Document bexY84arYJk7DyZB1k3j60k0

HWHW' BgeJBM M W W O * me ii inwiiB'inwiwi LIA16314 V !- o LEAD INDUSTRIES ASSOCIATION 400 UDDNOTON AVVMUS MW TOM 17, M. T. THE DU0H05I3 JUH> TREATMENT Of LEAD K)I9enmO--SOME KET COMCtfW* Elston L. Belknap, X, t Medical Director, Olobo Union, las* Milwaukee, tlaconoin Sine* Z Zat talked to 70a iom fie* or tlx jwn *40, tbor* ban bow caw toi7 intorooting dm and noteworthy dseolapaect* both in tbo diagnosis and traataant of load poisoning, Whil* many other* and Z aetuAly engaged la keeping a*n physically fit and ebl* to continue at work la lead-exposed trad** still raly largely oa tho alapla mi relatively Inexpensive era*;!nation of tb* guns for l*ad lino and tbo qualitative oxanl notion of tbo blood for hcaoglobln asd stippled coll dstemlnatica, thoro la conataat prearure for oor* oxact and spoelflo ootboda la aoao quartan* This Involves not only tb* quantltoti** dotoralaatloa of lead la urlao bat at fa quant. t*tIts blood load amlyaea. Walla auch da fiid.ties studies an esrtalnly advisable for nsoaxcb and aodicsl-legal purposes, I a* rtlll ecevinced that they an not absolutely neoassary for kooplag tbo worker saftly at work la tbo * load trodo*. Certainly such refined studies an not o substitute for tb* oUsr Mtboda bocauao seen quantitative finding* of load la blood do not of salve* oak* a dlagnoala of load polaonlaf. Ia fact Z ban continued to ao* a largo nuabar of mb under ay rial00 la different load tndoa and I bon successfully controlled tbalr load oxpoaon and aboorptlca by ode lag only a eanful study of tho guao for load Hm aa roll aa by oraelnlng tb* blood for heao,lotla and stippled oolla. With syrten of oodlcal control tb* planta under ay supervision ban ao llttla load Intoxication that it la difficult to find any easaa for demonstration to Mdical atudont*. Whoa ocoaalonally duo to a b-oakdewn la engineering toehnlqa* wo do ban lead exposure and absorption, wo find physical evidence of It long before tbo aaa goes Into a load Intoxication with disability. If wo find load line of tb* giaa, which la easily demonstrable oncer a Iona, or a mountirg cum of 15 to 20 atipplod oolla per SO fields, w* ban ample tin* either to move a an ontlnly froo hi* oxpoaun or supply hla with a positlve-praseer* respirator which is tbs equivalent of Boeing him. This method is sunly Bach simpler fbr tba doctor and the technician lneoleod as well aa leas axpeoaie* for tbo 00mpany which la paying tb* bill* Two or thro* years ago a eory ilapl* quelltatle* Indicator of lnoroaaad load absorption was brought Into rather wide uaogo, naoely tba porphyria tost of urlso. T)da tort Involves tho uo* of a aoail ultraelolst light ocsting aboot Preeented at tbo 21tb Annual Mooting, Load Znduatrioo Aasoolatloe. April 16-11, IPSt, Chicago, Illlanla. Tf w<M M'W IWM Sf w . * p g M > a B p q i j p i i llil' Hljl I lU H l . iBlllillll* Ig M p | N 3296 mr i ' imrtr m ` ii - ' r rraUr--if--1----- ifflimni r LIA 16315 a ,rinmin . .-Ann I __ _ M __ __ __ L* Belknap, M.D, _______________ _ _ ________ __ --2-- i $25. The test 1* really M 1lapis that It cto b dons by *7 technician and interpreted by any doctor vary rapidly within half an hour. It hM alao an added value in that it shows evidence of early leal absorption before the stippled calls appear. However, besides being soaevhat non-epacific, it has the disadvantage that once positive it nay retain so for several weeks after the stippled cells hare alsost returned to noraal. Therefore, it too oar.not replace the stippled cell count and the examination of the gua* for lead la addition to a careful evaluation of the nan's eyaptoos, The test for porphyria in the urine Is alaply another evidence of probable lead absorption la the feoa of known lead exposure. Though like the stippled cells the porphyrin test la not specific, I believe froa ny experience with over 3000 detemirations that it Is as additional useful diagnostic tool whan applied carefully aid judiciously. When British Antilewiaite or Bil was found to give such rwsiarfcably affective results in the treataest of acute aercury and arsenic poisoning, it was hoped that it would land Itself to the treataest of lead poisoning also, as lead la one of tbs group of these heavy aetals. However, it has been found by a oueber of investigators end it la in line llth ay own experience that BAX la of very little help la the treataent of either the acuta or chronic type of lead absorption. It is, Moreover, a rather difficult and unpleasant asterial to work with and la tcxlo in its own right. It aay actually sake a lead easa definitely worse so that In general we do not advice ltc uaa for lead eases at this tlaa. Within the past few worths wooh Investigative work has been dona oe the cat of EDTA or ethjlaae-<H sal ne-tatre-acetrta. This f^raa a very stable eoapooad with lead which Is then rather promptly excreted safely in the urine to the aaount of SO or 60 per cent within X8 hours according to soas reoent experlaants. Very careful studies co sniaals have been done oe this subject by Or, Martin Rubin of Georgetcrn University, a young scientist with shea I aa personally acquainted and in whoa I have great confidence. He is one of the first, with Dr, Harry Foreman of the University of California, who conceived the idea of clearing lead froa the body In soaething of the sene way that it and ether heavy aetals are cleared industrially free various solutions, I aa aware also that Dr, Robert Bauer, et si,, introduced by Dr, George X. Maisce, Depertaent of fharwannlogy, Boston University School of Medicine, Ucrtoc, Massachusetts, gave a paper April lli, 1952 in Vew fork oe experiaeotal work regarding oalciue got need te protact chickens free axparlaental lead poiaocln*. Dr, rtubln reported his original results oe EJTA tea days earlier at a reoent seating of the Aaarlcan Chaaical Society in Milwaukee during the waak of March 31st to April Uth, Also, I have favorable inforaatloa froa hie regarding the apparently successful use of this substanes about a year ago in tbs case of a child who bad severe lead poisoning with brain lnvulvwaent. Since that tins I have had the opportunity to apply KDTA In the treatSant of three industrial cases of severe lead absorption and intoxication. Ooa was an instance of brain Involves*nt or encephalopathy, 00s of lead 00lie and secondary anenia, and one without syaptcaa though with narked wvidanoa of load absorption and Barked anemia, Ton would probably ha interested in the types of lead exposure of these three eases. WMWJ--I LI M6316 miiftnriftm MtftSnM rm tf iwni 4 ' Elite* L. Belknap, ICO. Th* first cxss, where there ni definite bruin Involvement, u tbe accidental exposure for several month* dus to inhal*tion of leed urate.ate (7 a worker who bala-i scrap paper for Junk ccnoem, neither the worker nor the employer w*3 <wir that th* dust evolved 5n great quar.tite* aa ha tramped It dew? In tha baler *u a lead dust. Tbarefora ba was not supplied with 4 respirator of as? kind. Tha second rasa lnrslwed a nan who was rutting painted steal In repair ing boats la a shipyard down deep in the hold with no respirator or exhaust protection. This la a major type of lead expoecre brought about bp the fusing of the lead with the burning torch. Tha third case, who had rathar aarked anemia as well as heavy lead abeorptlon, was a aan who poured trees In a brass foundry without adequate pro tection froa the Inhalation of tha lead fuaes. All of these eases had aarked lead lines and stippled cells of areo than 200 par 50 flslds, tba equivalent of 20,000 per million red cells. Jo'S of them required blood or urine lead determination to aaka the diagnosis otms the go* and blood sneer* were exaolned. All three were In snail plants, not i undf-r ny supervision, where there was In fact no nodical examination program of ary kind. These are tin situations and cases which we do use to draonstretm to oar asdlosl students* Under treatment with ETJTA all three petlents have laproved *7epteastieally. Their lead ahecrptlon has also improved objectively ae seen by dlsappearenoe of lead line, narked reduction of (tippled cells ad sharp drop in porphyria ew> cration. Moreover, the aaterlal Is easily given Intravenously and is not toxic according to our hospital blood chaeistry stouies. Boos marrow studies well be reported cn later. Tha quantitative study of lead In urine is some what complicated after the use of ETTA because with this cate rial tha union of the lead and the chemical is so tight .hat special analytical aethodj haws te ba worked out. These are now being carried forward In Columbia Hospital laboratory with tbe cooperation of Or. Subin. They will be imported upon later. Then I can pass a more considered Judgement cn E27A. In the meantime I belirwe that EUTA promises to be one of the most Important discoveries In tbs treatment of lsad poisoning since the use of etlclisa salts intravenously to relieve le^ colie originally reported In tha outstanding 1926 nonograph of Aub, frlrhall, Minot and Atsnlicoff. I believe this work was originally sponsored by the Lead Industries through funds given to the Harvard Medical School. Since 1926 though much additional definitive work has gone forward la tha treatment and diagnosis of lead poisoning, tha average physician is still quits uninforad as to the meclunlsa of leed exposure, absorption, sad in toxication due to Inadequate Instruction in most medical schools on this subject. Be therefore often treats such cases in a somewhat unenlightened manner. Xf 4 standard teaching film cm lead could be made available for instructing not only medical students but aenber* of ocunty societies, the widespread fxibllc dreed of leed poisoning could be largely mitigated. One must educate the fmslly physician correctly if puhlio opinion is to be brought abreast of tbs scientlfle facts on lssd absorption. Sons time ago X outlined such a teaching film for year Association te sponsor. X trust that eventually you will find it expedient to go forward with this projeot. Wf eswweppp Ai! bwiMjin.is. I lyn m "w.J W w ' "W *"*"*<y if