Document OEzrJp4XknJ1vYJ3Jjx9Xg2Zv

( h O %, tw1fi*5bd ( Dear Sir:- ' ISA1) POISQffISS ' . Mr. J.'O. Elton, of the International' Smelting Company, has very kindly writ-teD us in regard to jour experience in the prevention and detection of lead poison ing eases at the East Chicago Plant. - We have in the past had considerable trouble from this source' at our plant here, and Mr. Elton suggests i, __ that you might be able-to furnish us with some valuable advice on the treatment of such cases of, poisoning. He also refers to-a.paper on. the subject written.by your former associate, Ur, G. W. Miller. We would be deeply indebted to ypu if you could furbish us with copies- of Dr. Millefs paper or advise us in regard to your ,own ex perience in handling these Cases. . Thanking you in advance for your co-operation in this matter, I am, '' Yours very truly, . International Smelting Company 25 BROADWAY n e w YORK, December 8, 1921. /.} rJ\- t^ ,'V' 5 Sf. > ,, ^ AV Mr.,B. B. Gaples, Asst. General Supt. Great Falls -Seduction Works, Great Falls, Montana. Dear Caples* , c/s? ' '' X I was in East Chicago for a few days and shall return there again before I go west. .' ' By.: the way, I ran onto some very interesting news in regard to prevention .and detection of lead poisoning. The prevention stuff is mostly old, and the essence of it is cleanliness, such, as washing hands, face and teeth before eating, daily bathing, no tobacco while on the job, all clothes changed before leaving the job, use of respira- I. , tor and goggles when in dusty .places, etc. It has been found here that a blood test will show the effect of lead long befor.e any other symptom will indicate it. - Once a month a blood smear sample is taken from every,man working where at all exposed to possible lead poisoning. These samples are numbered and sent to a reliable pathologist. His return classifies the workers into several groups. . Wo, 1. If reported negative the normal amount of-red corpuscles are present in-the sample. - " 2. Are the positive tests. This shows the first indication of lead poisoning, and the number of red corpuscles have slightly decreased. " 3'. Are mildly:.positive tests. Show a decrease in the number of red corpuscles, with the addition of a few stippled eells. n 4. is mildly positive with stippled cells and mild anisocytosis. Medical terms from now on increase rapidly. ft A? > ,ut- Reproduced from materials in the Montana Historical Society Archives. May. bs subject to Copyright Laws (Title 17 US Code) ColLNo.^'........... Bx/FdNo. |^ ' ' '' V..Y Our East Chicago records show that if we do not aot at once when the tests show that a man is absorbing lead and is near the danger point, he may be taken down with acute lead poisoning within a few days. Both Johnson and Bowman claim that this test spots the man- susceptible to lead poisoning- before it has really done him any harm and before he knows it. By following this test we .can remove v -4 the man to a place wbiere there is less lead and give liim a chance to recover, and-in certain other cases it has been necessary to discharge the man, because he would not obey instructions. ' ' (These records also show that a man fully recovers if re moved to a place where there is no lead. Busty places are by far the worst, as we all know. .1 thought you might be interested in .this information, and X am giving the address of our physician, as 1 thought Dr, Davis might want to write to him for additional dope. j - ' Dr.'S, C. Ernst 720 Chicago Avenue, . . East Chicago, Indiana. ' . Dr. Ernst was formerly associated with the late Dr.. G. W. Hiller, who for several years made a specialty of lead poisoning and presented a paper before the Medical Socisty at San Xrancxsco in the latter part of 1920. ' . 1 believe it will pay you to have Dr. Davis follow this up and. he might be able to get a copy of Dr. Miller's paper. ' . Yours very truly, 1 JGElton/j -disappearance..,ot me oacuii. -in o - sausiaciury means oi eaten iu ivuu m w h j w u tuuu "was,been devised :for destroying the bacilli. When local lead; when food or tobacco is handled with.hands .dirty BieaSureS'are 'of. vahtedt is usually because they, aid in ' with lead compounds; when water or food containing correcting;'abnormal conditions which interfere :with-' lead is used; and When men working in atmospheres - diedestruction of the bacilli by the'natural bactericidal contaminated with lead dust swallow either- the.; dust-. . processes of the body. If such-local treatment has been which accumulates in their nasopharynx or what is unsuccessful, removal of .tonsils and adenoids will dissolved in their saliva.., y. . .... . .. : usually be. followed by`the disappearance of . the bacilli. :'.The : second channel ;bf -enhance is Uyovay* of. the . respiratory tract through breathing of lead fumes ahd vHtr.'JC ;.y y ^^:^:Sdusti:cdEdiuu^le^di^Leadpoisoning may.occur fiom , ' tIvNriDTUtcSTTinRI\At L TL1-ElAnD nPjOiTICSiOnxNirINMGr-**: tqhethfucmlaetsteorfc!omesolnteont rleeaadche,vtheen bwohileinngthpeo.intet.mpIe.hraatvuere , ' '! ' MARVIN D. SHIE. M.D. demonstrated by means of sodium sulphid papers that WKEWOoD. o h m " " ' /.' " lead-ftimes are given oft' f rom pots_of molten lead at 'v:,-;-,..... . , . : a-temperature of approximately. 750 E.. .and have.. A- '. Lead, poisoning :is ' almost as old as' written' history..'.1;- found case's of lead pois'onirig among the men'workii'ig' ' Ancient Rome used lead pipe in its wonderful water- with lead at this temperature. -It. is quite likely that works system, and many of the inhabitants became fumes are given off at temperatures even lower than afflicted with the disease.. It has received the attention this. 'Most of the lead dust breathed is caught in the of physicians ever since the dawn of medical science, nasopharynx and swallowed. Lehman and Saito have arid every age has witnessed contributions on the sub- shown experimentally that when dust is breathed only ject by medical men. The'more recent additions to our 12 per cent, reaches the lungs, whereas 70 per cent, knowledge of the problem have been made through the - reaches the alimentary canal, -. - . researches and writings of such authorities as Oliver, The third and least important channel of entrance is ... Legge, Goadby, Hamilton and Hayhurst. Notwith- through the skin. Some investigators have denied that . standing all these contributions, there still remain.a few lead poisoning-can be caused in this way, but enough points about which there is some disagreement, arid the cases have been encountered with apparently no other ---- present-papery-notintendedas arthorough discussion of -'pos-sible lii'ehhs" of" absorption "to entitle'It to considera-' all the phases of- plumbism, is offered for what it is tion. As mentioned in a previous paragraph, cosmetics worth' as an. aid in clearing up a few of these points. and hair dyes containing lead have been known to The material is drawfi^ from experience; gained during cause-plumbism. A case was encountered in Cleveland aj study of lead poisoning in several industries, during which had apparently developed from the use of a cane . which I made thorough, physical examinations, includ- with a lead head. This case is similar to that of the xijg laboratory work, of more than 900 workers'exposed harness-maker reported in the literature who developed -to the lead hazard. Eighty of these were found to be jea(j poisoning from the use of a small piece of metallic ' suffering from lead poisoning m various degrees of -,Iead wjth which he wa5 in the habic 0f. pounding the seventy, and ninety-five others had sufficient signs and leather. I myself encountered two- mild cases among symptoms of plumbism to warrant a tentative diag-. men wtlQ handied 100-poutid lead pigs.- In this Case qosis... - -- ... . ` . there' is, of course, the possibility that .they breathed : & . et io l o g y . -. and later ingested tiny bits- of' metallic lead dust or By far the greatest amount of lead poisoning occurs lead oxid worn off the pigs in handling, camong industrial workers. There are now approxi- The lead' that reaches the stomach is converted into lately 200.'American industries in which lead in some the chlorid by the- action of the gastric juice. In this \ form is'used, and. in which, there is consequently a form it is capable, of osmosis and so enters the blood possibility of the workers' contracting plumbism. As stream, ivhere.it combines' with proteins, forming an industry is becoming more and more diversified, this albuminate. The lead that reaches the lungs passes . number is constantly being increased. ' ; through the alveolar and capillary walls and forms the With the possible exception of- the silicates, it seems same compound. If lead is really absorbed through the. . that lead in any form is capable of producing poisoning. shin, it is likely that this, compound is formed there This danger is more apparent with the soluble salts also.. . andd. with the fumes from the molten metal. It decreases Some of the lead albuminate is excreted bvy the IkriHd- as the salts become less soluble, and as the temperature neys; the remainder passes into the tissues, where it of molten metal is decreased. Thus, with lead sulphid, remains insoluble so long as tlie reaction is neutral. It a salt relatively insoluble in the gastric and .intestinal may remain here for long periods, doing 'no harm jjiices, arid with the cold metal itself, there is compara- until some change occurs in metabolism to alter the tively little danger.. _ ' reaction of the tissues. This renders the albuminate' Aside from the industrial sources, lead poisoning soluble and capable of reabsorption. It is tints able occasionally occurs in domestic life. - Formerly this type to reenter the blood stream and once more exert its was fairly frequent, owing to. the lead absorbed from harmful effects. For this reason it is sometimes lead .pipes by drinking water.. Cases have also occurred - unwise to give iodids to patients who have worked in from- eating' canned food, because of the dissolving lead, as the iodids may. release the albuminate and action of certain fruit juices, etc., on the lead in the cause the lead to be reabsorbed, with resulting mani-- solder. _ Other cases have occurred through the use of festations of acute plumbism. Any sudden unusual (c'ohesmmaeftiinces, hair jd-Tytreosc, eefrtvc., ocnonnHtairinttifnlrgp TleoanrdT. . ' exposure, a drinkin__g Lb. o_ut, o__r__a.n.. inf<e* c. t. ion. suc^h as 1 The "portals of entry'.' by means of which lead enters i"nffluenza, may prod4uc.e4the same efrfi*ects, the body are: threefold. The most important of these . . Lead that is not acted'on by the gastric juice passes for *1T92in<fs. pgarapnetredwabsyaLwtbaerdeCdlevtheelan$d1D0AfeHdaicmailltolinbrFairsyk BAisgsgoacria, t,,Siorn.*. pmr~e coauptabin-le tOhTe* feces as exeftlllg ITalOrse*ulSrpohtlivde.n,t Tahc,tewiongaOsitlri1lceaJjdu, iwcefacisil ;lNDbWriUAl L.AAD z 4* - 4 - <- h1- -'1'V-%L t t'4,-1 \ 1 '' y-.,f'- tHesttjmaeS'4^ empty;:.therefore"workers:`exposed to* causes constipation,' and deny that diarrhea can occttc. r the-, lead hazard s&ouid always-eat' breakfast before -- This is a'false assertion, for diarrhea often o c c u f s in K .going to'.work: and. light lunches, e. g.t a glass,of milk, patients haying a gastro-enterochlitis, and constipation At mtenAls during the'working,daj' , are desirable. ...and diarrhea .-sometimes alternate,, .This case is also ! - ; The'susceptibility to pluvhtsisni;varies enormously., Van- ins.tance! of. a person's being-peculiarly susceptible- . Some workers will develop' amacute attack after, work- to- the-effects of. lead intoxication. . .'" . ' ; Jug only a few days', while others may-work, for months. -. at the same,.employment without experiencing deleteri-: Ca s e , .2.--rA , man, aged, 57,, who had beeu. a dipper in a rs.'podeiii^i.twentyraiS},y.4aw," siopped. potte`i.y,~;wo.rfe fowl and-;;.one- ,ii ous effects/ 1 found workers"'who had been exposed . half Vsyar5'.3.gd'.aTvi .'farmed fnr- three, years... ,At! the entL of.: ;i1 for more than .forty'years-1 vraEhout;'experien.cing 'any '1 thik period he began1 dipping' agaia..'-.Hc dipped: two weeks, i. i ill effect's,; arid! found others...ty-Ho had been, at the same:,...ivhejtf; a. petonealVparalysis of: the right-leg ocetrred with toe ' work .only a few .weeksandv had' taken.'just1 as many"-;j: drop VkThere- wasi'considerable pain in the foot and -ankle and , precautions, who developed plumbism. --v- : along the course of the'peroneal, nerves. He bad a metallic : ....~ "PhtHdbO'dY^AKS- SVMETdilATOLOGy'-'~ .'taste, nausea,4and trempr-.pf'the.tongue.' There.were.tio other. . ' symptoms.;; He.,discontinued work four-monttis, during which . f;: '. ;i-Acute .itcrpj.^-The .usual casen bogins with; some' "time he-gradually regaiiied strength in--the.pero.iri'eal;;.iniisctcs;, ; .' digestive; disturbance--.a sweetish metallic taste in the Vi. mouth, nausea, sometimes vomiting, anorexia, and fre- fiuci 'po-.vee 'of dotsiflexfon cfTis toes;. gradually Iet.V The netiritfc pairs . :guently diarrhea. ' The' latter is. due to the-, gastro- . . This case illustrates' the a.cute form' with paralysis . enteritis; that is so: often present.' Constipation'and. . which sometimes1 occurs-; almost without symptoms in : colic also occurin a large number of cases.. The.calie cases'; previously- epeposed-to-lead." Acute plumbism, is'yejry 'severe, wholly;incapacitating .the ,padsnii.,.There' however, is-usually diagnosed by symptoms * rather . - is''dstiaUy'- marked -pallpr of the,- skin,. due to-wjnstric-_ than-by.-the; physiehl signs; ; - /_ ' ' tioii- pf the peripheral vessels rather than to any actual V A\ V anemid/V.These SymptbmsVareVcommbnly.'adcdmpahied'. . Gas s '`3.-^As .ipaaf agfid .22;: waf a, glost-kihi placet" iur a. * by^freguent severe- headaches,- insomnia,*-.general . pottery' for thfee'Vears:' He was- then iu-the-army six months, asthenidy apd a feeling of lassitude, -.Oftea.an- acute. after, which- he" returned' to the..pottery arid: has now been working- kbv:ntbnths. He-Is losing weight;-has general tnal-aise . asthenia-and-a feeiing.of lassitudeiTretinent'-severe-headaCh'es,-:- ' /.Vi- seyereV.pa'ins along;.,'thenerves!./affected;,;- . The: optic. '..nausea,',, breakfast;.anorexia; a.'metalljc taste:, constipation, - - nerve may be attacked, later'causing optic atrophy and ; lumbago; ajuscular.-cramps in the legs, and- arms, didt-WHSc .- . -- bHndnessv /There is nsnaMy's.om^albgmmh^fdde-itO:-'' chiatadhei,;-and:,fFequeht:atiaeiis 'of diVjiheSs'-.'fie has., pallor - r anc acute - nephritis. affecting. the,- cells--.aflthei-renhl ' aiid/t&riior,pf thTfingersi ,;.Exain'!patfon'.>therivise- is, nega-- ,* -"hahiilesV-V V " tiypl' '-Tlie'^dfagnosfs';l.H ihild acute - lead: poisoiilng-. " .: ; - .-it is^ in- the acute form- that the encephaiopathies;. Cas e A,--A^rnah,. aged 42,..who was; a.gldst-kila placer'spt , iv`i.V-schineoKrwiestebovrafetler/hndeifomdcocarurrrehsa"cg- aTeushs.e-esdebScyyarcsneepnsie;pabir.heras..cioedmdreepha?jsr^aeavt3enjr:deeI'mfyhifeh,rauadtree-.,.j\ tyatrhg^eeostr.Fne.foa.aHrftt.hee'oerhf,raVht(he.Tse:''-us-afididinldd:.gdaeee-hrIReslyt,ay/d'da. terIoihdvsitee'-hl,-ofcyopoprenesdsrcao:icmomtuievsa'enrr.ekL sremesdtet.er/xa.pOe'na.n-dl:leow.trdh,aar"esy'a::e;'ss,uthhyr'ieeoenafpii:ranlsy,-..,;'', . f'.s;-.;-..adies^;delmtmij- convulsions,vomiting,, retinal changes ?,' 's.cipus . for ahont^orie'- hour.- ' This! was -followed:: by . severe: . '^y>wft!r?'^ipfoptal---ors;tK>nsieat blindness,' and sdihetriries'. headaclie-.:'ntosis-'.of the- r.x'giit--'u&per-eveliil anif dibl'o'oiaf.- He- T,,;,paralysis,_CGmaand-death. ; .- , fdijd/no.t.- work-for sik.!months, ahcl'- .gradually tecovefed,;/He-' r"s .vstt'Thdacate icases -the red blood! cell's. become mote ;sfUi/haS.'a; tead:' lme,,atid;ifemdr'-of the tongue';.:- -Tlife-.lieni&f-'. /r-v.^^nesKtrux^txic'heiaotjAis' than normally. Therefore in '^o^risV^j^i^^yijrpjsiHexiiMi. is- .impaired/on.^e/rigiit, : ifthese 'c^s;;fde&erfi^n^s...:5topdvebi^usele1;tesist^ce; -.- -f-itcstVtSKoTdiagnostic value. .. Tt l chronic "cases- this le^t TKjf '.Waase^anri;TMt--Attd/yehe'reaf history-'^ ;ar'e-'`'nej^^SV i t Thw'/Han fs/'ah;-JnStanee:;o; acule -encephalopatby;; supenimf posM:,-:od': a-.:.:easeroi''teadL;abidrptioA.,. He 'j^ceweEei: Eonii|tS:t is..worthless,- vi\t tins stage, basophilic degeneration,of acufeiattack/brit sb'ir has'/lcadoyJjsorpiiori.- as; evidetic'e'dlby": . ..'the.rcd.cells mayialso'be. detected.! ri" rV:^v-. - the-:lead;.tine, - - Shpuld:..h;s'prf:ser,t .balance bet<fBivabi^^ ' Aimterases sometimes occur within a few days after an.4; iex.cretipn ;be;.agad!l-disturbed,, he vrouid; prob.abIy/li^ye,. rrl lit these the lead line is*absent-- another acute attack.-."'-.. . . V-: . ' c Iji'-ThpsdV'cjtses,-'' howeyeri.Vwbicfi::. suddenly - attack: art . iCksE i.S^A 'fhah;; aged-/4/j. a, dipper for thirty years*',three . > 1 'V rMi-frTMuT* "ft fiadvt a.v^>^r<-j->^.'. -CX*! --7k. - :'irioiims...agov:ater ! a. drinkitig. boiit began "to feel d'i'Hjj-Vaiid . light keaded-''These' symptottis.:rapidly-,became mofe';s,eMrp, ` /r'beeu; absorbing lead'for. some time. >:Such. attacks: are: - due to a.sadden,,change in.-metabolism whereby fhe iadividuaFs' excretion: can nodouger keep pace withfus- ari'd-idiplopta.tlevelpped';' , Sootr he-;began;-to-;notice numbness of his whole- -left sTde*-arid- - he'-.becameivery -weak..' .Af 'tBfi"/ time he1; had -.breakfast; anorexia, -great drowsiness,;. tinnitriS: '1 atiHtmfe extremevriergousaess, tremor of the.-tortgue ariil'ifiri' . ::;c;'-:ah.sorptioa-,;`::.i.Sueh.-.cases:sometiines develop a sudden ge.rs-, triarkedi yiibor.' cyaiiotic'- gums,- lead- line, weak'.grip, . , - paralysis almost without any previous symptoms. ' ic -j j im'paifeid;.; jiijre.if'ejdb^tand.:. atbumiiiuria. Suddenly - heydeVelr. -'^'il^.T^'kite-aTew^EepresehtatLve^casc hfstoffes/wHch oped, .severe abdoininat, cramps, which lasted ,oS arid .oii ..fpr- v ': ; :fllustEale'Somelof .die.ToFtris. Qf acute plumbism,": " ; ` -scA^affd^'i.-duniii^-Afcliielj, his- temperature was-. 7 p/pulse,- ' 56-;,. systelic:.bIp.o'd'.pressure,.; 160; .diastolic, ?0;'- .The;.nerikiy - L Cas e It --A itrattp-aBed 24, works'manager in * pottery, grobiul-svas: PO/rieri. cent!'.;'' a,.two months''' rest,, his.fsymp-*'.. durtrigslhe abspn.ee -of ,aisaggeriwaslter painted." saggers .with.' .toms; have;;gfa<faaUjv disappeared/though- he .is- stil-l, very/weak' 'a-.`solution'.ot.redC'Jead.-.'jHiere developed severe ;diarrhea , and- has. a. riiarkedflead:-line. The pulse is--now. 80, tempera-- J- - ttccoiripanierl-wfth !andrevia, nausea, headache;, dull -abdoui-, tttre: normal,, snd - Maod- pressure; 140 And 85,. Thia-.riase-:-i5, ,s . iffitf;.-. pain, albuminuria -.and, a -gcnecal , :eetag, of.- lassftudc.- another.-, fn's^ricp;'.a.,;'dist.urbed balance' and - resultirij^-ierict , / Syuiptonis soon cleared op on cessation of the wirfr and. .intoxicatroW'aft&^a/riihriberi.rif years! ..exposure- had; ., ' be'gan-.again 'seveTal days- after, its resumption. A diagnosis ' had lead; kbsp.rptlori'Blf'-sfflrifc time, as ivas. shotvni.-hyrhis,.|'eai ; of mildacute pliitabism. was made, ` . ' . line;. buhads,expeiericed:yo-,ilt effects therefrom. . : _ ;/fhis- case is listed merely: as-am instance of a case Chronic TurrM.--Mai-ked pabr is almost a. cofistaut in. which fcliere^was diarrheai Some, iphysidans assert . symptom. Adicofding; to many investigators, this fs ' , that the: intestra^.'spaam wluch:..sa frequently . tKcttrs due to an actiial anemia.: I am. inclined to .believe, tbgt. Reproduced from materials in the Montana Historical Society Archives. May be subject to Copyright Laws (Title 17, US Code) '^--0 * fxrusTRi.-iL .u rorsuXt.u,~tSt l ,, . ,ta-, . , -i'-;----; -< / -i-.-'V' * vriyV" V<%. r- , > ' ' i <s L *** ' "arieitiiT beenr<- lo% TreqiibMly than its* eot-tiuvenU-' supi ' it' it ctuitntLic.Trcstil<^{irsV cntn>bA ppb^di-for aliluuigh-most oithe patient* tin my soncs . of rite nerve-aftVetCil atid.later in writt drop. too drop.; ' cxirbitoii the pallor, red Wood' counts in"'nearly all .ditutlderidrop ur Itemi drop.jas the casemaybe, .'After ricases' were'.bttt slightly below normal. As stated in a : a.time-1tic inuscles;'affe'cte<f'niayyinHler.t> atrophy ninl. T previous paragraph. 1 believe thisnallor to. be due to tr- f;tuy: degeneration. and the opposing .(set of muxcic* . ' (vasomotor constriction,- a- spa.stji'of the 'peripheral 'imy goiuraer. This- sonietitneis'oconrs'iir cases of wrist ,. arteribles. perhaps of.a nature similar to 'the.spasm'of drop, and a partial subUixatitm of the wrist results. Eu S&theidti^rin^:\yhkhaso:ri:fi^m.Qj:gn.vs,v-ari(lidlS1iiarT^n.lsx>..U'ngsstaifclinj^cases, of..stielp..prir;dvsptfevtvtiih;i: .tUP'ors. Wsimilar to. the tmisciiiar.spasriv/wliich.e.irttSe the ijaii-i.i\me\yjK^C*^<sciittd j* a ganglion;" litay-litehn':"f These / '.tnusemar cramps, a; rarit:hecr': common syymmpiftfoqmm.,./'^'frhttce ' tairrouly^fraiysesihietsi^piiatlw Avtir. TeVy-""suddctiIy-~ ; herin.iogliobiu peorcenritages vary econp.ssiiddeerr:aibbllyy.a.but doiil thhee; atmo.st wirhritu-.w^^ Ari-whoollCc aree.''intbbt.nmuuiccIhV,.lloower thilaaiivv.itltoseir'ifoouiiniudl'raiiurodng aiiy a ^|xi^cV^r.sdntt}!tiniei'i-f.tn'.'r:itetciis^!'-|jK.Tc. are-gen-l M- 'simmiillhalri-'groufrpp '-ooffv ivwoo.rrkkini'fgr-*' 'people-' rniot affected (.wwiitrhit' ' eraiizbd^piLfsies, fehieh nitty.invoke tlifc diapliragul.-aiul;. phlummiliism.l None were found below 65 per cent: the cause death. ' '> j ^m..majaojroirtiyty,,; were .betwyveeeen^SSOO-A-jandy; .110Q0&..w. -TThfise tennddss-*. ,.to..s:;-v'.||.eajllapheiijs thcfriuost^imnon,syniptc|ni.prcse;nte(l lie ' bear out the 'hyvpothesisi' thhlaft:-.r'i:tiei-'--'pialloll.or'r:':i:is/: caused by - dig. nervous system, t fus"is''soinetiiv.o-~- constant and is ./ ; ''ecocnstrfiction of the.periphheerraall'vveesssseels rather than by a ' frequently'very severe..-1 he. other tiCfViuis symptoms.;-; secondary anemia. 1 . * mentioned above under acute-. forms Sometimes occur. In iIcoiinection with this it may bee'weljl to discuss, but not with such frequency. There may he periods of briefly the other blood changes. A number of investi- profound'mental depression apparently without cause, gators have reported the finding of basophilic degetti- . which may alternate with periods of excitability. . eration of the red cells in chronic cases. In my s:eerriies Marked tremor of the fingers, tongue, lips and eyc- I found it in only onee'-iinnssttaance--an early case--and the - lids-are nearly always present, and constitute a prom- stippling was. not marked even, in this case. It is my mew sign. _ Ihese may be accompanied by muscular convipction that basophilic degeneration has been grreeaattlyly- incoordination and possibly fibrillation. There -is overrated .as a diagnostic sign. If present frequently usually distal ataxia due to the peripheral neuritis. In -eennoouugghh- 'to bee.'oof diagnostic vaalluuee., it must be in tthe the early cases the reflexes are usually hyperactive; early sisttaagges. . ' . ' .- . later they are diminished. The pupils may be springy In all cases of chitronic plumbism'. however., I did find and irregular. Chronic muscular rheumatism, lumbago, one change inn. the blood picture which was practicailly mid pains in the ankles, feet and knees are frequent constant. This was a marked increase in the large complaints. . ' '' _ _ monoiiuclear cells, ranging from 10 to 35 per cent. Contrary to the' reports of many investigators. I This 'increase was frequently at the expense' of the found the lead line to be one of the most constant signs, ' polymorphonuclear cells, and sometimes at the expense This may be due in some measure to the foun.of the of the lymphocytes. Hayy-hhuurst is the only other hives-' lericl ,t0 which the patients were exposed. At any rate, tigator that I can didsicsocvoevrerwwhohohahsasmmadaeden-nooteteoot fa a more than 90 per cent, of all my patients had well similar finding. It wwasassosococnosntsatnatntininmmyycacsaessesthtahtatI I marked lead lines.1 hese were very readtjy demonbelieye it i'iss a- point possessed of some diagnostic strated by lifting the margin of the gum away from value; provided, of course,; that other caauusseess--of .. such a -^ie T9or^! vv!th a thin, white toothpick, .1 he black mondnucleosis can be ruled out. Such conditions, how- ' deposit of lead sulphid in the end arteries of the gums ever, lare not likely to be confused with plumbism. . men appeared very prominent against the white wood Although there iiss usually some anisocytosis and a3 a background. Most- of the patients in nty series ^ poikilocytosis, I did not find them present to the extent ,a'so *iad very bad gums and teeth--whether as a cause usuallyy ' spoken of.; nor did I find the presence of pr a result of the lead line. I do not know. I am nucleated red cells mmucuhchabaobovvee,thteheavaevreargaeg.e. ThTehseese inclined to believe the former, however, for it is cer- facts!jcoincide very ninciecleylywwithiththteheabasbesnecneceofo.mf.marakrekded 'ainly true that there is more pyorrhea and carious anemia: . . . teeth among workers exposed to lead than among sim- MNearly all chronic cases exhibit some onnee- or all of ilar groups of workers not so exposed. 1 also found thesej digestive disturbances: metallic taste, anorexia, a number of patients with lead lines who stilt had very nausea, abdominal pain and tenderness, constipation, good teeth and gums. It may be that the deposit of . and colic. The. constipation Iiss-often of an extremely lead sulphid in the end arteries of the gum margin obstihfiate type, and is much more common in the chronic impairs the -circulation there, resulting in decreased cases; than is diarrhea. The latter may be alternated nutrition and vitality. This in turn would cause laclc wiitthh.lit, however. The truuee, lead colic causes vveerryy- of tone and decreased resistance, and would'readily severe pain, tnorphih sometimes proving inadequate in . permit decaying food particles am! mouth organisms to giving relief. The colic usually follows constipation., find their way in between the tooth and the gum. thus The ganorexia is probably responsible for mffiuucdhi of the facilitating the rapid development of pyorrhea. . loss of weight which offtteenn- occurs. While a lead line is positive evidence of lead absorp- General malaise and asthenia are early .symptoms., tion, it does not mean necessarily Lhat the individual These are ofterraccompanied by insomnia, dizzy spells, has lead poisoning. 1 saw many patients with well lleetthhaaprggyy,, eettcc.. ' _ _ 1 marked lead lines who were apparently well. These In.a;ann individual who works with his hands a great are all potential cases of plumbism, however, and if deal, paresthesias in the bhands and'fingers, weakness of something should happen to disturb the balance the grip and weakened power of dorssiifflleexxsion of the between absorption and excretion, which thus far then- wrist' may be the first warnings of chronic plumbism. have been able to maintain, .they would probably develop These are due to a beginning interstitial neuritis, winch acute plumbism. The same thing is true of lead in the affects usually the nerves supplying the muscle groups urine and feces. ' which are most used. This is probably the most impor- "Oliver's sign," a black discoloration, of the buccal 'jJ/jcir'fc.- A'*. St.: .V.' -v. iw- v '|b this sign, however, for tYtt? discoloration is often >u basophilic ^'in'bt'-s. t-afRc tnut-.iiiitwlfur.-. 2-t tier present in the mouths of people not exposed to 'lead. l,f cells.- ..TltevJiJofld pressure w.:_..s>sio tc,- a, "a*- For example, such discolorations occur normally in the buccal mucosa of negroes, .. , , ' Amohg women, irregularities of menstruation arc a common"result of plumhisni. 'These may appear as t0 ,c *v t '' . "V . 'V . This case is noteworthy because of the-'sudden fiiicai- de,'uiicec oof tthe pparaallyyssiiss wwithoouutt ppremoonniitoryy ssymptommss;; except for weakness of the thumbs (which are used ,dysrpeuorrhea. ^menorrhagia,or ameno.rrhOa,, .It also xiuost,.ia dipping')., in a man who had beem.esiJbAd t`> 'Isseedemmss ttoc:bb^e:''aann .;:iestapHshe^,fagt;tha^i\vbirfeh^^oseddf|(:T"J^:a;lf' for. jgafs: and for ..the; absence of any\da'tTo- tthlidi- lleeaadd, hhaazzaarrdd arc more subj-eet 'thaif others toabor- mrcstnial . disturbances--eyeh jcmistfpattou, :; s... l ]erc, i^ : .direct proof to cuiUrovett the popular idea. that ic:ul poisoning cannot occur without cons|ip:i[ion.:' This fact is also illustrated by Case . r ipbr'/.V,i' - v \\\J?5Q^ Cas e 7.--A man. aged 55, a dipper in a pottery for twenty years;, and; a heavy drinker for-thirty years, ilu-ce-and a half ' rfSjr.-VV years ago began to experience Truailiitess and tmglmg-.jn hisright hand and forearm. This steadily'.-increased, and soon ww i, si. j \ \ fr \ \ ,^ %ir ....... his left hand and forearm were also affected. This pares thesia was accompanied with edema of the wrists and fingers, and was alternated with muscular cramps. Soon his wrists and fingers became weak, and he lost fits dexterity, being almost unable to button his clothes and to accomplish the . finer movements. His arms became-stiff at times, and be . -suffered from ncuritic pains. After about six months of this, he became so weak that he was scarcely able to work. Fear ing wrisi drop, be ceased pottery work and cook up the insur ance business, which he continued for six or eight months. During this period he became considerably stronger and so X Y& again took up' pottery work. His weakness soon began to recur, and in about one year he had double wrist drop. While this was developing, he bad begun to have general malaise, asthenia, anorexia, nausea, vomiting, metallic taste, fits of Ft. t (Case 6)---EiJatera.1 wrist drop*, trotn photograph taken whi't; depression without apparent cause, insomnia., and pains in patient was frying to extend his hands. the arms, legs and neck. After the wrist drop occurred, he began medical treatment,-which he continued for about a In long standing cases of plumbism a fibrotic change occurs in, the blood vessels and in many of the organs, ' Hypertension, except where there is lead colic, is not so common, however, as would be supposed.* In this my , results also differ from those of some other in vestiga year, his wrists gradually becoming stronger. He then began dipping again. He dipped'for nineteen days, when the double . wrist drop recurred, and he began to have difficulties in loco motion and severe pain in his legs, together with a recurrence of his former symptoms. Examination revealed almost no pallor, poor teeth, good gums. with marked lead line, mitral tors, for I did not find it at all frequently, except in one group, in which the patients were working in a lead refinery. In many of these there was hypertension; but among'pottery . workers, who labor -just as hard, there was practically none (eight patients with bilateral Wrist drop had practically none). It may be that here insufficiency, antebrachial paralysis with some atrophy, and tremor of the tongue and fingers. He was not constipated at any time. The hemoglobin was 90 per cent.; red Wood count. 5,180,000; no basophilic degeneration: large mononuclears, 18 per cent, of white cells; blood pressure: systolic, 140: dias tolic, 90. - ' tod the form of the lead- to which the worker is exposed is more or less of a determining factor.. In mdny cases the liver becomes fibrotic, the kidneys con tracted, heart valves sclerosed, and the" vocal cords thickened. The latter often results in a tremulous voice, which is rather marked in old cases of plumbism. ' At death, lead may be found in the liver, kidneys, jggg&pg ` spleen, brain and muscles. . .. ' . * The following case records are given as a means of Ffff. 2 CCnse 6).--Manner i:: tvMdi it is nectary for tlie patient to illustrating some of the types of chronic lead poisoning: support his arm ami turn his wrist in onlur to grip atsy object. Cas e 6.--A man, aged 37, a dipper in a pottery fifteen years, has been a heavy drinker for years. Although he had some pallor, he felt perfectly well until six months ago, when he began to notice, weakness in his thumbs: This became pro gressively- worse, until his whole hands and wrists vv'crcaffeefed. Two months ago he was lifting a- ware board when his wrists' suddenly "gave way," and he has had complete bilateral wrist drop ever since (Figs. 1 and Z). He has had absolutely no 'symptoms of plumbism'.except paresthesias in his hands. Examination reveals, besides double wrist drop with antebrachial and some scapulohumeral muscular atrophy, marked pallor, - edema of the hands and fingers, ' marked tremor of the 'fingers, lips, eyelids and tongue, muscular fibrillation, springy pupils, absence of all teeth, mitral insuf ficiency, edema of feet, and distal ataxia. The blood pres sure is normal. The.reflexes are decreased. The hemoglobin The. tendency for the paralysis to disappear when exposure to lead.ceases is well marked in this case. . Cas e S.--A man, aged 43. a.dipper in a pottery for eighteen years, a ."moderate" drinker, complains of genera! asthenia, frequent severe headaches,' tnalaise, morning- nausea, pro nounced anorexia, metallic taste, abdominal pain and tender ness but nt> true colic, very bad constant constipation, neuritic pains'in the arms, hands and shoulders, sore muscles, painful joints, lumbago, parethesias, alternating periods of depression and .excitability, failing sight, insomnia, dizziness and lethargy. He has been losing weight for the last six mouths. He is poorly nourished, abd has an unhealthy appearance; local emaciation of the hands, wrists and forearms; pallor of the' Face, lips and conjunctivae; arcus senilis; springy pupils; cyanotic gums; fair teeth but much warn: marked isnm kifckd muscles-: -tremulous muscular weakness : lii^Rireti'dorsifiexion of the. wrists, especially on the right; grip, 60/70-i(normally 120/110 tor men, 65/55 for women); enlarged, joints. and; hyperactive reflexes. The systolic blood pressure; is/I-10: diastolic.'SO;.heuioglctbiii-,' 63 per cent.; red blocjdi count,: 4.600.000; central pale area, increased; large tufirtcri-uclears, 16 per cent, of white celts;- no basophilic degeneration .oE reds. ' , ., : ... . ` sclerosis, we must diagnose the disease and begin treat ment in its incipience. The mistake is frequently made of refusing to diagnose a case as lead poisoning unless there is a lead line or colic or wrist drop. As a rule, however, these arc fairly hire symptoms. Tim fallacy of expecting constipation its all cases of plumbism has already been pointed out. __ _ 1 '' < v \ ' , . , , One-of rthe'grearest-aids dn diagnosis is'.a historv of - * This is-af taurlv typical case, of chrome plunibism,, expogdfer -WitiroiJtiLis.kha^^ with,the exception of the fact.that the hemoglobin per- ieqUently be overlooked. With this know ledge, plum- cenatage ia&^floovwfe'eer thhaann* ussuuaal.l.' " . >, , bism. shliould' bbee=a-at-h-l'eleaasftc..ccoonnssitdtleerreedd- '!i'inni'all obtissccuttrreeccoom- 1 C-ssEiS-^A'anaa;; agedi'SlKa/ glostddln-: placer, notices that plaints arising among tljc workers. .Ballorof the.skia, his arms- feel'unduly'weak and tired;- there is increasing muscular- weakness, headaches, general asthenia and numbness, in- the hands.;-:;He has. dizzy ..spells several times a malaise/paresthesias, anorexia especially for breakfast, week.; hbnsfant metalIiVtas.tey: andyhe^aiches^;- about; once a -: conssttiippaattiioonn- or ppeerrhhaappss-- diarrhea,; rheumatism,: muussceuu-mr week-he has attacks of1 nausea with`colicky pains around the umbilicus,: which- last several Hours, not severe enough for typical lead colic; he Has' rheumatism in the shoulder. He . has pallor of the skin and conjisncdvae, pink, healthy gmtis with firarked lead line, good teeth/ and tremor of the tongue. ]laarr Ssoorreenneessss,, 'aabbddboimTuintiaali'ppaaiinnss aanndd tteennddeerrnneessss,, ccoolliicc aanndd nervousness are all symptoms which should be. care fully weighed in any worker exposed to lead before a. diagnosis of lead poisoning is ruled out, .- His grip is 70/75.. Dorsifiexion is impaired. The systolic blood;pressure is 135; diastolic,-SO; hemoglobin, 92 per cent.;' red blood count,. 5,100,000-large mononuclears, 13 per cent. Some! basophilic degeneration of tlte red cells, not marked, is defected. . . , ' This case illustrates- early chronic.lead poisoning. Cases 8.and 9 are examples of loss of strength in the handb and,.>yeakejned dprsiBexion of.the .wrist, .This, is more marked in the hand that is most used. ' Cas e 10.--A man, aged 41, a. dipper, has had repeated attacks of lead colic during, the last five 'years.' He has fre quent! headaches, malaise, asthenia, morning nausea, metallic , taste, abdominal pain and tenderness, "muscular rheumatism," ? . paresthesias, tinnitus,, aurium, itching eyelids, and dizzy sp.ells. ' His expression is drawn; the .pupils are unequal, with slug gish reaction; he has..pyorrhea, a lead line, and fair teeth; twelve teeth are out; there are coated tongue; hyperactive reflexes; atrophic nails, and tremor of the tongue, lips and . fingers; the hands are edematous; sight and hearing are impaired! The blood pressure is: systolic, 135;-diastolic, 78; . . . Fig. J,--Wrist drop in another patient. - hemoglobin, 84 per cent.; red count, 4,800,000; no basophilic degeneration; large mononuclears, 17 per-cent.; small tfiono- The lead line is of considerable value as a diagnostic - nuclears, 35 per cent, of white, count. . " . - point in all chronic cases, and often in acute cases Cas e 11,--A woman-, aged 46, a dipper's helper, has anor exia, 'metallic taste, constant headaches, abdominal pain and tenderness, frequent attacks of colic, constant constipation, ..paresthesias and neuritis in arms, -muscular soreness, pains which occur in people who have been exposed to lead" for some time. Although a lead line does not neces sarily mean lead intoxication/ yet it is absolute evidence . in the joints, dysmenorrhea, menorrhagia, and fits of depres- of lead absorption, and as such should at least be con .sion without apparent cause. .She has- had one abortion; sidered as indicating potential lead poison.' The same ' there-are"no living children. She has im unhealthy appear significance can b'e attached to the finding of lead in the - ' ance, | lead line, spongy gums and poor -teeth. The grip is urine or feces.. ' 58/39. The systolic blood pressure is 138;--diastolic, 86; hemoglobin, 0 per cent.; red blood count, 4.200,000; large mononuclears, 18 per cent. ' 'Lead colic-may sometimes be confused with appendi citis, intestinal obstruction, gallstones; etc. In the case of lead colic, however, the temperature is rarely These various cases represent some of. the common increased, the pulse is slow and hard, and the blood types of chronic plumbism. They demonstrate the . general absence of basophilic degeneration of the red . cells ; and the- absence of marked anemia and hyper tonus. Thfise are signs to which I believe undue prom inence has been given. The' mononucleosis which so frequently occurs is. well illustrated in these cases. Ederha of the hands ;is rather frequent, and is usually associated with paralysis or a warning of its approach. pressure usually increased. Furthermore, there is little if any.leukocytosis, and the protective rigidity of the abdominal muscles is usually absent. . In' acute cases, basophilic stippling and increased resistance to hemolysis of the-red' cells may be of diagnostic value. In chronic cases these are usually absent, but iii their stead there is commonly a mono nucleosis of from 10 to 35 per cent., which may aid in '' ' ' DIAGNOSIS ' the diagnosis. In order to accomplish the best results in treatment, PROPHYLACTIC TREATMENT the diagnosis of plumbism, like that of tuberculosis, By -means of proper .prophylactic measures, lead should be made early. If we wish to prevent the m.ore poisoning in American /industries could be greatly ' severe effects of lead' poisoning--encephalopathies, lead reduced, if not wholly prevented. Proper prophylaxis colic,; wrist drop, optic atrophy, perhaps generalized necessitates dose cooperation between employers and PiHHUlwaiWl ' . - , U 4- f i n i i c r`y-Au t?40 , < ' ixDUsr&uL n POISON^ i.; \ * ~*'+>*A* ^ ^- ' . 'ing conditions. This: meansr. the removal, of dust and ' 1, , ', - J ,' CURATIVE THE VTIIEXT ' ^ ' limes, and the provision of clean. working rooms, In curative'treatment, the first thing is to remove v adequate ventilation,, lunch rooms, drinking and wash the patient from the source of the poisoning. After tins, ing facilities, locker rooms; and capable medical super potassium ioditl in from 5. to 10 grain doses, three times ' . vision Frequent periodic examination of all workers a day, is usually given, the theory being that it:liberates exposed to. lead is- a necessity; and workers should the fend which has been deposited as an albuminate in report'immediately any symptoms suggestive of plum- ' the tissues, and thereby permits it to be excreted v,. bism. Rules prohibiting.;eatingrin;rooms, in which there - through .the kidueys,: Tiie liherated. lead is in a soluble ' "is kad.mus't: he''rigidly 'enforced/. The, education-of the term. and'in some cases is likely to be reabsorbed With , ; workers along: tile lines: of personal hygiene, and/the , air exacerbation" tit symptonis. lt is therefore vise to . ; prevention ofrdisease should be-the aini-'rof- alk indus'- vb^^Cth^'ttffltna^?\vidf%|ii?lMQSies and in acirfe cases tries. Industry should consider the victims of lead ' to'withhold .it altogether, $^ , pdisoning in a more.sympathetic'light. Inyriany plants. For the constipation, magnesium sulphate is-probably - -if-ithe-foreman thiriks-a man-is developing, plimibisni,. best, since this aids in the prevention of absorption of . he' either discharges hihi; propermits; hiinto eontinue. at .lead by the intestines through the formation qf. a rela- - " the- same .work- until absolutely incapacitated. Since lively insoluble, compound, which passes out' in t!ie . - neither of these policies is; constructive, both should be feces. Iii some cases the constipation is so obstinate condemned. Instead, an effort should be made to give that salts, castor oil, etc., all fail, and it becomes neces such men different work which will not expose them to sary to-administer croton oil; 1 drop on a piece of sugar the lead hazard and which will permit them to recover is usually sufficient. A mixture of potassium iodic!, from many of the effects that they have already magnesium sulphate and a bitter is sometimes resorted experienced. ' to for the colic and constipation. (These various factors, however, will fall far short The researches of Maci.it1 and his co-workers and . of accomplishing all the good, of which they are capable ^ of Litzenberg - on the action and uses of benzyl ben- unless the workers do their share. They must cooperate zoate, an opium alkaloid of the benzyl-isoquiiiofin ' with, the management in keeping the; workrooms clean group, have shown that this drug counteracts remark arid the various personal service facilities in good con ably well the spasm of smooth muscle. They have also " ' tlitionr' They must'u'se. 't'hV conveniences' provided tor " 'shown" that ureteral colic, excessive intestinal peristalsis " tlijem, and observe the rules o personal hygiene, etc., and spastic constipation yield to the. tonus-lowering which they' have been 'taught. The importance of the anlispasmodic effect of the drug. Its very low toxi.city, lajter can scarcely be overestimated. 1 have just seen' combined with its peculiar pharmacologic action, sug its value demonstrated among a- group of pottery . gests that it may readily become the sovereign remedy workers. At the time of their first examination, the for the constipation anci-coiic of lead poisoning. It may wbrkefs were advised as to the precautions they should ' observe to avoid plumbism and to decrease the -effects , thjey had already experienced. Four months later, ..when I returned to consult with those who had had . ' positive diagnoses, I found that a large' number of be prescribed-in this mixture: - Gm. , Ffc Benzyl benzoate ........................... ..................... ... 10 . Mucilage o acacia.......... ^......... ........ 5 , Aromatic'elixir of eriodictyon., ..................................... 35 Give from J4 to 3 drams about every two hours', according to necessity* these had-been following the advice given them four For the colic, hot applications are-of value also, .. month's: before and, as a result of the simple measures together with the administration- of morphin or mor oj personal hygiene employed, had .greatly improved. phia arid atropin, when necessary. . . The symptoms of practically all had decreased in sever In cases of convulsions, the bowel should be washed ' . ity, and a number had gained from 10 to 20 pounds in out with warm water containing a little mustard. This `weight even.in this brief time. By the observance of is. followed by an enema containing chloral or one of the rules of hygiene and common sense, they had been the bromids. - able to stop or at least minimize the absorption of lead, For the paralysis, massage and the galvanic current ' and'as a result their bodies were better able to cope with that which they had already absorbed. - ' ' are of the-greatest value. In case of wrist drop, the hand should be placed on a splint to prevent contraction ` . ; A. few of the men whom we had diagnosed had not of the opposing groups of muscles. Strychnin sulphate . seen fit to follow our advice, and practically all of these or nux vomica is often, used'empirieally as an adjuvant showed progression and were worse than when first to this treatment. ' . . , seen. .' Many of the men habitually take magnesium sulphate several.times a week as-a preventive. This is undoubt . The Clague-Oliver electrolytic treatment has 'been much advocated in some quarters as having both pro phylactic and curative value. Its sponsors claim that edly of. some value, for it keeps the bowels open and tends to precipitate the lead in the intestinal tract and cause it to be excreted in the feces.-. A number of the . men take a course of sulphur baths several. times a. year, and' report, a feeling of increased well-being and ' vigor afterward. Their actual value is problematic, as. is: also the prophylactic use of the Oliver-Ciague elec . trplytic treatment. ' -. . In some factories in which-lead is used, it is the custom to'give the men 1 grain calcium sulphid tablets daily. This forms the more or less insoluble. lead it abstracts lead from the body through electrolyse;. The experiments of Goadby and others have proved this assumption to be wrong. I have had a good opportunity to observe the effects of this treatment, and while I think that its value has beefr greatly overrated, yet I believe that its use is nevertheless productive of some slight benefit. This value lies, not in the with drawal of lead from the body, but in certain symptomatic effects. Most of the men who have tried tine method say that after treatments they eat better,, sleep . -'a ; . sulphid, which passes out in the feces. It is reported ' h Afaclit, D, I.: A Therapeutic Study, Pharmacologic and Clinical, . that the incidence of plumbism is less in these plants of Benzyl Benzoate, J. A. M. A. 731 599, (Aug* 23) 1919, - titan in thnsp in which this drug is not used. 2, Litzenberg, J. C.r The Use o Benzyl Benzoate in Xtysmenorrhca* T- A. M. A. 7as6tn (Alia, 23) 1919. * Renrnriuccfi from mflffTi&ls in the Mont3.nL histories] Socicuv Archives Msv he snhiccl' to C"onvr>o~ht I au;gi T'it Ip f? I IK fVyip. H [XWlJSTn 1:4L-/ L`` 1 - T'O/riOAAV0.-- A 'A y A .ij k;:.R;n: " a ^Ari- ' - * ' "i ' .. in, \ , ' `.vjf, o Tv/iv '-* .* better. iii(t;'fef [letter, their wrists- a re.-: stronger,'and -. and arteriosclerosis, and me-this way..often cuts,--shinA;: ku-tftfef inake slight-gains in weight. The gains in weight the-normal span-of years. In lead poisoning centers, Bf' credited to the treatment are clue,, .1 believe, to the better. the true' end-results of cases: of pltunbism are to be; ' 7, eating, and sleeping. The improvement in; symptoms found in the mortality rccorus under, sueli headings-as rioted above may be due to the tonic effect of the cur-' "died of a complication of. diseases." A number of : rent or to the psychologic effect of the treatment. In ' patients, however, live "to a ripe old age. I know one any case, even such,a symptomatic improvement as. man. now over 70. with double wrist drop and muscular ,:, . notedcis of some, value, and would be of assistance, as .-atrophy, which he lias had for twenty, years. During - 'an adjuvant to the other methods of treatment already "this time-he.h.as been practically disabled and dependent - : ., v outlined, -., -,,"::hTSy;/!.; v v;"T*: Tv y ~'v: AA-Ari pv A vAA, oh his friends for support: A, A' A'VA "A , As an aid to both- the pro-phi lactic and1 the curative ' ':?i:lTttt-icnti'(Ktjon-twi-tl^tiOgi>os,^oow PbsefvyficHn.sjart^, 'treatment of mdusmal plumbism,. laws providing-for pertinent which I recently . made' ini-Ahe cbr.tinncd ' compensation for .ocithpatronalMiseaseS: tire becoming * exposure to. lead .after a-1 diagnosis of.piumbism. hn<i morel' and more necessary. The injustice o allowing been made. In 1913 and 1914. the Ohio State Board . . compensation, .for accidents. , which -may- disable a .inavv .ofHealth, undertook, an extensive. survey. under, the. b for a'TecWweeksi-.antlatThe^^ lo itllow ` - direction of lbribE>fR,-;HaYlittrihcriiithexiiTectSlof:t.fli;i it for lead poisoning, which may cause, disability for various " occupations on the health of the worker.- :" life, -jis beginning to be recognized. Compensation-for engaged therein. During this survey a number of occupational diseases is now allowed in several states cases of lead poisoning were encountered. Five years and territories, and the indications are that it will soon later, through the courtesy of Dr. Alba'ugh, director be granted in others. Under such a system the loss of the division of industrial hygiene, I had an opportu of wdges due to cessation of work for a- time in order nity to compare the present condition of a number of to recuperate from the effects of lead would not cause my patients with their condition in 1914, as shown by . . such a large economic 'loss as at present, and .a man the 1914 case histories and records. I also looked up- with; say," approaching wrisr.'drop could stop work a number of the 1914 patients who are no lougcr before becoming wholly incapacitated; with the kuowl- exposecl to lead, in order to note the effect of removal. edge1 that he-ivould be cared*for during his illness. from the source of the poisoning'on the health of die . Tliis; would cause a' great reduction in the number of individual. The following conclusions, drawn from permanent disabilities due to lead and in the number this-' follow-up work, were made after a study of more - of cases of severe plumbism. . - * than 100 such cases: The incidence of lead poisoning In American industry 1. Cases of lead poisoning in which the patients con-' is far greater than is commonly supposed. This is tinue to be exposed to the lead hazard under the same Ht because the majority of the cases are not reported, even conditions steadily progress. 0F though many state laws require the reporting of.all 2. Patients with lead poisoning who continue, to be ' occupational diseases. Some of the. cases are not exposed to. the lead hazard under the same conditions reported because there is no attending physician. This but who lessen or abolish the absorption of lead through- is'sometimes true in even severe cases with-wrist drop. the observance of proper hygiene, etc., usually tend to Others are not reported because of the fear of giving improve.' Many such patients.recover. . , ' the factory a `'black eye" in the estimation of'the state . 3. Patients with lead poisoning who continue to be , . department of health,.or because of`the patient's fear ` of discrimination by insurance companies, etc. Itiis a function of most .state departments of health potentially exposed to' the lead hazard, but whose absorption of lead has been decreased or abolished through improvement in- working conditions and per ' to study the cause, prevention and cure-of occupational, diseases. Progress cannot' be made in such work unless sonal-service facilities^.usually tend to improve. such patients recover. - - Many . there is complete knowledge-of 'the incidence of. the ' various. 'diseases due to occupation. Such knowledge ' can be.gained only through the prompt and thorough reporting of all cases. This means that every physician should cooperate- with the state department, at least to the extent of reporting all cases with'which he comes - ' in contact. * - ' :' , PROGNOSIS 4!' Patients with lead poisoning who remove them selves entirely from the source of the poisoning usually recover. Except in the more severe cases noted in the first part of this article:-the recovery is usually, com plete. - . ' These conclusions may be considered, in a general way, as principles of prognosis. They also serve to emphasize still more the principles of removal of the In mild cases the prognosis is good. In the enceph source of the poisoning as the- prime desideratum in alopathies the outlook is worse, for in such cases per both prophylactic and curative treatment. ' ' manent mental symptoms may follow. Some severe . acute cases are fatal.' . ' . ' SUM-WARY Patients with wrist drop usually recover. I -have Certain signs and symptoms of plumbism have-been known patients to- have wrist drop six or seven times given somewhat more importance as diagnostic poims- and recover. Wrist drop or-ocher paralyses associated than they deserve. These are anemia, basophilic degen ' with the muscular atrophy, how.ever, usually persist to eration of the- reel cells, hypertonus and constipation. a greater or less degree. Among habitual users of Pronounced anemia is present in only relatively few' alcohol the outlook is worse than for abstainers. cases; in many severe cases there is no anemia what ' Lead poisoning, as a rule, is a disabling rather than ever. . The pallor that is .usually present is therefore a fatal disease. The records of its effects niust be due to some other cause--possibly a constriction of.the sought in the morbidity records rather than in the mor peripheral blood vessels. /Basophilic degeneration of tality records. Aside from its own immediate effects, the red cells is rare in chrbuic cases, and its value as a if is a cause of such degenerative diseases as diagnostic point, even in acute cases, has probably been cirrhosis of the, liver, valvular heart lesions, nephritis overrated. , `' i'43 -t ' , , fACKSOS CP1 l-f-'t'i, / T ' 'V ,, , vH ^V - 1/`*' - . ;; 'f* a * * 4^% ,J" The-presence of hypertoims is 'estremeJy vanaWe... Among a'. group..of pottery, workers' exposed to .lead , tTHhEr " DDIIAAGGNNOOSSTTICIC^'.:'sS1IGCNNIIFFIKC:AANNCCEE't 'O0FF ' . ' - ''dust, there was practically none: but among a group of ' JACKSONIAN EPILEPSY* ; lead refiners exposed to lead fumes', it was present in .j-.V ;'neariy every, .case.'-, ,>The cause of this, variance is - unknown; however,, the difference in the form of the ' lead to which the different groups are exposed may have something.to do, .with ,,iv . Hypertonus is nearly ' - . ' . ' GEORGE WILSON. M.D. . ' ' ' i- ` : . rinLADeuMiU ; . Of all the forms of epilepsy, perhaps none is.so- - juteres-ati"ng; andt o_ f.such dJ 1iagn^ostic.imapnoitnt ar,<s >th!lret jnck- . ''>always present d'uring-dltacks-ip-f 'colic. .-fC 'j[. V* -'iiAsoiuau-' viiriety.-'- This" cei'm -is..;uSed'iicrc'Ao..;cover-, . Althougir constipati'on is'usual.'it is not invariably hemispasm or monospasm: llie'"spasint if properly-. , present.'. The1 assumption, therefore;' that a patient who - observed, wilt be .seen-to; have a signal symptom, am! not- constipated' does, uot bave'dead poisoning is falla-' a' regular sequence' uf ^ents. !lh*-the minds of most ' .. cious.-i Many cases ; of ; plumbism--especially acute * physicituts.;iaclisoniatx;epilepS5r means a definite, focal _ cases-roccur without constipation, _ - - disease of the motor cortex. Such is not the case in , ^ point of .diagnostic, value.\yhieh appears to have .^.-larg^ percentage of instances; in fact, Collier goes recbgiutioni except byr Hayhut;stvi&:tKe;pres- so. far a-s w statc that-tlie co'nimbit^t cause of jtickso* ence bf tnonoiuicleosis in chronic cases.'. This'is almost man epilepsy is idiopathic epilepsy. Dr. C. K, Mills, in -. invariably present. . ' _ a personal communication; lias" expressed his concur ! The presence of a lead line is also extremely variable, rence with Collier's belief. In my series it was present in about 90 per ceirt, of the , when a.paiient exhibits jacksouian epilepsy, we must Cases. Other investigators have sometimes found it recall, in addition to neoplasm involving the motor present in not more.than 20 per cent, of their cases, cortex, that (i) lesions other than tumor of the motor . This difference, like- that in the case of bypertomts, cortex may produce unilateral spasm; (2) tumors, in' may possibly be d'ite to the difference in the form of the parts of- the brain remote from the motor cortex some- lead in- which the patients were exposed. ' times are associated with monospasm; (3) toxic condi ; In the treatment of piumbism, prophylaxis is of tions may produce Jacksonian epilepsy; (4)' the much'more importance than the curative treatment, myoclonic type of epidemic encephalitis -form may pro- ;.By._means; at proper working conditions and medical -duce a picture somewhat similar to the spasm under . supervision, on the. one- hand, and' the observance discussion'; (5) the so-called reflex epilepsy may do of the rules of personal.hygiene and common, sense, likewise; (6) hysteria may simulate the condition'and -on the other, together with cooperation bet%veen . (7) idiopathic epilepsy frequently has an "inside" employer's and employees, the incidence of piumbism jacksonian spasm. ` in American industries could be greatly decreased. Proper compensation for occupational diseases is a j a c k s o .v ia x s p a s m d u e t o n e o p l a s m o e - ' necessity, and would help to decrease both th'e inci- . . . mo t o r c o r t e x . . dence.and the severity of lead poisoning Tumors of the motor cortex are preeminently asso- : If the cause, of the poisoning .is. removed, the prog- dated with this dramatic form of epilepsy. The spasm nosis, - except in a few cases, is gtrad even without may be limited to the face or the upper or lower . medical treatment. If, however, the lead continues to extremity. At rimes in such cases the- spasm partakes exert its deleterious effects through small, steady doses, of the nature of the epilepsia partialis continua first the case steadily progresses, finally terminating in some described by a Russian, Kbshewnikow,. and later by form of paralysis or in some of the common degenera- Spiller and by Burr. By epilepsia partialis continua is - Ative diseases. As a rule, lead poisoning is a disabling meant a form in which clonic movements at different father than a fatal disease, although in chronic cases it sites occur between attacks of major epilepsy; some . undoubtedly hastens dyatlr. - . - times this type of epilepsy is seen in organic disease of . i . Vital, statistics of all occupational diseases, including the motor cortex. : lead-poisoning, are very incomplete. Rapid progress by state or federal agencies in the devising of methods for state or teclerai agencies m tne devising oi metnods tor the prevention or cure of all such diseases cannot be ._ . T- u ,, ... CaS 1-~U- F'-' a neSro> aed 26' who t0 nervous diapensary of the Hospital of the University of Pennsylvania, Sept. 2o, 1920, and was referred to the nervous ward, com- piade unless there is prompt and complete reporting of plained chiefly of convulsions. He was well'until January, all cases. ' ` 1920. At this time while sitting talking he suddenly felt | 1657 Larchmout Avenue. . . .` -- ' . Increase in Alcoholism in Germany.--The Deutsche medi- satische Wocheuschrift relates that, alcoholism is on the .increase again itcGermany, saying that eight thousand million marks are spent for'alcoholic drinks at present CEs.werdeh 2. Z. etwa 8 Milliarden Mark fur alkoholische- Getranke bei uns verausgab:)..- At Bremen the number of cases of delirium tremens, which was 176 before the war and nine in - 1918, reached sixty- in 1920- Cases have been observed' at Bremen where young people have spent 500 marks in one night for 'liquor and been, taken to the hospital with serious toxic effects. The editorial adds: "During 1914, 6,000,000 bottles of champagne (sekt) were consumed, but in 1919 the figure was 10,000,000:" Bavaria has removed the restrictions- on the manufacture of strong beer,, and one of the Munich dailies refused to publish an-appeal by Kraepelin protesting against removing the restrictions. The Ncdcrhmdsch Tijdschrift quotes the above figures with the laconic comment, "The world needs mending." . ' sick and began to- make a grunting noise, while his head jerked rapidly back and forth. His eyes were glassy, he frothed at the mouth, he bit his tongue, and he had an invol untary evacuation of urine. This attack lasted several min utes. -He did not fall from his chair and his legs and arms did not move, although he was unconscious during the attack and slept for about an hour afterward. He has had a number of attacks since the first one, hut of late they have, been less . in number and in severity. Three months ago he began to have trouble in speaking. For the last two -months he has been drowsy and frequently yawns,' and bis suffered from severe headache. For the last few weeks he has complained of weakness of the right foot. His previous medical history and family history were negative. ' During the examination the patient fell asleep several times and had to be aroused. His station and gait were normal. The pupils were equal and regular, and reacted sluggishly delp*hRiae,aJdanb,efo24re, t1hSe21S. ection" o-.i Medicine, Ccffcge of P. hysicians. Phila , * Front the Neurological Department of the University of Pennsyl vania School of Medicine and the Philadelphia General Hospital. Reproduced from materials in flue Montana Historical Society Archives. May be subject to Copyright Laws (Title 17, US Code). . ColLNo.^^ BxffdNo.jjyi - j, .. / /o o :i ~ Oct. 22,-,1919. 'Mr.. P. L. Seibert, President, ' Mill & Smelteraen* s Union, . . Soiling Mill ^Department. .; ... Pear Sir:- COHPLAOP BS.GAHPIHG CLOTHS PUKHISHBB HBff WORKING Iff BLOBS '___ ' ' ___ - ___ _ laa enclosing Herewith: one of the cloths which we are giving the men who are working in the flue. Complaint was made. this morning by the Executive Committee that the men were not .being given sufficient cloth to protect themselves. The 3&mple which ! am enclosing is identical with the cloths which have been out, and you will note that it contains twelve thicknesses of cheese cloth and that the cloth is of ample siae to cover the nose and mouth. Mr. Egan, Pirst Aid Man, who, gives.these cloths out, says that he has had no - complaint from any Of'the men about the* cloths and that he has given the men all of the cloths asked for. ' I- think that you will agree with me that this complaint was not justified in any way, and it seems to me., that you should take this matter up with the man or the men making the complaint, in order, that, these groundless, complaints may be eliminated as much as .possible. .. '' fours very truly. m General Superintendent. A)iW:fiAL. Reproduced from materials in the Montana Historical Society Archives. May hs-Stobieet to Copyright Laws (Title 17 OS Cade). '. CoD. No.ttJqfjp&i jgl' '' / O o t2~ Address all Communications to the . Company May 4th, 1918. Mr.M.W.Krejei, Asst, Mgr, B.& M. My Dear Sir: la reply to your request for suggestions reguar^ding the possibility of 'eliminating to a degree,. the danger of the men^n the Arsenic and Lead portions of the works,from the poisenous effects of ' those metals, will state that all that I can make at this time is a fiew suggestions,, . In attaching this problem there are hut two points to work on, first.Elimination of the1 dust$ whiehincludes -ventilation) and this you are better qualified in instituting, than I am. but will from time to. time make any suggestion that oceurs to me, '. -i , Second:- The personal cleanliness of the men.which'is a problem requi ring eternal vigilehce, and on which most of ay suggestions will be. Among the Arsenic workers practically the only complaints have been from the local effests,although in a very fiew^ foundsome slight symptotos of the constitutional. Among the workers at the Bag' House and Eeverbatory, found some slight symptoms of leading,but youhave to their complaints with a grain of salt, as they-, are all anxious- to be , transferred. ' If it be feasible to have two or more crews for the more dangerous portions of the work,so that a man would only have to worE two weeks or less eaeh month in those places. Reproduced from materials in die Montana Historical Society Archives. May he.sufej.eet to Copyright Laws (Title 17, US Code). ' ColLNo.^^- - Bx/FdNoJ ' Would suggest that the Janitors at the ehange house he instructed to see that the men that signed the book there had fir3t taken a hath. Also that one of the most intellegent and trustworthy men on each shift beappointed to see that the men wash thoroughly and rinse out their mouths before eating, and at the Arsenic plant, that1 he sees that they use the wash That all water coolers he placed entirely away from any souree of dust and that sanitary drinking cups he provided,Th^ men he instructed - to rinse their mouths before drinking, To transfer at onee any man that shows any symptoms of acute poison . ing. . ' . If we could impress on the men the fact thatit is thi particles thef^ swallow that practically does all the damage, and what they inhale is of very secondary importance, they would likely co-operate with us more freely'., . ' > If we coUldalso get them to understand the necessity of keeping ** their teeth In good condition,it would he a big step foreward.most of the Lead lines Isaw was in my opini on Pyorrhoea. The hood you hare installed at the Reverbatory, the men state is a great help on the dust proposition,, To improve the dust condition in the Bag House,is a difficult proposition tohandle., but believeby ' inducing the men to take reasonable precautions,and transfering at once any one showing any signs of poisoning,the danger will be reduced to the minimum, and if it could be arrainged to alternate crews a week about it would practically obviate the danger. Will report to you from time' to time any suggestions that occur to me, ' ' , Hoping that ,1 may be of service to you in this vering problem. r c'U/K____ /J-j\ i ; . - <$Uf 0m #4 0. <?M'smz7r- - X am . . Yours very truly ,. , , -Reproduced from materials in the Montana Historical Society Archives. May,hLSubject to Copyright Laws (Title 17> 'US Code). F 44C-10MJ-17 2,'%7 m %' Coll. No.HftjS ' Bx/Fd No. ' MEMORANDUM '. f OFFICE OF An a c o n d a Co p pe r min in g Co mp an y GREAT FALLS REDUCTION DEPARTMENT TO.... E>R. * R*. J'-OIl''lIjSf ....................... -............. ............. eer s e . -GREAT .FALLS, MONT.,. ..April .SMfe.......ail_ / .... / Bear Sip: . ' . ,f -< In accdrdanoa with our conversation of today, please stake a sani tary survey .of the various departments of these Works- relative to analysing . } V unhealthy conditions therein, 'criticlems of aj|y present methods and practices. X would suggest that the Arsenic, Reverberatory Furnace and Bag House depart ments be Investigated first. At the Arsenic Plant department, me are- allowing the men one-half hour at the end of the shift In which to bathe and have provided a record ' ht .the Change house in which the employee is supposed to sign his name after basing bathed, ,- ' \ A lotion and salve of iron-hydroxide is also provided* as well as . gauss to protect exposed parts* A lunch and wash room has been installed at the Arsenic Plant and each man is supposed to eat only at that place and only after he has washed up, so as to prevent contaminating his food with ar- i sehlcal duet. .. . . . . The Reverberatory Furnaces and Bag House departments treat and pro duce a material containing lead. Thors is a slight possibility of lead . poisoning which can he entirely eliminated by the men exercising a little care and-prevention. -. We have installed -wash and lunch r&oms at both places and have, ins tructed the men to use the seme. Ho lunch buckets are tp be allowed at or around the furnaces or bag house where there Is any chance of lead diist con taminating the food. We Are installing hoods for taking away the lead fumes arising from the slag and matte pots during skimming and tapping, Wien you have completed a survey of each department, please let me have your report of the same, stating conditions as you find them, together with your criticisms and recommendations for improving conditions. Very truly yours, II /'/ {! C! {/i/ t { f'< MUM ! Copies :J2r, W.E.Mitchell Mr.' A.T.Elliott Assistant Superintendent. , 1 tJCry^A-- t // f^'