Tox and Hound – Archery: The Official Sport of Medical Toxicology

A very special welcome to our newest hound, Dr. Trevonne Thompson! You can learn more about him here . . .

by Trevonne Thompson

Archery should be recognized as the official sport of medical toxicology. Medical Toxicology is, by my own estimation, an avant-garde specialty, and is arguably the best specialty in medicine. While its modern history, especially in the United States, is well known and well documented, there are aspects of its history that are obscure.^​1​ Toxicology has a historical connection to the sport of archery. I am not aware of another field of medicine that has such an intricate link to a single sport as archery does to medical toxicology. Of course, there is the field of sports medicine; however, sports medicine deals with all sports and physical activity and does not have the specific link that I will describe between archery and toxicology. In my inaugural Tox and the Hound post, I will detail this link, chronicle some of the arcane historical aspects of toxicology as they relate to modern medicine, and then mention a link between archery and politics/leadership.

First, a little etymology. Archery is the common term used to describe the sport that involves shooting an arrow from a bow. A person who practices archery is called an archer. The terms archery and archer derive from the Latin words arcus, meaning “bow,” and arcarius, meaning “maker of bows.” Another term for archery is toxophily, and a person who practices toxophily is called a toxophilite. Toxophily and toxophilite are quasi-Greek terms invented by Roger Ascham, who wrote the first English language book on archery in 1545, derived from the following Greek words: toxikos, meaning “bow;” and philos, meaning “love.”^​2​ Finally, the term toxicology is similarly derived from the Greek terms toxikon, “arrow poison,” and –logia, “the science of.”

There are two interesting connections to the term toxicology having an origin in arrow poisons. The first is that arrow poisons have been used throughout human history; a glance at arrow poisons reflects a history of modern medicine and modern medical toxicology. The second is that archery has been used as a conceptual metaphor for leadership and politics – at a time when politics is so toxic this should be of interest to many in medicine.

A look at just a few arrow poisons highlights the importance of archery and toxicology in human history. Ouabain is a cardioactive steroid that functions by binding the Na+/K+ ATPase. It is derived from the Acokanthera and Strophanthus plants native to certain parts of Africa.^​3,4​ While likely used even earlier, reports go back to the 3rd century BCE describing hunters dipping arrows in the thick extract that resulted from boiling the leaves and branches in water.^​3​ These poisoned arrows were primarily used for hunting but were also used for warfare. The term ouabain is from the French derivation of the Somaili word waabaayo, “meaning arrow poison.”^​5​

Curare is a well-described Central and South American arrow poison. Derived from various plant species, curare was used to hunt by causing paralysis in the sought after game. The word curare is derived from the term wurari, a word that originated from the Carib language of Macusi people of Guyana. Curare has been dubbed by some as “The Flying Death” because of its certainty to kill prey when delivered by arrow.^​6​ The primary alkaloid in many curare preparations that is responsible for paralysis is d-tubocurarine—a neuromuscular blocker that works at the nicotinic acetylcholine receptors. While d-tubocurarine is no longer in clinical use, nicotinic acetylcholine receptor blockers remain a staple in anesthesiology and emergency medicine practice.^​7​ Another curare toxin, this one derived from the plant Strychnos toxifera, is toxiferine.^​3​ While not used in clinical practice, toxiferine has a much more toxicologically-appeasing name. In addition to its historical use in hunting, curare has been implicated in murders throughout modern history. One of the more famous incidents occurred in 1966 in New Jersey and was dubbed the “Dr. X Killings.” Nine suspicious deaths in a Bergen County hospital were linked to curare (tubocurarine) and the hospital’s chief surgeon. Though acquitted in a trial, Dr. X was long thought to have been responsible for the murders.

No treatise on arrow poisons would be sufficient without mention of the poison dart frog. In Central South America there are a group of frogs belonging to the Dendrobatidae family characterized by brightly colored skin. Of this family, three within the genus Phyllobates contain bactrachotoxin, a potent Na+ channel blocker (technically, it’s a Na+ channel opener).^​4​ As a result of its mechanism of action, bactrachotoxin leads to cardiac and neurotoxicity. The poison dart frogs, also known as poison arrow frogs, are so named because of their use historically in Central and South America as poisons on blow darts and arrows for hunting.^​3,4,8​

In all of the instances listed above, I only mention the primary toxin of interest for this discussion. It is important to understand that there are other alkaloids present in the various arrow poisons. Many of the alkaloids mentioned above, and their lesser-known counterparts, are under active study for scientific and medicinal use.^​4​ The story of arrow poisons is still being written.

Archery has served as a conceptual metaphor for political theory and leadership. Niccolò Machiavelli was an Italian, Renaissance politician, philosopher, and writer. One of his more famous writings is a short treatise focused on political theory called The Prince. In the opening paragraph of chapter VI of The Prince, Machiavelli introduces an archery reference:

A wise man ought always to follow the paths beaten by great men, and to imitate those who have been supreme, so that if his ability does not equal theirs, at least it will savour of it. Let him act like the clever archers who, designing to hit the mark which yet appears too far distant, and knowing the limits to which the strength of their bow attains, take aim much higher than the mark, not to reach by their strength or arrow to so great a height, but to be able with the aid of so high an aim to hit the mark they wish to reach.

I read this and think of my own progress through toxicology fellowship and my career as an academic physician. I am reminded of the paths forged by the Lewis Goldfranks, Michael Shannons, and Barry Rumacks of the toxicology world, and how their efforts made it possible for many of us to succeed in this relatively small field of Medical Toxicology. There is another interesting analogy. As there are controversies in medical toxicology practice, there are also controversies surrounding The Prince. Leo Strauss wrote a critique of The Prince, stating:

Machiavelli is the only political thinker whose name has come into common use for designating a kind of politics, which exists and will continue to exist independently of his influence, a politics guided exclusively by considerations of expediency, which uses all means, fair or foul, iron or poison, for achieving its ends—its end being the aggrandizement of one’s country or fatherland—but also using the fatherland in the service of the self-aggrandizement of the politician or statesman or one’s party.^​9​

I am intrigued by the use of a poison reference, in a critique of a treatise, that uses archery as a metaphor – especially knowing archery’s (toxophily’s) history with poisons. While perhaps not intended by the author, I am fascinated by the influence in both medicine and leadership of archery and toxicology.

Toxicology and archery are historically and etymologically linked. Many of us in medical toxicology appreciate esoteric and arcane references and associations within the field. Historic toxicologic disasters are, for example, listed in the core content of medical toxicology.^​10​ In this vein, I propose that archery be considered the official sport of medical toxicology. Imagine the toxicologic discussions that could be held when a group of toxicologists is at the archery range perfecting their skills with bow and arrow. Regarding a group of toxicologists, terms of venery (e.g., a group of crows is called a murder) often make for delightful banter. Perhaps a group of toxicologists should be called a quiver?

Disclosure: Trevonne Thompson is the 2015 Illinois Target Archery Association Indoor Longbow Champion