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sis ''tSJ: Sdi .'NGf J?2| siV>Si ;| l | fffl v*s# -Vv'A:i HP 118 THE MEDICAL JOURNAL OF AUSTRALIA. F ebruary 11. 1922 the malignant process. I am surprised to hoar his "suggestion that connective tissue is developed, lly experience, as I have said before, is that radium seems to gelatinize any connective tissue with which it may have come in contact. Redasens says to avoid serious infection, he treats the cancer with a 1% solution of copper sulphate before applying the radium : he douches the vagina with a 1% solution. Of course, we realize that there are different forms of cancer which an: less amenable to treatm ent by radium. But the papillary form of cancer is more demure. ments? I think we have quite enough *viden<v show that, at any rate in some cases, we ran eff.s.. a cure and. if not in all cases, at any rate we ,)r4. knocking at the door and with a little more inve-,::. gat ion may at last open that door. I want you to consider these remarks seriously and to ue- ;the Government cannot be forced to help us. AN H ISTO R IC A L ACCOUNT OF T H E OCCURRENCE AND CAUSATION OF L EA D POISONING AMONG QUEENSLAND CH ILDREN. <r Now. the last p art of my paper I consider is by Draw s U p F ob ard E sdohsed B y t r e C a r s e n . far the most important. We have here in our hands Q c r e .nblawd B e a r c e o f the. R s n u s K a means of curing some forms of cancer, a means of M edical A ssociA T iex. improving the condition of other forms of cancer, at any rate for a certain time, a means which, if I W e propose to give, firstly, a brief account o f not curative, at any rate will alleviate in some forms i the symptoms of the affections which we attribute of cancer many of the most distressing symptoms, ! to lead poisoning among Queensland children ami pain, bleeding and haemorrhage. Associated with ' our reasons for this diagnosis and. secondly, to surgery it is the greatest ally surgeons have ever i discuss briefly the source of the poison and our ren- had in those dreadful cases. The price of radium j sons for believing that this is fully ascertained and limits its purchase to a fortunate few who are suf I easily removable by legislation, ficiently wealthy to invest in its purchase. I do not really know how many of the public hospitals have a supply. I believe the Women's Hospital has purchased a certain amount, but not enough to make extensive observations and to help the indigent poor. We are entirely dependent upon the graciousness of a practitioner to lend his own private supply for hos pital use. When radium is being taken to the public i i i i 1 I I | The first cases were recorded in 1 5 9 2 they were ten in number and occurred among children admined into the Hospital for Sick Children, Brisbane, in 1S91 and 1892. Reference is made to another case, not included in the report, which was admitted early in 1890. N aturally the cases which first attracted attention were those which showed peripheral paralyses with degenerative electrical hospitals from time to time, there is always a risk of it being lost or stolen. It would be a great mone tary loss to the owner. Had it not been for the graci ous and kindly help of Dr. Herman Lawrence, I should have had no opportunity of making these investigations. He never failed me; he regulated the dosage and he indicated where best to apply the different parts of radium. We generally arrange for week-ends to apply radium, when he is not so likely to require his supply as he would during the other days. I cannot say enough about the kind ness and generous help which Dr. Lawrence and with him his assistant. Dr. Colquhoun, have always given me. ; i | j : | i i : ! i i reactions and wasting of mnscies. In all ten cases three groups of muscles were affected: (1) Extensors of the fingers in all cases, the extensors of the wrists in one only. Consequently, with the fingers extended there was wrist drop. but with the fingers clenched the wrist, except in that one rase, could be extended. The tumnoior Iongun was never pa rased fcompare Gowers's "D:s eases of Nervous System.-' 188S. article on lead poisoning, page 871 i. (2) The small muscles of the hand were wasted and paresed. the abdurtor opponent and flexor brent pnllicis always, sometimes the adductor, hypothenar muscles and interossei. These muscles appeared to Bnt here comes my final point. It is not right j suffer from what Gowers terms the "primary at.ro- that we should have to apply to medical men to help i phic" form of paralysis i ibid.. page 873). us at the general hospitals with their own private iff) Paralysis, usually with wasting of the tibicli* supply. There should be a central supply available | ontioiit and extensor longttx digitoritm pedis, was for all the hospitals financed by the Government and I present in all cases. In one there was some affection under Government control. By applying to the i of the peronei. radium bureau a trusted officer would convey the i The paralyses were always of gradual onset and radium to the operator and collect it again when | their duration varied from six weeks to several the application was completed. Or a radium bureau I months before admission. In two cases there was could he established by wealthy philanthropists and I a history over several years, the first attack having couid be conducted and controlled in much the same I been recovered from and succeeded by a second after manner. The cost to provide radinm for each indi j long intervals. vidual metropolitan hospital and country hospital In nine cases the leg muscles were affected to a would be very great, whereas the one set of radium, j greater extent than those of the arm. This puzzled I am sure, at a less cost could be made quite ! us. until we found that .1, J. Putnam fin Keating's effective. ! "Cyciopsrdia of Diseases of Children" ) had re- si i Now, gentlemen, do not you think that it is quite | corded this as characteristic of lead palsy in time that we made our voices heard and made them i childhood. carry far and wide to the Government and to the ! The electrical reactions were tested in three cases general public, urging what are our great require In all faradic irritability w a s lessened o t abolished. F e b r u a r y 11, 1922. THE MEDICAL JOURNAL OF AUSTRALIA. 149 Sometimes galvanic irritability waa slightly in nephritis.1,1 Most of the cases observed were in creased, the anodal closure disproportionately, so Brisbane children; but cases had occurred in Char as to equal the kathodal closure, or the irritability ters Towers, Gympie and Southport. to kathode teas diminished, so as to be about equal In 1899 cases were recorded also from Marybor to that of the anode, or again the kathodal irrita ough, Ipswich and Toowoomba and two cases were bility was diminished, bo as to be distinctly less exhibited which had originated in New South than the anodal, which was normal or less than 'Wales.'*'' In a paper published in this year171 no normal. important facts are added. but the "blue line'' is These extensor paralyses below knee and elbow discussed. This is rarely conspicuous in children. were considered attributabie to peripheral neuritis. It consists, when observed by a lens, of confluent Such possible causes as beri beri, alcoholism, arsenic dots inside the gum opposite, perhaps, one or two poisoning were thought of. but no evidence could be teeth only. Its absence does not negative the diag found pointing that way. The symptoms associated nosis of plumbism. Rarely it may occur without with the paralyses were consistent with plumbism. symptoms, perhaps in a family in which others have They were anaemia more or less marked, pain in characteristic symptoms. When necrosis and sup the affected limbs, colicky attacks and the presence puration are present in or around the teeth there of a blue line on the gumn in some of the cases. may be extensive blackish discolouration, not only In two cases the urine, after the administration of in the gums, but also in the mucous membrane of a few doses of iodide of potash, was analysed by two the inner surface of the lips. independent observers and found to contain small In 1904'*' in a paper dealing chiefly with the but distinct traces of lead. stiology, an account of several fresh cases of ocular The subject was reopened in 1897.:2i So far as neuritis is given. The great swelling of the ocular the paralytic cases were concerned, former observa discs is emphasized, the presence of ocular paralyses tions were confirmed. It was noted in accordance affecting always the external rectus, with but one with American experience of plumbism in children, exception, and the mildness of the constitutional that in every case foot-drop appeared before and dis- I symptoms in many of the cases. Of four cases in appeared later than wrist-drop. Paralysis of the which the urine was analysed for lead, one gave 0.4 peronei had been occasionally observed, also spasm milligramme per litre, one 0.32 milligramme; in the of the calf muscles and secondary talipes eqviruis. j other two no lead was detected. In two cases there had been paralysis of the dia In 1905'5' two hundred cases of plumbism in all phragm. It was found possible to recognise a pro had been recorded at the Brisbane Hospital for Sick dromal stage of poisoning before paralysis appeared, Children, including fifty-four cases of ocular neuritis. characterised by attacks of colic, often with vomit In only two or three of these cases did paralysis of ing, relieved by pressure and usually accompanied limb muscles occur at the same time as ocular symp- by constipation, often also with pain and tenderness j toms, though in several others both groups of symp or severe cramps in the leg muscles. Sometimes a toms occurred in succession in the same patients.' bine line would be observed in these early cases. The resemblance of the ocular symptoms to those of Severe attacks of convulsions, sometimes fatal, had cerebral tumour is pointed out and also to those of been observed in many of the paralytic cases. New basal meningitis; bnt, unlike these conditions, ocu ground was broken by the recognition of a group of lar plumbism docs not cause death. cases with ocular symptoms. In 1892 four cases were described'11 as a definite clinical group char acterized by symptoms of cerebral irritation--headache, vomiting--with intense optic neuritis and paralysis of external recti. Three cages, recovered completely, the fourth was removed from observation. It was suggested that the cause might be a localized basic meningitis. In 1897 twenty-four eases were reported14 in children between the ages of four and eight. These cases were remarkable for the excessive swelling of the optic disc and paralysis of one or both external recti in every instance. In two there was paralysis of all the external ocular j i j The process used in the Government Laboratory for testing urine for lead is given. The possibility of traces of lead existing in the reagents used had been eliminated by careful controls. In 190S'10' and 1909:t:) the whole subject was again reviewed. Two hundred and sixty-two cases had occurred in the Brisbane Children's Hospital and some twenty children were being admitted, every year, while every medical man practising among children in that town should see several cases armually. The symptomatology is given in detail, but little of it is new. muscles and in one of these ptosis. In the more severe cases the head was slightly retractitd and the neck muscles stiff. All the patients recovered, but In 1 9 i r i:i the importance of lumbar puncture as a remedy in plumbic ocular neuritis was demon strated. Increased tension of cerebro-spinal fluid is seven became blind; in two vision was impaired, in the remainder it appeared normal. Only one patient had had a previous attack of wrist-drop and footdrop. Some of the patients had suffered from coiic. In several a blue line waa observed on the gums. always present. Out of nine children so treated, all recovered good sight except one, who had seen badly two weeks before treatment was commenced. The condition most liable to be confused with plumbic ocular neuritis is gummatous meningitis.' In several lead was found in the urine. The con In 1914'1*' the Report of the Institute of Tropical clusion arrived at was that these eases were due to Medicine gives an account of lead poisoning in plumbism affecting the brain and ocular nerves. In children in Townsville. At first the eases were some cases of plumbism albuminuria was observed regarded with some scepticism, but this was com and in one fatal ease there appeared to be actual pletely removed by chemical analysis of the excreta. . 150 THE MEDICAL JOURNAL OF AUSTRALIA. F krp.i -ary 11.1022, Basophilic granulations in a small number of ery ment. But even here iff a well-marked rase showing throcyte* wen' found in the majority of eases, some the symptoms and stigm ata of piumbism. such times only after a prolonged search. A blue line knowledge is unnecessary for diagnosis, though of was observed in a small percentage of the cases. the utmost importance for prevention and cur*. The symptoms observed were malaise, vomiting, Still more strongly does this hold of a iargp number fviins in the calf muscles, foot- and wrist-drop, of cases occurring consistently without interruption paralysis and wasting of the small muscles of the in one locality over a period of thirty years. Them- hand, mental irritability and in one case dimness of eases show symptoms which are recognized all over vision. Severe convulsions occurred in some. the world as characteristic of plumbism. Indeed Amentia was only marked in cases of long standing. few. if any. of such symptoms have been absent. Both fa-res and urine were examined for lead and And if we have enlarged the known iist of symp a tabular statement of the quantities obtained in toms somewhat, this is not surprising, as no other re!tea ted examinations in sixteen cases is given. locality has furnished such a number of case* in An attempt to find lead in the urine of healthy childhood spread over an equal period of years. The children living under the same conditions com characteristic stigma on the gums has been present pletely failed. It may be stated that for several in a large number of these cases. Repeatedly the years the basophilic reaction of the red cells has urine has been tested by onr Government Analyst ln-eu used as a routine test of plumbistn in the Bris and by other skilled chemists and has been found bane Children's Hospital and lias been found to be to contain minute but indubitable traces of the a valuable aid in diagnosis. tnetal time after time. We m aintain that these In TJ171' 4' the diagnosis of the ocular neuritis facts should bring conviction to every coraiieten* due to plumbism was again discussed, its difficulty, and unprejudiced mind. Unanimity in onr profes especially to one unaccustomed to these cases, being sion is rare and we cannot say whether it exists on fully recognized and the importance-of immediate this subject in Brisbane; tint the diagnosis of treatment, osjiecially by lumbar puncture, clearly plumbism. a t' first confined to a few. has spread set forth. . until it lias become the settled conviction of all In 1U11)13> the deionizing treatment recom medical men connected with the Children's Ho- mended by Oliver was instituted at the Child ren's Hospital. Brisbane. In one case, in which active symptoms had disappeared, after de ionization. the Ooveriinient Analyst found just ; pital. of all specially interested in children's eases, of many excellent general practitioners of at least the great majority of members of Branch. dis and this under O.ti milligramme of lead on the negative elec Needless to say, the source of the poison has exer trode. Since then the same official has found lead cised the minds of some of the profession here for under similar circumstances in another case. (Ow the last thirty years. What we believe to be the ing to the absence of controls, these analyses are ; true solution was slow in discovery: it was first sug not absolutely diagnostic as are the urine analyses. 1 gested by one of our members, lately alas deceased. Then? is a strong impression among some Bris in course of a discussion in lS99,'r' but attracted bane practitioners that the prevalence of chronic little attention, as suspicion was then directed in nephritis in young adults in this city is partly a ; another direction and. being unsupported by dehue result of the absorption of lead during child ; tailed evidence, it was forgotten until revived in hood. To prove this would he very difficult and in IfiOL'8' Received then with mingled acceptance and the absence of proof it can only lie regarded as a : doubt it lias stood the test of eighteen years' re probable opinion. peated investigation and use for prophylaxis and At our request we have received a report from the Brisbane Children's Hospital, showing that there , : cure, for the cure of plumbism consists primarily in the prevention of the further ingesrion of lead are at the present time twelve children in the wards . Any hypothesis as to the source of the poison had suffering from lead poisoning. One of these has ; to explain |i.I why cases arose every year among ocular plumbism. the other eleven paralyses of i children, while no case (apart from those traceable limb muscles; of the latter, one has had papilloedema ! to industrial occupation! was ever discovered in recently. Colic is noted in three children; leg pains an adult, (ii.) why it occurred in Brisbane and in two. Ten children have foot-drop: three have i other towns in Queensland front the extreme norih wrist-drop. Ten of the children are said to he nail- to the extreme south, bur noi in rural areas, ttii. ' biters; two are not. A blue line on the gums is why it should be comparatively common in Queens- present in four; in one it is doubtfully present. All ; land, but rare or unknown as a malady of childhood have basophilia, of the red ceils. In four the red in the southern States, (ir.) why. though often cell count is lielow 3,000.000. Urinary casts have ; affecting several in a family, it often also picked been found in seven, albuminuria in two. out one child, the others remaining immune. It had So far nothing has been said as to the source' also to he a vera causa, that is to say. the ingestioB of the poison. We are anxious to establish the of lead in sufficient quantity over a sufficient period fact of lead poisoning among Queensland children, had to be proved. We claim that al] these conditions apart from any theory which may be held as to its i have been fulfilled. causation. Certainly when considering any single At the outset in IH92'-11 suspicion was directed to case the fact, if known, that the child has been ex i the metal wrappings of sweetmeats and cigarettes. posed to the ingestion of poison, may lie a factor of some of which were found on analysis to contain some weight in determining our diagnosis and treat I lead in large proportion. This hypothesis was found .FE3BrA.t>.Y 11. 1922. THE MEDICAL JOURNAL 0 ? AUSTRALIA. 151 to in' inapplicable to so many cases that it was ko.oi abandoned. ' (f all Hourcon of plumbum, apart from the indns1rt.-i1 forms, [verhaps the most important has [seen the contamination of drinking water. Now in Queensland towns much of the drinking water is collected from galvanized iron roofs which are fas tened together by lead-capped nails This water is stored in tanks, usually made of galvanized iron, the iron of some of the cheaper kinds being coated with an alloy containing lead instead of with pure zinc.1' Tanks were sometimes repnin*d by solder containing lead and the connexions were sometimes made with lead piping. Suspicion of tank water was natural ami was supported by the Government Analyst's report of the presence of lead in three samples of tank water. The hypothesis admirably explained the occurrence of pitunbism in Queens land towns, but failed to explain why it did not affect adults. W e were compelled to assume a greater susceptibility in childhood, bnt as year after year failed to bring forth a single adult case. thU assumption became overstrained. I t was also weak ened by the failure of the Government Analyst to rind lend in repeated samples of tank water suit mined to him after the three positive analyses. Finally the hypothesis was destroyed by the Analyst informing 'ts that water stored in galvanized iron tanks always contained zinc, that in the presence of dissolved zinc wilts lead in solution is an impossi bility. and that his previous positive results may have been due to impurity in 'he reagents used. We were grateful to him f -r his candour, our faith in the accuracy of his analyses t which are universally acknowledged i was. if anything. increased and we were left in doubt as to tae .-etiology of our cases. in ifi04:S evidence was brought forward that the plunibism of children was caused by lead paint. It was pointed mil that lead paint was dangerous it. i when it was fresh and sticky. <fi.l when by exposure to sun and air the paint was lm.se and powdery and easily came off on the hands and was present in the form 'of du**!. The first condition, stickiness, was of short dura lion and likely to be guarded agtunst. The second. p>wdenues*. was fersistent until The *uriai-es were repainted and was especially common on verandah railings, fences and other outside s u r f a c e s exposed to sun and air. Two pieces of calico each a foot square were rubbed ou ~iae verandah raiiings. (n analysis the first gave 0.3 gramme o! lend, equivalent to 0.373 gramme of `white lend." Eighteen square inches from the tail ire of the other cloth were soaked in distilled water fur twenty-four hours and practically the whoic <>f the lead went into solution. No attempt was made to keep carbonic acid out of the distilled water, as it is present :n ail natural waters. Id ihe ease of one child angering from ocular plumbism and passing u.f milligramme of lead p c litre of urine, the child's brother showed a bine line on the gtuns. The parents had moved into a freshly painted house on December ' and '.he child was brought to the Children's Hospital on January 7. The paint was still sticky. The mother said: ``Those are the only two of my children who bite their nails.'' The evidence in not conclusive th at the poison was de rived from this house and not from powdery paint at their previous residence. A visit was made to the house of a child suffering from ocular plumbism and passing 0.32 milligramme of lead per litre of urine. The child was two years of age and must have acquired the poison a t home. The paint inside the house w h s in good condition, polished and not detachable on light friction. The verandah floors, as well as railings, were painted. Here the paint was dried and powdery. Pieces of calico cloth. 22.5 cm. X Hi cm., were used for rub bing the ceilings, walls of the living room, painted rioor margin and verandah floors. The house had been cleaned and vacated and there was not much dust in the room. Samples of dust were carefully brushed off ledges into watch-glasses with a camel's hair brush to avoid dislodging the paint. From the cloth rubbed on the ceiling, where the paint was glossy and showed no signs of wear, no lead was obtained. From the cloths nibbed on the walls where the painted snrface showed signs of wear 0.2 milligramme of lead carbonate was obtained. A similar quantity of lead carbonate was obtained from the. cloth rubbed on the painted floor margin. From the cloth nibbed on the verandah floor twelve milligrammes of lead were obtained. D u st. T otal Lead Carbonate W eig h z. Found. Grammes. M illigram m es F ro m top of m o u ld in g ab o v e d o o r 0.2 1.5 Top or fanlight facing side v eran d a h ........................................................... 0.25 N il T op of floor facing fro n t v e ra n d a h 0.25 0.2 Top piece of verandah blind . . 0.32 N il Top of sk irtin g near door and side verandah ..................................... 0.2 N il It was a hot day and it was found that the paint, came off more noticeably on bands moist with sweat than on calico ciorhs. This child spent much of the day on the verandah floor and was fond of grasp- ins: the verandah rails. Another house visited had white painted railings and a white painted gate from which the paint was readily detachable as powder. The paint had l>een rubbed off railings just at the height the children's hands would come in contact, with it. One of the affected children in this household sucked her thumb. She had bad repeated attacks of lead pois oning. occurring always in the summer months. in summer children spend much time on the verandah and have hands moist and sweaty, so that the powdery paint adheres easily to them. On in quiry ii was found that of eighty-five cases of lead poisoning in the Children's Hospital, forty-two had been admitted during the three hottest months, De cember to February, twenty-eight during the four months October, November, March, April and only sixteen during the five cooler months. It was pointed ont that powdery paint might be inhaled as dust and absorbed through the lungs, that possibly it might be absorbed through the skin, but it was thought that biting qaiis and sucking fingers was the chief method of absorption. The parents of ten children who suffered from lead pois oning. in answer to a question, replied in eight cases that these children bit their nails or sucked their fingers. Of live other children then under direct 152 THE MEDICAL JOURNAL OF AUSTRALIA. F k b r u a k t 11. 1521. observation in hospital, four bit their nails and one. aged two years, sucked his fingers. "A F orm of C erebral D isease C haracterized by L ig n ite Sym ptom s. P robably a L ocalized B asic M eningitis." by A. J e ffe ris T u rn e r . iiHd.. p a g e 98. In lfK)5'"' these facts were brought before the : "L ead P o is o n in g A m o n g Q u een slan d C h ild re n ," by Intercolonial Medical Congress in Adelaide. The J e ffe ris T u r n e r . A u stra la sia n M edical G a zette.-O cto b er. It'jC . following motion was passed by the Section of "O cular N e u ritis S iq iu latiu g B asal M eningltis-Piu-pb ism ." by J. L oekhart G ibson. Ophthalmology and reported to full Congress: " S o m e U n u s u a l F o r m s o f L e a d P o i s e s ! sjc. b y T. K. T h a t p e rm a n e n t blin d n ess from lead poisoning am ong young children in Q ueensland has been recognized: th a t it is highly probable th a t paint used on v eran d ah railin g s, etc., especially w hen exposed to w eath er Influences, is th e source of the poison and th a t th is m atter should be brought under th e notice of the proper authorities. ' Subsequently a confirmatory communication was re- G reen, ibid.. A. Je ffe ris T u rn e r : A u stra la sia n M edical Gazette. M a rc h . I .*99. i " H o w to R e c o g n iz e L e a si P o i s o n i n g i n C h ild r e n ," by A. J e f f e r is T u r n e r ,. A ** ir is h m a n M e d ic a l tid s e tte , O c to b e r. 2899. ; " "A P l e a f o r P a i n t e d R a i l i n g s a n d P a in te d W all* of R o o m s a s t h e S o u rc e o f L e a d P o i s o n i n g A m o n g s t Q ueer: *- : land C h ild re n ." by J. L o c k h a rt G ibson, cal G azette. A p ril. 1904. page 149. .tw ira iu io r. M ceived from the Queensland Commissioner of Health : ``P lu m b ie N e u r i t i s ." by J . L o c k h a r t G lb eo n . T ram - and published in the Transactions. actions of th e Intercolonial M edical Congress, A delaide 1905, p age 305. In 19<)8!ll) special stress was laid on the danger I on " p lu m b ic O c u la r N e u r itis in Q u e e n sla n d C h ild re n ," of powdery paint on verandah railings and it was shown how the domestic architecture of Queensland towns favoured poisoning. The houses are almost ; ; by J . L o c k h a r t G ib so n . T h e B r itis h M edical J o u rn a l. 13iW. V olum e II., p ag e 14*S. " " "O n L ead P o iso n in g In C h ild h o o d ." by A. Je fferis T u r n e r . T ra n sa c tio n s o f th e In te r c o lo n ia l M*-dvca1 Congress always built of wood, raised on wooden piles and ; M e lb o u rn e, V o lu m e I I I .. 190?. p a g e 3, a n d T h e B ritish M edi the verandahs railed in with painted railings. ; cal Journal. A p ril, 19i>9. Young children pass their playing hours on these I "T h e Im p o rta n c e of L u m b a r P u n c tu re In th e Plum bic O cular N e u ritis of C h ild ren ." by J . L o c k h a rt G ibson. Trans verandahs and clasp the railings with their moist, 1 a c tu m .2 of th e In te rc o lo n ia l M edical Congress. S y d n ey . 1311. sweaty hands. In country districts, where the pag e 750, a n d A u stra la sia n M edical G azette, J a n a a r y . 1512. verandahs are low and unrailed or the railings un page 25. painted. these cases of poisoning do not occur. - land "The O ccurrence C hildren." by A. of L ead P otsooing A m ongst Queens B re in i a n d W . J . Y oung. R e p o rt of In 19l7tl4` experience had shown that recurrent ; I n s titu te fo r T ro p ic a l M e d ic in e . T o w n sv ille . U I4 , and attacks of lead poisoning could be prevented by 1 J r .n a i i of T ro p ica l M edicine and B arssilo lo g y, D ecem ber, warning the parents of the source of the poison and ; 1914, <*., page 575. --T he D ia g n o s is . P rophylaxis and T reatm ent of getting them to replace lead paint by zinc paint on P lu m b ic O c u la r N e u r itis A m o n g st Q u e e n sla n d C h ild r e n .' verandah railings and outside surfaces within the by J. L o c k h a rt G ib so n . T h e Me p ic x i J o e s v a n o r A v r T t u u , reach of children. Among those who lived in rented : S e p te m b e r S. 1917. houses and especially in the case of hospital patients, we could seldom get this done and patients cured : of so l;*' " O n t h e I m p Plum fcism in Q n. T he M oiCAL o u J rtance o e e n s la n d o c x .v a l f D eionization C h ild re n ." by or A fsntA tiA . In J. Ap th* T Lock ril a. reatm ent h a rt Gib ISIS in hospital frequently returned within a few months, often with a more severe attack. Here cure with out prophylaxis was of no permanent value. Reports of Cases. We had come to the conclusion that to prevent lead poisoning among Queensland children, legisla IN T E R M E D IA T E PA R A LY SIS OF RESPIR A TO R Y tion was necessary. Our effort in this direction cul CENTRE. minated in a resolution familiar to readers, adopted at the Australasian Medical Congress held in Bris B x F. J. T. S aw kths, M-3-. C u_M , bane in 1920. A deputation from the Branch waited M edical O fficer, K e m n o rc , Hess: S o u th W a les. upon the Queensland Home Secretary in 1921 and from him obtained a promise that the forthcoming Health Act will contain a clause prohibiting the use of lead paint on verandah railings and outside S-j k e t w e n ty - e ig h t y e a r s a g o I *aw s e v e r a l h o s p ita l patients w ith interm ediate centra! respiratory para;yx In w hom th e o u ts ta n d in g c lin ic a l fe a tu re s w ere sudden failu re of resp ira tio n , w niie th e h e a rt continued to beat surfaces within reach of children's fingers. That re g u la rly fo r c o n s id e ra b le p e rio d s. If a r t'.f ic a i re s p ira tio n this proposed legislation should meet with determined opposition from powerful moneyed interests ! j w ere to be o th e r m ain ta in e d One p a tie n t recovered sufici-m ciy d isc h a rg e d from h o sp ita l and w as lo st zigiit of. One r e c o v e r e d t e m p o r a r i l y , b u t -- i w r i t e trace, m e m o ry -- we fully expected. That th at opposition should re d ied in a s u b s e q u e n t a tta c k . T h e c o n d itio n : s b o th th e se ceive medical support, we certainly did not expect. p a tie n ts w as. I b e lie v e , d isc o v e re d fcy D r. W. F, L i-u ifie id In 1921 the subject of lead poisoning was introduced I c e rta in ly th e firs t o n e w as. at an inquiry held by the New South Wales Board of Trade on the use of white lead in the painting A nother p a tie n t w as th e su b ject of an h iato n e case at [ b ra in T his h y c a tid m an had recorded been the by th e rate S ir Jam es G raham . first or one of th e first to recover industry. Evidence was given by Dr. S. A. Smith i a fte r o p e r a tio n th e r e fo r . .H e h a d tw en re -a d m itte d so m e subversive of our conclusions. We propose to criti y e a rs a f te r th e o p e r a tio n t e r a r e c u r re n c e tA c e re b ra l cize Dr. Smith's mnnication. evidence in a subsequent com- ; sym ptom s p a ra ly sis . and The died of in term e d ia te cen tral rasp tratcry post m ortem ex am in atio n d!*cked aeverai h y d a tid c y s ts in t h e r e g io n a t th e a n g i n a ! c y s t; oast at R eference!. j theae h ad b u rs t in to th e la te ra l T en tricie. Theme eases ``N o te s on L e a d P o is o n in g a s O b s e rv e d A m o n g C h ild - j a n d s e m e o t h e r s w e r e a f t e r w a r d s p u b lis h e d try D r. A . 3 . ren in B risb an e," by J. L o c k h a rt G ibson. W ilton Love, | V allack in T he Lancet. David H ardie. P eter B ancroft an a A. Jefferis T u rn er. Inter- > C onsidering th e e x tra o rd in a ry re su lts of su rg ical ta la r co lo n ial M ed ical C o n g ress, S y d n ey , 1892, page 78 (o m itte d fe re n c e In c o n d itio n s of t a t e r n a l h y d r o c e p h a lu s re c e n tly r e In index). ported from A m erica. I v en tu re to record another s u e at