- Email: [email protected]
Death from accidental poisoning
368
THE JOURNAL OF PEDIATRICS
The rise in the rate in recent years in the Southwestern states suggests to the authors t h a t it m a y be of interest to watch the t r e n d in the Southeastern states where the increase in the annual rate has been only moderate over the t w e n t y - y e a r period. I n this connection it is of interest to note the incidence as it has developed so f a r this year. F o r the entire United States in the seven weeks f r o m J u n e 1 to J u l y ]8 of this y e a r (latest detailed figures available as this issue goes to press), 4,353 cases of polio were r e p o r t e d as c o m p a r e d with 4,455 in the same w e e k period in 1952. H o w e v e r , the r e p o r t e d incidence in the South Atlantic states was 769 in 1953 as compared with 375 in 1952, and in the E a s t South Central states
was 533 as compared with 428. This is a 62 per cent increase for the Southeastern area. The two regions combined reported 30 per cent of the total cases reported in this seven-week period in 1953, as compared with 18 per cent of the total for the same weeks in 1952. W h e t h e r this increase both locally and in relation to the total n u m b e r of cases for the y e a r will continue for the r e m a i n d e r of the s u m m e r is unpredictable. As of August 1, the total reported incidence for this y e a r is a little less t h a n reported last year. REFERENCES
1. Dawson, LaBoecetta, Tornay, and Silverstein, 5. :PEDIAT.40: 71, ]952. 2. Seriting and Sherman: Pub. Itea]th Rep. 68: 453, ]953.
DEATH FROM ACCIDENTAL POISONING S E V E R A L occasions d u r i n g the O Npast years the JOURNAL has commented editorially on accidental poisoning in y o u n g children (iron, 1, 2 aspirin, 3 and parathion4). We p r e f e r to designate it as poisoning due to parental carelessness or ignorance. W i t h the tremendous decrease in the I M R a f t e r the newborn period which has taken place in the last f o r t y years, death f r o m accidental poisoning has become a significant f a c t o r in the runabout child aged l to 4 years. I n a recent issue of the Archives of Disease in Childhood, Swinscow ~ of London discusses the deaths f r o m accidental poisoning t h a t have occurred in children aged 1 to 4 in E n g l a n d and Wales. I n the ten-year period, 1940 to ]949, there were 218 reported deaths, not including those due to toxic gases. The rate f o r males u n d e r 5 years was considerably above the s rate, as is true f o r the incidence of i n j u r y in the home. The types of poisoning were as follows:
No.
%
Medicaments 135 Household poisons 47 Disinfectants and antiseptics 15 Poisonous plants 8 Miscellaneous 13
62 22 7 4 6
218
101
Thus nearly two-thirds were due to medicaments, either p h y s i c i a n ' s prescriptions or p r e p a r a t i o n s bought over the counter for internal or external use. The chief offenders a n d the nmnber of deaths were: iron p r e p a r a t i o n s 21, oil of wintergreen 17, strychnine 15, and aspirin and quinine 12 each. A m o n g the less frequent offenders opium or morphine was responsible for 8 deaths, soporifics as phenobarbital 8, c a m p h o r a t e d oil 5, and antihistamine drugs 5. A n u m b e r were occasionally responsible, including ipecac, iodine, acetic acid, digitalis, antimony, and copper sulfate. Thus a long list of medicines left carelessly within reach of y o u n g children which caused accidental deaths.
369
EDITOR'S COLUMN
Twelve of the 47 deaths from household poisons were due to Caustic soda and 11 to phosphorus in rat poisons. Other deaths in this group were due to the hydrocarbons as kerosene and petrol, ammonia, nicotine, arsenic, and carbon tetrachloride. Phenol and creosol caused 9 of the ]5 deaths in the disinfectant and antiseptic group. Eleven of th'e deaths from poisonous plants were due to the nightshade weed, and only 1 to fungi. Hydrochloric acid was the chief cause of death in the miscellaneous group. There is no reason to believe that the incidence is much less or ~oTeater per 100,000 of population in the United States. Assuming this, it would work out to around 900 death's in runabout children from accidental poisoning in the United States in the same ten-year period. As Swinscow summarizes, "Accidental poisoning by ingestion of toxic substances, especially medicaments, is a notable cause of death in the age group' 1 to 4 years." Who is responsible? What can be done to prevent these unnecessary deaths ? Direct responsibility lies with the parents of the runabout child who, as a normal phase of his development, learns by exploring and investigating at this age. But the blame cannot be placed entirely on their shoulders. An element of blame in some instances rests squarely on the physician who fails to warn parents that such ordinarily nondangerous drugs as aspirin and ferrous sulfate may cause fatal poisoning if accidentally taken in quantity by a young child. Another element rests on the manufacturers of these drugs which are sold without prescription over the counter, who fail to warn the purchaser of their danger. The poison warning on some of the rat poisons and insecticides is not sufficiently prominent or emphatic enough
to impress many who become careless and leave these substances within reach of children. Perhaps it is a case of familiarity breeding contempt in some instances. Certainly something can be done about it. First of all the medical profession--and the pediatricians should take the lead--should start a definite educational campaign to educate parents as to the potential danger of many drugs. Verbal education by the physician at the time the drug is prescribed will probably be more effectual than education by printed words. Warnings on labels should be more emphatic and prominent. To cite an example of what can be done: The two articles reporting ferrous sulfate poisoning in young children including two deaths, together with the editorial on the subject in the January, 1952, issue of the JOURNAL, were submitted in proof form to the national medical committee for Red Cross blood banks, before publication in the JOURNAL. The result was an immediate rewriting of the label on the iron tablet packages given to donors at the blood banks, carrying a prominent and emphatic warning as to their danger if ingested in quantity by a young child. I f physicians will take a definite stand on the matter, the pharmaceutical houses will fall into line. Further, such a stand will be reflected upon the Government agencies who control the labeling of commercial substances such as rat poisons and insecticides. We are quite sure no maker of these products will want to bear any of the responsibility for the death of a young child from accidental poisoning. REFERENCES 1. 2. 3. 4. 5.
40: 41: 42: 42: 28:
141, 1952. 122, 1952. 276, 1953. 642, 1953. 26, 1953.
THE JOURNAL OF PEDIATRICS
The rise in the rate in recent years in the Southwestern states suggests to the authors t h a t it m a y be of interest to watch the t r e n d in the Southeastern states where the increase in the annual rate has been only moderate over the t w e n t y - y e a r period. I n this connection it is of interest to note the incidence as it has developed so f a r this year. F o r the entire United States in the seven weeks f r o m J u n e 1 to J u l y ]8 of this y e a r (latest detailed figures available as this issue goes to press), 4,353 cases of polio were r e p o r t e d as c o m p a r e d with 4,455 in the same w e e k period in 1952. H o w e v e r , the r e p o r t e d incidence in the South Atlantic states was 769 in 1953 as compared with 375 in 1952, and in the E a s t South Central states
was 533 as compared with 428. This is a 62 per cent increase for the Southeastern area. The two regions combined reported 30 per cent of the total cases reported in this seven-week period in 1953, as compared with 18 per cent of the total for the same weeks in 1952. W h e t h e r this increase both locally and in relation to the total n u m b e r of cases for the y e a r will continue for the r e m a i n d e r of the s u m m e r is unpredictable. As of August 1, the total reported incidence for this y e a r is a little less t h a n reported last year. REFERENCES
1. Dawson, LaBoecetta, Tornay, and Silverstein, 5. :PEDIAT.40: 71, ]952. 2. Seriting and Sherman: Pub. Itea]th Rep. 68: 453, ]953.
DEATH FROM ACCIDENTAL POISONING S E V E R A L occasions d u r i n g the O Npast years the JOURNAL has commented editorially on accidental poisoning in y o u n g children (iron, 1, 2 aspirin, 3 and parathion4). We p r e f e r to designate it as poisoning due to parental carelessness or ignorance. W i t h the tremendous decrease in the I M R a f t e r the newborn period which has taken place in the last f o r t y years, death f r o m accidental poisoning has become a significant f a c t o r in the runabout child aged l to 4 years. I n a recent issue of the Archives of Disease in Childhood, Swinscow ~ of London discusses the deaths f r o m accidental poisoning t h a t have occurred in children aged 1 to 4 in E n g l a n d and Wales. I n the ten-year period, 1940 to ]949, there were 218 reported deaths, not including those due to toxic gases. The rate f o r males u n d e r 5 years was considerably above the s rate, as is true f o r the incidence of i n j u r y in the home. The types of poisoning were as follows:
No.
%
Medicaments 135 Household poisons 47 Disinfectants and antiseptics 15 Poisonous plants 8 Miscellaneous 13
62 22 7 4 6
218
101
Thus nearly two-thirds were due to medicaments, either p h y s i c i a n ' s prescriptions or p r e p a r a t i o n s bought over the counter for internal or external use. The chief offenders a n d the nmnber of deaths were: iron p r e p a r a t i o n s 21, oil of wintergreen 17, strychnine 15, and aspirin and quinine 12 each. A m o n g the less frequent offenders opium or morphine was responsible for 8 deaths, soporifics as phenobarbital 8, c a m p h o r a t e d oil 5, and antihistamine drugs 5. A n u m b e r were occasionally responsible, including ipecac, iodine, acetic acid, digitalis, antimony, and copper sulfate. Thus a long list of medicines left carelessly within reach of y o u n g children which caused accidental deaths.
369
EDITOR'S COLUMN
Twelve of the 47 deaths from household poisons were due to Caustic soda and 11 to phosphorus in rat poisons. Other deaths in this group were due to the hydrocarbons as kerosene and petrol, ammonia, nicotine, arsenic, and carbon tetrachloride. Phenol and creosol caused 9 of the ]5 deaths in the disinfectant and antiseptic group. Eleven of th'e deaths from poisonous plants were due to the nightshade weed, and only 1 to fungi. Hydrochloric acid was the chief cause of death in the miscellaneous group. There is no reason to believe that the incidence is much less or ~oTeater per 100,000 of population in the United States. Assuming this, it would work out to around 900 death's in runabout children from accidental poisoning in the United States in the same ten-year period. As Swinscow summarizes, "Accidental poisoning by ingestion of toxic substances, especially medicaments, is a notable cause of death in the age group' 1 to 4 years." Who is responsible? What can be done to prevent these unnecessary deaths ? Direct responsibility lies with the parents of the runabout child who, as a normal phase of his development, learns by exploring and investigating at this age. But the blame cannot be placed entirely on their shoulders. An element of blame in some instances rests squarely on the physician who fails to warn parents that such ordinarily nondangerous drugs as aspirin and ferrous sulfate may cause fatal poisoning if accidentally taken in quantity by a young child. Another element rests on the manufacturers of these drugs which are sold without prescription over the counter, who fail to warn the purchaser of their danger. The poison warning on some of the rat poisons and insecticides is not sufficiently prominent or emphatic enough
to impress many who become careless and leave these substances within reach of children. Perhaps it is a case of familiarity breeding contempt in some instances. Certainly something can be done about it. First of all the medical profession--and the pediatricians should take the lead--should start a definite educational campaign to educate parents as to the potential danger of many drugs. Verbal education by the physician at the time the drug is prescribed will probably be more effectual than education by printed words. Warnings on labels should be more emphatic and prominent. To cite an example of what can be done: The two articles reporting ferrous sulfate poisoning in young children including two deaths, together with the editorial on the subject in the January, 1952, issue of the JOURNAL, were submitted in proof form to the national medical committee for Red Cross blood banks, before publication in the JOURNAL. The result was an immediate rewriting of the label on the iron tablet packages given to donors at the blood banks, carrying a prominent and emphatic warning as to their danger if ingested in quantity by a young child. I f physicians will take a definite stand on the matter, the pharmaceutical houses will fall into line. Further, such a stand will be reflected upon the Government agencies who control the labeling of commercial substances such as rat poisons and insecticides. We are quite sure no maker of these products will want to bear any of the responsibility for the death of a young child from accidental poisoning. REFERENCES 1. 2. 3. 4. 5.
40: 41: 42: 42: 28:
141, 1952. 122, 1952. 276, 1953. 642, 1953. 26, 1953.