Document JrQz5DqX11EVn6p4rzy3YV8MX

Dtatt AIRBORNE IAD IN PERSPECTIVE CONTENTS .. : ; . i PREFACE ,' ROSTERS (committee, panel, contributors and reviewers) INTRODUCTION Panelist: Paul B. Hammond; Contributors: Charles R. Malone; Woodwell? ENVIRONMENTAL FORMS, SOURCES, AND FATE Panelist: Robert G. Keenan; Contributor: Ralph C. Wands A. IN THE ATMOSPHERE B. IN FOOD AND WATER C. VARIABILITY D. MEECASOURUEOMEGNTY. A op J. ctAA IOS INPUT AND DISPOSITION IN VEGETATION Walter H. Heck Contributors: Robert H. Daines; INPUT AND DISPOSITION IN MAMMALIAN SYSTEMS Panelist: Paul B. Hammond; Contributors: Roy^'Albert, Norman Cohen BIOLOGIC EFFECTS IN DOMESTIC AND WILD ANIMALS Panelist: Arthur L, Aronson BIOLOGIC EFFECTS IN MAN ' A. CLINICAL SIGNS AND SYMPTOMS Panelists: J. Julian Chisolm, Harold H. Sandstead B. SUBCLINICAL AND BIOCHEMICAL EFFECTS Panelists: Harold H, Sandstead, J. Julian Chisolm C. BEHAVIORAL EFFECTS Panelist: John L. Falk D. EVALUATION OF BODY BURDEN AND DIAGNOSTIC CRITERIA Panelist: J. Julian Chisolm E. SUSCEPTIBILITY AND TOLERANCE Contributor: Robert A. Coyer F. EPIDEMIOLOGY Panelist: Gordon J, Stopps ORGANIC LEAD COMPOUNDS Panelist: Gordon J, Stopps; Contributor: J. M. Wood Re c e iv e d . NOV 23 1970 HASKELL LABORATORY . --I DUP050055793 Chapter 7 8 9 10 Appendix A CONTENTS (Cont'd) .. ' NONBXOLOGIC EFFECTS Contributors: Frank J. Rizzo, Dennis J. Viechnicki .. APPRAISAL OF IMPACT The Panel A. COST AND EFFICACY OF MEDICAL TREATMENT Panelist: Harold H. Sand stead B. DAMAGE COSTS Contributor: Harold Bond C. ESTHETIC COSTS " AIRBORNE LEAD IN PERSPECTIVE: CONCLUSIONS: The Panel <. SUMMARY AND RECOMMENDATIONS FOR RESEARCH: The Panel , Tables of Biologic Effects of Pb after Quantitated and Nonquantitated Exposures. DUP050055794 Draft 10/19/70 PREFACE v* The price man is paying for his mindless use of the biosphere includes an appalling array of destructive effects, from the crumbling of irreplaceable stonework and frescoes to the loss or blighting of young human, lives. These are intolerable effects, whether interpreted as irrespect for civilization or as irreverence for life. In an effort to check the destruction, several national governments have promulgated legislation designed to set standards for, environmental quality compatible with human welfare and to facilitate their implementation. The United States Congress passed the Clean Air Act in.1963, and has strengthened it through subsequent amendments. The National Air Pollution Control Administration (NAPCA) was charged with issuing air quality criteria guidelines to assist the states in developing standards on a regional basis. *. As part of its effort to discharge its responsibilities, NAPCA asked the National Academy of Sciences to prepare evaluative reports on current knowledge of selected atmospheric pollutants, reports that could serve NAPCA as background for preparation of its criteria documents. Through the National Research Council's Division of Medical Sciences, the Committee on the Biologic Effects of Atmospheric Pollutants was constituted to coordinate and supervise the activities of ad hoc panels of experts brought together to pool their knowledge of specific pollutants. The Panel on Lead was charged with preparing a report that would accurately reflect the scientific knowledge of the effect of lead on health and human welfare,, enumerate the variable factors that alter these effects, and indicate areas whex*e data are lacking. Because of the pervasiveness of the air environment, the scope of the report is wide and provides a perspective of the role of airborne lead in the biosphere. The Panel's first meeting was on 8 July 1970, when a tentative timetable and outline were developed that seemed reasonable within the constraints of NAPCA1 s needs. DUP050055795 -2- Through subsequent meetings, consultations, and homework, a.draft was prepared for circulation to reviewers from the Committee, to appropriate divisions within the c f National Research Council and the National Academy of Engineering, to outside specialists, and to the NAS Report Review Committee* The final report was transmitted to NAPCA on 30 November 1970. Only by the cooperation of many persons was successful preparation of the report within the time allowance made possible. . In addition to the activities of panel members, the response of NAPCA staff to requests for help was indispensable. The Panel1s needs for information services were met in part by the NRC Advisory Center on Toxicology, the NAS Library, the National Library of Medicine, and the Air Pollution Technical Information Center. Members of the Committee who had specific responsibilities to the Panel are Dr. Bertram D. Dinman, Dr. Victor G. Laties, and Dr. Gordon J. Stopps, and the staff officer was Dr. Louise H. Marshall* The Panel on Lead was the first to undertake its study, and problems of organization and communication came on stream that needed instant solutions. We are indeed grateful to those who became involved for their patient and generous cooperation. DUP050055796 Introduction The Lead Panel, BEAP, was formed to consider the impact of environ mental lead on human health and welfare. It was hoped that from a consideration of the relevent facts would emerge conclusions and recommend ations useful in the formulation of public policy regarding control measures and future research needs. Hie panel's efforts will no doubt come under some criticism for being incomplete as to scope and depth. Given the limitations on time which were imposed on the panel it was not possible to explore every facet of the lead problem. The panel's activities were monitored by NAPCA, NRC, the parent commit tee, and by individual experts from beginning to end in order to minimize the chance that important issues were being overlooked or inadequately considered. The major concern motivating the study was for the atmospheric sources of lead and their impact on human health and welfare. Effects resulting from other sources of exposure were freely included for a number of reasons. Not the least of these was the fact that the importance of atmospheric contributions can only be properly understood when viewed against the background of total environmental input. Further, the biological effects of lead as they are known to occur or as they have been studied experimentally, rarely involve either atmospheric sources or the low levels of intake assoc iated with atmospheric sources, certain industrial situations excepted. This being the case, judgements concerning possible biological effects of atmospheric origin must largely be arrived at by the process of extra polation from the area of high level, short-term exposure into the area of OUP050055797 2 low level, long-term exposure. Unfortunately, the science of toxicology has not advanced to the point where such extrapolations can be made with any high degree of confidence. The panel's deliberations were beset with other difficulties which are characteristic of the emerging area of environmental science, wherein the emphasis is on the identification of situations potentially hazardous to the general population or to special subgroups. Recommendations for limiting the environmental input of a toxicant such as lead should obviously address itself to the safety of all the people. Since it is impossible to know the responses of all the people (or all the plants and animals for that matter), recommendations must emerge from speculation as to how tolerant the most sensitive individual can be expected to be. While the recommendations may be hard to dvfCudy wlley must be made by someone and the shreds of evidence and reason underlying theta must be put on display so they may be reshaped as wiser, better-informed decision-makers appear on the scene It was the purpose of this panel to display the evidence on which they felt the decisions would be based and to volunteer a few recommendations of their own* DUP050055798 DUP050055799 i/itupcer j . a f V Page 1 First Draft - R. G. Keenanj CHAPTER I ENVIRONMENTAL FORMS OF LEAD A. NATURAL OCCURRENCE . paiViLSGED INFCTL'AVnON NOT FOR PUCLIOATSO-JJ OR PUBLICATION REFERENCES I Lead is one of the seven metals known to the ancients* It is ubiquitous in nature, occurring^in soils, coal, vegetation, vege table products, the waters of the earth, mammals, fish, reptiles, eggSj and air. An extensive compilation of the results of the anal ysis of these diverse materials for lead has been reported by Kehoe (1). Australia has surpassed the United States as the free world's largest lead miner. The U.Sv.lead mines are located in Missouri, Idaho, Utah and other Western States. Other important lead produ cers include Canada, Mexico, Peru, Southwest Africa, Russia and Yugoslavia (2). The principal ore of lead is galena (lead sulfide, PbS) although cerussite (lead carbonate, PbOOj), anglesite (lead sulfate, PbSOA) and pyromorphite (PbgCLf104)5) are common ores. Lead occurs in minor concentrations in numerous other minerals of lead but are of much less importance. The lead sulfide in galena is usually associated with the sulfides of antimony, arsenic, bismuth, copper, silver and tin. The minerals of these other elements are recovered during the production of lead by smelting and refining methods. DUP050055800 PROPERTIES AND USES. Lead has an atomic weight of 20722, a density of 11.34, a melting point of 327C. and a boiling point of 14700. Unlike zinc, lead cannot be distilled per se in closed vessels; in the absence of air, lead is not volatilized appreciably below a white heat. Pure lead is almost white and it is soft, malleable and slight ly ductile. It tarnishes in air forming a film of oxide (3)* The presence of traces of most other metals makes metallic lead marked ly harder. Approximately 69 per cent of the lead consumed in the United States in 1968 was for the production of metal products utilizing metallic lead and lead alloys. Of the remaining 31 per cent, approximately 20 per cent went into the manufacture of gasoline antiknock compounds, principally lead tetraethyl, Pb(C2Hpj)4 and lead tetramethyl, Pb(0113)4; 8 per cent was used in the production A of pigments; and 3 per cent found miscellaneous uses such as anneal ing, galvanizing^and the fabrication of lead weights and ballast.Qb) It has been stated that "even though it is not the largest of the non-ferrous metals in production and usage, it is the broadest in its applications'* (2). Over 1,3 million tons of lead were used in the United States in 1968. A breakdown of this consumption by products is given in Table 1 (4). DUP050055801 Table 1 Lead consumption in the United States by products (Short tone) Product 1967 Metal products; Ammunition---------------- 78,766 Bearing metals------------* 19,561 Brass and bronze-------- 20,467 Cable covering-------- - 63,037 Calking lead--------------- 48,789 Casting metals------- ---- 10,083 Collapsible tubes------------ 11,299 6,148 Pipes, traps, and bends--- 20,184 Sheet lead-------------- 26,763 Solder-------------------- 68,833 Storage batteries; Battery grids, posts, etc------------- ---- 229,287 Battery oxides------ 237,378 Terne metal---------- 1,620 Type metal------------- 28,55* Total-- 870,769 Pigments: White lead------------ Rejfd lead and litharge---- Pigment colors--- -------- Other -- ------------------- ------ ' * 8,087 76,589 13,041 5,473 Total--! 103,190 1968 82,193 18,441 21,o21 53,456 49,718 8,693 9,310 6,114 21,098 28,271 74,074 250,129 263,574 1,427 27,981 915,500 5,857 86,480 14,163 5,234 109,734 (Continued on page 4) DUP050055802 (Continued from page 3) 4 Product 1967 Chemicals: Gasoline antiknock additives------- ------ -----------Miscellaneous chemicals--- 247,170 609 Total------ 247,779 Miscellaneous uses: Anneal i ng-------------- Galvanizing---- ----- ------ lead plating ----------Weights and ballast------ 4,202 1,854 532 15,794 Total--- .22,382 Other, unclassified uses-'--- 16,396 1,260,516 Grand total *----, 5.J, 1968 261,897 629 262,526 4,194 1,755 389 16,768 23,106 17,924 1,328,790 2 Includes lead content of leaded zinc oxide and other pigments. Includes lead which went directly from scrap to fabricated products. DUP050055803 The number of applications of lead and its compounds as indicated in Table tell only part of the story* Lead is an extremely valuable me.tal which is needed by many industries and whose products are important to our lives. For example, lead is used to shield us against nuclear radiation, to paint our houses (white lead, basic lead carbonate) and structural steelwork (red lead, TbjO^), to impart desirable properties to the finest crystal and optical glass (lead oxides and silicates) and to make the type metal in our printing presses. The paint industry uses several other lead compounds, Including lead chromate, white basic lead sulfate (leaded zinc oxide is produced by a fuming process whereas silicate formulations result from a chemical precipitation process), blue basic lead sulfate (containing a mixture of basic lead sulfate, lead sulfite, lead sulfide, zinc oxide and a small amount of carbon). lead paints are intended for (ip outdoor use only. Their weathering characteristics make them valuable for this purpose. However, lead chromates provided some 14,000 tons (a^Pb) of yellow, greensand red pigment colors in 1968* These find many uses, including traffic marking paints and print- Lead has found numerous applications in the ceramics industry. Glazes for china and structural clay products may contain lead in glazed brick, light-weight aggregate, and porcelain enamels for aluminum and steel.' DUP050055804 The electric storage battery Industry has been the largest single user of lead in the United States for many years. In I968 this usage accounted for 38.6 per cent of all .lead consumed in this country# There is almost an even distribution of lead between its metallic form used to make up the grids containing 4 to 8 per cent antimony and lugs and lead oxides (litharge, PbO; red lead, ^304; and black oxide, Pb20), which constitute the active material pasted on the plates# ^ The second largest consumer of lead is the petroleum industry. r? USi -t/cL- In 1968, this industry utilized 261.9 short tons for gasoline additives (lead alkyls) or 19.7 per cent of the total lead con sumption for that purpose alone. In addition, this industry uses lead in the form of pipe and sheets for the fabrication of corro sion-resistant equipment. Oy Miscellaneous uses of lead, on a tonnage basis, include lead arsenate used as an insecticide for many years but on a decrease , lead as a stabilizer in vinyl plastics for elec trical cable insulation as well as in hose, pipe, sheet^and floor coverings made from vinyl plastics. The examples of lead usages given above provide^ some defi nition of the scope of the chemical forms of lead encountered in commercial products in our daily activities. DUP050055805 1 ATMOSPHERIC LEAL a. Physical Characteristics Lead emitted to the atmosphere may be in the form of dust, fume, mist, or vapor depending upon the source material and the method of generation. These physical forms of aerosols have been defined generally as follows: Lusts are disperse systems of particles or aggregates of particles ranging from ^50>\^jy/u in diameter that are thrown into the air by mechanical activities (5) during blasting, crushing, drilling, grinding^and other industrial, constructional, or agricultural processes. Those particulates that are smaller in diameter tend to remain airborne for greater periods; those that are less than lOyu in diameter are capable of being inhaled (6),. Examples include' the oxides and salts of lead that become airborne during handling or packaging, 1 dVywW Men. 3 50% ** M <,Mb^esi -l* pU'VWWy '<h< > ( Fumes are formed from chemical reactions including combustion or from such physical processes as distillation, sublimation, calcination, and condensation and range in size from 1 to 0.2yu* Examples of lead fumes are those of metsl-r- 11c lead and lead oxide generated as vapors in smelters or foundries during melting operations followed by condensation from the vapor state. Mists are formed, by the condensation of water vapor on submicroseopipijKtrtioles ;of dust or gaseous ions or by the atomization of liquids (7), Sprayed lead arsenate insecti cide is probably the only example of a mist of a lead compound DUP050055806 8 that is important in air pollution studies* Vapors are formed from liquids by an elevation of temperature and, like gases, produce a true solution with the atmosphere. However, as soon as they regain their liquid state, from a lowering of temperature, they form mists, fogs, and fumes. Evaporated lead alkyls provide the best examples of vaporous forms of lead. Particle Size, The particle size distribution of urban lead aerosols have been determined by Robinson and Ludwig (8). These investigators report a mass median equivalent diameter of 0.25yu with 25 per cent of the lead aerosol mass smaller than 0,16yu diameter and 25 per cent larger than 0,43/i. Their data are based w$on 59 urban size-distribution analyses of samples collected with a modified Goetz Aerosol spectrometer in Los Angeles, San Francisco Bay Area, Cincinnati, Chicago, and Philadelphia. 25 samples were collected in the Los Angeles Basin and 8 in the Bay Area during the summer of 1963 whereas 12 were collected in Chicago and 7 each in Cincinnati and Philadelphia during the mid-January to mid-March period of 1964, A-Z'b & These results are repre-sentatlon of lead aerosols from a variety of urban sources .as there was a. fair uniform division of samples between residential, commercial^and industrial areas in each Of the 5 Cities. A.comparison of estimated emissions of lead from several sources in the Cincinnati area indicates that the principal contribution comes from the combustion of leaded gasoline (9). In view of this, studies of the particle size DUP050055807 Ba l t imo r e Cit y He a l t h De p a r t me n t Policy concerning the removal of lead paint in order to prevent lead paint poisoning in children 1. All peeling lead paint to be removed above or below the -4 foot level. 2. Treatment of tight lead paint on certain other surfaces. (a) Window sills - complete removal (b) Door frames below 4 foot level - complete removal (c) Windows below 4 foot level including mu1lions - complete removal. (d) Stair rail spindles - complete removal of 3 sides nearest to steps (e) Stair treads - removal from lip to riser on bottom and 4,; back from lip on top of tread (f) Doors - removal from chewing edges back 4" on both hinge and latch edges (g) Stair rails - complete removal (h) Any surface presenting a chewing surface - complete removal 3. Tight paint surfaces not requiring removal. (a) Walls in good condition without broken plaster (b ) Baseboards (c) Skirtboards on stairways (d ) Step risers {e) Chairboards except where they present a chewing surface (f) Any surface below the 4 foot level not presenting a chewing surface. In accordance with the above policy lead paint sampling will be limited to the surfaces listed above for removal. November 10, 1961 Commissioner of Health ( SS-636 DUP060055808 The program in Philadelphia, Pennsylvania differs somewhat in that there is no active screening program but between Jauary 1 and September 30, 1970, 2,463 blood lead specimens have been submitted by Philadelphia hospitals on suspicion of disease# Of these- 2,463 blood specimens 393 (16%) have blood lead levels greater than 60 micrograms Pb adhc per 100 grams whole blood and 481 a*x (19.5%) had blood lead levels between 40 and 59 mierograms percent. Of the 2,463 children tested, 214 (5.4%) were reported as cases of lead poisoning. 874 homes were investigated. In addition, unique to the Philadelphia Health Dept, is the fact that a parent may request inspection of the home which will then be tested. Even in the absence of disease all paint containing greater than 1% lead k s c k s c when found will be ordered removed. In both New York and Philadelphia injunctions may be obtained so that if g&gix compliance is not obtained promptly from the landlord the city will order repair of the home, the cost fif repairs to be recovered as a lien on the value of the property. DUP050055809 ~to- n 9 The effectiveness of complete removal of lead pigment paints for transfer of the family into modern public housing can be seen in Table I. fecal Here it will be noted that pdta output of lead decreases to the XKKiaai values approaching the normal level when children are discharged from the hospital into safe housing. Other controlte^measures include intensive followup of affected children throughout the age of pica or until they reach 3 to 5 years of age. This approach requires approximately one medical social worker per 50 affected children and repeated blood lead examinations to detect the level of exposure to lead in these children, 19 * 20 Attempts to control pica through conventional public educational techniques have not been successful. No substitute has been found for pronpt and adequate environmental hygiene. Simple chemical tests^'^ suitable for small operations have been published. More recently^utilizing the principle of x-ray flucresenee^ a jEKKtokiKx prototype portable non-destructive detector for lead in housing surfaces has been developed at the Institute for Environmental Medicine at NYU and is currently in use in New York City, Other instruments utilizing the same principle are said to be under developments currently; The systematic screening of both children and houses, followed by prompt and adequate environmental hygiene^ is the only effective control measure so far developed for control of this par ticular environmental source of lead. Currently these principles have scarcely been implemented at all, v} Lead^contalning glazes on culinary ceramic ware. Acidic foods and beverages A such a$ tomatoes, tomato juice, most fruits and fruit juices, as well as alcoholic beverages, (cider and wine) have the capability of leeching the lead from leadbearing glazes if they are stored in improperly lead-glazed earthenware containers. ,) Repeated ^d^deis--^repeated/ instances of classical plumbism have been traced to the consumption of food and beverage so contaminated. This experience has recently DUP050055810 been reviewed by Klein,"et al. Here a distinction should be made between '.'atone ware11 and "earthenware" These differ in both clay composition and in the firing and application of the glaze* - Stoneware clays are usually fired between 23^nd 2400 degrees fahrenheit. Above 2200 degrees F.^lead is rarely used as a glaze constituent and if used the lead volatilizes, thereby eliminating the hazard of lead contamination. 23 On the other hand, the term "earthenware" is applied to pottery which has been fired between 1085 and 2174 degrees F., either glazed or unglazed. When fired at this temperature lead is apparently an essential component of the glaze in order that a smoothe and full covering of the clay be obtained* Occurrences of food contamination are traceable to earthenware but not to stoneware. Klein, et al. following the occurrence of fatal lead poisoning in a child who drank apple juice from an earthenware container purchased on the open market a number of earthenware containers in Montreal, Canada imported domestic commercial and handicraft items were tested for lead release by standard procedures. The results are shown in Table^^S*. Approximately one-half the samples from all three sources released, more than 7 parts per million of lead under standard testing procedures* This being considered the upper limit of safety under the Canadian Hazardous Products Act, the Canadian Department of Consumer and Corporate Affairs has confirmed the findings of Klein, et al* and is currently promulgating regu lations and procedures for adequate control of this particular hazard.. With respect to this particular hazard, the temperature.and time of contact between the lead glaze and acidic food or beverage is important in determining the amount of lead released. No adequate data on this aspect of the problem have been found, while* commercial producers of earthenware may be able to meet safe standards, it is doubtful at this -point to state whether amateur pottery makers can meet safe standards with the types of kiln available for home use. In this same DUP050055811 t abl eau Report o f Lead Extractions from 264 Earthenware G laze Surfaces it o a. if> O o g& ill I1I On O5 c o I D, o O Cl . 2 CM IUx Xf O <D I Cu K CL CO to S3 I CM l M3 IT) S3 I K CM S3 Sf I CCOM CL. lO K **fr I S3 SCO3 to S o CL VO. On fs* O j CSO3 CSO3 o0) D <0*. tD 3o Z no O BO 0 jj CL ODO On 00 CM O IxNi* | o. I? S. 8 J -ao> .42- .*2: *r <D VCD) 38_. n O a ou (0 q 4~ O co CL O (0 o n o J) M a P> -- L<lDl <!> <4- o x> <1) 3*07 C 8 & c0 1 2 Cua>L *r n4- ~u CD v0>) 4-- 3 o q u <OOD a> OO CD CL E CD E o o q "8 030 J3 C DUP050055812 regard home wine brewing has been a common practice in many parts of the world. Historically wines have been contaminated by lead at a variety of different points in the wine `making process. Clearly their storage in or fermentation' in earthenware containers should be discontinued in the light of the above information. The extent to which the general population is exposed to this particular source of lead is quite unknown but the data in Table VIII suggest that it can be controlled by elimination at the source ^ommercial production, 2, inspection of imported ware and 3, alerting the amateur handicrafter and education of the general public and appropriate labeling of earthenwarevessels) Lead contamination of whiskey. . This is largely a regional problem in Southeastern United States, Illicitly dj^tilled whiskey is often produced with makeshift equipment employinginside of an automobile rmk&diith radiator for the condenser. Lea\ is leached Jrfito the liquid passing through A Also, tasttmay be itoroyed by placing lead plates in the mixture The Alcohol, Tobacco, and Fire^rmsVDivision, Internal Revenue Service, Department of the Treasury has routinely c^etermined the lead content of a large proportion of the "moonshine'l/s amples acquired when illegal stills were confiscated. Currently the analyses ara'performed by atomicXabsorption spectrometry. Many ( \ ^SBBT samples contain excessive amounts of lead as is $Jiown in Table -3EX. Recently many different varieties of alcoholic beverages were obtained and analyzed in NAPCA's Division of Air Quality and Emission Data Laboratory\to provide a base for comparison. Seven samples (bourbons and blends) showed a lead content in tbe 0.2 to 0.4 mg/1 range and eight samples (gin, vodka, and Scotch) bad levels which were below detectable (0.1 mg/1). DUP050055813 ~L i c\ o o Lead Poisoning and Illicitly Distilled Whiskey Lead is a common contaminant of the illicitly distilled whiskey (moonshine) manufactured in the United States. The reason for this is the method of con struction of the stills. Automobile radiators are frequently used as conden sers, while the other components are connected by soldered joints. Thus, hot vapors and the liquor come into contact with metallic lead. Although the forms in which lead is present in the liquor have not been identified, it has been sug gested that acetic acid in the distillate may react with lead to form lead acetate (1/. In any case, the concentrations of lead in moonshine whiskey may j e : *sc> exceed 1 mg/liter in 30% of s ample s (Table I) (2^. In contrast to moonshine, concentrations of lead in twenty brands of alcoholic beverages assayed by the laboratory services (Branch of NAPC, Cincinnati, Ohio) were found not to exceed 0. 4 mg/liter. Twelve beverages contained less than 0.2 mg/liter (Table M) (3). The use of moonshine whiskey is wide spread. ) The map ^4^ indicates the major areas of manufacture and distribution. Although the amounts produced are unknown, it was estimated in 1968 that an excess of 36,000,000 gallons were produced 04). Lead intoxication due to Inge station of moonshine may be either inside ous (5) or fulmanent, depending on the amount of lead in the drink (6^%d3* It has been suggested from animal studies that the absorption of lead may be.increased by alcohol and that the absorbed lead enters soft tissue cells more easily when DUP050055814 DUP050055815 Prepared fro m data com piled by the Internal Revenue Service by the Licensed Beverage Industry, Inc. Table X C*)<? I ) Brand Name Hiram Walker Imperial Corby's Old Sunny Brook Old Taylor Schanley Reserve Cabin Still Carl Jones Four Roses Jack Daniels Jim Bean Canadian Club VAT 69 Johnny Walker (Red) BaJlantines Black and White Smirnoff Vodka Haig Beafeater Gin Bicardi Gordon's Gin Bottle I Bottle II (mg/liter) 0. 3 0,2 0.3 0.3 0.3 0.2 0.4 0.2 <0.2 < 0. 2 <0. 2 <0.2 <0. 2 <0.2 <0.2 <0. 2 <0. 2 <0.2 <0.2 <0.2 0.2 0. 3 0.3 0.2 0. 2 0.2 0.3 0.2 Z0.2 40.2 < 0. 2 <0.2 <0. 2 40.2 <0.2 <0. 2 <0.2 <0. 2 <0.2 <0. 2 DUP050055816 2J &. yi alcohol is present (9^. If these findings also apply to man* they help explain why moonshine drinking may, on the one hand, be an insideous source of lead V* and on the other, cause fulminent poisoning with encephalopathy fkd). The clinical findings in patients with non-fulmanent poisoning include a lack of awareness of illness, mind anemia, colic, subtile neuropathies, azeotemia PSQ, and gouty arthritis T[T|. The renal effects appear to be similar to those described from Australia in patients chronically exposed to lead in childhood (T2^, tSJ. One is impressed that all of these patients are not alcoholics, but rather may be social drinkers. The incidence of poisoning seems greatest in Negroes perhaps for economic reasons. Examination of the service records of some of the patients with this type of lead poisoning suggests that they may have had quite responsible jobs when in the service, but are presently unre liable and not particularly bright, A careful evaluation of the effects of lead on the intellects of these patients have not been done, therefore, the above im pressions are tentative. Abnormalities in certain tests of endocrine function have been observed in moonshine drinkers with both non-fulmanent and severe lead intoxication# These include an impairment of iodine uptake by the thyroid gland impaired *{**> renin-aldosterone response to sodium deprivation and an apparent decrease in anterior pituitary and adrenal responsiveness to metapyrone and insulin ad ministration as well as a decreased pituitary secretion of gonadotropic hormone HI The few experimental animal studies (K(, 1^ 1^) and observations on in- 42 ^ gcr Xl dustrial workers 2^) which have been reported suggest that these endocrine abnormalities are indeed related to lead poisoning. DUP050055817 Lead intoxication related to moonshine may apparently affect the fetus (&) just as it may cause fetal damage in women intoxicated due to industrial exposure Because ingestion of moonshine is so common in the lower socio-economic groups of the south, the incidence of this type of poisoning should be defined so that adequate preventive and therapeutic measures can be instituted. The clinical subtility of lead poisoning due to moonshine drinking is exem- 33 plified by the measures which may be necessary to establish the diagnosis ($>). If the patient has ingested lead contaminated whiskey shortly before hospitalization his blood and urinary concentrations of lead are usually increased. On the other hand, if ingestion has been more remote, blood and urine levels may not be ele vated The diagnosis of an increased body burden of lead can then only be established by administration of a chelating agent such as calcium disodium edetate to increase its excretion. The observations on eleven patients with clinically evident lead intoxication shown in Table'TIL illustrate this fact. Studies by Morgan (Sy in patients admitted to the general medical ward of the V. A, hos pital, Birmingham, Alabama, who were not suspected of having clinical lead poisoning but who had ingested moonshine in the past support this impression. Of interest in Morgan1 s patients was the finding that except for patients with obvious intoxication^the urinary ALA excretions and hematocrits correlated poorly with the urinary lead excretion in response to calcium disodium edetate adminis tration. Treatment of patients with florid intoxication with chelating agents seems to b useful as far as acute signs and symptoms are concerned (IQ. On the other hand. DUP050055818 '"^X TABLE EEL Effects of Lead Poisoning Due to Chronic Ingestion of Illicitly Distilled Whiskey on Selected Parameters for Assessing Lead Intoxication Patient (Hg%) Blood Lead (Htg/1) Baseline Urine Lead (pg/1) Post Ca EDTA Urine Lead Qualitative Hematacrit ' Urinary % Coproporphrin i. 80 2. 120 3. 130 4. 110 5. 80 6. 50 7. 60 8. . 70 9. 50 10. 80 11. 20 180 , 2,200 140 9,200 1,300 40 2, 200 180 2,700 40 930 30 2,100 90 8, 500 50 2, 000 3,300 300 9, 500 21 25 35 25 24 30 29 28 28 27 25 pos itive positive positive positive positive negative positive positive not done positive pos itive Acceptable in industry <80 Goldwater and <40 Hoover {254 <150 <70 <450 >40 negative t +Lead analysis performed by the Toxicology Laboratory, State of Tennessee, Department of Public Health. t i DUP050055819 A aI the deleading of these patients may be an extremely drawn out process, because of their high body burdens of the metal. The long term clinical consequences of increased body burdens of lead, without obvious intoxication are as yet un known, Therefore, from a practical point of view, prevention of intoxication with lead through education concerning the dangers of moonshine, and elimination of moonshine industry by law enfor cement agencies seem measures of prime importance. Acute episodes of poisoning can be successfully treated by chela tion. DUP050055820 Lead C o n te n t o f N o n t& a p a id W h iske y - "M oonshine TABLE O CO M1 CM 0\ CM it m * O rn VO o CM H CM in c m t* 00 lO CM rn 00 VO CO I5 in o ^ o` o H A cyoHH H CM O ro 10 m CM CM r* c m m 0 in h n H 1 ih H Ho m NOH t* co in O CM CM \ n c m cn gv<n c m st h H V cri c m in o *H pH in m* co i*-4. in o n o cm CM vo CM CM fH m CM Ch CM H CM in r-j *?3* m in t in rH fO H pH M HOOO H CM o m CM pH U a CO ^ O h iH <0 H min mvo CM 01 r* in 0> e 0 44 $ 10 44 >i 03 , C fi a00 cs H *H 0 On fr* 0) 5 &^ 0 <0 cn *H rH HH 0o is pu g $ o 44 H $ ? 0 Me fc* CM DUP050055821 The effects potential injury to the fetus amo considered in Chapter 5. whiskey, including Icoholic mothers, are Unusual sources of lead exposure Sporadic cases of classical plumbism in children and adults have been traced to the following: lead- painted children1 s toys and furniture, lead toys and baubles eaten by children, lead nipple shield, home battery manufacture, artist pink pigments (hand mixing), lead dust in shooting galleries (attendant at risk),Sol(ubmle i{end conveyed A. in lead pipes, ashes and fumes of painted wood, burning of discarded battery cases used as fuel in cook stoves and fireplaces, "medications11, jeweler's wastesj and lead-type in schools for the blind. Lead pigments have also cropped up through the years in cosmetics. By voluntary skkxdaxdx agreement the American .^ Standards Association has eliminated lead pigment paints from children's toys and * furniture. Consideration of the total elimination of lead from children's toys and furniture is now under consideration. In 1933^40 cases of plumbism in Baltimore were traced to the burning of discarded battery casings in the homes of the poor. A similar outbreak was reported in , Wh*' England in the late 1950* vi |) 1 Rotheringham, DUP050055822 Y when discarded battery casings were distributed to impoverished miners for use in their homes. In the Baltimore epidemic d&B&ets wetfe*rdi-srihu^ --^--that six junk shops were distributing discarded battery casings at the rate of approximately 2750 per week. To control this vthe*4iealtib=depar:meat-warried^lir-1^^ ^TufT&er*_dd^txIbu^ ,caisfrgs^p' the health department and police commissioner warned the proprietors of junk shops to refrain from further distribution of battery casings to be used as fuel and.the city arranged to pick up all discarded battery casings for safe disposal at the city incinerator. Under these and other measures no further cases were discovered in Baltimore until more than 2 decades later when in 1957 two similar cases occurred. The other sources listed above have been controlled XhxHHgk at the source through similar steps and do not constitute a significant health hazard to the general population in the United States at this time. The sole exception to this is the continued use of lead in cosmetics, a source which has not received adequate evaluation. gjmxKixxiHaxx Respiratory Intake of Lead. EsfeimatKXXHfxxsxpsxafeHx^xixXake Hfxikaai published estimates of respiratory intake of lead in humans have usually been based upon adult humans. When estimates are applied to children due account should be taken of their increased! metabolic rate. Thus at birth total daily expenditure of calories l^^B?sxxKxXKk^:xx is on the average 120 calories per kilogram body weight. At 3 years of age that has decreased to approximately 100 calories per kilogram body weight for 24 hours^ ^t 9 years to 80^ and by adulthood to 40 calories* For example^ a one-year old child weighing 10 kilograms consumes 1000 calories per day and a six-year old eh&Ui A weighing 25 kilograms will consume approximately 2000 calories per day. Increased activity, feverf and infection can almost double these requirements, for brief DUP050055823 periods of time. Studies in respiratory physiology indicate that the oxygen consumption requiryfes an intake of approximately 5 to 6 cubic meters of air per 1000 calories metabolized. DUP050055824 VH4.WVAW -- vaiajJUCJ. x > Page t3~ Z. <* References 1. Lourie, R. S., Layman, E. M., Millican, S. K,: Why Children Eat Things that are not Food. Children Ten 143, 1963. ... 2. Cooper, M.: Pica Springfield, 111,, 1957. Charles C Thomas, Publisher 3. Gutelius, M. F., Millican, S. K., Layman, E. M., Cohen, G. J. and Dublin, C. C.: Nutritional Studies of Children with Pica I. Controlled Study Evaluating Nutritional Status II. Treatment of Pica with Iron Given Intramuscularly. Pediatrics 29, 1012, 1962. 4. Millican, S. K. Layman, E. M., kmriha Lourie, R. S. and Takahashl, L Y. Study of an Oral Fixation: Pica, Journal Amer. Acad. Child Psychiatry 7:79, 1968, 5. Sobel, R.r/^feiychiatric Implications of Accidental Poisoning in Childhood In Pediatric Clinics of North America, Coleman, A. D. and Alpert, J,j. Eds. Vol. 17 No, 3, August 1970 , W. B, Saunders Co., Philadelphia pp. 653-686. or 6. Neumann, H. H.: Pica - Symptom far Vestigial Instinct? Rsra-d Pediatrics 46: 441, 1970. 7. Roland, R, A. National Paint and Varnish Lacquer Association, Washington, D.C. Personal Communication, 8. Lin-Fu, J. S, Lead Poisoning in Children, II.S. Dept, of Health, Education, 452 - 1967 and Welfare, Social Service, Children's Bureau Publ. No. (U.S. Gov't Printing Office, Wash., D.C. 20402). 9. Lin-Fu, J. S. Children 17.: 2, 1970, 10. Schuker, G, W., Vail, . H., Kelley, E, B., KaplAn, E.: Prevention of Lead Paint Poisoning among Baltimore Children, Public Health Report (Washington) 80: 969, 1965 11. Ingalls, T. H., Tibonj. E. M,, Werrin, M. Lead Poisoning in Philadelphia, 1955-1960, Archives Environmental Health. 3:575, 1961, DUP050055825 Page 1,1. References 1. Lourie, R. S., Layman, E. M., Millican, S. K.: Why Children Eat Things that are not Food, Children Ten 143, 1963, 2. Cooper, M,: Pica Springfield, 111., 1957. Charles C Thomas, Publisher 3. Gutelius, M. F,, Millican, S. K., Layman, E, M,, Cohen, G. J. and Dublin, C, C.: Nutritional Studies of Children with Pica I. Controlled Study Evaluating Nutritional Status II. Treatment of Pica with Iron Given Intramuscularly, Pediatrics 29, 1012, 1962. 4. Millican, S. K. Layman, E. M., braze Lourie, R. S, and Takahashi, L Y. Study of an Oral Fixation: Pica, Journal Amer. Acad, Child Psychiatry Y: 79, 1968. 5. Sobel, R.:/Psychiatric Implications of Accidental Poisoning in Childhood In Pediatric Clinics of North America, Coleman, A. D. and Alpert, J.J. Eds. Vol. 17 No. 3, August 1970 , W. B. Saunders Co., Philadelphia pp. 653-686. or 6. Neumann, H. H.: Pica - Symptom fear Vestigial Instinct? Read Pediatrics 46: 441, 1970. 7. Roland, R. A. National Paint and Varnish Lacquer Association, Washington, D.C. Personal Communication. 8. Lin-Fu, J. S, Lead Poisoning in Children, N.S. Dept, of Health, Education, 452 - 1967 and Welfare, Social Service, Children's Bureau Publ. No, dSRsskS&X (U.S. Gov't Printing Office, Wash., D.C, 20402), 9. Lin-Fu, J, S. Children 1Y: 2, 1970. 10. Schuker, G. W., Vail, E. H., Kelley, E. B,, Kaplto, E.: Prevention of Lead Paint Poisoning among Baltimore Children, Public Health Report (Washington) 80: 969, 1965, 11, Ingalls, T. H., Tiboni E. M., Werrin, M. Lead Poisoning in Philadelphia, 1955-1960, Archives Environmental Health. 3.:575, 1961. DUP050055826 Page iiS~ 12. Barltrop, I). and Killala, N.J.P : Factor a Influencing Exposure to Lead, Archives Disease in Childhood 44:476 1969. 13. Chisholm, J. J., Jr . and Harrison, H. E.: The Exposure of Children to Lead, Pediatrics 18:943. 1956. 14. Kehoe, R. A. Metabolism of Lead in Man in Health and Disease (Harben Lectures, 1960) J. Royal Institute Public Health and Hygiene 24;81, 101, 129, 177, 1961. 15. Chisholm, J. J., Jr. The Use of Chelating Agents in the Treatment of Acute and Chronic Lead Intoxication in Childhood. J. of Pediat. 73: 1, 1968. (phonetic) 16. Barry, P. S. I. Personal Communication Note here: Barry, P.S. I. and Mossman, D. M. if published will appear in the British Journal of Industrial Hygiene for October 1970. If it does not appear, carry as personal communication. 17. Bradley, J. E., Powell, A. E., Niermann, W., McGrady, K. R. and Kaplan, E. The Incidence of Abnormal Blood Levels of Lead in a Metropolitan Pediatric Clinic, J. of Pediat. 49:1, 1956. (phonetic) 18. Roth-child, Edmond Personal Communicaton - Note: Carry as personal communication until exact reference for publication shortly to appear is obtained. 19. Chisholm, J. J., Jr. and Kaplan, E. Lead Poisoning in Childhood - Comprehensive Management and Prevention. J. of Pediat. 73.: 942, 1968. 20. U.S. Public Health Service . Statement on Childhood Lead Poisoning for release November 1970 Scrappings 21. Kaplan, E, and Shaull, R.S.; Determination of Lead in Paint Scrapings as an Aid in the Control of Lead Paint Poisoning in Young Children, American J. Public Health 51:64, 1961. 22. Kneip, T. M., et al. Determination of Lead In Situ on Housing Surfaces Report, Report to the Health Research Council of New York City, 1970. DUP050055827 Chisolm - Chapter IB. Page i? v 23. Klein, M,, Hamer, R., Harpur, E. and Corbin, R. : Earthenware Containers as a Source of Fatal Lead Poisoning, Case Study and Public Health Considerations, New Eng, J. Med. 283: 669, 1970, HixxxSaKmEs: 24. Klein, M., Personal Communication 25, Williams, H., Schulze, W, H,, Rothchild, H. B., Brown, A, P. and Smith, F. R., Jr Lead Poisoning from the Burning of Battery Casings. J.A.M.A, 100:1485% 1933. 26. Laurer, G, R. safety, Kneip, P, .J,, Albert, R, E., Pasternak, B. S. and Kent, F. In Situ Determination of Lead on Painted Surfaces for the Prevention of Childhood Lead Poisoning, Presented at the Symposium on Application of Low Energy X and Gamma Ray Emitting Isotopes. Boston, June, 1970 - Proceedings of the symposium, in press. A. Gillet, A. A. An Outbreak of Lead Poisoning in the Canklow district of Rotherham, Lancet 1:1118, 1955. JL b . Travers, E., Rendle-Short, J. and Harvey, C. C.: The Rotherham-Lead-Poisoning Outbreak, Lancet 11:113, 1956. ... 28. Owen, C., Dodson, W. N., and Hammack, W. J. Medical Grand Rounds from the University of Alabama Medical Center, South. Med, Journal 60:44-50, 1967* DUP050055828 Bibliography Ball, G. V. and J. M. Morgan: Southern Medical J. 61:21, 1968, Alcohol, Tobacco and Fire Arms Division, Internal Revenue Service, Department of Treasury, U. S. Government. %t\, Enrione, R. E. Daqed, 1/20/70, Official File, Rm, 5-47, C. P. ,.NAPCA, Cincinnatti, Ohio. Licensed Beverage Industries, Inc. Pamphlet on Moonshine, 1968, Morgan, J. 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