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 The (>ausati()n and Prevention 
 
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 Poisoning. 
 
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 The Causation and Prevention 
 
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 Medical Research Committee. 
 
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LNTKOULcniON 
 
 The enquiriw of wliith Dr. Mixin? givM an account in the 
 prcsfnt Keport onKinattU in a rt'qut*t ma4t> in Auguitt, 1915, 
 to lUv Apj)lii-«l I'hy.-ioiojjy lK|«irtnn-iit of i\\v MfUiral K«-«-arch 
 C'oniiiiittce by the Moliiai lii-iH-ctorn <if Kiutonts at tin- Homo 
 Otficf, for aiuti»tante in the inve'^tig.ition of tlie t<>xi<-.>li.gy of 
 trinitrotoluene. 
 
 In tlie proviinw nionth-s the.se Inspectors, Dr. I>'gge and Dr. 
 Collix, hail their attention laUitl to the occurrence of ^erioull 
 ttyntptonis leading to to.xic jaundice among worker^ engaged in 
 the nianufucture of T.N.T. or in its manipulation for tilling 
 munitioiLS of war. The lirst reconl<-<l ih-ath from this eauiM) 
 otciirred in the manufai ture of T N.T. in IVItruary, l'Jl.>, and 
 from its u.te in a filling factory in August, I'JI5. Kut already 
 in a lilUng factory in .luly. IDIj, a ca-^e of to.xic jaundice had 
 heen rcjiorted. The .^yrnptomH of iMiisoning wen- <l>«<ly akin 
 to thowe which were then being re|)ortid as due to c.xjjo.suro 
 I the funiett of tetrachlorethane, u.tcd an a coiLstitueiit of vaniisb 
 Li'plied to aeroplaiicM. Thi.s ooincid"nce in time of the two fomiB 
 
 • •t poisoning made it natural, then, to liH)k upon the inhiilation 
 of the fumes or tin- du.st of T.X.T. as a po.s-ible cause of tins new 
 ancl une.\|K><te<l d'kng«-r at the tilling factories, in spile of tho 
 fact that the path of entry to tho Ixnly in tho most familiar 
 examples of |H>i!ioning from the imlustrial use of iutro-cora|H)unds 
 «rts well known to b«' the skin. 
 
 The rapidly increasing use of T.N.T. at that time inatU- tho 
 i-ition «>ne of grave anxiety, and had it not been for tli.- pre- 
 ventive measures, iuunil on jm-vious knowletlge and cxiHrienco 
 of the nearest analogies, which were then pronjplly adv.xatwl 
 by the Home Otlice, the mortality from ihia |>oisoniiig. wtiich 
 Ivancetl during 1915-1(1 until the autumn of 1016. w hen it 
 i«hc<l its gnatest height, niii.-t have iM-en fax h'gii'T. In 
 luly, IU15, the Home (iflice had wanu-il the factories* that T N.T. 
 iglit be al»orlK^l through tiic .-kin. or by the iniialation of 
 I i-t and fmnc^, ami had recommended accordingly that pre- 
 lUtion.s should Iw taken against lH>th avenues of entry. 
 The work U-gun in these circumstances under the dirtntion 
 ■ f Dr. MfKtre at the ('ommilt«T"s Appliid Phy.siology I>opart- 
 "lent had for its imnu-diate object the .settlement of this qnnttion 
 f the mod", or nnxles, of entry of the |>oison, with a view to H» 
 . iTectivc prevention. The enquiries of Dr. M<iore and hi* eol- 
 leagues were only rend-f d |>os.sible by the supply of mnloriab 
 for laboratory exjwrnncnt- and by facilities obtaitutl f..r him 
 at the factories by the H>me Ollice. acting with the rc.nly co- 
 
 • iK'ration of the ivrupiers and of the Mini.stry of Muiutioiw. 
 I .>r the opp<irt unities so provided, and no lejw for the .I'-.-.i-f.-inco 
 <f managent and other ofticials at the factories by their practical 
 help and by chticisni, the Committee ore greatly indrbto*!. 
 
 auKi-riiii»> wxuut-iJO ion M« Su j c » s «p.st. \i 
 
 4037 17 
 
These investigations show how far the measures adopted in 
 the original emergency were corrctl ; it was inevitable that 
 praelice and e.\i)enenee, illuniinated by scientific enquiry, should 
 have called for their niodilicalion and j)rogret<sive improvement. 
 In the aulunui of I'.UO, llic Minister of Munitions appointed an 
 Advisory ('(jmmittec to icjn^idcr and advise him upon the pro- 
 gress of knowledge and its ai)plicati()n in the organising of pre- 
 ventive work at the factories. This Committee, upon which 
 the Medical Researcli Connnittee were directly represented, 
 framed and recommended the Code of Rules wliich during the 
 present year has been imjjosed upon all factories concerned in 
 the maniiiulation of T.N.T. They have been in close touch 
 throughoift Mith Dr. Moore's work and with other supplementary 
 enquiries, and the regulations they were led to recommend were 
 in verj' large jtart either based upon or fortified by the investiga- 
 tions now to be described. 
 
 It may be mentioned here that the number of cases of toxic 
 jaundice from T.N.T. given in the Returns of the Home Office 
 for the months of July and August, I'JIG, show 53 cases, including 
 13 deaths, as compared with 17 cases (7 fatal) in the corre- 
 sponding months of 1917, though the number of the workers 
 exposed in the i^resent year to risk has been far gi-eater than 
 in 1916. Accompanying the cases of jaundice there has ako 
 been an unmeasurable volume of minor illness, standing pre- 
 sumably in some liigli direct ratio to the number of serious eases. 
 The latest Retm-ns show that the number is being kept down— 
 and especially the number of fatal cases — and there is now good 
 ground for believing that when all factories have reached the 
 standards attained by the best of them from this point of view, 
 T.N.T. ])oisoning may become almost unknown. The results 
 already obtained must be regarded as a striking testimony to 
 the value of close co-operation between research work on the 
 one hand, cai'ried out not only in the laboratory but also in 
 the field of its practical apiilication, and administrative action 
 on the other. 
 
 While tlie experimental analj'sis of the paths bj' which T.N.T. 
 may enter the bod}', and the new tests which have been devised 
 for tracing its elimination in changed form, have greatlj- aided 
 the succcs.sful measures of prevention, it will be seen in the 
 following pages that much still remains to be discovered ^^■ith 
 regard to the detailed nature of the complex toxic effects of 
 T.N.T. or of its derivatives, when it has once gained access to 
 the system. As in the case of other nitro-compounds, an 
 immediate and obvious result of T.N.T. absorption, whether 
 through the skin or otherwise, is a chemical change in the 
 ha?moglobin of the red blocd corpuscles and a consequent damage 
 to the oxygcn-carrjnng functions of the blood. This shows 
 itself by a darkening of the blood colour and in a pallor or 
 
diuikincAs of the skin \rjth blnorifss nf the lijw (" cynnwU "). 
 ThfHC cheiiiiriil sigiw are lui i>ii)|miii()l l>y >\ iiiiitoiiiH illiistruting 
 the deficiency in oxygen traasi»ort, and tlie jcjus. (juent oxygen 
 famine, which in intenxiticd in time of mttl, a^ is shown by 
 breat hUtfunettii or nir hunger iij)on exertion. At U-a<*t witliin 
 wifle limits, this condition in one from whirii the body can Mpiiliy 
 recover. If the fn-wh entry of poi.son U« preventttl, what is 
 present in eliminated and the n-d bloo«l coqiUHcles are rajiidly 
 restorwl by reversc-d chemical change and by fresh j)roduction. 
 or b<jth. to the normal, ami tliis procvss is greatly uitled by 
 access to ubundant fresh air. 
 
 Cyanosis is an abnormal condition, but by itself it dm>s not 
 kill. The fiital ivsults of T.N.T. isiistiiiing have Ixen due to 
 two other |)atholi)gieal conditions. The most common ha.-t U-en 
 u destriution of liver siilHtance, oven-oming the efforts of the 
 botly towanU re|)air, and the outward sign of this is given by 
 the <vsra|K> of bile-pigments from the liver to the general system. 
 These pigments give the yellow tinge in the skin and other tissues 
 to which the name " toxic jaundice " of this disen.se has n-fer- 
 once. The second antl rarer form of fatal ending has \icon the 
 so-called '■ aplastic anicmia," in which the blood forming organs 
 fail in function and a progressive Kkss of the blood elements 
 results. At present ls)th "toxic jaundice" and "aplastic 
 ana>mia " are incurable and rapidly fatjil disea.ses when onco 
 Ostablishe<I. It is of the hight-sf importance, then, to detect the 
 earliest possible inilicutions of their Isginnings, with a view to 
 prevention, ami the question of early detection. esiKciaily of 
 toxic jautvdicc cases, has U'on one of the cliief practical problems 
 during the jmst year. 
 
 It will Ik« seen in the following pages that Dr. MiMin- regards 
 both toxic jaundice anil fatid amemia as secondary results of 
 the sjime action (»f the jsiison as that which causjvs tin- symptoms 
 of cyanosis. It is reasonable, n prinri. to reganl with him Isith 
 these diseases as the lulminating cffet-ts of stmin thrown by 
 the c<ihditions of cyanosis u|K)n the liver and upon the blcMni- 
 forming organs n's|H'ctively, of which ls>th are concenutl in the 
 maintenance of normal blmxl conditions, and he develojvs tliis 
 line of argument fully iiv his Keport. 
 
 I'lMin pn-sent evidence, however, it is possible to hold, ond 
 some do hold, that while the cyanosis due to T.X.T. (loisoning 
 i.s that characteristic of ntnny nitro com|)ounds, j-et T.N.T. , or 
 sonic of its isomeric impuriM-^ i r . i .• or other of its ilerivatives 
 in the Ixsly, may have .1 1 up<in the liver cells, and 
 
 may pnsluco toxic jaiml :• ntly of, or even without, 
 
 A coniiirriMVt cyanosis. 1' Id this \-iew lay .sfn^s on 
 
 the inde|M>ndent variability in the degree of cyano«.is on the one 
 hand ami of jaitmlice on the other. Cyanosis is the inevitable 
 ami invariable rr.sult of TNT imisoning in ex|)erinut»lal animals, 
 while toxic effects uptm the liver have bi>en verj- ran-ly pn dur<»<l. 
 In dinitrobontene poisoning, of which there is long industrial 
 
experience, wliile cyanosis is invariably produced, toxic jaundice 
 is practically unknown. In the T.N.T. factories, again, while 
 there have been many cases of severe and jirolonged r\'anosis 
 upon which toxic jaundice has not supervened, many of the 
 most serious cases of toxic jaundice liavc begun apparently 
 without cyanosis, and it has been specially notable that toxic 
 jaundice has occurred in many, if not in mo.st. eases after a very 
 short period of exposure to risk, and therefore after a necessarily 
 short history of cyanosis. 
 
 It is plain at all events that we are not yet possessed of 
 definite knowledge as to the precise modes of action of T.N.T. 
 in the body, apart from its capacity as a nitro-compound to 
 produce cyanosis. 
 
 Nevertheless, all will agree with Dr. Moore that, as a matter 
 of practice, evidence of cyanosis should be taken as a danger- 
 signal, and as an indication for immediate cessation from ex- 
 posure. This principle has, indeed, been laid dowii for the 
 guidance of medical officers at all the factories from the beguining, 
 and it has been progressively adopted in routine practice. 
 Whether or not cyanosis and toxic jaundice are merely separate 
 signs of one and the same toxic action, or -whether they repre- 
 sent different and independent poisoning processes, all may 
 agree that the existence of cyanosis shows certainly that the 
 poison is being absorbed, and that at all events the liver and the 
 bone marrow, no less than the blood, are now, as Dr. Jloore 
 says, 'n the " danger zone." 
 
 Further studies of the detailed toxicology of T.N.T. and of 
 some of its derivatives are now in progress on behalf of the 
 Committee, and it is hoped that these may solve some of the 
 problems still unsettled. Fuller knowledge of this toxicology 
 must be expected to lead to definite advance in curative treat- 
 ment, but the progress of preventive measures may perhaps 
 remove in the near future, as we may now hope, any need for 
 its practical application. 
 
 SOlh October, 1917. 
 
 Medical Research Committee, 
 15, Buckingham Street, 
 Strand. W.C. 2. 
 
(•uMi:.\T 
 
 I. IWTEODICTIOX. r.lOK 
 
 (i) Constitution and propertie-t of 7"..V / >j 
 
 (ii) ChanneU of ahsurplion into the ImmIu 1 1 
 
 (iii) Fate of ahnorbfJ TXT 10 
 
 (iv) Aplastic Annnia causing T.S.T. imm.ini.j ... J| 
 
 II. Hesk.\k<iiks at Faltokv F. 
 
 (i) Methods and Uesults ... ... ... ... 22 
 
 (ii) Expirimintis with Sieif (iorman respirators ... 25 
 
 (iii) Experiments on absorption by skin alone, other 
 
 channels being purposely excluded ... ... 27 
 
 (iv) Experiments on the effrcls of skin protection in 
 
 ilnniniihing ahsorption ... ... ... ... 30 
 
 (v) iJeterminntion of the actual amount of T.X.T. in 
 the air of the workshop, and eslimiilion of the 
 tnaxiiiinm amount which could he breathed by a 
 worker during a shift ... ... ... ... 32 
 
 (vi) Effect on authors of atcallowing known amounts of 
 
 pure T.S.T 33 
 
 III. Heskvki iiKs vT A Xatiknai.Siiki.i. Fii.i.iNii Factory. A. 
 
 IV. Action «>k T N.T in tiik Sy.htkm. anu tiik ('<>n- 
 
 NKtTio.N (.!•• .Minor T.X.T. Ii,i.xk.s.s. Toxic Jain- 
 
 DUE ANI> .\|'I..VSTIC Ax.tMIA. 
 
 (i) Action of T.S.T. on the bloo-l 3.1 
 
 (ii) Toric effects of T.S T. comjxirrd with thoi,- „f 
 
 Dinitrophenol 37 
 
 (iii) 3/iMor T ST. illness caused by /</<**/ change ... :\s 
 
 (iv) Action of pure T.S.T. and of impurities ... 39 
 
 (v) Causes of Toric Jaundice and .Aplastic An rmia 4«1 
 
 I. Preliminary I)i»cu.-i.sion. 40 
 
 2 Physiology of incn>ftM'<l liat-inagloliiii inc- 
 
 ta>x>li.-*iii. 42 
 
 3. Toxic jaundice and ftpla«tic anirmia a,s 
 n rmult of incroa««'«l bacmaglobin mcta- 
 ImUsiu. 43 
 
 4 ludn-ftiions of incifjvto*! baomof^lobin nw- 
 
 taboliMU among T.N.T. workerji. 44 
 
 S. Powflihility of the dirrrt action of TNT. 
 
 niMin the liver and red in.'\rrnw. 4J5 
 
 (vi) Cases shewing intimate relation betireen Cyanosis 
 
 and Jaundice ... ... ... ... ... 40 
 
V. PROPnYLAOTio Measures. 
 
 (i) Early detection of Cyanosis ")4 
 
 (ii) Ventilation ... ... ... ... ... ... 54 
 
 (iii) Prevention of skin absorption ... ... ... ri4 
 
 1. Provision of sliell-filling machinery. ... 54 
 
 2. Protective clothing, gloves and boots. ... 55 
 
 3. T.N.T. solvents and protective varnishes 
 
 for the skin 56 
 
 (iv) Removal from T.N.T. u-ork of persons specviUy 
 
 susceptible to the poison... ... ... .. 58 
 
 VI. Treatment of Cases 61 
 
 VII. Appendices. 
 
 (A) Effects of xveek-eruls, holidays, and alternation 
 
 of labour . . . . . . . . . . 64 
 
 (B) Analyses of Factory Air for Dust and Fume.s . . 68 
 
 (C) Amounts of T.N.T. absorbed under various 
 
 experimental conditions . . . . . . 71 
 
 (D) Experiments on Protection of the Hands. . . . 73 
 
 (E) Protocols of Experiments on Administration of 
 
 T.N.T. and other Nitro-Compounds in 
 Animals . . . . . . . . . . 75 
 
The Causation and Prevention of 
 Tri-Nitro-Toluene (T.N.T.) Poisoning. 
 
 AN Aivor.vr OF RKSKAKCIIKS HV THE STAFF OF THK 
 AI'l'LlKI) l»HYSIOL()(;V UKl'AKTMI+NT OF TIIK 
 MKDICAL RESKAUCH roMMllTKK. 
 
 KKPORTKll BY 
 
 BKN.IAMIN MitoHK, D.S, .. F.R.S., M.U.C.S . L.H.C.P. 
 
 I. Intkodcctiox. 
 
 Thi.-* iv{)<>rl i^ iiiteri«lf<l to funiixh a historiciil and M-iciitific 
 account of iin|iiiri<-rt coninifiicod in Aiigu.st, iyi.'», when our 
 attention wivs dniwii by Dr. K. L. Collis, of tlic Home Ollice, 
 to the eiirlicst kiiouii cascM of |H>i!4uning amongst workers 
 manipulating T.N'.'l'. in the footorie»». 
 
 Tlie work wiki (wirried out for tho first year by the writer, 
 as^iitteil by Mr. T. .\. Webster ; in May, 1910. we were j«)iiUM| by 
 Dr. O. A. \N'von, and tiie pro.sfcutitjn of the work in facttiry 
 and UilM)nitory has oceupie<l our attention since tlieii. 
 
 (i) C'liislilulioH and Properties of T.X.T. 
 
 Tlie niateriid known commercially a.s T.X.T. i.s mainly 
 coni|H)(ted of one of the thne i.somcric tri-nitro-toluene-, lieing 
 that one called .symmetrical trinitrotoluene lM-cau.>io the thnt- 
 iiilrogroups (NO,) am symmetrically arrange<l on the toluene 
 nuclrufi. In tlic commercial protluct then* are present only 
 in.<«iguilirant amounts of the two atiymmctrical isomer?*, and a 
 variable iwrccnlage of mono- and dinitro-toluejie« occonling 
 to the dcjrne i>f nitration and purification ; ihert- are aUo small 
 anionnt.H «>f nitruted mcthivnc.s and other sulxNtantx-o. The 
 que^tion of I he n-liitive .shan' of thc>»> vnriouH impurities «<>n- 
 tributinu to the production of the toxic ctTicts on the workem 
 has Ix-tn j^oiu- into fairly fully by our>«lvc!., and i* now U-ing 
 »till furtln r invr.<>tigated by other i>li»<erver>', for the pharntaco- 
 logical action of these suKttances |>o?<sejises an interest in itself. 
 It is suflicient to state here that wo found none of those a.-<sociato<l 
 inipuritics poM>es>ed high enough toxicity to a4-count for the 
 ofleets sr<'n amongst the workers, that workers on pure T.N.T. 
 showtnl all the symptonis. and that similar toxic oflocts rosndtcd 
 in aninirtit treafetl «ith pun> T.N.T. 
 
 The symmetrical tn nit ni toluene is the main constituent 
 of the high explosive TNT Itccause it is that one formed «lnii 
 
■.• . . ... 10 
 
 toliKi(nc fCjH5'''W3> is nitrated fully in the woll-knowii processes 
 with sli-ong nitric acid ; it is assigned the formula : — 
 CH3 
 
 ''^2 r= Symmetrical 
 Tri-'nitro-toluene 
 
 H -''■''■''■ 
 
 The ]iurc i.rodiict is a hard crystalline powder, the crystals 
 Mhen thrown out from hot alcohol form long glistening needles. 
 When free from impiu'itics it is almost odourless, unless fine dust 
 of it be stirred up to irritate the nasal mucous membrane, and 
 tlie smell of commercial samples of lower grades is almost entirely 
 due to lower products of nitration and other impurities. 
 
 It melts at 82"C., and sublimes slowly at this temperature. 
 At atmospheric temperatures its vapour pressure is very low, 
 and practically none, as we show below, is contained as vapour in 
 factory air. 
 
 Tiiis substance was perfectly well known as a high explosive 
 internationally, and was used fairly extensively for mining 
 pui'poses, long before the war. 
 
 It was not only used alone, but in mixtures with diluents, 
 and the varieties known as " Amatol " are of quite pre-war days. 
 
 It owed its successful introduction in the times of peace as 
 a blasting powder to two excellent properties of such an explosive, 
 viz. : (1) its high stabiUty, so that it could be relied upon not to 
 go off spontaneously, but remain stable imtil intentionally de- 
 tonated ; and (2) its low toxicity to human beings, so that it did 
 not induce illnesses and poisonings amongst those employed in 
 its manufacture and after manipulation. 
 
 In sj)ite of all that has hapj)ened since, these two properties 
 it must be admitted to possess in a high degree. As regards 
 stability it may be hammered or turned up in a lathe, and as 
 regards toxicity, any pharmacologist would agree that the toxic 
 and lethal doses showai below are relatively enormous doses. 
 
 Paradoxical as it may sound, it is these two safe properties 
 which have conduced to the greater ]mrt of the mischief. 
 
 Used aright they may be made to conduct us to relative 
 safety, both from toxic effects and from fires and explosions ; 
 l)ut, treated as ab.-^olute safeguard*, they may lead to T.N.T. 
 poisoning on the one hand, and to fires followed by explosions 
 on the other. 
 
 When once it is realised that it is a low-grade chronic poison 
 ^^^th which we have to deal, and the channel of entry to the body 
 is known, and the earliest symptoms of its presence in toxic 
 amount recognised, all the means are then at hand for practically 
 sweeping out T.X.T. poisoning, and that goal we are now rapidly 
 approaching. 
 
.11 
 
 ANo, wlirn it has heccmp rcccgnifttl. a.-* it Iwim how, how 
 iiiHuiniiinhIc it it once any ignition haH cccurrtd, aril that th»ri-- 
 after the high stability xaffguard tlit^apin-apt, a proper ohjeetive 
 iM Hupphed to meanit fur |irfventiun of accidents, for tlicn relianre 
 on higli ntuhihty is replaee<l hy reliance on Hcrupuluux cleaulinetut, 
 and ri-«ks fall to a ntininitiin. 
 
 'rinH many of the meiiuH of prevention arc identical for both 
 ty|Ms of danger, and, in iuldition, a.s will pn-wently Im- hhowii, the 
 indii-try and ingenuity called forth for the invention of tin- 
 necessary Wifeguanls eventually lea*! to ({uicker and better 
 nictho<lH of lat)otir, yielding the rowani of incn-aned output by a 
 diiniiushed army of tniinition workent oxiKJs<d to the jjoison. 
 
 The inno<ent chani« ter aserilxtl to T.XT. piior to the 
 enormous increase in its manipulation caused by the war. may Ix- 
 gathere«l from the following quotations from tin- clas-i»al articles 
 of RoluTt I'ros-er White, the chief authority on the toxic 
 projH'rtiis of such Iwwlies, in the Iaii<-,i, Au-ii t .'ll-t. lyol, 
 and in a later work, "Manufacture .? • 
 
 "t<iniin(» to thr t'llucnc Rroup, the mU" 
 
 tolllCll.- li|.i\.-,l, ll^f.• 11-- h. lU-i. ■KH.-, 111. ■11. 
 
 whet!. 
 evi(1< II 
 II not 
 
 I injected SO mintiiu o( a I per cent 
 
 *i|vUi . with a (atal rMult \Vc then injecteit 
 
 60 nvr. •■• ■ • I •'•' • .' 
 
 Willi t. 
 
 f tibihly of man 
 tttlil IrtHtltotoltUHf 
 
 Ha< i .1 •:. : ,'/! i;r<.i/ ,i..'. ;o:M^'f lo iht keaHh 
 
 11. c»i|K'cially tho «cnt»>ne««.4 w'hieh w»» have 
 
 itnlici-i.i, iiiu !i,i'<' !,..■ .i-jH'cl of eX)" ; ' 
 
 of T.X.T previous to the war. Thcexi 
 It is li,w-..| i- w iHlieve, .<>oiind. for w • 
 of ilii a.s well i\s dinitiut'liu 11 -. ! 
 
 and \]i|i*»ivc.s for the lH|urtniciit 
 
 Suppl; 'onlirm Pmsscr White thi\t dim'; 
 
 mort< piunoiioiis than tiinitrutoluenc, iind that both dmiiro- 
 toluene* and trinitn>toluenc are pmcti<ftlly innociiouH in such 
 dojicn as ho admitiisterrd in this early work. 
 
 (ii) Chnnnel.1 of Absorption ittlo Ike lU^i . 
 
 As rcv'anls till- I luiiiiM'ls of al>«iorj)tion of lhes<< nitp' < m. 
 in general, ti.ire nn- -.Mue desultory ol>-.erviiti'>us an- 1 r. 
 
 in the i>i. VI I r i..rio«l by lM»th our nun . i .i .;.if..t 
 Thus 1 I Min.* iit a pi i . 
 
 • .-n t)ei cirr Ar 
 
 (LehiL L - ,acf-ver»ithrrui.^ 
 
 |>rrcht. o. riofitu* u. O. Kiglcr. L«i|>*>g, \<d\i, J. A. i^utih-f 
 
12 
 
 aniline and nitro-derivativcs, draws attention to the importance 
 of the skin as an absoq^tive channel, and says this throws light 
 on several cases of obscure poisoning, which were doubtless due 
 to skin absorption. 
 
 Prosser Wliite also points out that poisoning with nitro- 
 derivatives may occur after the most careful attention to use of 
 respirators and ventilation of factories from dust and fume has 
 been applied, because of the nitro-compounds getting upon the 
 skin of the operatives. 
 
 Neither observer saj's anything of tiie substance of our 
 immediate quest, tri-nitro-toluene, which then enjoyed a most 
 innocent reputation, and no one .seems to have made an attempt 
 to determine the peril, if any, from inhalation of its dust and 
 fumes, up to the time when cases of poisoning first came into 
 notice and the preventive measures were directed against such 
 inhalation. Such preventive measures were taken as had been 
 jiroved effective in preventing otlier proved inhalation poisons, 
 such as lead or silica dust. 
 
 The breatliing of operatives was incommoded by the use of 
 respirators even in places where the air was almost guiltless of 
 dust, and time, labour and money were expended on elaborate 
 systems of fan ventilation in factories situated in open country 
 sites where the natural air circulation seemed to us excellent. 
 
 This is an object lesson in the value of getting at root causes, 
 for when the thoughts for prevention are throwia into fresh 
 channels and the essence of the problem becomes that of keeping 
 sldn, and eipecially the hands, clean, not only may there be the 
 saving of thousands of pomads which would otherwise be spent on 
 useless preventive appliances, but attention is turned to clean 
 rnd mechanical methods of pouring and filling, to finding out how 
 the numbers of hands necessarily in contact can be diminished, 
 to the introduction of impermeable preparations for keeping 
 the skin clean, and to finding out methods for testing before 
 their employment those individuals Avho have susceptible skins. 
 
 In the beginning of our inquiry, to test the "fume" theory, 
 different species of animals were exposed in a respiratory chamber 
 lor daj's to the strongest fumes which could be produced by heat- 
 ing up crude T.N.T. well above its melting point in a flask and, 
 by means of a pump, aspirating air through it and the respiratory 
 chamber containing the animals. So strong were the fumes 
 1 hat crystals of T.N.T. appeared on the outlet tube. Guinea pigs 
 i\nd white rats exposed to this treatment did not show any 
 effects. 
 
 Next, rabbits, guinea pigs and wliite rats were taken down 
 to Factory W, and by kind permission of Major O'Reilly and 
 Mr. P. J. Hincks, manager of the Danger Buildings, tiiese 
 were suspended in cages over melting pans containing molten 
 T.N.T. in a position where exposure to fumes was worse than 
 any workman endured, and constant during the whole sliift, 
 
13 
 
 itut fur Kmall interviil.i a» in tho ca«e of the workman who tuu to 
 throw in occafiiutially fn-»*h ({uantities of T.X.T. to mi-lt. 
 
 Tilt Hc fxinriineiitH wi-n* rf|KatfU Hovt-ral tinu-Jt and krpt up 
 for luontiirt , tho aniinalii ^n\v up, wuxtil fat, and ri'an-«l fuinilic». 
 \\V liavf never »een liner, hirj^er and fatter wliite rat« tlian tiioMS 
 of orn< -u't after itix nioiitk^' exjxwun* r»v«T i\f \V'«i|«i.h melting 
 I" ' Oil tlie other hand, further ■ ^ ' n iw that 
 
 111 . . "ive ex|)Ohun' does give '., atltct 
 
 kit f. t- kiui cause thetii to iKHoine i\ it animal 
 
 vt r\ Mii-itive to TNT. 
 
 Next, \>y the kindness of the mana>;ement hen-, we were 
 proviiied with a mean.s of aspirating the air from over the 
 molten T.X.T. in the \uinn, tlm>U(;ii a system for eolkxting 
 •■ fuiue " devi.sed as follows; A larj^e funnel was huiiy mouth 
 downwanl ri)j;ht over the centre of the lar{;e double jiu-ketctl 
 Utiler in which eru<le T.N.T. waH melted liy steaui. This waa 
 (oMiiccteil with a long wide ghiMM tulte which ||.»d i\t <tw jKjint a 
 nliiM.s wrM»l plug to cati'h any dutt ■f ■. ,,r con- 
 
 deii«e»l T.X.T. va|H>ur. Thi-* wide . ^uiother 
 
 Diitxide the hut. and a> the ex|KTiiM. i.ir three 
 
 weeks round aUiut Christmas, IKl.'i. th. ti.iii-ai.)U frum the hot 
 air in-ide to the <<ild outside sufli<'e<l to throw down any T X.T. 
 not ile|M)>ited on the funnel and IuIk- within*the warm hut. 
 Then- wen- a few delicate cryhtals of T.X.T. in this tuU- at the 
 end of the ex|KTimpnt, hut the main amount (and that, an will \w 
 sc«ii Im>Iow, not very much) was ftiund on the • - ' ,.f 
 the ftuuu-1, on the first gliuss tuU- and in the ^! 
 
 To make sun- r.f < ..ttip!<fc iil).-or|»tion, rli;rM ' <| 
 
 of till- ex|MiinH I,! f an entire -l i re 
 
 pl.i.cd .iftci {\u inenliomd re 
 
 surrounded, to . roughly, wn' .w 
 
 The whole sysUni w.i.^ uli.wiied hy tid>ing to a g.k» au ter, and 
 fn»m this in s«'rieM to a Hunsen'?' water suction pump. The air 
 WHS ikspiratetl away from ovi-r the molten T.X.T. at a rate of 
 ''lit douhle that at wliich a man would hrrathe. 
 
 The only thing which condensed in the \J tubes kept at the 
 ii ni|wratun' of carhonie-aciil snow was a few dropt* of .slightly 
 turlijil wat«'r conden.He^l fnim a<|Mcous va|>nur, which were in- 
 jected into a nihliit without any obvious n-nlt 
 
 The air was then aopirutcil for thre<> w< • > jli 
 
 the ap|>ivnitus. At the end f»f the exj V. 
 
 and ammonium nitrate could I-' f'>u'i'l . , in 
 
 the system. This wa*t thor i wul witji ether, ilic 
 
 ethcrtal solution drie«l and i: .lied and founil to be 
 
 alMiut <»-4 grnnune. Hy tin . ,,... ,, ; .kuil a melting jmint 
 determination a j>art of this sulx>ta>tcc w»« shownt to U* T X.T. 
 The n-mainder (Iwing almost the whole nf the o | gramme) wa» 
 then fc«l at one <lo-4 to a rabl>it wiili . .\ny oltM^rAable 
 
 toMc ciTiTt. a n^ult \i\ keeping' w ' i>»rr\"atioiu« on 
 
 the dinit eflcet* of foding l' XT i 
 
The apparatus had l)ccn working for a period of 40 shifts, 
 drawing air througli at doiililc the rate of human respiration, so 
 that if we wanted to calcuhite tiie amount breatiied bj' a workman 
 during a shift we should have to divide 0-4. grammes, or 400 
 milligrams, by 80, so obtaining 5 milligrams. The inhalation of 
 this amount can hurt nobody ; it corresponds fairly well with 
 what we later -obtained by even more precise methods of experi- 
 mentation in workshops, both at Factory F. and elsewhere. 
 
 The first case of poisoning which seemed to be attributable 
 to T.N.T. occurred early in 1915, and in tlie summer of 1915 
 there was the first fatal case. 
 
 The reason for believing at this period that " fume " rather 
 than " dust " was the causative agent was that these earlier 
 cases appeared exclusively amongst workers wdth hot molten 
 T.N.T. ; this occupation was not, on the whole, as dusty as 
 other occupations such as filling " exploder bags " or " hand- 
 stemming " with dry jiowder where as yet no cases had appeared. 
 
 A few months later, however, there occurred the death of 
 a worker filling " exploder bags " with pure dry T.N.T., who had 
 never been near molten T.N.T. 
 
 Widening our ^^ews someM'hat, we then asked, is this simply 
 another form of inhalation of fumes, or of very fine particles of 
 T.N.T. suspended in the air ? Sureh% in the case of a substance 
 with so. liigh a boiling point as T.N.T. the fumes would soon pass 
 from vapour into fine particles in solid form. 
 
 So, we set forward on that basis, recommending in factories all 
 possible devices for dust and fume prevention or removal, and 
 on the laboratory side, inventing an apparatus in which, by 
 Imocking and blowing a suspended bag containing T.N.T. powder, 
 an atmosphere containing fine dust could be blown at the head of 
 an animal. Rabbits exposed to tliis treatment for an hour daily 
 for weeks showed no signs of poisoning. 
 
 It also struck us at this point as pecidiar from the workshop 
 side that in the incorporating and grinding mills of certain 
 factories where the amoimt of dust was enormously greater than 
 elsewhere there had been no severe cases and very little minor 
 illness. 
 
 Two other disconcerting cases of T.N.T. jamidice, one of 
 them fatal, dropped in upon our train' of thought about this 
 period. One was the case of a wohian who only stencilled 
 shells, it is true in the same room as tamping or stemming was 
 done, but much more remote and less exposed to the dust. 
 The second case was more j^erplexing still, being that of a 
 woman who merely put Avaxed blocks containing T.N.T. 7nade 
 at quite another factory into shells, where there seemed no possi- 
 bility of dust or fume ; later on a second toxic jaundice case 
 occurred on this type of work where only waxed blocks were 
 handled. 
 
 Parallel to these events many laboratory experiments had 
 Bho\\Ti the low toxicity of T.N.T. administered by the mouth to 
 
15 
 
 the mujunty of (>])«-» uf lii>Kir..tury aiiiiiiiil, Ruch a.t nibtiit", 
 guinpa pitfs nnfl wliite rat*. CatH and dopn n?lieve<l thfm'»flv«i» 
 by vuiiiitiiiu up the dose, but wen- diHtinctly more affected than 
 the nMhiit-'. 
 
 A wmiplp of thcM> Ittl)oratorv ••.\[K'riinentH, nfU><tMl from many 
 of vitrialile length, on nocotitkt <>( prolun^e*! dunitioii, niuxt liere 
 «uf)iie. (So© abo Apjiendix K) 
 
 'I'wo rabhitM were eiuh yiviu 1 (;ruinmc (lO<) milli^fmniii) 
 «.f 'r NT. witli their f«MMl iluthj. i\.t|)l Smuhiy-, fnmi (VtoU-r l.'.th 
 (ill DfcemlK-r :JlMt, l'Jl.» ; lM>th <>f tht-w animaU not only nurviviNl, 
 hut tli<uri.she<l timl put on weight. 
 
 Ihily when Mich di»^es »s half a gmnime (.'MtO nullignirno), 
 <'normoUf«ly diMpn>|M>r1ioiiftle to aii\'tliirit; which an ojx-nitive 
 rould NWiillow at work, iw whowii Ik-Iow, weri- jjiven hy the mouth 
 to u rahhit, whs it |MM.Hih!e, and then only after thrc« or four 
 rapidly re|M-ate<l dofii^es, to kill the animal. 
 
 In many animals "f several s|K(ies we have patiently tri*«l to 
 n-proiUue typical T.X.T. jaundice hy re|MM' ' 
 hut in only three ,Huli-chn>nic cik.M's ditl w< 
 liver proiiounicd hy the pathol<>ni.-<t to Ik- m; 
 to «'arly TNT. |M)i.sonin(;. Tlii- i-* not n-maik. il.lt, for u l- !ni"i i 
 ou.tly difficult to obtain e\|M-riinentally the loioim of chnmic 
 lioisoning : thiw leail ))oisoninn n.s wen in oiH-nitive.t has never 
 IxHii n*pro<luce<l in IalKjratc»ry exiJerimentM, and, 80 far an uo 
 know, no jiharmacolo^.st hivs «-ver pnxluced alcoholic eirrluMix 
 of the liver by admini.stnttion of the druR to atiimalx. Tlu-'-e 
 three jMvsiiive restult.-* <iimpan<l with the tutai numlM-r of ex|Kri 
 mental animalt are imt a Ic-s pro|Mirtiiiii tli.iii the nuiiitxr >f 
 <a»e.s i(f toxic jftuiidite in workers ciimparc<l with the tot il I.;! 
 of workers on TNT. diir thanks are due to Dr llui 
 'rumbull, Dire«tor of the Patholouicrtl In.xtitute, I,ondoii II. 
 for uiulcrtakiiii; for us the |Hitholo|;ical inve>>ti);ation of the 
 <ir>;ans of thes«> animal.s, a.s well im tlios«< taken froni sevemi 
 «a.se« of human T.N.T. iKii.Honinjf.* The attempt.s arv still liein^; 
 <'or»tinue«l, but it mu«t l>c n-memben-*! in this coimrction what 
 a snjall projKirtion of T.N.T. o|M'nvtive« ever show typical lesions 
 of liver and kiilney so characteristic of fatal |<oi>onin(r 
 
 l>urit»>j the year 11>I«5 the output and manipulations of TNT 
 iiureas*-*! enormously, ami from alMnit .Manh in that year the 
 numU'r of ca.ses U-gan to incn-a^e to reach a maximum in AuKxi-t 
 and S>pt«'mlxr. 
 
 It was diirini; a visit to a ^mall factor)* II AVf near Ix>n<lon, 
 ill comjiftny with Dr. Iie|;j;e and Dr. Wyon in .Vujjnst, lOlfl, 
 that it first ooctirrwl to the writer that the trnubic might ariM* 
 thn^utih the skin. 
 
 The iM-ca-sion wa.s due to a ras#< having oeeurrwl in the preying 
 of T.X.T ix'llets fn>m dr> pure T.X.T.. and a visit !ihowe<l that 
 this work was carritnl out in small iwlatrd sh«<<U umler almnut 
 open-air ronditiomt; there wa.s no appreriable dii-t in the air, no 
 
 • Sfi IToc. R.v S.» ul MclKiiw. U>i:. X 4; 
 
smell of T.N.T. fumes, no ammonium nitrate, or molten T.N.T. 
 But the hands of the workers were dccpW stained and oily, 
 and a test for tlie presenee of T.N.T. in the urine, a test whieh one 
 of us (T. A. Webster) had just then evolved, indieated the presenee 
 of T.N.T. in their urine. Here, then, were ojieratives working 
 under conditions practically free from dust and fumes, but with 
 hands saturated with oil and T.N.T. Webster's test showed that 
 the T.N.T. was passing into their bodies, and T.N.T. illness had 
 been noted amongst tiiem. 
 
 (iii) Fate of Absorbed. T.N.T. 
 
 As AVebster's test indicated the presence of modified T.N.T. 
 in the urine, it formed a most important engine of research for us 
 in our future work, and it is more in this direction than as a 
 diagnostic or prognostic sign that it has its significance. 
 
 Our attention had been directed from an early period in the 
 research to the fate of absorbed T.N.T. in the l)ody ; we iiad 
 sought for its presence in the organs, faeces and urine of poisoned 
 animals, in the urine of patients suffering from toxic jaundice, 
 and in the organs of persons who died from the poison. 
 
 With the exception of (1) the organs of Vhite rats which died 
 after taking heroic doses of T.N.T. from acute T.N.T. poisoning, 
 (2) the faeces of rabbits which had received large doses by the 
 n'-outh, (3) the urine of white rats allowed to walk about in the 
 T.N.T. j)owder, Ave had not been able to trace the T.N.T. in the 
 body. . 
 
 The drug l^ehaves differently in different animals ; if the 
 white rat be given a dose by the mouth, or be allowed to walk 
 about in a box smeared over with T.N.T. dust, the urine shortly 
 thereafter acquires without any treatment tha.t pink colour which 
 is sho^A^l by T.N.T. solutions after treatment with alkaline akoliol. 
 This is the only animal experimented upon by us in whieh the 
 coloi'.r reaction appears in the urine straight away ; the lu-ine 
 in Uiese animals is pink even in the bladder. It is interesting 
 to speculate what the consequence would have been ha.d the 
 human organism behaved like that of these rats, for then the 
 majority of our tens of thousands of T.N.T. workers would be 
 pa sing a bright pink urine. 
 
 In the ea.se of the rabbit and the human being the colour may 
 be shown in the urine by the procedure presently to be described ; 
 in the cr.t we have failed to obtain it even by this procedure. 
 •Another .'ubstance related to T.N.T. is detectable in their urine, 
 giving qiiite a different colour reaction. This difference maj* 
 perhaps le related to the higher susceptibility of the cat. 
 
 Webster's Test. Although T.N.T. and also the modifications 
 formed from it in the bodj^ are easily soluble in ether, yet, if the 
 urine containing the excreted compound be sliaken up with 
 ether, and the ether be separated and tested with alkaline alcohol, 
 no colouration results, showing that the ether has failed to remove 
 it. But if the urine be mixed with an equal volume of 20 per 
 
cent, hiilphiini- a«nl solution,* tind i. ■ ' • r, 
 
 the etliiT s<|)iinttt<l and washed fn< u 
 
 tiiitrd ^vitti ikikalino ivli-ohul, the [uiil 'li 
 
 of T.N.T. iitid a ntluctiua dfrivativc u( ii (oriui<U tii lUo Uxiy 
 u|t|H-ar>«. 
 
 Wlu-n ihf amount of T.N.T. in a Miniplo it Iart»f. giving rwo to 
 a MLipition of contaminatiun of tin- urin«" by kiuI.k t with nkin, 
 hair or rlotliing, thf urine whould bt< extnuN-.! lir-' \m(1» t-iher 
 without adiUng any atid ; if a pink rolour tls !i ailding 
 
 nlkalino al.ohul. it is dui- to T.S.T. uj a.r Hut th.- 
 
 ii|Hfiinfn III-*"! not Jh* thrown away, th"' lii .tti t-ther 
 
 without acidifying lia«* n-niovt-*! tho T.S.T. »/ cunUintnntum : 
 nil that is tic<'"..>ary now, to di.icliw**' tlio ino<liii<-<l T.N.T. wluth 
 him pus.teil thnniijh the nyatetn, is to tK-idify a.-* dintttti alxjvi-, 
 ithakc out with ither again, 8C|>anwto tlio ether, and tost with 
 nUohitlii- iK>ta.«h. 
 
 l'\.k' t dotail.s and quantiticit for larryii • ^t have 
 
 ain ly li'<n finulatcd to th<' fmlorii-!*. I ' for th«» 
 
 pur|M>H«-t of ihi.s pa[Mr to htato that, ahhoii. •• way uf 
 
 innkii'g till- test quantitativf i.t known at pn..M;;t. i.\uh ol»*'rv«T 
 ran agnv u|K>n an cinpirii-al ntandani fur himself for judging 
 variou.s ticgrec!* of intcnuity. 
 
 Having found this t(>>4t for the ]taM«agc of T.N.T. through the 
 Ixidy of tho rabbit, no time was lost in determining whether it 
 applied to human U-ing.s, by obtaining namph-s from T.N.T. 
 worki'pt .-.• vi'.rioMs ffifurit-, iu>d by taking d'».(s of T.N.T. 
 oiin*olvi-s. Korf Mil it. 1\ i; xwis fmind that tin? human Ix-ing 
 abnorlMng TNT ' \n this mtMUfitdfarm, ami na we had 
 
 at i>ur ili>po-.il I I to our n->earvlM'>«. of whieh wt at 
 
 on«e pnMev«Ird !■ . i-. 
 
 IJefor«> taking up the tah* of the.se again, a few wonh« may lie 
 dcv<>t,.d to the rliantf."* whi'h T NT mm«1its«w>« in tho bo.lv 
 
 I ■ ■ .. I. 
 
 i.tliir. 
 
 The < hangcs »*crc »tudit>tl in tin- rabbit's urine, beeaiiso of 
 till dil1i' iiltieti of colU-t-tion of hiinuut urine nt workx and the 
 \iv .1 ••' in the degree to whieh this wa.<« lo«de«l with T.N.T. 
 
 I ii I l>bit 19 a highly rv^iMtant animal, im> tii.it by feeding 
 on T .N r. Its urine mii U- loadi-*! with TNT. d« rivative an<l a 
 aufliiiciit ikinount scp.inHcil f.>r an.dysis anri idiMtiru-alion. 
 
 Thi' urines of pra. lu.klly all worker* in T.N.T. eontain thi.* 
 wulk^taiue. but in some th<"re in only a minute tnieo. in othen* 
 an inleiLse ri^nctinn. aiul then' may be a high rvai-tion wherr there 
 is no sign of T.N T " ^ n •.,-•'; •' ■ -• > -, 
 
 »>f n'action 
 
TIlis work has been carried out Ijy Mr. T. A. Webster and 
 Dr. G. A. Wyon — Mr. Webster underlaking the ehemical side, and 
 Dr. Wyon the physiologieal prepaivition and tests on the animals. 
 This work commenced independently ha.s been continued under the 
 super\asion of Dr. H. H. Dale, F.R.S., and Dr. Barger in the 
 Bio-ehemical Department of the Medical Research Committee, at 
 the Lister Institute, and our warmest thanks are due to our 
 colleagues of this department for the special knowledge which 
 they have so freely placed at our disposal. 
 
 The researches will form the subject of a sjjccial memoir, 
 so the proofs and details of experimentation need not be given 
 here. It may, however, be said that the solution of the problem 
 is now practically complete, and that the interesting changes 
 undergone by T.N.T. in passing through the body are as follows : — 
 
 The colour obtained when T.N.T. urine is treated as in 
 Webster's test is not due to T.N.T. itself, but to a substance 
 formed from it by the reduction of one of the nitro-groups. This 
 substance is 2:6 dinitro, 4 hydroxj-lamino-toluenc. It is 
 excreted in the urine, conjugated with glycuronic acid, from 
 which it is liberated by the treatment with acid. 
 
 The fact that the tri-nitro-toluene after the prehminary reduction is 
 finally excreted as an ester of glycuronic acid is of interest because 
 glycuronic acid shares with the sulphonic esters, or the so-called ethereal, 
 sulphates, the task of removing from the body in innocuous form such a 
 large number of poisonous substances. These poisons may either be 
 formed autogenously in the body by physiological or pathological pro- 
 cesses, or obtain admission by some channel from without the body. 
 
 Examples of the first category are the phenolic compounds such as 
 indol and skatol, which are formed in putrefactive processes in the large 
 intestine. When unpaired they are highly poisonous, but if conjugated 
 with glycuronic acid they are harmlessly excreted as esters, and are found 
 in this condition in the urine. The number of drugs which after adminis- 
 tration are excreted as glycuronates is legion, and one of the chief methods 
 for obtaining glycuronic acid is the daily administration of such drugs 
 to a resistant animal. For example, camphor may be administered for 
 this purpose to rabbits. Amongst drugs which appear conjugated wth 
 glycuronic acid in the urine are cliloral hydrate, phenol, resorcin, syn- 
 thetic febrifuges, menthol, camphor, sandal oil, p-naphthol and morphine. 
 
 A most interesting example of the formation of a glycuronic ester is 
 that recorded by M. Jaffe {Z. f. physio!. Chewie. Bd. 2, 1878, S. 47), which 
 occurs when ortho-mono-nitro-toluene is administered to dogs. The 
 para- and meta-isomers do not yield such esters, but conjugate with 
 glycocoll and with hippuric acid. 
 
 In view of the extreme tolerance for tri-nitro-toluene of herbivora, as 
 contrasted with carnivora, it is noteworthy that amongst the large number 
 of substances which are rendered less noxious in the body by conjugation 
 with glycuronic acid, many can only be so united by herbivora, while 
 others can be dealt with in much greater quantities by the herbivora than 
 bj' the carnivora. 
 
 Man with liis mixed diet stands in an intermediate position. 
 
 Various diets yield varying amounts of glycuronates or glycuronate 
 esters utilizable for countering these poisons, and it would appear of 
 importance to provide for all workers on toxic nitra-compounds of 
 benzene, phenol or toluene, a diet which will yield a good supply of 
 glycuronates. Such a diet should contain plenty of fresh vegetables 
 and fruit, and be, in fact, arranged on the principles of anti-scorbutic diet. 
 
There nwy be a utrtiggle between the p<jis., 
 from witlmut, such ait ttiiiitro- toluene, and th'^ 
 the intestmr. hutli as pi,. n ,1. .r.-^..l, m.I..I. .1:1; 
 flycuroiuc acid wh 
 die aupiily is in^u^: 
 either th..H>- rif o 
 
 typr •• >■• > ■■■<' ■ 
 Whi' !. 
 
 Th.n 
 
 It is ifn|)<<rt.uit to note the reaembtance between certain 
 of T.N T jH.iM.niiii', *u.:h a* fmrftuta lnrmitrrhaffii.t. ,uu1 tlMtw-'' 
 
 In a P! •. . * ( r V r ... . 
 
 »uU .' 
 
 aur 1. 
 
 rct«-n' . 
 
 Icaturc. an,! .u .■;:. .a 
 
 gums, aiul till- titlU \\<: 
 
 •corbutii ir.Mtiiiciit . I.u 
 left (rrr in tlw I.|.h„| i; 
 illllcrriit (1..111 tti.il «t,i. '.I 
 amount i.f il.iiii.i>;c iii.i\ 
 bqiatiL cclU. «liiih i>tii..it.. >... .Ml, ,. :,„:., 
 
 Additmnal weight is given ti> thcno olitt-rvntionii bv the result 
 in a recent i..i|-r t.v I!;Ur(. M It. -J,,,,: Z, if, '. . I!.! (VS, I'.i 
 in wIikIi .1 
 rabbit-. Ill 
 firt- olli.r , 
 «ij ni'- •' 
 hrM 1 
 ubK 
 
 in tl. 
 
 mriill t 
 
 thuu 
 
 ot,- 
 
 an- 1 
 
 tionit 
 
 ccmjiig.iU- M> .u lu iiaJir lliciu ... 
 
 rhlni ■ : I 
 
 lunl ; •' 
 
 id raMly i.-ul.ktid uiul uU iitilittt. 
 
 It liiK liit-u JMilntrtl frniu the urinra of rnhhitA oitd n r 1 i > 
 iiiftH tl il \Mili 1" N.T. ; niso from human urino nftrr tl,. .,r,il 
 mlnuiu t; 11 1. .f T.N.T , nr.il fmiu tlio uriiw <>f Mi.rk< r- i:t 
 T.N.T. f.i' I, 11, . It in not prfstnt in the urinr of cnt.-i |Mii<Ktnt<I 
 J>y adiiuniotrution of T.N.T. 
 
 The rrlationship of thcsr two Hrnv.\tivi « to Iho original iri- 
 nitro iuhirn«< Am 'hown l>v tlir foil,- .1 v| formulip : 
 
Symmetrical 
 
 Tii niliotohicnc 
 
 T.N.T. 
 
 2 : 6 Dinitro— 4, 
 hydroxylaminotolucne. 
 
 Azoxy- 
 compound. 
 
 CH3 CH3 
 
 rN'_n _N 
 
 HNOH 
 
 United in urine to 
 another substance not 
 derived from T.N.T. 
 Wlien freed and 
 treated with alkaUne 
 alcohol gives pink 
 colour (Webster's test). 
 
 Formed synthelic- 
 allv by reduction of 
 T.N.T. 
 
 A z o X y-c o m p ound 
 2 : 6 dinitro, 4, azoxy- 
 tolucne formed by con- 
 densation of previous 
 compound by acid or 
 alkali. Gives perman- 
 ent blue with alkaline 
 alcohol. Both urinary 
 derivative and syn- 
 thetic ones give this 
 test. 
 
 In the free condition the hydroxylamine derivative is not 
 innocuous ; in fact, exijeriments on animals show that it has 
 about treble the toxicity of T.N.T. 
 
 The action upon T.N.T. in the cat (which, like the dog, is 
 much more susceptible than other species of animal) diilcrs from 
 that in the rabbit and man, where the colour tests would appear 
 to indicate identity of action. No pink colouration is obtained 
 when Webster's test is applied after administration of T.N.T. in 
 cats, but instead a yellow colour. Tlus yellow is only obtained 
 when T.N.T. is given. The substance giving the yellow colour has 
 not yet been isolated, but it is hoped as soon as opjjortunity 
 serves to carry out more experiments on the subject. 
 
 Taking up again the historical thread of our progress on the 
 workshoji side of the investigation, wc had found that cases 
 of toxic jaundice had now occurred not only amongst \\orkers 
 with molten amatol, but (1) with workers with pure dry T.X.T., 
 (2) with dry amatol, (3) with cold waxed block charges, and (4) 
 finally, amongst pellet -compressors ^\■here both dust and fume 
 in the air were at a minimum. 
 
 The hands of tliis latter class of workers were oily and deeply 
 stained from coming in contact with pure T.N.T. pellets and 
 pure T.N.T. on the benches, but there was practically no T.N.T. 
 dust in the air, and no smell of T.N.T. fume. Also, the Webster 
 test showed that T.N.T. was passing in varying degrees tlirough 
 the systems of these workers. 
 
 It was this situation which decided us upon making the 
 prolonged and crucial research at Factory F. wliich, iinally, 
 indicated clearly the share taken by the different channels in 
 admitting T.N.T. to the body. 
 
21 
 
 Tho inception und conduct of tluH rei«-iin.h niujit now Ijo 
 dcHcrilxMl, but Ix-fore doing ho, in <ir<lcr to prv»*orvo tiifitoriciil 
 continuity, it in ncct-tMary to givu Iteio Hotno iiicount of a nunilMrr 
 of |x'culiiir aberrant cawtit, turniinutint; fatally, tho first two of 
 which luau) under obtiervution Ixjlwwn August and September, 
 lUlU. 
 
 (iii) Aplaatic Amtmia caused by T.X.T. Puisonimj. 
 
 One of the carlieMt of th«'-H« cas*** I luiw wiw at FiK'tory 
 W.. by the courtesy uf Major I'. S. O'Heilly. K.A.M.C . «eiu..r 
 medical ollicer, who thn>UKhout the whole of then*- n-«-.in h<H 
 tuiM always put himself unweariedly at our M-rvice in the niidit 
 of luH abuniLtnce of otlicial duticH. 
 
 The patient was a man who had In'tii for some months engaged 
 on amatol work, and who hud never lMH>n known to have ln-<ti 
 jaundice<i, but he hiwl grown progreswively worxe fnjm 
 ami when we miw him he looked the picture of ptrnicunm n 
 this was, indeed, what his disease was Kupi>OMil to lx« in s|ii,.- ct 
 the [MTplexity intnMluctil by his eontiut with T.N'.T., and al»o by 
 the fact that he hml forn\erly W'vix a painter. 
 
 HIihmI films were taken, staininl, and examined, when the 
 n>markable fait wiw discovere<l that none of the charicteriiitic 
 bliMxl ehiuige.s of |H'niicious aniemia wen* present. 
 
 The films might have iM-eii taken from a healthy per»on, ami 
 in this we were coiilirmed by Dr. Willi. mi HiiH.rIi, F.K.'s., of 
 the l,on<lon fiospital. who kindly examined them for us. 'i'ho 
 only change that could be dett-ctetl was a certain varial>ility 
 in siz«5 of the re<lbloo<l cor])U.Hclen, but there were no nuije.ited 
 red torpuscU'.s, no |)oikilo<-vte.s and no abnonnalities in the wluto 
 cells. 
 
 Dr. Wyon and the writer then went do\ui to Fmtory \V. and 
 madi* counts of th)* red blood eorpu.seles, and al-<o haein<i;;|iibin 
 determinations, when the true state <>f iilT.iirs wa-; at <uice 
 revealed ; the numlM-r of re<l McmmI ei.rpii-. les was i.iily l,2«Ht,0<J<J 
 |HT cubic millituetn< and the haemoglobin |iereentage 30. 
 
 The case terminate<l fatally, and an examination of the organs 
 by Dr. liulxTt M. Tunil>ull showiMl that the eas<« wivs, as indicated 
 by the alxive determinatioits, one of npluMir niurmin* 
 
 Mad this cMeurreii solely it might have Imh-h doubtful whether 
 it was due t<) T.X.T., but just a week prior to the making of tho 
 bloo<l counts menlioneil alwive, I had l>een taken by Dr. T .M. 
 \*'\lft,v to .m««» an exactly similar case of a woman «i>rker im T.N'.T. 
 at WatfonI ; then* had hen' also U-en no dear ol>serviition <)f 
 jaundice, then- lm«l certainly l>e«'n nn marLnl jaundice and there 
 was none when we saw her she had In-^-n treati-d for intluenzA 
 ami then for gastritis. The nnn>mia wa* prr>found. the IiUmkI flow 
 on pricking the linger w-n.s scanty and tiiin, not welling up into » 
 dntp, but spreading in a thin dark layer over the akin, Mtd it wa« 
 with diflicultv that films were obtained. 
 
22 
 
 These films on cxainiiiatiou gave the same result as in the case 
 of the man above, viz., almost normal con<lition of both white 
 and red cells, ^vith a certain amount of variation in the diameters 
 of the red cells. 
 
 Four days after our visit this patient died. On account of 
 default in notification of the death, the post-mortem examination 
 was delayed for four days, and this prevented histological examina- 
 tion of the organs. The autopsy was carried out by Dr. Leggc, 
 and the liver was foiind atrophied, fibrosed, and very shrunken 
 from before backwards in the middle lobe, in the manner typical 
 of so many cases of T.N.T. poisoning. There was no question 
 in our minds that death had resulted from T.N.T. absorption. 
 
 Tliere have since been recorded at least four other deaths 
 from this aplastic ancemia due to T.N.T. absorption, making six 
 in all. 
 
 Quite recently the writer saw at Northwich, under the care of 
 Dr. R. Mainwaring White, a ease of a woman munition worker 
 who had worked at a manufactui'ing chemical T.N.T. plant ; there 
 was no jaundice when she was first seen, and we were assured there 
 had been none. It was almost certainly an aplastic anaemia case 
 of milder type. The prognosis was grave, but she is still living, 
 and, we are given to understand, slowly recovering. 
 
 II. Researches at Factory F. 
 (i) Methods and Eestdts. 
 
 It was this research which gave us the key to the causation 
 of T.N.T. poisoning and thence led on to the institution in logical 
 sequence of means for its prevention. 
 
 Observations were made in the workshop and imder workshop 
 conditions on the workpeople and on ourselves, and these showed 
 quite conclusively that the all-important channel of absorption 
 is the sldn. 
 
 It was shown by testing the value of the more efficient 
 respirators that the effect upon the amount of poison passing 
 through the system was almost negligible. Also that when the 
 hands of workers, or our .own hands when we carried out the 
 same operations, were completely protected, the amount then 
 absorbed as showir by the urinary reaction dwindled to a trace. 
 In confirmation of these observations, direct analj^ses of the air 
 of the Avorkshop for the amount of T.N.T. which any worker 
 would breathe during a shift showed that this is so minute a 
 quantity as to be incapable by itself of doing any miseliief. 
 
 In such workshop investigations there are at any one time 
 hundreds of individuals under naturally arranged expei'imental 
 conditions vmavoidably exposed, and, imder the conditions of our 
 research, which were quite different from those of a rapid visit, 
 it was possible by close and continued exjiericnce to get accus- 
 tomed to the appearances of workers suspected of suffering from 
 the effects of T.N.T. poisoning, and to observe with continuity 
 how the minor symptoms led up to the more serious events. 
 
Ill tins i„.ii,)i.-I It wa 
 |x)is(>ii is (III I lie lilixxl. 1 
 gidilinos, ii.kUH<-a, luul, 
 
 cyttii<)-.i-, ami |)allr)r». whKli toul.l 1m n.i*..l la •^•\*f^l . a« - .>ii 
 to 8«-v<r<- tiixio juuiiiiice. Fiktal nt>ultrt were avoided \>y prrjuiptly 
 tuniiiij^ ciiw.n ohuu'ing the initial Kyiii|)tuint oil contact with llio 
 
 |X)iMII|. 
 
 Ax a nwult o( thcHO contiiuufl oWrvAt ionn in th« fA/>(orv, 
 wo \vir«> able in OitolH-r. 1916, Id •.iijjjii-tt n t 
 teristic of early T.N'.T. jMiisoninj;, Ix-fun- i! 
 and to it-iomnuMid tliat di-tii-tion Hhoiild Im : 
 nigns by ulwcTViTs |witri>llin>{ and ul)»MTvnin i\.- .v..i k-h'j. 
 
 Thi-rtJ i«, \v«' lH-lifv»', n«»o<l ••vidciKt- Iwiit-d Ixjtii ujxm tlio 
 jttatonu-nt.H of factory doctors and oti tin- inoiitlily Monn' (»ili<o 
 Itftiims, that xvhiTf thin KVitotn ban Im-cu carrii-<l out illiciriilly, 
 the tide of toxic jaundice haH shrunk to a small fnwtion of it8 
 former value, atul on the other hand in faetorieM when- thin 
 early workshop cUtection ban not Ikkmi efficiently carrieti on there 
 have l»ocn tleathn froni to\ic jaundice. 
 
 Wo have sonu* reason to c|ain> that these workshop exj>eri- 
 nients and observations h.ivc ItHl to the saving; of life, to tho 
 rwlui'tion of the volume of minor T.N'.T. illne-'S. and so by a 
 saviiij; of labour tliroui;h the di-cri-a-e in the nundn-rs of absenti'«>«, 
 to results of considerable economic vidue. 
 
 Analyses of the air in the sho|>s combine<l with tho demon- 
 stration that only a ne^li|;ible amount of T.N'.T. wa.s >twalli>wcd 
 by a worker who did not u.so a respirator, have free<l the workers 
 fn)m the discomfort of wearing n-spinitors and save<l their 
 provision. The work ba.s also shown the inutility of |M-nneablo 
 cotton gloves, the wearing of which oidy makes the skin M>ft, 
 flushed an<l more ])ernu-able. These, with the laudable obje<t 
 of protection, were supplied fn-*- to every T.N'.T. worker, and their 
 UM- made so far as {x>ssible oonipulsorv. 
 
 Sui b n-xult.s flemonstnite the im|M>rtanc(> of medical rr-searrh 
 carried out in the actual workshops, and we an* greatly iiulebtcti 
 to the facilities offered u."* at Favershani. 
 
 It was in Auj;ust, 1910, while visiting the Amatol Pn's 
 i{iM>ms along with Dr. T. M. I>*gge that this factory nvu-anb 
 was first discu«-cd. I>r. l^egge had brought with him i ^ ' 
 (Sonuan respirator, which is a valval metallic l»ox p 
 usofl by workmen who are employetl whert* then* are jv 
 fun>es or gases in the air The pure inconune air is ' 
 by a long wid»' lublxT tulH* froni the o|M>n nir out.-icle. 
 e.\pired air is >.imply breathed out into the workshop tin 
 mica flap valve, o|»etiing outwnrtLt. 
 
 It was a ipte>tiot\ whether on aerount of their irkMimencM 
 
 fropj weight and tuljo altachmcnto thrae rMpirat"*-" '■' '— 
 
 worn AS A daily routine by working girin for m 
 
 * .Mmixt siniiLir cHctts. <lur t>» the rxpl<«ivr diniti 
 to m.\nv clf'nth-s. »rr rrcordr»l t>v French ob—rvrr^ 
 
shift, but it was thought feasible that we might get a selected 
 number of the girls to wear them for some days, while daily 
 analyses were made of the urine by Webster's test in order to 
 determine how much T.N.T. was really tr.ken up by the mouth 
 and nose. 
 
 It was pointed out by the writer that the amount of T.N.T. 
 dust in the air at the level of the workers' mouths was very 
 small, as it all fell floorward from the level of the machine moulds, 
 so that while there was plenty of dust (at this period) on floor, 
 benches, and the girls' dresses, very little dust settled on ledges 
 above their heads. These ledges, we were assured, had not 
 been dusted for some time. 
 
 This contention as to the small amount of dust in the air was 
 not admitted by others present, who appealed to the bitter taste 
 in the mouth and the irritation of the nostrils. It was accordingly 
 determined to make analyses of the air for dust and fumes at the 
 level of the workers' mouths with the results shown below. 
 
 The process employed in this factory consists in compressing 
 the T.N.T. powder into Large pellets. Two girls work at each 
 machine, one measuring or weigliing with ordinary scales,the charge 
 of powder taken from a box-full alongside, and tipping it into the 
 mould, the other girl manipulates the macliine, takes the moidded 
 pellet, which has alwaj's some loose dust about it, out of the 
 mould with her hand and places it in a box. 
 
 The Avi-iter asked several girls to remove the cotton gloves 
 with which they were supplied, and found the powder inside 
 caked in the creases of the skin in many cases, and quite wet 
 from perspiration. The skin of the hand was in many cases soft, 
 and the skins of all the hands were a deep orange colour. It was 
 evident that the gloves were perfectly useless as a means of 
 keeping the powder oif the skin ; indeed, on the contrary that 
 they were i)robably harmful in making the skin soft and moist, 
 and holding the powder to it like a poultice cloth. 
 
 Our suspicions of the dust and fume theoi-y had already been 
 aroused, and the importance of the skin channel presented to 
 our minds at our visit to H.W.C. (page 15) a few weeks 
 previously ; here seemed to be more evidence pointing in the 
 same direction. 
 
 It was determined therefore that wliile one set of girls were 
 protected as completely as possible from dust and fume swallowing 
 or inhalation by respirators, and not otherwnse intei-fered with ; 
 another set, or some of ourselves, should take the risk of dis- 
 pensing entirely M'ith respirators so that we swallowed as much 
 as was avciilable of dust and fume while actually working, but 
 should have our hands protected as completely as possible with 
 rubber gloves, and other means, to keep the T.N.T. off this most 
 important part of the skin where the powder is rubbed in during 
 the process of labour. 
 
 The Webster test of the urine was to be made as quantitatively 
 as possible for the two sets of workers — so that a good idea might 
 
35 
 
 be i;.itluTc(l iir)t ((Illy of whether the |>oiiiuii entered \ty one or 
 both of thrsf iIuuimi-Im, but ali»o Honie cMtiinatton might emerge &« 
 to their n-liitive im()ortanci*. 
 
 Dr. Ix'KKe ttpi>rottchetl the clirectonvte of the factory, who 
 rfji'lily uraiitiHl |H<riiu>wion for the n-Hfanh to \» carried out ; 
 not only ho, but tlwV pliMt-d a nniall wi-ll rquipiKtl laboratory in 
 the ;;roun(U mljiif<-iit to flu- fintory ontin-ly at uiir ilixito-al 
 ivMil iiicurml a con.'^iilorablc f.x|H-n<iitur*- upon chcmit-al-i uii>i «tlicr 
 inattriaU for our um*'. 
 
 TIm' thi'ii niana</int; <lirti'tor, the late Mr. \\'at«»ori Smith, did 
 »'Vfrythinj^ in hi-* i>ow«t to facilitate <iur lalx)unt, and our thanlu 
 for much valuable help an* duo to Mr. H. Minter, worlw mana(;er, 
 and idl his Htatl. and to the workers aUo, for their patient 
 aHNJstance. 
 
 (ii) AV/vriwi'M/j wilh Siebe Ciorimin Respirators. 
 
 Two of the hMiall worlothops eiwh containing two machines 
 oper.wtfd by four work<rs were Mele<"t«'d, and litti-d up with wide 
 rubber tubes d— -igned to p.iss from the rewpiratnr-^ l'> the uih-ii 
 air out-sich' near the r«)of. Similar tulx's were al'^ii arranued 
 to be connected uutitidu to an ehi-tric vacuum air pump and 
 iiisidu to an abMorbiin; a|>paratus for catching T.X.T. du><t nr 
 fume. This con.«iHted of two tubes in serien, the tirsit contain- 
 ing water through which the workshop air conid >»•• Hucki-*! 
 When makini; an ex[Mrimcnt the ii' ' ' ' 
 
 at the level of tlic n..-,c and mouth «.i 
 to the machine, uit<l as favoiintbls 
 
 catching any du^t which mi^'ht Ih> in tlic ;ur N') ii. •!•■ . I' NT. 
 is used in or near llie-e sheds, but scveml fatal cases i.f T.X.T. 
 [Mii.soiiin)^ have occurn<l amongst the workers in them. 
 
 Kxperinunl 1 in Shop So. 1. Two girls, V. Met.', ai.d L. F., 
 consented to wear the respirators. They won* them all d»y 
 on Momlay, Sj-ptemUr 4th. 11)10. and the >:i "f 
 
 SepfemlK-r '>th, but had to take them off on ^ ii. 
 
 7th and sth <»n account of sore faces causi><| i.<. in- 
 
 of tlu" riil>lx-r pads. Advantage was takeit of thi.-' mitrini -ion 
 to establish the iiilcti-ity of the urinary reaction when no 
 respirators were worn as followH : — 
 
 \' McC. Tuesday, Soptomlirr .ith ... R. 2 
 
 Thursilav. .'^•■ptembrr 7th ... H. 4 
 
 \. F. Tue««lav". ^ i. ... K. 2 
 
 Thiintchiy. - U ... R. » 
 
 The lower pcii..., ,n l,.i': r in the wwl. . ;.- 
 
 to the partiid •' week end. 
 
 During our ■ v F. holh on diffrrvnt wr«k-4>nds 
 
 and a munition \\.>n,' n . i y^ 
 
 OS we could, first wli-n 
 
 or immetliatcly after tic -t 
 
 t>efort> they retunietl un M'li'l.ns ,.r .>f th'> enl of flir (,>iir i\.\W 
 
2G 
 
 holiday. There was in the average a decided drop in the intensity 
 of the reaction, some urines almost completely cleared, but 
 manj' still showed a good deal of the T.N.T. derivative on the 
 Monday morning. (See Appendix A for details.) 
 
 Tlie two girls above-mentioned resumed wearing the 
 respirators on Saturday, Se))ten'iber 9th, their faces having healed 
 with the rest, and tiiey wore them constantly while at work until 
 Friday, September loth, thus making a complete week. They 
 could not stand the respirators any longer, on account of the 
 skin irritation and discomfort. The results of the urinary 
 reactions were as follows :■ — 
 V. McC. 
 
 Saturday, September 9th R. 4 
 
 Wednesday, September 13th ; Thursday, 
 September 14th ; and Friday, Sep- 
 tember 15th R. intense each time 
 
 L F. 
 
 Saturday, September 9th R. 3 
 
 Wednesday, September 13th ; Thursday, 
 September 14th ; and Friday, Sep- 
 tember 15th R. intense each time 
 
 It is thus seen that in the three later days of the week of 
 ■^'earing the respirator the reaction for T.N.T. in the urines 
 of these two girls was " intense," and as no visible effect on the 
 urine had been obtained and the respirators were making the 
 girls' faces sore, the experiment was discontinued. 
 
 Experiment 2 in Shop No. 2. Four girls wore respirators, 
 of whom two left the works in the course of the experiment. 
 This v^as compensated for by the behaviour of one of the other 
 two girls, E. S., Mho wore her respirator well and uncomplain- 
 ingly for nearly a fortnight. This girl did all in her power to 
 help us, being interested in the work, and she later helped us 
 in the complementary experiment with her hands protected from 
 contact (see below). 
 
 (1) L. G. Started wearing respirator Tuesday. September 5th, 
 and wore it till September Sth. Urinary reactions : September 
 7th, R. intense ; September Sth, R. intense. Left works. 
 
 (2) S. T. Started wearing respirator Tuesday, September 
 Sth, and wore it from Tuesday, Septcmlter 5th, till Saturday, 
 September 9th, then again the next week on Monday and Tuesday, 
 when she also left works. Urinary reactions : Tuesday, Sep- 
 tember 5th, R. 3 ; Thursday, September 7th, R. intense ; Saturday, 
 September 9th, R. intense. 
 
 (3) R. A. Wore respirator from Tuesday, September 5th, 
 till Saturday, September 9th, and again in following week 
 from Mondaj% September 11th, till Saturday, September 16th ; 
 but it was more irksome to her than to next subject (E. S.), 
 and she occasionally took it off. The greater jjart of the 
 period, however, she wore it. Urinary reactions : Tuesday, 
 
27 
 
 September Sth, R. 3 ; Satimlay. S«-|it.iiili.r 0th It 4, 1 
 September 12th, K. 3. Xo hitt-r HiKtiniiMi-* ubtaiiiitblc. 
 
 (4) E. S. Started wcArin<< renpinitor on Tuc»tlny, - 
 ber Tith, wuru it cotuttuntly uiui wi*ll nn<l wax k<-<-ii mi 
 it, up to and including; Friday, SeptemU-r Hth. Sin 
 eomu to work on S<it unlay, S«'pteniU'r l»th, but r< 
 home and did not j{o ni-ar any T.X.T. She rt»jtnrii»v| 
 it on Monday. .StptendM-r lltli, and wore it eofi-.t i 
 work until Sutunlay, S<'ptiiiil>cr HUh inclu.Hivf, !• 
 \ifis than a fortiiinht of working jK-riodM. rrin i 
 Tueftday. ScptiMuljiT .'»th, It. 3 ; 'rhunMlay, .""n-pteiub i 7.ii, It J . 
 Friday, Soptendn-r Hth. U. 4; TuoHtlay. SfptfiidK-r ll'th. K 4. 
 No lattT Humpli* ol)tainabU'. (Contnist thivHc with rt-iults of »km 
 protection in thin name girl as given Ik'Iow.) 
 
 Ah there was no diminution in the reiiotiou and tho girl'n 
 face was Ijeinj; ma lo sore by tho respirator pati, tho experiment 
 was discontinued. 
 
 TluTo is tlius no evidence that in any of thcM.* girU tlieru was 
 any decrejisc in the amount of altertxl T.X.T. Ix'ing excri'tetl an 
 the result of wiarinj; the nuist complete re«pinktory prutfotion 
 that couM Ik' ^ugj;.Ht.'d. 
 
 (iii) KxperiiiunU on Absorption by (he Skin alone, other channels 
 being purposely txclwletl. 
 
 The aUjvo ex{>«"rimenls haviti^ shown of how HmoU im|M>rtaneo 
 atksorption fron» the air liy swallowing or breathin.; ••' " i .. i.. 
 nary workshop ronditioiiM, wo <letermin<Hl to m 
 of i'X|HTim<'utH iijM)ii ourselves in M'hieh oidv fh- li 
 should Im< e.xiMwed to the [M.i 
 
 when thesulije. t of exjHTilMelii 
 
 any part of th'- fji^-tory i>r wori. 
 
 diLst or fuiue. After shiiwint; l.\ tl\. ;•;!! I'iiMi ..f tir ;!; iv 
 tt>8t that our systems wen' fn>e fn>m TNT., we either rubbil 
 T.N.T. into the ]mlms of our hamU (much as a girl would Ix' 
 expoAfil to T.N.T. eontaot in haiulling pcUeta) or else dusted 
 it into our soekA. 
 
 Exju-rimrnU I aivl 2 mulr on II. M. After p " u 
 
 visitini? the worksho|M for a d.»y the urine was te^. I 
 
 only tlie fainfi'>.f trace of TNT i .■. 'ion. W :: 
 
 Ab<uit in the lar^e orehani att • i. tnry. li. .M r':!i!><.d 
 
 T.N.T. into the |vilms of his h ilnnit in thoh uvl* .^n 
 
 amatol pellet rontainiuk; 2<> [" : i NT. After two h'Mir* 
 
 A sinn-imen «>f urine WiH |wssr»l. ami this siiowtHl n <listinct T.N.T. 
 reaction. This n-action went on increasing until next day when 
 then> was (juite a stn>n>; nwtion, lyina in intensity about at tho 
 average given by the urine of the shop worker. The rtd)bing 
 in of the amatol on the previous day had U-en kept up inter- 
 mittently for about six hour>*. after which the hand* were wished 
 with soap and >Tater. The T.N.T. Fraction remnined in grvluivlly 
 
28 
 
 decreasing intensity for a period of ten days, after which the 
 urine became clear, althougli 13. M. neither rubbed T.N.T. in 
 again, nor went near any Hource of dust or fume. 
 
 Tiie first morning after ru))hing in, 13. ]M. awoke with all the 
 symptoms of a minor attack of T.N.T. illness. 
 
 He had a marked frontal headache, a feeling of nausea, and 
 intermittent abdominal pain. This abated towards evening, 
 but a feeling of malaise and drowsiness persisted for about two 
 days. 
 
 After a fortnight, and when iiis urine had become free of T.N.T. 
 reaction, B. M. repeated the experiment with the same results as 
 above. 
 
 Experiments 3 and i on G. A. W. and T. A. W. Dr. Wyon 
 and Mr. Webster then dusted T.N.T. powder into their socks and 
 worked during the day in the laboratory, but quite away (at least 
 100 yards) from all dust or fume. The result was that each 
 obtained a distinct but slight trace in the uruae, which previously 
 to the experiment had been quite clear. The amount, however, 
 was nothing approaching that in the case of B. ]\I. 
 
 These t-\vo observers then rubbed T.N.T. into the hands with 
 similar results, namely, a slight trace in the urine. 
 
 Urinary Reactions.— T. A. W. : September loth, 1916, 
 hands rubbed -n-ith amatol (20 per cent. T.N.T.) in lanolin ; two 
 hours later, R. a trace. September 19th, similar experiment ; 
 urine after three hours, R. a trace ; next morning, nil. October 
 5th, both socks sprinkled with amatol at 9.30 a.m. ; urine at 
 10.30 a.m., R. nil ; at 12.45 p.m., R. nil ; at 3 p.m., faint trace ; 
 at C p.m., trace; next morning at 11 a.m., trace. G. A. W. : 
 September 25th, hands rubbed with T.N.T. in lanohn at 1 p.m., 
 washed at 1.30 p.m., T.N.T. rubbed in again at 3.30 p.m., and 
 rubber gloves worn ; urine at 11 a.m. (control), nil ; at 4.30 p.m., 
 trace ; next morning at 10 a.m., nil. October 5th, amatol 
 sprinkled in left sock at 9.30 a.m. ; urine at 10.20 a.m., nil ; 
 at 12.45 p.m., nil ; at 5.30 p.m., faint trace. 
 
 This varying absorption by the skin is important from the 
 light it casts on individual idiosyncracy. It becomes obvious 
 that some individuals let the poison through the skin with ease, 
 while others by the natm-e of their skin bar its entry, so that on 
 the same job the system of one would be fully exposed to the 
 poison, while the system of the other might be comparatively free. 
 
 Again, the long delay in the clearing up of the urinary reaction 
 showed that the susceptible person ■^^'hose skin liad become loaded 
 with the poison might continue under the influence of the tlrug 
 for days after his apparent removal from it by absence froni work, 
 owing to the gradual unloading of the reservoir of T.N.T. in the 
 layers of his ejiidermis. 
 
 'J'liis conclusion casts light on the increase of symptoms, 
 even in cases that recover, often seen for some days after 
 retnoval from outward contact mth T.N.T. 
 
Tho {Mxition no longer ro«ts upon the i-vidt-nco of our own 
 thi\-<- cas<4 ninno ; it linit MJnce lx>en ttttuljliHlutl by tfitU) upplioil 
 to niimy |M-oplf, hw^\\ hh laboratory worki-rH m«ver befon? ex- 
 po-nl to TNT. iiiliiiliktion, uad to onfoniin); T.XT. workt-rn 
 bffori' any ixpi»»uri-. 
 
 Th«' tochniijuo uwcmI for the ilrttction of tlu- T.X.T. dcrivativo 
 in tlir< urine Iwi^ lK«cn worki-d out on quiuititative lines by <i A W 
 with till' view to suppiyini^ a pn-liniiniiry tost for tlu- ) 
 of tlisfoverinK those irthoil-* h|K-«ially hU.-<(i'ptible to ul. 
 and keepinj* thi tn iiwuy fiorii T.N.T. work. TheM- exjx^ 
 were eonduetcd .ifdr the ravemluini |H'rio<l, and will 1k< d<-' i ' • I 
 later under tli<- hiatlinn " prophylaetie nu-ii.sun-'," but an out- 
 line of the ri >iili-< is preM^nte<| liere to round off thi.-* Meelioii <>n 
 variablf ab-iii|itiiin from skin alone. 
 
 The latrr < \|M'rinientH hhowed that B. M. gives a <UHtinct 
 T.X.T. reaitiiin in the urine when xo little a«» 10 millifn^ms of 
 T.X.T. in one [M-r (•••nt. .solution in aeetone is rubbe<l into the 
 |>aln) of one h.ind, while (!. A. \V. xhowj* no r«'U<-tion after 
 rubbing llH) niilli},'nuns «iver hand and forearm. It ih interesting 
 that (J. A. \V. j^'etrt a dermatitis while U. M. gels none. 
 
 The fiut that (J. A. W. thnvs not give the n-aetion froni oven l<)0 
 tnilligram.H i.s not <luo to a holding up of T.X.T. by tlu- liver and 
 kidney.s after its jm-s-sage through th<« -kin. firnt, In-eause G. A. \V. 
 has no .symptoms of T.X.T. p id. seeondly, on the 
 
 grounds of the nsult «jf a <lii. '. When O. A. W. 
 
 inje<ti(| hyp<Hlern)ii-a!ly only .. i T.X.T. in olive oil, 
 
 he almost at on<t< got the reiuiiuii in lii~ urine. 
 
 The eoncliHioit is thus elearly «sia!)lishefl that B. M. |K).siieKsea 
 a p«'rmeable skin for T.X.T., ami tJ. A. W. an impermeable skin. 
 It ix eonlirmefl by a workshop ex|)eriment with B. M. and G. A. \V. 
 as suhjeets, to Im- descrilM-tl later. 
 
 The next ex|H>riment was carrii^l out <»n nine lal. : 
 persons (ineluding H. M. and C A. W.) ; of these H. M 
 only one fo givi- a |¥>sitive n-sult with 10 milligntm.s ; |. : 
 lalM)rator>- lioys. L. I,. B. ami L. \V. ('.. gave |)o.sitive n*-sult.-. \uth 
 20 milligrams. The T.X.T. in all the.se easett \va» applie«l to the 
 {Mvlm in 1 |H>r rent, .solution in aeetone. 
 
 A large se.ile ex|)criment is now In-ing made u|Kin all on- 
 coming workerx at a eertain mtmition wnrk?> In the conr«^ of 
 this many men ami women ha\ ' ' '•> 
 
 an- here given to pn)ve the • - 
 
 high variability by the eonsid. 
 
 .Mm i>|i' I I MS having 10 millitir.tm.- tit .t(«ti>ite apphol tt> 
 thr p.ilm -lnu •! in 33 ea.s**!« only 3 per cent, of poiitive result, 
 i.«-.. :i2 M«ie II. j^.itive, I jtositive. When the dcvv on the jK»lm 
 was inereanod to l.'» milligntm.s, out of Mil men tcjitod 27 (23 per 
 cent.) were positive ami 02 (77 |ier rent.) negative. When 
 women o|x>rative,s were tt'sted similarly with 7 milligr.imis out 
 of 107 cooes lo (U [kt cent.) »Tre poRilivc and D2 (JUi per cent.) 
 
30 
 
 negative. On increasing the dose to 10 milligrams, out of 65 cases 
 ]ii (29 per cent.) were positive and 40 (71 per cent.) negative. 
 
 (iv) Experiments on the Effects of Skin Protection in Diminishing 
 Absorption. 
 
 Experiment I. The greatest difificulty ■\\'as experienced in 
 keeping the hands of factory operatives clear and free from 
 contact with T.N.T., on account of holes in gloves, T.N.T. dust 
 getting under gloves, and, in intervals of work, operatives remov- 
 ing gloves, or touching contaminated surfaces Ijefore putting on 
 gloves. There was no disposition to thwart our work, we ex- 
 perienced great patience on the part- of most employees, but the 
 problem was like that of teaching the principles and practice of 
 asejjtic surgery to a lay person without technical knowledge, or 
 any considerable education, in a week or two of time. 
 
 We only succeeded in keeping the hands chemically clean for 
 over a week in one girl, E. S., who had previously helped us so 
 well in the respirator experiment. 
 
 Tiiis we could only manage by asldng her to come to onr 
 laboratory when goiug on or coming off from each working period, 
 so that we could test her hands with alkaline alcohol to make 
 certain T.N.T. had not penetrated to the skin, and b}' putting 
 on and taldng off the preventive coverings ourselves and thus 
 making certain this was done without any contamination. 
 
 After several failures, -u'c finally achieved our object by putting 
 next the sldn of the hands a pair of rubber gloves, then bandaging 
 vdih. an ordinary three-inch surgical bandage over the top of the 
 rubber glove so that no powder could fall in between glove and 
 hand. The bandage reached from -nTist to elbow, and i:)rotected 
 MTist and forearm. In order to preserve the rubber glove from 
 mechanical injury, an ordinary pair of cotton gloves, such as are 
 supplied in the workshops, was worn on top of the rubber gloves. 
 
 The girl was quite able to work in tliis outfit as no delicate 
 finger manipulation is required in the process. 
 
 For nearly a foi-tnight, from October 10th till October 23rd, 
 1916, inclusive, we were able to keep her hands continually 
 clean as shown by the alkaline alcohol test. 
 
 The reactions of the urine \Alien she was wearing a 
 respirator have been given above. In the period with no 
 respirator or the shop respirator only, and with hands unprotected 
 or partially protected in various ways, her urinary reaction had 
 varied between 2's and 4's, that is about the shop average, as 
 follows :-^ 
 
 Urinary reactions period previous to hand protection : 
 September 22nd, 1916, R. 4 ; September 25th, R. 2 ; September 
 27th, R. 4 ; October 2nd (Monday before ivork), R. faint trace ; 
 October 5th (morning), R. 3, (night), R. 2 ; October 6th (Friday 
 morning), R. 3 ; October 9th (Monday morning), R. trace. 
 
 Ii was on Tuesday, October lOtli, 1916, that we first managed 
 to gei her hands free at the end -of a shift, and this was maintained 
 
until Turxl.iy. •fctobtT 24th, wh«-ii they became fouled throuKh 
 a hole u|)|M-uriiit( in a ruhlx-r j^love. The uriri.m hmh,^ (.,r 
 this interval with (-li*aii lianiU Hen- UM ftillouH : 'I'i, ix-r 
 
 I2lh. K. tnice ; Friday. (KtoUr 13th. K. I ; S.i -r 
 
 Nth, K. trace, Thur«-lay. (Xt..lnT lUth, K i. - i .i.i.iv. 
 ().t..lM r 2inh. H. I ; .Siitunlay. (ktolxr -M«t. K 1 , M..n<iay. 
 OrtnUr •J:Jrii, H. nil ; Tiii-..lay, (Ktolx-r 24th. U 2 (<.n (Ktolx-r 
 24th hole in nil)>M-r ^ti)Ve<> iiml haniU t-ttntuniinattti ). 
 
 This ex|X'rinietit <harly kIiowh the value of luiiul |)r»)tec-tion. 
 The trutift in the urine are junt aliout thone wliieh wouhi bo 
 antieipatetl from thi- mmihII amount of <luit in the nir. Sueli traoen 
 are obtained by |>ur|M>>i<-ly NU'allou-in>{ the amomit of T.N.T. 
 indic'ate<l by the dutt extraetion ex|M-rinient (see Im-Iuw) ah being 
 the amount iii.s|iirt-d by a worker ilurini^ a xluft. 
 
 Kxprrimrnt 2. The diflieulty enfounler*-*! in keepini; the hancU 
 of o|Hnitives chemically clean from T N'.T. and \t^•\^\\^ certain 
 that the whole ex|M'riment remained imd»T our control induciti 
 iiH to institute nn ex|N>riment in which we should work oursi'lves 
 in the workshop u[M)n the wime task. Acconlinnlv, the writer 
 (B. M.) ami a voluntary co-worker. Miss M. ti. Francis (M. (J. F.) 
 worked for a we«'k on one of the sanu- machines o|M-rale4l by the 
 factory employees and luuler similar conilitions in the sjinie «hop. 
 
 All pn)ttHtion to mouth and nose was dis|>ense«l with, but tho 
 hands were thoroughly protect*-*! by leather jjlovc- next the skin 
 anil nililK-r (jloves outside of tlu-se. At th<' t«'nnination of each 
 working; |M'riiMl. a negative n>sult was obt<une<l on te»tin|{ the i«kin 
 of the liamls with alkaline alcohol, no proving that we hail attainetl 
 to complete hand pn)tection. 
 
 There wi'.s a hi>;h wiml on two of the days of the ex|M<nmrnt. 
 which blew some of the TXT. i)owilcr into the air. causing i'Vfn 
 the workshop employees to com|ilain to one another of the dis- 
 comfort of the {Miwiier in the air. Thi« two c\|Mrimenters, like 
 most Ixginni-rs, felt it seven-ly and sufTcn-<l fn-m -nee/iii^; and 
 nnuiint! from nose and eyes n-fpiiring the copinus ii.s«« of 
 *' n*spinv»or wfill.H " divertt«<l from their UHual puqwwe to oct 
 as sulwtitnfex for |>ocket handken-hiefs. Yet neither of thrin 
 with hariils no pnitecteti showe<l ntom than a small amount 
 of the urinary naction at the etwl of a -.hifl. ami this <mly for a few 
 hours thi-n-after, and each «lay they wvre usually clear of it 
 Ix'fore the nvsumption of work. (Se Ap|iendix (V) 
 
 The usual inipIoye<s of the frti lory working alongsitU- hoti on 
 tlie average at leost live times the (piantity in tho unne. oilhouch 
 wearing r<-spiratorx acconiing to regulation.s at that date, but 
 their hamis were hiavily laden with T.N.T . wlulc those of tho 
 two ex|M rinitiital workers wen* (r»e fn»m it. 
 
 It hud Utu intimiid to carry out the cnnvcr»e of thiit ex|>eri- 
 ment in the following week, when it w ;« fl. « i-nrd that the two 
 »\orkcrs .should o|Hn»te in re^pinM' ihe hands un- 
 
 pnitcctr.l 
 
Unfortunately a fire, followed by an explosion, wrecked tiie 
 workshoj) in which the experiment was to have been perforined, 
 and the experimenters only escaped being involved by a detention 
 in London on business connected with T.N.T. poisoning. 
 
 This portion of the experiment was subsequently carried out 
 by B. M. and G. A. W. at an exploder bag filling factory B., 
 and as it is the proper corollary to the above experiment it may be 
 placed here. 
 
 Experiment 3 at an exjdoder bag factory B. On June 
 4th, 1917, the two experimenters, G. A. W. and B. M., spent 
 a whole period of working in the factory, close to the actual 
 workers, so that they would take in (by breathing and swallowing) 
 the same amount of dust and fume in the air as the workers take 
 in by these channels. They did no work on machines during 
 tlus period, and protected themselves from all contact, save that 
 of inhalation by mouth and nose, but in this latter respect they 
 were as much exposed tis ;iny (ipciai ives. 
 
 On the following day the ]ii( caul ions against skin absorption 
 were set aside, and the two cxpiiimenters proceeded, -with bare 
 hands, to manipulate the macliines and behaved like ordinary 
 workers. 
 
 The results given below show the contrast, in these two days of 
 a workshop experiment, between a worker exposed to all inhala- 
 tion of dust and fumes and a worker exposed in addition to actual 
 skin contact with the deleterious substance. They show also the 
 difference in degree of absorptive power of two different workers. 
 
 Urinary reaction at 
 end of shift. 
 
 June 4th. 
 
 Idling in workshop 
 
 with liands protected. 
 
 G. A. W., very faint 
 
 trace. 
 B. BI., faint trace. 
 
 June 5th. 
 Working maclunes 
 with hands exposed. 
 
 G. A. W., R. 1. 
 B. M., R. 3. 
 
 This experiment accordingly confirms the results of the rubbing- 
 in experiment and of experimental exposure to the acetone solu- 
 tion of T.N.T. (see above). 
 
 (v) Determination of the Actual Amount of T.N.T. in the Air of the 
 Workshop and Estimation of the Maximum Amount which 
 could be Breathed by a Worker during a Shift. 
 
 A prolonged experiment of this kind had already been made 
 elsewhere, but without any attempt at exact quantitative 
 accuracy. No elaborate aj^paratus was at our disposal, so we 
 utilised as interceptors two large "y-shaped calcium cliloride 
 drjing tubes fitted with rubber connections in series. Electric 
 connections were taken to a vacuum pump, which was placed in 
 the open air to avoid all daiiger from sparking. The mouth of 
 
the al)ttorl)iii(; \J tulje won |jtiu.-c<l iii »•« nearly n niniilar iMMitiuii 
 an rt-gunl-) TNT dmt at the worker'* month inul mjitu un couhi I** 
 arrttiiKi-'l The giwi cireuit |>tt.«eil tn scries through thr two \J 
 IuIk-., llitti to ii Kiis meter lihuwiii^ litn-H. nml h<-iue to the vuc-uuiii 
 jjuniji The pump wa** run itpproximately at inti-rvuU of twfiity 
 miiititii on iin<l ten miiuitet oiT to avoid heutini; of lM-unnp>. 
 anil thii v\.k-> continued for n whole shift |>i'no<l The \J tuljp at 
 inli t < ontuined wiiler. whirh w.is reneweil at interval- «• it 
 evi»por<ite«i, to enteh the 'I'.N 'I' dunt. The M-eond \J liiln' wa- 
 empty iiiul u-«e4l at a ti.ip to determine uhethi-r All lh<- T.N'.T 
 dust had >H-en Htop|M-d. On letting with alkaline aleohoi at tho 
 em! of the e.x|M'rimi-nt thit tiilM* ^ave no pink eoiour, thu« showing 
 that ;ill TXT. hiul Uen al>HorlK'<I l>y the tir-t \J tulu-. 
 
 The water in the first tulw shouetl tloatinj; in it a numt>er of 
 |>artiele-< of iiiHohilile |Miwder. hut the aniouiit was s«'<n to Ix* 
 Kiuall. The eontenttt wert" taken down to dntiu^^ot on a Iwith and 
 extracted with ether, in whieh TXT. is very soliihle The ether 
 was |M)ured off into a wei);hcd ^la-n ve^vnel and evajxirat*-*! ofl, an<l 
 the ves.tel and eontent.H weighe<l. The inereuM- in weight showe<l 
 the amount of TX.T. ohtikiiusi from the niimlMT of litres n-i;iHti're<l 
 hy the meter, a mean r>f thn-e e.x|K'riiiic-iitH (jivi- II miiliumniH, 
 equivalent to DIHtrnkin, or a pinV hea<l i|uantity. Ik-taiU of the 
 fxperimenis aiul ealeiilations are piven in .\p|M-ndix H. 
 
 (VI) Sffrnton Aulhura ttf SiittUniniig Knoirn Amountnof I'uri^ T.S T. 
 
 Xow that Wf knew hy direet analy.He^ the amount of TX.T. 
 in the fa«tory air, ami id.H«) the ilepret- of n-aetion of the urine 
 when wiirkiiiK in the faetory hut with hands prot«-«-ti-<l, it iMi-ame 
 inlen-slinR to tent whi'ther swallowing the small amount of T.X.T. 
 directly indieateil hy the air analysis would fjive in thi' urun' 
 the »ame th'urif of n-iu'tion ik.s if it had Ik-*-!! hn'athe<l in while 
 working. 
 
 The air analysis liad Um-ii iditaine<i U-fon- M. (.J. F. and B. M. 
 slarte<l their week's ex|H>riment in the shop, with their hamls 
 pmteiteil as ih^seriUtl alnive. While tiny work'tl in the shop, 
 (J. A. W. and T. A. \V., n-frainiiiK otherwi.M- fn)m woim; anywhere 
 
 4i«ar MOiiri'e* of T.X.T. al>sorpti«Mi. nd-' 
 
 .loses ,,f T.X.T.. <;. A. \V. tnkinK I 
 T. A. VV. took !«• milligmms daily, an, 
 level whirli the air analysis •thow«>d niif^ht )»' t: 
 air 
 
 The urinary reactions ohtained ran -w tlir 
 ohlaimd hy B. M. and M. (;, F. in th 
 and eteanni^ oveniiifht. IVIails are 
 
 wa]!MU..i :oid ii.li.d..!^ u.l t!w .,.r,^l,r.| ,|, 
 (ni>t-rBl'M) 
 
 •' nselve. 
 
 whil. 
 
 ..1 the 
 
 J. in'tn faetory 
 
 l.NeUa* tho^e 
 
 / to I or 1 * 
 
 . iiili* (' ff»r 
 
34 
 
 Moreover, it is clearly shown that this is only a small fraction 
 of the amount taken up by the average shop worker, and there 
 is complete nightly clearance. 
 
 The above experiments taken in their entirety appear to us to 
 afford concordant evidence not only that T.N.T. is absorbed by 
 the skin, but that under ordinary average workshop conditions 
 this is by far the most important channel. 
 
 Observations were made at Factory F. indicating the close 
 connection bgtween minor T.N.T. illness and toxic jaundice or 
 aplastic aiifemia. In order to avoid splitting up the clinical 
 evidence this portion will be reserved till after the next section 
 dealing with a research at a National Shell Filling Factory. 
 
 III. Researches at a National Shell Filling Factory (A). 
 
 These incpiiries were carried out in November, 1916, and the 
 particular factory selected was chosen because it was one of two 
 national factories which showed at that period the highest incidence, 
 both in minor T.N.T. illness and in notified cases of toxic jaundice 
 and deaths from toxic jaundice. 
 
 It has since turned into one of the healthiest in the country, 
 and a member of its medical staff recently informed the writer 
 that he attributed tliis happy result to the early detection of cases 
 by a medical officer patrolling the workshop. The other two 
 changes which have been made, as we have been informed by 
 several visitors to this factory, are that all the processes arer 
 carried out with greater cleanliness, and, secondlj', that increased 
 forced ventilation has been introduced. 
 
 The analysis of the air of one of the chief workshops of this 
 factory where most of the cases of toxic jaundice and fatalities 
 had occurred shows how very little T.N.T. dust or fume was 
 present (see Appendix B), so that, in our opinion, this cannot be 
 an important factor in the change for the better. 
 
 The results obtained here formed confirmations and extensions 
 of our earlier work ; they have already been given in another 
 report, and so need only be epitomised here. 
 
 (1) It was sho\TO that because enough stress had not been 
 laid on the danger of skin absorption sufficient attention was not 
 being paid to keeping all processes clean. As a result, persons 
 engaged in cleaning up the soiled shells with oily rags were often 
 cj'anosed, and amongst such persons then classified in this factory 
 as " shell finishers " there hafl been several cases of toxic jaundice. 
 
 (2) That the chipping off and rubbing with oil did not com- 
 pletely remove T.N.T. from the outside of the shells, so that these 
 went on to the so-called " clean shell store " covered by a film of 
 oily T.N.T. This accounted for the presence of T.N.T. cyanosis 
 and iUness in the " clean shell store," and for the occurrence 
 of cases of dermatitis here. This and the fact that railway men 
 loading filled shells on to railway trucks had been cyanosed or 
 jaundiced showed again the importance of skin absorption. 
 
(3| .si.iliitici wiTf i)lji;iiiiiil III tlif vurioiit MCftiiiim mIihIi 
 showed clciirly the ijreat iiiii»ortiiin.e i»f minor T.X T. ilhii-«i» la 
 oauriiii^' ^K'kia-Hs and aUH*uti>tMrtiu. The iue<iHun'H nuux' tnk<Mi 
 have greatly reduced thiit Iom. 
 
 (4) ('onipunitivo MtatUticM were alno colle4-te«i, ^Itowing iliat 
 those I iiiployocs who workwl t-lone to molten T.N.T iiml dune 
 poMMensed us g(Mxl a re<«)rd us to health and att«-ndan<-«' for 
 average |M*riodM enKaK(<4l on the joh at did other worker-< niiieh 
 more remote from the molten T.X.T. 
 
 (3) Similar ex|MTini<iits to those eonductcnl at Fiutury F. 
 nhowetl that the factury air vht^v to the cylinders of molten 
 T.N.T. wan even Ix-tter than at Fattory F., and that we oidy 
 obtairxil a minute traee in our own urines after remaining; for an 
 entin- shift <'lose hy the |>ositi<>n at whii-h the molten amatol wiw 
 |)ound. 
 
 Till- w.is rontirme<| by our analysis of the air during lliin 
 8ami- "hift, iiur estimation^ yiehling only M milligrams, or li's.t than 
 one-tenth nf a gniin, a.s the available amount jkt worker |kt shift. 
 
 The greater part even <jf this small amount of absorption was 
 caused lit two short intervals durini; the shift, when the workmeti, 
 engaged in ileaiiing up, ehipjK-d olT fmm the Hour a layer <>f con- 
 gealed amatol at least half an inch thi<-k all round the |>ouhng 
 places, sora|K-d it away with metal -.eriiK-rs, and swept it up dry. 
 
 Our analysi'H also demonstntted that there wen- pnuti<ally 
 no nitrous fume.M in the air. (Set< Ap|H-ndi.\ B.) 
 
 («) .\nalys««!t of the reconis of fatal and non-fatal cjum-h were 
 given, showing what a largt- pro|»ortion wen- truckentanil finisher* 
 (cleaners) who wen- largely e.\|»os«>«l to skin contact an<l com- 
 paratively much less to iln-<t or fume inhalation. 
 
 IV. Action ok T.X.T. is thk .^svstkm. .vm» thk ('<>nnk<tion or 
 Minor T N.T. Ii.i.nkss Tu\ir .Imni>|(k .vm> .\i'I a'H-k 
 An.»:mi\ 
 
 (1) Artinn of T..\T. on ihf «/o<«/. 
 
 Tri-nitro. toluene iM'longNto a very large cUi.s.s of IxHlit^.includuig 
 both the organic nitro <-om|M)unds and their re<lnction products 
 the amino <omiM)un<|s, which |>»s.ses., the comnxui i-haracteri-tn 
 of acting in the lir^t wt-'am-e on the IiIcmmI. This iKtion is Ivt-wsl 
 on a rhiiiiire in l' ' ' '!■ h is to a \ . 
 
 ronverte<l into a r !>bin and nu ■ 
 
 Sin< e tlie«e hn'ni" .iuii>t fun.' 
 
 . ur,r- ,• f-.llow-. llu: 
 
 h I r :ii ha-" \m-VI\ i\]' 
 
 ■!■ '• ■ ' ■■|'<-j»rs, more • • . , , _ . . 
 
 i" i i Tlu.s i.s ihtf stAge tti niiniir T.N.i. diiirw, v»r)-tng 
 'lom VMC to CMC orronting to the dcgroc of deficiency 
 
3« 
 
 Tlic symptoms complained of by the pcatients are very similar 
 to those of niountaiii sickness, such as breathlessness, tightening 
 in throat and cliest and difficulty in breathing, giddines8,'tlro\vsi- 
 ness, nausea, abdominal pains, general malaise, appetite at first 
 stimulated, then lost. 
 
 The changes in appearance observed before any jaundice occurs 
 are also due to the changes in the blood. A drop of blood obtained 
 by pricking shows a venous blue colour which does not soon turn 
 scarlet when exposed to the air or when absorbed by blotting 
 pajjer ; this effect is quite characteristic and might be used for 
 diagnostic purposes. 
 
 This alteration in the colour of the blood shows itself by 
 producing ashen-blue lips, and also in many cases by giving a 
 peculiar pallor to the face which simulates antemia but is not 
 anscmia, for counts of red blood cells and estimations of haemo- 
 globin give normal figures in these cases of minor T.N.T. illness. 
 
 Although there is a normal number of red blood cells and a 
 normal haemoglobin index there is considerably increased labour 
 thrown upon the hsematopoietic organs due to the increased 
 rate of breaking up of the altered red blood cells and the increased 
 rate of production of hfematocj'tes, balancing this loss, with an 
 overworking of the red marrow hsematoblasts. Similar effects 
 occur in malaria and in various forms of jaundice. 
 
 Evidence of such destruction and regeneration is afforded 
 by the very frequent statement volunteered bj' these patients 
 that their urine turns dark-coloured during an attack, and by 
 the frequent presence of bile-stained serum. 
 
 The relative degree and incidence of this cyanosis and its 
 attendant symptoms differs Auth the different organic nitro- 
 compounds and also in the case of the same nitro-compound 
 according to the species of animal to which it is administered. 
 So also does the frequency with which these minor symptoms 
 lead on into toxic jaundice differ in different animals and with 
 different drugs of this class. 
 
 These facts are in interesting keeping M'ith the results obtained 
 industrially upon human beings .Avith other nitro-compounds 
 than T.N.T. which are more directly poisonous when absorbed, such 
 as dinitrobenzene and diiiilro phenol. These drugs would appear 
 in man to cause death Ijcfore the toxic jaundice and the tyjiical 
 liver lesions have had time to develop, as does T.N.T. itself in 
 the case of the cat, to which animal it is more toxic. A case of 
 toxic jaundice \vas, however, reported some years ago due to 
 dinitrobenzene, and it is here to be remembered that T.N.T. 
 before its present enormous production had the most innocent 
 reputation of any of the group. 
 
 It may be added that when given in large doses T.N.T. also 
 kills without any jaundice or liver lesions in all the tj'pes 
 of animals subjected to experiment, viz., white rats, guinea pigs, 
 rabbits and cats. 
 
:«7 
 
 Tlie li-ioiu^ 111 liviT uml l)oi>t< iiiarnKs 
 in t)ifHc- ^Jx•cit•s of luiiiiiuU not »|»i-i lullv 
 aa li Itttir and more or Icm ihrwim ■ _ 
 
 cliangc)>. 
 
 (li) Tuxic EfftcU uj T.S.T. cumpureU unlh thuat of hnntruyhtmA. 
 
 Till' i-tIi-<'tM of (linitn>|tiirniil, whitli hiw n<ccntly Imcii lu.kiiii- 
 facturtHi ami iimni|itilatf«l on a larxc M?ale ubruaU, arc rtin.krkilily 
 xiniilur tu thoM- of trinitrotoluene, and funu«b an inten-xtini; 
 rxaiii|iie of U'liat tiari jii->t Im-<-ii htitird alxive. 
 
 Over a year a^'o we inve!<ti^^ite<l the toxicity of (iinitro|>h('nol 
 amongst a iiuiuImt of other nitro coni|iouniiM at the n'<|iie-( of lin' 
 Departinent of Kxplo^ive?* Supply, ami re|)orte<l tint it v» i- 
 inui-li inon- ixiisonous tu lal>oratury aniniaU tlian th-nitro-tolueiiu 
 or any of the other Kuhtitances Hiibiiiitte<l. 
 
 This opinion is subf<tantiitle(l l>y a n'[K»rt on " Inf^xi^wHon 
 by Dinitniphenol,' hy Professor Ktiiinie .Martin. >! 
 cle I' classe, and his <-ollea;;iie« m IV.iiice* This siit) 
 to Im- iiuieh nion- dan^jiroii- to the workers tli.u 
 t-oiisideralile miiiilMr have died fnun its tdleots, and ju L .1- ..ilh 
 T.N.T. a much larjrer nuinlxr have suflerfil minor poJHoning 
 and Im-^'ii imapa<itate<l from work. 
 
 The Myiiiptom.s of the inort' serious cases, as «lc««cribc<l by the 
 French olwcrvers, are strikingly like those of T.N.T. as do«oril)c<l 
 bv ours«-lves and othcn*. 
 
 ca-nm are tharactchsrd at first by pallor, wttli 
 ot the lips, a little d>-spn(Mi. with a feeling n| tightnrM 
 
 (rct{uent .itt.i> ks have Ijccn giutro intc-stinal, ] .>!>• (uirnl 
 ' anorexia. vi>mittn(; and >oroctinir» »light |.iui><i;i'-, ai.d 
 
 I 
 
 All thest- an* the same symptoms as are shoMii by ob.<4crvalion 
 of workers on T.N.T. in thit coimtrj-, and the basia is the wme. 
 namely, an action on the hemoglobin of the blootl ; but the 
 dinitrophenol is more |K>isonoini and kills liefurv liver lesions have 
 ha4| time to apjK-ar. 
 
 The Freiuh oli^ervers state tl»at thcsiv fiicts ralhrr point to 
 altsoq.iioii of the |s»i.son throtiph the pulmonary ntid di»»>«five 
 ii ; I-, but they do not app«>ar to have ma<le 
 • h- amount of flmitrophenol dust in the i . 
 
 M.iiilirant that 17 out of 27 di.kll. nn. . 
 
 I npaf{itl m wemhinp. eleaninc ihi piu.iui.1, who 
 
 would l>e ex|K>seil heavily to >1 
 
 They maku tin statoiiient. ' I-i>tl'. :;; iio 
 
 ro^e of all the Workers one mux! 
 
 • Chir lhank.1 are Awn t.i 1>t I 
 (uiniAtion rited. 
 
38 
 
 of absorption of diiiitrophcnol by the skin of tlie bunds and fore- 
 arms." 
 
 It would appear from tliis, ai\d especially if dinitrophenol is 
 to be introduced upon any large scale in this country, that 
 quantitative experiments ought to be instituted as to the amount 
 of dinitrophenol in the air under ordinary workshop conditions 
 and tlie amount taken up by the skin.* 
 
 Lal)oratory experiments are now being made by us upon 
 animals and ourselves as to the channels of absorption, and if 
 these show us that skin absorption occurs the problems of pro- 
 phylaxis would be identical with those already u.sed for T.N.T. 
 (See Appendix E.) 
 
 It is interesting to note, in view of what we have found in the 
 case of tri-nitro-toluene, that dmitrophenol is also reduced in pas- 
 sage through the body to a mixture of mono- and diamino-phenols, 
 which give distinctive colour reactions. The reduction appears 
 to occur in the liver. There are no microscopic lesions in any of 
 the organs, possibly for the cause assigned above. 
 
 (iii) Minor T.N.T. Illness caused by Blood Change. 
 
 Returning to the consideration of the minor T.N.T. illness 
 caused by the initial blood change it may be pointed out that, 
 although this is termed " minor," it is probably of " major " 
 importance from the point of view of national economics. 
 
 In the earlier period of our researches there were at several 
 filling factories hundreds of workers '" off work " and on com- 
 pensation pay owing to " minor " T.N.T. illnesses. All over 
 the country there must at this period have been some thousands 
 of workers temporarily incapacitated, and the economic loss in 
 labour and money must have been very large. In addition this 
 large tide of minor illness was giving the T.N.T. occupations a 
 bad name and cutting short the supjjlies of labour. 
 
 Now as a result of cleanliness of labour and of early detection 
 of susceptibles and sending them oE to other work, this evil has 
 been combated, and the number of workers " off work " from 
 minor T.N.T. illness has largely abated. 
 
 * A remarkably interesting observation of the French researchers 
 appears to show that dinitrophenol both goes in and comes out by the 
 skin. " When a worker is going to be affected by dinitrophenol the 
 parts of the skin protected by the clothing, such as are not likely to be 
 stained by dinitrophenol (the chest, shoulders, back and upper arm) 
 assume a patchy yellow colour. It appears to be an excretion of sweat 
 containing dinitrophenol. On the other hand, workers who are unsus- 
 ceptible show the staining only in the uncovered parts, such as the head 
 and hands. This symptom is of importance, as it shows that tlie sweating 
 comes on when the organism is impregnated with dinitrophenol ; it is 
 an indication for suspension and treatment." Many T.N.T. workers 
 have assured us that they sweat pink sweat under the armpits, where 
 there would be little chance of direct contact with T.N.T. dust. 
 
31* 
 
 (iv) Action of Fare T.S.T. and of Jinpuntus 
 It hiiM U-fii often diwu.*Jtf<l ainon^^t thtme inten-Ktctl «h'*th«'r 
 riiinor TNT. illneait in due to nlitorplioii of tri-iiitro toluciie 
 itwif or to nitruuM or other fuiiuM which come off the crude T NT. 
 or to iiiipuritieit such a.-* thedi uitru-tolueuett or the nUnnn. ». in.- 
 coiiiimiuiuIh {mttent in Minall amounts. Some havi- 
 tluit tritiitro-tolueuc cuu-st-M the cyano«ijt aiui the uuii": 
 illnexft, but that toxic jaundice may be cauiM*d by Nometlim- • i-i- 
 ttuch aM a h(|uiil impurity or fume, and potwibly apiaittic ana>mia 
 by it«)me otiicr uukiioMii .•.ub^tiwue. 
 
 It i.-* excec«lin>rly dinicult to pn>vidc a riponius pnx'f • 
 whole of thew effi< t.s are due to tri-nitni-tohiene and to 
 toluene only and are all caiLMally relalivl, but we nmy 
 
 (1) a« the n-.-ult of dirvct ex|H'riiiicnts with pun- trinitr<i-t..Uii'in-, 
 
 (2) of exclu.tive exiieriment.-* with all the varioii.-* impunties we 
 could obtain, (3) of iu>(;ative result.'* in attempt.x to obtain fumt*H 
 or volatile impuritie.H in the work.sliop, and (4) of f*«-veral per>ional 
 obttervatioiiM of traa^itioiiH from minor TNT. illnesn into toxic 
 jaundice, we an- .stronjjly of opinion that all thes«' eflwts are cautted 
 by the hjime Mub,-*tance, trinitro toluene, aiidthat they an- probably 
 closely c«)nnect«'d in their nuMle of cau.nation. 
 
 Administration of pure T.N.T. to kitten.>( either by mouth or 
 inunction ra[)idly pnuluces cyanosi.s, dyspntpa, and oficn nau^-a 
 and sicknef.s ; the animalt an- then obviously suflerinj: fn>m 
 minor T.N.T. poi.'winin^;. A larger dose kill.n them from acute 
 T.N.T. cyanoNi«. Rodents show it les.s markedly, but a defjree 
 of cyanosis is pnxluce*! hen- also. 
 
 • )ne of ourM<'lves (T. .\, \V.), taking by mouth .'»0 milli(;nim!i 
 of pure T.N.T. ilaily and not Koing near any other ex}s>!>un' to 
 T.N.T. for a |M-ri<Ml of ten da\s, iMi-ame distinctly cyantised, 
 and his bloo<l was shown ^iH-ctroscopically to contain met- 
 ha-mo^lobin. 
 
 Workers tilling " explixler liajjs " with ;»iirr TNT and iu)t 
 anywhcn- in the vicinity t)f other T.N.T., havi- Ih-cohi. iii.irke<lly 
 cyanoM'il, and hoiuc have accjuin-il toxic jaundice and dicil on 
 such iKcupations. (See n^onls of ca.M's lielow.) 
 
 There is no eviilenw that workers* with cnide T.X.T. containiiif; 
 a lar^e |M>rcenta(;e of impuntio have lx>en any more M'vcndy 
 hit than worker* with the punr ijUiklitics. nor that tho«e working 
 near molten cnnle TNT., when- then- would U- much mon- vola- 
 tile impurities, have U-«-n nmn- ••evi-n-ly attacki-cl th.^ii !h«»o 
 working: n-mote from such .»oun-es of volatile impurity 
 
 If an impurity presi-nt only to the extent of a fni( iinn <>f mie 
 per cent, in a factory tample of T.N.T. is to be mnanh-*! «-•» a 
 causative a^ent of any iiii|>ortance, it must evi<lrntl% when 
 isolateil and a«lmiiu>tert-<l by it.>«elf have a pro|M>nionatelN morv 
 lethal efle»t. For example, if it l)e present to the extent of 
 one |>er cent., then in neat coiulilion after isolation it -thould be 
 approximately one hundredfold as pniMinnu.* as T NT. and alM) 
 prtxluce the olwervetl eflects of T NT. illneM>. 
 
40 
 
 No sucli substance is known. We have, through the kindness 
 of Messrs. J. Leitch & Co., been supplied with samples of all three 
 of the isomeric di-nitro-toluencs in pure condition which are only 
 present in small amount in crude T.N.T. We have tested these 
 on animals and only found them of the same order of toxicity 
 as the tri-nitro-toluene. So far as there was any difference they 
 were somewhat less toxic. 
 
 Again, samples of the various impurities separated from crude 
 T.N.T. in the processes of purification necessary to obtain a purer 
 product for filling " exploder bags " and for other purposes were 
 placed at our dispo.sal by a large manufacturing firm. These 
 were examined and tested, and none of them showed any sub- 
 • stance pos.sessing a higher degree of toxicity than tri-nitro-toluene 
 itself. 
 
 It has recently been shown that in certain processes of 
 nitration the methyl-group in the toluene molecule (CgHj.CHj) 
 is s])lif oft' to a certain minute extent, and as a result the crude 
 nitnilion product contains a certain amount of benzene-nitro- 
 oompounds and nitromethane compoimds. These latter com- 
 pounds resemble chloroform and carbon-tetrachloride in their 
 chemical structure, except that instead of chlorine the nitro-group 
 (NO2) takes a place in the molecule. They are well known to be 
 very poisonous. One of them, tetranitromethane, has recently 
 been isolated and investigated by JMr. F. W. Linch, chemist of 
 Explosives Supply. But this substance is only present when cer- 
 tain processes are used, and is then only found in the crude product 
 to the extent of 0*12 per cent.* Moreover, the toxic effects 
 produced by it are quite different from those of T.N.T. poisoning. 
 
 On all the above evidence, it becomes clear that tri-nitro-toluene 
 itself, and not any volatile impurity or fume, is the cause of the 
 blood change and of the cyanosis, pallor, and clinical .symptoms 
 >o produced, known collectively as " minor T.N.T. illness." 
 The evidence that the toxic jaundice and liver lesions are also 
 caused by pure tri-nitro-toluene is scarcely less clear. 
 
 (v) Causes of Toxic Jaundice and Aplastic Ancemia. 
 
 1. Preliminary Discussion. — In the laboratory experiments, 
 as vrill be recorded later, we have obtained in three rabbits liver 
 lesions which on microscopic examination showed necroses and 
 fatty degeneration closely resembling the early stages showing in 
 the liver lesions in human beings dead from T.N.T. poisoning. 
 Also in one of these animals there was distinct jaundice, all the 
 tissues and serous fluids being bile-stained. 
 
 In the workshops several fatalities have occurred amongst 
 workers who had never been near crude or molten T.N.T. and 
 worked oidy with the purest industrial form of re -crystallised 
 
 * Tlie greater part even of this small amount would be removed before 
 the T.N T. reached the shell-filling factories. 
 
T.N.T., w'hiih would only ctmtAin u fraction of one |j<t cent of 
 iai|iiirit y. Wt- hnvr ountclvox mm-ii JuiukIuo fulluwing on cyancmin 
 where only pun? Iri nilro tolut-m- «•»« um-«|. 
 
 Ah ri-^anlH a|iltt«tii- ann-niin the nuni>NT of caMeii in kuwill, l*ut 
 llun- i« oiu- c'ttho (S. S.) wliin" cniiiloynii-nt on pun- T NT (uily 
 in tilling " f.\|ilo<liT lutfis " ittUNol toxir jauntluc in !>•. >! ' i 
 HiWl : thin wiiH ni ovrriil from in Ktbruiiry, lul", Imi 
 (i/iy luir lontiirt with T.S T., itplaKtic iinn-niia tli-vi'lo|M<l in M . 
 iind April. MU7. TliiN KU^)!fxl» tin- intinmtf i-onncotion of (•■xic 
 jiiundicc aiiil uplantir iinuiiiia. ikixl al.^o thi' coininon r<M>t of ImiIIi 
 inf'X| t)Mirf to tri nitiD loluiiii-. Otlu-riUAt-x of death front apltt^tic 
 annMiiia have ithown ..t tho auto|Mira HiniiUir le^ionH in the liver 
 to tho!*e « hanutcrixlie of toxic jaundice. 
 
 Thi> ground Uroim-.-t lci».s certain when the ()ue>>ti(>ii i^ •. ■! 
 ittden'<l. whither the initial IiIimmI changes pri-«li>|H)><- t>. !■ x ■ 
 jaunilite and aplji.-.tic annniia, and in a certain niiinlMr i-t < ■. < - 
 lead on into thexe nion* grave alTections. 
 
 No rigorous proof can Im- given, and the deeiHion, aii in many 
 legal anil clinical ca^^eH. must In- made on the weight and Imlk 
 of the evidence. It mu«t Im- n-mendM-red that the majority 
 of our lieliefH in nuilicine an- n>uched by such a pnuet-i. and not 
 by deductioits po><M(>..Hing mathematical e.MU-titiide. 
 
 The be*f plan will Ik- to put evidence U-fon- the n-ader. and 
 diMeu.i.s the underlying physiology of the londitions induciyl by 
 the primary |M>i.'4oning in the blooil, and then leave the judgment 
 with him. 
 
 The gnat pnictical ini|Mirtan°ce €>f the issue in whether pon-ouM 
 distinctiv cvanosed or slutwing in other wavs signu of minor 
 TXT. illness shoul.l U- tumid off TXT. work. 
 
 If thi-n- wen- no riuincctioii lM-twe<-n i-yanowis and to\ic 
 jaundice, thi-e |Hr><>fis might safely Ik- left on. and many -ln>ni;ly 
 cyanosed individuals have Ix-i-n left on without toxic jaundice 
 developing for many months. This by no means pnive« the 
 matter, a« we shall see prewnfly. and. in the opinion of the writer, 
 many livcM were lost earlier in thi- cnm|)Aign by this cyano>i« 
 not iM-ing use«l i\n a danger signal. 
 
 The pictun- given by us in liiUl for diagnosis an<l suspension 
 nlii-s practically entin'ly on cyanosis; the stace of jaiindix-d 
 conjunctivn- is too late. We lx-lie\e that the enonnous rrslui tmn 
 of incidence of all TXT, illness is largely due to the we i>( this 
 sign. The conjunctivn- must cirtuinly U* wat<-h«-<l. but so aNo 
 niuxt thf- lips and face, and the mon- attention is |>nid to li|»s mid 
 face the smaller nnmU-r of cas«-!» there will U* of JAundic<-<l 
 conjunctivie to n-|»ort. 
 
 This, however, it must frankly lie admitted, doe-- n-f -h^w 
 that toxic jaundi<-e follow^* on ivs n n-sulfant of the I 
 and not aw a din-ct |Miisonous effect ii|Min the he|>Ati< 
 What if do<-s show IS that the i yanose<| |h-p>4U) is not 
 with a giMwl «kin protection, but i- one who hft« let in tlt« ^isoii. 
 
42 
 
 which may now attack both blood cells, liver cells, and bone- 
 marrow tells, either simultaneously and directly, or seriatim and 
 indirectly. 
 
 The important matter from the preventive point of view is 
 that cyanosis and its accompanying pallor form the best danger 
 signal we possess, that liver and bone marrow are in the firing 
 zone, and so long as there is in the country a sufficient supply of 
 insusceptible people susceptible individuals ought to be removed. 
 
 To await jaundice as the danger signal is accordingly the unsafe 
 course, to utilise definite cyanosis the safe one, and this apart 
 from whether jaundice be due to direct attack on the liver, or 
 indirect through oxygen-dearth, or a mixture of both. 
 
 2. Physiology of Increased Hcemoglohin Metabolism. — The first 
 evidence to be taken is that for the existence of increased blood 
 destruction as a sequence to formation of met-hscmoglobin. Tlie 
 importance of this investigation lies in the long-continued over- 
 work which is presumably thrown upon the organs involved 
 in the katabolism of the met-hsemoglobin and the regeneration of 
 the new erythrocytes. These organs are the liver and the red 
 bone marrow, and these are precisely the organs liit in the two 
 graver issues of toxic jaundice and aplastic anaemia respectively. 
 
 The e\idence for increased haemoglobin metabolism will first 
 be considered, and then that which has appeared to certain 
 obsei'Vers to negative it. 
 
 Increased haemoglobin metabolism need not, and in other well- 
 known pathological conditions often does not, lead either to 
 jaundice, or increased deposits of iron in the liver, or the appear- 
 ance of nucleated erythrocytes or poikilocytes in the blood, or to 
 diminution in number of red cells, or reduced haemoglobin content. 
 All ordinary moderate cases of chronic malaria are examples 
 of this fact. On the other hand, it is not denied that other 
 agencies may produce any of the blood changes above enumerated. 
 
 The whole question centres around a labile physico-chemical 
 reaction going on in the blood and the haematopoietic organs, 
 and the point at which this reaction comes into balance like a 
 reversible chemical reaction between haemoglobin destruction and 
 h3emoglol)in regeneration. 
 
 The metabolism may vary within wide limits, as do manj- 
 other metabolic equilibria in the system, -without materially 
 disturbing the equilibrium point, as shown by use of haemocyto- 
 meter and haemoglobinometer. 
 
 The only set of substances which must be increased in their 
 production as a result of increased haemoglobin destruction are 
 the waste pigments of the body, namely, the biliary and urinary 
 pigments. If this increase be observed, it is clear evidence 
 of greater haemoglobin destruction because they arise only from 
 such destruction, and they are that fraction of katabolised 
 haemoglobin which is not utilised in the red bone marrow for 
 the anabolism back to haemoglobin. The iron-containing fraction 
 
43 
 
 i*) retaitiot luwl iitiliwci, anil, acconiiiigly. if aitaU^liHin it* [)ro<-«HHl- 
 ing ax fiiMt at kntuljoliHin thi-n- iu-<-<| not Im* any occuniuUtiuii o( 
 iron <-()rii|Miiiniix in li\'er or ••UiwIuTf. 
 
 '.i Toxir Jiiuiulirf anil Aplntlir Ainrinin <u a rrsuU of Inrrttutd 
 HirmiKjltJiin Metnholijnn. TK«" n-^ultn of the inc-n«iwf<l |ir>Mlu(^-tiun 
 of iii^incntH will (ie|ienil on the condition ami activity of the 
 or^nnx which <liH|>uMe of th«-ni, namely, liver ami kidney If, 
 -iiy, four tinuft the nornifil ainoiint of ha>moglohin is katalxjIiM-d 
 hy the liver celU, ami four tinien the normal amount of liile 
 |iif;mefttt« »o formed, i-.nd if now the liver cells exrnte out into the 
 hile caniiliculi four time-, the normal amount of |iii.'meni. tlu-n 
 there will Im- no accumulation of hile pi};mcntH in liver, <>r |ilii>nia, 
 or tirtHues. The liver parenchyma will, so far as tin- r.i-k it 
 concenuMi, hiivc to work at fourfold its normal rate, ImjIIi in the 
 themiial hnakdown of the luemoiflohin and its after excretion 
 into the l)ile stream. S> lonj; iw* the liver can cojm- uith thin 
 all ^iK's well so far a.s jaundice in coiiecnM-*!, and thi- only efT«-et 
 noticed will U- incn-a.>ic<l hiliary piginentM in the fji^es and pndialily 
 a darkening; in the urine due to an increasc<| formation ff uro 
 chrome. .As n'jjanls the inin-containin^ fnutioii, tlii> m.i\ < ith.-r 
 l>e stond in the liver, or S4nt out at fourfold llie r.i*< ».■ i ht- 
 red iMine marrow to supply the increased demand of tin h im.i 
 tohlti.HtM for iron com|Niunds If the iron is held up tli< f wll 
 l»e an iron starvation of the hicniatohlasts Icatlin^; to .uti.i : m 
 of ana'inia, hut not to jaundice. This may ap|><-ar ' 
 diminisheil erythrocyte |iriH|uction and in ap|M*arance of u-. 
 and im-Kular fonns. On the other hand, if the liver di- ■.>... - 
 the increase of iron com|Miunds info the MikmI stn-ani, ,ind tlm* 
 in fully ufilisjMl hy the hn-matolilik.stie tisNue^, then the ntl marn»w 
 will now also have to work at fourfold tin- nonnal rate ami may 
 suc< t-i-d in doini; this or hn-ak down. If it Kn-aks down, then 
 then- will Ix- aplastic ann-mia simply fn>m atrophy and exhaustion, 
 with an enormous drop in erythnxytes luid a replacement of rf*\ hy 
 yi'llow marrow, hut no jaiimlice will ap|M'ar if the liver U- func- 
 lioninn pro|Mrly. Then- may also obviously In- parti. il hn-ak- 
 •lown of Inith liver and nnl marrow functions when therr may be 
 hoth nnn>mia and jaundice pn>«ont. or one may HiirctHHl the 
 other a.s ha-s U-en olwcrved. 
 
 lii't us consider a little mon* minutely the poisihility that th«> 
 liver i.s not able to cxcnMe into tlu' bile stn'am the incrna.s«tl bile 
 pigments a.s fii>t as it can form them by katalM>lisini! hn-ni-L- 
 The effi-cts will then vary a<«-onliiii; ti> what pari I'f the ' 
 mechanism has broken dowii If the bn-akdown i« in flic 
 |»an>nchyma. this will Ucome bliM'ke<l with pipnienf. and pr 
 commence to ilef»encn»te anil atn>phy. after a stiniulatt. 
 imthological n'>;eiienition. ami at this stajp* then- may t 
 little general jaundice. If the hn^akdown i* in the bile « .n 
 tlu-ir inen>n»<rtl load raii.Hin|t olmlnirtion or catarrh, ilmi ;■ 
 pi|!mcnlM will lie damnxHi Iwick after prndurtion oiit.si<i< ine 
 Jie|N»tic crIU. and they will commence to filter thmufth into the 
 
44 
 
 blood capillaries. The serum will now be loaded to a higher level 
 with bile pigmeuf, and this will stimulate the renal epithelium 
 to take on the function normally performed through the biliary 
 mechanism and excrete bile-pigments in the urine. The physical 
 signs seen will de|)cnd on how far this compensation can be carried 
 out, if it is incomplete, the concentration of bile pigment will 
 increase until plasma and all serous fluids become bile-stained, 
 and then jaundice is established. 
 
 In the great majority of T.N.T. workers, all of whom must be 
 cyanosed in varying degree according to the extent to which they 
 are absorbing, the compensatory balance is established, there is 
 no critical breakdown in liver or red marrow or kidney, and the 
 degree of minor T.N.T. illness varies with the degree of the blood 
 change. 
 
 But any individual who absorbs freely is always in danger, 
 some intercurrent illness or indiscretion may just tip over the 
 balance and establish a condition which will run downhill of it.self 
 when once set going. Such persons ought obviously to be 
 removed, so that a salting out process is established and the 
 workshops become filled with those individuals who do not let 
 in the poison. 
 
 It is, of course, possible that there may all the time be a 
 direct attack of the poison on hepatic cells, hsematoblasts, and 
 renal epithelium, but the blood condition, if it exists, would 
 form a powerful adjuvant to such a direct action and make 
 all the difference between survival and degeneration of such tissues. 
 In addition to the chronic overwork and organic fatigue, there is 
 also to be thought of the continual pathological stimulus of 
 heightened amounts of metabolites in solution in the cells, and 
 the fact that when the rate of working is at a maximum these 
 may be qualitatively different from normal metabolites. 
 
 4. IiuUcafion of Increased H(J£rnoglobin Metabolism umon(j 
 T.N.T. Workers. — ^There are two important indications of thi.'<i 
 heightened haemoglobin metabolism found amongst T.N.T. 
 workers. 
 
 In the first place, it is a common complaint amongst them, 
 when suffering from minor illness, that their '" water " became very 
 dark-coloured during the attack. No bile pigments are present, 
 but the colour shows an increase in the amount of urochrome. 
 
 In the second place, it has been noticed, in the first instance bj- 
 Dr. Castellain, who has endeavoui-ed to found an early diagnostic 
 test upon it, that the serum of T.N.T. workers complaining of 
 minor T.N.T. illness is often bile-stained before any colour can be 
 seen on the sclerotics. 
 
 This cholwmia has been investigated by Dr. P. N. Pantou* 
 in the case of 100 women workers in T.N.T. not complaining of 
 illness. This observer states that : — 
 
 * A report on tlie blood conditions of workers in tri-nitro-toluene by 
 Dr. P. N. Panton, Clinical Pathologist, Ixjndon Hospital. — Lancet, July 
 21st, 1917. 
 
45 
 
 " In twenty ol the cjkttu the trrum was bile ttnged. Tlii» woulii 
 •ppear t<> «how tb<it iii a hif;>i proportion •>< th't* ai wrk '•"m" !i< ton 
 
 of th'- - •' ' • " ■■ - ■ ' ' • '" 
 
 be f . 
 
 a •>;. 
 
 •veil so J, |i. J 
 
 No c.ise ».iN 
 
 bile tiiiRwl I 
 
 leiul »lip|>«>lt t'l III'- ^ ,.|.'.-.ili 'ii til, it I S I « ikii> iii.is \f ir. .r.i;!j 
 
 citiiugc til tl.c livrr without uttatk> ol MLkn<r>!i ur toxic juuiiiiitc.' 
 
 It nmy \>f |M>iiiti-(l out tluit Hiiicc the m»1o Hourt-c of bile 
 pignicrtt in katalMilisitl lin'iii<i;;l<>>>iii. wliiit thi- bilr Htaiiii-«l mtuim 
 most |iii)hiihly in(li(ii(«H JH thiit tlii- iiurfii-M'«| LttulxiliHin of tlm 
 ba>n)i>Klobiii r«-»<'lics Mich a U-vcl tliikt tin* liver rclU uinl biU< 
 eunalii-iili nn> nut hI>Ic to \m-is it nil llinxi^li into tin* bile i-ltniiuelii 
 without xoino Ifukiit!)' into tli<- bliMnl (■a|iillarii>s (liu> to its iiifn>(V4«Mt 
 com'fntriitioit in irlls uml tissin* spaces. 
 
 It is hpneo diniciilt to a^rc*' with Dr. Pantoii in atmtlipr 
 M'Ctioti of his pa|M'r, where he states that :-- 
 
 ■■ The daily al^Tption <>( I" X 1 . lUxn not contmonlv havcany ilclctcriou* 
 action on the bhwHJ 
 
 " Ni> tlcRrp*- ol aiixinui apprsint to have bc«n priHliiced among tlvc 
 fifty w.ifkepi fv.iiiiiiirtt On the lonlrary. the retl cells and hf nii>t;loljiii 
 were well up to the nuriii.il standard " 
 
 Aj* has iRfh s«'t out aljove, increastMl destruction of rc^l bliKxt 
 rorpuscles can iMciir without lemlinK to aivy ann-niiu. pmviclitl 
 the re<l iMine mi-rrow r< >|>on<ls to the call and pnMliices an eipii 
 valent iiiinil)er of new risl bliMxl corpii.scles. 
 
 Acconling to Dr. FantonV own oliservations lh«-n' wen- in a 
 certain factory Ix |H'reent. of tin* workirs niarkeilly eyanos»-«|. and 
 Me are unable lo conceive how thi-" pathological condition cotdd 
 |M rsist for months without any imrcascd tlestruction of rc«l liloo<l 
 r«)rpust |«>s. In tin- majority of c.i-es. in our opinion, a lMilan«e is 
 cstahliohed with increased destruction and incrcas«-d pnHluctioii . 
 in the ■••mall minority of <aM's. such cnm|H'nsati<in fails, and 
 this leads to toxic jntindiee or aplastic nnn-mia. 
 
 S. Pa*AibilUi/ of the tUrtcl Anion of T.X.T. upott Ihr /,»ivr and 
 Bed Murroir. Ik-yond this jmint it is ini|MNwibU< at pres«'nl to 
 adviuice ex|H>rimentally so a- to exclmle any din-ii action of the 
 poi«i>ii on the t«o main tissues lomernetl . we h'ixe no desin' to 
 inuiniuin that such n direct action in iin|H>ssibU>. but would |Mtint 
 out that the two sitti« involvtHl are lluwc roiicrmvcl in rt>painnK » 
 hltxxl (it struct ion. 
 
 .\ detiniie i-«ue could only l>e obtainr<l if them wir< 
 
 iiu<ans of exposing! liver ami n-d marrow to attack by ir; 
 toluene without involving; bloo<l chani{es. aiid this i« oliv 
 in)|H>ssibio iM-cAii.se the |Miisitn must naeh the»e ti*suei> throutih ihv 
 IiIimmI stn>flm and will act u|»on the erjthrocyteji on the way 
 
 The last rrniaininc n'soiin-e for a dear proof of dirvct action 
 on these ti.s«iies wilhoiit blood chang«>« i^ a negative onr, namely. 
 
46 
 
 the supposed clinical observation that jaundice has been the first 
 sign of attack without any precedent minor T.N.T. illness or 
 evidence of cyanosis. 
 
 This position is surrounded by all the difficulties of a negative 
 proof. It could only be admitted where there had been most 
 careful examination of selected cases beforehand and thorough 
 exclusion of other symptoms. Such proof has never been given, 
 and the circumstances are not such that it can be given. Each 
 factory doctor has a thousand or more of T.N.T. workers to look 
 after, and it is quite impossible that he should examine each one 
 of these daily and rigorously, and by scientific evidence, exclude 
 blood changes. A great many of those cases where jaundice 
 ap2)cared to be the first trouble were antecedent to the introduction 
 of workshop inspection or in j)laces where there has been delay in 
 introducing it. One occun-ed recently in which it w^as declared 
 by doctor and welfare supervisor that jaundice was the first 
 sign to appear and that there had been no cyanosis, but the case 
 did not bear investigation, for intimates of the deceased at her 
 home, lodging-house, and the workshop, volunteered the informa- 
 tion that her lijjs had gone blue, and that she had suffered from 
 breathlessness, giddiness, and sleeplessness. (See case records 
 below.) 
 
 It is indeed difficult for a physiologist to conceive how there 
 could be such a concentration of tri-nitro-toluene in blood plasma 
 as to attack the liver parenchyma, cause degeneratioii of the liver 
 to half its normal weight, and produce jaunrlice, without touching 
 the blood cells, for which this poison like others of its class is 
 known to possess such a strong si^ecific affinity. 
 
 It may, we think, be assumed that tri-nitro-toluene in all cases 
 attacks the blood, that tliis attack shows itself by indubitable 
 physico-clinical signs, and that care over such cases and their 
 early detection in the workshop is the surest safeguard against 
 toxic jaundice and aplastic anaemia. 
 
 This position is supported by a large number of the returns 
 in the monthly records issued by the Home Office, in which it is 
 recorded that patients in earlier days were seen to be jaundiced 
 by their workmates or by their intimate friends at home when 
 they themselves did not know they were ill. The sequence of toxic 
 jaundice upon minor illness and cyanosis is also shown by our 
 clinical oljservations in the cases quoted below. It was these 
 observations which led the writer in October, 1916, to make the 
 following suggestions, which are quoted verbatim from a report 
 then .sent in to the T.N.T. Advisory Committee : — 
 
 24th October, 1916. 
 
 " Living, as I have done, amongst these workers for several weeks 
 and going round the shops and examining daily, I have found that it 
 is perfectly easy to detect the early cases of T.N.T. illness short of jaundice. 
 There is a T.N.T. facies that is unmistakable, a pale face lacking in e.xpres- 
 sion and like anaemia, but peculiar in itself, lips that can scarcelv be 
 described as cyanosed, but of an ashen-blue colour, similar gums, and 
 
(wrhaiJB a (.tint trace ol yellow uit the oinjunctiw, the real of l)w> tkio 
 •bowing ri.) icterut In such a axac qut-it»oiimg will often elicit a hittory 
 of h(rada4liir*>, or nausea, or abdominal (Kkin« 
 
 " The two fundamental recommendations arisini; out ul these observa- 
 tions, itre. Ill th<- iirst place, the rrni'ival. as rapidly ixs it laii lie a4.<.om 
 plishc'l. o( the lUMcptible iiuliMdu.tl'. Ironi l N I wurk. and llwrir lepUtc 
 tneiit )>y (rcrsli workers sent by the labour l'.XLliaIi»;<~> by priority tu 
 T N I w'lrk I estimate thiit there are between 5 ami 10 [>er tent of 
 peopl«- at work on TNT who should be sent to other work. 
 
 ■ Ihe pitkini? out n not a duhcult task ; it scarcely even re.juire^ 
 medical skill , there i« a foreman and a forewoman who are right nearly 
 every time they Nend them to me " 
 
 fi . .., . ,,;■ \... ,i,.i,. II. 11 !,■ {..-oplc who liavc soni-- .•« •- i .. ... - .i 
 t' • by a vi»itiii(! surg" 
 
 I ' \. itement o( Roing to 
 
 il ot munition time in .' 
 up th'- p.iti' ih' symptom* The iK-st u.i\ is !■■ •,ir,s\ 
 
 round the wt k them out as they work or get the (oreman 
 
 or welf:irf n'v. , n. tly to draw attention to th'«r -snspr.-trd 
 
 " I'i I iiiust lie a large one and Ik I' 
 
 crop iH to lie avoided The •tii. 
 
 besni.i. :. must be exercised on new U'Ks: 
 
 have Ih ■ 1. . u^ i^.'.i i..i over ^ year and never liad a d.i> o, , ., , m. kih-^-<. 
 anil theM' .irr uitcn not very well developed physically or m any way 
 resistant l>n>king " 
 
 It i>4 iiliiiOHt imivtTHnlly n<lniitto<l. pvon by tfia-<r who con- 
 teiul thiit tlii'rt" is im pr«>((f that < yaiii»i.s and jaiiiutiri- an* n-lattil, 
 that till- •.ystom of early (Utrctioii in thf workshop tht-u btinn 
 intnxliii'i-)! ha^ \n'vt\ a .tlu-t-t anrhur in conilMitinjj toxic jauntlit-e. 
 
 Til'- |Miuliar |Millor or jjn-y IiIimmu-^-* of tin- rountj-naiue of 
 tlii-M- |Miipli' uliifli .sitmilnti-s nnaunia m not tnutinia. ilh Ur. 
 PantonV rfxult.H. iiml our own. .show ; it is thr nlten-<l lolour of 
 thf hliMwl .showing through thi- .nkin in othor wonl*. liko lh<> 
 <v.Hht'n bhir li|ts, if i.s cyano.sjs. Thi- only otluT ini-nilMr in ouf 
 triad of >yinptoin.s ^ivcn last (IiIoImt is "and jtrrhnit^t a f.iint 
 tra«v of yillow on tlu- ronjunttivif. tlu- n-st of thi* .skin showuiK no 
 icttriis " 
 
 Wlirn thisc an. oksrrvcd thf |Mttr<>llini; surnfon tttoi** and 
 <|U('.st loiLs the workiT. and thon hf may hear of ah<h>niinal |MiiitH. 
 I^iddines^. sU-epincMM, lin'athles.snt's.s. .si(kneH.M. He may tir may 
 not elicit this history areonlinn to whether the worker U'vU like 
 tt»f>tinn or jjoinR on with work ; if the irftfU'rver U* wise he will act 
 mr.irly on wh.\t lie S4iw iM'fon* lu" disturU-*! or questioned the 
 worker. 
 
 It is out of the «|iie.stion to wait till general jaundnr devrlo|ts, 
 attd the lir-t faint trace on the .s<'li'n)tics is valuable a-. contirminK 
 the cyaiiosi'.. One must not wiiit for deeply yellow conjunctiva! 
 iK-fon- tuniini: olT, it is too dangemus. 
 
 We are well a wan* from having s«'en them t hat t here arv workers 
 
 ■A for months wit hclreply blue li|t<and never loenpUin , 
 
 re people who can liv«< for years with sennu* valvular 
 
 heart. Then? is a chemical coiii|irnsaii<>n in the»o 
 
 i\.i:. ■ 1 pctiple. and they p«v«4*<',s.s n-«uaAikt Iiv»«r criLs oad rvd 
 
48 
 
 marrow cells, but they arc in a danger zone, and the sooner they 
 are weeded out from T.N.T. and put on to other work the better. 
 
 Converselj', there are cases where, without any cyanosis 
 so marked as to have attracted attention, jaundice had appeared 
 apparently as the first symptom. It is here to be remembered 
 that some skins show ( y^uiosis more readily than others, and that 
 the same poison in diilc rent iiidivichials may hit the two types of 
 cell, viz. : (1) red blood corpuscles and hsematoblasts on the one 
 hand, and (2) liver parenchyma on the other, in var\'ing degree. 
 This is well known for other toxic substances. 
 
 Wljile the cyanosis in such eases was not apparent, we have 
 little doubt, for reasons already given, that it was there, and 
 would have been found had it been carefully sought for l>v blood 
 examination. 
 
 On the other liand, there is no question of the frequent associa- 
 tion of cyanosis and jaundice, or of the large number of cases 
 where cyanosis appeared first, and later the jaundice. 
 
 Several cases have been sent off work for cyanosis and minor 
 T.N.T. .symptoms and have developed mtfrked jaundice at home. 
 In other cases, accompanying cyanosis and the minor symptoms 
 there has just been the faintest trace of yellow on the sclerotics, 
 and a few days after, the patient being at home in the interval, 
 there has been jn-ofound general jaundice developed, leading in 
 several cases to a fatal result. 
 
 One difficulty is the small number of cyanosed cases wliich 
 go on to jaundice, but widening the outlook on the field of 
 medicine affords parallel cases. Chronic alcoholism, for example, 
 is, like T.N.T. poisoning, a prolonged chemical toxic action, but how 
 few chronic alcoholics pass on into cirrhosis of the liver ? Lead 
 poisoning is a slow chemical effect, but how many lead 
 workers, with the blue line on their gums, pass on to the other 
 classic symptoms and to death from lead poisoning ? 
 
 Another point urged against the relationship is that, while 
 cyanosis can be pi'oduced by the exhibition of pure T.X.T., it is 
 not possible as a result of chronic poisoning in animals to produce 
 the T.N.T. effects on the liver. 
 
 In reply, we woidd say that we have actually produced these 
 effects as already mentioned in one rabbit by administration of 
 pure T.N.T. where there was marked jaundice, and in addition the 
 liver afterwards was examined for us bj' Dr. Turnbull, who 
 described the effects as similar to the early stages of attack on the 
 liver in human cases. In two other cases of experimental pure 
 T.N.T. poisoning, also in rabbits, well-marked liver lesions of 
 similar tj^pe were obtained but not accompanied by jaundice. 
 
 It is questionable whether a larger number of positive results 
 than this ought to be expected amongst the numbers of animals 
 experimented upon. As every pharmacologist knows, it is 
 notoriously difficult to re-produce chronic pathological lesions 
 experimentally in animals by the use of drugs. The adjustment 
 
49 
 
 of the dosage ami ifH variiitioii with the ilumliuii of the ex|KTiiiiciit 
 uii- very ilitficult to ac-eoiii[ilii«h with the iiievty required. 
 
 .Moreover, we kikuw fniin our workxho]) n-<ultri that for M-veral 
 hiiMdn.JH uf |MM)|jh< daily ex|M>M>«l ihnmnully to TNT only one 
 or Hvn (lcvflo|i jaintdiee. Mow many |»<>sifivi' r«'sult» may then 
 reii-.iinaljly lie oxjKKrt*-*! ainon>{st fwo or thn*' doZii-n animaU ? 
 Nor ean the reHults Ix- ha-dem-*! I>y a<hniniHtration of hcitvicr 
 doM-«. becautte that only thrown ovt-r from ilmmie into a< iite 
 efleets, and doe.s not n-|tr<Mlu<e the requiNite conditions. In how 
 many ea.He» has alcoholic cirrhohin of the liver Ix-en reprodiaeii 
 in animaln, ulthuugh it Iuim often lieen attempted t 
 
 (vi) Caites Shoiriiaj Inlinuite Hflalion hftireen Cyanosis ami 
 Jittimlice. 
 
 Next we Hliould like ti> relate the case-, w hich caiiMMi iw to adopt 
 the view that cyanosi.s and jaumiice were intimately connected, 
 and to atlvocate a-^t a result early detection in the actual work>«ho|iM. 
 
 Cast I (Ki-cunled l.y II M ) NV <). It wa* while wurkiiu. ilailv at 
 
 in S'-ptcmtirr, hUH. that my i"' ■" .. .. .1. . ,. ,. i., , i . i ..i, \v. i, ,,j 
 
 Sii|»crviV)r. Miss Vork. t.> this j.; : ;.^ 
 
 and th<- |h-<. iiliar |>.»lliir in .1 mail. .r 
 
 nclcrotitH. t)n (|ucKtii)iiinK, sU>- .. ;..it 
 
 she Iiail » certain ammint nl nausf.i. \<\\\ had u 'l Im..-u :.i.,k.. .lud lluit she 
 bad slit;ht alHlnminal (kiinit, l>ul iinthiiig, mIic acldr<l, siiflii init to ■ttnn 
 worktiic f..r I t.,1,1 |„r 1 w.is , .rt.-iin sh.. h.-.d .. mild .itt... k .? T N 1 
 din. ■ .. 
 
 thai ;.. . n 
 
 llir IxiloWi:: -.e 
 
 atwrkth. 
 
 Ilrthcri.tt t.r 
 
 alter the h"lid-i> --h'- niii^t ii ■! .l.iil \s 1 k .i^^uu 
 
 Iw<i dayn later Dm I-oRKr an<l <)|iMn.i\an visited the factory, and 
 1)1 t!')inK rtiiiud I)r D'l >.mi' \.iii <lr. w .r».!:'i :. t.. .1 di-tin. t \ . tl. w <>n 
 
 this Rirls "ulerDtics ; I had not it 
 
 oiur M-nt oti home, anct I ti>l<l Xv -. ./• 
 
 thick on MoiitLiy after the miu. • n 
 
 the (Ktlient vamr ti> «-e me nn tl„ .'.; , . te 
 
 A« villiiw ai fsninean. and she lutd a Rri. v .n 
 
 iiiiiiK-ihati'lv -enl inln hospital iimlei t 
 
 At tif.>t sh<- <Iid ii.'l v.ni \i-iv ill. in -; .| 
 
 WA> qilitr hiiKht aiirl ihrerfiil l>n t\v 1 ull. 'f 
 
 »hr talke<l to me i)iiitr intelliRilily. tuit A few il ' '.p 
 
 wa« worse, and mi >.^IIiiij: fiiui ! !,. r d'tiri.niH i %«• 
 .liid died .\t th. 
 
 l.lKudl.r du.- t- 1 M* 
 
 ..I iv.ui..^i- .ind t e 
 
 ('d<' // F. S The above cMT finit •wakened 
 
 mr tn the .1- • thf-^^ mw-i <^»rlv .ind ! nsk«-H ff-rrmen 
 
 ai>d (..rrwMiii. :; ...... . ,,, 
 
 f;..iru; "l< .■.•!.. ur. .!■ ~« 
 
 Th.H i;,tl %va» ^r„. ..I 
 
 W ( .w I ) > , : ;.>lr 
 
 'n|<lr\ii>n. I>tit with a very lia>< Muuktlh aktii. antl tttcic wiU it Uighl Uut 
 
so 
 
 quite distinct yellow tinge on the sclerotics. I had her go away at once 
 to the hostel and be put to bed. Two days later I saw her and examined 
 her carefully. The yellow on the sclerotics had definitely developed, so 
 that it was quite obvious at a glance to anyone, and there was a faint, 
 but quite definite yellow on the unexposed skin area of breast and arms. 
 Fortunately, things did not go beyond tliis stage with tliis patient. In 
 about a week both cyanosis and jaundice cleared up, and the change 
 in complexion was most remarkable ; her delicate skin was now white 
 and semi-transparent, with a perfect pink on the cheeks. The change 
 from the muddy, greyish-yellow to this was most striking, and was com- 
 mented upon by a lady visitor, who had seen her along with me when 
 she was jaundiced, and again a week later when she had recovered. 
 
 Case III. — (Recorded by B. M.) E. C, a young girl, one of four, whom 
 I took ofi on the same forenoon in October, 1916, employed in filling 
 exploder bags with pure T.N.T. This is a case wliich I insist ui)on, 
 and emphasize as of the utmost importance from the point of view 
 of settling definitely the true causative agency in the poison causing 
 jaundice and proving it to be trinitrotoluene itself. The actual T.N.T. 
 in use by these girls was a very pure commercial sample, almost colourless, 
 crystalline, perfectly hard and dry. There was no molten T.N.T. anywhere 
 in their neighbourhood, and no fume detectable, except by a slight bitter 
 effect on mouth and nose. In view of the intense bitterness of T.N.T. 
 this sensory effect cannot be taken as indicating the presence of any 
 quantity of fume or dust which might be toxic tlirough inhalation ; our 
 experiments cited above disprove this possibility. 
 
 There was nothing present here but T.N.T. in hard solid form. 
 
 I inspected, at first asking no questions, a gang of about thirty girls, 
 and, separating four on one side, by questioning found that they had all 
 had the well-known symptoms of minor T.N.T. illness. I then sent 
 them to the certifying surgeon, who stood them all off T.N.T. work. 
 
 A most interesting point is that the gang were all alternating their 
 work, and all, including these four girls, had only resumed ivork on T.N.T. 
 that very morning about two hours before my visit to the workshop, after a 
 full week's remission on black powder work quite free from T.N.T. 
 
 Next, as to the symptoms on which I detected these four girls ; these 
 were ashen-blue lips and gums, a peculiar pallor of their faces, and in 
 three out of the four cases a slight yellow on the sclerotics. The most 
 impressive appearance was the blueness and pallor, without which one ■ 
 would probably have passed over the slight yellow on the sclerotics. 
 But, as one is ever on one's guard for the first signs of jaundice, when- 
 the other signs are there, one looks most carefully at the eyes, and then 
 in many cases sees a faint trace of yellow. One would not " stand off " 
 individuals with little or no cyanosis and pallor on such a trace of yellow 
 alone as these girls showed, under present conditions of admission. 
 
 Now for the subsequent history : within a week off work three of 
 the four, namely, the one who had no yellow tinge on the eyes, a dark- 
 complexioned girl of fourteen (E. M.), and two of those with a slight 
 tinge (M, and L.), quite cleared up, and the change in colour of lips and 
 cheeks was most remarkably striking. 
 
 The fourth case (E. C, fair complexion, sixteen years old), is that 
 upon wliich I wish to lay most stress as showing the connection between 
 cyanosis and jaundice. 
 
 Let it be remembered that she was working on the purest form of 
 T.N.T. used, very much purer than that used for melting and making 
 any form of amatol. When she was detected by me she was cyanosed, 
 pale, and had a just definitely detectable tinge on the sclerotics, but no 
 general jaundice on unexposed parts of breast or arms. I sent her. like 
 the others, to the certifying surgeon, who " stood her off " like the other 
 three, and sent her into the nursing home. Two days later I called and 
 saw her, when she was jaundiced quite distinctly all over the body. Again 
 I saw her a week later when the jaundice was fading, but still distinctly 
 
61 
 
 prnwnl The cyuiKiftis and |ullur luid liy tlii% tiiiii? y.: .1. 
 
 The jdundlcr clcare<t in about three week* tunc .iiiil Uv : ■J 
 
 ThiH liiSK- WdJt crrtlfieil to the llunie Ollur .11 a la^' !ii« 
 
 l>y the irrtifying aurgeuii, Dctober ISth. li»IH 
 
 (ate II' (Rec<irded by H M and C. A W ) R. K.. aged filty-five, 
 nu»l<- liiiployed in wriKhiiiR I" N T in IVew Muum. Not near any 
 nirltrd T NT , an none is used 111 the entire building 
 
 I he material which thit niAii w.is rouKlJy weighinK out in an ordinary 
 pair ii( grocer's scales, whilr ii"t |><-r)iap« so pure a.s tluit u»etl by the girlii 
 dr«<ritied in the previous .aic wat hard, dry, scaly T NT . and would 
 nut on thr whole contain aiiv ^ipprri table amount o( inipuritm 
 
 Up was detected by u<t on the aiternoon o( November llth. 1916, 
 on u|>|>earance« only. He wait then niarke«lly cyanused and pallid, and 
 had a i|iiite distinct icterus on the conjuiictivx and a slight general one 
 on the skin 
 
 Only ' r tiim <lid he state tliat he had suffered from 
 
 (latulencr .itMlomrn li>r the last two weeks, and that he 
 
 had l.itcK ly I><>ttor and l>een ofl work (or a week, since 
 
 when he 1. 1 »i work (or ten days 
 
 He liad no intention i>( going to see the doctor liecause he had had 
 this week o(T so recently, and we luiil some diflTiculty in arousing him 
 to the fill t that he was seriously ill and must leave work and go tn the 
 doctor at once. 
 
 He was sent to the N. Inlirniary by the terti(ying surgetm. and we 
 saw him there two days later ; he was then deeply jaundiced, but did 
 not complain much, and talke<l intelligibly. 
 
 .\ week later we saw him when he was stdl deeply jaundiced, drowsy, 
 and (lyspnieu . and unable to answer questions, and our pnignosis was 
 that he would not recover He remained like this (or a (ew days, and 
 then liegan to get l)etter. and finally recovered 
 
 Hr w.is certifie<l to the Hi>me Office as a case o( toxic )aundire. 
 date Novcmlx-r 9th. IHlii ; occupation, weighing TXT. in l*rewi House; 
 duration ol rinployiiunt, three months ; severity, severe : remarks, 
 vomited November Stli, continued at work till tletected bv Surgetin 
 November mh. still declared he felt all right. 
 
 This cxse illustrates again the connection of cyanosis and early jaundice. 
 
 Can r. — (Recorded bv U. M. and C A. W.) K . male, aged 32. 
 Trucking to cylinders. Melt House ; November 29th, 1916. 
 
 We caught this c.vse in a curious way — just one day before our visit 
 t.' the fact. TV r.>n.Iiid-<l 
 
 We w., re- 
 
 at tion ol I his 
 
 one Wr ' <n 
 
 workers w • ts 
 
 midr ex. ry 
 
 |i.iiis. (uni ■ 'ih 
 
 m-in turm ! ; ins 
 
 lastead of int.. til"- uriiiai W -• g.'t the tw.ti'j t.ur >innr> u. rr.jiiired 
 in aU^ul as many minutes. 
 
 We look notes of the condition and employment of each man wjio 
 contributed, and K. was one of thcae He was markedly cyamnsed on 
 the li|M. and also showeti jaundice, not only on the eyes, but on cheat 
 .111.1 .■\t>.t. mrn 
 
 1 01 
 
 .11 '>t. 
 
 It .. Kat 
 
 hlin »•■ ii..im-.- rir w.Mii.i i;' ' "'■ -l"-< •iii'-ii 'i 'i'> >"ii" ..n.*.., .. i.igb 
 
 content ol altered TNI (equivalent to 3 on our scale) 
 
We did not ourselves see this patient again, but he was returned to 
 the Home Office by the Certifying Surgeon of the Factory as a case of 
 toxic jaundice, and we quote the ffiUowing from the monthly returns of 
 February, 1917 : — K., male, 32 ; date of disablement, 29th November, 
 1916 : precise occupation, filling under cylinders ; duration of employ- 
 ment, 4i months; severity, slight; remarks, October 17th symptoms, 
 severe gastric catarrh ; suspended until October 31st, when allowed to 
 resume at cylinders. Again suspended November 29th (this was the point 
 of our intervention) until January 3rd {i.e., for five weeks), when returned 
 to another part of factory. January 10th, suspended for continued 
 signs of jaundice. January 16th slight conjunctival jaundice. At sus- 
 pension on November 29th his whole skin was washed with acetone. 
 
 It is clear that this patient had minor T.N.T. illness prior to appear- 
 ance of jaundice. 
 
 It is interesting that in this history supplied from the Factory to Home 
 Office there is no mention of cyanosis, either in the period of his illness 
 prior to our detection of him, at this period, or later. Yet when we sent 
 him off on November 29th he was markedly cyanosed. This is not said 
 in order to tlirow blame on any observer, for cyanosis at the early stage 
 in these jaundice cases may be too common to mention. 
 
 Summing up on these five cases, which are our own personal experi- 
 ence and detected in the actual workshop when they had no intention 
 of reporting ill, we would point out in the first place how clearly they 
 demonstrate the value of early detection, for we feel certain that one, 
 if not more, would have perished but for our detection. In the second 
 place, the universal presence of cyanosis in cases caught and observed 
 in the initial stages and the importance of this sign in attracting early 
 attention. 
 
 Case VI. — (Recorded by B. M.) F. W. Weigher to Pellet Press. 
 
 This case occurred at a considerably later date than the previous 
 five, and is here recorded to show the fallacy of accepting without thorough 
 investigation negative evidence as to absence of signs and symptoms 
 other than conjunctival jaundice. 
 
 I was down at the factory where this fatal case of toxic jaundice 
 occurred, endeavouring to perfect a mechanical contrivance for keeping 
 the girls' hands out of contact with the powder in one of the most dangerous 
 forms of T.N.T. employment, when it was reported to me that one of 
 these very girls was then in hospital seriously ill with T.N.T. poisoning. 
 
 I had been told by the Works Manager and the Welfare Superintendent 
 that the very first thing noticed was the jaundice in the eves, and this 
 without any premonitory warnings, thus showing the impossibility of 
 catching early some of these cases. The same evening 1 visited the l-"actory 
 Doctor and heard the same tale. I asked specifically if cyanosis or other 
 signs of T.N.T. illness had been observed, and was definitely answered 
 in the negative. The doctor told me he had seen the girl on his usual 
 Wednesday visit three weeks previously. The only thing he detected 
 was a faint yellow on the sclerotics, and, cross-questioning, failed to elicit 
 any admission of symptoms of T.N.T. illness. He did not send her off 
 work, but said she was to be kept under observation. On the following 
 Monday she was sent to him with much deeper jaundice on the eyes, 
 aud with slight general jaundice, and was then sent to the nursing home. 
 
 Here, then, seemed to be a typical case of jaundice occurring first, 
 unaccompanied by cyanosis and other minor symptoms, the sort of case 
 upon which those medical officers rely who hold that (1) minor T.N.T. 
 illness and cyanosis, and (2) toxic jaundice are distinct clinical entities. 
 
 Being on the spot, I determined to examine thoroughly into the evi- 
 dence of this seemingly foudroyant case, and I interviewed her relations, 
 her co-workers in the same shed, aud her lodging-mates. These, without 
 any leading questions whatever, all ooncordantlv vohmteered the informa- 
 
53 
 
 >n tlut her li|>ii luil i;f>iie blue (ur nearly 4 (•jftiiight bcltfe. ttkal klie lutd 
 •iiiplaiiie«l o( KtililiiirM. had »hown ■tlrrpiiKiu and Ltuttud^. and in the 
 - i.-w .lav, t..,l u-.-„ l„.-..i,l..,, -,.,,1 ^ .r.^iv able U. walk tbeam 
 
 li 1 atlrndnl. and it «ra» 
 I t>y I vani«u and all the 
 
 IIrt^- »M-rc ■ - • ,ted 
 
 '.3 ■,wn tiuh ll .>.i!. ..%:-. i.l the 
 It mu!tt tte done 111 Ihtr worlohop 
 
 b«-'--''K ... ■■ > ..■■ .ij.,. ,. ,,.. ,.,-..•...••.■■. .......... ..,,., . aiiiica 
 
 flu-.liiin; "1 l.ur and iiin 
 
 Tliin a|>|M-tirs to luivr licrn \vluit«luippcncd in this case, the same reti- 
 ecucv, ami |«Th.ii>-. .1 Icir of licin^; turned ofl work when she did not leel 
 b'rstll ill inmii-li fur that, seem to have complicated the tituation and 
 m.nli- tur diny to the doctors tpieries even the Kanty information she 
 gAv in her lodKinc^ in. I .if th. f.i. t.rv 
 
 Til.- i..|l..wiiu; . 
 
 On 1 1,.- Sim.l. 1 visited her 
 
 at til.- Niir-.iiu: li I nbvtoiitly 
 
 ds ''■ ^' ' ,..^ i.. .1. ..I I... .11 ..II eyen and 
 
 *^.. • . k» previously, but she liad not 
 
 n 
 
 ■ r ri-l.iti\.> I «... ! 1.! tl,. N M.I. 
 in II. ■ . r t.>..!u. ft;ul I w,ia .it min- .mil inttTN 
 
 r(H-\ were a brotlu-r and three Hintrr* I 
 ni.- I'.'f.mir tt..--v ti.i.I n.Mi. .,1 n. tl„-jr sisf. : 
 ^ .n.l wriit 
 
 t' t told ma 
 
 t t».. visit* 
 
 r' -'inf 
 
 •!icr 
 
 .1 vmt .■vnv ju.-.M :. t .i:u .4 tliini. cxtciil my ini^.i.^l ..ne 
 \ft*Ti\ . .n I inV-f. i.'u. .1 .1 i;irl M K vvl... «.->^ th.- .V. ca*wl 
 
 :<-d. but would not go home and 
 
 I |. in .. |..iU ... t,^r i;„| ,|M 
 
 •■r 
 v..t 
 
 f.> I . tlir <|.wt..r Mir ».,s . 1.^ f 
 
 tired, slevpy, and ahort of breath 
 
54 
 
 Confirmation of this statement was given at the inquest. 
 
 The deceased girl's sister, N. W., at the inquest stated again that 
 she had noticed the blue lips and mentioned it to her two other sisters, 
 who agreed and said she was also short of breath. She could hardly touch 
 food, and was very sleepy, but persisted in saying she was all right, onlv 
 short of breath. 
 
 A girl working on the same machine with her gave evidence that the 
 deceased had complained to her of giddiness, and she had noticed her 
 lips had gone blue a week before, and on the Saturday afternoon previous 
 to leaving ofif work she had been giddy and trembling. 
 
 Clearer proof than the above of cyanosis and oxygen-deartli pre\ icus 
 to the onset of the jaundice could scarcely be adduced. 
 
 V. Prophylactic Measures. 
 
 (i) Early Detection of Cyanosis. 
 
 The researches and observations recorded above seem to furnish 
 not only a sure guide for the introduction of i^recautiunary 
 measures, but show liow unnecessary expense and fruitless 
 employment of skilled labour in such a time of dearth may be 
 avoided. The importance of early detection of the preliminary 
 stages of T.N.T. poisoning has been throughout insisted on in 
 this report and the methods have been indicated by which early 
 detection may be ensured. 
 
 (ii) Ventilation. 
 
 We believe that if a dust -extraction experiment be made 
 beforehand, as it obviously ought in each case, it will be found 
 that many proposed schemes of forced ventilation need not be 
 carried out. The vast majority of T.N.T. workshops are clean, 
 airy, naturally well ventilated, one-storey buildings, in which 
 our analyses, as far as thej' go, show tliat the quantity of T.N.T. 
 dust is negligible. 
 
 (iii) Prevention of Skin Absorption. 
 
 The knowledge that the main absorption occurs through the 
 skin of the hands indicates three lines of action, namely. (1) keep- 
 ing all that the hands can touch clean, (2) protecting the hands, 
 (3) detecting those hands which are permeable and keeping their 
 o-wTiers off T.N.T. work. 
 
 1. Provision of Shell Filling Machinery. — The realisation of 
 the skin danger has produced a remarkable change for the better 
 in recent months in many factories ; this has far-reaching results 
 in other directions as well as the hygienic one. The provision of 
 machinery for shell filling is, of course, considered a matter 
 of the greatest urgencj'. Not only will it enable each worker 
 to avoid much hand contact with T.N.T., but in addition the 
 greater speed attained will allow very large numbers of workers 
 to be set free for other national work, and lead to gieat saving. 
 Another point which may be suggested is that the most inti- 
 mate relation should be developed between the different factories, 
 so that the quickest method for a given operation used in any 
 one place may be installed rapidly and efficiently l)y means of 
 demonstrations given to the others. 
 
5S 
 
 2. Frttteetivt Clotkimj, (ilov<a and Uotjis -Vhn mcwt iiu(iort*nt 
 «kiii i»r.-H to protect i^* that of the hiiiuls, (or. although thero i* 
 Ht.iMtiii.' of fiue ami hair, thu iututil litiioiiiit of TNT (ailing on 
 t!i ;- m siiinll, unci wr lukVi- «hoMii that it ih only when tho 
 
 '1' ; 'I liamU an« iih«"<I to i i»rry on thi* inanipulationx of th«« 
 
 v^ -i ,^-ii..|, that any appri-tialile amount of iniKlifiitl TNT. 
 u|>|M-,iiH in the urine. 
 
 Thf niowt obviouM (irKt thoii^^ht is to cover the lianiiK with 
 ini|M'rviuu.t j?loves, and we havr «|)ent muth tinio in tl*-<i>{ning 
 gloves and K'ove utturhinints of variouM kimis and of ililTt-n-nt 
 matt-rials ; these all lin>ke ilown in prat^tice. We louKl protect 
 ourselves and did do so (or an entire week while working in a hhop, 
 and we coulil protect wurken< under ex|>erimei»t whom we our 
 selviH arrayeti and di.-uirrayed from their workshop io<)tunier<, 
 but our In-st attempts to drill a band of workers to earry out the»o 
 o|HTations for themselves failed, (hue the TNT. n«ts under- 
 neath the iflove, as it tl<H-s withal! workshop >;loves hitherto tried, 
 they an- worse than useless, for the inner surf(»<e of the flovo 
 holds the |Miwder in eloser ap|)osition to the skin, while the 
 perspiration makes it soft and damp, and the (;lovo and the 
 |M-rspinition together make the skin soft and |K'rmeable. So 
 that, exeept for very rouKh tasks whieh hurt the skin of xirls' 
 IwuuU, iMtre han<ls an- prefemble to j;lovetl ones, and in the few 
 rases whert< gloves mu'^t Ih- worn they should In* !oos«', thick 
 leather ones. 
 
 The other |Mirtions of workshop clothing ought to 1k" arrangc<l 
 to prot«it the skin, and the clothing of T.N.T. workers is rightly 
 kepl apart from that of other workers. Often a needless amount 
 o( roiif.Kt with T.N.T. is contracte«I in the cloakn>om.s from 
 candeo.- handling of l>oots and costumes by the workers, .\lter 
 nat»«»J workers have two s«'ts of clothing, one for ■" i>(T '" and oive 
 for ■■ on " T.N.T. . the.s*- ought to Ik- kept in sepjirnte cloakrooms 
 with sejHirate access, and ins|)ection ma<le that no worker dons 
 " off " clothes with his or her own home clothing contaminat«tl 
 with TNT. 
 
 n|M>ralions witit damp amatol |M>w4ler leiwling to damp clothing 
 nn- now fortuimtely much mon< ran« than formerly, thank" 
 mainly to the apprt-ciation of the fact that illneKs is pnMluced fn>m 
 Hkin I. intact aiul that accordingly th<' o|M>rations must U' con 
 ducted with as gn'at cleanline— « iw iMxsible. For this reoMin 
 it is only in a few instances thiH "verills or apn>ns of waterprx)ofe»l 
 material need Im- employed, and an overall or blouse of Uuler 
 house cloth IS Iwi-oming very common in the fartorie"! ami is \vr\ 
 jierviceable for its pur|x>se A« to the makeup, the " bloomer " 
 suit has l>eeome very jiopular for women munition workers an<l 
 
 • ; h to \ic prefemil to any form of «kirt \ two piece suit 
 
 .; of bli>omers and a blouse is now in very g«neral u.m« 
 
 1 'Miers ought to l>e inadi- shorter in the leg^tbanat pronent 
 
 , • . . II 1 over, mo/ III. lone Wi-llington l>not<« Such boot* w»m 
 
56 
 
 introduced at certain factories and have proved a great success. 
 The skin of tlie girls' feet, which used to be quite yellow from 
 T.N.T. absorption, is now clear of it. 
 
 At three large national facturics visildl by Ihc writer quite 
 unsuitable footwear was being worn by all the girls, in the form of 
 low, open shoes, leaving the doi-sum of the foot epvered only by a 
 thin stocking and so exposed for the T.N.T. to fall upon it. 
 This is quite an unnecessary area of absorption to add to hands 
 and face, as is now generally admitted. 
 
 3. T.N.T. Solvents and Protective Varnishe-'i for the Stin. — 
 Prolonged experiments have been carried out by B. M. and 
 C. A. W. at an explosives factory on methods for protection of 
 the skin, either by T.N.T. solvents, or by protective varnishes 
 to keep the powder off the skin of hands and face. 
 
 The results have been most interesting, and, if properly applied, 
 ought to ensure^a great degree of protection, not only to T.N.T. 
 workers, but to " tetryl " workers also, who have suffered greatly 
 in the past from dermatitis. 
 
 Our thanks have been expressed to the directors for per- 
 mission to carry out the work and for much kindness during its 
 progi-ess ; we have also expressed our indebtedness to the works 
 manager, and to the nurse at the works, for much valuable 
 assistance. 
 
 Xylene Washing of Skin. — As washing of the skin with acetone, 
 a solvent for T.N.T., had, in the cases of workers being taken 
 off work on T.N.T. with severe symptoms of illness, given 
 beneficial results in the opinion of several observers, an experiment 
 v/as started to observe the effects of daily washing with a T.N.T. 
 solvent upon the colour of the hands, and reaction in the urine, of 
 a band of T.N.T. workers. 
 
 The underlying idea of the experiment is that, as T.N.T. is 
 practically insoluble in water, the ordinary ablution with soap and 
 water at the end of a period of labour does not remove the minute 
 particles of T.N.T. from the skin, and thus the worker is not only 
 exposed to the poison during the hours of labour, but the absorp- 
 tion from the reservoir in and on the skin goes on during the 
 hours of recreation and repose in the ea«e of the susceptible 
 worker. 
 
 Jt was thought, therefore, that if the hands were soaked in 
 a good solvent for T.N.T. at the end of the day"s task, a good 
 portion of tliis T.N.T. could be washed away and the su-^cejjtible 
 worker be spared a considerable amount of absorption during the 
 rest period. This would show itself objectively in a decrease 
 of the stain on the hands and in a diminution of intensity of the 
 characteristic i-(^aetion in the urine. 
 
57 
 
 A liarnl of tweuty-four k*''!'* wiu* iu.-cuniiii|{ly M'lvctvd, uiul 
 ttfltr ili-tfriniiunt; the de^ret- of iittciiMity of tht* urinary n-iutioii 
 f<»r TXT., tlu-y wt-rv ituttnu-tcU to wil-Ii tlnir KaiuN i-.i 
 oil l«-iiviii|{ otT work uitli » inixtiirf of tiic xyl< ii)-< ri-<-oiiii 
 to iiM iis it j{«mhI TXT. tolvi'iit \>\ l)r. Ct. lUirmr ulirr v\\ni n 
 tioii witii M>vi-nil Holvi'ittH. Ai-t-tuiiu uiid Hcvoml othtr moUlmiU 
 an- l>i'.rn*<l out l»y thfir pn-Mnt M-artity. 
 
 Tlif rftultx |tnivi'<l ili.>ui|>|>oiiitiuK. The Hulvent ap|icared to 
 dimiMJoh fomowhat thr <l«iiih of loloiiriiiK of tho haiKbt, l»ul 
 tht' (K'kfrff t>f uriiiury n-iniKni liuriiii: the fortnight on T.X.l'. 
 M*i<n)e<t to run on it.s twinil upwarl rouix*. jiuit as if ni> ua^hint; 
 hAtl taken placf tin- liuun>s are niven below. (Appendix D.) 
 
 It iii.iv \» tl..ii tlii I. Milt I- dui' to the particular -.olvi-nt u-.*-*! 
 (\\l ' . ri of ipideriiil-< iiinii- iMinii-ablc 
 
 a>i<l I I ii<l«- lliroti^li iiit<i lh<- xv-tt-iii at 
 
 tl\.- !i: i .lit <li<l iM tiially remove itil TXT. 
 
 from lilt- iiul«-r layerT.. a» r.|i<i«n l»y the failure of tho alkaline 
 ali-ohol tfsl aflrr the »-.e of tli«* -.ilvfiit. 
 
 The failuri' of this experiiiifUt liiK't not necessarily rule out 
 tho nToinmen<lation that jx-r-nas mtiousIv ill with T.X T. 
 poidoniiiK. or artually jaundui-d. xhoiild at the lime of their 
 removal from work and lontat t with T.X.T. have their skins 
 tlioroii^jhly rlcaivfd whenever p<)s«il«l«' with acitotie. Thi-ir ca*e 
 djJTer.s tiilirfly from that of |M'r>oii> who ei>nliiuie to Ix- i'X|H>M'd 
 to T.X.T. daily, and they oujsht at oiuc to Ik- cut olT a.-i lompUtoly 
 tit pi.- ihU« fn)tn all contact with T.X.T. in clothing; or .-.kin. 
 F.xfHrii luc may show whether the acetone treatment i> of value 
 for n\ic\i cn.Hejt. 
 
 Frittittut Varni^ihimij o/ iSiifi wilk Casein Varnish. — Our 
 attention next turned in the dirretion of cnatinf; the skin with 
 umie imfxTDiealile varnish b«-fon' starting work, whiih could !)«• 
 wi-^hfd of! or removed Ity solvents at the ciul of work, m> carryin^ 
 Auay any TXT. with it. 
 
 An imp«Tnieal)lc vanii^h. in.'olub!e in water, wa» lir»l triinl 
 in the form of a solution in appropriate Milvciit.s of aeetatc of 
 iillulosc. but this vamixh m-i'led and |Hirtially enicked urt. 
 
 • X()o»mu the .okin, and a similar fate fell upon euiludiun and 
 ■ uu.okiii " vaniiftliesi. 
 
 A water >oliiMc varnish ouiteevtitl itM'lf next, which would 
 »iniply wa.sh olT with water at the concluxion of work and at ih« 
 »ame tune float ort tie '"' ^ ' ' > ■.' with it. At tin 
 Mr Artliiir Whitticid w ul he hel|ii-«l \u u\ 
 
 by «imv'' -""i! "cvi ml ■ if water fioluble v.n , 
 
 »moht."-i iliem 1' I !;i'' " cawin vami«h " ■>! ilie 
 
 rTiii-h I'liitini.k' at to in- fat and oil frii*. ThiA 
 
 f.rep.-vratioM wn- i i>\ .i In m v \.'"ii.j' m, ui.i 
 
 ■■.•i the rrsult of iK'V. ral wi'v^- ' 
 
 • xccUent rrnulLs. An ex|x.riii 
 
 ui.ide «t another factory, ami . . 
 
 ef ih« country uv notr roiixiiicB>jnK to uar it. 
 
68 
 
 Experience may indicate in time a better " body " for the 
 varnish, and it may be necessary to work out something which 
 will resist better in hot weather and not be removed by per- 
 spiration ; but the experiments have already shown that for dusty 
 types of T.N.T. employment, such as "exploder bag" work, 
 protection of the skin of face and hands by a varnish is feasible, 
 and that when the skin is thus protected there is a great fall in the 
 amount of T.N.T. in the system, as shown by the urinary test. 
 
 The improvement is visible to the girls themselves and to the 
 nurses. Some girls stain much more heavily on face and hands 
 than do others, and we have taken purposely the very highly 
 stained workers and seen the stain under the use of the vai'uish 
 almost disappear from face and hands in about a fortniglit to 
 three weeks ; at a later stage the urinary reaction falls off. 
 Details are given below. The preparation also protects against 
 " Tetryl " stain and has been found of great service in " Tetryl " 
 dermatitis. It is not unsightly in use, as it sinks into the skin and 
 disappears. It has at present one defect, that when kept it tends 
 to thicken, and then sometimes lathers and does not become in- 
 visible on the skin ; when this occurs some of the girls object to 
 applying it. Also, on a few very delicate skins there have been 
 complaints of slight tingling after its application. But in all cases 
 it protects, and a slight tingling or its showing on the face is a 
 small discomfort compared to a dermatitis. 
 
 (iv) Removal from T.N.T. Work of Persons Specially Susceptible 
 to the Poison. 
 
 Some difference of opinion appears to exist as to whether 
 the same workers ought to be allowed to remain for many months 
 engaged upon T.N.T. work on account of the danger of the 
 prolonged period of absoqjtion, or whether such individuals have 
 proved themselves insusceptible and ought to be cherished and 
 retained. 
 
 The answer depends on the health history of the individual. 
 A person who has been upon T.N.T. work continuously for, say, 
 a year or more, and has never shoMii any signs of T.N.T. illness — 
 and we have examined many eases of both sexes of whom this is 
 true — such a person is a most valuable asset to a factory, and 
 should be preserved most sedulously. 
 
 On the other hand, a person who has been ill more than once 
 during a working period of, say, five or six months, with minor 
 T.N.T. illness and been " stood oft' " work on this account, 
 should be watched most carefully and " .stood off " at once at 
 the appearance of any considerable cyanosis. Li fact, if we had 
 our will we shoidd gradually remove these people who are evidently 
 absorbers and susceptibles, for there are plenty of non-susceptib!es 
 to carry on all the T.N.T. work. 
 
 Our experiences leave us little doubt that an important 
 factor in the recent improvements is the gradual operation of a 
 natural " salting out " process, whereby an industrial " selection 
 
')! tli<- liilrii " f'tr Mm ptirltruUtr tn-ik ltiw< txiiirn-*! TliLt natural 
 t«'U(lrai y, iiiaiuktfftufnt an<l iiittlual »tafl. M<>rkiii|4 tom'lhcr, 
 HhouM try to i»c-cflcr«t«< by n-iiiuviii^ the hu-rtt-ptiljUw um rapully 
 ad tho fxi){fiuif>t of latx>ur MU|i|ily will allnw. To iMMiixt thftii 
 ill tlii-i nil tiiilcMVuur nhuuld U- iiuwli' l>y tlioM- in clutrge of l<t>>our 
 HU|t|)lif.t to ilirfit ii ntront; tidi- of oiicoiniiig lulHJur toMunU T.X.T. 
 Sucli an effort will Utotni" more «'ffeftive tut the conditioiu of 
 TXT. (K-ou{Mttioni ljf<onu< hfulthier. 
 
 Thort> ii4 » natural liy(;i*'ii>i° Htn'ant which i^ tondinx to n-move 
 •<iiM-f|»tihU-* all thi" tiiiu'. ami to rt-tain iiutusc«'|»tilil«- If a 
 workir i" licaltliy on TNT., the j{ood waKi-s will n-tain thai 
 worker \lv or ».li«- will luivi- iit> fear of TXT iI1iii-s,h, ami will 
 stfotit thi* idt-a of ilaiigt-r to all lifarcr> inside and otitsidt- tho 
 factory ; thi- «»• havo M-fii |M-r><>nally in liundn-ds of tat*'*. 
 On th«' otlu-r hand, if thf workrr i> a MitstH-ptihU- and i> ftfling 
 ill and tni^<•ral>ll■ whilf at work, and ha.-* fn-ijufntly l»roki-n tinio 
 from minor T.X.T. illne».H and ln-en off on " coni|M>n.-<ition l>ay." 
 tlu-n that worktT in an uanound wononiic {)ni|Kwiti(>n fn)m the 
 factory 'j» point of view. 
 
 The liitltT ly|H' of worker will natiimlly ten<l to clear away 
 from T.X.T. lalKmr. while the former ty|R- will .stick to it, and thus 
 a fiu-torv which has Inmii o|H'raliii^ for many months \ull |M>s.s4^-fvs 
 a far Ix-tter " rgiltetl " .st-t of workirs than one just startini;. 
 
 This IS dearly KCt-n where the illness and irritation rausctl l>y 
 a work siil>stance i.s more acute and gives more di»comfort and 
 Mtiffvring -a work Kubfttanco. for example, cau.sing such «'ffect« 
 is ■■ tetryl, ' which s«-ts up in a large pn>|K)rtion of U-ginnepi an 
 acute inHammation of tlie skin and mucous memhniiies. and 
 iiNlcma under the eyelids. Some |M>ople U'come inund in a few 
 daVK, othen* never do. and after suffering fmm seven- dermatitiH 
 for week.s have to give the work up. Fortuiuitely, then* is no 
 coiLstitiitional attack la* in T.X.T. 
 
 When a new •■ tetryl " workshop is starteil with an •• um^iltcd " 
 wt of workers there is always a hiisy time for a win-k or two for 
 the medical staff ; in w)me ca.s»-s the whoK- shop ha.s hail to clr>M« 
 down for a few days. Then for sonu* wii-ks or montLs there is 
 a ctinMiderahle amount of dernmlitiii, which finally die« down alnuxit 
 to zen>. 
 
 Tiioso who have U<en very Iwdly affectr<i have jioon •• had 
 enough of it " and go a%vay to other work ; " new start.n " i-onie 
 on and take their places, (inuitially tiios*' who lio not acquire 
 immunity clc;'r away, and the tnnihle drD|)M ilown to ooranional 
 ca-s**. 
 
 The fuvme thing lia.s doiil>tles.s Ix-on hap|iening in n letut obvioiui 
 way uin..nk;si T NT wrkers. 
 
 A prophyliutu iini»-un- which ha* rrcrivwl • ven- wide- 
 -ppMd nppliiation in th'- iam|Mign against T.X T. iioiMming in 
 'iiA* 1 iii^nn AM "alleniation of litlHuir." a plan which ha<l lM<cn 
 ■ iii|li"<d in pre-war tiim-s in other oc<Mipations in which th« 
 .V rk«rs »en< »ubjei-t to absorption of |M)i«onnaA Aubst*n<T«. 
 
/ 
 
 60 
 
 The writer was at one period a liearty supporter of this policy, 
 but recent events liave caused him to alter his views, not because 
 he does not still consider that alternation is good for the individual 
 worker, but because there are other objections to it from the 
 point of view of the workers e»i inas.se, and from the national 
 aspect of economy and output, and because there are other 
 means by which the end in view can be achieved with equal 
 certainty and at much less cost in every way. 
 
 The princij)le of alternation of employment is that double the 
 number of woriicis should be employed to work upon the dangerous 
 material and relieve one another of half the risk by working for 
 equal alternative periods of a week or a fortnight. There is 
 certainly a distribution of risk to the individual in such a policy, 
 but in the mass, for reasons which will be disclosed, the exposure 
 is much more than doubled. 
 
 The most important point to bear in mind is that all our 
 experience teaches us that there is a marked idiosyncracy in the 
 incidence of T.N.T. illness, that some individuals with constant 
 exposure month after month have never been ill, while others 
 have died as a result of one fortnight of exposure only. 
 
 Any system of alternation, if the output per individual were 
 equally good, would obviously expose just double the number of 
 susceptible individuals to attack, but the statements of managers 
 as well as factory returns show that the output is not nearly 
 so good under alternation as under continuous employment, and 
 so the total number of exposures to T.N.T. poisoning as a result 
 is correspondingly more than double. 
 
 Again, the risk of exposure of each individual under alterna- 
 tion is by no means reduced to half of what it is under continuous 
 employment. This is shown by our urinary estimations upon 
 alternated workers given in Appendix A, Tables IV', V. and VI, 
 by our clinical exjjerience on workers returning after a week's 
 " off " employment ill with T.N.T., by outbreak of T.N.T. 
 illness in many cases in the records a fortnight or more after 
 going ■' off " T.N.T. work, and by our knowledge of the 
 T.N.T. reservoirs in skin and clothing. Compare the figures 
 given in the Appendix which show the clearance effected in the 
 urine by four days' holiday, spent probably in fresh gala 
 clothes, with that effected by a fortnight on alternated work 
 (" off " T.N.T.). La the latter case the workers are perhaps in 
 contact \vith clothing soiled (hiring the " on " period, and with 
 soiled woodwork of boxes, trucks or shells. 
 
 In the earlier months of the trial it looked as if the statistics 
 showed that there was a great balance in favour of alternation. 
 Those factories where there was alternation appeared to be healthy, 
 while those which did not alternate had the hea^'ier incidence. 
 But it does not appear as if the figures of more recent months 
 substantiated this result. Since other improvements have been 
 introduced into certain of these " continuous " factories their 
 vecords have become quite as favourable as those of the " alter- 
 
CI 
 
 iiiHiii iinvH . iiiul now |rx<kiiij{ but k at tin- p.iit, inoit •( w>.<so 
 wliii iiin|Mi-tt.tl the wtioiv Jtytiiii u( fiiLtnriii \v<iiit>i luivu to .mIiiuI 
 that till- Iji'tter ruiulitiuiut uliit h ixiitcd furiiitrlv at tiie aller- 
 luitrtl " fuituricH might in rvuhty huvi- Ufii <liu' tu prfcautiuiut 
 uthtr ihuii iiltiniutioii, prfcuiitiuiLh U'tii<-h wen- not iit that time 
 taken at " ciintiauouii " faiioiit-j*. 
 
 It iH th(* itlmutit uiiivcDiui U lit-f of worL* manajj;i-rM that tite 
 «■< otiomic |»riie to be puiti for alti-rnution in fttiii«-nt-y and output 
 is <i very heavy one, and amongst tlie Ix-^t wi^rkerx, ei|x-«ially 
 where liuiui>«e« ure paid <>n pie<.ov«oik, it ij< commonly d<-lented. 
 
 It may lie ^uid that thi-^ ({uestion of output Uoa nothing; to do 
 with the hy^itui't'-. tik.^k, and ut lirst Might thi» would upiK-ar tu 
 be true, hut in aiis < a-e it is a mait im|>ortiknt luitituuil question, 
 ttiid further <-<iii-.iderati<«ii .thowK that it do*-* direetly emu em 
 the hyj;ieni.-t. Kor the M|Mt'«Uer the n»t«' of working the le»<8 
 the numlM-r of hantLs requireil and the Miuiller the numlx-r Hub- 
 jeet to tht- al>sorption of |>oiHon. The more ^killed a worker 
 become;* the \vns iiu'nn that worker mukett, uud lestt mesh meaiut 
 lens iufoetion for everjoiie com'enietl. Also, if !<|Ki-d of working 
 if* inen>a«itl. say, 50 jter cent.,* fn>m the skill that eomes fr»>ni 
 continuuuH labour, then two-thinls of the op«'nitive« will do 
 the same amount on a shift, and the double sets of ' off " and 
 "on " workers will not be re<piireil. Thus on contimuius work- 
 ittg on such a luisis there will only Ik- n-tpiiretl (no workerx instead 
 of aix as on alternation who will run the risk of T.N.T. ilhu-sH 
 and Ix' paid the hij^her nitt« of T.N.T. wa^es. Also when the 
 six workers are half "on" and half "oil" T.N.T. work they 
 are a ((reat deal more than half their time subject to T.N.T. 
 a>>«or(>tion for the reasoiLs already given. 
 
 What, then, is it pro|)ose<l to put in the place of altrnuktion ? 
 The reply is, mcn-jusetl me<lieal ean* of the smaller numlMT of 
 wi>rken<, and iiurea.sed amount of " salting out " or rem«>ving the 
 su.seeptihie fttrmuntntlij from T.N.T. work. 
 
 VI. Treatment ok C.tsBS. 
 It ought in thi- future only to Ik> in rare iiLstAnce* that ca«*« 
 |MVi.H unnntired through cyanosis into toxic jaun<li<-c. When 
 this luis <Kcurri-d, ivs well a.s in all "everely < yanosed cases, the 
 lii^l «'>sentiid to attend to is a comph-tc <ut <>tl from all sourcc« 
 of T N T For this puqH)««e it is not sunicient simply to give 
 iii«tnirHoii ti> the patient and M-ml him, i>r her. home to n-lativcfl. 
 
 Til'-' |«<>ple and their friends have lif' • ' -n of the 
 
 !■< riMii-ni -s of their illness, and for this !• ide light 
 
 of j;.'ii\<lc»- fnr t!;<v in r!vif-> whi''h h!\\- '•■ jt^vhI 
 
 f... ,• \ ■ •■ a 
 
 h 
 
62 
 
 clean cut-off from contact with T.N.T. It was only continued 
 experimentation on the effects of (1) week-ends, (2) holidays, 
 (3) alternation, and (4) the study of the decline in the urinary 
 reaction in patients " stood off " T.N.T. work, which taught us 
 this lesson. The T.N.T. is carried home on hair and hand.s and 
 clothing, so that not only are these people subject to contact 
 during working hours, but their homes, or lodgings, and their 
 furniture and bedding become contaminated with it. As a 
 result we have seen the skins of infants and little children in the 
 homes, who have never been near the factory, dee])ly stained 
 from contact wnth the persons and clothing of their parents, 
 and the hair of wives stained the characteristic auburn brown 
 from powder comiuuiiicatcd from their husbands. Also we have 
 seen the stain on bt'd-shects and pillows. 
 
 This must always be borne in mind in treating severe cases 
 of T.N.T. poisoning, and especially when any jaundice is present. 
 As a rule, such cases ought never to be treated at home, but in a 
 hospital by a physician possessing some experience of T.N.T. 
 cases. 
 
 It ought i^articularly to be emphasised that this is true of the 
 first few days of incipient jaundice, for at this stage the case looks 
 le.ss serious than it does later when the jaundice deepens, and so 
 the physician may be inclined to risk these few days, to see how 
 the case develops with home treatment and ^'isits to the con- 
 sulting room. But these few initial days are the all-important 
 ones, far more so than those after the skin becomes deeply 
 jaundiced, for then the physician can but watch and wait, and 
 is powerless to give much help in the struggle. The first appear- 
 ance of jaundice shows that the compensation described above 
 has been surpassed, a stern fight is going on between processes of 
 degeneration and regeneration in the heijatic parenchyma, 
 and degeneration is slowly gaining so that there is no longer 
 enough sound, tissue left to carry on the metabolic functions. 
 A little longer attack by the poison, and the descent will soon 
 become more rapid. This is the point at which the prompt 
 action taken by the physcian in completely cutting off the supply 
 of poison makes all the difference. 
 
 The patient should be removed at once from factory and 
 home surroundings to a nursing home or hospital. Every stitch 
 of clothing which has been near T.N.T. or in contact with the 
 patient's body previous to the purification now to be described 
 should be removed. The patient should then be giveii a warm bat h, 
 dried, and the skin, wherever it has been exposed, thoroughly 
 cleaned from all trace of T.N.T. by scrubbing with pledgets of 
 cotton wool soaked in acetone or ether until no pink colour 
 is shown with alkaline alcohol. Special attention should he |)aid 
 to palms of hands. The nails should be cut short and carefully 
 manicured, and the roots of the hairs cleaned, especially on the 
 scalp. The patient should then be put in bed in an airy position 
 and given a purgative. The bowels must be moved as soon as 
 
63 
 
 Iio«Hil>li», and kej)t open. Tin* uni\ar\' s^orptii>ri and p«T»pjni 
 tifxi oiitrht tUfix (<> \ni Htiinulutrd by a Miiiplf naiiiu- mixture, 
 and iluK »hould Im> kept up for two or thr»-<' dayn untd Webster '« 
 rt-jution in no longer obtained in the urine, and the tent remaina 
 ni'kMtive even after thin diuretic and diaphoretic action in di«- 
 (Mt, tinned. 
 
 VtvxU ve^etftble (oo<l and fruit arc d»'«irrtble, and alkalies 
 should U' niven an there in a certain amount c»( acidooiH in some 
 ca^«•M. 
 
 Where, in slinhter vihu-h of cyanonin, the patient in not kept in 
 U'd, an o|>en air treatment in be»it; there ought not to be ko much 
 exercise an to make the patient breathlei-<, but nuHlerate exerciw) 
 and Hitting or reclining in the 0|mmi. In a few days thcRe ca«e« 
 clear up as the met-ha-moglobin break.n up. 
 
 If any cyammetl ca*ie Ix- allowed back on T.N.T. work, he or 
 she must U- can-fully watched and a n-<urrence «)f the symptom* 
 ought to dctcrmiiu- the matter. The patient should then be 
 jjivcn a pernifuu-nt di.scharge. and no attention paid to the 
 request which i.t so often made that they >hnuld be allowitl to 
 continue at the work. 
 
 No |N'rson who ha.s ever had toxic jaundice in under anj 
 circumstaiues allowed back to T.N.T. employment or work 
 connected in the same fncton' with TNT labour. 
 
APPENDICES, TABLES, AND PROTOCOLS OF 
 EXPERIMENTS. 
 
 APPENDIX A. 
 
 Effects of Cessation of Work (1) at Week-ends, (2) Holidays 
 (four days) and (3) at periods of Alternation of Labour, upon 
 the Amount of T.N.T. passing through the system. 
 The figures stand for the judged intensity of colour in the Webster 
 
 test upon an arbitrary scale, and are in many cases the agreed judgment 
 
 of two observers (T. A. W. and G. A. W.) using the test daily so that they 
 
 are cumparable amongst themselves. 
 
 Table I. 
 Effects of week-end rest at Messrs. 
 23rd, to Monday, September 25th, 1916 
 
 from Saturday, September 
 
 All girls. 
 
 
 Reaction. 
 
 
 Reaction. 
 
 Girl. 
 
 
 Girl. 
 
 
 
 Before. After. 
 
 Before. After. 
 
 
 
 
 Brought Jorwd. 
 
 92 
 
 66 
 
 
 4 
 
 3 
 
 29 
 
 4 
 
 1 
 
 2 
 
 3 
 
 2 
 
 30 
 
 ] 
 
 2 
 
 3 
 
 4 
 
 4 
 
 31 
 
 4 
 
 1 
 
 4 
 
 5 
 
 2 
 
 32 
 
 3 
 
 
 
 5 
 
 3 
 
 1 
 
 33 
 
 4 
 
 2 
 
 6 
 
 4 
 
 2 
 
 34 
 
 4 
 
 1 
 
 7 
 
 3 
 
 0-5 
 
 35 
 
 3 
 
 2 
 
 8 
 
 3 
 
 4 
 
 36 
 
 4 
 
 1 
 
 9 
 
 
 2 
 
 37 
 
 3 
 
 2 
 
 10 
 
 2 
 
 5 
 
 38 
 
 3 
 
 0-5 
 
 11 
 
 2 
 
 2 
 
 39 
 
 5 
 
 4 
 
 12 
 
 4 
 
 4 
 
 40 
 
 3 
 
 2 
 
 13 
 
 4 
 
 2 
 
 41 
 
 4 
 
 2 
 
 14 
 
 4 
 
 3 
 
 42 
 
 3 
 
 1 
 
 15 
 
 3 
 
 1 
 
 43 
 
 5 
 
 I 
 
 16 
 
 3 
 
 3 
 
 44 
 
 3 
 
 
 
 17 
 
 3 
 
 1 
 
 45 
 
 2 
 
 2 
 
 18 
 
 4 
 
 3 
 
 46 
 
 4 
 
 2 
 
 
 4 
 
 2 
 
 47 
 
 3 
 
 0-5 
 
 20 
 
 3 
 
 3 
 
 48 
 
 5 1 4 
 
 •21 
 
 1 
 
 3 
 
 49 
 
 3 1 1 
 
 22 
 
 5 
 
 3 
 
 50 
 
 5 
 
 3 
 
 2:i 
 
 3 
 
 2 
 
 51 
 
 2 
 
 
 
 24 
 
 3 
 
 1 
 
 52 
 
 2 
 
 0-5 
 
 -5 5 
 
 3 
 
 1 
 
 
 
 
 
 
 
 •JA 
 
 3 
 
 3 
 
 Totals 52 
 
 174 
 
 101-5 
 
 27 
 
 3 
 
 4 
 
 0-5 
 3 
 
 
 
 
 28 
 
 Ay. Rn. 
 
 3-3 
 
 2 
 
 Carried Sorwd. 
 
 92 
 
 66 
 
 
 
 
 Notes. — The intensity set down at the value 05 is what we customarily 
 called a trace, and is equivalent to what would be obtained when 5 to 10 
 milligrams is swallowed, and a little less than is obtained during a shift 
 in the case of a careful worker with completely protected hands. It is to 
 be observed that no worker was clear to this extent on the Saturday, 
 and that only three were clear completely on the Monday and five others 
 
do«ni to a trace, while the average reaction Idl to twu third* ut it* prevtoua 
 value At thi* iwrfxl in our invr^tigationt wc luid not yet rcahiictl how 
 eaitily upcciineum might be accidentally cuutanunatcd i( pa**ad at the lact(^ 
 doaets, and *o there may have t>ecn a certain number o( contaminated 
 •pecimen* amongst the*« which would raitc both average*. 
 
 lUected. Lach girl 
 
 I to ...llc^l MU -.J-vM 
 
 Tahle II. 
 A lortnight later a (econd Mrt ul sample* wa« i 
 given two bottle* with her name on tli' tii .t!i t .iik' 
 a* *o<m a* |)<)*siblr alter rrachiiiK I; 
 the time un the bottle, iiiul to t.ik 
 aiter rwiiiR and brin,; l.. tli t ■ ft.. 
 
 a method <or dclt- ■ ''niK • '•iit.niuii.iii' ii. .in.l ;!i ^ms . .i--- 
 
 givtng a high vain i was apphed wtkcre necessary (See 
 
 text p 17 ) The i. ; .w» :— 
 
 ErrscTs ok VVkek knu lUn ai MtssRs. 
 
 FROM Saturday. 
 
 October 
 
 7tm. till 
 
 MOMOAV. C> 
 
 CTOBER dTH. 
 
 1916. 
 
 
 
 HMeliOB. 
 
 r... .^f^i'r 
 
 IL-I r 
 
 
 
 
 ,^r/«,«J. 40 
 
 H-S 
 
 1 
 
 
 
 2\ 
 
 0-5 
 
 5 
 
 
 1 
 
 
 25 
 
 2 
 
 US 
 
 s 
 
 ■_• 
 
 II .S 
 
 26 
 
 2 
 
 1 
 
 4 
 
 •i 
 
 o 
 
 
 
 
 
 
 5 
 
 1 
 
 5 
 
 28 
 
 
 
 
 
 6 
 
 2 
 
 5 
 
 29 
 
 1 
 
 0-5 
 
 7 
 
 1 
 
 1 
 
 30 
 
 2 
 
 
 
 8 
 
 2 
 
 1 
 
 31 
 
 1 
 
 0-5 
 
 9 
 
 OS 
 
 i)-5 
 
 32 
 
 
 1 
 
 lo 
 
 o i 
 
 If S 
 
 33 
 M 
 
 1 
 
 1 
 
 \2 
 
 ! 
 
 1) 
 
 35 
 
 w 
 
 II 
 
 13 
 
 
 1 
 
 ■M 
 
 
 
 
 It 
 
 1 
 
 37 
 
 0-5 
 
 0-5 
 
 I.S 
 
 u-.S 
 
 38 
 
 
 
 
 Iti 
 
 i\ > 
 
 39 
 
 
 0-5 
 
 17 
 
 1 
 
 0-5 
 
 40 
 
 
 
 
 l« 
 
 ;{ 
 
 1 
 
 41 
 
 0-5 
 
 u 
 
 IV» 
 
 .1 
 
 
 Ij 
 
 
 (1 
 
 20 
 
 
 
 
 
 
 
 
 
 
 ■- ■; 
 
 £1 
 •.'3 
 
 
 
 
 
 
 
 
 
 
 
 OWrr.W/orw( 
 
 
 
 
 
 
 Thor 
 and 
 oulv 
 
 tlic SatuiiU) and 1 •urltcu . ii the MumUy. 
 ice only on the Saturday and •e\-cntern had 
 
 Tamjc III. 
 
 A FOOR I>AV«' MtltCITIOK W.i 
 
 a va m , ; - . . . 
 
 to lutc;;A)l> ui («a£tiu(t. 
 (Bri«l-rBlMO) 
 
 Uu Um >Uy oi (Gluta aitd Hm totu «Uy»° f«at 
 C 
 
85 urinary samples were obtained from as many girls ; these showed 
 Webster reactions as follows : — 
 
 Nos. Reactions. 
 
 62 Free 
 
 10 Trace 
 
 10 1 
 
 1 2 
 
 2 3 
 
 Thus there is only an appreciable amount of T.N.T. in the system in 
 3 out of 85 girls. This is a most remarkable clearance for a four days' 
 rest, and quite eclipses anything given by alternation of labour (see below). 
 Our returns show that in the course of our routine examinations we 
 had happened to get specimens from 59 out of the above 85 girls on one, 
 two or three days before the holidays. These are given for contrast 
 with the above figures, as follows : — 
 
 Nos. Reactions. 
 
 None Free 
 
 2 Trace 
 
 13 1 
 
 19 2 
 
 15 3 
 
 9 4 
 
 1 Intense 
 
 The explanation probably lies in the complete " cut-off " from all 
 contact during the four days. On an ordinary week-end the girls live 
 in the same rooms to which they have conveyed T.N.T. on their clothing, 
 they are touching it on their clothing, and probably a good many sleep 
 in day underclothing. A very large number of these girls come to lodgings 
 from homes in healtlw situations at a distance, and we know they nearly 
 all went back home for the holiday. They probably all cleaned up 
 smartly and went into gala clothes for the occasion, and also probably 
 enjoyed themselves a good deal in the open air in fresh seaside and country 
 breezes. 
 
 The effects aie even more striking than the crude comparison of the 
 two sets of figures show ; for of the 23 positives out of 85 after the 
 holidays, 8 (wliich included one of the two reaction of 3 and the only 
 reaction of 2) were passed after the girls had been several hours back at 
 work. The other reaction 3 after two hours back at work, and 7 others 
 were taken during the first day's work. Thus at least 16 of these 23 
 positives were taken after restarting work. This leaves the position 
 that out of 69 specimens taken before resuming work after the four days' 
 holiday only 2 showed any T.N.T. reaction, and these were " traces." 
 
 Tables IV, V, and VI. 
 Effects of Fortnightly Alternation of Labour on Amounts of 
 t.n.t. in the system as indicated by urinary reaction. 
 Carried out at National Shell Filling Factory, 
 
 Urines were obtained from 76 girls " on " T.N.T. and 76 girls " off," 
 with the object of using the urine test for T.N.T. as an indication as to 
 how far freedom from contact with the poison was realised by alternation. 
 
 All the samples were morning urines, since most or all of the T.N.T. 
 inhaled or swallowed the previous day while at work will have been 
 eliminated by the morning. Thus the reactions give a rough indication 
 of the relative quantities absorbed by the skin of the individuals concerned. 
 
 The specimens were obtained from 45 girls in the filling sheds (amatol) 
 and from 31 trolle3-ing in the same part of the factory, all having been 
 a fortnight " on " and " off " T.N.T. respectively. 
 
 On the exploder-bag side of the factory urines were obtained from 31 
 girls filling (pure T.N.T. powder) and from 14 cleaning, and 31 at " fuses 
 and gaines," the two latter being " off " jobs; all these had been one 
 
' jikI " t>tl " TNT rMpectivoly A (umiiury o< the results 
 > u litiuwii in th« lulluwtng tw<j taUeit — 
 
 Table IV 
 wixij Ubine RxACTtoNs IN 76 Girl* " <»»• " / V / 
 
 
 N.. 
 
 I~"l 
 
 ' Vn of nHw« aMvintr ri n- 
 
 FlIllllK Shr.l 
 
 Expl<Nlfr 1.. 
 
 
 
 1 t«> 1 1(4 
 
 • 1 15 ! I* 
 
 Tr. Ilpying 
 
 it?6 
 
 o n 
 
 13 
 
 Thr^ r»^iilt< h|. lit (rom alternation, but thoy 
 
 also "^ti '"^ • nng "off" periods is not so 
 
 ah«.ili' 
 
 1 1 .-s (or more) of TNT in the 
 
 uriu' -81 per cent, of trollcycrs. 
 
 43 |M:r cuul. u( «.W.iiii:i3, -IH \>i:t i.viii. •>( workers on fuses; confirming 
 other obaervatious on the possibihtics of contact of the trollcyers wiih 
 TNT 
 
 At I ' were token a 
 
 rinicnt were in 
 
 lortu: 
 the li! 
 
 next table. 
 
 ilmtated in the 
 
 I'rinrn <•( I i 
 fortnuTlifi t- 
 
 the end of the 
 Ms troUeying. 
 
These results are instructive, and seem to indicate that those who 
 gave tlie liigh reactions when filUng are those whose skin most readily 
 absorbs T.N.T., and who are therefore presumably the most likely to 
 suffer from poisoning. It may be that they are simply the most careless 
 individuals, but the well-known fact that some of the fatal cases have been 
 those who have rigorously followed all the hygienic rules seems to negative 
 this suggestion. 
 
 APPENDIX B. 
 
 Analyses of Factory Air for Dust and Fumic r.v Ixtkaction 
 
 Apparatus. 
 The apparatus and mode of using it have been described in the text. 
 The connections will be imderstood from the accompanj'ing sketch (see 
 Experiment V). The only portion which varied was the piece at the 
 inlet for absorbing the dust and fume. In the first experiment this was a 
 modified U tube with an expanded chamber to facilitate bubbling on the 
 outlet limb ; this apparatus was very fragile and was broken when in use 
 for the second time. It was then replaced by the two ordinary (J tubes in 
 series, as described in the text, care being taken to test for complete 
 absorption at the end with alcoholic potash, and these ser\-cd lor Experi- 
 ments II, III, and IV. For Experiment V the Young's Fractional 
 Distillation Column, which happened to be available to us, was used for 
 the bubbling and proved most effective for the purpose. 
 
 Experiment I, September ird, 1916. — Breaking Doivn Home at . — 
 
 Tliis experiment is really given as a control to the others to indicate that 
 if there were a large amount of T.N.T. dust in the air the apparatus as 
 arranged would absorb and show it. The inlet was placed near a receiving 
 bin at the foot of a leaky shoot where there was abundance of visible 
 dust. No worker in the room would breathe as much as this, but this 
 defect made the room about the dustiest we have seen in any T.N.T. 
 factory. All the workers in this room wore respirators for comfort's 
 sake, but there had never been any cases of toxic jaundice amongst them, 
 nor any excess of minor T.N.T. illness. Their work was mechanical 
 and did not involve much handhng. 
 
 A volume of 1,633 litres of air was drawn through in twenty minutes. 
 The total solid in the water at the end was dried and weighed and found 
 to be 0-18 gramme ; from this was extracted by weighing 0-05 gramme of 
 T.N.T. In the mouthpiece there was dust weighing 0-26 gramme, calculated 
 by the above ratios to contain ^5 of T.N.T. or 0-07 gramme of T.N.T. 
 So that 1,633 litres of air at this point contained 0-05 + 0-07 giamme = 
 0-12 gramme of T.N.T. 
 
 Tidal air of adult man at rest = 0-3 X 18 litres per minute 
 
 = 324 litres per hour. 
 Add 50 per cent, for exercise and air 
 
 breathed per hour = 486 litres. 
 
 So that air breathed in lOJ hours' shift = 5,103 litres. 
 And from above determination of amount 
 of T.N.T. in air the maximum amount 
 of T.N.T. breathed by a worker who 
 had his mouth opposite tliis leak in the 
 
 5103 
 shoot would be = 0'12 x , j^. 
 
 «= 0-37 gramme. 
 
 No worker was in this situation, and this preliminary experiment 
 only serves to show that the apparatus will show dust when present. 
 
 Experiment II, September 20th, 1916.— A'o. 2 Shop, F.— Four girls in 
 shed pressing amatol blocks. A fatal T.N.T. case had occurred in this 
 
*!ie<t Ttu- iiiirt wraa pUced within a (<jot u( the head o( a girl Mrfvin^ 
 b?«i<le thf >iiix 1)1 powder, and e()uaUy cxp<««d to dtut. 
 
 A voliini.- i>r SStt litres vrx* drawn t)ir<>ut;h. tl»c water was ilrf ! • r. 
 anil tin- w. i>;lii I I'ltjl «<j|iil. I t , aiii'xiiit 111 du»t in 5S<J htrt-n. w.i- ' 
 l)v w.-.v!ii!i- t.i lie <)Ui>5 gramiiio tlu- am-iunt <•( T NT in tliui. a^ * . 
 
 12 
 29 
 
 the anu>unt ^4 V N T in 550 litre* ol air waa 0-0021 erainme 
 Volume nl air lireathed in one hour, ieo 
 
 calculatiMii in Kx()criment 1 (above) > AW^ 
 
 Volumr »\ ;nf III 7| hour*" «hi(t -=• 7| 
 
 Thereliiriv luiniiiium amount ol T.N.T. 
 
 364S 
 al«tirl»al>l.- \i»m the air « 0-0021 X ,^ 
 
 -■=' 0-OU iframme 
 Eifttttnent III. Stptettdxr 2\il. I9lfi -Same Shed at Exptnmtnl II — 
 A volume III :{.87ti litres drawn through in one liotir Innu 12 niHJii till I p m. 
 Weight ..( ilrv wilid in water =• 0-O29 gramme 
 
 Iroiu till*. T NT extrai ted by ether. 
 
 filtcreil, ev.iporated. weighed •" 0-012 gram. 
 
 .\ir c.ili-iilated as in Hx|)eriment II, 
 
 breithe I in 7| h lurs ^ 3.A43 litres 
 
 Thcredire. iniximuni amount of TNT. 
 
 '1645 
 available fur abtiorption from air ^ 0-012 x *^ " 
 
 — 0-012 gramme 
 EMf<eritnenl l\'. SepUmbfr 22nJ, 1916. — Made in similar t\tJ iiu)iin.i:,- 
 Ikat u\tJ for liifxrimenls II and III -K volume ol 8.000 litres drawii 
 through in a total perio<| of |HM minutes, divided into the fclluwing 
 p«-ri<Kh 
 
 3 37 p m till 4 7 p m. 
 
 4 15 4 45 .. 
 
 5 5 5 23 .. 
 •■•J5 .. 8.S5 .. 
 ~ '-> .. 7 ^y> 
 
 > t 8;«« 
 
 wa-> • .1 I he 
 
 lonRr- •-r\.kl. 
 
 \V..K >... ,.,...,.. .,.„. ,„ ,, ,1,.-, ,. .;,..., I-.,- 
 
 The proi. .rlion <>i T N T. in thi.s was '". 
 2y 
 
 •o that the amount of T.X.T. in the 
 
 dust ol S.iHKi Utres - 0-018 gramme 
 
 Vi>luiiii- ol air lireathed during 7| hour*' 
 
 shilt .1 Al.^ Iiirrt 
 
 Therelore. maximum amount of T N i 
 
 available trom air dnnng a *hift 
 
 The average maximum uptake from .^" 
 
 mrnls II. Ill and IV. is r^l.r.'f r.- tl m' 
 
 '■Ir' U ■■. . 1' .Vi 
 
 »n atntnlioiK appar-ttiis. . . ;>~; tn.; I i «.-t .( |.:1! . ..•; I .i it^xti-nAl 
 distillatioti apiMratiM contaimng water, and then through a m«A<ana^- 
 
meter {see Sketch). The completeness of absorption was shown by 
 failure of the alcoholic potash test in a glass tube placed between bulbs 
 and meter. 
 
 The apparatus ran for total of 8 hours 9 minutes. 
 
 Air passed through . . . . . . = 8,427 litres. 
 
 Average rate . . . . . . . . = 17-2 litres per minute. 
 
 Tidal air of healthy adult man . . . . = 300 c.c. per respiration. 
 
 Therefore, air breathed per minute at rest = 300 x 18 respirations. 
 = 5,400 c.c. 
 
 Therefore, air breathed in 9J hours . . = 3,078 litres. 
 
 Add 50 per cent, for exertion : — 
 
 Air breathed in 9i hours' work . . = 4,500 litres approximately. 
 
 Results. 
 
 1. T.N.T.— 
 
 Weight of T.N.T. in 8,427 litres of 
 
 air . . . . . . . . . . = OOl 1 gramme. 
 
 Therefore, weight of T.N.T. in 4,500 
 
 litres of air =0011 x ^^"^. 
 
 = 0011 X 0-534. 
 Maximum T.N.T. breathed in 9J 
 ■ hours' work under cyhnders . . = 00061 gramme. 
 
 2. Ammonium nitrate. — Trace, unweighable. 
 
 3. Nitrite. — The Gricss Tlosway test only gave a reaction corresponding 
 to 1 part in 150,000 NaNOj. 
 
 This was in total water of 65 c.c. 
 Therefore, nitrite . . 
 Nitrous fumes 
 
 Ap para rUs 
 
 ..= 0-00043 gramme as NaNO,. 
 . . = 0-0029 gramme as HNOj. 
 A negligible quantity. 
 Note. — Tliis experiment shows that the maximum amount of T.N.T. 
 possible of absorption by mouth and nose during a 12 hours' shift is only 
 00061 gramme. 
 
 Diagram of apparatus used for the 
 estimation of T.N.T. dust and fumes 
 in the air near the cylinders in the 
 Melt House. The suction was obtained 
 from a vacuum apparatus present in 
 the Melt House. The amount of air 
 passing tlirough was nieasured by 
 means of the gas-meter. 
 
 On starting the suction, the current 
 o{ air forced water (pre\'iously placed 
 in the U-tubc to about the level AB) 
 )ip in the left limb of the U-tube, and 
 the suction force was adjusted so that 
 the spray reached to C or a little higher. 
 All dust and any water-soluble gas were 
 caught by the water. Water was added 
 from time to time to make up for loss 
 by evaporation. 
 D Efficiency of extraction of all T.N.T. 
 ^ from the air was proved by testing the 
 inside tube D with alcoliolic potash at 
 the end of the experiment ; it was found 
 absolutely free from T.N.T. 
 
 yy is a Young's fractionating column. 
 E is the air inlet, diameter 1 cm. 
 
71 
 
 APPENDIX C. 
 
 AUOUNTS or T.N r. absorbed under various EXfERIMBNTAL 
 
 (.'unl>iiion:>. 
 Thu appendix (how* in comparativs (oriii the p»rall<-lti>in between 
 thrcr -^ti of oVcrv-nfiirif (l( thf imonfit «l TNT ali-^T»>^! irum the 
 
 wof !. ' ' ' . - . ■ .. .V . .1 j^ijj 
 
 o( lo 
 
 ally W<;«;|iiiig aMay Uuiu tiiu Mu:l>.^l.v/^. 
 
 pe sets of resulu arc concordant, and to lorm 
 
 lo T.N.T. in the air (i( tlic Khcdx in thr amount 
 vr, Aa shown by Ex{>criincnt!> II and III <>( 
 
 T.N r. jU'bji jjHou. 
 The results were as (ollows : 
 
 Reactions in T. A 
 
 Tine of DoMC*. 
 
 Oct 18th 5 |. m. (at tM). 10 mg. 
 
 All J. IS p.m. .. 
 
 Oct. iStb— At 7 p.in.. nil : 8 p.m . 
 
 (.t. ; 9 p.m., I ; 10 p.m.. I-. 11 
 
 p.m.. 1-. Oct. I9tb— 12.45 a m.. 
 
 t. ; a 45 a.m.. ft. 
 Oct. 19th-n.l5 a.m., ml; 7 l» 
 
 p.m . I-; 8 20 p.m . I : 10 IS 
 
 p.m.. nil. 
 Oct. 20th— 8 30 am., ml (before 
 
 tl.iMi < K '. Jist ij :<<i .1 III « 
 
 . I. Ott. 
 
 nil : 5.30 
 u V ft ; A2U 
 I.I. Oct. 20th 
 
 1 .1 m . nil 
 
 ■ • •'.■>rc 
 
 .Vo<«j.— Obaervc that the rr.i 
 M.\ hour* alter Uking the done. *n l tlut thr w^inn i. umjaIIv (Wat witlun 
 twelve hour*. It IS to be noted in the caa« o( B. M. and M. G. F that 
 
72 
 
 work accompanied by mouth and nose absorption in small amount went 
 on until 10 p.m. each d;iy, and that the morning urine is a mixed sample 
 of a secretion period from midnight till about 8 a.m. The most important 
 sample in their cases to observe is accorcUngly that immediately before 
 resuming work at 2 p.m. daily. These figures run for B. M. as follows : — 
 Thurs., v.f.t. ; Fri., v.f.t. ; Sat., 1 ; Sun., f.t. For M. G. F. the corres- 
 ponding intensities are — Thurs., nil ; Fri., nil ; Sat., f.t. ; Sun., nil. 
 Thus, with the exception of B. M. on the Saturday, the urine was practically 
 clear each day before resuming work. 
 
 III. — At the same period B. M. and M. G. F., with their hands com- 
 pletely protected, but wearing no respirators to stop absorption of any 
 T.N.T. in the air, carried on the ordinary work of the workshop. 
 
 The results were as follows : — 
 
 Reactions in B. M. 
 
 
 Dat«. 
 
 
 Period of 
 working. 
 
 Reaction, and time of taking it. 
 
 Mon., 
 
 Oct 
 
 16th 
 
 2-10 p.m. 
 
 Oct. 16th— 8 a.m., nil ; 5.45 p.m., v.f.t. ; 
 11.50 p.m., 1. Oct. 17th— 8 a.m., 1-; 
 1 p.m., f.t. 
 
 Tues. 
 
 
 17th 
 
 Breakdown 
 
 No work done. 
 
 Wed., 
 
 
 18th 
 
 4-10 p.m. 
 
 Oct. 18th— 8 a.m., 1- (?) ; 3 p.m., v.f.t. 
 
 Thurs 
 
 
 19th 
 
 2-10 p.m. 
 
 Oct. 19th — 1 a.m., 1 ; 8 a.m., 1 ; 1 p.m., 
 v.f.t.; 5.30 p.m., t. ; 10 p.m., 1-; 
 midnight, 1 -. 
 
 Fri., 
 
 
 20th 
 
 2-10 p.m. 
 
 Oct. 20th— 8 a.m., 1 ; 1 p.m., t. ; 1.40 
 p.m., v.f.t. ; 5.30 p.m., f.t. ; 10.30 
 p.m., 1-. 
 
 Sat., 
 
 
 21st 
 
 2-10 p.m. 
 
 Oct. 21st— 4 a.m., 1 -f ; 9 a.m., 1 ; 2 
 p.m.,1; 5.30 p.m., f.t. ; 1 1.30p.m., 1 -. 
 
 Sun., 
 
 
 22nd 
 
 No work 
 
 Oct. 22nd— 8.30 a.m., 1-; 3 p.m., f.t. 
 
 Reactions in M. G. F. 
 
 Date. 
 
 
 Period of 
 working. 
 
 Reaction, and time of taking it. 
 
 Mon., Oct 
 
 16th 
 
 2-10 p.m. 
 
 Oct. 16th — 8 a.m., nil ; 5.45 p.m., nil ; 
 11 p.m., t. 
 
 Tues., ,, 
 
 17th 
 
 Breakdown 
 
 No work done. 
 
 Wed., „ 
 
 18th 
 
 4-10 p.m. 
 
 Oct. 18th— 11.45 p.m., t. 
 
 Thurs.. „ 
 
 19th 
 
 2-10 p.m. 
 
 Oct. 19th— 9 a.m., 1 ; 1 p.m., nil ; 5.30 
 p.m., v.f.t. ; 11 p.m., 1. 
 
 Fri., 
 
 20th 
 
 2-10 p.m. 
 
 Oct. 20th— 9 a.m., 1 ; 12.30 p.m., nU ; 
 1.30 p.m., nil ; 5.30 p.m., v.f.t. ; 10.30 
 p.m., 1. 
 
 Sat., 
 
 21st 
 
 2-10 p.m. 
 
 Oct. 21st — 9 a.m., 1-; 1 p.m., f.t.; 
 11.45 p.m., ft. 
 
 Sun., 
 
 22nd 
 
 No work 
 
 Oct. 22nd— 8.45 a.m., 1- ; 4 p.m., nil. 
 
 Mon., ., 
 
 23rd 
 
 No work 
 
 Oct. ^3rd— 10.30 a.m., nil. 
 
 Tues., „ 
 
 24th 
 
 No work 
 
 Oct. 24th— 9 a.m., nU. 
 
 Notes. — The contractions mean as follows : — v.f.t., very faint trace ; 
 f.t., faint trace ; t., trace. Allowing for breaks for tea and undressing, 
 the working period was about seven hours. 
 
71 
 
 APPENDIX D. 
 
 KXFKKIMeNTS ON PrOTKCTIUS OK THE MaHOS. 
 
 F.xp«nfnenu devised to aflord protection to the slun have be«n camcd 
 out on the lines dcscnbed in tlic text. The reaulti are given in the iuUowinf 
 protocols : — 
 
 I. — EXPKKIMKWr UPON THE WASHING OP THE MaNOs BV A T.N.T. 
 
 Solvent iXvlenes). 
 
 Tlie ftmt column givea the amount of T.N.T. still in the system on 
 returning to TNT work alter a rest pen<Kl on other work The columns 
 marked " ' On ' TNT., Xylene in use all thi-i time " show the unnary 
 reactions during the period " on " TNT work. The remaining columns 
 •bow an ai tcr- period ; hrst. when " ofl " TNT work. and. secondly. 
 when " on " T.N.T. work but without any washing during this penod. 
 
 
 I. 
 IV>Cur« 
 
 
 On" 
 
 T.N.?: XvlMMlo 
 •U this ptnod. 
 
 T.N.T. 
 
 work. No 
 
 X,l«. 
 
 «Mtun(. 
 
 IV. 
 "On" 
 
 T.N.T. 
 No XrUo. 
 
 3 
 
 Nui» 
 
 • ■.hmi. 
 7ih A Sib 
 
 
 
 
 
 
 Jmn.. I»I7. 
 
 Jan. Ju. Jan. 
 
 Jan. 
 
 Jan. 
 
 Jnn. 
 
 N.lur« o( 
 
 
 
 Sun. «im1 
 
 n. 17. 1«. 
 
 19, 
 
 11. 
 
 n. 
 
 )obm 
 
 F^'iib. 
 
 
 Mun. 
 
 Th. W. Th. 
 
 y. 
 
 8u. 
 
 8. 
 
 bfMkM.. 
 
 
 t. 
 
 
 
 
 
 rKb.*u 
 
 1911. 
 
 c. 
 
 
 , 
 
 
 1 
 
 _ 
 
 _ 
 
 F. 
 
 V It 
 
 1 
 
 __ 
 
 
 
 
 
 2 
 
 
 
 
 G. 
 
 
 3 1 - 
 
 
 
 
 
 
 
 2 
 
 ft. (fuses) 
 
 
 
 H. (1) .. 
 
 I 
 
 1 3 
 
 — 
 
 I 
 
 2 
 
 3 
 
 f.t. (fuses) 
 
 2 
 
 H. (2) . . 
 
 It 
 
 1 
 
 -_ 
 
 _ 
 
 _ 
 
 __ 
 
 — . 
 
 
 4 
 
 i.,., :: 
 
 3 
 
 ) 
 
 3 
 
 ..^ 
 
 3 
 
 3 
 
 3 
 
 1 (fOMt) 
 
 4 
 
 1 
 
 t 
 
 t 
 
 V.I. 
 
 V.I. 
 
 V.I. 
 
 — 
 
 
 
 
 
 
 
 
 t. 
 
 t. 
 
 t. 
 
 
 
 
 R. 
 
 2 
 
 - 
 
 1 
 
 .^ 
 
 — 
 
 — 
 
 — 
 
 — 
 
 — 
 
 S. (1) .. 
 
 2 
 
 1 
 
 
 ^ 
 
 _ 
 
 
 
 
 
 
 
 _ 
 
 S. (2) . . 
 
 1 
 
 1 
 
 1 
 
 
 
 3 
 
 
 
 3 
 
 1 (btack 
 
 3 
 
 T.(l) .. 
 T. (2) .. 
 
 J 
 
 
 
 
 1 
 
 
 
 powder) 
 
 
 2 
 
 7 
 
 
 
 
 
 l.t. 
 
 
 
 3 
 
 
 
 z 
 
 W. (1) .. 
 
 1 
 
 2 
 
 — 
 
 — 
 
 — 
 
 — 
 
 — 
 
 — 
 
 — 
 
 W. (2) .. 
 
 1 
 
 4 
 
 -^ 
 
 — 
 
 — 
 
 — 
 
 — 
 
 — 
 
 — 
 
 W. (3) .. 
 
 
 
 t. 
 
 L 
 
 _ 
 
 _ 
 
 __ 
 
 ..^ 
 
 _ 
 
 _ 
 
 U.W .. 
 
 — 
 
 — 
 
 1 
 
 — 
 
 3 
 
 1 
 
 - 
 
 — 
 
 2 
 
 Totrnk .. 
 
 19 
 
 15 
 
 11 
 
 
 
 13 
 
 _ 
 
 20 
 
 _ 
 
 IS 
 
 No. of 
 
 
 
 
 
 
 
 
 
 s«m|>tc-i 
 
 Ifi 
 
 II 8 
 
 _ 
 
 9 
 
 __ 
 
 8 
 
 _ 
 
 5 
 
 Average 
 
 
 
 
 
 
 
 
 
 intensity 
 
 12 
 
 14 14 
 
 
 14 
 
 — 
 
 2-5 
 
 "~ 
 
 3 
 
 Afal«s.— The above Ubie illustrates many points. The Ur«e 
 
 of bl-illW^ in It -.(n.^i thr ,!irl:, nlltr!« of obtairUntT urin.iri.- v.»-, ■tiirr 
 
 coti lumn ahow t! 
 
 fC" .iltrrtvation " 
 
 The 
 
 day^ ■ i>n " -show 
 BtMI-rBl»30 
 
 The n«e in 
 of the Xvlrn 
 
w 
 
 The column headed III shows the gopd j^esults of the period " oS " 
 T.N.T., but the number of samples is too small for fair judgment ; but 
 Column IV showfs the additive effect of tlie period " on " T.N.T. A 
 large number of controls were carried out upon girls not using the 
 " Xylenes" wash during the actual experiment (Column II, Jan. 11th 
 till Jan. 27th) ; the average of these gave 1 '3, a figure almost identical 
 with that of the girls using the wash — certainly no worse. 
 
 II. — The Casein-Varnish Experiment. 
 
 Twelve girls were started on 28th Feb., 1917, with an application 
 of rasein-varnish twice daily to hands and face, before starting work. 
 The results of the urine tests in these twelve, or in as many of them as 
 gave samples, may be summarised as follows : — 
 
 28.2.17 I Before varnish and after 2 days on T.N.T. | 10 
 
 10.3.17 I After ,, ,, 2 weeks on ,, 10 
 
 19.3.17 I ,, „ „ 1 week off ,, 8 
 
 30.3.17 j ,, ,, ,, 11 days on ,, 7 
 
 28.4.17 I ,, ,, „ 2 weeks on ,, i 6 
 
 I i 
 
 The full table of results is appended. 
 
 
 28/2. 
 
 2w?eeon 
 
 19/3. 
 
 30/3. 
 
 2w^^{io„ 
 
 Number. 
 
 2 days on 
 
 1 week off 
 
 lldairBon 
 
 
 T.N.T. 
 
 T.N.T. 
 
 T.N.T. 
 
 T.N.T. 
 
 T.N.T. 
 
 1 .. 
 
 
 2 
 
 2 
 
 
 v.f.t. 
 
 2 .. 
 
 1 
 
 v.f.t. 
 
 1 
 
 3 
 
 v.f.t. 
 
 3 .. 
 
 f.t. 
 
 1 
 
 — 
 
 f.t. 
 
 
 
 4 .. 
 
 2 
 
 4 
 
 
 
 
 
 5 .. 
 
 f.t. 
 
 1 
 
 f.t. 
 
 v.f.t. 
 
 f.t. 
 
 6 .. 
 
 2 
 
 4 
 
 3 
 
 1 
 
 
 7 .. 
 
 8 .. 
 
 9 .. 
 
 
 2 
 
 1 
 
 2 
 
 t. 
 
 2 
 
 2 
 
 f.t. 
 
 _ 
 
 _ 
 
 10 .. 
 
 2 
 
 2 
 
 1 
 
 — 
 
 — 
 
 11 .. 
 
 1 
 
 — 
 
 — 
 
 — 
 
 — 
 
 12 .. 
 
 1 
 
 2 
 
 
 
 v.f.t. 
 
 v.f.t. 
 
 Totals 
 
 12 
 
 20 
 
 9 
 
 8 
 
 2 
 
 Samples 
 
 10 
 
 10 
 
 8 
 
 7 
 
 6 
 
 Average re- 
 
 
 
 
 
 
 action 
 
 1-2 
 
 2-0 
 
 11 
 
 11 
 
 0-3 
 
 The letters f.t. mean faint trace ; v.f.t. very faint trace ; and t. trace. 
 
 The appearance of the hands and faces of these six girls, who had 
 carefully iised the varnish throughout the period of two months, tallied 
 with the low results in the urinesi The highest of the six is only a " trace." 
 This furnishes another proof of the value of skin protection ; this trace 
 probably represents the amount swallowed. 
 
 The numbers are, of course, too small to draw final conclusions. Large 
 scale experiments have been arranged at other factories. 
 
APPENDIX E 
 
 fKiM-i-oi.-. jr iMt..i.l».««TS on ADMINISTHa.. .■ ■ 
 OTHER NlTKO-COMPOfNDS IN ANIMAL^ 
 I. — EXPBBIMENTS ON T N.T WITH LeiHAL K. 
 A.—Animatt tltoa'tng Ltvtr Lenom 
 
 Enfurtrntnt I —May 2nd, l^)lrt —Rabbit »rii;lui:i" 
 given I -5 gram p'Wilered T N T bv mouth at lo 
 dark red colourc<l. 
 
 This do<e l^^ 15 ^uni w.n r and 8th 
 
 (Saturday), antl thr .minul wa vj Th« 
 
 unnc wai d:irk-rc<l II! colour throiir . ■•r^tainrd 
 
 free T N T After the third dose it jpftart J u'wcll uiil t> (ii«e<l locd 
 On May 5th thr weit;ht bad dropped to 1,854* grammes, and at death it 
 «ra.-i 1.765 grammes 
 
 The tissues o; ■ ■ T N.T. The orKan* were examined 
 
 by Dr H M Tir ted that the Uvcr showed lar>;t 
 
 01 itecrofiis ai> I (at: m centres of lobules. 
 
 • '.'.O.^O giamaies. 
 Mav 3rd. urine ta 
 
 arra« 
 
 caR. 
 
 Th.^ . 
 
 louixl .1....! i.ii .\!.4\ lUii , w. 
 
 P.M. examination thoro was ob 
 
 lat. p.:.'..r....l ...,,1 ■.t...r ilu.>l 
 
 launcide showing in »ubcutanr< 
 
 tlOII 
 
 The organs were extiucted with hot ' 
 lor TNT with negative results. 
 
 rnmiiii > 
 ■ <r The 
 A etc bile 
 
 . ucd onne 
 
 the extracts were tested 
 
 li. — Antmals 
 F.xf>*nnuHl I.— May SIh. 
 
 given by mouth 0-«5 gram ol tlie pink matir.al* 
 or alcoholic v\.i.U No ..(,.., .,. rr .;lts .,-,. 
 
 M.iv r 
 
 gr.. 
 
 tl.'TutHg HO Lt'.tr Li'^tom. 
 
 1916 — Rabbit. wciKhing 2.li'2U graronie*. 
 
 ibtamcd by the action 
 The doic ol 6 gram 
 Idth. nth. 12th. 13th 
 V 12th. -.2^* gmmmrs . 
 ;m M \ "ttl ;.TiiO 
 
 givr 
 
 of T.N T. i:i tt.i 
 gram. The dc»e 
 
 17th. ?»th. r>th 
 
 1916 
 
 -RabNt. weighing 2.170 gramme^. 
 
 . rnt •.•! .<i.'ti I 1 -.irV vf ■.: •.Ate 
 
 .U IM r- 
 
 Jth. 2.I20. 
 2Qth. 1 730 
 
 Mav 15th. 
 ]»nr 7th. 
 
76 
 
 Experiweni III.— May \lth, 1916.— Kabbit, weighing 2,250 grammes, 
 given by mouth 2 grammes of " pure "• pranvlntfd T.K.T. (C. & H., P.). 
 The urine was a pale red colour next rrornirg (ThurFday, >'ay 18th), and 
 cont?ired a little free T.K.T. , otherwise no rol-ccaHe ef ccts. Cn this 
 afterncon the urine paF-ed was very dark reddish brcwn in colour, and 
 cr ntained free T.K.T., but no bile, albumen, or blood. On Friday mrrning, 
 Fay IPth, the an-mal was found dead ; thr urine ppFSfd during the night 
 contained a good deal of blood. The P.M. examination was made by 
 Er. Turnbull. The bladder was full of urine, darV: red in colour and 
 c< ntaining blood but no fiee T.K.T. fat this f cried Vcbster's test was not 
 known to us). The tissues were examined ior free T.K.T. by extraction 
 with hot alcohol, but none could be detected. 
 
 This experiment should be compared with one on T.N.T. residues 
 separated from crude T.N.T. 
 
 Experiment IV. — May Mth, 1916. — Pabbit, weighing 1,660 grammes, 
 gi-en by mouth 05 gram of " pure " T.N.T. without obvious symptoms. 
 This dosage of 0-5 gram was repeated by mouth on the following dates, 
 th" drug being enclosed in gelatine capsules : — Mav 19th, 22nd, 24th, 
 26ch, 29th, 31st and June 2nd. This makes in all eight doses of 05 gram 
 repeated at short intervals, totalling 4 grammes. The animal died on 
 Tune 5th. The P.M. examination showed no macroscopic liver lesions. 
 The liver was rather small, and dark brown in colour. The kidneys 
 were somewhat swollen. The urine contained blood and casts, but no 
 free T.N.T. 
 
 The body weight shows the characteristic decline of repeated doses 
 of these compounds at this- level, as follows: — May 17th, 1,660; May 
 22nd, 1,670 ; May 29th, 1,320 ; June 5th (dead), 987 grammes. 
 
 Experimetit V. — May 22vd, 1916. — A small kitten, weighing 500 
 grammes, was given by mouth 0'5 gram of " pure " T.K.T. The animal 
 died the following day. At the P.M. examination the liver was pale in 
 colour, the Vidneys swollen and injected, and yellow coloured at outer 
 part of cortex, the pleuritic and pericardial fluids were increased in amount 
 and greenish-yellow in colour as if there had been slight icterus present. 
 
 No free T.N.T. was found in liver, kidneys, urine, brain, bowel contents, 
 stomach contents, or heart muscle. 
 
 Experiment VI. — May 22nd, 1916. — Another kitten on this date was 
 given by mouth 025 gram of " pure " T.N.T., and on the following day 
 another 0-25 gram of the same drug. This latter dose was vomited up 
 two hours later, and the vomitus contained T.N.T. The animal recovered 
 after being ill, and in the five days after administration its body-weight 
 fell from 530 to 450 grammes. 
 
 Experiment VII. — May 24th, 1916. — Cat, weighing 2,170 grammes, 
 given by mouth, in gelatine capsules, 1 gram of the pink precipitate of 
 T.N.T. The animal was found dead next morning with rigor mortis 
 established. At the P.M. examination the liver surface was pale over 
 large areas, anl lobulation was very distinct. The stomach contained 
 dark coloured fluid in which the T.N.T. compound was present, and this 
 extended down the small intestine for about 15 inches {i.e. about one- 
 third its length). The kidnevs were swollen and much congested, but the 
 cortex was pale in colour. There was no urine in the bladder, but a small 
 volume passed about one hour after the administration of the T.N.T. 
 gave no reactions for free T.N.T, There was also absence of T.K.T. in 
 liver and kidneys. The lungs were grcNash-brown in the greater part ; 
 pink in smaller areas. This, with the pre\dous experiments, demonstrates 
 that the pink substances formed by the action of T.N.T. on alkalies are 
 
 • The eipression " pure" T.N.T., as used hero, means T.N.T. eommereially purified. 
 It still contains small percentages of p and y tri-nitro-toluenes, and of the three 
 isomeric di-nitro-toluenes. None of these, however, is approciably more poisonous 
 than tri-nitro-toluene. 
 
not lanocuoua, but b*vc abuut the kAOte intensity ol lethal action as T NT. 
 iWll. and hk« xpe mother ititwtanco are more lethal to cats than to 
 
 rabbitu 
 
 /:i/Wfi»M«i l7V/—/«iw MM. 1916. -iaM.it, wcitt. ■•■nr%. 
 
 Tlu» ojiimal wa» givrn. at intervals o< a few lUys. ;i.'; red 
 
 dmuigcoJO-Sgriira, to try toproUm.ei.hiomccllccts T! ken 
 
 at intprvaU, counts made o( red bluud corpitfcle*. <»n.i miuun'Mia ol 
 btfinoglobtn percentages, with the following reaulta : — 
 
 Daw and Utm^f- 
 
 'H. 
 
 ^ 
 
 W.%bl. 
 Ciramn. 
 
 1 - June Mth 1 
 
 
 75-8 
 
 7.900.000 i i.sao 
 
 2- ,. leth 
 
 
 , 75-0 
 
 8,400.0O«J — 
 
 3.— .. I9lh 
 
 
 
 
 
 
 
 4.— .. 2l»t 
 5.- „ 26th 
 
 Given 05 gram " pure ' 
 TNT. 
 
 58-0 
 
 5,200.000 
 
 1.310 
 
 6.— ., 28th 
 
 — 
 
 — 
 
 1.350 
 
 7.- ., aotb 
 
 
 650 
 
 7.400.000 
 
 
 8— July 3rd 
 
 
 650 
 
 8.400,000 
 
 — 
 
 9.- ., 5th . 
 
 
 — 
 
 — 
 
 — 
 
 (Urine, red coloured ; 
 10.— July 6th 
 II.— .. lOth 
 
 12.— 
 18.— 
 
 12th 
 t4th 
 
 Lii'ias tor T.N.T. but contains no 
 63 , 6.300.000 
 gram '" pure "J i 
 
 \ 38 I 4.500.000 
 
 bl.»)d ) 
 1.390 
 
 This animal bad the relatively enonnoua weight of six 
 adnunLnterrd in twelve h.ilf-gniro iliwes wittun a period of one month. 
 Note the u.%ual largr drop m IkmIv wriRht. and the re<luction in harroo- 
 globin percentage .iml numlxrr "( red bloo<l corpuscles. 
 
 Simil.ir bliH.d iluiiRi-^ h.ivc Urn olmrvcil in other animals, and the 
 ouittcr IS i\i>w N'tni; further lnvc^tl^•.ltcd 
 
 EMfurimuut IX.—Junt \6tk. 1916.- Rabbit, weighing 1,260 gntmiBca. 
 given by mouth, in Rclatine capsules. 2 grammes of the pink prccipitata 
 ol T.N.T. Next day the anim.il lies on its sulc without voluntary move- 
 ments. IS comatose, and lias very feeble respiration Death occurred at 
 11.45 am. about twenty-four hours after admini.'«tration of the drug. 
 
 Eif>*rim*nl X -Jttiv I9U. 1916.- KabUt. weighing 1.9rt» gr.immos, 
 
 ?ven by nuiuth one duso <if 2 grarames of the pink precipitate ol 
 N T No other ik»cs given. 
 July li)th. KHC. 7.900.000. July 31st. R.B.C 6,100.000. Weight 1.900 
 frammc. , August 7th. KUC. 4..S00.000 ; August Nth. djetl. By aa 
 •rrcy, no 1' M. oxaminatinu was nkute. 
 
 ErftTtm^nl XI - fuiv 2Slk. 1916 - KabUt. wnghing 1. 100 grs 
 0v«n 2 grammrs " pure " T N.T. by mouth at 1 1 a ni. . put in a roetaboUxoi 
 box. and pu.isr<l urine atwiut S p m. The nnne tested \tr Wcbntcr's test 
 containetl the TNT (itrrivative . it did not cuntain any blw>d. A umpl* 
 of bloo<l drawn fri>m the ear at about 3 9U p m itave a faint pouuv* 
 reaction with aKohohc i^..t.v<h The animal wai drad next nu tning. 
 A tantple of ann« (vunad during the night contained mo<liticd T N T. 
 but no blcxHi 
 
 At the I'.M. e aom m ation no nartodcopic changes in any ol tho organ* 
 was observed. The bladder contained a small amount of dark-colonrcd 
 urtne. which contained the TNT prr>«lurt bat no hh^d 
 
78 
 
 The several organs were tested by extracting with hot alcohol and 
 testing for T.N.T. in the alcoholic extract, with the following results : — 
 Liver, negative ; kidney, negative ; heart, negative ; blood, negative ; 
 lungs, a distinct purple reaction of unchanged T.N.T. ; stomach contents, 
 a large amount of unchanged T.N.T. ; brain tissues, negative ; intestinal 
 contents, a little unchanged T.N.T. ; bronchial raucous, reaction of un- 
 changed T.N.T. 
 
 Experiments on White Rats. — The prolonged experiments (a) in the 
 respiratory chamber and (6) in the workshop over the melting pans, had 
 ehown that air-dust or vapour taken in by mouth and nose had produced 
 no ill results in wliite rats. In the following experiments the " pure " 
 T.N.T. used in the workshops was dusted over the cages or vessels in wliich 
 the animals were kept, so that they trod in it and also doubtless Ucked 
 some off their fur. 
 
 Experiment I. ^Started March 8th. 1916, ended fatally March \3th. 1916.— 
 Kept a white rat in a large glass Ijeaker, mounted on a layer of felt to 
 keep warm. The beaker was dusted over the bottom with fine " pure " 
 T.N.T. powder. The rat's paws and the abdominal fur, as well as the floor 
 of the beaker showed, in a few hours, the characteristic pink of the reaction 
 given by unaltered T.N.T. with alkaline alcohol. Tliis animal was fed 
 daily in the beaker, and the food was also contaminated with T.N.T. 
 The animal was very ill on March 11th, and was changed over into a 
 clean wooden cage provided with straw. Death occurred on March 13th ; 
 the weight had fallen from 68 grammes at start to 50 grammes at death. 
 At the P.M. examination the. liver looked pale coloured and patchy on 
 the surface. Tlie intestine contained a dark-brown coloured material, 
 looking like altered blood, but giving no haemin test ; no hajmorrhagic 
 areas could be made out. 
 
 Experiment H. — Started March 8th, moribund and killed March l\th, 
 1916. — -This animal was fed in a separate chamber so that food did not 
 becomj contaminated with T.N.T., and was then transferred to a beaker 
 which had been dusted over with T.N.T,, as in the previous experiment. 
 
 On the following day the paws and body were bright pink in colour, 
 and urine passed in the beaker was a bright pink, but it was thought then 
 that this colour might have developed by the urine coming in contact 
 with T.N.T. on the floor of the beaker. Tlie animal was moribund on 
 March 11th (Saturday), and was then killed. The only abnormality 
 found was a brown material in patches on the mucosa of the stomach. 
 The brown was not due to T.N.T., and also did not give the haemin test. 
 
 Experiments III and IV.— Started March \Qth, ended fatally March 
 15(A.— A 10 per cent, emulsion of " pure " T.N.T. was made in butter, 
 and this was mixed with bread and fed to two white rats. The animals 
 rapidly fell ill, and both died on March 15th. The P.M. examination 
 showed in both cases dark purple coloured intestinal contents ; these, 
 after boiUng in alcohol, decanting and adding alkaUne alcohol to the 
 alcoholic extract, showed the deep purple colour of the T.N.T. test. The 
 bladder of one contained a quantity of urine which was a bright pink 
 even in the bladder, so proving that the pink colour seen in previous 
 experiments was not due to external contamination but was really formed 
 intra vitam. The livers were abnormally dark in colour, and on extracting 
 with hot alcohol the alcohohc extract gave a markedly strong purple 
 with alkaline alcohol. The same result was obtained with heart-blood, 
 and the tissue of the lungs and brain, and kidney. 
 
 II. — Experiments with Non-Lethal results, and on Effects 
 OF Respiring Fumes and Dust. 
 
 A. — Laboratory Experiments on Effects of Breathing Fumes of Crude T.N.T. 
 
 The animals were placed for these experiments in a respiratory chamber 
 
 similar in design to that described by Edie, Moore, and Roaf (Bio-chemical 
 
7» 
 
 Jmim<tt. Vol V . p 341, 1910) Thr capacit 
 50 litrM . a watrr pump mucked air thrciuRh a 
 air-iril.-' t. »-■ ..f t»i.- • h..mb.r .i rt:i'fc t rr. ■! -.v 
 III th 
 citl. 
 
 Ill ihr rhambrr wau 
 the outlrt tuU-. an<l 
 
 . .1 • ! r-r rm.t twr 
 
 about 
 (•> ttie 
 
 .,t r ■. . 
 
 .iir drawn o',cf itii- ln-t iu..!t. n IN r lul i.trr:- ' 
 or (umo into the chamlicr which condensed cm tl 
 ExptrtmtHl I AiiguU '.'O/A. 1915 —Two j;,i 
 pectivcly 445 and XSt> ^;I.lIn^ll"). wcrr pUiced in t: 
 lor seven houri d.uly iripiii Monday till I'riilay. t; 
 and left (ree on Siinda>s The exprriniciit w 
 working day^t, and tlicrc wat no observable effect up'n tu- .inun.n'N 
 appeared at the end quite well, ate well, and •difthtly incrcaAed in 
 dunni; the experimrnt. nt which the detaih are AS (filliiw< • — 
 
 «...ch 
 weight 
 
 
 
 IVn..lm -^ ,^ 
 
 
 
 1 
 
 R«-p.«i..ry J^, 
 
 
 
 
 Chkiiib-r. '^'■ 
 
 
 Fri. 
 
 .\\.\% 2<>th. I9IS 
 
 lOa.m,— Sp.u. 
 
 ,:■.„.. 
 
 Sat. 
 
 .. 2Ut .. 
 
 10 .. -1 .. 
 
 
 Mon. 
 
 .. 23rd .. 
 
 10 ., —5 ,. 
 
 5 crammes 
 
 Tues. 
 
 24th ., 
 
 10 .. -5 .. 
 
 5 grammci 
 
 We«l , 
 
 .. 25th ,. 
 
 10 .. —5 .. 
 
 
 Thuri 
 
 .. 2«th .. 
 
 10 ., —5 .. 
 
 
 Fn. 
 
 .. 27th .. 
 
 10 .. -5 .. 
 
 
 Sal. 
 
 .. 28(h .. 
 
 10 ., -1 .. 
 
 
 Mon. 
 
 Mn\\ .. 
 
 10 .. -5 .. 
 
 
 Tues. 
 
 .. :M»t 
 
 10 .. —5 ,. 
 
 
 Wed.. 
 
 Sept IM 
 
 10 .. —5 .. 
 
 
 Thur, 
 
 2nd 
 
 10 .. -5 .. 
 
 
 Fn. 
 
 .'. Jr.l " 
 
 !<• .. --5 . 
 
 
 Sat. 
 
 4lh 
 
 Ill 1 
 
 
 Mon. 
 
 fith ., 
 
 n> !! 5 ;; 
 
 
 Toes.. 
 
 .. 7lh .. 
 
 10 .. — 5 „ . 
 
 
 in another t 
 
 diml and ^'' 
 
 ATM ry. 
 
 ha.l : 
 an<! : 
 
 the ! 
 
 Hi 26/*. 1915. — Two other Kuinea-piK^ 
 Mil>cr on Thumday. AuRu^t 2«th l im- ..i thcM: 
 ■ in thr clvambcr on Krulay. Si-jitmiltt-r 2nd. 
 
 ...!. .u'. t It W.1-, vli..«fi tl..it TNT I- I •ling 
 
 1 
 
 'T''' ■ . . . --• "'K 
 
 thr c(uU< iwuiia^-ivul i>io.iuvi Hum jbt»»lMli.< .ikutiol Itic multa 
 wrrc Minilar. that i5 to t^\y enlirrly nrfcattvr. th« ammah «hnwrd no trace 
 of injunous action. 
 
 B -L.tUvdt<yry Etf<*r,mtKl .>H »*/ Eftult of BrMlkxn^ Iks Dry l>ful of 
 
 futt ' r s T 
 
 A rabbit was daily placed in a l>ux used (or adnuiustennc drap by 
 thr month u> that the head only piojected oat at th* cod o< the boa. 
 
80 
 
 A larger box, about 18 inches square at the ends and about 2 feet long, 
 had a round hole made at one side against which the end of the smaller 
 box containing the rabbit might be placed so that the animal's htxid 
 projected in a fairly fixed position into the large box. At the opposite 
 side of the large box a pipe led in which was attached to a rotary air fan 
 by means of which a strong current of air could be blown through the pipe 
 into the box. A glass rod was fixed horizontally a few inches from the 
 point of entry of this air inlet, and a thin muslin bag filled with " pure " 
 T.N.T. was hung by a thread so that it touched this glass rod when at 
 rest. When the fan was worked this bag was blown about, and kept 
 knocking incessantly against the glass rod, so shaking out T.N.T. dust. 
 
 A piece of blotting paper, moistened with alkaline alcohol and lield 
 opposite the hole in the large box, soon became covered over with pink 
 spots where T.N.T. dust had landed upon it. Also, the rabbit's head, 
 after an hour's exposure here, showed dusty all over. A slight corneal 
 inflammation appeared after a week's experimentation, but even at the 
 end of a long period of exposure there was no general T.N.T. effect whatever. 
 
 Experiment I. — Rabbit weighing 1,670 grammes exposed to T.N.T. 
 dust-box as above described, as follows : — May 23rd, 1916, exposed for 
 one hour (11.55-12.55) ; an exposure of one hour given on May 24th, 
 25th, 26th and 29th. Again exposures made of one hours' duration on 
 May 30th and 31st and June 1st, 2nd, 5th, 6th, 7th, 8th, 14th, 1 5th, 16th, 
 19th, 20th, 21st, 22nd, 26th, 27th, 28th, and for two hours on June 29th 
 and two and a half hours on June 30th. 
 
 The experiment was discontinued at this point on account of keratitis 
 from the dust, and as no general effects appeared to be arising from the 
 exposure. 
 
 C. — Workshop Experiments on the Effects of Exposing Unprotected Animus 
 to Fume and Dust over melting pans for T.N.T. 
 
 These experiments were carried out at W. A., and the fume and dust 
 must be regarded as in excess of anything to which workers would be 
 exposed. 
 
 Experiment I. — Started October 4th, 1915, ended December 6th, 1915. 
 — Four guinea-pigs exposed in two pairs in two T.N.T. melt houses. 
 These animals remained in good health for the whole period of two months. 
 when one died suddenly and the other three were taken ill. These other 
 three also died, although removed to the laboratory, but the P.M. examina- 
 tion showed that death in all four cases was due to an infection of a 
 pneumonic type, and unconnected with T.N.T. poisoning. This epidemic 
 gave us great trouble amongst guinea-pigs all this winter, and also put 
 a stop to several of our prolonged experiments in the laboratory with 
 sub-lethal doses of T.N.T". Fortunately it did not set in until our 
 experiments on exposure to T.N.T. had lasted sufficiently long to .show 
 the points at issue. These four pigs were exposed for eleven hours daily, 
 as described in the text, from October 4th till November 23rd, and taken 
 away to stores at night, the day temperature being about 80°F. On the 
 latter date there being no T.N.T. effects observable, the cages were placed 
 nearer still to the melting pans, and from November 23rd till December 6th 
 the day temperature for eleven hours daily was about 95'^F. No visible 
 result followed, and, as stated, the deaths were due to infection. 
 
 Experiment Il.Started December 6th. 1915, ended March 20th. 1916.— 
 Four guinea-pigs were exposed lor this period, as described in the preceding 
 experiment. One died of a pneumonic infection on March 20th, 1916, 
 having been quite well until two days pre\'iously. There were no signs 
 at the P.M. examination of T.N.T. poisoning, and no T.N.T. reactions 
 could be obtained from urine or tissues. The other three remained healthy, 
 and one had a healthy progeny. 
 
 Experiment III.— Started March 22nd, ended June 26th. 1916.— Six 
 young white rats were exposed for tliis period m the same situation and 
 
gl 
 
 «ori.|itt"ii-> The white (ur turned yellow in colour, but the animal* 
 
 rr-tAi'<<-.| »<»u| h«ilih and grew to a laree tiize. One was lulled and 
 
 rr- ■' •' t., ......I -..^pt pcrhiipt a very larje 
 
 ;i 'ncscntery. There waa no 
 
 1 lit with expenntrnts on 
 
 • !.'*, 1916 — 
 1 . Iv o<;cupied 
 
 1 , •!• rrpi»rt 
 
 • I thy, 
 
 ail liavo 
 
 I.. . .i.A.u 11..11I- «-.i. II u.iv . aiM n.ivi- i«en 
 
 r-i iiiKlit " 
 
 /' ,:;W> Jim*// or ml !f that ilvt.-'. otef longtr 
 
 itme luUnals. 
 
 I tpttttMtnli OH Gunu<t 
 
 ••>.. liM6 — 
 
 I. itrammea, 
 
 y^ N T . over 
 
 V ■( l>c given, 
 
 t. :'•> graimiK each were administered. 
 
 1 \ wr 1. ! • in f;i.iiiiiiii-; at inten'ala 
 
 ttt-, .1 ' ; October 
 
 2Hth. -Il> ruU-r I6th. 
 
 ■A''M : * VMh. Mi) , 
 
 J' 
 
 ■ T . 
 
 tbat 
 ■I Uble 
 
 t • :i<i tluS too 
 
 ■ ■-.::. !Q,5. 
 
 ■ven 
 .! -.all 
 
 :<-' .-.-un 
 
 '■ ;. in 
 
 WO: 
 
 '16. 
 
 ...Vr I.VA. 
 
 ' "inica. 
 
 • rp " 
 
 long 
 
 Wen 
 
 "«b. 
 
 his 
 
 . .i^'-.i I'l •I'l wc«la 
 
 alter the terniiii.ilKii ii il.. tx;«-iii.i ut ah,! u.^i ;<i;>hed in the (eoerml 
 r(>idcmic 
 
 Kx/trriHMliI /K— >/.t#/*J So:tmt^> Xtt. U>»5. ruJ*^ Dt<*mU* 17tt. 
 1915 — Guiac«-pif. wwKlanK 440 gramnu at Murt and S25 fx»mmt» 
 
 tan .■; 
 
at end, given 0050 gramme doses, by mouth ; a companion experiment to 
 preceding one. Number of doses, 27 ; total amount, I 35 gramme. Body- 
 weight, in grammes, November 1st, 1915, -14() ; November 9th, 500; 
 November 16th, 459 ; November 23r(l, 500 ; December 2nd, 520 ■ 
 December 13th, 525. 
 
 No poisonous effects visible, and the animal continued well for some 
 weeks afterward. 
 
 Experiment V. — Started November \st, 1915, ended December \5th. — 
 Guinea-pig, weighing 340 grammes at start, 360 grammes at end, was given 
 by mouth doses of 0-075 gramme [i.e., half as much again as two animals 
 in Experiments III and IV) of T.N.T. Total number of doses during 
 interval, 21, making a total of 1-575 grammes of T.N.T. Body-weight in 
 grammes : — November 1st, 340 ; November 9th, 295 ; November 16th, 
 257 ; November 23rd, 290 ; December 2nd, 362 ; December 13th, 360. 
 
 No visible effects ; died later, January 18th, 1916, from pneumonic 
 infection. 
 
 Experiment VI. — Started November \st, 1915, ended December IStlt, 
 1915. — Guinea-pig, weighing 370 grammes at start and 370 grammes at 
 end. Companion experiment to above ; given doses of 075 grammes 
 T.N.T. Total number of doses, 21 ; total weight of T.N.T., 1 -575 gramme. 
 No visible effects ; died of pneumonic infection four weeks later, on January 
 12th, 1916. 
 
 B. — Experiments on Rabbits. 
 
 Experiments I and II. — Started October ]5th, 1915, ended December \7th, 
 1915. — Two large rabbits were kept during this period at times in meta- 
 bohsm cages, and at times in hutches in animal house, and given frequent 
 doses of 0-100 gramme of T.N.T. by mouth. Rabbit No. 1 weighed at 
 commencement 2,190 grammes, and was given crude commercial T.N.T., 
 while rabbit No. 2 weighed at commencement 2,520 grammes, and was 
 given twice crystallised T.N.T. (re-crystallised from hot absolute alcohol). 
 
 Rabbit No. 1 (on crude T.N.T.). — Total number of doses of 0100,'gramme 
 of T.N.T. given during experiment, 37, making a total amount of 3-7 
 grammes. On December 1 7th this animal was given 0-300 gramme of crude 
 T.N.T. by mouth, followed by 5 c.c. of 50 per cent, alcohol, thus making 
 a total of 4 grammes of T.N.T. throughout the experiment. No positive 
 results were obtained as a result of this long continued absorption of 
 crude T.N.T. This rabbit, during the period, had administered to it at 
 least six-fold the amount wliich the average T.N.T. worker could possibly 
 absorb, by mouth and nose, from factory air in a similar period. 
 
 The following results of weighings at intervals show that the animal 
 throve and increased in weight ; — October 15th, 1915, 2,190 ; October 
 26th, 2,137 ; November 2nd, 2,160 ; November 16th, 2,110 ; November 
 23rd, 2,250 ; December 2nd, 2,259 ; December 13th, 2,570 ; January 6th, 
 1916, 2,350 ; January 24th, 2,450. 
 
 Rabbit No. 2 (on recrystallised T.N.T.). — Total 'number of doses of 
 0100 gramme of T.N.T. given during experiment, 37, making a total 
 amount of 3-7 grammes. On December 17th this animal was given a 
 single dose of 03 grammes, which was not followed by any alcohol. The 
 results throughout were negative, as in the companion experiment with 
 the crude drug, and show that at tliis level of dosage the rabbit is 
 immune to T.N.T. and also to any admixed impurities in its commercial 
 production. This is interesting because, in regard to action in the body^ 
 this animal stands nearer to the action in human beings than any of 
 the other animals experimented upon. 
 
 The bodv-weights of this animal were as follows : — October 15th, 1915. 
 2,520 ; October 26th, 2,585 ; November 2nd, 2,830 ; November 9th, 
 2,590 ,- November 16th, 2,590 ; November 23rd, 2,740 : December 13th, 
 2,970 : January 6th, 1916, 3,120 ; January 24th, 3,180. 
 
FxperinuHl III ^Starttd Aufuil 23rd. 1916. dnetmlinued Augusl 28/A. 
 I9lrt This expenmtnt wait instituted to test for «iun atworption in the 
 rabbit 
 
 A rat' ISO grammes, had tbr .' vrr an arc* 
 
 ol the 1m mt H ■ II tm. ■< rtoliutulin 
 
 II .' 8 ' I'll thr iiuislin wan kat •<( olive 
 
 oil in wUrIi J ;j:i cut. .i( • imr.- ' T N f • .king 
 
 the amount nl T N' T a[)|.lK<l ilui> t.. the skn. The 
 
 Ollr.l iK.i.l.u A ■, . ..\.-,..| ir. (,, .■,>!!..• ,.■• : '.Silk 
 
 (.r -.1111.1 with 
 
 .\l f.ir TNT. 
 
 w; by lickini; 
 
 aii.l ...... ....I. . ...1... .....1.., ,.,„„...„, ,., i„. urine. The 
 
 annual w.-ui thi-n '.ilxjiiani box to collect urine. 
 
 A »am|)I<- 'if Kt iiiiirnmij; nt 1 1 n m wi>s |v.-»le coloured 
 
 and coiit.uii' <l II. . - i ' ■■• ' ■• ' •■ "i vras dark 
 
 amber in colour, l.iiiiir. The dose 
 
 on oili-il iniiiliii «.is I. re applied. 
 
 NVxt.lis !!,.■ I N 1 !■ The jaws 
 
 .11.. I . will- iL-:.ua tui 1..N.1'. I. J txcluUc lii-king eflect», 
 
 .!■■ '■ At. The T.N T. reaction in the urine was found 
 
 t." ; : lour daj-s afterwards. 
 
 c. — EMperitnenti on Catt. 
 i:,pfninfnt l.—Slartti iWoi*mber 17<A. 1915. ended lUconUr 3td. 
 1915. — .\ cut, Meighiiig 3,75(1 grammes, was given by mouth during this 
 interval SIX doses each of I) UK) gramme of crude T.N.T. No ill results were 
 
 iillMtTVril 
 
 J^/*, I9lfi. di5coM/i«w<<yM/v7/*, 1916 — 
 \ was given by mouth I gramme "• pure " 
 
 or .listMf 
 <|iiut . t! 
 
 
 
 .cr>' 
 the 
 
 •• purr • ! . . 
 
 
 
 . so 
 
 miicli .ll.-. I .., 1 
 
 
 
 . on 
 
 Juno llith with . 
 
 
 
 Ihe 
 
 animal was giv. i; 
 
 
 
 .1 in 
 
 metalx.liMii l><>.\ t 
 
 . . .11.-. 1 : 
 
 .li:..- .1 
 
 -.1 l.r,.>. l..it w.is M..l.ntly M.k and 
 
 v.imit«-.| up thr Krr. 
 
 ,t.r p..rt . 
 
 .(thr.l 
 
 . iM- HO the experiment was discontinued. 
 
 riif vv.'ii;lit on July 7lh was J.liMt grammes. 
 
 Ill ExrEHIMK-XTS WITH T.N.T. iMPfRITIES. ANDTMEMoNO- AND DI-XITIIO- 
 
 ToMPOUNns WIIU 11 ACCOMPANY IT. IS Tlir ...MMiH.IM IKoLLCTS. 
 
 /.,' M.n ../ / Uiv Ifi/A. I9lfi ! mea 
 
 givfu l>v tii'.iiili J i;r.vimiies of T N,T tion 
 
 of cru.l.- I N 1 ,11 \| \ ( .. n,. . be 
 
 much darker (l.ulv. ami . tbe 
 
 urine on Mav hnii and N' JiHh 
 
 and w.i-i liill' I t?. ... ■ , rt>- 
 
 T ■■ Uy%. 
 
 T: : m 
 
 .Uly 
 '■■wlf 
 
84 
 
 Experiment II. — June 22nd, 1916, — Rabbit weighing 2,510 grammes 
 given by mouth 1 gramme of di-nitro-tolucnc, viz., tliat fraction melting at 
 20-25°C. (L. B. H.) ; this remains in small percentage in commercially 
 " pure " T.N.T. The animal showed no injurious effects a fortnight later, 
 its body-weight was 2,020 grammes, and no later results followed. 
 
 Experiment III.— June 22nd, 1916.— Rabbit weighing 2.010 grammes 
 given by mouth, in gelatine capsules, 1 gram di-nitro-tolucne ; that 
 fraction ' melting at 65°C. (L.B.H.). No ill results followed ; the body- 
 weight on July 7th was 2,020 grammes, and there were no later results. 
 
 Experiments IV and V. — Started December \4th, 1915, ended January 
 nth, 1916.— Two guinea-pigs were given mono-nitro-toluene by mouth — 
 No. 1 received doses of 5 cc. and No. 2 doses of 1 c.c. 
 
 Guinea-pig No. 1 was given four doses of 05 c.c. of mono-nitro-toluene 
 on December 14th, 15th, 16th, 17th. No results were observed. The 
 body-weights were December 14th, 390 ; January 6th, 1916, 340 ; January 
 17th, 1916, 330. 
 
 Guinea-pig No. 2 was given four doses of 1 c.c. on December 14th, 
 15th, 16th, 17th. Weights — December 14th, 590; January 6th, 590; 
 January 17th, 620. No ill results. 
 
 Experiment VI. — Placed three guinea-pigs in respiratory chamber 
 into which air was bubbled through mono-nitro-toluene, which is fluid 
 at atmospheric temperatures. The animals were subjected to the fumes 
 from mono-nitro-toluene from 10 a.m. till 5 p.m. daily on IStli, 16th, 
 17th and 18th December, 1915, without showing any effects, and were 
 subsequently kept under observation until January 17th, when they 
 succumbed to the universal epidemic of pneumonic infection amongst 
 the guinea-pigs. Thus, the vapour of the fluid mono-nitro-toluene, 
 which occurs as an impurity in crude commercial T.N.T., is as innocuous 
 quantitatively as is T.N.T. vapour itself, and it is onlj' present in the 
 commercial mixture in small amount. The body-weights at start and 
 finish were 400, 250, 370 grammes and 370, 240, 370 grammes respectively. 
 
 IV. Experiments with Di-nitro-phenol. 
 
 Experiment I. — May \5th, 1916. — Rabbit weighing 1,780 grammes 
 given by month 1 gram of di-nitro-phenol died the same afternoon, showing 
 strongly marked dyspnoeie convulsions. The urine was stained a deep 
 yellow colour. 
 
 Experiment II. — May nth, 1916. — Rabbit weighing 1,935 grammes 
 given, at noon, 05 gram of di-nitro-phenol dissolved in water, by mouth. 
 The animal died at 2 p.m. next day. 
 
 At the P.M. examination the bladder was found distended ; the urine 
 was dark coloured and contained D.N. P. ; there was no bile present, 
 or blood, albumen or dextrose. The kidneys seemed to be swollen, the 
 stomach wall tliick and oedematous, and the intestinal blood-vessels 
 were congested. 
 
 Experiment III. — May 22nd, 1916. — Rabbit weighing 2,480 grammes 
 was given by mouth 01 gram of di-nitro-phenol, and showed no immediate 
 effects. The dose of 01 gram was repeated on Maj^ 24th, and on May 
 26th and May 29th doses of 02 gram were given, all these doses being 
 administered by mouth. The animal was found dead on May 30th. No 
 macroscopic lesions were found in any of the "organs. 
 
 Experiment IV. — Rabbit weighing 1,450 grammes given by subcutaneous 
 injection 01 5 gram of the sodium salt of di-nitro-phenol, dissolved in 
 3 c.c. of water. The animal died in 30 minutes. 
 
 Experiment V. — Rabbit weighing 1,160 grammes given hypodermically 
 05 gram, dissolved in 07 c.c. of water. A second 005 gram dose was 
 given twenty-four hours later, the animal having survived the first dose, 
 and it died forty-five minutes after receiving this second dose. 
 
85 
 
 llic amino denvative ol di nitr<vi.Krii..l ^^ ., i.r<r»cnt m the urmc the 
 nKinmig aJttr tJir tir»t di«««r, but u bUddcv (I'M) gavo 
 
 no fraction. No change* in ti«»ut- cd. 
 
 l.tf'fnmeHl 17 -R*bbit, givt'i ()•! gram o( di iiUf. 
 
 phrnol. diMolved in olive oil. The auiau.1 died la two and a h;i:t ! ;% 
 Thr- kidney* gave a poattive reaction to the tett lur amiiio-nitro ; 
 
 litp<riiment I'll. — A tut was i;u«-ri. hyiaHlcrmiialls', i 'i2^ 
 dinitro-phenol in 75 c.c. of lihve oil. One hour latrr 
 W.H observed, and in two and a ItaK hour* there was .: 
 Alter twenty lour hours a il<^<- <d 05 gram r,( di ; 
 similarly given, and twu h'<iir-< Utrr there was <!'. 
 Next day there was w luriK't •lv^pnll•a but »til. 
 third doHc, thi* tim<- ul m(p7-S «rani. was Kivrn 
 
 and the animal died in two houru. At the I'M : 
 
 mottled on the surlaie ; there were no other abnoriiuililu-K m;<.-ii. 
 
 r./vrim^ii/ 17// /ulv 'lllh. 1917 ICil.l.il ..I l,V>«<) KraminrH luid 
 applied on a clip|>ed surface of the back a lanolmr cjintnient which had. 
 in the portion used, about 2 gram of di-nitro phenol On the 28tb it 
 was noticed that the coat had been disarranged, and the aniiiul bad 
 licked ofl some of the ointment A second df.se of 2 gram was given, 
 and the coat fixed firmly. The animal survived both do«e«. 
 
 i:%p(nmrnl IX Julv 'Mil. 1917 labbit nl l.NO graiiimr* had 
 3 gram of di-nitrophenol applfd to •skin "f Kif k lirkinc wr\^ rsrrfjdly 
 prevented Next day at II ' ''>■ 
 
 in the rectum had fallen t M 
 
 examination showed tluit .i 
 
 not more than 15 Krani . , , .'.u 
 
 methaenioglobin could I>edetri.trd in tin- bluud. and iiiiiic wl ttir diuK wa« 
 demonstrable in kidneys, liver or IiIcmkI. 
 
 ICffvrimfnl .\ Au^-ti'.l Jul. I9I7 Kalibit of l.-lOO gramnu's kimii 
 I gram in lanolin ointment on skin. The animal die<l during night of 
 August fith. I e , after three and a half days Mr«t of the drug had l>ecn 
 absorbed, and at the I'M. examination the liver showed a slight nutmeg 
 appearance. 
 
 rxptrnnfHl XI .AufuU Wtk. 1917 — Rabbit «>f l.20»i grammea given 
 on the skin in Innnlin O 05 prnm nf di nttrn phrni^l with r,r< obvtrn;^ ri-<it!t» 
 
 niiH u ■ • • • • 
 
 Tl'. 
 al»s< 'il 
 cliaioi 
 tri-nr- 
 a rrr' 
 
 TNI •■! 
 
 there iH auy nsUjIlsoi in ihi-. l.itt-t .luinuil 'las-.. 
 
 V FxPrSIMrVT* WITH f>l-NITI»fv VAPMTMAI » * • 
 
 /•,• ■ r* 
 
 giVrll 
 lolli. A 
 (Oll.iu 
 •IX .1. 
 The,:, 
 
 born [■ ' ■ \ 
 
 22nd. 2. 35u. Mav J.itU. J. 1 H) . /u.v 7.' 1 !.t .^iiitnal 
 
 thus completely recovered even with the*.- 
 
 /'i/wrinun/ // - .Way 31 if. 1916 - Cat v : ,r,;r-> r.vrn 
 
 b\ nioullt 195 gr.Am of di nitr.> naphthalcnr :;. ''. 
 
 inpinous effects of any kind wrr'- p<>T<-eived. an'', 
 is five weeks later, the animal * bo«lv- weight wa..i .' 
 
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