Metal exposure and common chronic diseases: a guide for the clinician

Abstract

n 1911 Dr Alice Hamilton, a pioneer in modern occupational medicine, long with colleagues, issued a report to the Governor of Illinois detailing he results of a survey of occupational disease in the state. They reported n investigations into brass chills, carbon monoxide poisoning, miner’s ystagmus, and boilermaker’s deafness. Hamilton described in depth the yriad uses of lead in Illinois industry and, using clinical records along ith personal follow-up, documented 578 cases of lead poisoning, ncluding many cases of wristdrop (Figure 1). In her memoir, Hamilton describes the steps she took to identify sources f lead poisoning: she reviewed hospital records to confirm the diagnosis, earched for the patient’s home, and interviewed the patient’s wife about is place of employment. Bemoaning this labor-intensive method, Hamlton relates that “[h]ospital history sheets noted carefully all the facts bout tobacco, alcohol, even coffee consumed by the leaded man, though bviously he was not suffering from those poisons; but curiosity as to ow he became poisoned with lead was not in the interne’s mental ake-up.” In the decades since Hamilton’s pioneering work, as a result of evelopments ranging from vastly improved exposure conditions to the se of biomarkers to detect subclinical illness, the clinical spectrum of ccupational lead and other metal poisonings in the United States has hanged dramatically. With lead, for example, wristdrop has been nheard of for decades, and concern has shifted to more subtle end points uch as the effects of lead on population blood pressure and on cognition n children. Newer industrial processes have introduced new exposures, uch as beryllium, and their associated diseases. As in so many other reas of medicine, modern laboratory methods have yielded new under-