QWhat condition—that might kill an apparently healthy young adult—might be difficult to detect through autopsy?
Charlaine Harris
New York Times best-selling author of Dead Reckoning
AMost illnesses and injuries are readily determined at autopsy, so these would not work. Poisons usually leave behind no physical signs and are not readily found with a routine autopsy. For instance:
Cyanide and carbon monoxide: bright red color to the blood and tissues.
Arsenic: erosions of and bleeding from the stomach lining.
Cantharidin (Spanish fly): swelling and blistering of the urinary tract.
Strychnine: rapid rigor mortis from the muscle spasms this drug causes.
Any of these might tip the ME off to look for the toxin.
Most poisons require toxicological tests, and they can be expensive and time consuming. Often poisons are not pursued for this reason or because they aren’t considered. The coroner will sign off the death as something else, maybe a cardiac arrhythmia since it leaves behind no physical evidence. He’s saved time and money, which he might not have in his limited budget, and no one is the wiser.
Toxicological testing is two-tiered: screening and confirmatory. Tox screens done as part of a routine autopsy typically test for alcohol, narcotics, sedatives, marijuana, cocaine, amphetamines, and aspirin. Some screen for a few other classes. If no toxins are found, that might be the end of the investigation. Again, time and money are saved.
If a member of a class is identified, confirmatory testing to determine exactly which member of the class is present and in what amount should be done. These tests are more expensive and time consuming. Using gas chromatography in conjunction with either mass spectrometry (GS/MS) or infrared spectroscopy (GC/IR) will give a chemical fingerprint for any molecule. Since each molecule has its own structure and thus its own fingerprint, every compound can be distinguished from every other one.
If your coroner is lazy, incompetent, corrupt, or limited by a sparse budget, toxicological testing might never be done, and a death from poisoning might be overlooked. Even if he does tox testing, it might consist of only the screening tests, and if they came back negative he would stop there.
What poisons might slip through the tox screening? Things like oleander, digitalis, deadly nightshade, selenium, thallium, sodium azide, Taxol, tetrodotoxin, and many others.