1: Historical Principles and Perspectives

INTRODUCTION

The term poison first appeared in the English literature around the year 1225 a.d. to describe a potion or draught that was prepared with deadly ingredients.^8,147 The history of poisons and poisoning, however, dates back thousands of years. Throughout the millennia, poisons have played an important role in human history—from political assassination in Roman times, to weapons of war, to contemporary environmental concerns, and to weapons of terrorism.

This chapter offers a perspective on the impact of poisons and poisoning on history. It also provides a historic overview of human understanding of poisons and the development of toxicology from antiquity to the present. The development of the modern poison center, the genesis of the field of medical toxicology, and the recent increasing focus on medication errors are examined. Chapter 2 describes poison plagues and unintentional disasters throughout history and examines the societal consequences of these unfortunate events. An appreciation of past failures and mistakes in dealing with poisons and poisoning promotes a keener insight and a more critical evaluation of present-day toxicologic issues and helps in the assessment and management of future toxicologic problems.

POISONS, POISONERS, AND ANTIDOTES OF ANTIQUITY

The earliest poisons consisted of plant extracts, animal venoms, and minerals. They were used for hunting, waging war, and sanctioned and unsanctioned executions. The Ebers Papyrus, an ancient Egyptian text written circa 1500 b.c. that is considered to be among the earliest medical texts, describes many ancient poisons, including aconite, antimony, arsenic, cyanogenic glycosides, hemlock, lead, mandrake, opium, and wormwood.^97,147 These poisons were thought to have mystical properties, and their use was surrounded by superstition and intrigue. Some agents, such as the Calabar bean (Physostigma venenosum) containing physostigmine, were referred to as "ordeal poisons." Ingestion of these substances was believed to be lethal to the guilty and harmless to the innocent.¹²³ The "penalty of the peach" involved the administration of peach pits, which we now know contain the cyanide precursor amygdalin, as an ordeal poison. Magicians, sorcerers, and religious figures were the toxicologists of antiquity. The Sumerians, in circa 4500 b.c., were said to worship the deity Gula, who was known as the "mistress of charms and spells" and the "controller of noxious poisons" (Table 1–1).¹⁴⁷