WEBVTT - SYMHC Class: Poison Control 0:00:02.360 --> 0:00:06.080 Happy Saturday. In our behind the scenes episode yesterday, we 0:00:06.320 --> 0:00:11.080 mentioned our prior episode on poison Control, so we're bringing 0:00:11.080 --> 0:00:14.920 that out us Today's Saturday Classic. This episode originally came 0:00:14.960 --> 0:00:21.279 out on March twenty fifth, twenty twenty. Enjoy Welcome to 0:00:21.320 --> 0:00:31.760 Stuff You Missed in History Class, a production of iHeartRadio. Hello, 0:00:31.880 --> 0:00:34.839 and welcome to the podcast. I'm Tracy V. Wilson and 0:00:34.880 --> 0:00:39.720 I'm Holly Prye. In case you've never heard our show before, 0:00:39.800 --> 0:00:43.680 this is episode two of us recording the show with 0:00:43.880 --> 0:00:47.400 everyone involved in the process in their own homes because 0:00:47.520 --> 0:00:54.360 of the current pandemic and resulting quarantine slash shelter in 0:00:54.440 --> 0:00:59.800 place slash self isolation slash social distancing instructions we have 0:00:59.840 --> 0:01:03.560 all been under. Yeah, So if you're a longtime listener 0:01:03.760 --> 0:01:05.640 and you're like, why doesn't this sound quite the same, 0:01:05.920 --> 0:01:08.560 that's why. If you're brand new, that's just a heads up. 0:01:08.840 --> 0:01:11.800 That's where we are right now. And we coincidentally have 0:01:11.840 --> 0:01:14.120 a medical history week that we did not plan that 0:01:14.240 --> 0:01:16.479 just happens to be falling in line with all of this. 0:01:17.240 --> 0:01:18.760 So the other day it was time to give our 0:01:18.880 --> 0:01:22.640 kittens their flea and tick prevention and then afterward I 0:01:22.760 --> 0:01:24.720 was idly reading the back of the box while I 0:01:24.760 --> 0:01:26.720 was washing my hands, and I noticed that it said 0:01:26.760 --> 0:01:31.400 to contact poison control if swallowed, And at first I thought, 0:01:31.800 --> 0:01:34.240 why not just print what to do on the box 0:01:34.800 --> 0:01:37.319 instead of directing people to call poison control? But then 0:01:37.319 --> 0:01:40.759 I was like, where did poison control even come from? 0:01:41.120 --> 0:01:43.560 How did we get to the point of having this 0:01:43.680 --> 0:01:49.200 one resource specifically for poisoning that's so reliable and available 0:01:49.400 --> 0:01:53.280 that companies can print it on the labels of consumer products, 0:01:54.000 --> 0:01:56.520 and especially here in the US where Holly and I are. 0:01:56.760 --> 0:01:59.200 This is a healthcare service that is staffed twenty four 0:01:59.240 --> 0:02:02.520 to seven and of and accessible to everyone for free, 0:02:02.600 --> 0:02:05.400 which is not a thing that exists in many other contexts. 0:02:05.440 --> 0:02:07.960 I mean, there are some other twenty four hour hotlines, 0:02:08.000 --> 0:02:11.480 but like, it's not often that anybody, literally anyone can 0:02:11.560 --> 0:02:14.440 call a medical professional twenty four hours a day and 0:02:14.480 --> 0:02:18.480 get an answer for free. The first service like this 0:02:18.680 --> 0:02:21.840 was established in the Netherlands in nineteen forty nine, and 0:02:21.960 --> 0:02:24.320 today they exist in a lot of countries around the world, 0:02:24.400 --> 0:02:27.200 particularly in the Americas, Western Europe, and parts of the 0:02:27.240 --> 0:02:31.040 Middle East. According to the World Health Organization, forty seven 0:02:31.120 --> 0:02:34.400 percent of member states have a poison center of some sort. 0:02:35.040 --> 0:02:37.640 But because the development of poison control centers in the 0:02:37.760 --> 0:02:41.920 US closely parallels some other shifts in American history, that's 0:02:42.000 --> 0:02:45.280 really where we're focusing on with this story today. So 0:02:45.480 --> 0:02:48.600 you can really define the word poisoning in a lot 0:02:48.639 --> 0:02:51.720 of different ways, but in general, it is any toxin 0:02:51.800 --> 0:02:56.160 related injury. The toxin can come from all kinds of sources, 0:02:56.400 --> 0:03:00.400 cleaning products, medications, mushrooms out in the yard, and things 0:03:00.440 --> 0:03:04.800 that we actually think of poisons, like insecticides and rat poisons. 0:03:05.280 --> 0:03:08.880 Sometimes people describe being envenomed from something like a snake 0:03:08.919 --> 0:03:12.320 bite or insect sting. Also is being poisoned that a 0:03:12.320 --> 0:03:15.560 lot of cases, exposure to a small amount of one 0:03:15.560 --> 0:03:18.120 of these substances isn't really dangerous, and when it's something 0:03:18.200 --> 0:03:21.760 like medicine, that can be helpful rather than harmful, but 0:03:21.880 --> 0:03:26.120 in large enough amounts, otherwise harmless or even beneficial substances 0:03:26.200 --> 0:03:29.880 can become lethal. To be clear, we also use terms 0:03:29.919 --> 0:03:33.480 like sun poisoning and food poisoning, but that's not really 0:03:33.480 --> 0:03:36.760 what we're talking about here. Sun poisoning is actually a 0:03:36.800 --> 0:03:40.040 severe type of sunburn, and in most cases, food poisoning 0:03:40.120 --> 0:03:43.400 is an illness that's caused by a pathogen like salmonella 0:03:43.520 --> 0:03:47.920 or Schagella bacteria. There are food borne illnesses that involve 0:03:48.000 --> 0:03:52.040 pathogens that can produce toxins, and foods can be contaminated 0:03:52.080 --> 0:03:55.560 with toxic substances. But most of the time, when we 0:03:55.600 --> 0:03:58.720 say food poisoning, we're actually talking about an illness, not 0:03:58.960 --> 0:04:02.160 a poison that some and put in your food. People 0:04:02.200 --> 0:04:05.440 have been exposed to poisons, of course, throughout human history. 0:04:05.760 --> 0:04:09.200 There are toxic plants and fungi and metals all over 0:04:09.240 --> 0:04:12.920 the world. Most places have at least some species of 0:04:13.000 --> 0:04:16.640 venomous animals. People have also done things like making their 0:04:16.760 --> 0:04:20.480 drinking vessels or makeup out of toxic metals like lead, 0:04:21.120 --> 0:04:26.800 but household toxins really started to proliferate with industrialization. Over time, 0:04:26.839 --> 0:04:30.680 people's most likely sources of poisoning shifted from things like 0:04:30.839 --> 0:04:33.880 berries that they had gathered to eat to things like 0:04:34.000 --> 0:04:37.679 cleaning products and pharmaceuticals. In some parts of the world, 0:04:37.920 --> 0:04:40.760 governments passed laws to try to protect people from the 0:04:40.760 --> 0:04:45.600 most potentially dangerous products starting in the nineteenth century. For example, 0:04:45.760 --> 0:04:49.880 in the UK, the eighteen sixty eight Pharmacy Act restricted 0:04:49.880 --> 0:04:53.760 the sale of a specific set of poisons. Only licensed 0:04:53.760 --> 0:04:56.479 pharmacists could sell them, and they had to keep a 0:04:56.520 --> 0:05:00.000 careful record of every sale. There was not a simil 0:05:00.360 --> 0:05:03.359 federal law in the US, but between eighteen seventy and 0:05:03.400 --> 0:05:07.480 eighteen ninety thirty three states adopted some kind of regulation 0:05:07.640 --> 0:05:10.760 on the sale of poisons at the federal level. The 0:05:10.800 --> 0:05:14.360 first bills were introduced into Congress in eighteen seventy nine, 0:05:14.440 --> 0:05:18.920 but broad legislation didn't come along until much later. Manufacturers 0:05:19.040 --> 0:05:22.359 also recognized the potential dangers involved with the products that 0:05:22.400 --> 0:05:25.480 they were making. Starting in the late eighteenth and early 0:05:25.560 --> 0:05:30.040 nineteenth centuries, manufacturers of things like rat poisons packaged their 0:05:30.080 --> 0:05:33.960 products in distinctively shaped bottles, marked with things like skulls 0:05:33.960 --> 0:05:37.720 and crossbones and the word poison. To try to prevent accidents. 0:05:38.560 --> 0:05:42.280 Manufacturers also used textured glass bottles so that people could 0:05:42.279 --> 0:05:44.920 tell what they were holding just by touch, and they 0:05:44.960 --> 0:05:49.080 also developed safety caps. Most of these innovations weren't being 0:05:49.160 --> 0:05:52.640 used on products that were being sold directly to consumers, though, 0:05:53.240 --> 0:05:56.080 they were being used on products that would be repackaged 0:05:56.080 --> 0:05:59.240 at a pharmacy or another store. So the idea was 0:05:59.320 --> 0:06:03.719 to keep the ruggists from selling somebody something dangerous by accident, 0:06:04.360 --> 0:06:07.680 not to prevent the consumer at home from accidentally hurting 0:06:07.720 --> 0:06:11.279 themselves or someone else. By the middle of the nineteenth century, 0:06:11.400 --> 0:06:16.600 the American Pharmaceutical Association and American Medical Association had each 0:06:16.720 --> 0:06:21.960 passed resolutions recommending clearer labeling on dangerous household products, including 0:06:22.000 --> 0:06:25.760 medicines that could be harmful at high doses. But in general, 0:06:25.920 --> 0:06:29.520 manufacturers resisted laws that required this kind of packaging and 0:06:29.640 --> 0:06:33.719 labeling on consumer products. They argued that people might not 0:06:33.880 --> 0:06:36.240 buy a product that was in a scary looking bottle 0:06:36.279 --> 0:06:39.560 with the skull and crossbones on it. Another argument was 0:06:39.600 --> 0:06:42.680 that consumers might put their products in a different container 0:06:42.880 --> 0:06:45.839 or reuse that skull and crossbone bottle to hold some 0:06:45.920 --> 0:06:48.720 other harmless substance, and that could just create all kinds 0:06:48.720 --> 0:06:51.760 of confusion. By the tart of the twentieth century, a 0:06:51.839 --> 0:06:56.360 couple of simultaneous developments dramatically increased the number of poisons 0:06:56.440 --> 0:06:59.239 that most people had in their homes. The germ theory 0:06:59.279 --> 0:07:02.839 of disease had become more widely accepted and generally known, 0:07:02.960 --> 0:07:06.239 so people became kind of hyper aware of the idea 0:07:06.320 --> 0:07:11.120 of germs infesting their homes and infecting their families. Progressive 0:07:11.160 --> 0:07:15.680 reformers were also advocating ideas like good hygiene and cleanliness. 0:07:15.720 --> 0:07:17.640 There was just messaging about this kind of thing all 0:07:17.680 --> 0:07:20.520 over the place in news articles and women's magazines and 0:07:20.520 --> 0:07:24.320 that type of thing. As a result, manufacturers introduced a 0:07:24.400 --> 0:07:28.880 ton of cleaning and disinfecting products, many of which were toxic. 0:07:29.480 --> 0:07:33.040 They marketed these products primarily to women as household time 0:07:33.120 --> 0:07:36.600 savers and as a vital part of keeping a clean home. 0:07:37.360 --> 0:07:40.520 Women's magazines also caught up to the trend and published 0:07:40.560 --> 0:07:45.520 household cleaning and sanitation tips, along with consumer education about safety, 0:07:45.720 --> 0:07:48.560 like keeping these products out of the reach of children, 0:07:49.040 --> 0:07:52.440 clearly labeling their packaging, and sticking a pin through the 0:07:52.480 --> 0:07:55.440 stopper of toxic products so it would be obvious which 0:07:55.480 --> 0:07:58.440 bottle you were about to open. At About the same time, 0:07:58.720 --> 0:08:02.880 drug makers were all so introducing all kinds of new medications. 0:08:03.280 --> 0:08:05.880 This is something that we've talked about in previous episodes, 0:08:05.880 --> 0:08:10.000 including our two parter on tholdamide. These new medications also 0:08:10.080 --> 0:08:13.800 became a potential source of poisoning. With so many new 0:08:13.840 --> 0:08:17.760 sources of potential poisoning in people's homes, the number of 0:08:17.800 --> 0:08:22.520 accidental exposures skyrocketed. Doctors and other members of the medical 0:08:22.520 --> 0:08:26.000 community reported huge increases in the number of patients they 0:08:26.040 --> 0:08:29.560 saw who had been harmed by a poisonous product, and 0:08:29.640 --> 0:08:33.040 because these products were brand new, doctors often didn't know 0:08:33.080 --> 0:08:36.840 what to do to treat these exposures. During the progressive era, 0:08:37.120 --> 0:08:40.559 muck raking journalists also tried to expose the dangers of 0:08:40.600 --> 0:08:45.439 these products, especially if they were poorly labeled or incorrectly handled. 0:08:45.960 --> 0:08:49.440 Running in parallel with this focus on household poisons was 0:08:49.440 --> 0:08:53.200 a similar focus on food safety. This included the safety 0:08:53.240 --> 0:08:57.160 and quality of the foods themselves, the cleanliness and safety 0:08:57.280 --> 0:09:00.600 of facilities like slaughter houses and packing houses, and the 0:09:00.640 --> 0:09:04.000 safety of food additives. As part of all this, doctor 0:09:04.080 --> 0:09:08.480 Harvey Washington Wiley studied the effects of food additives by 0:09:08.559 --> 0:09:11.360 feeding things to a team of volunteers who came to 0:09:11.400 --> 0:09:14.520 be known as the Poison Squad. There's an episode in 0:09:14.559 --> 0:09:17.800 our archive about this. It's called A Pure Food Father 0:09:17.920 --> 0:09:20.120 and His Poison Squad, and it came out in May 0:09:20.200 --> 0:09:23.920 of twenty eleven. It's shorter than our episodes typically are today, 0:09:23.960 --> 0:09:25.880 and I haven't found a good companion to kind of 0:09:25.960 --> 0:09:28.240 pair it with, so we haven't lined up as a 0:09:28.280 --> 0:09:32.080 Saturday classic as of yet. All of this together led 0:09:32.120 --> 0:09:34.679 to the passage of the Pure Food and Drugs Act 0:09:34.760 --> 0:09:36.920 of nineteen oh six, which is also known as the 0:09:36.960 --> 0:09:40.720 Wiley Act. Most of its provisions were focused on food 0:09:40.800 --> 0:09:44.840 and food additives, but it also included labeling requirements for drugs, 0:09:45.280 --> 0:09:49.800 and it forbade patent medicines in interstate commerce. The Wiley 0:09:49.920 --> 0:09:52.600 Act was one of the first consumer protection laws of 0:09:52.640 --> 0:09:56.000 its kind, and while it did introduce some requirements for 0:09:56.120 --> 0:09:59.720 drugs and drug labeling, it didn't really address the many 0:09:59.760 --> 0:10:03.920 talk household products that were being introduced into the market. Then, 0:10:03.960 --> 0:10:07.280 in nineteen twenty six, bills were introduced in the House 0:10:07.320 --> 0:10:10.080 and the Senate that required labeling for a list of 0:10:10.160 --> 0:10:15.800 caustic substances. This included several acids, ammonia, silver nitrate, and 0:10:15.920 --> 0:10:20.040 sodium hydroxide also known as LYE. As part of this 0:10:20.440 --> 0:10:25.559 Chevroyet Jackson of Jefferson Medical College and Philadelphia testified before 0:10:25.640 --> 0:10:28.680 the Senate about injuries that he had witnessed from these 0:10:28.720 --> 0:10:32.200 types of substances in his practice. One case was a 0:10:32.320 --> 0:10:35.560 child who swallowed a product called clean al and that 0:10:35.679 --> 0:10:39.720 had caused terrible damage to his esophagus. When the mother 0:10:40.000 --> 0:10:42.600 was asked why she had given this product to her child, 0:10:42.679 --> 0:10:45.559 she said she had not known it was poison. In 0:10:45.600 --> 0:10:49.240 his testimony, Jackson said, quote, I got her to bring 0:10:49.280 --> 0:10:51.600 me a can, and here you can see on this 0:10:51.720 --> 0:10:54.600 can that I have here, which was bought in the stores, 0:10:54.880 --> 0:10:58.000 that there is not only no poison label whatever on it, 0:10:58.320 --> 0:11:00.920 but it says does not in ma, You're the finest 0:11:00.920 --> 0:11:04.680 fabric or the most delicate skin. Now, how could you 0:11:04.760 --> 0:11:07.760 expect any mother to think that this thing was dangerous? 0:11:08.520 --> 0:11:12.079 After this and other testimony, in nineteen twenty seven, President 0:11:12.120 --> 0:11:16.280 Calvin Coolidge signed the Caustic Poison Act into law. This 0:11:16.360 --> 0:11:20.000 act required a list of caustic poisons to be clearly labeled, 0:11:20.080 --> 0:11:23.680 with the warnings and contrasting colors also in the largest 0:11:23.840 --> 0:11:25.880 type that was on the package or the bottle that 0:11:25.880 --> 0:11:29.600 the product was in. There wasn't really any data being 0:11:29.720 --> 0:11:33.640 kept on household poisonings at this point, but anecdotally justice 0:11:33.760 --> 0:11:37.680 labeling requirements significantly reduced the number of poisoning deaths that 0:11:37.720 --> 0:11:41.400 were happening. Household poisoning was still a problem, though, and 0:11:41.440 --> 0:11:44.000 it was not long after this that the first steps 0:11:44.040 --> 0:11:46.960 were made toward the poison control system that exists today. 0:11:47.440 --> 0:11:49.480 We'll talk about that more after we pause for a 0:11:49.520 --> 0:12:04.199 sponsor break. Overall, manufacturers supported the Caustic Poison Act when 0:12:04.200 --> 0:12:07.160 it was assigned into law in nineteen twenty seven. It 0:12:07.200 --> 0:12:11.560 replaced a previous and sometimes really contradictory hodgepodge of state 0:12:11.679 --> 0:12:14.880 regulations on labeling, so it kind of made things easier 0:12:14.920 --> 0:12:20.920 from the manufacturer's perspective, but they resisted broader regulations, including 0:12:20.960 --> 0:12:24.000 a Federal Volatile Poisons Act that was proposed in the 0:12:24.040 --> 0:12:28.480 nineteen thirties. This would have introduced more specific labeling standards, 0:12:28.520 --> 0:12:33.160 including marking poisonous products with a skull and crossbones, something 0:12:33.160 --> 0:12:37.560 that had also been proposed earlier. On Again, manufacturers argued 0:12:37.559 --> 0:12:40.920 that this labeling would just keep people from buying the products. 0:12:41.320 --> 0:12:44.120 This was happening during the Great Depression, and the chemical 0:12:44.160 --> 0:12:47.240 manufacturing industry was one of a very few that have 0:12:47.400 --> 0:12:52.199 actually increased production, so legislators were worried that if customers 0:12:52.240 --> 0:12:55.760 did become reluctant to buy these products, as manufacturers feared 0:12:55.760 --> 0:12:58.600 they would, it would harm one of the few industries 0:12:58.679 --> 0:13:02.560 it was not seriously struggling. Meanwhile, in the late nineteen 0:13:02.600 --> 0:13:06.720 twenties and early nineteen thirties, multiple doctors published papers on 0:13:06.760 --> 0:13:09.760 the patterns of poisoning that they were seeing in their practice. 0:13:10.200 --> 0:13:13.960 In nineteen twenty seven, pp. Vinson reported that well over 0:13:14.120 --> 0:13:17.240 half the esophageal strictures that he had seen at the 0:13:17.360 --> 0:13:21.360 Mayo Clinic had been caused because someone had swallowed LYE. 0:13:22.240 --> 0:13:26.320 Doctor J. Arena of Duke University published similar findings in 0:13:26.400 --> 0:13:30.120 nineteen thirty nine. In some cases, the concentration of LIE 0:13:30.200 --> 0:13:32.480 in the product had not been high enough for the 0:13:32.600 --> 0:13:36.319 labeling that was required under the Caustic Poison Act. Also 0:13:36.400 --> 0:13:39.640 in the nineteen thirties, Lewis Godalman, who was a pharmacist 0:13:39.720 --> 0:13:43.000 in Chicago who also had a chemistry degree, was also 0:13:43.160 --> 0:13:46.760 collecting information on poisonings and the products and substances that 0:13:46.800 --> 0:13:50.800 had caused them. He started documenting products in their ingredients 0:13:50.840 --> 0:13:53.680 on index cards, including what to do in cases of 0:13:53.720 --> 0:13:57.560 exposure to those ingredients, creating records for at least nine 0:13:57.640 --> 0:14:02.880 thousand products. Eventually, he also started collecting stomach contents and 0:14:02.960 --> 0:14:07.280 other samples from poisoning victims for analysis. Through this work, 0:14:07.360 --> 0:14:11.319 Godalman became the go to person for poisoning cases in Chicago. 0:14:12.000 --> 0:14:14.760 The pharmacy at Saint Luke's Hospital where he worked was 0:14:14.840 --> 0:14:17.600 directly across from the emergency room, so it made it 0:14:17.679 --> 0:14:20.880 really easy for er doctors to just come ask him questions. 0:14:21.400 --> 0:14:24.640 But he also took calls at home and elsewhere twenty 0:14:24.680 --> 0:14:28.080 four hours a day. As words spread beyond Saint Luke's 0:14:28.080 --> 0:14:31.040 Hospital of what he was doing, doctors from other Chicago 0:14:31.120 --> 0:14:34.440 facilities started to call him for advice and information as well. 0:14:35.080 --> 0:14:37.200 It eventually got to the point that people from other 0:14:37.360 --> 0:14:40.440 states would call around in Chicago trying to find this 0:14:40.560 --> 0:14:43.720 pharmacist that they'd heard about who knew so much about poisoning. 0:14:44.080 --> 0:14:48.160 As Godalman was becoming a one man poison hotline, the 0:14:48.280 --> 0:14:51.720 legal and regulatory landscape in the United States was continuing 0:14:51.760 --> 0:14:55.560 to evolve. The Food, Drug and Cosmetic Act was passed 0:14:55.560 --> 0:14:59.000 in nineteen thirty eight, which required drugs to be evaluated 0:14:59.040 --> 0:15:02.560 for safety by the Food in Drug Administration. In nineteen 0:15:02.600 --> 0:15:07.600 forty seven, the Federal Insecticide, Fungicide and Rodenticide Act required 0:15:07.600 --> 0:15:11.520 these products to be registered with the FDA. This law 0:15:11.600 --> 0:15:14.520 updated an earlier version that was passed in nineteen ten, 0:15:14.840 --> 0:15:17.920 and among other things, it required these products to be 0:15:18.000 --> 0:15:22.800 in child resistant packaging and clearly labeled with an appropriate warning. 0:15:23.320 --> 0:15:26.080 Even with these kinds of steps, though by the nineteen fifties, 0:15:26.160 --> 0:15:29.600 as many as four hundred children a year were dying 0:15:29.640 --> 0:15:34.000 from poisoning. There were also adult poisoning victims as well, 0:15:34.080 --> 0:15:38.640 of course, including incidents that had multiple victims. For example, 0:15:38.680 --> 0:15:42.120 on November eighteenth, nineteen forty two, a patient at Oregon 0:15:42.200 --> 0:15:46.120 State Hospital was helping out in the kitchen. He accidentally 0:15:46.120 --> 0:15:49.720 brought the cook's cockroach poison instead of the powdered milk 0:15:49.760 --> 0:15:53.040 that they had asked for. These two substances looked visually 0:15:53.160 --> 0:15:56.720 very similar and had been stored near each other. Forty 0:15:56.800 --> 0:15:59.960 seven patients died, and this is something where the chemical 0:16:00.200 --> 0:16:04.240 manufacturing industry had resisted calls for these kinds of products 0:16:04.240 --> 0:16:08.080 to be tinted rather than white and easily mistaken for 0:16:08.120 --> 0:16:11.360 something like salt or sugar powdered milk. By this point, 0:16:11.560 --> 0:16:14.600 medical experts just could not keep up with the massive 0:16:14.680 --> 0:16:18.160 increase in the number of potentially dangerous products and what 0:16:18.280 --> 0:16:21.480 to do if someone was exposed to them. About two 0:16:21.600 --> 0:16:24.840 hundred and fifty thousand drugs and household products had been 0:16:24.880 --> 0:16:28.200 introduced since World War two, and there wasn't any kind 0:16:28.200 --> 0:16:31.600 of centralized system for keeping up with all of these products, 0:16:31.840 --> 0:16:36.600 their ingredients, and their antidotes. Accidents replaced disease as the 0:16:36.680 --> 0:16:39.560 leading cause of death in children, and according to a 0:16:39.600 --> 0:16:43.160 survey of members of the American Academy of Pediatrics, about 0:16:43.200 --> 0:16:47.120 half of the accidents that pediatricians were treating were poisonings. 0:16:47.480 --> 0:16:51.359 In nineteen fifty three, doctor Edward Press and Lewis Godalman 0:16:51.560 --> 0:16:56.200 established the first formal poison control center. This was in Chicago, Illinois. 0:16:56.720 --> 0:17:00.200 The Illinois Chapter of the American Academy of Pediatrics, the 0:17:00.240 --> 0:17:04.040 Illinois Department of Public Health, and seven Chicago area hospitals 0:17:04.080 --> 0:17:07.600 were also part of this project. They provided information on 0:17:07.720 --> 0:17:11.840 poisonings and their antidotes to doctors who were treating affected patients. 0:17:12.440 --> 0:17:16.160 Illinois State Toxicology Laboratory was also part of this project. 0:17:16.400 --> 0:17:18.920 Toxicology was still a pretty new field at this point, 0:17:19.000 --> 0:17:22.800 and that lab analyzed any specimens that were collected. A 0:17:22.920 --> 0:17:25.800 number of sources also credit some of this work to 0:17:25.880 --> 0:17:30.080 an unnamed secretary who would call the area emergency rooms 0:17:30.160 --> 0:17:33.040 every morning and ask what the children who had been 0:17:33.080 --> 0:17:36.960 admitted for poisoning had eaten. She would then contact the 0:17:37.040 --> 0:17:40.480 manufacturers of those substances to try to get them to 0:17:40.520 --> 0:17:43.680 disclose the ingredients, and she would document all this information 0:17:44.119 --> 0:17:46.520 on an index card. I wish I could find out 0:17:46.560 --> 0:17:49.600 more about this person. I found several references to this 0:17:49.800 --> 0:17:54.399 unnamed secretary and no other details. The Chicago Poison Control 0:17:54.480 --> 0:17:57.800 Center started with a pilot program that ran from November fifteenth, 0:17:57.920 --> 0:18:01.159 nineteen fifty three, to March tenth, nineteen five four, and 0:18:01.240 --> 0:18:05.159 it was so successful that other hospitals started their own programs. 0:18:05.640 --> 0:18:09.040 Within a year, there were eleven poison control centers just 0:18:09.200 --> 0:18:12.679 in Chicago and the surrounding area. In December of nineteen 0:18:12.760 --> 0:18:16.359 fifty four, Edward Press and doctor Robert Mellins published a 0:18:16.400 --> 0:18:20.439 paper titled a Poisoning Control Program in the American Journal 0:18:20.480 --> 0:18:24.280 of Public Health. This paper described poisoning as a major 0:18:24.359 --> 0:18:28.480 public health concern before describing how the poison control centers 0:18:28.480 --> 0:18:31.640 were operating and what they had found during that time. 0:18:32.359 --> 0:18:35.960 The paper also made recommendations for future poison control centers 0:18:36.000 --> 0:18:39.920 based on that experience. The following year, the American Academy 0:18:39.960 --> 0:18:45.600 of Pediatrics published a reference book called Accidental Poisoning in Childhood. Soon, 0:18:45.760 --> 0:18:50.680 poison control centers were expanding beyond Chicago. In nineteen fifty seven, 0:18:50.760 --> 0:18:55.000 the US Surgeon General established the National Clearinghouse for Poison 0:18:55.040 --> 0:18:58.679 Control Centers. This was the federal government's first attempt to 0:18:58.680 --> 0:19:02.600 try to provide some standardized resources for poison control and 0:19:02.680 --> 0:19:05.639 to collect data on poisonings to report back to the government. 0:19:06.359 --> 0:19:09.080 The Clearing House produced a set of index cards with 0:19:09.160 --> 0:19:13.280 information on potentially hazardous drugs, chemicals, and household products and 0:19:13.359 --> 0:19:16.439 plants along with their antidotes, and it also published a 0:19:16.440 --> 0:19:20.240 monthly newsletter as well as a statistical report of all 0:19:20.240 --> 0:19:24.040 that collected data from each year. Also in nineteen fifty seven, 0:19:24.160 --> 0:19:27.960 the first edition of the Clinical Toxicology of Commercial Products 0:19:28.320 --> 0:19:32.000 was published and quickly became a standard reference work. It 0:19:32.040 --> 0:19:35.560 included basic first aid and emergency treatment, followed by an 0:19:35.720 --> 0:19:39.840 ingredient index that listed more than one thousand substances ranked 0:19:39.840 --> 0:19:43.000 on a scale from one to six according to their toxicity, 0:19:43.359 --> 0:19:47.280 with one being nearly harmless and six being extremely toxic. 0:19:48.000 --> 0:19:50.280 It had a separate index for the trade names of 0:19:50.359 --> 0:19:53.760 products that used these ingredients, along with the symptoms and 0:19:53.800 --> 0:19:57.640 treatments for exposure to a range of different compounds. The 0:19:57.680 --> 0:20:01.960 American Association of Poison Controlsters was founded in nineteen fifty eight, 0:20:01.960 --> 0:20:04.720 and by that point the number of poison control centers 0:20:04.720 --> 0:20:06.840 in the United States had grown to at least two 0:20:06.880 --> 0:20:12.000 hundred sixty five. On April twentieth, nineteen fifty nine, Arthur S. Fleming, 0:20:12.080 --> 0:20:15.400 the Secretary of Health, released a statement about the poisoning 0:20:15.480 --> 0:20:19.160 data that the National Clearinghouse for Poison Control Centers had 0:20:19.200 --> 0:20:23.360 compiled between July nineteen fifty six and April nineteen fifty eight. 0:20:24.119 --> 0:20:27.600 The clearing House reported that almost five hundred child deaths 0:20:27.640 --> 0:20:32.920 and six hundred thousand non fatal poisonings were happening per year, 0:20:33.240 --> 0:20:37.440 which overwhelmingly occurred at home. More than eighty five percent 0:20:37.480 --> 0:20:40.240 of the people affected were children under the age of five, 0:20:40.640 --> 0:20:42.800 and most of those were between the ages of one 0:20:42.840 --> 0:20:46.800 and two. Although many types of household products were involved, 0:20:47.000 --> 0:20:50.680 a major source of poisoning was candied aspirin, which was 0:20:50.720 --> 0:20:53.960 a chewable formula developed to be palatable to children and 0:20:54.080 --> 0:20:57.800 was introduced in nineteen forty seven. Fleming's statement gave some 0:20:57.920 --> 0:21:01.360 examples of the types of poison exposure that led calls 0:21:01.400 --> 0:21:03.960 to a poison control center, and most of the time 0:21:04.040 --> 0:21:06.800 it was something that had taken just a moment when 0:21:06.880 --> 0:21:10.080 a parent or other caregiver's back was turned. He also 0:21:10.240 --> 0:21:12.920 noted the need for the public to be better educated 0:21:13.000 --> 0:21:16.840 about poisons and poison safety. Many of the cases that 0:21:16.880 --> 0:21:19.800 the clearing House had compiled involved parents who had waited 0:21:19.880 --> 0:21:22.879 hours or days after a child was exposed to a 0:21:22.920 --> 0:21:25.840 poison to seek help instead of doing it right away. 0:21:26.800 --> 0:21:30.600 Other major contributors to accidental poisonings were products that had 0:21:30.640 --> 0:21:34.120 been transferred to food cans or other containers rather than 0:21:34.160 --> 0:21:37.400 being kept in their original packaging, as well as hazardous 0:21:37.440 --> 0:21:40.160 products that had been kept in easy reach of children. 0:21:40.680 --> 0:21:43.479 It was about this time that poison control centers started 0:21:43.520 --> 0:21:47.520 working directly with the public rather than mostly providing information 0:21:47.600 --> 0:21:50.520 to doctors. And we'll get to that after another quick 0:21:50.560 --> 0:22:02.760 sponsor break. The rapid expansion of poison control centers in 0:22:02.800 --> 0:22:05.760 the nineteen fifties and sixties was kind of a tangle. 0:22:06.800 --> 0:22:10.080 They were definitely giving medical staff and the general public 0:22:10.160 --> 0:22:13.440 an on call resource to use in cases of potential poisoning. 0:22:14.080 --> 0:22:17.199 That was good in many places where they operated. They 0:22:17.200 --> 0:22:21.560 were also educating consumers about household safety, things like keeping 0:22:21.600 --> 0:22:25.080 toxic products in their original packaging and keeping them locked 0:22:25.200 --> 0:22:28.520 out of the reach of children also useful, But at 0:22:28.560 --> 0:22:32.119 the same time, most of these centers were being established 0:22:32.160 --> 0:22:35.360 at hospitals, with the hospitals trying to staff them from 0:22:35.400 --> 0:22:39.200 their existing emergency rooms. The idea was that this would 0:22:39.240 --> 0:22:41.639 be an easy addition to a department that was already 0:22:41.640 --> 0:22:44.440 staffed twenty four to seven with people who were used 0:22:44.440 --> 0:22:47.919 to the high stress world of emergency medicine. From the 0:22:48.000 --> 0:22:51.440 hospital's point of view, adding a poison control center might 0:22:51.520 --> 0:22:54.760 even bring in more patients as the center referred emergencies 0:22:54.800 --> 0:22:58.879 to the hospital's own er. As poison control centers started 0:22:58.920 --> 0:23:02.080 marketing their services directly to the public, they also became 0:23:02.119 --> 0:23:04.919 a positive source of pr for the hospitals where they 0:23:04.960 --> 0:23:08.320 were operating. As more and more people became aware of 0:23:08.359 --> 0:23:12.160 the dangers of poisoning and the existence of poison control centers, 0:23:12.359 --> 0:23:16.080 more and more hospitals opened them, in part motivated by 0:23:16.160 --> 0:23:19.800 the idea of good publicity. In practice, though this did 0:23:19.800 --> 0:23:22.879 not always work out. There were some centers that didn't 0:23:22.880 --> 0:23:26.040 get a lot of calls. Either they weren't well publicized, 0:23:26.160 --> 0:23:28.240 or they were in a city that had multiple other 0:23:28.320 --> 0:23:31.159 poison control centers, or they were in a location with 0:23:31.200 --> 0:23:35.399 a small population. But many poison control centers found that 0:23:35.440 --> 0:23:38.440 they had to have a dedicated twenty four hour staff 0:23:39.200 --> 0:23:42.080 just for the calls about poisonings. There were just too 0:23:42.119 --> 0:23:45.760 many calls to add it into the existing emergency department's work. 0:23:46.080 --> 0:23:49.239 This is how it goes for so many projects that 0:23:49.440 --> 0:23:52.119 someone says, you can just add the center where it 0:23:52.160 --> 0:23:55.639 won't take long. This also meant that there was no 0:23:55.880 --> 0:24:00.000 real pattern to where these poison control centers were being established. 0:24:00.359 --> 0:24:04.000 Some cities had more than one hundred centers scattered across 0:24:04.040 --> 0:24:08.240 all their hospitals and pharmacies and other medical practices. Others 0:24:08.320 --> 0:24:11.679 had not enough to really serve their whole community, or 0:24:11.720 --> 0:24:14.639 they had no poison control center at all. Even though 0:24:14.680 --> 0:24:17.399 the nineteen fifties had seen the establishment of the National 0:24:17.440 --> 0:24:20.639 Clearinghouse for poison Control centers and the publication of the 0:24:20.680 --> 0:24:24.840 clinical toxicology of commercial products, there also wasn't a lot 0:24:24.880 --> 0:24:28.440 of standardization among all these centers. The quality of care 0:24:28.520 --> 0:24:31.399 could be vastly different depending on which center you called 0:24:31.800 --> 0:24:34.800 and who answered the phone, and in places where there 0:24:34.800 --> 0:24:38.520 were multiple centers operating within the same city, those centers 0:24:38.560 --> 0:24:41.280 were often competing with each other, each with their own 0:24:41.400 --> 0:24:46.000 phone number logos warning stickers and educational materials, which could 0:24:46.080 --> 0:24:49.760