Main Page > Vol-26 No- 2 > Paper 4 (you are here) LinkedIn X (Twitter) Facebook Copy link Share Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology Volume 26 Number 2 (July - December 2025) Received : May 17, 2025 Revised manuscript received ; May 28, 2025 Accepted : June 10, 2025 Ref: Dalua P, Behera C. Reluctant to Give: Exploring Youth Attitudes Towards Organ Donation in Delhi. Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology [serial online], 2025 ; Vol. 26, No. 2 (July- December 2025): [about 6 p]. Available from: https://www.anilaggrawal.com/ij/vol-026-no-002/papers/paper004 Published: June 16, 2025 DOI: 10.5281/zenodo.15708613 Email: drchitta75@rediffmail.com Click here to access PDF. ( All photos can be enlarged on this webpage by clicking on them ) Reluctant to Give: Exploring Youth Attitudes Towards Organ Donation in Delhi Abstract Introduction: India continues to grapple with a notable imbalance between the demand for and their actual availability of transplant organs, despite of concerted efforts in creating public awareness through mass campaigns and policy driven initiatives. While biomedical solution to this problem asks for more efforts for cadaveric or living donors as a viable way for addressing this challenge, the persistence shortage indicate existence of deeper and complex interrelationship between medical and socio cultural factors. Aim: This paper critically examines the socio-cultural factors influencing the reluctance to organ donation among youth in Delhi, the capital city of India. Material and Methods: Using online surveys and telephonic interviews this study has identified four thematic frameworks that converge together and shape the youth reluctance regarding organ donation. Result: By examining the ways in which youth today navigate in between the complex moral framework and societal values, this paper reframes the organ donation refusal not as a simple irrational act of the youth but as a conscious and contextually grounded act of resistance that are often been shaped by their cultural norms and institutional structure. Conclusion: Organ donation reluctance among the youth must be viewed as a culturally embedded decision-making process rather than a lack of awareness, calling for approaches that engage with the socio-cultural realities of contemporary youth. Keywords: Organ donation, youth, values and attitudes, cultural beliefs, transplantation Introduction There is an established tradition of empirical research in sociological and anthropological literature on organ donation and transplantation, arguing that it goes well beyond medical technology and is reflective of the psycho-social wellbeing of donors, families, recipients that is deeply interwoven in their socio-cultural specificities.1 In other words organs, viewed from a social life approach appear to be having a social life of their own.² Understanding the reasons behind either the eagerness or reluctance requires examining the social and cultural factors that influence it. While there has been scholarly empirical researches on this topic in India from a biomedical or health perspective, relatively scanty literature exists in India taking into account its cultural and social concerns baring few.³ Biomedical perspective to organ donation rests on the organ transplantation ethos of ‘saving life at any cost’ is a problematic affair owing to the fact that it emphasises too much on the market logic, individual choice while ignoring the socio-cultural insights about the importance of understanding death, bereavement, the body, organs and its transfer to others , claim scholarly studies.⁴⁻⁷ Ben-David⁸ emphasizes the social and emotional dimensions of organ exchange are frequently dismissed when organs are viewed merely as commodities governed by supply and demand. He argues it is necessary to define what constitutes the body and its parts in the context of organ transplantation. Studies that recognise socio cultural dimensions of organ donation are extensively present in international domain. For instance Lock and Crowley-Makota⁹ in a comparative analysis of the United States, Mexico, and Japan, noted that both donating and receiving organs should not be understood as the "autonomous choice" of an individual but rather as based on moral positions and obligations again reiterates the socio cultural dimension of organ donation and transplantation. The metaphor of the 'gift' or reciprocity is frequently emphasized in organ transplantation discussion , but this is to some scholars an oversimplifies the concept. For many involved, this 'gift' can evoke feelings of coercion, extending beyond simple health implications and healing, as noted by Scheper-Hughes¹⁰, Siminoff and Chilag¹¹ and Margaret Lock² explored the contrasting cultural and historical reasons for organ donation across countries. In the United States, organs retrieved from post-mortem donors are generally accepted without hesitation, while in Japan, the practice faces significant obstacles due to deeply rooted beliefs about death. Lock pointed out that definitions of death are culturally constructed within modern medicine. Hogle¹² discusses how medieval beliefs about the diffusion of life essence throughout the human body complicate organ donation in multicultural Germany. Despite the state’s political narrative of ‘solidarity’ being used as a powerful metaphor in East Germany, and Christian notions of ‘charity’ being employed to encourage organ donation at the state level, the process remains fraught with difficulties. Additionally, based on extensive fieldwork, Crowley-Matoka⁹ illustrates how organ transplantation in Mexico is often viewed as a family matter, particularly concerning kidney donations among living relatives, contrasting with the practice of seeking donations from strangers that is more common elsewhere. These broader discourse under the socio cultural perspective therefore acknowledges that organ transplant discourse is a complex socio cultural matter and cannot therefore only be understood with the overused concept of ‘gift’ metaphor alone which many see as a ‘politically loaded and non-neutral concept’ to make sense of this act.¹ This is so because the gifts entail a complex and contradictory meaning in itself and if taken into account then it demands a through exploration of meanings behind such thoughts. These studies recognising social and cultural construction of organ donation frame the tone of argument of the current study on youth refusal to organ donation in Delhi. Considering young adults as key representatives of future donation system, it becomes more pertinent to understand their reluctance or apathy towards organ donation. While substantial discussion exists on this topic among health practitioners and policy planners in India, there has been a lack of academic focus on this issue from social scientists, particularly sociologists. Drawing from the empirical study, this paper seeks to elucidate the underlying reasons for the refusal of organ donation among undergraduate students in Delhi within a broader critical theory framework. A Socio-medical History of Organ Transplantation in India: Organ transplantation in India has a relatively short history compared to the developed world. The first case of Kidney transplantation in India dates back to 1970s. During the 1980s and early 1990s, although this activity became more widespread, it was largely restricted to live donors in selected urban centres. In the 1990s, kidney transplants became much more visible with the establishment of additional transplantation centres. According to NOTTO¹³ sources, there has been an increase in number of transplants cases from 4,990 in 2013 to 16,041 in 2022. Extensive studies in India exists exploring organ transplantation issues from legal perspectives or from a rational choice perspective. For instance, reports from the National Organ Transplant Programme indicate, an increasing demand for human organs in India. The figures stated by the organization are as follows: As per Director General of Health Services, Govt. of India, an estimated 180,000 people suffer from renal failure every year; however, the number of renal transplants performed is only around 6,000. Approximately 200,000 patients die of liver failure or liver cancer annually in India, and about 10-15% of these could be saved with a timely liver transplant. Therefore, about 25,000-30,000 liver transplants are needed annually in India, but only about 1,500 are performed. Similarly, about 50,000 people suffer from heart failure annually, but only 10 to 15 heart transplants are performed each year in India. In the case of corneal transplants, about 25,000 are done every year, against a requirement of 100,000.¹⁴ Viewed from this perspective existing studies mainly focus on the motivations or barriers components of organ donation process noting the low level of awareness.¹⁵,¹⁶ Studies conducted in India also underscore the inadequacy of regulatory mechanisms to prevent illegal trafficking of human organs.¹⁷⁻¹⁹ Several studies also document mistrust and misinformation surrounding organ donation as significant barrier to organ donation in India.²⁰,²¹ The structural factors such as economic disparities are highlighted is some studies.¹⁷,²² Few studies also propose stringent mechanism to regulate illegal trade of organs, implementing educational programmes while examining correlation between awareness levels and willingness to donate.¹⁶⁻²³ Many do also emphasise on government and private stakeholder intervention in these critical matters.²⁴ These studies while elucidating the complexities surrounding organ transplantation from a positivist or biomedical perspective, fail to consider the perspectives of the donors themselves especially when they express their reluctance towards the acts of donation. In other terms, this discourse tends to depict the process of donating body parts as primarily an informed decision based on empirical knowledge of the donors and interpret donors who show their reluctance as ignorant and lack information . This surely undermines to capture individuals’ profound socio-cultural and symbolic dimensions associated with life, mortality, and human corporeal form. Moreover, providing a critical understanding in this context that goes beyond biomedical comprehension of the issue is more important for creating an inclusive and culturally aware public health policies. MATERIALS AND METHODS This qualitative study aimed to explore the reasons for refusal or reluctance toward organ donation among youth in Delhi. The research specifically sought to examine how this reluctance is expressed within the broader public discourse that frames organ donation as a life-saving act and promotes it as a "gift of life." Participants for the study were recruited through snowball sampling, initiated via the researcher's social media networks, including WhatsApp, Facebook, and Instagram profiles. Individuals who consented to participate were selected for the study. From these virtual platforms, a purposive sample was drawn to complete a questionnaire consisting of both closed- and open-ended questions, followed by one-on-one telephonic interviews. All participants were undergraduate students who drawn from across different states in India. In total, twelve in-depth interviews were conducted. These individuals were drawn from a broader pool of seventy-nine respondents who had completed the online survey via Google Forms intended to know their general knowledge and attitude towards organ donation. A hermeneutic approach was utilized to analyse the interview data, allowing for an interpretative understanding of the participants' perspectives. To guide the analysis, typologies of reluctance toward organ donation developed in previous studies were employed as ideal types. Pfaller et al.,²⁵ proposed a fourfold typology based on their research in Germany, identifying key factors such as (1) information deficits, (2) mistrust, (3) objections to killing, and (4) concerns regarding bodily integrity, noting the potential for these categories to overlap. Similarly, Saxena et al.,26 developed a typology relevant to the Indian context, identifying mistrust of the donation process, fear of responsibility, emotional reactions such as shock and grief, challenges in obtaining familial consent, concerns about the post-mortem appearance of the body, and religious beliefs as critical influences on reluctance. This study framed four types of frameworks to interpret the forms and expressions of refusal and reluctance among the sample respondents. This framework is being designed on the basis of existing literature and recurring theme that emerged during the course of data collection. A tabular representation is provided below. Table 1: Workflow of the study Component Details Objective To explore reason for refusal or reluctance towards organ donation among youth in Delhi Population Undergraduate students studying in Delhi Recruitment Method Snowball sampling through social media network (WhatsApp, Facebook, Instagram). Data Collection Methods Online questionnaire (Google Forms, including closed- and open-ended questions) One-on-one telephonic interviews. Sample Size 79 questionnaire responses; 12 in-depth interviews with participants expressing uncertainty, scepticism, or negativity toward organ donation. Analytical Approach Hermeneutic analysis (interpretive understanding of participant narratives) and critical analysis of power and organ donation. Typologies Developed from Interviews Mistrust Social conformity Familial authority and bonding Spiritual world views Findings and Discussion: Four recurrent themes emerged from the study’s extensive telephonic interviews regarding respondents beliefs about organ donation and ideas around it. Though these four thematic frames are not exclusive categories of concepts but rather they are indicative patterns which help in understanding the reasons for youth reluctance to be a donor. These are: Mistrust Social conformity Familial Authority and bonding Spiritual World View I. Mistrust During the investigation, the researcher encountered personal opinions of respondents mistrusting the process of organ retrieval and donation. This mistrust was created either due to lack of information or due to mis representation of the processes involved in it. Though many of the respondents were not completely hostile to the process, but they expressed their concerns in various ways often by linking it to the institutional facilities or scary stories heard over the media. As a. result few respondents preferred not to accept to be a donor . For instance, Aparna (a pseudonym), a third-year undergraduate student, said: “Yes, I have heard about it advertisements and large hoardings near hospitals. But I don’t have complete knowledge about it as to how it happens; the idea of retrieving human organs sounds so scary! Death itself scares people, and separating body parts from a dead person sounds scarier. It’s a topic I would rather not deal with. May be I would be more open to it if I understood it better.” Nirmal is a second year graduation student, expressed similar concerns by asking, ‘I want to be an organ donor, but I am just worried that if something happens to me in the process, who will be held responsible for it? I am the only child of my parents. Social work can wait, but not my parents. Will the medial team do everything possible to save my life? I have heard stories of medical negligence, thus my fears are real, I am not just apprehensive only’. Adding to this, another respondent, Shruti, age 19, said reluctantly, “ I am so young and have never thought about death and donating body parts after death would surely not come to my thoughts. Anyway, if I had to decide right now, I would surely say ‘no’. Who would want to be cut into pieces?” (frowning her eyebrows). “I want my body to remain in one piece not in pieces after my death. ” Shruti’s beliefs have something deeper in its meaning her beliefs and reluctance are not just casual reflections of an younger person but rather it reveals how the younger adults are socialised into thinking about the ritual impurities, integrity of the body and more over how the fear of death is internalised in the subconscious minds of younger adults who are thought generally to be so open. Shruti’s view also construct death as an age affair. Death being a natural process comes only through aging. Similarly, Smriti (a pseudonym), a second-year political science student, said: “We were working on a classroom project about human trafficking. While searching for relevant articles, I came across with how kidney rackets and organ theft happens in India involving health professionals like doctors and nurses. This is so frightening! whom to believe then? One really cannot say ‘yes’ strongly if such things are happening and getting flashed in newspaper stories so often. Even if you want to participate in a noble cause like saving others’ lives, who knows who are the beneficiaries of your organs!” Pragati aged 20, was very authoritatively asserted, “It does not matter whether one is saying yes or no to participate in it . Reliable and motivating stories need to reach out to them in order to think about it. One need to be also sure that lives of all individuals are given priority not just the ones having more money. There are instances of how human organs are sold for money even if these are donated for all the needy” Pragati had never heard of possibility of donating body parts while being alive. She said she would consider to be a donor in only to her family or to a known one and not to strangers. Her refusal to organ donation is conditional and is due to her mistrust in the institutional structure aiding organ retrieval and transplantation. II. Social conformity Social conformity is the process in which individual members of the society adjust their behaviours and actions in accordance with the prevailing norms and values of the society. Those who don’t confirm to certain societal moral or value standards, society often treat them as deviants. This analysis is rooted in the concept of collective conscience coined by Durkheim. Therefore, conformity towards prevailing norms has always been emphasised in societies to maintain solidarity and to avoid chaos argues Durkheim in his scholarly work. In the present study while assessing younger generations beliefs towards organ donation, few of the respondents showcased their stronger conformity towards their family or community values which was negatively associated with motivations to be a donor. Particularly they confirmed that’s the judgments from peers and distant family members do affect them. These judgements are mostly based on the idea that donating body parts for saving life is a noble idea but these are not part of a normalised behaviour as their meanings are fused with beliefs about life and death. One respondent shared that relatives' opinions matter, especially if one is closely associated with them. Decisions about death rituals are collective affairs and involve consultation with both close and distant family members said Shalini a 20 years old girl. She added: “ This is a big decision! The decision to register or not register for organ donation cannot be made by me alone. Does not matter that it sounds good to me to save someone’s life but it’s about life and death not about donating money as charity.” She became emotional remembering how her younger uncle’s face got distorted after his cornea retrieval. His death was already a shock for all of us but his face was even more shocking for those who came for paying last homage. She added, “The decision was made when everyone was in shock due to his death, and not everyone was consulted about his cornea donation. We don’t know what happens after death, but if there is a belief that spirits never die, then extracting body parts is not a great idea. That belief needs to be changed first to make it happen without guilt. His body has already undergone through pain and later by removing his body parts we surely did not do good to him” Shalini’s narrative highlights how decisions about organ donation after death are influenced by collective beliefs about the body and about life and death. ‘ Separating body parts is linked to disrespect’ , she asserted. Conformity to family values, religious or traditional belief about bodily integrity therefore are significant factors influencing donors reluctance. III. Familial Authority or bonding Familial authority refers to the structured power dynamics within the familial domain that influences individual’s decision making process. In the context of India, family remain still a pivotal institution of power shaping individual’s decisions, actions and values bypassing the personal autonomy. The decision to donate organs is therefore not a rational one for the member of a family. It is a collective one. To some respondent’s family support is needed for all kinds of organ donations living or non-living. Akriti (a pseudonym) said, “ What if I decide to go for it, but my family does not approve? I am educated and well-informed, studying in a big city like Delhi, but my parents are not exposed to these new aspects of medicine. For them, it’s a weird ‘city thing’. They would put all the blame on my education, if even I try to convince on this. ” Akriti’s hesitation to be a donor is rooted in her deeper submission to familial authority and moral obligation. Her apprehension is real as she does not want to disturb the social cohesion and stability within family by making such a decision about something which is completely unknown in her family history. Another respondent Deepika, added to the above position in a similar line, “ I cannot decide on this sensitive issue. Death cannot be discussed so casually after all. My parents have greater control over my life; I cannot make this decision on my own. Donation, saving life of others sounds good but when it comes down to a persona and a family … there are a lot of things to consider, my family won’t approve of it and I can’t go against them. ” Fear of death came out as a real fact in her narration along with the importance of familial authority for younger adults in India. Deepika’s anticipation of disapproval or rejection from her parents was also echoed in Sreemant’s narration. Sreemant, a native of Bihar (a pseudonym) while remembering his brother who died in a road accident said, “ These kinds of campaigns are only prevalent in big cities. In rural areas, death does not bring an end to our memory , we still feel as if our beloved departed person is still around us whenever we think of them, so it is not be acceptable to impose an additional burden on grieving family members by forcibly convincing them and blackmailing them to go for organ donation. ” Sreemant’s narrative signify how the reluctance to be donor is rooted in one’s emotional experiences with the departed person in the consideration for organ donation. The role of family in these revelations suggests that acts of organ retrieval and transplantation go beyond medical rationalization theories that view the body as a machine and organ donation need is a universal rational act. IV. Spiritual World View Death is not a clinically determined condition but rather is socially and culturally constructed. For instance Mampe²⁷ argues a good death is a normative idea of living and dying well and is constructed socially and culturally by studying marginalised communities of transgenders. Haddow²⁸ argues that new inventions and discoveries in modern medicine during the 18th and 20th centuries have further complicated these beliefs by demonstrating that individuals previously thought dead could now be revived. Organ transplantation system is therefore gripped around certain ambiguates which need to be elaborated only though people’s lived experiences and though their beliefs and practices not through ‘methodological nationalism’ -an apt terms used by Jamieson.²⁹ Organs as ‘gift of life’ therefore goes contested when one looks at the everyday experiences of individuals , their beliefs on it. Understanding life and death is connected to the concept of organ donation, though they may appear different themes altogether. Scholars argue that ideas about life and death are significant in understanding people’s perceptions of organ donation in cases of brain death or accidental death. Fear of bodily mutilation often arises in these discussions as contradictory ideas not supporting the idea to be an organ donor. As Sanner³⁰ argues, families of such individuals “generally are not able to imagine a difference between the living and the dead. The dead body was ascribed qualities that only a living individual possesses”.²⁸ In this context then, a spiritual world view can significantly shape one’s reluctance to be a donor. For few respondents, the dead should be respected and that any act of mutilation, such as organ retrieval, can mean a form of disrespect. The body is not a biological entity rather is a spiritual entity. Therefore, body and self are inseparable in their view. Ruby (a pseudonym) stated, “ We see others through our eyes; the same logic applies to the dead. If there is an afterlife thing then it’s a crime! Seeing their face before cremation is the last memory that we create before cremation. If their eyes are gone, that last image will never leave one's mind. It’s not something you would do to your loved ones after all.” Shikha age 20, an undergraduate student at the University of Delhi questions the contradictions involved in the idea of organ donation and one’s spiritual world view. She said, “ Deciding to donate organs is not just any casual matter; parents would surely be hesitant to allow us. I am not a very religious person but am sure all do follow rituals of death and birth in their families. It’s so strange that we want to ensure that the soul is resting in peace but how is this possible if organs are gifted to other persons and that person is still alive. Is it not a contradiction? ”. Her refusal was clearly indicative her dilemma that is rooted in a rational and logical thinking and a spiritual world view that she adhere to as a member of society. CONCLUSION The current article aimed to elucidate the ‘rational’ reasoning of young adults in their ‘irrational’ decisions to decline their participation in organ donation within a specifically selected demographic of young adults in Delhi. While existing literature pertaining to this topic has specified numerous factors contributing to the reluctance for procuring organs from the deceased donors, this research paper particularly aimed at analysing the data using a fourfold framework based on the responses of respondents drawn from a qualitative study in Delhi. These categories are not entirely distinct; conversely, they are all interrelated to each other. Despite the limitation of a small sample size, the study revealed deep-seated doubts and apprehensions among respondents regarding organ removal and transplantation. Within the scholarly critical discourses on Organ donation, the biomedical process of organ donation and retrieval is often understood through the lens of exercise of power. For instance Foucauldian disciplinary power ³¹ conceptualisation may help in understanding how romanticising organs as gifts campaign are rooted in the creation of a disciplined body, normalised citizens to control and exercise power over bodies for purported betterment. Agamben ³² would argue in the similar line to say that through this process exercise of power over bodies are performed for creating a normalised body which is the aim of the sovereign power of the state. Feminist scholars like Butler ³³ from a critical perspective therefore are interested in showing that how this biomedical technology that generally aims to safeguard the life of some, puts few selective others , mostly the vulnerable population at the brink of death or exposes them to the corporeal harm involved in organ theft or illegal organ removal process that is based on manipulation, persuasion, deception etc. ³⁴ From a critical theory lens reluctance to donate organs can be interpreted not as an irrational act of the youth but rather this mode of reasoning is a rational one that may have been rooted in the often assumed irrationality of family authority, customs, spiritual world views etc. It is a rational response because is a mode of resistance to the disciplinary powers of biomedical and institutional apparatus. The discourse on organ donation therefore moves beyond the organic life of biological bodies rather they are rooted in individual subjectivities, a symbolic world that sees and imbues diverse meaning to the very act of organ donation. The cited narratives of the young individuals depicts these diversities by disallowing their subjective selves to submit to the politics of biopower argued from a Foucauldian perspective. Refusal attitude therefore means the rational act of resistance that construct the life worlds of these young adults in a meaningful way away from bio ethical rational models. Rather than understanding refusal as an irrational logic, attention need to be paid on understanding the reasons of their reluctance as valid expressions of their rational decision. This also reveals how the narratives of organ transfer caught in between the complex and contradictory structures of life and death. The study has certain limitations and is acknowledged by the researcher due to smaller sample size. Although the study is based on a limited number of respondents, however it did not prevent it to explore and theoretically explain the cultural embeddedness of organ donation among a sample of youth population in Delhi. The study recommends macro-level empirical research to explore the link between individual factors and social determinants such as caste, class, education, and ethnic identities in shaping attitudes toward organ donation to the future researchers. Conflict of Interest There is No Conflict of interest in the paper References Shaw , R., Bell, L & and Webb, R. New Zealanders’ perceptions of gift and giving back as participants of organ transfer procedures. Kōtuitui: New Zealand Journal of Social Sciences Online 7, 26–36 (2012). Lock, M. M. Twice Dead: Organ Transplants and the Reinvention of Death. (University of California Press, 2002). Fox, R. C. Spare Parts: Organ Replacement in American Society. (Routledge, New York, 2017). doi:10.4324/9781315130125. Fox, R. & Swazey, J. The Courage to Fail: A Social View of Organ Transplants and Dialysis. Routledge & CRC Press Link . Sharp, L. Strange Harvest: Organ Transplants, Denatured Bodies, and the Transformed Self 9780520939615. dokumen.pub Link (2006). Sque, M. R. G. A dissonant loss: the bereavement of organ donor families. in (eds. Sque, M. R. G. & Payne, S.) 59–81 (Open University, 2007). Antipov, A. V. & Владимирович, А. А. The Bioethics of Dying: Dignity, Commercialisation and the Organ as a Gift. Čelovek 36, 32–51 (2025). Ben-David, O. B. Organ Donation and Transplantation : Body Organs as an Exchangeable Socio-Cultural Resource. (Westport, Conn. : Praeger Publishers, 2005). Crowley-Matoka, M. Domesticating organ transplant: Familial sacrifice and national aspiration in Mexico. Medicine Anthropology Theory | An open-access journal in the anthropology of health illness and medicine 4, 216 (2017). Scheper-Hughes, N. The tyranny of the gift: sacrificial violence in living donor transplants. Am J Transplant 7, 507–511 (2007). Siminoff, L. A. & Chillag, K. The fallacy of the ‘gift of life’. Hastings Cent Rep 29, 34–41 (1999). Hogle, L. F. Recovering the Nation’s Body. Bucknell University Press Link (1999). MoHFW-GoI. NOTTO: National Organ & Tissue Transplant Organisation. Under Aegis NOTP, Dir Gen Heal Serv MoHFW, Govt India. (2011). DGHS. National Organ Transplant Programme. Link Chakradhar, K. et al. Knowledge, Attitude and Practice Regarding Organ Donation among Indian Dental Students. Int J Organ Transplant Med 7, 28–35 (2016). Burra, P. et al. Changing attitude to organ donation and transplantation in university students during the years of medical school in Italy. Transplant Proc 37, 547–550 (2005). Shroff, S. Legal and ethical aspects of organ donation and transplantation. Indian J Urol 25, 348–355 (2009). Muraleedharan, V. R., Jan, S. & Ram Prasad, S. The trade in human organs in Tamil Nadu: the anatomy of regulatory failure. Health Econ Policy Law 1, 41–57 (2006). Parakh, H. Illegal Organ and Human Trafficking during Covid 19 | International Journal of Law Management & Humanities. Link (2021). Manojan, K., Raja, R., Nelson, V., Beevi, N. & Jose, R. Knowledge and Attitude towards Organ Donation in Rural Kerala. (2018) doi:10.4103/0973-. Kennedy, K. Organ Donation and Transplantation in India: An Inquiry in Kerala. Journal of Social Distress and the Homeless 11, 41–67 (2002). Khan, N., Masood, Z. & Zahra, S. KNOWLEDGE AND ATTITUDE OF PEOPLE TOWARDS ORGAN DONATION. Journal of University Medical & Dental College 2, 15–21 (2011). Vijayalakshmi, P., Sunitha, T. S., Gandhi, S., Thimmaiah, R. & Math, S. B. Knowledge, attitude and behaviour of the general population towards organ donation: An Indian perspective. Natl Med J India 29, 257–261 (2016). Abraham, G. et al. Evolution of deceased-donor transplantation in India with decline of commercial transplantation: a lesson for developing countries. Kidney International Supplements 3, 190–194 (2013). Pfaller, L., Hansen, S. L., Adloff, F. & Schicktanz, S. ‘Saying no to organ donation’: an empirical typology of reluctance and rejection. Sociol Health Illn 40, 1327–1346 (2018). Saxena, D. et al. Challenges and Motivators to Organ Donation: A Qualitative Exploratory Study in Gujarat, India. Int J Gen Med 16, 151–159 (2023). Lampe, N. M. SATISFICING DEATH: Ageing and end-of-life preparation among transgender older Americans. Sociol Health Illn 46, 887–906 (2024). Haddow, G. The phenomenology of death, embodiment and organ transplantation. Sociology of Health & Illness 27, 92–113 (2005). Jamieson, L. Intimacy as a Concept: Explaining Social Change in the Context of Globalisation or Another Form of Ethnocentricism? Sociological Research Online 16, 151–163 (2011). Sanner, M. A. Exchanging spare parts or becoming a new person? People’s attitudes toward receiving and donating organs. Soc Sci Med 52, 1491–1499 (2001). Foucault, M. The Subject and Power. Critical Inquiry 8, 777–795 (1982). Agamben, G. I. HOMO SACER: Sovereign Power and Bare Life. in The Omnibus Homo Sacer 1–160 (Stanford University Press, 2017). Butler, J. Precarious Life. Verso Link Roy P. Organs and their travels: an analysis of organ donation and transplantation(unpublished). *Corresponding author and requests for clarifications and further details: Dr. Chittaranjan Behera, Professor, Department of Forensic Medicine, AIIMS, New Delhi, 110029 Email ID - drchitta75@rediffmail.com

Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE JUNE 2000 ISSUE THE POISON SLEUTHS DEATH BY FLUORINE -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 person is Ramlal and he was 26 years old. He was found dead in his room today morning. When the milkman came to deliver the milk in the morning today, Ramlal did not open the door, and he got suspicious. This was especially because Kalu, his neighbor had threatened to kill him several times.” “Who is Kalu doctor, and why did he want to kill Ramlal?” “Tarun, Kalu is a 35 year old person, who lives in the neighborhood. Kalu thought that Ramlal used to meet his wife furtively, although all the other neighbors sincerely believed that this was not the case. Many times, they even told Kalu that he was mistaken, but he did not believe anyone. Many a time, Kalu has even threatened to kill Ramlal, if he did not stop meeting his wife. Let me tell you that Kalu works in a chemical factory making all sorts of chemicals. He is a reasonably good chemist and knows a lot about various chemicals.” “So what happened when the milkman came?” “Yes, I was telling you about the events occurring in the morning today. When Ramlal did not open the door, milkman enquired from the neighbors if he had gone out for a few days, and he was informed that Ramlal was very much in town. In fact one person told, that he had seen Ramlal with Kalu only the previous night. As Ramlal always got up late, there was no question of his having got up early and going out for a walk or something. Everybody got suspicious. They called the police. When the door was forced open, everyone was stunned to see Ramlal lying dead on his cot. Everyone noticed a faint smell coming from the room, but they could not identify that smell. They said that they had never smelt anything like that.” “Perhaps Ramlal was not keeping his room tidy and hence the smell” “It was not that kind of smell. At least that is what has been informed to me by the neighbors.” “Doctor, how do you think Ramlal died?” “Tarun, this is a case which even defeated me for several hours. Since he was not admitted to a hospital, I did not have a hospital report to fall back upon. You might have noticed that many times, hospital records, such as initial symptoms etc give away the cause of death. If a poison has been administered to the individual, we can immediately know about that poison from the symptoms encountered. But in this case, there was no hospital report, and I had to rely solely on my postmortem findings. To make matters worse, there were no significant postmortem findings. The only findings which deserve mention are a reddening of his eyes, and of the mucus membranes of his respiratory tract, such as those of nose and windpipe. His lungs were very much congested with blood. His stomach showed lot of alcohol. It appears he had been drinking alcohol before his death.” “Perhaps he died by consuming too much liquor?” “I have done his blood alcohol levels. A blood alcohol level of around 600 mg% is necessary to kill a human being. But in his case, the blood level was just about 150 mg%, enough to produce a mild sensation of well-being, but not death. We enquired the neighbor - a person called Shamu - who claims having seem him with Kalu the day before. Shamu told that Kalu came to Ramlal’s house at about 9 pm the previous night. He had a big bag in his hand. Shamu knew it because at that time he was just returning to his house from his evening walk. When Shamu asked what he was doing there, initially Kalu looked nonplussed but very soon, he regained his composure. He told that that he wanted to bury the hatchet with Ramlal, and was going to his house to have a friendship drink. He even opened the bag and showed him a bottle of Rum which he had with him.” “Then how are you going to find out how he died?” “Tarun. I had just three abnormal and suspicious looking pieces in the whole story. One that Kalu his neighbor who was his enemy, showed a suspicious behavior the previous night, and two that Kalu works in a chemical factory. Add to this the third factor that the neighbors noticed some strange smell coming out from the house when they opened the door, and my mind immediately turned towards some poisonous gas as the possible killing agent. Still I was in the dark because there are so many gases which can kill a person. I had no way but to perform a chemical test on his lungs, and guess what I found - fluorine! Ramlal has died because of fluorine” “Come on doctor. We have never heard of a person dying from fluorine. He must have died some other way.” “Tarun, I am very sure Ramlal died of fluorine. In fact the circumstances which Kalu created were perfect for a killing with fluorine. He first made Ramlal tipsy with alcohol and then released fluorine which he had brought with him in his bag. He had this gas in a pressurized container, which the police has seized from a half opened almirah. Of course they would never have looked for it, had I not told them about it. I went to Ramlal’s house and did some tests on the air in his room. Although much of the fluorine had diffused out of Ramlal’s room, yet I could demonstrate a significant amount of fluorine in his room.” “Doctor, it appears we are on to some other good of your stories. Please tell me something about fluorine first, so I can follow you better.” “Tarun, fluorine (F), is the most reactive chemical element, and the lightest member of the halogen elements, or Group VIIa of the periodic table. Its atomic number is 9, atomic weight 18.9984, melting point -219.62° C (-363.32° F), boiling point -188° C (-306° F), and density at 1 atm, and 0° C about 1.696 g/litre. Under ordinary conditions fluorine is a gas a little heavier than air, with a pale yellow colour; inhalation except in very low concentrations is dangerous. Upon cooling, fluorine becomes a yellow liquid. Fluorine occurs combined in the widely distributed mineral fluorite ( calcium fluoride, fluorspar), its chief source, in the minerals cryolite and fluorapatite, and in small amounts in seawater, bones, and teeth. Not a rare element, it makes up about 0.065 percent of the Earth's crust. Only one isotope occurs in nature, stable fluorine-19. Let me tell you that Fluorine is difficult to isolate from its compounds, and in fact it is impossible to free it by chemical means. No other element is powerful enough, as an oxidizing agent, to replace it.” “Doctor since when do we know about fluorine?” “Tarun, the French chemist Henri Moissan first isolated fluorine in 1886 by electrolysis of anhydrous hydrogen fluoride (HF), in which potassium hydrogen fluoride (KHF2) had been dissolved to make it conduct a current. Elemental fluorine of high purity is prepared commercially by Moissan's procedure. The elemental gas is used as an oxidizer in rocket fuels and to prepare fluorides. Fluorine, composed of two-atom molecules (F2), is so reactive that it combines with all other elements except helium, neon, and argon to form ionic or covalent fluorides. Its chemical activity can be attributed to its extreme ability to attract electrons (in fact, it is the most electronegative element) and to the small size of its atoms. The oxidation state of -1 is the only one observed in fluorine compounds. Because of the small size of the fluoride ion (F-), it forms many stable complexes with positive ions; for example, hexafluorosilicate(IV) (SiF62-) and hexafluoroaluminate(III) (AlF63-). One of the principal industrial compounds of fluorine is hydrogen fluoride, obtained by treating fluorite with sulfuric acid. It is employed in the preparation of numerous inorganic and organic fluorine compounds of commercial importance, e.g., sodium aluminum fluoride (Na3AlF6), used as an electrolyte in the electrolytic smelting of aluminum metal; and uranium hexafluoride (UF6), utilized in the gaseous diffusion process of separating uranium-235 from uranium-238 for reactor fuel. A solution of hydrogen fluoride gas in water is called hydrofluoric acid, large quantities of which are consumed in industry for cleaning metals and for polishing, frosting, and etching glass. Boron trifluoride (BF3) and antimony trifluoride (SbF3), like hydrogen fluoride, are important catalysts for organic reactions; cobalt trifluoride (CoF3) and chlorine trifluoride (ClF3) are useful fluorinating agents; and sulfur hexafluoride (SF6) is used as a gaseous electrical insulator. Sodium fluoride (NaF) is used to treat dental caries and is often added in small amounts to fluoride-deficient water supplies (fluoridation) to reduce tooth decay. Elemental fluorine, often diluted with nitrogen, reacts with hydrocarbons to form corresponding fluorocarbons in which some or all hydrogen has been replaced by fluorine. The resulting compounds are usually characterized by great stability, chemical inertness, high electrical resistance, and other valuable physical and chemical properties. This fluorination may be accomplished also by treating organic compounds with cobaltic fluoride or by electrolyzing their solutions in anhydrous hydrogen fluoride. Useful plastics with non-sticking qualities, such as polytetrafluoroethylene ([CF2CF2)x]; known by the commercial name Teflon), are readily made from unsaturated fluorocarbons. Organic compounds containing chlorine, bromine, or iodine are fluorinated to produce compounds such as dichlorodifluoromethane (Cl2CF2), the coolant used in most household refrigerators and air conditioners." “Doctor, what is the color of this gas? And how does it smell?” “Fluorine is a yellow gas that does not occur free in nature because of its great reactivity. Before World War II it was generated only in gram quantities, but the need for stable fluorocarbons in the atomic energy program stimulated the chemical industry to devise electrolyte cells for the preparation of elemental fluorine. The present availability of the compressed gas in nickel or steel cylinders has led to its use for the preparation of a host of new organic fluorine compounds, many of them of commercial value. The gas can be liquefied at low temperatures. Its odor differs from that of chlorine. It is rather difficult to describe, but it can be compared to that of relatively concentrated ozone. It can be piped through standard steel pipe or copper tubing equipped with Monel metal…” “Sorry to disturb you doctor, but what is Monel metal?” “Tarun, fluorine is a very reactive gas, and thus it can only be piped through certain very resistant metals. Monel is any of a group of nickel-copper alloys, first developed in 1905, containing about 66 percent nickel and 31.5 percent copper, with small amounts of iron, manganese, carbon, and silicon. Stronger than pure nickel, Monel alloys are resistant to corrosion by many agents, including fluorine and rapidly flowing seawater, both of which can be very very corrosive to metals. They can be fabricated readily by hot- and cold-working, machining, and welding. Monel is a registered trademark of the International Nickel Company. So I was telling you, how the gas can be piped. Well, it can be piped also through nickel valves with Teflon packing. With metals, fluorine reacts only slowly, except at sufficiently elevated temperatures. Under suitable conditions, it reacts spontaneously with most materials at room temperature except the inert gases, metal fluorides in their highest valence states, and carbon tetrachloride. Under some conditions, fluorine at atmospheric pressure can burn even steel equipment. For reasons unknown, fluorine does not always react with water, but at times the reaction may occur explosively. With the moisture of the air, it forms hydrogen fluoride and, possibly, oxygen fluoride, OF2." “Doctor, how does fluorine kill a person? Have scientists done some studies on how fluorine kills a man?” “Tarun, the only studies of the effects of exposure of animals to metered dilutions of fluorine in nitrogen were those made at the University of Rochester by a team led by Stokinger in 1949. They did a number of experiments on various animals, and let me tell you what they found. The gas was uniformly fatal to rabbits, guinea pigs, rats, and mice in exposures ranging from 5 minutes at a concentration of 10,000 parts per million (p.p.m.) to 3 hours at 200 p.p.m. Guinea pigs survived an exposure of 7 hours to 100 p.p.m., but the over-all mortality among the various species was 60 per cent. Respiratory damage, with swelling of the lungs - technically called pulmonary edema-, was the cause of death. More prolonged exposure, up to 35 days, was made to lesser concentrations. Irritation of the eyes and nasal and mouth mucosal lining was noted at concentrations of 5 to 10 p.p.m., and dogs exhibited irrational seizures, many of which were fatal. Moderate to severe lung irritation occurred at all levels down to 3 mg./cu. meter, and rats showed also a high degree of destruction of their testes at 25-mg. level. The tolerated exposure was taken as 1 p.p.m. (1.7 mg./cu. meter),and hydrogen fluoride and fluorine were regarded as independently toxic. The Rochester group also exposed the skin of the back of anesthetised rabbits for periods of 0.2 to 0.6 sec. at a distance of 1 in. to fluorine under 40 lb. pressure. The briefest exposure led to the appearance of a small area devoid of blood about 1/4 inch in diameter, surrounded by an reddened area. This became a superficial eschar that sloughed off by the fourth day, disclosing normal epidermis. The longer exposures were accompanied by a flash of flame, burning the hair and causing a special type of destruction - technically known as coagulation necrosis - of the burned area and charring of the epidermis. The thermal flash burns resembled those induced by an oxyacetylene flame.” “Sounds like a really dangerous gas. Doctor, you told me that Kalu worked in a factory from where he might have smuggled a canister of fluorine. Surely if Kalu works in a factory, he himself might be exposed to it. Has the government set up any regulations regarding it?” “No, to the best of my knowledge, there are no governmental regulations on the allowable concentrations of fluorine. But the American Conference of Governmental Industrial Hygienists (1961) has recommended 0.1 p.p.m. as the threshold limit for fluorine. Apparently if the concentration increases beyond it, there is danger to one’s health.” “Doctor, now I know reasonably enough about fluorine. Please tell me how Kalu killed Ramlal with Fluorine” “Tarun, it was a very devilish plan. Kalu stole a canister of fluorine from where he was working. He was working in a chemical factory, and it was not difficult for him to do that. He knew about the killing potential of fluorine as he had studied chemistry upto college level and was reasonably conversant with all the chemicals, and their effects on the human body. He knew that if he released the gas in Ramlal’s house he would recognize the smell and would throw open the doors and windows of his house. So he decided to first lull his senses. For this purpose he came to Ramlal’s house along with a bottle of liquor. Did you notice that Shamu told us he had a big bag with him, and from it he took out a bottle of liquor to show him. I am sure that the canister of fluorine was also in the very same bag, but he did not take it out to show to Shamu. At Ramlal’s house, he said that he wanted friendship. Ramlal was also tired of day-to-day bickerings and he readily agreed for a drink. After two or three pegs, when Ramlal was quite tipsy, Kalu got up on the pretext of going to the bathroom. He furtively opened a nearby almirah, put the canister inside it, and slightly unscrewed its cap, so the gas could leak slowly into the room. After this he went to the bathroom. When he came back, he found Ramlal lying lazily in his bed, with his eyes closed. Kalu took leave of him, and came back to his house. Ramlal closed the door behind him, and came back to his bed to sleep. By this time, enough gas had not come out of the canister to arouse Ramlal’s suspicions. Anyway, Ramlal was drunk, and he was not in a position to recognize the special odor of fluorine. Soon he fell asleep. The concentration of fluorine increased in the house, and killed him in his sleep. Ramu did one mistake in his whole episode. He left the canister in the almirah. He never thought that our investigation can be so thorough. Anyway, this was the only way, he could ensure a gradual build-up of the gas in Ramlal’s house. Come, let us tell the police that Kalu has killed Ramlal, and that he should be caught” “That is very clever of you doctor. Without your clever deduction it would have been impossible to say how Ramlal died and Kalu 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 - Potassium Bromate."

SCIENCE IN CRIME DETECTION-18 USE OF INFRARED PHOTOGRAPHY IN FORENSIC SCIENCE Last year I came across a very interesting case. The case related to a businessman Mr. Valecha. He had about 5 Acres of land in NOIDA, on which he wanted to build a factory relating to paper business. Somehow, some financial problems arose and Mr. Valecha could not build a factory immediately after acquiring that land. The land was lying vacant as a result. As there was nobody to look after the land, and also because Mr. Valecha became very complacent, the land remained unguarded for about 2 years. In between those two years Mr. Valecha kept going to Japan to finalize the details of technology transfer relating to paper factory. So perhaps his not visiting the factory site was somewhat justified too. After about 2 years all the deals were finalized and Mr. Valecha was able to acquire a loan of about Rs. 2 crores from the Govt. Now when he reached the site of factory he found that the place had been occupied by one local goon Mahto. He was running some liquor business from there. When Mr. Valecha asked him to vacate the land, he asked him to get lost. This infuriated Mr. Valecha very much and he contacted the police to help him in this matter. Valecha had good contacts in the police and he was sure he could get the things done. Unfortunately for Valecha, Mahto had good contacts too. Not only did he know higher‑ups in the police, he had contacts with the Underworld dons too and even with some local influential politicians. It was believed that he was paying regularly something to them, and was always actively engaged in the political campaigns of those leaders. Thus having him moved through local police contacts was not likely to be of much consequence, and that was what actually happened. The local SHO did try his level best in the beginning, but very soon when he realized the enormity of the task he had inadvertently taken, he lost all interest in the case. There was no option left for Mr. Valecha than to go to court, but this would have taken several years obviously, and Mr. Valecha could not hold on to his Govt. loan till that time. The loan would lapse only after 2 months, if Mr. Valecha could not use that loan till that time. And Valecha did not want the loan to lapse at any cost. It was under these circumstances that Valecha took a very impetuous decision. Somebody suggested to him that he should strike a deal with Mahto. Perhaps he would take a few lakhs Rupees and vacate the land himself. Valecha liked this idea and approached Mahto. He had imagined that the deal would be finalized in a few lakh Rupees. He was prepared to pay up to Rs.5 lakhs for having that land vacated. However when he talked with Mahto he was dumbstruck when Mahto kept before him a demand of Rs. 50 lakhs. This was beyond the capacity of Valecha. Try hard as he would, he could not bring Mahto to reduce his demand. Repeated discussions with various representatives of Valecha also did not bring any fruitful results. Valecha was quite exasperated now. At this stage somebody suggested to him that there was a local goon MunnaLal who could help him. MunnaLal specialized in murder. He would charge a hefty sum from his client and do away with anyone indicated by his client. When MunnaLal was contacted he agreed to kill Mahto for a sum of Rs. one lakh. As Valecha had no other option, he agreed to this. On May 15, 1993 Valecha gave a phone call to Mahto and told him that he had arranged for Rs. 50 lakhs as desired by him and he could come to Valecha's house any time to collect it. Mahto jumped at the suggestion and replied that he will be there on that very night. The time was fixed for 10 pm. This suited Valecha and MunnaLal, who wanted to do away with Mahto. Valecha had a plush house in Golf Links area. The house was tastefully decorated. MunnaLal reached Valecha's house at 8 pm sharp. He was a hatchet specialist. He had brought his hatchet with him. The plan was to kill Mahto with the hatchet and then to do away with the body. At 10 pm the door bell rang. Valecha opened the door and found Mahto standing in the doorway. Till now everything was going according to plan. Mahto was asked to take a seat. He sat on a modular sofa. This is a modern kind of sofa which can be converted into a bed at night (reproduce fig. 1 on page 191 here). The upholstery on the sofa was of a dark red colour. Mahto took the left side of the sofa. While Valecha engaged Mahto in talks, MunnaLal came from behind and struck hard on Mahto's head. Mahto immediately dropped dead. After this both Valecha and MunnaLal disposed of the body of Mahto by throwing it away in the bushes of the Ridge area. When the body of Mahto was recovered by the police the next day, they started investigation. Their line of investigation led them to Valecha. When one of Valecha's servants was questioned, he told the whole story to the police. He was present in the house when the incident had taken place. When the police started building up the case against Valecha, they were quite dismayed to find that the bed on which Mahto was alleged to be sitting did not show any blood stain. This seemed to refute the story given by the servant. But in fact the stains were not visible because the upholstery of the sofa was of red colour. Here the police was in great dilemma. If they showed the normal pictures of the sofa in the court, it would have been extremely difficult for them to convince the judge that a murder had indeed been committed on that sofa, simply because the sofa did not show any blood stain. It was at this point when they approached me for help. I made use of a special kind of light ray called the infra‑red ray. This type of ray can not be seen by the eye, but it can make several invisible things visible. After taking the photograph in infra‑red ray exposure, the blood stains were clearly visible ( reproduce fig. 2 and fig. 3 on page 192 here). One can see a large patch of blood on the left side of the sofa. The close‑up photograph shows many fine areas of blood splashing. The contrast appears dramatic when you compare these two figures with fig.1 which has been taken in normal light. In fig.1, although blood stains are present, they are hardly visible. The police then got encouraged and asked me to take the photographs of MunnaLal's shirt also. MunnaLal was wearing a black shirt at the time of murder, and police had taken that shirt into custody. But that shirt was not showing any signs of blood, and because of that police had got discouraged very much (reproduce fig. 5 on page 194 here) . But when the same shirt was photographed in infra‑red rays, it showed blood stains very clearly (reproduce fig.4 on page 193 here). Thus the infra‑red photography helped the police immensely in building up evidence against Valecha and MunnaLal. The honorable court accepted the photographic evidence, and both of them were convicted. This was yet another victory for Forensic Science!

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

SCIENCE IN CRIME DETECTION-29 AN UNUSUAL CASE OF SKULL FRACTURE I had a tremendous response for my article on "Forgery of cheques" published in the July 1995 issue of Crime & Detective. One of the best letters was received from Mr. Sanjay Gupta of Florida. He tells me that he is studying air conditioning in Gainsville University, but he is deeply interested in crime and crime related stories. He has liked "Crime & Detective" so much that he has asked one of his friends in New Delhi to keep sending him issues of this magazine regularly. He has also in his possession several crime books. He tells me that decipherment of erasures is possible depending upon the thoroughness of the erasure. No technique will decipher a complete erasure. He has appreciated the way, I solved Mange Ram and Ramesh Chand's case. However he gives us some additional techniques for deciphering partial erasures. Partial erasures can be deciphered using low magnification. Other techniques available to enhance images are (1) examination through coloured filters to enhance contrast, (2) high contrast photography (3) infrared examination. For the benefit of our readers, I may tell that infrared (IR) is just a kind of special kind of light which can not be seen by human eyes. Carbon particles are very opaque to IR light. This means that if carbon particles are present in an ink (as they are in many inks), this technique will enhance the image. He also tells me that erased iron-based fluid inks can be restored by fuming the document with sulfo-cyanic acid which reacts with the iron in the paper to produce a red colour. All readers may not be familiar with the kinds of inks that are available in the market. For them the term "iron-based fluid inks" may be incomprehensible. Well, there are two basic types of fountain pen inks. The iron-gallotannate type was used as early as the eighth century and with substantial improvement is still in use today. Iron salts are combined with gallotannic acid in an aqueous solution. This solution when applied to paper is first colourless but darkens quickly when oxidized by air. Modern inks of this type contain a synthetic blue dye to provide an immediate blue colour to the ink which turns black after oxidation on paper. This explains the origin of the name blue-black fountain pen ink. Blue-black inks are very stable. The ink is insoluble in water and cannot be erased effectively by abrasion. The other type of fountain pen ink consists of an aqueous solution of synthetic dyes. These inks have a bright colour but are not as stable as the blue-black inks. When we talk of iron-based inks, we are actually talking about the iron-gallotannate type of inks. What Mr. Sanjay Gupta tells me is this. Had I fumed the forged check (submitted to the bank by Mange Lal), with sulfo-cyanic acid, I could have got a red colour in place of the words "ve", which were supposed to have been deleted by Mange Lal. Well! well!! I am thoroughly impressed at the depth of technicality our readers are going into. I have since checked up with certain research papers related to forgery of cheques, and have found Sanjay's method perfectly in order. Well Sanjay, thanks for giving us such valuable information. I will certainly keep this thing in my mind for future. Meanwhile I will request our readers to keep sending similar stories, news clippings or other material of interest to me for inclusion in our forthcoming issues. This time I am going to tell you about an unusual case which I solved in 1993. On 23 August 1993, the police found the dead body of an unknown male on the outskirts of Delhi, in a deserted area. From the external appearances, the man appeared to be around 45 years of age. The head of the dead body was badly mutilated and crushed. The skull bones were lying scattered on the ground. The brain matter was completely pulped and was flowing out of the open skull cavity. The mouth was gagged with a cloth, which was later identified as the victim's own handkerchief. Some blood was found around the head of the victim. From first appearances it appeared to be a case of death by blunt force impact. It appeared as if someone had killed him by hitting his head with an iron rod or lathi. The photographs of the victim were published in all the leading dailies. An effort was also made to establish the identity of the victim, by tallying the records of missing persons maintained with the Missing Persons Bureau. Soon a lady by the name of Champa identified the photograph as that of her husband Mewa Lal. He had been missing from the house since 21 August. On that day, Champa along with her two young children had gone to her parent's house for some family wedding. Mewa Lal was to join the family the next day. But he did not turn up. Champa thought that he must have got busy in some work, so she attended the wedding on 22nd. However since she was anxious about her husband, she cut short her stay and returned before schedule in the early morning of 23rd. On coming back home, she found that the front door was ajar, and nobody was inside. She enquired about him in the neighborhood, and from the relatives, but no one could tell anything about Mewa Lal. Mewa Lal was a man of doubtful character. Women were his weakness. He would often flirt with women, spending lavish money on them. In his quest for women, he wouldn't spare even married females. He was lately running an affair with Jaya, a 35 year married female. Jaya hailed from a lower middle class family and was exceptionally beautiful. Her husband Chandran was not earning well, and Jaya always felt the pinch. She would often curse her luck that she had got married to Chandran, who could not even arrange for a day's square meal. Needless to say when Mewa Lal tried to become intimate with her she gladly submitted herself to him. Mewa Lal would give her new Saris, bangles, sandals and other cosmetic items off and on. At times he would even give her cash to meet her day-to-day needs. Jaya did not need anything more than this. So she had surrendered herself completely to Mewa Lal. Mewa Lal was not particularly a rich person. He had no fixed job. He did sundry jobs on a commission basis. This made his earnings very erratic. Sometimes the cash flow would be very good, while at other times, it would be almost nil. His wife Champa was always in financial trouble. She knew that her husband was a flirt, and she also knew that he was lately running an affair with Jaya, but she was helpless. Ever since her marriage, she was telling him by various means, not to engage himself in such activities, but he wouldn't listen. His affairs with Champa had increased his expenses a great deal. According to some estimates of neighbors, he was spending almost Rs. 2,000 on her every month. This was a huge amount for Mewa Lal, who was not earning much. To meet his expenses, he took a loan of Rs. 10,000 (in October 1992) from Kaushik, an affluent person of the town. Kaushik knew Mewa Lal well. In the past he(Mewa Lal) had done some odd jobs for Kaushik. It was agreed that Mewa Lal would return the money to Kaushik within 3 months, with 16% interest. Of course Mewa Lal had no means to return the money to Kaushik, but he did not disclose this fact to him. In Jan 1993, as promised, Kaushik went to Mewa Lal to get his money back along with interest. Mewa Lal didn't even have a single paisa to give him. This generated some tension between the two. However Mewa Lal sent Kaushik back saying that he would soon arrange for money, and settle his account. These were empty promises however. In June 1993, Kaushik had become so frustrated that he had decided to take the help of some muscle power to extract money from him. When police asked Jaya about the murder, some more interesting facts came to light. Jaya told the police that Chandran, her husband left for work on the morning of 21st August. Soon afterwards Mewa Lal came to her house. He was slightly drunk. He told Jaya that his wife had left for her parents' house to attend a marriage and they could have some uninterrupted fun then. Since Chandran was also not at home, they indulged in sexual intercourse as usual. The whole day they spent like that. In the evening Chandran came back early quite unexpectedly. This caught both of them by surprise. Although, Jaya was able to slip Mewa Lal out of the house through the back door, his undergarments were inadvertently left on the cot itself. Chandran's anger knew no bounds, when he saw Mewa Lal's undergarments on his wife's cot. He immediately took his Lathi and left for Mewa Lal's house. Jaya said that he was murmuring very angrily to himself. She couldn't understand much, but he was muttering something to the effect that he would settle the matter once and for all. Her neighbors also confirmed this statement who saw Chandran rushing angrily towards Mewa Lal's house. Jaya told the police further, that Chandran had returned home after about 20-25 minutes only. From his looks, it appeared as if he was very much satisfied. This was the backdrop of the story, against which we had to see the death of Mewa Lal. The police story was that Chandran had killed Mewa Lal with his Lathi, and had returned back satisfied. All the available facts pointed to this only. He had left his house with his Lathi in anger, and had returned back quite satisfied. He was muttering that he would kill Mewa Lal. He (Mewa Lal) had ravaged his wife, so his anger was understandable. But when Chandran was apprehended, he vehemently denied his involvement in murder. It was at this stage that the police contacted me and requested me to help them with the case. A quick look at Mewa Lal's face showed that his face had indeed been battered very badly( Please reproduce top figure on page 594 here-Designate this as Fig 1 ). Many of the pieces of the skull bones were missing. I asked the police where the other missing pieces of bones were. I was told that they had collected everything they found on the scene, and had submitted them to me. I knew that the police had missed several bone pieces. I requested them to take me to the place where the body was lying. At that place also, I couldn't find anything of importance. But sure enough, some of the skull pieces were missing. I knew this because, I couldn't reconstruct the whole skull cap from the pieces of bone available with me. The remaining pieces of bone just couldn't vanish in thin air. Finally I demanded to be taken to Mewa Lal's house. I made a thorough search there. Sure enough I found three skull cap pieces there. They fitted the missing portion of the skull quite neatly. This meant that the killing had been done at Mewa Lal's house itself and the body was later dumped at the place where it was found ultimately. This was the first great advantage of a thorough autopsy. Had the autopsy been done less thoroughly, i.e. if I had not taken the trouble to try to reconstruct the skull, (which was not very necessary too) everybody would have thought that Mewa Lal had been killed in the deserted area itself. The skull had been shattered to such small pieces that it was impossible to piece them together by any conceivable means. Finally I decided to "sew" the pieces together with the help of wires. I drilled holes in the broken skull pieces, passed metal wire through the holes and then stitched them together ( Please reproduce the bottom figure on page 594 here - designate this as Fig 2) . I had to encounter a bigger surprise, when I reconstructed the skull in this manner. Staring before me was one neat round hole in the skull! Look carefully at the reconstructed skull in Fig 2. T he black arrow depicts the outlines of a neat round hole. The full circumference of the hole is not visible because I couldn't fit one piece with the wire (the piece was too small for that). However I fitted that piece at the gap with my bare hands, and the neat round hole was complete in its entirety before me. I placed the skin back on the reconstructed skull, and the bullet hole gaped before me so clear, no one could have missed it ( Please reproduce fig on page 595 here - Designate it as fig 3). This turned the whole police story topsy turvy. It was as if I had gone back in time and was witnessing the murder with my own eyes. Mewa Lal had not been killed by Lathi at all. He had been killed by a gun! This was a startling new fact for the police, brought about only by the autopsy. This changed the police story completely. Chandran was a poor man. It was impossible for him to keep a gun. So in one stroke, Chandran was out of police's clutches. However from the external appearance of the dead body of Mewa Lal, it surely appeared that he had been battered by a Lathi. A less thorough autopsy would have failed to bring out this new fact. Now that we knew that Mewa Lal had been killed by a gun, we knew there had to be a bullet also. We had to recover the bullet also. Since the bullet was not recovered from the body, it had to be at the scene of murder. Since we already knew that Mewa Lal had been killed in his own house, we decided to search his house for the bullet. After a thorough search, we found it buried in a wooden door. The bullet had apparently pierced Mewa Lal's head and had lodged in the door opposite to where Mewa Lal was standing. The story was beginning to become clearer to us now. The only other enemy of Mewa Lal was Kaushik. He had to recover his money from him. Till now, he was not under suspicion at all. But now the police decided to question him too. He seemed nervous from the very start. The police got suspicious and decided to interrogate him in more detail. He was told that Mewa Lal had been killed by a gun, and the police had come to know about it. Kaushik had a licensed revolver. We recovered that revolver. Test fires from that revolver showed that the bullet which was recovered from Mewa Lal's house had indeed been shot from that revolver only. Now Kaushik broke down, and he narrated the whole story to the police. He had gone to Mewa Lal's house on the night of 21 August to recover his money. Mewa Lal once again asked for some more time. This led them to a quarrel. In a sharp fit of anger, Kaushik drew his revolver and shot at Mewa Lal. This killed Mewa Lal instantly. Kaushik had never intended to kill Mewa Lal, but now he had to do something fast. He dumped the body to the outskirts of the city in his jeep. Later, when he heard that the police suspicion had fallen on Chandran, he was too happy. As for Chandran, while he was rushing to Mewa Lal's house in anger, he met one of his friends Raju, who asked what the matter was. When he narrated the whole story to his friend, he discouraged Chandran to resort to violence. He convinced Chandran that he should talk to Jaya with love, and she should understand. Any way Raju was somehow able to convince Chandran, that violence does not solve anything. This seemed to satisfy Chandran somewhat, and he returned home, apparently in peace. Had he gone to Mewa Lal's house, perhaps he would have caught Kaushik stashing away Mewa Lal's body in his jeep. The court admitted my scientific evidence, and convicted Kaushik to life imprisonment. Thus a thorough autopsy helped nab the correct criminal. What on the face of it seemed to be the handiwork of Chandran, turned out to be the deed of Kaushik. This was yet another victory of Forensic Medicine. (To protect the identity of individuals, the names of persons and places, and the dates have been changed)

Forensic Science Fiction The mystery of the assassinated prince When I got a telephone call from the Indian High Commission in Timbuktoo, I was relaxing in my bed with a cup of coffee and the morning newspaper. My wife was sitting besides me, and we were gossiping. Nothing irritates me more at such times than a telephone call. With some measure of irritation, I picked up the receiver. “Is it Dr. Aggrawal, Professor of Forensic Medicine at the Maulana Azad Medical College?”, a faint voice asked from the other side. “That’s right”, I replied. “Dr. Aggrawal, I am Abhinav Sinha, High Commissioner of the Indian High Commission in Timbuktoo. We are in a great problem. We have a doctor here, who is being falsely framed in a medical negligence case. I am convinced he is innocent. Could you please come and help us?” and without waiting for my reply, added, “Your tickets are being sent to your house, along with some money to take care of your travel expenses. All the hospitality here will be taken care of by us.” “Look.. .”, I protested, “I don’t know what your problem is, and I am really not sure I can help you in this case. Moreover I can’t possibly leave my college for any great length of time.” “Everything has been taken care of sir. Your trip is official. You will be treated as on duty. All expenses paid. Please come as soon as possible”, and he hung up. I was quite nonplussed, and I was almost sure, it was some practical joker trying to play a fast one on me. But within five minutes, I received a phone call from the Ministry repeating the same thing almost verbatim. Within half an hour, a government official came to my house with some travelers cheques and a club class return air ticket to Timbuktoo. There was an accompanying letter from someone higher up in the Ministry asking me to proceed to Timbuktoo immediately. It also said that I would be treated as on duty. There was no option now. The flight was at 9 pm. I looked at my watch. It was still 8 am. I had about 13 hours for preparations. I requested my wife to start packing. For those, who are not aware of Timbuktoo, it is a very tiny principality somewhere in the Middle of Africa - quite near Lake Victoria. It is a hereditary monarchy. Elections have never taken place here. Kings have been ruling this principality since time immemorial from the same family clan. Mostly the eldest son gets the chance to rule, but sometimes court intrigues result in murders, and the younger brother gets the throne. There have been cases, when a still younger brother has in turn killed his second brother and got the throne! In short, the history of this principality is rife with murders, court intrigues, treachery, debauchery and so on. Our country had no diplomatic relations with this country till sometime back, but recently in the wake on the so-called Non Aligned Movement, we had developed diplomatic relations with them. A small mission had been opened there, which was staffed by just six people. One of them was a young Indian doctor, whose main job was to look after the Indian officials and their families, as the medical fraternity in that principality was really in a very nascent stage. After a relatively comfortable nine hour flight, I landed at the King Hassan Airport in Timbuktoo. The High Commissioner of the mission was there personally to take me to my hotel. Along with him was the young doctor posted in the Mission. His name was Dr. Harish. While I was being driven to my hotel, I looked out of my window, and was amazed at the clean air and greenery all around in that tiny nation. Coming from New Delhi, it was certainly a very welcome change. The hotel was comfortable and clean. After I took bath and changed, the duo narrated their story to me, and it was something like this: Ndubuisi Eke was the king of this nation since about three years. He had a younger brother called Mombutu Eke, who wanted to usurp his throne. On 18 February 2001 - a Sunday - when Ndubuisi was taking his morning stroll, one unidentified man came from somewhere and stabbed him in the neck. The attack was so sudden that Ndubuisi’s two bodyguards couldn’t do anything. However there were rumors that they had been “bought” and did not try to stop the attacker on purpose. There was an immediate commotion all around, and in the mêlée that ensued, the attacker managed to slip away. Again people who had an ear to the ground said that this was also stage managed. The killer was someone hired by Ndubuisi’s younger brother Mombutu, who wanted to usurp his throne. As luck would have it, Ndubuisi did not die immediately thereafter. He did however receive a nasty gash in the neck. As the whole of Timbuktoo did not have a reasonably smart surgeon, he was brought to Dr. Harish in the Indian Embassy. To be sure, he too was young and rather inexperienced, but better than the best Timbuktooan doctor. Dr. Harish tried his best to save Ndubuisi, but he died immediately after arriving at the hospital. No autopsy was ever conducted on the body, and the body was cremated in haste. Mombutu Eke ascended the throne immediately thereafter. However the public - who loved Ndubuisi no end - was restless. In Mombutu, they saw a killer and usurper. There were hushed voices all around. And perhaps to silence his critics - and perhaps to clear him as well - Mombutu ordered an enquiry against Dr. Harish. It certainly was against diplomatic norms. But as far as Mombutu was concerned, it didn’t matter as his throne was in jeopardy. He wanted to show that the wound received by Ndubuisi was not fatal, and the death occurred instead because of Dr. Harish’s negligence. It was where I came into picture. I was to prove that Dr. Harish had tried his best. There was no negligence on his part and the death occurred prima facie because of the wound. But how could I do that? Had Ndubuisi’s body been with us, it would have been a relatively simple matter for me. All that I needed to do in that case was to conduct a thorough autopsy on his body to find out the correct cause of death. But the body had already been cremated in haste. Now all I had in my possession were some reports prepared by Dr. Harish, when Ndubuisi first arrived at the hospital. I interviewed Dr. Harish in great detail. He was young and inexperienced, but certainly a very bright doctor. Obviously he was terrified. He was being prosecuted in an alien land, and if found guilty, they could send him behind bars for a lengthy period of time. Something had to be done very fast. Fortunately Dr. Harish had prepared a very detailed injury report. I read the injury report over and over again, and found that the most significant part was that his left sternocleidomastoid had received a gash 6x2x4.5 cm in size. It was that wound which appeared fatal to me. But the volume of blood that Ndubuisi lost was not very much. Dr. Harish had immediately sutured the wound. At a rough guess, he had lost about 500 cc of blood. Now that is not sufficient to cause death by shock. One would require at least 2000 cc for that. Obviously Ndubuisi had died because of some other reason. But what? That was the million dollar question. I could not sleep that night. I kept thinking the whole night. And I do not know when I fell asleep. But soon I started dreaming. I saw Ndubuisi going down and down in deep water. He was struggling to stay at the surface. But something was taking him down and down. Bubbles of air were streaming through his nostrils. Bubbles of air.. .. I woke up with a start. It came to my mind in a flash. It had to be air embolism! Perhaps I was thinking about air embolism subconsciously. That is why I dreamed of those air bubbles, perhaps. For recapitulation, let me state what air embolism is. It was Rudolf Virchow, the famous 19th Century German pathologist who introduced the term embolus and embolism into modern medicine. In 1856 he applied the term embolus to a loose clot in the blood stream. These words are of Greek origin and come from the Greek word “emballe” meaning to throw in, or to lay in or to put in as a stopper, peg or bolt. A loose blood clot in the circulation indeed acts as a stopper or a peg. As long as it travels in vessels bigger than its size, it is alright, but as soon as it encounters a vessel smaller than its own size, it gets stuck there, acting as a stopper or a peg. Many of you would be surprised to know that embolism is used in a general sense too, meaning the adding or “throwing in” of an extra day to the year. In relation to medicine, we usually speak of embolism in relation to blood clots which travel from leg veins upwards and get lodged in pulmonary arteries. This is a serious condition causing almost instantaneous death. Under certain conditions - as when veins are cut - air can get sucked inside the veins. It forms a bubble inside and this bubble travels towards the heart along with the blood stream, and gets lodged in the pulmonary arteries just as a blood clot does. A bubble of air is incompressible, and there is no way the blood stream can negotiate this bubble. Inside the vein this bubble acts just like a blood clot. That is, it blocks the circulation just as effectively as does ordinary blood clots, causing immediate death. It is almost as if someone had put an arterial clamp over that place! Detecting ordinary blood clots in pulmonary arteries, or for that matter anywhere else in the body, is relatively easy, but detecting air embolism is a different game altogether. It remains one of the most challenging tasks faced by a forensic pathologist. The reason is that the moment you open pulmonary arteries, the bubble is going to disappear in the air. For this reason, forensic pathologists usually dissect the heart under water in suspected cases of air embolism, but believe me it is a very difficult and challenging procedure. Nobody loves it. There is a silver lining though. If you are suspecting air embolism in a case, before you start the autopsy, one of the best things you can do is to X-ray the body. If an air bubble is present in the heart or pulmonary arteries, it will show up in the X-rays. So you conduct this difficult procedure only in the cases in which you see the bubble in the X-rays, and leave out the rest. In fact, the X-ray plate itself is proof that the person died of air embolism and many forensic pathologists don’t take the trouble to dissect the heart under water after that. But we all know, no post mortem was ever conducted on Ndubuisi. Even if it had been conducted, I am doubtful, if anyone would have been able to detect the cause of death as air embolism, as there was no forensic pathologist in the whole of Timbuktoo. I was now in a very unenvious position. I did not have the dead body of Ndubuisi, and I had to prove that he had died of air embolism. That was the only way to save Dr. Harish. Only then we could prove conclusively that it was the initial stab wound which caused the death (by air embolism), and not negligence on the part of Dr. Harish. But how could I do it? That was the million dollar question. In the evening, I was sitting by the lakeside looking at the beautiful lake and the birds leisurely floating in it. I was recalling my younger days, when we had to send almost all bodies for X-rays, in which we suspected air embolism. Then for many months, our X-ray unit was out of order, and we had to start the autopsy without the benefit of the initial X-ray plates. This meant that effectively we had to open all hearts under water and nobody liked that. You have to make a sac in the pericardial cavity by making appropriate cuts in the pericardium; then you fill that pericardial sac up with water with an assistant holding up both the flaps of pericardium with forceps; and then finally you inserted the blade in the pulmonary artery and under various heart cavities, twisting and turning it expecting a bubble to rise through water. Not many forensic pathologists love this. And many complained. To solve the problem, I came up with an interesting formula. I had for long observed that more people tend to die of embolism if the cut was longer and deeper. Similarly if the muscle involved was more voluminous, chances of air embolism were higher than if the muscle were less voluminous. Thus if someone got a 5 cm cut in gluteus maximus, he would stand much greater chances of getting air embolism than if he got a cut of the same size in, say, temporalis muscle. It was because temporalis muscle is less massive than gluteus maximus. Could I turn this observation into a strict mathematical formula, I had asked myself at that time. And quite interestingly I did come up with an interesting formula. It was: E=mc² Now if you think you are already familiar with the formula, probably you are wrong. E in our formula stands for Embolism (rate of), m for muscle mass (in grams) and c was a somewhat complicated parameter, which I called the “Cut factor”. I had observed that air embolism tended to depend both on the length and the depth of the cut, but depth had a greater effect on producing air embolism than the length. Thus if the length of the cut was twice, the chances of air embolism in a person would be doubled, but if the depth was twice, the chances would be four times. To take this observation into account, I put the Cut factor equal to [(cut depth)2 x (cut length)]. The interesting thing about this formula was that this stands true across all animal species. Once this formula was in place, we applied it in some experimental animals too, namely rats, guinea pigs, hamsters and pigs. To my satisfaction the formula proved true in all cases. Now as you can see, this formula actually gives the rate of embolism. To put it in other words, it would give you the probability that the person might have suffered air embolism. What we did with this formula was to look at the muscle which was cut and the size of the cut, and put the numbers in the formula (we had to put the decimal back by four digits, i.e. we had to effectively divide the figure by 10,000 to arrive at the correct rate of probability). If we got a figure, say, 50, it effectively meant that the person had a 50% chance of getting air embolism. If we got a figure of, say, just 2, there was just a two percent chance of getting air embolism and the forensic pathologist could perhaps look the other way and forget about dissecting the heart under water. Gradually all forensic pathologists in our institution got round to opening the heart under water if the figure was greater than 50. This made sense too, because if the probability of getting an air embolism is greater than 50%, you must take enough trouble to find it out. For those, who are able to follow me only vaguely, I would illustrate with an example. Gluteus maximus’ weight on the average is 493 g. Now if it sustains a cut which is 5 cm long and 3 cm deep, what are the chances that the person would die of air embolism? We would calculate it as follows: The cut is 5 cm long and 3cm deep. Since the cut factor is equal to [(cut depth)² x (cut length)], simple mathematics would show that it would be 45. Now putting this figure in our earlier formula E=mc² We get 493 x 452 or 998325 We put four decimals behind and we get 99.8325. This means that a person getting a 5 cm long and a 3 cm deep cut would stand a 99.8325% chances of getting an air embolism. This is well near hundred percent, and I would certainly like to take all trouble to dissect the heart under water. Over the years this formula had gained International acceptance, and almost every forensic pathologist was using it in his day-to-day practice. Could I use this formula in Ndubuisi’s case? Then suddenly I remembered that Dr. Harish had been careful enough to record the dimensions of the cut quite accurately. I jumped and ran back to my hotel room. Once inside the hotel room I phoned Dr. Harish immediately and in a most excited voice asked him to give me the dimensions of the cut. He was a little surprised at my strange request but gave the figures to me. The dimensions were 6x2x4.5 cm. Now my only problem was to find out the weight of the sternocleidomastoid muscle. I am no anatomist and did not know its weight at all. But fortunately I have many good anatomists as friends. One of them is Dr. R.K.Suri, Professor of Anatomy at our own medical college. I immediately made an overseas call, forgetting the time difference completely. It was 2 am in India, and he picked up the phone with some measure of irritation. “Dr. Suri, what is the weight of Sternocleidomastoid muscle?” “Is it Dr. Aggrawal?” he asked in great irritation. “Never mind. The weight?” I insisted. “Why! it is 153 grams. But why do you ask this question in the thick of the night?” He was obviously quite nonplussed. “Thanks” I said, ignoring his question completely, banged the receiver back and got back to crunching numbers. The cut factor in this case would be 121.5 as the length of the wound was 6 cm and its depth 4.5 cm. Now putting all the figures in our good old formula E=mc², we get: 153x(121.5)2 =153 x 14762.25 or 2258624.25 Putting the decimal back by four points, we arrive at the figure 225.862425 I jumped on my feet in glee. The probability of getting air embolism was even greater than 100! To a mathematician it may look silly, but we had encountered such figures before. It meant that the person was sure to get air embolism. Everything was clear now. With such a deep cut on his Sternocleidomastoid muscle, Ndubuisi stood a 225% chance of getting air embolism. In other words, he died of air embolism. That was for sure. We immediately filed our answer in the Law Ministry of Timbuktoo. I am given to believe that the Ministry was going to dismiss that answer too, but before doing that they took the advice of some international forensic experts, and all of them advised that my reasoning was watertight and there was no scope of rebutting it. In fact if they did it, they would go down in the eyes of the International Community as an utterly unjust nation, and would stand the risk of getting completely isolated. Mombutu obviously did not want to take this risk. Dr. Harish was immediately cleared of all charges. I returned back to India, and the very next day went to Dr. Suri and thanked him for the help he rendered us. He was still very very angry with me, especially because I had banged the phone on him, but when he heard the great service he had rendered for our nation, he forgot all anger and is once again a very great friend of mine.

Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE JANUARY 1997 ISSUE THE POISON SLEUTHS POISONS, ANTIDOTES AND ANECDOTES -Dr. Anil Aggrawal "Good morning doctor. I have heard a lot about poisons, and unscrupulous criminals killing innocent people with poisons. Could you tell me a little bit about it?" "Good morning Tarun. Sure I would tell you about them. Poisons of various descriptions were commonly used in ancient times by unscrupulous people to kill their enemies. Even today, mere mention of the word poisoning is enough to conjure up in the minds of most people ideas of diabolical infamy. No doubt this is due to what they have read about the subject in history. Numerous killers in the past set out to achieve their evil designs by using poison to dispose of those who stood in their way. The records over the ages are replete with accounts of this kind. By its very nature, poison is premeditated and secret- the real horror lies not so much in those poisonings that are discovered but in those which remain undetected." "Should be exciting to know about such an interesting thing. But first, would you tell me what you call this science?" "Tarun, the study of poisons in all its aspects is known as toxicology. You would be surprised to know that this word has an unusual origin. It comes from the Greek word toxon which means a bow for shooting arrows. The word toxeuma meant an arrow. Since in ancient times, poisons were often used on the tips of arrows to render them more lethal, the word toxicos came to refer to such a poison. From this we get the word toxicology. Of course you would be knowing that the Greek word logos means "the study of" or "the science of". If you combine the two words, you would understand the proper meaning of the word toxicology." "That is certainly interesting doctor. I do recall now that another term for archery is toxophily. So that explains the origin of this other entirely non-related term too." "Sure Tarun. Greek philos means "love of". So the term toxophily literally means "love of arrows". A person who loves archery is often known as a toxophilite. I may tell you that in the year 1545 A.D. a man called Roger Asham published a book called Toxophilus. The intended meaning of the title was “lover of the bow”. Since then the word toxophilite has come to be associated with archers. Another term for poison is toxin, which also has the same origin. Of course, in modern times, we use this word more often in connection with bacterial poisons." “And what is the origin of the word “poison” doctor?” “The origin of this term is also quite unusual. The word comes from Old French puison, which means ‘drink’. The French word itself comes from Latin potio, which has the same meaning. The word drink came to be associated with poison in a very interesting way. Many times in the past, the poison was mixed with drinks. In English, the French word puison entered as poison. This term was initially applied to a drink prepared with a poison. Later, the poisonous substance itself came to be known as poison.” "Good. Doctor, could you please tell me why poisons are so much important in the annals of crime and crime detection?" "Tarun, poison has been called "the coward's weapon". It is administered unemotionally and by stealth, often little by little over a long period, and in full recognition of the victim's often prolonged suffering. Special hatred attaches to the poisoner, who is regarded as more sinister than the gunman or knife-user. The poisoner is thus reviled for his lack of pity. He often kills his victim in cold blood, unlike a gunman who often kills in the heat of the moment. A poisoner carefully plans for the murder, and he knows exactly what he is going to do, and what the result of his deeds would be. It is commonly supposed that female murderers resort more readily to poison and get away with it more readily than their male counterparts. This prejudice probably arises because of the activities of such celebrated historic poisoners as the Marquise de Brinvilliers (1630 - 1676) and Mary Ann Cotton (1833 - 1873), whose murderous ways probably accounted for a collective total of well over a hundred lives. Mary Ann Cotton, thrice married former nurse is regarded as Britain's greatest mass murderer...." "You mean to say that these women killed as many as 100 people among them? That certainly is outrageous." "I haven't finished yet Tarun. An Italian woman of the 17th Century, Madame Giulia Toffana (ca. 1635-1719), invented a strong poisonous mixture in about 1690, and is reputed to have been responsible for as many as 600 killings! She is perhaps the greatest poisoner of all time. Her invention was called Agua Toffana, also sometimes referred to as Aqua Toffana, Aquetta di Napoli, Manna of St. Nicholas di Bari, or Elixir of St. Nicholas of Bari, Bari being a town whose water had healing qualities. Aqua Toffana literally means "the water of Toffana". It was a poisonous liquid containing the deadly arsenic. She sold it to the would-be-murderers who paid well for it and were instructed about its poisonous properties and its potential as a lethal weapon. She was executed at Naples in 1719. After her death Heironyma Spara of Rome imitated and perfected her art. She was a sorceress and fortune-teller by profession, but trained young housewives in the art of poisoning too. Sixty years before Toffana's execution - in 1659, she is said to have formed a society in which she taught women how to murder their husbands by means of poisons. Her influence increased as a number of bored wealthy housewives gathered around her. She was eventually arrested by the Papal police, and as was the custom in those times with poisoners, tortured on the rack. She refused to confess. Nevertheless she was hanged along with a dozen other women, suspected to have been her aides. "Even kings and queens did not refrain from giving poisons. Poisons were given not only to their rivals but also to the poor deliberately just to study their effects on human beings! You may be surprised to know that Catherine de Médici (1519-1589) of Florence and later queen of France tested and carefully studied the effects of various toxic concoctions on the poor and the sick. At this time, France was literally infested with poisoners. The pinnacle of the "poisoners' glorious period" reached in France, in the late 17th century when a woman Catherine Deshayes (1638-1680), also popularly known as La Voisin developed a flourishing trade in selling poisons to wives who wished to rid themselves of their husbands! She is said to have been responsible for the death of many thousands, and could well have been a greater poisoner than even Toffana. La Voisin was burnt at stake in 1680." "This is certainly most outrageous. It is also surprising that even kings and queens revelled in poisoning others!" "You would be surprised that even Popes and their children have been involved in notorious poisonings. The most famous case is of the 15th and 16th century family of Borgias which flourished in Italy. The most notorious poisoners of this family were Cesare Borgia (1476-1507) and Lucrezia Borgia (1480-1519) who dispatched several of their rivals with a secret poison, then known as "La Cantarella". Their name is so inseparable with 15th and 16th century Italy, that whenever there is a mention of this time and location, the name of Borgias immediately springs to one's mind. Most people associate them with murder-by-poison plots. They were the illegitimate son and daughter of one Rodrigo Lenzuoli Borgia (1431-1503), who went on to become Pope Alexander VI from 1492 onwards till his death. He is said to have had five children by his mistress Vanozza de Cattanei, out of which two - Cesare and Lucrezia - proved to be most notorious. La Cantarella, often known as "the poison of the Borgias", was a secret poison and no one seems to know its composition today, but it most probably was a mixture of subacetate of copper, arsenic and crude phosphorus. Borgias were such feared poisoners that a historian, Max Beerbohm has made a very interesting comment about them. At one place he says, that in fifteenth century Italy, though one might have heard a snobbish Roman say, in a would-be-off-hand tone, ‘I am dining with the Borgias tonight’, no Roman was ever able to say, ‘I dined last night with the Borgias.’! Borgias were not only dreaded poisoners, but they had other vices too. For instance, incest is supposed to have been rampant among them, with Lucrezia rumoured to have had sexual relations with her father and brother. Certainly her first husband Giovanni alleged incest between Lucrezia and her father. He was so apprehensive of the whole family that he fled Rome in great terror. In 1501, she brought out a son, then aged three. He was recognized by papal bulls first as the son of Cesare (her brother), and later of Alexander (her father). " "Lucrezia sounds like an interesting character. Can you tell me more about her?" "Sure. In her short life span of 39 years, she married as many as three times. Some historians think that Lucrezia probably never poisoned anyone, but certainly her brother Cesare dispatched several people with poison. She was most probably used by her father and brother to further their own political ends. She married for the first time in 1493 into the powerful Sforza family of Milan. This was just one year after her father was made a pope. However as we have already seen, her husband ran away from Rome in terror. In 1497, her father Alexander annulled the marriage, and in 1498, she married one Alfonso, an illegitimate son of the King of Naples. In 1500, he was murdered at the behest of Cesare. The following year (1501), she brought out a son, and as we have seen earlier, he was three years of age at that time. She married for the third time in the same year (1501); this time to the son of the Duke of Ferrara. This marriage was arranged by her brother. After her father's death in 1503, she retired to Ferrara, where she spent the last days of her life." "How was La Cantarella, the famous poison of the Borgias prepared?" "The recipe sounds quite interesting. It is believed that first of all a hog was killed with arsenic. Its abdomen was opened and sprinkled with more powder, which contained more poisons. Some historians think that the powder contained just arsenic, but it might have contained other poisons as well. The animal was then allowed to putrefy. The juices which trickled from the decaying corpse were collected and evaporated till only dry powder remained. This dry powder was called La Cantarella" "That's remarkable! You said that the Borgias lived in Italy. Were the Italians as skilled poisoners as the French?" "Sure. In fact it were the Italians who developed poisoning to a fine art! You may be surprised to know that in Venice there was a "Council of Ten" who met regularly to arrange poisoning for the State and their written records are preserved. Victims were named, prices agreed and contracts with poisoners recorded. When the deed was accomplished the marginal note "Factum" was written in the record and payments were made, sometimes in the form of a regular pension. The "Council of Ten" appears to have had a number of poisons in their repertoire. Three of them are preserved as the "secreta secretissima" in archives dating from 1540-1544 A.D. Their chief ingredients were corrosive sublimate (mercuric chloride), white arsenic (arsenic trioxide, also known as Sankhya or Somalkhar in Hindi), arsenic trisulfide and arsenic trichloride. So rampant was poisoning in 15th to 17th century Italy, that expert poisoners ran schools for would-be-poisoners, just as there are schools today for medical and Engineering entrance examinations! Even the great Italian Renaissance man Leonardo the Vinci (1452-1519) experimented with poisons." "Really! It seems he didn't leave any area of knowledge untouched. Anyway can you tell me, what those experiments were?" "Leonardo invented the so-called technique of "passages", in which an animal was killed by an injection of poison and the essential organs that had been impregnated with the poison, such as the liver, spleen and lungs were then removed. An extract was prepared from these organs and administered to another animal and the process was repeated. With each "passage" the strength of the poison was supposed to increase. He also studied the procedure in plants. In an effort to produce most innocuous looking poisons such as fruits, he injected the bark of certain fruit trees with potassium cyanide. The idea was that it would rise up along the conducting system and be incorporated in the fruits. The resulting fruit were of course poisonous, but contained only small amounts of cyanide. They had to be eaten for weeks before they could cause death." "Fantastic! Did his recipe manage to kill someone after all?" "Tarun, legend has it that at a banquet in the house of Lodovico Il Moro, fruit from Leonardo's garden was presented to Giangaleazzo Sforza, who was fighting for Italian unity. More fruit was sent to him during the following days, until he finally died of poisoning." "Unbelievable! What about the tradition of poisoning in our own country?" "Tarun, ancient Hindu physicians were very well-versed in the art of poisons. The famous Indian surgeon Sushruta who lived in the 7th century BC defined agadatantra, which is very much akin to the modern term of "toxicology". It dealt with the diagnosis and treatment of any person bitten by poisonous insects or venomous reptiles or affected by any natural, artificial or compound poison. Tradition also tells us that many Indian kings used to have poison damsels or Vish Kanyas in their courts. Legend has it that they were fed on poisons right from their birth, and were thus made so venomous that a mere kiss would prove fatal to her lover. It is said that when Alexander the Great invaded India, King Chandragupta sent such poison damsels to him, in consultation with his minister Chanakya." "It seems to me now that poisons held a kind of morbid attraction for the ancient people and that most ancient cultures revelled in studying them." "You can say that again. Take for example the Egyptians. you may be surprised to know that the earliest documentary accounts of poisons are to be found in ancient Egypt. Three millennia before Christ, Menes, the first of the Pharaohs, is reported to have cultivated and studied poisonous and medicinal plants and to have accumulated animal, mineral, and vegetable poisons. Ebers Papyrus also mentions several of them...." "Doctor, sorry to interrupt you, but what is Ebers papyrus?" "Tarun, it is one of the oldest medical documents available. It was found in the 19th century, between the legs of a mummy in a tomb near Luxor which is a town on east bank of river Nile in upper Egypt. It was advertised for sale, and acquired by Professor Ebers in 1872; hence the name Ebers papyrus. The papyrus is dated about 1550 BC, and it reveals many customs, traditions and practices of the ancient Egyptian doctors. It describes over 800 recipes, many containing recognizable and identified poisons-for example, hemlock, aconite, opium and some of the toxic heavy metals such as lead and antimony. Some of the pharaohs are known to have experimented with poisons, perhaps for practical matters of government and State. Similarly the mythology and literature of classic Greek history also shows a considerable knowledge of poisons. In the Odyssey of Homer, Helen is described as discreetly introducing into the wine of Telemachus and Menelaus a drug that acted as a powerful anodyne. An anodyne as you know is a drug which relieves pain. In Greek legend, Hecate was knowledgeable about aconite, Medea was familiar with the properties of colchicum and Hercules is said to have met his end from wearing a shirt after his wife had impregnated it with poison. The first professional treatment of toxicology begins to appear in various Greek writings in around 3rd to 4th century BC. Thus Theophrastus, who lived from 370 to 286 BC, a pupil of Aristotle, included numerous references to poisonous plants in his work De Historia Plantarum. Nicander of Colophon (204-138 BC) wrote two treatises, which are the most ancient works devoted entirely to poisons. One was on snake poisons, the other on plant poisons, including opium, henbane, poisonous fungi, colchicum, aconite and conium. Nicander divided poisons into those that killed quickly and those that killed slowly and he recommended emetics in the treatment of poisoning, a recommendation which is valid even today." "Doctor, can you tell me how many poisons exist in this world?" "Nobody really knows Tarun. It has been said that anything and everything in the world can act as a poison. It is merely a matter of dose. A drug which acts as a medicine in small doses may act as a poison in a large dose. A striking example is that of common salt. We all take it daily in small doses, but half a kilogram of it can kill a man. That way it also is a poison. Of course, nobody could give common salt to his enemy in such a large dose. In a more accepted sense, the term poison is restricted to those chemical substances which kill in very small doses. The idea of classifying all known poisons has vexed scientists since ancient times. The Greek physician, Dioscorides (AD 40-90) classified poisons under three headings. They were the animal poisons, such as cantharides, toads, snakes, etc; poisons from plants, including opium, hyoscyamus, mandrake, hemlock, aconite, cherry laurel and yew, and mineral poisons, including arsenic, copper, mercury and lead. This simple classification remained in use for many centuries and is still vaguely recognizable in modern classifications of poisons. "I have heard that poisons were used as a mode of capital punishment too." "Yes, you are right. Poisons were used by the ancient Greeks as a means of capital punishment, the best remembered case being that of Socrates who was given hemlock. It was also used as a means of political assassination, though this use was developed on a much greater scale by the Romans subsequently. Thus started the search for antidotes for poisons. In fact it became a practical necessity if the king wished to survive in office." "Doctor, you introduced a new term antidote. What is it?" "Tarun, antidotes are the remedies administered against poisons. The term literally means "give against". It is derived from the Greek words anti or against and didonai, to give. The most famous example of an antidote was that devised by King Mithridates VI. He was king of Pontus in Asia Minor, living from 114-63 BC. The Roman scholar Pliny (AD 23-79) wrote a good deal about him. Mithridates experimented with poisons, trying them out on condemned criminals, and he also tried out various antidotes to the various poisons on these prisoners, either before they were poisoned or immediately after they were poisoned to see whether in fact the antidotes were effective. In this way he discovered various antidotes or what he considered to be antidotes against different poisons and he then compounded them all together in order to produce a universal antidote which could neutralize any poison. Adopting an overcautious approach, he then began taking this supposed universal antidote daily, so that nobody could secretly kill him with poison. It is often stated that the original recipe had more than 36 ingredients; Greek physician Galen (AD 130-200) said there were 54!" "Great! Did this recipe help him finally?" "This has an interesting ending. Eventually Mithridates was defeated by the Roman general and statesman Pompey (106-48 BC) and holed up in his fortress; he massacred his wives, concubines and daughters and he then took poison to commit suicide, but, alas, protected as he was by his daily dose of his magnificent antidote, the poison failed to act! The antidote by this time was known as Mithridatium. Perhaps he failed to die from poison because of this antidote. He had to get his Celtic soldier servant to stab him to death with his sword! After his defeat and death, Pompey discovered Mithridates' notebooks on antidotes for poisons, and so Mithridatium became known in Rome." "And the science of poisons and antidotes moved on to Rome?" "Well, the Roman emperor Nero (AD 37-68) showed a great interest in poisons. Andromachus, one of Nero's personal physicians, improved the formula of Mithridatium and it then became known as Theriac of Andromachus, containing 64 ingredients-and this included the flesh of vipers! For some strange reason, people have always thought that the flesh of vipers is a good antidote to poison. Perhaps this thought arose because the snakes are poisonous yet they do not die of their own poison, so it is rather reasonable to think that the snakes' flesh acted as an antidote. Viper's flesh was a very common ingredient of any antidote that was developed in ancient times. In the course of time Theriac became not only an antidote against poison but also a panacea against all diseases and it was in medical use until the 18th century. To prevent fraud, in many cities, including Venice, Montpellier, Toulouse and Strasburg, Theriac was carefully compounded and prepared in public under official supervision! Even today Theriac jars can be seen in museums. It was only in the 18th century, that a serious challenge was mounted against this antidote. In 1745, William Heberden (1710-1801), one of the most outstanding physicians of London of the mid 18th century published a critical analysis of this antidote. It was entitled Antitheriaka: An Essay on Mithridatium and Theriaka." "Are there some other so-called Universal antidotes too?" "Sure there are. Other universal antidotes which survived for centuries in popular use were bezoars-stomach stones-found in certain animals, particularly ruminants and some varieties of goats. They were probably gallstones. These were first used in the Middle East and they were introduced into Europe by the Arabs, who still have some faith in them in some parts of the Middle East to this present day. These stones were pulverized and put into drinks of wine to treat cases of poisoning, but small stones were also mounted and worn as amulets as a protection against poison. Bezoars were also thought to be very effective against snake bite." "How popular were the bezoar stones?" "Oh, they were very popular - even among the kings and queens! Charles IX of France (1550-1574) was once presented with a bezoar of which he was very proud. Ambroise Paré (1510-1590), French physician and one of the most notable surgeons of the European Renaissance told him that there was no universal antidote, much less the bezoar that he possessed, but so strong was everyone's belief in bezoars, that Charles refused to believe him. Somehow Paré coaxed Charles into conducting an experiment - if somewhat disgusting and gory - to convince him that bezoar was indeed useless. Paré suggested that Charles test his bezoar on a condemned criminal. Charles IX agreed to this happily. He sent for his provost and asked if he had on hand any prisoner who merited hanging, and was told that there indeed was such a prisoner. He was a poor cook who had stolen two silver plates from his master, and he was to be hanged the next day. You may be surprised at such a severe punishment being handed down for such a trifling crime, but it was the order of the day. The cook's consent was taken, who was only too happy to give the consent. He is supposed to have said that he would like much better to die of poison in the prison, than to be strangled in view of the people. And of course there was an outside chance of him being saved by the bezoar, in which case, he would probably have been let off, as a kind gesture. The apothecary was asked to give him a poison, and he duly administered him a strong dose of bichloride of mercury, immediately after which he was given the bezoar stone. The poor cook immediately started vomiting and purging, and so burning was he from the inside that he asked for water immediately. It was given to him. An hour later the cook was on all-fours, going like an animal, his tongue hanging out from his mouth, his eyes and face red, retching and in cold sweat, bleeding from his ears, nose, and mouth. Paré made him drink oil, which was probably a much better remedy, considering the state of knowledge in those times. Oil acts as a demulcent and might have served to prolong his life somewhat. The cook died an agonizing death after seven hours, cursing that he would probably have been better off at the gibbet. The king was so disgusted that he burnt the bezoar - or whatever was left of it." "That might have brought about an end to an era of superstition." "Not at all! So strong was the belief in bezoars that even after this convincing experiment, Charles never lost faith in bezoars; he only thought he had been cheated. To be sure, it was very common in those days to pass of ordinary pebbles as costly bezoars. In fact during the reign of King James I of England (1566-1625), considerable attention was attracted by legal action brought against a goldsmith for having sold a hundred pounds' worth of counterfeit bezoar stones. In any case, the use of these stones did not cease at all; they even spread across the Atlantic! It is known that Governor John Winthrop (1588-1649), first governor of the Massachusetts Bay Colony and the chief figure among the Puritan founders of New England desired a bezoar to use in his practice. He was supplied one by John Endicott (1588-1665), who in turn had procured it from one Mr. Humphry." "Oh, that is certainly most interesting!" "Tarun, then there was another very interesting substance being touted as the Universal antidote. It was the Unicorn's horn. It was supposedly derived from the mythical unicorn. The unicorn, as you surely must be knowing is a mythological animal resembling a horse or a kid with a single horn on its forehead. Unicorn's horn was first described as far back as 400 B.C. by the historian Ctesias. Although the Unicorn as is described in most legends never exists, there IS an actual animal which resembles the mythical unicorn, and that is the Narwhal. Also spelled as Narwal, or Narwhale (Monodon monoceros), it is a small whale belonging to the family Monodontidae. It is found along coasts and, sometimes, in rivers throughout the Arctic. It is mottled gray in colour and grows to about 16 feet long. It has only two teeth, both at the tip of the upper jaw. In the male, the left tooth develops into a straight tusk protruding forward from the upper lip. This tusk grows to about 8 or 9 feet in size - about one and a half times your height - and it was this tusk, which was prized in medieval times as the fabled horn of the unicorn. Interestingly, it is grooved on the surface in a left-handed spiral. Rare males may develop two tusks; females usually develop none. The tusk has no known function; it is believed to have developed as a result of sexual selection. Quite possibly the tusk of a rhinoceros was also being passed off as the Unicorn's horn." "Was the Unicorn's horn as popular as the bezoar stones?" "Oh, certainly! They were being sold for thousands of dollars. A specimen in Dresden was estimated in the sixteenth century to be worth $75,000. So costly was it, that its use was confined to the nobility. Ordinary lay people simply could not afford to buy it. So afraid were kings at this time (of poisoning), that the Unicorn's horn became part of official regal dowry! When Henry II (1519-1559) the king of France , married Catherine de Médicis (1519-1589) in 1533, Pope Clement VII, bride's uncle presented Francis I - the bridegroom's father - with a piece of unicorn's horn. A legend was rife at this time that the unicorn purified poisoned waters with its horn so that other animals may drink. Interestingly it was valued as a remedy despite the fact that the identical substance is in every tooth and is therefore in the mouth of everyone who has any teeth. During medieval France, there was the curious custom among the nobles and kings of dipping the unicorn's horn in any drink before it was taken. Court intrigues were rife at the time, and one was always worried about getting poisoned from some unsuspected enemy. Many would go a step ahead and would drink from a cup made from such a horn! The famous French physician Ambroise Paré tried to abolish this custom, but was unsuccessful. In England, the belief in unicorn's horn as an antidote for poison lasted until the reign of Charles II, when the Royal Society was requested to investigate the properties of a cup made from such a horn. The society reported that the cup was useless as an antidote. Like the bezoars, Unicorn's horn also enjoyed popularity across the Atlantic and it is known that Governor Endicott loaned Governor John Winthrop a horn for use in his medical practice." "Fantastic! Bezoars...Unicorn's horns...Were there other Universal Antidotes too?" "Yes, sure, there were several others. Another interesting universal antidote was Terra Sigillata, a special clay earth from a particular hill on the island of Lemnos. It might have had some value, as clay is quite adsorbent, and it must have adsorbed some poisons. This clay was often formulated with goat's blood to make it into a paste. Like the bezoars and the Unicorn's horn, there was fraud in its sale too. And it was quite easy. Because virtually any kind of clay - which is so easily available - could have been passed off as the real one from the Island of Lemnos. To prevent fraud, this special clay was often prepared in tablets and stamped with a seal, thus giving the substance its name. Later, other sources of similar earth were found in different parts of Europe and in the 16th and 17th Centuries mugs were made of it, from which anyone could drink without fear of poisoning. In much modern times, another formulation has been touted as the Universal antidote, and it was supposed to consist of 2 parts of activated charcoal, 1 part of magnesium oxide and 1 part of tannic acid. It definitely sounds more scientific than the bezoars, Unicorn's horns and Terra Sigillatas, but it is equally worse - probably much more. The reason is that it could be quite easy to convince a scientifically minded person of the uselessness of the bezoars etc. but it takes quite an effort to convince him of the uselessness of such scientifically sounding formulation as the so-called "modern universal antidote". You may be surprised that even in several of today's text books, this antidote finds mention as a useful antidote. Till recently it could be purchased legally from respectable chemists' shops under the trade name Unidote® or Res-Q®. The latter as you can very well see is an interesting take-off from the word "rescue", implying that it would rescue one from every kind of poisoning." "Alright, but what was the idea behind this antidote?" "Tarun, it was thought that charcoal would adsorb many alkaloids, magnesium oxide would neutralize acids without gas formation and the tannic acid would precipitate many of the glucosides and several metallic poisons. But it was all humbug, simply because the ingredients which were included were not the real thing. Burnt toast was included as activated charcoal - which it is not; strong tea was included as tannic acid, and milk of magnesia was included to account for magnesium oxide. Even if actual ingredients were included, it is doubtful if it would have been of any use. This Universal antidote has probably killed more persons that it has saved, simply because it instilled false sense of security among people, who were poisoned. They did nothing except taking this antidote and died. Had they not fallen prey to this false sense of security, they would probably have taken advise from some wise doctor, and would have been able to save their lives." "Oh, certainly. What has been the status of toxicology in modern times?" "Tarun, modern toxicology has emerged from the dark, murky world of secret poisoners, fantastic antidotes and so on. The last 150 years have seen great progress in the analysis of poisons. Today, with modern techniques and instrumentation, the most minute traces of alien compounds can be detected, not only from tissues and organs at post-mortem, but also in biological samples such as blood and urine collected during life. The science of antidotes has also become more scientific. We have moved from the age of Mithridatium, bezoars and Terra Sigillata to the age of physiological antidotes and chelating agents. Several medical journals are devoted solely to the study of toxicology. Toxicology is taken up by several promising young students as their career. It is no longer the murky, shady, crime-infested vocation of the poisoners; instead it has become a true science pursued by brilliant investigators. Toxicology is a promising career for any young scientist." "Thank you doctor for introducing the science of poisons to me. What are you going to tell me the next time?" "Tarun, next time I shall tell you about Arsenic, which has often been called the 'King of poisons'. "

SCIENCE IN CRIME DETECTION-19 DEATHS IN POLICE CUSTODY I have got a good news to give you. Our dear magazine has traveled to foreign lands. I got a tremendous response for my article "Murder by Electric Shock", published in August 1994 issue of Crime & Detective. Quite surprisingly, one of the many letters I received was from Edinburgh, Scotland. It was from a young girl Miss Kavita Vasudeva, an 18 year old NRI living in Britain, who had come to India on a pleasure trip. She picked up this magazine at the airport while returning back to Edinburgh. In the plane she read my piece. She was so moved by it that the first thing she did after reaching Britain was to shoot off a letter to me. She says that she was quite moved by my story and asked if I was aware of any such similar instances from India. To recapitulate the memory of readers, I had talked about a case in which a husband had cunningly electrocuted his wife while she was having her bath. The case which I described was from Britain. Kavita wanted to know if anyone had used this novel method for killing in India. Electrocution is indeed a very rare form of homicide. I am aware of very few such cases from India, but in this piece, as a rejoinder to Kavita's query, I will give a true story which is sent to me by Prof. S.P.Gupta of Faridabad, in response to the very same piece. He has sent me a cutting from "The Times of India" Aug.28,1994 (page 1, column 2 4) which gives a very interesting case of homicide by electricity from India. In this case the accused Surinder Kumar of Rohtak and Kulbir Singh of Hissar concocted a plan in which they were to hire a taxi to go to a different city. Surinder was familiar with electriccal fittings and he knew that a battery attached to a transformer can generate enough voltage to kill a person. Their plan was to hire a taxi to some outside city, electrocute the driver in the way and then decamp with the taxi. The taxi was then to be sold and thus money was to be earned. Both of them first bought a transformer and a battery for Rs. 1800 at Lajpat Rai market in New Delhi. Then they hired a taxi to go to Rohtak. The driver was a man called Munna. Surinder sat with Munna in the front seat and Kulbir sat behind. They had kept the transformer and the battery in a green bag. Near Shiela bypass, Rohtak, Surinder asked the driver to stop and said that he wanted to look up an acquaintance. As Munna was parking the car, Kulbir opened the green bag carrying the transformer and the battery, activated the connections and put the live ends to Munna's temple. Munna died instantly within 30 seconds. Over the next two days they tried selling the taxi a van but one police constable heard of the abnormally low price they were offering and got suspicious. His investigations brought the whole story to light, and thus both the culprits were caught. A very fantastic story indeed. If I had not seen the cutting myself, I would have thought that it was an excellent crime story. But the cutting is right here before my eyes. I have given the reference and all interested readers can look up the relevant paper for more details. Truth is indeed stranger than fiction! Please keep sending such material for the benefit of all our readers and I will see that all contributors get credit for their contributions. Thank you Mr. Gupta for making us aware of such an interesting case. This time I am going to tell you an interesting case of death in police custody. On 17.9.1991 a dead body was brought to me by the area magistrate with the allegation that the said person had been beaten to death by the police. The deceased's name was Harvinder Singh and he was living illegally in Canada since almost three years. He was extradited from Canada when it was found that he did not have the necessary papers to stay in that country. This naturally caused unnecessary embarrassment to the Indian Govt. When Harvinder landed in India, police sleuths were waiting for him at the airport. He was immediately taken into custody where he died after 3 days. His father lodged a complaint with the area magistrate that Harvinder was illegally taken into police custody where he was unnecessarily tortured and it was because of this torture that he had ultimately died. Harvinder may have been living illegally in a different country, and the Indian Govt. may have been embarrassed by his extradition, but Indian police had nothing against him and thus they had no business to detain him, and certainly they were not authorized to torture him, as was alleged. This was the background against which I had to conduct the postmortem and give an opinion. Torture cases by and large are very tricky cases, where many times we may not find any signs of injury. This is mainly because these days many refined methods of torture have appeared which do not leave any overt signs of injury. Preventing a person from sleeping is an excellent form of torture and yet it leaves no signs of injury whatsoever. However such modes rarely if ever, cause the death of a person. Where the death has occurred it is quite obvious that massive injuries have been inflicted, but many a time they are not obvious at all and certainly not in the first instance. An unsophisticated way of torture is simple beating by lathis or rods. If such a type of torture has occurred it makes our work simpler in the sense that such type of torture leaves tell tale signs such as bruises and contusions. A typical sign of beating by rods is the formation of parallel bruises on the body, known as railway track bruises or tramline bruises (reproduce fig. 4.17 given on page 134) .Sometimes injuries inflicted in this manner are so severe that they heal with the formation of a scar. The scar in such cases also take the shape of a railway track (reproduce fig. 10.2 here taken from the book on page 274). Torture by burning is also not uncommon. Such injuries are generally followed by the formation of massive ugly looking scars known as keloids (reproduce fig.10.3 & 10.4 here taken from the book on page 275). Keloid in Latin means like a claw. It certainly looks like a claw. It is an abnormal type of scar which generally forms in black skinned people after not only burns but after any type of severe injury. It differs from an ordinary scar or a hypertrophic scar. We are all aware of ordinary scars which form after cuts and lacerations. These scars do not grow in size after about 4 weeks. A hypertrophic scar on the other hand continues to grow even upto 12 weeks. It is commoner in younger people and it forms particularly after injuries such as burns. It is so common that it may be considered a normal pattern of scar formation in burn injuries. Keloid differs from both these scars in the sense that it continues to grow in size even years after the injury was sustained. Seeing such scars on the body of victims immediately tells us that the victim may have been tortured in the past perhaps by burning. In some cases we can even extrapolate the time period of the infliction of injury by noting the appearance of the keloid. There are many other ways in which a victim can be tortured. Whipping was very common in our country in the past and even now it is being used in many parts of our country. The use of a multi thronged whip, such as a `cat o nine tails' is lot more painful, so many times this device is also used. It leaves a series of linear abrasions or superficial tears. These marks immediately give away the weapon. Sometimes there may be metal tags or knots on the ends of each thong. These metal tags cause much focal damage. By seeing these areas of damage we can even say something about the construction of the whip which was used for torture. There are some special forms of torture too. The most common and perhaps most painful is the so called `falanga'. This is the name given to beating of the soles of the feet with canes or rods. Its practice is going on since ancient times. The beauty of this method is that despite being very painful, it leaves little or no external signs of injury. This is because the skin and other tissues of the soles are very tough and thick, and even after taking tough beating they do not show any signs of injury. However if the investigator is careful and dissects the tissues of the sole, he may find heavy oozing of blood underneath. Another favourite means of torture is the so called `telefono'. It consists of repeated slapping of the sides of the head by the open palms of the assailant. I have conducted many autopsies in cases where the victims were subjected to telefono and who subsequently died of exhaustion. These cases are very tricky because externally there is hardly anything one would find. But if ears are dissected (they have to be dissected from the base of the skull),one finds the ear drums to be ruptured. By seeing the state of repair, we can say if the rupture was recent (and hence due to beating) or old. One last form of torture must be mentioned before I move on to our case. This is known as `knee capping'. This form is practiced in Northern Ireland. This is a form of non fatal punishment, meted out to suspected traitors and opponents. In this method the victim is shot through the knee joint or through the lower thigh. This form of torture obviously leaves tell tale signs and such cases pose no problems from forensic point of view. Coming back to our case now. As I had expected there were no marks of injury visible on external examination. Opening up the thoracic, abdominal and skull cavity also did not reveal anything vital. Generally the cause of death becomes obvious after these three great cavities of the body are opened. Finally I decided to dissect the muscles of the back of the trunk and of thighs. Sure enough I found massive amount of blood there. There was more in the tissues of the sole. This indicated heavy beating by a heavy blunt weapon, perhaps by a cane. Perhaps the police wanted some sort of confession from Harvinder, which was not forthcoming. I called the magistrate and showed him the massive amount of effusion that had taken place. He was nonplussed to see such massive amount of blood, especially as he had not seen anything on the outside and he was treating this case as a routine formality. The verdict that I gave was that "the death was due to haemorrhagic shock (a clinical entity seen when massive amounts of blood are lost from the circulatory system) consequent upon beating".This was yet another case in which forensic science turned out to be a winner.

Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE AUGUST-SEPTEMBER 1998 ISSUE THE POISON SLEUTHS POISONING BY CADMIUM -Dr. Anil Aggrawal "Good morning doctor. Oh, my God, what are you doing today? You have the dead body of a young girl today. What happened to her? Please tell me." "Good morning Tarun. The name of this young girl is Kanta, and she died this morning in the hospital. She was a chemistry student and about 19 year old. Yesterday night she took part in a party thrown by Sohan who was her classmate. Three other students also participated in that party, two of whom were girls. So in all there were 2 boys and 3 girls, including Kanta and Sohan. All are chemistry students studying in a local college. At the party, Kanta took some food and some soft drinks. Soon after that she complained of a choking sensation around her throat and excessive salivation. She also had a feeling of nausea and vomited several times, and had diarrhoea too. She was rushed to a local hospital, where the doctors diagnosed that she was suffering from gastroenteritis, a kind of infection of the stomach and intestines which gives rise to these symptoms. It was thought that she had some form of food poisoning. But what was surprising was that the other four students did not have any problem whatsoever. Had they suffered the same symptoms, the death could have been passed off as a natural death due to gastroenteritis, but since all the others are well off, the police has suspected some foul play and has brought her dead body before me. Of course they have requested me to conduct a post-mortem on the dead body and tell them about the cause of death." "Oh, so how are you going to find out the cause? Do you think that there has been some foul play somewhere?" "Well, anything is possible in this world. I contacted the doctors in the local hospital where she was taken, and also went through her hospital case sheet. What caught my attention was that Kanta was suffering from severe aches and pains too. And these aches and pains started only after she drank the soft drinks, and ate the foodstuff at Sohan’s house. I do not know of any form of gastroenteritis where you also get generalized aches and pains...." "So what are you trying to arrive at?" "Tarun, I have made a detailed study of the symptoms which Kanta displayed, and a very unusual poison is coming to my mind as the possible cause of her death" "Doctor, what is that poison? Please tell me. I am getting curious." "Tarun it is a very unusual poison- cadmium chloride." "Cadmium Chloride? Never heard of its being used as a poison. Is it a poison really? "Yeah it is indeed a very deadly poison. If fact its very discovery is related to its toxicity..." "Really? How? Seems like we are in for another of your interesting historical stories." "Yeah, it does make an interesting story. The story starts in the early part of 19th century. Zinc oxide was then widely used for a number of ailments, and was freely available at chemists shops. To ensure that the medicines were not adulterated, the Government of Germany in those days employed district physicians. Their job was to go to chemists’ shops and find out if the medicines they sold were spurious or not. One such physician named Rolow – who was incharge of the province of Hannover - got the reports of toxicity from zinc oxide being sold at local chemists’ shops. From the reports of symptoms, he suspected arsenic poisoning (for details of arsenic poisoning, see Science Reporter February 1997 issue). So he went around from shop to shop, collected zinc oxide samples from the shops and put them to test. One of the standard methods in those times to test for various oxides was to treat them with hydrogen sulphide. This caused various metallic sulphides to form which could be detected from their color. When Rolow treated zinc oxide with hydrogen sulphide, he got a yellow precipitate strongly resembling the sulphide of arsenic. From this he concluded that the samples of zinc oxide were indeed impure- they contained arsenic oxide as well." "So did they really contain arsenic?" "Wait. The local supply of zinc oxide was made by one influential businessman- a man called Hermann. He was also a chemist by profession. He got his own samples tested for arsenic in his own way. He employed all chemical tests known for arsenic at that time and came to the conclusion that his samples did not contain arsenic at all. On the strength of his analysis, he applied to the local authorities, requesting them to restart his supply of zinc oxide to the local chemists’s shops." "So how was this controversy resolved?" "To resolve the controversy, the authorities of Hannover employed the services of a very reputed chemist of those times- Professor Friedrich Stromeyer (1776-1835), head of the department of chemistry at the Göttingen University. The added advantage was that he also held the post of Inspector General of all Hanover chemists’ shops. Hermann’s factory was situated in a place called Schönebek. Samples of zinc oxide were sent from Schönebek to Göttingen where Professor Stromeyer got to work. Quite intelligently first he investigated how zinc oxide was being produced. He found that chemists in Schönebek calcined zinc carbonate to obtain zinc oxide. So he started from zinc carbonate instead, and heated it strongly. To his surprise he got a yellow colored compound. He was expecting zinc oxide, which as we all know is a white colored compound. He asked both Hermann and Rolow to explain that." "Oh, so even the Great Stromeyer was confused, is it?" "Not in the least. On the contrary he gave enough opportunities to both sides to explain their stand before he got to work. Interestingly both sides gave wrong explanations. Hermann explained away the color by saying that the samples contained iron, although it is not known how that explained the yellow color. For him it was better to explain by resorting to something like iron which is a natural constituent of the body, and can do no harm to anyone. Well, to be sure, even iron can be poisonous, but for that it should be administered in very large quantities. Rolow, who was intent on getting Hermann’s factory closed, explained away the color by contending that the samples contained arsenic. After listening to both sides, Stromeyer got to work and discovered a hitherto unknown metal in the samples. It looked very much like zinc, but could easily be separated from it by means of hydrogen sulphide. So much did it look like zinc that Professor Stromeyer preferred to call it Cadmium- after cadmea, a word which in Greek means zinc ore." "Oh, very interesting indeed!" "In fact how the zinc ore came to be called cadmea is in itself an interesting story. Legend has it that a Phoenician Cadmus was the first to have found a zinc rock and to notice that it gave a golden tinge to copper during smelting. It is from his name that zinc ore finally came to be called Cadmea. You may be surprised to know that naming chemical elements was a big fashion in 19th century Europe, becuase new and new elements were discovered almost every year, and it became fashionable to name elements after various Gods, legends, scientists, countries, even rivers. Element Rhenium for instance is named after the German river Rhine! In 1818, when Professor Stromeyer published his paper on Cadmium, many people came forward with the suggestion that they had already discovered that element first and even suggested names for this new element. German chemist Kersten, for instance, suggested that the new element be called melinium (yellow) after the color of its sulphide. Two other scientists Gilbert and John proposed two more names. One of them suggested that it be called junonium (after the newly discovered asteriod Juno in 1804) and the other suggested that it be called klaprothium, after the German chemist Martin Heinrich Klaproth (1743-1817), but ultimately the name given by Stromeyer stuck." "Oh, this is most interesting. Tell me some other important facts about Cadmium." "Tarun, Cadmium is used in a wide range of industrial processes, which include electroplating to impart corrosive resistance to ironware. Cadmium compounds are used as pigments, as components of batteries and photographic materials and cadmium is also used as a plastic stabilizer. Cadmium sulphate in a 1% solution, is a constituent of a shampoo used in the treatment of seborrheic dermatitis and dandruff." "So we were talking about the Cadmium poisoning. How can it occur?" "Cadmium poisoning can occur accidentally in a variety of circumstances. In the 1940s, it was usual for people to have their kitchenware electroplated with cadmium, as this makes them corrosion resistant. In the very beginning, Cadmium coating was deposited by immersing the metallic ware in molten cadmium...." "Sorry to interrupt you doctor, but melting cadmium must be quite a task. That too for just coating metals. Wasn’t it a very costly process?" "No, not at all. Cadmium melts very easily. It’s melting point is only 3210 C. In fact, its such a low melting point makes it a very suitable candidate for making low melting alloys. Among them Wood’s alloy containing 12.5 percent of cadmium was developed as far back as 1860 by a British Engineer Wood. These low melting alloys are used as solders and as the material for delicate and intricate castings, as well as in automatic fire-warning systems. Okay so I was telling you about the cadmium coating on kitchen ware. Later on, the coating was done with the help of electroplating. Unfortunately organic acids, many of which are used in day-to-day cooking such as vinegar (acetic acid), imli (tartaric acid) and lemon (citric acid) can dissolve cadmium from the thin electroplated layer, and this caused several cases of poisoning. In one accident which involved three adults and five children, the source of poison was "lemonade" ices prepared with citric acid in metal trays of a reconditioned refrigerator. All were sick and four also had diarrhoea, but recovery was complete within 24 hours. The citric acid solution contained 279 ppm (parts per million) of cadmium and it was estimated that each ice contained about 3 mg of cadmium. The ill effects resemble those of zinc poisoning. It is thought that the salts formed by organic acids are converted into cadmium chloride by HCl in the stomach. When the cause of these poisonings was discovered, the practice of cadmium electroplating was abandoned. But by no means are the incidences of accidental poisoning by cadmium ceased altogether. As late as in 1981, a case of accidental cadmium was reported. In this case, the victims inhaled fumes from a plated shelf of a refrigerator, used as an improvised barbeque grill!" "Oh, that is certainly most extraordinary!" "Yeah, that is right Tarun. Accidental cases of cadmium poisoning can also occur from cadmium fumes and dust. Cases have been reported where the poisoning occurred in some women who were using a cadmium powder to clean silver. These cases occur especially if the cleaning was being done in small, ill-ventilated rooms. It is interesting to keep in mind that inhaled cadmium is about six times more dangerous than ingested cadmium. Thus poisoning from inhaled cadmium fumes is much more dangerous. We have seen that in earlier times, metals were frequently electroplated with cadmium. Interestingly this practice has given rise to some cases of "delayed" poisoning now. Scrap metal from those times – if cut, dismantled, or recycled today, especially if with the help of oxyacetylene torches – can give rise to dangerous levels of cadmium fumes. Cases of fatal poisoning in such circumstances have been reported. It is important to realize that since cadmium was once used to electroplate metals, and there may be several such metallic objects in an average house, a housefire can give rise to cadmium fumes, and firemen must wear protective masks. There was a time when carbon tetrachloride was used as a fire extinguisher. But when carbon tetrachloride came in contact with hot metal surfaces, it gave rise to the poisonous phosgene (see Science Reporter Jan 1998 "Death by Phosgene"). Cadmium fumes, if produced during these fires were often confused with phosgene gas, and this caused serious blunders in treatment of such poisoned victims. But now since the use of carbon tetrachloride in fire extinguishers has been banned, chances of such graves mistakes are very remote." "This is very interesting. Have cases of poisoning occurred in such circumstances?" "Oh yes. In one interesting incident which occurred in 1956 in a chemistry laboratory in Leeds (Great Britain), some cadmium propionate was being dried in an oven for experimental purposes. This is a safe procedure as long as the temperature does not rise above 1000 C; above this temperature fumes of cadmium oxide and propionic acid are produced. Because of an inadvertent mistake, although the temperature of the oven reached 1600 C, it was read only as 600 C. Because of this, an explosion occurred, followed by a fire, and thick red fumes were seen to be coming out of that room. Four of the firemen, who entered the room to put out the fire inhaled those fumes, and one died after 6 days. On postmortem examination, significant amounts of cadmium were found in his internal body organs." "Oh, I see. Is cadmium found in some of our day to day products too?" "Tarun, Cadmium is found in significant amounts in unfiltered cigarettes, and this can be a cause of poisoning. Twenty unfiltered cigarettes a day can yield 6 mg of cadmium, of which the smoker may retain upto 65%." "Doctor you said that Kanta was suffering from muscle aches and pains and from this you deduced that she might be suffering from Cadmium poisoning. Can you elaborate on that?" "Oh, sure. This symptom is so prominent in Cadmium poisoning that it has even given a name to a disease caused by Cadmium. Let me elaborate. An outbreak of food poisoning due to Cadmium occurred in Japan in 1945. The syndrome has been called itai-itai disease, which when translated in English means ouch-ouch disease. The syndrome has been so called because it caused severe pain in the back and legs (which forced the victims to cry "ouch-ouch" so to say!). In more serious cases, there was decalcification and fracture of bone. Dislocations were also found to occur. For some strange reason, the complete syndrome was restricted to post-menopausal women, who had had several pregnancies. On investigation it was found that a local mine – the Kamioke zinc-cadmium-lead mine – released its effluents (containing cadmium) in the local Jintzu river. The water from this river was used both for drinking as well as for irrigating the local paddy fields. Thus cadmium found its way in the rice grown there as well. Cadmium ingested through intake of water as well as rice caused chronic cadmium poisoning, which was responsible for this syndrome. For the osteomalacia, undernutrition (common in post-war Japan) was also thought to be a factor." "So now it is becoming clear that somebody mixed Cadmium salts in Kanta’s drinks. Tell me has Cadmium been used for murder before?" "Not many times, but I do remember a case which was even reported in The Yorkshire Post of July 23, 1981. In this case two youths aged 14 and 15 administered cadmium chloride mixed in an orange drink to eleven children. They suffered from sickness and blurred vision, but fortunately no one died. The younger boy had strong political views and intended to poison his opponents. They had stolen the chemical from the Humberside Education Authority." "Doctor, you have already told me the symptoms one experiences when one ingests the poison. What happens when one inhales Cadmium fumes?" "Tarun, the initial symptoms and signs are sensation of constriction around the throat, a nasty taste in the mouth, irritation of the upper respiratory tract manifested by troublesome cough and redenning of the eyes. After a latent period of about one to two hours grave respiratory symptoms develop rapidly. Signs of pulmonary oedema (a technical name of a condition in which lungs are water logged) are also seen. The prominent respiratory symptoms are difficulty in respiration, pain in the chest, malaise, shivering and profuse sweating." "Has Cadmium been administered in some other way also?" "Tarun, I know of an interesting case of poisoning by intravenous injection which occurred in Japan. The patient had to be given an injection of calcium bromide, but by a rare accident, an injection of cadmium chloride was given. I may tell you that when Cadmium is given as a poison, the person usually dies in 24 hours, although death may be delayed for 7 to 14 days. If death occurs within 24 hours, the cause of death is shock due to loss of fluids. If the death is delayed, the cause is likely to be acute kidney failure or cardiopulmonary depression (depression of heart and lungs)." "Doctor, you have certainly made most interesting conclusions. Now how are you going to conclusively prove that Kanta was given Cadmium?" "Tarun, I have taken out Kanta’s internal organs, and have tested them for Cadmium. They have all given positive tests for Cadmium. Since it is not a normal body constitutent, it is clear that Cadmium has been given to her by someone. Following this I told police the whole story, and they investigated the death further. But this time they had murder in their minds, so they investigated more deeply. They found out that Sohan had been spurned in love by Kanta, and he wanted to take revenge. He stole some Cadmium Chloride from the chemistry lab, and then invited Kanta to his house. Although Kanta had spurned his love offer, she did not say no to his party as she wanted to continue a clean friendship with him. Moreover he told her that some other friends were coming over too. So there was nothing to be afraid of. When she and other friends arrived at Sohan’s house, he offered them cold drinks, and in the cold drink of Kanta, he mixed Cadmium Chloride. He probably chose this poison as this is such an unusual poison, and he thought that he could get away with that. But he didn’t know that forensic science can catch even the most intelligent of criminals. So even all his knowledge of chemistry could not come to his rescue." "Oh, how very clever of you doctor. If you had not made such an intelligent and logical deduction, Sohan could be roaming in free world today. Criminals like him are very dangerous and should be put behind bars. This was a most interesting discussion. Tell me what are you going to tell me the next time?" "Tarun, next time, I would tell you about a very interesting poison- Aluminium Phosphide. "

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

< Back To Main Page. LinkedIn WhatsApp X (Twitter) Facebook Copy link Anil Aggrawal's Book Review Journal This is a Title 02

Forensic Science Fiction