FOR DECEMBER 2000 ISSUE

THE POISON SLEUTHS

DEATH BY YELLOW JASMINE

-Dr. Anil Aggrawal

“Good morning doctor. Oh, my God, what are you doing today? You have the dead body of a young girl today. What happened to him? Please tell me.”

“Good morning Tarun. The name of this young girl is Rajni, and she is only three and a half years old. In the morning she was playing happily in front of her garden. After sometime, she staggered back in her house. She was showing some strange symptoms such as headache, vertigo, marked weakness and prostration. She had a staggering gait. She repeatedly lost balance and was repeatedly bumping into walls. Her head was down on her chest, and she seemed unable to lift it. Her jaw was slack and her eyes were droopy. Her mother asked if she had eaten anything, to which she replied in the negative, probably out of fear. However her older brother who was playing with her said that some strange person had given her some yellow flowers mixed with honey to eat. On hearing this, her mother took her immediately to the hospital. The doctors found that her pupils were dilated and she had blurred vision. She had shallow and labored respirations, drooping of the head and jaw, and feeble cardiac action. They immediately started an IV drip, but the child’s condition soon worsened and she died after about 4 hours of bringing into the hospital. Since her brother had reported seeing some person giving her some strange yellow flowers, this became a police case, and the police has handed over her body to me. My job of course is to tell them how she died.”

“Oh, that is indeed terrible doctor. How did she actually die? And what do you think she consumed?”

“Tarun, from the symptoms and from what her brother told us, I can only think of one poison – a flower commonly known as yellow jasmine. I have opened the stomach of Rajni, and have indeed found some yellow petals of this flower. So the death by this flower is almost confirmed.”

“Do you mean, that flowers can also be poisonous? I think we are once again on the trail of one of your great poison stories. Please tell me more about yellow jasmine.”

“Tarun, Yellow Jasmine or jessamine is botanically named as Gelsemium sempervirens. It belongs to the family Loganiaceae. It is the same family to which some other poisonous plants such as Nux Vomica and Ignatia belong. It grows in several parts of India and the piedmont and coastal areas of the southeastern U.S. It is an early flowering climbing vine. Glossy rich green leaves are about 2-4 inches long by 1/2 inches wide and grow in opposite pairs along wirey stems. The vine will grow 10-20 feet up tree trunks and along fences or other support. The flowers are yellow, funnel shaped, with five spreading, rounded lobes and have a strong odor. They are sometimes known as trumpet flowers because of its shape. The roots and rhizome of yellow jessamine were historically used to treat migraine, headaches and types of neuralgia. Honey made from nectar may be toxic. Yellow Jessamine begins blooming in early March. This plant gets its generic name from the Latinized form of gelsemina, the Italian name for the true jasmine. It is the State Flower of South Carolina, and that is why it is known as Carolina Jessamine in the US. In other countries its names differ. In Germany it is called Gelber Jasmin  and in France Jasmin sauvage. It is also known as Sariyasemin.”

“What poisons does it contain doctor?”

“All parts of the plant are toxic, but the highest concentration of toxic chemicals is in the roots and in the flower with its nectar. Gelsemium sempervirens contains many toxic chemicals known as alkaloids, of which the main are gelsemine, gelseminine and gelsemoidin. Some other important toxic principles are Gelsedine, Gelsemidine, Gelsevirine and Gelsemicine, all of which are CNS depressants.”

“How does these poisons kill doctor?”

“Tarun, you must be knowing that for a nerve impulse to pass successfully from nerve to nerve, or from nerve to muscle, a chemical known as acetylcholine is released at the nerve junctions known as synapses. For producing its actions, acetylcholine binds with certain receptors on the muscle known as acetylcholine receptors. Gelsemine and gelseminine bind to these acetylcholine receptors and thus block the actions of acetylcholine. The result is muscle weakness and paralysis. This action is technically known as anticholinergic action. In fact because of this action, yellow jasmine has been used in many diseases.”

“Oh, that is interesting. In which diseases has it been used doctor?”

“Tarun, it's medicinal effect on fevers was recorded by a Mississippi farmer who cured himself of bilious fever with an accidental overdose of the root. Because of its weakening action on muscles, gelsemium has been used in asthma, painful menstruation, spasms and stomach ache, besides a variety of other conditions. I may tell you that most of these conditions result because of abnormal muscle spasms. For instance asthma occurs because of abnormal spasm of the muscles of the bronchi, because of which they constrict and make the passage of air difficult. This makes the respiration very difficult for the patient. Its use in these conditions thus appears logical at least pharmacologically. But I must stress that its use is not recommended in modern medicine, although perhaps this flower is still used in other systems of medicine. In Germany, human therapeutic use of the rhizome is not permitted, because it is not believed that efficacy has been adequately documented and serious risks are known. In some Australian states, the use of G. sempervirens is restricted and subject to poison control. The therapeutic dose in humans and the toxic dose are very close.”

“Doctor, can we recognize its poisoning by symptoms?”

“Oh, yes. The symptoms are mostly the same which Rajni showed. Since initial symptoms appear within a short period, it is reasonable to expect that the absorption occurs in the stomach. Toxic symptoms begin in from 10-20 minutes and are mostly what Rajni displayed. Marked tetanic convulsions are said to occur late in the clinical course, which is an enigmatic feature, because they can not be explained by the anticholinergic actions of its active principles. These symptoms were not seen in Rajni’s case too. These symptoms are more prominent in the reports from nineteenth century literature, and may be dependent on the concentration of alkaloids other than gelsemine which are present in the roots and lacking in the blossom. Since Caroline jessamine is in the same family of plants as the strychnine bearing Strychnos nux vomica, it is possible that one of its alkaloids may have a strychnine-like action. I may tell you that strychnine causes tetanic convulsions.”

“Doctor which parts of the plant are toxic?”

“All parts of Gelsemium sempervirens are toxic, including the flower and nectar. Accidental poisoning is rare because of the plant bitterness, but it may be mixed with honey and given with homicidal intentions as has been given to Rajni. Death occurs from respiratory paralysis.”

“How many flowers must one eat for a fatal outcome?”

“It is not known for certain. However in one case, ingestion of five blossoms in a young child caused severe poisoning. I would say about ten flowers are fatal. It appears that the death should occur within 12 hours.”

“Is there any effective treatment for this poisoning doctor?”

“Oh yes. Generally in a poisoning case the doctors prefer to give vomit inducing drugs or emetics so the poisoned patient can vomit out the poison. But in this case, emetics don’t seem to work. Consequently doctors put a thick tube through the mouth, and suck out all the poison. Activated charcoal is recommended, because it can adsorb the poison. The most logical antidote appears to be physostigmine. It inhibits a natural enzyme in the body known as cholinesterase. Its natural function is to destroy acetylcholine after it has done its function. By a complicated pharmacological action, it helps in the improvement of symptoms.”

“Doctor you said that marked tetanic convulsions have been reported more often from the nineteenth century literature. Why is this so?”

“It is because in that era, the tincture of gelsemium was produced by soaking rhizomes and roots in whiskey. The rhizomes and roots are probably richer in some toxic chemical which produced convulsions. Scientists are not sure about it, but they think it should be so. This practice led to one report of poisoning in barge sailors transporting the kegged product up the Mississippi and Ohio rivers to market. I may tell you that all parts of the plant are toxic, so much so, that even honey made from the nectar is poisonous.”

“Doctor I think I now know enough about yellow jasmine. Now tell me how would you catch the killer?”

“Tarun, we made some detailed enquiries from the parents of Rajni. We came to know that one person Ramlal, held some grudge against Rajni’s father Kewal, because of office rivalries. He had studied botany in college, and obviously was conversant with poisonous flowers. We visited his house and located several yellow jasmine plants growing in his back yard. Rajni’s brother has identified him too. There seems no doubt that the court would prosecute him”

 “That is amazing doctor. Without your clever deduction it would have been impossible to say how Rajni died and Ramlal may have gone scot-free. What are you going to tell me next time?”

“Tarun, next time, I would tell you about a very interesting poison – Mandrake.”

****************

(To protect the identity of the individuals, their names, as well as the various dates of occurrence have been changed)

****************

(Dr Anil Aggrawal is working as a professor of Forensic Medicine at the Maulana Azad Medical College, New Delhi-110002. His E-mail is dr_anil@hotmail.com, and his website is  HYPERLINK http://www.fortunecity.com/campus/electrical/314/iafm.html http://www.fortunecity.com/campus/electrical/314/iafm.html. His address for correspondence is S-299 Greater Kailash-1, New Delhi-110048: Phone: 6465460