Document Dk22b9m50RNR9YL0pNaJbeYN

July 15# 1970 John S. Chapman# M.D., Chief Editor Elect Archives of Environmental Health ^- The University of Texas Southwestern Medical School 5323 Harry Hines Boulevard Dallas# Texas 75235 Dear Doctor Chapman: . Thanks for your letter of July 8# and for the privilege of a pen-acquaintance with you in this new relationship with the Archives of Environmental Health. I am sorry that the papers forthcoming from my office as the result of the Conference in Amsterdam cannot be published together in a special issue. Z had thought# from a letter of Dr. Hussey to Katharine Bducot# that this might be done if I were to see that the extra expense Of so doing could be defrayed. However# if the decision has been made# I# of course# will abide by it. X do hope# however# that these papers can be gathered together after their publication into a reprint with a very simple paper cover. Perhaps the best thing I can do for you is to explain the origin of these papers# my role in connection with them# and their usefulness at this time for educational purposes within the profession# as X see it. This Conference was called in November of last year by R.L. Zielhuis# M.D. of the University of Amsterdam# to meet in Amsterdam, and to spend several days together discussing the problems associated with occupational health in the lead industries. Especial emphasis was to be put on hygienic standards for the handling of personnel in such trades and a report was to be made to the International Association on Occupational Health who sponsored the meeting for that purpose. The Conferees# with but two Americans# were to come from various European countries {including England), and we^e invited to provide prepared reports representing their experience as investigators and practitioners In Industry. A program was prepared under various headings and the speakers or authors on these subjects were asked to speak and read their papers. Discussion followed# and the subjects were explored as well as they could be by the assembled group. Ronald Lane and I# and one or two other elder Investigators# were asked to conduct sessions and to summarize the report of persons within an assigned# specific subject-group. As you can imagine# there was much which could not be dealt with# after the fact# as proceedings# and indeed the only things once could get his teeth into# afterward# were the prepared papers, which were as variable in their qualities of ideation# observation and writing as were the individuals. At the end of this session# the question of the preservation of the proceedings and the preparation of a report arose# and in brief, I was asked about a publication in the Archives. X promised to find out what could be done# and to do all X could to get this accomplished in a satisfactory manner# even to editing the reports# subject# John 8 . Chapman, M.D Page 2 July 15, 1970 of course, to the wishes of the Chief Editor and th official policies of the Archives. Two of the British contributors were given the job Cor perhaps they volunteered) of putting the material together in understandable English (since a number of the contributors were incapable of doing this, despite the degree of their familiarity with the proper usage of their own language. In due course, the material, including the individual papers, and a resume of the meeting by the British representatives (Dr. Malcolm and three other British Associates), were forwarded to me (in June of 1969). 1 had been in touch with Katharine about the means of handling this, and I forwarded the material to her, on the basis of an understanding that the papers were to be sent to various members of the Editorial Board and to others, some of whom 1 suggested. All of this took some time to accomplish, and when the opinions of the reviewers came in and were examined, all of the material, including the reviews of unidentified reviewers, was passed along to me (several papers at a time) with the request that I reexamine them, revise them (linguistically) as X thought best, and act as the more or less final arbiter as to their acceptability, being influenced, of course, by the opinions of reviewers and also by the views of the editorial office. Meanwhile^ there was an International Congress on Occupational Health in Tokyo (a meeting every third year in one of the countries, the next of which, in 1972, is to be in Buenos Aires), after which I spent a month in Australia. The first of the papers to which 1 was to direct my attention arrived in Cincinnati in January of 1970, and others have followed in large or small groups, after having been considered from the viewpoint of advice to me. was in San Francisco from the middle of January until early in March, working on an "editorial" job of my own, but I began on these papers fairly promptly. Unfortunately, I developed a labyrinthitis in February, as a sequel, apparently, of a viral epidemic there, and while it has subsided gradually and, I believe, is on the way out, has kept me working at about half-speed. (This is not, by any means, the only job I have to perform, for I am keeping a fairly large experimental program going, and it is an infuriating experience for me to have to "talee things easy." I have the worst of the job finished, however, and after I have had a vacation in the mountains, I expect to return to work substantially whole.) Now, as to specific papers and their disposition. I have rejected several papers outright, one of these being a product of Dr. Beritic of Jugoslavia. The other, the one to which you object, is of a different character. There is little doubt in my mind that the observations and the data presented by Dr. Beritic are valid. However, he has failed to take into account the fact that the concentration of lead in the blood of persons whose occupational exposure to lead has been brief, subsides rapidly (after their removal from exposure) by the time they appear at a hospital. Days or Weeks have elapsed without, however, a marked subsidence of toxic manifestations. You will have noticed, no doubt, my tactful introduction of this fact into the article, and I shall comment on this further in a discussion and summary of the outcome of the Conference. Matters of this type did not escape comment at the time of the Conference, and I need not express my own views of this matter in such a manner as to depart from the spirit of the Conference. In my view, this is much too excellent an example of this very important fact, which has been responsible for a very large amount of fruitless controversy in'this country and abroad, to pass up. As it happens, Beritic is a good clinician, whose knowledge of physiological mechanisms and methods is (scanty. ; -1 1\ John 8. Chapman, M.D. Page S July 15, 1970 ' . ' r (T. He has had son good technical assistance.. He -learned a great deal in this Conference, andtin his country, hg^has~~great need of learning/where there are some rather appalling environmental problems in relation to lead,^ This Conference was something of a means to an end, and I would like to make it as useful as possible to the professional audience of the Archives, It may surprise you to know that physicians generally, and physicians in industry^ as well, know almost nothing about preventive medicine in the lead trades. This Conference was made up of people who face these problems daily in their work. Some of them are real experts, some are experienced without being very knowledgeable, and some have an angle or two to deal with, without having the means of studying the entire problem. I would not like, therefore, to discard a paper because it is Incomplete, or because its facts may be misinterpreted through some degree of inexperience, ignorance or enthusiasm, or the opposite. It was in this attitude that I accepted and edited Dr. Beritic's paper, and put into it, I hope, enough additional information to make his observations credible. There is no doubt that what he has observed, has been observed by other competent clinicians, to their great dismay. It is one of the great difficulties of industrial plumbism, that to the physiologically uninitiated, lead poisoning often seems to occur when it should not, and fails often to appear when it seems that it should be evident. I trust that you will understand that I am fully aware of your responsibilities and authority as Chief Editor. I will do as you bid me. However, this is not a series of papers, each of which is entirely complete in itself. There are several papers on every phase of the subject, and the opinions of individuals vary, as do also their competences. This, therefore, represents something of the status of the subject at present. 1 believe the position will become fairly clear to readers who examine the papers as a whole, even by scanning them once they have been put together. That, of course, is why I had hoped that they could be published in the context of the Conference. I have sent in to Katharine Boucot, seven (7) completed manuscripts, and have two others well under way. I have had to .write to several of the authors for specific bits of Information, and, therefore, there has been a considerable expenditure of time. I think it worthwhile, however, to spend this time. (I only protest, inwardly, at the delays caused by the naivete of some of the authors, and my own disability.) There were, originally, twenty-six (28) papers, of different lengths, in the material which I sent to Dr. Boucot. I have received most of these, from her office with the reviews. Some have been discarded as irrelevant; some have been rejected outright; two have been dropped completely since they have been published elsewhere, and were given in but slightly different form at the Conference. The number yet to be edited appears now (including the two now nearing completion) to be seven (7) papers, unless there are some which have not been forwarded toime from the Editorial office. There is, I believe, one such paper there, and there may be another. I shall inquire about this at once. In any case, you will have a series of papers, in (hopefully) proper form, which will fit together and portray, fairly well, the situation in which Occupational Medicine and Industrial Hygiene find themselves, with respect to standards of performance at this time, In the lead-using industries. The physiological answers are not all in, but the standards of safety and the methods of procedure which are applicable in the handling of the premises and the personnel In the lead trades are such that occupational lead poisoning could be eliminated completely from organized industry if these could be adopted and complied with. I have now written at home length to give you the setting and (I hope) the flavor of this Conference, and, at th last, I have given you my view of the paper of Beritic - one which I may apply to certain other papers. Having so expressed myself, I hope John S. Chapman, M.D. Pago 4 July 15, 1970 that I have not gone to excessive speech, but I should like to relieve you of any embarrassment in expressing: your opinions and in informing me of the decisions which are your responsibility to make, j Sincerely yours. RAK:wb Robert A, Kehoe, M.D. Professor Emeritus of Occupational Medicine KE 0018408