Document yrjQwDBbn7yVJGZw4kVGVzmdE

iiuiii e.\jiwM,ie u) .iiij u'.\it material mrougnout this large plant. in general1,. it can be said with a fair certainty th it the>c changes are brought skin, primnr-iilly by the contact of the U K' *c r! Chlorinated Naphthalenes and Diphenyls vapors of theeSsev compounds, uor bnvy actual " V **-> tu* them in the form of solid or p-articulate^'^1 .r LEONARD GREENBURG, M.D., have found, for example, that workers Executive Director, Division of Industrial Hygiene, fumes have more acne than those exn a New York State Department of Labor alone, and we have also found that worl; ^ .rw THE chlorinated naphthalenes comprise a group of chemical substances made by the addition of vari to the solid material or its particulate veloped dermatitis. In this connection ous amounts of chlorine to a naphthalene base. The ,.,<s ' amount of chlorine may vary from three to six or pos sibly more atoms providing compounds from trichlor- naphthalene to hexachlornaphlhalene. In the same manner, the varying amounts of chlorine are added to a diphenyl base providing a group of compounds of varying chlorine content. ' As a rule, the final substances, as used in industry, are mixtures of differing chlorinated naphthalenes. Earlier, these were, as a rule, possessed of a lower degree of chlorination and later on the compounds were habit of playing with the child prior to eh lr- fi clothing. thrtn,fiO ^ A r.. -More recently, Schwartz6 has described '""''it t'-wi dermatitis among cable strippers employed 'V** ** Ik 8' building establishments and working with f which had been impregnated with these cornpou Systemic Effects ' .*.. rCMhkr . ` i ht usually of a higher degree of chlorination with varying amounts of chlorinated diphenyls added thereto. These substances are not new. Perchlornaphthalene was used in Germany during the last war. IN THE United States, systemic effects in <KP < w to ; .QacPuii +teQ yellowI'olln,,1 antrnotpnh*y ofr\f +thVe.n liver _w__ere repo ~ A?4--.At- f l*u Flinn and Jarvik7 in 1936 among men workin' A fS m-t It is to be clearly understood that these groups of compounds are not manufactured by any one company but rather by approximately five in the United States, and they are sold under varying trade names by the tetra and pentachlornaphthalene. These finding verified by animal experimentation. In 1937( Uri-T^ Warren and Bennetts reported such liver among animals exposed to the material by inhaLtf `o t>ul sr,C the manufacturers. The chlorinated naphthalenes and diphenyls are val uable industrial products. Because of certain prop erties which they possess, we may briefly state these valuable properties as follows: 1. Resistance to water and alkali. 2. High insulating value. They possess high dielec tric constant. 3. Thermo plasticity. . and similar findings were obtained with the chlorirlu3 diphenyl compounds. These latter authors also c* !& t Oft tion four non-fatal cases among humans and the it* $?*<. the fatal cases previous!/ cited by Flinn and Jarvik " L'- :o I should like to cite two or three cases which -- have encountered m our own experience1' and may be of intereesst from the point of view of syst of exposure prior to this type of poisoning. A g.y, 7V years of* age was engaged in soldering electrical" '.'isbtbc; 4. Quite stable chemically. densers which were impregnated with tri- and tctrv'vS -v 5. Flame resistant. chlornaphthalene for a period of approximately For these reasons, these substances possess much months. The autopsy for this case showed mild to !r value industrially in the making of electric condensers, vere degeneration of the liver and presented a * and in the insulation of wire and cable, etc. picture of what is generally known as acute ydW'ifVwmme atrophy. It was apparent in this case that the l*!itr;y| ; Method of Use in Industry organ displayed areas of healing and new areiu TpHE chlorinated naphthalenes and diphenyls are used in industry by two methods: 1. A cold method in which the material is dissolved in a solvent usually a mixture of petroleum naphtha and toluene, and 2. A hot method wherein the material is rendered plastic by heat. pathology. e;r; In the second case, a man 24 years of age develop jaundice after five months of exposure in the costlr^ V of wires with wax containing the higher chlorimbd n naphthalenes. He was away from work for a perM U3';t4tf 0 ' of time and four months later the jaundice beeis*'-^"Jrt ^ pr Q^r quite intense, with general malaise and loss of ajTpt-5^m. ^ tite. After two months more of work he was sent to ibry% ^ . . Toxic Effects ` hospital, where he rather rapidly passed away. Tfcf ;v'| ^ " T N the United States, the first three cases of acne autopsy in this case showed extensive areas of necro*a '/0 produced by chlorinated naphthalenes were reported by Sulzberger1 and his co-workers in 1934. Fulton and and fibrosis of the liver with regeneration. In a third case, published by Drs. Mayers ir>! ' " Matthews,2 of the Pennsylvania Department of Labor, Smith,10 of the staff of the New York State Dcpirt* ^ reported 101 cases of dermatitis in a wire insulating plant in 1936. In 1936, Dr. Louis Schwartz,3 of the United States ment of Labor, an 18 year old girl became ill afw five months of exposure in the soldering of elect no- ^ ~T~ ; condensers. The waxes in this case were comp"1^ .''4 Public Health Service, described cases of acne pro principally of trichlornaphthalene. She was hospiub^ duced by chlordiphenyls, and in the same year, Jones ized and recovered after a long and slow period ' m and Alden1 reported similar findings. convalescence. In 193S, Mayers and Silverberg described acneform skin eruptions in workers mak'r.g electrical con densers.5 Recent Industrial Experience DURING the past vear the Division of Industrial Hr giene of ^----- ^ :"3!' Round Table Discussion, Regulation in the Use of Toxic Substances. National Conference of Governmental Industrial Hygienists. Roches ter. New York. May 24, 1943. bor has conduc using chlorinated w wr"1wI nTTjw <^ 00036 HARTOLDMON0021612 ..',4 ut in 1 with 'itact V i.'uter. y? ^Posed ! d to duS **** 7 workers in the industry. _. examination of workers in the two factories -d relatively few- cases of enlarged liver--five in ^"n palpation. ^"r iparison in these two plant? showed a very much Y incidence of acneform dermatitis in one of the as compared with the other; namely 217<> as f`,*n `ired with 601c, the former being in the cold "s.exPo^ ! have d,. rc,Port y '>' Pictur* h'frlD establishment and the latter being in the f'\.r^hment employing the hot process only. The der^ titis appeared to take place on the average in about T'* months in the hot process plant as compared with !( a. *h ` 'Vlth as in tht ne>ng hu jp'month? in the cold process plant. emlus'ons c a RESULT of our general re-study of this whole cases 0( ship, -h cable* 'ounds. A* problem and our experience in two recent out breaks, ns "'ed ns several isolated experiences we desire lr draw several basic conclusions: j Chlorinated naphthalenes and diphenyls are in arnl highly toxic compounds and must be used with xtreme care. Industrial hygienists should make every e form of. ported by hing with ;ngs wen Drinker, changed nhalation, ; ilorinated 'Iso men. the three vik. vhich vre ad which duration A girl 17', deal connd tetra-; sly seven ild to se2 1 a clear.;I Vor< to see that such exposures are controlled, in so fj'r as humanly possible. In this effort, we do not be lieve it safe to rely on limiting atmospheric concentra tions but rather to depend on a maximum of mainte nance and engineering control. 2. Toxic exposures may be more readily controlled where the cold or solvent method of impregnating cable j, employed than where the hot process is used. 3, Of the known cases of liver disease in our experi ence, the available history and experience generally points to exposure to vapors or fumes from the hot process. There is no clear evidence in our experience, iJthough it is possible that skin absorption may pro duce systemic poisoning. Physiologically we see no reason why this is not possible. However, most der matitis cases do not develop liver damage. Finally, I should like to call attention to a group of recommendations which were agreed upon by all of the groups involved in the last outbreaks of poisoning as being of utmost importance in control of this hazard. e yellow.,' he latter ' areas of- Recommendations r inless there is a very good reason for using the hot 'D method of impregnation all new installations eveloped coating iorinated a period became of appe- .' r.t to the ' ay. The necrosis should use the cold or solvent method of impregnation with chlorinated naphthalenes and diphenyls. Where the hot method is now being used it should be changed over to cold, if possible, or surrounded with every known protective measure. 2. General hygienic measures should be followed, but in no case should these be allowed to supersede engineering control of the primary source of the ex posure, the operations in the plant. The following hygienic measures may be considered ers and Depart.'11 after '.ectrical mposed .ospitai- . :riod of 1 good practice where these compounds are handled. (a) Two lockers for each worker exposed to chlorin ated waxes (one for working and one for street clothes). (b) All work clothes above the underwear should be provided and laundered at least twice a week by the management. (c) The workers should change to clean underwear at the end of each shift before getting into his street clothes. ial Hyof Laplants In this (d) Supervised cleaning: (1) At noon the workers anould remove outer clothing and scrub hands and face '-nder supervision. (2) At the end of the shift they anould be required to take a supervised shower before changing back to street clothes. lion of the foreman,, nurse, medical, or plant super intendent. (f) All departments handling chlorinated synthetic waxes should be thoroughly cleaned according to a prearranged schedule. This should include the removal of all deposits of waxy material from the machines, floors and surrounding objects. Workers doing the cleaning should be provided with protective clothing and supplied air or organic vapor masks where exhaust ventilation is inadequate or not possible. 3. The foremen of all departments where this ma terial is handled should be apprised of the toxic nature of the material and instructed in safe handling pro cedures. These men should make it their duty to check up on the workers in their departments and instruct them in safe practice. 4. Pre-employment and periodic physical examina tions should be made of all exposed workers. These should include the taking of a full clinical history, with special emphasis on gastro-intestinal disturbances and dermatitis. In addition, the skin should be care fully examined periodically and the more reliable liver function tests performed. Gastro-intestinal complaints developing in a worker at any time should be a signal for an immediate medical check-up. A history of liver disease, jaundice, or antisyphilitic treatment should automatically exclude a worker from jobs involving a possible toxic exposure. Pregnant women should not be employed where there is a possible exposure to the synthetic chlorinated waxes. 5. Engineering control of plant operations cannot be overemphasized but specific recommendations are not applicable to all cases. It would be wise for a plant using this class of materials to check their control measures with the state industrial hygiene agency, the insurance carrier and some competent consultant be fore occupational disease occurs. Bibliography 1. Sulzbercer, M. B., Rosenberg, A. I., and Shek, I. 1.: Acneform eruptions. Arcic York Stale J. Med., 34:899, 1934. 2. Fulton*, W, B., and Matthews, I. L.: A preliminary report of the dermatological and systemic efTects of exposure to hexachloronaphtha- lene and chlorodiphenyl. Pennsylvania Dept, of Labor, Spec. Bull. A'o. 1936. 3. Schwartz, L.: Dermatitis from synthetic resins and waxes. Am. J. Public Health, 26:5S6, 1936. 4. Jones, J. W., and Aldex, H. S.: Acneform derm&tergosis. Arch. DcrTTtafoi. < Syphil., 33:1022, 1036. 5. Mayers, M. R., and Silverberc, M. G.: Skin conditions resulting from exposure to certain chlorinated hydrocarbons. J. hid. Hyp. < Toz., 20 :244, 193S. 6. Schwartz, L.: An outbreak of halowax acne ("cable rash") among electricians. J.A.M.A., Vot. 122. p. 15S, 1943. 7. Flinn, F, B,, and Jarvik, N. E.: Action of certain chlorinated naphthalenes on the liver. Proc. Soc. Ezpcr. Biclop. <C- Med., 35:115. 1936, Also, Liver lesions caused by chlorinated naphthalene, ,4m. J. Hygiene. 27:19, 1938. 8. Drinker. C. K., Warren, >f. F., and Bennett, G. A.: The prob lem of possible systemic efTects from certain chlorinated hydrocarbons. J. hid. Hyp. & Toz., 19:283, 1937. 9. Greenburg, L., Mayers, M. R.. and Smith, A. R.: The systemic effects resulting from exposure to certain chlorinated hvdrocarbons. J. I nd. Hyp. < Toz.. 21:29, 1939. * 10. Mayers, M, R., and Smith. A. R.: Systemic effects from exposure to certain chlorinated naphthalenes. Industrial Hygiene, ludust. Bulletin, New York State Labor Dept., January, 1942. Abstract of Discussion Manfred bowditch (Boston): A few issues ago an article appeared in the Journal of the American Medical Association dealing with that subject of cable wire treating. One of the two authors is here; he might say a word or two on that subject. PjR. Irving R. tabef.shaW (Boston); Those were experi ments to remove wax fTom the skin, and, as you know, it is practically impossible to get off. DR. greenburc mentioned scrubbing, but that doesn't do it. As a matter of fact, workers themselves have attempted everything, even washing their faces with ether and using the harshest abrasive soaps. , 00037 HART OLDMONOQ21613