Document Rja6xMqME0baxx3YZewy848ja

December 2 , 1935 Dr. B. H,. H ayhurst C o n su ltan t, I n d u s tr ia l Hygiene S ta te of Ohio D ept. o f H ealth Columbus| Ohio Dear Dr* H ayhurst* _ _ ^ I i ^ g e D l v t o your l e t t e r of Hovember 20th concerning am g la d to make c e r t a in a d d itio n a l comments on th e c a s e . co n tin u e d to Im prove and although he is T io ^ e n tir e ly recovered, he Is a p p a re n tly on th e way to reco v e ry u n le s s he h as some recurrence or ascerbation of his cerebral condition. The d ia g n o sis is a m a tte r of c o n sid erab le q u e stio n and i f he re c o v e rs co m p letely , I do n o t see how a d ia g n o sis can be a r r iv e d a t* I am q u ite c e r t a i n th a t le a d was n o t a s i g n i f i c a n t f a c t o r in h i s ill n e s s * I am n o t q u ite c e r t a i n what was responsible.-'* We s h a l l keep in touch w ith him and we a re s t i l l c a rry in g on c e r t a i n s tu d i e s . D e sp ite th e f a c t th a t we s h a l l n o t be a b le to make a diagnosis* I c e rta in ly hope th a t he recovers w ithout ahy re sid u a l damage. As to th e s ig n if ic a n c e of la b o ra to ry evidence i n a ;? d ia g n o sis* I th in k th e c a se can be s t a t e d in com paratively sim ple term s. I have previously ca lle d a tte n tio n to th e f a c t th a t th e presence o f abnormal amounts of lead In the blood or the ex creta in d icates merely th a t th e r e h as b e e n an abnorm al le a d exposure* I t i s a l s o my experience a f te r ra th e r wide study of the problem, th a t i f th ere i s no ex creto ry evidence of abnormal lead abs o r p tip n , one is J u s t i f i e d in concluding t h a t no abnormal lead absorption has occurred provided the examination in t h i s re x p e c t i s mad m c lp se tim e r e l a t i o n to the ex p o su re. We have n e v e r y e t se en a c a se o f le a d in to x ic a tio n (u n le s s t h i s man i s th e e x c e p tio n ) in w hich th e examination of th e blood and the ex creta immediately a f te r the cessatio n of exposure has not shown a m easureable e le v a tio n of th e lead l e v e l . I t i s my o p in io n t h a t i t i s n o t p o s s ib le f o r a man to absorb s ig n if ic a n t q u a n titie s of lead w ithout showing an immediate and f o r a tim e p e r s is te n t e le v a tio n of h is blood le v e l and of th e le v e l of h is lead exdretion* This b rin g s me to s t a t e my d e f i n i t e o p in io n t h a t a lth o u g h ab normal le ad fin d in g s do not prove the e x iste n c e of lead Hayhurst 2 in to x ic a tio n , y et the absence of abnormal lead fin d in g s in immediate re la tio n s h ip to exposure disproves the e x is te n c e of le a d in to x i c a tio n . You w i l l n o te t h a t I am n o t speaking h e re o f r e s id u a l in ju r y , b u t I am speaking r a th e r of a c tiv e symptoms of in to x ic a tio n . I have previously discussed the general problem of lead analyses w ith you and I have . In d ic a te d t h a t I do n o t b e lie v e you can p u t much con fid en c e in them f o r d ia g n o stic p u rp o ses. This is n o t because p ro p er la b o ra to ry work can n o t be ad eq u ately in te r p r e t e d by a man who i s com petent to do s o . I t i s ra th e r th a t a t the p rese n t tim e the methods of a n a ly sis a re so v a r ia b le in th e hands o f d i f f e r e n t men and th e b a se s of i n t e r p r e t a t i o n have in many In s ta n c e s been so poorly worked o u t, th a t r e lia b le inform ation and tr u s t worthy opin'ons are not g en erally a v a ila b le . A ctually the p re s e n t s itu a tio n is such th a t I do not tr u s t la b o ra to ry methods ta k e n a lo n e . Y.'h a t I would w ish to base iay o p in io n on is a th o ro u g h -g o in g stu d y of th e p a tie n t in w hich th e whole q u estio n of the n atu re and duration of the exposure# the c lin ic a l p ictu re Including the la b o ra to ry fin d in g s are a l l lumped to g e th e r in an ad eq u ate i n t e r p r e t a t i o n in th e hands o f one who u n d e rsta n d s both the c lin ic a l and la b o ra to ry asp ects of the problem. Tilth referen ce to I -would c e r ta in ly not urge any h andling of h is ease which would d e p riv e him of com pensation. I t i s my p o in t o f view t h a t in cases of th is type experim ental stu d y and d iag n o sis from idle p o in t o f view o f e x p e rim e n ta l...in v e stig a tio n are one thing# and a c l in ic a l d iag n o sis fo r medico le g a l p urposes i s som ething e l s e . I r e p e a t, i t i s my o p in io n th a t t h i s man does n o t have and n ev er d id have le ad in to x ic a tio n . Howdver, u n less I could prove th a t point to the s a tis fa c tio n of the average c lin ic ia n , I would w ish to see t h i s man have th e b e n e f it o f such doubt as th ere is as a b asis fo r in d u s tria l compensation. This may seem to be draw ing a v ery f i n e l i n e , b u t i t is one which I c o n sid e r j u s t i f i a b l e . With k in d e st p erso n al re g a rd s, C ordially yours, RAKjls R obert a V Keh'oe,' 1.1.D.