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U. S. DEPARTMENT OF LABOR JAMES J. DAVIS, Secretary BUREAU OF LABOR STATISTICS ETHELBERT STEWART, Commissioner BULLETIN OF THE UNITED STATES'! BUREAU OF LABOR STA T ISTIC S/ INDUSTRIAL ACCIDENTS AND ........ No. 426 HYGIENE SERIES DEATHS FROM LEAD POISONING BY FREDERICK L. HOFFMAN, LL. D. Consulting Statistician, Prudential Insurance Co. Newark, N. J. FEBRUARY, 1927 WASHINGTON GOVERNMENT PRINTING OFFICE 1927 CONTENTS Page Part I.— Statistics of chronic lead poisoning in the United States and foreign countries......................... ................................................................ 1-14 1, 2 United States registration area__________________________________ Industrial experience of Metropolitan Life Insurance Co___________ 2 United States Navy-------- ----------------------- ----------------- ---------------2, 3 State and city statistics: 3 California----------------------------------------- ------------ ------- ------- ---Chicago, 111............................................ . ...................................... 3,4 St. Louis, Mo_________________ _______- ................................... 4 New Jersey------------------------------------------------------------. --------- 4, 5 New York State____________ ______________ ____________ ____ 5 New York City.......... ...................... .............................................. 5, 6 Buffalo, N. Y............. ......... ...................................................... . 6 Ohio................... ........................................................... .................. 6 Pennsylvania__ _______ ______________ _____________________ 7 Providence, R. I_ „----------------------------------- --------------- ----------7 Maine______________________________________ ________ ______ 7, 8 New Hampshire___________________________________________ 8 8 Connecticut_______________________________________________ Wisconsin_________________________________________________ 8, 9 Canada-------------------------------- ------- ---------- ---------------------------- — 9 Ontario______________________ ________ ____________________ 9 Great Britain__________________________________________________ 10-13 England and Wales________________________________________ 12 Scotland__________________________________________________ 12, 13 Australia-____ _________________________________________________ 13 New Zealand__________________________________________________ 13 Italy..................................... ...................... ............................................ 14 Paris, France__________________________________________________ 14 Oppeln, Germany________________________________________ ______ 14 Part ft.—Analysis of deaths from chronic lead poisoning in the United States registration area, 1914-1924-------------------------------------------------- 15-34 Lead workers____________________________ ________ _____________ 16, 17 Miners_______________ __________________ ______ - --------- ------------ 17, 18 Painters_______________________________________________________ 18-23 Paint mixers___________________________________________________ 23 Plumbers.--------------- --------------- ------------- ---------------- ----------------- 23, 24 Potters and tile workers__________________ ______ _______________ 24, 25 Rubber workers-------------- --------- -------------------------- -------------------25 25 Storage battery workers________________________________________ Printers_________________________________________________ _____ _ 25-27 Tin and copper smiths---------------------- -------------------- -------------------27 Glass workers.............. - ------------------------------ -----------------------------27 Metal workers_________________________________________________ 27 Carpenters and woodworkers____________________________________ 27, 28 Laborers---------- ------- -------------------------------------------------- -------------28 Farmers................................................ .................... .............................28-30 Professional occupations________________________________________ 30, 31 Miscellaneous occupations.------------ -------------------------------------------- 31,32 32 Unknown or retired__________ __________________ _________ ______ Women............................. ................................... ............................... . 32,33 Boys under 18.------- ----------------------------------------------------------------- 33, 34 Girls under 18. ---------- -------------------------------------------------------------34 Part III.— Statistics of chronic lead poisoning from State industrial acci dent boards_______________________________________________ ______ 34-40 Massachusetts__________________________________________ _____ 34,35 35 Pennsylvania— .......... - --------- --------------------- — --------- --------------California______________________ __________________ - ...............— 36 New York State_______________________________________________ 36-40 Bibliography......... .......................... ...................... ..... l....... .................... . 41-45 hi BULLETIN OF THE U. S. BUREAU OF LABOR STATISTICS WASHINGTON n o . 426 F e b r u a r y , 1927 DEATHS FROM LEAD POISONING PART I.— STATISTICS OF CHRONIC LEAD POISONING IN THE UNITED STATES AND FOREIGN COUNTRIES The present investigation is primarily concerned with the available statistics of chronic lead poisoning, for the United States and certain foreign countries, which are useful for practical purposes. In most of the works on lead poisoning there are numerous statistical references suggestive of the urgent need for a more comprehensive viewpoint of the past and present situation. Most of the data included in the present inquiry are for the last 10 years, which should prove sufficient at least as an introduction to the proper statistical treat ment of this important subject. UNITED STATES REGISTRATION AREA Through the courtesy of the Division of Vital Statistics of the United States Bureau of the Census, I have been furnished with original death certificates representing all the deaths from lead poisoning which are a matter of record for the registration area for the period 1914-1924. I am not aware that in any previous investi gation original death certificates have been considered with a due regard to all essential facts contained therein. Table 1 shows the number of deaths classified as chronic lead poisoning for the United States registration area during each of the years 1910 to 1924. T a b l e 1.—DEATHS FROM CHRONIC LEAD POISONING, U NITED STATES REGISTRA TION AREA, 1910 TO 1924, BY YEARS Year 1910......................... 1911......................... 1912......................... 1913......................... 1614......................... 1915......................... 1916......................... 1917......................... Death Num rate per Population ber of 1,000,000 deaths popula tion 53,831,742 59,183,071 60,359,974 63,200,625 63,813,315 67,095,681 71,349,162 74,964,498 136 145 148 162 149 155 190 147 l ii 2.5 2.5 2.5 2.6 2.3 2.3 2.7 2.0 , Year 1918.. 1919.. 1920.. 1921.. 1922.. 1923.. 1924.. Death rate per 1,000,000 popula tion Num Population ber of deaths 81,333,675 85,166,043 87,486,713 88,667,602 93,241,643 96,986,371 99,200,298 124 148 120 142 137 141 142 1.5 1.7 1.4 1.6 1.5 1.5 1.4 1 DEATHS FROM LEAD POISONING According to this table there were 1,085 deaths from lead poisoning during the first seven years of the period and 959 deaths during the last. The rate in proportion to population decreased from 2.5 per million in 1910 to 1.4 per million in 1924. The decrease in the death rate is progressive and obviously reflects the results of the efforts that have been made in the direction of improving factory and workshop hygiene on the one hand and the personal hygiene of the worker on the other. INDUSTRIAL EXPERIENCE OF METROPOLITAN LIFE INSURANCE CO. The returns for the United States registration area are in a large measure confirmed by corresponding data representing the industrial insurance experience of the Metropolitan Life Insurance Co. for the years 1911 to 1924, which are shown in Table 2. T a b l e 2 . — DEATHS FROM CHRONIC LEAD POISONING, INDU STRIAL D E P A R T M E N T OF THE M ETR O PO LITA N LIFE INSURANCE CO., 1911 TO 1924, B Y YEARS Year 1911. 1912. 1913. 1914. 1915. 1916. 1917. Number exposed to risk 7,790,227 8,219,695 8,696,543 9,247,323 9,665,699 10,177,060 10,847,852 Death rate per 1,000,000 exposed Num ber of deaths 17!I 37 35 39 30 33 25 i i j ! i Year 2.2 1918.. 4.5 1919.. 4.0 1920.. 4.2 1921.. 3.1 1922. 3.2 1923.. 2.3 h 1924. Number exposed to risk 11,553,347 12,424,509 13,086,725 13,500,762 13,776,239 14,534,242 15,382,916 Death Num rate per ber of 1,000,000 deaths exposed 2.5 2.1 2.2 1.9 2.2 2.3 1.6 Leaving out of the comparison the first year of the period, it is shown that the rate decreased from 4.5 per million in 1912 to 1.6 per million in 1924. This experience represents the wage-earning population of the country and, largely, employments in which chronic lead poisoning is most likely to occur. It is therefore of particular interest and value in supporting the returns of the registration area of the country as a whole. During 1925, in the experience of the Metropolitan Life Insurance Co., there were 26 deaths from chronic lead poisoning, equivalent to a rate of 1.6 per million; for white males the rate was 3.4 per million and for colored males 3.2. UNITED STATES NAVY Through the courtesy of the Surgeon General of the United States Navy I have been furnished with the chronic lead poisoning statistics of the Navy, differentiating the acute and the chronic lead poisoning cases which have occurred in the Navy during 1913-1924. Table 3, which presents these statistics, is of general interest, as it illustrates that the case frequency rate may be high, while the resulting mor tality may be practically nil. The returns also indicate a decrease in the relative frequency of the disease, except as regards acute cases, which in 1923 were 25. During 1925, there were 6 cases of acute lead poisoning, but no deaths, in the United States Navy, giving a case rate of 5.2 per 100,000. There were 3 cases of chronic lead poisoning, but no deaths, giving a case rate of 2.6 per 100,000. DEATHS FROM LEAD POISONING 3 T a ble 3 .— N UM BER OF OASES AND DEATHS FROM LEAD POISONING, UNITED STATES N A V Y, 1913 T O 1924, BY YEARS Acute lead poisoning Com plement Year 1913........................................................... 1914.......................................... ............... 1915...................... ................................... 1916.......................................................... 1917........................................... .............. 1918.................................... .................... 1919................................ ......................... 1920......... ................................................ 1921........................................................... 1922................... .................... ................. 1923................ .......................................... 1924........................................................... 65,926 67,141 68,075 69,294 245,580 503,792 298,774 140,773 148,861 122,126 116,565 119,280 Cases Chronic lead poisoning Case Deaths rate per 1,000 0 0 0 0 0 0 0 0 0 0 1 25 34 46 45 19 12 19 4 3 7 25 1 0.4 .5 .7 .6 .08 .02 .06 .03 .02 .06 .2 .008 Cases 86 30 24 20 21 13 11 1 1 7 8 6 Case Deaths rate per 1,000 0 0 0 0 0 0 1 0 0 0 0 0.5 ' ¥ .4 .3 .09 .03 .04 .007 .007 .06 .07 .C5 STATE AND CITY STATISTICS It has not seemed necessary for the present purpose to tabulate in detail the statistics of chronic lead poisoning for the several States otherwise than as appears in connection with the analysis of the data for the period for which actual death certificates have been available. (See Part II.) The data in Tables 4 to 17 have been in most cases furnished by the local health authorities and the figures may possibly differ slightly from the returns for the United States registration area in view of differences in methods of death classifi cation. CALIFORNIA The first of this series of tables is for the State of California, limited to the years 1912 to 1920, no later data being available. T a b l e 4 . — DEATHS FROM CHRONIC LEAD POISONING IN CALIFORNIA, 1912 TO 1920, B Y YEARS Year 1912......................... 1913....... ................. 1914......................... 1915......................... 1916....................... Num Population ber of deaths Death rate per 1,000,000 popula tion 8 16 14 7 8 3.1 5.9 4.9 2.4 2.6 2,616,234 2,724,317 2,832,400 2,940,464 3,048,568 Year Population 1917......................... 1918......................... 1919......................... 1920......................... 3,156,652 3,264,736 3,372,819 3,480,902 Death Num rate per ber of 1,000,000 deaths popula tion 6 0 7 4 1.9 2.1 1.1 The indications are strongly to the effect that chronic lead poison ing in California, as reported by the State board of health, has been considerably on the decrease during the last half of the decade. CHICAGO, ILL. That the conclusions drawn from the general returns for the coun try are in full conformity to the local rates for representative cities in which certain lead industries are represented on a large scale is shown in Tables 5 and 6, though in St. Louis the rate for 1924 shows an increase over 1923. Table 5 is for the city of Chicago, covering DEATHS FROM LEAD POISONING the period 1914 to 1924. The frequency rate at the beginning of the period was 3.3 per million, but during the last year under obser vation the rate was only 0.69. T a b l e 5 .— DEATHS FROM CHRONIC LEAD POISONING IN CHICAGO, ILL., 1914 TO 1924, BY YEARS Year Population 1914......................... 1915......................... 1916......................... 1917......................... 1918......................... 1919......................... 2,411,018 2,464,452 2,517,486 2,570,120 2,622,754 2,675,388 Death ! Num rate per 1 ber of 1,000,000 j deaths popula- ! tion 8 2 5 3 2 5 3.3 .8 2.0 1.2 .8 ; 1.9 j Year Population 1920......................... 1921......................... 1922......................... 1923......................... 1924......................... 2,728,022 2,780,655 2,833,288 2,886,971 2,900,000 Death Num rate per ber of 1,000,000 deaths popula tion 2 5 7 2 2 0.7 1.8 2.5 .7 .69 ST. LOUIS, MO. Table 6 gives corresponding statistics for the city of St. Louis for 1913-1924. T a b l e 6.—DEATHS FROM CHRONIC LEAD POISONING IN ST. LOUIS, MO., 1913 TO 1924, BY YEARS Year 1913......................... 1914......................... 1915......................... 1916......................... 1917......................... 1918......................... Population Num ber of deaths Death rate per 1,000,000 popula tion 715,405 724,250 733,095 741,940 759.630 759.630 0 4 1 3 2 1 5.5 1.4 4.0 2.6 1.3 Year | 1919......................... 1 1920......................... I 1921......................... ! 1922......................... i 1923......................... ! 1924......................... i Population 768,475 777,320 786,164 795,008 803,853 812,700 Death Num rate per ber of 1,000,000 deaths popula tion 4 0 1 0 0 4 5.2 1.3 4.9 NEW JERSEY Of special interest in this connection are the returns for the State of New Jersey, in which lead-using industries, particularly the pottery industry, are carried on on a considerable scale. These returns are shown in Table 7. T a b l e 7 .— DEATHS FROM CHRONIC LEAD POISONING IN NEW JERSEY, 1914 T O 1924, BY YEARS Year ! NumTopulation1 ber of ; deaths i ! 1 9 1 4 ............................. 1 9 1 5 ............................. 1916 ...................... 1917 ......... 1918......................... 1919......................... 2,806,375 2,869,107 2,932,839 2.996,671 \ | i i 3,060,303 ! 3,124,035 i 9 9 16 9 7 4 Death rate per 1,000,000 Population 1920.............................. 1921.............................. 3,187,767 3,251,499 8 6 3,315,231 3,378,963 3,442,695 8 6 4 popula tion j 3.2 3.1 Death Num rate per ber of 1,000,000 deaths popula tion Year 5. 5 1922......................... 3.0 1923......................... 2.3 : 1924......................... 1.3 2.5 1.6 2.4 1.8 1.2 The frequency of chronic lead poisoning in New Jersey reached a maximum of 5.5 per million in 1916, while during the last year the observed rate was only 1.2. The strenuous efforts of the New DEATHS FROM LEAD POISONING 5 Jersey Bureau of Labor in cooperation with manufacturing indus tries, especially the pottery industry which has left little undone to reduce the lead-poisoning hazard, are considered primarily respon sible for these gratifying results. The facts in the case are fully confirmed by certain statistics of labor organizations, which also show that chronic lead poisoning is no longer an occupational hazard of serious concern, at least in the pottery industry. NEW YORK STATE Table 8 gives data for the State of New York, furnished by the State health officer. Other statistics for lead poisoning, derived from the State department of labor, will be dealt with later. T a b l e 8.—DEATHS FROM CHRONIC LEAD POISONING IN NEW Y O R K STATE, 1915 to 1924, BY YEARS Year Num Population ber of deaths 9,795,808 9,926,790 10,057,772 10,188,754 10,319,736 1915. 1916. 1917. 1918. 1919. Death rate per 1,000,000 popula tion 2.5 1.5 2.2 2.1 1.8 Year Population Death Num rate per ber of 1,000,000 deaths pot e - 1920. 1921. 1922 1923. 1924 10,450,718 10,581,700 10,712,680 10,843,661 10,974,642 1.3 1.4 .7 1.3 1.4 The preceding table, amplified to some extent by returns for New York City (see Table 9) fully confirms the downward trend of the lead poisoning death rate in a section of the country in which leadusing industries are represented on a considerable scale. During 1915-1924 the rate for New York State decreased from 2.5 to 1.4 per million. NEW YORK CITY Table 9 presents data for the city of New York covering the period 1901-1924. It is a most illuminating return, in view of the enormous building activity in New York, involving an exceptional amount of exposure to the risk of lead poisoning on the part of painters, plumbers, and others. T a b l e 9 . — DEATHS FROM CHRONIC LEAD POISONING IN THE C ITY OF NEW YORK, 1901 TO 1924, BY YEARS Year 1901......................... 1902......................... 1903......................... 1904......................... 1905......................... 1906......................... 1907......................... 1908......................... 1909......................... J910......................... 1911......................... 1912......................... Num Population ber of deaths Death rate per 1,000,000 popula tion 7 13 7 18 8 9 11 10 15 18 16 16 2.0 3.5 1.9 4.5 1.9 2.1 2.5 2.2 3.2 3.8 3.3 3.2 3.544.000 3.665.000 3.781.000 3,971,422 4,104,977 4,238,532 4,372,087 4,505,642 4,639,197 4,772,752 4,862,057 4,951,362 4682°—27----- 2 Year 1913. 1914. 1915. 1916. 1917. 1918. 1919. 1920. 1921. 1922. 1923. 1924. Population 5,040,667 5,129,972 5,219,277 5,308,582 5,397,887 5,487,192 5,576,497 5,665,803 5,755,107 5,844,411 5,933,715 6,023,019 Num ber of deaths Death rate per 1,000,000 popula tion 2.8 2.3 2.5 1.9 2.8 2.6 1.6 1.2 1.2 .9 1.5 1.2 6 DEATHS FROM LEAD POISONING While the population of New York City in the 20 years from 1904 to 1924 increased 54.6 per cent, the actual number of deaths from lead poisoning decreased from 18 in 1904 to 7 in 1924, while the rela tive frequency rate decreased from 4.5 to 1.2 per million. During 1925 there were 5 deaths from chronic lead poisoning in the city of New York in an estimated population of 6,877,000, or 0.7 per million. BUFFALO, N. Y. Returns for the city of Buffalo, presented in Table 10, are equally suggestive of a decided diminution in deaths from lead poisoning during the period 1914-1924. There were six deaths from lead poisoning during the first five years and only three during the last, regardless of an increase in lead-using industries. It would have been interesting to have had an extended and detailed statement of the lead-poisoning cases of Niagara Falls, where certain lead-using industries with a high degree of hazard are in operation on a large scale. Unfortunately, the data can not be furnished by the local board of health, but some information has been obtained through the State department of labor and will be dealt with later. The local hazard of Niagara Falls is particularly connected with the making of electrical storage batteries, which seems to involve a special liability to lead poisoning, but probably most cases are of a minor or mild character, while the fatality rate has apparently been very low. T a b l e 10.—DEATHS FROM CHRONIC LEAD POISONING IN BUFFALO, N. Y.,1914 TO 1924, BY YEARS Year 1914 ...................... 1915 .................... 1916......................... 1917......................... 1918......................... 1919......................... Population Num ber of deaths 459,718 468,273 476,829 485,385 493,941 502,497 1 2 1 1 1 1 Death rate per 1,000,000 popula tion Year 2.2 ! 1920......................... 4.3 1921....................... 2.1 1922......................... 2.1 1923......................... 2.0 : 1924......................... 2.0 i Population 511,053 519,608 528,163 536,718 545,273 Death Num rate per ber of 1,000,000 deaths popula tion 9 0 0 2 1 3.7 1.8 OHIO Table 11 shows data for the State of Ohio, covering the period 1913-1924. It is also suggestive of a decline in frequency, regardless of the expansion of lead-using industries. TABLE 11.— DEATHS FROM CHRONIC LEAD POISONING IN OHIO, 1913 TO 1924, BY YEARS Year Population Num ber of deaths Death rate per 1,000,000 popula tion 1913 _. 1914 . . 1915 1916......................... 1917......................... 1918........................ 5,095,042 5,197,250 5,299,458 5,401,666 5,503,874 5,506,082 12 12 9 18 13 6 2.4 2.3 1.7 3.3 2.4 1.1 Year Population 1919......................... 1920......................... 1921......................... 1922......................... 1923......................... 1924......................... 5,708,290 5,810,498 5,912,706 6,014,914 6,117,122 6,200,000 Death Num rate per ber of 1,000,000 deaths popula tion 10 10 13 7 8 11 1.8 1.7 2.2 1.2 1.3 1.8 DEATHS FROM LEAD POISONING 7 PENNSYLVANIA Quite similar are the returns shown in Table 12 for the State of Pennsylvania, where the frequency rate has decreased from a maxi mum of 2.8 per million in 1916 and 1917 to 2.1 per million in 1924. T a b l e 12.—DEATHS FROM OHRONIO LEAD POISONING IN PENNSYLVANIA, 1913 TO 1924, BY YEARS Year 1913......................... 1914......................... 1915......................... 1916.................... — 1917............ ............ 1918......................... Num Population ber of deaths 8,013,727 8,122,387 8,231,047 8,339,707 8,448,367 8,557,027 17 17 15 23 24 12 Death rate per 1,000,000 popula tion 2.1 2.1 1.8 2.8 2.8 1.4 Year Population Num ber of deaths 1919......................... 1920 . 1921......................... 1922......................... 1923J........................ 1924......................... 8,665,687 8,774,347 8,883,006 8,991,666 9,100,326 9,208,986 19 9 13 11 12 19 Death rate per 1,000,000 popula tion 2.2 1.0 1.5 1.2 1.3 2.1 PROVIDENCE, R. I. Table 13 shows the lead poisoning deaths for the city of Provi dence, in which, however, such deaths have been of extremely rare occurrence. T able 13.—DEATHS FROM CHRONIC LEAD POISONING IN PROVIDENCE, R. I., 1913 TO 1924, BY YEARS Year 191 3 191 4 191 5 191 6 1917_....................... 1918......................... Population 228,710 230,077 231,444 232,811 234,178 235,545 Num ber of deaths Death rate per 1,000,000 popula tion 0 0 0 1 ...........4.3 0 1 Year 191 192 192 192 192 192 9 0 1 2 3 4 Death Num rate per Population ber of 1,000,000 deaths POt?o ^ 236,912 238,279 239,635 241,011 242,388 244,000 1 0 0 4.2 ? .......... 4.1 MAINE In somewhat curious contrast to the foregoing are the lead poison ing returns for the State of Maine, presented in Table 14, which show an increase from 29 deaths during the six years ending with 1918 to 37 deaths during the six years ending with 1924. The average rate for these groups of years has increased from 6.4 to 8 per million. T a b l e 14.—DEATHS FROM CHRONIC LEAD POISONING IN M AINE, 1913 TO 1924, BY YEARS Year 1913......................... 1914......................... 1915......................... 1916......................... 1917......................... 1918......................... Num Population ber of deaths Death rate per 1,000,000 pojula- 4 5 4 4 7 6 5.5 6.6 5.3 5.3 9.2 6.5 750,840 753,482 756,124 758,766 761,406 764,050 Year 1919......................... 1920......................... 1921......................... 1922................. 1923......................... 1924......................... Population Num ber of deaths 766,692 769,334 771,976 774,617 777,259 779,900 10 4 3 10 3 7 Death rate per 1,000,000 popula tion 13.0 5.2 3.9 12.9 3.9 9.0 8 DEATHS FROM LEAD POISONING In Maine very few deaths from chronic lead poisoning are due to industrial causes, practically all the deaths being the result of water contamination from lead pipes. As will be shown later the lead-poisoning hazard in Maine is largely concentrated in two counties, where most of the deaths have occurred. NEW HAMPSHIRE Much the same conclusions apply to the State of New Hampshire, where, in proportion to the population, the mortality from lead poisoning is also excessive, although the actual number of deaths is relatively small. Table 15 gives the facts for the years 1913 to 1924. T a b l e 15.—DEATHS FROM CHRONIC LEAD POISONING IN NEW HAM PSH IRE, 1913 TO 1924, BY YEARS Year 1913 ...................... 1914......................... 1915......................... 1916......................... 1917......................... 1918......................... Population Num ber of deaths Death rate per 1,000,000 popula tion 434,712 436,000 437,288 438,576 439,864 441,152 4 1 2 6 4 0 9.2 2.3 4.6 13.7 9.1 Year 1919......................... 1920......................... 1921......................... 1922....................... 1923...................... 1924......................... Population Num ber of deaths 442,440 413,726 445,016 446,304 447,592 448,882 1 1 1 3 1 2 Death rate per 1,000,000 2.3 2.3 2.2 6.7 2.2 4.5 The preceding table, however, indicates a substantial reduction in the frequency rate during recent years, although the returns for 1924 are suggestive of a continued risk, the entire elimination of which is, of course, a matter of great practical difficulty. CONNECTICUT Table 16 includes fragmentary returns for the State of Connecticut, covering the period 1910-1918, suggestive of a decline in the rate during the later years of the period as compared with earlier years. T a b l e 16.—DEATHS FROM CHRONIC LEAD POISONING IN CONNECTICUT, 1910 TO 1918, BY YEARS Year 1910....................... 1911......................... 1912......................... 1913......................... 1914......................... i Death Num- | rate per Population ber of 1,000,000 deaths popula tion 1,122,512 1,149,898 1,177,284 1,204,670 1,232,056 1 6 4 7 2 0.9 5.2 3.4 5.8 1.6 Year 1915......................... 1916..... ................... 1917......................... 1918......................... Population 1,259,442 1,286,828 1,314,214 1,341,600 Death Num rate per ber of 1,000,000 deaths popula tion 2 1 1 2 1.6 .8 .8 1.6 WISCONSIN Table 17, for the State of Wisconsin, covers the period ending with 1924 and suggests a material decrease in the mortality from chronic lead poisoning in that State. DEATHS FROM LEAD POISONING 9 T a b l e 1 7 .— DEATHS FROM CHRONIC LEAD POISONING IN WISCONSIN, 1914 TO 1924, BY YEARS Year 1914......................... 1915......................... 1916......................... 1917......................... 1918......................... 1919......................... Num Population ber of deaths 2.463,130 2,493,846 2,524,562 2,555,278 2,565,994 2,616,710 3 l 3 10 3 0 Death rate per 1,000,000 popula tion 1.2 .4 1.2 3.9 1.2 Year Population Num ber of deaths 1920......................... 1921...................... . 1922......................... 1923......................... 1924......................... 2,647,426 2,678,142 2,708,559 2,739,574 2,300,000 3 4 2 1 15 Death rate per 1,000,000 popula tion 1.1 1.5 .7 .4 2.2 1 Deaths due to mineral inhalation containing lead. In addition to the preceding statistics for the United States and certain selected States and cities, I am able to include some returns for foreign countries which will be found both interesting and valuable. CANADA Table 18 is for the Dominion of Canada, covering the registration area of that country for the period 1921-1924. The rate has been relatively low, the deaths being largely concentrated in the Province of Ontario, as shown in Table 19. T a b l e 1 8 .— DEATHS FROM CHRONIC LEAD POISONING IN CANADA, 1921 TO 1924, BY YEARS Number Population of deaths Year 1921........................................................................................................... 1922................................................................................. ........................ 1923............................................................................................................ 1924....................................................... ................................................... 8,788,483 8.900.000 9,000,000 9.100.000 Death rate per 1,000,000 population 3 4 5 6 0.3 .4 .6 .7 ONTARIO Ontario statistics covering the period 1913-1924, shown in Table 19, are indicative of a slight tendency toward a diminishing rate of fre quency, more or less corresponding to the observed decline in this country. T a b l e 1 9 .— DEATHS FROM CHRONIC LEAD POISONING IN ONTARIO, 1913 TO 1924, BY YEARS Year 1913......................... 1914......................... 1915......................... 1916......................... 1917......................... 1918......................... Num Population ber of deaths Death rate per 1,000,000 popula tion 1 1 4 5 5 3 0.4 .4 1.5 1.8 1.8 1.1 2,605,352 2,646,390 2,687,429 2,728,468 2,769,507 2,810,546 Year 1919......................... 1920......................... 1921......................... 1922......................... 1923......................... 1924......................... Num Population ber of deaths 2,851,584 2,892,623 2,933,662 2,981,182 3,028,907 3,062,000 l 2 1 4 3 Death rate per 1,000,000 popula tion 0.4 .7 .3 1.3 1.0 10 DEATHS FROM LEAD POISONING GREAT BRITAIN For Great Britain, data are available from two different sources: First, there are the returns of cases and‘deaths made annually by the Chief Inspector of Factories, and second, the returns of deaths from chronic lead poisoning as returned by the Registrar General. The former, of course, cover only the employed population, while the latter cover all ages and both sexes. Table 20 gives a report of the cases of lead poisoning for 1914 to 1923 according to the returns of the Chief Factory Inspector, differentiating important industries and employments. The returns are particularly suggestive as indicating a decline in the frequency of lead poisoning among house painters and house plumbers. T a b l e BO.—NUM BER OF CASES OF CHRONIC LEAD POISONING IN FACTORIES AN D WORKSHOPS IN GREAT BRITAIN , 1914 TO 1923, BY YEARS 1914 1915 1916 1917 1918 Smelting of metals................................... Plumbing and soldering........................... Printing.................................................... File cutting and hardening...................... Tinning and metals....................... _........ Other contact with molten lead_______ White and red lead works........................ Pottery..................................................... Vitreous enameling-................................ Electric storage batteries............ .......... Paint and color works.............................. India rubber............................................. Coach building. ....................................... Shipbuilding....................... .................... Paints used in other industries............... Other industries...................................... 36 27 23 11 10 21 35 28 11 41 21 9 57 31 39 45 47 17 27 2 3 16 48 26 5 64 12 8 39 18 16 33 39 12 12 8 4 29 33 23 5 44 22 9 33 25 20 30 46 34 6 4 2 27 30 15 1 27 10 8 21 19 20 47 15 24 8 2 2 7 2 11 T otal.............................................. 445 381 348 317 144 108 23 52 20 43 14 Industry House painters i_..................................... ! 207 House plumbers *..... ............................... 34 ! i i 1919 |1920 24 1 0! io ! 0! 2 ; 9 25 21 1 48 11 5 11 8 9 13 16 3 7 12 9 15 11 25 ] 207 243 37 46 10 3 10! 45 6 9 3 2 13 28 25 2 47 9 7 13 9 10 15 1921 1922 25 14 12 9 25 11 19 46 6 1 7 17 35 8 35 13 4 20 4 12 23 2 15 22 42 3 32 14 3 15 12 23 19 2 12 37 44 5 95 11 5 13 8 21 13 230 | 1 247 337 42 !1 40 | 8 ! 18 i i 1923 53 17 * Not compulsorily reportable under the factory and workshop act, 1901. Table 21 gives the deaths from lead poisoning as reported by the Chief Inspector of Factories in an identical manner. T a b l e 21.—NUM BER OF DEATHS FROM CHRONIC LEAD POISONING IN FACTORIES AND WORKSHOPS IN GREAT BRITAIN, 1914 TO 1923, BY YEARS Industry Smelting of metals.................................... Plumbing and soldering .. . ___ Printing................. ................................. File cutting and hardening.. ____ _ Other contact with molten le a d ............ White and red lead works. .................. . Pottery...................................................... VitreoUS ftnamftUng__________ _________ Electric storage batteries.. Paint and color works.............................. India rubber............................................. Coach building........ ...... ........................ Shipbuilding..... ................ ...................... Paints used in other industries............ . Other industries....................................... 1914 3 2 1 1 2 1 6 4 5 1915 1 2 3 4 1 1916 4 2 1 1 7 1917 1918 i 1 3 1 1919 1920 1921 1922 5 3 1 4 2 1 2 1 | I 1 I 1 i 8 j 1 7 i!..... i 1 1 1 2 i _____i_____ 1_____ 3 2 ! 32 2 3 i ! 3 5 1 1 2 4 5 2 2 1 Total............................................... 29 21 21 21 i House painters *....................................... House plumbers *..................................... 35 4 29 8 15 5 13 5 11 13 7 * Not compulsorily reportable under the factory and workshop act, 1901. 1 1 2 13 2 1 1 1 1 11 1 1 1 1 1923 2 1 1 1 2 17 11 1 2 1 1 1 2 3 1 1 2 26 23 23 26 25 16 1 21 6 15 4 12 5 17 7 DEATHS PROM LEAD POISONING 11 In amplification of the foregoing statistics on lead poisoning for Great Britain I am able, through the courtesy of the Chief Inspector of Factories, to present a table of statistics for the period 1900-1925, which is also indicative of a decided downward trend in cases of lead poisoning in both fatal and nonfatal form. Table 22 is for all the principal industries in which the disease is most likely to occur, but does not include house painters and plumbers, for whom the return of information is not obligatory. T a b l e 2 2 . — N U M BER OF CASES OF LEAD POISONING IN GREAT BRITAIN, 1900 TO 1925, BY YEARS AND OCCUPATIONS Occupation or industry 1900 Average, Average, Average, 1915-1917 1918-1920 1921-1923 Smelting and refining___ ______ ______________ Plumbing and soldering_______________ ______ Ship breaking.................... ................................... Printing____ _____ ____ _____________________ Tinning.................................................................. Other contact with molten lead........................... White and red lead works_________ ____ ______ Vitreous enameling.______ __________ ____ ___ Potteries.............................. ......... ........................ Electric storage batteries...................................... Paints and colors_____ ___ __________________ India rubber____ _______________ ____________ Coach building............................................ ......... Shipbuilding................................................... ...... Paints used in other industries________________ Other industries.................................................... 34 9 44 21 18 5 30 377 11 210 33 56 1 70 32 50 122 Total............................................................ 1,058 1924 15 3 24 37 4 21 45 15 8 31 20 19 42 28 11 2 9 2 10 18 1 19 37 8 6 12 9 11 15 18 8 21 10 2 U 24 5 40 54 13 4 16 8 19 18 38 6 131 6 3 23 20 9 47 101 15 3 30 8 24 22 349 198 271 486 1925 22 7 31 8 4 17 19 9 47 73 8 2 23 13 } 43 326 Excluding house painters and plumbers, for whom notification is not obligatory, the number of cases of lead poisoning in 1925 was 326, as against 486 in 1924; in 1900, however, the number of such cases was 1,058. The number of deaths from lead poisoning in 1925 was only 13 against 32 in 1924 and 38 in 1900. In the smelting of metals there were 22 cases in 1925 against 38 in 1924. In plumbing and soldering there were 7 in 1925 and 6 in 1924. In ship breaking, which no doubt had to do chiefly with dis mantling of ships after the war, there occurred 31 cases in 1925 and 131 cases in 1924. In printing there were 8 cases in 1925 and 6 in 1924; in 1900, however, the number of such cases was 18. In the manufacture of white and red lead there occurred 19 cases in 1925 and 20 in 1924; in 1900, however, the number of such cases was 377 with 6 deaths, as against 1 death in 1925. In the pottery industry there occurred 47 cases in 1925 and the same number in 1924; in 1900, however, the number of such cases was 210. The number of deaths in the pottery industry in 1925 was^5 as against 18 in 1924. The indications are that since 1915 conditions in this respect in the pottery industry have not improved but rather grown worse. In the manufacture of electric storage batteries there were 73 cases in 1925 against 101 cases in 1924; in 1900, however, the num ber of such cases was only 33. In the manufacture of paints and colors there were 8 cases in 1925 and 15 in 1924; in 1900 there were 56. In the manufacture of india rubber there were 2 cases in 1925 and 3 in 1924, as against an average of 8 cases during the period DEATHS FROM LEAD POISONING 12 1915-1917. In coach building, which has reference chiefly to paint ing and enameling, there were 23 cases in 1925, as against 30 cases in 1924; an average of 90 cases occurred in this industry during 1909-1911. In shipbuilding there were 13 cases in 1925, as against 8 in 1924. With reference to house painters and plumbers, it is said that for 1925 information was obtained for 89 cases of lead poisoning with 9 deaths among house painters and that the corresponding number for 1915 was 108 cases with 29 deaths. ENGLAND AND WALES The returns of the Registrar General for England and Wales, shown in Table 23, cover the period 1908-1922, differentiating the sexes and in the summary the occupational and nonoccupational cases, suicides, and accidents. Table 23.—DEATHS FROM LEAD POISONING, ENGLAND AND WALES, 1908 TO 1922, BY YEARS Number of deaths Year 1908............... 1909............... 1910............... 1911............... 1912............... 1913............... 1914............... 1915............... 1916............... Number of deaths Death rate per 1,000,000 Occupa Fe Total popula tional Males males tion 105 90 82 108 108 87 84 71 57 12 14 11 13 9 6 6 1 4 117 104 93 121 117 93 90 72 61 3.33 2.34 2.60 3.34 3.21 2.54 2.44 2.04 1.76 105 91 86 110 106 81 79 67 ; 54 | Year Death rate per 1,000,000 Occupa tional Fe Total popula Males males tion 1917.. 1918.. 1919.. 1920.. 1921.. 1922.. 1.75 1.08 1.36 1.62 1.58 1.42 Total.. 1,087 50 36 48 61 58 48 101 1,188 Su m m a r y Occupational, males................................................................................................................................. 1,046 Occupational, females............................................................................................................................... 34 Nonoccupational................................... ................................................................................................... 67 Accidents................................................................................................................................................... 36 It is explained in this connection by the Registrar General that: Before 1911 chronic nonoccupational poisonings were listed to violence. The nonoccupational chronic poisonings of females prior to 1918 were probably due to the use of diachylon as an abortifacient. In 1917 the sale of diachylon was restricted by its being scheduled as a poison. Some lead deaths before 1917 are omitted owing to. their being classed as criminal abortion without distinction of lead as the agent/ SCOTLAND Through the kindness of the Registrar General of Scotland I have been furnished with the returns for that country, covering the period 1917-1924, and they are presented in Table 24. Chronic lead poison ing is obviously a disease of much less frequency in Scotland than in England. DEATHS FROM LEAD POISONING 13 T a b l e 2 4 . —DEATHS FROM CHRONIC LEAD POISONING IN SCOTLAND, 1911 TO 1924, BY YEARS Estimated population Deaths from lead poisoning Males Rate per 1,000,000 popula tion 4 2 2 3 4 4 3 4 3 2 3 2 3 1 1.7 .9 .9 1.3 1.7 1.7 1.3 1.7 1.3 .9 1.3 .8 1.3 .4 Year 1911............................................................... 1912............................................................... 1913............................................................... 1914............................................................... 1915............................................................... 1916.............................................................. 1917............................................................... 1918............................................................... 1919............................................................... 1920............................................................... 1921............................................................... 1922............................................................... 1923............................................................... 1924............................................................... Males Females 2,304,100 2,300,941 2,295,370 2,307,334 2,312,946 2,318,722 2,320,493 2,308,024 2,313,600 2,337,010 2,347,642 2,358,201 2,356,587 2,347,228 2,447,032 2,440,136 2,431,762 2,439,833 2,457,852 2,475,986 2,489,845 2,504,250 2,506,477 2,527,386 2,534,855 2,546,255 2,544,513 2,534,409 Fe males Rate per 1,000,000 popula tion 11 21 0.4 .4 » Female child, age 4 months; it is stated that “ the mother vfas using lead nipple shields.” * Wife of a railway surfaceman, age 53. AUSTRALIA From the Commonwealth of Australia I have been able to secure returns of chronic lead poisoning for the period 1913-1924, as shown in Table 25. T a b l e 25.—DEATHS FROM CHRONIC LEAD POISONING IN AUSTRALIA, 1913 TO 1924, BY YEARS Year 1913......................... 1914......................... 1915......................... 1916......................... 1917......................... 1918........................* Num Population ber of deaths 4.800.000 4.900.000 5.000.000 5.000.000 5.000.000 5.000.000 10 6 11 18 18 10 Death rate per 1,000,000 2,1 1.2 2.2 3.6 3.6 2.0 Year 1919......................... 1920......................... 1921......................... 1922......................... 1923......................... 1924......................... Death Num rate per Population ber of 1,000,000 deaths popula tion 5.200.000 5.400.000 5.500.000 5.600.000 5.700.000 5.800.000 18 13 20 25 22 26 3.5 2.4 3.5 4.5 3.9 4.5 In Australia the rate has shown a tendency to increase rather than to decrease, though the situation is more or less stationary. NEW ZEALAND Lead poisoning is relatively uncommon in New Zealand, where lead-using industries are not developed on a large scale, but Table 26 gives the returns for 1912 to 1923. T a b l e 2 6 . —DEATHS FROM CHRONIC LEAD POISONING IN N EW ZEALAN D, 1912 TO 1923' B Y YEARS Year 1912......................... 1913.......................... 1914......................... 1915.......................... 1916......................... 1917.......................... Num Population ber of deaths 1,052,627 1,084,662 1,095,994 1,102,794 1,100,563 1,097,672 4682°—27---3 Death rate per 1,000,000 popula tion 2 1.8 3 2.7 Year Population 1918......................... 1919......................... 1920......................... 1921......................... 1922......................... 1923......................... 1,108,373 1,177,405 1,207,835 1,239,966 1,265,397 1,290,000 Death Num rate per ber of 1,000,000 deaths popula tion 1 3 1 0.9 2.5 .8 1 1 .8 .6 14 DEATHS FROM LEAD POISONING ITALY There is also included in the present discussion a rather interesting return on chronic lead-poisoning deaths in Italy covering the period 1908-1915, later records being as yet unavailable. It is shown by Table 27 that the rate has not been excessive, but corresponds in a general way with the rate for this country, while there is apparently a slight decrease. T a b l e £ 7 . —DEATHS FROM Year 1908 ........................ 1909 ........................ 1910......................... 1911......................... CHRONIC LEAD POISONING IN IT A LY , 1908 TO 1915, B Y YEARS Num Population ber of deaths 33,826,688 34,077,068 34,376,610 34,688,814 58 64 57 54 Death rate per 1,000,000 popula tion 1.7 1.9 1.7 1.6 Year Population 1912......................... 1913......................... 1914......................... 1915......................... 35,026,486 35,418,391 35,858,951 36,394,325 Death Num rate per ber of 1,000,000 deaths popula tion 70 56 48 55 2.0 1.6 1.3 1.5 PARIS, FRANCE Finally, I include in the foreign statistics Table 28, covering deaths from chronic lead poisoning in Paris during the period 1908-1919. T a b l e 28.—DEATHS FROM CHRONIC LEAD POISONING IN PARIS, 1908 TO 1919, B Y YEARS Year 1908_____ _________ 1909 ....... .............. 1910.......................... 1911_____ ________ 1912......................... 1913........................ Num Population ber of deaths 2,772,530 2,797,430 2,822,329 2,888,110 2,889,946 2,891,782 20 30 20 15 14 18 Death rate per 1,000,000 popula tion 7.2 10.7 7.1 5.2 4.8 6.2 Year 1914......................... 1915......................... 1916......................... 1917......................... 1918......................... 1919......................... Death Num rate per Population ber of 1,000,000 deaths popula tion 2,893,618 2,895,454 2,897,291 2,899,127 2,900,983 2,902,799 10 8 12 8 5 9 3.5 2.8 4.1 2.8 1.7 3.1 The returns for Paris also indicate a material decline during the period under observation, corresponding to the observed decline in chronic lead poisoning in this country. OPPELN, GERMANY Efforts were made to secure statistics for Germany, but the data furnished are not so comprehensive as would be desirable. Table 29 gives a record of sickness^ experience of persons employed in lead smelters in the administrative district of Oppeln. T a b l e 3 9 . — CASES OF LEAD POISONING IN LEAD SM ELTERS I N T H E A D M IN ISTR A TIVE D ISTR IC T OF OPPELN, G E R M AN Y, 1903 TO 1912, B Y YEARS Year 1903.......................... 1904.......................... 1905.......................... 1906.......................... 1908.......................... Number Number of workers of cases 875 912 999 897 828 340 321 329 190 165 Case rate per 1,000 workers 388.6 352.0 329.3 211.8 199.3 Year 1909......................... 1910......................... 1911......................... 1912......................... Number Number Case rate of per 1,000 workers of cases workers 834 803 798 822 106 204 224 277 127.1 254.0 280.7 337.0 DEATHS FROM LEAD POISONING 15 PART IL— ANALYSIS OF DEATHS FROM CHRONIC LEAD POISONING IN THE UNITED STATES REGISTRATION AREA, 1914-1924 For the purpose of a reasonably thorough study of the recent chronic lead poisoning situation, I decided upon a detailed examina tion of the original death certificates representing the recorded mortality in the United States registration area during the 11 years 1914 to 1924. Through the courtesy of William M. Davis, chief of the division of vital statistics of the United States Bureau of the Census, I was able to obtain transcripts of original death certificates comprehending the entire recorded mortality frotn chronic lead poisoning during the 11 years under observation, repre sented by 1,592 deaths. This mortality was found to have been distributed, by principal occupations or otherwise, as follows: T a b l e 30.—OCCUPATIONAL DISTRIBU TION OF DEATHS FROM CHRONIC LEAD POISONING, U NITED STATES REGISTRATION AREA, 1914 TO 1924 Occupation Lead workers________________________ Metal miners__ . . . ________________ . . . Painters-____ . . . . . ___________________ Paint mixers__ . . . . . . _________________ Plumbers____________________________ Potters and tile workers_____________ Rubber workers._______ _____________ Storage battery workers_______________ Printers_____________________________ Tin and coppersmiths Glass industry_____ __________________ Metal workers...... .................................... Number of deaths 62 35 841 15 25 13 3 5 67 g 9 23 Occupation Carpenters and joiners________________ Laborers_________________ . . . ________ Farmers___ __________ ______________ Professional________________________ Miscellaneous______ _________________ Unknown or retired__________________ W omen _______________________ ______ Boys under 1 8 .. ______ __________________ Girls under 18........................................ ......... T o t a l ................................. Number of deaths 18 93 61 29 114 103 48 11 8 1,592 As far as known, this is the first definite statement of its kind ever published revealing the true extent of the mortality from chronic lead poisoning among the American people. It brings out the startling fact that a considerable proportion of the deaths are non industrial or not connected directly with lead-using industries. This conclusion will be more clearly emphasized in a detailed analysis of the different 21 groups. It will certainly prove a surprise that 48 of the deaths should have occurred among women a and 19 of the deaths among boys and girls under 18 years of age. Of particular interest also is the relative frequency of chronic lead poisoning among farmers, who are, of course rarely exposed to the risk of industrial lead poisoning, except occasionally in connection with painting jobs done on the farm. • With reference to the liability of women to lead poison, it may be said that excepting five deaths, all the deceased were nonindustrial. Of the five deaths, one was a school tcacher, one a florist, one a weaver, one a dressmaker, and one a waitress, all involving no industrial occupational lead hazard. DEATHS FROM LEAD POISONING 16 A question of considerable interest is the age distribution at death from the disease, which will be dealt with in each and every group individually, but which is here briefly summarized in Table 31. T a b l e 3 1 . — AVERAG E AGE A T D EATH FROM CHRONIC LEAD POISONING, 1914-1924, B Y OCCUPATION Occupation Lead workers.............. Metal miners.............. Painters....................... Paint mixers................ Plumbers..................... Potters......................... Rubber workers............... Storage battery workers.. Printers....................... Tin and coppersmiths.... Glass industry............ Metal workers_______ Aver Num Aggre gate age age ber of years at death deaths of life (years) 62 35 841 15 25 13 3 5 67 9 9 2,808 1,507 43,165 659 1,205 588 141 228 3,044 438 345 987 45.3 43.1 51.3 43.9 48.2 45.2 47.0 45.6 45.4 48.7 38.3 42.9 Occupation Num Aggre Aver gate age age ber of years at death deaths of life (years) Carpenters and joiners... Laborers_______________ Farmers..____________ _ Professional_________ __ Miscellaneous_________ . Unknown______________ Women_______________„ Boys under 18_____ ___. . . Girls under 18_________ . . . 18 93 61 29 114 103 48 11 8 1,035 3,894 3,460 1,463 5,396 5,440 2,485 84 41 57.5 41.9 56.7 50.4 47.3 52.8 51.8 7.6 5.1 Total...... ................ 1,592 78,413 49.3 According to this tabulation the average age at death in 1,592 fatal cases of chronic lead poisoning was 49.3 years, while, leaving out of consideration boys and girls, the average was as high as 57.5 years for carpenters and joiners and as low as 38.3 years for the glass industry. The boys and girls were mostly little children who accidentally contracted lead poisoning as the result of reckless exposure. LEAD WORKERS In the group of lead workers there occurred 62 cases, distributed as follows: At smelting plants there occurred 28 deaths, of an aggregate age of 1,334 years and an average age of 47 years. Some of the smelting operations were unquestionably merely incidental to other lead plants while most of the smelters were probably chiefly devoted to lead production processes. Other smelting plants were in connection with silver and zinc smelting. The largest number of deaths in any one State occurred in smelting plants in Utah, where there were 9 deaths, mostly in and about Salt Lake City. A specific occupation mentioned is “ yard foreman,” but the remainder of the deaths were of laborers. There were 3 deaths in Colorado, one of which occurred at a silver smelter; 2 in Kansas, 2 in Nebraska, 4 in Missouri, 1 each in Washington and Texas, 2 in Illinois, 3 in Essex County, N. J., and 1 in Brooklyn, N. Y. Of deaths of lead workers not otherwise specified, practically all common laborers, there were 19, and of this number 5 were colored persons, most of whom were employed in East St. Louis and in Essex County* N. J. Four deaths were returned of lead burners, 2 of whom were em ployed in New Jersey, 1 in Maryland, and 1 in Indiana. There were only 8 deaths of persons (2 of whom were colored) directly con DEATHS FROM LEAD POISONING 17 nected with white lead plants, as far as it is possible to judge from the certificates. One of the plants in question was located in Essex County, N. J.; 2 in Cook County, N. Y.; 1 in Philadelphia; 2 in St. Louis; 1 at Anderson, Mo.; and 1 in Madison County, 111. One of the persons was a fireman, 1 was a packer, and 1 was a foreman and the remainder were laborers. One person died from chronic lead poisoning while employed in a lead-dipping shed in a cutter factory in Michigan, and 1 was a lead puller at a white lead works in East St. Louis. Finally, there was 1 person engaged in spraying lead who died from chronic lead poison ing in Detroit. In Table 32 is given the age distribution at death of lead workers from chronic lead poisoning, which will be useful for comparative purposes. The lowest age at death was 17 years and the highest age 78. T a b l e 33.—DEATHS OF LE AD Age group Under 20 years_______________ 20 to 29 years_________________ 30 to 39 years 40 to 49 y e a rs___ ____ ______ _ 50 to 59 years_________- _____ — W ORKERS FROM CHRONIC LE AD POISONING, BY AGE GROUPS Num ber Per cent 2 6 15 16 9 3.2 9.7 24.2 25.8 14.5 Age group Num ber Per cent 60 to 69 years___________ 70 years and over__________ . . . 13 1 21.0 1.6 Total. ............................ 62 100.0 MINERS Among miners there were 35 deaths from chronic lead poisoning, excluding 1 death of a coal miner, which was included in miscellaneous occupations. The mining occupations represented by this group were as follows: Number of deaths Mining and quartz mining________________________________ Silver lead mines_________________________________________ Lead mines______________________________________________ Jiggerman in mines_______________________________________ Laborer in mines_________________________________________ Zinc miner______________________________________________ 28 2 2 1 1 1 Total_____________________________________________ 35 By States the distribution of the deaths have been as follows: California, 2; Washington, 3; Colorado, 4; Utah, 14; Montana, 1; Kansas, 3; Missouri, 5; Illinois, 1; Virginia, 1; and Florida, 1. The 14 deaths in Utah were distributed by locality as follows: Salt Lake, 7; Summit County, 3; Toole County, 2; Wasatchie County, 1; and Jordan County, 1. The Missouri deaths occurred in St. Louis (2), Jasper County (2), and Jefferson County (1). Of the total deaths 12 were persons of foreign birth, 5 having been bom in Austria, 2 in Finland, 1 in Poland, 1 in Russia, 1 in Germany, 1 in Denmark, and 1 in England. The number of deaths of single persons was 11 and of married persons 24. By divisional periods of life the ages at death follows. 18 DEATHS FROM LEAD POISONING T a b l e 3 3 . — DEATHS OF M IN ERS FROM CHRONIC LE AD POISONING, B Y AGE GROUPS Age group Num ber Per cent 6 9 11 4 17.1 25.7 31.4 11.4 20 to 29 years__ __ . __ ____ . __ 30 to 39 years____ __. . . _______ 40 to 49 years 50 to 59 years_. ___ _____. . __ Num ber Age group Per cent 60 to 69 years_____ ____ ____ . . . 70 years and over___ __ ____ . . . 4 1 11.4 2.9 Total_________ _________ 35 100.0 The aggregate number of years lived by the 35 miners was 1,507, giving an average age of 43.1 years. The deaths occurring in the individual years were as follows: 1914, 6; 1915, 6; 1916, 4; 1917, 4; 1918, 3 (1914-1918, 23); 1919, 1; 1920, 4; 1921, 2; 1922, 2; 1923, 2 (1919-1923, 11); 1924, 1—making a total of 35 deaths. PAINTERS Deaths from chronic lead poisoning among painters represent ap proximately one-half of the total mortality during the period under observation. There were in the aggregate 841 deaths of painters distributed during the period 1914-1924, as follows: T a b l e 34.—DEATHS OF PAINTERS FROM CHRONIC LEAD POISONING, 1914-1924, BY YEARS Year or period Aver Num Aggre age age gate ber of years at death deaths of life (years) 1914................................... 1915...................... —......... 1916................................... 1917................................... 1918................................... 81 85 99 75 67 3,992 4,266 5,096 3,790 3,440 49.3 50.2 51.5 50.5 51.3 Total, 1914-1918.... 407 20,584 506 Year or period Aver Num Aggre gate age age ber of years at deaths of life death (years) 1919................................... 1920................................... 1921................................... 1922................................... 1923................................... 72 67 73 74 74 3,812 3,430 3,771 3,834 3,845 52.9 51.2 51.7 51.8 52.0 51.9 Total, 1919-1923.__ 360 18,692 1924................................... 74 3,889 52.6 Total, 1914-1924.... 841 43,165 51.3 It is shown that the average age at death has increased from 49.3 years in 1914 to 52.6 years in 1924. During the first five years of the period the average age at death was 50.6 years, while during the five years ending with 1923 it was 51.9 years. Distributed by divisional periods of life, the mortality has been as follows: TABLE 35.—DEATHS OF PAINTERS FROM CHRONIC LE AD POISONING, 1914-1924, BY AGE GROUPS Deaths Age group 20 to 29 years______ ______ 30 to 39 years..___________ iA t.AAQvpArfi 60 to 59 y e a r s ......._______ Num ber 33 112 214 257 Per cent 3.9 13.3 25.4 30.6 Aggre gate years of life 858 3,958 9,550 14,011 Deaths Age group Num ber Per cent Aggre gate years of life 60 to 69 years_____________ 70 to 79 years_____. . . . ____ 179 46 21.3 5.5 11,454 3,334 Total.......................... 841 100.0 43,165 DEATHS FROM LEAD POISONING 19 The geographical distribution of deaths from chronic lead poisoning among painters during the period 1914-1924 is given in Table 36. T able 3 6 . — GEOGRAPHICAL DISTRIBUTION OF DEATHS OF CHRONIC LEAD POISONING, 1914-1924 Number of deaths State Connecticut....................... Rhode Island..................... Massachusetts................... New Hampshire................ Vermont............................. Maine.__.......................... . Total, New England 131 New York.......................... New Jersey........................ . Pennsylvania...................... 127 52 96 Total........................ . 275 Ohio................................... Illinois................................ . Indiana.............................. . Michigan........................... . Wisconsin............................ Minnesota......................... Iow a ................................. . Nebraska........................... . Missouri.............................. Kansas............................... . Total, Central West 242 PAINTERS, FROM Number of deaths State District of Columbia............ Maryland.............................. Virginia............- ................... West Virginia....................... Tennessee.............................. Kentucky............................ . North Carolina..................... South Carolina..................... Georgia................................ Florida.................................. Alabama.............................. Mississippi............................ Louisiana.............................. Texas..................................... 16 9 5 16 9 2 7 12 9 11 5 4 4 1 Total, Southern States 110 California.......... .................. Oregon................................... Washington........................... Colorado................................ Utah...................................... Montana............................... Hawaii................................... 54 5 14 5 Total, Pacific coast___ 83 2 2 1 Grand total................. It would have been of interest had it been possible to have given frequency rates in proportion to the total number of painters ex posed to risk. But such a calculation is not possible in the absence of accurate information regarding the geographical distribution of painters for the period under observation. It is possible, however, to work out an approximate death rate of painters from chronic lead poisoning on the basis of the available membership of painters’ unions as given in the report on The Growth of American Trade Unions, by Leo Wolman, published by the National Bureau of Economic Research in 1924. This, of course, does not make allow ance for the painters not connected with labor organizations, but their number in proportion to the total is probably relatively small. In any event, it will be sufficient to make allowance for this omis sion and consider that the rate is somewhat understated throughout the period under observation. T a b l e 37.—CHRONIC LEAD POISONING: DEATH RATES OF PAINTERS, BASED ON T R A D E-UNION M EM BERSHIP, 1914 TO 1924, BY YEARS Year 1914................................... 1915................................... 1916................................... 1917................................... 1918...................... ............ 1919................................... Tradeunion Total mem num ber of ber ship deaths 74,400 75,300 78,200 85,200 84,500 82,700 81 85 99 75 67 72 Death rate per 1,000 union mem bers 1.09 1.13 1.27 .88 79 .87 Year 1920................................... 1921................................... 1922................................... 1923................................ 1924__ _ _____________ Trade- Total union mem num ber of ber ship deaths 103,100 113,300 97.800 92.800 93,500 67 73 74 74 74 Death rate per 1,000 union mem bers 0.65 .64 .76 80 .79 20 DEATHS FROM LEAD POISONING Granting the inherent deficiencies of this tabulation the results are nevertheless of considerable interest as suggestive of a measurable decline in the relative frequency of chronic lead poisoning among painters during the period 1914-1924. It would, of course, serve no practical purpose to have worked out frequency rates on the basis of the general population. But for certain large cities some additional information may be of interest. The number of deaths from chronic lead poisoning in Boston, Mass., during the period under observation was 16. In New York City it was 69, distributed by boroughs as follows: Manhattan, 27; Brooklyn, 24; Bronx, 9; Queens, 7; Richmond, 2. In Philadelphia there were 24 deaths; in Newark, 8; in Cincin nati, 9; in Cleveland, 16; in Columbus, 6; in San Francisco, 13; and in Los Angeles, 7. For other cities the numbers are too small to justify extended consideration. The economic loss from chronic lead poisoning is, of course, partly proportionate to the marital condition. It has therefore seemed of some value to extract from the data the information as regards the married and single, with the following results. Of the 841 deaths from chronic lead poisoning among painters 134 were of single persons while 707 were of married, widowed, or divorced; in other words, the proportion of the unmarried was 15.9 per cent. This proportion can be compared with the proportion of the unmarried in other important occupations. The race factor is not apparently of much relative importance, except in certain specified lead-using industries in which a con siderable number of negroes are employed. Whether the latter have a lesser or greater liability to lead poisoning can not be deter mined. For painters I have extracted such information for the Southern States only, and it shows that out of 110 deaths from chronic lead poisoning 18 were deaths of colored persons. The question of nativity is somewhat more significant, but here again it is not possible to calculate frequency rates for the different racial elements. As a matter of interest, the following information is, however, included. Of the 841 deaths, 224 were deaths of painters born in foreign countries, distributed as follows: Fifty-six were born in Germany, 28 in Canada, 22 in Russia, 20 in Ireland, 20 in Sweden, 15 in England, 13 in Austria, 10 in Hungary, 9 in Norway, 6 in Italy, 4 in Denmark, 3 each in Scotland, Poland, and France, 2 each in Finland, Rumania, Belgium, and Spain, and 1 each in Greece, Switzerland, Holland, and China. I have throughout proceeded upon the assumption that the present methods of death certification are at least approximately complete and scientifically correct. A careful examination of each and every certificate leaves a question of doubt in a small number of cases in which the word “ probably” is used, while in others circumstances justify a suspicion of incorrectness. Examining the certificates with particular reference to contributory causes or conditions it is evident that the terms have been introduced convertibly as regards primary and secondary causes; in other words, in some cases lead poisioning is given as the primary cause and in others as the contributory cause. But under a rule of statistical practice of the Census Office all such certificates are listed in the final classification as deaths from chronic lead poisoning which is assumed to be the primary cause through DEATHS FROM LEAD POISONING 21 out. The contributory causes are of considerable interest, and they have therefore been separately tabulated with the following results: T a b l e 38.—C O N TRIBU TORY CAUSES OF DEATHS OF PAINTERS, FROM CHRONIC L E AD POISONING, 1914-1919 Contributory causes Num Aggre gate ber of years deaths of life Aver age age at death (years) 9,499 5,908 3.320 2,378 2.320 1,999 1,923 1,118 1,254 881 558 49.2 52.3 58.2 45.7 52.7 52.6 54.9 48.6 54.5 51.8 50.7 452 50.2 Chronic and acute ne phritis........................... Cardiovascular............... . Arteriosclerosis............... . Intestinal and digestive.. Respiratory.................... . Apoplexy......................... Anemia........................... . Encephalitis................... . Paralysis.......................... Liver diseases.................. Spinal cord..................... . Tumors, benign, and ul cers.............................. . 193 113 57 52 44 38 35 Contributory causes Aver Num Aggre age gate age at ber of years deaths of life death (years) Miscellaneous.................. No complications............. 9 4 3 3 2 2 1 1 49 152 450 190 149 125 116 108 57 41 2,589 7,730 50.0 47.5 49.7 41.7 58.0 54.0 57.0 41.0 52.8 50.9 Total....................... 841 43,165 51.3 Insanity........................... Alcoholism.................. . Diabetes........................... Appendicitis.................... Leucaemia....................... Drug addiction—............. Tuberculosis............ ........ Chronic and acute nephritis.—The outstanding fact of the preceding table is the predominating occurrence of acute and chronic nephritis in complication with chronic lead poisoning. Since there is some question as to the absolute accuracy of the statements it does not seem advisable to separate acute from chronic nephritis cases or from other renal complications. The average age at death in these cases was 49.2 years, which compares with 51.3 years for all the cases whether complicated or not. Cardiovascular diseases.—The second most important complication is the group of cardiovascular diseases, chiefly myocarditis. Here again it has not seemed advisable to specify the different forms of complications in the table but myocarditis appears to have been more common than endocarditis. In a good proportion of cases there was dilation of the heart, in others, mitral insufficiency, and in still others, cardiac asthma or aortic insufficiency. In 11 cases chronic lead poisoning was complicated by angina pectoris. The specified indications of myocarditis number 34 and of endocarditis 11. Arteriosclerosis complicated lead poisoning in 57 cases, the average age at death being 58,2 years. In a few cases arteriosclerosis com plicated other oirculatory affections included under diseases of the heart. Intestinal and digestive complications accounted for 52 cases with an average age at death of 45.7 years. This group includes a large variety of affections which it would hardly serve a useful purpose to discuss in matters of detail. As would be natural in chronic lead poisoning there are quite a number of cases of intestinal obstruction, intestinal paralysis, diarrhea, etc., but none of them seem to be of special significance. Respiratory affections of a nontubercular type occurred to the num ber of 44 cases, chiefly in the form of pulmonary embolism, pneu monia, lung abscesses, pulmonary oedema, lung paralysis, etc. The average age at death in these cases was 52.7 years. Apoplexy and brain softening.—There were 38 cases of this group, of an average age of 52.6 years. The certificates reveal no facts of special interest. 4682°—27------1 22 DEATHS FROM LEAD POISONING Anemia, both in the common and the pernicious form, occurred to the extent of 35 cases, of which 17 specified the anemia as having been of the pernicious type, while 7 stated it to have been of the secondary type. The average age at death in these cases was 54.9 years. Encephalitis occurred in 23 cases with an average age at death of 48.6 years. The inflammation of the encephalon or brain is of comparatively common occurrence in fatal cases of lead poisoning, but no doubt often obscured by other concurrent diseases to which the preference is given in death certification. Legge and Goadby, in their treatise on Lead Poisoning, give a tabulation of cases of encephaloma which shows a fairly consistent occurrence in Great Britain. They also describe a case of chronic lead encephalitis, with an examination of the nervous system, which may be referred to for the purpose of a better understanding of this important aspect of lead poisoning. Paralysis is one of the most important contributory effects in chronic lead poisoning but apparently not as common at the present time as would be assumed. There were only 23 cases of various forms of paralysis but mostly of the progressive type involving the extrem ities. Unfortunately, the death certificates do not contain much information regarding the part or portion of the body chiefly affected corresponding to those which are included in the treatise by Legge and Goadby, which indicates a larger relative degree of frequency than is met with in this country. Liver.—Diseases of the liver have been almost as common as paralysis. There were 17 cases, with an average age at death of 51.8 years. In 11 of these cases, the affection was cirrhosis of the liver. Curiously enough, Legge and Goadby do not mention liver diseases in their tabulation of 264 cases. It is, of course, an open question as to how far those cases were complicated by alcoholism. Of the other complicating diseases special reference may be made to ulcers and benign tumors. There were 9 of these cases, of an average age at death of 50.2 years. In view of the extended recent discussion of the possible influence of lead on malignant tumors, the question has arisen whether cancer is met with among workers exposed peculiarly to lead poison. The present investigation con cerned with 841 death certificates does not reveal a single case in which the occurrence of malignant tumor concurrently with lead poisoning is indicated. Ulcers, abscesses, and benign tumors, how ever, have occurred, and in detail were as follows: One case was that of a chronic epileptic who had what is referred to as probably a brain tumor, most likely of a nonmalignant type; 5 cases were gastric or peptic ulcers; 1 case was an ulcer of the duodenum, 1 a case of ulcer ative colitis, and 1 a pelvic abscess. There were 4 cases of alcohol ism, 3 of diabetes, and 3 of appendicitis, and 2 drug addicts. There was 1 case of tuberculosis, probably pulmonary, and 1 case of goiter in a painter, aged 41 years, who died in Holt County, Nebr. The proportion of cases of insanity seems rather large, there having been D cases at an average age of 50 years. In 1 of these cases chronic lead poisoning is referred to as the cause of paresis, while the other cases of this type of insanity are referred to as acute and chronic melancholia, possibly directly induced by the physical condition re sulting from lead poisoning. DEATHS FROM LEAD POISONING 23 Of the miscellaneous affections, which number 49, reference may be made to 4 cases of sclerosis, 3 of peritonitis, 3 of neuritis, 4 of rheumatism, 3 of thrombosis, and 2 of meningitis. Death certificates indicating no complications number 152, of which the average age was 50.9 years. For all cases combined, with or without complications, the average age at death, as previously stated, was 51.3 years. I conclude the foregoing discussion with Table 39, showing the age distribution by divisional periods of life for the four principal joint causes and for the group without complications. T able 39.—C ON TRIBU TORY CAUSES OF DEATHS OF PAINTERS FR OM CHRONIC LEAD POISONING, 1914HL919, B Y AGE GROUPS Cardio vascular Nephritis Arterio sclerosis No compli cations Anemia Age group Num ber Per cent Num ber Per cent Num ber Per cent Num ber Per cent Num ber Per cent Under 30 years_____ 30 to 39 years............ 40 to 49 years............ 60 to 59 years______ 50 to 69 years............ 70 to 79 years............ 4 34 60 57 32 6 2.1 17.6 31.1 29.5 16.6 3.1 2 16 31 25 33 6 1.8 14.2 27.4 22.1 29.2 5.3 1 8 22 21 5 1.8 14.0 38.6 36.8 8.8 3 5 13 12 2 8.6 14.3 37.1 34.3 5.7 9 19 36 52 24 12 5.9 12.5 23.7 34.2 15.8 7.9 Total.............. 193 100.0 113 100.0 57 100.0 35 100.0 152 100.0 PAINT MIXERS There have been only 15 deaths of paint mixers during the 11year period, who died at an average age of 43.9 years. The certifi cates reveal nothing of special interest, with the possible exception of one case in which a laborer was employed as a maker of paint sand paper at a Ford plant in the city of Newark, N. J. An even more interesting case is that of a salesman for a paint and glass house, who may possibly have formerly been a worker. This death occurred in Highland Town, Md. There was also the death of a fore man of a paint company in St. Louis, Mo. Three of the deaths were of negroes. PLUMBERS Relatively to the number of plumbers employed throughout the country the number of deaths from lead poisoning appears dispro portionately low. The number of plumbers in labor organizations is fortunately known so that an approximate estimate can be given. There were 25 deaths during the 11-year period, distributed by age groups as follows: T a b l e 40.—DEATHS OF PLU M BERS FROM CHRONIC LEAD POISONING, 1914-1924, B Y AGE GROUPS Age group 20 to 29 years.......................................................................................................... ......... 30 to 39 years........................................................... .......................................... ............ . 40 to 49 years_______ _____ ____ _____________ _____ _____ ______________ ________ 50 to 59 years..................................................................................................................... 60 to 69 vears _ _ T otals Num ber Per cent 4 4 10 5 2 16 16 40 20 8 25 100 24 DEATHS FROM LEAD POISONING The union membership has changed so much from year to year that it probably does not exceed at the present time 60,000, which if increased by an arbitrary estimate of the nonunion membership, would give an approximate number of 100,000 plumbers throughout the country, which for the year 1924 would give a rate of 7 per 100,000. This can not be considered excessive and may be compared with the corresponding rate for painters given as 79 in the previous discussion. There have been included in this group three acetylene burners or welders. Two of the deaths occurred in Philadelphia and one in the city of Detroit, Mich. The subject of lead poisoning among acetylene burners has been discussed with admirable thoroughness by Lieut. Commander E. W. Brown in the United States Naval Medical Bulletin for 1925. I quote from a summary of his conclusions the following statement: The lead poisoning in this study was induced by the inhalation of lead volatil ized in fumes arising from the burning of paint adherent to scrap metal in the process of cutting by the oxyacetylene torch. The lead particles are extremely fine being about one-half micron for the average diameter, or one-fifteenth of the diameter of a red blood cell. With reference to the admissions it is said: Eighty-three first admissions of plumbism over a period of observation approxi mating 8 months—i. e., from June 6, 1924, to February 15, 1925; 29 recurrences; total of 112 cases; number of men employed the entire time, 221; number work ing not less than 1 week, 201; average period worked per man, 3.6 months; 37.5 per cent of first admissions and 50.7 per cent of total admissions based on 221 men; 41.2 per cent and 55.7 per cent based on 201 men. Of the 82 cases of plumbism, the shortest period was 7 days, the longest 13.2 months, the average 2.4 months. The duration of disability varied from 3 days to 69 days, average 20 days. For first admissions the rate varied from 225.3 per 1,000 in June, 1924, to 5,830 in January, 1925. The average admission rate was 2,578 per 1,000 for all classes. The preventive measures recommended are as follows: The essential requirement is a protective apparatus to prevent the inhalation of the lead fume. Among the various devices tested the modified Burrell indus trial gas mask was found to be decidedly the most efficient. POTTERS AND TILE WORKERS The occupation of potters and tile workers is generally thought of as one in which lead poisoning is proportionately still of considerable frequency. As a matter of fact, the present investigation reveals a surprisingly small number of fatal cases. There have been in the aggregate only 13 cases, distributed by specific occupations, as fol lows: Potters, 3; dippers, 3; kiln men, 1; enamelers, 5; and tile workers, 1. Five of these cases were of persons born in foreign countries, 2 having been born in England, 1 in Ireland, 1 in Sweden, and 1 in Poland. By conjugal condition, 11 were married while 2 were single. The average age at death was 45.2 years. One of the deaths occurred in 1914, 2 in 1916, 1 in 1917, 1 in 1918, 2 in 1919, 1 in 1920, 3 in 1922, 1 in 1923, and 1 in 1924. The membership of the potters’ labor organizations in 1920 was 8,000. The number of wage earners employed in the pottery industry in 1920 was returned by the census as 29,273 Assuming, therefore, an average member ship of 30,000 for the 11-year period and making no allowance for DEATHS FROM LEAD POISONING 25 ©namelers and tile workers, who have been included in the mortality returns, the average fatality rate from chronic lead poisoning was approximately 4.3 per 100,000. In this connection references may be made to a consolidated mor tality report for the 9 years ending with 1923 published by the National Brotherhood of Operative Potters. In the aggregate there were 839 deaths, of which only 2 were specifically attributed to lead poisoning. RUBBER WORKERS Of rubber workers there were only 3 deaths each reported from Passaic, N. J.; Providence, R. I.; and Walpole, Mass. STORAGE BATTERY WORKERS The occupation of storage battery workers is frequently referred to as one of exceptional hazard, with particular reference to liability to chronic lead poisoning. A special bulletin on the subject published by the United States Bureau of Labor Statistics in 1915 1 gives a record of 164 cases of chronic lead poisoning among 915 workers in 5 large factories during 1913, equivalent to a rate of 17.9 per cent of the number of persons employed. Information derived from other sources, particularly the New York Department of Labor, is decidedly suggestive of an extraordinarily higher degree of frequency of cases of lead poisoning in the manufacture of electric storage batteries, but as far as it is possible to judge the affections as a rule are nonfatal and are of a comparatively slight degree of intoxication. Be this as it may, it is certainly suggestive that there have been only 5 deaths reported for the United States registration area for the 11 years ending with 1924, or 1 in 1915, 1 in 1917, 2 in 1919, and 1 in 1920. The cases occurred at the following points: Two in Chicago, 1 in St. Louis, 1 in Camden, N. J., and 1 in Philadelphia. None appeared to have occurred at Niagara Falls, from which a large number of cases have been reported through the New York Depart ment of Labor. The experience suggests possible inaccuracies in death certification in connection with lead poisoning, well deserving of more extended consideration. PRINTERS The printing trades have for many years been charged with a specific and exceptional liability to chronic lead poisoning. It is rather curious that most of those who have written on the subject should have been satisfied with rather crude data, in many cases derived from foreign sources. Granting that deaths from chronic lead poisoning are not necessarily a satisfactory index of disease liability in the nonfatal form, it is, nevertheless, decidedly suggestive that during the last 11 years only 67 deaths from chronic lead poison ing should have been reported for the United States registration area for the different branches of the printing trades. The death certificates, unfortunately, do not indicate the specific occupation followed, with a few exceptions in which the employment is given 1U. S. Bureau of Labor Statistics Bui. No. 165: Lead poisoning in the manufacture of storage batteries. Washington, 1915. 38 pp. 26 DEATHS FEOM LEAD POISONING as that of linotype or monotype operator. The approximate number of printing employees in the United States is probably not less than 300,000, while the average number of deaths from chronic lead poison ing is about 6; in other words, the frequency rate is equivalent to about 2 per 100,000 workers. Of course, a considerable proportion of these workers are not in any way exposed to the risk of lead poison ing, but for the present it is not feasible to calculate more specific death rates for particular branches of the printing trades. The 67 deaths which occurred were distributed during the last 11 years as follows: T a b l e 41.—DEATHS OF PRINTERS FROM CHRONIC LEAD POISONING, 1914-1924, B Y YEARS Year Aver age age Num Aggre gate at ber of years death cases of life (years) Year Aver Num Aggre gate age age ber of years at cases of life death (years) 1914 1915 ........................... . 1916................................... 1917 1918................................... 5 4 11 4 2 238 168 534 185 61 47.6 42.0 48.5 46.3 30.5 1921................................... 1922................................... 1923................................... 10 7 10 445 314 487 44.5 44.9 48.7 Total, 1919-1923.... 38 1,739 45.8 Total, 1914-1918.... 26 1,186 45.6 1924................................... 3 119 39.7 302 191 43.1 47.8 Total, 1914-1924.... 67 3,044 45.4 1910................................... 7 4 The distribution of deaths by divisional periods of life is given below: T a b l e 42 .—DEATHS OF P R IN TE R S Age group Under 20 years_______________ 20 to 29 years_________________ 30 to 39 years_________________ 40 to 49 years 50 to 59 years___ __ ___________ FROM CHRONIC LE AD POISONING, B Y AGE GROUPS Num ber Per cent 2 5 9 27 15 3.0 7.5 13.4 40.3 22.4 Age group Num ber Per cent 60 to 69 years........... .................. 70 to 79 years_________________ Unknown____________ _______ 3 5 1 4.5 7.5 L5 Total.................................. 67 100.0 The youngest death occurred at the age of 19 and the oldest at the age of 75. The subject of lead poisoning in the printing trades will be ex haustively dealt with in a forthcoming report on Health Survey of the Printing Trades,2 which includes extended field investigations and analysis of the mortality experience of printers’ labor organiza tions for recent years. The evidence contained in that report will confirm the conclusion that th# rate of fatal incidence is not a matter of serious concern at the present time, while the relative frequency of the affliction is unquestionably diminishing. Of the 67 printers who died from chronic lead poisoning, 13 were single and the re mainder were married, widowed, or divorced. Only one was a colored person. All but a few were native born, there having been 2 deaths of printers born in England, 1 in Ireland, 2 in Canada, 1 in Germany, * U. S. Bureau of Labor Statistics Bui. 427. {In press.] DEATHS FROM LEAD POISONING 27 and 1 in Italy. The outstanding complicating diseases were ne phritis in six different forms, there having been 19 cases, or 28.4 per cent. Other complications were not of sufficient numerical impor tance to justify detailed consideration. The average age at death for this group was 45.4. TIN AND COPPER SMITHS In the group of tin and copper smiths there occurred 9 deaths from chronic lead poisoning, of which 6 were returned as tinners and 3 as coppersmiths, including 1 mentioned as a coppersmith’s laborer. The average age at death in these cases was 48.7 years. The certifi cates reveal nothing additional of special interest. GLASS WORKERS There were 9 deaths of workers in the glass industry, occurring at an average age of 38.3 years. The occupational distribution is fairly well indicated, the different employments having been as follows: One glass worker, 1 laborer in a plate-glass company, 1 glass molder, 1 glass mixer, 1 glass decorator, 1 glass cutter, 2 glaziers, and 1 glass worker not otherwise specified. Deaths occurred in the following places: Philadelphia, 1; Beaver County, Pa., 1; Chicago, 1; Oak Park, 111., 1; Jefferson County, Mo., 1. Of the 9 glass workers 6 were foreign born, 1 having been born in Germany, 1 in Bohemia, 2 in Austria, 1 in England, and 1 in Italy. METAL WORKERS The group “ Metal workers” includes a variety of specific occupa tions which for the sake of convenience have been combined. There were 23 deaths in this group, of an average age of 42.9 years, dis tributed by specific occupations as follows: Metal pattern maker_____________________________________ __ 1 Sheet metal workers________________________________________ 3 Laborer in iron shop_____________ _________________ ________ 1 Metal polishers__________________________________________ __ 2 Iron worker_____________________________________________ __ 1 Helper in machine shop_____________________________________ 1 Moulder________________________________________________ __ 1 Foundry worker_________________________________________ __ 1 Superintendent metal specialties_____________________________ 1 Laborer in steel works____________________________________ __ 1 Riveter_________________________________________________ __ 1 Metal workers not otherwise specified______________________ __ 2 Machinists______________________________________________ 7 Six of the 23 were single. Most of the metal workers were native bom, 2, however, having been born in Germany, 1 in England, 3 in Austria-Hungary, and 1 in Canada. CARPENTERS AND WOODWORKERS The number of deaths from chronic lead poisoning among carpen ters and woodworkers was 18, with an average age at death of 57.5 years. In the nature of the carpenter’s occupation he is apt to do painting to a limited extent. By specific occupations 12 were car penters, 3 were wood finishers, 2 were woodworkers, and 1 was a cabinet maker. Certificates reveal nothing of special interest, except ing that in one case it is specifically stated that “ lead poisoning was 28 DEATHS FROM LEAD POISONING due to drinking water through a lead pipe.” This death occurred in the township of Hampden, Me. In another case which occurred in Cheshire County, N. H., a woodworker died from chronic lead poison ing, the cause being specifically stated to have been the drinking water. In another case a woodworker is mentioned also as having been a painter by trade, and the same statement was made with reference to a carpenter. LABORERS The group “ Laborers” includes all whose occupations were simply designated as laborers, with no clue to a more specific employment followed. There were 93 deaths in this group, occurring at an aver age age of 41.9 years. The most suggestive aspect of the mortality is the distribution by nativity, 51 having been native bom, while of the remainder 3 were bom in Germany, 1 in Switzerland, 9 in Poland, 2 in Russia, 11 in Austria, 6 in Ireland, 1 in Belgium, 1 in Holland, 1 in France, 3 in Italy, 1 in Armenia, 1 in the Azore Islands, 1 in the West Indies, and 1 in Mexico. The geographical distribution of the deaths of laborers from chronic lead poisoning is a matter of some interest in view of the possible concentration of lead-using industries in particular sections. The deaths were distributed as follows: Pennsylvania, 18; Missouri, 11; Ohio, 10; New York, 9; Indianapolis, 6; Illinois, 6; California, 5; Michigan, 4; New Jersey, 4. There were two deaths each in Wiscon sin, Massachusetts, New Hampshire, Utah, Virginia, and Connecti cut, and one death each in Minnesota, Nebraska, Kentucky, Wash ington, Louisiana, South Carolina, Florida, and Georgia. The geographical distribution is more or less suggestive of the conclusion that many of the laborers were employed in connection with leadusing industries, particularly in the States of Pennsylvania and Missouri. It is regrettable that the death certificates should not be more definite with reference to the specific occupation of the deceased, for the term “ laborer” for practical purposes is, broadly speaking, meaningless. FARMERS There were 61 deaths of farmers from chronic lead poisoning, at an average age of 56.7 years. By divisional periods of life the deaths were distributed as follows: T a b l e 43.—DEATHS OF F A RM E R S FROM CHRONIC LE AD POISONING, BY AGE GROUPS Age group 20 to 29 years . ........... 30 to 39 years_______ . . . . . . . . . . dO tn AQvpflrs 50 to 59 years. . . . . . . . . . . . . . . . . . 60 to 69 years__ . . . . . . . . . . . . . . . . Num ber Per cent 3 4 9 16 16 4.9 6.6 14.8 26.2 26.2 Age group Num ber Per cent 70 to 79 years_____ ___________ 80 years and over...................... . 10 3 16.4 4.9 Total................................. 61 100.0 It has previously been intimated that deaths from chronic lead poisoning among farmers are, to a certain extent, the result of painting done on the farm and probably in a more or less careless manner. The large majority of the deaths was unquestionably nonindustrial and attributable to drinking water obtained through lead pipes, as is clearly proven by definite statements to this effect on some of the death certificates. The first question of importance, therefore, is the DEATHS FROM LEAD POISONING 29 geographical distribution of the deaths of farmers from chronic lead poisoning, which presents some really extraordinary aspects. The deaths by States are given in Table 44. T a b l e 4 4 . — GEOGRAPHICAL DISTRIBUTION OF DEATHS OF FARM ERS FROM CHRONIC LEAD POISONING, 1914 TO 1924 Number of deaths State Connecticut_________________________ Rhode Island________________________ Massachusetts_______________________ J M aine._____________________________ New Hampshire_____________________ Total, New England...................... New York______________________ ____ Pennsylvania________________________ O hio......................................................... ) Michigan Illinois____________________ ______ _ I Wisconsin................................................. J Missouri______________________ ______ Total............................................... 18 .7 Number of deaths State Colorado____________________________ Utah.......................................................... Wyoming___________________________ } Washington_________________________ I California________ ______________ ____ | 3 2 4 29 Total............................................... 9 4 4 Maryland___________________________ North Carolina....................................... Virginia_____________________________ 1 1 3 3 3 Total............................................... 5 4 Grand total____________________ 61 18 It is shown by the preceding table that nearly one-third of all of the deaths of farmers from chronic lead poisoning occurred in the State of Maine, while a relatively large number of such deaths also occurred in the adjoining State of New Hampshire. On further examination it appears that the 18 deaths in Maine were distributed as follows: Oxford County, 10; Franklin County, 5; Knox County, 1; Cumber land County, 1; city of Lewiston, 1. For New Hampshire the county distribution was as follows: Carroll County, 2; Merrimack County, 2; Sullivan County, 2; Grafton County, 1. The preceding analysis of deaths by counties is strongly suggestive of local conditions favoring chronic lead poisoning through lead pipes, for there are no industrial conditions in the counties referred to which could possibly have a bearing upon the occurrence of chronic lead poisoning cases among farmers. As a matter of fact, the death returns for Maine specifically mention water supplied through lead pipes as a contributory cause of chronic lead poisoning in 8 out of the 18 deaths which are a matter of record. No mention of lead pipes, however, is made in the 7 death certificates for New Hampshire. The distribution of the deaths by years has been quite irregular, due possibly to the relatively small number of cases involved. The information is given in the statement following as a matter of record: T a b l e 4 5 . — DEATHS OF FARM ERS FROM CHRONIC LEAD POISONING, 1914 TO 1924, BY YEARS Year Maine New Hamp shire Year New Maine Hamp shire 1 1921................................................ 1914................................................ 1 1922................................................. 4 1 1915.................................................. 1916................................................ 1 1 1923................................................ 1 1 4 1 1917 —1918.................................................. 10 1 1 Total, 1919-1923................... Total, 1914-1918.................... 7 1919.................................................. 1020.................................................. 5 4 1924................................................. 1 2 Total, 1914-1924................... 18 7 30 DEATHS FROM LEAD POISONING In the 18 cases for Maine, chronic and acute nephritis was the* principal complicating contributory cause, observed, however, in only 4 instances out of 11 showing complications, the remainder having been arteriosclerosis, 2; apoplexy, 2; and heart disease, pulmonary oedema, and spinal sclerosis, 1. In 7 cases there were no complica tions. In the New Hampshire cases the complications were paralysis, 2; pneumonia, 1; myelitis, 1; and hemorrhage of the brain, 1. The preceding data are decidedly suggestive of the risk of nonin dustrial lead poisoning in certain sections of the country where pecul iarly soft water supplies very probably aid in the introduction of’ minute but accumulative substantial quantities of dissolved lead into the human system. It is certainly extremely significant that one county in the State of Maine should have had more than twice as many deaths from chronic lead poisoning among farmers as the entire State of New York or the entire State of Pennsylvania. The subject matter is certainly one fully deserving of more extended investiga tion on the part of the authorities directly concerned. PROFESSIONAL OCCUPATIONS Differentiating obviously professional or exceptionally scheduled occupations from general industrial pursuits classified as miscellaneous; for the present purpose, there were 29 deaths thus classified, of an average age at death of 50.4 years. These deaths are of exceptional interest in revealing a wide range of employments, most of which have no connection whatever with lead-using industries. It is quite probable that the consideration emphasized in the case of farmers applies also to professional occupations—that is, the general risk of chronic lead poisoning due to water supplies derived from lead pipes. The professional occupations classified for the present purpose are as follows: Physician who died of chronic lead poisoning in Franklin County*, Me., at the age of 56 years. Dentist, Huron County, Ohio, who died at the age of 70 years. Accountant, Spokane, Wash., 64 years of age. Chemist, Dayton, Ohio, age 24, death attributed to tetraethyl lead poisoning. Chemist, Columbus, Ohio, age 32. Musician, Canton, Ohio, age 35. Commercial artist, Minneapolis, Minn., age 40. Art teacher, Johnson County, Kans., age 54. Policeman, Grant County, Ky., age 56. Fire marshal, Chester, Pa., age 56. Mail clerk, San Diego, Calif., age 59. Electrician, age 18, Putnam County, Ohio. Electrician, age 42, Manhattan, N. Y. Civil engineer, Pittsburgh, Pa., age 46, complicated by Addison's disease. Civil engineer, age 64, Stevens County, Wash. Railroad engineer, 69 years of age, Pueblo County, Colo, (this man died at the county poor farm). Gas engineer, Bronx Borough, N. Y., age 55. Engineer, age 54, Mecorta County, Mich. Engineer, age 41, Northampton, Mass. Stenographer, age 58, Chester County, Pa. DEATHS FROM LEAD POISONING 31 The remainder were commercial occupations, including traveling salesmen, real estate dealers, grocers, etc. MISCELLANEOUS OCCUPATIONS This relatively large group of employments not directly or obviously connected with lead-using industries is represented by 114 deaths at an average age of 47.3 years. Of course, in possibly quite a num ber of cases persons concerned may have been incidentally engaged in painting operations. A rather suggestive group of employments, however, concerns the ship trades or workers at navy yards. There were 9 such cases, distributed by specific occupations, as follows: Lighthouse keeper, 1; shipyard worker, 1; navy-yard helper, 1; chief gunman, United States Navy, 1; shipyard laborer, 1; mariners, 2; seaman, 1; quartermaster, 1. The risk of lead poisoning on ship board or in lighthouses where drinking water may be kept in lead tanks is, of course, self-evident. Of considerable interest also are deaths among persons connected with the automobile industry. There were 5 deaths in this group, 1 auto dealer, 1 auto mechanic, 1 garage man, and 2 chauffeurs. The death certificates do not indicate whether deaths in any of t lese cases were the result of tetraethyl lead poisoning. There were 3 deaths of barkeepers, regarding which it may be said that in former years lead pipes were rather extensively used in old bar fixtures, and the risk may possibly repeat itself in soda-water fountains unless carefully supervised. There was 1 sudden death from tetraethyl lead poisoning, complicated by duo denal ulcer, at a dye works in, Salem County, N. J. The man died at the age of 28. Particularly suggestive also is the death of a horti culturist who died at Danville, 111., at the age of 35, possibly because of the use of lead arsenic in spraying. There were also 2 deaths of foresters, who likewise may have been employed in spraying oper ations for the destruction of insects injurious to forest life. In one of these cases, at Boston, Mass., the death certificate contained the specific statement that “ lead poisoning was due to exposure to lead from arsenic spray for many years.” The other death, at the age of 72, occurred in Essex County, Mass., also of a forester, but with no further specific information except that the disease had a duration of only six months. There were three deaths of brass finishers and bronzers, all occurring in the city of New York. Another case of tetraethyl lead intoxication occurred in the case of a janitor, also employed at Salem, N. J., who died at the age of 47 years. Curiously enough, there were 4 deaths from chronic lead poisoning among shoe workers, occurring, however, in 4 different places, or Alameda County, Calif.; Norfolk County, Mass.; Stafford County, N. H.; and Fulton County, Ohio. The last case was of special interest, it being stated that the same was of a duration of 8 years. It would hardly serve a useful purpose to further enlarge upon the deaths of this group, but a few individual occupations may be mentioned: One railroader, 1 switchman, 1 clock maker, 1 building contractor, 1 lumberman, 1 electric worker, 1 elevator operator, 1 file cutter, 1 boiler engineer, 1 electric laborer, 1 silver gilder, 1 boilermaker, 1 slater, 1 furnace keeper, 1 lineman, 1 bottler, 1 laundryman, 1 cement worker. There were also 5 blacksmiths. The latter, no doubt, may have been employed also in the painting of coaches or in using paint materials otherwise. It is, however, suggestive that one of these 32 DEATHS FROM LEAD POISONING deaths should have occurred in Oxford County, Me., and one in Hillsboro County, N. H. The wide occupational distribution of these deaths would seem to indicate that in most cases chronic lead poison ing was of a nonindustrial character and more probably the direct result of lead absorption through drinking water conveyed through lead pipes. UNKNOWN OR RETIRED The number of deaths in the group “ Unknown or retired” was 103, of an average age at death of 52.8 years. The distribution of deaths by divisional periods of life was as follows: T a b l e 46.—DEATHS FROM CHRONIC LEAD POISONING IN GROUP OF “ UN KNOW N OR R E T IR E D ,” B Y AGE GROUPS Age group Under 30 years. __ . . . . . . . . 30 to 39 years_________________ Af\ AQTTPQrQ ___ 50 to 59 years _ . 60 to 69 years_____ . . . _________ Num- i Per cent ber 8 11 26 20 20 7.8 10.7 25.2 19.4 19.4 Age group Num ber Per cent 70 to 79 years_________________ 80 years and over_____________ 15 3 14.6 2.9 Total................................. 103 100.0 The higher average age at death in this group is clearly suggestive of the fact that many of the men, as occasionally intimated on the death certificate, had retired, but, unfortunately, the previous occu pation is not indicated. In some cases a direct connection with pre vious painting operations is clearly evident. It is rather curious that only one case of this group in which lead poisoning from water supplied through lead pipes is indicated to have occurred was in Penobscot County, Me. One certificate of a death in Cook County Hospital, Chicago, states that death was due to involvement of kid neys and urinary organs, the results of lead absorption and mercury taken in medicine. The certificates reveal nothing else of special interest, but it may be pointed out in this connection that investiga tions of this kind would be materially facilitated if the death cer tificates were more completely filled out, especially as to the specific occupation followed and possible contributory causes or conditions bearing upon the death of the deceased. WOMEN There were 48 deaths of women from chronic lead poisoning, at an average age at death of 51.8 years. These deaths are of special sig nificance, in that it is self-evident, of course, that with few exceptions the women in question were not exposed to lead as an industrial hazard. Yet relatively the number of deaths is very large and de serving of extended consideration.3 By divisional periods of life the deaths were distributed as follows: T a b l e 47.—DEATHS OF W OM EN FROM LEAD POISONING, B Y AGE GROUPS Age group Num ber Per cent 3 7 11 11 6.3 14.5 22.9 22.9 Age group Num ber Per cent 60 to 69 years_____ ____________ 70 years and over__ . . . . _______ 11 5 Total.................................. 48 100.0 3 See United States Bureau of Labor Statistics, Bui. No. 253: Women in the lead industres. ton, 1919. Washing Under 30 years_______________ 30 to 39 years____ ____________ 40 to 49 years 50 to 59 years.............. ................ 22.9 10.4 DEATHS FROM LEAD POISONING 33 As in the case of farmers there is in the case of women an extraor dinary geographical distribution, with a peculiar concentration of the deaths in Maine, New Hampshire, and Massachusetts. In the State of Maine there occurred 16 deaths of women from chronic lead poisoning, distributed by counties as follows: Franklin County, 8, in 2 of which death was attributed directly to lead absorption from water conveyed through lead pipes; Oxford County, 3, in 1 of which death was attributed to lead poisoning by drinking water which passed through 30 feet of lead pipe; Kennebunk County, 2; Cumberland County, 1; Androscoggin County, 1; and Penobscot County, 1. In New Hampshire there were 7 deaths, distributed as follows: Carroll County, 2; Grafton County, 2; and 1 each in Hillsboro, Merrimac, and Cheshire Counties. In the one which occurred in Cheshire County, in the city of Keene, death was attributed to chronic lead poisoning from the domestic water supply. In Massachusetts 7 deaths occurred, distributed as follows: Wor cester County, 2; Hampshire County, 2; Middlesex County, 2; and Plymouth County, 1. The death in Plymouth County was attributed to water from lead pipes, one death in Middlesex County, in the city of Lowell, being attributed to “ lead poisoning as the result of hair dyes.” The death in Dracut, Middlesex County, was attributed to the water supply, and likewise a death in Worcester was attributed to drinking water drawn through a lead pipe. In Connecticut 1 death occurred; in New York, 1; in New Jersey, 1; in Pennsylvania, 2; in Ohio, 4; in Missouri, 4. One of these deaths, the case of a woman 34 years of age, was attributed to “ lead poisoning from using white flake face powder.” The remainder of the deaths occurred, 1 in Indiana, 1 in Illinois, 1 in Kentucky, 1 in Kansas, and 1 in Louisiana attributed to drinking water from a roof painted red. Only 5 of the 48 deaths were of unmarried women, suggesting the seriousness of the deaths from a social economic point of view, in that 43 were married and no doubt, in many cases, mothers. As shown before, 18 of the deaths were of women between 30 and 50 years of age. The evidence is quite suggestive that in most of the cases deaths were directly the result of drinking con taminated water but particularly so in the cases in the States of Maine, New Hampshire, and Massachusetts. BOYS UNDER 18 There were 11 deaths of boys under 18. The youngest of these was only 9 months of age, it being stated that death was caused by the “ unwarranted use of lead ointments by the parents.” The death occurred in Wellesville, Columbiana County, Ohio. The sec ond death occurred at the age of 1 year and 7 months, it being at tributed to “ eating paint.” This death occurred in New Orleans. The third death, which occurred in Baltimore, was that of a boy 1 year and 10 months, and was also attributed to “ eating paint off toys.” A death in Franklin County, Me., occurred at the age of 5 years and 4 months. Another death in Baltimore, that of a boy 6 years and 11 months old, was attributed to “ eating paint and enamel off toys,” while another in the same city at the age of 7 years and 9 months was attributed to “ playing in a paint shop.” Other deaths were 1 at 11 years and 7 months, a boy in Reynolds County, 34 DEATHS FEOM LEAD POISONING M o.; 1 at 16 years of age, a school boy in Scott County, Minn.; I at the age of 17 years and 4 months in King County, Wash., the death being attributed to “ chewing lead foil.” There was also a death at the age of 17 years and 8 months of a boy who died in the city of Indianapolis. GIRLS UNDER 18 There were 8 deaths of girls under 18 regarding which the follow ing details are of interest. One girl died in New Haven, Conn., at the age of 10 months, death being attributed to the infant having “ gnawed lead paint from the side of the bed.” One at the age of II months occurred in Madison County, 111. The third death oc curred at the age of 2 years and 4 months in Westchester County, N. Y., being attributed to “ eating paint from window sill and paint can.” The fourth case occurred in New Rochelle, N. Y., at the age of 2 years 8 months; the fifth case in Boston, Mass., at the age of 3 years and 1 month; the sixth case in Cleveland, Ohio, at the age of 3 years and 2 months, it being attributed to “ eating enamel off bed” ; the seventh case in New Haven, Conn., at the age of 13; and the eighth case in Minneapolis, Minn., at the age of 16 years and 1 month, death being attributed to “ face powder containing white lead carbon flake.” PART III.— STATISTICS OP CHRONIC LEAD POISONING FROM STATE INDUSTRIAL ACCIDENT BOARDS M y efforts to secure a reasonably complete statement of lead oisoning cases and deaths reported to industrial accident boards ave not been successful. I am able, however, to furnish statistics for a few States, which make a useful addition to the preceding in formation. E MASSACHUSETTS According to the Department of Labor and Industries of the State of Massachusetts the returns regarding chronic lead poisoning made to that department during the period 1921-1925 have been as follows: T a b l e 4 8 .—N U M BE R OF CASES OP CHRONIC LEAD POISONING A N D OF DEATHS F R O M IT IN M ASSACHUSETTS, 1921-1925, B Y YEARS Year Cases Deaths 1921................................................................................................................................... 1922..................................................................................................................................... 1923.................................................................................................................................... 1924..................................................................................................................................... 1925..................................................................................................................................... 89 71 85 102 67 2 1 1 Total........................................................................................................................ 414 4 This indicates approximately 1 death to every 100 cases, which compares with Great Britain as follows: During 1925 there were 326 cases of lead poisoning, with 13 deaths, reported to the Chief In spector of Factories. This would give 1 death to every 25 cases, suggestive of the poss'bility that in this country more mild cases are reported than in England. In 1925 the British returns gave 89 cases of lead poisoning among house painters, with 9 deaths, or approxi DEATHS FROM LEAD POISONING 35 mately 1 death to every 10 cases. It is conceivable, of course, that chronic lead poisoning cases in this country, while fairly common, receive earlier and more qualified treatment and are therefore less fatal than abroad. The Massachusetts returns, by industries and years, are given in Table 49. T a b l e 4 9 . — LEAD POISONING OASES IN MASSACHUSETTS, 1921 TO 1925, B Y YEARS AND INDUSTRIES 1921-1925 1921 Industry 1922 1923 1924 1925 Num ber Paint and varnishing......................... .......... ................... Rubber............................................................................... M etals._____________ ______________________________ Wire and cable mnufacturing________________________ Automobile................................... ................................... Printing__________ ____ _________________ ___________ Plum bing.......__ ____________ ;____________________ Lead_____________________ ________________________ Shipbuilding..... .............................................. ................. Storage battery________ ____ ____________________ Brass and copper_____ ________________ _______ _____ Insecticide and spraying______________________ ,______ Carpenters and furniture.___________________________ Potteries________________________________________ . Farmers__________________________________ _________ Glass................................................................................... Paint manufacture_________________________________ Miscellaneous______________________________________ 49 9 13 3 1 9 10 17 Total............................................................... ......... 89 71 85 104 1 2 6 1 1 1 2 1 24 6 7 4 7 2 43 21 1 3 4 2 1 2 2 2 2 1 2 43 20 8 5 3 3 2 2 Per cent 6 187 68 23 21 18 14 10 5 5 4 3 3 3 2 1 1 1 45 45.2 16.4 5.6 5.1 4.4 3.4 2.4 1.2 1.2 1.0 .7 .7 .7 .5 .2 .2 .2 10.9 65 | 414 100.0 28 12 9 3 4 2 1 1 As shown by this return, during the five years under review there were 187 cases of chronic lead poisoning among painters out of a total of 414, or 45.2 per cent. The next most important industry in Massachusetts as affected by lead poisoning is the rubber industry, reporting 68 cases. Plumbing accounts for 10 cases, while in the printing industry there occurred only 14 cases. Other occupations mdicate a wide distribution of lead poisoning in Massachusetts industries, which, however, suggests that in a few cases the disease was probably not the result of the employment. Rather suggestive also is the relatively large number of cases occurring in the manufac ture of steel and wire, while there have been only a few cases in con nection with the handling of lead and none in the manufacture of white iead. PENNSYLVANIA The Department of Labor and Industry of the State of Pennsyl vania has been good enough to furnish me with the following informa tion: The department receives cases of lead poisoning from only a very small propor tion of the industries of this State in which workers are exposed to the hazards of lead. The reports we have been receiving are from the manufacturers of white and red lead, with occasionally a report from an industry using these substances. The data which we have on hand are as follows: 1920, 4 cases; 1921, 5 cases; 1922, 5 cases; 1923, 2 cases; 1924, 13 cases; 1925, 13 cases. 36 DEATHS FROM LEAD POISONING CALIFORNIA The chairman of the Industrial Accident Commission of California informs me that— The number of cases of lead poisoning reported to the board involving injuries that caused disability lasting longer than the day of the injury have been shown by the following returns. During 1919 there were 31 cases; 1920, 38 cases; 1921, 84 cases; during 1922 and 1923 no record was kept, while during 1924 there were 370 cases and during the first six months of 1925 there have been 117 cases. It is explained, however, that of the 370 cases reported for 1924, 278 were due to* inhalation of fumes in burning paint from discarded battleships; of the 117 cases reported for the period January 1 to June 30, 1925, 60 were due to the same cause. NEW YORK STATE I have been favored with more detailed information by the Depart ment of Labor for the State of New York, which has placed at my disposal the original certificates covering the reported cases of lead poisoning during the period 1912 to January, 1925, inclusive. This is perhaps the most interesting information which has thus far been made available, but unfortunately there is incompleteness for cer tain years. The information consists of 707 certificates, in detail by industries and principal occupations, as shown in Table 50. T a b l e 5 0 . — LEAD POISONING CASES IN THE STATE OF N E W Y ORK, 1912 TO JANUARY,. 1925, BY INDUSTRIES Industry Num ber Painters................................. Electric storage batteries___ Lead workers_____________ Paint workers_____________ Brass and copper.................. Machinists, metal workers.. Tin and solder____________ Plumbers.._______________ Rubber Automobiles______________ Wire and cables.................... 285 228 47 29 25 16 8 7 7 5 4 Aggre Aver gate age ages age (years) (years) 41.0 33.4 36.6 40.9 41.0 32.8 35.1 40.6 40.3 26.8 34.3 11,696 7,611 1,718 1,187 1,025 524 281 284 282 134 137 Industry Num ber Aggre Aver gate age ages age (years) (years) Lead arsenate........................ Glass workers........................ Potters_____ _____ ________ Carpenters_________ ______ Linoleum............................... Polishers and buffers............ White metal_____ _________ Miscellaneous_____________ 3 3 3 2 2 2 2 29 114 140 160 80 63 62 104 1,235 38.0 46.7 53.3 40.0 31.5 31.0 52.0 42.6 Total___ _______ . . . . 707 26,837 38.0 The outstanding fact of this experience is the really extraordinary relative proportion of cases reported in connection with the manu facture of electric storage batteries. An interesting parallel is the comparatively large number of cases reported for the rubber industry in Massachusetts. The incompleteness of the returns is best indi cated by the following statement of lead-poisoning cases in the manufacture of electric storage batteries in New York during the entire period under review. Number 1912................................................ 1913................................................ 1914............................................... 1915................................................ 1916...................... .......................... 1917............. ........ ............- ........... 1918-.............................................. 1919................................................ 2 7 12 23 16 41 2 13 Number 1920.............................. .................. 1921................ ............. .................. 1922........................... ____ _____ 1923............................... .................. 1924_............ - .............. .................. 1925 (January)_______ .................. 17 10 5 31 38 11 Total...................... ..................228 DEATHS FROM LEAD POISONING 37 It would appear from this statement that for 1918 and 1922, in any event, the reports in all probability are incomplete, but no expla nation regarding the deficiency is at the present time available. Of the 228 cases of chronic lead poisoning which occurred in the manufacture of electric storage batteries, 164 were reported from a single establishment in Niagara Falls; 23 were reported from a single establishment at Depew; and 27 were reported from a single estab lishment in Brooklyn. When the certificates for Niagara Falls and Depew are analyzed by years of occurrence, it appears that of the 164 cases at Niagara Falls, 92 occurred subsequent to 1920, while out of the 23 cases at Depew only 2 cases have occurred since 1920. Likewise of the 27 cases reported from a single establishment in Brooklyn no cases have been reported since 1920. As far as it is possible to judge, therefore, the conditions giving rise to lead poison ing, other than at Niagara Falls, have been brought quite effectively under control. The average age for all of the 707 cases was 38 years. The varia tions in the average age are apparently not of particular significance. They are, however, in marked contrast to the ages at death in fatal cases of chronic lead poisoning as dealt with in a preceding section of this report. In somewhat more detail the following observations concerning certain important occupations may be of interest. Of the 47 lead workers included in Table 50, mention is made of the following specified occupations: Smelter working on lead and copper; burners reducing dross and scrap lead and copper to original metal; sprinkler in white lead works; lead workers recharging dry pans; tvpe makers; laborer pouring molten lead; lead burner making copper; lead furnace stoker; laborer unloading lead; lead-pipe worker; smelter of dross lead and zinc; machine operator, copper and lead; lead pattern maker; lead burner making all kinds of utensils; lead burner for oil company; lead smelter; white-lead worker. It is particularly significant in this connection that all of the whitelead workers’ cases should have been reported previous to 1921 or in the following order: 1912, 1 case; 1914, 2 cases; 1915, 8 cases; 1916, 4 cases; 1917, 1 case; 1919,2 cases; 1920, 1 case. It would, therefore, appear that the conditions giving rise to lead poisoning in white-lead plants in the State of New York have been brought entirely under control. Cases of lead poisoning among other than white-lead workers in this group of lead workers were distributed by years as follows : 1912, 2 cases; 1913, 6 cases; 1914, 5 cases; 1915, 12 cases; 1916, 8 cases; 1917, 7 cases; 1919, 4 cases; 1920, 5 cases; 1921, 3 cases; 1922, 1 case; 1923, 3 cases; 1924, 2 cases. In this group of occupations, therefore, the trend has been measurably downward in the recent occurrence of lead poisoning. It is also highly suggestive that in connection with the entire experi ence there should not have been reported a single case of chronic lead poisoning among employees in the different branches of the printing trades. This, of course, may be considered evidence that the returns are incomplete and defective in matter of detail. 38 DEATHS FROM LEAD POISONING The 29 miscellaneous cases referred to in Table 50 report the follow ing particular employments: Fireman of furnaces melting scrap lead, furnace man in tin and brass plant, longshoreman, manufacture of window sashes, butcher, baker, gas engineer, grist mill, grocery clerk, ink mixer, surgical maker, flour maker, gas-meter inspector, elevator man, optical-instrument maker, laborer in copper company, worker in photo apparatus companv, truck driver for builders’ supplies com pany, stock handler, supply clerk and chauffeur. The remainder were common laborers or not specified. Of special interest and importance, naturally, are painters, repre senting the largest number of certificates, 285 out of a total of 707, or 40.3 per cent. These have been distributed by years of occurrence as follows: Number 1912____________ ______________ 1913____________ ________ _____ 1914____________ ______________ 1915____________ ______________ 1916____________ ______________ 1917____________ ______________ 1918____________ ______________ 1919____________ ______________ 34 43 37 46 60 19 4 12 Number 1920.______ _________ _________ 1921_________________ _________ 1922_________________ _________ 1923_________________ _________ 1924_________________ _________ 1925 (January)_______ _________ 6 8 5 4 5 2 Total.................._________ 285 The certificates contain no information of importance that would justify extended consideration. Indications are, however, that there has been a substantial reduction in lead poisoning cases in the State of New York during the last five years, as compared with earlier years. Since the foregoing data for New York State were received, I have been furnished with 45 additional lead-poisoning certificates covering the five months from February 1 to June 30, 1925. The details of these reports are as follows: TABLE 51.—LEAD POISONING CASES IN THE STATE OP NEW YORK, FEBRU ARY TO JUNE, 1925, B Y INDUSTRIES Industry Number Electric storage battery_______ ______ _____ _______ ______ ____________ Paint grinding.......... .......................................... ................... ........................ Painting....................................... .................................................... ............. Building construction_______________________________________________ Lead arsenate___________________ ______ ____ ______ ______ ___________ 40 1 1 1 Total_____________________ ____________ ____ _____ ______ ______ Aggregate Average ages age (years) (years) 2 1,429 29 36 31 74 35.7 29.0 36.0 31.0 37.0 45 1,599 35.5 It is shown by this table that the average age of the 45 cases was 35.5 years, which compares with an average age of 38 years for 707 cases for the years 1912 to January, 1925, shown in Table 41. It is highly significant that during the five months there should have been only one case of lead poisoning in painting. There were, however, 40 cases of lead poisoning in the manufacture of electric storage batteries. As I have previously pointed out, these cases occur at the present time chiefly at a single establishment at Niagara Falls, and all of the 40 cases have been reported by this one corpora tion during the five months under observation. I have thought it worth while to go somewhat farther into this matter and find that DEATHS FROM LEAD POISONING 39 of the 40 eases 14 were men employed as pasters, 7 as mixers, 3 as lead burners, 3 as inspectors, 2 as potsmen, 2 as repair men, 2 as sweepers, 1 as yardman, 1 as pressman, 1 as lead dipper, 1 as sawyer, 1 as weigher, and 1 as millwright. It also appears that of the 45 cases reported for all occupations, 30 were married and 15 were single. Divided by race it appears that 37 were white and 8 were negroes. According to nativity there were 20 natives (1 from Porto Rico) and 25 foreigners, born respectively in the following countries: Italy, 8; France, 1; Bulgaria, 1; Poland, 2; Russia, 2; Lithuania, 1; England, 4; Wales, 1; Scotland, 1; Ireland, 1; Canada, 2; and Cuba, 1. In 3 of the 45 cases the report indicates a previous instance of lead poisoning. A blue line on the gum was observed in 5 out of the 45 cases. Otherwise the general symptoms were pain, nausea, and vomiting. I have also been furnished by the chief medical examiner of the New York State Department of Labor with a statement of lead poison ing cases and deaths during the period September 1, 1911, to June 30, 1925. According to this statement there were in this period in the aggregate 890 cases of lead poisoning, with 105 deaths, or at a ratio of 1 death to every 7.6 cases. Of the foregoing, 375 affected painters with 67 deaths, while the ratio is 1 death to every 5.6 cases. Of the 375 cases in painters, 289 concerned house, structural or ship painting, while 85 cases concerned factory or shop painting. It is of interest that of the 85 cases, 31 should have occurred in the painting of automobiles. In general manufacturing there occurred 465 cases with 26 deaths, or a ratio of 1 death to every 17.9 cases. The 465 cases in manu facturing represent chiefly the following industries: T a b l e 52*—LEAD POISONING IN NEW Y O R K M AN UFACTURING INDUSTRIES, SEP TE M B E R 1, 1911, TO JUNE 30, 1925 Industry Electric storage batteries________ White lead.................................. Smelting or casting....................... Printing......................................... Wire goods____ ________ ____ ___ Electric goods___________ _____ _ Brass and copper goods. ............... Cases ! Deaths I 269 69 23 21 8 ! 15 i 11 1 3 5 4 5 2 1 Industry Rubber g oods................... .......... Tin goods...................................... Copper smelting............................ Cut glass........................................ Linoleum................................. ...... Sheet-metal work________ ______ Cases 8 5 4 3 3 3 Deaths 2 1 The remainder of some 19 different industries are represented by only one or two cases each. The manufacturing industries in which one or two cases of lead poisoning occurred are as follows: Breweries, white-metal goods, bridges, canned goods, casket trimming, chinaware, wagons, pumps, telephone, typewriters, surgical instruments, gas meters, automobiles, and insecticides. Aside from the foregoing there were 12 cases in plumbing with 3 deaths, 6 cases at electric power stations with no deaths, 12 cases in connection with tree spraying, 1 case in shipbuilding, and 29 miscellaneous cases with 11 deaths. To emphasize more clearly the distribution of cases and deaths by single years since 1912, Table 53 has been prepared, show ing the essential facts for all industries, for painters, for white lead, and electric storage batteries. DEATHS FROM LEAD POISONING 40 T abu e 5 3 . —N UM BER OF OASES AND OF DEATHS FROM LEAD POISONING IN SPECI FIED INDUSTRIES IN N EW Y O R K STATE, SEPTEM BER 1, 1911, TO JUNE 30, 1925, BY YEARS All industries Painters White lead Electric storage batteries Cases Deaths Cases Deaths Cases Deaths Cases Deaths Year 1912....................................................... 1913....................................................... 1914....................................................... 1915...................................................... 1916._______ ___________________ 125 114 74 98 73 8 23 25 11 12 73 66 43 42 35 5 16 15 9 8 9 9 4 16 7 1 1 15 14 12 21 13 1 2 3 Total, 1912-1916......................... ! 484 79 259 53 45 2 75 1917 1918 1919 1920 ....................................................! 1921 133 38 37 18 28 12 5 3 2 3 59 16 12 4 8 6 2 1 2 1 10 4 1 1 2 2 1 47 4 8 6 11 Total, 1917-1921......................... i 254 25 99 12 18 3 76 1 4 5 3 5 2 1 1 2 2 105 375 67 69 1922 1923 1924. .................................. 1 ! 1925 Total, 1912-1925......................... | 6 45 34 67 i 890 1 34 28 55 5 269 3 This table brings out in a very suggestive manner the very sub stantial decline in cases of lead poisoning in New York State indus tries, with the exception of the manufacture of electric storage batteries. It is particularly significant that cases of lead poisoning among painters, which in 1912 numbered 73, should by 1923 have diminished to 5, with no deaths. Equally significant is the reduction in the manufacture of white lead which in 1915 reached a maximum of 16 cases, while in 1925 there were only 2 cases. In electricstorage-battery manufacture the largest number of cases occurred in 1925 when there were 55 cases, closely approaching a previous maximum of 47 cases in 1917. BIBLIOGRAPHY Au b , J o s e p h P a u l. C., F a ir h a ll, Lead poisoning. L aw ren ce T., M in o t, A. S., and R e z n ik o ff, Baltimore, The Williams & Wilkins Co., 1926. 265 pp. Includes a chapter on the prevalence of industrial lead poisoning in the United States, by Alice Hamilton. A u s t r i a . Handelsministerium. Arbeitestatistisches Amt. Bleivergiftungen in Huttenmannischen und Ursachen und Bekampfung. Vienna, 1909. gewerblichen Betrieben. Part 1. Causes and prevention; Part 2. 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Vol. IV.—Minutes of evidence taken by both committees. London, 1920. 804 pp. (Cmd. 632.) 41 42 DEATHS FROM LEAD POISONING G r e a t B r ita in . Imperial Mineral Resources Bureau. Laws and regulations relating to lead poisoning, by Gilbert Stone. London, 1922. 250 pp. — —Secretary of State. Regulations: Lead compounds. Regulations, dated August 23, 1921, made by Secretary of State under section 79 of the factory and workshop act, 1901, for the manufacture of certain compounds of lead, namely, any carbonate, sulphate, nitrate, or acetate of lead. (Stat. rules and orders, 1921, No. 1443.) London, Harrison & Sons (Ltd.), 1921. H a m il t o n , A l ic e . Industrial poisons in the United States. New York, The Macmillan Co., 1925. 590 pp. ------ Occupational diseases in Pennsylvania: Lead poisoning. Monthly Labor Review, July, 1919, pp. 170-172. H a r n , O rlando C. Lead, the precious metal. New York, The Century Co., 1924. H a r r i s , L o u is I . Clinical types of occupational diseases. Journal of the American Medical Association, Sept. 20, 1919, vol. 73, pp. 880—886. H a y h u r s t , E m e r y R. Critical examination of 100 painters for evidences of lead poisoning. Journal of the Medical Sciences, June, 1914, vol. 147, p. 788. H o p e , E d w a r d W. Industrial hygiene and medicine. New York, William Wood & Co., 1923. 766 pp. H y g ie n ic I n s t it u t e o p C o p e n h a g e n . Lead poisoning, by Johanus Lou. Publications, 1923. Vol. 3. H y g ie n ic m e t h o d s o f in d u s t r ia l p a in t in g . British Medical Journal, Jan. 27, 1923, vol. 1, pp. 167, 168. I n t e r n a t io n a l L a b o r O f f ic e . Draft convention concerning the use of white lead in painting. Geneva, November, 1921. ------ (New) article on lead poisoning. Encyclopedia of Occupation and Health, Encyclopedia of Hygiene. Geneva, 1926. ------ Prohibition of the use of white lead in painting. Geneva, O'ctober, 1921. Item III (6) of the agenda, International Labor Conference, 3d sess. ------ The use of white lead in painting. Geneva, Oct. 24,1921. 19 pp. (Studies and reports, series F, No. 4.) Translation of a memorandum of the Dusseldorf Chamber of Commerce. I n t e r n a t io n a l p a in t in g e q u ip m e n t . Malden, Mass., International Engineering Corp. [n. d.]. C. A. Prevention of lead poisoning in industry: Part I. The India-rubber industry. Journal of industrial Hygiene, July, 1926, vol. VIII, pp. 296-299. K o b e r , G e o r g e M., and H a y h u r s t , E m e r y R. Industrial health. Philadelphia, P. Blakiston’s Son & Co., 1924. 1184 pp. K o e l s c h , F. Bericht des Landesgewerbearztes. Munich, 1914, 1918, 1919, 1920, 1921, 1922. K l e in , Contains annual observations on lead poisoning in different trades. ------ Die Bekampfung der Bleivergiftung bei der Herstellung von Bleifarben und anderen Bleiverhindungen auf Grund der Yerordnung vom 7, Januar 1920. ------ Die Bleischadigungen im Maler—und Lackierergewerbe. Hamburg, 1921. L e a d p o i s o n in g a t t h e P h i l a d e l p h i a N a v y Y a r d . United States Naval Medical Bulletin, February, 1925, vol. X X II, p. 191. DEATHS FROM LEAD POISONING 43 and G o a d b y , K e n n e t h W. Lead poisoning and lead absorption: The symptoms, pathology and preven tion, with special reference to their industrial origin, and an account of the principal processes involving risk. London, E. Arnold, 1912. 308 pp. L b g g b , T h o m a s M ., T h e MANUFACTURE OF STORAGE BATTERIES. Inspection News Bulletin, June, 1921. T h e m a n u f a c t u r e o f w h it e l e a d b y t h e m o d e r n C a r t e r p r o c e s s . Chicago, Carter White Lead Co. [n. d.]. R. Lead anemia. Journal of Industrial Hygiene, May, 1926, vol. VIII, pp. 222-231. M ayers, M ay M cK a il , D a v id . Prophylaxis in industrial lead poisoning. Journal of Industrial Hygiene, February, 1926, vol. VIII, pp. 74-77. N e w S o u t h W a l e s . Board of Trade. Report on white lead as used in the painting industry: Its dangers and their prevention. Sydney^ 1921. 778 pp. N e w Y o r k (C it y ) . Department of Health. A clinical study of the frequency of lead, turpentine, and benzine poisoning in 400 painters, by Louis I. Harris. Reprint series, No. 71. August, 1918. N e w Y o r k (S t a t e ) . Department of Health. Suggestions for painters: How to avoid lead poisoning, [n. d.] ------ Suggestions for workers in lead and antimony, [n. d.] A NOVEL SOURCE OF LEAD POISONING. Journal of American Medical Association, Dec. 19, 1926, vol. 85, p. 1981. State Board of Health. Lead poison—its chief causes, with observations on its diagnosis and pre vention, by Emery R. Hayhurst. Monthly Bulletin, May, 1914. ------ The standardization of a method for the detection of lead in urine, by Charles H. Parkinson. Monthly Bulletin, October, 1914. O l i v e r , Sir T h o m a s . Lead poisoning and the race. The Eugenics Review, June, 1911. ------ Lead poisoning: From the industrial, medical, and social points of view. London, H. K. Lewis, 1914. 294 pp. O h io . Lectures delivered at the Royal Institute of Public Health. O n t a r i o . Provincial Board of Health. Lead poisoning (a compilation of present knowledge), by R. M. Hutton, Division of Industrial Hygiene. Toronto, 1923. 304 pp. T h e p r e v e n t io n o f p l u m b is m . The New Statesman, April 14, 1923, vol. X XI, pp. 11, 12. S a b in , A l v a h H o r to n . White lead: Its use in paint. New Y ork , John Wiley & Sons (Inc.), 1920. Se l l e r s , A r t h u r . A contribution to the study of punctate basophilia in lead workers. Journal of Industrial Hygiene, April, 1925, vol. VII, pp. 145-154. S h a r p e , N. C. Clinical aspects of industrial poisoning. Public Health Journal, March, 1923, vol. 14, pp. 110-118; April, 1923, vol. 14, pp. 172-174. ----- Report on an investigation to determine the hazard of the health of operators using the spraying machine for painting: The risk of lead poisoning. Journal of Industrial Hygiene, April, 1922, vol. Ill, pp. 378-386. 44 DEATHS FROM LEAD POISONING T an qu erel des P lan ch es. Lead diseases: A treatise from, the French of L. Tanquerel des Planches, translated by Samuel L. Dana. Lowell, 1850. T e l e k y , L u d w ig . Diagnosis of lead poisoning [in Austria]. Mtinchener Medizinische Wochenschrift, Feb. 29, 1924, vol. 71, pp. 266-269. ------ Report on lead poisoning among painters and decorators in Vienna. 0See Great Britain. Home Department. Reports of the departmental committees appointed to investigate the dangers attendant on the use of paints containing lead in the painting of buildings, etc. London, 1920. Vol. Ill, pp. 40-47.) T e l e k y , L u d w i g , G r o t j a h n , A., a n d K a u p , T. Article on industrial poisons including lead, with bibliography. Handworterbuch der Sozialen Hygiene, Leipzig, 1912. T o l m a n , C. P. Lead poisoning and its prevention. (in National Safety Council, proceedings, eighth annual congress, Cleveland, Oct. 1-4, 1919. [Chicago, 1919?], pp. 448-458.) U n it e d S t a t e s . Bureau of the Census. Census of manufactures: Smelting and refining (nonferrous metals). Washington, 1923. 12 pp. — Bureau of Labor Statistics. Deaths from industrial lead poisoning (actually reported) in New York State in 1909 and 1910, by John B. Andrews. Washington, 1911. Bulletin No. 95, pp. 260-282. ----------- — Clinical study of frequency of lead, turpentine, and benzine poisoning in 402 painters. Monthly Labor Review, March, 1919, pp. 226-229. ------------- Hygiene of the printing trades, by Alice Hamilton and Charles H. Verrill. Washington, 1917. 118 pp. (Bui. No. 209.) ------------- Industrial lead poisoning, with descriptions of lead processes in certain industries in Great Britain and the western States of Europe, by Sir Thomas Oliver. Washington, 1911. Bulletin No. 95, pp. 1-188. ------------- Lead poisoning in potteries, tile works, and porcelain enameled sanitary ware factories, bv Alice Hamilton. Washington, 1912. 95 pp. (Bui. No. 104.) ------------- Lead poisoning in the smelting and refining of lead, by Alice Hamilton Washington, 1914. 97 pp. (Bui. No. 141.) ------------- Lead poisoning in the manufacture of storage batteries, by Alice Hamilton. Washington, 1914. 38 pp. (Bui. No. 165.) ------------- Mortality from respiratory diseases in dusty trades (inorganic dusts), by Frederick L. Hoffman. Washington, 1918. 458 pp. (Bui. No. 231.) ------------- Report of British departmental committee on the danger in the use of lead in the painting of buildings. Washington, 1918. 207 pp. (Bui. No. 188.) ------------- The white-lead industry in the United States, with an appendix on the lead-oxide industry, by Alice Hamilton. Washington, 1911. Bulletin No. 95, pp. 189-259. ------------- Women in the lead industries, by Alice Hamilton, Washington, 1919. 38 pp. (Bui. No. 253.) DEATHS FROM LEAD POISONING 45 Public Health Service. Lead poisoning in the pottery trades, by B. J. Newman, W. J. McConnell O. M. Spencer, and F. M. Phillips. Washington, May, 1921. 223 pp. (United States Public Health Bulletin No. 116.) ------------- A note on the prevention of lead poisoning in certain rubber-working industries, by L. Greenburg. Public Health Reports, June 27, 1924, pp. 1567, 1568. ------ Women’s Bureau. Women workers and industrial poisons, by Alice Hamilton. Washington, 1926. 5 pp. (Bulletin No. 57.) U n it e d S t a t e s . U n iv e b s it e t e t s H y g ie in is k e I n s t it u t . Meddelelser. Bind III. Copenhagen, 1923. Lead poisoning, by Johanus Lou. V. Clinical aspects of lead meningo-encephalopathy. Annals of Clinical Medicine, March, 1923, vol. 3, pp. 604-613. W e l l e r , C a r l V., and C h r i s t e n s e n , A i l e e n D. The cerebrospinal fluid in lead poisoning. Archives of Neurology and Psychiatry, September, 1925, vol. 14, pp. 327-345. W eller, C arl T h e w h it e l e a d q u e s t io n . An anonymous contribution. [London, 1924 ?] (Photostat.) LIST OF BULLETINS OF THE BUREAU OF LABOR STATISTICS The following is a list of all bulletins of the Bureau of Labor Statistics published since July, 1912, except that in the case of bulletins giving the results of routine surveys of the bureau, only the latest bulletin on any one subject is here listed. A complete list of the reports and bulletins issued prior to July, 1912, as well as the bul letins published since that date, will be furnished on application. Bulletins marked thus (*) are out of print. Wholesale Prices. No. 284. Index numbers of wholesale prices in the United States and foreign countries. [1921.] No. 415. Wholesale prices, 1890 to 1925. Retail Prices and Cost of Living. ♦No. 121. ♦No. 130. ♦No. 164. No. 170. No. 357. No. 369. No. 418. 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 by 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 1925. 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.] No. 161. Wages and hours of labor in the clothing and cigar industries, 1911 to 1913. No. 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 m the United States, 1919. No. 297. Wages and hours of labor in the petroleum industry, 1920. No. 348. Wages and hours of labor in the automobile industry, 1922. 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. [1924.] No. 365. Wages and hours of labor in the paper and pulp industry, 1923. No. 371. Wages and hours of labor in cotton-goods manufacturing, 1924. No. 374. Wages and hours of labor in the boot and shoe industry, 1907 to 1924 No. 376. Wages and hours of labor in the hosiery and underwear industry, 1907 to 1924. No. 377. Wages and hours of labor in woolen and worsted goods manufacturing, 1924. No. 381. Wages and hours of labor in the iron and steel industry, 1907 to 1924. No. 387. Wages and hours of labor in the men’s clothing industry, 1911 to 1924. No. 394. Wages and hours of labor in metalliferous mines, 1924. No. 404. Union scale of wages and hours of labor, May 15, 1925. No. 407. Labor cost of production and wages and hours 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. No. 421. Wages and hours of labor in the slaughtering and meat-packing industry, 1925. (In press.) No. 422. Wages and hours of labor in foundries and machine shops, 1925. Employment and Unemployment. ♦No. No. ♦No. ♦No. No. 109. 172. 183. 195. 196. ♦No. 202. No. 206. ♦No. 227. No. 235. ♦No. 241. No. 247. No. 310. No. 409. Statistics of unemployment and the work of employment offices in the United States. [1913.] Unemployment in New 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, Minn., January, 1916. Proceedings of the conference of Employment Managers’ Association of Boston, Mass., held May 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. 11918.j Public Employment offices in the United States. [1918.] Proceedings of Employment Managers’ Conference, Rochester, N. Y ., May 9-11,1918. Industrial unemployment: A statistical study of its extent and causes. [1922.] Unemployment in Columbus, Ohio, 1921 to 1925. Proceedings of Annual Meetings of International Association of 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., May 19-23, 1924. No. 414. Thirteenth, Rochester, N. Y., September 15-17, 1925. (i) 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?] 117. Prohibition of night work of young persons. [1913.] 118. Ten-hour maximum working-day for women and young persons. [1913.] 119. Working hours of women in the pea canneries of Wisconsin. [1913.] 122. Employment of women in power laundries in Milwaukee. [1913.] 160. Hours, earnings, and conditions of labor of women in Indiana mercantile establishments and garment factories. [1914.] •No. 167. Mmimum-wage legislation in the United States and foreign countries. [1915.] ♦No. 175. Summary of the report on conditions of women and child wage earners in the United States. [1915.] ♦No. 176. Effect of minimum-wage determinations in Oregon. [1915.] •No. 180. The boot and shoe industry in Massachusetts as a vocation for women. [1915.] •No. 182. Unemployment among women in department and other retail stores of Boston, Mass. [1916.] No. 193. Dressmaking as a trade for women in Massachusetts. [1916.] No. 215. Industrial experience of trade-school girls in Massachusetts. [1917.] •No. 217. 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 lead industries. [1919.] •No. ♦No. •No. ♦No. No. Workmen’s Insurance and Compensation (including laws relating thereto). ♦No. 101. •No. 102. •No. 103. No. 107. •No. 155. No. 212. No. 243. No. 301. No. 312. No. 379. No. 423. Care of tuberculous wage earners in Germany. [1912.] British National Insurance Act, 1911. Sickness and accident insurance law of 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 by the International Association of Industrial Accident Boards and Commissions, Washington, D. C., December 5-9,1916. Workmen’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 1920. Comparison of workmen’s compensation laws of the United States as of January 1, 1925. Workmen’s compensation legislation of the United States and Canada. [1926.] 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. 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, Md., October 9-13, 1922. Tenth, St. Paul, Minn., September 24-26, 1923. Eleventh, Halifax, Nova Scotia, August 26-28, 1924. Index to proceedings, 1914-1924. Twelfth, Salt Lake City, Utah, August 17-20,1925. Industrial Accidents and Hygiene. •No. 104. Lead poisoning in potteries, tile works, and porcelain enameled sanitary-ware factories. [1912.] No. 120. Hygiene in the painters’ trade. [1913.] •No. 127. Dangers to workers from dust 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.] No; 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 by occupation. [1917.] •No. 209. Hygiene of the printing trades. [1917.] No. 219. Industrial poisons used or produced in the manufacture of explosives. [1917.] No. 221. Hours, fatigue, and health in British munition factories. [1917.] No. 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. •No. 236. Effect of the air hammer on the hands of stonecutters. [1918.] No. 249. Industrial health and efficiency. Final report of British Health of Munition Workers Com mittee. [1919.] •No. 251. Preventable death in the cotton-manufacturing industry. [1919.] No. 256. Accidents and accident prevention in machine building. [1919.] No. 267. Anthrax as an occupational disease. [1920.] No. 276. Standardization of industrial accident statistics. [1920.] No. 280. Industrial poisoning in making coal-tar dyes and dye intermediates. [1921.] No. 291. Carbon monoxide poisoning. [1921.] No. 293. The problem of dust phthisis in the granite-stone industry. [1922.] No. 298. Causes and prevention of accidents in the iron and steel industry, 1910 t;o 1919. No. 306. Occupational hazards and diagnostic signs: A guide to impairments to be looked for in hazard ous occupations. [1922.] No. 339. Statistics of industrial accidents in the United States. [1923.] No. 392. Survey of hygienic conditions in the printing trades. [1925.] No. 405. Phosphorus necrosis in the manufacture of fireworks and the preparation of phosphorus. [1926.] No. 425. Record of industrial accidents in the United States to 1925. (h ) Conciliation and Arbitration (including strikes and lockouts), *No. 124. Conciliation and arbitration in the building tiaies of Greater New York. [1913.] “No. 133. Report of the industrial council of the British Board of Trade in 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 New York City. *No. 191. *No. 198. No. 233. No. 255. No. 283. No. 287. No. 303. No. 341. No. 402. No. 419. Collective bargaining in the anthracite coal industry. [1916.] Collective agreements in the men’s clothing industry. [1916.] Operation of the industrial disputes investigation act of Canada. [1918.] Joint industrial councils in Great Britain. [1919.] History of the Shipbuilding Labor Adjustment Board, 1917 to 1919. National War Labor Board: History of its formation, activities, etc. [1921.1 Use of Federal power in settlement of railway labor disputes. [1922.] Trade agreement in the silk-ribbon industry of New York City. [1923.1 Collective bargaining by actors. [1926.] Trade agreements, 1925. Labor Laws of the United States (including decisions of courts relating to labor). No. 211. No. 229. No. 285. No. 321. No. 322. No. 343. No. 370. No. 403. No. 408. No. 417. Labor laws and their administration in the Pacific States. [1917.] Wage-payment legislation in the United States. [1917.1 Minimum-wage legislation in the United States. [1921.1 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. Labor legislation of 1925. Labor laws relating to payment of wages. [1926.] Decisions of courts and opinions affecting labor, 1925. [1925.] Foreign Labor Laws. *No. 142. Administration of labor laws and factory inspection in certain European countries. Vocational and Workers* Education. [1914.] *No. *No. No. No. 159. 162. 199. 271. Short-unit courses for wage earners, and a factory school experiment. Vocational education survey of Richmond, Va. [1915.1 Vocational education survey of Minneapolis, Minn. [1916.] Adult working-class education in Great Britain and the United States. No. No. No. No. 331. 336. 338. 350. No. No. No. No. No. No. 351. 364. 375. 378. 382. 410. Code of lighting factories, mills, and other work places. Safety code for the protection of industrial workers in foundries. Safety code for the use, care, and protection of abrasive wheels. Specifications of laboratory tests for approval of electric headlighting devices for motor vehicles. Safety code for the construction, care, and use of ladders. Safety code for mechanical power-transmission apparatus. Safety code for laundry machinery and operation. Safety 'code for woodworking plants. Code of lighting school buildings. Safety code for paper and pulp mills. Safety Codes. [1915.] [1920.] Industrial Relations and Labor Conditions. No. 237. No. 340. No. 349. No. 361. No. 380. No. 383. No. 384. No. 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. Works council movement in Germany. [1925.] Labor conditions in the shoe industry in Massachusetts, 1920 to 1924. Labor relations in the lace and lace-Curtain industries in the United States. [1925.] Welfare Work. *No. 123. Employers’ welfare work. [1913.] No. 222. Welfare work in British munitions factories. [1917.] *No. 250. Welfare work for employees in industrial establishments in the United States. [1419.1 Cooperation. No. 313. Consumers’ cooperative societies in the United States in 1920. No. 314. Cooperative credit societies in America and in foreign countries. Housing. [1922.] •No. 158. No. 263. No. 295. No. 424. Government aid to home owning and housing of working people in foreign countries. Housing by employers in the United States. [1920.] Building operations in representative cities in 1920. Building permits in the principal cities of the United States, 1925. No. 266. No. 307. ♦No. 323. No. 352. No. 389. No. 411. Seventh, Seattle, Wash., July 12-15, 1920. Eighth, New Orleans, La., May 2-6,1921. Ninth, Harrisburg, Pa., May 22-26, 1922. Tenth, Richmond, Va., May 1-4, 1923. Eleventh, Chicago, 111., M ay 19-23, 1924. Twelfth, Salt Lake City, Utah, August 13-15, 1925 [1914.] Proceedings of Annual Conventions of the Association of Governmental Labor Officials of the United States and Canada. (in) Miscellaneous Series, *No. 174. Subject index of the publications of the United St ates Bureau of Labor Statistics up to May 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. [1919.1 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. No. 326. Methods of procuring and computing statistical information of tne Bureau of Labor Statistics. No. 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. The cost of American almshouses. [1925.] No. 398. Growth of legal-aid work in the United States. [1926.1 No. 401. Family allowances in foreign countries. [1926.] No. 420. Handbook of American trade-unions. [1926.] (nr) SPECIAL PUBLICATIONS ISSUED BT THE BUREAU OF LABOR STATISTICS Description of occupations, prepared by the United States Employment Service, 1918-19, •Boots and shoes, harness and saddlery, and tanning. •Cane-sugar refining and flour milling. Coal and water gas, paint and varnish, paper, printing trades, and robber goods. •Electrical manufacturing, distribution, and maintenance. Glass. Hotels and restaurants. •Logging camps and sawmills. Medicinal manufacturing. Metal working, building and general construction, railroad transportation, and shipbuilding. •Mines and mining. •Office employees. •Slaughtering and meat packing. •Street railways. •Textiles and clothing. Water transportation. ADDITIONAL COPIES e r THIS PUBLICATION HAT BE PROCURED FROM THE SUPERINTENDENT OF DOCUMENTS GOVERNMENT PRINTING OFFICE WASHINGTON, D. C. AT 10 CENTS PER COPY V (▼)