Document MMxLyN8vba4gB0RXvB122aLrV

T h e J o u r n a l of the -<. in .1 1111*xi\ nK*nt .\ IUT i lliri'c it' f i l l ICS urine. m| Ihe cm mi 117.?. ' Avita- 1*. I1VO. n t r II. tumor They al cells ;c other :<santly y really ieration Where te is to :iy Men. % suits of A Ulcers M in era l '&. p. 1 1 8 0 . : ateros-'.*^>aticnts,;% .red his ^ remain-;? i c e s he Mils the W too far :jt s t a n c e s , :K In two and in cvealed;^ n elder ^ and 20. i 1nences 3,. Present 3 1153. iod T y p e / ,59` W*' loltke.-- r 'ib a lg in ).-^ istic.-- -i _ .ignated i j | here is, ^ - -eceptor'J f aggiu-7^ f n hlood [ i is not lutinins. American Medical Association P u b l i s h e d U n d e r i he A u s p i c e s of tire B o a r d of T r u s t e e s Vo*~ 1 0 4 , X u . 2 C ( ,h i c a ii . I 1. 1. i x n i s Ia n i 'a r v 12, 1` 5 E P I D E M I O L O C Y O F L E A D l '( )IS< >X I X < 1 A. J. LANZA, M.l). A *-i-im it Medical Director, M etropolitan I.iff Insui.iiio ( NEW YORK |.;t rt T h e u se o f lead is so w id e s p r e a d th r o u g h o u t all c iv i lized co u n tr ies that lead p o iso n in g c o n tin u es to he a m ailer of con cern to the ph ysician an d the public health official. A s n e w p r o c esse s are e v o lv e d in in d u stry a n d n e w m a t e r i a l s d e v i s e d f o r general c o n s u m p t i o n , s o d o e s lead p o iso n in g c o n tin u e to a p p e a r u n d e r n e w a n d s o m e tim es stran ge.circu m stan ces. F or cen turies the origins nf lead p o iso n in g , its n atu re, its v a ried fo r m s, the action nt L a d in the b o d v , the tr ea tm e n t a n d the p rev en tio n oi lead p o is o n in g h a v e all o c c u p ie d th e m e n nl scien ce a n d tile m e n o f iu d u s t r v a n d th e la st w o r d h a s n o t v et b e e n sunken. Lend poison in g m a y well he thou ght of as a cutim erpart o f syp h ilis n ot o n ly in d ie v a riety o f its effects m i th e h u m a n s y s t e m b u t in th e m a n n e r in w h ic h it m a y lie d o r m a n t a n d u n s u s p e c t e d in t h e t i s s u e s f o r y e a r s , apparently in n ocu ou s, until so m e alteration in the m e ta b o lic p r o c e s s e s lib e r a te s it w it h u n im p a ir e d v e n o m . . Like sy p h ilis, it is a c o n tr ib u tin g c a u se o f m a n y a d e a th fur w h ic h it d o e s liot r e c e iv e its r ig h tfu l sh a re o f th e M aine. I ead m a y gain entrance to the b od y through the re.-niratory sy s te m b y inhalation, th r o u g h the gastro niie-tinal sy stem b y ingestion, an d th rou gh the skin. L L dou btful w h eth er skin absorp tion o f inorganic lead ' "m p ound s e v er ta k es p lace e x c e p t w h e n the sk in is dam aged by inflam m ation or w ou n d . W hile cases have keen reported du e to the application of lead-containing m edication to u lcerated or d a m a g e d skin, this fo r m o f rm r y is o f little p ractical interest. O r g a n ic lead c o m P"uud.s, su ch a s tetra-eth yl lead, w ill p en etrate th e sk in ;i,|u t h e i r e m p l o y m e n t is g u a r d e d b y c a r e f u l l y d e v i s e d precautions. R ecently Fairhall an d H e i m 1 published the results their stu d y o f lead w eigh ted silk fabrics and fou n d 110 e v i d e n c e o f a b s o r p t i o n e v e n w h e n t h e f a b r i c w a s "urn n ext to the skin and u n d er ex trem e conditions of activity a n d perspiration . Inhalation and ingestion are the tw o routes by w hich rad g e ts in to th e s y s te m , a n d th e first is th e m o r e ""portant. M o st of the industrial e x p o su re arises fro m 'm^t a n d fu m e s th at a re b r e a th e d in to the lu n g s a n d uppvr respiratory tract, w h ere absorption and excretion Uivulve en try into the sy stem ic circulation. L ea d that ;. A '*'"t lieforc the Section on Preventive ami Im lustrinl Medicine and Health at the Eighty-Fifth A nnual Session of the American " `.'"'`I A ssociation. Cleveland. Line 13. 1934. ; Fairhall. L. T ., anti H e im .'J. \Y \: J. ln d u st. Hyg. 1 4 :3 1 7 (N ov.) is in g e ste d m a y h e e x c r e te d u n c h a n g e d a n d , e v e n if a b s o r b e d , m a y h e c a r r ie d to th e liver a n d e x c r e te d in the bile." In the m a in , in d u strial p o iso n in g is d u e to inhalation an d nouiudustrial poison in g to ingestion, though there are, ot course, exceptions. W ater supplies conducted through lead pipes have been an im portant source ot co m m u n itv poisoning. In a stu d v ot 10 2 lea d -co n d u c te d w a te r su p p lies in N e w E ngland, 24 per cent oi 253 individuals exam in ed w ere tu m id to he le a d 'poison ed . This stu d v indicated that the greater the carbon dioxide content of the w ater, the m ore readilv lead w a s carried into solution. T h e auth ors ot this investigation conclu ded that the dailv in gestion oi 0.1 m g . o f lead o v e r a period oi eight a n d o n e - f o u r t h y e a r s c a u s e d p o i s o n i n g . :: I n t h e I h i l l e t i n o f t h e L 'n i t c d S t a l e s I 'u h li e H e a l t h S e r v i c e f o r |tilv 2 S . l l)3 2 . th e s ta te m e n t is m a d e th at " X o w a te r to h e u s e d lor drinking purposes should contain the equivalent of o tic -h a lf p a r t le a d p e r m illio n w a t e r . '' A n E n g l i s h s t u d v sh o w e d that the infant m ortality in an area e x p o se d to l e a d - c o n t a m i n a t e d w a t e r f e l l f r o m 134 t o 5 6 w h e n t h e w ater w a s treated to prevent the lead goin g into solu tion.' E p id em ics o f lead p o iso n in g fro m w ater su pplies have been reported from E ngland /' France." flerm an v ; and other countries. N u m e r o u s in stan ces h a v e b een rep orted both in this cou n try an d in E n g la n d o f lead p oison in g du e to h o m e ferm en tin g an d distilling of w ines, beers, ciders an d sim ilar b e v e r a g e s in u ten sils g la ze d w ith a lead c o m pou n d . A s w ith w ater, the acid content of these b ever ages causes the trouble: the resultant chem ical action lib e r a te s t h e le n d f r o m t h e g la z e a n d it g o e s in to s o lu t io n in the beverage.' O th er interesting anti im portant epidem ics of p o iso n ing have occurred from tim e to tim e to hear w itness to the ubiquity of lead and to the strangeness of the cir c u m s t a n c e s u n d e r w h ic h it m a y m a n if e s t itself. A sc r ie s o f cases o f lead p oison in g w a s reported from .Austria in 1931. L ea d w a s u sed to cou n terb alan ce a grin d in g w h e e l in a flour m ill, w ith the result that the flour w a s im p reg n a ted w ith fine particles o f m etallic lead, p o iso n in g a n u m b e r o f people." T h e use of snuff has been identified w ith lead poisoning, the source of the lead b e i n g t h e m e t a l l i c f o i l i n w h i c h t h e s n u f f i s w r a p p e d . 1 "2345678910 2. Alii), J . C .; F airhall, L. T ., an d o thers: Medicine 4 : 1 (Feb.-M ay) 1925. 3. W right, \V\: Sappington, C. O., and R antoul, E .: J . In d n st. Ilyg. 1 0 :2 3 4 (S ept.) 1928. 4. M illigan, E rnest: Mrit. M. J. 2 : 2 2 2 (A ug. 1) 1931. Ingiesou: Action of W ater on Lead, Technical Paper No. 4, W ater Pollution Research, Dept. Sc. Ind. Res., London, His M ajesty's Stationery Office, i 934. 5. U niversity of Aberdeen Report, Lancet, December 1933. 6. Thouvenet, cited in Chronic Poisoning from W ater in Lead Pipes, P aris letter, J . A. M. A. 9 7 : 6 5 4 (A ug. 29) 1931. 7. K ruse and Fischer: Hull. Hvg. G :7 4 (J a n .) 1931. ' 8. Willcox, R. L.: Brit. M .* J. 2 : 2 22 (A ug. 1) 1931. W right, Sappington and Rantoul.'* 9. Merger. W .; Studcny, 0 .. and Rosegger. F .: W ien. klin. W ehnsehr. ft.**: 58o ( May 6 ) 1932. 10. Brch, A. A.: Bull. Ilyg. (nbstr.) S : 679 (O ct.) 1933. 86 LEAD PO ISO N IN G -- LANZA Jour. A. M. .\ J an. 12. 1935 - O n e of the strangest occu rrences w a s lead poisoning in a n u m b e r o f B a ltim o re fam ilies ca u sed by the use o f d i s c a r d e d s t o r a g e b a t t e r y c a s e s f o r f u e l . 11 T h e r e w ere forty cases w ith several of severe encephalopathy a m o n g the children. A sim ilar in stan ce in N ash ville, T e n n . , i n v o l v e d f i v e f a m i l i e s a n d f o u r t e e n c h i l d r e n . 12 O n e o f the m o st in terestin g o f all the ch a p ters on lea d p o iso n in g is that d e a lin g w ith o c u la r n eu ritis a m o n g children. In 1897 D r. L ockhart G ib son of Q ueen sland, A ustralia, published a pap er on this subject, referring t o t w o p r e v i o u s r e p o r t s i n 1 8 9 2 . 1 3 14 D r . G i b s o n f o l l o w e d u p this subject for forty years, reporting cases and en d eavorin g to trace the sou rce of infection. T h e g e n eral conclusion w as that the Q ueen slan d cases w ere due to lead paint on veran das and railings w h ere the children p la y ed .1* R ecen tly sim ilar cases h a v e been describ ed in th is c o u n t r y .13* I n J a p a n , t h e u s e o f le a d - c o n t a in in g toilet p o w d e rs has cau sed w id e sp re a d lead p oison in g i n b o t h i n f a n t s a n d m o t h e r s . 1,1 It is n o t p ossib le to d e scrib e o r e v e n to e n u m e r a te , in a p a p er o f this len gth , all the v a ried industrial p r o c e sse s in w h ic h lead is u s e d a n d th e c ir c u m s ta n c e s w h e r e in lea d p o is o n in g m a y arise. T h e ir n u m b e r is legion . U n fo r tu n a te ly , also, th ere is b u t little statistical in fo r m ation on the m ortality from lead poison in g and none w ith respect to m orbidity. In n o year since 1920 have there been as m a n y as 150 cases of death from lead p o iso n in g reported in the registration area o f the U n ite d States. In 1930 there w e r e 101 ca ses; in 1931, 111. H a l f o f t h e 1 9 3 0 p a t ie n t s w e r e p a in t e r s .17 T h e s e r e p o r ts are b a se d o n d e a th certificates, a n d th e r e is n o doubt that m a n y cases of lead poisoning are reported as nephritis or other organic diseases, w ith no m ention o f t h e u n d e r l y i n g c a u s e . T h e J o i n t O c c u p a t i o n S t u d y 13 (a life insurance u n d ertak in g) sh o w ed , for h ou se paint ers, on the basis of 6 1 ,0 0 0 life years, 2 4 9 actual deaths fr o m all causes, w h ic h w a s 2 2 p er cen t in e x c e ss o f the exp ected . T h is excess w a s reck on ed on the basis of ordinary policyholders, corrected for age grou p s and se x . A s id e fr o m th is m e a g e r in fo r m a tio n , th e r e is little w orth recording. T h e follow ing su m m a r y refers to the m ain classifica tion o f in d u str ie s a n d p r o c e s se s in w h ic h leatl is a hazard: 1. Lead mining when lead is in the form of soluble carbon ates or other soluble salts. It is doubtful whether any appre ciable amount of lead poisoning occurs when the ore is galena (lead sulphide). 2. Lead smelting and refining. 3. Handling and fabrication of metallic lead: (a) Manufacturing of lead articles of all kinds (poison ing due to formation of lead oxide on surface of metallic lead). ( b) Handling metallic lead in hot processes, lead burning, soldering, lead tempering, plumbing. (f) Brass and other founding in which lead is used. Id) Bulling and polishing metallic surfaces in which lead is an ingredient. 11. Williams. IIuntington; Schulze, W. I!.; Rothschild. II. I*.; Hiowti. A. S., and Smith. F. K., Jr.: Lead Poisoning from the Homing of Kattery Casings. J. A. M. A. 1 0 0 : 14S5 (May 1.1) 19J3. 12. Crutcher. J. S. Jr.: J. Tennessee M. A. 2<:20 (Jan.) 1933. 13. (lihson, I. I..: Australian M. (la/... Oet. 20. 1S97; M. J. Australia 2 : 201 (Sept. X) 191". and 1: April 1. 1922. 14. (lihson. J. I..: Itritish J. Mphth. 15 : (.37 (Nov.) 1931. 15. Vogt. K. (.!.: Kurntyenolngit: Diagnosis of Lead I'nisoning in Iniants and Childien, .1. A. M. A. J).S: 125 ( Ian. 9) 1*>32. McKhanu. F.: Lead I'msnning in Children, Am. I. |)i>. Child. *12: 3X0 (Sept.) |92*. Metropolitan Life Insurance Company, statistical bulletin, vol. 11, No. ID. I(t. Kato. Katsuji: Lead Meningitis in Infants. Am. J. Lis. Child. It: 5<i' (Sept.) 1932. 17. Ilolfm.an: Lead Poisoning Legislation and Statistics. Newark. N. J . Prudential Press, l'U.L IN. Joint Oempatiou Study. 192X (Actuarial Society of American and Association of Life Insurance Medical I>irectors). L Manufacture of lead salts and compounds, especially lead oxide by Dutch method. Carter method, and other methods; lead pigments; organic lead compounds. 5. Manufacturing processes in which lead compounds are used. Those are extremely numerous; among the important ones are the storage battery industry, paint industry, glass industry, rubber compounding and chemical industry. 6. Application and removal of lead-containing paints, enamels and glazes. Painting, spray painting, vitreous enameling, pottery dipping, sandpapering, scraping and chipping painted surfaces flame cutting of painted metal; tree spraying with leadcontaining insecticides. 7. Typographic trades : type founding, electrotyping, stereo typing. It m a y lie sa id th a t in th o s e in d u s tr ie s in w h ic h lead p la y s a m a jo r part th e h a z a r d is fairly w ell con trolled , a n d it is - e x c e p t io n a l n o w a d a y s to s e e c a s e s o f a c u te poison in g w ith colic a n d w rist d rop in the sm elters and establishm ents w h ere lead oxide, paints and storage b atteries are m a n u fa c tu r e d . T h e r e is still in th e se in d u s tries a considerable a m o u n t of m ild lead poison in g, m uch o f w h ic h e s c a p e s d ia g n o s is b e c a u s e it is m ild . In d i vidual carelessness a n d b reak s in the discipline o f su p er vision d o occur, an d fam iliarity b reed s c o n te m p t in the d an gerou s trades as elsew here. M u c h credit, h ow ever, is d u e the lead indu stries for the p erfection o f a technic o f p rev en tio n a n d su p e r v isio n , w h ic h is, in th e -m a in , effective. W h e n o n e c o m e s a c ro ss a n o u tb r e a k o f lead p o i s o n i n g it is u s u a l l y in a n e s t a b l i s h m e n t in w h i c h a lead p rocess is b u t o n e ste p in th e p lan o f m a n u fa ctu re , a s it is u n d e r s u c h c i r c u m s t a n c e s t h a t t h e h a z a r d is v ip t t o b e u n d e r e s t i m a t e d o r i g n o r e d . M o r e o v e r , it is not u n c o m m o n to see lead p oison in g a m o n g industrial w o r k e r s not e n g a g e d in h a n d lin g lead but w h o , through n eg lig e n c e , a re e x p o s e ^ to d u st or f u m e s fr o m lead processes not properly isolated or oth erw ise protected. S o m e tim e a go I h ad occasion to visit a plant w here o n e process consisted in sold erin g b rass strips. T hese strips w ere a ssem b le d b y girls w o r k in g at lon g tablea n d p a s se d to th e m a n at o n e e n d o f th e table, w h o did the sold erin g. T h e p r e v a ilin g air c u r r e n ts ca rried the fu m e s fr o m th e lead p o t a lo n g th e table, a ffe ctin g the g ir ls , w h i l e t h e s o l d e r e r e s c a p e d a n y ill e ffe c t. S o m e of these lead p oison in g cases w ill cau se the m edical S h erlo ck H o lm e s to e x ert his best faculties in detecting the source of contam ination. A notable exam p le wac o n t r i b u t e d b y D r . L e a t h e r s o f N a s h v i l l e , T e n n . 1,1 h' this instance, in the v itreo u s e n a m e lin g o f dom estic h e a t e r s , a l e a d - f r e e p i g m e n t w a s u s e d . A n u m b e r 01 acu te cases o f lead p o iso n in g d e v e lo p ed , in clu d in g indi viduals not associated w ith the enam eling process, k fin a llv d e v e l o p e d t h a t t h e r e w a s l e a d in t h e g l a s s frit u sed in m a k in g th e e n a m e l. A s this h a d n o t b een real ized. no precautions w ere taken. N u m e r o u s cases lead poison in g h ave been rep orted d u e to cutting meta co a ted w ith lead p ain t, w ith th e o x y a c e ty le n e flame e sp e c ia lly in th e h o ld s o l n a v a l v e sse ls a n d sim ila r cm ; fined sp aces. H e r e a g a in the p o is o n in g w a s not liinitc1 to the m en actually d o in g the cutting.-" A great deal o f effort h as b een e x p e n d e d in en d eavor in g to ascertain the a m o u n t o f lead p resen t in o K atm osphere under varyin g conditions and the m ininum d osage that will cau se lead p oison in g. B loom licl'l rep orted that in a n u m b e r ol in d u strial esta b lish m en t lie fo u n d 0 .1 0 m g . ol lead to 10 c u b ic m e te r s ol at^ 19. Leather**. \V. S.. ami Morgan, IT. J.: The Study nt Lend I'"'10- img in an Knainding Riant. J. A. M. A. SO: 1107 (Oct. 1) 1927. . 20. Stitt: l', S. Navy M. Hull., April 1912. Brown, K. A.. IndtiM. Ilvg. M: 113 (March) I92n. . 21. ItliM.intidd. I. L. and Ishrll. II. S.: I. Indust. Ilvg. 15: 1* ' 193 L t .H ft fa th ra far fcfw ;tr- nhj Of n U.; :-*rx .'i **fit. n 'Au . > A|* . A. M. A. s . 13'. 1 9 3 5 . ^ -ially lead | | methods; a o u n < lis u r e i4g-5;i important.^? ary. glass t j is, enamels'^ :tg, puUery|| 1 surfaces jiff vitli lead^s ig. stereo-35 hich lead^ ontrolledjS of acute smeltersj id storage^ esc indusA ing, much Id. Iudg of super| npt in howeve ... a technid the main| ak of lead in whic _ nufactur hazard '.i| over, it IS industrial o, through from .leM protects iant whe os. T h | ong tabig e; whdJjT :arried ff fectingrt|| ct. SoM, ie mediral -. detecting ample wa3 'enn.* 'K f domestKg number ; a | uding inqg .rocess. t glass fn| : been re is cases'io| tting m<|![ lene fla ;imilar,X not limi n endeaji ;entjtii>| .e-inlnir lloomfiel ablishme ters' of~aj f Lead .Pi 1) 1927.v ,n. E. W .^ 1 5 : 144 NV Vo Mu - f*' -' UH LEAD IN TH E R O D Y-- AU B 87 -m to in o b ile rep a ir sh o p s, 0 .1 3 m g ., a n d in street air. this v iew B r o o k s - a g r ee d , h u t M a x w e ll a n d B isch olT (>()) m g . to 1 0 c u b ic m e t e r s . G r e e n b u r g J- h a s r e p o r te d a n d r e c e n tly K c h o e a n d T l u i m a n n J h a v e o b je c te d , . I ,nsr o f lea d d a ily fo r tw o a n d o n e -h a lf y ea rs largely o n the basis that lead in the b lo o d str e a m reacts jn i caused p o i s o n i n g . T e l e k y sta te s th a t 1 m g . o f ',-u ! d a i l v f o r s e v e r a l m o n t h s a n d L e t ::e a n d G o a d b v -* 1 ' ` ( l r l 't 2 m g . d a i l y f o r s e v e r a l y e a r s w i l l c a u s e l e a d m ore w ith red blood cells than does the phosphate. M a x w e l l a n d B i s c h o f f 1 h a v e p r o d u c e d s o m e e v i d e n c e that lead , w h e n in je c te d in tr a v e n o u sly , is ca rried as a w n sotm i'c ~ W h ile these figures m a y seem to vary con 'd -ra h lv it is tr u e th a t le a d in th e f o r m o f v a p o r is m ore* d an gerou s than as dust, and the circum stances under w h i c h th e f o r e g o i n g e s t im a t e s w e r e d e t e r m i n e d ' w e r e n o t id e n tica l. C e r ta in ly it m a y h e c o n c lu d e d th a t fj:ij|v d o s a g e o f f r o m 1 .5 t o 2 m g . is d i s t i n c t l y h a z a r d - m is a n d ev en tu a lly w ill ca u se p oison in g in m ost, if not all in d iv id u a ls . I n th is c o n n e c t io n it s h o u ld b e n o t e d (h.-i: w ! i i n l e a d is in a m o l t e n c o n d i t i o n f u m e s w ill b e ..jv r:, u p ' ; t h e h i g h e r t h e t e m p e r a t u r e , t h e m o r e f u m e s ; a L o inside w ill fo r m on the surface and get into the air as dust. C O N C L U S IO N 4 It m a y b e stated that lead; p o iso n in g isw e r y prevalent, though m o s t o f i t i s m i l d . H o w e v e r , b o t h m i l d a n d occasionally severe cases are com m on ly not recognized. M a n v cases are d iagn osed as chronic appendicitis and e v e n a s g a llb la d d e r d ise a se , w ith all to o fr e q u e n t su r gical intervention. In con n ection w ith industrial h ygien e studies, insu ran ce c o m p a n y records sh o w that, w ith d ip h o s p h o g ly c e r a te , w h ile J o w e t t 5 th in k s th a t it f o r m s a com p lex inorganic phosphate w ith calcium and chlo rine. In a chem ical sy stem as com p licated as blood plasm a, an equilibrium of several such chem ical c o m p o u n d s is n o t u n re a so n a b le. A n y o f th ese c o m p o u n d s m ig h t rem ain ionized a n d disp ersed in the p resen ce o f p l a s m a p r o te in s. B u t w h e t h e r it is tr a n s p o r te d a s a n in o r g a n ic o r o r g a n ic p h o s p h a te , it is o b v io u s th a t lea d in the blood stream can exert deleterious effects on b o d y cells. O f co u rse, s o m e a b so r b e d lead is p r o b a b ly e x c r e te d (partly in the urine but m o stly in the feces) w ith o u t e v er h a v in g b e e n stored. T h e r e is a g r o w in g a c c u m u lation of data obtained b y different chem ical technics that indicate a sm all daily lead excretion in the urine in the vast m ajority o f th e p eop le in this cou n try an d elsew here.4 T h e average result of these observations indicates a urinary excretion of lead of fro m 0.05 to 0.1 m g. daily in individuals w ith n o un u su al lead exposure. T h is urinary excretion represents lead that has been actually absorbed, but a large percentage of rcsju-ct to illnesses o f m o r e than seven d a y s' du ration the lead fo u n d in the feces has probab ly n ever even a m o n g w a g e earners, respiratory diseases greatly out been absorbed. B ecau se of su ch repeated observations n u m b e r g a str o -in te stin a l d ise a se s. W h e n th e ratio is it m u s t n o w b e a g r e e d th a t a q u alitative d e m o n s tr a tio n in v erted a n d o n e is c o n fr o n te d w ith a situation w h e r e in o f sm all qu antities o f lead in the excreta d o e s n o t the gastro-intestinal cases o u tn u m b er the respiratory necessarily signify abn orm al exposure. A cco rd in g to cases, the possibility o f lead poisoning should alw ays B arth,7 a very sm a ll-a m o u n t of lead m a y even be l>c c o n s i d e r e d . .. - " gradually accu m ulated in n orm al bon es du rin g advan c- V in g years (fr o m 0 .0 2 'm g.' fo u n d in in fan cy to 0.1 m g . THE BIO C H E M IC AL BEHAVIOR' OF-CW per 3 G m .-of,bone ash in the aged). - If larger quantities of lead are inhaled, sw allow ed L E A D IN T H E B O D Y, '. ' * >.. . o r i n j e c t e d , e x c r e t i o n d o e s h o t m a i n t a i n a n e q u i l i b r i u m ; '.' J O S E P H ' -C.; X'u b / ' BOSTON :-i if"I a n d l e a d b e c o m e s s t o r e d i i v B u t t h e e x t e n t o f p o 's s i b l e . ; ' ; storage can be ascertained best w h en a k n o w n quantity " 'Y y 'V '. ' o f l e a d i s i n j e c t e d i n t r a v e n o u s l y . M i l l e t , 3 K e h o e a n d In t h e la s t t e n y e a r s , a g r e a t d e a l o f w o r k h a s T h a m a n n , 9 a n d A u b a n d S m i t h w i c k 10 h a v e s h o w n t h a t a p p e a r e d b e a r in g o n th e b io c h e m is tr y of lead. T o c o m b u t little o f .this is e x c r e te d p ro m p tly . F o r e x a m p le , bine this n e w k n o w led g e w ith that su m m arized in a p r e v io u s p u b lic a tio n 1 is m y p u r p o s e in this article. In r e g a r d to a b s o r p tio n th e r e is little im p o r ta n t n e w evidence. T h e exp erien ce in industry confirm s ..w hat h a s b e e n f o u n d in t h e l a b o r a t o r y 1-- th at lea d w h i c h is the average of six of our cases, studied for forty-six days du rin g the injection period, sh ow ed that only 69 m g. of lead w a s excreted in both the urine and the feces, alth ou gh 4 7 3 m g. o f lead as colloidal p h osp h ate w as injected intravenously. . - ' T `V in h a le d is fa r m o r e to x ic th a n lead w h ic h is sw a llo w e d . D f c o u r se , it is lik e w ise g e n e ra lly c o n c e d e d that in g ested lead is a h azard . D ie fo r m in w h ic h lead is tran sp orted in th e' b lood strea m is o f practical a s w ell a s scientific interest, as 2. Brooks, John: The Interaction of a Finely Divided Lead Suspen sion with Blood Serum , R inger Solution and Aqueous Phosphate Solution, Biochem. J . 2 1 : 766, 1927. 3. Maxwell, L. C., and Bischoff, F ritz : The Reaction of Lead with the Constituents of the Erythrocytes, J . Pharmacol. & Exper. Therap. 3 7 :4 1 3 (D ec.) 1929. ... . r . 4. Kehoe, R. A ., and Tham ann, Frederick: The Behavior of Lead in 4 '^ :the Animal Organism: I I L ^Colloidal-Lead Compounds, J. Lab. & Clin. i t h a s a b e a r i n g i n g u i d i n g i n t e l l i g e n t t h e r a p y . . T h e M e l _ j f w ( 8. M a u r i ^ lead'com pouod* with Scrum .. 1 n cn iS , 2.S . w e l l . a s x L -i. Li -j , -r *' -- * i" r r ' - i o u r b l o o d s t u d i e s w i t h . i v e z n i k o f f r 1. i ___j ,- L .__ l * < : , ^ - r i " - ' . frbnr.the.^*^. .W ales, for *me year, enaea jis i-u e c a n o e r a o t o c , a . j \ , ; JLagar, G rah am ;_ > Thamann, F rederick,'and S anders,-L ester'j-^T he Excretion of Lead by N orm al P e rso n s.' T. .A. ML A / 8 7 * 2081_-^Dec..:18) 1926." F retw u rst. F z 'L-i rL3Xraxikhdtodns<;]|^nungcn.F. sowie^vseine ^ d ia g n o stisc h c r^ ^ ::' -'Bedeutung, .'Arch'^f.-' Gewerbepatb.:`iuV>':Gewcrbehyg. "42 74/-1932. ' Kehoe, v-' 7'? 7 22. C re en h u rg , I ..; ^ h a y e .^ A r r lA L a n d "ShlionA r; ,flT > K b '." H e 2 ith ' 4 4 : 1666, (J u ly ,12) R obert; Thamann," Frederick, and Cholak,-Jacob: .' On the N orm al Absorp-.' tion and Excretion of L e a d :- IiVLead "Absorption: and Excretion in Prim i- l - , 23. Teleky, L .: A rch.: f; Gewerbepath. u. Gewerbehyg;-5 rl32-137, 1933. tive L ife ,'J . Indust. Hyg. -15": 257/(S ept.) 1933. "{ - -V ry yi *j an d G oadby: Lea'd Poisoning an d Lead'A bsorption, London, A rn o ld ; N ew Y ork, L ongm ans G reen & Co^J 1912.T*.?'-'i .j ` ' t> } ,.ca<* before the Section on P rev e n tiv e a n d Industrial..M edicine and \ i '\.lc . H ealth a t th e E ig h ty -F ifth A nnual Session of the American 01`cal A ssociation, C leveland, J u n e 13, .1934. ;.. . . . .. J ,, ; A ub. J; C .; F a irh a ll, L . T .; M inot, A nne S., and Reznikoff, P a u l: *I'orn*pa1nyois7o-n. in1g9.26M. edicine M onographs, Baltimore, W illiams & Wvi.lkins 7. B arth, E .: - Investigation 'o f the Lead Content of H um an >,Bones, Virchows A rch. f . path. A nat. 2 8 1 : 146, 1931. ' .. 8. M illet,. H .: The Excretion-"b f :Lead in U rine, J . Biol. Chem. . 8 3 : 265 (A ug.) 1929. r . . " a "' 9. Kehoe, R. A. r and Thamann, Frederick: The.B ehavior of Lead in the Animal O rganism : II . Tetra-Ethyl Lead, Am. J. Hyg. 1 3 :4 7 8 (M arch) 1931; footnote 4. ~ , 10. Aub. J. C., and Smithwick, R. H .: : Lead T reatm ent of Cancer, New England J . Med. 2 0 8 : 310 (Feb. 9) 1933, c.... -- -.-a' . ' .h