Michelle Muscat MD MRCS(Ed) MSc, PG Dip, FRCPath, PhD

Most of us have read the fabled tales of devious murders in detective stories. Most of us have watched movies and television series on poisonings, holding our breath as the final pieces of the puzzle unfold. Agatha Christie wrote “poison has a certain appeal”. The science of toxicology has a rich historical and literary foundation. Toxicology transcended the boundaries of time.

Old Victorian era royal beauty treatments included the use of various concoctions which contained arsenic, lead, mercury or antimony. At the time it was believed that arsenic supposedly promoted a fair complexion. In 1858, in the incident of the Bradford sweets poisoning there was accidental arsenic exposure of many people who consumed the adulterated sweets. Arsenic was also popular in world history to dispose of one’s enemies. Arsenic is colourless, tasteless and odourless hence making it an ideal poison.

After the King of Pontus was poisoned and possible failed attempts at assassinating Mithridates, he explored in some detail the realm of poisonous plants, wildlife and heavy metals. Mithridates, outside the battlefield, was known as a king of poisons. At the time he ingested small amounts of poison in the hopes of eventually becoming immune to their effects, allegedly also poisoning both his mother and younger brother in his rise to power. Mithridates sought a universal semi-mythical antidote, mithridatum.

In the past, potions and elixirs containing ingredients such as mercury, cocaine and alcohol were part of an old array of self-medications available over the counter, with ingredients that made them more poisonous than healthy. ‘Swaim’s Panacea’ elixirs, which claimed to cure a multitude of diseases, contained mercury and could have been the reason of mortalities.  An incident occurred where old ‘Sulfanilamide Elixir’ caused mass poisonings due to inclusion of diethylene glycol. Other mythical potions, Vin Mariani tonic and some toothaches remedies in the past contained cocaine. At the time it was also believed medicinal properties were proportionate to bad taste. There was a time which saw a soar of a sea of dodgy potions and gimmicks with very dubious ingredients. Later, use of alcohol and narcotics in the potions and remedies saw a decline.

Some speculated Beethoven may have died of lead poisoning, but others disputed this. Napoleon met his demise via arsenic poisoning. Cyanide was allegedly used against Rasputin. Socrates drank hemlock. The great emperor of China Qin Shi Huang savored a deadly elixir of immortality containing mercury. It is suspected Van Gogh may have had foxglove intoxication, given known side effects such as xanthopsia, coronas and his painting of a physician with the foxglove plant. Abraham Lincoln’s mother was a victim of milk sickness, where animals ate white snakeroot plant and the poison transferred into their milk which was consumed by humans.

In 1978 Georgi Markov was poisoned via an umbrella tip rigged with ricin (derived from the castor plant). Sarin made its way to the Tokyo subway in the infamous 1995 attack. Letters containing anthrax spores were sent in the 2001 bioterrorism attacks. In 2006 the Alexander Litvinenko Polonium-210 case made headlines. At one time, ricin tainted letters also made their way to president Obama’s post.

In alchemy, mercury was considered a first matter. In wildlife there are many naturally occurring poisons. Mushroom contain amatoxins. Notable poisonous mushrooms include ‘Destroying Angel’ and ‘Death Cap’. Poisonous plants abound, such as azalea, hellebore, aconite, hemlock, rhododendron, yew, dumbcane, foxglove, pong-pong, oleander, deadly nightshade and rosary pea. Other notable examples are the strychnine tree and the endangered Manchineel tree. Allegedly, Christopher Columbus called the Manchineel tree the ‘little apple of death’, given it is believed to be the most toxic tree on earth. From aquatic life such as the stingray, lionfish, jellyfish and the infamous golden dart frog, to on land, squirming snakes and stinging scorpions, poison may be found.

Blowfish or fugu fish dishes are only prepared by chefs with a fugu license due to tetrodotoxin toxicity if not properly prepared. Another potential food poisoning scenario includes that from tainted canned food with Clostridium botulinum, which is a relatively well-known food safety issue. The detection of lead in some old children’s toys and jewelry has been well documented. Even arsenic poisoning was documented in children due to arsenic laden toys. Environmental surveys have found cases where lead was also a water pollutant.

An example of a notable toxic place on Earth is the Berkeley pit, where even snow geese who landed in the noxious water containing heavy metals met an untimely death.

The above are just some examples, since many other instances of note could be described.

In this day and age, an online search on renowned selling platforms has revealed for sale a Vin Mariani empty green bottle and its vintage posters from the 1890s. For sale online, there also featured, what was labelled as an arsenic ‘homeopathic’ remedy (arsenic trioxide), designated as not for human use. Hopefully, these days magical broths with heavy metals have fallen out of favor, although other harmful substances such as drugs can be found online and on dark web trafficking sites.

From past to present… given the broadness of the field of analytical toxicology, which may include tests performed for overdose patients, drugs of abuse, heavy metal testing, amongst others, rigorous documentary and technical competence requirements need to be met by the laboratories delivering the services. Frameworks, such as for example, rigorous standard operating protocols should be in place and specific guidelines adhered to. Other points of note include, calibration and use of certified reference materials in accordance with method scope. Given the vast array of chemicals with complex toxicokinetics and toxicodynamics, adherence to health and safety guidelines, ISO guidelines and conducting risk assessments is essential.

The future may hold more promise than originally envisaged for a toxin, with old toxins potentially finding their way to being used in targeted treatments for cancer.

These instances are intended to give some glimpses and insights into the world of toxicology.