March 25, 2020 • 37 mins
How did the U.S. get to the point of having this 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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Episode Transcript
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Speaker 1 (00:01):
Welcome to Stuff you missed in History Class, a production
of I Heart Radio, Go Low, and welcome to the podcast.
I'm Tracy V. Wilson and I'm Holly fry Uh. In
case you've never heard our show before, this is episode
(00:21):
two of us recording the show with everyone involved in
the process in their own homes. Because the current pandemic
and resulting UM quarantine slash shelter in place slash self
isolation slash social distancing instructions, we have all been under UM.
(00:42):
So if you're a longtime listener and you're like, why
doesn't that 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. So the
other day it was time to give our kittens or
flee and tick prevention. And then afterward, I was idly
(01:04):
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 want to do on the box instead
of directing people to call poison control. But then I
was like, where did poison control even come from? How
did we get to the point of having this one
(01:24):
resource specifically for poisoning that's so reliable and available that
companies can print it on the labels of consumer products
um and especially here in the US where Holly and
I are, this is a health care service that is
staff seven and of inaccessible to everyone for free, which
is not a thing that exists in many other contexts.
(01:46):
I mean, there are some other 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 and nine and today they exist in a
lot of countries around the world, particularly in the America's
(02:06):
Western Europe and parts of the Middle East. According to
the World Health Organization, 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 really where we're focusing on with
this story today. So you can really define the word
(02:28):
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. Sometimes people describe being envenomed
(02:48):
from something like a snake bite or insects staying 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 can become lethal. To be clear,
(03:09):
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 Chigella bacteria. There are food
born illnesses that involve pathogens that can produce toxins, and
(03:31):
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 someone 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 the world. Most places have at least
(03:52):
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 berries that they had gathered to
(04:13):
eat two 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 pharmacists could sell them, and
(04:36):
they had to keep a careful record of every sale.
There was not a similar 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, but broad legislation didn't come
(04:56):
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. Manufacturers also used textured
(05:21):
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 to keep the
druggist from selling somebody something dangerous by accident, not to
(05:45):
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 medicines
that could be harmful at high doses, but in general,
(06:06):
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 a skull and crossbones on it. Another argument was
that consumers might put their products in a different container
or reuse that skull and crossbone bottle to hold some
(06:26):
other harmless substance, and that could just create all kinds
of confusion. By the part of the twentie century, a
couple of simultaneous developments dramatically increase the number of poisons
that most people had in their homes. The germ theory
of disease had become more widely accepted and generally known,
so people became kind of hyper aware of the idea
(06:46):
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, and news articles, women's magazines, and that
type of thing. As a result, manufacturers introduced a ton
of cleaning and disinfecting products, many of which were toxic.
(07:10):
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,
like keeping these products out of the reach of children,
clearly labeling their packaging, and sticking a pin through the
(07:33):
stopper of toxic products so it would be obvious which
bottle you were about to open. At about the same time,
drug makers were also introducing all kinds of new medications.
This is something that we've talked about in previous episodes,
including our two part are on the litamide. These new
medications also became a potential source of poisoning. With so
(07:53):
many new sources of potential poisoning in people's homes, the
number of accidental exposures sky rocket in Doctors and other
members of the medical community reported huge increases in the
number of patients they 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.
(08:16):
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 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
(08:39):
packing houses, and the safety of food additives. As part
of all this, doctor Harvey Washington wildly studied the effects
of food additives by feeding things to a team of
volunteers who came to be known as the Poison Squad.
There's an episode in our archive about this. It's called
Pure Food Father and His Poison Squad, and it came
(09:00):
out in May. 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 read
the passage of the Pure Food and Drugs Act of
nineteen o six, which is also known as the Wiley Act.
Most of its provisions were focused on food and food additives,
(09:22):
but it also included labeling requirements for drugs, and it
forbade patent medicines in interstate commerce. The Widely Act was
one of the first consumer protection laws of its kind,
and while it did introduce some requirements for drugs and
drug labeling, it didn't really address the many toxic household
products that were being introduced into the market. Then, in
(09:44):
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 sodium hydroxide
also known as lie. As part of this, Chevalier Jackson
of Jefferson Medical College and Philadelphia testified before the Senate
(10:06):
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 all and that had caused
terrible damage to his esophagus. When the mother was asked
why she had given this product to her child, she
said she had not known it was poison. In his testimony,
(10:27):
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 injure the finest fabric or the
most delicate skin. Now, how could you expect any mother
to think that this thing was dangerous? After this and
(10:50):
other testimony, in 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 type that was on the
package or the bottle of the product was in There
wasn't really any data being kept on household poisonings at
(11:12):
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 were made towards the poison
control system that exists today. We'll talk about that more
after we pause for a sponsor break. Overall, manufacturers supported
(11:40):
the Caustic Poison Act when it was signed into law.
In 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 Little Poisons Act that was proposed in
(12:02):
the nineteen thirties. This would have introduced more specific labeling standards,
including marking poisonous products with a skull and cross bones,
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
(12:25):
that have actually increased production, so legislators were worried that
if customers 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
(12:46):
in their practice. In n p. P. Vincent reported that
well over half the esophageal strictures that he had seen
at the Mayo Clinic had been caused because someone had
swallowed lie. Dr J. Arena of Duke University published similar
findings in nineteen thirty nine. In some cases the concentration
(13:07):
of LIE in the product had not been high enough
for the labeling that was required under the Caustic Poison Act.
Also in the nineteen thirties, Louis Goodallman, 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 and their
(13:28):
ingredients on index cards, including what to do in cases
of exposure to those ingredients, creating records for at least
nine thousand products. Eventually, he also started collecting stomach contents
and other samples from poisoning victims for analysis. Through this work,
Goodalman became the go to person for poisoning cases in Chicago.
(13:50):
The pharmacy at St. Luke's Hospital where he worked was
directly across from the emergency room, so it made it
really easy for E R doctors to just come ask
him questions, but he all they took calls at home
and elsewhere twenty four hours a day. As words spread
beyond St. Luke's Hospital of what he was doing, doctors
from other Chicago facilities started to call him for advice
(14:11):
and information as well. It eventually got to the point
that people from other states would call around in Chicago
trying to find this pharmacist that they'd heard about who
knew so much about poisoning. As a Goodloman was becoming
a one man poison hotline. The legal and regulatory landscape
in the United States was continuing to evolve. The Food,
(14:31):
Drug and Cosmetic Act was passed in ninety eight, which
required drugs to be evaluated for safety by the Food
and Drug Administration. In seven, the Federal Insecticide, Fungicide and
Rodenticide Act required these products to be registered with the
f d A. This law updated an earlier version that
was passed in nineteen ten, and among other things, it
(14:54):
required these products to be in child resistant packaging and
clearly labeled with an a appropriate warning. 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,
(15:19):
a patient at Oregon State Hospital was helping out in
the kitchen. He accidentally brought the cooks 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
(15:41):
these kinds of products to be tinted rather than white
and easily mistaken for 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 fifty thousand drugs and household products had
(16:02):
been introduced since World War Two, and there wasn't any
kind 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.
(16:25):
In nineteen fifty three, Dr Edward Press and Louis Godalman
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
(16:45):
poisonings and their antidotes to doctors who were treating affected patients.
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 called elected.
A number of sources also credits some of this work
to an unnamed secretary who would call the area emergency
(17:07):
rooms every morning and ask what the children who had
been 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
(17:32):
Control Center started with a pilot program that ran from
November fift nineteen fifty three to March tenth, nineteen fifty 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 Dr Robert Mellin's
(17:53):
published a 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
(18:17):
American Academy of Pediatrics published a reference book called Accidental
Poisoning in Childhood. Soon, poison control centers were expanding beyond Chicago.
In nineteen fifty seven, the U. S Surgeon General established
the National Clearing House for Poison Control Centers. This was
the federal government's first attempt to try to provide some
(18:37):
standardized resources for poison control and 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
(18:59):
from each year. Also in nineteen fifty seven, 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
(19:21):
one being nearly harmless and six being extremely toxic. 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 Control Centers was founded in nineteen fifty eight,
and by that point the number of poison control centers
(19:42):
in the United States had grown to at least two
hundred sixty five. On April twenty, nineteen fifty nine, Arthur S. Fleming,
the Secretary of Health, released a statement about the poisoning
data that the National clearing House for Poison Control Centers
had compiled between July nineteen fifty six and April ninety eight.
The clearing House reported that almost five hundred child deaths
(20:05):
and six hundred thousand non fatal poisonings were happening per year,
which overwhelmingly occurred at home. More than 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
(20:25):
source of poisoning was candied asprin, which was a chewable
formula developed to be palatable to children and was introduced
in nineteen forty seven. Fleming 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
(20:48):
need for the public to be better educated about poisons
and poison safety. Many of the cases that 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
(21:09):
to food cans or other containers rather than being kept
in their original packaging, as well as hazardous products that
have 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.
(21:36):
The rapid expansion of poison control centers in 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
(21:58):
products in their original packaging and keeping them locked 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
(22:19):
seven with people who were used to the high stress
world of emergency medicine. From the 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
e r. As poison control centers started marketing their services
directly to the public, they also became a positive source
(22:39):
of pr for the hospitals where they were operating. As
more and more people became aware of 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
(23:03):
were in a city that had multiple other poison control centers,
or they were in a location with 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
(23:23):
how it goes for so many projects that someone says,
you can just add the center where it 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 a hundred centers scattered across all their
hospitals and pharmacies and other medical practices. Others had not
(23:45):
enough to really serve their whole community, or they had
no poison control center at all. Even though 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
(24:08):
answered the phone, and in places where there 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
(24:30):
patients to the e R, when people called the poison
control center for advice and we're told to go to
the R, the opposite 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 wait.
(24:54):
In a lot of cases, 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 e 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
(25:14):
holding or in the same 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
(25:36):
federal government continued to add 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.
(26:00):
In nineteen sixty one, those eleven poison control centers that
have been established in the Chicago area were consolidated down
into one facility at Presbyterian St. 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, which is something I learned
(26:24):
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 at the federal level.
(26:45):
National Poison Prevention Week was first observed March two. In
nineteen sixty six, Dr James Goddard, Commissioner of the FDA,
convened a meeting of aspirin producers who voluntarily agreed to
restrict baby aspirint packaging to a non lethal dose. Each
package would contain no more than thirty six tablets of
(27:06):
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
(27:27):
from Mayor. All of these things are, of course, imperfect solutions,
right because of 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
(27:50):
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 Mr Yuck, Officer,
Ug Pinky, the Elephant, Uncle Barf, and No psi Op
(28:13):
the snake with no Siop being poisoned spelled backwards. The
most widely known of these is probably Holly's favorite Mr Yuck,
whose development started in. Dr Richard Moriarty of Pittsburgh Children's
Hospital wanted some kind of child friendly warning or mascot
for toxic products. One reason for this was that the
(28:35):
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 ya sports um. Moriarty started
by asking children what would happen to them if they
got into poison, and their responses were that their parents
(28:57):
would yell at them, they would get sick, or they 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 one by
fourth grader Wendy Brown. A commercial was released in nineteen
seventy one with a Mr. Yuck is Mean, Mr Yuck
is Green theme song. Pittsburgh Children's Hospital made Mr Yuck
(29:21):
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 Mr. Yuck theme song, I won't because I do
not sing well. Uh. More developments followed after this. Of course,
(29:44):
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 ninety eight,
(30:06):
the National Animal 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.
(30:27):
I have a friend whose cat wound up in the
veterinary hospital not long ago at all after eating some lilies.
That same year, the number of poison control centers for
humans reached its peak, with more than six hundred sixty
in the US and its territories. Many of them, as
we talked about earlier, overlapped in their coverage area, some
(30:49):
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
(31:12):
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 a seat
a menifin 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
(31:33):
could be, but the poison control center was ordered to
pay a larger 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 and the nineties. Over the next
(31:53):
decade or so, the poison control center shifted from this
overlapping assortment of centers at multiple hospital 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
(32:14):
or tests in 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
(32:38):
toll free number. The nationwide number of one eight hundred
two two two one two two two was launched in
January of two thousand two. In two thousand three, the
federal government reauthorized the Poison Control Center Enhancement and Awareness Act,
citing the need for emergency preparedness following the nine eleven
terrorist attacks and the ant wrax attack that followed in
(33:01):
October of two thousand one. Today, in the United States,
there are about fifty five regional poison control centers that
serve the entire country. Through that number When people call
the number, it routes them to their regional center. There
is also now an online triage tool at web poison
control dot org. The regional center's staff generally includes pharmacists,
(33:24):
board certified toxicologists and certified specialists, and poison Information or
csp I, and these centers take about four million calls
a year. At this point, the Poison Control Network is
the only real time healthcare database that applies to the
whole US population. Centers also provide education to the public,
(33:44):
as 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 fift are medical personnel. More
than seventy of the people who call poison control do
not wind up meeting to go to the hospital. Numbers
(34:06):
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 need
to call into the poison control system for whatever reason
(34:29):
are covered by Medicare, Medicaid, or Estate 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 to note
that I am not the only person who has had
(34:51):
this whole experience of kind of going where did poison
control come from? Nearly that exact UH scenario inspired a
radio lab episode on poison control that came out in
UM That was after the reporter involved had to call
poison control for their child. UH controlled the poison UM Tracy, Yeah,
(35:15):
do you have non poisonous, non toxic email from I do? UH?
This is from Doug. Doug says Dear Holly and Tracy.
I just listened to your two part episode on insulin.
Early in the first episode, you mentioned that a diabetics
urine was sweet and wondered who verified that. When I
was young, my dad a doctor told us about a
(35:36):
standard practice in medical school where the instructor would dip
his finger into a beaker of diabetic urine demonstrate tasting it.
The beaker was then passed around the room for each
student to taste. Afterwards, the instructor would tell them they
had learned two things. One, the urine of a diabetic
is sweet too the power of observation, because the instructor
dipped his middle finger into the urine and tasted his
(35:58):
index finger. This scenario was used in the movie Young
Doctors in Love roughly twenty years after I heard about
it from my dad. Plays out a little differently in
the movie, but the concept is the same. Thank you
for your always interesting podcast. I like the addition of
your behind the scenes many as I really enjoy the
more casual discussion of the week's topics. Doug. Thank you, Doug.
(36:18):
I wanted to read this email number one because it
was funny to me. Uh number two. We've gotten a
couple of notes from people who remember this same urine
tasting scene in the TV show Outlander Um, which yes,
I also remember being a person who watches Outlander Um,
and they just to make it into the episode for
(36:40):
whatever reason. So anyway, if you'd like to write to
us about this or any other podcast that's currently the
best way to reach us rather than physical mail, as
we are all working from home for the time being.
Um So we're at history podcast at my heart radio
dot com, and then we're also all over social media
at missed in History Me. That's where we'll fund our Facebook, Pinterest, Twitter,
(37:02):
and Instagram, and you can subscribe to our show on
Apple podcast, the I heart radio app, and anywhere else
you get your podcast. Stuff you Missed in History Class
is a production of I heart Radio. For more podcasts
from I heart Radio, visit the i heart Radio app,
Apple Podcasts, or wherever you listen to your favorite shows.
Welcome to Stuff you missed in History Class, a production
of I Heart Radio, Go Low, and welcome to the podcast.
I'm Tracy V. Wilson and I'm Holly fry Uh. In
case you've never heard our show before, this is episode
(00:21):
two of us recording the show with everyone involved in
the process in their own homes. Because the current pandemic
and resulting UM quarantine slash shelter in place slash self
isolation slash social distancing instructions, we have all been under UM.
(00:42):
So if you're a longtime listener and you're like, why
doesn't that 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. So the
other day it was time to give our kittens or
flee and tick prevention. And then afterward, I was idly
(01:04):
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 want to do on the box instead
of directing people to call poison control. But then I
was like, where did poison control even come from? How
did we get to the point of having this one
(01:24):
resource specifically for poisoning that's so reliable and available that
companies can print it on the labels of consumer products
um and especially here in the US where Holly and
I are, this is a health care service that is
staff seven and of inaccessible to everyone for free, which
is not a thing that exists in many other contexts.
(01:46):
I mean, there are some other 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 and nine and today they exist in a
lot of countries around the world, particularly in the America's
(02:06):
Western Europe and parts of the Middle East. According to
the World Health Organization, 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 really where we're focusing on with
this story today. So you can really define the word
(02:28):
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. Sometimes people describe being envenomed
(02:48):
from something like a snake bite or insects staying 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 can become lethal. To be clear,
(03:09):
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 Chigella bacteria. There are food
born illnesses that involve pathogens that can produce toxins, and
(03:31):
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 someone 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 the world. Most places have at least
(03:52):
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 berries that they had gathered to
(04:13):
eat two 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 pharmacists could sell them, and
(04:36):
they had to keep a careful record of every sale.
There was not a similar 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, but broad legislation didn't come
(04:56):
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. Manufacturers also used textured
(05:21):
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 to keep the
druggist from selling somebody something dangerous by accident, not to
(05:45):
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 medicines
that could be harmful at high doses, but in general,
(06:06):
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 a skull and crossbones on it. Another argument was
that consumers might put their products in a different container
or reuse that skull and crossbone bottle to hold some
(06:26):
other harmless substance, and that could just create all kinds
of confusion. By the part of the twentie century, a
couple of simultaneous developments dramatically increase the number of poisons
that most people had in their homes. The germ theory
of disease had become more widely accepted and generally known,
so people became kind of hyper aware of the idea
(06:46):
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, and news articles, women's magazines, and that
type of thing. As a result, manufacturers introduced a ton
of cleaning and disinfecting products, many of which were toxic.
(07:10):
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,
like keeping these products out of the reach of children,
clearly labeling their packaging, and sticking a pin through the
(07:33):
stopper of toxic products so it would be obvious which
bottle you were about to open. At about the same time,
drug makers were also introducing all kinds of new medications.
This is something that we've talked about in previous episodes,
including our two part are on the litamide. These new
medications also became a potential source of poisoning. With so
(07:53):
many new sources of potential poisoning in people's homes, the
number of accidental exposures sky rocket in Doctors and other
members of the medical community reported huge increases in the
number of patients they 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.
(08:16):
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 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
(08:39):
packing houses, and the safety of food additives. As part
of all this, doctor Harvey Washington wildly studied the effects
of food additives by feeding things to a team of
volunteers who came to be known as the Poison Squad.
There's an episode in our archive about this. It's called
Pure Food Father and His Poison Squad, and it came
(09:00):
out in May. 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 read
the passage of the Pure Food and Drugs Act of
nineteen o six, which is also known as the Wiley Act.
Most of its provisions were focused on food and food additives,
(09:22):
but it also included labeling requirements for drugs, and it
forbade patent medicines in interstate commerce. The Widely Act was
one of the first consumer protection laws of its kind,
and while it did introduce some requirements for drugs and
drug labeling, it didn't really address the many toxic household
products that were being introduced into the market. Then, in
(09:44):
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 sodium hydroxide
also known as lie. As part of this, Chevalier Jackson
of Jefferson Medical College and Philadelphia testified before the Senate
(10:06):
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 all and that had caused
terrible damage to his esophagus. When the mother was asked
why she had given this product to her child, she
said she had not known it was poison. In his testimony,
(10:27):
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 injure the finest fabric or the
most delicate skin. Now, how could you expect any mother
to think that this thing was dangerous? After this and
(10:50):
other testimony, in 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 type that was on the
package or the bottle of the product was in There
wasn't really any data being kept on household poisonings at
(11:12):
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 were made towards the poison
control system that exists today. We'll talk about that more
after we pause for a sponsor break. Overall, manufacturers supported
(11:40):
the Caustic Poison Act when it was signed into law.
In 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 Little Poisons Act that was proposed in
(12:02):
the nineteen thirties. This would have introduced more specific labeling standards,
including marking poisonous products with a skull and cross bones,
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
(12:25):
that have actually increased production, so legislators were worried that
if customers 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
(12:46):
in their practice. In n p. P. Vincent reported that
well over half the esophageal strictures that he had seen
at the Mayo Clinic had been caused because someone had
swallowed lie. Dr J. Arena of Duke University published similar
findings in nineteen thirty nine. In some cases the concentration
(13:07):
of LIE in the product had not been high enough
for the labeling that was required under the Caustic Poison Act.
Also in the nineteen thirties, Louis Goodallman, 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 and their
(13:28):
ingredients on index cards, including what to do in cases
of exposure to those ingredients, creating records for at least
nine thousand products. Eventually, he also started collecting stomach contents
and other samples from poisoning victims for analysis. Through this work,
Goodalman became the go to person for poisoning cases in Chicago.
(13:50):
The pharmacy at St. Luke's Hospital where he worked was
directly across from the emergency room, so it made it
really easy for E R doctors to just come ask
him questions, but he all they took calls at home
and elsewhere twenty four hours a day. As words spread
beyond St. Luke's Hospital of what he was doing, doctors
from other Chicago facilities started to call him for advice
(14:11):
and information as well. It eventually got to the point
that people from other states would call around in Chicago
trying to find this pharmacist that they'd heard about who
knew so much about poisoning. As a Goodloman was becoming
a one man poison hotline. The legal and regulatory landscape
in the United States was continuing to evolve. The Food,
(14:31):
Drug and Cosmetic Act was passed in ninety eight, which
required drugs to be evaluated for safety by the Food
and Drug Administration. In seven, the Federal Insecticide, Fungicide and
Rodenticide Act required these products to be registered with the
f d A. This law updated an earlier version that
was passed in nineteen ten, and among other things, it
(14:54):
required these products to be in child resistant packaging and
clearly labeled with an a appropriate warning. 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,
(15:19):
a patient at Oregon State Hospital was helping out in
the kitchen. He accidentally brought the cooks 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
(15:41):
these kinds of products to be tinted rather than white
and easily mistaken for 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 fifty thousand drugs and household products had
(16:02):
been introduced since World War Two, and there wasn't any
kind 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.
(16:25):
In nineteen fifty three, Dr Edward Press and Louis Godalman
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
(16:45):
poisonings and their antidotes to doctors who were treating affected patients.
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 called elected.
A number of sources also credits some of this work
to an unnamed secretary who would call the area emergency
(17:07):
rooms every morning and ask what the children who had
been 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
(17:32):
Control Center started with a pilot program that ran from
November fift nineteen fifty three to March tenth, nineteen fifty 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 Dr Robert Mellin's
(17:53):
published a 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
(18:17):
American Academy of Pediatrics published a reference book called Accidental
Poisoning in Childhood. Soon, poison control centers were expanding beyond Chicago.
In nineteen fifty seven, the U. S Surgeon General established
the National Clearing House for Poison Control Centers. This was
the federal government's first attempt to try to provide some
(18:37):
standardized resources for poison control and 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
(18:59):
from each year. Also in nineteen fifty seven, 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
(19:21):
one being nearly harmless and six being extremely toxic. 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 Control Centers was founded in nineteen fifty eight,
and by that point the number of poison control centers
(19:42):
in the United States had grown to at least two
hundred sixty five. On April twenty, nineteen fifty nine, Arthur S. Fleming,
the Secretary of Health, released a statement about the poisoning
data that the National clearing House for Poison Control Centers
had compiled between July nineteen fifty six and April ninety eight.
The clearing House reported that almost five hundred child deaths
(20:05):
and six hundred thousand non fatal poisonings were happening per year,
which overwhelmingly occurred at home. More than 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
(20:25):
source of poisoning was candied asprin, which was a chewable
formula developed to be palatable to children and was introduced
in nineteen forty seven. Fleming 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
(20:48):
need for the public to be better educated about poisons
and poison safety. Many of the cases that 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
(21:09):
to food cans or other containers rather than being kept
in their original packaging, as well as hazardous products that
have 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.
(21:36):
The rapid expansion of poison control centers in 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
(21:58):
products in their original packaging and keeping them locked 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
(22:19):
seven with people who were used to the high stress
world of emergency medicine. From the 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
e r. As poison control centers started marketing their services
directly to the public, they also became a positive source
(22:39):
of pr for the hospitals where they were operating. As
more and more people became aware of 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
(23:03):
were in a city that had multiple other poison control centers,
or they were in a location with 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
(23:23):
how it goes for so many projects that someone says,
you can just add the center where it 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 a hundred centers scattered across all their
hospitals and pharmacies and other medical practices. Others had not
(23:45):
enough to really serve their whole community, or they had
no poison control center at all. Even though 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
(24:08):
answered the phone, and in places where there 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
(24:30):
patients to the e R, when people called the poison
control center for advice and we're told to go to
the R, the opposite 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 wait.
(24:54):
In a lot of cases, 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 e 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
(25:14):
holding or in the same 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
(25:36):
federal government continued to add 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.
(26:00):
In nineteen sixty one, those eleven poison control centers that
have been established in the Chicago area were consolidated down
into one facility at Presbyterian St. 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, which is something I learned
(26:24):
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 at the federal level.
(26:45):
National Poison Prevention Week was first observed March two. In
nineteen sixty six, Dr James Goddard, Commissioner of the FDA,
convened a meeting of aspirin producers who voluntarily agreed to
restrict baby aspirint packaging to a non lethal dose. Each
package would contain no more than thirty six tablets of
(27:06):
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
(27:27):
from Mayor. All of these things are, of course, imperfect solutions,
right because of 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
(27:50):
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 Mr Yuck, Officer,
Ug Pinky, the Elephant, Uncle Barf, and No psi Op
(28:13):
the snake with no Siop being poisoned spelled backwards. The
most widely known of these is probably Holly's favorite Mr Yuck,
whose development started in. Dr Richard Moriarty of Pittsburgh Children's
Hospital wanted some kind of child friendly warning or mascot
for toxic products. One reason for this was that the
(28:35):
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 ya sports um. Moriarty started
by asking children what would happen to them if they
got into poison, and their responses were that their parents
(28:57):
would yell at them, they would get sick, or they 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 one by
fourth grader Wendy Brown. A commercial was released in nineteen
seventy one with a Mr. Yuck is Mean, Mr Yuck
is Green theme song. Pittsburgh Children's Hospital made Mr Yuck
(29:21):
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 Mr. Yuck theme song, I won't because I do
not sing well. Uh. More developments followed after this. Of course,
(29:44):
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 ninety eight,
(30:06):
the National Animal 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.
(30:27):
I have a friend whose cat wound up in the
veterinary hospital not long ago at all after eating some lilies.
That same year, the number of poison control centers for
humans reached its peak, with more than six hundred sixty
in the US and its territories. Many of them, as
we talked about earlier, overlapped in their coverage area, some
(30:49):
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
(31:12):
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 a seat
a menifin 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
(31:33):
could be, but the poison control center was ordered to
pay a larger 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 and the nineties. Over the next
(31:53):
decade or so, the poison control center shifted from this
overlapping assortment of centers at multiple hospital 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
(32:14):
or tests in 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
(32:38):
toll free number. The nationwide number of one eight hundred
two two two one two two two was launched in
January of two thousand two. In two thousand three, the
federal government reauthorized the Poison Control Center Enhancement and Awareness Act,
citing the need for emergency preparedness following the nine eleven
terrorist attacks and the ant wrax attack that followed in
(33:01):
October of two thousand one. Today, in the United States,
there are about fifty five regional poison control centers that
serve the entire country. Through that number When people call
the number, it routes them to their regional center. There
is also now an online triage tool at web poison
control dot org. The regional center's staff generally includes pharmacists,
(33:24):
board certified toxicologists and certified specialists, and poison Information or
csp I, and these centers take about four million calls
a year. At this point, the Poison Control Network is
the only real time healthcare database that applies to the
whole US population. Centers also provide education to the public,
(33:44):
as 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 fift are medical personnel. More
than seventy of the people who call poison control do
not wind up meeting to go to the hospital. Numbers
(34:06):
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 need
to call into the poison control system for whatever reason
(34:29):
are covered by Medicare, Medicaid, or Estate 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 to note
that I am not the only person who has had
(34:51):
this whole experience of kind of going where did poison
control come from? Nearly that exact UH scenario inspired a
radio lab episode on poison control that came out in
UM That was after the reporter involved had to call
poison control for their child. UH controlled the poison UM Tracy, Yeah,
(35:15):
do you have non poisonous, non toxic email from I do? UH?
This is from Doug. Doug says Dear Holly and Tracy.
I just listened to your two part episode on insulin.
Early in the first episode, you mentioned that a diabetics
urine was sweet and wondered who verified that. When I
was young, my dad a doctor told us about a
(35:36):
standard practice in medical school where the instructor would dip
his finger into a beaker of diabetic urine demonstrate tasting it.
The beaker was then passed around the room for each
student to taste. Afterwards, the instructor would tell them they
had learned two things. One, the urine of a diabetic
is sweet too the power of observation, because the instructor
dipped his middle finger into the urine and tasted his
(35:58):
index finger. This scenario was used in the movie Young
Doctors in Love roughly twenty years after I heard about
it from my dad. Plays out a little differently in
the movie, but the concept is the same. Thank you
for your always interesting podcast. I like the addition of
your behind the scenes many as I really enjoy the
more casual discussion of the week's topics. Doug. Thank you, Doug.
(36:18):
I wanted to read this email number one because it
was funny to me. Uh number two. We've gotten a
couple of notes from people who remember this same urine
tasting scene in the TV show Outlander Um, which yes,
I also remember being a person who watches Outlander Um,
and they just to make it into the episode for
(36:40):
whatever reason. So anyway, if you'd like to write to
us about this or any other podcast that's currently the
best way to reach us rather than physical mail, as
we are all working from home for the time being.
Um So we're at history podcast at my heart radio
dot com, and then we're also all over social media
at missed in History Me. That's where we'll fund our Facebook, Pinterest, Twitter,
(37:02):
and Instagram, and you can subscribe to our show on
Apple podcast, the I heart radio app, and anywhere else
you get your podcast. Stuff you Missed in History Class
is a production of I heart Radio. For more podcasts
from I heart Radio, visit the i heart Radio app,
Apple Podcasts, or wherever you listen to your favorite shows.
Stuff You Missed in History Class News
Hosts And Creators
Holly Frey
Tracy Wilson
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