Part 10: Drugs, Poisons, Toxins & Iatrogenic Disease

“Who serves the gods dies young, – Venus, Bacchus, and Vulcan send no bills in the seventh decade.”
– Sir William Osler –
Drugs, Poisons, Toxins
& Iatrogenic Disease
There are, of course, two types of drugs – those taken medically (and usually prescribed by doctors), and those taken recreationally. Illnesses caused by medically prescribed drugs are called iatrogenic (a Greek word meaning ‘physician-produced’) and a rational physician always considers what harm a drug might do before prescribing it. Take for example paracetamol (acetaminophen), which in low doses is among the most commonly prescribed and well-tolerated drugs used. In high doses, however, a toxic metabolite builds up beyond the body’s ability to cope, rapidly causing fulminant liver damage. Paracetamol overdose is a very important differential diagnosis to exclude in any depressed or suicidal patient with abdominal pain and vomiting. If suspected, an antidote called N-acetylcysteine can quickly be given to detoxify the patient.

Weighing up the risks and benefits of all treatments and procedures is an important and often difficult part of the work of a doctor.

Lead and the Fall of the Roman Empire

One interesting toxin is lead, known to cause illness for centuries. The Romans, for example, used it for everything from make-up to crockery and from a wine preservative to chastity belts. In fact, geologic cores from the Arctic suggest the ancient Romans polluted as much as half of the world with lead many centuries ago, as fumes drifted off from melting metal ores.
Most importantly, the Romans used lead widely in a vast plumbing network that supplied their cities with water.
The Romans knew that acute lead poisoning had consequences such as madness or death – but what they cannot have guessed was that continual low-level exposure caused chronic poisoning. The metalworkers forging the lead pipes should have suspected something – their God Vulcan exhibited several important symptoms: lameness, pallor and a wizened expression.
Widespread chronic lead poisoning was inevitable and autopsies of the corpses of ancient Romans have revealed unusually high quantities of lead in their bodies. One of the most crippling aspects of the problem was that the ruling Roman nobles were particularly susceptible, for reasons of unprecedented gluttony and drunkenness. Emperor Domitian, for example, had a fountain of leaded wine installed in his palace to ensure a never-ending supply. Epidemics of illness consequently struck the nobility: gout, lethargy, sterility and stillbirth, mental retardation and insanity were perpetual. Julius Caesar managed only one child despite an enormous appetite for procreative adventure, and Augustus Caesar had none. Emperor Caligula is said to have fallen ill seven months into his term and emerged a tyrannical megalomaniac, and Emperor Nero, who wore a breastplate of lead to ‘enhance his voice’, fiddled while Rome burned in a great fire.
Many modern scholars believe that the degree of lead poisoning was so destructive that it strongly contributed to the decline of the Roman Empire.