Document 0q3OEkka52RVGNZbroV5J46LO

January 26, 1961 Mr. Roger C. Furst Ritter, Boesel & Holden 240, Huron Street Toledo 4, Ohio Re: Industrial Commission # O.D.7104-22 Dear Mr. Furst: I have received and have examined carefully your letter of January 24 and the attached documents and records which accompanied it. I have considered the facts set forth in your letter, and I reply to your question as well as I can, with as full an explanation of my answer as; I am able to supply. It is my opinion that the illness of this claimant, insofar as it has been diagnosed as lead poisoning, did not result from the exposure to lead (in paint) in the course of his employment at the factory of Willys Motors, Inc. In explanation of this opinion, let me say, at the outset, that it is impossible, at this time, and from the information available, to visualize the precise conditions tinder which Mr. flHHR^worked, and to^create in one's mind, from the record, the precise and complete character of his illness. The only time that the facts in these matters can be assembled properly and accurately, and interpreted with certainty, is at the time of, or in close temporal relation to, the occupational conditions that actually existed, as well as the onset and development of the Illness complained of. It Is rare indeed that the diagnosis of lead poisoning, for example, can be made by any physician with reasonable certainty some years (in this instance, apparently five) after the cessation of the exposure to lead. I do not believe that this man had occupational lead poisoning at the time of or in relation to his employment at Willys Motors, because of the characteristics of his work and exposure, as described at this time in the records. Moreover, I do not believe he had lead poisoning at all, for the available evidence does hot justify that opinion. But the fact of the situation is this - unless this man had some absolutely characteristic clinical sequel of lead poisoning, no one, by any available diagnostic method, could arrive at a reasonably substantiated diagnosis of lead poisoning five years laterj it is equally true that, unless an incontrovertible alternative diagnosis chn be arrived at at this time, and one which explains, reasonably and probably, his present illness and disability, no diagnosis of any kind relevant to his employment at WillyS Motors can be arrived at with reasonable assurance. A physician, at this time, therefore, is compelled to speculate as to the existence of an occupational factor in the illness and disability complained of. N5292 Mr, Roger C. Frst -2- January 26, 1961 With this proviso with respect to my own or any other opinion, at this time, the reasons for my conclusion concerning lead poisoning in relation to the occupational situation as described are as follows:** 1. According to the facts in evidence, the occupational exposure to lead, from 1947 through 1954, was not of an order of severity as to give rise to a rapid or intense absorption of lead. This opinion is inescapable from the fact that the lead content of the paints used and applied by M r ^ f U f e h v e r e quite low In their lead content - so low in fact, as to imply that, under ordinary conditions in the usual industrial plant, the hazard of lead poisoning would be slight and probably negligible. It may hot be assumed, at this time, therefore, that was subjected to a dangerous type of occupational exposure to lead. The non-occurrence of other cases of lead poisoning in this plant during the period with which we are concerned, tends to support the conclusion that he was not. 2. No evidence is available, clinically or otherwise, to demonstrate that Mr. M B I ^ a b s o r b e d appreciable quantities of lead during the, period of his employment. The only evidence from which one might suppose that such absorption had occurred during this period;is the existence in 1959 of a form of illness which is atypical of lead poisoning (none of the characteristic sequelae are present), and the apparent presence in the urine (whether one analysis of one sample of urine, or three analyses of three samples, is dubious) of an abnormal quantity of lead. This boils down to the fact that after nearly five years after the termination of a mild and questionably significant type of occupational exposure to lead, the lead content of one (perhaps three) sample' of urine was elevated. This, as evidence of such prior oceupatiohal exposure to lead is not only invalid, but actually absurd. ~ It may be that the concentration of lead in this man's urine, as actually voided, was high. This, however, may be seriously doubted. Nothing is said in the record as to the manner of collecting the urine, and the method of analysis is not referred to. The facts are that samples of urine (especially those of large volume collected over 24 or more hours) are regularly contaminated with lead under the usual conditions that apply to their collection in a hospital or under any other than the most carefully supervised methods of collection. It is equally true that all but the most precise methods of analysis yield grossly inaccurate results. Such results have continued to confuse and to plague medioo-legal procedure. This is one of the most difficult of laboratory procedures, and every analytical result that is obtained must be checked and scrutinized critically before it is accepted as valid, There is double reason to suspect the accuracy of the result obtained in this instance, for the reason that the concen tration of lead, as reported, is so high, as compared to normal values, as to be associated only with the more severe and hazardous types of occupational exposure to lead during or shortly after such exposure is being experienced. It is so highly improbable, in association with any type of absorption of lead that may have occurred 5 or even 2 years before, as to be regarded as virtually impossible. This is to say, that this result is such as to convict itself of inaccuracy. It is probable, in terms of our common experience, that it was Mr. Roger C. Frst 3 - January 26, 1961 improperly collected and so contaminated in the process. It is possible, of course, that this sample of urine was collected in the course of, or in association with, the administration of chelation therapy. If so, it must be discarded as invalid evidence of Mr. Motter's status with respect to lead that had been absorbed years before. One other point should be made. Much the best method of demonstrating the presence and the extent of any abnormal state with respect to the absorption of lead at the time this was attempted in Mr. Motter's case, would have been the determination of the lead in his blood. This certainly should have been done, not only because of the superior value of this information by itself, but also because, such an analysis paired with that in the urine, would have supplied mutually supporting or mutually exclusive information. Without such information in this case it is nearly impossible to interprer^significance of the analytical result in the urine. This is very important in present-day medical and medico legal practice, and the failure to recognize this fact in this instance, as it is in many another obscure and controversial situation in relation to lead absorption, is most unfortunate. ^ Very truly yours, / RAK:ss Enclosure Robert &. Kehoe, M.\ D *u