Document LgBmeyyKJZJVYxKJymqwagwZz

September 10, 1968 P.S.I. Barry, M.D. The associated Qctel Company Limited Ellesmere Port, Cheshire England Bear Pat: He la.A. 3.1. I am most grateful for your comprehensive letter of July 30th. It came after I had left Cincinnati on ray vacation in Montana. I had made no attempt to have mail forwarded to me, except in emergency, and since this did not fit in that category, I actually received it in person on my return some days ago. It is plain to be seen that the views, or, at least, the practices, of most of the participants in the conference do not correspond to our own. The reason for that in this instance, or so it seems to me, is that they are in no position to handle their wards - the employees in their lead plants - on a strictly preventive program in which they put dependence on the analytical findings for lead in the blood, but rather must undertake to recognize toxic manifestations in sufficiently early stages to enable them to ward off the more serious disabilities associated with plumbisra. It may be that this will turn out to be feasible, in that the removal of men from exposure to lead when they develop minimal abnormalities in the levels of A.L.A. or of porphyrins in the urine. However, in my opinion, this is not only a faulty procedure, in principle, but it is highly unlikely to work out practically, not only because systemic intoxication (as contrasted with chemical signs of impending? /actual^?/ intoxication) may appear concurrently in some instances, but also because managers will not be willing to remove a man from his work simply because he has this potential threat, while the employees, themselves, will protest. This raises the entire issue of whether and when a man is ill, and it lacks the specificity and therefore the significance of the concentration of lead, per se, in the body. I am sorry that I was not present to combat the apparent consensus, and to support, vigorously, the concept of preventive medicine that is involved in the concentration of lead in the blood. However, there is to be a conference in Amsterdam in November on the subject of the maximum allowable concentration of lead in the air of industrial plants (it does not appear at present, that the lead in the ambient air is an issue, but it is bound to come up). Zielhuis has written to me (received yesterday) urging me to attend, and I think I should do so. I am not much interested in the main issue, although I have some pertinent experimental results to present on it. However, " the matter needs to be ventilated thoroughly, and in addition the tolerable concentration in the ambient air will be discussed, I am sure, by some one, if only for the deliberate purpose of keeping this issue alive. This is to be a "closed conference" which means, I suppose, that it will be open to invited persons. Beritid, Djurid and Stankovid, it seems will be there from Yukoslavia, and I should find it possible to talk to them, as will Teisinger from Prague (if he is permitted). The intention seems to be to thresh this out, under the auspices of the Permanent Committee, International Association of Occupational 0006338 P. S. I. Barry, M.D. Page 2 September 10, 1968 Health, before the meeting in Tokyo. I may be taking on a foolish mission, but I have a feeling that these conferences have potentialities for mishandling these matters. It is likely that I shall go to Amsterdam via London, or that I shall return via London. In any case, I shall certainly have a chance to see and talk with you and my friends at 20 Berkeley Square. If you have any purpose in mind that I can serve on your behalf, let me know promptly. I'm writing to Ray Bevan also, to let him know of the prospects. With all the best, Sincerely, RAK:wp Robert A. Kehoe, M.D. Professor Emeritus of Occupational Medicine . AUG `19b THE ASSOCIATED OCTEL COMPANY LIMITED ELLESMERE PORT, CHESHIRE Head Office: 20 Berkeley Square, London, W.l t e l e ph o n e : ELLESMERE PORT 3611 TRUNK DIALLING: 051 ELL 3611 TELEX NO. 62384 ~Dr. R.A. Kehoe, University of Cincinnati, KDeeptaterrtminegntLoafboErnavtoirroyn,mental Health, ^CEIdNeCnINANvAenTuIe,,Ohio 45219, U.S.A. TELEGRAM S: O C T E L . E L L E S M E R E P O R T . T E L E X CABLES: O C T E L . E L L E S M E R E P O R T ~ | OUR REF. M . A . 3 . 1 . YOUR REF. 30th July, 1963. Dear Dr. Kehoe, I returned fromJugoslavia on 24.7.63, also having spent 2 days in Germany at our plant at Biebesheim on the way back. I travelled fromLondon with JimStopps (Haskell Laboratory, Dupont) on July 14th and we were met by Prof. Beritic and his wife at Dubrovnik airport, together with Waldron and his wife, who were on tiie same 'plane. Don Fowler and wife had arrived at Dubrovnik the previous day and we were oaflsothjeoiInnesdtitbuytePrfoofr. MSaerdiiccaalndRehseisarwchi,fe.inclPurdoifn.gStahreicInisstitthuetetitouflaIrndhuesatdrial Hygiene, at Zagreb; Prof. Beritic works under him, although he is realty tiie more senior of the two. This, I gathered, is because Saric is a member of the Communist Party and Beritic is not. However, they were both obviously hvaedryagcocoedptefdrietnodas.ttenWde wtheereCaolnsfoerjeonicnee,dDirn. DScuhbrleogvneilk, MbyedtihcealoDnliyreGcteormranofwhthoe Mercedes motor manufacturers. Tiie whole party set off in three cars on the 15th July spending the Jpnuaiglsyhst1toe6nthPr,eocuhwatevhiincahgt BwtreiajnevtleotlolePdaonljthearlotaiuntgduhdaesrormoivfein6agm,0a9az0tinTgftr.ecpoucaanndtroynatitnhticemlueedvsiennpgirnogvaidmoefodunhtaaiinr raising moments. Apart from the mountain pass, which was a dust road, all other roads we travelled were tar-macadamed. Although it was a very interesting experience, I think Lucille would have found the journey somewhat trying. The accommodation at Trepca was very good, all of us staying at a hotel wdhtriahsailtcnlahsnwlacahetpiicpohoenafwreotadhsfepttohmaerinbtepeolaoifpntesgaresrtlofwe.cartsheTealahtiTieodrnecpooncncaefeninMrterineRnciunefsogsrwiapansteh,oehpSeleTledrrbaenpiondc-Cawarwoimtaohtor,irkneeEratsnh.gamlniisSlheaimdoaeunrqldtuasanoFteeroeunsch, although only one speaker. Dr. Zurbo fromProf. Vigliani's group, gave his paper, in French and no French delegates were present at the meeting. After the meeting was officially Boi'eeristmice,ltwinhgo wplaasnttheforpriametouorr.ganiser, owpeenaeldl opnrotcheeedemdortnoingtheofb1a7tt.e7r.6y8pblaynPtraonfd, K M 0306340 / continued.... -2- in goTodhccobnatdtietrioynp, lawnitthwtahseoepxecreaptitniognwoitfhthneewderqyuinipgmaenndt and seemed to storage rooms be for the battery plates, where ventilation was poor, and a high level of lead in the roomatmosphere was evident. wcre Tqhueiteoreapfpoaulnldinrgy wreitahllya pboewldieers}'dleesacdripdtuisotn;formthinegcoantdhiitcioknscaorpfewtorokn the floors and yard area. Lead dust and fume was issuing fromroasting woahftuhnpahryezeincwerhoaahwccteiaecranespasgpsoiipeonnaarntnreoedatsdhleeenthmottoenp.pellmaboTwnsyuhhtei,oletedosriwebnbduogeditrdeidIasotnammbnofoteeoowtslrwiphmeaheavpaeteorrpuefearaserleteosclapaetotntsihhrstaeeeb.etreonerSxafyawatevccankepse-itnrnpaotgtivitehleaacwacietltatiaisnobwagnpliet,cehorsymfnaosnpstirotateatmrenmftditelftarfeolosmrg, eaaltthinougghonTthgeotjotbhe. imIpwraesssnioont tshuaret tihferbeathwiansgnofaocbijleitcite!osr.wteorethaevamileanble or were used. /;s sanitation generally in Jugoslavia was most primitive, 1 would doubt it. The Conference nroper started on the afternoon of July 17th and it became apparent during the course of the proceedings that- there was some cross-:ii sunderstanding between the views of the LaIkan delegates and the Lester.i group. Whereas the paoers delivered by the Wester;: delegates were concerned with the provention and early detection of lead poisoning in Industry, those fromJugoslavia and the other Balkan countries were concerned more wiIh the diagnosis of established lead poisorting. As Prof. Berttic pointed out lead poisoning is a common disease ju Jugoslav!: and t.heir concern was the effective diagnosis of the disease, rather than its prevention or early recognition of prc-clirical states. Al the prose time they were unable to effect, a reasonable control towards prevent?or. Ur indicated the two main sources of poisoning: (?) from lead glased witie pots and (b) from lead ore foundries. As there appeared to be a differeoc of view as to the interpretation of terminology such as "prc saturnism" a; "lead absorption", he pleaded for a recognition, of the moan?ng of such tet that we could all understand what was meant. relatiEviuechvoafluethseoafrgAuLAmeanntdwciothprorpesoprpehctyritno basioolopgpoicseadl atoidsthecenbltoroedd aleraoudn.d the Pdertoefr.mCinraamtieornantod Dber.thSeelamnodsetrsefrnomsitiGvoethetensbturagn,dSwineddeicna, ticvoensoidfereeadrly.ALA. interference with haemsynthesis, whereas they considered lead in blood bdascntoleuoptodeirdnryomdipnaoiigcsrnepamsahtiyeoosrdnafiiasfcedinoateemnlislamtya,gteia,itnB,sdirKtimhcWeaieniattg.el'shddiiacrnmrogna.d,leUildewnvdhieotivhaleegirnyonscfioiatsdyacte,cbinecspaotatadrlipvdalotyicoolanehftveaedsac"nhdatohoieBdcfei.dSc.siAccrn.Aaiomital-rt.qP.hdpuboru/aiolOsgnvhOtidintgeohamweti.ve ddcaiedvseesnloopatrebarotinrfugelitthsteilsnesoivutaitvluiintey. htios pleaapder,andhethbaetliebvloeosdthleaatdthesetriemaarteionpseoipnlethwehose 00G634 /continued... -3- Stopps Indicated that ALAlevels may remain elevated after levels of lead in blood and urine have reduced to normal. Don Fowler in his paper indicated that tiie lead level in blood was the best parameter for use in the control of Industrial lead exposure, but this view appeared to be in the minority, most of the speaicers being more in favour of ALAand coproporphyria estimations. ^ Beritic, as a clinician, considered that the reticulocyte count and basophilic stippling provided a sound confirmation of lead poisoning and that these investigations should not be ignored. This opinion was held by other Jugoslav representatives, who also considered coproporphyrins and the ALAtest to be of more value than blood lead level, partly because fatrhoedmyirHweceotrlleainnsddimicspaultpeirpoonarntedodfchtthheeeapuaerscetitooonfuocnofdpelrreotaapdkoero,pnhbyhuratienmsalsasonydnbtAehLceAas.uitssee. stthsD.ery. DreepDrersaeinnted wleiatdhoTpuhoteispoRrnouivsnisgdiainningcRosntuatsitsniiagsteinwctaaslwvadesreyitnartiealrsre.eslytiPnsrgeoefn.inKastohkafoatrcotvtohrteyoirldcospnthetearoklaeurwsdaiegsnecnneoewrtahliasted excellent. However, this statement hardly matched up v/ith tiie rest of his paper, ir. part of which he mentioned the prophylactic use of EDTA, which he later indicated was at present under review. Another Russian speaker spoke of gastrointestinal motility in lead colic which was diagnosable radio'onicall A speaker from the Zagreb Institute discussed tiie work they had undertake on lead in Mood and bone marrow, showing a Mosr correlation between tin two, Papers on the effect of lead on liver and kidney function were given by Jugoslav authors, indicating that normal function was deranged, ARussian delegate U think Prof. Samcevic) however did net accent that lead caused renal disease as she had never seen evidence of tins in cases of poi souin;;. Dr. Lalcolm discussed the work of Prof. Lane wit.h respect to pensioners fron otinn'thCeatetefrfeycwtoorkfsloinadMoanncthheestcernradnido-vthasiscuclaaursesdystaemfaairs daegcareues,eooffdhisycpuesrstieonnsion It was noted that transient hynerte-nsion was seen to occur in cases of 1cod. epiotihsoenrinrg.uswcliethspcaosmlicorandreiftlexwasstismuguglaetsitoend othfisthepheanuotmoneonmonicmnayervboeusa rseyssvte.lmt.of Hith regard to the treatment of lead poisoning Prof. Cramer compared EaDsTAitwciatnh pb,eengicivie1n.1ambyinmooauntdh eafdfveocctaitvedelypeannidcilhlaasmninoesiadsetheeffedcrutsg wofhenchgoiivceen, therapeutically over short periods. Ail agreed that oral EDTAwas of very 1imited value, but some delegates considered EDTAintramuscular!v or einftfreacvtesn.ouTshlye wefafsecmt,oroefefcfheecltaitvioenthtahnerappeyniocnillacompirnoepoarnpdhydriidn enxoctrecatiuosne wsiadse udrisincuesdseudr,ingandthetheeaprloyinsttamgaedse othfatthethraeppy.orphyrins tended to increase in tiie To sunt up, the conference was attended by 55 delegates fromJugoslavia, Russia (6), Bulgaria (2), U.S.A. (3), Britain (4), Italy (1), Germany (1) oanrdgaSnwiseeddenan(d2).conIdluoicmteqduiisnt farofmrieSnwdeldyensfpaiirleitd, wtoithturonn uelpe.meIntt wofasinwfeolrlmality largely engendered by Prof. Beritic, who was himself amost hospitable and congenial individual. The problemof lead poisoning is a serious one in v f 0008342 /conLinued... -4- Jugoslavia and results in a somewhat different approach to the subject than wproeudldombienaoteuroovwern.coAntsidtheeraptiroensesnftortimperevaespnteicotns oanfddiiatgnloooskiesdantodmtreealtimkeelnyt that this approach would continue indefinitely. The diagnostic tests most favoured were the ALA, coproporphyrins and Reticulocyte count, including Basophilic stippled cells. The estimation of lead in urine and blood was less favoured. Pre-saturnism, or the pre-clinical picture, was discussed on the basis of abnormal laboratory findings indicating pre-symptomatic disease, but no reasonable accord was reached on what constituted a disease picture in these terms. and nNeoithreerferweansceanywamsemnatidoentomaadeiropfollelaudtioanlkwylithcomrepsopuencdts.to Public Health lie each received a set of copies of the papers tiiat were delivered at PthreofC. oBneferrietniccetoandforiwfarydouyowuoualdselitk,eamltehotuoghdopesorhaIpwsocuiltdhebre FhaopwplyertoorasS!t:opps may be able to let you have one. As I have mentioned earlier, on my way back" I visited our plant at. Biebesheira, which has undergone a dramatic improvement in the past year. It is nowoperating very satisfactorily and a firm control is being exerci sec! in respect to housekeeping and safety factors. This is reflected in the urinary lead excretion figures which arc really very good at the present time. One man is on alternative work with some suspicion that he may be absorbing lead froma source other than fromhis work. After the troubles we experienced earlier at Biebesheim it is a relief to have the plant operating so satisfactorily. Incidentally, Prof. Beritic was very sorry you were unable to make it ItohJopuegotshlaavtiah,erbutrtouIbtlhesinkarLeuccleilalerinwgo.uldAhnnaevesefonudnsdhtehreretrgiaprdssomasewahlastotrdyoinIg. . Sincerely yours, PSIB/dt.