Poison and Poisoning

Chapter 20

OVER THE YEARS THERE have been many pieces of legislation relating to poisons. The examples below are a very brief summary of some of the more relevant ones up to the present day. A careful reading will show numerous instances of that well-known phrase ‘the law is an ass’.

The Arsenic Act of 1851

The Arsenic Act of 1851 was introduced because so many people were dying from arsenic poisoning in the mid-nineteenth century. The government of the day decided to take action to try to reduce the year on year ever-increasing numbers. The Arsenic Act laid down a number of provisions for each and every sale of arsenic. These requirements had to be entered into a special book by the seller and included the date of the sale, the name of the purchaser, the purchaser’s place of abode, his or her condition or occupation, the quantity of arsenic sold and the purpose for which it was required.

The signatures of both the purchaser and the seller were required, and if the purchaser was unknown to the seller then the sale required the presence of a witness too. The Act declared that arsenic could not be sold to anyone ‘under full age’, which at that time was 21. In addition, the arsenic, with a few exceptions such as for medicinal use, had to be coloured with indigo or soot to prevent it being mistaken for other harmless substances.

This Act did not restrict the sale of arsenic to the newly emerging chemists and druggists, as pharmacists were then called. It may seem very strange but any shopkeeper, of any trade, was allowed to keep and sell arsenic along with whatever other goods or provisions the shop also sold at that time.

The poisoned sweets that changed the law

In November 1858, a mass poisoning occurred in Bradford on such a scale that it eventually resulted in further legislation – although the Bradford poisonings only happened because sugar was expensive and a much cheaper, harmless alternative was readily available.

A market stallholder sold sweets to the public in small quantities. These were supplied to him by a wholesaler who made them nearby. The sweets contained oil of peppermint in a base of sugar and gum and, because sugar was expensive, it was the custom at that time to adulterate it with an inert but very cheap substance, known locally as ‘daft’. This ‘daft’ might have been plaster of Paris, powdered limestone, sulphate of lime or some other innocuous substance; anything would do as long as it was cheap and harmless.

Unfortunately the chemist and druggist, from whom the ‘daft’ was normally purchased, was ill on the fateful day. When his young assistant went to the stock room to weigh out 12 pounds of ‘daft’, he picked the wrong container – the one he chose contained arsenic trioxide, not a harmless substance at all.

Arsenic trioxide used to be called white arsenic for the simple reason that it is a white powder. This meant that it looked like the hundreds of other chemicals that are also white powders. The assistant’s mistake went undetected, even though the resulting sweets looked unusual, and even though the sweet-maker himself became ill while making them. The market stallholder also ate one and promptly became ill himself, but this did not put him off. Because of their strange appearance, the market trader purchased the sweets at a discount. They were sold on the market at three halfpennies for two ounces (about 50g). In those far-off days, money went a lot further than it does today, and £1 then would have purchased 160 such bags of the sweets.

About 200 people were affected with symptoms of severe illness after eating the sweets, and 20 of them died, including some young children. Prompt action by the local constabulary traced the source of the poison to the sweets. The sweet-maker, the chemist and druggist and his assistant were all committed for trial on a charge of manslaughter, but were all subsequently discharged. Analysis of some of the poisoned sweets showed that each one contained 700-1,000mg of arsenic, definitely a lethal dose.

The Pharmacy Act 1868

Although somewhat delayed, the Pharmacy Act, 1868, was a direct result of the mass poisoning case of the sweets in Bradford. This 1868 Act recognised the chemist and druggist as the suitable custodian and seller of named poisons. The requirement for record keeping, introduced in the Arsenic Act of 1851, was retained, as it has been in various acts since, and up to the present day.

This Act also introduced the requirement that containers of medicines for external use should be distinguishable by touch from those used for medicines to be swallowed. At this time, the only lighting in people’s homes was provided by candles or oil lamps; electric lights had yet to be invented. Consequently, there were many cases of poisoning caused by people fumbling about in the dark during the night, mistakenly taking a dose of something that was intended for external use only, and dying as a consequence. The ribbed bottle to be used for all external preparations was the answer, because it could be easily distinguished in the pitch black of night without having to light a candle.

The Workmen’s Compensation Act of 1906

By the beginning of the 1900s, illness and disability caused by certain occupations had begun to be recognised. The Workmen’s Compensation Act of 1906 placed a heavy liability upon certain employers who were engaged in various dangerous trades. The Act encompassed any disablement of employees by a disease incidental to and arising out of their occupation. It included anthrax (a danger to textile workers, especially those handling wool) and poisoning by lead, mercury, phosphorus or arsenic, as well as ankylostomiasis (a hookworm infection that caused anaemia).

One industrial disease, first recognised in Glasgow as long ago as 1827, was known as chrome ulcers. It was common in those working with chromium compounds, in the chrome-plating, dyeing, tanning, French polishing and calico-printing industries. The symptoms were the sudden appearance of holes in the skin, which were unbearably itchy and exposed raw flesh. Inhalation of chromic dusts could also lead to rhinitis and painless nasal ulcers, which could, in time, cause the perforation of the nasal septum.

Amendments over the years and new legislation, such as the Health and Safety at Work Act of 1974, which included the Control of Substances Hazardous to Health (COSHH) Regulations (SI1989 No1657), have greatly reduced the number of people suffering from work-related medical conditions. Today, the main hazards are chemicals used in agriculture and horticulture.

Unfortunately, many older workers were harmed long before this legislation was enacted. Many of these work-related conditions, such as asbestosis, do not cause problems until many years, even decades, later. Workers in these industries are now finding that they cannot get the compensation they are due, as their former employer or the employer’s insurers have chosen to go bankrupt in order to avoid an increasing number of claims from retired workers who have become ill.

The Poisons and Pharmacy Act 1908

The Poisons and Pharmacy Act went a step further than the Pharmacy Act of 1868 and finally required that the seller of poisons be a chemist and druggist or a registered medical practitioner, and that, before delivery was made, all sales and supplies should be entered into the poison register. The following details were to be recorded: the date, the name and address of the purchaser, the name and quantity of the poison and the purpose for which it was required, together with the signature of the purchaser. And if the purchaser was unknown to the seller, the signature of a witness, who was known to the seller, was required as well. This Act also specified how the poison should be packaged and labelled.

The Venereal Diseases Act 1917

A century ago, many advertisements were for quack medicines sold by mail order that claimed to prevent, relieve or cure venereal diseases. The Venereal Diseases Act 1917 prevented any treatment of venereal disease unless it was given by a duly qualified medical practitioner. Anyone not duly qualified, but advertising such treatment to the public, would suffer a severe penalty designed to put a stop to such quackery: imprisonment, with or without hard labour, for a period of up to two years, or on summary, conviction, for a period of six months or until the payment of a fine of up to £100, a very great sum of money at that time.

The Dangerous Drugs Act 1920

The Dangerous Drugs Act 1920 related to both raw and prepared opium as well as other drugs such as cocaine, diamorphine and morphine. It laid down the regulations for the import, export, sale and supply of these products and required records of each and every transaction, similar to those required for poisons.

The Pharmacy and Poisons Act 1933

All the various pieces of legislation relating to pharmacy or to poisons which had been enacted up to this time were brought together in the Pharmacy and Poisons Act 1933, which was to remain in force until the enactment of the Medicines Act 1968, much of which did not come into force until the early 1980s, and which is still in use today. But it was decided to keep the Dangerous Drugs Act as separate legislation.

The Cancer Act 1939

As with venereal diseases and the 1917 Act, this Cancer Act was to deal with advertisements for quack medicines aimed at the general public offering to treat or prescribe remedies for cancer. It was enacted to prevent unscrupulous people from taking advantage of desperate cancer patients or their relatives by selling and supplying quack medicines purporting to cure cancer.

The Pharmacy and Medicines Act 1941

The Pharmacy and Medicines Act was the result of a long campaign begun by the British Medical Association (BMA) in 1909. A royal commission was set up by the government but World War I intervened and further attempts at legislation in the 1920s and 1930s failed to gain parliamentary time. So, it was not until the 1941 Act that advertisements for quack remedies aimed at the general public for such conditions as Bright’s disease (a kidney disease), Cataract, Epilepsy, Diabetes, Glaucoma, Paralysis, Tuberculosis and Locomotor Ataxy, were finally banned.

Quack medicine was rife in the eighteenth, nineteenth and early twentieth centuries, with hundreds of remedies on sale, some of which could be purchased over the counter, but most could only be obtained by mail order. At that time, the manufacturers of medicines and remedies were not obliged to state the ingredients on the label.

The BMA wished to expose the fraudsters and so they employed a chemist to analyse a number of remedies. They asked him to ascertain the ingredients and then estimate the possible cost of them. The results were published in a book called Secret Remedies, published in 1909, and a further volume More Secret Remedies was published in 1912.

In 1783, a tax had been introduced on patent medicines, but was only payable if the ingredients were not disclosed and, unsurprisingly, the vast majority of manufacturers preferred to pay the tax (and pass it on to their customers) rather than expose the nature of the frequently useless ingredients they used to make their product. The system was wide open to fraud. The analyst discovered that any remedies for which massive claims were made were found to contain innocuous ingredients that cost next to nothing, and some ‘medicines’ contained only water.

Legislation today

Although enacted several decades ago, the current legislation in force today comprises the Medicines Act 1968 and the Poisons Act 1972, together with the Misuse of Drugs Act 1971, which jointly regulate all retail and wholesale dealings in medicines and poisons.

The Medicines Act 1968: This Act declares that all medicinal substances must be classified into one of three categories: prescription-only medicines, pharmacy medicines and those on the general sales list. Prescription-only medicines are only available on production of a prescription written by a suitably qualified person, usually a doctor or dentist, or nowadays even a nurse or pharmacist. Pharmacy medicines are those that appear on neither the prescription-only list nor the general sales list. While they do not require a prescription, they can only be purchased from a pharmacy. The sale of such pharmacy medicines must be made under the supervision of a pharmacist. The general sales list encompasses everything that is not listed as prescription only or sold as a pharmacy medicine.

The sale and supply of medicines in the United Kingdom is somewhat different from the rest of Europe, where all medicines must be obtained from a pharmacy. In the UK, medicines on the general sales list can be bought anywhere – the corner shop, the supermarket, even the petrol station!

Somewhat confusingly, a substance may be designated prescription-only when used in a medicine, but may also have non-medicinal uses. No prescription is required for a non-medicinal supply to be obtained, even though it is exactly the same substance.

Even more confusingly, some medicines may be licensed in all three categories, with only the smallest pack of the lowest strength available on the general sales list for purchase at the corner shop, larger packs being sold as pharmacy medicines and the higher strengths being only available on prescription.

The Misuse of Drugs Act 1971: Dangerous or otherwise harmful drugs, now called controlled drugs but previously called dangerous drugs, such as morphine and cocaine, even cannabis too, are all covered by this Act. Under this Act, there is a total prohibition on the possession, supply, manufacture, import or export of these drugs except as laid down in the regulations or by licence from the Secretary of State. Controlled drugs are classified into five schedules, depending on the level of control needed. There are different classes within each schedule, relating to the penalties for offences for production, possession and supply of such substances.

The use of these drugs in medicine is permitted by the Misuse of Drugs Regulations 2001, as amended. The drugs, such as morphine, must be kept in a special locked cupboard in the pharmacy or hospital ward and all transactions involving them must be recorded in the Controlled Drug Register, whenever new supplies are received as well as at the time of dispensing or administering doses of them. Despite the control in the pharmacy and hospital, once a supply is dispensed and given to the patient to take home, the medicine becomes the patient’s property, and he or she can keep it anywhere and any way.

The Poisons Act 1972: This Act includes a list of specific poisons and substances containing them. Any other substances, no matter how toxic they may be, are not considered to be poisons under this Act if they are not included on the list. Some of the listed poisons are used in medicines and then become subject to the provisions of the Medicines Act 1968.

The poisons list is divided into two parts. Both Part I and Part II poisons may be sold in a pharmacy under the supervision of a pharmacist. However, Part II poisons may also be sold by registered sellers of poisons from registered premises, such as agricultural merchants. The local authority maintains a list of all registered sellers of poisons, who are only allowed to sell pre-packed containers of the Part II poisons, and some of these are only allowed in a specified form.

Some poisons may only be sold to purchasers engaged in the horticultural or agricultural business and are not available to the general public through a pharmacy. Every transaction involving poisons must still be recorded in the poison register of each registered premises, as has been the case since the Arsenic Act of 1851 was enacted.

Dr Harold Shipman – a law unto himself

Harold ‘Fred’ Shipman was in a totally different league than other murdering doctors. The final total of his victims will never be known, but it is believed that he murdered about 250 people, mainly women aged 75 years or older, over a period of about 25 years.

Shipman was born in 1946 into an ordinary working-class family. His mother died of lung cancer, having been given injections of morphine during the final stages of her illness. No doubt this is when the young Shipman saw its magical effect in stopping pain. Two years after she died, he went to Leeds University to study medicine. Here he met Primrose, who was only 17, and by the time they married she was already five months pregnant.

By 1974, Shipman had qualified and joined a medical practice in Todmorden, Yorkshire. The Shipmans now had two children. It was while he worked in Todmorden that his addiction to narcotics, such as pethidine, came to light. He was made to undergo a period in a drug rehabilitation centre in 1975 and, two years later, he was working as a GP once more, but now in Hyde, near Manchester.

In Hyde, he worked as a single practitioner rather than in a group practice as he had done previously. Nobody noticed over the years that a number of Dr Shipman’s patients were dying, many of them while sitting in an armchair, fully clothed. He killed them by injecting opioids such as morphine and diamorphine (heroin) when he visited them at home. The symptoms of a morphine, or diamorphine, overdose have been listed in Chapter 3, but the only one that mattered here was respiratory depression – if you can’t breathe, you die. A few he even killed when they visited him at his surgery. At the time of his arrest, the police found that he had stocks of diamorphine sufficient to kill 1,500 people.

It was only when Kathleen Grundy, an active 81-year-old, suddenly died and her daughter was contacted by a local firm of solicitors that suspicions were aroused. The daughter, Angela, was a solicitor herself, and always dealt with her mother’s affairs. The local solicitors said that they had a copy of her mother’s will, but Angela knew that she had the original. As soon as she saw the badly typed and poorly worded document the solicitors had, she knew that it was a forgery and called the police. The fake will included a bequest to Shipman of £386,000: he had murdered her for her money. Mrs Grundy’s body was exhumed and a post-mortem found enough morphine in her body to kill her. The bodies of other patients were then exhumed and examined.

The police searched his home and the surgery premises, finding the typewriter that he had used to type the fake will. The Shipman house was littered with filthy clothes and old newspapers; it was a scene of total squalor, and not what you would expect to find in a doctor’s home. The police investigation found that Shipman had doctored computer records, back-dating entries, making things up, even suggesting in patients’ notes that they were addicted to opioids. Many of the bodies had been cremated, and the evidence they held had been lost forever.

In the trial that began late in 1999 and lasted for 57 days, Shipman was charged with only 15 of the murders. On the last day of January 2000, the jury found him guilty of all 15 as well as guilty of a charge of forgery. The judge announced in court, after sentencing him to 15 life sentences and four years for the forgery, that he recommended that the Home Secretary ensure that Shipman spend the rest of his life in prison, never to be released.

The inquiry that followed his trial decided that he had murdered at least 215 people while practising as a GP in Hyde and Todmorden, and that he may have killed at least another 35. Shipman never explained why he did it. Was it for money? Or because he hated older women? Nobody knows, but it was most likely simply his obsession. It was only in August 2003 that the hundreds of murders attributed to Shipman appeared in the crime statistics, skewing the murder figures for all time. Shipman committed suicide in his prison cell in January 2004. He had no poison, so he hanged himself.

Though legislation has been honed throughout the centuries, it has never been able to stop the abusers – both those accidental and deliberate poisoners of the past and present.

The End

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