If elimination is insufficient, or absorption takes place more quickly than excretion, the poison accumulates in the body, and has a cumulative effect which in chronic industrial poisonings plays a very important rôle. Under certain circumstances poisons are not thrown off, but stored up—fixed—in the body.
The poison absorbed in the body can act unchanged from the place where it is stored. A number of poisons, however, undergo in the organism chemical change through which the action of the poison is partly lessened, rarely increased. Among such changes and weakening of the poison are: oxidation, as, for example, of organic poisons into their final products (carbonic acid, water, &c.), oxidation of benzene into phenol, oxidation of sulphur dioxide into sulphuric acid, &c.; reduction in the case of metals, peroxides, &c.; neutralisation of acids by alkaline juices; chemical union (for instance, of aromatic compounds with sulphuric acid). The splitting up of albuminous bodies is not of importance in regard to industrial poisons.
GENERAL REMARKS ON THE TREATMENT OF INDUSTRIAL POISONINGS
Although in industrial poisoning the importance of treatment is small in comparison with that of preventive measures, in discussing particular forms of poisoning, full weight must be given to it; and in order to avoid repetition, certain points will be brought forward here.
Of the treatment of chronic industrial poisonings not much in general can be said; unfortunately, special treatment has often little chance. It will usually be of advantage to maintain the activity of the excretory organs. So far as there is question of poisons affecting metabolism and injuriously influencing the general state of nutrition, treatment aiming at improving the general health and strength offers hope of success. For nervous symptoms, especially paralysis, disturbance in sensation, &c., treatment generally suitable to nervous diseases can be tried (electro-therapeutics, baths, &c.). In treatment of acute industrial poisonings, which often demand the prompt intervention of laymen, ‘first aid’ is more hopeful.
The most important general rules of treatment arise in reference to irritant poisons which produce ulceration of the skin, and further in regard to those poisons which cause unconsciousness, especially blood poisons.
When an irritant poison is acting on the skin, the first object to be aimed at is naturally the immediate removal of the cause of corrosion by water, or, better still, neutralisation by an alkaline solution (for example, soda solution) in the case of corrosive acids, and weak acids (organic acids, acetic acid, citric acid) in the case of caustic action by alkalis. Such remedies must be at hand in factories as part of the equipment for first aid, where irritant poisonings can occur.
In those industrial poisonings which result in loss of consciousness, arrest of respiration and suffocation, attempts at resuscitation should at once be made. In these attempts at resuscitation, artificial respiration is of the greatest importance; of course the sufferer must first be withdrawn from the influence of the poison, i.e. be brought into fresh air. Great care must be taken, especially where it is necessary to enter places filled with a poisonous atmosphere, to prevent the rescuers, as is often the case, themselves falling victims to the influence of the poison. They should be provided with suitable smoke helmets or breathing apparatus.
We will not describe the methods of resuscitation and artificial respiration universally enjoined; they can be found in every first-aid handbook.
Emphasis is laid on the great importance of treatment by oxygen in cases of industrial poisoning through gaseous blood poisons, as this treatment is attended with good results. Apparatus for the administration of oxygen should be kept wherever there exists the possibility of such poisoning, especially in mines, smelting works, chemical factories, and chemical laboratories.