Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE DECEMBER 1998 ISSUE THE POISON SLEUTHS DEATH BY SODIUM CHLORATE -Dr. Anil Aggrawal "Good morning doctor. Oh, my God, what are you doing today? You have the dead body of a young man today. His whole body seems to have a chocolate brown color. Well, this is the most peculiar color I have ever seen in a dead body. What happened to him? Please tell me." "Good morning Tarun. The name of this young man is Radhey, and he died in Dr. Gupta's nursing home today morning. Yesterday he and his friend Shyam had a dinner at a 5-star hotel. While they were still having dinner, Shyam got a phone call and had to leave suddenly leaving the dinner unfinished. Radhey became sick immediately thereafter. He started vomiting. Seeing his condition, the hotel staff called the ambulance, and he was shifted to Dr. Gupta's nursing home. The doctors there started a battery of tests to arrive at a diagnosis, but before any diagnosis could be made, he died." "Oh, looks like he died of some natural disease. You said he had vomiting. May be he died of gastroenteritis." "Doesn't look like to me. Look at his body. It is so darkly colored. You yourself remarked on that as soon as you came here. One doesn't get that kind of color in gastroenteritis. There may be more to his death, than meets the eye." "Really? Well, let me know. I am all ears." "Tarun, I have asked the police investigating this case. It appears, Radhey and Shyam did not have good relations. They were business partners, but lately there had been lot of tussle between the two regarding the ownership of certain business properties, which ran into lakhs of rupees. Naturally each wanted the other out of way. In fact, yesterday's meeting at the 5-star hotel was meant just to sort out these problems...." "Oh, so you are hinting that probably Shyam killed Radhey. Did he administer some poison to him?" "Tarun, I have enquired in detail from the police about yesterday's events. They have taken the help of waiters and other staff to find out what exactly happened yesterday evening. Radhey and Shyam arrived in the dinner hall at about 7.30 pm yesterday night, and first of all they started having some drinks. After about two drinks, they called for soups. Just when the soups were brought, a phone call came for Radhey. We know this from the waiter who received the call. Well the waiter tells us that Radhey came back within a minute and started having soup. Soon after Shyam got a phone call and he had to leave. After this Radhey became sick. This peculiar story, coupled with the fact that the body of Radhey is showing this characteristic chocolate brown color, leads me to think that Radhey indeed has been poisoned..." "Really? With what poison doctor?" "Tarun, it is a very interesting poison. May be you never realized it is a poison. It is a very common salt available in all chemistry laboratories- sodium chlorate." "Sodium chlorate? Yeah indeed it is a very commonly available salt. But I never realized it is a poison also." "Yes, Tarun, it is a very deadly poison. In fact the brown color of Radhey's body led me to that. It causes browning of the body, because it forms a brownish colored compound in the body- methemoglobin." "Don't really know what methemoglobin is. Please tell me more about it doctor." "Tarun you know that all of us have hemoglobin in our bodies. It is the basic pigment which picks up oxygen from the lungs and delivers it to all tissues. It resides in the Red Blood Corpuscles or R.B.C.s. If anything were to go wrong with hemoglobin, oxygen transport to the tissues would be seriously hampered and the person may die. Hemoglobin molecule has four iron atoms in it, all of which are in the reduced or ferrous state. This is usually written by the chemical symbol Fe++. Methemoglobin is nothing but a molecule of hemoglobin, in which one or more of iron atoms - may be just one, or all four- are oxidized to Ferric state. Chemically we can represent these iron moieties as Fe+++. Once the hemoglobin molecule is modified in this way, it no more remains useful as an oxygen carrier. It becomes useless in other words, and the person may die for want of oxygen. Sodium chlorate is a strong oxidizing agent. It oxidizes the hemoglobin to methemoglobin and this may cause rapid death." "Just a minute doctor. You said that normally hemoglobin takes oxygen from the lungs and delivers it to all tissues. Doesn't that too oxidize the hemoglobin and render that useless?" "Oh, no Tarun. That is a very loose combination of hemoglobin with oxygen. In fact nature has devised it to be so loose that it readily delivers its oxygen to the tissues. In this combination, all iron atoms remain in the ferrous state. Only the whole molecule simply picks up the oxygen molecule, much as you would pick a hot coal with a tong. But Sodium chlorate really "oxidizes" the molecule rendering it useless. So although Hemoglobin normally carries oxygen around, it doesn't get oxidized in the true sense of the word. In fact, if it were to be oxidized by any means, it would immediately be rendered useless." "Oh, Sodium chlorate really appears to be an interesting poison doctor. Please tell me more about it." "Tarun. Two chlorates are very important from a toxicologist's standpoint- Sodium and Potassium chlorate. Chemically we can write them as KClO3 and NaClO3. At one time potassium chlorate was widely used in medicine and being obtainable without restriction, it was a popular household remedy, especially for sore throat. It has now been completely abandoned as a remedy and therefore it is a rare source of poisoning today. Sodium chlorate on the other hand, has a reputation as a safe and effective weedkiller, and is commonly available. Sodium Chlorate is also used as an explosive in many parts of the world. It is still commonly available in the market. Unfortunately many people think that it is non-poisonous, and this wrong belief has given rise to several poisonings." "Doctor, how can poisoning with sodium chlorate occur usually?" "Tarun, poisoning with sodium chlorate can occur accidentally, suicidally or even homicidally as seems to be the case I am handling today. Accidental poisoning is perhaps the most common. Sodium chlorate has been mistaken for common salt and Epsom salts..." "Sorry to interrupt you doctor, but what exactly is Epsom salt?" "Tarun, it is a bitter, white crystalline powder consisting of hydrated magnesium sulfate. It was once used in medicine as a cathartic and to reduce inflammation such as in sore throat. Its formula is MgSO4.7H2O. It is named after a place called Epsom, in Surrey, England, where it was originally prepared from the water of mineral springs. If magnesium sulfate is prescribed for some disorder, and the person inadvertently took sodium chlorate, which looks very much like it, he may be severely poisoned. In some cases poisoning has occurred when potassium chlorate was taken as a medicine, mainly to treat inflammation or septic spots. In many such cases, potassium chlorate was given for local application, but it was swallowed instead. In one such case, a person was having an ulcer in his mouth. He was given potassium chlorate to gargle his mouth with, but he swallowed it, and was severely poisoned. Illegible prescriptions have also given rise to some poisonings. In one such case, the intended drug to be given was potassium chloride. But on the prescription, only the words "potassium chl." were written. This was misinterpreted by the chemist as potassium chlorate. This drug was dispensed and the patient was severely poisoned!" "Very interesting indeed!" "Tarun, I know of several instances when potassium and sodium chlorates have caused inadvertent deaths. In one case, a 5 year old girl had scarlet fever. Inflammation of her throat was treated with repeated sponging with a 2% solution of potassium chlorate. On 7th day, the symptoms of poisoning appeared, and even though the treatment was stopped on that very day, the girl died on the tenth day. In another case, a 61 year old woman sucked daily on 20 tablets of potassium chlorate (324 mg each) for 6 to 10 weeks. She thought that a cancer was developing on her tongue and that she would be cured by this. She was severely poisoned. In one case, a chemist gave his wife several tablets of potassium chlorate for treating her tonsillitis. She died after five days. But probably the most interesting is the case of a 48 year old gardner who was severely poisoned in a curious way. He was using a concentrated solution of sodium chlorate in an atomizer, while a strong wind was blowing. In consequence, spray was blown on to his face and he inhaled and ingested some of the solution. Symptoms of poisoning started the same evening. He could be saved with some heroic effort on the part of the doctors, yet he could only return to full-time work at the end of about a year." "Doctor, what symptoms does one get on swallowing this poison?" "Tarun, immediately there is acute digestive upset. Vomiting is usual. It may persist for upto 48 hours. There may be severe pain behind the breast bone or in the abdomen. Red Blood Cells begin to break down and may reduce in number to half. Red cells may only be 2.5 x 1012/L in this poisoning, while normally they are 5 x 1012/L. Heinz bodies are seen in the red cells...." "What are Heinz bodies doctor?" "Tarun, Heinz bodies are nothing but denatured hemoglobin. I told you that sodium chlorate destroys hemoglobin. This destroyed or denatured hemoglobin, also known as methemoglobin precipitates in the RBCs as Heinz bodies. These bodies were first described by a German doctor Robert Heinz. Hence the name. Besides these symptoms, acute renal failure also occurs in sodium chlorate poisoning. This is in part due to direct action of chlorate on the kidney and in part due to mechanical obstruction of tubules of the kidney by hemoglobin set free from the red cells. Urine is scanty and dark brown. Total stoppage of urine may also occur." "Doctor, how much sodium chlorate is needed to kill an adult robust man?" "Tarun, about 20-35 grams would be required. And the person would die in about 4-5 days, although death can be quicker as in this case." "Oh, Doctor, now I know all about sodium chlorate. Tell me how you deduced that Radhey died of sodium chlorate poisoning?" "Tarun, the color of Radhey's body gave away the poison to me. You will agree the color is very peculiar. It is chocolate brown. This is the color of methemoglobin. So the moment I saw the chocolate color of Radhey, I knew I was looking for some poison, which converts hemoglobin to methemoglobin, and sodium chlorate is one such poison. Then I made a blood film of Radhey and saw it under the microscope. RBCs were broken, and they showed fragmentation which was expected in sodium chlorate poisoning. Numerous Heinz bodies were also seen in the RBCs. His kidneys as you can see are enlarged, as we would expect in sodium chlorate poisoning. I have made a microscopic examination of the kidneys too. And I have found that the tubules of the kidney are occluded with broken red cells and brown pigment granules. You surely know what the tubules of the kidney are. They are the microscopic tubes through which filtered blood - or urine- passes forwards. These tubules are dilated and many are completely blocked by debris. This is exactly the change that we would expect in sodium chlorate. There is no doubt that Shyam has given Sodium chlorate to Radhey." "But how could he do that? They were both having dinner together." "Tarun, Shyam was probably working with some accomplice, who was sitting outside the dinner hall probably with a mobile phone. Just when the soups were served, the accomplice phoned from his mobile to the reception desk of the dinner hall, asking for Radhey. When Radhey went to pick up the phone, Shyam quickly mixed the sodium chlorate which he already had in his possession. Radhey discovered that it was a blank call and returned to his table and started having his soup. The taste of sodium chlorate is somewhat similar to that of common salt, so one may not discover any change in taste, especially when he is already drunk as Radhey was. When he had finished his soup, Shyam and his accomplice knew it was not safe to remain there any more. So according to their pre-arranged plan, the accomplice phoned again- this time to Shyam. He took the call, came back to Radhey and told him that he had to leave as he had got some important call. The idea was to leave the scene immediately to remain out of trouble. You know the rest of the story." "Very clever indeed. But how do you know the story with such gory details?" "Tarun you will be surprised but Shyam has told us this story himself. Actually when I conducted the post-mortem, I immediately suspected I was looking for sodium chlorate. I told the police about it. They raided Shyam's house and recovered a small sachet, containing a white powder. When I examined it chemically, I discovered it was nothing but sodium chlorate. Faced with this fact, police renewed their interrogation of Shyam. Faced with all the scientific evidence against him, Shyam broke down and told these details to the police. The police are now looking for his accomplice, who is on the run." "Very clever doctor. This was a most interesting discussion doctor. Without your masterly deduction, Shyam could never have been caught. Every one would have thought that it was a case of death due to gastroenteritis. Tell me what are you going to tell me the next time?" "Tarun, next time, I would tell you about a very interesting poison- Sodium nitrite. " "

Forensic Science Fiction

Forensic Science Fiction The mystery of the drowned man The man had been drowned for five days! At least that is what Dr. Khanna made me believe. Dr. Sunil Khanna as we all know is a leading forensic expert of our country and his opinion had to be respected. Well! before proceeding further, I shall explain what forensic experts are. They are doctors who, among other things, cut up dead bodies and try to find out the cause and manner of death. After we completed our graduation in medicine, we decided to devote our energies to the detection of crime, rather than to the routine, drab, utterly boring checking of festering sores, furred tongues, missed heart-beats, aberrant pulse rates and bizarre temperature patterns. Coming back to our case. The man was ultimately identified as one Ramlal. When the police made investigations, they came up with some rather dubious evidence that Ramlal had been killed by Jagga and then thrown in the Indian Ocean, off the coast of Gujrat. It is well-known that in our country, criminals often kill their victims and then do dispose of the body by throwing it in this manner in deep ocean, river, lake or pond or some such similar body of water where it would be difficult to retrieve the body for quite some time. But it so happened that I personally knew Jagga and was quite convinced that Jagga could not kill anybody. I talked to Jagga, and after talking to him, I became all the more convinced that Jagga was not the killer. When I talked to Jagga, he categorically denied his hand in Ramlal's killing. He requested me to save him from the clutches of the law. Well then, if Ramlal had not been killed by Jagga, how had he died. I surmised that Ramlal must have gone to the sea shore for a bath and then must have been carried away by the tidal waves. He thus drowned accidentally. But I was told that Ramlal was an accomplished swimmer. If this was true how could he drown accidentally? Well, even accomplished swimmers have been known to drown in sea water. The tidal waves are really very strong, and can carry the person deep inside the ocean in no time. Before the person has time to think, he finds himself deep inside in the sea. The waves are so forceful that they do not allow him to swim back to the shore. The person gets exhausted and ultimately drowns. This is what should have happened to Ramlal. But the law wants solid proof. The courts do not pay attention to mere conjectures. If I wanted to save Jagga, I had to produce some real good scientific evidence in favour of my theory of accidental drowning. The police was bent upon implicating Jagga. They had even requested the court and taken him in police remand for a period of 15 days. I had to do something fast. I consulted Dr. Khanna and he suggested me that our question basically boiled down to proving that Ramlal's drowning was a case of antemortem drowning. If the police version was correct, then Ramlal's drowning was a case of post-mortem drowning. Before proceeding further, I must tell you a little bit about ante-mortem drowning and post-mortem drowning, in case you are unaware of it. This is an age old question in forensic medicine and one for which no satisfactory answer has been found yet. Basically ante-mortem drowning means that the person drowned when he was still alive. Post-mortem drowning on the other hand, means that the person was first killed by someone and then thrown in water to conceal crime. While post-mortem drowning almost certainly points to homicide, ante-mortem drowning could be anything; accidental, suicidal or homicidal, roughly in that order. It is rather difficult for someone to drown a conscious adult person with homicidal intent, so on the face of it, a case of ante-mortem drowning goes against homicidal drowning. I had to do an autopsy on the dead body of Ramlal and find out the cause and manner of his death. Now if I could prove that it was a case of antemortem drowning, it would go in favour of my theory that Ramlal had died accidentally while taking a swim. If on the other hand the autopsy showed it to be a case of post-mortem drowning, it would be a very strong evidence in favour of the police theory that Jagga had done him to death and then thrown away the dead body in the ocean. Of course we forensic scientists know that one of the best ways to differentiate between ante-mortem and post-mortem drowning is to conduct the so-called diatom test. I won't bother you with details, but just give you the outline of the principle of this test so that you could follow the story better. In all bodies of water- in rivers, lakes, ponds, oceans, even in tap water- are present some minute microscopic unicellular organisms called diatoms. These are microscopic algae with hard and highly refractile silicon shells. They come in all kinds of shapes; in fact about 15,000 different species are known. Under the microscope they all appear very beautiful and symmetrical, presenting rather a kaleidoscopic picture. Diatoms are quite abundant. A mere c.c. of water would contain literally thousands of diatoms. Now if a man drowns while he is still alive, he would make violent efforts to respire. Water would enter his respiratory passages along with respiratory air, and would reach the alveoli, the fine balloon like terminals of the lungs. Sure enough diatoms would also reach the alveoli along with the water. Due to the violent respiratory efforts, some of the alveoli would get ruptured causing the water (and the diatoms along with it) to be sucked in the tiny blood vessels lining the alveoli. From here they would find their way to the left chamber of the heart and from there the aorta would pump this water (and the diatoms along with it) to all the conceivable organs of the body- liver, spleen, brain, bone marrow, everywhere. In case the person was thrown in the water when he was already dead, neither his lungs, nor his heart would be functioning. Thus in the first place almost no diatoms would enter the lungs. If due to sheer pressure of water, some diatoms did enter the lungs, they would not be able to penetrate the alveolar wall. Further, for the sake of argument if we assume that the water pressure was enough to break some of the alveoli, and some diatoms did enter the alveolar blood vessels, they couldn't be pumped to all the systemic organs for the simple reason that the heart would not be beating. Thus a simple test to prove a case of antemortem or postmortem drowning was simply to look for diatoms in some internal organ, say liver or spleen or brain. If you found diatoms there, it was a case of antemortem drowning; if you didn't find any, it was of course a case of postmortem drowning. When I conducted a post mortem on the body of Ramlal, I found all his internal body organs literally infested with diatoms. Diatoms were to be found everywhere- in his liver, spleen, brain, bone-marrow, everywhere. This naturally made me very jubilant, as this proved beyond doubt that my theory was correct and Ramlal had indeed died while he was alive. But when I contacted Dr. Khanna with these findings, he seemed doubtful. He reminded me that the diatom test was in fact challengeable. Well, I will digress for a moment and tell you why he said so. It so happens that the diatoms are rather ubiquitous; they are present in all bodies of water- even in the tap water as I have already said. Now imagine a situation when a person has been drinking tap water all his life. Suppose he has an ulcer in his stomach (or for that matter, even some minor abrasion anywhere in his gastrointestinal tract) the diatoms would be entering his circulation all his life and be pumped throughout his internal organs. The internal organs of such a person would show diatoms irrespective of the cause of his death. Such a person might die of, say, electrocution and yet his internal body organs would show diatoms. Dr. Khanna rightly told me that my findings could be challenged by a well-informed prosecution. I could see his point, especially as I knew the prosecution was taking the help of Dr. George Paul, another well-known medico-legal expert of our country. Certainly Dr. George Paul, when called to the court would rip my theory apart. What should I do then? This question gave me many restless moments. Then like a flash of lightning, a possible solution crossed my mind. I recalled that a few days back, there had been a big oil spill off the coast of Gujrat. A big oil tanker had been bringing crude petroleum somewhere from the Gulf, when just off the coast of Gujrat, a crack appeared on the bottom of the tanker and many thousand tonnes of crude oil leaked into the sea. This incident had been the talk of several environmentalists, especially as this was causing threat to marine life. Well, if there was crude oil in the sea water, and if Ramlal was breathing at the time of immersion (as I believed), then some petroleum must have seeped into his circulation, through the same route as the diatoms would normally take in a breathing man. This would result in traces of petroleum being present in his internal body organs. If I found traces of petroleum in, say, liver or spleen, I could prove my point beyond doubt. In that case, Dr. George Paul was definitely going to have a hard time explaining how it reached there, otherwise than what I was suggesting. We all know that petroleum is not a normal constituent of the body and no sane person drinks petroleum, so indeed there was no conceivable way for the petroleum to reach the internal body organs other than through ante-mortem drowning. This naturally made me very jubilant, and I used our newly acquired Gas-Liquid Chromatograph to determine petroleum in Ramlal's body organs. But contrary to my expectations, Ramlal's internal body organs failed to show any trace of petroleum. What had gone wrong? Well, Dr. Khanna suggested that may be I was wrong from the very beginning. Ramlal was indeed killed by Jagga first and then thrown in sea water. Otherwise why didn't I find petroleum in Ramlal's internal organs? Failure to find petroleum there meant only one thing- that Ramlal was not respiring at the time of his immersion in water. But I refused to believe Dr. Khanna. Something deep inside my heart told me that Jagga was innocent. But if he was innocent why was I not getting any traces of petroleum in Ramlal's internal body organs? That was the sixty-four thousand dollar question. Soon I forgot the question anyway. Meanwhile Dr. Khanna and I jointly started an ICMR project in which we intended to find out the etiology of solvent abuse or glue sniffing. It is a poorly understood phenomenon, in which the addict gets an inordinate pleasure in sniffing various hydrocarbons. Most commonly sniffed substances include various glues, paint thinners, gasoline, chloroform, carbon tetrachloride and so on. We were trying to find a biological cause for this phenomenon. It so happened that one day I was talking casually to Dr. S.K.Gupta, Professor of Biochemistry in our college. He was working on some new cellular enzymes, and his work was being internationally appreciated. While talking to him, suddenly a weird thought crossed my mind, and I ran back to my department, silently crying "Eureka", much in Archimedean fashion. Thank God I had my clothes on! I retrieved some of Ramlal's tissues I still had in bottles, and brought them back to Dr. Gupta. I asked him to look for a specific cellular enzyme, which had not been discovered till then. Dr. Gupta, as is his wont, told me I was a fool, but I let that pass, and asked him to look for that enzyme anyway. But after a few days, Dr. Gupta was quite surprised that I was right. He could indeed find the enzyme I had asked him to look for. In fact he reported that the cells were very rich in that enzyme. I know you are getting curious. What was that enzyme, you may ask. You will laugh at what I will tell you, but you can confirm it from Dr. Gupta who has lab reports to confirm my statement. In fact even he would not have believed me, had he not found the enzyme himself. This was an entirely new enzyme. An enzyme which metabolizes hydrocarbons! Dr. Gupta suggested that we should call it Petroleum dehydrogenase. Dr. Gupta found 50 microgrammes of Petroleum dehydrogenase per c.c. of tissue, which is quite high as you can understand. A minor mutation in Ramlal's body gave rise to that enzyme. He was a mutant in other words. Well, how does this fact fit in our story. I will tell you shortly. But first things first. While talking to Dr. Gupta, I was subconsciously working on my own multifarious problems and suddenly it occurred to me that the solution to my problems lay in the realm of biochemistry. Perhaps Ramlal had an enzyme in his tissues which metabolized any petroleum that had seeped in his body cells during drowning. Now we were indeed able to find that enzyme in Ramlal's body cells. This changed our investigation much in our favour. I will tell you what happened. Ramlal was indeed breathing at the time of immersion. Some petroleum did seep inside his circulation and got deposited in his internal organs as explained earlier. Molecular death, as we all know occurs a few hours after the somatic death. Somatic death is the time when a doctor pronounces a person dead. But we all know that molecular activity continues for a few hours after that. During the interval between the somatic and the molecular death, the enzyme Petroleum dehydrogenase metabolized any traces of petroleum that had seeped in Ramlal's body tissues. That was the reason why we did not find any traces of petroleum in Ramlal's body despite the fact that he died while still breathing. You might say this is spurious reasoning. It is quite possible that there was no petroleum in Ramlal's tissues in the first place. Merely the fact that the enzyme Petroleum dehydrogenase had been discovered in Ramlal's tissues does not necessarily mean that this was responsible for the absence of crude petroleum in his tissues. This was certainly one of the possibilities but the possibility of crude petroleum being absent in Ramlal's tissues from the very beginning could not be ruled out. I knew if confronted with my new findings, Dr. George Paul would certainly come up with this question. So I decided to play one up on him from the very beginning. I took out Ramlal's preserved tissues once again, and looked for the metabolites of Petroleum in them. I had worked out its metabolites in detail, and one of them was 2-Butyne. In my renewed analysis with my Gas-Liquid Chromatograph, I looked not for petroleum but for its metabolites, mainly 2-Butyne. You can perhaps imagine my joy when I found fairly rich quantities of 2-Butyne in Ramlal's tissues. Earlier when I was not specifically looking for it, I met with failure, but now I knew what I had to look for and sure enough I got it. All of us know that 2-Butyne is not a normal constituent of body cells. Thus the only way it could have accumulated in the tissues is through metabolism of crude petroleum by the enzyme Petroleum dehydrogenase. This was the final vindication of my theory. Of course if Ramlal had survived longer, even 2-Butyne would have got metabolized further to carbon dioxide and water. Petroleum dehydrogenase was capable of metabolizing all hydrocarbons down to their very basic elements. I knew I had killed two birds with one stone. I enquired from his family members and was quite satisfied to find out that Ramlal was a glue sniffer. In fact I was quite sure of this fact when I was submitting his tissues to Dr. Gupta. I will tell you now what happens in a glue sniffer. These glue sniffers are all mutants. They have the enzyme Petroleum dehydrogenase in their body cells. Petroleum dehydrogenase is able to metabolize not only petroleum products but all hydrocarbons, liberating a good amount of energy in the process. These glue sniffers sometime during the course of their life discover accidentally that sniffing hydrocarbons gives them a renewed sense of well-being. What actually happens is that they are able to metabolize the hydrocarbons quite effectively which gives them short bursts of energy, which they construe as a sense of rejuvenation or well-being. They ultimately get addicted to the hydrocarbons. So now Dr. Khanna and I had hit upon an entirely new and novel theory of glue-sniffing. Initially Dr. Khanna was quite hesitant about accepting it, but I am happy to tell you that since my fateful meeting with Dr. Gupta, I have submitted blood samples of more than 50 glue sniffers to Dr. Gupta and he has found Petroleum dehydrogenase in all of them, which is a good confirmation of my theory! Thanks to Ramlal's death mystery, we found out a solution to an age old forensic question. Oh, yes, I must also tell you that the court admitted my findings and released Jagga. But the thing that satisfied me most, was that when Dr. Khanna read our paper on glue sniffing at The International Conference on Drug Addiction at Tokyo next year, it was adjudged the best paper of the conference! *** This story was published in Spandan, 1995-96 on Pages 13-17

Forensic Science Fiction

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Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE NOVEMBER 1997 ISSUE THE POISON SLEUTHS POISONING BY CAPSAICIN -Dr. Anil Aggrawal "Good morning doctor. Oh, my God, what are you doing today. You seem to be doing the post-mortem on a very young infant. What happened to her? Please tell me." "Good morning Tarun. The name of this young 5 month old girl is Neeta. She was born to Pyarelal and his first wife Seema. Just after her birth, Seema expired because of some complication. Pyarelal soon remarried another woman Anita, apparently because he wanted someone to look after his young daughter. But from her behavior it did not appear that Anita had any great liking for Neeta. She would often keep her hungry and would torture her in several other ways. There were rumors that Anita even wanted to do away with Neeta for good. In fact she wanted that her own children - as and when they were born- get due importance in the family....." "So you think that Anita has killed this young child?" "No, I didn't say that. But certainly all facts have to be kept in mind while investigating suspicious deaths." "What do the parents of the girl say?" "The father Pyarelal was in the office when the girl died. The girl's stepmother Anita says that she had given milk to the child at 10 am in the morning, soon after Pyarelal left home for office. After that Anita put her to sleep and got busy in her household chores. At 2 pm when she wanted to give her the second feed, she found that the child was lying listless in the cot. She panicked and immediately phoned Pyarelal. He came home at once. A doctor was called, but when he found that the child was dead, he suspected some foul play, and informed the police. The police conducted some preliminary investigations, and then handed over the body to me, to find the cause of death." "So what have you found out?" "Tarun, you won't believe it but I have found a very strange cause of death in this case. She was poisoned by a very exotic poison.." "What is that poison doctor? Please tell me, I am getting curious." "Tarun, the poison in this case is a chemical known as Capsaicin. It might sound a very alien name to you, but it is found in a very common household item- chilies. In other words, Neeta was done to death with chilies!" "What? I don't believe that. How can anyone kill with chilies?" "Tarun, Chilies contain an exceedingly acrid, volatile poisonous substance Capsaicin. It is because of this substance that capsicum has a pungent smell and taste. In India, capsicum fruits are powdered and universally employed as a condiment known as red pepper or lal mirch. You may be surprised but chilies are used in India for a lot of criminal activities. They are used by the police for the purpose of torture for instance...." "Really? Well, I am beginning to believe that Capsaicin indeed is an interesting poison. Why don't we begin from the beginning doctor?" "Oh sure Tarun. There are so many interesting tales to tell about capsicum and its active principle capsaicin. While capsaicin in small quantities may tickle our palates, in large quantities, it may act as a poison. The fatal dose of capsaicin has been estimated to be about 150 mg/kg in mice and rats. Taking the same figure to be true for a human being, it would take almost 9 g of capsaicin to kill an adult human being weighing 60 Kg. This is rather a large amount as far as homicidal poisons go, but small children can be killed with far lesser doses. Experimental rats and mice die within 4 to 26 min after the fatal dose, so it appears to be rather a quick poison..." "Doctor, how does a person die of capsaicin?" "Tarun, as I told earlier death by chilies is unusual except in very small children. Death by capsaicin is due to fall in blood pressure and stoppage of respiration. At autopsy, the stomach lining is found to intense red due to irritation and there may be erosions and even ulcers." "Doctor, you said there are so many interesting tales about chilies and capsaicin. Please let me know some of them." "Sure. Tarun, chili plant belongs to the family Solanaceae. History of this plant is most interesting. Archaeological findings show that capsicum was eaten in Mexico already in prehistorical ages back to 7000 B.C. It was one of the first plants domesticated in the Americas. Beautiful pictures of Capsicum fruits are seen on pottery of the Nazca Culture in the Southern part of Peru; the fruits are linked to the forelegs of the "Mottled Cat" which was a fructiferous symbol. It is said that when Columbus arrived in 1492 in San Salvador, Cuba and Haiti, it was not only the first step into the New World, but also the entrance right into the center of the "Capsicum Countries". In his first letter to the Spanish Catholic Majesties Ferdinand and Isabella, he already mentioned the habit of the people to eat meat with very hot spices. On his second voyage he was accompanied by the physician Dr. Diego Alvarez Chanca from Sevilla. He gave the first detailed report about the hot spice called Agi, which was nothing but modern day chili. Fernandez de Ovieto described the plant in detail and mentioned already its common use by the Spaniards. Cortez regarded in a letter in 1526 Agi as one of the most valuable products of Mexico, saying clearly that he enjoyed the hot taste of this spice. Quite soon an exchange of seeds and plants between the Old and the New World took place: oranges, lemons, melons and grapes were brought to the West, capsicum, tobacco and maize to the East. It is remarkable that the ancient name Agi or Aji remain in use until present days in the territory formerly governed by the Inca. Tschudi, a Swiss traveller, who gave a detailed description of life in Peru around 1840, mentioned the meal "Piccante" being served for lunch every day. It contained so much Agi that after a few spoons the mouth started to burn like glowing coal. He mentioned that one soon got adapted and acquired a preference for the condiment; even the ingestion of large amounts of these hot fruits was devoid of any adverse effects on the gastro-intestinal tract. I may tell you here that an acetic acid extract of only two capsicum fruits, when applied to the skin, produces severe pain and reddening, followed by the formation of a blister." "Oh, so chilies were very common in South America, even in prehistoric ages. Were they used for killing in those times too?" "If they were, no records exist of such killings. Capsicum however captured the imagination of people as a condiment. Within a few decades after Columbus, Capsicum had been distributed world-wide. Its distribution in Europe started with the cultivation and use as a spice in the Iberian peninsula. It is however unknown whether Capsicum came from there to other parts of Europe. It seems more likely that Portuguese trade connections to Ormuz in Persia in 1513 and Diu in India in 1538 opened the way for Capsicum to Ottoman Turks. Capsicum probably reached Central Europe concomitantly with their invasion of the Balkan peninsula and of Hungary which was occupied by them for about 150 years. The collection of Herbal woodcuts, published by Leonhard Fuchs in 1545 in Basle, contained already three plates of Capsicum under the name of Indian and Calicut pepper. Capsicum was cultivated in monastery gardens of that time, as documented e.g. in Brünn (Brno) in Moravia in 1566. It seems that Capsicum was highly welcomed as spice in Europe to substitute for black pepper. From Greek and Roman times on, aromatic spices and frankincense came from the Orient to Europe via secret trade connections. These links between the Lands of Spices and Europe were for centuries the monopoly of Arabs and Venetian merchants, resulting in an exorbitant price for pepper. So costly was pepper that only very rich traders could expect to trade in it. It may interest you to know that in Germany even today, rich traders are called "Pfeffersäcke" which means pepper sacks! Black pepper, the spice most sought after, was so costly in old days that it was counted out peppercorn by peppercorn!" "Doctor, earlier you mentioned about the name Aji for chilies. I usually eat pepperoni pizza which contains lot of chilies. Now after talking to you, I realize the word "pepperoni" contains the word "pepper" too." "Yes, that's a good observation. Chili is known by a number of names around the world. In the West Indies and South America the ancient name "Aji" is still in use. In Mexico the Nahuatl word "Chili" was used when the Spaniards arrived; the name remained in use not only in Mexico but also in Northern America as chili or chili. The name of the long black pepper of India, Piper longum, was soon also used for Capsicum and remained in use as "pepper" in most English-speaking countries. Pepperoni is actually the name of a fairly hot variety of capsicum which is eaten in Italy. In Europe, Capsicum found its main domicile in Hungary. The Hungarian name paprika stems from the Slavic name peperke used in Balkan countries for pepper. Another version, although not based on linguistic sources, seems to be more charming: The Hungarian diminutive form for Ilona is Ilonka, and Mary is Marika. On the same lines it has been suggested that paprika was the definition for a small pepper!" "Doctor, how many varieties of capsicum exist in the world?" "Tarun, there are about 1600 to 1700 varieties of Capsicum in the world, but only around 200 of them are commercially available. The Mombasa variety, the black chili from Africa, is too hot to be eaten; it would blister the mouth! Other varieties are as mild as green peas and do not contain capsaicin." "That's interesting. Doctor, tell me why do people eat peppers, chili or paprika at all? Doesn't it appear more or less like a paradox to you? Chilies are so hot; by no stretch of imagination can they be called pleasant, yet people seem to enjoy the hot taste of chills. Why?" "Tarun, you must remember that highly spiced meals, flavored with chili, chili-containing curry, black or green pepper or ginger are preferentially consumed in countries with hot climates such as India. The common experience during such a fairly hot meal is sweating beginning in the face. This occurs only in hot climates or in a warm restaurant, but not in a cold environment. It is called gustatory sweating because it differs from sweating following physical exercise, protecting against hot environment or expressing emotional stress. The effect of gustatory sweating is explained by the action of capsaicin on thermoregulation. It stimulates heat sensitive fibers in the periphery and the temperature regulation center. This results in sweating, which is basically a heat loss reaction. This effect is observed not only in man but also in rats. This also counteracts the heat production by a heavy meal and facilitates food intake in hot climates. All these facts explain the enormous fascination of people with chilies. So high is the consumption of chilies in the world, especially in hot climates that the world-wide production of Capsicum is estimated to be in the range of 6 million metric tons each year. There is even an International Chili Society which arranges Local and World Championship Chili Cookoffs, thus connecting peppers with entertainment! Capsicum plays a very interesting cosmetic role in chickens too which has nothing to do with the action of pungent capsaicin..." "What is that?" "Tarun, when chickens have access to green food in springtime their feet become bright yellow and the yolk of their eggs almost orange red. This is based on the rising intake of carotenoils. Thus bright yellow color of chicken's feet and orange red color of egg yolks is indicative of the fact that chickens have had a lot of green food. In fact this is often touted as a "healthy color" to the customers. Quite strangely poultry owners can produce a similar color in their chickens without giving them green food." "How?" "Tarun, besides capsaicin, chilies also contain Capsanthin which is the red pigment of ripe paprika pods and accounts for about one third of their colorants. The red color of chilies is because of this pigment. When this red pigment is included in the food of chickens, a similar change in color in chicken's legs and in their egg yolks appears because Capsanthin accumulates there. The interpretation that the "healthy color" of legs or egg yolk is linked to life of chickens in open air is therefore suggested to the customer!" "That is certainly highly interesting doctor. You said earlier, that chilies are used for a lot of criminal activities in India. Can you tell me about some?" "Oh, sure. To begin with, I must tell you that homicide by pepper although a rarity, is a distinct possibility. The first report of a case of homicide by pepper in world's literature was published in 1964. Homicidal asphyxia by pepper has also been reported. In such cases, the pepper is forcibly introduced in the nostrils and mouth of very young children who get asphyxiated. Another reported criminal use of pepper is by robbers. They often throw chili dust in the eyes of their victims to "blind" them temporarily to facilitate robbery. This act can in fact be done by anyone to temporarily inactivate his enemy or opponent. Chili powder is often used by police in our country- and in fact in several third-world countries- to extract confession from criminals. It may be introduced in the mouth, nose, anus, urethra or vagina to torture a suspect and extract confession from him. It is said that during emergency in India in 1976, chilies were used as a means of torture by introducing them in rectum! This process was known as Hyderabadi Goli. In India, superstitious people use chili fumes to "scare away" ghosts and spirits. These fumes are very irritating to the eyes and the nasal passages and can cause severe inflammation. Such practices can cause severe breathing problems in children, if they are around. Finally, in our country, chili powder is often introduced in the vagina as a punishment for infidelity." "Doctor, what symptoms does the victim experience when chili powder is given to him?" "Tarun, capsaicin is mainly an irritant poison. Applied to skin, it causes irritation and vesication. When ingested in sufficient quantities, it acts as an irritant poison, with the usual symptoms of vomiting and diarrhoea and a burning sensation in the mouth, throat and stomach. Burning sensation also occurs during defecation. When thrown in the eyes, it can cause severe burning pain, watering of the eyes, intense spasm of the eyelids and photophobia, which is another term for sensitiveness to intense light. It is for this reason, that robbers and thugs use chili powder on their victims to rob them. Capsaicin is volatile and because of this, fumes arising from burning capsicum are highly irritant. Major toxic symptoms in experimental rats and mice are salivation, erythema of skin, staggering gait, slowing of respiration often leading to difficult and labored breathing, blueness of skin, tremor, convulsions." "Doctor, I feel now I know fair enough about capsaicin. I am now ready to see the autopsy of this young child. What important findings are present in this child?" "Tarun, when this child was brought to my dissection table, I noticed some pepper, or lal mirch as you would call it, sticking to her clothes. This immediately alerted me of some foul play, especially as I knew that pepper can be used to liquidate unwanted children. I asked about the relationship of the mother with the child in detail and the history made me still more suspicious. Then I looked at her mouth, and I was stunned to see lot of red pepper in her mouth. On opening her food pipe and stomach, I found still larger quantities of red pepper there too, which almost solved my case. Not only that, there were large quantities of red pepper in her windpipe and bronchi too. I can now imagine what must have happened. When Pyarelal left for office, Anita waited for some time. Then she brought a fistful of red pepper from her kitchen and forcibly introduced it in the child's mouth. The poor child could not resist. Whatever resistance she did make only helped to introduce chilies in her nose too. Needless to say, with so much of pepper in her stomach and windpipe, the child soon died. Anita then smoothed out everything, removed the traces of chili powder from her face and from the cot, and phoned her husband at 2 pm. She hoped that she could pass the death off as a natural death. She however forgot to clean Neeta's clothes completely, and I could find traces of chili powder in her clothes which immediately alerted me. Well, even if she had assiduously cleaned her clothes, I would still have found out the cause of death by looking at her stomach and windpipe. Come, let us tell the police that Neeta did not die a natural death; Anita is her killer." "Oh, how very clever of you doctor. This was a most interesting discussion. I never could imagine that chilies could be put to such a draconian use. Tell me what are you going to tell me the next time?" "Tarun, next time, I would tell you about a very deadly poisonous gas- Lysol "

SCIENCE IN CRIME DETECTION-25 DEATH BY STRANGULATION I had a tremendous response for my article " Death by air injection" published in the March,1995 issue of Crime & Detective. Many readers have complained that their clippings, stories and ideas which they have sent to me with great hope have not found their way in my subsequent pieces. I would request all such readers to be patient with me. I am receiving such a heavy mail, that it is not possible for me to include all the letters. Nevertheless I shall try to include as many letters as possible. Needless to say, more useful contributions find their place earlier. One of the best responses that I got for my above named article was from Dr. Ritu Gupta from Nizamuddin, New Delhi. She has sent me a photocopy of page 153 from a book called "Murder What Dunit?" The book is written by JHH Gaute & Robin Odell. It describes a remarkable case in which a doctor killed his patient by air injection. It was a mercy killing. In December 1949, one Dr. Hermann Sander attended one of the patients, Mrs. Abbie Borroto, who was dying of cancer in a New Hampshire hospital. In the presence of a nurse he took a hypodermic syringe and injected 40 cc of air into a vein in the woman's arm. A death certificate was made out giving cancer of large intestine as the cause of death, and the body was duly buried. Some days after the funeral Dr. Sander completed the dead woman's medical record by making a detailed entry of her final treatment, including the injection of air. This virtual confession to mercy killing was spotted by a hospital records clerk who reported it. In due course the newspapers learned of the story, and a great controversy blew up, with the doctor being applauded for an act of mercy killing. Dr. Sander, having refused to reconsider the statement made on his patient's record, was brought to trial in what became known world-wide as `The Mercy Killing Trial'. Thankfully enough, the doctor was found not guilty. A remarkable story indeed on death by air injection. I had thought that killings by air injections could be done only by criminals with criminal intentions. But here is a remarkable case in which a doctor having an exalted place in society killed his patient with air injection. It was done with good intention however. The doctor couldn't see the pain of the patient. He could neither cure her disease, nor lessen her pain. So he deemed it fit to end her life. However whether he did it right or not remains a controversial topic. Readers may send their views on this. Thank you Ritu, for sending us such a nice story related to death by air injection. Readers may keep sending similar stories, newsclippings or other material of interest to me for inclusion in our forthcoming issues. This time I am going to tell you about a very interesting case which I solved in November 1993. On 16th November, 1993, I was called by the police to a house in Vasant Vihar, where they had found the dead body of an 18 year old girl Rajni. Rajni was a student of B.Com. in Delhi University. Her parents were simple middle class people. She had a younger brother, a 15 year old boy called Raju. Rajni was in love with a boy Pramod, who was her colleague in the college. Everybody knew about their love-affair. Her parents were however very much against this love-affair, and had advised their daughter to terminate this affair but she would not listen. Pramod came from a good family, but his company was not good. There were rumors in the campus, that they even had sexual relations. However Rajni had confided everything to Sarita, her best friend. During the police investigations later on, Sarita told the police that Rajni had no sexual relations with Pramod. However only a few days back Rajni had told her that lately Pramod was insisting to start sexual relations with her, but as she was against such things before marriage, she had refuted his advances. Anyway she had not lost her love for Pramod. It was just that she did not want to have sexual relations with him before marriage. On 15th November, 1993 Rajni came home from college at the usual time of 5 pm. She had her evening cup of tea, and then went to meet her friends. She came back again at about 8 pm, had her dinner and went to her room. At about 10 pm, her father heard some voices from her room. Out of curiosity he went to her room, and knocked at the door. Rajni opened the door after an inordinate delay. Her father however saw someone run away from the window. He immediately rushed to the window and saw a shadow rapidly moving away from the house. Her father became very furious with Rajni and asked who had come to meet her. She wouldn't say anything, but his father knew it was Pramod. He woke up his wife and told everything to her. Rajni's mother became very furious and slapped Rajni twice. She also shouted at Rajni and said that she was ruining the name of the family. This drama went up to 11.30 pm after which Rajni's parents left the room. When in the morning, her parents saw the room still closed at 8 am, they became very worried and knocked at the door. When they couldn't get an answer, they called their neighbors. Someone broke open the door. To everyone's horror, Rajni was found dead in her bed with a scarf tied around her neck. Her skirt was folded up showing her thighs and even her undergarments. Her face was congested. The bedclothing had been thrown back in a manner consistent with getting out of bed. There were no signs of any struggle. However I could notice a flower pot which had tipped down. Rajni was dressed in a nightgown. Some bleeding had occurred from her nose which made a stain on the bedding. The tongue was protruded. From the circumstances, it appeared that someone had strangulated her. Rajni's parents immediately accused Pramod. Her father told the police that he had indeed visited his daughter the previous night, and had entered their house through the drainage pipe. He said that when he caught him in some dastardly act, he ran away from the house. His contention was that Pramod came again after sometime, and killed her. Sarita's statement that lately Pramod was demanding sexual intercourse from her, seemed to corroborate the story that Pramod had indeed killed her. It was quite possible that Pramod came back again after some time, demanded sexual intercourse from Rajni, and when she wouldn't relent, he strangulated her out of frustration. When Pramod was contacted and told that Rajni had died, he seemed perturbed. However he could not give satisfactory answer as to where he was on the night of 15 Nov. Police swung in action and arrested Pramod even as he kept insisting about his innocence. It was at this stage that Rajni's dead body was brought to me for post-mortem. Here I would like to say a few facts about strangulation before we go on further. Strangulation is a kind of death in which the neck is compressed by a ligature. By and large strangulation points to homicide. Although one can commit suicide by strangulating himself, such cases are not very common. I generally take a case of strangulation to be homicidal in nature, unless proved otherwise. Many types of ligature have been used for strangulation. Cases of strangulation with such weird materials as electrical cables are not unknown (reproduce fig. 143 on page 402 here). Strangulation is of several different types. The cases in which some kind of ligature (such as a necktie, scarf, dhoti, or even an electrical cable as just mentioned) is used, go by the name ligature strangulation. However the neck could be constricted by other means too. For instance, one could simply use hands to constrict the neck of his victim. These cases go by the name throttling or manual strangulation ( From Latin manus, hand ). Manual strangulation can leave tell-tale fingernail marks and scratches (from nails of the assailant) on the neck (reproduce fig. 147 on page 411 here) . There might be signs of struggle too, such as bruising of the face (reproduce fig. 139 on page 397 here). The face is generally congested (engorged with blood), but it might be pale (reproduce fig. 141 on page 398 here). Strangulation can also be effected by compressing the victim's neck against the assailant's forearm. This form is known as mugging. When a victim is attacked from the back without warning, and strangled by grasping his throat or throwing a ligature over the neck and tightening it quickly, it is known as garrotting. It can overpower and kill even a healthy robust male without any struggle. Loss of consciousness is so rapid that the assailant is able single-handed, to tie the ligature with one or more turns. Garrotting, as a mode of execution, is practiced in Spain and Turkey. In Spain, the prisoner is seated with his back to a post, to which he is firmly secured. A metal collar is then applied to the neck and tightened. The apparatus may include a spike which is forced into the nape of the neck during the execution. The bowstring is used in Turkey. In our country, especially in the Northern regions, a very weird form of strangulation is used. This is known as Bansdola ( doing away with a bamboo). In this form of strangulation, the neck is compressed between two sticks or hard objects, usually bamboos, one being placed across the throat in front and another behind. These are strongly fastened at one end and a rope is passed at the other to bring the two bamboos together. The unfortunate victim is thus strangled to death. Sometimes, the throat is pressed by means of a bamboo or lathi placed across the front of the neck, the murderer standing with a foot on each end of the bamboo or lathi, thus squeezing the victim. There is another method of strangulation known as the palmar strangulation (reproduce fig 137 on page 393 here). In this method, both palms are so pressed over the nose and mouth that the victim can not breathe. In cases of strangulation, abrasions and bruises round about the ligature mark are quite common. These injuries are produced by the assailant's nails, and even by the victim's own nails during the struggle to pry the ligature away from his neck. Many times, the pattern of the ligature material is reflected very faithfully on the neck. The weave of a rope for instance can come very accurately on the neck and many times a victim can be apprehended from that. In the adjoining figures (reproduce figures 133 and 134 on page 391 here), the weave of the ligature material gave away the criminal. The criminal strangulated a young boy with a plastic twine, with a characteristic weave. This weave was faithfully reproduced on the neck of the victim. When the accused was finally apprehended, a plastic twine was recovered from his which had exactly the same weave as was found on the neck of the boy. This helped to nab the criminal very easily. Differentiating suicidal from homicidal strangulation however can be a very tough affair. In the given case, I found at my wit's end to decide whether I was dealing with a case of suicide or homicide. The pattern certainly seemed similar to homicide. It was quite possible that Pramod came back later in the night to press his demand for sexual intercourse, and when Rajni resisted he strangulated her with her own scarf. It was quite possible for him to do that. Police investigations revealed that lately he was moving in bad company. Rajni's upturned skirt showing her underclothings pointed to the fact that Pramod might indeed have tried to molest her. However the two things that caught my attention were relatively undisturbed state of the room and the position of the knot in front of the neck. If the death was as result of homicide, there should have been a struggle between the two. Rajni might have shouted, but nobody heard her cries in the night. Furthermore one would expect the furniture and other things in the room to be in a violently disturbed state. But everything seemed to be in order, save for a flower pot which might have tipped because of the carelessness of Rajni. In suicidal cases, mostly the knot is in the front. Further the scarf was applied with five turns, and there was a final tying of the free ends with a half-knot. This is the hallmark of self-strangulation. A killer generally makes only one turn around the knot, and more often than not he would merely tighten the ligature without actually tying it. A person committing suicide by strangulation would have to tie the knots. If he merely tightened the noose, he could not strangulate himself. The reason is not hard to find. First of all he would tighten the noose with his muscular effort. Before dying he would fall unconscious. The moment he would fall unconscious, his muscles would relax. He would not be able to keep the ligature tight. The ligature would loosen up and he will start breathing again. Thus if a person wants to commit suicide by strangulation, he would have to tie a knot, so that the grip is not loosened. Another interesting point was the presence of scarf round the neck of Rajni. If Pramod had killed Rajni by strangulation, why hadn't he taken away the ligature material (the scarf) with him? It is very natural for a killer to take away the ligature material from the scene of crime. No criminal wants to leave behind any incriminating piece of evidence. All these pieces of evidence led me to conclude that Rajni had actually committed suicide by strangulating herself. She had been severely scolded by both her parents the previous night. She was in a state of great turmoil otherwise too. Her love-affair was not seen in the proper light by her parents and this had disturbed her a lot. All this caused her to take that drastic step on that night. The police had faith in my findings and released Pramod. A few months later, Rajni's father confided in me that he had indeed found a suicide note in Rajni's drawer, in which she had stated that she was taking her life because her parents refused to acknowledge her love-affair. He had destroyed that suicide note because he wanted Pramod to go behind bars. In his opinion, Pramod was morally and ethically responsible for his daughter's death. This confession confirmed my conclusions in that case. I was very satisfied on that day, that forensic science could help save the life of an innocent young man.

Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE APRIL 1999 ISSUE THE POISON SLEUTHS DEATH BY ARSINE GAS -Dr. Anil Aggrawal "Good morning doctor. Oh, my God, what are you doing today? You have the dead body of a middle aged man today. What has happened to him? Please tell me." "Good morning Tarun. The name of this middle aged man is Radhey. He used to work in a factory, where they used to make soldering flux. He was working in his factory five days ago, when at about 2 pm, suddenly he started having nausea, headache, vomiting and diarrhea. He had taken lunch only a few minutes before so naturally everybody started thinking that he had had food poisoning. His illness soon became worse. He started complaining of intense headache and pain in the loins. He passed urine after sometime, and everybody was alarmed to see that it was very dark. He was taken to the hospital, where the doctors were unable to diagnose his illness. However the history of having taken his meals only a few minutes before, and the non-specific symptoms prompted some doctor to write "undiagnosed poisoning" on the hospital case sheet." "So it was a case of poisoning? Was somebody else was poisoned too?" "No, nobody else was poisoned - of course presuming that Radhey died of poisoning. Only Radhey showed these peculiar symptoms. The tentative diagnosis of "undiagnosed poisoning" flared up everybody's tempers, especially those of Radhey's relatives. They thought that somebody had surreptitiously mixed poison in his food. And all suspicion fell on another man Suleiman." "Why on Suleiman doctor?" "Because and Radhey apparently did not have good relations. They did not even talk to each other. Nobody knows how their fight started, but it is for sure, that they were sworn enemies. After Radhey was taken to the hospital, the doctors tried their level best to save him, but they could not, and he died today morning after an illness of about four and half days. The doctors refused to give a death certificate, as they did not know the illness Radhey was suffering from. Meanwhile the relatives of Radhey actually lodged an FIR in the police station, in which they alleged that Suleiman had poisoned Radhey, and he should immediately be taken in custody. Apparently the relatives of Radhey had some political clout too, so the police had to act fast. Now they have sent this body to me. My job obviously is to find out how Radhey actually died." "Very interesting indeed. That explains the big mob outside your mortuary. When I came to meet you, I was surprised to see several people sorrounding this mortuary several of whom were toting cellulars." "Yeah, they are very influential people, and apparently they would leave the mortuary only after they have come to know of the cause of Radhey's death. The pressure on police was so much that they had to arrest Suleiman." "What does Suleiman say doctor?" "I have talked to Suleiman myself. The police has also talked to him. He says he has absolutley no hand in this killing. He has hired a lawyer for his defense and he is pressurizing the police by saying that they can not arrest his client without any solid evidence. So the police are finding themselves in a Catch-22 situation. As you can understand, I have been showered upon with a very heavy responsibility." "Yes indeed. I can understand that. Now where do you start from?" "Tarun, I have already started actually. Whenever a death occurs in a factory, I make it a point to visit the factory first and see what kind of activities were going there. I found that Radhey was involved in making soldering flux by putting zinc scrap in hydrochloric acid." "Please explain this to me in some great detail doctor." "Tarun, in several industries there is a "rough and ready" practice of producing zinc chloride to provide a soldering flux by putting zinc scrap in hydrochloric acid. This is actually not recommended as sometimes a very poisonous gas arsine may form in this process. The zinc scrap may contain arsenic as an impurity, and when arsenic acts with hydrochloric acid, it forms arsine (AsH3) a very dangerous gas." "So you think Radhey died of arsine gas?" "I can't say for sure at present, but after you know more about this interesting gas, you can make a guess yourself." "Looks like we are on the trail of yet another interesting poison. Doctor please tell me more about arsine gas." "Tarun, arsine is a very toxic gas, a molecule of which contains just four atoms - three of hydrogen and one of arsenic. It is a colorless inflammable gas. It is supposed to have an odour of garlic, but it is not always apparent, especially when a person is suffering from common cold. It is an unstable compound which when exposed to light or moisture, decomposes to deposit arsenic. It is heavier than air, its vapour density being 2.68 times that of air. You might be surprised to know that the German chemist Gehlen died of accidental arsine poisoning in 1815." "Oh, I didn't know that." "Tarun, arsine is one of the most poisonous gases known. It can kill outright. Even brief exposure to moderate concentrations can cause serious illness. I will give you some figures which will tell you something about the killing power of this gas. The four most poisonous gases are carbon monoxide, phosgene, chlorine and arsine. Inhalation of carbon monoxide in concentrations of 1000 parts per million (ppm) for a few minutes can cause death. The equivalent figures for Chlorine and Phosgene are 400 ppm and 50 ppm respectively, meaning thereby that they are more poisonous. Obviously the lesser concentration required for killing, more poisonous the gas. You would be surprised to know that in the case of arsine, only a concentration of 10 ppm inhaled for about half an hour could be dangerous. And at such low concentrations, the pecualiar garlic odor of the gas may not be apparent at all. The safe maximum concentration of carbon monoxide - generally considered by all to be very toxic - is 100 ppm, while that of arsine is just 0.05 ppm. This can give you some idea of the lethality of this gas" "Oh, sure. From the figures it appears to be about 2000 times more poisonous, which is remarkable. Especially considering the fact that everybody considers carbon monoxide to be a very deadly gas." "Exactly. Like carbon monoxide, arsine is a cumulative poison too. This means that it is excreted much more slowly from the body than it is absorbed. This results in gradual accumulation of the poison in the body which can be very dangerous. A good simily is of a tank, in which poisonous water is entering much faster than it is being let out. This would ultimately result in overloading of the tank with the poisonous water." "Yes, I understand. But what is the significance of a cumulative poison doctor?" "Tarun, it means that repeated or prolonged exposure to even a very low concentration can be dangerous. Thus a cumulative poison - that whose excretion rate is slower than that of its absorption- is a much more dangerous poison, than a non-cumulative poison. The hazard of arsine gas exists in a number of industries including the refining of metal, the manufacture of corrosive acids, galvanizing and electroplating. It is also a risk in laboratories. There was a time when the use of wall papers colored with pigment which contained Scheele's Green, yielded arsine in the home, when acted upon by a mould. This could create severe poisoning in the inmates, especially considering that arsine is a cumulative poison." "Just a minute doctor. What is Scheele's Green?" "Tarun, Scheele's Green is a popular name for cupric arsenite. Its formula is Cu3(AsO3)2.2H2O. It is named thus in the memory of the famous Swedish Chemist Kark Wilhelm Scheele (1742-1786). It is a brilliant green pigment which was once used for paints, but since it is a potentially poisonous compound, it is no more used now. When mould acts on this compound, arsenic may get combined with hydrogen molecules and may form arsine, which may be very poisonous. Arsine may be produced in quite a few other remarkable ways." "What are those doctor? Please tell me." "Tarun, I know of a unique case of industrial poisoning by arsine in which three men were poisoned - one of them fatally. They were engaged in unloading fish scrap from the hold of a wooden schooner. The close, warm atmosphere promoted bacterial activity and, in turn, the production of arsine." "Oh that is indeed quite unusual." "Yes. Another likely source of arsine is the interior of tanks used in the preparation of sulphuric acid from iron pyrites (sulphide). Some of the deposits in these tanks was hard and had to be scraped from the walls. It contained upto 45% of arsenious oxide. The production of arsine from this material was unsuspected for quite some time. In yet another case, a person had cleaned a water jacket by pouring freshly diluted hydrochloric acid into its pipes. Fumes were liberated and he was in close contact with them in an unventilated room for about half an hour. The acid contained an "inhibitor", which proved to be a mixture of sodium arsenate and aniline hydrochloride. Arsine was produced from the inhibitor n the presence of nascent hydrogen and the man was severely poisoned." "Oh, I see. Arsine can be produced in most unusual circumstances. It does appear to me that Radhey too got involved in arsine poisoing." "Yes, it became apparent to me, when I came to know that he was involved in making the soldering flux by that precarious method, which I have described you just now. My suspicion was confirmed to a great extent when I heard that he had passed dark urine. This was because of the presence of hemoglobin in the urine." "Why should hemoglobin appear in the urine in a case of arsine poisoning?" "Arsine is a deadly poison tarun. It hemolyses (breaks) all the Red Blood Cells of the body. This liberates hemoglobin which ultimately finds its way in the urine which become dark. I have made some slides of the blood of this patient, and you can see under the microscope that all the R.B.C.s are broken. This is a very strong indication that he had died of arsine poisoning. Moreover his kidney tubules are blocked by these broken R.B.C.s which is another finding in favour of arsine poisoing. Coupled with his peculiar history, I am sure Radhey died of arsine poisoning, which is an accidental poisoning. Suleiman had nothing to do with it. Come, let us tell the police about it." "Very clever indeed. This was a most interesting discussion doctor. Without your masterly deduction, police could have unnecessarily went on harassing Suleiman. Radhey's relatives and other people might have thought, it was a case of killing by Suleiman. Tell me what are you going to tell me the next time?" "Tarun, next time, I would tell you about death by aflatoxins. "

Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE FEBRUARY 2000 ISSUE THE POISON SLEUTHS DEATH BY GOLD -Dr. Anil Aggrawal "Good morning doctor. Oh, my God, what are you doing today? You have the dead body of an old lady today. She appears to have a gray pigmentation all over her body. What happened to her? Please tell me.” “Good morning Tarun. The name of this 58 old lady is Rita, and she belongs to a very rich family. She married a relatively young, smart and ambitious doctor about a year back, after the death of her first husband. She was a chronic patient of rheumatoid arthritis - a disease mainly affecting women, in which there is intense pain in the joints- and was constantly taking medications for it. For some days however, she was complaining of vague symptoms, like stomach upsets, sore throat and tongue, a general lassitude and so on. Her own husband -the second one - was a doctor. He was treating her by his own medicines, but when things went out of his hands, he took her to the hospital. The senior doctors at the hospital also couldn't diagnose anything specific, and were treating her along general lines. Today morning her husband reported to the hospital that Rita was dead, and could they please issue a death certificate. That is how the case came to me." "But you only deal with police cases doctor, and this doesn't seem like a police case to me at all. After all, she was an old lady and was suffering from a disease for which she was taking medications too. The doctors should have issued her a death certificate and that would have been an end of it. Why at all has she been brought to you for a post-mortem examination?" "Tarun, this lady is worth about 65 crores of Rupees, and her husband Satyanand stands to inherit all that money. Some cousin of Rita has alleged that Rita has not died a natural death as is alleged by Satyanand, but in fact he has killed her by some poison. He has approached the police too, and lodged an FIR to this effect also. That is why her body has come to me. Naturally, like every other time, I have to tell the police, if she died of a natural death, or if some poison was used to finish her off." "Oh, I see. So what do you think of this case doctor?" "Tarun, I have taken a detailed history from that cousin of her, from the neighbors and from the doctors at the hospital who treated her. Two or three things have been bothering me quite a lot. Firstly the grayish pigmentation over her body, about which even you commented when you entered this post-mortem room. Secondly that almost all mucus membranes of her body are inflamed. She has an inflammation of her food pipe, wind pipe, her tongue, and even her vagina is inflamed. At her age, I wouldn't expect her vagina to be so inflamed. Moreover she appears to have a strange skin disease. I have examined her skin closely under the microscope and found that she is suffering from a special skin disease known as Lichen planus." "What does this all point to doctor?" "Tarun, to me, it seems to be a case of one and only one poison. A very unlikely one for you - one which would undoubtedly baffle you - gold!" "What? Gold? You must be joking doctor. Never heard of gold being used a poison." "Death by gold is surely a very very unlikely phenomenon. Nevertheless, it is possible. We must not forget that Rita was suffering from Rheumatoid arthritis, and one of the medications for it is gold. So gold salts were available in her house, and they could jolly well be used to kill her. We must also not forget that her husband was a young and ambitious doctor, and he surely knew that gold salts can be toxic in high doses.' "Doctor, I feel, we are again on the trails of one of your great poison cases. Can we start the tale of gold from the beginning please? Please tell me about gold in some detail, so I could follow your conversation better." "First, a few basic facts about gold. Known since antiquity, gold is a soft, malleable, lustrous yellow metal that steadfastly resists corrosion. Its atomic weight is 197 and it is a member of Group 1B in the periodic table of elements. Metallic gold is one of the least active metals chemically. It does not oxidise or burn in air even when heated and it is inert to strong alkalis and virtually all acids, except to selenic acid and to aqua regia, which as you know is a mixture of Concentrated nitric and hydrochloric acid." "Doctor you were telling me, that Rita was taking gold salts for her ailment. So that means that gold is useful as a medicine too?" "Sure. Gold, in elemental form, has been employed for centuries to relieve the itching palm. The real interest in gold as a medicine started when in 1890 the great bacteriologist Robert Koch told an international congress in Berlin that gold-cyanide complexes were most effective of all known antiseptics against tuberculosis bacteria, at least when tested in the test tube at high dilution. Unfortunately animals having tuberculosis could not be treated with these complexes. This dampened everybody's interest in gold compounds. In 1924, a Danish veterinarian demonstrated that gold sodium thiosulphate (known as Sanochrysine when sold in the form of a drug) had a beneficial effect in tuberculosis of the cow. Physicians tried the same compound in humans, but no success could be achieved. In those times, arthritis (pain in the joints) was wrongly thought by some to be a tuberculous manifestation. Under this impression Lande in Germany administered aurothioglucose (Solganal, a gold compound prepared by the Schering Corporation), to thirty-nine patients suffering from a variety of complaints. Many of these patients had joint pains due to rheumatic fever, and most of these patients reported relief of joint pain. Lande concluded that a full-fledged trial of the drug in arthritis would be worthwhile. Four years later in 1929, Jacques Forestier in Paris began to use another gold compound, gold-thiopropanol sodium sulphonate (Allochrysine) in rheumatoid arthritis. His observations were favorable, and it were mainly these observations which were largely responsible for the popularity of use of gold compounds in medicine. Therapy with gold compounds now even has a name; it is called chrysotherapy. Gradually the use of gold preparations in arthritic conditions began to spread, but it was not until 1944 that the results of a properly controlled clinical trial were first published by Fraser in Glasgow. He reported that clinical improvement occurred in 82% of 57 rheumatic patients who received intramuscular injections of sodium aurothiomalate (Myochrysin). Sodium aurothiomalate had been investigated in 1939, but only after the Glasgow trial was its value in therapeutics generally accepted. At present Gold is employed mainly in the treatment of rheumatoid arthritis. Its use is usually reserved for those patients with rapidly progressive disease who do not obtain satisfactory relief from therapy with aspirin-like drugs. Gold has however also been used in the treatment of several other diseases, but by and large, its use in other diseases is not very beneficial. Gold has also been used as a prosthetic. Because of its malleability and its anti-corrosive characteristics, gold has been employed as a prosthetic in dentistry and has been used widely as the predominant component of dental alloys containing silver, copper and small amounts of platinum and lead. These alloys can be heat treated to develop strengths as great as 150,000 psi (per square inch). Ophthalmologists have successfully implanted carefully balanced metallic gold weights into eyelids, as a surgical correction for patients who suffer from lagophthalmos. Before proceeding further, I may tell you that lagophthalmos is the technical name for the inability to voluntarily close an eyelid; the name comes from Greek lagos, meaning hare, because many people feel that in this disease, the eyes become rather like those of a hare! Gold has been recently used for delivery of genes inside the cells by genetic engineers. It has been seen that DNA can be absorbed to the surface of minute metallic gold particles and efficiently delivered by a controlled helium pulse to cells of the inferior epidermis. This is a painless maneuver, and results in notably efficient gene expression." "Oh, I see. It seems, gold is really a useful metal for doctors. Can you tell me which compounds of gold are most commonly used as medications?" "Sure Tarun. Mainly three compounds of gold are in clinical use. These are aurothioglucose, gold sodium thiomalate and auranofin. Aurothioglucose (SOLGANAL) and Gold sodium thiomalate (MYOCHRYSINE), both contain approximately 50% of gold by weight (For instance, gold sodium thiomalate is C4H3O4Na2SAu. Thus the molecular weight of the molecule comes to 390 of which 197 is gold, making it almost 50% by weight). Solganal is sold as a sterile suspension in a suitable fixed oil. Commercial preparations contain 50 mg/ml. Myochrysine is available as a sterile aqueous solution for injection. The usual dose is 10 mg of either of these compounds in the first week as a test dose, followed by 25 mg in the second and third weeks. Thereafter about 50 mg is administered at weekly intervals until the cumulative dose reaches 1 g (i.e. for about 20 weeks). A favorable response is generally not evident till after a few months. If neither significant toxicity, nor clinical response is visible, the dose is increased, but never more than 100 mg a week. Auranofin is available in India as GOLDAR, and RIDAURA. Both are available as 3 mg tablets, one tablet costing about Rs 12. The oral dose is 6 mg daily (i.e. about 42 mg a week) or one tablet two times a day, for a minimum of 3-6 months. As you can see in the accompanying formulae of these compounds, you will find that all significant medicinal preparations of gold are those in which the atom of gold is attached to an atom of sulphur. Nobody knows how gold salts work as medicines. But two facts are known about gold; one that monovalent gold has a strong affinity for sulphur and two that they have inhibitory effects on various enzymes of the body. This has led theoreticians to speculate that the therapeutic effects of gold salts might derive from inhibition of sulfhydryl systems which are present in the body. I may tell you that sulphydryl enzymes of the body have sulphur as their main component. However, other sulfhydryl inhibitors do not appear to have therapeutic actions in common with gold." "Doctor, is gold a component of normal human body also?" "Very little. An average human being has just about 2.45 mg of gold in his body. This however leads us to an interesting fact. Considering that the total population of the earth is about 6 billion at present, it follows, that the total gold contained in all human bodies is about 20 metric tons!" "Oh, that is really an amazing fact. Doctor, when a patient takes gold salts for his ailment, where does it go? Does it go to joints?" "Tarun, gold does go to the affected joints where its concentration is about ten times that in muscle, bone or fat. When one takes 50 mg of gold, about half of it disappears from the body in about 7 days. Technically doctors like to put this fact by saying that the half-life of gold is about 7 days for a 50-mg dose. You must however not confuse this half life with that used in radioactivity. But when a patient goes on taking successive doses, the half life lengthens, and values of weeks and months may be observed after prolonged therapy. After a cumulative dose of 1 g of gold, about 60% of the amount administered is retained in the body. In normal adults, minute amounts of gold can be detected in the hair, nails and skin. Using Neutron Activation Analysis (NAA), values ranging from 0-1.1 micrograms per gram of dry tissue weight, with a mean of 0.35 micrograms per gram (i.e. 0.35 ppm) have been reported. Following a course of gold therapy for 12 months, an increase of about 2-5 fold in these values occurs. After termination of treatment, urinary excretion of gold can be detected for as long as a year, even though concentrations in blood fall to the normal trace amounts in about 40 to 80 days. Substantial quantities of gold have been found in the liver and skin of patients many years after the cessation of therapy. Large amounts of gold salts, or their metabolic by products are commonly contained within phagolysosomes called aurosomes. The excretion of gold is 60 to 90% renal and 10 to 40% fecal, the latter mostly by biliary secretion. "Doctor, now I feel, I know enough about gold compounds used as medications. Now tell me what are their adverse effects, and how can they be used as poisons." "Tarun, with gold therapy, skin and mucus membranes are affected most, and occur in about 15% of all patients. Skin reactions may vary from simple redness to severe inflammation. The minimum cumulative dose of gold salts that has been associated with skin reactions is 250 mg. Dermatitis is so common that, out of all reported adverse reactions to gold therapy, almost 66% constitute diverse forms of dermatitis. Lesions of mucus membranes include stomatitis, pharyngitis, tracheitis, gastritis, colitis, glossitis and vaginitis, as we have seen in Rita's case. As with silver, a gray-to-blue pigmentation (Chrysiasis) may occur in skin and mucus membranes, especially in areas exposed to light. This pigmentation is due to the excessive collection of aurosomes in the skin cells. We have seen this too in her case. In 5-8% of patients, the kidneys may be affected to some extent. Kidneys may begin to pass proteins and even blood in about 1-3% of cases. Gold may also cause severe blood disorders, inflammation of the brain and peripheral neuritis, and of the liver. The usual fatal dose of gold is 50-500 mg/kg of the body weight. This means that for a person weighing 50 kg, which was Rita's weight, a dose of gold, as little as 2500 mg is sufficient to kill. We have seen that the Commercial preparations of Aurothioglucose (SOLGANAL) contain 50 mg/ml. This means that an injection of about 50 ml of this drug was sufficient to kill her. Before proceeding further, I must tell you the contraindications of gold therapy. Contraindications of a therapy means those conditions, in which that particular therapy should not be performed, otherwise it could prove dangerous. Gold therapy is contraindicated in patients with kidney, liver and blood diseases. Patients who have recently received radiation (as those suffering from cancers) should also not receive gold. Gold is also poorly tolerated by aged individuals, and should thus be given to them with care. I have examined Rita's body, and have found that she was suffering from kidney ailments. Thus gold should not have been administered to her in the first place. Obviously this fact was known to Satyanand. She was an old patient too, in which case too, gold should not have been given to her. Now I think I know what happened. Satyanand was administering gold to her unsuspecting wife for quite some time, under the pretext that he was giving her medicines. Rita had no reason of suspecting him. Even if she had consulted some other doctor, he would have told her that he was giving her the right drug. That was precisely his plan. He knew that nobody would suspect him of administering her a poison, as gold is commonly used as a drug in rheumatoid arthritis, which was exactly what Rita was suffering from. But he was administering gold to her in very high quantities. Rita did get some symptoms of gold poisoning, and to show to everyone, that he was really concerned about her, he took her to various hospitals fully convinced that the doctors wouldn't be able to diagnose gold poisoning in her case, because it is so rare. And he was right! Then yesterday night, or probably early in the morning today, he gave her a heavy dose of gold by injection - may be about 40-50 ml-, thus giving a final blow to her. I have examined her liver, spleen and lymph nodes chemically and have found heavy doses of gold in those organs. Satyanand would have tough time explaining how such large doses of gold reached her organs. I also examined Rita's hip area where Satyanand gave her the last injection, and the muscle beneath is loaded with gold. This also is a point against him. Satyanand had probably used gold in the belief that nobody would ever be able to catch him, as this is a poison, so rarely used. But the typical hue of Rita's body, and her other body findings gave him away. Come, let us tell the police that Rita did not die a natural death. It was Satyanand, who administered her gold to kill her." "Unbelievable! 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 - Radon."

Forensic Science Fiction

Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE JUNE 1997 ISSUE THE POISON SLEUTHS POISONING BY SILVER -Dr. Anil Aggrawal "Good morning doctor. Oh, my God, what are you doing today? Oh well, today you are examining an old man. What happened to him? His body appears to be grayish blue all over. Please explain" "Good morning Tarun. The name of this person is Pyarelal, and he is 65 years old. He can not do much work now, and is mainly dependent on his son and daughter-in-law for his day-to-day needs. He however has a good bank balance which represents his life long savings. During his life time he had worked in relatively respectable positions." "So why is he with you today?" "Tarun, this makes an interesting story. He was quite unwanted by his son and daughter-in-law. His son is working in a private firm as an executive and his daughter-in-law is a chemist. For a few days he has discovered a grayish blue discoloration of his body, especially over the exposed parts of his body, and he contacted a local physician for this. He also complained of some tiredness, but besides this, he was alright. The local physician could not make much of his problem, so referred him to a specialist, and in turn this specialist referred this case to me." "But you are a forensic medicine man. As far as I know, you deal with criminal cases only. How can you be helpful in this case?" "You are right Tarun. I am a specialist in forensic medicine, and these specialists look at cases-live or dead- which are involved legally in some way. Well it goes like this. This specialist friend of mine thought that somebody might be trying to poison him slowly, and he consulted me on phone. When I had a look at this man, I thought he may be right. I enquired about his family life from Pyarelal and after talking to him for sometime, I became all the more convinced that it could indeed be a case of poisoning....." "Do you mean to say that a man who develops bluish gray discoloration of his skin is getting slowly poisoned?" "Not necessarily. There are other causes for this too, but my specialist friend had exhausted all those causes by various tests. Now only one possibility remained; slow poisoning by silver, a condition technically known as argyria, and that's why he referred this case to me. As you know, all cases of poisonings have some legality involved, so they are dealt with by forensic specialists. Before you start feeling uncomfortable with the word argyria, I must tell you that it comes from the Latin word for silver argentum. The chemical symbol Ag for silver has also come from the same Latin word. This condition was first described in 1816 by Johann Abraham Albers." "So you decided Pyarelal was being poisoned. But by whom? and how?" "Probably by his son or his daughter-in-law on whom he was a burden. They had an eye over his money too. Probably some silver salt was being mixed in his food. This rare and exotic poison was probably chosen because it is a relatively unknown poison, and it was probably thought by the culprits that doctors would find it impossible to detect it. But as you can see in a moment they had underestimated the capabilities of modern poison sleuths, who have an impressive array of facilities at their disposal. I asked him not to consume one day's food given to him by his daughter-in-law and instead submit it to me. He has done that today and I have submitted it to the lab for chemical analysis. While the test reports are awaited, let me tell you something about this rare but interesting poison." "Oh, sure I would love to know about it. In fact I didn't even know silver was a poison" "Well, in metallic form, it indeed is not. It is the chemical salts which are poisonous. Compounds of silver important from a toxicological standpoint are silver nitrate, silver lactate, silver picrate, silver acetate and the silver halides. Silver nitrate is a poisonous salt, also known as Lunar Caustic. Silver was likened to the moon by the ancient chemists on account of the latter's silvery color, hence the word Lunar. You would probably recall that Latin luna means moon. This term appears in the term "lunar month" which refers to the period during which the moon waxes and wanes completely once. This period as you know is equal to 28 days. This term also appears quite surprisingly in the word "lunatic". It is because ancient people thought that madness results from the effects of full moon. Even today, an excessively sentimental, dazed or a lunatic person is sometimes referred to as moonstruck." "Interesting! And what is the origin of the term caustic?" "The term caustic refers to the salt's caustic properties both as crystals and in aqueous solution. Silver has both medicinal and non-medicinal uses. Among the main non-medicinal uses are in jewelry, coins, silverware, tableware, and in manufacturing of mirrors and electrical wiring. You will probably recall that pure silver has the highest thermal and electrical conductivity of all metals. That is the basis for its use in electrical wiring." "Yes, I do. And what are its main medicinal uses?" "Tarun, silver and its salts have been used as medicines for various ailments throughout history. During the nineteenth century it was prescribed for the treatment of digestive disorders, including stomach ulcer. Later small sticks of compressed crystals of silver nitrate began to be used for cauterization, notably of throat lesions, because of its astringent properties...." "Excuse me doctor. You have used certain terms which I don't quite understand. What is cauterization and what is meant by the term astringent?" "Tarun, an astringent is a drug which precipitates proteins and causes contraction of tissues. The term comes from Latin astringere which means "to draw tight". Astringents have so little penetrability that only surface of cells is affected. Application of astringent often arrests secretions or discharge, so it is often applied to lesions which are discharging secretions. Precipitation of proteins also kills the cells. The idea of applying these drugs was also that it would kill any infective microorganisms lurking in the lesions, by precipitating proteins in their cells. The most popular astringents are salts of zinc and aluminum. Zinc sulfate (0.25%) is often recommended as an eye medication. Another common astringent is tannic acid. Cauterization is the destruction of tissues by the application of an astringent. Of course cauterization can be done by heat too. Warts can be cauterized by heat or by some astringent substance. There was a time when silver salts were popularly used for cauterization of warts." "Oh, I see. Are these salts still used today for cauterization?" "Not usually. This procedure carried a substantial risk of the silver nitrate stick getting broken and the patient swallowing -or worse- inhaling the detached fragment. Certain quacks in India still keep these sticks for such purposes. These sticks have been known to be used for the cauterization of infected umbilical stumps and in the treatment of nosebleeds too. They have been used in the treatment of warts as I told you earlier. Ayurvedic doctors are known to use Bhasmas (roughly equivalent to ashes) which contain various noble metals, of which silver may be one. Indian sweetmeat manufacturers often decorate sweetmeats with a paper thin sheet of silver, and consumers are known to consume sweetmeats along with it, but I am not aware of silver poisoning occurring by this means. Several other typical Indian preparations such as paan are also decorated in this way." "Does silver nitrate have other medicinal uses too?" "It is used as prophylaxis for ophthalmia neonatorum, which is an infective condition of the eyes in the newborn because of the gonorrhoea bacterium. Infants suffer from this condition when their mothers are known to be suffering from gonorrhoea. Silver nitrate is used in this condition, because of its known antiseptic effect against gonorrhoea bacteria. Dressings soaked in 0.5% silver nitrate have been extensively used in the treatment of burns. Topical use of silver nitrate in this way can produce poisoning although it is not common. Poisoning due to silver iodide nose drops has been reported. Silver is also used in dentistry for dental fillings. Silver salts, because of their germicidal properties, are also used as drinking water disinfectants. Such treated water may contain upto 50 mg/L of silver. Drinking water not treated with silver, usually contains extremely low concentrations of silver -up to 5 mg/L only." "So silver is used for disinfecting water too. I didn't know that. I thought only chlorine is used for disinfecting water." "Oh yes, silver indeed is used for disinfecting water. These days some companies are even marketing gadgets called "mobile electronic water purifiers" which work by generating silver ions. These are shaped like pens. The device is to be opened and dipped in water. In fact it has two silver electrodes and while in water, it is supposed to generate silver ions which in turn are supposed to kill microorganisms lurking in water. But as you know now, such disinfected water has more than the normal quantity of silver in it." "Can one ingest silver accidentally too" "Tarun, silver can be ingested accidentally in a most unexpected manner. To understand how it is possible, first of all I must tell you that sea water is known to contain silver in concentrations of 0.055-1.5 mg/L. Much higher concentrations have been reported in waste water effluents. For instance effluents entering southern California coastal basins have been known to contain silver in concentrations as high as 0.03 mg/L! Note that I am talking of milligrams here, not micrograms. Silver has been accumulated in concentrations of 14-20 mg/kg in bottom sediments in these areas. Molluscs ingesting this water accumulate seawater in their bodies. Molluscs collected from coastal areas of the North Sea have been reported to contain silver concentrations of up to 2.0 mg/kg. Ingestion of these molluscs as well as other marine food can thus lead to chronic silver poisoning!" "Oh, that certainly is most unusual!" "Exposure to silver can occur in other unusual ways too. For instance it can also occur from small amounts released from dental fillings and from eating out of utensils made of silver. Human activity has been known to increase silver concentration in the air. You perhaps know that a silver salt -silver iodide- is sometimes used to seed clouds precipitate rain artificially. The emission of silver iodide crystals during cloud seeding has been estimated to result in silver concentration in air of about 0.1 ng/m3. Silver concentrations in rainwater as a result of this process have been estimated to be between 0.04 pg/ml and 5 ng/ml. I must tell you that ng stands for nanogram and pg for picograms. 1 nanogram (ng) is equal to 10-9 g and 1 picogram (pg) is equal to 10-12 g. There is some amount of silver in tobacco too, but this is generally too low. Because of its high boiling point, most of the silver in cigarettes is not inhaled." "This is quite interesting information about silver. But what happens to silver once it enters inside the body? I know this is not a normal constituent of the body, nor can the body make any use of it. Then how does it handle silver?" "That's a good question Tarun. In humans, more than 50% of the body burden of silver goes in the liver. Elimination is mainly via faeces. The concentrations of silver in kidneys, liver and spleen of normal people have been reported to be about 0.4, 0.7 and 2.7 mg/kg respectively on a dry weight basis. This means that if these organs were dried into powder and then silver estimation done, one would get these figures. Normal concentrations in skin are 0.009 mg/g. This latter figure is on wet weight basis, i.e. estimation is done on the skin as such, without first converting it into dry powder. Daily excretion in urine is 0.006-0.015 mg/day and 0.02-0.11 in feces." "Doctor, how much silver is needed to kill a person?" "Tarun, fifty mg or more of collargol which is a silver salt has been reported to be lethal after intravenous injection for therapeutic purposes. Autopsy findings in such cases have included watery lungs, and destruction of bone marrow, liver and kidney. Silver nitrate has been used by quacks to induce criminal abortions. These are abortions done in a clandestine manner by quacks on girls who do not want a baby. Most of these girls are unmarried girls who contact these quack abortionists to get rid of unwanted pregnancies. They use all sorts of weird chemical compounds to get rid of these pregnancies. In a case which has been reported in medical literature, intrauterine administration of approximately 25 g of silver nitrate caused rapid death of the mother." "And what is argyria?" "The cases which I have mentioned above are cases of acute poisoning- cases in which silver is administered in one single big shot. Poisoning can occur in a chronic fashion, in which small doses of poison are administered slowly. In my earlier stories I told you about acute and chronic poisonings. Argyria is a chronic poisoning with silver. It is an interesting condition, which once seen is never forgotten. The patient- as in the case of Pyarelal- acquires a blue-grey color of the skin, especially over exposed areas. Silver bound to body proteins, is deposited widely in the body tissues. Internal body viscera may get discolored too. Pigmentation results partly from stimulation of melanin deposition but mainly from photoactivated reduction to metallic silver in the dermis- hence the distribution over areas exposed to light. It is like exposure of a photographic plate. The whole body -which has absorbed silver- becomes a kind of photographic plate which blackens on exposure to the sun." "Can you prove this in the case of Pyarelal?" "Yes certainly. In cases of argyrosis, microscopically detectable silver containing granules are found in the skin cells and particularly around the hair follicles and in the sebaceous and sweat glands. I have taken a skin sample from his neck area and have done electron microscopy on it. The dermis of this area showed irregular silver granules both inside as well as outside the skin cells. I also did a special investigation - neutron activation analysis. This technique can tell the exact amount of a chemical in a given sample. This technique showed that the silver concentration in his skin was 72 mg/g, far exceeding the normal 0.009 mg/g. You can plainly see that it represents an accumulation 8000 times normal. His total body content of silver is almost 8 g which is really quite high. In addition he shows a black colored line near the teeth, which is because of the deposition of silver there. It is called the silver line. I must tell you that although silver shines as a metal, in a colloidal state it appears black. That's the reason a photographic negative receiving more light becomes black. It is at these regions that silver halides are converted to colloidal silver by sunlight." "That certainly is quite interesting. If silver is administered slowly to a person, how much silver needs to be introduced before the person suffers from argyria?" "Tarun, it has been estimated that a total dose of about 1-8 g of silver is required by inhalation for argyrosis to occur. The dosage by ingestion seems a little higher; between 1 to 30 g of a soluble silver salt. Blond people are considered more susceptible than others. The reason for this is unknown. Argyrosis seemed to have become only of historical interest, but it has recently reappeared, especially in the West. Respaton an anti-smoking lozenge, available in the West from retail chemists since 1974, contains silver acetate and ammonium chloride. Another similar anti-smoking lozenge is Tabmint. Manufacturers of these lozenges claim that regular sucking of these lozenges can reduce one's desire to smoke. They recommend a maximum of 6 lozenges per day. Chronic use of these lozenges has caused argyria in several cases. The patient remains discolored for life and ironically the smoking habit for which he took all the trouble remains!" "That is certainly most interesting. Can argyria occur in other ways too?" "Tarun, repeated occupational handling of silver objects, especially if repeated minor injury is involved, may give rise to so called local argyria, which is bluish-gray discoloration of the skin at the exposed site. This condition is however considered harmless apart from aesthetic considerations." "So it is now almost certain that Pyarelal was being given some silver salt in low concentrations by his son and daughter-in-law." "Yes it is. Here comes the chemical analysis report of the food and milk submitted by Pyarelal. Oh it shows a rather high concentration of silver nitrate. So my worst fears have proved correct. His daughter-in-law was taking advantage of her position as a chemist and was regularly giving him silver nitrate in his milk and food- probably just a drop or two in his milk. But over the years this has caused silver poisoning in this poor fellow. We have all the evidence now. Let us go to the police and tell them the whole story." "Sure we should. And thank you doctor for telling me about such an interesting poison. What are you going to tell me next time?" "Tarun, next time I shall tell you about vanadium which as you shall see is a very important poison. "