I am a forensic medical examiner who is exposed to unnatural deaths.
One day, a 51-year-old man in the jurisdiction fell into a coma in his bedroom for no apparent reason. After being sent to the emergency room, the rescue efforts failed and he died.
The deceased had a small amount of vomiting before his death, and showed symptoms of pulmonary edema and acute heart failure when he was sent to the hospital for emergency treatment.
The doctor in the emergency department suspected poisoning and was worried that someone had poisoned it, so they called the police immediately.
Image source: Zhanku Hailuo
Is it really poisoned? We started a field search.
The time of death of the deceased was around three in the afternoon, well past lunchtime. We only picked up part of the lunch scraps in the trash.
While examining the deceased’s bedroom, we also found an empty glass on the desk and a small bottle of liquor with a small amount.
The food at these sites was sent to the poisoning laboratory for testing, and then I examined the body of the deceased…
Autopsy examination: no trauma was found on the body of the deceased, except for flaky tan papules on both elbows with silvery white scales on the surface, consistent with psoriasis Performance.
Anatomical findings: The brain tissue of the deceased was slightly edematous, there was mucus in the pulmonary trachea, showing mild pulmonary edema, and no other damage was seen in the rest of the organs.
Histopathology: Hepatocyte and renal tubular epithelial cell necrosis, focal myocardial fiber granular disintegration, pulmonary edema, and focal pulmonary hemorrhage.
Poisoning test: Cantharidin was found in stomach contents and blood, and cantharidin was also found in wine bottles and glasses extracted on site.
The toxins in the wine are consistent with the toxins in the deceased and the physical examination.
Combining the above tests, we determined that the cause of death was: Acute respiratory and circulatory failure caused by cantharidin poisoning.
Image source: Zhanku Hailuo
After detailed inquiries and multiple investigations, we have clarified the approximate death of the deceased.
The deceased was suffering from psoriasis and went to the unlicensed Chinese medicine clinic in the village alone for treatment. The unlicensed Chinese medicine prescribed the self-made “Cantharidin Medicinal Wine” to the deceased, telling the deceased to take it internally and externally.
In this 100ml bottle of Mylabris medlar, about 3g of Mylabris southernis is soaked. The processed cantharidin generally contains 1.98% of its own weight cantharidin [1]. According to this ratio, the cantharidin content in wine is about 59.4mg.
According to research, cantharidin poisoning is mainly caused by cantharidin, and the lethal dose of oral cantharidin is 10-60mg[2].
And there was not much wine left in the small bottle. The deceased should have ingested an excessive amount of cantharidin, which led to his death.
Because the doctor did not have a medical qualification certificate and charged a fee, the case was finally determined as illegal medical practice causing death.
A lot of people think it is very strange to mention Mylabris. In fact, we have seen it in middle school textbooks.
Mr. Lu Xun’s “From Baicaotang to Sanweishuwu”, this article mentioned the cantharidin: “If you press your finger on its spine, it will snap, and then A puff of smoke came out of the orifice.”
Mylabris is actually a highly toxic Chinese medicine, which comes from the whole worm of Mylabris phalerata Pallas or Mylabris cichorii Linnaeus.
It is recorded in the 2020 edition of the Chinese Pharmacopoeia: Mylabris, acrid, hot; highly toxic. Returns liver, stomach and kidney meridians. Functions and Indications: Detoxifies blood and eliminates L, works toxins and erodes sores, induces redness and foaming, and is used for L lumps, stubborn ringworm, scrofula, warts, carbuncles that do not collapse, malignant sores and dead muscles.
The dosage of Mylabris is: 0.03～0.06g, after processing, it is mostly used in pills and powder. Appropriate amount for external use, ground into powder or soaked in wine vinegar, or ointment applied to the affected area, not suitable for large-scale use [3].
Mylabris can be used medicinally in traditional Chinese medicine, but because of its toxicity, the dosage is very small, only 0.03-0.06g.
In the above-mentioned deceased, the dosage of cantharidin was 3g, which was close to 100 times the normal dosage, which directly led to poisoning, causing acute renal failure, respiratory and circulatory disorders and multiple organ dysfunction and death. .
Image source: Station Cool hero
Folks often use a variety of Chinese herbal medicines to make wine, and people are prone to misuse toxic Chinese herbal medicines, resulting in poisoning. In addition, self-brewed medicinal wine has unknown efficacy, may not be symptomatic, or may cause damage to the body. Don’t try it, just in case of an accident.
In addition, the tragedy would not have happened if the deceased had chosen to go to a regular hospital instead of an unlicensed doctor.
He suffers from psoriasis, although it is a difficult disease, there is no cure for it, and the recurrence rate is high. However, regular drug therapy and physical therapy can also relieve symptoms and reduce recurrence and complications [4].
Therefore, when you have a disease in your body, don’t believe in wandering doctors and unlicensed “sacred doctors”, and don’t blindly seek “radical cure”, you must go to a regular hospital for regular diagnosis and treatment .
This is being responsible to yourself and your family.
Reviewer: Tang Guihua |Associate Professor of Crude Drugs and Natural Medicinal Chemistry, School of Pharmacy, Sun Yat-sen University
References
[1]Wang Yishuo, Zhao Lina, Zhang Zhenling. Comparative study on the content of total cantharidin before and after processing different batches of traditional Chinese medicine cantharidin [C]https:// New Technology of Traditional Chinese Medicine, New Achievements, New Experience Academic Exchange Conference. Chinese Association of Traditional Chinese Medicine, 2011.
[2]Wang Nuoqi, Zhang Li, Yang Xiuying, Du Guanhua. Historical understanding and modern research on “poison” of toxic Chinese medicine in animals [J]. Medicine Herald, 2019, 38(11) :1425-1430.
[3] National Pharmacopoeia Commission. Pharmacopoeia of the People’s Republic of China: 2020 Edition [M]. Beijing: China Pharmaceutical Science and Technology Press, 2020.
[4] Wang Mingxing, Wang Yan, Zhao Jingxia, et al. Research progress on the pathogenesis of psoriasis [J]. Liaoning Journal of Traditional Chinese Medicine, 2017, 44(6):1334-1338.
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