preventive approach can reduce those costs in the long run, as well as prevent occurrences of severe lead poisoning and its consequences such as we have heard about today.

I would like to comment further on certain specific provisions of S. 3080. This bill would make state agencies, as well as units of local government, eligible for grants. While large cities such as New York and Chicago can provide the necessary laboratory facilities to support their programs, this may not be economical or efficient in the case of smaller cities or in areas where health department laboratories are under state jurisdiction. For example, in Baltimore, laboratory backup for the city's program is provided by a laboratory which is funded by the State of Maryland. (This makes the service available throughout the State as well.) It is also my understanding the with the excep tion of New York City, much of the laboratory diagnostic service in the rest of the State of New York is provided by the State Health Department through a control laboratory. There may be other similar situations that I am not aware of. The inherent technical difficulties in performing accurate lead analyses make it unlikely that small laboratories, performing a limited number of tests on an irregular basis, can provide results of consistently high quality. It would be more efficient and economical, in a number of areas, to establish centralized laboratory facilities for the analysis of biological and environmental samples for lead on a state-wide or regional basis. I believe that needs will differ in various parts of the country. Any step that assures better quality control in the laboratory and adequate reporting will serve to improve the health supervision and treatment of the children. This provision will provide greater flexibility to meet differing local needs. Centralized and certified laboratory facilities (5) should also improve cost effectiveness.

S. 3080 also redefines the term "lead-based paint" as any paint containing more than 0.06% lead in the final dried solids. The American Academy of Pediatrics strongly support the 0.06% limit for the lead content of paints intended for use on housing interiors and those exterior surfaces of residential housing accessible to young children. A copy of the AAP position on this point is attached (6). The AAP strongly urges that paints for such use be banned as hazardous substances under the Hazardous Substances Act. Mere labelling will not suffice: labels on paints sold today are of no use to owners, parents and pre-school age children who move into today's houses 10 or 20 years hence. The problem as it exists today results from past wide-spread use of lead in house paints and coatings. The lead has already been disseminated and so the present problem cannot be controlled simply at the point of manufacture or distribution of lead-based paints and coatings for residential housing. However, prevention of lead poisoning and undue lead exposure in children can be prevented in the children of the future, if we act now to limit the lead content of house paints and coatings.

The health hazard to a child who eats paint chips is related not to the concentration of lead in paint, but rather to the total dose of lead in a chip which may be composed of one or many layers. While one layer of paint containing 1% lead may not contain a hazardous amount of lead, ten layers of the same paint would contain ten times as much lead. The amount of lead in a small ten-layered chip containing ten layers of 1% lead clearly would contain an amount of lead which is in excess of the "maximum daily permissible intake of lead" for young children (7). On the basis of available scientific data, it has been calculated that a small child may "safely" eat no more than 300 μg Pb/day on the average. This amount is termed the "maximum daily permissible intake," and if it is not exceeded, it is unlikely that there will be any hazard to such child's health. If a child eats more than this repetitively, the level of lead in his tissues will rise in proportion to the dose and undesirable effects on his metabolism can then be demonstrated (3c). The less than 0.06% limit for lead in certain residential house paints provides a margin of safety so that the eating of small chips of paint, up to ten layers in thickness, is not likely to be hazardous to the child's health. The purpose of this <0.06% limit is truely preventive, for it should halt perpetuation of dangerous exposure of young children, ad infinitum, to lead-based paint and so protect future generations. With regard to existing paints and coatings on old housing surfaces, a more meaningful term is the amount of lead per

square centimeter (or per square inch) of exposed surface (6). This is a better measure of the dose of lead contained in multiple layers of old paint and, hence, a better measure of the risks involved in eating chips of such paint. In implementing P.L. 91-695, both the content of lead in fresh paint in the can and the amount of lead on existing residential surfaces should be taken into account and treated separately.

One of the basic components of the childhood lead poisoning problem and of other accidental poisonings in young children is the prevalence of pica in pre-school age children. Pica may be defined as the habit of eating a great variety of non-food substances. It has been report (8, 9) that up to 50% of children exhibit this habit between one and three- to five-years of age. This is the age range in which accidental poisonings of all sorts are most prevalent. Our current working hypothesis is that pica is a response of very young children to stress. This hypothesis is not entirely satisfactory. A better understanding of the dynamics of pica could put educational efforts directed to parents, educators and health professionals on a much sounder basis. I would ask the Committee to consider carefully the need for supplemental authority for needed research in this behavioral aspect of the problem. Better knowledge might reduce costs and improve effectiveness in the approach to the resolution of this particular health problem in children, as well as many other accidental poisonings in young children.

In summary, we urge that the authority of P.L. 91-695, as provided in S 3080, be extended beyond one year. At present, it is estimated that five years would be required to bring the current problem under control. The American Academy of Pediatrics also strongly recommends banning the use of paints in residential housing (as defined in the bill) containing more than 0.06% lead. We would further point out that amount of lead per square centimeter of exposed surface provides a more meaningful measure of the dose of lead as found on existing housing surfaces. We support the provision of S. 3080 which makes state agencies eligible under P.L. 91-695. These measures can lead to a more economical and effective resolution of this particular health problem in children.

REFERENCES

1Chisolm, J. J., Jr., Statement before the Subcommittee on Health of the Committee on Labor and Public Welfare, United States Senate, 91st Congress, Second Session: Lead-Based Paint Poisoning, pp. 203-217, November 23, 1970. 2 Chisolm, J. J., Jr., Statement before the Subcommittee on Housing and Urban Affairs of the Committee on Banking and Currency, United States Senate, 91st Congress, Second Session: Housing and Urban Development Legislation of 1970. pp. 524-530, July 20 and 23, 1970.

* Airborne Lead in Perspective, to be published by National Research Council, National Academy of Sciences, Washington, D.C., 1971.

Sa Chapter 4, Biologic Effects of Lead in Man, Section on Epidemiology In Children, pp. 174-180.

3b Appendix F, Treatment and Costs of Lead Poisoning in Man, pp. F1-F10. Chapter 4, Biologic Effects of Lead in Man, pp. 105-276.

3с

Chisolm, J. J., Jr. and Kaplan, E.: Lead poisoning in childhood-comprehensive management and prevention. J. of Pediat. 73:942, 1968.

5

Keppler, J. F., Maxfield, M. E., Moss, W. D., Tietjen, G. and Linch. A. L.: Interlaboratory evaluation of the reliability of blood lead analyses. Amer. Industr. Hyg. Assn. J. 31:412, 1970.

6

* American Academy of Pediatrics statement to F.D.A. on Lead Based Paint, Nov. 30, 1971-Reference: 21 CFR Part 191, Federal Register, November 2, 1971. 7 King, B. G.: Maximum Daily Intake of Lead Without Excessive Body LeadBurden in Children. Amer. J. Dis. Child. 122:337, 1971.

8 Lourie, R. S., Layman, E. M. and Millican, F K.: Why Children Eat Things That Are Not Food. Children 10: 143, 1963.

Sobel, R.: The Psychiatric Implications of Accidental Poisoning in Childhood Pediat. Clin. N. Amer. 17:653, 1970.

ESTIMATED CURRENT AVERAGE DIRECT MEDICAL COSTS TO 45 CHILDREN, BASED ON 1970 BASIC HOSPITAL RATES

Note: Children were handled under the general policy that no child is discharged until either home is "deleaded" or family moves into safe modern housing; length of hospitalization is determined by this factor, rather than by severity of acute illness.

Source: "Airborne Lead in Perspective," to be published by National Research Council, National Academy of Sciences Washington, D.C., 1971.

TOTAL DAYS OF HOSPITALIZATION AND ESTIMATED DIRECT MEDICAL COSTS FOR 45 CHILDREN WITH INITIAL BLOOD LEAD CONTENT GREATER THAN 80 μg./100 g. OF WHOLE BLOOD (INCLUDING 10 CHILDREN WITH ACUTE ENCEPHALOPATHY) WHO ARE NOT DISCHARGED TO HOME UNTIL REMOVAL OF OLD LEAD-PIGMENT PAINTS FROM HOME ENVIRONMENT-BALTIMORE, MD. 1965-70

1 Basic hospital rates roughly doubled between 1965 and 1970. Most of the 34 children for whom complete hospital charges could be verified were hospitalized during 1965, 1966, and 1967 at public expense.

Source: "Airborne Lead in Perspective," to be published by National Research Council, National Academy of Sciences, Washington, D.C. 1971.

Dr. Chisolm, you come out in your statement as supporting the 0.06percent limit in lead content.

Dr. CHISOLM. Yes.

Senator HUGHES. How did the association arrive at this conclusion? Dr. CHISOLM. It is based upon the taking into consideration the daily permissible intake DPI. It is also based on some information obtained at the U.S. Public Health Service injury control branch laboratory in analyzing paint for total lead content per square centimeter of exposed surface as applied to wood surfaces.

Apparently there is a lot of variation in the way a painter applies paint. The thickness of layers determines the amount of lead that will be found in one square centimeter of paint of various layers and containing different percentages of lead. These figures are attached as a part of my written statement.

In arriving at conclusions based upon paint containing various amounts of lead one can then derive how much lead will be found in 1 square centimeter of one layer, five layers or 10 layers.

It certainly is quite true if you have only one layer of paint, that the level percent of lead could be much higher than 0.06 percent without harm. On the other hand, 10 layers of paint containing 1 percent, would clearly contain an excessive amount per square centimeter of exposed surface.

Senator HUGHES. You also commented on the labeling procedures which we have discussed with the previous witness.

Dr. CHISOLM. With respect to labeling, the Academy takes the position that labeling is of little use, so that house paints in excess of adequate standards ought to be banned. The children do not read labels. Paint applied now in homes that are subsequently rented or change ownership in the future may not be safeguarded-we do not quite see how labels now will protect future owners or renters with young children.

The man who applies the paint and reads the label today is not necessarily the one who will be there 10 years from now. But the paint he applies today will probably be on the walls long after he leaves.

Senator HUGHES. Can you tell us how many children a year need hospitalization because of lead paint poisoning?

Dr. CHISOLM. I really wish I could, but I do not think that sound figures are available.

The disease is not reportable in all cities by any matter of means. I do not think there are really good statistics available.

Senator HUGHES. Perhaps I should have asked you whether the ladies there with you care to make some statement in the record.

Dr. CHISOLM. These ladies are the mothers of 2 children I have treated. I was asked to bring them along with me.

Senator HUGHES. I think it might be helpful, but would you introduce

them to us.

Dr. CHISOLM. This is Mrs. Burton; and this is Mrs. Haskins.

Senator HUGHES. They both have children who have been affected? Dr. CHISOLM. They both have children that have been affected by the disease. One has lost a child as a result of lead poisoning.

Senator HUGHES. Would either one of them or both of them just tell us what happened and how it has affected the children.

Mrs. HASKINS. Well, I had a child, and he was very active as an infant. The first thing I noticed was that he stopped talking. He was 32 years old when he stopped talking. We did not know exactly what was wrong with him when he first stopped talking.

First I had taken him to a private doctor, and he didn't know for sure what was wrong with him. At that time I wasn't in the city. When I moved back to Maryland; I took him to the hospital here.

They treated him at Johns Hopkins. At that, the doctors didn't know what was wrong with him there. They gave him some medicine to calm him down because he was very overactive. This did not help. Two years later when he was 6 years old he went into convulsions. That is when they discovered he had lead paint poisoning.

Dr. CHISOLM. I think the point of her testimony so far from the medical point of view is the great difficulty in making a proper medical diagnosis until it is much, much too late.

Senator HUGHES. The chair is sympathetic to the feelings and the difficulty of this type of testimony regarding children.

I believe you stated the child is now 10 years old.

Mrs. HASKINS. That is right.

Senator HUGHES. His mental capacity, doctor, is limited to what? Dr. CHISOLM. He is functioning at the 2-year level currently. Mrs. Haskins told me in relation to her other children she thinks he is at a 3-year level, but he still is not talking.

Mrs. HASKINS. Still not talking.

Senator HUGHES. Of course he does not go to school at all.

Mrs. HASKINS. No. He doesn't go to school. He's been in the hospital-Rosewood State Hospital for the retarded-over 2 years, but I brought him back home with me recently. I am trying to get him in a school for the handicapped, riding the bus, coming back and forth from home.

Senator HUGHES. Do you have other children?

Mrs. HASKINS. Yes; I have three others.

Senator HUGHES. Were they checked for the possibility of having this also?

Mrs. HASKINS. They have been treated, you know, tested for it, but they didn't find anything wrong with them.

Dr. CHISOLM. Nothing was found wrong. There was one younger sister who was checked.

Senator HUGHES. Mrs. Burton, would you care to relate to the committee your experience with this?

Mrs. BURTON. My daughter, Valerie, started losing weight. She started complaining, and I had taken her to the hospital, but they couldn't do nothing. They always said it was a cold or stomach ache. In her final illness she started to vomit and went into convulsions. Four days later, she went in a coma.

She went in the hospital August 10, and she died August 29, and the doctor said if she lived she would have been blind.

They worked on her all day, and they had to give her a brain operation, and they told me that she was deaf, and she would never be able to talk any more.

I have another little girl 5 years old now. She still has lead in her. Senator HUGHES. She is still in bed?

Mrs. BURTON. She had lead poisoning. No, she is not in bed. She goes and gets a blood check every 3 months. They say the paint usually don't peal, but it does. The paint is pealing off the walls now, and I live in a project.

Senator HUGHES. You live in a Government project?

Mrs. BURTON. Yes, and it does contain lead, because I carried it to the hospital, and the doctor tested it.

Dr. CHISOLM. I think she is referring to some samples that have been sent to the health department. I do not know the results of these paint analyses.

Was Barbara sick when she first was brought in?

Mrs. BURTON. No. Barbara stayed in the hospital from the 11th of August until she had to go to Happy Hills. She stayed in Happy Hills Hospital about 2 or 3 weeks.

Dr. CHISOLM. I think that the point of her testimony is that, although one child had nine fatal illnesses there were three other young children found with increased lead absorption among all children examined, not only in the house where Barbara and Valerie lived, but also in the house where they had lived 3 months earlier.