PATHOLOGY CLUB MEETING NOVEMBER 2003

Murder By Poisoning or
The Importance of A Very Good Pathologist & Toxicologist

Dr. Alphonse Poklis, PhD, Director of Toxicology and Professor of Pathology, Chemistry, Forensics, Pharmacology and Toxicology at Virginia Commonwealth University presented Murder by Poisoning at the Medical Student's Pathology Club November 12, 2003.

"Forensics is a little bit different," said Dr. Poklis, "because the results of your work are presented as evidence in court where it can undergo extreme scrutiny." That's why you cannot have a good medical examiner's office if you don't have a good forensic toxicologist, he added. 

"In the vast majority of suspected poisonings it is the role of the pathologist to prove that there is no reasonable cause of death but poison," he said. In the past, poison victims were often misdiagnosed and their deaths attributed to other causes. Today however, said Dr. Poklis, detection technology is so good, it can find just about anything.

Pathologists correlate signs and symptoms with a particular poison. In addition, they must identify and isolate affected organs and tissues. In the toxicology lab, the toxicologist specifically identifies the poison and its levels in the body are measured. The team needs to be acutely aware of the pattern of poisoning signs and symptoms, since they can mimic other diseases and conditions. For example, the signs and symptoms of chronic arsenic poisoning--general malaise, nausea and vomiting, blood dyscrasias, progressive, symmetrical, peripheral neuropathy and a rash or keratosis--mimics the rare, Guillain-Barre Syndrome. "With the advent of modern analysis," he said, "murder by poison is a pretty rare occurrence in the US."

When it happens, he added, it's almost always within families, usually spouses poisoning the other spouse. Other prime victims are dependents--the elderly and children.