Document O1K7VRZYyzNznDZvrLQyOVxdK

" . 1 LEAD INDUSTRIES ASSOCIATION OO tA*T ASM* STRICT NXW YORK IT, ft T. . fun* 2b, 1S$9 LEAD fflBim sad sx/wrKjmnr ToTTD-------------- to the Meetan at the Lead Industrie* AaaoelaUont two quit* disparate aocloaure* o o m to you with this bullatla. *A LOriSR LOOKS it PLOdST . _ Kotable anenf tha eddraaae* dallrered at oar 1959 Annual Meotlac wa* that with tha aboro titla by lhaodora C. Vatera, Eaq., an attorn*/ with wlda experience In lndurtriAl liability practlea. In this, Kr. Veters sought to point oat tb* obllcation* to thalr wortctrs and to tbs public,la tarws of haalth and safety, lapoaad oo employers by fadaral, atata end _ nnlclpal atatutas, and tha potential ooata lnrolred la neglect of thalr ` provision*. It *111 boar careful reading* ` ' ,,y . ' ie a s Fosaran n cnunvi d u c k o b t x s csmaii* ...................... tboufb a problaai of only ladlroet oooaaqueao* to iuny of oar awbera, load polaonlnf In children la a aourc* of nor* adrara* publicity to our lnduatrlaa than or* all other fonu of ploafclsn eoafclned. Baring found that tha diagnosis of such oases was often oa a nost laaoenrato basis, resulting la frequent falsa allocations of lead poisoning, oar orfanlsatlon recently taarad up with tha Rational Paint, Tarnish sod Lacquer Association to aacur* tha creation of a radical oonnlttaa whoa# actlvltlaa her* born* fruit In tha isauanc* of our aocond enclosure by the 0.3. Public Health Sarrlcs, It la hoped that the** criteria will hara central acceptance throughout tb* oountry. Harft:rad Bowditch Director of Haaltb and Safety LEAD INDUSTRIES ASSOCIATION M (AIT *tmm OTStST NSW YOMC 17, M.T. 'i a mm maa a t ranciato , , . w----momm^ ------ - * -. V 1 Thsodoro C, Vatora blM 4 fltookbrldf* In addroaslnc sysslf to tba axsoutlroa of your Association X wish to call y'W ottontloo to two phuu of potontlal local llabU- ' . lty of aai*cBifit - (1) tho liability to oaployeoo who nay bo oapoood . to tbo baaard rf pluabloa durlnc tho course of oporotlrwo, and (2) tbs liability of aonbor eoapanios to tbo conotmlnf pcbllo la aatsrlalo . that aro aold cootainlnc load, ' - .; ; _ . . , ' 1 . In tblo onllchtonod no X do art bailors It la noooaoary to labor ; >>; , tbo roapocolblllty of aanacsaint In tbo two eatocorloa to ablob X hawa Just raforrod. Too aro awaro of year rospritlblllty to glra to ymr ^ onployoos a aafo plaoo In wMoh to work and oafs toda with which to work] eortolnly with rsapoct to tbo conauadne public yoo aro oharfod v _ ' with tbo responsibility that tbo aatsrlalo which you prodaoo and " aarkot oontaln toxlo oabotaaeos. fr<s tho standpoint of tbo lston- - . tlon of aanajsusnt, you rocofnlto year obligation and tbo lndoatrya - obllcstloa to protoot tho oonaualnf public trm any potontlal daaafo . that say rsrult trm tho uoo cf ymr products. Tor tbo orderly pro- aontatlon of *y subjsot, X haro broken It down Into tbo olassifloa- tlor.a Just aontlonod, and trust that ay rosaries nay bo of lntorsst * Prsssntsd at tho 31at Annual Msstlnc of tho toad Industries Aasoclatlon, Chlcaso, 111.. April 2-21. 1959 ; t . o. unn -z- a urat l o c k s a t mooisM and uiliUnci to you in tha conduct ot your operatloni. FIRST. The liability to aeploreae who ay bo expoeed to the hawd of plicblam durlr-a the courae of operatl<-na. Coopenaetlon lawa in new iflMllw In all at* at of the union, to gether with all our tarrltorlaa and federal Jurledietlma, They ara the reeult of aoelal Mad to remora fro* tba field of eoamon law 11tlCation dlaputea arialng between employer? and employees with raapaot to Industrial lnjuriaa arialnc out of and In tha couria of aaplaywast. Thay iwpoee upon tha oaployara tha liability of an lnaurer for thcaa injuriaa nada ccapanathla under tha rurloua statutes and aaaura to tha Injured workman a method fpr tha prompt datamlnation of hit elala for Injury *th an lnaurad obllgatlTi for tha payment of that liability. Tba law* rf our rupeetiro atataa ara not uniform; thay differ ,, with raapaot to corerace, requirements rt Inaurar.ee, lnjuriaa cpeo able, haMflta payable, and adtinietratlvw agencies to which la a> aimed tha adalnlatratlon of tha lawa, Howerer, thalr baalo purpooa la almilar and with raapaot to tha Injury ao easpenaeble, thay provide tha exclualee remedy of tha mployee for compensation for auoh Injury. Slnoo their original anaotMnt, thaaa lawa hare been repeatedly mended and aaoh legielatlre year eouatlaaa Mila are Introduced Into our retpeotire legislatures for tha purpoaa of effeotli* aueh aaendmanta. Tha canaral tenor and trend of auoh legislation la to llbarallta tha lawa extending thalr banafita, lncraaalnc an employtr'a liability not only with roapaot to Brnatary paynocta, but with raapaot to tha oonoapt of the lnjuriaa nada eocpenaabla under tha atatutaa. For example, tha original purpoae aid objeotlre of thla laglalatlon . . r... -..r, . T. C. WATERS -3- A u*m l o o k s a t runBBK t u to provldo oou.wnaati n for trauaatlo Injuries, but by aaerxfcortt and Interpretation, w* nne find that benefits have boon axtaodod to eeeponeatlon for occupational diseases In *11 state* oxoopt two (1)*, Again, vo find dlfforonoo* with rospeet to tbo dloouo* that ro oodo eooponoabl# under too atatuUa. Hfhtooo outoo (2)o provldo *o-e*llod schedule coverage defining tbo tor* oecup*tl<'nal dlooooo" tgr apedflo reference to tbo dloouo coo onotblo u, for example, tho tom *lo*d . poisoning.1 2 Twenty-cine ototoa (3)*, tbo Clotriot of Colmbl* and federal Juriedietl'-na provldo so-eallod general coverage vblob make* ooaponoAblo any and *11 occupational dloouo* arising out of and la - tbo eouroo cf employment, * May Z dLroet my eoemant for a few mooenta to tho subject of tbo Imposition upon Industry for tbo pajmsnt of ooaponoatlon for all Indus trial injuria*, including occupational dlseuea, arising out cf and la tbo oouroo of seploymant. Z tauw that In thla enlightened i|t every uohor coopery of jrcur Association doolrea to provldo eoaponaatlon for any truly industrial Injury that your oaployou aay sustain. It is yrur responsibility aa ocployoro to provldo for your aaployooa a aafa fdaoo In which to work and aaft tools with whleh to work. Tour employ- mi aro justly demanding safe, sanitary and eloan working condition*. *J (1) Wsalaelppl and Wyoming. (2)* Alabama, Arlsona, C -1 orado, Georgia, Idaho, leva, Kansu, - Louisiana, Kid re, Montana, Bov Hampshire, Mow Mexico, Korth Carolina, Oklahoma, South Pakota, Tennessee, Texas, Vermont, ()) Alaska, Arkanou, California, Connootlcut, Doluaro, florid*, Illinois, Indiana, Kentucky, Maryland, Maasaohusotta, Hohl**r., Mlrr.esota, Missouri, llebruka, Nevada, Kov Jaraay. Maw fork, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Utah, Virginia, Washington, West Virginia, Wlaoor.aln, t .c .w at iw -U- a urns l o o k s it nwaisu Ho--y%r, tha purpoae of compensation statutes la to provide oajpenee- tloa for th'-ee injuries truly occupational In nature and not to aaka eoopenaebla tha 111a of ordinary lift unralatad to eopleynent, Hoo- rer, tba trand rf eoapsnsatlea legislation and declaims of oourta - and coatdsslma In oonatrulrg such ls* la to troat all Injuries arising out of and In the course of m jloysent aa being ooaponaabla ... ... . wbatber or wt they aro occasioned hy aeoldont and whether or not tba particular dlaaaao for whioh coapenoatlon la aought la oharaotarlatla ' of or pacullar to tha lnduati7 whoroia It arlaaa. In thia connection, Z lah to atraaa tba laportanco to jrvr Industry of tha rola of tha Industrial physician and engineer la effecting control of haaardoua - ' condition within jrur plants. Tlaa doaa not pamlt a dstallod dlaeuaaloa of tha progressive - legislative tranda increasing sonata17 benefits and liberalising legislative provisions prorldlnf ccRpeneatlon for injured workxen. Our jtnaral standard of living has aatarlalljr inproved, Tha coat of living la higher than artr before, n(M ara higher and industry will ^ bo not by tha continuing dssand of a okaaaan for labor to ralato nona- tary banaflta undar tha ecepensatlon aota to auoh lncrsasod sohadula of *g#e. Industry Bust adjust ltaalf to auoh reasonable deiandj and prlca its product to sake prorlalona for tha lncrtasad coat lneidant to tha payment of Industrial injuries. Z faal oartaln that no ona would disagree with tha gsnoral atata- nanta Just nade and lsaedlatsly thar* arlaaa tha question as to what, if anything, *n ba dona ty Eanageaent to affaot proper oontrola and protection for anployaaa against hatarda pacullar to your Industry, I y/.$ I p: r t .o . w at er s -5- a l at t er l o o ks at pl u o l w Thi* Li a Mttir tint 1# th* #ubJ*ot of tb* raipenelbllity that itM trm top Mnagentnt, She* a* th* top *xoutir* wfc- oonoro* hlntalf ldth th* health, welfare and protection of hi* aaploy** fra* lnduitrial InJurl**, and I will *bow you in industrial organisation wb*r* oo p*asa- tioa oo#t* r* At a siniKM resulting froa tb* prevention And ooctroi - of injuries, . - Zt It Aoaevhit *s*y for santgoMnt to Adopt slogan* for tb* aafety and promotion of *aploy**a, patting on to tubordlnAt** th* Job of *xa- cutlng auch program; but Z aay that th* r**perwibillty of sanagesont do*t not *od with th* presult*tiro of aueb plan*, but In carrying out thair axeoution, Theio of you wh- do to will find that tM* la toed buaintta, not only In aavlng yrura*lftht oeat of coapn*tlco, but in . winning th* eocfidanc*, r**p*ot and *ff*etlm of your *nJiloan* In ' '* dmonatratleg your ptraonal int*r*at in thair wslfar*. V_ Z h*T* rad* r*f*r*ne* to th* rol* of th* industrial phyaldan and th* angineer with r*:p*ot to th* control of httatdoua h**lth oonditlona , in your plant*. Th*ir *ff*ctiv* ua la th* ultimata answer to ecetpen**- tion coota and ce*p*naatioo problaa*. If you hat* woll-d*r*lop*d nodical and engineering ooctroi eathoda than th* eonp*naatlon eoata arising under the different atatotoa will boooe* sininun. furtherwcr*, it la lnply good bual *sa and good lndu*trial ralatlona for nanagoaaat ' to ooneern Itself with th* haalth and walfan* of ploy***, - In hia role, th* indu*trial phyalelan nay becona ona of th* noat ' ffeotlv* agenole* for th* prcaotlon of good relation* between canag*- n*nt and it* asployaea, It nay b* that in looe of th* plant* tb* 0 *ttployc*nt of a full-tin* phyalcian la not Justified, JkwrtYer, th*r* -'i *+ - r' r"wf >A I i i ipr- 3 *<*SKr '' ^v- ' _ *`- ' .-" - - J..' . . ... .;,! : ' '-- : . ' V'- ':j ' &: p*. I T.C. WATERS A LATTER LOOKS AT FUUBXSM la armilahls to arary sasbar caspany tha tanrleee of part-tins physicians end unitsa and until an effective sedloal control* prograa la mtabU(had you ar *laply not going to low tho condition of tho health of your nploy* and ara not going to bev* Intelligent raoorda that anabla you to evaluate e<vpen*ettoe costs, Tha fact la that an Industrial physician, if ha proparly fttlfllla tha aselgaasnt that la given ho fcia, say sail ba tha 'father confessor* to tha aaployaaa la tha plant that ha la oallad open to esrvu. This *. should not ba 11*1tad to tha asplqyaa hiaself but should alao axtand to hla ftally ao that ha say baeoaa faslllar with tha prbblasa that ara ;i> < incident to tha faaily Ufa of tha eaployee. It la naadlaaa to raped, that cansgesent should conduct pre-aaplcyaent and post aaplcysert , phyalcal sxaeinetloaa, X knew of asatgr eonpenlea that hsva m to V-\-u \ praolata tha value of tba phyalelan who randara service to tha sploy -r: -. , .-..-v-w -o t- aaa of thoaa ccapandes. ReUeve uf they ara rail, and X a eartaln ! , that through their effort* many natters of Industrial relations ara reaolred bafora thay raach tba stags of cospenssllon. , Tho saintananoa of sadleal raoorda Is invaluable, particularly /'V: with respect to tha ultlnate trial and disposition of oospsnsatlni " < dels*, X si not g'ing to soberness you by asking how sany of tha eospanles bars present ara foHwrlng a constructive ssdloal prograa, but as osrtaln that there is such rocs for laproveasnt. Treatise ; to tins X have heard criticism of rising ocspansatlon costs but until . top nenagmont beoooes convinced of the need for competent ssdloal aervica arid oontrol you will ba facad with rising oosts for ooopsnse- tlon which say lew to you to ba out of reason, Therefore, 1st us stop 4 **,, ry ^ T.O. WARM -7- A uma LOOKS AT FUMHS* talking about thla phut of our probleo and do amethlftg about It. Thara ara otbart in attandanee at thla neetlng wbo ara battar abla to adrlaa with raapaot to the detaila of auch aarrloaa than X at. X boneatly baliava that If affaotlva prograna ara developed you will not onljr raalita tha banaflt of deertaalng coata for oa^enaatlon but will enjoy a wuoh aore aatiefaetery railtiro*hip with your eoploywea. With raapaot to engineering ooctroi, baar in wind that /on ara daalinc *lth a toodo Material and tha ejdatenet of axpoaura to that notarial in your plana aoy wall tend to indict tha oeopeny aa being , raaponalbla for health haaarda that nay ariaa therein. It ia cartd nly naoaaoary to have engineering control with tha saintananoa cf raoorda that indioata expoew*. However, pbaao racerda ahculd be primarily for tha purpoaa ef indicating tha particular part* of tha oparation wharo haaarda exiet. In other worda, they ahould ba uaad by tha oaapaqy to \ affect eathoda cf control, frees tha atandpolnt of being affaotiwa in' dafanaa in coopeneatioc eaaaa on trial, X wuat eoofaaa that they do not have much value unleea it can ba abrwn that thara ia actually no injurious axpoaura. Tha faot la that if an ewplcyee taatiflaa to hia . axpoaura to an atoaoephere oontaininf a toxic notarial, lmedlately tha eoapanaatlon cccniseion aoeopta thie teetlnony aa indieatinf a poten tial Injurious axpoaura. Tou nuat c o m to accept thla and to do ovary** thine you eon to allalnate any possible axpoaura in your planta. , SECOND. Tha liability of goober cooanleg to the oonaxalng publio In materials that ara aold containing load. Tha Manufacturers and producara of load alao hava a potential liability under libelling lawa and regulation* enacted and promulgated by govermenteil agendas dealgned to protect the general public frou ,, : i' g* - * - ; ' -r .' ~~ . * : ... . sj T.C. HATERS 4- A UttM LOOKS AT PUMBISX fcasarde Involved la the use of taodo net* rial*, Only reoently, the Connitta* oa Toxicology of the Aaarloan Medical Aasoelatlen ha* reccanendad tba anaotnant of a Onifora Hasardou* Subrtenoe# Aat la tba oral state*. Vhil* X do not wish to present any arguMnt of tba proa and eona of thi* propoaad legislation, iCla of Itaolf a warning to the#* ooooaroad with tba production and aanufaotura of load that they nay b* required to catply with tba raqulroaacta of that Aet If It should b* paaaod la tba savwral atataa. Thara ar* already la existence varleua ordlaanoaa and regulation* acactad In various Jurisdictions having aa tbalr objective tba aaaa purpool aa tba legislative ohengea rafarrad to, Tbaaa ordlna&oaa and regulations ar* net untfona and Industry aay ba eonfroatad with on* type of ordlnanoa or regulation la a (Iran Juriadlotloo and an entirely dlffar*nt typo of ordlnanoa or regulation la anotbar Jurladictioc. It la naadlaaa to aay that tba obligation raata upon tba canufaeturor and producer to cceply with ary (Ivan ordlnanoa or regulatloa la tba jurladiotlcn where auch product* ar* add. Violation thereof would lxpoa# tha liability provided by th* crdlnano* or regulation with resulting prejudicial publicity, Th* reaporalblllty of nanbar eoopanlaa of thla Aaaoolatlon extends to tha general public whloh purohasaa or omsutaa tba product* which yon produo* and tall, Xour raaponalblllty aabmeoa'tt* potential Injury to tboao who nay not be infontod aa to tha toxic feature* of your nato riai that aay oaua* Injury to aoao per*on not aware of their hatard, Haro tba nanufaeturer, producer or user nay be aubjeot net only to punlshnant for violation of a given ordlnanoa or regulation effective In tba Jurladlotlon where the product la eold but nay alao be aubjeot w\fc T.C, lUItn A UTX&X LOOKS AT FlOffiXS* to tb* poMlbillty ot the lnatltution of a comon In aetion for damage* to an injured party arising out of the failure to oonply with tha ordinane* or regulation affective in th particular Jurisdiction In whioh tb* product 1* told. Action* at oomon lew ar* typical daaaga ult* fllod In la* oourt* whar* jury la empowered to award aooh dau|t* aa nay ba Justified In it* discretion. provided. however, that th* In jured party aatahllabaa th* fact that failure of th* renufaeturer to di*clo*e th* torlo or haaardoua aubatano* of th* notarial to old o*ua*d th* Injury that la th* *ubj*t of oaaplaiat, Zt la aonaahat ldl* for n* to tall you of th* **rluan**a of thin ty.j* of litigation. Coaplalnta ar* baaed upon th* all*g*d nagligeno* rf th* nanufaoturer or uar In pacifying or requiring th* ua* of paint* or cthr aatarlal* in th* aancar which r*nd*r*d it unaaf# or hareful because It contained an *x- c x iIt c anount of d*l*trloua auh*tancaa aueh a* leed. and falling to warn the Injured party of th* d*l*t*rlcu* nature In order that protectlv* clothing or appliance* could b* u*ed by tb* parson so using th* cat*rial. Aaaimlng that th*r* ha* . ben a violation of aaa atatut* or regulation 1 ''' with reaped to th* labelling of th* tojdo ub*t*no*, then th* nanufao- turer nay b* legally r**pon*lbl* for resulting lnjurlt* providing thar* la a direct oauaal relation*hip between expoaur* to th* toxle aubatano* and th* lnoldeno* of Injury. , , r . ^ * Umber* of thi* Aaaoclatlrn ar* fully advlaed with reaped to th* particular ordinance or regulation that nay exist within th* jurisdic tion* wtcre you tell your product* and I will not attmpt to dlaouaa this phase of th* natter In any detail, However, th*r* la a continuing concern on th* part of th* publlo and public health agenda* to tee  'J,atLi-aogS-,4i&ft^a. -- ~ t .c . w at o o -io- i urns toots At aurnai that th* piblle la full/ protected egalnat any unknown haaard lneldant to th* uae of tojdo aubataaoas. Tour Aar'oiatlan, through your IHreo- tor of Baalth and Safety, haa dona an excellent job la apprlaing you of rule* and regulation* anaetad or affective In tha varl -ua Juriadlo- tlcn* where ypu t product* ara told, Rcwwrwr, tbara la a continuing aaad ter thla type of aarrlo# not only to tha and that you say ba proparly odrlaad of tha atatua of tha lav under which you nay ba gor- arnad, but alao to ocnault with and adrlaa govaratantal agenda* about tha datalla of atatutas, *-rdlnance* or ragulatlcna which nay ba tha tub- jaot rf anaotnant. Tou people and yrur Aaaoolatlon here nore Information about thla aubjact than ary governs*ntal agency could poaalbly obtain and It la autcltted that you racogni** your rweponalbllity ln thla con nection, On tho other hand, najy well-intentioned gorerneantal agenda* not haring tha bcnaflt cf tho Intonation vhloh ym hare, nay frequently - oorjider ill-adrleed, Ineffective or unneoaaaary legislation vhloh nay - ba highly prejudicial te your industry and to tha public that uaea your product*. Therefore, nay Z auggait a progrm for your Ifioclation la- volrlng continued and Ir.creaael concern dealing with the po*lbla enact*ent of statute*, ordinance*, rule* or regulation* relating to the labeling cf ymr product*, to tha end that auoh laglilatlcn upon baoo*- lag affactlra aay aocaapllsh tha objective* for vhloh it vaa daaigaad without the lapodtlon open yur lnduatry of umoooasary, unvlao or unjuat burden*, .. "" >weywgi^f ' v : ; itei!' ' ' i ::-;M ?- <-: , ' .. ...i m wpapwj^^ ^ '*' " *' ' '*' 'j: ` ' ^ i- .' . ."J' - ' . ' -' ' ' iiiiiiitoi aArrjf--- j-u? ifrimi ItriiTnwifV -jM iirrtlirii7i^y^x- - ' aiitAiakkMJtaituth \%i y -xi i 1. Olaleol Laboratory Criteria 2- A. GotVol*t*Stlol UoalfaitOtionS On* *r more of 4>* fallowing: I) Anorexia 2 Intsrmrttent vomiting 2 Abdominal *>* 4) Constiparien . " .; B. Control Nervous System kionifextotion* _ On* w more of the Mllil(i I) Irritability 2 Drowsiness 2 Persistent vomiting 4) UcoerAnatien 5) Canvui slant 6) Co m 2 Oedutest or priy*is 8) HrfOltaiiM 0) P*itl*4*M 10) P4f*i| af *n* if nr* o*v 4 MTV** 11) Br*lc4rai^*4 lull pretein content 12 C*bi*M4 1*44 pleocytosis 12 Devoid wntnipnil fluid flMM* C Hawlelejic Manifestations On* or M it 4m fallowing: 1) Hypochtomlc nJcracflic mil 2 A significant degree *1 Imlulic stippling *1 fk* r*4 bleed call* . : IX Eicawlia Coptoporpkyrinorio - v .% E. Urinary findings On* *> both al4mfollowing: ' I) Glyeeewrin z a -j -mmc J*^ ,; ` fi . .Jv*1 ' ' - ` . v' , - mm?. F. Tk# demonstration of incraosed radiologic density at tba metapkyses of long 2. Ontario fot Lead Absorption .. Tka following findings present evidence for absorption of load ia guontitios tkotore :' known to ka copobl* of inducing iatoxicotion. A. Th* finding of a concentration *1 l*od in 4m Mood, a* detsrmin*d by a meihed af known high sensitivity and precitien.7 f 0.08 e>g. per 100 gm. af whole blood or greeter. Valu**af 0.060.08 *t- pot 100 gw. of whole Mood a* indicative of abnormal ebeerption *1 Ini bat often not a d*gr** *f absorption which i* CM*bU of inducing symptoms of intoxication. Rapoal d*t*rminatlon* ora preferred. : . ....... 8. The findtag of urinary eacretion el leod. et determined by aMthodt of andysle of kneem ki^i sensitivity and precltlon.7 in amount! of 0.08 mg. or mor* par IfiwwiM in patiantt not ratalring treatment to inCroat* toad excretion. Repeat datonninotlona or* preferred. > 3. Exposure to a Land Source , A canfirmad klttory, by chemical identification of 4m source, of ensure to load of luck severity and *f such duration at to be Indicative of a dangerous degree of absorption. , .i 3. Discussion The child who I* poisoned by leod will hove taVen in and absorbed dangerous owountt of leod. Tb presence o( clinical ond loborotary manifestations io web child anbits a diognosis of food poisoning to be aode. C//nice/ end Lekorefery Crirev/# - Monlfestations included under clinical ond laboratory criteria ora non-specific, tinea ony of these con be favnd in ether illnettee. Even the Increoted redie-opooue oreat or line* ot the atttaphyses of the long bonat ora net Iff cific indicotiona of lead absorption, for ihoto rodlo-opoque lines ora teen with ether diseases, a.g., obnormol absorption end storage of otntr heavy metals ond hooting richets. Such lines ore Ml indicative of illness, but ora so frequent in their occurrence in swell children who ore absorbing obnormol omounts of leod os to servo os warning. A child eshibiting this manifestation should be investigated carefully, with respect to the extent of his absorption of leod, ~ When ony two of the criteria listed under clinical ond loborotary criteria occur together with oae of the criteria far leod obsorption, o diognosis of leod poisoning may be mode. Taro or atom of the clinical and laboratory criteria listed may be used to mohe a pro* sumptire diognosis ef plumbiaa in children with eorly manifestations of increased Intro* cranial pressure; such children require remove! from the source of leod ond emergency treatment. A delay in treatment while o blood or urine analysis for lead is being per* formed may be bexordous. Edathomil calcium disodium (celcium EDTA or edothomil) * therapy con bo instituted while blood or urine determinations ora being performed. Treat* aiant con be stopped if repeated lead analyses show the provisional diagnosis to be la tffOfe ' ' ' ' - \ ; .. The central nervous system is frequently involved in children with leod poisoning. Whoa involvement Is such that obnormol cerebrospinal fluid findings (swat commonly elevation of protein content) become manifest, the diagnosis of leod poisoning with encephalopathy may be mode.* . Excessive coproporphyrlnvrle is a constant finding In acute episodes of leod intoxication, ond con bo demonstrated by a relatively simple qualitative test on freshly voided urine. Briefly, the urine is acidified to pH4 with acetic ocid. Coproporphyrin is extracted immediately from the acidified urine into other end than from tho other into 1.5 N. hydro* chloric ocid. Intense rod fluorescence of tho hydrochloric odd loyer when viewed under 0 Wood's light is indreotivo of on increased amount of coproporphyria. Quantitative copra* porphyrin determinations on 34-hour urine collections con olso bo .performed.? Those 4 may bo helpful in long-term monogement of patients. I? The coproporphyrinurlo encountered in food poisoning Is incompletely understood, but derongement in hemoglobin synthesis ond interference in prephyrio metabolism In tissuoa other then blood ore probobly underlying factors.A ' Cr/terfe far Leod Ahte/ofJon Once the suspicion of leod poisoning Is oroused, the most Important single consideration in the diflerentiol diognosis is whttnor or not leod hot been absorbed In quantities sufficient to induce Illness. This con best bo demonstrated -4- br determining tho lead content of iho Wood. THo threshold value cited obovt, 4.01 mg. of food pec 104 gm. of whole blood, ) 0 criticol on*. Lood concentrations between 0.06 end 0.01 mg. pot 100 gm. of whole blood art indicative of abnormal obsorption of lood, but ofton not of o dogroo of absorption which is copoblo of Inducing symptoms of intoxl- cation. Extensive studios hcvo boon modo on fho variability of tho concontrotlons of food In tbo blood ond utlno of odults ond childroa, both undot erdmory circumstonces ond undor con* ditions of obnotmol exposure to leod.4.1 I'D In n group of children botwoon tho ogos of six months ond four years, in whom thoro was no evidence of obnormol intoho ond ab sorption of lood, tho OTorogo blood lood coneoatrotloa was 0.027 mg. pot 100 gm. of blood. 11 In o rocont popor tho uppor normal limit of blood lood concentration in young children is stated to bo 0.05 mg. pot 100 gm. of bleod.13 .. Tbo appraisal of the significance of lood ebsorption by moons of analysis of tho urfno Is much more difficult and much lost effective than that of analysis of the blood, especially with children. In young children there Is o wide physiologic variation in 24-hour urinary volume. Factors such os dehydration and oddest*, often accompanying tho acuta epi* soda of lood poisoning in children, con alter urinary load output In tho untreated patient, SO that tho amount excreted mey foil within tho norerol range. Tho collection of on unconteninatod somplo of urina tram a young child for the purpose of lood analysis If usuolly difficult, extreme precautions being required to prevent contamination of tho urine with lood.6 Administration of calcium EDTA to patients who have abnormal amounts of lood in their tissues is followed by o rite in urinary excretion of Itod^'l This increased lood os* cratioa following edoihamit administration bos been suggested os the basis for o diog* ' noetic test.'4 Potients receiving edothomil therapy should eecrtte 1.5 mg. or more of - toed in the erine on any one of the first throe days of treatment. This test, while by no mtons os satisfactory os that of the determination of the level of tho urlnory excretion of lood prior to ony therapy, mey bo etore practical than the collection ond analysis of s 24hour urine specimen from on untreated patient in those instonces where o delay In therapy Is hosordows. Different methods for analysing blood end urine for lood ora ovailobta. A simplified pro cedure for the determination of lood In smoll somples of urine ond blood has boon re- ported.*7 This procedure requires only 2 ml. of blood whore most determinations requirt 10 ml. Tho requirement of a smeller volume of blood Is odvontageous whan working wldl children. Certain other analytical procedures art described in articles listed in a mono graph published by the Americon Public Heolth Atsocistion.7 - Closswore ond other equipment used in ths collection ond onolysls of blood ond urine : eomplts con ond should bo rendered free of ony possible contaminating food by rinsing with worm 20 percent nitric acid, followed by thorough rinsing in "leod-free" distilled water. Other special precautions must bo taken in the laboratory to prevent contamina tion of tho samples from Ited-containing airborne sources during ashing ond analysis. B-* Fixervre fe e Lend Source Childhood load poisoning 11, In gtntraj, a disease of poverty,'4 almost always found In ortos of old, run-down housing, ths source of food r i i if I* etuolly leod pigment paint epplied ond r-opplld oorly In this century, t wells ond fi stores which more recently have been neglected ond allowed to loll Into disrepair. These coats may be buried beaeolh other coots of paint, covered with wollpooer, or stay cover wollpoper or ploiter. With neglect the point ond pointed watlpopef peel, and the painted platter crumbles. PorticUs may then be picked ond ingested by young children. Lead paint in good condition hot been chewed oil of turfocet alto. An odeguole safe substitute Indoor paint wot not made available until about 1940. Lead point applied to outside turfocet hat alto been reported to be the source of leod in cases of childhood plumbis*. *>* . Children's toys ond furniture ore net significant sources of leod unless repointed with leod pigment point. Since 19SS the Americon Standards Association hat recommended that only points with a leod content of one percent or lets may be considered tefe fee eta on children's toyt, furniture ond in bousing interiors.t' Other sources of leod should be kept in mind. Numerous coses of poisoning bave oc curred in both children and adults worn inhalation of toad fumes? and asposura la eshes?* resulting from ths burning of leod ttoroge battery cesings for fuel, a procfico sometimes resorted to by destitute families. Other sources of leod involved in childheod poisoning can be found in the modicei litereture, bet in this country these sources pley a relatively unimportoat role. References to these are lieted.??*?* In most coses of childhood load poisoning, pice, the obnormal oppetito for ean-odibfe substances, is responsible for lead being token into the body. Children, etvoily between the dgee of one end five yeort, most often inhibit this abnormal oppetito which may re sult from emotional disorder?* or nutritional deficiency.?? It hos been shewn that leod It retained in email omovate in the tissues of on odult with o doily intake of 1 eg. of Soluble lead in addition to the normal daily dietary intake (0.2-0.4 mg. of leod).?* Sines lead plgmont-contoining point peelings may contain 100 mg. or siora of lead, the ropeatod Ingestion of small amounts of these peelings is compatible with absorption end retention of dangerous quantities of leod m the tissues. This will eventually result in clinical manifestations of poisoning if the osposure it not interrupted. , A history of ingesting point chips or chewing on walls or woodwork may or mar not bo obtained. Often tuch octiv'.ty goes unnoticed or the amount ingested is considered in significant by the porents. The history may be obscure, incomplete or fragmentary. The possibility of the enistence of leod poisoning, therefore, must occur to the dinicion from tho nature of tho illness itself, ond he must be prepared to make a presumptive diagnosis in on ocutely ill child without on elicited history of leod ingestion. Diagnosis (ond therapy) must not bo doloyad becouso a source of leod is not rtodily demonstrable. The explongtion of the origin of the disease, if it turns out to bo leod poisoning, ie often found after the foct. A positive history of pico for point ond a roontgenogrom of the abdomen demonstrating radio-opoque notarial in tho Intestinol troct ore voluoble clues to the Ingestion of lead. In New York City, blood lood analyses ore performed on all children under the ego of sis years enrolled in the City Well Boby Clinics with a history of pico; young household siblings of thsse children are also examined in this monner.?9 The absence of these clues does not rule out the possibility of lood poisoning. 6 Exposers t* load source may b# confirmed by demonstrotlng that th# source centals* leod in excess el recommended limit*. In children the history el lend exposure My vsvolly be sttoblithed by oxelyelng peint porhcles taken Item the environment el the child and demonstrating eiceitiv* lead concentration*. The enolyticol procedure vied should be on eccepted one end should be performed by cempelent and experienced per*eanel. Clerilficerien */ Flotl Diegoesli U making a Dnel diognotl* involving * child oxpeted to teed, th* following do**i(icatio lor diognonl* ) recommended: A. Asymptomotlc lncrooed Leod AboorpHoa Hut Aegnesis relev* te the child vAe dieer evidence ti preeenc* in (he tUeuee wed ebeerpTien el ebnevmelly lerge amounts el lead, but wlte It eiymetemenc. A source el lend, evidence el lead oh aeration, end in* treated tedielegit metephyeoel dentrty el long bene* ecy be demenftVetedL 8. Lead Intoxication 1. Lead Intoxication Withowt Encephalopathy Twe er mere el die ciinicd end I Aeimetj crilevie eoduAng cefttd nerve ve xyxftem men tenement accompanied by deired cerehvepincd Held finding*, evidence lev AtevpMen el leed in deige*v* pmiiliM, and demonwretien el e leed eource enehle di* deyteili le be node . 2. Lead letoxication with Encephalopathy Twe or neve el tho dmicd and IxbaieMi; criteria Including central narvoue ytem ewnHettatien* mecemg--led by ebnenehl twit* ipinel Ovid liaAngs, evidence ier absorption el leed in dwigtrae* qvantitioe, mid dononewotion el e teed oourco eneble Ihi* Aftgnft*i> le he mode. Thi* category moy he oubAvidoA en the he*i* el am verity el enceghdeernhy, Into lead par*ening el* etild and leed pel toning wilh errovo encophAoeothy. The letter group fthovtd he* cledo ihete patient* ftA* convul e end/or Ao are cometftfte foe 24 h#urt or longer.* -' . The long-term prognooio of childhood plvmblsm (with roforonco te mental end novrologi* col function) eioy depend upon the *everity of the ocvto symptomatic opi code. Theraloro this classification should be of prognostic volut. Th# obovo diagnostic classification is also suggested In ardor that children who ore ingesting abnormally torge quantities of Itod ond children wilh leod poisoning withowt ancopholopothy will not be overlooked. Eorly diognosis is essential far a good progno sis in this disease. Removal from load exposure ond therapy wilh colciurn EDTA'* will r more often result in e fovoroblo outcome II Instituted eorly. Therapy with calcium EDTA Is not as slloctiv* one* ocut* leod oncopholopothy hss occurred. This drug hat net ilgnlficontiy rsducod th# 10 15 percent mortality rat* from load poisoning In children 9 .7. #d Ml to bo no_ir.Of* effective then older atooovrot ln torminoting itio ocvto epltod* o( *nc*pholopothy.^" Nowouor, thor* It inn oridonc* tuggotting ihot neurologic ood menlol togeolo* ottodotod with childhood plumbitm, od otpociolly with oncopne* lopethy may bo reduced by tbo ut* of coUlwm EDTA. JO.JI 1 TheM communitioo with octlvo program* fen lh control of childhood food poltoning, whor# only c o m* of lood oncopholepothy end dootb jrt being roportod, or* undoubtedly Kitting number* of *orly COM*. Defection of th*M oorly cotot it on importoni octirity I, triiicb tbovld b undertaken by phyticiont, pvblic heolfh worker* and poiton control contort In conwnonltiet wh*tt tourcet of food moy exist. : Tk* Public Hooltb Service effort centeltetie* torvlcot end technical ottlttonc* to any community irilb 0 childhood load poitoning problem. Co m finding and prorontion ectiulMot togolhor with th* inititution of odogoot* diognottic service* or* ottontiof for con* trolling thit problem.^ For mor* details coated th* Notional OearingheuM for Poiton Control Contort, U. S. Poblic Hoolth Sortie*, Washington 25, 0. C Sonwory *r Crittria to b* wood It diognotlng load poitoning in children her* boon protenttd. Qini* E, cal end laboratory criteria, critorio for load ebierptioa, and oxpotvr* to 0 Itod tovret or* th* thro* orrot rodor which th* diognottic critorio foil. Two or more d inicol end labor** tory critorio corplod with on* or both criteria for load abtorptioa enable 0 diognotitof , food poltoning to be node. Although chenicel identification of the feed source larolred , it important in orriring at * finol diognotit, treatment mvtl net be doloyed if th* ooorce It net readily demonstrated. A clottificotloa for final diognotit concoming the exposure of a child to food it rocom " mended. Th* Importonc* of recognising oorly coMt of load intoxication and area earlier ' ;& ntymptomotic cotot in which incrootod lead oboorption occurs It emphatltod by the dottificotioa. Um of tbit clottihcation thoold aid in ettoblithing a lotg-term prog _ notit. Eorly diagnosis it necassery to reduce seguolat end mortality from lood poiso*r ' ing in children. Acknowledgment W* with to thonk the following phytldont for thoir ottittonct in tho proporotion of this communication: Robert H. Alwoy, Eliton L. Belknap, Somuet P. Uestmon, Randolph K. Byort, J. Julian Chisolm, Jr., John Fovlgtr, Leonard J. Goldwotor, Harold Jacob liner, Robert A. Kohoo, May R. Mayert, Edword Prtft, Hugo D. Smith, Lowit W. Spolyor, Goorg* kl. Whootloy, end Mitchell R. Zoroe. 1 'i i .rw * t 1 RafarancM I. CMh Ii^ X X, J>., and Hd Him, H. E.i Prflrtlti tl:94X 1936. X W|||1H. K. Kaplan. E,, CMdn, C E. mi S^tn, R. R.> PaX Haaldt Ra*. 67:23% 1931. X JanAlni, CO,J Madia.. R. B.: A.M.A. AnX. Naoral. 1 PtycMat. 77:7a 1937. 4. Rape***!, M., and RvUn, H.L; Am. X Di. CWIi 61:343, WL X BIk Imi, i 3, Bull. John. Hoptilna Hoop. 61:1, 1937. 6. by**. R. 1C: Pndiatrlci 21565, I9J9. 7. M*6*4i Itt Oatarnlatin Load )<i Air U la 8i<1|1al Mrtariali, Nn YM, Aatikw PU< Haaldi 6iu<taHi, hn.( 1933. % Byor*. R. 1C, Ualaal, C. C. CmUw , Ui Am. X Du. Odld. *7:544, 1934. 9. Jtkwrti, l, lira, L.. and Wataon. CJ.: J. Lok. and Ok lU. 37:40, 1951. 10. CU*ln, X X, 3., mi Hw Him, H. E.: X Ola. Imwt 3X1131, 1936. 11. Rakinaan, M. yKa^atU, F. E, 4 Brltja, H.: Pa4a<rl<i 21:793, K53 12. Bradlay, X C, Pmll, A. E, Hiww, HcCnlgr, K. R, and Fabian, E.: X Padial. 49:1, 1936. IX Owlak. X. mi Bnafech. K: X Indwal. My*. 2547, 1941 14. Rwbin, K, Salanpa, <2, Bataa, X P. and Balk***, E. L.: Sclanc* 117:699, 19SX IX Buaa, X P.. R*k. R. and Laikan, X: Paiawica 14:201. 1934. 16. Albakary, C_, Trvkawt, R., mi BdM, C.: Pitk. Malad. Praia, alennatlaa 19:122, 1956. 17. Bmu w , X P,and Layna*, E. C: X Lak. X OR. Mai. 43:139, I93X IX Brad lay, X E, and Bat.-*, X P.: PvA. Haali Ra*. 7X467, 193X 19. Aawrlcan Standard Srtcll>nt<wi H Mlakolta Haiarda la Ooldraa Iraa Ranidwal 5wriaca CaaMnf Malarial*. 266.1 - 193X N York, Anarlcan Standard* AaaaclaWaa, 193X 3X Editorial: Intamat. Mai Dlgni 63:13% 1954. 31. Travart, E^ Randla Short, X, and Harvay, C C: Lane#! XIIX 1936. 22. Vanaa, R., AJbahory, C-, and Schlwiakargar, H. G.: Praaaa Mai 65:177, 1937. 2X Danllarlc, V.: Briiiak Mai X 3061, 27, I93X 24. Darldion, W. X i C>c*r 2:1096, 1937. 2X Laanard, A. R-, and Lynch. G.: Calllatttla Mai 9MU, 195X 26. Milllcan. F., Uwria. R. X. and Layatan. E. R: An. X 01*. Odli 91:144, 1936. 27. Caaar, M.: PIOL SariaallaM, C C ThaaM, 1937. 2X Kakoa, R. A., at al.: X InduaL Hyf. 22:391, 194% 39. Cntnittt R, Jacaktlnar, K, McLovgMlit, R C, FwarC H. T., mi PaMlttarf, Od Padiatrica 23:736, 193X 3% Oiiaolat, X X. and Hantaan, H. E.: Padialrtca 192, 1937. . 3L Bradlay, X E, and Bowaigarlnar, R. Xi X Padlai 33:311, 193X JljUKuii )>1CdLW4\ Howard R Conn, R 0., Oiractar Hanry L. Varfwlal, Aailitont Oiractar ^uAWWBIff3W^IW^iyiM-JWM1W1BBayi7-|il|||p.Bi||ipUWPWWWWW|4B8l>9^ilpilB^iPPlwi!iJ7^wW)WPWB!^56,48ffly