Excretion is by the urine. The phenol passes out partly unchanged and partly oxidized to hydroquinone and pyrocat-echin in combination as ethereal sulphates and glycuronates. The urine may have a smoky or dusky appearance, or may change to brownish-black or greenish-black on exposure to the air. In poisoning, practically all the sulphates of the urine may be in the form of ethereal sulphates, the inorganic sulphates completely disappearing.

Toxicology

Phenol is usually readily obtainable, and is a favorite drug for committing suicide. Darlington points out that, in New York city alone, as the result of an ordinance forbidding the sale of strong carbolic, the number of suicides fell from 343 in a year to 36. Its recognition is usually easy from the odor, the corroded tongue and mouth covered with white pellicle, and the empty bottle. A case of fatal poisoning occurred from a surgical dressing at St. Thomas' Hospital, London.

The effects from a poisonous dose may be of three types:

1. After an overwhelming dose the victim becomes unconscious almost immediately and dies in a few minutes from shock.

2. From good-sized but not immediately fatal doses of strong phenol the local corrosion is marked, and there is rapid absorption of a large quantity of the drug. The patient is found in collapse, perhaps unconscious, with muscular tremors and twitchings or rarely convulsions. Death may follow in a few hours from paralysis of the respiration, the patient never regaining consciousness. Or recovery may take place, with extensive corrosion of the mouth, pharynx, esophagus, and stomach. Perforation of the stomach may occur, or months later cicatricial contractions in any part of the burned area, as in the pharynx, esophagus, and stomach.

The symptoms of poisoning by strong phenol are, then: corrosion of the alimentary tract, followed by collapse, coma, and perhaps convulsions.

3. Where weak solutions have been taken, there is no local corrosion, but there is a gradual onset of collapse from depression of centers and heart muscle. There are cold, clammy skin, nausea, vomiting, weak shallow breathing, weak rapid pulse, mental depression and anxiety, or coma and prostration, followed by recovery or death. The sulphates are lacking in the urine, so that when barium chloride does not give a precipitate in the urine, it is a fair conclusion that the patient is poisoned with phenol.

Phenol is the most frequent cause of ochronosis (Beddard).

Treatment Of Poisoning

1. Locally, to remove the phenol, the best application is alcohol. But a bland oil or fat (olive, cottonseed, or linseed oil, or lard or butter), or glycerin or vinegar will serve. These have more solvent powers for carbolic than the liquids of the protoplasm, so tend not only to prevent penetration, but also to extract the carbolic from the tissues. For the stomach, whisky or a 20 per cent. solution of alcohol may be employed; but this must be washed out at once, as the alcoholic solution of phenol is very readily absorbed, and alcohol does not prevent the systemic effects. Clarke and Brown have shown that lavage with water is an effective measure. It is said that lime will form an insoluble compound, and that potassium permanganate will oxidize and destroy the phenol, but these substances can hardly be given in sufficient quantity. After thorough lavage with water or 3 per cent, sodium sulphate, demulcents, such as oils, milk, and white of egg, may be swallowed. The burns, ulcers, or cicatricial contractions must later on be treated like any other burns or ulcers or cicatrices.

2. Systemically

On account of the disappearance of the inorganic sulphates from the urine and their replacement by ethereal sulphates, it has been believed that the alkaline sulphates would combine with the phenol to form non-toxic sulpho-carbolates (phenolsulphonates), and so lessen its activity and promote its excretion. (The phenolsuphonates are not formed in a test-tube or in the stomach, though they are slowly formed in the body.) On this theory sulphates have been given by mouth in carbolic poisoning, and sodium sulphate in 1 to 2 per cent. solution has been administered intravenously. Sollmann and Brown (1907) studied this matter very carefully by an extended series of experiments, and found that the combination takes place too slowly for any useful antidotal effect, whether the sulphates are given before, with, or after the phenol, and whether they are given by mouth or intravenously; therefore they are not chemic antidotes. A saline infusion may, however, be of great value in the treatment of collapse and to promote diuresis; and it would be well to add 1 per cent. of sodium sulphate to this. The treatment is that for collapse.

Therapeutics

Locally, phenol is added to lotions to allay itching. Strong phenol is used as a powerful local antiseptic in dog-bite, carbuncles, small infected cavities, and other small superficial wounds. Its continued action or penetration may be checked by alcohol. It is sometimes injected into cyst cavities to cause an inflammation and obliteration of the cyst (bursitis, hydrocele), and also into hemorrhoids.

For ordinary antiseptic purposes, as washing a wound, disinfecting excreta, towels, bedding, etc., solutions of to 5 per cent. strength are employed for from one-half to two hours. They -are more antiseptic and more penetrating than the ordinary solutions of bichloride of mercury, and they do no harm to fabrics or metal dishes. In the European war Chlutnsky's Solution has been much employed. It consists of phenol, 30 parts; camphor, 60; alcohol, 10.

Bacelli (1911) tabulates 94 cases of tetanus treated intravenously by increasing doses of 5 to 22 1/2 grains (0.3-1.5 gm.), in twenty-four hours, in a 2 per cent. solution. He found that in 190 reported cases the mortality was only 17.36 per cent. The method would seem to be highly dangerous; but Bacelli thinks that patients with tetanus are exceptionally tolerant to phenol.