THE FOLLOWING ARTICLE APPEARED IN THE

APRIL-MAY 1997 ISSUE

THE POISON SLEUTHS

POISONING BY BORON

-Dr. Anil Aggrawal

"Good morning doctor. Oh, my God, what are you doing today? You have the body of a young woman here."

"You are right Tarun. This woman lying here on my table is Lata. She is a 23 year old young unmarried girl. Her parents tell me that she was not feeling well for the last few days. She got frequent bouts of vomiting and in general was down and out. They insisted to take her to a doctor, but she said the symptoms were not troublesome and she would soon get well. She did not inform her parents but the police has found out during the investigations that about a week back she contacted a quack Dr. Harish for treatment, and allegedly he administered her some medication. Soon after she began to feel nauseated. She had severe diarrhea and vomiting. Her parents tell me that the color of both her feces and vomitus was somewhat bluish green. She was also reported to have severe pain in her stomach, severe convulsions and tremors. They did not know why the symptoms had become so severe and they again insisted to take her to a doctor, but again she declined. Since two days she was feeling extremely lethargic and was having headaches off and on. She again contacted Dr. Harish yesterday and he was reported to have administered something to her again. Within about 2 hours of this she died. Now the police has brought her body to me to tell them how she died."

"Should be quite simple. Obviously Dr. Harish has administered some poison to her."

"Yes, it appears so. But the question is why he would administer her the poison. The police has talked to Dr. Harish and he seems quite confident that he gave her the correct medicine. He asserts that Lata died of her original illness which she was complaining of."

"So what are you going to do now?"

"Well, I will have to conduct an autopsy on her dead body. Do you see her fingers and fingernails? Do they not seem abnormal to you?"

"Why! they certainly do. They appear as if they have been painted red! Doctor I am getting curious. Please let me know what this is?"

"And if you look at her buttocks you would find the same change. In medicine, we call it erythema. It is a kind of inflammation of the skin. The skin as you can see, is sloughing off at several places. Of course the most prominent finding as you have noticed is the marked redness of the skin. You may be surprised to know that in toxicology there is a special term for this change. This is known as "boiled lobster" syndrome. The skin appears like a boiled lobster, doesn't it?"

"Now that you tell me, it certainly does. But tell me doctor, does it indicate any particular poison?"

"Yes Tarun. It indicates one and only one poison- boron. It appears to me that Dr. Harish gave her one of boron compounds."

"What? Boron? Doesn't sound like a poison to me. Poison to me means things like cyanide. Please tell me more about boron."

"Tarun, admittedly boron is not a common poison, but it is certainly poisonous and can cause death. Boron in elemental form is not poisonous, but its salts are. Its most common salts are sodium borate, sodium biborate, sodium pyroborate and sodium tetraborate. Boric acid (H3BO3) is a colorless, odorless compound commercially available as granules, and white powder. A teaspoon of 100% boric acid crystals contains approximately 4 g of boric acid..."

"Sorry to interrupt you doctor, but does it have any medical use?"

"Tarun, it was introduced in 1702 by Homberg as a sedative, pain-killer, and antispasmodic. An antispasmodic relieves spasms, especially those of the stomach and is thus useful in stomach pains. At that time it was widely known as "Homberg's sedative salt". But by next century it had fallen in disfavor till Joseph Lister (1827-1912) revived its use once again employing it as an antiseptic in 1875. A little later- in about 1885- it was used as a food preservative, being frequently added to milk to keep it from rotting. But it was soon discovered that its use as a food preservative can cause serious poisoning. Since then its use as a food preservative has been abandoned, but it has been used in several other forms- as solutions, medicated powders, skin lotions, ointments, toothpastes, mouthwashes, water softeners, topical astringents and antiseptics. In the early part of this century, it was recommended for the treatment of ammoniacal dermatitis in children...."

"What is ammoniacal dermatitis, doctor?"

"Tarun, dermatitis means inflammation or redness of the skin. Ammoniacal dermatitis is an inflammation of the skin caused by ammonia. You might be surprised how children can get exposed to such an unusual gas as ammonia. Well, the gas is produced as a result of the chemical breakdown of urine by bacteria in the feces. Nappies of very young children can get soiled with both urine and feces. The bacteria in the feces produce ammonia from the urine. Ammonia has a burning effect on soft baby skin. It produces a rash in the surrounding area. Since the rash is in the area of the diaper it is commonly known as diaper or nappy rash. In fact, so commonly was boric acid prescribed for diaper rash, that at one time it was suggested that a history of diaper rash in any infant under the age of one year, who has died unexpectedly, should raise the suspicion of boric acid poisoning! This aphorism was true for two reasons. Not only was it often applied as a remedy for diaper rash but its poisoning in children often took the appearance of a diaper rash, even if did not have it in the first place! You have seen marked redness of the skin in Lata's case; in children the same happens in the diaper area, giving an appearance mimicking diaper rash. Boric acid was once famous for the treatment of burns too. In fact it was successfully used in the treatment of burns sustained in the Cocoanut Grove disaster..."

"Sorry to interrupt you once again doctor, but what was the Cocoanut Grove disaster?"

"Tarun, Cocoanut Grove was a Boston night club in USA, which caught fire on Nov 28, 1942. A corner of the Lounge had fallen into complete darkness as someone -probably a customer- had taken out a bulb. A 16 year old employee of the club was asked to replace the bulb. He lighted a match in order to illuminate the area and tried to screw the bulb in position, but the match started an artificial palm tree burning, and the fire spread quickly. As a result 491 men and women lost their lives. During the two hours following the onset of fire, 114 casualties were brought to the Massachusetts General Hospital. Many were dead on arrival and many died soon afterwards. Only 39 lived and were treated. In this disaster, the doctors successfully used boric acid to treat many cases of burns. Following this success, it began to be used widely in the treatment of burns as a sterile boracic ointment in place of tannic acid, which was being used earlier. But it was once again shown that poisonous amounts of boric acid can get absorbed from burn wounds and can cause serious symptoms..."

"So it appears boric acid is no good as a medicine after all"

"You can say that again. British Medical Association in 1966 published a statement in which practitioners were advised to refrain from prescribing boric acid and related salts in any form of treatment. The Pharmaceutical Society of Great Britain in the same year advised pharmacists not to sell boric acid as a dusting powder, nor to supply borax in any form. Boric acid solutions have been used as antiseptic irrigating solutions for cleaning wounds and abscesses and even internally for irrigating bladder, pleural cavity and lower bowel, but as I have already told you, it may produce toxicity. Other poisonous compounds of boron are the boron hydrides.."

"Doctor please tell me something about boron hydrides."

"Tarun, Boron Hydrides are a class of chemical compounds having the general formula BnHn+4. They have been investigated as possible propellant fuels as they have nearly double the energy content of standard hydrocarbon fuels. Examples include diborane (B2H6), a gas; pentaborane (B5H9) a liquid, and decaborane (B10H14), a solid under standard conditions. They oxidize vigorously to produce boric acid, water and much heat. Some of the hydrides are spontaneously pyrophoric, i.e. they have the capability of catching fire spontaneously in air, just like phosphorus. Boron hydrides are extremely poisonous compounds. It is believed that they are even more poisonous that cyanide! Levels in air as low as 0.005 parts per million may be toxic!"

"Have poisonings occurred from boron hydrides as well?"

"Yes surely. Boron hydrides are used in the industry for several purposes. You must be knowing that for making semiconductors, the wafer of silicon has to be "doped" with boron. This doping is done with boron hydrides. There are several other complicated uses of boron hydrides in the industry. Cases have occurred when pentaborane has accidentally released in industrial area and poisoned the workers. This can cause quick death. Another curious boron preparation is the Dobell's solution...."

"What is Dobell's solution doctor?"

"Tarun, Dobell's solution was first prepared by the London physician Horace Benge Dobell (b. 1828) in the last century. It consists of a solution of borax, sodium bicarbonate, phenol and glycerine in water and it was used as an antiseptic in the last century and in the early part of this century. Borax (Na2B4O7.10H2O), another poisonous boron compound has been known as a cleaning agent since the days of the Greek and Roman empires and has long been used as a food preservative in Europe and America. Today the principal compound of boron easily available to a common man is sodium perborate. It is an oxidizer which is normally present in tooth powders and toothpastes. It is available to the general public in powder or tablet form for the cleansing of dentures. The white tablets of sodium perborate look quite like sweets and may be taken by curious children! Contact lens solutions also contain salts of boron."

"Doctor, how can one get poisoned from boric acid or other boron salts? Can it be administered homicidally?

"Tarun, Boric acid- one of the most important toxic salts of boron- can certainly be administered homicidally especially as it is a colorless and odorless compound, and is quite commonly available. But no homicidal poisoning with boric acid has yet been reported perhaps because its lethal dose is rather high- about 20 g. As I told you in one of my earlier meetings, an ideal homicidal poison is one which is not only colorless, odorless and tasteless, but whose lethal dose is very small too. But this is not to say that homicidal cases may not have occurred. It is quite possible that cases of homicidal poisoning occurred, but because of poor investigation techniques, the poisoners remained scot free."

"Has it been taken for suicidal purposes?"

"Not to my knowledge, but certainly people have got poisoned when they mistook it for certain other salts. There are cases on record when boric acid crystals have been mistaken for other innocuous salts and ingested. It has frequently been mistaken for Epsom salt....

"Sorry to interrupt you doctor, but is Epsom salt the same as magnesium sulphate?"

"You are right Tarun. Epsom is actually a place in England, very near London which is now famous for Derby- the world's best known horse race. Before the first Derby race here - in 1780- this place was better known as a spa. A spa as you know is a place where one goes to take bath in natural spring waters. Mineral springs were discovered here in 1618, which were quite rich in magnesium sulphate. This is how magnesium sulphate came to be known as Epsom salt. It has great medicinal value and is taken orally to treat constipation and heartburn. It is also prescribed as injection to prevent seizures, especially in preeclampsia, a dangerous condition seen in pregnant mothers."

"Well, I think now I know a lot about boron. Coming to our own case, why do you think Dr. Harish administered Boron to Lata? Did he want to kill her with an exotic little known poison, so that no one could suspect him?"

"It is a possibility but I do not think it must have happened, especially as Dr. Harish had no motive to kill Lata. Actually Borax has a reputation among quacks as an emmenagogue; it is supplied to induce criminal abortion...."

"Well, you have introduced two new terms doctor. What are emmenagogues, and what is criminal abortion?"

"Tarun, emmenagogue is a drug which increases the flow of menstrual blood. The term comes from the Greek roots emmena, menses, and agogein, to draw forth. Thus literally the term refers to any drug which "draws forth the menses". Interestingly the root agogein is seen in many other medical terms such as cholagogue, which refers to any drug which increases the secretion of bile (from Greek chole, bile). Many drugs have a reputation as emmenagogues, some of them being aloes, potassium permanganate, pennyroyal, caulophyllin and apiol. You would surely remember that last time we talked about cantharides in another context. Well, it is also an emmenagogue. Borax is also a strong emmenagogue. Criminal abortion is any abortion done against the law. The law requires that the doctor doing the abortion should have certain requisite qualifications and experience. Girls who become pregnant before marriage can not go to regular doctors for abortion for obvious fears of facing embarrassment and insult in society. So they chose an easy way out; they go to quacks who often do it in a hush-hush manner so that no one else may come to know about it. But they do not have the requisite qualifications, so abortions performed by them are obviously criminal in nature. If found out, they could be prosecuted by law. Since these doctors are not properly qualified, they do not know of standard and safe methods of abortion. They resort to centuries' old dangerous methods of abortion; methods which properly qualified doctors do not resort to. One of the methods employed by the quacks is to administer emmenagogues. The idea is that by promoting the flow of menstrual blood, they would somehow be able to "wash down" the young embryo lodged in the uterine wall. This method does work at times but is an extremely dangerous method. It is like trying to cut your nails by banging your fingers against a sharp knife."

"I am getting the picture now. Lata was pregnant and she contacted Dr. Harish for a criminal abortion. Dr. Harish administered her borax as an emmenagogue. But it did not work; it caused her death instead."

"You are very right Tarun. This is indeed what happened. The symptoms which Lata had were symptoms of pregnancy. Since she was unmarried, she did not want to make it known to her parents. She herself contacted Dr. Harish who was quite sure that he could do the job, but he killed her instead. Post-mortem findings in boron poisonings are not very specific. The mucosa or the lining of the stomach may be bright red and the blood may be cherry red in appearance. Characteristic rash as described earlier may be seen. I have seen all these findings in Lata's body. But I have not relied on autopsy findings alone. I have conducted blood tests on Lata's blood which are confirmatory. The levels of boron in her blood were important. Normally boron levels in the blood are minimal. A level of 50 mg/100 ml indicates poisoning, but I found boron levels exceeding 500 mg/100 mg, which surely is enough to cause death. The actual lethal dose of a boron salt is between 15-20 g for adults and from 3-5 g in infants. So I believe the second time Dr. Harish must have administered her a dose greater than about 20 g. He must have given her a lesser dose the first time, but when it did not do the trick, he administered a larger dose the next time, which killed her. Let us call the police and tell them how she died."

"Oh sure we should. And thank you doctor for telling me about such an interesting poison. What are you going to tell me the next time?"

"Tarun, next time I shall tell you about silver which as you shall see is a very important poison. "