DOMESTIC
CARBON
MONOXIDE
POISONING
FROM
GAS
STOVES
E.
R.
HAYHURST,
M.D.,
FELLOW,
A.
P.
H.
A.
Consultant,
Division
of
Industrial
Hygiene,
State
Department
of
Health,
Columbus,
Ohio
CARBON
monoxide
poisoning,
ac-
cording
to
Lewin,
the
well
known
Berlin
authority,
is
now
and
al-
ways
has
been
since
the
first
discovery
of
fire,
the
most
widespread
poisoning
in
connection
with
human
life
and
activi-
ties.
We
have
long
been
familiar
with
it
in
industrial
pursuits
and
more
recently
in
connection
with
motor
cars
and
gas
engines
in
confined
places
like
garages
or
basements.
"
You
can
do
it
better
with
gas
"
is
the
well-known
slogan
of
a
prominent
gas
distributing
corporation,
but
it
may,
however,
have
a
double
significance:
in
a
word,
the
careless
or
ignorant
use
of
gas
by
the
householder
in
his
various
heating
appliances.
During
the
winter
just
past
there
have
been
recorded
by
the
Ohio
State
Depart-
ment
of
Health
over
50
deaths
by
acute
carbon
monoxide
asphyxiation
and
100
partial
asphyxiations
from
the
burning
of
gas
as
a
fuel
in
domestic
heating
ap-
pliances,
despite
widespread
and
repeated
public
warnings,
to
which
the
press
gave
ardent
support
from
the
beginning.
,The
recorded
fatalities
and
hair-
breadth
escapes
occurred
throughout
the
State.
The
first
shocking
tragedy
oc-
curred
at
Lancaster
on
the
night
of
November
21,
1922,
when
the
six
mem-
bers
of
one
family
were
wiped
out
by
carbon
monoxide
gas
generated
by
a
flue-
less
gas
stove
located
in
the
living
room
of
a
new
four-room
cottage.
Imme-
diately
upon
the
heels
of
this
event
occurred
the
death
of
a
bridal
couple
on
their
wedding
night
in
their
new
home
in
Columbus.
Thereafter
a
wave
of
cases
followed
each
cold
spell
throughout
the
winter.
Health
officials
also
dis-
covered
that
the
situation
was
not
appre-
ciated
even
by
physicians
and
coroners
and
that
undoubtedly
many
mysterious
deaths
from
the
same
cause
have
been
incorrectly
diagnosed
in
the
past.
In
fact,
in
the
Lancaster
cases
food
poison-
ing
was
the
proclaimed
cause
until
the
laboratory
proved
food
remnants,
water,
vomitus,
etc.,
negative,
while
at
the
same
time
the
circumstances
together
with
the
necropsies
and
laboratory
agreed
on
the
death
agent
as
carbon
monoxide
gas.
There
is
another
than
the
acute
or
tragic
aspect
of
the
subject.
Undoubtedly
a
large
amount
of
ill
health
is
chargeable
to
breathing
minute
quantities
of
carbon
monoxide
gas
from
these
sources
asso-
ciated
with
the
other
combustion
products
which
it
is
customary
in
innumerable
dwellings,
to
permit
to
escape
into
living
rooms.
This
whole
situation
recalls
pre-
Franklin
days
when
the
defectively
con-
structed
fireplace
on
one
side
of
the
room,
with
the
charcoal
brazier
on
the
other,
was
so
often
the
cause
of
mishap
that
Franklin's
interest
was
aroused
and
he
invented
the
so-called
"Franklin
stove."
This
undoubtedly
proved
a
marked
ad-
vance
in
the
safety
and
healthfulness
of
room
heating
for
more
than
a century.
About
1795
William
Murdock
is
credited
with
having
discovered
illuminating
gas
and,
in
1855,
Bunsen
discovered
the
famous
burner
which
bears
his
name.
These
discoveries,
which
did
away
with
smoke,
brought
about
the
advantages
of
better
lighting.
There
soon
followed
gas
fired
room
heating
appliances
without
flues.
Thus
we
have
slipped
back
to
con-
ditions
similar
to
those
prior
to
1744
when
Franklin
made
his
invention
and,
on
tumane
grounds,
gave
it
to
the
world',
refusing
to
have
it
patented.
In
Ohio,
a
"
committee
on
funda-
[462]
DOMESTIC
CARBON
MONOXIDE
POISONING
FROM
GAS
STOVES
463
mentals
regarding
the
safety
of
gas
heat-
ing
appliances"
was
formed
early
in
the
winter
of
1922-23
by
professors
at
the
State
University
and
technical
men
of
various
official
state
departments,
headed
by
the
Department
of
Health.
After
a
number
of
pr'eliminary
conferences,
a
general
hearing
was
held
at
which
stove
manufacturers
and
gas
companies
of
the
middle
west
were
represented
and
agreed
unanimously
on
six
fundamental
safety
measures
to
be
taken.
These
were
then
drafted
into
a
bill
and
presented
to
the
legislature.
After
numerous
committee
hearings
gave
opportunity
for
full
under-
standing
of
the
proposed
law,
all
oppo-
sition
faded
away
except
that
of
certain
commercial
interests
which,
in
spite
of
the
fact
that
the
bill
was
reported
out
unanimously
by
a
senate
committee
on
manufactures
and
commerce,
wielded
enough
influence
to
have
it
held
in
the
legislative
steering
committee.
However,
from
the
first
it
was
recognized
that
a
wide
educational
campaign
would
un-
doubtedly
accomplish
the
greatest
good
for
the
present,
the
gist
of
which
is
that
the
householder
must
flue
or
vent
his
flame-fired
heating
appliances
to
the
out-
side
air
and
cease
to
permit
the
breathing
of
combustion
products
in
his
home.
A
recent
report
by
a
consulting
gas
expert
states
that
there
are
over
2,000
natural-gas-using
towns
and
over
4,600
manufactured-gas-using
towns
in
the
United
States,
and
that
gas
is
used
by
over
one-half
of
our
population.
It
is
estimated
that
there
are
over
four
mil-
lion
users
of
gas
in
the
state
of
Ohio
alone.
Correspondence
shows
that
even
Louisiana
is
vitally
interested
in
gas
heating
stoves.
Artificial
gas
creates
a
double
hazard
since
carbon
monoxide
is
an
important
component
and
therefore
death
may
re-
sult
from
simply
breathing
it,
as
from
unsuspected
leaks.
Natural
gas
does
not
contain
carbon
monoxide
nor
other
readily
toxic
ingredients,
but
if
burned
incompletely,
as
most
frequently
happens
from
a
poor
or
defective
air-mixer
on
a
gas
stove
built
on
the
Bunsen
principle,
will
readily
yield
death-dealing
amounts
of
the
gas.
So
also
will
any
carbon-con-
taining
fuel.
In
this
respect
the
cigar,
cigarette
and
pipe
are
common
illustra-
tions,
one
authority
stating
that
the
habitual
smoker
shows
as
much
as
6
per
cent
saturation
of
his
blood
with
COHb.
About
25
per
cent
saturation
produces
symptoms
in
the
average
person;
50
-per
cent
will
produce
unconsciousness,
while
75
per
cent
usually
produces
death.
As
small
an
amount
as
1/10
of
1
per
cent
in
the
air
may
ultimately
prove
fatal
because
of
the
affinity
of
the
gas
for
the
red
corpuscles
which
is
some
300
times
that
of
oxygen,
by
which
a
slow
displacement
ending
in
asphyxia
results.
The
unusual
increase,
at
this
time,
in
the
incidence
of
mishaps
is
said
to
be
due
to
the
appearance
of
the
"
radiant
"
type
of
domestic
heating
stove
which,
accord-
ing
to
Smithsonian
Institution
Bulletin
102,
No.
8,
is
likely
to
produce
carbon
monoxide
gas
whenever
the
radiants
glow
over
three-fourths
of
the
distance
from
the
bottom
to
the
top.
Hence
a
slight
increase
in
gas
pressure,
as
usually
occurs
overnight,
due
to
lessened
general
use
of
gas,
may
easily
change
a
stove,
operating
innocently
enough
in
the
day-
time,
to
a
carbon
monoxide
generator
in
the
middle
of
the
night.
This
is
borne
out
by
the
fact
that
most
of
the
mishaps
occur
overnight
in
bed
rooms
(in
which
windows
are
also
closed).
It
is
note-
worthy,
too,
that
the
size
of the
room
has
little
significance
in
the
end
as
some
Ohio
mishaps
occurred
in
large
rooms
open-
to
each
other
and
even
in
stores
during
busi-
ness
hours.
Furthermore,
investigations
by
the
Ohio
State
Department
of
Health
and
the
United
States
Bureau
of
Mines
have
shown
that
some
of
the
cheaper
heating
stoves
placed
on
the
market
are
inherently
defective
and
yield
death-deal-
ing
amounts
of
carbon
monoxide
under
regular
conditions
of
normal
gas
pres-
sure
even
when
burned
according
to
di-
rections
accompanying
them.
While
the
makes
of
two
or
three
manufacturers
THE
AMERICAN
JOURNAL
OF
PUBLIC
HEALTH
were
somewhat
more
frequently
noted
than
others,
by
the
end
of
the
winter
gas
stoves
representing
the
products
of
thir-
teen
different
manufacturers
were
re-
corded
by
the
Ohio
State
Department
of
Health
as
involved
in
the
reports
of
asphyxiations.
One
of
the
public
health
aspects
of
the
case
is
the
wayside
hotel,
rooming
house,
and
tenement
house.
In
Steubenville,
Ohio,
according
to
the
press,
four
fatali-
ties
occurred
over
a
period
of
eleven
months
in
the
same
hotel,
two
of
which
occurred
in
the
same
room
and,
indeed,
from
the
same
stove!
Thus
will
people
refuse
to
accept
the
evidences
even
where
death
may
be
the
answer!
A
similar
situation
of
doubt
exists
in
the
case
of
the
gas-fired
water
heater
of
the
instan-
taneous
type
which
is
too
commonly
set
up
in
bath
rooms,
kitchens,
etc.,
without
a
chimney
attachment.
Here,
Prof.
Schoch
of
the
University
of
Texas
found,
a
family
refused
to
accept
the
car-
bon
monoxide
explanation
of
the
cause
of
death
of
one
of
its
members
despite
chemical
air
analyses,
and
continued
to
use
the
unvented
water
heater!
Water
heaters
are
especially
dangerous
because
carbon
monoxide
is
yielded
whenever
a
carbonaceous
flame
touches
a
cool
surfa-ce.
Poisonings
are
frequently
recorded
also
from
so-called
"gas
plates"
as
used
in
the
laundry
to
heat
a
boiler
of
water,
or
in
the
kitchen
to
cook
the
day's
meals.
Even
the
gas
cooking
range
in
the
kitchen
is
included
at
times,
1)ut
when
such
occurs
the
burners
are
invariably
found
set
too
high
so
that
the
inner
blue
cone
of
the
flame
impinges
on
the
vessel
placed
over
it.
The
gas
companies
have
themselves
spent
thousands
of
dollars
in
educational
campaigns
on
the
correct
use
of
the
gas
cooking
range
and
point
out
that
burners
should
be
set
at
least
one
and
preferably
1/4
inches
below
the
top
of
the
grid.
The
usually
brief
period
of
use
of
gas
plates
and
cooking
ranges,
the
accom-
panying
steam
and
odors
which
necessi-
tate
ventilation
and
the
fact
that
the
cook's
"
eye
is
on
them,"
is
much
in
their
favor
as
regards
full-fledged
cases
of
asphyxiation,
but
they
are
often
also
a
genuine
menace
when
used
for
hours
at
a
time,
as
for
room
heating
purposes.
Another
phase
of
the
question
is
the
keen
competition
between
manufacturers
of
gas
stoves
which
has
resulted
in
con-
stantly
cheapened
products
with
wide
variations
from
the
fundamentals
of
safe
construction
laid
down
by
the
United
States
Bureau
of
Standards.
Still
an-
other
is
the
fact
that
distributors
and
retail
dealers
are
said
to
remove
the
warning
labels
in
many
instances
which
are
attached
by
the
manufacturer,
which
labels
proclaim
danger
unless
the
devi-ces
are
adequately
ventilated
when
set
up.
However,
it
would
seem
easy,
in
this
con-
tingency,
to
stamp
or
impress
the
warn-
ing
label
into
a
conspicuous
part
of
the
stove.
Furthermore,
building
laws
re-
quiring
permanent
types
of
chimney
con-
struction,
such
as
brick,
etc.,
for
all
smoke
flues
(underwriters
usually
place
the
flue
for
gas
stoves
under
this
heading)
offers
another
serious
block
to
remedying
the
situation,
both
in
buildings
already
con-
structed
as
well
as
the
expense
of
extra
chimneys
in
new
construction.
There
is
another
public
health
aspect:
One
can
not
help
reading
the
papers
on
the
recent
symposium
on
respiratory
dis-
eases
which
this
Association
held
at
its
last
annual
meeting
(Cleveland)
and
which
appears
in
the
December,
1922,
issue
of
this
JOURNAL,
without
wondering
how
much
the
breathing
of
combustion
products,
perhaps
other
than
carbon
monoxide
in
detectable
quantities,
have
contributed
to
the
significant
figures
that
show
pneumonia
to
be
so
seasonal
in
character,
one-third
more
frequent
in
urban
than
in
rural
districts,
and
very
much
more
frequent
in
Pittsburgh
than
Cleveland
(where
a
flue,
or
vent,
ordi-
nance
has
been
enforced
for
many
years),
or
in
a
more
climatically
favored
city
like
San
Francisco
where
the
pneumonia
rate
is
lowest.
464
SCARLET
FEVER
IN
A
STATE
JUVENILE
HOME
Have
we
already
reached
a
condition
of
civilization
where
man's
own
inven-
tions
and
devices
are-
destroying
his
health
and
hi-s
life
faster
than
the
so-
called
natural
causes?
In
tonnection
with
the
gas
-poisoning
phase
under
dis-
cussion,
the
situation
is
one
which,
as
has
been
said
by
a
gas
expert
of
wide
repute,
really
imperils
the
whole
gas
industry
so
far
as
/domestic
consumption
is
con-
cerned,
including
the
manufacture
of
do-
mestic
gas
consuming
devices,
unless
something
is
done
very
soon
to
stabilize
the
safety
aspects
of
the
matter.
Nat-
urally
a
nation-wide
solution
is
to
be
desired
in
preference
to
state
or
local
endeavors.
It
is
logical
that
this
should
be
brought
about
by
the
industries
themselves.
In
the
meantime
the
householder
should
utilize
the
summer
season
to
in-
vestigate
his
fireplaces,
chimneys,
etc.,
and
to
provide
means
for
actually
vent-
ing
his
gas
heating
appliances
before
the
next
season
approaches.
While
placing
the
gas
stove
in
the
fireplace
or
equipping
it
with
a
hood
and
outlet
pipe
does
not
always
guarantee
its
safety
(because
of
faultily
constructed
or
blocked-up
smoke
flues,
or,
indeed,
reverse
drafts
which
sometimies
occur
in
chimneys),
'such
is
the
best
known
safeguard
at
the
present
day.
Experience
shows
that
it
is
useless
to
repeat
that
plenty
of
room
ventilation
will
suffice
since,
on
cold
days,
people
insist
first
on
comfort.
Or
even
to
re-
peat
that
a
person
is
a
fool
for
sleeping
with
the
windows
closed
and
a
fire
burn-
ing
in
his
sleeping
room.
This
does
not
solve
it
for
the
bath
room,
or
the
hotel
room
over
which
one
may
have
no
con-
trol.
Do
not
use
without
adequate
flue
ventilation
should.
be
the
slogan
for
all
types
of
gas
fired
room
heating
devices,
to
which
should
be
added
the
instanta-
neous
water
heater.
Bulletins
are
already
beginning
to
ap-
pear
on
this
whole
subject
from
the
United
States
Bureau
of
Mines,
the
United
States
Department
of
Agriculture
(on
fireplaces),.
the
Public
Health
Serv-
ice,
and
the
Smithsonian
Institution.
SCARLET
FEVER
IN
A
STATE
JUVENILE
HOME
DON
M.
GRISWOLD,
M.D.,
M.P.H.,
FELLOW
A.
P.
H.
A.
Associate
Professor
of
Hygiene,
State
University
of
Iowa,
Iowa
City
T
HE
State
Juvenile
Home
was
founded
to
care
for
normal
chil-
dren
f;om
three
to
sixteen
years
of
age,
who
need
a
home.
One
hundred
and
fifty-nine
of
these
children
are
housed
in
the
buildings
formerly
used
by
the
Leander
Clark
College.
The
main
building
is
used
as
a
dormitory,
dining
room,
kitchen,
laundry,
and
school
for
about
one
hundred
and
thirty
of
the
younger
children.
About
thirty
of
the
older
girls
use
the
"
Cottages"
for
a
dor-
mitory,
but
use
the
main
building
for
all
other
purposes.
To
have
this
number
of
children
housed
under
one
rbof
means
that
they
come
in
very
intimate
contact
with
each
other
many
times
each
day.
Likewise,
when
a
disease
appears
that
is
spread
by
contact,
the
means
of
trans-
portation
is
so
everpresent
that
it
is
pos-
sible
for
a
large
number
of
exposures
to
be
made
very
early
in
the
outbreak.
For
this
reason
eternal
vigilance
must
be
exercised
and
prompt
and
adequate
medi-
cal
attention
must
,always
be
at
hand.
One
of
the
local
physicians
calls
daily
at
the
Home
and
holds
dispensary,
and
examines
all
children
referred
to
him.
The
rules
of
the
Home
require
matrons,
teachers
and
attendants
to
send
all
chil-
dren
to
the
dispensary,
whenever
they
need
attention,
no
matter
how
trivial
the
case
may
seem.
A
trained
nurse
is
a
permanent
part
of
the
staff
to
care
for
sick
children
and
to
promote
the
physi-
cian's
influence
for
good
health
over
the
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