Document QgMjZYo33roDeMDNdGO98j5vv

April 1? 1955 Dr. E. C. Piaobbein 620-650 Fidelity Medical Building Daybon, Ohio My dear Docbor Fischbeins- Please accept my fchanka for the courtesy of your letter of April 9th, and the ex pression of your point of view. I am describing my 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 much as you or any other doctor the increasing tendency to svxbatifcute laboratory tests for sound clinical study and judgment, and I have so expressed myself in relation to the recent trends in the problem of lead in toxication. There 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 I have always insisted upon the necessity of basJ.ng judgment on a complete study of the patient, and not on his blood or excreta. Your point as to variation in sus ceptibility is also well taken and cannot be passed over lightly, although in my judgment it is nob as Important as it is often thought to be in the case of lead, be have yet to see a case 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 be sure, a considerable variation in the amount of ab sorption required to produce illness, but in our rather wide experience it Is always well above the level of normal lead intake. This brings me 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 we have been learning something of the physiology of lead absorption and excretion, so as to be able to interpret diagnostic procedures. One thing has become quibo clear, in these studies, namely, that even slight changes in lead absorption are accompanied 2 Dr* B* C# Fisohbein by corresponding changea in tho transportation and excretion of lead, therefore we can use lead trans portation and excretion as an adequate measure of the magnitude of exposure* if observations are made in close tine relations hi p to tho exposure# Now in the case of tetraethyl lead in gasoline vse find that exposure to high concentrations of lead in the gasoline either by way of akin contact or by inhalation results in lead absorption# However when the dilution is sufficiently 1cm (1 part of tetra ethyl lead to 1000 parts of gasoline) there is no evidence that absorption occurs von after intensive and prolonged exposure. The question is not whether intoxication occurs as the result of specific degrees of absorption* lut rather Whether any lead absorption occurs* Tho evidence which has been obtained by extremely sensitive methods of study in dicates that no load absorption takes place as a result of contact with commercial leaded gasoline which contains not more than 1 part of load in 1260 parts of gnsol'no# This evidence is in agrao&xmt with the rsuits of some ton years of clinical experience* I do not believe, therefore, that am being oversanguin in regarding it as sound and well established# Obviously, if there ia no lead absorption, tho factor of susceptibility to lead docs not enter into tho question. Despite all those considerations consider leaded gasoline to he a relatively unsatisfactory loaning agent for a variety of reasons, and I see no reason why it should b used for such a purpose. It la intended a3 a fuel and ia so labeled* I sm glad, therefore, that you have advised against its usa in cleaning parts, tools and similar objects* I enclos herewith a copy of a single analytical result obtained on the blood of Hr. Pogol The result is within th limits observed for normal in dividuals with no lead exposure# Out of a group of 72medical students there were 21 whose blood lead was of this magnitude# There ia no reason for believing from this result, that Mr# Fogel has recently absorbed any abnormal amount of lead* Tho other results will be sent to you when they have been obtained# Cordially yours, M Eila Robert' A#" K e k o o V I O .