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Red Blood Cell Stippling in Negro Workers --A Study of Cans of Lead Absorption among Jamaican Negroes Observed by the Authors at the National Lead Company, Atlantic Branch, Perth Amboy, New Jersey-- WM. C. WlLENTZ, M.D,, and CHARLES MOLCSAN, M.T. Red Blood Cell Stippling in Negro Workers --A Study of Cases of Lead Absorption among Jamaican Negroes Observed by the Authors at the National Lead Company, Atlantic Branch, Perth Amboy, New Jersey-- WM. C. WILEN7Z M.O., end CHARLES MOLCSAN, M.T. Th er e prevailed a general man-power short data were accumulated with the interesting fact age throughout this area during the war but that not one of these men developed lead in our shortage was further complicated by thetoxication. additional factor that the laborers in this local The tables provide the results of our studies; ity had a fear of lead exposure--which we term however, we believe that it will be more informal `'plumbophobia." This phobia is of many years tive if we first present our classification of var duration and exists wherever lead industries ious degrees of absorption which we use as our prevail. This is most unfortunate and is due to guide (Brockway). the fact that too many men who have too little clinical experience in this field write too many unsupported articles and thus freely disseminate information about this metal which is untrue, misleading and exaggerated. During April, 1945, when the peak of our man power shortage developed and the need for war '___________ Tabl e I._________________ Croup 1 Group 2 Group 1 Group 4 Group 0 -- 14 gtippWd eili ia oatlro flld -- $ or moro tipplod emik la 10 floida -- 10 stippM eofli ia 40 flaida -- 40 to 120 atlppkd oath la 30 flaida -- | gtfppbd calk ta mry Paid materials became the greatest, our company with the assistance of the U. S. Employment Agency and the British government, was fortunate enough to obtain the services of 86 Jamaican Negroes. Of this group, 55 men were directly employed in our smelting department where the exposures prevalent were from lead fumes and lead dust in combination with oxides, sulfates, hydroxides and antimony; the most prevalent exposures be ing lead dust and the primary manner of ab sorption being through the respiratory tract, by inhalation of the dust. Table 1 shows the various groupings of lead absorption and intoxication. As to Groups 1 and 2, the absorption is minimal and usually insig nificant. However, as soon as the one reaches Group 3, there is sufficient evidence in the blood smears to indicate genuine absorption with impendings signs and symptoma depending upon the reaction of the individual to the expofore. From that point, evidence of intoxication can be expected, and the caae then treated accord ingly. It is interesting to note that all of these em ployees were of colored stock and in view of the generally accepted thought that the Negroes Ta b l x ii. STTmX-CZLLS Gr o u t in g were extremely susceptible to absorption, we were most interested in keeping an unusually 14 MlMi* -- Group 1 IS MMi -- Group 2 11 Cmm -- Grasp 1 3 Cmm -- Grasp 4 close watch as to their behavior and response to their exposures. Another reason for this close observation was the obligation that our company assumed towards these men (through the Brit ish government which requested this pledge) Table II indicates that all employees exposed to lead fumes or dust, absorb variable quantities and eventually demonstrate their effects in blood smears. that the best available care be provided for their health and welfare. Our company fulfilled its pledge by leasing an entire small hotel directly Ta b u in. Ra t s or Assoarnow (v ia rarm-cxiA c o u n t s ) opposite tite plant where they were all comfort ably accommodated; all rooms were thoroughly cleansed before their arrival--beds were all 10 mm iknd lUppUpp M oaptorapst (14 Mlb par 10 tUp> 33 mm (bond .tippHnf from 34 pnta (1-73 par 10 AoM*) 33 e--M thowod ttippKnp (wUwMta (140 mUi par 30 Sqld> painted--bathrooms made adequate--large rec reation^ rooms provided--soft drinks and candies made available--radios installed--religious ser vices held weekly. Speeches and lectures were given by key men as to the types of work they were to perform, along with descriptions of the hazards to be encountered; and at the same time cleanliness and the use of masks were stressed. Our studies covered a period of eight months, and during that period the following statistical Table III indicates that 16% of the entire special group employed (86) demonstrated evi dence of stippling on pre-employment examin ations and yet were never exposed to any lead hazard. This confirms what is universally known, that many other diseases and conditions exist which produce this stippling phenomenon other than lead. This table likewise shows that in this special group of employees, the rate of absorption varies Sm "PtttnbnphnMq OwuppHansl bad Poimlae.'* br w*. c. Wtunm. N.D.. txscvnui. Kwtcnra il:4. tM-tM. April. IMS. among individuals, just as occurs among all groups of workers. 0000-NLI-000022562  arsp i--is rr*. a--a rn. i-U m. 3--24 f n. t-a rn. 11--M rn. Ta b u IV. Acz-OaouriNGS 4--2*1 rn. t--is m. 4--IS yr. 4--30 fTI, 2---- 11 TT*. 2--32 rn. 3--32 rn. 1--34 rn. 2--33 rn. 1--31 rn. 1--3t rn. 1--41 m. Table IV shows that the average age of this group was 28 years. Ta b u V. Bl o o d Va b l a t io n Ra a c * f itippUn* -- 1 to H (In 10 lUaco of hmofiobi -- 1M to $i% (la It w*ks) IUa-- of rod btood cofli -- T,300,000 to 4,030,000 (la tt wmk) Table V shows range of stippling, hemoglobin and red blood ceil counts, and periods at which these extremes were reached. was maximum. (3) No lost time resulted in any case. (4) No disability of temporary or per manent nature occurred. (5) No evidence of lead intoxication was found. (6) This study again shows what excellent results can be ac complished when cooperation exists between the medical department and, the lay executives of a company. (7) General fear of lead exposure (plumbophobia) is again proved to be unfound ed, inaccurate and unfair. An industry that is spending large amounts for the installation of modern protective equipment in addition to pro viding well trained physicians, technicians and modern medical dispensaries, deserves a more equitable and unprejudicial reception from the medical profession. r CuUKAEY: A study of 55 lead absorption cases among Negroes with no evidence of intoxica tion has been presented--this study covered eight months and terminated when the group returned to their native country. Table I shows that (a) when stippling count is less than one stipple to a field, minimal, ab sorption is present; and (b) when stipple count shows at least one stipple to a field, then one may expect evidence of intoxication unless im mediate steps to therapy are inaugurated. Table II shows that (a) most of the group were in Group 2; and (b) all employees exposed to lead fumes or dust absorb variable quanti ties of lead and their effects are easily demon strated in blood smears. Table III shows that (a) rates of absorption vary with the individual and exposure; and (b) intensity of absorption also vary with individual and exposure. Table IV shows that average age of group under study was 28. Table V shows that there exist marked time variations as to blood changes between stippling, hemoglobin and red blood cell counts. /Co n c l u s io n s : (1) A study of 55 Negroes with various degrees of lead absorption is pre sented. (2) Exposure to lead dust and fumes 0000-NLI-000022563