Document Gz1yKXXzvXxKM6RpybO63MG44

' iy'** LEAD INDUSTRIES ASSOCIATION S MADISON AVINUC NSW VOMC IT. M. T. -'U ' Julylk, 19& l ead rrorm and tmn BULiarn &02L *0 tbs Nii*iii ot tbs Land Zadnstrlss A--odatloai naxt nun u ad xnocczcmai Us rsccssnsnd for your wading tbs stfchsd pspsr on Vbm Hatbods for tbs Frovontlcn* Sotsctlcn and trontaont of Xsnd ,, toodestlen" by Butbtrford T. Jntrutooa, lt.ll., cf Loo Angolas, bo Is 000 of tbo cotnUy's noot oslnaBt autborltlo* on la> dustrial asdlclao aad.leod lrtnrifrtla. Us bellrrs that it contains asieb practical l&fomstlon on tbs safejoct of tntorost vv. . V ^to naaaganant as voll aa to Industrial pbyalclau and hygienists. Tory truly yours* ;> KZtML Att. Sscrotsoy ;VV r*T.- LEAD INDUSTRIES ASSOCIATION aea ma o io o n Avenue MCCBOr HCT0O8 PGR TO FREVOfTICM, ECTCCTIOB AJTD TRSttMUO o p txAD jyrarranc* llutberftrd f. Jcteatone, M.B. Jm As<tUa Mr. Chalraan and anbira of the Aaeoclatlon of American Battery Nanufactorarei I beeltate to preface paper with tho sUtonaot that I m honored aad daUghtad to bo Invited to apeak to you today, for aoao noothe to ccao that hackneyed declaration will bo ca tho Ilpo of every politlelaa during thla election year. Xevertheleee, I oak you to bolioro tho elncerity of *7 dolight in being with 700 bocaaoo tho eobject to bo diocoaood ia 000 of agr Major interest# la Medicine. For Marly 0 quarter of a oontury I have llidtod 17 nodical . practleo to cllnloal induatrial toxicology or, to torw it differently, tho . dl000000 of workoro. ihooo yaaro have boon apart la a geographical aroa -.... that ccotaino probably oro anall plants engaged la aoaifaetuyliv batteries or ia reclaiming load froa old battorioa thaa oxlata anytharo o Im la tho ^ world. Hardly a wook gooa by bet what wo 000 ia oer office an actual case of load latoxleatioo or era erroneously allogod to bo oo.? Froa aoeh < axporlooco o Umo ay subsequent rooiirfci. . ,- A. t o c o s t o f mmsisH Sinco physicians are not known for their boeiaoea arunen, It *'" will appear prooeaptooea that Z enter into a diocoaalor of tho oococalo -:;a. aopocto of year induetry. Obviously I 00 not qualified to diacosa ouch " coat foctora aa wagea. Material, freight, advertialng and tho like. Rather Z would like to aek-- i&at la the coat of aa occupational illaaaa and aora apociflcally what ia the eoat of load latoxleatioo to your laduatrjrf Freeleely thio la not known. Flret of all, wo do not knew tho incidence ef pluWblan, Iho ayotoM of reporting on occupational dlaeaao of whatever nature la inadequate. Oily a few atatoa have oonpuleory reporting of oa oocupotional dloeaoa aad ron in thoao, the dlaooaa nay not b# reported or tho diagnosis nay be arronoooa. Tho* it ia to bo appreciated that tho coot of pluablM 1* not known beceuee tho statistics are oooplatoly unreliable. Alao there are several factors, often unrecognised by you non ia aanagoMont, that induce unwarranted eoete. Among theee, as previously Mentioned, la the erroneoue diagnosis. Rext la the unduly prolonged period of treatment and dleablllty. Subeequently theaa will be diacuaaed but at F*P*r delivered before the Meeting of the Aetoclotion of Aaerioan Battery Manufacturer#, loa Angelee, California, June t, I960, N 371.01 urifTMi'*nw , 3r>V ;..., lit it -2- thia point I would like to criticise the attitude non*****nt takes too frecently toward* the worker who baa boon sway froo hi* Job for several woo1c* because of load intoxication. At a tin* whon the worker no longer baa any syrptcna of hi* plumblsn, th* conscientious physician will return bio to work with a sutenent that bla patient la no longer disabled but should bo placed on a job whore, for a period of tine at least, be la not axpoeod to lead fuses or dust. Too often this ntodod cooperation la not obtained. The worker la Informed that there la no job for hln other than th* one be bad. Ibia la the typo of case that goes to the Induetrial Accident Cctedstlon and hence farther needle** coat. POPSPUK) COKTRCt A1though th* sources of expoaur* are lanmerebla, leed la present In the air either aa a duat or foaaa. It haa generally bean ballared that the font la wore haxardoua becauee of lte snail particle elae. Sees authorities contend that th# particle else la not a* important a* the solubility. Engineering design attempts to proride exhaust rcntilatlon for ach epee ifle proceas. It aay be a downdraft exhaust, a lateral exhauet -.f . or In certain processes both my be utilised, Vfcatever mthdd la utilised > _ ;.l tt tfiould be mde certain that th# exhausted air la not drawnaeross cr into th* breathing tone of the worker. In sore operations th* worker function* t&ils standing outside a booth with bla hande inserted Into - ` v -. . gsuntlet type of glove, the glow* being a part of the closed eystes. This .. .... is a principle sixllar to that need In aandblaatlng. Tha weighing of lead.; , oxide should always be done In a booth that la exhausted. The vster-fall type of booth oaoally offera adequate protection to one apraylng leedconU.ir.lng n*Uriel. The eae of a vacua* sweeper to collect dost la of obrious value. Rosing deem the machinery and floor la reeorted to in aona Industries and particularly It la utilised In England Respirators art cf value In post Instance# only for auxiliary protection. To depend upon the respirator, especially upon workers' faithfulness In using it is sheer folly. An exception would be abort tins or temporary specific assignment. There my be clrcunstancea where aa air-line reepirstor la Indicated. Even though It la assured thst tbs best engineering'control exist* thtrs is need for periodic stapling of tbs air, that la analysis of the air for lead. For a long tine In the past the accepted upper ltelt of pendealble lead concentration In the air was 0.1$ ng. of lead par oubic mUr of air. This haa recently been changed by the Association cf Governmental RyglenlsU to that of 0,2 age. f r; Mtfcfrrl aw,rfda^^gAitftiSaaiMafclfhM o- epic al c c w t r o l Management's first responsibility in this regard if to diligently seek intelligent radical service. I wlah to artulti the word** diligently seek. Admittedly Boat snail plant# cannot afford a full-time physician or even abort-tin* Inplant aarrlca. So the offlea of a physician In tha neighborhood la usually otlllaad. Tha proximity of tha doctor'a offlea la thereby made tha baala for hla cbclca, not hla knowledge of tha prevention, diagnosis and treatment of load intoxication. Tha doctor choaan by a small plant should here an understanding of tha various procaaaea involved in tha oanufactora of a battary and tha haaarda InrolTad. If ha doaa not have thia knowledge but apparently haa all other requisite* for rendering good nodical aarrlca, ha ahoold ba relocated to rialt and inapact periodically tha anall plant ha la aaVad to terra. Tha establishment of thia typa of rapport rill lead to an Intoreat on tha physician's part and Induce a renewal of hit education in tha field of pltablam. -> ' 'v r *;* {: * "* rvfe 'e^V- J In fact, I oaa no reaaon why thia aaaociation ahoold not publish * anall booklat daacribing tha dataila that enter lntothe process of - making rarioua types of, battariaa. It could contain illustrations and definition!, it could explain tdxat la oaant by a grid or pasting ^ar litharge or black axida, ate. Thia booklat coold bo a much ahortar raraioo of the ",?/3?rt- book lead in Modern Industry,* published by tha lead Induatrlaa Association in 1952. It should not bo technical and should bt distributed io?hll tha - doctors earring snail plants Baking battariaa. Before continuing with a discussion on nodical control. It should be understood that it la not possible to separata completely control procedures frea those used in diagnosis. At tha outset ire mat define " A lead intoxication and differentia's it fron lead absorption. So bs of yoa younger nan, new in thia industry, nay not appreciate thia difference and oat certainly it la not unirareally recognised by the nodical profession. The difference between absorption and intoxication can beat be illustrated by utilising whiskey as an example, a substance with which you are not t onfaedllar. Two nan alt at a bar and conacre tha tare arount of ahiakey in the sane period of tine. At the end one ran ahows no algna^of intoxication idille tha other ahows obrioua evidence of lntoxicatioo.Tet'ths arount of alcohol absorbed vaa the same. Applying thia truth to laboratory*findings of the lead content in the blood or urine, the arount present when above the accepted limits of normal does not seen necessarily that the individual haa lead intoxication even though he baa increased lead absorption. Under the subject of nodical control the workers should become participants In the preventive program. There la an increased tendency today to lntUete that lead poisoning is the thing of the past. This la far froa being true. Workers on a job in tdiich there exists potential hasard tfiould not be kept ignorant of the fact. They should ba educated r V,,- ! *-* % 4- in the principle* of plant hygiene and personal hygiene. They should b informed of the early manifestations of abnormal lead absorption and Instructed to report to management as soon as each are noted, Ve now cone to a very pertinent question, one often asked by both management and by physicians. that laboratory procedures should ve utilise to detect early abnormal absorption before Intoxication occurst there la no single answer to that question due largely to a great variety of circumstances. Ibeae include the alas of the plant population, the efficiency of engineering control and tha type of nodical aerrice. Let m numerate theee several teats end lndlcete the edvantageo and disadvantages of aach. X shall uae lay terna aa such as possible or rpts<n tha Mdical ttrsi, Prinary Coproporphyrin Determination , Porphyrin metabollM la too nuch of a problan of physlologioal chemistry for a discussion In a paper of thia type. Suffice It to state that porphyrins are derived frat hemoglobin, a normal oonstitoent of the red blood cells. Apparently lead Interferes with introduction oflroo intojf the hemoglobin molecule with the roeult that one type of porphyrin, the coproporphyrlni is-excreted in theurine. theee pigments fluoresce in ` ultraviolet light.' In view of the feet that the urine of ell persona contain* io m porphyrin, all teats are positive when properly done, ... 4, ," - v'rW'-' f'>~ .V Tollwring the preparation cf the urine by the addition of chemicals, tha reaulu are read la a dark rooe, using an ultraviolet leap. The resulte brooit out by the ultraviolet light ere recorded arbitrarily on a seals of one through four. A light blue to a light green color Indicates norual porphyrin concentrations. Slightly observable lavender, pink or reddish indicates an Increase in porphyrin. A distinct red fluoreacence indicates Increase in porphyrin. A brilliant scarlet fluorescence la e narked Increase in porphyrin. Only tha third and fourth atagea are con* sidered aa auggeatlvo of lead intake. Tha fact that positive teats aay be obtained In toxic states ether than those dot to lead mat always be considered. There are certain factors thlch favor thia type cf teat.* It it not difficult to do and it is not ooetly. Likewise, unlike the collection of sample* of urine or blood determinations of lead, no precautions are necessary in the obtaining of the urine staple such aa against contaainatioo or the failure to use lead free containers, syringes, eto, likewise, It la believed that coproporphyrinula occurs earllar than stippling of the red blood cells. The disadvantage of thle test la that it is purely a screening test and does not lndlcete exactly tha quantitative factor. Too frequently, those in thorn this teat ia positive are then subjected to aore accurate determinations of ths lead in tha urine or blood, Tn a plant with relatively few employees and without a doctor or laboratory facilities, tha if." 4"-- worker Km to bo oont to tho doctor'* office for whatever typo of oxaslnatlon and therefor* th* vhol* blood load determination could well bo don* at ouch a tlx* and thuo eliminate tho too to for porphyrin*. _1be Baaophllle Stippling toot *_ In th* blood 0N*ar of one exposed to load there nay bo ootod 0 typo ef rod blood eoll which contain* anoll granule# or etlpplli*, hone* th# torn basophilic rtlppllng. lb* word anoar la cleleeding, for actually a drop of blood la not aaoarod on a glass alldo bat rtthor th# blood la gantly and oronly aproad alone <h# turfaca of tho alldo tfclch la than atalnod by a apodal dy# and, aftor drying, la examined ondor th# idero*;. C0P** Hanaroo* thoorlo* have boon advanced aa to th* cause ot basophilia. It la conaonly ballrood that baaophllla la th* roapenaa of lmaatur* rad blood call* to th* proacnc* of aono toxic oubotanco circulating In tho blood stroaa, Tboro ar* a noabor of dlaoaaoa that dhow baaophllla v and honco tho toot la not apodflo for abnonal load absorption. However, an Increased rorbor of baaochlllo stippled cells In a load worker la.. - hlfhly soggeatlv* of Increased load absorption. Without going into th# ` , wechanlaa of coontin* thoao colla, tofflea It to atato thatbaeothllla4!f?.,~ within tT{* of 1-lS por 100,000 rod colla la conoldorod ooraal. Generally apeaklng, tho froator nonbor of baaophlltc otlpplod calls jfcVe**--'' present tho greeter th* degree of abaorptlon. However, tho nonbor present dooo not noceeearlly lndleot# th* degree cflfltcxleetlon. Hoc*ntly,''bn* C' of our caao* Wicvod an exceedingly high otlpplod coll coont and yot ha V v*l only mildly Intoxicated fro* hi* load. , lb* frequent, periodic examination of load workers for baaophllic atippling la an axcollont watch-dog procodor* In :th* preventive program If th* technique la exacting and tho technician woU trained and oxporlancod. lb* alldo* mot bo specially cleaned and car* axarclaod In naklng and otalnlng tb* blood snears. fair* reading* occur If thla 1* not done or If tho anoar la too thin or too thick, orpoctally la thla true If tha aaaar la too thick, lb# counting ahould bo done by tbo aaaa individual utilising tha aano technique in axanlnlng and recordlrg tbo , . = otlpplod call*, lb* roaolta derived fro* noat clinical laboratories or fro noat boapltala' laboratorloa and froa tha technicians aeployed by oat doctor* are unrallabl*. Dr, Daton Belknap proclaims th* valu* of baaophllla atlppllng and uaea hla roaolta to rotato hla worker* or to rorov* tho* froa exposure, But Dr. Belknap ho* had year# of experience In thla flald, has trained hi* technician and hae developed an axcollont oyoton of developing a basophilia baee-lln# record for all of hla worker*. Hla la an axeoptional situation. * Primary Lead Tests The lead content In the urine constitutes a reliable Intel of the dsgr* of eeote lead abaorption. One cannot ba too oarafal In collecting a twenty-four boor specimen of urine for load determinations. It tfiould ba collected In a larje Fyrax conUlnar, and all duat or eon* taelnation of ary form Wiould ba avoided. I recall that aararal yeara ago a private physician reported an excessively high lead content In the urine of hla patient* But the nature of th patient1 work and bit clinical picture ware not eo^atlble with the laboratory reeolta. After carafal Inquiry It vaa found that the urine had bean collected In an old paint can. If It la neceeeary to reaort to rubber or natal catheters, these ehodd bo free of load In their composition. Several consecutive analyte* of a twenty-four hour epeelean ahould ba nado. Zt la aleo advisable to chock the reeolta against Whole blood determinations. the rage of nomal values cf lead excretion varlea conelderahly In the opinion ef the verloue Investigators. for neny year* the upper Unit of nomal mi coneidcred to be 0,0$ ng. per liter for^ea^lee of x;,*- - one liter or mart, low met experienced worlrere conelder 0,06 mg, per liter for large samples to be the upper Unit of the normal-nngecf lead - In the urine. However, even today tone cllnleal labcretorleebave net - j;. changed thaee figures on their printed foraa. \ Blood lead Teat* Here, again. In the technique of collecting the blood easple, contamination ahould be avoided and the uee of lead-free containers, ayrlngee, end needlea le required. Reliance nay be pieced only In a laboratory or chomlet qualified to perform thla teat, for not ell clinical laboretorlee or hospitals are equipped or manned to carry out thla type of analyals. Blood lead concentration! In the Individual are subject to little variation free hour to hour, except in reeponee to brief, interne lead exposure, and therefore samples my be obtained for analyela a} any time of day. The nomal lead concentration! in the blood, as previously Indicated, rang* from 0.01 rg, to 0.07 or 0.08 mg. per 100 ge. of tdiole blood. Results in excota of 0.06 mg. per 100 gm. of whole blood are indicative of load exposure within tome recent period, while reeolta in exeeee of 0.10 ng. per 100 gm. Indicate the exposure bee been considerable. Rewlte approximating 0.50 mg, per 100 gm. ere unusual but may occur when i. the exposure le severe. Result! much above this level ere open to question ee to their aocuracy, and except In rare Instances of overwhelming accidental exposure, results In excete of 1.00 mg. per 100 gm. met be regarded as evidence of contamination of the sample In the process of collection or analysis. All questionable results rtiould be checked by the analysis of additional samples, or by analysis of the urine, or by both means. Let It be understood that regardless of the lead level In the urine or blood, the V-Sfe.. diagnosia of lead Intoxication wot net b* based upon th laboratory finding* don*. Th# dlagnoais rust combine th# occupational hlatory and th* clinical plotur# with tha laboratory f lading*. TWOmOfT Ontil recently thar* baa baaa no drug that gave satisfactory evidence that it vaa able to rid tha body of lta burden of load, further more, It haa long boon wy opinion that non* waa nacaaaary In tha used caaa aoan In oodarn Industry, for raof years ry regime has baan to mow frat further exposer* tha worker with lead intoxication, addnlater intrarenoua cdcloa gluconata for hla lctestlnd colic, correct hla eoostlpatlon and prescribe iron by Booth for any wild anatda, X ballera tha calclua roller** tha colic but In no way affect* th* load netabolia*. yurthorrore. It haa long ba*n ay beliaf that recantly abaortwd laad la axcratad by th* noreal physiological process. It is not found necessary to hospitalise the** caaaa and In th* average case be la returned to woilr . In three to four weetea but not, of course, to lead expoacre. Vila type of treatment requires only a few office visits, tha - > Bfdloal cost is low and tha duration of disability la short. At tha outsat * of treatment tha nature of plurblm la discussed with tha worker, Ms fears allayed and old wives' talcs reweed. Ha la told In how nany days w- C. ha can axpact to feel greatly improved-- s prognostication in which I not always correct. ' \+ Obviously, I aa referring to the Boat cowon type of lead poisoning, nawly tha gaatro-lntaaUnd type oocurrlng In workers whs bare had a relatively short exposure to lead and not prolonged periods of aecurulatlon. Alto, I s b not referring to the rare case cf peripheral neuritis, often evidenced by wrist drop or to tha rare case of laad anoophalopathy. gone years ago a drug was found that proved to be a mat sffsctive wans of dl*sdlng. Vila la monoedeiuw dioodlan ethylene dtaaln* tetraacetat*, to bo referred to hereafter In this paper aa calclua EDIA. This cheated Is often referred to by the trade nan# of Tarsana or Tersanata. It la a chelating agent, the word chelate, of Greek origin, weaning a dsw. In staple language, when edelur EDTA Is Introduced into th* body It reach*# out a claw, grabs hold of th* lsad and this bonded complex Is rapidly eliminated froa th* body. Z ditll not discuss th* dosago. It nay b* giron Intramuscularly but It Is advlsabl* to adninlsUr It lnlravsnoeely with Ui# patient in th* hospital. Hospitalisation Is urged because th* results of treatment can be observed better and dso because calclua tDTA la capable of harmful alda-affscta, especially to th* tubular system of th* kidneys. Practically all of tha load In combination with this chalet!ng agent imposes a burdaa upon tha kidneys within a period of five hour*. Therefore, th* dng i rfiould not be given without a proper evaluation of the patient's renal statu*. Fatal raaulte do# to Injur/ to the kidnaya htra been reportad. Lika neny ether therapeutic agents rrolved in recent years, calolon EDI* la heralded aa a adracla dreg. I do not dan/ lta efficacy. But I Mintain it la not a drug to ba tiaad routinely In tha ueoal type of lead Intoxication. It Aould ba uaad only in selected caaaa. 2 hart o m ~ further warning to naira regarding tha uaa of calcloa OU. There are cone phyeiclana tho recomend the oral or tablet fora of thia drug aa a prophylaxis, that la, aa a preventive raaaura. Also, 2 know of eons companies that diatrlbuta thaaa tablata to tha worker* without radical advice or Mpanrlalon. Such a practice la an outrageous violation of tha prlnclplea of induatrial hygiene. 2 have vitnaaaad an outbreak of lead intoxication in one corpary that railed upon dally oral Intake of calclso EDH. " SOieORT : X need not tall you gentlanea that pluabla* la 00a of tha oldaat dlaaaaca incurred from verk exposure. There waa a tine aban It waa ~ difficult to prevent or whan no-sincere attatpt waa nada to'^proteet the . worker. Today tha Incidence of plurbian la a needleaa coetto industry and to tha Industrial worker. Factors regarding coot, engineering control, nodical control and treatment have bean presented. Xt la urged that Mnagenent seek Intelligent nedlcal care and that it conduct an educational wprogran aa outlined In this paper.