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Criminal Mischief: Episode #16: Arsenic: An Historical and Modern Poison

Arsenic

Criminal Mischief: Episode #16: Arsenic: An Historical and Modern Poison

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From HOWDUNNIT:FORENSICS

Toxicology is a relatively new science that stands on the shoulders of its predecessors: anatomy, physiology, chemistry, and medicine. Our knowledge in these sciences had to reach a certain level of sophistication before toxicology could become a reality. It slowly evolved over more than two hundred years of testing, starting with tests for arsenic. 

Arsenic had been a common poison for centuries, but there was no way to prove that arsenic was the culprit in a suspicious death. Scientist had to isolate and then identify arsenic trioxide—the most common toxic form of arsenic— in the human body before arsenic poisoning became a provable cause of death. The steps that led to a reliable test for arsenic are indicative of how many toxicological procedures developed. 

1775: Swedish chemist Carl Wilhelm Scheele (1742–1786) showed that chlorine water would convert arsenic into arsenic acid. He then added metallic zinc and heated the mixture to release arsine gas. When this gas contacted a cold vessel, arsenic would collect on the vessel’s surface. 

1787: Johann Metzger (1739–1805) showed that if arsenic were heated with charcoal, a shiny, black “arsenic mirror” would form on the charcoal’s surface. 

1806: Valentine Rose discovered that arsenic could be uncovered in the human body. If the stomach contents of victims of arsenic poisoning are treated with potassium carbonate, calcium oxide, and nitric acid, arsenic trioxide results. This could then be tested and confirmed by Metzger’s test. 

1813: French chemist Mathieu Joseph Bonaventure Orfila (1787–1853) developed a method for isolating arsenic from dog tissues. He also published the first toxicological text, Traité des poisons (Treatise on Poison), which helped establish toxicology as a true science. 

1821: Sevillas used similar techniques to find arsenic in the stomach and urine of individuals who had been poisoned. This is marked as the beginning of the field of forensic toxicology. 

1836: Dr. Alfred Swaine Taylor (1806–1880) developed the first test for arsenic in human tissue. He taught chemistry at Grey’s Medical School in England and is credited with establishing the field of forensic toxicology as a medical specialty. 

1836: James Marsh (1794–1846) developed an easier and more sensitive version of Metzger’s original test, in which the “arsenic mirror” was collected on a plate of glass or porcelain. The Marsh test became the standard, and its principles were the basis of the more modern method known as the Reinsch test, which we will look at later in this chapter. 

As you can see, each step in developing a useful testing procedure for arsenic stands on what discoveries came before. That’s the way science works. Step by step, investigators use what others have discovered to discover even more. 

Acute vs. Chronic Poisoning 

At times the toxicologist is asked to determine whether a poisoning is acute or chronic. A good example is arsenic, which can kill if given in a single large dose or if given in repeated smaller doses over weeks or months. In either case, the blood level could be high. But the determination of whether the poisoning was acute or chronic may be extremely important. If acute, the suspect list may be long. If chronic, the suspect list would include only those who had long-term contact with the victim, such as a family member, a caretaker, or a family cook. 

So, how does the toxicologist make this determination? 

In acute arsenic poisoning, the ME would expect to find high levels of arsenic in the stomach and the blood, as well as evidence of corrosion and bleeding in the stomach and intestines, as these are commonly seen in acute arsenic ingestion. If he found little or no arsenic in the stomach and no evidence of acute injury in the gastrointestinal (GI) tract, but high arsenic levels in the blood and tissues, he might suspect that the poisoning was chronic in nature. Here, an analysis of the victim’s hair can be invaluable. 

Hair analysis for arsenic (and several other toxins) can reveal exposure to arsenic and also give a timeline of the exposure. The reason this is possible is that arsenic is deposited in the cells of the hair follicles in proportion to the blood level of the arsenic at the time the cell was produced. 

In hair growth, the cells of the hair’s follicle undergo change, lose their nuclei, and are incorporated into the growing hair shaft. New follicular cells are produced to replace them and this cycle continues throughout life. Follicular cells produced while the blood levels of arsenic are high contain the poison, and as they are incorporated into the hair shaft the arsenic is, too. On the other hand, any follicular cells that appeared while the arsenic levels were low contain little or no arsenic. 

In general, hair grows about a half inch per month. This means that the toxicologist can cut the hair into short segments, measure the arsenic level in each, and reveal a timeline for arsenic exposure in the victim. 

Let’s suppose that a wife, who prepares all the family meals, slowly poisoned her husband with arsenic. She began by adding small amounts of the poison to his food in February and continued until his death in July. In May he was hospitalized with gastrointestinal complaints such as nausea, vomiting, and weight loss (all symptoms of arsenic poisoning). No diagnosis was made, but since he was doing better after ten days in the hospital, he was sent home. Such a circumstance is not unusual since these types of gastrointestinal symptoms are common and arsenic poisoning is rare. Physicians rarely think of it and test for it. After returning home, the unfortunate husband once again fell ill and finally died. 

As part of the autopsy procedure, the toxicologist might test the victim’s hair for toxins, and if he did, he would find the arsenic. He could then section and test the hair to determine the arsenic level essentially month by month. If the victim’s hair was three inches long, the half inch closest to the scalp would represent July, the next half inch June, the next May, and so on until the last half inch would reflect his exposure to arsenic in February, the month his poisoning began. Arsenic levels are expressed in parts per million (ppm).

An analysis might reveal a pattern like that seen in Figure 11-1. 

IMAGE in HOWDUNNIT: FORENSICS

 The toxicologist would look at this timeline of exposure and likely determine that the exposure occurred in the victim’s home. The police would then have a few questions for the wife and would likely obtain a search warrant to look for arsenic within the home. 

LINKS: 

Arsenic Poisoning (2007): CA Poison Control: https://calpoison.org/news/arsenic-poisoning-2007

Arsenic Poisoning Cases Wikipedia: https://en.wikipedia.org/wiki/Arsenic_poisoning_cases

Arsenic” a Murderous History: https://www.dartmouth.edu/~toxmetal/arsenic/history.html

Facts About Arsenic: LiveScience: https://www.livescience.com/29522-arsenic.html

Poison: Who Killed Napolean?: https://www.amnh.org/explore/news-blogs/on-exhibit-posts/poison-what-killed-napoleon

Victorian Poisoners: https://www.historic-uk.com/HistoryUK/HistoryofEngland/Victorian-Poisoners/

12 Female Poisoners Who Killed With Arsenic: http://mentalfloss.com/article/72351/12-female-poisoners-who-killed-arsenic

 

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What’s the Deal with Typhus?

Ever heard of Typhus? Probably in history class, or something similar. It reared its head many times during the Middle Ages and helped take down Napolean’s Grand Army in 1812. Many believe that as much as one-third of his army succumbed to the disease. It pops up here and there from time to time. Like now. Seems LA has a Typhus problem and it’s centered around City Hall.

Typhus is what we call a Rickettsial disease since it is caused by a bacterium known as Rickettsia typhi—-at least the form that comes from fleas is. A Rickettsial disease you’ve likely heard of is Rocky Mountain Spotted Fever (RMSF). There are several types of Typhus, each caused by a different bacterium and spread by a different vector. Scrub Typhus is carried by mites, Endemic Typhus by lice, and the one that’s affecting LA is Murine Typhus, which is carried to humans by fleas from infected rats.

Flea

When an infected vector bites a human, the bacterium enters the body and spreads. A week or two later the victim will develop fever, chills, and headaches. Sometimes GI symptoms such as nausea, vomiting, and abdominal pain occur. Not unlike a bad flu. Then, a few days later, the rash appears. 

Typhus-murine

If untreated, the disease can cause severe damage to the kidneys, liver, lungs, heart, brain, and can lead to death. But once diagnosed, the treatment is rather easy. The antibiotic doxycycline, sometimes ciprofloxacin, kills the rickettsial bacterium quickly and efficiently.

Right now, LA is treating the infected and trying to figure the best way to clear the rodents and fleas from City Hall. It’ll be a big job.

Typhus Wikipedia: https://en.wikipedia.org/wiki/Typhus

Typhus in LA: http://www.newser.com/story/271086/city-hall-faces-medieval-illness.html

Napolean and Typhus: https://qcurtius.com/2017/07/16/the-victory-of-general-typhus-napoleons-catastrophic-invasion-of-russia/

Typhus WebMD: https://www.webmd.com/a-to-z-guides/what-is-typhus#1

Murine Typhus CDC: https://www.cdc.gov/typhus/murine/index.html

 
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Posted by on February 11, 2019 in Medical History, Medical Issues

 

Criminal Mischief: The Art and Science of Crime Fiction: Episode 11: Civil War “Limb Pit” and the History of Infectious Diseases

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Criminal Mischief: The Art and Science of Crime Fiction Podcast:https://soundcloud.com/authorsontheair/limb-pits-and-germ-theory

Past Criminal Mischief Podcasts: http://www.dplylemd.com/criminal-mischief.html

Here in the 21st century we know a great deal about infectious diseases. We can treat bacterial infections with antibiotics, immunize people against numerous diseases, understand how viruses work, and have a huge fund of knowledge about surgical sterility and disease prevention. This was not always the case. In fact, in the history of medicine, all of this is fairly new.

During the 14th century, Europeans didn’t understand infectious diseases so when the Bubonic Plague, also known as the Black Death, struck, they had no understanding of what was going on, how to prevent it, and, more importantly, how to treat it. They were at the mercy of a bacterium that currently is easily treatable. The Black Death killed between a third and a half of the population of Europe and dramatically altered the trajectory of world history.

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The transition from ignorance to enlightenment concerning infectious processes was a long process and involved some of the giants of medicine. Names like Ignaz Semmelweis, John Snow, Louis Pasteur, Joseph Lister, and Robert Koch. The observations of these famous scientists were ultimately distilled into Robert Koch’s famous Koch’s Postulates, which proved the Germ Theory of disease. These postulates served as the foundation for our understanding of infectious diseases, and still do today. Simply put they say:

koch_s postulates(1884)

!-If an organism is causing a disease, it must be present in those who suffer from the disease and not in those who are healthy.

2-The suspected organism must be isolated from the diseased individual and grown in culture.

3-The cultured organism must then be given to a healthy individual and reproduce the disease.

4-The organism must then be isolated from this newly diseased individual and identified.

Each of these steps is necessary to show that a particular organism causes a particular disease and is transmissible from one person to another. Basically, this is how infectious diseases work.

Unfortunately, Koch’s Postulates were not put forward until the 1880s, a couple of decades after the Civil War.

During the Civil War, almost any battlefield injury could lead to death, most often from a secondary wound infection. A gunshot to the leg, or arm, or really anywhere could become infected quite easily and this infection could spread through the entire body causing sepsis, which would ultimately lead to death. More soldiers died from infection than from their injuries. Surgeons at that time understood the danger of infections, even though they didn’t know what caused it, and had no clue how to prevent or treat them. This meant that serious limb injuries were treated with amputation. Get rid of the injured limb and hopefully lessen the possibility of a secondary infection. Of course, post-surgical infections were also common and also lead to death.

Not only were sterile techniques and antibiotics unavailable at that time, but also any form of anesthesia was not to be found on most battlefields. Ether was around, having been first demonstrated by William T. G. Morton in 1846, but it’s use and availability wasn’t widespread. This means that a battlefield surgeon’s best skill was speed. Sort of the surgical equivalent of “ripping off the Band-Aid.” Any surgery was agony and the quicker it was done, and the sooner it was over, the better for the victim. And the amputated limbs piled up.

It seems that Virginia’s Manassas National Battlefield Park has yielded what can only be called a “limb pit.” It is a place where surgeons deposited removed limbs. This discovery underlines the state of surgical treatment and its brutal nature during the 1860s.

http://www.newser.com/story/260874/first-civil-war-limb-pit-is-excavated.html

Germ Theory: https://en.wikipedia.org/wiki/Germ_theory_of_disease

Koch’s Postulates: https://en.wikipedia.org/wiki/Koch%27s_postulates

Joseph Lister: https://en.wikipedia.org/wiki/Joseph_Lister

Ignaz Semmelseis: https://en.wikipedia.org/wiki/Ignaz_Semmelweis

John Snow: https://en.wikipedia.org/wiki/John_Snow

Louis Pasteur: https://en.wikipedia.org/wiki/Louis_Pasteur

William T.G. Morton: https://en.wikipedia.org/wiki/William_T._G._Morton

History of General Anesthesia: https://en.wikipedia.org/wiki/History_of_general_anesthesia

 

Cancer Isn’t a Modern Disease

What is cancer? You know the term and odds are great that you know someone personally who has suffered from a member of this constellation of diseases. But what exactly is it?

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Cancer is basically a genetic disease in that something changes in the DNA inside certain cells and this, in turn, disrupts their normal functions. These changes might result in uncontrolled growth and this can cause problems simply by the tumor’s size and location. The cancerous tissues might obstruct a bowel or a bile duct, or compress brain cells and increase the pressure inside the cranium, or erode into nearby organs of blood vessels. Others changes within these cells might alter their internal workings so that they no longer function as intended or they might produce chemicals or hormones that alter the function of other cells within the body. Cancer comes in many forms.

cancer-cells-growing

What causes cancer? This has been the subject of debate, as well as a tremendous amount of research, for many many years. We have some answers, but there are even more questions. We know that things such as cigarette smoking, exposure to the sun, certain chemicals, and many other things can trigger these genetic changes within cells that can lead to cancers of various types.

Medicine has made tremendous strides in our understanding of cancer and in our methods of early detection, diagnosis, and treatment. There are programs for the early detection of breast and colon cancer and newer treatment protocols have revolutionized the approach to these malignancies. The progress in leukemia and lymphoma treatment, as compared to when I was in medical school, has been nothing short of astounding. 

We often think of cancer as a modern scourge, but cancer is not a new disease. Not by a long shot. It’s been around for many centuries. Evidence for cancers have been found in Egyptian mummies and a recent report from Live Science underscores that.

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Did “Tourista” Kill the Aztecs?

Many people who travel to other countries end up suffering from Tourista, or Traveler’s Diarrhea, a gastrointestinal upset that is manifested by diarrhea and sometimes nausea and vomiting. It’s due in many cases to E. coli, which is found everywhere. Various regions will have different strains of E. coli. Residents of the area are able to live quite compatibly with it. The problem arises when you travel to a new area and are exposed to a different strain. Until the body readjusts to this foreign strain, gastrointestinal symptoms can occur. Usually, this is mild and inconvenient and after a few days everything settles down and life goes on.

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Not so with the Aztecs. In 1545, an epidemic swept through the Aztec nation killing millions, perhaps as much as 80% of the population. Twenty years earlier an epidemic of smallpox had come through and damaged the population and 20 years later another epidemic swept through killing another huge portion of the population. There have been many infectious processes indicted for the 1545 plague, which the Aztecs called cocoliztli. Smallpox, measles, mumps, and various other infectious entities have been blamed for this. But what if it was actually a gastrointestinal bacterium that did the damage?

The symptoms the victims suffered seem to have been gastrointestinal. Apparently, there was bleeding, vomiting, diarrhea, and splotches on the skin. These symptoms and signs suggest a form of enteritis and that’s exactly what the bacterium salmonella does.

New evidence suggests that it might be a strain of salmonella that caused this problem, in particular, salmonella Paratyphi C. Genetic research using DNA obtained from the teeth of those who succumbed to the epidemic indicate that this might be the case. Where it came from is another question. Did it come with the influx of Europeans? Or perhaps extend south from northern Mexico? This is still being debated and researched but it does appear that salmonella may have been the culprit in the epidemic that destroyed the Aztec Empire.

Salmonella has been responsible for other public health crises, one of the most famous being Mary Mallon, aka  Typhoid Mary. In this situation, the type of salmonella was salmonella typhi, which causes typhoid fever.

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The Mystery of Chopin’s Heart

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Did Frederic Chopin die from Tubercular Pericarditis? And what the heck is that anyway?

Pericarditis is an inflammation has occurred of the pericardium, the sac that contains the heart. Most often it is due to a viral infection but there are many others causes. One of the worst is tuberculosis (TB).

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Tubercular Thickening of the Pericardium

 

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X-Ray Showing Thickened Pericardium
(White ring around heart shadow)

Tuberculosis has wreaked havoc in humans for centuries. It has been found in Egyptian mummies and has devastated entire populations. Treatment didn’t appear until the 20th century and in recent years new, more malignant forms have appeared. Even after several millennia, it remains a difficult medical problem.

It attacks the lungs and slowly destroys the tissues, leading to cough, fatigue, weight loss, and muscle wasting—-the reason it was called “the consumption.” It, at times, literally consumed the sufferer.

When it spreads to the heart, particularly the pericardium, it can quickly become deadly. A thick viscous fluid collects in the pericardial sac, compresses the heart, and interferes with its function as a pump. This fluid can also solidify into a leathery trap around the heart so that even survivors of the initial infection can suffer severe, long-term problems that we term constrictive pericarditis—-the encasement restricts cardiac filling and thus effects pumping.

Recent studies suggest that this is what happened to Chopin. His heart took a strange and convoluted journey. He had requested that at his death that his heart be removed and returned to his native Warsaw, Poland. When he died in Paris in 1849, his heart was indeed removed, placed in a crystal jar, and encased in a stone pillar at the Holy Cross Church in Warsaw. In a recent examination, researchers found evidence that suggested he had suffered from TB pericarditis.

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Holy Cross Church

 

Burking Still Lives After 200 Years

Asphyxia is the interruption of oxygen (O2) supply to the body, particularly the brain. Normally, air contains O2 and, when breathed in, it passes into the blood, using hemoglobin as a transport molecule, where it is distributed to the tissues. Any interruption of this delivery chain can lead to death from asphyxia.

The air might be deficient in oxygen such as at high altitude or when another gas such as carbon dioxide (CO2) accumulates, depressing the O2 content to dangerous levels. Or flow into the mouth and nose could be restricted by smothering, choking, or strangulation, or by anything that restricts the expansion of the chest. Or the inhaled air could contain a toxin such as carbon monoxide (CO) or cyanide (CN), and these, in turn, interfere with O2 delivery to the tissues.

Burking is the term applied to asphyxial deaths that result from someone sitting on another in a fashion that restricts breathing. The victim dies from asphyxia. This is a form of Mechanical Asphyxia, where the movement of the chest wall is restricted to the point that breathing isn’t possible. Burking refers to the famous case of Burke and Hare.

 

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From FORENSICS FOR DUMMIES:

Applying Pressure: Mechanical Asphyxia

Mechanical asphyxia results when some external force applied to the body prevents the expansion of the chest and leaves the victim unable to breathe. A person trapped beneath a heavy object, such as a car or a collapsed wall or ceiling, can die because the force of the external pressure prevents the victim from taking in a breath.

A boa constrictor kills in exactly this way. This muscular species of snake wraps itself around its prey. Each time the prey exhales, the snake coils a little tighter. So, each successive breath becomes increasingly shallower until the prey can’t take another breath. Death follows quickly.

 

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Suffocation by “Burking” 

Experts have come to know a particular form of mechanical suffocation as Burking. William Burke was a merchant of sorts around Edinburgh, Scotland, in the early 1800s. In 1827, he hooked up with William Hare, who ran a beggars hotel in the village of Tanners Close. In December of that year, a resident of the hotel died, and Burke arranged to sell the body to a Dr. Knox, who needed corpses for his dissection demonstrations. Burke and Hare loaded a coffin with bark and buried it in front of many witnesses. They then delivered the body to Dr. Knox and received seven pounds and ten shillings. The men struck an arrangement whereby Burke and Hare would deliver the doctor more bodies for eight pounds in summer and ten in winter. (Apparently grave robbing was more difficult when the ground was cold.)

Burke and Hare began digging up fresh corpses for their new enterprise, but the local populace refused to die fast enough for the greedy men. They began kidnapping and killing people who were not likely to be missed. Burke sat on his victims, holding their mouths and noses closed until they suffocated, after which Burke and Hare delivered the corpse and collected their fee.

A lodger at the hotel notified authorities when she discovered the sixteenth and last victim beneath a bed. Police arrested the two men. Hare then cut a deal and testified against Burke. Burke was convicted and experienced asphyxia for himself when he was hanged on January 28, 1829, an event attended by as many as 40,000 people.

 

Burking is alive nearly 200 years later. It seems that 325-pound woman sat on her 9-year-old cousin to punish her for some indiscretion. Unfortunately, the child died from mechanical asphyxia—-“Burking.”

 
 
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