Historical Perspective

If one seeks out the American Academy of Toxicology on the internet you will find the following "Historical Perspective."

"The AACT was founded in 1968 by a group of physicians and scientists with the specific goal of advancing the diagnosis and treatment of poisonings. The mission of the AACT was to unite scientists and clinicians whose research, clinical and academic experience focused on clinical toxicology and to encourage the development of safe, effective therapies and technologies for the treatment of human and animal poisoning.

In 1974, the AACT established the American Board of Medical Toxicology (ABMT) to certify physicians in the specialty of clinical toxicology. This subspecialty was recognized by the American Board of Medical Specialties in 1992. In 1985, a second certifying board, the American Board of Applied Toxicology (ABAT) was established for non-physician peer recognition.

Today, the AACT is an international organization whose membership is comprised of clinical and research toxicologists, physicians, veterinarians, nurses, pharmacists, analytical chemists, industrial hygienists, poison information center specialists, and allied professionals.

The AACT, affiliated with many professional organizations, holds annual meetings in conjunction with both the American and Canadian Associations of Poison Control Centers and the American College of Medical Toxicology. It was a charter member of the World Federation of Associations of Clinical Toxicology Centers and Poison Control Centers sponsored by the World Health Organization. The Academy supports the efforts of other toxicology organizations worldwide."

What this doesn't reflect are the details of the evolution and growth of this prestigious and well established organization. The Academy was the brainchild of Eric Comstock, a Texas physician, who because of a specific incident had the idea and impetus to start an organization specifically related to matters of human poisoning.

The early years of the Academy were a combination of skill, luck and fortitude as well as a substantial dose of serendipity. In the early 1960's with the passage of the Hazardous Substances Labeling Act there was an immediate need for an experimental toxicology lab and it was Eric Comstock who developed such a lab in response to the Act's requirements.

Very little was available in the way of overdose information and in some cases, the manufacturer's package insert was unreliable and often inconsistent. For example, one company's recommended treatment for a specific drug overdose was contrary to the same drug manufactured by a different company, and in some cases even contraindicated!

Therefore, with a dearth of useful information, Eric's interest in toxicology grew as his evolving expertise increased. Since most serious poisonings were self-inflicted and virtually no physician felt comfortable treating these patients, a quick referral to someone more adept at toxic situations put Comstock in demand. He made himself available to ER's and hospitals in the Houston area giving information as well as reassurance to the non-toxicologically trained physician confronted with a poisoned patient. Overtime, he was spending more time in the hospital than in his lab. On rounds he carried a special bag he created to do on the spot analysis. Ethanol and carbon monoxide, for example would take about an hour to confirm by a miniature diffusion procedure, whereas thin layer chromatography, or TLC was done on microscope slides which would take 10 to 15 minutes per test. There were other unusually bazaar diagnostic tests such as the live beetle test where a few drops of lavage fluid containing a commonly used insecticide was put into a test tube with live beetles. If the beetles died in an hour or less the test would be considered positive. Since there were virtually no ICU's and surgical recovery rooms staffed after hours, a call to Comstock necessitated a visit to the hospital for stabilization. It often became necessary for him to stay with the patient from a few hours to several days depending on the clinical situation. An example of this was a child Eric described in "Roots and Circles in Medical Toxicology: A Personal Reminiscence" (Clinical Toxicology, 36(5), 401-407, 1998). A pediatric patient with severe salicylate overdose required 28 consecutive hours of personal attendance until the patient was over the crisis. He also notes the insurance company paid $15 for a "hospital visit."

A definitive case for Eric occurred in 1966, when he was called to participate in the care of a 2 year old admitted with an organophosphate poisoning and was being treated by an anesthesiologist in the pediatric surgical recovery room. Pralidoxime and atropine were administered to the patient without clinical improvement. A call to the CDC led to the referral of Comstock to Griffith Quinby of Wenatchee, Washington. Dr. Quinby had extensive experience treating OP poisoning and this piqued Eric's interest that a network of physicians seemed the logical way to best treat the complex issue of a poisoned patient.

In 1967, during an AAPCC meeting, new players entered the team. For his pesticide interest and expertise, Quinby was a logical choice. Daniel Teitelbaum, an internist with a background in occupational medicine and analytical toxicology was added to the team along with Jock Greame, who was the adverse reaction officer for Ciba Pharmaceuticals. Founder and editor of the new Clinical Toxicology Journal, Richard "Toby" Rappolt, rounded out the initial members of the team. This nucleus of physicians each with a different approach to medical toxicology made up the founding body of the AACT. Eric was appointed secretary treasurer of the group who, in turn placed letters and announcements in various medical publications describing the new group and inviting interested physician applicants.

In June of 1968 the "team" met to formulate a constitution and by-laws. On October 22, 1968, in conjunction with and following the AAPCC's post American Academy of Pediatrics Fall meeting in Chicago, the first AACT organizational meeting was held. Since there were a number of pediatricians attending the AAPCC, it was thought many would stay the additional day to attend the potential birth of a new organization geared primarily for the physician. The night prior to the meeting the AAP president strongly urged Comstock from pursuing the new organization. He was told that if they joined the AAPCC he would, in turn, promote and facilitate their activity in the AAPCC. He went on to say that the new organization would be discredited if organized separately. According to Eric in his Clinical Toxicology Reminiscence, "The ensuing schism persisted for a number of years."

On October 22, 1968, 52 of 87 (members of AAPCC) attended the organizational meeting. As one who was there I recall the tremendous enthusiasm many of us had who were doing the best we could with what we had in running our Poison Centers.

The 1968 AAPCC meeting agenda below included a number of the AACT founders.

Sunday, October 20, 1968

11:30 am

• Business Meeting: Irving Sunshine, President, AAPCC

1:00 pm

• Address to the Association: "Environmental Safety: The Challenges to Poison
• Control Centers" James L. Goddard, MD, Commissioner, FDA
• Symposium: Communication, Roger Meyer, MD, Chairman

2:30 pm

• Communications Systems Analysis in Environmental Safety,
• James L. Goddard, MD; Henry Kissman, MD, Director,
• Science Information Facility, FDA; Charles Rice, National Library of Medicine

3:45 pm

• Poison Information, Storage and Retrieval, Sumner Yaffe, MD;
• David Burkholder, PhD; John Levchuk, MS, Schools of Medicine and Pharmacy,
• University of New York at Buffalo and Poison Control Center,
• Children's Hospital, Buffalo, New York

4:30 pm

• Discussion Panel: Merritt B. Low, MD, Chairman, AAP Committee on Accident
• Prevention; Alan B. Coleman, MD, Chairman, Sub-committee on Accident
• Prevention; Paul F. Wehrle, MD, Chairman, AAP Committee on
• Environmental Hazards; Harry Shirkey, MD, Director, Poison Control Center,
• Children's Hospital, Biringham, Alabama.

Monday, October 21, 1968
9:30 am Scientific Session
1:00 pm

• Programmed Learning and Other Techniques of Professional Education: Eric Comstock, MD, Clinical Toxicology, Houston, TX;
• Howard Mofenson, MD,
• Director, Poison Control Center, Meadowbrook Hospital, East Meadow, NY;
  Dialysis for Toxins: John Maher, MD, Director, Renal Clinic, Georgetown
• University Hospital, Washington, DC;Rueben Meyer, MD, Professor of
• Pediatrics, Children's Hospital, Detroit, Michigan
  Hallucinogenic Drugs: Allan Done, MD, Associate Professor of Pediatrics,
• Children's Hospital, Detroit, Michigan; David Smith, MD, Medical Director,
• Haight-Ashbury Clinic, San Francisco, California; Robert W. Deisher, MD,
• Chairman, AAP Committee on Youth; Richard T. Rappolt, Sr., MD, Clinical
• Toxicology, San Francisco, CA
  Pesticide Toxicity: Jay Arena, MD, Director, Poison Control Center, Duke
• Hospital Medical Center, Durham, North Carolina; Griffith Quinby, MD,
• Director, Community Pesticide Study Project, Wenatchee, WA
  What every Poison Center Should Know about Potentially Toxic Plants: John M.
• Kingsbury, PhD, Associate Professor of Botany and Lecturer in Phytotoxicity,
• Cornell University, Ithaca, New York; Henry Verhulst, Director, National
• Clearinghouse for Poison Control Center, Washington, DC

I recall this first meeting in the Palmer House was held in a stark plain room lite solely by the light from the windows. It was a casual and informal meeting but the interest and enthusiasm was infectious. To have an organization specifically for those of us who diagnose and treat the poisoned patient was heartening. The stark unpretentious facilities on that day seemed strange until later when I found the AAP may have had a hand in the less than ideal facilities.

Besides the founders giving various facets of their own thoughts on the organization there were a number of others who spoke such as AMA Drug Evaluation Section spokesman, Dr. Bradford Craver. Also, Dr. P. F. R. deCaires, from Parke-Davis discussed the drug industry's need for clinical data on adverse and overdose experiences. Dr. Lee Miller, from Proctor and Gamble spoke on the industrial aspects of occupational chemical hazards. During the afternoon business session, the first AACT officers were elected: Eric Comstock, president, Griffith Quinby, Vice President and Daniel Teitelbaum as Secretary Treasurer. Incorporation of the Academy came about with the help of Dr. John Pepper, of Hoffman-La Roche who persuaded his corporate legal colleagues to handle the incorporation of AACT as a New Jersey entity which was later granted tax exempt 503(c) status.

By December 31, 1968, there were 128 charter members listed below:

Frank Aldrich, MD, PhD Vernon Green, MD E. Plunkett, MD C.H. Allen, MD Gerald Gunson, MD Rothwell Polk, MD Herbert Anderson, Jr., MS Charles P. Haseltine, MD Griffith Quinby, MD John D. Archer, MD Ray E. Helfer, MD R. Radeleff, DVM Daniel Azarnoff, MD John B. Henry, MD Irene Raisfeld, MD Paul F. Baranco, MD Elizabeth Hillman, MD Theron Randolph, MD Eleanor Berman, PhD F.G. Hirsch, MD Richard Rappolt, Sr., MD Paul W. Boyles, MD L. Hobson, MD, PhD William J. Rees, MD Rowine E. Brown, MD, JD Robert C. Hoppe, MD Marcus Reidenberg, MD Peter Capurro, MD R.P. Hudson, MD Earl T. Rose, MD Louis J. Cella, Jr., MD Philip Huffman, MD Robert Rowan, MD Paul J. Christenson, MD Glen D. Journeay, MD James L. Salomon, MD P.J. Clancy, MD K.K. Kimura, MD, PhD Monroe Samuels, MD Walter H. Comer, MD G.F. Kiplinger, MD, PhD James Schmidt, MD, PhD Eric G. Comstock, MD Kinya Kuriyama, MD J.C. Schoolar, MD, PhD Avery L. Cook, MD Robert F. Lash, MD Raymond Seidel, MD Bradford Craver, MD, PhD James Lawson, MD S. Franklin Sher, MD P.F.R. deCaires, MD Theodore Lefton, MD John E. Silson, MD Allen J. Dennis, Jr., MD E. Leonhardt, MD Dennis M. Slone, MD Norman De Nosaquo, MD Dean LeSher, MD, PhD David E. Smith, MD C.H. Denser, Jr., MD J.S. London, MD J.T. Sobota, MD Raoul Desjardins, MD O.J. Lorenzetti, PhD Jacob Sokol, MD O. Bruce Dickerson, MD Frank J. Lyman, MD A.A. Stein, MD Dwight Dill, MD W. McCarthy, MD Robert J. Stein, MD Charles J. Dunn, Jr., MD Richard McCormick, MD Aldolf Stern, MD Richard W. Dyke, MD Allan McNie, MD A.L. Strasser, MD R. Eklund, MD L. Massey, MD F.W. Sunderman, Jr., MD Herman Ellenberger, PhD Henry Matthew, MD Raymond Suskind, MD Matthew Ellenhorn, MD Jacqueline Mauro, MD Wilmier Talbert, MD Park Espenschade, Jr., MD Hassan Mehbod, MD Daniel T. Teitelbaum, MD Carl Essig, MD G.B. Meyers, MD Mark Thoman, MD Myron A. Fisher, MD Lee H. Miller, MD J.S. Tobin, MD Arthur D. Flanagan, MD F.C. Minkler, MD Paul F. Tumlin, MD Edgar M. Flint, MD John B. Mitchell, MD Thomas W. Tusing, MD John M. Fong, MD Howard Mofenson, MD Julian Vilareal, MD Richard Fraser, MD Moses Muzquiz, MD James Weaver, PhD Christopher Frings, PhD D. Nelson, DVM, PhD Sidney Weinberg, MD Mary S. Furth, MD Richard O'Dillon, MD Harry Weisberg, MD Vincent Gagliardi, MD F.W. Oehme, DVM, PhD F.W. Wilson, MD Solomon Garb, MD Ronald Okun, MD Charles Winek, PhD John Garrett, MD John Palese, MD George Wise, MD Sander Garrie, MD Rafael Penalver, MD Peter Wolkonsky, MD Jock Graeme, MD John J. Pepper, MD

The first few years were challenging with a concerted effort to describe the organization in the medical literature. The 1969 meeting, again in Chicago, had as its objectives, GI decontamination and sequestration. Featured speakers included Dr. Henry Mathew of Edinburgh and Dr. Emilio Astolfi of Buenos Aires. At the business session during this meeting, the Board established the position of Executive Director which was filled by Eric Comstock with Quinby taking over as president. Though the AACT did not have the funds to support Eric's position, his faculty appointment at the University of Texas School of Public Health and later the Department of Community Medicine partially funded his activities. By 1969, the AACT membership had reached 200 with 87% physicians and 13% non-physicians. The early years were hand to mouth. In fact, Secretary-Treasurer Dr. Frank Aldrich, colorfully described those early years in his "Looking Back" (Clinical Toxicology, 36(5),399-400) as ...an operating floating crap game until it finally found a home in Pennsylvania." Early financing was derived from dues, training programs, annual meetings, industry and $118,000 grant from the Bureau of Narcotics and Dangerous Drugs to develop a nationwide Drug Abuse Early Warning, known today as Project DAWN.

In 1972, at the Aspen meeting, the Academy faced a major crisis. The Board was concerned with the slow rate of growth of the membership and concluded that the criteria should be expanded to include full membership to non-physicians. Though this made the non-physician welcomed and accepted, some physicians left the Academy since, it was felt, that this "dilution" effect would significantly jeopardize the chance for developing a specialty board for physicians practicing medical toxicology. Comstock resigned as Executive Director turning over the Academy affairs to the officers.

In 1974, the Academy created a subsection of AACT, the American Board of Medical Toxicology, under the president, Dr. Ron Okun. The following is a list of the first examiners appointed to the ad hoc committee:

Daniel Teitelbaum, M.D., Chairman
Frederick Lovejoy, Jr., M.D.
Albert Nantel, M.D.
John Ott, M.D.
William Robertson, M.D.
Mark Thoman, M.D.
Anthony Temple, M.D.

The first examination was given the following year at the annual meeting in Kansas City. The diplomats of this and subsequent exams formed the basis for the new ABMT Board of Examiners. The ABMT became a legal independent entity incorporated in Massachusetts. ABMT, however, continued a close relationship its parent Academy.

The Academy continued to grow over the ensuing years, necessitating communication in several phases. The Clinical Toxicology Newsletter was published in the early 1970s in Houston by Eric Comstock. In 1975 the AACT created AACTion which continued as an independent publication until incorporated into Veterinary and Human Toxicology under the able guidance of V and H editor and veterinarian Fred Oehme in Manhattan, KS. AACTion in 1990s took several different forms with the evolution of internet communication and ultimately V and H Tox unfortunately ceased publication.

AACT ANNUAL MEETING LOCATIONS
The annual meetings, over the past 4 decades, were in places from the metropolitan to the exotic and are listed as follows:

1968 Chicago (organizational meeting) 1969 Chicago, IL 1970 San Francisco, CA 1971 Philadelphia, PA 1972 Snowmass, CO 1973 San Diego, CA 1974 Montreal, Quebec, Canada 1975 Kansas City, MO 1976 Seattle, WA 1977 Le Chanteclair, Quebec, Canada 1978 Chicago, IL 1979 New Orleans, LA 1980 Minneapolis, MN 1981 Salt Lake City, UT 1982 Snowmass, CO 1983 Boston, MA 1984 San Diego, CA 1985 Kansas City, MO 1986 Santa Fe, NM 1987 Vancouver, BC, Canada 1988 Baltimore, MD 1989 Atlanta, GA 1990 Tucson, AZ 1991 Toronto, Canada 1992 Tampa, FL 1993 New York, NY 1994 Salt Lake City, UT 1995 Rochester, NY 1996 Portland, OR 1997 Saint Louis, MO 1998 Orlando, FL 1999 La Jolla, CA 2000 Tucson, AZ 2001 Montreal, Quebec, Canada 2002 Palm Springs, CA 2003 Chicago, IL 2004 Seattle, WA 2005 Orlando, FL 2006 San Francisco, CA 2007 New Orleans, LA 2008 Toronto, Canada 2009 San Antonio, TX 2010 Denver, CO 2011 Washington, DC

AACT PRESIDENTS
Academy Presidents ranged from M.D.’s Pharm. D.s and DVM’s signifying the wide range of Academy professional inclusions. The presidents since 1968 are listed as follows:

1968-70 Eric Comstock, MD 1970-72 Griffith E. Quinby, MD 1972-74 Clinton Thienes, MD 1974-76 Ronald Okun, MD 1976-78 Jack Ott, MD 1978-80 Fred W. Oehme, DVM, PhD 1980-82 Franklin Aldrich, MD, PhD 1982-84 Mark Thoman, MD 1984-86 Helmut Redetzki, MD 1986-88 Frederick Lovejoy, Jr., MD 1988-90 Donald Kunkel, MD, JD 1990-92 Michael McGuigan, MD 1992-94 Wayne Snodgrass, MD 1994-96 William Banner, MD, PhD 1996-98 Edward Krenzelok, Pharm D 1998-00 Jeffrey Brent, MD, PhD 2000-02 Milton Tenenbein, MD 2002-04 Donna Seger, MD 2004-06 Michael McGuigan, MD 2006-08 G. Randall Bond, MD 2008-10 Michael Greenberg, MD