Document Evoy9k8ED2bVdGmZdGX6xVKjg

HARPER & BROTHERS PUBLISHERS New York and London INDUSTRIAL TOXICOLOGY COPYRIGHT, 1934, BY HARPER 4T BROTHERS PRINTED IN THE UNITED STATES OF AMERICA THIRD EDITION K-M V CONTENTS PREFACE INTRODUCTION HEALTH OF THE WORKING CLASS PROTECTION OF THE WORKER POISONING AGAINST vii ix ix xi I. Alkalies Acids ` Chromium II. Lead HI. Arsenic Mercury Metal-fume Fever I z 17 zo 64 72- . 81 IV. Othbr Metals phosphorus MANGANESE ANTIMONY COPPER ZINC CADMIUM VANADIUM NICKEL TBLLURIUM SELENIUM TIN THALLIUM TITANIUM * 86 86 S2- 96 98 IOZ 104 107 109 hi hi IIZ 123 116 V. Asphyxiants CARBON MONOXIDE V 117 117 t(*, 2-1 7 i VI CONTENTS Citfur CARBON DIOXIDE HYDROGEN SULPHIDE HYDROGEN CYANIDE VI. Benzene Toluene, Xylene Coal-tar Derivatives VII. Petroleum Derivatives PETROLEUM DISTILLATES ALCOHOLS ACETATES KETONES ALDEHYDES CHLORINATED HYDROCARBONS BROMINE DERIVATIVES VIII. Turpentine Carbon Disulphide Tobacco IX. Mineral Oils Occupational Cancer ' X. Radioactive Substances BIBLIOGRAPHY INDEX Ft[t I44 147 151 156 165 167 180 l8l l86 I9I I93 I97 ZOZ ZZ8 Z40 Z41 Z44 Z48 Z50 Z58 z7z 311 PREFACE It is clearly impossible to give anything like a thor ough treatment of such a subject as industrial toxi cology in the space permitted to a volume in this series, and, in order to avoid a superficiality which would rob the book of all value, I have deliberately neglected some important but very well-known poisons, such as mercury, arsenic, phosphorus, wood alcohol, and have devoted the space which might have gone to them to rarer but much more un familiar poisons, such as tetraethyl lead and radio active compounds. The newer solvents, especially the, chlorinated hydrocarbons, call for detailed treat ment since they play very important roles in modern industry and many of them have recently been tested by animal experimentation. Finally, there are two ancient poisons, carbon monoxide and lead, which, although very familiar can never be given cursory treatment because each year brings some new additions to our knowledge concerning them. In the selection of material, therefore, I have been guided by a desire to present what is most needed in a short review of modern industrial toxicology rather than a logically planned textbook. The literature up to January, 1933, has been covered. A. H. Flury and Zernik's textbook, "Schaedliche Gase" is frequently referred to in these pages. It will, however, be easier for Amer ican readers to consult the earlier work, "Noxious Gases'' by Henderson and Haggard, published in 1927, from which the German authors quote extensively. ST 0853295 INTRODUCTION Industrial poisoning is not so important a subject as industrial diseases in general, for not nearly so many working-people are employed in the danger ous trades as in the dusty trades or in hot and strenuous labor. But the effects are more definite, more is known about the action of poisons-, there fore prevention is better understood and a greater responsibility for prevention is placed on the state, on the employer, and on the physician. We can plead ignorance as to the exact cause of the high sickness rate and death rate of textile workers be cause we do not know what proportional part is played by the cotton or linen or wool dust, and what part by the fatigue of standing, of noisy, jar ring machinery, and what part is played by low wages, by the age or sex or nationality of the work ers; but when we are asked about the ill health of lead smelters or of workers in benzene coating of artificial leather, we can answer at once that we know the principal cause and that if there are other causes they are only contributory. That is why the study of the poisonous trades, which affect relatively few workers, is highly important because the knowl edge is available which is necessary for their control. Health of the working-class.--The men and women who make up the industrial class have cer tain physical handicaps as well as a general physical IX x INTRODUCTION inferiority, which is reflected in their higher death rate from all diseases. Dublin (122) says that the mortality of males who carry industrial insurance is higher than the average for all males from age 25 on, reaching an excess of 43 per cent between ages 45 and 54. The most important causes are the lesions which re sult in an inordinately high death rate from cerebral hemorrhage, Bright's disease, and organic diseases of the heart.1 These, Dublin attributes to the effect of long-continued strenuous labor, exposure to ex treme heat, to rapid changes of temperature, and to specific poisons. Several recent studies of industrial workers have revealed a marked deviation from the normal stand ards. Thus hypertension above mean insurance standards was found' by Floyd P. Allen (5), of Cincinnati, in 249 out of 1,000 negro factory work ers; and Wychgel (648), of the American Steel & Wire Company in Cleveland, in an examination of 354 white workmen over 55 years of age, found 73 per cent with a blood pressure higher than normal for their age. He regards a persistent systolic pres sure of 150 and a persistent diastolic pressure of over 100 as pathological at any age; and in the men examined by him, 27 per cent only were not over 150/90, but 47 per cent had up to 170/110; 22 per cent had up to 200/120; and 4 per cent over 200/120. This means that in the examination of men ex posed to certain industrial poisons the control used 1 See also Sydenstricker and Britten (3S1). INTRODUCTION xi should alwaysba a group drawn from the same eco nomic class, not the average of all the male popula tion. Mayers (385), of the New York State De partment of Labor, examined 481 lead workers and found a high proportion of early arteriosclerosis and hypertension, but when she checked up the findings by examining non-lead workers of the same eco nomic class, she found no significant difference be tween the two groups, and what had appeared to be evidence of the effect of lead proved to be evidence only of the effect of hard, unhealthful labor. An other significant fact was brought out by Smyth (363)j in his examination of spray painters. He found that the normal standard for blood counts must be modified somewhat in dealing with men and women in industry, that the average red-cell count is lower, 4,500,000 for men, 4,000,000 for women, while the white-cell count runs higher, 10,000 or over, this last being due probably to the prevalence of focal infections. Protection against poisoning.--(1) Plant man agement.--The prevention of industrial poisoning is primarily the task of the engineer, but the phy sician can always make valuable contributions in this field, and in well-managed establishments he is given a very important part to play. There can be no efficient system of protection unless the men in charge understand how the particular poison they wish to guard against makes its entrance into the body, whether with the inspired air or through the skin or through contaminated food and tobacco. A great deal of money has been wasted by well-mean- xii INTRODUCTION ing employers who sought to protect lead furnacemen or oxide roasters or white-lead grinders against poisoning, by providing baths and lunchrooms and clean overalls and mouth washes and such, instead of preventing the escape of lead into the air the men were obliged to breathe, and unfortunately this has sometimes been done under a physician's advice. It must never be forgotten that the great majority of the industrial poisons enter the body with the in spired air and that while a workman eats only three times a day he breathes sixteen times a minute dur ing the eight or ten hours of his working-day. For the majority of industrial poisons, therefore, the preventive measures must be planned with a view to keeping the air of the workshop free from poison. These measures may be briefly summarized as follows: (a) Prevent formation or escape of gases, fumes and dust. (b) If (a) is impossible, remove by means of ex hausts. (c) If (b) is impossible, dilute as much as pos sible by abundant ventilation and by fans blowing air past the face of the worker. (d) If all these are impracticable, protect the worker by a filter-mask, absorbent gas-mask, or positive pressure air-mask.1 (e) If all the above measures are impracticable, select men with proved resistance to the poison and put them on in short shifts. 1 For information as to the selection of an appropriate mask, apply to the Bureau of Mines Experiment Station, Pittsburgh, Pa. INTRODUCTION xm () For poisons which enter through the skin, prevent escape of fumes and dust and pre vent spilling of liquids. (g) Maintain scrupulous cleanliness of benches, apparatus, etc. (h) Provide and launder washable workingclothes. (i) For all, provide adequate washing facilities and a clean lunchroom. Workers with poisons that enter through the skin and workers exposed to excessive dust in the air should have shower baths provided, with hot water, soap and towels. Medical service.--The above measures come un der the domain of the management, the following under that of the physician: (a) Selection of employees: This involves the determination of the specific hazard in each job and the selection of individuals who are apparently fit to be given the dangerous ones and of those who should be assigned only to the relatively safe jobs. Several factors will have to be considered in this connection, such as race, youth, sex, physical consti tution. Race.--With regard to race, experience points clearly to a greater resistance on the part of negroes to skin irritants. The Chemical Warfare Service found them far less susceptible to mustard gas than white men. I found them less susceptible to TNT dermatitis, and they are often selected for work with such skin irritants as dinitrochlorbenzene because of XIV INTRODUCTION this characteristic. On the other hand, there is evi dence pointing to a greater liability in negroes to the severer forms of lead poisoning, especially to acute encephalopathy. There is a belief widely held by practical men that blonds should not be employed with skin irritants nor with those poisons which en ter by way of the skin (aniline, nitrobenzene, etc.), and this seems a reasonable precaution. Youth.--The youthful of both sexes are more likely to suffer rapid and severe intoxication than are the mature, as we found during the war in con nection with TNT and the English in connection with tetrachlorethane. There is a striking number of young women among the reported instances of severe benzene poisoning and of lead poisoning in lithotransfer work and in type founding. Fortu nately there is little employment of minors in such work in this country, but the physician should not forget that physical immaturity lasts longer than legal minority. Experience with munitions poisons in factories and with carbon monoxide in the trenches pointed to a greater susceptibility among the men under 25 years than in the older men. Sex.--It is less easy to speak with authority about the part played by sex in susceptibility to poisons, for the subject is clouded by such extraneous factors as national mores (Latins and Anglo-Saxons differing decidedly), competition for jobs, sentiment, desire for cheap and docile labor, etc. There are some facts, however, which seem incontrovertible. One is that women in industry average much younger than men, they are largely massed in the early-age INTRODUCTION xv groups, and thr&dias a bearing on their susceptibility # to illness. Statistics show that they have more days of absence from work on account of sickness than men do, and this is true in all age groups and for all diseases except rheumatism and hernia. With re gard to lead, there is good evidence to show that women develop plumbism more rapidly than men and have a greater liability to encephalopathy (Oliver (446), Prendergast (489), Newman et al. (434)). Striking figures are found in the German Factory Inspection reports concerning the incidence of dinitrobenzene poisoning during the war, when the men in the munition plants were chiefly those unfit for military service, while the women were the general average of the working population, but the men had a much lower rate than the women. Benzene, which causes aplastic anemia, with tendency to hemorrhage, is obviously more dangerous for women than for men. There are also industrial poisons which have an abortifacient action (see Lewin (349))Idiosyncrasy.--If the industrial physician could at his initial examination discover and reject the over-susceptible among the applicants for employ ment, he would save himself and his employer a world of trouble, but it is as impossible for him to do this as it would have been for him to discover the recruits who would prove to be susceptible to influenza-pneumonia. One may feel sure that an alcoholic, a nephritic, a victim of intestinal ulcer, must not be put on lead work; that anemia and still more hemophilia, are contra-indications for ST 0853302 rvi INTRODUCTION work with benzene; that the man with latent tuber culosis must not be exposed to nitrous fumes; but one cannot feel any confidence that the individuals who seem in perfect health will prove to have a normal resistance to any given poison. Individual susceptibility varies markedly even in animals, and in man it constitutes one of the most troublesome factors in the practice of the industrial physician. Fifty women worked in a can factory with a ben zene-rubber sealing compound, some of them sev eral years with no apparent harm. One girl worked for a month and died from aplastic anemia and hemorrhage. In a plant making bearing-metal (al loys containing lead), no known cases of lead poisoning had occurred for several years, yet one man, no more exposed than the others, suffered a severe attack of encephalopathy. Perhaps the most striking demonstration of varying susceptiblity to a poison was furnished by the experience of a British submarine crew during the war. While the sub marine was submerged there was an escape of arsine gas from the storage batteries, and the crew of 30 men, all selected for physical soundness, were ex posed to exactly the same amount of arsenic for ex actly the same length of time, yet they differed markedly in their response to it. One was not af fected at all; seven had anemia and jaundice (the severest case had a count of 1,980,000); the rest had symptoms of anoxemia but not severe enough for hospital treatment (Dudley (125)). (b) Medical supervision.--(I) Of employees. The only way to detect the over-susceptible in time INTRODUCTION xvn to avoid actual-injury is to keep new workers under observation for the first few weeks and to shift them promptly to other work if they show signs of poison ing. This involves periodic physical examinations at fairly short intervals and may require blood ex aminations (especially for lead, benzene, tetrachlorethane). All employees exposed to poisons should have regular medical examinations, but the fre quency varies according to the degree of exposure. It is also the duty of the physician to instruct the worker as to the particular danger he faces, the way that danger should be avoided, and the symptoms which should be promptly reported if they appear. The wise physician will not hold the worker respon sible for matters which are beyond his control, such as the presence of dangerous fumes, gases, dust, but only for those which he can himself avoid.' It is a great error to think that by clearly explaining the nature of the danger you will frighten the workman away. He knows the work is dangerous, but unless he is dealt with frankly he is likely to imagine that everything is equally dangerous and he cannot deal with the real risks intelligently. (II) Of conditions influencing health. Food and alcoholic drink are important factors in industrial poisoning and must be considered even if they can not be controlled. The influence of food on lead poisoning is notorious and for many years English and German employers have furnished milk free to lead workers on empirical grounds which have since been amply justified (see page 24). The effect of semi-starvation in increasing dinitrobenzene poison- XVI11 INTRODUCTION ing was shown clearly in Germany as the food blockade tightened through the years of the war. Alcohol acts upon the tissues of the central nervous system as do such industrial poisons as aniline, nitro benzene, ether, and the chlorinated hydrocarbons; and practical experience shows their action is greatly enhanced by alcoholic drink. This is strikingly true of carbon tetrachloride (see page 206). Alcohol also acts synergistically with lead and with mercury. (Ill) Of the conditions of work. Hours of labor, excessive exertion, extreme heat and humidity, are factors outside the doctor's domain; but he may be able to exert some influence over them in view of the fact that all have an important bearing on the action of poisons. The longer the hours of work, the greater the daily dose and the shorter the period allowed for the elimination of one dose before an other is absorbed. Legislation in several foreign countries prescribes short hours for certain very dangerous jobs; and experience in this country has led some employers to adopt similar restrictions. When the physician finds that his advice as to mechanical ways of preventing contamination of the air is rejected by the practical men, he can always fall back on this measure, for though the dangerous work may have to go on, the workers can be shifted at intervals too short to permit of a dangerous dose of the poison being absorbed. Excessive muscular work increases intoxication, not because of fatigue, but because the man must breathe more deeply and thus take in more. Lutkens (363), in Lehmann's laboratory, tested working and resting animals with INTRODUCTION xix a narcotic poison* carbon tetrachloride CCU, and got a greatly enhanced effect in the former because of their deep inspiration. Heat and humidity in crease the absorption of those poisons that enter through the skin, such as the coal tar derivatives, and munition workers during the war suffered much more from trinitrotoluene and dinitrobenzene in hot weather than in cool. Leites (343), found that heat increases the effect of those poisons also that enter with the breath, but here it is simply another case of increasing the depth of inspiration.