Chapter XXXIV

MEDICO-LEGAL ASPECT OF POISONING

Definition of Poison:

A poison is anything other than physical agencies which is capable of destroying life,
either by chemical action on the tissues of the living body, or by physiological action by
absorption into the living system. Legally, a poison is a substance which, if applied or
administered internally, has been applied or administered with the intention to kill or to do harm.
The intent in the administration is the essential element in law. The quantity does not affect
culpability, nor is the law concerned with the quantity in which the substance acts. (From: A
Synopsis of Forensic Medicine & Toxicology by E. W.Caryl Thomas, 2nd ed., p. 142).

In cases of suspected poisoning, it is not advisable to confine the toxicological analysis to

the stomach and its contents because:

1. The gastrointestinal tract is not only one of the means of entry of poison into the body.
2. Even if the poison was taken orally, after a significant period of time the poison might have
passed out of the stomach and could no longer be present in identifiable amount.
3. It is possible that the said poison could have been introduced post-mortem to conceal the real
cause of death.
4. There must be a demonstration of absorption of the poisonous agent. This can be shown by the
presence of the toxic materials in other organs or parts of the body.

Site of Action of Poison:

1. Local Action:
The poison may act on the skin or on the mucous membrane or on any part of the body where it
is applied.
Example: Sulfuric acid.

2. Remote Action:
The poison may act remotely in any of the following ways:
a. By the production of shock.
Example: Poisoning by strong acid.
b. By absorption into the blood and being carried to the organs they affect.
Example: Morphine is absorbed by the blood and carried to the brain and depresses it.
c. By transmission through the nerves of local parts affected going to the nerve centers and
then reflected to the organs on which they act.

Site of Remote Actions of the Different Poisons are:

a. On the Brain: Narcotics, alcohols, cerebral stimulants like caffeine.

b. On the Cord: Strychnine.
c. On the Peripheral Nerves: Conium, curare.
 d. On the Alimentary Tract: Corrosives
e. On the Kidneys: Cantharides.
f. On the Salivary Glands: Mercury.
g. On the Liver: Phosphorus.
h. On the Mucous Membrane: Arsenic
i. On the Heart: Digitalis,
j. On the Blood Vessels: Ergot, nitrites,
k. On the Blood Cells: Snake venom.

3. Both Local and Remote:

The poison may act at the site of application and in some distant place.
Example: Carbolic acid is an irritant to the alimentary tract and also toxic when absorbed.

Condition of the cadaver when the organs or other tissues are removed which makes the
examination difficult or the result meaningless:
1. Embalming: a dead body must be autopsied and organs and other tissues saved for
toxicological analysis before embalming because:
a. Fixation of tissues by formaldehyde makes them more resistant to the action of
organic solvents used for the extraction of non-volatile organic substances, such as
most drugs, leading to low recovery of these substances.
b. It is extremely difficult, if not impossible, to detect and identify most volatile poisons.
Cyanide, for example, reacts chemically with formaldehyde so that it is no longer
identifiable in an embalmed body.
c. Many embalming fluids contain methyl alcohol or ethyl alcohol or both so that
analysis of these substances is rendered meaningless.
2. Putrefaction:
a. Most volatile compounds are lost as a result of putrefaction.
b. Putrefaction of normal tissue components may produce substances which yield
chemical reactions similar to those obtained from toxic compounds.
c. Some substances, like alcohol and cyanide, may be produced in the process of
putrefaction of normal components.
d. Many substances which might be present in the tissue may undergo chemical changes
and may no longer respond to the identifying test made for them.

Minimum Amount of Autopsy Specimens for Toxicological Examination:

1. Brain One hemisphere
2. Liver 500 gms.
3. Kidney One whole kidney
4. Stomach content 50 gms.
5. Spleen Whole spleen
6. Urine All avilable up to 100 cc.
7. Blood 100 cc.
8. Bile AH available

Recommended Organs to be Saved for Suspicious Poisoning

Poison to be Tested Organs to be submitted:
1. Arsenic (Acute poisoning) Liver, kidney, stomach contents
2. Arsenic (Chronic poisoning) Liver, urine, hair
3. Alcohol Blood, liver, kidney, urine, brain
4. Cyanide or HCN Stomach and liver
5. Carbon monoxide Blood placed in a sealed container
6. Alkali Stomach and contents, esophagus
7. Morphine & other Stomach and contents liver, urine alkaloids
8. Barbiturates Brain, liver, kidney, urine
9. Phosphorus Stomach, liver, kidney
10. Lead Kidney, liver, bone
11. Phenol Liver, kidney, stomach
12. Pesticide (insecticide) Stomach and contents, liver, blood
13. Antibiotic Liver, blood
14. Kerosene, gasoline Brain, liver, lungs, blood

Circumstances Affecting Action of Poison:

1. Method of Administration:
Poisons may enter the body in the following ways:
a. Orally:Except irritants and corrosives, poisons must be digested or absorbed in the
gastric or intestinal mucosa before producing effect.
b. Hypodermically: Poison reaches the blood stream without passing the digestive organs.
This method is only available for such substances that are soluble in the lymph and tissue
juices.
c. Intramuscularly: Absorption is faster than in the hypodermic method.
d. Endodermically: The poison may be rubbed into and absorbed through the skin.
e. By Rectum, Vagina or Bladder: Absorption through the rectum is about twice as much as
absorption through the mouth.
f. By the Lungs: Poison through this route may be made of a substance which can be
transformed to gaseous state.
2. Idiosyncrasy:
Some persons possess sensitivity to certain foods or drugs. The most common drugs are
potassium iodide, arsenical preparations, aspirin and the sulfas. As to foods, the most
common are fish, shrimps, eggs and oysters.
3. Age:
There are substances which are considered poison for babies but wholesome for adults,
while the opposite is true for other substances. There are substances which children can
take more than the proportionate dose in adults, like mercury and belladonna. In case of
some other drugs, children may be so sensitive that they cannot take the proportionate
dose for their age, like opium preparations.
4. Habit: The body may acquire tolerance to some drugs. Habit diminishes the effect of
certain poisons. Tobacco, alcohol, opium, barbiturates, arsenic are good examples of this.
5. Dose: The effect of drugs and poisons in the body is usually proportional to the dose
taken.
 Example: Alcohol, when taken in small dose, stimulates body reflexes and tone, while
large amount depressed the whole body.

Fatal Dose: This is the smallest dose known to cause death: not the smallest amount
which will certainly cause death.

Guide in Determining the Single Dose of Drugs Suitable for Children:

Clark's Rule: Divide the weight of the child in pounds by the average weight
of the adult (150 lbs.) and take the fraction of the adult dose.
Example: The weight of the child is 50 lbs. then 50/150 equals
1/3. So the child can take 1/3 of the adult dose.

Young's Rule: Divide the age of the child by the age of the child plus 12, and the resulting
fraction is the portion of the adult dose which may be used.
Example: If the child is 6 years old, then 6/6+12 equals 6/18 or 1/3 of the adult dose.

Cowling's Rule: Divide the age of the child on his next birthday by twenty-four and the
fraction of the adult dose is to be used.
Example: If the child is 8 years old, then 8/24 equals 1/3 of the adult dose.

Gabius stated a series of fractions of the adult dose which may be used for different ages:

For a child one year or less ...1/12

2 years .. 1/8
3 years .. 1/6
4 years 1/4
7 years ....1/3
14 years ..1/2
20 years ..2/3
Above 20 years ..For adult dose

6. Stare of the Stomach and Kidneys: Since the stomach is the first organ where the ingested
food stays for a time, so it must be the first organ to be affected by the action of poison. If
the organ is diseased or abnormal, it has less resistance to the effect of poison. A healthy
person is usually more resistant to the action of the ingested poison in insoluble form.

SIGNS AND SYMPTOMS THAT MAY LEAD ONE TO SUSPECT POISONING:

1. The complaints and symptoms appear suddenly like an acute abdomen, apoplexy, heart
failure or cholera.
2. The symptoms appear when the individual is at the state of health.
3. The symptoms usually appear after a meal or after taking some food or medicine. The
onset of the symptoms is influenced by the modifying factors mentioned, but it appears
within an hour in most cases.
 4. When several persons partake the food or drug at the same time, the approximate
occurrence of the symptoms is at the same time.
5. The course of the symptoms may either be getting severe or having steady improvement.
6. The detection of the poison can be done on any of the following:
a. food taken c. vomitus
b. container d. excretions

Failure to detect poison does not show that the substance is absent because:
a. The poison might have already been eliminated.
b. The material examined may not contain the poison.
c. The procedure applied is not delicate enough to detect small quantity of the drug.
d. The poison might have already been transformed to another state in the body before
detection.

In order to confirm the suspicion that it is a case of poisoning, the following must be done:

1. Obtain information from:

a. The victim himself.
b. Member or members of the family.
c. Police or other peace officers.
2. Obtain sample of the vomitus, urine and other bodily discharges for analysis.
3. Observe the patient as to other developments of the symptoms and progress of the
condition.
4. Request a fellow physician to assist and observe the patient if necessary.

Signs:
Coma
Collapse
Delirium
Paralysis

TREATMENT OF PATIENT SUFFERING FROM ACUTE

POISONING:
1. Evacuation of the Stomach:
This may be done by:
a. Stomach Tube: A long rubber tube is introduced to the mouth and allowed to reach the
stomach. Fluid must first be introduced into the stomach to prevent the tube to come in
close contact with its wall. Fluid is withdrawn and introduced until traces of the poison
are removed. The procedure is contra-indicated in poisoning by corrosives on account of
the danger of tear or laceration of the stomach wall.
b. Administration of Emetics:
(1) Zinc Sulfate 30 grs.
(2) Ipecacuanha 20-30 grs. in two six drachms of wine.
(3) Mustard and Water One tablespoon in one tumbler of water.
(4) Salt and Water.
(6) Apomorphine 1/10 gr. hypodermically.
 2. Neutralization of the Poison that Remains in the Stomach:
a. Neutralization by Direct Chemical Reaction:
Examples: (1) Acids neutralize alkalies.
(2) Alkalies neutralize acids.
b. Neutralization by Physiochemical Reaction:
Examples: (1) Silver nitrate is precipitated by common salt.
(2) Iodine reacts with starch.

c. Physical Reaction: This is the formation of a non-soluble compound therebym

preventing absorption.
Examples: (1) Tannic acid precipitates Strychnine.
(2) Egg albumen precipitates mercuric chloride.

When the exact nature of the poison is unknown, a mixture composing of the following
substances may be used:
Powdered charcoal 2 parts
Magnesia 1 part
Tannic acid 1 part

The following formula is advanced by Murrel to be used in cases of poisoning of any kind,
although it may be incomplete:
Saturated solution of sulphate of iron ..100 parts
Calcined magnesia ..88 parts
Animal Charcoal .40 parts
Water ...100 parts

The above formula is indicated in case of arsenic, zinc salts, digitalis, acids of ordinary
types, mercury salts, morphine and strychnine poisoning; but this is of no use for alkalies,
phosphorus, tin salts, or hydrocyanic acid poisonings.
3. Application of Physiological Antidotes:
a. Strychnine may be used to stimulate respiration.
b. Depression of the heart by aconite may be counter-acted by digitalis.
c. Blood vessels may be constricted by ergot, suprarenal extracts, digitalis and dilated by
amyl nitrate and sodium nitrite.
d. Morphine, bromides or barbiturates may be given for poisoning by stimulants.

4. Keep the patient alive by general measures, while his organs of elimination are getting
rid of the poison. Treat any urgent and dangerous symptoms.
5. Eliminating the Poison: The elimination of the poison is aided by purgatives,
sudorifics, and diuretics. Sweating may be encouraged by hot bath, warm packing, and injection
with apomorphine.

Symptomatic Treatments:
Pain may be relieved by the injection of morphine. Absorption from the stomach
may be hindered by adrenalin and the use of demulcent like oil, starch, egg-albumen and
water.
 In some cases, it is advisable to administer glucose either by mouth or
intravenously to restore the depleted glycogen.
Diffusive stimulants, artificial respiration, inhalation of oxygen and carbon
dioxide, and application of heat on the skin surfaces may be adopted.

MEDICAL EVIDENCES IN CASE OF POISONING

In the trial of a case of poisoning, the defense counsel will prove:

1. That the death of the victim was not due to poisoning but to some natural cause.
2. That the victim did not suffer from poisoning of the particular poison mentioned in
the complaint or information.
3. That there was no intent on the part of the defendant to poison the victim.

For the purpose of clarification and in the best interest of justice, the medical witness
must answer the following questions:
1. What is the actual cause of the death?
2. Why is death attributable to poisoning rather than to disease?
3. What is the maximum fatal dose of the poison alleged to have caused the death?
4. If the symptoms which appeared do not resemble the typical symptoms of poisoning
by the alleged poison, what explanation can he give?
5. Was the dose taken by the victim necessarily fatal?

In order that the physician may be able to answer the above questions, he must know and
report on the following points:

1. History and Symptoms During Life:

a. History of any previous suicidal attempts.
b. History of his mental condition.
c. History of business, marital and social failures.
d. Presence of persons having grudge against him.
e. Possible source of the poison.
f. Time of actual administration of the poison.
g. Nature and actual time of occurrence of the symptoms.
h. Order of occurrence of the symptoms.
i. If the victim died, note the exact time of death and the period of time from ingestion to
death.
j. Inquire about the presence of vomitus, urine, and other bodily discharges for analysis,
k. Date, time and place where the victim was last seen alive.

2. Post-mortem Examination:
a. External Post-mortem Examination:
(1) Note the attitude of the body and dress, especially for stains.
(2) External signs of physical violence.
 (3) The expression of the face. Some poison, with convulsion as the symptom, may be
inferred from the expression of the face.
(4) Approximation of the time of death.

b. Internal Post-mortem Examination:

(1) The bodily openings must be noted for any peculiar smell characteristic of some poisons.
Examples: Carbolic acid, hydrocyanic acid, phosphorus, chloroform, etc.
(2) The tongue, mouth and esophagus must be examined for inflammation, erosions and
stainings.
(3) The larynx, trachea and bronchi must be opened to see the effect of volatile irritants.
(4) Examination of the stomach:
(a) The color of the stomach wall may sometimes indicate poisoning by certain drugs.
However, the color changes may be due to food, bile or post-mortem changes.
(b) Ulceration: Strong corrosive may produce ulceration of the wall.
This must be differentiated with simple ulcer and cancerous growth.
(c) Actual perforation: This may be found in poisoning by strong mineral acids,
especially sulfuric acid. It must also be differentiated from perforation brought about by
disease of the wall.
(d) Softening: Usually found in poisoning by strong alkaline irritants.
It must be differentiated from post-mortem digestion of the stomach wall.
(5) Examination of the stomach contents:
(a) Quanity.
(b) Nature of food.
(c) Color.
(d) State of digestion.
(e) Presence of matters not commonly considered as food.
(f) Odor.
(g) Reaction.
(6) Examination of the duodenum and its contents.
(7) Condition of the rest of the small intestine.
(8) Examination of the large intestine and its contents.
(9) Examination of other visceral organs.
(10) Examination of the bladder and the vagina, in the case of a female, for poison that might
have been introduced into the body through these channels.
(11) Saving of organs for chemical analysis.

For the purpose of chemical analysis of the visceral organs, theForensic Chemistry
Division of the National Bureau of Investigation Department of Justice have recommended the
following organs to be saved by the physician for the quantitative and qualitative determination
of poisons and offer poisonous substances as enumerated below:

Poison to be Tested: Mercury . . . . . . . . . . . . . . . . . . . . . . . . . . .

Arsenic (Acute poisoning). . . . . . . . . . . . . . . Phenol . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Arsenic (Chronic poisoning) . . . . . . . . . . . . Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Cyanide or HCN . . . . . . . . . . . . . . . . . . . . Liver, kidneys, stomach, intestines.
Phosphorus . . . . . . . . . . . . . . . . . . . . . . . . Liver, kidneys, stomach.
Carbon monoxide . . . . . . . . . . . . . . . . . . . . Blood, liver, kidneys, urine, brain.
Veronal, luminal, amytal . . . . . . . . . . . . . . Stomach and liver.
Strychnine . . . . . . . . . . . . . . . . . . . . . . . . Stomach, liver, kidneys.
Blood (placed in sealed container).
Morphine . . . . . . . . . . . . . . . . . . . . . . . . . Urine, brain, liver, kidneys.
Other alkaloids . . . . . . . . . . . . . . . . . . . . . Stomach, stomach contents, liver,
Lead (chronic) . . . . . . . . . . . . . . . . . . . . . . kidneys, urine.
Mineral acids . . . . . . . . . . . . . . . . . . . . . . . Stomach and contents, liver, urine.
Oxalic acid . . . . . . . . . . . . . . . . . . . . . . . . Same as morphine.
Alkalies . . . . . . . . . . . . . . . . . . . . . . . . . . . Bone, kidneys, liver.
Organs Required Stomach and contents, esophagus.
Liver, kidneys, stomach contents. Same as morphine.
Hair, urine, liver. Stomach and contents, esophagus.

3. Chemical Analysis: This portion of criminal investigation is beyond the scope of a

physician's duty. The expert analyst or a toxicologist is much more in the position to
perform the work.
The expert chemist, analyst or toxicologist must be able to answer the following questions:
a. When, where and from whom did you receive the article which you have analyzed?
b. In what state were they received?
c. When did you analyze it, and where?
d. Did you analyze it alone, or were you assisted?
e. What test did you employ?

CLASSIFICATION OF POISONS

Poisons may be classified in different ways. Some authors classify poisons based on the
manner of action and effect on the body, while chemists usually classify them from the purely
chemical standpoint.
The following are the classifications of poisons based on the manner of action and effect in the
body:
b. Antimony Trichloride
A. Corrosives:
1. Strong Acids: B. Irritants:
a. Sulfuric Acid d. Carbolic Acid 1. Non-metals
b. Nitric Acid e. Oxalic Acid 2. Salts of Metals
c. Hydrochloric Acid 3. Vegetable Irritants:
a. Castor oil c. Belladonna
2. Caustic Alkalies: b. Digitalis d. Croton Oil, etc.
a. Potassium Hydroxide
b. Sodium Hydroxide 4. Animal Irritants:
c. Ammonia a. Cantharides

3. Compounds: 5. Food Irritants

a. Zinc Chloride
C. Narcotics: 2. Brucine
1. Somniferous Group: 3. Thebaine
a. Opium c. Synthetic Hypnotics
b. Chloral F. Poisonous and Irrespirable Gases:
1. Poisonous Gases:
2. Deliriant: a. Carbon Dioxide
a. Belladonna c. Stamonium b. Carbon Monoxide
b. Hyoscyamus d. Cocaine c. Hydrogen Sulfide
d. Arseniureted Hydrogen
D. Depressants: e. Carbon Disulfide
1. Neural Depressant: Paralysis of the spinal
cord. 2. Irrespirable Gases:
a. Chlorine c. Hydrogen Cyanide
a. Aconite b. Benzene
b. Conium
G. Contact Poisons:
2. Cerebral Depressants: Inhibiting the 1. Vegetable Irritants
brain functions. 2. Animal Irritants
a. Hydrogen Cyanide 3. Chemical Irritants
b. Oil of Bitter Almond
c. Laurel Water H. Vulnerants:
1. Nails
3. Cardiac Depressants: 2. Broken Glasses
a. Digitalis 3. Dust
b. Strophanthus
c. Camphor

E. Poisons which are Exito-Motor in Action:

1. Strychnine
 The Forensic Chemistry Division of the National Bureau of Investigation,
Department of Justice made the following classification based on the Chemical Standpoint:

A. Gaseous Poisons (Poisons Present in the Gaseous State): Carbon dioxide; Carbon
monoxide; Hydrocarbons; Hydrogen sulfide; Sulfur dioxide; the Oxides of nitrogen
(Nitrous oxide, Nitric acid and Nitrogen dioxide); war gases.
B. Inorganic Poisons:
1. Corrosives (Poisons characterized principally by an intense and destructive action a
few organic corrosives are included in this group for the sake of completeness):
a. Acid; Mineral and Organic:
Sulfuric acid; Hydrochloric acid; Nitric acid; Oxalic acid; Acetic acid.
b. Alkaline Corrosives:
Potassium hydroxide; Sodium hydroxide; Calcium oxide; Ammonium hydroxide.
c. Halogens:
Chlorine; Bromine; Iodine; Fluorine.
d. Corrosive Metallic Salts:
Silver; Zinc.
e. Organic Corrosives:
Phenol; Pyrogallol; Formaldehyde.
2. Metallic Poisons and Salts: (These chemicals are protoplasmic irritants, but their chief
action is the deleterious effect produced after absorption into the system.)
a. Heavy Metals:
Phosphorus; Antimony; Arsenic; Bismuth; Mercury; Lead; Radioactive
substances; Thallium; Gold; Osmium; Platinum; Nickel; Chromium; Tin;
Vanadium.
b. Inorganic Salts:
Alum; Alkaline earths; Magnesium sulfate; Lithium salts;
Potassium salts; Boric acid and borax; Tellurium; Sodium silicate.
C. Organic Poisons:
1. Volatile Poisons (Volatile liquids or easily sublimated solids many of which are
irritants; their chief action occurs after absorption):
a. Alepathic Compounds:
Methyl alcohol; Ethyl alcohol; Fuel oil; Amyl alcohol; Tertiary or Dimethyl
carbinol; acetaldehyde; Paraldehyde; Methyl chloride; Methyl bromide;
Tribromoethanol; Ethyl chloride; Ethyl bromide; Ether;
Chloroform; Bromofonn; Chloral hydrate; Carbon tetrachloride;
Tetrachlorethane; Amyl nitrite; Nitroglycerin; Carbon bisulfide;
Hydrocyanic acid and the cyanides; Paraffin hydrocarbons.

b. Atomic Compounds: Benzene series; Essential oils.

2. Alkaloidal Poisons: (These substances are toxic principles of plants which have a
characteristic action on some parts of the central nervous system; they are
a well- defined group).
a. Volatile Alkaloidal Poisons:
Nicotine and tobacco; Conine and poison hemlock.
 b. Non-volatile Alkaloids:
Opium and morphine; Aconitum and aconitine; Atropine and related alkaloids;
Epicac and emetine; Cocaine and allied alkaloids; Nux vomica and its
alkaloids strychnine and Brucine; Physostigmine; Alkaloids of the veratrum
species;
Gelsenium and its alkaloids; Colchicum and Colchicine; Ergot and its alkaloids;
Cinchona and quinine; Pilocarpus Jaborandi and pilocarpine; Caffeine;
Curare.

3. Non-alkaloidal Poisons

(A conglomerate collection of other organic toxic substances, non-volatile and

non-alkaloidal):
a. Hypnotics:
Alepathic series; Aromatic series.
b. Aromatic Compounds:
Naphthol; Salicylic acid; Picric acid; Dinitrophenol;
Trinitrotoluene; Acetanilid; Antipyrine; Atophan; and the
Cinchopen group.
c. Glucosides:
Digitalis, Strophanthus; Oleander; Hellebore; Gossypium;
Locust; Scilla; Cannabis indica.
d. Organic Purgatives:
Purgative oils; anthracene group; Jalap; purgatives.
e. Essential Oils:
Aspidium; Abortifacients; Oil of chenopodium; Apiol; Affion; Turpentine.
f. Picrotoxin Group: Picrotoxin; Water of hemlock.
g. Miscellaneous Group: Taxus; Sparteine; Abrus; Laburum; Larkspur; Health
family; Santonin; Cantharides.

D. Miscellaneous Poisons: (Associated with botulism; food poisoning; mushroom

poisoning; snake venom poisoning).
1. Food Poisoning:
Toxic substances in the food; Abnormal hypersensitivity to normal constituents of food.
2. Poisonous Plants.
3. Poisonous Animals and Their Poisons: Arachnids; Centipedes; Insects; Caterpillars;
Vertebrates.
4. Biological Products.
5. Ground Glass.

FOOD POISONING

Food poisoning is a state of ill-health resulting from food which has some abnormal or noxious
content.
Food May Cause Disease in the Following Ways:

1. Lack or excess.
2. Unbalance proportion of proper constituents.
3. Absence of certain constituents, including vitamins and specific proteins.
4. Idiosyncracy. The most common reaction occurs in the gastrointestinal tract in the form of
nausea and vomiting. The sensitivity may be manifested in the form of rashes.
5. Presence of abnormal constituents:
a. Products of putrefactive bacteria.
b. Specific bacteria.
c. Parasites.
d. Molds.
e. Vegetable substances as ergot in rye or solanin in potatoes.
f. Chemicals.
6. Food inherently poisonous as fungi, horse raddish, water hemlock.

Bacterial Food Poisoning:

1. Food Poisoning of Non-specific Bacterial Origin:
This is sometimes called ptomaine poisoning and is probably caused by the degradation products
of the protein molecules occurring in the decomposition of food when they have reached an
advanced stage.

2. Specific Bacterial Food Poisoning:

This is brought about by infection with the salmonella group of microorganisms.
Symptoms:
a. Vomiting and diarrhea.
b. Abdominal pain.
c. Prostration.
d. Collapse with cold sweating.
e. Rigor with pain at the back and limbs.
f. Headaches and dizziness.

Post-mortem Examination:
a. Congestion of mucous membrane of the stomach and intestine.
b. Petechial hemorrhages of the visceral organs.
c. Cloudy swelling of the kidneys.
d. Congestion of the liver and spleen.
e. Isolation of the specific organism.

Bacteriology:
The members of the salmonella group which may cause food poisoning are:
a. B. Enteritidis e. B. Suipestifer
b. B. Paratyphosus A f. B. Psittacosis
c. B. Paratyphosus B g. B. Abortus equi
d. B. Aertryke
Botulism:
This is a specific infection in which symptoms arises from the ingestion of a very potent
exotoxin of anerobic Clostridium botulinum. Poisoning is usually due to ingestion of food stored
and prepared in unsatisfactory conditions and eaten without cooking.

LAWS ON POISONS AND OTHER POISONOUS SUBSTANCES IN THE PHILIPPINES

Provisions Relative to Dispensing of Violent Poisons:

Sec. 755, Revised Administrative Code:
Every person who dispenses, sells, or delivers any of the following violent poisons, to
wit, arsenic, arsenical solutions, phosphorus, corrosive sublimate, cyanide of potassium or other
cyanide, atropine, cocaine, morphine, strychnine, or any of their salts, and all other poisonous
vegetable alkaloids or any of their salts, hydrocyanic acid, or prussic acid, oil of bitter almonds
containing hydrocyanic or prussic acid, oil of mirbane (nitro-benzene), opium and its
preparations, except paregoric and such others as contain less than four hundred and fifty
milligrams of opium per one hundred cubic centimeters (two grains to the ounce), shall make or
cause to be made in a book kept for the purpose of recording the sale of such poisons an entry
stating the date of each sale and the name and address of the purchaser, the name and quantity of
the poison sold, and the purpose for which it was claimed to be purchased, before delivering it to
the purchaser. He shall not deliver any such poison to any person without satisfying himself that
such person is aware of its poisonous character, and that the poison is to be used for a legitimate
purpose, and he shall affix to every box, bottle, or other package containing any dangerous or
poisonous drug, a label of red paper upon which shall be printed in large black letters the word
"poison" and a vignette representing a skull and bones, before delivering it to any person. Books
kept for the purpose of recording the sale of poisons shall be open at all times to the inspection of
the Board of Pharmaceutical Examiners, and of health officers or officers of the law, and every
such book shall be preserved for at least five years after the last entry in it has been made.

Provisions Relative to Dispensing of Less Violent Poisons:

Sec. 756, Revised Administrative Code:

Every person who dispenses, sells or delivers any aconite, belladonna, cantharides,
colchicum, conium, cotton root, digitalis, ergot, hellebore, henbane, phytolaca, strophanthus, oil
of tansy, veratrum viride, or their pharmaceutical preparations, carbolic acid (Phenol), chloral
hydrate, chloroform, creosote, croton oil, mineral acids, oxalic acid, paris green, salts of lead,
salts of zinc, tartar emetic, white hellebore, or any drug, chemical, or preparation which
according to standard works of medicine or materia medica is liable to be destructive to human
adult life in quantities of four grams (sixty grains) or less, without the prescription of a physician,
shall label the receptacles containing them as is above provided for violent poisons, but shall not
be required to register the same.
Nothing in this section shall be construed as applying to the dispensing of medicines,
drugs, or poisons on physicians' prescriptions, but no prescription the prescribe dose of which
contains a dangerous quantity of poison shall be filled without first consulting the prescribing
physician and verifying the prescription.
Receptacle for Poisonous Drugs:

Sec. 757, Revised Administrative Code:

The poisonous drugs specified in the two next preceding sections shall be kept in a
cabinet to be provided in every pharmacy carrying such drugs in stock for the retail trade; and
the same shall be kept securely locked when not in use.

POST-MORTEM FINDINGS IN SOME CHEMICAL POISONING

A. Sulfuric Acid:

1. External Appearance:
a. Putrefaction is frequently delayed.
b. There are cutaneous stains in areas where the corrosive liquid has been spilled. The stains are
frequently found in the angles of the mouth and running in a linear fashion from the posterior
part of the lips to the chin.
c. The outer layers of the skin are destroyed and the derma is parchmentized, while the deepest
layer is reddish-brown in color.
d. The lips may be blackened.
e. The tongue and mucous membrane of the mouth may be softened, corroded and white in color.

2. Internal Appearance:

a. Internal findings are usually confined to the changes due to the local action of sulfuric acid.
b. Cardio-Vascular System:
(1) The aorta may be found with the outer wall blackened and corroded.
(2) The blood in the vessels may be coagulated and hardened.
This produces black arborescent cast in the smaller vessels and in their branches
and larger cylindrical casts in the vessels of greater caliber.
c. Respiratory System:
(1) The epiglottis may be blackened and shrunkened.
(2) The mucous membrane of the larynx and trachea may be swollen and congested.
(3) Death may be due to asphyxia when acid has been inspired.
(4) The diaphragm may be perforated after the escape of the acid into the peritoneal
cavity.
(5) The surface of the lungs and pleura is then tough, leathery and stained brown.
d. Digestive System:
(1) Mucous membrane of the pharynx is gray and may be softened. Patches of brownish
color are scattered in the pharynx due to the effusion of dark-colored blood.
(2) The stomach, if not perforated, shows an injected surface and the contents are coffee-
ground color.
 (3) The mucous membrane of the stomach is brown or black with some thin or perforated
areas. If perforated, the edges of the perforation are black and irregular.
(4) The intestine has a dark-brown content. The pylorus may be hardened and constricted.
Mucous membrane of the duodenum is usually congested and swollen.

B. Hydrochloric Acid:

1. External Appearance:
a. External staining is absent.
b. The angle of the mouth may be whitish, opaque and may be inflamed.

2. Internal Appearance:
a. Blood is darkened but not as a rule coagulated by the action of acids.
b. Edema of the glottis.
c. Larynx and trachea are congested and the mucous membrane is converted into whitish-gray
opaque layer which can be rubbed off.
d. There may be congestion and edema of the lungs.
e. Mucous membrane of the mouth and pharynx is opaque and grayish-white.
f. Esophagus is dilated with the mucous membrane reddened and inflamed.
g. The liver is pale and fatty.

C. Nitric Acid:
The lesions produced by nitric acid are similar to hydrochloric acid except that the cutaneous
stains are distinctly yellow.

D. Caustic Alkalis (Potassium Hydroxide, Sodium Hydroxide):

1. External Appearance:
a. Dirty yellow color stains at the angle of the mouth and on the chin.
b. Swelling of the tissues in contact with the alkali.
c. Surface of the tongue, mouth and lips becomes slightly reddened or dark and eroded.
d. The membrane may be detached exposing the submucous layer which may be chocolate in
color or sometimes black.

2. Internal Appearance:
The only changes are those due to the local action of the alkali.
a. Pharynx is lined by softened and hyperemic mucous membrane.
b. Edema may be considerable especially at the opening of the larynx.
c. Esophagus is corroded in its upper part.
d. Peritoneal surface is pale and blood vessels are filled with dark fluid blood.
e. Stomach contents are viscid, turbid fluid.
f. The mucous membrane of the stomach at the region of the cardiac end is brownish-red in
color, uneven and hardened.
g. The wall of the stomach is edematous and with a soapy feel.
h. The entire length of the intestine is congested.
i. Larynx and trachea are inflamed and congested.
j . Bronchial tree is congested and contains viscid mucous.
E. Ammonia (Ammonium Hydroxide):

1. External Appearance:
Lips, mouth, pharynx and larynx are inflamed with patchy erosion of the mucous membrane.

2. Internal Appearance:
The only characteristic changes are those in the respiratory and digestive systems:
a. Digestive System:
(1) The tongue is swelling with the mucous membrane softened and peeled off.
(2) The mucous membrane of the esophagus and the lower portion may be detached and
it is intensely inflamed.
(3) The mucous membrane of the stomach may be with dark-colored blood, thinned, or
perhaps destroyed at the point of contact with the chemical. Perforation may
be present. The whole membrane is edematous and congested, and may show
petechial hemorrhages. There may be a strong odor of ammonia.
(4) The duodenum and jejenum may contain blood but are usually unaffected.

b. Respiratory System:
(1) The epiglottis may be very swollen and eroded. There is a considerable edema of the
vocal cords.
(2) The laryngeal and tracheal mucosa are swollen.
(3) Trachea and bronchi are lined with a fibrinous membrane which can be easily stripped
off leaving a raw surface.
(4) The lungs may be congested and edematous.
(5) Broncho-pneumonia may be present in those cases which survived for a time.
Death may be due to suffocation brought about by the gas or edema of the glottis or
pulmonary changes, if the victim does not die immediately.

F. Phenol and its Derivatives (Lysol, Cresol, Carbolic Acid):

1. External Appearance:
a. Brownish and shrunken stains at the angles of the mouth, chin and cheeks.
b. Characteristic odor of phenol is perceptible.
2. Internal Appearance:
a. The blood is dark and fluid.
b. The lungs are congested and sometimes edematous. If the victim lived for sometime, broncho-
pneumonia may be found.
c. There may be edema of the glottis and of the vocal cord.
d. Digestive System:
(1) The tongue is swollen with white fur and the mucous membrane is hardened.
(2) The esophagus is contracted and the mucous membrane is thrown into ridges. It is
grayish-white in color and the longitudinal fissures running between the ridges
are hyperemic.
(3) The stomach may contain blood-stained mucous with a characteristic smell. The
mucosa may be thrown into longitudinal ridges. The muscular and subserous
coats are edematous and with small hemorrhagic patches. The peritoneal surface is
congested.
(4) The upper portion of the intestine may show similar, changes as that of the stomach.
e. The liver is large, pale, and fatty in those cases which have survived for a length of time.
f. The kidneys are congested and swollen.
g. The urinary bladder contains greenish smoky urine.
h. The meninges and brain are usually congested.

G. Acute Arsenic Poisoning:

1. External Appearance:
a. The whole body may have a shrunken appearance.
b. The cutaneous surfaces, especially the hands and feet are cyanotic.
c. Putrefaction of the body is quite delayed.
2. Internal Appearance:
a. Cardio-Vascular System:
(1) Heart contains coagulated blood.
(2) Ecchymosis is frequently observed underneath the pericardium.

b. Respiratory System:
(1) The lungs are congested and sometimes edematous.
(2) Subpleural hemorrhages may be present.

c. Digestive System:
(1) Changes in the mouth, pharynx and esophagus are rare.
(2) The mucous membrane of the stomach is swollen and spongy with tenacious mucous
adhering. The mucous membrane may be thrown into rugae, often with a dark
red color. There may be petechial hemorrhages distributed all over. Crystals of
arsenic may be present.
(3) If death is delayed there may be inflammatory changes in the duodenum. The solitary
and Peyer's patches are swollen.
d. The liver may show cloudy swelling. If death did not occur within 24 hours, the organ may be
enlarged and pale.
e. There may be cloudy swelling of the cortex of the kidneys with numerous small hemorrhages.

H. Chronic Arsenic Poisoning:

1. External Appearance:
a. Body is emaciated.
b. Hair is scarce.
c. There is pigmentation of the skin with eczematous eruptions.
d. There is a yellowish-brown color of the skin.
e. Localized thickening of the epidermis is present.

2. Internal Appearance:
a. Cardio-Vascular System:
(1) Diffused fatty degeneration of the myocardium.
(2) Musculature is flabby, pale and friable.
 (3) Blood vessels are thick and dark in color.

b. Respiratory System:
(1) There may be ulceration of the nasal septum.
(2) Bronchitis may be present.
c. Digestive System:
(1) Tongue may be coated.
(2) Mucous membrane of the stomach is inflamed with ulcerative patches. The whole
surface is covered with tenacious mucous with blood or blood streaks.
(3) Mucous membrane of the duodenum and upper part of the jejenum, ascending colon
and rectum are inflamed.
(4) Peyer's patches are swollen and minute ulcerative areas are common.
d. The liver is enlarged and shows advanced fatty changes.
e. The kidneys are enlarged. On section, the cortex is swollen and pale.

I. Mercury (Perchloride and Nitrate Salts):

1. External Appearance:
If the salts (perchloride or nitrate) of mercury has been taken by mouth, it produces corrosion of
the epithelium and swelling of the lips.

2. Internal Appearance:
a. Digestive System:
(1) The mucous membrane of the mouth is softened, whitish and sodden-looking.
(2) The esophageal mucosa is corroded, softened and inflamed in patches.
(3) The muscular coat of the stomach is contracted and the mucous membrane is thrown
into folds. The surface is converted into a grayish-white layer. The mucous membrane is
reddened and with dark ecchymosis. There are areas of necrosis with white color and
those that are found at the cardiac and pyloric end are easily detached.
(4) The small intestine shows severe inflammation. It takes the form of diphtheritic
enteritis and this is most prominent at the cecum.
(5) The whole of the large intestine shows severe inflammation.
The mucous membrane is thickened and' the contraction of the muscles made it thrown
into folds.
The summit of the folds is converted into a grayishwhite necrotic layer. The rest of the
mucosa is deep red, swollen and soft.

b. Renal System:
Both kidneys are enlarged. Section shows that the cortex is pale, yellowish, and swollen.
The capsule strips easily and leaves a smooth pale surface. Hemorrhagic spots may be seen in the
cortex and on the outer surface.
If the victim survived for a time, he will later succumb to renal insufficiency. The pale
cortex is streaked with yellow due to fatty changes in the section, owing to the deposit of calcium
carbonate and phosphate.
c. When poisoning is due to mercurials administered by injection or absorbed through the skin or
mucous membrane, the changes in the stomach are slight although intense congestion may be
found.

J. Lead (Chronic poisoning):

1. External Appearance:
a. Emaciation.
b. Skin shows icterus.
c. Parotid glands are sometimes enlarged.
d. Wasting of the muscles of the shoulder, arm and forearm.
e. Gouty tophi and arthritis or simple effusion of fluid may be found in joints.

2. Internal Appearance:
a. Blood is thin and watery.
b. Cardio-Vascular System:
(1) Fibrosis of the myocardium.
(2) Interior of both auricles and ventricles is whitish and opaque in appearance.
(3) There may be some degree of atheroma of the aorta and large blood vessels.

c. Digestive System:
(1) Teeth are discolored and brown.
(2) Gums may show bluish line in their edges near the lower canines and incisors. The
gums may be ulcerated and softened.
(3) Stomach shows chronic gastric catarrh.
(4) Intestine is inflamed, contracted and thickened.
(5) Patches of pigmentation may be present in the mucous membrane of the large
intestine.
d. Renal System:
Kidneys resemble that of arteriosclerosis. They are smaller than their normal size. The
surface is granular, the granules are yellow separated by reddish depressions. The capsule is
opaque, thickened and possibly adherent. The cortex is somewhat reduced in size. There is an
increase in the pelvic fat.
e. Nervous System:
(1) The meninges of the brain are thickened.
(2) The pia-arachnoid is opaque and shows hemorrhagic spots.
(3) Convolutions of the brain are atrophied.
(4) Section of the brain shows that the gray matter of thecortex is narrowed.
(5) The blood vessels at the base of the brain show somethickening and are sometimes
rigid.
f. Hematopoietic Organs:
(1) The spleen may be somewhat atrophied and fibrotic.
(2) The bone marrow in the shaft of long bones is red owing to hyperplasia.
K. Phosphorus (Rat-poison, fireworks, match stick):
1. Cardio-Vascular System:
a. Heart is flabby and the musculature is pale, friable and fatty.
 b. The blood is dark and fluid.
2. Respiratory System:
a. Blood-stained fluid may be effused into the pleural cavity.
b. The lungs are congested.
c. There may be a subpleural hemorrhages.
3. Digestive System:
a. The stomach may show swollen grayish-white mucosa.
b. The intestine may also show the same changes as that of the stomach.
4. The liver may be enlarged, soft and doughy. The lobules may be easily seen. There is necrosis
of the liver cells and intense fatty changes.
5. There may be small hemorrhages in the omentum.
6. Renal System:
a. The kidneys are enlarged and soft.
b. The cortex is swollen, thickened and pale yellowish-gray in color.
c. Hemorrhagic! areas are present.
7. Meninges and brain are congested.
8. The skeletal system may show fatty changes, being pale and brownish.

L. Hydrocyanic Acid (Potassium and sodium cyanide):

1. External Appearance:
a. Rigor mortis sets in early and persists longer than usual.
b. Skin is bright pink in color.
c. Cyanosis of the skin may be present due to asphyxia.
d. Hypostasis is distinctly lighter in color than normal.
e. Face is pale.
f. Eyes are prominent and pupils are dilated.
g. Mouth and nostrils may show froth.
2. Internal Appearance:
a. Characteristic odor is emitted on opening of the abdomen.
b. Blood is bright red in color and coagulated.
c. Cardio-vascular System:
(1) Right side of the heart is distended with blood.
(2) Left ventricle is contracted and empty.
(3) Venous system is engorged with blood.
(4) Pericardium may show petechial hemorrhages.
d. Respiratory System:
(1) Larynx and trachea contain blood-tinged froth.
(2) Lungs are congested and edematous.
(3) Odor of bitter almond is perceptible.
(4) Subpleural petechial hemorrhages.
e. Digestive System:
(1) Mucous membrane of the pharynx, esophagus and stomach is apparently
normal, but may be congested.
(2) Subserous ecchymosis is present.
(3) If potassium cyanide is taken, the stomach may be wrinkled, reddish-brown in
color and the blood vessels in the wall are distended.
f. Congestion with edema of the brain.
g. Other organs do not show any gross changes.