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  • History of Clinical Toxicology

    • Historical Aspects of the

      • Treatment of Poisoning

    • The Development of Effective

      • Antidotes for Poisoning

  • Introduction of the Poison

    • Control Center

  • Clinical Strategy for the

    • Treatment of the Poisoned Patient

  • Clinical Stabilization

  • Clinical History in the Poisoned Patient

  • Physical Examination

  • Laboratory Evaluation

  • Radiographic Examination

  • Prevention of Further Poison Absorption

  • Enhancement of Poison Elimination

  • Use of Antidotes in Poisoning

  • Supportive Care of the Poisoned Patient

  • Case Examples of Specific Poisonings

    • Acetaminophen

    • Ethylene Glycol

      • Serum Chemistries

    • Valproic Acid

  • Summary

History of Clinical Toxicology

Historical Aspects of the Treatment of Poisoning

The history of poisons and poisoners dates back to ancient times. One of the earliest documented uses of poisons was for military use. The use of toxic smoke can be tracked to as early as 2000 bc in ancient India. Formulas for creating poisonous and noxious vapors have also been found from 1000 bc in Chinese writings. The incorporation of fire-generated arsenic containing smoke from the burning of wood covered with pitch and sulfur containing material was reportedly used by Sparta against Athens around 400 bc (Osius, 1957; Mayor, 2003). Documentation regarding the use of antidotes can be found in the Odyssey and Shastras from approximately 600 bc. What is believed to be the first documented use of a specific antidote may be found in Homer’s Odyssey where it is suggested to Ulysses that he take moli to protect himself from poisoning. Moli may actually be Galanthus nivalis, a plant-derived cholinesterase inhibitor that might counteract the effects of the anticholinergic plant Datura stramonium (Plaitakis & Duvoisin, 1983).

Galen (129–200 ad) wrote three books called De Antidotis I, De Antidotis II, and De Theriaca ad Pisonem that described the development of a universal antidote known as a alexipharmic or theriac by King Mithridates VI of Pontus who lived from 132 to 63 bc (Wax, 1997). The antidote reportedly contained 36 or more ingredients and was ingested every day conferring protection against a broad spectrum of poisons such as venomous stings and bites from vipers, spiders, and scorpions (Jarcho, 1972).

The refinement of theriac (antidote) formulations is documented for nearly 2000 years. Andromachus (first century ad) was a physician to Nero and improved the Mithridates theriac by modifying the formula to include up to 73 ingredients (Wax, 1997). The use of these ancient antidotes included treatment of acute poisoning and prophylactic treatment to make one “poison proof.” The Mithridates theriac with subsequent modifications remained in use until the early 20th century. William Heberden wrote Antitheriaka: An Essay on Mithridatium and Theriaca in 1745 in which he questioned the effectiveness of these products (Jarcho, 1972). Despite the skepticism concerning these antidote formulations, their use continued for two millenniums.

One of the earliest writings on the prevention of the gastrointestinal absorption of poisons was by Nicander (Major, 1934). In this ancient writing, the induction of ...

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