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

< Back To Main Page. LinkedIn X (Twitter) Facebook Copy link Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology Volume 26 Number 1 ( January - June ) Contents Editorials Puneet Setia Apology Laws – Are they the right answer for Medical Practitioners? By Puneet Setia India DOI: 10.5281/zenodo.14599219 Read > Papers P Shruti Knowledge and Attitude Towards End-of-Life care and Advance Directives amongst Medical Students and Postgraduates in a Tertiary care Hospital of South India By P Shruthi ¹ , J Damodharan ² 1. Professor, Department of Forensic Medicine and Toxicology 2. Former Dean and Professor, Department of General Medicine, Saveetha Medical College, Chennai, Tamil Nadu, India India DOI: 10.5281/zenodo.12666258 Read >

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

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

Forensic Jokes, Puns & Tidbits Forensic Poems The Toxic Avenger From the grave, if lips could speak the person who was, pleads – you must seek the individual who had my trust, and thru deceit and cunning into the grave did thrust this body once alive and well, now silenced by death, who can not tell my death was NOT what all thought then, for a poison brought my life to end! Avenge me now, for you alone can find the truth beneath the stone. Look close and the clues you will see that tell the tale of what killed me. For you must tell all others now, That this was MURDER – and tell them how! For if no one looks to find what’s here, An injustice was done to a life so dear. If now only you could hear, My muted pleadings to make wants clear. I’d speak as plain as it could be. Since I can’t – You must AVENGE ME! -Anonymous. From a promotional leaflet on the book “Criminal Poisoning” by John Harris Trestrail, III (Acknowledgement: This leaflet was sent to me by John Harris Trestrail, III of the Regional Poison Center, Grand Rapids, MI) Milton Helpern (1902-1977) What kind of man is he we honor here, A doctor who has served his science well? Why, yes, of course, but most of us could tell Of science or profession served. A peer Without a peer in his own field and sphere? Why, yes, that too, but more than this, his spell Is cast by greatness of the mind. We dwell On inner strengths of character so dear To all who know him, radiance that springs From hidden depths of manliness and truth. These are the constant hallmarks of the soul That draw us to the man, these are the things Of which we offer now as humble proof The heartfelt testimony of this scroll -Anonymous. From the book “Autopsy – The Memoirs of Milton Helpern, the World’s Greatest Medical Detective” by Milton Helpern, M.D. with Bernard Knight, M.D. (Acknowledgement: This book was kindly lent to me by Dr. R.K. Sharma of the DDU Hospital)

Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE JUNE 1999 ISSUE THE POISON SLEUTHS DEATH BY NITRIC ACID -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. He has these strange yellowish stains over his face and chest. What has happened to him? Please tell me." "Good morning Tarun. The name of this middle aged man is Radhey Shyam, and he was living alone in this house for the last five years. His dead body has been found today morning from his house. His wife and son died long ago, and since then he is living in a very depressed state of mind. He had become alcoholic and had taken to gambling too. He had taken lot of loans from various sources. It is said that from one person Munna, he took as much as one lakh of rupees. Munna was actually a professional money lender and he used to give money at a very exorbitant rate of interest..." "Oh, I see. But what has all this to do with his death?" "I am coming to that Tarun. Munna was pressing Radhey Shyam for his money for quite some time. Last week Munna had visited Radhey Shyam's house, along with some of his goons for his money, and when Radhey expressed his inability to return the money for about six more months, Munna had threatened him with grave consequences." "So Munna has killed Radhey for retaliation?" "This is what the police thinks. Actually Munna had visited Radhey's house yesterday night too, and had threatened him with grave consequences once again. Today morning they have found the dead body of Radhey. So it is very natural to assume that Munna and his goons have killed Radhey." "What does Munna say?" "The police has arrested him. He looks terrified. He is swearing that he has nothing to do with this killing. He does admit that he had visited Radhey yesterday night, and that he indeed was with two of his goons. He also admits that he had threatened Radhey with grave consequences, but he swears he gave those threats merely to terrify Radhey into returning his money as soon as possible. He never intended to kill Radhey. He has also come out with an interesting argument. He says that he would not have got his money anyway by killing Radhey. So killing Radhey was not in his interest anyway." "Sounds like a valid argument. What do you think doctor?" "Tarun, as you know, I deal every case from a scientific angle. Are you looking at the yellowish stains over his face and chest and over his clothes?" "Yeah, they are very prominent. In fact that is the first thing I noticed, when I came here." "I have looked at his teeth and tongue too. Even they are stained yellow. Come, you also have a look" "Yes, indeed. But what are you trying to arrive at?" "Tarun, it seems to me, that Radhey has died because of Nitric Acid" "Nitric Acid? Never heard of this poison being used to kill anyone." "Nitric acid is not a homicidal poison. It can not be given homicidally to anyone, because it has such a pungent taste. It is in fact a suicidal poison." "Looks like we are on to another of your rare and exotic poisons. Doctor please tell me about nitric acid from the beginning." "Tarun, Nitric acid is a colorless or yellow fuming liquid with an acrid odour. It is a powerful oxidizing agent and reacts with organic matter such as with proteins to produce trinitrophenol or picric acid with the liberation of nitrogen monoxide. This is known as xanthoproteic reaction. Organic matter is thus turned yellow. Stains of this acid on clothing are also yellow, which is a distinctive feature of poisoning by nitric acid. In fact this is how I first suspected that this could be nitric acid poisoning." "Oh, I see. Can you tell me, what are the symptoms a person experiences when he consumes nitric acid?" "Sure. The person gets eructations and abdominal distension. Actually this symptom is also seen with other acids such as sulphuric acid, but eructations and abdominal distension are more severe in nitric acid than with sulphuric acid, because with nitric acid more gas is formed. Then, as you know by now, there is yellowish staining of the teeth as well as of the skin around the mouth, cheeks, and neck, which is very characteristic. Yellow stains may also be found on hands, forearms, and the chest because of splashing. In severe cases, the stomach may perforate, but this is unusual." "Doctor, what is the usual fatal dose of nitric acid?" "It is around 10-15 ml. Actually one tablespoonful contains about 5 ml of liquid. So about two to three table spoonfuls of nitric acid are enough to kill a person." "And what is the usual fatal period?" "It is around 18-24 hours" "How can a person obtain nitric acid to kill himself?" "Tarun, nitric acid is widely used in the art and manufacturing industry. It is used for cleansing nickel ornaments and separating gold from other metals. It is also used in the preparation of gun cotton, nitroglycerin, picric acid, and colouring matters. Because of its wide use in industry, and even in domestic affairs, it is commonly available in the market. And because of its easy availability, suicidal and accidental poisoning is quite likely." "Can a person commit murder with nitric acid?" "Majority of cases of poisoning by nitric acid are either suicidal or accidental. Homicide with nitric acid is extremely difficult, and perhaps even impossible. Because of the corrosive nature of the acid, it can not be given to an unsuspecting individual, who would immediately discard it on tasting. However forcible administration of this acid in drunk patients has been reported. A forensic expert by the name of Christison describes a case where nitric acid was forcibly poured down the throat of a woman when she was drunk. Nitric acid has also been used in vitriolage, although the use of sulphuric acid is more common for this purpose." "Excuse me doctor, you have used a new word. I am not quite familiar with this. What is vitriolage?" "Tarun, vitriolage is intentional throwing of a corrosive substance over the face of an enemy. Often the corrosive substance such as sulphuric or nitric acid is filled up in an old used bulb, and this bulb is then thrown over the face of the victim. A person who commits vitriolage generally does not intend to kill his victim. He merely wants to disfigure him or her. When this bulb smashes on the victim's face, the corrosive substance is released and corrodes the face of the individual. This method is usually employed by disgruntled youths to disfigure the face of beautiful girls who have spurned their love offers." "Oh, that is really sad. Now in the current case of Radhey, how did you reach the conclusion that he had died of nitric acid poisoning?" "By his peculiar post-mortem findings. I have already talked to you about his yellowish stains. These yellowish stains have to be differentiated from those of the iodine stains, because they can cause similar stains. However if ammonia or some other alkali is applied to the stains, the ones due to nitric acid deepen in colour to become orange, whereas those by iodine are decolorized. I did this test in this case, and found that these stains were indeed caused by nitric acid only. In addition, I found that his stomach was perforated. This can only happen if the acid has corroded the stomach wall. But I did not stop at that. I took some material from his stomach and chemically tested it in my lab. I have confirmed chemically that the substance which Radhey ingested was indeed nitric acid. Subsequent to this, I asked the police to search his house and look for some suspicious looking half filled bottle. And sure enough they found a bottle of nitric acid in his almirah which was half filled. Now I will tell you what must have happened. Munna indeed visited Radhey's house yesterday along with his goons, and he also threatened Radhey. But he did not kill him. After Munna had left, Radhey got depressed. He anyway was living alone and no meaning to life was left to him. He wanted to commit suicide and the only thing available to him was nitric acid. He consumed this acid and died. Come let us tell the police that Munna has not killed Radhey. He has actually committed suicide." "Very clever indeed. This was a most interesting discussion doctor. Without your masterly deduction, police could have unnecessarily went on harassing Munna. Everyone might have thought, it was a case of killing by Radhey. Tell me what are you going to tell me the next time?" "Tarun, next time, I would tell you about a very interesting poison. It is oxalic acid. "

Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE MARCH 1998 ISSUE THE POISON SLEUTHS DEATH BY COMMON SALT -Dr. Anil Aggrawal "Good morning doctor. Oh, my God, what are you doing today? You have the dead body of a very young female infant today. What happened to her? Please tell me." "Good morning Tarun. The name of this 6 month old tiny girl is Babli. When she was born, her mother died due to some obstetric complication. Her father Ramdev soon remarried a nubile young girl Rekha. Before marriage she had promised that she would look after Babli well, but after marriage she often showed frank animosity towards this girl. She would not look after her well and would often not even feed her properly.." "Oh, so she probably starved her to death?" "Don't jump to conclusions Tarun. Look at her body. She doesn't look starved. An infant who dies of starvation looks just like a bag of bones. There is no fat in his or her body. But this girl is looking fairly well fed. What I was going to tell you is that Babli's grandmother Shanti Devi, i.e. Ramdev's mother, is still alive. She was not in favor of Ramdev getting married to Rekha in the first place. She probably knew that Rekha was not of good nature. Rekha was undoubtedly not feeding her well, but Shanti would always make up for her, giving her feeds in time. In fact that is why starvation was never a problem for Babli." "Then how did Babli die?" "Babli died of some respiratory disorder. At least that is what her physician told me just now. I will tell you what happened yesterday. Till yesterday morning, Babli was fine. Ramdev left for work in the morning at 8. As usual Rekha started seeing TV just after that, completely ignoring Babli. Seeing that it was her feeding time, Shanti prepared her feed, and filled her milk bottle with that. Just then a neighbor came to meet her, and she went to the drawing room to attend her, leaving the bottle in the kitchen. For half an hour they discussed about some religious programme they were going to attend that evening. After the guest left, Shanti went back to the kitchen, picked up the bottle and gave the feed to Babli. About half an hour later, Babli, who had consumed only about half the bottle by that time, started showing some strange symptoms. She started crying. It appeared as if she was irritable. She vomited twice. Shanti tells me that she had convulsions and muscular twitchings, fluttering of eyelids and of facial muscles. She displayed avid thirst. Shanti knows this because when she gave her water, she would feel a little relaxed, but after some time she would start crying again. But what was most prominent was that she was not breathing well. She had extreme difficulty in respiration. Shanti called Rekha for help, but she kept on seeing TV. Then Shanti phoned her son Ramdev, who immediately got in touch with their family doctor on phone. Dr. Saxena, the family doctor, arrived within 15 minutes, and found that the child was in real bad shape. Ramdev also reached home soon after. Dr. Saxena injected some medicines for respiratory distress, but although the injections seemed to help initially, they weren't of any lasting help. The doctor couldn't really understand what had happened to her. He thought that probably it was an attack of asthma. But what was most confusing was that Babli never displayed this symptom before. They were preparing to shift her to some big hospital for diagnosis and treatment, but before arrangements could be made, Babli died." "Oh, I see. So Babli's body has been brought to you to let them know how she really died?" "Yes, that's right. Actually Dr. Saxena was quite prepared to give the cause of death as asthma, but Shanti Devi immediately raised doubts. She has alleged that while her guest came to meet her, Rekha went to kitchen and mixed some poison in her feed. That is why Babli started having those strange symptoms immediately after having that feed. Rekha, of course, vehemently denied this, and Ramdev too refused to believe her mother, but she wouldn't listen to anyone. She phoned police immediately and called them to their house. The police ransacked the whole house and even searched all Rekha's belongings, but they couldn't find any poison anywhere in the house. That is what is lending weight to Dr. Saxena's theory that Babli indeed died of asthma. Every one including the police is thinking that Shanti Devi is making all this fuss, because she didn't like Rekha in the first place." "Yeah, that looks likely to me as well. So what are you going to do now?" "Tarun, since the matter has reached the police, Dr. Saxena preferred not to give cause of death and leave that to me. The body has been brought to me for post-mortem so that I could comment upon the cause of death." "How do you think Babli died?" "Tarun, the symptoms that Babli displayed surely point towards some respiratory trouble. But the symptoms also point towards a very unusual poison, a poison no one can ever think of. And that is why I have to be extra careful. You have got to remember, that I have a reputation as a poison sleuth, and so I can not afford to leave out even a remote possibility as far as administration of poison is concerned. "Come on doctor. No poison was ever found in the possession of Rekha. Not even that, there was no poison in the whole house. How could anyone administer any poison to Babli?" "Yeah, that sounds very convincing to the police, and that's why they think Shanti Devi is a nut. But I don't think so. I know of a poison which produces exactly the same symptoms as displayed by Babli..." "Please don't talk in riddles doctor. Explain everything to me in clear terms." "Yeah sure. To test my theory, I took some of the stomach contents of Babli and subjected them to chemical analysis. Not to my great surprise, they have shown very high concentrations of salt. Then I took Babli's blood and examined it chemically too. And again it showed very high levels of sodium. I am inclined to think that Babli has been killed with ...." "With what?" "With common salt!" "Common salt? You must be joking doctor. How can anyone be killed with common salt. This is what all of us take daily in our food. Well my father is so fond of common salt he always puts an extra teaspoonful of common salt in his dal." "Yeah, this is what is not known to most people. Common salt is a deadly poison. The only difference between this and other commonly known poisons is that one has to administer rather large quantities to kill with it. One or two teaspoonfuls of salt would not kill an adult but can easily kill a 6 month old baby. Come to think of it, even an adult can be killed with common salt. Only he would have to be fed larger quantities. About 40 teaspoons of common salt would kill an adult human being too." "Well the information is getting interesting. Why don't we begin from the beginning doctor?" "Tarun, before you start visualizing it as a villain, I must hasten to add that there is no doubt that common salt or sodium chloride (NaCl) is indeed essential to all life. It is the basic milieu of mammals. It occurs as colorless cubic crystals or as white crystalline powder. When salt is administered in larger quantities than required, it can cause death too. One teaspoonful of salt weighs about 5 gms. Normal uptake by adults is about 5 to 15 g daily or about 1-3 teaspoonfuls. Children consume less. Salt is even necessary for normal growth in children. The sodium needed for growth is 0.5 mEq/kg from birth to 3 months of age, which decreases to 0.1 mEq/kg at 6 months. The average content of sodium in human milk is 7 mEq/L and that in cow milk is 21 mEq/L ..." "Doctor, you started your answer telling me weights in grams, but suddely you have switched to milliEquivalents. I don't really understand the concept of milliEquivalent so well. And why should we talk in milliEquivalents, when we can talk equally well in grams?" "Tarun, in ordinary day-to-day life, it is useful and convenient to talk in grams and kilograms, but chemists and biochemists often find it easier to talk in terms of equivalent weights because of several reasons. You would surely agree that chemists are mainly interested in chemical combinations, and Equivalent weights are actually measures of the characteristic proportions in which given elements combine. For this reason, this term is also often known as Combining weight. Equivalent weights can be used for elements as well as for compounds. In plain and simple words, they are the measure of the combining capacity of a substance with other chemical substances. Well, even if after this, you are feeling inconvenient with equivalent weights, let me add that 1 mEq of sodium equals 23 mg and that of salt equals 58.5 mg. I would also like to tell you that 1 milliequivalent would be equal to 1/1000 Equivalent weight. Now when I say that the sodium needed for growth is 0.5 mEq/kg from birth to 3 months of age, I simply mean that for every kg of baby's weight, 0.5 mEq of sodium is needed. Thus if the infant weighed, say, 4 kg, he would need 4x0.5 or about 2 mEq of sodium. Since 1 mEq of sodium is 23 mg, it would mean that the infant would need about 46 mg of sodium daily. This much sodium would be available from about 117 mg of salt. Thus in effect, a baby from birth to 3 months needs about 117 mg of salt. Similarly you can convert other values which I told you earlier in grams. I told you the sodium contents of human milk, because this is the only food available to young babies." "Oh, I see. Doctor, you were saying that 40 teaspoons of salt would kill even an adult?" "Yes Tarun. The toxic oral dose of salt is 0.5 to 1.0 gm/kg. For a 70 kg man this amounts to about 35-70 gm. That means that if an adult consumes about 70 g of salt (or about 14 teaspoons), he would be severely poisoned. The estimated fatal amount, i.e. one that would kill is about 1 to 3 gm/kg. This amounts to about 70-210 gm (or about 40 teaspoonfuls) of salt for a 70 kg man." "Oh, that is interesting. Has salt been used to kill people before?" "Tarun, interestingly the Chinese used saturated salt solution for suicide. Salt intoxication and death have occurred when it is used to induce vomiting." "Why would one want to vomit anyway?" "When somebody has consumed some poison, it is imperative to remove as much poison from his stomach as possible. One of the best ways to do this is to make the person vomit. It has been known from ancient times, that a strong solution of common salt induces vomiting, and that is why for centuries, it was a favorite method of doctors to induce vomiting in poisoned patients. But it is known now that saturated solution of salt itself can cause salt poisoning, so it is rarely used these days." "Oh, I see. So you are suggesting that Rekha mixed salt in Babli's feed when Shanti was talking to her neighbor in the drawing room." "Babli's stomach contents, and her blood analysis definitely tells me that salt has been administered to her. I have examined her brain tissue under the microscope too, and I have found that the capillaries of her brain are damaged. They are full of blood, and there are innumerable bleeding points - technically known as hemorrhages- in her brain. There is bleeding underneath one of the coverings of the brain. We call it subarachnoid bleeding, because it occurs underneath the covering known as arachnoid mater. Many venous channels of her brain - technically known as dural sinuses- are blocked. All these findings are strongly in favor of salt poisoning. I have no doubt that someone had indeed mixed salt in her feed. To tell you the truth now, I surreptitiously picked up the milk bottle from Ramdev's house and have analyzed it for salt. It showed as much as 11 g of salt and it was only half full. It means that the full bottle must have contained about 22 g of salt. In other words, Rekha must have put about 4 teaspoonfuls of salt in Babli's bottle when Shanti was talking to her neighbor. There was no other person in the house at that time, and no one except Rekha could have done that." "Rekha indeed is a wicked woman. It is surprising she knew that salt can kill." "I have enquired about Rekha's background. She studied biochemistry in college, although she dropped out of college later. Surely when she was studying biochemistry she must have learnt that salt is a poison and can be used to kill infants. It is indeed a rather safe poison, because you don't need to buy anything. It is available right at everyone's home. And the police won't suspect you either, because they won't find any poison....any traditional poison, I mean. Come let us tell the police that Babli didn't die of asthma. It is Rekha who has added salt to Babli's feed to kill her." "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 interesting poison- iodine"

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

Tarun and Anil Aggrawal's Forensic Programming Page MASTER INDEX OF LESSONS Hi. It is at this page, where I ultimately intend to put some preliminary lessons in computers, internet and computer languages. The instructions would mainly be meant for forensic professionals, but professionals from other specialties can use the information with almost equal ease. Hopefully, after these basics in computers and programming, forensic professionals would be able to put together their own web pages. They would also be able to produce their own programs to manipulate their data. They would, for instance, be able to write programs, which could tell them in a matter of seconds, how many homicides they dealt with in the previous year, how many of them were, say, gun shots, how many stab wounds and so on. These programs could be very useful in writing statistical papers. To be sure, a number of such "ready made" can be bought from the software market. But if you think like I do, you would prefer to make your own programs. Besides the satisfaction of having been able to write your own programs, it has a more practical value. You could devise a program to "suit" YOUR needs, and not be dependent on some other "ready-made" program written by someone else, who was never aware of your own special needs in the first place. Here are some languages which I intend to put on these pages. But I am afraid, you will have to bear with me for some time. I have about ten other websites to maintain, besides of course, perform post-mortems, take undergraduate and postgraduate lectures, conduct research work and so on. I will gradually - but surely - be there. Languages C++ (To appear soon) HTML (To appear soon) DHTML (To appear soon) Visual Basic (To appear soon) JavaScript (To appear soon)

< 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 >