Document bV663VD82O3b6ME7BLRQXJa0

October 2, 1942. Lieutenant Albert E. Abraham, Medical Corps, United States Army, Dale Mabrey Field, Tallahassee, Florida. Dear L t . Abraham: I have just received a reprint of your article in the May issue of War Medicine, entitled "Clinical and Sub-clinical Lead Intoxication? I vas greatly surprised vhen I read the clinical reports and the laboratory data and vhen I recognized that the conclusion arrived at had been voiced in large part on the presumptive evidence of lead exposure conveyed by the analytical data. My first impulse vas to vrlte the editor of War Medicine and to express some criticism of your article. On second thought, it seemed the better part of courtesy to direct my letter to you in the first instance, since in any event it vill be necessary for me to call the attention of the Office of the Quartermaster General as veil as some of my colleagues at the Army Medical School, to certain points in the discussion. You may be interested t o d m o v that ve have studied the lead exposure "associated vith the operation of the gasoline stove vhich;vas used in this cooking. I am assuming that the regular field cooking equipment vas available and that this vas the cooking equipment referred to in your article. Our observations vould indicate that significant lead exposure would not occur accept under highly unusual circumstances. It is my opinion that the exposure described in your two cases are quite insignificant and, moreover, that the symptoms com plained of vere in no vise suggestive of lead intoxication. The laboratory data vith the exception of the lead analyses, ~ vas not very suggestive, in my opinion, since basophilic stipling of the red cells can be found in moderate numbers in the blood of most persons. Passing nov to the urinary lead findings, the results are such on mere inspection as to indicate their complete lack of any significance. Inasmuch as both in the taxt and in the table the quantities are vritten out, I assume that no mistake has been made in recording the results obtained* Otherwise, it might, be thought that reference vas made here to micrograms of lead rather than milligrams. In any case, they are insignif 1- Lt. Albert E . Abraham - (2) - October 3, 1942* cant .If they should be micrograms Instead of milligrams, they are not high enough to be significanti if they are milligrams they are completely beyond the range of possible lead excretion. No such values have ever been seen in human beings in the most acute cases of poisoning that are known. It is doubtful if the urinary lead excretion at its absolute maximum can ever exceed 2 1/2 to 3 1/2 milligrams per liter. Thus excretion of 5 milli grams in 2 k hours vould be a phenomenon of very'great rarity in the most acute even fatal types of lead Intoxication* These results therefore Instead of .proving lead exposure have merely proved.that the samples analyzed were grossly contaminated with lead from external sources* At least this is' thej&ost logical explanation since samples of urine will always bo contaminated unless they are collected with' extreme precautions* The only other explanation is that the analyst contaminated the-samples in his laboratory. 'Knowing nothing of the analytical facilities at the Fourth Corps-Area^-:'Laboratory, 1 am not .in position to judge that end of the matter but in any case such a result as 135 milligrams o f lead per 24 hours or even 9.1 milligrams'per 2k hours is preposterous. I think lt is most "unfortunate that this article was written and still more so 'that ,it :vas published since It is likely to creatf certain '.dlfficiiltiee among the armed forces without any 'corresponding gain in safety. I should feel that in some way'the impression gl'ven by the article should .I :- ' ; RAE ef W ' 2f/i`1 / Iv 7 !iv i? *. // Robert A. iCehoe, . ,jJ. _ ' -' 1 (' < 04440