Poisoning Management.(What is poisoning and How to manage poisoning cases..?)
INDUSTRIAL ANILIN POISONING.
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115 THE AUDIBILITY OF GUN-FIRING.-INDUSTRIAL ANILIN POISONING. as low as 0’02 per cent. In the three large towns there were 1629 new cases of syphilis, 8168 new cases of gonorrhoea, and 1126 new cases of ulcus molle. While the total population of the three towns was only 665,638, the total population of the country districts was 4,156,717. Yet in the country districts there were only 121 new cases of syphilis, 666 new cases of gonorrhoea, and only 26 new cases of ulcus molle. It appears from these figures that the danger of infection from venereal disease is 75 times greater in the large towns than it is in the country districts, and that far more active measures are required to combat the disease in the crowded communities than elsewhere. That the relative preponderance of venereal disease in the large towns coincides broadly with the incidence of prostitution is the inevitable conclusion from these facts and figures, and if the problems of venereal disease are those of prostitution it is only by reforms in the conduct of prostitution that an appreciable reduction of venereal disease can be anticipated. This, the moral of Dr. Sederholm’s communication, is a point of view not shared by all the other members of the Board of Health to which Dr. Sederholm belongs. This body, apparently, is in favour of the abandonment of regulation of prostitution in any form, and relies mainly on educational methods and free treatment for every patient. THE AUDIBILITY OF GUN-FIRING. SEVERAL correspondents have written recently calling attention to the unusual audibility of the gun-nring in Flanders, so that a paper read at the last monthly meeting of the Royal Meteorological Society by Mr. Miller Christy and Mr. W. Marriott has a topical interest. The audibility of the gun- firing in Flanders over the south-east of England has been repeatedly noticed since an early period of the war, but Mr. Christy says that undoubtedly the intensity of the sound varies considerably with the quality of the guns and the meteorological conditions. Sometimes slow and deliberate firing is heard at the rate of 3 to 12 shots a minute, each shot being quite loud and distinct. This is probably the firing of the monitors and other warships bombarding the German positions on the Belgian coast. Usually, however, the firing has been much more rapid, much less distinct, and apparently more distant. This is, no doubt, the sound of the fighting further inland-say, around Ypres, Dixmude, or Arras; it varies in rapidity from perhaps 4 or 5 shots to the minute up to more than 100. This sound is, as a rule, very faint, though easily per- ceptible and quite unmistakable; it resembles more nearly a dull and distinct thud, which is rather felt than heard. From the records collected it appears that the gun-firing has been heard at one time or another over the counties of Essex, London, Kent, Surrey, and Sussex, the most distant place being about 150 miles from Ypres. Mr. Marriott, in dis- cussing the meteorological conditions under which the gun-firing was heard, said that the weather charts showed that generally there is a somewhat irregular, or not definitely defined, distribution of barometric pressure, but mostly with a region of high pressure wedged in between areas of slightly lower pressure. These conditions are such as to produce light winds at the surface, mostly between north and east, over the neighbourhood of the North Sea. Aspect and elevation are also im- portant factors for the hearing of the firing, so that there is nothing mysterious about the audibility altering so greatly as it obviously does. The weapon and its position, the weather and its modifications, all combine to make the audibility vary from day to day. ____ INDUSTRIAL ANILIN POISONING. THE paramount position of the anilin industry in Germany has naturally caused the experience of anilin poisoning to be mainly German. The pro- duction of anilin dyes in England consequent on the war is likely to familiarise us with anilin poisoning. The United States made no attempt to compete with Germany in the manufacture of anilin or anilin dyes until the supply was shut off by the war, but in the Journal of the American Medical Association Dr. R. V. Luce and Dr. Alice Hamilton now publish an important paper on Industrial Anilin Poisoning, based on experiences in the tyre factories of Akron, Ohio. Apart from the production of anilin colours, anilin is used in America in the compounding of rubber, especially for tyres, and in reclaiming rubber from scrap. When the war suddenly shut off the supply from Germany rubber manufacturers began to manu- facture anilin, so that now to the men exposed to anilism in rubber manufacture must be added those engaged in producing the anilin. Industrial anilin poisoning, which a few years ago was negligible, suddenly assumed importance. So far the making of dyes is too new in the United States to furnish cases ; those reported come from the rubber industry and from the use of a wash for printers’ ink which contains anilin. The victims are known as " blue boys," from the cyanosis which is so prominent a symptom. Since the discovery of the cause of the trouble the rubber manufacturers have taken measures of protection, either by installing exhaust ventilators or simply by warning the men to seek the open air as soon as flushing of the face and violent headache come on. Pure anilin has never been known to cause poisoning; but pure anilin is not used in industry. What is known under this name is a mixture of anilin (amidobenzene) with metatoluidin, paratoluidin, orthotoluidin, and xylidin in varying proportions. Unlike most volatile poisons, anilin gives no warning, for it does not irritate the eyes and throat. Yet according to the researches of Lehmann, anilin is toxic in even smaller doses than benzene, chloroform, or carbon disulphide. Most of the industrial cases follow spilling or splashing of anilin over clothes or skin, and doubtless both skin absorption and lung absorption play their part. Rambousek places anilin and all the nitro and amido derivatives of the aromatic series among the blood poisons the principal action of which is to cause the formation of methæmoglobin, in which the oxygen is firmly bound, thus producing a condition of "internal suffocation." In England Dr. W. Malden has examined the blood of men employed in the manufacture of anilin dyes and nitrobenzene. In about half he found , a high red count with a low colour index and many i imperfectly developed red corpuscles. The spectrum rof methaemoglobin could be detected only when it ! was present in the proportion of 1 part to 10 of oxyhæmoglobin. Loss of hæmoglobin ran from )5 to 50 per cent. Stained specimens showed great variations in the size of the red corpuscles. Baso- e philic granules were found. Dr. Malden believes . that this is often the earliest sign of anilin j poisoning, as it is of lead poisoning. The first
Transcript of INDUSTRIAL ANILIN POISONING.
115THE AUDIBILITY OF GUN-FIRING.-INDUSTRIAL ANILIN POISONING.
as low as 0’02 per cent. In the three large townsthere were 1629 new cases of syphilis, 8168new cases of gonorrhoea, and 1126 new cases
of ulcus molle. While the total population ofthe three towns was only 665,638, the total
population of the country districts was 4,156,717.Yet in the country districts there were only 121new cases of syphilis, 666 new cases of gonorrhoea,and only 26 new cases of ulcus molle. It appearsfrom these figures that the danger of infectionfrom venereal disease is 75 times greater in thelarge towns than it is in the country districts, andthat far more active measures are required tocombat the disease in the crowded communitiesthan elsewhere. That the relative preponderanceof venereal disease in the large towns coincidesbroadly with the incidence of prostitution is theinevitable conclusion from these facts and figures,and if the problems of venereal disease are thoseof prostitution it is only by reforms in the conductof prostitution that an appreciable reduction ofvenereal disease can be anticipated. This, themoral of Dr. Sederholm’s communication, is a pointof view not shared by all the other members ofthe Board of Health to which Dr. Sederholmbelongs. This body, apparently, is in favour ofthe abandonment of regulation of prostitution inany form, and relies mainly on educational methodsand free treatment for every patient.
THE AUDIBILITY OF GUN-FIRING.
SEVERAL correspondents have written recentlycalling attention to the unusual audibility of thegun-nring in Flanders, so that a paper read at thelast monthly meeting of the Royal MeteorologicalSociety by Mr. Miller Christy and Mr. W. Marriotthas a topical interest. The audibility of the gun-firing in Flanders over the south-east of Englandhas been repeatedly noticed since an early period ofthe war, but Mr. Christy says that undoubtedlythe intensity of the sound varies considerably withthe quality of the guns and the meteorologicalconditions. Sometimes slow and deliberate firingis heard at the rate of 3 to 12 shots a minute, eachshot being quite loud and distinct. This is probablythe firing of the monitors and other warshipsbombarding the German positions on the Belgiancoast. Usually, however, the firing has been muchmore rapid, much less distinct, and apparentlymore distant. This is, no doubt, the sound of the fighting further inland-say, around Ypres, Dixmude,or Arras; it varies in rapidity from perhaps 4 or 5shots to the minute up to more than 100. Thissound is, as a rule, very faint, though easily per-ceptible and quite unmistakable; it resembles morenearly a dull and distinct thud, which is rather feltthan heard. From the records collected it appearsthat the gun-firing has been heard at one time oranother over the counties of Essex, London, Kent,Surrey, and Sussex, the most distant place beingabout 150 miles from Ypres. Mr. Marriott, in dis-cussing the meteorological conditions under whichthe gun-firing was heard, said that the weathercharts showed that generally there is a somewhatirregular, or not definitely defined, distribution ofbarometric pressure, but mostly with a region ofhigh pressure wedged in between areas of slightlylower pressure. These conditions are such as toproduce light winds at the surface, mostly betweennorth and east, over the neighbourhood of theNorth Sea. Aspect and elevation are also im-
portant factors for the hearing of the firing, so that
there is nothing mysterious about the audibilityaltering so greatly as it obviously does. Theweapon and its position, the weather and itsmodifications, all combine to make the audibilityvary from day to day.
____
INDUSTRIAL ANILIN POISONING.
THE paramount position of the anilin industry inGermany has naturally caused the experience ofanilin poisoning to be mainly German. The pro-duction of anilin dyes in England consequent onthe war is likely to familiarise us with anilinpoisoning. The United States made no attemptto compete with Germany in the manufactureof anilin or anilin dyes until the supply wasshut off by the war, but in the Journal of theAmerican Medical Association Dr. R. V. Luce andDr. Alice Hamilton now publish an important paperon Industrial Anilin Poisoning, based on experiencesin the tyre factories of Akron, Ohio. Apart fromthe production of anilin colours, anilin is used inAmerica in the compounding of rubber, especiallyfor tyres, and in reclaiming rubber from scrap.When the war suddenly shut off the supply fromGermany rubber manufacturers began to manu-facture anilin, so that now to the men exposed toanilism in rubber manufacture must be added thoseengaged in producing the anilin. Industrial anilin
poisoning, which a few years ago was negligible,suddenly assumed importance. So far the makingof dyes is too new in the United States to furnishcases ; those reported come from the rubber
industry and from the use of a wash for printers’ink which contains anilin. The victims are knownas " blue boys," from the cyanosis which is so
prominent a symptom. Since the discovery of thecause of the trouble the rubber manufacturershave taken measures of protection, either byinstalling exhaust ventilators or simply by warningthe men to seek the open air as soon as flushing ofthe face and violent headache come on. Pureanilin has never been known to cause poisoning;but pure anilin is not used in industry. What isknown under this name is a mixture of anilin(amidobenzene) with metatoluidin, paratoluidin,orthotoluidin, and xylidin in varying proportions.Unlike most volatile poisons, anilin gives no
warning, for it does not irritate the eyes andthroat. Yet according to the researches of
Lehmann, anilin is toxic in even smaller dosesthan benzene, chloroform, or carbon disulphide.Most of the industrial cases follow spilling or
splashing of anilin over clothes or skin, anddoubtless both skin absorption and lung absorptionplay their part. Rambousek places anilin and allthe nitro and amido derivatives of the aromaticseries among the blood poisons the principalaction of which is to cause the formation ofmethæmoglobin, in which the oxygen is firmlybound, thus producing a condition of "internalsuffocation." In England Dr. W. Malden has examinedthe blood of men employed in the manufacture of
anilin dyes and nitrobenzene. In about half he found,
a high red count with a low colour index and manyi imperfectly developed red corpuscles. The spectrumrof methaemoglobin could be detected only when it! was present in the proportion of 1 part to 10of oxyhæmoglobin. Loss of hæmoglobin ran from)5 to 50 per cent. Stained specimens showed greatvariations in the size of the red corpuscles. Baso-e philic granules were found. Dr. Malden believes. that this is often the earliest sign of anilin
j poisoning, as it is of lead poisoning. The first
116 MEDICAL WOMEN’S FEDERATION.-TETRAGENUS SEPTICÆMIA.
symptoms are weariness or sleepiness, flushing ofthe face, a sense of fullness in the head andeven of slight mental confusion, dryness of thethroat, and dysphagia. The colour of the facechanges from red to livid blue, which mayincrease to a deep purple. The pulse is rapid andweak, the temperature subnormal. Headache comeson early and is often violent, accompanied bydizziness and nausea, and in the more serious casesthere is decided dyspnoea, increasing mental con-fusion, and finally loss of consciousness. These
symptoms are due to want of oxygen. Later
symptoms - icterus, methaemoglobinuria, bladderirritation, and bronchitis-are caused by theelimination of the poison. In some cases the
subjective symptoms are slight and the man seeksadvice because of his livid or blue colour, whichis alarming to him and his friends. Usually indus-trial cases do not exhibit the severest symptoms,but epileptoid convulsions and protracted comahave occurred and proved puzzling to the medicalattendant. Recovery in the milder cases is prompt,the men usually returning to work on the followingday, though the cyanosis often persists for severaldays more. Chronic anilism is described by vonJaksch as a condition resulting from repeated dosesof the poison so small as not to set up symptoms ofacute poisoning. There are more or less headache,nausea, vertigo, muscular twitchings, disturbancesof vision, sense of exhaustion, and loss of strength.The skin is usually livid, or it may be jaundiced.In one American case the man was treated forheart disease because of his cyanotic appearanceand dyspncea on exertion.
MEDICAL WOMEN’S FEDERATION.
THERE has been for some years a Federation ofUniverity Women with the object of facilitatingthe expression of united opinion and the concertedaction of University women on matters speciallyaffecting them, and this federation has local asso-ciations in the cities of England, Wales, and Scot-land, and is affiliated with similar associations inIreland and India. An association of registeredmedical women was established more than 35 yearsago. Other associations have since arisen, and itis now proposed to do for medical women what hasalready been done for University women in generalby means of a federation of their existing associa-tions. An application for incorporation has accord-ingly been made to the Board of Trade. Theaffairs of the federation are to be managed by anelected council, each association sending represen-tatives in proportion to its numbers, and the firstappointed representatives, of whom Miss A. HelenBoyle, M.D., is president, and Miss Jane Walker,M.D., provisionally secretary and treasurer, havedrawn up a scheme which is being circulated to allmedical women. At the central office a register ofmedical women will be kept indicating the type ofwork upon which they are engaged, the posts opento them, details regarding assistantships, and thesale and purchase of practices, and so forth. Thereis to be a salaried secretary at this office readyto give members any information and help that
they desire. It is intended to take specialsteps to deal with public work in connexionwith war emergency, school inspection, healthinsurance, public health, and factory inspection,in order to secure the fullest possible cooperationbetween the federation and the various Govern-ment departments concerned. The promoters hope
that every medical woman will join this federationand thus ensure its becoming a responsible pro-fessional body as well as a bond of communicationbetween its members. The subscription has beenfixed at one guinea entrance and one guineaannually, and intending members are asked tocommunicate at once with the secretary of thefederation at 122, Harley-street, London, W. Thefederation is the natural result of the steadilywidening sphere of woman in medicine.
TETRAGENUS SEPTICÆMIA.
IN the Annali di Medicina Navale e Coloniale,issued from Rome by the Italian Admiralty,Dr. Dante Ferraro, a senior medical officer in theItalian Navy, details two cases of generalised infec-tion by micrococcus tetragenus which followedwounds of the feet and came under his notice inthe naval hospital in Venice. In each case thewound of the foot seemed to heal, but two or threeweeks later an indolent bubo formed and was
opened. In each case there arose an endocarditiswhich ultimately led to the patient’s invaliding out ofthe service. One also suffered from a tolerably severenephritis. Dr. Ferraro quotes the case reported byH. Robinson in the Journal of the Royal ArmyMedical Corps for May, 1915, where an otorrhceasupposed due to typhoid infection was shown byblood culture to be caused by M. tetragenus, and henotes that certain French authors who investigatedby blood culture 738 cases of pyrexia in men whohad undergone antityphoid inoculation, found infive the micrococcus tetragenus which had notbeen previously suspected. It has been reportedon ship board/ and Tremolieres and Loew,mentioning 25 cases of this septicaemia seen inFrench armies during the war, divide them intothree classes: (1) benign, temperature not above102° F.; (2) severe, to 104°, lasting 8-10 days; and (3)a pleuro-pneumonia in which a few diplococciare found in blood culture along with a greatmajority of M. tetragenus.
AT the Royal Society of Medicine the Section ofSurgery has arranged for a special meeting to beheld on Friday next, July 21st, at 5 P.M., at whicha paper will be read by Major Tait McKenzie,R.A.M.C., on "The Treatment of ConvalescentSoldiers by Physical Means," illustrated by lanternslides of cases under treatment. Members of othersections are cordially invited, and the paper willhave special interest for members of the Sectionsof Balneology, Electro-therapeutics, and Neurology.
THE death is announced of Dr. Walter WilliamHunt Tate, obstetric physician to St. Thomas’sHospital. We hope to publish a full obituary notice
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later.1 Home : THE LANCET, June 12th, 1909, p. 1715.
DONATIONS AND BEQUESTS.-By will the late Mr., Lestocq Robert Erskine left .:E200 each to the London Fever, Hospital, the Royal Berks Hospital, and the London, Hospital.-The late Mr. B. H. Deakin, town clerk of- Monmouth, bequeathed £500 to the Monmouth General
Hospital and Dispensary for the maintenance of a cot in thechildren’s ward in memory of his daughter.WATER-SUPPLY OF BIDE FORD (DEVON).-The Bide-
ford town council has adopted a scheme for augmenting the, water-supply of the town at an estimated cost of £13,588. A
new reservoir is to be erected capable of holding 27,000,000gallons, to be supplied from a collecting area of 900 acres,
’ and this would be capable of yielding at least 350,000,000 gallons per annum.
