Document 93nr2g5qbVdprm60rpZZbvm96

HARVARD MEDICAL SCHOOL BOSTON September 16, 1940. Hr. Robert A. Xehoe, University of Cincinnati, Cincirjnati, Ohio. 0 7. f * AA-SuAVV-J U iu*, Tty dear Or. Xehoe: First of all, let ir.e congratulate you on this paper. Inasmuch as most of it is your own work, I think it represents an accomplishment of ?.'hich you nay v;ell he proud. h'hile I do not have adequate personal experience to evaluate some of it, I feel sure of its value and, therefore, approve of the report os a whole. As you have asked, I cm going to rake some suggestions for changes, though they are not very great. I notice' on page 3 and L, rhere you talk about treatment, that you speck of the inadequate v;ay it is treated, end I vjonder whether you thought the paper I gave you as inadequate. If you will tell me hat you think, I Till be glad to go over my carbon copy and try to correct it. After all, this re port -rill he used frequently in litigation end I think it should be gone over with this idea in mind so that no difficulties '.Till occur by our lack of specificity in statement. For instance, note the place I have marked on page 5 and 6. There arc a Iso others in trie report hich I have not marked. I have also rede a note on page 18. On pomes FI and 22, I mould add that stippling and basophilic aggregation are not as good a quantitative value as justified by the figures, for they very during the day and vary considerably from day to day though the cause of this variation is not knoun. On page 2L I object to the examination of single fecal evacuations. nv-t is meant is fecal evacuation per day, or total excretion per day, for a run sight 'veil have more than one bowel movement per day. This is mentioned on page 25 also. On page 27, at the top, I should like to suggest, though I do not think you '-ill approve of it, that either twenty-four-hour or eight-hour samples should be collected. The liter content may have errors. I also think this paragraph is not very clearly stated. Page. 28 -- a small change. Page 29 -- top paragraph.-- should there not be a suggestion here as to .That constitutes a concentration of possible lead poisoning? Pages 29 and 30, of course, refer to absorption in industry, and I think there should be a statement that the analyses must be cone soon after "-ork stops, because of a rapid drop; also, that the analyses must he done by experienced analysts, that the methods ere tricky, and that poor determinations give- on entirely erroneous impression, as the figures are such that they give the impression of accuracy! It is my experience that v.'hen arguments occur r'S to whether a person has lead poisoning or not, it is very difficult to controvert a urine analysis finding even though one is sure that the analysis is at l-alt. A chemist cannot do one or two lead determinations a year and depend upon his accuracy. This I think should be brought out very specifically. COLLIS P. HUNTINGTON MEMORIAL HOSPITAL HARVARD MEDICAL SCHOOL BOSTON 2- - On the top of page 42, the report seers rotter verbose and unnecessarily complicated. The last sentence of the first paragraph contains the rest of the idea. On the bottom of page 43 I should like to add sore such thing as this: "In a high calcium and high phosphorus diet, as obtained r.'ith milk, the bones are kept veil supplied rith calcium so that an active deposition of salts is not so likely". As you mell knon, there is also recent evidence for this and for the fact that intestinal absorption of lead seems to be re duced 'vith a high calcium diet. There is one fundamental thing about the report which I think you could improve. It deals largely with a technic for avoiding lead poisoning v:hich ''-ill he quite nev: to many Industrial physicians, yet in it you have no specific suggestions of jhat should be done in order to put it through effectively. In other words, I think it is an excellent theoretical discussion of the problem of avoiding lead poisoning, but is not sufficiently practical in its description of hov: the method should be set up and used. In this discussion I also think stress should again laid on the necessity for accuracy of the de terminations and that it should be stated specifically that the value of the r ethod -Again let me congratulate you on it. I really think it is a T!Stveil" job. If you have an extra copy of it, I should like very much to have one. Very sincerely yours, JCA:EA 0008121