Chapter 16
DELIBERATE, SELF-INFLICTED POISONING using an overdose is the choice for more than one in four people intending suicide. Intentional killing of oneself – suicide – is far more common to men, and only one quarter of all suicide fatalities are woman. Unsuccessful attempts, regardless of sex, may be a cry for help, which may later lead to a fatal attempt.
Intentionally killing yourself is regarded as praiseworthy in some oriental societies. In Japan, hari-kiri is a ritual disembowelling, done either to escape humiliation or even to demonstrate loyalty. In India, although abolished 175 years ago, some Hindu widows in the remote regions of northern India still practise sati, in which they are voluntarily burnt to death on their husbands’ funeral pyres.
Legal niceties
Christianity, Judaism and Islam all forbid suicide, and for many centuries in Christian countries it was regarded as a crime, and those who committed suicide were refused burial in consecrated ground. It was only in 1961 that the criminal penalties for attempting suicide were abolished in England and Wales.
Today in the UK, it is an anomaly in the law that it is not a crime for a person to end their own life, but it is a crime to assist someone in doing so. This ‘crime’ is punishable by 14 years imprisonment. However, the Director of Public Prosecutions currently considers that it would be against the public interest to prosecute a relative who might have ‘assisted’ a suicide. This topic is currently the subject of much debate.
The Voluntary Euthanasia Society, recently renamed Dignity in Dying UK, has campaigned for many years for the right to assist suicide in the case of the terminally ill. But, at present, such cases must travel to other parts of Europe such as Switzerland and the Netherlands where euthanasia is allowed. There are currently over 800 people in the UK who have joined Dignitas, the Swiss medical charity that assists such patients who wish to end their life at a time of their own choosing. So far, more than 115 Dignitas members from the UK have ended their lives in this way.
Organisations such as the Samaritans train volunteers to listen sympathetically to the distress of the suicidal.
Termination of a tiny life
Frequently in the past, self poisoning was used as a means to procure an abortion. A small number of herbal medicines came to be used for contraceptive purposes or as abortifacients (substances that induce abortion). Such medicaments were in use from ancient times throughout the Middle Ages and up to the first half of the twentieth century. These herbs included savin, tansy, myrrh, cow parsley, juniper, wormwood, pennyroyal, white poplar bark, ivy and rue. These herbs had many other uses too, but would not have been given to those women trying to get pregnant (in the case of those herbs with contraceptive properties), or to the already pregnant (in the case of those herbs that act to terminate a pregnancy). Even back in the mists of time, herbalists appreciated the importance of side effects and contraindications in their practice.
In the nineteenth century, women who wanted an abortion would even eat match heads, which in those days used to contain phosphorus, although this act was often fatal to the mother as well as the expected child. It was not until the 1930s that information and access to effective methods of birth control began to be available to the working classes. Until then, abortion was a major form of birth control, with infanticide not far behind.
Even in the 1950s and 1960s, medical journals were continually reporting cases of attempted abortion. Doctors and nurses call any early loss of an embryo or foetus from the womb an abortion. This terminates the pregnancy. Non-medical people tend to make a distinction between abortion and miscarriage, considering the former as being deliberately induced and the latter as an accidental occurrence. In modern times, with the introduction of newer, innovative methods of conception, such as In Vitro Fertilization (IVF), the injection of potassium chloride has also been used in cases of multiple pregnancy, where medical staff considered that selective reduction was necessary. Further details are given in Appendix V.
Abortion – performing or procuring one – was a criminal offence until the passing of the Abortion Act in 1967. It had been made a statutory offence in 1803 and further legislation led to the 1861 Offences Against the Persons Act, but the Abortion Act changed all that overnight. But even before the new act, most working women regarded it as neither immoral nor illegal to attempt abortion as long as it was before the ‘quickening’ – the time when the baby’s first movements are felt by the mother, usually at about the 16th week of pregnancy. Even today, abortion is still illegal in some countries, such as the Republic of Ireland and Iran.
In 1913, The Lancet carried a report of colocynth poisoning. More commonly known as bitter apple, colocynth is a drastic cathartic, causing violent vomiting and diarrhoea. A teaspoonful and a half of it has been known to be fatal. It was often used in the early twentieth century to try to induce an abortion. One woman, who took about five grams in powder form, suffered vomiting and diarrhoea for several hours, although she had little abdominal pain. She was treated with arrowroot, morphine and atropine, and after two days she was given the antiseptic, chlorbutol, in olive oil every six hours, together with a milky diet, and she ultimately recovered.
Potassium permanganate was also used in the past for its supposed abortifacient action, by inserting tablets, crystals or douches containing it into the vagina. Unfortunately, this could result in corrosive burns, severe vaginal haemorrhage and perforation of the vaginal wall, sometimes leading to peritonitis. The fatal dose of about ten grams could result in death, which was long delayed, sometimes for up to one month after such poisoning.
Lead plaster, sometimes known as diachylon plaster, is made by the combination of olive oil and lead oxide heated together in the presence of water. Such plasters have been in use since the time of the ancient civilisations of Greece and Egypt, where women were known to have eaten them in an attempt to procure an abortion.
Even a hundred years ago, lead plasters were still being used as abortifacients, as were diachylon pills. In the 1920s, there were reports of women who took a teaspoonful or two of lead oxide for the same purpose, resulting in serious and prolonged ill-health. Considering that the poisonous nature of lead has been known for centuries, it seems amazing that a diachylon bandage, Lestreflex, was still prescribable on the NHS until about 20 years ago.
In 1938,The Lancet reported the case of a woman who recovered from severe lead poisoning after ingesting a quantity in excess of 100g of lead acetate over a period of about a month, in an attempt to kill her unborn child and abort the pregnancy. She was lucky as she was given treatment with a high calcium diet and calcium lactate tablets, which, together with injections of parathyroid extract, led to her recovery.
Ergoapiol was a medicine, available as capsules, which contained ergot extract, aloin, oil of savin and parsley extract, used in the first half of the twentieth century for the treatment of menstrual disorders. Regrettably, some women misused it in an attempt to induce an abortion, sometimes with fatal consequences. One woman took 17 capsules of ergoapiol in an attempt to induce an abortion, and died.
An American journal reported on 37 women suffering from toxic polyneuritis following the use of apiol, an alcoholic extract of common parsley, as an abortifacient. This misuse of apiol led to its inclusion on an official list by the British authorities in 1939, a list of substances likely to be used to procure an abortion, still a crime at that time.
The antihistamine, dimenhydrinate, used to be taken for travel sickness, nausea and vomiting, and, because drowsiness is a major side effect, also as an aid to sleep. In 1962, a 24-year-old woman died of an overdose which she had taken in an attempt to procure an abortion. She took 7.5g (150 tablets), which caused vomiting, vertigo and convulsions, and this then led to coma, cyanosis and death from respiratory failure just an hour and a half later. Post-mortem showed that massive damage had occurred to both her lungs and kidneys.
Quinine, derived from Cinchona bark, has been used to treat malaria for several hundred years. In 1935, the British Medical Journal reported that quinine was often used in Greece for the purposes of suicide. While in some cases, doses of ten grams might not lead to serious intoxication, doses of 20g or more often proved fatal. Even smaller doses of less than ten grams could be fatal though, as shown by the woman who took only six grams of quinine sulphate to procure an abortion and died as a result.
It is hardly surprising that she tried quinine because, at that time in the 1930s, it was very popular among doctors, who gave small daily doses (300mg) to expectant mothers in the last few weeks of pregnancy, in the belief that it shortened labour and led to an improved childbirth generally. Needless to say, this useless and ineffective ‘fashion’ went out of the window over 50 years ago.
A breath of fresh poison
In the past, when the household gas supply was manufactured from coal at the gas works, the gas produced was poisonous. Many people were killed accidentally by gas leaks and explosions. But many used gas to commit suicide. Even though the natural gas we use today may not be poisonous, it still manages to cause deaths and injuries from leaks and explosions.
In 1924, dressmaker Florence Martha Miller, who was living in London, committed suicide by putting her head in the gas oven. The cause of death was coal gas poisoning. The French surrealist painter, René Crevel, committed suicide in the same way in 1905. In 1963, the poet Sylvia Plath also killed herself in this way, having previously made an attempt on her life some years earlier with an overdose of sleeping pills.
Major James Dunning was a 59-year-old retired American Army officer living in London. He had financial interests in the City and lived in fine style in Chelsea. He also owned a farm in Sussex. He was very proud of his 1913 Rolls-Royce, which he liked to repair himself, if he could. Any major repairs were undertaken by a specialist garage.
In February 1931, he sent his car to the specialist garage and several days later went to Birmingham by train for a business appointment. He sent his wife a telegram saying that he would collect the car on his way home to London. He did collect the car, but did not return to his wife, who was waiting at their home in Chelsea. Instead, he drove to the farm in Sussex and told the maid there that the car had some mechanical trouble which he proposed to work on after his evening meal.
The maid and the cook slept above the garage. They both heard the car engine running when they went to bed and thought that it continued for perhaps another 30 minutes. Early the next morning, the Major was found dead underneath his car. Tests showed that he had died of carbon monoxide poisoning, as there was a high level in his blood. The coroner gave a verdict of death by misadventure. It then transpired that the Major’s life was heavily insured for accidental death, but the terms of the policy excluded suicide. The insurance company refused to pay out, as they felt he could have killed himself, and the case eventually reached the court.
It appeared that the Major was having some income tax difficulties, which had put his financial position in doubt. The insurance company thought this to be a sufficient cause for him to commit suicide, hence their refusal to pay out. However, the medical experts supported the original verdict of accidental death. Calculations showed that the Rolls-Royce could easily produce the required lethal level of carbon monoxide in the garage, with the doors and windows all closed. The court found in favour of the widow and the insurance company then had to pay up the £10,000 due, which was a small fortune in 1931.
Accident, overdose or suicide – who knows?
Thomas Chatterton was born in Bristol in 1752. He was apprenticed to an attorney but was released from his apprenticeship in 1770 and went to London to seek his fortune. He was a poet and spent his time writing essays, satires and even a burlesque opera. Sadly he killed himself with arsenic that same year, at the age of only 18. Presumably he had found the streets of London were not paved with gold.
Chloroquine, like quinine, is used both to treat and to prevent malaria. In the 1950s, a young man committed suicide by taking a massive overdose of chloroquine. The accepted toxic limit was usually considered to be 20mg per kg of body weight, but this young man took the equivalent of about 100mg per kg and died about two and a half hours later of respiratory failure. Another man also died following overdose; he was taking three or four chloroquine tablets every day to prevent malaria, instead of just two tablets each week.
In the earlier chapter about household products, cases of poisoning by the use of formic acid for descaling kettles were mentioned. Many of these poisonings were undoubtedly attempted suicides. A report from only 20 years ago concerned some 53 such cases, among which there were 15 fatalities.
In 1936, the British Medical Journal reported an amazing case of strychnine poisoning and its treatment, at a time when treatment lacked all the monitoring devices and intensive care facilities that are available today. A man had taken strychnine for suicidal purposes, but he was treated promptly. He was given zinc sulphate within 20 minutes of taking the poison, anaesthetised using chloroform and given a morphine injection. He became cyanosed and was then given amyl nitrite to relax the blood vessels and so lower his blood pressure. His stomach was washed out with dilute potassium permanganate solution.
Later, more morphine and atropine were injected, while both chloral hydrate and potassium bromide were administered rectally. All these medicaments were continued as well as oxygen until the spasms diminished, the cyanosis lessened and the respiration improved. Amazingly the patient eventually awoke, drank some water, vomited, then slept again, and was discharged from the hospital, having apparently recovered, the following day.
People have even taken rat poison containing thallium deliberately, in order to poison themselves. In 1946, a 26-year-old French woman ate about 40g of rat poison, which contained just over two grams of thallium. Two days later, she had gastro-intestinal symptoms, and by the fourth day she had developed peripheral neuritis in her legs, and then a severe stomatitis (a sore inflamed mouth) on the fifth day. She eventually died on the ninth day due to pulmonary congestion.
Certainly cyanide
Everyone seems to know that cyanide is poisonous, having watched films and read books about spies, James Bond and the like. Cyanide poisoning can even occur accidentally with products such as Cymag, an agricultural product, which releases hydrogen cyanide gas when used to kill rabbits and rodents. However, many people have deliberately taken cyanide for personal reasons. Cyanide capsules were also used by secret agents during World War I and other wars since.
Heinrich Himmler, a German Nazi leader and Commander of the SS, committed suicide in 1945 by taking poison, rather than risk trial and execution at the end of WWII following his capture by the British near Bremen. He committed suicide at Luneberg by swallowing a dose of cyanide which he had concealed in his mouth. As the initiator of the gas ovens, with responsibility for the concentration camps and the butchery of seven million people in what we know as the Holocaust, he would undoubtedly have been executed after a trial at Nuremberg after the war. So, he took the easy way out.
Another deliberate, but non-military, use was in the case reported in The Lancet in 1978. The patient had taken 413mg of potassium cyanide and only survived because of the aggressive treatment and supportive measures given. These included intracardiac injection of adrenalin, 100 per cent oxygen, correction of his body’s acid/base balance and blood volume replacement.
Another man, 21 years old, was admitted to hospital unconscious. As the doctors had no idea of what had caused his unconscious state they could only treat him symptomatically. The man developed pulmonary oedema and acidosis and was treated with oxygen, the diuretic frusemide and various intravenous fluids. It was nine hours after admission before it was discovered that the patient had deliberately taken three 200mg capsules of potassium cyanide. No specific treatment was given apart from responding to his symptoms, and he made an uneventful recovery.
In the 1970s, the Reverend Jim Jones was the leader of The People’s Temple, a religious sect founded in California. The faith-healing preacher had gathered a flock of social misfits of various kinds, including the mentally ill, drug addicts and ex-convicts. In 1978, when a group of relatives wished to investigate the sect’s activities at their base in Guyana, South America, he persuaded no less than 913 members of his sect to commit mass suicide, by taking cyanide. He then shot himself.
More recently a young man used cyanide to end his life only a week before he was due to start a degree course at the University of St Andrews in 2003. He left a note in which he described the pain and anguish he had suffered since the age of 13 because of the particularly aggressive type of acne that he had suffered from, which had not been amenable to any form of treatment he had tried.
And in 2006, a toxicology lecturer suffering from depression, who must have known about the effects of cyanide, swallowed the poison in front of his partner. No post-mortem was carried out because of the potential risk to the hospital staff at the very same hospital, Arrowe Park, Birkenhead, where another suicide by poisoning occurred, mentioned in Chapter 9.
Sleeping finality
In the past, when barbiturates were used mainly as sleeping pills, many people took them in an attempt to commit suicide. Some were successful, although not as many as might be supposed. In 1934, The Lancet carried statistical tables detailing all fatalities associated with barbiturates that were recorded up to the end of 1932. Of 5,147 recorded suicides in 1931, only 13 of them were attributed to barbiturates, and there were none at all in 1932.
In 1936, an American medical journal reported the case of a small man, weighing only 54kg or about 8½ stone, who survived a total dose of 18g of sodium barbital, which he had taken with suicidal intent. He was in a deep coma for six days, with a very high temperature, a rapid pulse and increased respiration rate. This was in contrast to the severe depression of these measurements in most similar cases of overdose, although why his were raised was never explained. However, supportive treatment was successful and he survived.
In 1970, the British Medical Journal reported the case of a 25-year-old woman who took no less than eight grams of phenobarbitone. She did not regain consciousness until four days later. Her blood-phenobarbitone level fell only slowly, and restlessness, rapid-eye-movement sleep and insomnia increased over the next 19 days following the overdose.
The introduction of the benzodiazepines as an alternative to the barbiturates in the late 1950s and early 60s was considered a major breakthrough at the time, as even large overdoses were survived. Patients who took as much as two grams of diazepam made a rapid recovery. As diazepam is available as tablets of 2mg, 5mg and 10mg strengths, 2g equals 200 tablets of the highest 10mg strength. Most intending suicides would, no doubt, expect to be successful after taking such a large quantity of tablets.
Downing your poison
Poisons can come in all shapes and sizes, and some suicides have occurred as a result of liquids instead of tablets.
A 42-year-old man suffering from depression drank 200ml of the solvent acetone in 1966. He went into a coma for 12 hours but then recovered. He was found to have slightly raised blood sugar during the next four months, and there was sugar in his urine, indicating that he had become slightly diabetic as a result of drinking the acetone.
A 38-year-old man drank between one and two pints (approximately 500ml to 1L) of Nitromors paint stripper, which contained methylene chloride, and other ingredients including detergent. The man’s condition was initially very serious, but with supportive treatment, his recovery was rapid, and kidney damage was prevented. Although the man developed ulceration of his intestines and diverticulitis, amazingly he went on to make a full recovery.
The American poet, Vachell Lindsay, suffered from depression and committed suicide in 1931 by drinking a quantity of Lysol. This product was similar to Jeyes Fluid, containing a mixture of tar derivatives, and is also used as a disinfectant.
One man who attempted suicide about 30 years ago drank 150ml of camphor liniment. He suffered peripheral circulatory shock and severe dehydration due to vomiting. He also had three attacks of severe and prolonged grand mal epileptic fits. His treatment began with a stomach wash-out and intravenous diazepam to control the fits. Intensive supportive treatment followed, as a result of which he duly recovered. This was believed to be one of the highest doses of camphor to be followed by survival.
Lethal law
In June 2008, an abusive father killed himself with poison while on trial, after learning that he would go to prison for a brutal assault on his baby daughter. He mixed a solution of crushed sleeping tablets in a Coca-Cola bottle and gulped it down as he stood in the dock. The Sri-Lankan-born father, 40-year-old Anandakumar Ratnasabapathy, had repeatedly threatened to commit suicide if he was found guilty of the assault on his daughter.
The three-month-old girl was left quadriplegic, epileptic and partially blind after he deliberately blocked her nose and mouth. He was taken down to the cells and a doctor was called, but he died there later. This was believed to be the first suicide committed in a British courtroom.
However, this was not so, as in 1795 the Rev. William Jackson, a former curate of St Mary le Strand and editor of The Morning Post (1784-86), took arsenic while in the dock of the King’s Bench court in Dublin, which was then part of the British Isles. He died before he could be carried out of the court.