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In the Caribbean, as a rule, certain poisons tend to crop up more often than others do. As poisoning is a relatively uncommon method of homicide worldwide, it is not surprising that most cases of poisoning in the West Indies are either accidental or suicidal.

Poisoning is a relatively uncommon cause of death in the Caribbean in general. In a series of 946 coroner’s autopsies performed 1973-75 at the Kingston Public Hospital (M. Ramu, West Indian Medical Journal 1976; 25: 235-40), burns, abortions and poisoning together accounted for only 4% of deaths. At the UHWI between 1980 and 1999, only 1% of coroner’s autopsies had poisoning as a cause of death, with herbicides/insecticides accounting for 41% of deaths and prescription drugs for 27% (Escoffery CT, Shirley SE. Fatal Poisoning in Jamaica: A coroner’s autopsy study from the University Hospital of the West Indies. Medicine, Science and the Law 2004; 44:116-120, PubMed).

Common suicidal poisons in the Caribbean are paracetamol, antidepressants, tranquilizers, benzodia­zepines and paraquat. Paraquat was used in 63.7% of cases of suicidal poisoning in Trinidad & Tobago (Hutchinson et al, West Indian Medical Journal, 1991:40; 69-73 Pubmed) and was also the most commonly implicated substance in suicidal deaths in the UHWI study. Common poisons in childhood (not necessarily fatal) are salicylates and other common prescription drugs, kerosene, insecticides and household products (especially cleaning agents), lead, poisonous foods and plants.

Poisoning by food is not uncommon in the Caribbean. Food products may be contaminated by exogenous poisons e.g. recurring incidents of contamination of flour by organophosphate insecticides in Jamaica. More commonly, however, poisonous foods or plants are intrinsically toxic. Some are invariably toxic e.g. datura (jimsonweed) and physic nut which are used for medicinal purposes. Others like ackee, cassava and some varieties of yam may be toxic if improperly prepared.

An interesting, and occasionally fatal, type of food poisoning endemic throughout the Caribbean is ciguatera poisoning. This occurs when certain sporadically toxic marine fish are ingested. These include shark, barracuda, grouper, red snapper, jack and parrotfish. The ciguatoxin is primarily a neurotoxin and signs and symptoms are usually related to the nervous system, but gastrointestinal and cardiovascular dysfunction may also occur.

The toxin is thought to originate in certain algae, which are eaten by small fish and passed up the food chain to larger fish without harm to the fish themselves. The bigger the fish, the more toxic it is. The poison concentrates in viscera, especially the liver and ovaries, which are more toxic than the flesh.

CTE/cte/Jan 2006

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