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Gasoline sniffing in children leading to severe burn injury
Volume 80 Number 6
Brief clinical and laboratory observations
recorder, and Mr. Roy Spikes, radiologic technician.
REFERENCES 1. Hennon, D. K., Stookey, G. K., and Muhler, J. c.: The clinical anticariogenic effectiveness of supplementary fluoride-vitamin preparations. Results at the end of three years, J. Dent. Child. 33: 3, 1966. 2. Hennon, D. K., Stookey, G. K., and Muhler, J. C.: The clinical anticariogenic effectiveness of supplementary fluoride-vitamin preparations. Results at the end of four years, J. Dent. Child. 34: 439, 1967. 3. Hennon, D. K., Stookey, G. K., and Muhler, J. C.: The clinical antieariogenic effectiveness of supplementary fluoride-vitamin preparations. Resutts at the end of five and a half years, Pharm. Ther. Dent. 1: 1, 1970. 4. Margolis, F. J., Macauley, J., and Freshman, E.: The effects of measured doses of fluo-
Gasoline sniffing in cbiMren leading to severe burn injury Richard C. Schmitt, Ph.D., ~ Harold A. Goollshian, Ph.D., and Sally Abston, M.D., Galveston, T e x a s
I N C1R E A S E D drug use in recent years a m o n g young people has been followed by research regarding the prevalence of the problem, the particular drugs used, a n d their effects. M a n y of these studies have documented the widespread use of volatile intoxicants, especially a m o n g preadolescents and early adolescents? -a T h e specific inhalants include pressurized liquids consisting of various aerosols, a n d containerized liquids
From the Department o[ Neurology and Psychiatry, Division of Psychology, and the Department of Surgery, University of Texas Medical Branch, and the Shriners Burns Institute. ~Address: ShHners Burns Institute, Galveston Unit, 610 Texas Ave., Galveston, Texas 77550.
10 2 1
ride--a five-year preliminary report, J. Dis. 9 Child. 113" 670, 1967. 5. Hamberg, L.: Controlled trial of fluoride in vitamin drops for prevention of caries in children, Lancet, 1: 441, 1971. 6. Hillman, R. W.: Effect of vitamin B~ on dental caries in man, Vitam. Horm. 22z 695, 1964. 7. Cohen, A., and Rubin, C.: Pyridoxine supplementation in the suppression of dental caries, Bull. Philadelphia Co. Dent. Soc. 22: 84, 1958. (Abst.) 8. McBeath, E. C., and Verlin, W. A.: Further studies on the role of vitamin D in nutritional control of dental caries in children, J. Am. Dent. Assoc. 29: I393, 1942. 9. Sanchis, J. M.: Determination of fluorides in natural waters, Ind. Eng. Chem. Anal. Ed. 6: 134, 1934. 10. Scott, R. D.: Modification of fluoride determination, J. Am. Water Works Assoc. 33: 2018, 1941.
such as airplane glue, dry cleaning fluids, p a i n t thinner, lighter fluid, a n d gasoline. T h e chronic use of these intoxicants has been associated with damage to various organ systems? A recent report documented 110 sudden deaths from the inhalation of concentrated doses of volatile hydrocarbons? Additionally, a potential risk in the use of hydrocarbons for sniffing is severe b u r n injury. Although no instances of such an injury were found in over 450 admissions to the Shriners Burns Institute in Galveston, Texas from 1966 to 1970, four cases were encountered in the next 10 months. These cases are described in this report. CASE R E P O R T S Case 1. A 14-year-old Caucasian boy from a large Midwestern city was sniffing gasoline while sitting in a tree on a vacant lot near his home. Two neighborhood friends were sniffing lighter fluid at the base of the tree. One friend started a fire with the lighter fluid. The patient became intoxicated, lost consciousness, fell from the tree, and spilled gasoline on his clothing in the process. He fell into the fire, which ignited his soaked clothing. The friends extingu!shed the flames by rolling him on the ground. Afterward, the fi'iends fled to their homes, while the burned youngster walked home and reported to his mother that he had been injured.
10 2 2
Brief clinical and laboratory observations
He was transferred to the Burns Institute three days following the burn. There were second and third degree burns over 47 per cent of his body surface. The circumstances of the burn incident were detailed by the patient and the two friends, who were subsequently questioned. The patient did not remember the incident, except that he was in the tree sniffing gasoline. He was described as a well-liked boy who made average grades in school. Case 2. A 14-year-old girl, an American Indian, was sniffing gasoline with two friends in the front seat of a car which was parked in front of her home. She lived in a middle-sized Northern city with her mother, who was divorced, and five siblings. While sitting between her friends and holding the gasoline container between her legs, one friend lit a cigarette, which caused an explosion. She was temporarily trapped until the two friends vacated the car, but was able to extinguish the flames soon after she escaped. She was transferred to the Institute 3 days following the burn. There were second and third degree burns over 35 per cent of her body. The circumstances of the burn incident were documented by a social case worker in her community, who interviewed one of the friends with whom the girl had been sniffing gasoline. The patient had a history of emotional instability and acting-out behavior, which involved difficulties at home, in the school, and with legal authorities. Her school performance was marginal, and she was in danger of failing. She had a history of brief experimentation with drugs other than gasoline, including marijuana and amphetamines. Her personal and social adjustment was so poor that she was to have entered a residential boarding school. Case 3. A 14-year-old Caucasian boy from a large Southeastern city was sniffing gasoline in a wooded area adjacent to the gasoline station where he and a younger friend had purchased the gasoline. The boys had skipped school. The younger boy bumped into the patient, causing some of the gasoline to spill on his clothing. The patient lit a cigarette which ignited his soaked clothing. His body became a torch, and the flames were not completely extinguished until he returned to the service station and was hosed by the attendant. He was transferred to the Institute the day of the burn, where he remained for 103 days until his death. The burns involved 85 per cent of the body surface. His course was marked by
The Journal o[ Pediatrics June 1972
chronic renal failure and septicemia. Autopsy revealed abscesses in the brain and other organs. The report of the burn from the fire marshaI1 was based on interviews with his friend and the service station attendant. The patient did not discuss the details of the burn incident prior to death. The parents indicated a history of actingout behavior, principally in school, which usually was manifested by rebelliousness to authority figures. His school performance was poor. A history of prior drug use was not obtained. Case 4. A 9-year-old Caucasian boy from a small Southern city was alone sniffing gasoline in the utility room off the garage of his home. An adult babysitter, responsible for the child's supervision, was inside the house. It was later determined that fumes from the gasoline were ignited by the pilot light of a nearby gas dryer. An explosion ensued which ignited the boy's clothing. He panicked and ran from the utility room into the yard until his clothing burned away. He was transferred to the Institute from a local hospital the day following the burn. There were second and third degree burns over 78 per cent of his body surface. The circumstances of the burn were told by the patient to his mother several weeks following the burn. The story was readily accepted by both parents since his father had found him sniffing gasoline once before in their garage. The father warned him of the danger of this activity at that time. The boy was described as friendly and outgoing. His grades in school were above average. DISCUSSION T h e cultural, geographic, a n d social backg r o u n d s of these four children who were b u r n e d as a result of sniffing gasoline are diverse; yet there are certain similarities. T h r e e of the children were 14 years of age 9w h e n they were burned. Gasoline sniffing occurred outside the h o m e with peers in a physically secluded situation. Dangerous introduction of a flame source was m a d e by the participants in each case. O n l y in one case did this p a t t e r n vary significantly in that the p a r t i c i p a n t was a preadolescent sniffing gasoline in the home without the c o m p a n y of peers. T h e danger of severe b u r n i n j u r y from this use of gasoline a n d other flammable liquids is clearly shown in this report.
Volume 80 Number 6
Brie[ clinical a n d laboratory observations
REFERENCES 1. Berg, D. F.: Extent of illicit drug use: A compilation of studies, surveys, and polls, Division of Drug Sciences, Bureau of Narcotics and Dangerous Drugs, 1969, United States Department of Justice. 2. Blumer, H., Sutler, A., Ahmed, S., and Smith, R.: The world of youthful drug use. A report of research sponsored by Health, Education, and Welfare Grant Nos. 65029 and 66022, Berkeley, Calif., 1967.
Diurnal height variation in children A. L. Strickland, M.D., Lieutenant Colonel, USA, and R. B. Shearin, M.D., Captain, M C , U S A , W a s h i n g t o n , D . C.
I r I s assumed t h a t an a d u l t is slightly shorter after m a i n t a i n i n g an u p r i g h t posture for a few hours t h a n u p o n arising after 6 to 10 hours in bed. This concept is not generally a p p r e c i a t e d in the growing child. None of the s t a n d a r d textbooks of pediatrics or literature d e a l i n g with g r o w t h problems of children mentions t h a t there m a y be a d i u r n a l height variation. F o r those who deal with problems of Short stature in children, it is obvious t h a t awareness of a significant d i u r n a l height variation would be i m p o r t a n t so t h a t all recorded measurements of a m b u l a t o r y children would be obtained at the same time of the day. This p a p e r presents evidence t h a t a child's height when he arises from bed in the m o r n ing is significantly different from his height in the evening.
MATERIALS AND METHODS All measurements were m a d e i m m e d i a t e l y u p o n the child's arising from bed in the
From the Department of Pediatrics, Walter Reed General Hospital. Reprint address: A. L. Strickland, M.D., Box 627, Walter Reed General Ir Washington, D. C. 20012.
10 2 3
3. Gossett, J. T., Lewis, J. M., and Phillips, "V. A.: Extent and prevalence of illicit drug use as reported by 56,745 students, J. A. M. A. 216: 1464, 1971. 4. Briggs, A. H.: Glue sniffing. In Drug Education Regional Center: Drugs: Use or abuse?, San Antonio, 1970, University of Texas Medical School, pp. 40-56. 5. Bass, M.: Sudden sniffing death, J. A. M. A.: 212: 2075, 1970.
T a b l e I. D i u r n a l A.M. a n d P.M. height differences of 100 children Variables
Range of variation (cm.) Mean difference (cm.) Standard deviation (cm.) Standard error (cm.) Number of observations
]
Values
0.80-2.8 1.54 0.46 0.04. 100
m o r n i n g and again between four a n d five o'clock p.M. T o obtain the d i u r n a l height difference on patients in the hospital a method similar to t h a t of T a n n e r 1 in his age g r o u p of 5y2 to 1 5 ~ years was used. W i t h the child standing with the heels on the floor, b u t as tall as possible, a r e c t a n g u l a r block was p l a c e d p e r p e n d i c u l a r to the wall a n d flat on the child's head. A m a r k corresponding to the height was carefully m a d e on a stationary wallboard. T h e m e a s u r e m e n t was r e p e a t e d in the afternoon by the same observer with the child standing at the same site. Differences in the A.M. a n d P.M. heights were recorded in centimeters. H e i g h t differences of 100 children were o b t a i n e d by one of us (R. S.) on a m b u l a t o r y children (ages 3 to 14 years) a d m i t t e d to the p e d i a t r i c w a r d of W a l t e r R e e d General Hospital over a 3 m o n t h period. Daily height differences were also o b t a i n e d by the o t h e r a u t h o r (A. S.) on his own four female c h i l d r e n (ages 10, 9, 7, a n d 6 years) biweekly for one year. These m e a s u r e m e n t s were m a d e by a more precise i n s t r u m e n t in which a sliding block (without p a r a l a x ) was m o v e d up or d o w n on a w o o d e n f r a m e m a r k e d off in centimeters; the A.Z~. a n d P.M. differences were recorded. T o e l i m i n a t e possible bias, neither a u t h o r knew the other's findings until completion of the study.
Brief clinical and laboratory observations
recorder, and Mr. Roy Spikes, radiologic technician.
REFERENCES 1. Hennon, D. K., Stookey, G. K., and Muhler, J. c.: The clinical anticariogenic effectiveness of supplementary fluoride-vitamin preparations. Results at the end of three years, J. Dent. Child. 33: 3, 1966. 2. Hennon, D. K., Stookey, G. K., and Muhler, J. C.: The clinical anticariogenic effectiveness of supplementary fluoride-vitamin preparations. Results at the end of four years, J. Dent. Child. 34: 439, 1967. 3. Hennon, D. K., Stookey, G. K., and Muhler, J. C.: The clinical antieariogenic effectiveness of supplementary fluoride-vitamin preparations. Resutts at the end of five and a half years, Pharm. Ther. Dent. 1: 1, 1970. 4. Margolis, F. J., Macauley, J., and Freshman, E.: The effects of measured doses of fluo-
Gasoline sniffing in cbiMren leading to severe burn injury Richard C. Schmitt, Ph.D., ~ Harold A. Goollshian, Ph.D., and Sally Abston, M.D., Galveston, T e x a s
I N C1R E A S E D drug use in recent years a m o n g young people has been followed by research regarding the prevalence of the problem, the particular drugs used, a n d their effects. M a n y of these studies have documented the widespread use of volatile intoxicants, especially a m o n g preadolescents and early adolescents? -a T h e specific inhalants include pressurized liquids consisting of various aerosols, a n d containerized liquids
From the Department o[ Neurology and Psychiatry, Division of Psychology, and the Department of Surgery, University of Texas Medical Branch, and the Shriners Burns Institute. ~Address: ShHners Burns Institute, Galveston Unit, 610 Texas Ave., Galveston, Texas 77550.
10 2 1
ride--a five-year preliminary report, J. Dis. 9 Child. 113" 670, 1967. 5. Hamberg, L.: Controlled trial of fluoride in vitamin drops for prevention of caries in children, Lancet, 1: 441, 1971. 6. Hillman, R. W.: Effect of vitamin B~ on dental caries in man, Vitam. Horm. 22z 695, 1964. 7. Cohen, A., and Rubin, C.: Pyridoxine supplementation in the suppression of dental caries, Bull. Philadelphia Co. Dent. Soc. 22: 84, 1958. (Abst.) 8. McBeath, E. C., and Verlin, W. A.: Further studies on the role of vitamin D in nutritional control of dental caries in children, J. Am. Dent. Assoc. 29: I393, 1942. 9. Sanchis, J. M.: Determination of fluorides in natural waters, Ind. Eng. Chem. Anal. Ed. 6: 134, 1934. 10. Scott, R. D.: Modification of fluoride determination, J. Am. Water Works Assoc. 33: 2018, 1941.
such as airplane glue, dry cleaning fluids, p a i n t thinner, lighter fluid, a n d gasoline. T h e chronic use of these intoxicants has been associated with damage to various organ systems? A recent report documented 110 sudden deaths from the inhalation of concentrated doses of volatile hydrocarbons? Additionally, a potential risk in the use of hydrocarbons for sniffing is severe b u r n injury. Although no instances of such an injury were found in over 450 admissions to the Shriners Burns Institute in Galveston, Texas from 1966 to 1970, four cases were encountered in the next 10 months. These cases are described in this report. CASE R E P O R T S Case 1. A 14-year-old Caucasian boy from a large Midwestern city was sniffing gasoline while sitting in a tree on a vacant lot near his home. Two neighborhood friends were sniffing lighter fluid at the base of the tree. One friend started a fire with the lighter fluid. The patient became intoxicated, lost consciousness, fell from the tree, and spilled gasoline on his clothing in the process. He fell into the fire, which ignited his soaked clothing. The friends extingu!shed the flames by rolling him on the ground. Afterward, the fi'iends fled to their homes, while the burned youngster walked home and reported to his mother that he had been injured.
10 2 2
Brief clinical and laboratory observations
He was transferred to the Burns Institute three days following the burn. There were second and third degree burns over 47 per cent of his body surface. The circumstances of the burn incident were detailed by the patient and the two friends, who were subsequently questioned. The patient did not remember the incident, except that he was in the tree sniffing gasoline. He was described as a well-liked boy who made average grades in school. Case 2. A 14-year-old girl, an American Indian, was sniffing gasoline with two friends in the front seat of a car which was parked in front of her home. She lived in a middle-sized Northern city with her mother, who was divorced, and five siblings. While sitting between her friends and holding the gasoline container between her legs, one friend lit a cigarette, which caused an explosion. She was temporarily trapped until the two friends vacated the car, but was able to extinguish the flames soon after she escaped. She was transferred to the Institute 3 days following the burn. There were second and third degree burns over 35 per cent of her body. The circumstances of the burn incident were documented by a social case worker in her community, who interviewed one of the friends with whom the girl had been sniffing gasoline. The patient had a history of emotional instability and acting-out behavior, which involved difficulties at home, in the school, and with legal authorities. Her school performance was marginal, and she was in danger of failing. She had a history of brief experimentation with drugs other than gasoline, including marijuana and amphetamines. Her personal and social adjustment was so poor that she was to have entered a residential boarding school. Case 3. A 14-year-old Caucasian boy from a large Southeastern city was sniffing gasoline in a wooded area adjacent to the gasoline station where he and a younger friend had purchased the gasoline. The boys had skipped school. The younger boy bumped into the patient, causing some of the gasoline to spill on his clothing. The patient lit a cigarette which ignited his soaked clothing. His body became a torch, and the flames were not completely extinguished until he returned to the service station and was hosed by the attendant. He was transferred to the Institute the day of the burn, where he remained for 103 days until his death. The burns involved 85 per cent of the body surface. His course was marked by
The Journal o[ Pediatrics June 1972
chronic renal failure and septicemia. Autopsy revealed abscesses in the brain and other organs. The report of the burn from the fire marshaI1 was based on interviews with his friend and the service station attendant. The patient did not discuss the details of the burn incident prior to death. The parents indicated a history of actingout behavior, principally in school, which usually was manifested by rebelliousness to authority figures. His school performance was poor. A history of prior drug use was not obtained. Case 4. A 9-year-old Caucasian boy from a small Southern city was alone sniffing gasoline in the utility room off the garage of his home. An adult babysitter, responsible for the child's supervision, was inside the house. It was later determined that fumes from the gasoline were ignited by the pilot light of a nearby gas dryer. An explosion ensued which ignited the boy's clothing. He panicked and ran from the utility room into the yard until his clothing burned away. He was transferred to the Institute from a local hospital the day following the burn. There were second and third degree burns over 78 per cent of his body surface. The circumstances of the burn were told by the patient to his mother several weeks following the burn. The story was readily accepted by both parents since his father had found him sniffing gasoline once before in their garage. The father warned him of the danger of this activity at that time. The boy was described as friendly and outgoing. His grades in school were above average. DISCUSSION T h e cultural, geographic, a n d social backg r o u n d s of these four children who were b u r n e d as a result of sniffing gasoline are diverse; yet there are certain similarities. T h r e e of the children were 14 years of age 9w h e n they were burned. Gasoline sniffing occurred outside the h o m e with peers in a physically secluded situation. Dangerous introduction of a flame source was m a d e by the participants in each case. O n l y in one case did this p a t t e r n vary significantly in that the p a r t i c i p a n t was a preadolescent sniffing gasoline in the home without the c o m p a n y of peers. T h e danger of severe b u r n i n j u r y from this use of gasoline a n d other flammable liquids is clearly shown in this report.
Volume 80 Number 6
Brie[ clinical a n d laboratory observations
REFERENCES 1. Berg, D. F.: Extent of illicit drug use: A compilation of studies, surveys, and polls, Division of Drug Sciences, Bureau of Narcotics and Dangerous Drugs, 1969, United States Department of Justice. 2. Blumer, H., Sutler, A., Ahmed, S., and Smith, R.: The world of youthful drug use. A report of research sponsored by Health, Education, and Welfare Grant Nos. 65029 and 66022, Berkeley, Calif., 1967.
Diurnal height variation in children A. L. Strickland, M.D., Lieutenant Colonel, USA, and R. B. Shearin, M.D., Captain, M C , U S A , W a s h i n g t o n , D . C.
I r I s assumed t h a t an a d u l t is slightly shorter after m a i n t a i n i n g an u p r i g h t posture for a few hours t h a n u p o n arising after 6 to 10 hours in bed. This concept is not generally a p p r e c i a t e d in the growing child. None of the s t a n d a r d textbooks of pediatrics or literature d e a l i n g with g r o w t h problems of children mentions t h a t there m a y be a d i u r n a l height variation. F o r those who deal with problems of Short stature in children, it is obvious t h a t awareness of a significant d i u r n a l height variation would be i m p o r t a n t so t h a t all recorded measurements of a m b u l a t o r y children would be obtained at the same time of the day. This p a p e r presents evidence t h a t a child's height when he arises from bed in the m o r n ing is significantly different from his height in the evening.
MATERIALS AND METHODS All measurements were m a d e i m m e d i a t e l y u p o n the child's arising from bed in the
From the Department of Pediatrics, Walter Reed General Hospital. Reprint address: A. L. Strickland, M.D., Box 627, Walter Reed General Ir Washington, D. C. 20012.
10 2 3
3. Gossett, J. T., Lewis, J. M., and Phillips, "V. A.: Extent and prevalence of illicit drug use as reported by 56,745 students, J. A. M. A. 216: 1464, 1971. 4. Briggs, A. H.: Glue sniffing. In Drug Education Regional Center: Drugs: Use or abuse?, San Antonio, 1970, University of Texas Medical School, pp. 40-56. 5. Bass, M.: Sudden sniffing death, J. A. M. A.: 212: 2075, 1970.
T a b l e I. D i u r n a l A.M. a n d P.M. height differences of 100 children Variables
Range of variation (cm.) Mean difference (cm.) Standard deviation (cm.) Standard error (cm.) Number of observations
]
Values
0.80-2.8 1.54 0.46 0.04. 100
m o r n i n g and again between four a n d five o'clock p.M. T o obtain the d i u r n a l height difference on patients in the hospital a method similar to t h a t of T a n n e r 1 in his age g r o u p of 5y2 to 1 5 ~ years was used. W i t h the child standing with the heels on the floor, b u t as tall as possible, a r e c t a n g u l a r block was p l a c e d p e r p e n d i c u l a r to the wall a n d flat on the child's head. A m a r k corresponding to the height was carefully m a d e on a stationary wallboard. T h e m e a s u r e m e n t was r e p e a t e d in the afternoon by the same observer with the child standing at the same site. Differences in the A.M. a n d P.M. heights were recorded in centimeters. H e i g h t differences of 100 children were o b t a i n e d by one of us (R. S.) on a m b u l a t o r y children (ages 3 to 14 years) a d m i t t e d to the p e d i a t r i c w a r d of W a l t e r R e e d General Hospital over a 3 m o n t h period. Daily height differences were also o b t a i n e d by the o t h e r a u t h o r (A. S.) on his own four female c h i l d r e n (ages 10, 9, 7, a n d 6 years) biweekly for one year. These m e a s u r e m e n t s were m a d e by a more precise i n s t r u m e n t in which a sliding block (without p a r a l a x ) was m o v e d up or d o w n on a w o o d e n f r a m e m a r k e d off in centimeters; the A.Z~. a n d P.M. differences were recorded. T o e l i m i n a t e possible bias, neither a u t h o r knew the other's findings until completion of the study.