Document 4vBQ2nJz7ML771nMqbb5ddLQG

December 2, 1935 Dr. S* R. Hayhurst Consultant, Industrial Hygiene State of Ohio Dept, of Health Columbus| Ohio Dear Dr, Hayhurst* ^IingDllto your letter of Hovember 20th concerning am glad to make certain additional comments on the case. ^r*flflHB^has continued to Im prove and although he isTio^entirely recovered, he Is apparently on the way to recovery unless he has some recurrence or ascerbation of Ms cerebral condition. The diagnosis is a matter of considerable question and if he recovers completely, I do not see how a diagnosis can be arrived at* I am quite certain that lead was not a significant factor in his illness* I am not quite certain what was responsible* We shall keep in touch with him and we are still carrying on certain studies. Despite the fact that wo shall not be able to make a diagnosis* I certainly hope that he recovers without ahy residual damage. As to the significance of laboratory evidence in a? diagnosis* I think the case can be stated in comparatively simple terms. I have previously called attention to the fact that the presence of abnormal amounts of lead in the blood or the excreta indicates merely that there has been an abnormal lead exposure. It Is also my experience after rather wide study of the problem, that if there is no excretory evidence of abnormal lead ab sorption, one is Justified in concluding that no abnormal lead absorption has occurred provided the examination In this rexpect is mad in clpse time relation to the exposure* We have never yet seen a case of lead intoxication (unless this man is the exception) in which the examination of the blood and the excreta immediately after the cessation of exposure has not shown a measureable elevation of the lead level. It is my opinion that It is not possible for a man to absorb significant quantities of lead without showing an Immediate and for a time persistent elevation of his blood level and of the level of his lead exdretion* This brings me to state my definite opinion that although ab normal lead findings do not prove tla existence of lead Hayhurst intoxication, yet the absence of abnormal lead findings in immediate relationship to exposure disproves the existence of lead intoxication. You will note that I am not speaking here of residual injury, but I am speaking rather of active symptoms of intoxication. I have previously discussed the general problem of lead analyses with you and I have indicated that I do not believe you can put much con fidence in them for diagnostic purposes. This is not because proper laboratory work can not be adequately interpreted by a man who is competent to do so. It is rather that at the present time the methods of analysis are so variable in the hands of different men and the bases of interpretation have in many Instances been so poorly worked out, that reliable information and trust worthy opin'ons are not generally available. Actually the present situation is such that I do not trust laboratory methods taken alone. What I would wish to base my opinion on is a thorough-going study of the patient in which the whole question of the nature and duration of the exposure, the clinical picture Including the laboratory findings are all lumped together in an adequate interpretation in the hands of one Who understands both the clinical and laboratory aspects of the problem, With reference to 7. `would certainly not urge any handling of his BSffe which -would deprive him of compensation. It is my point of view that in cases of this type experimental study and diagnosis from the point of view of experimental...investigation are one thing, and a clinical diagnosis for medico legal purposes is something else. I repeat, it is my opinion that this man does not have and'never did have lead intoxication. However, unless I could orove that point to the satisfaction of the average clinician, I would wish to see this man have the benefit of such doubt as there is as a basis for industrial compensation. This may seem to be drawing a very fine line, but it is one which I consider justifiable. With kindest personal regards. Cordially yours. RAKjls Robert A. Kehoe, LI.D. K 0016591