Document o9z9kZGRMwnJxj2qQG7NZv1BR

hirvi:- wres, patino tiW *, j -- . - . ..enCO laboratory of Applied Physiology College of Medicine university of Cincinnati Iinclunati, Ohio ' U.P.. fear Or. [ishoe: lhanks very much for the information contained in your letters of hay iCth. and April 3bh. ` The sitat-ion in Chili is, T ceu.itve, outisce toril;/ l a w n core of. I an informed that the non in cuestin have scan ..isi.-iewo ac .an sons ctner than f u s e discussed. Tea are correct in assumin--; che Transirn situation formant for the tine being. ':efording Venezuela, [ h n t : c hr. -cijo ins roa traer hecn^-e of inactivity dt'undara Oil Company has as vet not opened up chi': a r m t, I shall go into che cuestin in detail i.non I next /o to w n ~ suela .union I ucee to be aole tc ar m m e .-. a riGu too nr..r u.x. r rl-. I enclose iurevith trun/nation of on rticln nuoli/hec in Are January, IS08 bulletin of the !,Ohras dunitarins de in dacin/ 1 in Argentine. The problem of naming a doctor for Argentina v-ill, 1 believe, soon present it self and I have taken some preliminary s t e m tenares this end. This bulletin suggests a possible avenue of approach end I mould appreciate having your re actions to the article, particularly as they reflect fundamental iciovicdre and understanding of the problem. In the meantime I shall obtain other information regarding the authors and other sources from which to obtain information. ':Ary truu.' .ours, L/h:RH c.c. Tuners, fn-awrin A hewn. *1 -TI-rK kROPKILAIIS OF PLUMBIC IfrTOSICATIOH By Drs. Alberto C. Peralta Panos & Juan M. Obarrio Jr. (of the Medical Staff of the Obras Sanitarias de la Nacin) lO O s-H oO Ui * One of the principal problems of industrial medicine is that refering to intoxication produced by the use of heavy metals and especially that con cerning piusbism. The battle against plumbism should be faces from two points of view; the orophylactic and the curative. The first is of far greater importance to us and v.e shall deal with it in this work. To this purpose the steps taken tosuppress industries that use lead should be considered, replacing them by others in which less tonic matter in employed, and in this respect there exist projected laws and ordinances ruling those industries that use lead and others prohibiting the use of matters containing lead. :.e can make a classification of those industries that predispose plumbic intoxication dividing them into two groups. In the first enter the so called dangerous occupations, among which rank the press -workers (linotypists), elec tric storage battery workers and those workers in charge of laying out tele phone wires. Various statistics snow that about a 7 per cent of the workmen are intoxicated. In the second group we must consider those industries in which the workmen come into accidental contact with the materials that are capable of producing the intoxication. Amongst these we must mention one that holds particular inter est for us and is that refering to workmen in charge of lining ike iron sheets of the water deposits with substances that mane them less corrosive, seeing as how: tie./ are generally covered with paint made on a lead basis. By individual and general prophylaxis we must take into consideration the nature of the noxious matter and the ways of penetrating into the organism, N25058.01 One of the principal problems of industrial medicine is that referirg to intoxication produced by the use of heavy metals and especially that con cerning plumbism. The .battle against plumbism should be faced from two points of viewj the prophylactic and the curative. The first is of far greeter importance to us and v,e shell deal with it in this work. To this purpose the steps taken to suppress industries that use lead should be considered, replacing them tryothers in which less toxic natter is employed, and in this respect there exist projected laws and ordinances ruling those industries that use lead and others prohibiting the use of matters containing lead. he can sake a classification of those industries that predispose plumbic intoxication dividing them into two groups. In the first enter the so called dangerous occupations, among which rank the press workers (linotypists), elec tric storage battery workers and those workers in charge of laying out tele phone wires. Various statistics show that about a 7 per cent of the workmen are intoxicated. In the second group vie must consider those industries in which the workmen come into accidental contact with the materials that are capable of producing the intoxication. Amongst these we must mention one that holds particular inter est for us and is that refering to workmen in charge of lining the iron sheets of the water deposits with substances that mane them less corrosive, seeing as how theg are generally covered with paint made on a. lead' basis* By individual and general prophylaxis we must take into consideration the nature of the noxious matter end the ways of penetrating into the organism, dekely de L'Usseldorf deals with this problem in an extensive publication. IPekeiy points out that the different lead compounds show a different solubility in the organic liquids, and to this is the danger due depending greatly furthermore, as an intoxication, factor, on the so called pulverization faculty. The manners of |absorption of the toxic being c.ealt with can be considered . as three: - 2- lst. hlF COETa GT Is of little importance though cases of intoxication produced by having the hands submerged during a long time in liquids containing lead salts have been proven. 2nd. Z "GESTIVE das considered: until a short tine ago as the principal node of absorption. The toxic is introduced by way of drinks with leaded water or by the ingestion of toxic substances for suicidal or abhortive purposes. Among the cases pro duced by the ingestion of leaded drinking water we should mention the obsfrvatiens presented to the Faris Academy of Medicine on the verification of great epioecics in those villages where the water for consumption was very poor in salts, the intoxication taking place because of the water dissolving the lead of tne piping. It is a proven fact that distille water attacks lead; uistilied and boiled water has a more intense action while on the other hand water contain ing carbonic acid does not attack it, forming a layer of carbonates on the wall of the pipings that prevents the water from coming in direct contact with them and therefore impeding the action of sane on the lead- From the studies presented to the Paris Academy, the conclusion has been arrived at that intoxications of a hydric origin developed in those localities that consume water poor in salts, no line and acids and that are little mineralized, have a PH close on 8, having found in some of the analysis practiced that the lead content readied 12 milligrams per liter. In the digestive way, intoxications of professional origin should also be mentioned. In these cases the toxic is taken to the mouth by means of dirty hands, be it by smoking or by tooth-picks or it can also be taKen by the saliva that transports the lead deposited on the pharynx by breathing. Once ingested, in the stomach the toxic transforms itself into soluble lead--diloride, the main KB 001 iena GESTIVE vas considre until a short tine ago as the principal node of absorption, The toxic is introduced by way of drinks with leaded water or by the ingestion of toxic substances for suicidal or sbhortive purposes. Among the cases pro duced by the ingestion of leaded drinking water we should mention the observa tions presented to the Paris Academy of Medicine on the verification of great epicenics in those villages where the water for consumption was very poor in salts, the intoxication taking place because of the water dissolving.the lead of tne piping. It is a proven fact that distilled water attacks lead; distilled ( and boiled water has a more intense action while on the other hand water contain ing carbonic acid does not attack it, forming a l ayer of carbonates on the wall of the pipings that prevents the water from coming in direct contact with them and therefore impeding the action of same on the lead. From the studies presented to the Paris Academy, the conclusion has been arrived at that intoxications of a hydric origin developed in those localities that consume water poor in salts, lime and acids nd that are little mineralized, have a PH close on 8, having found in some of the analysis practiced that the lead content reached 12 miligrams per inter. In the digestive way, intoxications of professional origin should also be mentioned. In these cases the toxic is taken to the mouth by means of dirty hands, be it by smoking or by tooth-picks or it can also be taxen by the saliva that transports the lead deposited on the pharynx by breathing. Once ingested, in the stomach the toxic transforms itself into soluble lead-chloride, the main part of the absorption taking place in the small intestine, passing then to the liver and on arriving to tne hepatic cells is only partially absorbed, the rest being again eliminated by the bile. In this manner is explained how only part of -the toxic is absorbed. 3rd. BY lEJiAAIEG After th. studies made in repent times, it i.; net impox-tant. It has been proven that the toxicity of the lead inhaled is ten tirr.es greater than that ingested. This is due to the fact that all salts, be they soluble or not, are absorbed at the height of the pylmonary alveolus, passing wholly in to the circulatory 'flow, there not existing consequently any filter as in the digestive v:ay. In that absorption, the presence of carbon dioxide in contact with the sodium bicarbonate of the organic liquids is of prime importance. In this mode what is also very important is the form of breathing, it being proven that with a good nasal respiration 60 per cent of the lead in haled is stopped, while by buccal respiration, 30 per cent reached the pulmo nary alveolus. The; lead on reaching the blood, is transformed into colloidal lead-diphosphate end partly into colloidal lead-triphosphate that is deposited on the bones but under certain conditions is transformed again into colloidal lead-diphosphate, thus explaining those cases of late intoxication. PROPHYLACTIC MEASURES The prophylaxis of this intoxication can be divided into individual and general prophylaxis. For the purpose of orientating the .Individual prophylaxis, we should keep in mincU- A g e .- It has been proven that intoxication is more frequent in adol escents than in adults. Sex.- More frequent in the femenine sex. Cengition: of health.- Certain morbid cases aggravate the intoxica tion: tuberculosis, syphilis, arteriosclerosis, hepatic insufficiencies and alcoholism, the latter being a predisposing factor. RESPIRATORY Breathing by the mouth, as we have mentiqned above, is n predisposing fac tor just as also is the prolonged breathing that can be observed in certain af- digestive vay In tint absorption, the presence of carbon dioxide in contact with the sodium bicarbonate of the organic liquids is of prime importance. In this mode what is also very important is the form of breathing, it being proven that with a good nasal respiration 60 per cent ox the lead in haled is stopped, while by buccal respiration, 30 per cent reached the pulmo nary alveolus. The lead on reaching the blood, is transformed into colloidal lead-diphosphate and partly into colloidal lead-triphosphate that is deposited on the bones but under certain conditions is transformed, again into colloidal lead-diphosphate, thus explaining those cases of late intoxication. PECPHYLAGCIC MEASOEES . The prophylaxis of this intoxication can be divided into individual and general prophylaxis. . For the purpose of orientating the individual prophylaxis, we should keep in minc.:Age.- It has been proven that intoxication is more frequent in adol escents then m adults. Sex.- More frequent in the fenenine sex. Condition of health.- Certain morbid cases, aggravate the intoxica tion: tuberculosis, syphilis, arteriosclerosis, hepatic insufficiencies and alcoholism, the latter being a predisposing factor. RESPIRATORY MEANS ' Breathing by the mouth, as we have mentioned above, is a predisposing fac tor just as also is the prolonged breathing that can be observed in certain af fections. - Immux ity.- Certain people ere immune to Iced, but it is not known whether it is a congenital or an acquired immunity: there also exists a certain degree of acustoming ones self to the toxic, demonstrable because the ailments that oresent themselves in the workmen that ere intoxicated repeatedly are each tine less intense. - 4- Coming back to'tlie ptophylaxis itself, we should first indicate the hy gienic attention tending to avoid that the toxic come into contact with the mucus of the respiratory and digestive passages which are the principal ways seeing as how the cutaneous is of little importance. The workmen should be advised not to take their dirty hands to their mouths ana not to use tooth-picks while working and once their work is over, wash their hands thouroughiy, preferably with sulphurous soaps, wash their beards and mus tache and carefully brush their teeth so as to eliminate the particles that may otherwise have remained. Smoking should be prohibited during working hours and y,:e workmen should be obliged to keep their nails as short as possible so as to avoid the tonic iron getting in below them, or also, the use of rubber gloves may be implanted. Also they should be advised not to go around barefooted arid to use special clothing for working in, which shoulc. be removed when not working > this as a. means to not take the toxic to their homes. As the introduction by breathing is the most important, it is against this that we should exc t our prophylactic care. For this purpose, dry work will be substituted by hum xl and the workmen shall be provided with special masks to avoid tiie inhaled lead from coming into contact with the pulmonary alveolus. These shall be metalic masks made of various superposed layers numbering more than ten, for it has been proven'that from 30 to 80 per cent of the inhaled lead passes o through ordinary breathing masks and that it car pass through as many as six metal layers. Nevertheless, the continous use of the perfect mask is not possible for any length of time because it is too heavy, for which reason the prophylaxis should be directed principally to-nrds hygienic steps ti.at exclude oust arc. lead vapour. PROPHYLACTIC "TRES too 3H jjY G 11X ic A.L Uih.X The workmen should be advised not to take their dirty hands to their mouths and not to use tooth-picks while working and once their work is over, wash their hands thouroughly, preferably with sulphurous soaps, wash their beards and mus tache and carefully brush their teeth so as to eliminate the particles thst may otherwise have remained. Smoking should be prohibited during working hours and ole workmen should be obliged to keep their nails as short as possible so as to avoid the toxic from getting in below them, or also, the use of rubber gloves may be implanted. Also they should be advised not to go around barefooted and to use special clothing for working in, which should be removed when not working, this as a means to not take the toxic to their homes. As the introduction by breathing is the most important, it is against this that we should exert our prophylactic care. For this purpose, dry work will:be substituted by humid and the workmen shall be provided with special masks to avoid the inhaled lead from coming into contact with the pulmonary alveolus. These shall be metalic masks made of various superposed layers numbering more than ten, for it has been proven that from 30 to 80 per cent of the inhaled lead passes through ordinary breathing masks and that it can pass through as many as six metal layers. Nevertheless, the continous use of the perfect mask is not possible for any length of time because it is too heavy, for which reason the prophylaxis should be directed principally towards hygienic steps that exclude dust and lead vapour. GENERAL PROPHYLACTIC MEASURES The measures of general prophylaxis can be summed up as follows: a) Fell ventilated premises. b) Replacement of d r y work by humid. c) Installing of air removing apparatus so as to avoid the dust and lead vapours from coming into contact, with the mucus oh the res- iratory ge. d) tallation of dressing rooms, ash-stanus and. water proof floors ana walls on the working premises e) General and popular measures of instruction should be taken. 33y means of conferences, signs, etc. alcoholism and the use of tobac co, predisposing factors of great importance, shall be combatted: the workmen shall be instructed as to the proper nutrition they should take, based principally on foods rich in fats; it would also be good to advise the workmen as to the conveniency of drink ing a good quantity of mill: before going to work as it contains a great quantity of fat. Individual prophylaxis should, also be ruds of common use taking measures to avoid this intoxication. 'Vhils it is possible, all industries that employ materials that contain lead shall be replaced. For this reason the use of paints manufactured on a basis of lead for protecting the iron sheets of water deposits is not advised and these should be replaced by zinc metallizing. By metallising is understood the pulverisation of a metal in fusion try means of a specie! apparatus invented by Schoop in 1910 and which is composed of two principal parts, one of which melts the metal to be used, and the other used to pulverize it finally on to the substance to be protected, by means of a compressed ge.s. Lastly vi e should mention that in the struggle against plumbism, there is as v.uch importance attached to the periodical medical visits to the working prem ises as to all the aforementioned, and the filing of the personal in charge of its Cd these worms,so much so that it has been said that to work efficiently against piuabism, the industrial, the workman and the doctor should work together. Ir this periodic::! medical examination, all slight signs of plunbism should be investigated, having in mind for this that with a good history of the men it is possible to catalogue those, workmen .that have suffered previous intoxications and by the acustozaing mentioned before, only present slight symptoms of intoxi K 001 the workmen shall be Instructed as to the proper nutrition tney should take, based principally on foods rich in fats; it would also be good to advise the workmen as to the conveniency of drink ing a good quantity of mill: before going to work as it contains a great quantity of fat. Individual prophylaxis should also be made of Common use taking measures to avoid this intoxication. Tihile it is possible, all Industries that employ materials that contain lead shall be replaced. For this reason the use of paints manufactured on a basis of lead for protecting the iron sheets of water deposits Is not advised t and these should be replaced by zinc metallizing, By metallizing'is understood the pulverisation of a metal in fusion try means of a special apparatus invented by Schoop in 1910 and which.is composed of two principal parts, one of which melts the metal to be used, and the other used to pulverize it finally on to the substance to be protected, by means of a compresse gas. Lastly we should mention that in the struggle against plumbism, there is as ::uch import.- nee attached to the periodical medical visits to the working prem ises as to all the aforementioned and the filing of the personal in charge of these worms,so much so that it 1ms been said that to work efficiently against piunbism, the industrial, the workman and the doctor should work together. Ir this periodical medical examination, all slight signs of plunbisn should be investigated, having in mind for this that with a good 'history of the men it is possible to catalogue those workmen that have suffered previous intoxications and by the acustoming mentioned before, only present slight symptoms of .intoxi cation, Furthermore, by the periodical medical examination, all those -workmen that present a morbid condition capable of predisposing or aggravering an intoxication shall be removed. To end this, we may freely say that since the propiiylactical measures mentioned are being applied and hygienic conditions of the working premises have been improved, the professional intoxication by lead has greatly diminished in a very evident man- ner KZ 001)5: i