Poison Prevention Pioneers

Dr. Jules Klein couldn’t get those kids out of his mind. He’d spent his early professional years in rural West Virginia, where homes were typically equipped with outhouses. These facilities were often stocked with toxic cleaning products. Though some did bear labels “Keep out of Reach of Children”, the curious toddlers who investigated these products were, of course, pre-literate. The oral and esophageal burns that they suffered were devastating, sometimes fatal. Klein didn’t ever want to see this kind of injury again.

By the mid 1950’s, Klein had relocated to the thriving metropolis of Cincinnati. The Academy of Pediatrics had recently recognized the need for local poison control centers, to provide physicians and the general public with information regarding the treatment and prevention of accidental ingestions. After discussing this problem with a few colleagues, Klein decided to take the first step. He opened a poison information center in his basement!

He installed a second telephone line, and spread word of this “hotline” service among local pediatric practitioners. His wife served as first responder, taking a history and then forwarding the calls to Klein or designated colleagues at their offices. Information about this service was spread to additional colleagues and to patients via word of mouth. At the time, syrup of Ipecac, the go-to first aid treatment for many accidental ingestions, was relatively unknown and difficult to obtain. Klein arranged with a local pharmacist to provide a 1 ounce bottle to families at low cost – even free of charge if necessary.

This grassroots effort eventually attracted the attention of Cincinnati Children’s Hospital itself. The Cincinnati Pediatric Society adopted the program, with support from Kettering Labs, as did, later, the Academy of Medicine.

By the mid-sixties, a parallel effort, but with a slightly different focus, was developing across the street at UC’s College of Medicine. The Departments of Pharmacology and Internal Medicine established a Drug Information Center, under the direction of Dr. Leonard Sigell, to serve physicians, including residents and medical students, who were caring for patients with unfamiliar drug ingestions and reactions. It too began receiving inquiries from the public. The psychedelic drug era was in full swing, and by the early 1970’s, UC’s Drug Information Center was partnering with Cincinnati’s Free Clinic that was serving an expanding population of recreational drug users.

In 1972, when the Academy of Medicine abruptly discontinued its poison control hotline (for reasons nobody seems to know), Pediatric Chair Dr. Ed Pratt asked Dr. Jennifer Loggie, Director of Pediatric Clinical Pharmacology at Children’s, to direct a task force to create a community service that would combine the Poison Control Hotline with UC’s Drug Information Center. Over the next 10 years, with input and support from many community agencies, including the Community Mental health Board, Alcohol and Drug Addiction Services, and several businesses, a Regional Poison Center was eventually established.

Dr. Ed “Mel” Otten, director of the Division of Toxicology at UC and Associate Director of the Poison Center, was a medical student when this service was being developed and worked there as a volunteer. Calls were answered at the Pharmacy during the day, he remembers. After hours the Poison Information Center consisted of a rolling cart with a microfiche reader and a telephone. “We’d unplug the phone from the Pharmacy,” he recalled, “and roll it up onto the Bridge” – newly renovated office space between the hospital and medical school buildings.

Providing up-to-date accurate information about an ever-increasing variety of drugs and products was quite challenging in those pre-Internet days. Poison Information Center staff – mostly volunteers with a variety of medical and pharmacological backgrounds, had to rely on their own basic knowledge and experience, as well as BOOKS. Goodman and Gillman’s tome “The Pharmacological Basis of Therapeutics” was a prime reference back then. Gold’s “Handbook of Poisoning” was also a popular resource; many residents carried a copy in a pocket of their white coats, along with their Harriet Lanes. The early DPIC also used microfiche technology: index card-sized flat films containing 60 or so microphotographs of relevant text. In photos and videos of DPIC’s early days, those clunky desktop screens that the staff are viewing are not first generation computers but microfiche readers.

Time, technology and increasing support from the medical community, private businesses and public agencies transformed DPIC dramatically over the 50 years since its inception. Now a Regional Drug and Poison Control/Information Center, it still provides a 24-hour hotline for health care practitioners and the community at large. Back under the auspices of Cincinnati Children’s since 1997, DPIC’s staff now includes consultant pharmacologists, pharmacists, toxicologists, and educators, addition to trained front-line triage personnel. Of course, now staff can access information and provide crisis services remotely. DPIC also provides extensive community education, as well as consultation services to businesses developing new products, to evaluate for potential toxicological impact. And of course, there’s now a website: https://www.cincinnatichildrens.org/service/dpic

Pediatricians like Jules Klein and his colleagues hoped that better information and crisis management would lead to better outcomes as well as prevention of accidental ingestions and overdoses. Better outcomes have indeed resulted; but successful prevention has remained elusive. Psychedelic drugs are no longer “in” but the use of highly addictive prescription and illegal opioids has become commonplace. Tamper-resistant packaging has been effective in preventing ingestions of some caustic and volatile substances, but new products lacking such safeguards, like detergent pellets and e-cigarettes, continue to present challenges. Childproof caps have also been effective, but the exponential growth in the number of therapeutic prescription drugs now present in most homes has increased the opportunity for inquisitive toddlers, for whose curiosity there is no effective (or desired!) remedy!

Keep those Hotline Numbers handy! 513-636-5111 and 1-800-222-1222

Watch the 1992 Heritage Series interview about the Cincinnati Drug and Poison Information Center. Featuring, Leonard T. Sigell, PhD; Suman Wason, MD; and Jules I. Klein, MD. Watch Now

 

Submitted by Elaine Billmire, MD (residency 1978, fellow 1979)