Investigations in a Case of Murder by Insulin Poisoning

Abstract

Since it was introduced in 1921 the potential dangers of insulin in the treatment of diabetic (Joslin, Root, White, and Marble, 1952) and psychiatric patients (Rees, 1949) and in diagnostic tests upon insulin-sensitive subjects such as those with hypopituitarism or Addison's disease have become well recognized. Deaths are known to have occurred in such patients as a result of accidental overdosage with insulin. Blotner (1954), in a comprehensive search of the literature, found eight recorded cases of attempted suicide by means of insulin and added one further case of his own; in three cases the outcome was fatal, and in all cases the subjects had firsthand knowledge of the effects of insulin. The present account describes the medical and scientific investigations in a case (Regina v. Barlow) in which a man was convicted of murdering his wife by injecting her with insulin. So far as we are aware, this is the first occasion on which such a charge has been substantiated and also the first in which insulin has been demonstrated in human tissue, other than the pancreas, after death. Outline of the CaseOn Friday, May 3, 1957, Mrs. E. B., a woman of 30 years, returned home from her work in a laundry for her midday meal. At about 11.20 p.m. on the same day she was found dead in the bath, which was empty when the police arrived.The body, which was left undisturbed until seen by the pathologist at 3.30 a.m. on May 4, lay on its right side in the empty bath with the right leg drawn up so that the right knee rested against the side of the bath and the right foot lay beneath the left knee, which was slightly flexed. The arms were bent so that the hands lay in front of and slightly below the face; the fingers of the right hand were loosely curled round the left wrist and the left hand was closed. The position of the body as a whole was one associated with natural sleep. Blood-stained froth ran from the nose down the right side of the face on to the right hand. On retraction of the eyelids it was noted that the pupils were widely dilated, and the colour of the iris, which was only discernible as a faint line round the pupil, could not be determined. In the hair, which had settled on the side of the bath, were fragments of vomited food which were also found on the sides and bottom of the bath. Caught in the crook of the right elbow were 110 ml. of clean warm water. The skin was damp where it came in contact with the surface of the bath, the bottom of which was also damp. The body was beginning to cool and rigor mortis was developing. The face was cyanosed and there was hypostasis op the right side of the body corresponding to the position in which it was lying. There were no obvious signs of violence, and the only other things in the bath were a wet face-cloth, a tablet of carbolic soap, and a soapdish which lay together beneath the right loin and thigh.The police, who searched the small semi-detached house in which the body was found, noted that the walls of the bathroom were dry and that there were no signs of splashing on t...

Twenty-one Uncommon Cases of Poisoning

“…As such they were distinguished from accidental hypoglycaemia, although the analytical and pathological findings were essentially negative. These cases, together with a case previously reported (Birkinshaw et al, 1958), make four deaths in a population of about five million in four years. The use of insulin in an unsuccessful attempt to procure an abortion (Case 9) was the subject of a criminal charge.…”

Complete Recovery From Prolonged Hypoglycemic Coma After Intentional Overdose With an Insulin Pump

“…17 Cerebral dysfunction during severe and prolonged hypoglycemia has been manifested with seizure activity, 11,18 -22 focal neurologic deficits such as hemiplegia, 18,20 or features of decortication or decerebration. 13,[22][23][24] Since the discovery of insulin in 1921, the lethal potential of an overdose has been recognized and has led to its use as a suicidal, 25 homicidal, 7,8 and even as a recreational agent. 19 However, the reports of insulin overdose for suicidal purposes have been a rare occurrence with only 73 cases reported in the world literature since 1927.…”

“…2,3 A decrease in the blood glucose level or tissue utilization results in acute sequelae, including neurogenic symptoms, cognitive dysfunction, lethargy, obtundation, coma, convulsions, and, if prolonged and severe, death. 4 -6 Hypoglycemia resulting from insulin overdose can occur as documented by cases reported in the literature of malicious 7,8 or factitious 9,10 administration, in addition to self-inflicted insulin overdose by depressed individuals with intent of suicide. [11][12][13][14][15] We describe a case of a patient with insulin-dependent diabetes mellitus who attempted suicide with the use of an insulin pump resulting in severe prolonged hypoglycemic coma followed by complete recovery…”

Identification and Characterization of Peptides and Proteins in Doping Control Analysis

“…Although comparably laborious, this approach demonstrated utmost accuracy and sensitivity enabling the precise determination of plasma levels of insulin and its precursors. A forensic application has been published by Darby et al, (2001), that allow the quantitation of human insulin in plasma samples obtained from victims of homicides or suicides (Birkinshaw et al, 1958;Bauman and Yalow, 1981;Haibach et al, 1987). Here, SPE in combination with LC-MS measurement of intact insulins and C-peptide was used, providing detection and quantitation limits of 1ng/mL.…”