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Classification of Poisons (Toxicology)

Introduction of toxicology
Poison:
Substance having life threating effects is called poison. Poison, in biochemistry, a substance, natural or synthetic, that damages living tissues and has a harmful or fatal effect on the body.

IPC Section 284,2999,300,3044A, 324,326,328,272,273,274,275,337,338, directly and indirectly relates to poison.
Various Acts related to poison:

  • Poison act 1919
  • The drug control act 196
  • Drug control act 1950
  • Opium act 1878
  • Narcotics and psychopathic act

Classification of poison
Administration of poison in body.

  1. By mouth\ rectum
  2. By parenteral route
  3. By inhalation.
  4. By external application or wounds
  5. Into natural orifices
  6. By sublingual route
  7. By injecting either- Intradermal, subcutaneous, intraarterial, intraperitoneal, atrathecal and into bone marrow.
     

Action of poison

  1. Local
  2. Remote
  3. Local and remote
  4. General- poison have been absorbed.


Factors which modify action of poison

  1. Dose
  2. Form of poison
  3. Method of administration.


Kinds of poison on the basis of its use

  1. Human poison
  2. Suicidal
  3. Homicidal
  4. Stupefying
  5. Accidental


Characteristics of suicidal poison

  1. Vegetation- flora and fauna.
  2. Not costly poison
  3. Easily available
  4. Easily missed with foods and drinks
  5. It must be pleasant in taste and smell
  6. Fatal dose must be small and short
  7. Must be painless and should be in comfortable zone.


Characteristic of ideal Homicidal poisoning

  1. Easily available, odourless, colourless, tasteless.
  2. Easily missed with food and drinks
  3. Fatal dose- small.
  4. Fatal period must be long because in homicide the culprit will always want to escape liability.
  5. Absence of antidote.
  6. Autopsy finding + laboratory method should not be detected.
  7. Symptoms as that of common diseases.



2. Stupefying poison
Alcohol, Dhatura, cannabis indices, cigarette containg arsenic\dhatura chloral hydrate in drinks. Usually used in case of date, rape, drug.

3.Accidental poisoning

  1. Careless storage of poisonous and non-poisonous substance together.
  2. Quack remedies- Hakimís medicine
  3. Bites of poison animals
  4. Putting poisonous substance in food container.


4.Cattle poisoning
Poison is applied on arrow then non productive cattles is stabbed to death.

Arsenic- nux vomica, yellow oleander, snake venom} cattle poison

  1. Diamond powder/ powdered glass.


Appearance: extremely small particles or dust of Diamonds.
Symptoms after consuming it.

  1. Sharp edges- burning pain- mouth-throat-stomach-intestine-rectum.
  2. Nausea followed by vomiting
  3. Vomitus contains streaks of blood
  4. Motion with pain+ blood.
  5. Death due to shock- stomach perforated.


Fatal dose: Uncertain
Treatment: Bulky food- rice, oatmeal bread, ice for thirst, morphine for thirst +pain= relief.

Post-mortem appearance:

  1.  Erosions- Mouth/pharynx/oeso/ stomach/ intestine
  2. Fragment of dust powder or powder dust- found or adhered in mucus and membrane of stomach.
  3. Stomach/intestine- red with blood congestion.


Medical legal importance

  1. Usually mixed with rice, wheat and sweets.
  2. Sometimes glass plus arsenic is given.
  3. Rarely used for suicide. Also used for cattle poisoning.
     

1. Nux- Vomica
Its Spinal poisoning (Strychnine). Stimulate all internal organs. Used as hemopathy medicine but taking fatal dose can kill.
Physical appearance of strychnine: seed- ripe fruit. Outer shell is called pericarp hard.

Symptoms arise when consumed.

  1. Unbroken seed are non- poisonous. Broken seeds are poisonous.
  2. Taste is bitter
  3. symptoms arise in 15 min to 1 hr

Restlessness and anxiousness, Stiffness of muscles before convulsion (Akadan)

  • Opisthotonas: 1st Stage Arch Shape Body
  • Emprosthothans: 2nd Stage
  • Pleurothanatoas: 3rd Stage
  • Fixed chest: difficulty in breathing
  • Blood stain froth coming out of mouth
  • Stage of convulsion passes and muscles becomes relaxed
  • Exhausted/breathing resumes
  • Effects of poison increases, spasm in severity
  • It leads to death od person due to asphyxia
  • The whole process is extremely painful


Treatment of such kind of poisoning:

  1. Treatment similar to tetanus/ epilepsy/ hysteria.
  2. Patient is kept in dark and quite room
  3. Anaesthesia mixed with chloroform
  4. Stomach was with potassium permanganate.


Fatal dose: 50-30 mg
Medical Legal Importance

  1. Death will be due to asphyxia
  2. Rigor mortis- early onset and offset (rapid)
  3. Presence of seed in stomach
  4. Resist putrefaction


Cardiac poisons. (Aconite, Nicotine, oleander)
Also known as sweet poison and oleander as Kaner.
Symptoms.

  1. Vomiting, pain in stomach
  2. Frothy salivation, restlessness
  3. Slow pulse, respiration becomes hurried
  4. Difficulty in swallowing
  5. Jaws lock, followed by muscular twitching
  6. Exhaustion, drowsiness - coma- death


Fatal dose: 15 gm of root
Treatment: Stomach wash and morphine injection
Post-mortem appearance: red spot, it resists heat

Medical Legal Importance

  1. In case of suicide: detox is used- prepared by roots, flower and fruit. Used for apportion also. And usually used in case of dowry.
  2. In case of accident: love fitter- given as a symbol of eternal love. Roots is used for treating vernal; disease like cancer also.


Dhatura
Physical appearance

  1. Bell shaped flower (figure
  2. Called apple thorn
  3. Seed yellowish brown
  4. 400-500 seeds, resembles chilli seeds
  5. All the part is poisonous- fruit, seeds and flower is most poisonous


Effects

  1. Higher centres of brain the motor centre of body.
  2. Initially starts with depression - then paralysis- vital centre medulla ( its cat on it)


Symptoms

  1. Seeds consumptions- half hours
  2. Decoction (concentrated watery fluid)- immediate

Toxic gases (respiratory)
Carbon monoxide
Colourless, odourless gas, produced by incomplete combustion, non- irritant.

Symptoms

  1. Degree of saturation in blood
  2. Lethargy/feeling of weakness
  3. Enter in the state of drowsiness then finally in coma
  4. Symptoms depends on the exposoure of body in carbon monoxide
  5. Concentration of of carbon monoxide (High - Low)
    • If low-dull judgement, senseless, not aware
    • Muscular weakness
    • Mental dullness
    • Incoordination
    • Canít withdraw himself from the situation
    • If high - coma then death
       

Red patches on body.
Fatal dose: 0.01 of co- stuper- coma in 2-3 hr
0.01 of co - for 15 min- coma then death instant death

Treatment

  • Withdraw from the situation
  • Keep body warm
  • Oxygen given
  • If high concentrated: whole body blood transfer.

Post mortem appearance

  1. Pm staining - bright red cherry- if more than 30%
  2. If less than 20%- No change in colour
  3. Blister formation

Usually seen in the case of accident.

Opium (Afim)

  • Somniferous/narcotic poison
  • Two common symptoms- excitement & narcosis (state of stupor/drowsiness/reduced activity)
  • Some common drugs- Heroin (Brown Sugar), Morphine, codeine, etc..


Physical appearance/origin

  • Dried juice of unripe capsule of white poppy Papaver somniferous
  • Poppy seeds- khas khas (creamish in colour, harmless. As not contain opium), Used as food
  • Crude Opium- is dark brown ...become black with passage of time

Symptoms
Appear within half - 1 hr after ingestion
Within 3-5 minute of injection
Acts on CNS-Causing stimulation, later on depression followed by narcosis

Symptoms arise in three stages:

  1. Excitement
  2. Stupor
  3. Narcosis

Fatal dose:

  • Not addicted
  • 200mg of Morphine
  • 2gms of Opium
  • 10ml of tincture


Fatal period- 9-12 hrs
Treatment- stomach wash with water, potassium permanate

Post Mortem Appearance

  1. Smell of opium
  2. Face cyanosed, figure nails blue, neck vein engorged, Post Mortem Stain is black
  3. Froth from mouth/nose
  4. Stomach shows presence of small, soft, brownish lumps of opium


Medical Legal Importance

  • Easily available in India, painless so choice for suicidal purpose
  • Rarely homicidal due to black colour, odour, bitter taste
  • For infanticide
  • In case of breast feeding...feeding by smeared nipples in opium tincture
  • Accidental ..drugging of infant /child to ep him/her quite


Alcohol
Ethyl alcohol/ ethanol

  • Physical appearance
  • Colourless/ transparent/volatile/liquid/characteristic smell/burning taste


Signs and symptoms

  1. Excitement
  2. In-coordination
  3. Narcosis


Fatal dose

  • As per Age/habits of patient/strength of liquor
  • Fatal period- 12-24 hrs... can be delayed for 5-6 days
  • Cause of death-depression of respiratory centre, asphyxia death, delayed R. Mortis, retarded decomposition, presence of alcoholic smell, congested liver/lungs/brain


Treatment & MLI

  • Vitamin B
  • MLI- Mass poisoning common
  • Methyl alcohol adulterated intoxicating beverages to poor people
  • Social events/gathering except in Islamic countries


Arsenic
Irritant Poison

Inorganic Irritants
Metallic Irritants
Arsenic, Antimony, lead, copper, zinc

Arsenic
Arsenic is known as King of poison.
Physical Appearance

  • Grey substance ...non poisonous
  • Insoluble in water
  • Not absorbed by alimentary canal
  • But when this substance continuously changing into arsenious oxide/white arsenic, it becomes poisonous & tasteless


Symptoms

  • Within 15-30 min. (acute P) delayed if taken with food
  • Burning pain in oesophagus and stomach
  • Vomit...stomach content, bile, blood& mucus
  • Stool with blood & water like rice water stools of cholera
  • Intense thirst but Water accelerates vomiting


Fatal dose

  • Dose-Adult -120-200 mg
  • F. Period- 2-3hrs
  • If survive- 7-10 days & died due to heart failure
  • Treatment Stomach washout with warm water & milk


Post Mortem Appearance

  • Depends on quantity & period elapsed before death
  • External- dehydrated & sunken eyeball
  • Wrinkled skin& jaundiced
  • Rigor Mortis lasts longer than usual
  • Internal - Red velvet like appearance of stomach, swollen in patches
  • Haemorrhages in larynx/trachea/lings


Uniqueness of Arsenic Poisoning

  • Retard Putrefaction so body remain well preserved
  • Doesn't deteriorate, chemical analysis of viscera reveals its presence after several years
  • Heat doesn't destroy it, if body charred/burnt
  • In Chronic poisoning, as it is excreted in hair, nails, bones,skin can be found after many years of death


Castor Oil Seeds (Arandi seeds)
Physical Characteristics

  • Grows all over India
  • Signs & Symptoms
  • Burning of throat, salivation
  • Seeds are oval, glossy brown colour
  • Entire plant is poisonous
  • Contains active principle called Ricin which is toxalbumin which is a toxic protein
  • Castor seeds are poisonous when eaten in the raw state but harmless when swallowed entire/after cooking


Sign and symptoms

  • Burning of throat, salvation
  • Copious & painful vomiting
  • Abdominal pain
  • Blood purgingÖ.. Followed by collapse
  • Dehydration & cramps
  • Coma & convulsions precede death
  • Dust from residue cause dermatitis, conjunctivitis,


Fatal dose/Time

  • 6 mg of ricin= 10 seeds
  • F. Time - can survive up to several days
  • Treatment- No specific antidote is available. But treatment is based on general principles

Post Mortem Appearance

  • Fragments of seeds found in stomach
  • Internal haemorrhages in internal organs


Medical Legal Importance

  • Accidental cases in children
  • Homicidal - when administered with food
  • Animal poison
  • Irritant poison- Organic poison- Animal poison- Snake venom.
     

Snake poison
Cantharides
Symptom

  • Local irritation
  • Irritation of gastrointestinal & Genitourinary Tract

Classification of Snakes

  • Poisonous Cobra, king Cobra, Krait, Vipers, Sea Snake
  • Non-Poisonous-Boas, pythons, bull snakes, king snakes

Signs & Symptoms
∑ Bite/absorption of venom through cuts or scratches
∑ Instantaneous death from shock due to fright, even before the commencement of symptoms
∑ Burning on the site of bite
∑ Salivation with vomiting
∑ Weakness in legs in manifested by staggering
Signs & symptoms
∑ Difficulty in speaking & swallowing
∑ Slow breathing & laboured
∑ After few hrs....... respiration ceases with/without convulsions & heart stops
∑ 15 min.-2 hrs to show Neurotoxic effects like-lethargy, muscular weakness, paralysis
Degree of toxicity depends
1. Potency of venom
2. Main toxic principles it contains
3. Amount injected
4. Age, size, sex, species of snake
5. Whether recently taken a prey Bite on bare skin/clothed part
6. Season & time of bite



11.Sulphuric acid H2SO4
Also Known as Oil of Vitriol/Battery Acid
Physical Properties -
∑ When Pure it is colourless/heavy/oily liquid/emit no fumes, mixed with water & evolve heat, chars & blackens skin/cloth & other organic matter
∑ when Impure it is brown/dark in colour
Symptoms -
∑ Tissues dehydrated, severe rise in temperature results in acid burns, burning pain in mouth, throat, oesophagus, blood-stained vomit
∑ Swollen tongue with white covering corroded & shapeless mass (due to concentrated acid)
∑ Teeth chalky-white colour & deprived of polish
∑ Swollen lips, hyper salivation on ii/iii day
Fatal Dose/Time
∑ Few drops of concentration acid produce death from suffocation by direct contact
∑ 2ml of acid- death of 1year child
∑ 5ml- 120 ml. Recovery can be possible
∑ 18-24hrs... average fatal period
Post Mortem Appearance
∑ Mouth/lips/surrounding skin show brown/brownish black corroded spots
∑ Disorganization & blackening of stomach & perforation is frequent
∑ Coagulated blood in the blood vessels
∑ Inflammation Small Intestine corroded
Medico Legal Importance
∑ Commercial use
∑ Suicidal purpose
∑ Homicide acid taste, physical changes in food
∑ Accidental mistaken for
∑ Glycerine/syrup/castor oil/as an enema
∑ Case- Rex V. Haigh
∑ Immersed bodies in drum of concentrated sulphuric acid
Treatment
Cold milk/cold unsweetened soda to wash the burn and cold water, An antibacterial ointment



11. Oxalic acid
Known as Acid of Sugar
Prepared from sugar by oxidation with nitric acid, prepared on large scale from pine sawdust (Timber production or particles of woods)
Physical appearance
Colourless/transparent/crystalline with crystals of magnesium, sulphate, soluble in cold water & alcohol but sparingly soluble in ether, volatile at 150 degrees Celsius
Symptoms -
∑ Local & remote action
∑ Prolonged contact with skin may produce cyanosis and even gangrene
∑ Sour acid taste / thirst / pain/ burning of mouth, throat, stomach...vomiting which persist till death
∑ Vomitus will be greenish brown/black in colour,
∑ Condition result in collapse...coma...death...lock-jaw
Fatal Dose/Period
∑ 15gm,30-60gm recovery medication given if proper
∑ 3-10min..usual period 1-2hrs which may be delayed for days
Treatment
Chalk, calcinied Magnesia, eggshells. Plaster from a wall in a small quantity of water/milk to neutralized the acid
Post Mortem Appearance
∑ If Pure corrosion in mouth/throat/Oesophagus/Stomach
∑ Mucus membrane become white & easily detachable with underlying tissue
∑ No stomach perforation but can easily be torn
∑ Kidneys with oxalate crystals
Medical Legal Importance
∑ Natural constituent of many plantsí vegetables, e.g., cabbages, spinach etc.
∑ Cleaning brass/copper articles/wooden surface
∑ Used in calico printing, manufacture of straw, hats
∑ Used in bleaching powder
∑ Accidental poisoning
∑ No homicidal poisoning




12. Mercury
Mercury is known as quick silver. Used in arts, commerce, industry, medicine Not commonly used as that of arsenic.
Only fluid metal can he swallowed, if in pure form cannot give symptoms
Physical appearance
∑ Liquid metal with a bright silvery lustre.
∑ Metallic mercury is not poisoning, if swallowed because it is not absorbed vaporized at room temperature and caused poisonous. If vaporizes mercury is inhaled, swallowed rubbed into skin.
Symptoms
∑ Confined to mouth/throat/ stomach/intestine
∑ Acute Pain
∑ Difficulty in swallowing, vomiting, diarrhoea
∑ Affects nervous system & kidney.
∑ Coarse, irregular involuntary movement of mascles of the neck
Fatal Dose/Time
∑ Fatal dose: 1-2 gram
∑ Fatal Period- Within few hrs but is usually delayed for 3-5 days
Treatment
∑ Egg Albumin forms an insoluble albuminate of mercury may be administer
∑ Medicinal Charcoal
post-Mortem Appearance
∑ White & sodden Tongue
∑ Greyish white appearance
∑ Mucus membrane of alimentary tract in flamed & corrode
∑ Large intestine show in tense inflammation ulceration & even gangrene
∑ Liver & heart show fatty degeneration








IRRITANT POISONS
INORGANICE IRRITANTS

13. Phosphorus

Physical Properties
∑ It exists in 2 forms- White (crystalline) & (Red amorphous);
∑ White phosphorus become yellow when expose to air
∑ Translucent, waxy in appearance
∑ Slightly soluble in alcohol & insoluble in water. Kept submerged in water to prevent ignition
∑ Used in the striking surface of match box (with Powdered glass)
PHOSPHORUS SYMPTOMS
Primary symptoms
∑ Arise in 2.6 hrs.
∑ Burning pain in throat with intense thirst
∑ Nausea, vomiting & diarrhoea mouth & breath
∑ Garlic taste in mouth and breath
∑ Vomitus - Darkened by blood & smell of garlic
∑ Faeces - dark & offensive
Secondary Symptoms
∑ Damage mainly liver & kidneys jaundice
∑ Distension of the abdomen pale faeces
∑ Scanty & concentrated urine with blood, albumin & bile.
∑ Ringing in ears, impaired vision, cramps paralysis
Fatal Dose/Time
Dose - 60 120 meg
Time - within 24hrs...6-7 days/longer in longer
Treatment - Oily & fatty substance. including milk.
PM appearances
∑ If death is within 24 hr. Highly irritant poison
∑ Inflammation/erosion of mucus membrane of pharynx/ oesophagus /stomach/intestine
∑ Cloudy swelling liver and kidney.
∑ Garlic smell in body.

Medical legal Importance
∑ Yellow phosphorus ingredients of fireworks/certain rodent/insect poisons
∑ Accidental deaths among children who have eaten fire crackers/rat pastes

14. Carbon dioxide
Complete combustion then it forms carbon
Incomplete combustion then carbon monoxide
SOURCE
∑ Fermentation
∑ Decomposition
∑ Refrigerating plants
∑ Manholes
∑ Closed space rebreathing
∑ Ship hold.
Symptoms
Concentration of gas
1. vagal inhibitory response with spasm of glottis.
2. 20-30% concentration of CO2 respiration diminished. Drowniness then coma
3. 50% in air - immediate death. Unconscious then convulsions then death
Treatment
∑ Immediately take person to fresh air.
∑ Body warm should be maintained.
∑ Artificial respiration given.
Post-mortem appearance
∑ Synopsis
∑ Deep congestion
∑ Eye wide open
∑ Dilated pupils
∑ Haemorrhage
∑ Froth from nostril and mouth
Medical legal importance.
∑ Deaths are due to accident
∑ CO2 is heavy gas settled in bottom.

15. Hydrogen Sulphide
Hydrogen Sulphide appearance-
1. Colourless
2. Smell like rotten eggs
3. Found in bodies after decomposition
4. Found in industries such as Artificial silk, leather workshops, human intestine while alive, purified body.
Post Mortem Appearance-
1. When inhaled, ocxy haemoglobin becomes meta haemoglobin
2.When inhaled in pure form; it causes instant death as it paralyses respiratory system.
When inhaled in impure form; causes dizziness-nausea-abdominal pain-laboured breathing-irregular heart action-delirium-convulsions-due to these symptoms- death.
Fatal Dose- varies but generally 0.2% of H≤S
Treatment
1. Shift in fresh air
2. Maintain body temperature
3. Artificial respiration
4. Supportive treatment
Post Mortem Appearance
1. Asphyxia
2. Offensive smell
3. Skin appear bluish-green
4. Body putrefies quickly
5. Internal organs appear brown in colour
Medical Legal Importance
-not used in suicidal as it's painful and chances of recovery
-rarely used in homicidal
-mostly used accidental, maximum cases of death of sever workers



16. Hydrochloric acid.
Appearance of Hydro Chloric Acid
1. Colourless
2. Instant odor- irritating and non inhale-able
3. Easily soluble in water, yellow colour and produce fumes with amonia.
4. Was used for toilet cleaning (acid attacks)
Symptoms
∑ -mild
∑ -no staining on skin or mucus membrane but if drops on clothes then becomes dark.
∑ -convulsions, paralysis of limbs
∑ -If Fumes are inhaled then- congectivitis, inflammation in RS and gums, bronchitis, vomiting, loosing teeth and cornual ulcer.
Fatal Dose- 4-18ml
fumes- 1000ppn
Fatal Time- 18-30 hrs
Post Mortem Appearance: Mucus membrane-greyish
Medical Legal Importance
∑ -not in homicidal cases
∑ -not in suicides as painful and takes time
- mostly in accidental cases
∑ -to prepare chlorine HCL is used
∑ -in forgery cases, to erase writings

17. Curare (Raisin)
Appearance of Curare (raisin)
- affects peripheral nerves (body surface)
- rare poisoning
- acts on motor nerves terminal
- black rotenoid appearance
- completely soluble in water
- obtains from bark or wood of STRYCHNOS plant (strychnos curare)
- tribal people used it for their weapons (arrows' tip)
- similar to snake venom(symptoms)
- -can enter body through wound.

Symptoms
∑ paralyses voluntary muscles
∑ then RS muscles and result in asphyxia
∑ no effect on Mind/brain, functions completely normal and understand everything clearly.
Fatal dose- 30-60mg
Fatal Time- 1-2 hours
Treatment
-poison is washed out by potassium permanganate
-antidote through injection
-wound if any- washed

Post Mortem Appearance: Similar to asphyxia

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