Document XJOL0zEa86B9jg3n4MzKMraG

.tna- l--.............. . 13 <7- , THE JOURNAL OF INDUSTRIAL HYGIENE AND TOXICOLOGY VOLUME 21 JANUARY, 1939--DECEMBER, 1939 PUBLISHED BY THE WILUAMS & WILKINS COMPANY Baltimore, Md. MOMS G97i3G t ... CONTENTS OF VOLUME xi JANUARY, 1938. NUMBER 1 Determination or Acid Insoluble Matter in thr Sputa or Siuootics. H. Civin, I. A. Schreier, G. Martello and J. D. Hardy............................. Thi Basophilic AaoiiBOATioN Test ArrLiED to Cement Workers. F. R. Holden and C. E. Ralston................................................................. Th> Metabolism and Retention or Lias ih Growimo and Adult Rato. J. B. Shields, H. H. Mitchell and W. A. Ruth............................................ A Cask or Fatal Gas Poisoning in Wilding in a Closed Tank. R. J. WrigbLSmith................................... Boor Reviews............................................................................................... 1 S 7 24 27 FEBRUARY, 1939. NUMBER 2 The Systemic Errdots Resulting ntoM Extosurb to Certain Chlorihated Hydrocarbons. Leonard Qreenburg, May R. Mayen and Adelaide Ross Smith....................................................................................... The Erracr or. Certain Imtimobment Oust Samplino Instruments on the Dust Particles. E. L. Anderson................. k........................... Tub Toxicological Study or N-Isobuttl Amides or Aliphatic Acids. W. Dcichmann-GruBbler................................................................................. Report or the Use or Biopbotometir and Vitamin A Theraft nr Industry. 0. H. Sehettler, R. F. Bisbee and B. H. Goodenough___ Book Reviews.............................................................................................. 29 39 48 S3 66 ' MARCH, 1939. NUMBER 3 Ventilation in the Granite Industry. Edward C. J. Urban................. Increasing the Portability or the Baubch ft Lome Dust Counter. Leslie Silverman and Charles R. Williams................................... The Physiological Restonsb to Isopropyl Ether and to a Mixture or Isoproptl Ether and Gasoline Willard Maehle, E. W. Seott and Joseph Treon.................................................... .--................................. DuruYTRiN's Contraction among Upholsterers. Kenneth O. Smith and W. Eugene Masters................................................................................. Book Reviews ........................................................................ 67 67 72 97 APRIL, 1939. NUMBER 4 . The Shattering or Dust Particles ev Impinosrs. D. G. Beadle.......... 109 A Note on the Shattering or Duet Particles by the Impinges. >H.H. Watson............................................................................ III . | j | | 1 | I I I .! j 101 121 i I' MOMS 097331 I .. i ys IRW.WW EPtfjNaHWWISi WWfH I1*--A W*Pi< Pr--~-r------- iv ' JOURNAL or INDUSTRIAL HYGIENE AND TOXICOLOGY IxniAU I'nkuuonia in Antmiiaoitr Minims, Moutality and ComtucaTioN Statihtics. Arahiltnld C. Colinn Mid ILjU ft Clmrr................. 134 Aouth Kimvi.hnm IJiimiAjuiuii I'oiMONlNd. ZolUm T. WirlAolmltor anil Kdwiml IX Schwarts............................................................................... 130 Tin Uiiinaiiy Sulyati Tin in tun SursuvisioN or Workers Exposed to Bkniknc. C. M. Jcphoott and F. M. R. Bulmor.......................... 133 Tin Years' Extbriencb with Industrial Hyoixnd in Connection with the Manutactuee or VucoEC Raton. H. L. Barthelemy___ 141 Boo* Review*........................................................................................................ 162 MAY, 1039. NUMBER 3 Fobtheh Obeehtatiohs oh the Possible Systemic Toiucitt or Certain or the Chlorinated Hydrocarbon* with Soooestionb tor Pkruibsible Concentrations IN IBB Air or Workrooms. C. K. Drinker........ :................................................................................................... 166 The Toxic Errscr* uroN Rabbits or Pehtachlorofkenol and Sodium Pbntachlor6hbnatb. Robert A. Keboe, Wm. Deiebnuuio-Giuebler, sod Karl V. KitsmiUsr................................................................................. . 160 The Toxicology or Sou* Qltooli and Derttatiybe. Edwin P. Leu*, Herbert 0. Calvary, Herman J. Morris and Geoffrey Woodard............ 173 Note on an Improved Cell toe Dost Coonting. Karl L. Dunn.......... 303 JUNE, 1939. NUMBER 6 The Treatment or HiDRorLuonio Acm Bohns. A. Tbelwall Jones___ 305 Ted Treatment on Comprehend Air Illness Utiluino Oxtoen. O. D. Yarbrough and A. R. Behnke...................................................................... 313 InvEanoATioNs on the Possible Carcdiooenic Eptect or Anthracene and Chrtsene and Soms or THEIR CoMrooNDS. I. The Emcr or Paintino on the Skin or Mice. Joseph A. Pollie............................ 219 Decomposition or Halooehatbd Hydrocarbon Vatore by Smoking. Harvey B. Elkina and Lao Levina.............................................................. . 221 A M ethod or Coontinq Samples Takxn with the Ihpinoer. Charles R. Williams..............................................................................................................226 SEPTEMBER, 1939* NUMBER 7 Henry K. PancoasT: In Msmoxuk.......................................................... 231 Duputtrsn's Contraction as an Occupational Disease. L. Teleky.. 233 Tbs Acute and 8ub*Acutb Toxicity op Moephounb. Thomas Emmett Shea, Jr............................................................................................................... 236 Tbs Coding or Occupations rom Macbins Tabulating Purposes with Reference Principally to Studies on Occupational Morbidity. Harry E. Seifort................. .......................................................................... 246 A Vapor Pressure Method for res Estimation op Volatile Solvents. Charles E. Couchman and Wilmer H. Schulse......................................... 256 A Vapor Pressure Method foe Determination or the Concentration or SoiiE Organic Bolvbmts in An. Kingsley Kay, George M. Rssos and Philip Drinkar........................................................................... 364 A Nkw V Buuvkv r nn.ni im.ovi itii'l H Book Ulv CnnoMc F. Manfr CnuoMc J-; F. T. i Chromic J. SUM*. Bekiekk (; IN N`|. GoJdn. The Hema\ A. Erf Boor Rev:. TreOmitih Fraderr SPECTROSCOf D. W. \ VOLATIUEA/ Drinker PossniiuTi.. 24 Ho: i Calibrator Book Rcvu- A Study or CARBON.- Use or t: Harrol i Tissue Ri \ J. Perry Acute Po> TJIACIf.. MncQiii The Diana Expxj.r Arthur Index to V MOMS 097332 I 134 130 133 141 133 . 135 i > . 100 .' 173 . 303 iit I I | . 305 X . 313 w >r .. 310 o. ..331 R. ..330 ; i I .. 331 .. 333 Ott in TV. ...340 m. ... 350 ION M. ... 304 V ' CONTENTS v A New Veron rniMuua Instrument tor Determining Oroanic Sol vents in Air. Leslie Silvorman, Gooige M. Recce and Philip Drinker. 370 Svavav in Seventeen Cement Plante or ATMoaniRRic Dusts and tiiant Erracra uron tun Lung* or Twnntv-Two Hundred EmriGYre. Ixiroy U. Gardner, Thomas M. Durkan, Daniel M. llnimfiol and llomer L. Sam|iaon.......................................................................... 370 Book Reviews ............................................................................................... 310 OCTOBER, 1030. NUMBER 8 Chronic Exrosuns to Bbnimnn (Bemiol). I. Thn Industrial Aspects. Manfred Bowditch and Horvay B. Elkins............................................. 321 Chronic Exposure to Bbnsbnb (Bnnsol). II. Tub Clinical Aaracra. F. T. Hunter............................................................................................. 331 Chronic Exrosuns to Bbnienb (Bbnsol). III. Thb Fatholooic Re sults. Tracy B. Mallory, Edward A. Gall and William J. Bricklcy.. 355 Brnibne (Bbnsol) Poisoning in the Rotogravure Printing Industry in New York City. Leonard `Greenburg, May R. Mayen, Leonard Goldwater and Adelaide R. Smith......................................................... 395 Thb Hematological Emcn or Bbnshnb (Bbnsol) Poisoning. Lowell A. Erf and C. P. Rhoads......................................................................... 421 Book Reviews............................................................................................... 436 NOVEMBER, 1030. NUMBER 9 The Ophthalmic Responsibilities or THE Industrial Medical Opricer. Frederick Ridley..................................................................................... 439 Sprctrosoopic Analysis or Biological Fluids tor Heavy Metals. D. W. Armstrong End F. S. Brackett................................................. 448 Volattusattom or Lrad Below 800*C. Paul F. Resin and Philip Drinker .................................................................................................... 461 Possibilities or Control or Lead Exposure by Examining Lass than 24 Hour Urine Samples. E.C. Barnes............................................... 464 Caubeatioh and Use or na Gas Iotwbtbrombtbr. F. A. Patty......... 460 Book Reviews.............................................................................................. 476 . DECEMBER, 1930. NUMBER 10 A Study or the Fati in na Oroahism or Some Chlorinated Hydro carbon*. H. M. Barrett, J. G. Cunningham and J. H. Johnston.... 479 Usn or thb Interperombysr tor Two Componsnt Mixtures. G. C. Harrold and L. E. Gordon............................................... ;.................... 491 Tissue Reaction to Bomb Carbon Arc Dusts. E. L. MacQuiddy, J. Pony Tollman, Leroy W. la Towsky and Stanley Schonbeiger-----498 Acutb Poisohino Animals aster Intraferitonsal and Intra tracheal Adminibthation or Dusts. J. Perry Tollman, E. L. MacQuiddy and Leroy W. La Towsky................................................... 514 The Distribution or Electric Cdrrrnt in the Animal Body: An Exfsrintotal Investigation or 60 Ctclb Alternating Current. Arthur Wt Weeks, Leo Alexander sod Reginald M. Dennis................. 617 Index to Volumb 21..................................................................................... 527 v v,"]TO a 1W*S90^p^|||lRI4.i.tifipW9lmiNi.ii'fWsss'iw<iw.iiw^ HONS 097333 tt, M*. / < ffrw#. ,n well to > bclwrrn {th many f.' and th ' irrloua. tcnMiloo ! i) health, j.l dlacnaa | rationed. ' ional dt* : ifie) with . f #* w* utmrnt of ^ matin In* in another frw worda 1 nc what to ', oyanldo, , ient la otlU >a la noeea* .cl volume uformation that other* to many denla of inaafaty and H abould ' pperiling h more com| .aular tpo Induatrin) . ration, will methoda of \\\ Itaader, iau <i*mt* Adam and r.-W). \\ tlw hiatory well known Ulttlmleir. the . n liitglnnd in r of tenera liver eanrr, IT, caiiMnl hy , -L. rafafty. i I Fi.il 19345 ^ . . ......................... - , \ THE JOURNAL OF INDUSTRIAL HYGIENE AND TOXICOLOGY tu^,t Volume 21 FEBRUARY, 1938 Nombee 2 THE 8Y8TEMIC EFFECTS RESULTING FROM EXPOSURE TO CERTAIN CHLORINATED HYDROCARBONS* Leonard Greenboso, Mat R. Mater* and Adelaide Row Smith Divrnon of Industrial Hylton*. How York Stall Oopartmnt of Labor, How York City HLORINATED iwphthalenea product is present. On the whole, and diphenyl*, beesuw of their the higher the ehlorination, the more electrical, heat and moisture- toxio this material becomes. In the resisting properties, and because they manufacture of chlorinated diphenyls, are non-inflammable, are uaed exten CH is converted into CuHi# whieh, in sively (or insulating win and in the turn, is chlorinated to CiCIjB; the manufacture of electrical condenser*. The chlorinated naphthalenes am naphthalones in whieh one or more of llio hydrogen atoms has boon replaced by chlorino. Thoro is, thus, a sories of tlieso substances beginning with inonochlornaplithalono and going on to tho pclochlor dorivativo. In in dustry llioy usually occur in mixtures in which more than ono chlorinatod substitution products range from the monochlor to tho docaehlor diphenyl. A rathor characteristic aeneform skin eruption resulting from exposure to these substances has been recognisod for a great many years--indeed, over since thoy began to be manu factured about 25 years ago. Theso skin ortiption* camo into somo prominoneo in Germany during tho war ami havo boon attracting sporadic interest * ltemived (or publication Boptember II, in this country over sinco. An in ms. Tito olilorinotod naphtimlonop *ro oomo* vestigation of this condition, as it ap limn* ruforrml to a* "IUIowm" by pur- peared among a group of young work KofiMcroniMl iMcro. While Urn ffatawax OnrtrUiin mnnufooturoN Umnw wilinVuiwifs ers engaged iu tho manufacture of nlmt insnuUnturea many ntimnt. Mine olontrioal condensers, was reported in a the tsrrm **lln1ow*aH la merely a Imtlo noma fur aubalanara manufantureri by thU reoonl Ihmuo of this Journal (1). Company, it should not bo used India- Exporionco has shown that tho medi ehmiaatoly. In alt inotaaeoo, aubotnnooo cal practitioner is still somowhat un should ^bo daaignatad by thalr oh--joal familiar with the skin eruptions, even MONS 097334 .' .;' (' | . ' v, . * '' .' 30 JOURNAL OF INDUSTRIAL HYGIENE AND TOXICOLOGY M. it, no. though they are by no moans uneom- and (C) givon off at I02*C and 172*C mon in the induulrice whore tho chlo- respectively. Largo doses, approx rinatod naphthalenes and diphenyls imately 16 mg. per kg, were injected arc used, Tho reason for this is that subcutaneously each day. any one physician is likely to sea such Animals receiving compound (A) casosonly rarely, unless he happons and the sublimate of compound (B) to bo practicing in the immediate vi showed no lesions attributable to these cinity of one of these factorise where substances when killed at the end of largo numbers of workers are em 2 months. The 30 animals, however, ployed. That the relatively rare sys which had received the higher chlo temic effects resulting from such rinated compounds (B) and (C) and exposure almost invariably go un the sublimate of (C), all died in from recognised is not surprising under the 12 to 26 days. Autopsies uniformly circumstances. It is of the greatest showed extensive damage. importance however, that physicians The next important study to be become acquainted as promptly as pos published was that of Drinker, Warren sible with the clinical and pathological and Bennett (4). These investiga pictures presented by these patients, tors administered chlorinated hydro particularly as regards systemic ef carbons by inhalation, subcutaneously forts, since failure to detect early and by mouth, to white rats. Mix clinical manifestations of toxicity, and tures of (a) tri- and tetrachlomaphtha- to remove susceptible individuals lene; (b) penta- and bexachiomaph- promptly from further exposure, may, thalenealoDe,and (c) with 10% refined on occasion, result fatally. chlorinated diphenyl; and (d) chlori Esvisw OF LlTSftATVRB ON gvSTCKIC Emcn* Experimental etudie*.--The first nated diphenyl were used. Briefly, these experiments showed, that the tri- and tetrachlomaphthalenes produced relatively unimportant mention in the literature of systemic pathological changes in the liver until effects from chlorinated naphthalenes extremely high concentrations were is that of Lehmann in 1919 (2). He used. Animals exposed for 6 weeks to found that animals which were fed or the higher chlorinations, however, in 4 which inhaled these substances lost relatively low concentrations, regularly appetite and at death showed "pecu showed minor degrees of liver damage liar" lesions in the liver. even though, as a group, they gave no ' In 1930, Flinn and Jarvik (3) ex clinical evidences of such toxicity perimented on rabbits with three dif while alive. Exposed to still higher ferent compounds; (A) a mixture of tri- and tetraehlomaphthalene, (B) g mixture of tetra- and pentarchlorNaphthalene and (C) a mixture of 'pent*- and hexa-cblomaphthalene. They also used sublimates of (B) concentrations, the rate lost weight and appetite, and began dying after 3 days' exposure--many with severe jaundice. Examination of the liver of these animals at autopsy revealed marked central fatty degeneration * A review of the literature on skin masi- with necrosis of liver cells. foslatioMiappeared in thsartiels by Mayen uf OUvorborg a--tlseod sbov (1). It is of considerable interest that re: Du N )> puixw Jmv Ioxj riiwil will I M< of k Don 11' WV ' W MQNS 097335 *> ***;" \ TV. (A) ' () id of ever, chlo* i and from [irmly . to bo `arren . Hydrocounly Mixphiha- tmn;>hrefined1 chlori- I i [ [ J i j 1 i ihowod, aphthaportant or until is wore seek* to ever, in vgularly damago. gavo no toxicity U higher V weight ig after S a aevere the liver revealed [coeration | j . i 1 j mat that JVk. tm| 8Y8TKMU1 Kl'KKtrrrt OK OllUMUNA TKD HYDHOOAIMtONH 111 tlu> 1`xponnl rain, '\vMi*h giivo no rllnl- i*al ovitiiMM'i'ii uf |Ht>m|>Uy illnl from mailt' yt()mv nlmpliy of Ilia Hvnr Wlion given a vary mimll dono of imwIhmi totrarlilmMln - a dom* well tolerated by control niiinmln. Two other point* of interest wero brought out by tlie study: (1) in the rats, which on autopsy showed even marked pathological lesions of the liver, no abnormalities were found in the other organs--a finding not un common in experiments on animals, but rathor rnro in humans who dio from acute yellow atrophy of the liver; (2) even the less important patho logical changes induced in the liver by these chlorinated hydroerbons in the lower concentrations were found to be very persistent, being present even 2 months after cessation of exposure. Clinical Reports.--Clinical reports of eases of systemic poisoning from the chlorinated naphthalenes are as yet rare in spite of the length of time that these substances have been in use. No doubt the infrequency of such re ports has been, in part, due first, to the fact that eases of systemic poisoning are unusual occurrences--the ele ment of individual susceptibility appearing to play an even more im portant r&le than usual in this situa tion--and second, to failure on the part of physicians to recognise cases of poisoning. Until recently there has boon general look of knowledge of the toxicological properties of these chlo rinated hydrocarbons, and there is still relatively little information avail able regarding the clinical picture of industrial poisoning from them. The danger that lies in such a look of knowledge is exemplified in a situa tion that recently earn# to the atten tion of the l.ultor OppHilim'til In Now York Mtutn, hi wMnli o pltyoirioo hot) Inhh Inviting 11 ftovpt'p rum of Joiuirtion in n youiig woiiiiiii ok|hhumI (,<* ohlorluatnri tififriillmlonflM. After 11 long and BorioiiM illnww, when tho girl won on her way to recovery, tho phyoician expressed the opinion that within a few weeks she would be able to return to her former work. Whatever tho cause of the jaundice in this case, there is good reason to believe, on the basin of the experimental work previously eited, that further oxponurc to nuch substances would havo entailed a grave risk to the patient's life. In 1994, Courtois-Suffit (6) reported on the work of Touraine who, with his associates, examined 60 workers ex posed to triehlomaphthaleno and found mild digestive disturbances and dissincss in 13, but nothing of a more serious nature. In 1935, Schwarts suggested the possibility of systemic disease from exposure to these substances in a talk before the American Public Health Association (6). In 1936, three fatal cases 0/ jaun dice in chlorinated naphthalene work ers were recognised in this country. These were reported by Flinn (3) and Drinker (4) who summarised the eases briefly. All three of the men were young and in none could any predisposing cause other than their industrial exposure be found to account for their illness. Two of the men who had worked side by side died within 2 months of each other. Both had been exposed to mixtures of pent*- and hexachlomaphthalene, and one had been exposed to a mixture of tetra- and penta-ehlornaphthaleae with 10% chlorinated diphenyl. In both, the I ! I t HONS 097336 32 JOURNAL OF INDUSTRIAL HYOIENB AND TOXICOLOGY (wl, *1, no. < diugiuMM of acute yellow Atrophy of tho liver >h made on autopey. In the third case no autopay was reported, but death oocurred after an acute ill ness characterised by jaundice. In one case dermatitis characteristic of the effect of chlorinated naphthalenes had preceded tbs jaundioe. In addition to these fatal eases, Drinker (4) also mentions four eases of hon-fatal jaundice amopg indi viduals with similar exposure. No details on given. Cass Bisrowns Because of the obvious need for more clinical data in regard to the effects of chlorinated naphthalene ex posure, we are reporting 3 eases in persons who, after exposure in the course of their work to these known hepatoxic substances, died of acute yellow atrophy of the liver, and in whose cases no other etiological factors could be discovered even after very careful investigation. The first case was seen in consultation at the Lin coln Hospital in New York City by Adelaide Ross Smith. The second and third cases were seen in consulta tion at the New Haven Hospital by Dr. Leonard Groenburg, (now Execu tive Director of the Division of In dustrial Hygiene of tbs New York State Department of Labor) when he was Commissioner of Health of New Havon, Conn. Tho plant conditions undor which the patients had worked were carefully investigated. Caw I. H. f.' A 17 year old girl u admitted to the Ltnooih Hospital, How York City, on tho Grateful acknowledgement It mad* of tha eourtesy extended by tho staff of Uaoota Hospital aad tho Medina! Kiwlw'l Often La prsatfeg service of Dr*. Kennoth Taylor, Edwin Hauser and Beott Johnson on April 96,1913 la a semi-comatose condition. Sh* was Intensely jaundieed on admission. Hor past medical history, obtained from members of the family, was entirely nega tive with the exception of a tonsillectomy in 1990, Until tha onset of tho present illness tho had boon unusually healthy and free from symptoms of any kind. Tha occupational history vu as follows: After being graduated from grammar school he attended high eohool for 1 year and then obtained a job, her only ono, with aconcern manufacturing electrical condensers for une la radios. She worked at this one place for 7 months aad stopped wdrking there 7 days before her admission to the hospital. Her work consisted of soldering and labelling condensers. H is possible, from the information given, that she may also have assisted in the sealing operations, but this eould not be definitely ascertained. In any event, in the soldering of the con densers she was exposed to the fumes of triand totraebloraaphtbalene with which the condemn were originally impregnated. At the same time the was exposed to fumes of tha higher chlorinated naphthalenes from the sealing operations eonducted in oloee proximity to the tables at which the solder ing was dons. The present illness began about 6 months before admission to the hospital--or ap proximately Smooths after starting work in the plant--at which time she noticed several pigmented areas oo her face. These con tinued to increase in severity and extent, and caused her to visit the outpatient de partment of the Lincoln Hospital. Iierr| sugar was found in her urine and ehe wae referred to the skin ciinio whore a diagnosis of acute catarrhal jaundice was made. Tier rectal temperaturo, at that time, was 100*. A diffuse pepulo-pustular eruption was also present on her faoo. On boing questioned about it, tbs patient stated that it had been present to her knowledge for about 2 months, t From then on she suffered from t Investigation revealed tbs fact that some of her oo-workers were also suffering (rasa a similar aoneforut eruption, aad one girl dteeontinuad her work because of it. Hen# of theee other glria Buffered any i/ifudi disease. i ! I I Fit,. It. t*> il>r. About iiw.U.rr t, About 3 ' of I.CVLTI: abated, a puflinc* feet and Site cl 1 week of admi** movement tary bob! with any seemed to change in the hospil This was curred. S state of pr Summer, patient gn colored gir white. Sl<' developed 1 puffines* o' men. She qucntly d:eontrsetioieisted wit' head. Tb*114, rcspiri.: The fir.M tient is to , More ram' m'ck rcvi-a' lion )>egioi.ir ing down t> Derides tbi were thrve ui rcNt, tippi-arii coal--uiir on nmi un the bluek e; of aRKri'cati* did not sliarr tii)D. Jt WOf ti riaiip of ja. The skin of of tho body ieh suhtiota. } 1 I MOMS 097337 is ; f P t r Li |om P* rkia dslrff WH tosto Her 100*. Ml 3 Hoot U. ..... .... ^ I ..... JT4- * r." . .. fab. /) SYSTEMIC EFFECTS OF CHLORINATED HYDROCARBONS 33 increasing weakness and nausea. Her p> polite u poor; her skin beeerne progres sively more Jaundioed, and tin pigmeoteUen inereaeod. About 0 woeke before admission hor mother noticed that hor eye* wero yellow. About 3 weeka later abo began to eomplain of aavore headaches which eontinued un abated. ThU waa followed la a few daya by a puflineaa and swelling of the faee, hands, feet and abdomen. She continued at ber regular work until 1 week befor4 admission. On the morning of edmiaaion aha began to have eonvulaiva movements of the abdomen with involun tary bobbing of ber bead, unnaaoelaied with any pain. Al the eame time there Mamed to develop memory defect# and * change in mental etatua. On the way to the boepital In the ambulance she vomited. This waa the first time vomiting bad oc curred. 8he arrived In the boepital in n Hate of prostration. Summery of pbypieaf ssommsiton.--Tba patient gave the impreaeion of being a colored girl although eke waa, in reality, white. She looked well nourished and well developed for ber age* There wea general puffineea of the faoe, bands, feet nod abdo men. She wee hiccoughing, and waa fre quently diaturbed by a series of tetanie contraction* of the abdominal muaeloa aaoo- eiated with involuntary bobbing of the bead. The temperature was 100*, pulse 114, respiration 36. Tba firat admission not# stated, "pa tient is to jaundioed her faee la bleak." More careful examination of tbo faee and neck revealed a negroid type of pigmenta tion beginning nt the hair line and extend ing down to, and including, tbo nook. Besides this general pigmentation tbore were three areas eordewbat darker than ike rest, appearing very much like dabs of charooal--one on eaeb shook below the oyeo and one on the shin. -t)n eloee examination than* Meek spota appeared to be the remit of aggregations of Oomedooee. The eaalp did net share In the general dark pigment* Mon. It was of a yellowish color ftkarnr tsristio of faundloo. The akin of tba thorax and tbo lower pert of the body wea dark brown with a yellowUh eubUnge. Over tbs akin ef the abdo- * i' .I men there waa a jtirriio-like area of deeper pigmentation beginning at the love! of the umbllieua and extending to the pelvis. There was also a line of deoper pigmentation In the garter region on the posterior surface ef the left thigh about 1 inch above the popliteal fold. Examination of the eyes revoaled deep jauadiee of the soleras and the conjunc tivas. The pupils wero equal and regular, and reacted to light and accommodation. There waa no nystagmus or strabismus. The Uephora! oonjunetivao were redder than normal. The discs wero somewhat pale, though well defined. There waa no exophthelmus. The normal ratio In width of artery to vein was preserved. The ves sels wero not contracted, end did not pre sent the hair-line appearance believed to be associated with aroenie or quinine poi son!eg. Other positive physical findings were: alight infection of the throat; slight edema of the foot and bands; an apical systolie murmur; abdomen distended and tympani tis; liver on percussion email, with tympany extending to the very costal edge. Laboratory findings: Theee wero as follows: Blood count on admission--White oelie, 6,100; Red cells, 4,600,000; Polya., 60%; Lymphs, 30% Hemoglobin, 87%; Bleeding time, 4.6 minutes; Clotting time, 3.6 minutes; Platelets, 230,000. Blood elmidry; Non-protein nitrogen, 86, later 46, mg./lOO oc.;Protein, 6. P mg./lOO on.; Urea N. 30.88 mg./lOO ce., Creatinin, 3 mg./lOO ee.; Olucoee, 68 mg./lOO cc.; Cho lesterol, 146mg./lOOee.; Calcium, S mg./lOO ee.; OO combining power, 62; Albumin, 3.6 mg./lOO ee.; leterie index, 330; Van den Berg, immediate direct reaction; Waaserxsaa, negative. Urine--8p. gr. 1.008: Alkaline. Albu min negative. Sugar, a trace. Aeetone, 1+. Bile pigment present. Urobilinogen a trees. Few red and white eella. Stoolo--Urobilin present. Spinol fluid--Pressure normal. Celle: 10, Lymphocytes. Clear. Glucoee pres ent. Globulin absent. X-rny sascmnncn--No evidence* of lotions of tbs heart and lungs; bones of skull, riba, abonldar joints, clavicles, tibia aad fibula. Tb* gastrincontents, and later, HONS 097338 34 JOURNAL OF INDUSTRIAL HYGIENE AND TOXICOLOGY M. U, no. l *! autopsy. iito organa wow analyard for tmitic, phosphate, load, Uo and antimony. A trace of phosphate vm reported, prob ably from inorganic phosphates ingested before idminion. Dieynesie--The patient presented a pic ture which wee distinctly pussling to ill physicians who enw her and no conclusive diagnosis woo reached at the time. The various diagnoses suggested included: obtructioa of the common bile duot, tone jaundice possibly due to some dye, obstruc tion of the inferior Vena Cava, Mood dyeeraeia, Addteon's diabetes, hemochro matosis, industrial poisoning of unknown origin possibly due to arseoto, causing scute glomerular nephritie and aeute hepatitis; and finally aeute yellow atrophy of the liver and pancreas possibly due to an unknown industrial poison. Caere*--The clinical eouroe woe steadily down-hill. At II p.m. on April 27th the patient became uneoneeiouo and want into a coma. There wae Cbeyne-fltokes breath ing. A peculiar odor wae present which was variously Identified by hospital physicians as ethylene or garlie. The pupils were im mobile to light. Deep reflexes were greatly depressed. There was no Babineki. Ab dominal reflexes disappeared. The skin became dusky throughout. Tbs liver dull ness seemed to diminish. On April 2Sth tbs temperature roaa to 109*; the pulse to 140, and the patient died. Anatomical dfaynaeie--An autopsy was performed at the Medical Examiner's ofliee on April 19, by Dr. Chan. H. Hoekman, Assistant Medical Examiner. The report * in full wae as follows: Body is that of a white adult female, well developed and nourished. Cyanosis of lips, cam and fingernails. Marked pigmentation about eyas, lower lips, neck and abdomen. General icteric tings to entire body. No ovidonea of violence. Some edema about ankles. Hair Is Meek. Eyebrows black. Brown iris. Conjunctives and scleras ioteric. Rigor mortis preccat. Postmortem lividlty of dependent parts. Scalp indeed and J-efiectod, calvarium removed. Brain found eongeotod. Meninges bile, tinged. On section, no ovidoneo of iutraaraaial In jury or hemorrhage. Dura stripped and rsvpais no evidence of fracture. Body opened in usual midlinn inrision. Sternum removed. Some remnants of thy mus still present. Lungs are free. Bron chi contain a bloody mucous. Mucosa injected, has yellowish tinge. Hemorrhagio infarct about site of hen's egg in left lower lobe. Thie ie airlosa and dark rad in oolor, firm. There are also similar smaller areas in other iobea. Heart is email and chows some sub-cpieardial hemor rhages. Borne hypertrophy of left ventri cle. Valves thinned. Arteries natural. All are bile stained. Nosignificantfindings in myocardium or coronary arteries. Esophagus ie natural. Stomach is dis tended, contains some dark material. The rugae are somewhat hypertrophied. The duodenum contains green chyme. The ampulla i patent. The jejunum, ileum and large gut are natural. Many petechial hemorrhagic orate noted in the mesentery with some enlargement of mesenteric lymph nodee. t Liver ie email, weight 720 gm. Capsule wrinkled. Right lobe on section shows areas of yellow surrounded by rod areas. Loft lobe much firmer although liver cuts firmly throughout. All duets patent. Gal) Madder email. Wall thickened throughout. Pancreas ie natural in site, somewhat congested. Spleen ii natural in eise. On ecetion, firm, dark red in color. Follicles are somewhat indlstinet. Kidneys show swollen cortex. Evidence of parenchyma tous dageneration of epithelial ceils. Capeule strips easily. No granulation. Degenerative changes in cells of glomeruli only. No glomerulitie. Uterus is small. Endometrium bile-stained. Ovaries are natural in eise; right contains corpus luteura oyst. Bladder wall is somewhat thickened. Mucosa ia injected. Afiero*eoptc eaammolMm--Liver--From eise of a through and through transverse station one suspects that the entire liver was about ) normal aise. Liver segment is very firm and composed of two distinct and peculiar types of tissue: (a) That con stituting major portion of parenchyma is red in oolor; firm and elastic in consistency; (b) Other areas are light yellow in color and are scattered indiscriminately throughout reddish areas. Yellow areas vary from | to 3 la. in diameter. External surface r*i>. /a | of liver, smooth. A typ I low etr; f red ana atrophy' dmsppex their no | scerne to Mood e* sod olds j numcrou 1 aet-m to h | yellow a generatii The ti j of the li' porting durts. * Tin.** U rtgoneracen ie t I Ae* bten t | inf/rtfm process i> | Skin-- , eorium Some of deeper i Heart myoeardi Kidnr erttioi is glomerul; glomcru:. A dm degener^ Pancr of eelle o Sumn dentiy r . volving liver. ?' end rtr imifor A y raitte.l : 2, 1034 toryg;-,. Be had I * Auih I' M4 yym PiiPJI.tf"ll|lg>|JIMWPBWP^4U^',rr. 0NS 097339 itistiiH li ii--'ifrti'ri fit. t8S9\ SYSTEMIC EFFECTS OF CHLOIMNATED HYDltOCARDONS 36 si liver, judging from this portion, u wire with wa*t from July to the middle of IDOOth. Deeomber, 1933. At that time he felt run A typical picture of door subacute y|- down and became jaandioed. He was seen low elrophy Si mealed. Ridee chow that In tha dispensary in January and found to rod area ie compored of so-called "rad have an enlarged palpable liver. He thon atrophy" In which oil the lim oolla bava epent several weeks in another hospital with dianppeored, their plaoo being occupied by slight improvement in the jaundice. their normal aupportiag stroma, which In March, 1034, be returned to the job aeemc to hove been spared, great number# of in the wire factory. Following this, the blood coll#, eerly fibroblastio proliferation jaundice became quite intense with increase end older rear tissue. In tboee red ereae, in general malaise, anorexia, attacks of nomeroua bile duett ere eeen. Theae alao dissineec and low of weight. Three days oem to have been epared deetruetion. Tbe before edmiamon vomiting had occurred. yellow areas are eompoeed of aetively re- He had taken no drugs and there had been genernting inland* of liver cell*. bo exposure to carbon tetrachloride or The toxin evidently he* destroyed moet chloroform. of the liver eella, leaving intaet their up- Summery of physical examination--The porting atroma, blood veeeela and bile temperature was 90*. pulw 74, respiration duets. The latter team to be regenerated. 30, blood pressure 130/74. Tbe patient waa Tboae liver eelle epared deetruetion have a thin well-developed man who appeared regenerated and have formad yellow Monde moderately ill. There waa bright yellow aaen in the groae picture. Thtrt evidently jaundice of the entire body. The pupils Am Ann one or mere attacks of tipotitii Judf- were widely dilated, the nasal septum de tug/rent (Ac different oyea 0/ the poiAdofieel viated, causing obstruction on tbe right, protest * various peris 0/ liwer.* the mucous membranes injectod end the Skin--Shore an inereaoed density of tongue moderately coated. The tonsils I eorium which ataine deeply with eoein. were enlarged and cryptic. Lungs were 8ome of the epidermal eelle are sltghtjy dear, heart normal, radial vcwela soft, deeper in eorium than normal. abdomen tympanitic, soft non-tender. The Heart--Bhowe mild parenehymatone liver edge wea felt at the eoctal margin. myocardial degeneration. Tbe organ waa soft Mid non-tender. The Kidneys--Bhow eevere epithelial degen upper edge of the liver duUnwc wee in tbe eration involving epithelium of tubuloe and 4th interspace. glomeruli. No inflammatory reaction of Leberalary jtndiny#--These were as fol glomeruli. lows: Adrenals--Show asvert parenehymatoue Urine--wot dark yellow and was nega degeneration of eelle. tive except for the presence of bile and uro Pancreas--Showe intones degeneration bilin. of cells of acini and of Mats. Blood eonnl--red oells, 4,300,000; hemo Summary--An unknown toxin has evi globin, 80%; white eelle, 0,800; Poly*., dently canned a severe diffusa aytolyaia in 5%; Lymphs, 20%; Large Monos., 4%; volving moat of prganc, predominately the Eos., 3%. Subsequent examinations liver. TAa latter Ana evidently undergono showed a slight rise in white cell* to 10,000. end racoscrcd from prooioua attache */ Stool-showed bile, considerable undi eimilar nature.* gested food, small amount of fat. iTaAs fed--negative. Cow l-F. D. Liesr function tests--Icteric index--30 to A young man, 14 years of age, was ad 10. Bromculfonphthelein shewed marked mitted to tbe New Haven Hospital on May % 1034, oompiaioing of jaundice. The hit- lory given wa# as follows: Ha had worked In n wire factory coating * Anthem' italtaa. ' t Tbe waxaa employed in tbia preeew are tbo higher chlorinated naphthalene*. Thaw are umd In a molten state in a bath through which tha wire to be eoeted ie pawed. Tbe preeew is partially but not entirely oneloaed. Bxhaqst ventilation ia . i t > HONS 097340 p1 U JOURNAL OF INDUSTRIAL HYGIENE AND TOXICOLOGY M. H, n#, $ Impairment; 100% retention la I mis., 86% nta(in in 30 mlo. Bleed dimiiirir.1 Nob-protein nitrogen, 38 mg./Ktt **.; Vnm N, II mg./100 ec.; Serum total proteins, 8.16 mg./IOO oe.{ Serum total albumin, 9.00 mg./100 ae.j Serum total globulin, 1.40 mg./IOO ee. A/Q ratio, 0.7A; Blood cugnr, 08.0 mg./IOO oe.; DIood faJciero, 10.83 mg/100 .; Blood phosphorus, 4.19 mg./IOO 00.; Scrum fatty Midi, Il.l mg./IOO ,; Serum lipoid phosphorus, 7.6 mg./lOO ee.; Seram total eboteeteroi, 10.6 mg./IOO ee.; Seram free cholesterol, 68.0 mg./IOO. Sugar teleranee feet wee eilbiit normal limite. X-ray of abdomen bowed hepatie fissure of colon unusually high. Course, The patient woe put on a high carbohydrate diet and hie general condition improved hut the jaundice poreietad. He woe dieehargod on May 16, 1094 with the diagnoeie of toxic hepaUtie. Up woe admitted again on June 1, 1884 oompUlidug of elxlowiaol swelling of 9 day*' dttruUmt, weakno**, nnomtia and odcnm of the lege whleh hail duvnl|ml aeon after hie illMihnrgn. Tim pliyeinal exam* {nation showed deep jaimdlee,' eyetolle mur mur, abdomen dietended and tympanitie with duilneae in the Sank*, moderato pitting edema nf the lege. Examinations of the urino, blood and (tool ehowod no Important niriidbiM from the original finding* with the exception of a drop in white mil nount to C,4W with 74% poly*., amt a daereoMt In aerum albumin to 1.88%. Hnrum COi eontent woe 64.64. Serum chloride woe 08.0 ung./lOO m. The patient's entires after the eooond admission woe rapidly downhill. The dis tention ootdd net be eontrolled and be soon paeeed Into eomplete coma. A eonvuleton escorted on June 86h and on Juno 10th he pneumonia (bilateral), oubpleurol hemor rhage*, eioudy ewelling of kidney*. Cnee 8~C. C. A young man 33 yean of age we* admitted to the New Haven Hoepita) on February 91, 1988 with tlie complaint* of jaundice, ab dominal pain, nauMa and vomiting of Moody material. The hietory given won a* follow* i Ho had worked in the same wire costing plants* the previous patient (F. >.). The present illness had begun with jaundice 3 months previously with no othersymptom*. This continued for about 1) month*. Two weeks before admieaion be became more jaundiced and concomitantly de veloped upper abdominal pain, malaise, nausea and finally vomltinn--the vomttu* becoming bloody in character. He wee treated by hit family doctor with no rolief. Hie condition became worse and be finally became delirious and incoherent. Hos pitalisation was advised. Nummary / physical examinalien--The patient woe cmnatono, irrational nnd vomit ing Moody material, lNmitivo fni'fluK* of significance were hi fallow*: not elevated. Blood prnwuro Generalised jaundice, petoehiae over the extensor aurfoeca of the arm*; tnndernrm over the upper quadrant* of the abdomen. No liver dullness poreuaaabla. Ceuree--IIie condition became rapidly worse, aoma coiling to noon oftor adini**ion. Tito vomiting nontinned. Tim patioot died about 34 hour* after ndmomiuo. Anoietnfeol </ayne*ts--KxtaiiHivo nccrotie and regeneration of liver; jaundice, aeuto lymphadenitis of portal nodes; ascite*; perienteritis of jejunum; cloudy ewelling of heart and kidneys; acute pul monary congestion; healing exanthematous rash of fore-arms. AnnfeunW dfsynesfr.* Extensive necrosii, fibrosis and regeneration of liver, sente MlerocoUib with edema, fibreela of pancreas, sente pancreatitis, jaundlee, so rites, edema of lower extremities, foeal * Autopsies on this and the following eeee were performed on the pathologies! service of the New Haven BoaqStelbyDr. B. M. Zlmlnermon. Orateful aeknowledgemant tom^toofhla courtesy In permitting nee of DIftCUMJON These three cneee chow the occurrenee of similar pathological changes in the liver in three young adults known to have been working with chlorinated naphthalenes and diphenyls--all were exposed directly or indirectly to the higher chlorinated hydrocarbons. In I i i ) all g/ilion the fir healthy the ithv poring ing or SUbMtUli' clear. It is the cas at lens; Us foil improt fetal a) In v Warren in orgru cxpfTtn.thftfc *<;' all L)ir< SmH h iny,H in Of t.i<! I. c( inlog) . knowing any wb primary Hrrnncin light (>l ' <HMT, Oi vicW ;ir i played ' t finul pa . It h:. Drinker no evi<: being c: thalcnc yellow ; :i done* o:' * as to b* ; This pr> whether atrophy e HONS 097341 rf ii'iiif lm i ii ^m' mini m. tM) BY8TRM10 EFFKCT8 OF OHbOPWATED HYDROCARBONS 37 all three ease*, a most careful invosti- larly exposed occurs only in those gritton failed to reveal any other pro- having some preexisting substratum disposing causo for tiro condition. In of Uvor damago--such as might follow the first ease in particular, that of a an attaek of catarrhal jaundice, for .healthy young girl on her finit job, example--and that this might ac* tbs abeenco of any conditions predis- count, in part at least, for tho fact posing to liver damage either prooed- that only a very occasional worker out ing or following hor oxposure to the of a large group will suffer from sys- ubstanees in question is especially temie effects of exposure to these sub dear. ' stanooe. In tho throe cases reported It is of interest to note that two of however, no history was given sug- the eases apparently had suffered from gesting that any hepatic disorder prior at least one previous attack of hepati- to exposure had occurred, tis followed by a oertain degree of Tho prosenco of a papulo-pustulsr improvement before tho onset of tho eruption in two canes is of interest, fatal attack. In ono it outedatod the systemic symp- In view of the faot that Drinker, toms. Tills typo of eruption is char- Wanren and Dennett found no lesions actorielic of tho dermatitis causod by in organs other Umn tho liver in their chlorinated naphthalenes, and until cxfttrimcntnl animals, it is noteworthy recently was tho only disturbance utr that such lesions were coHj>iciiotiB in tribuiod to thorn, nil threo of tho eases hero reported. . Tire presence of "aggregations of Such lesions, are, indeed, usual find- oomodonos" such as were found in inge in eases of acuto yellow atrophy Case I is also characteristic of tho of Uto liver in humans regardless of skin otuptions produced by those sub etiology. On tho basis of prosont stances. Tho question as to whothor knowledge, it would lie impossible to or not tho skin eruption in such a caso say whether they are tho result of is in any wny connected with the onset primary intoxication or are merely of systemic effects cannot bo answored, secondary to livor dninngo. In the since time far no coirolation has been tight of Uto animal cxjwrimenU, how- established between skin lesions and over, ono would incline to tho latter systemic dlseaso (1). view and s|>eoulate as to the part It Is interesting, therefore, that in played by length of exposure, In the Case I the skin eruption apparently final pathological picture. antedated all evidenoes of systemic It has been mentioned that in. disease. Had the girl been promptly Drinker's (4) experiments, rate with removed from further exposure, when no evidence of eiinieal disease while it was first observed, it is possible that being exposed to the ehlorinated naph- her life would have been saved; or had thalenos, promptly died from acuto the physicians first oalled upon to yellow atrophy of tho (Ivor when given treat tho jaundioe (of whatever origin) doooo of carbon totraphlorido so small in her ease, or in the seoond cans bore as to bo harmless to control animals, reported, recognised tho danger of Thio prompts speculation aa to continuing exposure to tho chlorinated whothor death from acuta yellow naphthalenes, these deaths might poa- atrophy of tba Uvor in worlmto stmt- oibly have boon averted. .ww.msarnmH HONS 097341 38 JOURNAL OP INDU8TIUAOHYQIENE AND TOXICOLOGY {--l. it, n*. HkCOUMKNOATIONB TOR MkDICAL Control 1. 71)0 authors wish to itrem the need for the conscientious reporting by physicians of all illnesses occur ring among workers exposed to the chlorinated naphthalenm and di phenyls, particularly cases which have been carefully worked up, so that the clinical disease entitled resulting from such exposure can become further clarifiod and thus more readily recog nised in the future. Fewer errors in the diagnosis and management of tbeee cases would occur, and workers' lives oould undoubtedly be saved in this way. 3. Persons suffering from the typical acneform eruptions should be removed from further exposure. 3. Persons who have, at any time in the past, had any liver disease---even a mild catarrhal jaundice--should not work with these substanoes; nor should workers with a history of typhoid fever, malaria, gall-stones or other dis eases known to affect the liver ad versely. 4. Persons receiving srspbenamine treatment for syphilis; or those who Are . taking drugs believed to be in jurious to the fiver in susceptible persons, should not bo further exposed in their work to potential liver poisons. 8. Persons working with the chlo rinated naphthalenes and diphenyls, if requiring a general anesthetic for an operation, should not be given chloro form or avertin, and vice vena, indi viduals who have recently received such anesthetics should not imme diately thereafter go back to their former work or to work with other substances believed to be potentially toxic to the liver. 6. Pregnant women should not be exposed because the liver, in preg nancy, appears to be peculiarly ausoeptible to injury. ' 7. Experience seems to indicate that by proper attention to ventilation and medical supervision of workers the ohlorinatod naphthalenes and diphe nyls can be used in industry with safety. Summary The systemic effects resulting from exposure to certain chlorinated naph thalenes are discussed, and the litera ture of the subject briefly summarised. Throe liver deaths in workers handling these substances are presented in some detail, with autopsy findings. Recom mendations for prevention are given. i; BIBLIOGRAPHY ' 1. Matsu*. M, R., aire Snmmo, M. 0.: Skis sosdltioas resulting from expo sure to certain chlorinated hydro earbone. Tme J., $0, 244 (1038). S, Lmmahn, K. B.: Kurses Lehrbueh dor Arbetie- usd Gewsrbehygiene. 8. nircel, Laipeig, 1310. p. 281. . t. Punk, P. D., and Jasvik, D. E.: Actios j of certain chlorinated naphthalenes on the fiver. Pros. 8oe. Esper. Bid. ami Med., U, US (MM). 4. Daimtm, C. K., Wanmi, M. a* Baarmm, 0. JLi The problem of pos sible cyst--1 effect# from certain chlorinated hydrocarbons. Tme J., 19, 383 (1337). g. Cotnrroie-Burm: fitude cur I'inioxieetion profestionnellc par ! Iriobloronaphthalene. Ann dc mod. legale, 14, 423 (1334). Abetr. of paper by Tow1AMB, A., AMD MisftTSBL, D.: Dermatoees prolemionncllea par le naphthaline et see derivie. Prat, med. franc., IS, 3M (1334). 8. Bomwabts, L.: Daratatitie from syotbetie rcaiaa and waxes. Am. J. Pah. Health, , Ml (1333). th |ut im r?*f hw th *V Or for "tt i*iU fhr ern tlu tf) mu thi m r t HONS 097343 ill j