Document Evw246o2DXDmZL4yYg173koYb

American Brake Shoe Company MEDICAL DEPARTMENT 4 5 5 0 W est 2 6 ln Street, Ch icaj o 23, Mincis Teleohcr.e: LAw r.dale 1-3210 November 11, 1957 Robert A* Xehoe, M, D University of Cincinnati Department of Preventive Medicine and In d u strial Health The Kettering Laboratory , Cincinnati 19, Ohio Dear Bob: * Thank yon very much for your letter of October 28, 1957 replying to the request I send you for information on high bloods leads and low urines, I was glad to have your information and also the references you included. We are going to check our records further and i f we are able to come up with anything I sh a ll l e t you know about ito Kindest personal regards. Sincerely yours, LEH:vm L. E, Hamlin, M* D, Medical Director O ctober 28, 1957 -, . 0 . H a m lin . '-ml D ir e c to r . ricau B rake Shoe Com pany >W est 26th S tree t Biicago 23, Illinois ' D ear Ham: ''i s q u e s tio n r a i s e d in y o u r l e t t e r o f O c to b e r 24 is o n e to w h ic h , so ax as am concerned, th ere is no satisfacto ry an sw er. The relativ ely low c o n c e n tra tio n of lead in th e u rin e of p e rs o n s , e sp e c ia lly c h ild re n , who a r e su ffe rin g fro m le ad in to x ic a tio n , a s c o m p ared w ith the co n cen tra tio n {often q u ite high) in the blood, h as b een see n by u s fre q u e n tly o v er the y e a r s . T his is one of the re a so n s th a t led u s y e a rs ago to ad v o cate a n a ly s is of th e bloc-d of p e rs o n s who h av e a c tu a lly o r a lle g e d ly b e en s u b je c te d to e x p o su re to in o rg an ic le a d (in c o n tra s t w ith te tra e th y l lead , w hich does not elev ate the lead co n cen tratio n in the blood to any g re a t extent). We have often seen low findings in th e u rin e , su cc e ed e d b y sig n ific a n tly h ig h e r fin d in g s l a t e r , w hen, a p p a r e n tly , a c h ild b e g a n -to r e c o v e r . I h a v e b e lie v e d th is to be evidence of re n a l in ju ry , p erh ap s edem a, p erh ap s v a sc u la r changes, isch aem ia o r g lo m e ru la r dam age, but I have no re a l evidence of the n atu re of the situ a tio n . We have a lso se e n fa irly p e rs is te n tly low e x c re to ry le v els { i.e . le a d e x c re tio n ), in a ss o c ia tio n with high co n cen tratio n s of le a d in the blood of p e rso n s who have the B rig h t's D isea se type of re n a l in su fficien cy , in a few c a s e s. The o rd in a ry c ase of v a sc u la r d ise a se w ith som e ap p aren t ren al involvem ent does not show this type of p ictu re g en erally . F ran k ly , I d o n 't u n d erstan d the phenom enon. T h ere a re also o th e r v ag aries of the e x c re to ry re sp o n se which in d icate the e x iste n c e of fa c to rs which we fa il to u n d e rsta n d . In g e n e ra l, a s you know, the u rin a ry e x c re tio n of le ad o v e r an y c o n sid e ra b le p e rio d of tim e (24, 48 o r 72 h o u rs) is fa irly p red ictab le in re la tio n to the ra te and extent of the c u rre n t le a d a b so rp tio n , but th is is n o t alw ay s true^ and th e re fo re we a r e dependent upon the co n cen tratio n in th e blood if we a re to e sta b lish th e facts in th is regax*'d. Id y g e n e r a l b e lie f o v e r th e y e a r s , a3 th e r e s u l t o f th e p r e ponderance of evidence, is th at poor re n a l ex cretio n of lead is the re s u lt of p re e x istin g ren al pathology, but the exceptional c a se s re fe rre d to above in c h ild re n , in which th e p ro c e s s a p p e a rs to be re v e rs ib le , in d icate th at dam age m ay be a sso c ia te d w ith the lead intoxication itse lf. N 6013.01 D r. L . E. H am lin - (2) - O ctober 2 8, 1957 As to the p ro b lem of childhood lead poisoning, we have a trem endous volum e of in fo rm atio n , m uch of w hich cam e o rig in ally fro m Q ueensland. T here w ere num erous a rtic le s in the M edical Jo u rn al of A u stra lia . A bulletin entitled P lu m b ism and C hronic N ep h ritis In Young P eople in Q ueensland - S ervice P ublication (School of P ublic H ealth and T ropical M edicine) N um ber 2, by R . E llio tt M u rray of the school liste d above in the U n iv ersity of Sidney, was issu e d in 1939. L . J . J a rv is Nye w rote a m onograph on the su b ject in 1953 entitled "C hronic N ep h ritis and Lead P o iso n in g " (Angus and R o b ertso n , L td. 89 C a 3 tle re a g h .S tre e t, Sydney, A u stralia). I doubt th at e ith e r of th ese publications is available at p re se n t. You m ight a d d re ss an in q u iry about th e m onograph to the a d d re ss given above, and about the b u lletin ,to The A u stra lia n M edical P ublishing C o m p a n y , LtqU , S e a m e r S t r e e t G le b e , N ew S o u th W a le s . I h a v e h a d th e la tte r fo r m any y e a rs, w hile Nye sent m e a copy of his book, w hich, I believe, is out of p rin t. T here a re , how ever, num erous a rtic le s in the M edical Journal of A u stra lia running back as fa r a s 1929 and as re c e n t as 1& 7. T here a re also num erous a rtic le s in A m erican publications as fa r back as 1922. Am ong the b e st of th ese a re the a rtic le s of P a rk - A m erican Jo u rn al D is. C hild, 41:485, 1931; a lso J. F e d ., 3:265, 1933, and th ose of Vogt - A m erican J . R oent. R adium T h e ra p ., 24:550, 1920; a lso J . A . M . A . 98:125, 1932; of Vogt and M cK hann, R adiology, 22:87, 1934. T h ere a re so m an y re c e n t a r tic le s th a t I w ould have a h a rd tim e , 'w ithout c o n sid e ra b le tro u b le , g iv in g you-.a good l i s t . The s a m e th in g a p p lie s to th e p u b lic a tio n on lead in re la tio n to v a sc u la r d ise a se and re n a l d is e a s e . I can dig som e of th ese out eventually, but I am sh o rt of tim e a t the m om ent. None of them w ill sa tisfy y o u r d e s ire fo r re a l ev id en ce. T he w ork of G eorge in gathering to g eth er the significant evidence on th is su b ject is the m ost im p re s siv e th a t I have found. A s lie in d icates, m uch m o re w ork w ill be req u ired to supply proof. Sincerely yours, RAK ef R obert A. Kehoe, M. D. American Brake Shoe Company MEDICAL DEPARTMENT 4 5 5 0 W est 26th Street, Ch icaso 23, I llinois Telephone: LAw n dsle 1-3210 October 2h$ 19$7 Robert A, Kehoe, M, D, Kettering Laboratory Eden and Bethesda Cincinnati 19, Ohio _ Dear Bob: , _ I am wondering i f you are aware of any recent developments or evidence to the e ffe c t th a t lead is capable of producing d irect damage of renal tissu e . For some time now, we have been concerned with a number of cases who show high blood leads but low urinary lead excretion. We have been doing P,S,P, te s ts on a f a ir number of individuals in an attempt to fin d some explanation fo r th is discrepancy. At the moment we are of the opinion th at perhaps 60%to 70%of these employees show impaired renal function as exemplified by the P.S.P, re s u lts . They are a ll chronic cases who have been exposed to high lead concentrations over many-years. We are perplexed because we cannot determine whether the renal impairement is the re su lt of exposure to lead or whether i t is due to some other pathological condition. Not too many of these employees show other signs or symptoms th at might indicate disease of the kidney from causes other than lead, I have been in terested in the recent pamphlet sent out by Manfred Bowditch and Dr, William E, George, Chief Medical Officer,, of the Consolidated Zinc Proprietary, Ltd*, and his review of health problems associated with lead, p articularly the references to non-industrial lead poisoning in children in A ustralia, I f you have ary good References on the subject* I would greatly appreciate receiving them along with your own views. . Sincerely yours, LEH:vm L. E, Hamlin, M* D, Medical Director `