Document GKo0kk20qeVv24bJrY8oMppZ7

ILeiSl&L TTira j IIu d al rpiiig a CLINTON N. CMANC. NllllAtNI P. M. CNOWNCU. VICt TftttiMMt P. W OCKW(kL. VlCC MlllOINT ' FCLtK COG** WONMtKff. tCa1*V *MO 420 LEXINGTON AVENUE Xinv' YOKIf/.1X7.Y. January 19, 1944 Dr. Robert <-. Kehoe College of Medicine University of Cincinnati Cincinnati, Ohio Dear Dr. ivehoe: If you read TliiE no doubt you saw the item which appeared in the December ?0 issue entitled, "Paint Eaters" derived from an article by Byers and Lord, published in the November, 1942 issue of the American Journal of Diseases of Children, entitled, "Late Effects of Lead Poisoning on iientol Development." It drew some amazing conclusions alleging that lead poisoning in early childhood had left effects showing up years later. It was a most alarming revelation. Laturally, I ii.iceaiately instituted an investigation because, if what this article describes is correct, then we have indeed a most serious public health hazard. However, on examining the article from which the TI..-.E condensation was made, I am really surprised that a reputable journal of the American medical Associa tion would publish such a dissertation. Superficially it is a long paper, well illustrated, and must seem impress ive to t:ie profession at large, iiany case histories are described, but to any one who has studied lead poisoning intensively and who is familiar with the vast amount of work that has been ucne in recent years on the rectal, and who wishes to sift fact from fancy, the assertions made appear to be far from proven. Although PC) cases of alleged lead poisoning in children are individually described in not a single case have I found the authors making the slightest attempt to ascertain whether or not the paint used on the cribs con tained any lead. They apparently proceed on the assumption that any paint chewed from any crib must be lead bearing and build up their contentions on medical diagnoses that do not sound convincing to me. For example, take the very first case. There was no stippling of the blooci, the-urine was normal, there Lt , .ahoe: January 19, 1344 "dense bands of metallic deposit at the growing ends of the shafts, characteristic of lead poisoning." For that reason alone the case was alleged to be lead ooisoning. Take Case No. ?, the youngster had scarlet fever and other infections. Again the X-ray is relied upon as tne only evidence. There was no analysis of the paint. Or Case 4, in which it was stated, "results of tne physical examination and laboratory investigation were not remarkable," but again the X-ray comes along with a "positive" determination of lead! No paint analysis. Ail the cases are more or less alike, but one of the prizes is Case Ko. 6 because here there is alleged to be a high lead content of t:ie blood but the X-ray was negative! Nevertheless it v;as diagnosed as lead poisoning. Or better yet, look at Case 11 in which an in fant's blood at -5/1?. years showed "a mild secondary anemia and her urine a moderate amounttof pus." ivhen she was 4jj- years old she showed a "history of chewing wood.." and "her blood was examined for stippled cells, without success." At 51- years her family stated definitely that "in chewing wood she had chewed painted articles of furni ture." On t is occasion "her blood showed 1.5 per cent stippled cells and a mild secondary anemia." The X-ray examination suggested "recurrent lead poisoning." Two years later the X-rays showed "faint bands of density some cistance behind the growing ends of the long bones, thought to be due to the old- deposits of lead." But, here comes tne cost interesting point of all; four years later, when she was 11, and still growing, "her blood, urine 'and spinal fluid showed about one hunured tines the concentra tion of lead found in normal persons. In spite of these results, roentgenograaps of the long bones showed no evi dence of lead deposits." Rather confusing, isn't it? A.11 the cases are more or less similar and there is no need of going into any more of them here. I note, too, that most of the work involved in this article was prepared by Tlizabetu 2. a.ord., Ph.D., who died recently. A.s you know, it is our belief here, based on careful investigation, that no crib manufacturer in the United Spaces today is using any lead paint on cribs, nor has he used any for years, for two reasons: (1) other paints, such as zinc oxide, lithophone and titanium base enamels are cheaper than white lead, and X& 0 03432 m hr. -3- January 19, .944 (?) they make a harder and nore satisfactory enamel taar. unite lead. Wouldn't you think, therefore, that rather than jump to conclusions, conclusions based chiefly upon only one precise, and X-ray diagnosis of the bones, tue authors would at least have tried to ascertain whether or not the cribs haa been painted v;itn lead? This would nave- been so easy to determine. Window sills night be painted v:itn lead but here, too, leadless paints are core apt to be employed union. is the current vogue on interiors. In the second place I am struck with the fact that the examinations made of the children in almost all cases showed no stippling of the blood and in most cases where an effort was made to find out whether the children were excreting any lead, the urine was normal, or no analy sis was made. On the other hand, the authors place creat weight upon the X-ray and their article is replete with /.-ray 'photographs of the bones calling attention to well marked deposits of "lead" on tne margins of the shafts of lon? bones. Now it may very well be that the authors did not see or don't agree with the careful work of Dr. L. T. Fairhall, reported in Public Health Report Vol. 52, he. e, dared February 5, 1943, entitled, "Identification of Lead in Bone Tissue" where he states: "It is apparent that the small amounts of leaa deposited in bone are insufficient to register by means of X-rays and that darkened areas which nave heretofore, been accepted as lead deposits are likely to be due to calcium. From what is now Known concerning tne distribution of lead in bone, it would be surprising indeed if such small amounts of lead so evenly distributed would be revealed by X-rays in the presence of such large amounts of calcium. The lead content of human bones with known exposure to lead is also insufficient in amount to impart any marked opacity to X-rays." If lead was so prominent in the X-ray photographs shown by Byers and Lord in their paper there must have been perfectly enormous amounts of lead in the bones to do so. This seems incredible to me. '7hy didn't it show up in the urine? Another point which I can not understand is that years after these youngsters were alleged to have contracted lead poisoning and were removed from tne exposure and sub sequently re-examined, tnis so-called lead line was still found in the bones. How do the authors account for that? ~r. Aehoe: January x9, 194-'. I hesitate, of course, to bother you in wartime v;i;a this topic but x tnink you will agree with me that this is an episode vvhica, because of your aeep interest in lead and your high standing: in the profession, can not be ignored. Is is unfortunately true, and I know fron bitter experience, that other doctors will accept as authoritative this paper cf Byers and Lord and probably build upon it still r.ore fantastic assertions. I would, thrrefore, like to knot; from you what, in your judgment, is the best thing to do. Bo you think, for example, that it is something which might be brought to the attention of your distinguished committee on lead poisoning which has .lust published such an able report for the American Public Hoaltn Association? With kindest regards, P.S. Ir. the event you do not have a copy of the paper mentioned at your disposal, I an enclosing a pnotostatic copy. 3 4 34