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NITRO DERIVATIVES OF TOLUENE 323

do not agree with the German data. They show that chemically pure α− trinitro-
toluene is as poisonous as the crude product. Finally, the view has been accepted in

Great Britain that the small number of poisoning cases that occurred in Germany

should be ascribed to the fact that TNT had been manufactured in Germany for
many years before the World War I, so that the production processes (including

safety regulations) had become well established, whereas in Great Britain TNT

manufacture was something new and it was not until 1917 that the proper level

of industrial hygiene was achieved in the factories and the appropriate regulations

were framed.

In one of the ammunition factories in the United States, 17,000 poisoning cases,

including 475 fatal cases, occurred during the first seven and a half months of

World War I. They were supposed to be caused by TNT as this was a period of

hasty production of ammunition. During the 20 months that followed, the number

of poisoning cases fell to 7000, including 105 fatal cases.

Investigations by Legge [122] have demonstrated that the following toxic effects

are produced by TNT:

(1) Irritation of the digestive tract (not differing from a similar effect produced

by other agents).

(2) Methaemoglobinaemia (and the effects induced by oxygen deficiency):

disturbed heart function, liver and kidney trouble and a dysfunction of the

whole vascular system.

(3) A particularly harmful, effect on the liver tissues, causing severe jaundice,

which in 25-30% of cases may end in death.

(4) Aplastic anaemia, manifesting itself by a fall of the number of red and white

corpuscles, caused by the dysfunction of the bone marrow. Almost all of

these cases end in death.

As Moore [123] believes, poisoning can occur when TNT is absorbed through

the skin.

In 1918 a special medical committee in Great Britain published a statement

on TNT poisoning. The committee believed that disturbances in the digestive tract

are not decisive symptoms, and if caused by other factors may lead to wrong conclu-

sions. Yellow stains on the skin, usually appearing when working with TNT, are

not indubitable symptoms of poisoning. The presence of trinitrotoluene in the urine

(Webster’s test [124]) should not be considered as a proof of poisoning. The real

symptoms are :

(1) Paleness of face, a grey colour of lips, which disappears upon excitation.

Sometimes the lips and the tongue may even be a violet colour.

(2) Stomach ache, characteristically localized.

(3) Constipation and flatulence.

If no jaundice has appeared, the treatment is simple, and the prognosis is good.

The treatment should consist in:

(1) Isolation of the patient from contact with TNT and allowing plenty of

fresh air.