The changes in the growing skeleton revealed by roentgen examination have proved to be among the most constant and useful diagnostic features of plumbism in infants and in young children since these lesions were first discovered by several American and Japanese observers1 independently in 1929 and 1930. Kasahara and his associates2 found lead lines in the tibias in all of seventy-eight Japanese infants who had lead meningo-encephalitis. In their large experience with lead poisoning in Boston, McKhann and Vogt3 saw only one patient who failed to show the characteristic changes in the bones, and they reported that the lesions seen with the roentgen rays led to the discovery of lead poisoning in numerous cases in which there were minimal clinical symptoms. At the Babies' Hospital in New York, shadows indicative of lead poisoning were present in the skeletal roentgenograms of the first thirty patients younger than 5 years
CAFFEY J. LEAD POISONING ASSOCIATED WITH ACTIVE RICKETS: REPORT OF A CASE WITH ABSENCE OF LEAD LINES IN THE SKELETON. Am J Dis Child. 1938;55(4):798–806. doi:10.1001/archpedi.1938.01980100134010
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