Certain cases of chronic carbon bisulphide poisoning in indiarubber
workers have come under my notice, and some remarks concerning them
may be of interest. The characteristic symptoms are essentially as
follows: the invalid appears in the consulting-room in a bent position,
leaning upon a stick with head and hands shaking. The gait is clumsy
(spastic-paralysis) so that the patient ‘steps’ rather than walks. When
seated, the tremor ceases to some extent, but in purposive movements
increases rapidly, involving the whole body, so that an exact systematic
examination becomes impossible, and the invalid sinks back into the
chair exhausted and bathed in perspiration. He complains of cold in
the extremities. He looks pale; the skin of the upper extremities is
totally without feeling, as also is the upper part of the feet; the skin
of the head is hypersensitive; the muscular strength of the arms is
almost lost; testing the strength brings on marked shaking, followed by
a fainting-fit caused by exhaustion. The extremities of the patient are
cyanotic (livid); the knee jerks are exaggerated. The patient suffers
from indigestion, constipation, headache, and giddiness; he is irritable,
and depressed; his memory is weak; mental derangement cannot be proved.
Chronic carbon bisulphide poisoning is rarely fatal. Slight cases end in
recovery after more or less long continuance; in severe cases improvement
occasionally takes place, but serious nervous disturbance (paralysis,
weakness of the muscles, deterioration of intellect) usually persists.
Treatment is symptomatic, aiming especially at relieving the nervous
symptoms and improving the state of nutrition. If psychical disturbances
are prominent, treatment in an institution is necessary.
CYANOGEN AND CYANOGEN COMPOUNDS (CYANOGEN GAS, PRUSSIC ACID, CYANIDES)
Industrial cyanogen poisoning is not frequent. _Cyanogen gas_ (C₂N₂,
existing in small quantities in furnace gas, illuminating gas, and other
kinds of gas) and especially _hydrocyanic acid_ (CNH, prussic acid) are
considered industrial poisons; the latter is a very unstable, colourless,
pungent-smelling liquid, boiling at 27° C. Among the cyanides employed
industrially and having an effect similar to that of prussic acid must be
mentioned _cyanide of potassium_ and _cyanide of sodium_ (KCN and NaCN),
_cyanide of silver_ (AgCN) and _cyanide of mercury_ (Hg[CN]₂).
Cyanogen and cyanogen compounds are extraordinarily powerful poisons. The
minimum dose lies, as Lehmann has proved by experiments on animals, at
about 0·05 per thousand of hydrocyanic acid in the atmosphere breathed;
1-5 mg. per kg. weight is fatal to animals; to man about 60 mg. would be
fatal.
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