Chapter XLIX: Part 2: of table

+---+-------------+---------+--------+---------+-------+---------+--------------+ |No.| Sp. Gr. | Urea |Albumen.| Bile |Sugar. |Urobilin.|Dinitrobenzol.| | |Water = 1000.|per cent.| |Pigments.| | | | +---+-------------+---------+--------+---------+-------+---------+--------------+ | 1 | 1029 | 2.6 | Nil | Nil | Nil | Nil | Nil | | 2 | 1030 | ... | ... | ... |Present| ... | Nil | | 3 | 1024 | ... | Nil | Nil | Nil | Nil | Nil | | 4 | 1021 | ... | Nil | Nil | Nil | Nil | Nil | | 5 | 1025 | ... | Nil | Nil | Nil | Present | Trace | | 6 | 1027 | 3.3 | Nil | Nil | Nil | Nil | Faint trace | | 7 | 1026 | 2.9 | Nil | Nil | Nil | Nil | Faint trace | | 8 | 1026 | 3.1 | Nil | Nil | Nil | Present | Nil | | 9 | 1022 | 3.0 | Nil | Nil | Nil | Present | Nil | |10 | 1022 | 2.8 | Nil | Nil | Nil | Nil | Nil | |11 | 1027 | 3.1 | Trace | Trace | Nil | Present | Nil | |12 | 1025 | 2.9 | Nil | Nil | Nil | Present | Nil | |13 | 1024 | 2.8 | Nil | Nil | Nil | Present | Nil | +---+-------------+---------+--------+---------+-------+---------+--------------+

Dinitrobenzine is a powerful narcotic poison. Death in acute cases is due to coma in man. Convulsions are frequently and generally observed in animals. It is a powerful disintegrator of the blood, and in dogs, cats, and rabbits causes oligocythemia, poikilocytosis, and hæmoglobinæmia. So great is the destruction of the blood corpuscles that Haldane attributes all the symptoms to the want of oxygen consequent on changes in the blood. In chronic poisoning men exhibit the features of a peripheral neuritis, although this point has not been confirmed by pathological investigation. Strassmann and Strecker (Friedreich’s _Blätter für gerichtliche Medizin_, 1896), in dogs, have obtained, by staining, degeneration of the lateral columns of the cord. They also found irritation and catarrh of the stomach and intestines, and after large doses small extravasations of broken-down blood-clot, with swelling and cloudiness of the mucous membrane of the stomach. There is also evidence of much tissue degeneration in the organs, probably fatty. In men, post-mortem, we find that the lividity entirely disappears, the skin becomes pale, and all the internal organs, such as the heart, lungs, and liver, are of a pale yellowish cast, and more friable than usual. The brain is of a dull pink colour, and the veins of the body, and especially the meninges, are filled with a thin, characteristically-fluid, black blood.

_Prognosis._--Prognosis in cases of poisoning by dinitrobenzine depends upon the amount absorbed, the time the men have been exposed to it, and their previous health. The headache and general malaise caused by small doses are usually recovered from in the course of a few days. A week’s absence from work enables the men to regain their usual energy, the appetite and urine becoming normal. Anæmia is a very persistent trouble. If the number of blood corpuscles becomes greatly decreased, it takes months to restore them. The peculiar dusky colour of the skin can be detected by those who are conversant with this symptom, even weeks after ceasing work. In cases of coma hours may elapse before consciousness returns. Recovery has taken place after insensibility lasting eight to twelve hours. In one fatal case consciousness returned after nearly sixteen hours’ insensibility, but death suddenly occurred half-an-hour afterwards, when the man was being raised quickly and carelessly from the recumbent position. Cases which are going to terminate fatally usually do so within twenty-four hours. Some months may elapse before muscular power is fully restored. The profound anæmia does not leave its mark permanently, it is eventually entirely recovered from when the workers are removed to other occupations. Workmen often affirm that after a time they become accustomed to the effect of the poison. This is not so, any more than individuals can become habituated to taking alcohol without being affected by it. In the early stages of employment the workers notice and complain of the effects of the poison, as it is new and strange to them; eventually they come to regard the symptoms as necessary to the work, and if slight, know from their own experience that, by more care in the manipulation, or absence from work, the symptoms will pass away. Any natural weakness is liable to be aggravated, and pre-existing anæmia will be made worse.

_Precautions._--With ordinary care the work is but slightly harmful, but without care it becomes immediately dangerous. The higher the percentage of dinitrobenzine used the greater the risk and the necessity for care. The dinitrobenzine used should be, as far as possible, chemically pure. We find a small admixture of mononitrobenzine makes it more dangerous to manipulate (_Lancet_, August 31, 1901). Commercial dinitrobenzine is a deadly poison, however introduced into the system. All precautions have for their object the prevention of poisonous quantities gaining access to the system, by the dilution of the poison, and the avoidance of personal contact. Works should be situated in the country. At the erection of the different houses, much attention should be given to their construction and arrangement. Each should be well isolated; not opening one into the other, nor contiguous to another building. Each should be surrounded by a plentiful air space, and have ample ventilation. Every house should be provided with a lantern roof, containing rain-proof windows easily opened and closed. The window space must be ample, and all windows capable of being freely opened or entirely taken out. It is often necessary to regulate the draught, and on windy days removing the windows on the lee side will permit a free current of air, and ample exit of the fumes, dust, and heat generated. No house should be overcrowded with machinery, and the different processes should be conducted as far as possible in separate buildings. All vessels, melting pots, cooling trays, or pans containing a heated compound must be provided with efficient and well-fitting covers, with flues leading from them to the outside air. The floors, tables, covers of pans, ledges, canisters, etc., in all the houses are to be kept clean and free from dust, the powdered compound, and manufactured explosive; and no utensils or useless articles are to be allowed in the houses. Canisters containing the powder must be kept closed with a well-fitting lid. No flue through which heated vapour has passed may be entered by any person. The cleaning of such flues must be done automatically, or from the outside of the building. Cooling trays should be in a shed open on all sides to the external air. A house, or other shelter from the weather, should be provided for the workmen to retire from the vitiated atmosphere of the house whilst watching the operations.

Wherever possible, the processes of grinding, filling, and emptying utensils, hoppers, pans, and cartridges should be done automatically. If done by hand, respirators should be used, and the men should be careful to stand on the windward side of the pans when the covers are off. Washing appliances should be freely supplied, preferably near each house. Towels inside the houses are objectionable; even if covered up they remain wet. Frequent washing of the hands with soap and nail-brushes is most desirable. The face, beard, and head should be kept clean, frequently washed, and free from dust. The beard, hair, and nails should be cut short. The air in the houses should be kept as dry as possible. Moisture in the atmosphere is always followed by an increase in sickness. Low temperature and dry atmosphere cause a proportionate decrease in the sick-rate. This is accounted for by the fact, that moisture makes the powder cling to the exposed parts of the body; perspiration has the same effect, as also some of the deliquescent salts used. In winter the number of invalids is very small, but during the hot summer months is greatly increased. In all houses where there is much dust, respirators are essential. They are of no use against the vaporised fumes. Cotton respirators fitting over the nose and mouth, kept very clean and frequently renewed, are least objected to by the workmen. Dr Snell has suggested a diving-bell apparatus. Gloves are necessary when handling the material. The importance of keeping the interior of the gloves scrupulously clean and tight at the wristbands is self-evident.

Special clothing should be provided, fitting well at the neck, wrists, and overlapping at the buttons; the caps should fit close. All clothing should be regularly washed, and never damp when put on. No overalls should be allowed in the eating place; they should be always removed before entering, and donned again before going into the working sheds. Separate dressing and dining rooms should be provided, suitably arranged with washing appliances.

Medical inspection of the works should be made regularly, preferably at the end of the week. The difference in the appearance of the employés at the beginning and end of the week is very noticeable. The number of visits should be not less than once a fortnight. In hot and damp muggy weather, where there is extra pressure of work and longer hours, and in the more dangerous processes, medical inspection should be more frequent.

The inspection should include the sanitary condition of each house, ventilation, number of hours worked, composition of the compound, condition of each employé, sufficiency of washing and drying requisites, the overalls, gloves, respirators, escape of vapour from melting pots or flues, dustiness of the air, cleanliness of the houses, and freedom of tables, floors, etc., from the powder. The surgeon should warn the management of any peculiarly dangerous process, suggest the number of hours to be worked, and notify any workman whom he thinks unfit for it. He may find it necessary to advise an earlier hour to begin work, on account of the heat, and more frequent exchange of workers in the different departments of the manufactory. In selecting men for work, he should choose men of middle age and strong constitution, and, other things being equal, the less frequently new hands are taken on the better. Young women, or nursing mothers, should not be allowed to work, or handle the crude dinitro, the organic compound, or the finished explosive. Pregnancy or anæmia should entail dismissal. The medical officer should watch carefully new beginners at the work, and initiate proper precautions to prevent chronic cases becoming acute. A written notice of employés off work supposed to be due to the effects of the poison should be sent to the medical officer in charge, so that he may investigate the conditions and causes. All employés should be examined and passed by the medical man, and their condition noted before being taken on. He may find it necessary to prescribe short shifts; this may mean either a short continuous number of hours at the work, as in the filling houses; or frequent intermission of work, as can be obtained by the mixing house workers. Sometimes it is necessary to advise very limited spells of work. The process of grinding and cleaning out of flues are operations attended with serious risk. About six hours’ work in the mixing and filling houses daily is as much as an average man can undertake. Headache, sickness, nausea, and distaste for food in the morning should be looked upon as warning symptoms, and men so affected should not be allowed to persist at the work. Heavy muscular exertion is not desirable for those who suffer from anæmia, or the cyanosis caused by the poison.

Alcohol is contra-indicated, and all oils and fats are solvents of dinitrobenzine. Lemons, apples, acid fruits and drinks, and milk, are usually advised; the two latter may be ordered by the medical man with advantage.

_Treatment._--There is no known antidote. Symptoms must be combated as they arise. If the poison has been taken into the stomach it must be immediately removed by the stomach tube. Oxygen freely inhaled and saline infusion are necessary. Artificial warmth, diffusible stimulants, and perfect rest must be persisted in until all danger from syncope is past. Warm, easily-assimilated liquid food per mouth and rectum must be given. Later the anæmia requires general tonics, fresh air, and good food.

ROBERT PROSSER WHITE.