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