[12] Chyzer, A.: Des Intoxications par le Plomb se présentant dans la Céramique en Hongrie. Budapest, 1908.
[13] Garrod: The Lancet, 1870.
[14] Goadby, K. W.: Departmental Committee on Lead Poisoning, etc., in China and Earthenware Manufacture, Appendix XXV.
[15] Hunter, William: Severest Anæmias.
[16] Goadby, K. W.: The Lancet, March 11, 1911.
CHAPTER IV
STATISTICS OF PLUMBISM[A]
[A] Based mainly on reports received from certifying factory surgeons during the ten years 1900-1909.
Classification of notified cases of lead poisoning was carried out on practically the same lines between the years 1900 and 1909, and comparison of the data so collected has interest, in view of their large number—nearly 7,000—in respect of (1) increase or decrease in recorded amount in each one of eighteen classes of industries; (2) severity and number of attack—i.e., whether first, second, third, or chronic; and (3) main symptoms.
Notification was first enjoined by Section 29 of the Factory and Workshop Act, 1895, which subsequently, on consolidation of the Factory Acts, became Section 73 of the Act of 1901. This enactment requires every medical practitioner, attending on, or called in to visit, a patient whom he believes to be suffering from lead poisoning contracted in a factory or workshop, to notify the case forthwith to the Chief Inspector of Factories at the Home Office; and a similar obligation is imposed on the occupier of a factory or workshop to send written notice of every such case to the certifying surgeon and inspector of factories for the district. In form there is close similarity between this section and that requiring notification under the Infectious Diseases (Notification) Act; but whereas the symptoms of these diseases are, within well-recognized limits, precise, in lead poisoning the differential diagnosis has not infrequently to be made from a variety of common ailments—headache, anæmia, rheumatism, abdominal pain; and there is no precise standard of what constitutes lead poisoning.
The notification of the practitioner as a rule gives no information beyond the belief that the case is one of lead poisoning. As a matter of routine the notification is followed up by an inquiry by the certifying surgeon and inspector to see whether regulations already in force have been infringed in the particular work-place or not, and as to how far there may have been contributory negligence on the part of the sufferer. The data supplied on the surgeon’s report form the basis of the tabulation[1]. Brief explanation is wanted of the method adopted in classification. Cases represent all attacks reported within a year, and not previously reported within the preceding twelve months, so as to make the number of persons and cases in a year the same. Where the interval between two reports on the same person was more than twelve months, the fresh attack was again included. The number of such second reports on persons already included in a return numbered 284 (4·2 per cent.), and a portion of these certainly, probably not more than 100, have been included twice or thrice in the total 6,638 cases. Cases in which there was obvious error in diagnosis, or in which the opinion of the certifying surgeon was very strongly against the diagnosis (especially when the report had been made in the first instance by the occupier alone, and not by a medical practitioner), were excluded from the return. These numbered 458 (6·8 per cent.). Others, again, where there was a strong element of doubt, but not to be regarded as more than a difference of opinion between two medical men, were marked doubtful and included. Of these there were 424 (6·3 per cent.).