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t ;^ J i " 6; TOXICOLOGY ~~ y^p & / PLAINTIFF'S EXHIBIT The field of toxicology and the study of the various toxic materials and hazards encountered in industry can be conveniently divided into the following main classifications: \ A. Abnormalities of Air Pressure: V 1. Compressed Air (increased atmospheric pressure). 2. Altitudes; Rarefied Air (decreased atmospheric pressure). 8. Abnormalities r Temperature and Humidity: 1. Heat. 2. Sudden Variations of Temperature. C. Dampness. D. Defective Illumination. 8. Dust: 1. Organic Dust. 2. Inorganic Dust Containing Free Silica. 3. Inorganic Dust (except Asoesto ) Containing .'.'o Free Silica. 4. Asbestos. . -- / / / F. Infections: 1. Anthrax. 2. Fungus. 3. Septic. 4. Undulunt Fever. G. Radiant Energy: 1. X-rays, Radium and Other Radioactive Substances (Radiochorlum and Uesothorium). 2. Ultraviolet and Infrared Rays. H. Repeated Motion, Pressure, Shod:, etc. J. Poisons. 002303 183967 A. ABNORMALITIES OF A13 PRESSURE: 1. Compressed Air: A lock is a chamber in which the air pressure is capable of being raised in order to keep out water and mud from an excavation. In building tunnels, laying foundations to large buildings, etc., it is often necessary for the work to be carried under increased air pressure in order to prevent the entrance of water into these excavations. Special care must be taken as to the speed with which the pressure is raised within a lock. If care is not exercised, workers will rupture their eardrums or they may hemorrhage from any one of the body orifices. THE GREATEST DANGER IN WORKING IN COMPRESSED AIR ATMOSPHERES IS THE HAZARD OF RAPID DECOMPRESSION, either through accident, faulty seams in the lock, or through an error in decompression where the air pressure is allowed to fall too rapidly. As the pressure in an air lock is increased, the body fluids (blood and tissues) dissolve more of the atmospheric air than would normally be dissolved at sea level or at normal pressures. Nitrogen is the gas that is absorbed most rapidly. Oxygen and carbon dioxide have great diffusion properties and thoy have the ability to "ebb and flow" rather rapidly with changes in pressure. Nitrogen, however, has a great difficulty in accomplishing this and as a result any increased content of nitrogen in the body fluids, expecially the blood, must be removed by slow decompression. Rapid decompression causes the formation of snail bubbles ia the circulation. These bubbles have the capacity to block small capillaries and small arterioles. In doing this, it robs vital organs of their blood supply. Small air bubbles in he lungs and the lung capillaries cause the patient to oecone extremely dyspnoeic (these are termed the "chokes"). Rapid decompression with the formation of bubbles in general is known as the "bends", causes severe abdominal pain for the same reason, the accumulation of small bubbles in the mesentery and the vessels contained therein. Severe danger to divers exists in rapid decompression, causing the accumulation of bubbles in the blood supply to the central nervous system and to the spinal cord, hemiplegias, paraplegias, cord damange'that can not be repaired. Small bubbles may appear in the blood vessels and canals of bone and the sane general symptoms occur with severe bone pain because of the depravation of the blood supply. The above is called "Caisson Disease", general symptoms being brought on by rapid decompression, causing severe abdominal pain and pain in the joints and the bones, severe feeling of pressure in the chest, inability to take deep breath with dyspnea, central nervous system manifestations many times with convulsions, aorophagia, paralysis, dizziness, and vertigo. Occupations Involved: .'.liners, tunnel workers, divers, those working in building subway tunnels, and those working to put down structures beneath the surface of the ocean in the Gulf area. 002303 183968 2. Altitudes; Rarefied Air (decreased atmospheric pressure): In contrast to working under compressed air, ris.' .ig to an altitude of ten thousand feet as in aviation is accouponi d by a reduction of barometric pressure from 7G0 millimeters at s ja level to 520 millineters, and at eighteen thousand feet the t orraal pressure is approximately one-half of 7G0 millimeters. One of the main diffi culties in altitude is oxygen depravation. As wo ascend the oxygen becomes less and less and our physiological chfnges accompanied with anoxia arc present. This brings on conditions called altitude sick ness, which arc really symptoms of oxygen want. If ascent into tho air is rapid enough, we may also once again have the "bonds"; mechanism is the same as for decompression, the only factor hero is that one is decompressing from a normal atmosphere to a rarefied atmosphere; however, the pressure gradients are the sane. V.:hen this is done as in jet flying, the term is called "aeroembolism". If the ' Eustachian tube docs not open and allow for equalization of pressure, the eardrum is one of the first organs to be Involved and ruptures very readily. Occupations Involved: Airplane pilots, test pilots, aviation personnel, and accidents involving the loss of pressure in pressurized cabins. Symptoms and Conditions of the Disease: Acute altitude sickness (acute anoxia), sleepiness, headache, fatigue, psychological, impair ments, unconsciousness, fugue, euphoria may bo the first early sign of lack of oxygen because of the dulling effect on the central nervous system which acts somewhat as narcosis or hypnosis. Repeated altitude exposures (chronic altitude sickness), seen many times during the war; combat fatigue, conitfat pilot fatiguu, those who have been exposed to rarefied oxygen atmospheres for repeated exposures and over a variable period of time results in body and mental fatigue. Oxygen want by the functioning cells of the brain is cause for easy mental fatigue and for marked deterioration in efficiency. This is particularly important in pilots and is watched for and considered a very important reason for frequent furloughs and checks. Sudden decompression, aeroembolism - sane as the "bonds" in Caisson Disease. 002304 183969 ES OF TEMPERATURE AND HUUIDITY :haustion - prognosis is good. TyptcST"picture1 UX-hcux m . n j g..>.hn.^i>rii^^^:!rSftrfzed^grsdn ^WfnF^rn;~<,t?f&~tropTcs< ]' n porffff"-j?-n*,,rcMTMt-r-.i>nriT .1 ^tl r>-ni>i 11 tT-ttrw^flMUfld, jjxery-quietrr-Qod.'Swoats-^.ory-JJ-ttic. The true- picture of thaustion in its clinical state is brought on by the body's ity to meet the denands of the heat regulation process. :ral vessels dilate in order to take blood to the sweat glands -n <-- to bring blood to the body surface ii* urdw to cool it. ais process is in an extreme, the patient suffers collapse much way of shock. He may immediately begin to sweat upon fainting inically, the person who has passed out on the street, and yet pulse is normal or only slightly altered and^who is sweating and temperature is not elevated to touch, has a good prognosis and y rallies very quickly. In the tropics this is a process that some time and newcomers to tropical areas are forever complaining igue for the first few months until hormonal activities, adrenal ty,changes in blood volume, nnd vaso-raotor control takes place. Iso happens in areas in the Southwest and in Texas, where the s may end abruptly and summer be upon the population very y. troke - it is an extremely grave situation. Here the body has in its processes of heat elimination and the patient has cd the effects of elevation of body temperature; hero, also, the t's temperature many times exceeds 104-105 to 100 degrees. The ill be dry, he has no ability to sweat, his regulation center in ain has broken down, there has been hormonal changes particularly .drenal cortex, and there be destruction of nerve cells not only i the cortex itself, but within the brain substance and in the il nervous system. Heat stroke may be brought on through prolonged ire to heat, where a person becomes dehydrated or where 3alt mco occurs, and at last the body is no longer able to regulate -at. sF Consider heat stroke a medical emergency and all efforts 1 be nado to lower body temperature. The use of ice and cold and immersing the patient in these as soon as possible - they ai be removed from the street and crowds should be kept back; if curs in a building, there is usually water available to help lower ody temperature. If after the cooling has been carried out and the nt is still unconscious, this indicates severe brain damages and regnosis is poor. Upon recovery - recovery is sporatic with ant excursions of temperature and these are difficult patients to Cramps - low salt syndrome when placed on exertion. Pain in the tal muscles, cramps. Best treated with salt and plenty of fluids, correction - body will cake its own adjustment. 002305 4 183970 2. Sadden Variations of Temperature: Some work has been done in the past to illustrate the effects of sudden changes in temperature. It has been kn^wn for some time that sudden changes in .temperature may bring on respiratory infections and sore throats. Much of the experimental work has been contradictory; however, some work has been of merit and one is the effect of sudden changes in- temperature from normal or hot to extreme cold, such as opening the door and going outside in the winter time. Here, experimentally, we can demonstate a blanching of the mucous membranes oi' the upper respiratory tract. The raucous membranes in those cases becomes deprived of blood supply and this may bo a factor in aiding the introduction oi virus and bacteria responsible for upper respiratory infections. There is no clinical explanation, but sudden variations in temperature do cause aa exacer bation of.disease in those who have rheumatoid and ostoo-arthritis. Asthma and chronic pulmonary disease is made worse with variations in temperature. Patients with peripheral neuralgia or the neuralgias from previous surgery or trauma many times will show exacerbations of symptoms with the variations oi temperature. Important to physicians in industry when choosing employees to be butchers, brewers, bakers, icc workers, chauffeurs, truck drivers, workers in dry cleaning plants, workers in hot houses, firemen, policemen, packing house employees, refrigeration plant workers, roofers, stokers, refinery workers, and all Jcbs where the patient goes from a warm atmosphere into a suddenly cold atmosphere. 002306 183971 5 C. DAMPNESS W'Ur`5l 11 ^ There is the saue general hazard in dampness that occurs in suddch variations ox temperature. Humidity - high humidity - predisposes to symptoms in patients with. respiratory disease, '"`neuralgia>'and rheumatism. These people also have difficulty in making the necessary automatic and rapid body adjustments to sudden changes and they do not do well in the jobs that require such adjustment. D. DEFECTIVE ILLUMINATION Of all of the hazards that wo see in industry the defective illumination is one of the greatest hazards. As physicians we spend very little time thinking that lighting is a direct etiological cause for many of our difficulties if not diseases. A full forty per cent, of accidents are caused by faulty lighting, v.'orkers who cannot see well are accident prone and they, themselves, are in hazard of their own life and limb. Efficiency is markedly reduced in defective illumination. Most large companies have the company from whom they purchase their electrical fixtures come in with illuminating engineers and do a survey of the area and advise them as to what is necdod. Many- times color is also a factor in illumination, diffusion and distribution of light arc extremely important in occupations that are dangerous, such occupations as buffers, steel and iron burnishers, clerks, compositors, embroidery workers, Jewelers, minors, photographers, steel engravers, train dispatchers, tunnel workers, watch' makers. E. DUST Definition: Dust may bo defined as solid particles of a matter, which are ordinarily produced by physical means, such as grinding, crushing, Grilling or blasting, the composition of the particles being the -ji.-ic that of the parent material - - these natcrials may be rocks, ores, coal, gram, wood. The size varies from ultramicroscopic and a fraction of a micron up to 10 microns (red cells around G to 8 microns). Fumes are defined as solid particles which are formed by processes similar to combustion, condensation, and sublimation. Most cocmon types of fumes encountered in industry are usually caused by the oxidation of a metal, of which typical examples arc the oxides of lead or the oxides of zinc and particle size -ace smaller than dust and usually range below l micron. In contrast to dust, fumes tend to flocculate very easily. Fumes ere not vapors; vapors arc given off from liquid material, such *.a -.eid solutions, solvents and the like. Dusts are divided into two- types - the organic and the ; .-.or- ar.ic. Tve inorganic is divided again into those that contain free silica -.ne containing no free silica, and then a special group by - special dust is the consideration uf asbestos. 1. Tho organic dusts arc many tines referred to as tr.c 6 :.*.rt ' 002307 183971 Organic dusts arc chemically inert. If a portion of any one of the organic dusts reaches the pulmonary tissues, no chemical reactionoccurs. A word regarding the amount of dust that reachesthe lungs. Only a negligible amount of dust ever reaches the lungsin a human being. This is a fact not realized by laymen and frequently forgotten by physicians. Nature has erected an efficient barrier to enable man to go through life without incurring harm, although he may be constantly living in a dusty atmosphere - hair in the nose, the anatomy of the nose, the many folds of mucous membrane, trachea and bronchi have ciliated epithelium, phagocytic cells of the lung itself. Particle size has a lot to do with the inhalation of dust. As a rulo of thumb, if the atmosphere looks dusty, not much dust is getting into the lungs because the particle sizes are too large - they arc not likely to be dangerous. Organic dusts, howuver, do cause difficulty because they are capable of promoting terrific allergic responses, particularly the pollens and the fungi. Along with the fact that they arc chemically inert, they may, however, excite a tremendous amount of fibrosis and of a fibrous reaction within the lung tissues themselves. Slderosis - inhalation of iron-containing-dust; causes pigmentation of the lung - benign condition. It is seen in welders, iron workers; does not predispose to tuberculosis, will not cause tuberculosis to flare up. . Bysslnosls - due to inhalation of cotton dust; causes asthma and pulmonary fibrosis, dyspnea (asthmatic type), tenacious thick sputum, emphysema typo changes*in the cliest. Bronchitis and catarrh of the upper respiratory passages are very common. WHAT IS MONDAY FEYEft? Holds and Fungi - mildew and mold can cause severe coughing and allergic responses; dirty cotton bales, dirty stored material may contain peni cillin glaucun or Aspergillus glaucum. b'ood - wood dust nay cause severe irritation to upper respiratory passages; also wood nay cause severe skin irritation, such as brazilwood , satinwood, tcakwood, soma cahoganics, cocobolo, and California redwood. Coal - coal dust can cause a benign fibrosis. Calcium Magnesium Carbonate - as seen in limestone, marble, chalk and calcine magnesium for insulation, furnace linings and the like. Those men can be exposed for years without any serious difficulty. Carbon. - carbon oust seen in minors, from both hard and soft coal; no particular defects. Tobacco - tobacco dust (tabacosis) - much debate as to whether this causes actual fibrosis or not. Crain - mill dust around grain mills - greatest hazard is in allergy, not lung pathology. > A^ 002308 183973 Snuts'- ainute thread-like parasitic plants of mycelium. They enter the 'growing seedling and arc thrown up with the dust during the crushing of grain; they contain spores and can cause contact dornatitis, skin allergy, atopic dermatitis, rhinitis, and asthma. Grain or l!alt Fever - probably due to foreign protein ingestion by inhalation. * Bagassosis - this is due to the dust from sugar cane; causes a pulmonary fibrosis. \;ool Glass -Fiber Glass - this is due to trauma with the glass spicules that stick in the skin. 2. Inorganic Dust; Inorganic industrial dusts are mostly metallic and mineral. These v;e divide into the group that contain free or uncombined silica and can produce a specific pncumonoconiosis known as silicosis, and those that contain the conbincd form of silica which do not cause silicosis. Inorganic Dust Containing Free Silica - silica is very plentiful on the earth's surface, has been reported to occur second only to oxygen in abundance. It is present in almost all types of rocko and granites, but never occurs as a free clement;(it must be conbincd with oxygen and with oxygen or a octal.") Quartz is a crystalline form of silican dioxide and it is silican dioxide*(Si02) that wo call silica. This is the fora of silica that causes silicosis. Silica is thought to be pathologically responsible for damage to the lungs when taken in in the fora of Si02 The dusts are picked up in the outer regions of the alveoli, they arc' phagocytlzd and taken into the lynph channels. As they travel the lymph vessels toward the hiluu of the lung, they move slowly on to the minute lynph islands which guard the entrance to the small lymphatic vessels; they pass through these and arc finally picked up by the lymph glands at the hilus of the lung. It is believed that at this point the dust cells acted upon by the alkaline body fluids form a colliodal silica hydroxide, which is a strong protoplasmic poison and its action causes death to the dust cell and a necrosis to the immediate surrounding tissue. Scar fibrosis tissue forms which acts as a blockage to the lynph channels and causes a further obstruction to the removal of future Inhaled particles. Fibrous tissue then forms along the lymph vessels and these lynph vessels accompany the blood vessels to the lungs. . As the obstructive blocking off by fibrous tissue of both lynph and small blood vessels occur, the lung itself becomes involved in a diffuse fibrosis. The blocking of the lynph flow toward the hilus in creases the spread of the dust cells toward the pleura; as blockage continues to increase, there are formed massive areas of fibrosis. This area of fibrosis tends to destroy the alveoli and the remaining alveoli distend like one secs in emphysema. The elasticity of the lung Is lost by progressive fibrosis and the aeration of the lungs is decreased. Compensation on the patient's part comes in now and when 00<w303 compensation stops, the first sign of silicosis, which is dyspnea, be gins. How, silico-tuberculosis, which is the most common cause of death in silicosis, nay be duo to activation of the walled off tuberculous 01 H, ossac or it may be duo to the fact that the lung itself has oocone o diseased and necrotic that local resistance is broken down. Of the occupations that arc exposed to silica and gone of the materials: Abrasives makers,and workers Olasters in unaercround siliceous racks Bricknakcrs Grinders usin': sandstone wheels Foundry chippcrs Concentrating mills Ore crusher mun Cutlery grinders using sandstone wheels Inamclors (free silica frits are present) Flint workers Foundry workers Glass makers Holders Sanders using sanding machine that have quartz paper for sand paper Slate grinders (slates for schools) Sand workers and Sandblasters Statuary workers (makers of tombstones and work in Granite or sandstone Inorganic Dust Containing Mo Free Silica - exposure to inorganic dust containing no free silica has been found in some instances to be associated with simple linear fibrosis of a benign nature with no disability resulting. The exact relationship of various dusts to this type of fibrotic reaction is not known by any of us. Occupations that it is seen in: Abrasives makers Abrasives workers Stone workers in marble Bricklayers Bricknakcrs Bronzers File makers Rubber workers Portland cement workers Foundry workers Chimney sweepers Chippcrs ' Coal passers Coal workers Core :xikers in a foundry Cotton mill operators Crushornon (crush stone and gravel) Construction workers Cut-glass workers Cutlery makers Drillers in rock Limestone workers and dusty atnosphorcs in general \: V o 183975 Fertilizer rollers Those who work in class, graphite, marble, mica Pneumatic-tool operators Street cleaners __ Stone workers Talc workers grinding, gypsum, line, Asbestos: Asbestesis is a silicate or combination of 5 silicates (hydrated magnesium silicate). It is duo primarily to tho large asbestos fibers and duo to its physical irritating capacity to excite fibrosis. Snail particles - snaller than 2 nicrons in length do not produce asbestosis; fibers nust be large enough to plug the alveoli and tho lymph channels and, therefore, set up a local fibrosis. Connective tissuo colls grow around the asbestos fibers that arc caught in the bronchioles, collagen forns and contracts, and the air space is obliterated by scar tissue. Ironcontaining-cocting is also deposited along with the collagen fiber. This takes on an iron stain and gives the characteristic "asbestosis bodies". Pulnonary fibrosis of asbestosis is diffuse in character, located around the bronchi and more frequently in the base of the lungs. Silicosis on the other hand is nodular and present mostly . in the upper part of the lungs. These aro in the early stages be fore diffuse fibrosis occurs. Asbestosis is characterized by cough, dyspnea, pallor, pulnonary osteoarthropathy, and emphysema lung changes. It is seen most frequently in: Asbestos workers Brake liners Carders Crushers Insulation workers 002311 10 183976 FUTJES Metal Fume Fever - this name is ap ' icd to a condition that results from breathing fairly heavy concentrations of freshly formed metallic oxide fumes, principally those of zinc and one of its alloys brass, although the condition nay result from the inhalation of other metallic oxide fumes; very commonly seen in welders and soldcrers. It is not a systemic poison, but it should bo kept in mind that metallic fumes can cause definite symptoms such as lead, cadmium, mercury, and manganese. These are included in your Section on Poisons. Symptoms come on some hours after exposure, usually after leaving work patient complains of dryness of the throat followed by dry cough and heaviness in the chest; there is a rise in temperature accompanied by sweating, leukocytosis, elevation of pulse rate and blood pressure may go up. Symptoms pass off in 12 to 24 hours, and most welders ere more aware of this than doctors. If you draw it to their attention, take a careful history of their occupation, most of the metal workers will uake the diagnosis for you. Natural immunity is conferred by certain types of workers because of their constant exposure to netal fumes. Outlook is good for complete recovery. Physicians arc seen sometimes more than once because the patient feels well during the day and then has influcnza-llko symptoms during the evening after work. Meta! fume fever is seen in: Zinc workers Zinc smelters Brass founders Brasicrs Bronze-powder makers Bronzers Core makers Galvanizers Mctallizcrs Holders Pourors v/cldcrs Smelters 002312 183911 u INFECTIONS Infections, both localized and systemic, are frequently of occupational origin. Anthrax, undulant fever, fungus, septicinfcctions are all examples. 1. Anthrax: (V.'oolsortcrs1 Disease, malignant pustule, ragpickers1 disease) Anthrax exists in Texas along the Gulf Coast. It is seen industrially in people who handle animal products such as wool, hides, and in butchers' shops. RECALL THE STORY OF THE SHAVING BRUSH AND WHY THEY ARE STERILIZED. The anthrax causes a local lymphangitis, local cellulitis, severe toxic reaction as far as the body is concerned; if it spreads, leukocytosis may be present in a slight degree, temperature goes up slightly, the toxicity is profound with some malaise, shock-like symptoms, death may ensue with positive septicemia of anthrax bacilli. Anthrax is seen in: Butchers Dead animal handlers Hide processors and hide handlers Carpet cleaners Carpet makers Cattle salesmen Dairy workers Farmers Fat Tenderers Fertilizer makers Freight handlers Fur handlers Glue makers Hair workers Leather workers Longshoremen Mattress makers Plasterers Rag workers Salvage workers in Junk yards handling rags and soiled refuse Warehouse workers * Veterinarians * Upholsterers * Taxidermists ** Tannery workers * Stablemen Slaughterhouse workers ^ Shepherds V.'oel handlers 00233:3 12 183978 Fungus: V.'c will not spend much tine on fungus infections; it will bo covered in Sections on pulmonary disease am1 lectures in general medicine. Suffice it to say that many fungi in the diseases caused by the pathogenic fungi arc spread by inhalation. Skin diseases are also caused by fungi such as monilia, yeast, dermatophytes, sporotrichum, biastomycetes. Fungus disease of the lungs cay bo due to blastonycotos, actinomyces, conilia, coccidioidos icnitis, cryptccoccns, and aspcrgillus. The symptoms are largely those of tuberculosis, from which it is often most difficult to differentiate. Occupations in which fungus infections, whether it be cutaneous or pulmonary, are always a hazard are: Aninal handlers Brewery workers Cigar makers Dishwashers Excavation workers F armors Flour and grain-mill workers Grooms Hide workers Mi liters Millers Paper makers Straw cutters 002314 183979 3. Septic Septic infections - syaptoms are thosefboils, carbuncles, furuncles, -cllulitis, localized lymphangitis, and erysipelas. These are seen in areas v;horu staph.x strep, and related organisms are seen, usually the hygiene is poor or the product handled is infected, it is seen in: Animal handlers Butchers Caimors ^Feather workers /^Fertilizer makers ^Fisherman Garbagoraen Glue and hair workers ^"Handlers in dead and decomposing animal products Packing-house workers ^AAlag workers 1 Slaughterhouse workers Scap makers A6 treet cleaners Taxidermists Veterinarians 4. Undulant Fever (Brucellosis) This should be taken up in general medicine. General symptoms are weakness, profuse sweating, chills, fever, headache. The effect of a generalized arthritis has not been emphasized too much in medicine, but is well known as a hazard to the veterinarian profession. Any veterinarian v/ith arthritis and arthralgias, undulant fever (brucellosis) should be entertained as a diagnosis. Seen in: Butchers Cattlemen Dairy workers Farmers Gardeners Manure handlers Heat inspectors riilk inspectors Packing-house workers Slaughterhouse workers Stablemen Stockmen Veterinarians Zoo workers 002315 Other infection hazards - wc see glanders in those who handle horses *A -- T 183980 and mules. Psittacosis - soon ia bacteriologists, parrot and parakeet handlers and brooders. Rabies seen in clog pound workers, nail carriers, veterinarians - and ringworm seen in barbers, bath house attendants, beauty parior operators, chanbcrnaids and masseurs. Rocky mountain spotted fever - seen in those oho are foresters, in the forestry ser vice, hunters, sheep herders, trappers, cattlemen who spend a good deal of tiue outside. V/o see it in surveyers, field party chiefs. Tetanus, generally widespread throughout Texas - everybody should be immunized and should keep their immunization up. Tularemia - we see it in bacteriologists, butchers, hunters, forestry workers, and farmers, '.'.'oil's disease - see this in dog pound workers, sower workers, fish market workers, any where rats are and people come in contact with rat urine. G. RilDXAKT EHEHGY Radiant energy is a hazard and should be divided into the various types of radiant energy. Of these, there is x-ray, radium, radioactive substances which Is radiothorium and ncsotboriun, ultraviolet and infrared rays also considerable hazard in radiant energy. The hazards of x-rays and radioactive material will be taken up in your courses on radiology. The general public is becoming more and nore aware of the dangers of radiant energy. Protection against the radioisotopes you will be familiar with and it should not necessitate separate handling at this tine, only to mention that it is a hazard that falls within the field of toxicology. Ultraviolet and infrared rays are an industrial hazard in a nunber of occupations whore there is exposure to excessive radiance. Welders and cutters especially arc exposed to ultraviolet rays; furnaccmen and other workers around molten metal and molten glass are exposed to infrared rays. Although wo cannot see ultraviolet and infrared rays, they are very active and powerful,and arc usually coexistent with excessive radiance. Ultraviolet rays causo intense irritation of the eyes and burns of the skin, similar to sunburn. Snow blindness, desert blindness/ and the "eye flashes" Zti&sithc welders are all the same condition. They arc duo to the action of ultraviolet ray3 on the eyes, very painful, and cause disability for several days; usually they do not lead to permanent damage. Infrared rays arc caused simply by heat, they may cause permanent cataract of the eye for those who watch the molten octal without eye shields. There is little evidence that welding has caused cataract. Glassblowers have cataracts, probably duo to tho prolonged exposure to infrared rays. Occupations where ultraviolet and infrared rays are a hazard would be: 15 0023X6 18398 Balters Blacksmiths Braziers Electric linemen Electricians Foundry workers Glass workers Furnace workers Iron and stool workers Food irradiators Photographers Soiderers Stokers '/elders REPEATED MOTION, PRESSURE, SHOCK, ETC. This is primarily a traumatic type of hazard. Here, the patient is exposed to repeated pressure or shocks and this repeated li^ht trauma causes tho decade to bone and muscle. Saan--" . J .. / Pncunatic-tool handlers Pneumatic hammer%operators Occupations of this type example is writer's cramp. Tenosynovitis, cursitis, arthritis, traumatic arthritis are the permanent damages. The '.cute and early damages arc hyperemia, oyanosis, burning sensations to the traumatized area, numbness and pain. Occupations that arc exposoa to this type of hazard are: Air-hannor operators Barbers Bicyclists Blacksmiths / Carpenters Cobblers Furniture polishers Grinders Hammermen Lathe turners Letter sorters Locksmiths Machinists Pile-drivers Pneumatic-tool operators Painters Prossers 16 Quarryuen Riveters Scissors sherpor.ors Stone cuttora Telecraphcra V/atchoakcrs './cavers 002317 183982 J. POISONS There are hundreds, and perhaps thousands, of toxic poisons that we deal with everyday. It would be impossible to list the total number. One has to rely upon their*knowledge of chenistry and the recall of various compounds and the group to which they belong. It would be iupocsible to list here all of the compounds that wc know are hazardous and toxic to workers, Vc will list the more common ones and the ones that are seen most frequently by the physician and those whose signs and symptoms are more dramatic and that necessitate nodical treatment, llany of then are self-limiting, but the ones that are listed are severe enough that you should be familiar with the physiology, pharmacology, and symptomatology, along with their clinical significance. Acetaldehyde - it is well to remember that the aldehydes' in general hi their toxicity due to their ability to combine with protein causing a precipitation of the protein, an s the cyanides, they interfere with the enzyme systen of the bo most aldehydes are very strong reducing substances. :.Tany of them, also, are capable of skin sensiti zation, The more toxic of the aldehyde compounds is Acrolein, Acetaldehyde Chloral, Formaldehyde'.-"tCnd Furfural^Acrolein is formed whenevor fatty substances are heated to dryness or decomposed while one is burning off fats. Here, the main symptoms arc irritation of the akin and mucous membranes of the eyes and respiratory tract with dyspnea and bronchitis. Commonly seen in bone Tenderers, fertilizer makers, fat Tenderers, candl*3 makers, bookbinders, acrolein workers, galvanizcrs, garage.workers, gape line engine workers, glue makers, lard makers, linoleum makers, linseed- oil boilers, those who work in paint and varnish factories, StlDWIH*- Amnonia - it is a colorless gas that can be compressed to liquid form. The liquid form of ammonia is used in refrigeration, extremely soluble in water, VERY STRONG ALKALI, irritating to eyes, upper respiratory passages and skin. Strong solutions exposed to the body cause caustic burns, RED CAUSTIC; inhaled vapors In high concentration cause pulmonary edema and death; when it is hard to breath, it is tine to get out. Treatment of ammonia poisoning - artificial respiration, positive pressure breathing of high oxygen concentration, '-.'here fuacs have caused eye irritation or exposure of the eyes to ammonia calls for flooding the part with water. Treat as early as possible - do not wait. Areas where ammonia Is liable to escape or be a hazard should be supplied with an emergency shower and a source of water in order to wash it off. Best prevention is to encourage workers to report when th^-y smell ammonia. Protective equipment to be worn - rubber gloves, goggles and respirators, particularly In times of emergencies when the conccntration is high. Never allow anyone to enter an at.xionla atnosphere without' 002318 183983 rin nir.i i nod -ir "ir-supullcd..r/JspiratQ^ Those exposed to ammonia are artificial ice uauers, cement mixers, dye makers, explosive makers, fertilizer makers, ice-cream makers, those who work in mills and dairy products, sewer workers, refrigeration plant workers, refineries and sugar refinerics. Aniline and Anino Compounds of Benzol and Its Monologues - ANILINE IS RAPIDLY ABSORBED ThROUC-H THE SKIN AND COMBINES V.'ITII THE BLOOD TO FORM METHE1IOOLOBIN - ACUTE ANOXIA RESULTS WITH CNS DEPRESSION. The story of tho interne with the dyed shoes. TlK>^asa-oi-thrfA-tKki3 y s t pscope. S Antimony and Arsenic - it is difficult to be certain in assigning antimony a toxic place in toxicology. Antimony as wo see it in industry is almost alwafs associated with arsenic; therefore, the compound cf arsenic we will give more attention to. Arsenic poisoning in its chronic state can be produced chiefly from breathing over a long period of time air containing dusts or sprays of arsenic compounds. These compounds of arsenic, such as lead arsenate, Paris green, arsenic oxide, and arsenic sulphide are among the mast dangerous forms. Arsenic poison symptoms arc eruption and bronzing of the skin with the loss of nails and hair, increased keratosis, increased formation of epitheliomas, Inflamma tion of eyes, nose, mouth, and respiratory tract, perforation of nasal septum, headaches, gastro-intestlnal disturbances with nausea, vomiting, and severe diarrhea and abdominal pains, a peripheral polyneuritis - very common enong arsenic workers - muscular weakness and paralysis arc present many tines. Occupations in which arsenic poisoning is a hazard are arsenic rcastcr3 and workers, artificial-flower makers, aviators who do crop dusting, bronze workers, canners, carpet makers, copper workers, olcctroplators, disinfectors, exterminators, farmers, feather workers, gold workers, lacquer makers, lead smelters, lcad-arsenate makers, gardeners! printers, pottery makers, refiners, people who work in sheep-dip, people who work in tanneries, taxidermists, tinners, zinc workers. 002319 10 183984 Bcr.zino - BENZINE IS FINE - Benzine end Benzol (Benzene) ere very readily confused. Benzine is naphtha-gasoline. It is a straight aliphatic com pound. The chief danger is from nild intoxication through heavy inhalation or fay the swallowing of the compour '^aphtha Jag" is a condition which resenbles nild aicohoiic intoxication, where they got visual disturbances, twitching of mscics and the patient is drunk. Symptoms of naphtha gaso line poisoning ore headache and vertigo, nausea and vomiting, abdominal pains, some irregular respirations, pneumonia, drowsiness, irritation of the skin. Any gasoline compound is dangerous when taken internally for purposes of suicide or by children who take it by mistake, but in general with care and nernai common sense benzine (naphtha gasoline) is not an industrial hazard except for its inflanmability. Benzol (Benzene) - benzene is an extremely dangerous material and is many times confused with the "benzine". Benzol is fully capable of causing not only acute but chronic poisoning. Poisoning occurs from absorbing benzol* by inhaling the vapor. As benzol evaporates easily and at lor/ temperature, it gets into tho air very readily. Chronic poisoning results from long, continued exposures tosaall amounts of benzol vapor. This causes injury to the blood-forming structures. Acute poisoning follows inhalation of large amounts of the vapor. In this form, unconsciousness may come on quickly and suddenly, anjl is frequently FATAL. _ Benzene or benzol is derived from ccal-tar and 1C nr* " pn. Any worker who has frequent headaches, dizziness, loss of appetite, increasing pallor and weakness should bo suspected if he is in any .of the occupations In which exposure is a hazard. The.following is a partial list: Aniline workers, artificial leather workers, any of the plastics or artificial materials that are cn the market, automobile painters, painters ic general, beauty parlor operators, coke-oven workers, color makers, paint makers, dry cleaners, dye makers, clectroplaters, ananelcrs, explosives workers, those who work with feathers or hair, gasoline blenders, lacquer makers and workers, paint removers. CAUTION FOR THOSE WHO USE PAINT REHOVERd, " 1-- polishers and polish makers, printers and rotogravure workers, shoo dyers and shoo finishers, tank cleaners, varnish removers. Brass - brass workers, duo to zinc intoxication. BRASS SHELTERS OR BRASS FOUNDERS' SHAKES. 00232Q 183985 19 Beryllium - Berylliosis - beryllium ov/es its toxic hazard to the fact that beryllium dust, of either the salts or alloys of beryllium, are capable of exciting tremendous granulouatous response in body tissues. This is particularly pronounced in the lungs and in the skin where minute quantities of cither inhaled or introduced beryllium dust sets up this granulomatous __ reaction. Acute beryllium poisoning causes a severe irritation and diffuse pneumonia acconpanied with pulmonary edema and cellular extravasation into the alveolar spaces. Chronic beryllium poisoning which is due to introductionof smaller amounts causes a picture not unlike that of tuberculosis, with nodular granulomatous lesions throughout the chest with the general symptoms of malaiso. fatigue, lowered resistence to pulmonary infections, frequent excursions of temperature arid progressive disability. Cortisone has been used, and is being used Liu, Llm ^rnmti!ai1i4^auwipaj^>hi<>oi>cThnbazarri. i ^ lw'L r Cadniun - cadmium poisoning is encountered in ore smelting and in welders who weld cadmium alloys. Cadmium plates or welding that takes place around 1500 deg. F. gives rise to acute inflammation of the lungs with pulmonary edema. The spraying of pigments containing cadmium the so-called blue powder compounds - some utensils like cooking utensils have been made of cadmium or of cadmium compounds in recent years. The pulmonary symptoms arc tluc to a severe irritation and pneumonitis with edema and congestion of the lungs and sometimes hemorrhage. GI symptoms can follow after oral ingestion and consists of diarrhea, hiccups, and abdominal pain. CADLIIUIJ IS THE L'OST DANGEROUS JJETAL THAT WE HAVE WITH REGARD TO LETHAL PROPERTIES - DEATH GIN FOLLOW AN ACUTE TOXIC EXPOSURE. Cadmium is used in the manufacture of automobile parts end in those parts where excessive wear is to bo encountered and where protection against rust and a high polish is essential", .'lost industrial poisoning is from inhalation and not from the oral route. Autopsy shows cloudy swelling of liver, kidney, and spleen. The following prescription is of value in general treatment of any exposure which has caused irritation of the mucous membranes of the upper respiratory tract: Oil of eucalyptus 20cc Oil of dwarf pine needles 30cc Compiler 15` gras Uenthol 15 grms Sig: One teaspoon in a pint of water steamed and inhaiod. Always suspect cadmium poisoning in those who arc working around molten metals, whose metal fume fever has not subsided nor docs not run the usual course. Welders and smelters are particularly prone to heavy exposures cf cadniun dust and vapors. c-oo/| 002o*X 183986 Carbon Disulphide - this is an extremely dangerous gas and the harmful effects aro not publicized enough in this country. .It is an essential ingredient in the manufacture ox rayon. Rayon is nanufac/tured by the viscose process. Here, cellulose is converted into a i^lly nass by the addition of soiiun hydrowide and carbon disulphide. During this process, hydrogen sulpuidc is eliminated; this, too, is a hazard. Carbon disulphide--" is a severe neural poison, this due to its strong properties as a fat solvent. Acute intoxication can follow a short but heavy exposure to vapors of carbon disulphide. All the symptoms of alcoholic intoxication are present. Chronic intoxication has been reported in rayon workers, where there are various symptoms and signs referable to damage to the central nervous system and to the peripheral nervous system. Carbonr disulphide is also capable of causing disturbances in vision with a central scotoma, optic neuritis is part of the toxic effects. Parkinsonism, shakes, disturbances in hearing, loss of corneal reflexes, loss of the pupillary reflex, symptoms similar to syphilis and tabes, diffuse and multiple varied CNS signs and are all part of chronic CS2 intoxication. 'watch for carbon disulphide in any of the operations whore a solvent is being used. The field of solvents and plastics is expanding so rapidly that it would be impossible to list all of the occupations where this nay be a hazard. At the present time it has beon particularly hazardous in degreasers, rubber driers, ary cleaners, enamel and explosives makers, insecticide makers, paint manufacturing, putty makers, rayon makers, rubber reclaimers, rubber workers, sulphur workers and extractors, varnish makers, and vulcanizers. Carbon Dioxide - Carbon Monoxide - these effects arc well known by all. wo mention need be made. x 0 Carbon Tetrachloride - one of the most common ar.d deadly.'solvents used. Symptoms are irritation in noso, eyes, throat with k-ad^cho, visual disturbances, dizziness, nausea, vomiting, diarrhea/^lass of appetite, mental dullness, confusion, central nervous system^ai.as, s-vore i-.;ury to the liver with jaundice accompanied by nephritis, kiurey aarna--. cloudy swelling of the kidney, severe dernatitos 01 t.w a arms. a -o death. Carbon tetrachloride is non-inflammalAe and has -ue -. a solvent. The odor is misleading - smells rrinoxious a-d -3 pleasant to those who u3e it. THE CASE OwCNfi PY?-2i:C PI.is _tT* . . : - i.a. * Occupational exposure - airplane hanger employees, :-y c:.-pai: i 002322 degreasing or cleaning motors, washing employees hands. I'.ior.t.rt .. rubber workers, cobblers, rubber ccucnt nixers, dye -auers, try : rif 183987 W** fire extinguisher makers, THE-CAiL'^P1 ll'!Bs*-&iiA-IRLliiNi; ink makers, insecticide makers, lacquer workers, paint, lacquer, and varnish removers, paraffin workers, perfume makers, shoe factory workers, waterproof fabric makers, and plastic nakers. Chlorinated Hydrocarbons (Also Halogenatcd Hydrocarbons? - this large group of hydrocarbons has in general the property of CHS toxicology. They are all well known and efficient solvents and most of the signs of acute and chronic- poisoning produce SNS findings, such as headache, vertigo, confusion, nausea, vomiting, convulsions,/visual disturbances, coma, and death. Of the halogenatcd group, the most common that r/e soe in broad use are methyl bronido, methyl chloride, dichlorodifluoronothane (freon 12), dichloroethano, ethylene chlorohydrin (additive to resins, wax,- lacquer, paints, and varnishes - widely used). Of the chlorinated hydrocarbons, these include carbon tetrachloride, chlorinated diphenyl, chlorinated naphthalenes, chloroprene, dichlorcthylene, cthylchlorido, ethylene dichlcrido, methyl chloride, methylene chloride, tctrachlorethano, tetrachlorethyicne, trichlorcthyiene, and vinyl chloride. Chlorinated hydrocarbons arc also used as additive to greases - they have certain ^ properties that cause grease to cling to tho lubricated surface.\ 1 cuM A tihf'P/iti*4} J\f^f j * ChroniUQ - this is an extremely dangerous compound - occurs In two forms, hoxavalent, which is soluble, and trivalent, which is relatively insoluble. Upon inhalation, perforation of the nasal septuns and severe bronchial irritation---------CHEOHE HOLES III THE BAUDS AND FINGERS. The incidence of bro&chogeoic carcinoma is 30 times greater in those who work in and around chromiun than those who do net. Chromium compounds arc enployed in battery nakers, bleachers, chrome workers, refining, explosives workers, furniture polishers, paint makers, pigment mixers, wall paper printers. V 002323 22 183988 CU'*' I 4*3 vu~. Cyanide - all cyanide compounds owe their toxicity to their ability :to disrupt the enzyme system and cause death by asphyxiation. Cyanide is used in art-printinc workers, blaclssniths, blast-furnace workers, bronzers, case hardeners*, disinfectant makers, exterminators, fertilizer makers, funi^ators, photocraphic workers,' oetal polishers, silver refiners, soldcrcrs, tannery workers, textile printers. Fluorine and Its Compounds - 1.0 is tho tolerable limit. Dental Fluorosis Lead - Lead poisoning will be covered in other courses. Synptons to be looked for are ashen pallor, jaundice, metallic taste, s3strointC3tinaJ> disturbances, constipation, abdominal cramp, occasional lead line on the (juns, severe asthenia, lassitude, and irritability; headache, backache, pain in the joints, weakness of one's ffrip, tremors of finders and tongue, lead paralysis of the aran-duchone typo (the hand-kissing position), lead encephalopathy, stippling of the red-blood cells, increased amount of load in urine and feces, complicates metal fume fever. New druc - Vcrsine - very effective in the management and treatment of lead poisoning. Dr. reason will speak more on lead. Occupations that offer exposure to lead are class finishers, crop dusters, . art-class workers, artificial-flower makers**, babbitt workers, battery workers-, tannery workers, bookbinders, bottle-cap makers, brass polishers, brass workers, brass founders, browners of cun barrels, buffers, cable workers and splicers, soldcrcrs, rubber workers, compound workers, white shoe manufacturers, clcctroplaters, cnamelers, er.cravers, farmers, fillinc- 002324 23 183989 station operators, garage workers, gasoline blenders, tetraethyl lead v/oriicrs, grinders, insecticide makers and workers,' lacquer workers, lead workers in lead foil, load nines, lead pipes, lead salts, lincoleun-makers, iiuotypers, paint makers, paint removers, painters, plumbers, polishers, retflead and white lead, sandpapers who sand off octal finishes like workers in autouobilo and body shops, type founders, and type manufacturers, welders, zinc workers, children with toys painted in load, particularly the crib and the new toys and olei toys that have been refinished. Manganese - manganese is almost indispc-n3ible to the manufacturing of steel - requires about 14 lbs. of nanganosc to renove tbe sulphur and oxygen in a ton of steel. Manganese gives strength and hardness to steel products; manganese is used in the manufacture of batteries, glass, pottery glazes, dyes, matches, fireworks, disinfectants, deodorants and germicides, also is a bleoch in textiles. The method of poisoning is by inhalation. Patients become intoxicated through the absorption of uanganese dust cr fumes; manganese has toxic properties that attack the nervous system - most common is the disturbance of gait with stiffness of the legs, frequent falls, easy fatigability and sleepiness. Autopsy shows degeneration of the nerve cells, satcllitosis and gliosis of the basal ganglia, widespread atrophy of the various portion of the brain. Patients characteristically have a slapping gait and a phenomenon of rotrapulsion and propulsion, nask-liko faces, monotonous voice with an economical speech; they have muscular twitching varying frou fine tremor to gross rythmical movements of the extremities; they have cramps in the calves of their legs with some stiffness and a slight increase in their tendon reflexes. Characteristically they have uncontrollable laughter and occasional crying; they have an inability to walk up an incline, they drag their feet while they are walking on straight eround, they sometimes will havo the same behavior as a Parkinson when given a forward or backward impetus and will not stop until they fall or hit an object. Occupations in which manganese is encountered arc the following: Alloy makers, aluminum extractors, battery makers, brick makers, chlorine nakers, smelters of any kind, enamelers, manganese workers either as grinders, separators or smelters, match factory workers, open-hearth-department workers, painters, puddlors in iron and steel, soap Linkers, textile printers, varuish Linkers, welders, and zinc'workers. 0G2325 183990 24 Mercury aud Its Compounds - will not discuss bichloride of mercury or scute mercury poisoning with suicidal attempt. Mercury is seen as an industrial poisoniag due to the chronic intoxication resulting fron the inhalation of mercury vapors. TUB errs OTiz.7%.,., / THE MAD HATTER IE ALICE*"lK V/OKDERLAMD. Symptoms of chronic mercury poisoning are stomatitis and gingivitis, salivation, blue line on guns, gastrointestinal tract disorders, metallic or fetid breath, a fine intention tremor, exaggerated knee jerks, scanning speech, loss of memory, insomnia and depression, anxiety and irritability, y cerebral signs. Mercury poisoning is encountered in the following occupations: acetone makers, alcohol makers, amalgam makers, baronetcr makers, battery makers, dry-cell battery makers, norcury liandlcrs such as laboratory workers, in core extraction laboratories in the petroleum industry and geological laboratories whore mercury is used as the metallic seal for severe pressures and extreme vacuum pressures; it is u3cd in the felt industry, antlccptlc manufacturing industry, manufacturing of scientific instruments, in explosives manufacturing - all percussion caps contain mercury fulminate; the making of cyanide compounds in the radio-tube, thermometer industries; printers, taxidermists, tannery workers, welders, painters. Methyl Alcohol - this Is dangerous both by inhalation and by oral Intake. Methyl Alcohol is a widely used solvent and extractor, but does harbor a certain danger. Patients and soldiers should be definitely warned and protected against the ingestion of wood aloohol. It causes burning and irritation of the eyes, respiratory tract ana skin, is a direct toxin to the central nervous system, causes headache, nausea, vomiting, vertigo, severe colic, convulsions, chilliness and cold sweats. Pathology - the methyl alcohol is converted to formaldehyde and formic acid which, in turn, exerts a toxic effect on the brain; has a specific effect on the optic nerve and causes optic neuritis, optic atrophy, and blindness. It is seen in the following occupations: Alcohol workers, antifreeze uakers, artificial - flower makers, automobile painters, bronzers, rubber shoe ccnentors, ciyors, dry cleaners, dye nal;er3, explosives workers, fur workers, lacquer workers, japanners, Japan makers, paint makers paint reiaove-rs, plastic workers, patent leather workers, rayon workers, shellac workers, shellac makers, varnish makers in wood alcoholuistillories. 002326 183991 Phosgene - phosgene poisoning causes an irritation of eyes with a violent lung inflannation with pulnonary edena, ueorosis of lung tissue, enphysena, bronchitis, bronchiectasis. Phosgene is given off when chlorinated hydrocarbons coac in contact with hot actals or an open flame. BlcacRhrs, carbon tetrachloride workers, ciye makers, city firenon**, welders**. Xylol - TOLUOL - XYLENE - stellar to but less ^oxiC/j than benzol. 1 C TI-Ac-?1-')/ J**n*i**%l& ^ C -foj* J1 *)b ^ 6r+k C yfa Co^r^ h YcufiL* /^ J. ' oJjM oJ' / & fit* frd t Tie# ^tSrys/u/J ' *. %+rXuS,* 'pH `3. ~ 3L ^ ^ C4*-* A V- **^1,7^ , syfl ' 183992