Document 2JeMRd43zKM1z44n9zEgDKVpg

July d, 1956 D r. W illiam U. G iessel, M edical D irector O ccupational H ealth L aboratories T il M ilhy Street Houston, Texas D ear D octor G iess el: You m ay be su rp rised , and perhaps even d isp leased , to receive this letter iron?, m e . L ot m s e x p la in , h o w ev er, that m y a tten tio n h as b een c a lle d by m utual fr ie n d s to so m e o y ou r a c tiv itie s in the fie ld of in d u stria l hygiene in the lead tra d es. This subject is one on which m uch of the effort of m y p rofession al life has been spent, end sin ce som e of the techniques that are being used were, developed in itially in this Laboratory, I m ay, perhaps, go c u t o i m y w ay to s p e a k o f th e m , w ith ou t p r e su m in g upon y o u r p a tie n c e .end good w ill, and without d isc o u r te sy . M oreover, it seem s w ise and proper to sa y what I h ave to s&y to you r a th er than to sp eak o f it to o th e r s . ' lx y o u h a v e r ea d th e e d ito r ia l w r itte n by m e in th e I . A . M . / * , o n th e su b je c t o f Die p ro p h y la ctic m is u s e o ITOTA, you w ill, I b e lie v e , 'r ec o g n ise that I disapprove of your efforts in that d irection . 1 am sure that oth ers, as w ell as y o u rself, are engaged in th is form of palliative treatm ent c f potential or actual lead poisoning in a ll good co n scien ce. I am equally certain that you do not understand the m edical and therapeutic problem at issu e , from the p h y sio lo g ica l view point, and that you a r e not aw are that you a re pandering to the ignorance o r, in som e few in stan ces, the d isregard of industrial m anage m en t fo r the w elfare of em p lo y ees. The failu re to prevent in d u strial lead poisoning is one of the m ost flagrant violations of the known and adequate canons of m odern in d u stria l h ygien e that can be found in th is cou n try. I w onder if you r e a lise that the control o f industrial lead exposure in such a m anner as to prevent the absorption of dangerous quantities of lead is now so open to tech n ical ach ievem en t a s to be a m oral and so cia l obligation on the part of industry. I w onder, a lso if you rea lize that when we physicians under take to p a llia te the w o rst effects of im p rop er environm ental conditions in the lead tra d es, we are contributing to the n eglect of appropriate m easu res of ind ustrial hygiene, and hindering, rather than prom oting, industrial health. You m ay argue that you:advise the in stallation of appropriate and adequate v en tila tio n . So what? That is on ly an e a sy g e stu r e of ab solu tion fro m resp o n sib ility , What ven tilation? When and how applied, and to what sp ecifica tio n s? These are the m atters that count, and it is a physician's job to p rescrib e such sp ecification s and to m ake ev ery p o ssib le effort to see that they are m et. This req u ires know ledge, hard w ork and a sen se of resp on sib ility. D r. W illiam U. G ie s s e l - (2) - July 30, 1956 I am not speaking here of resp on sib ility in any hypothetical sen se , o r of in d u s tr ia l h y g ie n e p r a c tic e fr o m th e v is io n a r y id e a l o f th e iv o r y to w e r . I'v e been working in the lead trades fo r thirty y e a r s. I know their prob lem s, I am fa m ilia r with the attitu d es, and I know the techniques good and bad. I te ily o u without any fea r o f p o ssib le contradiction , that th ere is no excu se for the p resen t high in cid en ce o f lea d p oison in g in A m e rica n in d u stry . It is an e x p r e ssio n o f alm ost incredible ignorance, intolerable technical slo p p in ess, and in a few in sta n ces, a thoroughly indecent so cia l c a llo u sn ess. Xm ust a lso sa y , in great internal wrath, occasioned by sham e, and kept below the su rface within the p ro fessio n , with the patience and forbearance of a long'tim e m ed ical teach er, thattiiis situation is , to a large extent, due to th e ignorance and the ir resp o n si b ility o f p h ysician s If the d o c to r s, who wokk in the lead u u sin g and producing in d u str ie s, and in p ro fessio n a l a sso c ia tio n w ith the responsible people in lead tra d es, had known, or aow know, th eir jo b s, the problem would be understood by in d u strial m anagem ent and production people, and it would not e x ist a s a problem , but as an ach ievem en t, of ind ustrial h ygien e, . If the u se o f iuDTA m o v e s the c lo c k b ackw ard in the in d u str ia l h y g ien e o f th e lead, tr a d e s, as it is now doing o r is on the point o f doing, it w ill have been a d istr e ssin g incid en t in m ed ica l ir re sp o n sib ility , rath er than a boon to the u n fortu n ate victim * o f 's o m e o f th e l e s s e a s il y c o n tr o lla b le s o u r c e s o f u n w ittin g and m ore or le s s accid en tal exposure tc lead . B ecause tuo things 1 a v a said above! a r e so evid en t, and sin ce I am sure that you and m any other-physicians (M auville is one of th ese, but there are oth ers) do not fu lly understand this situ ation , I w rite to su g g est to y o u , that if you could find tim e to spend a day w ith m e, so m etim e soon, but at your convenience o th erw ise, I could 3how you by fa cts and figtass, by the plain-spok en data oi experim en tation and of ind ustrial ex p erien ce, ju?t how u tterly fu tile in m o st in s t a n c e s , i s th is b u s in e s s o f p r e s c r ib in g EDTtPu, e x c e p t in th e tr e a tm e n t o f a m an who is actually ill. T here a re, I b eliev e. a few situations that m ay properly ju stify the ad m in istration of SDTA to a m an who is w ell. T h ese, how ever, are v e r y fe w , and th ey m u s t be w eig h ed c a r e fu lly , w ith al l th e o b je c tiv ity o f a co m p letely resp o n sib le p h ysician , again st oth er fa cto rs in the life and a s s o c ia tion s of the patient - for he m u st be a patien t, and not m e r e ly a pare of the m achinery of industry. I h op e I s h a ll n o t h ave g iv e n cf&ause in e x p r e s s in g m y v ie w s at> v ig o r o u s ly and so bluntly, and I do hope that you w ill find it p ossib le to accept m y invitation. I sh a ll be on vacation in A ugu st, but a fter then I sh a ll b e a v a ila b le ex cep t when som e engagem ent takes m e out of town. C ordially yours R obert A . K ehce, M. D.