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By Howard M. Cann, M.D., Henry L. Verhulst, M.S., and Dorothy S. Neyman

National Clearinghouse for Poison Control Centers, Accident Prevention Program, Public Health Service,

U. S. Department of Health, Education, and Welfare





HE PEDIATRICIAN 15 repeatedly

con-fronted with the problem of accidental

poisoning. The young “mouth-exploring”

child, his careless, unthinking, or uninformed parents, and a seemingly innocent mcdi-cinal or household product are the

prin-cipals involved. In 1956, 1,422 people died

from accidental poisoning by solid or liquid

substances. Of the total deaths 394 (28%)

occurred in children less than 5 years of

age.’ It has been estimated that 150 to

200 nonfatal poisonings occur for every

fatal poisoning. Thus, one can get some

idea of the magnitude of the problem. The American Medical Association has estimated that there are approximately 250,000 toxic or potentially toxic trade-name products on the consumer market. Many of these bear labels containing in-gredient information. Federal law requires that the ingredients of drugs, pesticides, and caustic-containing products be on the label, but cleaning fluid, bleach, soaps,

de-tergents, polishes and a host of other

“labor-saving” household fluids which are

respon-sible for many accidental poisonings are

not required to be labelled with

informa-tion about ingredients except in those few

states with laws requiring labelling.

Obviously the physician cannot be fa-miliar with the composition of all these

unlabelled products, although some idea of the ingredients of the ingested product is

necessary for institution of proper

treat-ment for poisoning. Furthermore, many

substances found in trade-name products

are obscure; pathophysiologic effects are

known td) only those few chemists,

toxicol-ogists, and physicians interested in the

specific substance. The busy practitioner cannot be expected to he cognizant of the

effects of sodium tripolyphosphate,

alumi-num chlorhydrol, ammonium thioglycollate, benzene hexachloride and many other un-familiar, potentially toxic chemical

constitu-cuts found in everyday household products. Local poison control centers have been

established throughout the country to help

physicians with the problem of accidental poisoning. Since 1953, when the first offi-cial poison control center was inaugurated in Chicago,2 the number of centers rapidly increased to 124 by April, 1958. It is the purpose of this paper to review and

dis-cuss the results of a survey of operations

of 102 of these local poison control centers.

To the authors’ knowledge, this is the first

study of such nature since information on

the organization of 18 centers existing in

May, 1956, was obtained.3


Special Health Services Consultants, Health

Program Representatives and Records Con-sultants of the eight Public Health Service

Re-gions obtained information by visiting the

poisoll control centers in their respective

re-gions. In a few instances state health officials

obtained the information by visiting poison

control centers within their states.

One of the authors (D.S.N.) developed an

outline as a guide for visiting officials in

re-viewing activities of poison control centers to

promote uniformity of information.

The survey was carried out during the

months of August and September, 1957.

ADDRESS: (H.M.C.) Washington 25, D.C.



As of April, 1958, there were 124 poison control centers in 40 states and territories. Forty per cent of the standard metropolitan areas in this country have operating poison control centers.

Growth of Poison Control Centers

Table I shows the growth of poison con-trol centers since the establishment of the

original Chicago Center. At the end of

1953 there were two centers in existence.



DECEMBER, 1953-MARcH, 1958

Cumulative Number


Centers ‘St at est

1953 l)ccemher

1951 March .Eune



193.5 March

June September


1956 March




1957 March**


September l)eeemher

19.58 March

* Includes centers known to be in operation on April

1, 1958. Excludes those centers once established but no longer in operation.

t Includes Hawaii, Alaska and District of Columbia.

** Authority to establish a National Clearinghouse

for Poison Control Centers was received from the Sur-geon General on February ‘26, 1957. Operation began in .July, 1957.

Includes three centers which officially opened in Apri’, 1958.

In 1954 six more centers \t’ere formed, anti in 1955 nine additional centers were

crc-ated, bringing the total to 17. Thirty-four

centers came into existence in 1956; 54

were established in 1957 and 19 in the

first quarter of 1958. At present only four States have no centers in operation or tinder development.

Organizational Pattern of Centers

Data were obtained on 102 centers. Eight of these have consolidated with other

cen-ters, and are, therefore, excluded from this

study. Ninety-three of the centers

main-tam 24-hour telephone service, providing

information concerning ingredients and

treatment of various poisonous or

pte11-tially poisonous substances; the remaining

cellter I)rovi(1e5 service 15 hours each day


8 A.M. to 11 p.xt.). vIost centers have

facili-ties for emergency treatment, available

‘2 ‘2 either in the center or nearby.

‘I ‘I There are 29 centers tinder tile



sion of a state center (or clearinghouse)

7 7 (Table II). In addition to these there are S 8 three centers supervising one or more

smaller centers (four in all, usually within


a city or county). The majority (58) of

1.5 poison control centers operate as

mndepen-17 13 dent units.

Table II shows that some cities have

36 16 two or three poison control centers; 17



ters are located in seven cities. Some of

.51 ‘21 these are smaller centers (2) co-operating

with a supervising center (1) in the city.

61 ‘27 Other cities have two or md)re centers



crating independently (5) or under the

105 37 supervision of a State center (9). Thus,

poison control centers give service on a

14 40 city, county, state, or regional basis.

Twenty-nine per cent of the centers serve

an area of several counties, 22% serve the

area within their state, 16% serve only the

city within which they are located, and


hospital 81

()utpatient or

eniergen-cy service 70 714

Other Ii 11.7

health department .5 5 .3

\Iedical school 3 3.‘1

‘e(li(Ill sOciety buil(ling I 1 .1

First aid stHtiOli 1 1.1

Drug store “ ‘2.1

Unknow,i I 1.I

Fotal 94 100.0

---.-86 .I American Academy of Pediatrics

City health department

State health department

Medical society Medical school Othert

81 86.1

59 6.8

50 53.’2

50 53.2

3’i 34.0

cs c29.8

33 35.1



I attern

Ofl!Y (‘enter


Two or More



in Same ( ity


(.\‘o.) (%) (No.) (%) (No.) (%)

State or regional center supervising one or itiore centers i 2.6 1 5.9 3 3.

(enters under supervision of regional center i L6 i 11 .8 4 4.

(‘enters under supervision of state clearinghouse 20 26.0 9 5’2.9 9 ‘30.9

Independent center 53 68 .8 5 929.4 58 61 .7

‘I’otal 77 1(K).0 17* 100.() 94 1()0.0

* Seventeen (18.1%) of (‘enters are loCate(l in cities having two or more poison control centers.

Location and Financial Support

Poison control centers are housed in a

variety of locations (Table III). Nearly 90%

of centers are located in hospitals, usually

in the outpatient departnient or the

emer-gencv room. Other locations are health

dc-1)artilients (state or local), ineclical school

1)uildings, medical society offices, a first aid

station and a blood hank.

\Vho sponsors and supports a poison

con-trol center? Often, more than one agency

or organization furnishes financial aid, per-sound, supplies, office space, and facilities

fur treatment. Eighty-four per cent of the

poison control centers in the country are

affiliated with hospitals, 63% with state



. Number of

JMeatlOfl Per ( eat


chapters of the American Academy of

Pediatrics, 53% with city health

depart-ments, and 53% with state health

depart-ments (Table IV). Medical schools are

supporting or co-operating with 30% of the

centers; local medical societies are affiliated

with :34% of the centers. Other affiliated

or-ganizations are parent-teacher associations,

local chambers of commerce, local safety

councils, Lions’ Clubs and women’s clubs. The Children’s Bureau provides maternal and child health funds through grants to

state health departments, some of which

may be used to support poison control





Number of

Ageneij , Per Cent

. Center8

* Supporting agencies may furnish financial ziid,

per-sonnel, supplie, office space, etc.

t Includes parent-teacher associations, chamber of comnierce, safety council, Lions’ Club, health councils, drug conpa ides, pharmaceutical associa tions, women’s


Number of Place of Treatment Centers

Total 94

Supervision of Centers

Most poison control centers are manned

by physicians. In 88% of the centers

physi-cians routinely answer inquiries concerning the toxic nature of and treatment of poison-ing. In almost all centers medical or para-medical personnel-pharmacists, nurses, or public health sanitarians-are available to give information. Clerks answer inquiries in

only 3% of the centers. All personnel who

give information about toxicity have re-ceived some orientation and training from the director of the center.

In 90% of the centers, the activities are directed by physicians. In those centers

where pharmacists, administrators of hospi-tals, nurses or sanitarians assume

director-ship, physicians serve in advisory or

consult-ant capacity. All the centers, then, are directed or advised by physicians.

Service Provided

The average number of telephone

in-quiries answered by centers is 18 per week, the maximum number, 75. For those centers which treat poisonings in addition to sup-plying information, an average of seven patients per week are treated, with a maxi-mum of 25. These include outpatients and


Most of the centers make treatment available to physicians and the community.

Eighty or 85.1% of the centers have such

facilities at the center (Table V). Nearly

one-half of these centers also offer addi-tional treatment at other participating



Treatment and information

centers 80 85 .I

(‘enter 4.5 47.9

Center and


Information center only 3.5




pitals. The 14 remaining centers furnish

informational services only, but treatment

is available at nearby co-operating hospitals.

Information Available from Center

The information about toxicity, ingredi-ents, and treatment which the poison con-trol centers must have on various products -drugs, detergents, insecticides, polishes, waxes, etc-is derived from a number of sources. Each center has a poison library containing texts on toxicology,

pharmacol-ogy and other related areas.47 Some

cen-ters use only three or four books while others have the facilities of hospital or medical school libraries, containing


Most of the centers also use files

contain-ing information about various potentially toxic products or substances,#{176} normally in-dexed by trade name, toxic constituent,

type of product and, in some cases, by

antidote or treatment.

Follow-up Information

Sixty-six per cent (61) of the centers oh-tam follow-up information about patients treated for poisoning at the center or brought to its attention. City health de-partments obtain this information for 51 of the centers; nine do their own follow-up and one center has patients followed by the local visiting nurses association. An av-erage of seven patients per week are fol-lowed, maximum being 25.

Records of poisonings vary from simple report forms on small file cards to several pages of clinical and follow-up data. Fairly detailed coding and mechanical tabulating procedures are used in 54.3% (51) of the centers, usually through the facilities of

Per Cent stateare nowor localutilizinghealth the departments.National Clearing-Thirt’

house for Poison Control Centers for this purpose. Several centers release periodic

bulletins and summaries of cases.

0 Recently the National Clearinghouse for Poison

Control Centers distributed a file containing

in-formation on 500 poisonous or potentially

poison-100.0 products and substances to all operating poison



That accidents are the chief cause d)f

death in children is becoming more and

more obvious to the medical profession.

Accidental poisoning, although ranking

eighth as a cause of death among all

acci-dents results in a significant amount of

morbidity. Of all types of accidents,

per-haps poisoning can best be controlled with

our present knowledge. The activity

cx-pended for the control of accidental

poison-ing may seem excessive for the importance

of the problem, but it should be empha-sized that there may be about 700 nonfatal

accidental ingestions for every fatal

poi-soning.8 Furthermore, the lessons and

pre-ventive methods learned from dealing with

accidental poisoning may be used to deal

with other types of accidents.

It is not a coincidence that the growth of control centers has paralleled the rising

interest in accidental poisoning

demon-strated by increased publication and

activ-ity of medical organizations in this field. The current system of poison control centers is serving the needs of the country

well, but there still are some areas in need

of centers. Wherever poison control

cen-ters exist there is a potential for

awaken-ing community interest in educational

cam-paigns on accident prevention.

Ultimately there should be at least one

poison control center in every state and territory. Where more than one poison con-trol center exists, co-operation in the area

should be stressed. It takes time, money and effort to operate a poison control ac-tivity; duplication should be avoided. In some areas excellent well-co-ordinated

programs for several centers are already

in operation, but most centers still operate independently.

The American Academy of Pediatrics has

been a pioneer in the control of accidental

poisoning, influenced by the fact that more preschool children died from this “disease” in 1956 than from scarlet fever, acute

polio-myelitis, diphtheria, infectious hepatitis, and acute infectious encephalitis combined.9 Local and state departments of health are

assuming more and more of a role in this field.

Where medical schools are affiliated with

poison control centers, research in

causa-tion of accidents, methods of treatment, and education of future medical

practi-tioners can be furthered. The hospital of a

medical school is an excellent location for

a control center. Facilities for 24-hour serv-ice in providing information and treatment,

consultants in the various fields related to

poisoning, laboratory and research facili-ties, and the library of the medical school thereby are made available.

To provide a 24-hour information serv-ice by telephone on the toxicity of almost

any product or substance an infant is likely to ingest is no small operation. The in-formation must be at hand or almost im-mediately available, and personnel must be trained to use the informational sources effectively.

The treatment services given by many poison control centers are an important as-pect of their operations, but emergency treatment is not limited to poison control

centers. Every hospital emergency room

should be equipped to give such

emer-gency treatment, and there should be

co-operation with the nearest control center. There is much to be learned about causation of accidents from reporting and follow-up of cases of accidental poisoning. The problem of lead poisoning in children

is being effectively dealt with in some

cities with the aid of these techniques.’#{176}’

The knowledge we now have about causa-tion of accidental poisoning has been ob-tamed as a result of this epidemiologic

ap-proach,’2 now being used by some com-munities for all types of accidents.13 It is to be hoped that all centers will ultimately institute follow-up, to help define the local problem and improve preventive measures.


given first aid directions and advised to call his family physician at once. The cen-ter may even make an effort to notify the family physician. The effectiveness of the

centers depends on the number of physi-cians in the area who use the services. All physicians should learn the location of the

nearest poison control center, by

contact-ing the local medical society, the local or state department of health, or the U.S. Public Health Service.


As of April, 1958, there were 124 poison

control centers in 40 states and territories.

The results of a study of the operations of 102 of these centers are presented. Co-ordination of activities of poison control centers is desirable, especially where more than one center serve the same area. The

American Academy of Pediatrics has led

the way in establishing centers all over the country. Increasing numbers of state and local departments of health and medical schools are participating in control of poi-sonings and strengthening the movement for development of poison control centers.

Poison control centers give information

concerning toxicity of a variety of products

and substances. Many also maintain facili-ties for treatment of poisoning, but emer-gency rooms of all hospitals should be equipped to give proper treatment for poisoning.

Prevention of accidental poisoning is the

best “treatment” for this “disease.” Follow-tip studies of patients will uncover sig-nificant causal factors and enable effective preventive measures to be instituted.

All physicians are encouraged to learn the location and utilize the services of the nearest poison control center.


Since this paper was written, more poison

control centers have been organized. As of

Oc-tober 1, 1958 there were 193 centers in

opera-tioii iii 4:3 states and territories.


1. U.S. Public Health Service, National

Of-flee of Vital Statistics: Unpublished data.

2. Press, E. : Public health aspects of

poison-ing. J.A.M.A., 163:1330, 1957.

3. Lindemann, L. C. : Organization of Poison

Information Centers.


Am. M. Women’s

A., 12:379, 1957.

4. Gleason, M. N., Gosselin, R. E., and Hodge, H. C. : Clinical Toxicology of Commercial Products. Baltimore, Wil-hams & Wilkins, 1957.

5. Dreisbach, R. H. : Handbook of Poisons.

Los Altos, California, Lange Medical

Pub., 1955.

6. Goodman, L. S., and Gilman, A. : The Pharmacological Basis of Therapeutics,

2nd Ed. New York, Macmillan, 1955.

7. Howard, M. E., ed. : Modern Drug En-cyclopedia, 6th Ed. New York, Drug

Pub., 1955.

8. Cann, H. M., Neyman, D. S., and Ver-hulst, H. L. : The control of accidental

poisoning-a progress report. J.A. M.A.,

to be published.

9. U.S. Public Health Service, National

Of-flee of Vital Statistics: Unpublished data.

10. Williams, H., Kaplan, E., Couchman, C. E., and Sayers, R. R. : Lead poisoning in young children. Pub. Health Rep., 67: 230, 1952.

11. McLaughlin, M. C. : Lead poisoning in

children ill New York Cit’, 1950-1954;

an epidemiologic study. New York


Med., 56:3711, 1956.

12. Jacobziner, H. : Accidental chemical

poi-sonings in children. J.A.M.A., 162:454,


13. Rice, R. C., Starbuck, C. W., and Reed,

R. B.: Accidental injuries to children.




Howard M. Cann, Henry L. Verhulst and Dorothy S. Neyman



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