Document 4v6xVgZ02qqwq270LwEMLqYvx

Ju ly 26, 19^6 Dr. H e d w i g S. K u h n ^pnm*alATiC logy 112 Rimcach Street Hammond, Indiana . Daar Hedia: I am g lad you wrote to me about tue mat t e r of therapy in the small plants that have the problem of excessive lead absorption among their employees, for this is a vexing s i t u a t i o n a nd one that needs proper handling* It has b e e n created or at least contr i b u t e d to by the naive viewpoint of the distributors of the therapeutic agent, in that they have encouraged "deleading" a3 a prophylactic measure* I s h a l l a n s w e r 3'our d i r e c t q u e s t i o n s a n d a d d some c o m m e n t s * Let me say first that this is p r e c i s e l y what was in the offing that led to ray e d i t o r i a l in the A. k . A , It Is one of the m o s t d i s t r e s s i n g situations that has appeared in relation to industrial hygiene in the lead trades in many a year* 1. T h e r e is no p a r t of this t h e r a p y of so c a l l e d p r o p h y l a x i which should be undertaken by any layman at any time* The problem is one of m e d i c a l care and m e d i c a l judgment, and E D T A s h o u l d n o t be given for purposes of prophylaxis except for unusual and carefully chosen medical reasons* I should think that the administration of this agent by a layman would be punishable as illegal. The idea that it i3 a h a r m l e s s m e a n s of s p e e d i n g up the e l i m i n a t i o n of l e a d f r o m the body, so as to keep pace w i t h its absorption,is naive, err o neous anu a c t u a l l y viclcuo. First because the drug Is not harmless, and its effects have not been fully explored, and second because It will not do what is e x p e c t e d of it in this p r o c e s s . It is on the p o i n t of becoming a lousy substitute for sound Industrial hygiene because of this absurd idea. Actually, this drug Is useful for the treatment of l e a d poisoning, a n d it is thus that it s h o u l d be u sed* 2*, 3 I have no idea who there m a y be in the C a l u m e t a r e a who knows something about this matter and who also understands wnat should be done to control exposure to lead In industry. I have had the impression, without having much evidence, that the lead trades in the Chicago area gener a l l y are not very well handled, m e d i c a l l y s pea Icing. I m a y be m i s t a k e n . Perh a p s s o m e o n e there w o u l d c o m e to see me and be willing to learn sometuing about it. In any case I w o u l d be ,;lad to do a n y t h i n g I c a n to help. The p r o b l e m Is simple, if an honest and i n telligent effort is made to u n d e r s t a n d it and to do w h a t is re q u i r e d . Dr. Hedwig S, Kuhn -(2)- July 26, 1956 I4.. T h e r e is r e a l l y no e x c u s e e x c e p t i g n o r a n c e and c a r e l e s s n e s s for the occurrence of lead poisoning in modern industry. We know in v e r y p r e c i s e t erms wiiat are the c r i t e r i a for s a f e t y j ^ h o w to r e c o g n i z e dangerous absorption of lead in the individual and in the group before it r e a c h e s the p o i n t of cau s i n g p o i s o n i n g . T here is no such thing as an unduly susceptible person who, suddenly and without any warning signs, develops lead poisoning. This concept relates to the dark ages of medicine and industrial irresponsibility. I am about to go on a much-needed vacation for a month. After that I shall be r e a d y to do what I can to help you. If you would like me to come up there and spend a little time with some of the people who are concerned with this matter - medical or management people, so long as the p r o f e s s i o n a l a m e n i t i e s are o b s e r v e d - I fd be .lad to d o it. If you want to read what I have to say on lead in Industry, read the c h a p t e r on it in P a t t y 's, I n d u s t r i a l Hygiene, Volum e II, I a l s o send you the report of a one-time Committee on Lead Poisoning of the A.P.H.A., w h i c h Is e s s e n t i a l l y u p - t o - d a t e e x c e p t for the part on t h e rapy, I do this because, in the i n d u s t r i a l h y g i e n e of the lea d trades, it; is essential to Ignore all matters related to medical treatment TKe o c c u r r e n c e of cases oT ~ p o i s o n i n g a n d the n e c e s s i t y 60 r e s o r t to the treatment of the disease, so far as these stem from industry, arise only because of failure - Ignorant or irresponsible failure - to provide s a t i s f a c t o r y c o n d i t i o n s u n d e r w h i c h m e n work. This is a simple, r e a d i l y demonstrable truth. Why confuse it with considerations of medical treatment? -* We are sending you a copy of the Journal you want, since we have found an extra. You m a y keep this. /I call your a ttention to the fact that this article deals with the treatment of lead poisoning, Brieger and his group have done g o o d w ork on this. Our o wn concern, because of the local situation, has been with the treatment of the Infants and young children among whom the disease is manifested mostly as encephalopathy a n d the m o r t a l i t y is 2 5 to 30 per cent. H ere is where a l i f e - s a v i n g type of therapy Is urgently needed. Some measure of success has a c c o m p a n i e d the use of "DTA, but not as m u c h as one would hope. .\ _ . Sincerely yours, RAK:jw Enc ^ `-/v *** <?i Robert A. Kenoe, M. D. s,/.j u j jf O r\ 0z cJ-lewteS". fC.uhn, .yPt. Oph t h a l mo l o gy i n RIMBACH STREET Ha m m o n d , In d ia n a July 23, 1956 Robert Kehoe, M.D* Director, Kettering Laboratory College of Medicine University of Cincinnati Cincinnati, Chio Dear Bobt There are a number of small plants in this area that handle lead* The superintendent o f one of them, a very fine young person who is also a neighbor and friend, himself had lead poisoning in his own lead plant, and is tremendously interested in helping to eliminate this toxic hazard in this area. He has informed himself of the so-called EDTA treatment which he seems to be under the impression can be carried out without medical supervision at the time as long as there is medical counseling available. This is entirely out of ray field and I would greatly like to have some direct informa tion, I tried to get a copy of the May *55 issue of Industrial Medicine but as soon as I get my cum copies they go overseas, so, I do not have it, I understand there is an article in that issue, I also have a copy of your statement in the AMA, January 22, 1955* /The primary questions I need to have answered are the following! 1, Could ary part of such treatment emergency as carried out by a layman immediately at a plant be compared to irrigation of eyes after they get acid in them? 2, Who in the Calumet area, medically speaking, would know most about this sort of thing and could prepare a statement for small industries where there are toxic exposures to lead or other metals for which this substance might be useful? As you know, Dave Johns has retired and gone to California, Ed Carleton does not seem to know anything about this, and I am afraid there are no other doctors in the area that he or I know do know, 3, Aschairman of a newly organized Hammond Safety Council, the hazard of ex posure to lead has been presented to us by the small industries in the area that handle lead, and I do have to concern myself directly with it, ii. My understanding was that leaden toxication is unnecessary if the proper pre cautions are taken with reference to apparel and ventilation, and that the existence of a suddenly detected individual who has lead poisoning is out of S 00823 Robert Kehoe, M.D, - 2 - July 23, 1956 line with m o d e m practices. Is this concept correct or not? Meanwhile, would appreciate having that copy of Industrial Medicine to borrow if you can loan it to me and/or a statement from you that I can give the superintendents of these plants who are interested in protecting their workers, and whose consulting doc tors know absolutely nothing about lead, prevention of exposure, or detection, car treat ment, Your cooperation would be much appreciated# Sine HSK:s HEDWHt S. KOHN, H.D, ) I 00824