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Homicidal poisoning in India: A short review
Accepted Manuscript Homicidal Poisoning in India: A Short Review Asit Kumar Sikary PII:
S1752-928X(18)30311-1
DOI:
https://doi.org/10.1016/j.jflm.2018.10.003
Reference:
YJFLM 1724
To appear in:
Journal of Forensic and Legal Medicine
Received Date: 21 May 2018 Revised Date:
15 September 2018
Accepted Date: 19 October 2018
Please cite this article as: Sikary AK, Homicidal Poisoning in India: A Short Review, Journal of Forensic and Legal Medicine (2018), doi: https://doi.org/10.1016/j.jflm.2018.10.003. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Title: Homicidal Poisoning in India: A Short Review Short title: Homicidal poisoning in India Dr. Asit Kumar Sikary
Corresponding author:
Assistant Professor
ESIC Medical College & Hospital,
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Department of Forensic Medicine
NH3, NIT3, Faridabad 121001, India
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Phone: +91 81303 78201
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Email: [email protected]
ACCEPTED MANUSCRIPT Title: Homicidal Poisoning in India: A Short Review Abstract This review has analysed various studies and case reports on homicide by poison from
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different parts of India till date. This review shows that homicidal poisoning prevalence varies from 0.3% to 3.7% having varied prevalence from different regions with no homicidal cases too. The poisons used in homicide were mainly organophosphates, aluminium
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phosphide, paraquat, and arsenic. No age-group or gender was spared and the perpetrators were first degree relatives.
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Keywords: accidental poisoning; first-degree relative; homicide; perpetrator; suicidal
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poisoning; victim.
ACCEPTED MANUSCRIPT Introduction Homicide is killing a human being by another human being (1). Weapons of homicide are firearms, knives or other cutting instruments, personal weapons (hands, fists, feet, etc.),
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blunt objects (club, hammer, etc.), strangulating and smothering objects, fire, water (as in drowning), explosives, narcotics and poisons (2,3). All these methods have been studied in detail by various authors; however, homicide by poison has not much studied. Even in the
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overshadowed by suicidal and accidental manners.
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studies exclusively focused on poisoning cases, the homicidal manner of poisoning has been
Studies amongst the developed countries showed that homicidal poisoning is an uncommon phenomenon. In the USA, Adelson (4) found 14 cases of homicidal poisoning, out of 6,246 homicide cases during the year 1951-1985. During that period there were total 3,972
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poisoning fatalities. As per FBI Uniform Crime Reporting supplementary homicide reports for the year 1990-1999, only 1.9 per one hundred thousand homicides were due to poison. The report has explained that this low counting of homicidal poisoning was mainly due to
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underreporting (5). Muazzam et al (6) presented a report of poisoning cases collected from the Centre of Disease Control and Prevention for the year 2003-2007 and found that total
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463 cases of homicidal poisoning occurred during that period with a rate of 0.3 per million. In England and Wales, Flanagan et al (7) found 106 cases of homicidal poisoning out of 2907 childhood (<10 years) poisoning cases during the period 1968-2000. In Sweden, Finnberg et al (8) found 34 homicidal cases during the year 1975 to 2008, with a rate of 1.2 cases per million. Among developing countries, in a series of 2,873 cases of poisoning among children in Zimbabwe, Kasilo et al (9) found only two cases of homicide during the year 1980-1989.
ACCEPTED MANUSCRIPT Zhou et al (10) found 212 poisoning death cases during the year 1999 to 2008 in Central China and among them, 8 cases were of homicidal nature. In a study from North-eastern Bangladesh during 2008-2011, Bari et al (11) found 4,435 cases of poisoning, out of which 1,919 cases (43.3%) were of homicidal manner. None of the aforementioned studies had
poisoning didn’t find any case of homicidal poisoning (12).
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studied homicidal poisoning in detail because of its rarity as some of the studies on
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Studies on fatal poisoning are reported from India too, but these studies mainly focused on the suicidal nature and less commonly accidental. Homicidal nature is far less in number and
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has never been analysed in any of the studies. For example, in my centre there were total 338 poisoning death cases during the year 2009-2015 and among them, only one case was of homicidal manner. Likewise, studies on homicidal deaths in India mainly focused on prevalent methods of homicide and again homicide by poisoning was more or less ignored
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because of its rarity. In my centre there were 264 homicidal cases during the same period and only one was due to poison.
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In this article, we have reviewed various studies on poisoning death as well as on homicidal deaths and case reports on homicidal poisoning, reported so far, to know the status of the
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homicidal manner of poisoning in this country. These studies and case reports were collected using the academic search engine of PubMed, Google Scholar and MedInd (National Database of Indian Medical Journals) using keywords ‘homicide’, ‘poisoning’ and ‘homicidal poisoning’. Those studies and case reports which directly or indirectly discussed homicidal poisoning were included in this review. These studies were analyzed to know i) the prevalence percentage of homicidal poisoning in India, ii) the poisons involved in those cases, iii) the demographical characteristics of homicidal poisoning victims and perpetrators
ACCEPTED MANUSCRIPT and lastly, iv) various studies on poisoning in which there were no homicide cases. For ease, the studies in each section have been grouped region-wise, i.e. northern region, southern region, eastern and western region of the country.
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Prevalence percentage of homicidal poisoning in India Prevalence of homicidal poisoning in India found to be varying from 0.3% to 3.7% in various studies from different parts of India (13,14). Studies from of northern India showed a
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prevalence of 0.8% to 3.7% (13, 15-19). Studies from southern India showed the prevalence
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of 0.5% to 3% (20-24). A single study from western India found a homicidal poisoning prevalence of 0.3% (14). All these studies were done at different centers at different time periods as shown in table 1.
Poisons involved in homicidal poisoning
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Some studies as well as case reports have analysed different groups of poisons while others studies have analysed individual poisons. Most common group of poison studied were
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pesticides, especially organophosphate. Pesticide group of poisons showed a prevalence of 2.0% from eastern India (25) and a prevalence of 1.9% from Southern India (26).
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Organophosphate group showed a varying prevalence rate of 0.3% to 4.6% (27,28). The prevalence was found to be 0.5% from a centre of central India (29), 4.6% from a centre western India (28) and 0.3% and 1.0% from two different centers of southern India (27,30). A case of fatal homicide by intraperitoneal injection of an organochlorine was reported from a centre of northern India (31). Aluminium phosphide, paraquat, arsenic, formalin and, methanol were the individual poison used for homicide. In studies from different centers of northern India, 1% of the aluminium
ACCEPTED MANUSCRIPT phosphide poisoning and 20% paraquat poisoning were homicidal (32,33). As isolated homicidal cases, arsenic poisoning admixed with tea and methanol poisoning were reported from different centers of northern India (34,35); aluminium phosphide poisoning was
reported from different centers of southern India (37,38).
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reported from a centre of western India (36); paraquat and formalin poisonings were
Besides these studies on poisoning cases, a study on homicide from southern India found
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reports, respectively, on homicidal poisoning.
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2.6% of homicide cases due to poisoning (39). Table 1 & 2 depict various studies and case
Gender and age-group distribution of the victims of homicidal poisoning Both the genders were involved in homicidal poisoning i.e. male as well as female. However, female cases were reported among infant and children while male cases were reported
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among older age-groups. As per age-group, homicidal poisoning involved all the age-group viz. infants, children, adults and elderly. Relative frequency of these age-groups cannot be
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commented upon because of lack of sufficient data in the studies reviewed. Perpetrators of homicidal poisoning
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No study has commented upon the perpetrator of homicide poisoning. However, information about the perpetrator was available in the published case reports viz a 38-yearold male was poisoned with arsenic mixed in the drink by his wife and in-laws (34); an organophosphate was given to a 1-month old female infant by her mother (40); in a murdersuicide pact, a father administered aluminium phosphide to his two children mixed in fruits (41); aluminium phosphide was given to a 22-year-old female by her husband on the pretext of being helpful in having birth of a male child (36); a 28-year-old female was poisoned by
ACCEPTED MANUSCRIPT her husband with dichlorovos (42); a 58-year old male was given injection of an organocholo- compound by an unknown person (31); a mother poisoned her 6-month old girl child with formalin (38); and, the parents poisoned their 18-year old boy with methanol at dinner in a murder-suicide pact (35). The data is not sufficient to arrive at a conclusion
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but in all of the case reports, except one, the perpetrators were first degree relatives. In one case perpetrator was not known.
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Studies with no homicidal poisoning
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There are other studies from various regions of the country on organophosphates, snake bite, medicinal drugs and corrosives without any homicidal poisoning. In a study from Central India, there were 2,092 poisoning cases involving organophosphates, organochlorines, pyrethroids, phosphides, alcohol, kerosene, snake bite, diazepam,
(43).
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alprazolam, phenol, and corrosives. However, no case of homicide was found in the study
Various poisoning studies from different centers from southern India also failed to report
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any homicidal case. These studies were i) on 138 total cases of poisoning cases, the poisons
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studied were organophosphates, alcohol, organochlorine, carbamates, sedatives, phosphides, and phenol (44), ii) on 57 homicidal deaths (45), iii) on 86 childhood poisoning cases (46), iv) on 150 admitted poisoning cases (47), and on 198 poisoning cases (48). Likewise, various studies from different centers of western India were also negative on homicidal poisoning. These studies were: i) on 4,245 cases of poisoning (49), ii) on fatal poisoning of 132 cases (50), iii) on 557 cases (51), and on 182 poisoning cases (52). A
ACCEPTED MANUSCRIPT combined study done among three medical colleges in northern India did not report any case of homicide among 290 pediatric poisoning cases (53). Discussion
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This review showed that studies and case reports on fatal poisoning have been reported from every corner of the country. However, all those studies were mainly focused on
suicidal and accidental nature of the poisoning and no study has focused on the homicidal
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nature of poisoning as such. The studies reviewed for this article have shown the prevalence
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of homicidal poisoning varying from 0.3% to 3.7% from different parts of India. This prevalence is, in fact, the percentage of homicidal death by poisoning among other causes of homicidal deaths or other nature of poisoning. Most of these studies are reported from southern and northern India.
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The studies done in the USA show a true prevalence of 0.2% to 0.4% of homicides among poisoning deaths (4,5) while in UK and Wales, the prevalence was 3.6% (7). In the neighbouring country of China, the reported prevalence was 3.8% (10). However, the
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prevalence of homicide poisoning in another neighbouring country of Bangladesh was 43.3%
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among poisoning deaths (11). This high prevalence was mainly due to commuter poisoning by a cocktail of stupefying agents and/or benzodiazepines which are easily available over the counter. This type of homicidal poisoning has not been reported from India yet. This low, and sometimes rare, rate of homicide by poisoning in India and other countries may be due to many factors pertaining to the poison such as disagreeable odor and taste (54), unknown effect and fatal dose, low fatality rate i.e. less than 10 in one study (11) in comparison to 20 to more than 40 with stabbing or gunshot (53), and an essential need of
ACCEPTED MANUSCRIPT beforehand preparation and planning. All these facts make the poison an infrequent weapon. The unreliability of the poisons for homicidal purposes is depicted more clearly by the fact
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that there were various poisoning and homicidal studies from the different regions of the country which showed no case of homicidal poisoning. The poisoning studies included a wide range of poisons including various organophosphates, snake bite, medicinal drugs, and
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corrosives. The number of the cases was 57 to 198 (40-49). Homicidal studies included all method of homicide viz. sharp and blunt weapons, personal weapons, firearms, chemicals,
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burns, and explosions and included 350 to 590 cases (55–58).
Nevertheless, the poisons used for homicide were mainly agricultural poisons i.e. organophosphates, aluminium phosphide, paraquat, and arsenic. Organophosphates have
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the highest fatality rate amongst the poisons (3-25%) (59) and have a clinical presentation similar to common clinical condition escaping the diagnosis (11). It may be forced to the victim (52) or may be mixed with food or drink. Aluminium phosphide possesses an
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unpleasant rotten fish/garlicky odor and it can be easily detected in the body tissues after death which makes it less popular for homicidal poisoning. It is offered as wonder drugs to
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the victim (36) or mixed with foods (51). Arsenic is a common homicidal poison till recently which is given chronically in small doses or an acute large dose. It mainly gives gastrointestinal and dermatological symptoms. The only drawback is that it can be detected in the body tissue long after death (60). Paraquat is brown-colored, highly water-soluble, and odorless liquid which gives upper respiratory symptoms with pulmonary edema and renal failure. It is given in a large dose or in smaller repeated doses mixed with food or drink (33,61).
ACCEPTED MANUSCRIPT Victims of the homicidal poisoning were of all age-groups, except 2nd decade, and of both genders, female mainly in younger age-group and male mainly in older age-group. The poison was given by deceitful means without any struggle between the parties, and the
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perpetrators were mostly first degree relatives. Limitation of the review
Most of the study reviewed here were retrospective studies and individual case reports, and
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none of the studies particularly focused on homicide poisoning. No in-depth information
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was available about the victims, accused and method used. Because of these facts, this review could not generate profiles of the victim and the perpetrator in detail, and also it was not possible to analyse the methodology of the crime. In-depth analysis of the homicidal poisoning studies, especially from criminology point of view, can provide more information
Conclusion
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about the pattern of homicidal poisoning, its victims and their perpetrators.
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In spite of the limitation, this review concludes that homicidal poisoning is not common in India compared to the suicidal and accidental manners of poisoning, and other methods of
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homicide. Most common poisons involved are agrochemicals viz. organophosphates, organochlorines, aluminium phosphide, paraquat, and arsenic. These homicidal poisonings involved all age-groups and both sexes as victims and, first degree relatives as perpetrators. Based on these facts poisoning can be ruled out as a homicidal weapon until and unless circumstances show otherwise keeping in mind that absence of struggle mark does not rule out homicide. In a case of homicidal poisoning, first-degree relative viz. parents, husband, and in-laws are the usual perpetrator. All the information in this review is based on
ACCEPTED MANUSCRIPT retrospective studies and case reports having limited information about the characteristics of the victims, their perpetrators and the poison involved. A detailed prospective study focused on homicidal poisoning is needed to have a complete view of these uncommon but
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important cases. Declaration of funding: This research received no specific grant from any funding agency in
Declaration of Conflicting Interests: None.
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the public, commercial, or not for profit sectors.
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ACCEPTED MANUSCRIPT Legends for the table: Table 1: Studies depicting homicidal poisoning cases (all studies were retrospective).
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Table 2: Individual case reports on homicidal poisoning.
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Table 1: Studies depicting homicidal poisoning* cases (all studies were retrospective) Cases 3 out of 164 cases 4 males out of 376 cases; 2. Chandigarh, northern India (32) 4 females out of 219 cases Jammu: 2 out of 357 cases; 3. Chandigarh and Jammu, northern India (16) on poisoning Chandigarh: 4 out of 333 cases 4. Amritsar, northern India (18) on poisoning 6 out of 340 cases 5. Chandigarh, northern India (33) on paraquat poisoning 1 out of 84 cases 6. Jammu, northern India (15) on poisoning 2 out of 256 cases 7. Saifai, northern India (19) on poisoning 7 out of 236 cases 8. Thrissur, southern India (24) on poisoning 7 out of 1485 cases 9. Sevagram, southern India (14) on poisoning 10 out of 196 cases 10. Mangalore, southern india (23) on poisoning 9 out of 321 cases 11. Bijapur, Southern India (30) on pesticide poisoning 2 out of 240 cases 12. Vellore, southern India (20) on poisoning 3 out of 629 cases 13. Mangalore, southern India (41) on poisoning Female 1 out of 166 cases 14. Mangalore, southern India (21) on poisoning in children 1 out of 81 cases 15. Melmaruvathur region, southern India (22) on poisoning Female 2 out of 106 cases 16. Gulbarga, southern India (39) on homicide 1 out of 39 cases 17. Four centres of southern India (26) on pesticide poisoning 42 out of 2169 cases 18. Kanyakumari, southern India (27) on organophosphate poisoning 2 out of 672 cases 19. Jagdalpur, central India (29) on organophosphate poisoning Male 2 males out of 164 cases 20. Bardwan, eastern India (25) on pesticide poisoning 4 out of 204 cases 21. Ahmedabad, western India (28) on organophosphate poisoning 2 out of 65 cases *The manner was decided by the police in all of the studies; †Only this study depicted age-group of homicidal poisoning viz 6-10 years.
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Sex-group Male & Female
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Study pattern on poisoning on aluminium phosphide poisoning
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Region Chandigarh, northern India† (17)
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S. No. 1.
Year of study 1970-1989 1982-2006 Jammu: 1980-2000 Chandigarh: 1994-2000 1997-1998 1998-2006 2015 2015-2016 1995 1999-2000 2001-2003 2003-2009 2004-2013 2008-2009 2010-2011 2010-2012 2010-2012 2011-2014 2014-2015 2007-2009 2011-2012 1995-1999
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Table 2: Case reports on homicidal poisoning*
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Poison Aluminium phosphide Organochlorine Methanol Organophosphate Arsenic Aluminium phosphide Paraquat Formalin Dichlorovos
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Sex-group Male Male Male Male Female Male Female Female
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Age-group Children 52 years 18 years 1 month 38 years 22 years 30 years 6 months 28 years
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S. No. Region 1. Amritsar, northern India (40) 2. New Delhi, northern India (31) 3. New Delhi, northern India (35) 4. New Delhi, northern India (50) 5. Rohtak, northern India (34) 6. Belgaum, southern India (36) 7. Bellary, southern India (37) 8. Kolar, southern India (38) 9. Surat, central India (42) * The manner was decided by the police in all of the cases.
ACCEPTED MANUSCRIPT Highlights
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This article reviews the homicidal poisoning reported so far from India. The prevalence of homicidal poisoning is found to be 0.3% to 3.7%. Most common group of the poisons was pesticide, especially organophosphate. Individual poisons involved were aluminium phosphide, paraquat, arsenic, formalin and, methanol. All the age-group and both the sexes were involved. First degree relatives were the perpetrator in all of the cases.
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• • • •
S1752-928X(18)30311-1
DOI:
https://doi.org/10.1016/j.jflm.2018.10.003
Reference:
YJFLM 1724
To appear in:
Journal of Forensic and Legal Medicine
Received Date: 21 May 2018 Revised Date:
15 September 2018
Accepted Date: 19 October 2018
Please cite this article as: Sikary AK, Homicidal Poisoning in India: A Short Review, Journal of Forensic and Legal Medicine (2018), doi: https://doi.org/10.1016/j.jflm.2018.10.003. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Title: Homicidal Poisoning in India: A Short Review Short title: Homicidal poisoning in India Dr. Asit Kumar Sikary
Corresponding author:
Assistant Professor
ESIC Medical College & Hospital,
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Department of Forensic Medicine
NH3, NIT3, Faridabad 121001, India
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Phone: +91 81303 78201
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Email: [email protected]
ACCEPTED MANUSCRIPT Title: Homicidal Poisoning in India: A Short Review Abstract This review has analysed various studies and case reports on homicide by poison from
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different parts of India till date. This review shows that homicidal poisoning prevalence varies from 0.3% to 3.7% having varied prevalence from different regions with no homicidal cases too. The poisons used in homicide were mainly organophosphates, aluminium
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phosphide, paraquat, and arsenic. No age-group or gender was spared and the perpetrators were first degree relatives.
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Keywords: accidental poisoning; first-degree relative; homicide; perpetrator; suicidal
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poisoning; victim.
ACCEPTED MANUSCRIPT Introduction Homicide is killing a human being by another human being (1). Weapons of homicide are firearms, knives or other cutting instruments, personal weapons (hands, fists, feet, etc.),
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blunt objects (club, hammer, etc.), strangulating and smothering objects, fire, water (as in drowning), explosives, narcotics and poisons (2,3). All these methods have been studied in detail by various authors; however, homicide by poison has not much studied. Even in the
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overshadowed by suicidal and accidental manners.
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studies exclusively focused on poisoning cases, the homicidal manner of poisoning has been
Studies amongst the developed countries showed that homicidal poisoning is an uncommon phenomenon. In the USA, Adelson (4) found 14 cases of homicidal poisoning, out of 6,246 homicide cases during the year 1951-1985. During that period there were total 3,972
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poisoning fatalities. As per FBI Uniform Crime Reporting supplementary homicide reports for the year 1990-1999, only 1.9 per one hundred thousand homicides were due to poison. The report has explained that this low counting of homicidal poisoning was mainly due to
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underreporting (5). Muazzam et al (6) presented a report of poisoning cases collected from the Centre of Disease Control and Prevention for the year 2003-2007 and found that total
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463 cases of homicidal poisoning occurred during that period with a rate of 0.3 per million. In England and Wales, Flanagan et al (7) found 106 cases of homicidal poisoning out of 2907 childhood (<10 years) poisoning cases during the period 1968-2000. In Sweden, Finnberg et al (8) found 34 homicidal cases during the year 1975 to 2008, with a rate of 1.2 cases per million. Among developing countries, in a series of 2,873 cases of poisoning among children in Zimbabwe, Kasilo et al (9) found only two cases of homicide during the year 1980-1989.
ACCEPTED MANUSCRIPT Zhou et al (10) found 212 poisoning death cases during the year 1999 to 2008 in Central China and among them, 8 cases were of homicidal nature. In a study from North-eastern Bangladesh during 2008-2011, Bari et al (11) found 4,435 cases of poisoning, out of which 1,919 cases (43.3%) were of homicidal manner. None of the aforementioned studies had
poisoning didn’t find any case of homicidal poisoning (12).
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studied homicidal poisoning in detail because of its rarity as some of the studies on
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Studies on fatal poisoning are reported from India too, but these studies mainly focused on the suicidal nature and less commonly accidental. Homicidal nature is far less in number and
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has never been analysed in any of the studies. For example, in my centre there were total 338 poisoning death cases during the year 2009-2015 and among them, only one case was of homicidal manner. Likewise, studies on homicidal deaths in India mainly focused on prevalent methods of homicide and again homicide by poisoning was more or less ignored
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because of its rarity. In my centre there were 264 homicidal cases during the same period and only one was due to poison.
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In this article, we have reviewed various studies on poisoning death as well as on homicidal deaths and case reports on homicidal poisoning, reported so far, to know the status of the
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homicidal manner of poisoning in this country. These studies and case reports were collected using the academic search engine of PubMed, Google Scholar and MedInd (National Database of Indian Medical Journals) using keywords ‘homicide’, ‘poisoning’ and ‘homicidal poisoning’. Those studies and case reports which directly or indirectly discussed homicidal poisoning were included in this review. These studies were analyzed to know i) the prevalence percentage of homicidal poisoning in India, ii) the poisons involved in those cases, iii) the demographical characteristics of homicidal poisoning victims and perpetrators
ACCEPTED MANUSCRIPT and lastly, iv) various studies on poisoning in which there were no homicide cases. For ease, the studies in each section have been grouped region-wise, i.e. northern region, southern region, eastern and western region of the country.
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Prevalence percentage of homicidal poisoning in India Prevalence of homicidal poisoning in India found to be varying from 0.3% to 3.7% in various studies from different parts of India (13,14). Studies from of northern India showed a
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prevalence of 0.8% to 3.7% (13, 15-19). Studies from southern India showed the prevalence
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of 0.5% to 3% (20-24). A single study from western India found a homicidal poisoning prevalence of 0.3% (14). All these studies were done at different centers at different time periods as shown in table 1.
Poisons involved in homicidal poisoning
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Some studies as well as case reports have analysed different groups of poisons while others studies have analysed individual poisons. Most common group of poison studied were
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pesticides, especially organophosphate. Pesticide group of poisons showed a prevalence of 2.0% from eastern India (25) and a prevalence of 1.9% from Southern India (26).
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Organophosphate group showed a varying prevalence rate of 0.3% to 4.6% (27,28). The prevalence was found to be 0.5% from a centre of central India (29), 4.6% from a centre western India (28) and 0.3% and 1.0% from two different centers of southern India (27,30). A case of fatal homicide by intraperitoneal injection of an organochlorine was reported from a centre of northern India (31). Aluminium phosphide, paraquat, arsenic, formalin and, methanol were the individual poison used for homicide. In studies from different centers of northern India, 1% of the aluminium
ACCEPTED MANUSCRIPT phosphide poisoning and 20% paraquat poisoning were homicidal (32,33). As isolated homicidal cases, arsenic poisoning admixed with tea and methanol poisoning were reported from different centers of northern India (34,35); aluminium phosphide poisoning was
reported from different centers of southern India (37,38).
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reported from a centre of western India (36); paraquat and formalin poisonings were
Besides these studies on poisoning cases, a study on homicide from southern India found
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reports, respectively, on homicidal poisoning.
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2.6% of homicide cases due to poisoning (39). Table 1 & 2 depict various studies and case
Gender and age-group distribution of the victims of homicidal poisoning Both the genders were involved in homicidal poisoning i.e. male as well as female. However, female cases were reported among infant and children while male cases were reported
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among older age-groups. As per age-group, homicidal poisoning involved all the age-group viz. infants, children, adults and elderly. Relative frequency of these age-groups cannot be
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commented upon because of lack of sufficient data in the studies reviewed. Perpetrators of homicidal poisoning
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No study has commented upon the perpetrator of homicide poisoning. However, information about the perpetrator was available in the published case reports viz a 38-yearold male was poisoned with arsenic mixed in the drink by his wife and in-laws (34); an organophosphate was given to a 1-month old female infant by her mother (40); in a murdersuicide pact, a father administered aluminium phosphide to his two children mixed in fruits (41); aluminium phosphide was given to a 22-year-old female by her husband on the pretext of being helpful in having birth of a male child (36); a 28-year-old female was poisoned by
ACCEPTED MANUSCRIPT her husband with dichlorovos (42); a 58-year old male was given injection of an organocholo- compound by an unknown person (31); a mother poisoned her 6-month old girl child with formalin (38); and, the parents poisoned their 18-year old boy with methanol at dinner in a murder-suicide pact (35). The data is not sufficient to arrive at a conclusion
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but in all of the case reports, except one, the perpetrators were first degree relatives. In one case perpetrator was not known.
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Studies with no homicidal poisoning
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There are other studies from various regions of the country on organophosphates, snake bite, medicinal drugs and corrosives without any homicidal poisoning. In a study from Central India, there were 2,092 poisoning cases involving organophosphates, organochlorines, pyrethroids, phosphides, alcohol, kerosene, snake bite, diazepam,
(43).
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alprazolam, phenol, and corrosives. However, no case of homicide was found in the study
Various poisoning studies from different centers from southern India also failed to report
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any homicidal case. These studies were i) on 138 total cases of poisoning cases, the poisons
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studied were organophosphates, alcohol, organochlorine, carbamates, sedatives, phosphides, and phenol (44), ii) on 57 homicidal deaths (45), iii) on 86 childhood poisoning cases (46), iv) on 150 admitted poisoning cases (47), and on 198 poisoning cases (48). Likewise, various studies from different centers of western India were also negative on homicidal poisoning. These studies were: i) on 4,245 cases of poisoning (49), ii) on fatal poisoning of 132 cases (50), iii) on 557 cases (51), and on 182 poisoning cases (52). A
ACCEPTED MANUSCRIPT combined study done among three medical colleges in northern India did not report any case of homicide among 290 pediatric poisoning cases (53). Discussion
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This review showed that studies and case reports on fatal poisoning have been reported from every corner of the country. However, all those studies were mainly focused on
suicidal and accidental nature of the poisoning and no study has focused on the homicidal
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nature of poisoning as such. The studies reviewed for this article have shown the prevalence
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of homicidal poisoning varying from 0.3% to 3.7% from different parts of India. This prevalence is, in fact, the percentage of homicidal death by poisoning among other causes of homicidal deaths or other nature of poisoning. Most of these studies are reported from southern and northern India.
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The studies done in the USA show a true prevalence of 0.2% to 0.4% of homicides among poisoning deaths (4,5) while in UK and Wales, the prevalence was 3.6% (7). In the neighbouring country of China, the reported prevalence was 3.8% (10). However, the
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prevalence of homicide poisoning in another neighbouring country of Bangladesh was 43.3%
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among poisoning deaths (11). This high prevalence was mainly due to commuter poisoning by a cocktail of stupefying agents and/or benzodiazepines which are easily available over the counter. This type of homicidal poisoning has not been reported from India yet. This low, and sometimes rare, rate of homicide by poisoning in India and other countries may be due to many factors pertaining to the poison such as disagreeable odor and taste (54), unknown effect and fatal dose, low fatality rate i.e. less than 10 in one study (11) in comparison to 20 to more than 40 with stabbing or gunshot (53), and an essential need of
ACCEPTED MANUSCRIPT beforehand preparation and planning. All these facts make the poison an infrequent weapon. The unreliability of the poisons for homicidal purposes is depicted more clearly by the fact
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that there were various poisoning and homicidal studies from the different regions of the country which showed no case of homicidal poisoning. The poisoning studies included a wide range of poisons including various organophosphates, snake bite, medicinal drugs, and
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corrosives. The number of the cases was 57 to 198 (40-49). Homicidal studies included all method of homicide viz. sharp and blunt weapons, personal weapons, firearms, chemicals,
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burns, and explosions and included 350 to 590 cases (55–58).
Nevertheless, the poisons used for homicide were mainly agricultural poisons i.e. organophosphates, aluminium phosphide, paraquat, and arsenic. Organophosphates have
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the highest fatality rate amongst the poisons (3-25%) (59) and have a clinical presentation similar to common clinical condition escaping the diagnosis (11). It may be forced to the victim (52) or may be mixed with food or drink. Aluminium phosphide possesses an
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unpleasant rotten fish/garlicky odor and it can be easily detected in the body tissues after death which makes it less popular for homicidal poisoning. It is offered as wonder drugs to
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the victim (36) or mixed with foods (51). Arsenic is a common homicidal poison till recently which is given chronically in small doses or an acute large dose. It mainly gives gastrointestinal and dermatological symptoms. The only drawback is that it can be detected in the body tissue long after death (60). Paraquat is brown-colored, highly water-soluble, and odorless liquid which gives upper respiratory symptoms with pulmonary edema and renal failure. It is given in a large dose or in smaller repeated doses mixed with food or drink (33,61).
ACCEPTED MANUSCRIPT Victims of the homicidal poisoning were of all age-groups, except 2nd decade, and of both genders, female mainly in younger age-group and male mainly in older age-group. The poison was given by deceitful means without any struggle between the parties, and the
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perpetrators were mostly first degree relatives. Limitation of the review
Most of the study reviewed here were retrospective studies and individual case reports, and
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none of the studies particularly focused on homicide poisoning. No in-depth information
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was available about the victims, accused and method used. Because of these facts, this review could not generate profiles of the victim and the perpetrator in detail, and also it was not possible to analyse the methodology of the crime. In-depth analysis of the homicidal poisoning studies, especially from criminology point of view, can provide more information
Conclusion
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about the pattern of homicidal poisoning, its victims and their perpetrators.
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In spite of the limitation, this review concludes that homicidal poisoning is not common in India compared to the suicidal and accidental manners of poisoning, and other methods of
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homicide. Most common poisons involved are agrochemicals viz. organophosphates, organochlorines, aluminium phosphide, paraquat, and arsenic. These homicidal poisonings involved all age-groups and both sexes as victims and, first degree relatives as perpetrators. Based on these facts poisoning can be ruled out as a homicidal weapon until and unless circumstances show otherwise keeping in mind that absence of struggle mark does not rule out homicide. In a case of homicidal poisoning, first-degree relative viz. parents, husband, and in-laws are the usual perpetrator. All the information in this review is based on
ACCEPTED MANUSCRIPT retrospective studies and case reports having limited information about the characteristics of the victims, their perpetrators and the poison involved. A detailed prospective study focused on homicidal poisoning is needed to have a complete view of these uncommon but
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important cases. Declaration of funding: This research received no specific grant from any funding agency in
Declaration of Conflicting Interests: None.
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the public, commercial, or not for profit sectors.
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ACCEPTED MANUSCRIPT Legends for the table: Table 1: Studies depicting homicidal poisoning cases (all studies were retrospective).
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Table 2: Individual case reports on homicidal poisoning.
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Table 1: Studies depicting homicidal poisoning* cases (all studies were retrospective) Cases 3 out of 164 cases 4 males out of 376 cases; 2. Chandigarh, northern India (32) 4 females out of 219 cases Jammu: 2 out of 357 cases; 3. Chandigarh and Jammu, northern India (16) on poisoning Chandigarh: 4 out of 333 cases 4. Amritsar, northern India (18) on poisoning 6 out of 340 cases 5. Chandigarh, northern India (33) on paraquat poisoning 1 out of 84 cases 6. Jammu, northern India (15) on poisoning 2 out of 256 cases 7. Saifai, northern India (19) on poisoning 7 out of 236 cases 8. Thrissur, southern India (24) on poisoning 7 out of 1485 cases 9. Sevagram, southern India (14) on poisoning 10 out of 196 cases 10. Mangalore, southern india (23) on poisoning 9 out of 321 cases 11. Bijapur, Southern India (30) on pesticide poisoning 2 out of 240 cases 12. Vellore, southern India (20) on poisoning 3 out of 629 cases 13. Mangalore, southern India (41) on poisoning Female 1 out of 166 cases 14. Mangalore, southern India (21) on poisoning in children 1 out of 81 cases 15. Melmaruvathur region, southern India (22) on poisoning Female 2 out of 106 cases 16. Gulbarga, southern India (39) on homicide 1 out of 39 cases 17. Four centres of southern India (26) on pesticide poisoning 42 out of 2169 cases 18. Kanyakumari, southern India (27) on organophosphate poisoning 2 out of 672 cases 19. Jagdalpur, central India (29) on organophosphate poisoning Male 2 males out of 164 cases 20. Bardwan, eastern India (25) on pesticide poisoning 4 out of 204 cases 21. Ahmedabad, western India (28) on organophosphate poisoning 2 out of 65 cases *The manner was decided by the police in all of the studies; †Only this study depicted age-group of homicidal poisoning viz 6-10 years.
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Study pattern on poisoning on aluminium phosphide poisoning
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Region Chandigarh, northern India† (17)
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Year of study 1970-1989 1982-2006 Jammu: 1980-2000 Chandigarh: 1994-2000 1997-1998 1998-2006 2015 2015-2016 1995 1999-2000 2001-2003 2003-2009 2004-2013 2008-2009 2010-2011 2010-2012 2010-2012 2011-2014 2014-2015 2007-2009 2011-2012 1995-1999
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Table 2: Case reports on homicidal poisoning*
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Poison Aluminium phosphide Organochlorine Methanol Organophosphate Arsenic Aluminium phosphide Paraquat Formalin Dichlorovos
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Sex-group Male Male Male Male Female Male Female Female
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Age-group Children 52 years 18 years 1 month 38 years 22 years 30 years 6 months 28 years
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S. No. Region 1. Amritsar, northern India (40) 2. New Delhi, northern India (31) 3. New Delhi, northern India (35) 4. New Delhi, northern India (50) 5. Rohtak, northern India (34) 6. Belgaum, southern India (36) 7. Bellary, southern India (37) 8. Kolar, southern India (38) 9. Surat, central India (42) * The manner was decided by the police in all of the cases.
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This article reviews the homicidal poisoning reported so far from India. The prevalence of homicidal poisoning is found to be 0.3% to 3.7%. Most common group of the poisons was pesticide, especially organophosphate. Individual poisons involved were aluminium phosphide, paraquat, arsenic, formalin and, methanol. All the age-group and both the sexes were involved. First degree relatives were the perpetrator in all of the cases.
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