Q4 LONG ANSWER 10M ★ High-yield

Describe the duties of a doctor in a case of poisoning and the collection and preservation of viscera.

Forensic Medicine · 2nd Professional — Para-Clinical

Duties of the Doctor

Duty	Detail
Treat first	Resuscitation and treatment precede every legal formality. Refusal or delay pending police clearance is unlawful (Parmanand Katara) and has killed people
Inform the police	Every case of suspected poisoning is a medicolegal case and must be intimated to the police in writing, with the time recorded. Failure may amount to an offence under BNS 239 (formerly IPC 201), causing disappearance of evidence
Preserve and hand over evidence	Vomit, the first gastric aspirate, urine, blood, the container, tablets, plant material, the syringe and the clothing — each labelled, sealed and handed over against signature
Record meticulously	The time of arrival and of every observation; the history as alleged and attributed; the clinical findings; what was given and when; and the identity of the person accompanying
Record a dying declaration	Where the patient is deteriorating — with certification of mental fitness before and after, in their own words, without leading, and excluding relatives who may be the accused
Do not destroy or discard anything	Gastric washings are routinely poured away and the container thrown out; both are evidence
In a case of a medical practitioner poisoning	The doctor must not shield a colleague or an institution; the obligation to report is the same

A doctor in private practice has the same obligations as one in government service, and there is no discretion to treat a poisoning case quietly to avoid police involvement — a course frequently urged by families and by institutions
The treating doctor is usually the only person who will ever see the early clinical picture, the container and the first aspirate; whatever they fail to record or preserve is lost permanently

Preservation of Viscera

Specimen	Quantity and notes
Stomach and its contents	The whole stomach, opened along the greater curvature, with all its contents; ligated at both ends before removal
Upper part of the small intestine with contents	About the first 30 cm of duodenum and jejunum, ligated — important where death was delayed and the stomach has emptied
Liver	About 500 g — the organ of metabolism and storage, and the single most useful solid organ
Kidney	One half of each kidney
Blood	About 100 mL, preferably peripheral (femoral) rather than cardiac, to avoid postmortem redistribution
Urine	About 100 mL, the whole available
Special specimens	Brain — for volatile poisons, alcohol, hydrocarbons and organophosphates; lung — for inhaled poisons; bone, hair and nails — for arsenic, thallium and heavy metals in chronic poisoning; long bone — for lead and radium; skin and underlying tissue around an injection site; the gravid uterus; vitreous humour — which resists putrefaction and is invaluable in a decomposed body

Preservative	Use and exceptions
Saturated saline (common salt solution)	The routine preservative for viscera, in a quantity covering them by about 2 to 3 cm
Rectified spirit	An alternative — but never where alcohol, paraldehyde, chloroform, ether or acetic acid is suspected, since it makes the result uninterpretable
Sodium fluoride with potassium oxalate	For blood alcohol — the fluoride prevents both bacterial fermentation (which generates alcohol after death) and glycolysis. Also used for blood sugar
NO preservative AT all	For carbon monoxide, cyanide and phosphorus — the specimen is sent in a clean, airtight container, filled to the brim and refrigerated
Never formalin	Formalin interferes with the detection of several poisons and must not be used for material intended for chemical analysis; it is for histology only

CLINICAL PEARL

Rectified spirit in an alcohol case, and formalin in any case, destroy the analysis. Preserving viscera in spirit when the question is whether the driver had been drinking makes the result meaningless; and formalin interferes with the detection of several poisons outright. Saturated saline is the default, fluoride is for alcohol, and carbon monoxide, cyanide and phosphorus get no preservative at all — four rules that cover almost every case.

Packing, Sealing and Dispatch

Containers — clean, dry, wide-mouthed glass jars with a glass or plastic stopper; filled to about two-thirds; and a separate jar for each specimen, since mixing renders the analysis uninterpretable
Labelling — the name of the deceased, the autopsy and inquest number, the police station and case number, the date, the contents, the preservative used, and the signature of the doctor
Sealing — each jar sealed with the doctor’s own seal, and a sample OF the preservative sent in a separate sealed jar, together with a specimen impression OF the seal on a separate paper — so that the chemical examiner can confirm that the preservative was not itself contaminated and that the jars were not opened in transit
The chain OF custody — handed to the police officer against signature, with a forwarding letter listing the specimens, the history and the suspected poison, and a copy retained. A break in the chain destroys the value of the analysis however accurate the result
Despatch — to the Forensic Science Laboratory or the Chemical Examiner, as soon as possible, refrigerated where required. The doctor should state what poison is suspected, since the laboratory cannot screen for everything and a general request produces a general answer

Applied Aspects

State the suspected poison on the requisition; a laboratory asked to "examine for poison" will run a routine screen that misses many agents entirely, and the history is what directs the analysis
Send a sample of the preservative and an impression of the seal; without them the defence can suggest contamination or tampering and the analysis is weakened
Use one jar per specimen and fill only to two-thirds; mixed viscera cannot be interpreted and a full jar bursts on transport
Take femoral rather than cardiac blood where possible; postmortem redistribution from the gut and lungs into the heart chambers falsely raises the concentration of many drugs
Preserve viscera even where the cause seems obvious; the body is released within hours and the material cannot be recovered, and a negative screen excludes a defence that would otherwise be raised
Never let anyone discard the gastric washings; they are the highest-concentration specimen available and are lost more often than any other
Vitreous humour resists putrefaction and is invaluable in a decomposed body where blood is useless
Take hair, nails and bone in suspected chronic poisoning; they give a chronological record that soft tissues cannot
Ligate the stomach at both ends before removal, and send it whole with all its contents rather than a sample
Take the brain for volatile poisons — alcohol, hydrocarbons, organophosphates — and the lung for anything inhaled
Record the time of every observation; in a poisoning case the sequence and timing are frequently the whole issue
Do not shield a colleague or an institution; the duty to report a poisoning case is the same wherever it arose
Never use formalin for material going to chemical analysis; it interferes with the detection of several poisons and is for histology only
Never use rectified spirit where alcohol is the question; it makes the result meaningless, and paraldehyde and chloroform are affected too
Carbon monoxide, cyanide and phosphorus get no preservative and go in a full airtight container, refrigerated
Send a sample of the preservative itself, so the examiner can exclude contamination from that source
Treat first and inform the police afterwards; refusal pending police clearance is unlawful and has killed people
A private practitioner has identical obligations; there is no discretion to handle a poisoning case quietly
State the suspected poison on the requisition; a general request produces a routine screen that misses many agents entirely
One jar per specimen, filled to two-thirds; mixed viscera cannot be interpreted and a full jar bursts in transit
Send an impression of your seal separately, so tampering in transit can be excluded by the examiner
A break in the chain of custody destroys the analysis however accurate the laboratory result may be

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