Document M7Ea03NRGg6J5BeJEgMyo4aV

February 21, 19^7 Dr .;. ? Miller, Medical Department, y. I. cu r-ont ae Nemours snd Co., Old Hickory Plant;, Davidson County, ienn. nee: Miller I have your letter or ebruary ljj vi th its attachments in relation to tile ease of ; oy Greener. Before givingjcareful consideration to the details of the case I should like !to raise the question of the adequacy and accuracy of the tesulta or lead analyses on the urine this man. observed that a series of analyses have been made and that the results as tabulated are reasonably consistent uign values are recorded from time to time, however, and somewhat irregularly. these would seem to indicate that the lead exposure was rather variable from time to time. Otherwise it would mean that the analytical results are subject to more v*ri&fion than they should be. I point this out,because I must be quite frank .An saying that I am very ske] .leal about analytical results c.ltinic in an industrial la:moratory. these insults may be highly accurate, but considering the difficulties not only of the analytical procedures but of me l:hods employed in the collection of samples, I beg; leave to be skeptical. In our experience it has not been possible to obtain satisfactory analytical results on biological materials from plant laboratories. If these results are'trustworthy, I can assure you that they ore quite the exception to common experience. Accordingly I raise the question of the methods employed by your medical personnel in collecting the samples and by your analysts in making the determination. If you will give me the information on these matters, I shall then be prepared to accent sue analytical results or to discard them as the case may be, on reasonably adequate infernation. For the present I must take the position, on the basis of my own experience, that these results cannot be trusted, and that I shall have to draw my conclusions from the oilaicui data alone. This position is based on the fact that such analytical evidence must be eerredt beyond any peradventure, or else it is wholly deceiving. I should like also to point out that our systematic experimental and clinical c bservatlons over a period of years have satisfied us completely the t the demobilisation of lead by means of calcium therapy , and 1 ta mobilization by means of ammonium chloride, are complete impos sibillties. The deposition of lead in the skeleton Dr. R. P. Miller - (2j - February SI, 19^7 is not materially influenced in the reasonably normal individual by the administration of calcium, nor is it influenced appreciably for more than the briefest period of time by the administration of ammonium chloride or by any of the other agents that have teen propose:; for this purpose, I do not express nese points Ox view in order to be! critical of what has been done. but merely to state the rcsiticn cn vhich I proceed vith the consideration of 'hip case It would appear from the acceptable facts presented in your description of: the case chat this employee has had significant lead exposure, this coincides completely vith cur experience in the matter of lead^burner a, especially when the latter word: rather steadily ac their job of lead burning. It appears also that this man hac seme cbgroe of clinical lead intoxication, this conclusion being yustif'ei by the symptomatic picture. 'Che absence of charac teristic evidence cf microscopic blood changes tstippled erythrocytes; makes this interpretation questionable, but again his is a question of method of ejxaminucion and sensitivity of the specific procedure employed. Accepting these things as facts, for che sake of the argument, I would t.ake the point of viev that this man has had intermittent exposure to lead ever some considerable period of time and that he hop accumulated lead In his body. I think you can .ake it as certain that he has never had ample time at any time to excrete hhe lead thus accumulated, ana therefore it takes less additional lead exposure to produce significant load absorption, than would be the case in a previously unexposed new employee. Accordingly when he is exposed to lead again, he develops symptoms more rapidly than would be anticipated in a previously unexposed person, this is the basis of his Susceptibility," if he can be said Lc be mors susceptible than another individual. If this man were given :ine to eliminate his retained lead, he would _then be no mere susceptible than aiy other .individual, assuming that he is otherwise reasonably normel and healthy. I would say that what is necessary in this case is ro establish his present status with reference to lead absorption. If he has absorbed appreciable quantities of lead, above normal levels, he will show an elevation of the lead content of his blood and urine. Iloreovex-, if he is kept but of lead exposure, the concentration of lead in the blood and urine will decrease to the normal levels, bills mav require months! or perhaps even years, dependent upon the length and severity of his previous exposure. He should not be permitted to resume hi: lead exposure, assuming that he has had significant exposure, unti such a- time as he shows substantially normal vi . j . ue in both the blood and urine. By way of establishing the facts at this time, I would suggjesc that you obtain samples of blood and urine for us n our* containers , 01 925 Dr. I.. ?. Hiller - {pj - February SI, ir47 following our instructions . On the basis of this information I can better advise you a3 to what should be done. If, at the same time, you should wish to check the accuracy of the analytical results obtainable in your own laboratory, you might obtain samples at about the same time for their analysis, so that the results of the two laboratories can be compared. I should warn you that samples ought not to be divided sc between the two laooracories, since .he h^ndl ng incident to this division is much too likely to result in contamination. ! If we can help :you in the manner indicated above, we should be glad to do so, and moreover, if what I have said raises further questions in your mine , t should be glad to answer them to the cest of my ability if you:will propose them. Cordially yours. F.AK ef } chert A. Kehoe, M. D J