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.a. i?" Permatitis*—This appears in the form of a papular or erythematous rash over
the hands, wrists, face, neck and feet, and is the most prominent where sweating and
mechanical friction are greatest. The rash on the hands is most frequently of the
cheiropompholyx type, seen on the webs of the fingers and on the palms. There is
mtense pruritus, and the character of the rash is often altered by a secondary infection.
Fine desquamation follows the rash, and in rare cases the skin is exfoliated in large flakes.
2. Toxic Gastritis,—This is characterized by a bitter taste in the mouth, spasmodic
pain in the epigastrium, anorexia, acid eructations, nausea, vomiting, constipation, later
diarrhoea with pain and tenesmus.
3. Blood Changes.—These are haemolysis of the red blood corpuscles and conver-
sion of haemoglobin into methsemoglobin, which cause the symptoms of pallor or cyanosis,
dizziness, breathlessness and passage of dark urine. Aplastic anaemia occurs in severe
poisoning, which often ends fatally.
4. Toxic Jaundice.—This occurs in cases of severe poisoning, and often appears
suddenly without preliminary warning. Sometimes, there may be premonitary symptoms
of dizziness, fatigue and headache. Toxic jaundice is associated in its early stages with
enlargement of the liver, and later with shrinkage ; ascites was observed in one case
in which considerable shrinkage of the liver was found. In fatal cases coma and deli-
rium supervene suddenly, usually about three weeks after the first appearance of
Toxic jaundice appears to occur more frequently in young adults who, when
attacked, are very prone to die. It usually develops between the fifth and sixteenth
week after exposure to T.N.T.,17 but a long latent period may sometimes supervene
before toxic jaundice occurs. Legge reports a case in which the latent period was
seven months, and Glynn reports one in which it was nine months.18
Treatment.—Where jaundice is absent, the treatment consist of rest in bed for a
day or two with a liberal diet of milk, fruit and green vegetables, demulcent drinks
and vegetable laxatives. A mixture containing sodium sulphate, potassium citrate and
sodium bicarbonate may be given as a routine measure.
In the treatment of cases with jaundice absolute rest in bed is essential. Milk
should be given and the bowels must be kept loose by aperients. Alkalies, such as
citrates and bicarbonates, should be given to counteract the tendency to acid intoxica-
tion. Rectal and intravenous saline infusions are recommended in severe cases.
Preventive Measures.—These are—
1. Employment in T«N,T. factories of healthy persons above 18 years of age.
2. Medical inspection of the workers at least once a week.
3. Efficien ventilation of factories.
4. Mechanical devices for preventing the accumulation of dust and getting rid of
5. Protection of the workers by the use of special clothing, such as gauntletted
gloves, respirators and veils.
6. Thorough washing of the hands and face before leaving the factories and before
7. Liberal supply of milk,
Post-mortem Appearances.—The liver shows extensive necrosis and atrophy. The
kidneys show cloudy swelling and fatty degeneration. The myocardium is soft, pale and
flabby, Petechial and diffuse haemorrhages are generally found beneath the endocardium,
pericardium and peritoneum.
Chemical Analysis.—If the urine of a suspected case of trinitrotoluene poisoning be
mixed with an equal volume of 20 per cent sulphuric acid solution, and shaken out with
ether, the ether is separated and washed free of acid with water and then treated with
alcoholic potash, a pink colour will indicate the evidence of trinitrotoluene poisoning
NITROGLYCERIN (TRINITROGLYCERIN, TRINITRIN, GLONOIN OIL, GLYCERYL
TRINITRATE, NOBEL'S BLASTING OIL), CaH«(O.NO3)3
This is colourless, odourless, oily liquid with a sweet, aromatic, pungent taste. It
is slightly soluble in water and rapidly in alcohol, ether, chloroform, oil and fats. It
is highly explosive, and is used in manufacturing explosives, such as dynamite and
Pharmacologically nitroglycerin is similar in action to amyl nitrite, but its effect is
more lasting. It is an extremely active drug, the medical dose being 1/130 to 1/60 grain,
17. Lancet, Dec. 16, 1916, p. 1026.
18. Medical Research Council Special Report Seriest No. 58, 1921; Brit. Med. Jour.,
March 12, 1921, p. 395,