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Excruciating Effect of Formaldehyde Exposure to Students in Gross Anatomy Dissection Laboratory

 

FM Onyije, OG Avwioro

Abstract

Background: Formaldehyde is extensively used for preservation of cadavers in departments of anatomy. However, it is a noxious chemical which may cause serious health problems.

Objective: To assess the effect of exposure of medical students to formaldehyde at the Department of Anatomy, Niger Delta University, Nigeria.

Methods: In a questionnaire-based study, 93 second-year medical students were surveyed at the Department of Human Anatomy, Niger Delta University, Nigeria. The average duration of exposure for each student in the dissection hall was 6 hr/wk. Participants with history of cough, respiratory or skin diseases were excluded from the study.

Results: Out of 93 questionnaires distributed, 75 were completed and returned (response rate: 81%). Of 75 students, 58 (77%) were strongly affected by unpleasant smell of formaldehyde. It was followed by “runny or congested nose” and “redness of the eyes.” “Skin-related diseases” was identified as the least ranked effect of formaldehyde.

Conclusion: Due to the numerous health challenges that formaldehyde causes to students in the gross anatomy dissection laboratories, it cannot be considered as a suitable chemical for embalmment of cadaver for dissection.

Keywords: Anatomy; Dissection; Formaldehyde; Students, medical

 

Introduction

Formaldehyde was discovered in 1856 by the British Chemist, August Wilheld Von Hofmann.1 It is a noxious, flammable gas, extremely soluble in water. Formalin is a colorless irritant which gives out pungent formaldehyde vapors and is widely used in the medical field as fungicide, germicide, disinfectant and preservative. Formaldehyde is a hapten and formaldehyde-protein complex may be immunogenic.2 The chemical is extensively used to preserve cadavers in departments of anatomy. The primary route of exposure to formaldehyde is by inhalation, where it is absorbed by the lungs and gastro-intestinal tract and to a much lesser extent through the skin.2 The literature on formaldehyde contains reports on dermatitis and asthma.3,4 On industrial exposure to formaldehyde, however only few reports have mentioned the effect of formaldehyde on medical students during dissection.5-7 The process of embalming a cadaver is by introducing a fixative into the body tissues. This helps to preserve the cadaver by maintaining, as far as possible, a life-like state, and in the process, retaining the normal anatomical relations as are required for dissection purposes. The embalming fluid is made up of a combination of chemicals that include fixatives, preservatives, germicides, buffers, wetting agents, anticoagulants, dyes, perfuming agents, etc.1 The formulation for the preparation of embalming fluid varies. It depends on the laboratory and some other factors such as the size, extent of edema and stage of decomposition of the cadaver. Although it is also utilized by manufactures of resins, particle board plywood, leather goods paper, pharmaceutical and other products, exposure to formaldehyde in the department of anatomy is continuous and higher than its use in other areas. The present study was therefore conducted to assess the effect of exposure of medical students to formaldehyde in the Department of Anatomy, Niger Delta University, Nigeria.

 

Materials and Methods

The study was carried out at the Department of Human Anatomy, Niger Delta University, Nigeria. Questionnaires were distributed to all the 93 second-year medical students, the so-called “200 level MBBS students” in Nigeria, from 2009 to 2011. Out of the 93 questionnaires, only 75 were completed correctly and returned. Informed consent was signed by all participants. The average duration of exposure for each student in the dissection hall was 6 hr/wk. Students with history of cough, respiratory or skin diseases were excluded from the study.

 

Results

Out of 93 questionnaires distributed, 75 were completed and returned—a response rate of 81%. Results are shown in Table 1. Of 75 respondents, 58 (77%) were strongly affected by the unpleasant smell of formaldehyde; 11 (15%) could not tolerate it; and 6 (8%) had no problem with it. It is followed by “runny or congested nose,” and “redness of the eyes.” Of the students, 14 (19%) experienced low assimilation during dissection while 3 (4%) could not assimilate at all during the dissection. One student fainted, 8 (11%) felt like fainting during dissection sessions.

Table 1: Frequencies and extent of complaints reported

Symptoms

Extent of Symptom, n (%)

Not at All

Barely Recognizable

Strong, Prominent
and Irritating

Intolerable

Unpleasant smell

3 (4)

3 (4)

58 (77)

11 (15)

Runny or congested nose

13 (17)

11 (15)

43 (57)

8 (11)

Redness of the eyes

8 (11)

21 (28)

38 (51)

8 (11)

Unusual tiredness or dizziness

13 (17)

10 (13)

34 (45)

18 (24)

Excessive lacrimation

10 (13)

17 (23)

32 (43)

16 (21)

Prolonged sleeping time

23 (31)

11 (15)

29 (37)

12 (16)

Itching or sore eyes

16 (21)

14 (19)

28 (37)

17 (23)

Disturbance of sight

23 (31)

21 (28)

25 (33)

6 (8)

Unusual thirst

27 (36)

23 (31)

23 (31)

3 (4)

Respiratory distress

22 (29)

21 (28)

22 (29)

10 (13)

Dry or sore throat

34(45)

18 (24)

21 (28)

2 (3)

Nausea

35 (46)

18 (24)

18 (24)

4 (5)

Headache

28 (37)

24 (32)

18 (24)

5 (7)

Disturbed nocturnal sleep

36 (48)

16 (21)

17 (23)

6 (8)

Dry or sore nose

37 (49)

20 (27)

14 (19)

4 (5)

Low assimilation

36 (48)

22 (29)

14 (19)

3 (4)

GIT disturbances

38 (51)

23 (31)

10 (13)

4 (5)

Syncope (fainting episode)

58 (77)

8 (11)

8 (11)

1 (1)

Skins eruption

49 (65)

16 (21)

8 (11)

2 (3)

Itching or sore skin on hands

42 (56)

23 (31)

6 (8)

4 (5)

Discussion

The first ranked excruciating symptom of formaldehyde was reported as “unpleasant smell;” 58 (77%) students strongly believed that formaldehyde would affect respiratory system during dissection. This observation is in agreement with a report from Japan,8 where formaldehyde has been considered a probable cause of nasopharyngeal tumors in humans, and that is why the Japan Ministry of Education, Culture, Sports, Science and Technology (MEXT) has set guidelines which recommends decreasing use of gaseous formaldehyde in gross anatomy dissection laboratories. It is also in keeping with the work done in Vienna,9 where exposure due to inhalation of the fumes of formaldehyde caused shortness of breath, mild irritation of the upper respiratory tract, and compromised pulmonary function. Inhaled formaldehyde vapor in large doses has been associated with cancers in laboratory animals, particularly of the upper airways. Thirty-eight (51%) students suffered from redness of the eyes, the second most common complaints reported. Excessive exposure of the eyes to formaldehyde could lead to pour vision latter in life, which was in agreement with reports from Belgium and India that formaldehyde caused irritation of the eyes1 so that 60% of the subjects felt tears in their eyes. One of the symptoms also noticed was the unusual tiredness or dizziness and 34 (45%) students were affected. Formaldehyde may also affect assimilation during dissection because when one is tired, dizzy and having other symptoms such as headache, little or nothing can be grasped while dissecting. However, only 14 (18%) students believed that formaldehyde would strongly affect their assimilation. In this research, we found that one of the most common effects of formaldehyde—“skin-related diseases,” as been taught by lecturers and practical instructors, which is the reason for protective wears in the hands and other parts of the body—was identified as the least ranked effect of formaldehyde (Table 1).

For the numerous health challenges that formaldehyde causes on students in gross anatomy dissection laboratories, it cannot be considered as a suitable chemical for embalmment of cadaver for student’s dissection. Unfortunately, most of the laboratory attendants and students have little or no knowledge about the carcinogenic nature of formaldehyde. Medical schools should continue to use protective equipment such as laboratory coats, gloves and also introduce the use of goggles, masks and ventilators when working in gross anatomy laboratories, while we look forward to getting a less toxic chemical for embalmment.

 

Conflicts of Interest: None declared.

 

References

  1. Dixit D. Role of standardized embalming fluid in reducing the toxic effects of formaldehyde. Indian J Forensic Med Toxicol 2008;2 (2008-01–2008-06)
  2. Maibach H. Formaldehyde: Effects on animal and human skin. In: Gibson J, ed. Formaldehyde Toxicity. New York: Hemisphere Publishing;1983:166-74.
  3. Hendrick DJ, Lane DJ. Occupational formalin asthma. Br J Ind Med 1977;34:11-8.
  4. Owen CM, Beck MH. Occupational allergic contact dermatitis from phenol-formaldehyde resins. Contact Dermatitis 2001;45:294-5.
  5. Chia SE, Ong CN, Foo SC, Lee HP. Medical students’ exposure to formaldehyde in a gross anatomy dissection laboratory. J Am Coll Health 1992;41:115-9.
  6. Kim H, Kim YD, Cho SH. Formaldehyde exposure levels and serum antibodies to formaldehyde-human serum albumin of Korean medical students. Arch Environ Health 1999;54:115-8.
  7. Mizuki M, Tsuda T. [Relationship between atopic factors and physical symptoms induced by gaseous formaldehyde exposure during an anatomy dissection course]. Arerugi 2001;50:21-8.
  8. Tanaka K, Nishiyama K, Yaginuma H, et al. [Formaldehyde exposure levels and exposure control measures during an anatomy dissecting course]. Kaibogaku Zasshi 2003;78:43-51.
  9. Wantke F, Focke M, Hemmer W, et al. Exposure to formaldehyde and phenol during an anatomy dissecting course: sensitizing potency of formaldehyde in medical students. Allergy 2000;55:84-7.

TAKE-HOME MESSAGE

  • Formaldehyde is a chemical for embalmment of cadaver for dissection.
  • Unpleasant smell of formaldehyde, runny or congested nose, and redness of the eyes are the three most common complaints of students.
  • Formaldehyde may decrease assimilation during anatomy dissection.
  • One of the most common effects of formaldehyde—“skin-related diseases,” as been taught by lecturers and practical instructors—was identified as the least ranked effect of formaldehyde.

Cite this article as: Onyije FM, Avwioro OG. Excruciating effects of formaldehyde exposure to students in gross anatomy dissection laboratory. The International Journal of Occupational and Environmental Medicine 2012;3:92-95.




 pISSN: 2008-6520
 eISSN: 2008-6814

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