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ISSN: 0972-8066 (CD version) ISSN: 0972-8074 (Online version) NLM Unique ID: 100960452 Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology ( Peer-reviewed electronic journal for Forensic professionals ) (Published biannually on the 1st January and 1st July every year) [Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology is Indexed / Listed with EMBASE / the Exerpta Medica database, NCJRS (National Criminal Justice Reference Service), Chemical Abstracts Service (A division of the American Chemical Society), Ulrich's Periodicals Directory, MedWebPlus (A service of Flexis, Inc., California), Genamics JournalSeek, getCITED, National Library of Medicine's LocatorPlus, Scopus™ (A service of Elsevier B.V., Amsterdam), Leids Universitair Medisch Centrum, Electronic Journal Miner, EBSCO, Budapest Open Access Initiative (BOAI), Electronic Journals Library (maintained by the University Library of Regensburg), Index Copernicus, Galter Health Sciences Library, Chicago, Directory of Open Access Journals (DOAJ), HINARI and Clarivate Analytics' Emerging Sources Citation Index.] Mentioned in the British Medical Journal [BMJ Volume 324 9 February 2002, page 372 Column - Netlines by Harry Brown, general practitioner, Leeds DrHarry@dial.pipex.com 1st entry in the column mentions this journal A t that time, the journal was hosted at a different URL, which is mentioned in the column. 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HOWEVER THE ARTICLES AND OTHER MATERIALS MAY NOT BE REPOSTED ON THE NET OR REPRINTED FOR COMMERCIAL GAIN WITHOUT THE PERMISSION OF THE EDITORIAL BOARD. Scope of the Journal Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology is published online twice a year. It is the world's first online journal of forensic medicine and toxicology. Started by Professor Anil Aggrawal of Maulana Azad Medical College, New Delhi, on 25 February 2000, it publishes original on forensic medicine, toxicology, medical law, science and the law and allied subjects such as criminology, police science, deviant behavior, forensic psychiatry and psychology. Any subject that has a forensic interest e.g., forensic astronomy, forensic economics, forensic geoscience, forensic gemology, forensic herpetology, forensic hypnosis, forensic limnology, forensic linguistics, forensic mathematics and statistics, forensic metallurgy, forensic microbiology, forensic microscopy, forensic nursing, forensic palynology, forensic pharmacy, forensic phonetics, forensic social work, jurimetrics, nanoforensics, teleforensics, veterinary forensics, wildlife forensics etc., as well as papers related to medicolegal aspects of various medical disciplines, such as pediatrics, surgery, ENT, ophthalmology etc. are also published. The journal has regular undergraduate and postgraduate sections, book reviews, interviews with famous forensic professionals, poster sessions, announcements of conferences etc. All back issues are archived for easy access and are available to all. The journal has an impressive editorial board comprising of at least one specialist from every single continent of the world. About 10,000 visitors visit and read the journal daily from all parts of the world. The journal is indexed/listed with several major abstracting services such as Chemical Abstracts Service, EMBASE, Index Copernicus, SCOPUS, and Web of Science [Clarivate (formerly Thomson Reuters)]. For more information, please visit following link (Wikipedia). Submit Here Call for Reviewers Interested in becoming a reviewer for this journal? Check Details Anil Aggrawal's Internet Journal Of Forensic Medicine & Toxicology (Access the pages by clicking on them.) Main Page (current Issues & Archives) Paper/Thesis Submission Guidelines Call for Reviewers Aims & Objectives Frequently Asked Questions (FAQs) Undergraduate Section Postgraduate Section History of the Journal Contributing Partners Be our Sponsor Editorial Board Journal CD Awards Credits Cumulative Index (Sorted by Publishers) of Reviews of Forensic gadgets/toys/other tidbits Models related to Forensics/Toxicology Electronic books related to Forensics/Toxicology Calenders related to Forensics/Toxicology Software/Multimedia/Videotape Reviews Books on CD/Audio books, CDs and tapes Cumulative Index of Editorials Theses/Dissertations Online Courses Reviews with Quizzes Animated Book Reviews Featured Reviews Interviews with Prominent Writers/Authors/Forensic Professionals/ Toxicologists Cumulative index of Book Reviews Sorted by Publishers Subjects (General) Subjects (Technical) The Punjab Corneal Grafting Act, 1963 Leading papers Aggrawal A., Busuttil A. Age Estimation in the living. The Police Surgeon (Journal of The Association of Police Surgeons). No. 38, Jan 1991, Pp 33-36. Aggrawal A. References to the paraphilias and sexual crimes in the Bible. J Forensic Leg Med. 2009 Apr;16(3):109-14. [Pubmed ] Aggrawal A. Estimation of age in the living: in matters civil and criminal. J Anat. 2009 May 11. [Pubmed ] Aggrawal A. A new classification of necrophilia. J Forensic Leg Med. 2009 Aug;16(6):316-20. [Pubmed ] Aggrawal A. A new classification of zoophilia. J Forensic Leg Med. 2011 Feb;18(2):73-8. [Pubmed] Some selected chapters in books and encyclopedias Aggrawal A. (2003) Age Estimation in the Living. In: Payne-James JJ, Busuttil A, Smock W (Eds.) Forensic Medicine: Clinical and Pathological Aspects, Pp. 391-408. Greenwich Medical Media, San Francisco & London Aggrawal A. (2005) Allergies. In: Payne-James JJ, Byard RW, Corey TS, Henderson C (Eds.) Encyclopedia of Forensic and Legal Medicine, Vol. 1, Pp. 58-68. Elsevier Academic Press, London Aggrawal A. (2005) Drug Induced Injury, Accidental and Iatrogenic. In: Payne-James JJ, Byard RW, Corey TS, Henderson C (Eds.) Encyclopedia of Forensic and Legal Medicine, Vol. 2, Pp. 230-238. Elsevier Academic Press, London Aggrawal A. (2005) Drug Prescribed: Product Liability. In: Payne-James JJ, Byard RW, Corey TS, Henderson C (Eds.) Encyclopedia of Forensic and Legal Medicine, Vol. 2, Pp. 243-252. Elsevier Academic Press, London Aggrawal A. (2005) History of Toxicology. In: Payne-James JJ, Byard RW, Corey TS, Henderson C (Eds.) Encyclopedia of Forensic and Legal Medicine, Vol. 2, Pp. 525-538. Elsevier Academic Press, London Aggrawal A. (2005) Internet: Toxicology. In: Payne-James JJ, Byard RW, Corey TS, Henderson C (Eds.) Encyclopedia of Forensic and Legal Medicine, Vol. 3, Pp. 171-181. Elsevier Academic Press, London Aggrawal A. (2005) Mass Murder. In: Payne-James JJ, Byard RW, Corey TS, Henderson C (Eds.) Encyclopedia of Forensic and Legal Medicine, Vol. 3, Pp. 216-223. Elsevier Academic Press, London Aggrawal A. (2005) Mass Poisonings. In: Payne-James JJ, Byard RW, Corey TS, Henderson C (Eds.) Encyclopedia of Forensic and Legal Medicine, Vol. 3, Pp. 223-229. Elsevier Academic Press, London Aggrawal A. (2005) Refugee Medicine. In: Payne-James JJ, Byard RW, Corey TS, Henderson C (Eds.) Encyclopedia of Forensic and Legal Medicine, Vol. 3, Pp. 514-525. Elsevier Academic Press, London Aggrawal A. (2005) Terrorism: Medicolegal Aspects. In: Payne-James JJ, Byard RW, Corey TS, Henderson C (Eds.) Encyclopedia of Forensic and Legal Medicine, Vol. 4, Pp. 269-276. Elsevier Academic Press, London Aggrawal A. (2005) Terrorism: Nuclear and Biological. In: Payne-James JJ, Byard RW, Corey TS, Henderson C (Eds.) Encyclopedia of Forensic and Legal Medicine, Vol. 4, Pp. 277-289. Elsevier Academic Press, London Aggrawal A. Tsokos M (2005) Terrorism: Suicide Bombing, Investigation. In: Payne-James JJ, Byard RW, Corey TS, Henderson C (Eds.) Encyclopedia of Forensic and Legal Medicine, Vol. 4, Pp. 289-296. Elsevier Academic Press, London Aggrawal A. (2006) Agrochemical poisoning. In: Tsokos M (Ed.) Forensic pathology reviews vol 4. Humana Press, New Jersey, chapter 10, Pp 261-327. Aggrawal A. (2007) Bride Capture. In: David S. Clark (Ed.) Encyclopedia Of Law And Society: American And Global Perspectives. SAGE Publications, Thousand Oaks, London. Pp. 134-35 (vol. 1). Aggrawal A. (2007) Discrimination, Sociology of. In: David S. Clark (Ed.) Encyclopedia Of Law And Society: American And Global Perspectives. SAGE Publications, Thousand Oaks, London. Pp. 418-20 (vol. 1). Aggrawal A. (2007) Dowry Customs. In: David S. Clark (Ed.) Encyclopedia Of Law And Society: American And Global Perspectives. SAGE Publications, Thousand Oaks, London. Pp. 435-7 (vol. 1). Aggrawal A. (2007) Homicide. In: David S. Clark (Ed.) Encyclopedia Of Law And Society: American And Global Perspectives. SAGE Publications, Thousand Oaks, London. Pp. 709-11 (vol. 2). Aggrawal A. (2007) Incest. In: David S. Clark (Ed.) Encyclopedia Of Law And Society: American And Global Perspectives. SAGE Publications, Thousand Oaks, London. Pp. 730-2 (vol. 2). Aggrawal A. (2011) Sexual Deviant Behavior and Crimes. In: Lynch, VA, Duval, JB (Eds.) Forensic Nursing Science, 2nd ed, ch 41,Pp. 512-20. Elsevier Mosby, Missouri. Aggrawal A., Sardana K (2014) Medicolegal aspects of Lasers in Dermatological practice. In: Sardana K, Garg VK (Eds.) LASERS in Dermatological practice, ch 16,Pp. 441-54. Jaypee, New Delhi. "I play 90 hours a week. Many people call it work."

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Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE AUGUST 1999 ISSUE THE POISON SLEUTHS DEATH BY DIGITALIS -Dr. Anil Aggrawal "Good morning doctor. Oh, my God, what are you doing today? You have the dead body of a young man today. What happened to him? Please tell me." "Good morning Tarun. The name of this young man is Surendra, and he died early this morning in the hospital. He was a business partner of Lokesh. They were in the business of assembling computers and distributing them to the customers. Lokesh has done an assorted medley of jobs before coming to this business, not the least significant of which was his brief stint as a pharmacist. He in fact is a qualified pharmacist and had tried his hand at that job in the beginning. But when he couldn't succeed in that job, he changed to other professions, changing them frequently, until finally he settled in the business of computers about a year back. It is said that his company Goodwin Computers Ltd was doing a business of several lakhs." "Do all these facts have a bearing on Surendra's death?" "I am coming to that. Lately Goodwin Computers Ltd was running in a loss. Surendra found out that Lokesh was illegally siphoning off a major chunk of money to his own personal company Lokesh Computers Ltd, which he had floated simultaneously only about a couple of months back. Surendra realized that very soon, he would siphon off all the money from their joint company to his own personal company. So he was clamouring for a dissolution of their joint company and to give him his due share. It is estimated that Goodwin Computers Ltd was worth about 50 to 60 Lakhs, so obviously Surendra's share was about 30 Lakhs. Lokesh always denied that he was illegally siphoning off money as alleged by Surendra. Ultimately to sign the deal, Lokesh agreed to come over to Surendra's house yesterday evening. After the initial pleasantries, Surendra offered Lokesh drinks which he readily agreed to. They were sitting in the drawing room. After the first drink, Surendra went inside to the bedroom to phone a nearby restaurant for some food. When he returned he found that Lokesh had prepared the second drink for both of them. They were to have dinner after that, after which Surendra and Lokesh would sign the deal to dissolve the company and share the proceeds. Surendra was himself trained in law, and had already prepared the deal. After Surendra finished his second drink, Lokesh got a call on his mobile and he expressed his desire to go to his home for some little work. He said that he would be back within 15 minutes. Just after Lokesh left, Surendra felt a nauseating feeling; in fact he vomited once or twice. But he thought that it was probably because of alcohol. But soon he complained of diarrhoea, fatigue and marked muscular weakness. He knew something was wrong with him, so he phoned his doctor. His doctor advised him immediate hospitalization. In the hospital, he became drowsy and restless. He complained of several strange visual symptoms. He had blurred vision and complained of seeing big dark circles. He also said that things were appearing yellowish to him. The symptoms rather confused the doctors. They were still investigating his case, when today morning Surendra suddenly expired. Surendra's parents have alleged that he has been poisoned and that is why the police has handed over his body to me for post-mortem. My job of course is to find out if indeed he has been poisoned." "What do you make out of this case doctor? Is it really a case of poisoning?" "Tarun, I have made a detailed study of Surendra's symptoms. And again and again my mind is coming back to one poison only - Digitalis. Indeed his characteristic visual symptoms are leading me to that. Of course I will have to do the detailed autopsy to find out if indeed it was digitalis which killed him." "Digitalis! Never heard of it being used as a poison. What is it anyway?" "Tarun, Digitalis is a drug which is given usually to heart patients. And regarding its use as a poison, it has been used several times before for killing people. The effects of this drug are best known to doctors. Indeed one of the first murderers to use digitalis to eliminate his victims was a doctor." "Oh, looks like we are again on to one of your exciting stories. Please tell me about digitalis from the beginning doctor." "Tarun, Digitalis comes from a plant called Foxglove. Its botanical name is Digitalis purpurea, and it has beautiful bell-shaped purple flowers. Figure 1: Foxglove plant from which comes the drug digitalis. Note the characteristic bell shaped flowers hanging like bells In fact the species name purpurea is derived from the purple color of its flowers. The term foxglove actually is a corruption of "folks-glove", which means "fairies glove". The name comes from the finger like appearance of its flowers. Because of the same appearance, it is called fingerhut in German, which literally means "finger hat" or "thimble". The botanical name digitalis is also derived in a similar fashion. In Latin digitus actually means a finger or toe. You may be interested to know that since early man counted on his "fingers", even the numerals 0-9 came to be known as digits, and from this comes our modern word "digital calculator". Isn't it interesting that as widely different terms as digitalis and digital calculator have similar origins?" "It surely is. Since when is this plant known to mankind?" "Tarun, the plant foxglove has been known to man since antiquity and has been used by herb doctors and wise old women (The proverbial "Dadi Ma")(Note to Non-Hindi Readers: Dadi Ma is a word of affection used widely in India for wise, loving grandmother) in multifarious concoctions. But it was used systematically for the first time by a young English doctor William Withering (1741-1799) in 1776. Figure 2: William Withering (1741-1799) seated in his chair. Note the Foxglove plant with the characteristic bell shaped flowers in his hand He received his M.D. Degree from the University of Edinburgh in 1766, and in 1775 came to practice in Birmingham General Hospital. In those days, physicians usually picked their own drugs from the plants, and thus botany was a subject included in medical curriculum. Oddly in his studies at Edinburgh the one subject Withering loathed was botany! But one of his first patients, Miss Helena Cooke, a talented flower painter, changed his loathing into love. She encouraged the young doctor to collect plants for her. Later their love grew, and Withering married Miss Cooke! After marriage he moved to Birmingham to take up his job at Birmingham General Hospital. It may interest you to know that Erasmus Darwin, grandfather of the great biologist, Charles Darwin had actually recommended Withering for this position. His friends included such great luminaries as Joseph Priestley, the chemist and James Watt." "That's interesting. How did Withering come to know of foxglove?" "At Birmingham, one of Withering's Hospital associates named John Ash informed Withering that one Dr. Cawley, principal of Brasenose College of Oxford University, was cured of a heart disease with a secret formula used by an old woman of Shropshire. She was a lady called Mrs. Hutton, and used a decoction containing some 20 herbs. One of these 20 herbs was foxglove, and Withering quickly realized that out of all the 20 herbs, it was the foxglove which was doing the trick. Figure 3: William Withering paying Mrs. Hutton with Gold coins for the secret of Foxglove. Note the Foxglove plants with the characteristic bell shaped flowers in the background Legend has it that Withering paid Mrs. Hutton with several Gold coins for the secret of foxglove which Mrs. Hutton gave him." "Oh, this is most interesting. So how does digitalis help the patient in the heart disease. And how come, a drug which is so useful in heart disease can act as a poison?" "Tarun, all medicines are potentially poisons. Indeed the great Swiss physician and Chemist, Paracelsus (1495-1541) said that all substances are poisons. There is none, which is not. He said that the right dose differentiates a poison and a remedy. You have already seen in my earlier discussions how innocuous looking substances as chilli powder (see Science Reporter November 1997) and common salt (see Science Reporter March 1998) have been used to kill people. You asked how digitalis helps the patient in heart disease. Well, it increases the force of contraction of the heart. In technical language we say that digitalis has a positive inotropic effect on the heart. But in large doses digitalis can be fatal." "Doctor, how much digitalis is fatal?" "Tarun, first of all, I must tell you that digitalis is the name given to the dried leaf of the plant Digitalis purpurea. It contains two principal drugs digoxin and digitoxin. Digitoxin is more toxic than digoxin. While the fatal dose of digoxin varies from 5 to 25 mg, the fatal dose of digitoxin is just 3-5 mg. For this reason, digitoxin is not used by doctors in the treatment of heart disease, because if they used this drug, there would be more fatal accidents, than with digoxin. I must tell you that digoxin is commonly available in the market under the names of Cardioxin, Digitran-250, Digox, Digoxin and Lanoxin. Different drug companies market the same chemical compound, i.e. digoxin under different commercial names. This tablet is available as 0.25 mg tablets. So about 20-100 tablets would be fatal. A patient of heart disease would require about 3-6 tablets daily." "How are you going to determine whether Surendra indeed died of digoxin poisoning?" "Tarun, normally there should be no digoxin in the blood. But even if we presume, Surendra was taking digitalis for some heart ailment, his blood should show very low quantities of digoxin. These low levels are called the therapeutic levels. The therapeutic levels of digoxin in the blood of a patient taking digoxin as a remedy should be around 0.5 to 2.5 nanograms per ml (one nanogram is 10-9 of a gram). Toxic levels are about 3.0 ng/ml. And levels of 10-30 ng/ml are associated with severe poisoning. I have estimated the levels of digoxin in the blood of Surendra, and I have found levels of 35.6 ng/ml. There is indeed no doubt that Surendra had been given digitalis by Lokesh. Lokesh definitely wanted to eliminate Surendra, so he could not ask for his due share in their joint business. In fact, when Surendra went inside to order for food on phone, Lokesh quickly prepared his drink, and laced it with about 30 to 35 tablets of digoxin, which he had already brought with him. Surendra was already a little tipsy because of the first peg of alcohol which he had taken, so he couldn't notice the slight change in taste that must have been induced by the addition of these tablets. I am almost sure this is how Lokesh has killed Surendra. In fact, I have already instructed the police to search Lokesh's house thoroughly. Oh, here comes a policeman with something in his hand which he has found from Lokesh's house. Lo and behold, these are the strips of digoxin tablets. Lokesh would have tough time explaining to the police and the court what these digoxin tablets were doing in his home, especially when he is not suffering from any heart disease." "That was very clever of you doctor. Without your clever deduction - especially your noticing the peculiar visual symptoms of Surendra at the time of his death- everybody would have thought Surendra died of some mysterious natural disease. This was a most interesting discussion doctor. Tell me what are you going to tell me the next time?" "Tarun, next time, I would tell you about a very interesting poison- Yellow Kaner. "

SCIENCE IN CRIME DETECTION-8 WHEN THE BODY TURNS INTO WAX ! Saroj, 16, and Mahendra, 12 were brother and sister. On June 8, 1987, they went to play as usual in the garden, but they never returned. Saroj was a beautiful girl and her parents were always quite reserved in allowing her out alone. On that day however, she was able to cajole her parents into allowing her to go out with her brother. A complaint with the police did not result in any benefit either. The police asked various questions, including about the people the parents suspected. But the family had no enemies whatsoever. As time passed, it became clear that Saroj and Mahendra were kidnapped by some gang, presumably with the purpose of having intercourse with Saroj. There was a gang in town which had once kidnapped a young 19 year old girl, kept her in detention for as many as three months, during which she was forced into intercourse day and night. When the gang members were tired of sex, they would all sit together in a circle and ask her to perform naked dances in the center. After meting out this inhuman treatment to her for three months, they finally did away with her. Her body was found three and a half months later, quite putrefied in a forest. Only one member of the gang could be arrested and from him, the whole story was revealed. The body bore several stab marks, which showed that the modus operandi of the gang was to kill by stabbing. Lakhiram and Revati, the parents of Saroj and Mahendra shivered at this thought. They kept searching for their children, but without any success. On January 15, 1988, one highly putrefied body was found in a forest about 50 miles away from the village of Lakhiram and Revati. Most of the body had been eaten away by animals and maggots were crawling on what remained of the corpse. It was impossible to identify the dead person from the remains. I was called by the police inspector at the place. I made some preliminary examination of the bone and told the police that the bones belonged to a male between 11 and 13 years of age. Moreover, the person, whoever he was, had suffered osteomyelitis (an infection of the bone) in his right leg, about two year before. This description fitted Mahendra exactly. Lakhiram and Revati were immediately contacted and they admitted that Mahendra had suffered from a terrible weeping sore about two and a half years back and also that the sore had healed with great difficulty after about six months of treatment. This, of course, is not the main part of the story. This only established that the victim was Mahendra. But I could not say who had killed him or how had he been killed. This was vital for the police to know. One thing however became clear. If Mahendra had been killed, it was quite possible that his sister Saroj had also been killed and was disposed off in a nearby area itself. A police party launched a massive search for the body of Saroj. They were expecting her body, too, to be in the same state of deterioration; so everyone's stomach was turning topsy-turvy. But lo and behold! Two days later a constable of the search party accidentally stumbled upon a quite well-preserved body of a teenaged girl on the shores of a nearby pond. The body was naked and so well preserved that everybody could at once recognize it was Saroj. When the search party touched the body, it felt as it was like soft wax. Everyone was nonplussed. What had happened to Saroj? I was called immediately. When I arrived there and looked at the body, I realized at once that I was dealing with an adipocere. I rubbed some of the body's material between my thumb and index finger. It gave me a cheesy feeling. I smelt the material. The smell was somewhat similar to that of old cheese. Here then was the body of Saroj, turned into adipocere and intuitively I knew that now I could tell a lot of things to the police regarding the crime. Let us introduce a red herring into the story and first see what an adipocere is. The word adipocere comes from two Latin words, adeps meaning fat and sera meaning wax. It is also known by several other names such as Grave Wax, Mortuary Fat , or Saponified Tissue . This is a situation when the body fat turns into wax under certain special conditions. When a person is killed and thrown away in a forest, his body will normally putrefy. But if there is water in the vicinity or the ground on which the body is thrown is wet and the temperature is quite high then the conditions are just right for the body fats to turn into wax. A very complex chemical reaction takes place for this to happen. For the more scientifically-minded readers, the unsaturated body fats are first saturated to firmer fats and this firmer fat is then split into fatty acids and glycerol. Glycerol usually drains away. The remaining fatty acids (mainly saturated fatty acids such as palmatic acid, stearic acid, hydroxystearic acid and oleic acid) may then combine with body calcium to form soaps and waxes. Adipocere is thus essentially composed of saturated fatty acids such as palmatic acid, stearic acid, hydroxystearic acid, oleic acid and their calcium salts. Adipocere forms mainly at those parts of the body where there is a lot of accumulation of body fat. Such areas are cheeks, buttocks, breasts and thighs. Since Saroj's body had been thrown near a pond, the conditions were just right for her body to be turned into adipocere. Once a body turns into adipocere, it does not undergo normal decomposition, and remains as such. It gives the forensic expert a lot of benefits. For one thing, the features of the person remain discernible. Secondly, since the body is more or less preserved, one can say how the person died. Adipocere is a yellowish white, greasy, wax like substance with a rancid smell. It is lighter than water. If we cut out some adipocere from the body of such a person, and put it in water, we find that it will float. It cuts easily and burns with a faint yellow flame giving offensive odor. Fresh adipocere is soft and moist, but old samples are dry and brittle. Adipocere takes about 3 months to form, so we can form a idea when the person was done to death. The body of Saroj was found on January 15, 1988. So, at a rough guess, she must have been killed on or around October 15, 1987. She had been kidnapped on June 8, 1987. So it appeared that she had been kept in captivity for about 4 months. This pointed to her having been used for sexual purposes. Since her body was well preserved, I could examine her genitals, which too had been converted into adipocere. Her hymen, the soft membrane which cover the vagina, was completely mutilated indicating that she had indeed been used for sexual intercourse. Her left breast and both buttocks showed very clear stab wounds. These stab wounds would normally have been obliterated if normal putrefaction had set in. But since her body had been converted into the wax-like adipocere, the stab marks were clearly visible. Her kidnapping and confinement, her use as an object of sexual intercourse and the method of her killing, all pointed to the dreaded Devi gang which had earlier done the same deed. Devi gang had big political connections and until and unless the police had solid clues to back them, they could not dare to touch the gang. But now since I had provided them with all vital clues, they went fully armed to nab the Devi Gang and made tough inquires. Sure enough, very soon, the gang cracked up and confessed to the abduction, sexual molestation and killing of Saroj. They had to finally kill Saroj because she had become pregnant. When the case went to court, the court admitted my medical evidence and had no difficulty in convicting the members of Devi gang. In this particular case, my knowledge of science helped me to unravel crime. A non-specialist would have been quite nonplussed to see the waxy body of Saroj, but I knew it was adipocere. To summarize, this adipocere formation helped me to (i) establish her identity (ii) establish the cause of her death and (iii) indicate the time of her death. These facts together enabled me to weave a coherent story which ultimately helped in catching the culprits.

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Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE MARCH 1997 ISSUE THE POISON SLEUTHS THE MYTH OF THE SPANISH FLY -Dr. Anil Aggrawal "Good morning doctor. Oh, my God, what are you doing with the dead body of this young woman? " "Good morning Tarun. This is the body of an unmarried 20 year old girl Rita. She was in love with one Suresh, who is a student of Ayurvedic medicine. It is suspected that they had secret relations and Rita was pregnant. In order to get rid of this unwanted pregnancy, Suresh secretly administered some drug to her. Immediately thereafter Rita complained of severe cramps in her abdomen. She vomited blood, passed blood in her urine, and died in about 4 hours." "So her body has been brought to you, so you can tell the police how she died?" "Exactly. The police apprehended Suresh, but he has alleged that he did not give anything to her. He has also alleged that she had an ulcer in her stomach which might have perforated and given rise to these symptoms. So it has become extremely important for me to find out the truth. Stomach ulcer does give rise to some of the symptoms exhibited by her, but at her age one does not generally get stomach ulcer. Moreover a patient of perforated stomach ulcer does not pass blood in the urine. To me it seems more like a case of Spanish Fly poisoning..." "What! Spanish Fly!! What kind of a poison is that? To me it appears the name of some insect rather than poison." "Yes Spanish Fly indeed is an insect. But the name is rather a misnomer. It is neither strictly Spanish nor a fly. It is a beetle belonging to the order Coleoptera, and Family Meloidea. Besides Spain, it is also found in several other Mediterranean countries such as southern France, and Italy and also in Russia. In Europe, it is usually found clustered on privet (an evergreen shrub, bearing small white flowers, much used for garden hedges) or such trees as ash or elder. Also known as blister beetle, it is about 2 cm long and 0.75 cm broad and is usually found on olive trees. Its body and wings have a shiny metallic green color. Its biological name is Cantharis vesicatoria. It is the most celebrated of all aphrodisiacs. When an average person thinks of an aphrodisiac, Spanish Fly comes immediately to his mind. "Just a minute doctor. You have introduced certain terms which I don't quite understand. You say that Spanish Fly is also known as the blister beetle. Why is that? And what is an aphrodisiac?" Spanish Fly. These are the crushed bodies of the insect, which can be used as a poison "Tarun, Spanish fly has a chemical in its body known as Cantharidin. It is an irritant. When it is rubbed over the body, it produces blisters. That is why it is known as blister beetle. The term aphrodisiac comes from Aphrodite, the Greek Goddess of love and beauty. When the dried and crushed body of Spanish fly is ingested, it causes severe inflammation in kidneys, ureters and all other organs of genital tract. Because of this property there is a swelling in genital organs. This gave rise to a false belief that Spanish fly could be used for the treatment of impotent people. There is however no truth in this. The swelling of the genital organs, instead of being pleasurable, is extremely painful. Moreover, the dose required to produce such swelling is close to the fatal dose. In women, it may cause violent and painful contractions of the uterus. Because of this, the beetle is sometimes administered by quacks for inducing clandestine abortions." "Are there several types of Spanish flies doctor?" "Tarun, Several different genus and species of beetles are known to contain Cantharidin. All of them have been called the Spanish fly. In the USA, Epicauta and Nemognatha genuses are commonly encountered, of which Epicauta vittata is very well known. In India, three different varieties are found. One variety known as Telni Makkhi (Mylabris cichorii), occurs abundantly in the rainy season in certain parts of North India, especially Kashmir. Another variety (Mylabris pustulata), is found in the fields of cereals and vegetables in the neighborhood of Bangalore. The third species known as Mylabris macilenta is found in southern regions of our country. In Morocco it is available freely in pure form or as an ingredient in the melange of hot spices called ras el hanout, which is usually taken to increase the libido. In 19th century France, it was commonly available as philtre amoureux or love philtre. "Doctor, how is the so-called aphrodisiac made from these flies?" "Tarun, by tradition the beetles were gathered before sunrise while still torpid and unable to fly, the collectors veiling their faces and hands before shaking them down on to cloths laid on the ground. This method may still be in use today. The insects were then dried and heated until they disintegrate into a fine powder. The powder can be easily recognized from its bright green metallic lustre. Several proprietary medicines are made from this powder. In USA, cantharides collodion is in recognized topical use for wart treatment. Cantharidin is used in several hair oils in India. The belief is that the cantharidin stimulates the hair roots and induces them to grow, but this belief has little scientific sanction. Sometimes a tincture is produced by dissolving the powder in alcohol. A vinegar type preparation may also be produced by percolation with acetic acid and water. Aphrodisiac sweets were made by impregnating sugared sweets, and were widely used under the name pilles galantes. They were also sometimes called pastilles de Richelieu, because Duc de Richelieu (1585-1642) administered them to his mistresses. As you must surely be knowing, he was chief minister to the French king Louis XIII from 1624 till his death in 1642. It was said that Madame du Barry, a famous French courtesan, referred to them as pastilles de sérail (pastilles of the seraglio), using them on herself, or perhaps administering them to young women to prepare them for their amorous duties with the ageing Louis XV. " Doctor, earlier you said that Spanish Fly contains a chemical known as cantharidin. Could you please let me know a little bit more about it?" "Yes, certainly. Cantharidin was isolated in 1810 by a French chemist, Roviquet. It is present in the ovaries, soft tissues and blood of the beetle. Cantharidin is a comparatively simple organic compound which occurs as colorless, odorless crystals..." "But doctor, you have just said that Spanish Fly powder is bright metallic green...?" "Tarun, although the Spanish Fly powder has a bright green metallic lustre, cantharidin- its active chemical constituent- is colorless. These crystals glisten in light yet give no color reactions and can not be detected by any simple chemical test. The old powdered preparations of Spanish Fly can however be identified by using a microscope to show the characteristic fragments of insect in the powder. "What is its fatal dose doctor?" "Tarun, about 1.5 grams of powdered Spanish Fly or 50 mg of pure crystalline cantharidin is enough to cause death. I must tell you that although Spanish fly is not an aphrodisiac at all, it has been used effectively in veterinary medicine in breeding farm animals." "What symptoms does one experience on swallowing the poison?" "When swallowed, there is a burning sensation in the throat and stomach, difficulty in swallowing, nausea, abdominal pain, vomiting of blood stained material, intense thirst, and diarrhoea with blood and mucus. As time passes, kidneys get damaged. There is a dull heavy pain in the loins, and a constant desire to pass urine, but only small amount of blood stained urine is passed This last symptom is known as strangury. After some time, convulsions occur and death occurs in 24 hours. Occasionally, blister formation may take place in the mouth and other parts of the gut with which the poison has come in contact. You will remember that Rita had several of these symptoms." "Yes, I do. Suresh probably gave it to her for abortion. But you told me earlier that it has a great - although false - reputation as an aphrodisiac. Has anyone administered it to someone to increase the desire" "Tarun, there is a very interesting case in which a married man Arthur Ford deceptively administered Spanish fly powder in coconut candies to two female colleagues, both of whom had earlier spurned his advances. He approached a pharmacist he knew personally to provide him with some cantharidin. It was used in those days in some lotions, so it was usually available with pharmacists. He gave the reason as administration to a neighbor's rabbits which were not breeding fast enough! Although the pharmacist was known to him, he refused to oblige. Ford returned during the lunch hour when the pharmacist was absent and stole some cantharidin. With a pair of scissors he inserted the powder in coconut candies and gave it to his female colleagues. His idea was to increase their desire, so that they may come running to him in his arms, but quite predictably both of them died and Ford got six years in jail! This celebrated case of Spanish fly poisonings occurred in UK in 1954. But about two centuries earlier another famous case occurred..." "What was that case doctor? Please tell me about it." "Tarun this case is most interesting. It is a very long and interesting one, but I shall tell you only the gist. On Saturday, 27 June 1772, the notorious French sex pervert Marquis de Sade (1740-1814) with the help of his valet Latour, arranged for four French prostitutes to gather at a place where he wanted to have fun with them...." "Sorry to interrupt you doctor, but isn't he the same man after whom the word Sadism has been coined?" "Yes, you are right Tarun. Although de Sade was a sex pervert, he was a great writer too, and has written such classical books as 120 Days of Sodom, Justine and Juliette. His writings revolved around a single dominant theme: cruelty of every kind performed for the purpose of achieving sexual excitement. This practice was later named "sadism". "Yes, so we were talking about Marquis de Sade...." "Oh yes Tarun. After he had called the prostitutes, he gave them sweet aniseed (saunf) balls laced with Spanish Fly, in the belief that it would "set them on fire". Later on the same day evening he met another - the fifth- prostitute and repeated the same practice with her. She as well as one of the earlier 4 prostitutes started having incessant and uncontrollable vomiting. You might wonder why the other girls did not get poisoned. Well, they had secretly dropped the sweets on the floor after suspecting something black at the bottom. A written complaint of poisoning was formally lodged on Tuesday, 30 June 1772. The investigating officer was Jean-Pierre Chomel, Lieutenant Général criminel at the Seneschal's Court in Marseille. He collected the sample of vomit and sent it for chemical analysis to two toxicologists, André Rimbaud and Jean-Baptiste Joseph Aubert. The first suspicion was that the poison was arsenic. We have already discussed about this poison in our last meeting. It may be interesting to note that in 1772, the methods of chemical analysis of poisons were extremely primitive, the first reliable chemical test of note for any poison being developed in 1836 for arsenic." "Yes, we talked about that last time. That was the Marsh test. Were these toxicologists able to detect cantharidin from the vomitus?" "No, they used very primitive methods, which could not determine the nature of the poison. The maximum they could say was that it was neither arsenic nor corrosive sublimate, the two poisons known in those times to cause severe vomiting." "This means that de Sade and Latour must have gone scot free." "Tarun, as we discussed in our very first meeting, in those times poisoning was considered a very grave offense, and the tendency of the authorities was to punish the suspects irrespective of the presence of evidence. The failure to detect poison did not, therefore, deter the legal authorities. Police teams were dispatched to arrest both de Sade and Latour, but they had fled. On 3 September the same year, despite the absence of both Marquis de Sade and his valet, the case was brought to trial. Both de Sade and his valet were found guilty of poisoning and sodomy. They were sentenced in absentia. The Marquis de Sade was to have his head struck off while Latour was to be hanged or strangled by the public executioner. Afterwards their bodies were to be burnt and the ashes scattered. However as both of them could not be caught, their straw effigies were hanged on 12 September 1772. For an utterly wrong belief, two innocent girls were in agony for almost a week, and almost lost their lives. This case occurred almost two and a quarter centuries back. But it is indeed unfortunate that Spanish fly still enjoys a reputation as an aphrodisiac and figures largely in lavatorial jokes and bawdy ballads. Its use is to be actively discouraged. "Yes, surely it must. But doctor, in the second case, which occurred in 1954, doctors must have been able to detect the poison quite successfully?" "Tarun, it is interesting to note that although almost two centuries had elapsed between the two cases, the advances in knowledge and technique brought about during this period still seemed scarcely sufficient for the task of solving it. The chemical analysis of the poison in Arthur Ford's case was done by Dr. Lewis C. Nickolls, director of the Metropolitan Police Laboratory at New Scotland Yard. He also could not find an infallible chemical test for it. He concluded that there were only three ways in which one could arrive at a positive identification for cantharidin: by its melting point; by the X-ray diffraction pattern obtained from its crystals; and by the standard observation that, when cantharidin is applied to human skin, pain and blistering are produced. But these tests can not be called ideal. For instance, applying cantharidin to skin can be dangerous....." "Really? How? Tell me doctor." "Tarun, in 1953- just one year before the notorious Arthur Ford case- an important case of accidental death with Spanish Fly had occurred, in which the poison seeped through the skin. A keen 43-year old fisherman had managed to obtain some cantharidin, believing it would attract fish...." "It is indeed remarkable how such bizarre beliefs have centered around Spanish Fly. Isn't it doctor?" "Yes, sure, and all of them are wrong. Well, we were talking about that fisherman. After shaking up the powder with water, he stopped the mouth of the bottle with his thumb, and then, within minutes, unfortunately pricked his thumb with one of his fish hooks. Within half an hour he was ill, within three days dead. This shows that the drug can penetrate broken skin, and possibly unbroken skin too, with toxic if not fatal results." "Oh, that certainly is most interesting. Doctor what have you found in the post-mortem of Rita?" "Tarun, Rita's mouth showed blisters, which at once made me suspicious about Spanish Fly. The whole alimentary tract from the mouth downwards is inflamed. You can see it is completely injected with blood. But the finding that has nabbed Suresh is the presence of bright green particles in Rita's stomach and intestines..." "Oh, yes sure. I can see bright metallic green particles sticking on the walls of stomach. Are there more clues doctor?" "Oh yes there are, but none as specific as the finding of green particles in the stomach. You can see that the kidneys and ureters are congested. The uterus is congested and it shows a fetus about 2 months of age. It is almost sure that Suresh administered Spanish Fly to abort this fetus to save her from the ignominy of childbirth before marriage." "Great, let us go and tell about this to the police." "Oh, I have already done that Tarun, and have instructed the police specifically to look for some bright metallic green powder in his possession. I knew that if this powder is found in his possession, Suresh's lawyers would find it very difficult to save him. And do you know what? Police specifically looked for this powder and has actually been able to locate it in one of the shelves of his house. Had I not informed them about it, they would probably have left it untouched. So Forensic medicine has indeed been able to nab Suresh." " Oh, Great, 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 Boron, which as you shall see is a very important poison. "

Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE JULY 1998 ISSUE THE POISON SLEUTHS DEATH BY DNOC -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 her? Please tell me." "Good morning Tarun. The name of this young girl is Seema, and she died this morning in the hospital. Yesterday night she had some severe problem for which her neighbors had taken her to a hospital, but there she died soon after. Well, let me tell you everything from the beginning. She is 24 years old and used to live alone. She is originally from UP, where her parents and family is still residing. She was doing a job in Delhi as a typist, and so was living here for about 2 years. She apparently had a love-affair with one of her colleagues Ramesh. They had a good relation for quite some time, and there were rumours that they were even going to marry." "Oh, I see. But how did she die?" "About a month back, Ramesh's parents fixed his marriage somewhere else, to which Ramesh also did not object much, which in effect meant, that he had tacitly consented for the marriage. When Seema came to know about it, she became mad, and there was a verbal duel between the two. Quite coincidentally, this happened in their office, and everyone saw them fighting them in this manner. That's how we know about this incident." "What was she saying during the verbal duel?" "The colleagues who were present there told the police, that the verbal duel suddenly started and went on for about 15 minutes, till their colleagues intervened. She was saying that Ramesh had shown utter meanness and had deserted her because of her looks. As you can see, she is quite fat. I have measured her height and weight. She is 157 cm in height and her weight is 76 Kg, which as you can see is quite much for her height. Apparently there were sexual relations between the two also, and she was heard saying that Ramesh used their friendship for his advantage, and is now deserting her. He never intended to marry her in the first place." "Is this accusation correct?" "Well, nobody knows for sure. But from what I hear from the office colleagues, Seema was not a very attractive girl, and no male was much interested in her, except for official relations. If Ramesh started nurturing relations with her, it's quite possible, that he was looking for some free fun. Once he had his fun, he decided to marry elsewhere." "Are you hinting that he killed Seema?" "No. Not me. I do not say anything before I have scientifically confirmed my facts. The sequence of events was this. Ramesh had visited her flat last night. Apparently the meeting was aimed at reconciliation. Ramesh wanted to explain Seema the circumstances under which he was marrying elsewhere. The fact of his visit last night is confirmed by Seema's neighbors. Even Ramesh himself has agreed to this fact. Apparently, he stayed there for about 15 minutes and then left. Sometime after he left, Seema knocked at a neighbor's door and told her she was not feeling well. She was sweating profusely, had very high fever, complained of intense thirst, and was in great distress. The neighbors immediately realized that something was terribly wrong with her. They took her to the nearby hospital. Before the doctors could ask her anything, she fell into a coma, from which she never recovered. She died after 6 hours." "Oh, I see. So how did she die? "I will tell you about that a little later, when I tell you about my scientific deductions. But before that, it would be very necessary for you to know, why this case has been brought to me. Her parents were immediately informed by the neighbors and they have arrived this morning. After hearing everything, they have put a very damning allegation on Ramesh. They say that last night during his visit, Ramesh must have given her something to eat because of which these symptoms started. The fact that the symptoms started just after Ramesh left has given credence to this allegation. The police also believes this theory. They think that Ramesh wanted to get rid of Seema, otherwise she could have made life hard for him. She could even have kept troubling him after marriage, and could even infuse all kinds of doubts in the mind of his future wife, so the best course for Ramesh was to put an end to her life." "What does Ramesh have to say in this regard?" "The police has enquired Ramesh, and he says that he did visit Seema to explain her his position. The marriage was being held at the instance of his parents, and he could not interfere in that. But Seema was not ready to listen to him. She was very depressed. After about 15 minutes of unsuccessful attempts at reconciliation, he left." "What do the doctors at the hospital say about the cause of her death?" "The doctors did not have much time to examine her. I have talked to the doctors there. They feel it could be a case of salicylate poisoning or perhaps even thyrotoxicosis." "I don't really understand these two terms. Please explain them to me." "Tarun, acetylsalicylic acid is used in modern medicine for the relief of pain. Ordinary dispirin, which is available in the market for pain relief contains 350 mg of acetylsalicylic acid. If too many tablets are ingested, one can get salicylate poisoning. The toxic dose of acetylsalicylic acid is about 200-300 mg/kg. Thus you can plainly see that for Seema who was 76 kg, the toxic dose is about 65 tablets. People may ingest pain killers for committing suicide. This practice although very common in foreign countries, is not so common in our country, mainly because people are not aware of this fact. But Seema was an educated girl, and she might be well aware of this fact. She was depressed because of recent developments and she might have ingested these tablets after Ramesh left. Ramesh obviously could not give her so many tablets to eat, and even if he had given her, she would not have eaten them. So if this case does turn out to be that of salicylate poisoning, it is quite probable that Ramesh is indeed speaking the truth, and had nothing to do with her death." "Why did the doctors at the hospital think in the first place that she was having salicylate poisoning?" "Because of her symptoms. The symptoms of high fever, thirst and profuse sweating are seen in salicylate poisoning. It might surprise you to know, that although acetylsalicylic acid is normally used for the control of high temperature, during overdose, it produces high fever itself. The doctors also noted difficulty in respiration and very rapid heart rate. Before she went into coma, she also had convulsions. These features are quite typical of salicylate poisoning. The same features are also seen in thyrotoxicosis, a disorder of the thyroid gland, in which the thyroid starts secreting excessive amounts of thyroxine. That is why the doctors gave this as the second diagnosis." "Oh, so now we have all the views. Now tell me what your investigation reveals." "Tarun, we can straightaway rule out thyrotoxicosis. In this disorder, the person is excessively lean and as you can see, Seema is very much overweight. Acetylsalicylic acid poisoning seems a more likely choice. But when I examined her hands, I found some yellow stains on them. This, and certain other findings, which I shall explain shortly, immediately alerted me in the direction of another poison- a very rare one, but one which causes exactly the symptoms exhibited by Seema" "What is that poison doctor? Please tell me. I am getting curious." "Tarun it is known as DiNitroOrthoCresol or DNOC for short." "DNOC? Never heard of this poison. Please tell me something more about this poison." "Tarun, DNOC belongs to a family of compounds known as dinitrophenols (DNP). These compounds are highly toxic and can rapidly produce death. Toxic effects often appear at blood concentrations greater than 30 mg/l while concentrations greater than 60 mg/l are associated with severe toxicity. Dinitrophenols are mainly used as pesticides. Dinitro-ortho-cresol (DNOC) and Dinitrophenol are the two main phenolic pesticides. These substances are used in agriculture chiefly as selective weed killers for cereal crops and for the destruction of potato haulm. In dilute solution they may be used as an insecticidal winter wash for fruit trees. The principal risk of poisoning is in the agricultural use of concentrated solutions for spraying crops. Absorption occurs by inhalation and ingestion and also through the skin; excretion is extremely slow so the poison tends to accumulate in the body. The risk of absorption is much greater during hot weather. Those exposed to these chemicals (such as farmers when spraying these chemicals) are generally recommended to wear respirators to avoid inhaling them. They are also subjected to periodical examination to determine the concentration of these compounds in the blood, which should not exceed 20 micrograms per gram. Dinitrophenolic compounds, especially DNOC stimulate the human metabolism very strongly. In fact DNOC can increase the tissue metabolism by 1200%! The effects of dinitrophenol in stimulating metabolism have been known since 1885, and at one time DNOC was even used in the treatment of obesity and misused for "slimming". "I couldn't understand that last point very well doctor." "Tarun, any compound which stimulates metabolism that greatly basically burns up your energy stores in the body. The main energy store in the body is the fat. If it is burnt, the person will get slim. All exercises are aimed at this only- to burn as much fat as possible. But exercise is time consuming, boring and exerting, so people are on the lookout for easy way out such as chemicals and drugs which can either reduce appetite or enhance metabolism, i.e. help burn up excessive fat. For the former effect, drugs known as amphetamines were once very popular, but they have lost favour as their side effects are too many and too serious. DNOC stimulates metabolism by as much as 1200%, i.e. it burns fats 12 times faster than in a normal man. Obviously this will form a good candidate for weight reduction." "Then why don't doctors prescribe it for weight reduction?" "Because it is a very toxic drug. But early in the century several people did take it for the reduction of weight. When fatalities started occurring, the doctors came to know about its serious toxic nature, and they advised the people against taking this drug. But it was commonly available, as it was a herbicide, so people purchased it with impunity and many overweight girls are known to have consumed it in an attempt to become slim overnight. But in fact nothing of that sort happened. They died instead. Following the deaths of several girls in this way, the availability of this drug was restricted to certain people only. But still many people can get hold of this drug and may consume it. You may be surprised to know that today DNP and DNOC can be illegally bought over the internet too! Many gullible youngsters who fall prey to these internet advisers are paying with their lives. These internet advisers are quacks who encash upon the gullibility of such youngsters. They claim that their concoction would cause a quick weight reduction, but it doesn't. It kills them instead. DNOC is about 5 times as potent as dinitrophenol. The characteristic effect of these two drugs is the uncoupling of the oxidative phosphorylation, causing a great increase in tissue metabolism......" "Sorry to interrupt you doctor. You just talked about uncoupling of oxidative phosphorylation. I don't understand this term quite well. Can you explain me please?" "Tarun, this is a technical term the details of which I may not be able to explain in such a short discussion. But I will tell you certain basics. When glucose is burnt in the body to carbon dioxide and water, it passes through 3 stages. The last stage is technically known as oxidative phosphorylation. During each stage some energy is liberated, which is stored in the form of ATP (Adenosine TriPhosphate) molecules. DNOC and other dinitrophenolic compounds inhibit the formation of ATP molecules, without inhibiting the process of oxidative phosphorylation. This means that although body is burning glucose continually, it is not getting any energy in the form of ATP molecules. This situation when energy is being produced, but is not available for the formation of ATP molecules is technically known as uncoupling of oxidative phosphorylation. This excess energy has to be dissipated in the form of heat. That is why patients poisoned by this poison show high body temperature and sweating. Since body is not getting adequate amounts of energy, it tries to burn more and more glucose in a futile attempt to get energy. Even fat stores are mobilized, but all the energy produced is dissipated as heat. This is the basis of increase of metabolic rate by these compounds." "Oh, I see. But the symptoms are also seen in salicylate poisoning. How did you know she had taken DNOC?" "By the yellow stains on her hands. This yellow staining is very typical of dinitrophenolic compounds. When these compounds come in contact with skin, they form trinitrophenol or picric acid, which is yellow in color. By the yellow stains on her hands, I immediately realized that she must have handled dinitrophenol compounds. I believe she was quite concerned about her weight, and was taking this compound reqularly in small doses. I do not know where she procured this compound from, but probably she must have contacted one of those quick weight reducing quacks, who must have given her this compound. When she was taking small doses, nothing dangerous happened. But due to recent developments, she was quite convinced that she had lost Ramesh because of her weight problem. In a bid to overcome her weight problem overnight, she must have tried to get at it in one go, and may have consumed a great amount of drug immediately after Ramesh left. That is how the symptoms appeared." "But how are you sure, Ramesh did not administer her this drug?" "Because of this drug's peculiar color, odor and taste. No one can administer this drug to another by deceit, without the other immediately coming to know about it. I have exmained her blood and have found high amount of DNOC in her blood. The levels are about 100 mg/l, which is surley a fatal level. Subsequent to this, I asked the police to search her house and look for all medication bottles there. Normally the police would never have even peeped there. But following this discovery, they looked at her almirah and did indeed find a medicine chest. They brought her entired medicine chest. I noticed 3 suspect looking bottles and put their contents to examination, and in one of these, not very surprisingly, I did find high amounts of DNOC. The police have noted the name and address of the doctor from the label of that bottle, and a party has been despatched to UP to arrest that doctor. It appears that the quack who prescribed this medicine to her is based in UP, and during one of her visits to her parents, Seema must have picked this medicine." "Oh, how very clever of you doctor. Without your clever deduction, poor Ramesh would have unnecessarily been arrested and implicated. This was a most interesting discussion. Tell me what are you going to tell me the next time?" "Tarun, next time, I would tell you about a very interesting poison- Cadmium."

Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE JULY 2000 ISSUE THE POISON SLEUTHS DEATH BY POTASSIUM BROMATE -Dr. Anil Aggrawal "Good morning doctor. Oh, my God, what are you doing today? You have the dead body of a young child today. What happened to him? Please tell me.” “Good morning Tarun. The name of this young child is Nitya, and he is four years old. He was the only son of his parents. Till yesterday evening he was alright. He was playing in front of his house quite cheerfully. After sometime, he started vomiting and felt very restless. His parents noted that he vomited some blood too. They became very afraid, and took the child immediately to the doctors. The doctors took it to be a case of gastroenteritis and started treating him along those lines. However the child failed to show any improvement and died today morning. Now the police has brought his body to me. My job of course is to tell them, how Nitya has died.” “But surely Nitya has died due to some natural disease. We don’t really need a post-mortem in this case, do we?” “Tarun, the doctors at the hospital where he was being treated have refused to give any cause of death. They say, that they just did not have the time to diagnose his disease. For all we know this could very well be a case of poisoning too.” “Really? Have the parents of Nitya given some hint in this direction?” “Police has made some enquiries and have come up with some interesting results. Ramlal, the father of Nitya was not going along well with his neighbor Raghav. Both Ramlal and Raghav claimed a hundred square yard plot somewhere in Ghaziabad. A court case was also dragging on in this connection for quite sometime. Recently there had been indications that Ramlal would ultimately win the case. Raghav had become very restless after that. He had sworn several times before neighbors that he would teach a good lesson to Ramlal. It is quite probable that Raghav gave some kind of poison to Nitya to get even with Ramlal.” “What do you think Doctor?” “Tarun, the first thing I did was to ask the police what Raghav does. They told me that he works at a modern hair saloon called “Hairwaves”. Now “Hairwaves” is really a very modern and posh hair saloon offering all kinds of hair treatments to their customers. The moment I heard this, I immediately became attentive, because a chemical potassium bromate usually found at hair saloons usually produces the kind of symptoms Nitya showed. Come to think of it, I think Nitya in fact has been poisoned by Potassium Bromate.” “But doctor how can you be so sure?” “Potassium bromate seems the most likely candidate Tarun. Now let me tell you that in Japan, in the 1960s and 1970s there were about 20 cases of suicides by hair dressers. And do you know which chemical they used for self-poisoning? All of them used potassium bromate, because this is so easily available to hair dressers.” “Doctor, it looks like we are on to one of your great stories. Why don’t you tell me about potassium bromate from the beginning?” “Tarun, the chemical formula of potassium bromate is KBrO3. Both Potassium and sodium bromate (NaBrO3) have no medicinal use. They are used solely as flour bleaches and as “neutralizers” in cold wave hair permanent kits, which can contain either 2% potassium bromate or 10% sodium bromate.......” “Sorry to interrupt you doctor, but what are flour bleaches and how are they used?” “Tarun, flour that we get from wheat has to be “treated” with the use of “improvers”. These “improvers” are nothing but oxidizing substances which enhance the baking quality of flour, allowing production of better and larger loaves. Relatively small amounts of these “improvers” are required, generally a few parts per million. Similarly to reduce the yellowness of the flour, bleaching agents may also be required. Although such improvers and the bleaching agents used to rectify excessive yellowness in flour are permitted in most countries, the processes are not universal. Improvers include bromates, chlorine dioxide (in gaseous form), and azodicarbonamide. The most popular bleacher used is benzoyl peroxide. But in many places potassium bromate is still used.” “Oh, I see. You used another word ‘neutralizers’. What are these?” “Tarun, there was a time when making the hairs wavy had become a fashion. In the late 1940s and during whole of 50s, it was fashionable to make the hair wavy. To do this, the hair was first treated with a milky waving lotion, the active ingredient of which was ammonium thioglycollate. At the appropriate time its effects were arrested by applying a neutralizer, i.e. a solution of potassium bromate, prepared from a small packet of the crystals. Outfits for permanent waving of hair by a cold process in the home became available in the UK round about 1950 and a little earlier in the United States. In the US in the late 1940s and early 1950s, home kits for making hair wavy were easily available, resulting in several cases of bromate poisonings, primarily in children under the age of 4. As I told you earlier, in Japan several cases were reported where hair dressers had apparently taken potassium bromate as a suicidal agent.” “Oh, that is most interesting. So this chemical is so dangerous that it can kill too?” “Yeah, and what makes it still more dangerous is that it is colourless, odourless and tasteless too, thus making it a very good candidate as a homicidal poison. A substance which is colourless, odourless and tasteless can be very easily administered to a victim mixed in his food, without him knowing anything about it. For the same reason, it can be taken by mistake too, especially if left in a cup or milk bottle. Cases have been reported in medical literature about the death of children who have ingested hair neutralizer accidentally. Many toxicologists in fact have talked about the possible danger of the ‘home perm’ outfits.” “Doctor, what are the other circumstances in which potassium bromate may be ingested by a human being?” “The majority of cases of poisoning are of course the result of accidents. A case has been described in the medical literature of the accidental poisoning of four adults who drank coffee prepared with fluid which proved to be hair neutralizer placed in an empty milk bottle. Except that they had thought the coffee tasted salty they were unaware of its nature until, half an hour later, they were seized with abdominal cramps and vomiting and, at the end of an hour, abdominal pain of a griping nature and diarrhoea. Fortunately all four made a complete recovery at the end of 24 hours. Hair neutralizer was administered by a woman to members of her family, apparently to enable her to enjoy the company of another man. She put some in her husband’s tea, and in orange squash which she gave to her daughters. The husband had abdominal pain which was ascribed to dysentery contracted while absent on military service. When the others became ill, the doctor suspected poisoning. The woman was later convicted of administering poison with intent to injure and was sentenced to 18 months imprisonment.” “Oh, that is quite interesting. What are the symptoms after ingesting this poison?” “Tarun, this compound is absorbed almost unchanged in the gastrointestinal tract. A very slow reduction of bromate to bromide may occur in the body, which can minimally elevate bromide levels in the blood. Potassium bromate causes gastrointestinal irritation and kidney damage as its principal effects and there may be incidental damage to the liver. Unlike potassium chlorate, however, potassium bromate does not break RBCs, a process known as haemolysis. The gastrointestinal symptoms are non-specific. Within half an hour the patient has nausea and vomits and this may be accompanied by epigastric cramps. Vomiting is repeated and may continue for a few days. There may be blood in the vomit. Within about an hour there is abdominal colic and diarrhoea. Some toxicologists think that the stomach and intestinal complaints are due to the caustic hydrobromic acid produced when bromate reacts with gastric juice. I may tell you that in Potassium chlorate poisoning, a special compound is formed in the blood. This is known as methemoglobin, and is chocolate brown in color. This feature has not been detected in humans with bromate poisoning. Fall in blood pressure may or may not occur. Severe poisoning leads to damage of kidneys and in consequence there is decrease in the formation of urine, coming to a complete halt after some time. This causes a rise in the blood urea concentration. In some cases generalized seizures are seen. It has been estimated that the fatal dose of potassium bromate is about 240-500 mg/Kg. If 300 mg/Kg is taken as the average fatal dose, then about 18 g would be required to kill a 60 kg man. The weight of Nitya is about 14 kg. So only about 4-5 g of potassium bromate must have been needed in this case. If you look under the microscope you would find that the kidneys of Nitya are damaged. Technically this change is known as renal tubular necrosis. Similarly I am also finding damage to his liver and heart, both of which are seen in potassium bromate poisoning. I have also recovered potassium bromate from Nitya’s stomach and have chemically identified it. There seems little doubt now that he was poisoned. And Raghav is indeed the poisoner. It was only he who had access to this dangerous chemical. He must have been taught during the course of his profession that this is a dangerous chemical. He somehow was able to smuggle some amount of Potassium bromate from his work place to his home. When Nitya was playing in the evening, he must have approached him with some kind of drink, may be a sherbet, in which he must have mixed potassium bromate. He wanted to kill Nitya, which was his way of getting even with Ramlal. Come let us tell the police who the culprit is. They will search his house, and if any of the remaining chemical is found in his house, everything would become very clear.” “That is very clever of you doctor. Without your clever deduction it would have been impossible to say how Nitya died and Raghav 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 - Ethylene Glycol."

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( Volume 3, Number 2, July-December 2002 ) Kill as Few Patients as Possible (and fifty-six other essays on how to be the World's best doctor) , 1997, (Ten Speed Press) , by Oscar London, M.D., W.B.D. ( Volume 3, Number 2, July-December 2002 ) Insects in the detection of Crime (Forensic Entomology) A Fly for the Prosecution , First edition, June 2000, (Harvard University Press) by M.Lee Goff ( Volume 2, Number 1, January-June 2001 ) To go to Forensic Entomology books of a more technical nature, please click here . Investigation Fitted in: The Cardiff 3 and The Lynette White Inquiry , 1997, ( The Fitted In Project ), by Satish Sekar ( Volume 3, Number 2, July-December 2002 ) [Featured Book] Who Killed King Tut? Using Modern Forensics To Solve A 3,300-Year-Old Mystery , 2004, (Prometheus Books), by Michael R. King and Gregory M. Cooper with Don DeNevi ( Volume 6, Number 1, January-June 2005 ) Mystery Plucked and Burned, 2003 ( Redbud Publishing Co. ) by Sylvia Tomlinson ( Volume 7, Number 2, July-December 2006 ) Pharmacology/Pharmacotoxicology Guidelines for the Appropriate Use of Herbal Medicines, 1 st edition, 1998 (World Health Organization Regional Office for the Western Pacific, Manila), ( Volume 5, Number 1, January-June 2004 ) Medicinal Plants in China - A selection of 150 commonly used species (WHO Regional Publications, Western Pacific Series No 2), 1989 (2nd impression 1997) (World Health Organization Regional Office for the Western Pacific, Manila), compiled by The Institute of Chinese Material Medica, China Academy of Traditional Chinese Medicine( Volume 5, Number 1, January-June 2004 ) [Featured Book] Medicinal Plants in the Republic of Korea - Information on 150 commonly used medicinal plants (WHO Regional Publications - Western Pacific Series No 21) , 1998 (World Health Organization Regional Office for the Western Pacific, Manila), compiled by Compiled by Natural Products Research Institute, Seoul National University( Volume 5, Number 1, January-June 2004 ) [Featured Book] Medicinal Plants in the South Pacific - Information on 102 commonly used medicinal plants in the South Pacific (WHO Regional Publications-Western Pacific Series No 19) , 1998 (World Health Organization Regional Office for the Western Pacific, Manila), ( Volume 5, Number 1, January-June 2004 ) [Featured Book] Medicinal Plants in Vietnam (WHO Regional Publications - Western Pacific Series No 3) , 1990 (World Health Organization Regional Office for the Western Pacific, Manila), ( Volume 5, Number 1, January-June 2004 ) [Featured Book] WHO guidelines on good agricultural and collection practices [GACP] for medicinal plants, 1st edition, 2003 (World Health Organization Avenue Appia 20, 1211 Geneva 27, Switzerland), ( Volume 5, Number 2, July-December 2004 ) To go to Pharmacology/Pharmacotoxicology Books of a more technical nature, click here . Poisons and poisoners The Young Poisoner's Handbook, 1995, Produced by Sam Taylor, Directed by Benjamin Ross. Music by Rob Lane/Frank Strobel. Studio - Mass Productions, Kinowelt, and Haut et Court (Jointly), ( Volume 8, Number 1, January-June 2007 ) [DVD (99 minutes)] Police Procedures Police Procedural - A writer's guide to the police and how they work (THE HOWDUNIT SERIES) , First edition, 1993, (Writer's Digest Books) by Russell Bintliff ( Volume 2, Number 1, January-June 2001 ) Ripperology The Ultimate Jack the Ripper: An Illustrated Encyclopedia , 2001, (Constable and Robinson Ltd.) by Stewart P. Evans and Keith Skinner ( Volume 3, Number 1, January - June 2002 ) Scene of Crime Crime Scene , 2002, ( Avon Books ) by Larry Ragle, [ Volume 5, Number 2, July-December 2004 (3 MB pdf file)] Scene of the Crime - A writer's guide to crime-scene investigations (THE HOWDUNIT SERIES) , First edition, 1992, ( Writer's Digest Books ) by Anne Wingate, Ph.D. ( Volume 4, Number 1, January-June 2003 ) Sex Nymphomania - A History , 2001, ( W. W. Norton & Company ) by Carol Groneman, ( Volume 8, Number 2, July-December 2007 ) The X-Rated Bible: An Irreverent Survey of Sex in the Scriptures , 2nd Revised edition 1998, ( Feral House ) by Ben Edward Akerley, ( Volume 8, Number 1, January-June 2007 ) Sherlockiana The Moriarty Principle: An Irregular Look at Sherlock Holmes , 1997, (Galde Press Inc.) by Rolf J. Canton ( Volume 2, Number 2, July-December 2001 ) The Pipe Dream Continues: An Irregular Look at Sherlock Holmes in Minnesota , 1998, (Galde Press Inc.) Written and Directed by Rolf J. Canton ( Volume 2, Number 2, July-December 2001 ) [Video Cassette, running time 58 minutes 30 seconds] Sherlock Holmes and the Skull of Death , 2001, (1st Books Library) by Robert E. McClellan ( Volume 2, Number 2, July-December 2001 ) All About GPS: Sherlock Holmes' Guide to the Global Positioning , 2000, (1st Books Library) by Jerry Huang ( Volume 2, Number 2, July-December 2001 ) Sherlock Holmes and the Adventure of the Three Dragons , 2000, (1st Books Library) by Luke S. Fullenkamp ( Volume 2, Number 2, July-December 2001 ) The Science of Sherlock Holmes - From Baskerville Hall to the Valley of Fear, the Real Forensics Behind the Great Detective's Greatest Cases (2001), ( John Wiley & Sons Inc ) by E.J. Wagner ( Volume 7, Number 1, January - June 2006 ) Terrorism/Counterterrorism America's Achilles' Heel: Nuclear, Biological, and Chemical Terrorism and Covert Attack (BCSIA Studies in International Security), by Richard A. Falkenrath, Robert D. Newman, Bradley A. 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Toxicology Death in the Pot: The Impact of Food Poisoning on History , 2007, (Prometheus Books) by Morton Satin ( Volume 8, Number 2, July - December 2007 ) Molecules of Murder: Criminal Molecules and Classic Cases , 2008, (The Royal Society of Chemistry) by John Emsley, ( Volume 11, Number 2, July-December 2010 ) The Elements of Murder - A History of Poison , 2005, (Oxford University Press) by John Emsley, ( Volume 6, Number 2, July-December 2005 ) The Poisoner's Handbook: Murder and the Birth of Forensic Medicine in Jazz Age New York , 2010, (The Penguin Press) by Deborah Blum, ( Volume 12, Number 2, July-December 2011 ) The Poison Quiz Book: Pearls of Wisdom , 2001, (Boston Medical Publishing) by John Harris Trestrail, III, RPh, FAACT, DABAT ( Volume 3, Number 1, January - June 2002 ) To go to related books of a more technical nature, click here . True Crime Cracking Cases - The Science of Solving Crimes, (2002), ( Prometheus Books ) by Dr. Henry C. Lee with Thomas W.O'neil ( Volume 6, Number 1, January - June 2005 ) Cracking More Cases, The Forensic Science of Solving Crimes , (2004), ( Prometheus Books ) by Dr. Henry C. Lee with Thomas W.O'neil ( Volume 6, Number 1, January - June 2005 ) Childhood Shadows: The Hidden Story of the Black Dahlia Murder, (2000), (1st Books Library) by Mary Pacios ( Volume 2, Number 2, July-December 2001 ) Mortal Evidence: The Forensics behind Nine Shocking Cases, (2003), ( Prometheus Books ) by Cyril Wecht, M.D., J.D., and Greg Saitz, with Mark Curriden ( Volume 5, Number 2, July - December 2004 ) The Man in the iron mask (Celebrated Crimes series) , (Rogue Publishing), by Alexandre Dumas ( Volume 7, Number 1, January - June 2006 ) [E-Book, available as a pdf file] [Featured Book] The Medici Conspiracy: The Illicit Journey of Looted Antiquities, From Italy's Tomb Raiders to the World's Greatest Museums, (2007), ( Public Affairs ) by Peter Watson and Cecelia Todeschini ( Volume 8, Number 2, July - December 2007 ) To go to books on Crime fiction, please visit our sister publication by clicking here .

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SCIENCE IN CRIME DETECTION-14 CONTUSIONS - THE VITAL EVIDENCE A remarkable case came to me in the summer of 1992. Bali Ram, a nine‑year‑old stepchild of Hari Ram and Bhairon Devi had fallen down the stairs and had fallen down the stairs and had died. Actually, when he fell down the stairs, there was a big hue and cry in the neighborhood. Some neighbors came to the spot immediately and brought the child to LNJP casualty. The child was declared dead on arrival and sent to me for post mortem examination. A few facts about the family may be said her, before we go on further. HariRam had lost his first wife Kasturi about 5 years back. She had died of tuberculosis. Bali Ram was Kasturi's son. After Kasturi's death, Hari Ram became a recluse for almost two years, but gradually the shock of his wife's death faded and Hari Ram married for the second time. From the beginning, it was apparent that Bhairon Devi, the new bride hated Bali Ram intensely. In the beginning, she would merely ignore him but gradually she started handing him more severe punishment. She would often beat him and deny him food. I got this history from the neighbor. The moment I got this history, I became very cautious and decided to look for clues that might give me the correct story. The boy had died from head injury which he had sustained during the fall from stairs. There were several fractures on his skull, and the brain inside showed blood clots. This was ample proof that he had indeed fallen down the stairs. However, the clues that could give me some 'behind‑the scene' story still eluded me. Finally I turned over the body and looked for injuries more closely. There were several contusions on the back. these are also known as bruises. In common parlance, in Hindi, we know these as " Neel ". These are commonly caused by blunt force application. I had looked at these contusions before starting the post‑mortem, but at that time I thought that they were produced by fall from stairs. Contusions can indeed be produced by a fall from the stairs. However, when I looked at them closely, I found them to have some pattern. These contusions are known as patterned contusions and are quite helpful in the forensic work. They tell us the shape of the object which was used to hit the deceased. If the hitting object was a lathi or an iron rod, the contusions would be linear in shape. If a hockey stick was used to beat the deceased, the contusions would take the shape of hockey stick and so on. Look at the figure A and you would realize that the contusions indeed have a pattern. I tried to decipher what the object could be, but the exact object eluded me. Then suddenly, like a flash of lightning, the object came to my mind. It had to be a coat‑hanger. The contusions looked exactly like that. I told this fact to the police officer Tejpal. I thought that Bali Ram was first mercilessly beaten by Bhairon Devi and then pushed down from the stairs. If this point of view could be proved, it would change the whole scenario from an accident to murder! The case was beginning to take a serious turn. Bhairon Devi was summoned by Tejpal, the investigating officer, and questioned. She reaffirmed that Bali Ram had indeed fallen down the stairs and she hadn't beaten him. She asserted that she loved Bali Ram like her own child. How ever her neighbors refused to confirm her assertion that she loved Bali Ram like her own child. They asserted that she often beat Bali Ram. Finally Tejpal decided to search her house. The specific thing he was looking for, was the hanger with which Baliram was supposed to have been beaten. Finally he indeed found the hanger and brought it to me. When I matched the shape of the hanger with that of the contusions, the shapes corresponded completely. (See figure B). This testified that the boy was indeed beaten. This evidence broke Bhairon Devi and she confessed the whole crime. She was duly prosecuted by the court on my evidence and sentenced to life imprisonment. This case amply illustrates, how a seemingly trivial clue can turn a case entirely.

Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE AUGUST 2000 ISSUE THE POISON SLEUTHS DEATH BY ETHYLENE GLYCOL -Dr. Anil Aggrawal “Good morning doctor. Oh, my God, what are you doing today? You have the dead body of a young man today. What happened to him? Please tell me.” “Good morning Tarun. The name of this young man is Ramlal and he died this morning. Yesterday night his friend Shyam visited his house with a bottle of liquor as he was reportedly getting married next month, and wanted to enjoy with his friend. Many neighbors saw them enjoying together. He left at around 10 pm. Around 2 am in the night, Ramlal began vomiting severely. Quite alarmingly there was blood in his vomit. At that time only his sister was there at the house. She took him to the hospital, where he died this morning. The doctors were unable to find out what disease he was suffering from. So the police has handed over his body to me, so I can tell them, how he died” “Doctor, are you suspecting some foul play?” “The police certainly is. Ramlal and Shyam are childhood friends. About a year back Ramlal had a severe tiff with Shyam as he had caught him in a compromising position with his sister. Shyam was having an affair with Ramlal’s sister and he (Ramlal) did not like that. At one time in the past, Ramlal had severe fight with Shyam too in this regard. Later Shyam compromised with Ramlal, and swore that he would never meet his sister. Following this Ramlal relented and the two met sometimes, although not as often as they used to be in the past.” “Do you think Shyam give him some poison mixed with alcohol?” “The police thinks so. I have met the doctors and asked them in great detail the symptoms he exhibited at the time of admission. The doctors told me that he was quite inebriated, which was quite natural as till ten p.m. the previous day, he was taking alcohol. But what interested me were the symptoms like coma, seizures, nystagmus, paralysis of muscles of eye and gait, depressed reflexes and tetany. Coma is a technical term for unconsciousness. Nystagmus is also a technical term which describes oscillatory movements of the black circular portion of the eyes (cornea). Tetany refers to spasms of the muscles. Depressed reflexes refers to depression of reflexes like the knee jerk. You may recall that if a person is sitting in a relaxed state, and if his knee is hit gently, at a particular point with a rubber hammer, the lower leg suddenly gives a jerk. This is known in medical parlance as the “knee jerk”. In many diseases, it can not be elicited, i.e. it disappears while in many others it is accentuated. Accentuation of the knee-jerk means that the lower leg would give a more energetic jerk than normal. Knee jerk is a very useful sign for doctors for diagnosing diseases. Neurologists -doctors who diagnose and treat disease of the nervous system - make good use of this jerk for diagnosing diseases. Toxicologists also make use of this knee jerk for diagnosis poisonings, as many poisonings can cause depression of the knee jerk. One of the poisons that cause this is ethylene glycol.” “So you think Ramlal died because of ethylene glycol. Never heard of this being used as a poison. Anyway how can you be so sure that he died of ethylene glycol poison, as you yourself say that many poisons can cause depression of knee jerk?” “That’s right. But look at the cluster of symptoms that he had. They are very typical of ethylene glycol poisoning. Anyway, I would confirm my suspicions by various typical findings after the autopsy is completed..” “Doctor, although I have heard about ethylene glycol in my chemistry class, yet I do not know enough about it to follow your conversation. Kindly tell me something about this poison.’ “Tarun, Ethylene glycol is also called 1,2-ethanediol. Its molecular formula is (CH2)2(OH)2. It is a colourless, odorless, water soluble, viscous, oily liquid possessing a sweet taste and mild odour. It is produced commercially from ethylene oxide, which is obtained from ethylene. Ethylene glycol is widely used as antifreeze in automobile cooling systems..” “Excuse me doctor, what is an antifreeze? Kindly tell me.” “Tarun, antifreeze is a compound which is used in cars to prevent the water in its radiators from freezing. In cold weather, freezing water can cause a burst in the radiator of a car which has been left standing. This freezing can be avoided by adding ethylene glycol to lower its freezing point. Good-quality solutions sold as antifreeze have a sodium-based inhibitor added, to prevent corrosion. Generally a 25% content of antifreeze in the radiator water will give protection against freezing, but some manufacturers prefer 33.33% solution. Antifreeze gives protection against corrosion too, so it is left in the radiator all the year round. An interesting fact is that manufacturers add a fluorescent dye called fluorescein to ethylene glycol. This dye fluoresces in ultraviolet light. This “trick” allows mechanics to detect radiator leaks by using an ultraviolet light. But this very fact can be made use of by doctors in detecting poisoning of patients by this compound. They direct Wood’s lamp on the patient’s urine. If the urine fluoresces, it is a sure sign of ethylene glycol poisoning.” “Doctor, you have used another term with which I am not familiar - the Wood’s lamp. What is it? Is it some kind of lamp made of wood?” “No, no. Wood is actually the name of a physicist who devised this lamp. He was a Baltimore physicist and his name was Robert William Wood (b. 1868). In this lamp, there is a special glass called Wood’s glass, which transmits only the ultraviolet radiation (with some red in the visible region). The radiation thus passed is known as “Wood’s rays”, and have a wave length of about 360 nm. This glass contains nickel oxide. One use of this lamp is for the detection of small spore ringworm of the scalp. I have taken some urine from the urinary bladder of Ramlal and have shone Wood’s light over it. Come on, you can also see it.” “Oh, doctor, I can clearly see the urine fluorescing. This is remarkable. This is enough proof that Ramlal died of ethylene glycol.” “I will do better than that, and come up with some more proofs. So I was telling you that ethylene glycol is used as an antifreeze. It was even used as a coolant in the Lunar Module! It is also used in the manufacture of man-made fibres, low-freezing explosives, and brake fluid. I may tell you that it was discovered as a substitute for glycerine (used in enemas). It has also been used in commercial products such as detergents, paints, lacquers, pharmaceuticals, polishes and cosmetics. It’s other uses are as a preservative in juices and as a deicer. Since the compound is easily available, has a warm sweet taste and produces a state of inebriation much like that of ethyl alcohol, it has been used by poor people in place of alcohol. For the same reasons, it has also been used by people for committing suicide. One can easily mix it in alcohol and give it to his adversary for killing him. Only about 100 ml are sufficient to kill an adult human being. I must tell you that Ethylene Glycol poisoning is one of the most serious and dramatic intoxications encountered in clinical toxicology. Just like methanol and isopropanol, it is used as a second-rate substitute for ethyl alcohol by poor people, because it is cheaper. However, while methanol poisoning occurs in epidemics, ethylene glycol poisoning is sporadic. There was a time when it was used in pharmaceutical preparations (as a solvent), but now it is banned. Yet many cases of poisoning still occur. In May 1998, over 20 children died in Gurgaon after consuming medicines, which were thought to be adulterated with ethylene glycol” “Oh, that’s terrible. How does ethylene glycol kill doctor?” “Toxicity due to ethylene glycol is not as much because of the compound itself, as because of its breakdown produces. Ethylene glycol itself causes some CNS depression, and a state of inebriation quite like that produced by ethyl alcohol. After ingestion, peak blood levels occur at 1 to 4 hours. Half-life of ethylene glycol is 3 hours, which means that half of the quantity ingested would get metabolized in 3 hours. Principally four breakdown products cause damage, namely aldehydes, glycolate, lactate and oxalate. The first three are responsible for severe acidosis. This means that the pH of the blood becomes less alkaline. The damage because of oxalate is because it gets deposited in tissues and causes widespread tissue destruction. Kidney damage is particularly likely. The compound itself is mildly toxic. Acute inflammation of the eye has been reported following accidental eye contact. Contact with skin can cause mild skin irritation. Inhalation can cause toxicity too. Factory workers who are exposed to vapors of ethylene glycol can suffer from chronic poisoning. The symptoms are nystagmus and recurrent attacks of unconsciousness. Toxicity occurs due to two main reasons. Tissue destruction due to deposition of calcium oxalate crystals (mainly in kidneys, but also in brain, blood vessels, liver and pericardium. Because of chelation of calcium, hypocalcemia occurs, and production of severe acidosis due to aldehyde, glycolate and lactate production.” “What symptoms does the victim of poisoning experience doctor?” “Tarun, the symptoms appear in three fairly well-defined phases. The first phase occurs within 30 minutes to 12 hours after ingestion. The patient appears drunk, but there is no characteristic alcoholic odour from his breath. Nausea, vomiting and hematemesis may be seen. CNS effects include coma, seizures, nystagmus, paralysis of muscles of eye and gait, depressed reflexes and tetany is seen as was seen in the case of Ramlal. The tetany is due to fall in calcium levels in the blood. This occurs because ethylene glycol produces oxalic acid in the body and it combines with calcium in the blood to form calcium oxalate crystals. The second phase begins 12-14 hours after the onset of first phase. By this time there is widespread deposition of oxalate crystals in the tissues. This results in tachycardia (increase in heart beat), mild hypertension (raised blood pressure), pulmonary edema (water logging of lungs) and congestive cardiac failure (heart becoming unable to pump blood out to the body). The third phase occurs 24-72 hours after ingestion. There is flank pain, with tenderness in the chest and evidence of kidney disease usually manifested by stoppage of urine. This is technically known as oliguria. Proteinuria (protein appearing in the urine) and microscopic hematuria (blood appearing in the urine) may occur. Urine with a low specific gravity may be observed.” “Doctor what is its fatal dose and fatal period?” “The Fatal dose is about 2 ml/kg weight, or about 120 g for a 60 kg man. About 90% patients die within 24 hours due to CNS damage. Rest die in about 8-12 days from renal failure.” “Doctor, I was reading somewhere that in 1937, more than 100 people died in USA because of ethylene glycol. Is this information correct?” “ Oh, you are talking about the famous Elixir of Sulfanilamide-Massengill disaster of 1937, which occurred during the months of September and October 1937. No, the incriminating compound was NOT ethylene glycol, but DIETHYLENE GLYCOL - sometimes also known as ETHYLENE DIGLYCOL. There is a difference between ethylene glycol and diethylene glycol. While the formula of ethylene glycol is (CH2)2(OH)2 or C2H6O2, as I told you earlier; that of diethylene glycol is HO[CH2CH2O]2H, or C4H10O3. In fact, the formula of Polyethylene Glycols (PEGs) is HO[~CH2CH2O~]nH. You can go on substituting n for 1,2,3 etc to get higher ethylene glycols. Substitute n for 1, and you get the so-called (mono)ethylene glycol - or simply ethylene glycol - about which we have been taking. Substitute n=2, and you get diethylene glycol, the one responsible for the tragedy you are talking about. Substitue n=3 and you get triethylene glycol. I do not know of any interesting disaster connected with this or any of the higher ethylene glycols. But Polyethylene glycols are toxic no doubt. Polyethylene glycols with molecular weights between 200 and 600 Daltons are clear viscouse liquids, while those with molecular weights between 1000-6000 are rather wax like or waxiform. These are known as Carbowaxes. Their solubility in water is - very roughly - inversely proportional to their molecular mass.” “Good. So what was the "Elixir of Sulfanilamide-Massengill" disaster all about?” “Tarun, Let me first give you some background, so you could appreciate the full significance of this disaster. Scientists had long been hunting for some kind of a magic bullet which could kill disease causing bacteria. The first antibiotic - as we all know - was penicillin. Although it had been described by Alexander Fleming as early as 1928, a usable form was not developed till 1941. So before this time, the world was practically devoid of antibiotics." “Sorry to interrupt you doctor, but what exactly do we mean by the term "antibiotic"?” “Tarun, the term antibiotic - as we all understand and use it - refers to a chemical substance produced by a LIVING ORGANISM, generally a microorganism, that is detrimental to other microorganisms. If the chemical is NOT produced a LIVING ORGANISM, we would NOT call it an antibiotic, even if it killed or were detrimental to microorganisms. Therapy by such a chemical would be known as "chemotherapy", as against "antibiotic therapy", if it were to be done by antibiotics." “Oh, I see.” Prontosil soluble Sulphanilamide Note the -SO ₂ NH ₂ moiety in both. “Coming back to our story. Before 1941, some of these other chemicals (i.e. those not produced by living organisms) were known. The first one to be described was a red dye PRONTOSIL RUBRUM - or "prontosil red" as some would call it - which cured certain bacterial infections in mice. It was described by a German chemotherapist Gerhard Domagk (1895-1964), in 1932. Domagk was awarded the 1939 Nobel Prize for Medicine for this remarkable discovery. Drugs against bacteria were very much sought after during this period, and virtually anyone who could discover an effective medication could get the Nobel Prize. Alexander Fleming, who discovered Penicillin, the first antibiotic got the Nobel Prize for Medicine 6 years later - in 1945. Thankfully his discovery penicillin had come in handy for wounded soldiers during World War II, which had started in 1939." “It must have been a proud moment for Domagk to receive the award.” “No, he never received it, because he was not allowed to." “Why so? That is preposterous.” “Tarun, Domagk lived in the era of Hitler's Germany. Right from the days of Ossietzky, Hitler had adopted a policy never to allow any German to receive the Nobel Prize." “Doctor, I know I am deviating, but who was Ossietzky.” “Tarun, Carl von Ossietzky (1889-1938) - sometimes spelled as Ossietsky- was a German journalist and pacifist who was against the war, and wrote a lot against the Nazis. He was declared the winner of the Nobel Prize for Peace for 1935. Hitler was enraged because the award had been received for writing against him. At least he perceived the situation like that. So he didn't allow Ossietzky to receive the award. In fact a policy was developed never to let any German accept the award. Domagk became a victim to this policy. It was only two years after the war ended - in 1947 - that he could travel to Stockholm to receive the award, but unfortunately by that time the award money had been reverted to the Nobel Foundation, so he did not receive any money. He did however receive the gold medal and the citation (the diploma)." “Doctor, you know so many stories. I am amazed. This must have been a great setback for Domagk.” “Sure it was. However I think that for Domagk, the greatest reward would have been when his own daughter Hildegarde was saved by his drug "Prontosil Rubrum". In February 1935, she pricked her finger with a needle and developed a severe bacterial infection - called septicaemia. Domagk's new drug "Prontosil Rubrum" was given to her and her life was saved. While on the subject of "Prontosil Rubrum", I may tell you that a related compound "Prontosil soluble" also became available during this period. It soon became clear that these compounds themselves were not responsible for the killing action. Instead, a chemical moiety - known as sulphonamide group - broke off from these compounds within the body. It was this chemical moiety which was responsible for the antibacterial activity of Prontosil. The chemical formula of this moiety is -SO2NH2. Scientists derived a number of drugs from this chemical moiety. All these drugs became famous as Sulpha drugs, and they heralded the era of modern chemotherapy against bacterial infections. By 1935, many of these sulpha drugs had become very popular and were marketed as tablets and capsules. One such drug was Sulphanilamide, which was successfully marketed by The Massengill Company of the US. In September and October of 1937, the executives of this company decided to market the same product for children too. But since small children can not take tablets or capsules, it was decided to sell the formulation in the form of an elixir. Technically speaking an elixir meant the solution of a drug in ethyl alcohol and NOT in any other solvent. But the company decided to make a solution of Sulfanilamide in diethylene glycol. Their Elixir was essentially a solution of 10% Sulphanilamide in 72% percent diethylene glycol, with some flavouring and coloring agents. In those times, it was not legally required for a company to test a new drug on animals before marketing it. So The Massengill Company floated the new elixir without any tests. Since diethylene glycol is a dangerous poison, about 76 people died as a result of taking this elixir. The cause was severe liver and kidney damage caused by diethylene glycol. These 76 were the confirmed deaths, but there are unconfirmed reports asserting that more than 100 people died as a result of this disaster.” “That is amazing. The Massengill Company must definitely have been sued by the relatives of all these people?” “No. How could anyone? The Massengill Company was well within its legal rights to sell anything to the consumers. You may laugh at it, but the company could only be prosecuted for mislabelling its product as an elixir, which applies only to an alcoholic solution and not to a solution in diethylene glycol. That is a very small offence though. The fact is that at that time all drug manufacturing and distribution companies were being guided by a very old and archaic law - The Pure Food and Drugs Act of 1906. Althouth it had been amended by the Sherley Amendment of 1912, it still allowed lot of freedom to drug manufacturers. It was only this tragedy, that the much more modern law - The Food, Drug and Cosmetic Act of 1938 was passed. In our country too, a similar Act was passed two years later. It was initially known as The Drugs Act of 1940. In 1962, by an amendment, cosmetics were also included within the purview of this Act and it became known as The Drugs and Cosmetics Act. It is unfortunately true, that it usually takes a great disaster for the government to change an archaic Act.” “Oh, come on. You can't say that just because of one incident, can you?” “Perhaps you are right. But interestingly yet another disaster occurred in late 50s and early 60s which caused further changes in similar Acts around the world. It was the much feared Thalidomide disaster, but if I were to tell you about this, we would be deviating from our initial topic - ethylene glycol.” “Doctor, either you should have not brought about this new topic at all, or you should explain it fully. Since you have mentioned it, my curiosity is aroused. Please let me know about this disaster. I don't mind being late at home.” Thalidomide Glutethimide Glutethimide is still sometimes used as a sedative. Note the structural similarity of both. “Alright, as you wish. But let me tell you an additional fact about Diethylene Glycol. Its story did not end with the Massengill company. This compound keeps raising its head again and again. As recently as in July 1985, Diethylene Glycol was again in the news - this time because it was discovered that Austrian wines were contaminated with this substance. Stocks of all Austrian wines were promptly withdrawn throughout the UK. About Thalidomide? Well it is chemically written as C13H10O4N2. This drug was marketed in more than 40 countries - mainly in West Germany and the UK in the late 50s and early 60s. In Germany, it was manufactured by Chemie Grünenthal and marketed by it as Contergan since 1956, and enjoyed good sales. In Britain it was licensed by Chemie Grünenthal to the Distillers Company. It became available in Great Britain from the beginning of 1958 as Distaval. In Sweden the license was given to a local company Astra. It was being used by pregnant women to counter nausea, which is usually seen in early pregnancy. It also acted as a sedative. Developed in West Germany in the mid-1950s, Thalidomide was touted as one of the safest sedative-hypnotics, just as Titanic was hailed as the unsinkable! Ironically both suffered the same fate. Titanic sank on its maiden voyage, and Thalidomide sank too - in a figurative sense. It caused birth defects in children known as peromelia. An estimated 5,000-10,000 children suffered from this terrible deformity. This ultimately caused its downfall.” “What is peromelia doctor? I have never heard this term.” “Tarun, peromelia is the collective name given to a number of deformities, where there is a congenital absence or malformation of the extremities. It is caused by errors in the formation and development of the limb bud, which normally occurs from about the fourth to the eighth week of intrauterine life. As I told you peromelia has several forms. One of the worst and most horrible is amelia in which there is a complete absence of all limbs. There is just head and the trunk of the baby - absolutely nothing else. Since all the essential organs of the body - brain, heart, lungs, kidneys, liver etc reside in head and trunk, such an infant, if cared for properly would not die. But imagine the quality of life of such an infant. He is just like a plant - with an essential difference. He can see, feel and sense his absolute helplessness. Fortunately this condition was very rarely seen in thalidomide disaster. The second form is Ectromelia, in which there is the absence of one or more extremities. There was also an interesting condition known as phocomelia or “seal extremities", because the extremities resembled like those of a seal. In this condition, the upper part of the limb was extremely underdeveloped or missing, and the lower part was attached directly to the trunk, resembling the flipper of a seal. It was as if the palms and feet were directly stuck to the trunk. Its counterpart was Hemimelia in which the upper part of the limb was well formed but the lower part was rudimentary or absent. Finally there was a condition known as Sirenomelia, in which the newborn resembled a mermaid or siren. The term literally means “mermaid extremity”. This was also a very severe abnormality in which the legs were fused to a greater or lesser degree and contained malformed bones; the anal and urinary orifices were absent, and the genitals and parts of the intestinal and urinary tracts were malformed. As limb buds form during fourth to the eighth week of intrauterine life, this condition was very common in women who took thalidomide during this period. Exposure during the later periods of pregnancy did not cause any abnormalities. Interestingly in the US, the rights had been given by Chemie Grünenthal to a local company W.S.Merrell Co., but they could not market it, because of the earlier Act passed by the Govt, about which I have already told you. The Food and Drug Administration (FDA) was simply not convinced of its safety. In Canada, a license to market it was granted by the Canadian Food and Drug Directorate. In our country too the drug failed to gain entry because of usual bureaucratic hurdles. Thus US and India were the two big countries which were saved of this disaster!” “Chemie Grünenthal must have been prosecuted for their wanton act?” “Tarun, it has traditionally been very difficult to prosecute big giants. Nine senior members of Chemie Grünenthal were tried in a criminal court in Aachen, but they disputed the very fact that the limb deformities had been caused by thalidomide, although there was very strong statistical evidence in favour of the fact that thalidomide did cause this disaster." “What was this evidence doctor?” “Phocomelia is such a rare disease that no case was reported in Germany in ten years between 1949 and 1959. But in just a single year in 1961, there had been 477 cases! Moreover after this drug was taken off in 1961, the cases stopped once again. Yet the defendants challenged the causation. Finally trials had to be conducted on rabbits to convince the court that it was indeed the thalidomide which had caused these deformities. Yet the case dragged on for about two years and was finally abandoned. The representatives of the deformed children however settled the issue with Chemie Grünenthal for just about 114 million Deutschmarks! In Britain, a good thing that happened was that The Medicines Act was passed in 1968, which forbade any company to market drugs like this. As I told you earlier, it is an unfortunate truism that it often takes a great disaster for governments to "wake up" from their slumber. This was yet another case of a disaster paving the way for the passing of a law. In our country too, this disaster had its echoes. The Drugs and Cosmetics Act of 1940, which had become archaic, was amended in 1964, mainly because of this disaster. Many other indigenous drugs were brought into its purview, which includes Ayurvedic and Unani drugs. As an aside I may tell you that Thalidomide comes in two enantiomers. While the right-handed molecules had the desirable property of sedation, it were the left-handed molecules which caused the deformities. So if somehow, only the right handed molecules had been used for sedation, there would have been no adverse effects at all!” “Now you are introducing new things. Please tell me what are enantiomers?” “Tarun, certain chemical compounds are mirror images of each other. So although their chemical and even structural formula is same, they are not exactly the same molecules. They are in fact mirror-images of each other. These compounds are called enantiomers. Your right and left palms are good examples of enantiomers. Although they are similar looking, you can't superimpose your one palm over the other. If you look at your right palm in the mirror, it will look like a left palm and vice-versa. If a chemical compound exists in its two enantiomeric forms, they would roughly be equal in number. When the scientists of Chemie Grünenthal manufactured thalidomide in their factories, roughly equal number of both enantiomers were produced. Only the right handed molecules - the so called D forms - were beneficial. The left handed molecules - the so called L forms - caused the defects.” “How very sad! Had they known about this, they would only have manufactured the D forms.” “It appears doubtful to me, because technology to do so did not exist at this time. Although once formed, they could have perhaps separated the two. I may tell you that there are several other drugs, which show the same dilemma. One of the best known is Dihyroxyphenylalanine (DOPA) which is used for a Central Nervous System disorder Parkinsonism. In this disorder, the person trembles and has a staggering gait. This disorder can be treated by DOPA. This too comes in two enantiomers - a D form and an L form. I may tell you here that these forms can be differentiated by a very shrewd test. It you pass a beam of polarized light through them, the D form would shift it to the right and the L to the left. In fact the D form and L form get their names from this property. D stands for Dextrorotatory (or turning to the right) and L stands for Laevorotatory (turning to the left). In the case of DOPA, the L form of the molecules are effective. D forms are not effective, but fortunately they do not cause any deformity too. It still makes far better sense to give just L-Dopa or Levodopa (as some call it) than just plain DOPA, which would contain both forms of the drug, of which the D form would be totally useless. You may be interested to know that in 2001, three scientists received Nobel Prize in chemistry for developing the first ever chiral catalysts [N.B. by the author: The original article appeared in AUGUST 2000 - at a time when these Nobel Prizes had not been awarded, so one would not find this information in the original article. It has been added subsequently]. These are the Japanese Noyori Ryoji (1938 - ) and the American scientists K. Barry Sharpless (1941 - ) and William S. Knowles (1917 - ). It was as late as in 1968, that Knowles produced the first ever chiral catalyst. This was seven years after thalidomide had been banned from everywhere. So as I said earlier, even if scientists would have known about the L forms of thalidomide causing problems, they probably would not have been able to synthesize it preferentially." “Doctor you have talked about chiral catalysts. What exactly are these?” “Tarun, chiral means "handedness". Remember that the art of palmistry - studying hands - is also known as Chiromancy, or Chirosophy! Chiral catalysts can favour a chemical reaction in the direction of a particular enantiomer - literally a left handed or a right handed molecule. Thus if one were to manufacture L-dopa without the help of these chiral catalysts, one would get both D and L forms in roughly equal quantities. But if these chiral catalysts were used, one could manufacture only the useful L-form. These catalysts are thus very helpful in the drug industry.” “Doctor you are amazing. Coming back to our initial topic. How do doctors diagnose ethylene glycol poisoning?” “One of the best points in favour of ethylene glycol poisoning is that the person appears inebriated without accompanying smell of alcohol. Calcium oxalate crystals in the urine are present. I have examined the urine of Ramlal and have found calcium oxalate crystals. The White Blood Count (WBC Count) may rise to 10,000-40,000 per cubic mm, while normally the maximum limit is just about 11,000 per cubic mm. On autopsy, there is extensive destruction of the renal substance. On microscopic examination of kidneys, birefringent crystals of oxalate are seen. I have found all these changes in Ramlal’s body after autopsy. I can now guess what happened yesterday at Ramlal’s house. Shyam was stung at Ramlal’s behavior and wanted to get even with him. He arrived at his house with a bottle of liquor and a can of coolant. This was probably hidden somewhere in his clothes. Shyam was preparing the pegs. After two or three pegs, when Ramlal was sufficiently inebriated, Shyam furtively mixed some quantity of coolant in his alcohol. Ethylene glycol is tasteless, so Ramlal did not know that something had been mixed in his drink. Moreover he was already drunk and was not paying very much attention to him. After giving him two or three more pegs like this, he left for his house. He was quite pleased with himself, as he had thought he had planned a perfect murder. Lo! Here comes the policeman from Shyam’s house and he has recovered the left over bottle of coolant from his house. Shyam does not have a car and would have tough time explaining to the court what this bottle was doing in this house.” “That is very clever of you doctor. Without your clever deduction it would have been impossible to say how Ramlal died and Shyam 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 - Botulinum Toxin.”