Document 1gKO2nmxOLJX21yrmgw10q7jZ

AHLBORG--HYDROGEN SULFIDE POISONING IN SHALE OIL INDUSTRY 259 Comment The primary symptoms of acute poisoning due to inhalation of hydrogen sulfide in relatively high concentrations, the subsequent signs of damage to the central nervous system and the gradual disappearance of symptoms after t-he patients have been removed from the surroundings containing hydrogen sulfide make the diagnosis "sequelae of acute hydrogen sulfide poisoning" probable for all these cases. Except for case 3, these cases showed the following characteristics: A history of repeated acute poisoning; Symptoms of sequelae developing immediately or within a short period after acute poisoning; With few exceptions, two types of symptoms, a neurasthenic type and an otoneurological type, the latter of central origin; A period of recovery of about 1]4 months; Considerable increase in sensitivity to gas afterward--even to pure gasoline vapor. In regard to symptoms, the neurasthenic symptoms are of the usual sort: fatigue, somnolence, headache, lack of initiative, irritability, anxiety and poor memory, the latter afflicting engineers and foremen in particular. Further, decreased libido is a very common symptom, which was pointed out early, by Delpech,17 in 1865 (Celui qui a travaille an sulfure n'est plus un homme [one who from effect of sulfur is no more a man]). In the majority of cases, the otoneurological investigations, which have mainly been made according to Radmark18 (1944) and which will be treated more thoroughly elsewhere (Ahlborg and Blomqvist), revealed central damages as after head injury, i. e., by demonstrating nystagmus, in serious cases, or other vestibular symptoms. These lesions were reversible in most cases, but in one case they still remained three years after the poisoning. Special attention has been devoted to the existence of psychogenic reactions during the examination. These showed up most clearly on the tilting table, and in a few cases the tilting test could not be performed lege artis owing to their existence. They usually first appeared after the patient had been on the sick list for some time, which made one think of a Renten neurose (revenue neurosis). The cause of their development, however, rather seems to be the fear of having to go back to work where there is risk of being exposed to gas. Generally, the fear of gas is so dominating after an acute poisoning that it has even caused difficulty in treating with oxygen. The psychogenic reactions are therefore most easily avoided if..the patient is told from the first that he will not be permitted to work where he will be exposed to gas again. The average duration .qf the disease was 1)4 months. The symptoms of disturbed equilibrium and the headache disappeared first; the signs of fatigue, irritability and decreased libido remained longest. Therapy.--In cases of acute poisoning..with interrupted respiration, artificial respiration is of course indicated, as the heart 'continues beating several minutes 17. Delpech, A.: Ann. hyg. pub. et de med. leg: 19:65, 1863. 18. Radmark, K.: Acta oto-laryng. 1944, supp. no. 52. V to.1 Ml;