July 12, 2025 • 36 mins
This 2020 episode examines how the U.S. got to the point of having one resource, specifically for poisoning, that’s so reliable and available that it gets printed on the labels of consumer products.
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Speaker 1 (00:02):
Happy Saturday. In our behind the scenes episode yesterday, we
mentioned our prior episode on poison Control, so we're bringing
that out us Today's Saturday Classic. This episode originally came
out on March twenty fifth, twenty twenty. Enjoy Welcome to
Stuff You Missed in History Class, a production of iHeartRadio. Hello,
(00:31):
and welcome to the podcast. I'm Tracy V. Wilson and
I'm Holly Prye. In case you've never heard our show before,
this is episode two of us recording the show with
everyone involved in the process in their own homes because
of the current pandemic and resulting quarantine slash shelter in
(00:54):
place slash self isolation slash social distancing instructions we have
all been under. Yeah, So if you're a longtime listener
and you're like, why doesn't this sound quite the same,
that's why. If you're brand new, that's just a heads up.
That's where we are right now. And we coincidentally have
a medical history week that we did not plan that
just happens to be falling in line with all of this.
(01:17):
So the other day it was time to give our
kittens their flea and tick prevention and then afterward I
was idly reading the back of the box while I
was washing my hands, and I noticed that it said
to contact poison control if swallowed, And at first I thought,
why not just print what to do on the box
instead of directing people to call poison control? But then
(01:37):
I was like, where did poison control even come from?
How did we get to the point of having this
one resource specifically for poisoning that's so reliable and available
that companies can print it on the labels of consumer products,
and especially here in the US where Holly and I are.
This is a healthcare service that is staffed twenty four
(01:59):
to seven and of and accessible to everyone for free,
which is not a thing that exists in many other contexts.
I mean, there are some other twenty four hour hotlines,
but like, it's not often that anybody, literally anyone can
call a medical professional twenty four hours a day and
get an answer for free. The first service like this
was established in the Netherlands in nineteen forty nine, and
(02:21):
today they exist in a lot of countries around the world,
particularly in the Americas, Western Europe, and parts of the
Middle East. According to the World Health Organization, forty seven
percent of member states have a poison center of some sort.
But because the development of poison control centers in the
US closely parallels some other shifts in American history, that's
(02:42):
really where we're focusing on with this story today. So
you can really define the word poisoning in a lot
of different ways, but in general, it is any toxin
related injury. The toxin can come from all kinds of sources,
cleaning products, medications, mushrooms out in the yard, and things
that we actually think of poisons, like insecticides and rat poisons.
(03:05):
Sometimes people describe being envenomed from something like a snake
bite or insect sting. Also is being poisoned that a
lot of cases, exposure to a small amount of one
of these substances isn't really dangerous, and when it's something
like medicine, that can be helpful rather than harmful, but
in large enough amounts, otherwise harmless or even beneficial substances
(03:26):
can become lethal. To be clear, we also use terms
like sun poisoning and food poisoning, but that's not really
what we're talking about here. Sun poisoning is actually a
severe type of sunburn, and in most cases, food poisoning
is an illness that's caused by a pathogen like salmonella
or Schagella bacteria. There are food borne illnesses that involve
(03:48):
pathogens that can produce toxins, and foods can be contaminated
with toxic substances. But most of the time, when we
say food poisoning, we're actually talking about an illness, not
a poison that some and put in your food. People
have been exposed to poisons, of course, throughout human history.
There are toxic plants and fungi and metals all over
(04:09):
the world. Most places have at least some species of
venomous animals. People have also done things like making their
drinking vessels or makeup out of toxic metals like lead,
but household toxins really started to proliferate with industrialization. Over time,
people's most likely sources of poisoning shifted from things like
(04:30):
berries that they had gathered to eat to things like
cleaning products and pharmaceuticals. In some parts of the world,
governments passed laws to try to protect people from the
most potentially dangerous products starting in the nineteenth century. For example,
in the UK, the eighteen sixty eight Pharmacy Act restricted
the sale of a specific set of poisons. Only licensed
(04:53):
pharmacists could sell them, and they had to keep a
careful record of every sale. There was not a simil
federal law in the US, but between eighteen seventy and
eighteen ninety thirty three states adopted some kind of regulation
on the sale of poisons at the federal level. The
first bills were introduced into Congress in eighteen seventy nine,
(05:14):
but broad legislation didn't come along until much later. Manufacturers
also recognized the potential dangers involved with the products that
they were making. Starting in the late eighteenth and early
nineteenth centuries, manufacturers of things like rat poisons packaged their
products in distinctively shaped bottles, marked with things like skulls
and crossbones and the word poison. To try to prevent accidents.
(05:38):
Manufacturers also used textured glass bottles so that people could
tell what they were holding just by touch, and they
also developed safety caps. Most of these innovations weren't being
used on products that were being sold directly to consumers, though,
they were being used on products that would be repackaged
at a pharmacy or another store. So the idea was
(05:59):
to keep the ruggists from selling somebody something dangerous by accident,
not to prevent the consumer at home from accidentally hurting
themselves or someone else. By the middle of the nineteenth century,
the American Pharmaceutical Association and American Medical Association had each
passed resolutions recommending clearer labeling on dangerous household products, including
(06:22):
medicines that could be harmful at high doses. But in general,
manufacturers resisted laws that required this kind of packaging and
labeling on consumer products. They argued that people might not
buy a product that was in a scary looking bottle
with the skull and crossbones on it. Another argument was
that consumers might put their products in a different container
(06:42):
or reuse that skull and crossbone bottle to hold some
other harmless substance, and that could just create all kinds
of confusion. By the tart of the twentieth century, a
couple of simultaneous developments dramatically increased the number of poisons
that most people had in their homes. The germ theory
of disease had become more widely accepted and generally known,
(07:02):
so people became kind of hyper aware of the idea
of germs infesting their homes and infecting their families. Progressive
reformers were also advocating ideas like good hygiene and cleanliness.
There was just messaging about this kind of thing all
over the place in news articles and women's magazines and
that type of thing. As a result, manufacturers introduced a
(07:24):
ton of cleaning and disinfecting products, many of which were toxic.
They marketed these products primarily to women as household time
savers and as a vital part of keeping a clean home.
Women's magazines also caught up to the trend and published
household cleaning and sanitation tips, along with consumer education about safety,
(07:45):
like keeping these products out of the reach of children,
clearly labeling their packaging, and sticking a pin through the
stopper of toxic products so it would be obvious which
bottle you were about to open. At About the same time,
drug makers were all so introducing all kinds of new medications.
This is something that we've talked about in previous episodes,
(08:05):
including our two parter on tholdamide. These new medications also
became a potential source of poisoning. With so many new
sources of potential poisoning in people's homes, the number of
accidental exposures skyrocketed. Doctors and other members of the medical
community reported huge increases in the number of patients they
(08:26):
saw who had been harmed by a poisonous product, and
because these products were brand new, doctors often didn't know
what to do to treat these exposures. During the progressive era,
muck raking journalists also tried to expose the dangers of
these products, especially if they were poorly labeled or incorrectly handled.
Running in parallel with this focus on household poisons was
(08:49):
a similar focus on food safety. This included the safety
and quality of the foods themselves, the cleanliness and safety
of facilities like slaughter houses and packing houses, and the
safety of food additives. As part of all this, doctor
Harvey Washington Wiley studied the effects of food additives by
feeding things to a team of volunteers who came to
(09:11):
be known as the Poison Squad. There's an episode in
our archive about this. It's called A Pure Food Father
and His Poison Squad, and it came out in May
of twenty eleven. It's shorter than our episodes typically are today,
and I haven't found a good companion to kind of
pair it with, so we haven't lined up as a
Saturday classic as of yet. All of this together led
(09:32):
to the passage of the Pure Food and Drugs Act
of nineteen oh six, which is also known as the
Wiley Act. Most of its provisions were focused on food
and food additives, but it also included labeling requirements for drugs,
and it forbade patent medicines in interstate commerce. The Wiley
Act was one of the first consumer protection laws of
(09:52):
its kind, and while it did introduce some requirements for
drugs and drug labeling, it didn't really address the many
talk household products that were being introduced into the market. Then,
in nineteen twenty six, bills were introduced in the House
and the Senate that required labeling for a list of
caustic substances. This included several acids, ammonia, silver nitrate, and
(10:15):
sodium hydroxide also known as LYE. As part of this
Chevroyet Jackson of Jefferson Medical College and Philadelphia testified before
the Senate about injuries that he had witnessed from these
types of substances in his practice. One case was a
child who swallowed a product called clean al and that
had caused terrible damage to his esophagus. When the mother
(10:40):
was asked why she had given this product to her child,
she said she had not known it was poison. In
his testimony, Jackson said, quote, I got her to bring
me a can, and here you can see on this
can that I have here, which was bought in the stores,
that there is not only no poison label whatever on it,
but it says does not in ma, You're the finest
(11:00):
fabric or the most delicate skin. Now, how could you
expect any mother to think that this thing was dangerous?
After this and other testimony, in nineteen twenty seven, President
Calvin Coolidge signed the Caustic Poison Act into law. This
act required a list of caustic poisons to be clearly labeled,
with the warnings and contrasting colors also in the largest
(11:23):
type that was on the package or the bottle that
the product was in. There wasn't really any data being
kept on household poisonings at this point, but anecdotally justice
labeling requirements significantly reduced the number of poisoning deaths that
were happening. Household poisoning was still a problem, though, and
it was not long after this that the first steps
(11:44):
were made toward the poison control system that exists today.
We'll talk about that more after we pause for a
sponsor break. Overall, manufacturers supported the Caustic Poison Act when
(12:04):
it was assigned into law in nineteen twenty seven. It
replaced a previous and sometimes really contradictory hodgepodge of state
regulations on labeling, so it kind of made things easier
from the manufacturer's perspective, but they resisted broader regulations, including
a Federal Volatile Poisons Act that was proposed in the
nineteen thirties. This would have introduced more specific labeling standards,
(12:28):
including marking poisonous products with a skull and crossbones, something
that had also been proposed earlier. On Again, manufacturers argued
that this labeling would just keep people from buying the products.
This was happening during the Great Depression, and the chemical
manufacturing industry was one of a very few that have
actually increased production, so legislators were worried that if customers
(12:52):
did become reluctant to buy these products, as manufacturers feared
they would, it would harm one of the few industries
it was not seriously struggling. Meanwhile, in the late nineteen
twenties and early nineteen thirties, multiple doctors published papers on
the patterns of poisoning that they were seeing in their practice.
In nineteen twenty seven, pp. Vinson reported that well over
(13:14):
half the esophageal strictures that he had seen at the
Mayo Clinic had been caused because someone had swallowed LYE.
Doctor J. Arena of Duke University published similar findings in
nineteen thirty nine. In some cases, the concentration of LIE
in the product had not been high enough for the
labeling that was required under the Caustic Poison Act. Also
(13:36):
in the nineteen thirties, Lewis Godalman, who was a pharmacist
in Chicago who also had a chemistry degree, was also
collecting information on poisonings and the products and substances that
had caused them. He started documenting products in their ingredients
on index cards, including what to do in cases of
exposure to those ingredients, creating records for at least nine
(13:57):
thousand products. Eventually, he also started collecting stomach contents and
other samples from poisoning victims for analysis. Through this work,
Godalman became the go to person for poisoning cases in Chicago.
The pharmacy at Saint Luke's Hospital where he worked was
directly across from the emergency room, so it made it
(14:17):
really easy for er doctors to just come ask him questions.
But he also took calls at home and elsewhere twenty
four hours a day. As words spread beyond Saint Luke's
Hospital of what he was doing, doctors from other Chicago
facilities started to call him for advice and information as well.
It eventually got to the point that people from other
states would call around in Chicago trying to find this
(14:40):
pharmacist that they'd heard about who knew so much about poisoning.
As Godalman was becoming a one man poison hotline, the
legal and regulatory landscape in the United States was continuing
to evolve. The Food, Drug and Cosmetic Act was passed
in nineteen thirty eight, which required drugs to be evaluated
for safety by the Food in Drug Administration. In nineteen
(15:02):
forty seven, the Federal Insecticide, Fungicide and Rodenticide Act required
these products to be registered with the FDA. This law
updated an earlier version that was passed in nineteen ten,
and among other things, it required these products to be
in child resistant packaging and clearly labeled with an appropriate warning.
(15:23):
Even with these kinds of steps, though by the nineteen fifties,
as many as four hundred children a year were dying
from poisoning. There were also adult poisoning victims as well,
of course, including incidents that had multiple victims. For example,
on November eighteenth, nineteen forty two, a patient at Oregon
State Hospital was helping out in the kitchen. He accidentally
(15:46):
brought the cook's cockroach poison instead of the powdered milk
that they had asked for. These two substances looked visually
very similar and had been stored near each other. Forty
seven patients died, and this is something where the chemical
manufacturing industry had resisted calls for these kinds of products
to be tinted rather than white and easily mistaken for
(16:08):
something like salt or sugar powdered milk. By this point,
medical experts just could not keep up with the massive
increase in the number of potentially dangerous products and what
to do if someone was exposed to them. About two
hundred and fifty thousand drugs and household products had been
introduced since World War two, and there wasn't any kind
(16:28):
of centralized system for keeping up with all of these products,
their ingredients, and their antidotes. Accidents replaced disease as the
leading cause of death in children, and according to a
survey of members of the American Academy of Pediatrics, about
half of the accidents that pediatricians were treating were poisonings.
In nineteen fifty three, doctor Edward Press and Lewis Godalman
(16:51):
established the first formal poison control center. This was in Chicago, Illinois.
The Illinois Chapter of the American Academy of Pediatrics, the
Illinois Department of Public Health, and seven Chicago area hospitals
were also part of this project. They provided information on
poisonings and their antidotes to doctors who were treating affected patients.
(17:12):
Illinois State Toxicology Laboratory was also part of this project.
Toxicology was still a pretty new field at this point,
and that lab analyzed any specimens that were collected. A
number of sources also credit some of this work to
an unnamed secretary who would call the area emergency rooms
every morning and ask what the children who had been
(17:33):
admitted for poisoning had eaten. She would then contact the
manufacturers of those substances to try to get them to
disclose the ingredients, and she would document all this information
on an index card. I wish I could find out
more about this person. I found several references to this
unnamed secretary and no other details. The Chicago Poison Control
(17:54):
Center started with a pilot program that ran from November fifteenth,
nineteen fifty three, to March tenth, nineteen five four, and
it was so successful that other hospitals started their own programs.
Within a year, there were eleven poison control centers just
in Chicago and the surrounding area. In December of nineteen
fifty four, Edward Press and doctor Robert Mellins published a
(18:16):
paper titled a Poisoning Control Program in the American Journal
of Public Health. This paper described poisoning as a major
public health concern before describing how the poison control centers
were operating and what they had found during that time.
The paper also made recommendations for future poison control centers
based on that experience. The following year, the American Academy
(18:39):
of Pediatrics published a reference book called Accidental Poisoning in Childhood. Soon,
poison control centers were expanding beyond Chicago. In nineteen fifty seven,
the US Surgeon General established the National Clearinghouse for Poison
Control Centers. This was the federal government's first attempt to
try to provide some standardized resources for poison control and
(19:02):
to collect data on poisonings to report back to the government.
The Clearing House produced a set of index cards with
information on potentially hazardous drugs, chemicals, and household products and
plants along with their antidotes, and it also published a
monthly newsletter as well as a statistical report of all
that collected data from each year. Also in nineteen fifty seven,
(19:24):
the first edition of the Clinical Toxicology of Commercial Products
was published and quickly became a standard reference work. It
included basic first aid and emergency treatment, followed by an
ingredient index that listed more than one thousand substances ranked
on a scale from one to six according to their toxicity,
with one being nearly harmless and six being extremely toxic.
(19:48):
It had a separate index for the trade names of
products that used these ingredients, along with the symptoms and
treatments for exposure to a range of different compounds. The
American Association of Poison Controlsters was founded in nineteen fifty eight,
and by that point the number of poison control centers
in the United States had grown to at least two
hundred sixty five. On April twentieth, nineteen fifty nine, Arthur S. Fleming,
(20:12):
the Secretary of Health, released a statement about the poisoning
data that the National Clearinghouse for Poison Control Centers had
compiled between July nineteen fifty six and April nineteen fifty eight.
The clearing House reported that almost five hundred child deaths
and six hundred thousand non fatal poisonings were happening per year,
(20:33):
which overwhelmingly occurred at home. More than eighty five percent
of the people affected were children under the age of five,
and most of those were between the ages of one
and two. Although many types of household products were involved,
a major source of poisoning was candied aspirin, which was
a chewable formula developed to be palatable to children and
(20:54):
was introduced in nineteen forty seven. Fleming's statement gave some
examples of the types of poison exposure that led calls
to a poison control center, and most of the time
it was something that had taken just a moment when
a parent or other caregiver's back was turned. He also
noted the need for the public to be better educated
about poisons and poison safety. Many of the cases that
(21:16):
the clearing House had compiled involved parents who had waited
hours or days after a child was exposed to a
poison to seek help instead of doing it right away.
Other major contributors to accidental poisonings were products that had
been transferred to food cans or other containers rather than
being kept in their original packaging, as well as hazardous
(21:37):
products that had been kept in easy reach of children.
It was about this time that poison control centers started
working directly with the public rather than mostly providing information
to doctors. And we'll get to that after another quick
sponsor break. The rapid expansion of poison control centers in
(22:02):
the nineteen fifties and sixties was kind of a tangle.
They were definitely giving medical staff and the general public
an on call resource to use in cases of potential poisoning.
That was good in many places where they operated. They
were also educating consumers about household safety, things like keeping
toxic products in their original packaging and keeping them locked
(22:25):
out of the reach of children also useful, But at
the same time, most of these centers were being established
at hospitals, with the hospitals trying to staff them from
their existing emergency rooms. The idea was that this would
be an easy addition to a department that was already
staffed twenty four to seven with people who were used
to the high stress world of emergency medicine. From the
(22:48):
hospital's point of view, adding a poison control center might
even bring in more patients as the center referred emergencies
to the hospital's own er. As poison control centers started
marketing their services directly to the public, they also became
a positive source of pr for the hospitals where they
were operating. As more and more people became aware of
(23:08):
the dangers of poisoning and the existence of poison control centers,
more and more hospitals opened them, in part motivated by
the idea of good publicity. In practice, though this did
not always work out. There were some centers that didn't
get a lot of calls. Either they weren't well publicized,
or they were in a city that had multiple other
poison control centers, or they were in a location with
(23:31):
a small population. But many poison control centers found that
they had to have a dedicated twenty four hour staff
just for the calls about poisonings. There were just too
many calls to add it into the existing emergency department's work.
This is how it goes for so many projects that
someone says, you can just add the center where it
(23:52):
won't take long. This also meant that there was no
real pattern to where these poison control centers were being established.
Some cities had more than one hundred centers scattered across
all their hospitals and pharmacies and other medical practices. Others
had not enough to really serve their whole community, or
they had no poison control center at all. Even though
(24:14):
the nineteen fifties had seen the establishment of the National
Clearinghouse for poison Control centers and the publication of the
clinical toxicology of commercial products, there also wasn't a lot
of standardization among all these centers. The quality of care
could be vastly different depending on which center you called
and who answered the phone, and in places where there
(24:34):
were multiple centers operating within the same city, those centers
were often competing with each other, each with their own
phone number logos warning stickers and educational materials, which could
often cause confusion. Also, while one of the reasons that
hospitals had started establishing poison control centers was to try
to bring in new patients to the er, when people
(24:56):
called the poison control center for advice and were told
to go to the off are, the offs had happened
when poison control centers started working directly with the public.
Rather than being primarily a resource for doctors, they were
essentially acting as triage. The person answering the phone would
find out what products someone had been exposed to, along
with their age and weight. In a lot of cases,
(25:18):
after doing the math with that it turned out that
the dose was not dangerous or that treating it could
be managed at home. Visits to the er for poisoning
went down, not up. This could be a really challenging
job as well. The poison control staff were often talking
to panicked parents who were holding or in the same
(25:38):
room with crying children. Calls often involved a lay person
who needed to be talked through a specific set of
first aid steps, which in the early days of these
centers could involve trying to induce vomiting. Some of the
calls that came in also involved people who were either
considering harming themselves with the poison or had already tried
to do so. Meanwhile, the federal government continued to add
(26:02):
new regulations regarding toxic products. The Hazardous Substances Labeling Act
was passed in July of nineteen sixty and that required
specific labeling of toxic, corrosive, irritant, flammable, strong sensitizers, or
pressure generating substances, as well as language like danger, warning, caution,
and keep out of reach of children. In nineteen sixty one,
(26:26):
those eleven poison control centers that have been established in
the Chicago area were consolidated down into one facility at
Presbyterian Saint Luke's Hospital, which got about fifty five thousand
calls annually. That same year, President John F. Kennedy named
the third full week of March as National Poison Prevention Week,
(26:46):
which is something I learned while researching this podcast. So
it is a weird coincidence that this episode is coming
out immediately after it ended. This started with Homer A. George,
who was a pharmacist from Missouri. George had convinced his
town and then the state of Missouri, to establish a
poison Prevention Week before advocating for one to be established
(27:07):
at a federal level. National Poison Prevention Week was first
observed March eighteenth through twenty fourth, nineteen sixty two. In
nineteen sixty six, doctor James Goddard, Commissioner of the FDA,
convened a meeting of aspirin producers who voluntarily agreed to
restrict baby asprin packaging to a non lethal dose. Each
package would contain no more than thirty six tablets of
(27:30):
eighty one milligrams apiece, so that if a child did
consume a whole bottle, it was not likely to be fatal.
Formal legislation along these lines followed with the Poison Prevention
Packaging Act in nineteen seventy, which required child resistant packaging.
Other laws about child resistant packaging, especially drug packaging, followed
(27:50):
from mayor. All of these things are, of course imperfect solutions,
right because a packaging that is harder for a child
to get into is also harder for many disabled and
elderly people to get into. But it's one of those
things where you have to evaluate the risks involved with
the packaging. Medical specialties involved with studying and treating poisoning
(28:13):
were also evolving during all this time. The American Academy
of Clinical Toxicology and the American College of Emergency Physicians
were both founded in nineteen sixty eight. By that point,
there were hundreds of poison control centers all over the
country and multiple competing mascots, including my favorite Mister Yuck,
Officer Uugh, Pinky the Elephant, Uncle Barf, and no Syop
(28:36):
the Snake with no Syop being poison spelled backwards. The
most widely known of these is probably Holly's favorite Mister Yuck,
whose development started in nineteen seventy. Doctor Richard Moriarty of
Pittsburgh Children's Hospital wanted some kind of child friendly warning
or mascot for toxic products. One reason for this was
(28:58):
that the Pittsburgh Pirates had adopted the skull and crossbones
as their logo, which understandably might cause some confusion for
children who can see the logo but not necessarily read
or get the context of what's involved. Like yay sports,
Morey already started by asking children what would happen to
them if they got into poison, and their responses were
(29:20):
that their parents would yell at them, they would get
sick or they'd die, and he wanted to find an
image that seemed to suggest these ideas, which led to
a design contest sponsored by the Pittsburgh Poison Center and
that was won by fourth grader Wendy Brown. A commercial
was released in nineteen seventy one with a mister Yuck
is Mean, Mister Yuck is Green theme song. Pittsburgh Children's
(29:43):
Hospital made mister Yuck stickers available to other poison control
centers and to parents through the National Poison Center Network,
established in nineteen seventy three. Yeah, I did not grow
up anywhere near Pittsburgh. I grew up in North Carolina.
I could still sing you the entire mister Yuch theme song.
I won't because I do not sing well. More developments
(30:06):
followed after this. Of course, the Consumer Product Safety Commission
was established in nineteen seventy two, so that was a
year before that Poison Control Center Network was established. The
Emergency Medical Systems Act was enacted in nineteen seventy three,
and that authorized grants to establish a more robust nationwide
emergency services system. In nineteen seventy eight, the National Animal
(30:30):
Poison Control Center was established at the University of Illinois, Champagne,
Urbana College of Veterinary Medicine. It started fielding calls about
animal exposure to toxic and caustic chemicals, as well as
substances that are safe for most humans but toxic to
many animals, such as chocolate, grapes, and lilies. I have
(30:51):
a friend who's a cat wound up in the veterinary
hospital not long ago at all after eating some lilies.
That year, the number of poison control centers for humans
reached its peak, with more than six hundred and sixty
in the US and its territories. Many of them, as
we talked about earlier, overlapped in their coverage area. Some
(31:12):
got very few calls. There were also concerns about training
and consistency at some of the smallest centers that had
the least funding and training, and a lot of centers
overall had really struggled to get adequate funding throughout their
whole history. Hospitals also became concerned about liability, especially after
an Arizona jury ordered a state funded poison control center
(31:35):
to pay out a more than three million dollars settlement.
This happened after a nurse at a medical practice accidentally
gave a patient liquid cocaine rather than liquid acetominifin, which
had been stored on a shelf next to each other.
The poison Control Center and the doctor both had outdated
information about just how toxic liquid cocaine could be, but
(31:57):
the poison Control Center was ordered to pay a large
settlement because it had not specifically told the doctor that
the patient should be taken to the hospital. All of this,
combined with the challenges we talked about earlier to prompt
hospitals to start closing down and consolidating their poison control
centers in the nineteen eighties. Over the next decade or so,
(32:17):
the Poison Control Center shifted from this overlapping assortment of
centers at multiple hospitals, sometimes in the same region, to
a more government funded regional model. The national clearinghouse for
poison control centers stopped collecting poisoning data, and that responsibility
moved to the Toxic Exposure Surveillance System or Tests in
(32:38):
nineteen eighty three. At that point, childhood deaths from accidental
poisoning had dropped to a quarter of what they had
been twenty years before. In February of two thousand, President
Bill Clinton signed the Poison Control Center Enhancement and Awareness Act.
This act provided federal funding for poison control centers and
made provisions for the establishment of a national toll free number.
(33:03):
The nationwide number of one eight hundred two two two
one two two two was launched in January of two
thousand and two. In two thousand and three, the federal
government reauthorized the Poison Control Center Enhancement and Awareness Act,
citing the need for emergency preparedness following the nine to
eleven terrorist attacks and the anthrax attack that followed in
(33:24):
October of two thousand and one. Today, in the United States,
there are about fifty five regional poison control centers that
serve the entire country through that one eight hundred number.
When people call the number, it routes them to their
regional center. There is also now an online triage tool
at webpoisoncontrol dot org. The regional center's staff generally includes pharmacists,
(33:48):
board certified toxicologists and Certified specialists, and Poison Information or CSPI,
and these centers take about four million calls a year.
At this point. The Poison Control now Work is the
only real time healthcare database that applies to the whole
US population. Centers also provide education to the public, as
(34:08):
well as monitoring and reporting events that might suggest some
kind of wide scale exposure or a deliberate chemical attack.
Most of the people who call into poison control centers
today are lay people about fifteen percent, or medical personnel.
More than seventy percent of the people who call poison
control do not wind up meeting to go to the hospital.
(34:29):
Numbers are really all over the place about how much
money this saves per dollar of money that is invested
into the system, But it should be noted that this
is not just savings on the patient's part, Like people
who are able to treat the potential poisoning at home
save a lot of money by not having to go
to the emergency room. But a lot of people who
(34:49):
need to call into the poison control system for whatever
reason are covered by Medicare, Medicaid, or a state children's
health insurance program, so there are savings for these programs also,
and for the people who do need to go to
the hospital, there is some data that suggests that their
stays tend to be shorter because of the immediate first
aid and recommendations from poison control. Also, I just want
(35:11):
to note that I am not the only person who
has had this whole experience of kind of going where
did poison control come from? Nearly that exact scenario inspired
a Radio Lab episode on poison control that came out
in twenty eighteen. That was after the reporter involved had
to call poison Control for their child, Ah Control the
(35:36):
poison Thanks so much for joining us on this Saturday.
If you'd like to send us a note, our email
addresses History Podcast at iHeartRadio dot com, and you can
subscribe to the show on the iHeartRadio app, Apple Podcasts,
or wherever you listen to your favorite shows.
Happy Saturday. In our behind the scenes episode yesterday, we
mentioned our prior episode on poison Control, so we're bringing
that out us Today's Saturday Classic. This episode originally came
out on March twenty fifth, twenty twenty. Enjoy Welcome to
Stuff You Missed in History Class, a production of iHeartRadio. Hello,
(00:31):
and welcome to the podcast. I'm Tracy V. Wilson and
I'm Holly Prye. In case you've never heard our show before,
this is episode two of us recording the show with
everyone involved in the process in their own homes because
of the current pandemic and resulting quarantine slash shelter in
(00:54):
place slash self isolation slash social distancing instructions we have
all been under. Yeah, So if you're a longtime listener
and you're like, why doesn't this sound quite the same,
that's why. If you're brand new, that's just a heads up.
That's where we are right now. And we coincidentally have
a medical history week that we did not plan that
just happens to be falling in line with all of this.
(01:17):
So the other day it was time to give our
kittens their flea and tick prevention and then afterward I
was idly reading the back of the box while I
was washing my hands, and I noticed that it said
to contact poison control if swallowed, And at first I thought,
why not just print what to do on the box
instead of directing people to call poison control? But then
(01:37):
I was like, where did poison control even come from?
How did we get to the point of having this
one resource specifically for poisoning that's so reliable and available
that companies can print it on the labels of consumer products,
and especially here in the US where Holly and I are.
This is a healthcare service that is staffed twenty four
(01:59):
to seven and of and accessible to everyone for free,
which is not a thing that exists in many other contexts.
I mean, there are some other twenty four hour hotlines,
but like, it's not often that anybody, literally anyone can
call a medical professional twenty four hours a day and
get an answer for free. The first service like this
was established in the Netherlands in nineteen forty nine, and
(02:21):
today they exist in a lot of countries around the world,
particularly in the Americas, Western Europe, and parts of the
Middle East. According to the World Health Organization, forty seven
percent of member states have a poison center of some sort.
But because the development of poison control centers in the
US closely parallels some other shifts in American history, that's
(02:42):
really where we're focusing on with this story today. So
you can really define the word poisoning in a lot
of different ways, but in general, it is any toxin
related injury. The toxin can come from all kinds of sources,
cleaning products, medications, mushrooms out in the yard, and things
that we actually think of poisons, like insecticides and rat poisons.
(03:05):
Sometimes people describe being envenomed from something like a snake
bite or insect sting. Also is being poisoned that a
lot of cases, exposure to a small amount of one
of these substances isn't really dangerous, and when it's something
like medicine, that can be helpful rather than harmful, but
in large enough amounts, otherwise harmless or even beneficial substances
(03:26):
can become lethal. To be clear, we also use terms
like sun poisoning and food poisoning, but that's not really
what we're talking about here. Sun poisoning is actually a
severe type of sunburn, and in most cases, food poisoning
is an illness that's caused by a pathogen like salmonella
or Schagella bacteria. There are food borne illnesses that involve
(03:48):
pathogens that can produce toxins, and foods can be contaminated
with toxic substances. But most of the time, when we
say food poisoning, we're actually talking about an illness, not
a poison that some and put in your food. People
have been exposed to poisons, of course, throughout human history.
There are toxic plants and fungi and metals all over
(04:09):
the world. Most places have at least some species of
venomous animals. People have also done things like making their
drinking vessels or makeup out of toxic metals like lead,
but household toxins really started to proliferate with industrialization. Over time,
people's most likely sources of poisoning shifted from things like
(04:30):
berries that they had gathered to eat to things like
cleaning products and pharmaceuticals. In some parts of the world,
governments passed laws to try to protect people from the
most potentially dangerous products starting in the nineteenth century. For example,
in the UK, the eighteen sixty eight Pharmacy Act restricted
the sale of a specific set of poisons. Only licensed
(04:53):
pharmacists could sell them, and they had to keep a
careful record of every sale. There was not a simil
federal law in the US, but between eighteen seventy and
eighteen ninety thirty three states adopted some kind of regulation
on the sale of poisons at the federal level. The
first bills were introduced into Congress in eighteen seventy nine,
(05:14):
but broad legislation didn't come along until much later. Manufacturers
also recognized the potential dangers involved with the products that
they were making. Starting in the late eighteenth and early
nineteenth centuries, manufacturers of things like rat poisons packaged their
products in distinctively shaped bottles, marked with things like skulls
and crossbones and the word poison. To try to prevent accidents.
(05:38):
Manufacturers also used textured glass bottles so that people could
tell what they were holding just by touch, and they
also developed safety caps. Most of these innovations weren't being
used on products that were being sold directly to consumers, though,
they were being used on products that would be repackaged
at a pharmacy or another store. So the idea was
(05:59):
to keep the ruggists from selling somebody something dangerous by accident,
not to prevent the consumer at home from accidentally hurting
themselves or someone else. By the middle of the nineteenth century,
the American Pharmaceutical Association and American Medical Association had each
passed resolutions recommending clearer labeling on dangerous household products, including
(06:22):
medicines that could be harmful at high doses. But in general,
manufacturers resisted laws that required this kind of packaging and
labeling on consumer products. They argued that people might not
buy a product that was in a scary looking bottle
with the skull and crossbones on it. Another argument was
that consumers might put their products in a different container
(06:42):
or reuse that skull and crossbone bottle to hold some
other harmless substance, and that could just create all kinds
of confusion. By the tart of the twentieth century, a
couple of simultaneous developments dramatically increased the number of poisons
that most people had in their homes. The germ theory
of disease had become more widely accepted and generally known,
(07:02):
so people became kind of hyper aware of the idea
of germs infesting their homes and infecting their families. Progressive
reformers were also advocating ideas like good hygiene and cleanliness.
There was just messaging about this kind of thing all
over the place in news articles and women's magazines and
that type of thing. As a result, manufacturers introduced a
(07:24):
ton of cleaning and disinfecting products, many of which were toxic.
They marketed these products primarily to women as household time
savers and as a vital part of keeping a clean home.
Women's magazines also caught up to the trend and published
household cleaning and sanitation tips, along with consumer education about safety,
(07:45):
like keeping these products out of the reach of children,
clearly labeling their packaging, and sticking a pin through the
stopper of toxic products so it would be obvious which
bottle you were about to open. At About the same time,
drug makers were all so introducing all kinds of new medications.
This is something that we've talked about in previous episodes,
(08:05):
including our two parter on tholdamide. These new medications also
became a potential source of poisoning. With so many new
sources of potential poisoning in people's homes, the number of
accidental exposures skyrocketed. Doctors and other members of the medical
community reported huge increases in the number of patients they
(08:26):
saw who had been harmed by a poisonous product, and
because these products were brand new, doctors often didn't know
what to do to treat these exposures. During the progressive era,
muck raking journalists also tried to expose the dangers of
these products, especially if they were poorly labeled or incorrectly handled.
Running in parallel with this focus on household poisons was
(08:49):
a similar focus on food safety. This included the safety
and quality of the foods themselves, the cleanliness and safety
of facilities like slaughter houses and packing houses, and the
safety of food additives. As part of all this, doctor
Harvey Washington Wiley studied the effects of food additives by
feeding things to a team of volunteers who came to
(09:11):
be known as the Poison Squad. There's an episode in
our archive about this. It's called A Pure Food Father
and His Poison Squad, and it came out in May
of twenty eleven. It's shorter than our episodes typically are today,
and I haven't found a good companion to kind of
pair it with, so we haven't lined up as a
Saturday classic as of yet. All of this together led
(09:32):
to the passage of the Pure Food and Drugs Act
of nineteen oh six, which is also known as the
Wiley Act. Most of its provisions were focused on food
and food additives, but it also included labeling requirements for drugs,
and it forbade patent medicines in interstate commerce. The Wiley
Act was one of the first consumer protection laws of
(09:52):
its kind, and while it did introduce some requirements for
drugs and drug labeling, it didn't really address the many
talk household products that were being introduced into the market. Then,
in nineteen twenty six, bills were introduced in the House
and the Senate that required labeling for a list of
caustic substances. This included several acids, ammonia, silver nitrate, and
(10:15):
sodium hydroxide also known as LYE. As part of this
Chevroyet Jackson of Jefferson Medical College and Philadelphia testified before
the Senate about injuries that he had witnessed from these
types of substances in his practice. One case was a
child who swallowed a product called clean al and that
had caused terrible damage to his esophagus. When the mother
(10:40):
was asked why she had given this product to her child,
she said she had not known it was poison. In
his testimony, Jackson said, quote, I got her to bring
me a can, and here you can see on this
can that I have here, which was bought in the stores,
that there is not only no poison label whatever on it,
but it says does not in ma, You're the finest
(11:00):
fabric or the most delicate skin. Now, how could you
expect any mother to think that this thing was dangerous?
After this and other testimony, in nineteen twenty seven, President
Calvin Coolidge signed the Caustic Poison Act into law. This
act required a list of caustic poisons to be clearly labeled,
with the warnings and contrasting colors also in the largest
(11:23):
type that was on the package or the bottle that
the product was in. There wasn't really any data being
kept on household poisonings at this point, but anecdotally justice
labeling requirements significantly reduced the number of poisoning deaths that
were happening. Household poisoning was still a problem, though, and
it was not long after this that the first steps
(11:44):
were made toward the poison control system that exists today.
We'll talk about that more after we pause for a
sponsor break. Overall, manufacturers supported the Caustic Poison Act when
(12:04):
it was assigned into law in nineteen twenty seven. It
replaced a previous and sometimes really contradictory hodgepodge of state
regulations on labeling, so it kind of made things easier
from the manufacturer's perspective, but they resisted broader regulations, including
a Federal Volatile Poisons Act that was proposed in the
nineteen thirties. This would have introduced more specific labeling standards,
(12:28):
including marking poisonous products with a skull and crossbones, something
that had also been proposed earlier. On Again, manufacturers argued
that this labeling would just keep people from buying the products.
This was happening during the Great Depression, and the chemical
manufacturing industry was one of a very few that have
actually increased production, so legislators were worried that if customers
(12:52):
did become reluctant to buy these products, as manufacturers feared
they would, it would harm one of the few industries
it was not seriously struggling. Meanwhile, in the late nineteen
twenties and early nineteen thirties, multiple doctors published papers on
the patterns of poisoning that they were seeing in their practice.
In nineteen twenty seven, pp. Vinson reported that well over
(13:14):
half the esophageal strictures that he had seen at the
Mayo Clinic had been caused because someone had swallowed LYE.
Doctor J. Arena of Duke University published similar findings in
nineteen thirty nine. In some cases, the concentration of LIE
in the product had not been high enough for the
labeling that was required under the Caustic Poison Act. Also
(13:36):
in the nineteen thirties, Lewis Godalman, who was a pharmacist
in Chicago who also had a chemistry degree, was also
collecting information on poisonings and the products and substances that
had caused them. He started documenting products in their ingredients
on index cards, including what to do in cases of
exposure to those ingredients, creating records for at least nine
(13:57):
thousand products. Eventually, he also started collecting stomach contents and
other samples from poisoning victims for analysis. Through this work,
Godalman became the go to person for poisoning cases in Chicago.
The pharmacy at Saint Luke's Hospital where he worked was
directly across from the emergency room, so it made it
(14:17):
really easy for er doctors to just come ask him questions.
But he also took calls at home and elsewhere twenty
four hours a day. As words spread beyond Saint Luke's
Hospital of what he was doing, doctors from other Chicago
facilities started to call him for advice and information as well.
It eventually got to the point that people from other
states would call around in Chicago trying to find this
(14:40):
pharmacist that they'd heard about who knew so much about poisoning.
As Godalman was becoming a one man poison hotline, the
legal and regulatory landscape in the United States was continuing
to evolve. The Food, Drug and Cosmetic Act was passed
in nineteen thirty eight, which required drugs to be evaluated
for safety by the Food in Drug Administration. In nineteen
(15:02):
forty seven, the Federal Insecticide, Fungicide and Rodenticide Act required
these products to be registered with the FDA. This law
updated an earlier version that was passed in nineteen ten,
and among other things, it required these products to be
in child resistant packaging and clearly labeled with an appropriate warning.
(15:23):
Even with these kinds of steps, though by the nineteen fifties,
as many as four hundred children a year were dying
from poisoning. There were also adult poisoning victims as well,
of course, including incidents that had multiple victims. For example,
on November eighteenth, nineteen forty two, a patient at Oregon
State Hospital was helping out in the kitchen. He accidentally
(15:46):
brought the cook's cockroach poison instead of the powdered milk
that they had asked for. These two substances looked visually
very similar and had been stored near each other. Forty
seven patients died, and this is something where the chemical
manufacturing industry had resisted calls for these kinds of products
to be tinted rather than white and easily mistaken for
(16:08):
something like salt or sugar powdered milk. By this point,
medical experts just could not keep up with the massive
increase in the number of potentially dangerous products and what
to do if someone was exposed to them. About two
hundred and fifty thousand drugs and household products had been
introduced since World War two, and there wasn't any kind
(16:28):
of centralized system for keeping up with all of these products,
their ingredients, and their antidotes. Accidents replaced disease as the
leading cause of death in children, and according to a
survey of members of the American Academy of Pediatrics, about
half of the accidents that pediatricians were treating were poisonings.
In nineteen fifty three, doctor Edward Press and Lewis Godalman
(16:51):
established the first formal poison control center. This was in Chicago, Illinois.
The Illinois Chapter of the American Academy of Pediatrics, the
Illinois Department of Public Health, and seven Chicago area hospitals
were also part of this project. They provided information on
poisonings and their antidotes to doctors who were treating affected patients.
(17:12):
Illinois State Toxicology Laboratory was also part of this project.
Toxicology was still a pretty new field at this point,
and that lab analyzed any specimens that were collected. A
number of sources also credit some of this work to
an unnamed secretary who would call the area emergency rooms
every morning and ask what the children who had been
(17:33):
admitted for poisoning had eaten. She would then contact the
manufacturers of those substances to try to get them to
disclose the ingredients, and she would document all this information
on an index card. I wish I could find out
more about this person. I found several references to this
unnamed secretary and no other details. The Chicago Poison Control
(17:54):
Center started with a pilot program that ran from November fifteenth,
nineteen fifty three, to March tenth, nineteen five four, and
it was so successful that other hospitals started their own programs.
Within a year, there were eleven poison control centers just
in Chicago and the surrounding area. In December of nineteen
fifty four, Edward Press and doctor Robert Mellins published a
(18:16):
paper titled a Poisoning Control Program in the American Journal
of Public Health. This paper described poisoning as a major
public health concern before describing how the poison control centers
were operating and what they had found during that time.
The paper also made recommendations for future poison control centers
based on that experience. The following year, the American Academy
(18:39):
of Pediatrics published a reference book called Accidental Poisoning in Childhood. Soon,
poison control centers were expanding beyond Chicago. In nineteen fifty seven,
the US Surgeon General established the National Clearinghouse for Poison
Control Centers. This was the federal government's first attempt to
try to provide some standardized resources for poison control and
(19:02):
to collect data on poisonings to report back to the government.
The Clearing House produced a set of index cards with
information on potentially hazardous drugs, chemicals, and household products and
plants along with their antidotes, and it also published a
monthly newsletter as well as a statistical report of all
that collected data from each year. Also in nineteen fifty seven,
(19:24):
the first edition of the Clinical Toxicology of Commercial Products
was published and quickly became a standard reference work. It
included basic first aid and emergency treatment, followed by an
ingredient index that listed more than one thousand substances ranked
on a scale from one to six according to their toxicity,
with one being nearly harmless and six being extremely toxic.
(19:48):
It had a separate index for the trade names of
products that used these ingredients, along with the symptoms and
treatments for exposure to a range of different compounds. The
American Association of Poison Controlsters was founded in nineteen fifty eight,
and by that point the number of poison control centers
in the United States had grown to at least two
hundred sixty five. On April twentieth, nineteen fifty nine, Arthur S. Fleming,
(20:12):
the Secretary of Health, released a statement about the poisoning
data that the National Clearinghouse for Poison Control Centers had
compiled between July nineteen fifty six and April nineteen fifty eight.
The clearing House reported that almost five hundred child deaths
and six hundred thousand non fatal poisonings were happening per year,
(20:33):
which overwhelmingly occurred at home. More than eighty five percent
of the people affected were children under the age of five,
and most of those were between the ages of one
and two. Although many types of household products were involved,
a major source of poisoning was candied aspirin, which was
a chewable formula developed to be palatable to children and
(20:54):
was introduced in nineteen forty seven. Fleming's statement gave some
examples of the types of poison exposure that led calls
to a poison control center, and most of the time
it was something that had taken just a moment when
a parent or other caregiver's back was turned. He also
noted the need for the public to be better educated
about poisons and poison safety. Many of the cases that
(21:16):
the clearing House had compiled involved parents who had waited
hours or days after a child was exposed to a
poison to seek help instead of doing it right away.
Other major contributors to accidental poisonings were products that had
been transferred to food cans or other containers rather than
being kept in their original packaging, as well as hazardous
(21:37):
products that had been kept in easy reach of children.
It was about this time that poison control centers started
working directly with the public rather than mostly providing information
to doctors. And we'll get to that after another quick
sponsor break. The rapid expansion of poison control centers in
(22:02):
the nineteen fifties and sixties was kind of a tangle.
They were definitely giving medical staff and the general public
an on call resource to use in cases of potential poisoning.
That was good in many places where they operated. They
were also educating consumers about household safety, things like keeping
toxic products in their original packaging and keeping them locked
(22:25):
out of the reach of children also useful, But at
the same time, most of these centers were being established
at hospitals, with the hospitals trying to staff them from
their existing emergency rooms. The idea was that this would
be an easy addition to a department that was already
staffed twenty four to seven with people who were used
to the high stress world of emergency medicine. From the
(22:48):
hospital's point of view, adding a poison control center might
even bring in more patients as the center referred emergencies
to the hospital's own er. As poison control centers started
marketing their services directly to the public, they also became
a positive source of pr for the hospitals where they
were operating. As more and more people became aware of
(23:08):
the dangers of poisoning and the existence of poison control centers,
more and more hospitals opened them, in part motivated by
the idea of good publicity. In practice, though this did
not always work out. There were some centers that didn't
get a lot of calls. Either they weren't well publicized,
or they were in a city that had multiple other
poison control centers, or they were in a location with
(23:31):
a small population. But many poison control centers found that
they had to have a dedicated twenty four hour staff
just for the calls about poisonings. There were just too
many calls to add it into the existing emergency department's work.
This is how it goes for so many projects that
someone says, you can just add the center where it
(23:52):
won't take long. This also meant that there was no
real pattern to where these poison control centers were being established.
Some cities had more than one hundred centers scattered across
all their hospitals and pharmacies and other medical practices. Others
had not enough to really serve their whole community, or
they had no poison control center at all. Even though
(24:14):
the nineteen fifties had seen the establishment of the National
Clearinghouse for poison Control centers and the publication of the
clinical toxicology of commercial products, there also wasn't a lot
of standardization among all these centers. The quality of care
could be vastly different depending on which center you called
and who answered the phone, and in places where there
(24:34):
were multiple centers operating within the same city, those centers
were often competing with each other, each with their own
phone number logos warning stickers and educational materials, which could
often cause confusion. Also, while one of the reasons that
hospitals had started establishing poison control centers was to try
to bring in new patients to the er, when people
(24:56):
called the poison control center for advice and were told
to go to the off are, the offs had happened
when poison control centers started working directly with the public.
Rather than being primarily a resource for doctors, they were
essentially acting as triage. The person answering the phone would
find out what products someone had been exposed to, along
with their age and weight. In a lot of cases,
(25:18):
after doing the math with that it turned out that
the dose was not dangerous or that treating it could
be managed at home. Visits to the er for poisoning
went down, not up. This could be a really challenging
job as well. The poison control staff were often talking
to panicked parents who were holding or in the same
(25:38):
room with crying children. Calls often involved a lay person
who needed to be talked through a specific set of
first aid steps, which in the early days of these
centers could involve trying to induce vomiting. Some of the
calls that came in also involved people who were either
considering harming themselves with the poison or had already tried
to do so. Meanwhile, the federal government continued to add
(26:02):
new regulations regarding toxic products. The Hazardous Substances Labeling Act
was passed in July of nineteen sixty and that required
specific labeling of toxic, corrosive, irritant, flammable, strong sensitizers, or
pressure generating substances, as well as language like danger, warning, caution,
and keep out of reach of children. In nineteen sixty one,
(26:26):
those eleven poison control centers that have been established in
the Chicago area were consolidated down into one facility at
Presbyterian Saint Luke's Hospital, which got about fifty five thousand
calls annually. That same year, President John F. Kennedy named
the third full week of March as National Poison Prevention Week,
(26:46):
which is something I learned while researching this podcast. So
it is a weird coincidence that this episode is coming
out immediately after it ended. This started with Homer A. George,
who was a pharmacist from Missouri. George had convinced his
town and then the state of Missouri, to establish a
poison Prevention Week before advocating for one to be established
(27:07):
at a federal level. National Poison Prevention Week was first
observed March eighteenth through twenty fourth, nineteen sixty two. In
nineteen sixty six, doctor James Goddard, Commissioner of the FDA,
convened a meeting of aspirin producers who voluntarily agreed to
restrict baby asprin packaging to a non lethal dose. Each
package would contain no more than thirty six tablets of
(27:30):
eighty one milligrams apiece, so that if a child did
consume a whole bottle, it was not likely to be fatal.
Formal legislation along these lines followed with the Poison Prevention
Packaging Act in nineteen seventy, which required child resistant packaging.
Other laws about child resistant packaging, especially drug packaging, followed
(27:50):
from mayor. All of these things are, of course imperfect solutions,
right because a packaging that is harder for a child
to get into is also harder for many disabled and
elderly people to get into. But it's one of those
things where you have to evaluate the risks involved with
the packaging. Medical specialties involved with studying and treating poisoning
(28:13):
were also evolving during all this time. The American Academy
of Clinical Toxicology and the American College of Emergency Physicians
were both founded in nineteen sixty eight. By that point,
there were hundreds of poison control centers all over the
country and multiple competing mascots, including my favorite Mister Yuck,
Officer Uugh, Pinky the Elephant, Uncle Barf, and no Syop
(28:36):
the Snake with no Syop being poison spelled backwards. The
most widely known of these is probably Holly's favorite Mister Yuck,
whose development started in nineteen seventy. Doctor Richard Moriarty of
Pittsburgh Children's Hospital wanted some kind of child friendly warning
or mascot for toxic products. One reason for this was
(28:58):
that the Pittsburgh Pirates had adopted the skull and crossbones
as their logo, which understandably might cause some confusion for
children who can see the logo but not necessarily read
or get the context of what's involved. Like yay sports,
Morey already started by asking children what would happen to
them if they got into poison, and their responses were
(29:20):
that their parents would yell at them, they would get
sick or they'd die, and he wanted to find an
image that seemed to suggest these ideas, which led to
a design contest sponsored by the Pittsburgh Poison Center and
that was won by fourth grader Wendy Brown. A commercial
was released in nineteen seventy one with a mister Yuck
is Mean, Mister Yuck is Green theme song. Pittsburgh Children's
(29:43):
Hospital made mister Yuck stickers available to other poison control
centers and to parents through the National Poison Center Network,
established in nineteen seventy three. Yeah, I did not grow
up anywhere near Pittsburgh. I grew up in North Carolina.
I could still sing you the entire mister Yuch theme song.
I won't because I do not sing well. More developments
(30:06):
followed after this. Of course, the Consumer Product Safety Commission
was established in nineteen seventy two, so that was a
year before that Poison Control Center Network was established. The
Emergency Medical Systems Act was enacted in nineteen seventy three,
and that authorized grants to establish a more robust nationwide
emergency services system. In nineteen seventy eight, the National Animal
(30:30):
Poison Control Center was established at the University of Illinois, Champagne,
Urbana College of Veterinary Medicine. It started fielding calls about
animal exposure to toxic and caustic chemicals, as well as
substances that are safe for most humans but toxic to
many animals, such as chocolate, grapes, and lilies. I have
(30:51):
a friend who's a cat wound up in the veterinary
hospital not long ago at all after eating some lilies.
That year, the number of poison control centers for humans
reached its peak, with more than six hundred and sixty
in the US and its territories. Many of them, as
we talked about earlier, overlapped in their coverage area. Some
(31:12):
got very few calls. There were also concerns about training
and consistency at some of the smallest centers that had
the least funding and training, and a lot of centers
overall had really struggled to get adequate funding throughout their
whole history. Hospitals also became concerned about liability, especially after
an Arizona jury ordered a state funded poison control center
(31:35):
to pay out a more than three million dollars settlement.
This happened after a nurse at a medical practice accidentally
gave a patient liquid cocaine rather than liquid acetominifin, which
had been stored on a shelf next to each other.
The poison Control Center and the doctor both had outdated
information about just how toxic liquid cocaine could be, but
(31:57):
the poison Control Center was ordered to pay a large
settlement because it had not specifically told the doctor that
the patient should be taken to the hospital. All of this,
combined with the challenges we talked about earlier to prompt
hospitals to start closing down and consolidating their poison control
centers in the nineteen eighties. Over the next decade or so,
(32:17):
the Poison Control Center shifted from this overlapping assortment of
centers at multiple hospitals, sometimes in the same region, to
a more government funded regional model. The national clearinghouse for
poison control centers stopped collecting poisoning data, and that responsibility
moved to the Toxic Exposure Surveillance System or Tests in
(32:38):
nineteen eighty three. At that point, childhood deaths from accidental
poisoning had dropped to a quarter of what they had
been twenty years before. In February of two thousand, President
Bill Clinton signed the Poison Control Center Enhancement and Awareness Act.
This act provided federal funding for poison control centers and
made provisions for the establishment of a national toll free number.
(33:03):
The nationwide number of one eight hundred two two two
one two two two was launched in January of two
thousand and two. In two thousand and three, the federal
government reauthorized the Poison Control Center Enhancement and Awareness Act,
citing the need for emergency preparedness following the nine to
eleven terrorist attacks and the anthrax attack that followed in
(33:24):
October of two thousand and one. Today, in the United States,
there are about fifty five regional poison control centers that
serve the entire country through that one eight hundred number.
When people call the number, it routes them to their
regional center. There is also now an online triage tool
at webpoisoncontrol dot org. The regional center's staff generally includes pharmacists,
(33:48):
board certified toxicologists and Certified specialists, and Poison Information or CSPI,
and these centers take about four million calls a year.
At this point. The Poison Control now Work is the
only real time healthcare database that applies to the whole
US population. Centers also provide education to the public, as
(34:08):
well as monitoring and reporting events that might suggest some
kind of wide scale exposure or a deliberate chemical attack.
Most of the people who call into poison control centers
today are lay people about fifteen percent, or medical personnel.
More than seventy percent of the people who call poison
control do not wind up meeting to go to the hospital.
(34:29):
Numbers are really all over the place about how much
money this saves per dollar of money that is invested
into the system, But it should be noted that this
is not just savings on the patient's part, Like people
who are able to treat the potential poisoning at home
save a lot of money by not having to go
to the emergency room. But a lot of people who
(34:49):
need to call into the poison control system for whatever
reason are covered by Medicare, Medicaid, or a state children's
health insurance program, so there are savings for these programs also,
and for the people who do need to go to
the hospital, there is some data that suggests that their
stays tend to be shorter because of the immediate first
aid and recommendations from poison control. Also, I just want
(35:11):
to note that I am not the only person who
has had this whole experience of kind of going where
did poison control come from? Nearly that exact scenario inspired
a Radio Lab episode on poison control that came out
in twenty eighteen. That was after the reporter involved had
to call poison Control for their child, Ah Control the
(35:36):
poison Thanks so much for joining us on this Saturday.
If you'd like to send us a note, our email
addresses History Podcast at iHeartRadio dot com, and you can
subscribe to the show on the iHeartRadio app, Apple Podcasts,
or wherever you listen to your favorite shows.
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