Document vB3pQkJg58vq5ELLxwoK6N876

7 134 3> Archives of Dermatology and Syphilology Vuli-.-: -a oiessor of Dermatol , Associate Profeuar Education and Reseat -tii edition. Price red plates. Philadeljft >y dermatologists.' s the son of Dr. pi as junior, author. : aspects of derraat credit to them and *pter. unfortunately tabolic) have .1 previous editions^, .ritten, notably ices and on disease^ etl myositis group. p l, to save space, appearV. revised by Dr. Qarktc ledge of histopatho|>C3^' s the excellent select Jtologic and my isidering the cost, [U text, and an ad-- the failure, in ' presence of name ng that different _ rors will be eoi rgetedj f '.rmatology. It shdil k of the publishers a HALOWAX ACNE ("CABLE RASH") .'.TAKEOUS ERUPTION IN MARINE ELECTRICIANS DUE TO CERTAIN CHLORINATED NAPHTHALENES AND DIPHENYLS CHARLES KEMM GOOD, MD. AMS NATHAN PENSKY, M.D. NEW YORK ' . 'resent study is concerned with an eruption observed and studied in a series - i'e electricians engaged in working with certain types of electrical cable in a : Upbuilding organization over a period of several years. -- first patient was seen on Dec. 31, 1941. The number of cases has gradually mcr- *ed to a total of 52 at the time of writing. Many patients have been under c* *ti-observation for a period of one and one-half to two years. The studies cm I'-rp function to be described were based on a selected group of 25 patients who itec a more extensive involvement New cases still are developing, and the ith'v continues. A cooperative and free exchange of information with physicians ikcv.hcre in the United States who are seeing and treating patients with this eruption lias been maintained. This has been mutually helpful in the attempts to %"hc the problems presented and beneficial to the patients in the relief that it has l*cen at times possible to afford them. Ilwlowax acne or "cable rash" is the general term commonly used to designate die eruption. It is by no means a new clinical entity. Soon after the introduction 01 tar and its derivatives into industry, acnefonn eruptions began to appear and were reported in the literature by early observers. Dermatologists and industrial physicians studied the causation, control and prevention intensively. Most of these studies have appeared in specialized publications, principally those devoted to industrial medicine. Perua Krankheit was the term used to describe the condition by the German writers1 at the time of World War I. This acneform eruption, identical with the timicai picture now appearing, occurred among workers on gas masks and on gas proof clothing. It was caused by chlorinated naphthalenes. Today chemically related substances (known by the trade name Halowax) are used in considerable amounts on siiips. Halowax is manufactured and compounded by the Halowax Corporation, a subsidiary of the Union Carbide and Carbon Company. It is a waxlike substance, a mixture of chlorinated hydrocarbons J'roduced_cheniically by chlorination of naphthalene and diphenyl. This material ,s incorporated into electrical cables designed for specific purpose on naval vessels. ----------- i t; 1. Tricky, L.: Die Pemakrankheit (Chloracne), Klin. Wehnschr. 6:845 and 897, 1927. J^oelich, F., m Ullmann, K.; Oppenheim, M.. and Rilie, J. H.: Die 5chadigungen der Haut durch *eruf und gewerbliche Arbeit. Leipzig. Leopold Voss, 1926, pp. 303-343. ' *. 'joch i; jj 252 ! ARCHIVES OF DERMATOLOGY AS'D SYPHILOLOGY |. GOO. It is a unique and invaluable material, possessing many essential and desirable qualities. Extremely resistant to physical wear, chemical corrosion (including sca water) :and wide range o changes in temperature, it is, in addition, waterproof arul ratproof. It strongly withstands heat and flame. Its value as an insulation f0r electrical currents is extremely high. Under heat it has a desirably high "flow point." By varying the degree of chlorination, materials of different plasticity may be obtained. The hardness of the Halowax is directly proportional to the percentage of chlorination. An average composition is 20 per cent pentachloro* ' -- --a an ner ce *" '--- * which as much as 20 ptr f '/ryjpracdcally eliminates the vs j ... ` firmly and securely arrache.- friction and pressure. Admirable descriptions i : SfeAwcrican writers Schwartz. . ^Efiritish writer ThehveU .Tone . ...~L]936 dearly establishes his \ } American literature. In fHT"handling the hot molten mate j ~ ~5~~with the cold electric cc3eo0nntptecenhrtlocoreifnnaatptocparrocaxsuimphmaigt^ehyly.a_s6_08v0pe_p_recrecnetnt,Tdheepeconndtinegnt omnatyheoepOhUyJsUic*al._ch--ara__c__t_e_r_ istic! ' h<c**fra<ed on workers engaged in llf^?5Jones * observed the eruptions 1 mm *"' as it was chemically' p1 desiHreadl.owax is principally used in insulating wire for systems of intercommumcaiion and for the de Gausse system of rendering ships electrically neutral to magnetic mines.! When in operation, a constant electric current of high amperage U (constantly) passing through cables strung through the entire length of the hull of the boat. This current, acting as a "flux," effectively counteracts and neutralize* the electric currents generated by the myriad of electric apparatus, including generators aboard modern ships, and the steel of die boat as it travels through tht of temperature were workers were exposed to was pfiese writers described a var: *' `fled them into three ma puies and large comedos; ( ^dermatitis venenata; (3) si ~-The eruption to be descrif been noted by these pre wcuamteTbrhe. eIrsocmabele(santhdeomcsceulvpeyscoamrtparrealativtievleylylittflleexsibplaec.e) They are not too bulky or and are designed to iaciliiatt ease of installation and connection. They are metal covered. The approxmute diameter is about 3 inches (7.5 cm.). The cable consists of individual bundles c>: copperj wire. Each bundle is coated with Halowax impregnated into asbestos. Tht bundle: is then coated with a layer of cellophane. Surrounding this is vc a.-, outer layer of rubberized fabric. This layer, in turn, has a rayon am . 1U incorporating several such bundles together, the large de Gausse cable i *-.!; i. udlitics shipbuilding construe ..Halowax began to be used, ^jajvarious shipyards. As a r - Marine electricians began to c . because of the disability product was lost, because skilled electn . aew, untrained workers taught ` tfw rash, tliey were deterred fro abent of women in defense ind formIned:m. aNkainvgalealencdtrcicargcoonvneescsteiolsnsareansdo waitrteadch. ing lugs, the cable and is.-t: iriucu :4r bundles are ``skinned/1 By "skinning" is meant the cutting hack of the i.ilh.outercovering and the individual covering of the bundles for several inch Tht covering materials, including the Halowax, are removed and the bare coppv '-and* exposed. In this process Halowax particles, in the form of a fine gray pov r, an emitted. A dust is gencratcdT At tames it may be necessary to neat tfle am bundle ends to effect connections. In addition to the dust itself, the el. -icon are exposed to the fumes that may be generated by the heat Because : wir is strung along the hull of the boat under construction, the spaces wher.* me work are necessarily dose and confined. Ventilation is extremely difnn- Practically all workers m the i -/varying degrees of "cable rash." . a ficeww wwecevkKsj tiuo several smuoonmthr '/wed to be definite predisposit Ifwinter did not begin to acqi Jpinptoms until the following si lffcure and coloring of the s 1^2 Schwartz, L.: Dermatitis irr The acneform eruptions previously reported were observed amoiv. -At! who, for the most part, were engaged in handling the chlorinated na;- -aka derived from crude tar (tar camphor, naphthalene, white tar naphthalene) in the preparation of the synthetic wax plasticizing materials, usually ir iii*1k= or hot state, or when the product thus obtained was melted and vane v<l? d electrical apparatus (such as condensers and coils) were dipped into i: i. . .vuriff VdK, 1936; Skin Hazards in Am ' tMfad States Treasury Department. IfcX^Cablc Rush1*) Among- Electric? U- Mayers, M. R., and Silrerberg Mb Chlorinated Hydrocarbons, J. . t-Jp'Exposure to Some Chlorinatt Hy August 2938, p. 361; Effect up tm, Indust. Bull, New York State insuIlnatitohne. present cases the eruption observed was in electricians handlii. CimtI ^Sulzberger, M. B.; Rostenberg ^tate J. Med. 4:B99, 1934. finished product for the most part. Only rarely was heat used, and to to any fumes so generated was slight. The latest method of connects A T.: The Etiology of ^J. ImiusL Hyg. & Toxicol. U: IREC***I . 3 SYPH1L0L0GY G0OD-PEXSKY--HAL0IVAX ACXE many essential and dc nical corrosion (including' s, in addition, waterproof ts value as an insulation' t has a desirably high ` terials of different; plas directly proportional to is 20 per cent peatachlt to which as much as 20 cture there may be h chit lay be adjusted to as low-: the physical characterise stems of intercommunicate _ trically neutral to magnefSr rent of high araperagrlS|.: le entire length of the h4: counteracts and neutralifl^.ectric apparatus, indudiaf->at as it travels through tfafr.- ley are not too bulky.jefc. e designed to facilitate ed. The approximate of individual bundles SP :gnated into asbestos. The]-, ounding this is woven all.' has a rayon cover. Bjrj de Gausse cable itself ti pni i.liy eliminates tlie use of solder and heat. An ingenious lug is used that nr; " *:nd securely attaches the wire to the points desired purely by mcclianical ric: ;:iid pressure. :*irable descriptions of the lesions seen have been those reported by the A:. writers Schwartz,' Mayers and Silverberg,* and Sulzberger4 and the rircr Thehvell Jones.3 Schwartz's detailed study and report published in !?' :~iy establishes his priority on this subject It was the first to appear in tiie ..:r.can literature. In his cases the rash was encountered both in workers ha:.. ,, the hot molten material, being thus exposed to the fumes, and in persons / with the cold electric wire and cable. Mayers and Silverberg's study was la*. . !> workers engaged in the manufacture of electrical condensers. Thelwell Jor. `'served the eruptions appearing in workers handling the crude naphthalene i: was chemically processed tor use in industry. In both reports high <ici- -.i temperature were involved and the concentration of fumes that the f>: ` were exposed to was relatively high as compared with the present series. T!:-. riters described a variety of lesions. Mayers and Silverberg conveniently da- 1 them into three main groups: (1) acnefonn eruptions with pustules, juj. . - :id large comedos; (2) vesicuioerytheraatous eruptions usually observed in . . iritis venenata; (3) simple erythematous eruptions with pruritus. . i-mption to be described and with which the present study is concerned lu> ` noted by these previous writers. With the onset of present world ;-.f shipbuilding construction expanded enormously. Considerable amounts i i wax began to be used, and Halowax acne or "cable rash" began to appear in *. . ..us shipyards. As a result, renewed interest in the problem has arisen. M;i. ; electricians began to consult physicians not only for the rash itself but .if the disability produced. Time vital for the production of critical material "a* . because skilled electricians were obliged to do other kinds of work and nw.'. . -.mrained workers taught to do the work. When other workers learned of ii`-c they were deterred irom handling the cable. With the increasing employ ment vt women in defense industries the situation may be further complicated. the cable and individ tting back of the me INCIDENCE . for several inches. ` I'T.vticaliv all workers in the department Iiandliag such cable tended to acquire id the bare copper strand?; varytuj degrees of "cable rash." The onset dated from a preliminary latent period if a fine gray powderr M*Sl weeks to several months. The elements of hot weather and perspiration .ary to heat the cable to be definite predisposing factors. Many workers engaged in the late fall - ust itself, the electric rjC `'inter clid not begin to acquire any considerable number of lesions or have heat Because the until the following spring and summer. Individual differences as to le spaces where the j and coloring of the skin produced no appreciable variations as to ctremely difficult T.Z, __ bserved among iwonctfm^S chlorinated naphthaler****: -y- 2. Schwarts, I--: Dermatitis irom Synthetic Resins and Waxes, Am. J. Pub. Health 77V*'- lf)36; Skin Hazards in American Industry: Part II, Public Health Bulletin 229, Red States Treasury Department, Public Health Service, 1936; An Outbreak of Halowax ir naphthalene) (CtfHya ("Cable Rash") Among Electricians, J, A. M. A 122:258 (May 15) 1943. ~ ials, usually in a ' ^ Mayer*, M. R., and Silverberg, M- G..* Skin Conditions Resulting from Expcsnrc to ed and various kinds^^g.^T^ rf;:",n Chlorinated Hydrocarbons, J. Indust. Hyg. & Toxicol. 20:244, 1938; Effect upon Skin pped into it for icians handling ^e <^_ used, and the expojBff ' connecting the '**' v ,d- Sulzberger, M. B.; Rostenberg, A., Jr., and Sher, J. J.: Acaetorm Eruption, New r. iork State J. Med. J4:P99, 1934. v r . * Jones, A. T.: The Etiology of Acne with Special Reference to Acne of Occupational Wf*m- J- Indust. Hyg, & Toxicol. 23:290, 1941. 254 ARCHIVES OF DERMATOLOGY ASD SYPHILOLOGY susceptibility to the development of the eruption. Dry and oily complexions is well as diverse types of skins were included in the various nationalities included in the survey. All the workers were men. The age group extended from IS to 63 years. In a few cases the workers' wives had a slight eruption resembling their husbands*, probably from contact with work dothes and irom laundering shirts and underwear.. * Patdi tests were of no value in anticipating persons predisposed tD acquire "cable rash." This observation has been consistently reported by alt previous writers.- DESCRIPTION or THE CUTANEOUS LESIONS In addition to the usual acuminate papules which result from the niecitamcsl plugging of the hair follides and the orifices of the sebaceous glands {folliculitis)t which become secondarily iniectcd to form pustules, furuncles and abscesses a follicular hyperplasia of the sebaceous glands of the skin of the face occurs. Large black comedos appear in the follicular orifices as a result of the activity of the follide. At times these cysts are large enough to suggest milia. These "comedo like" lesions are found in almost countless numbers on the exposed portions of the body, espedally on the face and forearms. In many cases less numerous similar lesions were found scattered on the arms, torso and legs. The most frequent site?, where lesions were found on all patients and in greatest amounts were on the $kir, over the malar eminences, the drcumorbital areas, the margins of the lobes oi tltc ears and the mastoid regions. Frequently they extended into the hairline an-.' feno the scalp. The eyelids and lips were devoid of lesions. The skin of the noe \v*> rarely affected and presented relatively few lesions. The dorsa of the fingers were frequently involved, as were the forearms. - SYMPTOMS In addition to the lesions described, severe, persistent and at time- . hiiwt intractable pruritus at the sites affected was a common complaint. The i . . ..rmii was most noticeable in those workers who had a superimposed or com; -*:ainr dermatitis in addition to the purely acneform lesions. Occasionally it wa- <-v enough to require use of a sedative to secure sleep. Heat and per*-* ::mi aggravated the symptoms. Burning and soreness of the eyes ("bloodsho."` w a frequent complaint Many of the men were engaged in electric work i! proximity to electric welders, and flashes from the oxyacetylene burners r. h aggravated this symptom. There were considerable dust and metallic p;;: .cs the holds of the ships where the men were laying cable. Lassitude was the next and most common complaint. It was felt thnt hours, often an average of ten a day, together with the time required in to and. from work contributed to the fatigue of the men. Also many w been recruited from ordinary peacetime positions, often sedentary, employed after short intensive training courses. Ventilation to an adequ.v was impossible. Other symptoms occasionally noted were anorexia, nausea, headacl It .el 1 w icg va: abdominal pains, impotence, loss of weight, insomnia, alopecia and disr . :ct taste. Jaundice was never observed. During the survey widespread publicity in the press to a smai; .iv* fatalities in plants processing the cable occurred. This factor definite!; - n << the number and variety of complaints. In a few cases the worker's wives had a slight eruption resembling their husbands', probably from contact work with clothes and from laundering shirts and underwear. Fie. IeiT I T GOOD-PENSKY--HALOWAX ACNE 233 SYSTEiflC INVOLVEMENT patients with extensive cutaneous involvement were studied for - -re:::ic effects. 2s addition to clinical examinations, including; fiuoro- !y. tests for hepatic function and impairment were included. Complete : studies were made. No evidence of any visceral effect was obtained iic ascribed to exposure to the chlorinated naphthalene and diphenyls. : attention was given to the possibility of hepatic damage (atrophy) i.-i suggesting the aplastic variety. No relation with "cable rash" or -menial disturbance was disovered. DURATION OF THE ERUFTIOK y a* many of the electricians continued working with Halovvas cable, >>i persisted and even extended in some instances. With the onset of :her, the institution of preventive measures described later and aggressive .:>y. many were able to continue at their work and a decided amelioration was effected. The eruption itself was improved in many in this group, iry of the patients the eruption persisted for as long as one and one-half : -r treatment and total freedom from exposure. These patients are still rved. THERAPY . I". iition to prophylaxis many measures were used to relieve symptoms and he eruption. These included various kemtolytic agents, such as sulfur . ;- iic add, and antiseptics, such as resorcinol, sulfonamide compounds, &ftiv:-:.v.ed mercury and icththammol. These were used in various ointment bases. Emulsions of both oil in water and water in oil types were used, bases included those ordinarily used, together with several of the flttrc ly cont types incorporating wetting agents. Various soaps containing sub- 'lain conceivably indicated for controlling and improving the eruption were tried. yawn: these were proprietary "antiseptic" and ``germiddal" soaps commonly t-JunO on the market; soaps containing pumice, marble and sulfur were also ^eluded. Various sulfonated oils were tried. Soaps containing trisodium meta- rhwphate were at times of value as detergents. Morris' recently suggested fcastng mixture incorporating oleic add and butyl stearate has not had sufficient *rU{. .V iew related formulas were found of some value. Those consisted of 45 fPnt sulfonated neat's foot oil, 45 per cent light liquid petrolatum and 10 per u: k solution of gelatin (1 part of gelatin in 4 parts of water; 1 part of this "Tjtparation was added to parts-of white granulated com meal, with a trace per cent chlorobutanol as a preservative). Another detergent used consisted ** Miltonated castor oil with a pu of 72 and containing 50 per cent of oil content, .,ngcther with 2 per cent cri a wetting agent (aerosol OT dry, the dioctyl ester of sulfosucewate in 99 to 100 per cent concentration). . Fr patients with acute dermatitis wet compresses of commonly used mcdica- ^USi were used to allay the symptoms. These induded isotonic solution of sodium ftwride, 3 per cent solution of boric add, hot magnesium sulxare solution, solution *' h'jric acid and salicylic add (Thiersch's solution), and solution of aluminum Estate fBurow's solution) 1:20 to 1:10. Solution of sulfurated lime (Vieminckx' Ration) in varying concentration was iound ineffectual and irritating. Sodium ^xametaphosphate in 1 per cent concentration seems to merit further trial. __ . Roentgen and ultraviolet therapy in careiul dosages were of distinct value in "'`Wing symptoms and accelerating the restoration of a dearer skin. Solid carbon -no expense spared -work clothes provided. -Frequent change of clothes -individual lockers, -showers HIVES OF DERMATOLOGY AKD SYPH1LULOGY occasionally beneficial. Attempts at removal of the hyperkerou: e tape left on ior varying periods were futile. Vaccines, autoger.oy* no demonstrable value. Mechanical removal of the plugs in th? of a comedo extractor or by facial massage was sometimes heipiai. |i attention to the fact that the substances in the follicles are UpiJ in the tissue by lipids. He suggested that a low fat dier [eliminating these substances and possibly as a preventive measure (there has not been the opportunity for pursuing these studies. PROPHYLACTIC MEASURES p prevent the development of "cable rash" and ameliorate v-: -symptoms m persons already affected, no expense was spared. Determined efioru to reduce the concentration of Halowax in die workers' environment were mace. At the same time measures to promote rigid cleanliness of the skin were institutes These preventive measures included ventilating hv blower and exhaust foj-o. frequent change nf Hnthing, hnth work clothes and underwear, individual lockert and adequate facilities for securing and opportunities to secure a thorough cicanir* of the skin during the work day. Frequent changes of clothing were stressed: he: water was provided, and the employees were given an opportunity to wash ani take shower baths on the company's time. Coverall work uniforms were provit-r.1 Various prntertiv* prMmt were furnished to the workers, and they were instructn! in detail as to how and when to use them. These creams were used alone or w some of the soaps recommended with diem. The sulfonated oils aforememionr; were used as substitutes for soap. The value of such creams has nr-i In adequately demonstrated as a preventive measure as yet. Use of coverall* a:,; other protective clothing devices, such as face masks, sleeves and trousers, - Ul:.. continued. It has been found that they increase the amount of heat and per>r>:ra*i * and that the workers do not cooperate in using them. They seem also to accrara:- the condition. Large doses of the entire vitamin B complex, a liberal ko ' carbohydrate, adequate intake of fluids and ingestion of saline tablets t<- loss of salts were found to be of value in controlling symptoms due to iativ::. Tjj? excessive use of alcohol and tobacco was discouraged One possible means of attack of the problem is the ingenious sugcv.-ikm Sulzberger. This involves the discovery of some chemical neutralize- . vai;--: the Halowax that could be applied to the skin of the workers before ar *h:rr.: their work with the cable. Such a substance might be incorporated in : lis new "penetrasols" he and his co-workersT have developed. Such **pc- .:r.voV have been demonstrated to possess considerable powers of penetration im- -:;t* har; follicles and ducts of the glands situated in the skin. This property is c wetting agents and fat solvents contained in them. If after a reason? no improvement was obtained, the worker was transferred to an entire'-; position. MECHANISM OF PRODUCTION OF LESIONS Because of the high incidence of Halowax dermatitis among a rein*' group of persons, the negative results of patch tests and the absent vesicular dermatitis as seen in contact irritations at the site of exposure a:. unnecessary to assume a development of hypersensitivity to the wax. I GOODprimary irritation by the wax explanation of this eruption r 5-^and borne our by the element ---i --'------------ - J Trtmdensation .-- ...v tUUICS emit jL^f^fspiradon and heat in the clc j ^Sebwartz and Tulipan stated fontain any free chlorine. T1 iTtmdical itself lias an irritating scat. 5ynthctic wax (Halowax) -ricians handling certain ty n increasing number oi e: ___;near iuture unless suitable lie,discovered or more effecti""S&n evaluation of various p cThe probable mechanism oi -:^Thc absence of systemic, vt fc'-gfnld** dry synthetic wax eablc `eiThe chronicity of the erup evidence of internal abs V'.The cooperation of the followittf States Public Health Service, and ' Hookey, E. D. Osborne, G. E. Mor *V2 East Fifty-Fourth Street i:. 2167 Eighty-First Street Broo: 6. Osborne. E. D.: Personal communication to the authors. 7. Hermann. F.; Sulzberger. M. B., and Baer, R. L.: New Penctrathu. Lotions, Science 92:451 (Nov. 13) 1942. ieecefe: T T X> SYPHILOLOGY GOOD-PENSKY--HALOIVAX ACKE 237 it removal of the *e futile. Vaccines, it 1 removal of the phsp! assage was sometimes I ances in the follicles re?j ed that a low fat diet- __ ibly as a preventive mgjjptV ' pursuing these studieSI*^ rSM? rritacion by the wax was believed to be the method oi production. The i ci this eruption offered by other investigators seems to be adequate .'ut by the elements involved being a foreign body reaction in the hair :v; sebaceous glands due to the presence of these chlorinated naphthalenes. . from mechanical plugging by the particles per se and from the ...-ii o: the tumes emitted by the waxes in the cable. Rubbing, scratching, and heat in the dosed holds of ships were further predisposing factors. ::icl Tulipan stated that the fumes are not decomposed nor do the}* room free chlorine. The}- agree with other investigators that the chlorine hra) : if has an irritating effect on the plugged follicle. *. rash" and araelio .... spared. Determined effefft ts' environment were-jjijti. s of the skin were instibflaU blower and exhaust rian idenvear, individual lockin' > secure a thorough cfcaokf clothing were stressed^* a opportunity to washing rk uniiorms were s, and they were instruct^ ns were used alone or wife - d oils aforementioned :reams has sot bee et. Use of coveralls wei rves and trousers, is besg nt of heat and perspirats* ley seem also to aggrava* nplex, a liberal intake .** __ saline tablets to ebflril* 5UUVASV AND CONCLUSIONS ::c wax (Halowax) dermatitis is a common cutaneous hazard in marine handling certain types of electrical cables. -.isine number of employees with this dermatitis may be anticipated in lure unless suitable and adequate substitutes for these synthetic waxes red or more effective means of prevention and therapj* are developed, -nation of various preventive measures is made. liable mechanism of the production of these lesions is discussed. rence of systemic, visceral and hemopoietic involvement in handling the v synthetic wax cable is noted. ronicitv of the. eruption and its resistance to therapy are emphasized, i'ieuce of internal absorption has been found in these cases oration of the following- persons made this study possible*. Col. L. Schwartz. United >c Health Service, and Drs. J. J. Brozdnwski, J. Herradora, A. G. Crar.ch. J. A. - D. Osborne, G. . Morris and M. B. Sulzberger. Fifty-Fourth Street iiwhty-First Street Brooklyn. :oms due to fatigue; /* * .. * r&Z ingenious suggestjoo : . meal neutralizer rkers before and' dtmiC^ rorporated in one _ * rd. Such "peneBiiafi* penetration into the b^ -.| s property is due tpjft ter a reasonal to an entirely ^ ONS - nong a relativeiyT*^- the absence of of exposure, itjj o the wax. Penetrating Vehides^ff^l?;