Document O3gkJMoLxz8dkgZzve5VEK8QK

LEAD POISONING WRING CONSTRUCTION' OP THE GOLDEN GATS BRIDGE, 1954-1957 Y< Kit VO t "vvu\. q - is u-, CO'v S K t~'- O- ' q iLc^Ll- C( Ul-Cl. \,4~k ( I INTRODUCTION: THE HOST, mHE 2in v ir o n me n t a n d t h e a g e n t The subject'"plumbism among Golden Gate Bridge Workers" was chosen for the term paper for Epidemiology e3 the writer has done some research on this particular epidemic in connection with his employment. In addition, the information, though incomplete, comes from the unpublished files of the Californio Division of Industrial Safety and may have special interest and record value to the Kettering which has concerned itself extensively with this disease. m industry lead is encountered oa metallic lead as well as various com"pCw*.nds, principally oxides, carbonate^, sulphates, chromate^, sulphide^ and disilicstate^. The hazard is not the same for all compounds, but var i&3 from almost nothing in the case of the disilicate^ and sulphide^ to considerable in the case of the oxides. The twe^c evenues of entranee^into the body in order of importance are the respiratory tra.ct^toouth^ end -akin. -when ih--irs bTo'E^wa. In this spi den le the incidence was due to inhalation of the oxides, pbo (litharge) nd PbjO!+ (Red Lead). One hundred and thirty cases were documented sa lead poisoning and symptoms^ aro 30 similar in almost all the cases that they can be typified by the following two cases diagnosed by LH. Cotter in another epidemic when an elevated railway in New York City was cut down. Cotter states (1) that incidence of inhaled lead poisoning ran as high as 30 percent when respir ators were not used. Case 1. "G. M. A 44 year-old American born iron worker engaged in burning painted steel for four months, pain and constipation whole period. Became nauseated by smell of paint. Unable to sleep lest two weeks. Showed lead lino* and abdominal rigidity. Urine l mg/liter, blood .2 mg/ IOC cc, basophilic stiopling 0.9^ reticulocytes l.Zt, blood count: TTGB l4 gm., R3C 4,000,000, W3C 6000, neuts 60^, lumphs Jl%, monos lfa, eos 5"5, bssos yt. Case 2. "A.B. A 40 year-old French Canadian. Burned painted steel two months wesring cannlster respirator. Increasing constipation, loss of weight, abdominal cramps, nausea. Showed lead line and tenderness and rigidity of epigastrium. Urine Ovl ng/liter, blood 0.6 mg/100 c.c., basophilic stippling It, reticulocytes 7`yt, blood count; HG3 io gm., RBC 5,000,000, TOO 4,000, neut3 &%, lymphs 26t, monos 6te>os 2t, bsaoo l^." The beginning of the epidemic, which extended over four years, wes in January 1954, when 5 employees of the subcontractor erecting the Marin bridg tower complained of leed poisoning symptoms. The peak was reached in * A characteristic dark line on the patients' gums 2 February of that year when 55 cases were reported end it tapered off through December 1957* See Charts 1 end 2. It appears tho epidemic ended because the job3 ended, rather than due to effective corrective action. Iin fact figures stated in this study are likely to be minimal because of the apparent reluctance of the contractor, the contractor's doctor and state authorities to ascribo the illnesses to lead. This reluctance i3 understandable from several view points. 1. Moot of those Mfected were engaged in riveting hot rivets into bridge members painted with red load. 'This work io usually done in the open sir, often in a stiff breeze. * 2. The wearing of forced-air respirators, the only really effective preverft^t ive measure, would bo difficult to enforce because men working several hundred feet above the water and in precarious positions would probably be uncooperative. 5* Air supply lines would be lenghtny, costly and curabersomo. In only 17 of the caaes is enough information provided in the form of accident reports and correspondence to determine the subclinical pro cess, or -what might be termed the. incubation period. This information is shown graphically on Table i. The moan length of time for tho cub- cliiiica! process was 57 days. In calculating tho mean, the individual who reported sick after 502 days on the job, was omittod. There is no discoverable reason in the file why this person (a riveter) should have had so much longer an incubation period, and so because of statisrical variance he is considered a spefrt. Tho means for individual trades is as follows: Ujf Rivetors - 6l, painters - 6l. Estimated * varianphs between these groups are as fellows* t /Sridgeaan (5) Riveters (J) painters (4) S*s n- S S3 34 Estimated standard deviations are* 241 9 b*s Estimated standard deviation.- of the means is--: 4-.1 < JrV. ; -V,-*iS r/ Estimated 95^ confidence levels (X)^(l.96^$)aroi 4i- a From the above calculations one would conclude the b rt*4 : are' unrelated. However, other imponderable factors might tend to invalidate *Red load paint is used as it has the property of expanding and contract ing with the steel during temperature changes, and it would appear reason able that the fumes would be blown away before being inhaled. -y wc p. 1^*70 ye i 01741 5 theca statistics. 3ome men had been working with lead paint for years end others just a short tine; csnnister gas macks were supplied, rnd though t^ey were ineffective, they would tend to prolong the incubation period, only in one case does the file show that p nan habitually wore ' hie respirator (see Chart 1). Some nor. were repeaters. This is noted only once in the sample (see chart 1) Nor i3 it ascertainable whet men and to what extent worked inside or outside of the towers. To the industrial hygienist, probably the moat interesting sspect of this epidemic would be the attempted control methods, end this constitutes a lug history in itself, ^he first entry in the file concerning control i3 in vay of 195^ by a consultant, M.K., Bio-physioist whose letter head shows him to be Technical Director of an organization callod the ''Institute of physio-Therapy." He seemed to feel discipline would solve the problem, and no a matter of Interest his letter to the California Industrial .Accident Commission is quoted in full. 11 Dear Mr. R............. Considering the existing avoidable deleterious health hazards faced by 'workers called upon to paint the small cubicles -with in the sauaalito Tower of tho Golden Gate Bridge, the follow ing is recommended to 'fee rigidly enforced by you, as the Safety Engineer on the premises, for the benefit of ell con cerned: h y g it :".- Every worker on this job is selected for his present physical fitness cud his readiness to co-operate with the constituted authorities and his superiors on this job to keep him so fit. This, in return, will safeguard his health, strength end endurance. This i3 done not only because it increases his capacity to do his work right, but to enable him to stay on the job uninterrupted and satisfactorily without incurring preventahle._disabilities too costly for ell concerned. HE3 JOB: Three shifto at two hours each with forty minutes of rest in the open air between each shift constitutes a day's work of eight hours on this special paint job. SPECI/.L PLEDGE; In order to keep the men in best physical fitnoss, the work ers selected for this special job pledge themselves to nppaerr for work in a strictly sober condition and with clean and wellaired garments upon their bodies, and that the overalls, shoes, gloves ana cap which they put on before sterting to work have been well aired during the preceding night and are free from p> 4 the noxious odor of tur pent ine, .00 'v'rnful in it 0 c effects for their physics i well-being. ?he wor he re selected for this special job pledge themselves upon their h nor, eft or working hour a, to r -not up mu to wer r light, loose V\C J)0 V GU. clothes r.r.d to prevent cat chins so-celled ''colds," Furtr;er , to ce outdoor recreation one sleep out of doors, if possible, or : least, in a room well ventilated - with en open window. They will avoid all need less muscular oxessras and organic strain and other imbalances of living. They '.'ill sveid over-rating md partake sparingly, while on this job, of neats me eggs. They will eat aoao hard, sous bulky and scuo raw -foods, also fruit in secson and they ./ill eat slowly and ^csticste well. They are cautioned to evacuate thoroughly, regularly and frequently, and they 'will be cautious not to allow poisons and infections to enter their body. They will keep their teeth, gums and tongue clean. Use sufficient water internally me externally, in short, they will work, plry, rest and sloop in moderation. While away from work, they will juuiciou3- ly do everything that will keep themselves in s "fighting trim" for the next day's labor and they will report to the Medical, Director on the job at once for whatever symptoms may arise in the day's work. Above all, they must be cheerful and not wo rry /) The poisoning from turpentine can become e serious cutter for them, but no one on this job needs to become sick from the fumes of this material. Their health cm be easily pre served but their co-operation in so doing is essential. Only through consistent, constant vigilance anc -whole oomo activity can this be attained and maintained with safety." r''he next entry is by the same consultant under the title of "Turpentine poisoning." -Aa he describes the symptoms of such poisoning, they seem to conform remarkably to the symptoms of lead poisoning. The.third end last contribution, by this doctor is an eleven page discourse on lead poisoning. This is followed by m informative and valuable pamph let issued by the National Safety Council. (2) Had the practices recommended in this pamphlet been enforced, especially the use of positive pressure ga3 masks, the epidemic would heve been ended. Another pamphlet, this one by the U.3. Navy Deportment follows, which strongly recommends positive pressure gas masks, in particular the Willson mask sold by the Bullard Co. in Can Francisco. Coreful perusal of the file indicates to the reader that recommendations, good and bad, from the informed end from the ignorant, were treated in the some way. They were not discredited, and thoy were not acted on. And one keops turning the pages and seeing casualty after casualty. 5 Tno next :a entry is titled, "Rules for the ;ir.ation Poisoning G'?; -s" by someone identified nly c s 2.G.3 * jU * j* ^ - mar z nd fuoer i nt en of Sf.f ('.is benighted missive any a in. 2-ir.g authority and no substantiation of .quoted statistics, tr.d control of zoning (fro: onye.Cdtylone flame cutting of 1 coated with lead paint) ds en occupational disease ia principally *u o "Theoretically, by far :ne os rcen- tags of .eau poisoning cases result from the introduction of lusd solids or graec into the stomach, a very small percentage by absorption through the lungs, and o. a till smaller per cent ego by abcorbtion through the shin. The average of the various authorities on the subject place the values of these percentages at 3p percent, 10 percent, and 5 percent." "There is no -reason for men getting lead poisoning who taka care of themselves and use the facilities provided for them by the company, as has been demonstrated by the experience of other industries, that (sic) these measures are successful." He then goes on to list various musts for cleanliness, smoking, proper clothes and gloves, rinsing the mouth, drinking of citro carbonate instead of water, drinking of milk, keeping the stomach full, avoiding constipation end taking of calcium sulfate pills. He ends with the steteaent, "Any employee not observing these rules should be subject to immediate dismissal." In justice to 2.G.S., his recommendations have some merit, and one concerns gas masks. How ever he rocomaends the cannister type which has little value for load ,,knc3 in the two micron magnitude. The value of tho positive pressure mack is test it maintains a pressure between the face and the mask greater then ambient pressure, and so prevents any outside fumes or gases from entering the ltfngs. Atj'thigy point in the file there is a 15 page reprint of a report by a D'r. McCord made at the 1929 meeting of the American Public Health Association, (p) This report adequately and comprehensively details prevenSk ive meesures and outlines an effective' safety program. /ithout laboring the point further or introducing other legitimate advice contained in the file, it is evident that information necessary to prevent this epidemic was in the hands of tho-se responsible for pre venting it and in retrospect is if difficult to understand why it was not used. On February 15, 195^* the California Deportment of Industrial Relations sent a telograo to the-U. S. public Health Service in v/ashington D.C. requesting aid in an emergency study of lead hazards, in thdureturn telegram, the Surgeon General offered to send a man on condition that the state pay his trevel expenses. The State wired back that the offer was appreciated but "we are unable to secure funds for traveling ex penses. J1 And 30 the ugly head of buresuocracy was raisod and the svate continued processing compensation claims for load poisoning. On this same date the Golden Gate Bridge Advisory Committee requested tho Industrial Accident Commission to take legal step3 to see that the tower for the Sen Francisco end which was being fabricated et pottstown ?s., be shipped and erected froe from all lead paint on splices on parts 0174 4 6 here field riveting would be necencary On March 1, 19T' 2b,OOO stipple; by the state tc responsible cut Company. The c should not be estopopoed uunnt til the hazard ceso following show causes, the hazard peak (28 cases) in May of that year. was removed, continued end as is often the ranched another with wire brushes. Dvery wire brush in Ssn Francisco was purchased and sn o-rdc-r was wired Hast for about A00 Tore. This effort net with doubt ful success as the brushers were tt-en exposed to red lead dust, and not all the paint could be brushed out. tivo in eliminating the hazard. The following month Trades exposed to lead fumes were limited to a the contractor ires ordered by the industrial Accident Commission to mechanically ream all rivet holes containing lead. It is probable that the latter order was imperfectly enforced, but this coincided approxima tely with the completion of the Morth (Marin) tower, end the epidemic temporarily subsided. ft was stated earlier in this report that responsible parties wore reluctant to blataa lead for the repetitious sickness among bridge 'work ers. "Ms will now be substantiated. 1. A previous attempt* to exoheratevleadtas 'the- culprit was made on o December 51#1955' whenMha'Genera 1 Manager of the'Golden Gate Bridge r.d Highway District sent the following letter to the Industrial Acci- ent Commission. Subject* Acetylene Gas poisoning. "Symptoms which were first suspected of being lead poison ing have been noted in the case of and G.I.H... who were both kept under observation several days. Lead poisoning was not indicated. Investigation showed however, that it was probable that these two mon, who are employed by the McClintic Marshall Corporation on tho Marin Tower erection, were exposed to the fumoo from the acetylene lights which were being used inside the column sections in confined spaces. As a result the contractors took immediate stops to supply elootric lamps, in lieu of t^e acetylene types. It`was thought at first that lead poisoning might be resul ting from driving these heavy rivets into materials previously red leaded in the priming coating.I I thought this might be very interesting to you for your files on the above eubjoct. Very truly yours ft 7 Hamilton and Hardy have this to sey about that. (4) "Then an acety lene welder suffers an attack of 'gassing1 the cause must be sought either in the metal he is welding or in some accidental impurity in the gas.......... if he is helping to scrap battleships by cutting through steel sheets, which are painted with red lead, he will be likely to have lead poisoning." 2. parts of several paragraphs of a letter dated January p, 1<?>4 from the supervising construction engineer of the Industrial Accident Commission to the General Manager of the bridge are quoted below: ".... in regard to the case of G.I.H., Dr. Barrett tells me that his cf'se has been diagnosed as ulcers of the stomach, end no sighs of lead poisoning were indicated. The case is not compensable."..................... "one other case has been reported as Iced poisoning, namely J.T., but this too has proved-to be a case of stomach trouble and not lead poisoning."............... 'Dr. Barrett informs me that it is almost impossible for a man to take enough lead into the elementary (sic) canal through fume3 to cause lead poisoning." p. T1ho voice of ethics was heard crying in the wilderness on April 2, 195^ in the fore of a "physicians Report of Injury." This is r standard form submitted by law when on injury is reported. U^der item o, "stato briefly how injury was sustained" is the following* "Inhaling lead fune3 whilst riveting. Ficked up from the strset unconscious and taken to house, ,'han I saw him at 9 p.m., he was unconscious, cyar.otic, groan ing, doubled up in extremis, feeble pul; Under "Remarl or: .tfiis form is stated, "After giving patient digalen pnd adrenelin hypo- dcrmically, I took patient to Rosa Hospital where he was placed in a tub of hot water and stomach washed while in tub( Gastric lavc-ge was clear. Awakened ih tub and complained of pain in abdomen and weakness." signed. Dr. 0. ?. Lsrson, Sausalito, California. Dr. Larson then s.ent the follov/- uo letter reoroducad below*. 'April 2, IppA To the Medical Director* Industrial Accident commission San Francisco, California Dear.Doctor: Herewith you will find roport3 on two patients who consulted me privately for illness which proved to be industrial. The delay in sending the reports is due to the fact that the men wore referred to Dr. 3arrett, Chief Surgeon for McClintic Marshall. *Unfortnnately this agency had no medical director. Safety order; en forcement has now succeeded to the Division of Industrial Safety, which also has no medical director oh doctor. The letter was probably referred to the Supervising Construction Safety Dngineer of the Industrial Acci dent Commission. 3 Cannot the commission insist upon the installation ox-1 powerful suction, fens, connected with hooeo, v/hich I am told is the only effective wsy to avoid these cases cf serious poisoning. It is quite evident that gas rnr ske '.lie p rarer.; uotneos ore quite ir.ade-ucte. Very truly 0. F. Lores i O-'.o V.' Ou aoctor iOrl 113 . .it < no ien; would hove noted a state of in; airier, tion. T'-is is 1. Tj. ted OUt f the following quote from an Industrial accident Conuiscion c communication dated April 8, from the Supervising C one t ruction, inoer:.........."As to the report of Dr. Larson that this teen was picked up from the street unconscious and taken to the house wh TU\V Lemon sow at 9 p.ra. (sic) end he was unconscious, cyancric, gr oonmg, doubled up and extremis and feeble pulse.(sic) Tho McGl ir.t ic-v zrsha11 has no record of such s condition, but did state that the nan is s heavy drinker, and it is possible be was in a state of intoxication on the night of March 10th, referred to in Dr. Lemons report." (! On about yay 10, a Dr. Moody ct St. Francis hospital, 5; n Fran- cisco received four samples of drinking 'water used at the bridge, from Dr. Barrett, the company doctor for McClint;cl Marshall Company. Dr. Moody found B. Coli counts per cc of 1848 in one case end in another. A local newspaper commented on this aspect as follows, under the headline, "Bridge Crew 'Ls^d poisoning1 Scouted." "Contaminated water rather khan lead poisoning, was the cause of 26 men being ill on the Marin pier project of the Golden Gate bridge. This report will be made to the idge11_] V. . iII,,;J directors tody by Chief Engineer Strauss. "The report will say that an investigation of the two mein sources of drinking water disclosed that one was definitely contaminated. It will a'so point out that the men disclosed no lead in their system." on May 22, Dr. Barrett wrote the Industrial Accident Commission, "On the positive findings of Dr. Moody of the St. Francis Hospital, the infected sources of supply were' cut out with a decided improvement in the bowel condition of the various men at work." However, the weter supplier, the Marin Mater District on hearing of this took five samples of their own from five different locations, and wrote the commission as follows; "... the'analysis in our own laboratory showed ell samples to be negstive or no trace of any contamination. "V,'e also communicated with prof. M. F. Langlier of the University of California who is our consultant on all canttors pertaining to water puri fication. Mr. Langlier mr.de a personal inspection and collected three more samples and the result of his analysis is reported to us in a letter dated May l4." "The'letter goes on to say tho highest count prof. Lnngelicr found was 0.02 B. Coli per cc, and quotes his conclusions; "The results of oil three samples collectively confirm analysis made in the District 3-office OU. 1I 7/ 4A 7/ 9 in nOr. "'rove conciluudsiivvoe.lyv "hot the water supplied by the Di3tr mains conforms to the highest standards of parity. a trace of contamina tier. suer. te is indicated in the water from the con-tractors ;tor: ~e tank ic of little or no hygienic sig :nce, and I doubt ve ry mu :hs it could be the causa of *the symptoms of illness displayed by acme cf the raon working on this job, -which ere c' a ra cteristicclly not those cf we ter borne Cio OCCO* " )n Jure 25, 1954 the turpentine issue -was revived with e note fron the Ic. Accident Consul so i or. no the Golden Gate Bridge rad High-way Dietr ict fl T,:.p that the use of turpentine -would not be sanctioned for peint 6 r rr f hne int erior of the Marin tower. This in spite of the fact that on Ju no 21st t r.e industrial Accident Co-amission received a copy of a letter fr cs the J. 3. Bureau of Mines quoting Dr. Alice Hamilton as ccying, (5) "i t is cons idered safe to state that paint thinned with pure gum spirits of turper.ti ns is non toxic from the standpoint of vapors of the solvent u e c." 6. These exerpt3 are from a letter dated September 19, 1956 to the Industrial Accident Commission engineer from '-,f. S. , special representative to the McQlintic Marshall Corporation: "You have requested certain information relative to the supposed lead or load absorption coses on the Golden Gate bridge...." "....71 cases were claimed lead cases with a total loot time of 6,570 days. On several of these cases I learned that the days were not lost so the parties -were actually working in steel con struction for contractors while drawing compensation from the -J* McClintic Marshall Corporation. I cannot give you the full figures / regarding this matter except to say that 71 cases end 6",570 days includes even the false claims." Despite the decision of the Industrial Accident Commission on February Ip, 1954 to have the splices or parts that required field riveting left clear of paint before being shipped to the site, e public health inspector noted on February 21, 1954, "The elimination of the lead paint around the field-rivotod joints seems necessary. Cn steel which is already in place or cn too ground this seems doubtful of accomplishment except s; the last resort." on March 24, 1954 the Industrial Accident Commission Engineer notified this inspector, "Considerable of this steel has been erected and I 'would roughly estimate that possibly one-third of the tower, when com pleted, will have had the holes cleaned of red lead paint, on the steel actually' erected, approximately one-third is riveted, peeving one-third unriveted and undefined of the red lead paint." Despite the i'sjnefficsciousneso of the commissions' ruling, it probably was largely responsible for reducing disease incidence from 55 in February to 13 in May, 1954. Incidence continued to drop until construction of the Lime point tower on the San Francisco side the next year. Susceptibility end resistance were not considered of major importance in this study. From the literature it appears that anyone is susceptible I 01748 10 sn sufficient exposure, sr.c the.t the body is not capable of building re; iatsr.ce to continually increasing increments of loed fuse3. However, or.: important aspect of susceptibility should be considered in this type of word. "No one ur.cer the age of 21 should be subjected to lead exposure ti "The general clinical conclusions of appointed surgeons in the various load factories would be, we believe, that the eusccctibi lity of your.Z persons i3 at least twice that of adult a, and there is some ground for supposing that the tissues of an adult, -when growth has ceased, o r o readily adapt themselves to deal with the absorption and elimination of poisonous doses than do the tissues of a young person." 1 ' ; "::o. female under 4p yesr3 of age should be permitted to handle any dry substance or dry compound containing lead in any fora where the lead content is in excess of 2h". (8) *hyso 1 oyics 1 Action sr.d T'oxicity of L:ad: '/her. lead is ingested, much of it passes through the body u nab sorbed", and is eliminated in the feces, The gr eater portion of the lead that is absorbed is caught by the liver and excrst od, in part, in the bile. For this reason, larger amounts of lead are ne cessary to cause poisoning if absorption is by this route, and a 1 or.ger period of exposure is usually necessary to produce symptoms, on the ot her hand, when lead is inhaled, absorption takes place easily froa the respir story tract end symptoms tend to develop more quickly. From the point of view of industrial poisoning, inhalation of lead 'is much more iaoort ant than is ingestion. /; Lead is a cumulative poison, Increasing amountc build up in the body a d eventually a point is reached where symptoms and disability occur. Lead produces a brittleness of the red blood cells so that they hoaolyne with but slight trauma; the hemoglobin is not affected. Due to their in creased fragility, the red cells are destroyed more rapidly in the body than normally, producing an anemia -which is rarely severe. The loss of circulating red cell3 stimulates the production of new young cello -which on entering -the blood stream, are acted upon by the circulating lead, with ccsultant coagulation of their basophilic material. These cells after suitable staining, are recognised as "stippled cells". As regards the effect of lead on the white blood oella, there i3 no uniformity of opinion. In addition to it3 effect on the red cells of the blood, lead produces a damaging effoct on the organs or tissues with which it comeo in contact. No specific.or characteristic lesion is produced. Autopsies of dsaths attributed to lead poisoning and experimental work on animals, have shown pathological lesion of the kidnoy3, liver, male gonads, nervous system, blood vessels and other tissues. None of these changes, however, have boon found consistently." (9) 017 4 9 II History ,rnd Status Resort Load poischins is the oldest recorded o uceiional disease, plir.y the elder in the 1st century described masks worn by lead workers. Hippocrates in the 4th century described adverse effects on diners one meteLlur~i fi \ .. ^ j Greek, Latin sr.d 'rabian physicians knew of lead colic following lead in gest ion. Biaucorides in the 2nd century described load colic and paralysis from swallowing lead end breathing ita fuses. (11) phillippus pare clesus, "Bombcstus", the redoubtable Swiss physician, in the l6th century decoribod diseases free: digging, smelting end washing lead and described lung consumption, asthma and dyspnea. K pointed out fallacies of cor.temporary medical theories and taught the use of specific remedies rather t-an bleeding and purging. (12) i. round 16^5 Stockhausen described the "Colic of Poitou" end sale to a region ir. prcnca where wine fermentation was promoted by adding lead to it. a similar syndrome was noted in the early days of prance and England caused by Iced in cider and by lead lined cooking vessels. In iSpO ^-nquercl des planches wrote hi3 famous treatise covering 1217 cases, yo was one of the few to note that lend poisoning can bo traced to :he innsiation of vapors or emanations. After Tanque vest amount of di -mice data was collected in England, prance, and Oarmany It is inter esting to note that an analysis by Kaye end Roznikoff of street dirts collected in 1924 before ethyl gasoline wca introduced had pOh lees lerd than in similar samples collected ton years later. (15) .tub has shown in 1924 that injection of lead in the trachea leads to rapid intoxication. As much lead, may be absorbed from one such injection as from 2-. I. ndninist ration which lasts for months. This is due to rapid phago cytosis and/to lead entering directly into the circulation instc-cd of pass ing through the liver as in G. I. absorption. Also excess phosphate ions in the G. I. tract keep lead insoluble and further decrees absorption. (14) As ear Ip* as 1912, Logg, a recoxnized'T.ut ,''ority in the field of load intcxication makes this statement which is of special importance in reference to the Golcen Grte Bridge epidemic, "There can he no intelligent control of the lead hazard in industry unless it is based on the principles of keeping the air clear of dust and fumes.'1 (Ip) a 1948 patty had this to scy; "Next to the smelting industry, the most anger from 3uboxide fumes would come from the burning of lead, 03 in the application of a blow torch to a load surface or one coated with lead paint." h'e gives the maximum permissable dose ag 1.5 mg per cubic meter. '' o establish background amounts, in 1955 K*hoe, phamsrun and Choleic obtained excretion and absorption samples from primitive communities in Mexico which were isolated from natural and industrial lead contamination. They found :jsa in urine m amounts from . no to .03 mg/lit., and .02 to .59 mg/24 hours in feces. Bisod samples ran.from .20 to .06 mg/100 grams of blood* ( lo) U* M ni 750 12 More recent ly ::i 1551, UieScnrohift and lead ooieoning i probably duo to acitoning of the enzymes, interferrin. v; i t h the cc. t r- b o 1 us :or. (17) Fried, Schubert and Lindonbr.un, ore doing product ivo work :ne Argor icorotoruoc i .`V rioic now . \J U - - C 'J uo university ox vilun ave 0-21:1 ctucying ;V;0- erythrocytes by electron nicrcscooo observation. ultra thin ey.es ox guinea pigs pcif.or.od wit! A r--n*-ro ver. ex-rumined. gono of the erythrocytes showed swollen end altered nit echor.dri: ;v: cluutere of dense granules of obout *0 Angstrom d iernet or with high electron .scattering power. Those wore not rot icul ocyt cc, end were not observed in control animals. _ Lead int orfores with the syntheses of hsom. 3 ^w1 Ou C ^ :his synthesis occurs in the mitochondria, it is believed those alterations r.re induced by load. This confirms work dona by Bessie end Broton-oorius in 1957. Bober t giegfeld (19) lists the Ip 52 consunpt i-.>ns of Litharge end Red Lev. d at 57,0n2 md 2p,0'.'0 tons respect ivcly and states 2?,020 tons we s used in paint and varnish alone, but that this i3 nowhere near the amount used kO years ego. However Red Lead is still the world's standard for natal oroj V.t . -iivTrc paint s. 3ho la k states that sampling of air from lp^l-55 v/ns rand 02 and ir.t eraittant <' nd in 1955 : continuous sampling v;as introduced, though ir. relatively few locations. gehoe says "The accumulated evidence of cur observations made ' from time to tine during the sect 20 years -substantiated by intensiveinvestigations of human subjects in the Kettering Laboratory justifiiba the categorical statement that there is no hazard to the public from lead content of the ambient atnosohera. IV Summary and Conclusion: The glaring deficiencies the investigator becomes more and more aware of as he follows this four year epidemic to it3 conclusion, are misinformation, apathy and lack of education. The latter two -work hand in hand. Adequate information was available long before the bridge was built, but fo\Cr utW most part it was ignored for worse counsel, v.'hat effective raeas we t & enforced appear to have been enforced haphazardly end without conviction. Management attitude even for pO yosre ago, seems to have been singularly unenlightened. A tendency to call a compensable disease contracted on the job by another name is quite apparent, in the bridge engineer, the con tractor's doctor and in the State insocctora. Since those days, the California Department of Industrial. Relations has been reorganized to include s Division of Industrial Safety consisting of over 1-iC field engineers and supporting personnel, including a subsection for industrial hygiene consultation, called the Environmental Engineering Unit. Four (and hopefully five) out of the seven engineers in this group have Masters degrees either in Health physics or Industrial Hygiene. In addition the chief of the Division is an industrial hygienist. Heedless to say work 0175 15 of the type leading to this apid-em .o is r.o longer permit ted .'itbo- t oositive prcr:3ure ga.3 masks. "he need for Q'^7 i'. ' J* linos cr.d c g : pressor pbeen obvisted by portable sir sups y unite such ss the cott peck It has been found necessary' in nary coses 7^6ro 0. worker needs unobstruc ed vision. to require masks with s single l&r ;e viiv:in.m ores. It is lonrer r.eoessarv in J to r- V c. *0i v v ;opar:msnt or funic Health is o,, r lory cistanco ceip. tsffed with m Si 0 CeAxppOoi rts i(n ir.dus- 7 u .p giehe end has well oouippod laboratories, indeed thee anviren iont mil '.-.'or::s core closely with this gspertuent than ts own. in ; counties throughout the otctc, have health wonts compar- L x* T' possibiy bettor. An interesting obs ;r- vetion at this point is that at leapt three California, counties hove bear, juciped competent by the Atonic energy Ocraraiaaion to take over pre-licensing inspections of isotope users, at a ties when many states have not yet done trie. The unions too are better equipped now to combat abuses such as resulted in this epidemic, cr.d the writer can state categorically fren four years of close association with union business agents that union action elor.e would step such an epidemic today. Therapy consists in preventing absorption or resorption of lead f rom the k liosntsry tract, promoting th e urinary and biliary ever etion of 1ead without esmsge to the excretory organs , and accelerating deposit lor. of le sd in ths bone, chelating agents hold g rest premise here, and may provide c* COm j 1 O ; C cure for those afflicted with what has been regarded ^pre viously s s a lifelong insult. At present (19^5) the most effecti^e single therapeutic agent appears to be tho calcium disodium salt of ^thylene diaminet el re?, cet ic ecic (gjr,A) or calcium disodium edetetate (20), This compound forms a stable, soluble, non-toxic, virtually nonionic complex with lead ions. The result of adminis tration is usually a considerable rise in the urinsry excretion of lead and at least a transient suppression of toxic signs and symptoms, including even the manifestations of lead encephalopathy. (21') _ 01752 . /. V. Bibliogrohhv 1. Cotter, L*v., "Load Intoxication by inhalsti jr." journal of industrial Hygieno and Toxicology, 23 ;44, 1946. Losd - Health practices persphlct No. 5, Published by the National Safety Council, 1C3 2. Ohio Street, Chicago. McCord, Report of ths Committee on Load poisoning the Meeting of vno A-an: :n public Health association, Sept cab or 5~ ly29. yinr.03 polis, Minnesota. Mf. . Hamilton and Hardy, industrial Toxicology, Haroor and Rroth-rs, o. 559/ 19-9. Hamilton, Alice, industrial ?oison3 in the United St t 2 3 f "t Ci O vecyillai Co., Now Yor'g, ? 199, 192.5* .6 Dr. C-crsy p. McCord, "Standards of Industrial Control," A?HA, 54 V/cct ?th street, Cincinnati, Ohio. 7. LsgC e"d Croodty1 a, "Lead Poisoning and Load Absorption,1' p. 55, 191?/ 5. Thonss M. Loggo, Journal of the Royal society of Arts, No. 4207, p. 1023, September 3, 1929. - / 9* Irving Sax, Dangerous proportion ci Industrial Materials, 2nd edition, Hein'nold Publishing Ccrp., No/york/ 19op, ?. 951* .10 patty, Industrial Hygiene end Toxicology, lp4S. Hamilton end Hardy, industrial Toxicology, 1949. .12 patty; op.cit. 15* Hamilton end Hardy: op. cit. f: 14. Aub, pairhell and Reznikoff, Recent Investigations of absorption and excretion of lead in the organism, Journal of the American Medical Association, 85j 588, 1924. 15. Legge and Goodby, Lead poisoning end Lead Absorption, London, 1912 13. Kehoe, Thamann and cholak, Lead Absorption and excretion in primitive Lifo, Journal of Industrial Hygiene and Toxicology, Ip: 257, 1955. 17. Hxerpta Medica Set 2/4 1951, P* 5^7. 13. MMA Archives of Industrial Health 1959, 20/3 (475-6). / i o Load Symposium, February 25-27,.19^5, the Mattering Laboratory. Boss.uan et olle 1954; Chisolm and Harrison* 1957; Cotter, icy4; Lockio and' Toapsett, 1953; Sidbury, 1955; tenis, 21. Gleason, Goooelin end Hodge, clinical Toxicology, of Commercial products p. P'S 1965. rat n 1 7 r i U I /0 ) H DW iDUrM-S & C m \> p Pa D\ \ -\ rv i...- V?. V* iWh'c^Ves a^e- 01 7.54 r i X o r\ 01 755 r> rA a , v c.v\ n 3 (. , n !3VV>J <?. J A A \ a -) ?} > .iO U L nlo V ? t/ cl V J " i)A i 01757 '0) y V 'l #1 ' Vr-i M ' Vr.v/i U- x 1J "V>. 2> V\> MY ';* <i V'*H 14 CA IV.CO 4 :V v--'^> > \. vN"X t i O1" Z\ q r* V v. i i - t : \* <Jc- 2 3 vci: //2as - *1 >1 11 nOO to w *1 S') V HI Ph vvvT Cv s 5b'S 1 2 *1 \A/ 6>i | b bc hsh I'Ll HI $K \Lii 5^3 Z1 5>`-o/ <3 = be /" i / 103 /\ - %*\ a \ ib3 . 1 01758 n (' b - ti /'S 160 U \ IV \f \ * /V J I V\ - 1 Yi W MX. = l~L = \ti V? ^ /u^SO v. v Ovv pcuviTC rS O' L>Liyc-_~ Ci"* 1 G S = b'l Mt (H*^ r 5! _ q,L = ( / f --: wr t* 0 ( G b' 1 A1' & ^ S' 7' ^ G - 7L /H Yo. L0^\O <^5 f0 Civ, Ct'p r?i.-tc-c Sl^-vvx ? t C &vs.t \v^ cO lev&A ) TYt Cv, l v^. vv; o y' V Z\\A Q,Xt yUv bs. n i 7r 9