forensic medicine and toxicology

1. DELIRIANT POISONS DR.BALAMURUGAN
INSTITUTE OF FORENSIC MEDICINE

3. DATURA FASTUOSA
 Datura (sanskrit) cheat
 Is a genus of vespertine
flowering plants
belonging to the family
solanacae
 Grows on waste land
all over India.
 SPECIES-
Datura. Metel
Datura. Stramonium .
 D. Metel has two
varities
Datura alba
Datura niger

4.  Datura alba (white
flowered)
 Datura niger (deep
purple flowered)

5. DATURA PLANT
 Plant: leafy herb with a
woody stalk that grows
up to 5 feet tall.

6. FLOWER
 BELL SHAPED
 FIVE PETALS

7. FRUIT(THORN APPLE)
 SPHERICAL SHAPE
 HAVING SHARP
SPINES

8. SEEDS
 DARK ORYELLOWISH-
BROWN KIDNEY
SHAPED RESEMBLING
CAPSICUM SEEDS.
 450TO 500 SEEDS IN A
FRUIT
 100 SEEDS WEIGHING
ABOUT 1 GRAM
 SEEDS AND FRUIT
MOST TOXIC

10. DATURA VS CAPSICUM SEEDS

11. TRAIT Capsicum Datura
size Small and thin Large and thick
Shape Rounded Kidney shape
surface smooth pitted
Odour Pungent Odourless
Taste Pungent Bitter
Cut section Embryo curves inwards
towards the hilum
Embryo curves outwards
Margins Convex border simple and
sharp
Laterally compressed , double
edged

12. ACTIVE PRINCIPLES
 Scopolamine (0.2-1.4%
hyoscine)
 Hyoscyamine
 Traces of atrophine
 Alkaloids:
competitively inhibit
the muscuranic effect
of Ach
 SIGNS AND
SYMPTOMS
 Contact with leaves or
flowers- Dermatitis in
sensitive persons
 Pollen can cause
unilateral Mydriasis
(CORNPICKER’S
PUPIL)
 Delirium

13. 8 D’s
 Dryness of the mouth
and throat
 Difficulty in talking
 Dysphagia
 Dilatation of pupils
 Dry hot skin
 Drunken gait
 Delirium
 Death

14. SIGNS
 Pulse- 120 -140/min , full bounding
 Volume-weak and Rhythm-irregular
 BP – raised
 R/R- increased
 Temp- increased (hyperpyrexia ) to 2 or 3
degree
 Muscle tone and deep reflexes- increased
with positive Babinski’s sign

15.  FATAL DOSE- 0.6 -1.2
gram (100-125 seeds)
 FATAL PERIOD-24 hrs
 TREATMENT;1)emetics
 2)gastric lavage- datura
seeds may be recovered
from stomach after even
36 hours
 Activated charcoal
 Physostigmine 1mg i.v or
i.m at 1 hr interval. usually
single dose is sufficient.
 Morphine is to be avoided
–depressing the respiratory
center.
 Light diet and purgatives
required for 3-4 days to
remove the seeds and
increase the intestinal
motility
 Symptomatic-iv diazepam

16. POST MORTEM APPEARANCES
 Insignificant
 Stomach and intestines- walls- inflammed
fragments of seeds and plant may be found.
Seeds resist putrefaction for a long time.
 Lungs- edematous
 Mydriatic test

17. Medico legal importance
 Suicidal and homicidal poisoning: very rare
 Datura seeds are generally used by robbers
to stupefy travellers ( ROAD POISON) and
rarely used as abortifacient .
 Accidental poisoning: occurs among
children and adults by eating raw datura
fruits as edible fruits and eating their seeds
as capsicum seeds
 A person suffering from delirium of datura
is not criminally responsible for his acts
 Aphrodisiac
 Love philter

18. ATROPHA BELLADONA AND
HYOSCYAMUS NIGER
 Deadly night shade is
a plant of europe and
asia
 All parts are toxic
 Active principle- 1-
HYOSCYAMINE
 FATAL DOSE-
120mg atrophine or
hyoscyamine and
30mg of hyoscine .
 FATAL PERIOD: 24 hrs.
 Signs ,symptoms ,PM
appearances
,treatment are simillar
to datura .

19. ATROPHA BELLADONA HYOCYAMUS NIGER

21. CANNABIS INDICA/
SATIVA(INDIAN HEMP)
 It’s cultivation is restricted and controlled by government.
 The female plant is taller , is darker and has more cluster
of leaves than the male plant
 ACTIVE PRINCIPLE: RESIN
 CANNABINOL
 CANNABIDIOL
 TETRAHY-DROCANNABINOLS

22.  CNS STIMULANT
 PSYCHOACTIVE DRUG
 METABOLISHED IN
LIVER AND EXCRETED
IN URINE AND FAECES
 MOST WIDELY USED
ILLICIT DRUG INTHE
WORLD

23. VARIOUS FORMS
 Bhang /siddhi/ sabji
 It is prepared from the
dried leaves and fruit
shoots. It is mildest
form of cannabis and
contain 15% active
principle.
 Fresh bhang is highly
intoxicating and
narcotic. bhang kept in
storage for 2 to 3 years
is mildly stimulating
and pleasure giving.

24.  MAJUN(MAJOON):
A sweet made from
bhang, after treating it
with sugar, flour, milk
and butter. Used as
appetizer and
aphrodisiac

25.  Ganja : Prepared from
flowering tops of the
female plant . It has a
rusty green colour
characteristic odour. It
is mixed and smoked
with tobacco in a pipe
or hukka . contains 15-
25% active principle.
Ganja (marihuana)
used for smoking in
cigerattes , contain 0.3
to 0.6 g cannabis
known as Reefer or
joint.
 .

26.  Charas or hasish: Its a
resin (dope or shit), a
dark green or brown
colour concentrated
gum extract of leaves
and stem of a plant .
25% to 40 % of active
principle.The smoke is
deeply inhaled into
lungs.

27. ACUTE POISONING
 symptoms occur soon
after smoking lasts 1-2
hrs ,swallowing half-
an-hour to 2-3hrs to
it’s ingestion.
 Small dose:
Euphoria
passivity
disorientation
 Moderate dose:
impaired immediate
memory function
disturbed thought
pattern , lapses of
attention,
unfamiliarity.
 High dose:
changes in body image
depersonalisation
marked sensory
distortion

28. symptoms of intoxication
Psychiatric:
Feelings of detachment
Irrelevant thought process
Vivid images , illusion
hallucination
Feeling of precordial distress and
fear of dying
Altered concepts in time and
space
During the so called ’trip’ due to
distortion of perception ,users
feels they could fly from high
windows or stop passing buses
by bare hands.
 Physical:
 increased appetite, thirst
nausea , heaviness ,
pressure in head , dizziness
dysthesia somnolence
polyuria tachycardia
tremor.
 characteristic odour-
smoked manner
 sensitive persons-paranoid
–even low dose
 Death -rarely

29.  FATAL DOSE:charas
2g;ganja 8g/kg ,THC
30mg/kg
 FATAL PERIOD: several
days
 TREATMENT: 100ml of
50% glucose,2mg of
naloxone,100mg of
thiamine i.v. 5 to 10mg
of diazepam if pt is
violent and aggressive
flashback-anti-anxiety
psychotheraphy
 PM APPEARANCES:
INSIGNIFICANT , but
are those of asphyxia

30. CHRONIC POISONING
 Characterized by: loss of appetite,
generalized weakness, emaciation, loss of
concentration
 Muscular incoordination and lack of sexual
power
 Gynaecomastia in males
 Moral and mental deterioration, toxic
psychosis , they become insane (hasish
insanity)
 Heavy marijuana users –manic or paranoid
psychosis
 Chronic use –amotivational syndrome

31. RUNAMOK
 Psychic disturbances
marked by a period of
depression followed by
violent attempt to kill
people(impulse to
murder or homicidal
mania) untill
homicidal tendency
lasts.Then he may
commit suicide or
calmly surrender.

32. MEDICOLEGALIMPORTANCE
 Poisoning –over
indulgence may
accidental inhalation or
ingestion
 Majun and charas –may
used as road poison or
stupify agent
 It sometime taken by
criminal before
committing crime , to
strengthen the nerves
 Aphrodisiac
 Ascetics and religious
medicants often take
cannabis to overcome
hunger ,thirst and
believe that it helps
concentration of mind
 Fakirs often believe
bhang frees them from
worldly attachment and
brings about
participation with divine
spirit.

33. ERYTHROXYLUM COCA VAR

34. Cocaine(coke,snow,cadillacwhitelady)
 Obtained from leaves
erythroxylum coca –
grows in south america
,india , java.
 Contain 0.5-1% of
cocaine
 Colourless , odourless ,
crystalline substance
having a bitter taste
 Contains alkaloids like
ecgonine , hygrine,
cinnamyl cocaine
 Local anaesthetic
 Crack –baking soda
and water , suitable
for smoking

35.  Action
 Vasoconstriction
 Powerful CNS stimulant-
depressant
 Action simillar to
amphetamine
 Euphoric effect –
stimulating pleasure
center of brain (release
of dopamine,serotonin
 Sympathomimetic
property
 Cocaine amphetamine
nicotine,barbiturates –
can be found in
stomach even given in
parenterally .
 Absorption and
excretion
 Rapidly by mucous
membranes and s.c.
tissues
 Route –nasal mucosal
membrane(snorting),i.v.,
smoked.
 Hydylosed by liver
 Biological half life -1/2 to
1 hr
 Immediately appear on
urine

36. SIGNSANDSYMPTOMS
 Onset of action ;
 Inhalation-with in 1-3 mins
 I.V. or smoked –acts in seconds ,peak in 3-5
mins
 Topically – 20- 30 mins
 Ingested orally -60-90 mins
 Action is short , taken every halt to one hour
to maintain a high.

37.  STAGE OF
EXCITEMENT
 Pt may excited , talk
active ,restless
 Rapid pulse and deep
respiration , dilated
pupil, headache , pallor
of skin , cyanosis.
 Hypertension –cerebral
bleeding
 Reflexes are exaggerated
 Tingling and numbness
of hands and feet.
 STAGE OF
DEPRESSION
 with in hour or less
respiration become
feeble perspiration
collapse , convulsion
death.
 Sudden death occur by
arrhythmias due to direct
action an myocardium
and c.p. arrest
 Foetal death and
abortion can occur.
 Developmental ,
behavioural ,learning
problem.

38. SPEEDBALL
 Large doses or a binge
may result in anxiety or
panic leading to paranoia.
 A combination of cocaine
and heroin taken by
injection is known as
“SPEED BALL”
 The person may die
suddenly and
unexpectedly during or
immediately after a
struggle.

39.  FATAL DOSE: One
gram orally , procaine
is about half as toxic as
cocaine , butacaine is
twice , dibucaine five to
ten times.
 FATAL PERIOD: Few
mins to few hours
 COMPLICATIONS:
Sub arachanoid ,intra
cerebral hemorrhage ,
myocardial infarction
skin necrosis , aortic
dissection ,pulmonary
infarcts
 TREATMENT: Gasric
lavage ,wash mucous
membrane, apply
ligature above the
injection site ,
convulsion controlled
by short acting
barbiturates , AMYL
NITRATE (
inhalational) , A B C
,thiamine 100 mg I .v. ,
naloxone 2mg

40. pmappearances
 Intense asphyxial signs
 Pulmonary congestion, oedematous weighing 3
to 4 times than normal.
 Heart show foci of scarring –source of fatal
arrythmia
 Cocaine decomposes rapidly
 Blood should be preserved by adding fluoride
 Brain should be analysed ,it does not hydrolyse
the cocaine into benzyl ecognine as in blood.
 Cocaine can be recovered from recent injection
site and nasal swabs.

41. Cocaine habit or cocainism:
 Chronic abusers can
tolerate 10 gms a day
 Face pale, eyes sunken
pupils dilated, gaze
shifting,
 Blackening of tongue and
teeth
 Anorexia ,salivation,
tachycardia, tachypnoea
Insomnia
 Sometimes manic ,panic,
depressive psychosis
develops ( cocaine
psychosis or excited
delirium)
 Complication :
 Nasal erosions , persistent
rhinitis, chronic bronchitis ,
sniffing causes ulceration
of nasal mucosa
,perforations rare
 Degeneration CNS –
hallucination, delirium,
convulsions, insanity.

42. Magnan”s symptoms or cocaine
bugs:
 There is a feeling is if
grains of sand are lying
under the skin or some
small insects are
creeping on the skin to
create itching
sensation(formication
tactile hallucination)
with resultant
excoriation , leading to
irregular scratches ,
ulcers .

43.  It is a drug of addiction
that lowering moral tone
loss of decency and self
respect.
 Cocaine substitute are
not habit forming.
 MEDICO LEGAL
IMPORTANCE:
 Rarely used as homicide
or suicide
 Accidental cases –
addiction , hypodermic
injection , urethral ,rectal
, vesical injection .
 Aphrodisiac
 Prostitutes sometime
inject cocaine solution
into vagina to produce
local vaso constriction.

44. THANK YOU
“ALL SUBSTANCES ARE POISONS;THERE IS NO
SUCHTHING AS A NON POISON”-PARACELSUS