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