Document ppeb77R0EpEn6vwxww4z1ZxvB

HARRISOI RADIATOR DIVISION QElERAL MOTORS CORPORATION ; LOCHPOETj, R.Y. A P relim in ary Study of .the..Lead Exposure A ssociated vjlta the H om al O perati.on of a P la n t Engaged In th e M anufacture of Automobile R ad iato rs and H ea ters, by Th K e tte r in g L a b o ra to ry o f A p p lie d P h y sio lo g y . in the - U niversity of C incinnati R o b e rt A* H enos* D ir e c to r ' . KP 0003672 C .....I n tr o d u c to r y Comment on th e S tudy o f O c c u p a tio n a l Lead E xposure In v ie w o f th e f a c t th a t th e g en eral methods o f p la n t study employed by the K e tte rin g L aboratory of A pplied P hysiology d if f e r somewhat from th o se used g e n e ra lly In in d u s t r ia l su rv e y s, i t may he o f some i n t e r e s t to r e f e r . fe th e a v a i l a b l e m ethods a n d t o p o in t out some o f th e ad v a n tag e s and d is a d v a n ta g e s in t h e i r us . (1) A -'Single .c r itic a l- 'I n s p e c tio n o f . o p e ra tin g c o n d itio n s i n a p l a n t , mad by an e x p e rie n c e d p e rs o n , w ill p ro v id e a g e n e ra l id e a o f th e o p p o r tu n itie s f o r le a d exposure and some knowledge of the lo catio n of the g reatest hasards. Periodic inspectionsof th is type w ill prove to be more u s e fu l than one f o r obvious re a s o n s , and moreover th e y a re a u s e f u l a d ju n c t -to any o th e r method of stu d y and control, ' . .' (2} A s in g l e c l i n i c a l su rv e y o f g r o u p s . o f workmen rep resen tativ e of various occupational a c tiv itie s in the p lan t w ill d efin e the g en eral le v e ls of le a d exposure in terms o f c lin ic a l evidences of le a d a b s o rp tio n and w ill tend to show th e m ost hazardous ty p es o f employment* (5) M aintained m edical su p erv isio n , w ith periodic exam inations o f a l l employees and w ith c a re fu lly recorded Inform ation as to th e c h a ra c te r and in cid en ce of i l l n e s s , th e amount o f l o s t tim e and th e e x te n t o f th e la b o r tu r n o v e r , w i l l e v e n tu a lly show th e h y g ie n ic sig n ific a n c e of p la n t c o n d itio n s , as no o th e r method can do, and i f such d a ta a re combined w ith d e ta ile d knowledge of p la n t p ro ced u res, H e 0003673 in cluding changas in equipment and p la n t p ra c tic e , a c le a r composite p i c tu r e o f th e h y g ie n ic s i t u a t i o n can b s t a i n e d * / . M l o th e r means f o r e v a lu a tin g th h y g ie n ic s i g n i f i c a n c s o f le a d xps u r e , as contru ste d w ith i t s a e re q u a n tity , depend f in a lly upon sound c lin ic a l ' d ata* In d eed th e b e l i e f i s wIX e n tre n c h e d in th e m e d ic a l a s w e ll a s th n o n -m ed ic al mind t h a t i n d i v i d u a l s u s c e p t i b i l i t y t o le a d i n t o x i c a t i o n is extrem ely v a ria b le and th a t even th e sm a lle st q u a n titie s of absorbed lead may, in tim e, re s u lt in lead poisoning in c e rta in persons, w hile c e r t a in o th e r p e rso n s may r e c e iv e no in ju ry : from m assiv e d o sa g e s. The complete, acceptance o f such a p o in t of view ,(w hich In our Judgment is e rro n e o u s ), im p lie s t h a t th e r e i s l i t t l e o r no v a lu e in any ty p e o f measurement of th e q u an tity of lead absorbed o r p o te n tia lly a v a ila b le . : fo r a b s o rp tio n on th e p a r t of-workmen* So lo n g as such an o p in io n is applied w ith even p a r tia l effectiv en e ss In raediaoM sgal and trade union phases o f in d u s t r ia l p ra c tic e * b u sin e ss management, cannot a ffo rd to - o p e r a te p la n ts a s s o c ia te d w ith an y o f th e le a d tr a d e s w ith o u t com-*p o te n t and adeq u ate m edical se rv ic e* F o rtu n a te ly , videnod has accum ulated to dem onstrate the existence of a re la tio n s h ip between q u an tity of lead abso rp tio n and the occurrence of lead in to x ic a tio n . Various expressions have been given to th is re la tio n s h ip , and i t cannot be s a id t h a t th e r e i s ^am p ete ag reem en t among a u t h o r i t i e s a s to the safe lim its of occupational lead absorption* N evertheless i t is now f a i r l y g e n e r a lly a c c e p te d t h a t th e r e i s a l i m i t o f le a d e x p o su re above w hich th e d a n g e r o f le a d p o iso n in g becomes p r o g r e s s 1v e ly g r e a t e r among a p la n t p o p u la tio n , and below w hich c a se s o f p o iso n in g w i l l e ith e r not occur a t a l l or w ill be of an e s s e n tia lly harm less type. Thus i t becomes f e a s i b l e to e s tim a te th e s ig n if ic a n c e o f lo a d exposure in q u a n tita tiv e terras*  '" I-"---i* J * {i}.) E xposure t o p a r t i c u l a t e le a d compounds l a d u sty le a d traded, stay be .estim ated by the .an a ly sis of a i r sam ple's;. taken from r e p re s e n ta tiv e p a rts ef th e p la n t O bviously the use of th is method in v o lv es: c e rta in assum ptions} - (1) th a t the in h a la tio n o f p a r tie u la te le a d compounds c o n s titu te s th e only im p o rtan t source o f l e a d 1'a b s o r p tio n on th e p a r t o f th e p l a n t 1p o p u la tio n f (2 ) t h a t th e le a d p s r t i o l e s '1found I n .a ir sam ples may be b re a th e d In and r e ta in e d ' w ith in th e lu n g to a more o r le s s uniform e x te n t-b y the oifcaen in the area. V arious te c h n ic a l p ro ced u res have been employed to in c r e a s e 'th e p r a c t i c a l r e l i a b i l i t y o f t h i s xaethod* F req u en t sam pling . -over p ro lo n g ed p a r i o d s i t e M s to re d u c e sam p lin g e r r o r s 6\ fho manner-.:;. /. ' o f p re p a rin g sam ples for: a n a ly s is a l s o te n d s t o e x c lu d e pa:, t i d e s of le ad compounds which because of t i e l r sis a re in cap ab le of in h a la tio n or o f r e te n tio n .in the lung Moreover th e g re a te r p r a c tic a l s ig n ific a n c e of in h a le d le a d i n com parison w ith in g e s te d le a d h a s been f a i r l y w e ll dem onstrated;,.by e x p e rie n c e and experim ent# .;and is . no, alm o st u n i v e r s a l l y recognised* On th e e t h e r hand le a d - p o is o n in g ean and does o cc u r - ; through in g e s tio n of .lead 'compounds, and u n le ss' p recau tio n ary , m eaaures a re e f f e c t i v e l y ta k e n '- a g a i n s t'c a r e le s s n e s s and u n c le a n ly h a b i t s on. th e p a r t o f workmen in g e s tio n can o cc u r to such an e x te n t, as to v o id c o n c lu sio n s a r r i v e d a t -by th e a n a ly s is o f a i r sam ples (5) I t has been-shown th a t the magnitude of th e lead exposure in a p la n t can bo determ ined by the study of the load content of th e e x c re ta o f th e employees* B rie fly sta te d # th e load c o n te n t o f a s i n g l e e v a c u a tio n o f th e f e c e s o f a workman s e rv e s to shew.'the m agnitude o f h is le ad exposure f o r the p erio d of from tw enty- four to seventy-tw o hours p re v io u s-to the c o lle c tio n of the sample* large proportion of a l l inhaled lead Is c o lle c te d in the nose and K f 0003675 k pharynx and e v e n tu a lly reach es th e a lim e n ta ry tra c t# through which i t p a s s e s ,in la rg e measure unabsorbed. I t becomes# th e re b y , an in d le a - t o r o f a man*s g ro ss lead In tak e f o r th e p erio d re p re se n te d by the feces accum ulated in th e low er bowel - a p erio d which experience has shown to be a p p ro x im a te ly twaty*four h o u r s . The c o n c e n tr a tio n o f lead in a la rg e sample of u rin e (c o lle c te d over a p erio d o f f o rty - .' -' . . w i t h ' : /. ,, e ig h t o r se v en ty -tw o hours} seems to v a ry Ath e le a d c o n te n t o f th e body and th e r e f o r e d is c lo s e s th e g e n e ra l m agnitude o f th e le a d afe- s o r p tio n o v e r a c o n s id e r a b le p e rio d o f time#, Th c o r r e l a t i o n o f th e se d a ta on th e e x c r e t a .w ith th e o b serv ed c o n d itio n s in: i n d u s t r i a l plants and w ith the c lin ic a l fin d in g s in the p la n t. populations has not : been mad o v e r a wide enough ran g e o f e x p o su re s =t o g i v e ' a f i n a l , e x - . p re s s io n o f th e r e l a t i o n s h i p s which o b t a i n . To t h i s e x te n t e v e ry new I n d u s t r i a l s i t u a t i o n w hich comes u n d er stu d y i s o f I n te n s e - 'in t e r e s t ,: x p e rim sn ta lly , in t h a t th e in fo rm a tio n mad a v a i l a b l e f i l l s on o r . more o f th e gaps in our u n d erstan d in g o f th e problem* D espite th is d i s t i n c t l y e x p e r im e n ta l'a s p e c t o f th e w ork, -th e know ledge of p l a n t , conditions gained by th is type of study is in v alu ab le in hygienic c o n tro l and is o f th g r e a t e s t p r a c t i c a l v alu e In th e s o lu tio n of in d iv id u a l c l i n i c a l problems*. .. - I t i s d e s i r a b l e t h a t i n i t i a l s tu d i e s mad l a a p lan t be supplem ented by fu rth e r o b serv atio n s. I f one is to know, w ith c e rta in ty * whether o r not a;.given m agnitude of exposure Is capable of producing lead In to x ic a tio n , he must be sure th a t the co I'-* c o n d itio n s o r i g i n a l l y o b serv ed a r e m a in ta in e d ( o r improved) and he CO os m ust: a ls o b sur t h a t 1 l i n e s sea t h a t d e v e lo p among th em ployees ar a d e q u a te ly s tu d ie d and r e c o r d e d . The s t a f f o f t h i s L a b o ra to ry h a s ev ery i n t e r e s t in prom oting th m ost ad eq u ate type- o f p la n t m ed ical serv ice and in ren d erin g every p o ssib le a id in d o ubtful or d if f ic u lt c a s e s , to th e end t h a t th c o n c lu sio n s once a r r iv e d a t may be s u b je c te d tfjr ooc to c r i t i c a l check, As i n d u s t r i a l h y g ie n is ts we a tte m p t to recognise and to elim in ate hazardous lead exposure* while a t the same tim e as e x p e r i m e n ta lis ts , we seek to b u ild a sound fo u n d a tio n fo r a sharp and p r a c tic a l d if f e r e n tia tio n of hazardous from non hazardous e x p o su re . From th e v ie w p o in t o f p la n t management th e s e may ap p ear to be som eshat in c o m p a tib le o b je c ti v e s , b u t th e y need n o t be i f adequate and accurate inform ation is a v a ila b le , A ctually both o b je c tiv e s may h e : a c h ie v e d ;a f t e r a a i n i t i a l th o ro u g h s u rv e y , if .g o o d c l i n i c a l d a ta on th e em ployees can be had and. i f q u e s tio n a b le c a se s can be stu d ie d by -adequate la b o ra to ry m ethods, :- The T ech n iq u e-an d Scop o f th e P re se n t. I n v e s t i g a t i o n ,. . . . For a .variety of reasons, th is study as carried : o u t on a sm a ll s c a le - to o .small, in f a c t to j u s t i f y more than t e n t a - tlv e conclusions as to the conditions ex istin g in the p lant as a . whole. I t is probable th a t the data p o rtra y th e s itu a tio n f a i r l y w ith reapect to lead;exposure, fo r reasons w hich,w ill be pointed out ; In l a t e r p arag rap h s, b u t they cannot p ro p e rly be regarded as mere than . the r e s u lts o f s e le c tiv e sam pling r a th e r th a n ' the g e n e ra l random sam pling which would be re q u ire d to d e te c t unrecognised fa c to rs in the exposure. -. . ; A p r e lim in a r y in s p e c tio n o f th p l a n t was mad, on th e b a s is o f w hich employ were s e le c te d f o r s tu d y from w hat ap p eared t be th e commonest and th e m ost h az ard o u s o c c u p a tio n s . M oreover, a number of s u b je c ts w ith th e lo n g e s t re c o rd s o f employment were chosen, and in r e c o g n itio n o f th e g e n e r a lly a c c e p te d b e l i e f t h a t women a re more s u s c e p tib le th a n men to in ju r y from le a d a b s o r p tio n , s e v e r a l fem ale employees were in c lu d e d . The t o t a l number o f em ployees was a p p ro x im a te ly 2500, of whom ab o u t .50D w ere women. Most o f t h e em ployees worked ' lh: la rg e " groups t h a t p erfo rm ed feh earn ty p e o f work and had th e same b a s ic c o n d itio n s o f e x p o s u re , fh u s some 1500 p erso n s worked on assem bly li n e s in la rg e rooms in which th e le a d exposure was o f th e same ty p e and o f th e same g e n e ra l o rd e r o f m ag n itu d e. In su ch a group g ro ss v a r ia tio n s in in d iv i d u a l le a d a b s o r p tio n a r e s c a r c e l y t o b a n t ic i p a te d ,: e x c e p t on th b a s i s o f v a r i a b i l i t y of etn d u c t in m a tte r s o f C le a n lin e s s and p e rs o n a l h y g ia n a . -Thus th e r e i s scan j u s t i f i c a t i o n f o r b e lie v in g t h a t the t h i r t y - s i x persons s e le c te d f o r exam ination (o f which fiv e were women) have p ro v id e d f a i r l y c h a r a c t e r i s t i c e v id e n c e o f th e le a d ex posu re a s s o c ia te d ' with .Si v a r io u s ty p e s .of work, in t h e p la n t* - . f a b l e X shows ' th e age g ro u p in g , o f th e p erso n s s e le c te d f o r exam ination* A wide rang has been co v ered . I t I s of some Importance-' -t o ' n o te t h a t th e mean ag e o f th e g roup examined;; is unusually high, fourteen out o f th e th irty -s ix being fo rty -fiv e y ea rs o f ag e o r o l d e r . -The group i s p ro b a b ly n o t c h a r a c t e r i s t i c / of th e p la n t p o p u la tio n , and th e f a c t has no p a r tic u la r sig n ific a n c e w ith resp e ct to any Increased lik elih o o d of th e occurrence of lead: poisoning, since older people, 3f d iffe re n t in any w ise, are believed to b somewhat l e s s s u s c e p ti b le th a n th e young. However, c e r t a i n o f . the d eg en erativ e d ise a se s of m iddle and l a t e l i f e have been lin k e d up w ith the e ffe c ts o f lead ab so rp tio n . A rte rie -s c le ro s is , fo r example, . . - . t has long been reg ard ed (on Inadequate evidence) as a seq u el .of pro longed lead exposure, and although i t i s q u ite c le a r th a t th ere are other causes, the coincidence of a rte rio -s o le ro s is and a h isto ry o f prolonged employment in a le a d tra d e I s reg ard ed by many p h y sic ian s and m edical w rite rs as s u f f ic ie n t evidence to w arrant the co n v ictio n o f le a d a s th e o ffe n d in g a g e n t, On t h i s a c c o u n t, and i n i l l u s t r a t i o n  . . ' f . . of the point under d iscu ssio n , the frequency d is trib u tio n of s y s to lic blood p ressures as observed in th e group i s lis te d in Table 2 , and the ages of th e persons shoeing abnorm ally high blood p ressu re are show n'in p a re n th e sis e The s ig n ific a n c e o f th e s e d a ta w ill be r e f e r re d to later* . , ' , .. ' ^ .. V; ' ; ; T ab le J* i n w hich th e s u b je c ts a re grouped a c c o rd in g __ to th e d u ra tio n of th e ir le ad exposure in th e p la n t, m erely shows th a t the group has- been w ell s e le c te d w ith re s p e c t to v a rie ty in le n g th o f . : exposure* As a sam p lin g p ro ced u re t h i s i s ad vantageous* The s i g n i f i c a n c e of prolonged exposure to le a d compounds i s w ell a p p r e c ia te d indeed too much em phasis h a s b een p la c e d upon th e tim e f a c t o r by th e t h e o r i s t s , in in d u s tria l hygiene. I t is not so w ell recognized th a t lead in to x ica tio n o ccu rs more commonly among new em ployees th an among th e'habituated..", (perhaps n a tu ra lly se le c te d } and long employed members of a p la n t p o p u la tio n . . b . yEach, p erso n in th e s e l e c t e d group was s u b je c te d t o d e t a i l e d q u e s tio n in g . E v ery e f f o r t was mad to g a in h is c o n fid e n c e and to induce him to ta lk f r e e ly about any a ilm e n t, i l l n e s s o r in ju ry which m ig h t, in h is m ind, be a s s o c ia te d w ith h i s employment heading q u estions, were avoided a t f i r s t so as n o t to c o lo r th e p ic tu r e , b u t wore employed su b se q u e n tly w ith r e f e r e n c e to s p e c i f i c symptoms, so a s to m iss no ; s ig n if ic a n t inform ation* The employee was a s s u re d th a t any in fo rm atio n which ha m ight w ish to w ith h o ld from M s em ployer would be k ep t in 'c o n f id e n c e , to th e end t h a t h i s p o s i t i o n would in no way b endangered by any s ta te m e n t he m ight make. (C o n fid e n tia l in fo rm a tio n was n o te d on the o rig in a l exam ination record and d eleted from exam ination records fu rn is h e d w ith t h i s r e p o r t* Hone o f i t had any r e l a t i o n t o le a d exposure or lead in to x ic a tio n .) Inform ation as to general p lan t co n d itio n s, the  '. . *' 0 a t t i t u d e o f o th e r workmen tow ard th e p o t e n t i a l h a z a rd s o f th e p l a n t , and t h e Gccurrene o f i l l n e s s among o th e r em ployees, was so u g h t from each employe, a f t e r e x p la in in g th e reaso n s f o r c o lls e tin g sush I n f o r m a tio n The men ap p eared t o resp o n d w ith th e utm ost f r a n k n e s s , ' A c a re fu l p h y sic a l exam ination was given each p erso n , to g eth er w ith such la b o ra to ry t 3ts as m ight be expected 'to y ie ld d a ta s p e c ific a lly u se fu l in th e reco g n itio n of abnormal le ad absorption! The scope o f th e exam ination is shown by th e in d iv id u a l reco rd s* I t . i s b e lie v e d t h a t no s p e c i f i c a l l y u s e f u l 'c l i n i c a l o r la b o r a to r y t e s t ; .. / was o m itte d . O b v io u sly , th e m ost s p e c i f i c .in fo rm a tio n was to bo ofo; .fcained from th e a n a l y t i c a l d a t a , l b h as been our e x p e rie n c e ,' t h a t th e m ost m eticu lo u s p re c a u tio n s m u st'b e employed ih av o id in g th e eontamin a tio n o f sam ples o f th e e x c re ta " .o f workmen in le a d t r a d e s . F or t h i s . re a s o n , in p a r t , i t was b e lie v e d to b e 'a d v is a b le to c o l l e c t a lim ite d number o f samples o f blood and sm all samples of u rin e a t the' tim e o f the p h y sical exam inations* These, o b tain ed by th a examiner in person, ' c o u l d sc a rc e ly bo contam inated under th e e x c e lle n t conditions of freedom from p la n t d u sts th a t-p re v a ile d in the stain in g rooms, and thus co u ld b u s s d as a check on th e sam ples o b ta in e d by the-em ployees ' F o r th e /l a t t e r , each employ was p ro v id ed w ith a ju g f o r th e c o l l e c t i o n o f h i s u r i n e , and a j a r f o r th c o l l e c t i o n ' o f a s in g l e f e c a l e v a c u a tio n . In stru c tio n s were given to th e group as to th e manner of c o lle c tin g the sam ples, and when th e c o n ta in e rs were shipped from th e la b o ra to ry , ready f o r u s e , a s h e e t o f p r in te d in s tr u c tio n s was p ro v id ed f o r each p e rso n . The c o n ta in e r s were d e liv e r e d t o th homes o f th em ployees, se ale d in paper b a g s, and were to be used only d u rin g th e hours away from th e p l a n t . The sam ples were c o l l e c t e d p ro m p tly and a r r iv e d a t th la b o ra to ry in good c o n d itio n , 'Fas d a ta o b ta in e d '.on e a c h employ# were stu d ie d ear fully as a c l i n i c a l whole in se a rc h o f e v id m m o f lead absorption or lead intoxication* S p ecifically Im portant item s on th e group were assem bled in ta b u la r form f o r com parison w ith s im ila r d a ta from e th e r groups of su b je c ts* $he a m b e r o f em ployees was to o sm a ll f o r a d e q u a te s t a t i s t i c a l handling*: and th o c a lc u la tio n of mean v alu es fo r moat o f th e ta b u la te d q u a litie s was not Justified* ' -'Tht R e s u lts o f th e I n v e s tig a tio n * . Y -The i n i t i a l in sp e c tio n ' of th e 'p la n t re v e a le d several sources of p o te n tia lly hazardous exposure. In decreasing order o f Im portance th e se appeared-to be, (1) the operat ion o f tin n in g e a s tin g s in th e fo u n d ry w ith a 5Q~50 t i n le a d a llo y * (Z) the p o lish in g of m etal s t r i p s * and th e sweeping in th e e le c tro p la tin g departm ent* (31 the so ld erin g o p eratio n s in th e servie departm ent* I4.) th e s o ld e r in g o p e r a tio n s in s p e c i a l r e p a i r work a t th e end of th e assem bly lin e s * ( 5) Sank assem bling {no lo c a l v e n t ila tio n } ( 6} d ism a n tlin g o p e ra tio n s in th e th e rm o s ta t depart* ment ( f ) rem oval and in sp e c tio n o p e ra tio n s a t th e e x i t from the co re d i p s , ( 8) s o ld e r in g o p e r a tio n s on th e l e s s modern and l e s s ad eq u ately v e n tila te d , assem bly lin e * She m ost modern assem bly l i n e appeared to be adequately safeguarded* and except fo r possible lo c a l v a ria tio n s in v e n tila tio n * hazardous exposure seemed im probable* Likewise the a re a around th e core d ip s appeared to be safe* except f o r s o ld e r on th e f l o o r n ea rb y w hich su g g e ste d th e need* perhaps* f o r improved housekeeping* In g e n e r a l, a l s o ,t h e th e rm o s ta t end th h e a te r departm ents gave l i t t l e evidence o f dangerous exposure* She KJT 0003831 magnitud o f th e exposure; a t any p o in t was open to c o n je c tu re , b u t i t wa3 n o t 'believed'.. -'be of s e r io u s p ro p o rtio n s (e x c e p t in th e fo u n d ry )* an opinion w hich was confirmed, by th e exam ination o f d a ta of a ir analyses c a rrie d out by others She h is to r ie s and the p h y sical exam inations cn th e employees f a ile d com pletely to develop any evidence of ' , s i g n i f i c a n t le a d absorption fh e s u b je c tiv e symptoms o f c o n s tip a tio n , fle e tin g c o llc -llk e p ain s* ''v ag u e-'in testin al disorders* m orning-anorexia* so ren ess, s tif f n e s s and w eakness.of muscles* and in d e fin ite i l l h e a lth , many o f w hich a re o f common occurreno in c e r t a i n h az ard o u s le a d -v: t r a d e s , were c o n sp ic u o u sly absent ' O b je c tiv e ly cm d id n o t 1s a ; sin g le so t of d in le a l -findings' su g g estiv e o f serio u s lead absorption P a llo r :was o f I n f r e q u e n t o c c u rre n c e -among th e men and n o t o f th e pro* nouncod ty p e seen in a '^leaded** group of man', l a s u g g e s tio n o f ex te n so r weakness o r of atrophy"-of th m uscles t the upper ex t r e a l t i e a o f any employe was found.- Ho dofinifc le a d l i n e was se en on th e gums o f any person* a lth o u g h th e r e were two in s ta n c e s o f f a i n t d is c o lo r a tio n o f a v e ry s m a ll gum a r e a .d o u b tf u lly s u g g e s tiv e o f su c h , d e p o s its . S in ce p yorrhoea was p re s e n t in the e n t i r e .m ale-group* ' ' w ith the exception of th e edentulous employees, th e f a ilu r e o f occur- renee of a sin g le d e fin ite .lead lin e is stro n g evidence of the in s ig n ific a n c e o f th e le a d exposure. ' . .' . : Th c l i n i c a l e x a m in a tio n o f th e u r i n e , and t h e c\? C-') m ic ro sc o p ic ex a m in atio n o f th e b lo o d a l s o f a i l e d to -a d d u c e a n y .e v id e n c e K f 00038 of Is a d a b s o rp tio n . The d a ta of. th e le u co cy te counts are grouped in Tabl k* T he. one d e f i n i t e l y abnorm al h ig h r e s u l t was o b ta in e d in a sm w ith a low grad c y s t i t i s and a b la d d e r f i s t u l a (B e n s e in ). T ables 5* 6 and J show th e o th e r d a ta on th e b lo o d , c l a s s i f i e d a c c o rd in g to th e ir frequencies of occurrence w ithin the group. I t is sig n ific a n t . . * XI -> th a t a m ild to sever re d u c tio n o f th e e ry th ro c y te count was observed in more th a n h a l f o f th e in d iv id u a ls in th group examined* b u t th e lack of any sp ecific rela tio n sh ip o f these findings to absorption is in d ic a te d by th f a i l u r e o f o cc u rren c e o f s i g n i f i c a n t numbers o f ''stippled** e r y th r o c y te s . I n m ost in s ta n c e s th e s e anem ias had t h e i r o rig in , in a l l p ro b a b ility , in the chronic in fe c tio n s of the nose and th r o a t and th e t e e t h o f th e em ployees* I n on in s ta n c e { C leri} t h i s e x p la n a tio n o f th e anem ia may be doubted* I n f h ia em ployee (fem ale) th e e r y th r o c y te co u n t (2, 900*000) and th e hem oglobin d e te r m in a tio n (75^) r a t i f y f u r th e r c l i n i c a l stu d y and treatm ent* The o th e rs a re w ith in th range a s s o c ia te d w ith low g ra d e in f e c tio n and claroni a toxem ia. . , - ' .. . . . :- : Th c l i n i c a l , f i n d i n g s , . w h ile i n s i g n i f i c a n t : in r e la tio n to le a d a b so rp tio n , were otherw ise of in te r e s t and m- p o rta s s e * C hronic r h i n i t i s was an alm o st c o n s ta n t f in d in g among th e p arso n s exam ined, and in s t e a d o f th common m i l d . c o n g e stio n and edema seen among workmen in g e n e r a l,, th e r e was a g l a i r y h o g g in s ss o f the. naso~pharyngeaX mucosa which denoted the p rese n ce o f some i r r i t a n t * . , . was . The exam inerra e a r l y s u s p ic io n i n th is 're g a rd A c o n firm e d by th d is c o v e ry nasal o f s e v e r a l u l c e r s o f t h e /(sopfcua and by two e a se s, of co m p lete p e r f o r a tio n of th septum , presum ably d e r iv e d fresa th a c id fumes a s s o c ia te d w ith soldering. , The te e th o f th e employees were in d e p lo ra b ly bad c o n d itio n w ith b u t few though v e ry s t r i k i n g e x c e p tio n s* One f i r s t su sp e c te d t h a t exposure to a c id fames may have h ad some in f lu e n c e on the Incidence and th e s e v e rity of d e n ta l c a rie s ,- which in the sm all group of men ap p eared to be u n u s u a lly e x te n s iv e * However t h i s t e n t a t i v e id e a was n e g a tiv e d by th e e x a m in a tio n o f th e fem ale em p lo y ees, who had th e c h a ra c te ris tic aaso-pharyngeal i r r i t a t i o n (one had a p erfo ra ted septum ). K F 00036 S3 <KO >aa$ K e 0003834 M 0 O<IH4'> tpKOt N* .3 C? a 1 f 3 01 o W *0 H H aH n& 8 8 0 i& m I 0 c? CP % s S' s s 1 1ST *ou 3 sr &t I *O % JB t oO' mH S3 & f 1 eir-- m *4..0e- 0 SiHerr ' # f* H t ft *H9f N> 1 H 3 H . Hi S3 %t OB8f 9O. I w ff CP g ft pF> < fa 3 *0* cP ffS1 g tr H f f g g' g 8- S - WCV S 0 a> I B cs CsTr H ' 'O a. i*3 w QHPor -. &as O, # SI0 qi|il I^EScm t i t i s u pST3 m%U. pisq ^s|qg#^ atioqiii !J CSnE e <TOa.p8 d^&&OCNIO Sil@1 %lpil0 l ' a l p t q llantion Bas bossi. waM- p t tsm fa II H* H* b R H 1 a i r pb eIt et et > M m HH E' ^ 5? x^> et M a 13* - ?M o 3 f : %** S S3 et 0 & 0 ct & C' f f 0 i h s &$ ci Ik f. ta Si H HSi 3 r l3 g* et et Ct o j & H>' o < H & H* 3 0& I! O I I* 0' I 1* 1 ? f a s ** a H P Q B S ff B a <4 B# et P a & H *4 H> et I*d et H . tx < H i et M t* m n . 4 fi"; B *J- P < et g* n ,,008 et I eC et $ PO |w# n 8 sm .1 t I I<53 & fc* 4 .jet g ff* m iShf n 8.e jt *1 e et 3 a 1*1 t* t-3 .5 et H> H g I g *o *' S et $ et $ C3* Hi M H -0g . ; . & 1 a . . >S gH P * 8 I e& *> p <* Sa H et i* t o et fi a f.f 0 P H et H Ct et P 0 8 ' $*a -o f a ' * it*. - -. , h e r e s u l t s on th e u r ln sam ples a re s h e a s i n ..'" " :. fbl@ :::9 * '16 ' should-be- r e c a l l e d th a t. 63s s m a ll p ie s o f 'a p p ro x im a te ly 100 c e were o b ta in e d u n d o r th e s u p e r v is io n o f th e exam iner l a .o r d e r to ' cheek th p o s s i b i l i t y o f co n tam in atio n to th e c o lle c tio n of th; la r g e sam ples - ?h s re s u lt oa th e s m a ll sam ples* 'hen cwostparcd w ith th o s e , on th e la rg e , sam p les, dem o n strate th a t .th e la rg e , s m p le e e re c o lle c te d - - w ith duo care* f he em ail samples fie ld e d both s lig h tly h ig h er sad - * s l i g h t l y l o s e r r e s u l t s th a n th l a r g e sea*pleaf and: in s i s o a se s o u t o f. tu e a ty -n in ' on ahasa b o th r e s u l t s o ra a v a ila b le th e two r e s u l t s uer w id e ly 'v a r i a n t . 'She 'e x p la n a tio n o f th e s e v a r i a t i o n s h as been, p ro v id ed . -.. th ro u g h p re v io u s e x p e rim e n ta l o b s e rv a tio n s * have found t h a t ,- u r i n a r y ......, assip lc s ta k e n from ho u r t o .'hour v a ry c o n s id e r a b ly in t h e i r lo a d .c o n te n t* / . p a r t l y b e c a u se o f v a r i a t i o n . 'i n th e le a d e x p o s u re o f th e o c c u p a tio n b a t la rg e ly because o f v a ria tio n In the In tak e and o u tp u t of. e a te r* Scanty .water o u tp u t ,o o .th e p a r t o f"-th e kidneys.- p ro d u ces a r e l a t i v e l y high, u r in a r y load c o n c e n tra tio n * .whil prefab w ater o u tp u t r e s u lt s In the revers. '. . - .i ' These v a r i a t i o n s -bead. t o be 'sm oothed p a t th ro u g h !to@ c o l l e c t i o n ' o f -a.. ' la rg e sam ple o v er a p e rio d of- hours- o r days and th e r e f o r e such a sample p o rtra y s th e s ta tu s of the in d iv id u a l w ith -resp ect to lead ah* so rp tio n eifch g re a te r accuracy than does th e sm all sp o t sample* Bespit th is g re a te r u se fu ln e ss o f th e la rg e samples i t .is ap p aren t th a t th e .small, sam ples y ie ld e d -s u b s t a n t i a l l y th a sane g e n e r a l in fo rm a tio n as th e la rg e * I n 'ts e ty ~ s .ix e a s e s 't h e r e s u l t s on th e te e sam ples ere in s u b s t a n t i a l ' agreement*,' M oreover the.m e r e s u l t s on' th e two. s e ts of samples of. u r in e a re s o t s i g n i f i c a n t l y d i f f r e n t s t a t i s t i c a l l y and from -the p h y sio lo g ic a l v iew p o in t they have the same sig n ific a n c e * shea compared w ith r e s u lt s o b tain ed by s im ila r methods on normal persons w ithout occupational l e a 2 exposure they dem onstrate conclusively.-the' .occurrence o f . o ccu p atio n al lead absorption* They do n o t exceed normal '  ... *'15' . ; .- '' v a lu e s b y aid saargln* and th e y as* lis t o f th a v m s s lf e d e t h a t n e !m ^ 'fau ad . f a tr a d e s f a b le b ve. have' found " " c l i n i c a l o v id e sc e s o f -lo a d in to x ic a tio n * For th e sak o f com parison* d a ta ..on -normal p e rso n s* -a n d 60' .groups, o f p e rso n s l n Af r a h k ly ; h az ard o u s . lo a d ' tr a d e ar g iv en la- `f a b le 10 I t i s o f I n t e r e s t to not?'., -the ' r e l a t i v e l y ..o&rrosi'. rang of v a r i a t i o n l a th e re su lt ' o b tain ed : .in; th e as ; o f noxmal :pern* and th e soslssaen in . t h e p la n t under- s tu d y Cfabl 9)V a c o n tr a s te d t t h th o s e in th e workmen' o f th e d e f i n i t e l y h a s s rd o n s "' ' p la n t* fiie- l a t t e r : p l a n t .had a v a r i e t y of. Im sards. o f d i f f e r e n t isagM*- /;fcade# mdvo a se s of in t o x i c a t i o n s e r e found among th e more h e a v ily exposed workmen# who a ls o hosed the. h ig h e r r a t e s " o f ' u r in a r y , lo a d d eratio n * . Tho.. p la n t u n d e r stu d y # on th e c o n tra ry # had. m cfc tlis sms fcyp: f . 'hasard- -throughout# and th e re -os l i t t l e e v id e n c e o f -g ro ss' v a r i a t i o n . 'l a . tho s e v e r ity of-th p o te n tia l exposure* The a n a ly tio a l r e s u lt s a re la s a t i s f a c t o r y gr@@isnbwith t h a t o b se rw a tio n i : ' .. " . ' `fh - a n a ly tic a l r e s u l t s on th e feces- a r e g iv e n l a T ab les l l 'a n d 12* : T a b ic v11 groups' th e r e s u l t s o n . th s tir s f o c a l - - 'susaple o h l l e T ab le 12 -shoes th e n on th e b a s i s o f th le a d p r e s e n t p er gram of focal, ash* ' The l a t t e r sieaaa o f p ro seatin g - th e d a ta w hile ' not holly sa tisfa c to ry - from .a p h y sio lo g ical point-of.view ^ is m a tte m p t t o com pare th e I n d iv id u a ls on some tim e o r q u a n t ity b a s is * a have shown p r e v io u s ly t h a t th e f e c a l o u tp u t o f le a d o f p e rs o n s . without o c c u p a tio n a l le a d ex p o su re i s a p p ro x im a te ly 0*25 s t i l l ig r s a a . ; p e r d a y , -On- th is '" b a s is th e mean f i g u r e o f 0*&06 0*075 f o r th e g roup s tu d ie d i s d e f i n i t e vifiende'-of - .abnormal lo a d infcfik* E x p re sse d i n ' term s of th e ash# th n o r m a l.f e c a l le a d h as b een found to bo a b o u t G*o8 m illig ram s per gram o f ash* The v alu e o f 0*136 J; 0*013 is th erefo r s ig n ific a n tly high# In d ic a tin g a lso th e occurrence o f aomeohat abnormal exposures* An' i n t e r p r e t a t i o n .o f th e 's ig n lf lo a n e e - o f th r e s u lt s on t h e . H * . ' . fe c s a la com plicated by the t i ;blgtr.:;ri&lta of'2*ii9'*n d 3*2$ m illigram per sample, fh ese r e s u lts ar-9 patently abnormal to the group- Whotticr they represent an unusual exposure on the parts o f those fc-wo men on fell day before the aa&pies re obtained, or whether ,they are.,tb s results o f ... -umsually bl^J-lead; oontsent in fell food fo r that particular'day*, cannot ' ,b e''.d eterm in ed * From 'th e .,p o in t of.-view o f p l a n t .sa fe ty - i t i s w is e r t o ,:--.. i n t e r p r e t 'the as d u e .'t o . earposwr in th e p la n t th a n '.to . ig n o re th e -as abnorm al and u n re la te d '-:to eecupsM .onal e x p o s u re , t h e r e I s some- j u s t i .- ;. 'flo a tto n f o r fo llo w in g th e .form er course* I f .he'examines .the e n tir e record of th e s e . too-laea-lo-Salm ons and stanhope) i t i l l ' be' seen th a t b o th '-men.c h o c e d ---re la tiv e ly h ig h .r e s u l t s In s m a ll and-, la r g e sam ples o f \ u r i s o , In e v id e n c e o f r e l a t i v e l y - h ig h le a d xp.oeur and a b s o r p tio n , ... . al-thcu ~h n o ltf ie r showed any c l i n i c a l video* o f-b o x lc '. le a d a b s o rp tio n .'- o f oven ?. d o u b tf u l v a r ie ty * The u r in a r y , r e s u l t s , how ever, a r e n o t In b eeping w ith a s f . sueli -'.daily ex p o su re a 1 r e p r e s e n te d by ,.ts*o -o rvt h r e e ;, ' s llllg r s s j s o f lead por day i n the 'feces* . Userefere ee. mas t conclude ' '. that such .an exposure-ss of infrequent ooourrene for these' sea-- and fo r o th e r risa in: th is p lan t* . .. .- .- . . P ro a the eonbined data. on. the'.urine -and fe c e s , -it i s quit:::- clea r that the employees., tn th is plant have been- exposed to le a d ever and above that which. as- ingested with th eir food'-and drink* I t i s a ls o -e v id e n t ,' e s p e c ia lly fro m -.the urinary r e s u l t s , - t h a t tbs- = occupational -Idad ekposare., was n o t so great that occurring in- many 'Other .and'. recognisedlyhazardoua le a d tr a d e s * From th e la c k o f c l i n i c a l evidence of lead in toxication i t i s a p p a re n t t h a t the le a d a b s o rp tio n in c id e n t to omployaent in th la p la n t as no t g en e ra lly s u f f ic ie n t to produce f r a n k c a s e s o f lo a d p o iso n in g * I t 1 d o u b tfu l i f le a d p o iso n in g m a y b e expected''t o .develop under conditions o f a b s o rp tio n ouch a s th o se r e p r e s e n te d by th e mean u r i n a r y lo a d o u tp u t o f th e group o f workmen* : . * IT ' Gn th e o th e r hand th e r e war I n d iv id u a l o a s e s among th e group w ith c a u n ifo rm ly h ig h lo ad ooafeeafi o f b lo o d , u r la # and f e c e s , Moreover I t Mh c o n c e iv a b le t h a t th e sub j e c t s s e le c te d ' f o r stu d y d i d n o t r e p re s e n t; - tb s CGmplot@-sa?aiigo..of; ex p o su re and o f e x o r e to ry rcacfeioo. to , sspoaurj. l , c . t h a t th ere way have been employos w ith somewhat g r e a t e r ex p o su re g than the g re a te s t're p re s e n te d in the 'group aeXeeted fo r stu d y . In any : ca se th e in d iv i d u a ls ho p o r tr a y th e e f f e c ts . o f maximal ..exposure' among our. group -are o f ...most s ig n i f loanee' s in e # thee#'' p erso n s* i t a n y , would be expected, to show b o r d o r liu o e v id e n c e s o f i n t o x i c a t i o n . A c tu a lly , -th e r e I s o n l y ' on# p erso n ' -l a -the. group (Sc o fc t), in whoa ea se th e r e -:: was such.;,a c o n b in a tio n o f #1.Ip l e a l a n d ; a n a l y t i c a l , f la d in g s as ,to.-, v,,,,. . V. s u g g a st t h e e x isto n a a f;'In o lp le n fc o r m ild pltuahiaai, .C e rta in 'c l i n i c a l / ' f in d in g s i n t h i s &.m. co u ld .h a i n t e r p r a te d .m d eriv in g , .from load- ab** '. s o rp tio n * Hi low e r y th r o c y te oust and th e lo h em o g lo b in , w ith ` c ' s t i p p l i n g t o th e e x ta n t of., 6 p e r .^O. f i e l d s , hen acMiid w ith a : d ubious lo a d l i n e , s l i g h t l y h y p e r a c t i v e .r e f l e x e s , tr e m o r -o f -th e hands and a s l i g h t tendency to- co u s'tip aticm a r e , a t l e a s t , o u g g e a tiv e . The . u r in a r y , load' c o n c e n tr a tio n o f 0*1? g* p e r l i t e r in t h e s p o t sam ple was confirm eci In I t s ' s i g n i f i c a n c e by th e f in d in g o f 0, 15 mg, p a r l i t e r in th e la r g o sam p le, t h i s b e in g fete h ig h e s t r e s u l t o b ta in e d in th e l a t t e r group o f sa m p les, f h i a man,, in our o p in io n , sh ould be k e p t u nder ct>s e r r a ti o n * ' n o t s o . c l o s e ly as t o indue a n x ie ty oh h i s p a r t , t u t s u f f i c i e n t l y - c l o s e l y t o safe p o s s ib le th e d e te c tio n o f any tr e n d . . In th e s ta te o f his. h ea lth and d e ll b ein g , - D isc u ssio n and .BjibcBmendattoaa ' . ; - Th& comments made In th e p r e s e n ta tio n o f th d a t a y ie ld a b a s is f o r i n t e r p r e t a t i o n , t o -which l i t t l e need b ad d ed . However, c e r t a i n g e n e ra l c o n c lu s io n s w hich re j u s t i f i e d by our. ex* p e rie n c e sh o u ld b e add ed . P ro o u r p re v io u s s tu d i e s we have Penned * 18 - . the opinion th a t a m aintained u rin a ry lead ex cretio n of approxim ately 0*20 nig. p ar l i t e r . o r more d e n o te s a d an g ero u s degrs" o f le a d 'a b s o r p tio n * and th a t under. conditions.' in' which -such r e s u lts -are found fre q u e n tly o r - r e g u la r ly * in a g ro u p -o f workmen* le a d p o is o n in g o f m o d erate t o s e v e re . degpe. w ill' e c u r # ' '- P e r s o n s /e x c r e tin g 'le a d to th e e x t a n t o f 0 ,1 5 g* per lite r* or thershouts* under conditions of reg u lar exposure-are in ; a d o u b tf u l group* w ith r e l a t i o n to tj p r o b a b ili ty o f th e i r be asmin g .-.- p o ia o n sd * -h u t up t o :th e p r e s e n t w@ have r e a s o n to b e l ie v e t h a t in to x i . ' e a t Ion i s l i k e l y to be m ild .'and. f l e e t i n g acmg such p e rs o n a * ..if in d eed I t o ccu rs a t a l l # : '"Therefor feb mean f i g u r e o f 0*df9 lag# p e r l i t e r o f u r in e in the growp " s tu d ie d denotes*, w b a ll w * a s u b s t a n t i a l l y s a t i s f a c t o r y 3feat* and one:.In. which: plussfeisia i s s'c& rcely .to jbe ex pected* ' ' ' ' fb q u e s tio n s which ..remain, to he ..answered* w ith r e s p e c t to t h i s p la n t* . . and Its- .employees* a re ' as. fo llo w s* (a ) Did. th e s u r v e y .c o v e r th e p la n t' .p o p u la tio n i n su c h a way a s t o d i s c l o s e -the r e s u l t s o f t h e g r e a t e s t . .le ad ' e x p o s u re ' in t h i s p la n t? ' (b> -Ars th e few' h ig h r e s u l t s 'o b ta in e d :' ' c h a r a c t e r i s t i c o f in d iv id u a ls ..who hmm had* aesae' u n u su a l magnitude.' o f ... exposure* ..or do th e y r e p r e s e n t th e ch a ac e o c c u rre n c e o f a tem p o rary ' fci$ i le ad , o u tp u t tt th e p a r t o f im liv id a s lis h u s u a lly e x c re te . le a d ' :at lo se r le v e ls , . ' .... - .. Flo adetguate answ er 'can h e 'g iv e n t o th e s e two q u e s tio n s ' fre e r th e a v a ila b le data.#' O b se rv a tio n s .would h ave t o h e 'made .on a much g r e a te r number o f em ployees to y ie ld t h s .answer prom ptly# on the o th e r hand* th e answ er can bo D etained by c o lle c tin g f a r t h e r d a ta o v er; a ' 6S9e u00 period, of time* I t is reeem ended* th erefo re* th a t d o u b tfu l or suspected cases o f plum btsai, and eases p re se n tin g sym ptom atic and p h y sical fin d in g s th a t might m istakenly be a ttrib u te d to lead -ab so rp tio n be stu d ied care f u l l y a th e y come to fch .atte n tio n o f th e p l a n t p h y sic ia n * In- such in stan ecs the r e s u lt o f a complete p h y sical exam ination should be checked by th .-analysis o f s u i t a b l e sam ples o f blood and. e x c re ta f o r d ec isio n as to th e s a fe ty of th e p la n t# I f c e r ta in f a c to rs which In flu e n c e the le a d exposure a t v a rio u s tlm m and u n d er v a rio u s con~ d iti o n a o f o p e r a tio n have b e e n m issed by tils p r e s e n t s u r r e y {which - a d m itte d ly i s n o t w h o lly adequate)*, su ch f a c t o r s w i l l a l m o s t .c e r t a i n l y come t o 'l i i j h t , and can ts d e a l t w ith as th e e lre a m s ta n cea re q u ire * . Meanwhile* ioiwiousXy, ..ontinned a t t e n t i o n m is t h e p a id t o .m a tte rs : o f good h o u s e k e e p in g -i o th e m a in te n an ce o f w e n tlla tiiig g u li^en ta a n d .. e s p e c ia lly * t o th e p o ssiM i. I t y t h a t th e ex p o su re m y toe m o d ifie d f o r b e t t e r o r w orse th ro u g h t h e 'I n tr o d u c tio n of -nea o p e r a tio n s and pro e e d u re s , w ith in ' th e s la n t* 'The combined d a t a o b ta in e d f r a a c a re fu l- s u p e rv is io n of; p lan t- .- a c tiv itie s * from c a r e f u l, m e d ic a l auperw is ion* . -. and from the a n a ly tic a l-.a to d y of u n u su al o a se s"w ill y ie ld valuable- In fo rm atio n , from .-tooth-,.-a s c i e n t i f i c and p r a c t i c a l p o in t o f .vie* I , ' . : , .. '. ' . , . ' ' . -. - : : .... ^ !. - , : ,r ... . '' -Signed$ A r*u ^ - Tul e t e r la g - to r y '' of Applied Physiology . . -C o lleg e' o f - % d lc in e ' -, - -U n iv e rsity o f C i n c in n a ti . . / ro o o se so IG9000J H *A%%m8$& 4 9 5 :w .i i b ;v |: * m o a ? a p m *mw& & t*a$ 9 0* *<iRgf $Hs t. 9 %m B S (2) g B } <t> .r is s is s firis ^ t' 1'L.*roL f ; % ** y. " 45 * SS;.. *5 ci' *! - S* S - 55 1| * ;: : .' %E.^,r "S3S^:'"a i 'y e2y 09 EuEcae? swssjisea s ao*tsa$ i*eiS '| , ' Bisfcritmti&Es o f w m tm m $m ving tu SfstsH Bleo F m m n m S j to llu Blesd pgassure , IDO - 109. ' . i fc e r f .f^*m a '3 . . y ' . n o * 119. >: , . 9 ' yy \ v 130' *;. 129 : ' . '3 ' y :X5 ~ .139- . .,.''y y 'y y ' '. y. ' 6 ' y .;-.; ; .. X# U|9 [, . ? C3XH36H38>iH5). 150 , 1 5 9 160 - l 6f l?o - 179 *' c- 1 (m c -, i 1" U|2) 18o = 1 8 f 190 199 mm < I (5) , S 1 62) 5?fcal C lia io a lly abnorssal bleo pm zs& m la ? $ l8* Hastiera i a p a re n th o ie s rap u ^aaali Me ag es e f; Me p erso n a fstfchin Me lla lf e a o f fch r u b r l a , ... - , B io bxlbabion. o f WmkmBm m a m ittg to pQ m tdott'.of M^oouro. P@*ls Of vSpi(MRirO :l.lrs : M b * * f . Poes , . $ 3 ~ 4 .9 5 .9 7 S#f . 11 1 2 * 9 ''" . 13 - 14.9 ' ' <2)$ (1)4. Cl)k ;? ,,5 1 .% IT *,18*9 . ,19 *'30*9. 21 *28*9 23 - 24.9 : ' '- ' a> 3 . ' 1 .. WW II W ,.. !.> --.I P |.r.IW|..M .. ftal . .- .W W W M ' J Stanbora i paren&haoa z*fs r fe fsia&lQ s o m a r a aia a re in o lu d ed ln..hb' t o t a l bado* tb o voapeofcivo vabY&e* ; : . .. , . ' ., . ....  * sm m k X^ftvlmt&oa eff M mwimg $e mm% Seooeyfcff p#s kam 5 O0 - 6900 tw 13000 :'9 0 0 0 : - hm w? (m im 8 S9 9 vm X0 S0 - 3 S3 9 ttOQO' - 1 1 3 9 9 13000 * 129 1 5 0 0 0 -. - 1 5 9 f t SttOMireff. fferem '' % t .5 ." f ? .I 1 = . . m Ttrnm .,.. 2MUrs$but&oa ' o f f t t e a cooydig t s Seytihrooji mmt I*& a sr^tiiroe^fees in ' >750 4- 2999 5000 :fr 3249 5250 .a:'. 3499 5500 - m a 1159 * wm' . - 4-000 a. 4249 , ii250 .a 4499 ; 45Q3 ** 44? 4750 4" 999! .' . 590 *s*. 52# : 5250- * 54 : 5500 ' a 5749 T tm % , ' `' tn 1V \ .# 1(i m : V .-1 :: V . c \:v . c 12) m ; Bersas I. ? 6 8 .9 ` 1. 2 2 ; .; 3$- S lg& floanty lew vanaos fcmbers tn parenfchsoos refor to fa tu la workers asid a r a looluaA a &h t o t a l im a? th a r a a p e o t i va rubrics 9 6 9 OO > * . m% p oe ffe^ m%% v% pepsf& ni *rs m m * 0 # '*veo v s^ & s u% B&m&k fg ' : .. i f^ m ii5 :.:;. C -' r } . ;; . ' 1 # im }: $& K^bi ; : W tt* & T * 60X : .6 4 * m : * QC 0 - 58 %3 08 a ** l nt l p oe tS J 8|QtBag g s & i^ e o e ? . "p n im . je a o ta ttw m a jw . ' 'TAS'XS 1 . D is trib u tio n -of woi&mta According to 'S tip p lin g of E rythrocytes 8tip p le d Srjfehroc^tec J s M s ^ lumbar o f Persons -- 0 y - 1 . .. 2 ea 5 ; '...;" - 21 4 :>; .0 6 ? . ' ' ; "' , 2 8 9 v" ` -1 10 l l " 12 a- 1$ c X ' i i0 { t k V 2.0 \ ';' v v -" , -a ( a % X?; . VC c2 18 / H* c1 fatu i . ' . .. 3$'. * V alues tshic h ma:/ bo b u t ar@ n o t s 3S@aaa.Pily /'"yasaeoi'afcosi wlt& aba o rn a i a b so rp tio n of load* Tabi 8 Di s fcribu t on o f Workmen According to Lead in Blm Mgs# Pfe por 100 *?rams 0 .0 - 0 .0 1 9 0.020 - 0.059 .0I4 O.O59 O.0 6 0 0 .0 7 9 , 0 .0 8 0 * 0*099 T otal hambcr o f Persona 1$ lean Standard D elatio n O.O5 O.OOti .0*022 11 o f th o s e n e re o b ta in e d a t .% tltiO > f o n r examina t o n s, a e ro o b ta in e d a t o th e r tim os by the plant physician. TABUS'" f: D is tr ib u tis m o f Wcatean'' According to Lead in U rine as ?b per Dites* of Urine 0.0 0.019 0.020 0*059 O.Oi|0 - O.O59 O.060 ~ O.079 0.030 0.099 0*100. ~ 0 .1 1 9 0.120 0 .140 0. I 6O - 0.139 0.159 0.179 Frequency In lia rle Samles ;. -. ; . k 6 ` .a ; -7-' .3 6 3 . 1:. 0 . ' 5 : ' 6 11 ; ; . 5- .a V . h 5 0 . . ' .f ta l -' ' 33 * " $6 : ; , Sean : . . S ta n d a rd s D eviation ., ' . 0.068 4 0.004 4 0 .0 4 0.079 4 0.004 4 0 .o4 s 29 o f th e s e s e r e o b ta in e d e t th e tim e o f our e s s e r n a t i o n s . 9 f o pv o b ta in e d a t o th e r tim es by th e p la n t p h y sician # C TABUS 10 " ' D i s t r i b u t i o n o f roups o f P ersg I t b V a r ia b le Le s scposure ' ' A ocording t s C o n c e tra tio n o f Lad in Urin \ ' . :: ' ,! ; . F retm eao? Mgs. Pb per L iter of XJrtm ! ............. -- 0*00 O.Oij.9 0*05 - 0*099 o .io tat 0*149 0*15 - 0*199 0*20 0*2L9 ' .25 0*30 .0*55' 0.299 0*349 'over D aily S ta p les from Tvto Normal Persons studled ader L aborator?.Ooadtfefona Persona S sploysd ln Porsons Etaployed an O cupatln w tth . lo a Hasardaia?. ; ap Laad Espoaure ' Lead frad . 194 ' 2 ' ' 17 6 6 9 10 8 3 Z 3 f t a l 193 23 IA Bea . Standard D eflation 0*01B + 0*00!*, 0*009 0*037 4; 0.004 4- e025 0 .20 1 0*QX5 0 *121 . Tmm li : D a fe r l b u fc o a o f Wo rfe son A ccording fco Load in Focos Kgs Pb p ar Sample o f Focos Q.Q 0*Xt 0*X5 - 0*299 0.30 - ./V4.9 O.I4.5 - O.599 O.60 - 0*7^9 0*75 - 0*399 0*90 I.04.9 2 .X I4. 2 .3 3 . 2 *t$ ; . ' 3*%% 5 ?0 fca2 '' Bomber of .Persons 'h .8 . - . I/ k '2 . 2 '3 ; l ` ; '2 ' 1 ' % 33:' Moan . S ta n d a rd D e v ia tin g ' . 0 .0 T 3 + 0l|0 '. # By the o m issio n o f the l a s t fcsso r e s u l t s (2 . 1*9 ad 3 . 2 5 } which, ap p e ar nofc to b e lo n g In t h i s s e t o f d a ta th e moan b e e v e s 0.1*70 O.O38 w ith an S . X>. o f + 0*3X8* : J; ' ' :/ - : ' ; : . TABIB' 12 ' : . D i s t r i b u t i o n o f Wrteieii ; ' A c c o rd in g 'to le a d P er Oram o f F o c a l Ash %sPb'.>or Qren-" Of all , ' 0.00 0 .0 4 9 O.05 - 0.099 0.10 V 0.149 0 .15 " 0.199 0.20 0.249 O.25 0 .4 4 0 .6 5 T otal V ' :, Humber -of P erso n s - '' \ 15 8 2 4 1 % 1 33 Maas . Standard D eviation 0 .1 5 4 4; 0 .0 1 5 * 0 .1 1 4 o B y .th e mission o f th e one l a s t r e s u l t (0&5.) i M e h a p p e a rs d e f in ite ly abnormal to th is u n iv e rse of data# the-m ean becomes 0 .1 2 2 0 .0 1 0 , o ith an S.D* o f + O.O85. Hoy to Symbols and A bbreviation in L arge T ab le 1 , Ago i s re c o rd e d .>0.-the n e a r e s t in te g e r 2 Mar i t a l s ta tes :*;M, m arrie d| S , s in g le ; 3V Yearn In t h i s p la n t- d o e s o c - t 'r e f e r 't o p r e s e n t ccap-r felon, an , is not no eoaarily re la te d to .a sin g le type or' se v erity , of exposure. i l *. H o b its o f s le e p in g G> god| F , f a i r . : 5 ' C o n s tip a tio n . , 'n o n e ; 4 s l i g h t or d o u b tfu l 3 4 . d e f i n i t e b i s to r y % " 4--S-.pe rs is te nt.' . - . " -, ' . ; . 7 G eneral h e a lth un s atis facto ry; 4 questionable! 4 s atis facto ry!. ' 8 # Fa tigu e - ."O. none'i * o cca s io n a l! 4 d e fi n it e c o m p la i n t .r . ;; 9 * Eoadaoh Q'no ne f o c c a s io n a l; 4 fre que n t complaint*-.-:;. v .r ' '' .10':A p p e tite ** G ,goodf F9 f a i r . .... " I I . hoaturi 0 on; ' .occasional! '4 fre q u e n tly o r .re gu la rly* ' - III. N u tritio n .. , ' - p o o rly n o u ris h e d ! f a i r s t a t e o f n u t r i t i o n j > .' j 4 good -.'n u tritio n ; 4*4' obese* *"* '. . - 1 5 . Vas cu latu re - po o rly de ve lo pe d! 4; .fa i r d e v e lo p m e n t + .w e ll--. - d e v e lo p ed ! 44 h e a v ily sm c ie d , ** . " .. 18 Blood Brea sure - , dash or pe rio d se parate s: s y s t o l i c a n d -d ia s t o lic 19 * *E , acute, r h i n i t i s , 0 . K*, c h ro n ic r h i n i t i s f Thrb* E d ., edema o f turbinate s '!- T#Byp* hype r tro p Me d '.tu rb in ate s ; .I* ? * , i n f e r i o r tu r b in a t e % S . B . L , *> 'septum" d e v ia te d t o Ioffe o r r i g h t % P a r , ob* p a r t i a l o b s tru ctio n ;"-?h *, pharyngitis -! ,, normal*' - . . 2 0 Ceu ce rte s | . .e dent* e de ntulo us ; Part lie n t., P a r t ia l de nture ; dev d e v i t a li s e d , .ging* g i n g i v i t i s , ' 21, Pyorrhoe a'. 0 non; s l i g h t and 'lo c a lis e d f 4 pre s e nt ge n e ra lly ! 44's e v e r e , 444 ve ry s e v e r e , 2 5 * l x t r c i t i e s - Se ale d fr .*, he ale d fr a c t u r e ! V-.-V* v a rico s e v e in s ! Derm* d e rm a titis * . 2 6 , Tremor 0 non| 4 in co n s ta n t! 4 d e fi n i t e . '. 9 +- To 44JLM040>iUt HOOCH W*CTt*\WX*IVirV*UM*t\WJ*v\HJ*w*O -jV*WO.ICVH*ts>C*tu^ ts *0 ta ta . *t? - r (a C9 * *x! Ha 3 - ShODtssoOggltDp^Sj MesMOt*Kai3ttt*EsstS s S o p J O . i si es-tg C ** ** O t* a * *50 H* '.T) "3 Ht. 4 o t~i p jy v i gP P3 ht r*h -*Ho *>*IJ rcat oc+ O ooo O* fi 00 m af f f *-*. * fsl #g *35 ^<0a>+w. X L n iri . o m it o ta ta s-'w, o- P & a. HHHHHH *CSj1-3M1asc3sn*,*cp3fr\hN! rhpo*HOota 'O{aB\.9K*Ct*StjXa3*OJ PCO5%3O G 8 ? CHS**C2" *1**$ Ol H r tft*.Pi:ir<33 hHr*rO.3h 2S $ * KKS &c 3% \ & et * pi;* - q t"S:!3* 0 epteoo sa o ' H**t:|*fW!-' o :S3 o ; CO *v3- o o O* *0H*0*0*O*'^*vmnv*mri'a*&Mi%'u*!iv*v0n4a.roVOyvmtt*tjretvM0n3 H h < o 50 0 6 ^ N os v * .. ' ce: o +: ? ? r s ^ *** V03 o, o + l+ 5 'd * O 000 * oa ' **> * n <- . < * J5" JS" \*jn >sS *O *O *O O#O. H* *M** 4*t o#c e MVs3o1 `**0' <# OvVO3VVOTo M ^f S^J O O V jn V n Q O - r/: M -* o O C Hi UVO-U3 * &s'-4>m m* 's,in tf f S?3 - " h * 4-V >0 Pi * Wtv0 .1w vti U) VI 1 VO O O O Cn CnV>J m V O M * ro~ 4Mv oivnvjivn vna vn v,,n OO1"' VNV0 ytMVO V1"*. o o o et V3vo O O V3 n Oo p < 5 H* O > lC.'T"vp0C- DO. SecvvO O O * C * t v O O (2) ' ; n Vv * b le,1 3 Harne Moran C. Salmons Petfey " : Wiek , ' Humbe r ' '' ' ^ 5 ... : ._ ..................... ' 6 1 . 38 56 " ' 38 2 *. ... M ;. M M P* i 4^ ' 10 G 25 . : 0 ' . ' 10 0 i 5. 0 6 i w#. 0 . + Extracfcions 0 / 4 . .* . ; # 0 - " 0 . ' ' 0 9. 0 0 0 .10. P ' : 11 c p 0 12. F? 68 ii ll: 17 . 18. .19* 20. 21 . 4y ' ' 7 .. . 68 oa . 11^=74 S.d .R. - A.K, En crst c-d-Krode 158 .0 4 ' fr 72 97.2 J. ,68 i . R . V CR E ae n t. 0 146.0 4 ' 72 97.8 114.70 C.R.~ X.T, Sl.Ging.GoQd .0 22. 0 0 0 23. S a a l ! .Varice s Sm all v a rle e s 0 4 . 3 ;..o, . ,0 0 0 0 0 - 0 , , : 0 ; 0 25. ..v. 90. . . 90 100 .. 100 100 100 26. 27. ! 28. ! 29. i 50. ! 51. | 52. Lid s ' ' " ' . . 8.75 4,990 100 1 . 59.0 0 4* 1 0 .5 4 ,5 0 0 95 0 8 7 .0 -- .'0 4- 6 .8 5 5,730 102 1 64 0 5!: 2.5 *4*v 3 1 .0 7 .5 2 0 .0 7.0 3 .0 8 .5 3.0 1 .5 1.0 0 .0 5 0 . 0 ? 59. 0 .0 1 0 .0 7 4-0. 0 .0 8 - 0. +1 . o.4o Oc 42. 0 .1 0 - 0 . 6 - . ... 7 56 :M 12 : G' V . 0 0 0 4- F re q .I r r e g : c- ' ... 0 .+ - 64 , 98.6 118-70 T.-Hyp.-R. Pb, llany E x t. + ' ' 0 P03 Aw 0 0 100 100 0 0 5 .1 0 4 ,1 8 0 93 7 5 8 .0 3*5 32.5 2 .0 2.5 *0.056, 0 0 ..0170 0.40 0 .0 6 Kr 0003705 3 t M O ' CO- 4 C M U fO ro ru w W H *OND #0 5*- 4 *O'. vwjn o W tONW W HKHHHHHPHH 4TV4K>H OSOCO-4c\Kit4sr\?i tv>H q sq > 4 <n 0 0 0 JM ooooo f& sfe| --t4 O' ta. o m *W OS ' itr s - j - i* M' ' . . H sO H O S W H O v H V . * ?*Mv0S- O * O O 4* O O U I CO-4 4* o w i *o *osxi V PVho31o0 ' H o O O sSot W*04o - POa O *eCip~O'*roOS vt 4" . ' * O O p i'O O "1 O C*j 0C3 O O O OO O K w Sw -M vor*4 -O~3O*3VO3TOS51OVlWIW O*OW OovOns* g * 0~4 o o O< H H Os H ' 2 0 - !*Mr * i W H tfi.i- Qft"- 4 ' 4 i * : O H -4 <1-* O . TO 'H5X fe Sii CSS SJ1 eO*>asOVM1Oum OOivVOnOilO'OHOo|orv\fjfiiOov|n\rjo4i 00H S4JoJrr1*'"v*0nCs>> o O '< s- HO O 3 4* * -o 4- ^ O O 4- O O O g g cf s1;00 >W ' .et . 00 * ta ' :C- *S ' Ci * M ' n* ce Sih' fi *OO OO t W Os UJ rOsjnPvSOsHWvHiVfO\Joo*(X> O OC0O5QO O 3 O 1 4- t "; ?i O* Hfo-'co0O5s+V4*VHM0O'>sO |+ 0 t6 0 1V.: V--:;,.:-V' i!. 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JSL X# 5 4 to 2* M 10 10 10 ' ' Er ' O' : *$ I: met 0 0 0 o . ' . 0 ++ + S ill lately I: 0 0 ' . ' . 9. 0 10 . G 0 Xi 12 * 67.0 0 6 7.75 ` 0 67.25 13 * 135*0 14 * + 15 . 14 1.30 ' : . ' . ' . '4 ' : ' 130 . 2$ 4* met 16. 17* %O70il *4K 72 \ :: ' y. 98*4 . 70 .' - - 1 0 . 110 .72 120 --70 118 -6 4 19* C.H, 'U lcers E .I .f * - C ru sts S . d . E . C r u e t s ri>: 9 L?"XT*-9 20. .2221, E d en s. :: iBad > JaOhfely .gOU 0 4. ' 0 '' ; ' 0 ' Very bad Ca. gen : 0' 23* Ooasplaine Am putated p h a la n g e s' 0 2 4 wes&Jcaoss* .0 not .o b .s * .-. .S lig ht \J v a r l e e` s .' . > . 00 ++4' 0 0 .. .: ' 0 . 4- 25 \ fO . 2to. 0 27* 0 90 10 0 .. 0 v " ' 0 $0 90. 0 . 4- . 28. 7*50 ., : . 8 .50 ' 7* 4*180 ; 3*990 : 3 0 . 80 95 31. 0 17 4*75 4*370 87 32* 51,0 ' 61*0 ' 1 .0 4*00 34-* 38 .0 :. 29*00 4 1 *0 2 .0 45*o 3 . 1*5 i : " ' 5nm.*'5' ' ' .. 61*.05 0 .5 . V-'V .. 0*5 0*5 5Sl 39 0*12 0*1i1t. . ' 0.11 , . 0.13* ' i g . 0.77 0*33 0 .2 0 + 0 *05- 0 14 * 0 .29 0*114- 35 M 12 6 0 4T 0 0 G 0 13683a .-2255. + 80 Cru1s3ts0-7-r*0 ! .. ,^ Li 6t i e Ca. Very' bad H>4 0 0 ) 4*40 0 120 10 a 0 *1* 8 .2 5 ^ ,660 18 very eoarse 43*5 2 .0 47*5 4*5 2 .0 0.5 0*08- 0*53 0*11* 3 00037 Tabi. 13 Hame Humber I, 2. 3. & 5. 6* 87* 9. XOo 11. 12. KISS Blundy v- Miss Meyer M rs. Asgan Mr3 , . ' Slo^inskl -.....-- m . ... -. - .Mrs. . . C leri 34. kc*9 ' . 25 s . 19 .. ' a. . ' h 0 0 ' :, 0 0 " : . 4- . , 0 00 0 'Q ' -Av',: 0 /G 0 " ' .'4 2k Wide 5 Bofe r e s t e d 44 0 ' ' 4 : . .4 4 F '. . . 0 . - 2k S. k.5 G' ' ' 0 ,' .. ' .0 . 4 . .0 ' ' 4 " . w 0 r ' . ' 3n5 ' . : .. 8 :- F F r* Dream: 0 4 0 4 .cr 0 ' , : :' . > i t 44 . ' . 4 4 4' - 15* 4 '. . 4 4 ' 4 . 16 . 8k *fZ % 7k 17. 18. 98.8 150-88 : 9 8 *0, B lO k -7 8 9 8 .0 98.0 .100-60 .' . l l 68o ' . 98 . :b- 110-68 19 V B e rf .S e p tUK;: S .e l.r . Kfo. Sd *r. Par.Ob* 0 S in u sitis' C ru sts C r* -C .T . L ..2. 20. E x c e lle n t 1'Good X or Fair- . . .1. d e v . : Many la rg e 2 0>:.t : ' FiVOt- ' Good ' :fillin g s 2 1 . 0 : : :4 0 0 ' ' '' 22. " O ' 0. 0 0 0 25. Burn Scars SI*va? 0 2k. : 0 4 , ,' 00 .0 . ' 4 ' 25. 70 60 0 Q: 0 .0 ' 50 0 0 0 90 0 0 .B 0 ; 0 60 ' 60 70 26. 27 '. *4m . . ' 0 . 60 44M ' ' 80 ' 60 ' : 00 28. U.55 9.0 5 k.oo 29. ila k Z O k.260 , .3,8 3 0 k .15 k#56 25,.90050 50. 90 90 70 5>?210#* - - 0 . 5k*. ' . 53. 1.0 5k. -27.0 55. 15. 5 - ; 36. 1.5 37. 2 . C . 38. O 50 .0 k .5 56.0 7.0 2*5 ' 36.0 k .o 3g 5 8.0 , .3.5 0 k |.5 k o .o 3.5 2 .0 0 38.0 k*5 51.5 ; k I ..55 39. 4. |1 . i2. ' . 0*064 0 .45 0*104 0.034 0.22 - O.O54 0 . 7 o0 ..5i5?4 0.07** 0.09 0 .1 0 o.ok* I .23 0 .1 9 - > \ 0003712