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2/05 cz/cTicxoatm.md—ma

 

 

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LIEHP 0F 13 IDES

ixoo6 nre of YounF Philczren to

Environment? 1
Fen' anfi 016 Urban mousinfi'

3:636), in

Rosoirrtory Exoosure to Tera :oflecfied in_the
ican Blood-L936 Vflues of Vfrious Grouns

Lech Paint Regulations

-

25 SESAS With the Greatest Iurber of LBLS

Current Programs

113T OF FiGUdEU

Seasonal Distribution b6 .6nth of Kenort of
Fftai :66 Eon‘atal C3686 of Ienfi Poisoning
an6 Increasefl Lead Absorntion

Iumbcrc of 06666 for htch Pi.6r06tic C] 8831-
iiCGtion, browned by ”mflhs of £66 at Time of
Disz1osis:

fitnosnhoric Concentrcti orn of 1666 From Ve-
hicles from miO-iSb? thr016h 616—1069 alon6
flifferent sections of U 3. 16h 96 1 in New
Jer6ey

‘re6icted Nationwifle Incifcoce of lea6 Posed
fuirt noiconinr - 2' 31336 With Create6 t Pre-
6ict66 Inciéenc

i

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H
(w

‘ .- t‘. ‘A . .‘I ‘ ,‘ 'fi . u
Census Tracts shake: LC or6116

City of low York - fienorted 0:6 -.8 of Lead Poi—
6,016. i 11:6

Soot 16h of P10 Case6 of Y666 Fcisor -166 by
PhiFFdanhia {@31606606 of ‘6t161‘s; 1056—1060

Childhood toad Poihoniu6 Control Trorraw St‘fi—
J-

oer 101")

CaU666 ¢n6 Conse"uerccn of Chiifihnod 3086
ioisonin6 966 0'66 it] Sites 'or Intervcn—
tion

I11 ’1‘ £011 UC 'I' I OH

...cities have shown 6 uninue and endurir6 nro—
nensity to create health nroblems end then
elect to treat the symntoms rather than deal
with the causes.

Alonso S. Yerby, h.3.

One of the host serious urban health nroblems evident in
our cities today, is that of lead noisoninn. A health nroblem
of many dimensions, lead noiscnins orininetes from a variety
of sources and affects a varietv of victims. In children,
at least, it is also Wholly nreventuble.

The substance of concern — lead, is an element which oc-
curs neturally in the environment as less than one her cent of
the material in the earth's crust. Lend is defined as a nure

metal and is used cs such for the manufacture of plumbing nines,

as

C‘J

n additive to pesoline, nesticides, end tcirts, in the ”ro-
cessing of many metallic and chemical nroducts and in the ma-
kine of nottery.l

In usins lead, mun tends to overload the environment, nar-
ticularly the urban environment. Tons of venorized lead are
emitted into the atmosnhere daily by 6onstant auto traffic.
Meny structures ere neinted internally ind externally with lead-
based nuints. Pottery containing lead is found in mfny urban
households, and various oceunetions utilise le'd as e raw ma-
terial. Conseouently, lead can enter the huzrn boéy in several
ways - breathir6 nolluted Cir, drinkinp centemineted water,

7 .

eating lend—exnosed foods or eatin6 :rcm hirh lead dishes, cc—

1.

’)

cunational exnosure, and insestion of lead-based naint.‘ Al—
though in recent years, snecific concern has been raised with
recard to lead emitted by the use of alkyl antiknock compounds
in gasoline, when the total environment is considered, two to
three tiJes as much lead is added from saint ninments and other
lead nroducts as from the use of lead alkyls.3

It can be seen then, that the eroblem of lead noisonins
is indeed extensive, bervasive, and comnlex. This never will
deal primarily with the most nrominent and serious manifestation
of this important health hazard - lead noisonins in urban chil-
dren, resultjnr from the ingesticn of lead-based taint. The
effects of airborne lead a a comnlicatina factor will also be
considered, but the basic thesis of this nener is the brimacy
of leaded saint as the cause of childhood lead noisonins in
urban children.

In the first section, the causes, ccnseouenccs, detection
and treatment of childhood lead noisonins will be described.
Section II discusses legislative annroaches to the nroblem,

nresents some investigative modelins technisues and a
brief examination of the exneriences of several cities which
have attempted to deal with childhood lead n7i6onin6. Secticn
III presents some snecific recommendations, followed by Section

IV the concludinr section.
9

O‘JE-E‘JIEI'I 0]“ THE: ~P:{(')BLEI‘-'I

CAUSESOF CHILDHOOD LEAD FOISONIKG

lead poisonina in children, resulting mostly
from ingestion of chins of lead-containing
taint from walls and woodwork in old, dila—
pidated housing, remains a unioue nublic
health rroblem. Its etiolosy, nathoaenesis,
nathoohysioloay, and enidemioloay are known.
Practical methods are available for scree-
nina, diagnosis, nrevention, and treatment.
Yet each year lead posionina continues to
cause the deaths of many children and men-
tal retardation or other neurolosiesl han—
dicans in many other children.4

Lead poisoning is not uncommon in the United States.
While the precise incidence of lead poisonins is not known,
surveys have shown that 10 to 25 per cent of young children
living in deteriorated urban slum housing shcw evidence of
increased lead absorption, and 2 to 5 per cent show evidence

of poisoning.5 Aporoximately 30 million housing units built

before World War II are still in use today. As many as 7 mil-

lion houeins units are deteriorated and contain surfaces cov—

ered with lead naint, and it is estimated the 2,500,000 chil-

dren live in substandard housing where a notential lead hazard

exists.6 Taken together, these statistics yield a frinhtening
potential.

Sluntarcas in the larrer older cit es seem to have the
areatest incidence of lead roisonine, concentrated in their
so-called "lead belts." The nroblem seems to arise from the
interaction of two rrimary causative factors: nica and the

environment. Tie term nica, can be defined as the habitual,

3.

purposeful and compulsive search for and ingestion of nonfood
items such as clay, blaster, laundry stfrch, ashes, putty,
string, naint chins, naper, dirt, crayons, yarn, matches, and
cigarette butts. Adults as well as children may develon nica
and both are usually selective in the materials they ingest.
Studies have shown that nutritional deficiency is not an etio-
logic factor in urban slum children, and in fact 50 per cent
of the children from both middle class and lower socioeconomic
groups habitually engree in pica. Pica usually benins at one
year of ase and disannears between the apes of 3 and 5. Nearly
50 per cent of mothers_of children with nica, have nica them-
selves, and the child with nica freouently stimulates the be-
havior in younger siblinas. The interaction between_child and
mother is usually the critical factor in the develonment of
nica in children. Sianificant interactive factors may include:
an absent or poorly functionine mother, or an emotionally trou-
bled-mother. In such families, pica often noes unobserved by
the mother, thereby nrecludinq early detection in the child.7
The amount of lead that is received bv the child t.rough

pica is also sisnificant:

A chip of naint about the sire of an adult's

thumb nail can contain between 50 and 100

millisrams of lead, and so a child eating a

few small chips a day easily innests 100 or

more times the tolerable adult intake of the
metal! 8

dtudies in selected slum ar-as reveal that 50 to 75 per
cent of old houses contain dcnserous ouantities of flakine
. .. c (2-... ..
lead-based paints on interior suriaces.’ stealinss in these

areas may have several coats of saint on walls, woodwork, and

4.

ceilinrs, and the base coats srnerally contain sisnificant
amounts of lead. Lead containins naint was "recuently used

for both interior and exterior dwelling surfaces until about
1940. Such noueinn is usually in bad revnir end naint neelinns
and loosened blaster provide a hazardous source of lead for
children with pica.

c‘

The usual locationsof leaded naint chewed by children de-

.‘

veloninn lead noisoning are window sills, nainted nlaster, and
walls. Outside sources commonly include nsinted door frames,
_- 10
fences, DOTCAGS, and house walLs.
A study in Cleveland clearly substfintiates this relation-
ship between childhood lead noisoninp and old deteriorating urban
housing. In this study, it was found that 2f ner cent of 901
nre—school children residing in old housine had absorbed ab-
normal Quantities of lead and 35 (4.7 ner cent) had symptoms
of lead noisonina. One hundred and five comnarable nre-schoolers
living in better housing were also tested and of these, only 3
showed evidence of increased lead insestion and none showed
clinical symntoms of noisoninn.ll (See Tfible 1.) Similar stu-
dies have been conducted in other cities.

Table l. hnvironnental hxnosurc of Younn Chil-
dren to Lead in New and 01d Urban housinp

location R0. of No. with ho. with
of home ‘Childrffil abnormal '?lumbism
Studied Urine (lead Poi—

soninn)

 

one Housins 801 216 _ 23(4.T$)

 

New fiousine 105 3 0
Project

 

 

 

Source: Chisolm and haplon, p. 944

In Ealtimore, QO oer cent of the renorted cases of lead
noisonine are in children who reside in multinle—dwelling,
rented housinc units. Su -rvevs in Baltimore, as well as in

Philadelphia and London, iave revealed that 70 to 30 ner cent

of interior neinted surfaces contain more than 1 nor cent lead.

L

xtraoolation of a limited survey in Boston, indicated a 98 oer

nt nroba bilitv of houses with positive findinas for lead if
a greater number of samnles had been analyzed. (Investigating
actual cases usually reouires analysis of 20 to 95 different
samnles in ordzr to identify all interior euri'ee. nositive
for lead.) Geosrachic snot maps have been Rent by the Baltimore
Uity Health Denartnent durine the last 30 years and indicate
that as old inner—city dwellines are renlaced by urban renewal
and other new construction, thelocation of renorted cases of

ad noisoninr moves outnard from the center of the city and
that cases are now foun -d in 0' er hous ins in nearly all tarts
of the city.-2

As stated earlier, lead noisoninn in children is believed

to be due almost entirely to tr e reoetitive eatinn oi leaded

on retro-

CL

house naint. Mort of the available data are brse
snective analyses of . mall Frouns of cas-s from cities in which
childhood lead noisonine is a reoorta ble disease and in which
the municinal health departments have active rrograms such as
New York Citv, Chicano, Philadelnhia, and .Elaltimore. While
the nat‘onw de incidence of the dis e~as e in children is unknown,
the followine nine coiderio We ical f: ctcrs are well—establshed:
7 Areas of "hi”h risk" are nrimarily centered in the
slums as LCCe”"‘bljle to fl: kins naint and broken elaster,

hieh incidence of ,,iCCs., and lack of adeouato "arertal sun-
ervision nrovide En ootimum environment for lead nelsonina.

6.

2. while children between 1 and o years of are are the
lain victims, 85 ner cent of the cases are children from
1 to 3 years old; more than 50 ner cent of the deaths
caused by lead poisoning occur in 2 year olds.

3. Childhood 1ead noisoninc is sirnificantly related to
nica, as 70 to 90 ner cent of lead— noise oned children exhi-
bit a history of this habit.

4. Symntometic lead noisonine in children ve r:ies by sea—
son and there is evidence that 80 to 85 per cent of the
cases occur in the surmer months of June tiroup h Sentem-
ber. However, more cases are being renorted in the winter
months as awarene"s of the nroblem amons health Workers
increases. (Some winter cases occur when leaded battery
cases are burned for fuel and the fumes inhaled, or there
is nrolonred contact with the asies ) ”hile lead encenh-
alOpathy (clinica 11 lead poisoning or brain injury) is more
freouent in the summer, asynntoma tic  (sub—clinical) lead
noisonins is a year—round disease.

5. Ne," .roes and Tuerto Ricans exhibit a hirh incidence
annarently because a nreater nronortion live in "lead
belts” and not because of any known penetic, ethnic, or
racial factors.

0. There is no sisnifica=nt difference in incidence by sex.

7. A hish incidence occurs amonr siblinss wiih a 30 ner
cent incidence rate cited bvs01e investiertors.

c. There is a high recurr nce ra ate.

9. Lezd noie onins associated with nice is a chronic ero-
cess and from 3 to 6 months of fairly steady inrestion is
required in most cases before clinical svnntoms apnear. 13

(See Fieures l and 2.)

Estimates of the- incidence of lead nois chine and the nre-
sence of adverse blood level concentrations are same on shaky
foundations. AS stated treviuoslV, the dis mrse is only renor-
table in a few of the iarscr citi s. Usually, reco,nition is

"sed on the case— fincins annroach, which is dencndent on the
level of local medical community awareness and the aveil: bility
of diagnostic laboratory facilities. Prosnective rass screening
nrogrcms are currently available only in Chicano (sin nce C-cto—

- . -- . -. , . .1, 14 ,
ber 1906) and in LOW York City \s1nce January lt/U.) Although

7.

Firure l..3¢f

 

30

'28

26

24

NUMBERS OF SUBJECTS

M

 

f

JAN.

Nonfatal

Source:

f, O
48 ’-
44 ~—
40 -
w h-
8 321-
V)
d
U 28 _
U.
0
24’ 2“ ‘
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D
Z
16 L-
12 »—
8 >-
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Groaned

13/4

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I i
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['3 Acme lead encephahnuhy, some

9 Dulh

 
   
   

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DEC.

Wtal
lead Absorntio

28

26

24

72

2O

18

16

216

FEB MARCH APWL MAY NOV.
MONTHS
onal 1st r1_but ion by Vonth o” eicrt of
08309 of 1-1. Poisoninv and Increased
omnittee on iriiolosic Lf:{ects of AtmOsnheric lollut'nts,

 

 

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011 364] 1859 6071 I283 (193 961W
AGE AT TIME 0‘ DEAGNOSIS K‘MOUPED BY MON "1.3)
P. anhcrs cf Cvses i1r L"ch bi: nost.ic Clfis
by Font‘s of see it “time of Uicsros is.
Go ..... ittee on mioloric 4ffects of htnosnheric

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.1'0 '11). ml". 1.

r3
“’9

adequdte enidemiolosical data 01 the distribution of blood lead
concentrations in children are lareely unavailable, larae—scale
screening programs in urban areas sueaest:

...nerhans 5 to 10 oer cent of youns children

who live in deterioratine old housing have con—

centrations of lead in their blood that may be

associated with adverse metabolic effects, at

the very least, and 1 to 2 oer cent mry have

evidence of lead noisoninp. where active

screening programs are in oneration, the num-

bers of renorted cases increase, while the

number of reported deaths decrease to well

under 1 Der cent of renorted cases.15

In addition to lead~based naint itself as a causative

factor, several other factors aearavate and naenify the nro-
blem. One such factor is the lack of awareness about the pro-
blem aiona nhysicians and other health workers. Many physicians
are unaware of the existence or the magnitude of childhood lead
noisonine, because they seldom encounter cases of it, or be-
cause the cases they do encounter are-incorrectly diaenoscd.
Another common misconceotion is that the manufacture of lead—
free taint today has resulted in the extinction of lead poison—
ina in children, without reeard to the fact that old houses
often still contain many layers of lead—based he nt, paints man—
ufactured for outdoor use still contain lead, and such outdoor
paints may be used for interior surfaces by uninforxed neonle.
Those Dhysicians and health wcrkers who are aware of the nroblem
of lead poisoning, are often hesitant to make a nositive diag-
nosis, resultina in undue delays in treatment and the loss of

. lo
valuable time.

A poorly informed nuhlic is the second cornlicatinp fac—

tor, as many narents are unaware of the danrer associated with

nica, or tre consecuences of taint intestion. AdditionallY,

8.

inadequate srevention of reeXsssure to lead results in a hinh
rate of recurrence of lead noisoning amonp children. The fail-
ure to nrevent reexnosure to lead contributes sreatly to the mor—
tality and morbidity of lead noisonins.

In addition to noor housins conditions end the lack of
awareness on the nart of nrofessionalsand the nublic, inadequate
health and housins codes also contribute to the nersistence of
lead ooisonins. In those cities with codes snecifically nro-
hibitine lead naint in the interior of dwellinss, enforcement
of such codes is usually unsatisfactory for reasons such as
eXpense to landlords, the city‘s fear of abandonment by land-
lords, a shortaae of nerscnnel to carry out the necessary en-
forcement nrocedures, and difficulties and confusion in legal
nrocedures and concepts. As lin—Fu states:

Failure to pet rid of lead naint in a house

where a child is kno n to have develoned

lead noisoninn usually means that a treated

child returns to the same hazardous environ-

ment to be execsed to another enisode of

noisonina.
"ven if the afflicted child is moved to another heuse, the bro-
blem still remains:

If the leed nflint in.thehouse is not removed,

the lethal heritase will soon bass on to other

families with children, and lead noisonina

amanr children multiplies.18

although the slum areas of lures urban centers exhibit

the highest incidence of childhood lead noisonins, the arc-

blem is not restricted to poor slum dwellers, as cases of lead

1.1
*1
{'0
:3
Q4

poisoning have been resorted in children from COCiTlH
economically advantased homes. Urban migration tatterns from

central core.cities to the suburbs have correlated well with an

\0
o

increase in cases of lead noisonina in nreviously unrerorted
areas, as older housina is subdivided into anartments. In
Baltimore, 48 mar cent, and in Philadelnhia, 50 ner cent of

.—

the rerorted casrs of Lead nosionins amona children occurred
. . . . 19
out31de the inner Cities.
dural areas and small towns are not immune to the oroblem
either:
Of 230 rural children 1 to 5 years old, tested
in New York's Dutchess County and Connecticut's
Litchfield County, 9 ner cent had blood levels

considered unduly high. Some of these children
were from unner- and middle-income families. 20

In a recent study of 0,500 children in lfl Illinois cities with
ponulations raneine from 10,000 to 150,000 nersons, 18.6 oer
cent carried hish levels of lead in their blood. (300 micro-
arams is the daily permissible intake fronifood and other
sources.)21
Still another previously unrecoeniaed notentiel lead
noisoning-causina situation, is that associ{ted with tte re-
modeling of old homes. Horkmen as well as children End their
oarrnts can set lead noisonins simnly by breathirs in finflll
nerticles of lead durina the nroeess of rewodeljns and renova—
tinr inner city houses with.lead-based weints on interior sur—
faces. In a study by Wolf, of schrCl cases in the Urnitol
Hill area of dashinaton D.C., the residue of the heavy sandinp
and soraninr in houses underaoinn renodelins was tested. It
was found to have a hirh lead content. Wolf does rot surrest
that neonle ston rerodelins old hous s, but does recommend
that certain rrecautinns be taken to aviod lead neisoninn inclu-

ding: Wearine face masks, mains a vet men after cleanina us

10.

debris, not eatins it the meme room where work is ”cine on and

insurinr that slates and utensils are not exeosed to lead dust,
22

q

and having. body leao levels checked neriodicclly.

From the noint of View of contamination of the total en-
vironnent with lead, lead-usina indnstries, taint niements, and
metallic nroducts 11: vs each contributed more than burned leaded.
fuel. Thus any eronosal to rid the environment of lead nollu—

tion throuph the removal of lead from autor.otive fueis must
9

take into consideration the existence of other lead nroducts

H
c‘.‘
'9
*3
L?
0

such es raints and manufactured

The veneral nioture that ewerees from con—
s'derction of lead is the environment is of
a steep sraCient oi nollution erovat1ns

rem tee cities in nronortion to their size.
file tbsence of si niijcant unnard trenrs in
t e concentration of lead in rural soils and
water and in the food sources of ran in the
last 30 years indicates that the nreat in—
crease in the combustion of lead slkyls has
not had 0 lzrce iILrnc ct on the intrke of lead
by nonurbfln neonle and animals, excert ner-
Iaes by direct inhalation.23

h“: t-h

')

The magnitude of transfer of airborne lead to the soil is direct—

ly rel: ted to the isity of auto trf fiic. In urban areas, tn,

,-

0

surface soil of marks, treet dust, and narrow bands beside ma-

\

jor roadways are heavily contaminated with lead.

Only in tre ur‘ocn settine is mzn no sibly
o‘nl'ec to h”7'roou circumstances relative
to atmosnheric lsM nollution, ocounaticnal
exnosures in the lead-usin" ind stries ex—
cented. The hier concentration of lead in
urbtn air end on the surfaces of nrrks and
streets constitute a source of intake add—
itionfl to t e usual dietary sources find in
sneci: l circ Us races may be a substfntial
source.24

Animal :‘uerage—Microzrgms cf Lead Per Cubic Meter at A?!

 

K! m 7
,000 Vet icles Per 03 ‘3' h: m, -
y ' ”I! R" .3
Wm "
Mum.‘arm "aw "ma
“,0 200 3’0 40") C100

he! fmrn Highway

Firure 3. Atmosnheric Concentrations of L,ad Trcm Ve-
hicles irom mid—1967 throuch mid—l?o9 along different
sections of U.3. His'v 83 l in N w Jersey.

Source: Grain and Berlin n. 6

while the reneral urban nonulation faces no identifiable
current threat from the concentration of lead in the air, tn'o
groups of re0ple are exnosed to airborne lead to what seems to
be an undesireable degree. The first sroun is those persons
who are exnosed to unx> .3 ually hip:h concentrvtions of lead in
ambient air far occunationol reasons — "'rrce \orkers, traffic
nolice, and lead trades workers. Such exnosure can nroduce
blood lead concentrations in excess of AO/qp; tqp=microgrcms and
refers to micrograms ner 100 milliliters of whole blood.) How—
ever, this level of blood lead concentration is nrobably only
attained by a relatively small nronorticn of those exnosed.25
The other aroun significantly threatened by lead in E sbient air
consists of infants End small children. decent survers of chil-

12.

dren in laree cities indicate that manv had blood lead concen—
trations in the ranses of no to 604‘s. while such hieh blood
lead concentrations cannot be cefinitelr said to arise from the
inhalation of lead, it is likely that at least some of the lead
burden in children does come from the ingestion of lead—bearins
street dust and soil, which freouently reaches lead concentra—
. . n 26; m, .
tions in excess of 20004h/g. \see llee 2.,

Table 2. Resniratory Exnosure to lead fieflected
in the mean Blood—head Values of Various Groups

POPULATION EXPOSURE MEAN BLOOD
(nicxoeiiis Phi LHED (11030-
CUBIC phThx or this rte
AIR) 100 GiflhS)

 

16
21

rural U.S. 0.5
l O

downtown Thiladelnhia 2.4 2A
1

8

urban U.S.

 

Cincinnati policemen 2. 25

Cincinnati traffic 2. 30
nolicemen

Los Anneles traffic 5.2 21
nolicemen

Boston Automobile 6.3 30

Tunnel emnloyees

 

Source: Chisolm, n. 21

the study which attemnted to determine the extent to which
the innestion of dirt and dust contaminated with lead exhiust
from cars’contributes to the childhood lead nroblem was con-
ducted bv Hear and Aronow. while most lead in dirt annears to
be a result of deteriorating lead—based house saint, Hear and
Aronow utilized a tracer nrocess to determine the amount of
lead a Child tight receive from eatins dust centerinated with
lead sources other than paint chins (nrimarily leeded arsoline.)

The tracer, Le d-2lO, is naturally occurrirn end is nresent in

13.

relatively ltree amounts in dust and “articulates, but nearly
absent in raint. The results of the study showed that children
with nica and other evidence of hieh lead intrke, end norncl
children both excreted identical awmunts of Lead—210. Thus,
this study concluded that dust and air—swsnended narticulates

were not the sources of lead in these urban children.27

Another study, however, concluded that st eet dust was in
fact a notential source of ineested lead, nerticularly for chil-
dren. In this study, monthly dustfall semnles were collected
in 77 midwestern cities in less. Che mean lead concentr tion
in dust from various sect rs in each city was calculated after
averagina the results for all of the cities in this way:

rcsidcntial.....l636 s/s of dust
commercial......24l3 s/s of dust
industrial. . . . . .15124' {tr/gr. of dust
It was determined from this study that "the swallowing of
as little as lfih of such dust could result in the oral intake
of an amount of lead that exceeds by e factor of l? or more
the estimated mean daily intake of lead from normal fcod and

. . . . 28
drink in non-eXrosed chlldren."

‘

.other =tudy, conducted in 1071, dentine lead levels

’3

'5

In ,3

I.

were measured from the shed deciduous teeth of children in two
Philadelphia school districts. One district, ristrict S, was
considered ”hiph risk” as it was within the acknowledscd "lead
belt" of the city. The second district, District 3, was con-
,sidered low risk. District 5 was characterised by a nredominantly
knack nonulation, which while mobile, tended to stay within the
district. The houses were older than 40 y are and many were

in a severe state of deterioration. The western half of district

5 is the Ucknowledsed "1 ad belt" of the city, from which many

14.

ca see of lea ad noisoninr are resorted. The eas:ern nortion of
the district is hiahly industrialized with a nredo ominantly
white nonulation. Housin: is old, but in generally hood re-
pair. Diagnosed lead noisonins is are from this Tr a.

Nistrict 8 is the area into which lhiladelnhia exncnded
efte er World War II. {ouses are newer and in seed reneir. The
nonulation is nredominently white. Dimsnosed lead noisonine is
extremely rare in this district.

In all, lol children with no frior histvry of lead poison—
ins' "ere tested for dentine lead 1 Hvel The resul,s of the

study sho‘ed th t blacle children in nublie schools from areas

:3
"J J

of det eriorc“ ted housins, had mark ed elev tions of dent inc le
W1 th 20 ner cent of the children havinp levels in the range as—
sociated with toxicity. In general, the white children in the
newer housine had the levest levels, but as an unexnected result,
a group of white children from intact housing, living near and
attenli ns school :djscent to a sajor lead nroces sor also had
elevated dentine lead. Because of this nroximity to a major

lea d processor and also because of xtresely heavy auto traffic
in the area, the authors concluded thet for thee e chi dren,
airborne lead was an 1H”O rtant vehic of exnosure. In their
discussion, the authors stc te that their study demonstrates

that exnesure to lead noisoning is more widesnrced than had been
reverted, and also suseests sources of lesd other than saint.
Furthermore, nonulatiwns other than these trLditionally acknow-
ledged are heine e"nos ed to eiolori celly in.nortant amounts of
lead.

'ihe iindina of elev;ted lead level.» in urban
tflack children livine in deteriorated housinfl

15.

and in white ehildrer whose hovcine is vener—
ally in Food reeair, eusnests thrt both oaint

and airborne lead are onerative factors, and

that children in deteriorated hourino the live

in areas of heavv vehicular traffic flow are

in fret beinc exnosed to both sources.29

while it has been shown thzt contaminated street dust alone

does not account for clinical lead noisonine in children, the
swallowin: of such dust may sienificantly account fer the higher
mean blood lead content in urban children and the relatively
laree fraction hevine a blood lead content of £0 to 60/«E. Com-
bined with nica for paint, an increased intake of lead from con-
taminated dust would result in a total load intake sufficient

30

to cause simntomvtic illness. However the direct investion
9

of lead—oirnent naints is unmistakeably the nrincinel environ—

 

mental source in cases of severe acute lead noisonine in chil-
dren.31
Other studies have attemeted to determine whether persons
(not necessarily children) in urban communities show an in-
creased absoretion of lead as comrared to non—urban coauunities.
In 1 61, Hofreutcr studied the blood lead concentrations of
grouns of oeovle from 6 American cities and comoared them with
those of a rural nonulation. Taking a number of factors into
consideration such as sex, and smokin; habits, Hofreuter and
his colleeeues were able to show thct for each sub—aroun, urban
lead concentrations were in excess of rural values. In 1065,
husbaum attempted to determine Whether body burden of lead cor-
related with the lennth of tin snent in a city (Los Anecles)
b” studying bone snecimens. He found no correlation, however,
between bone lead concentrations and “ennth of stay 12 the area.

Another study conducted in 1903—71, determined the concen-

15.

tratien of lead in the ambient atmosnherc at we semnlina sites
in 8 American communities. (This study was an cxeansion of and
a follow-um to a similar study carried out in 1962, entitled
"Survey of Lead in the Atmosnhcre of Three Cities.”) The nur-
nose of the study was to examine the extent to which the blood
lead levels of selected nonulation erouos reflect cxoosure to
lead at various levels in community atmosnhere. The study was
conducted in 3 reaions reflecting various reoeraphical and cli-
matological Characteristics and included the communities of:
Cincinnati, Fhiladelnhia, Les Aneeles, New Yo k City, metroooli-
tan dashinaton R.C., Chicano, Houston, and Les slamos (N.T.).

In order to insure as s ecific and consistent a relationshin to
known air levels of leal as possible, the non lations studied
were nrimarily women volunteers livine within a nrescribed reaion
surroundina an air samnline instrument. Whe study was concerned
exclusively with tbsorotion of ambient cornunity atmosnheric
lead throunh the resniratory system and did not involve nedia—
tric exnosures or oceunationally—associated exnesures of ren.
The study indicated that while urban levels of blood lead are
hisher than suburban levels, air concent~ations of lead are not
clearly reflected in tte blood lead levels on a rene‘al nctional
basis. Thus, there are factors other than atmosnheric lead level
which are of relatively greater imnortance in 'eterminina the
blood lead levels in nonulation arouns. The erecise nature of
these other variables anneared to differ teens the regions stu—
died and was not defired. Between reniors, lead from food in-
take is believed to br sirnificant 5nd elirete may also be im—
portant, but it urban—suburban comnfrirons, tirherne lead levels

seen” to be the rajor deter inent. this study did not attemet

III.

. . . i - 3
to examine the relatimnshin between are are blooe lead level.

The association of “ica with childhood lead noisonins was

‘14.

first nostulated by duddock in 1924.“ hesnite the variety of

evidence and often conflictina data, it is nrobably safe to
conclude that inaestien of lead—based naint is still the chief
source of lead noisonire in children, with inhalation of air-

borne source aearavatinn existine symntoms, but nrobably not

initiating them in the absence of lead—saint nica.

EFFLCTS OF UHILBHOOD LEAD lulSvKlRG

It has been known for over 100 years thtt lead is an aborti-
facient and that female lead workers had a his} rate of miscar-
riepe. Paternal actors have also been known to be sicnificent

for many years. It annears that

a man sufierina from lead noi—
sonina may nass abnormal snerms to a woman, resultirc in chil-

dren born with lethal malformations. Even those children who
anncar to be normal, may carry an elevated concentration of
lead from birth, and thus may be more suscentible to further
contamination from any source.35
Children who are born normal and later develen lead ooisen—
inn, are likely to be left with hermenent nhysieloeical and men-
tal damage. lead poisoning is cumulative. Symntoms beein to
annear some weeks or months followine the continued ineestion
of small amounts of lead. Early symntoms may include irritabil-
ity, fretfulness, or disturbed rastrointestinal function, char-
.aeterized by lack of arnetite, constination, vomiting or cramps.
More severe intoxication results in lead encenhalitis (brain in-

jury) due to intracranizl nr ssure. The acute stares of the

18.

disease are manifested in Chen es in mental state, ataxia {ir—
resularities in the functions of the body), nersistent vomiting,
muscle weakness or naralysis, delirium, stunor, come, convul-
sions, and frequently death. lead noisonins is further known
to have an inhibiting effect on red blood cell develonment and
may cause damage to kidneys and liver. The disease in children
differs considercbly from that in adults. A ults rarely develon
central nervous system complications or encenhalorathy, while
eerinheral neuritis, lead line of the sums, and colic, common
symptoms in adult cases, are rare in children.36
While increased efficiency of treatment has decreased the
mortality rate associated with lead noisonins, meny victims of
the disease suffer some form of intellectual or behavioral se-

quelae toomnlications.) The ssecific sequelae seem to be deter—

U1

mined by length of exnosure, sneed of diaeno is, and the method
of treatment. In cases of reexnosure, the rrobebility of ner-
manent brain danene is 100 per cent.

The severity of intellectual sesuelae rnnears to be closely
related to whether or not encephalonathy is uresent. If it is
nresent, the nrobability of sequelse is at least 4“ *er cent.

The snecific canabilities usually affected are nercertien, form
discrimination, and lanruase skills. Ueterrinntion and dies—
nosis of eroticnal and behavioral sesuelae is sore difficult

and subjective than the intellectual comnlications just described
as ”the effects of the syndrome are honelessly confoundrd with

the effects of environmental denritation, which often character-

ises the lives of children in the socio—economic area which pro-

"37

q

uccs the lareest incidence of lean rsisonins. Children with

C);

lead noisonins usually ethibit hynercctivity are easily distrac-
. 7 .

19.

ted ene +101 1 V labiJF. 1Fer also tend to he cnfiressive end
hfive difficulty in establishinr ”normal” social relatinnshins.

There a nears to be a close rclztionrhin be—
tween severity of into"iceti'n and emotional
seoue1”e. Also, the tvre of treatvcnt Ph-

D”rcm tlv does not have a stron ” rel"tion to
err;ctio1'f1 1- sesuelae, '-.'."nile the ebi111,v of the

.1

relents to nrovide suwnort ooes.38

n q a
1 l
.

Accordine to a recent Juo_ic Veslth Jervice ienort (1071)
ann 01:1..ntely 500,00 Arerican children have elevated blood lev-
els and some 10,030 reeuire treatment for lead noiscnine. Annu-
ally, 20? children die end COO ere so severely injured as to re-
quire nernenent care. Thiry—two hundred suffer wodcrate to

0.

- . - . . . . 3
severe Drain serene, xecuirin" substantial sne01elJVed care.”

Thus, with sufficient evidence to indicate that lead ofn cro-

{J

duce disturbances in body Cnd brain metabolisr, end cause as—
tinn mental imnnirment, it is essentie that ever” effort be
node to reduce the body leed burden of children to 93 low a level

as noseible.

DETECTED? AND TRHATIEhT CF CHILDHOOD LEAD PMISCWILG

Evidence of lead noisonine is best obtrined throunh.com-
munity screening. rive es sentie l f:‘ ctors must be considered
in blannine such a screening nronrcm:

l. The children at risk — which children, by nresent
kn wledec should be tested?

As leaded pa ' nt her 1; ieentifies the children 0t risk, screening
should ('enter on those areas where there are older homes in
poor renair, hevine surfaces painted with lerded .nint.

2. iccess to the children — whet orsnn'7ations c2 n most
readily reach these children?

Parents are the key to reachins childr at risk, as educated

20.

narents can exert effective pressure to obtuin relevewt tests

for their children. Althoush several facilities may combine to

I..J

pool their outreech efforts, screeninfi of 81 chil ren at risk
may not be feasible, and thus it is necessary to ninnoint tar—
get areas.- One why of determinine such terset areas is to assure
the children already identified as lead noisoned define hish
risk environments. In some cities, this icy be 3 sinsle local—
ized area, while in other cities, cases may occur over a larse
part of the citv. In the latter situatinn, the indicator

cese can be used to determine "clusters" to be screened. Such.
cluster testinr could be done by the heclth deeartment upon
notification from a laboratory testing for elevated blood lev—
els, and would irrolve visiting the indicator child's residence
to test other household members between 1 end 6 yezrs old, and
neiehborhood children (where housinc conditi us WPrrPnt it.)

3. The technology of testins - whet technolosy is avail—
able for doins the screening test on children?

The technique of obteininn snecimens hfs been simnlified by the
substitution of finrer sticks for venenunctur.s, allowins more
peonle to be treined tc take snecinens. The success of any
screenins nrogram is denendent on the accuracy std velidity of
the laboratory date, as both netient and entircnnentnl follow-
un rely on laboratory results. Because of the difficulty and
exnense of creatinfi end maintainins a hish finality lab, ell_but
the larrest nrcrrems Fenerally contract for the tork.

djcal fol—

we

V 4. Follow—us — What are the sechcnisws for n
1 01‘7" L113 ?

The blood levels 3t which vnrious actions are taken are some-
what arbitrary 3nd vcry from nrosrem to nroertw. In Newark,

N. J. a blood lead level under LOfiws, reuouires only a reheat

21.

test within a year if the chil” still seems at risk. Jitt a

'7
1

blood lead level between 4d ant 52/Wg, the child is considered

to have evidence of increased absorntion and till be tested at

l to3 month intervals until the ertent of the denser is clari-
fied. If thr child exhibits a blood lead level of bQ/qg or more,
hosbitalisation and tree mert are reuuired. These children who
require re—testins and re-examination must be under a ohysician's
care, although his services mey be augmented wit} the helm of
hora-professionals. Screeninn brosrams must be eble to entici—
nete the needs for various services, and the families' ways of
paying for outnatient and hosnitul car. should also be consi-
dered in the olrnnins nrocess. Ad itional factors to be dealt
with, esnecially in urban areas, are the nroblem of missed an—
nointments and the fact that children may be tegen to more than

one facility for health care.

each facility, #hile only incidentally aware of
other services to individual nation.s, tends to
assume natients lost to follow-us are receiving
care elsewhere. Difficulties are further in—
creased by the mobility of the urban nonulation.
In a Kewark lead screenins survey, 40 ner cent of
the families had been less than two years at their
nresent address. For lead noisoninn, some common
resistry is scential. In hewerk, this function
is nerformed by the Centrel lead deeistry.40
5. Environmental control to clininete the source of lead
ooisoninn is exnens ve — What ontions are there for envi—
roneentel control and who will set oriorities for their
annlication on an onsoine basis?

Somethinn rust be done to the walls of the house in which lead
noisonina has occurred, and althoueh a variety of vethods exist,

they all rresent nroblems. H311 coverinrs in houses with lead
. - . q the _, .

.aints usually held for only a few months eve tOAWCLK infra-

structure of such houses. dtiffer coverinr such as beaver

board works tell but is flOTG ennersive. Pfiint :ey be flared

22.

off but this involves substcnfial

mechanically requires intense end

tion of the child after tr _.e.tme1':t

offers no nrotection to new yeuns
Innovfitive fundine
mertc for revolving lo:
need exnloration. er
ful nroerex of environr
brinte leeisletion end
enforce resnonsibilitv

removel of the surface

.‘1
I“.

“A

1'! GCZ"...

h.ze r“s, 1rd renovine noint
costly lebor. hile reloca—
is 9 tennornrv solution, it

occur nts.

nisms, such Cs erranee-
he end t:K incentives,
ereouie ite for a force—
ente control is ennro-
reeula tione tc fix and

for reh“bilit:tion (i. e.
or rrkire it inaccessible )41

Screenin’ is most ef ectively accomnlished throueh a COOn-
rative effort emonr existine orfcn'r'tions end asencies end
by buildine unon the health service structures elreadv in oner—

étion within a community. "Centrz lization end senarement of
the nroeram, 7111 almost certainly reouire a snecinl office to
nrovide comxunicrtion, leadership, end access to tle fee ilities

needed for the combined efforts

‘1

owerd the comnon of elim—

"42

real

inetine childhood leod noisonine.

The innortent stens in di: nosine lead noisonins as out-
lined bv the U.S. henerteent of Health, Education, and aelfar
(HEJ) in a booklet entitled, ”The ecoenit n of lGLd ‘cisonine
in the Child" fire:

1. ht"rere'1 that nice may be essocieted with lead ncison—
inn.

2. Tresence of symntoms sue? as leek of ennetite, list-
lessness, increased irrit bility, v (me 1.1670 i1r main or
cremns, constinction, or vomiting.

3. Convulsioxis or unexnleined unconsciouh ss.

4- Sneciul loboratorv tests ere indicated W1en sue niciL n
is nresent err include tests for the nresence of in iron

5 efici encr: C new 1.2:, ebnorrsacl

the red blood cells,

bones as seen bv X- C.y, rnd
concentrations of lead in

ebnorme

blood

blue enots or ”s+ irnlinr in
l density of t1e ends of the

51 tests for abnormal
erM’11rine.fi3

sneci

The i entificatien of a child vzith lee .d noisoni1e is just
the beginnine of several nreventivc and therapeutic measures.
First, and most imnortantly, the child and the source of lead
must be senarated, initially by hosn italization, if the child
is toxic. Jhile in—natient treatment reeimens vary, all are
based on chelation - the use of c11erica ls which combine with
lead and thus facilitate its urina.rv excretion. In milder ca see,
the chemical edathamil calcium disodium (CahDTA) is used, While
in more severe ca ses the aeent is l3rit1ch hnti-Lewisite (EAL).
while these drues are life—saving, the? ere also toxic.44

Lone—term care is escentie, and is the nest difficult and
most imnortant eW1ect of treatment. Lone-term care is dependent

ubon the nrecent that no child ever returns to a leaded house

 

This Csrect of theraoy requires the coordinated
effor;: of nublic health authorities to efiect
the remova.l of hazardous lead sources, as stznc
for the mother in her dues st for safe housine, and
increasingly, mobilization of the conmunity it-
self. heeeuete care often reouircs brief hosei-
talization in a convalescent fecilitv or foster
home. Thereafter, the child must be followed
closely un til he reaches school are. where nos—
sible, enrollment in nurserv school or Head Start
nroerams is Cdvisa ble to nrovide stimulation for
the child, thich may for the pre—school child,
reduce his enotionel needs for rica.45

Because of the deny aedical and environmental factors in-
volved, it is difficult to make a comnrehersive estie ate of
total medical and related exnenses attributrble to lead noi-
sonins. Generally sneakint, the tyne of exnosure, the ass of
the cziticnt, and the severity,.recurrence, and seduelae of the
illness are the imnortant variables influencing total direct
medical costs in eases of lead noisonine.

Sencration from exnosure is the ess.ntiel comnonent

24.

of lead noisonine therapy and thus hosnitolization is freouently
indicated. Obviously, costs frr treatment fall most heavily

(ind directly on the poor, who are the least able to nay. Treat-
ment costs can oe divided into six eeneral cetenories:

1. direct medical costs for acute and convelescent core

2. Cfter—ctre and excess school costs for the partially
1

brain—ccmasee

3. custodial care for the nerrfine1tlv and severely in-
jured

4. correction of hazards in housins
5. nreventive hee th sunervision

6. sunnortine municinfil and state health denartm nt act-
ivities

It is difficult to senernlize about the economic innact of child—
hood lead noisoninr as diernostic 8nd tr&£‘tmc:71t f cilities. vary
Widely amone connunities 3nd few of thee e heve nrorrams Which

can be considered either comnrehensive or Wholly adequate.

In Baltimore, children ere treated under the senerfl medi-
cal oolicy that no child found to have increased lend absorp-
tion, with or Without svmntons, is returned to a ”loaded" home.
The child is first trected in a eencrel hosnitzl for a brief
beriod and then nluccd in a convalescent ffcility until a safe

dWellinr (modern n1 1blic housins or adeduetely renaired old

hous inn) is found for the ‘emily. In a F“0Uh of 45 3altimore
children treated from 12e5-1e7o, the avernre ote.l tixe of

acute and convalest cent ho snitulizetion was 100 drys and tte
averaee r”ire-ct hosn1telifi”t1on cost for 34 natients was 2746.
The two hirhest hosnitul bills were over $9000 each - in one
case a res ult of rene ted hosnitslizetion for cornlicetions

of encenhalonathy and in tke other cece, from fin excessively

long wait for admission to nublic housins. Acymntosetic

Children c
basis in c
The t

rouehly es

follows:

3.

These Giro
repairs to
In Baltixo

While New

on be trertcfi at lower cost and on an out-natient

onvcleecent i:cilities.r
otel flirect mecical cast of lead “OiCO‘infl crn be

timetefl accordins to the fin 1 clinical outcome, as

osymntomntic increased lead 8 sorntion without obvi-
ous resifluul oermrnent injurr: 31500—2000 her eatient

moGerPte he moment brain damage (snecjml schooling
requireo): $13,000 per oatient

severe nermanent brain demase (institutioncl care re-
quired): $245,000 her natient (1972 mcéical costs)

ct tre t ent costs ecn be contrasted wit? the cost of
substandcro housine to eliminate the nfint hazard.

re, hose costs rinse from 5190—1700 oer acartxent,

47

York City estimstes costs at fil?b3 oer anartuent.

Ageeuute housine retair is therefcre ccm arable
in dollars with the direct xcfiiccl costs of
trestment of a sinsle asymptomctic child with
increaseo lead burden. Elso reecirc to sub—
stenflerd houslnr can nrevert lead o isonins

in €11 children who may live in a riven house
durine the remainder of the house‘s useful ex-
istence. If houses were inseected 9nd renaired
before tre onset of nice, direct medical costs
could be totally eliminated.48

2C).

AE—‘l‘-L~.UACH;.E~5 To ,*.--:{.=.:3'r-:I;.:

IJE SluiTILJN

On January 13, 1971, rresioent Nixon siened the Lead—Based
Paint Poisonine Prevention Act (P.L. “1-865). It 'cs the first
federal law desiened to red we the k:20.rd of lcfld noisonine for
the nation's children. lssehtielly the Act erovideé fisc
and leeal sueeort for the followine:

Title I - firents up to 75 her cent of total cost for
10031 “Tofrans, for detection end treat_eet of lead-
bwsed euint noisoninr, includine community testih.” 3nd
follow—ue and edUCPtionsl ororrrms outlininr he Clth dan-
Hers.

Title II — Grants in conjunction "ith thrs C under Title
I for the elimination in rerideotiul hovm jn" of lead-based
otint on interior end other surffices to Leich children
may be commonly exnosed. (floth titles cull for emoloyine
reeieehts of communities or neirhborhoedc to cerry out
ournoses of the Act.)

Title III - A federal rese?rch and oe“.onstration nrohrsm
to ceternii: :e the exteifi of lead eois onine and to find more
effective ways of controllins lead neint risk.

Title IV — Authority to erohibit fut re use of lee5.—’r:ed
etint in residential structures eittcr ccnstrrcted or re—
hsbilit1ted after the effective cate of the ect.49

(See Annendix)

The fit, authorired nonronriati«ns of 51 W,» 0 ,0 in l€7l and

iPO,Vio,JoO in 1‘72 to carry out its erovic ions. Amendments

to the :ct were mode in l”72 and l“73, With the le .tt er roue

fl" }

incorooretine rest of the elements of the earlier, rfmely:

1. an increase in fedcrur feedier free 75 eer cent to
93 nor cent of the cost of local “roerets

2. an exornsion of the fefieitioe of ”leod—brsed emint"
from 1 her cent lend content to c.0e eer cent

27.

lusion of the leC5—htsed nnint neisonine nroblcm
scone of the Pub‘ic ueelth Service Act

A. the creetion of e fictionel Childhood Ieee Based Paint
Poisonine Board to advise HEN

5. n: ohibition of leCd— hes
tures receivinn federal assi
niture, cookine, drinking, and e:

The ameneed Act Ceeronriates 3o1,3oo,ooe e veer for two years
of thich $25,000,000 is for detection and tree newt of lead
noisenine, 535,050,000 is for elimin notion of the neieonine
and ::3,OJ), 000 is 10f Jeze earch. 50 Under this Act, HEJ hes nro-
vided funds for (0 cities to start or exwend efferts to ere—
Vent leCd-besed nnint noisonine. In addition to these 40,
ennroxiznetely a dozen ot*er cities heve stfrted nroerens either
in the health Henertment or the Housine Insnector's Office,
or both, with many other cities indicatinr their desire to start
a lead poisonine nroerun Es soon as enoueh nublic end official
interest to Cllooete iujids is renereted. In e5diti(:n to fun-
dine, technical heln is also available throuel a National
Clearinphouse on Lead taint Poisorinp Irevention es tcblished
bv Hhfl in the Health Services and ientel Health £5ministretion
in Rookville, tnrylnnd. The federal eoverneent is Clso ooinr
ree cCrch to imnrove and sienlify screenin", testine, and treat—
ment methods.51
In fiifiition to felerfil leeislction, other hinEs 31 level
solutions to the nrohlem of lead neieoninr need to be considered
such as housine code reeulstion bv lo Me eovernnents and land-
lord—tenant innovations. Several chIies h”ve n'eeed ordin.t:nces
(ieelizwrxvith lxvui ntirn:‘noisordjvf, nleoirxr it in iflne'brocd

context of eovernmentel code enforcement. (Sec TCole 3 )

PO
1")

Table 3.

load

”0-4-1 AO”_*—‘ Q “.‘.

3f?jfi1t

 

 

i . [Abel U
- health ‘ . nvt 0n
. LIX-Ht I ("'V
Area 01_ {or II L.|or
[hutxfixxtq ‘ SLzrflnck‘s
.3310
Bxltimorc Housing yefi vc<
Boston chltlx yes
nChicago Housing yes ”.5
Cincinnati Health yes 50»
Connecticut Health, yec \vx
. {musing {“nczccsible
i >Ul‘(‘.¥« Pa")
! Jersey City Health 5r: ye:
’ Mussachu>ett< HL\11L \Ls yo: 0
' t‘xffx‘ihl‘
.‘vuuarL H0311}! \, . x. .
New Huvtdx Hedltia, ch )vfi +
“quaing (Jexowslhle
(~_\‘?{‘) in] ‘
:‘(N (‘21.:Vlllh !L”\lth \(‘.V "'f“: .
(AggLfifiIan
1xh‘l'it71}
XrK \Irk VYJLC HrJXIL \yu Veg ~
. (detuniblv
exterinr)
New kark (iitv In.311}1 f . ‘
s
Nzrfoll h ”‘11.
Rhodc Isluxul luqlith
‘hiluJClphid H‘ner .~‘ y.~
3 ft. LuutS ix:.\u \\ 3w .
- 'li'~v!!:[l.‘
-.',Y."{1::=;b
LJ‘nington, H.C nzAlth, .(w
Manning
Kilrihgton ”(fillh ye~ M

Source:

 

}ilsinn, n.

 

 

 

 

forujfrbiwns

tilt.
farce

R (‘21:0V3!

y.-_ .— _._.»-

yvn

veg

\c<

\'L‘. 5

 

u
.__.._.—.._._._ ____._

 

 

bourCu

_.-_ ___.,.___ —._.-

 

Rwltzwwxp Lvrl
*lStl, fi{”/33,

rn1\ lu'q
., -v

lJiH' Labeling 0rdin1ncc
”easing Cole, Oriinance

 

Wnniyipul Cnie ef (Hi:\go. gcctggn 78-17.2

Cincinnati Le1d Urdirxnce, 1960
{w‘lic Act l0: An A;t to Enforce th:
E11min.tan uf Lend Es$ed Faint in Housing
KKZOmOJJYionV, 1971

(itv Oldir1nev ’C-ifi — fin Ordinance Repu‘ i
ln'xng the W1lc Hf 'vaJ FJtnt in the City I
0f Jtrtcv City, 1963

th1ptcr 109). An fiLt Pre\1d|nq for a Cnn-
yrvhvnfi} c “r(”er of Lead Poisoning Pre-
xentirn unJ Cart: [-1971

Urdilmn " funnieru 3‘1113170, 35102170.
°PIU£1"V, 81102270. and FFIOZI‘O of the
('ity of .‘.‘r-:..\:‘lx, N.J., 'I'N. 1370.

inrndnvnt uf va.inu CaJe relative to Lend
S‘nxwr (n) Hue]?irp,t‘nirs ltN-E - Lan ikllnt
:ICiHJHCL' l‘|(.'l

deinan\e RI“ unenlvd 19']

'{{1Li\? Vn“yil}fiUJS 31 Vodefi, Rules 3rd
P: wlution. If the State if flew York _
mural) mm. 'm t3 wand the Fu-“lic‘
Hrrlth 13v il!‘h*rx’k‘H To Vb? Prevention

Jul {cn‘rol ~f Lend Peiaoning

‘ Alflin‘ktrllixc {air - lend 7uint

.\:lwt|nnn 1T‘0

.01 vurl

l \
A

"guil;i(n~ Fel”in‘ I. Labellng, fippli-

 

.11“. And ECHOYJ’ hf IULH PLint 195“
< 9r 2 in} nu.- - I.‘.f-’ H i ".‘el ‘ .. i-=-)|n i11:! (‘l'xl 111:111c c
[j] '1

H 112% ”" HIJITTH- YJlt ' U"P :§ [CH4

!
ininr, 337‘ Hun in; “.qwinvinns Sr;tinn

“VJianrv 'vgn‘uIiLu wri finscrning

fl qxvnr -f Hunt'r; ng In. Yvnq J ing
[mic 'H “Elwingtun, D 1., “C“lth , Lead
Pniwt, 1953 7

. -__. 7-. ‘--—- . . .

However, a variety of nroblems arise in at c ntino to enforce
such a muricirfll orfiinance. Some of these oroblems are related
to the manrer in which cefie violations are Getcc ted. Voluntary

renortine by occunants is inexnensive, but may not be satis—

I4)

ectory as eccun: nts mav refuse to disclose violftions of which
they are aware. By renortinr an infraction, a tenant may bring
about retaliation, eviction, concemnation Cf the building, or
rent increcses. Feriodic survey insoections bv the municinel-
ity are both costly and may ceus e 86ministrctive eroblems. Oc—
cunants may deny citv insnectors access to units. Owners may
obstruct code enforcement when the cofie is too strict end if
compliance reouires ler e ex: nditures.

A second tyne of oroblen associated with cooes, coxicerns
the tyne of enforcement itself. Strict enforcement may compel
some occunents to vacate condemnefi or (htnfloned substandard
housing and seek shelter in tighter marks , whereas loose
enforcement, \vhjle oossiblv maintainine the hour inr mcrlcet,
may involve and~oermit the occunancy of unsafe and unsanitary
units.

Owner's resnonse to a municinel code rroerum is 8 third
kind of rroblem. fiesnonse is Effectefi by the substvnce of
the code ane tie l.oca tion on holdinrs, tax considerctions, and

q

overall orcfit nicture. Tonoloros are hesit rt to fenrove in
herd—core slum areas where nronerty v;lues are reduced as
buildines one one the area's socio—econoeic status declines.
Also, if the cost of irnrovements is nascee on to the tenants

via rent increases, the toner may have flifficultv firdine oc—

cuernts or pres ent terunts rev vacate. leeorfiine tex consider—

2 '2? .

ations, althounh removinc the load hozsrd from a dwellins unit
may not be an assessable imnrov:ment, Fenerel tux ores ures

on the owner mny affect his investment scheme so es '0 nreclude
voluntary renoir exncnditures. Some owners may simnly be un—
able to nay for buildinn imnrovene ts, and even if lone—term

financing were available for improvements, mrny mieht still re—

J

frein believing that the buildine -oes not eerit inveStment, or
the fear of poine into debt. The alternatives fecine an owner
Who does not consider his returr on imnrovements to be adeouate
are: continuinn oneretion in violation of the code, ellowinn the
city to make the necessary renairs, or slendonnent.

The final set of nroblems concerns those leeel nethods
which code enforcement asencies may be authorized to use. Crim-
inal brosecution is the foremost method of enforcement, with.
fines serving to deter infractions and induce res irs. However,
this aonroach has often been criticised. First, determining
the fine is difficult as it must be lsrne enough to be considered
more than a nonlinible cost of business and small enough to
leave canital for the needed reneirs. Rise, mony owners may
be willinn to risk Onnrehension if enforcement efforts seldom
resu7t in nrosecution, or when the cost of comnlience is firea—
ter than the amount of the nrobable fine. A fixed oer diem civil
penalty for each dey t violation nersists miort encourese rabid
rensir to avoid a lorne total fine, but many landlords might
continue to risk erosycution as that nronosel would Unnenr not
to increase the nueber of violations enueht and nenslised. Equi—

eble remedies such Cs injunctions and receivershin ire effec—

tive, but require lerre commitments from the enforcement arencies.

30.

injunctions reouire the owner to rencir or cease oncrctins his
buildi in", with eouity nrovidinm needed suoervision of the com—
pliance effort and the sveilablility of contempt sanctions.

In the receivershin orocess, hen bos ically sound buildihes are
not renuired, the court—unoointed receiver mekc. renoirs and

12!

ms es th: bu i1 ire until the amount of rent collected eouols

H
{+3

the cost of repair. Desnite the substantial enforcement efforts
involved, the use of these tho methods in controline the ero-
blem of lead poisonine can be desirable. n direct municipcl
emergency reneir nroyrem is a fino' alternative when the owner

does not re eir and immediate work is necessary for occunant wel-

52

f8 re.

Jhen one considers the unwillingness of rsny
owners to renuir, the inefficiency of crimi—
nal sunct ions and fiscal limitations on city
novernments, txe nrosoect of solvins the lead
boisonins problem is poor. It has been sug-
nested thet the frustrations of C code en-
forcement nro"rom lead to "a tendency to ne—
sotiF to the tenant's riehts sway with the hone
that sooner or later e.rd o.deQUFtely financed
rent—subsid3 or oublic- housirrr nrogrcm will
elininzte the slums. In cons ec,uence, s vic—
ious circle of non-cction is ere? ted."53

In Cddition to municinFl codes 9nd lows, the existence
of e leidlord's oblieeticn to keen his tenant's nremises free
of lead nuint hazards may be derived from soecific state leni-
slstive enactuelt more reneral stetutorv duties, or judicial

.P‘n

internretetions of the com:on 1e".: . sechusetts, beryltnd,
and New York have nusFed statutes which imnose a duty not to
€nnl y leao o".int to the interior .urieccs of dwellinss. Thir—
teen stFtes have statutes which establish o an €.lord's duty to

rennir those units in which such neint hrs Flrrziy been aenlied

and is allowed to noel - creating 2 lead hozrrd. L few juris-

31.

dictions nrovide thet in sore circumsterces, u tenant may repair
certain deficits in his dwellinf and deduct the cost incurred
from his rental neyment. Statutes in hossachusetts and N w York
hermit rent abatement, susoendinp the tenant's obligation to

pay rent until reoeirs are made. Other erovisions hermit rent
withholdine — in which a court collects and holds the tenant's

. . 54

rent until PCpClTS are made.

Finally, in addition to the neintenunce of mainted surfaces,

the nature of the oeint itself has also been subject to legisla—

t—t.

tien. n 1955, the Americen standards hssociation deveIOped a

stELdFrC (thndord Z 66.1) snecifyine thet reints for toys, fur-
niture and dwellin: unit interiors should not contain htrmful

quantities of lead, limitins the lead content to less than 1

oer cent in the final dried solids of fresh pFint. This ex-

cluded lead niements but did not necessarily eliminate other
lead additives in the total neint formulation. Additionally,

this standard Fs well as the Federal hazardous substances (La—

beling) Act of 1960, reouired the saint industry to comely with

55

certain lebelinr erovisions on cans of menufectured stint.

RFODE LS

a.

Because the coste in olved in eeeline with the nroblem of
lead noisonine ere substantial, the use of models mey orove to
be an effective end efficient eneroach. One set oi two huthe~

u..-

metical moflelc eeviSed in 1972, by staff 3. the rational Bureau

Fs on aid to determine the heenitude

"‘J

of Standards we
9

C)

zzse
and extent of leed eoisoninr in the U.$. in order to ascertain
wha£ level of commitment of resources would be rest ennroorinte
to alleviate the erobler, one where those resources could be

32.

l-J

nost effectively an_ied. The nodel relFtes the mfienitude of
lead noisoninr in en ereF to characteristics of the neonle and
housine in the area. The model is based on the assuention that
thos' areas now renortinn lead noisonine cen be characterized
well enoueh to nredict Which other areas are similar and thus,
(on the averaee) should have the same levels of noieonine. The
Primary purpose of the model was to estimate the nctionwide
magnitude and extent of lead noisonine, by estiuntine the number

of children with eleveted blood lead levels (EBJ: AOMh/IOO ml

or more) senerately for Zileetronoliten areas of the country.

ft

The initial moiel was not CFnable of nredict-ne ESLs or sena-
rate neirhvborhoods within a city.

The nrocedure followed in the model to obtain estimates
of the nationwide meenitude and extent of lead ooisonine con-

of 4 tees common to most modeline efforts:

'1)
F"
U)
cl"
’1')
:1:
m

1. data aceuisition
2. model construction
3. model validation
. annlication of the model
The output of the model consisted of several thles of statisti-
cal information inelurinr:
* the number of children 6 years of :"r’e and under, the
estimated number of hirh risk chileren_(those livins
in dil'nidated or deteriorated neusinn) and the num—

ber of Edie estimated by the model

Of the 241 SfiSAs listed, there were 17 million children 6 years

L-pJ

of use and under, an estimated 2,000,000 0 thich were Lien risk,

with 600,000 EBLs to be ex ected in these SKSAs.

* a mini-tire oi" the {35 .f)E'~ESAr: havine t? e. ,“l‘é‘f test nre-
dicted incidence of Lt}, in or or to illustrate any

ooesible seoyranhic t ndencies. (fire Firure 4
and Wahle 4)

33-

 

Firure 4
soninc —

lredicted
25 JLSfls

.

l.

ilt‘l

cf

flitiODWifie Inciderce of I
Greatest Predicted

 

e? 6

based Paint Poi-

Incidercc

‘ ‘S-J‘.
l l 0
0
'2'“-
1 ~“' A ‘ "
I , '
I
1 \
u " I ‘
r l u it own a. n . '. i
I ~ ‘
I | .\’
. I
O to '. -.’ » :
a I \- \t-lt I I I v ‘
o .3 ‘. I
s u ‘ E" .J . I .
V. . .
s . . ~ * .‘1 1 4
1 d C.- r... ‘n ‘ 4
' V f. ‘ c- t“. '
‘ I ~ . s‘ '
.. 'P '. .
N r E ' " ' ‘v‘ —‘ l
"* ' . i ‘ ’9'": J
o 7" '
p u -b-4'l. . '-' . c
' - a - ’ "' hi I . ..... ~“ ' ' 1 .
r‘ -‘1 ’ ‘ ' I i ‘ ' . g I.V\. - ‘ I (C ‘ ' ' 1'). I
‘. b. - .6‘ . . "2.":
( I. I ‘ ’4. \ ,a h r.
o.".; o r -, -. ' ‘ ’.
D's.- | -
I w '0 r}. ' . V‘ I EL.
0 'c-a-n {‘1 ‘ .>J
l ' “
. ~ ~ - . U r n J... . x.
I . - t u
C no-.- r ' U ‘ ‘
' ‘ I! '3 I v '1 t ‘ J
u )
0 ~ ,, r'l"'y
r'--—1 - I‘ 1
, l .
1 ‘. ~| ‘ '
' .I ‘ {\—
j, ‘n I . “1.1
Ir../ ~ "
L- _. ' ‘ \
.. . ‘
‘ A S F l I I- U A ‘
I J
I
‘ I v ' I )
nu. I t‘c .- f“‘ .._ \ ‘ o‘.‘ 4
, ~- L.» .
‘ I' . ’l ‘ ‘ . J I ' f
I f ‘ I l.- l‘. i 3 ‘ .' '
L“ nu-“
J -
I t
I I r p ' ulv'uxv \I '
I | A S a U
3 I f “ 'I.'-V '
A 7 ,. |.\IIIH\|\I|‘~
-. ' , ' e
(g . u' I.
' l! . ‘ " —-- - ~—_
\ 11' e. . . .... '~
- t- R
I ‘5'-.. f .. ‘\
s ' \
. ' a 13-: \M’,’ . \
l I -, v
| I _ ‘ I
t .. ../ n
l -l ... t ‘ I
. . : h 4, - ‘~ . -.
1, ’ '.: \ .’
' I " \Ql '
.’ - ,1- n} n .1 . ... ‘ ’
I __ \ '1

 

Source:

Gilsinn,

 

Vifieewe

"yr-"‘1

-—.—..—.. —.

fa fl

YOYAL' /

-' lrnrmcvm mun-tn er voums
mm urn www.m-

N‘OU'JNCI

U’MTS ' 9
I i .
l LN

L--.)

i
1
l
1
!

 

RANGE 0")191

[ficmefiéfivkm't

 

0

000 (Human
(3

1.000 (HILURM

,...
/ \\

/

,
I
I

39.000 6.6.10! m

 

—- ~~.--..-- _ m*~——_—_ --“---v ~—— -

t wsouw mum nun 1m rmmnm l DlAPlDAI’fD)

.3233

f]
23'- 000 must:

U

OOJKN) I'wxs

 

\-_..-- -_ _._7-

1.0F0.000 HOUSIS

 

 

no. 3

ll2, 17

Q

_ r' -‘:':- “ ‘50 <‘n "Q- ‘.A J. '7 ,- A, J‘ 1'.-
221310 4. 29 ti hm: dltfl t11~xjcectest Limieer Oi fails

 

 

 

SHSA 1U”. PopulaLion
Rank
1. New Yerk, N.Y. 40600 1
2. Chicago, Ill. 24100 3
3. Los Angeles - Long Beach, Cal. 14600 2
4. Thilxulelrdiia, It}. 144CH) 4
5. Detroit, Mich. 14200 5
71. 53:. Ixiuixs, DhJ.-11 1. 1 lSCfll 10
7. Pittsburqh, IJ. 10500 9
5h Ike‘nisu. Tom. 9700 13
9. Boston, Muss. 9400 8
.10. Dallas, Tex. 52600 16
ll. Atlanta. Us. 8100 ' 10
12. Rnltimoxc, Md. 7800 11
13. New Orleans, La. * 7200 30
14. Sarl Fra:u:isscr«lnklguri, (kil. 70CK) 6
15. Newark, N.J. 6800 14
16. Minneapolis—St. Paul, Minn. 6700 15
17 . Cincinnati, Ohio-Ky. --lnd . 6400 20
18. Cleveland, Ohio 6400 12
19. Keishingtcni, D.C.-+k1.-Vfi- 6300 7
20. San Antonio, Tex. 6000 37
21. Kansas City, Kan.—Mo. 5800 25
22. Birmingham. Ala. 5500 43
23. Seattlemfiverett, Nash. 5300 18
24. Indianapolis, Ind. Sl00 28
25. Buffalo, N.Y. 5200 23
Total 253400

 

 

 

~-—~o—---. ---_wrouu~p-m—.——--. ‘Ww—_” "

 

Source: Cilsinn, n. 114

 

* sit tee of? the number of children in each 1:31.311,
.ith blooci lead levels of 404m or more, 50 or more,
60 or sore, end 70 or sore

The estimates yielded bv the N33 model, confirmed that nedie—

tric leud noisonine is a Ina.jor uro n heelifl rrobltm in this

country, as they sueeested that some $00,000 children if tested,

H . - . . 6 . . .
mould show undue sosorntion of lead? The authors of the study

ceution:

...it is believed that the nrebdem will nersist

es lone es neeline lead sainted surfeees are ec—
cessiele to youne children. Discoverine and
treatine children with BBLs will nsrtially alle—
vivte the nroblem, but its full solution re uires
the renovel of leed neint on all suri ces accessi—
ble to children.57

A secrnd model, devised in 1372 hr Juenite Heston (KSU
r of Arts, Densrtment of Geoeranhjj tnk s a different

sch. It is a snatic l r? ther than mathematical model,

and it is to be used on e comr: unity-wide rather then nation-

wide scale. The nurnose of the model is to ascertain which

children are at erratest risk to lead noiseninn by defining

and then mannine by census tracts the areas of a city (in th

icnsinn mes used) with low incomes end old deteriorated

nre-Jorld Her II h-u_s ins. ”he model was intended to address the

oadvsntupes nosed by the three most commonly used risk-deter-

minetion annronches:

l. The reneom selection of ectients from nediatric hos—
nital wards or nnticnts from neirhborhood health clinics —
Tee enjor disedventvee'of this aenronch is that the most
denrived and disorrcnized femilies do not use health cen-
ters, thus ccusine the child livine in n hish risk area
who does not come to the health center to be the most
likely af ected.

”sis of nfint from the child's environment -
edvzntcse of th's Cnnroach are first, a

d rovine from a house conteirine lead ncint
so of such print mould not he screened, end
chine used to do such screenire is suite

34.

ezr'ertrtve €116 iflNJS Ln1e07¢unric2fl for~z”oexs scrv enicdf.

3. Tciehborhood door—to—door leed noisoniro educationcl
carneiens in vhich femilies €1wv1xr~ed to hrjre their chil—
dren to heclth centers for lead reironi1~ tests ~ The dis-~
cdventeee of this Unnrooch is that sore 1r"enilJ'es m3? HOt
hcve trensnwrtntion, or cannot efford to take time off
from tork to hove their children tested.

Gretcn's rodel is hesicclly constructed by ninneintins in
Shoes the residents ct risk. (See Tieure 5) “he stens involved
include:

1. coretr*ctire tehles 8rd tens of t”e "orcentcee of
residential structures built before 1940 find the redian
income by census tract, for the uholo city

2. connifiction of urns in terns oi fire of the residential
structure end tre condition of the struct“re for all struc-
tures in each of the census trects screened intensively
in the hieh risk arecs

3. the use of certain veriehles celled nredictors to in-
crecse the nredictive value of the model including:
e. n historv of mica
b. existence of anemia
c. number of siblings livinh ct here
d. zwfiritel snxrhis
e. sunervision of c
f. source of familv incone
E?- 1’1‘10unt of tine child is left in the are of
others
The edv0nt? es of the CnPtlEl model es nronesed by naston
are: it includes ell children within a nre—sclected Cree, not

just those visitinfi clinics; the chilfren MP“ be tested in the

home by a finder stick blood test, scvinr e femily t‘cnsnor-

tction costs and velueble work tine; the “nrrOCCh has only a

minimal cost, szinr it econoxiccl for-massive screenins.58
Althounh detection is only ”helf the b ttle” Crcinst lead

poisonine, rodels srch es ttesc can Cid states, cities end

inn ene conductine intensive local ero—

commurities in develon

Prams to acconnlish this.

“IQ.

- -' “-0 *.--~u~o.ooo.--w

CENSUS TRACTS RANKED ACCORDlNG TO RISK

!

l’-_\_/

33.07

 

 

35

 

    
    

 

 

 

 

 

 

 

 

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1
I. u- ‘3’.
f, I V

_ . I, , I
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\ '..“‘\“) ‘\\\“\\‘\‘ l 3“ \ \
A. ,

   

;'
" “"3" . Q; u.
. =,¢M
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f
H I\(‘\u
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v.0
I

 

 

i
... , ,
j" ,, ,,

.AL \__......_.._._ _. ‘/. -—
,.... r...“ 2". r '\._...-_.-
36 07 37 K79
')

 

 

16 0|

 

 

 

 

HIGH RISK AREAS

-

2". _
0 such
1960 C€npus auflc

.,.. _-. —.... -———--. am-“ _.".‘R: I m1-

 

5——

 

 

Fifiure 5. Census Era ts fivnkefi nccorfilnr to {18k

gource: fiqston, n. 60

(338% ATUU‘LS

Es entially, a pivcn city's nrorr1m for fierlins with lead
hazercs consists of Mh'ee carts: identificetion, includinfl
casefindinfi; environmental control, incluflins treCtment of
‘victirs of lead intoxicati1n ; and elie'rCtion of sources.

The

*‘S
(‘3

e re six necessC.ry colicies to be incluecd when ini—
tiatine C Cd— control hroarLu. First, the chief ,xecuuive of
the city Covernmert rust actively suocort the concent, as the
croeression of activities will inevitably lead to involvement
of a nurbcr of int~e—city ove. W1ental (enortmcvti. decond, it
it must be underrtood that success ul 10-6 control meCsures
will intiCllf increase in cost as more le 6 “1""*'c Cre identi-
fied. Sri r6 there is ittle VC l-ue in C‘hTOhri.t “n funds
for casefindin‘ of one 838 eroun for one year, Cnd eliminating
the funds in the next veer. The fourth nolicv is that ececific
Foals must be established ct tne outset, co the t tee evaluation
nrocess used will :ive a true nicture of the “rocrer in erosress.
Short rCnre coals would include: or'”11 cticn end st u.fiine of
the evency, linkinfi neiehborhcod orecnirations end other com-
munity fienarteents, berinninfi co munitv efuCCtion Cnd screenine
in
effortsgNthe svsterCtic selection of FCO*PP“th Grove to he tes-
ted. Lon: rCnre so: s xivht be: lsrislction Cnd firm ficleecine
and renovation hro: ems. The cstobl1shmcnt of clear—cut objec—
tives Crc review of sricrities is 'he fifth er entiei_ n licy,
as if such objectives Cre lifiited CD6 re: listic, the nrotecilitv
of continuint fiscal succort is ercutcr. PinCllv, each city
must develon Cnfi follow C mien of Cttfe ’ Gcsicred s“ecifiCCllv

for its individual needs and resrurces.

A snecific sequence of stews Cr: recesrCrv in “lCnninc and

eicecutinp a lecd cor

l. EWM3 "wrinm .m
Cm elite, must hecozn
f st convince th
.f‘

ts of deelinr m
tionally, thr
acces to the

(EiW',

("'1

2. The estrblis
size of which een
set for the eroer
finnlized‘within

3. Mobilize
of lead.

f. Cesefi
attcck

5.
effort.

{17.2”}

«iimw
.1 ( u-A-‘ ,

the lrrrer
Wr‘

.1—

CthiniNE

50:

The eradication

Jhile slum cleertwce

for the moor is the

DOiSODiF” cup be ruc

detectitni, trettrmrfl;

moval of lose fr

have demonstmetefl

In Chicveo, the
poisoninr onercted t

Ciels, he l_th “ON er

in 1955 and by 176?
over 1500 treated.

GJCVQted bloee lead

rer cent in 1007 to

of

Ar‘
\/L S

in the member

Ifi?te. Ir1 lo2

203 cases cf 700d

cit,

\.; r

{101.1530 {-7

+11.

trol

“roerem:

overs” in tie city, inclueine ehetto resi—
e concerned about the wrehlem {37 must

9 10931 r"“"\f£‘.1”‘r.'£91’1t thet tee econonic bene-
jth the “roolem, “9?“’nt the costs. Adfii-
ector cf t}1e leJc—control rrorran must have
chief e} meCI uiVC.

17.0

0

hment of C staff for the less nrorram, the
ends on the size of the city, Chfl the reels
’T’l. A time —ohased ,ct'cl ol-‘n Should be
three months this steff

educational effort concern‘ the hroblem

. .~
1. S .

but tool to

tie environment.
total

reind 13x t it
lecfl in

r in

nu”
u.-

keenin
hroblem

disintive enfl fiecsl sueeort for a

of eafi neironinr is not “n i: oessible t sk.

I"

with erovision o: edeeuFte hou“1nr

combincfl

most effective means of elimihétion, lea

c1119

cess . lly reduced throueh efiucatiOh, early

emé follow~un ororrtus 0 include re~

‘

vherever it is founfi. A few cities

vzlne of such methrés.

re is C mas;ive screehihe crorruh for Feefi
Wroubh the co Joi Fted ef“ort of local offi-

0, find the conmunity. Uhc nro~row was be.un
over 190,090 chilére* hid hcen testefl no

lkxuuise Of this DTTVWTU , the incidence

levels {‘non” eri lriren

_..\¢

3.fl cent in 19b3. Alone with the rise

7701‘

93 99 99b39y Cffie U decline in the fatality
first F93? the 9180:”e WES Knee rewortablc,
'fiiS nirwti ere ifiviortnf Kitn fr~m:1it¥

r) A (N

rfite of L.U her cent. In 19c , the number of reverteé creec
rose to 707, while tre frtality rate cronneé to 1.? rev rent.
The Chiceeo nroere: iv concentrated in nine (rein in the city
enfi inclxmflnz'the onereifiCN1 of an.rmflmilutory tiwwrbnent cnnwter.60
pimilLr ficuree hwve been ren rted iron New Yorl City,
tnrounh e nronrcn in which physicians from all mc.ical ceenciec
in the city are encourvrec to eenc blood encci one on all sus-
nected arses of lead noisoninr to the cit“ health cencrtnent
laboratory for n onnt vnc accurate blond lead anilysis. In
the "leafi belt” “rcan of the city, nublic health senitcriene
visit ever? houee in Cesirnetefl bl eke. (flee Ficure 6) They
tLLe scraeines for 7eC€ écterminntion , in uire ebout nice, tcke
uriLe scmnles from all children under 6 years of Lee, and ac-
vise ncrents about the cenrers of nice and its association with
lead noieonine. irem Jenner? to July 1970, bfi,54& blood sneci—
mene were Cnelycefl by the New York Cit" 'eFFth Vehirtnent, ”0‘0
children with blood lead concentrationn of baflr or erefiter
were found, enfl 2 lecd noieonine ccueec deaths were rewrorteé.61

x'fe U renortable dis—

J
C)
\

In Ihilfidelnhit, lead noisonivw ma
ease in 1053, hu‘ with little effect. In 1 en, the Philacelnhia
City Council took action end reeulatinne were ieeuefi rerarfiine
the labelinr, ennlicnticn, and renoval of 19:6 neint. In lécQ,
a urine screenine nrocram for lead noisonfin’ rwcn" chilflren l

1

to F years 016 was initittcr in Philudclnhia'e hieh risk areas.
(See Figure 7) Thronflh tiese efforts, numerous nronerties have
been mcie Ser, renorted Sees of lead neieonirr hfve increased,
Elrul the-'wurluyr of :LCCG.1T31FWUliHF rieetiy” herirlcCIWN1305,

Baltimore $33 one of the first cities to recernize leafi

TDOiraoninF in chileren Us a eublic heclth nroblen. For over

38.

  
  
  
   
  

Repofled Co ses Of

£3119 POISONWG

- ..--__—....,___.—_ .—

 

8)’ Place Of Residence
; New York cny -—w¢3

....
,.- .

_.v .
a"

LEGEND

't'a-n a

High 'ncédcncc Ava-'35

Q lwio'ed Cases

 

 

 

AfTER JACOBZINFR AND QAYBIM, 19¢;

 

 

 

 

 

 

' " "" -‘-—-—4-—— .— -A.——-— a-a——-,._—.—— A-.- .—

Firnre 6. City of New York — ienorted Cases of Lead Poi—
eonine

Source: Gaston, n. 95

,--.--—-- ~ ~-....—.-ns mmmwnm;-~~-m. A—A -—- —-

 

1952'
a“

ZNGAll S.

\

AFTER

\

\\

 

 

 

 

 

 

LJ
ii”

C
.q: CL

LL
.J

 

Spot map of 219 cases of lead poisoning by Philadelphia residences of patients; 1356 -1960

 

y-
§
t
i
1
4
I
1
l
i

 

 

 

Fieure 7. Soot Koo of ?19 0930? e? Vere Toironinr' by

Philfflel hi? Reeifiencee of Patients; l9fif-1960

Source: Heston, n. 2?

3O Yeflrsy the city has dealt win

detection and orevention nroereus, t-eu

health and
educational connCiFns.
Association, the city
tion from landlords.

nrosrers alone with n:

.4

6
'1' IV
*n'.

yielded encouror

ent nroeress is that

environment.

hsvardous sources have been reroved,

helned to find

Cincinnati has attemnted to deal with the coynlpx

case-findine,

by the establis‘ment of

US

troject of vario

End a

in mrnv fields,

The Center mointeins

Poison Inforre

1"

OJ diarnosed

for insurinr adcouote
vidine tennor:rv

\ f“. r-
C, (mi)

records of known

V

a sienificant role in

In 1909, the Urhen Le;
." T 3. 111') O f :3? Q ; 1 t j
to the I

(1 qr: . (NJ-
U~L11\) U

housine codes,

re
no child
After hosnitolization,
lead-free
nrevcntion,
cit? onencies,
a
tion Center,
lead
eiurtodicl_

CS

fo‘unterv citisen action

:r Gomrittce

r‘11 the erohlem throush continuous

J.

include enforcewent of

eniderioloeicel surveys, erd intensive

'aith the hole of the Irooerty Owner‘s

heelti desertment hos received coonera-

The continued existence of the various

int removcl from Sony dvellines, has

silligs. W

Another k~v to Unltimore's annar—

'3 ever returned to s denserous

the child goes to a con-

returned to his f“milv until all

I1

or the ifirily hes bee
housine.
ities of

nublic and orofess'onnl education,

'7)
t...

Control Center, a co.eorotive

institutions, erofeseioncls

variety of other interested individucls.

close relfitionehin rite Gincinnati's

and is rcseonsihle for renortine all

noisonine to the teelth denertnent,

insnection of victim's hetes, for tro-

CCfre, and for mejntf jninr‘ ’t’TT'OfiCI‘

- . . . , 67
one infurins C eoufite lOllOW—UD care. J

in several cities hes also slaved

G

r‘.
I...

the iisht to eradicate le ooisonine.

cue of Rochester, Ken Vrrk, nereuedcd e

s ?rofiect Uniiit Youth Incentives Prcrrum

fei'Lfljientiifi(é Infl‘mfmtixrl in

its study of lead noisoning, ti ouvh the collection of stint-
ssmnles from slim herbs. the erorrem has continued and the
Youths new work with the Rochester Keiehborhood fleclth Genter
aid with doctors from the University of flochester's Strong
tenorial Hoseitel Deportrent of redistrics. In edditien to col—
lectine ruith semrles, ifiu31youne neorflta<iistrihute cWhMKItionel
materials End collect urine somnles as indiceted by ncint sem-
nlinf. lhroush this crorrum, nearly 7 vcr cent of the children
tested so fer nrve been found to hcve denserous levels of lead
in their systems.64
iev volunteers were also used i- 9 flow York Uitv ghetto
comrunitv in 0 four fey door—to—door lefd eiwcotien and case—
findine nroprtm in lhoo. The sorl of the nroeram’which we
coordinated by several “hysicians end the her York C'tv Leerrt-
ment of health, nos to reach those his? ris? fccilies who hcve

J,‘

limited contact rifln nrofessionul medical sersonnel. The Froun

of volunteers were nercnts and all were resifients of the cornu—

”l

nity. Some smoke Snenish es well is Lnrl sh. The volunteers
were instructed in ell asnects of lead eojgonig¢ _ mpthoas of
nrevention, irnortcrce of early detectio , Led etioloey the se-
suelce of tte disease, and ties conducted o four dcv door-to—
soor csswfiijui to educrimyzieirhborimxxi residents :flxnrt lefd
noisoniNf. In cdfiition, oosters, “revs (rd refiio :nnouncerents,
truism voanrteer—xrsnzed sorwui trucP:\ er: slrvwlxtili7ed. the 3
result of this volunteer ef ort, llo children were screened,
of which 9 were feund to hove elevzted blood lead levels. In
evaluatine this rrorrer, the orrenisins nhvsieices corrented:

’;Le ~emlth services in the rhetto slum evens

resuiiw: incrwx sod :Turoovc1n iuct.::71nove1‘ "s

orescnt end wil‘inr, filthcue: it needs to he

uncovered rrd mobilired. Our volunteer hole

40.

fies sccnrce Titrout difficult? {n6 their
entrusivsn tee snirii were excellent....

eirf:;bor-to—nejPhhor tree of Einnroa‘ch
lenes itself horticulzrly eel! to the cis—
seminzt'mn of nublic health informrtien en?
mcv bsvc advantrees over flore Tuthoritzrien
'techeistun?‘nartiCEflznfhr in fie idxnni areHS.
I; SUC*INZSTU].‘WTOF’KYL oi‘iieelifii eermn‘tifu:
.ust hrve come iouneetion within the commu-
nity if it is to recch the neonle 6nd sti—
rultte e nositive resnonse.c*

“1',” ' F. V
L.:l...) -.‘

Z-Eumerous nror’rems, nlzfans end fuieelines hzz'ce been. nronosed
by a ariety of neoele in men* fields to solve the nroblem of
childhood lead ooisoninc. (See Teble 5) while most incooorete
any of the sore hey erincinles 2nd recommendations, some of
the flifterenees in their scone and focus Ere worth notine.
(See Fieure 8)

Some 3 nroeches to lead poisonins erevewtion ere rather
nerrow end snecific. Seherz nroeoses e sir-stem nroerrm which
focuses on nrevcutinr the exn see ohil* frem incestine nsint:

1. All oceuoen.s should be warneé.

2. Heeove lendeé naint or cover it.

3. Keen e child suseected of eating leed from further ex-
nosure.

4. Alert health workers ere these rho cone into centect
with children from hezraeous dwellines to early Gym“-
toms, cnfi test ell susnect"

C "3"‘(3'3‘ "j ":6: 'C- '1“ fi‘ ten-VJ.- ‘l‘ ,.'r‘ 'n‘ilfirx ' '1 ti - ' o

J. Mu.” L else is -ouno, eel ou.el chi .ien 1L ac house.

q 66

-6. Treeteent shoule start ireedietelv Cf:TT oieenosis
LOSt ennrcuches, however, are brerer {no more one mnassine.
Buree enfi fleeces ViCW the nroblem of lead voisonire es 3 cycle
which, in order to orevent serious COhee“uences, rust be broken

a.-
O
l

at 1&1 eorfljr jururture. (See lfiLsuITé'3) -t1 theifi“vievf. trw=reost

. ‘

vitel sten is the T€KOVCI of substflndnre houeirr there lLvers
of lead-containine fl kins eaint one cruneline olester are
nrecent. Lurine the time sea: necessary for effective housinr

reeTece ent, ernhtsie shoule he "iven to the crevention of nice

.5
PO
0

f Jrv‘

FJltz'urc

Fuffniu

Vhicuyq

Cinrirnnti

(olu‘hnfl
Vuuhecti n.
Lral“ ,-;{

Ai-H’t :RI‘I L!

Lew FLVcH

 

“thV“f

llla'ni»
inluxn

' horny fi~2l

l Peoria

I... .‘H. l'12);

Pvzntur

Juliet

Roe}. isTuvvi

"i 3‘"! i'ij'.
VIer:
":11'}1r‘v‘ !_, !.
ln!i1nu;nl..
krnuafi Fitv
Hus lquty,t,
unvlnn
C313": “ii-I.
th'll

'.'.')T\'.‘ ‘ [l 1‘

 

 

 

 

 

 

 

 

 

Currer‘Lt

1: mm.
iro. ..--s

Dv<eription cf

angrnm

 

$1 at 1y l‘y gfl.v; iei;|n\ 01‘ In 1‘: q~itzllt

Hill] cftrr:

-v:«:ninq

”J83 u-reeninq

5Wull screening C'fort, t<ut childrvfi with uvnptCHS
lqut (hillrvn klth symftnmu

“-ing [llmeliy the \!\ wrinv ten!

2 (J\HC$ reguirted, seulll JCIUOIUIU1,.I‘SO tot! P) cliLi
lent iv ho p~lnl and t~<t (hildrzn hllh s>nyiosa
3||~5 “\IW‘CYlinjj ixu li“'fi n(\t fu'xiu I it} l 1‘1 , n.,.

in t08p13d13 awd .Ylnlca

.HJII merceninq effort

weal] isrtcning cffdlt

H‘ifl AUTch, Fvull SCXCPning. in L(.pitnl$

"mall screening effort.

Hues screening, 12% of all thildren screenwd

SCTCkhiHS in 9e10:101 arcna

iӤ?31 so: Ve}', Serxll 3(l ceiling; of :oxt

Iv ling in howpltnlu

l‘ilot lirojcct, hxitintrul hv ctwtavnity' groove

In ’H\5pitill , 3~lnvnninq tilture 1 {tort:;

In Tlinixi

Ferorning in Nodel Clries

5! TC” 5'

,.___ -..———.— » --~~-- ”.-.-.....- .. -—- —----——

.w‘“ -._— —_- ,-

~...._ ....~.. . ..

:;rcering

---__ .. ...____..1

A-..‘

I
C4 !
|
l

Primarilyo

——.-— “ham—-....—

Continuefi

 

 

 

 

 

 

‘ .
1 Area i fi::f:::l Yrur Descrigticr of PY05er
‘ L _, - --__ __-._._..__-_____._ ______-.- _. __...---
fxiluaukcc { {vat thldlon with <ymr:om;
Minneapolls I rust children with symptdms
ilzshtu), N.l|. ' hfii?1 SLIXVU\’
Ynshville “7 Fllr! prujhrt
Sew Jersey: l
i Jersey City I Texting in hospitnl5, tcvlin; .liJJrcn with b§mjf0m?
% heunrk 3H43 l 1971 Come rnsw 5crccninu and also in hnbpitn14
i Paterson Tvstinp childrnn klth 5)mp:cwu
i Trenton Tvsting in hcspitals
i New OrleanS 527 U”inp a fingcr [liik trs!
: How York (itx' “045 lFbQ 1
7 843m; 1970 “‘55 M‘I‘cvnin:
8‘5»? 197]
norfolk Abort 115] Grant (rum HCLM In condnat Sfisl) crrcuning
llun
DHTLJ FNJII scrncning Cffulf
Philadelphia Abdul Screening in ”del Viti's Arvin, t”nti”fl in huthilalQ and Clinics,
EPgh not u~inn blood 1091 tc€t
Tcrtlnnd, Mlinv A“onf 19?” Fm.ll Scr'oninu "ffnrt, lvfitnnw in h0~;nfn1J. u in} fiLfi urine test
.1 ICU)
PortlJnU. “re RtIM survey
Rhko lslwnd it?” hcrvcning using Mai: *er)v§
Roc1u3<tL1', J.\'. Scraun:ing, Lllso t! :: cl.il$1c:n mitt: '§~3-Inm~
Sacrnmcnfo Lfilfi curvcy, 63311 Strccuinn 'xwrl
Ft. Luurs 4027 13’1 Puss scrcvning in scl.ct" 1rr1‘
San Antonio Test rhillrcn kifh «)11r0fl=
SJ” francxsun ' $1111 survcning rf‘nrt
Salt Lake Cxty NFL“ survvf
South PonJ Small nrrrvniny vffwrt
Syslcusc erIi \crncning vifo:t. tvst LhrlJrrn J|?h 9YPPI‘73
hafldlnflt‘lh U.C. Sf‘S A1979
fwwnll figrtwwrlng t‘ff<n‘r nxnl tr‘ tinnt an ‘.iini< :
18’)
Yonerk. :hmlll ngKWW11nfi 'WW"r!, t( ‘t vhilr'rvn «;t’| ;;m;!'~u‘
.--.--.___- - .- , _.__._JL.._ .- ._

 

Source Gilsinn, nn.

 

-....-- ..,--. . .-.- .. -—-.—-._--..-— -.—_._..___-— .7—

Fi

mamas:- tmmw ° 9 ’

 

C‘NJ‘JK'W
III-ION it

man manner I} Q 3 {23. HT ”Mn - Lump
la Mfiq

{fure

Source:

. 0%.};

 

 

9. Childhood lead Poisonihfi

Tern? et r1 n. 102

Rehabilitation N

  
 

‘4.-

 

 

 

 

..—-~-... .

Ohm} n 11
my)" mum:

“-

an t.
WWW“ flux: '
(’01!qu

O- with“ I045!" I

 

 

 

 

 

 

Fm...

W1 0‘

 

 

Removal oi
Substandard Housing

i

 

Slum Area

 

 

Slum Areas

 

 

Sequelae

 

 

 

Treatment -—->

 

Lead Poisoning

 

 

 

Early /
Treatment

 

 

Lead Exposure

 

 

Firure 9. Crnccn “n6 Comte“
zoning 91* 1oteniirl Sites

Source: flurfié

 

Deprived Children

 

 

 

Transfer of Small
Children From

4—.— Prevention ol Pica

 

Pica

 

 

 

\

Case Finding

innicertifil 'piii12lzoofi
for lntrrver ti

{NC-3 (crimes, T). 739i

(1

Poi—

1

. - ~ - I q ~ II'A- —\ yea J- 1 ~'( . - .~\ ~ I ‘ - ~. '..I ~\“ .3 I ‘
1n phone ChliFFGfl nnw _uc. 2c :1? 1% a Pfrco c s "UuHClD'C.

" ‘ ‘I' H‘ '4 rm -: I . . '-~‘ ' \ 3 \”.J‘ ~ ' . . v\' . .lr 1. .I‘ V . v
lrlmerv res? H;;OlllL¢ far as urOl oi nlca 1103 .Ltu fire fgm113,
0" ‘ Jo ‘ . . - - J- ‘ . in -' . V.“ . ' -.- 3.. q I-‘ a» - I ~ . ra o N
3nd U'U? izrentrinunzs cc lflfOTmG? oi ch etn.crc economrtcc

with this hibit. nose refiin, school narcnt FTOPUS, :16 commu—

rs

nity mcctinfls shoulc C11 be utilized in iris CGUC‘tionF1 effort.
Burce and defines Cleo reconmcné for sne11er ccrwutities, the
establiecnent of "lead centers” - sccciCI clinics Vierc rich
risk children receive evaluation can care. “hose centers should
Ibo comnrisod of an intordiscinlincry staff to_he?n femilies cone
with environncntal situations which nroduce tn: rrrceurc hrzurds

.. .g n‘ ‘ 1" o a. . A. . -,;J- ’ o . o‘c‘ "(fly— - ~' - . a
one n30v1cc co:rnrfig,.u efiucntlcn of L (‘11.flfii: tnrnnrh reieonal

(‘3

contact. The efficrcv of ruch centers nil? ultirctcTy dewend

. - . .. . . . - b7
unon the locatlon End 0339 filth whlcn hFTOPtC can Othln HOLD.

“

nccorfiinf to tnrllon, a two—fold tssk exists for eny com-

J

munit“ th~t in consjcer‘nn the estrbliekrent of In Cctivc leer
noixon'n: Control nror~cn. First, the chiifircn ct frertest risk

nficctec. Second—

‘4-

must be locatcé, screened, find trC'ted crew
J, (n0 ecrbfns Kore imnortfntlv, vs fer US the overcll eliminfi-
tion of lead h0i80hifl“ is concerned, the 70‘rce cf the lend—
bccefi sci t must be iocafed ape made uneveilcble for further
incestion. ”It 17 obvious thtt any wvcchn desirnrd to control

or elimin to load—based ntint noisenirfl in e cormutity nuct be
bruscrf or1 {' lilo Henri; Iznrleiés‘fizrufiiz" rof' true rviif‘efirioi<of:r 01' 1310

1086 ixrobicn‘ in lfln“t cormnrijty.‘£jf (Hu*filo:~r'lec CH‘WY'SiCCWB'thG
nccd for an inter—Eicciciiurry as roach iv the wroblcm and fittes-
sco +h€t the chinl “rofcscion alone cc not "curt” 103d noi—
.c"orrjfir to 0&0310n, while neiict' inrut is needeé in

.1.

encrt Tscilities, leac

.-

.. f "a . IA 'V “v“ ‘--~'~ . - . \-- ' :1‘i H ‘L ‘
CCS.‘( 1-1.!T fif' ..’ ; 13‘." TYCI‘C‘Eull’ZC Elf .J‘CL

A}.

~

.‘

idoironinr is besicclly a housihc rnc noliticcl croblcm:

The tire is nov rieht to broaden tie fieht, to
extend the rer.='nor:si.bilit:.r for the rhvsr‘crzl curl
WORtTl well—beina of 2% million chilcre: below
the one of e livine in cetcriorttibc ho sine

to the other nrofessions that can ei'fcct chance.
The time is rieht for lawyers 8nd juoses to en-
force howsinr coées Car “rotect those children
who CPO too “nor to crotcct their constitution—
al rinhts; ior coliticians and office holoers,
to cor: “P839 ."e of. row, more norhhlo orflinances
and Cwmlonr :ite measures; for SE‘.1’ll.l‘-«'7T‘lf.1‘53,h0u—
sire t<c11rolorists, unemnloycd NASA enrinecrs

to lend theii ski].s ; uhfi most imnortant, for
oorents and co::tu:1itv crouns to become in"
volved in their Oan oes tiny. If this oroblem
is to be solved, it is at the community level
tiuit the action till occur.OW

Chisolm and honlnn noint out thct comcrchcnsive health
clinics for diseov hie ed chilcren iflrany cities nroviee a
suitable module for core effective child and cnrent cure in
the tree of lead unisonine:

In hick~rist trees, tie inc cornorotion of

u scrocninr test for excessive loco inces-
tion intn the rceular laboratory nrocedwres

in such clinics, together with the oovcloe—
ment of interview techniwues dcsioucd to icen-
tifv the child with incinient oico offer the
best Crrrrc t hone for the oreventiin of Chile—
hoofi nluwo-sa...[_ itionall .JW ...... t t”rilics in
in such neirhborhooos revuire 4‘9 tie intrin—
ative and continuous efforts of heflth {no r-*o--
0131 action teens oirectcfi at ntrent n rtic'
nation 0nd couch tior .70

Lin—Pu s etes tart the 16053 solution to chi lrhoorf lead
poisonin" 's slum clearance .né urh n renewal with the nrovi—
sion of wfieoucte housinc for f milicc of low incores. however,

W

as this "001 czhnot he achi“ved ouickly, control for nrevcntion

must de end on other metre includihr:

l. ?uhlic coucction throurh Ull chi els Una fl neoia
of communicctioo to noint out the den.~cr of nzjnt eftifir,
the ("Twfivvws of loco notcninv, Irv tyros “:rcntr to seek

hrlxi hCHEVN“r FCC .ri-coiscciir" i: sunrccctcc.

44.

r
J

2. Efiuceticn vi thrsici ,, nureef, 300131 WC”KCTS: 33d
ell other heelth torkcre 3% t1: “rerfilb700 of feed e iso-
nins nrpn» Chjlfiren, so r: t: serve US an index 'or sushi-
cicn

3. hues screenine nro~rems in "leflfl belts” for all Chil-
dren between 1 :ne 0 _eers of eve, 1fsin." blood Feed eetermi-
nation.

4- ImflQfiifitG Tfiferral cf children iouefi to hrve elevated
blood leed levels to a reéical center for éi:“nosis and
treatment if necessary; ereventicn of re—exnosxre; fol—
low—uh end retestinr1 of 3.11 treeteé ehi‘fliefi 110 continue
to be c-xnosee'. Health a; or-cers r113". 1::or}: closely ‘.'.-‘,1th hou—
sinn euthoritics :1 insure- t? :ct lee o saint is removed from
every dwelline where noieoninp hes occurred.

5. The estfiblishnent of effective he lth e:
ccdes rerteinirr to less and lead noisonine :
Pent enforcerent of tfiee e ccdes.

:d housine
:18 the dili-

rt by resetrch irrtit"t ms to deve-
cal and relhtivclv ircx»e1eive iethod.

. A concertec c
e. "1::r* 0, n1? C

\

‘Cint rerHov l.

0-.

O

:1
L] C!‘ “‘1
t-J 1-" H)

*4) 1.1
(N
L“

r)
'2)

o.re sees the solution to the leed noiscninfi nroblem as
lyine in the imnrevee interaction of he? rub—eroues in tre com-
munitv. One s1cn Slb— .ercun is comnosed 01 :eeneies rnd insti-
tutions concerned '.'_:1'":.l hemlth, ho'sins, education, T'Y‘W' social
5 rvices. Such inst ituticns hive a tendency to onerute uni—
laterally and in isolation fro: one vnother, vita cfired fine
seecific tests 2nd l10111rnt.. Tte chili Vith lecd noisoninr
m"v be bounccfi between trencies With nene tek'n" :nv reel ac—
tion. A second sub-eroun is th7t comnrisee of business Sne in-
fiustry, verticulrzqirixnfl es ttte owners era ifiW1111'ei"e in”ustry.
Current reel estfte €16 investment treetices Ire often diecrini-
nstory {n6 racist, 3nd tene to lock blechs “in O‘PCr minorities
into "bet tos CAerecterizee b? novertv, overerc dine, emu life-
threetxxpiufi lutfilth hareimu: sue} 1:? lead indisonineu “in: final
sub-erou. “re the corfiunitv residents thererlvee. Few co: r1u1ni-
ties wrve invitefl rre1reui “:rticineticn in in xul ti e nl ns

1.5.

E nfi Urornfn 8 1K) couflr t 1oac1 nofifWUQinru ”itrwv 111', fou'zv'on-
' , (

'<
3
._—J

)1

(1108 dovo1 o coxrunit? innut to *ork—tr iri; 'ers into the

he: 1t

F)‘
u

nrofcnoionr, :16 fewer ctiJ? hFVO 36605 t“ ino6 community

:flvocrfcs. Accordinfi

r w
L)
')
O
3
g:
3
a
4
I.._J
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p)
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w
"1

017V nimatiorn. std 3“
to ioore, Fronoics :36 community ronifienfis ruot borih to work

fl

1nyflether'im>rfievelgwwzhotho6s CH” ifiontifjdru* roor~1wmxsirr and

lead—inforted units. 101 Ckianncls znfl 00‘ unit* ore. SUre

must combine to dcvelon zcthods of removal, cnfi the forcinr of

10ndlorés to Unh016 00608 81 ovfito1v desinne6 to include testing
of “c.1nt 1£y01s. {elooztion services crn servo Us 0 bcsic tool

bnfi only if oomhiao6 with RoodUite xetho6s of sorennin~ anfl ce-

curin? the new unit. bnifir hovsinv an6 invest rnfi ovmctice

FD

nust be abol shod, :26 the behcvior r nj.fesL 06 in rovernmontal
and othor struct“res that nernetuau es such condifii ns must be
.72

nc11y, the rolo of :11 levels of FOVG“”K€Tt is L130 key
to Uny efforts m11ioh seok to erafiiocto 1036 roiooninr. In 1974,
a firoun of 200 rovernmrut oificit1s Lnfi Civic loaéows met in
.Jashi-n ton D.U. to 6ruw unfrOUOSD Is for nrovcntive measures.

The aroun's rccomm ndations were:

1. Lsto )‘z1iszthin'T 0.10301‘ '~.'-.-'02“1.£i31.* 1‘6.faitionsz‘vwinr; ‘oe't‘rxeen
Cd ral ro»ornxcnt unoncies cné or Vtte hosnitalg

1‘")

2. Incrovcinr the number of he fin? offici'1s Who ixsnoot
ffwn’1ead hur916::LWW‘ roonirinfl‘j31¢wectionr of':ffll units in
Cm roartuont housc in “hioh a 1036 r ihcniflfi victim 1ives.

3. - r1iv~ coucctiov€1 C“rn irns Throurh'fl:01001s, 50?-
ornr crvtors (H6 r“<io —to1cvi ‘n to 01ert “arento Hnfi 01—

V

Si
60: Chi_16rcn to 7930 huzurés {n6 noinonidr evrntors

. Imoro'nino fefierf1 FunFinr For Uva:to research of
”vosr“io1c '1036 ‘nojxronijrfi itwfittn s.

eta

'—

9. Inr~cct 6 flow 073? ccqtorr in? Crfi h"¢?rin Ls “firt
of tip :PCWU1?I°i1ico“rde' h OCCWItre.

40.

. UOZTQJT‘ tC L?" of *uflilic lnn 1th
kc
ti

:1 ‘1 c“

8.73

In Etflition to fife devolonnrn of V'

- g »‘

FYITF’C T "" ("00] 1.‘-' 3101“"-

s #Fx) CL? EMSTiGt YV rent: (V? victixw* or ”firtonfiicl ‘fic-

Ohrtrr anfl Tt77tGFies,

research is Flco vrrently nocfied to accomnlish a number of ob—

jeotivcc:

1. §3€V€JJT‘HCIM7 of :;w acrnrrflt(=z r0

r‘iane newt-7:310 (levice

fcr lead fictccfiion irncnfhxr'to 9V3f3unti¢fil7y i503tif?
TV

houses contcjuinfi lorfl maint, to rcnwfice tVn rore tije-

consuminr cochction snfl chemical Pnalys a of firint surfizcs

?. A uriforw rovortinp svrtem for
to f Ciiitfte 63th COTTOCtion, iLfO

.--'. r‘ .. 2..
COhUChlSCE 0; reauius.

3. Imhrovcf rothoffi of “98G noimonin fvn'fimrfih.

1. Increas(6krowledfic Chout the c

5. Betcrminttior of the ”subtie”
nzrcnt effects of Jetd.

6. TBCVTC‘OTvrrfii; of'zf ”TilifolO, Pit

xcthoé fio OetCTminc blonfi JCGfi levc

[7,

V "l 1 Port r-n 711;" ‘1‘."OF‘T‘PV'"

.;.g)
,. ,r- - . -. q' 2.1". .' 1
W LLlCH ego“ nrc, inc
J.

Buses *wfi curs: of “lCQ.

or not immohittclv an—

:“76 'n9 incx“0?nivo

1 o (l7 "I

(TCTKJIifiEICJ?

Althouch we know ? erect Eeel ebout the neijcrl reboots of
chilehood lecfi noieonine {no have node wuch crocreco in the dice—
nosis one treftment of this diseas=, "our socjeLIy hte not de-
veloeed sociai fine volitiCPl technologies to keen cece with the
reoical ones." Tr“: is, we e9n treat 1935 noieonirn eucceee—
fuily, if detected CTF1V enomfih, but me thO no nefiieul means
by which to Prevent the occurrence cue recurrence of the disease:

HOE jJifre”:MUit]fir, ctUiM3re“:'treCimw“ fcn' Tecf1 in—
toxication Ere rctmrueo to the some Cl m environ—
ment which crused their i11ness ir the first nlflce.
In this revere, intervention b? herlth ornctitio-
ners in th« matter of chilehooa leed noieoninr hes
much in comron vith U.3. heffith fie‘ivcry 'n rere-
rcl -'tho EVfStCY1 Is thhchefl Inervilir iitT<7(‘irec-
tion of treatment after-tbe-fvct while oreventive
stratcries remuin urfievelO“ed.75

In sedition to health nrectitiocere — iredloroe, nerents,
nublic officie 8, community erou s, :ue the ecncrfT nuhlic 811
bear recoousibility for the cersjeteflce of FCfifi eoiccninn. How-
ever, exintirr lite oture on the o hjcct nruvicrc little as to
how concerned certiec wicht nroceefi most etf'etivejy, brace on
the fret that nuulic resource? to Heal viii ifine-nvebjrm are not
likely to suhethtiully ihcrefise in the "ear fut-re. A v riety

of putters ucefl to he stuoied and unficretoec:

-z {EH t kjryqs 01‘(3CTKINLify':fiCtjflyi pttgjtr,j(fi‘,fjj? irre—
fluoe the {reffeffi orobcbijity for Wehlirr succeeefully
”it” *h0 1005 hoioonirr hezerfi?

% Given Timitefi rec urccs, Vhit “re +*c “cwcfiis of eublic
f ?rer€¢s 'Cmezirne, oerent:1 cvuucrfli“*, howciur Fetox—

'icm*ticni ef“07 TC, lion: inf (icce e“‘V\rchtrvi' $11} 0 lirt

fiction, LPN reeCFHe? irto thr ce”ece {“8 orrvcetion of

m.

chilchood nice?

h

* OW ire effective co litions o1 co nu it? freurs coc-
( :lction 13w inst lrfxl'noironiYV‘lmiilt?

* Jhy h.ve some com u ities eccernlishefl more than others
in dealinr wi‘t the croblem?

fieuntinr comnzrftivc, cross—cit? stuéics mirht he one va of

31157176171171." F703? (31" UlC‘SC “LEGCt‘

O

1’18:

To fiete, little if Gny nublic toner hes been
LAHfiiltli‘e fcn" tha-Ichwé of'2reseeiwfl: tn"i:ifiould
heln to oevelo~ eiiective social Unfl volitical
technolocics for combttine the lead nuint tro—
blem. icnefully, this situation aill he recti-
fiefl in the near future as more fittention is
devote? to ccreful stufiv on? eonnsrieon of 6i—
verse {nvroectmN311tili7efi in Gifiercnt cities

7

triwuicncwrt tin: COLYTtTy..{)

For $1; its comnlexity enfi severity, Etc tbe ctmosnhere o?

of ienorcnce, burefucretic red tone, one often sinnle unconcern

which surrounds it, Cnfl definite the fact that it kills are ner—

mrnently irnairs huecrefis of chileren eeev vehr,,lecf roieoninr

h

. .. -. I“ -A . ..
is Still fin cheiccble rirecee. h? 9ene cubes, lulitser :rise
uinnine triter on man the his environment arrrce it his sneech
at a conference on Iced noisonéne helfi in l o0:

3(* nrwflnlcni is: s \Wellx4icffiiwe5, so Excel it TWZCIG—
ince, wit bot ccuses tnfi cures known, Lhit if
we cofi't eliminwte this cocifl crixc, our soci—
etv feserves fill the rieCSters thrt have been
forecast for it.77

N
[:( o

APPENDIX

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FOOTfiOTbS

1. fihite, on. 1-2

2. Ibid., D. 2

3. Hoar (in Coulston anfl Forte), n. 76
4. Lin—Fu, n. 1

Committce on Environmental E

0‘. U1
o

Greer, n. 248

7. Subcomcittee on Accidental Poisoninfi, n. 2??
8. Chisolm, n. 21

9. Subcomxittev on ficcieentfl Poisoninfi, n. 232

10. Ibid.
11. Ibid.

12. Committee on Uiolorio Effects of Atmosnherie Pollutants, n. 135
13. Lin-Pu, no. 5-6

14. Committee on Bioloric Effects of Atmoeoheric Pollutants, n. 135
15. Ibid., no. 139-140

lb. Lin-Eu, n. 12—13
17. Ibid., on. 14—15

8. Lin—Eu (in Chiifiveg Jon—Feb 1970), n. 5
19. Graham and Grnhbm, n. 39

20. Ibid.

21. Ibid., n. 38

22. Ecrncs, on. o—9

tv-l

23. Committee on Hioloyie Effects of stmosnhcrjc Foilutauts, on.

206—207
24. Ibid., no. 200, 20*
25. Ibid., n. 209
26. Ibid., n. 210

Hear end Aroncw (in Uoulston and Korte), an.
e

L_J

-97—900

‘cllutfints, c. 139

K)
«3
O

E“)
on
9—4

3. Committee on Bioloric Eff etc of Atmocnheric

\Q

Heedlemen et 81, no. 245-243

(MR)
0

COLLittee on fiioloyie Lfiects of Atmosoherjc Toilutunts, n. 139

1bié., n. 140

(J)

1"
I‘.b~

'..J

dron arfl Stofen, no. 11V—120

{\J H
O

Tenner anfi Kev n (13 Couleton an? kortr), no. 152, 154, 165, 189

W W
be)
0

34. «alfron 6nd Stofen, n. 191
. 1bi6., n. 175

16. fiilfljann et 81, Two. 330-231.
37. Fulwiler cnc Jrirht, n. 374
38. Ibid.

39. Bernbko, on. 1737—1739

40. Browfier et Cl, n. 47

41. Ibid., n. 48

42. Ibid.

A3. Allen, n. 90

£4. Browder, n. 207, 200, 211
45. 3nbcom~ittee on AccidrntLl Poisonine, n. 207

46. Comiittee on BiolOFic Eiiects of Atmosnherio Pollutants, no.
2o4-Qo7 '

47. Ibid., no. 257-258

48. Ibi6., n. ?63

49. Holman, pp. 592-593
50. Greer, no. 260-263

51. 33., nn. 4, 6

52. Greer, fin, pAo_955

53. Ibid., n. 755

54. Ibid., nn. 556-259

'5. Committee on Biolonic hffects of Atmocntoric Pollutrnts, on.

75, 78
56. Gilsinn, on. 13-20, 102—10
570 1016., he 1“,]?

58° Gfiston, ... 53—61, 91—v2

\J']

59. Subcomrittee on Hetlth, no. 76—78

60. Cormittee on Qiolorie iffeetc of atmosrhefiic Pollutants, on.
135—137

01. Ibid.
. Lin—Pu (in Chilereg J n—Feb 1970), n. 7

64. Lin-Eu (in Chilcren Jan—Feb 1970), on. 7-“

.'\J

65. Thomas et 21, n. 103
06. GChCIT, 7N1. 30-721
67. Burdg {nfi 70:10:, h. 7K2
63. Challon at E1, o. 659
9. (Hufllon, 7T7. 561r4h32

b
70. Chisolm "n5 Fenlvn, n.<£“

71.
72.
73.
74.
75.

Lin-F11
noore,
(iralyim
Lin-Fa
fiuinn,
Ibid.,

Graherl

K1

(in mrujlr‘Lgfl Jan—Feb 1970). m. “~31
UH. 1430—1434

{qy- CIT U“m, T7. 41.

(in Uhilflren Jen—Fob 1970), p. 9
Duncan, 1nd Cox, no. 4—5

n. b

1.116 Crnhrxm, n. 41

1213.7:(1‘ (1 uit’IIlf

ilffILFJEj

 

Allen, John 3. ”L636 Lois oninp: Lew Look 3t up Old Hazard," To—
EGE'S Health, JCfluC_y 1962, UN. 22+.

 

 

Americ n Ace demv of Peéietrics, Cor121ttee 01 :nvironmentol F37”r6s.
"Leute and ’hronie Ch116h006 Leah Poisoninfl." PC6L tries
47 ( "”511! 197 J- ). 9 (4’ I) O o

 

American Aea6emy of To e6iatrics, Subcormittee on Aeei6ental Poi-
soninr. ”Crovefi+1 on, Diaenos 3, 0R6 Trea.tnent of Lead Poi—

sonin" in Ch 116h006. " PeoJLtriee Al (Aueust 1C’“): 291—298.

Barnako, Donne. "Chil6hoo6 10:6 Poinonine." Journr1 of the Ameri—
can Le6io€1-.is.o<i?tion 220 (June 26, 1972): 1737—1738.

 

 

Barnes, Brrt. "T066 Poisonin" in iemo6e1inr of 016 Homes." Children
To6.:v, Hentrfibor Oct ober 1973, nu. 7—C.

‘azell, 1. J. ”Health Proerzms: Blue Chilfiren Hui ‘cr oees use of

Low Fun6in6.” Science 172 (IFy 1971): ;?1- 995.

387011, 1. J. ”Ledfl Foisoninr: CombstiNfi 150 Threfit From the Air."
geiegge 174 (Novewbcr 1971): 576—576.

Ann. "How to Dinrnoee and Treat Terd Poisonire it Chil—

Browder,
dren.” Le6ieai Times 100 (October 1972): 903—215.

 

 

Brovxdeerw, Ann; Jeee1ow, Morris; nn6 Io irr, Jrnes. "Screening for
otion of Chithood feed I‘oisonine in Lewyrk.” The Jour—
1:1jof the Heiieal “ociety of Lew Torso? 71 (January 1974):

 

V. ./ . - u 1 . . h
Huree, Br1"eite 60 16 enc iearcs, Netty. "“TGVCF'IOfl of P106, the
1 Jor Cause of Lead Poeicnine in 6111191. The American

Journvl Ci‘IEfiiliC Hea1th.b3 (:Auw1st 19.’3): 737— 7'42.

'11
LL

 

 

1

allow, Moror 3. "I;C§ Poisonine: A Crisis of “once e::ee.‘ ‘e6_~
1(2):

cal Anans of the Dietrict of Columbia 41 (”cetember
Sol—563.

 

Ckmfiilon, to~rnn 3.; ineflflxz, Li :1r6; (116 fleece, {ohe1%:. "WITVflqinr:

.26 1'osio:1ir6 (JVCJG — A Prorrtm for Co mu-
pity Canefin6inr can self—3016.” The American Jonrnr1 of
Tuhlie Herith 69 (E?v 1972): 696—557.

 

 

”Uhi16rer At (13%.” Lature T93 (Deecwber 1970): 1953.

i3hieualm, (I. éhfilifrl. ”Txfi.6 ?”Ni or11"”. ";Jcimnfit11'ie jumfriczu1 2?4 (Fe-
hymn rV"1971 )- 1C¢_21
. I} .- -.. -.- O -I. .1 .

 

‘ ' o a w r - I '
Cfllsolm, J. Ju111r ”no LCDlLN, »Uflehc. ”1-0'1601.60111"r 1n Cri1_6-
hooc — Hoxvrchcnsive .rrPrCfiCht 566 1rc veriion." The Jour-
f9—

n“1 of Lc6iatrics 73 (December 1967): 50.

I

 

 

Christiin, Jocenh 1. "Childhooi Lead Lcicorjur: A rjnr Urban Health
3C3C9‘?“-" lebF77L” 5””‘tc 3e6iCB1 «1“UTD714 (Mrtoher 1C6§H Ina.
b I .7”) .120

 

Jlark, A16" J. Qn6 361lett, Georre d. ”1036 Esisonirr durvey —
”ortlfhd, 7Iihe.1 The Journal of the «tint 106iccl Asso-

 

ciftion,J nu r" 1971, n“. 697.
Craig, Paul P. 3n6 'BQrJin, E6wtr6. ”The Air of Poverty." Environ-
m__§__11t l3 (JOIN? 15,171): 2—0.
Lee chin, CeJiJ S. "Know1e66e is heithcr Ieutrc1 Eor Aholitical."
Amorice.n Journal of Crth ocsvchivtry 41 (Avril 1.971): 344-346.

 

Fu1wiler, ”ohert Lea and Wright, Loren. "3e ue1oe of 1006 Poisonir~
in Chiléren.” Oklchoma Stvte 1efijcu1 RH.OC17t19U 65 (Sen-
tcmoer 1979): 377—fi74.

 

11r21u12, 1111 cm6 f}rCLm13,W3 6:. "Imflxi Pfijfflfllin9‘12U1 t‘c 'nfim1rb8r1

1
Chil6." To6fy's . 81th, March 1974, on. 33—41.

‘
i

 

'4—
'1

Cnd

Greer, 9111irm F. ”Lec6 Paint Poisoninn — Eunicinrl, 0.te,

)
Federal throaches." Urban Lrw Arnunl 7 (1974);

 

Grigss, iobert et 31. "Environmental Factors in ChiJ6hood Lead
Poisoning." Journfil of the American Ledica1 Aseocia fltion
187 \LErch 7, 1964): 7'03-707.

 

Ingalls, Theoforc H.; Tiboni, Emil A.; z‘nd :errin, Yilton. "Lend
Poisoninn in Philadelnhia, 19% —1960." Archives of Envi-
ronmental Le filth 3 (hovcmbcr 1961): 575-579.

 

 

”LeU6 Foiconirv ir Chi16hooc: Fni6eriolory,
Trevention." 311n1c61 1661: wt ics 5

I

M cob iner, Moro
srwiifk1st.f
1"

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k .‘I_L ".‘r
0,

 

TCuerI‘, Gcnfi‘r6 ft. 0115'1. ”TFUe Lirrtrilxztirr1 of‘ Tecé‘chirrt irwi’ew
York City Tencmeht 6ni16ihflm.” Aficric"n Jowrrf1 of Lublic
_- ,- _ ,",‘ ,‘ w~~—- --
geclth b3 (1ebrua‘ry 1C! { ) : . 16/7; -113. ,

 

"Lezi6 10151021111?- irn (3"116ren." :i_‘hV_c [1:111th of"; Il__"__.._1;-§[Ur1£ts 5.9610571
Epcietg 66 (1: nu ry 1970): 990.

 

 

Lin—Pu, Jone S. ”(hj16hoo6 3-066 Pow<on1.' ..u Jrc'iccx1c Disease.”
'11 “ (JcnIX rv-Ieoruzry 197 0): 9—9.

 

L99716s0h, £1711e1 UH 'VIiLf Ster\}%xrrfir6." rvi7m ' (U1 1:3 (1ure JC‘71):
11—13.

 

“95173: ‘3 l'G‘CI‘. "”511 Oc'wrnytjcwifi1 T{e?1:th ’”“"co. :1 He111 Us ‘10"1
111.3“l‘H‘00r Zec6 T919021?97“'1UU3T10UH .ournf1 of Lublic
*°”11h 93 (aflvfinbrr 1“72): 1683—1476.

 

J

rOore, Jet 115. W30m:nnity kawrlr of Chjjrhnor fqu: ?Oj_nflnifirj”
nfirriCEn Journ“1 of E“b"c He:.71_th 60 (flm7" st 1“70): 1430—

1'71?~ 23'1""W

 

....._ -m---——o-. —o-~..‘

eeo1on" Eebcrt 1. ct ”1.”SHFC1iWiCS1.}£ff7‘~~un~U"’ in ThiJa—
Eelnhifi fichoolc ohi1dren." i‘he 1o: j:~17nfi qur7:1 of Leni—
cine 290 (January 31, 1 gf717 Lj— 243.

 

Puesche1,3ie~friufi H.; 10 Quito, Louis; 7nfl finhwcchmcn, Harry.
”“hj1rrcn Jith Increa.ed Lead WL160r° A Screeninfi SUC-
Pollow—Ln fitufly." Journal of the IzcriC'n Lefiical irroci—
31793 222 Mother :73, 1972): 4625—476. ‘ ....-.

 

r1
' L

flea, John. '=~rmnt0“ tic

Rennert, Owen 3.; »oifior, F=Fau1; 3&6
C larch." C1in7CH1 1eéiatrics

Iced foisoniNC in 9} Whicap (h
9 (Jnnwery 1970): 9-13.

I?
L
)-

 

I

Scherg, Col Robert C. ”Prevention of Childhooé Toimoninn: A Com-
mu if? Frfljnct. ” Fediftric Clinics of Forth America 17
Aurunt 1970): 713.—7’2'I.

 

"A Strinrent Co-

: n Lean in Urban Air.” Sciencc flaws 101 (Febru-
ary 26, 1C ’

 

V
O.
!._.I

Lu
J.)
.

Thomcs, Lloyd A.; Turner, Ritz 0.; Una Trice, Dorothy L. ”fi Com—
.unity Centered inrroach to The Prob1em of Irné Poisoning."
Journ31 of inc Fnti‘nfl Yeéinn1 3R"OCiF1j01 52 I arch 1970):
100—107). ”1“---“ “~"._“

 

 

 

a’ . ‘ -. '._- ..7 ~
71711139, t n J. "10‘. it-

 

(Fr E101uiizi“ 1711f1n (1h7‘1n259n3' Wrifxfir's 110713th1
1

i

1&12tin"+on et 91. "Lctfi Toinoninr in Younv ChiJPren."
Eubl C {ehlth (enarts 67 (March 1952): 230—235.

 

 

3t 00k on ”b 1dhoo

holman, J. "The .31 d I
«tricg 10 =Imc enzber 1C71)

095 Toisoninr."
Clinical :

D-l .

»7 «771:0! 7777.1;

 

‘uinn, Fimfluzcl fi.; Ennumwi, lrncv C.; “no {327,7Hwncs P. ”1ecn
b

‘ Sixit E 'ijiorrinrr ir7 Ih"0.rl Cryi1vrrnr7: r.n_s nruitz”'efl.31i1f1icn-
" hy.” fiounci? of ?1rnnjnn Liorcrifins f1130: October 1576.

irorrvnt:1 dclocted Bib1i-
1i“ns 9137: Aurust 1473.

white, Anthony ’7. "1177771 in the [Trbtrn I.
erranhy.” Council of Flanninn 11

\J
"3

BC ‘(JI‘I'S

Uom.. 93i7w1<xf‘the huroneflr7(kxt'unitics aqwi thn Lkrt on EJctes
nJironunnffl Crotection fifin":cv. Tr icoofiinnn of tie In-
tor nfltioncl Srfinnnium cw L1Y1VPW“DR*1' :0 1th A?“ecis of

 

 

...-..---

6. Lmsterfism: n. n., 7972.

1’.
Comrittee on BioJoric EJTCC'S 07 utwosnheric Po1lut8nts , Diviaffin
of Heflicnl Sciencee,1 t1 Cl xeeefrch Co ncil. «-&.. Air-
borne 10:6 in 1cccocet1ve. dashineton 3.0 .‘1onplflgeeurC“
2 ,

  
 

 

 

 

demy of oc1rrc.n, 16/

Coulston, Prefierick #no Forte, Friedhelm, eds. 1935- New York:
Reecemic Press, 1975.

rh13H1e 1th ‘e swerica. Lew York: Uxforé Univer-
sity Press. 1E/b.

Gaston, Juunitfl. Georr?“hy (ifwlegf 101$ oninc: Sevelorment of a

90661. 110318 for he leCree of 1.1., Cichirtn otcte Uni—
versity, 1972.

 

 

'olory 3rd Ietcction of lead Toxicitx. IWe ork: M38

Hardy, Herriet 3.; Goyer, {obert A.; and Guinec, Jincent F. Eni—
:1
”ormation Coreoruti n, 1976.

 

 

Heonle, Peter, ed. Leufl in the 1aniron: cpt. rkinn, hscex, Ene—
111M1: Anrflixn‘ SCiPNCC?1fllbliS hers, 1d;€.., 1972.

dalflron, V.A. “n6 Stofer, U. Sub-CliniCTlmigea Fqiconjnp. New York:
Aca.§ex;ic 1re.e, 1974.

 

 

 

DUCUTRKTB

 

U.5. Confr es, Senfte. Comrittee on Isbcr aha Public welfvre.

Leefi-Fc ace 1airt Tcisoninc. Hearing_ before the Subcom-
mittee on Pealth of the denote Committee on labor Cue Pu—
blic welfare on 5. 3215 and 31’.{. 1&172, glst Cone., 2nd

898;). ’ 1:4FZCT.

 

U.5. Confiress, SenCte. Committee on ICbor and Public Je -fcre.
Lead—BC sed Pavint Poisonin'7 1m913meete of 1‘72 Hearings
before the Subcommittee on Health of the Son: te eommittee
or vaor CH6 Public welfare on S. 3070, 22nd Conn., 2nd
s-sn., 1972.

SS, chflte. Co :1. ittee on Tabor (n5 Fub1ic JelfCre.
—5Csc€ 1 int Poisonire Prevention Act of 1975. Bee—
rinn before t‘e euficornittce on fieu1th of the .enfite Com—
mittee on Taber C36 Public welfare on a. 1064, 94th Conq.,
lst sese., 1975.

 

 

U.S. Dec rtrcrt of Conwrrce. Iationq] Eurefn (f Utrno‘rre. isti—
m tee of the ymture wee Extent of Le“r 1;:ijnt Posieninfl in
tEG lef‘mfri1h't s 1wz.%1dith 15 (kilsirn. :nLj TechniCCJ_1krtc
' 1.0.: Government Prirtinfi Ofticc, 1972.

 

U.S. IN??? TtHClliJ of Herfliflt, Pflzur"tion, Clu‘ {e11r re. (fizilflren'51
Buref U. I?"fl 1fi‘nonin:_iC__[LL1?9Q: b? JVTC S. Fin—Fa.

.':',_}11'1:rtrm 12.11.: (J—I’OJOrLz. {Cg-rib r'rinti‘nr" Office, 1‘_‘c7.

 

 

 

 

 
 

 

 
 

 
 

 

 

   

 

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