PART II THE SYMPTOMS AND TREATMENT OF INDUSTRIAL POISONING (continued 2)

The higher alcohols (propyl-, butyl-, amyl-alcohol, C₃H₇.OH, C₄H₉.OH, and C₅H₁₁.OH) occur in fusel oil. They cause but slight (if any) industrial poisoning. Cases of more severe industrial poisoning through amylalcohol fumes have been described (in factories for smokeless powder), with symptoms of sickness, headache, giddiness, with fatal issue in some cases, preceded by severe nervous symptoms (convulsions or delirium).

Beyond speedy removal out of the dangerous atmosphere, probably no special treatment is needed in these cases of industrial poisoning from alcoholic vapour.

GROUP: NITRO AND AMIDO COMPOUNDS OF THE ALIPHATIC AND AROMATIC SERIES (BLOOD POISONS WHICH FORM METHÆMOGLOBIN)

Characteristic of the nitro and amido compounds of the aliphatic and aromatic series of the organic substances is their action upon the blood. The normal oxyhæmoglobin (blood-colouring matter) is changed into methæmoglobin, with which the oxygen is so firmly combined that the internal exchange of gases necessary to life becomes impossible. Methæmoglobin has a dark chocolate-brown colour and a clearly defined characteristic spectrum.

Of the poisons belonging to this group several are important. In so far as these substances are volatile—and this is generally the case with those causing industrial poisoning—effects are due to inhalation of fumes, but it is proved that the poisons of this group in liquid form can be absorbed by the intact skin, and this channel of absorption is characteristic of industrial poisoning. Severe poisoning results especially from wetting the skin by spilling on the clothes, &c.

The grey-blue discoloration of the mucous membrane, especially of the lips, is characteristic; sometimes also the skin is altered in colour. This discoloration is often noticed by others before the patient feels unwell. Soon the person affected has general nausea, vomiting, headache, giddiness, severe nervous symptoms, feeling of anxiety, and difficulty of breathing; in severe cases unconsciousness comes on, and death occurs with increasing cyanosis (lividity).

Treatment is naturally that which has been emphasised in the introductory words to Part II, which hold for all blood poisonings. In mild cases oxygen treatment has given good results. In all factories where such poisoning can occur provision should be made for immediate oxygen treatment. Besides this, the workers must be adequately instructed as to the danger and symptoms of poisoning, especially of the characteristic premonitory skin discoloration, in order to be able to assist their fellows.

NITROCOMPOUNDS ALIPHATIC SERIES

Nitro-glycerin (triple nitric acid ester of glycerin, C₃H₅.[NO₃]₃), the well-known oily explosive liquid, has also an irritant local effect. When absorbed into the body, in addition to methæmoglobin formation, it causes dilatation of the bloodvessels, slowing of the respiration and heart’s action, and attacks of suffocation. The general remarks upon this group apply here, but symptoms referable to central paralysis occur as the methæmoglobin formation is slow. Industrial poisoning arises through inhalation of gases containing nitro-glycerin and also by absorption through the skin. Statements as to its poisonous nature are very varied. Under certain conditions moistening the skin with small quantities of nitro-glycerin suffices to produce symptoms. Probably the susceptibility of different persons varies greatly.

Amylnitrite (nitric acid amyl ester, C₅H₁₁NO₂), a characteristically smelling liquid, acts similarly. The fumes of amylnitrite, even when inhaled in small quantities, cause marked dilatation of the bloodvessels, through paralysis of the muscular walls of the bloodvessels, thus causing marked flushing of the face; the pulse becomes quick, then weak and slow.

NITRO AND AMIDO COMPOUNDS AROMATIC SERIES

The substances of this group are important.

Nitrobenzene (C₆H₅NO₂, named oil of mirbane), a yellowish liquid of characteristic smell, induces especially the formation of methæmoglobin in the blood; the effect upon the central nervous system (first excitation, then depression) is often absent. The description of the disease in general in the introductory words of this whole group is characteristic. Occasionally signs of asphyxia show themselves; sometimes there are twitchings, disturbance of the power of sensation, and convulsions; early discoloration of the mucous membrane and the skin, which assume a blue to grey-black colour, is characteristic.

Chronic poisoning is also attributed to nitrobenzene, showing itself in lassitude, headache, malaise, giddiness, and other disturbances of the nervous system.

Nitrotoluene (C₆H₄CH₃NO₂), of which the ortho-compound acts most powerfully, and also nitroxylene (C₆H₃[CH₃]₂NO₂) have similar but less marked effect.

The dinitrobenzenes (C₆H₄[NO₂]₂) are stable bodies. Meta-dinitrobenzene inhaled as dust or otherwise, can produce marked poisoning symptoms essentially the same as those described. Especially characteristic is the early dark discoloration of the skin.

Symptoms resembling nitrobenzene poisoning in general are caused by nitrophenols (C₆H₄.OH.NO₂), of which paranitrophenol is the most toxic; also by dinitrophenols (C₆H₃[NO₂]₂OH), solid crystalline substances which melt at different temperatures, and the mono- and di-nitrochlorobenzenes (C₆H₄.Cl.NO₂ and C₆H₃.Cl[NO₂]₂). In cases of industrial poisoning by dinitrophenol, observed by Leymann, the workers were taken suddenly ill, with symptoms of collapse, pains in the chest, vomiting, distress of breathing, rapid pulse, and convulsions, and died within a few hours. At the autopsy a yellow substance was found with picric acid reaction which appeared to be di- or tri-nitrophenol. In other cases, some fatal, of industrial nitrochlorobenzene poisoning, also observed by Leymann, the typical grey-blue discoloration of the skin was obvious, and the chocolate-brown colour of the blood produced by methæmoglobin.

Trinitrophenol (picric acid, C₆H₂[NO₂]₃OH) is a yellow crystalline compound with bitter taste; poisoning by this substance exhibits clearly strong local irritant action (upon skin, mucous membrane, and intestinal canal, and especially upon the kidneys), besides effect on the blood and central nervous system. Prolonged action of picric acid upon the skin causes inflammation. Absorption of picric acid dust causes inflammation of the mucous membrane of the respiratory passages and symptoms of gastric and intestinal catarrh as well as inflammation of the kidneys.

A jaundice-like discoloration of the skin and darkening of the urine are also characteristic; sometimes picric acid poisoning produces a rash resembling that of measles and scarlet fever.

Nitronaphthalene (C₁₀H₇[NO₂]) and nitronaphthol (C₁₀H₆.NO₂.OH) in addition to methæmoglobin formation have an irritant action. It is stated also that dulness of the cornea is produced.

Azobenzenes also, which are to be considered as intermediate between nitrobenzene and aniline, form methæmoglobin (azobenzene, C₆H₅N = NH₅C₆).

Aniline (amidobenzene, C₆H₅.NH₂), a colourless, oily liquid of aromatic smell, has only slight local irritant effect. In the frequent cases of industrial poisoning by ‘aniline oil’ or aniline hydrochloride, in which the aniline enters through the skin or is inhaled in the form of fume, there appear the typical symptoms common to this group, of the action upon the blood through methæmoglobin formation: headache, weakness, cyanosis, difficulty in breathing, &c., to which are added nervous symptoms such as convulsions and psychical disturbance, although these play a subordinate part in industrial poisoning. In severe cases the typical symptoms of air hunger are shown. Occasionally recovery only takes place gradually, and signs of irritation of the kidneys and inflammation of the urinary organs are seen. These symptoms occur only rarely in acute industrial poisoning, but are, however, in so far worthy of notice because of the frequent occurrence of tumours in the bladder among aniline workers. It is possible that here the irritant action of the urine which contains aniline plays a part. The tumours in the bladder operated upon, in some cases with success, were many of them non-malignant (papillomata), but some were carcinomata (cancerous new growths) running a malignant course, and recurring after operation. In the urine the aniline combines with sulphuric acid, and is partly excreted as paramidophenol sulphuric acid.

The treatment of aniline poisoning is the same as that for all the poisons of this group. In view of the occurrence of tumours of the bladder in aniline workers, they should be instructed to seek medical aid on the first indications of trouble, so that a careful cystoscopic examination may be made.

Toluidine (C₆H₄.CH₃.NH₂), which is mixed with aniline for industrial use, produces the same symptoms with marked irritation of the renal organs.

Of the nitroanilines (C₆H₄.NH₂.NO₂) paranitroaniline is the most poisonous. Characteristic of the action of this compound is methæmoglobin formation, central paralysis and paralysis of the heart’s action.

Of the benzenediamines, paraphenylene diamine (C₆H₄[NH₂]₂) may be regarded as an industrial poison. The irritant action of this substance is prominent; it induces skin affections, inflammation of the mucous membranes, more especially of the respiratory organs, and sometimes inflammation of the kidneys. They have been noted in workers using ursol as a dye; here, doubtless, the action of diimine (C₆H₄.NH.NH.) must be taken into account, which arises as an intermediate product and exercises a markedly irritant action. Further, the general effect of paraphenylene diamine is an irritant one upon the central nervous system.

APPENDIX TURPENTINE, PYRIDINE BASES, ALKALOIDS

Turpentine oil..—Turpentine oil is a peculiar-smelling, colourless liquid of the composition C₁₀H₁₆; different reactions show that turpentine oil contains the aromatic nucleus (cymene). It is used in the manufacture of varnish, and thus can cause industrial poisoning by inhalation of fumes. Even from 3 to 4 mg. of vapour of turpentine oil per litre of air brings on severe symptoms. Turpentine oil acts as a local irritant, and when absorbed into the system has an exciting effect upon the central nervous system. Inhalation of large quantities of turpentine vapour cause rapid breathing, palpitation, giddiness, stupor, convulsions, and other nervous disturbances, pains in the chest, bronchitis, and inflammation of the kidneys. The last-mentioned symptom also arises from the chronic action of turpentine vapours.

Pyridine.—Pyridine (C₅H₅N), a colourless liquid of peculiar odour, is employed as well as methylalcohol in denaturing alcohol. The disturbance of health observed in workers occupied with the denatured spirit are probably mainly due to the inhalation of fumes of methylalcohol. Pyridine is comparatively innocuous. Eczema, from which persons suffer who come into contact with denatured spirit, is ascribed to the action of pyridine. Larger doses produce a paralysing effect, but this need not be considered in its industrial use.

Nicotine, tobacco.—According to various published statements, effects among tobacco factory workers are attributed to the nicotine contained in tobacco dust and to the aroma which fills the air. Nicotine in large doses has at first an exciting followed by a paralysing effect upon the central nervous system; it causes moreover contraction of the unstriped muscles and has a local irritant effect.

The symptoms of illness ascribed to nicotine are: conjunctivitis, catarrh of the air passages, palpitation, headache, want of appetite, and, particularly, tendency to abortion and excessive menstruation. Severe industrial poisoning due to nicotine has only been observed in workers who chewed tobacco leaves.

Poisonous wood.—The symptoms of disease noticed in workers who manipulate certain kinds of wood are attributed by some writers to the presence of alkaloids. Such knowledge as we have of the illness due to them—they are evidently of the nature of poisoning—is referred to at the end of Part I.