Abstract
Physostigmine salicylate (Antilirium®) is a short-acting, lipid-soluble, nonselective, carbamate cholinesterase (ChE) inhibitor used to increase acetylcholine (ACh) concentrations at cholinergic receptors and most commonly employed in the treatment of anticholinergic-induced delirium. Physostigmine was the first known anticholinesterase used by humans. The native Efik people of West Africa used dried, ripened Calabar beans () containing the alkaloid physostigmine in their “trial by ordeal” [1, 2]. First described in 1840, the Old Calabar “trial by ordeal” required an accused individual to consume 1–20 Calabar beans in various fashions. If the individual vomited (and thus cleared the gastric bean burden), he was deemed innocent; if emesis did not occur, a cholinergic crisis followed by death was considered a guilty verdict. Predictably, very few accused survived their ordeal [1].