Josef Rambousek

“ Industrial poisoning which in respect of its duration stands midway between acute and chronic is called sub-acute poisoning. This usually means that more frequent absorption of greater quantities of poison has taken place, though not in doses large enough to produce an immediately acute effect. This is important legally because industrial poisonings caused through the sudden absorption of poison in sufficient quantity to act immediately or to bring about subsequent symptoms of poisoning, are reckoned as accidents. Thus acute and many sub-acute industrial poisonings are accounted accidents. ”

“ In those industrial poisonings which result in loss of consciousness, arrest of respiration and suffocation, attempts at resuscitation should at once be made. In these attempts at resuscitation, artificial respiration is of the greatest importance; of course the sufferer must first be withdrawn from the influence of the poison, i.e. be brought into fresh air. Great care must be taken, especially where it is necessary to enter places filled with a poisonous atmosphere, to prevent the rescuers, as is often the case, themselves falling victims to the influence of the poison. ”

“ Occasionally also considerable quantities of poison enter quite unnoticed into the body, such as odourless poisonous gases in breathing, or poisonous liquids through the skin. In chronic industrial poisoning unsuspected accumulation of poison takes place, until symptoms of illness ultimately reveal themselves; as the first stages of poisoning are not recognised in time by the person affected, he continues exposed to the influence of the poison for weeks, months, even years, until the chronic effect has reached its full development and becomes obvious. ”

“ Since industrial poisoning, as defined above, is of course neither desired nor intended by the sufferer, who unsuspectingly takes into his system poison used or developed in the factory, solid substances in finely divided condition—in the form of dust—can be considered as industrial poisons. ”

“ The gases serve partly for the heating of the blast for the furnace itself, and partly for driving the gas engines which serve the electrical power apparatus, electric lighting, &c., in the works. Through the rational utilisation of the blast furnace gases, the workers are protected from their injurious action during the working of the furnace. Serious gas poisoning, however, occurs not infrequently to workers who have to enter the gas mains for cleaning purposes. ”

“ In general, poison can be absorbed at very different points of the body; so far as industrial poisons are concerned, these are the mucous membrane of the respiratory passages, the mucous membrane of the digestive tract, and the skin, intact or broken. The rapidity of absorption depends on the nature of the poison, of the individual, and the channel of absorption. Of industrial poisons gases are relatively the most quickly absorbed ”

“ Evolution of poisonous gases is greatly increased by the action of moisture, or of moist air, under the influence of which phosphoretted hydrogen is generated from calcium phosphide, which, in turn, is formed, in large part, at any rate, from the calcium phosphate present in anthracite and quartz, at the high temperature of the electric furnace. If spontaneous disintegration of the alloy also occurs, much larger quantities of gas would be given off from such friable and unstable material, other conditions being equal. ”

“ Workers should only take food and drink or leave the works after thoroughly washing the hands with soap—if possible with pumice stone; if drinking during work cannot be wholly given up the edges of the drinking vessels ought not to be touched by the hands.
If a file-cutter falls ill in spite of precautions with symptoms pointing to lead poisoning he should, in his own and his family’s interest, at once consult a doctor, telling him that he has been working with a lead bed. ”

“ Naturally maintenance of the general health by good nourishing diet is one of the best means of defence against onset of chronic industrial poisoning. Over and over again it has been noticed that ill-fed workers speedily succumb to doses of poison which well-nourished workers can resist. It is not our province here to discuss fully the diet of a working-class population. ”

“ Effects on Health.—From what has been said of the manufacture of coal-tar dyes it is evident that poisoning can arise from the initial substances used (benzene, toluene, &c.) , from the elements or compounds employed in carrying out the reactions (such as chlorine, nitric acid, sulphuric acid, arsenious acid, sodium sulphide, and sulphuretted hydrogen gas) , from the intermediate bodies formed (nitro and amido compounds, such as nitrobenzene, dinitrobenzene, aniline, &c.) , and that, finally, the end products (the dyes themselves) can act as poisons. ”

“ Workmen who are susceptible to the disease, yet without marked disposition (idiosyncrasy) towards it, can become acclimatised to the poison. Lehmann has succeeded in artificially producing an attack in a brass-caster who was highly susceptible. The symptoms in him were the result of work with pure zinc in a burning condition. The proof, therefore, is clear that brass-founders’ ague is due to zinc, and not, as some authors have supposed, to copper or the simultaneous action of both metals. The symptoms are produced through inhalation of zinc oxide, not zinc fumes. ”

“ A few only hold good for our purpose. It is characteristic that Lewin, after attempting a definition of the conception ‘poisoning,’ himself rejects it and declares that he can see no practical disadvantage in the impossibility of defining this notion, because deductions based upon the knowledge of undoubted cases can never be dispensed with, even if a definition were possible: one justification the more for our inductive method. ”

“ Hence medical aid should be sought on the earliest appearance of symptoms, and the worker, therefore, should know the nature and action of the poison with which he comes into contact. This brings us to the subject of the education of the worker and particularly observance of all those rules and regulations in which his co-operation is necessary. This co-operation of the workers is indispensable; it is the most important condition of effective defence. The best regulations and preventive measures are worthless if the worker does not observe them. ”

“ This point was fully discussed at the eighth International Congress for Workmen’s Insurance held in Rome in 1908. There is no valid ground for granting compensation only for sudden disturbance of health arising in the course of employment by accident or acute poisoning, and withholding it in the case of gradual disturbance of health caused equally by the trade, as the effects of such chronic indisposition weigh often no less heavily on the sufferer. ”

“ In this way a number of skilled resistant workers, familiar with the risk and knowing how to meet it, will be maintained. Casual labour works in a vicious circle—increase of fresh workers increases the danger and the number of cases of poisoning, and, vice versa, these augment again the need of change in the personnel, so that the number of cases of poisoning rises very high. ”

“ Lead poisoning is the most frequent and important chronic industrial poisoning; the symptoms are very varied and associated with the most different groups of organs. We shall describe the typical course of a case of industrial lead poisoning, laying stress, however, on the fact that numerous cases follow an irregular course, in that special symptoms or complications of symptoms are in some especially accentuated, while in others they become less marked or are absent altogether. ”

“ The most important general rules of treatment arise in reference to irritant poisons which produce ulceration of the skin, and further in regard to those poisons which cause unconsciousness, especially blood poisons.
When an irritant poison is acting on the skin, the first object to be aimed at is naturally the immediate removal of the cause of corrosion by water, or, better still, neutralisation by an alkaline solution (for example, soda solution) in the case of corrosive acids, and weak acids (organic acids, acetic acid, citric acid) in the case of caustic action by alkalis. ”

“ Cyanogen and cyanogen compounds are extraordinarily powerful poisons. The minimum dose lies, as Lehmann has proved by experiments on animals, at about 0·05 per thousand of hydrocyanic acid in the atmosphere breathed; 1-5 mg. per kg. weight is fatal to animals; to man about 60 mg. would be fatal.
The poisonous action of cyanogen and cyanogen compounds depends upon their power of preventing absorption of oxygen from the blood by the tissues with the result that the venous blood flowing to the heart retains the bright red colour which otherwise only arterial blood exhibits. ”

“ While with the mechanical appliances of resuscitation belonging to older systems the hand of the helper regulated the rate of breathing, in the case of the Pulmotor the lungs, according to their size, automatically fix the rate of breathing; as soon as the lungs are filled the apparatus of its own accord marks the moment for ‘deflation,’ and as soon as they are emptied of ‘inflation.’ This automatic reversal is effected by a little bellows which is connected with the air tubes. During inflation the same pressure is exerted in the bellows as in the lungs. ”

“ Extension of workmen’s insurance to cover chronic industrial poisoning is, however, most desirable in the interest of employers and employed, and also of science. The German accident insurance legislation is especially suited to do this, since the trade organisations direct their attention not only to the prevention of accidents but of industrial diseases also. ”

“ Regulation 10.—The employer shall entrust the supervision of the workers’ health to a duly qualified medical man approved of by the public authority, and notified to the factory inspector (par. 139b of the G.O.) , and the said medical man shall examine the workers once at least in every six months for symptoms indicative of plumbism.
The employer shall not permit any worker who is suffering from plumbism or who, in the opinion of the doctor, is suspected of plumbism, to be employed in any work in which he has to handle lead colours or mixtures thereof, until he has completely recovered. ”

“ Seegar, the celebrated expert, praises the advantage of lead glaze and the use of lead in the ceramic industry—it is indeed practically indispensable—and speaks of the poisonous nature of lead as its only fault. The components of the glaze must have definite relation to the hardness or softness of the body. The higher the proportion of silicic acid in the glaze the harder the firing it will stand; the more the flux materials are in excess the lower will the melting point be. ”

“ Speaking, singing, or whistling during work favours inhalation of the fumes and is, therefore, to be avoided. Indulgence in spirits, especially during working hours, increases the danger of poisoning. Habitual drinkers should not be allowed to work at all with quick-drying paints and oils.
At the first signs of discomfort work should be stopped. An immediate stay in the open air will then usually dispel the poisonous symptoms.
If, notwithstanding this, severe symptoms develop, oxygen inhalation should be commenced forthwith and medical aid called in. ”

“ On the one hand phosphorus necrosis probably arises partly from the general poisonous action of the phosphorus, and on the other from local inflammation which leads to the occurrence of local symptoms. The general symptoms of chronic phosphorus poisoning described above support this view, especially the effect observed on the bones of the skeleton. This view is also strengthened by the fact that workmen with perfectly sound teeth, who had been exposed to phosphorus fumes for many years, were attacked by necrosis only when traumatic inflammation produced by chance injury was set up. ”

“ During work smoking, snuff taking, and tobacco chewing, which invariably convey lead into the mouth, should be given up, as it is impossible to prevent the hands getting contaminated with lead. Lighting the pipe with glowing lead ashes is in the highest degree dangerous from the risk of inhaling lead fume. The body must be strengthened to withstand the action of lead. Moderation in drinking, especially avoidance of spirits, should be observed. Alcoholic subjects succumb to lead poisoning much more readily than the temperate. ”

“ In comparison with chemical workers they have, it is said, relatively the lowest morbidity. Although in this industrial occupation no special factors are at work which injure in general the health of the workers, there is a characteristic effect, without doubt due to the occupation—namely, disease of the respiratory organs. Leymann’s figures are sufficiently large to show that the number of cases of diseases of the respiratory organs is decidedly greater in the sulphuric acid industry than among other chemical workers. ”

“ Poisoning arises from inhaling the fumes of hydrocarbons. The symptoms are oppression, headache, inclination to vomit, cough, hiccough, giddiness, noises in the ears, drunken-like excitement, trembling and twitching. Inhalation of larger quantities brings on, quite suddenly and without previous warning, unconsciousness, which may last many hours and is often fatal. Except in severe cases the symptoms generally soon disappear, if the affected person withdraws from further contact with the fumes. The most effective protection therefore against poisoning is fresh air and temperance. ”

“ Many have demanded, in view of the possibility of substituting leadless for lead glazes, the total prohibition of lead. Such is the view of the Dutch inspector De Vooys; Teleky and Chyzer share the view expressed so far as the small industry is concerned, since the practicability of the change has been demonstrated.
English authorities (Thorpe, Oliver) propose diminution of the lead in the glaze in such a way that on shaking with weak acid not more than a specified small quantity shall be dissolved (Thorpe test) . In my opinion such a measure is hardly enough for the small industry. ”

“ In the manufacture of white lead processes which create dust are specially dangerous, namely, emptying the corrosion chambers, drying and grinding, transport of the material in the form of powder, and packing. The following measures are called for: emptying the chambers should only be done by men wearing respirators or equipped with breathing helmets after preliminary damping of the corrosions by means of a spray. Use of a vacuum cleaning apparatus suggests itself. Drying should be done as far as possible in stoves charged mechanically, the temperature in which can be watched from the outside ”