The diagnosis, treatment, and follow-up investigation of lead poisoning in childhood, including initial confirmatory roentgenograms, have been well covered in the literature. Such sequelae as encephalopathy and involvement of other organs of the body are well understood. There have appeared, however, no significant late studies of the bones in children who suffered from lead intoxication. Plumbism is seen in children usually between the ages of two and four, occurring almost always in large metropolitan areas among low-income groups living in old dwellings. The walls of these abodes most often have been decorated several times, with paint upon old paint, forming thick layers which easily crack and scale. Fragments of dried paint containing lead from the walls or window sills or peelings which have fallen to the floor are picked up and chewed by these young patients. A case study in point was made by Bradley and Bessman (1), who reported on 333 children living under such circumstances in Baltimore, Md. In 44.4 per cent of this group they found blood lead values of 0.05 mg. per cent and higher. Until public health measures prohibited the sale of cribs and toys covered with paint containing lead and banning the sale of lead toys, plumbism in children was not uncommon in all parts of the country. Lead intoxication also occurs from inhalation of fumes from the burning of discarded battery cases. The habit of pica, the ingestion of inedible material, and geophagy, the eating of dirt, have been known since ancient times and still exist in certain regions of the United States and other parts of the world. Investigations by Solien (2) and by Cooper (3) indicate that in some instances this abnormal appetite occurs not only in childhood but continues throughout most of the life of the individual. Chronic lead poisoning may occur in children without any significant signs of illness. From 1951 to 1960, 85 children were admitted to The Children's Memorial Hospital (Chicago) for treatment of lead poisoning. Of this number, 13 died from encephalopathy; 48 of the remaining 72 have had follow-up roentgen studies and, of these, 24 showed metaphyseal dysplasia of varying degrees, exactly 50 per cent. Among the 48 children with lead intoxication followed, there were ten pairs of siblings, including twin brothers. Two sisters, aged two and three years, respectively, and their two-year-old cousin who lived in the apartment above them were all treated for lead poisoning within a two-month period. In 1931 Pyle (4) reported dysplasia of the long bones in a five-year-old boy who was brought to him for correction of knockknees. He described what he called a peculiar development of the bones, consisting of widening of their ends associated with thinning of the cortices. There was no history of a similar condition in the parents or the grandparents of this child. Pyle performed supracondylar osteotomies to correct the knock-knees.
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Jul 1, 1975
Paul Baily + 1
Open Access