Few have heard of the so-called “Black Widow” killer who posed as a wife, widow, mother, friend and nurse to murder perhaps as many as 21 victims [over a period of almost 20 years], living off her husbands before eventually claiming their estates. Two decades before Jack the Ripper would terrorist the streets of Whitechapel in London, Mary Ann Cotton had already become a killing machine, perhaps murdering as many as eight of her own children, seven stepchildren, her mother, three husbands, a lover — an an inconvenient friend.

Mary Ann Cotton’s murder weapon was arsenic, readily available at that time over the counter as a disinfectant. Cotton was no doubt aware that the symptoms of acute arsenic poisoning — vomiting diarrhea, abdominal pain — were similar to common medical conditions such as severe gastroenteritis or dysentery. Coroners and physicians would invariably determine that her victims died of natural medical causes, not foul play. In addition, arsenic had heretofore been impossible to detect. However, the science of forensic toxicology was developing groundbreaking techniques during this time, and traces of arsenic were detected in the exhumed remains of one of Cotton’s final victims. She was convicted of murder and hanged in 1873.

The following clips are from a British TV documentary about Mary Ann Cotton:

www.youtube.com/watch?v=_dUfcifMhZY

www.youtube.com/watch?v=eWrzDIg98oI

www.youtube.com/watch?v=Qp0W_DyyFxw

www.youtube.com/watch?v=cDFnQsHvn_I

“Bath Salt” Ingestion Leading to Severe Intoxication Delirium: Two Cases and a Brief Review of the Emergence of Mephedrone Use. Kasick DP et al. Am J Drug Alcohol Abuse 2012 Jan 5 [Epub ahead of print]

Abstract 

This paper from the Ohio State Department of Psychiatry is worth reading for vivid descriptions of acute toxic delirium in two patients after they used a product sold as “bath salts”:

• Patient A presented after ingesting “bath salts” sold under the label “Arctic Blast”. He was tachycardic (heart rate = 144.min), anxious and paranoid, and suffering visual hallucinations of snakes. For some bizarre reason he was given 2 mg naloxone in the field. At the hospital, he slowly improved after treatment with fluids, lorazepam, and haloperidol.
• Patient B snorted four lines of “Posh Aromatherapy Bath Salts”, and presented with paranoia, delirium tremors, hyperreflexia, clonus, as well as visual and auditory hallucinations that lasted for 2 days. He also gradually recovered normal mental status after treatment with fluids, lorazepam, and risperidone.

The authors’ discussion of mephedrone is somewhat strange, since bath salts can contain other drugs and no definitive testing was carried in in either of these cases.  According to the U.S. Department of Justice National Drug Intelligence Center, baths salts can contain any of a number of synthetic cathinones:

• MDPV
• Mephedrone
• Methylone
• Naphrone
• 4-Fluoromethcatinone (flephedrone)
• 3-Fluoromethcathinone
• Methedrone
• Butylone

Fortunately, treatment of toxicity from synthetic cathinones does not depend on the exact substance involved. This includes: fluids, sedation, detecting and reversing significant hyperthermia, and monitoring for rhabdomyolysis and acute renal failure.

Irukandji Sydrome [sic] in the Torres Strait: A Series of 8 Cases. McIver LJ et al. Wilderness Environ Med 2011;22:338-342.

Abstract

The problems with this paper merely begin with the dropped “n” in the second word of the title. Then we get to the first sentence of the abstract, where despite the title’s promise of a case series of Irukandji syndrome (or sydrome, or whatever) we find a classic medical literature bait-and-switch:

Objective–To review the presentations of a series of patients with suspected Irukandji syndrome in the Torres Strait, where the syndrome has hitherto been unknown or undocumented, in order to identify at-risk groups and improve the management of this condition in the region.

So we’re dealing not with cases of Irukandji syndrome in the Torres Strait, but with suspected cases. So we might reasonably ask — what characteristics were exhibited by the patients described in the study to arouse suspicion of Irukandji syndrome? Unfortunately, the paper contains no description of methods used to identify cases. Four of eight patients had welts, 4/8 were diaphoretic, 5/8 had tachycardia, and 5/8 had hypertension. The only characteristic common to all 8 cases was pain. So what we have is a case series of 8 people who went in the water and developed pain. Hardly convincing. And there is no indication in the paper that Carukia barnesi, the jellyfish that causes Irukandji syndrome, was identified in the area where these incidents occurred.

Related posts:

Just when you thought it was safe to go back to Malaysia   . . . fatal box jellyfish stings

Is that a jellyfish on your leg or are you just glad to see me? Priapism and Irukandji Syndrome

Irukandji Syndrome Case Series From Australia’s Tropical Northern Territory

Murder by insulin: suspected, purported and proven — a review. Marks V. Drug Test Analysis 2009;1:162-176.

Abstract

With the recent death following an unexpected hypoglycemic episode of a fifth patient at Stepping Hill Hospital in Greater Manchester (U.K.), this classic article on the forensic pathology involving insulin as a murder weapon has become even more timely. Dr. Marks is one of the foremost experts and expert witnesses in the field, having testified at the Claus von Bülow trial, among many others.

Marks points out that:

[Insulin] is an inefficient and ineffective weapon, largely because of the length of time it takes to cause death and the ease with which it can be diagnosed and treated.

Through personal knowledge and review of both medical and lay literature, the author provides summaries of 66 cases involving persons who were alleged or known to have been poisoned by insulin. He makes the following points:

1. Blood glucose measured after death is unreliable as an indication as to whether the victim actually died of hypoglycemia.
2. In general, glucose disappears from blood after death.
3. However, post-mortem blood collected from the right heart can be artifactually elevated, because of breakdown of liver glycogen.
4. B-cells of the pancreatic islets of Langerhans produce proinsulin, which is broken down after release into equal amounts of insulin itself and C-peptide.
5. Surreptitious insulin administration will cause elevated insulin levels but low or absent C-peptide.
6. The differential diagnosis of hypoglycemia with extremely elevated insulin and C-peptide levels include insulinoma and poisoning with drugs such as sulfonylureas that stimulate insulin release.
7. Other causes of life-threatening hypoglycemia include sepsis and alcohol-induced hypoglycemia.

By the way, the Claus von Bülow affair is case number 32 summarized in this paper. It is discussed in much more detail in Dr. Marks’ book Insulin Murders: True Life Cases. Von Bülow was initially convicted for using insulin in the attempted murder of his wife Sunny, but the conviction was overturned during a second trial. This episode was the subject of the movie Reversal of Fortune, that had this classic scene between von Bülow (Jeremy Irons) and one of his defense lawyers Alan Dershowitz (Ron Silver):

www.youtube.com/watch?v=nTFflehHtvI

This scene was later referenced in The Lion King – an animation in which the villain Scar was voiced by Jeremy Irons.

www.youtube.com/watch?v=lx0lSRGMB1g