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Original scientific paper

Clinical and industrial hygiene aspects of occupational manganese poisoning (with report of ten cases)

Sergije Dogan ; Neuropsihijatrijska klinika Medicinskog fakulteta Zagreb
Tihomil Beritić ; institut za higijenu rada Zagreb

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Ten cases of occupational manganese poisoning having occurred in a plant producing manganese alloys (ferromanganese, spiegeleisen, silicomanganese and silicospiegel) are reported. All of these patients were engaged on the same work in which they were highly exposed to the inhalation of manganese are dust and manganese fumes. The manufacturing method of the plant is briefly described. The total length of exposure to manganese varied between 18 months and 12 years. The most prominent neurological signs corresponded to a mild form of parkinsonian syndrome, in two cases with prevailing unilateral manifestations. The main neurological features were disturbances of gait, present in all cases: patients gave a history of weakness in the legs (and some of them in the arms); the gait was found to be slapping and in one case the so-called »cock-walk« was observed; retropulsin and propulsion, masklike face. increased muscle tone. inconstant tremor of the hands and of extended tongue, disturbances in speech with palialic and slow, monotones voice, and micrographia were often noted. Nearly all patients complained of muscular cramps. Uncontrollable laughter less frequently weeping, were also noticed. Symptoms of the affection of the pyramidal tract were also seen in one patient and hemihypaesthesia in another. In blood picture only a slight leucopenia (4,2-4,7 WBC) in 5 patients was found. Liver function tests revealed no abnormalities. Liver biopsy performed in 5 cases showed no histological changes; in one of these, however a pigment which did not give positive iron reaction, was discovered in large quantities in liver tissue. Cerebrospinal fluid, examined in 8 cases, gave normal findings in 3 and slight abnormalities in others: globulin reactions were in one case clearly positive and in subsequent three slightly positive; in five patients there were small changes in mastix and collargol reactions. Pneumoencephalography was performed in two cases: there was a normal finding in one and a slight diffuse cerebral atrophy in the other. Six patient were submitted to electroencephalographic examination: one record was of explicity low voltage, another one exhibited an abnormality consisting of bursts of generalised medium voltage slow and fast activity; all older records were normal. Treatment with 2.3-dimcrcaplopropanol (B. A. L.) was tried in seven cases following the dosage which Thompson suggested for the treatment of hepatolenticular degeneration. ln another case pyridoxine was also tried. The patients failed to respond to both kinds of therapy. A detailed account is given of occurrence of manganese in the nature and its occurrence and role in plant and animal tissue. Industrial uses of manganese, its alloys and compounds are listed. The industries and technical processes which give or might give rise to occupational manganese poisoning are described. The sources of occupational poisoning reported in literature up lo the present time are reviewed. The importance of a particular disposition towards manganese poisoning as evidenced by numerous examples from literature is emphasized. Opinions are put forward on the toxicity of manganese and its action upon liver, blood, lungs and oilier organs. An analysis of symptoms and a comparison with the clinical feature of manganese poisoning as described by other authors is made. Some control methods for the prevention of further manganese poisoning in the plant are recommended. Case histories of patients are added.


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