Document 821eabZOqy3qJZYk1e51w8Rpo

4 LEAD INDUSTRIES ASSOCIATION 0 CAST 41m TACCT NCW TO** 17, N. Y. t9,torch 1957 uun tmrr??E *nd sjjTTT fc'-TJLrrrs Ko. 1?J To the Xber* of the Lead In-hietrie* Associations CK1L3C08 LEAD PO13000 iVia Ia A 4 ** a A a n> a a 1 # V. -- -- A j l ma a a a Im^ 4a 1h 41a a 4Wa cesssr Vo continue the wort under front froe the 0. 5. Public Health Service, there he* been jr*t delay In eocplotlon of the study Of child hood leed polsontrf arranged for by the Le*d Industries Association with The John* Hopkins Hospital nearly six years afo. P.sports of the work have only now beooos srailable to us in the fora of three reprints, all under the euthorehlp of J. hullsc Chloola, Jr., X. D. and Harold E. Harrison, X. D., with the followlnf tltleei The Exposure ot Children to Lead* Quantitative Urinary Coproporphyria Excretion and Its Kelstloc to Edetheell Calclua Dieodlua AxtelnlStratlon In Children with 1cute lead Intoxicatioa* The Treetaer.t of Acute Lead Enc ephalopathy la Children A copy of the first of these reports is herewith. Attention Is called to the sueeary and conclusions on p{e 955. Subject to limitation* of supply, copies of the tw> other reports will be sent on request. Xar.fred howditch Director of Health and Safety tygt sgwps.sy,'.. sf wtiPHHratnjytjSPnwiMiffitiy .,w|p<i!nyinnp mss L IA10950 mm JUpriatlrd /.*r>t ftA**b*. i. Vot Jft, Na # D*r*.U*. It* THE EXPOSURE OP CHILDREN TO LEAD Q 9f y CWialia, >H M 0,, m*4 H*t*W I, KrrftM, M O. </ fft/xtrii, / A<m ( iJifTfai / i.J-M l/.yia**# //.-jfiW, **/ frdaW'k .*/ KAt**** i mf lU+pmJU tif A%AtLjk*urrr td a nrw !*! HJral/sr TOrfAjwnttx. Artt Sa rrvik'd in rr* mental rtatwi td affrvloal children *ml (tar in avltkh tlar^* dr- irnl iirtntil in )rl iiHmkufKx) in <Kjlrti-rkprti ir*d N'nk(ind THr purpntr td lanud. Hrp*rt*` 4 rmAnatiftg ff*n % A/fcnji (hit rrprt it to pfrart4 tbr*r riiti and to |wtt (4 the I nflni Mitn, todtcatr u b* ditniu thr rrtaihr f<4r *hkfe mk td th* iTmlng rrcufpaitioa of thti diviM*, |ur- tr>rr*i emfrantytmU] nut ptv in taf'iUffv in urfwn Afrat \Mulr c^Athamd Or pnritditn td trad InkniCBlkn in (kd* diMMlmm kt prwm tii tar td \ alur Am It h hoped liul (hit mo focihtAte M Oar (rraimrol td ncvtr f|Muiin of thr impirntmtAtkan td nirtptftr pomO* piumKiun, M onnn( hr it*n! to pmnH (lir nnurfri tnuc rlnii of }tf(t|nnprt) ncmhc afmnrjv (wn of ifMil In chiUfvo as in adultt. prr aeration oi rurwitr rt)iMtfr (n in*J re*- CUNlCAl MATHIAL AND d iag n o s t ic ctrruiA nuira Oar pnoil(wl mr%*m id cinOd A MMiari prmmtur prt^riin muv( U intrd up nlnjiuir rmwwtfnrnts! dili Thr Age itarklmcr. it a a v u ) (lointufmA rd thr ondr suniiolstinm a tad nmmliAtiria rd ram among chihlrm rrudmg in urlun Thr (irwj oaairtul a derived from (W |dta(nr (irtAa of (hr Mamrl Ijtttt Kom cd j'litM limpu) tn! td luklwvr (jh |hnf*t.*l ! *1 IV7 dtiUrni n|nard lo Ird. taslwdmg Mi patmll avtfh MVtr Irod rntjiiaal^tatltt, Lar |rm 4W Afl atom arm nr Aril loo*n K 1 Akbmagh (tr tdul(ina d Irod (uim-t dtnr d o jduidHM* in chihlma Ka Iw t h rqxrtrd.1 T ft it Winrd tint At prrvnl if# tuCnthd td b'4i)t'ti<Aitur^ pouif Aikn it liar mmi (nmm<n mittr (nn a Im li ( itildrm niAsia rtrmtivr qtarrirfiri d ka*i Ttr prmtat irjtri dnk cufwrly antth tfi Urirr h|r id npnurr. IX1I4 Katr lrrq oitfainnl u|t (tar tntctnrtr of vtath npi*u/r, d*ar*tina rd rt* cVefled M Or irlaAn dm Aoai d Minor. W iOmii that puup. 59 dskirm *rt prmar* &> titdtnl \rs Or MflW | (War rkaUrm, droatMTA oaa drarV^an aatil liaiw aid prr* anulmtal hir nhaatauan were nwir. TV tTuch natUinJ <Vtn( lV arm IffU t* 1UV4. irnWf. An impart##* pari td Or pnad nran rat thr iVaild anaiatH td ttpwTr ladort In Mnr btirUJJi in Vk tlnanwl kiartn td Ird *w (VtnMfAnl Wa U (hnr nine cmirtararfiial waifi, thrrr tt 9 kdn ram pimirr tnd Oar Inuorul !(<< in thr prod<K(inii of Irn! inimk *twm in tlMkirrii Thr 'arumUn nir fair 4irm*v/t hanite* irutn d i)n t awi Kj i Wi }*rn atiMird, t-Art itr, liar rrhftirtiliip Mv*rrn ftar taa<klrwr td mrfr Jiftm4nn4 dsnu^i' in (tar h*#in i /h ! rr-n|*nifr f Irod vwnj( tin* alaici id Ait Htrtul riktair <d aortr |rrl etxrjdukijMOia lut tarti runknn) Ota* AtvtihifH %mic rrwlr up** (far doelrap* wd 17 arflrt (htkhrn taniVi 6 am td i|v ohn artxad t (xaitttk, tot#! td SA talk |nti rath Iimk rtpaw* to |rnl AfAo( Or 17 (uiird nalfrt* id lh*a UatrbJJAudt poip, thr mwlrtaf id atnwtpnfd "nt* AtUa* ram vat alrlmvaurd Ararfhrf pop id O dvVVm m plirntt vfw vm <t>vlni twl dirt VtpuVf- hm fiA vndr |rrl olnn <a rtw^V- i^ofha Art** |k"J |<rt| In aKkhOn. a rr- atrv not matlr td *8 lunptU) fractiii (4 04* |Wiin4td Mat It. a>t*p(d )Ji A Ittl ) IVit rri m k p'.M I* * fir |/i latLalifea AtMiafin. V* T'fi, W f##4. mI Iftw |l twMH4a >4 ||#hk l' A TmIJj * VfW# ft. rf|lt AOOilil' (J ) ( Jr ) Mllnaay ( J#y Hpn*l. (V(0 rAk m. Ankwawer li Ma^Ld vu lu^naiL^ ^ mnry'^r '1 W N 352.01  iwarn u mw .u u m4^, LIA 10951 Ml UIINOI M - KM'OSt'HE OF CHII.URKN TO UCAD ! dnn od*n:rtrd to thr almnr cfarut* dririg (hr iKtmi'i Ambngb in (hr crtrlitiopmal fluid anti |rVRJt 1} rn ami M*ir%rd "W raw w nm*T <4 (ha fnlkwtrkg ngro and i>mp- i Mig* or "V*J iitgr-MI'm ~ Ammt| llatr fcurd*,. tmni. p rwMrnt vumMm& hijr'tUrttalv'ltfr, |M caiUlini ItJirmalVrt to Hih latia, UtfrTmillmt iTviw/idnoa and Ktnitu- fed) *rtd rLuf\ tl*c <ht.**l duff**)! a<nrlif.j to (hr iTitrrU Ui:>* l)nr **i*lif*dr oIrmc tr trni*4t}Y* Kimhifj,* Mi tlr rridwti- juual Jhod wrtf <mnlrrd altfvrm*) it |u I It td tlr- iVT *u))rr1* (m haVd Ui (hit rrpurt at ovitr td |l*r full.wing nrtr promM; to* th*x _n trn Cxn t k j * All uJ'^tia %tr ftmia<d ontrtKfifkm <4 pMiin, Itttniutl rUw&rd Hi lit <W*ma) latrjiwi u liA" nod |iUry(*>ii in the (tfuitiaptnl Typr I F-ij*--n4Sf+t**i o-ith a fluid. h)t<*Y td tD{nO<m <4 (Miituii wtjnlr*! (4 Ty/*r V ts+d t.*rrjJvUofa?fky. Srrrrr. Thr (latalMAt Irad or till rWf td riw- ntT^ihik^alli) wa* titbuhrd a* unrtr if thr up*<|ur Imnjjn ttwlouii in (hr fwtwin rifi-rt mm jUrd rontlniulh hr a t*ta) trad b> tf (LmM mciirntM* pond erf 24 Kauri tr rtaulncd npnvd tarmtii. 4 lio Kati ttavrtitutiirt (Awuiuif hr a pvv4 al 24 tmin or luogre, erf W<) mi lAond Vh iKm 0 00 m 100 nt hJr Uu4, alnrntr U *V#d kn* M rum)- or KrK. Pr ffuoilirrv <4 miijnii in each dugnoatk gmogtatm *4 lr>r\ arau] (taiiA{i it (llrjfui wrtr m (4Vmt; mmuutni #4 llr I4ui (it an anmu wimlr' L t^^d-nonnal |ria.mni U4 mpnn<lni rapidh to lir oval aiiMntrrjiiaii *c-r*r> 41 td tnm) ami no MoUalaa ttni<M(aUr to Io mJ Wifn(i in thtt ralrpri iw aihinlJn) Milo two group* a) ihw U Uw n|urr to IntJ tr&i miM in aiuidt icmcd* pi(nj[ (hr idniOftrttkA al trad oTn4 4 (hr Mulrtul Mtgnird U tlir fluid am) L) Hnr tor then (al mind <4 Wad ante* otrfaMr 14 (h) tmtJ <4 Wad anti? not narfUldr 27 U Aflnp>rwCk. MKWnafl Wvd lattpkn 39 ill (rad Mhnkatkn hmM rncrflwhyrdiy 19 fY. Lrd raKfphahyafhy. mU (N V. laai mvihd^r^f, run 41 nai aoahttr tatardt mrrr M ttatUUr, oh ttf thtmtgh thr chuira) m*d ImUtln) that a e Thr rmoftlftf If ailfili of thr total| minr of Irad had brm found Mi thr child* jfTtaj^i c4 IV? rhiU/m npard to Irad nor nMrcnmml. wtitul crirfuj atlwrii Mi thr WwirWAi-iMnh Typr (1 A*yn|rciwfa. (m*rrd Isad .Ah ; m*f*not Tlinr d/flrrrd hum |!r n- ptip *Wi appamiti) had orf hjfnird Wwd cnrtaMrtg matrruh i (w*rJa<mJ jfTu|> n |}u< tlio had 4oatrd x*nri*<rr(**i t4 had in M**l im! n-rfgrt* pipiir naimif c4 rn{r <4 Irad Mi (hr MCTHOW Of STUOT Thr Mrttufi *4 npnirr to Irad was dr- / hn rLaj| mmjriatr* fUitligliiJr to Irad trtmMtrd In mrtMfnnnrf c4 dalh (ml rwtr- Mnuatma ^ulilalDr Inii lit n^vnpir- Mi 4 Irad ia all Mmltn td the Wwrliolrf* phxrw to aftnr w |am(t\v n amr <4 thr*r < hakim*. Chd) gfttufi M*drr A )wt of afir NArrf f to 4 da nrfVctkim 4 atouh nrrr made in f Tyj*r ttf IrwJ ftdarirmhom f- tlir Uaor in n*rd tl t|uart Pwn cuwtnir (*jd*d*petky) Tlr dofnnM td Irad (aw a mxlr M> chM/rn ho had. to *dd> lino to nnVia r at Mirrantl Irad i)mt|i(Kin. Mortal <4 rfr |*An)ii>( matlrt)a(nrn am-mia fmittant to torn llnijjn. tmtravd uiwuo didwa MippWd In llr lalnvalrry. \|r*hm ttf rftftilrd to imr llr child drlrmlr dh lf)(K Mli Or uwfulr dth In WapNilulnl ptlrttli <iiun(rf*llir <idiedkm erf ftord* Mrrr maW Wt thr clnVWrn ftf on wiHahrdi-- rviHMm td mm crjotCipa- Irion Mm, iwtrtli, htf vrirTila)*tat, Id/artr br> hatfctf paMrfw and Monutinit In llr clrVhrfi td thri pnw(t. ihrir ana oo al- Mcmal hmlutg* to lit jnrftiapml hid. 7|7*r /V. hW t.mrfdwl*`jwlhy JIfJd |* aitUlrn to lufoiUof (1m tiWrtia hr Irad M AUp*<i c4 thr prwJrd t- to 4-da* 4on| Mmplr* ti ptrjwrd hw aoah^M In hmo(frtraalMm td ml Ur wmplrt M> a Waring IdftKhr Mi nhkh tlir iliwUid |r* Irwring wa replied In a < aV in*n Witif 1 Dii{4(<a1r U`p4 mrtr d/> *lrd' am) adahard h/tk*tMm. (hr (hddmt yf (Ini (roup had ah lt Iral In Or mitrdctjir diOiiiur Ink V **wiuqpa^*aiiMwOTiy^ mj w 1 ' LI A10952 T a j h ic u c s f\ i ./ Hivir f4 S'xlrf** Afl *|UpTW*it *-* tic- ntsutn Wi U-<Ud" ith tiifm 5<ft jutrk a*d, futkrard / a In tl*uugli rtnatag in *Tr<J frra* v*lrr, ^ "lx**) low* ilrf i*t pit-jNued In tlw j>- >/ d.Willed *te~ n kKi-i-u hm(f it tUr i**nwi*oM v'Uxi'*i fitf tirtaiVtl *1k Iv of rtpmi.fr- Vt'rft tlwre wrrr If IfrU-* (Man ami 17 otlwr amh.iLlorv <lviSdi*n W-* tlun fl Mon 4 #r, sehn irprd TV <*>rdl %* rt}nh *uii*fd<v T* llr nJiOl nf V*d in lr t in tjjei Oneit* mrrfiiiunj jrealrf llun ) (t> **f |1 24 hr. \ Jpin t4 1> *<l (inrrnl ibt ll# m!l-f |>fr*rn1 in Knr > Of tlw nine Itoln nut, four had ooitr trad nm-ph.ik'jsathv, two Iwwt lead inti 4t*d tlurr r*TTr (Littlftrd a* a%m[)(<Kn4tK. tfKirorr| |r*<l alivrp- liidi Data OQ llr inlrtmtt (4 ind rtpworr t^tn mk*ikl *owd |!<r*i(i{ in *-rtr oifAinrd in (Ui l V (u mI ntrtc<ii Mrp TV* ini rfcirque wU group tWtJd|;li tl*r mraiarriTM-ftl <4 frwl in sum ijmiinriH cmt*hvM im rvtdiiHi <4 Ind Mur and after (lr rr- f tVrt 0 J(Jf) m |i Ji I.* nt Uh wnlwm< fiMnal of all wminr* of Irad b iKtwrm pitfi m jjTt-^1 i tw4<4d *w m* Mni(4Trtl TV fwnnNT of Inm in rotattilti- t**H kjftitml to IMrrfrtr sttfl, uuKtlt the liHidt luiLiyr ttudirt it hat lm ilomn In l^rlrir afat hu atvxutn*1 tfaat Kfiatn) miK la tV ><! <f p!wtts (rrrlv Inal rvtrtwm <4 Iral pnnvVi a ^n) b> i/** jr^-dumaO'. This a m*dh <ua<lrd Itiilrt <4 toad ittgmtxtfi itwiCTUartt at p- In cL*t*n<mj*n |U l/to trtnjS4n]i Hr- |nnifluliK bit (4 ItijnlnJ trad K n* (ia t T\ tf in*d oi Inn In iKii mdUa! a i V5 trHnl in thr itwf. IVVf In the rrmina] of to } I CfJ TV r u ih mmi *tWn*)>lr rtl\0 (fton nlndifird Kwavrt 4 trad, tiiaf umpln lhr mrxn <4 iktjV*te% at \if\ (U l(<\ to loomc n> :4 k#> mtmi Miim mg n> u Id eirrirf) TttJun nftr ipal Ihvni tnd hn**r<i.t/vd l* the frairn aflr wtth Badta/ tnd |v4lr. lld^ rrr llm dnrd to it IuV<I. (nwro and fr-lwienu/r<l Amhtn, in Iriftlajlr, if ilapMi <4 thti |iih ) homo- fmilr nrrr llm caittnl nut In (! lnr v'r-tr tolkxlrd (UKunnit)i fnaa rrnitnf an>l flntnl Sumta/ nflnlium (4 itiiiK Ift an tlam* uilifrxli nlth trad Wtrti- (attoci am irtalf in tlar at )m4 I *crl aftrt tlar o4 therapy ailH nlitlumil nViittn diudiiun and again upon rrtum to (hrtr hmn aftrr thr n-mnil r4 all idmti&rd munfi of trad. b iHImI IWicohm, rt-mdtmg |rtm ln nn In all. fH uttdaclivy protrd. 2- to 4-day rnitfita* 4 Vv4, ftr ctinmnlrtnl n*U in oflnlmm <4 yt(M>U %rrrr oftaitard frrwn ti <vds%4t <4 l**m ?tAbr tn V t> ^atuUn 22 (4 tlar 24 amlmUton ilaMfm umtrf 6 fi<on the tnmn of tupladtri t | \t |a tlwr tiiMm ttfiiiddi fnB tlir **w# dxl ruf fvml 3 W, In n (an of It mI in (laVl/i'n in fUkimrir, umj>)n if l4r bld *tnj <4 tutjvrtrd nnlriddnnHal damn if V%k J rp tiiytmrli auKird | }ra<l In tld FUhi.-rtdf (j<( llrahK |V|nr1mn4 U< <iuK Ki) fr J ^l4(P4fddi ditluMOl in hurfitr ut|L/n>j i l|nt>"|J*it'diirtft III yr^r* of agr in right c4 tlwxr nine house hold* (Zomparal4r fttno) samplr-t nrrr nh tairKxl Inro ut dutlrm <4 [fiuHitm on tlir pediatric stafi Tlax nrrr cUtuhrd a* 'twdr*\jwiuxr c*artn4i Sti*d sample* arrr mlVxtol <n <Iirii**ion to thr hcnpital loan som aiWitumal patient* rsjth acuta trad rorejilMlopathv- Tlw sif|e*t* <4 tlr fx'iiu^iotd stud) WrtT IimI nil NiliuUn " Sisipln <4 {unit dmifinl juxiatfmg In tV ilii^Matic Cfh ju*>t'd pUito, H . m iiAtlfij m t V t-rU outlined lltr ronhi c4 tlw analyses Kttn V m mw h V>kh ru7*r TV ImiI tw4r4 H<l In Ihr In h 1 iul (ipnrlol ijiMMafhrh D | V4 U%. |K*n n II .4 h4 T%* if lrJ O |1 to I in >4 Wd haiil.r f*d Irol |l |n tt if kol l<d IfaJ- jmM |)>* M f VI of tlw sf(d*U ha tral afr jwrutitixl in Tahir I 7!w result* <4 tmular fWiinmiiMt^ai* hi i^tTM-sjdrv'tf (Otifftih and ailditbrnal patW-nt* vs ith eTHvjduV'jiuthv arr in* Kk U'*! In TaMe I as a lew t^o mu mI fia tlw oaltutlofi <4 tlw IwMisa ImiM IimIv |pap. All <nitjMftt f4 lead in fetss srr (ak-iUtrd ft*an tlw o .vaiik.  oo jjiilWi ,4*lj^p3jP!gjiTO^ * p* > V W.WJ M'lf1-----(-I/S1095 3 W8 CHISOLM - KAPOSI UK OK CH11J>IIKS TO LKAD urn i r fh 4 I: > r |j i < <m t few fl*i ti * Vrtta H m* 4 T. * y ; w y ow^w ; *)/#* M Ym* 1 V*>w jy a (n n ^ Trt^lir. IVUV Al k>-- nfw*> u *r*> iwf7 H Ml O 1 *4 -IW 1 If Mt a cm SM Tjy~ ft. m. tv **4 r AI Jl/t nfi<i <** a U Mil in |M i l 1 H * 14 ill tl- a* i ll ti IhM 411 M3* 1 oiurw^t T,-- H V tit* rr a 4 M 4 trs +ci TV* Wwkil-d wly 1^* Vm U* W*4< 1* L*4k <U^M(a 4*1 etf i- Mr* W trwl (A 4tf lk*4 iW w lr| rt<Mk td M Wtrf ifcr* U * IV*-V 4 i ( !r prH rtJVrlrt *d frm frja ttar tr*J nasiret d )ar4 hi llw w i>^h w i W4 pr* f I ki,^% Am |t*npp W lw Mri am rtiWrArl |mi rar4 4*n< ta^h |*mI <4 4^r*~rml m* fvUlx* l> rtp*w. t |h|mrfir (^Miratiw. rtl h fTMM ** ( <a>if4i H I* ihilimi <4 aiwilifi *4 p*l**lr*r 4| (* *V iVrtr *m M | TVm M rfV W*J m i4 wnalafi | ImirhillM4; pa ^ Vly aka H 1 4--1 p M] bfcl rw4^-1 4 ** a(>^, J|T*M t*J llir III 4*1* ** iW M n i^t l*) rtirailr^, pm t 1 xi<i* 43j pooled collntlnns * 24-houf outputs In moil uil^ti f*n pi>U ti t to 4-<t*v col- IrxtKmi nf tlnolt witr <4<t*mrt! during rt- pr*mr. Tlw data, thrrrf<r. rrj*r*cTt ap- prmiHMtrS onr *n[wmjf rri* <4 ids* KT>atK* In tlx* Hif trrm 'npnnff wrrk* h iimt I, iruumKh as the Mmpirt *cfc laH ah*a>* nvxt#tisr Of* tlx firM lifif i4 TilV I arr i)n*n itr irnt- puts nl lr ad during < nl i jvatMi*ti ssith load rTK<~j>fuiV*|V4tfi> 4<m1 infotit ittion Tin* mean (ntfjMri i4 Wm1 in this jjn>p during rp*ufr * * 44 fog Us and flir faogr **s ^ to |(fl rng/<lay Three *4 tlw**r futd acute lead rtKT^dsnVvpathy. Thcif 24* hour outputs arc cilniUtrd from tlx* load cxmlmt of t!r finl it() passe*! after () mission to the hospital. Ad otlxt stool collet <i**m during rt|*ttrc were madr H t)*c bicnn. Ulim (Ixv Irad-pntvmcd thililim ssrte fmimrd from nptuir to lra<i liy |**pitah/a!kn nr, aftrf discharge, by tmvnal of fell klmtiftod sifm of Irad fro*n tlwHr Immrt. tlc daily fetal rtcrrtWai of lead f-II to normal value*, apjicntimatrly 03 ard 0$ mg. rrsprstisrly {lion i and 1) On tin* fifth line *4 Tahir I, tl*r f?w*n clath output of tlc 11 control tol^xtt Ht 1ii1 "Tt.41u iiPfcf?-' - .v- . >-gr^.-wafeSty I'.uysiii1 mmmM LIA 10954 ART1C1JH <K7 t u i u it t%M i | i<rtM * lass* Tff 4 ***/^ s fy t*+i JT^s S^mJ (UIm Ni> IfW > TnKyl U* f M A ay > t K*rly M a tl a I- la at < m | |s w Ck AS l;)M J v|*a*et fW S|i< l^t| i ti a- u a It'll* 1^4 f*1 ti (UAfi |V>rK di; u 1 -h u * * I- tU. UUr tU 4*4, lrrl Wd p* <4 (W M> wj ~l tW t~- *Valr (W 1 .. i.-K W r--h/i 4 w^V tuWl iiu (W K (4 * W * " 7Vj iw lr%4 rw44 W i<^ 1^*1 f^*lM |pk >VJii>m n I ynMlifV nt*wMT m4 m rAVW n- <W; kw Lfuk4 4Uk (Vrt <A_^Ur* lV*l k (u <4 M fWtf ^wl <lH TWj ii4i i--4 m<W ArCi fit'o* i--i n nynnl ! 4Urmt *i/n lW j4inww M *|i><^ 4 M*i^v U<W^w \ tW |*rl rvMa* W lr4 bf IW ciAU* rvwl |twl *4 *+*+*{} r%f i i4 ii I nO| !#, *ib lW( *4 (Wtf I i 4mA4 I*4|W mm Wfiiit- * |k*l W fc" ! >! tunjiod t Tt~ 4*u w uxc ms W W J l-J*U II;I, Ilr jXnaxr <4 rtjsxu/r lo lead wu jv jKnxirrutrK OS mg 4 Jr-*d daily. It (in Ik * ftrrti thaf th>Hf children (Uttifird as It) diplomatic. IrxTtaM-d lead atrsaptinn (line 4) c *c u j >a an intermediate hHA*xn tlw- jw>tvww<d iml tlw omlml sub ject* Thus, during exposure the ffciiwKwd children sxcrr f<nud lo lie eitTctiug ap proximately V) ttnut at much in tin- fete* at tlw timiLrh rxjwned h<utelnk] ixxttrf4 The results tho*n in Tahir I may be compared A*th tlw studies <4 Krhur cl cl'' * <k j fetal rxcfrtton <4 lead untJeT %*ttext* ctmdilKim <4 i-xprmirr lo lead (Tahir II). It (an be w v t i tlut dal'K fr<] r\tTr1nn e4 lead in tie (tvrfnj Milipti <4 Or fWt'w-rit Uh )v U 4 lltr umr nrrlrr <4 nugmitKle at that (4 the norma! chiMorn ttKlmi U kdvr rf af.M F.vrm An fro atloa* ancc be (liflrrmri in analytic and umpltng tnhtikjie b made, it is evident Out the lead poisoned children <4 the prt'trtif study a* err rutrtiiig in the free* far greatrf quantities of lead Oun do hn\iK' reposed industrial wrriitv An unrspreted finding c4 thia household tody u the diKtrvrrv c4 fit? ixkiitinrul cases c4 umrcogni/cd increased lead ah* srvjitKjn and lead tntmieatkKi among (he 17 contml lulijalv All *4 these unsuspected Cates frO urtthin the tame age range a the indcs (ate*: rumrh. 1* to 35 tmntht c4 age. No nklnirr <4 increased Irwi abanrjV tkm or Ingntksi sat demonstrated among tin* oMcf Imoirtfutrt (Tahir III). Indeed, if tie indes cates are included. 14 of the IS child/m aged 12 to 33 montht in the nine t ahu: hi lUtuKoISm |Vtr<tv<i t mi re t m Tta ua <w iits^a m<, lAttiwu uua uatamra an i t irnrs is mm <k s is a is set t i*a > wla 4 Amkjmti Aft .(ty^niar. /s-ad i a 4<4 i/J m! IfUUft^Mk Hi MMrfk T*4*b V*Mt t*< II aj 1 II ipmwsr KT^ L I A 10955 ~*s* WS CIIISOl.M - KAIVM. HK OK CIUt.OIIKN TO IXAD t o u t iv * -. i tor \ a. it n Ll. lu (`<>u t *# Ti*w * <'rniiMM 1 > I**! rwi U> - T-- - - -* '. -> -- ' - t++4 < wk-W na^a `4 ; f--W ' IWA* ft / > r* !*#%?) A.at r*rn uu,% 11 JU *- 1 to* ! i*to> - - t[ i 1 to to . <1 r< kiie* to t 1i to l tt W<wr* M 1a to 1 II 1 1 i 41 a l*a* | to i > i - a a l j t | to l | _l to . J__ _____! |VMV S4 a t * Tm* / rVvlk */l# A^M 4 tlik fki f T*Ai *4 lr4 >* ww tki | y U <Wi ** f k H^t t 4 W*M, ntriMlJ M r<4>UW <4 *toi ** I M4 huu*r)>Ulj *m found In U injr<inj | trntialh fcnic qtuntitHt of trad. In Iih j ( |Mt>mh tio d*n) during an rulr rp(K*V oi Irad fnrrjilul^uthy, tialur iOhln>( d lrJ at drtrrramrd (TibW IN'), lltfrf 4 tlw (our julmh died wtlhta 24 hrMtft iflrf thr irotrtutxxa d therapy %Hth ciUiKimll cakiufli divRlium. To<il unna/) oi/f|Hrf <4 IraJ pn*r U> drath Va/ird frten 2 to S mg While It li M pnttihW* to rUittuIr Mnir^lrli tie total It m) ontint <4 tltr hod\ (rttn |hr*r data, tie ovitent of trad to 4t tiuun ran Ir appr*nimatrd. Auh ci af'* ami Kdxr rt W " lui^r found to ammak and tit human hmTt*j*y putmd nlraturd (nan mdi\>!uali ihuig within a In* (Lm r anii after invitHin i4 dtnNMC rtpmutr to lead tf_t( fnvtt onr thud to t*t> think <4 thr I<4a1 trad to tarttdrlrfal ti%* iun ft (xmtainrd to Inrt. UU-y and train. Mrlrtil itirn >ar\ gtrafh and rdlnt to a ii-Ttjin r\trt*t tie duration (4 npnurr. Kr*n tlr data in Tahir IV ami thou* c4 thr utlen <px4rd. *r may ntinufr total (tntrot (4 lead in *4t liitnn in ihv children at 20 to lttlmg. In tla* mtirr arrhr, monk 4 hlrtitihrd Kmnn <4 trad *ctr asailahir fir l(*N<hddrm. Tt*r locatim* <4 ttwar vaiftr* aUw( thr dwelling* arr ihmn to Tahir V. Of lie 220 uiiiplo Inin! which (trUiinl pmlrf tlun If <4 trad, tmih 4 rrr r*htaifM'tl (nrn <rftn and fumitorr. Mrr %tiik* log it tlw fart tliat 110 <4 tla- 220 aoortrt wtfr window.tdlt and frarnra IVeling wall* p*|rV and (Tumlding pUttrf accounted (<r an wililxeul 4S axinn Fn rack of thr l ftjirtnl dntkrfl, (nan <e to hr <14frrmt wmn containing greater tlian If T\*U. V f.%*MiA*avT4 So b m Lava* Um+~r; r% -r M-* t--r * U s toma >.lrn< U to* It *7 U * TV If V4 m| knito, *4 lV 90 vl**aiiiJ p--aa imifinx ir^wW h m4 l. tCrl MO <**/ * Ml (trn OTV-* * TV* tf* rlrtJkVJ IJ *!; W r4 fatal t*V Inv <W mW* Mk ml Ua iVf lnW*V l*l 0r* rrkW# *4 VitKf to* He*#4 Y+0 ml 1 t<* k wnw m4* k>VaiAr4 fa vB IM | ** we* fNvIrt lU* 1% *4 l*4 l>4H*l to MT *4 |V lai ftl tra *<** mw(wikiiif (to* *4 l* *4 M I lit LIA 1095 6 AMICI XS 0 4 lead *rre kleiiUfird among the \nrknii items rsuh 4-1*4Vet **** (liought to lunr ' Ir-'Atd J <4 l<*2 <4 dtrrn there n A at lr**t *** *mne tootajr.irig prrat<-x tl^ri M (4 )'e-*d Tin* had w a s <Ttu:tMxl In tlw p*itit n t!*- nu<r T?*- |vi*t v*j old aid Haling aid ffrsjucoth (outauK'd mam Uv* tv <`<*r * mr (4 wl.xh mav Vme tenfainrd W-.d pigments in vstinh |}e cxmlrtit 4 h-jd rows luxe then 30 to 7(t* c4 (!* total soldi in Or pwuit An atfnnj* wat tna*lr to aMrrtain dtr duratM* <4 repnure Ukrh to produce iutic ntn]i<(4m Mjlrrrul ntunalrt ai thr doraifn <4 tIsrir duVf toj;n(inn <4 lead-cootaming nulrtuli (mjirniK wefe rjilrr un<4rfajndte nr tmfrluMr The fxj>r <4 rt pmtrr. Umi, J*rmirttrd an kdtfrvt esti mate c4 Or pn4ul>ir (jufition <4 njwnufr. 4 thr folk** mg aswimptxn* wrrr nvwle 4' thr Veittum <4 thr munn c4 Io k I fr juanl tfwsl thr duVliro hr rmhiLton to fwdrr to trit h firm, atd h) etjxnure Iw-gan at Or time 14 amlniLsUm, <* l I. lixeilhi <4 agr in% ttr average. \S Kii thnr a&tomp tmm thr prididdr dinlina <4 rtpnurr Ir ntiituli d 4i thr mterxa! in (mnOu mc'CfduVoftathy Tltr lmj{th 4 ra*h Var. tltrfdfrr, rTftfrarttti tfr abiumrd ditfa- ttio ol r*jknon- in months hr rath child In tin* tipjMf pnflktn <4 Kl|^urr 1 tin* ihlh df'-n tlinr first Iti/tlMlay Itrtvtrrc* Mav aid S*frtmd** afr TWy wefr jamimrd to Iw^r lmen ift^rttlnj' trad dii/injf M4ttr part <4 this Smotith tumnrf prmnl {nl*n thr peak IfKhirorr f4 acute Ir-ad n*pluk>fathy nctxin). >< then d>d t*4 laxTarr iQ unfit Or itiitMitff (4 thr Wliminji year as 0r> ajijirtndrd iA nvMtth* r4 ajjr In thr kmrr portKm <4 Ktgu/r i arc damn tl**c palwn*t reach* in/* timer hrt InrlfxUy during thr kinlrf mtmcha prsor to April Tlri Iwxamr |Q dur* ing thr tint nuumrr aifrr Or jirrsumrd <a* Vtl <4 ingrMfcm Heading (lt*n Or top to tl*r lwrfticn c4 Figure I thr pmluldr dura* tfci <4 ingralkjo, therefore, Inwm pro* peasnrh ihorirr and AjpmidMi a mini* mutn c4 3 it k o Ou \\ idia (hit group c4 32 patiruts thrtr *t no ctatictK'alh lipiificant cxirreiatim hrtaern nvstfh *4 first lurthday and sorrily <4, <r lunlu) during, aculr lead ecxrplialopathy. Etcluding DnrmlMf, tlr dntnluttmn t4 lariht In mnoth la tfir I !r-fwren thr child's fint bulldas aid tin* grtmjp <4ne% m4 dilrt ugmficanth frum thr 4C* *( Uh Or child u (hiu&x) at iiMj(fJy di*lnl*ofHm <4 lartlu la Bdtinwrr ax InctT-ased lead atmrptxm. <4 duieil lead puissaiing 4l divTnrfnl \M*ti tfr Uif4 were <iiulorl on tint luui, Im tfsr >r*n Tl*d Vi IAI indutiir, during * h*c h rrvn4 <4 tlie pabrmts a err Urn. la this mull gnup flir |srak in lurths duruig no 4t4(ntM*!K tigntfi* *M (irrrUtirin crmld lw fi*itd UtiMTii presumed iliifalmn <4 n* pmfc 4ih 1 srxrtrtv <4 <tiw-4v (npurd rurnul c hiUrm ru IimIh I l Iik Io O, Or data indicat'd lliat Or |rrtiiiMil np**ufr a as >4 ttrmljf duration in *H dn gnostic class*- muriih-sting |im teased drs<x jifxm DroWrf. and the passage <4 die nldrt infants tlrmugh llrir first mmnrf <4 amine Utum xntUxit tMpjittims, suggest* that 5 to 6 rrwvtfhi <4 Irxl ingestknt may rlpr prvr to thr umH c4 acute lead mcrphaJops thy. The pni1n!it> tfiat a minimum npitctrr 4 |rl. * ifh <4 without sxmptuint prTi>d <4 3 mocithc U cciptlfcxl. altrf sshkh \n ct pi mat* h i for this Inanr apparent ahm llr r4W4Ml fxlia a a* taken iritis Momiit Thirfi Iv mi in Or rrtn Or arfient <4 summer IriHnei ftie omtmh Ung fact14 in (tie prahntkKi <4 limptiam. is also S'iggestrsI hy the ffdkming 6rxlmg lr>eloft'd acute Irad rftcephalo|Mfli\ pi'* In t \r*tt <4 age. Thr rrUtxmdiip I**- tssren t!r fxlof ami lltr pesomed In thr entire group ttn*rr wrfr 14 thiklrrti nifh iitirxpii>t*tn! r*s diKT <4 eccescKr lead itigrntion inclixhng khytifi< atkm (4 at least duration t4 etpmur U darwn ft* each i4 the patients In Figure I. In which fhr tsvatfh <4 tltr cl*thl a first VwrtlnlaV I* In a Im/ mth tin1 nratth i4 mtwi <4 acxitr nnr niviMNtmenfal Kmttr (xmtaining ptylrt Oun If <4 trad, Ih | mth no ni* rh'fMr *4 i'vrrased lonf alrnrjitkm. Eight <4 Orw lourtern tamial-ripnrd ihddfe* -nsurmr LIA 1095 7 QSQ CHISOLM - FALOM/NK OK Cmi-ORKN TO !X\!> RCLATlONSHIP 6CTWCCN MONTH Of f I AST BIRTHDAY ANO ; \ - | u. | la liik (Tlptl riv IMtV f4 *4 *4 Mlk 4 iW ti |Whrll h uu l4 fkrjJ|if% hi { t*jn W ( to i1k * m rt rtrN (Ito tV Wl to (W irfk mk O# tiA) i Li to iVrw pato t/r y<w<l tn * M |W L fw k M. <Ulrk#f. tol ikr it^f ! *4 k -m& rtj*wr toi k (* It iiU t ck nliM <4 (r kitrl ** fW 1 (ir <4 aiUfk TW balittr *4 tW "fmtt la iklt rtri >rj'Mtt'J |M IW MVI W MtkwL b# M t>> ft*)( |U *#.*-* >4 k <>t to kn rmliwivbi tn l'j4 n.iwl * f |# J: i i in,} k4lia 4 rt|>M0T to lrl nd (i# *ntul lnM toi lk 4 HtoftotoM Cto U 4into4tto4 torfr lrx Oua IS mm<Hi til ij;r. (j*- An inihtH (4 (hr ntwtmr <4 trrrtr mv-K, nvmj( the !W |utm< tlb rft- prttnjnm( <Umi(r to (lir l*if unm^ tttf* tT^ilulnpat^, (hr LmtftjjnK to4% IS muntfn >( <4 an inttul c4 aoatr Inn! i4 %r. rmr{>)ukipatliv HKUatn tlir (mpudahcr A It) tomtit thrv (ttotj (toi <!iuj(t<iu 4 rt- <4 (t>n(>niirt| mortinnrfifjl npimitr to ffctonrr nr?r IwlmtS tlrOmnl. tl*r> rr trad in tmfrating Oar km xlt-mc (4 <Tt4f*l inpfurlni In' |ii*twkn ln*n irvim rM-r>in i>(rm cipartLr. In Oar rtatirr jufrtilv u !mi (tat Own )u(l wv Owf trrtrt 01 *nhi*i <4 aotlr Inn! rtx'r|hji cLihlrr-n logntm^ Itjkn <r ta! ftmrwt r*)Mt)n to^rr tfc*tr| nv*r Own 1. rmwilln platfn jwirlkk^ in tlw (K.M* it<*>) nwr |iftir to nahutt*n 4 utpirllar (tlwfjp> tHr tfmr Oar thtld ta<I fw^un to to nfk It to itK tiff*tr, | A pafkrfttt. lUlapi to ith AM*. toM !* olnrfinl (tat n>n>5 jwtH'nti tot*r ^ pofwiriv in ) (iNiapy toith nltlha/nil i mr>tm! in |nt*Ul rptvwlr <4 < utr Iml (4k torn iltiulliim, 17 jtotkntil IVtma 4 rrwr|h4kijto(hv aftol torn* ir to (Im- Cfoop to nr ktot (fin folkm -up fort* lr*<l, fit\nrnil'Knlr <4 riMr|t)u kjviOn uiiulh <1h I k 4 itxitf 11M1I tin* Ii4 it *4 Oic 4%fY-<*r pafkrtrti (Hr*tr. H pt (h H*. MU tV jMttmli, ant) nklhamil Into Jtijj lumtwv <*klum OktoMlhim. 14 ftolimlt) hatr )rrt ( 9H LIA10958 ;? ..... p p \ r i ARTICLES 1 i I j fofkuard foe 1 ywt i* )m>grf. Of tlw-vr id wtom luuJ jx~mvafx-ot rmklu* in tJrt* i 4fl patwfiU, 14 t*v klMm-n to have ct*>* tvain. a/v tmvflrd fnxn Table V! If (Ixae tiin*r\l tnsJntM i4 trad for t4 2 doubt fulh rr-*-ij**rd C'auA arr ctxukirrrd t ^ tmtulhi cr Irmgi't. 4 Iwwl dmdrfful rc-ov M \, 2 AH ami P > 0.1 ^ |>nrr fix) 2> tu<J > Lijrmn ft* {ir njunufr it j*4 tlafitfkalH ftfgmh*nut). Wvd *Jlft lU' triiful t'JRKKk <4 Kur the entire gr^ip d *rvhtir <4 miW! TW iwvirfxr f utjurlUr in the a im) tnrff ftkr|>,`al>p!h tltrre to no sig nuifwn <4 Kxlr k'w! nvrpluVijvithy iui nify a v A iTHTi U'wxj Mrm serpu-flar and anahtol. without regard to (}p<- of l)rr|y lie dofttkJQ of acute rrurpiultjutiiv, t*pe during the acute plta*e. to cWr* rtmnc e4 tix-rap* during the acute phase or u- %drthrf there a t am tuotUtVin lirtrm crotfatxm c4 lead tot KVa*) after lie acute ti*r occtifTrwr of roitp prruunmt (r*i<iiU (tlneai Tl*e V*vt 4 patient* from foOcAr-up to the m4/d nmtMt ntlrtn nod re-ev dor* not iitutr lie AiuKiii la lunhtxi |kiirr to lrtJ lVvtnf of m>t <n more of fait rr-npaoj to W-ad t)rrr to no nrrrii' the h*tVrmg mamfrAtatlnm n ctm* tk Irtotea *cqucIW and age of incidence inlttnl mtioKr of irriou prfftMflrnt dam at the I V 24. or 30-month Inrk *gr to ll*c twain. mnr narotaJ rrianiattna, rv'cvormt twuluum rud *nrrt OtSCUSSfON duonltr Of t)c 21 survivor* cUui&rd a The age* and aoaaona] ditthhutka cd Kiuof l)w 'mm KxjielW,* 6 dcm*wv- >)mptimuat>c rate* tot thto xrWt are the trlnj one of thne urirtu, 5 had to and iunr a* tbnur rrprtni fir diialrra W 12 fulticd a Q three (Tahir \T). Three ft*, rtal*fx*I}>. hrghto **gni&rttn( Aimru- vartou* imniijjtKin.^1 Ktglr> -ctgfg of the one hundred &ve rum of acute Inad tn brtufen (hr uxtinrtxr d ludi "r- tntmtratkm occurred during Mu, juar, irrr ttepartUr* and reoj*utr to trad Juh. Aupat, and Wptmlct. Ninety of the fofVrw ug nxmm (run mild mccphah one* hundred he caara occurred to chfh pitlit (X, * 14 JO. I* < 001) TW (tvrtb* drrn letarro the age* <4 12 and 36 nratW tkJA b*<ier tf^udUr and tr-njowrr to It oerd onto he rr-ctnphauacd here that Wad to mure dd?xpdt to auru In tlw giuup inmrt tot )ik 4 thr children <4 thtf irrkt tunmng m rjwdc <4 severe mt'iiio* Jt^ulhv Amo**g the 20 mrtr c avt. fr-n- lived luul kntti! fraturr* tn crcnmno. they errft old and to vimig state* of Atrnnn* pautr m HMTrUm in 4. Thnr four. all trod and dnopur. In tie Wmn vtMted, t \nix \i KutTvn wtw% lrmvt <# i i m lev (tcii it eat Nu*< f^ime w K*-tta*M 1* ta ******? ii r**u 4 lrtik hima u# A<t La * * f.v i/c .tn* iyW |I .1 ,VwW f>W* %tide* - A. Ik m* ! to*4 | % Im* N y iww I* kiai | IT auiu.r^4 v'*u ti.r<t T* >en>.e *4 ***** v<* In4 TM tt0m H* |<w> I to t)4r (\* Utl to * f V^vltortm. t****mJ I* <U to*-- I>kirv* 4toel*ie), * t>tn M to *W f-n^*na \m Ih 4 n*a>**e twf<t *3A o+KMW-' .*w??1.*/ I.J W.;njiflfyinam;j. l*1--wwpfwiy?? ' " '*****'r*s* d immum LIA 10959 W 952 CIIISOI-M - EXPOSURE OF CMII.DRKN TO LEAD cnunMmg, painted pb|rf t* Vwae pai/tl i4iq> fnxn **idU, teilingt. d<*x frames, *to- d<m-*i!l, outndr .;*! lour* Wife readily aotcttjbb to thr liandt and ru.*jth* f r sm-dl thlldien T)r data iA live present t*idv %iwm tlx* intensify of this Ivpc *4 nptiuitr, l*l tlwy cannot be ap plied dim*H- to such quest k h u a* the minimal quantity of lra<l tmk* fur chiklrm nf tlx* itMunul safe omloil of lead in Uqud paint Amonjj the rmirnt>mrri<a) data prr- Kulfti, two f*ct*s ttand out: the inlcoMfy of lead rspoiufr peopled Iry small quaJi tJty of |uu4 flairs tod tl*c role of the srasoo in pmctprtatkio nf acute |ri<l e<rpK*Jn|^thv. The data in Tahir I on (rtul fUTty of lead may hr utilm) as a measure of the quantity d Ira! intotid by the various gnmps n# sultyrrt* in the household study' Tfr diflrrmcr between five poiauord and tie tmuflortn! chiklrm in these house* hold* Art Out require statistical anah si*, lor tie mean <Uth (mil rsrrrtkxj of lead in tie poisoned diiklrrn c iit t iW, In .Vh fold, that ef the controls in which M feJl wtfhiu the normal cvptxtrd taugr. In Table II M tan be seen that the mean datb fecal ontjxM sf lead U thr Irwdpmscwrd chiidfm (44 mg Ih'ilas) ^needed. In aj>prmtmatrfy fitfold. that of a jfroup of se verely exposed industrial wxxkers (T 6 mg f1/L*v) and. by elevenfold. that of srorh* m in vahnus trades in vdiK~h npusurr to Ir-ad is less severe The groups if Jodntrial mxkrrv tbarn f<e tfwrqwixjtj1* wrtr exposr*d to Irad-ctxHairvtag dust, much of ahk h h rwaJVrwrd srith the lath a. As in tlse rhiVhen f the jaramt study, the principal mode tf alunrptw* in these mxkfti OfMikl fa* thnwjjli the j[Astrnritrvtinil Irat It has lerti piinlnl <n*t that tie oc* ormnet rf Wad rtrtepfsak>j>*thr in adults Ha* usually lees associated with interne rsptaurr ** *H>e mrr frequent occurrence <4 ctMrjdvaWpafhy In (hiMr^n as <Mnp*ml with adult* mas <trj****d in part op*** their more intense npaurr rstler than upon any inlxsmt l*okg>c chflrfctKrx between child irsl adn* lehmafT' ifscnth fr*\ irsnl thr IjfrTa- tufr and cxirw h*d*d that tle a'etagr iLnh 4ii^c-*U<sv <4 f*`t tn4e than I iS ng f lr*d b vutlx.Mit hjrm Hdwa* ft /.* Ivave fcwrrxi that *ij;uiEiaut r<rt;t4n of k-ad in the ti- u k ^ (no us a in adtiition to normai <iHary intake, adult vxIuntrrr are fxl 2 <4 aoUihW* bad fa* Irad aertatr) daily. The data in Tahir I are in am rtl alth tlrse cw k hKti. C rxirr lie *pKs<xdup of (Itr An^tloin .ArTsdetm* of Pediatric*, the Caanmittee on Hazard* to Children of the Amrruaa Standards AocutV ftudsed (lie prolilrxn and mxvnmrods that paints may he nmklmd safe for use on cM* d/m't tms and furniture aad housing io- frrvei if tlx* imd contmt does not e*- ored If of thr total midi1* Paints and other surface on*tins meeting this aprei* heatmo and those relating to other prv tentuDy Unic metal* may be Labelled: *ctn> form* to Amosaa Standard Z flflMKS." It U rtientul to recognize that this rrcom- mrvKUtian apphrs only to the two or three livers of paint usually applied to a surface, k 4 to multiple lasers of paint M mar bo found in old deteriorated bousing. As thr numlvt of layers increase* or when a W layer of paint containing Irad pigments is added, the quantity c4 lead per unit a/ea iiKTeasrs to tl*r plant where nm a small flake may orkaia an runshr amount of lead The magnitude of nprarutf to Wad asxxfated with thr Ingestion of a few small paint flakes h emphasized tf wr calculate tlie rpuntities nf paint flakes necraanr to yield the anrKitits of Wad found In die stool* id the Irad pnisoned children: far rsample, 44 mg of lead would be equivalent In tl*e ingmiiuo of Oflfl gm or less of fwmt flakes explaining M or mnr* of trad, or to 4 4 gm of flakes <voUiiiing IS of trad. An example of d ' sire and quantity of paint chip necessary to yield |i4ro(U))y Ionic mount* of Wad b sfiown ia Figurv 1 In Tahir V the Wcatino and lead tea* trot of cm imometHa) sounet of lead are slmwn. 1C*2 if Oxse |0ft chiVWro were p Hed to at lead Me sourtw containing giralfS than M of Wad. No m of load |a> bokattoa Has Ins fnsnd Sahara (U only ,'lff ) __ j flC. t Cun(4 cd Mm m) *p+ad#j *4 f>h< ftifnnli tcWMi>( * potnrfUlK hnk ipycfffT c4 Wad. fnM tm >8 |HM l(<j Mr ! *v. l<4 ita^MMii cd Mif. TV fld (Vlt hi(Mnrti 1M p, |V) M ( |tf9M>U W*1 W A (V laCMMd they ft *yd}r Inn iLm Im Ui a fhcttr4 iii tf kJ n latW*. Hh Vkfc nltaiiJ m UiMa to d* )sMal ani M Vmi Wtrr (V Um niiMlU. (raitlarl |W ad lrl TV* mb(U tf****! iKd tU <U) WW Uf brad {MW iali< Um( ch4 It o m (Vi ami c(Vf WI1 InaiaM*^ >*wd* T--ifiUttwi ad M) Urn ip|*iwtimlily 10 n<ta ptor to V*p<Vaftm iout\T c4 Ind (uniilnn) lr% lion IS rd Wd b the dnrd paint iu Hmt . The present fiUtto spph to old bm*ing tn*ih at bvl Is pfrw-rHh uard *i a paint drier m aril u a pjfmrtii. )1 t4 lead in Hul paint 4k H aj'jviotImt tftr minimum ctauistmt fih a utn/jdiirv Vmik * paint. It b h k h cmatlr tint poor matninuixr of mndm U"din|( with rnMhanl toniRMilitKMi of many Uvrrt 4 paints (toolaiftbrg u httle as IS oi Irsd) o*i lurlvn sorttiltlf t ctuMfro may la fix future orwtitutc a lu/ard In tmafl childrrtt. Kv^lmcr Ui l)cm pnmtnl whkh |U* t-ln that. ailrf a minimum (4 afpctnl* nwlrK 3 rrmcM l* f4 tki type c4 exposure, thr adtetit rd /in thr pmmtT c4 imtbiird npwiir to Irad) Is t)ir Ia < mvi#iwnrr*tal f*<^ In thr prettpstafan td *<irir |rd mcr-jJaalnpath* (h< I). Ablrmjjh the mnhiftiun id this ptwnumc* i<i M nnt futS unUfttiiN!, npilrnmiil nklrwf has tr idtilnnl In srtimsb whkh inikaln llai vitamin t) ami the attlnk rm rd Oar tuentirt m InTnut thr atmrptifift id lead ff*m fh* IMrdinr * It has aho hrra wfijpwted that the ! (Tminl Imat <4 thr MlMnct Intocts to de tn-drsibo and sddnb In mttl chOdrrfi and In this manner srvaY play a foie la the pudiuhto U riaqdalujtolKy^ la the jimm! study no trliaiik* data (tiuld he ohtainnl (Wrtninf sHamdn I) intsir hi view id the sporadic use c4 vKania D-fottitrd mpratni and frrah Mi& products by tha lulijrcti Arraaf thr patients Interviewed, a history i4 no titmb D mppb merit dttfb| winter or Mifmnrr was |Hia hy shut half ud the tsm Wbrti lie pruttahW duration of npowrv rttmlnl 3 wrmths, tm osfrhlkn iuM tie (V mrmifalnl Muna Increasing severity c4 disease are! further monthly Inrrrtnmb la etpstu/r. This lading may far explained liy the interplay i4 two trflet fsd<n: the magnitude nd Wwd b*gfwtkr (Jaensd la tlie leuidsdil study pnup, and the seatosul faster In lie prr'itpttatkMt of StvU tyn^rinns If rfn|J*ti#** the oigef*<y dialog (h tomuwi fM*sta <4 tl*# psimpl fetnoval <4 dtikbra mnifr*ftg a*;tnpt(mtir In* creased lead sU*|4ka ft*an froth intense r r r to^sMai'-gfruyeyf'v1 ajto-W! ;aTO'tfgw. Jt LI A 10 961 ^' `` <U CHISOLM-EXfOSl/RK OK CHILDM-S* t o IXAD npoaure to IraJ Tl*r data Imlicatr Out, In Huh a patient, ftcutr rTKeplulopatliy may tW-w-l<p if nprHurr t jKTmittol to iMtitutiH' |m( a few wrck.% Vmgtr. Kr^prency <4 tngMi<rtt, is, course, &n iin|iurtui)t itmtuleratiwn. l*mg*term tlata <4vk*m3v look) r*< Ij c olrfaincd cm this potnt. The data In Table I frpcew*nt, #t mr*st, only | Vxprwurrworlt" la {<mr The frjwtithe In grxttun <4 A frw partk lr from nttc of Ow* Identified tamex of Irar) tcml limn dnflnj* tliat *ri \tuuld be nxnpAti* I4e with this data. Tusnc contents a4 load (Tal3c IV) gt\e an approximation of lie tmounti c4 Irad luOi may lie lUnrbn] umlcr tlT*C CUtKlitkUttS. Tlw finding In fKe household study of five ~ecoo<Ury* run among the lit con trol lubpU a^rd 11 to i5 moot hi b Sig nificant If cnnfirmnl, it Unite*tr* that A larger public health iijuxt of Obi dnoua custi In ok] Uniting arras than haa here* toforr been rrropwrd Furthermore, abef* on an indn U (ound. bb environ mental ctnUrti undrr 3 )r*r> of agr should hr submitted to oarrfid cbiUn) and l*U> ralnrv examination. Although the nerd fur kirntificatloa and fenvnal of environmental sources of lead ift well known/'M a Ugl.h sigiufkant earrrUtinn Irtumi rr-nptufr to k-ad i ;k ! the tnckJruce of rmr permanent mjtrl* Ur In the central amtnii system In wf- vKiin tf an initial (pwxk <4 acute m(rphik*]Xilliv )ut nut |>nkiuH lm re ported This Indicates that immediate and aliardutr j*fr\rotH*o of rr-cvpmire may, |>nfujn, be the singir most impt*r*t k*>g* term fact'* In the nnitiul mU<nr in nxh In out nprrlrtKr this tut Imen satisfactorily a\imjln)ini only by burning the okl Iradewrfatiiing paint ttan plrtrly away re In transfer of fl*e child to a nm dwelling in g**d repair. Tle term "pica* k frrsjweMly used In a s - aeiatWm with lt)i It m! prisoning am! with mmtd iMrtl In ibiUfio Urns. In (le tnindt if Rusty. plitmlnun and nrrnUl (If* Arlrn*y are frrxprt>tly Aiwatatrd `114s N twit so with rrsprvl to the Ingration <4 other toxic ub>1*me*f a angle Jwgrvtimi wtm.li, luJhie? to prhwr Mt)}ri<ni. Tltc wtrtil t4 tiddlers in llr ] y-*r ag** gr**ip t. ta*tr ami rxt a Urge vark tv (4 I mo go iru trrU! ik x%-tl krarwn am) h MniiKbin! to !> V_ a part of tlw-if iwtfti:*! lx-la^*eal Jiattmi, at kjt fee a Orel ip-m of tm*e, In tie prrw-nt all tretnlen o4 the Itoutch^k) grifup wrtr auljorffnd to psycho metric exariurutMin Witljin tlU* group no Inking dr\rk>jMiMTU! deviatiotu cvukJ he f<Ami brtween tie afleeted and tl*e oorv- affected memlwrt Ip additioo, 21 paticnti who wrtr nut re-exj k wed were p*>xho- mrtrinsDy evaluated I year aftrr recovery from acute lewd intmiratym ai*d eoceplia- Inpathv The dtttributkun c4 bvtrlligeooe (juatimtj o q lie hash of (ha revised Stanford Huvrt Intelligence Scale, form U was as follow^; (Vawt atv m Tn* 79 so. m 90* M 1UO-I09 t)0-llt >--ih r * s. t I 4 Thew findings would agree with the con* cr]4 l!*a( the i/kgrstkm of foreign material ethdxtrx! In thor chikhro wa* not a maruhwtatkxt of mental lirficfctay, but that a mafltr frw<!y suiUhllty of highly toxic terial In the environment was the important f*ct<. This U certainly sojjparted by the high *ia*fUn'* attack rate fmrnd among \ tie <mtrrl mlyxti <4 ll>r Uxarhold study. If the ittim)(tims are omlf tlat flaking, lr*<! <*>Uioing paints are wklrly ditnl>* utrd In okl hmng that there are large rmmlen <4 Infants and toddlers bring la Kwh a plnxkal rnvirt>nmn< and that nor mal * well as defer (n e rlriklrm may mad- Uy hgrat amourHr of Id k I softs lent to |*<Uwr Intmkatiiai, tl*e rpwwtion arisea; N\1r> h kl MuxkatWm not rrnrr prrs* Irot |fw*n tfw* )Mmleri <4 cases presently frxognisrd would IimUs It ^ Many case* <4 Wser degrees (4 intnskatkm may go unrfxs^niae*] imleaa mug)* end (as Indk mm OKJ^,. r J! yMWMyjBIBMiMJIli '( L IA 10962 i AIU1CI.ES its Jistrd !iy the im-idrrxe rf then lea* than 5 tears nf gr. They atatrd (iMi') oc tnav V tlr result of lr*wr in- that in order to g*4 tsrioui tij>ri nf Home* I potion In *tiU ikln-f rluMrrti |V dura- iofV <Hnr, tlsry shirt tV chdd/rfi in other txm <f lng"ktim mj\ Iir imuffn Kill to jsro- fmi He ftisort totrr\*U, in ihrv nmnw fdtKr- mft iign of l*-jd Ihtr.mjUrn. amfni rf lewd Hrfr found. Miwrvrr, prrVMu|>K%il fa<1fr% rVitrd V-vtrml if t V children In tV Hospital In tlwnr subject* t tidied Hv tV iu IIk O <VniMNvtrsfed an mmlvr ikii/r fir if* may. In part. arcuf*t f* t V frUtivelv fn<M>n From tHr point rf \irw of tire pr^lff ingi-itton of UmI in tV |ul>|<tti thcid, tie* tngealmn if futrign truti-rul was of tlii* rrjvxi aft otnjMinj with (! population of duklxm wlo may H* to an ofrvi Hi* attmtion grttitg doVe1 to rmr. [urtkul-irb to ttaar bo Had Hem vmuW pHytkaJ rm uimnutilt \Sj!h ;r- pmidinj He tt Many title n appeared to 4pnt to maternal informatsm cttxtmirajj ndfir madvrrlmtly upon tie* wfodn** wQ piumHum, rootl*-r* wrtr tiled if they ami tUr frames as fl*ry ga/rd Out into tHc *err war of their tHikTi togr-ithm of rtirrt In thrar, Uerrlnm was apparently punf or M Irard of liir danger ff irad ccmdiKiir to tHr lr-a<l IngrtlinA, and may He po%ontng StgmHoairf is tlx* (xl llul 14 of aftnliitaldr to tHr lack nf an cmutkmalHr 11 mothm, while awarr of lHe danger in* and iotriUvfualK stimulating rtninoomrtit. iohrd. attr not (Tmrrmrti tlrj Mam parent* reacted In an mtTpn4rrthT nnuionl the amount <4 |talnt &tlo thrif attttiadr foQtming tHrir diikTi fmnrty child w* rating to Hr imufioml *Vj H<irt fnm srutf Imd mcrpHalopatby. THry fre* Him.* Such maternal rfjlnnniti afr quite <|urntH aiu^Kt adtice ahout pUy srtnitKi undmtandaldr in \Vw of tV pnolmg Urn tHnr duld, the dtmtoutioci to pfen ms < AmUtino that leu tHso 1 gro cf paint eftm striking. Aaket mat cxwUia highly Imic quantities rf Sta<i It b tHr frprtrthr mgrUwwi of tHv SUMMAfty ANO CONCLUSIONS minutr quantttkn of such paint chips which ii jiK to Irw) ttUoik If it it conoxird A study cf mor nuiroMiinrtat bdum torsi #ml snria) factres to tHr productkm cf llut no tiM^lxr tan rrjvttuiiK lr rtpxlnl lead pif*nuing to dulilmi to an urHan rom- ' to pnm( tlm hje if in the mutiiTy Has Hrcn rrprtrd. late if ciuinlJmg Juint st>! pLttrf, ft wilt Mint s*gmH< xtA among tltr mviru* tic fmfmml llut proper mamfmawc of mmtal data [rmirtixl sitr the nuputudr Nrfh interior ami raferb* {viirrfnl surfaces of f)r n(ti<rr t lead /mm rrprtithe to- i prnHuldy tlr most kupvlant rmifua- fntmn rf imsf] quantit kn if It mIh I pint mmtal fact** in tV kwg term uptl of isirt, ami tl*e p`lr of tHr seasonal Isdtr jXT-smtxw of cKitDirtjd lr>J intrnnation. (tummrr) in thr pretipilatHm of acute Irad TV <rmtivr efHelft tak*q In tV par- rncrpluk^kathv iHr jrfdnnurut ff these rtfti v*Ho sMnnprd to o m! thr tifpstvja fattier may mplain the alnrorr of any (uniiilfd Wjjrb rf punHur inraiu/n sigruHcant (firTfUtwo betwrm srsrrrty of which mas Iw uxl. prims facte. tn hasc Vc* briinltul OnH <**r had iltitnpitl dtsrasr am! inctrromti (Ijryond a minimum rf .1 furmtln) to tl*r prolaldr dufattoo rf In fnmnr fV court r if (rail l<lr- npituff It was concluded tliat M tKfld w nr. mi |V Lm k if kwr p4ff4*tal upi>i*k*u of tV affected children TWtcrn rf tin- thirl) th/or im4Vrs ntr wage rarorrs uirHrwj! nmpifvni Inst Having IlKTnnrd a! aptkm rf Irad, fevognt/rd diififg tie lummrt rmmtHi, may prng/rts tn sevrfe re mUi wiekrd at mnl ilm <f rmh <rpluki(c4t!*y wifHin few week* f ni a**ai (ftwn tunir WHiV > lft*n smitn rf H'arl are mf promptly identified Uanr tiny left 0*-i utw!) ihik'rrti with ami rtimiiMtrd iwtghH** of in tHr catr if iJUt children IV jeramt atudirs ilermmstrate fl*al m< Sit of tl*r mr4hrtt had tmer than three d4< pn+ure to Irwd may le intense to diikktu '.4MWV- rae 1 ia^;>,uijy$eppgw^l*,'e'-! [f4wwsigww..l ?  j mut" j!m LIA10963 ftf CHISOLM - LX!Csou: Or CHU.D8KN TO lU.AD ovrr t yx-ar at age living Id ddaj>idalrxl cfiiklltoud ptumbism than specific limita dwelling* in which ILAing IrmWd paint Is tions on tlx* content of non|7tgnkent lead In fr-oddy acxr'itihlr TIk 1 intoaiili of lead fresh paint. Tle vorkftii environmental found in Oh - free* of Oh * p>i*wvrd children data *11 point to the conclusion Out, where in flic jirrMiil itiiJi runt!/-i! Oul fotin** by hooting lias Ixvo permitted lu deteriorate, <*!h t In tin* lexn of e-pmrd industrial rtposurr to Wed may lx* <d st*th intensity as wtxlers Thu *ug*vt that tin- hlgliet in- to outweigh such individual vorialde? as ridroex- id lend rricephalopatliv Among mental rrfaruatkxi and emotional malad cftldrei as compared with adults may. In justments to t!e child. Such lotnoc ex part, result Ifurn their fcUtJvrh ginstrr ct* posure Is a preventable hazard to normal pnsurr. small dilUfrn. and, as such, constitutes a The importance id continued mimo- pobhc health protdrai which may he more mental rtpaurt to trod in (Defeating the ntrtHivf tlao has Imdifore hern thought bcklrtier id to ore permanent damage tc the twain among run tvor? nf an lrutlaJ at* Ui at acute lead encephalopathy to exist Pending die wider miUUWy of better housing, pneuthr measurrs will have to drfrwwntrstrd. Tle orTrUtKn Ulxteu t!e be adapted to Individual home situation* rxe-urrmer of mdi injuriW and re-ex- and to the available (oolitic* within a give* pmuir to trod In patients rnuvrrinj* from community Hur In am* preventive pro mild orutc encephaWipatliy w as statistically highly significant. It w a s concluded that removal nf Iral fnu tie child* enviroo- gram ore fociblirs for the prompt identifi cation and removal of environmental aiurvn of lead, as has been emphasised by meat la the onH sd^uitr protective mrai* urr in such tart The high |nijmtkia at children aged others.1* * Equally important b a cxvaprrhemhe social investigation <4 the home I* order to evaluate the circumstance? uadev I! In 15 months with average fnfrllrrtnal which the child obtained toxic quantities <r(iMitv found amrmg n of Wad iss* of lead and to determine u hrthrr the iden ImkatMi, and tie high intiilircr at ua* tified sources of lewd can le adequately rrsuvprcted u k i (tMtnd among 12- to 35- nwnrd. or whether a change of dwelling W mntlieiJ buuurruln of the Index cases rrvjuirrd to prnrat further dangreoui ex i 'lemrwutiafr Ihr importance of the environ posure to lead. ment*] <4 Ur problem m uHaon ilutn arras Thu high Incidence of "sextesdary AOCNOWUOGMENTS cases* rmplwst/rs tl*e plniNiini oihgatxm In rvammr rwrrfulb and promptly all rmiruiiUTifd (txitali under 3 years id agr shl^rf an index case U (tniml The drvrlnfwnmtaj lactiws In the child and tie sra-tal iHtalkni In tie home w likh Thr authors wtdi |n acknowledge the > operation at tie HaKj truer (aty Health De partment, and of Huntington Williams, MO. DP II., Ovnmlvunt, who mode its sen Ices frrrh- nsiUUr to ui Miss Jean Ajiio. HS., prtformed all td f may intensify tie to|ntkn d Wsdxmfalning materials were disocsied While |lw pwcfaenetric niminstNM included In this frj*>ct. Mr Peter Wet preformed some tie* resprWioUUty id parents l/> |otrx1 tl*eir children furs rnvttimmrotal hazards is nut (leiiol, tw ftsrfhrr can mswlfy be rv Iral analyse? td the frees and tkuurs. ftffuiNas i piinl to prevefd fl*e irjstHIxr Ingrstkm 1 Hrrs. It i. VtA4. C r. and Cush td a Ira paint chips Un the ore rrelily man. M t'rtuuy ruerthai id Wwd in acsrssdh As lracl is wfrlrH nsrd as a palirf ilitliWm \m j f)is (Tultl. H7-34A, drier, (intlrttwil g**l maintenance *d luvt 2 Ww imS. % P. Ms h , M . iwl l/Als. % t painted surfaces would a|prc to la* mwe Die t4 Wa<l prftinrot In tie W> tong* pnnfkn of A metlad lie tha ut Wwd hf* ' -u -iwj*.)ipSf.Zi-Ji'M.M nui-isMiaBa inci.cy .fJ-Wu^aii eapjJW*' j j i ue i .............. LIA 10964 T MbMHafci -a i \ i Annci-Es 957 li.g ikr acute rtafa. fttnAf***. 14 201, I9M. 1 Wdlumt, IK l*jUn. t, Gowkmati, C K. and %4\m, B B Lr*4 r>* wrung in Xnftg * KMsm |\*h Mrahn Jlrp. 47. 2VK 1W32. 4 Mrllmt, H B, afd Jrtdk*, C U; |* drfrwoi^'ta *1 *td jfevTl-Ajga.-*] itud\ U Ir^l tniraM^f ift <h*kr*v JA MA. IS* IV JU%V i jUpi^wl, M. and Bui***. M. I : Irtd |4wn A <t**al and rtprtuumfal atudv id liar factor* k*B**crciftg 'hr armfinal |r*t*U-iar In duklm* An | Oil. 0ld.4l 74V mi 4. WiHumi, IK Sclmlrr, U . IK II B,, Brun. A S, ami Sm*k. K B. |f : t/H prittki<(|{ lw the burning d halirry raun^v JAMA, 144 IWi, 1911 7. Wtlbr, J: A (ntS oullml d W putmung Ii i m burning d 4>n(r bd- tce> uungt Canad. M. A. J, 7# JA., 1914 A VlHkdt U |)rtftfluain( L**d la Kit and M fWolnguat M*lrruk Nam Tori, Amrfirato Nblir Mrakb Am , 1944. 9. ()&ul a*d NMbrtit d AmS* Ml. 3tb M Aiaaohua d OAiul A(rt- cvkural OwmiMlt, 19W. n 597. 10 V'de*. L J linpmnl WtW*nne lortlnd lor (ic^nitniuln d Irad MnnJ<olf al k|^) pH AaKl (Ina, |4 fA4 1947. 11 Iiaj4*n. )*. Nt v m) rnniniiiUrdwa lo tlf** r^kf i; iri---. n a . 0-4*1. j. M4Mt4 u w, lUmlitil. 1. ard M<\*/v H H Ka prTWkiJ rfniWl t trad ml rvifi**i and ikm irliltca lo ibr iiu(i*wi and frn#ltarnl d Wad (waa |f>< J |i*5m<t Hi | A T`*d, 23 71. 1941 11 Kfb#, B A . HiifM'a. >-.*! O..L.I. | On rfw roftrul *fl ratKim d Wad. lr| daorplMi and rvrrta In ldn(4 and ctwbWm j l#*KrV ll>g, is mi. joii ||. Kdmr. B A. TKurytnn. 3', and Off4*1. J . Lr*d ltrrnlioi nd iMfrttoa In certain 1rud (rt<U J Jndok Hg. I* It*. 19U II Adi. I (1. larbdl I. T, lfk*4. A S, *nt(fU^ui<4 . .. Lr*d r*e*Wrg Ball* fiver. MiRu mi A ViiftlM. p IB Kfkf. B A . Do h w ik i. I'. **11 W4l. I |/| afa|4^a aful in fm |ka* l*t llf d bd j*n*ii| J Mig A T.-.k.J. 13 3jn 1931 17. lUmiWm, A.m| lUtli.H K < Industrial Totk*4og>, 2nd Kd New TK HocinT. IWtf. p.60. 1% t,rl>rtun. A. J: Qua/trrlr lU-port to tkr Kcbl<* on Tup*.* rd turrmt lutrreofi L/mI in dnu*(K jainl fur children'* lni ai*d funoturr Quart Bull, A F*ud ajal IWug Otfki-U l .5.20 30. 1950 10 Aw t m ii S4*n>l*fd &prc*fk *tjn* |o Mitrtuvrr IKiJirtit to OiiWboa in*n Htatliul SuHar Oalihf MatrrUla (Z 60.1 -- 195V Sa Y<*i, Auxtiran bUixli/di Auraiiltm, 19VV 2*1 ftlulman. S. V Jr. Tbc Inkaa id trad in cKildrm. BuO. tub** lioplim liuap, 4I:|. IW7. 21. B'rft. B K . and VlalW, C C: RdaChaind rilrhim-diwMlnjni (Venmatr) In trnat* tnmt d ln*d poiaoning in HdWWm. Am. J. D*. OaU , *7 559. 1US4. SUMMABIO M SKTlftUNGUA Lc F.KpotBioa dt Jintndci a FlumU fjt wportak on tud*o dr cttlr factorrt dr niWu r ncm in W prodtartwa do Wwuwn wr*4p a pknlie In |mrtuVi in t cammidtilf nrinn. D pbn (ignificnb^ dd datm do ndWm bk pmrtiutf ri W Mpdidr drl npontka A (Jumbo tvntkr (xa W ftprtMr WgNUn (W pavf (paHdliin dr it|uaimilat <W (nba 4 pWo r tr (mIi* aaitona] (|.r. If ImpvtantU <M rotate) In V |*rctpttation dr aoitr rmr* ptub^atlui a plumlai 1/ pmVadruafu dr HIv ami farturm rxpWra pfiwiWb uwiitr W iW inrfu dr ta (irTrUdin MgradWatnr Mft lr rvriHjtc dr| M<r!>i f Jujjmmli* drl pdaUV doratam drl npmrikn (ultra un mltijian dr $ wnwil Krri ruraWlitr ipr in mo d# tm|4umhr augnimtu drl alivr|4ina dr pturnln ipr rt tu^pMnr durantr lr to44r ptr popubt a met rtKcpbiloptlbU infra iWua iqfmmrmi i lr funtr drl iJtmvbo toon (tffjauptrmrrrfr kW^ifificatr r ffimioatr Lr (Wnrnr k*grot)m mrdir dr jdwt qur II tof dr pWmln n pfitmtulmmtr totk. 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