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U. S. DEPARTMENT OF LABOR JAMES J. DAVIS, Secretary BUREAU OF LABOR STATISTICS ETHELBERT STEW ART, Commissioner BULLETIN OF THE UNITED STATES ) AQQ B U RE A U OF L A B O R S T A T IS T IC S f ..................1 1 0 * * fO O INDUSTRIAL ACCIDENTS AND HYGIENE SERIES DEATHS FROM LEAD POISONING 1925-1927 By FREDERICK L. HOFFMAN, LL. D. Consulting Statistician, Prudential Insurance Co. JUNE, 1929 UNITED. STATES GOVERNMENT PRINTING OFFICE WASHINGTON : 1929 CONTENTS Page Decline in lead poisoning death rate_________________________________________ 1-4 Nonoccupational deaths______________________________________________________ 4 Nativity distribution of decedents__________________________________________ 5 Geographical distribution of deaths__________________________________________ 5 -7 Cases of lead poisoning at the Buffalo City Hospital_______________________ 8-13 Lead poisoning, by industry groups, State of New York___________________ 13, 14 Lead poisoning in manufacture of electric storage batteries________________ 15 Workmen’s compensation for lead poisoning________________________________ 15-17 United States workmen’s compensation data________________________________ 17 Lead poisoning in the United States Navy, 1913 to 1927__________________ 18 Lead poisoning statistics of the Metropolitan Life Insurance C o_____ _ 18, 19 Lead poisoning in New York City____________________ ______________________ 19 Compensation for lead poisoning in Ohio____________________________________ 19, 20 Lead poisoning in New Jersey, 1924-25 to 19 26-27________________________ 20, 21 Lead poisoning in Great Britain, 1918 to 1927__________________ ___________22 -2 4 Lead poisoning in Canada____________________________________________________ 24, 25 Lead poisoning in Germany________________________________________________25, 26 Lead poisoning in France_____________________________________________________ 26, 27 Lead poisoning in Scandinavia_______________________________________________ 27 Lead poisoning in South Africa______________________________________________ 27 Lead poisoning in Japan______________________________________________________ 27 Physical condition of lead workers___________________________________________ 28-33 Conclusions____________________________________________________________________ 34, 35 Lead-using industries____________________________________________________ 34, 35 Bibliography_________________ _________________________________________________ 36, 37 in BULLETIN OF THE U. S. BUREAU OF LABOR STATISTICS WASHINGTON NO. 488 JUNE, 1929 DEATHS FROM LEAD POISONING, 1925 TO 1927 Decline in Lead Poisoning Death Rate N C O N T IN U A T IO N of the review of the lead-poisoning situa tion in the United States and certain foreign countries, published in Bulletin No. 426 of the Bureau of Labor Statistics, this bulletin adds some recent statistics which bring the information down to the end of 1927. The new statistics reflect a further decline in lead poisoning as measured by the death rate, the actual number of deaths in the United States having been, respectively, 142 in 1925, 144 in 1926, and 135 in 1927. These deaths, however, are only for the United States registration area, which represents approximately 90 per cent of the total American population. It is very doubtful if in the remainder of the population not represented by the registra tion area the number of the deaths attained to measurable proportions. In any event, it is exceedingly doubtful if the total number of the deaths for the whole country, including Alaska, would reach, and certainly would not exceed, 150 per annum. Of the mortality from lead poisoning in the United States, approxi mately 50 per cent are the deaths of painters. This is shown con cisely in the following table: I Deaths from chronic lead poisoning, United States registration area, 1925-1927 Class of persons Painters_____________________________ ______ _________________________ Other m a les____ ____________________________ _____________ __________ Females___________________ ____________________ ____ ________ _______ Children __ T o t a l____ 1925 1926 1927 Total 75 61 4 2 74 61 6 3 67 60 3 5 216 182 13 10 142 144 135 421 The average age at death for all males was 51.5 years; for painters, 52.9 years; and for all occupations, 51.5 years. The age distribution of the deaths from lead poisoning during the last three years is shown in Table 1 for males only, differentiating painters from other males, including some unoccupied and retired. 1 2 T DEATHS FROM LEAD POISONING, able 1 9 2 5 -1 9 2 7 1.— Deaths of adult males from, lead poisoning in United States registration area, 1925 to 1927 1925 1926 1927 Total Age group N um ber Per cent N um ber Per cent N um ber Per cent N um ber Per cent Painters: 20 to 29 ................ .............. 30 to 39_________________ 40 to 49__________________ 50 to 59__________________ 60 to 69.._____ __________ 70 to 79__________________ 80 and over............ . T otal............ .......... ........ ! Other occupations: 20 to 29__......................... 30 to 39__________________ 40 to 49_________________ 50 to 59_______ __________ 60 to 69__________________ 70 to 79__________________ 80 and. over__________ T o t a l._______ ________ ! A.11 occupations: 20 to 29_________________ 30 to 39__________________ 40 to 49__________________ 50 to 59__________________ 60 to 69__________________ 70 to 79............................... 80 and over_____________ T o t a l.______ _________ 9 21 19 19 7 12.6 28. 0 25. 3 25. 3 9.4 4 8 22 19 15 5 1 5. 4 10.8 29.7 25. 7 20.3 6.8 1.3 3 9 12 20 17 5 1 4. 5 13.4 17.9 29.9 25.3 7.5 1.5 7 26 55 58 51 17 2 3. 2 12.0 25.5 26.9 23.6 7.9 .9 75 100.0 74 100. 0 67 100.0 216 100.0 5 8 15 17 11 4 1 8.2 13.1 24.6 27.9 18.0 6.6 1. 6 1 16 9 15 14 5 1 1.6 26.2 14.8 24.6 23.0 8.2 1. 6 8 10 16 13 9 4 13.3 16.7 26.7 21.6 15.0 6.7 14 34 40 45 34 13 2 7.7 18. 7 22.0 24.7 18.7 7.1 1.1 61 100.0 61 100. 0 60 100. 0 182 100.0 5 17 36 36 30 11 1 3.7 12.5 26. 5 26. 5 22.0 8.1 •' 5 24 31 34 29 10 2 3.7 17.8 22.9 25.2 21.5 7.4 1.5 11 19 28 33 26 9 1 8.7 15.0 22.0 26.0 20. 5 7.1 .7 21 60 95 103 85 30 4 5.3 15.1 23.9 25.9 21.3 7.5 1.0 136 100.0 135 100.0 127 100.0 398 100.0 The average age at death for all occupations in 1927 alone was 50.5 years against 52 years during 1925 and 1926 combined. For painters the average age at death was 53.3 years for 1927 against 52.7 years for 1925 and 1926. The indicated differences are too slight to be considered significant. In 1927 the range in ages at death for painters was from 26 years to 82 years, while for other males, the range was from 23 years to 73 years. During the previous two years, the range in ages for painters was from 22 years to 86 years, while for other males it was from 21 years to 87 years. Here again there is only a slight difference which can not be considered significant. On ac count of the slight variations in the average age at death from year to year, it does not seem necessary to give a table in detail for each of the three years, bat Table 2 will show the average age at death in the different occupations represented in 1927 in a mortality of 127 males, showing that for all but a few of the occupations the number of deaths is too small for the average age to be considered significant for the present purpose. 3 DECLINE IN LEAD POISONING DEATH RATE , T a b l e 2 — Deaths of adult males from lead poisoning in United States registration area, 1925 to 1927 1927 Occupation 1925 1926 Painters ____ ____ _________________ _____ ________ L a b orers_____________ ______ _____ _____ _________ Metal workers_______________ ____ _______ ________ Lead workers_____________ __ __ _______ ______ Farmers. ____ _______________ _____ _______ Commercial___ _____ _________ __ _____ _____ __ Printers___ _______ ____________ _____ ________ Paint manufacturing.... .......... ......... .......... ............... M iners.. __ _____________ ___ ___ ________ Electric storage b atteries_________ _. ____________ Carpenters___ ____ ________________________________ Glass workers___ __ __ __________________ __ __ Plumbers__________ _________ ______ ______________ Potters. _______ _______ .. ___________________ . Miscellaneous ______ ____ _________________________ Unknown and retired___ _________ . _________ 75 11 7 8 5 6 5 3 3 3 1 1 1 2 5 74 7 6 5 6 2 2 4 3 2 3 2 1 1 7 10 T o t a l ________________________________________ 136 135 Total Number Average age 67 17 53. 3 39.0 9 2 1 5 45. 6 45.0 55.1 48.8 2 62.0 4 47.5 17 3 53. 0 55.3 216 35 13 22 13 9 12 7 6 5 6 3 6 1 26 18 127 50.5 398 This table is perhaps the most valuable and important in the series as indicating the concentration of the lead hazard in fatal form in particular employments. Aside from painters, laborers naturally con stitute a large number, representing unquestionably many employ ments connected with lead-using industries in which unskilled manual labor is required to a considerable extent. Highly suggestive is the small number of deaths of lead workers considering the wide distribu tion of the lead industries throughout the country. Unfortunately, the exact number of employees can not be given. Another important industry is that of printing, which for the year 1927 showed a some what higher mortality than during 1926, but the same as during 1925. During 1927 there were only five deaths in the printing industry, which in the aggregate employs an extremely large number of work ers, of whom, perhaps only one-third are exposed to lead hazards. Again, precise figures of the number employed with exposure to lead can not be given. Very surprising is the small number of deaths in electric storagebattery manufacture, three deaths having occurred in 1925, two in 1926, and none in 1927. Since, as is well known, the lead hazard in electric storage-battery manufacture is particularly accentuated in certain localities, it is surprising to find that there is rarely a fatal termination. This can be explained only on the ground that lead poisoning in the electric storage-battery industry in serious form is very rare, while lead absorption is extremely common. Particularly surprising is the rarity of deaths of potters, no deaths having occurred in 1925, one during 1926, and none during 1927. The far-reaching sanitary reforms introduced into the American pot teries during recent years have unquestionably been productive of excellent results. Other occupations are numerically of small importance. There are reasons for believing that in quite a number of deaths the source of lead poisoning was nonindustrial, particularly in the case of commer cial and professional occupations. In the case of farmers there is a 4 DEATHS FROM LEAD POISONING, 1 9 2 5 -1 9 2 7 suspicion of lead painting being carried on privately, leading to lead infection. An exceptional case in 1927 was the death of a doctor, 63 years of age, and a case of the death of a jeweler, 71 years of age. Aside from the foregoing there were 4 deaths of females in 1925, 6 in 1926, and 3 in 1927. Additional thereto, there were 2 deaths of children in 1925, 3 in 1926, and 5 in 1927. These were mostly in fants during the first or second years of life, or cases in which lead poisoning is alleged to have resulted from the eating of paint from cribs or toys, or absorption otherwise. In the case of women the lead poisoning was nonindustrial, chiefly the absorption of drinking water conveyed through leaded pipes. Nonoccupational Deaths H E foregoing is highly suggestive of the nonindustrial origin of lead poisoning in many cases, even though the person was exposed to lead hazards in the occupation followed. The problem of lead poisoning from lead-piped water supplies has recently been dealt with in a contribution to the Journal of Industrial Hygiene, September, 1928, by Messrs. Wright, Sappington, and Rantoul. The observations of these authors on the results of their investigations are summarized as follows: T A chemical study was made of 102 lead-conducted water supplies— city, well, and spring waters— 90 of which were used by a total of 253 persons subjected to clinical investigation. All the waters analyzed contained lead. The lead con tent was most strikingiy related to the carbon dioxide content. There was no apparent relation between length of pipe and lead content. Of 90 sources used by the persons studied, 35 caused poisoning as determined by certain criteria. Of 253 exposed persons, 63, or 24.9 per cent, were poisoned. Poisoning occurred among 14 persons ingesting as little as 0.1 mg. of lead daily over an average period of eight and one-quarter years. The incidence of poisoning was distinctly lower in children under 10 years of age than among children from 10 to 20 years old or amang adults, and was greater among adults than among children under 20. The duration of exposure, except for very short periods, was not significant in its relation to the incidence of poisoning. The incidence of poisoning was quite uniform among those ingesting varying amounts less than 1.5 mg. daily but was much greater as this amount was exceeded. Under almost all conditions of comparison— by age, duration of exposure, amounts of lead ingested daily, and total amounts of lead ingested— women showed a lower incidence of poisoning than did men. The term lead poisoning as used in the preceding discussion, how ever, requires qualification. The term lead absorption would in most cases have been preferable. Lead poisoning in fatal form as the result of drinking water conveyed through lead pipes causes an aggre gate mortality probably not exceeding 20 to 30 deaths a year through out the country. This phase of the question has been more exhaus tively dealt with in the discussion in Bulletin 426. The present investigation shows rather a lesser than a heavier incidence due to nonindustrial sources than was shown in the former study. 5 GEOGRAPHICAL DISTRIBUTION OF DEATHS Nativity Distribution of Decedents F SOM E interest in connection with a general discussion is the nativity distribution of the deaths from lead poisoning during the last few years as shown in Table 3. The table does not indicate any particular predilection of any one nativity over another as regards liability to lead poisoning, unless it be the case of the Negro. Unfortunately, the number of colored persons employed in leadusing industries is not known, but the general mpression is that the negroes are more liable to lead poisoning than the whites, and they are certainly more liable to lead absorption. This, how ever, may be due to the fact that the negroes are generally employed in the dustiest and most dangerous of occupations, and particularly is this true in the manufacture of electric storage batteries, in which, however, fatal cases of lead poisoning are extremely rare. O T able 3. — Deaths of adult males from lead 'poisoning in United States registration area, 1925, 1926, 1927, by nativity Total N ativity 1925 1926 1927 Number United States 1_____________________________________ Canada____________________________________________ England___________________________________________ Ireland. ________ ____________ ____ i ------------------Scotland _ _ __ - Germany_________ ___ ____________ --------------P ola n d .____ _____ _______ ----------- Sweden____ . . ______ ____ ________________________ Austria ____________ - _______ _____________ - Hungary__________ _ - ____ __ France___________ _____ _ Russia__________________ _____ --- ------------------- ___ _ ____ Czechoslovakia . C roatia _ _ ____ __ ___________ Galicia_____ _______ Lithuania_________ - . ___ _______ ____ ____ Rumania___________ __ . _______________________ - ___ - - ____ __ Portugal_____ N orw ay____ _______ .. ____ - ___ Armenia ________ _ _ _ ____ _______ Mexico __ -_________ Switzerland________ ______ ________ _______ Bohemia_____________ __ ____________ ______ _ T otal............................ ............... ................... ..! Unknown________________ ____ _________ __________ (28) 91 5 2 7 (29) 94 5 7 1 3 6 2 2 2 1 3 1 1 5 5 3 3 3 2 2 2 (22) 86 3 6 5 1 4 5 2 4 3 1 1 1 *271 13 15 13 4 15 12 7 9 7 3 3 4 3 1 1 2 3 1 1 1 1 1 1 69.1 3.3 3.8 3.3 1.0 3.8 3.1 1.8 2.3 1.8 .8 .8 1.0 .8 . 25 . 25 .5 .8 .25 .25 .25 . 25 . 25 .25 100. 00 1 1 1 1 1 1 1 1 2 1 i ; 134 . 132 126 392 2 i 3 1 6 1 Per cent 1 Figures in parentheses denote that one or both parents were of foreign birth. *28 of these deaths were negroes. Geographical Distribution of Deaths H E geographical distribution of deaths from lead poisoning in Table 4 is of interest. If required this table should be correlated to persons employed in lead-using industries rather than to the population as has been done in previous investigations. The high mortality from lead poisoning in Maine and New Hampshire in pro portion to the population, as indicated in the previous report, is no longer apparent in the light of recent statistics. The relatively high rate for Massachusetts may partly be attributed to hospital facilities T 34968°— 29------- 2 6 DEATHS FROM LEAD POISONING, 1 9 2 5 -1 9 2 7 in Boston, where excellent diagnostic facilities are available. But considering once more the enormous extent of lead-using industries throughout the country, the relative frequency of lead poisoning in fatal form is much less than would generally be assumed and unques tionably less at the present time, by possibly as much as 50 per cent, than 10 years ago. This is so much more significant considering the large increase in construction activities involving an ever-increasing amount of painting operations, as well as an actual increase in the output of lead-using industries, from white lead to the manufacture of electric storage batteries. T able 4 .— Geographic distribution of deaths of adult males from lead poisoning, 1925 to 1927 State Connecticut ________ M assachusetts Maine __ New Hampshire .......... Rhode Island _ _ _ _ Vermont Total______ ______ Delaware. ______ N ew Jersey. ........... ________ New Y ork .. Pennsylvania.. _________ Total 1925 1926 1927 Total 1 14 5 1 1 1 2 10 4 3 1 13 3 1 1 4 37 12 5 2 3 23 21 2 19 8 15 12 3 23 14 1 27 47 33 m 35 40 108 Total 10 2 5 1 3 3 6 3 10 3 46 10 1 2 2 5 1 9 1 16. 3 50 11 3 1 1 2 7 2 11 2 1 41 1926 1 1 1 2 1 4 1 2 3 2 31 6 California _____ ______ 8 Colorado_______________ 4 ' Id aho............. . 10 i Montana 4 Oregon_______ _________ 22 U ta h .. ________________ 6 Washington_____ ______ 37 W yoming ____ 8 New Mexico 1 Total 137 Grand total_______ 1 1 3 3 _^ 1927 Total 3 1 3 1 3 1 1 2 1 2 2 1 I n<> Total Illinois Indiana_____ ________ Iowa ____ __________ Kansas __ __ __ . Michigan__ Minnesota- . . . ___ ____ Missouri___ ______ ____ Nebraska_______ __ ___ Ohio - ___________ ___ Wisconsin North Dcikotci 1925 Alabama . . .................... Arkansas District of C o lu m b ia __ Florida _________ . Georgia._______ _ ____ Kentucky________ ______ Louisiana M aryland___ ________ T1VJ. VTlQQiQQlT'lT'W j.i3oloOi_P [./i__________________ North Carolina South Carolina Tennessee _ _ West Virginia. Virginia 63 1 16 9 7 1 State ! 19 8 10 2 1 1 2 3 2 1 1 2 3 1 2 4 2 4 1 20 7 1 3 1 2 1 ___ 2 4 3 5 4 3 8 7 2 3 3 7 5 5 61 25 4 4 1 4 5 7 1 1 15 52 142 | 144 | 135 421 18 1 19 To amplify the foregoing statistics for the last three years for the country at large, statistics for certain American cities for the last 10 or 15 years are given for the purpose of historical retrospection. T able 5 .— Deaths from lead poisoning, in specified cities, 1915 to 1927 Los Angeles Detroit Boston Year Popula tion 1915. 1916_ 1917_ 1918_ 1919_ 1920 _ 1921_ 1922. 1923 _ 1924_ 1925_ 1926_ 1927 _ 732,049 788, 590 864, 471 915, 653 968, 087 993, 678 994, 341 995, 004 995, 688 1,118, 856 1, 242, 044 1, 290, 000 1, 334, 500 Deaths Rate per 1, 000,000 2.7 3 2 1 3 1 4 1 2 1 3 3.5 2.2 1.0 3.0 1.0 4.0 1.0 1.8 .8 2.3 Popula tion 464, 488, 513, 537, 560, 584, 609, 634, 674, 714, Deaths Rate per 1,000,000 4.1 "i.’8 1, 222, 1, 300, 1, 377, 2.3 Popula tion 720, 726, 732, 738, 744, 751, 757, 764, 770, 776, 779, 787, 793, Deaths Rate per 1, 000,000 4.1 4.1 1.4 1.3 1.3 1.3 5.2 2.6 1.3 GEOGRAPHICAL DISTRIBUTION 7 OF DEATHS T a b l e 5. — Deaths from lead 'poisoning, in specified cities, 1915 to 1927— C on. Pittsburgh i Philadelphia Year Popula tion Rate per Deaths 1,000,000 1,696, 342 1, 724, 630 1, 753, 058 1, 781, 346 1, 809, 635 1, 837, 924 1, 866, 212 1, 894, 500 1,922, 788 1, 951, 076 1,979. 364 2,008,000 2, 035, 900 191 5 191 6 191 7 1918, 191 9 192 0 192 1 1922__ 1923._ 1924__ 1925__ 1926__ 1927._ 7 6 4 2.9 4.6 2.3 1.1 3.9 1.1 2. 7 3. 7 3. 6 3.1 2.0 2 1.0 5 8 4 2 7 2 5 San Francisco 2 Rate per Deaths 1,000,000 Popula tion 563, 028 568, 409 573, 790 579,171 584, 552 591,033 602, 452 607, 902 620, 367 626, 015 631, 563 637,000 665, 500 1 1.8 3 5.2 3 3 5.1 5.1 2 3. 2 3 4.7 Popula tion 465,069 474,315 483, 561 492, 807 502, 053 511, 300 520, 546 529, 792 539, 038 548, 284 557, 530 567, 000 576,000 Deaths Rate per 1,000,000 2 1 1 4.3 2.1 2.1 1 4.0 2.0 3.8 1.9 1 1 3.6 1.8 1.7 1 1 Including 1 nonresident in 1917 and 2 in 1920. 3 Years from 1915 to 1920 are fiscal years for this city. These cities reflect a declining death rate from lead poisoning with the possible exception of the city of Boston, which during 1927 had five deaths from the disease, wliich is the highest number on record since 1915. In view of the apparent frequency of lead poisoning in the State of Massachusetts, a special return from the Massachusetts General Hospital covering the period 1918 to 1927, giving the cases of acute and chronic lead poisoning treated at that institution is shown: Cases of acute and chronic lead poisoning treated at the Massachusetts General Hospital, 1918 to 1927 Year Acute 1918 .................... 1919-............................. 1929 ______ 1921__ _____ _________ 1922 1923. - ............. ............... Chronic 1 2 7 1 3 5 9 14 8 18 30 Total 6 11 14 15 19 33 Year 1924__ 1925 1926 1927________ Acute ____ ______ T o t a l.. _ __ Chronic Total 5 2 4 1 16 20 18 18 21 22 22 19 26 156 182 It is thus shown that the number of cases treated at the Massa chusetts General Hospital has increased up to the year 1923, subse quent to which cases have declined, but not measurably so, maintain ing about an average of 21 cases during the last four years. It should be explained, however, that aside from the foregoing, during the past 10 years 861 cases of lead poisoning have been treated in the out-patient department of the hospital, and of this number 236 were registered as painters. This, unfortunately, is the only occupational classification which is made in the hospital, so that no further infor mation is available regarding other occupations. DEATHS FROM LEAD POISONING, 8 1 9 2 5 -1 9 2 7 Cases of Lead Poisoning at the Buffalo City Hospital N F U R T H E R amplification of the available data regarding lead poisoning in particular localities, through the cooperation of the superintendent of the Buffalo City Hospital, the details of 16 lead poisoning cases treated at the hospital since 1921 are given. The reports in question are probably the most nearly complete records ever made of all the facts of lead poisoning cases, but only the essential details can be given. I C A SE I, A. P., A P R IL 23, 1921 Admission history. Ill 4 weeks; male; white; married; 5 children; age, 51; birthplace, Buffalo; occupation, lead burner; last date patient worked, April 23, 1921. Present illness. Admitted April 23, 1921. Illness began three weeks previous with nausea and vomiting, and cramps in abdomen. Trembling and pains in limbs. Appe tite fairly good. Admitted as chronic lead poisoning, chronic alcohol poisoning, general arterial sclerosis. M ay 14: Has almost complete paralysis of upper extremities, though he retains a slight power of flexion on the fingers. Diminished sensation to pain. July 2: Complete paralysis extensors wrist and fingers. Some use muscles posterior shoulder girdle. Marked swelling hands and forearms— left side particularly. Some atrophy muscles legs without disability. January 20, 1922: Improvement slow but steady. Can not shake hands or feed himself, although the movements of the shoulder girdle are limited. Still has paralysis of deltoids, with atrophy and limited abduction. Hands swollen and painful at times. Walks normally. Physical examination No. 1. Eyes: Pupils myotic, right slightly larger than left. Regular reaction to A. & L. Ears: Normal. Nose: Evidence of nose bleed. Septum deviated to R. M outh: Membranes of gums bluish tint. Bluish color of membrane at cor ners. Teeth poor condition, much pyorrhea, breath foul. Chest: B. V. D. in right interscapular region, increased tactile and vocal fremitus. No rales heard. Heart: Somewhat enlarged to both left and right. Muscle sounds of poor quality. No murmurs. Arteries: Marked sclerosis. Abdomen: Somewhat distended tympanitic to percussion. Spleen not pal pated. Liver palpated just below costal margin. Diffuse tenderness, no masses. Extremities: Normal appearance. Paresis of extensors and flexors but more pronounced in extensors of arms and legs. Reflexes: Patellars active— achilles present. Tremor of tongue, lips, and hands. Skin: Not remarkable. Glands: Cervical palpable. Diagnosis: Chronic lead poisoning; post typhoid; arteriosclerosis; chronic alcoholism; cerebro spinal syphilis. Physician’s recommendation for discharge. I hereby recommend for discharge from the Buffalo City Hospital, A. P., effective February 22, 1922. Admitted on April 23, 1921; admission diagnosis— chronic lead poisoning; revised diagnosis— chronic lead poisoning; complication or sequel— chronic lead poisoning, syphilis, chalazion. Destination and recommendation regarding future conduct— To home, under care of private physician. CASES OF LEAD POISONING AT BUFFALO CITY HOSPITAL 9 CASE II, R. W ., J U L Y 24, 1920 Admission history. Male; married; white; age, 43; occupation, lead solderer; ill since Easter Sun day. Present illness. Has worked for past six years as a lead solderer. Has noted bleeding of gums, lower extremities becoming weaker. Pain noted in hands, wrists, and forearms. Pain in stomach for past six weeks, of colicky type. One attack of diarrhea. Physical examination. General appearance: Anemic, pasty complexion. Eyes: Slight conjunctival congestion move in right eye, pupils irregular in out line but react to light. Ears: Negative. Nose: Some catarrhal obstruction. Mouth— tongue: Some tremor, brown coating. Teeth: Very poor condition, many missing. Gums: Blue line noted, patient says that they bled last week. Nasopharynx: Unable to make thorough examination— gags very easily. Cervical glands: Palpable but not tender nor hot. Circulatory system: Radial arteries— moderate sclerosis. Pulse is small, easily compressible, regular, frequent. Heart: Not enlarged to percussion. Heart sounds good quality, no murmurs, nor thrills. Lungs: Respirations are increased in rate, regular but noisy due to mucus in respiratory tract. Breath sounds diminished in left lower base posteriorly, few moist subcrepitant r&les heard posteriorly at both bases. An expiratory grunt heard all over chest. Vocal fremitus somewhat increased continuously right side. Abdomen: Negative for rigidity or tenderness or masses. Skin: Dry, anemic, and warm. Diagnosis: Chronic lead poisoning;.chronic parenchymatous nephritis. Discharge. Patient was discharged without consent on August 31, 1920; discharged im proved; per cent of disability, 100. C ASE III, J. C., N O V E M B E R 2, 1922 Admission history. Male; age, 51. Present illness. Was working up to one week previous to admission, when he had to stop work on account of pain in the abdomen. The pain is of a dull character not localized in abdomen and has been present more or less for the past two months. He is troubled with flatulence and belching of gas after taking food; has never vomited. Three years previous had similar illness and spent nine weeks in bed at home. Four years ago he weighed 220 pounds; two months ago he weighed 175 pounds, a loss of 45 pounds. Physical examination. General condition: Patient a white male of apparently stated age, well devel oped, fairly nourished, pale, normal expression, lies comfortably in bed in any position, not in distress. Respiratory system: Chest well developed, symmetrical, moves freely, only fair expansion. Slightly impaired resonance over right apex. Circulatory system: Heart sounds normal quality, but diminished intensity. Digestive system: Abdomen is retracted, moves freely with respiration, no re bound pain. Liver and spleen not enlarged. Nervous system: Intellect, normal; sensation, normal. Diagnosis: Chronic cholecystitis; chronic lead poisoning. Discharge. Patient discharged November 17, 1922, condition improved. DEATHS FROM LEAD POISONING, 10 1 9 2 5 -1 9 2 7 C A S E IV , W . S., M A L E , A G E 38 Present illness. Began about three weeks previous to admission with dull aching pain in lower abdomen. Has poor appetite, no vomiting, no nausea at any time, constipated since onset, no cough, no sputum. Physical examination. General appearance: Slightly emaciated. Respiratory system: Chest emaciated. Circulatory system: Heart regular, rhythmic, not enlarged. Digestive system: Abdomen sunken, emaciated. Liver enlarged, spleen not palpable. Skin: No rashes, few scars over chest. Diagnosis: Chronic appendicitis. Occupation. Patient worked in rubber factory nine months on a mixing machine, and in haled much red blue powder, which he claimed made him sick. Worked eight hours daily at hard labor. C ASE V, L. A ., A P R IL 4, 1921, M A L E , A G E 58 Present illness. Weakness in forearms, loss of grip, headache, nausea, constipation. Physical examination. Teeth: Poor condition, much pyorrhea. No lead line. Extremities: Varicose veins on legs, emaciation. Diagnosis: Arteriosclerosis; chronic cardio-vaseular disease; mitral insuffi ciency; chronic interstitial nephritis. Discharge. Patient discharged April 11, 1921, condition improved. C A SE V I, V. W ., M A L E , A G E 37 Present illness. Sick for three weeks beginning with pain in back. Dull pain all over the abdo men with a general loss of strength and ambition. Pain has not been severe at any time. No headache and no cough. Has not been able to eat at all. No joint pains, no pain in chest. Physical examination. General appearance: Lies in bed in dull stupid manner, apparently quite sick and weak. Eyes react sluggishly to light and accommodation, teeth very unclean, tongue heavily coated, breath foul. Chest: Well developed. Heart: Normal. Action regular and rhythmical. Diagnosis: Typhoid fever; chronic lead poisoning. Occupation. Pouring lead for six weeks ending two weeks prior to admission. Discharge. Patient discharged April 11, 1922, with consent, condition improved. C ASE V II, W . S., M A L E , A G E 30, O C T O B E R 17, 1924 Present illness. Began eight days previous to admission, with diarrhea and vomiting. painter for 12 years. Was Physical examination. General appearance: Well-developed and well-formed. Marked pallor, skin cold. Lead line not marked but present. Breathing normal. Heart sounds of good quality. Diagnosis: Lead poisoning. Discharge. Patient discharged, without consent, October 27, 1924. Condition improved. CASES OF LEAD POISONING AT BUFFALO CITY HOSPITAL 11 CASE V III, P. H ., M A R C H 3, 1923, M A L E , A G E 59 Present illness. Pain in stomach for two weeks, quite severe. appetite, constipated, no cough. No vomiting or nausea. Poor Physical examination. General appearance: Quite thin, rather poorly nourished. Teeth very unclean, tongue coated, foul odor to breath. Diagnosis: Chronic lead poisoning; indirect inguinal hernia; external hemor rhoid; pyorrhea alveolaris. Discharge. Patient discharged from the hospital April 3, 1923. CASE I X , F. K , S E P T E M B E R 5, 1924, A G E 41, M A L E Present illness. Patient is lying on his back, in no apparent pain, with a constantly roving, searching look; some part of his body always is in motion, twitching of facial muscles or movement of low^er extremities or turning of head. Face is bright, but pasty and moist. Strange urinous odor to his breath. Some evidence of unbalanced mind. Physical examination. Skin and mucous membranes pale, skin worst. Lead line definitely marked. Tongue moist and but slightly coated. Heart normal. Muscles flabby. Diagnosis. Chronic lead poisoning. Patient expired September 7, 1924. CASE X , J A N U A R Y 13, 1925, M A L E , A G E 44 Present illness. Began working in shop where lead was melted in March, 1924. In July began to vomit, followed by cramps and numbness and coldness in right hand in half thumb, index finger, and half of second finger up the wrist on the radial side. Lost 18 pounds. Appetite poor. Physical examination. General appearance: Poorly nourished, underdeveloped, weak and anemic, suffering with gastric distress. Pus at base of teeth, lead line on gums. Chest large in proportion to rest of body. Heart rate slow. Diagnosis. Chronic lead poisoning with peripheral neuritis of right hand; secondary anemia; some infiltration of left lung. Discharge. Patient discharged on February 6, 1925, condition improved. CASE X I , T. R., M A Y 5, 1925, M A L E , C O L O R E D , A G E 27 Present illness. Began two weeks previous. Started gradually with slight pain in abdomen, vomiting and sweet taste in mouth, and constipation. Attacks became very severe. Occupation: Weighed lead for three months. Physical examination. General appearance: Well developed and nourished. not acutely ill. Appears depressed but Diagnosis. Lead poisoning with lead colic. Discharge. Patient discharged on M ay 28, 1925, condition improved. 12 CASE DEATHS FROM LEAD POISONING, X I I , P. B., S E P T E M B E R 1 9 2 5 -1 9 2 7 5, 1927, M A L E , PO LISH , A G E 24 Present illness. Began one week after he started working at battery company, with occasional pain in arms, shoulders, and leg. Became constipated, lost appetite, and became generally weak, followed by severe cramps in abdomen. Three weeks’ exposure to dust from scraping batteries. Physical examination. No previous illness, no previous complaints. Patient well-nourished and welldeveloped, and not markedly ill. Definite lead line in gum margins. Chest well developed. Heart regular. Diagnosis. Acute plumbism; slight pulmonar}" fibrosis. Discharge. Patient discharged from the hospital September 27, 1927, condition improved. C ASE X I I I , J. U., A P R IL 7, 1923, M A L E , A G E 43 Present illness. Sent to hospital as an alcoholic, after fainting spell. Worked as a laborer, then in a lead furnace room putting lead into large vats and ladling the molten lead Was exposed to gaseous vapors. Ate his lunches at factory but claimed he always washed his hands before eating. Physical examination. General appearance: Tongue thickly coated, teeth carious. Lungs, impaired resonance over bases, suspicious pneumonia. Swelling of right hand. Rather stuporous. Diagnosis. Acute alcohol poisoning with stupor; oral sepsis— pharyngitis; dental caries; possible pneumonia; enlarged heart. Discharged. Patient discharged on M ay 18, 1923. Disability, 25 per cent. Patient readmitted to hospital December 11, 1926, with a carcinoma of the stomach with chronic lead poisoning. Died on January 4, 1927. CASE X I V , R. C., A U G U S T 19, 1927, M A L E , A G E 49 Present illness. Patient became ill after drinking some liquor. Severe pains in abdomen with vomiting and straining. Had one or two attacks of dizziness and was uncon scious with one attack. Father and mother alive and well. One sister alive and well. No past illness. Painter, drinks considerably. Admission diagnosis: Alcoholism, chronic. Physical examination. Poorly nourished but not acutely ill; teeth carious; no lead line; no impair ment of lungs; heart regular. Admission history. Scotch-American descent; decorator, painter; drinking 30 years; never incapacitated. married twice; no children; Diagnosis. Chronic plumbism; chronic alcoholism. Discharge. Patient discharged without consent, August 29, 1927. CASE X V , G. S., JU L Y 27, 1927, M A L E , A G E 44 Present illness. Patient an automobile painter for 13 years. Had been well until previous August, at which time he noticed that his hands became numb and his grasp on the brush was weaker. Weakness gradually became so marked that he was LEAD POISONING, BY INDUSTRY GROUPS, N E W YORK STATE 13 unable to feed himself. Wrist joints became swollen but never painful. Swelling gradually subsided, some strength recovered but can not extend the hand. Ankles and muscles also painful. Admission diagnosis: Chronic lead poisoning, possible acute cholecystitis. Previous admission date, May 9, 1927. Admission history. Uses alcohol in moderation; smokes; married— wife, one son, and five daughters alive and well; mother, age 72, alive and well; father and one brother dead. Physical examination. Scalp, ears, and nose negative; teeth all out, no lead line; chest expansion good and equal; heart normal. Diagnosis. Double wrist drop; hypertension; possible chronic nephritis. Discharge. Patient discharged with consent of superintendent, May 27, to return to out patient clinic. Readmitted on July 27, 1927. Diagnosis: Chronic lead poisoning. Dis charged August 19, 1927, to return to out patient medical clinic. CASE X V I, A. A., J U L Y 10, 1920, M A L E , A G E 43 Present illness. Began six weeks previous after working for three weeks in a lead factory. Had dizzy spells, felt nauseated, and stomach felt sore. Vomited often and had to stay in bed for about a week. Physician advised him to go to the hospital. Has been constipated since onset, and has lost considerable weight. Physical examination. General appearance very anemic, is emaciated; pulse small; heart weak at apex, hardly audible at base; no murmurs heard; teeth in very poor condition; tongue coated; breath foul; no lead line. Diagnosis. Thyrotoxicosis; lead poisoning; pulmonary tuberculosis. Discharge. Patient discharged July 28, 1920; condition improved; disability 10 per cent. Lead Poisoning, by Industry Groups, State of New York T IS information of this nature which is most urgently required, but on a much larger scale, to justify definite conclusions as regards both diagnosis and treatment for lead absorption and lead poisoning properly differentiated. That we are far from being able to settle an important question of this nature is explained in a discussion of lead poisoning in the last annual report of the New York State Industrial Commissioner by Dr. M ay R. Mayeis, medical inspector of the section of special research. This author considers in some detail the question of terminology, pointing out that the matter is still debatable as to exactly what is lead poisoning. She, however, agrees with the conclusion which is gradually gaining approval that lead absorption should be differentiated from lead poisoning and that a higher standard of diagnosis should be adopted, including laboratory analyses both of blood and urine, as the result of which the administration of compensation laws for lead poisoning cases would be greatly facilitated. The importance of the differentiation of lead absorption and lead poisoning as a compensation factor is clearly visualized in the I 34968°— 29------- 3 14 DEATHS FROM LEAD POISONING, 1 9 2 5 -1 9 2 7 statistics of the New York State Department of Labor for the two fiscal years, 1925-26 and 1926-27, as shown in Table 6. This table brings out the numerical concentration of lead poisoning cases for certain outstanding industries and the relative financial burdens resulting therefrom. T able 6.— Number of cases of temporary disability caused by lead poisoning, time lost, and compensation paid, by industry,11925-26 and 1926-27 Year ending June 30, 1928 Industry group Time loss (weeks) Cases Metal goods: Blast furnaces_______________________ 1 12 Foundries.. ________ _______________ 2 Lead and lead alloys_________________ Metal fixtures.. . . . ______ _________ Metal sta m p in g_____________ _____ 1 1 Sheet metal work____________________ Beds_________________________________ 1 Cutting and welding___________ _____ M achinery building: M edium machinery _____ __ ______ 3 1 Special machinery. . . . _ . ___ Electrical apparatus, including storage 133 batteries______ __ S a fe s ___ ______ _ ____________ . Small arms __ . . ...................... .. 1 Automobiles and auto parts......................... W ood products: 1 ......... ................. Planing mills Brnrvms and hrnshfis Bakeries !__ ____ _ 6 Chemicals____ . . . ____________________ _! 20 Paints, inks, and dves____ ______________ Printing TVTisnellaneons nrvmnosit.ion eoods 2 Stone grinding . . . ___ . 1 _________ Pottery m a k in g ____ _ 2 ___________ Glassware Miscellaneous manufacturing___________ Total, manufacturing_______ ____ _ Construction: Structural iron and steel Plumbing and gas fitting.. _________ Painting and decorating.......... ............ . Ship repairing __ ._ _________ i Compen sation 6 150 65 27 ! 37 ,' 6 540 740 78 12 15 230 303 ! 827 11, 580 1 147 | 7 300 j i 1 359 1 2,473 13 ! 61 ! i1 250 : 532 ! 93 i 20 215 188 1, 4S5 3 2 15 1 25 40 404 35 Time loss (weeks) Compen sation 33 10 1 447 76 14 $8, 010 1,412 284 1 13 247 133 1 1 6 1,005 3 133 52 12, 236 39 451 993 1 1 1 9 22 3 4 9 9 5 47 223 38 32 167 67 90 867 3, 240 681 392 Cases $117 1, 649 1,225 17 Year ending June 30, 1927 20, G16 1 4 77 228 2, 1J0 29, 233 1 8 3 225 47 4, 457 9 228 4, 504 2 2 2 76 10 25 1, 472 .184 464 243 2, 449 35,857 ! 487 790 8,040 698 1 Total, construction________________ 21 504 10,015 Transpoitation and public utilities______ Trade . . _ . . ___ _________ Clerical and personal service _________ 1 3 5 8 103 139 Grand total, all industries__________ 213 2,002 30,873 i | No cases of lead poisoning resulted in permanent partial disability in the years ending June 30, 1926, and June 30, 1927. According to Table 6, the number of compensated cases of lead poisoning within the definition of the compensation law increased from 213 to 243 between 1926 and 1927. The amount of compensa tion paid out on account of such cases increased from $30,873 to $35,857. The number of fatal cases of lead poisoning, however, decreased from 3 to 1, while the amount paid on account of such cases decreased from $18,384 to $10,054. The major number of cases of lead poisoning occurred in the manufacture of electric storage batteries, while the number of such cases was precisely the same for both years. 15 W O R K M E N ’S COMPENSATION FOR LEAD POISONING Lead Poisoning in Manufacture of Electric Storage Batteries H E following statistics are based upon a detailed analysis of certificates of lead poisoning furnished by the New York State Department of Labor, covering the year 1927, also with particular reference to compensation. Table 7 gives an analysis of the returns for 185 battery workers, showing the average age at the time of disease occurrence and the average duration of employment. T T able 7.— Average age and duration of employment in cases of lead poisoning in electric storage battery plants in New York State, by occupation, 1927 Duration of employment (when taken sick) Age White race Occupation Number reporting Pasters..... .......... ......... Sweepers ................. Plate workers Pitmen _ _________ Millers ...... ............ . M ix e rs ......... .............. Electricians- ......... . Oxide workers______ Potmen Truckers .... ............ Inspectors N ot reported......... ..... Total_________ Colored race Average N umber (years) reporting 68 12 11 6 6 4 3 3 2 2 16 31.5 41.0 29. 5 41.0 31.5 36. 0 26.0 45.7 46.0 29.5 26.3 35.0 140 32.6 White race Average Number (years) reporting Colored race Average Number (years) reporting 33.7 67 12 9 6 6 4 3 3 2 2 17 3 6.7 3.4 5.4 3.7 5.8 6.3 8.7 6.7 1.5 6.0 3.1 8.9 31.7 134 5.7 7 31.7 1 31.0 '61 45 A verage (months) 7 4.3 1 9.0 35 1.8 43 2.4 According to Table 7, while for the white employees in the manu facture of electric storage batteries the average length of employment was 5.7 years, it was only 2.4 months for the colored labor. Here the average duration of employment was lowest for mixers, only 1.8 months. The average age is almost the same. The certificates contain very little additional information of statisti cal value. It is very regrettable that most of the certificates should be incompletely filled out as regards complications and previous attacks. It is to be hoped more attention will be given in the future to the practical importance of sending in completely filled out cer tificates, of importance for both legal and medical purposes. Workmen’s Compensation for Lead Poisoning H E whole question of compensation law and its application to lead cases has very recently been reviewed by Dr. M ay R. Mayers of the Bureau of Industrial Hygiene, New York State Department of Labor, published in the Industrial Hygiene Bulletin for October, 1928. This discussion is exceedingly valuable and of great practical importance. It draws for the first time a clear distinction between lead poisoning and lead absorption, emphasizing, however, the equivalent use of these terms for compensation purposes. T 16 DEATHS FROM LEAD POISONING, 1 9 2 5 -1 9 2 7 The foF owing extended extract from this discussion is quoted as of permanent value. The plain intent of the compensation law is that, in all compensable diseases, compensation should be available to the worker injuriously affected well before the acute stage, resulting in total disability, is reached. This is clearly evidenced by section 39, above set forth, which specifically provides for compensation even where the employee is able to earn his wages at another occupation, so long as such wages do not equal his full wages prior to the date of his disablement. Such being the intent of the compensation law, it would be manifestly contrary to that intent to limit the term “ lead poisoning” to such cases showing acute symptoms. Only by embracing within the term all cases in which, as a result of exposure to lead, there is resulting disability, of whatever degree, and whether manifestly itself in acute or subacute, objective or subjective sj^mptoms, can the intent of the law be carried out. In effect, therefore, the term “ lead absorption” as used in the present discus sion is synomymous with the term “ lead poisoning” in the compensation law. It has the advantage, however, as above pointed out, of helping to standardize both terminology and diagnosis in a disease where the lack of standardization has led to much needless disagreement among medical men and consequently no end of difficulty in the administration of the compensation law. For this reason it is argued that the term “ lead absorption” be substituted for the term “ lead poisoning” in the compensation law. Article 1, section 3, subdivision 2, would then read as follows: “ Occupational diseases.— Compensation shall be payable for disabilities sus tained or death incurred by an employee resulting from the following occupational diseases: 1. Lead absoprtion.” Clearly, the suggested substitution involves no change in the law. It is merely a substitution of convenience, as will be still further brought out in the ensuing discussion. Before proceeding to a discussion of the procedure to be followed in determining whether a claimant is suffering from incapacity due to lead-absorption as just defined, there are several fundamental points to be kept in mind: 1.’ In any given individual, lead may be present in his body either in toxic or nontoxic form. In an individual where all of the lead present in his body has been stored in his bones it is nontoxic to him for the time being. 2. Lead which is present, however, in the circulating blood may be either toxic or nontoxic, depending upon the quantity of lead present. It is only those cases where toxic quantities of lead appear in the circulation that any incapacit}7 may occur and it is only those cases which are, therefore, of any interest to the compensation tribunal. 3. Lead workers are just as subject as any individual to the ordinary ailments such as ordinary stomach ache, gastric ulcer, appendicitis, etc. It is quite obvious, therefore, that all other causes be definitely eliminated in considering the health of a lead worker quite as much as in making a differential diagnosis in any other individual. Confining ourselves to those cases where lead is thought to be actively present in the body in toxic amounts, resulting in clinical manifestations of disability, we may divide these for the present purpose into two groups, depending upon whether the manifestations are such as to produce definite demonstrable disa bility, or are merely subjective, resulting in a claimed disability, the existence of which may be difficult to prove. The foregoing interesting discussion is followed by a consideration in detail of cases with positive disability and cases wTth doubtful dis ability. The former is subdivided into cases with positive laboratory findings and cases with negative laboratory findings. In each case the procedure to be followed is indicated and diagnostic possibilities are pointed out. As regards the diagnostic possibilities in cases with positive laboratory findings, it is stated: Diagnostic possibilities.— Cases with objective clinical manifestations (positive disability) and positive laboratory findings present the following diagnostic possibilities: 1. If the disability is such as to be definitely associated with lead absorption and this is further confirmed by the laboratory, there can be no doubt as to the diagnosis. 17 UNITED STATES W O R K M E N ’S COMPENSATION DATA 2. If the disability is such that its relation to lead absorption is in doubt, the presence of laboratory evidences of lead absorption should, generally speaking, be presumptive evidence in favor of lead as a cause for the disability— other possibilities, of course, being ruled out in the usual manner. As regards the diagnostic possibilities in cases with negative laboratory findings the observation reads that— Diagnostic possibilities.— The cases which can arise under this group present several diagnostic possibilities. 1. If the disability is such as to leave no doubt whatever as to its relation to lead absorption the absence of laboratory confirmation should not prevent a positive diagnosis being made. 2. If the disability is such as to leave some doubt as to its relation to lead absorption, the absence of laboratory confirmation should, generally speaking, be presumptive evidence against lead as a cause for the symptoms. In these cases repeated laboratory tests should be made, however. If no other cause for the disability can be established, a medical expert should be called into consultation. 3. If the disability is definitely one which has never been associated with lead absorption, and the laboratory findings are negative, the presumption is against lead as a cause for disability. To the foregoing are added the diagnostic possibilities in cases with doubtful disability as a matter of record. If the symptoms of which the worker complains, though ever so vague, are those definitely associated with lead absorption, and the laboratory findings are positive, the presumption is in favor of lead as a cause for the sumptoms and consequent disability. All other possible causes for these symptoms must, of course, be ruled out as indicated above. 2. If the sj^mptoms complex is a doubtful one, and the laboratory findings show lead absorption, the presumption of evidence is still in favor of lead as a cause for the symptoms and the disability. 3. If the clinical picture is doubtful and the laboratory findings negative the presumption of evidence is definitely against the possibility of lead absorption as cause for the symptoms. United States Workmen’s Compensation Data N D E R the Federal compensation act, cases of lead poisoning are compensable in the same manner as industrial accidents. Through the courtesy of the secretary of the commission the returns for the period 1920 to 1927, giving details of 198 cases, of which 9 or 4.5 per cent terminated fatally, are shown in Table 8. The total amount paid for compensation on account of all cases, with the estimated valuation for permanent total-disability cases and deaths, was $119,207.70 for the period under review, giving an average compensation of about $600. T I T T a b l e 8 .— Number of cases of lead poisoning and compensation paid under Federal compensation act, 1920 to 1927 Year Total number of cases Permanent, partial, and te m p o ra ry to ta l d is a b ilit y cases. N um ber Amount of compen sation Permanent total disability cases N um ber N um ber Esti mated valuation $13,222.00 1920_ ........................... ............. 1921 . . 1922 .......................................... 1923 . ...... .......... 1924.................. .......................... 1925 ________ _____ ________ 1926 _ ...................... 1Q27 16 8 8 7 57 72 12 18 15 6 7 5 54 71 11 17 $2,324.34 655. 60 2, 546. 31 6, 418. 83 2, 490.17 6, 218. 11 738.34 ! 1,374.00 2 21,509.00 2 $15,068.00 1 7, 764.00 2 15, 717.00 1 6, 276.00 1 123.00 1 4, 470. 00 1 12, 293 00 Total, 8-year period____ 198 186 22, 765. 70 | 3 34, 731.00 9 1 Estimated valuation Death cases 61, 711. 00 18 DEATHS FROM LEAD POISONING, 1 9 2 5 -1 9 2 7 Lead Poisoning in the United States Navy, 1913-1927 N A previous report/ are given some statistics of lead poisoning in the United States Navy, which are now brought down to the end of the year 1927. Table 9 has been derived from an article on five cases of lead poisoning occurring on board the U. S. S. Wyoming in 1926, by Lieut. Commander W . W . Hargrave, United States Navy. I T able 9. — Lead poisoning admissions and deaths in United States Navy, 1913 to 1927 Year Average strength 1913. 1914. 1915. 1916 _ 1917.. 1918.. 1919.. 1920. 1921. 65,926 67,141 68, 075 69. 294 245, 580 503, 792 298, 774 140, 773 148, 861 Cases of acute lead poison ing Cases of chronic lead poison ing 36 30 24 20 21 13 Year Average strength 122,126 116, 565 119, 280 115, 391 113, 756 115.316 1922. 1923. 1924. 1925. 1926. 1927. Cases of acute lead poison ing Cases of chronic lead poison ing 7 1 25 1 6 26 27 i 11 1 1 Total__ 2. 310, 650 i Including 1 death. A surprising fact in this experience Las been the small number of deaths considering the relatively large number of acute and chronic cases. In proportion to the Navy personnel the rate of incidence has been 215 per million exposed to risk. It may be observed in this connection, however, that of the 26 cases of acute lead poisoning in 1926, 13 cases were caused by lead paint, but the manner in which the men were poisoned was not specified. Five other cases were caused by particles of dust from paint. Poor ventilation in double bottoms and bilges was regarded as the cause in six cases. One man was poisoned by a native drink, “ aguardiente,” which was distilled in containers lined with lead, and one by coming in contact with red lead. In 1927, 9 of the 27 cases of acute lead poisoning resulted from chipping and painting aboard ship, but the circumstances which caused the poisoning were not mentioned. Chipping and painting in double bottoms caused poisoning in 13 cases and chipping in double bottoms in 5. In these cases deficient ventilation was regarded as the primary factor. It would appear, however, from the foregoing that the cases in question were lead absorption rather than lead poisoning, for the small fatality rate is suggestive of the certainty that in the Navy, cases of lead absorption are early recognized and receive prompt as well as qualified attention. Lead Poisoning Statistics of Metropolitan Life Insurance Co. H E statistician of the Metropolitan Life Insurance Co. has been good enough to supply the returns of lead poisoning deaths in the industrial experience of that company down to the end of 1927, as shown in Table 10. The tabulation shows a slight increase over the rate of 1925 during the last two years, but a much lower rate than during the early years of the experience under review. T 19 COMPENSATION FOR LEAD POISONING IN OHIO T able 10. — Deaths from chronic lead poisoning, industrial department of Metropolitan Life Insurance Co., 1911 to 1927 Number exposed to risk 1 N umber of deaths Rate per 7, 790, 227 8, 219, 695 8, 696, 548 9, 247, 323 9, 665, 699 10.177, 060 10. 847, 852 11. 553. 347 12. 424, 509 1911. 1912. 1913. 1914. 1915. 1916. 1917. 1918. 1919. 2. 2 4.5 4.0 4.2 3. 1 3.2 2.3 2.5 Number exposed to risk 1 Year 1,000,000 192 192 192 192 192 192 192 192 0 1 2 3 4 5 6 7 Number of deaths Rate per 1,000,000 13, 086, 725 13, 500, 762 13, 776, 239 14, 534, 242 15, 423, 233 16, 271, 168 17, 087, 706 17, 521, 595 2.2 1.9 2.2 2.3 1.6 1.6 1.8 1.8 2.1 i Ages 1 year and over. Lead Poisoning in New York City T A T IST IC S for the city of New York have been given in a previous review but they are here brought down to the end of 1927. Tne number of lead poisoning cases in 1925 was 5, in 1926,10, and in 1927,12. There has, therefore, been a substantial increase suggestive of the possible neglect of known safety precautions or the none too rig orous enforcement of the law governing the protection of the workers. S Compensation for Lead Poisoning in Ohio Q U ALLY interesting statistics have recently been made avail able through a publication of the industrial commission of Ohio. The number of compensated claims for lead poisoning from July 1, 1924, to July 1, 1927, in that State was 907. Of this number, 37, or 4.1 per cent, terminated fatally. The number of cases of permanent disability was only 1, while the number with a disa bility of more than 7 days was 759, and cases with disability of less than 7 days, 45, aside from 65 cases which suffered no time lost. E The occupational distribution of compensated claims for lead poison ing and the number of days lost, with compensation costs, and medical costs for each industry group have been as follows: T able 11.— Compensated claims for lead poisoning in Ohio, July 1, 1924, to July l t 1927 Industry group Number of claims Building construction_______ ___________ 1 Chemicals---------------- ------- ------------------------ | Clay, glass, and stone------------------------------Leather and leather goods________________ Lumber and wood products___ ___ ____ Blast furnaces___________________________ Machinery manufacturing ___________ Metal goods_____________________________ Vehicles _______________ ____ ___________ Paper and printing-- ---------------------------Rubber _________ _______________ _____ Textiles and clothing- _____ ______ - __ Miscellaneous____________________________ Transportation Utilities- _____ ________ _________________ Commercial _ ___________________________ Care of grounds______________________ . . . Public employees_______________ _______ Food and beverages _______ _____ ____ T otal, ............................. ....................... Fatal cases.................... ............. ......... .......... 84 112 57 1 21 4 29 356 161 25 15 1 8 1 17 6 6 2 907 Days lost Total 42, 790 24, 431 32,711 11 14, 746 139 7,157 45, 907 40, 094 35, 002 7,488 24 503 3 18 7, 299 6, 280 6,318 6,106 1 277, 027 371 222,000 Average Compensation cost Total 509 $43, 313 218 20, 301 574 20,019 11 8 702 18,484 35 256 247 5, 111 129 44, 990 249 35, 651 1,400 19, 287 499 9, 775 24 45 63 1,188 3 18 | 29 429 8, 865 7,106 1, 047 1,053 7, 086 246 3, 053 305 241, 760 133, 584 6, 000 Average Medical cost $516 181 351 8 880 64 176 126 221 771 652 45 149 $6,910 5, 208 2, 363 51 1,518 99 884 15, 221 8, 265 2,771 480 30 509 29 521 1,184 1,181 123 267 64 1,154 387 295 72 46, 293 8,888 3, 610 20 DEATHS FROM LEAD POISONING, 1 9 2 5 -1 9 2 7 As shown by Table 11, the 907 compensated cases of lead, poison ing involved a time loss of 277,027 days or an average loss of 305 days per case. The compensated cost was $241,760 or an average compensation return of $267. The total medical cost was $46,293, or an average medical cost of $51. The 37 fatal cases involved an estimated time loss of 222,000 days, or an average loss of 6,000 days. The compensation cost on account of such deaths was $133,584, or an average cost of $3,610. The total medical cost on account of fatal cases was $8,888. Lead Poisoning in New Jersey, 1924-25 to 1926-27 OR the State of New Jersey, statistics are rather fragmentary but nevertheless of interest in connection with the preceding discussion. Workmen’s compensation benefits in industrial poisoning by lead, etc., became effective in New Jersey in 1924. During the fiscal year ending June 30, 1924, 38 cases of lead poisoning were reported to the department of labor, but the report for that year gives no further information. During the fiscal year 1924-25, the number of reported cases of lead poisoning was 164, of which 14 terminated fatally. For this year the industries in which lead poisoning occurred are specified in the annual report as follows: F T able Industry group Chemical plant Enameling___ __ Ink manufacturing. Jnsecticides ___ Junk yard- _____ Lead batteries_____ Lead cables_______ T QQr? raAniti(t Lead oxide ........... O ilcoth___________ 12. — Cases of lead 'poisoning in New Jersey, 192^-25 Fatal Nonfatal 1 8 v i i i 2 2 19 1 1 Total Industry group 1 8 1 2 1 1 2 21 1 1 Fatal Oil refining. Paint and dry col ors ___ _ Painters, _ _____ _ Red lead __ __ __ Soldering. ____ Tetraethyl lead___ 12 T o t a l............. 14 Nonfatal Total 1 1 9 12 3 85 9 12 3 3 97 150 164 -3 Of outstanding significance is, of course, the large number of cases and deaths due to tetraethyl lead. But suggestive also is the large number of cases in lead refining. The outbreak of tetraethyl lead poisoning was attributable to ignorance as regards the required pre cautions in the manufacture of a new type of gasoline which at tracted nation-wide attention and led to the appointment of a special committee of inquiry by the United States Public Health Service, which published an extended report in 1926. The report, however, does not include an extended consideration of the cases which had occurred in different parts of the country in a form useful for the present purpose. The report concerns chiefly persons em ployed in the handling and manufacturing of ethyl gasoline. The resulting recommendations were widety adopted and few deaths have since occurred in this country and abroad. During the year 1925-26 the number of cases of lead poisoning entitled to compensation in the State of New Jersey was 32, only 1 of these terminating fatally, that of a painter, 51 years of age. Two LEAD POISONING IN N EW JERSEY, 1 9 2 4 -1 9 2 7 21 •of the cases suffered temporary disability of from one to two weeks and 29 extended over two weeks. The total number of days lost on account of disability was 7,816, on account of which the total indemnity was $9,478. The amount paid for medical aid for reported cases was only $ 1 °°. ^ During 1926-27 the number of cases of lead posioning receiving compensation in the State of New Jersey was 48. Only 1 of these terminated fatally, 8 being partially but permanently disabled, while 39 suffered temporary disability. The total amount of dis ability suffered was 13,773 days, on account of which a total com pensation of $21,167 was paid. The total medical cost on account of 23 cases was $1,007. The foregoing statistics clearly emphasize that lead poisoning in the State of New Jersey is no longer a question of very serious im portance. Certainly considering the extent of the pottery industry alone in that State, many more fatal cases might have been expected. In a survey of the pottery industry of New Jersey made by Newman, *et al., in behalf of the United States Public Health Service in 1921, it was found that among 2,422 male pottery employees in that State, 16 gave a positive diagnosis of lead absorption, but among 480 female employees, there was one case. In addition, there were 20 male cases presumptive of lead absorption, and 3 females, as well as 18 additional suggestive cases for malt and 2 for females. In the State of Ohio, among 6,171 male pottery employees, 57 positive cases of lead absorp tion were found, while among 2,868 females, there were 10 cases positively diagnosed as lead absorption. In addition thereto, how ever, 43 males and 22 females were considered presumptive of lead absorption and 76 males and 27 females suggestive. Combining the four States of New York, Ohio, Pennsylvania, and West Virginia, among 12,297 pottery employees, of whom 1,902 were considered exposed to risk of lead poisoning, and of whom 1,809 were examined, 139 were positively found to be suffering from lead absorption, 106 from presumptive lead absorption, 168 gave suggestive symptoms, while 1,396 were negative. It was therefore concluded that con sidering only positive cases of lead poisoning, the rate of lead injury was 8.8 per cent for the men, 3.5 per cent for the women, and 7.7 per cent for both, or at a rate of 77 per 1,000 of those examined. But if both positive and presumptive cases are considered, the rate of lead absorption was 135 per 1,000. But since this report was made, con ditions have unquestionably considerably improved in the State of New Jersey, at least so far as positive evidence of deaths from lead poisoning may be accepted as a clear indication. The more minute the diagnostic procedure, of course, the more certain it is that small traces of lead will be discovered which may or may not necessarily be of industrial origin. Methods of diagnosis vary so widely that no exact comparison between the different industrial employments or different services can be looked upon as entirely conclusive. In other words, deaths from lead poisoning are a more certain indication of the seriousness of the situation than cases of lead absorption of a widely varying degree of pathologic or physiologic significance. 22 DEATHS FROM LEAD POISONING, 1 9 2 5 -1 9 2 7 Lead Poisoning in Great Britain, 1918 to 1927 N C O N T IN U A T IO N and elaboration of the foregoing analysis of statistics of lead poisoning for the United States, certain international statistics of lead poisoning are inserted for a few important countries as a matter of convenient reference. The first of these tables shows the number of reported cases of lead poisoning according to the reports of the chief inspector of factories and work shops of Great Britain for the years 1918 to 1927 with the corre sponding number of deaths and the percentage of deaths to the number of cases. Except as indicated for 1927, Table 13 does not include painting of buildings. I T able Year 1918.................. ........ 1919 1920 _____ 1921_______________ 192 2 192 3 13. — Lead 'poisoning in Great Britain, 1918 to 1927 Cases 144 207 243 230 347 337 Deaths Fatality per cent 11 26 23 23 26 25 1 Including painting of buildings. 7.6 12.6 9.5 10.0 7. 5 7.4 Year ! | i ! ! 1924 _......................... 1925 ______________ 1926.......................... 1927......................... /\ Cases 486 326 242 1347 2 249 Deaths 32 13 28 1 35 214 Fatality per cent 6.6 4.0 11. 5 i 10.1 2 5. 6 2 Not including painting of buildings. In this connection the senior medical inspector, Dr. John C. Bridges, observes as follows: Poisoning by lead produces a definite train of symptoms, though in certain cases these may be ill-defined. A worker exposed to lead has on more than one occasion been notified as suffering from lead poisoning which, on investigation, has proved to be a septic infection of an injury. Such cases have been excluded in calculating the total number of notified cases, but a diagnosis such as this may lead to difficulty for the employee and employer. The decline in the reported cases noted last year, is continuing, there being 84 fewer cases than in 1925 and 244 less than in 1924. Some of this diminution is undoubtedly due to the ad verse conditions of trade, although electric accumulator works, from which 21 fewer cases of lead poisoning have been reported, do not appear to have been so seriously affected. It is to be hoped, therefore, that the greater protection afforded by the code of regulations, which came into force in March, 1925, may, at any rate to some extent, be responsible for this fall in the number of cases. There is reason to believe that the overtime which has been worked occasionally in the manufacture of electric accumulators has contributed to the incidence of lead poisoning in the industry. Overtime in work exposing the workers to lead, or indeed any toxic substance, is to be discouraged, for each additional hour worked means an increase in the inevitable daily dose of lead dust or other harmful ma terial. There is, however, room for further improvement in the observance of the regulations affecting this industry, not so much in the mechanical arrangements for exhaust ventilation— though these are by no means perfect in all cases— ■ but in attention to the details of the regulations which concern cleanliness of floors and benches. Constant supervision of the exhaust plant is undoubtedly essential, for a new plant, which may be admirably designed and fulfil its purpose well at the outset will, unless constantly tested and overhauled, become of little value. This refers not only to works under the electric accumulator regulations, but to all exhaust plants designed for the removal of dust or fume. A striking example of this may be cited. In 1914 a modern and up-to-date plant wras in stalled in a factory for the manufacture of litho-transfers. This year three cases of poisoning occurred in rapid succession, and it was then found that the exhaust plant and the inclosed machines had become ineffective and failed to prevent the LEAD POISONING IN GREAT BRITAIN, 1918 TO 1927 23 escape of the lead dust, generated in fine powder during the process, into the air of the workroom. Attention to the exhaust plant might have prevented these three cases and saved the firm much anxiety and trouble. In elaboration of the foregoing, a statement by Doctor Bridges from the annual report for 1927 is quoted, as follows: The general health of the workers, particularly the younger ones, has, I believe, improved during the past few years. The factors which have contributed to this improvement are many, and not the least, I consider, is “ summer tim e,” which enables the workers to take advantage of the recreational facilities now provided by many employers. An increase of such facilities, whether by individual firms or by municipalities, will, in the future, be reflected in the improved health of the workers. There can be no doubt that the arrangements for welfare, now made by many firms, benefit the health of their employees. Progress has been made from year to year in this movement, but there is still a tendency to limit the application of welfare to female emploj^ees. Of particular importance are those projects which have for their object recreation outside working hours for juvenile employees. These, if well organized, can not fail to counteract the potential ill effects of monotony and tedium consequent upon the many me chanical and repetitive occupations unavoidable in modern industry. Reference is next made in the report to the effects of the lead paint (protection against poisoning) act of 1926, which has come into force. This act made compulsory the notification of lead poisoning among workers engaged in the painting of buildings, and gave the secretary of state power to make regulations. It is possible that the discrep ancies in the returns for the two years are explained on this ground in that the returns for 1927 include cases of lead poisoning among painters which apparently are not included in the returns for the previous year. The report includes some brief observations on lead poisoning in the manufacture of electric storage batteries, which are also quoted as a matter of convenient reference. Activity in this industry has continued, and 58 cases were notified, being an increase of 6 over those of last year. Twenty-four of these cases, as compared with 14 last year, occurred in work involving exposure to dust from pasted plates, in such occupations as trimming, trucking, and packing, where it is difficult, and in some cases impossible, to control the dust effectively. With the exception of lead burning, which accounted for 6 cases, as compared with 3 last year, and cast ing, with 2 cases as against 6 last year, the incidence in other processes remains much the same. One large works have appointed a whole time works doctor. This appointment, following as it does on the establishment of a dental clinic at these works, is clear evidence of the anxiety on the part of the firm to safeguard the health of their workers. The following observations on the painting of buildings are sug gestive of the practical value of the new act which came into force the 1st of October during the preceding year: On January 1 lead poisoning occurring among workers employed in or in con nection with the painting of buildings became compulsorily notifiable. The number, 98, shows an increase of 8 over that of last year. This small increase, even in spite of compulsory notification, may be ascribed to the fact that for the past two or three years all cases of lead poisoning which have come to the notice of the union officials have been referred by them to the department. It was observed by Sir Thomas Legge some years ago, in his annual report, that the percentage of severe cases amongst house painters was very much higher than among other lead workers. A review of the cases notified this year confirms this view. It may be that once a man becomes a painter he is always a painter, while in other industries where the use of lead is involved a man, after an initial attack of lead poisoning, can turn his attention to other work not involving exposure to lead. The fatalities, 21 in number, account for 60 per cent of all the fatalities due to lead poisoning. These have occurred in men who have been employed for many years as painters, the average age at death being 54. The distribution of the cases has been widespread, and among 92 firms 6 having 24 DEATHS FROM LEAD POISONING, 1 9 2 5 -1 9 2 7 had two cases each. The regulations which came into force on the 1st day of October have not and can not be expected to have produced any effect on the incidence of lead poisoning amongst this group of workers, although from the reports it appears that in the majority of cases an effort has been made to com ply with them. Some years must elapse before an appreciable effect is produced. An even longer period must elapse before the fatality rate falls. Finally, there are some brief observations on color spraying, with particular reference to women: Three females, ages 20 to 24, employed for four to six months in spraying leather with various colors in liquid form were found by Doctor H enry’ to be suffering from signs of lead absorption, slight punctate basophilia being pres ent in every case. Two of the colors in use were found to contain lead to the extent of 18.6 per cent and 1.3 per cent, respectively, calculated as lead monoxide. Table 14, derived from the annual report of the registrar-general for England and Wales for the period 1916 to 1926, shows the sex distribution of the deaths from lead poisoning throughout England and Wales as well as the rate per million of population for both sexes combined. T able 14.— Deaths from industrial lead 'poisoning in England and Wales, 1916 to 1926 Y ear 1916............ ....................... 1917____________ . . . . 1918______ . ___ 1919__________________________________________________ 1920__________________________________________________ 1 9 2 1 _____________________________________________________________ 1922____________ __________________________ 1923............ 1924................... ....... ................... _ . . _ 1925____ _______ ______________________________ ______ ... 1926................... ....... Total............................................................................ Population Male 34, 642, 000 34,197, 000 34,024, 000 35, 427, 000 37, 237, 000 37, 887, 000 38,158, 000 38, 403, 000 38, 746, 000 38, 890, 000 39, 067, 000 54 41 35 48 56 56 43 51 47 28 44 406, 678, 000 503 Female 1 2 1 Total Rate per 1,000,000 5 2 5 4 2 3 3 55 43 36 48 61 58 48 55 49 31 47 1.6 1.3 1.1 1.4 1. 6 1. 5 1.3 1.4 1. 3 .8 1.2 28 531 1.3 According to this table it is shown that during the first five years of the period there were 243 deaths, and during the second five years there were 241 deaths, or an average of about 48 per annum for the decade. But during 1926 the number of deaths was 47, so that the resulting rate was 1.2 per million for that year against 1.3 for the whole period. Evidently the lead poisoning situation is slowly im proving, and that is made particularly evident by the returns for 1927, not included in the tabulation, showing that during that year there were 44 deaths among the males and no deaths among the females. Lead Poisoning in Canada OR Canada the information as yet is limited to the years 1921 to 1926, but is of interest by waj of comparison with the corresponding rate for the United States and England and Wales. The information is exclusive of deaths from lead poisoning in the Province of Quebec, which at the time was not in the Canadian registration area. F 25 LEAD POISONING IN GERMANY T able 15.— Deaths from lead 'poisoning in Canada (excluding Province of Quebec), 1921 to 1926 Fe males Population Total 1,000,000 0.5 6, 406, 000 6, 507, 000 6, 577, 000 6, 659, 000 6, 737, 000 6, 815,000 1921. 1922 1923. 1924 1925. 1926. Rate per .6 The foregoing tabulation is supplemented by a more extended state ment for the Province of Ontario for the period 1910 to 1927, includ ing also the rates per million of population. T able 16 .— Deaths from lead poisoning in the Province of Ontario, 1910 to 1927' Year Population Deaths 1910. 1911. 1912. 1913. 1914. 1915. 1916. 1917. 1918. 2, 489, 241 2, 523, 274 2, 564,313 2, 605, 352 2, 646, 390 2, 687, 429 2, 728, 468 2, 769, 507 2, 810, 546 Rate per Year 1,000,000 1.2 1.2 1.6 .4 .4 1.5 1.8 1.8 1.1 Population Deaths Rate per 1,000,000 2, 851, 584 2, 892, 623 2,933, 662 2, 981,182 3, 028, 907 3, 062,150 3,103, 000 3,150, 000 3, 200, 000 1919. 1920. 1921 1922. 1923 1924 1925 1926 1927 0.4 .7 .3 1.3 1.0 .7 1.0 1.0 2.8. Lead Poisoning in Germany OR Germany statistics of lead poisoning are rather fragmentary and not available for the entire Republic. For Berlin the statistics have not been tabulated since 1921 on account of the simplification of the tabulation of the causes of death. This is rather disconcerting since Berlin has a considerable number of leadusing industries, including several large plants manufacturing electric storage batteries, in which lead-poisoning cases, certainly in nonfatal form, have by no means been rare. As a matter of fact a personal investigation in 1926 brought home the conclusion that in all proba bility cases of lead poisoning were relatively more common in the manufacture of electric storage batteries in Berlin than in some of our representative industrial plants in this country. The Prussian statistical office, however, has furnished the returns of lead-poisoning cases in Prussia for the period 1910 to 1925, which makes an interesting contribution. F T Year 1910. 1911. 1912. 1913. 1914 1915. 1916. 1917. able 17.— Deaths from lead poisoning in Prussia, 1910 to 1925 Population Deaths 39, 551,351 40, 500, 283 41,074, 664 41, 649,062 42, 223, 453 42, 223, 453 42, 223,453 42,421, 556 Rate per 1,000,000 0.9 .5 .6 .5 .5 .5 .4 .2 Year 1918. 1919. 1920. 1921. 1922. 1923. 1924. 1925. Population Deaths Rate per 1, 000,000 42, 421, 556 39, 340, 447 37, 890, 862 38, 887, 722 38,095, 628 38, 589, 045 37, 695, 833 38, 054, 894 .4, .6 .3 .4 .4 .4. 26 DEATHS FROM LEAD POISONING, 1 9 2 5 -1 9 2 7 An elaborate report on the occurrence of lead poisoning in the manufacture of electric storage batteries was published by the Im perial Health Department in 1898 but seems not to have been followed up in future extended investigations. It is chiefly a descriptive ac count of processes of manufacture, amplified by regulations adopted in 1898 and not substantially altered in important details. As regards the effects of the regulations in Great Britain in reducing the incidence of lead poisoning in the manufacture of electric storage batteries, it may be of value to quote the following statement on the number of cases previous to 1926. (Parliamentar}^ proceedings.) Mr. Robinson asked the home secretary how many cases of lead poisoning occurred among pasters engaged in the manufacture or repair of electric accumu lators in the years 1921, 1922, 1923, and 1924, respectively; and whether any cases had been reported since the new code of regulations came into force on March 1, 1925. Sir William Joynson-Hicks replied: There were 5 such cases reported in 1921, 11 in 1922, 44 in 1923, and 42 in 1924. Since March 1 last, there have only been 15 cases among pasters. The new regulations can not be expected to have their full effect for a considerable time, but they appear to have already caused a substantial reduction in the number of cases. Lead Poisoning in France S R E G A R D S cases of lead poisoning in the manufacture of electric storage batteries in France, the following is quoted from a brief letter from the Paris correspondent of the Journal of the American Medical Association, dated October 5, 1925. A Balsac, Lafont, and Feil recently published in the Medical Bulletin the results of an inquiry made to complete their previous investigation of occupational morbidity among workmen employed in the manufacture of accumulators. They found that lead poisoning in workmen so engaged is frequent. They examined 50 workers, 2 women and 48 men. Of the latter, 19 were Frenchmen and 29 were Moroccans. Only 2 of the workers were under 20 years of age, while 8 were past 40. The stigmas of lead poisoning and of preliminary stages, which the authors studied particularly, are: Urticaria, basophilic stippling of red-blood cells, nucleated red-blood cells, Teleski’s sign (extensors of the wrist too weak to laise the hand above an angle of 4 5 ° when the forearm is extended), and finally lead colic. For the 19 Frenchmen and 2 French women, the findings were: Urticaria or wheals, 8 (38 per cent); red-blood cells with granulations, 15 (71 per cent); nucleated red-blood cells, 0; sign of the extensors, 7 (33 per cent); lead colic, 9 (43 per cent). For the 29 Moroccans the findings were: Wheals, 21 (72 per cent); red-blood cells wTith granulations, 23 (80 per cent); nucleated redblood cells, 22 (79 per cent); sign of the extensors, 14 (49 per cent); lead colic, 3 (11 per cent). In elaboration of the foregoing, through the courtesy of the bureau of public hygiene of the city of Paris, returns of lead-poisoning cases for the period 1910-1924 have been obtained. These show the population of Paris, the number of deaths from lead poisoning, and the rate per million of population for each year. T a b l e 1 8 . — Deaths from lead poisoning in Paris, 1910 to 1924 Year 1910______________ 1911.. ___________ 1912___________ 1913...____ _______ 1914..................... . 1915..................... 1916....................... 1917_____________ Population Deaths 2, 822, 329 2, 888,110 2, 889, 946 2, 891, 782 2, 893, 618 2, 895, 454 2, 897, 291 2, 899, 000 18 13 14 15 9 8 Rate per ■ 1,000,000 6. 4 4. 5 4.8 5.2 3.1 2.4 2.8 2.4 Year 1918 1919. 1920 1921. 1922. 1923. 1924 IPopulation Deaths Eate per 1, 000,000 2, 900, 960 2, 902, 799 2, 904, 635 2,906, 472 2, 899, 464 2, 892, 456 2, 885, 448 0.7 2.8 1.7 1.7 2.1 1.7 1.0 27 LEAD POISONING IN JAPAN It is shown by this table that the rate from lead poisoning has very materially declined in Paris from an alarmingly high rate of 6.4 per million to a rate of 1 per million in 1924. Lead Poisoning in Scandinavia R E T U R N from the statistical office of Norway, limited, how ever, to the city of Oslo, for the period 1910 to 1925, shows only one death from lead poisoning during the entire period of 16 years. The population of Oslo in 1925 was about 260,000. The same rarity of lead poisoning is found in other parts of Scandi navia. According to returns furnished by the statistical department of Denmark, not a single death from lead poisoning was reported for the city of Copenhagen during the same period of 16 years. The population of Copenhagen in 1925 was 729,000. Precisely the same results were reported by the statistical bureau of Sweden for the city of Stockholm for the period 1910 to 1925, according to which not a single death from lead poisoning occurred in that city during the 16 years under review. The population of Stockholm in 1925 was 442,000. A Lead Poisoning in South Africa E T U R N S for the Union of South Africa cover the period 1912 to 1926 and indicate that during recent years lead poisoning in that country has become of rare occurrence. This is most extraordinary in view of the development of mining and smelting industries in connection with which lead poisoning cases are more likely to occur. R T able 19. — Deaths from lead 'poisoning in Union of South Africa, 1912 to 1926 Population Deaths 1 Rate per 1,000,000 Y ear 1, 305. 217 1, 330, 053 1, 354, 889 1, 379, 725 1, 404, 561 1. 429, 397 1, 454, 113 1, 476, 419 1912_______________ 1913 1914 ]915 1916 1917 1918 _____________ 1919 __ ___ 2 6 1 1 Year Population Deaths Rate per 1,000,000 1,499, 911 1, 523, 403 1, 546, 895 1, 579, 733 1, 610, 774 1, 637, 472 1, 677, 520 1920........................ 1.5 _ ________ 4. 5 1921 .7 ! 1922........................... | 1923 1924 7 1925 1926......... .............. _ 1 1 0.7 .7 1 .6 1 .6 Lead Poisoning in Japan F R A T H E R unusual interest is the return for the city of Tokyo, furnished by the local statistical office for the period 1910 to 1925, suggestive of an increase in the frequency of lead poison ing, probably largely to be explained on the ground of a considerable development of lead-using industries within recent years. O T 20. — Deaths from lead poisoning in Tokyo, 1910 to 1925 able Y ear Population Deaths 1910 ........... 1911_______________ ! 1912_______________ I 1913_______________ ! 1914 1915.____ _________ 1916......................... . 1917............. ......... . 2, 006. 900 1,871,400 1, 871, 900 1, 780, 200 1, 870, 300 1, 870, 500 1, 870, 900 1,871, 400 3 1 2 2 2 Rate per , 1,000,000 ; Year 1918. ................... . 1919__ ____ _______ 1920_______________ 1.6 .6 ' 1921______ ____ ___ L1 1923........... ............. 1.1 i 1924......................... . t i | 1925........................... Population Deaths Rate per 1,000,000 1 2,156, 500 2, 218, 000 2,173, 200 2, 204,400 2, 236, 000 2, 265, 300 2, 917, 308 1, 995, 567 1 3 7 2 5 1 3 1.4 3.2 .9 2.3 .4 1.3 3 1.5 28 D EATH S FROM LEAD POISONING, 1 9 2 5 -1 9 2 7 Physical Condition of Lead Workers 4 SIDE from the foregoing statistics of the general frequency of lead poisoning in fatal form, information regarding the phys ical condition of lead workers in certain lead-using industries make an extremety interesting addition to general knowledge. It is recognized that the physical condition of lead workers has an important bearing upon their predisposition to lead absorption and lead poisoning, particularly lead poisoning. But heretofore data regarding the physical condition of lead workers have been very fragmentary and broadly speaking not comparable with statistics of other employments. For the present purpose the following information has been col lected: First, 3,879 examinations of workers in a representative electric storage battery plant; second, 921 examinations in a whitelead plant in the Central W est; third, 527 examinations of workers in the same plant for the year 1927; and fourth, 833 examinations of workers in a white-lead plant on the Atlantic coast. The results of these examinations are given in detail and in a fairly comparable manner, although the variations in the blanks used make precise comparison on all points somewhat difficult. Another complication arises out of the varying racial compositions of the labor force. As far as practicable, however, this has been taken into account. The statistics of the electric storage battery plant employees cover height, weight, and pulse rate with due regard to racial composition and age. The average age of about 3,880 examinations was 27.4 years; the average height, 66.6 inches; the average weight, 147 pounds, and the average pulse rate, 74.4 per minute. By racial composition, as regards height and weight the figures are shown in Table 21. T a b l e 21 .— Height and weight of workers in an electric storage battery plant Height (inches) Race or nationality and age group Num Num ber A ver ber Aver re re age age port port ing ing American: Under 30 years.......... 840 209 30 to 39 years_______ 136 40 years and over----T otal.................... . 1,185 Canadian: Under 30 years_____ 433 93 30 to 39 years_______ 40 years and over----33 T o t a l...................... British: Linder 30 years........ . 30 to 39 years............. 40 years and over----T o t a l...................... Eastern European: Under 30 years.......... 30 to 39 y e a rs ............ 40 years and over___ Total.................... Northern European: Under 30 yea rs......... 30 to 39 years.. ____ 40 years and over___ Total........................ Weight (pounds) 147 66.8 66. 9 67.4 425 90 33 140 150 153 559 66.8 548 208 103 84 66.4 67.1 66.9 207 103 84 395 66.7 394 164 71 37 272 65.3 66.1 66.0 65.6 162 71 37 270 49 28 22 67.4 67.5 66.1 67.2 49 28 22 99 143 155 158 841 67.0 67.4 211 67.8 136 67.2 1,188 99 Height (inches) Race or nationality and age group Southern European: Under 30 vears_____ 30 to 39 years_______ 40 years and over___ Total....................... Colored: Under 30 years........ . 30 to 39 years_______ 40 years and over___ Weight (pounds) N um Num ber ber re Aver re Aver age port port age ing ing 495 119 93 500 120 94 139 155 155 707 | 65.0 714 144 200 87 47 200 87 47 334 156 161 163 142 67.9 67.7 66.9 334 j 67.7 139 150 151 65.9 65.2 66.7 57 20 3 144 151 168 65.8 80 147 67.5 66.8 66.5 67.1 150 47 52 148 158 157 249 152 66.5 2, 591 777 66.8 508 66.8 142 155 156 66.6 3,876 147 Total......... .............. Miscellaneous: Under 30 years........ . 57 30 to 39 years. ........... 20 40 years and over___ 3 144 Total........................ 80 Not reported: 136 Under 30 years.......... 150 157 30 to 39 years_______ 46 154 52 40 years and over___ 144 Total........................ 248 All races: 147 Under 30 years.......... 2, 596 155 30 to 39 years............ 776 151 j 507 40 years and over___ 150 Total........................ 3,879 64.9 65.3 65.4 158 29 PHYSICAL CONDITION OF LEAD WORKERS These and other results following may be compared with the physi cal measurements made of conscripts during the World War. The total number of men measured was 868,445, of an average height of 67.49 inches. In the final report on the measurements there is in cluded a standard table of heights for certain European races giving an average of 67.9 inches for Scotch, 67.8 for English, 67.7 for Ger mans, 67.5 for Irish, 66.7 for Poles, and 65.0 for Italians. No meas urements are given for persons of Mexican origin. The average height of white soldiers on demobilization was 67.7 inches, and of negro sol diers, the same. It would, therefore, appear that the average height of electric storage battery workers is somewhat below the average, due obviously to the inclusion of many South Europeans. The aver age height of white American workers and colored American workers in the electric storage battery plant corresponds almost precisely to the average revealed by the Army measurements on demobilization. The average weight of 872,419 draft recruits measured during the World War was 141.5 pounds. This is 5 pounds less than the average weight of electric storage battery workers according to the preceding table. It illustrates that the men employed in this industry are well nourished and more so in view of the slightly lower height which would give a larger proportionate weight to every inch of height, which for standard purposes is usually placed at two pounds to the inch. No comparative weights for other races are conveniently available, but the heigher weight of colored men conforms to the general expe rience of a higher actual as well as relative weight for persons of color when compared with white persons of corresponding age. Table 22 concerns the physique of lead workers in a white lead plant in the Central West, and represents about 950 examinations. T a b l e 2 2 . — Results of examination of workers in a white lead plant in the Central West, 1926 Age (years) Height (inches) Weight (pounds) Duration of em ploy Number of ment children (months) Race or nationality and age groups Num Num Num ber Aver ber A ver ber re re re A ver port age port age port age ing ing ing American: Under 30 years............................... ....... 3C to 39 years______ _______ ________ 40 years and over.______ _________ 77 31 30 24.6 32. 7 47.8 74 26 29 Total ............................... ................. 138 31.4 320 140 23 Colored: Under 30 years _____ ___________ 30 to 39 years.. __________ 40 years and over__________________ T otal__________________ ____ _ Eastern European: Under 30 years.............................. ....... 30 to 39 years................... .................... 40 years and over..... ............................ T otal. ............................................. 68.1 68.6 67.9 Num N um ber ver ber re Aage re A ver port port age ing ing 77 31 29 152 164 170 76 31 29 2.9 6.5 5.7 21 18 17 1.0 1.8 1.7 129 68.1 | 137 159 136 4.3 56 1.5 24.8 34. 0 43.6 310 136 22 68. 9 68. 3 68.0 320 140 23 158 162 163 313 135 23 .9 1. 2 3.3 179 103 16 .9 1.4 1.2 1 483 28.2 468 68.7 483 159 471 1.1 298 1.1 25 64 44 24.8 35.3 44.2 25 63 43 67. 3 67.0 66.0 25 64 44 149 156 158 25 63 44 .8 .9 3.3 4 32 18 1.3' 1.9 2.3 133 36.2 131 66.7 133 155 132 1.7 54 2.0 30 T DEATHS FROM LEAD POISONING, able 1 9 2 5 -1 9 2 7 2 2 . — Results of examination of workers in a white lead plant in the Central West, 1926— Continued Age (years) Race or nationality and age groups Height (inches) Weight (pounds) Duration of Number of em ploy ment children (months) N um Num Num N um N um ber ber A ver ber A ver ber A ver ber A ver re re re A ver re re port age port age port age port age port age ing ing ing ing ing Northern and Western European: Under 30 years_____ __________ ____ 30 to 39 years_______________ ______ 40 years and over_______ _ . ____ 47 28 27 25.0 34.0 46.9 46 27 24 68.4 67.5 67.6 47 28 27 154 159 160 47 28 26 2.0 2.0 3.7 10 14 14 1.2 2.1 2.0 T otal........................ .......... . . . ... 102 33.4 97 67.9 102 157 101 2.5 38 2.0 Mexican: Under 30 years.................... ................. 30 to 39 y e a rs______________________ 40 years and over_________ ________ 52 12 5 24.5 33.7 41.2 51 12 5 66.4 65.4 66.2 52 12 5 141 141 150 52 12 5 1.7 1.9 1.4 13 10 3 1.8 2. 3 2.3 69 27.3 68 66.2 69 142 69 1.7 26 2.1 6 14 8 25. 5 34. 6 43.3 6 14 8 68.0 65. 3 67.0 6 14 8 164 147 161 6 14 8 2. 1 .6 3. 1 3 7 7 1. 0 2. 9 2. 6 T otal................................. ................ 28 35.1 28 66.4 28 154 28 1.7 17 2.4 Grand total........................................ 953 30.5 921 68.0 952 157 937 1.9 489 1.4 T otal_________________ ________ Miscellaneous: Under 30 years_____________________ 30 to 39 years____________ _________ 40 years and over.. ______ __ __ Conjugal condition Previous lead em ployment General appearance Race or nationality and age group Single Mar ried W id owed American: Under 30 years______________ 30 to 39 years________________ 40 years and over___................. 52 7 7 25 24 20 3 18 17 12 T otal...................................... Colored: Under 30 years______________ 30 to 39 years________________ 40 years and over____________ 66 69 3 130 24 5 190 115 16 T otal.______ _______________ Eastern European: Under 30 years_______________ 30 to 39 years................... ......... 40 years and over______ _____ 159 Yes Not re ported Good No 46 8 12 13 6 6 47 66 1 2 52 31 6 241 97 15 321 3 89 18 28 21 6 36 23 1 Total—.................................... Northern and western European: Under 30 years______________ 30 to 39 years_______ ____ ___ 40 years and over............. ........ 67 65 36 14 10 Total................................... __ Mexican: U nder 30 years................. ........ 30 to 39 years________________ 40 years and over____________ Fair Not re ported 63 26 24 8 2 2 25 113 12 13 27 12 2 266 107 18 6 12 4 48 21 1 353 41 391 22 70 4 21 16 19 39 21 2 4 7 21 44 28 3 12 10 1 8 6 1 41 79 13 93 25 15 11 14 15 2 6 8 5 32 17 18 9 3 4 36 21 21 i6 4 3 5 3 3 60 40 2 19 67 16 78 13 11 38 1 2 14 11 3 6 41 11 3 5 1 2 45 7 1 4 3 3 3 2 1 Total........................................ Miscellaneous: Under 30 years_______________ 30 to 39 years______ ____ _____ 40 years and over...... ................ 41 28 8 55 6 53 10 6 3 6 1 3 7 7 1 2 3 12 6 1 5 2 5 9 4 1 1 2 1 Total................................ ....... 10 17 7 18 3 21 2 4 540 211 84 119 Grand total............................ . in clu d in g 1 “ poor.” 403 9 638 104 749 6 3 4 31 PHYSICAL CONDITION OF LEAD WORKERS According to Table 22 the average height of white lead workers is 68 inches, while the average weight is 157 pounds. The tabulation includes numerous detailed observations which need not be enlarged upon. Certain details are given by racial composition and by selected divisional periods of life. The preceding statistics are for the year 1926. Corresponding figures for a white lead plant in the central West in 1927 are given in Table 23, the number of employees reported, by departments, being as follows: Yards, 230; oxide, 77; track, 52; cartage, 43; metal shipping, 38; repair, 34; general, 21; power, 18; mill, 16; total, 529. T able 23.— Results of examination of workers in a white lead plant in the Central West, 1927 Age (years) Height (inches) Weight (pounds) Duration of em ploy Number of ment children (months) Eace or nationality and age group N um N um N um N um N um ber ber A ver ber A ver ber A ver ver re A ver ber re Aage re re re age age age port port port port port age ing ing ing ing ing American: Under 30 years. _____ ____________ 30 to 39 years_______ _______________ 40 years and over___________________ 54 21 9 23.8 33.7 49.6 54 21 9 68.9 68.7 67.2 54 21 9 159 160 180 54 21 9 2.0 4.9 7.9 4 12 3 0.5 2.0 2.0 Total........ ......................................... 84 29.0 84 68. 7 84 162 84 3.3 19 1.7 Colored: Under 30 years._____ ______________ 30 to 39 years_______________________ 40 years and o v e r . . . __________ ._ 174 117 15 24.6 33.5 43.1 174 116 15 69.7 69.0 68.4 174 117 15 165 167 170 170 117 14 .7 1.1 1.2 59 72 9 1.5 1.7 2.6 Total________________ ________ _ 306 28.9 305 69.4 306 166 301 .9 140 1.7 Eastern European: Under 30 years___ _ __ ___ 30 to 39 years_____________________ . 40 years and over___________________ 3 10 10 20. 7 35.8 44.6 3 10 10 68. 4 65.6 66.0 3 10 10 166 161 156 2 8 10 2. 8 3.6 6.3 5 7 2.2 3.1 Total................................. ................. 23 37.6 23 66.1 23 159 20 4.9 12 2.8 Northern and Western European: Under 30 y e a r s _________ _. ........... 30 to 39 years_______________________ 40 years and over___________________ 15 9 11 24.1 36.1 45.4 15 9 11 68.3 67.5 67.1 15 9 11 160 161 163 14 9 11 2.6 .8 3.6 4 3 7 1.8 2.7 1.0 _ 35 33.9 35 67.7 35 161 34 2. 5 14 1.6 Mexican: Under 30 years_____________________ 30 to 39 years_______________________ 40 years and over________ _________ 35 14 3 23.7 33.1 43.0 35 14 3 66.2 65.9 66.3 35 14 3 145 147 149 35 14 3 1.2 1.7 1.9 4 4 2 .5 2.5 1.5 52 27.3 52 66.1 52 146 52 1.4 10 1.5 14 7 6 24.4 34.4 46.7 14 7 6 67.7 66.0 66.7 14 7 6 155 153 164 14 7 6 2.1 3.6 6.4 2 2 3 1.0 3.5 3.7 Total................................................... 27 31.9 27 67.0 27 156 27 3.4 7 2.9 Grand total...................... ................. 527 29.6 526 68.6 527 162 518 1.7 202 1.8 Total____ __________ _________ T otal............................................... . Miscellaneous: Under 30 years_____________________ 30 to 39 years_______________________ 40 years and o v e r . . . ____ _____ ____ 32 T DEATHS FROM LEAD POISONING, able 1 9 2 5 -1 9 2 7 23. — Results of examination of workers in a white lead plant in the Central West, 1927— Continued Previous lead em ployment Conjugal cond:tion General appearance Race or nationality and age group Single Mar- j Widried i owed Yes No Not re ported Good Fair ! Not re ported 1 American: Under 30 years____ _____ _______ 30 to 39 years. _ __ 40 years and o v e r .... ....................... 42 6 4 12 15 5 6 4 10 1 8 11 7 44 17 7 7 4 2 3 1 Total............................................... 52 32 ! 7 15 26 68 13 I 3 Colored: Under 30 years.................................. 30 to 39 years. ___________ _______ 40 years and over _ 7 18 1 95 99 14 29 28 5 129 75 6 16 14 4 155 102 15 6 | 11 1 2 | 13 4 26 208 I 62 210 34 272 19 ! 17 1 4 3 6 7 3 1 7 2 1 3 5 3 9 6 1 3 1 Total__________________________ 10 13 4 10 9 IS 4 1 Northern and Western European: Under 30 years______ ___ _____ 30 to 39 years____________ ______ 40 vears and o v e r ___ __ 8 6 3 6 3 8 2 1 2 10 5 3 3 3 6 13 7 11 3 1 | 1 T ota l................................ .............. 17 17 5 18 12 31 4 1 30 8 3 5 6 5 4 1 24 7 1 6 3 1 29 8 2 i4 2 1 2 4 41 11 ! 10 32 10 39 i7 6 4 3 5 | I 1 1 1 9 5 2 4 1 14 4 1 Total............................ ................ 12 12 1 3 16 5 24 3 Grand total___________________ 158 293 96 452 j 50 Total........... ......... ...................... Eastern European: . . _i Under 30 y e a r s . .__ 30 to 39 vears. 40 years and over _____________ _ Mexican: Under 30 years.......... ................. . 30 to 39 years...... .......... .......... _ 40 years and over T otal........................................... . Miscellaneous: Under 30 years 30 to 39 vears 40 years and over _ 3 91 301 | 3 3 28 i Including 1 “ poor.” During 1927 the average height was 68.6 inches, against 68 inches during the preceding year. The average weight was 162 pounds, against 157 pounds during 1926. The returns for examinations of employees in a white-lead plant on the Atlantic seacoast are shown in Table 24. These examinations show trade life, height, weight, pulse, and blood pressure. Efforts are now being made to bring about standardization of reporting so that in the future it may be possible to present uniform returns for different plants, which, of course, would very materially increase their value. 33 PHYSICAL CONDITION OF LEAD WORKERS T able 2 4 .— Results of examination of workers in a white lead plant on the Atlantic seaboard, 1926 Blood i)ressure Trade life (months) Pulse (per minute) Weight (pounds) Height (inches) Diastolic Systolic Age group Num N um N um Num Num N um ber Aver Aver ber Aver ber Aver ber Aver ber Aver ber report age report age report age report age report age re] 't- age ing ing ing ing ing ing Under 30.......... 30 to 39________ 40 and over____ Not reported. 354 244 186 49 9.5 28.1 96.2 67.4 353 247 182 50 66.8 66.4 65.9 63.7 354 249 187 50 148 154 157 154 357 250 188 53 76 77 77 78 356 246 185 26 121 122 137 126 354 245 185 25 67 69 77 68 Total___ 833 37.7 832 66.3 840 152 848 77 813 125 809 70 The data following contain information concerning 128 examina tions of workers in a white-lead plant in the Central West. The num ber of cases is too small for a safe generalization but the information is included as a matter of interest, suggestive of further studies in this direction. T able 25.— Results of 128 examinations in a white lead plant in the Central West Department Y a r d _______ ____ ___ Oxide___________ .. ____ M ill_________________________ Lead__ __ .................... Warehouse___ ___________ __________ Corroding'___ Shinnine kJ 1J l 1J [ J\. L i g ,--------------------------------------------------------------------- --Office. ___ ___________ Condition of— Gums: Pyorrhea...... ................... ..... B ad________ ______ ______ F a i r . ____ _____ _________ Normal__________________ Good______ ____ _________ Not stated.. . . ______ Number Per cent 49 24 17 8 4 3 1 1 38.3 18. 7 13.3 6. 2 3.1 2.3 .8 !8 Cases Per cent 85 5 12 4 20 2 66. 4 3.9 9.4 3.1 15.6 1.6 Number Department Mechanics: Engine room...................... . Carpenters_____ _____ ___ Electric helpers__ Pipe fitters ......................................... Blacksmiths. ____ _____ T otal________________ . Condition of— History of— Previous lead employment ______ ____ __________ ____ _________________ _______________ _____ ___ Lead poisoning__________________ _____ Rheumatism_________ ______________ ____ _____ ________ ______ _____ 11 6 1 1 2 8.6 4.7 .8 .8 1.6 128 100.0 Cases Teeth: Bad______ ____ _______ Fair. ______ _______ ______ Good*! ............................. Not stated____________ 64 42 20 2 Number Number reporting of cases 128 128 128 Per cent 68 16 26 Per cent 50.0 32.8 15. 6 1.6 Per cent 53.1 12.5 20.3 The average duration of employment of the 127 reporting on this subject was 40.5 months, and the average age of 118 was 37 years. Of the 124 reporting as to dependents, 98 reported an average of 2.5 dependents. 34 DEATHS FROM LEAD POISONING, 1 9 2 5 -1 9 2 7 Conclusions IN C E most of the foregoing data are entirely new in the study of the subject, it is felt that it would be premature to enlarge upon the resulting conclusions. The data are made public chiefly for the purpose of suggesting new lines of research which could be followed to much practical advantage. To illustrate, however, the great practical urgency of uniformity in the medical and physical examination blanks used for the different establishments, as previously intimated, efforts are being made with a promise of good results. The foregoing observations may properly be concluded with a brief abstract from an address on “ Some Clinical Aspects of Industrial Poisoning/’ by Dr. N. C. Sharpe, University of Toronto, and Division of Industrial Hygiene, Ontario Board of Health, January 30, 1923. S In so many cases of industrial poisoning from chemicals the early subjective symptoms are the same and there is no known early diagnostic test. This would indicate, then, that an intimate knowledge of the occupation and its risks are necessary for diagnosis in order to remove the man from danger of further absorption— and 3^et not to unnecessarily interfere with his work. In many of the cases of industrial poisoning (especially the slight acute intoxications from volatile bodies) either no physician is summoned or if he is, the man has fre quently recovered by being placed in the fresh air alone. Yet, although he seems to have fully recovered, repeated exposures and similar intoxications must undermine his health, and a knowledge of the occupation is necessary so that precautions may be suggested to do away with the exposure if at all possible. Lead-Using Industries TN T H E interpretation of the preceding and earlier statistics sugA gestive of a decline in lead poisoning it is, of course, of the utmost importance that use should be made of correlation data as regards the corresponding changes in the lead-using industries. An accurate comparison of this kind, however, is not feasible until the manufac turing census for 1928 is available. But certain statistics can be utilized, although the most important data for the construction industry, in which, of course, painting figures to a large extent, are not available. The quantity of lead produced in the United States during recent years has changed as follows: In 1917 the production of smelted and refined Lead in the United States was 614,704 tons. This by 1921 had decreased to 445,654 tons, but increased by 1926 to 814,086 tons. The output of refined primary lead in the United States, from domestic ore, in 1927, amounted to 668,320 short tons. The production was nearly 2 per cent less than in 1926. The apparent consumption of refined primary lead in the United States in 1926 amounted to about 663,000 short tons as compared with about 718,000 tons in 1926. The production of lead pigments since 1917 is given in Table 26, derived from the preliminary report on the Mineral Resources of the United States, by A. Stoll, published by the United States Bureau of Mines in 1927. 35 CONCLUSIONS T able 26. — Lead pigments sold by domestic manufacturers in the United States, 1917 to 1927 (short tons) White lead Basic lead sulphate or sublimed lead Red lead Litharge Year 1917_______________________________ ____ 1918_____________________________________ 1919_____________________________________ _______________ 1920 -1921 ____________________________________ 1922 ____________________________________ 1923 _____________________________________ 1924 ____________________________________ 1925 ____________________________________ ________________ 1926 1927 ________ __________________ Dry In oil 27, 869 20, 089 30. 085 33, 078 26. 738 41, 598 37, 786 42, 622 43, 426 37, 968 38, 669 87.331 82, 799 109, 005 112, 017 143, 545 153,393 125, 087 ] 44, 872 120, 479 111,845 119, 026 White 8, 231 7,403 9, 068 12,412 11, 568 13, 765 11, 949 14,572 14, 996 12, 271 13, 482 Blue 1,369 1, 343 1,350 928 463 972 800 1, 088 1,090 1, 236 1,061 25, 478 30, 069 32, 362 34, 431 21,805 30, 509 38, 037 36,813 41, 669 42, 550 39, 073 44,102 48, 874 46, 739 62,329 41,909 58, 261 75,107 74, 724 86, 546 82, 540 81, 655 Since some of the industrial lead poisoning is known to arise from the manufacture and use of lead pigments, the preceding table sus tains the conclusion that the industry in this respect has made sub stantial progress^ in total production during recent years, with a coinciding decline in the actual number of deaths from lead poisoning. According to a preliminary statement by the Department of Com merce, the total amount of lead and zinc pigments produced during 1927 shows an increase in basic lead sulphate or sublimed lead from 12,271 tons in 1926 to 13,482 tons in 1927 for white lead, while for blue lead there was a decrease from 1,236 tons to 1,061 tons, com paring 1926 with 1927. There was also a reduction in the amount of red lead produced, or from 42,550 tons in 1926 to 39,073 tons in 1927, and a slight decline in the production of litharge from 82,540 tons in 1926 to 81,655 tons in 1927, while the production of dry white lead increased from 37,968 tons in 1926 to 38,669 tons in 1927. There was an increase in the production of white lead in oil from 111,845 tons in 1926 to 119,026 tons in 1927. Lithopone increased from 159,931 tons to 176,994, and zinc sulphate from 3,649 tons to 8,971 tons. Building construction involving painting indoors and outdoors has been maintained at a higher level during the last few years than during the years preceding. There are, therefore, no reasons for believing that the actual decline in industrial lead poisoning is meas urably attributable to a decline in the primary production of lead pigments for industrial purposes. Quite to the contrary, there are reasons for believing that a substantial increase has taken place in both mining and manufacturing of lead and lead productions, par ticularly electric storage batteries, compared with the earlier period covered by the present review. Bibliography C h a n g e s in the blood as r e f l e c t in g in d u s t r ia l damage . Journal of Industrial Hygiene, February, 1928. C h r o n ic l e a d p o is o n in g f r o m s n u f f . Journal of American Medical Association, January 28, 1928. H a r t A c c id e n t a n d In d e m n ity H H C o. Spray coating, its hazards and safeguards. Hartford, 1928. a r t , C. D. Manufacturing lead covered telephone cable. Bell telephone laboratory, 1928. o w a r d , C h a r l e s D. Lead in drinking water. Journal of American Medical Association, March, 1923. I n t e r n a t io n a l L a b o r O f f ic e . Encyclopedia of Occupation and Health. Lead colors and lead compounds, No. 13; red lead, No. 14; white lead, No. 19. Geneva, 1925. ------- Encyclopedia of Occupation and Health. Lead poisoning, No. 54; the painting industry, No. 57. Geneva, 1926. ------- Encyclopedia of Occupation and Health. Lead poisoning, No. 87; tetraethyl lead, No. 87; accumulators (electric storage batteries), No. 182. Geneva, 1928. ------- Report on white lead. Geneva, 1927. K ehoe and T ham ann. The behavior of lead in the animal organism. American Journal of Public Health, M ay, 1928. L ead p o is o n in g from lead - p ip e d w ater s u p p l ie s . Journal of Industrial Hygiene, September, 1928. L e a d p o is o n in g r e s u l t in g f r o m t h e u s e o f s n u f f . Journal of American Medical Association, March 10, 1928. L e a k e , J. P. Observations on lead hazards. Journal of American Medical Association, October 1, 1927. L e a t h e r s , W . S ., a n d M o r g a n , H . J. Lead poisoning in an enameling plant. Journal of American Medical Association, October, 1927. A N E W HAZARD IN THE W E IG H TIN G OF SILK. Scientific American, January, 1928. Je r s e y . Department of Labor. Industrial Bulletin, October, 1927-September, 1928. N e w S outh W a le s. Division of General Health. Lead poisoning report No. 7. Sydney, 1927. N e w Y o r k (C it y ). Department of Health. Lead poisoning caused by snuff. Weekly Bulletin, November 5, 1927. N e w Y o r k (S t a t e ) . Department of Labor. Annual reports, 1924-1927. ---------------- Lead poisoning and lead absorption, by M . R. Mayers. Industrial Hygiene Bulletin, October, 1927. ----------------The significance of the lead line in the diagnosis of lead poisoning, by M . R. Mayers. Industrial Hygiene Bulletin, August, 1927. N ew 36 BIBLIOGRAPHY P r o c e e d in g s u n d e r t h e lead act. p a in t The Lancet, November 26, 1927. S w o p e , S. D. Lead poisoning in smelting process of lead ores. Southwestern Medicine, 1927. A TEST FOR LEAD ABSORPTION. Journal of American Medical Association, July 28, 1928. States. Public Health Service. Annual report, 1927. Washington, 1927. U n it e d T he use of w h it e lead in p a in t in g The Lancet, November 6,1 927 . . LIST OF BULLETINS OF THE BUREAU OF LABOR STATISTICS The following is a list o f all bulletins o f the Bureau o f Labor Statistics published since July, 1912, except that in the case o f bulletins giving the results o f periodic surveys o f the bureau only the latest bulletin on any one subject is here listed. A com plete list o f the reports and bulletins issued prior to July, 1912, as well as the bulletins published since that date, will be furnished on application. Bulletins marked thus (*) are out o f print. Conciliation and Arbitration (including strikes and lockouts). *No. 124. Conciliation and arbitration in the building trades of Greater New York. [1913.] •No. 133. Report of the industrial council of the British Board of Trade on its inquiry into industrial agreements. [1913.] No. 139. Michigan copper district strike. [1914.] No. 144. Industrial court of the cloak, suit, and skirt industry of New York City. [1914.] No. 145. Conciliation, arbitration, and sanitation in the dress and waist industry of N ew York City. [1914.] ♦No. 191. Collective bargaining in the anthracite coal industry. [1916.] ♦No. 198. Collective agreements in the m en’s clothing industry. [1916.] No. 233. Operation of the industrial disputes investigation act of Canada. [1918.] No. 255. Joint industrial councils in Great Britain. [1919.] No. 283. History of the Shipbuilding Labor Adjustment Board, 1917 to 1919. No. 287. National War Labor Board: History of its formation, activities, etc. [1921.] No. 303. Use of Federal power in settlement of railway labor disputes. [1922.] N o. 341. Trade agreement in the silk-ribbon industry of N ew York City. [1923.] No. 402. Collective bargaining b y actors. [1926.] No. 468. Trade agreements, 1927. No. 481. Joint industrial control in the book and job printing industry. [1928.] Cooperation. No. 313. Consumers' cooperative societies in the United States in 1920. No. 314. Cooperative credit societies in America and in foreign countries. [1922.] No. 437. Cooperative movement in the United States in 1925 (other than agricultural). Employment and Unemployment. *No. N o. *No. *No. No. 109. 172. 183. 195. 196. *No. 202. No. 206. No. 227. No. *No. No. No. No. 235. 241. 247. 310. 409. Statistics of unemployment and the work of employment offices in the United States. [1913. J Unemployment in N ew York City, N. Y . [1915.] Regularity of employment in the women’s ready-to-wear garment industries. [1915.] Unemployment in the United States. [1916.] Proceedings of the Employment Managers’ Conference held at Minneapolis, M inn., Jan uary 19 and 20, 1916. Proceedings of the conference of Employment Managers’ Association of Boston, Mass., held M ay 10, 1916. The British system of labor exchanges. [1916.] Proceedings of the Employment Managers’ Conference, Philadelphia, Pa., April 2 and 3, 1917. Employment system of the Lake Carriers’ Association. [1918.] Public employment offices in the United States. [1918.] Proceedings of Employment Managers’ Conference, Rochester, N . Y ., M ay 9-11,1918. Industrial unemployment: A statistical study of its extent and causes. [1922] Unemployment in Columbus, Ohio, 1921 to 1925. Foreign Labor Laws. *No. 142. Administration of labor laws and factory inspection in certain European countries. [1914.] Housing. *No. No. No. No. 158. 263. 295. 469. Government aid to home owning and housing of working people in foreign countries. Housing b y employers in the United States. [1920.] Building operations in representative cities in 1920. Building permits in the principal cities of the United States in [1921 to] 1927. Li] [1914.] Industrial Accidents and Hygiene. *No. 104. Lead poisoning in potteries, tile works, and porcelain enameled sanitary ware factories. [1912.] N o. 120. Hygiene of the painter’s trade. [1913.] *No. 127. Dangers to workers from dusts and fumes, and methods of protection. [1913.] *No. 141. Lead poisoning in the smelting and refining of lead. [1914.] *No. 157. Industrial accident statistics. [1915.] *No. 165. Lead poisoning in the manufacture of storage batteries. [1914.] *No. 179. Industrial poisons used in the rubber industry. [1915.] N o. 188. Report of British departmental committee on the danger in the use of lead in the painting of buildings. [1916.] *No. 201. Report of committee on statistics and compensation insurance cost of the International Association of Industrial Accident Boards and Commissions. [1916.] *No. 207. Causes of death, b y occupation. [1917.] *No. 209. Hygiene of the printing trades. [1917.] *No. 219. Industrial poisons used or produced in the manufacture of explosives. [1917.] N o. 221. Hours, fatigue, and health in British munition factories. [1917.] N o. 230. Industrial efficiency and fatigue in British munition factories. [1917.] *No. 231. Mortality from respiratory diseases in dusty trades (inorganic dusts). [1918.] •No. 234. Safety movement in the iron and steel industry, 1907 to 1917. N o. 236. Effects of the air hammer on the hands of stonecutters. [1918.] N o. 249. Industrial health and efficiency. Final report of British Health of Munition W orkers’ Committee. [1919.] *No. 251. Preventable death in the cotton-manufactuiing industry. [1919.] . N o. 256. Accidents and accident prevention in machine building. [1919.] N o. 267. Anthrax as an occupational disease. [1920.] N o. 276. Standardization of industrial accident statistics. [1920.] N o. 280. Industrial poisoning in making coal-tar dyes and dye intermediates. [1921.] N o. 291. Carbon-monoxide poisoning. [1921.] No. 293. The problem of dust phthisis in the granite-stone industry. [1922.] N o. 298. Causes and prevention of accidents in the iron and steel industry, 1910-1919. N o. 306. Occupation hazards and diagnostic signs: A guide to impairments to be looked for in haz ardous occupations. [1922.] N o. 339. Statistics of industrial accidents in the United States. [1923.] N o. 392. Survey of hygienic conditions in the printing trades. [1925.] No. 405. Phosphorus necrosis in the manufacture of fireworks and in the preparation of phosphorus. [1926.] N o. 425. Record of industrial accidents in the United States to 1925. N o. 426. Deaths from lead poisoning. [1927.] N o. 427. Health survey of the printing trades, 1922 to 1925. N o. 428. Proceedings of the Industrial Accident Prevention Conference, held at Washington, D . C .f July 14-16, 1926. N o. 460. A new test for industrial lead poisoning. [1928.] N o. 466. Settlement for accidents to American seamen. [1928.J Industrial Relations and Labor Conditions. N o. N o. N o. N o. N o. N o. N o. N o. 237. 340. 349. 361. 380. 383. 384. 399. Industrial unrest in Great Britain. [1917.] Chinese migrations, with special reference to labor conditions. [1923.] Industrial relations in the West Coast lumber industry. [1923.] Labor relations in the Fairmont (W . Va.) bituminous-coal field. [1924.] Postwar labor conditions in Germany. [1925.] Works council movement in Germany. [1925.] Labor conditions in the shoe industry in Massachusetts, 1920-1924. Labor relations in the lace and lace-curtain industries in the United States. [1925.] Labor Laws of the United States (including decisions of courts relating to labor). N o. N o. N o. N o. N o. N o. N o. N o. N o. No. N o. 211. 229. 285. 321. 322. 343. 370. 408. 444. 467. 486. Labor laws and their administration in the Pacific States. [1917.] Wage-payment legislation in the United States. [1917.] Minimum-wage laws of the United States: Construction and operation. [1921.] Labor laws that have been declared unconstitutional. [1922.] Kansas Court of Industrial Relations. [1923.] Laws providing for bureaus of labor statistics, etc. [1923.] Labor laws of the United States, with decisions of courts relating thereto. [1925.] Laws relating to payment of wages. [1926.] Decisions of courts and opinions affecting labor, 1926. Minimum-wage legislation in various countries. [1928.] Labor legislation of 1928. [II] Proceedings of Annual Conventions of the Association of Governmental Labor Officials of the United States and Canada. (Name changed in 1928 to Association of Governmental Officials in Industry of the United States and Canada.) *No. No. No. No. *No. *No. No. No. No. 266. 307. 323. 352. 389. 411. 429. 455. 480. Seventh, Seattle, Wash., July 12-15, 1920. Eighth, New Orleans, La., M ay 2-6, 1921. Ninth, Harrisburg, Pa., M ay 22-26, 1922. Tenth, Richmond, Va., M ay 1-4, 1923. Eleventh, Chicago, 111., M ay 19-23, 1924. Twelfth, Salt Lake City, Utah, August 13-15, 1925. Thirteenth, Columbus, Ohio, June 7-10, 1926. Fourteenth, Paterson, N . J., M ay 31 to June 3, 1927. Fifteenth, New Orleans, La., M ay 15-24, 1928. Proceedings of Annual Meetings of the International Association of Industrial Accident Boards and Commissions. No. 210. No. 248. No. 264. *No. 273. No. 281. No. 304. No. 333. No. 359. No. 385. No. 395. No. 406. No. 432. No. 456. No. 485. Third, Columbus, Ohio, April 25-28, 1916. Fourth, Boston, Mass., August 21-25, 1917. Fifth, Madison, Wis., September 24-27, 1918. Sixth, Toronto, Canada, September 23-26, 1919. Seventh, San Francisco, Calif., September 20-24, 1920. Eighth, Chicago, 111., September 19-23, 1921. Ninth, Baltimore, M d., October 9-13, 1922. Tenth, St. Paul, M inn., September 24-26, 1923. Eleventh, Halifax, N ova Scotia, August 26-28, 1924. Index to proceedings, 1914-1924. Twelfth, Salt Lake City, Utah, August 17-20, 1925. Thirteenth, Hartford, Conn., September 14-17, 1926. Fourteenth, Atlanta, Ga., September 27-29, 1927. Fifteenth, Paterson, N. J., September 11-14, 1928. (In press.) Proceedings of Annual Meetings of the International Association ol Public Employment Services. No. 192. First, Chicago, December 19 and 20, 1913; second, Indianapolis, September 24 and 25, 1914; third, Detroit, July 1 and 2, 1915. No. 220. Fourth, Buffalo, N. Y ., July 20 and 21, 1916. No. 311. Ninth, Buffalo, N. Y ., September 7-9, 1921. No. 337. Tenth, Washington, D . C., September 11-13, 1922. No. 355. Eleventh, Toronto, Canada, September 4-7, 1923. No. 400. Twelfth, Chicago, 111., M ay 19-23, 1924. No. 414. Thirteenth, Rochester, N. Y ., September 15-17, 1925. No. 478. Fifteenth, Detroit, M ich., October 25-28, 1927. Productivity of Labor. No. 356. Productivity costs in the common-brick industry. [1924.] No. 3T50. Time and labor costs in manufacturing 100 pairs of shoes, .1923. No. 407. Labor cost of production and wages and hours of labor in the paper box-board industry. [1926.] No. 412. Wages, hours, and productivity in the pottery industry, 1925. No. 441. Productivity of labor in the glass industry. [1927.] No. 474. Productivity of labor in merchant blast furnaces. [1928.] No. 475. Productivity of labor in newspaper printing. [1928.] Retail Prices and Cost of Living. *No. *No. No. No. No. No. No. 121. 130. 164. 170. 357. 369. 464. Sugar prices, from refiner to consumer. [1913.] Wheat and flour prices, from farmer to consumer. [1913.] Butter prices, from producer to consumer. [1914.] Foreign food prices as affected b y the war. [1915.] Cost of living in the United States. [1924.] The use of cost-of-living figures in wage adjustments. [1925.] Retail prices, 1890 to 1927. Safety Codes. *No. 331. Code of lighting: Factories, mills, and other work places. No. 336. Safety code for the protection of industrial workers in foundries. No. 350. Specificatioiis of laboratory tests for approval of electric headlighting devices for motor vehicles. No. 351. Safety code for the construction, care, and use of ladders. No. 375. Safety code for laundry machinery and operations. No. 378. Safety code for woodworking plants. No. 382. Code for lighting school buildings. No. 410. Safety code for paper and pulp mills. No. 430. Safety code for power presses and foot and hand presses. No. 433. Safety codes for the prevention of dust explosions. [m] Safety Codes—Continued. No. No. No. N o. 436. 447. 451. 463. Safety Safety Safety Safety code code code code for the use, care, and protection of abrasive wheels. for rubber mills and calenders. for forging and hot-metal stamping. for mechanical power-transmission apparatus—first revision. Vocational and Workers’ Education. *No. *No. No. No. No. 159. 162. 199. 271. 459. Short-unit courses for wage earners, and a factory school experiment. [1915.] Vocational education survey of Richmond, Va. [1915.] Vocational education survey of Minneapolis, Minn. [1917.] Adult working-class education in Great Britain and the United States. [1920.] Apprenticeship in building construction. [1928.] Wages and Hours of Labor. *No. 146. Wages and regularity of employment and standardization of piece rates in the dress and waist industry of New York City. [1914.] *No. 147. Wages and regularity of employment in the cloak, suit, and skirt industry. [1914.] N o. 161. Wages and hours of labor in the clothing and cigar industries, 1911 to 1913. N o. 163. Wages and hours of labor in the building and repairing of steam railroad cars, 1907 to 1913. *No. 190. Wages and hours of labor in the cotton, woolen, and silk industries, 1907 to 1914. No. 204. Street-railway employment in the United States. [1917.] No. 225. Wages and hours of labor in the lumber, millwork, and furniture industries, 1915. No. 265. Industrial survey in selected industries in the United States, 1919. No. 297. Wages and hours of labor in the petroleum industry, 1920. No. 356. Productivity costs in the common-brick industry. [1924.] No. 358. Wages and hours of labor in the automobile-tire industry, 1923. No, 360. Time and labor costs in manufacturing 100 pairs of shoes, 1923. No. 365. Wages and hours of labor in the paper and pulp industry, 1923. No. 394. Wages and hours of labor in metalliferous mines, 1924. No. 407. Labor cost of production and wages and hours of labor in the paper box-board Industry. [1926.] No. 412. Wages, hours, and productivity in the pottery industry, 1925. No. 413. Wages and hours of labor in the lumber industry in the United States, 1925. No. 416. Hours and earnings in anthracite and bituminous coal mining, 1922 and 1924. N o. 435. Wages and hours of labor in the men’s clothing industry, 1911 to 1926. N o. 438. Wages and hours of labor in the motor-vehicle industry, 1925. N o. 442. Wages and hours of labor in the iron and steel industry, 1907 to 1925. N o. 446. Wages and hours of labor in cotton-goods manufacturing, 1910 to 1926. No. 450. Wages and hours of labor in the boot and shoe industry, 1907 to 1926. No. 452. Wages and hours of labor in the hosiery and underwear industries, 1907 to 1926. N o. 454. Hours and earnings in bituminous-coal mining, 1922, 1924, and 1926. No. 457. Union scales of wages and hours of labor, M ay 15, 1927. No. 471. Wages and hours of labor in foundries and machine shops, 1927. No. 472. Wages and hours of labor in the slaughtering and meat packing industry, 1927. No. 476. Union scales of wages and hours of labor, 1927. Supplement to Bulletin No. 457. No. 484. Wages and hours of labor of common street laborers, 1928. No. 487. Wages and hours of labor in woolen and worsted goods manufacturing, 1910 to 1928. Welfare Work. *No. No. *No. No. 123. 222. 250. 458. Employers’ welfare work. [1913.] Welfare work in British munitions factories. [1917.] Welfare work for employees in industrial establishments in the United States. Health and recreation activities in industrial establishments, 1926. [1919. J Wholesale Prices. No. 284. Index numbers of wholesale prices in the United States and foreign countries. No. 453. Revised index numbers of wholesale prices, 1923 to July, 1927. No. 473. Wholesale prices, 1913 to 1927. [1921.] Women and Children In Industry. No. 116. Hours, earnings, and duration of employment of wage-earning women in selected industries in the District of Columbia. [1913.] ♦No. 117. Prohibition of night work of young persons. [1913.] No. 118. Ten-hour maximum working-day for women and young persons. [1913.] N o. 119. Working hours of women in the pea canneries of Wisconsin. [1913.] *No. 122. Employment of women in power laundries in Milwaukee. [1913.] N o. 160. Hours, earnings, and conditions of labor of women in Indiana mercantile establishments and garment factories. [1914.] •No. 167. Minimum-wage legislation in the United States and foreign countries. [1915.] *No, 175. Summary of the report on conditions of woman and child wage earners in the United States [1915.] [IV ] Women and Children in Industry—Continued. *No. *No. *No. No. No. *No. 176. 180. 182. 193. 215. 217. Effect of minimum-wage determinations in Oregon. [1915.] The boot and shoe industry in Massachusetts as a vocation for women. [1915.] Unemployment among women in department and other retail stores of Boston, Mass. [1916.] Dressmaking as a trade for women in Massachusetts. [191G.] Industrial experience of trade-school girls in Massachusetts. [1917.] Effect of workmen’s compensation laws in diminishing the necessity of industrial employ ment of women and children. [1918.] No. 223. Employment of women and juveniles in Great Britain during the war. [1917.] No. 253. Women in the lead industries. [1919.] Workmen’s Insurance and Compensation (including laws relating thereto). *No. *No. No. No. *No. No. 101. 102. 103. 107. 155. 212. *No. 243. No. No. No. No. No. 301. 312. 379. 423. 477. Care of tuberculous wage earners in Germany. [1912.] British national insurance act, 1911. Sickness and accident insurance law in Switzerland. [1912.] Law relating to insurance of salaried employees in Germany. [1913.] Compensation for accidents to employees of the United States. [1914.] Proceedings of the conference on social insurance called b y the International Association of Industrial Accident Boards and Commissions, Washington, D . C., December 5-9, 1916. W orkmen’s compensation legislation in the United States and foreign countries, 1917 and 1918. Comparison of workmen’s compensation insurance and administration. [1922.] National health insurance in Great Britain, 1911 to 1921. Comparison of workmen’s compensation laws of the United States as of January 1, 1925. W orkmen’s compensation legislation of the United States and Canada as of July 1, 1926. Public-service retirement systems, United States and Europe. [1928.] Miscellaneous Series. *No. 174. Subject index of the publications of the United States Bureau of Labor Statistics up to M ay 1, 1915. No. 208. Profit sharing in the United States. [1916.] No. 242. Food situation in central Europe, 1917. No. 254. International labor legislation and the society of nations. [1919.] No. 268. Historical survey of international action affecting labor. [1920.] No. 282. Mutual relief associations among Government employees in Washington, D . C. [1921.] No. 299. Personnel research agencies: A guide to organized research in employment management, industrial relations, training, and working conditions. [1921.] No. 319. The Bureau of Labor Statistics: Its history, activities, and organization. [1922.] No, 326. Methods of procuring and computing statistical information of the Bureau of Labor Statistics. [1923.] N o. 342. International Seamen’s Union of America: A study of its history and problems. [1923.] No. 346. Humanity in government. [1923.] No. 372. Convict labor in 1923. No. 386. Cost of American almshouses. [1925.] No. 398. Growth of legal-aid work in the United States. [1926.] No. 401. Family allowances in foeign countries. [1926.] No. 420. Handbook of American trade-unions. [1926.] No. 439. Handbook of labor statistics, 1924 to 1926. No. 461. Labor organizations in Chile. [1928.] No. 462. Park recreation areas in the United States. [1928.] No. 465. Beneficial activities of American trade-unions. [1928.] No. 479. Activities and functions of a State department of labor. [1928.J No. 483. Conditions in the shoe industry in Haverhill, Mass., 1928. A D D IT IO N A L COPIE S OF THIS PUBLICATION M A Y BE PROCURED FROM THE SUPERINTENDENT OF DOCUMENTS U. S. GOVERNMENT PRINTING OFFICE WASHINGTON, D. C. AT 10 C E N T S P E R C O P Y V [V]