IRRITANTS

1. Non-Metallic irritants.
i. Phosphorus. ii. Iodine iii. Chlorine iv. Bromine
2. Metallic irritants.
i. Arsenic (As) ii. Mercury (Hg) iii. Lead (Pb) iv. Copper (Cu) v.
Thallium vi. Zinc
3. Vegetable Irritants.
i. Ricinus communis (castor oil plant).
ii. Croton tiglium (Jamalgota).
iii. Abrus precatorius (rati).
iv. Colocynth (bitter apple).
v. Ergot
vi. Capsicum (chillis).
vii. Semecarpus anacardium (marking nut).
viii. Calotropis (madar).
ix. Plumbago rosea (lal chitra) and Plumbago zeylanica (chitra).
4. Animal Irritants.
i. Snake Poisoning. ii. Scorpion. iii. Cantharides (spanish fly).
5. Mechanical Irritants.
Phosphorus:
Introduction – Types – Physical properties: Phosphorus exists in two forms; white
phosphorus and red phosphorus.
1. White Phosphorus : It becomes yellow on exposure to the air. It is therefore also called
yellow phosphorus.
I. It is freely soluble in carbon disulphide, slightly soluble in alcohol, and insoluble in
water.
II. Being easily oxidizable it is kept submerged in water to prevent ignition.
III. When exposed to the air it gives off dense white fumes with a strong odour of garlic
and are luminous in the dark.
IV. Phosphorous is mainly used in fertilizers, insecticides and rodenticides. It is also
used in trace bullet, incendiary bomb, smoke screen, fire crackers and fire work.
2. Red Phosphorus:
i. It is insoluble in carbon disulphide.
ii. It is inert.
iii. It does not gives off fumes when exposed to air. It is odorless and non-luminous.
iv. It is mixed with powder glass and used on the side / striking surface of the match box.
The tip of the match stick contains a mixture of potassium chlorate and antimony
sulphide.
Mode of Action: Phosphorus is a protoplasmic poison and affects cellular oxidation. Under
such anoxic condition, the metabolism of the cells diminishes considerably. This anoxic
condition in the liver is known as ‘necrobiosis’. Deposition of glycogen in liver is inhibited
while deposition of fat in the liver is increased . This is known as ‘fatty degeneration’.
 Acute phosphorous poisoning.
Symptoms and signs: There are two phases in the symptoms and sings.
1. Primary is due to the local irritant action of the poison on the gastrointestinal tract.
2. Secondary is due to the action of the absorbed poison, damaging mainly the liver and kidneys.
1 Primary symptoms and signs.
i. There is burning pain in the throat, esophagus and stomach with; nausea, vomiting, diarrhea and intense
thirst. The patient may complain of a garlic taste in the mouth.
ii. Breath, vomit and feces have garlic odor . Vomit and feces are luminous in dark. The feces may be
offensive. The luminosity of vomit and faces are diagnostic.
2. Secondary symptoms and signs.
i In the early stages, the liver is enlarged due to fatty denegation. while In the late stages, the liver is
shrunken due to necrosis (acute yellow atrophy).
ii. There is Jaundice and feces are pale.
iii. Hemorrhages from natural orifices of the body. Epistaxis, hematemesis, hemoptysis, malena and
purpura. Hemorrhage in mucous membrane and viscera may follow due to hypoprothrombinaemia.
iv. Priapism is frequent.
v. Kidneys: Tubular necrosis – oligurea, the urine is suppressed or scanty, concentrated and contains
albumin and blood.
Cause of death: Death result from hepatic and renal insufficiency.
Fatal does: A dose of 60-120mg is usually considered a fatal dose.
Fatal period: Death may occur from collapse within 24hours.It may be occur in six to seven
days or longer.
Treatment
Demulcents - fatty substances are “contraindicated” as they
dissolve and promote absorption of phosphorus.
i.The stomach should be lavaged with potassium
permanganate repeatedly, till no more smell of garlic is
perceptible. It acts as chemical antidote.
ii. The bowl is evacuated by purgatives.
iii.200mg copper sulphate may be given every five minutes until

vomiting occurs.
iv. The Rest of the treatment is symptomatic.
 Postmortem appearances:
 If death takes place within first 24 hours, the appearances are those of an irritant poison.
External signs: The body may smell of garlic.
Internal signs:
i. The contents of stomach have a garlicky odour and may be luminous in the dark.
ii. Congestion, inflammation and ulceration of the mucous membrane of esophagus and stomach.
Liver and kidneys should be preserved in saturated solution of common salt and not in sprit
as the luminosity is lost.
 When death takes place after a few days, characteristic external and internal appearance are found.
External appearance:
i. There may be smell of garlic.
ii. The body may be emaciated.
iii. Jaundice.
iv. Hemorrhages from natural orifices of the body.
v. Hypostasis is dark brown in color.
Internal appearance:
i. The contents of the stomach may have a garlicky odour and may be luminous in the dark.
ii. Mucous membrane of the mouth and stomach are corroded (congested, inflamed, ulcerated) and
stained yellowish.
iii. Liver: If death is in early stage, liver will be enlarged due to fatty degeneration - “Fatty liver”. Swollen,
soft, yellow, fatty and easily ruptured. If death is late the size of the liver, will be small due to necrosis –
“acute yellow atrophy”.
iv. Kidneys: Tubular necrosis. Enlarged, greasy and yellow.
v. Heart: Flabby, pale and shows fatty degeneration. Sub endocardial heamorrhages in the left ventricle
are common.
vi. Lungs: Fat emboli may be found in the pulmonary arterioles and capillaries.
 Medico legal Aspects:
Accidental Poisoning in children by fire crackers or by chewing fireworks
or by eating rat poison are known.
Suicidal Poisoning: Rat poison and insecticides (vermin killers) which
contain yellow phosphorus are taken to commit suicide.
Homicidal Poisoning: Rat poison and vermin killers can be mixed
in sweets, strong sweet tea or coffee then can be used for homicidal
purpose. White phosphorous in missile, used by Israel on Gaza.
Chronic phosphorus poisoning results from frequent
inhalation of phosphorus fumes over a period of years. The gas attacks
the lower jaw. The clinical features are;
i. Toothache, followed by swelling of the jaw, loosening of the teeth,
necrosis of gums, and then sequestration of bone in the mandible. This is
known as ‘phossy jaw’. Or
ii. Phossy Jaw is an osteomyelitis of the jaw bone with multiple sinuses
discharging foul smelling pus.
PHOSSY JAW IN PHOSSY JAW IN
LIVING CASE DEAD CASE
Q:1. A body was brought for postmortem examinations having garlic odor and dark brown staining in the stomach
which is due to:
a. Atropine.
b.Carbon dioxide.
c.Oxalic acid.
d.Phosphorus.
1- d - Parikh: 9.4
Q:2. Yellow / white phosphorus is easily oxidisable hence readily ignitable that can be prevented by keeping it
submerged in which of the following solutions:
e. Alcohol
f.Formalin
g.Spirit
h.Water
2- d - Parikh: 9.2
Q:3. Red phosphorus can be differentiated from yellow phosphorus on the basis of which one of the following features:
i. It gives off fumes on exposure to air
j. It is luminous
k.It is odorless
l.It is oxidizable
m.It is soluble in carbon disulphide
3- c - Parikh: 9.2
Q:4. Priapism is a frequent feature of poisoning with which of the following ones:
n. Arsenic
o.Cadmium
p.Lead
q.Mercury
r.Phosphorus
4- e - Parikh: 9.3
 Iodine
Uses: Iodine is used as antiseptic. Iodine kill bacteria, fungus and amoeba.
Mod of Action: Strong solutions of iodine act as corrosives, as it precipitate proteins. The
vapors of iodine are strongly irritant to the respiratory passages.
Acute poisoning:
Symptom and Signs:
1. When iodine is swallowed the symptoms and signs are those of corrosive and irritant
poisons.
Primary symptoms and signs: (local effects).
i. Sever burning pain extending from mouth to stomach followed by vomiting, diarrhea and
intense thirst. The vomit and stool may be yellow or dark brown in color with iodine smell.
ii. Lips and oral mucosa are stained yellow or brown.
Secondary symptoms and signs: Mainly effect the kidneys.
i. Edema of the glottis and lungs and some times pleural effusion.
ii. Maturation is pain full, the urine may be suppressed or scanty contain albumin and blood.
The color of urine is “dark brown ” with “iodine smell”.
iii. Weak pulse, delirium and collapse.
2. Inhalation of Iodine vapors are responsible for edema of glottis and lungs causes death
from ‘asphyxia’.
Fatal Dose: 8 to 10ml of tincture iodine may cause death.
Fatal Period: The average fatal period is 24 hrs. Rapid death may occur from anaphylaxis
Treatment:
i. Stomach should be washed with sodium thiosulphate.
ii. Demulcents such as fat, oil, milk and white of egg are helpful.
iii. Rest of the treatment is symptomatic.
Postmortem appearance of iodine.
External signs.
i. Lips may be stained yellow or brown.
ii. Oedema of the face and eyes may be observed.
Internal signs.
i. The Mucous membrane of the mouth, esophagus and stomach is corroded and may be stained yellow or
brown.
ii. Oedema of the glottis and lungs and some times pleural effusion.
iii. Tubular necrosis of kidneys.

Medico-legal importance.
Accidental Poisoning: Poisoning by iodine is usually accidental specially in children attracted by its colour.
Suicide Poisoning: Tincture iodine is occasionally taken to commit suicide.
Homicide Poisoning: Iodine can not be used as homicide due to its color and smell. Iodine in strong
solution has been employed for ‘vitriolage’.

Chronic Iodine poisoning - Iodism: Prolong ingestion of iodine or

iodine compound leads to chronic poisoning called ‘iodism’.
The clinical features are,
i. Frontal Headache
ii. Conjunctivitis.
iii. Oedema of the face and eyelids.
iv. Bronchial Catarrh
Treatment: The use of iodine or iodides should be discontinued.
 Iodism

Oedema of eye lid.

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