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Throughout history, mass poisonings have caused suffering and misfortune. From the ergotepidemics of the Middle Ages to contemporary industrial disasters, these plagues have had great political, economic, social, and environmental ramifications. Particularly within the past 100 years, as the number of toxins and potential toxins has risen dramatically, toxic disasters have become an increasingly common event. The sites of some of these events—Bhopal (India), Chernobyl (Ukraine), Jonestown (Guyana), Love Canal (New York), Minamata Bay (Japan), Seveso (Italy), West Bengal (India)—have come to symbolize our increasingly toxic habitat. Globalization has led to the proliferation of toxic chemicals throughout the world and their rapid distribution. Many chemical factories that store large amounts of potentially lethal chemicals are not secure. Given the increasing attention to terrorism preparedness, an appreciation of chemicals as agents of opportunity for terrorists has suddenly assumed great importance. This chapter provides an overview of some of the most consequential and historically important toxin-associated disasters.

Inhalation of toxic gases and oral ingestions resulting in food poisoning tend to subject the greatest number of people to adverse consequences of a toxic exposure. Toxic gas exposures may be the result of a natural disaster (volcanic eruption), industrial mishap (fire, chemical release), chemical warfare, or an intentional homicidal or genocidal endeavor (concentration camp gas chamber). Depending on the toxin, the clinical presentation may be acute, with a rapid onset of toxicity (cyanide), or subacute or chronic, with a gradual onset of toxicity (air pollution).

One of the earliest recorded toxic gas disasters resulted from the eruption of Mount Vesuvius near Pompeii, Italy, in 79 A.D. (Table 2–1). Poisonous gases generated from the volcanic activity reportedly killed thousands.37 A much more recent natural disaster occurred in 1986 in Cameroon, when excessive amounts of carbon dioxide spontaneously erupted from Lake Nyos, a volcanic crater lake.20 Approximately 1700 human and countless animal fatalities resulted from exposure to this asphyxiant.

Table 2–1. Gas Disasters

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