It was a Saturday, about tea-time in the quaint village of Athelstaneford, East Lothian. Mrs Alexandria Agutter sat in her cottage, enjoying the delights of the late-summer evening with a glass of gin and tonic. She listlessly sipped from the rather generous pick-me up, no doubt chewing over the happenings of the day. Blast! The taste was much too bitter to her liking. She stood up. And promptly crumpled to the floor in a dizzied heap. It had not been five minutes when a fiery pain gripped her parched throat and in her frenzied turn she watched the bleary room become draped in a gossamery silk. How Dame Agatha would approve. But this is no crime novel, on that fateful day, 24th August 1994, poor Mrs Agutter immortalised herself in the history books of forensic medicine; she was the victim of a revered toxin and a vintage one it was too. She had unwittingly imbibed a G&T laced with a classic poison of antiquity. A clue from the 21st century: do you recall the first Hunger Games film adaption? Those inviting purple-black berries or as Suzanne Collins coined them ‘Nightlock’; a portmanteau of hemlock and Deadly Nightshade. True to the laters’ real life appearance those onscreen fictional fruits played a recurring cameo role. Deadly Nightshade is a perennial shrub of the family Solanaceae and a relative of the humble potato (a member of the Solanus genus). It is a resident of our native woodland and may be found as far afield as Europe, Africa and Western Asia. The 18th century taxonomist, Carl Linnaeus gave the plant an intriguing name in his great Species Plantarum. The genus Atropa is aptly named after one of the three Greek Fates, Atropos. She is portrayed shearing the thread of a mortal’s life so determining the time and manner of its inevitable end. The Italian species name belladona (beautiful woman) refers to the striking mydriatic effect of the plant on the eye. The name pays homage to Pietro Andre Mattioli, a 16th century physician from Sienna, who was allegedly the first to describe the plant’s use among the Venetian glitterati - ladies of fashion favoured the seductive, doe-eyed look. Belladona is poisonous in its entirety. It was from the plant’s roots in 1831, the German apothecary Heinrich F. G. Mein isolated a white, odourless, crystalline powder: it was (surprise, surprise) atropine. Atropine is a chiral molecule. From its natural plant source it exists as a single stereoisomer L-atropine, which also happens to display a chiral potency 50-100 times that of its D-enantiomer. As with many other anaesthetic agents it is administered as a racemic mixture. How strange that atropine now sits among the anaesthetist’s armamentarium, its action as a competitive antimuscarinic to counter vagal stimulation belies its dark history. It was a favourite of Roman housewives seeking retribution against their less than faithful husbands and a staple of the witch’s potion cupboard. Little wonder how belladona became known as the Devil’s plant. Curiouser still it’s also the antidote for other poisons, most notably the organophosphates or nerve gases. On account of its non-selective antagonism, atropine produces a constellation of effects: the inhibition of salivary, lacrimal and sweat glands occurs at low doses; dry mouth and skin are early markers. Pyrexia is a central effect exacerbated by the inability to sweat. Flushing of the face due to skin vessel vasodilatation. Low parasympathetic tone causes a moderate sinus tachycardia. Vision is blurred as the eye becomes dilated, unresponsive to light and accommodation is impaired. Mental disorientation, agitation and ataxia give the impression of drunkedness or a delirium tremens like syndrome. Visual hallucinations, often of butterflies or silk blowing in the wind, are a late feature. It was then that Mr Agutter, seemingly untroubled by the sight of his wife’s problematic situation, proceeded to leave a message with the local practitioner. How fortunate they were to have the vigilant locum check the answering machine and come round to the Agutter’s lodge accompanied by an ambulance crew. The attending paramedic had the presence of mind to pour the remainder of Mrs Agutter’s beverage into a nearby jam jar, while Mr Agutter handed over what he suspected to be the offending ingredient: the bottle of Indian tonic water. As it soon transpired there were seven other casualties in the surrounding countryside of East Lothian – all involving an encounter with tonic water. In fact by some ironic twist of fate, two of the victims were the wife and son of Dr Geoffry Sharwood-Smith, a consultant aneasthetist. Obviously very familiar with the typical toxidrome of anticholinergic agents, he was quick to suspect atropine poisoning. Although for a man of his position with daily access to a sweetshop of drugs, it was not something to draw attention to. Through no small amount of cunning had the poisoner(s) devised the plan. It was elegant; atropine is very bitter. So much so that it can be detected at concentrations of 100 parts per million (0.001%). Those foolish enough to try the berries of belladonna during walks in the woods are often saved by the berry’s sour taste. They are soon spat out. But the quinine in the tonic water was a worthy disguise. The lethal dose for an adult is approximately 90-130mg, however atropine sensitivity is highy variable. In its salt form, atropine sulfate, it is many times more soluble: >100g can be dissolved in 100ml of water. So 1ml may contain roughly tenfold the lethal dose. There ensued a nationwide scare; 50 000 bottles of Safeway branded Indian tonic water were sacrificed. Only six bottles had been contaminated. They had all been purchased, tops unsealed, from the local Safeway in Hunter’s Tryst. Superficially this looked like the handiwork of a psychopath with a certain distaste for the supermarket brand, and amidst the media furore, it did have some verisimilitude: one of the local papers received a letter from 25 year old, Wayne Smith admitting himself as the sole perpetrator. The forensic scientist, Dr Howard Oakley analysed the contents of the bottles. They all contained a non-lethal dose, 11-74mg/litre of atropine except for the Agutter’s, it contained 103mg/litre. The jam jar holding Mrs Agutter’s drink bore even more sinister results, the atropine concentration was 292mg/L. It would appear Mrs Agutter had in some way outstayed her welcome. But she lived. A miscalculation on the part of the person who had added an extra seasoning of atropine to her drink. According to the numbers she would have had to swallow a can’s worth (330ml) to reach the lethal dose. Thankfully she had taken no more than 50mg. The spotlight suddenly fell on Dr Paul Agutter. He was a lecturer of biochemistry at the nearby University of Napier, which housed a research syndicate specialising in toxicology. CCTV footage had revealed his presence at the Safeway in Hunter’s Tryst and there was eye witness evidence of him having placed bottles onto the shelves. Atropine was also detected by the forensic investigators on a cassete case in his car. Within a matter of two weeks he would be arrested for the attempted murder of his wife. Despite the calculated scheme to delay emergency services and to pass the blame onto a non-existent mass poisoner, he had not accomplished the perfect murder. Was there a motive? Allegedly his best laid plans were for the sake of a mistress, a mature student from Napier. He served seven years of a twelve year sentence. Astonishingly, upon his release from Glenochil prison in 2002, he contacted his then former wife proclaiming his innocence and desire to rejoin her in their Scottish home. A proposition she was not very keen on. Dr Agutter was employed by Manchester University as a lecturer of philosophy and medical ethics. He is currently an associate editor of the online journal Theoretical Biology and Medical Modelling. We will never know the true modus operandi as Dr Agutter never confessed to the crime. Perhaps all this story can afford is weak recompense for the brave followers of the Dry January Campaign. Oddly these sort of incidents never appear in their motivational testimonials. Acknowledgements Emsley J. Molecules of Murder. 2008, Cambridge, RSC Publishing, p.46-67. Lee MR. Solanaceae IV: Atropa belladona, deadly nightshade. J R Coll Physicians Edinb. March 2007; 37: 77-84. Illustrator Edward Wong This blog post is a reproduction of an article published in the The Medical Student Newspaper January issue, 2014 http://www.themedicalstudent.co.uk/
about 7 years ago
2014 is already more than a month old (if you can believe it) and with each passing day, the world we live in is speeding towards breakthroughs in every sphere of life. We're running full tilt, wanting to be bigger and better than we were the day or the hour before. Every passing day reinvents the 'cutting edge' of technology, including medical progress and advancement. Gone are the medieval days when doctors were considered all knowing deities, while medicine consisted of leeches being used to drain 'bad blood'. Nowadays, health isn't just about waiting around until you pick up an infection, then going to your local GP to get treated; in today's world it's all about sustaining your wellbeing. And for that, the new kid on the block is biohacking. Biohacking is the art and science of maximizing your biological potential. As a hacker aims to gain complete control of the system he's trying to infiltrate, be it social or technological; similarly a biohacker aims to obtain full control of his own biology. Simply put, a biohacker looks for techniques to improve himself and his way of life. Before you let your imagination run away with you and start thinking of genetic experiments gone wrong, let me assure you that a biohack is really just about any activity you can do to increase your capabilities or advance your wellbeing. Exercising daily can be a biohack. So can doing the crossword or solving math sums, if it raises your IQ by a few points or improves your general knowledge. What characterizes biohacking is the end goal and the consequent modification of activities to achieve that goal. So what kind of goals would a biohacker have? World domination? Not quite. Adding more productive hours to the day and more productivity to those hours? Check. Eliminating stress and it's causes from their lives? Check. Improving mood, memory and recall, and general happiness? You bet. So the question arises; aren't we all biohackers of sorts? After all, the above mentioned objectives are what everyone aspires to achieve in their lives at one point or the other. unfortunately for all the lazy people out there (including yours truly), biohacking involves being just a tad bit more pro active than just scribbling down a list of such goals as New Year resolutions! There are two main approaches to selecting a biohack that works for you- the biggest aim and the biggest gain. The biggest aim would be targeting those capabilities, an improvement in which would greatly benefit you. This could be as specific as improving your public speaking skills or as general as working upon your diet so you feel more fit and alert. In today's competitive, cut throat world, even the slightest edge can ensure that you reach the finish line first. The biggest gain would be to choose a technique that is low cost- in other words, one that is beneficial yet doesn't burn a hole through your pocket! It isn't possible to give a detailed description of all the methods pioneering biohackers have initiated, but here are some general areas that you can try to upgrade in your life: Hack your diet- They say you are what you eat. Your energy levels are related to what you eat, when you take your meals, the quantity you consume etc. your mood and mental wellbeing is greatly affected by your diet. I could go on and on, but this point is self expanatory. You need to hack your diet! Eat healthier and live longer. Hack your brain- Our minds are capable of incredible things when they're trained to function productively. Had this not been the case, you and I would still be sitting in our respective caves, shivering and waiting for someone to think long enough to discover fire. You don't have to be a neuroscientist to improve your mental performance-studies show that simply knowing you have the power to improve your intelligence is the first step to doing it. Hack your abilities- Your mindset often determines your capacity to rise to a challenge and your ability to achieve. For instance, if you're told that you can't achieve a certain goal because you're a woman, or because you're black or you're too fat or too short, well obviously you're bound to restrict yourself in a mental prison of your own shortcomings. But it's a brave new world so push yourself further. Try something new, be that tacking on an extra lap to your daily exercise routine or squeezing out the extra time to do some volunteer work. Your talents should keep growing right along with you. Hack your age- You might not be able to do much about those birthday candles that just keep adding up...but you can certainly hack how 'old' you feel. Instead of buying in on the notion that you decline as you grow older, look around you. Even simple things such as breathing and stamina building exercises can change the way you age. We have a responsibility to ourselves and to those around us to live our lives to the fullest. So maximise your potential, push against your boundaries, build the learning curve as you go along. After all, health isn't just the absence of disease but complete physical, mental and social wellbeing and biohacking seems to be Yellow Brick Road leading right to it!
about 7 years ago
The guidance is for commissioners and providers of public health services, hepatitis testing and treatment services and laboratory services for hepatitis B and C testing. It is also for local organisations providing services for children and adults at increased risk of hepatitis B and C infection, including those in the NHS, local authorities, prisons, immigration removal centres and drugs services, and for voluntary sector and community organisations working with people at increased risk.
over 5 years ago
German politician and psychiatrist face manslaughter charges for their role in assisted suicide deaths
Prosecutors in Hamburg, Germany, have charged a politician and a psychiatrist with manslaughter after the deaths of two elderly women from assisted suicide in 2012. If convicted, both men could face five years to life in prison.
almost 7 years ago
It has been called a pioneering strategy for treating opioid addiction, and has already been adopted in a small yet growing number of jails and prisons in the United States.
almost 6 years ago
Prison policies vary on treating transgender inmates, which could put inmates and institutions at risk
Gina Gibbs, a University of Cincinnati criminal justice doctoral student, presented a synopsis of the legal issues posed by such inmates at the annual meeting of the American Society of...
almost 6 years ago