Book review: The Poisoner's Handbook

Authored by Deborah Blum in 2010 (ISBN 9-781-59240-243-8).

When I first spotted this volume on the shelf at the library I thought the title might be "The Young Poisoner's Handbook"; I once watched an enjoyable movie by the same name.

Even though the book explains thoroughly the chemistry behind poison, the central stories of Charlie Norris, New York City's long-serving chief medical examiner, and his assistant Alexander Gettler. Before Norris' arrival in 1918, New York, like many cities, allowed the Mayor to appoint the coroner. By law, no medical degree or experience was required, and the appointments generally followed exigencies political rather than scientific. The appointees could be inept or corrupt or both. Pay was sometimes based in part on commission; the coroner might perform multiple autopsies on the same body to collect multiple payments. One coroner received kickbacks from funeral homes for directing bodies there. Coroners would accept payment from relatives or interested parties in exchange for a particular finding regarding cause of death. As an example of ineptness, Blum cites a death certificate identifying "assault or diabetes" as the cause of death.

Norris was a skilled scientist, but his main contribution to the professional medical examiner we take as a given in today's cities was political and monetary. Norris forcefully demanded the independence of his office, bullying or embarrassing the mayor where necessary. He could do so because of his independent means: he was of the Pennsylvania Norrises, leading bankers and founders of Norristown. When he first took office the coroner's laboratory had no equipment (itself testimony to merits of the former office-holders). He used his own funds to purchase the equipment, and throughout the years when a poor economy or an emboldened mayor caused his funding to be cut, he would again dip into his own pocket to pay the salaries of his staff. Norris also used his political skills and charm to organize conferences of medical examiners from other cities, further strengthening the notion that the coroner's office should be a professional, rather than political, post.

The science Alexander Gettler inherited was primitive. Poisoning was a preferred method of murder because it was so easy to "get away with". Few methods existed for reliably detecting the presence of a poison in a cadaver. Even if its presence could be proven, no one knew what a lethal dose was. These uncertainties meant in many cases no arrest, or if an arrest then no conviction. Gettler was an exceptionally skilled chemist and toxicologist. He, together with Norris, invented the tests necessary to isolate poisons and determine what levels caused which symptoms.

Blum divides her book by poison. These divisions fall to some extent into time periods, although many poisons spanned (and continue now) across multiple periods:

Chloroform (CHCl3). Chloroform was one of the first widely-used anesthetics. Cheap and effective, surgeons preferred it, pharmacists stocked it, and it was widely available. It was, however, capricious. No one knew for sure what a safe dose was, and the burning and scarring of throat and lung tissue made overuse painful. Doctors preferred its use in part because suits for malpractice often failed because no one could say what was safe. Robbers and murderers appreciated its effectiveness.

Methyl (wood) alcohol (CH3OH). Like its cousin ethyl alcohol, methyl alcohol gives its user a buzz, though more intensely. After the buzz, blindness and death often followed. As opposed to ethyl alcohol, when the body breaks down methyl alcohol the by-products are formaldehyde and formic acid. Ordinarily, no one would willingly imbibe methyl alcohol in place of ethyl. But, the Prohibition laws were not ordinary. Ethyl alcohol was harder to come by; bars and saloons sold liquor from unmarked, or mislabeled, containers. It was drinker-beware, and the poor populations, those without access to previously acquired stashes of alcohol, were most at risk.

Cyanide (HCN, KCN or NaCN). Cyanide is present in yew tree leaves, cherry laurel flowers, peach and apricot pits, and in bitter almonds. It was a popular choice for suicide because it acted quickly; it was not so popular for murder because of the tell-tale signs of death: bruising discoloration and convulsions. Accidental deaths were commonplace: before Norris was able to successfully lobby for their outlaw, insect fumigation commonly included cyanide in a gaseous form (hydrogen cyanide is used in the gas chamber).

Arsenic (Ag). While pure arsenic is poisonous, it mixes easily with oxygen to form white arsenic (As2O3), a nearly tasteless and odorless substance that can be added to food and causes death. As a murder weapon, its benefits include easy accessibility and handling (it was a key ingredient in weed and rat poisons) and, if administered in small doses, a slow death that mimics natural causes. However, because it is a metal and is not digested, it remains detectable in a body long after death. Alexander Gettler's contribution was to develop tests that detected ever smaller amounts.

Mercury (Hg). Pure mercury is not particularly poisonous, mostly because as a liquid its surface tension is so high that it tends to slip right through the digestive system, although its drinkers did tend to develop cancer. When mixed with chlorine in HgCl2, however, it becomes a salt, and like most salts is easily absorbed into the body. Like white arsenic, mercury bichloride was readily available in rat poisons and other household products (including treatments for constipation and syphilis). As with white arsenic, Dr. Gettler improved the sensitivity of the existing tests.

Carbon monoxide (CO). Carbon monoxide was a key ingredient in "illuminating gas" (along with hydrogen); the gas was also used to power stoves and heaters. Carbon monoxide is particularly toxic; at the time government scientists reckoned that the 22 horsepower Model-T, running in a closed, single-car garage would produce a lethal dose in ten minutes. Its lethality stems from its attractiveness to hemoglobin, the protein that transports oxygen in our blood. It turns out that hemoglobin prefers carbon monoxide to oxygen 200-to-1; thus, even with plenty of oxygen available, the body suffocates. The challenge for New York City toxicologists was to differentiate the carbon monoxide level in the cadaver from the level which existed in all urban dwellers. Gettler and others performed autopsies on dozens of decedents, from rural and urban settings, to discover the expected amount of "background" carbon monoxide. These discoveries were critical to securing convictions.

Radium (Ra). Radium is a poor choice as a murder weapon or suicide modality. It kills over a period of years. Its discovery in France by Madam Curie in 1898 came at the same time as her discovery of polonium, named after her native Poland. Both were radioactive, like uranium. Radium was considered especially useful, as it "burned" (emitted alpha and gamma radiation) much faster than uranium but more slowly that polonium (polonium's half-life is only one year). The military appreciated its use in watches whose numbers and indicators glowed in the dark, providing the time to soldiers without revealing their location to the enemy the way lights would have. Today, the same effect is achieved in watches and street signs with phosphorescent materials. The sparkle of radium was considered healthy in the early 1900s; the substance was added to soda, candy and facial creams. A hot spring that emitted radon gas was more popular than those that did not.

How was the radium made part of a watch? By hand-painting. The young gals who worked in the manufacturing plants were instructed, or learned on their own, that the paint brush could be brought to a finer point by smoothing it with their mouths. Unfortunately, from a chemical perspective (the number of electrons circling the nucleus) radium looks like calcium, which the body readily absorbs. Over time the radium entered their bones, causing their legs to break and their teeth to fall out.

Ethyl (grain) alcohol (C2H5OH). Beer, wine and liquor have caused countless deaths, either directly by incapacitating the brain, or indirectly, by causing poor judgment or coordination that precipitates an accident. But the science necessary to determine the level of intoxication of a decedent did not exist in Norris's time. It had to be invented.

One thing Alexander Gettler established was that the amount of alcohol consumed, the amount in the stomach, even the amount in the blood, was of no importance. It was the amount in the brain that mattered. And, by testing dogs, he established that the amount in the brain had the same effect on anyone, regardless of their drinking experience. What differentiated the habitual drinker, who could seemingly imbibe without effect, from the novice was the amount of ingested alcohol that made its way to the brain and the speed at which it did so. The chronic drinker's liver generates more enzymes to break down alcohol; thus, the chronic drinker seems to have a higher immunity to alcohol's effects.

Thallium (Tl). This was the preferred mode of the young poisoner in the movie mentioned above. It was first isolated in 1861, and its poisonous nature was soon recognized, but many in industry believed, or at least said, it was harmless in small amounts. It appeared in depilatory creams that very effectively removed hair from wherever on the body it was applied. Manufacturers derived pest control substances from it, mixed it with tungsten in lamp filaments, added it to eyeglasses to increase refraction, and combined it with mercury to achieve thermometer readings below -50 Celsius.

Its effectiveness as a poison derives from its chemical resemblance to potassium, which the human body is happy to incorporate into all of its tissues. The indications of poisoning included delirium and coma, tremors, nausea and diarrhea, and varied from person to person. Death from 10 grams followed in a few days or weeks. To the poisoner, these varied symptoms and extended period between application and death were very attractive, especially if the poisoner disliked the victim. As an added bonus, thallium has no taste or texture and is easily combined with foods and liquids. The poisoner only needed to hope that no autopsy was performed. Because thallium is a metal is remains in the body well after death and is easily detected.

Ms. Blum uses a light, story-telling style. I could have finished the 280-page book in a day had I not been distracted. I found her closing note amusing: when her husband discovered the topic of the book she was writing he made sure to place his cup of coffee beyond her reach.