Med. Sci. Law (1976) Vol. 16, No. 1
9
Poisoning by Paraquat* PROFESSOR R. D. TEARE,
M D , FRCP, FRCPath, D M J
Department 9. f>*rtmentof ofForensic Forensic Me Medicine, St George's Hospital Medical School, "Yde Park Corner, London e
Paraquat is a herbicide widely used i n over 130 countries. I t is a bipyridyl a n d available f» Gramoxone for agriculture purposes. This « a 20 per cent solution of P a r a q u a t in water. Oomestically, Weedol now contains 2-5 per Paraquat a n d 2-5 per cent D i q u a t a n d is Put u p as solid granules which are dissolved water for use. T h e r e a r e several other {"eparations, all of which are properly 'abelled as to their constituents. P a r a q u a t has the peculiar ability to destroy weeds b u t is ^ a c t i v a t e d by contact with clay a n d as all normal soil contains a proportion of clay this means that soil can be sown or planted WUhin days, if not hours, of herbicidal treat with P a r a q u a t a n d in countries such as y l o n has resulted in 3 crops instead of 2 per »nnum being taken off the same field. A n additional advantage is that ploughing is unnecessary in m a n y cases with m u c h less soil erosion, so that economically it is of immense * d worldwide value (Calderbank, 1968; *'etcher. 197 — • Gramoxone, ™««» icals > and there was no suggestion that he had actually laid hands •We p t
s
n c r e a s e
s
z e
w
e
r
e
s
Q 1 S 0 n
t h a t
w
a
s
11
macrophages could be seen in some of the alveolar spaces but in general there was no suppuration. Eventually the appearances become those of 'honey comb lung', similar to those of diffuse interstitial fibrosis from whatever cause.
u s e d
j,
"ere was also evidence produced that once enyon was in hospital his wife with a girl friend went th ° ' ' P pick^ P foi?' . y° ' '8 owing night the same two women picked up two 'nerent men and took them home to the other woman's flat for the night. he chief lay witness for the Crown was Olive ernrmng, a great friend of Mrs Kenyon, who had been Resent during several telephone conversations between two accused and had actually accompanied Mrs W t l
l
o c a
took
to
u b
K e n
n
s
a
n
h
d
o
U
m
e
f o r
t h e
t
n
w
o
h t
a
m
n
e
d
n
w
t h a l
n
o
m
t h e
1
Fig. 2: Paraquat lung.
e
n t 0
t h e
M
i
d
l
a
n
d
S h i r e s
F
a
r
m
S h o
t o
u r c h a s e
the"r° P P wamoxone and was probably also present when Kenyon took a brown-coloured eye-drop bottle • kitchen drawer and poured some of the contents r s m
a
f a V y
w
n
i
c
h
w
a
s
s , i
i n
t n e
t i n
o i l
i n
o
p u t
dec*^ " f which the ^ e a s e d ' s meal of faggots had been cooked. Mrs H e " / " " did not see this particular gravy tipped on to M v° ' shortly afterwards asked dish »• " ° ' Mrs Kenyon's reply was 'It is some stuff that askpd I ^ ) gave me'. Mrs Hemming repeatedly had k y ° " whether it was the stuff which she en n Midland Shires Farm Shop but ^RUally frequently Mrs Kenyon denied it. The opened ainer of Gramoxone was subsequently found in m m i n g ' s house. 1
18
K e n y
n
y
n
s
d i n n e r
W
n
a
t
w
a
b u t
s
t h a t
s t u f f
y
u
o
n
t o
h i s
O B E R T S K e n
a i n e d
m
f
r
o
m
Case 2 c a s e
18
p ,?. poorly documented since it occurred in the ! , . Islands just after Christmas, 1973 when 4 rj u r a l workers had been having a Boxing ox ^ y for some unknown reason some Gram^ ° n e was slipped into the beer of one of them. He Ph '" ' 48 hours with vomiting and oesoSeal pain, p i g on to jaundice and suppression , |J n d finally to grave respiratory embarrassT h e diagnosis was achieved largely on the n
d
a g r i c u l t a r t
a
n
t
m
n
a s s
a
C n
e
n
n e
S
e
f
s
m
t o m s
a
n
d
t n e
r a
i d
pat' ^ ° y P P gravity of the I, " '"ness by a series of signals from the Falkland 1 C
1 s
(
l
l h e
F o r e i
n
f f i c e
i n
n d o n
T
h
e
a t i m t
died ° 8 ° L° ' P w ? i o n of his lung is demonstrated in Fig. 2 C a s ^ !' ' " c n ' ^ resemble those of Work h g e s against the other 3 agricultural ers were contemplated but eventually dropped, esseI ° showed changes which were and^K ° 8 alveolitis with widened nbrosed alveolar septa and fibrous obliteration of °f the alveolar spaces. Haemosiderin-laden a i
d
a
s e c t
n
W
b e
C
f
t h
y
s c e n
t n a t
t h c
a r
g y
l-5mgperg 25-6 mg per g
Kidney Lung
-
89 0 mg per g 27-0 mg per g
Case 4 This patient died some 7 days after taking an unknown amount of Paraquat for suicidal purposes. He was jaundiced and showed gross consolidation of the lungs with free fluid in each side of the chest but little other macroscopic change and microscopically the consolid ation proved to be haemorrhagic and to combine regeneration and fibrosis.
d
w
r m e
Brain Liver
t h e
He
a
Case 3 A man of 28 years, suffering from domestic worries and unable to find accommodation for his family, admitted to drinking half a pint of Paraquat at 9.30 a.m. on 9 March, 1974. He was transferred to the Hammersmith Hospital but died 14 hours later. He showed gross laryngotracheobronchitis with congestion of the lungs but little else. Chemical analysis of organs showed the following concentrations of Paraquat:
t h e
s e
o f
l u n g s
n b r o s i n
3
0 5
Case S A man of 44 years had a history of previous suicidal attempts and was found in bed by his wife with a three-quarters empty packet of Weedol. On admission to St George's Hospital, Tooting, he denied having taken Paraquat but a spot test revealed the presence of that drug in the urine. X-rays showed 3 needles in the chest and abdomen which he admitted having inserted himself. On thc fourth day of his illness his blood urea had reached 180 mg per cent and by the seventh day X-rays of thc lung showed changes related to Paraquat poisoning, which progressed and he terminated in cardiac arrest on the seventeenth day. It was known that Weedol had been stolen from a neighbour's allotment shed and probably eaten like
12
Med. Sci. Law (1976) Vol. 16, No. 1
sweets for several days. The Paraquat levels in 4-hourly specimens of urine were as follows: Third day Fourth day Fifth day Sixth day Seventh day onwards
3-12 mg per cent 1 -3 mg per cent 0-162 mg per cent 0-0618 mg per cent No Paraquat
The size of the vital organs was the most dramatic aspect of the post-mortem examination in that the left lung weighed 1980 g and the right 1920 g. T h e liver weighed 3480 g and the kidneys 660 g. This man was in gross congestive failure as the result of his respiratory disease and subsequent acute pericarditis. His urine Paraquat levels are interesting in that the lung damage only seemed to get under way when the excretion of Paraquat became negligible. This is somewhat com parable to the findings of Mathew et al. (1968) who saw typical histological lesions in a transplanted lung.
CONCLUSIONS 1. P a r a q u a t is a most valuable herbicide a n d carries little risk for the person using it. Its economic value in avoiding soil erosion a n d rendering l a n d available for i m m e d i a t e cropping is universal. 2. I t would seem to produce a b o u t the most unpleasant form of d e a t h of a n y poison b u t it is doubtful t h a t 'stenching' the p r e p a r a t i o n will deter the suicide. It should, however, minimize the risk of accidental swallowing.
3. I t produces a characteristic chain of symptoms a n d can be recovered from the urine. Ultimately the microscopic changes in the lung are of great significance. ACKNOWLEDGEMENTS The author is most grateful to Detective Chief Super intendent R. Booth of the West Mercia Police for providing him with notes of evidence and many references and also to D r Jerry O'Sullivan of the Department of Histopathology at St George's Hospital Medical School for his help with thephotomicrographyREFERENCES Almog C. and Tal E. (1967) Death from paraquat after subcutaneous injection. Br. Med. J. 3, 721. Berry D . J . and Grove J . (1971) The determination of paraquat (l,l'-dimethyl-4,4'-bipyridylium cation) in urine. Clin. Chim. Acta 34, 5-11. Br. Med. J. (1967) Poisoning from paraquat. 3, 690691. Calderbank A. (1968) The bipyridylium herbicides. Adv. Pest Control 8, 127-235. Cant J . S. and Lewis D. R. H . (1968) Ocular damage due to paraquat and diquat. Br. Med. J. 2, 224. Fletcher K. (1974) Forensic Toxicology. Bristol, Wright, pp. 86-98. Hearn C. E. D. and Keir W. (1971) Nail damage in spray operators exposed to paraquat. Br. J. Ind. Mei28, 399-403. Masterson J . G. and Roche W. J . (1970) Another paraquat fatality. Br. Med. J. 2, 482. Mathew H., Logan A., Woodruff M . F. A. and Herd B(1968) Paraquat poisoning—lung transplantation. Br. Med. J. 3, 759-763.
9
Poisoning by Paraquat* PROFESSOR R. D. TEARE,
M D , FRCP, FRCPath, D M J
Department 9. f>*rtmentof ofForensic Forensic Me Medicine, St George's Hospital Medical School, "Yde Park Corner, London e
Paraquat is a herbicide widely used i n over 130 countries. I t is a bipyridyl a n d available f» Gramoxone for agriculture purposes. This « a 20 per cent solution of P a r a q u a t in water. Oomestically, Weedol now contains 2-5 per Paraquat a n d 2-5 per cent D i q u a t a n d is Put u p as solid granules which are dissolved water for use. T h e r e a r e several other {"eparations, all of which are properly 'abelled as to their constituents. P a r a q u a t has the peculiar ability to destroy weeds b u t is ^ a c t i v a t e d by contact with clay a n d as all normal soil contains a proportion of clay this means that soil can be sown or planted WUhin days, if not hours, of herbicidal treat with P a r a q u a t a n d in countries such as y l o n has resulted in 3 crops instead of 2 per »nnum being taken off the same field. A n additional advantage is that ploughing is unnecessary in m a n y cases with m u c h less soil erosion, so that economically it is of immense * d worldwide value (Calderbank, 1968; *'etcher. 197 — • Gramoxone, ™««» icals > and there was no suggestion that he had actually laid hands •We p t
s
n c r e a s e
s
z e
w
e
r
e
s
Q 1 S 0 n
t h a t
w
a
s
11
macrophages could be seen in some of the alveolar spaces but in general there was no suppuration. Eventually the appearances become those of 'honey comb lung', similar to those of diffuse interstitial fibrosis from whatever cause.
u s e d
j,
"ere was also evidence produced that once enyon was in hospital his wife with a girl friend went th ° ' ' P pick^ P foi?' . y° ' '8 owing night the same two women picked up two 'nerent men and took them home to the other woman's flat for the night. he chief lay witness for the Crown was Olive ernrmng, a great friend of Mrs Kenyon, who had been Resent during several telephone conversations between two accused and had actually accompanied Mrs W t l
l
o c a
took
to
u b
K e n
n
s
a
n
h
d
o
U
m
e
f o r
t h e
t
n
w
o
h t
a
m
n
e
d
n
w
t h a l
n
o
m
t h e
1
Fig. 2: Paraquat lung.
e
n t 0
t h e
M
i
d
l
a
n
d
S h i r e s
F
a
r
m
S h o
t o
u r c h a s e
the"r° P P wamoxone and was probably also present when Kenyon took a brown-coloured eye-drop bottle • kitchen drawer and poured some of the contents r s m
a
f a V y
w
n
i
c
h
w
a
s
s , i
i n
t n e
t i n
o i l
i n
o
p u t
dec*^ " f which the ^ e a s e d ' s meal of faggots had been cooked. Mrs H e " / " " did not see this particular gravy tipped on to M v° ' shortly afterwards asked dish »• " ° ' Mrs Kenyon's reply was 'It is some stuff that askpd I ^ ) gave me'. Mrs Hemming repeatedly had k y ° " whether it was the stuff which she en n Midland Shires Farm Shop but ^RUally frequently Mrs Kenyon denied it. The opened ainer of Gramoxone was subsequently found in m m i n g ' s house. 1
18
K e n y
n
y
n
s
d i n n e r
W
n
a
t
w
a
b u t
s
t h a t
s t u f f
y
u
o
n
t o
h i s
O B E R T S K e n
a i n e d
m
f
r
o
m
Case 2 c a s e
18
p ,?. poorly documented since it occurred in the ! , . Islands just after Christmas, 1973 when 4 rj u r a l workers had been having a Boxing ox ^ y for some unknown reason some Gram^ ° n e was slipped into the beer of one of them. He Ph '" ' 48 hours with vomiting and oesoSeal pain, p i g on to jaundice and suppression , |J n d finally to grave respiratory embarrassT h e diagnosis was achieved largely on the n
d
a g r i c u l t a r t
a
n
t
m
n
a s s
a
C n
e
n
n e
S
e
f
s
m
t o m s
a
n
d
t n e
r a
i d
pat' ^ ° y P P gravity of the I, " '"ness by a series of signals from the Falkland 1 C
1 s
(
l
l h e
F o r e i
n
f f i c e
i n
n d o n
T
h
e
a t i m t
died ° 8 ° L° ' P w ? i o n of his lung is demonstrated in Fig. 2 C a s ^ !' ' " c n ' ^ resemble those of Work h g e s against the other 3 agricultural ers were contemplated but eventually dropped, esseI ° showed changes which were and^K ° 8 alveolitis with widened nbrosed alveolar septa and fibrous obliteration of °f the alveolar spaces. Haemosiderin-laden a i
d
a
s e c t
n
W
b e
C
f
t h
y
s c e n
t n a t
t h c
a r
g y
l-5mgperg 25-6 mg per g
Kidney Lung
-
89 0 mg per g 27-0 mg per g
Case 4 This patient died some 7 days after taking an unknown amount of Paraquat for suicidal purposes. He was jaundiced and showed gross consolidation of the lungs with free fluid in each side of the chest but little other macroscopic change and microscopically the consolid ation proved to be haemorrhagic and to combine regeneration and fibrosis.
d
w
r m e
Brain Liver
t h e
He
a
Case 3 A man of 28 years, suffering from domestic worries and unable to find accommodation for his family, admitted to drinking half a pint of Paraquat at 9.30 a.m. on 9 March, 1974. He was transferred to the Hammersmith Hospital but died 14 hours later. He showed gross laryngotracheobronchitis with congestion of the lungs but little else. Chemical analysis of organs showed the following concentrations of Paraquat:
t h e
s e
o f
l u n g s
n b r o s i n
3
0 5
Case S A man of 44 years had a history of previous suicidal attempts and was found in bed by his wife with a three-quarters empty packet of Weedol. On admission to St George's Hospital, Tooting, he denied having taken Paraquat but a spot test revealed the presence of that drug in the urine. X-rays showed 3 needles in the chest and abdomen which he admitted having inserted himself. On thc fourth day of his illness his blood urea had reached 180 mg per cent and by the seventh day X-rays of thc lung showed changes related to Paraquat poisoning, which progressed and he terminated in cardiac arrest on the seventeenth day. It was known that Weedol had been stolen from a neighbour's allotment shed and probably eaten like
12
Med. Sci. Law (1976) Vol. 16, No. 1
sweets for several days. The Paraquat levels in 4-hourly specimens of urine were as follows: Third day Fourth day Fifth day Sixth day Seventh day onwards
3-12 mg per cent 1 -3 mg per cent 0-162 mg per cent 0-0618 mg per cent No Paraquat
The size of the vital organs was the most dramatic aspect of the post-mortem examination in that the left lung weighed 1980 g and the right 1920 g. T h e liver weighed 3480 g and the kidneys 660 g. This man was in gross congestive failure as the result of his respiratory disease and subsequent acute pericarditis. His urine Paraquat levels are interesting in that the lung damage only seemed to get under way when the excretion of Paraquat became negligible. This is somewhat com parable to the findings of Mathew et al. (1968) who saw typical histological lesions in a transplanted lung.
CONCLUSIONS 1. P a r a q u a t is a most valuable herbicide a n d carries little risk for the person using it. Its economic value in avoiding soil erosion a n d rendering l a n d available for i m m e d i a t e cropping is universal. 2. I t would seem to produce a b o u t the most unpleasant form of d e a t h of a n y poison b u t it is doubtful t h a t 'stenching' the p r e p a r a t i o n will deter the suicide. It should, however, minimize the risk of accidental swallowing.
3. I t produces a characteristic chain of symptoms a n d can be recovered from the urine. Ultimately the microscopic changes in the lung are of great significance. ACKNOWLEDGEMENTS The author is most grateful to Detective Chief Super intendent R. Booth of the West Mercia Police for providing him with notes of evidence and many references and also to D r Jerry O'Sullivan of the Department of Histopathology at St George's Hospital Medical School for his help with thephotomicrographyREFERENCES Almog C. and Tal E. (1967) Death from paraquat after subcutaneous injection. Br. Med. J. 3, 721. Berry D . J . and Grove J . (1971) The determination of paraquat (l,l'-dimethyl-4,4'-bipyridylium cation) in urine. Clin. Chim. Acta 34, 5-11. Br. Med. J. (1967) Poisoning from paraquat. 3, 690691. Calderbank A. (1968) The bipyridylium herbicides. Adv. Pest Control 8, 127-235. Cant J . S. and Lewis D. R. H . (1968) Ocular damage due to paraquat and diquat. Br. Med. J. 2, 224. Fletcher K. (1974) Forensic Toxicology. Bristol, Wright, pp. 86-98. Hearn C. E. D. and Keir W. (1971) Nail damage in spray operators exposed to paraquat. Br. J. Ind. Mei28, 399-403. Masterson J . G. and Roche W. J . (1970) Another paraquat fatality. Br. Med. J. 2, 482. Mathew H., Logan A., Woodruff M . F. A. and Herd B(1968) Paraquat poisoning—lung transplantation. Br. Med. J. 3, 759-763.
