Document ZJgyL3DK6epxK94KKGOawBaxY
Sept ember 13, 1939
Dr. Hugh B. Ale xan d e r 6 13 -6 1$ Goodhue B u i l d i n g Beaum ont, Te xas
Dear Booto r Alexanders
The q u e s tio n r a i s e d In yo u r
l e t t e r o f Au gu s t "$ \ Bt i s on w h ich w o u ld b e r a t h e r
d i f f i c u l t to answer w ith o u t somewhat d e t a i le d knowledge
o f th e n atu re and th e d u ratio n o f th e le a d exposure o f
t h e p a t i e n t . The re i s no q u e s ti o n .'th at w e l d i n g o p e r a tio n s
on h e a vily pain te d m etal c o n s titu te a rath e r serio us
e x p o s u re to l e a d fu m e s . The s e v e r i t y o f t h e e x p o s u re ,
however* depends upon a number o f f a c t o r s , o f which th e
most im portant are th e v e n tila tio n o f th e area in which
th e work i s do ne, and th e le n g th o f tim e d u rin g which
expo su re o ccu rre d . Acu te p o is o n in g can o ccu r from th e
In h a la tio n o f fumes c re a te d b y w e ldin g* and eve n f a t a l
c a s e s h ave be e n s e e n in a number o f i n s ta n c e s . In de e d
t h i s may be re ga rd e d a s one o f th e most dan ge ro u s o f th e
o ccu p atio n al le a d h as ard s . Se rio u s and f a t a l c a s e s ,
hen-/ ever, h ave u s u a l l y be e n th e r e s u l t o f f a i r l y p ro lo n ge d
and co n tin u e d expo s u re , as in sh ip c u ttin g and b rid ge b u ild
in g.
..
.
:
As yo u know t h e d i f f e r e n t i a l d ia gn o s is o f cram ping abdom inal p a in , d iarrh o e a and
a li m e n ta r y hem orrhage I s n o t a lw a ys e a s y* Th i s corn*, b i n a t i o n o f symptoms can o c c u r In a number o f c o n d itio n s and b e fo re a ttr ib u tin g i t to le a d in to x ic a tio n , I sho uld
want to have somewhat d e f i n i t e e vid e n ce o f th e n ature o f th e o rgan ic le s io n which produced th e hemorrhage. I s h o u ld a l s o want to know th e g e n e r a l c h a r a c te r and th e d u ratio n o f th e le a d e xpo s u re , and I should want some
e vide n ce o f th e magnitude o f th e le ad abso rptio n in term s o f blo o d le a d co n ce n tratio n s and u rin a ry le a d co n c e n t r t i o n s . As to t h e r e l a t i o n s h i p be tw e e n l e a d p o is o n in g and coronary o c c lu s io n , I sho uld be ve ry s k e p tic a l. In vie w o f the v e r y la r g e number o f v a s c u la r le s i o n s which a r e a t t r i b u t e d to th e e f f e c t s o f l e a d , X v/ ould h e s i t a t e to say th at coronary o cclu sio n could not be induced by an e p is o d e o f le a d p o is o n in g. However I c o n s id e r an y c a u s a l a s s o c ia tio n as h ig h ly Im probable.^ I f th e re a re any fu rth e r m atters in co n n ectio n w ith th is cas e in which
i n t o x i c a t i o n i s o f t e n made much to o h a s t i l y . Th a t, I th in k
2- ~
Is one re aso n why th e l i t e r a t u r e i s so co n fu s in g. Alm o st e ve ry le s io n s w hich can he im agined has heen a ttr ib u te d by someone to the e ffe c ts o f le ad * and o fte n fo r th e re aso n th a t t h i s p ro vid e d a prompt and e as y answer to an o th e rw ise d i f f i c u l t problem in d i ffe r e n ti a l diagn osis.
Co rd ia lly yours*
RAXi i s
Ro be rt A. "Kehoe iO>.~