The medicolegal importance of volatile substance abuse, as an example of toxicological deaths, is reviewed. A case of a 13-year-old boy who died after inhalation of volatile substances from a deodorant spray tin is presented. Another similar case has been summarized in the discussion.
Different aspects of volatile substance abuse are considered with special emphasis on those facets which are relevant to forensic pathology practice. The most important pathological alterations associated with the acute and chronic abuse of volatile substances are discussed and some histological features of these conditions are illustrated with photographs. These include some microscopic changes of the central nervous system, respiratory system and the kidneys.
The roles of the pathologist and the toxicologist in the investigations of the fatalities resulting from the volatile substance abuse are reviewed and practical points are explained. Lastly, some relevant legal points are discussed.
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References
1.
AkermanH. E. (1982) The constitution of adhesives and its relationship to solvent abuse. Human Toxicol.1, 223–30.
2.
AllanA. R.BlackmoreR. C.ToselandP. A. (1988) A chloroform inhalation fatality: an unusual asphyxiation. Med. Sci. Law28, 120–23.
3.
AndersonF. R.HamiltonD. S.BessonJ. A. O. (1985) Changing trends in solvent abuse in the north-east of Scotland. J. Royal Coll. Gen. Pract.35 (279), 476–7.
4.
AndersonH. R.DickB.MacnairR. S.PalmerJ. C.RamseyJ. D. (1982) An investigation of 140 deaths associated with volatile substance abuse in the United Kingdom (1971–1981). Human Toxicol.1, 207–21.
5.
AndersonH. R.MacnairR. S.RamseyJ. D. (1985) Deaths from abuse of volatile substances: a national epidemiological study. Br. Med. J. (Clin. Res.)290, 304–7.
6.
BlythA. M. (1982) Solvent abuse: summary of a paper presented on behalf of the DHSS. Human Toxicol.1, 347–9.
7.
ChasonJ. L. (1985) Nervous system. In: KissaneJ. M.AndersonW. A. D. (eds) Anderson's Pathology. Vol 2, 8th edition. St Louis, C. V. Mosby Company, pp 1870–1938.
8.
CherryN.McArthyT. B.WaldronH. A. (1982) Solvent sniffing in industry. Human Toxicol.1, 289–92.
9.
ClaydonS. M. (1988) Myocardial degeneration in chronic solvent abuse. Med. Sci. Law28, 217–18.
10.
Coroners' Rules1984 (Reprint 1986) (S.I. 1984/552), Sched. 4. Reporting Deaths to Coroners. In: MasonJ. K.Forensic Medicine for Lawyers. 2nd edition, Appendix B. London, Butterworths, pp 360–61.
11.
Crown Office (1986) Death and the Procurator Fiscal. Edinburgh, Crown Office.
12.
EkbergK.BarregardL.HagbergS.SallstenG. (1986) Chronic and acute effects of solvents on central nervous system functions in floor-layers. Br. J. Ind. Med.43, 101–6.
13.
FrancisJ.MurrayV. S. G.RuprahM.FlanaganR. J.RamseyJ. D. (1982) Suspected solvent abuse in cases referred to the Poison Unit, Guy's Hospital, July 1980-June 1981. Human Toxicol.1, 271–80.
14.
FroedeR. C. (1980) Microscopical Changes in Drug Abuse. In: PerpperJ. A.WechtC. H. (eds) Microscopical Diagnosis in Forensic Pathology. Illinois, Charles C. Thomas, pp 149–205.
15.
GeschickterC. F.CannonA. (1963) Colour Atlas of Pathology: Central Nervous System. London, Pitman Medical Publishing Co. Ltd; London, Philadelphia, J. B. Lippingcott.
16.
HanksP.McLeodW. T.UrdangL. (1986) Collins Dictionary of the English Language, 2nd ed. London and Glasgow, Collins.
17.
HeathM. J. (1986) Solvent abuse using bromochlorodifluoromethane from a fire extinguisher. Med. Sci. Law26, 33–4.
18.
ISDD Library and Information Service (1985) Drug Abuse Briefing: a guide to the effect of drugs and to the social and legal facts about their non-medical use in Britain. London, ISDD, pp 1–24.
19.
KnightW. (1982) Solvent abuse: the role of the police. Human Toxicol1, 345–6.
20.
KringsholmB. (1980) Sniffing-associated deaths in Denmark. Forens. Sci. Int.15, 215–25.
21.
LushM.OliverJ. S.WatsonJ. M. (1980) the analysis of blood in cases of suspected solvent abuse; with a review of results during the period October 1977 to July 1979. In: OliverJ. S. (ed) Forensic Toxicology. London, Croom Helm, pp 304–23.
22.
MeyerA. (1963) Intoxication. In: BlackwoodW.McMenemeyW. H.MeyerA.NormanR. M.RussellD. S. (eds) Greenfield's Neuropathology. 2nd ed.London, Edward Arnold. pp 235–87. (Reprint 1971.)
23.
OliverJ. S. (1983) The investigation of solvent abuse deaths. J. Forens. Sci. Soc.23, 247–9.
24.
OliverJ. S. (1984) Solvent Abuse. In: CurryA. S. (ed) Analytical Methods in Human Toxicology, Part 1. London, Macmillan Press, pp 84–100.
25.
ProudfootA. T. (1983) Drug Addiction. In: MasonJ. K.Forensic Medicine for Lawyers. London, Butterworths, pp 251–60. (Revised reprint 1986.)
26.
RaaschF.Jr. (1977) Drug abuse. In: TedeschiC. G.EckertW. G.TedeschiL. G. (eds) Forensic Medicine: a study in trauma and environmental hazards. Vol 2: Physical Trauma. Philadelphia, W. B. Saunders, pp 826–39.
27.
RamsayA. W. (1982) Solvent abuse: an educational perspective. Human Toxicol.1, 265–70.
28.
RamseyJ. D. (1983) The role of the laboratory in the investigation of solvent abuse. J. Forens. Sci. Soc.23, 245.
29.
ReynoldsJ. E. F.PrasadA. B. (1982) Martindale: the Extra Pharmacopoeia. 28th ed.London, The Pharmaceutical Press.
30.
RonM. A. (1986) Volatile substance abuse: a review of possible long-term neurological, intellectual and psychiatric sequelae. Br. J. Psychiat.148, 235–46.
31.
WadeA.ReynoldsJ. E. F. (1977) Martindale: the Extra Pharmacopoeia. 27th ed.London, The Pharmaceutical Press.
32.
WatsonJ. M. (1982) Solvent abuse: presentation and clinical diagnosis. Human Toxicol1, 249–56.
33.
WatsonJ. M. (1984) Solvent abuse and adolescents. Practitioner228, 487–90.
34.
WindholzM.BudaveriS.BlumettiR. F.OtterbeinE. S.(1983) The Merck Index: an Encyclopaedia of Chemicals, Drugs and Biologicals. 10th ed. Rahway, N. J. Merck & Co. Ltd.
