CHAPTER 6

Asphyxia
At the end of this chapter, the student will be able to:

Define asphyxia

Enumerate the common causes of asphyxia

Identify the major classifications of asphyxia

Distinguish Suffocation, Smothering, and Choking from one

another

Describe the indicators that help determine the cause of

drowning

Differentiate between Suicidal and Homicidal Asphyxia.

The word asphyxia is of Greek derivation and means
"without a pulse." It refers to a condition of severely
deficient supply of oxygen to the body, which arises from
being unable to breathe normally. It may be described as
interference with respiration due to any cause like
mechanical, environmental, or toxic. Any death is asphyxial
in nature because all bodies deoxygenate after death.
However, in modern forensic medical practice, asphyxia
means interference with the natural exchange of oxygen and
carbon dioxide in the body. Many medico-legal death
investigations involve mechanical asphyxia, or the physical
interference with breathing and/ or circulation. oxygen,
When the respiratory function of lungs stops as a result of
lack of it causes failure of heart and brain due to oxygen
deprivation. This mode of death can be due to any of the
following causes (Sharma, 2011, p. 39):
1. Mechanical obstruction to air passage (e.g., impaction of foreign bodies,
bronchospasm, suffocation, drowning) or external pressure to close air passages
(e.g., hanging, strangulation, smothering);

2. Being at a higher altitude where oxygen is deficient;

3. Poisoning (e.g., cyanide) resulting in the interference in the utilization of oxygen at

cellular level;

4. Penetrating injuries of the chest causing the collapse of lungs or chest muscles;

5. Pulmonary embolism, tetanus and cold that lead to asphyxia; and

6. Ingestion of poisons, such as strychnine, barbiturates, and opium.

The transfer of oxygen that can be compromised in
asphyxia is separated into the following four phases
(Prahlow & Byard, 2012, p. Spuf 633):

1. Decreased amounts of oxygen in the

environment;

2. Reduced transfer from the air to the blood;

3. Reduced transport from the lungs to the tissues;

and

4. Reduced transfer across cell membranes.

Deaths caused by asphyxia can be broadly classified
depending on the mechanisms of death where
respiration/ventilation is affected, including those listed
below (Walker, Milroy, & Payne-James, 2005, p. 151):

1. Suffocation deprivation of oxygen, either from a lack of

oxygen in the surrounding environment or obstruction of
the upper airway

2. Smothering - mechanical obstruction of the flow of air from

the environment into the mouth and nose

3. Strangulation pressure using one or both hands when the

term throttling may occur by ligature, or by manual may be
used

4. Choking - usually occurs when a foreign object becomes

lodged in the throat or windpipe blocking the flow of air
5. Garroting - to achieve the strangulation of a person
where an iron collar is being placed around the neck and
tightened by a screw driver

6. Chest compression due to fixation of the external chest

wall as a result of crushing

7. Hanging - by another, deliberate self-harm, or autoerotic

asphyxia

These terms are interrelated, the use of which can be

misleading when used too rigorously. Rather, emphasis
should be placed on having a clear description of the cause
of deprivation of oxygen or prevention of
respiration/ventilation and the findings associated with
each episode.
Suffocation

Suffocation refers to the exclusion of air from the lungs by means other than
compression of neck, such as through entrapment in an airtight enclosure with
inadequate oxygen in the environment. It is the most common term used for deaths
associated with reduced availability of oxygen as well as in cases where other
nontoxic irrespirable gases are encountered. This could happen to a homicide victim
who is left to die while tied up in a confined space, or a child who enters a self-
locking fridge or box while playing hide-and-seek then finds no mechanism of
escape. In a submarine, an increase in carbon dioxide can result in central nervous
system depression and respiratory collapse. Carbon dioxide poisoning can also occur
when infants are placed in a sleeping position that puts them at risk of rebreathing
carbon dioxide. There are also toxic gases, such as carbon monoxide, cyanide and
hydrogen sulfide, which can cause rapid collapse and sudden death when high
concentration is present in an enclosed space (Walker, Milroy, & Payne-James,
2005). Another form of suffocation involves the creation of a local hypoxic
environment within a plastic bag securely fastened around the head. This could
occur as a deliberate suicidal act, or accidentally by children. The decedent's face is
usually pale when the bag is removed. The term suffocation can also broadly refer
to cases of entrapment, suffocating gases, smothering, choking, mechanical
asphyxia, and traumatic asphyxia.
Smothering is the mechanical obstruction of the external airway or plastic bag. This
requires at least the partial obstruction of both the (mouth and/or nostrils) by an
object such as a hand, pillow, duct tape or plastic bag. This requires at least the partial
obstruction of both the nasal cavities and the mouth or the upper airway.

It may be difficult to diagnose smothering as the mechanism o death, especially when

the victims are very young children, the elderly, or the infirmed who cannot resist and
will show no sign of struggle, such as bruises and abrasions to the face, lips, or inside
the mouth.

Choking
Choking involves the obstruction of the larynx by food, vomit, blood, or other foreign
bodies. This sometimes happens when a large bolus of food material becomes lodged
in the opening of the pharynx or larynx, making the victim gag and unable to inhale or
exhale (Adelman, 2007), thus leading to asphyxiation.

Choking is usually accidental and often involves intoxicated by people with no

dentition or with dentures, eating inappropriate foods, or eating too quickly. It can also
be homicidal, such as when a gag is placed in the mouth and/or pharynx. Choking can
also happen to infants and toddlers who put nonfood materials or inappropriate foods
con in their mouths, and have limited chewing skills. In both children and adults,
choking can prove fatal despite resuscitation attempts (Dolinak forc mo & Matshes,
2005).
Chest Compression
Chest compression is the mechanical limitation of the expansion of the lungs by
compressing the torso, hence interfering with breathing Soft Compressive asphyxia
occurs when the chest or abdomen is compressed posteriorly, thereby preventing
cardiorespiratory function.

One form is the phenomenon of crush or traumatic asphyxia wherein the chest is
compressed, either by other individuals (such as in a stampede situation where there
is crushing by body upon body) or from solid objects (e.g., pinioning against strong
security fences during a stampede). Although the structures of the chest wall are
intact, compression of the chest wall prevents the normal movements respiration, thus
leading to asphyxia.
Strangulation

Strangulation is a violent form of death that occurs when mechanical is applied

pressure to the neck by means of a ligature (ligature strangulation), by utilizing only
the hands (manual strangulation). It is to be differentiated from hanging since it is
not one's own body it weight that is applying the suffocating force, but an assailant
using, for instance, a rope as ligature device. Most strangulation cases are homicidal.
Death comes by a combination of ischemia by compression of the carotids and
obstruction of the trachea, with more marked signs of congestion than hanging
because the compressive force is not enough to the vertebral usually occlude
arteries allowing more arterial inflow. The perpetrator usually lets go when the body
goes limp, leaving less indented ligature marks. The ligature marks do not slant
upward. If the device used is soft like a scarf, ligature marks may not be evident.
Manual strangulation is sometimes associated with sexual
attack and is often used by a man against a woman or a child.
Common injuries sustained include abrasions and bruises on
the front and sides of the neck, at each side of the laryngeal
prominence, and just below the jaw line. However, such
injuries may be difficult to interpret if the hands are applied,
loosened, and reapplied over and over again. There may also
be linear abrasions or scratches from the fingernails of both
the assailant and the victim (Shepherd, 2003). In ligature
strangulation, a constricting band (e.g., a rope, wire, string,
electric cable, telephone cable, scarf, stockings or a piece of
cloth is tightened around the neck. The mark on the neck is a
vital piece of evidence that can reflect the material used for
the ligature. Scratches and bruises on the neck may have been
caused by the victim trying to pull off the ligature.
Hanging
Hanging refers where to the situation to a victim's own body weight (or part of their
body weight) causes a compressive force be applied to the neck. A ligature device
(e.g., rope, cord, belt or other material fashioned into a slip knot) is wound around
the neck in a snug fit, after which the person lets his/her own weight apply the
suffocating force. Hanging often involves suspension from a high point with the
body hanging fully free under gravity and with the feet clear of the ground. Most
hangings are suicidal, but accidents do occur, most often in infants and young
children. Asphyxial death by hanging may come by any of these four means:

1. Occlusion of the carotids and vertebral arteries;

2. The base of the tongue is pressed to the back and upwards inside the neck
occluding the nasopharynx;

3. Direct laryngeal or tracheal damage and occlusion; and

4. Cervical fracture ("drop" hanging) causing brainstem injury.

Occlusion of the carotids and vertebral arteries
The base of the tongue is pressed to the back and upwards inside the neck
occluding the nasopharynx
Direct laryngeal or tracheal damage and occlusion
Cervical fracture ("drop" hanging) causing brainstem injury.
Drowning

Drowning refers to a form of death that occurs when atmospheric in water or other
fluids. It is a specialized form of asphyxia in which air is prevented from entering the
lungs due to submersion of the body oxygen (air) is displaced by a liquid (usually
water).
Drowning is the frequent cause of death in bodies that are recovered from water,
such as swimming pools, ponds, lakes, oceans, rivers, fountains, and wells. However,
complete submersion is not essential for death to occur: drowning can occur even if
only the face is submerged. It can also occur indoors, such as in bathtubs, water or
even in buckets containing water. Drowning is common among infants, toddlers, and
young children who fall into water and cannot extricate themselves. It is also
common among intoxicated or risk-taking adolescents and young adults (Prahlow &
Byard, 2012).
When a body is discovered in water, one must question whether death is indeed
due to drowning. Merely finding a human body submerged or floating in the water
does not necessarily indicate drowning. Why was the dead person in the water and
why was he or she unable to get out of it? It could be that the person may have died
of natural causes before falling into or while in the water, or he/she may have died
of injury before being thrown in the water or while in the water. Inability to swim,
hazardous environment, trauma, seizure disorder, heart disease, exhaustion, alcohol
and drug use, hypothermia, and other causes should be sought to answer the
question of why this person drowned.
There are several phases involved in drowning (Adelman, 2007, pp. 55-56).

1. Upon submersion in water, the body initiates a prompt involuntary reflex of

breath-holding.

2. This is quickly followed by the voluntary act of holding one's breath because the
victim is fully conscious and aware of the dangers of inhaling water. Panic usually sets
in and a desperate effort to swim or to float to the surface knowing fully well that if
this is not possible, the result will be death. A person in good physical condition can
probably hold his/ her breath for about one minute, possibly even longer, but there is
a limit (usually under 2 minutes).

3. After this, another involuntary reflex occurs and the victim gasps for air. At this
moment, enormous quantities of water are inhaled and swallowed. A choking cough
reflex may be set up, which leads to further discomfort, terror, and the inhalation and
swallowing of more water.

4. As the victim loses consciousness, the water filling the (the spaces in the chest that
house the lungs). As the body fills with water, additional water may begin to leach into
the lungs oozes out of these organs into the pleural cavities abdominal (peritoneal)
cavity and into the pericardial sac.

5. Severe deficiency of oxygen in tissues or organs, possibly involving hydrostatic and

osmotic effects of inhaled fluid within the small airways, thereby results in death.
The following are indicators that help determine the cause of drowning.

1. Suicidal
• Heavy articles or weight may be found in the pocket of clothing
• Presence of suicidal note
• Strong reason to commit suicide
• Mentality of the person
• Previous attempts of suicide

2. Homicidal
• Evidence of struggle
• Articles belonging to the assailant
• Presence of motive for the killing
• Presence of ligature on the hands or legs
• Presence of physical injuries which could not be self- inflicted T
• Testimony of witnesses

3. Accidental
• Absence of any mark of violence
• Condition and the situation of the victim before death
• Exclusion of homicidal or suicidal nature of drowning
• Testimony of witnesses
4. Natural death while in water
• Presence of pre-existing cardiovascular disease
• Exacerbation of current condition due to physical exertion of swimming or
struggling

5. Injuries sustained while in water

• Can be due to waves or current against any kind of obstruction
• Contact with rough bottom of a river or stony beach
• Damage from boat or ship's propeller
Regardless of the cause, there is a need to perform an autopsy on a body found in the
water to rule out natural disease or injury as the cause of why the decedent was
unable to escape the deadly aqueous environment. External findings may include the
following:

1. Skin maceration as major sign of immersion (wrinkled, pale, sodden,

"washerwoman" changes to the skin) that may develop within 4-5 hours
depending on temperature;

2. Submersion of mouth and nostrils in water for a time preventing free entrance of air
into the lungs;

3. Death usually occurs 2 to 5 minutes later; and

4. Gross skin shedding, muscle loss with skeletal exposure, and partial liquefaction
There are no specific autopsy findings for a pathologist to
definitely determine that drowning has occurred. The findings
are different in cases of wet drowning in fresh water and sea
water. In dry drowning, water enters the air passages and
induces laryngeal spasm, which in turn, leads to complete
closure of air entry into lungs; water does not reach the lungs
and the characteristic features of drowning are absent. Internal
examination may indicate the presence of froth (usually white,
sometimes pink) in the nostrils and mouth, as well as in the
upper and lower airways. Lung weights are usually higher (600-
800 g) in drowning cases (non-drowned bodies have 350-550 g),
although normal weight is also possible, as in dry drowning. The
most valuable Positive sign could be an overinflated filling of the
thoracic cavity.
Differentiation of homicidal or suicidal strangulation

Hanging can be suicidal, accidental, or homicidal, and these backgrounds must be

discriminated by police and forensic pathologists. We herein report a case involving a
33-year-old man who was found dead on the floor behind the entrance door of an
apartment house. The man's brother declared that he had found him hanging in the
gap between the stairs on the top floor. When his brother tried to cut him down, the
victim fell three floors down through the gap between the stairs. Autopsy was
performed to confirm suicidal hanging and a postmortem fall into the narrow gap. In
this case, however, a homicide was suspected, and the version of events told by the
victim's brother was initially doubted. Homicidal hanging may be uncommon, but
intensive scene investigation and thorough autopsy are necessary in hanging cases to
rule out homicide.
SUICIDE
• In secured residence
• Suicide note
• History of depression, schizophrenia, or other mental illness
• On psychiatric medications
• Prior suicide attempt / ideation
• Significant recent life-altering event (example: death of spouse, being place in a
nursing home, or sent back to jail)
• Hesitation marks or scars on wrist, neck, or elsewhere
• Ligature furrow above level of thyroid cartilage
• Little internal neck injury (reflecting no or mild struggle)
• Fracture of thyroid cartilage horns, hyoid bone, and cricoid cartilage very
uncommon

HOMICIDE
• “Dump body”
• Unlocked residence
• Evidence of burglary or belongings rummaged through
• Jewelry / belongings missing
• Inconsistent statements from acquaintance / witness / other
• Convincing motive(s) identified
• Recent life insurance policy started / significant shifts of money
• History of previous physical / sexual assult
• Ligature of extremities
CHAPTER 7
Poisoning
Learning Objectives

At the end of this chapter, the student will be able to:

• Define forensic toxicology and explain its significance in criminal investigation

• What are the common types of poisons involved in criminal acts

• Differentiate between drug misuse and drug dependency

• Enumerate the more popular kinds of stimulants and depressants

• Describe the significance of specimen collection and laboratory analysis in the

conduct of postmortem forensic toxicology
Forensic Toxicology

Toxicology is defined as the science that deals with knowledge of source,

character and properties of poisons, their symptoms in the body, their
pharmacological actions, and their treatment. It is a study of the adverse
effects of chemicals, such as alcohol, drugs, poisonous gases, and industrial
chemicals on living organisms. It is also concerned with the detection and
measurement of such chemicals through the analysis of samples such as blood,
urine or hair. A poison is a substance or agent capable of producing harm, such
as disease or death, to a living organism. It may be introduced through any
route in the body, such as the mouth, nostril, anus, vagina, ears, eyes, or by
injection or inhalation. Legally, a poison is a substance which, if applied or
administered internally, is said to be used with the intention to kill or to afflict
harm. Forensic toxicology involves the use of toxicology for the purposes of the
law, especially when criminal activity is suspected. It encompasses the
determination of role of drugs and chemicals in accidental deaths and suicides.
Examples of toxicology-related deaths include cases involving a restless infant
who was drugged in an attempt to promote intoxicated sleep, a drugged
student who became a homicide victim, driver involved in a fatal car accident, a
middle-aged chronic pain victim who abused opioids and anxiolytics, and an
elderly individual with multiple debilitating medical conditions who
intentionally accidentally overdosed on medications
All chemicals have the potential to be poisons if present in a sufficient amount. As
Paracelsus said, "All substances are there is none which is not a poison. The right dose
differentiates a poison from a remedy." In addition, people differ widely in their is
responsible for detecting chemical agents in biological samples, and responses to
many substances. Nonetheless, the forensic toxicologist providing answers to the
following questions in order to assist the medico-legal investigation (Stripp, 2007, pp.
16-17).

• What drug was taken, when, and how?

• Was the drug or drugs sufficient to kill or to affect behavior?

• Was a substance taken for therapeutic purposes, was it abused recreationally, was
it used for suicidal purposes, or was it administered homicidally?

• Or Was the person intoxicated at the time of the incident?

• What are the effects on behavior or performance?

• How would a person show intoxication with this substance?

• Is there an alternative explanation for the findings?

• What additional tests might shed light on these questions?

Poisons
As explained earlier, any substance can be a poison if taken in
the right amount. Some chemicals have more toxic potential
than others. Further, some people have higher susceptibility to
certain drugs and poisons, depending on time of usage, genetic
predisposition, individual metabolism, preexisting medical
conditions, among others.

it is toxic enough even at small quantities, if it can be easily

disguised A poison can be an efficient and deadly instrument of
murder if (e.g., the taste or odor can be easily masked when
mixed in water or food), if it causes symptoms that are delayed
and nonspecific to be due to natural illness, and if it is readily
obtainable and easy to or appear work with (Stripp, 2007).
Arsenic
Arsenic
Arsenic is a metal that is not in itself poisonous; the arsenic compounds used in
insecticides, pesticides, herbicides, alloys, wood preservatives, additives to animal feed,
semiconductors and light- emitting diodes, homeopathic medicines, paints, and
ceramics are the ones that make potent poisons. Arsenicals have been used since
ancient times as the 'Poison of Kings' and the 'King of Poisons'. Although less common
today, arsenic is still being used, and sufficient doses can result in death.
Arsenic has been widely used for homicidal purpose as it is cheap, easily available,
tasteless and odorless, and therefore cannot be detected in food or water. Low doses
can be given slowly over a long period of time so that death may appear to be natural.
Intentional poisonings most often involve rodent poisons or pesticides. Accidental
occupational exposure to arsenic compounds occurs in industrial settings, such as in the
manufacture of pesticides or herbicides, and in smelting industries. Environmental
arsenic exposure can also occur from arsenic-contaminated drinking water. Arsenic in
drinking water is often from natural sources. Environmental exposure also occurs from
burning of coal that contains naturally high levels of arsenic, perhaps from wood
treated with arsenical preservatives. Lewisite, an arsenic-containing gas, has been used
in chemical warfare. Arsine gas is a potent hemolytic agent that can produce acute
symptoms of nausea, vomiting, shortness of breath and headache.
Exposure to arsine can be fatal and can result in hemoglobinuria, renal failure,
jaundice, and anemia. Sub-lethal doses of arsenic cause irritation of the stomach and
intestines (stomach pain, nausea, vomiting, and diarrhea), anemia, arrhythmia
(abnormal heart rhythm), sore throat and irritated lungs (if inhaled), impaired
peripheral nerve function, and darkening of the skin, particularly on the palms and
soles. With large doses of arsenic, much may be vomited and can be survived. With
fatal doses, death can occur within hours from shock and cardiorespiratory failure, or
may be delayed for many days. Arsenic exposure has also been reported to increase
the risk of cancer of the liver, bladder, kidneys, prostate, and lungs. Upon exposure,
arsenic can be detected in blood, urine, gastric contents, and other tissues (including
bone) by atomic absorption spectrophotometry. Arsenic can be measured in bone
and hair for a long time after death, so the remains of many exhumed bodies have
been studied to determine the role of arsenic in their deaths.
Cyanide
Cyanide

Cyanides are chemical compounds, many of which are toxic. Cyanide products are
used in several industrial processes, mainly for the mining of gold and silver. It is also
employed in case hardening several chemical processes, such as fumigation, of iron
and steel, electroplating and photographic processing.

Cyanide is a rapid-acting and deadly poison that can kill in a matter of minutes. Its
use has been relatively common in suicides and accidents, and has also been used in
homicides. The most hazardous compound is hydrogen cyanide (also known as
prussic acid or hydrocyanic acid or HCN), very pale, blue, transparent liquid or
colorless gas that can kill a human within minutes. It has been used for capital
punishment in gas chambers and by terrorists as a chemical weapon.

Other common poisonous cyanide compounds include potassium cyanide (KCN) and
sodium cyanide (NaCN), which come in the form of white crystalline salts with a faint
almond-like odor. Cyanide in salt form is often administered orally, but can also be an
inhalation hazard when dissolved in acidic liquids. The toxicity of cyanide is due to its
ability to stop cellular respiration and ATP synthesis in cells, thereby causing anoxia.
Symptoms of poisoning include headache, dizziness, nausea, vomiting, shortness of
breath, and mental deterioration. Ultimately, seizures, apnea, coma, and cardiac
arrest cause death.
Strychnine
Strychnine

Strychnine is a highly toxic crystalline alkaloid usually obtained from the seeds of
the Strychnosnux-vomica tree, which is commonly found in India and Southeast
Asia. It is odorless and appears as a white or translucent crystal or crystalline
powder, with an extremely bitter taste that can easily be detected in foods and
beverages. It is primarily used as a pesticide against rodents. Fatal poisoning can
occur following exposure by inhalation, swallowing or absorption through eyes or
mouth. It produces excruciatingly painful and violent spastic reactions, resulting in
a horrific death. A lethal dose results in painful muscle cramps, followed by
extremely intense muscle contractions that are worsened by the slightest external
stimulus such as a simple touch. The convulsions appear to resemble seizures, but
the victim is completely conscious and aware of the painful event.
Carbon Monoxide
Carbon Monoxide
Carbon monoxide (CO) is a highly toxic gas produced by the incomplete
combustion of organic materials. It forms when there is insufficient oxygen to
produce carbon dioxide. It is colorless, odorless, tasteless and initially non-
irritating; hence, it is very difficult for people detect.

Saukko and Knight (2004) identify the following common causes, among
others, of carbon monoxide poisoning:

• Faulty heating systems that lead to absent or inadequate ventilation;

• Automobile exhaust fumes confined to a small space, producing a lethal

concentration of carbon monoxide in the atmosphere;

• Structural fires in houses and buildings where victims are overcome by the
gradually spreading monoxide while trapped or asleep;

• When a drunken person collapses with a lit cigarette then the bed cover
catches fire; the smoldering bed cover results in a high level of
carboxyhemoglobin; and

• Many industrial processes that could lead to monoxide poisoning,

especially in iron and steel works, where producer gas and water gas are
deliberately formed and stored as part of the manufacturing process.
Carbon monoxide produces its toxic effects by binding to hemoglobin in red blood
cells and thus preventing oxygen from binding, which in turn causes tissue anoxia
and impairment of ATP synthesis. Early symptoms of poisoning include progressively
worsening headaches, light-headedness, nausea, light-headedness, fatigue, visual
disturbances, mental confusion, and eventually coma and death. Prolonged
exposure can lead to brain damage and death. The most significant post-mortem
change in carbon monoxide poisoning is a cherry red color of the blood, which
manifests itself as a reddish coloration of the skin (Stripp, 2007).
Thallium
Thallium

Thallium (Tl) is a soft gray metal mostly found geologically in produced as a byproduct
from the refining of heavy metal sulfide semiconductor industry, manufacture of
special glass, and for certain ores, and used in the manufacture of electronic devices,
switches, the medical procedures. Thallium sulfate is an odorless, tasteless and highly
toxic dense white powder salt that has been commonly employed as a rat poison. This
sulfate salt is soluble in water and can enter the body by ingestion, inhalation, or
through contact with the skin. It has been banned in several countries due to safety
concerns.
Thallium disrupts many cellular functions and is also a suspected cause of carcinogen.
Following absorption, it is distributed to the red blood cells and also appears in the
brain, lungs, guts, muscle tissue, salivary glands, pancreas, testes, spleen, kidney, liver,
and bone. Characteristic symptoms of thallium poisoning include loss of hair,
paresthesia (damage to peripheral nerves causing pain in the hands and feet described
as a sensation of walking on hot coals), endocrine disorders, gastrointestinal and
pulmonary distress, psychosis, delirium, and convulsions. Death may result from
cardio-respiratory collapse (Stripp, 2007 and Saukko & Knight, 2004).
Aconite
Aconite

Aconite (or aconitine) is a toxin produced by the Aconitum napellus plant, which is
also known as monk's hood, wolf's bane, women's bane, devil's helmet and blue
rocket; it is found chiefly in mountainous parts of the northern hemisphere. Once
believed as the most toxic substance known to man, it has been historically used to
poison arrow and lance tips, to kill condemned criminals, and to poison the water
supply of enemies. Women were thought to be especially vulnerable to the poison.
Aconite is a white powder that is barely soluble in water but very soluble in alcohol.
The rapidly acting poison takes effect within minutes of exposure and targets the
electrically excitable cells of the nervous, cardiovascular and skeletal muscular
tissues, causing abnormal and potentially fatal heart rhythms. Early symptoms
include a tingling and numbness at the point of contact (usually the mouth and
throat), sweating and nausea.
Ricin
Ricin
Ricin is a highly toxic, naturally occurring protein derived from the seed of the
castor oil plant Ricinus communis. Ricin is twice as deadly cobra venom and it is
poisonous if inhaled, injected, or ingested. It has a high lethality, causing
weakness, fever, and pulmonary edema after inhalation that can lead to death
from hypoxemia in 2 to 3 days.

Following ingestion, the first symptoms of ricin poisoning usually occurs in less
than six hours. Death takes place within 36 to 72 hours of exposure, depending
on the route of exposure (Stripp, 2007, pp. 34- 251. Ricin poisoning can occur
through three channels:

Inhalation - difficulty breathing, fever, cough, nausea, tightness in the chest,

heavy sweating, fluid building up in the lungs that makes breathing even more
difficult, the skin might turn blue; low blood pressure and respiratory failure may
occur, eventually leading to death

Ingestion - vomiting, diarrhea that may become bloody, severe dehydration, low
blood pressure, hallucinations, seizures, blood in the urine; Within several days,
the liver, spleen, and kidneys might stop working, and the person could die

Skin and eye exposure - ricin in the powder or mist form can cause redness and
pain of the skin and the eyes.
Ricin poisoning has been connected with several terrorist incidents involving the Al
Qaeda (the Islamic militant group Ansar al- Slam tested ricin, along with other
chemical and biological agents, n northern Irag), KGB (used for assassination during
the Cold War), and the Bulgarian Secret Service (killed a dissident named Georgi
arkov by injecting his leg with a small ricin-containing metallic pellet narged from the
tip of a weapon built into an umbrella).
Lead
Lead
Lead, is a soft and malleable metal used in building metal construction, lead-acid
batteries, bullets and shots, weights, as part of solders, pewters, fusible alloys, and as
a radiation shield.

Lead acetate is the most common salt that causes acute poisoning. Immediately upon
ingestion, the person will feel a sweet, metallic astringent taste in the mouth along
with a burning sensation in the include vomiting, constipation, cold clammy skin,
feeble rapid pulse throat and stomach, salivation and intense thirst. Other symptoms
and shock, drowsiness, headache, muscular cramps and convulsions. Paralysis of lower
limbs may be seen, and death may occur.
Drugs of Abuse

Drug abuse is a growing global problem often resulting in accidents, criminal

activity and death. Drug-related crimes are usually committed either to fund the
purchase of drugs or as a consequence drug misuse. Examples of such criminal
activities include shop-lifting or burglary; offences under the various acts
established to control the possession, distribution and consumption of drugs; and
criminal acts carried out by persons in an abnormal mental state due to drug
intoxication or withdrawal, such as assault or damage to property.
Drug misuse is defined as "any taking of a drug which harms or threatens to harm
the physical and mental health or social well-being of an individual, of other
individuals, or of society at large, or which is illegal." Meanwhile, drug dependency
is defined as "a state, psychic and sometimes also physical, resulting from the
interaction between a living organism and a drug, characterized by behavioral and
other responses that always include a compulsion to take the drug on a continuous
or periodic basis in order to experience its psychic effects and sometimes to avoid
discomfort of its absence" (Stark & Norfolk, 2009, pp. 80-81).
Toxicology reports involving drug-related deaths should be considered in the context
of the entire case investigation, including the person's medical history, drug
use/abuse history, scene investigation, circumstances of the death, and complete
autopsy findings. The drugs may have played a primary role in a death and may,
therefore, be listed as the cause of death. Alternatively, the drugs may have played a
minor role in the death and will therefore be listed as a contributory condition.

An autopsy can reveal the following clues that a person may have died of a drug
overdose (Dolinak, 2005, p. 500):

• "Foam cone" over nose and/or mouth;

• Colorful discoloration of lips, tongue, oral mucosa or stomach;
• Granular, grainy, or pasty pill material in mouth and/ or stomach;
• Pills in stomach;
• Pulmonary congestion and/or edema;
• Frothy fluid in bronchi and trachea; Mucus in bronchi; and
• Increased amount of urine in urinary bladder.
Stimulants
Stimulants (also called "uppers") are psychoactive drugs that stimulate the nervous
system, resulting in euphoria, increased energy and alertness with loss of appetite.
Effects may also include increased heart rate, blood pressure and respiratory rate;
aggressive behavior and confused thinking leading to exhaustion and sleep; dry
mouth, are widely used as prescription medicines for treatment of narcolepsy,
delusions and paranoia; and even fits, coma, and death. Stimulants sweating, dilated
pupils and hyperactive reflexes; hallucinations, obesity attentional disorders and
clinical depression. quickly Amphetamine is the most popular stimulant. It may be
taken intravenously, orally or sniffed/snorted, with effects coming on and lasting for
several hours. Other notable stimulants include caffeine (found in coffee, tea, cocoa,
chocolate, soft drinks and energy drinks), nicotine (the active chemical constituent in
tobacco), ephedrine (commonly used as a stimulant, appetite suppressant,
concentration aid and decongestant), and anabolic steroids (used for cosmetic
purposes to develop and maintain masculine characteristics). Abuse of CNS
stimulants can lead to insomnia and severe depression, as well as medical,
psychiatric, and psychosocial deterioration.
Cocaine
Cocaine

Cocaine is a strongly addictive controlled substance derived from the leaf of the
Erythroxylon coca bush. It has become an extremely popular drug with some
medicinal value, although it also has a high potential for abuse.
Cocaine in the form of white crystalline powder can be snorted intranasally or
injected intravenously, while crack cocaine is the less expensive form that can be
smoked. Injecting cocaine produces the most rapid, almost immediate effects.
Snorting results in a peak effect within 30-120 minutes; while smoking effects peak
within 5 minutes. The euphoric effects wear off very quickly and therefore have to be
quickly repeated. Larger doses or a "binge" may result in anxiety and panic leading to
paranoia (Stark & Norfolk, 2009). Cocaine makes the user feel euphoric, stimulated,
and alert. It also results in difficulty sleeping, loss of appetite, increased heart rate
and blood pressure, and causes the body temperature to rise. Adverse effects
include cardiovascular complications, psychosocial problems, and addiction resulting
in powerful cravings to produce the desired effect. Chronic abusers develop
dangerous psychological and behavioral patterns, and even severe psychosis.
Another unfavorable outcome of cocaine intoxication involves an episode of bizarre
behavior called "cocaine psychosis" or "excited delirium," which manifests in
hyperthermia (elevated body temperature), delirium, paranoia, abnormally great
strength, highly agitated state, cardiorespiratory arrest, and sudden death (Stripp,
2007).
Ecstasy
Ecstasy

Ecstasy is the street name for Methylene dioxymethamphetamine (MDMA). It is a

"party drug" that is classified as both a stimulant and hallucinogen. It is administered
orally as a tablet or capsule, and the effects last approximately three to six hours. Its
popularity in nightclubs and raves is due to its empathy-enhancing properties, which
increases a sense of intimacy and diminished anxiety with others, which can induce
euphoria and mild psychedelia. a High doses of MDMA can damage neurons, resulting
in depression, anxiety, memory loss, learning difficulties, sleep disorders, and sexual
dysfunction. It can also lead to increase in heart rate and blood pressure, fainting,
panic attacks and, in severe cases, loss of consciousness and seizures. Although not
commonly fatal, a potentially dangerous side effect is hyperthermia (an increase in
body temperature), which can lead to the death. MDMA-related deaths have in fact
increased markedly, possibly due its wide availability to young people, especially in
parties and clubs.
Methamphetamine
Methamphetamine

Methamphetamine hydrochloride or "shabu" is a synthetic drug that comes as a

white odorless powder, tablet or as crystals that look like shards of glass with a
bitter numbing taste. It can be swallowed, sniffed/snorted, smoked or injected,
resulting in a feeling of physical and mental well-being, as well as a surge of
euphoria and exhilaration. When smoked or injected, it produces an instantaneous
"rush" and euphoria that can last anywhere from 4 to 12 hours. Effects from oral
ingestion occur in around 30 minutes and 3 to 5 minutes from snorting. Effects may
continue for up to 24 hours; the half-life of the drug is 12 hours. Oral ingestion or
snorting does not produce the "rush" (Stark & Norfolk, 2009)

Methamphetamine abuse leads to effects similar to those of cocaine, aggressive

and violent behavior, auditory hallucinations, mood can result in homicidal and
suicidal thoughts. Other potential adverse disturbances, delusions, and psychotic
and paranoid episodes that stroke. If not treated immediately, methamphetamine
overdose can effects include cardiac and neurological problems, hypertension, and
lead to hyperthermia, which can result in death.
Hallucinogens
Hallucinogens
Hallucinogens are drugs that alter the perception of reality. They rarely cause toxicity
sufficient enough to result in death, but may cause convulsions, respiratory
depression, coma, hyperthermia and seizures that may prove fatal. Psilocybin may
cause coma and convulsions In addition, the effect of altered perceptions, psychosis,
and bizarre behavior may lead to or contribute in some way to traumatic death. For
example, an abuser under the influence of LSD may be under- the impression that he
can fly and thus project himself from a high window (Dolinak, 2005; Saukko & Knight,
2004). as well Examples of hallucinogens include LSD and cannabis, as PCP
(phencyclidine, also called "angel dust"), mescaline (from the peyote cactus), and
psilocybin (from mushrooms).
Lysergic acid diethylamide (LSD)
Lysergic acid diethylamide (LSD)
Lysergic acid diethylamide (LSD) is a powerful hallucinogenic that is not fatal in itself.
It is usually taken orally with sympathomimetic effects within 5 to 10 minutes and
psychological effects within 30 to 60 minutes, depending on the dose taken. The
effects can last for 8 to 12 hours with a recovery period of 10 to 12 hours. Visual
effects such ex as intensified colors and distorted shapes occur, as well as distortions
of hearing.
Cannabis
Cannabis
Cannabis or marijuana is a tobacco-like greenish or brownish material made of the
dried flowering tops and leaves of the cannabis (hemp) plant. It is usually smoked or
taken orally as "brownies," and can make users feel pleasurably relaxed or euphoric. It
has mood- altering properties and is addictive. When smoked, effects occur within a
few minutes and last up to one hour with low doses or 2 to 3 hours with higher doses.
If it is ingested, it may take an hour or more to have an effect which can last 12 hours
or more. The active component in marijuana, which is tetrahydrocannabinol (THC),
activates the brain's reward system in the same way that other drugs of abuse do and
causes increased heart rate, dilation of the blood vessels in the whites of the eyes,
relaxation and dilation of the bronchial passages, and euphoria. Other effects include
dry mouth, excessive hunger and thirst, sleepiness, and occasionally dysphoria
(anxiety, fear, panic, and Marijuana is the most widely used illicit drug in the world. It is
not known to cause death via direct drug toxicity, but THC has been detected in a fairly
significant number of deaths, particularly those due to overdose of other drugs and
violent or accidental deaths. Studies have shown that THC alone impairs driving
performance, and the effects are even greater when combined with alcohol (Stripp,
2007; Saukko & Knight, 2004).
Depressants
Depressants
CNS depressants (also called "downers") are drugs that slow brain function in a
progressive manner and are most often used in the treatment of anxiety and sleep
disorders. These include sedatives, hypnotics (sleep inducing), and antianxiety drugs
(tranquilizers). Depression of the nervous system leads to sedation and relief of
anxiety but, because of disinhibition, may initially result in euphoria, excitation, and
risk-taking. Physical effects include disorientation, drowsiness, slurred speech,
nystagmus, loss of co-ordination, ataxia, coma, and death. They should not be used in
combination with other CNS-depressing drugs. At high doses, cerebral depression may
occur; so the effects are more dangerous when taken with other cerebral depressants
such as alcohol (Stripp, 2007; and Stark & Norfolk, 2009).

Among the most common CNS depressants are the following:

• Barbiturates - used to treat seizures, anxiety, tension and sleep disorders;

particularly dangerous drugs when taken in overdose and cause a physical and
psychological dependence;

• Benzodiazepines - prescribed to treat anxiety, sleep disorders and panic attacks

(withdrawal syndrome includes the major complications of fits and psychosis); and

• Ketamine - used as an anesthetic agent that can be taken intranasally, orally or by

injection (users can experience a cocaine-like "rush" with psychological
dissociation).
Alcohol (Ethanol)
Alcohol (Ethanol)
Ethanol is a colorless, flammable, volatile liquid that is soluble in water and has
a characteristic taste and odor. It is commonly referred in alcoholic beverages.
It is a product of fermentation by the action c to simply as alcohol or spirits,
and is the principal type of alcohol found yeast cells on sugars found in fruits
and grains. A person's blood alcohol concentration (BAC) is directly linked to
CNS depression. Factors that determine BAC include the volume alcohol
consumed, whether consumption was with or without food, body weight,
gender and distribution of ethanol. This means that if a man and a woman of
the same weight drink equivalent amounts of alcohol, the woman will have a
higher BAC; and if two men of different body weights drink the same amount
of alcohol, the lighter man will have a higher BAC. Tolerance lessens the
effectiveness of alcohol Therefore, chronic alcohol users may appear to act
normal or only slightly impaired despite having a high BAC. Highly tolerant
alcohol users can be capable of engaging in physical activities and actions at
levels that would result in unconsciousness or even death in non- tolerant
individuals (Stripp, 2007). Deaths due to the toxic effects of acute over-
ingestion of ethanol are due to severe respiratory and CNS depression. It can
be caused either by the direct depressive effects or through secondary events
such as aspiration of vomit. Lower alcohol intoxication can also be fatal if the
ethanol is combined with an opiate or other types of depressant (Saukko &
Knight, 2004; Dolinak, 2005).
Alcohol intoxicated persons are also often involved in fatal trauma triggered by their
aggressive behavior. Road accidents often involve alcoholic vulnerability, either caused
by drunk drivers or drunk pedestrians. Other fatal incidents may occur (Saukko &
Knight, 2004).

• Falling down the stairs resulting in head injuries

• Falling from high places due to drunken carelessness or unsteady gait

• Burns and carbon monoxide poisoning (a common scenario is for a drunk to go to

bed and fall asleep whilst smoking, the cigarette igniting the bedclothes. Sometimes,
a gas, electric or kerosene heater may be knocked over during drunken staggering,
which can also start a fatal fire)

• Drowning especially in river or docking areas (e.g., falling from a bridge or

passageway into the water)
Gamma-hydroxybutyrate (GHB)
Gamma-hydroxybutyrate (GHB)

Gamma-hydroxybutyrateor (GHB) is an anesthetic with primarily sedative

properties. It has been used as a bodybuilding drug and treatment to conditions
such as insomnia, clinical depression, narcolepsy and alcoholism. It is also used as
an intoxicant or as a date rape drug slipped into a drink by sexual predators,
causing the victim to become incapacitated and develop amnesia. Clinical effects
start within 10 to 15 minutes but the duration of action is unpredictable (Dolinak,
Toxicology, 2005; Stark & Norfolk, 2009). as GHB typically generates feelings of
relaxation, euphoria and intoxication. Lower doses cause drowsiness, dizziness,
nausea, and visual disturbances; at higher dosages, unconsciousness, seizures,
severe respiratory depression, coma, and death have been reported (Stripp, 2007).
Opioids
Opioids
Opioids are addictive and potentially deadly drugs, in which analgesic (painkiller)
effects decrease the perception of pain and reaction to pain as well as increase
pain tolerance. They are also considered as strong cough suppressants. Side effects
include mental clouding, drowsiness, visual disturbances, sedation, constipation
and a strong sense of euphoria. Severe intoxication can result in respiratory
depression and death. Examples of opioids include morphine, heroine, codeine,
methadone and other opiates. Morphine is the major representative of the general
group of opioids, which comprise natural opium and a whole series of chemically
related derivatives. Heroin is the most abused and the most fatal; it has no medical
use and a high potential for abuse. The most common route of exposure is
intravenous injection, but it can also be snorted or smoked. Side effects include
severe itching, flushing, dry mouth, nausea and vomiting (Stripp, 2007). In cases of
fatal heroin abuse, a person may die suddenly, sometimes with the needle or the
tourniquet still around the arm. Intravenous abusers may have a single scar from a
favored injection site or have multiple needle tracks, usually in the veins of the arm
and hands. Other injection sites are the veins in the leg, groin and even the neck.
Heroin can also be volatilized and then inhaled by heating on a spoon, bottle cap,
portion of a metal beverage can, or on a piece of tinfoil (Dolinak, 2005).
Post-mortem Forensic Toxicology

In suspected drug and poisoning deaths, the pathologist collects and preserves the
specimens for toxicological analysis subsequent to the autopsy. These cases usually
involve toxicological scenarios, such as drug overdosè, homicide by poison, alcohol
impairment in an accident or crime, or use of drugs to commit suicide. Toxicological
analysis is also required in determining if assertions plausible, of self-defense against
drug-induced psychotic behavior are if drugs were used to incapacitate a victim of a
crime, or if a patient was in compliance with their prescribed medicines. Sometimes,
the cause of death is unknown, and the toxicologist has to review the case history
and investigation to narrow the search for a specific poison.
Specimen Collection
Specimen selection, collection, and preservation play an enormously important role in
toxicology. It is important to know which specimens are most useful for yielding drug
concentrations that are practical for interpretation. Furthermore, the proper specimen
must be used to assemble all the pieces of the puzzle when trying to determine a cause
and manner of death. The challenge with post-mortem samples is that the quality and
availability of the samples themselves can vary greatly. Unlike testing clinical samples
from living individuals, post-mortem toxicology has the unique problem of testing
samples collected at autopsy that may have undergone varying levels of decomposition.
For example, decomposed bodies may no longer have blood, yet may have vitreous,
urine, and tissue samples. The use of proper preservatives is important to prevent
further post-mortem changes in the samples. Even the selection of the container itself
can be important (Stripp, 2007; Molina, 2010).
• Blood is the most common and preferable sample to use, when possible. It is a
relatively easy sample to obtain and store. For post-mortem studies, peripheral
blood is more desirable than central blood as it is less affected by post- mortem
redistribution.

• Urine can be used as a second sample for confirmation of a drug's presence. It is

good as a screening sample tends to have less interfering substances, and provides
qualitative information on past exposure or use. It is also as it relatively easy to
obtain and store.

• Vitreous is an excellent specimen to use in the absence of blood. It is less subject to

contamination, is not affected by embalming, and demonstrates good stability.
Vitreous is an excellent specimen for water-soluble substances, including ethanol
and barbiturates.

• Bile is usually not a first-line specimen but can be useful in qualitative screening.
Bile is not always present, and when it is available, it is usually in limited quantities.
It is most often used for detecting opiates and morphine.
• Tissue specimens are commonly collected at autopsy and are readily available in
large quantities. However, interpretation of drug concentration can be difficult
since data is not often available for comparison. Tissue concentrations may also
be elevated in oral overdoses and chronically administered drugs. Muscle is a
preferred tissue sample. Liver can be used as a secondary sample when blood is
not available; there is extensive data available for comparison of post-mortem
drug concentrations. Kidney specimen is used mainly in heavy-metal testing; lung
specimen for inhaled toxins, such as volatile substances; spleen for cases of
carbon monoxide poisoning; and adipose tissue for pesticide poisonings and
volatile analysis.

• Stomach contents are often collected in cases where an oral drug overdose is
suspected. Odors may be present that give a clue of agents present.

• Hair is an excellent screening source for arsenic poisoning and is becoming more
commonly used in screening for the chronic use of illicit drugs, including
morphine, cocaine, and amphetamines. Drugs can be deposited in hair as it
grows, allowing hair samples to yield information about drug intake over a period
of several months to years, depending on the length of hair sampled.

• Other samples include fly larvae (maggots), blood stains, soil samples and
cremation ash, which may contain drugs or poisons. Tablets, capsules, vials, and
various household products may also be collected at the death scene.
Laboratory Analysis
Once the samples have been collected and properly preserved the next step is called
the extraction procedure, which involves the, separation of the analytes (the
substances you want to measure) a certain degree from the biological matter. Most
specimens require of pretreatment to isolate the drug or poison by using separation
techniques such as distillation, protein precipitation, liquid-liquid extraction and
solid-phase extraction. This is followed by forensic toxicological analysis using two
types of tests: screening tests and confirmatory tests. Samples are usually first
screened for the presence of medications and/or intoxicating substances, then a
more specific, confirmatory test is performed to determine the exact substance and,
often, concentration. A confirmatory test should be a different methodology from
the screening test and should be run on a different sample/specimen, if possible
(Stripp, 2007; Molina, 2010).
Preliminary Screening Tests

Screening tests allow the toxicologist to rapidly test for a variety of drugs and toxins.
Screening tests give preliminary results, and then a positive result must be verified
with a confirmatory test.

• Immunoassays are popular techniques that can be used to screen a large number
of drugs. The methods are relatively fast and straightforward to use. Immunoassays
use antibodies that bind with a target class of compounds (in this case, drugs). The
antibody binds to the drug in question, thereby yielding a positive screen if the
drug is present.

• Spectrophotometry is easy to use but it is not commonly used in forensic toxicology

because of its lack of sensitivity and specificity. A spectrophotometer can measure
the changes in the wavelength of light (ultraviolet or infrared) passing through a
substance to determine the presence or absence of certain molecules within the
matrix.

• Chromatography can be used as a screening test for a large number of drugs when
combined with a detector. Gas chromatography (GC) and liquid chromatography
(LC) are very popular in forensic toxicology, because they are easy to perform,
sensitive, and can provide good initial separations. Drugs are dissolved into a
mobile phase (gas or liquid), which is then passed through a stationary phase
allowing for separation and isolation of the constituents of the sample. The time
taken to traverse the stationary phase is recorded by a paired detector and compared
to an internal standard, thus facilitating the detection of each component within the
sample.

Confirmatory Tests

The process of confirmation involves the use of various methods that give structurally
specific information about a compound in order to eliminate the potential for false
positive results. When a drug has been identified by one of the screening tests,
confirmatory tests should be performed using a different methodology than the
screening test and on a different sample, if possible (or at least a different extract of
the same sample). The confirmatory test should also be more specific than the
screening test. The popular method is GC or LC paired with mass spectrometry. Mass
spectrometry is accomplished by fragmenting a molecule using a barrage of electrons
and then analyzing the relative abundance of the fragments or by ionizing molecules
and analyzing the charge transference (Molina, 2010).