Document qwyjmGgQkZy8Orq6my0XVexk

COMMONWEALTH OP PENNSYLVANIA Department op Lador and Industry RALPH M. DASHORE, Secretary Special Bulletin No. 43 A Preliminary Report OF THE Dermatological and Systemic Effects of Exposure to Hexachloro-Naphthalene and Chloro-Diphenyl BUREAU OF INDUSTRIAL STANDARDS RAYMOND J. NICAISE, Dirrcinr Harriiburg, Pcniuylvania March IS, 1936 MONS 076193 1 COMMONWEALTH OF TeNNtYLVANIA Dcfastmsmt or Lamn and Inouitrf A Preliminary Report op the Dermatological and Systemic Eppects of Exposure to Hexachloro - Naphthalene and Chloro-Diphenyl By WILLIAM B. FULTON. M. D. Chief of JndusmaJ Hyjic-w JULIA L. MATTHEWS, Pb D. Chrmm 1 i Industrial Hygiene Section Bureau or Industrial Standarm ......... HONS 076194 A Preliminary Report of the Dermatological and Systemic Effect* of Exposure to Hexachloro-naphthalene and Chloro-diphenyl. Introduction The demand in industry lor electric insulation will) fire-resistant and water-proof qualities lias led to the use of increasing quantities of chlorinated naphthalenes and chloro-diphenyl. While the dermatological effects of other closely related organic chlorine substitution compounds have been studied, there is little mention in the literature of hcxnchloronaphlhalcnc and chloro-diphenyl. As early as 1916 Wnucr (1) de scribed a condition which he termed "Pcrnakrankheit," resulting from ex|wstire to pcrchloro-naphthalene. Telcky (2) found that live gravity of the injuries and the clinical symptoms would appear to dqicnd. in direct proportion, on the halogen content of the chlorinated derivatives. In 1929, J. Xicolas and J. Lacassagcn (3) reported a man suffering from chlor-acne of the greater part of the body. Tlicsc investigators were able to distinguish it from ordinary acne as a result of the localiza tion of tlie former. At the last meeting of the American Public Health Association at Milwaukee, Louis Schwartz (4) reported the 'occurrence of "an acne like condition of the exposed parts and sometimes of the covered jwrts, if the fumes penetrate tlie clothing, of 'workers cxjoscd to the volatile fumes of these sulistanccs." In his paper he stated that jratch tests with these sulistanccs give negative results. Chemical and Physical Properties Chlorinated naphthalene and chloro-diphenyl arc organic substitution products. Under trade names they arc sold to industry either in the solid or liquid form, combined witli other plasticizers such as resins, waxes, and pitch compounds. . The base of the products encountered in this investigation was Ircxnchloro-naphthalcne with chloro-diphenyl present in amounts not over ten per cent. The addition of the latter to tlie synthetic wax tends to lower the melting point of tlie compound. Synthetic dyes, added in quantities of less than one per cent, give tlie desired color to tlie different products. The compounds liave a faint aromatic 'odor, are insoluble in water and arc unaffected by dilute acid and alkaline solutions. They are, however, soluble in organic solvents, such as carbon tetrachloride, naphtha, benzol, acetylene tetrachloride, acetone, gasoline, etc. The melting and boiling points of these compounds arc dejiendent on the nature and amount of fisc different ingredients present and vary between 140o-275o F. and 500-752 F., rc*|iectively. In their fluid or molten state the waxes have a very low viscosity and readily impregnate textile fabrics. Some of the chlorinated products contract only slightly during solidification, have a low coefficient of expansion as compared with natural waxes, and arc non-inflammable. 3 HONS 076195 Plant Process The fabric covering of wire aiu! cable in the plant studied was im pregnated by |ssmg the wire to be insulated through the melted wax or by immersion of the material in a solution of the wax. In the former mciJmd the operating temperature of the wax was maintained at 270s F. at which temperature volatilization and condensation of the wax oc curred. In the latter method impregnation was effected by j)aing the wire through a solution of the wax, in either toluene or a mixture of carbon tetrachloride and ethylene dichloridc, at room tcmjxraturr Medical Findings Little mention is made in the literature concerning the systemic ef fect as a result of exposure to hcxachloro-naphthalene and chluro* diphenyl. That the dermatitis resulting from cxjxtsurc to these chlor inated derivatives can lie produced by skin contact with them, may Itest be illustrated in the presentation of Case Number 26 (See P. 12). What role tlx- effect of the absorption, ingestion, and inhalation of tltcse com pounds has, in combination or separately, deserves more detailed study. Whether .they may lie considered as etiological factors to the production of acute yellow atrophy of the liver has not been determined. Dnnt of srrtrHT Ki'tilive . Doubt fMl . KIM ....... Stltbt .... Moderate . Adraoced . Total* Kumbrr of rrnuni Mol* | Vraata U <1 T a nT Tfr rent of Prron* Male 17.0 314 II .0 Female 31 ;C.O ?;>.o t!' o too 0 Physical Examination--A partial physical examination was made on one hundred and one persons, who were exposed to either the solid, liquid, or vapor state of the wax. Of this number seventy-eight per cent were found to be affected with the dermatitis. A second group with well defined dermatoses was selected for complete physical examination in an attempt to determine the presence of any systemic effect. In the latter group were twenty-three men (two of whom were control-*) and two women. Table I shows the occurrence and degree of severity of the dermatitis in both groups. Any correlation of the incidence of the dermatitis according to operations in the plant studied was found to be impractical, as a result of frequent transfer of the workers from one op eration to another. Those persons having the greatest exposure con- 4 "J. 1 'JWv C MGhS 076196 4. Minut'd only twenty-six per cent of the total group examined and max account for the relatively low percentage of those having a moderate or advanced dermatitis. In the group of twenty-five selected for complete phvsica! examina tions only those persons with a well defined dermatitis were chosen. An attempt was made to obtain those individuals with long exposure and those with exposure of shorter durations. The average length of ex posure of this group was 24.3 months. Table II shows iltetr age ditnhution and it will be noted that eighty-seven per cent of the total group examined were under forty years of age. tabi.f 11. percentage DisTRtmmox nr aof or the group given court i r ______________________________________PHTS1CAL EXAMINATIONS I EtPOOfd j Control* I Number Per cent 'Number Per tent INumber Percent Number Per rent .... I .... I .... H.< too ................ U.i i , so 111 i I 1W Tlte length of exposure Itcfore the apfxrarance of the dermatitis, which factor was fmtttd to lte sovnewltat dependent on the severity of the ex posure. is shown in Table III. In only one jterson, who was in direct contact with tlte vapors of the hot wax. did the chlor-acnc appear before two month* exftosure. Fifteen months were required for tlte earliest manifestation of the dermatitis in two otltcr cases, each of whom had a more remote exjiosure, while tlte average length of exposure for the en tire group was approximately 5.9 months. TAIIU: III. M'MHFtt AM* PFK'FNTAOF Of PFJtSnN'S KllOwtXn TIIFIM I.EMJTII or or- f.xpork m:roHK fihst appearance tiif nunmrnv Moottia or Eipoouro I .1. Male P*r eeol F(tulc Konix* | Per tmt Over 15 .............. .....................-1 a '1 I ti " M too I ! i MOWS 076197 ( 1 A complete history, which included chief complaints, objective symp toms, previous illnesses, family, personal, and occupational histories, was obtained from each individual. Particular attention was given, in ob taining the history, to the individual's susceptibility to skin diseases. A preexisting acne vulgaris was preset)! in one person, who noted as a re sult of his exposure, an accentuation of his symptoms. Symptoms refer able lo the skin were usually given as chief complaints. Table IV gives the percentage frequency of objective symptoms as compared with the degree of involvement. Pruritis, remissions, and progressivencss of the dermatitis, were the objective symptoms most fre quently elicited. Sensory disturbance of the skin was present in only one individual. A small area on the anterior thigh of this worker showed a loss of heat and cold sensations. Two men. included in the group given a partial physical examination, complained of the rancid odor associated with sebaceous secretions. TAM.K tv. xi*mreb and percentage op pKitnoxat having nyiinoMs ________INDICATED. AS COMPARED WITH THE DEGREE OP INVOLVEMENT Degree of Involvement ftpnptoms Advanced , Moderate | Slight Number I'd cent Number I'ereent Nutnb r ivr tern H<iuI*>Ioim ....................... . rrorllli of Sklu .................. .. Progressive pervstIUs .... .. Lassitude ......................... .. lunHig ol Skin .................. Pustular Stage Palatal ... .: Constipation ....................... .1 .i Polyuria ........................ ........ -- Insomnia ...................... ........ Abdominal Psln ................... Diarrhea ....... -....................... Headset* ................. .. fteneory Skin Irtsturjaner .. 1 t '1 i i J2 1 & * .. - 1 9t.* . ei M.ft , ao.g 0.1 1 ts.t j t 1 i .. .. II. ) .. ___ 1 1 7.7 ! .. .... | . 1.... I 1 HO 100 SO M i i A I 1 s .. 1 &0 I so .. .. I SO .. i ST STS 1? 3 IS. 3 Two vale controls had none of the above symptoms. Two females. with flight dermatitis, are included. Evaluation of symptoms referable to other systems and regions, as a result of additional exposure of the group to organic solvent vapors (tol uene or a mixture of carbon tetrachloride and ethylene dichloride), is difficult. Each person given a complete physical examination was at work on the day of the examination. Data was obtained on present and greatest weight and allowed practically no variation. Five minute oral tempera tures were found to be normal. Examination of the head and neck was v --l> i i i. n.i--fwaur HONS 076198 essentially negative in the entire group except for the presence of ccrvicle adenopathies in a few cases. In one individual a small pedunculated tumor, which develojietl following trauma to a papule, was found in the region of tl>e right temple. The tumor was spherical in shape, about the size of a large pea, and was attached to the shin by a pedicle. Its surface, devoid of hair, was marked wit!) indefinite convolutions. The tumor was reddish in appearance and showed signs of inflammation of one of its lobulations, the result of an injury produced by scratching. Physical examination of the chest was essentially negative in the en tire group. The pulse and respiratory rates, obtained with tlx* indivi dual at rest, and blood pressures, recorded with a standard mercury syphgnnmnnomctcr, were found to be within normal limits. Observations were made particularly for evidence of tenderness nr muscular rigidity over the region of the liver during abdominal exam ination. This condition was found to be present in one individual, whose liver margin could not be palpated. Other clinical and laboratory find ings in this case failed to indicate additional evidence of liver damage. TADI E V. KUMRKH AND PERCENTAGE OP PERSONS HAVING C1I7.0R ACNE ON THK _____ INDICATED BODY SCRl'ACES M Bodr sortMM SuDbfr el 1 P*t mtl ot Ptriona IVriont Eorrh+ari ............. . Angle of thr Jew . Cltfrk Prominent* . All oboe* Surfam NKCK .................... Poflrrlor .... Anterior ......... Hmh Awfeee* ARMS .................................................. -................ Kxtcnor .............. ........................................................ Flexor ...................................... ............................. ................. FOREARMS ......... Fxtenror ......... Flexor ........... Rolli pnrfaere enmr ............. t>per Sternum ErttorM Region Roth lurlira . ABDOMEN Fleoki BACK .......................... SrapnlM .............. Thorarle ____ ____ t.umliir ................ AH ibovr Snrfnn* buttock .......... THIGHS .............. Kxleoeor -----Flexor .............. Both Bnrtai** LEGS ..................... Extensor ......... Flexor ............. 7 10 s$ ) C 9 It <7.7 6 SI.7 IS 70.I l* an. 10 <3.< I* W.6 l# BS .. .... IS M.l 14 0* 1 7 IS , Ml 4.H.4 197..74 71 1 7 IT 'iPW-^Hyaipji.U ii i MliSf..ipiii MCNS 076199 r Examination of the skin was made with the subject stripped ami ex posed to an excellent source of light. Of the entire group, thirteen, or fifty-six per cent, were found to be in tire advanced stage of tta dernmtitis, while the remainder had it to a less marked degree. Four distinct lesions of tta chlor-acnc were noted, all of which were present at the same time in the moderate and advanced eases. However, in tire early stages, comedones and small papules made their appearance, while at later stages, pustules ami setaceous cysts of the skin occurred. Healing, following the pustulur stage, usually occurred in a similar manner as the same process in acne vulgaris. At this stage dried scrum was found over the pustules which had been traumatized. As healing progressed, slight scaling ot the skin was noted over the site of the pustule. The scales were usually very small and dry in character. Tendency to in creased oiliness of the skin was not evident. Pitting of (lie skin was found in fourteen persons, or 60.8 per cent of the group, and the site most frequently affected was the posterior lateral neck. In these cu>c> there was evidence of depigmentadou in the cicatricial tissue. A predilection of the dermatitis for the extensor surfaces was especial ly evident on the arms and forearms, and to a lesser extent, on the thighs and legs in the group given complete physical examinations. Table V shows the percentage frequency of the chlor-acnc for various regions of tta body. When the dermatitis occurred on the face and neck it terminated at the hair line and in no instance was the scalp in volved. Gross involvement of the sebaceous glands of tta nose was absent, a tendency to diminution in the intensity being apparent at tta mkl-line of the face. In a few eases comedones were present on the dorsal surfaces of the tands and feet. In the group examined differences of complexion apparently had little effect on the susceptibility. The influence of age and sex on the indi vidual's susceptibility was not determined, for the greater numtar of those examined were between the ages of twenty and thirty years, and only two women were found working in the plant who Imd definite ex posure. Laboratory Findings--Appreciable changes were not evident in the erythrocyte and Imcmoglobm determinations. Tire total average leucocyte count was uncliangcd except for a slight increase in the group having an advanced chlor-acnc. In this group the average leucocyte count was 11,130 cells per cubic millimeter, without a eorrcsjXMiiltng average increase in the polymorphonuclear leucocytes. Routine examination showed albumin in the urine of three arsons, who were twenty-five years of age or less, as tlie only evidence of 'renal pathology. Tta icterus index and Van den Hergh determinations were made with a Klett colorimeter and the results are given in Table VI. Coincident with the lime tta first tests were made, all operations of the plant were stopped, so that those persons (10 in the exposed group and 2 controls) showing an icterus index greater than tlie upper normal limit, were per mitted a week's rest at home. At the end of (his period, a second deter mination was made, and in practically every case tlie icterus index had returned to normal. 8 P>C3 MONS 076200 HONS 076201 TAB1.KVI. Hrm.l.TS or ICTKKIH |M>KX AXP VAX DKX HEHfiM DETERMINATIONS First Determination Second Delenatoatloa OSM JrttnM Index Van dm Derph-- ncs- bilirubin per 100 c c. Icterus Index 7m dea inth- ntfs- bllirablit per 100 c.e. 1 ....................... ...... ..... to ................................... IS ................................... IS ..................-........... IT (Control) ................. IS (Control) ................ ................................. n ................................... n .............................. . t ................................... u ................................... a.i SI .e S.4 7.S S.S M S.t i.a T.t s.a >.< $.1 S.4 S.S e.6 S.4 s.s 10.0 4# 41 4-0 s.e o.ss 0.S4 O.SS 087 O.SS O.SO o-ss 0.40 O.SS 0.47 o.ao 0.S) .... M SO 7.S I 4.5 | S.S so 4.S .... 0*1 ow .... .... * iMiRd dHNinfMtlMi mtiK tiler to Inltrrtl of terra dnys. Hi nidi. * ftenmd determination sot wada. Figures 1, 2, and 3, and a brief summary of the clinical and laboratory findings of three advanced eases are presented to show the nature of the dermatitis encountered in this study. Case Numltfr 4--White male: complexion brunette; aged 26 years. Chief Complaint--"Pimples." Analysis of Chief Complaint--First noted the dermatitis about twelve months {(Mowing first exposure. Eruption first noted on dteeks and then gradually spreading to forehead and neck. The. dermatitis next made its appearance on the arms and anterior chest. Trunin present particularly during hot weather. Notices remissions of two or three days. Notes iwrsistcnre of papules for a period of six months. Burning sensation not present. States that the pustules aru painful. Past Medical History--Essentially negative. Family History--Negative. Occupational History--Negative. Physical Examination--Apparently healthy aduil mate. Height 67 inches. Weight 152 pounds (greatest weight 155 pounds). Pulse rale at rest: 7R. Respiratory rate: 14. Blood pressure 142/94. Head and Neck: chronic right otitis media; eervielc lymph glands not palpable. Chest: normal shape; percussion normal; breath and voice sounds normal; no rales. Heart: apical impulse, 5th interspace midclavicular line: no murmurs. Abdomen: flat; no areas of tenderness or rigidity; no masses. Skin: con*.clones: papules; pustules; pitting of the skin especially prominent posterior literal neck. Lesions especially prominent over cheeks, forehead, and posterior 10 WfP*P> HONS 076202 HONS 076203 itfjfc 4*. Imwil neck. Upper Lip and Nose: clear. Arms: all stages of dermatitis present over extensor surfaces. Forearms: relative!) unaffected except for a few comedones over extensor surfaces. Cltcst and Back: occasional comedo, papule, and pustule, particularly over upjwr jxirtion of the sternum and over scapulae. Abdomen: all stages of dermatitis over both recti. Thighs: distribution on extensor surfaces. Buttock: dermatitis present and uniform both sides. Legs: rare comedones over extensor surfaces. Scalp: dear. Hands, Feet, and Nails: negative. Laboratory Findings--Blood Examination: erythrocytes 4,940,000; leucocyte? 9,050; haemoglobin 100. Differential Count: jmlymorphonuclcar leucocytes 66 per cent; small lymphocytes 12 per cent; large lymphocytes 20 per cent; basophiles 0.5 per cent; eosinophiles I S per cent. Icterus Index 5 1 Urimtlylit: reaction acid; specific gravity 1.020; albumin negative; sugar negative; microscopic examination, many pus celts in small clumps; no casts; no erythrocytes, Case Number 5--White male; complexion blonde; aged 24 years. Chief Complaint--''Pimples." Analysis of Chief Complaint--Dermatitis <!evclo|wd about three mouths after first ex|Kwure. Eruption first noted on face at the angle of the jaw. Noted gradual extension oi the condition over the rest of the face during a |*errod of one month's time. Dermatitis next involved the arms and neck. Pruritis noted at times especially aiter liot bath or in warm weather. Burning sensation not present. Remissions of two or three days. Past Medical History--Usual childhood diseases. Family History--Essentially negative. Occupational History--Negative. Physical Examination--Apparently healthy adult male. Height 68 incites. Weight 132 pounds (greatest weight 140 pounds). Pulse rate at rest: 70. Respiratory* rate: 16. Blood pressure 140/80. Chest: normal shape; per cussion normal; breath and voire sounds normal; no rales. Heart: ?;*ca) impulse, 5th interspace midrlavicular line; no murmurs. Abdomen: Hat; no areas of tenderness or rigidity; no masses. Skin: comedones; papules; pustules; pitting of the skin. Face; dermatitis pronounced over the angle of the jaw and checks. Neck: posterior lateral neck most markedly in volved. Chest and Back: essentially negative. Arms and I-unarms: dis tribution of dermatitis noted over extensor surfaces but less marked on the forearms. Thighs: small patchrs present anteriorly aitove the knees. Legs: essentially negative. Hands, Feet, and Nails: negative. Scalp: clear. Laboratory Findings--Blood Examination: erythrocytes 5.190.000; leucocytes 9,050; haemoglobin 100. Differential Count: polymorphonuclear leucocytes 67 per cent; small lymphocytes 25 per cent; large lymphocytes 4.5 per cent; eosinophiles 3 per cent; basophiles 0.5 per cent. Icterus Index 6.0; Van den Bergh 0.33 mgs. bilirubin per 100 c. c.; icterus index (7 days later) 5.0. Urinalysis: reaction acid; specific gravity 1.015; albumin 3 +; sugar negative; microscopic examination negative. Case Number 26--Infant male; complexion blonde; aged 2Yi years. History Obtained from Mother--Child's lather had been working at the plant for about two months wirvn the mother first noticed development of the dermatitis. Mother stated that the child's father returned home in his soiled working clothes and that it was his habit to play and romp with bis son, without changing to dean clothing. She also staled tliat father ami son slept together, the father always sleeping in his underwear. Tlie dermatitis made its first appearance on the child's anterior thighs above the knees. Shr next noticed small patches on the flexor surfaces of (he forearms which gradually extended to the extensor surfaces. Finally, the dermatitis 12 HONS C76204 1 ^"lyj 1 "^fwppp'fmstiMi,,iSi^JitJM,,, w " HONS 076205 developed on the iwck iwl (are. Motlwt stated that the iwited child vcralrhitiR oceasioirally. Site lias noticed a diminution in hit appetite. Constipa tion not present. No vomiting. Stools normal in color and consistency. No jaundice. No hacmatnria. No imlyuria. Mother stated that ehtld has been active, sleeps well, and is apparently unchanged except for the utorcsM. Past Medical History--Pertussis at age of six months. Family History--Father suffering from generalised chlor-arne as result of ex posure to hcxachtoro-naphthalcne and chloro-diplteny). Mother shows der matitis: cheeks; buttock; and extensor surfaces of thighs. Sister, II nwMitlis old, with chlor-acne in the comedo s:agc over both cheeks. Physical Examination--Well developed infant male. Weight 35 pounds. Axil lary temperature: 101*. Pulse rate at rest: 140. Respiratory rate: 26. Head and Neck: essentially negative exrqtl for acute left otitis media; ante rior cerviclt lymph glands palpable. Chest; normal shape; hreath atwl voke sounds normal; rv rales. Heart: no apparent enlargement; no murmurs. Abdomen: convex: no tenderttesi or rigidity; liver edge iwi (l|tai>lr. Ex tremities: negative. Skin: comedones; papules; pustules; slight |itting of the skin. Face: comedones and paimics alnindant over cheeks and (ordtrad. Note and Upper Lip: relatively unaffected. Neck: anterk>r ami pmnritT neck involved with occasional pustule. Arms and Forearms: all stages of the dermatitis present particularly un (lie extensor surfaces. CIm-sI : tew aimrdiMics over superior portion of the sternum. Hack: few comedones and papules over scapular. Abdomen: essentially negative. Thighs: dermatiiit prevent on both lateral and anterior surfaces. Ujn: occasional cumrd'ims over extenscr surtaevs. Scalp: clear. Hands, Feet, and Nails: rtegaiivr. Prevention Tltc j>rodurlion of iitdiixtrial dermatoses is |iarti:dlv dqrendenl ti|>on the nature ami severity of tltc exposure and upon individual Misccptibility. The relatively high jrcrccmnge of those individuals aliened, follow ing exposure to hcxachlnro-naplithalcite anti chloru-diphcnyl. in a total group of one hundrctl and twenty-six jtersons exatninetl. indicates a need for the arlttption of preventive measures where these ennqrounds arc used in industry. Prevention of skin contact with these substances would defend somewhat u{>ou the process employed. In tltose processes where tltc compounds arc heated to a teni|*ernture sufficient to cause volatiliza tion and subsequent condensation in air, citlter closed methods, operating under fiartial vacuum, or exhaust ventilation should Im* instituted. In tltose processes where the compounds arc handled in tire solid or liquid form, oiIkt means of prevention must lie adopted. Wlrctt (he operation is such tltat contamination of the exposed portions of (tie l>ody and clothing is unavoidable, adetprate protective clothing, lockers, and other sanitary facilities, should be provided. Furtiter prevention of skin con tact with these substances, for persons handling the finished product in the plant and for tire consumers, could Ire had by application of pro tective coatings applied to tlte finished product. Sum si Aar 1. Hexachloro-naphtlialene and chloro-diphenyl produce, on contact with the skir. of some individuals, an aenc-like dermatitis after varying degrees of exposure. Id Vp HONS 076206 2. From one to fifteen months exposure to varying amounts of liexachloro-naphthalcue and chloro-diphenyl on the group examined was required before tin? onset of the dermatitis. . 3. The dermatitis, in the group of twenty-three persons examined, rr>uhmg from exposure (average length of cx|>osurc approximately 24.3 months) to hexnchloro-naphthalcne and chloro-diphenyl had a predilec tion for the face and the extensor surfaces of the boJy. 4. Svsteinie effects produced as a result of exposure to hcxacldoronaphthalenc and chloro-diphenyl should be further studied. Acknowledgments Tlie Department of Labor and Industry of the Commonwealth of Pennsylvania wishes to thank tlie management and employe* of the plant studied for their cooperation and interest which made tlie success of this study |x>sstble and tlie laboratory technicians of the York Hospital for the icterus index and Van den Bcrgh determinations. BlBbtOCKAPliY 1. Wauer: Ztrbl. f. Gewcrlwhyg., P. 100, 1918. Berlin. 2. Teleky, L.; Klin. Woch., Nos. 18 ami 19, pp. 845; 897, 1927. Berlin. 3. Nicolas, J. and Lacassagne, J.: Bull. Soc. franc, de dermat, ct sypli., P. 223, March 1929; abstr. J. Ind. Hyg.. 11, 187, 1929. 4. Schwartz. Louis; UnpuMisIxxl paper--"Dermatitis from Syn thetic Kesins and \\ axes.'* Bead October 8, 1935 at the Sixty Fourth Animal Meeting of the American Public Health Asso ciation in Milwaukee. Wisconsin. 15 HONS 016207