Good morning, we'll get underway. Dr. Ken Lankin. Hello, good morning and welcome back to Center City, Philadelphia. How many people are from outside the area? Good, all right. Okay. I wanted to introduce Dr. Curtis Cummings. To those of you who might not know him, Dr. Cummings is currently serving in the Federal Occupational Health System. He also has a faculty appointment at the Drexel School of Public Health and is a retired Navy captain and has vast experience in industrial occupational medicine. I actually had the honor to follow Dr. Cummings with an assignment at the Naval Shipyard in Philadelphia. It's truly full circle being on the same podium with Curtis. With that said, I'll let you take over from here and I might be back just for a little bit of color commentary, but please go ahead. Thanks. What I thought you would do is a couple slides, I'll show you. Here, we'll get to that. Okay, go Navy. I didn't expect necessarily in my career to get directly involved in both this hour's topics. My first assignment on active duty, Ken and I both had full active duty careers, was at a location that definitely used explosives and chemicals related to what we're going to be covering now. We grew up with these industries near us or our parents did, although factories have almost entirely moved on. I have nothing to disclose other than I've been interested in explosives and reactive nitrates since back then. We natives are aware of corporations that built this city and region, not always aware of the Ock Health history, even when we went here to med school, as I did. Our local medical community, in my opinion, still under appreciates this, not underrated, under appreciated. Ock Med's not been strong in the medical schools except out at UPenn, as stated in other sessions already this time, very strong there and nowhere else. My med school, Jefferson, had one Ock Health physician when I arrived in the 70s. He was already sick. He died the next year. I had no mentors, no real guidance. I would mention my interest in this field and not only classmates, but faculty would look at me and say, oh, what's that? We were taught nothing. It's better now. It should be better. We know the DuPont Corporation that began by manufacturing explosives. E.I. DuPont was a student of the great French chemist Antoine Lavoisier and a refugee of the French Revolution and came here, set up along the Brandywine River. To me, it's just a creek, as we pronounce C-R-E-E-K. Near here, he made charcoal from local willow trees and imported up to Delaware, past what's now Wilmington, the sulfur and saltpeter that he needed, and bought this former cotton mill and converted it into the first U.S. powder mill to produce high-quality gunpowder. About 45 minutes from here, take a ride with all the time you don't have this conference. It used water power to turn imported French water wheels and turbines. Saltpeter, this version of it, was an industrial-grade potassium nitrate. They refined it nearby. This was 1802. In 1804, it made and sold 39,000 pounds of gunpowder, and by the next year, it had tripled that amount. The U.S. government and the War of 1812 increased demand and profits, so DuPont expanded and expanded and did very well. Just downstream to what became the Hagley Yards, you can visit now, and there's a museum. After war's national development and use by sportsmen drove increased demand, gunpowder invented in China over 1,000 years ago. There are a couple of valid equations. This is one of several. This is pretty simple and pretty well explains it, and the Chinese figured this out on their own. Nitrate, sulfur, and charcoal, they knew, and a couple of KNO3s and sulfur and some carbon produces the energy you want and those byproducts. This is a low explosive. It burns quickly. You'd think firing a bullet or a small projectile is an explosion. No, that's actually a rapid cook-off or just a very rapid burn. You don't always want it to detonate. That's a high explosive, and DuPont made those later also. Similar ingredients, different proportions, and mistakes with either one caused explosions that you did not want. Nitrate's the oxidizer. For guns, it's KNO3. Charcoal is a fuel, not pure carbon usually, but partially combusted cellulose, other ways to do it. Sulfur also fuel. They lower the ignition temperature, and that works on the rate of combustion however you want that. Blasting powder, for example, is a high explosive, more sulfur and maybe sodium nitrate. In a gun, we don't want that. It'll blow the gun up. The DuPonts and their workers lived in communities right nearby that mill and right by the Hagley Yards and everyone knew it was dangerous. Ingredients were mixed wet, ground to a paste, then pushed through a mesh to form granules, and the granules, when they were dried, now they were dangerous, pressed into blocks, milled into a powder, and our references at the end have a lot more detail than that that well, being interested in this field, I thought it was really cool. They were famous for emphasizing safety and quality, and they did do better than most to prevent sparks, no metal in shoes. Your typical sole of a shoe would be tacked on with metal. They didn't allow that. They wrapped wagon wheels and horseshoes in leather, and it worked to some degree, and there were disastrous fatal explosions. In August 1915, the Pounding Mill, eight workers killed. I like this bit of artwork from the Library of Congress. Before even this one, in 1818, one of their worst ones killed 36 workers and leveled five buildings attributed to a foreman's drinking, so they banned alcohol and carousing and bad behavior on site, which usually worked, but this great conflagration in 1950 killed over 50 people, and they report a total of 288 significant explosions, killing over 200 until the First World War. They expanded outside this region into many states and with new products such as blasting powders, powders for heavy artillery, similar safety risks, similar health effects such as these. They weren't worried about the health effects. The company wasn't. The workers weren't. They were worried about getting blown up, damaging limbs, spines, those kinds of things. Understandable, but these are not benign substances. Brimstone, that's pure sulfur, maybe even in liquid form. Can be flammable, combust or burn them, you get sulfur oxides, we know about those. Charcoal, it's an irritant, and it's hard to get the pure carbon, so it's going to contain, among other things, polycyclic aromatic hydrocarbons, carcinogens. Fine dust, that's flammable or explosive. Nitrates, all of them. DuPont literature states, even today, that the nitrates have a risk of, quote, cyanosis. I think what they mean is a methemoglobinemia we know about, and respirators should be worn around all these, and of course there were none, and no engineering controls or IH. Going ahead decades, the Kearney's Point plant in Salem County, New Jersey, began as an explosive facility in 1892 for a less smoking gunpowder, and it really ramped up for World War I, and they named it the Chambers Works. You might remember. Now, that I've heard of. After that war, DuPont diversified into other chemical manufacture, much of it here, this old image. There's the Delaware Memorial Bridge carrying Interstate 295 from New Jersey into Delaware, which here is on the left. It was about two square miles then. Its active facility is now much smaller, much of it closed and renamed as DuPont has spun off its pieces. The brownfields, part of that site, could serve as a museum of toxicology, of persistent chemicals, because all these were produced there. Radioisotopes for the nuclear industry, leaded gasoline, carcinogenic dyes, including beta-naphthylamine. I'll get back to that next topic. Paraphenylene diamine to produce another of their big products, Kevlar, Freon's chloroprene to make neoprene, and PFAS, which produces groundwater there and elsewhere. So there are all these paradoxes in their history, including the first industrial safety lab down in Newark, Delaware, the Haskell Laboratory, who was a pioneer in industrial safety, begun in 1935 at the request of their medical director, who noticed that dye workers were getting urinary bladder cancers there. That time, there was little formal study of industrial toxicology, and DuPont calls this lab a premier toxicology research facility, and its scientists influential leaders in toxicology. Now, this was process improvement and engineering controls, important and not trivial, but not classic experimental toxicology or any animal work. They did gain a reputation for worker health and safety, while explosions did continue. Backing up to the start of World War I, 1914, most explosives that were more modern than gunpowder were made in Germany, that then cut off supplies to us and the Allies, and the new and unfamiliar high-explosive industry developed rapidly for us to sell to Britain, France, and Russia before we joined the war, and then we used them. And much of it was just about right here, along the Atlantic seaboard, and much of the riches of this area was based on railroads, and along the tracks of the Pennsylvania Railroad sprang up factories that made these products, picric acid, TNT, and a compound, nitrocellulose, more toxic themselves than the previous locally made explosives using more toxic chemicals to make them. And that's where one of the heroes of medicine, and especially our field, comes in. The center of the study of these industries was Alice Hamilton, her second really big project in our field. Not only the founder of our field in America and the only full-time OCMED physician when she started, and not only did she publish our first OCMED textbook, Industrial Poisons in America, she started in OCMED first working for the state of Illinois, and then with a new US Department of Labor doing surveys of the lead industry, discovering over 70 processes that caused lead poisoning when states and industry and the federal government were aware or stated there were none. And she began working on our topic after returning from a visit to Europe early in 1915, where she had been attending the International Congress of Occupational Diseases and back-to-back with the International Congress of Women, agitating for the end of World War I. All these cool paradoxes here. They sent her to study the new explosives facilities. This photo when she was in middle age, and here on one of the versions of the cover of her famous textbook, which I have a version with the last photo, and this is another version of her when she was older. Her descriptions are amazing. I highly, well, I consider it to be required reading for us, but I recommend it to anyone. She wrote in chapter 11 there what she did with explosives was, quote, pioneer exploration. I'm going to be quoting her a lot right now. In Washington, in the military, in industry, sites of explosive camp plants were kept secret, so she had to find them herself. And she wrote, my old procedure was, quote, visit the plants I knew, pick up gossip about the others, and this method worked well. One way she found them was, quote, I was helped by the great clouds of yellow and orange fumes, nitrous gases, which in those days of crude procedure rose to the sky from picric acid and nitrocellulose plants. We all could have seen them, but she found them. There were nitrating plants in the New Jersey marshes near here, located now on the highways about half an hour from here, from this spot, and the picric acid workers became known as canaries. The left an illustration from her book drawn by her sister, Margaret Hamilton, an illustrator and artist, of the Canary Men of New Jersey. That's what they called themselves. This photo, excuse me, this image appears to our eyes in this decade of this century to be racist. It was probably pretty accurate, and it's right there in the book. The better known and more documented Canary Women of Britain, there's a drawing that was not hard for me to find online, and there's the link. That's how they were drawn then in British publications. I was amazed when I found, I was amazed of a whole lot of things in researching this. The men were at war, women made weapons like our Rosie the Riveter. These words paraphrased down there that you can't read, say, on our little train into the munitions factory, the officers looked at us like insects. One of them said, well, they're doing their bit. Now my only source for the Canary Men is Dr. Hamilton's book. And now a little tox. Chemicals are still around. They have modern uses. I first heard of picric acid, 2,4,6-trinitrophenol, as a histology stain or boon solution, and it has other uses, metallurgy, more stable than nitroglycerin, nitrocellulose, so it can be used in artillery, still occasionally fairly easy to make. You react phenol with first sulfuric acid to set it up and then nitrate it with a nitric acid. And there are other methods, nitrocellulose, one depiction down there from online, other ways to draw it, was made at the Picatinny Arsenal about an hour north of Philadelphia and elsewhere, and by itself unstable, it could detonate in the artillery barrel, not where you want it, and she visited there also. But although more toxic than previous explosives, I'll get to more of that in a moment, irritants both can cause headaches, dizziness, possibly unconsciousness, they didn't care about that. The big worry at Picatinny was static electricity, which could make it detonate. When she visited, I'll show you, they tested for static by waving their hands and feeling for whether or not their hairs stood up, and they told her, if there's a spark, you run out that door. But the raw material's a little more toxic, a lot more toxic. Nitric acid, nitric is really nasty. At the rail station near a picric plant, she saw two canaries and asked them, is it dangerous? That was one of her methods, just to ask people, and it worked. One of them told her, not this yellow stuff ain't, but there's a red smoke that comes off when the yellow stuff is making. It knocks you out, and if you don't run, it gets you. It's a lot medically right there. Nitric is such a strong corrosive, it slowly eats through metal and all organic material. You need special metals or glass to hold it. And making nitrocellulose generates these that we know so well, the NOX, NO2, N2O4, raw strong corrosives can rapidly cause pneumonitis and delayed pneumonitis. She wrote that making nitrocellulose generates these gases that blew the lids off the reaction vessels at one plant eight times a day that she observed. And she was quite sure there was more than that. Sulfuric and nitric gases just poured out injured workers who are typically poor farm workers. They run from the fume and gases, but some died. She wrote it was similar to the effects of, quote, war gases in Flanders, nitrous fumes not so choking as chlorine, so they might linger long enough to get a fatal dose and end up with this. That same man said, quote, you goes home and eats your supper and goes to bed. And then you chokes up and by morning you're dead. Said it happened to his roommate. The other man nodded his head. And what other pioneering thing did she do? She published the first ever type of report on industrial poisonings in the US. Just amazing all she got done. 1917 by the new Bureau of Labor Statistics. In her words, for occupational sickness, which was something new. Now, those of us who've been feds, including in the Federal Personnel Manual, it's an injury if happens within one workday or one work shift. And an illness for longer exposure. But her key distinction was this. They were not injuries for explosions nor from acid burns. Plenty of those too. This was exposure to poisons. And this was the best image I could put up. And I know it's hard to read, although it's in her book and you can read it from there. This covers 41 plants employing 90,000 workers, one-third of which actually were exposed in, quote, one year's time. About 11 months out of 1916 in her data. She found 2,432 cases of occupational poisoning, 53 deaths. Nitrous fumes accounting for 1,389 cases, 28 deaths. TNT, 60 cases, 13 deaths. That's all right in here. Benzene plus toluene or toluol, they are single cases. She was clear they were underestimates and no information available for almost one-third of the plants. Manufacture and open vats, no engineering controls, no sanitation, the workers wearing the chemicals everywhere they went. And she didn't have nice things to say about local physicians. Now, her work continued as we entered the war in April 1917 wrote, now this field became a proper one for medical research. So, she was the first one, again, the first one to teach Achmed to medical students in the U.S. and sent them into TNT plants who found, her words, very shocking conditions under criminally negligent doctors. And, well, I was shaking my head a whole lot, again, looking at this topic. She wrote in her autobiography conditions that improved by the next war, plants were safer. And by then, this was already old news. Amitol was also made near here. That word's an amalgam of ammonium and toluene. And its use lasted until the Korean War. These two chemicals work synergistically with increased energy to detonate. They can stretch TNT supplies when it became scarce, which was often. Bombs, mines, depth charges. TNT's not hard to make. The nitrate toluene, same way as before, as with picric. First sulfuric, then nitric acid in three steps. We still use a lot of it. It's probably the most toxic stuff of the explosives. Causes all this. Patotoxicity, anemia. It's a severe irritant, methemoglobinemia. Probably carcinogenic, although it's not agreement. Ammonium nitrate, even easier to make. React ammonia with nitric acid to make this explosive salt. With lesser levels of the same adverse effects. And how dangerous are these? Anyone not heard of the tragic 1917 explosion in the Halifax Harbor? No need to raise hands. What I didn't know until researching this, that explosion of a ship carrying picric, TNT, and nitrocellulose, had a force of 2.9 kilotons of TNT. That's the size of a tactical nuclear weapon. And it was the largest ever man-made explosion in history until the first atomic bomb. Her observations there were groundbreaking. It absorbed through the skin and by inhalation. The acute yellow atrophy, she found out quickly. And then, not too long after that, how the anemia was reversible, but could very well proceed to hematogenous jaundice, CNN effects, on to stupor seizures, and maybe death. Remedy was PPE and basic industrial hygiene. And she urged them to use protective clothing and wash them, and ventilation. I knew the name of a town, Amital, New Jersey. What's left of it is maybe 40 minutes from here. A planned community sprang up near the Atlantic Loading Company munitions factory along a rail line that now runs next to what became US-30 on its way to Atlantic City. The population exploded to about, another bad pun, about 10,000 maybe more. And online, you can find the images that I found, videos, and the printed plans of the town's footprint. They could fill 60,000 shells per day with a mixture of picric acid and nitrocellulose in a facility and town together covering thousands of acres. There's a picture of the place. East K Street from 15th, carved out of the pine barrens, far from other towns so it would be safer. So town was separated by a mile from the plant in case of an explosion. They had churches, homes, shops, schools, firehouse. I planned this pun. It was a booming community. Ha, ha, all right, never mind. But it was built to be temporary. After the war, it closed. There's no more work. It became a ghost town. There are two buildings left standing. One became a state police barracks. Mostly what's left look like this. These probably are pouring rooms and see the concrete walls angling upwards so that if there's an explosion inside, it would blast upward and not knock down surrounding buildings. Remnants survive like this, reclaimed by the pine barrens, but you can go there, go down US-30 and turn left in the right place. There are concrete chimneys, foundations, dirt trails, pieces of wood, broken plumbing. You can see the grid in aerial images. These days, explosives are not made legally here. Local use for individual tasks and references. Should we take questions now on this, maybe one or two, or what do you think? Like us also to mostly keep rolling, but question or two so far about this? Or ask at the end? Okay, now another local topic that's familiar to some of us, the tragedy at Bribesburg caused by BCME, bischloromethyl ether. It's a cancer cluster we should all know about. It was in the news in Philadelphia in the 70s. Case in point in OCMED. This topic's information comes from references at the end that include books, medical publications, news articles, Senate testimony, interviews. And some of us in our field could have done better than they did. Physicians, safety people, federal agencies. One of my senior colleagues and mentors who's speaking later today has said, in this case, we are not always the good guys. We collectively. Want to mention a little about Roman Haas? Sure. Please. Okay. Ken. Do you want to use this? Yeah. No, that's okay. So the story takes place at a chemical company called Rome and Haas. Anybody familiar? Anybody here of Rome and Haas? Great. It's Dr. Aronoff here. He was a North American medical director for Rome and Haas. And if he throws things, I want them to be fruits and vegetables, nothing worse. I asked him to come. Okay. At any rate, as you might infer from the name, the company did, in fact, start in Germany. And actually, Mr. Haas decided to come to the United States and set up shop here to start a North American operations. The original business had to do with tanning, the tanning of leather. And much to, I think, the dismay of many workers, the key ingredient was nothing really very sophisticated. They actually used dog feces as an enzyme agent to help with the tanning procedure. And Rome and Haas developed a system where they could use pancreas extract to do the tanning. They then moved in to produce a variety of specialty chemicals. I think their largest contribution and what they're known for was the invention and production of plexiglass, which was critical during World War II and to make canopies for aircraft and jets. And they also were later credited with the invention and production of semi-gloss latex paint. The key aspect of this, and I want to make sure, do you want to punch up to the next show picture? Nothing to disclose. Nothing to disclose other than I lived nearby growing up. The plant here in Philadelphia is in a town called, well, it was a town, Bridesburg. Like a lot of other cities in the United States, it didn't just pop up out of the ground as one thing. Philadelphia is actually an amalgamation of numerous, what had been independent towns and municipalities. Where you are right now is the original Philadelphia that Penn set up. Also, as an interesting side note, since you'd mentioned Delaware, I don't know if people know, anybody been to Delaware? Okay, good. Well, Delaware was actually part of Pennsylvania at one point. It was part of the land grant from the king to Penn's father. But Penn being a good Quaker, there were some religious differences, and rather than having a war, Penn felt that Pennsylvania as it is today was enough and let Delaware be its own colony. Bridesburg is an industrial, like other cities like Baltimore and Chicago, with a very heavy industrial footprint. And Bridesburg was actually named after James Kirkbride, who ran a ferry service from this part of Philadelphia over to New Jersey. And then after he died, they named the town in his honor Kirkbridesburg. So if you try that three times, Kirkbridesburg, it's too long. So they changed it to Bridesburg. And what was interesting is that Bridesburg shared very common characteristics with three other industrial mini cities within the city, mainly Kensington and Manioc. Kensington is known as being the epicenter of the opioid epidemic, and Manioc is actually a very exciting, fun place to visit now. Since you mentioned Powder Mill, actually there is a Powder Mill Road in Wilmington. And thank you, now I know why it's called Powder Mill Road. It's very interesting, and I hope during your visit to Philadelphia, if you're not from the area or even if you are, to just look at the street signs and see what they mean. They do mean something. There's a reason that they're there. The big joke in Center City is that all the streets are named after the trees that were once there. Walnut, Cherry, Lombard, Pine, Spruce. But the Native American names are also very important as well. Manioc literally means the place where we go to drink. And it was true then, and it's true now. The other thing that's interesting is that there's a very small street, and you can probably walk there from here, South Street, just below South Street, there's a very tiny street that it's probably, it was designed clearly not for cars but for horses, and it's called Cater Street with a K, K-A-T-E-R. Are there any German speakers in the room? Well, as you might imagine, cater, it sounds a little bit like cat, and that's the connection. Cater is kind of a nickname for a tomcat, but it's also an expression that means, in German, a hangover. So after you go to Manioc and do your drinking, then you presumably go to Cater Street and do the rest. At any rate, Bridesburg was an industrial portion of the city, and very close quarters where people could literally work. There was no reason to leave Bridesburg, and that is their headquarters, as it was, and many of you might know they were bought out by Dow Chemical. They were also very famous because they were sued, or actually they sued, because the IRS found a 10-cent discrepancy in their taxes, and the company was fined $47,000 for it. But at any rate, they've since been bought out with Dow, and with that, do you want to? Just skip ahead. Yeah, just skip ahead. Here's the Bridesburg plant. The windows of this building were made by their own plexiglass, and at the time of this cancer cluster, Roman Haas was the Port of Philadelphia's biggest exporter. All this cool stuff. Well, at least a nerd like I am thinks it's cool. Methylmethyl ether, one of the products and product it used itself. There's a structure and formula, colorless alkylating agent, made by mixing formaldehyde, aluminum chloride, methanol, and HCL in open vats. The vats had lids, but the process started and ended with the lids open. Multiple chemical corporations made and used it. Roman Haas used it to manufacture the burgeoning industry of ion exchange resins, starting in the growing demand, rather, in the late 1940s and after. Now, CMME liquid was never pure. The factory-grade CMME contained usually 1% to 8% or more of BCME. It's difficult to get it pure. So although this is termed a known carcinogen, that's greatly because of its BCME content and the toxicology of the two probably will never be separated. This is bischloromethyl ether. Came first, actually. It's easier to make. Mixed formalin, chlorosulfonic acid, and sulfuric acids. More acutely toxic. Their own chemists said so. One Roman Haas chemist spilled pure BCME on himself and it ate away his clothing. Chloromethylating agent, it's one of OSHA's 13 listed carcinogens, where they want as close to zero exposure as feasible. And resin production moved to CMME in the 1950s because production was more efficient and the workers tolerated it better. Both share health effects, BCME being a bit worse, but they're described together with slight differences. They're strong enough irritants to the point of being corrosive that multiple species, humans included, will get upper and lower respiratory moderate to severe disease or worse, and chronically pulmonary irritation to the point of chronic bronchitis. And these killed most of the lab animals when tested on them. I said most. Looking ahead just for a moment, they evolved as carcinogens in stages. Nelson's NYU Institute for Environmental Medicine reported tox data, as did the Hazleton Lab in 1969. More on that soon. But human evidence, as usual, came first. They used it to make, or used them to make ion exchange resins as cross-linking agents in polymers. Bridesburg facility made many chemical products using large volumes of all kinds of organic chemicals and corrosives. Building 6, which is in there, uses CMME. This is high production, about 1958. Saw several figures for the number of acres, about 55 acres. The work paid better than most. One of my colleagues said he would be here, said, Dr. Rogowski, thank you, said that his father very nearly worked there and took a job nearby instead. I'll show a photo later. The work paid well. There were also explosions and other accidents. They made the ion exchange resins initially in open kettles of BCME, CMME, pouring in formalin, methanol, and HCL in 1,000-gallon kettles. First to make that, then the ion exchange beads in 100-gallon vats with the workers standing over it or right near it, offered cloth or gas masks. They refused, reportedly out of bravado, and although the kettles had lids, the lids were open when they started and when they stopped. So the vapor and fume poured out of them, and the workers all ran outside at the beginning and at the end of each batch. This is not their image. I searched online a recent example of a modern open vat. Now medically, the Philadelphia Pulmonary Neoplasm Research Project, also worth our knowing, or PPNRP, was founded in 1951 by academic physicians here. They wrote, quote, primarily to study the natural history of lung cancer with emphasis on chronological relationship between symptoms and rentinographic changes. In older males starting at 45, this was the first large prospective cohort study of lung cancer and outgrowth of their TB studies, and lung cancer did deserve such study back then. It was not well-characterized. I haven't been able to find out what they told their research subjects. What they did were 70-millimeter x-rays, screening x-rays. This is a broken one-foot-long yardstick, and here's 70 millimeters, like this. They got respiratory questionnaires and smoking histories taken by Dr. William Weiss of the former PGH, Philadelphia General Hospital. In the annals to internists, the annals of internal medicine, I mean, 1961, over the next four years, this is a quote, 6,137 men 45 years of age or older were enrolled. To our knowledge, first such study done on a significant group of older men. They had 2,804 age 45 to 54, mostly working class. By 1970, they'd found 16 cancers, a five-year incidence in that group of 0.57 percent. So there's a baseline. Its founder and driving force behind the PPNRP, Catherine L.R. Bucco-Sturgis. Her name changed several times. Mostly she went by Bucco, professor of preventive medicine at Women's Medical College that became MCP, and then Drexel. Also had positions elsewhere and with the city. She did a lot to advance TB and lung cancer research, revived the struggling archives of environmental health, first woman president of Philadelphia Medical Society, a lot of other things. Campaigned against industrial air pollution, and again, sprayed on asbestos, which was still going on on Market Street when I got to medical school. One of my classmates went out to demonstrate in front of an asbestos spraying. The police escorted him away, basically said, shut up, kid. She also consulted with industry, including Roman Haas, from about 1951, directing a chest x-ray program out of her office, starting to study TB, and they had been x-raying some Roman Haas workers every six months, but not an organized group. By 1962, internal memoranda at Roman Haas discussed cases of lung cancer in Building 6, including in younger men. Managers wrote memoranda stamped, Company Confidential, telling each other, including that five had died out of that group. And in December that year, their senior staff met with Bucco, told her this, asked her advice. She'd found some, too, more nonsmokers and younger than expected. So the PPNRP enrolled 125 men from Building 6 and other exposed areas for further study, 111 of whom remained in the cohort throughout the 60s, and cancer cases rolled in. They published, wait for it, they published nothing. Weiss said he couldn't. He said Roman Haas told him they had no exposure data. Roman Haas sent a list of their chemicals to Memorial Sloan-Kettering, well, they're the top cancer center, right, asking if the chemicals caused cancer. At that time, they were a treatment center in detoxicology. Bucco urged him to get a tox study done with NYU. And Roman Haas, all kinds of documents and news articles and books, it's pretty clear they wanted to control the data. And the lab director, Nelson, refused. So they contracted instead with Hazleton Lab in Virginia. No medical publication yet before any tox studies. NYU went forward on its own with internal funding, started rodent studies, and then got federal funding and did more convincing rodent studies. Roman Haas dismissed these as early and small rodent study. Documents show they wanted human data. My mentors in my residency called this counting the bodies. They did enclose a CMME process, completing that in about 1969, depending on the report you read. And this image also is not theirs, another recent one. I once had a photo of their enclosed vats that I couldn't find. DuPont was the one who introduced that process, closed chemical vats, at the Chamber's works in the 30s to control exposure to beta naphthalimine. Remember last topic? That ocial listed carcinogen had caused urinary cancer there. And after the NYU study came out, Roman Haas further tightened their controls to try to cut BCME exposure to one part per billion. By 1970, that would be tiny exposure. It's tough to do that now. But the workers complained of leaks, felt safer and physically better at work, and some exposure happened. Roman Haas met in 72 with the chief of toxicology of the new agency, NIOSH. Based on what they told him, his report of the meeting concluded, there is nothing to indicate that BCME is a human carcinogen. That's a quote. When OSHA did not yet list it as a carcinogen, internal OSHA documents said it would, quote, cost industry millions. Another thing that I kept hearing in my residency. Makes my hair stand up. And still no medical studies or reports until a local lung specialist, who later became my mother's pulmonary doctor, noticed a problem in his patients. Dr. Bill Figaro was a pulmonologist in the 60s and 70s at Germantown Hospital, a community hospital not known as a research center. And some of the Roman Haas workers lived not in the closest communities of Bridesburg or Port Richmond, a lot did, but some lived near his hospital, and he noticed that a lot of them were getting sick at young ages. One case in 1971 impressed him, a 43-year-old nonsmoker with seven children, a CMME operator at Roman Haas. He collected cases and called his former instructor, Dr. Weiss. They found four cases in the 88 men aged 35 to 54, and mentioned it at local meetings and the American Lung Association meetings. That's 4.54 percent, nine times higher than the PPNRP had been finding in similar people. They studied further and asked Roman Haas for data. Roman Haas didn't want to work with Dr. Figaro because he was asking a lot of questions. That's documented. They told him and Weiss they had no exposure data. They knew who worked where. So Figaro got the exposure data himself by interviewing workers and other physicians, each separately telling him the same stories. They wrote it up, and the Ahmed world was surprised with a short article in the New England Journal, first presented at the American Lung Association that May, and this was in November, 11 years after the first internal memoranda about the cancers, all in chemical operators working with CMME at Roman Haas, mostly oat cell carcinomas, which we now call small cells. That's what had gotten his attention. And here's his table of data out of the New England Journal. There it is. At least 12 of the 14 were oat cell carcinomas. If you can read it, look at that. That never happens, but it did happen. These 14 cancers out of 111 CMME chemical operators, that's 12.6 percent. See here? And there's the P value, highly significant. Total of 54 cancers eventually attributed to the Bridesburg site. Roman Haas offered worker families $25 million in 1986. Number of other studies came out in the 70s and 80s, several by Weiss. Relative risks varied, but all showed a cancer risk with the chloroethers, short latencies, a lot of small cell carcinomas. Oh, good. This is projecting better than I could get it on my own home computer. This is ATSDR's latest summary and compilation. It's certainly almost completely current from 2017. The top two are Roman Haas workers, increased risk even with exposure under five years. Lowest risk ratio here. One of Weiss's reports is a little bit odd. The papers of his that I found are generally higher than that. That's short exposures and smokers in that one. He got criticized by my mentors for tending to blame a lot of it on smoking. That criticism wasn't entirely true. And again, he had higher relative risks, more comparable with some of the others. One by Dick Lemon at NIOSH that got a lot of attention because around then was when the Senate investigations of this happened. CMME and BCME are treated as the same in regulations and all workplace guidance since they almost all always accompany each other. OSHA-regulated carcinogens, NIOSH exposure guidance has not been updated during my career, but ACGIH wants as little as possible. And it's almost entirely phased out. Now top of the hierarchy of controls is elimination and substitution, and we don't use those in industry anymore. Then engineering controls and plastics manufacturers now more enclosed and better ventilated. So I haven't heard of cancer clusters in plastics manufacturer recently. Maybe I've missed one, but some were not quick to act. Our priority should be the patients in public health, and this Sonny and Cher song from 50 years ago, our work's never done. In 1985, four more cancer cases were related to BCME and Roman Hoss got and fined by OSHA and more lawsuits. Another Roman Hoss site, a research lab in Springhouse, PA, about 12 minutes north of where I live in Montgomery County, in a pretty suburban setting, 14 chemists were reported to have brain cancers, double the rate in the general population, some working with nitrosamines and chloroethers. And Dow who bought Roman Hoss settled a lawsuit with two of them. Other lawsuits dismissed because tox studies have not connected BCME to their glioblastomas. The recent chemical spill here that threatened our water supply, former Roman Hoss plant that once used BCME, making acrylic paint. I took this photo myself one month ago of the old northeast Philadelphia site of Roman Hoss, all 50 or so acres of it, now owned by Dow, lots of history, memories, and tragedy. In Philadelphia Inquirer called it the tragedy at Bridesburg. I wish I had, I can't find the article I had, maybe I do somewhere, including photos of Figaro looking at an x-ray and the families. Now an irony that I didn't realize how the two topics of this hour connected. This back there is the Frankfurt Arsenal, not in the Frankfurt neighborhood, but high on Frankfurt Avenue, right behind what was Roman Hoss. To the right, Dr. Wachowski was allied chemical. His original industrial center, we can walk to it in six minutes from here, now upscale Society Hill. Dr. Lankin mentioned tanneries, its biggest industry in the late 1600s, the first 20 years of Philadelphia was tanneries right there, close to people's homes with the overwhelming stench and filth, and by 1703 they moved five miles to the northeast here, eventually joined by the rest of the chemical industry, and as Ken said, Roman Hoss started making tannery chemicals, and this arsenal began in the 1800s, storing and making gunpowder. Explosions with injuries and deaths, so history of explosives in this area include the city itself side-by-side with the chemical industry. We come full circle this hour. Questions and discussion? Ken, do you want to join me here? I just wanted to share. Thank you. You mentioned, the first part we talked about the explosives, and you presented it as a historical problem, and what I will share is it's not just historical. Oh, no, that's true. In about 2010, because they made all these World War I munitions, I'm out in West Virginia, and the problem is they, as the Navy, very slowly decommissioned those World War I munitions, because a battleship still launches the same thing at the enemy that they did in World War I. They've taken them apart, they sent the, Tetrol was the one that they were mostly using, which is still the Canaries, sent them to West Virginia, and they were admixing them into the explosives used in surface mining, and exposing the workers in West Virginia to Tetrol, and saying, oh, it's just like the ANFO that you use all the time, without telling you about the health hazards. As you're going, ANFO and Tetrol, highly explosive, we have fewer explosions now, but it can happen any time, any day. Our problem with the explosives was the tox part. We saw a series of those workers, they hired temps to come and dump the Tetrol into the ANFO holes as they were blasting, and tried to dispose of them. Apparently the Navy has warehouses and warehouses full of this stuff, they don't know what to do with. It may reappear somewhere in your service area when they find something they can do with them. We saw a bunch of people who were exposed with all the respiratory things, there was some people were getting yellow looking, but that, so yes, it's a historical problem, it's still around, you may still see it. I was shocked. We're trying to take care of these patients, and all the literature is from like 1927, which was the last time that there was a lot of good science about it. I didn't mean to imply that the exposures are gone, and if I did, I should have watched my emphasis. Oh, things are better now, problem's gone, mm-mm, and so thanks for that. The Navy still has multiple warehouses full of stuff they're trying to figure out what to do with. It may show up somewhere that you guys take care of. That might very well be. We finished the hour about one minute ago, but I see Dr. Wachowski, my senior colleague at Federal Occupational Health, should we do one more here, and then after that, we'll have further discussion up here. Listen to this, but you're right, my dad worked right across. He wanted to work for Roman Haas because they paid better. They were known as a model employer at the time. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. At that time, it was called Barrett's because they were working on cold, soft coal. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. At that time, it was called Barrett's because they were working on cold, soft coal. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. At that time, it was called Barrett's because they were working on cold, soft coal chemistry. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. At that time, it was called Barrett's because they were working on cold, soft coal chemistry. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. At that time, it was called Barrett's because they were working on cold, soft coal chemistry. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. At that time, it was called Barrett's because they were working on cold, soft coal chemistry. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job. He started as a bench chemist at Allied Chemical. He was a veteran, couldn't get a job.

explosives

historical dangers

occupational health and safety

Philadelphia

chemical industry

BCME

cancer cluster

Roman Haas plant

ion exchange resins

lung cancer