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Foodborne Disease
Handbook
 FOODBORNE DISEASE HANDBOOK

Editor-in-Chief
Y. H. Hui

Volume Editors
J. Richard Gorham
David Kitts
K. D. Murrell
Wai-Kit Nip
Merle D. Pierson
Syed A. Sattar
R. A. Smith
David G. Spoerke, Jr.
Peggy S. Stanfield

Volume 1 Bacterial Pathogens Volume 3 Plant Toxicants

Volume 2 Viruses, Parasites, Volume 4 Seafood and

Pathogens, and HACCP Environmental Toxins
Foodborne Disease
Handbook
Second Edition, Revised and Expanded

Volume 4: Seafood and Environmental Toxins

edited by
Y. H. Hui
Science Technology System
West Sacramento, California

David Kitts
University of British Columbia
Vancouver, British Columbia, Canada

Peggy S. Stanfield
Dietetics Resources
Twin Falls, Idaho
First published 2001 by CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742

Reissued 2018 by CRC Press

© 2001 by Taylor & Francis Group, LLC.

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Introduction to the Handbook

The Foodborne Disease Handbook, Second Edition, Revised and Expanded, could not be
appearing at a more auspicious time. Never before has the campaign for food safety been
pursued so intensely on so many fronts in virtually every country around the world. This
new edition reflects at least one of the many aspects of that intense and multifaceted
campaign: namely, that research on food safety has been very productive in the years
since the first edition appeared. The Handbook is now presented in four volumes instead
of the three of the 1994 edition. The four volumes are composed of 86 chapters, a 22%
increase over the 67 chapters of the first edition. Much of the information in the first
edition has been carried forward to this new edition because that information is still as
reliable and pertinent as it was in 1994. This integration of the older data with the latest
research findings gives the reader a secure scientific foundation on which to base important
decisions affecting the public's health.
We are not so naive as to think that only scientific facts influence decisions affecting
food safety. Political and economic factors and compelling national interests may carry
greater weight in the minds of decision-makers than the scientific findings offered in this
new edition. However, if persons in the higher levels of national governments and interna-
tional agencies, such as the Codex Alimentarius Commission, the World Trade Organiza-
tion, the World Health Organization, and the Food and Agriculture Organization, who
must bear the burden of decision-making need and are willing to entertain scientific find-
ings, then the information in these four volumes will serve them well indeed.
During the last decade of the previous century, we witnessed an unprecedentedly
intense and varied program of research on food safety, as we have already noted. There
are compelling forces driving these research efforts. The traditional food-associated patho-
gens, parasites, and toxins of forty years ago still continue to cause problems today, but
newer or less well-known species and strains present extraordinary challenges to human
health.
These newer threats may be serious even for the immunocompetent, but for the
immunocompromised they can be devastating. The relative numbers of the immunocom-
promised in the world population are increasing daily. We include here not just those
affected by the human immunodeficiency virus (HIV), but also the elderly; the very young;
the recipients of radiation treatments, chemotherapy, and immunosuppressive drugs; pa-

//;•
Iv Introduction to the Handbook

tients undergoing major invasive diagnostic or surgical procedures; and sufferers of debili-
tating diseases such as diabetes. To this daunting list of challenges must be added numer-
ous instances of microbial resistance to antibiotics.
Moreover, it is not yet clear how the great HACCP experiment will play out on the
worldwide stage of food safety. Altruism and profit motivation have always made strange
bedfellows in the food industry. It remains to be seen whether HACCP will succeed in
wedding these two disparate motives into a unifying force for the benefit of all con-
cerned—producers, manufacturers, retailers, and consumers. That HACCP shows great
promise is thoroughly discussed in Volume 2, with an emphasis on sanitation in a public
eating place.
All the foregoing factors lend a sense of urgency to the task of rapidly identifying
toxins, species, and strains of pathogens and parasites as etiologic agents, and of determin-
ing their roles in the epidemiology and epizootiology of disease outbreaks, which are
described in detail throughout the Foodborne Disease Handbook.
It is very fortunate for the consumer that there exists in the food industry a dedicated
cadre of scientific specialists who scrutinize all aspects of food production and bring their
expertise to bear on the potential hazards they know best. A good sampling of the kinds
of work they do is contained in these four new volumes of the Handbook. And the benefits
of their research are obvious to the scientific specialist who wants to learn even more
about food hazards, to the scientific generalist who is curious about everything and who
will be delighted to find a good source of accurate, up-to-date information, and to consum-
ers who care about what they eat.
We are confident that these four volumes will provide competent, trustworthy, and
timely information to inquiring readers, no matter what roles they may play in the global
campaign to achieve food safety.

Y. H. Hui
J. Richard Gorham
David Kitts
K. D. Murrell
Wai-Kit Nip
Merle D. Pierson
Syed A. Sattar
R. A. Smith
David G. Spoerke, Jr.
Peggy S. Stanfield
Preface

Most people prefer to think of marine environments farthest removed from human settle-
ments as being pristine and pure; however, much of the ocean is under attack on several
fronts. One of the foci of this fourth volume of the Foodborne Disease Handbook is the
topic of pollutants, which are being deposited in the oceans in unprecedented quantities—
as raw sewage (often with viable pathogens and parasites), industrial effluents containing
toxic or radioactive chemicals, trash and garbage, pesticides in runoff from crop lands,
and top soil, one of our most valuable natural resources.
Some of these potentially harmful organisms and chemicals enter the food webs of
freshwater and marine organisms. Some of these organisms are harvested for human food
and have the capacity and tendency to concentrate and sequester in their bodies many of
the chemicals and pathogens present in the aquatic environments. The methods of how
harmful organisms or hazardous chemicals are detected, analyzed, and identified, and how
they can affect human health, are thoroughly reviewed in this volume.
In contrast, some marine organisms do not collect toxins from the environment but
rather produce their own toxins as a part of normal metabolic processes. When such fish
are used as human food, the result can be life-threatening. This volume discusses the
species and toxins of importance, analytical methods, and epidemiological aspects of in-
toxication.
The seafood processor was one of the first food industries required to implement
the HACCP principles. The development of the seafood HACCP program and its benefits
to the consumer are discussed in this volume.
A cloud of controversy hovers over the concept of food irradiation. In this volume
we present informative facts needed for the reader to come to an enlightened conclusion
about the safety of food irradiation. We caution that no matter how successful irradiation
might be, mishandling after irradiation treatment makes the product unsafe. We also dis-
cuss the continuing need to adhere to HACCP principles and essential sanitary standards
that make it possible for HACCP to work.
Many, perhaps even most, of the food toxicity issues addressed in this volume are
subtle and unknown to most of us. For example, the use of food additives, radioactive
isotopes, pesticide chemicals applied to our crops, toxicants occurring naturally in some
of our foods, and the therapeutic and growth-promoting drugs fed to domestic animals
vi Preface

are important topics of food toxicology. In addition, plasticizers in many kinds of vessels
used for food storage and handling may in some instances be a source of toxic chemicals.
Most consumers are quite unaware of rat hairs, beetle setae, and fly eggs in their food,
and less aware of what effect, if any, such adulterants might have on their health.
The editors and contributors to the fourth volume of the Foodborne Disease Hand-
book have provided an abundance of facts and supporting explanatory information en-
abling readers to make confident decisions about their health. Moreover, all sectors of the
food industry have the tools needed to apply the sanitary practices and HACCP-driven
safeguards that will result in the prevention of foodborne diseases and help to make avail-
able wholesome foods for all consumers around the world. Volume 4 is a composite of
current information and policies that enable proper risk-assessment decisions to be made
regarding potential food toxicants derived naturally in the environment or through agricul-
tural production and food processing practices.

Y. H. Hui
David Kitts
Peggy S. Stanfield
Contents

Introduction to the Handbook Hi

Preface v
Contributors xi
Contents of Other Volumes xiii

I. Poison Centers

1. Seafood and Environmental Toxicant Exposures: The Role of Poison Centers 1

David G. Spoerke, Jr.

II. Seafood Toxins

2. Fish Toxins 23
Bruce W. Halstead

3. Other Poisonous Marine Animals 51

Bruce W. Halstead

4. Shellfish Chemical Poisoning 77

Lyndon E. Llewellyn

5. Pathogens Transmitted by Seafood 109

Russell P. Herwig

6. Laboratory Methodology for Shellfish Toxins 183

David Kitts

vii
viii Contents

1. Ciguatera Fish Poisoning 209

Yoshitsugi Hokama and Joanne S. M. Yoshikawa-Ebesu

8. Tetrodotoxin 253
Joanne S. M. Yoshikawa-Ebesu, Yoshitsugi Hokama, and Tamao Noguchi

9. Epidemiology of Seafood Poisoning 287

Lorn E. Fleming, Dolores Katz, Judy A. Bean, and Roberta Hammond

10. The Medical Management of Seafood Poisoning 311

Donna Glad Blythe, Eileen Hack, Giovanni Washington,
and Lora E. Fleming

11. The U.S. National Shellfish Sanitation Program 321

Rebecca A. Reid and Timothy D. Durance

12. HACCP, Seafood, and the U.S. Food and Drug Administration 339
Kim R. Young, Miguel Rodrigues Kamat, and George Perry Hoskin

III. Environmental Toxins

13. Toxicology and Risk Assessment 347

Donald J. Ecobichon

14. Nutritional Toxicology 379

David Kitts

15. Food Additives 447

Laszlo P. Somogyi

16. Analysis of Aquatic Contaminants 517

Joe W. Kiceniuk

17. Agricultural Chemicals 537

Debra L. Browning and Carl K. Winter

18. Radioactivity in Food and Water 557

Hank Kocol

19. Food Irradiation 571

Hank Kocol

20. Drug Residues in Foods of Animal Origin 579

Austin R. Long and Jose E. Roybal

21. Migratory Chemicals from Food Containers and Preparation Utensils 599
Yvonne V. Yuan
Contents ix

22. Food and Hard Foreign Objects: A Review 617

J. Richard Gorham

23. Food, Filth, and Disease: A Review 627

J. Richard Gorham

24. Food Filth and Analytical Methodology: A Synopsis 639

/. Richard Gorham

Index 645
Contributors

Judy A. Bean Children's Hospital of Cincinnati, Cincinnati, Ohio, and National Institute
of Environmental Health Sciences (NIEHS) Marine and Freshwater Biomedical Sciences
Center, University of Miami Rosensteil School of Marine and Atmospheric Sciences, Mi-
ami, Florida

Donna Glad Blythe Department of Epidemiology and Public Health, University of Mi-
ami School of Medicine, Miami, Florida

Debra L. Browning Food Safe Program, Department of Food Science and Technology,
University of California-Davis, Davis, California

Timothy D. Durance Food, Nutrition, and Health, University of British Columbia, Van-
couver, British Columbia, Canada

Donald J. Ecobichon Department of Pharmacology and Toxicology, Queen's Univer-

sity, Kingston, Ontario, Canada

Lora E. Fleming Department of Epidemiology and Public Health, University of Miami

School of Medicine, and National Institute of Environmental Health Sciences (NIEHS)
Marine and Freshwater Biomedical Sciences Center, University of Miami Rosensteil
School of Marine and Atmospheric Sciences, Miami, Florida

J. Richard Gorham Department of Preventive Medicine, Uniformed Services Univer-

sity of the Health Sciences, Bethesda, Maryland

Eileen Hack Department of Epidemiology and Public Health, University of Miami

School of Medicine, Miami, Florida

Bruce W. Halstead International Biotoxicological Center, World Life Research Insti-

tute, Colton, California

Roberta Hammond State of Florida Department of Health, Tallahassee, Florida

Russell P. Herwig School of Fisheries, University of Washington, Seattle, Washington

xi
xii Contributors

Yoshitsugi Hokama Pathology Department, John A. Burns School of Medicine, Univer-

sity of Hawaii, Honolulu, Hawaii
George Perry Hoskin Office of Seafood, Division of Science and Applied Technology,
Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, Wash-
ington, D.C.
Miguel Rodrigues Kamat Office of Seafood, Division of Programs and Enforcement
Policy, Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration,
Washington, D.C.
Dolores Katz Department of Epidemiology and Public Health, University of Miami
School of Medicine, Miami, and State of Florida Department of Health, Tallahassee,
Florida
Joe W. Kiceniuk Department of Chemistry, Dalhousie University, Halifax, Nova Sco-
tia, Canada
David Kitts Food, Nutrition, and Health, University of British Columbia, Vancouver,
British Columbia, Canada
Hank Kocol* Health Physicist, Roseville, California
Lyndon E. Llewellyn Australian Institute of Marine Science, Townsville, Queensland,
Australia
Austin R. Long Pacific Regional Laboratory Northwest, U.S. Food and Drug Adminis-
tration, Bothell, Washington
Tamao Noguchi Laboratory of Food Hygiene, Nagasaki University, Nagasaki, Japan
Rebecca A. Reid Department of Fisheries and Oceans, Vancouver, British Columbia,
Canada
Jose E. Roybal Animal Drugs Research Center, U.S. Food and Drug Administration,
Denver, Colorado
Laszlo P. Somogyi Consulting Food Scientist, Kensington, California
David G. Spoerke, Jr. Bristlecone Enterprises, Denver, Colorado
Giavanni Washington Department of Epidemiology and Public Health, University of
Miami School of Medicine, Miami, Florida
Carl K. Winter Department of Food Science and Technology, University of California-
Davis, Davis, California
Joanne S. M. Yoshikawa-Ebesu Oceanit Test Systems, Inc., Honolulu, Hawaii
Kim R. Young Office of Seafood, Division of Programs and Enforcement Policy, Center
for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, Washington,
D.C.
Yvonne V. Yuan School of Nutrition, Ryerson Polytechnic University, Toronto, On-
tario, Canada

* Former affiliation: California Department of Health Services, Roseville, California.

Contents of Other Volumes

VOLUME 1: BACTERIAL PATHOGENS

I. Poison Centers

1. The Role of U.S. Poison Centers in Bacterial Exposures

David G. Spoerke, Jr.

II. Bacterial Pathogens

2. Bacterial Biota (Flora) in Foods

James M. Jay

3. Aeromonas hydrophila
Carlos Abeyta, Jr., Samuel A. Palumbo, and Gerard N. Stelma, Jr.

4. Update: Food Poisoning and Other Diseases Induced by Bacillus cereus

Kathleen T. Rajkowski and James L. Smith

5. Brucella
Shirley M. Hailing and Edward J. Young

6. Campylobacter jejuni
Don A. Franco and Charles E. Williams

1. Clostridium botulinum
John W. Austin and Karen L. Dodds

8. Clostridium perfringens
Dorothy M. Wrigley

xiii
xiv Contents of Other Volumes

9. Escherichia coli
Marguerite A. Nell, Phillip I. Tarr, David N. Taylor, and Marcia Wolf

10. Listeria monocy to genes

Catherine W. Donnelly

11. Bacteriology of Salmonella

Robin C. Anderson and Richard L. Ziprin

12. Salmonellosis in Animals

David J. Nisbet and Richard L. Ziprin

13. Human Salmonellosis: General Medical Aspects

Richard L. Ziprin and Michael H. Hume

14. Shigella
Anthony T. Maurelli and Keith A. Lampel

15. Staphylococcus aureus

Scott E. Martin, Eric R. Myers, and John J. landolo

16. Vibrio cholerae

Charles A. Kaysner and June H. Wetherington

17. Vibrio parahaemolyticus

Tuu-jyi Chai and John L. Pace

18. Vibrio vulnificus

Anders Dalsgaard, Lise H0i, Debi Linkous, and James D. Oliver

19. Yersinia
Scott A. Minnich, Michael J. Smith, Steven D. Weagant, and Peter Feng

III. Disease Surveillance, Investigation, and Indicator Organisms

20. Surveillance of Foodborne Disease

Ewen C. D. Todd

21. Investigating Foodborne Disease

Dale L. Morse, Guthrie S. Birkhead, and Jack J. Guzewich

22. Indicator Organisms in Foods

James M. Jay

Index
Contents of Other Volumes xv

VOLUME 2: VIRUSES, PARASITES, PATHOGENS, AND HACCP

I. Poison Centers

1. The Role of Poison Centers in the United States

David G. Spoerke, Jr.

II. Viruses

2. Hepatitis A and E Viruses

Theresa L. Cromeans, Michael O. Favorov, Omana V. Nainan, and Harold S.
Margolis

3. Norwalk Virus and the Small Round Viruses Causing Foodborne Gastroenteritis
Hazel Appleton

4. Rotavirus
Syed A. Sattar, V. Susan Springthorpe, and Jason A. Tetro

5. Other Foodborne Viruses

Syed A. Sattar and Jason A. Tetro

6. Detection of Human Enteric Viruses in Foods

Lee-Ann Jaykus

1. Medical Management of Foodborne Viral Gastroenteritis and Hepatitis

Suzanne M. Matsui and Ramsey C. Cheung

8. Epidemiology of Foodborne Viral Infections

Thomas M. Liithi

9. Environmental Considerations in Preventing the Foodborne Spread

of Hepatitis A
Syed A. Sattar and Sabah Bidawid

III. Parasites

10. Taeniasis and Cysticercosis

Zbigniew S. Pawlowski and K. D. Murrell

11. Meatborne Helminth Infections: Trichinellosis

William C. Campbell

12. Fish- and Invertebrate-Borne Helminths

John H. Cross
xw Contents of Other Volumes

13. Waterborne and Foodborne Protozoa

Ronald Payer

14. Medical Management

Paul Prociv

15. Immunodiagnosis of Infections with Cestodes

Bruno Gottstein

16. Immunodiagnosis: Nematodes

H. Ray Gamble

17. Diagnosis of Toxoplasmosis

A Ian M. Johnson and J. P. Dubey

18. Seafood Parasites: Prevention, Inspection, and HACCP

Ann M. Adams and Debra D. DeVlieger

IV. HACCP and the Foodservice Industries

19. Foodservice Operations: HACCP Principles

O. Peter Snyder, Jr.

20. Foodservice Operations: HACCP Control Programs

O. Peter Snyder, Jr.

Index

VOLUME 3: PLANT TOXICANTS

I. Poison Centers

1. U.S. Poison Centers for Exposures to Plant and Mushroom Toxins

David G. Spoerke, Jr.

II. Selected Plant Toxicants

2. Toxicology of Naturally Occurring Chemicals in Food

Ross C. Beier and Herbert N. Nigg

3. Poisonous Higher Plants

Doreen Grace Lang and R. A. Smith

4. Alkaloids
R. A. Smith
Contents of Other Volumes xvii

5. Antinutritional Factors Related to Proteins and Amino Acids

Irvin E. Liener

6. Glycosides
Walter Majak and Michael H. Benn

1. Analytical Methodology for Plant Toxicants

Alister David Muir

8. Medical Management and Plant Poisoning

Robert H. Poppenga

9. Plant Toxicants and Livestock: Prevention and Management

Michael H. Ralphs

III. Fungal Toxicants

10. Aspergillus
Zofia Kozakiewicz

11. Claviceps and Related Fungi

Gretchen A. Kuldau and Charles W. Bacon

12. Fusarium
Walter F. O. Marasas

13. Penicillium
John I. Pitt

14. Foodborne Disease and Mycotoxin Epidemiology

Sara Hale Henry and F. Xavier Bosch

15. Mycotoxicoses: The Effects of Interactions with Mycotoxins

Heather A. Koshinsky, Adrienne Woytowich, and George G. Khachatourians

16. Analytical Methodology for Mycotoxins

James K. Porter

17. Mycotoxin Analysis: Immunological Techniques

Fun S. Chu

18. Mushroom Biology: General Identification Features

David G. Spoerke, Jr.
xviii Contents of Other Volumes

19. Identification of Mushroom Poisoning (Mycetismus), Epidemiology,

and Medical Management
David G. Spoerke, Jr.

20. Fungi in Folk Medicine and Society

David G. Spoerke, Jr.

Index
1
Seafood and Environmental
Toxicant Exposures: The Role of
Poison Centers

David G. Spoerke, Jr.

Bristlecone Enterprises, Denver, Colorado

I. Epidemiology 1
A. AAPCC 2
B. Who staffs a poison center? 3
C. What types of calls are received? 4
D. How are calls handled? 5
E. What references are used? 6
F. How are poison centers monitored for quality?
G. Professional and public education programs "
H. Related toxicology organizations 7
I. International affiliations 10
J. Toxicology and poison center Web sites 10
II. Poison Information Centers in the United States 10
References 21

I. EPIDEMIOLOGY

Epidemiological studies aid treatment facilities in determining risk factors and who be-
comes exposed, and in establishing the probable outcomes of various treatments. A few
organizations have attempted to gather such information and organize it into yearly reports.
The American Association of Poison Control Centers (AAPCC) and some federal agencies
work toward obtaining epidemiological information, while the AAPCC has an active role
in assisting with the treatment of exposures Epidemiological studies assist government
and industry in determining package safety, effective treatment measures, conditions of
exposure, and frequency of exposure.
Studies on seafood and environmental exposures provide information on the type
of people most commonly involved in exposures. Are they children, adults at home, out-
doorsmen, industrial workers, or blue-collar workers. Studies can also tell us which bacte-
rial species are most commonly involved. What symptoms are seen first, what is the onset
2 Spoerke

of symptoms, and are their any sequalae may also be determined and compared to current
norms.

A. AAPCC
1. What Are Poison Centers and the AAPCC?
The group in the United States concerned, on a daily basis, with potential poisonings due
to household agents, industrial agents, biologies, and food poisoning (including seafood
poisoning) is the AAPCC. This is an affliliation of local and regional centers that provides
information to health care professionals and the lay public concerning all aspects of poi-
soning. These centers also refer patients to treatment centers. This group of affiliated
centers is often supported by government and private funds, as well as industrial sources.
Poison centers were started in the late 1950s; the first is thought to have been in
the Chicago area. The idea caught on quickly and at the peak of the movement there were
hundreds of centers throughout the United States. Unfortunately there were few or no
standards for what could be called a poison center, including the type of staff, hours of
operation, or information resources. One center may have had a dedicated staff of doctors,
pharmacists, and nurses trained specifically in handling poison cases, while another had
nothing but a book on toxicology in the emergency room or hospital library. In 1993 the
Health and Safety Code (Sec. 777.002) specified that poison centers provide 24-hour ser-
vice for public and health care professionals and meet the requirements established by
the AAPCC. This action helped the AAPCC standardize the staffs and activities of the
various poison centers.
The federal government does not fund poison centers, even though for every dollar
spent on poison centers there is a savings of $2-$9 in unnecessary expenses (1,2). The
federal agency responsible for the Poison Prevention Packaging Act is the U.S. Consumer
Product Safety Commission (CPSC). The National Clearinghouse for Poison Control Cen-
ters initially collected data on poisonings and information on commercial product ingredi-
ents and toxic biological agents. For several years the National Clearinghouse provided
product and treatment information to the poison centers.
At first most poison centers were funded by the hospital in which they were located.
As the centers grew in size and the number of calls increased, both city and state govern-
ments took on the responsibility of contributing funds. In recent years local governments
have found it very difficult to fund such operations and centers have had to look to private
industry for additional funding. Government funding may take several forms, either as a
line-item on a state's budget, as a direct grant, or moneys distributed on a per call basis.
Some states with fewer residents may contract with a neighboring state to provide services
to its residents. Some states are so populous that more than one center is funded by the
state. Industrial funding also varies, sometimes as a grant, sometimes as payment for
handling the company's poison and drug information-related calls, and sometimes as pay-
ment for collection of data regarding exposure to the company's product. Every year the
AAPCC reports a summary of all kinds of exposures.
2. Regional Centers
The number of listed centers has dropped significantly since its peak of more than 600.
Many centers have been combined into regional organizations. These regional poison cen-
ters provide poison information, telephone management, and consultation, collect pertinent
data, and deliver professional and public education. Cooperation between regional poison
The Role of Poison Centers 3

centers and poison treatment facilities is crucial. Regional poison information centers, in
cooperation with local hospitals, should determine the treatment capabilities of the hospi-
tals in the region and identify and have a working relationship with their analytical toxicol-
ogy, emergency and critical care, medical transportation, and extracorporeal services. This
evaluation should be done for both adults and children.
A "region" is usually determined by state authorities in conjunction with local
health agencies and health care providers. Documentation of these state designations must
be in writing unless a state chooses (in writing) not to designate any poison center or
accepts a designation by other political or health jurisdictions. Regional poison information
centers should serve a population base of more than one million people and must receive
at least 10,000 human exposure calls per year.
The number of certified regional centers in the United States is now less than 50.
Certification as a regional center requires the following:
Maintain a 24 hours/day, 365 days/year service.
Provide service to both health care professionals and the public.
Have available in the center at all times at least one specialist in poison information.
Have on call by telephone at all times a medical director or qualified designee.
Readily accessible service by telephone from all areas within the region.
Comprehensive poison information resources and comprehensive toxicology infor-
mation covering both general and specific aspects of acute and chronic poison-
ing should be available.
A list of on-call poison center specialty consultants.
Written operational guidelines that provide a consistent approach to evaluation,
follow-up, and management of toxic exposures should be obtained and main-
tained. These guidelines must be approved in writing by the medical director
of the program.
A staff of certified professionals answering the phones (at least one of the persons
on the phone has to be a pharmacist or nurse with 2000 hours and 2000 cases
of supervised experience).
A 24 hours/day physician (board certified) consultation service.
An ongoing quality assurance program.
Other criteria, determined by the AAPCC and established with membership ap-
proval.
The regional poison information center must be an institutional member in good
standing of the AAPCC. Many hospital emergency rooms still maintain a toxi-
cology reference such as the POISINDEX® system to handle routine exposure
cases, but they rely on regional poison centers to handle most of the calls in
their area.

B. Who Staffs a Poison Center?

The staff of poison centers varies considerably from center to center. The three profes-
sional groups most often involved are physicians, nurses, and pharmacists. Who answers
the phones is somewhat dependent on the local labor pool, moneys available, and the
types of calls being received. Other persons who answer the phone include students in
medically related fields, toxicologists, and biologists. Persons responsible for answering
the phones are either certified by the AAPCC or are in the process of obtaining the certifi-
4 Spoerke

cation. Passage of an extensive examination on toxicology is required for initial certifica-

tion, with periodic recertification required.
Regardless of who takes the initial call, there is a medical director and other physi-
cian backup available. These physicians have specialized training or experience in toxicol-
ogy and are able to provide in-depth consultations for health care professionals calling
the center.
1. Medical Director
A poison center medical director should be board certified in medical toxicology or in
internal medicine, pediatrics, family medicine, or emergency medicine. The medical direc-
tor should be able to demonstrate ongoing interest and expertise in toxicology as evidenced
by publications, research, and meeting attendance. The medical director must have a medi-
cal staff appointment at a comprehensive poison treatment facility and must be involved
in the management of poisoned patients.
2. Managing Director
The managing director must be a registered nurse, pharmacist, or physician, or hold a
degree in a health science discipline. The individual should be certified by the American
Board of Medical Toxicology (for physicians) or by the American Board of Applied Toxi-
cology (for nonphysicians). The director must be able to demonstrate ongoing interest and
expertise in toxicology.
3. Specialists in Poison Information
These individuals must be registered nurses, pharmacists, or physicians, or be certified
by the AAPCC as a specialist in poison information. Specialists in poison information
must complete a training program approved by the medical director and must be certified
by the AAPCC as a specialist in poison information within two examination administra-
tions of their initial eligibility. Specialists not currently certified by the association must
spend an annual average of no less than 16 hours/week in poison center-related activities.
Specialists currently certified by the AAPCC must spend an annual average of no less
than 8 hours/week. Other poison information providers must have sufficient background
to understand and interpret standard poison information resources and to transmit that
information understandably to both health professionals and the public.
4. Consultants
In addition to physicians specializing in toxicology, most centers also have lists of experts
in many other fields as well. Poison center specialty consultants should be qualified by
training or experience to provide sophisticated toxicology or patient care information in
their area(s) of expertise. In regard to seafood or environmental toxins, this would include
specialists in pesticides, heavy metals, botanical exposures, marine toxins, and hydrocar-
bons, just to name a few. These experts should be willing to donate their expertise in
identifying and handling cases within their specialty. Most poison centers do not have the
money to pay a wide variety of consultants.

C. What Types of Calls Are Received?

All types of calls are received by poison centers, most of which are handled immediately,
while others are referred to more appropriate agencies. Which calls are referred depends
The Role of Poison Centers 5

on the center, its expertise, and the appropriateness of a referral. Below are lists of calls
which generally fall into each group Remember, there is considerable variation between
poison centers; if there is doubt, call the poison center and they will tell you if your case
is more appropriately referred. Poison centers do best on calls regarding acute exposures.
Complicated calls regarding exposure to several agents over a long period of time which
produce nonspecific symptoms are often referred to other medical specialists, to the toxi-
cologist associated with the center, or to an appropriate government agency. The poison
center will often follow-up on these cases to track outcome and the type of service given.
Types of calls usually accepted
Drug identification
Actual acute exposure to a drug or chemical
Actual acute exposure to a biological agent (plants, mushrooms, various animals)
Information regarding the toxic potential of an agent
Possible food poisonings (including seafood poisoning)
Exposure to environmental toxins
Types of calls often referred
Questions regarding treatment of a medical condition (not poisoning)
Questions on common bacterial, viral, or parasitic infections
General psychiatric questions
Proper disposal of household agents such as batteries, bleach, insecticides
Use of insecticides (e.g., which insecticide to use, how to use it) unless related
to a health issue (e.g., a person allergic to pyrethrins wanting to know which
product does not contain pyrethrins)
1. Data Collection
Records of all calls/cases handled by the center should be kept in a form that is acceptable
as a medical record. The regional poison information center should submit all its human
exposure data to the association's National Data Collection System. The regional poison
information center shall tabulate its experience for regional program evaluation on at least
an annual basis.
a. AAPCC Toxic Exposure Surveillance System (TESS) In 1983 the AAPCC
formed TESS from the former National Data Collection System. Currently TESS contains
nearly 16.2 million human poison exposure cases. Sixty-five poison centers, representing
181 3 million people, participate in the data collection. The information has various uses
for both governmental agencies and industry, providing data for product reformulations,
repackaging, recall, bans, injury potential, and epidemiology.
The summation of each year's surveillance is published in the late summer or fall
in the American Journal of Emergency Medicine.

D. How Are Calls Handled?

Most poison centers receive requests for information via the telephone. Calls come from
both health care professionals and consumers. Only a few requests are received by mail
or in person, these are often medicolegal or complex cases. Most centers can be reached
by a toll-free phone number in the areas they serve, as well as by a local number. Busy
centers have a single number that rings on several lines. Calls are often direct referrals
from the 911 system.
6 Spoerke

Poison information specialists listen to the caller, recording the history of the case
on a standardized form developed by the AAPCC. Basic information such as the agent
involved, the amount of the agent, time of ingestion, symptoms, previous treatment, and
current condition are recorded, as well as patient information such as sex, age, phone
number, who is with the patient, relevant medical history, and sometimes patient address.
All information is considered a medical record, and is therefore confidential.
The case is evaluated (using various references) as

Information only, no patient involved

Harmless and not requiring follow-up
Slightly toxic, no treatment necessary but a follow-up call is given
Potentially toxic, treatment given at home and follow-up given to case resolution
Potentially toxic, treatment may or may not be given at home, but it is necessary
for the patient to be referred to a medical facility
Emergency, an ambulance and/or paramedics are dispatched to the scene.

Cases are usually followed until symptoms have resolved. In cases where the patient is
referred to a health care facility, the receiving agency is notified. The history is relayed,
toxic potential discussed, and suggestion for treatment given.

E. What References Are Used?

References used also vary from center to center, but virtually all centers use a toxicology
system called POISINDEX® which contains lists of products, their ingredients, and sug-
gestions for treatment. The system is compiled using medical literature and toxicology
specialists throughout the world. Biological products such as plants, insects, mushrooms,
and animal bites etc are handled similarly. There is an entry for each individual plant
containing a description, the toxic agent present, potential toxic amounts, and so forth.
The physician or poison information specialist is then referred to a treatment protocol that
may be for a general class of agents; for example, exposure to malathion is referred to a
protocol on organophosphate pesticides. An unknown skin irritation or potential infection
would deserve a consult with an infectious disease specialist. Questions involving specific
agents, such as lead or mercury, are directed to individual treatment protocols. POISIN-
DEX® is available on microfiche, CD-ROM, over a network, or on a mainframe. It is
updated every 3-months.
Various texts are also used, but much of this information is already in POISIN-
DEX®. It is often difficult to identify some potentially toxic marine animals using a de-
scription given over the phone, so often the assistance of a marine biologist is used. If a
type of marine food poisoning is involved, the help of an infectious disease consultant
and an epidemiologist may be requested. Some poison centers have more experience with
certain types of poisonings than do others, so often one center will consult another. These
are often more complex cases, or cases involving centers in the same region. For example,
a poison center in Utah may consult with one in California or Hawaii concerning a lion-
fish envenomization.
A recent trend has been for manufacturers to contract with one poison center to
provide poison information services for the whole country. Product information is given
The Role of Poison Centers 7

to only that center and exposures throughout the country can only be handled effectively
in that one center.

F. How Are Poison Centers Monitored for Quality?

Most poison centers have a system of peer review in place. One person takes a call, another
reviews it. Periodic spot reviews are done by supervisory and physician staff. General
competence is ensured by certification and recertification via examination of physicians
and poison information specialists.

G. Professional and Public Education Programs

The regional poison information center provides information on the management of poi-
soning to health professionals throughout the region. Public eduction programs aimed at
educating both children and adults about poison safety and potential dangers should be
provided.
In the past, some centers provided stickers or logos such as Officer Ugh, Safety
Sadie, and Mr. Yuck that could be placed on or near potentially toxic substances. While
the intent was to identify potentially toxic substances that children should stay away from,
the practice has been much curtailed because in some cases the stickers actually attracted
children.
Poison prevention week is held each year in the spring. National attention is focused
on the problem of potentially toxic exposures. During this week many centers run special
programs for the public. This may include lectures on prevention, potentially toxic agents
in the home, potentially toxic biological agents, or general first aid methods. Although
an important time for poison centers, public and professional education is a year-round
commitment. Physicians are frequently involved in medical toxicology rounds, journal
clubs, and lectures by specialty consultants. Health fairs, school programs, and various
men's and women's clubs are used to educate the public. The extent of these activities
is often determined by the amount of funding from government, private organizations,
and public donations.

H. Related Toxicology Organizations

ACGIH American Conference of Governmental and Industrial Hygienists
Address: Kemper Woods Center; Cincinnati, OH 45240
Phone: 513-742-2020
FAX: 513-742-3355
ABAT American Board of Applied Toxicology
Address: Truman Medical Center, West, 2301 Holmes St., Kansas City, MO
64108
Phone: 816-556-3112
FAX: 816-881-6282
AACT American Association of Clinical Toxicologists
Address: c/o Medical Toxicology Consultants, Four Columbia Dr., Suite 810,
Tampa, FL 33606
AAPCC American Association of Poison Control Centers
 Spoerke

Address: 3201 New Mexico Ave. NW, Washington, DC 20016

Phone: 202-362-7217
FAX. 202-362-8377
ABEM American Board of Emergency Medicine
Address: 300 Coolidge Rd., East Lansing, MI 48823
Phone: 517-332-4800
FAX. 517-332-2234
ACEP American College of Emergency Physicians (Toxicology Section)
Address: P.O. Box 619911, Dallas, TX 75261-9911
Phone 800-798-1822
FAX: 214-580-2816
ACMT American College of Medical Toxicology (formerly ABMT)
Address: 777 E. Park Dr., P.O. Box 8820, Harrisburg, PA 17105-8820
Phone: 717-558-7846
FAX: 717-558-7841
e-mail: lkoval@pamedsoc.org (Linda L. Koval)
ACOEM American College of Occupational and Environmental Medicine
Address: 55 West Seegers Rd., Arlington Heights, IL 60005
Phone: 708-228-6850
FAX: 708-228-1856
ACS Association of Clinical Scientists
Address: Dept. of Laboratory Medicine, University of Connecticut Medical
School, 263 Farmington Ave., Farmington, CT 06030-2225
Phone: 203-679-2328
FAX: 203-679-2328
ACT American College of Toxicology
Address: 9650 Rockville Pike, Bethesda, MD 20814
Phone: 301-571-1840
FAX: 301-571-1852
AOEC Association of Occupational and Environmental Clinics
Address: 1010 Vermont Ave. NW, #513, Washington, DC 20005
Phone: 202-347-4976
FAX: 202-347-4950
e-mail: Io478x@gwis.circ.gwu.edu
ASCEPT Australian Society of Clinical and Experimental Pharmacologists and
Toxicologists
Address: 145 Macquarie St., Sydney N.S.W 2000 Australia
Phone: 61-2-256-5456
FAX: 61-2-252-3310
BTS British Toxicology Society
Address: MJ Tucker, Zeneca Pharmaceuticals, 22B11 Mareside, Alderley
Park, Macclesfield, Cheshire, SK10 4TG UK
Phone: 0428 65 5041
CAPCC Canadian Association of Poison Control Centers
Address: Hopital Sainte-Justine, 3175 Cote Sainte-Catherine, Montreal, Que-
bec H3T1C5, Canada
Phone: 514-345-4675
FAX: 514-345-4822
Another random document with
no related content on Scribd:
wife, M. Pichon and his American wife, Mr. and Mrs. Madison, and
some other persons whose names were not mentioned. When
dinner was announced, the President offered his hand to Mrs.
Madison and took her to table, placing her on his right. Mme. Yrujo
took her seat on his left.
“Mrs. Merry was placed by Mr. Madison below the Spanish
minister, who sat next to Mrs. Madison. With respect to me,” continued
the British minister in his account of the affair,[267] “I was proceeding
to place myself, though without invitation, next to the wife of the
Spanish minister, when a member of the House of Representatives
passed quickly by me and took the seat, without Mr. Jefferson’s using
any means to prevent it, or taking any care that I might be otherwise
placed....
“I will beg leave to intrude a moment longer on your Lordship’s
time,” continued Merry’s report, “by adding to this narrative that
among the persons (none of those who were of this country were the
principal officers of the government except Mr. Madison) whom the
President selected for a dinner which was understood to be given to
me, was M. Pichon the French chargé d’affaires. I use the word
selected, because it could not be considered as a diplomatic dinner,
since he omitted to invite to it the Danish chargé d’affaires, who, with
the Spanish minister, form the whole body.”
Merry’s report was brief; but Yrujo, who also made an official
report to his Government, after mentioning the neglect shown to
Merry before dinner, added a remark that explained the situation
more exactly:[268]—
“I observed immediately the impression that such a proceeding of
the President must have on Mr. and Mrs. Merry; and their resentment
could not but be increased at seeing the manifest, and in my opinion
studied, preference given by the President throughout to me and my
wife over him and Mrs. Merry.”
There the matter might have rested, had not Madison carried the
new “canons” beyond the point of endurance. December 6, four days
after the dinner at the White House, the British minister was to dine
with the Secretary of State. Pichon and Yrujo were again present,
and all the Cabinet with their wives. Yrujo’s report described the
scene that followed.
 “I should observe,” said he, “that until then my wife and I had
enjoyed in the houses of Cabinet ministers the precedence of which
we had been deprived in the President’s house; but on this day the
Secretary of State too altered his custom, without informing us
beforehand of his resolution, and took to table the wife of the
Secretary of the Treasury. This unexpected conduct produced at first
some confusion, during which the wife of the British minister was left
without any one giving her his hand, until her husband advanced, with
visible indignation, and himself took her to table.”
Even Pichon, though pleased to see the British minister humbled,
felt his diplomatic pride a little scandalized at this proceeding. He
admitted that it was an innovation, and added,—
“There is no doubt that Mr. Madison in this instance wished to
establish in his house the same formality as at the President’s, in
order to make Mr. Merry feel more keenly the scandal he had made;
but this incident increased it.”
The scandal which Merry had made consisted in saying that he
believed his treatment at the White House was a premeditated insult
against his country. Madison’s course took away any remaining
doubt on the subject in his mind. Merry became bitter. He wrote
home informally:[269]—
“On this occasion, also, the pas and the preference in every
respect was taken by, and given to, the wives of the Secretaries of the
Departments (a set of beings as little without the manners as without
the appearance of gentlewomen), the foreign ministers and their wives
being left to take care of themselves. In short the latter are now placed
here in a situation so degrading to the countries they represent, and
so personally disagreeable to themselves, as to have become almost
intolerable. The case yesterday was so marked and so irritating that I
determined to hand Mrs. Merry myself to the table, and to place
ourselves wherever we might conveniently find seats.”

Merry then received an official explanation that Jefferson

invariably gave precedence to the wives of his Cabinet ministers,
and that he made no exceptions in favor of foreigners in his rule of
pêle-mêle.[270] Merry notified Lord Hawkesbury to that effect. He did
not fail to point out the signs which indicated to him that these
proceedings were but part of a general plan intended to press on the
British government. In truth, the whole issue lay in the question
whether that intent influenced Jefferson’s behavior.
A sort of civil war ensued in the little society of Washington, in
which the women took prominent part, and Mrs. Merry gave back
with interest the insults she considered herself to have received. The
first serious evil was an alliance between Merry and Yrujo, the two
men whom Jefferson had most interest in keeping apart. Pichon
wrote home a lively account of the hostilities that followed.[271]
“M. Yrujo, who is vanity itself, blew the flame more vigorously than
ever.... He concerted reprisals with Mr. Merry, and it was agreed that
whenever they should entertain the secretaries and their wives, they
should take none of them to table, but should give their hands to their
own wives. This resolution was carried out at a dinner given some
days afterward by M. Yrujo. Mr. and Mrs. Merry were next invited by
the Secretary of the Navy. Mrs. Merry refused; yet this minister, a very
well-bred man (homme fort poli), had so arranged things as to give
her his hand. Apparently what had taken place at Mr. Madison’s was
thought harsh (dur), and it was wished to bring Mr. and Mrs. Merry
back to a reconciliation. The Cabinet took up the question, as reported
in the newspaper of which I sent you an extract, and it was resolved
that hereafter the President should give his hand to the lady who
might happen to be nearest him, and that there should be no
precedence. Mr. Merry was invited to a tea by the Secretary of War
and by the Secretary of the Treasury. To avoid all discussion he wholly
refused the first, and after accepting the second he did not come.
Finally, New Year’s Day gave another occasion for scandal. On this
day, as on the Fourth of July, it is the custom to call upon the
President; and even the ladies go there. This year neither Mme. Yrujo
nor Mrs. Merry went, and the Marquis took care to answer every one
who inquired after his wife’s health, that she was perfectly well. Since
then Washington society is turned upside down; all the women are to
the last degree exasperated against Mrs. Merry; the Federal
newspapers have taken up the matter, and increased the irritation by
sarcasms on the Administration and by making a burlesque of the
facts which the Government has not thought proper to correct. The
arrival of M. Bonaparte with his wife in the midst of all this explosion
has furnished Mr. Merry with new griefs. The President asked M. and
Mme. Bonaparte to dinner, and gave his hand to Madame. There was,
however, this difference between the two cases,—the President had
invited on this day, besides myself and Mme. Pichon, only the two
 Messrs. Smith and their wives, who are of Mme. Bonaparte’s family.
But when Mr. Merry heard of it, he remarked that Mme. Bonaparte had
on this occasion taken precedence of the wife of the Secretary of the
Navy.... I am aware,” continued the delighted Pichon, “that with tact on
the part of Mr. Jefferson he might have avoided all these scandals.”
The British minister wrote to Lord Hawkesbury a brief account of
his reception, closing with the remark:[272]—
“Under these circumstances, my Lord, I have thought it advisable
to avoid all occasions where I and my wife might be exposed to a
repetition of the same want of distinction toward us until I shall have
received authority from you to acquiesce in it, by a signification of his
Majesty’s pleasure to that effect.”
Accordingly, when the President invited the two ministers to dine
at the White House without their wives, they replied that they could
not accept the invitation until after receiving instructions from their
Governments. Jefferson regarded this concerted answer as an
insult.[273] He too lost his temper so far as to indulge in sharp
comments, and thought the matter important enough to call for
explanation. In a private letter to Monroe, dated Jan. 8, 1804, he
wrote:[274]—
“Mr. Merry is with us, and we believe him to be personally as
desirable a character as could have been sent us; but he is unluckily
associated with one of an opposite character in every point. She has
already disturbed our harmony extremely. He began by claiming the
first visit from the national ministers. He corrected himself in this; but a
pretension to take precedence at dinner, etc., over all others is
persevered in. We have told him that the principle of society as well as
of government with us is the equality of the individuals composing it;
that no man here would come to a dinner where he was to be marked
with inferiority to any other; that we might as well attempt to force our
principle of equality at St. James’s as he his principle of precedence
here. I had been in the habit when I invited female company (having
no lady in my family) to ask one of the ladies of the four Secretaries to
come and take care of my company, and as she was to do the honors
of the table I handed her to dinner myself. That Mr. Merry might not
construe this as giving them a precedence over Mrs. Merry I have
discontinued it, and here as in private houses the pêle-mêle practice
is adhered to. They have got Yrujo to take a zealous part in the claim
of precedence. It has excited generally emotions of great contempt
 and indignation (in which the members of the Legislature participate
sensibly) that the agents of foreign nations should assume to dictate
to us what shall be the laws of our society. The consequence will be
that Mr. and Mrs. Merry will put themselves into Coventry, and that he
will lose the best half of his usefulness to his nation,—that derived
from a perfectly familiar and private intercourse with the Secretaries
and myself. The latter, be assured, is a virago, and in the short course
of a few weeks has established a degree of dislike among all classes
which one would have thought impossible in so short a time.... With
respect to Merry, he appears so reasonable and good a man that I
should be sorry to lose him as long as there remains a possibility of
reclaiming him to the exercise of his own dispositions. If his wife
perseveres she must eat her soup at home, and we shall endeavor to
draw him into society as if she did not exist.”
Of all American hospitality none was so justly famous as that of
Virginia. In this State there was probably not a white man, or even a
negro slave, but would have resented the charge that he was
capable of asking a stranger, a foreigner, a woman, under his roof,
with the knowledge that he was about to inflict what the guest would
feel as a humiliation. Still less would he have selected his guest’s
only enemy, and urged him to be present for the purpose of
witnessing the slight. Reasons of state sometimes gave occasion for
such practices, but under the most favorable conditions the tactics
were unsafe. Napoleon in the height of his power insulted queens,
browbeat ambassadors, trampled on his ministers, and made his
wife and servants tremble; but although these manners could at his
slightest hint be imitated by a million soldiers, until Europe, from
Cadiz to Moscow, cowered under his multiplied brutality, the insults
and outrages recoiled upon him in the end. Jefferson could not afford
to adopt Napoleonic habits. His soldiers were three thousand in
number, and his own training had not been that of a successful
general; he had seven frigates, and was eager to lay them up in a
single dry-dock. Peace was his passion.
To complicate this civil war in the little society of Washington,
Jerome Bonaparte appeared there, and brought with him his young
wife, Elizabeth Patterson, of Baltimore. Jerome married this beautiful
girl against the remonstrances of Pichon; but after the marriage took
place, not only Pichon, but also Yrujo and Jefferson, showed proper
attention to the First Consul’s brother, who had selected for his wife
a niece of the Secretary of the Navy, and of so influential a senator
as General Smith. Yet nothing irritated Napoleon more than Jerome’s
marriage. In some respects it was even more objectionable to him
than that of Lucien, which gave rise to a family feud. Pichon
suspected what would be the First Consul’s feelings, and wrote letter
after letter to clear himself of blame. In doing so he could not but
excite Napoleon’s anger against American society, and especially
against the family of his new sister-in-law.
“It appears, Citizen Minister,” wrote Pichon to Talleyrand,[275] “that
General Smith, who in spite of the contrary assurances he has given
me, has always had this alliance much at heart, has thrown his eyes
on the mission to Paris as a means of appeasing (ramener) the First
Consul. He has long since aimed at the diplomatic career, for which
he is little qualified; this motive and the near return of Mr. Livingston
have decided his taste. For some time there has been much question
of this nomination among the friends of General Smith. There is also
question of promoting, on the part of the First Consul, for minister to
this country, a selection which should be connected with the other. It is
thought that the appointment of M. Jerome Bonaparte would be an
honorable mode of leaving the First Consul’s brother time to have his
fault forgotten, and of preparing his return to favor.”
Such readiness among Jefferson’s advisers to court the favors of
the young First Consul was sure not to escape the eyes of the
embittered Federalists. Pichon’s account, although sharp in allusions
to General Smith’s “vanity,” was mild compared with the scorn of the
New Englanders. Apparently the new matrimonial alliance was taken
seriously by prominent Republican leaders. One of the
Massachusetts senators mentioned in his diary[276] a “curious
conversation between S. Smith, Breckenridge, Armstrong, and
Baldwin, about ‘Smith’s nephew, the First Consul’s brother.’ Smith
swells upon it to very extraordinary dimensions.” Pichon openly
spoke of the whole family connection, including both Robert and
Samuel Smith, and even Wilson Cary Nicholas, as possessed with
“an inconceivable infatuation” for the match; “it was really the young
man who was seduced.” Nothing that Pichon could say affected
them. Senator J. Q. Adams remarked: “the Smiths are so elated with
their supposed elevation by this adventure, that one step more would
fit them for the discipline of Dr. Willis,”—the famous English expert in
mental diseases.[277]
The President and his friends might not know enough of
Napoleon’s character to foresee the irritation which such reports
would create in his mind, but they were aware of the contrast
between their treatment of Jerome Bonaparte and their slights to
Anthony Merry. Had they felt any doubt upon the subject, the free
comments of the British minister and his wife would have opened
their eyes. In truth, no doubt existed. Washington society was in a
manner ordered to proscribe the Merrys and Yrujo, and pay court to
Jerome and the Smiths.
Had this been all, the matter would have ended in a personal
quarrel between the two envoys and the two Virginians, with which
the public would have had no concern. Jefferson’s “canons of
etiquette” would in such a case have had no further importance than
as an anecdote of his social habits. The seriousness of Jefferson’s
experiments in etiquette consisted in the belief that they were part of
a political system which involved a sudden change of policy toward
two great Powers. The “canons” were but the social expression of an
altered feeling which found its political expression in acts marked by
equal disregard of usage. The Spanish minister had already reason
to know what he might expect; for six weeks before Merry’s dinners
John Randolph proclaimed in the House that West Florida belonged
to the United States, and within the week that preceded Merry’s
reception, he brought in the Bill which authorized the President to
annex Mobile. After such a proceeding, no diplomatist would have
doubted what meaning to put upon the new code of Republican
society. Merry’s arrival, at the instant of this aggression upon Spain,
was the signal for taking toward England a higher tone.
Merry could not fail to see what lay before him. From the
President, notwithstanding heelless slippers and “canons of
etiquette,” the British minister heard none but friendly words. After
the formal ceremony of delivering the letter of credence was over,—
“He desired me to sit down,” wrote Merry,[278] “when we
conversed for some time on general affairs. The sentiments which he
 expressed respecting those of Europe appeared very properly to be
by no means favorable to the spirit of ambition and aggrandizement of
the present ruler in France, or to the personal character in any respect
of the First Consul, and still less so to his conduct toward all nations.”
From this subject the President passed to Spanish affairs and to
the Spanish protest against the Louisiana cession, founded on
Bonaparte’s pledge never to alienate that province.
“This circumstance,” continued Merry, “as well as the resistance
altogether which Spain had unexpectedly brought forward in words,
Mr. Jefferson considered as highly ridiculous, and as showing a very
pitiful conduct on her part, since she did not appear to have taken any
measures to support it either by preparation of defence on the spot, or
by sending there a force to endeavor to prevent the occupation of the
country by the troops of the United States. He concluded by saying
that possession of it would, at all events, be taken.”
If Merry did not contrive, after his dinner at the White House, to
impart this conversation to his colleagues Yrujo and Pichon, he must
have been a man remarkably free from malice. Meanwhile he had
his own affairs to manage, and Madison was not so forbearing as the
President. Merry’s first despatch announced to his Government that
Madison had already raised his tone. Without delay the matter of
impressments was brought into prominence. The “pretended”
blockade of Martinique and Guadeloupe was also strongly
characterized.
“It is proper for me to notice,” said Merry in his report of these
remonstrances,[279] “that Mr. Madison gave great weight to them by
renewing them on every occasion of my seeing him, and by his
expressing that they were matters upon which this Government could
not possibly be silent until a proper remedy for the evil should be
applied by his Majesty’s government. His observations were, however,
made with great temper, and accompanied with the strongest
assurances of the disposition of this Government to conciliate, and to
concur in whatever means could be devised which should not be
absolutely derogatory to their independence and interests, to establish
principles and rules which should be satisfactory to both parties....
But, my Lord, while it is my duty to do justice to Mr. Madison’s
temperate and conciliatory language, I must not omit to observe that it
indicated strongly a design on the part of this Government to avail
themselves of the present conjuncture by persisting steadily in their
 demands of redress of their pretended grievances, in the hope of
obtaining a greater respect to their flag, and of establishing a more
convenient system of neutral navigation than the interests of the
British empire have hitherto allowed his Majesty to concur in.”
The British government was aware that its so-called right of
impressment and its doctrine of blockade rested on force, and could
not be maintained against superior force; but this consciousness
rendered England only the more sensitive in regard to dangers that
threatened her supremacy. Knowing that the United States would be
justified in declaring war at any moment, Great Britain looked
uneasily for the first symptoms of retaliation. When Madison took so
earnest a tone, Merry might reasonably expect that his words would
be followed by acts.
These shocks were not all that the new British minister was
obliged to meet at the threshold of his residence in Washington. At
the moment when he was, as he thought, socially maltreated, and
when he was told by Madison that America meant to insist on her
neutral rights, he learned that the Government did not intend to ratify
Rufus King’s boundary convention. The Senate held that the
stipulations of its fifth article respecting the Mississippi might
embarrass the new territory west of the river. King knew of the
Louisiana cession when he signed the treaty; but the Senate had its
own views on the subject, and under the lead of General Smith[280]
preferred to follow them, as it had done in regard to the second
article of the treaty with France, Sept. 30, 1800, and as it was about
to do in regard to Pinckney’s claims convention, Aug. 11, 1802, with
Spain. Merry was surprised to find that Madison, instead of
explaining the grounds of the Senate’s hesitation, or entering into
discussion of the precise geographical difficulty, contented himself
with a bald statement of the fact. The British minister thought that
this was not the most courteous way of dealing with a treaty
negotiated after a full acquaintance with all the circumstances, and
he wrote to his Government to be on its guard:[281]—
“Notwithstanding Mr. Madison’s assurances to the contrary, I have
some reason to suspect that ideas of encroachment on his Majesty’s
just rights are entertained by some persons who have a voice in
 deciding upon the question of the ratification of this convention, not to
say that I have much occasion to observe, from circumstances in
general, that there exists here a strong impression of the
consequence which this country is supposed to have acquired by the
recent additions to the territory of the United States, as well as by the
actual situation of affairs in Europe.”
In view of the Mobile Act, introduced into Congress by Randolph
on behalf of the government a week before this letter was written,
Merry’s suspicions could hardly be called unreasonable. A like
stretch of authority applied to the northwest territory would have
produced startling results.
Merry’s suspicions that some assault was to be made upon
England were strengthened when Madison, December 5, in
pursuance of a call from the Senate, sent a list of impressments
reported to the Department during the last year. According to this
paper the whole number of impressments was forty-six,—three of
which were made by France and her allies; while of the forty-three
made by Great Britain twenty-seven of the seamen were not
American citizens. Of the entire number, twelve were stated to have
had American papers; and of the twelve, nearly half were impressed
on land within British jurisdiction. The grievance, serious as it was,
had not as yet reached proportions greater than before the Peace of
Amiens. Merry drew the inference that Jefferson’s administration
meant to adopt stronger measures than had hitherto been thought
necessary. He soon began to see the scope which the new policy
was to take.
Dec. 22, 1803, Madison opened in a formal conference the
diplomatic scheme which was the outcome of these preliminary
movements.[282] Beginning with a repetition of complaints in regard
to impressments, and dwelling upon the great irritation created by
such arbitrary acts, the secretary next remonstrated against the
extent given to the law of blockade by British cruisers in the West
Indies, and at length announced that the frequent repetition of these
grievances had rendered it necessary for the United States to take
immediate steps to find a remedy for them. Instructions would
therefore be shortly sent to Monroe at London to negotiate a new
convention on these subjects. The American government would wish
that its flag should give complete protection to whatever persons
might be under it, excepting only military enemies of the belligerent.
Further, it would propose that the right of visiting ships at sea should
be restrained; that the right of blockade should be more strictly
defined, and American ships be allowed, in consideration of the
distance, to clear for blockaded ports on the chance of the blockade
being removed before they arrived; and finally that the direct trade
between the West Indies and Europe should be thrown open to
American commerce without requiring it to pass through a port of the
United States.
In return Madison offered to the British government the
unconditional surrender of deserters by sea and land, together with
certain precautions against the smuggling of articles contraband of
war.
Although Madison pressed the necessity of an immediate
understanding on these points, he did so in his usual temperate and
conciliatory manner; while Merry frankly avowed that he could give
no hopes of such propositions being listened to. He did this the more
decisively because Congress seemed about to take the matter of
impressments into its own hands, and was already debating a Bill for
the protection of seamen by measures which tended to hostilities.
Madison disavowed responsibility for the legislation, although he
defended it in principle.[283] Merry contented himself for the time by
saying that if the United States government sought their remedy in
municipal law, the matter would immediately cease to be a subject of
negotiation.
Thus, in one short month, the two governments were brought to
what the British minister supposed to be the verge of rupture. That
any government should take so well-considered a position without
meaning to support it by acts, was not probable. Acts of some kind,
more or less hostile in their nature, were certainly intended by the
United States government in case Great Britain should persist in
contempt for neutral rights; the sudden change of tone at
Washington left no doubt on this point. Edward Thornton, who had
not yet been transferred to another post, wrote in consternation to
the Foreign Office, fearing that blame might be attached to his own
conduct while in charge of the legation:[284]—
“When I compare the complexion of Mr. Merry’s correspondence
with that of my own, particularly during the course of the last summer,
before the intelligence of the Louisiana purchase reached this country,
I can scarcely credit the testimony of my own senses in examining the
turn which affairs have taken, and the manifest ill-will discovered
toward us by the Government at the present moment.... I believe that
the simple truth of the case is, after all, the circumstance ... that a real
change has taken place in the views of this Government, which may
be dated from the first arrival of the intelligence relative to the
Louisiana purchase, and which has since derived additional force and
acrimony from the opinion that Great Britain cannot resist, under her
present pressure, the new claims of the United States, and now, from
the necessity they are under of recurring to the influence of France in
order to support their demands against Spain.... The cession of
Louisiana, notwithstanding that the circumstances under which it was
made ought to convince the vainest of men that he was not the sole
agent in the transaction, has elevated the President beyond
imagination in his own opinion; and I have no doubt that he thinks of
securing himself at the next election by having to boast of
concessions and advantages derived from us, similar to those he has
gained from France,—that is, great in appearance, and at a
comparatively insignificant expense.”
From such premises, the conclusion, so far as concerned
England, was inevitable; and Thornton agreed with Merry in affirming
it without reserve:—
“Everything, as it relates to this government, now depends on our
firmness. If we yield an iota without a real and perfect equivalent (not
such imaginary equivalents as Mr. Madison mentions to Mr. Merry),
we are lost.”
 CHAPTER XVII.
Whatever objects the President and the Secretary of State may
have expected to gain by their change of tone in the winter of 1803–
1804 toward Spain and England, they must have been strangely free
from human passions if they were unconscious of making at least
two personal enemies upon whose ill-will they might count. If they
were unaware of giving their victims cause for bitterness,—or if, as
seemed more probable, they were indifferent to it,—the frequent
chances of retaliation which the two ministers enjoyed soon showed
that in diplomacy revenge was not only sweet but easy. Even the
vehement Spanish hatred felt by Yrujo for Madison fell short of the
patient Anglo-Saxon antipathy rooted in the minds of the British
minister and his wife. When Yrujo, in March, 1804, burst into the
State Department with the Mobile Act in his hand and denounced
Madison to his face as party to an “infamous libel,” he succeeded in
greatly annoying the secretary without violating Jefferson’s “canons
of etiquette.” Under the code of republican manners which the
President and his secretary had introduced, they could not fairly
object to anything which Yrujo might choose to say or do. Absolute
equality and “the rule of pêle-mêle” reached their natural conclusion
between such hosts and guests in freedom of language and
vehemence of passion. What might have been Merry’s feelings or
conduct had he met with more cordiality and courtesy was uncertain;
but the mortifications of his first month at Washington embittered his
temper, and left distinct marks of acrimony in the diplomacy of
America and England, until war wiped out the memory of reciprocal
annoyances. The Spaniard’s enmity was already a peril to Madison’s
ambition, and one which became more threatening every day; but
the Englishman’s steady resentment was perhaps more
mischievous, if less noisy. The first effect of Jefferson’s tactics was to
ally the British minister with Yrujo; the second bound him to Senator
Pickering and Representative Griswold; the third united his fortunes
with those of Aaron Burr. Merry entered the path of secret
conspiracy; he became the confidant of all the intriguers in
Washington, and gave to their intrigues the support of his official
influence.
The Federalists worked mischievously to widen the breach
between the British minister and the President. They encouraged
Merry’s resentment. Late in January, nearly two months after the first
pêle-mêle, Madison officially informed Merry for the first time that the
President meant to recognize no precedence between foreign
ministers, but that all, even including secretaries of legation in
charge, were to be treated with perfect equality, or what Madison
termed “a complete pell-mell,” and would be received, even at their
first audience, with no more ceremony than was practised toward
any other individual. Merry replied that this notice should have been
given to him on his arrival, and that he could not acquiesce in it
without instructions. He then wrote to his Government,[285]—
“I have now but too much reason to fear, what I did not at first
suspect, that the marked inattention toward me of the present
Administration of this country has been a part of their unfriendly
disposition toward his Majesty and toward the nation which I have the
honor to represent.”
At the same moment, in January and February, 1804, Pickering
and Griswold were plotting their New England confederacy. Merry
was taken by them into the secret, and gave them aid. The Senate,
February 9, voted to strike out the fifth article of Rufus King’s
boundary convention, and to approve the other articles, which
provided for fixing the disputed boundary-line of Maine, New
Hampshire, and Vermont. Merry wrote to his Government that the
object of cancelling the fifth article was to deprive Great Britain of her
treaty-right to navigate the Mississippi:[286]—
“It is hardly necessary for me to point out to your Lordship that the
other articles of the convention are of great importance to the Eastern
States of America, which are much interested in the immediate
settlement of the eastern boundary. I am led to believe from the
language of some of the members of this State [Massachusetts] that
their anxiety on this head is so great that the rejection of those articles
by his Majesty would, as having been occasioned by the exclusion on
the part of this government of the fifth article, prove to be a great
exciting cause to them to go forward rapidly in the steps which they
 have already commenced toward a separation from the Southern part
of the Union. The members of the Senate have availed themselves of
the opportunity of their being collected here to hold private meetings
on this subject, and I learn from them that their plans and calculations
respecting the event have been long seriously resolved. They think
that whenever it shall take place it will happen suddenly, yet with
quietness and the universal concurrence of the people. Although it
does not appear to be their opinion that any external secret agency
would accelerate the moment, they naturally look forward to Great
Britain for support and assistance whenever the occasion shall arrive.”
As the summer of 1804 came on, Merry’s despatches grew more
sombre. He reported that at Norfolk twelve British ships were
detained at one time in consequence of the desertion of their
seamen, several of whom had entered the United States service on
the frigates which were under orders for Tripoli. Six British seamen
having deserted at Charleston and re-enlisted in the same way,
Merry remonstrated. He was told that the seamen, having voluntarily
enlisted in the United States service, could not be restored, because
the British government never restored American seamen who had
voluntarily enlisted. Merry could only reply that the British
government did not knowingly enlist deserters. On the other hand,
Madison remonstrated in “high language,” “accompanied even with
some degree of menace,” against the conduct of Captain Bradley of
the frigate “Cambrian,” one of the British squadron cruising off Sandy
Hook, for taking a British seaman out of a British vessel within
American jurisdiction. Merry added that in contrast to this strictness
toward England the authorities had allowed the officers of the French
frigate “La Poursuivante,” at Baltimore, to send armed parties on
shore at night for the purpose of seizing French seamen, one of
whom they had actually taken by force from a Spanish vessel lying
at the wharf.
“From this government having brought into such serious
discussion objects which would certainly have passed unnoticed had
they occurred in relation to the King’s enemies, his Majesty’s ministers
may be led to suspect that such a resolution has been dictated by
some hostile design,” wrote Merry, with increasing solemnity; “but it is
proper for me to observe that ... I cannot persuade myself that they
 will dare to provoke hostilities with his Majesty, at least before Mr.
Jefferson’s re-election to the Presidency shall have taken place.”[287]
Merry made a representation to Madison on impressments; but
his arguments did not satisfy the secretary. “This specimen of Merry
shows him to be a mere diplomatic pettifogger,” wrote Madison
privately to the President.[288]
Merry’s temper was in this stage of ever-increasing irritability,
when an event occurred which gave him, as it seemed, a chance to
gratify his resentments. After the adjournment of Congress in March
the British minister heard nothing from Pickering and Griswold. Early
in June he wrote home that the democrats were carrying all the
elections:[289]—
“In addition to this triumph of the reigning party, there have lately
appeared in the prints of this country, which are generally made the
instruments of the measures of all parties, publications of the
discovery that has been made of secret meetings held at this place by
some of the Federal members during the last sitting of Congress for
the purpose of consulting upon the important point of the separation of
the Eastern from the Southern States, which publications seem to
have imposed a complete silence upon the Federal adherents.”
A few weeks afterward, July 11, occurred the duel between Burr
and Hamilton. Merry had no relations with Hamilton, and felt no
peculiar interest in his fate; but he had become intimate with Burr at
Washington, and watched his career with the curiosity which was the
natural result of their common hatred of Jefferson. July 21 Burr fled
from New York, and a few days afterward reached Philadelphia,
where Merry was passing the summer. While there, Burr sent one of
his friends—an Englishman named Williamson—to the British
minister with a startling message, which Merry immediately
transmitted to his Government:[290]—
“I have just received an offer from Mr. Burr, the actual Vice-
President of the United States (which situation he is about to resign),
to lend his assistance to his Majesty’s government in any manner in
which they may think fit to employ him, particularly in endeavoring to
effect a separation of the western part of the United States from that
which lies between the Atlantic and the mountains, in its whole extent.
 His proposition on this and other subjects will be fully detailed to your
Lordship by Colonel Williamson, who has been the bearer of them to
me, and who will embark for England in a few days. It is therefore only
necessary for me to add that if after what is generally known of the
profligacy of Mr. Burr’s character, his Majesty’s minister should think
proper to listen to his offer, his present situation in this country, where
he is now cast off as much by the democratic as by the Federal party,
and where he still preserves connections with some people of
influence, added to his great ambition and spirit of revenge against the
present Administration, may possibly induce him to exert the talents
and activity which he possesses with fidelity to his employers.”
Meanwhile a change of ministry occurred in England. Pitt
returned to power, representing a state of feeling toward America
very different from that which prevailed under the mild rule of
Addington. Subordinates were quick to feel such changes in the
temper of their superiors. Every British officer knew that henceforth
he had behind him an energetic government, which required
vigorous action in maintaining what it claimed as British rights. Merry
felt the new impulse like the rest; but Pitt’s return acted most
seriously on the naval service. After the renewal of the war in May,
1803, a small British squadron cruised off Sandy Hook, keeping a
sharp look-out for French frigates in New York Harbor, and searching
every merchant-vessel for enemy’s property. During the summer of
1804 this annoyance became steadily greater, until the port of New
York was almost blockaded, and every vessel that sailed out or in
was liable not only to be stopped and searched, but to lose some
part of its crew by impressment. The British ministry did indeed
instantly recall Captain Bradley of the “Cambrian” for violating
American jurisdiction, and gave strict orders for the lenient exercise
of belligerent rights; but all the more it showed the intention of
insisting upon the submission of America to such rules as England
should prescribe. The President, already in trouble with Spain,
began to feel the double peril; but Congress pressed him forward,
and even while busy with the trial of Judge Chase it found time for
two measures which greatly disturbed the British envoy.
The first of these measures was an “Act for the more effectual
preservation of peace in the ports and harbors of the United States.”
Under this law any United States marshal, on the warrant of any
United States judge, was bound to board any British or other foreign
ship-of-war lying in American waters, and seize every person
charged with having violated the peace. If the marshal should be
resisted, or if surrender was not made, he must call in the military
power, and compel surrender by force of arms. If death should
ensue, he should be held blameless; but the resisting party should
be punished as for felonious homicide. Further, the President was
authorized to interdict at will the ports of the United States to all or
any armed vessels of a foreign nation; and to arrest and indict any
foreign officer who should come within the jurisdiction after
committing on the high seas “any trespass or tort, or any spoliation,
on board any vessel of the United States, or any unlawful
interruption or vexation of trading-vessels actually coming to or going
from the United States.”
Such laws were commonly understood in diplomacy as removing
the subject in question from the field of negotiation, preliminary to
reprisals and war. The Act was passed with little debate in the last
hours of the session, in the midst of the confusion which followed the
acquittal of Judge Chase. Merry immediately called on the Secretary
of State, and asked him for some assurance that might serve to quiet
the apprehensions which his Government would feel on reading the
Act.[291] Madison could give none, except that the President would
probably not exercise for the present his discretionary powers. As for
the words, “any trespass or tort,” Madison frankly avowed “he could
not but confess they were meant to imply the impressment of any
individual whatsoever from on board an American vessel, the
exercise of which pretended right on the part of his Majesty’s officers
was a matter, he said, which the sense of the people at large would
never allow the government of this country to acquiesce in.”
To this announcement Merry replied in substance that the right
was one which would certainly never be abandoned by his
Government; and there the matter rested at the close of Jefferson’s
first term. Madison assured the British minister that the authority
granted to the President by Congress over foreign ships of war in
American waters would not at present be enforced. He went even a
step further toward conciliation. The Legislature of Virginia was
induced quietly to modify the Act which had hitherto offered so much
encouragement to the desertion of British seamen.[292]
The second threatening measure was a Resolution of the
Senate, March 2, 1805, calling upon the Secretary of State for such
Acts of the British Parliament as imposed heavier duties on the
exportation of merchandise to the United States than on similar
goods exported to the nations of Europe. Such an export duty upon
merchandise for the United States and the West Indies had in fact
been imposed by Parliament some two years before; and this
Resolution foreshadowed some commercial retaliation by Congress.
While sending to his Government these warnings to expect from
Jefferson’s second administration a degree of hostility more active
than from the first, Merry suggested means of giving the United
States occupation that should induce them to leave England alone. A
new element of conspiracy disclosed itself to the British minister.
Under the Louisiana treaty of cession, the United States
government had promised that “the inhabitants of the ceded territory
shall be incorporated in the Union of the United States, and admitted
as soon as possible, according to the principles of the Federal
Constitution, to the enjoyment of all the rights, advantages, and
immunities of citizens of the United States.” This pledge had been
broken. The usual display of casuistry had been made to prove that
the infraction of treaty was no infraction at all; but the more
outspoken Republicans avowed, as has been already shown, that
the people of Louisiana could not be trusted, or in the commoner
phrase that they were unfit for self-government, and must be treated
as a conquered race until they learned to consider themselves
American citizens.
The people of New Orleans finding themselves in a position of
dependence, which, owing chiefly to their hatred of Governor
Claiborne, seemed more irritating than their old Spanish servitude,
sent three representatives to Washington to urge upon Congress the
duty of executing the treaty. Messieurs Sauvé, Derbigny, and
Destréhan accordingly appeared at Washington, and in December,
1804, presented a remonstrance so strong that Government was