Document XRz11BdzNQ58yvaK2JYzox9ox

Ti fri?^ fc- V. Lead h^dwftrlen A#uoc.iatloii 420 LEXINOTON AVENUE NKW \TJHK.XY. Vovember 1, 1989. LEAD POISOHIHG RESEARCH BT DR8. AUB ARC OTHERS. In 1920 Dr. Aub asd hlr associates at the Massachusetts General Hospital, who had been Investigating lead poisoning with the support of lead mining smelting and fabrloatlng companies, published the results of the earl? part of their medical research, In a volume entitled *Lsad Poisoning*.* This work constitutes the most noteworthy advance ever made In the Investigation and treatment of lead poisoning and the book has been highly praised as an eminent contribution to medical literature. It Is the most comprehensive and up-to-date work on the subject, and 1s briefly summarized here for the benefit of those who may not be familiar with it. The book begins, first of all, with a thourough exposi tion of ths new methods for lead detection and estimation In blologlo material. Considerations are then offered whloh form a reasonable basis for the conception that in gested lead. Is converted after absorption to a colloidal phosphate, very stable at the normal hydrogen Ion concentra tion of the body, but passing Into more soluble form If the reaotlon Is altered even slightly. Reasons for the deposi tion of lead phoaphate In the bones of the body and the sensitiveness of the compound to changes in acidity are discussed. The routes by which lead compounds are absorbed are described and the reasons for the preeminent danger of Inhaled lead dusts are driven home. An Investigation for 'normal* lead was carried our and the conoluslon drawn that the usual activities of dally life cause no retention of lead In the body. It was next experimentally shown that there Is no marked retention of lead exoept In hard bone, which la apparently unharmed by it. A discussion of the medicolegal aspeot la worthy cf note. * Lead Poisoning. By Aub, Palrhall, Minot and Reznlkoff. Published by Vllllaas A Vllklns, Baltimore, Ud. Pries |4. P's i-jin egmmi-ww v 1 ' --lawmn '*' I'm. nut* - i.M. 7fflM.'mWBn LU1* P^UJjq^y1 mW V^--- > 1'g^SfJ^S 4?i53o`xlk,^4.[.VWi Se .'WWMWw -I- Then lend appears exclusively in the hone it must have been absorhod at tone previous timo, hut mere storage in the skeleton la no evidence that lead was Involved as a cause of death. Similarly, if lead is present only in the gastro-lnteetlnal traot or its contents, it may merely have hern swallowed and not absorbed. On the other hand, the presenoe of lead in the urine or in a majority of the tissues is a sign of aotive transportation of lead by the blood stream. This is evidenoe of either recent absorption or mobilization of stored lead from the bones. In either oaee danger of the exposure of the tissues to soluble lead is obvious, and lead nay then rightfully he considered at least a complicating factor in the pathological ploture." The analogy between the metabolism of calolua and lead is next made olear. It is shown that a low calolus diet plus ammonium chloride (to acidify) cause lead excretion and that a high calcium diet favors deposition nd retention of lead in hone. A general examination of the physiology of lead poison* lng oonalders, first, the effeots on the blood. Stippling and anemia are two of the aost pronounced symptoms and are fully explained. Brief descriptions of the action of lead on the germ cells and a dlsousslon of the reasons why lead compounds cause premature deliveries are given and followed by sections on the "lead line" and on lead oollo. It is experimentally demonstrated that lead attaoka the site of greatest fatigue, and that nuscle, not nerve. Is affeoted. Very stringent conditions are set down for a positive diagnosis of lead poisoning, and those conditions are dearly stated. Say the authors, "Very little weight can he placed on the more presence of such common persistent symptoms as constipation, anorexia, headache, insomnia, eto., unless thoy have markedly increased sinco exposure, for lead workors are no more immune to the other diseases which might also cause those symptoms than are individuals who are not exposed to lead." The seotlon cn treatment is noteworthy heoause of utilization of the new Information already described. The latest method of troataent Is fully deoarlhed olsewhore in this memorandum and la a further development of that outllnod in the hook. t v -pj w j p. wr1 ry1"'1----1<-*--yr ' 'MJ.WWH.UgWtl JISHf . * I tj2W?*m wyiil'j ifyjjpn ujPJIJ/lipji - ^.t. <* 4?^^^ypf**^ LIA21531 -3 KBCOTT DgVELOFICCTTS Sinoe 1926 Sr. Auh hr oontlnued hit work and eaoh year hat thiown new light on the eubjoot. In hit laat report to the companlee eupportlng hie work, whloh oovera the yeart 1927-28, Sr. Auh describes hit lateet, quiokest, and moot satlsfeotory treatment for lead poisoning. Then a patient entert the hoapltal with aerere lead oollo he la given a diet at flrat which la high In oalolua In order to prevent the further liberation of lead from the bonea. At the same time he la glTen aterlle calolum chloride intravenouely (a tlow lnjeotlon of 16 o.o. of a 6J aolutlon). This usually stops the load collo within a very few clnutea ao that the patients who have been In Intense pain uaually go promptly to sleep. If the oollo returns In the natter of a few hours oalolua ohlorlde la again given. In the meantime the patient la given a large dose of epaoa o salts. On this treatment the lead oollo usually com pletely and permanently disappears within a very few hours and oontlnued pain means that sose other abnormal condition la present. After the patient has had three or four days of freedom from symptoms he la given an r add diet low in calolua oontent and calntalned on this for a period of about a month. At th sane time he la given large doses of a salt which pmduoes aold In the body, usually ammonium ohlorlde. This treatment causes a liberation of calolua end lead from the bonea without reprecipitating manifestations of lead Intoxications. At the end of thla treatment the patient la again given large quantities of calolum In hla diet In order that the depleted atore of calolum may be replaced. The readily available storehouse of lead in the body is thue partially removed, which largely eliminates the possibility of a late manifestation of poisoning fron lead stored in the bones. This treatment, whloh Is quite simple and which cat: easily be carried out at home, has had an extremely beneficial effect on practi cally all cases of lead poisoning. The patient can get baok to work reletlvely quickly and the unpleasant nouroals so often seen with ohronlo lead poisoning is cow extremely rare in our oases."