A middle aged man from West Bengal presents with paraesthesia of hands and feet, hyperkeratosis, lines in the nails and rain drop pigmentation in the hands.

Question 72

59. A middle aged man from West Bengal presents with paraesthesia of hands and feet, hyperkeratosis, lines in the nails and rain drop pigmentation in the hands. The most likely causative toxin for the above mentioned symptoms is:

1. Lead.

2. Arsenic

3. Thallium.

4. Mercury.

Answer

2. Arsenic

Reference

The Essentials of Forensic Medicine and Toxicology 21^st Edition : K.S.Narayana Reddy Page 462

P.C.Dikshit 1^st Edition Page 477

Quality

Reader

Status

Repeat

QTDF

All books give this

Discussion

Ä     Arsenic is termed a metalloid as it has properties of both metals and non-metals.

Ä     Forms

o       Trivalent (e.g. arsenic trioxide, arsenious acid, and arsenites) and

o       Pentavalent (e.g. arsenic pentoxide, arsenic acid, and arsenates) derivatives.

o       Inorganic arsenical compounds may generate arsine gas when in contact with acids and reducing metals (e.g. iron and zinc) or with sodium hydroxide and aluminium.

Ä     Use

o       Electronics industry,

o       Production of special types of crystal and optical glass,

o       Hardening lead and copper alloys,

o       Manufacture of fireworks,

o       Wood preservative and

o       Pesticide. It is a byproduct of copper smelting.

Ä     In exposed individuals high concentrations of arsenic are present in

o       Bone,

o       Hair, and

o       Nails. The half-life is in the range of 1 to 3 days.

Ä     Excretion is predominantly in the

o       urine as mono- and dimethyl-derivatives.

CLINICAL FEATURES

Ä     Acute poisoning

o       This can follow accidental, suicidal, or deliberate ingestion,

o       Toxicity being largely dependent on the water solubility of the ingested compound.

§        Within 2 h of substantial ingestion of a soluble arsenical compound, severe haemorrhagic gastritis or gastroenteritis may ensue with collapse and death usually within 4 days.

§        A metallic taste, salivation, muscular cramps, facial oedema, difficulty in swallowing, hepatorenal dysfunction, convulsions, and encephalopthy are reported.

§        A peripheral neuropathy (predominantly sensory), striate leukonychia (Mees' lines) and hyperkeratotic, hyperpigmentated skin lesions are common in those surviving a near fatal ingestion.

§        In moderate or severe arsenic poisoning investigations may show anaemia, leucopenia, thrombocytopenia, and disseminated intravascular coagulation. ECG abnormalities have been reported and include QT prolongation and ventricular arrhythmias.

o       Exposure to arsenic trioxide and trichloride dust causes irritation of the eyes, nose, throat, and lower respiratory tract. Corrosive skin damage may follow skin contact with arsenical compounds such as arsenious acid and arsenic trichloride.

Ä     Chronic poisoning

o       Source

§        Contaminated drinking water or

§        “Tonics” containing inorganic trivalent arsenical compounds

o       Features

§        Progressive weakness,

§        Anorexia, Nausea, Vomiting, Stomatitis, Colitis,

§        Increased salivation, Epistaxis, Bleeding gums, Conjunctivitis,

§        Weight loss, and Low grade fever.

§        Hyperkeratosis (palms and soles of the feet)

§        “Raindrop” (skin),

§        “Mees” (nails).

§        Skin cancer (usually squamous cell epithelioma)

§        A symmetrical peripheral neuropathy is typical.

§        Sensory symptoms predominate but motor involvement is also

§        Central nervous system effects

·        hearing loss,

·        psychological impairment and

·        EEG changes.

§        disturbances of liver function

§        Ulceration and perforation of the nasal septum.

Ä     Chronic exposure to trivalent and pentavalent forms of arsenic has been linked to excess lung cancer and lung cancer occurring in lead, tin, and copper smelter workers has been attributed to arsenic.

Explanation

1. Lead poisoning presents with a whole lot of features like Aneamia, Colic, Neuropathy, facial pallor, lead line or Burtonian line, lead encephalopathy , optic atrophy etc.

2. Acute Arsenic Resembles Diarrhoea where as Chronic Arsenic resembles “fading Measles”

3. Thallium poisoning resembles Guillain Barre Syndrome.

4. Minamita disease, hatter’s shakes and mercurial erethesm are a few of the prominent features of Mercury Poisoning.

Comments

TREATMENT :

Ä     Dimercaprol (British Anti-Lewisite, BAL) given by deep intramuscular injection (2.5-5 mg/kg four hourly for 2 days followed by 2.5 mg/kg intramuscularly twice daily for 1 to 2 weeks).

Ä     DMSA (succimer) and DMPS (unithiol) are more effective in reducing the arsenic content of tissues and, unlike dimercaprol they do not cause accumulation of arsenic in the brain DMSA and DMPS may be given orally (in a dose of 30 mg/kg body weight daily).

Tips

The fact that Arsenic is tasteless and odorless was known even eras ago. It is alleged that the governor of St.Helena “slow poisoned” the “petit corporal” while he was in the jail as a prisoner of Britain. But they didn’t perhaps know that Arsenic is a BAD homicidal poison as it can be detected even centuries after in Bone and Hair (as was detected from Napolean’s mortal remains).

An example of Polychlorinated hydrocarbon is Endrin

Question 71

An example of Polychlorinated hydrocarbon is

a.       Parathion

b.      Malathion

c.       Diazinon

d.      Endrin

Answer

d. Endrin

Reference:

P.C.Dikshit 1^st Edition Page 573

Park 18^th Edition Page 589

QTDF

Most Books

Quality

Reader

Status

Repeat

Discussion

Endrin is a cyclodiene insecticide used on cotton, maize, and rice. It also acts as an avicide. As a rodenticide, it is used to control mice and voles. It is a solid, cream to light tan to white, almost odorless substance. It melts and decomposes at 200 °C. It is moderately soluble in benzene and acetone, slightly soluble in alcohols, alkanes, and xylene, and almost insoluble in water.

Explanation

Parathion, Malathion and Diazinon are Organophosphorus Insecticides

Comments

Endrin is a stereoisomer of dieldrin and is structurally similar to aldrin, and heptachlor epoxide.

Tips

It is also known as Mendrin, and Compound 269.

Mechanism of labour in abortion stick is due to . Necrosis of uterine endometrium and stimulation of uterine contraction

Question 70

Mechanism of labour in abortion stick is due to

a.       Necrosis of uterine endometrium and stimulation of uterine contraction

b.      Oxytocin present in the stick

c.       Prostaglandins present in the stick

d.      All of the above

Answer

a. Necrosis of uterine endometrium and  stimulation of uterine contraction

Reference

P.C.Dikshit 1^st Edition Page 355

QTDF

Most Books

Quality

Reader

Status

Repeat

Discussion

An abortion stick is a thin wood or bamboo stick, from 12 to 18 cms long. This stick is wrapped around at one end or for the greater portion of its length with cotton wool or a piece of cloth, and soaked with juice of marking nuts , calotropis, jequirity, asafetida, or a paste made of arsenic oxide, arsenic sulphate and red lead.

Explanation

It is introduced into the vagina or the uterine os by professional abortionists (dhais) and retained there till uterine contractions begin. In some cases the irritant fluid is directly applied to the os or a piece of cloth saturated with irritating juice or paste is introduced into the vagina.

Comments

Instead of stick, a twig or irritant plant such as calotrophis, Nerium Odorum or Plumago rosea can be used.

Tips

To avoid the misuse of induced abortions, most countries have enacted laws whereby only qualified Gynecologists under conditions laid down and done in clinics/hospitals that have been approved can do abortions. The Medical Termination of Pregnancy Act was enacted by the Indian Parliament in 1971 and came into force from 01 April, 1972. The MTP act was again revised in 1975.

The reagent used to detect presence of Vaginal Cells in on the penis of an accused in a rape case is Lugol’s Iodine

Question 69

The reagent used to detect presence of Vaginal Cells in on the penis of an accused in a rape case is

a.       Lugol's iodine

b.      Phenophthalein test.

c.       Orthotoluidine test.

d.      Benzidine. 

Answer

a. Lugol’s Iodine

Reference

P.C.Dikshit 1^st Edition Page 395

Discussion

If the accused has had a sexual intercourse with the victim, there could be vaginal cells over his penis. These vaginal cells can not be seen with the naked eye, but can be detected by chemical. These cells turn brown when exposed to the vapors of Lugol's iodine.

The skin of the penis is wiped with a filter paper moistened with salt solution and then it is exposed vapors of Lugol's iodine. It the filter paper turns brown, the accused as had sexual intercourse.

Explanation

1. Benzedine test: Stain Extract in Test Tube + few drops of 10 % Benzidine in Glacial Acetic Acid + few drops of H₂O₂ à Blue Colour indicates Positive test (Similarly the stain is moistened with Normal Saline and a blotter is pressed over the area  + Benzidine Solution + H₂O₂ à Blue Colour indicates Positive test.

2. Phenophthalein test (Kastle mayer test): Diluted Stain Extract + Reduces Alkaline Phenopthaline + few drops of H₂O₂ à Pink Colour indicates Positive test

3. Orthotoluidine test (Kohn and O’Kelly test): Equal volume of Working Solution (4% Orthotoludine in Ethyl Alcohol + Glacial Acetic Acid + Distilled Water in equal amounts ) and H₂O₂ are mixed . Then few drops of this mixture is added to the stain extract in a test tube à Blue or Green Colour indicates Positive test

Comments

The paper turns brown in colour due to the high glycogen content of vaginal cells, when present.

Tips

While we find Glycogen with Iodine in this test, there is another test where the plant equivalent of Glycogen (ie Starch) is used to find Iodine. It is done to find out whether the common salt is iodised or not

Expanded Lungs may sink due to Atelectasis

Question 68

Expanded Lungs may sink due to

a.       Atelectasis

b.      Putrefaction

c.       Mouth to mouth respiration

d.      Alcoholic fixationMeconium aspiration

Answer

a. Atelectatis

Reference

P.C.Dikshit 1^st Edition Page 321

QTDF

Most Books

Quality

Reader

Status

Repeat

Discussion

Hydrostatic Test is also called as Raygat’s Test

·        First noted by Scheyer in 1683

·        Done to determine whether the child was live born or still born

·        Specific gravity of lung decreases from 1040 - 1050 (more than water) to 940 (less than water) after respiration

·        If lung sinks à Unexpanded Lung àNo Respiration

·        If lungs Float à Expanded Lung à Child has taken the first breadth

Explanation

·        Expanded Lungs may sink due to

o       Diseases

§        Acute pulmonary Edema

§        Pneumonia

§        Congenital syphilis

o       Atelectasis (non expansion)

§        Air not reaching the alveoli due to feeble respiration

§        Complete absorption of air from lungs by blood if circulation continue after respiration has been stopped or a state of asphyxia

§        More air being expelled from the lungs during expiration due to recoil of lung tissue

§        Obstruction by alveolar duct membrane

o       Drowning

§        When birth occurs in toilet bowl or bucket containing water

Comments

·        Unexpanded Lungs may float due to

o       Putrefaction

o       Artificial inflation – eg : mouth to mouth respiration

o       Alcoholic fixation

Tips

·        This test is not needed when

o       Fetus < 180 days

o       Fetus is a monster

o       Fetus is macerated or mummified

o       Umbilical cord is separated or cicatrized

o       Stomach contains milk

o       Whole of thorax contents float

contusion of neck muscles is seen along with fracture of Hyoid Bone. Manual Strangulation

Question 67

On postmortem examination, contusion of neck muscles is seen along with fracture of Hyoid Bone. The most probable cause of death is

a.       Manual Strangulation

b.      Drowning

c.       Burking

d.      Smothering

Answer

a. Manual Strangulation

Reference:

Apurva Nandy 1^st Edition Page 329

QTDF

Dikshit

Quality

Reader

Status

New

Discussion

Strangulation is compression of the neck that leads to unconsciousness or death by causing an increasingly hypoxic state in the brain. Fatal strangling typically occurs in cases of violence, accidents, and as the mechanism of suicide in hangings.

Explanation

Drowning, Burking, and Smothering do not lead to contusion of neck muscles

Comments

Strangling involves one or several mechanisms that interfere with the normal flow of oxygen into the brain:

·        Compression of the carotid arteries and jugular veins — causing cerebral ischemia.

·        Compression of the laryngopharynx, larynx, or trachea — causing asphyxia.

·        Stimulation of the carotid sinus reflex — causing brachycardia, hypotension, or both.

Depending on the particular method of strangling, one or several of these typically occur in combination, but vascular obstruction is usually the main mechanism. Complete obstruction of blood flow to the brain is associated with irreversible neurological damage and death, but during strangulation there is still unimpeded blood flow in the vertebral arteries.

Tips

Strangulation does not have to be fatal; limited or interrupted strangling is practiced in erotic asphyxia, in the choking game, and is an important technique and in many combat sports and self-defense systems.

Which of the following is not a death due to suffocation - Throttling

Question 66

Which of the following is not a death due to suffocation

a.       Burking

b.      Gagging

c.       Throttling

d.      Choking

Answer

c. Throttling

Reference

P.C.Dikshit 1^st Edition Page 289

QTDF

Dikshit

Quality

Reader

Status

New

Discussion

Classification of Asphyxial Death

1.      Hanging – Neck constricted by endogenous force (weight of body)

a.       Mode of Hanging

                                                        i.      Judicial  

                                                      ii.      Sexual (Auto erotic)

                                                    iii.      Lynching (homicidal hanging)

b.      Manner of Hanging

                                                              i.      Suicidal hanging

                                                            ii.      Homicidal hanging

                                                          iii.      Accidental hanging

c.       Position of Noose

                                                              i.      Typical hanging

                                                            ii.      Atypical hanging

d.      Position of feet

                                                              i.      Complete hanging

                                                            ii.      Partial handing (Partial standing, sitting, reclining or kneeling position)

2.      Strangulation – Neck constricted by exogenous force

a.       Ligature Strangulation

b.      Manual Strangulation (Throttling)

c.       Mugging

d.      Garotting

e.       Bansdola

f.        Palmar strangulation

g.      Strangulation with bend of knee / elbow

h.      Foot strangulation

3.      Suffocation – Respiration prevented by mechanical means

a.       Smothering

b.      Overlaying

c.       Burking

d.      Gagging

e.       Choking

f.        Café Coronary

g.      Traumatic Asphyxia

4.      Drowning – Respiratory tract is occupied by some fluid

a.       Dry Drowning

b.      Wet Drowning

c.       Secondary Drowning

d.      Immersion Syndrome

Explanation

Self Explanatory

Comments

Lynching is the illegal execution of an accused person by a mob. The term lynching probably derived from the name Charles Lynch (1736-96), a justice of the peace who administered rough justice in Virginia. Lynching was originally a system of punishment used by whites against African American slaves. However, whites who protested against this were also in danger of being lynched. On 7th November, 1837, Elijah Parish Lovejoy, the editor of the Alton Observer, was killed by a white mob after he had published articles criticizing lynching and advocating the abolition of slavery.

Tips

“Dry submarine” is introducing the head of the detainee in a bag to induce his/her suffocation.