Document Bvg1qyJX799Yo67y19qdYV4J

, . September SO, 1931 Dr* F. R* Walters, Medical Department, Kellogg Company, Battle Creek, Mich* Dear Dr* Walters: i I am sending you under separate cover some reprints which have to do with the subject of lead poisoning, in which I hope you will find some Information which interests you. Unfortunately some of the more important things vvhieh we have don are not yet published, and it will be some time before they appear. However, I can briefly give you my own notions as to the manner in which the diagnosis of lead poisoning may sometimes be made -- opinions which are based on our experimental work and observations over a period of several years. . In general in order to make a certain diagnosis of lead poisoning, there are three points on which there must be definite information* (1) There must be a history of significant exposure* By significant exposure I mean on which is known to be capable of producing lead poisoning. That Is to say, one must know something of the actual magnitude of the exposure involved. (2) There must be symptoms and physical signs which are at least compatible with a diagnosis of lead poisoning* Obvi ously, a variety of symptoms and a variety of physical signs are produced by lead, and I need not discuss these except to point out a few things which are the most significant* in active cases there m a t be some toxemia, as shown by pallor, muscular weakness, tremors, colic, e t c It Is very rare also to find lead intoxication without definite evidences of changes in the blood, of which the earliest sign is baso philic stippling. I, personally, question very much whether an active plumblsm can be in existence without the presence of a considerable amount of stippling. I have never seen a case of lead poisoning that did not show stippling, except In a few instances which I have described in a series of cases of tetraethyl lead poisoning where the intoxication came on rapidly and was primarily a central nervous system 0011318 F. B* Walter, M*D. 5pe-3g0*8S1 .1 . affair So far a my observation goes, one of the very first signs of lead poisoning la this ehange la the blood* Of oourae frequently there la an anemls, but this comes later than the microscopic ehangea In the cells* * r**'* l 'll T *1 t ' (5) There must be evldenee of.a algnlfleant exposure to?lead compounds aa ahown by. laboratory testa specific for lead* Zf expoaure ha, been reoent, and by reoent X mean not liore than a few week.prior to the examination, the faeces and the urine aheuld show definite evidences of elgnlfleant quantities of lead* Lead la normally found in both faeees and urine* Xt la therefore of no value to have qualitative testa for lead* One must know the quantity la order to determine whether the amount which is being excreted Is significant of moro than tho ordinary exposure to lead* Obviously, If one is attempting to make a diagnosis on a c s s s a s n y weeks or many months after the cessation of exposure this laboratory teat will be of no avail, unless exposure haft been enormous so that a higher than normal excre tion of lead persists for many months* Xn some instances this is the eeee* However, as a general thing, even following in tense expoaure, the excretory level is down to normal in less than six months Xn most Instances ths level la dropped very nearly to normal in one month from the cessation of exposure* It is therefore important to make these examinations early and if possible to study the thing in relation to the source of the exposure, , Xf one Is not in position to study and to arrive at a definite Conclusion on thsse three points/ X vary much fear `that it ls not always possible te caake a definite diagnosis* aXn instances it ^becomes necessary to rely upon purely eUnlcalinrormatlon* However,! do not believethatthere : , nostic oflead.poisoning* Kany treaties have besnwrlttsn on ^ l e A'aatter't"..bmt'so:;jfar a s l k n o w there is not a single injury prodneed'''bfi.>leadfwhlOhCd not occasionally produced Sjy,-M* ' other regend*|Xt is pf the ots*et importenee therefore to - > have accurate ^formation by which one is.enabled to estimate '. thesignlfioanoe tit ithe exposure* Xn many iostenoes thiscsn .beCml^o^ibe^lilatory alone* xn othere, it le quite nee- . eee^-eltdidi%*laiow,,'the'exaetc^dltlonetdf exposure, or to have noemto^iaboratory information whloh an measure this factor withoutknowledgsof the exact oheraoterofthe indi vidual* gpqtaget.-^ 5 *{^ t i ' , . < r5os-'liv HE 0011319 F* R. Walters, M. D #3 I trust-that the above Information states clearly enough my own point of view, and I hope you may find it usei*ul. If any questions arise in your mind out of my letter I should he pleased to answer more fully any of your questions on which I have information. Very truly yours, RAK:EJ .1 I 1 Kr 0011920