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Toxicology is the study of the adverse effects produced in living organisms by chemical agents under varying conditions of exposure. It is an evolving discipline, historically supported by associated disciplines such as pharmacology and pathology, and increasingly informed by molecular biochemistry, epidemiology, and statistical and information sciences. Toxicology is a critical pathophysiologic cornerstone on which any understanding of the health effects of chemical and nuclear agents is built. The medical and public health consequences of BCN terrorism operates at the nexus of three major scientific domains: clinical medicine, public health, and toxicology. With the probable exception of intensivists, emergency room physicians, occupational medicine physicians, and medical toxicologists, practicing clinicians’ comfort level with applied toxicology is usually limited to medical therapeutics. One of the purposes of this book is to enable clinicians and front-line public health practitioners to understand some of the fundamental principles intrinsic to BCN terrorism, many of which are usefully generalizable to other public health and clinical issues.

Basic knowledge of the principles of toxicology is important for a deeper understanding of the pathophysiology from BCN agents. Understanding toxicologic principles is important when considering the health effects of BCN terrorism for several reasons. First, knowing these principles will facilitate an understanding of how cells and cellular structures, tissues, organs, and ultimately, individuals respond to these agents. This short overview of toxicology summarizes physicochemical properties common to many of the chemical agents covered in this book.

The study of poisons, as toxicology is rightly viewed, stretches back into antiquity. The scientist and alchemist Paracelsus conducted extensive experimentation on metals from which basic concepts, such as dose and dose response, were placed on more scientific rigorous ground. Indeed, it was Paracelsus (Fig. 8–1) who observed that all chemicals may be injurious given the right circumstances, an aphorism widely quoted but infrequently sourced. Careful clinical observations by the Italian physician Ramazzini (1710–1767), the English surgeon Sir Percival Pott (1780–1843), and many others established the connection between trades and a wide variety of disease processes. Propelled by Newtonian scientific principles, the Industrial Revolution of the 17th and 18th centuries vastly expanded the number, utility, and adverse health and environmental consequences of a wide range of hazardous materials and led directly to the creation of entire industries, including the chemical and pharmaceutical industries from which many of the chemical agents discussed in The Bioterrorism Sourcebook emerged.

Figure 8–1

A woodblock print of Paracelsus, the father of modern toxicology.

Courtesy of the National Library of Medicine.

In time, the health hazards brought about as a result of this remarkable economic transformation were recognized and led to the creation of the discipline of industrial toxicology in the 1930s. Indeed, some of the earliest pioneers in this area were physicians, such as Harvard’s Alice Hamilton, whose work integrated field investigation, clinical assessment, and laboratory-based toxicologic evaluations. The ...

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