Document dQ31vjV3RQgxR16GgjpOjLNN0

INDUSTRIAL rKIGILNL DIVISION or INDUSTRIAL HLGICNE, NEW UOR^ STATE DEP(5RTAENT OP LABOR. LEONARD GREENBURG, M . DEXECUTIVE DIRECTOR Rapriotad from Thm Induatriml Bulletin iaauad math month at Albany, by tha Indsutriol Committiomir oi tA State ( Now York, Vol. 1$; No. 11, Nautmbor, 1939 SYSTEMIC EFFECTS FROM CHLOKIN'ATED ri CERTAIN By LssnsrS Grtenburg. XI.O.. May K. Miyscs, M.D., 404 Ad.l.S. R( Smith, M.O. These three eases show the occurrence o{ similar patho logical changes in the liver ia three young adults known to liavc been working with chlorinated naphthalenes and diphenyls--all were exposed directly or indirectly to the higher chlorinated hydrocarbons. In ail three cases, a most careful investigation (ailed to reveal any other prcdispoiing cause lor the condition. In the firs: case in particular, that or a healthy young girl on her first job, the absence of any conditions predisposing to liver damage cuher preceding or foiiutviiig her expo*ui\ to the substance* in question is especially clear. It i of interest to note Uwt two of ihc casea apparently had suffered front at least one previous attack of hepatitis followed by a certain degree of improvement before the onset ot the latai attack. In view of the fact that Drinker, Warren and Bennett iound no lesions in organs other than the liver in their experimental animals, it is noteworthy that such lesions were conspicuous in ail three of the cases here repotted. Such lesions, are. indeed, usual findings in cases ot acute yellow atrophy of the liver in humans regardless of etiology. On the basis of present knowledge, it would be impossible to lay whether they are the result of primary intoxication nr are merely secondary to liver damage. In the light of the animal experiments, however, one would incline to the latter view end speculate as to the part played by length of exposure, in the final pathological picture. it has been mentioned that, in Drinker's* experiments, rats with no evidence of clinical disease while being exposed tu the chlorinated naphthalenes, promptly died from acute yellow atrophy of the liver when given doses of carbon tetrachloride so small as to be harmless to control animals. This prompts speculation as to whether death from acute yellow atrophy of the liver in workers similarly exposed occurs only in those having some pre-existing substratum of liver damage--such as might follow an attack oi catarrhal jaundice, for example--and that this might account, in part at least, for the fact that only a very occasional worker out of a large group will suffer from systemic effects of expoiurc to these substances. In the three cases reported, however, no history was given suggesting that any hepatic disorder prior to exposure had occurred. _ The presence of a papulo-pustular eruption in two csics i of interest. In one it antedated the systemic symptoms. This type of eruption is characteristic of the dermatitis mused by chlorinated naphthalenes, and until recently was the only disturbance attributed to them. The presence of "aggregations of comedones" such as were found in Case 1 is also characteristic of the skin eruptions produced by these substances. The question as to whether or not ihe skin eruption in such a case is in any way connected with the onset of systemic effects cannot be answered, since thus tar no correlation has been established between skin lesions and systemic disease *. _ It is interesting, therefore, that in Case 1 the skin eruption apparently antedated all evidences of systemic disease. Had the girl been promptly removed from further exposure when is was first observed it is possible that her life would have been saved: or had the physicians first called upon to treat the jaundice (of whatever origin) in her case, or in the second case here reported, recognised the danger ot continuing exposure to the chlorinated naphthalenes, these deaths might possibly have been averted. Rocommendatione Por Medical Control I--The authors wish to stress the need for the con scientious reporting by physicians of all illnesses occurring among workers exposed to the chlorinated naphthalenes ami diphenyls, particularly cases which have been carefully * C*ntUu*4 {torn tmjutlnat Mullrlim. PI ( tbs Osiskar IUI imi* *1 The worked up, so that the clinical disease entities resulting irom such exposure can become further clarified and thus more icatlily recognised in the future. Fewer errors in the diagnosis and management of these cases would occur, and workers' lives could undoubtedly be saved in this way, ---Persons inhering from the typical acneform eruptions should be removed from further exposure. o--Persons who have, at any time in the past, had any liver disease--even a mild caurvliul jaundice--should not work with these substances; nor should workers with a hiatus y oi typhoid fever, malaria, gall-stones or other diseases known to affect the liver adversely. a--;Vi r,living arsphen.miine troainunt .<.r ,y,T.i..L>. or those who are liking il.iie- believed to he injurious t- expose.', in that- wu.k tr- p.,tc; liver l'.; <n:t working wi h the chlorinated :-.a;.-'.:;a:.--ir, a: , diphenyl*, if requiring a general anesthetic for an operation, should not be given chloroform or avenin, and vice vena, individual* who have recently reesived such une*thtic, should not immediately thereafter go back to their former work or to work with other substances believed to be iKMeniially toxic to the liver. 6-- Pregnant women should not be exposed because the liver, in pregnancy, appears to be peculiarly susceptible to Injury. 7-- lixpcfience seems to indicate that by proper attention to ventilation and medical supervision of workers the chlorinated naphthalenes and diphenyls can be used m in* dustry with safety. Summary The systemic effects resulting from exposure to certain chlorinated naphthalene* are discussed, and the literature of the subject briefly summarised. Three liver deaths in workers handling these substances are presented in some detail, with autopsy findings, Recommendation* for pre vention are given. BtbllosrtpHr . 1 -- Mnyrrs, M. R.. and Sil*lllr, M, C Shin cnnililians i.i,P. 'K irwn io certain rMerinalsd h .Irwsrlam*. the fWa,. trial /`m/I,'tin. /V'giml ,I9JS. ?^-l.*i>ms*n. K. It.: Kurw l.*>i*tnirl, *, A.b*.l--C,rW hfu'cnr. S. Hir*i, Lsime, ISIS. u. M], .1 --I'Tnia, F. H., *imI Jaivik. I>. rl.t Action f ririxn <hJ*m*irl nItiHiilii(liIn'iljnr.ui,1, un die liver. I'roe. See, sinner. Ll.el, end Mvd.. P 4--tVmker. C. K.. NVsrren, M. P., Sad htnneit. G. A.: The irl,. Inn ui |o ible lysicmis rffi frnm eerltin clilsnnsltd lii'divcsrIk.iiJ. it,it, Hv*. IS. MJ nsW). .*--Cuuciiiis-Suntii Buttle -ur l'liii*iiriiii*> preftt*innrll par lr (rithlnransi'hdislene. Ann de med. leesle, 14, i2. (IMSI. Ah-ir, ol psiier l>y Ttmrsiuc. A., tnd Mtnelrel, 11.: Dermstetes jiri>*. tinniteile* per le nnplithslins et in derives. Prsi, med. (rare,, j). JJJ (tV.UI. 6--Schwarts. L,: llrmstitii frem eyathetis resins tnd wanes. Am. J. Puli. Health. 16. ISA (I9.1A). HEALTH CONSERVATION IN TUNNEL CONSTRUCTION Dust is generated in tunnel construction by the rock drills, in blasting and during the shovelling and removal of broken rock (mucking). Smoke and toxic gases are inrmrd during blasting and fog frequently forms at the hcadmu when the drills are in operation. The contamination of the tunnel atmosphere by those several substances creates health and accident haxards which must be controlled in order n> maintain good working conditions. This is the object of Industrial Code JJ on rock drilling and of the various regulations issued by the Industrial Commissioner. The control of these contaminants involves new procedures in tunnel ventilation never before attempted n New Yoik on the scale required by the Delaware Aqueduct. Indeed, in certain respect, tlte regulations are wholly new and without precedent. MUNS 097430