Document KJG7oYVNEJB5vQnmaZJaqMN4X

February 1 4 , 1951 D r. R o b e rt H. K o t t e 1710 Madison Road C in c in n a ti, Ohio Dear Doctor K otte r I am s e n d in g you h e r e w i t h some d a t a e x t r a c t e d from our : c o o rd s gath ere d over the y e a r s , b egin n in g w ith 1928 and running tm ough 1950- The in fo r m a tio n is not as complete as I would l i k e , but i t would t a k e a g r e a t d e a l o f tim e and stu d y to comb th e a d d i t i o n a l in fo r m a tio n in a p r e c i s e manner. I have not bad anybody who has had the tim e to go b a c k to the h o s p i t a l r e c o r d s and d i g up the d e t a i l e d i n f o r m a t i o n - V h a t we have a r e the n o te s p r o v id e d l o r us by p h y s i c i a n s , members o f the r e s id e n t and house s t a f f o f the s e v e r a l h o s p i t a l s i n v o l v e d , p l u s n o t a t i o n s made by one or th e o t h e r o f us in t e le p h o n e c o n v e r s a t i o n s . As you lo o k o v e r th e s e d a ta you w i l l be 8 t r u c k by the f a c t t h a t t h e r e have been a number o f y e a r s t h a t have y i e l d e d no c a s e s and no i n f o r r s a tio n . For obvious re a so n s I sh o u ld not want to be quoted too e x t e n s iv e ly in th is re g a rd , 'out I th in k there i s very l i t t l e question as to vhat is the answer. By reason o f the changes in the personnel of h o sp ita l sta ff*, th is problem has r e c e i v e d much, l i t t l e o r no a t t e n t i o n from y e a r to y e a r . You w i l l n o t e , f o r e x a m p le . In the y e a r s f r o n 1941 t o 1945 we li&d o n ly one ca se r e p o rte d to us or brought to our a t t e n t i o n . There i s ve ry l i t t l e q u e s t i o n i n my mind t h a t t h i s was th e r e s u l t o f p r e o c c u p a t i o n w i t h o t h e r m a t t e r s d u r i n g t h i s p e r i o d . In l a t e r y e a r s we had t h r e e c a s e s in 1 9 4 3 , s i x i n 1949 and t w e lv e i n 19 5 0 . One m ight draw the c o n c lu s io n th a t t h e r e has been an in c r e a s e i n the number o f su ch c a s e s i n the p o p u l a t i o n . T h i s , I doubt v e ry much. The same cau ses which were a c t iv e in b r in g in g about cases in 1950 were c e r t a i n l y a c t i v e in the p r e v io u s y e a r s . There i s n o th in g r e a l l y new in the s i t u a t i o n . I t o n ly i l l u s t r a t e s th e f a c t t h a t when the d o c t o r s in the community are on the a l e r t , and are lo okin g f o r cases o f a c e r t a i n t y p e , t h e y may w e l l be fo u n d . The h is t o r y o f p ic a w hich runs throughout th is s e r ie s of ca se s i s , i n my m in d , n o t t o b e ta k e n too s e r i o u s l y . Anyone who has r e a d any of the l i t e r a t u r e on t h is s u b je c t in r e la t io n to c h ild r e n , w i l l r e a liz e that p ica is spoken of reg u la rly as^part of the background. Thus r e fe r e n c e to t h i s i s very l i k e l y to be'made in the i i i s t o r y , w ith o u t v e r y much comment a s to I t s d e g r e e . A f t e r a l l th e r e l e v a n c e of this h istory is a matter of degree only, since p ra c tic a lly a l l c h i l d r e n p u t t h e i r hands and e v e r y t h i n g e l s e t h e y can f i n d i n t h e i r mouths d u rin g c e r t a i n p e rio d s in t h e i r eariy l i f e . The problem , t h e r e f o r e , i s not so much th a t th e s e c h ild r e n chew t h i n g s , b u t th a t there are things in th o ir immediate environment which o ff e r oppor tu n itie s to y ie ld considerabie q u an tities of lead . A c a re fu l study g 00825 D r. R ob ert X o t t e - (P) - F eb ru a ry 1 4 , 1951 o f the h i s t o r i e s o f t h e s e c h i l d r e n m ight g i v e some u s e f u l i n f o r m a t i o n . The above i s p a r t i c u l a r l y t r u e v i t h r e f e r e n c e to the s p e c i f i c so u rces of le a d a b s o r p t i o n . A l l to o f r e q u e n t l y no a t t e m p t i s made t o examine c a re fu lly in to the household of the c h ild to fin d the exact source o f n is l e a d i n t a k e . Most c f th e h o s p i t a l r e c o r d s make a ssu m p tio n s on th is point w ithout g iv in g the p recise inform ation that is n ecessary. We nave here p r e c i s e l y th e problem t h a t o c c u r s i n i n d u s t r y . U n le ss one goes to the s o u r c e o f th e a c c i d e n t or i n j u r y , he does n o t know t r e c i s e l y vn a t h a p p en ed . T h e r e f o r e , I am q u i t e su re Th a `. i n t h is mat -.<=!' vc a r c leaking g u e s s e s , w hich may be a p p r o x im a t e l y c o r r e c t in a f a i r number o f c a s e s , t u t w h ich i n the s p e c i f i c in s t a n c e a re b ased on in ad equ ate in f o r m a t io n . I tru st that th is in fo rm a tio n w i l l be of use to you, and c e r t a i n ly i f I can be of any a s s i s t a n c e to yo ur com m ittee, p l e a s e do not h e s i t a t e t o c a l l upon me. I am p a r t i c u l a r l y I n t e r e s t e d in s e e i n g to i t t h a t die b o o k l e t th a t i s i s s u e d has v i s e and p r a c t i c a l in fo r m a tio n w hich can re a d ily be follow ed in the household. Wi th k in d e st r e g a r d s , Sincerely yours, RAX e f Enc . R o b e rt A. K e h o e , M. D. ^ 00826 Year 1928 1951 1932 1933 193* 1935 1936 1937 1938 1939 1940 1943 1945 19*7 1948 1949 1950 Cases of Lead Poisoning in C h ild ren Recorded by Tne K e tte r in g L ab orato ry by Years (Ho c a s e s r e c o r d e d d u r in g th e y e a r s o m itte d ) Number o f C ases 2 1 1 1 4 5 2 4 3 5 5 1 2 2 3 6 12 Number o f F a t a l i t i e s 1 1 1 2 1 1 1 1 1 3 4 Confirmed by Analir t ic a l Data On B lo o d and (bn T i s s u e Urine 2 1 1 1 31 32 2 4 3 5 5 1 11 11 3 53 84 A ll Years 59 IT 47 14 Comments 1 . The h i s t o r i e s o f exposure as su p p lied v e re i l l d e fin ed in most i n s t a n c e s . The f u l l ca se r e c o r d s may have b e e n more i n f o r m a t i v e . These vere not in v e s tig a te d at th is tim e. Paint from to y s , fu rn itu re , woodwork in h o u se , p o rch r a i l i n g s and u n s p e c if ie d so u rce s was in crim in ated sometimes by im p lica tio n o n ly , in 16 cases; b a tte r y casings used as household fu e l vere im plicated in 2 cases; m eta llic le a d to y s were In v o lv e d in 2 i n s t a n c e s , one o f w hich was f a t a l , and a le a d n ip p le s h i e l d was c o n v ic te d in 1 c a s e . 2 . P i c a was a l l e g e d as a f a c t o r i n 22 c a s e s . 3* T hree o f t h i s s e r i e s o f c a s e s o c c u r r e d a t c o n s i d e r a b l e d i s t a n c e s from C in c in n a ti ( P h ila d e lp h ia , L o u is v ille and C in c in n a t i) , the remainder being from C incinnati or i t s environs . forth Street fork 1 3 * h*. Y. COPY The C ity o f New York DEPARTMENT OF HEALTH August 2U j 195h T e l. WOrth 2-6900 i t . \1. SLOCUM Raynolds Co. jey & Rutherford S tr e e ts 5 , New J ersey jp'At i t s m eeting in May, 195^ the Board o f H ealth o f the C ity o f New York flk at a d r a ft o f a proposed Sanitary Code change be subm itted to i t in Qtlon w ith p a in ts and co a tin g s co n ta in in g e x c e s s iv e amounts o f le a d and ftiould in d ic a te to th e u ser th a t th e m a teria l i s hazardous when chewed Ldren. The fo llo w in g proposed s e c t io n on t h is su b jec t w i l l be p resen ted Joard o f H ealth f o r adoption by i t as i t s coming meeting in September: S e c tio n o f the S an itary Code: "No person s h a ll have, keep or o ffe r fo r s a le in the C ity o f Hew York any liq u id coating m aterial or p aint which contains le a d compounds o f which the le a d con ten t (c a lc u la te d as Pb) i s in excess o f 1 of the to ta l weight of the contained s o lid s in clu d in g pigments and dryer u n less i t b ears the fo llo w in g statem ent c le a r ly and con sp icu o u sly p la ced on the co n ta in er or la b e l "Warning: This p ain t co n ta in s le a d - u n safe - poisonous - and should not be used to paint childrens toys or furniture or in te r io r su rfa ces in dw elling u n its which might be chewed by c h ild r e n ." Lease note th at th ere i s no c o n f li c t between t h is proposed la b e lin g int and th e American Standards A sso c ia tio n Z66.1 Subcommittee p rop osal, ^recommendation o f t h is group r e la t e s to p a in ts which conform to the Standard. The above proposed S anitary Code la b e lin g , you w i l l n o te, |ed to th o se p a in ts and c o a tin g s v/hich do not conform to the standard. W would be required to bear the Board o f H ealth warning la b e l. jinform ation is sent to you in order to g ive you an opportunity ^ our view point on th is..p rop osal before i t is considered by the ^ I t h . P le a se submit any comments b efo re September 9, 195^* Very tr u ly yours, Signed - JEROME TRICHTER A ssista n t Commissioner Environmental San itation EFI (100884