DAVID MICHAELS

Department of Epidemiology and Social Medicine
Montefiore Medical Center and Albert Einstein College of Medicine

Waiting for the Body Count: Corporate
Decision Making and Bladder Cancer in the
U.S. Dye Industry
Scientists in Europe determined in the early part of the 20th century that

beta-naphthylamine (BNA) and benzidine, two chemicals widely used in
the production of dyes, were potent bladder carcinogens. Yet the accumulation and dissemination of scientific information about occupational
bladder cancer had little impact on U.S. dye producers with regard to
protecting the health of workers in their employ. As a result, hundreds of
workers developed bladder cancer. This case study explores the worker
protection policies offour U.S. dye manufacturers and demonstrates that
these corporations allowed uncontrolled exposure to occur until the human cost became so obvious that it was no longer possible to ignore.
These data underscore the limitations of voluntary corporate compliance
with workplace health and safety regulation, and suggest the need for
more active governmental involvement in the dissemination of technical
information to employers, unions, and the public.

ince its inception, the synthetic dye industry has been dominated by the
largest multinational chemical manufacturers. While the technology developed for dye production has resulted in important advances in chemical,
munitions, and pharmaceutical manufacturing, the intermediate chemicals used
in producing dyes have been responsible for a series of epidemics of bladder cancer in virtually every region of the world where the industry has located (Hueper
1969). The U.S. dye industry has been responsible for at least seven documented
outbreaks of occupational bladder cancer, with at least 750 cases of the disease
appearing since 1930.1
Bladder cancer is an uncommon type of tumor, and for that reason the occurrence of more than one or two cases in any group of workers is cause for suspicion. When outbreaks of the disease have occurred at dye factories, the relative
rareness of the cancer in the general population and the extreme magnitude of the
increased risk associated with exposure to the dye intermediates have generally
made the occupational clustering of the cases so obvious they ultimately could not
be ignored. As a result, the manner in which the history of bladder cancer has
unfolded for each dye manufacturer, a process entailing the "discovery" of the
epidemic, the communication of information about the risk of exposure, the overdue decision to institute control measures, and the eventual acknowledgment that
the product cannot be manufactured safely, is readily documented.2
215

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MEDICAL ANTHROPOLOGY QUARTERLY

My objective in this article is to investigate the development and communication of knowledge about bladder cancer within the U.S. chemical industry by

focusing on four companies: Allied Chemical, the Swiss-owned Cincinnati

Chemical Works, Du Pont, and Upjohn. More data about the production of dyes
and bladder cancer exist for Du Pont than for any other producer, in part because
Du Pont has traditionally been in the forefront of the design and provision of cor-

porate occupational health services. It has long encouraged its physicians to publish in academic journals, and Du Pont occupational health specialists are responsible for one of the most important early U.S. texts in the field (Fleming, D'Alonzo, and Zapp 1954). For these reasons many other manufacturers have looked
to Du Pont for leadership in the area of occupational health, and for these same
reasons data from Du Pont play a significant part in this article.
In focusing on Allied, Cincinnati Chemical, Du Pont, and Upjohn, I do not
seek to indict these four manufacturers in particular. There is substantial evidence
that other important U.S. dye producers (Johnson and Pares 1979; Kleinfeld
1967; Lieben 1963; Markowitz and Lyons 1979) as well as dye producers in Ger-

many, Great Britain, France, Italy, and Japan (Hueper 1969; Temkin 1963),
treated the bladder cancer epidemics for which they were responsible in ways very
similar to those profiled here. I have selected this group of corporations for study

because their policies and actions are documented in published studies, in testimony submitted to hearings and trials, and in internal memoranda that have become available as a result of legal suits.

Birth of the Synthetic Dye Industry and Discovery of Associated Bladder

Cancer

The history of the synthetic dye industry can be traced to the discovery in
1856 by William Henry Perkin, an 18-year-old British chemistry student, that
coal tar could be transformed into a synthetic dye. Perkin had been attempting to
prepare artificial quinine from coal tar, until then a useless byproduct of the distillation of coal to produce gas for lighting. Instead of quinine, he synthesized a
delicate mauve solution, which he named mauvine (Borkin and Welsh 1943). Perkin's discovery was the first in a rapid series of scientific advances related to dyes
that occurred throughout Europe in the second half of the 19th century. While not
as colorfast as natural dyes, these artificial substances were the beginning of an
important new industry that provided textile dyers with bright and inexpensive

colors.

Armed with the first patents, the English chemical industry initially dominated the global dye market. The German industry, however, grew very rapidly,
with substantial public and private sector investment in the construction of research facilities and the education and employment of organic chemists. Seeing
the opportunity for sustained industrial development, the German government
built formidable university laboratories to train scientists and provide the basic
research needed by the organic chemical industry. As a result, German scientists
obtained hundreds of patents, which they then used successfully to dominate the
world dye market for decades (Norton 1915; Scott 1962).
While the dye industry was notable for its size and financial return, its importance in economic history stems primarily from its relationship to the devel-

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217

opment of the synthetic organic chemical industry. The patents and production
processes of the dye industry became the basis for the global expansion of organic
chemical production, including pharmaceuticals (most notably sulfa drugs and
aspirin), explosives, synthetic resins, petroleum additives, and numerous other
materials (Beer 1959; U.S. Tariff Commission 1946).
The first bladder cancer cases among dye workers were seen by Rehn, a surgeon in Frankfurt-am-Main, a center of the German chemical industry. In 1895
Rehn reported that three of the 45 workers employed in the production of fuchsine
had developed bladder cancer. In addition, many more workers developed non-

malignant bladder disease. Grandhomme, the factory surgeon employed by
Hoechst, one of the largest dye manufacturers, immediately disputed the report,
claiming that while many workers had suffered severe irritation of the bladder, so
few had cancer that it could not be work related. This debate continued for the

next decade, as additional cases continued to appear. By 1906, Rehn had identified 38 workers with bladder cancer, and other investigators reported more cases
in subsequent years (Hueper 1969). Reports of an independent outbreak involving
18 cases in Basel, Switzerland, and of 100 cases in Germany (data presented at a
conference of German factory physicians in 1913) finally confirmed for at least
the German-speaking scientific community the causal relationship between the
dye intermediates and bladder cancer (Hueper 1969; International Labour Office
1921).
Occupational bladder cancer generally appears 15 or more years after first
exposure to the carcinogen. While it is sometimes fatal, most people who develop
bladder cancer currently are cured. The five-year survival rate, the statistic epidemiologists use to approximate the cure rate, is now about 76% among whites
and 56% among blacks. This has been improving consistently in recent decades;
in the early 1960s, only 53% of whites and 24% of blacks who developed the
disease survived five years after diagnosis (American Cancer Society 1986).
In the first outbreaks of occupational bladder cancer, it was difficult to differentiate between the carcinogenic effects of several of the most important substances used in dye production. Published reports consisted primarily of case series, listing the exposures of each worker who was diagnosed as having bladder
cancer. In 1921, the International Labour Office (ILO) issued a monograph entitled Cancer of the Bladder among Workers in Aniline Factories that reviewed the
exposure histories of all cases reported through 1920. Applying rigorous criteria
for identifying the actual bladder carcinogens, the ILO asserted-correctly, as it
turned out-that the chemicals most likely to have caused these cases were benzidine and beta-naphthylamine (BNA). The report concluded optimistically:
Hygienic precautions, strictly applied, will assure at the end of a few years the
diminution and even the disappearance of the disease. 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. [International Labour Office 1921:22].

The Spoils of War: Du Pont and the Development of the U.S. Dye Industry
Although the artificial dye industry began in the United States on a small
scale in the late 1800s, it was soon dominated by the local output of European-

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owned plants. U.S. manufacturers were not able to compete successfully, because
German and Swiss dye producers controlled virtually all important patents in the
field. World War I radically changed this situation, since the U.S. government
then seized enemy-owned plants and patents and distributed them at low cost to
U.S. chemical companies (U.S. Tariff Commission 1946). As a result, three man-

ufacturers-E. I. duPont de Nemours & Co.,3 Allied Chemical and Dye Corporation (later Allied Chemical, subsequently the Allied Corporation, and now Allied-Signal), and American Cyanamid-became the largest synthetic dye producers in the United States. After the war, however, the Europeans returned and repurchased their original facilities or started new ones.
Du Pont chose the quiet town of Deepwater, New Jersey, for the first of its
factories to be dedicated to the production of organic chemicals, a field in which

Du Pont would become a global leader (E. I. duPont de Nemours & Co. 1952).

The Chambers Works, as the factory complex was named, was located just across
the Delaware River from Wilmington, the center of the Du Pont industrial empire.
Among the chemicals produced at the plant were BNA and benzidine, the two
products that had been identified in Europe as powerful human carcinogens.
The Chambers Works, which opened during World War I, was soon the site
of a major occupational disease outbreak, accompanied by a national scandal,
unrelated to dye production. In the early 1920s, Du Pont and General Motors,
which at the time was partly owned by Du Pont, agreed to manufacture and distribute leaded gasoline, a product designed to reduce engine knock in automobiles. Du Pont chose the Chambers Works for its production facility. The neurological effects of lead exposure were so severe and widespread there that workers
named the plant the "House of Butterflies," referring to the hallucinations of insects experienced by so many of the lead-poisoned workers. A New York Times
reporter who investigated the situation estimated that more than 300 workers were
poisoned and 8 were killed by the lead during the first two years of production

(Rosner and Markowitz 1985:347).4 The national notoriety Du Pont earned

through the "House of Butterflies" scandal may have convinced the company that
public disclosure of further outbreaks of occupational disease would most profitably be managed differently.
The first bladder cases among workers at the Chambers Works were recognized by Du Pont physicians in 1932, although they apparently started appearing
some years earlier (Washburn 1936). For the next several years, these physicians
documented the rapidly growing epidemic both at national conferences and in the
scientific literature. In November 1933, 27 cases were reported by Dr. G. H.
Gehrmann, Du Pont's medical director, at a scientific symposium the proceedings
of which were published in the Journal of Urology (Gehrmann 1934). Three years
later the medical superintendent at the Chambers Works, Dr. E. E. Evans, reported at a meeting of the New York branch of the American Urological Association that the number of cases of bladder cancer among workers at the plant was
increasing rapidly (Evans 1936). By that date the company knew of at least 83
cases, although other accounts suggest that the actual number was higher (Washburn 1936).
After its initial flurry of publications, Du Pont decided to end its openness.
For the next several decades, while the company's scientists continued to attend
public meetings and participate in the scientific debate on occupational bladder

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cancer, they no longer presented data on the ever-growing number of workers who

developed the disease at the Chambers Works (Gehrmann, Foulger, and Fleming
1949). However, internal reports by the medical department noted that 140 cases

were known to the company by 1946 (Hueper 1969). Du Pont eventually acknowledged publicly that by 1981 it was aware of 316 workers at the Chambers
Works who had developed bladder cancer (Mason et al. 1986). Since this registry
was unlikely to include most workers who stopped working at Du Pont before
developing the disease, the true number of victims is undoubtedly greater.

Du Pont Slowly Reduces BNA Exposure: A Chronology
The history of beta-naphthylamine production at the Chambers Works, including the chronology of Du Pont's numerous changes in the production process
over time, is provided in a 1958 memo by D. T. Smith, Protection Division supervisor at the Chambers Works. Smith wrote the memo in order to help the company determine the year and extent of exposure to BNA among workers who developed bladder cancer. Smith wrote,
the manufacture of beta-naphthylamine was started in the Chambers Works in
1919. It was cast in open pans, broken with a pick, and transferred by hand into
barrels, ground in an open mill, and shoveled by hand into operating equipment.
There was no ventilation provided. Gross exposures occurred.
In 1932, the occurrence of bladder tumors and their possible connection with
beta-naphthylamine was first recognized. In the ensuing months a still, flaker and
mill were installed in the low pressure autoclave building and positive ventilation
was installed on all equipment handling this material. This equipment was put in

operation in 1934, and the casting and grinding was [sic] discontinued. We consider that the period of general gross exposure was terminated April 1, 1934.
[Smith 1958:1]

As the memo proceeds, it becomes clear that significant levels of exposure
nevertheless continued throughout the 1930s and 1940s. Smith describes how Du
Pont considered additional improvements in 1940 but moved slowly and eventually decided to delay any changes because of World War II. No further improvements in the BNA production process were implemented until 1948 when, Smith
reports, exposure was finally eliminated in at least one of the production buildings. Total enclosure of the production process was completed in 1951, more than
35 years after BNA production began and 20 years after the epidemic was rec-

ognized. "After that date," Smith concludes, "possibility of exposure was

greatly reduced" (1958:2). The new building, which permitted safer production,
was used for only four years; Du Pont terminated BNA production in 1955 (Smith
1958).
When Should Du Pont Have Known?

It is worthy of comment that the discovery of occupational bladder cancer
among dye workers in this country was made and initially publicized voluntarily
by the industry. Rehn's initial reports met with such intense opposition from the
industry in Germany that it was ten years before the causal relationship between
dye manufacture and bladder tumors was recognized in that country (Hueper

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1969). What is unfortunate was the necessity of repeating Rehn's (and others')
findings 40 years later, without precautions having been instituted in the interim.

Could the Du Pont physicians in the period 1916-30 have been unaware of
occupational bladder cancer in Europe? If they were, their ignorance is not attributable to a lack of published scientific information on the subject. The etiology,
treatment, and prevention of that epidemic caused a major debate in the medical
journals of Germany, Switzerland, and Austria, with at least 15 articles appearing
before World War I and that many or more in the years between the armistice and
Du Pont's first reports. Germany and Switzerland made bladder cancer among dye
workers a compensable occupational disease in 1925 (Hueper 1969).
It was not even necessary to read German to learn about the relationship between dyes and bladder cancer. A study conducted in 1925 by the National Research Council of Great Britain, which investigated cancer rates among members
of different occupations and trades, found that chemical workers and textile dyers
had elevated rates of bladder cancer, and the report suggested that benzidine and
BNA were responsible (Young and Russell 1926). In addition, there were several
other review articles and case reports of bladder cancer among dye workers published in England during the 1920s (Bridge and Henry 1928; Wignall 1929).
Most important, the International Labour Office published its monograph on
occupational bladder cancer in February 1921, ten years before the Du Pont epidemic was recognized. The explicit purpose of this report was to inform dye manufacturers in countries where the industry was young, such as the United States,
of the dangers of dye production (International Labour Office 1921:2-3).
The ignorance of Du Pont (and other American chemical companies) can
also not be attributed to a lack of contact with the management of the dye producers of continental Europe and England. During the second and third decades
of the century, Du Pont worked tirelessly with I. G. Farben, the huge German
chemical cartel;5 Imperial Chemical Industries, the British chemicals giant that
held monopolistic control of the dye production and sales throughout the British
Commonwealth; and the leading Swiss, French, and Italian chemical and dye producers, building collaborative business ventures and monopolistically dividing
the world's chemical markets. Du Pont and Farben negotiated continuously from
1927 through 1929 to form a joint dye-producing venture, tentatively called the
American Dyes Company. When the companies realized they would not be able
to reach a successful agreement, they both accepted a state of "amicable cooperation" (Borkin and Welsh 1943; U.S. Tariff Commission 1946).6
Dr. Wilhelm Hueper: Du Pont Makes An Enemy
Data provided by other internal Du Pont sources show that the initial bladder
cancer outbreak, reported in 1933, was not a surprise to the Du Pont management.
The rapid onset of this epidemic was predicted by a physician, Wilhelm Hueper,
who had been employed at the Cancer Research Laboratory of the University of
Pennsylvania. Hueper eventually became one of the United States' experts in
chemical carcinogenesis, and he served as chief of the National Cancer Institute's
Environmental Cancer Section from 1948 until 1964.7 He originally met Irenee
duPont in the early 1930s, when he accompanied the director of his laboratory,
who at the time was also a duPont family physician, on house calls. Hueper told
an interviewer that in 1932,

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I had written to Mr. E. I. duPont, whom I knew personally at that time, that from
my observations after visiting the dye works, I had come to the conclusion that
their workers would have the same cancer hazards to the bladder as similar work-

ers in European plants, especially Germany, Switzerland, and England and that
an investigation would show that these men have an increased incidence of bladder cancer. I didn't get any personal answers to this. My boss at the cancer research laboratories at the University of Pennsylvania told me several months later
that they had come to the conclusion that they had no cancer among their work-

ers. "Well," I said, "that may be, but they would get them." Then about four
months later, suddenly Gehrmann and the research director of the [Du Pont] research station came to us in Philadelphia and said, "We have some now." I said,

"How many?" And he said, "We now have 26." I said, "You will have more.
This is a going concern now".... At that time I had already figured out that it
would take about fifteen years. I told them that men who are getting cancer now
are those who your company employed in 1917 when they created the dye work

operation. [Breslow 1979:1-2].

Hueper, who published the first of his many articles on occupational bladder
cancer in 1934, was hired by Du Pont to join in its newly formed Haskell Laboratory of Industrial Toxicology. Working for Du Pont, Hueper was able to perfect
the first animal model for bladder carcinogenesis (Hueper, Wiley, and Wolfe
1938). In his capacity as a Du Pont toxicologist, he requested permission to visit
the Chambers Works. The experience shocked him:
When I first visited the dye works for collecting exposure information, I was
shown the beta-naphthylamine operation. I talked to the foreman. It is always
very important to talk with the foreman-he doesn't know why you ask the questions; the plant physicians do. You see, you need to know not only the facts but
the tricks, so that you can't be fooled by anybody. I always have looked upon
myself as a sort of medical detective. A medical detective must know all the
tricks. So, I said to the foreman, "You have a very nice clean plant here." He
said, "Oh, you should have seen it last night. We worked all night to clean it up
for you."
When we were through with the visit of the beta-naphthylamine operation, I
said to the manager of the dye works, "Now I would like to see the benzidine
operation." "Oh," he said, "this is not really important." I said, "I would like
to see the benzidine operation now. I came this far; I would like to see it too."
That was a little bit farther up the road, in a special building. When I saw that, I
knew why they didn't want me there. This building they did not work all night
to clean up for me. The benzidine was spread all over the place, inside and outside, on the loading platform and on the road. I said, "I know now why you did
not want me to see this."

When I came back to Wilmington, I wrote a letter to the president of the company telling of the conditions, and I said that it would not help my investigation
of the bladder cancer problem if they would not provide plant management that
would cooperate with me. Now, the result of that letter was that I was never
permitted to see the dye works again. This was my introduction to industrial
ethics and professional medical integrity. [Agran 1977:175-176]

Hueper's disagreements with Du Pont became acute, and he was told that he
would not be able to publish all of his findings. He was later dismissed in 1937.
Du Pont refused him permission to publish or present data on his work on experimental induction of bladder cancer with aromatic amines, which was conducted

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while at Du Pont (Breslow 1979). In 1942 Hueper nevertheless published his seminal text Occupational Tumors and Allied Diseases. It contained the most thorough review of world literature on occupational carcinogenesis to date.8
Allied Chemical

The Allied Chemical and Dye Corporation began production of benzidine at
its Buffalo, New York, plant in 1915, and of BNA the following year (Johnson
and Pares 1979). Like Du Pont, Allied did nothing to protect its employees from
these materials until 1935, when the first workers with bladder cancer were discovered at the plant (Goldwater, Rosso, and Kleinfeld 1965). During the next 15
years Allied continued to accumulate cases while sponsoring important toxicological experiments on benzidine carcinogenesis (Maguigan 1950; Spitz, Maguigan, and Dobriner 1950).
While the European manufacturers had recognized benzidine as a human carcinogen decades earlier, there was evidently great debate within the U.S. dyeproducing community regarding its carcinogenicity. In a 1950 article, W. H. Maguigan, a scientist employed by Allied's National Aniline Division in Buffalo,
reviewed the state of knowledge on the subject to date, and summarized Allied's
groundbreaking laboratory experiments on benzidine carcinogenesis. Maguigan,
referring to Du Pont's contention that benzidine was not a human carcinogen,
wrote,
More recently one group of investigators in this country have [sic] disputed the
carcinogenicity of this material, pointing out that most of the benzidine cases
were also exposed to beta-naphthylamine. Although I must admit that the evidence against benzidine is much less conclusive than that against beta-naphthylamine, I cannot agree with them. There are a few cases where exposure to benzidine is not complicated by exposure to beta-naphthylamine; there are more with

a large exposure to benzidine and very slight or questionable exposure to betanaphthylamine; and, as we shall see later, it has been possible to produce tumors

in animals with benzidine. [Maguigan 1950:1360]
Allied funded the research that demonstrated in 1950 that benzidine was an

animal carcinogen (Spitz, Maguigan, and Dobriner 1950). With publication of
that finding, it no longer became possible to deny benzidine's hazardous nature.
However, according to U.S. government investigators, the benzidine production
process was not fully enclosed until 1957 (National Institute for Occupational
Safety and Health 1972).
The elimination of exposure to benzidine came only after studies involving
laboratory animals proved conclusively that the substance was a carcinogen (Ferber, Hill, and Cobb 1976); no action was taken earlier, perhaps because the numerous cases among workers at the plant and elsewhere were evidently not sufficiently convincing. Allied's true level of concern for the health of its workers is
better illustrated by its delay in implementing controls in BNA production. While
there may have been a legitimate scientific debate about the carcinogenicity of
benzidine, BNA had been shown to be both a human and an animal carcinogen
decades before Allied's 1954 decision to eliminate the open distillation and flaking of the chemical (Ferber, Hill, and Cobb 1976). Allied finally ceased production of BNA in 1955, but continued to purchase it through 1962. In addition, until

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1960, Allied produced a closely related chemical (alpha-naphthylamine, or ANA)
that was heavily contaminated with BNA (National Institute for Occupational
Safety and Health 1972).
In contrast to Du Pont, Allied did not initially publish information about
bladder cancer among its workers on its own initiative. In 1965 the New York
State Health Department identified 96 workers at the plant who had developed
bladder cancer, 46 of them dying from it (Goldwater, Rosso, and Kleinfeld 1965).
Allied eventually made a public count of the number of bladder cancer victims
from the plant in 1974; by that point, at least 151 workers were known to have
developed the disease, although, as with Du Pont, the actual number of cases was
probably substantially higher (Ferber, Hill, and Cobb 1976). Allied continued
producing benzidine until 1976 (Johnson and Parnes 1979).

Ignoring the Evidence from Home: The Cincinnati Chemical Works
The three largest Swiss chemical firms, Ciba, Geigy, and Sandoz (the first
two eventually merging to form Ciba-Geigy), were among the first important dye
manufacturers; as was the case in Germany, dye production formed the primary
basis for the Swiss national chemical industry. From dyes the firms expanded to
pharmaceuticals, pesticides, and other chemicals, and they are now among the
world's most important chemical manufacturers. Following the German model of
I. G. Farben, the Swiss dye manufacturers formed an Interessen Gemeinschaft
(I. G.), or community of interest, to control the production and marketing of dyes

(Emi 1979; U.S. Tariff Commission 1946).

In the early 1920s the Swiss I. G. established a manufacturing operation in
the United States, the Cincinnati Chemical Works, whose benzidine production
facility opened in 1929. As early producers of dyes, the cartel's original manufacturing facilities in Switzerland had experienced numerous bladder cancer cases
in the pre-World War I era. The relationship between BNA and benzidine exposure and bladder cancer was so apparent at these factories that by 1925 the Swiss
government recognized bladder cancer as an occupational disease in workers exposed to the materials (Hueper 1969). Ignoring the extensive epidemiologic evidence and the control measures in effect in factories at home, the Swiss managers
designed a benzidine production process with no concern about worker exposure.
Laborers at the Cincinnati plant shoveled benzidine by hand, with no controls
provided. Furthermore, no provision was made for medical screening or monitoring, or for keeping track of past workers who left the plant's employ (Eula
Bingham, personal communication, 1988; Zavon, Hoegg, and Bingham 1973).

Following the practices of Du Pont and Allied in this country, the U.S.
branch of the Swiss cartel treated the carcinogen as safe until workers at its own
factory actually developed the disease and the problem could no longer be ignored. However, it is unlikely that the Swiss I. G. was unaware of potential bladder cancer problems overseas, since the first cases of benzidine-related bladder
cancer appeared in 1938 at its British subsidiary, the Clayton Aniline Company,
Ltd., of Manchester. T. S. Scott, Clayton's medical officer, reported that by 1951
66 workers, including 23 exposed only to benzidine, had developed bladder cancer (Scott 1952).

When in 1956 the first recognized case of occupational bladder cancer appeared at the Cincinnati Chemical Works, the company management expressed

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surprise. A group of consultants from the University of Cincinnati, brought in to
start a bladder cancer screening program, later wrote,
From the vantage point of 1972, it may appear strange that in 1958, eight years
after Spitz et al. had used benzidine to induce bladder tumors in dogs and six
years after Scott had reported 23 cases of bladder tumors in workers without
contact with other known carcinogens, there would be any question about the
carcinogenicity of benzidine. Yet, it was obvious at the time it was neither generally known nor accepted that benzidine was a bladder tumorigen. Consultation
with those engaged in the manufacture of the material in the United States indicated that, as of that time, they did not generally view benzidine as a tumorigen.
Our statement that epidemiological evidence strongly suggested that benzidine

was a tumorigen came as a shock, and resulted in some troubled and anxious
managements. [Zavon, Hoegg, and Bingham 1973:1]

Because the personnel records at the plant were so poor, it was difficult to
identify exposed workers other than those employed at the time the first case was

discovered. Of the 25 men in this group, however, 13 had developed the disease

by 1972 (Zavon, Hoegg, and Bingham 1973).

The Upjohn Company
The history of benzidine production in the North Haven, Connecticut, factory, which was originally operated by the Carwin Company then purchased by
the Upjohn Company, is illuminating because its production of dye intermediates
began more than a decade after the highly publicized Du Pont epidemic. In this
case, there is clear documentation that the manufacturer knew from the onset of
production of the carcinogenic nature of benzidine, took only limited precautions,
and after realizing that their precautions were insufficient, later actually denied
having known the substance was a human carcinogen.
Carwin began benzidine operations at its North Haven plant in 1946 (Johnson and Pares 1979). The following year, clearly worried about the cancer risk
at the plant, the company contracted with several scientists associated with the
Institute of Occupational Medicine and Hygiene at the Yale School of Medicine.
With the collaboration of the U.S. Public Health Service, this group conducted a
series of studies on the routes of benzidine exposure and biological metabolism
of the substance among those exposed. Benzidine air levels were regularly monitored, and individual exposure levels determined. As a result, the group was able
to develop a rapid technique to measure benzidine metabolites in urine (Meigs,
Brown, and Sciarini 1951; Murray 1973). The level of activity at the plant focused
on benzidine must have been substantial, since the research team produced at least
five scientific papers describing different facets of their work there (Rye, Woolrich, and Zanes 1970). It seems likely that as a result of these studies exposure to
benzidine was reduced. In retrospect, however, the limited value of these new
procedures seems clear. As discussed above, Allied had already by the mid-1950s
acknowledged that there was no safe level of exposure to this carcinogen and had
installed an enclosed system for benzidine production (Ferber, Hill, and Cobb
1976).
Upjohn purchased the benzidine plant from Carwin in October 1962. Ignoring the extensive and well-publicized scientific work related to benzidine that had

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been going on at the North Haven plant for over a decade, corporate officials date
Upjohn's knowledge of the carcinogenicity of benzidine to 1964, and claim that
the discovery was somewhat fortuitous. According to a sworn statement by William M. Murray, the manager of the plant's Process Development and Control
Department,
In late October of 1964, The Upjohn Company was informed by another manufacturer that they had evidence of human carcinogenesis through industrial experience limited solely to benzidine. Following the receipt of this information, a
thorough and exhaustive reexamination was conducted of existing toxicological
data. After engineering considerations we determined that it was not economically feasible to obtain the known levels of exposure warranted by a known human carcinogen and thus The Upjohn Company decided to terminate manufac-

ture of benzidine. [Murray 1973:4-5]

While Murray was aware of the Yale studies done at the plant throughout the
1950s, he suggests that Upjohn had no prior knowledge of reports of benzidinerelated bladder tumors in exposed workers at other facilities. This seems unlikely,
since on the first page of the first article they published on exposure at the North
Haven plant the Yale investigators cited five studies containing evidence that
"workers who have been involved in manufacturing benzidine for periods of 10

years or more have an unusually high incidence of bladder cancer" (Meigs,

Brown, and Sciarini 1951:533).
A second "official" account of Upjohn's discovery of benzidine's carcinogenicity can be found in a 1970 article defending the safety of several related
aromatic amines. In Facts and Myths Concerning Diamine Curing Agents, authors Dr. W. A. Rye and Mr. P. F. Woolrich were respectively director and chief
of Industrial Health Services for Upjohn, and Dr. R. P. Zanes was director of
Health Services for the North Haven plant and a member of the Yale faculty. In
recounting the history of Upjohn's knowledge about benzidine, they assert, contrary to extensive scientific evidence, that it was only in 1964 that it became clear
that benzidine by itself was a carcinogen.
Prior to 1964, investigation of the experience and practices of other American,
English, and European plants in which tumors had occurred pointed to concurrent exposure to beta-naphthylamine. As workmen in this plant and one other
producer were not exposed to beta-naphthylamine, and neither had experienced
bladder tumors, it had been concluded that the carcinogenicity of benzidine
alone, if carefully handled, was not yet proved. Animal experimentation added
little since tumor induction was not comparable to the human experience [Rye,

Woolrich, and Zanes 1970:212, emphasis added].

It is worth noting that Upjohn was here taking the same position as had the
other dye manufacturers, 30 or, if we count the European experience, 60 years

before. Yet the absence of identified bladder cancer cases at North Haven did not

prove benzidine was not a carcinogen, no matter what the manufacturer hoped.
Evidently it was only the warning of a medical officer from ICI's Dyestuffs Division, coming on the day before Christmas 1964, that convinced Upjohn to treat
benzidine as a carcinogen (Rye, Woolrich, and Zanes 1970:212).
A 1972 inspection of the North Haven plant by the National Institute for Occupational Safety and Health (NIOSH) found evidence that working conditions

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MEDICAL ANTHROPOLOGY QUARTERLY

had been quite dangerous: "open centrifuges and filter presses had been used in
the manufacture of benzidine, and past exposures to workers in these operations
appeared obvious after viewing first hand some of the old equipment" (Johnson
and Parnes 1979:280). While the NIOSH scientists located six cases of bladder
cancer among past workers at the plant, there is no evidence as to whether these
cases were known to Upjohn.
The human cost of these years of exposure is only now being measured. A
cohort mortality study, published in 1986 by one of the Yale scientists originally
asked by Carwin to help reduce exposure, determined that the rate of bladder cancer among the workers with the highest exposure levels was more than ten times
that of the Connecticut population (Meigs et al. 1986:7).
Conclusion

The German dye industry discovered in 1895 that two of its most important
(and profitable) chemicals were bladder carcinogens. With the publication and
dissemination of the 1921 ILO report, the uncontrolled exposure of dye workers
to these carcinogens should have been eliminated. Instead, each U.S. manufacturer went through its own discovery process, ignoring well-publicized warnings
and allowing uncontrolled exposure to occur until the human cost became so obvious that it was no longer acceptable. Du Pont, with a high public profile and a
production facility that had received extensive public scrutiny only a few years
earlier, was successfully able to manage the public discussion of the situation.
While Du Pont scientists openly presented data on the outbreak at a series of scientific meetings, its managers were slow to institute changes in the production
process and attempted to muzzle their own toxicologist. In contrast, Allied made
little effort to protect its workers during this period and avoided public discussion
of the number of cases at its plant until decades after the epidemic began. The
Swiss I. G., repeating Du Pont's behavior but 25 years later, allowed uncontrolled
exposure until the epidemic began, while Upjohn, making little attempt to identify
bladder cancer cases and ignoring the well-developed scientific literature, became
concerned only after a strong warning from a physician employed at another dye
manufacturer. Once dye production began at each of these companies, corporate
managers did little but wait for the body count.
What thoughts went through the minds of these managers while production
was occurring? It is plausible that the corporate managers of Du Pont and Allied
were actually unaware of the scientific literature on bladder carcinogenesis when
they began production, although once the first cases appeared, this would not have
continued. A lack of information could not have been attributed to the managers
at Ciba-Geigy, Sandoz, and Upjohn. The tragic experiences of earlier manufacturers did nothing to encourage these newer ones to install the environmental controls necessary to protect exposed workers from bladder carcinogens. Hundreds

of workers died as a result.

This study is most profitably considered as part of an emerging literature on
the history of occupational health (Rosner and Markowitz 1987). There are striking parallels between the history of dye production and that of the industrial production of asbestos products (Brodeur 1985; Castleman 1984; Kotelchuck 1987),
beryllium (Zwerling 1987), and tetraethyl lead (Graebner 1987; Rosner and Mar-

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 CORPORATE DECISION MAKING AND BLADDER CANCER

227

kowitz 1985). Workers employed in the manufacture of these products were exposed to extremely toxic materials, while corporate managers and scientists ignored scientific evidence (much of it gathered by the industry itself) about the
hazardous nature of the exposures. Further, in each of these cases, corporate scientists played an important role in justifying management's production policies,
and attempted to limit the epidemiologic information released to the scientific
community and the public.
The dissemination of scientific information about bladder cancer among dye
workers at other plants had little impact on the decisions of corporate managers
to protect the health of workers in their employ. This chronology, like those of
asbestos and tetraethyl lead production, underscores the limitation of voluntary
compliance with workplace health regulation. Acknowledging that it could not be
manufactured safely, Switzerland banned BNA production in 1938, and Great
Britain followed in 1952. In the absence of state regulation in the United States,
Du Pont did not stop producing this carcinogen until 1955, and Allied continued
to manufacture BNA-containing chemicals through 1960 and to purchase it for
two additional years. Smaller companies maintained production, often with virtually no protection for their workers, until federal intervention finally began a
decade later (Johnson and Pares 1979; Stem et al. 1985).
Having seen the recalcitrance of some of the country's largest and most profitable chemical manufacturers about protecting their workers from exposure to
known human carcinogens in the absence of state intervention, it seems extremely
unlikely that employers will voluntarily protect workers from less obvious hazards. If, decades after BNA and benzidine were shown to be human carcinogens,
manufacturers chose not to protect workers until bladder cancer cases began to
appear and an epidemic was inevitable, it is unrealistic to hope that industry will
voluntarily protect workers from substances only suspected to be human carcinogens, or from ones shown to cause cancer in animals but which have not yet been
studied in humans.

For many years, the chemical industry did not regard itself as responsible for
acquiring, interpreting, or applying information contained in the extensive scientific literature about the relationship between dye manufacture and bladder cancer. The findings of this case study underscore the need for strong federal regulation of workplace exposures, as well as for active government participation in
the dissemination of technical information to industry, unions, and the public, in
order to curb similar epidemics.
NOTES

Acknowledgments. I would like to gratefully acknowledge the following colleagues
for the generous assistance and suggestions they provided me in the preparation of this
article: Barbara Aiken, Eula Bingham, Ernest Drucker, Alan Harwood, David Kotelchuck,
Alaine Krim, Steven Markowitz, David Rosner, Joel Shufro, Ida Susser, and Stephen Zo-

loth.

Correspondence may be addressed to the author at the Department of Epidemiology

and Social Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY
10467.

'This figure was calculated by adding the results of several recent studies to the compilation of cases performed by Hueper in 1969. As an estimate, it is likely to be an ex-

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MEDICAL ANTHROPOLOGY QUARTERLY

tremely conservative one, since it includes only cases identified in published epidemiologic
studies and case reports.
2There is no discussion in this article of the activities of either the workers at these

companies, or, where they existed, their unions. The history of workers' struggles to obtain

safer workplaces is generally more difficult to examine than corporate policies, because
written documentation of worker efforts, when it exists, is often not easily obtained. A
study of workers' reaction to the bladder cancer epidemics would serve as a very useful
complement to this case study.
3This large chemical manufacturer was founded and is still controlled by the duPont
family, and is known as E. I. duPont de Nemours & Company, or, in its shortened form,
Du Pont. For this reason, the spelling duPont is used here only for individual members of
the family or for the family itself; Du Pont is used for the name of the enterprise.
4The history of the development and uncontrolled use of leaded gasoline, resulting in

a particularly severe and global public health problem, has been documented by David
Rosner and Gerald Markowitz (1985). Their fascinating study raises many of the same
questions about the relationship of scientific knowledge, public health, and corporate decision making that are addressed by this and other articles in this issue.
5In the aftermath of World War I, the six German chemical manufacturers, including
three that are still of paramount importance in the global economy (Hoechst, BASF, and
Bayer) formed a cartel, named I. G. Farben, in an attempt to dominate the world chemical
industry. Dyes and dye-related chemicals were their most important products. (Interessen
Gemeinschaft Farbenindustrie translated is the Community of Interest of the Color Industry.)

Farben and Farben's chemical production played a vital role in the Nazi war effort.
Farben produced synthetic rubber and petroleum, without which Hitler's tanks could not
have stormed through Europe. Using production techniques perfected in manufacturing
dyes, Farben's factories also produced pharmaceuticals and munitions, as well as Zyklon
B, the poison gas used in extermination camp gas chambers throughout the Reich. Farben
built its own synthetic rubber and oil factory at Auschwitz (known as I. G. Auschwitz).
An estimated 25,000 prisoners were worked to death there, sometimes dying at a rate
greater than 1% per day (Borkin 1978).
6These agreements were not only in the area of dye production and sales. Beginning
in November 1919, with the ink of the recently signed armstice barely dry, Du Pont began
negotiations with the companies that constituted the Farben cartel for the organization of
a "World Company" for the synthetic manufacture of ammonia. By 1926, Du Pont, Farben, and ICI had also successfully divided up the world gunpowder market (Borkin and
Welsh 1943).

Multinational cartel agreements remained in effect into World War II, with U.S. and
British chemical manufacturers secretly continuing their collaborations with important

Nazi companies. In May 1942, a federal grand jury indicted the five leading U.S. dye
manufacturers-Du Pont, Allied Chemical, American Cyanamid, GAF (the U.S. branch
of I. G. Farben), and the Swiss-owned Cincinnati Chemical Works-for restraint of trade.
They were accused of price fixing, setting quotas for foreign markets, preventing other
companies from entering the field, and a host of other charges. Several other foreign manufacturers, including ICI and Mitsui Enterprises of Japan, were also named as parties in
the case. The trial, however, was delayed to avoid interference with the U.S. defendants'
war production activities. The case was settled in 1946, when all defendants entered pleas
of nolo contendere, and were fined a total of $111,000 (U.S. Tariff Commission 1946).
7Dr. Wilhelm C. Hueper, at one time one of the leading U.S. scientists in the field of
occupational and environmental carcinogenesis, devoted much of his life to the investigation and prevention of occupational bladder cancer. His books, which contain the most
important and complete chronologies of this tragic history (Hueper 1942; 1969), served as

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229

my primary source of information and inspiration for this article. Throughout his life, Hueper continually refused to separate his scientific work from his dedication to public health

and social justice. For a summary of Hueper's career, see Samuel Epstein's (1975) presentation speech when Hueper was awarded the Society of Occupational and Environmental Health's first Annual Award.

8Never forgetting Du Pont's role in the bladder cancer epidemic at the Chambers
Works, Hueper initially wanted the book's dedication to read, "To the victims of cancer
who made things for better living through chemistry." This was a caustic allusion to Du
Pont's well-known advertising slogan, "Better things for better living through chemistry."'
In the end, probably fearful of the company's retribution, he substituted, "This book is

dedicated to the memory of those of our fellow men who have died from occupational
disease contracted while making better things for an improved living for others" (Agran

1977).
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