Published weekly by the Department of Health, City of New York, 505 Pearl St.,) New York, N. Y. Entered as Second-Class matter October 16, 1917, at the Postoffice at New York, N. Y Under Act of March 3, 1879. Subscription, 10 cents per annum. ROYAI NEW SERIES, VOIT ,COPELAND, M. D., Commissioner of Health. JANUARY 10, 1920. No. 2 POISONING BY WOOD ALCOHOL. There having been many reports in the daily press of fatal poisoning from wood alcohol-most of the supposed cases having occurred outside of this citythat a short consideration of the subject is of interest. Owing to prohibition and the increasing difficulty with which alcoholics, suitable for beverage purposes, can be obtained, it was to be expected that, through the actions of the ignorant and unscrupulous, wood (methyl) alcohol would find its way into concoctions intended for drink. While isolated instances have occurred in this city, surprisingly few have come to notice, and, although the Department of Health is continuously on the watch, very few attempts have been made, on the whole, to adulterate liquor with this dangerous substance. Since refined wood alcohol tastes like ethyl alcohol, and, in the past, has been used in the preparation of essence of peppermint, Jamaica ginger, lemon extract, cologne, Florida water, witch hazel, liniments, etc., it is important to remember that poisoning may-result from such adulteration. Such use is, of course, now a violation of the Sanitary Code and subjects anyone attempting it to criminal prosecution. The poisoning of thirty persons, six of whom died, from the use of whiskey, which, upon analysis, was found to contain a considerable amount of wood alcohol, was investigated in this city some time ago. At that time a canvass of certain sections of the city, where adulterated drinks were most likely to be found, was made by food inspectors of the Department of Health. About eight hundred establishments were inspected and five thousand five hundred and thirtytwo samples of spirituous liquor were examined. The only samples in which wood alcohol was found were those from the saloon from which the liquor, causing the above mentioned deaths, had been purchased, and one other, formerly owned by the proprietor of the first-both establishments being located in the lower part of Manhattan. In connection with the cases of poisoning alluded to there has recently appeared (J. A. M. A., January 19, 1918) an interesting article, by Gettler and St. George, recording and discussing the effects of wood alcohol in such instances. Some of the findings are of particular interest and are covered in the following summary which also includes data from an article (in the Johns Hopkins Hospital Bulletin of August, 1902) by Hunt, "The Toxicity of Methyl Alcohol." Symptoms and effects, as given are the result of observations upon cases of accidental poisoning among men and experiments upon animals. Acute Poisoning. Symptoms are similar to those of poisoning from ethyl alcohol, only they come on more slowly and are more prolonged. For instance: coma, caused by methyl alcohol, commonly lasts two to four days while that resulting from excess of ethyl alcohol rarely lasts over six hours. Methyl alcohol produces marked fall of body temperature, and marked changes in the alimentary tract with intestinal hemorrhages, and vomiting of blood is frequent. Convulsions may occur and last for a day or two, ending in loss of sensation and most reflex movements. Convulsive movements of the eye are often very noticeable. Very few of the cases of acute intoxication recover and in those that do, blindness is a common result owing to degenerative changes in the retina. Chronic Poisoning. While a single dose of methyl alcohol is no more toxic to one of the lower animals than an equal quantity of ethyl alcohol, small doses of the former, given every other day, are fatal in all cases within a few weeks. This, notwithstanding the fact that doses of ethyl, or isobutyl, or amyl (fusil oil) alcohol, in doses sufficient to cause intoxication, can be given to such animals for months without harmful results. In animals dead from chronic methyl alcohol poisoning extensive fatty change of the liver has been uniformly found. The idea has been prevalent in some quarters that methyl alcohol owes its chief poisonous effect to the action of impurities contained. That this is an error, has been proved by many authorities-Hunt says, in reference to such impurities, "While the toxicity of the preparation may be considerably increased by them, methyl alcohol is still the chief toxic agent." To test the effects of methyl alcohol upon the eye, Birch-Hirschfeld experimented upon monkeys with the following results: Pure methyl alcohol, diluted with several times its bulk of water, was given to three monkeys, in doses of from three to seven cubic centimeters, every one or two days. One monkey received 28 c. c. of methyl alcohol over a period of 8 days; one 79 c. c. over a period of 15 days; the other 56 c. c. over a period of 11 days. The animals were killed when it was evident that death was approaching (at the end of the periods given) and their eyes studied microscopically. Two of the monkeys had marked degenerative changes in the retina and one was totally blind. Similar changes were found in the eyes of three dogs, poisoned by methyl alcohol, although no disturbances of vision could be detected during life. An explanation of the toxic action of methyl alcohol may be deduced from the fact that the urine of men and animals, for days after its administration, contains considerable quantities of formic acid, a markedly poisonous substance. This acid results from the incomplete oxidation of methyl alcohol, and is excreted very slowly from the animal body, thus readily producing cumulative effects and chronic disease. In the cases of the six deaths from acute poisoning by methyl alcohol in whiskey taken in bar rooms of this city, previously alluded to, all were seized with violent symptoms soon after taking the adulterated drink. These were violent abdominal pains, incessant vomiting, and extreme weakness. Three of the patients complained of blindness, and three came to the hospital in coma. The main symptom of chronic methyl alcohol poisoning is disturbance of vision and blindness. Treatment. The treatment of acute methyl alcohol poisoning is thus given by Gettler and St. George. "The treatment, to be at all efficacious, must be promptly instituted, and consists essentially of ridding the body of the poison, and supportive measures. ... For a considerable period of time, the alcohol is excreted and re-excreted, unchanged into the stomach and intestine, and it is therefore important that early and frequent gastric and rectal lavage be carried out. . . . Intravenous saline or sodium bicarbonate infusions and phlebotomy and transfusions, if the latter can be had quickly, should be administered. In addition, warmth and strong stimulation with strychnin, digitalis, caffein, camphor, epinephrin and oxygen must be given. It is said that ethyl alcohol is indicated to replace the methyl, and that it acts as a powerful stimulant; but we doubt this." The Section of the Sanitary Code, which regulates the use of wood alcohol in this city, follows: Sec. 124. Wood naphtha (otherwise known as wood alcohol or methyl alcohol), sale and distribution regulated.-No person shall sell, offer for sale, give away, deal in, or supply, or have in his or her possession with intent to sell, offer for sale, give away, deal in, or supply, any article of food or drink or any medicinal or toilet preparation, intended for human use internally or externally, which contains any wood naphtha, otherwise known as wood alcohol or methyl alcohol, either crude or refined, whatever may be the name or trade mark under or by which the said wood naphtha shall be called or known. No person shall sell, offer for sale, give away, deal in, or supply, or have in his or her possession with intent to sell, offer for sale, give away, deal in, or supply, any wood naphtha, otherwise known as wood alcohol, or methyl alcohol, either crude or refined, whatever may be the name or trade mark under or by which the said wood naphtha shall be called or known, unless the container in which the same is sold, offered for sale, given away, dealt in, or supplied, shall bear a notice containing the following device and words conspicuously printed or stenciled thereon, viz.: POISON. WOOD NAPHTHA OR WOOD ALCOHOL. Warning. It is unlawful to use this fluid in any article of food, beverage, or medicinal or toilet preparation, intended for internal or external human use. THE DESIRABILITY OF SPECIAL CLASSES FOR CHILDREN SUFFERING FROM CARDIAC DISEASES. The Director and Assistant Director of the Bureau of Child Hygiene, of the Department of Health, recently conferred with representatives of the Association for Study and Prevention of Cardiac Disease, and of the Association of Cardiac Clinics, with reference to the establishment of special classes in the public schools for children suffering from cardiac diseases. A difference of opinion exists on this question. Arguments in favor of such special classes would include the consideration that, thereby, the children could be placed where there would be no physical strain due to going up and down stairs and that, because of their grouping in one classroom, they could receive special medical attention with individual supervision of their school work. On the other hand, it is believed by others that the grouping of these children in one classroom is apt to call undue attention to their physical condition, and that group supervision does not offer any advantage over the individual supervision that may be carried on over these cases, irrespective of the classrooms to which they may be assigned. There seems also to be a difference of opinion as to the harm or benefit caused by physical exercise in these cases. The general conclusion is that each case must be treated separately, and that no genera! rule may be made in this direction. Definite conclusions have not yet been reached by any considerable group of authorities as to whether special classes for children suffering from cardiac diseases are desirable or not. LOUD NOISES FROM AUTOMOBILES MUST BE PREVENTED. At a meeting of the Board of Health of the Department of Health of the City of New York held in the said city on the 17th day of December, 1919, the following resolution was duly adopted: Resolved, that Article 12 of the Sanitary Code be amended by adding thereto a new section to be numbered "229," to read as follows: Sec. 229.-Automobiles and Other Motor Vehicles; Loud and Explosive Noises Prohibited.-Every automobile or other vehicle equipped with a gasoline or other internal combustion engine in which a gas is generated or used for the purpose of propulsion, shall be constructed so that the exhaust from such engine is made to discharge into a muffler or other device which will prevent loud or explosive noises; and no person having the management or control of any such automobile or vehicle, or operating the engine thereof, shall cause, permit, suffer or allow the exhaust from such engine to discharge into the open air, or otherwise than into a muffler or other device which would prevent loud or explosive noises. PRECAUTIONARY MEASURES TO PREVENT LEAD POISONING. The Industrial Hygiene and Medicine Office of the United States Public Health Service has recently concluded a survey of the pottery industry, located chiefly in Trenton, N. J., and East Liverpool, Ohio. The survey was made with a view to determine the extent of lead poisoning in this industry, and to give such oral and written advice as might be indicated. Physical examinations were made of some 2,000 men during this survey. Where any pottery worker was found to be suffering from lead poisoning, even to the slightest degree, he was informed as to his condition, and was given treatment and advice. Where any prominent physical defect was discovered, the worker was informed in regard to the defect, and consultation with a physician was advised. As a result of these physical examinations, a number of cases of lead poisoning were discovered, and it was considered advisable to call the attention of all pottery workers to precautionary measures designed to reduce the hazard involved in pottery production. Consequently, printed instructions and advice were sent to the workers concerned, copies of which can be obtained, by those interested, from the U. S. Public Health Service, Washington, D. C. SCHICK TESTS OF CHILDREN ENTERING SCHOOL. Arrangements have been made whereby children entering school for the first time at the beginning of the school term in February next will receive circulars relative to the value of the Schick test. Their parents will be urged to have this test performed either by their family physicians or by the school medical inspectors. Arrangements have been made, by the Director of the Bureau of Laboratories of the Department of Health, to instruct the medical inspectors of the Bureau of Child Hygiene in the technique of making these tests. TREATMENT OF MALARIA. Report of the Subcommittee on Medical Research of the National Malaria Committee. "The subcommittee on medical research of the National Malaria Committee presents the following as a standard method of treatment of malaria for the purpose of curing the patient of his infection and recommends its general use by the medical profession. We believe that this treatment will, in the great majority of cases, prevent relapses in the patients themselves and also prevent transmission of infection to others. Our opinion is based largely upon the results of the treatment by this method, under average conditions, in their homes, of a large number of persons infected with malaria. "For the acute attack 10 grains of quinine sulphate by mouth three times a day for a period of at least three or four days, to be followed by 10 grains every night before retiring for a period of eight weeks. For infected persons not having acute symptoms at the time only the eight weeks' treatment is required. "The proportionate doses for children are: Under 1 year, one-half grain; 1 year, 1 grain; 2 years, 2 grains; 3 and 4 years, 3 grains; 5, 6 and 7 years, 4 grains; 8, 9 and 10 years, 6 grains; 11, 12, 13 and 14 years, 8 grains, 15 years or older, 10 grains. "It is not claimed that this is a perfect or even the best treatment in all cases, but it is our belief that it is a good and satisfactory method for practical use to prevent relapse and transmission to other people. "C. C. BASS, Chairman, "CHARLES F. CRAIG." |