Document zz9kqJGbg4Ym7BmGYDvd4K7Jm

Page 520 INDUSTRIAL MEDICINE August, 9&3 dling this type of material in the San Diego Division Time does not permit a discussion of the histology of the Consolidated Vultee Aircraft Corporation there of these dermatological changes produced by this sub has not occurred a single case of serious intoxication stance.. from exposure to any toxic material throughout this In general, it can be said with a fair measure of large plant. certainty that these changes are brought about in the skin, primarily by theicontact of the skin with the -^^Chlorinated Naphthalenes and Diphenyls vapors of these compounds, or by actual contact with them in the form of solid or particulate matter. We LEONARD GREENBURG, M.D., have found, for example, that workers exposed to H Executive Director, Division of Industrio! Hygiene, New York Stale Department of Labor fumes have more acne than those exposed to dust alor.i*. and we have also found that workers exposed T HE chlorinated naphthalenes comprise a group of chemical substances made by the addition of vari ous amounts of chlorine to a naphthalene base. The amount of chlorine may vary from three to six or pos sibly more atoms providing compounds from trichlornaphthalene to hexachlornaphthalene. 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 to the solid material or its particulate form have de veloped dermatitis. In this connection, the report of Fulton and Matthews is very interesting. They picture aiid describe a case of an infant, 2 : j years of ace, who developed the dermatitis as a result of contact with the soiled working clothes of its father who was in the habit of playing with the child prior to changing his clothing. More recently, Schwartz5 has described cases of dermatitis among cable strippers employed at ship building establishments and working with cables which had been impregnated with these compounds. degree of chlorination and later on the compounds were Systemic Effects cbuawuamtevavromnansruaaaiatumTbIdlT345Fl12dctsiouutnal....e.hhopeuareculisuteearloinbhnofsyRsTFsQitulaewtinenechetltshnencuytodhahshdHehoseddtistfmpeeluuiortiarsuuoiiasecsrmansngrfbeitbrrsoebhaetnatehiethorsyp.srrrncGnrsititseteeirahacuacihgpsaaa.eesnrtllnloelbehllprnaetlieoasalciymsylesdpaodttrueseetopoirirrtsataloisnlponrinanunnydcwnmoacosxtaaanyteithid,tsspi.tearnauodghemsyuehdtndgfnrtmeeefec.hteauoursdrthnwieevtmssdlfrecoeals,aa.vaiiiraoolltnaerpnlcsayelwweufkglthdtrnnByoeuiyecessfeaen..oeria:tuhniwnvshegncldmblyedkTd.aeogasloaausrhttniclylfbihanPsetidanae.rynaayeesbaabtcdrlttdlhtdearceepdoiiiecnoweh,tspoeefhtynldfhseraUoelnsiptcerycswrceoan.eonten.snmhirsyicsastettseoelgthapeesarhdnrcsihsetnoivdoasettgSuhobaemrhenpryat.pmtapyhlssretdvaeiueotennhniarcsopessglyeeehf,l,ec--yvytfhoWaaBtdeT^FanpmieamenuhateefeoiNiirattc.rpivrnadIlannraoanioyoeetherrsfatclunTnnxhsrsriseefuebuer~iHhgphcndroemaedte7na?oaaoovEyeenur.psanfusl~g..icorb'reowlnruUdlveToiaafya.dIsfc_irnetnhnuthrmgneohpilJpoeiadnelneiwfmgalcawaotrrninitpMtlehakrnleewhapeeiaw-?rvdtevmrBduna>orfaiieiwaoioeaitetcuekaeoSadnsotrsnthrneaxt"olugatpt.rifrIcppnatsesorsioeoseiofoontpelicnciyprrxeynrw.tisaiagrgohispttet.srmoa*aeeef,hcamydteeT1eogrnuihpisrsp9ntehpsreteherietyor3rwttmeeodradeioehsf5ttahsrom_polytghbieeielateiwtnoibolpninvthahonimysadypreonmeateelneittanaortirnehsgcFeoctkooetmieoldeiaindtnniit-afofxshldseivehtagondnnepufrpaeTrtwwswdecf.noemeeporuehmrsarafnrieipicihcsiteaaIiptuswneehterhahvonsnnosrtgnocna-eleiwhesdneatxcstrt1isohihlwseeewrnbeifna9eiJereidmliayv'an3ng'-a?enosrttceo7dcc.rhteadrtaiurefva,nhktptewniatnAreetnntilihilohiedDhkodinhlsgdccfetyaruore.Tioghaa?rgtlicrviewalranttilnashtoememrdanwctwhaehtklcl~itltilgvtroireoeeoteiowsebceeeao1etrnannwerndhhyne7ees-frr,J, Method of Use in Industry organ displayed areas of healing and new areas of *T"*HE chlorinated naphthalene? 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. In the second case, a man 24 years of age developed -jaundice after five month? of exposure in the'eoafing cf wire? with wax containing the higher chlorinated r.anhthalenes. He was away from work for a period of time and four_mpnths later the jaundice became tmite intense, with general maiaise and lo?s of appef lite. After two months more of work he was ?ent to the - Toxic Effects hospital, where he raiher rapidly passed away. The TK THE United States, the first three cases of acne produced by chlorinated naphthalenes were reported by Sulzberger1 and his co-workers in 1934. Fulton and Matthews,- of the Pennsylvania Department of Labor, reported 101 cases of dermatitis in a wire insulating plant in 193C. -- -2>ln 193G. Dr. Louis Schwartz,3 of the United States ^Public Health Service, described eases of acr.r pro duced by chlordiphenvls, and in the same year, Jones and Alden* reported similar findings. autopsy in this case showed extensive areas of necrosis and fibrosis o: the liver'with regenerattofl. In a third case, published by Drs. Mavers and Smith.1* of the staff of the New York State Depart ment of Labor, an IS year old girl became ill alter five months of exposure in the soldering ofielectrical condensers. The waxes in this case were composed principally of t richlornaphthalene. She was hospital ized and recovered after a long and slow period of convalescence. In 1938, Mayers and Silverberg described ncnefurm skin eruptions in workers making electrical con densers.5 Recent Industrial Experience T*\n:iNC the past year the Division of Industrial Hy^ giene of the New York State Department of La U o u iH T11f l) i'C U `*ii,n. i;,.-u jaiin n in l h i U - r of T ftxir S .i .`.nr>X a t io n a l C oN rcrcscc or G'ncr.K m e n t a l I n u v i m a l H v c e m v .-. K w k p 1er. N tw Y ork. >1av 24. 1V43. bi >r ha* conducted an investigation in two cable plants using chlorinated naphthalenes and diphenyls. In this 906035 .-it, m s istology iiis sub- sure of t in the .th the ict with ter. We osed to lo dust exposed .ave derport of picture (re, who vith the ' in the ring his ases of it ship- cables inds. form of rted by tg with 'A were Irinker, hanges dation, u'inated o menie three {. ' ich we i which uration girl 17 ;al coni tctra- seven d to seJ .1 clear yellow ? latter reas of veloped coating -rinated period became f appe: to the V. The -..crosis rs and 'lopart,1 after -rtrical nposed -spital` iod of lai Hyof La plants In this Voi 12, No. 8 INDUSTRIAL MEDICINE Page SSI investigation, a large number of cases of dermatitis (e) Protective skin creams or protective clothing were found, and several deaths due to liver damage should be provided by the management at the discre among workers in the industry. tion of the foreman, nurse, medical, or plant super The examination of workers in the two factories intendent. ihowed relatively few cases of enlarged liver--five in (f) All departments handling chlorinated synthetic al], on palpation. waxes should be thoroughly cleaned according to a Comparison in these two plants showed a very much prearranged schedule. This should include the removal higher incidence of acneform dermatitis in one of the of all deposits of waxy material from the machines, plants as compared with the other; namely 21CV as floors and surrounding objects. Workers doing the compared with eOfo, the former being in the cold cleaning should be provided with protective clothing pnBs establishment and the latter being in the es and supplied air or organic vapor masks where exhaust tablishment employing the hot process only. The der- ventilation is inadequate or not possible. matitis appeared to take place on the average in about *--^ 3 . The foremen of all departments where this ma- lz months in the hot process plant as compared with terial is handled should be apprised of the toxic nature 10 months in the cold process plant. of the m aterial and instructed in sale handling pro cedures^ These men should make it their duty to check Conclusions up on the workers in their departments and instruct AS A result of our general re-study of this whole ** problem and our experience in two recent out breaks, as well as several isolated experiences we desire -XDto draw several basic conclusions: Chlorinated general hi extreme care^ _____ ____________ them in safe practice. r 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, gastrointestinal disturbances addition, the skin should be care- and the more reliable liver effort to se elh a t such exposures are controlled, in so~ fgf as humanly possible. In this effort. 7ve do notlSj^ lieve~t sale to relv on limiting atmospheric concentra tions b~uf~ratfrer 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 function tests performed. Gastrointestinal 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. is employed than where the hot process is used. - y n^ n99rine control of nlant operations cannot 3. Of the known cases of liver disease in our expert- ^ ov*eremnha?ized but specific recommendations are ence, the available history and experience g e n e r a ll points to exposure to vapors or fumes from the hot process? There is no clear evidence in our experience, although it is possible that skin absorption may pro duce systemic poisoning. Physiologically we see no reason why this is not possible/However, most der y -n--o--t--a-p~pl-i-c-a--b-l-e--t-o---a-l-l--c-a--s-e-s--.--It w"ould 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. matitis cases do not develop liver damage. Bibliography Finally, 1 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. Cr^SvmtERCru. M. B.. R i.iitM inc. A . 1., sn<i S m r . I. I.: Ac nr form tuM ion*. .Vr* 5(ofr J. 3J 1"34. L p J V c iT i.y . W . B.. * n j Matt n e w s . I. A i reliroir.nry r*rt>ri o f ihr ii*rm atolxital anil v-trniic ftrcit o f c.\iio*urt to he.yneMurofiHl ntha- Itn e and chl'srvliiiht-nyl. IVnny]vania titp t. nf I-abor, Bull. .Vo. i t 15*3. -- Recommendations 3. S ell "'aFTC* L .; rirrn n u titil fro m fv n th c lic r i n i and ir a x t r Alii, J . PuhUr Iflo lfli. 2 $ :?-5 . l;*3i. TTNLESS there is a very good reason for using the hot method of impregnation all new installations 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 4. JuVKS. J . W ,, t.nd ALI'LN, H . S. 1 A ci.cform d e m ia lrrc o fis. ArrA. f y w ' i r o l J.- S . , h i;'.. 3:i:3 33, lv *S. G ^ M aytiu. M. R.. and 5; (AT.RBLHC. M. G.: Skin conditinni Tt-ukinc from \n rhlorinalrd hydrocarbon!. J. Ind, H jp. & T o r . . 2<';344, I r f i . V ( y Sen w a k i, 1_; A n nut break of barytran acnr l "cable ir.*h") a m o r : r !r fir in -n -. J_1 .'.(.A.. Vnl. 123. p, 13. 1P43. over to cold, if possible, or surrounded with everv .known prot,ective mr easure. - General hygienic measures should he 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 r - n. E.: Acsn of certain cMorinair-] n a n h t h a , . r * on th f liv rr* J'roe. See. I / w r , BttfoQ. I- .V.rf,( 3 ^ : 1 1->. l:"3d. AI>o. Livrr l--i-n* raused by rhlorir.a:r-i napblhairnr. Am . J. H 'j p u * t , 22 :li*. 1-3. Q jO K M itE . C. K.. W akrlv. M. r .. and B ennett. C, a .: The r ro U lrm nf me H-s). j* Tot., *;7i-l:>:v3T-f.yryom terrain chlorinated hydfvfaibons. 0 4} G n tt.\ai rx. L., Ma i tr.a, M, R,, and S u iT H . A . R . : T h e *; - i r a i t t i m i . Itui:ine fn-m ,\j w u rr , to c t D iin chk.rinatrJ hydrocarbon.. if m. a-r-..., _n iS3:*V good practice where these compounds are handled. Pi nrTii^u/i^n c(hm^nirni ram.li 'rit' emir from rxi>n-urt to i n u o ' U i a ) H j i f i t n c , ) n d n * t> towi'.Ut (a) Two lockers for each worker exposed to chlorin- V n** v.-m Smir Uti-.r Hrin.. January, aj. 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 it the end of each shift before getting into his street clothes. (d) Supervised cleaning: (11 At noon the workers should remove outer clothing and scrub hands and face under supervision. (2) At the end of the shift they should be required to take a supervised shower before changing back to street clothes. Abstract oi Discussion M-'AXTREii BnwniTCH (Boston 1: A frv issues ato an article ajipvared in the J'-innal of the Aunrinm Mcdital A t`ocirt'n)> dealing with that subject of cable wire treating. One oi the two authors is here; he might say a word or two on that subject. DR. irving n. tabkkshaw (Boston): Those were expi riment= to remove wax from the skin, and, as you know, it is practically impossible to get off. dr. crrE N st kg 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. 906036 yr Wr*i-' K'XV '3 i.r fcv ^(1*i'1j `V.V. i :w ir $5? -'"f i * *M-fSt"f: I\- - mu v ~ cl ''?-: i. ~ . ..I< t iVv. ; i Page 522 INDUSTRIAL MEDICINE Aij/hs, 193 Vfe evolved a mixture which effectively removes the located in 36 states and employing approximately 2.5 halowax from the skin, consisting of equal parts of butyl stearate and sulfonated castor oil. A little cornmeal is added as a mild abrasive and oleic acid is used to hold it in suspension. It is very effective in removing halowax. We have not used it as a curative measure, although it can be used that way. However, if a case of halowax has once developed and is removed from exposure entirely, it takes three months or longer to clear up. million workers were included in these surveys. More than four-fifths of the 962 establishments included in the present report were covered in a study which was primarily concerned with industrial nursing but necessarily included some data pertinent to this report; data from the remaining plants were secured from a study dealing more specifically with industrial medical We have also found ultra-violet to be of some help. It services. Since definitions regarding medical personnel is not completely efficacious in clearing the condition, but and facilities were the same for both studies it was it does help, and, in my estimation, it helps as much as possible for present purposes to combine the schedules *-5*y'*TThe cnix of the situation is cleanliness, and, as DR. tREEKBERG stressed, it is necessary to do it under super vision. Perhaps the use of this mixture might help in re moving the halowax before the worker leaves. Dr , LLOYD M. f a Rn e r (Seattle) : I would like to ask dr, tabershaw to answer an observation we made in the state of Washington. We had 60-odd cases of cable dermatitis, and, interestingly enough, these cases were among men stripping cables in the shipyards. We saw not -a single lesion of pore acne on the hands, and yet the hands were the most exposed part of the'body. We felt very definitely that the washing of the hands for these items. It should be kept clearly in mind that all establish ments covered by the two surveys were chosen be cause they had some organized medical services al ready in existence in 1942. Obviously the majority of them had at least a full-time industrial nurse. At the time they were surveyed a large proportion of these establishments were engaged in or were in process of changing over to essential war activities.' Approxi mately a third were located in the New England and the Middle Atlantic states, a half were in the Middle West, and the remainder were in the Pacific Coast with plain soap and water was the reason we saw no states and in the South. lesions on the hand, because the men rubbed their ears Within the limitations stated above these data and their faces, and the other parts of the body were exposed to the wax that adhered to and went through the .clothing. We saw lesions everywhere except on the hands. I would be interested in getting your reaction, Doctor, as to why that situation existed. Dr. tabershaw: Of course, it occurs chiefly where the sebaceous glands are present--ears, crevices along the should represent reasonably well conditions actually existing during the first year of the war. The topics chosen for discussion are of such nature that quantita tive measures are readily available. No attempt has been made to evaluate the quality or the efficiency of the medical services being rendered in these plants. This paper aims merely to describe certain facts per eyes and face. As DR. GREENBERG pointed out, it develops taining to the medical personnel, medical services, along any abrasion or sebaceous gland. I can't explain it dispensary facilities, workmen's compensation and sick except they must have cleaned their hands very thoroughly. benefit plans, and the type of food service found in Dr. Gr e e n b e r g : I think you can wash this material off establishments according to certain size and industry your hands. It is difficult to get any results once you groups. Comparisons by industry have greater signif develop pore acne. I believe those cable strippers did icance when they are limited to establishments within wash their hands thoroughly before they developed pore the same bvoad size group. acne, and they prevented it from developing in the hair follicles in the hands, where it often occurs, in the sebace Medical Personnel ous glands there. I think that is why you find pore acne on the body where it has penetrated through the clothing, around the neck and sometimes on the face. After it has developed, washing doesn't do very much good. Then you are up against a case where the skin is loaded down, and you have to get rid of it by some other more radical procedure. '"pHE medical service personnel of an establishment is considered to include all of those individuals employed or retained by the company officials to render medical care to the employees. Persons engaged in a specified activity for a regular work day. every day in the work week, are classed as full-time employees. Person; having regular hours of duty in the plant W artim e Industrial M edical Services each week which are less than the entire period are classed as part-time employees. On-call physicians HUGH P. BRINTON, PH.D., Statistician, W. C. DREESSEN, M.D., Surgeon, and VICTORIA M. TRASKO, A.B., Aijijlont Stofiriicion, Belhesdo, Maryland serve no regular hours at the plant but are called from a prepared list or panel whenever an emergency arises. All plants which had a full-time registered nurse, bul no full-time or part-time physician, were considered to have a physician on call even if they did not so state on the schedule. No distinction has'been made between T here is little factual information regarding the part-time physicians who are at the plant for only status of industrial medical service since this one hour a wvek and those.who spend several hours country entered the war. Something is known coneach day at the plant. _*.. cerning the medical organizations created to care for Of the 962 esi:iblishments.-induded in Table 1, 3D the needs of the very large new war plants, but little had only in on-call physician, 43fT had a part-time has been published concerning establishments with physician, and IS'"* had one or i. -*re full-time physi less than 5,000 employees which, after all, are carrying cians. In Table 2 which considers each of these three a large share of war production in this country. Com groups separately, it is found that 12'"* of the plants parisons of medical services found in plants of corre with an on-call physician had no full-time registered sponding size but in different industries are still more nurse but depended on a practical nurse, first-aid rare. worker, or part-time registered nurse for duty in the The Division of Industrial Hygiene of the National dispensary. Seventy per cent of these plants bad a Institute of Health is fortunate in having participated full-time registered nurse without other assistance, during 1942 in two surveys which throw some light and IS"* of the plants had a full-time registered nurse upon the important problem of wartime industrial plus other assistance usually on the night shift when medical services. Nearly a thousand establishments the regular nurse was not on duty. From the Division o f Industrial I l j t i r n r . N ational Im liiu l* of H ralth, U nilrd S ta in PuLlic llra lth Servir*. Of the 414 establishments with a part-time physi cian, Cr* had other attendants but no full-time regis- 906037 3 ii l