Ophthalmology and death by poison

In Ancient Rome, death by poison was common. Emperors poisoned potential rivals. Aspirants to the throne poisoned emperors. Mothers poisoned the other potential male heirs of the emperor so that their own sons would be next in line to "wear the purple." Poisoning people you didn’t like was the thing to do. 

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My position is that murdering people with poison is a terrible thing, even if the victim is an annoying parent, mother-in-law, or department chair. Personally, I consider it inexcusable for an ophthalmologist to be party to such a thing. It's morally wrong, plus the penalty would likely be severe (suspension of operating privileges or even being fired-unless, of course, you have tenure).

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Yet ophthalmologists certainly have the means to go around poisoning folks. Agatha Christie wrote a murder mystery in which eye drops are the instrument of death. According to The New Yorker, one of her readers probably copied the crime in real life:

'Indeed, Christie’s attention to detail left her open to the accusation that she offered a handbook for would-be murderers. [Kathryn] Harkup recounts a 1977 case in France, in which Roland Roussel, a fifty-eight-year-old office worker, murdered his aunt using atropine eye drops. The gendarme who found a copy of the Miss Marple mystery “The Tuesday Club Murders” in Roussel’s apartment reportedly declared, “I’m not saying Roussel was inspired by the book, but we found it in his apartment with the relevant passages on poison underlined.”' 

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Nonselective beta blockers

In The Poisons of Agatha Christie, the use of alkaloids in both modern and Roman times is described:

"Belladonna (also known as Deadly Nightshade, Devil’s Berries, or Death Cherries) features in The Caribbean Mystery and The Big Four. Foliage and berries are toxic, containing a mixture of alkaloids including hyoscine (scopolamine) and atropine (both anti-cholinergic anti-muscurinic in action) and hyoscyamine (an isomer of atropine). Both the Emperor Augustus and Agrippina (wife and sister of Claudius) used belladonna to poison contemporaries. Symptoms include dilated pupils, blurred vision, tachycardia, dry mouth, slurred speech, urinary retention, confusion and hallucinations."

All ophthalmologists know that a nonselective beta blocker, such as timolol, can cause death in an individual with asthma or cardiac conduction abnormalities. Squirted under the tongue, large amounts of this eye drop could be quickly systemically absorbed with fatal consequences.

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Finally, I will mention the Tom Clancy novel, Teeth of the Tiger. The author describes the assassination of bad guys by the members of a super-secret nongovernmental agency that exacts revenge.

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The instrument of death is the injection of succinylcholine, causing prompt paralysis (including the muscles of respiration) and the victim is believed to have died of a heart attack.

Why I'm pointing this out

Making this relevant to us is the wrinkle that an ophthalmologist friend and loyal Ophthalmology Times reader suggested the succinylcholine angle to Clancy. Does my friend need to consider taking a remedial course in ophthalmic ethics?

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I point these scenarios out to you, my fellow ophthalmologists, only so that you won't imitate those Romans or the English people in Agatha Christie novels and make the mistake of poisoning anyone.

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Not even your mother-in-law. No matter how mean she might be to you, it would be wrong to poison her with agents readily available to any ophthalmologist.  Very, very wrong.

References:

http://www.newyorker.com/books/page-turner/agatha-christie-and-the-golden-age-of-poisons

http://hubpages.com/education/The-Poisons-of-Agatha-Christe