Document DMYvqqO7zwD1qR30GRqLMOkz5

Ju n e 17, 1955 & M r. P h ilip D rin ker A. M .A . A r ch iv es of In d u str ial H ealth 55 Sh attu ck St r e e t Boston 15, M assach u se tts D ear P h il: I am n ot d isp o se d to ar gu e on th e poin t of y ou r accep tan ce of M an ville's p ap e r fo r p u b lication in th e A r c h iv e s, n ot b e c a u se I h ave an y dou bt a s to th e p er t in en ce o f m y c r it ic ism of th e con cep t in volved in it , bu t r a t h e r b e c au se I do n ot w ish to st ifle id e as w ith w h ich I d isa g r e e by den yin g th em a h ear in g. I'm afr aid th at I h ave n ot m ad e th is eviden t in m y p r ev io u s an d som ew h at veh em en t p r o t e st a ga in st th e p r o ce d u r e . If you an d y ou r e d ito r ial c o n su lt a n t s b e lie v e t h a t t h e p a p e r i s w o r t h y o f p u b lic a t io n , Let i t b e p u b lish e d by all m e an s. On th e oth er h an d, I w ish to m ak e m y p osition c le a r to you on th e m e d ical p r in cip le in volved . In doin g so I h ave no in ten tion of p r each in g to you o r in in st r u ct in g you . I m e r e ly th in k it im p o r tan t to e st a b lish c le a r ly a p r in cip le th at h as been v alid ated to m y sat isfac t io n by n eairly a life tim e of m e d ical p r a c t ic e in in d u str y . Th e p h y sician in in d u stry fu lfills se v e r a l r o le s, on e of w h ich , b e cau se of the fr a ilt ie s of h um an kn ow ledge an d p er fo r m an ce , is th e tr eatm en t of in d u st r ial c a su a lt ie s. In th e p rod u ction t e am , h ow ever, h is p r im a r y fu n ction , id e ally an d in due c o u r se of evolu tion , is th at of se r v in g a s th e co n scien ce an d th e c r it ic of in d u stry , in m at t e r s of h ealth . To d efin e h um an h ealth in t e r m s of ph ysiological c r it e r ia , an d to in sist upon the p r eser v atio n of th at la st in crem en t of h ealth and w ell bein g th at m ay be jeo p ar d ized fo r produ ctive gain , is h i3 sim p le du ty. Good in d u st r ial h y gien e, in it s en gin eer in g fu n ction of co n tr o llin g th e in d u st r ial en vir on m en t, in v o lv es ad eq u ate co m p lian ce w ith ap p r o p r iat e p h y sio lo gical sp e c ific a t io n s. An yth in g le ss th an th at is not good, if th e sp e c ific a t io n s a r e grou n d ed in e st ab lish e d p h y sio lo gical fa c t s, r e g a r d le ss of how an d w h at is b ein g don e. Good in d u st r ial h y gien e, in t e r m s of th e m e d ical su p e r v isio n o f th e p e r so n n e l em p loy ed in th e h azar d o u s en viron m en t, is m ad e up of stu d y of th e h ygien ic st at u s of th e m en , h ygien ic in str u ctio n , p rovision fo r th e p rop er u se of p e r so n al p rotective d ev ices, an d rem oval fr o m exp o su r e, i. e. rotation in jo b s, t r a n sfe r to a safe en viron m en t, etc. Th erapy is in d icated ,on ly if th e c r it e r ia fo r safe ty a r e unknown o r in th e p r o c e ss of bein g e stab lish e d , o r if th e m e asu r e s of con trol fail th rough in ad verten cies, accid en ts an d h um an fa ilu r e s. Now a s th e se p r in cip le s ap p ly to th e le ad t r a d e s, w e h ave, at p r e se n t , ad e qu ate an d v e r y n e a r ly ab so lu t e c r it e r ia (in p h y sio lo gical t e r m s) fo r a sa fe in d u st r ial en vir on m en t. I h ave e x p r e sse d t h e se in sim p le d ir e c t lan gu age K 0010442 M r . P h ilip D r in k e r - (2) - Ju n e 17, 1955 (se e th e ch ap ter on le ad in P a t t y 's book ), an d th ey a r e acce p t e d an d ap p lied by a n um ber of in d u str ies. Th ey ar e b ased upon car e fu l, elab o r ate and lon g term clin ical an d experim en tal ob servation s. They h ave proved th eir ad e q u acy in p r a c t ic e , an d th ey a r e not su b je c t to an y doubt w h atev er , so fa r a s th ey go. We do n ot know th at the p e r m issib le le v e ls of le ad ab sorp tion (as now d efin ed in p r a c t ic e ) a r e w h olly an d p e r m an e n t ly sa t isfa c t o r y , in t e r m s of th eir com plete in su ran ce of freed om from an y vagu e o r in sid iou s o r p r e se n t ly unknown in flu en ce of le ad on h um an w ell-b ein g o r lon gevity , but we do know th at th ey p rovid e aga in st the o ccu r r e n ce of lead p oison in g in an y of its p r e se n tly recogn izab le clin ical o r sym ptom atic fo r m s. The m atter of lead accu m u latio n in th e body is tak en c a r e of by th em , an d I m ay sa y th at an y st an d ar d th at d oes n ot do t h is, in con for m it y w ith 'ou r p r e se n t fa ir ly fu ll in fo r m at io n on th e su b je c t , o r an y c r it e r io n of "go o d in d u st r ia l h y gie n e " th at d o e s not m e e t t h is, is a co n t r ad ict io n in t e r m s. F o r p r o fe ssio n a l p eop le in the field of in d u strial h ealth , the accep tan ce of stan d ar d s th at m ak e co m p r o m ises w ith safe t y , when th e la t t e r can be sou n d ly d efin ed , r e p r e se n t s a st u ltificat io n of con scien ce and a b r u talization of so c ia l se n sitiv ity , th at can on ly be r egar d e d a s a m an ifestation of callo u sn e ss, stu pidity o r in tellectu al d ish on esty. If sa fe t y can be ach ieved in th e m o st d an ge r o u s of th e le a d t r a d e s, it can be don e (an d h as been in at le a st a sc o r e of t h o se w ith w h ich I am d ir e c t ly fa m ilia r ) in th o se in volvin g l e s s e r h a z a r d s an d m o r e t r a c t a b le e n gin eer in g p r o b le m s. A s I h av e p o in t ed ou t pi'e v io u sly , m an y o f th e le a d t r a d e s in th e U. 3. A . h ave been gr e a t ly im p r oved in m o d e r at e ly r e ce n t y e a r s, but n ot v e r y m an y of th em h ave im p r oved to th e poin t of th e elim in ation of m ild ty p es of l e a d p o iso n in g. V/e h a v e r e d u c e d th e in c id e n c e o f t h e m o r e s e r i o u s fo r m s of le ad p o iso n in g, w ith out a c t u a lly e lim in at in g th e m ild e r c a s e s . Som e of ou r e n gin e e r s an d p h y sician s in th e fie ld of in d u st r ial h ygien e a r e ap p ar e n t ly con ten t w ith t h is, tak in g sa t isfa c t io n fr o m th e in v e sted e ffo r t an d th e q u alitativ e ap p e a r a n c e s of p r o g r e ss. In t h is, I can n ot go alo n g w ith th em , fo r I am n ot p r e p ar e d to accep t th e p ro p r iety of th is attitu de on the p ar t of a p h y sician . Th e p h y sician in p r iv at e o r ge n e r al p r a c t ic e is p r iv ile ge d to t r e a t le ad p oison in g in an y of it s fo r m s, a s h e th in k s b e st . In fa c t it is h is duty to do so . Bu t th e p h y sician in in d u st r y m u st r e g a r d e v e r y in st an ce of th e n e c e ssit y to t r e a t le ad p oison in g, am on g th e m en u n d er h is su p e r v isio n , as a fa ilu r e in the r egim en of in d u st r ial h ygien e of w h ich h e is a p a r t . To e st a b lish an y fo r m of t h e r ap y a s a con ven tion al ad ju n ct to su ch a r e gim e n , is to a c c e p t an d to condone its in ad equ acies, u n less in deed h e tak es th e ste p s n e c e ssa r y to n eedle the co lle ctiv e co n scien ce of th e r e sp o n sib le p eop le. Th is b u sin e ss of con don in g in ad eq u ate m e a su r e s of in d u st r ial h ygien e i3 p r e c ise ly w h at i s h appen in g in the "p r o p h y lact ic" u se of d iso d iu m - calciu m v e r se n a t e . Th at it is bein g done ign oran tly an d w ith out su ch in ten t, an d th at it is bein g ad v ise d , m o r e o r le ss n aively, by the r e p r e se n t at iv e s of R ik er La b o r a t o r ie s, is b e sid e th e poin t. Th at is its effect, as I am su r e b ecau se of m y corresp on d en ce and con ver sat io n s w ith qu ite a n u m b er of p eop le in th e p r o fe ssio n . If you now o b je ct to m y speak in g of th is p r o ced u r e a s the tr eatm en t of lead poison in g, let m e rem in d you th at M an ville r e fe r r e d to sym ptom atic im provem en t of th e p er so n s t r e a t e d , an d to c e r t a in ch an ge s in th e o b je c t iv e c lin ic a l fin d in gs. If m en sh ow M r . P h ilip D r in k e r - (3) - Ju n e 17, 1955 an y sy m p t o m atic o r p h y sio lo gical d e t e r io r at io n in r e sp o n se to le ad ab so r p t io n , th ey h ave le ad p oison in g, an d n oth in g but con fu sion of m in d an d co n scie n ce r e su lt s fr o m callin g t h is "le a d ab so r p t io n , " o r "lat e n t le ad p o iso n in g. " We sh ou ld not d elu d e o u r se lv e s w ith w o r d s, but st ic k to th e fa c t s. It is p o ssib le to acco m p lish th e avoid an ce of le ad poison in g am on g m en who a r e exp o sed to too m u ch le ad , w ith out lu llin g th e m an agem en t to .sle e p o r con ten tm en t, by rem ovin g the m en from exp osu re b efore th ey reach a dan gerou s le v e l of ab so r p t io n . Th is is b e t t e r th an th er ap y , in th at it av o id s an y su gge st io n of illn e ss, an d at th e sam e tim e p oin ts th e fin ge r at th e situ atio n w h ich r e q u ir e s atten tion . Not on ly is th is p o ssib le . It is stan d ar d p r ac t ice in ce r t ain in d u st r ie s. C e r t ain ly it c a u se s t r o u b le . Why sh ou ldn 't it ? C e r t a in ly th e r e gim e n th at m ak e s it p o ssib le is c o st ly . Why sh ou ldn 't an y in d u st r y b e a r the n e c e ssar y co st of providin g safety fo r its people, o r if it can n ot do so , fo ld u p an d get ou t of b u s m e s s? Is t h e r e an y so c ia l ju st ific a t io n , e xce p t in em ergen cy o r du rin g a p eriod of tem p o r ar y st r e ss, fo r the con tin uation of a b u sin e ss th at d am ages people o r sh orten s th eir liv e s? M y h ear t d oes not b leed o v e r th e eco n o m ics o f th e situ atio n . N or am I im p r e sse d by th e h igh ad ven tu r e a sso c ia t e d w ith d isr e g a r d of life an d lim b . Le t th o se who w ant it h ave it,b y a ll m e an s. Bu t le t u s not con fu se th e issu e by in volvin g th ose who h av e to w or k , w h e r e t h ey c a n , to m ak e a liv in g for* t h e m se lv e s an d t h e ir fam ilie s. O n ly on ^oth er poin t o c c u r s to m e in su ch a w ay a s to r e q u ir e a w ord of com m en t. I h ave no cr it icism of M an ville's experim en t a s an experim en t, so r e c o gn iz e d an d p r o c la im e d . N or 3h all I o b je ct to th e e xp e r im e n t s of o t h e r s, a s e xp e r im e n t s. I r e a liz e th at M an ville w ent in to th is w ith out recogn izin g its im p lication s. I fo r giv e th at a lso , for it is h um an to be ign oran t an d in experien ced . I could n ot fo r giv e m y self, h ow ever, if I w ere silen tly and su p in ely tc se e th is situ ation d evelop b efo r e m y eyes an d n ot p r e t e st . Sin cerely y ou rs, RAK ef H obart A. Kehoc, M. D.