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2178. The case of the deadly diapers
THE CHEMICAL
ENVIRONMENT
601
2178. The case of the deadly diapers
Brown, B. W. (1970). Fatal phenol poisoning from improperly laundered diapers. Am. J. publ. Hlth 60, 901. Three successive appearances of a mysterious syndrome of fever and sweating among infants in a hospital nursery in St. Louis led to a painstaking investigation of the possible causes. The infants affected had rapid heart rates and swollen livers, but showed no loss of appetite, vomiting, diarrhoea or evidence of infection. No skin irritation was noted. Despite the lack of evident cause, the infants developed a progressive metabolic acidosis, and in one who died, fatty vacuolar changes were seen in the renal tubules. Thin-layer chromatography of serum taken from some of the infants revealed the presence of a phenolic derivative. The serum and urine of one infant was subsequently shown to contain pentachlorophenol, and the same compound was identified in freshly-laundered diapers from the affected nursery. The toxic effects were traced to the use in the laundry of Loxene, a disinfectant compound containing 4 ~ 3,4,4'-trichlorocarbanilide, 22.9~ sodium pentachlorophenate, sodium salts of other chlorophenols and various inert ingredients. Despite warnings on the package that the powder should not be used for laundering diapers, and that the working concentration for other purposes should be 1 oz for each cycle, the hospital laundry staff had apparently made a habit of using 3-4 oz for laundering diapers. [The percutaneous absorption of water-soluble pentachlorophenates is well-known and is always a hazard to be reckoned with in their handling. This is not the first report of fatalities resulting from the misuse of these compounds (Lancet 1966, i, 875), and the manufacturers of Loxene, who have withdrawn their product from the market, must surely be wondering just how large a warning label or instruction must be if there is to be a reasonable chance that it will be heeded.] 2179. Assaults on the nose
Acheson, E. D., Cowdell, R. H. & Jolles, B. (1970). Nasal cancer in the shoe industry. Br. reed. J. 2, 791. Hadfield, E. H. (1970). A study of adenocarcinoma of the paranasal sinuses in woodworkers in the furniture industry. Ann. R. Col. Surg. 46, 301. A UK survey of over 15,000 boot and shoe operatives revealed a 0-007 ~ incidence of nasal cancer, eight times the normal incidence (Cited in F.C.T. 1970, 8, 604). Since this survey was published, data have become available on the numbers of personnel in different departments of the industry during 1949-1961, and this breakdown has now been applied to the survey findings obtained during 1950--1969 (first paper, cited above). The estimated annual incidence of nasal cancer was highest among workers exposed to the dusty environments found in the press and finishing rooms. The incidence of all types of tumours of the nasal cavity and sinuses was 0.014 ~o in this group compared with 0.001 ~o among workers in other departments. The latter incidence is equivalent to the average rate for the general population in southern England. Other U K workers particularly at risk from nasal cancer are apparently to be found among makers of wooden furniture (Cited in F.C.T. 1968, 6, 680). In an interesting analysis of 92 cases of nasal carcinoma identified in Oxfordshire and Buckinghamshire, Had field (cited above) reports that while the 34 cases of squamous carcinoma were roughly equally
ENVIRONMENT
601
2178. The case of the deadly diapers
Brown, B. W. (1970). Fatal phenol poisoning from improperly laundered diapers. Am. J. publ. Hlth 60, 901. Three successive appearances of a mysterious syndrome of fever and sweating among infants in a hospital nursery in St. Louis led to a painstaking investigation of the possible causes. The infants affected had rapid heart rates and swollen livers, but showed no loss of appetite, vomiting, diarrhoea or evidence of infection. No skin irritation was noted. Despite the lack of evident cause, the infants developed a progressive metabolic acidosis, and in one who died, fatty vacuolar changes were seen in the renal tubules. Thin-layer chromatography of serum taken from some of the infants revealed the presence of a phenolic derivative. The serum and urine of one infant was subsequently shown to contain pentachlorophenol, and the same compound was identified in freshly-laundered diapers from the affected nursery. The toxic effects were traced to the use in the laundry of Loxene, a disinfectant compound containing 4 ~ 3,4,4'-trichlorocarbanilide, 22.9~ sodium pentachlorophenate, sodium salts of other chlorophenols and various inert ingredients. Despite warnings on the package that the powder should not be used for laundering diapers, and that the working concentration for other purposes should be 1 oz for each cycle, the hospital laundry staff had apparently made a habit of using 3-4 oz for laundering diapers. [The percutaneous absorption of water-soluble pentachlorophenates is well-known and is always a hazard to be reckoned with in their handling. This is not the first report of fatalities resulting from the misuse of these compounds (Lancet 1966, i, 875), and the manufacturers of Loxene, who have withdrawn their product from the market, must surely be wondering just how large a warning label or instruction must be if there is to be a reasonable chance that it will be heeded.] 2179. Assaults on the nose
Acheson, E. D., Cowdell, R. H. & Jolles, B. (1970). Nasal cancer in the shoe industry. Br. reed. J. 2, 791. Hadfield, E. H. (1970). A study of adenocarcinoma of the paranasal sinuses in woodworkers in the furniture industry. Ann. R. Col. Surg. 46, 301. A UK survey of over 15,000 boot and shoe operatives revealed a 0-007 ~ incidence of nasal cancer, eight times the normal incidence (Cited in F.C.T. 1970, 8, 604). Since this survey was published, data have become available on the numbers of personnel in different departments of the industry during 1949-1961, and this breakdown has now been applied to the survey findings obtained during 1950--1969 (first paper, cited above). The estimated annual incidence of nasal cancer was highest among workers exposed to the dusty environments found in the press and finishing rooms. The incidence of all types of tumours of the nasal cavity and sinuses was 0.014 ~o in this group compared with 0.001 ~o among workers in other departments. The latter incidence is equivalent to the average rate for the general population in southern England. Other U K workers particularly at risk from nasal cancer are apparently to be found among makers of wooden furniture (Cited in F.C.T. 1968, 6, 680). In an interesting analysis of 92 cases of nasal carcinoma identified in Oxfordshire and Buckinghamshire, Had field (cited above) reports that while the 34 cases of squamous carcinoma were roughly equally