Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE JANUARY 1998 ISSUE THE POISON SLEUTHS DEATH BY PHOSGENE -Dr. Anil Aggrawal "Good morning doctor. Oh, my God, what are you doing today? You have the dead body of a young man today. His eyes look suffused. What happened to him? Please tell me." "Good morning Tarun. The name of this 36 year old man is Manhar. He is a welder by profession and was working for the last five years as a welder in Messers Arihant Welders Ltd. Welders as you know work with hot torches, and seal metallic objects. He used to weld metallic pipes in a small confined space in basement. Yesterday he was suffering from common cold, but he reached his workplace at 9 am as usual and started welding pipes in the basement. After sometime, a cup of tea and some snacks were sent to him by the management as he was having common cold. This was not a usual practice, but as he was ill and the management wanted quick work on that day, this sympathetic gesture was made. He took tea and snacks and got back to work. Soon he started feeling as if his throat was dry and burning. His eyes began itching, and there was a copious outflow of tears. He took it merely to be an aggravation of his common cold symptoms, and kept on working. Soon however he started coughing violently. Still he did not take things seriously. He took some water to soothe his throat and continued working. When the cough became unbearable, he came up and told about this experience to the manager on duty. He asked him to relax on a side chair. Soon thereafter he died." "Oh, sure enough this is a mysterious death. What do you think happened in this case?" "A few facts about Manhar would be in order before I proceed with this story. Manhar was a Union leader, and for the last three months was fighting with the management for better working conditions and salary. I have talked to the Union and its other leaders. They all hold Manhar in great respect. They have come out with a most outrageous suggestion, and in fact that is part of the reason, why his body is with me today." "What have they suggested doctor? Please let me know." "Well, the Union leaders think that the management has secretly poisoned Manhar. There is no secret of the fact that the management did want to sack Manhar, the moment he took up the cause of workers. But they couldn't do so, because the Union threatened to go on strike. Since then the Management was thinking of various ways and means of doing away with him. The Union leaders- as well as the family members -think that the management sent poisonous tea and snacks to Manhar on that fateful day. Manhar was naive enough to think that the Management was being friendly to him, and took the tea. The fact that Manhar started having symptoms of throat irritation, redness of eyes and coughing immediately thereafter has lent strength to their suspicion." "Well come to think of doctor, even I think that he might have been poisoned." "Tarun, I have made a habit of examining the scene of crime always before starting the autopsy. So before starting the autopsy on this case, I asked police to take me to the place where he was working. I was surprised to find that he was working in a really cramped place in the basement. The place had a rather musty odour. "Perhaps you are suggesting that he died of suffocation. But he was working there daily for the last five years, and nothing happened to him!" "Yes that's right. But I looked around and found some strange looking cans there. I enquired about these cans and was told by the Management staff, that they contained dry-cleaning fluid. They were soon going to expand into dry-cleaning business and for this purpose had bought dry-cleaning fluid and had stored the cans there. Some of the cans were lying open...." "Sorry to interrupt you doctor, but is this observation of any help in this murder investigation?" "Oh yes, surely it is. When you look at all the facts, you can pinpoint the probable cause of his death." "Sorry doctor. I can't make any head or tail of the facts you have just mentioned." "Tarun dry-cleaning fluid usually contain chlorinated solvents, such as carbon tetrachloride or tricholoroethylene. I investigated about the contents of that dry cleaning fluid and found out that it contained tricholoroethylene. It is a well known fact that welding in a poorly ventilated, confined space in the presence of chlorinated solvents can cause phosgene to form rapidly in lethal concentrations. After I found the dry cleaning cans there, and saw how cramped the place was, I immediately came to the conclusion that Manhar must have died of phosgene poisoning. There were some additional pointers to my hunch. In the first place the place had a musty odour much like the actual smell of phosgene...." "But Manhar never noticed the smell. If phosgene was forming, he must have noticed it." "Phosgene is not a particularly offensive smelling gas. Its odour has been described as musty, resembling that of fresh mown hay or green corn. Of course, in high concentrations phosgene is rather pungent and mildly irritating, but Manhar was having severe cold on that day and it is quite possible that he couldn't notice the smell because of his cold. In addition to the smell, the other things, that go in favor of phosgene poisoning are the peculiar symptoms that he displayed...." "Oh, well, I am getting the idea. You certainly are a clever doctor. But let us begin from the beginning. Tell me something about phosgene first, so I could follow you better" "Tarun, Phosgene is a colorless gas, about 3.43 times heavier than air. It liquefies at 80 C. Phosgene is an acidic chloride and its chemical formula is COCl2 . It is known by several other names. Some of these are Carbonic dichloride, carbonyl chloride, carbon oxychloride, and chloroformyl chloride. It has a musty odor resembling fresh mown hay or green corn as I have already told you. Because of these peculiar properties, and especially the fact that it is heavier than air, it was used extensively in gas warfare in World War I, and caused 80 per cent of the deaths by gas in that conflict. Fortunately, gas warfare was sparingly used in World War II, otherwise the casualties could have been much more. A curious fact is that smokers report a flat, metallic taste when smoking in the presence of phosgene. Phosgene does not occur naturally and was first synthesized by Sir Humphry Davy in 1812 by means of passing carbon monoxide and chlorine through charcoal. It was quite natural for a curious mind to do such an experiment, because these two were the most poisonous gases known at that time, and one would have thought, he could perhaps create a deadlier gas by mixing the two chemically. In a way, he succeeded too, because phosgene is in fact deadlier than both the other gases. According to most estimates, Carbon monoxide can prove fatal if inhaled in a concentration of 1000 ppm for sometime....." "Sorry to interrupt you doctor, but would you tell me the meaning of ppm?" "Sure, ppm is an abbreviation of parts per million. When we talk of the toxicity of gases, we usually talk in terms of ppm. If I mix 1 cc of a poisonous gas with ordinary air in such a way that the final volume of the mixture turns out to be 1 million cc, the concentration of the poisonous gas in that mixture would be referred to as 1 ppm. Of course you can understand that to make the final mixture to be 1 million cc, I would have to use 999,999 cc of ordinary air. Similarly if I mix 1000 cc of a poisonous gas with 999,000 cc of air, the resulting mixture would measure 1 million cc and the concentration of poisonous gas in that mixture would be 1000 ppm." "Oh, that is quite clear doctor. So you were telling me about the lethality of certain gases." "Yes, I told you about the lethality of Carbon monoxide. For chlorine the fatal concentration has been estimated to be somewhat lesser; about 400 ppm, but phosgene kills rapidly in as low concentration as 50 ppm. Its lethality is compounded by the fact, that it is not a particularly irritating gas, being only mildly irritating and that too in high concentrations. Because of this curious fact, the victim does not make any attempt to run away from the gas, as he would do if he were exposed to, say, chlorine. This is what happened in Manhar's case. In fact phosgene is such a dangerous gas that cylinders of phosgene are not normally supplied by the manufacturers unless they have satisfied themselves that the purchaser and his premises are satisfactory." "But why would anyone want to buy such a deadly gas doctor?" "Tarun, Phosgene is an important industrial chemical being used in the synthesis or manufacture of isocyanates, polyurethane, polycarbonate resins, aniline dyes, pharmaceuticals, plastics, and insecticides. It is also used in the "Uranium enrichment" process. Because of its wide use in industry, there is always a danger of workers getting dangerously exposed to it. Currently it is generally agreed that a Maximum Allowable Concentration (MAC) of phosgene should be 1.0 ppm of gas, which means that during a 10 hour continuous working period, there should be no more than 0.1 ppm of the gas in the environment (0.1 ppm x 10 hours = 1 ppm). Phosgene can form by burning of several compounds, most important of which is polyurethane. This is the chemical with which furniture upholsteries are made. In December, 1987, in Tampa, Florida, an individual was filling an air mattress with a hair dryer when the mattress exploded, burned and released phosgene into the apartment. This occurred because the mattress was made of polyurethane. This gas represents one of the many hazards to fire-fighting personnel and fire victims for similar reasons. Welding in a poorly ventilated, confined space in the presence of chlorinated solvents or other halides can cause phosgene to form rapidly in lethal concentrations as I have already told you. You would be surprised to know that phosgene was also implicated in the Bhopal tragedy that occurred in our country in December 1984..." "Yes, that certainly surprises me doctor. Because I was under the impression that the gas responsible for the tragedy was Methyl Isocyanate (MIC)." "Oh, sure it was. But that was just one of the main gases involved. MIC in turn is made from phosgene and methylamine and is used as an intermediate product in the manufacture of carbamate insecticide Carbaryl, or Sevin, the chemical which Union Carbide used to make. On that fateful day nearly 50,000 pounds of stored MIC was released in vapor and liquid forms over a period of 2 hours. Because of the hypothesized reactions that took place within the storage tank and in the surrounding atmosphere, it is thought that MIC, phosgene, and hydrogen cyanide all played a significant role in this disaster." "That's certainly a good addition to my knowledge doctor. Tell me doctor, how does phosgene kill?" "Tarun, phosgene damages the body in several ways. It slowly hydrolyzes in mucus membrane water to produce carbon dioxide and hydrochloric acid. Because this hydrolysis tends to occur slowly, phosgene is less irritating to the mucous membrane of the upper airway and eyes and therefore penetrates more deeply into the lungs. Formation of hydrochloric acid within the lungs causes damage to lung cells. This causes water to ooze out of the blood into the lungs. This in turn causes lungs to become water logged, a condition medically known as pulmonary edema. This is a very important and conspicuous finding in deaths due to phosgene. I have examined Manhar's lungs, and they are severely water logged. Hydrochloric acid can also cause red blood cells to break down, a process medically known as hemolysis. This usually occurs at high concentrations. There are other complex reactions too, which cause severe kidney and liver damage." "Doctor, earlier you said that Manhar's symptoms also led you to conclude phosgene poisoning. Can you tell me what are the symptoms experienced in phosgene poisoning." "Oh sure. In concentrations of 3 ppm, phosgene causes dryness and burning of the throat. At 4 ppm, it causes eye irritation, redness of eyes, and watering of eyes. At 5-10 ppm, it causes coughing. Exposure to 25 ppm for 30 minutes is very dangerous, and even brief exposures to 50 ppm or greater is rapidly fatal. You will remember that Manhar displayed roughly the same symptoms. 80% of mortalities occur within 48 hours of the initial exposure, which may be considered as its fatal period. There are no specific diagnostic tests for phosgene exposure. A detailed and meticulous history and crime scene examination is the only likey thing to help. And that certainly has helped me. Come let us tell the police that the management is innocent. They have not given any poison to Manhar. But certainly they were careless to keep those cans in the basement. The management may be charged for being careless, but certainly the charge of murder can not be proved." "Oh, how very clever of you doctor. 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 deadly poison- Sodium Monofluoroacetate, commonly known as SMFA."

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

Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE JANUARY 1999 ISSUE THE POISON SLEUTHS DEATH BY SODIUM NITRITE -Dr. Anil Aggrawal "Good morning doctor. Oh, my God, what are you doing today? You have the dead body of a young woman today. Her whole body seems to have a chocolate brown color. I remember last time too, I had seen a dead body with chocolate brown color. Did this woman also die of the same poison? Please tell me." "Good morning Tarun. The name of this young woman is Radhika, and she is about 25 years old. She died in her flat at about 9 am today morning. She was a junior executive in a private firm here in Delhi, and was living alone in this flat. Her family members are living in Jaipur. She was living here solely for the purpose of this job. Her parents were looking out for a match for her marriage." "Oh, I see." "Yesterday night she was fine. In fact, she met one of her neighbors Shyamala -also a 25 year old girl- at about 9pm, and she tells us that she was perfectly in good spirits. That rules out suicide...." "Wait a minute doctor. If a person is in good spirits and cheerful a day before his or her death, does it rule out suicide? Is it not possible that she was trying to mislead the neighbors by being cheerful so that nobody gets to know her intentions?" "There are other indications too. There is no suicide note. Generally a person who commits a suicide, leaves a suicide note." "Oh, I see" "Well, the police interrogated Shyamala more about her as she was the only one, who knew Radhika very well. She told the police that she (Radhika) was in love with Chaman, a 26 year old colleague in her office. Recently she had become pregnant by him, and she was pressing him for marriage. However Chaman had lost interest in her, and was trying to avoid her. Only 2 days back she had threatened him to go to his parents if he did not agree for the marriage. Chaman's parents are very religious and God-fearing, and he knew if she approached them, they would force him to marry her. To settle matters he came yesterday to Radhika's flat at about 7 pm. Shyamala knows because when he came, Radhika called her as a mediator. Shyamala tells the police that Chaman was looking very tense and jittery. She thought it was because he had such a difficult matter to resolve. Anyway she just sat there for about an hour. When she saw that the matter is going to take more time, she left the house making an excuse. When she left, Radhika was just preparing to go inside the kitchen to make tea for everyone. She offered Shyamala to go after having tea, but she just left. She however saw Chaman leaving Radhika's house only about 15-20 minutes later. She was sitting idly at her window when she saw him. He looked to be in great hurry." "Oh, I see. So did you find anything in the post-mortem that corroborates what Shyamala is saying?" "Yes, I found a 4 month old male baby inside Radhika's uterus, which definitely tells us that she was pregnant. I have kept the tissues of this fetus for his DNA profiling, which will tell us definitely if Chaman was his father or not. More about that later. What interested me was the color of her body. I told you last time (See SR December 1998 issue) that there are certain poisons which can cause methemoglobin to form inside the body. It is this compound which imparts such color to the body. Well one of such poisons is sodium nitrite. I got a hint that she might have died of sodium nitrite poisoning when I went to her flat and saw that she had unfinished breakfast on her table. She was in the habit of having a full meal in the morning itself. She had prepared Dal and Roti and must be eating it. And it was lying there unfinished. Nearby I could see some dried vomitus on the floor. Obviously when she was eating the food, she must have got sick and must have vomited. I saw a salt cellar on her table which was open. I got quite curious, when I glanced underneath the dining table and found lot of white salt like powder spilled over there. As a poison sleuth, I don't want to take chances and intuition told me there was something either in the salt cellar or in the powder spilled over the floor that we were looking for. So I quietly kept the salt cellar in my pocket and also some of the powder spilled over the floor underneath the dining table. I examined both these substances in my lab. And do you know what I found?" "What? Please tell me doctor. I am getting curious." "Tarun, I had the most extraordinary finding in the salt cellar. It had a substance looking like salt but it was not sodium chloride. It was sodium nitrite. And the salt like powder which was spilled underneath the table was nothing but sodium chloride. Do you get the picture now?" "Well, not really. I don't understand how such a curious thing happened." "To me it is clear like glass. Obviously someone replaced the salt in the cellar with sodium nitrite. And before doing this he spilled the salt underneath the table to empty the cellar so he could fill it with the poison he had brought with him. The only commonly available poison which looks and tastes like salt is sodium nitrite" "Really? Doctor I am getting curious. Please tell me more about sodium nitrite." "Tarun, as I told you earlier, sodium nitrite causes methaemoglobinaemia; even small doses of sodium nitrite can kill within a few minutes. Even the nitrates can be dangerous. Organic nitrates in fact are reduced to nitrites in the intestine. Inorganic nitrates, bismuth subnitrate excepted, are not normally reduced to nitrites in the body, but this may occur when the upper digestive tract (stomach and upper part of small intestines) is infected with nitrate-reducing bacteria, e.g. Escherichia coli. Inorganic nitrates are irritants of the stomach and, in large doses, potassium nitrate is a diuretic. A diuretic is a chemical which increases the production of urine. Poisoning by nitrites is actually not very common. It can result from mistaking this salt for common salt or Epsom salts." "Doctor, under what circumstances can sodium nitrite poisoning occur?" "Tarun, poisoning can be homicidal, accidental or suicidal. With sodium nitrite, accidental poisoning is probably most common, although homicidal poisoning is also possible as we have seen in the case of Radhika. One of the earliest reports of sodium nitrite poisoning came from Middlesborough, UK in 1936. Two adults and their daughter aged five were suddenly taken ill after the midday meal. The adults died before a doctor could reach them and their daughter died shortly after her admission to hospital. It appears they had complained to neighbors of acute abdominal pain and vomiting. Their faces went blue. Investigation showed very similar results to what I found in Radhika's case. A basin of cooking salt and a salt cellar contained sodium nitrite; the upper layer in the latter was of 98% sodium nitrite and the lower layer 98.2% common salt. Unconsumed food contained sodium nitrite, e.g. cabbage 6.5% and Yorkshire pudding 4.5%. The gastric contents of the man contained 4.275 g and those of the woman contained 1.284g of sodium nitrite. Over a gram of the poison was present in the child's vomit. The vomit of the adults was not available for analysis, but presumably they had ingested considerably more than remained in their stomachs. The source of the poison was not determined, but the man had had access to sodium nitrite in the course of his employment. Nobody knows how the mix up happened. Probably someone filled up a half empty salt cellar either intentionally or mistakenly with sodium nitrite." "Oh, that is most extraordinary and bears an eerie resemblance to the case we have on our hands." "Yeah sure. Accidental deaths due to the ingestion of sodium nitrite used in error for common salt in the preparation of soup have also occurred. Several such accidental deaths have been reported. Death in these cases occurred within a few minutes following symptoms which included nausea, headache, vertigo, urgent vomiting, profuse diarrhoea and cyanosis (bluing of the skin). Stomach contents in most of these cases contained sodium nitrite ranging from 1.74 to 84.0 mg/kg of the gastric contents. There was a more consistent concentration in the organs, e.g. in the liver, where the concentration was between 3.0 and 4.35 mg/kg. A quarter of a litre of the soup in most of these cases contained l.5 g of sodium nitrite. I must tell you that the fatal dose of sodium nitrite is from 1 to 2 g. I have already explained you the concept of fatal dose (see "Poisoning by Thallium" SR, October 1997)." "Yes doctor, I do remember you having mentioned it." "In another case, eleven men were poisoned after eating oatmeal seasoned with sodium nitrite in mistake for common salt. The men added more salt from salt shakers later shown to contain sodium nitrite. Immediately after the meal they felt sick and vomited. There was dizziness and abdominal cramps. They went blue and five lost consciousness. Methaemoglobin was later demonstrated in their blood. One of these men, aged 82, died the next morning; his organs had a diffuse brown colour. The source of the poison was nitrite used to cure meat. Only eleven of 125 persons who ate of the oatmeal were affected and these eleven had used contaminated salt shakers of which one contained 0.137% of nitrite. It was estimated they had taken at least 163 mg. In yet another case, a boy aged two months suddenly went blue, 'almost black', after his 7.0 am feed. Sodium citrate had been prescribed for the relief of indigestion and two tablets had been added to the feed. When seen in hospital, about five hours later, the appearance of the child simulated those of congenital heart disease; he was neither distressed nor febrile. A diagnosis of toxic methaemoglobinaemia was made and the remaining tablets, fortunately available, were subjected to analysis. They proved to contain 65 mg of sodium nitrite each. The infant, therefore, had ingested 130mg, the maximum dose for an adult. There are a host of other such cases of which I am aware." "Doctor please tell me a few interesting ones out of these." "In one case, two children aged two and three months respectively took feeds to which from 35 to 40g of sodium nitrite had been added in error for sodium citrate. The elder infant died. Cyanosis and blackening of the mouth were outstanding features. In another case, a boy aged two years vomited while playing with his elder brother aged nine. After a second vomit he was given a glass of water to drink. Vomiting continued and he was taken to hospital. He was deeply cyanosed, collapsed and crying with spasms of pain. Poison was taken out from the stomach with the help of a tube and oxygen was administered, but the child died at about three hours after being poisoned. Sodium nitrite was detected by analysis of his stomach contents. There was methaemoglobin in the blood. It is probable that the boy had ingested and absorbed appreciably more of the poison. The source of the poison in this case was a bottle of sodium nitrite, now nearly empty, which the elder boy had brought for the purposes of a chemical experiment. The dead child had licked the bottle. I must tell you that sodium nitrite is highly soluble in water and its taste resembles that of common salt and that is what makes it such an attractive homicidal poison. Interestingly sodium nitrite is used in machine oil also as a corrosion inhibitor, and deaths have occurred when someone accidentally drank machine oil. There is a case of a girl on record who died in this way. She was eleven years old, and drank a mouthful of machine oil accidentally, some of which she immediately spat out...." "Just a minute doctor. I think sodium nitrite is an oxidizing agent, and if I remember my chemistry alright, corrosion is an oxidative process. Then how can nitrite be used as a corrosion inhibitor?" "Tarun, sometimes oxidizers are also reducing agents. Such is the case of nitrite, which can be further oxidized to nitrate. I must tell you that the tendency of nitrite to act as an oxidizer is increased in an acid environment such as that found in the stomach. At higher pH levels its oxidizing potential is greatly decreased. Corrosion can be inhibited by using a sacrificial reducing agent such as nitrite. Sodium nitrite is also commonly put into packaged foods like meat to keep oxidation from happening. So I was telling you about that little girl. Within an hour she was unconscious and deeply cyanosed. Fortunately she recovered after proper treatment. Analysis showed that the oil contained 36.5% sodium nitrite, 7.5% of an emulsifying agent and 56.0% water. Her stomach washings contained 7-8mg/ 100 ml of sodium nitrite." "Oh, that is certainly most extraordinary!" "Tarun, sodium nitrite poisoning has happened in other ways too. Poisoning by well water drawn from badly constructed wells near farmyards may contain an appreciable amount of nitrate which makes it unfit for drinking and a source of poisoning newborn infants. This illness is however rarely fatal. About 30 cases are on record and only one, it appears, was fatal. It is apparent that the risk is only to infants of under 90 days old, who live in rural communities..." "Doctor, can boiling the water make such water safe? I have heard that boiling the water makes it cleaner." "Yes boiling the water does make it free of infective micro-organisms, because they get killed by boiling, but when the water is contaminated with a chemical substance, it gives no protection whatsoever. On the contrary, it concentrates the nitrates, which can get concentrated upto 3 times on boiling the water! Older children are unaffected, probably because they can tolerate the amount of nitrate likely to be present in their normal fluid intake. It does appear that poisoning in these circumstances is not dependent only upon the amount of nitrate ingested· It has been suggested that poisoning by nitrate will only occur in those whose gastric juice exceeds pH 4.0 and when nitrate-reducing bacteria are present in the upper digestive tract." "Doctor, this is a most extraordinary fact that you have told me. Can you tell me what is the concentration of nitrites in such contaminated water coming from wells?" "The contaminated water, usually drawn from shallow wells, of not over 75 feet deep, usually contains over 20 ppm (parts per million) of NaN03. Methaemoglobinaemia (the existence of too much methemoglobin in the blood) does not normally occur unless the water contains 30 ppm. The upper limit of nitrate should not exceed 10 ppm because as I told you earlier, if boiled the water could be concentrated threefold and thus to a dangerous concentration. Even cows which feed on beet tops rich in nitrates develop methaemoglobinaemia. This is known as the condition of 'purple' cows and is well recognized. Purple is the color the cows get when there is lot of methemoglobin in their blood." "Oh, this is most extraordinary." "There are more interesting facts Tarun. Nitrite poisoning from spinach has also occurred. During 1959-65 in Germany there were 15 cases of nitrite poisoning in infants, aged two to ten months, who had eaten spinach. Nitrite and the remains of spinach were found in the stomach contents of one of the infants. Two factors were responsible. First, the excessive use of nitrate fertilizer, which should not, but often did, exceed 80 kg/hectare. Second, bacterial activity converted the nitrate in spinach into nitrite. Samples of spinach, fresh, frozen and tinned, showed a nitrate contamination of from 40 to 2100 mg/kg. The risk arose when the feed was prepared in advance and stored overlong at room temperature. Even after cooking, a sufficient number of bacteria remained to produce nitrite. The maximum nitrate content of spinach should not exceed 200mg/kg. It has even been recommended that during the first three months infants should not be given spinach." "Doctor, such an interesting poison must have caught the fancy of suicides also. Have there been cases of suicidal poisoning too with sodium nitrite?" "Yes, sure. Suicidal poisoning with sodium nitrite has also occurred. A medical practitioner, aged 51, committed suicide in 1942 by ingesting sodium nitrite. He had been mentally ill for some time. On the night of his death he awoke his son, a medical student, and told him that his mother had suddenly been taken ill during the night. A doctor was summoned and while he was attending to the woman a bump was heard in the passage. The deceased was then found lying on the floor; he died within five minutes of his fall. Poisoning was suspected, but a search revealed only a glass of brandy and another which appeared to contain water. Toxicological analysis demonstrated 2g of sodium nitrite in the gastric contents. The blood was 'dark'. Unfortunately no analysis was made of the brandy or water, otherwise I am sure they would have found nitrite in the brandy. The deceased had given his wife some of the brandy during the night and this may have been the vehicle of poison responsible both for her illness and his death. I feel he first gave brandy laced with nitrite to his wife and then consumed the poison himself, but of course it is only a guess. But sure enough, it is possible to kill someone by lacing his or her drink with as little as 2 grams of sodium nitrite. It was believed that the poison was taken within an hour prior to his death. It was suggested by the relatives that he had died of a heart attack, but the doctor said that he had died of nitrite poisoning." "Oh, doctor. We could go on and on with such interesting stories. Tell me how you can prove Radhika died of nitrite poisoning?" "Tarun, I told you I examined both the contents of the salt cellar as well as the powder spilled over the floor. Now I will tell you what happened. Chaman came to Radhika's house not for reconciliation, but for killing her. He was sure, killing her was his only way out. He got sodium nitrite from a chemistry lab. We have still to find out, how he got hold of it, and who gave it to him. He came fully armed with this poison in a packet. When Shyamala left and Radhika went inside the kitchen to make a cup of tea, he quickly picked up the salt cellar, spilled the salt in it on the floor underneath the table and refilled it with the powder that he had brought. He knew that sometime she would consume the contents of the salt cellar thinking it was salt and she would die. It was no doubt a very clever plan, but thankfully we could catch it. The color of Radhika's body at once told me we were looking for a poison which produces methemoglobinemia, and that was Chaman's undoing. I have found an appreciable quantity of Sodium nitrite from Radhika's stomach contents, and to top it all, the police has found some left over sodium nitrite from Chaman's house too. Initially he denied having any hand in Radhika's death, but when he was told of all the medical and circumstantial evidence against him, he broke down and admitted his guilt." "Very clever doctor. This was a most interesting discussion doctor. Without your masterly deduction, Chaman could never have been caught. People might have thought, it was an accidental death. Tell me what are you going to tell me the next time?" "Tarun, next time, I would tell you about a very interesting poison. You may not have even thought that it was a poison. I will tell you about death by Potassium Permanganate."

Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE JULY 1997 ISSUE THE POISON SLEUTHS POISONING BY VANADIUM -Dr. Anil Aggrawal "Good morning doctor. Oh, my God, what are you doing today? Oh well, today you are examining a middle aged man. What happened to him?" "Good morning Tarun. The name of this person is Ramashanker. For some days he is having some respiratory problem. He has difficulty in breathing, persistent cough, sneezing and sore throat. As you can see he is having red eyes too, which in medical parlance is known as conjunctivitis. He is also reporting some weakness, ringing in his ears and headache for a few days. His local doctor prescribed medicines for these ailments but apparently he didn't get any relief. He was then referred to a specialist, who conducted thorough tests on him and then came to the conclusion that he was perhaps exposed to some poison, and that's how this patient came to me." "And what are your conclusions doctor?" "Initially Ramashanker was thinking that he is suffering from some natural ailment, but when he heard about himself being possibly exposed to poison, he immediately named his employer as a possible suspect who might be trying to poison him. According to him, his employer was trying to fire him on several occasions but each time the Workers Union intervened and he could not be fired. But his employer was bent upon getting rid of him, and Ramashanker thought that he was probably trying to poison him as a last resort." "But how can he possibly poison him?" "The lunch of all the workers is distributed by the employer. It is part of the work conditions. Ramashanker thinks that somebody- most probably his employer- is mixing some poison in his food, perhaps through the help of some goons." "Do you think he is speaking the truth doctor?" "Frankly Tarun, I was not convinced by Ramashanker's assertion. But I wanted to examine him in some more detail before coming to any conclusion. When I saw his tongue, I found that it was greenish colored. This set my mind working and I asked where he was working. He answered as I had expected. He was working as a boiler cleaner in a power plant." "I do not understand what you are referring to. Please explain in some detail." "Tarun, I think no one is trying to poison him, yet he is suffering from poisoning- poisoning from a very exotic poison." "Doctor please stop speaking in riddles and tell me what poisoning is he suffering from." "Tarun, this person surely is suffering from Vanadium toxicity..." "Vanadium! That doesn't sound like a common poison to me. And how is he suffering from this poisoning when no one gave it to him?" "Tarun, Boiler cleaning is a highly hazardous profession in which workers are exposed to high levels of Vanadium. Before we proceed further, I think I should tell you a little about Vanadium." "Yes surely doctor. I would appreciate that. Although I am a good student of chemistry, I know very little about Vanadium, and I would like to know more about it before we discuss its toxicity." "Tarun, Vanadium is an element having an atomic weight 50.94 and atomic number 23. Its density is 6.11 at 18.10 C. Its melting point is about 18900 C and its boiling point is 33800 C. Elemental Vanadium is a corrosion resistant, hard, steel-grey solid. It was discovered in 1831 by the Swedish chemist Nils Sefstrom. The story of its discovery is very interesting. About 30 years before its actual discovery, in 1801, the Mexican chemist and mineralogist Andres Manuel del Rio was almost on the verge of discovering it, but he missed it by the breadth of thin hair, so to say. In that year he was studying the brown lead ores of Mexico. During his experiments he came across several colored compounds which he initially thought were the compounds of a hitherto unknown metal. He was right. These were the compounds of Vanadium, which are in fact so beautifully colored that today one of their major uses is in coloring pottery and porcelain. He even gave the new element a name "panchromium". "Pan" as you know is a Greek prefix meaning "all". Thus the element meant "all colors", which was quite an apt name because Vanadium compounds come almost in all colors. Later he changed the name to "erytronium" which means "red". But even after all this, del Rio could not proved his discovery scientifically, and thus couldn't get the credit for its discovery. Later the German chemist Friedrich Wohler also made a similar mistake." "Then how did sefstrom find the element?" "In 1830s, metallurgy was making its first steps in Sweden and plants were going up in different parts of the country. Quite curiously metallurgists found that iron smelted from some ores was brittle while that from some other ores had great plasticity, i.e. it was less brittle. On investigation it was found that the ores came from different deposits. It was quite obvious that there was some unknown substance, probably a new element, in some ores which was giving rise to this high plasticity of steel. Sefstrom was determined to isolate this new element and after strenuous efforts he was able to do just that. He and another Swedish chemist Jons Jakob Berzelius named this new element Vanadium, after a Swedish Goddess of love, Vanadis!" Interesting! But why this element should be named after a goddess of love?" "Berzelius was an established chemist and he was a very imaginative person. He described the story of Vanadium's discovery as an interesting allusion. He construed the earlier scientists such as del Rio and Wohler as prospective lovers who knocked at the door of a nubile young girl, but couldn't get her simply because they were not persistent enough and went away after knocking just once. Sefstrom was persistent enough to knock at the door of this girl continuously till the girl opened the door and thus was able to get that girl. Obviously the allusion of the girl was to this new metal, and of the knocking to the efforts made to extract that metal. Since Berzelius likened the new metal to a young nubile girl, he preferred to name it after the Swedish Goddess of love, Vanadis. It is said that after Sefstrom's success Wohler wrote to a friend,`I was a real ass to have overlooked the new element in the brown lead ore, and Berzelius was quite right when he laughed at me and described, not without irony, how I knocked at the door of Vanadis, so feebly, bashfully and haplessly!'" "Interesting indeed. How is Vanadium extracted from ores today?" "Tarun, Vanadium accounts for about 0.2% of earth's crust, which may not sound much but would sound significant when you consider that even this concentration is about 15 times more than that of lead and 2,000 times more than silver. But the world production of this metal is far less than these two metals. The world production of Vanadium was just 3 tons in 1907. It however increased to 18,000 tons in 1971 and 21,000 tons in 1975. The main producers are South Africa, US, erstwhile USSR and Finland. The reason why the production of this metal is far less than the other two metals is that it is fairly evenly spread in the crust unlike the other two metals which often occur in accumulations. Vanadium rarely occurs in accumulations, and ores containing just one percent of Vanadium are regarded as exceptionally rich. Even ores containing a mere 0.1% are taken for industrial processing. There are about 60 Vanadium minerals but mining is restricted to carnatite, which is a source of both uranium and Vanadium and vanadinite. Curiously, the meteorites that hit the earth contain two to three times more Vanadium than the earth's crust. Solar matter is also much richer in this element than our planet is. On earth, coal and oil have high quantities of Vanadium. Some coals may have up to 1% Vanadium, but the average is about 30 mg/kg, which is still quite high. Among the oils the highest concentrations of Vanadium are found in the Middle Eastern and Venezuelan oils which may contain up to 100-1400 mg/kg of Vanadium. Because of this, a significant source of Vanadium is the extraction from the furnace (boiler) ash of power plants which are fueled with residual oils. Because of this very same reason, persons engaged in boiler cleaning business are exposed to exceptionally high levels of Vanadium and they are quite prone to Vanadium toxicity. And this is probably the problem of Ramashanker" "Oh, I see. Before we go on to its toxicity, can you please tell me how such a toxic metal can possibly be used in any way?" "Tarun, despite Vanadium being toxic, it finds use in many industries. Its greatest use is in the production of special steels. You may be surprised to know that about 80% of the world production of Vanadium is used for this purpose. A small addition -just fraction of a percent- of Vanadium to steel makes it fine grained, very resilient, very strong and better fit to resist impact and bending. In fact, it has been described as a "vitamin" for steel. Interestingly both words begin with V. There is an interesting story regarding this use..." "Oh, I am a sucker for good scientific stories. Please tell me this story doctor." "The motor king Henry Ford is supposed to have said,`But for Vanadium, there would have been no automobile'. In 1905, he was present at a big motor racing event. Quite coincidentally a collision occurred. Ford went to up to the scene of the accident and picked up a fragment of one of the crashed cars. It was a French car and the fragment had belonged to its valve spindle. Ford was struck by its lightness and considerable hardness. Out of curiosity he sent it to a laboratory for analysis. The report came that this unusually steel contained Vanadium. Ford introduced this technology on a much larger scale in his own cars. And thus although this technology was known to the French before, it really came to be used on a mass scale only after Ford came to know about it. Today such important vehicle parts as the engine, valve springs, suspension springs, axles, shafts and gears are manufactured from steel laced with vanadium." Interesting. What are its other uses?" "As I said earlier, its salts are beautifully colored. The colors of these salts range from green, yellow, red and black to golden and hence they are used in porcelain and pottery industry to color them. Vanadium pentoxide and certain compounds of vanadium known as metavanadates are important catalysts in inorganic and organic chemical industries. They are used in sulfuric acid and plastic production. But only about 3% of all Vanadium is used as catalysts." "Does it have any medical use too?" "Vanadium does not appear to have any medical use. However dental caries incidence in children aged 7-11 years was reduced three times as compared to controls by local application of ammonium vanadate in glycerol. This is however an early Russian study and other workers have not been quite convinced by these results." "You said Vanadium is toxic. Can we ingest it through food too? And what about other sources of Vanadium?" "Wide variations occur in Vanadium levels in food. In the potato the reported concentrations range from about 1 mg/kg to 1.5 mg/kg. This could be due to differences in Vanadium concentrations in soil or to the bias of analytical methods or both. In cow's milk Vanadium was found at levels from about 0.2 mg/kg to 10 mg/kg. Meat concentrations are about 1 mg/kg. Vanadium is present in the air too. Its concentrations recorded in rural areas in the United Kingdom and Canada varied from 0.25 to 75 ng/m3. The concentrations in urban areas are higher- 60 to 300 ng/m3. There is marked seasonal variation, the mean for winter months being 6 times higher than for summer months. It has been estimated that about 1 mg of Vanadium could enter the respiratory tract per day if air concentrations are assumed to be about 50 ng/m3. The major sources of atmospheric emission are metallurgical works, followed by oil and coal burning. Fossil fuel combustion is the largest source of air pollution by Vanadium. You may recall that coal and oil are among the richest sources of Vanadium. The concentrations of Vanadium in water depend largely on geographical location and may range from about 0.2 to more than 100 mg/L. Levels of Vanadium in drinking water in India are not known but in the United States the average level has been found to be 4.3 mg/L. However typical values in drinking water appear to be about 1 mg/L. Concentrations in the soil range from about 5 to 140 mg/kg, and may reach high values when the soils are polluted by fly-ash. Then the values may shoot up to 400 mg/kg." "You said Ramashanker was suffering from Vanadium toxicity and you said that this occurred because he was working as a boiler cleaner. Are their other jobs too in which Vanadium can be absorbed?" "Tarun, industries where exposure to Vanadium may occur are Vanadium pentoxide production, Vanadium metal production, and production of Vanadium catalyzers. But as I said earlier, the most dangerous profession still is probably boiler cleaning. Very high levels in air may occur in boiler cleaning which may range from 17 to 60 mg/m3." "Doctor, what happens to Vanadium inside the body. Since it is not a normal constituent of the body, it should not have any use for it?" "Ingested Vanadium compounds are, in general, poorly absorbed. The absorption of soluble Vanadium compounds is just about 2%, i.e. if someone ingests 100 mg of a soluble Vanadium compound, only about 2 mg of it would be absorbed. Thus Vanadium salts, are very poor candidates for homicidal poison; they are simply not absorbed from the gastrointestinal tract. On the other hand Vanadium is a very important and interesting environmental poison because it is rapidly absorbed from the lungs! Skin is a minor route of absorption in man. Absorbed Vanadium accumulates in mainly in bone, and to some extent in the liver, muscle and kidney. The whole Vanadium content of a normal human weighing about 70 kg has been estimated to be between 17 and 43 mg. Interestingly although Vanadium is toxic, it is an essential element for chicks and rats, and its deficiency may result in their growth reduction and impairment of reproduction!" "You said that Ramashanker is suffering from Vanadium toxicity. How can you prove it in a court of law, if Ramashanker prefers to sue his employer for poisoning him intentionally?" "Tarun, his symptoms, especially his respiratory symptoms and his greenish tongue, coupled with the fact that he is working as a boiler cleaner are quite strong proofs in support of my contention. Yet there is an interesting test by which I can prove my theory. In Vanadium toxicity, the cystine content of fingernails is supposed to decrease. Cystine as you know is an amino acid. Thus determination of the cystine content of finger-nails is a useful diagnostic tool during a continuing exposure of Vanadium. I have already done that and I have indeed found the cystine levels in his fingernails to be reduced. Thus I shall have no difficulty in explaining to the court that Ramashanker is indeed suffering from Vanadium toxicity, and nobody is trying to poison him intentionally. Of course under the various industrial laws, he is entitled for compensation, should his toxicity make him an invalid. But I feel he should be shifted to some other work, so that his exposure to Vanadium is minimized and in time he would be alright. I would also be giving him a drug called BAL. It stands for British Anti Lewisite and is useful in the toxicity of several metals. I am sure that in time, he would be completely alright." "Thank you doctor for letting me know about such an interesting poison. What are you going to tell me next time?" "Tarun, next time I shall tell you about Methyl Bromide, which as you shall see is a very important poison. "

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

Forensic Jokes, Puns & Tidbits Forensic Jokes 1. On September 2, 1999, Dr. Soni, who had come from Gwalior to take MBBS exams told me this story which he claims to be true. Later it was confirmed by several colleagues of mine, including Dr. Dikshit and Dr. Khanna. (i) Dr. K.K.Mishra was the Principal at the Medical College, Cuttack, when the college was sanctioned a decent sum of money for Post-partum program. Normally forensic medicine departments are so neglected, they never get such fantastic sums. Due to a clerical mistake somewhere along the line, the phrase Post-Partum program got changed to "Post-Mortem Program", and all the money came to the department of Forensic Medicine. The Head of Forensic Medicine department (who was Professor K.K. Mishra himself) was surprised, how the government was so generous in sanctioning such a fantastic amount for such a neglected speciality. Anyway he thanked his stars and started making an entirely new building and purchasing brand new equipment for the department. After the project was almost complete, the mistake came to the notice of someone sitting in the administration, but by that time, almost all the money had been utilized, and the department of forensic medicine had got an entirely new look. Well, who says mistakes are always disastrous. I am waiting for the day when some bright clerk in my college makes the same mistake! (ii) On 25 February, 2000, I received this contribution from Dr SK Sharma, Senior Medical Officer at the General Hospital, Gurgaon (Haryana), who claims it to be a real incident. It has got such an eerie similarity to the above story, that I was forced to put this one alongside it. Here is his contribution verbatim! May I submit my first hand departmental experience I underwent after my postgraduation in forensic medicine from Mualana Azad Medical College, New Delhi. I reported to my directorate for my placement anywhere in the district. I was referred to the concerned clerk. He asked me what did my postgraduation in forensic medicine mean. He wanted this information, so that a proposal for transfer was made commensurate with my newly acquired qualifications. I replied that it was in relation to medicolegal examinations and postmortems. Quite interestingly, the orders I received were to report in the postpartum center in a district. It took many months to be back on the post where my specialization could be used. 2. The following joke was sent on September 9, 1999 by Cyril Thomas, who claims it to be a true incident. ********** MAKING THE JOB EASIER ******** In Westminister,CA, Kevin V.Condon,36, shot himself to death after calling 911 emergency line and pinning a sign to the front door of his home said, "DEAD BODY INSIDE, CALL CORONOR, ATTEMPT SUICIDE." Inside police found a fresh pot of coffe waiting for them and the victim's body lying on several plastic bags carefully spread across his bed. A completed death certificate was on top of his night stand. Police said that Condon, a former mortuary attendent used to pick up corpses from the coroner's office, apparantely wanted to make things easy on the officers and coroner's deputies who would be handling his case. 3. The following joke was sent on September 15, 1999 by Dr. Yasar Bilge of the Forensic Medicine Department of Ankara University Medicine Faculty, Turkey. Two doctors diagnose a different disease for a patient. The patient obviously gets very annoyed. He goes to them and asks,"Both of you have given me a different diagnosis. I demand to know who is right." One of the doctors who had just spent a housemanship in forensic medicine, ponders for a moment and then replies after careful consideration,"Well, we all know that autopsy is the final diagnosis. So we can only be sure, when you die, and we conduct an autopsy on you! So if you want to know the right diagnosis, well! you know what you have got to do!" 4. The following joke was sent on September 22, 1999 by Sudhir Gupta of Fantasy International, Greater Kailash-1, New Delhi, India. The thing that relates it to Forensic Medicine is really quite dubious and dawns upon the reader in the last line. Readers who shun blue jokes may please excuse me. Two men camping in the mountains had spent four days together, and they were getting a little testy. One morning, the first friend says, "You know, we're starting to get on each other's nerves. Why don't we split up today. I'll hike north and spend the day looking around, you hike south and spend the day. Then tonight, we'll have dinner and share our experiences over the campfire." The second friend agrees and hikes south. The first man hikes north. That night over dinner, the first man tells his story. "Today I hiked into a beautiful valley. I followed a stream up into a canyon and ate lunch. Then I swam in a crystal clear mountain lake. As I sat out and dried, I watched deer come and drink from the stream. The wildflowers were filled with butterflies and hawks floated all day overhead. How was your day?" The second friend says, "I went south and ran across a set of railroad tracks. I followed them until I came across a beautiful young woman tied to the tracks. I cut the ropes off, gently lifted her off the tracks, and we had sex in every imaginable way all afternoon. Finally, when I was so tired I could barely move, I came back to camp." "Wow!!" the first guy exclaimed, "Your day was MUCH better than mine. Did you get a blow job, too?" "Nah," says the second friend over his meal, "I couldn't find her head." 5. The following joke was sent on September 24, 1999 by Dr. R.K.Sharma of the Forensic Medicine Department of All India Institute of Medical Sciences, New Delhi. This is a good one..... bizarre too! At the 1994 annual awards dinner given for Forensic Science, the president, Dr. Don Harper Mills, astounded his audience with the legal complications of a bizarre death. Here is the story: On March 23, 1994, the medical examiner viewed the body of Ronald Opus and concluded that he died from a shotgun wound to the head. The decedent had jumped from the top of a ten story building intending to commit suicide.He left a note to that effect indicating his despondency. As he fell past the ninth floor, his life was interrupted by a shotgun blast passing through a window, which killed him instantly. Neither the shooter nor the decedent was aware that a safety net had been installed just below at the eighth floor level to protect some building workers and that Ronald Opus would not have been able to complete his suicide the way he had planned. Ordinarily, Dr. Mills continued, "a person who sets out to commit suicide and ultimately succeeds, even though the mechanism might not be what he intended" is still defined as committing suicide. That Mr. Opus was shot on the way to certain death nine stories below at street level, but that his suicide attempt probably would not have been successful because of the safety net, caused the medical examiner to feel that he had a homicide on his hands. The room on the ninth floor from whence the shotgun blast emanated was occupied by an elderly man and his wife. They were arguing vigorously, and he was threatening her with a shotgun. The man was so upset that when he pulled the trigger he completely missed his wife and the pellets went through the window, striking Mr. Opus. When one intends to kill subject A, but kills subject B in the attempt, one is guilty of the murder of subject B. When confronted with the murder charge, the old man and his wife were both adamant. They both said they thought the shotgun was unloaded. The old man said it was his long-standing habit to threaten his wife with the unloaded shotgun. He had no intention to murder her. Therefore, the killing of Mr. Opus appeared to be an accident, that is, the gun had been accidentally loaded. The continuing investigation turned up a witness who saw the old couple's son loading the shotgun about six weeks prior to the fatal accident. It transpired that the old lady had cut off her son's financial support and the son, knowing the propensity of his father to use the shotgun threateningly, loaded the gun with the expectation that his father would shoot his mother. The case now becomes one of murder on the part of the son for the death of Ronald Opus. Now comes the exquisite twist. Further investigation revealed that the son was in fact Ronald Opus. He had become increasingly despondent over the failure of his attempt to engineer his mother's murder. This led him to jump off the ten story building on March 23rd, only to be killed by a shotgun blast passing through the ninth story window. The son had actually murdered himself, so the medical examiner closed the case as a suicide. Very tidy of him. Dr. Sharma informs me that this is a true story from Associated Press, by Kurt Westervelt. 6. The following three short jokes were sent on Wednesday, 22 Dec 1999 by Subhash Niyogi and Dr.Prasenjit Once a reporter asked a famouse forensic scientist,"Sir,How do you feel when somebody dies?" "It's time to work!" replied the scientist with a smile. "What happens if somebody swallows potassium cyanide", asked a student. "Nothing worth happening remains", said the teacher. Here is a hint on how to identify THALLIUM poisoning: When the body of a person becomes stiff like a THALLUS then it's thallium poisoning. 7. The following joke was sent by Moneek Mehra on 23 January 2000 Three dead bodies turn up at the mortuary, all with very big smiles on their faces. A Detective Inspector (DI) is sent and is taken straight to the first body. "This guy was an Englishman, 60, died of heart failure while playing with his grandchildren. Hence the enormous smile Inspector ", says the mortuary chief. The DI nods understandingly and is taken to the second dead man. "This was an American, 25, won 124 million dollars in the Power Ball lottery, spent it all on booze. Died of alcohol poisoning, hence the contended smile." "Nothing unusual here", thinks the DI, and asks to be shown the last body. "Ah," says the chief, "this is the most unusual one, a Sardarji, 30, struck by lightning." "Why is he smiling then?" inquires the Inspector. "Thought he was having his picture taken," replies the chief. 8. The following series of jokes was sent by Mike Duxbury on Friday, the 28 January 2000 Subject: Massachusetts Bar Association Lawyers Journal Date: 14 November 1997 15:05 Recently reported in the Massachusetts Bar Association Lawyers Journal, the following are questions actually asked of witnesses by attorneys during trials and, in certain cases, the responses given by insightful witnesses: 1. "Now doctor, isn't it true that when a person dies in his sleep, he doesn't know about it until the next morning?" 2. "The youngest son, the twenty-year old, how old is he?" 3. "Were you present when your picture was taken?" 4. "Were you alone or by yourself?" 5. "Was it you or your younger brother who was killed in the war?" 6. "Did he kill you?" 7. "How far apart were the vehicles at the time of the collision?" 8. "You were there until the time you left, is that true?" 9. "How many times have you committed suicide?" After these nine one-liners, Dr. Duxbury gives us this series of questions and answers 10. Q: "So the date of conception (of the baby) was August 8th?" A: "Yes." Q: "And what were you doing at that time?" 11. Q: "She had three children, right?" A: "Yes." Q: "How many were boys?" A: "None." Q: "Were there any girls?" 12. Q: "You say the stairs went down to the basement?" A: "Yes." Q: "And these stairs, did they go up also?" 13. Q: "Mr. Slatery, you went on a rather elaborate honeymoon, didn't you?" A: "I went to Europe, Sir." Q: "And you took your new wife?" 14. Q: "How was your first marriage terminated?" A: "By death." Q: "And by who's death was it terminated?" 15. Q: "Can you describe the individual?" A: "He was about medium height and had a beard." Q: "Was this a male, or a female?" 16. Q: "Is your appearance here this morning pursuant to a deposition notice which I sent to your attorney?" A: "No, this is how I dress when I go to work." 17. Q: "Doctor, how many autopsies have you performed on dead people?" A: "All my autopsies are performed on dead people." I8. Q: "All your responses must be oral, OK? What school did you go to?" A: "Oral." 19. Q: "Do you recall the time that you examined the body?" A: "The autopsy started around 8:30 p.m.." Q: "And Mr. Dennington was dead at the time?" A: "No, he was sitting on the table wondering why I was doing an autopsy." 20. Q: "You were not shot in the fracas?" A: "No, I was shot midway between the fracas and the navel." 21. Q: "Are you qualified to give a urine sample?" A: "I have been since early childhood." 22. Q: "Doctor, before you performed the autopsy, did you check for a pulse?" A: "No." Q: "Did you check for blood pressure?" A: "No." Q: "Did you check for breathing?" A: "No." Q: "So, then it is possible that the patient was alive when you began the autopsy?" A: "No." 0: "How can you be so sure, Doctor?" A: "Because his brain was sitting on my desk in a jar." Q: "But could the patient have still been alive nevertheless?" A: "It is possible that he could have been alive and practicing law somewhere." After tickling us so lustily Dr. Duxbury adds: Hi, My name is Mike Duxbury and I am a Police Surgeon ( Forensic Medical Examiner) in Leicester, England. I couldn't agree more with your observations on having more humour in Forensic Medicine. You might like the above jokes. (They still make me laugh every time I read them!) The last sentence is probably an understatement Dr. Duxbury. Many thanks for such nice jokes. -Dr. Anil Aggrawal 9. The following joke (claimed to be a true story) was sent on May 12, 2000 by Geo & Joyce LeonardThis is a good one..... bizarre too! [Bloomberg News Service] A terrible diet and room with no ventilation are being blamed for the death of a man who was killed by his own gas. There was no mark on his body but an autopsy showed large amounts of methane gas in his system. His diet had consisted primarily of beans and cabbage (and a couple of other things). It was just the right combination of foods. It appears that the man died in his sleep from breathing the poisonous cloud that was hanging over his bed. Had he been outside or had his windows been opened, it wouldn't have been fatal. But the man was shut up in his near airtight bedroom. According to the article, "He was a big man with a huge capacity for creating "this deadly gas." Three of the rescuers got sick and one was hospitalized. 10. Many people ask me why I chose Forensic Medicine as a career, and I tell them that it is because a forensic man gets the honor of being called when the top doctors have failed!

Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE MARCH 2000 ISSUE THE POISON SLEUTHS DEATH BY RADON -Dr. Anil Aggrawal "Good morning doctor. Oh, my God, what are you doing today? You have the dead body of a middle aged man today. What happened to him? Please tell me.” “Good morning Tarun. The name of this 45 year old man is Ramlal, and he was working in a drug factory. He was living with his invalid wife and a 20 year old son, in his ancestral house for the last so many years. For some months now, he was not feeling well. His friends and relatives were constantly advising him to see some doctor, but he refused to believe he was sick. He died today morning. Normally in such cases, no police enquiry occurs, but this man was a Union leader, and there have been widespread rumors that the management somehow managed slow poisoning in his case. It has been alleged that this was particularly easy for the management to do so, as he was working in a drug factory, and all sorts of harmful drugs were available to the management. The pressure of the workers was so much, that the police had to arrest the top management people. Currently they are in police custody, and can’t meet anyone." "So what do you think doctor?" "Tarun, I have just now conducted a thorough autopsy on him, and I found that he has died because of lung cancer. Now there is no poison except one that can induce lung cancer, and that is the Radon gas." "You mean someone gave him radon gas to kill him? That sounds preposterous." "I will talk about it later. But first some investigations that I did in this case. When I found that his body was unusually radioactive, I visited his house, and was not very surprised to find a great amount of radioactivity in his house too. In fact this is what I had expected." "From where is that radioactivity coming doctor? Did someone from the management lace his house with radon gas?" "Tarun, the radioactivity in all probability is coming from the underground." "From the Underground? I really don't understand that. Now doctor, I feel I must know the radon story from the beginning. Otherwise I won't be able to follow you intelligently. Kindly tell me the radon story from the beginning." "Tarun, Let me tell you about some general facts about Radon first. It is a colorless, odorless, and tasteless gas found in Group 0 of the Periodic Table. It has a density of 9.25 g per cubic decimeter. In fact, it is the heaviest gas known. It is 7.5 times heavier than air and more than 100 times heavier than hydrogen. The gas liquefies at -61.80 C (-800 F) and freezes at -710 C (-960 F). On further cooling, solid radon glows with a soft yellow light that becomes orange-red at the temperature of liquid air (-1950 C [-3190 F]). Natural radon consists of three isotopes. They have the atomic weights of 219, 220 and 222, and thus are written as radon-219, radon-220 and radon-222 respectively. In chemistry the usual practice of writing the atomic weights is on the upper left hand side of the element symbol; thus the three isotopes are often represented as 219Rn, 220Rn and 222Rn. The half life of all three varieties is very short. But among themselves, the shortest half life is that of the variety having least atomic weight, and the longest half life is that of the variety having the maximum atomic weight. Thus the half life of 219Rn is only 3.92 seconds. Half life, as you surely know is the period, in which the original amount of a radioactive material is reduced by half. The half life of 220Rn is slightly more; 51.5 seconds. The longest lived of all is 222Rn, but even this variety has a half life of just 3.823 days. All the three varieties do not occur in nature as such, but are produced as a result of decay of other radioactive materials. 222Rn is produced by the decay of Radium; 220Rn from the decay of Thorium, and 219Rn from the decay of Actinium. In fact their parent elements give them their more popular names. 222Rn, since it is produced from radium, is known as radon. For similar reasons, 220Rn and 219Rn are known as thoron and actinon respectively. Thus when we speak of radon, we usually refer only to the isotope 222Rn. The other varieties, i.e. thoron and actinon, may be referred to as the isotopes of radon. I may tell you that the first isotope of radon to be discovered was thoron, which was discovered in 1899 by the British scientists R.B. Owens and Ernest Rutherford, who noticed that some of the radioactivity of thorium compounds could be blown away with the passage of time. Radon was discovered in 1900 by the German chemist Friedrich E. Dorn. The last isotope of radon to be discovered was actinon which was found in 1904, independently by Friedrich O. Giesel and André-Louis Debierne. Although these three are the naturally occurring isotopes of radon, now more than a dozen artificial radioactive isotopes of radon are known. I may tell you that radon and all its isotopes are rare in nature because they are all short-lived and because their sources, radium, thorium and actinium are rare. The atmosphere contains traces of radon near the ground as a result of seepage from soil and rocks, all of which contain minute quantities of radium. You may ask where the radium comes from within the soil and rocks. Actually Radium occurs as a natural decay product of uranium which is present in various types of rocks. It is now known that some tracts of land contain unusually high amounts of uranium beneath. This gives rise to more radium and more radon, which seeps up through the soil and collects in homes if they happen to be built on that land. Radon is now known to cause lung cancer in populations which are exposed to it. Indeed, radon is now thought to be the single most important cause of lung cancer among nonsmokers. By the late 1980s, naturally occurring radon gas had come to be recognized as a potentially serious health hazard. The gas, arising from soil and rocks, seeps through the foundations, basements, or piping of buildings and can accumulate in the air of houses that are poorly ventilated. Exposure to high concentrations of this radon over the course of many years can greatly increase the risk of developing lung cancer. Radon levels are highest in homes built over geological formations that contain uranium mineral deposits. I may tell you that 222Rn is itself radioactive, and it decays into 218Po, which in turn decays into 214Pb, 214Bi, 214Po. These four radionuclides are called the radon daughters. They all become attached to particles in the air and get breathed into lungs. 222Rn, 218Po, 214Po are all alpha emitters. Radiation can cause damage to biological molecules, and can induce cancers, genetic defects and accelerated aging." "Doctor, all this sounds very frightening indeed. You told me that by the late 1980s, radon had come to be recognized as a serious health hazard. Tell me how exactly scientists discovered that radon gas could be emanating from the soil and collecting in the houses." "Tarun, it is a very remarkable story indeed. It started on December 2, 1984, in Pennsylvania, USA. Before that it was known that radon occurs as a serious health hazard in mines, but its occurrence in ordinary homes was not known. During December 1984, the alarm bells in the Limerick nuclear power plant (in Pennsylvania, near Philadelphia, USA) were constantly ringing, indicating that someone had been contaminated with radioactivity. But it was not known who it was. There were concerns that the radioactivity might escape and pollute the environment. Then on the fateful day of 2 December 1984, a worker Stanley Watras was found to be unusually radioactive. When more investigations were done, it was surprisingly discovered that the radioactivity was coming from his house. Some people believed that he was stealing some radioactive material from the work place and taking it home, but none was found. Still more investigations showed that unusual amounts of radon were leaking in his house from the underground. The house of Watras was so radioactive that the health risk of living there was the same as smoking hundreds of cigarettes a day! On detailed investigations it was found, that his house straddled a vein of uranium ore. The authorities decided to investigate the levels of radon in other nearby houses and the results were worrying. By the end of 1986, about 20,000 houses had been checked in Pennsylvania, and one in eight were found to be overloaded with radon! Well, here in the table you can find some important dates in radon research in America. (N.B. The table is quite complex and is very difficult to put over the net. Readers desirous of having the table may want to get in touch with the webmaster.) "Oh, that is quite informative." "Gradually, the public became so concerned about radon, that the government found it imperative to decide upon a safe level of radon, which could be allowed in the homes and at workplaces. These levels were called Action Levels. Levels above these Action Levels were considered unsafe and legislations were passed, which could prosecute managements if they allowed radon levels to rise above these prescribed limits. Action Levels for homes were 200 Becquerels per cubic meters (200 Bq m-3), while those for work places were 400 Becquerels per cubic meters (400 Bq m-3).” “Sorry to interrupt you doctor, but I don’t quite understand the concept of Becquerels. Could you please explain me that?” “Sure. Antoine Henri Becquerel, as you surely know was a French physicist who discovered radioactivity through his investigations of uranium and other substances. In 1903 he shared the Nobel Prize for Physics with Pierre and Marie Curie. In his honor, scientists have named the unit of radioactivity. A sample of radioactive substance would be said to have a radioactivity of one Becquerel if in that sample one atom disintegrates per second. So if I say that the level of Radon in a particular home is 200 Becquerels per cubic meters, it means that there is so much Radon in that house that in every cubic meter of that house, 200 atoms of Radon are disintegrating per second. This is a very small Unit. A bigger Unit is Curie, which is equivalent to 3.7 X 1010 Becquerels. You might be surprised at this odd figure. Actually one Curie is the amount of radioactivity given off by one gram of radium. And it is seen that in one gram of radium, about 3.7 X 1010 atoms disintegrate per second. Hence this figure. You might think that the unit Curie is named after Marie Curie, the joint winner of Nobel Prize with Becquerel, but it is actually named after her husband Pierre Curie, who too shared the Prize with them. This is a little known interesting fact. Most people wrongly think that this unit is named after Marie Curie. While I am on the subject, I may tell you something more about the safe levels of Radon in houses. It was found that houses with levels of 2000 Bq m-3 and more were very dangerous places to live in. The house of Stanley Watras had fifty time more radioactivity than this - a radioactivity of 100,000 Bq m-3!” "Doctor, now I know enough about Radon and its dangers. Do you seriously think, someone from the management arranged for the radon gas to be accumulated in Ramlal's house so he could die of lung cancer?" "Tarun, theoretically speaking it is possible, but practically such a possibility is exceedingly low. Radon is not an easy gas to prepare. Concentrated samples of radon are prepared synthetically for medical and research purposes only and that too in highly specialized labs. Typically a supply of radium is kept in a glass vessel in aqueous solution or in the form of a porous solid from which the radon can readily flow. At intervals of a few days, the accumulated radon is pumped off, purified, and compressed into a small tube, which is then sealed and removed. The tube of gas is a source of penetrating gamma radiation, which comes mainly from one of radon's decay products, bismuth-214 (214Bi). Such tubes of radon have been used for radiotherapy and radiography. My initial thought was that Ramlal's house is built on a tract of land which is rich in Uranium, but I had to get the opinion of a geologist before I could finally say anything. I have got that opinion now, and the report says that my guess was correct. Ramlal’s house indeed is constructed over a land rich in Uranium. Come let us tell the police that those management people are innocent, and it was Radon, which took the life of Ramlal. "Unbelievable! This was a most interesting discussion doctor. Tell me what are you going to tell me the next time?" "Tarun, next time, I would tell you about a very interesting poison - Hydrogen Peroxide."

< Back To Main Page. LinkedIn X (Twitter) Facebook Copy link Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology Volume 26 Number 2 ( July- December 2025) Contents Papers Ivan Tsranchev Forensic Interpretation and Importance of Pathologic Findings in an Unusual Case of Hanging By 1. Ivan Tsranchev 2. Pavel Timonov 3. Iliana Toneva 4. Antoaneta Fasova 5. Elizabet Dzhambazova 6. Petar Uchikov Medical University of Plovdiv, Republic of Bulgaria, Europe DOI: 10.5281/zenodo.15708563 Read > Mukesh R Death due to Clinically Undiagnosed Hematolymphoid Malignancy: An Autopsy Case Report and Review By: Mukesh R ¹ , Pampa Ch Toi ² , Vinod Ashok Chaudhari ³ , Karpora Sundara Pandyean ⁴ , Kumaran M ⁵ 1. Assistant Professor, Forensic Medicine & Toxicology, JIPMER, Pondicherry, India 2. Professor, Pathology, JIPMER, Pondicherry, India 3. Additional Professor, Forensic Medicine & Toxicology, JIPMER, Pondicherry, India 4. Junior Resident, Forensic Medicine & Toxicology, JIPMER, Pondicherry, India 5. Associate Professor, Forensic Medicine & Toxicology, JIPMER, Karaikal, India DOI: 10.5281/zenodo.15708004 Read > Jitendra Kumar Proposing a Single centre as a Drug and Toxicology Unit for Complete Care of Substance Abuse and Poisoning Patients at Tertiary Care Centers By: Jitendra Kumar ¹ , Irfan Ahmad Khan ² , Mohammed Reyazuddin ³ , Afzal Haroon ⁴ , Farhan Ahmad Khan ⁵ 1. Assistant Professor, Department of Forensic Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India 2. Assistant Professor, Department of Pharmacology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India 3. Associate Professor, Department of Psychiatry, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India 4. Professor, Department of Forensic Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, India 5. Professor, Department of Pharmacology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India DOI: 10.5281/zenodo.15708358 Read > Pravati Dalua Reluctant to Give: Exploring Youth Attitudes Towards Organ Donation in Delhi By: Pravati Dalua ¹ , Chittaranjan Behera ² 1. Associate Professor, Department of Sociology, Kamala Nehru College, Delhi University, August Kranti Marg, Delhi, India 110049 2. Professor, Department of Forensic Medicine, AIIMS, New Delhi, India DOI: 10.5281/zenodo.15708613 Read > Book Review (Technical Section) Basic Sciences as applied to Forensic Medicine and Toxicology by Anil Aggrawal Publisher: Arya Publishing Company, India (1st edtion) Pages: XVIII + 301 Publication Date: 2025 ISBN: 9789360590864 Language: English DOI: 10.5281/zenodo.15708670 Read >

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

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

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