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An accidental death caused by the absorption of phenol through skin. A case report
177
Science International, 19 (1982) 177 - 179 Printed in The Netherlands 0 Elsevier Sequoia S.A., Lausanne
Forensic
AN ACCIDENTAL THROUGH SKIN.
DEATH CAUSED A CASE REPORT
BY THE ABSORPTION
OF PHENOL
J. F. LEWIN and W. T. CLEARY Chemistry Division, (New Zealand)
Department
of Scientific
and Industrial
Research,
Private
Bag, Petone
(Received May 11, 1981; accepted July 8, 1981)
Summary This paper reports the postmortem toxicological findings for a person who died shortly after being painted with benzyl benzoate as a scabicide with a brush that had been steeped in 80% phenol and not thoroughly washed before use. The paper also describes the circumstances leading up to the death.
Introduction Phenol or carbolic acid has been known for a very long time to be an effective antiseptic. However over the past 10 - 20 years since the realization of its very high dermal toxicity, its use as an antiseptic has been largely discontinued. Perhaps because of this, while a number of cases of death due to accidents involving phenol have been reported [ 1 - 31, only one analytical result which was very much higher than our results was found in the literature. However, when the coroner considered the symptoms exhibited by the deceased prior to death, the pathologist’s finding of cerebral edema but no macroscopic or microscopic abnormalities, and the detection of phenol in some of the postmortem samples, he attributed death to the accidental absorption of phenol through the skin. We present our results in the hope that they might help other toxicologists faced with the interpretation of analytical results from a death due to what has now become an unusual poison.
Circumstances
of case
A 24-year-old male inmate of a penal institution suffering from rashes over a large area of his body was prescribed a daily application of benzyl benzoate as a scabicide. A 75 mm paint brush was used to apply the benzyl
178
benzoate emulsion to the man’s body below the neck. After the first application, the brush was steeped in Liquified Phenol B. P. (80% phenol) as an antiseptic. Next evening the brush was taken from the phenol, washed under running water and the application repeated. The man complained of ‘stinging’ but as it did not seem to worry him greatly the application was continued. Ten minutes later he was found to be unsteady on his feet and was told to go to the prison surgery. A few moments later he was seen supporting himself with one hand against a wall and when the nurse was called he collapsed on the floor. He appeared to be suffering an epileptic fit. His fists were clenched tight and he was convulsing. His eyes were open and the pupils dilated, his face was ‘blue’ and he was gasping and frothing at the mouth. The spasms soon stopped but although he was breathing his face was still ‘blue’. Within a few moments he gasped and then stopped breathing. Resuscitation and later cardiac massage were tried with no effect. The paint brush, two bottles of benzyl benzoate and the autopsy specimens from the deceased were submitted for analysis. When the plastic bag containing the paint brush was opened there was an obvious odor of phenol. Further questioning of police officers involved with the case, disclosed that phenol had been used as an antiseptic. It was decided at this stage to test for phenol as a possible cause of death, particularly because of its toxicity in relation to benzyl benzoate.
Method
of analysis
Samples of blood, homogenized liver, stomach contents and urine were acidified with 0.05 M H2S04, and steam distilled. The distillate was passed into 1 M NaOH. When some 40 ml of distillate had been collected, an aliquot was made acidic, t,he phenol extracted into ether and then back extracted into 0.1 M NaOH fojt analysis by UV spectrophotometry. Quantification was achieved by comparison with a phenol standard. A portion of liver was hydrolyzed with 6 M HCl prior to steam distillation and then analysed in the same way. As further proof of the identity of the phenol another aliquot was tested by TLC against authentic phenol. (Solvent: benzene:methanol, 95:5 developed with diazotized sulphanilic acid [ 41.) Results and discussion The results of the analyses are given in Table 1. Phenol was not detected in the stomach contents, the lungs and the urine strongly suggesting that the poison was adsorbed through the skin and that death occurred very soon after application. The difference between the hydrolyzed and unhydrolyzed liver levels is a result of the hydrolysis of phenol conjugates by the hydrochloric acid.
179 TABLE
1
Analytical -.~
results
Sample
Phenol
level
Liver (unhydrolyzed) Liver (hydrolyzed) Blood Lung Stomach contents Urine
3.3 E.lglg 7.1 /Jg/g 4.7 pg/ml nil nil nil
Sax [5] reports that death can occur if 64 in2 of body surface is covered with phenol. This is an indication of the considerable dermal toxicity of the poison. Consden (personal communication) reports the level of phenol detected in the blood of a workman who fell thigh deep into a vat of the poison as approximately 90 pg/ml. No other dermal absorption results and no results from oral ingestion were found in the literature.
Acknowledgements The authors gratefully acknowledge the assistance of Dr W. L. Kenealy, pathologist, and their colleagues in the Toxicology Section of Chemistry Division, DSIR.
References Quarterly
Safety
Summary
of the British
Chemical
Industry
Safety
Council,
35 (1964)
zarterly Safety Summary of the British Chemical Industry Safety Council, 36, (1965) 6. Quarterly Safety Summary of the British Chemical Industry Safety Council, 42, (1971) 4. E. Stahl (ed.), Thin Layer Chromatography: A Laboratory Handbook, 2nd edn., George Allen and Unwin, Springer Verlag, 1969, p. 663. N. I. Sax, Dangerous Properties of Industrial Materials, 4th edn., Van Nostrand Reinhold Company, 1975, p. 1008.
Science International, 19 (1982) 177 - 179 Printed in The Netherlands 0 Elsevier Sequoia S.A., Lausanne
Forensic
AN ACCIDENTAL THROUGH SKIN.
DEATH CAUSED A CASE REPORT
BY THE ABSORPTION
OF PHENOL
J. F. LEWIN and W. T. CLEARY Chemistry Division, (New Zealand)
Department
of Scientific
and Industrial
Research,
Private
Bag, Petone
(Received May 11, 1981; accepted July 8, 1981)
Summary This paper reports the postmortem toxicological findings for a person who died shortly after being painted with benzyl benzoate as a scabicide with a brush that had been steeped in 80% phenol and not thoroughly washed before use. The paper also describes the circumstances leading up to the death.
Introduction Phenol or carbolic acid has been known for a very long time to be an effective antiseptic. However over the past 10 - 20 years since the realization of its very high dermal toxicity, its use as an antiseptic has been largely discontinued. Perhaps because of this, while a number of cases of death due to accidents involving phenol have been reported [ 1 - 31, only one analytical result which was very much higher than our results was found in the literature. However, when the coroner considered the symptoms exhibited by the deceased prior to death, the pathologist’s finding of cerebral edema but no macroscopic or microscopic abnormalities, and the detection of phenol in some of the postmortem samples, he attributed death to the accidental absorption of phenol through the skin. We present our results in the hope that they might help other toxicologists faced with the interpretation of analytical results from a death due to what has now become an unusual poison.
Circumstances
of case
A 24-year-old male inmate of a penal institution suffering from rashes over a large area of his body was prescribed a daily application of benzyl benzoate as a scabicide. A 75 mm paint brush was used to apply the benzyl
178
benzoate emulsion to the man’s body below the neck. After the first application, the brush was steeped in Liquified Phenol B. P. (80% phenol) as an antiseptic. Next evening the brush was taken from the phenol, washed under running water and the application repeated. The man complained of ‘stinging’ but as it did not seem to worry him greatly the application was continued. Ten minutes later he was found to be unsteady on his feet and was told to go to the prison surgery. A few moments later he was seen supporting himself with one hand against a wall and when the nurse was called he collapsed on the floor. He appeared to be suffering an epileptic fit. His fists were clenched tight and he was convulsing. His eyes were open and the pupils dilated, his face was ‘blue’ and he was gasping and frothing at the mouth. The spasms soon stopped but although he was breathing his face was still ‘blue’. Within a few moments he gasped and then stopped breathing. Resuscitation and later cardiac massage were tried with no effect. The paint brush, two bottles of benzyl benzoate and the autopsy specimens from the deceased were submitted for analysis. When the plastic bag containing the paint brush was opened there was an obvious odor of phenol. Further questioning of police officers involved with the case, disclosed that phenol had been used as an antiseptic. It was decided at this stage to test for phenol as a possible cause of death, particularly because of its toxicity in relation to benzyl benzoate.
Method
of analysis
Samples of blood, homogenized liver, stomach contents and urine were acidified with 0.05 M H2S04, and steam distilled. The distillate was passed into 1 M NaOH. When some 40 ml of distillate had been collected, an aliquot was made acidic, t,he phenol extracted into ether and then back extracted into 0.1 M NaOH fojt analysis by UV spectrophotometry. Quantification was achieved by comparison with a phenol standard. A portion of liver was hydrolyzed with 6 M HCl prior to steam distillation and then analysed in the same way. As further proof of the identity of the phenol another aliquot was tested by TLC against authentic phenol. (Solvent: benzene:methanol, 95:5 developed with diazotized sulphanilic acid [ 41.) Results and discussion The results of the analyses are given in Table 1. Phenol was not detected in the stomach contents, the lungs and the urine strongly suggesting that the poison was adsorbed through the skin and that death occurred very soon after application. The difference between the hydrolyzed and unhydrolyzed liver levels is a result of the hydrolysis of phenol conjugates by the hydrochloric acid.
179 TABLE
1
Analytical -.~
results
Sample
Phenol
level
Liver (unhydrolyzed) Liver (hydrolyzed) Blood Lung Stomach contents Urine
3.3 E.lglg 7.1 /Jg/g 4.7 pg/ml nil nil nil
Sax [5] reports that death can occur if 64 in2 of body surface is covered with phenol. This is an indication of the considerable dermal toxicity of the poison. Consden (personal communication) reports the level of phenol detected in the blood of a workman who fell thigh deep into a vat of the poison as approximately 90 pg/ml. No other dermal absorption results and no results from oral ingestion were found in the literature.
Acknowledgements The authors gratefully acknowledge the assistance of Dr W. L. Kenealy, pathologist, and their colleagues in the Toxicology Section of Chemistry Division, DSIR.
References Quarterly
Safety
Summary
of the British
Chemical
Industry
Safety
Council,
35 (1964)
zarterly Safety Summary of the British Chemical Industry Safety Council, 36, (1965) 6. Quarterly Safety Summary of the British Chemical Industry Safety Council, 42, (1971) 4. E. Stahl (ed.), Thin Layer Chromatography: A Laboratory Handbook, 2nd edn., George Allen and Unwin, Springer Verlag, 1969, p. 663. N. I. Sax, Dangerous Properties of Industrial Materials, 4th edn., Van Nostrand Reinhold Company, 1975, p. 1008.