Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE APRIL-MAY 1997 ISSUE THE POISON SLEUTHS POISONING BY BORON -Dr. Anil Aggrawal "Good morning doctor. Oh, my God, what are you doing today? You have the body of a young woman here." "You are right Tarun. This woman lying here on my table is Lata. She is a 23 year old young unmarried girl. Her parents tell me that she was not feeling well for the last few days. She got frequent bouts of vomiting and in general was down and out. They insisted to take her to a doctor, but she said the symptoms were not troublesome and she would soon get well. She did not inform her parents but the police has found out during the investigations that about a week back she contacted a quack Dr. Harish for treatment, and allegedly he administered her some medication. Soon after she began to feel nauseated. She had severe diarrhea and vomiting. Her parents tell me that the color of both her feces and vomitus was somewhat bluish green. She was also reported to have severe pain in her stomach, severe convulsions and tremors. They did not know why the symptoms had become so severe and they again insisted to take her to a doctor, but again she declined. Since two days she was feeling extremely lethargic and was having headaches off and on. She again contacted Dr. Harish yesterday and he was reported to have administered something to her again. Within about 2 hours of this she died. Now the police has brought her body to me to tell them how she died." "Should be quite simple. Obviously Dr. Harish has administered some poison to her." "Yes, it appears so. But the question is why he would administer her the poison. The police has talked to Dr. Harish and he seems quite confident that he gave her the correct medicine. He asserts that Lata died of her original illness which she was complaining of." "So what are you going to do now?" "Well, I will have to conduct an autopsy on her dead body. Do you see her fingers and fingernails? Do they not seem abnormal to you?" "Why! they certainly do. They appear as if they have been painted red! Doctor I am getting curious. Please let me know what this is?" "And if you look at her buttocks you would find the same change. In medicine, we call it erythema. It is a kind of inflammation of the skin. The skin as you can see, is sloughing off at several places. Of course the most prominent finding as you have noticed is the marked redness of the skin. You may be surprised to know that in toxicology there is a special term for this change. This is known as "boiled lobster" syndrome. The skin appears like a boiled lobster, doesn't it?" "Now that you tell me, it certainly does. But tell me doctor, does it indicate any particular poison?" "Yes Tarun. It indicates one and only one poison- boron. It appears to me that Dr. Harish gave her one of boron compounds." "What? Boron? Doesn't sound like a poison to me. Poison to me means things like cyanide. Please tell me more about boron." "Tarun, admittedly boron is not a common poison, but it is certainly poisonous and can cause death. Boron in elemental form is not poisonous, but its salts are. Its most common salts are sodium borate, sodium biborate, sodium pyroborate and sodium tetraborate. Boric acid (H3BO3) is a colorless, odorless compound commercially available as granules, and white powder. A teaspoon of 100% boric acid crystals contains approximately 4 g of boric acid..." "Sorry to interrupt you doctor, but does it have any medical use?" "Tarun, it was introduced in 1702 by Homberg as a sedative, pain-killer, and antispasmodic. An antispasmodic relieves spasms, especially those of the stomach and is thus useful in stomach pains. At that time it was widely known as "Homberg's sedative salt". But by next century it had fallen in disfavor till Joseph Lister (1827-1912) revived its use once again employing it as an antiseptic in 1875. A little later- in about 1885- it was used as a food preservative, being frequently added to milk to keep it from rotting. But it was soon discovered that its use as a food preservative can cause serious poisoning. Since then its use as a food preservative has been abandoned, but it has been used in several other forms- as solutions, medicated powders, skin lotions, ointments, toothpastes, mouthwashes, water softeners, topical astringents and antiseptics. In the early part of this century, it was recommended for the treatment of ammoniacal dermatitis in children...." "What is ammoniacal dermatitis, doctor?" "Tarun, dermatitis means inflammation or redness of the skin. Ammoniacal dermatitis is an inflammation of the skin caused by ammonia. You might be surprised how children can get exposed to such an unusual gas as ammonia. Well, the gas is produced as a result of the chemical breakdown of urine by bacteria in the feces. Nappies of very young children can get soiled with both urine and feces. The bacteria in the feces produce ammonia from the urine. Ammonia has a burning effect on soft baby skin. It produces a rash in the surrounding area. Since the rash is in the area of the diaper it is commonly known as diaper or nappy rash. In fact, so commonly was boric acid prescribed for diaper rash, that at one time it was suggested that a history of diaper rash in any infant under the age of one year, who has died unexpectedly, should raise the suspicion of boric acid poisoning! This aphorism was true for two reasons. Not only was it often applied as a remedy for diaper rash but its poisoning in children often took the appearance of a diaper rash, even if did not have it in the first place! You have seen marked redness of the skin in Lata's case; in children the same happens in the diaper area, giving an appearance mimicking diaper rash. Boric acid was once famous for the treatment of burns too. In fact it was successfully used in the treatment of burns sustained in the Cocoanut Grove disaster..." "Sorry to interrupt you once again doctor, but what was the Cocoanut Grove disaster?" "Tarun, Cocoanut Grove was a Boston night club in USA, which caught fire on Nov 28, 1942. A corner of the Lounge had fallen into complete darkness as someone -probably a customer- had taken out a bulb. A 16 year old employee of the club was asked to replace the bulb. He lighted a match in order to illuminate the area and tried to screw the bulb in position, but the match started an artificial palm tree burning, and the fire spread quickly. As a result 491 men and women lost their lives. During the two hours following the onset of fire, 114 casualties were brought to the Massachusetts General Hospital. Many were dead on arrival and many died soon afterwards. Only 39 lived and were treated. In this disaster, the doctors successfully used boric acid to treat many cases of burns. Following this success, it began to be used widely in the treatment of burns as a sterile boracic ointment in place of tannic acid, which was being used earlier. But it was once again shown that poisonous amounts of boric acid can get absorbed from burn wounds and can cause serious symptoms..." "So it appears boric acid is no good as a medicine after all" "You can say that again. British Medical Association in 1966 published a statement in which practitioners were advised to refrain from prescribing boric acid and related salts in any form of treatment. The Pharmaceutical Society of Great Britain in the same year advised pharmacists not to sell boric acid as a dusting powder, nor to supply borax in any form. Boric acid solutions have been used as antiseptic irrigating solutions for cleaning wounds and abscesses and even internally for irrigating bladder, pleural cavity and lower bowel, but as I have already told you, it may produce toxicity. Other poisonous compounds of boron are the boron hydrides.." "Doctor please tell me something about boron hydrides." "Tarun, Boron Hydrides are a class of chemical compounds having the general formula BnHn+4. They have been investigated as possible propellant fuels as they have nearly double the energy content of standard hydrocarbon fuels. Examples include diborane (B2H6), a gas; pentaborane (B5H9) a liquid, and decaborane (B10H14), a solid under standard conditions. They oxidize vigorously to produce boric acid, water and much heat. Some of the hydrides are spontaneously pyrophoric, i.e. they have the capability of catching fire spontaneously in air, just like phosphorus. Boron hydrides are extremely poisonous compounds. It is believed that they are even more poisonous that cyanide! Levels in air as low as 0.005 parts per million may be toxic!" "Have poisonings occurred from boron hydrides as well?" "Yes surely. Boron hydrides are used in the industry for several purposes. You must be knowing that for making semiconductors, the wafer of silicon has to be "doped" with boron. This doping is done with boron hydrides. There are several other complicated uses of boron hydrides in the industry. Cases have occurred when pentaborane has accidentally released in industrial area and poisoned the workers. This can cause quick death. Another curious boron preparation is the Dobell's solution...." "What is Dobell's solution doctor?" "Tarun, Dobell's solution was first prepared by the London physician Horace Benge Dobell (b. 1828) in the last century. It consists of a solution of borax, sodium bicarbonate, phenol and glycerine in water and it was used as an antiseptic in the last century and in the early part of this century. Borax (Na2B4O7.10H2O), another poisonous boron compound has been known as a cleaning agent since the days of the Greek and Roman empires and has long been used as a food preservative in Europe and America. Today the principal compound of boron easily available to a common man is sodium perborate. It is an oxidizer which is normally present in tooth powders and toothpastes. It is available to the general public in powder or tablet form for the cleansing of dentures. The white tablets of sodium perborate look quite like sweets and may be taken by curious children! Contact lens solutions also contain salts of boron." "Doctor, how can one get poisoned from boric acid or other boron salts? Can it be administered homicidally? "Tarun, Boric acid- one of the most important toxic salts of boron- can certainly be administered homicidally especially as it is a colorless and odorless compound, and is quite commonly available. But no homicidal poisoning with boric acid has yet been reported perhaps because its lethal dose is rather high- about 20 g. As I told you in one of my earlier meetings, an ideal homicidal poison is one which is not only colorless, odorless and tasteless, but whose lethal dose is very small too. But this is not to say that homicidal cases may not have occurred. It is quite possible that cases of homicidal poisoning occurred, but because of poor investigation techniques, the poisoners remained scot free." "Has it been taken for suicidal purposes?" "Not to my knowledge, but certainly people have got poisoned when they mistook it for certain other salts. There are cases on record when boric acid crystals have been mistaken for other innocuous salts and ingested. It has frequently been mistaken for Epsom salt.... "Sorry to interrupt you doctor, but is Epsom salt the same as magnesium sulphate?" "You are right Tarun. Epsom is actually a place in England, very near London which is now famous for Derby- the world's best known horse race. Before the first Derby race here - in 1780- this place was better known as a spa. A spa as you know is a place where one goes to take bath in natural spring waters. Mineral springs were discovered here in 1618, which were quite rich in magnesium sulphate. This is how magnesium sulphate came to be known as Epsom salt. It has great medicinal value and is taken orally to treat constipation and heartburn. It is also prescribed as injection to prevent seizures, especially in preeclampsia, a dangerous condition seen in pregnant mothers." "Well, I think now I know a lot about boron. Coming to our own case, why do you think Dr. Harish administered Boron to Lata? Did he want to kill her with an exotic little known poison, so that no one could suspect him?" "It is a possibility but I do not think it must have happened, especially as Dr. Harish had no motive to kill Lata. Actually Borax has a reputation among quacks as an emmenagogue; it is supplied to induce criminal abortion...." "Well, you have introduced two new terms doctor. What are emmenagogues, and what is criminal abortion?" "Tarun, emmenagogue is a drug which increases the flow of menstrual blood. The term comes from the Greek roots emmena, menses, and agogein, to draw forth. Thus literally the term refers to any drug which "draws forth the menses". Interestingly the root agogein is seen in many other medical terms such as cholagogue, which refers to any drug which increases the secretion of bile (from Greek chole, bile). Many drugs have a reputation as emmenagogues, some of them being aloes, potassium permanganate, pennyroyal, caulophyllin and apiol. You would surely remember that last time we talked about cantharides in another context. Well, it is also an emmenagogue. Borax is also a strong emmenagogue. Criminal abortion is any abortion done against the law. The law requires that the doctor doing the abortion should have certain requisite qualifications and experience. Girls who become pregnant before marriage can not go to regular doctors for abortion for obvious fears of facing embarrassment and insult in society. So they chose an easy way out; they go to quacks who often do it in a hush-hush manner so that no one else may come to know about it. But they do not have the requisite qualifications, so abortions performed by them are obviously criminal in nature. If found out, they could be prosecuted by law. Since these doctors are not properly qualified, they do not know of standard and safe methods of abortion. They resort to centuries' old dangerous methods of abortion; methods which properly qualified doctors do not resort to. One of the methods employed by the quacks is to administer emmenagogues. The idea is that by promoting the flow of menstrual blood, they would somehow be able to "wash down" the young embryo lodged in the uterine wall. This method does work at times but is an extremely dangerous method. It is like trying to cut your nails by banging your fingers against a sharp knife." "I am getting the picture now. Lata was pregnant and she contacted Dr. Harish for a criminal abortion. Dr. Harish administered her borax as an emmenagogue. But it did not work; it caused her death instead." "You are very right Tarun. This is indeed what happened. The symptoms which Lata had were symptoms of pregnancy. Since she was unmarried, she did not want to make it known to her parents. She herself contacted Dr. Harish who was quite sure that he could do the job, but he killed her instead. Post-mortem findings in boron poisonings are not very specific. The mucosa or the lining of the stomach may be bright red and the blood may be cherry red in appearance. Characteristic rash as described earlier may be seen. I have seen all these findings in Lata's body. But I have not relied on autopsy findings alone. I have conducted blood tests on Lata's blood which are confirmatory. The levels of boron in her blood were important. Normally boron levels in the blood are minimal. A level of 50 mg/100 ml indicates poisoning, but I found boron levels exceeding 500 mg/100 mg, which surely is enough to cause death. The actual lethal dose of a boron salt is between 15-20 g for adults and from 3-5 g in infants. So I believe the second time Dr. Harish must have administered her a dose greater than about 20 g. He must have given her a lesser dose the first time, but when it did not do the trick, he administered a larger dose the next time, which killed her. Let us call the police and tell them how she died." "Oh sure we should. And thank you doctor for telling me about such an interesting poison. What are you going to tell me the next time?" "Tarun, next time I shall tell you about silver which as you shall see is a very important poison. "

SCIENCE IN CRIME DETECTION-12 EXAMINING THE SCENE OF CRIME Many people have asked me, what do we do at the scene of crime. In this column, I hope to explain a little bit about what we do at the scene of crime. Many times when a murder is reported in an outfield, the police officers prefer to take us to the scene where the dead body is lying. The idea is to give first hand information to the police regarding the murder. There are many vital pieces of evidence which can get lost once the body is moved. Consider the case of a man who has been shot down by a bullet and is lying on the field. Only a forensic pathologist can say by examining the dead body, as to which is the entrance wound and which one the exit wound. To a lay person, or a police officer, both the wounds of entrance and exit would appear the same. If forensic pathologist examines these wounds, he can reconstruct the line of fire, by joining these two points and say which direction the bullet came from. Once the body is moved, it would become impossible to reconstruct this 'line of fire' which can prove vital in later police investigations. Sometimes, when a dead body is moved from the actual place of murder to the mortuary, it might have to be dragged, dropped and dumped at various places in between. This produces artificial abrasions after death. These are technically known as 'post‑mortem abrasions' or simply as 'P.M. abrasions'. A doctor may wrongly think that these abrasions were produced during life and this may confuse the whole issue. So it is better to examine the body at the scent of crime itself. If you refer to diagram 1, you can have some idea about how we examine the body at the scene of crime. This persons was killed in a shoot‑out incident and it was very important to know which direction the bullets came from (Fig.1A) . You can see from the figure, the body is lying in the open, and an overcoat is lying spread‑out along with him. In such case, first thing we do is to photograph the body. The body has now to be removed. Before removing the body, we insert pegs around it and any material lying beside it, such as overcoat in this case( Fig.1B). the body and accompanying materials are then removed. However, before removal of the body, we note all the injuries on the body and determine how they were caused. This includes the determination of entry and exit wounds caused by firearms. Now a strong string is passed round the pegs (Fig.1C) . This gives an idea of the position of the body. The body is now removed to the mortuary and injuries are marked in great detail. First of all, the body is examined with the clothings on (Fig.1D). Any injuries on clothings are marked by circles. Now the clothings are removed and the injuries on the body are noted (Fig.1E) . The injuries on clothings and on the body must be co‑related. Finally we may return to the scent of crime and check once gain the position of the body. Since, now we have an idea of the entry and exit holes on the body, we can tell the police, which direction the bullets came from. Many times interesting clues can be recovered from the scene of crime, such as cigarette butts, hair, fibre fragments, blood stains, empty cartridges and so on. These clues also help us in several ways. But the main thing to be stressed here is to have a look at the body in a detailed manner and record its position most accurately. That single thing can work wonders for us several times.

Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE APRIL 1998 ISSUE THE POISON SLEUTHS DEATH BY IODINE -Dr. Anil Aggrawal "Good morning doctor. Oh, my God, what are you doing today? You have the dead body of an old man. He has some brownish-yellow stains too around his mouth. What happened to him? Please tell me." "Good morning Tarun. The name of this 57 year old man is Ramlal. He was living alone in this house. He had no children, and his wife expired some time back. From all the accounts of neighbors, it appears he was having some depression. There were other reasons for depression too. He was a gambler and had taken a lot of money as loan from his friends. Some of them were pressing him to return his amount, and some were even threatening him with dire consequences, if he did not return the amount soon. The main among these was a person known as Mahto. He was seen entering Ramlal's house yesterday evening. Nobody knows what happened after that. Today morning when the maid came to Ramlal's house and knocked at his door, nobody opened the door. She got suspicious and called the neighbors. The neighbors broke the door open and found Ramlal dead." "Oh, I see. So definitely Mahto must have killed Ramlal." "Don't jump to conclusions Tarun. How do you know he didn't die a natural death?" "Well.....I thought that was the most natural conclusion to make. But come to think of it, Ramlal could well have died a natural death too." "But surely he didn't die a natural death. The reason is that a bottle was found in the room containing some dark liquid. The bottle was marked "poison" and it was half empty. As you can see Ramlal's face, the angles of his mouth are stained. It does appear he had taken this liquid." "Oh, yes, now I see. The area around his mouth is stained brownish yellow. So do you think Mahto gave him this poison?" "Well, this is what police is thinking. They have come to a startling conclusion. According to them, Mahto went to Ramlal's house to ask for money, but when Ramlal couldn't give him the money, Mahto wanted to get even with him, and gave him this poison. They have called Mahto, but he is denying this allegation completely. He says, that he did go to Ramlal's house and demanded his money, but when Ramlal expressed his inability to pay up, he left after giving him another warning." "It is quite possible that the police would torture Mahto to arrive at the truth." "Well, the possibility can not be ruled out. But I have examined Ramlal's dead body, and it appears to me Mahto is indeed innocent." "Oh, my God. How can you say about Mahto's innocence by just looking at Ramlal's dead body?" "Tarun. I have examined the contents of the empty bottle. It containes a strong tincture of iodine. It is the medicine which one applies to abrasions and wounds. It is used as an antiseptic. Iodine has a strong odor and a very bad taste. This poison can not be given to anyone as a poison...." "Do you think Ramlal never ingested the contents of the bottle, and died by some other means?" "No, Tarun, Ramlal did ingest the contents of the bottle. In fact, I have found signs on his dead body, which point to death by iodine. Not only this I have recovered some iodine from his stomach too. But the iodine was not given to him with homicidal intention. He ingested it himself with suicidal intentions. He probably did it so, because he was very depressed. He was not able to pay up his debts. Yesterday night Mahto visited him and demanded his money again. It dawned upon Ramlal, that he would not be able to stall his creditors for long, so after Mahto left, he consumed iodine to kill himself." "So iodine is such a strong poison, that it can kill? Well, can you tell me a little bit about iodine, so that I understand better how you detected iodine in his body?" "Tarun, Iodine was discovered by the French Chemist Bernard Courtois (1777-1838) in 1811. It might interest you to know that he was not interested in discovering a new element at all. He was actually in the buisiness of manufacturing potassium nitrate which was needed for making gunpowder. He used to get potassium nitrate from potassium carbonate (potash), which in turn he got from seaweed. As one of the steps to get the potassium carbonate, he had to heat the seaweed in acid. One day in 1811, he added too much acid and, on heating, obtained a beautiful violet vapor. On condensing the vapor, he produced dark lustrous crystals. This was in fact iodine. Courtois had in fact unwittingly discovered a new element! The element was given its name 3 years later by Sir Humphry Davy from the Greek iodes (like the violet). The name clearly refers to its unique color. It was originally prepared from the ashes of kelp and other seaweeds, just as Courtois had done. However at the present time, the major sources of iodine are natural and oil field brines, from which they are separated by a special process known as ion exchange chromatography. Kelps are very rich in iodine. I may tell you that although iodine in large amounts is poisonous to our body, it does need iodine in very small quantities. It is needed by the thyroid gland to make the hormone thyroxine. If someone's diet is deficient in iodine, his thyroid gland may enlarge. This disease is known as goitre. Kelps are so rich in iodine, that people who consume kelps don't suffer from goitre at all." "Oh, I see. How much iodine is required by our body daily?" "Tarun, the daily requirement of iodine is about 150 micrograms/day in adults, of which the thyroid gland takes up about 70 micrograms. Rest of the iodine is used for some other essential purposes. Some commercial preparations containing iodine are povidone-iodine and tincture of iodine. These are basically used as antiseptics and disinfectants. Ramlal probably kept the tincture of iodine in his general medical chest, as most of us do. Povidone-iodine is primarily used as a vaginal disinfectant. Tincture of iodine is usually applied on cuts and abrasions, to prevent them from getting infected. Tincture of iodine consists of 2% iodine, 2.4% sodium iodide, 47% ethyl alcohol and rest is water. Then there is the strong iodine tincture, which was found in Ramlal's house. It consists of 7% iodine, 5% potassium iodide, 83% ethyl alcohol, and water. It might interest you to know that the word tincture comes from the Latin tinctura (dyeing), which in turn comes from tingere (to dye). This Latin word also gives us the common English word tint. It is interesting that the word tincture is applied only to alcoholic solutions. Medicine and dyeing may appear to have no connection at all, but in fact there is an interesting link. In pharmacy alcoholic solutions are commonly called tinctures because many dyes will dissolve in alcohol but not in water. Tincture of iodine is reddish brown in color. In addition to tincture iodine, another preparation, Lugol's iodine is also available which consists of 5% iodine and 10% potassium iodide and the rest is water." "Oh, the information is interesting indeed. Can you tell me what symptoms does one experience if he is given iodine?" "I would like to tell you, it is not easy for someone to give iodine to others for homicidal purposes, because it has a characteristic color, odor and taste. Iodine vapors too have a characteristic odor and taste and are intensely irritating to the eyes, mucous membranes, and skin. In several countries, such as the US, the maximum allowable concentration is 0.1 ppm (1 mg/m3). Ppm, as you know stands for Parts Per Million. Even at this concentration, i.e. 0.1 ppm, some people may experience eye irritation. Higher concentrations may lead to excessive tearing, tightness in the chest, sore throat, headaches, irritation of the respiratory tract, and water-logging in the lungs, similar to that seen with chlorine gas exposure. Iodine is a powerful irritant and vesicant, which means it can cause skin eruptions. Symptoms may occur through inhalation, skin or eye contact, or ingestion. Iodine vapor may cause brown staining of the cornea. A 7% solution of iodine, which as you know now is the strong iodine tincture, is corrosive to the eye and the skin. Owing to its strong oxidizing action, iodine acts as an acid corrosive, precipitating cell proteins. Symptoms of iodine ingestion include unpleasant metallic taste, brownish-colored vomit, diarrhea, weak pulse, and retention of urine. There may be corrosion of skin and and mucus membrane with brownish yellow stains. Finally there may be delirium, stupor, and collapse. Changes in the body involve staining of the walls of food pipe and of stomach walls and rapid development of pneumonia-like symptoms." "Doctor, how much iodine is sufficient to kill a person?" "Tarun, about 3-4 g of elemental iodine or 30-250 mL of strong ticture can kill a person. Death usually occurs in the first 48 hours. However death can occur as early as about ½ hour after ingestion to as late as 52 days." "Oh, I see. Well, in the current case how can you prove to the court that Ramlal did die of iodine poisoning?" "As I told you, I found Iodine in his stomach. Iodine can be detected in stomach by some deceptively simple tests. If the stomach contents contains iodine, it may be made to sublime, by taking the stomach contents in a beaker and warming it gently. The purplish iodine vapours may be made to condense on a watch glass placed on the top of the beaker. Another test involves adding 1 ml of starch solution to 10 ml of stomach contents. A blue-black colour will develop immediately due to the formation of starch iodide. If death has occurred after 2-3 hours, some iodine may have reached urine too. To detect iodine in the urine, we add 5 ml of chloroform and a few drops of nitric acid to 10 ml of urine and allow to stand for 3 minutes. A pinkish violet chloroform layer forms, which confirms the presence of iodine in the urine. I have done all these three tests on Ramlal's body and have found iodine in stomach contents as well as in the urine." "You said you found some signs on Ramlal's body also which pointed towards iodine poisoning. What are those signs?" "Tarun, the main sign is the brownish or yellowish stains of skin, which you can see on Ramlal's body. Furthermore all internal organs such as liver and spleen are found engorged with blood. Sometimes there is a characteristic odor too from the body, but this is very rarely perceptible. Now since we have proved that this is a case of death due to iodine, we can easily prove that Mahto couldn't have given this solution to Ramlal. Come, let us tell the police about it, so they can release Mahto." "Oh, how very clever of you doctor. This was a most interesting discussion. It is doubtful if Mahto could have been proved innocent without your excellent detective work. Tell me what are you going to tell me the next time?" "Tarun, next time, I would tell you about a very interesting poison- Barium "

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Forensic Science Fiction The mystery of the burnt bride When I was called at Sarita's house, she was already dead! To be sure I didn't expect anything better. They don't call forensic pathologists when people are still alive. The very fact they had called me, meant that someone had died. That's in our fate you see. Sometimes I take perverse pleasure in describing myself as one who is called in when all doctors have failed! As you can plainly see I do not have any wrong intentions, but the people tend to get misguided somehow. Whenever I say this, I get appreciative glances from everyone around. I frankly do not know what they make of my statement. Although I love forensic pathology, and would love to fiddle around with dead bodies, some forensic pathologists do want to shed off the image of the "doctors of the dead", and want to do some clinical work. Not that forensic medicine does not provide a scope for this. In fact there is enough scope for this. For instance there is a whole lot of toxicology, which we can dabble with. We can treat patients suffering from poisons, and can devise new treatments for them. But as I told you earlier, I would rather fiddle around with dead bodies. I love dissection you see. I want to see the intricacies of the human body, and no one can do that better than a forensic pathologist- or perhaps an anatomist. But Dr. Sunil Khanna, professor of forensic medicine in our department does not share my views. He is constantly seeking to excel in the clinical sciences. He has several patents to his credit, and his recent research concentrates on finding an effective treatment of some poisonings, especially poisonings by asphyxiants such as carbon monoxide. In fact he has contacted me several times with a request to start a joint project on this, but I have always declined it, as I have no aptitude for clinical work at all. But of course I am taking interest in his work and am aware of all the developments he is making. But coming back to our case. The moment I reached the spot, I was inundated with the usual questions. How had she died.... who killed her.... was her death suicidal or homicidal and so on and so forth. Let me tell you a few details about Sarita. She had married only a year ago. Her husband Ramesh was a petty clerk in a private company, but they were carrying on very well. Of course there was a dowry problem in the family in the beginning, but everything had settled by now, and apparently the couple was living together in good harmony. But the police would have nothing of this. They cooked up a theory that Sarita had been burnt by her in-laws. To be sure they were in a kind of bind. According to recent legal amendments, if a bride dies within 7 years of marriage, the case has to be registered as a murder. To the legally minded, I may add that the relevant section is 304B of Indian Penal Code, and it is entitled "Dowry Death". It was introduced as an amendment in 1986 when dowry death cases had increased to enormous proportions. In all such cases the presumption is that the husband or some of his relative has murdered the bride, and the onus of proving himself innocent lies on the husband or his relative. This is a lot tougher situation than the normal. Normally a person is deemed to be innocent and the prosecution has to prove otherwise. When the presumption is the other way round and you have to prove yourself innocent, things become lot tougher. This was the situation in which Ramesh and his family found themselves. It so happened that I personally knew Ramesh. I also knew that there had been some minor dowry problem in the house, but it had settled. In any case, I was not prepared to believe that he or any of his relatives could go to the extent of killing Sarita for bringing insufficient dowry. Of course there are people who do it, but Ramesh definitely was not among them. I talked to Ramesh in isolation, and took him in confidence. He told me that Sarita was rather a sentimental girl. She used to get depressed very soon. Recently the results of her MA exams had been declared and she had failed miserably. She used to remain too depressed after that and that was perhaps the reason she had burnt herself. Sounded like a fair reason to me. Sentimental people often do take their lives for petty reasons. I am personally aware of several youngsters who have committed suicide when they could not get admission to a medical or an engineering college. But there was a snag. Such people often leave a suicide note, and in Sarita's case, no suicide note had been found. I asked about this from Ramesh and he couldn't explain about it to me either. Well, I let it leave at that. Although suicide notes are usually found in suicidal deaths, they are not invariably found in all suicide cases. In any case, I made up my mind to defend Ramesh. When I examined the scene of death, it did not appear to be too disturbed to me. You see, things like turned up chairs, fallen flower pots, rumpled up bedsheets and so on. Such a set up often points to violent struggle having taken place soon before death, which in turn could strongly point to homicide. Since the scene was too "clean", I made up my mind that it indeed had to be taken as a case of suicide. Of course there are snags to this too. Murderers can set up a scene after having committed a murder. They can place everything back in order so that no one gets other ideas. But in such cases, I can often read it in murderer's faces. This is due to my long experience you see. I could see none of that in Ramesh or his family member's faces. But you would surely agree, I couldn't defend Ramesh in a court of law on hunches. I had to produce sound scientific evidence to be produced in court. But what was it going to be? I must admit, I had no idea of that at that point in time. Fortunately for me (and my case), the police had formed a rather weird theory of murder. They asserted that Sarita had first been killed by Ramesh and her family members by some means, such as gagging and then had been burnt by them, to give it the color of suicidal burning. Normally of course bride burnings occur when the bride is still alive. The traditional theory is that the mother-in-law comes surreptitiously from behind, pours kerosene on the hapless girl, and then someone lights a match. You might tend to believe that the police was foolish in building up this theory in the first place, but I wouldn't blame them. Sarita had died at about 11 am on Sunday, when every one is up and about. If they had developed a theory of traditional bride burning, some of their neighbors would of course had heard her cries, and other sounds of scuffle, but no one had heard such sounds. Indeed this was another factor which helped convince me towards a suicidal theory. Since no one had heard her cries, the police were a lot better off theorizing that Sarita was already dead when she was burnt. How could any forensic pathologist prove or disprove police theory? Gagging as we all know, doesn't leave any remarkable tell-tale signs of its own, especially when the gagging cloth has been removed from the mouth, and the body has been burnt subsequently. So an autopsy was not likely to prove with any conviction that the death had occurred because of gagging. In such circumstances, the only way the police theory could be proved was by showing that Sarita's was a case of post-mortem burning. On the contrary, if Ramesh and his family members' theory of suicide was correct, then Sarita's was a case of antemortem burning. So basically the question boiled down to this: Was this a case of antemortem or postmortem burning? I wouldn't bother you with details, but in a single line would tell you what these dreadful terms mean. An antemortem burning refers to a case of burning when the person was still alive, while postmortem burning refers to a case where the person was already dead when his body caught fire. While post-mortem burning almost certainly points to homicide, a case of ante-mortem burning could be anything- accidental, suicidal or homicidal- roughly in that order. There are some very clever ways to differentiate antemortem from postmortem burning. One of them - and one on which I rely heavily - is the finding of carboxyhemoglobin in the blood. During burning of any carbonaceous object, especially if the burning has taken place in closed surroundings, lot of carbon monoxide is produced. If the victim was alive at the time of burning he would be respiring and would invariably inhale some of the carbon monoxide (or CO for short). CO binds very strongly to hemoglobin to form carboxyhemoglobin. This bond is almost 200 times stronger than that made with oxygen. Because of this, carboxyhemoglobin does not "break up" even after death and can be detected by forensic pathologists. On the contrary, if the victim was already dead at the time of burning, he wouldn't be respiring and would thus not inhale any carbon monoxide. What does this piece of information lead us to? Simple. Do an analysis of the blood of the victim, and try to find out if there are appreciable amounts of carbon monoxide in his blood or not. By "appreciable amounts", I mean about 15-20% or more. People living in cities do tend to have small amounts of carbon monoxide in their blood anyway. With the vehicular pollution showing a steady rise - outdoing even our national economic growth rate- we couldn't expect anything better. Cities like Delhi would beat Hitler's gas chambers hands down any day. But I am straying away from the main line again. Let us come back to it. I brought Sarita's body to my mortuary, took some blood from her iliac vessels and got down to work straightaway. I almost certainly expected to find carboxyhemoglobin in her blood, but try hard as I would, I couldn't find even traces of it. I tried again, with more sophisticated methods, with spectrophotometer, with everything else I could lay my hands on, but try hard as I would, I couldn't find any carboxyhemoglobin. As you can imagine, this had grave repercussions for Ramesh and his family. Not finding carboxyhemoglobin in Sarita's blood could only mean one thing- that she was already dead at the time of burning. And that raised a very strong accusing finger towards Ramesh and his family. To tell you the truth, the finding did send me in a bout of confusion. I tried hard to explain the absence of carboxyhemoglobin but couldn't, except assuming that she was already dead at the time of burning. If I assumed her to be alive at the time of burning, there was no way I could explain the absence of carboxyhemoglobin. I was sitting confused in my anteroom thinking over the problem while the body lay in the mortuary. At five O' clock, the attendant came and informed me that he was leaving. I told that I would shut the department and asked him to leave. I came home and continued racking my brains over the problem. The next day was a public holiday and then there was a Sunday. After that a public holiday once again, made a continuous break of three days. It was only on the morning of the fourth day- the day when I was to go to the department once again- that I realized that I had left Sarita's body on the mortuary table itself! I should have transported the dead body to the cold room before leaving the mortuary. The mortuary attendants always do that. But on that Friday evening, I had stayed in the mortuary longer than usual; the mortuary attendant had left and I had promised him that I would do the needful before leaving the department. But I am not used to closing the mortuary. Coupled with this was the fact that I was quite puzzled that evening. That was the reason, I forgot to put back Sarita's dead body in the cold room. It was horrifying to even think of the consequences. The body would be badly putrefied now. In this summer heat, three days could play havoc with a dead body. At best, it would be a swollen, greenish-black putrid and badly smelling mass of organic matter. Of course things could be a lot worse. There could be maggots crawling all over the body for instance. What worried me was not the bad state of the body I would be confronted with, but that the putrefaction would blot out all medical evidence pointing to the mystery of her death. There was absolutely no hope of unearthing any more useful evidence now. With the worst fears in my mind, I opened the door of the mortuary, and expected a strong gush of revolting smell to hit my nose. I was mentally prepared for it. But nothing of that sort happened. I looked at the table where I had left Sarita's body, and was nonplussed to see the body there with almost no putrefactive change! Now I do believe in wonders, but not in wonders of this sort. I mean the ones, which defy logic and science. Sarita's body was lying there out in the open on the mortuary table and had not putrefied in the least! This was a wonder I could not believe. Something extraordinary had happened. But what could have happened? I started thinking about the problem, but couldn't come to an answer. Finally I took some of her muscle tissue and took it to Dr. S.K. Gupta, professor of biochemistry in our own college. Everybody knows he is a genius, and I personally believe he is made of Noble Prize stuff. In fact it is a mystery to me why he has not been able to get it till now. Well let us not digress from the main point. I submitted the tissue to him, and asked him to look for anything abnormal. I was a little surprised when two days later, he told me he had found abnormally high amounts of formaldehyde in the tissues. In fact so high was the amount that he asked me if I had preserved the body in formalin. I surely hadn't, but perhaps Jamman Singh, the attendant who left the mortuary on that Friday evening had done it before leaving. That was perhaps the reason, the body had not putrefied. I went to Jamman Singh and asked if he had sprinkled formalin over the dead body before leaving, but he informed me he hadn't done so. Why would he do so, when we have an excellent facility of a cold room? This confused me a lot more- and I had one more problem on my hands- to explain the presence of formalin in Sarita's body. Sarita surely hadn't ingested formalin. She had no access to it, and it couldn't have been given to her by Ramesh and his family members as a homicidal poison. Formalin has a strong smell and a very acrid taste, and because of these properties, it is a very poor homicidal poison. All homicidal poisons must be tasteless and odorless. If you tried to kill me by putting formalin in my milk, I would know somebody had put something in it and I wouldn't drink it. Of course I would do so, if you put arsenic trioxide in it, because it is colorless, odorless and tasteless. So if you wanted to kill me you would be much better off with arsenic trioxide than with formalin. The problem before me was how formalin reached her tissues. I thought for the problem for a few hours, and then a possible solution flashed in my brain, like the stroke of a lightning. Well, the train of my reasoning was this. There should have been carbon monoxide in Sarita's blood and muscles, but it wasn't there. And there should have been no formalin in her muscles, but it was there. Was it possible that carbon monoxide in her body had somehow converted to formaldehyde? Well, chemically it is not impossible. Formaldehyde is chemically HCHO, while carbon monoxide is CO. Plainly and simply, if CO can combine with water - which is quite abundant in human body- it can extract two hydrogen atoms from there and get converted to HCHO, while releasing the single oxygen atom free. Theoretically it is possible, but can it occur actually? I am no chemist, and surely I did not know the answer to this. To find the solution to this, I had to see no farther than my own home. My wife is a professor of chemistry (besides being a great cook, just in case you are reading it), and one fine day when I returned from college, the first thing I asked her was if that was possible. You can do that, she told me, but it is not simple. You have to have high temperatures and pressures and costly catalysts. Trickier is the situation in a human body- dead or living- where you have no catalysts, no high temperatures, no high pressures and so on. Why don't we have catalysts in the body, I asked her. Catalysts are not merely the domain of chemists. We do have our own catalysts. They are the various enzymes in the blood and in the body cells. And they can do seemingly impossible jobs. Like burning glucose so slowly and deftly that the body does not get burnt. Instead a fairly equable temperature is maintained. Is there any catalyst with the chemists which could even come anywhere near it? Of course she did not have to answer that, because she had gone to the kitchen to make a cup of tea for me, but her statement had already set me thinking. I couldn't kid myself with the weird notion, that an enzyme existed in human body which could convert carbon monoxide to formaldehyde, but what I came up with was the thought that perhaps Sarita was a mutant and such an enzyme existed in her body. Now why would such an enzyme creep up in the human body, you may ask. We all know that mutations do keep occurring in our bodies constantly, and they can lead to the formation of new proteins and enzymes. That is how evolution has occurred. Most mutations are of course deleterious to the body, but some are quite useful. Take for instance the enzyme which could convert carbon monoxide to formaldehyde in a body. Both are poisons, but the body finds it harder to deal with carbon monoxide, especially because it sticks so strongly to hemoglobin. On the contrary, formaldehyde is much easier for the body to tackle. This mutation could be quite helpful to Sarita if she had survived, and perhaps had been doing good to her all her life. It is a built in mechanism to protect you from the carbon monoxide of this increasingly polluting city. But we are again digressing from the main issue. The main point was whether or not Sarita had such an enzyme in her tissues. If I could positively prove that, only then could I simultaneous solve all my problems. In fact, the more I thought about it, the more I got convinced that this indeed was the solution. In science, the best solution is that which simultaneously solves several problems, however weird that may appear in the first instance. And once again I found myself in the lab of Dr. S.K. Gupta, but with a different request this time. He is an expert in cellular enzymes, and if there was one person on earth who could help me, it was he. I asked him to look at the muscle tissues once again and tell me if there was an unusual enzyme in it, especially one which had the property to convert carbon monoxide to formaldehyde. Now Dr. Gupta knows for sure that I am a little soft in the head, but he also knows that I can turn violent, if my genuine hunches are not attended to. They have to be either proved or disproved. So despite thinking that I was turning senile, he preferred to keep quite and got to work. He was in for a surprise. He did find an enzyme next day with exactly the same properties that I had predicted. It could effectively convert carbon monoxide to formaldehyde. He preferred to call it carbon monoxide reductase. He also told me that it was a completely unexpected finding- one that would stun the biochemical world. All my problems were solved now. I now knew that Sarita was a mutant. There was a unique enzyme in her blood, which converted the carbon monoxide of her blood in formalin, and that is why her body was so remarkably preserved. The presence of carbon monoxide in her blood meant that she was alive at the time of burning, and this in turn meant that she had committed suicide. One could of course argue that there was no carbon monoxide in her body from the beginning, but if we assumed that, we could not explain the presence of formaldehyde in her blood and muscles. So we had to assume that there was carbon monoxide in her blood to start with which got converted to formaldehyde. The court accepted my findings and conclusions and set Ramesh and his relatives free. But the biggest surprise was when I found that Dr. Khanna had lapped up my findings and was trying to make an useful drug aimed to treat carbon monoxide poisoning. He got Dr. Gupta to decode the chemical structure of this new enzyme and got him to make samples of it in his laboratory. He is trying to give injections of artificially prepared carbon monoxide reductase to patients of carbon monoxide poisonings and see if it helps them. The initial reports are encouraging. He has published several papers on this. Some have been written with me as a co-author. I wrote some on my own, and some with Dr. Gupta. I am giving you the references for some of the more interesting papers. Interested readers may look for details in the said references. 1. Khanna S.K., Aggrawal Anil. The role of carbon monoxide reductase in carbon monoxide poisonings. Journal of the American Medical Association 1998; 247: 1471-1475 2. Aggrawal Anil, Gupta S.K. The story of the discovery of Carbon monoxide reductase. Medical History 1999; 145: 365-377 I hope these papers would satisfy the curiosity of the more scientific minded people. But I must tell you that the thing that surprised me most was when Dr. Gupta was called by the European Academy of Biochemists to give them a series of lectures on the new enzyme, and Dr. Khanna got a call from the American Medical Association to tell them of his latest developments on the treatment of carbon monoxide poisoning. As for me, I was being burdened with more autopsies! Well, I asked for it!! *** This story was published in Spandan'97 (1996-97) , on Pages 53-57

Forensic Science Fiction

Forensic Science Fiction

< Back To Main Page. LinkedIn X (Twitter) Facebook Copy link Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology Volume 27 Number 2 ( July - December 2026) Contents Papers Domestic Violence Leading to Pediatric Burns: A Clinical Forensic Case From East Java, Indonesia Ibnu Chaldun ¹ , Ahmad Yudianto ² , Putu Bagus Dharma Permana ³ Forensic Medicine and Medicolegal Specialist Program, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia Postgraduate Forensic Science Study Program, Faculty of Medicine, Universitas Airlangga, Surabaya Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia DOI: 10.5281/zenodo.15743408 Read

Forensic Science Fiction The Freak I was surprised. Extremely surprised. Never before had a patient come to me with such a complaint. I asked him again. "Are you sure, you keep moving back and forth in time? Just how do you know?" Rajiv coughed nervously. "All of a sudden sometimes, I feel dizzy. Then I feel as if I am falling in ordinary three dimensions. In an abyss. Rapidly. But it's not the height I loose. I find I have gone back in time. I see all sorts of things. Mughal splendor. Coming of the English people. Freedom struggle. Everything." "Are you sure you are not hallucinating? I am asking this because people of your species can control movement in time you see." "Yes, we four-dimensionals are not like you. Sure enough we can control movements in time just as you can in space. But I just don't know what's the trouble with me. I just can't control it. Look at this ancient coin. I brought it yesterday, when I tipped back in time." I looked carefully at the coin. A rare gold circlet from the reign of Akbar. There was no mistake about it. This four-dimensional sure enough meant business. He wasn't joking. In the last twenty years of my practice, I must have treated thousands of people - both three dimensionals as well as four-dimensionals. But never before had I seen such a patient. There wasn't much of a difference in the anatomy and physiology of the two major human species currently living on earth. Just a little difference here and a little there - so that the four dimensionals could adapt to their special needs and requirements. Four dimensionals were so called mainly because they had a special ability to move back and forth in time at will. We three dimensionals could do so only in three ordinary dimensions. How the four-dimensionals had come to live on earth is a long story. Centuries before, a space ship went from earth in search of intelligent life. After some years of departure, the radio contact between the space ship and the earth broke down and despite best efforts could not be re-established. God knows what happened to those humans, but when they came back some years ago, inhabitants on earth found they had acquired a new ability - to move back and forth in time at will. They couldn't tell anything as they didn't seem to know much. Exobiologists surmised that their forefathers- the ones that left the earth- must have been captured by a super intelligent race and they must have used them as guinea pigs for their genetic experiments. Most probably the ability to move back and forth in time had come as a result of massive genetic alteration by those super-intelligent beings. Anyway the fact was that their genetic makeup had been substantially altered - so much so that they couldn't interbreed with ordinary three-dimensionals. In spite of my best efforts, I couldn't treat Rajiv. He kept falling back and forth in time. The best I could do was to administer antihistaminics like Avomine so he wouldn't feel dizzy. But that wasn't much help as everybody would agree. Then one day I received the sad news that Rajiv had expired. I was shocked. Worst of all, I had to conduct a post-mortem examination and find the cause of death. I opened the body and as expected found petechial hemorrhages in all internal organs-liver, spleen, heart, brain, everywhere. Hemorrhages of the shape of pin-point. The cause of death was clear. He had been falling continuously over long periods. Small Hemorrhages kept on accumulating everywhere and their effect on the brain was devastating. Tried hard as I did, I couldn't locate any other abnormality. I started closing the body when suddenly I was gripped with a strange curiosity. Could I find the cause of his uncontrollable movements in time? I had more working space now. I had his entire dead body. I could examine all his organs in detail. I might hit upon some curious finding. Besieged with this strange curiosity, I ripped open the stitches and took out all the organs once again. Then I donned my researcher's hat and got down to work. Till late night I had made sections of all his major body organs and examined them under the microscope in great detail. I could find nothing. Tired, I decided to call it a day. I asked my assistant to wrap up the body in formalin and keep it in the cold room. I would have a last go tomorrow. And then I went to sleep. At 4 am I woke up with a start. My subconscious mind must have been working at the problem. That's why I had this ridiculous dream. I thought I had found out the cause of his strange abnormality. I couldn't contain my anxiety, and wanted to test the hypothesis right away. I took out my car and headed for the mortuary in the darkness. The roads, drowned in darkness at that time of the night appeared unusually spooky. At the mortuary, as expected, I found everything closed. The assistant had locked up the main gate, mortuary doors, cold rooms, everything- and had gone away to his house. I took out my duplicate set of keys and opened the mortuary. In the cold room, I opened catacomb number 13, the one where Rajiv was resting. Needless to say, my hands were trembling; perhaps both from fear and from the anxiety of making an unknown discovery. I took out the body myself and laid it out neatly at the table. The skull cap and brain matter were already removed. I looked at the base of skull- at the petrous part of the temporal bone. The one that forms the roof of the middle and inner ear. The mystery could be lying there, I told myself. Gradually and neatly I started chiselling away the temporal bone, so that none of the inner ear structures would be damaged. And then with great precision I took out the inner ear contents. The cochlea, the utricle, the saccule and the semicircular canals, along with vestibular nerves. I kept the whole complex under a simple hand lens and examined it - especially the semicircular canals. Suddenly I found myself trembling in excitement. My conjecture was correct. There were only three semicircular canals in his body, while actually there should have been four. The three semicircular canals are at right angles to each other, each representing a single dimension of space. Whenever someone tips in one or the other dimension, the otoliths inside the appropriate semicircular canal would start moving and activate the vestibular nerve which would send the information to the brain immediately. The brain would then send orders to proper muscles and joints to correct the body position. Those who had a disease of semicircular canals would not be able to stand erect properly. Since each semicircular canal represented one dimension, four dimensionals must have four canals, all perpendicular to each other. Three dimensionals like us, of course had only three canals. My reasoning was this. If Rajiv tipped slightly in the fourth dimension and didn't have the fourth semicircular canal representing the fourth dimension of time, the brain wouldn't get the necessary information and he would keep on falling in that dimension. Of course when he started seeing ancient scenario, he realized he was falling and could thus consciously control the fall. But by that time he would have gone quite far back in time and had to come forward in time on his own. This was the reason for his constant trippings in time. One last thing. How could one have four canals perpendicular to one another in ordinary three dimensions? One may wonder, where exactly I expected to see the fourth canal. Well, a four dimensional cube can be projected in three dimensions as a tesseract. What I expected to see was a tesseract of the semicircular canals, but there was none. There were just three semicircular canals. The finding has since been confirmed by dissection of other four-dimensionals. They all show their semicircular canals as a tesseract. They have four mutually perpendicular canals alright, but they show up as a tesseract, in ordinary three dimensions. This unexpected discovery gave me much satisfaction in itself. But the thing that surprised me most was to find my name in the Padma Shree winners of next year. *** This story was Published in July 1988 issue of 2001 (Science Today) on centerfold page under the title Time and Again

SCIENCE IN CRIME DETECTION-24 CLUES FROM PUTREFACTION I had a tremendous response for my article on abrasions, published in the Feb,1995 issue of Crime & Detective. However I keep receiving stray requests from interested readers to publish stories of their interest in our forthcoming issues. One of the most interesting letters I received this month is from Ashok Rawat of Sector-J, Rail Nagar, Lucknow, who has sent me an interesting clipping from the Times of India of Feb.13, 1995. I will narrate the story briefly for the benefit of our readers. One Ms Meera Juneja, a 47 year old single woman was living alone in Sector 11, Noida. She was the daughter of a former UN official. In December 1994, she reportedly told her parents that she was going to Kanpur to take her LLB examinations. Her father visited her Noida house on January 8,1995, but the door was locked and a milk packet was lying outside the door. Perhaps her father thought that she had left for Kanpur, so he returned. However when he visited Kanpur in February and checked up with his relatives, he found that she had not reached Kanpur. This worried him and he lodged a complaint with the police on February 6,1995. The police went to her house on February 10 and broke open the door. Inside, they found a highly decomposed body of Ms Juneja. The post mortem report said that she had been dead for more than one month. This eased the investigations of the police very much. Mr. Rawat now wants to know how the doctor could say that she had been dead for more than a month. This is an interesting topic and it reminded me of an interesting case I was involved in about 3 years back. I thought that in this instalment I must share that experience with my readers. After reading this true story, much of the mystery surrounding Ms Juneja's death will also become clear. But before I dwell on this story, I must thank my readers for sending me such interesting stories and clippings. And thanks Rawat very much, for sending this interesting clipping. Please keep sending me such clippings for the benefit of all our readers. On 29 July, 1992, the dead body of 67 year old Bankelal was found in a secluded spot outside the city. It was quite decomposed and putrefied. He was a millionaire but did not have any child. He used to live in his palatial house along with his 64 year old wife Ramadevi. She was healthy and not suffering from any disease. On 15th July, Bankelal left his city for Madras to finalize an important business deal. He had to return to his house on 28 July. He did not leave any forwarding address, as it was not of any use. Going away from his house was normal for him and his wife had become used to it. Some interesting events occurred after he left the house. On 22nd July, his wife Ramadevi suffered a massive heart attack and expired. So when Bankelal did not return on 28th there was no one to worry about him. His body was accidentally found the next day by some passers-by. When the police brought the body to me for post-mortem, the first and foremost thing they wanted to know from me was the time of his death. This is normally necessary in all cases of murder, but in this particular case this question assumed a highly significant role. I will explain that in a moment. But before I say anything I would like to add that this case is highly similar to the case of Ms. Juneja referred to earlier. In both cases the time of death was calculated using the putrefactive changes found in the dead body. Ramadevi had a greedy brother Bihari, who lived alone. He had had a tiff with his wife long back, and was now living separately from her. Bankelal also had two brothers. They were married and were living a decent life with their respective families. Since Bankelal had no child, and he had died intestate (without a will), the property which amounted to millions of Rupees should have gone to Banke's brothers. But Ramadevi's brother Bihari contacted the best lawyers and came up with an interesting legal point. If a person dies intestate, the first right of inheritance is of his wife and children. If the wife is already dead, and their are no children,(as was the case with Banke), then the right passes on to the next legal heirs which are the brothers and sisters of the deceased. In Banke's case, his wife Ramadevi was alive till 22nd July. Now if Banke had died before 22nd July, the property automatically passes to Ramadevi, even if she is unaware of his death. Banke's brothers are automatically cut off from his property. Now if Ramadevi dies, the property passes the her legal heirs, which is only Bihari. But the situation changes dramatically if Banke had died after 22nd. On 22nd Ramadevi died. Now suppose Banke died on 25th. What is the legal situation. On 25th the only living heirs of Banke are his two brothers. And thus the property should pass on to them. In this situation, Bihari does not get anything. Bihari's lawyers told him that he could cash in on this confusion. So Bihari gave an application in the court saying that the property be passed to him, because Banke had died before 22nd July. Of course there was no reason to assume that he had died before 22nd, but Bihari said it because this situation suited him. The police now wanted to know from me if I could solve this case. In this case I took the help of putrefactive changes which I found on Banke's body. Let me tell you briefly what putrefactive changes are. When a person dies, his body can no longer defend itself against the bacteria - both inside and outside his body. Our environment is full of millions of bacteria although we can not see them. If they could have their way, they would invade our body immediately. But the defence mechanisms of our body keep them at bay. After death they attack the body both from outside and within and cause it to deteriorate. By their actions on the body tissues they form a gas called hydrogen sulphide. When eggs get rotten, same gas is liberated. The peculiar smell of rotten eggs is due the hydrogen sulphide only. This gas interacts with the haemoglobin present within the red blood cells, and forms a greenish coloured compound sulphmethaemoglobin. This compound is greenish black in colour. Because of this the body assumes a greenish colour. The first part of body to become green is the right lower side of abdomen. This colour appears 12 to 24 hours after death. Thus if we see the greenish discolouration of the right lower side of the abdomen in a dead body, we can say that the person must have been dead for at least 12-24 hours. In the next 24 hours i.e. after 36 to 48 hours after death, the whole body turns greenish-black. Around the same time another peculiar change appears in the dead body. It is called marbling. In this change several parts of the body such as legs, arms, shoulders and chest show long tortuous greenish coloured streaks (reproduce fig 2.7 on page 60 here). These streaks are nothing but veins, which are stained by the sulpmethaemoglobin produced within the body. After death, the red blood cells break down, and haemoglobin from them is released. This haemoglobin combines with hydrogen sulphide gas and forms sulphmethaemoglobin as already explained. This compound then stains the vessels of the skin, in much the same way ink stains your hands. Thus the veins, which are normally invisible become visible as green streaks. Marbling begins in about 24 hours and is well pronounced in 36-48 hours. When I see pronounced marbling in a dead body, I can say that the person must have been dead for almost 36 to 48 hours! Another putrefactive change is the appearance of gases. When bacteria feed on body tissues, they release foul smelling gases. These gases collect beneath the tissues, and bloat the features of the dead person. The tongue may begin to protrude. The features may become so distorted that even close relatives find it hard to identify the dead body (reproduce fig. 2.8 on page 60 here). After about 36 hours, flies lay eggs around the natural orifices of the body such as nose, mouth, eyes, ears, anus and vagina. These places provide a safe nidus for the young ones of insects and they choose these places quite instinctively. In the next 24 hours, maggots come out of these eggs. These maggots look very much like miniature earthworms. Each maggot is of the size of a rice grain, and is seen wriggling leisurely. Thousands of such worms may be found wriggling all over the body. This is not a very pleasant sight, and most persons will begin to retch at such a sight. Only a forensic pathologist is well trained to stand such a ghastly sight. These maggots become pupa in the next 4-5 days, and in another 4-5 days, the pupa becomes the adult fly and flies away from the dead body. Thus we can roughly calculate the time of death from the appearance of these maggots. The following table will make the things a little bit clearer. 1. If we find eggs on the body the death could have been 36 hours before. 2. If we find maggots on the body, we add 24 hours (because maggots appear 24 hours after the eggs have been laid). Thus the time since death becomes 36+24=60 hours. This is about 22 d ays. In actual practice, we can never be so sure, so we take the time of death in such cases to be between 2 to 3 days. 3.If we find pupa (which looks like a grain of wheat), the death should have been about 6 days back. This is because maggots appear about 2 days after death, and become pupa in another 4 days. 4. If we find only the empty pupa shells, it means that pupa became the adult fly which escaped from the shell. This means that the death must have occurred about 10 days before. Three more changes help us determine the time since death. In about 3 days after death, the nails become loose. In 4 days teeth become loose in their sockets and in 5 days the brain matter becomes totally liquefied. Normally the brain matter is much like a jelly. In about 12 to 14 days, so much gases collect within the body, that the body cavities like abdomen burst open. This is called colliquative putrefaction. If the body has been thrown in river or sea where there are predators, they will feed upon the body. After sometime much of the body tissues disappear from the body. It is rather tricky to opine on the time of death in such cases but nevertheless, with experience, we can give a rough estimate of the time since death. In the photograph shown here, the person had been thrown in the sea for about 3 months (reproduce fig. 2.9 on page 61 here). As one can see, most of the body tissues have been devoured by the marine predators. Coming to our case. There was no colliquative putrefaction, so I could say with certainty that at least Banke had not been dead for 12 or more days. Since I did the post mortem on 30th July, I subtracted 12 days from that. This meant that Banke must have died after 18th July. Further, I found that many maggots were crawling around the anus of Bankelal. Thus clearly he had died more than 2 days before. Thus by noting just these two changes, I could say that Banke must have died between 18 and 28 July. There was no pupa on the body. Had I found a pupa on the body, I would have concluded that Banke had died about 6-7 days previously i.e. around 23-24 July. Thus clearly Banke had died after 23 July and Bihari's claim was wrong. Actually to refute Bihari's claim, only this much examination was necessary. But I could do better than that. Banke's teeth were loose, but his brain matter had not liquefied. Thus I could say that Banke had died 4-5 days before or between 25th and 26 July. This was a victory of Forensic medicine. The doctors in Ms Meera Juneja's case found out the time of death using these types of techniques only.

Forensic Science Fiction

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