QPMPA Journal September 2011 - Qualified Private Medical ...

cme
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When I am introduced to people as a toxicologist,
some of them ask, “What is
toxicology?” I never cease to be
amazed at this question. Not that I blame
those who query me thus. The subject of
poisons and poisoning is so underdeveloped
and neglected in India that even
doctors sometimes are a little unclear as
to what is the actual relevance and utility
of this speciality.
“Poisoning?” exclaimed one physician,
“Of course I treat poisoned patients.
There is no difficulty at all. After all, we
have a dialysis machine. It is just a matter
of hooking the patient up in time. I
don’t think we need any toxicologist’s
help for that!” I was so taken aback at
this profound statement of ignorance
(and arrogance) that I was rendered
speechless. The belief that all poisons are
dialyzable is (as I would learn in due
course) a myth that is well entrenched
among medical professionals. Sad, since
dialysis is an exercise in expensive futility
in most cases of poisoning.
My special interest in toxicology began
with a near catastrophic incident in my
personal life. More than 20 years ago, my
daughter (then aged 8 months) was poisoned
accidentally, largely due to my own
fault. She consumed a newly introduced
cockroach bait that I left around the
house quite negligently, in locations
where such pests abound: kitchen, bathroom,
etc. We rushed our daughter to
the teaching hospital where I worked and
had her admitted in the paediatric ward.
The paediatrician on duty was a brilliant
young man, but he had no inkling of what
should be done. I suggested a stomach
wash. He was apprehensive about the
traumatic nature of the procedure but
agreed that it was imperative to flush out
any toxin remaining in the stomach. After
the procedure was accomplished and
a moderate quantity of pinkish liquid was
siphoned out, the paediatrician turned
to me as if to ask, “Now what?”
His dependence on me for guidance was
understandable. I was an expert in forensic
medicine (which also includes
toxicology), and taught the fundamentals
of poisoning to undergraduate medical
students. However, I was flummoxed.
I had no idea as to how to proceed, nor
did I have any information as to what
the bait actually contained. Only much
later when I went home briefly to fetch
some things while my wife fretfully sat
at the bedside of our sleeping daughter,
did I chance upon the discarded empty
container of the cockroach bait and
dr. v. v. pillay
Chief, Poison Control Centre; Head, Analytical
Toxicology, Professor, Forensic Medicine & Medical
Toxicology, Amrita Institute of Medical Sciences &
Research, Kochi 682041
revolution in toxicology
realized that all our anxiety had been
pointless. For, written in bold letters
across the package was the legend “Nontoxic
to humans.” I almost cried in
relief.
I rushed back and gave the happy news
to my wife and the paediatrician. Subsequently
we were to learn that the bait
(which had recently been introduced)
was not only nontoxic to humans but
to cockroaches as well! The product was
quickly withdrawn from the market by
the manufacturers and is not available
today.
This incident served to open my eyes to
the appalling state of toxicology in our
country. If such ignorance as to how to
deal with a case of poisoning could occur
in a premier teaching hospital involving
the daughter of a doctor (who
teaches toxicology!), then what about
the thousands of other unfortunate victims
of poisoning admitted to less sophisticated
hospitals all across the
country? I was bewildered. After all toxicology
was very much part of the medical
curriculum and was being taught to
budding doctors; there were teachers
(like myself) who taught the subject, and
there were textbooks galore. Then what
was wrong?
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QPMPA.JMS . Vol. XXV . No. 3 . June-Sept. 2011