Classify poisons based on the chief symptoms. Describe the legal duties of a medical practitioner in a case of suspected poisoning.

Classification of Poisons Based on Chief Symptoms

Poisons can be broadly classified based on the predominant symptoms they produce, which helps in initial diagnosis and management. This classification is crucial for medical professionals to quickly identify the type of poisoning and initiate appropriate treatment.

Type of Poison	Chief Symptoms	Examples
Corrosives	Severe burning pain in mouth, throat, and abdomen; vomiting (often bloody); perforations, shock.	Strong acids (e.g., Sulphuric acid), Strong alkalies (e.g., Caustic soda).
Irritants	Inflammation, pain, nausea, vomiting, diarrhea, abdominal cramps. Can be metallic, non-metallic, or organic.	Arsenic, Mercury, Phosphorus, Aconite, Opium (in some contexts).
Neurotics	Affect the central or peripheral nervous system. Symptoms vary widely.	Cerebral: Coma, convulsions, delirium, paralysis. (e.g., Opioids, Barbiturates, Alcohol, Cannabis) Spinal: Convulsions, muscle spasms. (e.g., Strychnine) Peripheral: Paralysis, muscle weakness. (e.g., Curare)	Opium, Barbiturates, Alcohol, Strychnine, Organophosphates.
Cardiac Poisons	Direct action on the heart, causing arrhythmias, bradycardia, or tachycardia, leading to heart failure.	Digitalis, Oleander, Aconite.
Asphyxiants	Interfere with oxygen supply or utilization, leading to hypoxia.	Carbon monoxide, Hydrogen cyanide, Hydrogen sulfide.
Hypnotics/Sedatives	Induce sleep or sedation; depress CNS.	Barbiturates, Benzodiazepines.
Deliriants	Produce delirium, hallucinations, excitement.	Belladonna, Datura.
Narcotics	Produce stupor, coma, analgesia, and constriction of pupils.	Opium and its derivatives (Morphine, Heroin).

Legal Duties of a Medical Practitioner in Suspected Poisoning Cases

A medical practitioner in India has critical medico-legal responsibilities when dealing with suspected poisoning cases, as enshrined in various laws. These duties are essential not only for patient care but also for assisting the legal process.

• Immediate Treatment and Preservation of Life: The primary duty is to provide prompt and efficient medical aid to save the patient's life, irrespective of the cause or legal implications. Refusing emergency treatment is unethical and illegal.
• Reporting to Authorities:
  • Government Hospitals: Medical officers in charge of government hospitals are legally obligated to report all suspected poisoning cases (accidental, suicidal, or homicidal) to the nearest police officer or magistrate immediately. This is mandated under Section 33 of the Bharatiya Nagarik Suraksha Sanhita (BNSS) [earlier Section 39 of CrPC] which requires reporting of certain offenses including those involving grievous hurt or suspicious death.
  • Private Practitioners: While traditionally bound to report primarily homicidal poisoning, it is advisable and generally practiced to report all suspected cases to the police or magistrate to avoid legal complications and ensure proper investigation. Non-compliance can be punishable under Section 176 of the Indian Penal Code (IPC).
• Detailed Documentation:
  • Maintaining accurate, clear, and comprehensive records of the patient's history (as narrated by patient/attendants), clinical findings, symptoms, provisional diagnosis, treatment administered, and the patient's progress.
  • Documenting all signs and symptoms carefully, especially those related to the "toxidrome" (toxicological syndrome) which can indicate the class of poison.
• Collection and Preservation of Samples:
  • Properly collecting and preserving biological samples (e.g., gastric lavage fluid, blood, urine, vomitus) and any suspected poisonous material (e.g., leftover substance, containers).
  • Ensuring strict adherence to the chain of custody to maintain the integrity of evidence for forensic analysis. These samples must be sealed and sent to the appropriate forensic laboratory.
• Recording Dying Declaration: If the patient is in a serious condition and might die, the doctor should inform the nearest magistrate to record the dying declaration (under Section 32(1) of the Indian Evidence Act), which is a crucial piece of evidence.
• Issuance of Death Certificate: If a case of suspected poisoning proves fatal, the medical practitioner should *never* issue a death certificate. Instead, they must communicate the facts of death to the nearest police officer for necessary medico-legal investigations and post-mortem examination.
• Assistance in Post-Mortem Examination: For deceased patients, the doctor may be required to assist in or perform a post-mortem examination to ascertain the cause of death and collect further evidence.
• Providing Expert Opinion/Testimony: Medical practitioners may be summoned by the police or judiciary to provide an expert opinion based on clinical findings and toxicology reports, and to present findings clearly and truthfully in court as a witness.
• Ethical Obligation: Beyond legal duties, doctors have an ethical obligation to ensure that both innocent individuals are protected and the guilty are brought to justice, contributing to the societal good.