Document zdD8g4D1vVBj4p6nV6J2wzV3R

Arnos ;.ir-v.s, ,u'. patina t i.- U * , L'<W r. .- u. -.ehc e Lsfooraxcry of Applied Physiology Collets of Medicine university of Cincinnati 'incinnati, Ohio U.P.A. hear Or. tiehoe: lhanks very much for the information contained in your letters of hay iCth. and April ifbh. TAa situation in Chili is, 1 celieve. aanisf: caorilv iwr core of. I an informed that aha nan in vacation have scan .. isAs; no -.or cvso.as e-oner than tu:se discussed. Too. are correct in ussunli-; ode Iranuliun cituat Lou formant for the tine being. Awarding 'V-nezueia, I Imagine hr. .exes a.a.s ron h.'.y.ec because of inactivity dt'uadaro Oil Ccuoany has as at not canned up chi': :-:a.:v-'< t. I shall go into ahe oucotion in detail \.hcn I next go to v.n-sueia vdon I hone to be aole tc arrange in a. not too via barn fart are. I enclose hurevith a.o_L: tie:: oh an rc.iale onoliuheo in Tne January, 13o8 bulletin of the !,OLras daixitarous he la ha.cidnsl in argentine. The Droalem of naming a doctor for urgentim. vaill, X det-ieve, aoou present itself and I have taken sons preliminary stem tovarcs 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 iciovlccd.'e and understanding of the problem. In the meantime I shall obtain other information regarding the authors and other sources fro:;! which to obtain information. "'cry iraj..- o vs, W| c.c. Tutors, fu-vu.iin A hewn. *1 .THE i-'HOPHYLiO-IS OF PLUMBIC IMT05ICATT0H By Drs. Alberto C. Peralta Pamos &. Juan M. Obarrio Jr. (of the Medical Staff of the Obras Sanltarias de la Uacion) 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 piucbism. The battle against- plumbism should be facec 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 to- suppress 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 these workers in charge of laying out tele phone v.ires. Various statistics show that about a 27 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 lO O i-H the intoxication. Amongst these re must mention one that holds particular inter o o est for us and is that refering to workmen in charge of lining the iron sheets Ul of the water deposits with substances that sat-e them less corrosive, seeing as * box the,/ arc. generally covered with paint made on a lead basis. By individual rnc general prophylaxis we must take into consideration the nature of the noxious matter end the ways of penetrating into the organ ism. dekeiy de Dtlsseldorf deals with this problem in an extensive publication. - JPekeiy N 25058.01 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 piuabism. The .battle against plumbism should be faced from two points of view} 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 matter 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. 7.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 vires. Various statistics show 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 the iron sheets of the water deposits with substances that make them less corrosive, seeing as how thev 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, fekely de Dttsselaorf deals with this problem in an extensive publication. iPekeiy points out that the different lead compounds shov; 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: k'fi' 00105 i. G 2- - ist. "in* comc? Is of little importance though cases of intoxication produced by living the hands submerged during a long tine in liquids containing lead salts have been proven. 2nd. I'.C-E STIVE das considered: until a short time ago as the principal mode 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 obs;rv&ticns presented to the Faris Academy of Medicine on the verification of great epioenics 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; uistilied and boiled water has a more intense action while on the other hand water contain ing carbonic acid docs not attack it, forming a layer of carbonates on. the wall of the pipings that prevents the water from coning in direct contact with them and therefore impeding the action of sane on the lead. Iron 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, to lime 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 miligre.es per liter. In the digestive way, intoxications of professional origin should also be mentioned. In these cases the toxic is taken to the mouth try means ox 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-chLoride, the main or-nt. ni' +.b ehsorTvMon tw irinc' olene in the s w p 11 i rto.qti.np>. rraSRinf' then to f,ho 100 2nd. --'OESTIVE das considered until a short tine ago as the principal mode 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 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 tue 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 v;ater 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 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 and that are little mineralized, have a PH close on 8, having found in some of the analysis practiced that the lead content reached 12 miligra.ms per liter. In the digestive way, intoxications of professional origin should also be mentioned. In these cases the toxic is taken to the mouth try means ox dirty hands, be it by smoking or by tooth-picks or it can also be tajeen by trie 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 the hepatic cells is only partially absorbed, the rest being again eliminated by the bile. In this manner is explained how only part of -fche toxic is absorbed. 3rd. BY lAJiALIAG After tL-.. studies made in repent times, it i.; the most important. It has KS 0010513 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 pulmonary 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. PROPHILACTIC 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 mind:- Age.- It has been proven that intoxication is more frequent in adol escents than in adults. Sex.- More frequent in the femenine sex. Condition: of health.- Certain morbid cases aggravate the intoxica tion: tuberculosis, syphilis, arteriosclerosis, hepatic insufficiencies and alcoholism, the latter being a predisposing factor. RESPIRATOR! MEANS Breathing by the mouth, as we have mentioned above, is n predisposing fac tor just as also is the prolonged breathing that can be observed in certain af- feetions MF 00105).;) digestive way. 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 lean-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. PF-OPHTLACTIC 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 mind:- Age.- It has been proven that intoxication is more frequent in adol escents then in 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. BECPIE/lTORI 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. . liiunux jty.- Certain people are immune to lead, 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 present themselves in the workmen that are intoxicated repeatedly are each tine less intense. KE 0010520 -4- Coning back to the 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 nays 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 v,-.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 and to use special clothing for working in, which shoulc. be removed -when not working, this as a. means to hot 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 ty 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, ir> 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 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 oust ant. lead vapour. NFPiih PROPHYLACTIC IT/hUr'ES The measures of general prophylaxis can be summed up as follows: H E 001 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 ana 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 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 hones. As the introduction by breathing is the most important, it is against this that we should exert our prophylactic cere. For this purpose, dry work will.be substituted ty 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 ciustand lead vapour. GENERAL PROPHYLACTIC MEASURES The measures of general prophylaxis can be summed up as follows: a) Well ventilated premises. b) Replacement of dry work by humid. c) Installing of air removing apparatus so as to avoid the dust and lead vapours from coming into con-tact, with the mucus of the rss- ".iratory passage. a) taliation of dressing rooms. 'ash-stanus and. water proof floors 0010522 ana walls on tne working premises e) General and popular measures of instruction should be taken, fry- means of conferences, signs, etc. alcoholism and tne 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 milk before going to work as it contains a great quantity of fat. Individual prophylaxis should also be na.de'of common use taking measures to avoid this intoxication. While 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 metallizing is understood the pulverization of a metal in fusion by 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, end the other used to pulverize it finally on to the substance to be protected, by means of a compressed gas. Lastly we should mention that in the struggle against plumbism, there is as vrach 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 o these worms,so much so that it has been said that to work efficiently against ooi plumbism, the industrial, the workman and the doctor should work together. Ir this perioaiccl 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 arid by the acustoming mentioned before, only present slight symptoms of intoxi cation. Furthermore. bv the o f -t *-!nd?i rieri-iod o t 'in-?-ton '----- --- 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 bests of lead for protecting the iron sheets of water deposits Is not advised and these should be replaced by zinc metallizing. t By metallizing is understood the pulverization of a metal in fusion by- 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 Lastly we should mention that in the struggle against plumbism, there is as : rack import.- nee attached to the periodical medical visits to the working prera ises as to all the aforementioned and the filing of the personal in charge of these worms,so much so that it has been said that to 'work efficiently against piumbism, the industrial, the workman and the doctor should work together. Ir this periodical medical examination, all slight signs of pluralism should he Investigated, having in mind for this that with s 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 aggravating an intoxication shall be removed. To end this, v/e may freely say that since the prophylactical 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 manner K 001 on; ;