Document XzR7nKOO52p1grm4re2nepJ2g

"Plumbo-phobia" Occupational Load Poisoning -A Study at Casas of Load Absorption and Load Infmdcation Obsorrod by tho Author at tho Notional load Com pany, Atlantic 8ranch, Forth Amboy, Now Jorsoy, and at tho Forth Amboy Gonorai Hospital-- WM. C. WllNT2, M.O. Part | 0000-NLI-000022564 lUprintod from Ik p c t o u l Mp io w , 15 : 4, 253 - 156, April, 1946 "Plumbc-phobia" Occupational Lead Poisoning --A Study of Casts of Load Absorption and Lead Intoxi cation Obierved by the Author at tht National Load Com pany, Atlantic Branch, forth Amboy, Now Jonty, and at tho Porth Amboy General Hospital-- WM. C. WtlENTZ, M.O. Part I IT is n o t my intention in this paper to present any to state frankly and without reservation that I ^am thing startling on this subject, since years of study no more frightened by its effects than I am about other and investigation by prominent members of the medical, toxic substance. Let's not continue to consider lead chemical and engineering professions have provided absorption and intoxication as "an incurable disease." our libraries with a large amount of scientific material. Let's put an end to this type of loose talk. We have It is my desire, however, to present certain phases of facts to state and nothing to conceal. Let's make sure this subject, along with my own interpretation, to those that men in laboratories be made familiar with the persons who are interested in the effects of lead as it practical and clinical aspects of the condition, and confronts us daily in industry. vico versa. This is the least that we have a right to My reason for this is the obvious fact that the lead expect from men of repute. industries have been on the defensive far too long and The exposures prevalent in our piant were from unnecessarily. The unfair and insidious propaganda lead fumes and lead dust in combination with oxides, which caused this situation has been permitted- to per sulfates, hydroxides and antimony, the most prevalent meate throughout the entire field of industry, govern exposure being from lead dust and primary manner of ment circles, and courts of justice and has, therefore, absorption being through the respiratory tract via of placed the entire industry in a very unfavorable posi inhalation of the dust tion. This is due primarily to the fact that too many men have written and are now writing too many books and articles about lead of which they know too little Ta il s L Asa Fac t o s s from a practical standpoint These men, either inno cently or by intent are responsible for this condition which I term "Plumbphobia," meaning "Fear of Lead." With the aid of information obtained by a survey 1999 Amia act a< iatoUwtfaa MMibMito. ss Annti axpomra ot to- 1949 t 1941 ss IMS a 1S4S M ISM S4 IMS >* n ---a of studies at our plant, we hope to assist in neutralis (total............... It ing this attitude. Atone* tfeto !tot froM 7 14 11 S 14 --- nii I can well recall that when I first undertook the work (days).............. se 0 ss a SI 11 a -- M responsibility of looking after the health and welfare A| at fottfat iitoi* cftdo* mm (jm).. se ss a 14 u n -- S4 of the employees at this plant, I had great fears of At o4 aidaat iatarito. what was to come. I did not know what to expect, what ttea mm (yaual----- ss 49 44 47 M 41 -- a dreadful complications were likely to arise, what thera peutic agents we had at our disposal, and what prog LaecU a< MMn at jomtm mm (Mata) Lmc U ai aipnana a4 noses to anticipate. My trepidation had its origin in the atoaM mm (*aata).. < IX is S 4 4 -- s talk and gossip among the people of the community, Lmc U a< Uartta of pomro tom (4ayd.. St se 44 11 11 IS -- ST where "everyone was familiar with the bad effects Lmc U ot Imc mC a*. from lead poisoning." As a matter of fact, the medical PMimaaM ss t IS 14 At* Groom itoMm and legal fraternities held similar impressions, so that 14 moo lltets it is not surprising to learn laymen felt the same way. 15 aaa ( aaaa se as 44 to 41 Such fears and impressions, generally encountered, 1 MM U 7 -- IS may have been justified some years ago, but they are not justifiable on any basis today. Industry is spending Table I discloses the wide range of age groups huge amounts of capital to install the most modern that may become affected, as well se showing clearly protective equipment, aaweff as providing the services a well knows fact, via, that the young and middle- of well trained physicians and modern medical dis aged men are primarily involved and most susceptible pensaries to deal with anything that may arise in the course of employment including the effects such ss they may be from exposure to lead. It is my belief that cases of lead absorption, and In toxication should recover without any resulting disabil ity. This is predicated on the fact that if sound medical observation and treatment are provided in conjunction with present-day cooperation from management, excel lent results can be obtained. I will say, however, that without this cooperation anything could happen, will to the effects of lead exposure. That is the reason why it is important that these younger men be given most "careful pre-employment examinations. The most serious cases encountered were two men who were employed In dismantling an old building. One was 36 years of age with a 16 weeks' exposure while the other was 39 years of age with a seven weeks' exposure. Both were of Spanish descent Dismantling has always been considered one of the most serioas most certainly happen, even today. Let no one mis understand my thoughts about the toxicity of lead. I am thoroughly acquainted with the possibilities and probabilities of this metal, but I am perfectly satisfied exposures. *" It seems to me that average time lost from work at 30 days should compare favorably with other plant figures. We have never made it a policy of insisting A I > 0000-NLI-000022565 upon quick return to work, but, at the same time, as soon as the subjective symptoms subside or disappear, arrangements are made in providing other types of work. The blood picture guides us in this respect, but only as an aid in estimating the entire picture. Ta s l e II. H03HTAL AND NON-HOSPITAX STUDtre Total No. Caaaa /ram lUt-ms.............................................. jr Cufl hoipiiaiiato .................................................... 2j Cun not hoipiUJiiad............................................... i Total ............................................................. J7 Hot-vital wi ttatittitt til cotta) Short*** hoopitaJ lUy............................................. 5 Loofcot hospital stay............................................. 34 dart Anrui .................................................................. 12 din A* act of pitltiit........................................... 34 rttn (23 to 14) Ararat* laatth of txsorart.................................... 9 wttka Ararat* loti tlfflt of coat....................................... 34 4^ Scn-Hotpital cott ttotutict (t cotta) Atone* tat of patlost........................................... 32 jroan (21 to 4T> Artnet Itoeth of expooor*................................... 13 wtoki Atone* looi tin* of coat....................................... 14 dor* Table II discloses some interesting facts relating to the hospitalization and ambulatory handling of these cases. It must be clearly understood that we were dealing with different degrees of intoxication, the most pronounced and seriously ill being hospital* ized while the mild types were treated as ambulatory. It is also worth noting that these studies clearly show that the average exposure for the moat serious cases (hospital case) was six weeks shorter than the ambulatory case, indicating a more acute fulminating, intense intoxication within a shorter period of time. Early hospitalization pays dividends--do not hesi tate or delay--patients will be gTsteful--funds will be saved--results will be excellent. Table III confirms what has always been known as a fact, namely, that there are many conditions other than lead exposure that must be considered whenever this subject is discussed. This truth is still not clear to the general medical and legal professions. Ta b l i IIL Ptt-EMnoYMXNT St if f u n q St u d ms Total No. Prt-tmpUimtnt Scorn. (1UP.HU)................. 1333 Total (V*. tkoanop atlppfin# prior to >< 4............. a-- (MS) Artrogt opt a/ ttipphug oocm............................................... 33 7TO, Ha. grpopt tt-mOlcd (From It pro. . 44 pro.)....................... 23 Apt preopt ikttritp Iarpmt >* of t*IppUmp: 21 m......................................... 1 20 TOO-.................................................S *7 r*S-................ S 31 jm...................................................... Proofatopmoot ocCMpatient af cUppUap toccc: 1 <nd-i 1 irotlr 2 track drloon 1 Uiopkoa* iplo4 1 bark* 1 armp illithane 2 til* luSMlm 1 tilk unfMtm 1 irca mrhar (nail*mi|bl> 1 atromlo wookor 1 oarbantailm (aaS ppoiKfc) 3 plaab aalS orrlon 1 ooal aiaor 2 brick worker* (aaS proUtla) (1) 1 railroad warkw 2 otoal worker* (om trpbOUti*) 1 fortllUor 4 rablo ororfcar* T ooppor ororkan (aaa-wUawoUttol (o m vftfe oookrMa) 2 A.S. a a. wacko* nualiai (om wttk Mplittbl 1 dotiaalaf woefcot wftk mm ootta kocHa 1 pftlsttf 13 load (whn aad hrlok onto torn ootta ooppor (1) (2) (1) Utt tattoo (I) profit!* (1) 7 Mao ta to oocapotioao, bat fcBootop tt****** wor* faaad OB pro oniplonnoat examination* la aSdttoa to th* ahoro: I >rpbill* 1 oopbrtti* and aadaroroitkt 1 pitoltarr dlafopctioa It is interesting to observe that no man employed (who had shown pre-employment stippling) has up to the present time shown any inclination towards absorption or intoxication. This fact has greatly as sisted us in the employment problem common to all in dustry today, owing to conditions beyond our control. Ta b l e IV. Bl o o o St u d ie s ft. *4 of Ormioat cAongoo m eovmu aad msari_ acute umDtoou iris*. *o li deyt 4/tor Por^od vhon blood <o*ats and tmmn rotam ta %ormol: iMeordinf whiter or not haspluiUed) Hoepiul Ambulatory Period wAe* Mood eoaat* d tmoar ratdr% to mormoi; 4H CBOQlhl I month* (oeeordi&c to length of exponn) 20 year group...................................................... 30 year group...................................................... 40 year group..........................-.......................... Period wAoa blood eoawtl oad smear* rsfnrt to oonmol: 3 Booths 4 (BOfitkj 3 Booth* (ereordlag to lesgth of exposure) Short txpoeur* groupe (below 10 wtoki > ..........4.4 aoath* Longer exposure groups (beyond 19 weeks).............4.3 Booth* lowest eoa&t <B) 2.990.00* (A) 3.740.00* highest eout (8) 4,230,000 (A) 4.740.004 iftrifi eout (H) imm (A) 4.034.000 lowest eoaiu (H) ** (A) 44% highest eoaat (8) 74% (A) 70% sroragt eoaat (8) 44% (A) 71% lowest eoaat <k> 17 (A) to kitkom coast (H) too (A) 141 STurmg* eoaat (8) 119 (A) 71 NOTE: (H) Hospital eaea. (A) Ambulatory cut. Stipple toil eoant por 30 fluid*. Treatment Wl DO NOT employ anything unusual in our treat ment We have nothing new to offer. We felt, how ever, that In view of the facts that during the past five years we have had to treat 37 lead intoxications, and that in no case so far has there resulted any dis ability, oar procedure in handling such eases must have some merit For that reason, and only for that reason, do I mention it Does it not prove that these cases are curable? If we can get such results, so can anyone else. Anyone who wishes the best information on treat ment should consult that most excellent pamphlet re cently published by thg American Public Health Asso ciation, entitled "Occupational Lead Exposure and Lead Poisoning." The psunphlet can be utilized as a guide to the fullest extent, and with maximum benefit to all concerned. I agree with all the suggestions, since I have utilized them generally in all my cases prior to their publication, as well as ever since. I do feel that treatment, in order to be satisfactory, must be admin istered in a definite specific manner, fully recognizing the problem, aa otherwise it makes very little differ ence what yon employ as tharspeutic agents. Our general routine is as follows: DUXINO THl ACTTO PILAU: 1. Hospitalize 2. Bad rest (or ambulatory, depending on severity of pain). 3. One ounce magnesium sulfate every morning on arising. 4. Teaspoonful tincture beQadonna-phenobarbitai mixture Q.41L for pain. 5. Narcotics seldom utilized. 6. lOce. 20% neocalgiuconate--intravenously Q.4.H. (preferred); intramuscularly Q.4.H. 7. 15 gr. neocalgluconata wafers or bone phosphate wafers orally Q.4.H. 8. Warm water bag or electric pad for abdominal pain. 9. Diet high ii^palcium and low in phosphites. 10. Complete blood count and stippling followed by red blood count, hemoglobin and stippling counts every other day. . 11. Estimation of lead ia urine and urinalysis, fol lowed by occasional urinalyses. 0000-NLI-000022566 DURING THE CONVALESCENT PHASE: 1. Regular diet permitted. 2. Mild laxatives recommended. 3. Calcium or bone phosphate wafers provided. 4. Iron and vitamin B complex tablets provided for anemia and as tonic. 5. Warn against overindulgence ef alcoholics, expo sure to colds, etc. 6. Monthly red blood counts, hemoglobin, and stip pling counts; * "'Uh ia s ; prc*4/-u-- 7. Return to some work as soon/as/possible for psy chological reasons. 3. Make sure compensation payments are made on time for same reason. 9. No further exposure permitted. DURING THE CHRONIC PHASE I 1. Permanent removal from exposure. 2. Fresh air. 3. Adequate diet. 4. Multiple vitamin tablets for fatigue, malaise and weakness. 5. Vitamin B and its complex for neurologic symp toms and signs. 6. Laxatives for constipation. 7. Calcium therapy if indicated. 8. Adequate treatment for sequelae (if they arise). REMARKS I 1. Calcium gluconate intravenously must be con tinued for at least several days after all symptoms of colic subside as safety measure, otherwise pains will recur and you will have to start all over again. 2. Calcium gluconate oral wafers depending on con valescence. 3. No iron preparations during hospital stay--can not be utilized or absorbed. 4. Vitamins, milk and special diets are questionable as to true value but can be used without any ill-effects if one so desires. 5. Oeleading not advocated. Summary . Ac o mpl et e and thorough study of 37 lead intoxica tion cases with no resulting disability has been presented. 2. Table / shows that: (a) Young and middle-aged are moat susceptible, (b) Average lost time is 30 days. 3. Table II shows that: (a) Average exposure for most serious cases (hos pital case) was shorter than for ambulatory cases. (b) Average age of hospital ease was two years older than that of ambulatory ease. 4. Table III shows that: (a) 5% of all pre-employment examinations show stippling. (b) 78* of stippling cases had no exposure to lead. 5. TabU IV shows that: (a) Period of greatest blood changes occur between seven and 14 days after acute symptoms arise. (b) Blood counts return to normal earliest in hos pital and oldest age group. (c) Length of exposure has no effect in bringing about normal count quicker. (d) Average R.B.C. and hemoglobin estimates are lower in hospital cases. (e) Average stippled count is higher in hospital cases. 6. Treatment is presented. Conclusions i~\0 n o t underestimate effects of lead exposure, but*j? frank attitude toward the entire problem on the part of management and medical department mi,- ^ mizes the hazard. mun- ; 2. The physician-in<harge must examine all blood counts a3 completed within 24 hours--delay may ^ serious--thorough study must be made in each case, and the following method is recommended. (A) When a blood count or clinical signs or both signify a "Suspicious" or "Absorption Case," a written order is immediately sent in triplicate to the general superintendent, department head and foreman with designation of "Watch Case," meaning just what it states. (B) The same procedure is followed when an "Im pending" true "Intoxication Case" is present, but here we designate our order as "Keep-Out-Case," meaning keep out of all exposure. An immediate telephone call to the department head always precedes the arri-al of written order on the same day. (C) These orders are again repeated in a Monthly Medical Report to the same members of management, whose duty it is to see to it that all medical orders are carried out without delay. Where discussion of the case is requested by management, a conference is alwaya arranged, but the original medical order stands unless there is unanimous approval of some other procedure. I would like to state at this point that compromise does not fit into this type of work and the medical department should adopt a fair but stern attitude, owing to the great responsibilities involved. (D) Aa soon as the condition of the employee changes to a satisfactory level, the medical department issues another order to that effect. 3. All dies must be in abaolute control of the plant physician or surgeon, as the treating of these cases requires experience peculiar to this type of exposure. Best results win otherwise not be obtained. 4. Early hospitalization important. 5. Deleading not recommended. 8. Monthly red blood counts, hemoglobin and stip pling estimates. Monthly physical examinations. Quar terly urinalyses. 7. No re-exposure permitted without the consent at the medical department. 8. Employees must be impressed with importance of reporting all illnesses immediately to the medical de partment, so that relationship to exposure be ascer tained quickly. If the company has no arrangement to provide medical care to the employees other than for those conditions arising out of their employment, then I strongly suggest that the plant physician visit the home of the sick employee for the purpose of deter mining this relationship. If this policy is not adopted, it is easy to see what dangers are inherent 9. Employees must be educated to this hazard by intelligent means. 10. Employees must be educated In the valus of hygienic measures, such aa cleanliness of hands and body, dental care, frequent change of working clothes, ingestion of sufficient and proper foods, sufficient sleep and rest aa well as reasonable abstinence from alco holics. 11. Central eating places should be established. We suggest providing employees with an extra 10 minutes prior to eating time for purpose of "getting cleaned up." We suggeat also that everyone be compelled to eat in thia central cafeteria, even if some are permitted to bring their own fooda to the plant 12. Lead ahaorption and intoxication cases should recover with no resulting disability. 13. The public is entitled to know our views, and it is onr responsibility to them, as well as to the pro fession, to soe that they hare access to these opinions. ' 0000-NLI-000022567