-phenylated acids. Benzoyle acid 2-5-7 may also be used.
The following is the method :—
50 cubic cms. of urine is cooled in ice and reduced by
means of ehlorhydric acid until it attains a slight congo red
reaction. Four drops of concentrated ehlorhydric acid are
added and a sufficient quantity of double-normal solution
of nitrite (1-10 drops) to show an excess of nitrite by reaction
on potassium iodide paper and starch. Diazotization is
effected by means of 1 cubic cm. of- soda salt of phenyleacid
2-5-7 at 1 %, 3 cubic cms. of a solution of soda, 1 part to 10,
and a sufficient quantity of water to make up 100 parts.
A small piece of cotton cloth is introduced into this solution;
the whole is boiled; the cloth is allowed to remain ten minutes
in the hot liquid, and then washed in cold water. With a
normal urine the liquid retains its colour or becomes slightly
red. If the urine contains amino-aromatic compounds it

— 19 —
takes a distinctly pink or even violet colour, which also
tints the cotton.
By this method the urine of workers dealing with fuchsine,
and particulary those preparing benzidine and naphthylamine,
has been periodically examined. Substances capable of
diazotation have thus been traced in large quantities among
workers exposed to the inhalation of dusts. The efficacy
of the means of prevention adopted has been confirmed by
such examination, for the quantity of products in the urine
has diminished and even disappeared. For the purpose
of obtaining exact data as to the value of the quantities
traced, a solution of naphthionate is used as standard. Urine
very rich in substances capable of diazotation gives a colour
the intensity of which is comparable to that of a solution
of 1:20,000 of naphthionate ; urine with a small quantity,
a colour comparable to a solution of 1 : 100,000, and, if it
contains only slight traces, to a solution of 1 : 200,000. The
reaction of Kuchenbecker is sufficiently perceptible.
The examination of the blood, of the respiratory organs,
etc., gives no indications of any value for the purposes of
diagnosis.
Prognosis.
Prognosis should be very reserved even for benignant
tumours (papilloma), having regard to their liability to relapse
even after a few months. Relapses after a long period are
even more frequent (six to eleven years after treatment).
There are certainly cases of cure, but only after operation.
One must also bear in mind the possibility of a metaplasia
of papilloma into malignant tumours. It may generally be
said that death will supervene in from six months to 1 % years
after the first symptoms.. The prognosis is infallible in cases
of malignant tumours, for they have all a fatal termination
even if operated upon (eleven deaths in sixteen cases).
Exceptions are known, but they are very rare. Possibly
.early treatment will improve the statistics.
Treatment.
The success of the treatment is naturally in very close
relation to the precocity of the diagnosis.
There is legitimate ground for confidence in treatment for
malignant tumours, inasmuch as a return to capacity for work
and a good state of health is thereby assured, sometimes for a
considerable number of years.
If the papillomata are not too greatly developed and
especially if they are in a favourable position, the preference
is now for endovesical treatment by destroying the tumour
by electro-coagulation under the direction of the cystoscope.
The method is a particularly intense diathermic process
obtained by a current of high frequency,which is very useful

— 20 —

for the complete destruction, not only of the papillomata
but also of their basis, such destruction being carried out
much better and Avith much more certainty by this means
than by cystotomic treatment. The diathermic method
produces little or no pain; it can be applied in the consulting
room; it does not favour the reproduction of the tumour;
it obviates surgical treatment and permits of repetition if
necessary. This method is also indicated for stopping the
repeated and dangerous haematurias produced by the
papillomata, and although counter indicated for the treatment
of the malignant forms, it is a good palliative in cases of
relapse after surgical treatment.
Very recent observations, however, have drawn attention
to the necessity for the patient treatedwith the high frequency
current not to leave the hospital immediately, as want of
attention is often the cause of serious and sometimes fatal
haemorrhages.
The treatment of malignant cases is the province of the
surgeon. In general, the results are not very favourable.
66% of the persons operated upon have died, and many of
the survivors have speedily suffered relapses.
As a medical treatment in the case of tumours in which
direct treatment is impossible , washing of the bladder has
been proposed (with solutions of adrenalin, gelatin, antipyrin,
or resorcin, 1 to 5%.) The last-named is useful in cases of
haematuria. Lately collargol in solution of 20% (6-15 cubic
cms. to be injected in the bladder under anaesthaesia) has
also been proposed, one hour later washing with oxicyanide
of mercury ('/¿-'A-, per 3,000), especially in cases with pains
and haematuria.
Prophylaxis.
I t must be said at once that the precautions taken in
the factories producing amino-compounds, after the researches
and reports of the obsei'A^ers, have yielded excellent results.
t i t r a t i o n and reduction particularly are now carried out
exclusivly by mechanical processes in closed and wellA^entilated apparatuses. The transport of the masses is
carried out either under compressed air or in a vacuum.
The efficacy of these precautions is proAred by the following
fact : out of the twenty-eight cases reported since 1913, only
one took place in the Höchste Farbwerke.
It might have been feared that the development of factories
producing aniline dyes, and particularly aromatic bases, would
have increased the number of tumours of the bladder.
The last word has not been said on this subject, for the long
period of incubation necessary before the appearance of the
first symptoms of malignant tumours has been indicated.
But it is to be hoped that the application of the precautions
summarised below will suppress the serious form of industrial
disease in question.

— 21 —
The prophylactic measures are as follows :—
Well-ventilated work-rooms with absorption of vitiated
air and introduction of fresh and, if necessary, cooled air;
rigorous cleanliness of floors and walls; absorption of dust.
Well-closed apparatus, including the apparatus for the
mechanical transport of materials; local absorption of dusts
and vapours.
Beduced working hours; adoption of shifts, in view of
the fact that a very short stay in the incriminated section
is sufficient to produce tumours.
Working clothes, always strictly clean, closed at the neck
and wrists ; gloves and shoes.
Daily bath, careful washing before going to the refectory
or leaving the factory.
Medical examination of workers, both on engagement,
and periodically; selection of healthy workers; periodical
instructions by the medical officer and director of the section.
The periodical examination will include examination of urine
as previously indicated.
Compulsory notification of haematuria and tumours of
the bladder among workers in factories producing aminocompounds.(')
Distribution of milk; prohibition of smoking and
consumption of alcoholic liquors; assistance to the worker
in procuring nourishing food.
Legislation.
Eegulation of labour in connection with nitro and aminocompounds only exists in Prussia, in which country regulations
were introduced by the circular of the-Ministry of Commerce
and Industry of the 21st October, 1911. England has
introduced the regulation of the manufacture of explosives
based on nitro and amino-compounds (Eegulation 30th
December 1908).
Conclusions.

Although it is not possible at present to formulate definite
conclusions, inasmuch as the problem still presents too many
lacunae and obscure points, it may, nevertheless, be said
that :—
(1) There is a close connection between the manipulation
of certain amino-compound products and the existence of
tumours of the bladder.
(1) In a recent report (1921) concerning compulsory notification of industrial diseases, it is proposed to add to the list now in force in different
countries tumours of the bladder in workers who have 10 years or more
previously left work in the explosive and aniline dye industries.

I

— 22 —

(2) The number of cases of tumour of the bladder proved
to have occurred among workers in contact with aminocompounds is certainly small. It must be concluded from
this that the individual factor plays a great part in the
pathology of the disease, seeing that the patients constitute
a small minority.
(3) Action of long duration is necessary to produce tumours
of the bladder. There is no relation, however, between their
occurrence and the duration of employment.
(4) It is not possible to determine the substance capable
of engendering tumours. At present one can go no further
than to incriminate the amino-compounds, and particularly
benzidine and /maphthylamine.
(5) The same substance may produce either simple cystitis,
or benignant or malignant tumours.
(ii) Hygienic precautions, strictly applied, will assure at
the end of a few years the diminution and even the
disappearance of the disease.
(7) It is, therefore, absolutely necessary that in factories
in which workers are exposed to the dangerous action of
aromatic bases, the most rigorous application of hygienic
precautions should be required.
(8) Meanwhile, it is desirable that the industries concerned
should continue to carry on researches with a view to
ascertaining the dangerous substance, and that the statistical
particulars in every case should be very precise and should
follow the proposed questionnaire.

BIBLIOGEAPHY.
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Vierteljahrsh. f. gerichtl. Mediz. 1898.
Bardenheure. Verhandl. d. Gesell, f. Chir, 1904.
Casper. 2. Congress d. Gesell, f. Urologie Berlin 1909. Ordin.
Gener. Versamml. Berliner Urolog. Gesell. 28-1-1913.
(,'urschmann. Statist. Erhebungen über Blasentumoren bei
Arbeitern in den ehem. Industrie.— Ztbl. f. Gew. Hyg. 1920
iJ". 8-9 =V.2. and Congres Int. Maladies Professionnelles,
Bruxelles 1910.
Grandhomme.
"Fuchsin" in Eulenb. Handwort. d. öff.
Gesundheitspfl. Berlin 1882.
— Die Fabriken des A. G. Farbwerke A'ormals Meister,
Lucius & Brunig in sanit. u. soziale Beziehung 1896.
Conferenz d. Fabrikärzte d. ehem. Industrie Leipzig 1913.
J. Israel. Ordin. Gen. Versamml. Berliner Urolog. Gesell.
28-1-13.
Leichstenstern. Harnblasenentzündungen u. - geschwülste
b. Arbeitern in Farbfabriken.— Deut, mediz. Woch. 1898.
H.45.

— 23 —

Leuenberger S. G. Die unter dem Einfluss der syntet.
Farbenindustrie beobacht. Geschwülstentwicklung. —
Beitr. z. klin. Chir. 1912 S. 208.
Leymann.
Ueber die Erkrankungenverhältn.
in einer
Anilinfarbenfabrik. — Vierteljahr, f. gerichtl. Mediz. —
Concordia 1910 H. 17.
Leivin A. Blasengeschwülste b. Arbeitern in Anilinfabriken.—
Z'tsch. f. Urologie 1913 Bd. VII H. 4.
Nassauer. Über bösartige Blasengeschwülste b. Arbeitern
d. organ. Grossindustrie. Diss. Frankfurt a/M. 1919.—
Ztsch. f. angew. Chemie Jhg. 39 (1919) S. 333.
Cesabianchi. Contributo alla conoscenza dei tumori di
origine professionale. — Bamazzini-Anno V. ìsT. 10-12.
Posner. Der Urogenitalkrebs in seiner Bedeutung für das
Krebs-problem. — Ztsch. f. Krebsforsch. 1904 Bd. 1.
Rehn. Blasengeschwülste bei Fuchsinarbeitern. — Arch. f.
klin. Chir. 1895 Bd. 50.
— Weitere Erfahrungen über Blasengeschw. bei Farbarbeitern. — Verhandl. d. Deut. Gesell, f. Chir. 1904S. 231.
— Harnblasengeschw b..Anilinarbeitern. — f. Chir: 1905 S. 231.
— Blasenerkrankungen bei Anilinarbeitern. — f. Chir. 1906
S. 313.
Schedler. Zur Kasuistik der Blasentumoren bei Farbarbeitern
Diss. Basel 1905.
Schiverin. Blasengeschwülste. — Ztbl. f. Gew. Hyg. 1920 S.64.
Seyberth. Blasengeschwülste b. Anilinarbeitern. — Munch.
med. W. 1907 H. 32.
Strauss. Blasengeschwülste b. Anilinarbeitern. — Verhandl. d.
Deut. Gesell, f. Chir. 1904 S. 237.
Wendel. ' Zu der Lehre von den Blasengeschwülste.
Grenzgebiete 1900. G. 15.
Zuckerkandl. Blasengeschwülste. — Verhandl. d. Deut. Gesell.
für Urologie Berlin 1909. S. 391.

PATHOGENY.

Adler. Wirkung u. Schicksal des Benzidins im Tierkörper. —
Arch. f. exp. Pathol. 1908 Bd. 58 S. 1666.
Bachfeld. Gewerbehyg. Erfahrungen über die Giftigkeit der
Teerfarben. — Ztbl. f. Gew. Hyg. 1920 H. 7.
Engel. Über das Schicksal des Naphtylamines im Organismus
des Hundes. — Ztbl. f. Gew. Hyg. 1920 H. 5.
Keubner W. Ueber das Wesen der akute Mtrobenzol- u.
Anilinvergiftung. — Ztbl. f. Gew. Hyg. 1914 H.12.
Kuchenbecker. A. Nachweis aromat. Amidoverbind. im Harn.
— Ztbl. f. Gewerbehyg. H. 1.— 1920.
— Ueber die Umwandlung aromat. Amidoverbindung im
Tierkörper. — Ztbl. f. Gew. Hyg. 1920 H.4.

— 24 —

Mueller R. Ueber die Einwirkungen des Anilins u. des
Dimethylanilins auf das Froschherz. — Ztbl. f. Gew. Hyg.
1916 H. 8.
— Ueber die Permeabilität der roten Blutkörperschen f.
einige Amino -u. Xitroderivate des Benzols.—Ztbl.f. Gew.
Hyg. 1914 H.8.
Oppenheimer. Ueber die bei den Arbeitern ehem. Betriebe
beobacht. Geschwülste d. Harnapparates u. deren
Beziehung z. Geschwülstepathogenese. — Muench. med.
Wochen. 1920 H. 1.
TREATMENT.

Roch A. Behandlung der Blasenpapillons.—Prag. med. Woch.
1913 H.51.
Oppenheimer R.
Zur Erkennung u. Behandlung der
Blasengeschw. der Anilinarbeiter. — Ztbl.f. Gew. Hyg.
1920 S. 105 u. Muench. med. Woch. 1920 H. I.
Rubrums H. Die Koagulatlonsbehandl. der Blasengeschw.
— Prag. med. Woch. 1913 H.51.
Schneider C. Ein Pali v. starker Nachblutung nach Operation
eines Blasenpapillons mittels Hochfrequenzströmen. — Ztbl.
f. Tirol. 1913 H. 7.
Sigurtà G. B. La elettro-coagulazione dei papilloni della
vescica. — Soc. Lomb. Scienze mediche e biolog. Milano
1916.

— 25 —
STUDIES AND REPORTS
already Issued
Where the English or French text of a Report has not yet been published it
will be issued at a later date.

Series A.
N° 1.

T H E AGREEMENT

BETWEEN

THE SPANISH

WORKERS'

ORGANI-

SATIONS, issued on September 25th 1920. French and English.
"

2.

T H E DISPUTE

UNION

IN

THE METAL

CONTROL

INDUSTRY

OF INDUSTRY,

issued

IN

ITALY.

TRADE

on September

25th

1920. French and English.
"

3.

ANNUAL

MEETING

OF

THE TRADES

UNION

CONGRESS

1920,

issued on October 4th 1920. French and English.
"

4.

INTERNATIONAL

CONGRESS

O F WORKERS

IN

THE FOOD AND

DRINK TRADES, issued on October 11th 1920. French and
English.
"

5.

T H E BRITISH GOVERNMENT AND THE MINERS' FEDERATION OF
GREAT BRITAIN. CONFERENCE BETWEEN SIR ROBERT HORNE

AND

THE MINERS'

FEDERATION,

issued

on

October

11th

1920. French and English.
"

6.

T H E CONGRESS OF THE LABOUR

AND SOCIALIST INTERNATIONAL,

issued on October 1+th 1920. French and English.
"

7.

T H E MINERS' INTERNATIONAL CONGRESS, issued on October

19th

1920. French and English.
"

8.

T H E INTERNATIONAL

LABOUR

ORGANISATION.

A

COMPARISON,

issued on October 21st 1920. French and English.
"

9.

T H E INTERNATIONAL

CONGRESS OF METAL

WORKERS, issued on

October 22nd 1920. French and English.
" 10.

T H E BRITISH GOVERNMENT AND THE MINERS' FEDERATION OF
GREAT
BRITAIN.
CONFERENCE
BETWEEN
THE
GOVERNMENT AND THE TRIPLE INDUSTRIAL
ALLIANCE, ÍSSUED ON

"11.

T H E DISPUTE IN THE METAL INDUSTRY IN ITALY. TRADE UNION

October 26th 1920. French and Englisli.
CONTROL OF INDUSTRY. (Second part)
ber 4th 1920. French and English.
" 12.

issued

on Novem-

T H E FOURTH INTERNATIONAL CONGRESS OF BOOKBINDERS,

issued

on November 26th 1920. French and English.
" 13.

T H E MINERS' STRIKE IN GREAT BRITAIN, issued on December 21st

" 14.

T H E X V t h CONGRESS OF T H E GENERAL CONFEDERATION OF
LABOUR (CONFEDERATION GÉNÉRALE DU TRAVAIL) held at Orléans

1920.

French and English.

the 27th September to the 2nd October 1920, issued on
December 23rd 1920. French and English.
" 15.

T H E INTERNATIONAL CONGRESS OF GENERAL FACTORY

WORKERS,

issued on January 24th 1921. French and English.
" 16.

TENDENCIES OF EUROPEAN LABOUR LEGISLATION SINCE THE WAR,

" 17.

T H E GROWTH

issued on February 11th 1921. English
OF TRADE

UNIONISM

only.

DURING

THE TEN YEARS

1910-1919, issued on February 16th 1921. English

and French.

— 26 —
Series B
N° 1.

COAL

PRODUCTION

IN THE RUHR

DISTRICT.

Enquiry

by

the

International Labour Office, end of May 1920, issued on September 1st 1920. French and English.
" 2.

PAPERS RELATING TO SCHEMES
TION FOR THE DISTRIBUTION

OF INTERNATIONAL ORGANISAOF RAW MATERIALS AND FOOD

"

T H E CONDITIONS OF LABOUR AND PRODUCTION IN THE UPPER SILESIAN

STUFFS, issued on October 5th. 1920. French and English.
3.

COALFIELD, issued on December 10th 1920. French and English.
" 4.

T H E SOCIALISATION OF COAL MINES IN GERMANY, issued on January

" 5.

T H E ESSEN

25th 1921. French and English:
MEMORANDUM

ON THE SOCIALISATION

OF THE COAL

MINES IN GERMANY (6 Nov. 20), issued on 28th January 1921.
French and English.
" 6.

WORKS COUNCILS IN GERMANY, issued on January 29th 1921, French

and

English
Series C.

N° 1.

BRITISH

LEGISLATION

ON UNEMPLOYMENT

INSURANCE,

issued

on October 26th 1920. French and English.
" 2.

GOVERNMENT ACTION I N DEALING WITH UNEMPLOYMENT IN ITALY,

" 3.

T H E BULGARIAN

issued on October 27th 1920. French and English.
LAW ON COMPULSORY

LABOUR, issued

on

No-

vember 4th 1920. French and English.
" 4.

T H E ACTION

OF THE SWISS

GOVERNMENT

IN

DEALING

WITH

UNEMPLOYMENT, issued on November 13th 1920. French and
English.
5.

L'ORGANISATION DE L'ASSURANCE-CHÔMAGE E T DU PLACEMENT DES

TRAVAILLEURS

French

EN FRANCE,

issued

on February

21th 1920.

only.
Series D.

N° 1.

STAFF REGULATIONS ON THE FRENCH RAILWAYS,

issued

on

Sep-

(Denmark

and

tember 4th 1920. French and English.
Series H.
N° 1.

CONSUMERS'

CO-OPERATIVE

SOCIETIES

IN

Sweden), issued on September 8th 1920.
" 2.

SEVENTH

CONGRESS

OF

THE BELGIAN

1919

French and English.
CO-OPERATIVE

OFFICE,

issued on September 25th. 1920. French and English.
Series K.
N° 1.

F I R S T INTERNATIONAL
CONGRESS OF
AFFILIATED TO THE INTERNATIONAL

LANDWORKERS'
UNIONS
FEDERATION OF TRADE

UNIONS, issued on November, 1920. French and English.
" 2.

AGRARIAN CONDITIONS IN SPAIN, issued

on November

10th 1920.

French and English.
" 3.

SMALL HOLDINGS IN SCOTLAND, issued on November

12th

1920.

French and English.
" 4.

T H E EIGHT-HOUR

DAY IN ITALIAN AGRICULTURE, issued on De-

cember 10th 1920. French and English.
" 5.

L A JOURNÉE DE HUIT HEURES DES TRAVAILLEURS AGRICOLES
DEVANT LA CHAMBRE FRANÇAISE, issued on February 10th. 1921.

French

only.

i

I

ERRATUM
P a p e . 6 , line 3 1 : for 10,0000, fread< 100,000,
,,

7, second table, third column,*-for .">, read ' J .

,,

9, line 2 : for the total number of irorkers at any one time,
read fvil-time
irorkers.

., 11, line 41 : for

(Y,IL((,HH)(AZ:N:¡),

,, 12, line r>: delete

»

CSMHS-.A^OI.

read CV,H4(('H3)(A!!H¿).