Document MMyJaNDMEb30JGQZ51rND7Q47

3 ,,, t >' s s r^" ,, ,,* <---v/i /''t-C4`*-`r' ' ' /*t.*i -1 ,V :/:-i .. . v -4 Aprill? 1935 t *-, 'W ,'1' V , .. . '_i r . ^ v . ' V - ^ .- - ' Dr* E* C* - .. ... - ^ , - '' - ' > ' i *. i ^ i r V . , s - Piaobhoin -- : ' V -l- ^ ife ^ ^ fc rS V ^ '-J S C 'i"- -*v<*^ 620-630 Fidelity Medical Building S iS sS saS 1-ite- Dayton Ohi`o ^lr*' '' ' 18881 Pl&lf ''-n"^ * -` -f^^/gf/s/. I *i\ My dear Dootor Flschbeiru- ^. < vir; *" , 'v -* / i? >f* ?5CL/ :'M?; Please accept ay thanks for the courtesy of your letter of April 9th, and the ex pression of your point of vies* 2 am describing ay position further because I should not wish you to feel that I disagree at all with your general attitude toward laboratory procedures as diagnostic criteria* X deplore as inuoh as you or any other doctor the increasing tendency to substitute laboratory tests for sound clinical study and judgment, and I have so expressed layself in , relation to the reoent trends in the problem of lead in- toxlcafeion* 'Chore is no laboratory procedure which Is , specifically diagnostic of lead poisoning, and if you examine everything I have said on the subject you will - find that 2 have always insisted upon the necessity of basing Judgment on a complete study of the patient, and not on his blood or excreta* , ' , * ' * / '*, .;vr - ' Ifour point as to variation In b u s - - / ceptlbillty is also well taken and cannot be passed over V. lightly, although in m y Judgment it is not as important -; as It is often thought to be in the case of lead* we have yet to see a ease of plumbism in which we have been unable to demonstrate the existence of significant lead exposure and absorption, when the.time interval between exposure and examination has been brief* There is, to bo sure, a considerable variation in the mount of ab- / sorptions required to-produce illness, but i n c u r rather wid#;^pe^lence:lt&Jlit^ ^ y e A|^p,abcva|^he|lvel of . normal.lead intake* *. ' ' ' c v ,/ ^ ''& Ifcia brings m e -to' the point of this , letter. I think ,,you;have misunderstood, .perhaps, what our studies of normal.and abnormal lead absorption have been working toward* / It is not that we have been pri marily interested in a diagnostic procedure per se, but rather that w e have been learning something of the / physiology of lead absorption and excretion* so as fco i-\ be able to. interpret;diagnostic:procedures'* >.One thing/ has become quite clear, In these studies, namely, that even slight, changes in lead absorption, are acoonpaniOdbiL sssglg ^;'r . , - '";V"v - b y corresponding change8 In the transportation and exoretibnlef -l e a d * T h e r e f o r e we can use lead fcransporfcatiohand excretion as an adequate measure of the magnitude' of exposure*' If observations are made in d o s e time relationship to the exposure. How In the case of tetraethyl lead in gasoline we find that exposure to high concentrations of lead In the gasoline either b y way of skin contact or by inhalation results in lead absorption. However when the dilution s sufficiently low (1 part of tetra ethyl lead'to 1000 parts of gasoline) there is no evidence that absorption oocurs even after intensive and prolonged exposure^ fh question is not whether intoxication occurs as .the result of specific degrees of absorption, but rather whether any lead absorption occurs, The evidence which has been obtained by extremely sensitive methods of study in dicates that no lead absorption takes place as a result of contact with commercial leaded gasoline which contains/ not more than 1 part of lead in 1260 parts of gasoline. This evidence la in agreement with the results of gome ten years of clinical experience* I do not believe, therefore, that I a m being oversanguine in regarding. It as sound and well established. Obviously, if there is no lead absorption, the factor of susceptibility to lead does not enter into the question. Despite all these considerations I consider leaded gasoline to be a relatively unsatisfactory cleaning agent for a Variety of reasons, and I see no reason why it should be used for such a purpose. It is intended as a fdel and is so labeled. I am glad, therefore, that you have advised against its use in cleaning parts, tools and similar objects, , I enclose herewith a copy of a single analytical result obtained oh the blodd of Mr, Fogel, The result is within the limits observed for normal in dividuals with no lead exposure. Out of a group of fl m e d i c a l 's tudents there were 21 whose blood lead was of this magnitude, There >la n o reason for believing from this result, that M r ^ d H I k h a s recently absorbed any abnormal amount; of l e a c u ^ T n e other results will be sent to you when they have been obtained. Cordially yours. RAKsis Robert a . kehoe, M.i. 0011085 f