Document 93moyNMG7YE9pYJ9d6jnq0NBD

John T . Levis and Bros. Co., 25^ 5 Aramingo Avenue, Philadelphia, Pennsylvania -.0 p'y3 o o Ua x: N16581 John i. Lewis &nd Bi-others Company, 2343 Arssilngo Avenue* Philadelphia, Penney1vanla. Bear r, Koerber *. I send you herewith my beet Interpretation of the analytical results obtained by us In the case o' luasry bobinaon, as veil as a general opinion on the case. Iheae are in triplicate as you requested. In order to le^ve argument out of the opinion, I call your attention herein to vhat any be regarded aa incorrect statements or interpre tations In your last- letter. Our results as reported 0 January S, 1.947 shoved a definitely abnormal lead concentration in the blood, e$ 30 indicated in the report forwarded with my letter of January 13, I9 4 7 . the urinary load concentration vas at. the upper level of normal values, but vas regarded dubiously because of the sise of the sample. Our second set of analyse* reported on March 1, 1947 and transmitted with say letter of March 4* 1947, shoved sctevimt higher but not contraditory values in the blood and an even lover value for the urine. 2n neither instance vas the urinary lead concentra tion beyond the limits of normal variation for samples of email volume* nor vare they-in any way remarkable in view of the volume of sample submitted, he status of this man, however, with respect to lead exposure, was shown not by the analyses of the urine but by those on the blood. `he blood results confirm each other quite adequately, and demonstrate beyond any reasonable doubt that r.ohinsan* lm\a exposure curing the months immediately preceding the taking of these samples was signifi cant. The fuperintendenfc1a statement does not. show that he had no lead exposure. On the contrary, it specifically refers to work which could have, and clearly did actually result in lead exposure and absorption. Moreover* the lead concentration in the blood in both instances is such that symptomatology from lend absorption could have existed . the result of this situation is that the diagnosis must bo mad on purely clinical grounds. I agree with your diagnosis and that of KE 0013761 evidence of lead exposure and absorption is, at present# incidental, from the diagnostic viewpoint. As to the relationship of lead absorption to gout, the evidence is of poor quality, and unsatisfactory* the British clinicians# especially# considered lead absorption to be a precipitating factor in gout, but their evidence lay purely in the coincidental occurrence of the two phenomena of gouty diathesis or the onset of gout, with load exposure in the lead trades. Gout vas and is common in England and the relationship, in my opinion, was fortuitous. I trust that this clarifie my opinion in this c-asc. Vdiat your fhiladelphia colleagues fail to recognise is that they and no one else can make the diagnosis of lead poisoning by analytical or any other than clinical means, head exposure and Icac absorption arc not synonymous vifil lead intoxication. They confuse the issue by not sticking to clinical considerations. Cordially yours, .AK ef me. -.obort A. hc-hoe, M. t-. k e c oo. <3_>7* h - f'aJ# of his occupation in the period immediately prior to December 21, 1'jkJ and thereafter. Ihe exposure v&s not highly hazardous, but it led to his absorption of potentially dangerous quantities of lead, as shown by the lead concentrations in the blood on tvo occasions t namely 1 . 0 8 3 mg. Fb per loo grams of vhole blood as reported by us on January 8, 19^7* and j .12 mg. f'b per lu./ grams of vhole blood as reported by us on March 1, 19^7* In our opinion, these results, taken with the relatively low (normal range; lead coneentration in the urine on both occasions, strongly suggests that lobinson's lead exposure vaa of a low but significant order of magnitude over a long period of time (years), "he occupational history indicates that this was the case. A diagnosis of lead poisoning is not justified by the symptomatology and the clinical facts, including the hematological findings. A diag nosis of gout is tenable and reasonable, thereby making it wholly unnecessary to explain any of the symptomatology on the highly dubious basis of atypical plumbism* An otiologic relationship between lead absorption and the onset of gout is, X should say, purely speculative. Iober1 A KeEoe7""k. iH Z ' c, QtiJ O it* N16581.01