[Lead poisoning by contaminated flour: an unfinished story]

A young Arab woman was diagnosed with severe lead poisoning in the early 80's. Detailed epidemiologic studies revealed many additional cases of lead poisoning in the rural population south of Nablus and a population survey conducted among schoolchildren revealed increased blood lead levels in 30% of the children. The source of poisoning was contamination from home-made flour by lead fillings used to secure the housing of the driveshaft to the millstone. Of the 146 village mills surveyed, lead concentrations in freshly ground flour exceeding 1.5 ppm were found in 8% of the mills. Following our original report, identical outbreaks caused by contaminated flour were reported from Spain, Turkey, Greece and Albania. In spite of administrative efforts to prevent the use of lead in flour mills, the problem still persists. In Israel itself, similar subsequent outbreaks have been documented in the Upper Galilee, and recently in the Hebron district. Apparently, the problem has existed since antiquity because flour mills employing lead parts were introduced to this and other countries during the Roman conquest. A coordinated international effort is essential to eliminate this unique and serious health threat from the environment.