Written by Dr. D. Rao

SULPHURIC ACID:

Fatal Dose: 10 to 15 cc; Fatal period: 18 to 24 hours.

Autopsy:

1. The clothes may show burns and stains.
2. Corrosion of mucous membranes of lips, mouth, throat and of the skin over the chin, angles of the mouth and hands is seen.
3. The necrotic areas are at first grayish white but soon become brown or black and leathery.
4. Internal changes are limited to the upper digestive tract and the respiratory system.
5. The upper digestive tract is inflamed and swollen by oedema and severe interstitial haemorrhage. The greater part of stomach may be converted into a soft boggy, black mass which readily disintegrates when touched. The mucosal ridges are more damaged than the furrows. In the damaged areas the mucosa is brown or black. Perforation may occur with escape of stomach contents into the peritoneal cavity. The small intestine may show signs of irritation.
6. Corrosion or severe inflammation of the larynx and the trachea may be present.

M L Aspects: (1) Most cases are suicidal. (2) It is not used for homicide. (3) Accidental cases are rare.

NITRIC ACID: Autopsy: (1) Findings are similar to those of Sulphuric acid but, the tissues are stained yellow.   (2) Perforation of the stomach is not common. In death from inhalation of fumes, the larynx, trachea and bronchi are congested and lungs are oedematous.

HYDROCHLORIC ACID: Autopsy: (1) Findings are similar to Sulpuric acid, but, corrosion is less severe. (2) Perforation of stomach is rare. (3) Acute inflammation and oedema of respiration tract and lungs are common.

VITRIOLAGE: Throwing of strong corrosive on another person is known as vitriolage. It causes penetrating burns. Repair is slow and scar tissue causes contracture.

CARBOLIC ACID: Fatal dose: 10 to 15g. Fatal period: 3 to 4 hours.

1. Corrosion of the skin has a grayish or brown colour.
2. The tongue is white and swollen, and there is smell of phenol about the mouth.
3. The mucous membrane of the lips, mouth and throat is corrugated, sodden, whitened or ash-grey and partially detached with numerous small submucous haemorrhages.
4. The mucosa of the oesophagus is tough, white or grey, corrugated and arranged in longitudinal folds. The stomach is hardened and has a leathery feel. The mucosal folds are swollen and covered by opaque-grey or brown mucous membrane. There may be partial separation of necrotic mucosa.
5. The upper part of small intestine may show similar but mild changes.
6. The liver and spleen usually show a whitish m hardened patch where the stomach has been in contact with them.
7. The brain is congested and may be oedematous.

M. L. aspects: (1) It is used for suicide. (2) Homicide and accident are rare.

CAUSTIC ALKALES

Fatal Dose: 5 to 30g. Fatal period: About 1 day.

Autopsy:

1. Alkalies produce soft, oedematous, translucent, soap-like, swollen eschar, red brown in colour.
2. The sloughs are mucilaginous.
3. Charring is not seen.
4. Lips, mouth and throat show corrosion.
5. Oesophagus and stomach show inflammatory oedema with corrosion and sliminess of the tissues. Mucosa may be brownish. Perforation of the stomach is rare.

ORGANOPHOSPHORUS POISONS

They are absorbed by inhalation, intact skin, mucous membrane, and the gastrointestinal tract.

Fatal dose: Parathion 80 to 175 mg; malathion and diazinon 1g. orally.

Fatal period: 3 to 6 hours.

Autopsy:

1. Signs of asphyxia are found.
2. Blood stained froth is seen at the mouth and nose.
3. The mucosa of the stomach is congested with sub-mucous petechiael haemorrhages. The stomach contents may smell of kerosene.
4. The lungs are congested, oedematous and show sub pleural petechiae.
5. The internal organs are congested and brain oedematous.

M. L. Aspects: (1) Suicide: Common. (2) Homicide. And Accidental deaths may occur.

ENDRIN

Fatal dose: 5 to 6 G. Fatal period: 1 to 2 hours.

Autopsy:

1. Signs of asphyxia are found.
2. Blood stained froth may be seen at the mouth and nose.
3. The mucosa of respiratory passages is congested and is covered with a blood stained frothy mucus.
4. The stomach contents may smell of kerosene.
5. The lungs are voluminous, congested and oedematous.
6. The internal organs are congested.

M. L. Aspects: (1) Suicide is very common. (2) Homicide is rare, but it is sometimes given mixed with food, sweets or alcohol.

OPIUM

Fatal dose: Opium 2 G.; morphine 0.2G.

Fatal period: 6 to 12 hours.

Autopsy:

1. Signs of asphyxia are prominent.
2. Froth is seen at the mouth and nose.
3. Smell of opium is noted on opening the chest.
4. Stomach may contain small lumps of opium.
5. Lungs are congested and oedematous.
6. Internal organs are congested.

M. L. Aspects: It is an ideal suicidal poison. Homicide is rare.

BARBITURATES

Fatal dose: Short acting 1 to 2 G; medium acting 2 to 3G; long acting 3 to 4G.

Fatal period: One to several days.

Autopsy:

1. Signs of asphyxia are seen.
2. White particles of barbiturates may be seen in the stomach with mucosal congestion.
3. Lungs are congested and oedeematous.
4. The brain is oedematous with softening of globus pallidus and multiple punctate haemorrhages into the white matter.
5. Internal organs are congested.

M. L. Aspects: (1) It is ideal suicidal poison. (2) Homicide is rare.

CHLORAL HYDRATE

Fatal dose:3 to 5g.

Fatal period: 8 to 12 days.

Autopsy: (1) Gastric mucosa is softened, reddened and eroded and smells of chloral hydras. (2) Brain and lungs are congested.

FOOD POISONING

1. In the infectious type the organisms belong mainly to the Salmonella group. Other organisms like Streptococci, Proteus, Coli group and Shigella are also involved.
2. The toxic type is due to the ingestion of preformed toxins in prepared food, such as, canned or preserved food. Exotoxins e.g. enterotoxins of staphylococci and Botulinum toxin, produce intoxication.

It may occur as isolated cases or small outbreaks.

Autopsy: (1) The mucosa of the stomach and intestines is swollen and is often intensely congested, and there may be minute ulcers. (2) Liver shows fatty change.

Diagnosis: (1) History. (2) Clinical features. (3) Isolation of the organism from the suspected food and from vomit, faeces, blood, etc., from sick persons. (4) Animal experiment.

BOTULISM

Autopsy: (1) Kidneys, liver and meninges are congested. (2) Histological examination of the organs may show thrombosis.

Diagnosis: History. (2) Clinical features. (3) Demonstration of the toxin in the suspected food. (4) Isolation of the bacillus from the food. (5) Isolation of the toxin in the blood and tissues. (6) Isolation of the bacillus from the patient’s faeces or vomit.

CYANIDES

Fatal dose: Pure acid 50 to 60mg; Sodium or Potassium cyanide 200 to 300mg.

Fatal period: Pure acid, 2 to 10 minutes. Potassium or sodium cyanide ½ an hour.

Autopsy:

1. The eyes may be bright, glistening and prominent with dilated pupils.
2. The jaws are firmly closed and there is froth at the mouth.
3. The colour of the post-mortem staining is bright red.
4. Blood stained froth may be found in the trachea and bronchi.
5. There is congestion of viscera and oedma of the lungs.
6. All the vessels of the body including the veins contain arterial blood.
7. The mucosa of the stomach and intestines is often red and congested.
8. Cyanide salts produce slight corrosion of mouth.

M. L. Aspects: (1) They are used for suicide, (2) Homicide is rare.

CARBONMONOXIDE

1. A cherry red colour of skin, mucous membranes, areas of post-mortem staining, blood, tissues and internal organs is the prominent feature.
2. The blood is fluid. Hyperaemia is general and serous effusions are common.
3. Fine froth may be seen at the mouth and nose.
4. Anoxic skin blebbing are common.
5. Lungs are congested and edematous.
6. Necrobiosis of the heart muscle and pleural and pericardial haemorrhages are common.
7. Bilateral symmetrical necrosis of the Globus pallidius  and punctate haemorrhages in the white matter of brain with widespread oedema are common.

M. L. Aspects: (1) Deaths are usually accidental.

(2) Suicide and homicide is rare.

ALCOHOL

Alcohol is a stimulant, but is a selective depressant especially, of the higher nervous centres which it inhibits. It is a hypnotic and diaphoretic.

Fatal dose: 200 to 300 ml. of absolute alcohol consumed in one hour.

Fatal period:  12 to 24 hours.

Alcohol Concentration and Clinical Effects

Blood Alcohol Mg.%	Effects on Drinkers
	Inexperienced	Experienced
0-50	Not noticeable	Not noticeable
50-100	Slight	None to slight
100-150	Under the influence	Slight
150-200	Drunk	Under the influence
200-250	Drunk to very drunk	Influenced to drunk
250-300	Very drunk	Drunk to very drunk
300-400	Stupor to coma	Very drunk to stupor
400-500	Comatose to death	Comatose to death

 

1. Slight effects: Flushed face; dilated pupils; euphoria; loss of restraint.
2. Under the influence: “Under the influence” means that due to drinking alcohol a person has lost (to any degree), some of the clearness of the mind and selfcontrol that he would otherwise possess. The symptoms are; Flushed face, dilated and sluggish pupils; euphoria; loss of restraint; thickness of speech; carelessness and recklessness; incoordination; stagger on sudden turning.
3. Drunk: The word “Drunk” means that the person concerned was so much under the influence of alcohol as to have lost control of his faculties to such an extent as to render him unable to execute safely the occupation in which he was engaged at the material time. The symptoms are : Flushed face dilated and inactive pupils; rapid movement of eye balls; unstable mood; loss of restratint; clouding of intellect; thickness of speech; incoordination; staggering gait with reeling and lurching when called upon to make sudden turns.
4. Very Drunk: Flused or pale face; pupils inactive; contracted or dilated; mental confusion; gross incoordination; slurred speech; staggering; reeling gait; tendency to lurch and fall, vomiting.
5. Coma: Rapid pulse, subnormal temperature; stertorous breathing; deep unconsciousness; contracted pupils; but stimulation of the subject, e.g. by pinching or slapping cause them to dilate with slow return.

Medical Examination:

1. Consent: It is necessary, preferably written. If the person is unconscious or unfit to give consent the doctor should examine the patient to decide whether immediate medical treatment is necessary and, if so, to make the necessary arrangements. He should not disclose to the police information he obtained during his examination, but should wait to seek the consent of the patient when he regains consciousness or is in a fit condition to be asked. When a person is arrested by the police, the doctor can examine such person without consent, even by using reasonable force if the examination is requested by a police officer not below the rank of Sub inspector  (Sec. 53, Cr. P.C.).
2. Note preliminaries, e.g., age, sex, address etc., identification marks, etc.
3. Note date and time of examination at the beginning and at the end of the examination.

Scheme of Examination:

1. Exclusion of injuries and pathological states: (a) Severe head injuries. (b) metabolic disorders, e.g., hypoglycaemia, uraemia. (c) Neurological conditions, e.g., intracranial tumours, epilepsy, acute aural vertigo. (d) Drugs: insulin, morphine, barbiturates, antihistamines, atropine. (e) High fever. (f) Exposure to carbon monoxide.
2. History: The history of the relevant events should be obtained from the accused person while observing him. Enquire whether he suffers from any disease or disability or he is under medical treatment.
3. General behaviour: (a) State of dress for presence of slobber on mouth or clothing, soiling of clothes by vomit or incontinence. (b) Speech: Note the type, e.g., is it thick, slurred or over precise. Slight blurring of certain consonants is one of the earliest signs of in-co-ordination of the muscles of the tongue and lips. (c) Self Control.
4. Memory and mental alertness: (a) The memory of the person for recent events and his appreciation of time can be judged by asking suitable questions about movements during the preceding few hours. A few very simple sums of addition or subtraction may be asked.
5. Writing: Ask him to copy a few lines from a newspaper or book and note: (a) the time taken, (b) repetition or omission of words, letters or lines, (c) ability to keep letters in a line, (d) ability to read his own writing.
6. Pulse: It is rapid and is usually full and bounding.
7. Temperature: The surface temperature is usually raised.
8. Skin: It is flushed.
9. Mouth: Note the smell of breath.
10. Eyes: (a) General appearance: Whether the lids are swollen or red and conjunctivae are congested. (b) Visual acuity: note any gross defect. (c) Intrinsic muscles: (i) Pupils: note whether dilated or contracted. (ii) Reaction to light: Note whether the action is brisk, slow or absent. (d) Extrinsic Muscles: (i) Convergence. (ii) Strabismus. (iii) Nystagmus. The presence of fine lateral nystagmus indicates intoxication.
11. Gait: Ask the person to walk across the room and note: (a) Manner of walking: is it straight, irregular, overprecise, staggering or reeling. (b) Reaction time to a direction to turn: Does he turn at once or continues for one or two steps before turning. (c) Manner of turning: Does he keep his balance, lurch forward, or reel to one side.
12. Stance: Note whether the person can stand with his eyes shut and heels together without swaying.
13. Muscular coordination: Ask to perform: (a) placing finger to nose. (b) Placing finger to finger, (c) picking up medium sized objects from the floor, (d) unbuttoning and rebuttoning shirt.
14. Reflexes: Test knee and ankle reflexes which are delayed or sluggish.
15. Pulmonary, cardiovascular and alimentary systems: They should be tested and blood pressure taken for the presence or absence of diseases.

Laboratory Investigation: The degree of intoxication can be estimated by the concentration of alcohol in the breath, saliva, blood or urine. Blood is the most suitable and the most direct evidence of the concentration of alcohol in the brain.

Collection of blood: Do not use spirit for cleaning the skin. The skin can be cleaned with 1:1000 mercuric chloride or by washing with soap and water. Draw 5cc. Blood and place in a small bottle which should be tightly closed. 5 mg. of sodium fluoride acts as preservative and anticoagulant. The sample should be refrigerated if not sent immediately for examination.

Precautions:

1. Use clean containers with adequate preservative.
2. Refrigerate samples while storing.
3. Obtain samples with a clean needle and syringe from the femoral or subclavian vessels or heart. Take samples from more than one area if postmortem diffusion is a possibility.
4. Spinal fluid and vitreous humor are very good samples.
5. Do not take samples from pericardial sac or from the chest cavity.
6. Do not use contaminated needles, syringes or containers.
7. Do not use spirit for cleaning the skin, before obtaining blood sample.

Alcohol after death: Alcohol diffuses through the intact stomach wall after death into surrounding blood tissues. The concentration of alcohol in the blood after death does not change until alcohol is produced as decomposition begins. If alcohol is found in urine at autopsy, the ingestion of alcohol prior to death is indicated.

Feature of Chronic alcoholism

1. Acute fatty liver
2. Cirrhosis of the liver with ascites
3. GI hemorrhage from bleeding esophageal varices
4. Bleeding peptic ulcers
5. Pulmonary TB
6. RT infection-bronchitis, bronchopneumonia
7. Acute pancreatic
8. Aspiration of gastric contents with aspiration pneumonia
9. Malnutrition
10. Alcoholic Cardio Myopathy
11. Hypothermia

Morphine (Heroin)

Scene Investigation

1. Decedent – Usually a young adult (<30) male, laborer or unsociable workers
2. Site of death: Usually a concealed spot with maximum privacy a closed room, location or bathroom, hallway; The decedent is usually on a bed, floot, sofa or chair.
3. Addicts paraphernalia: commonly turned at the scene of death are disposable plastic syringe previously used disposed of medicine dropper with tip titled to hypodermic needle, towniguest, matches, spoon, bottle cap, cotton, water.
4. Drug: The powdered drug is frequently mixted with lactose mannitol of quinine before use,

External Examination

1. Fresh needle punctures on antecubital force on arm, forearm, hands, femoral area, buttom, fugulas area on feat.
2. Contusion asnud recent needle punctures.
3. Dark brown pigment scary of kolnds due to needle punctures in the part (sometimes in a row) on antecubital fona, arm, forearm, hand. Temoral vein area, buttoc of on jugules are
4. Tattoos at the sites of needle puncture of scari ( Imprinted to conceal sites)
5. Ropelike thickened virus with or without knots caused by thrombi at the x-ray
6. Subcutaneous abscelles at the injection site.
7. Palpable enlarged lymph nodes – axillary, cewical or ingwinal
8. Froth (occasionally bloodlinged) in the nostrib of mouth
9. Cigarette burns of scari on upper chest
10. Jaundice
11. Evidence of malnutrition.

Internal

1. Injection sites: Fresh needle puncture concealed under blood spots of tattoos, with sc. Hemorrhage of needle tracts ( skin increased to explode there features of to see needle puncture in view. Se fibrous and absell: thickening and thrombosis veins previously used for injecting (positions excised for microscopy)
2. Generalized finding: Generalized viral cognition, dark red blood, signs of septicemia and systemic neeroto
3. Lung enlarged and heavy with intem congention of muccosal ademe. Slight acute emphyema froth in the trachea and brochi aspirated material in the mouth, stomach trachea and man brochi and variegated acute changes in the lungi narcotic contn
4. Heast: marked dilatation of RV; bacterial endocarditis commonly from staphylococcus aerens; septic embolism; abscesses of infarction.
5. Liver: Congestion: hepatomegaly; acute hepatitis; postneuostic cirrhosis postal fibrous
6. Lymphnodes: Enlargement of axillous, hepatic and subpylocical
7. Brain; cerebral edema; congestion; softening due to septicemia
8. Kidney congestion; softening and smelling are to s
9. Spleen enlargement: congestion softening
10. Complications: If death not from overdose / hypersensitivity it may occur from one of the following complication septic endocarditic,  viral hepatitis, postnecrotic cirrhosis. Titanium (organic sc tumor) military TB, Bronchopneumonia, lung abcess, pulmonary fibrosis, malnutrition.

Microscopy

1. Microabsesses : brais, heart, spleen, liver kidneys, LN secondary to septicemia
2. Chronic hepatitis: Lympocytic infiltrate of postal and peripostal areas with occasiona neutrophils acute hepatitis with necrosis and acute inflammatory cell infiltration.
3. Edema and lymphocytic hypaplacia of LN
4. Intestitied pulmonary fibrosis. Pulmonary TB; scattered glannlomar of FB type (polarized light urea and see foreign material talc or starch, x-ray diffraction can be use.
5. Foreign body granuloma in skin around blood vessels; thrombus phrobitis; organizing thrombus of view

Speciman to be collected

1. Tissue from injection site – skin, sc and muscle
2. Blood
3. Urine
4. Liver.