Report of Deaths and Prostrations.

R. P. ALBAUGH, M.D. Director, Division of Industrial Hygiene, Ohio State Department of Health.

The physician is almost constantly. confronted with perplexing problems, prominent among which are the sudden deaths and prostrations which occur from obscure causes. In view of this fact it seems proper to call attention to three deaths and a number of prostrations and illnesses which occurred under unusual circumstances in a construction camp, and which I had occasion to investigate. As the investigation was made almost eight days after the first death occurred, the account is to a large extent dependent on hearsay.

At about 8:30 p. m., Monday, Dec. 18, 1916, a member of the construction gang, consisting of about thirty white and thirty colored men, discovered one of the colored waiters lying in an unconscious condition on the floor in the bunk house, where he had apparently fallen from the second-tier bunk which he had occupied. The superintendent was notified, and with several others attempted to revive the unconscious man. His respirations were rapid and shallow and his pulse weak and rapid. A physician was called, and by the time he arrived another colored waiter had fallen unconscious and the superintendent and several others were suffering from throbbing temporal headache, dizziness, palpitation, epigastric pain, and weakness, especially of the lower extremities, to such a degree that they were forced to seek_their beds. When the physician arrived he concluded that all had eaten poisoned food, and administered apomorphin and other emetics and also cathartics. The physician stayed at the camp for an hour or two and left, thinking that everything possible had been done. The two unconscious men had not regained consciousness, however, but the other afflicted men had fallen asleep and were apparently in good condition.

About I a. m. it was noticed that both unconscious men were vomiting and that the one was apparently near death. The physician was again called but was unable to come at that time and sent another physician instead. When he arrived, the waiter was dead, five other men were unconscious, and five more were suffering from dizziness, headache, palpitation, nausea and general weakness to such an extent that they were forced either to sit or to lie down. The physician, also assuming that they had eaten poisoned food, and knowing that the other physician had administered emetics, thought it best to get them to a hospital, and accordingly called ambulances and taxicabs and sent ten of them (six white and four colored) to a hospital, a distance of about 12 miles. Two of the unconscious men regained consciousness during the journey, and several others who had suffered from head

* Reprinted from The Journal of American Health April 7, 1917, Vol. LXVIII, pp.

ache, dizziness, weakness, etc., felt much better by the time the hospital was reached. Physicians at the hospital were agreed that the men were poisoned, probably by contaminated food, and accordingly thoroughly lavaged the stomachs of the afflicted men, and by means of the stomach tube administered a large dose of castor oil to each man. One of the unconscious men died later (December 22) without regaining consciousness (second death). The others gradually recovered, and in three or four days were apparently none the worse for their experience. The physician who was responsible for sending these men to the hospital informed the investigator that, after returning to his home from the camp, he himself suffered from a severe headache and drowsiness, the headache persisting for the greater part of the day.

At 2 a. m., Friday, December 22, the superintendent and three other men returned to the camp, which had been deserted since the night of the experience recorded above. The superintendent and the cook occupied one room while the other two men occupied a room separated from their room by the "white" dining room and the kitchen, All retired feeling well, but at 4 a. m., when the cook rose to prepare breakfast, he had a violent headache, and was so "weak in the knees" and dizzy that he was forced to go back to bed. He so informed the superintendent, who thought it best to call a physician, but he fell to the floor unconscious before he reached a telephone. One of the nien in the other room also became unconscious about this time, and when a physician reached the camp, three were unconscious, and the other was suffering from headache, dizziness and general weakness. All were sent to the hospital and all recovered in a short time except one white man, who died Monday evening, December 25, from what was apparently pneumonia (third death).

To determine the poison responsible for these deaths and prostrations, the stomach and its contents were removed from the body of the man who died first and sent to a physician in a neighboring city for analysis. Feeling certain that such an analysis would reveal the cause of death, the two physicians who removed the stomach did not complete the necropsy, although the heart was opened and found filled with very red liquid blood. The necropsy was performed twenty-four hours after death. A careful analysis of the stomach contents did not reveal the presence of any poison, and it was concluded that ptomains were responsible.

Necropsies on the bodies of the other two men who died revealed. in one, the right lung in a state of general red hepatization and some small petechial patches in the stomach, and in the other the right lung bound down with adhesions laterally and both lungs congested posteriorly and moist on section.

The camp buildings were located approximately 150 yards from the nearest building (the shear room) used by a rolling mill company. The men were housed in three buildings (Fig. 1), the largest of whiclı contained a "colored” bunk room, “colored” dining room, store room, kitchen, “white” dining room, office and two other small bunk rooms used by overseers and kitchen help. The other two buildings were the "white" and "colored" bunk houses. Each room was equipped with a coal stove except the store room, and all stoves were new and in good condition, and equipped with pipes, without dampers, extending through the roof. No attempt was made to keep fires all night in the bunk rooms, and it was stated that windows were invariably opened at night. The buildings were clean and well kept, and the food in the store room was of good quality and in good condition. The kitchen was equipped with a sink from which a waste pipe led through the floor, and all wastes were allowed to accumulate under the floor to be absorbed by the earth. Several of the men stated that they had noticed some odor as a result of this arrangement, and were inclined to think that they might have suffered from poisoning by “sewer gas.”


Fig. 1. - Construction camp in which the men were poisoned.

No gas was used in the building, and it was stated that no gas mains or pipes were situated near the camp. The buildings were located on an old fill or dump, where dirt, slag, scrap, mill wastes, ashes and cinders had been deposited for a period of about five years, but where none had been deposited for the last six months. This fill covered an area of about 12 or 2 acres, and was from 10 to 15 feet deep.

About ten days previous to the time of the occurrence related above, an employee of the mill noticed what seemed to be a little steam arising from the edge of the fill about 50 feet from the camp building. It was thought that the dump might be on fire, and by means of teams and scoops trench was dug around the part thought to be on fire in an effort to isolate it. The dump was found to be frozen to a depth of about 2 feet, but at a depth of 5 feet red hot cinders were encountered, and a second trench was started to feet back of the other trench. Hot cinders were found in this one, and when the investigator left, the fourth trench was being dug, which extended under the camp building, and in which hot cinders were found at a depth of about 5 feet (Fig. 2). While working in one of these trenches, six men suffered from headache, dizziness, and "weakness in the knees" to such an extent that it was necessary to help them from the trench, and two were taken to the plant hospital of the rolling mill company. On entering one of these trenches the investigator noticed within a


Fig. 2. — Camp after dump was torn up. The photograph was
taken after it had rained, and clouds of steam are seen

rising from the hot cinders.

few minutes a sense of pressure in the temples, general weakness, especially of the lower extremities, and blurring of the vision.

The deaths, prostrations and toxemias undoubtedly occurred as the result of the inhalation of carbon monoxid. This gas was formed as a result of the smoldering, incomplete combustion of cinders and other material in the dump, and owing to the frozen surface, found its only outlet beneath the camp buildings where the surface was not frozen, having been protected by the building, which was equipped with stoves. The hot water which came through the kitchen sink was probably also a factor in keeping the cinders soft and porous, allowing for free outlet of these gases, acting as a sort of flue for the smoldering fire beneath. Gases passing through earth lose their impurities and odors as they pass onward.*

The symptoms and complaints of the men affected were typical of carbon monoxid poisoning, with practically no symptoms pointing toward poisoning by contaminated food or ptomains. It must be remembered, however, that this camp had been occupied for a period of about three months with no trouble, and this can be explained only by the fact that the dump might have been on fire only for a short length of time, or that the gas had never found its way to the surface in quantities sufficient to produce poisoning. The latter explanation is probably correct, as the extent of the fire and the fact that nothing had been added to the dump for a period of more than six months would indicate that the burning process had been going on for some time. It is unfortunate that more complete necropsies and chemical tests were not performed, as the presence of carbon monoxid could undoubtedly have been shown by the spectroscope or various chemical tests. Unfamiliarity with carbon monoxid poisoning clinically and the prejudicing theory of food or ptomain poisoning were mainly responsible for the failure of accurate diagnosis.

The company made preparations immediately to move the buildings to a point at which there would be practically no danger. Canaries were placed in the various apartments in order that traces of poisonous gases might be detected early. This was done because of the fact that, with the wind in the right direction, and under certain other atmospheric conditions, harmful amounts of the gas might prevail when the dump was torn up in an attempt to extinguish the fire.

Carbon monoxid causes more cases of industrial illness and death than any other gas, and is a constant danger in thirty or more industries.† The gas is colorless, odorless and tasteless, and is found as a by-product wherever combustion of carbon-containing material occurs. It has been said that a volume of air containing 0.01 per cent. may increase headache, dizziness, weakness and other phenomena, while two to three parts per thousand of air are dangerous to life. The gas is toxic by virtue of its power to unite itself with the hemoglobin, replacing the oxygen and forming a stable compound known as carboxyhemoglobin. The affinity of

The affinity of hemoglobin for carbon monoxid is 300 times greater than the affinity for oxygen (Haldane). It probably also has a distinct toxic action on tissues.

Bronchopneumonia is found to have been a frequent complication in those who died several days after being poisoned by the gas. It will be remembered that the last two deaths recorded above were probably directly due to a pneumonic condition of the lungs. Postmortem, the blood usually flows freely, is a bright, cherry-red, and has a characteristic appearance as seen by the spectroscope.

In some cases of carbon monoxid poisoning the victim may succumb instantly, while in others there are often prodomal symptoms, as throbbing or feeling of pressure in the temples; epigastric disaress,

Oliver, Thomas: Diseases of Occupation, London, Methuen & Co., 1908.

† Kober and Hanson: Diseases of Occupation and Vocational Hygiene, Philadelphia, P. Brakiston's Son & Co., 1916.

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