Document v6MY8y4x6Qb6ykVxeD1oGR2bq

SKIN CONDITIONS RESULTING FROM EXPOSURE TO CERTAIN CHLORINATED HYDROCARBONS* Mat R. Mayers Division of Industrial Hygiene, New York State Department of Labor AND Mabel G. Silverberg Cancer Unit, New York Post-Graduate Medical School and Hospital, Columbia University, New York City OR a number of years there has Fbeen sporadic interest in the occurrence of a rather charac teristic acneform eruption in workers handling the chlorinated naphthalenest and diphenyls. Manufac turers of these substances recognized this condition among workers in their factories years ago, and found that the cases could be materially reduced or even completely eliminated by the introduction of adequate ven tilation and by the practice of good personal hygiene on the part of their employees. During the World War when perchlornaphthalene suddenly began to be used in quantity in Germany under the name of "Perna" as a substitute for resin and rubber, large numbers of workers contracted this* * Received for publication December 23, 1937. t The chlorinated naphthalenes are some times referred to as "Halowax" by pur chasers and users. While the Halowax Corporation manufactures these sub stances, it also manufactures many others. The term "halowax" is merely a trade name for substances manufactured by this com pany and should not be used indis criminately. In all instances substances should be designated by their chemical names only. 244 246 JOURNAL OP INDUSTRIAL HYGIENE AND TOXICOLOGY in some detail. These waxes, it was learned by personal communication with the authors were chlorinated naphthalenes.* The fact that one of us (M.G.S.) had the opportunity to examine these cases at the time proved an added stimulus to the present investigation. Another illuminating contribution along these lines was a bulletin from the Pennsylvania Department of In dustry and Labor in 1936, in which Fulton and Matthews (2) presented the results of a study of 101 cases of dermatitis which occurred in a wire insulating plant in their State. In addition to describing the lesions as they found them, they showed that it is possible for a worker suffering from this type of dermatitis to transfer the skin disease to other members of his family through intimate contact with the clothing worn in the factory. Through the cSurtesy of Dr. Fulton, the authors had the opportunity to see one such worker, his wife and two children, one a young baby, who were all affected by contact with him and his clothes when he came home from work. As long ago as 1899 Herxheimer (3) accused the halogen, chlorine, of being the direct cause of acne, coining the word "chloracne." Considerable at tention was thereafter concentrated on chlorinated substances as the cause of acne. However, it gradually came to be felt that it was not the chlorine that was responsible but that a chlorinated hydrocarbon was to blame in most cases. Tar, mineral oil, vase line, paraffin and similar hydrocarbons have long been recognized as causative * Personal communication from Dr. M. Sulzberger. agents in follicular and ac' eruptions. The use of a chlorinated napht known in Germany as "Pemd" already been mentioned. WhejJ material came into use again' the war, Teleky (4) describ many cases of skin eruptions t observed during the years 1 Improvement in hygienic coil in the factory appeared to bein controlling this disease. Teleky's final conclusion thn deciding factor as to the po any particular chlorinated causing acneform dermatoses d not so much on its chlorine as upon the amount of unbo loosely bound chlorine that 4 tained. A method was sub introduced and patented for so ' the chlorinated naphthalene"' remove all loosely bound chlor it was believed that the incide acne in workers exposed material was greatly reduced t" Courtois-Suffit, Touraine > Mdndtrel (5) in 1934 drew at to this condition in France? admirable paper in which they ] out that the coal products t* most apt to give rise to lesions pilo-sebaceous apparatus are f of the second distillation fr ` These writers noted erythemato vesiculo-edematous symptoms in' workers as well as the acneform, They believed that seborrhea predisposing factor and repor patch tests with the chlo waxes were negative in all casifig| In 1935, Jones and Alden ( Atlanta, reported their observe concerning industrial skin eru of an acneform type in workers DERMATOSES FROM CHLORINATED HYDROCARBONS 247 the manufacture of chlorin$tphenyls. It was their belief 11)6-:eruptions were perhaps due Parities rather than to the themselves. $ (7) in a report on "Derma- op Synthetic Resins and Mn 1936 confirmed the reports ' investigators that patch |h these substances regularly tive results. literature with reference to Systemic effects from exposure chemicals is not considered ty pertinent to the present ion to be discussed here. Pry and Toxicology ted naphthalene is a naph- which one or more of the atoms has been replaced by ; Thus, there are many naphthalenes beginning monochlomaphthalene and ;tp the octochlor derivative, ated naphthalenes as used Hy, however, are usually each of which contains one of the chlorine deriva- so-called trichlomaph- lor example, which is most used for the impregnation irs, in reality contains tri and tetra derivatives. *|he higher chlomaphthalenes d in various combinations, penta, and hexachlor- enes are sometimes used ination with chlorinated |r ! , ' 6y speaking the higher the , the higher is the melting Ube wax and the more water- ecomes. Since resistance to moisture are the outstanding characteristics of these materials, the higher chlorinations are in great de mand commercially. Unfortunately, however, the higher the chlorination of the naphthalene, the more toxic does it become. That is the dilemma which manufacturers of these products are working hard to solve. r"" Diphenyls are manufactured by passing benzene through molten lead so that C6Hs is converted into CmHjo. Chlorine is then bubbled through, dis placing one or more of the hydrogen atoms and forming substitution prod ucts ranging from the monoehlor iiphenyl to the decachlor diphenyl, ill of the hydrogen atoms having finally been displaced (C12CI10). O- The Process of Manufacture The manufacture of electrical con densers is not carried out in exactly the same way in all factories, but it usually follows the same general lines, depending upon whether the con densers manufactured are of the socalled "Inductive" or "Non-inductive" types. Winding and soldering.--In making inductive condensers, long ribbons of paper alternating with tinfoil (three sheets of paper with two of tinfoil) are rolled on small spools by winding machines. When the winding is com pleted the paper is seen to extend out beyond the tinfoil. In this type Of condenser ingoing and outgoing metal leads are introduced at right angles to the direction of the winding and the condenser is then impregnated. In finishing condensers of this type, a wire is soldered to each lead by means of a soldering iron. In winding non-inductive con densers, the tinfoil strips are wider 248 JOURNAL OF INDUSTRIAL HYGIENE AND TOXICOLOGY [oZ.^ than the strips of paper, so that when condensers to seal them. This the winding on the spool is completed, not contain any chlorinated na the tinfoil extends beyond the paper. thalene. Since this latter mate ' Sometimes aluminum foil is used difficult to pour in the ordinary 1 instead of tinfoil. No leads are in because of the ease with which troduced after impregnation. The solidifies on cooling, it is more soldering of these condensers is done tomary in using this wax to dip by passing the tin or aluminum foil condensers into a pot in which portions over a hot plate, using a stick chlorinated naphthalene is kept-' of solder to solder on the wires. This proper temperature. When it is* process gives off far more fumes than sired, however, to pour molten chi does the soldering of the inductive con ated naphthalene into condensers1 densers above described. especially designed small closed - Impregnation--After the spools are is used, in which the chlorifi wound they are placed in wire baskets, naphthalene is kept at a p" several dozen to the basket, which temperature. When a key is p are subsequently put into an enclosed the molten wax drops from the , oven in which they are impregnated into the condenser. The hi with one of the chlorinated hydro chlorinated naphthalenes are use carbons. The one most commonly these operations. used for this purpose is a combination The soldering operations hav|f of trichlor and tetrachlor-naphthalene, ready been mentioned. a wax-like material heated to a In handling the condensers iHfe temperature of 248-258 F. After im finishing rooms, there is cons pregnation, the oven is opened, the contact of the hands with the chi basket of condensers is removed and ated naphthalene in its cold immersed in an open vat usually state, usually somewhat mois`( containing mineral oil. with mineral oil. Finishing operation--The basket of All workers engaged in tf* condensers is then transferred to a finished condensers or employe' so-called finishing department where any other processes carried on ta workers, mostly young girls, sit at "finishing room" are apt to be long tables and perform various finish directly exposed to the vapors o^ ing operations, including what are chlorinated naphthalenes given' known as sealing operations and the in the soldering and sealing operatl soldering of metal parts to the con unless the ventilation of the room ` densers. whole is adequate. The sealing of condensers may be done either by dipping them into a Examination of Workers small pot containing a molten sealing In the present investigation, U compound, or by pouring such a plants in which a mixture of tri* molten compound into them. In tetra-chlornaphthalene was emplf many plants, including the two which in impregnating condensers were i| were selected for special study, a ied, and 31 workers examined,`k pitch preparation was poured into the of these workers were employed ift DERMATOSES FROM CHLORINATED HYDROCARBONS 249 % "finishing departments" sure to the material re flaming the impregnated jig- or otherwise causing a Ifpn of the wax. duration of employment-- '** of the workers and the time that they had been in the same plant at the fess are presented in the .tables: Number of workers :ears............................. 26 i %>.......................... o 31 p of Employment: .h 6 months................. 11 fifths............................ 4 ............................ 16 and over.................... 1 31 In examining the workers taken in each case in age, (2) sex, (3) process at fer was engaged, (4) dura^loyment before rash ap- uration of rash, (6) total ; (7) family history of acne personal history of acne family history of dermata, and other allergic 'hs, (10) whether work ted naphthalene was ntinued without inter- rmanently discontinued of the skin eruption. The skin of the workers y examined and finally were applied with the instances: (1) potassium in anhydrous lanolin, (2) potassium bromide 25% in anhydrous lanolin, (3) sodium chloride 25% and 50% in anhydrous lanolin, (4) naph thalene, and (5) mineral oil in use in the factories, with (6) anhydrous lanolin and (7) ammoniated mercury ointment 5%, as controls. Dermatological Observations From an analysis of the observa tions made, the skin conditions ap peared to fall into three main cate gories, as follows: 1. Acneform eruptions with pus tules, papules and large come dones. 2. Vesiculo-erythematous eruptions usually observed in dermatitis venenata. 3. Simple erythematous eruptions with pruritis. In addition, localized dry scaling patches of dermatitis were observed in cases presenting any of the three types of eruptions listed. These patches were never a prominent part of the picture, and were never seen in the absence of one or another type of eruption mentioned. They were less than 5 cm. in diameter, and oc curred on the face, neck or arms. Such scaling patches are often asso ciated in the lay mind with eczema, and are frequently seen in all types of patients who complain of any of the longstanding itching dermatoses. They are sometimes at least secondary to friction applied for relief of the itching. I. Acneform Eruptions. To the uninitiated the acne which is seen among workers in this industry, and acne vulgaris look very much alike. Their clinical differentiation will be considered later. 250 JOURNAL OF INDUSTRIAL HYGIENE AND TOXICOLOGY [vol. The high incidence of skin eruptions in workers engaged in the manufacture of electrical condensers has not es caped the attention either of employers or of those engaged in the manufacture of the chemicals used in this industry. Consequently there has for years been a concerted effort on the part of all concerned to remedy this situation, and to a large extent this has been accomplished by the introduction of better yentilation into the workrooms. In addition the practice has been fol lowed, particularly in the larger plants, of examining all applicants for em ployment for any abnormalities of the skin, including the acne of adolescence. Only those with clear skins are or dinarily employed.* It is not surprising, therefore, when walking casually through plants en gaged in the manufacture of electrical condensers, and observing the skin of young men and women sitting at thenwork benches as carefully as one can under those conditions, to note that the incidence of acne vulgaris ap peared to be definitely lower among these young people than what one ordinarily finds in an average un selected group of workers of the same age. Severe cases--Among the 31 workers whose skins were carefully examined in the present series, there were six (4 females and 2 males) with marked aeneform eruptions, showing pustules, papules and large comedones. One had a coexistent dermatitis venenata and was suffering from paronychia, involving the index fingers especially. * There is an unconfirmed belief among employees in this industry that blondes are more susceptible to skin irritation than brunettes, so that the latter are usually selected for employment whenever possible. In the case of one young girl ined, the aeneform eruption w severe and had persisted for soil time that the deep layers of thehad become involved; and t" she was receiving excellent trea there was marked scarring of, face with resulting permanent disfigurement. An investigation in the case -^ girl who contracted a severe form eruption in one of the studied, but who was not p when the plant examinations made and so is not one of the, now being reported, revealed t" that at the site of an itching acn eruption on the cheek, a furun of the inner aspect of the chefi developed which, probably due ondary infection from scratching on to septicemia and resulted! death. The tendency for this aeneform eruption to develop p' and even go on to abscess for has been recognized and repo the literature. Mild cases--In four cases the. form eruption was discernible i so slight that its presence was but not regarded as significant, with a few pinpoint papules o" tered comedones on the face!' were found a few pinpoint p surrounding hair follicles aroi! elbows or on the extensor surf the arms. In none of theses was there any pruritus. In') instances there was an appare' gravation of a pre-existing ve; acne vulgaris. The eruption mild in these cases that one h to make a definite diagnosis, distribution of the lesions, ho more than anything else, te * DERMATOSES FROM CHLORINATED HYDROCARBONS 251 ft .differentiation of these skin mentioned by Fulton, but has not 'from a true acne vulgaris. been greatly stressed in the literature ution of the eruption--The as a whole. Though not a constant ^appeared principally on the finding it is an important diagnostic dirteck and the extensor sur- sign when present because acneform i l:ihe arms. Sometimes the eruptions as a group are not usually Wire also involved, and very associated with pruritus. Acne vul ly the chest, back and garis seldom itches. Four of the ` surfaces of the legs. The workers in this group complained of ^cheeks and chin were most intense itching. Volved, the line along the In one very severe case, the acne '/being a site of special pre- form eruption was associated with The eruption appeared a dermatitis venenata, and a paro , fe often than elsewhere, and nychia which persisted long after the ,inarked tendency to persist eruption had disappeared. This case it had cleared up elsewhere, will be mentioned later. ig that the nose was al- Period of exposure preceding erup spared. The importance tion--The period of employment before `button of the eruption as a the acneform rash appeared varied differentiating it from acne from a few weeks to a little less than I be subsequently discussed. 1 years. On the whole cases tended of the lesions--Six of to be more numerous in the summer. workers examined suffered On removal from exposure the rash severe acneform erup- tended to disappear in 2 or 3 months, these cases the lesions were though in very severe cases it appar pbint to pea size, yellow- ently may persist for a much longer ' slightly pinkish papules, period of time. ctly perifollicular and sur Family predisposition--Though the * large comedones. Some- cases were few, it was noted with ea of closely packed large some interest that there appeared to could be seen without be a family predisposition to exposure ding reaction. This gave to the chlorinated naphthalenes which a black spotty appearance. Was not apparently based on a sus Ifiustulation occurred, it was ceptibility to acne vulgaris. For ex Ominent feature in these ample, three of the workers who were basionally there were also suffering from severe acneform erup blotchy areas of erythema tions had sisters or brothers who had scaly itching patches, had to give up that type of work rkers themselves were espe- because of serious skin eruptions. ftressed with the comedones Two of these workers, both girls from piling, so that the rash was two different families, each had two ItTy characterized by them brothers so affected. One of these Iftckhead itch"--a term which families was using iodized salt at home In to have coined. The because the mother was suffering aflteter of the eruption was from goitre. This may have supple- 252 JOURNAL OF INDUSTRIAL HYGIENE AND TOXICOLOGY [vol. 00, merited the occupational hazard in along the extensor surfaces of,., that family, but the fact remained arms, and particularly around that no member of the family had elbows; and its predilection for. ever suffered from acne vulgaris, as area along the whole length of;, far as could be determined, and that mandible is not characteristic of all three who began working in the vulgaris. Furthermore, the b condenser plant developed a very which is an important site of severe type of skin eruption--so dilection for acne vulgaris, was,. severe in the case of two of them that often involved in the workers, they had to go into some other type amined. Lesions may also be: of work. Both recovered satisfac served on the legs and abdc torily after exposure ceased. In the along the belt line, or other areas1 other family there was no history of there is friction from clothing, ; the ingestion of iodides or bromides not usually involved in acne vulg and yet three members in turn were forced to discontinue work in the plant II. Vesiculo-Erythematous Erupt because of severe acneform eruptions. One worker, in addition to Here again, there was no history of a severe acneform eruption, acne vulgaris in the family. The from a weeping vesiculo-erythem family where iodized salt was being eruption of the dermatitis ven used appeared to have a very poor type. The eruption had a widet standard of personal cleanliness, but distribution on the face, neck, in the other family a high standard of and trunk. It began about 6 mo personal cleanliness was observed. after starting work with the Differential diagnosis from acne vul ated naphthalenes and clear garis--In the severe cases, there is within a month after exposure/ usually little or no difficulty in differ permanently discontinued. The. entiating these conditions. In the returned to work in the same milder ones, however, the diagnosis is and was given a job in a dep apt' to be more difficult. Certain were she would not come into points of differentiation are helpful, contact with the substances to however. When present, the intense she was sensitive. Nevertheless," pruritus, for example, is of great continued to complain of reel importance, since this is seldom found attacks of moderately severe itcT in cases of true acne vulgaris. The This case, among others, showe prominence of comedones in workers chronic paronychia involving exposed to the chlorinated naph index fingers which was extrem thalenes, and the frequency with persistent. which these comedones may be seen crowded together, is so striking as to III. Simple Erythematous Reacti suggest definitely this type of acneform Two of the workers examined \f eruption rather than acne vulgaris. found to be suffering from what The distribution of the lesions tends peared to be a simple erythemat to throw further light on the differ eruption with severe itching, ential diagnosis. The distribution appeared mainly on the face . DERMATOSES FROM CHLORINATED HYDROCARBONS 253 though in one case it could simple erythematous eruption, one be seen on the extremities. There refused to be patch tested, and the HO typical acneform eruption in other was negative. `^oses. Mechanism of acne -production-- tiJne of the cases the eruption ap- Because of the resemblance between twice-^once 6 months and the acneform lesions found among year after beginning employ- these workers and acne vulgaris, the $ch time clearing up in 2 or question arose as to whether the same In the second case, the mechanism might not be operative made its appearance 3 months in both conditions. If this were so, ^ginning employment and had a one might expect the sporadic cases pf about 1 week. to break out in those individuals who cases the erythema in- had already suffered from attacks of jjjie face, neck and extensor acne vulgaris or in whose families Jpf the arms; and was asso- there was a predisposition to such a Wi,th a severe pruritus. Both condition. A careful examination of complained not only of itching the evidence in this series of cases did hue of the eruption, but also not, however, appear to support this jpllttent attacks of itching conclusion although a more extensive jfer the eruption was no longer series might throw additional light on the question. utests--As was anticipated in The further question suggested it orm cases, all of the patch self as to whether or not a relationship ormed with the chlorinated might exist between hypersuscepti Ipes in this series gave es- bility to the chlorinated naphthalenes |pggative results. This was and a general hypersensitivity to ,with the experience of previ- members of the halogen group gener rs including that of Dr. ally, such as, for example, the iodides, bwartz of the United States or the bromides. That these latter th Service, substances are frequent causes of Incase which was associated acneform eruption is well known. rmatitis venenata the patch The relation of chlorides to the other the tri and tetrachlomaph* halogens in these conditions is not (to which the worker was entirely clear. It is of interest to was positive, as were also note, in this connection, that the cji tests with the 25% potas- chlorides are at present being pre de, 25% potassium bromide scribed by ingestion and injection in tvj>% ammoniated mercury, cases of iodide or bromide poisoning j; words, this worker when with a view to mobilizing' the other parcntly had a polyvalent halogens. ty. The substance with Sulzberger, Rostenberg and Sher, ije had worked was thus only as well as other writers, have felt .y substances to which she that acne vulgaris may occur as a ersensitive. result of a hypersusceptibility of the e two workers who had a pilo-sebaceous system to stimuli ema- 264 JOURNAL OE INDUSTRIAL HYGIENE AND TOXICOLOGY [vot. io, no nating from specific circulating endo crine substances. A hypersuscepti bility to potassium iodide, if clearly demonstrated by patch tests, might indicate that such individuals had an especially labile pilo-sebaceous system, easily responsive to a number of common insults to the pilo-sebaceous apparatus. It might on the other hand indicate a specific response to insults from members of the halogen family. Because of these theoretical con siderations, all cases studied were patch-tested with an ointment of potassium iodide, and an ointment of potassium bromide. Though the patch tests seemed to indicate a slight increase in susceptibility to these substances among the workers with the acneform eruptions, un fortunately, none of the reactions were sufficiently strong to warrant any definite conclusions on this point. There is still a question whether the eruption here discussed is due to mechanical plugging of the sebaceous glands in the skin, or whether the sebaceous glands are overstimulated either when end'products are circulat ing in the blood or are being excreted by the skin after absorption of the waxes by the body. That these sub stances are not excreted unchanged by the skin has recently been demon strated by feeding experiments con ducted by Dr. Cecil Drinker.* He found no increase in the chlorine content of the skin of rats who had been fed toxic amounts of the higher chlorinated naphthalenes. As a final point in relation to the skin lesions, it may be pointed out that no correla * Private communication. tion existed between these lesions ai systemic effects of any sort. T failure to connect skin and poss' liver lesions corroborates the exp ence of others. Prevention The process of impregnating trical condensers has always preset! so obvious a health hazard that effort in the past to protect wor in this industry from injurious posure to fumes and vapors ofc chlorinated naphthalenes has concentrated at this point. Inf, early days, condensers were im nated in the general workroom.' covered pots were sometimes this purpose and everyone in the was more or less exposed to vapors were given off. The inc* of skin eruptions was high, adays, the impregnating rooms in plants are completely separated all other workrooms; the ovens, are, with few exceptions, t'` constructed and well covered; the incidence of skin eruptio dropped so low that one rarely case in this department. It is the very innocuous Id finishing departments which ar sponsible for most of the ca skin eruptions one sees. In thf ping, pouring and soldering opera the chlorinated naphthalenes ar atilized by heating or flaming, cause the fumes are given o,, relatively small amounts from a * many different points in the room, their importance as a K hazard is apt to escape the attd of the casual observer. Consequ no concerted effort is usually : correct this situation. S] DERMATOSES FROM CHLORINATED HYDROCARBONS 255 le each plant has its own special ting problems which require if**study, the following general es are applicable to all, and if,carefully adhered to. yjfl&gnation of Condensers |||pfegnating ovens should be jTjaid tightly constructed so vapors may escape as a result Oven should be provided with 'fahd equipped with lateral ^ventilation so disposed that e door is opened, the vapors ^immediately exhausted at llrce. A velocity of 1000 ecommended. Jbess should be conducted in yrhich is isolated from other of the plant. Dipping tthe chlorinated naphthalenes for sealing condensers, all pots into which such con jee dipped should be equipped >al exhaust ventilation having of 1000 f.p.m. The higher 'ons are employed in these impounds, and these are more are the tri and tetrachlor'ene used for impregnation, oyer the pot, together with exhaust ventilation as freemployed at the present inadequate for the purpose, ould instead be a duct comffeurrounding the upper part j>pt through which the vapors Rusted laterally. Pouring condensers are filled by instead of dipping, various pitch preparations are used more frequently than are the chlorinated naphthalenes. However, when these latter materials are employed for this purpose, the molten wax may be kept in a small tightly enclosed storage tank on the table. The condenser is placed under a slot beneath the tank, and when the operator presses a key the wax drops from the storage tank into the condenser. Such a tank should be supplied with lateral ex haust ventilation. The storage tank is refilled by dropping in lumps of the solid wax. Soldering Workers doing soldering should be similarly protected. Work benches at which this is done should be sup plied with a series of small hoods, one for each worker, under which the soldering operations are carried out. Each hood should be equipped with lateral exhaust ventilation so disposed that the fumes given off are carried back and away from the workers' faces. An air velocity of 1000 f.p.m. is required. Where soldering of tinfoil condensers is carried out by rubbing the end of the condenser on a hot plate, the hazard is greater than where wires are soldered on to leads. All such hot plates should be equipped with a hood having a slot at the end of the plate and supplied with lateral ex haust ventilation. An air velocity of 1000 f.p.m. is required. General Ventilation In addition to the local exhaust ventilation above outlined, careful attention should be directed to ade quate ventilation of the room as a 256 JOURNAL OF INDUSTRIAL HYGIENE AND TOXICOLOGY [vol. S0;no'rt whole wherever any worker is exposed directly or indirectly to fumes or vapors of the chlorinated naphthalenes or diphenyls. rJ pPeerrssoonnaall HHuygaiieennee has been recommended for this purpose is the following:* ^inc oxide...................i oz. Calomine lotion............. $ oz. SAdaelipcsyliLcaanciHd.y..d...........................240flguriadmsoz m This may be briefly summarized as follows: Medical Supervision 1. Employers should supply workers with highly starched uniforms, under- wear, caps and gloves; these clothes should be laundered every day. . 2. Two lockers should be provided, one for street clothes and the other for uniforms. 3. Employers should provide work- ers with sanitary eating facilities, re- moved from their workroom. 4. Wash periods should be sched- uled on company time, and washing up before lunch and before leaving work at night should be done under factory supervision. 5. Cold cream, plenty of hot water, soap and individual towels, together with a protective lotion for the skin should be supplied by the management, Since the chlorinated naphthalenes are not soluble in water, the wax-like film which is deposited on the skin should first be removed with cold cream in which it dissolves. Workers should then wash thoroughly with plenty of warm water and a mild soap, This ritual should be carried out conscientiously before lunch, and again before leaving the factory in the evening. A shower before leaving wor,k i.s d,es.ira,b,le. All workers should apply a protec- tive lotion to all exposed parts of the body before starting work in the 1. All workers should be instruct as to the hazardous nature of work and the rules to be follow in order to keep well. They sho$ be encouraged to report promptly i evidence of a skin eruption or ' general ill health. 2. Young workers suffering fr acne vulgaris should not be emplej in this industry. fH 3. Because of the possibility's severe scarring of the face follow a severe acneform eruption, it seem particularly desirable not ,4 employ young girls. 4. Workers developing skin er tions of any severity should^ immediately removed from fur exposure to the chlorinated na,| thalenes. In rare cases the eruptions may be aforerunner systemic poisoning, such as a| yellow atrophy of the liver. 5. All workers developing skin 6^ tions, particularly of the itchy va should be carefully watched so guard against infection. 6. Workers should be given perkf physical examinations. Summary 1. Exposure to the chloringj naphthalenes in the manufactu electrical condensers may result^ morning and before starting Work Recommended by the Halof again after lunch. A lotion which Corporation. 3$g] DERMATOSES FROM CHLORINATED HYDROCARBONS 257 eruptions, characterized by , papules and comedones, ;ciation of comedones in timbers, with a severe pruritus fi* has given it the name itch" among the workers, e 31 workers examined in two fifing a combination of tri and ^naphthalene in the manu al condensers were all em- the finishing departments, leering or testing of condensers ' already been impregnated, eruption observed fell into types, which have been eruption may or may not ibling. ally occurs within the first fbs of employment, though exceptions to this rule. appears to be great differ<3 susceptibility of individuals substances. Some workers IjJjTected. 'incidence of the acneform appears to be higher in the j|n in winter. ; acneform eruption differs a|he commonly found among p in the following important 54 e pruritus, which very selaccompanies vulgaris, (ation of acne with a dermaHs venenata or a paronychia the fingers, especially of dex fingers. jidones are far more nu merous, more closely crowded ether to form patches, 'bption along the exterior aces of the arms and esially aroimd the elbows, an area almost never affected by acne vulgaris. The back, so often affected in acne vulgaris is not commonly affected here except in very severe cases. The legs and abdomen may be affected. The line of the mandible is an area of pre dilection. e. The condition may be transferred to other members of the family by contact with the skin and clothing, when these have a coating of the chlomaphthalene on them. 10. The mechanism for these acne form skin eruptions is not clearly understood. 11. The eruption may in severe cases involve the deeper layers of the skin and result in permanent scarring. One case of permanent facial dis figurement in a ypung girl was ob served in the course of the present study. 12. In severe cases, there is a tendency to secondary infection, es pecially when there is a coexisting pruritus and the worker scratches the lesions. In the present investigation a furunculosis of the cheek super imposed on a severe acneform eruption resulted in death from septicemia. 13. There is every reason to believe that attention to adequate local and general ventilation, good personal hygiene on the part of the workers and adequate intelligent medical supervision will effectively- eliminate the hazard. 14. Fumes and vapors should be exhausted laterally at their source, the velocity of air being maintained at 1000 f.p.m. 258 JOURNAL OF INDUSTRIAL HYGIENE AND TOXICOLOGY [vol.iOi 15. General ventilation for the room 16. Principles of personal hyg|i as a whole should be introduced when and medical supervision have ' necessary. briefly outlined. BIBLIOGRAPHY 1. Sulzberger, M. B., Rostenberg, A. Jr., and Sher, J. J.: Acneform eruptions. N. Y. State J. Med., 84, 899 (1934). 2. Fulton, W. B., and Matthews, J. L.: A preliminary report of the derma tological and systemic effects of ex posure to hexochloro-naphthalene and chloro-diphenyl. Penn. Dept. Labor, Spec. Bull. no. 43 (1936). 3. Herxheimer, K.: Ueber Chlorakne. Munsch. med. Wchnschr., 46, 278 (1899). 4. Teleky, L.: Die Pemakrankheit. Klin. Wchnschr., 6, 845, 897 (1927) ant 214 (1928). 5. Courtois-Suffit, Touraine Mntrel: Etude sur l'intoxica professionnelle par le trichloro-ns thalene. Ann. de M5d. legale, 422(1934). 6. Jones, J. W., and Alden, H. S.: form dermatergosis. Arch. Der Syphil., 88,1022 (1936). 7. Schwartz, L.: Dermatitis from thetic resins and waxes. Am. J. Health, 86, 586 (1936).