T.N.T. poisoning and the fate of T.N.T. in the animal body.

Date:
1921
Catalogue details

Licence: Public Domain Mark

Credit: T.N.T. poisoning and the fate of T.N.T. in the animal body. Source: Wellcome Collection.

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    When cases are picked out with slight icterus from among the general body of the workers these cases are symptomless and apyrexial and the factory doctors uniformly stated their inability to distinguish these cases from the catarrhal jaundice of ordinary experience. This difficulty of diagnosis has been previously referred to by Dr. H. Morley Fletcher of St. Bartholomew’s Hospital (Proceedings of the Royal Society of Medicine, January 1917). In severe cases of rapidly increasing jaundice, generally the diagnosis of liver atrophy will be correct, and the exclusion of the rarer causes of grave jaundice among young and middle aged munition workers is not as a rule difficult. Cases of secondary carcinoma of the liver, familial acholuric jaundice, of gall stones, and large cirrhotic livers, have been met with; but their exclusion, as being cases not due to T.N.T., is not difficult after full investigation. A noteworthy feature in cases of toxic jaundice has been the absence of Webster’s reaction in the urine of these patients, and Dr. Barbara Crawford carried out the following experiment to see whether or no the inability to excrete the T.N.T. derivative giving Webster’s reaction might be used with safety for diagnostic purposes : ‘ From a series of several hundred examinations of the urine my experience has been that T.N.T. is normally present (Webster’s test) when a worker is in contact with this substance, and that instead of this being a danger signal, as has been held, it is on the contrary normal and quite compatible with good health ; it is not found in the urine of patients suffering from toxic jaundice. I have recently confirmed this at the suggestion of Dr. O’Donovan, by rubbing a small quantity of an ointment containing 12^ per cent, of T.N.T. into the skin of a healthy adult as control. The urines were tested for the next 48 hours with the result that no T.N.T. was detected in the toxic jaundice patient’s urine, while it appeared in that of the control after a few hours.’ April 1918. A diminution in liver dullness that progresses while under observation might be regarded as definitely diagnostic in a T.N.T. worker of toxic jaundice. A diagnosis after the event in these cases is often difficult. A patient who has given a history of jaundice after work on T.N.T. associated with prostration, white stools, and pain in the liver area, may later show a fairly clear picture of cholelithiasis. It is to bo remembered, however, that gall stones have been found post-mortem in cases of T.N.T. workers dying of liver atrophy. It may be held that the presence of gall stones may predispose a worker to an attack of toxic jaundice, and the present certain diagnosis of gall stones does not negative a previous jaundice of toxic origin. Illustrative Case of Gall Stones and Jaundice in T.N.T. Worker. Mrs. L. Under Dr. Alexander of Faversham. Married. One child. Husband alive and well. First went to work at a factory in Faversham, May 1917. Was employed as an examiner gauging T.N.T. pellets on alternative fortnights. This work stained her hands yellow. Alternate fortnights were spent on non-T.N.T. work. She last left the factory about beginning of November 1917. She was jaundiced about November 23, 1917. Onset of Illness : Symptoms : Headache, nausea, malaise. Attacks of pain in R. hypochron- dium, which came on at any time day or night, severe, radiated up to right