Document wDJbka94oxqKea5XpVLYG9aoD

FILE NAME: Goodyear (GY) DATE: 1940 DOC#: GY076 DOCUMENT DESCRIPTION: Journal Article - Status of Benzene V olume IH N umber 7 S T A T U S O f B E N Z E S E --DAVIS 553 m atter. A t this point it must he remembered that the industrial worker is usually a member of a family group who eat together at the same table. In addition, any practical diet plan must take into account the fact that families have some preferences in the choice of foods: the plan must he adjusted to At the pockethouk, and the food should be attractive and pleasing. The foods common in this country can he classified into about a dozen m ajor groups. Suitable (plantties of foods in these several groups can lie combined to provide adequate nutrition over a period of a year, a month or a week for individuals o f different age, sex and activity. O f course many combinations of these tvvel'-e m ajor food groups can be worked out so that all the nutritive requirements which have been discussed in this paper will be amply provided. A s an example of such a combination, table I shows the respective quantities of food in each group that will provide these nutritive essentials over a period of one year, listed opiKisite the descriptions of each type of family mem ber. T h is particular combination of major fond groups is one that can be provided at a tdatively low cost. W hen the family composition is known it is a simple matter to read off in each of the twelve columns the quantities of foods that will supply the nutritive needs o f individual members of the household. Simple addi tion of these quantities will provide the totals required bv the family during the period ot mte year. If each of the sums is divided by 13 the results will give the quantities of foods iti each m ajor food group required by the family for one month ; if divided in 50. the tesult is the approximate weekly quantities needed by the family. If a fanulv consisted of one moderately active man, one moderately active woman, a 5 year old daughter and an N year old son. this family's food requirements could he adequately met by weekly supplies of the kinds and quantities of foods (shown separately ini each member o f the fam ily) indicated in table 3. I Itese weekly allowances of loud provide for the approximate daily intake of ealunes. protein, Ial and cai hnlivdraUas well as certain m ineials and vitamins in the quan tities shown in table 3. The weekly cost of this food for these four persons would vary somewhat depending on current prices ol food in the particular locality in which the family lived. According to prices reported in 1935-ld3h by families of wage earners and clerical workers living in a wide range of localities in the L'nited States, with adjust ments made in accordance with trends in price levels obtained from the Bureau of Labor Statistics, this fam ily's total food bill for one week during the period January to October ld.fS would lia.vc varied (depend ing on the locality) between SB and S(L50 T h is diet plan provides for choice m eight of the twelve food groups as to which particular food-, in the group the family civets to eat. bor reasons discussed earlier, the family is urged to introduce as much variety as possible in its choices within those food groups which provide for choice. According to surveys based on about 4,000 records of weekly food consumption. Suebehng and I'hipnrd ' report that approximately 50 per cent o f employed wage earners and clerical workers in various cities of the United Slates actually spent enough money for food to obtain diets of this nutritive quality. A h hough they actually spent enough money to get a diet as good as the one suggested in table I. the actual food selection of many o f these families was such that the nutritive value fell short of this plan. The remain ing 50 per cent did not spend enough money to obtain a diet with as good nutritive value as that suggested for a good low-cosi diet in table 1. Th e practical problem of goorl nutrition is often, as was shown in these studies, a combination of educational and economic factors. The plan of food selection outlined ill table 1 is (dieted merely as a sample plan to show how the indus trial workers and their families might solve the pioblcm of adequate nutrition without undue expense. I' R U S K X T S T A T U S O l- B F.X /.LX I-: I*. A . D A V I S , M .I ) . \KKO\. (Mint lit urder to dispel auv eunfiision concerning the present status o f benzene, it is necessary to have a very definite differentiation between benzene and benzine. Uenzene (benzol (.',,I I , , ) *12 is a single chemical sub stance obtained by distillation of coal tar and is purified by ledistillalion at from 70 to SO U . (iasoliiie, or benzine.- is obtained from the distillation of petroleum and is a mechanical m ixture of hydrocarbons ranging from (A,11,2 to U J I ,,. Its composition varies accord ing to tlte boiling point. At 30.3 U . it contains from 00 to 70 per cent o f pentane, t .11, ,. Substances dis tilling between 30 and 70 U produce what is commonly called gasoline. Benzene is obtainable in w-vcial grades m commerce: 1. b e n z e n e . I I ic m ic a lly pu re <l ' S I*. X I , t> S 5 l V5 r i . (tislils liclvvecn 7V5 am i SI 2. ben/ene VII per ecu! : This is Oil jx-r cciil m die tltslillaic up tu IIH) C . I i>ni]Kisilinn irniii SI) Pi K5 jx*r cent hruzene. irnni 1.1 to 15 ptr cciil ot liilucnc, 2 i.r 5 per tent ni xvlene ami 1 per tent heavy residue. ,t benzene 50 pee iciil: This o 50 per u-nt ni llic distillate ticluvv 100 C'.. VI) per cent hcluvv tJU U 0 `)nt*>sinnii from 45 tn 50 per cent henzenc. Iicavv residue ui utetiits, paraffins and complex butties anil some lnhienc. 4 Solvent naphtha ConsisiscliirlK of svlcnc, a -malt amount ol toluene and thiophene. A thorough knowledge of the differem e between benzene and gasoline will. I believe, explain the dimin ishing number o f cases ni poisoning by the volatile hydrocarlioii.s o f the benzylic series. Benzi ne, toluene, xylene, naphthalene, anthracene and phenauthiacene hilling to the henzvlic series and contain one or more caibnn rings. ( iasoline, on the other hand. doe-, not belong m ibis series hut to a lower uiisatrated carbonhvdrogen combination commouh called the marsh gas scries. ]'ure heio.ene is a chemical enlilv. while all gasolines varv over wide ranges in composition. Uommcrcial benzene hits the following impurities m varying am ounts: xvlcne. toluene, phenol, thiophene, carbon bisulfide, acetonitrile, pyridine and traces of many other .s'/ , tances. (iasolines have no definite com position; for example, gasoline from I'emisyIvania contains pentane, hexane, heptane and paiadins while gasoline from California and Texas contains cyclopeolaoes, cyclohexanes and cyclop,-tra Dins. Kt-.td In lure tl- M iM 'dl nil I V u n l i t r .md |udu*-tttd Medium.* .Mid I'ltldtc lliu ltb . at (he Xuu'tudb .\niiu.d of llu A n iu u .ir. Medical SsMiunlitin, H u ) '', M u' 19 19*9 1 Hfitztfdf (C oll. t.t W ill = 7S benzol I C u n i.m ) benzole I [`rent h ) tdten\!!i\drnle o cb.lu'x.ilriomu*. |<lu*ur) t< a ir .lm l.s , . .t cr> su K wiih a dt*c> ai .'i (\ vi u s;*/ nu-linm ]-.m i 5 j c . jioml S't.d t \ . .i*-<hililt* m wdid and ntiM ihk- utili tlti.linl .onl iih ir . iTCidono ami glacial .iridic acid 2 iUnzitu'. ! g i-o b iif tx 1 mixture ol *:>dt <v.n buns i.lum icd (torn llu* -com! portion of Mu 11.u it.dial distillation of crodi petrolitim Inch run <si<st- of the fraction Imduig betuem 70 :md 90 C . ,\ clear K**- li<C!td utlh a di,n,ot' of from A iijn >.* Of.- ' 554 STAT US O f B E X Z E S E --U.II'IS Jo in A M A. 1'eii 17. 19 HI USES Benzene lias the following u ses: 1. As a solvent for iiaints, lacquers ami varnish, rubber and inis. 2 In color printing. ,1. As n cleaning agent for clothes. -1. As a motor fuel. 5. In the chemical manufacturing industry. Both benzene ami gasoline are poisonous but benzene is quicker in its action, and tbe intensity is lnncli greater. There are three avenues of entrance m benzene into tbe body: i l l the respiratory system. (2) tbe alimentary si stem and (2 ) tbe skin. It is mi opinion that in from 'to to 95 per cent of cases the benzene enters by way o f the respiratory system, the incidence ot cutaneous absorption being \crv small except in those cases in which the hand' anti anils are immersed in solutions containing a large percentage of benzene or when the bands are washed in benzene to remove grease and rubber. T h is pro cedure. however, should lie condemned. Absorption by way o f the alimentary system is not great but often occurs when materials are introduced into the mouth or food that lias been in the same room with the benzene is eaten or tobacco that Inis been exposed to benzene innies is jmt into the mouth. A small percentage o f benzene is dissolved in tbe mucous secretions of the mouth and throat and swallowed. Th e greater the concentration o f the |times, the greater ibe uinnnui absorbed by the skin and the alimentary ttact. but under controlled conditions these two avenues o f absorption are practically negligible. The Unman system can tolerate minute amounts o u r a period of many months if proper aeration and elimi nation are instituted. In other words, a small faetoi o f immiimly develops through an eipiilihrinni between intake and output o f absorbed material. Just as soon as a minute increase o f intake over output develops, symptoms begin to appear. Tbe following clinical symptoms semi to me to Ik the most predominating alter observing and examining between b.fXXl and 7.1XK1 men and women who have worked with the various compounds containing lmtzeite or its hotuolognes for the last twenty yeat' 1 Peculiar brackish taste. 2. Slight giddiness. ,1. I'nste.-ub vision and sligtn lu-.idache. 4. Xaiisra and \mniting 5 1lizziucss, `'lii-n/i in- j.w ," odor of Itin/i-ne. it Weakness Itcn/im- hrt-.d.' down (he hmli dcfeiisv .igninst n iilv micrnotis ami main siT.iml.irv mnilitiiins develop, siuli as In! g .n g iu tis. (/I hods. Ir) pii'lidar conditions of die skin, of) frequent eolds, i.-j arthritis and (/) inlecturns of the gaslroimeshnal Mart llekloen lias dune uiilcti work on the effect of Inn/vnc on antdiody formali.ut. 7. Iiu reaped nervousness with increased pnlsc. nosetiieeil, uterine hk-rdmg, bleeding from the goi.is 8 Slight u-mpnr.-iri inerease in hleud pi essiire. h. K.wi-ssiie laogin al tile end of o g lu hours' work. 111. M a r k e d tr e m o r s o f th e h a n d s 11. I.oss of eipiilihralion m the dark 12. G a s tr ic and m u -son al d istu rb an ce s 1.1 Parestlu'si.i-- minihiuss. tingling 14 Insomnia--in die lirsl stages drowsiness and ill later stages insomnia. Is Loss of weight, henr/eue pallor In llen/ene purpura, nosiliKed, aiieuna. . I l i k l m i ,. I ml s iy .1 l i d Ills l D l M ( I n ly ) 1910. 17. Menstruation every two or three weeks by female employees. 18. Dermatitis. 19. Nephritis. 20. Labored respirations and coma. W ith reference lo anemia under paragraph 16, it may be said that many thousands o f blood counts have shown that this is one o f the main factors that the industrial physicians must rely on to show the effccl of liciizcno on the individual. There lirsl develops a slight leukocytosis, later a slight leukopenia, and erythropenia with a slight reduction in hemoglobin content. W illi increased absorption this progressively get' worse, and tile following divclnps; 1. 1m 'O -.isi it li ilk . ipi ni.i 2. In r n .iM 'd ( i `. l l o o p n i k i . .1, 1 i in p h o c i 11 O ' 4. 1Irvrlop m cn l of frw lr,-in sitio ii..h ih< tihH-d P-rnim i: n ( g .n i' are m-.u li 11 ils d i. n i.i ini mi r a p n lli A point is rc n ilir d wln-i. suppressed and d ie nevv 5 l l e i r e .i s , in 11 in giil.n n il. t .tiised In ,i d f i <use in pis >di|-' -in- !>: .un i d ir t.iiih m . o l U i r t a s e In h ln o il .1 li 1urn. 7 I P e r i .i 'i m anlihinh fortnali<-n s s i u n d o reuse m lieutoglolun loroialion with increase uf In upitin in iln n n m and dec n a s e 111 hlnnd | l.d i-le i fo rm a lio n s . h I In lu g iiiM iiig o f 1 n d o llu -lia l 11inner c e lls 1,. ap|K-ar in die M o-id s1 n ,1111 I he a | i| n .n a n c e ol th ese 1 - lb n n h i .U is i)n- s t i i i ii' 11 n*-l d u t.ita l '( a g e o f p m s o iiin g . In 1 , 11111I1 It , 1 ss.iii.......... i iormalion of in w Unoil te ll' I b an observed in a lew e;i'i ' a condition of vacuolalion in the leukocyte', but ilii' is not a conslanl factor. It |>r*d wilil\ is due to tbe inahiliu o f tile cells to retain i.iitv compounds, and I believe that fatty substances are either extracted or prevented from form ing in tbe nerve tissue, iliii' producing tile nervous complex I'lie elTccls o f benzene are accumulative, more lasting and more severe lliau those o f gasoline. Temporary exposure to slight ronccnlralioiis of benzene ot gasolene m e transient, and complete aera tion causes the e lic it' to disappear. It is the constant absorption ol small am .nm l' dadi tltal produces the detrimental etleets In ( >eti>her 1, .15 Y am and Stivers and their asso ciate' ' picsciited a new method for controlling expo sures to hoii/ciie by the dcirriitinaiioii of urine sulfates, .since I h X am and III' associates advocated this mcilunl of detection of the absorption o f in .izenc. i have inaugurated it as a routine procedure tor all patients who work with benzene. During the last ten months I liaie studied fi50 w orkcis with the inorganic sullate method m conjunction with blood work, physical exam i nations. .o ia li'is o f die air and any other clinical examinations which I thought might throw some light mi this method. ITom my experience I lave found several tailors, which I shall mention: 1 In most industries using large quantities o f ben zene the lire hazard is g re a t: when il is possible, some other solvent is combined with benzene to reduce tile fla-li point o i tile hen/ciic. The nature o f llu- solvent deieimines the aeeiuacv oi tile lest. I'm- example, carbon tetrachloride i ' often Used: it causes the opposite cITcrt from benzene on the sulfates and therefore, unless there is all extreme reduction, the results are not useful a-- a diagnostic factor. Ktliylene dichluride is auotliei solvent that is used with benzene and changes du- ri-siilts 1 \jiin. W I* : S<lii1 11k, II II ; .s.twTS, R. R.; Horvath. A A., and R<-mli.iii. VV\ II .1 Imlii-i ll>u. S. 'J'imcoI. 18;f>9 (Jan.) 19'G. \VI CU E 114 N i mbe 7 s T . i r r s o r b e x z e .x e --d . h 'i s 2. There is some variation on different days in the same individual working under the same concentrations. I have found that in sonic cases the inorganic sulfates in the urine are as low as SO per cent one day and a recheck the following day at the same time and with the same concentration shows them to he 80 per cent. I f this were a single case 1 would say that the dis crepancy was due to technic, 1ml a careful check o f all reagents was made and controls were run to eliminate the possibility o f error. I have made it a regular rule to rave all urines below 70 per cent rechteked. and if this concentration persists I know that there is some thing wrong in the ventdatiim nr that the individual is absorbing benzene from some other source. 3. Atmospheres containing from 100 to 115 parts per million in eight hours bate hut little effect on the inorganic sulfates, but over a period o f time there is a slight change o f from 8 to 10 points. I h a ir not noticed any change in the blood when the concentration has ranged between 100 to 125 parts per million. 4. Alcohol and certain foods cause a change in the daily sulfates. 5. It has not been determined how long a person can work with "torganic sulfates below 50 per cent before a change in the blood occurs. 1 have set end workers who have been working for one year and four months, with their inorganic sulfates fluctuating from 50 t" <S2 per cent, ami their blood and all other examinations normal. These men ai . examined completely every month, and at the slightest change in the blood picture tile} tire removed from contact with benzene. O n several occasions I have found the inorganic sulfates between 8 and 10 |>er cent when the person had been cleaning clothes with benzene, but in two days, after there was no contact with benzene, the inorganic sul fates were up to 75 per cent. However, may I impress llic point o f reclieeking all eases in which the ratio is less than 70 per cent : if the percentage is 50 per cent or less two courses must lie taken: The person must be removed from contact with benzene and the ventilation must lie corrected until air samples show from 100 to 115 parts per million. The accompanying table shows one o f the numerous surveys made and the correlation between the concen tration o f benzene, inm ganic Mil fates and tile blood picture. T h is experiment shows the value o f making frequent urinal \ sulfate determinations for the cmurol of ben zene absorption. I M I K Y E X ' I 1Y E A M I I ' U K W i V T I V K S l t W H l h 1. 1`cntihition ami S a fe ly D evices.-- This is one of the most important factors. T o keep the concentration o f benzene in the atmosphere below a certain point one must recognize the fact that benzene f u m e s are heavier than air and that lliev are very diffusible. \ enlilation from the floor bv nuaits of suction is preferable to overhead ventilation. Ventilation must be general, fin benzene fumes form pockets. Ilcnzcnc fumes liberated on one floor may produce a rather high concentration on ;t Ilnur below if Miction ventilation is not Used. 2, H ealthy P ersons in O perations L'siin/ Benzene.-- M v experience has shown that undernourished, anemic persons or those afflicted with b r o n c h itis . a m pulinm iarv condition or cardiac nr kidney infections should not lie placed where they tome ill conlacl w ith benzene m gasoline mines, fem ale help, as far as possible, should not he placed where there is a very high concentration o f any o f these fumes, for no matter how health} thev are llicv begin to have menstrual disturbances alter some absorption. A certain group of persons can tolerate a large amount o f benzene and show hut little physical ell net. Those who are shallow breathers seem to he less affected than the deep breathers. There appears to lie some relation between the permeability o f tissue diffusion in the lung tissues and the amount o f absorption which causes physical symptoms to appear. Persons addicted to alcohol seem to tolerate benzene or gasoline fumes to a greater extent than others. I attempt to place o rb those in line physical condition on operations in which benzene or any allied product mav have to lie Used, and I believe that it has been worth while. .1 Etluealnw Protjmn.--l'ro|>er instructions to the supervisors and the workers in all departments in which any volatile substances are Used, such as benzene, gaso line. carbon tetrachloride or other Mich substances, are C oi rchuion fU'lwi'i'i) Conci'iilruliun oj Hcnzcnc, him //timv .Sulfall's oiul Pinna Picture* sample* SuImnial- Voolufme Thin1, Sinopie. SimiiIk'I 1*11*11ion Min. r. 1 Heihicii-i.l-ruiili/l>tT'1.<n.t 2 '2' ro 2 IfPilli pIT.** !*# I.**) rinlimfititiI>rlniin(Ti**>111h[1' `,,'I IVi A IleOiHHl1l1r*1i1llj/1IT*l nitri 2 2`2 1.71 i'unit pr** . . r 1H i. s*amonsNo. l. . 2. T Siittn*a*No. :1. -2i r.o s ri(ohootmiItpanli***wi'say In-- 'J.*i .lift )li*rlnuioci'toir>' nini I Ip 1Vj to HiM'lwiT'iI'ItItIff*r timi |> *21 r-n 1'nrt. MiPllIiTon i*0 A'*) ::i:(i 1.171 <411. .(Ill .111 117 IM. 1IT ( OJllHlCItl KiilnlearlooviD'-1flowr<*nin KIltlTMJC I.eonnkCi!n2lirti/i'u' tun* nilrroit' 1)00^ (](ml Moor**1*>1 lindi pm**.- IIIl>>rit11- ' Ml l*t* w i le l . i l m til n w*rklim o i irtii.t !< t 1 to. In - !., (ml *i lt|tIlf', wllcli Ihr (i|nTllIor'* t(ir*>< I* liinM n|t to In' \\||i')t ;r, wo r k Thi'*!' Hi mj i i'* w n r tiiki'ti f r o m i l m riil. ` >r iii>intrv ( l a m i tint) f> l nipi *j il.-igti.U!' insuliim-*, \erv important They should lie told n i the properties of the substance they are using, what conditions might develop from excessive inhalation nr exposure to it ami bow these conditions can be successfully prevented by taking precautions and obeying the instructions given. 4. l :ret)ucnt l ..vawinaliollS.-- All persons should he examined before being allowed to work in these depart ments. T!iev should have examinations every dm tv to nineiv days, according to the coiieunrations o f the vapor in the various departments. If examination oi the blood, m ine, blond pressure, vision, sensation and equilibration shows ally indications o f absorption, the person should lie tiatisferred in some other job W orkers are advised o f general health principles and method.' of elimination ol absorbed benzene. 5. Sithslnnlion P n n lm ls in Phiee o f Benzene -- M ane substitutions have been tried to replace benzene, such as its higher homolognes toluene, naphthalene and .xvlene ami oilier solvents of the mi'aturated livdrncaibons. M\ experience has liven that gasoline is Its . Imi stuii hi s and will eventually replace licu/.enc ill nearly all o|ierations uniil a heller uonpoisonoux solvent is found 556 S T . i r C S OF B11X ZF..XF--DAVIS 'meFneu.A17.M194A0. Batchelor has done some remarkable experimenting with benzene and some o f its higher homolognes by using intfaperitoneal and subcutaneous injections and inhalations in groups o f animals. H is conclusions are that toluene, xylene and hi-Hasb naphtha are vastly superior from a toxic standpoint and are practically devoid of the industrial hazard involved in the use of benzene. T h is statement is true with regard to the relations o f the toxicity, blit 1 do not believe that toluene, xylene and hi-llash naphtha can be so lightly considered. It is not occasional exposure to these compounds that causes the harm but the daily exposure over long periods o f tone. Various m ixtures, under commercial names, have been tried for solvents in order to reduce the Hash point, thereby reducing the lire hazard. These invariably contain carbon tetrachloride. Carbon tetrachloride in small quantities. when inhaled, causes extreme nausea and often severe vomiting and should lie used only in dosed systems o f ventilation. 1 have found that gasoline works almost as well as benzene in most operations, and die number of eases of dizzi ness and nausea has been reduced to a minimum. C . U se o f lhe substance in a closed, airtight system, which prevents dissemination o f the gases, or institu tion of suction ventilation, depending on the nature of the substances as to whether its gaseous form is heavier or lighter than air. 2. The rotating of the individuals who work with the substance to other jobs. 3. Use o f gas marks. T h is has not proved very practical in industry. 4. frequent exam inations: Removal from the job of any one showing signs o f poisoning, such as: (1) persistent urinary sulfates below 70 per ce n t; (2) slight purpura or hemorrhage from morons membranes or other organs: (3) reduction in white cells o f 1.500 below normal (a 7,000 count is assumed as n orm al); (4) reduction o f red cells o f from 10 to 15 per cent below norm al; (5) reduction of hemoglobin below 80 per cent, and (6) slight variation in coagulation time. TUi:.VI'MI-.ST A person who. on exam ination, shows any effects o f a solvent such as benzene nr its homolognes, gasoline or its derivatives or carbon tetrachloride, is immediately removed from contact with the substance. Th e treat ment proper o f benzene consists o f; (1) elimination: (2) aeration, oxygen inhalations; (3) treatment of gastric disturbances; 1 4) treatment of secondary anem ia; (5) supportive measures for the heart and protection o f the kidneys; (6) stimulation of the blood forming organs by iisv o f iron compounds, reliculogen, liver and spleen substances, nansfiisions and roentgen therapy to the long hones; (7) nom ishing food with an excess o f animal fa is ; |8 ) increase of die calcium inlake, and l9 ) iiuravenmis saline and dextrose. Hi ini'hli.'dn .iml to) cdl i'mt m-l iiT<11%1. in*-utlui<*nl i \]ni*Ttrt.; cxj-M-tiu c<m11141vi! !-> uiiioin 'till.it. !<t. ittmt.itloif. M any things must he considered before the use of a Mihsiitnle product in industry is advocated: 1. Is n injoriims in ilu- Inniiini liringr 2. I- Us M|K.-r,'iOiiii mere nr k -s iffn'ieni' .i. K Us i,|n.T;Uinn innrr nr lrss cxpcn-ive' A 4. lints it rn|iiiic ,i hirer mulav ni cspni-t In install 5. \\ leu is lhe tnnipeliior n-iim and vvhal is llie t|ti.-ihi\ ni llis prmliH ti ll requite- verv close cooperation lieiween the medi cal depaioiH-nt. the chemical department, the safely (kpanm eni and the production efficiency department In arrive at a propel conclusion. M in io n s ni- loiiuia iix o c o x o m o N s The mcihoils of cm reeling conditions when volatile siilisUmees tire Used resnlve- themselves lulu ;i very definite procedure 1 I. Kxpcrimcntation and re-i-arch made on the sub stance used as to its detrimental effects on the human system. If such a substance causes detrimental effects, three mam rcommicndaiinns should he made: A . 1Jisciintimitmee o f the substance, and if this is not possible, then B . Snh-iilulitni ni an allied xubstanee not s.i detrinKtual. amt if tins is impossible then v Istulid-i. 1 I Hit liotuivt pAuio i,i Ilu,.,,!, Am 1. Ihz - - -M.,, i ' COXl'I.l'slilN Kxpeneuce has shown that benzene and its deriva tives present a very ik liin ic and serious industrial health hazard. The primary effects o f these substances arc produced on the blond and lilood-fornting organs with secondary involvement of the nervous system and mliei organs. In high concentcatiinis they cause acute poisoning, often with sudden death, and in low concentrations a slow lull chronic poisoning The hazard can he perfectly controlled by certain definite procedure-: 1. I'roper ventilation 2. Substitution of less poisonous solvents. 3. Frequent exam ination, and the caily removal o f any one showing slight symptoms o f poisoning, as Ivlecicd by a low urinary- sulfate determination. 4. 1'roper education o f the stqtervisors and workers. 5. Close cooperation between the production and medical departments. <i Kslablishmcnl o f phvsica! standards tor those who ate going to work with benzene or any of its homol ogous compounds. a.U Ka-t Market Street. AllsT FACT OK Ul.xCl'SSlnX t)H. A Ci. C k.vs-i ii, New York- TIu- warning is still timely not In lonni-c lien/.eiiL- vvitli lien/iiH- 'I lie two products are different lecluiically and in lnMfiiy, Tlu-re are also various impnrioe- in eunnnercinl ln-n/uie Willi regard to early ease liiidinn, mueli t-mpha-i-. i- i.iu-ii plated on blood counts show ier iiiluelioii in leukocyte- and red cell- ])r. Oavi- lias named of ltie- leukocytosis w111,I i si,income- prei ecles tile Itilkolienia and may lie nii-teaclmr- Crinnrv tests iurni-li a praotii'al tiuide. hut l)r. l)ti\is well eiiijilin-iitetl the pitfalls: the V o l u m e 114 N'c u u e b 7 H EATSTROKE--WILSON errors due to mixed solvents, the daily variations which n.ay occur in the individual case and the failure ai times to obtain a significant test even in the presence of dangerous exposure. In preventive work it is well to rcircmbcr the heaviness of the fumes. This condition is present with many industrial solvents and calls generally for lateral or down draft for its removal. I would stress the value of education. I have had good results by particularly instructing workers not to inhale the fumes recklessly, mid in case of an unusual or temporarily increased exposure they almost involuntarily withdraw and cease to breathe deeply. There are dangers in substituting other solvents for benzene as sometimes the substitute may prove to he equally or more toxic. Tins is true alsu in >otne cases in which benzene 1ms been diluted with other solvents I would ask Dr. Davis what he can tell us ns to recurrence of serious symptoms among patients who had apparently iclumed to normal after treatment for benzene poisoning. .Such apparently cured persons with a nouual blond picture after a slight intercurreiU infection like influenza sometimes seem rapidly to grow worse. Is this usually tile ease? bornethiug to bear in mind with icgard to benzene poisoning is that in the patients' subsequent life great care should be exer cised to avoid the exposures which might reactivate their symptoms. 1)k. L o n s S chwartz, Xew York: As Dr. Davis slated, the use of benzene in industry is diminishing and its place is being taken by solvent naphtha or some othci agent which is less toxic. Toxic symptoms usually occur from inhalation of these substances and not from contact with the skin D i. Davis has said that 95 per cent of the cases of benzene poison ing are due to inhalation. That is true because when these substances aic inhaled they are inhaled in minute propoi lions and taken into the body; they do not irritate the mucous mem branes or the skin. If the skin is exposed to them in concen trated form, it is defatted and blistered and its absorptive qualities are impaired. This is true of all the volatile .solvents; those substances do not inflame the skin but penetrate it. and they are more likely to cause toxic reactions than those which inflame the skin. Most of these volatile solvents take the fat out of the skin. Persons who have greasy skin can with stand their action much better than those who have dry skins. This brings up the point of bow lo prevent dermatitis hum these substances. When a person bandies them lie should i uh olive oil or some other animal or vegetable fat into die skin to replace whatever fat has been taken out by the solvent. Another way of preventing dermatitis from these substances is to wear gloves: rubber gloves ordinarily do not withstand tile action of these solvents and arc easily soluble in them, so synthetic rubber should be used because that stands up much belter. I should like to ask Di. Davis what his experience has been in noting svmpttims of dermatitis in cases of benzene poisoning. He will probably tell >oU that dermatitis is not common among those who .suffer with benzene poisoning, and those who suffer from dermatitis are not so likely lo have benzene poisoning. Du. P. A. Davis, Akron, Ohio: In answer to l)i. Craneh*s question in regard to the recun cnee of upturns will some concurrent intectiou. 1 do not believe that the patient has been discharged as completely cured before lie has this condition. For instance. I had tucaMoii recvntly during an epidemic of influenza lo observe several men win, while they had a low nrinnrv sulfalr level, around o0 or 7o per cent, were i.iken off the job and subsequently coniraeled an influenza infection. Thev returned to normal slowly, pmbably because benzene absorption had produced some effect on ihe myelogenous tissues and oil the spleen and prevented the normal return of the blood cells. 1 recall a case in which a man had had acute bui/cnc poisvming and llierc developed definite leukopenia and crvthropciria; his urinary sulfaies returned m nornul in thru* weeks and his blood to 95 per cent. The red and white ells ivuirm.il t< normal He was not pin hack in m(ac( v\Uh benzene hut was placed in another po-Uioii cnOrtk ir.e (i.<m am volatile substances, amt influenza developed Allei bis influenza apparently cUared up he lit) seemed In have bcn/uie poisoning, and the only explanation I have tor that is that the blood-forming organs had not returned lo normal before he had a subsequent infection or some oilier involvement. It lakes a long time for the blood-generating organs to return to normal antibody formation. They remain as a stationary factor for some time after the blood picture and the urinary sulfate picture have assumed a normal status. With regard to the dermatitis caused by benzene, acute lienzene poisoning does not necessarily show* up as a skin condition at all. The dermatitis from benzene is contact dermatitis and not systemic (ieunntilis. In only a few cases does systemic dermatitis result ft oni benzene poisoning. With regard to protection of the workers, i have a hard time convincing the engineers that, since nobody lias been killed or poisoned while manufacluiing these material, no one should be poisoned or killed while using ihcin. If piopcr protection is given, whether against benzene, a bnlogcnatcd compound or any other volatile substance with toxic effect, hv mak or whatever safety devices arc avail able, I do not think any trouble will be experienced. The organization with which I am connected ha. insiitnted the use of a wax ointment. Men who are going to work wit.li benzene smear it all over their hands, arms and faces. This ointment is not soluble in benzene, so they have little absorption but sullincpt skin pmtcctinii. *1 think there must he external pro tection against all these Mibstancc if acute absorption is to be avoided T11F. C A K D I O P A T H O F O G Y O F H EA TSTR O K E GA1.K W ILSON1, M.D. SEATTLE Under the term "heatstroke" arc herein included four deaths from hyperpyrexia, one caused l>v insolation or " sunstroke," and three from artificially induced pyrexia by the so-called fever machine. Historically this affliction is as old as Biblical times, being described in 2 K in gs ( O s ie r 1). The early Arabians fell that Sirius, the Dog Star, in nmc way was responsible (or the symptomatology and called the disease "siriasis." During the British occupation of India and subsequently, heatstroke has received con siderable attention, hut the pathologic condition in the fatal cases has apparently been decidedly .secondary to the clinical manifestations. O s ie r 1 dispenses with the morhicl anatomy in these few words: " Rigor mortis occurs early and putrefactive changes may come on with great rapidity. The venous engorgement is extreme, particularly in the cerebrum. The left ven tricle is contracted (W o o d) and the right chamber dilated. The blond is usually fluid: the kings are intensely congested. Parenchymatous changes occur in the liver and kidneys." Webster - also dismisses death from heatstroke with tins concluding sentence: "T h e autopsy findings will he those due to either syncope nr n>ph\xia.M From the condition at autopsy of the four cases to he presented it would appear that the cardiac lesions found in all the casts dusely approximate those found in death from clcctrici'.v or lightning as described In* F la tte r (quoted l>v Webster) and consisting of '` subendocardial cechyniotic extravasations combined with bloody emphysema of the larger bronchi." W ood J adds nothing to Osier's description of the morbid anatomy. 1 (Mir. VVill..lit) 11k l'linui'h - :.n.| 1'i.iOut i-f Mi.uim. til )'. \ , ,, V -rV.. l> .N|<!>t t'<1 \ t'-'.r. W i l ' . u i , it VV l. v il ! t 11c in f am) T u u c u lc r ) , 1'In 1;i<Itlplna. 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