A number of questions arise from the “Clinical” section relating to the toy car.

1. The child is stated to be of Non-European origin. Was he Asian, Middle-Eastern or African? Did a family member use lead containing cosmetics, such as “surma” or “kohl” favoured in some communities in these area. Could this have been a source of his lead poisoning rather than the car or other toys. Bit of a long shot and on balance unlikely.

2. What is the evidence that the car is the origin of the lead? What else did he ingest as a result of his pica habit?

3. Was it considered that the lead poisoning was the cause of his “mental retardation”? Does lead poisoning cause mental retardation? Encephalopathy with seizures, mania, delirium & coma are better recognised consequences of lead poisoning. Is it not more likely, or certainly possible, that the mental retardation referred to, now more sympathetically called learning difficulty, was the underlying cause of his pica and not the result of it. It was not clear from the details given what the clinical assessment had been in this respect

4. The increase in his lead level by 79μg/100ml (790 μg/l) of lead in the blood indicates a very high level and this was the amount by which the lead level had risen. What was the actual level? What was the outcome for this unfortunate child? Did he die? Is the toy car his memorial? The shroud which your colleague from the Slade is making might be even more appropriate if he did die.