Document d80OnBqovLVEgr70QoGp0Qw9

A p r i l 2, I 9 3 5 D octor A lfr e d von F r is c h I * H e i fe r s fcor fe r a t r a ss ij. Vien n a A u s t r i a My d e a r D o c t o r vo n F r i s c h : v X am p le a s e d t o h a ve t h e o p p o r t u n it y t o w r i t e you w it h r e ga r d to th e c o n s u lt a t io n work wh ich you h ave a gr e e d t o c a r r y o u t i n t h e m e d ic a l s u p e r v is io n o f workm en who a r e t o bo en gaged in m ixin g E th yl F lu id w ith ga so lin e in Au stria H ungary and Cze ch o slo va k ia . I s h a ll t r y to o u t lin e fo r you th e g e n e r a l p roblem a s s o c ia t e d w it h t h is work as I see i t , and a cq u a in t you w it h my p o in t o f vie w , and w ith th e in fo r m a tio n wh ich h as a ccu m u lated over a p er io d o f ye a r s . I t h a s b e e n my p u r p o s e t o s o p r o v id e a g a i n s t t h e d an gers o f t h is typ e o f work th a t no cases o f le a d p oison in g xould o c c u r a n yw h e r e . The f i r s t p r o b lem h a s b e e n t o p r o v id e equipm en t fo r m ixin g t h a t wou ld lim it th e exp osu r e to n e g lig ib le p rop ortion s and to se t up such s p e c ific a t io n s and r e gu la tio n s a s wou ld g ive a s su r a n ce t h a t th e equ ipm en t was b e in g u sed in the p rop er manner and m ain tain ed in an e ffe c t iv e co n d it io n . Th is has b een a ccom p lish ed in a g e n e r a lly s a t is fa c t o r y m anner. The n e x t m ea su r e h a s t o d o w it h t h e s e l e c t i o n o f r e l i a b l e men who c o u ld b e t r u s t e d bo u n d e r s t a n d an d fo llo w t h e p r e s c r i b e d tech n iq u e and whose ge n e r a l h e a lt h was good a t th e s t a r t th us m akin g lb p o s s ib le to a vo id , t o a la r g e e xten t d i f f i c u l t i e s due to h o n -o ccu p a tio n a l d is e a s e s wh ich m igh t b e con fu sed w it h le a d in t o x ic a t io n Moreover I h oped to bo a le to e lim in a t e la r g e ly , th e u n u su a l s u s c e p t ib ilit y to le a d w h ich m igh t be a sso cia te d w ith th e e xiste n ce o f or ga n ic d ise a se s o f the c ir c u la t o r y system and o f th e d ig e s t iv e system p a r t i c u la r ly th e live r . Acco r d in gly I h ave a d vised th e s e le c t io n o f workm en wh o a r e f r e e o f d e f i n i t e o r g a n ic d i s e a s e , an d who h a ve n o h is t o r y o f p r e vio u s e xp o s u r e t o le a d com pounds in in d u s t r y . L iv e r , k id n e y, and c ir c u la t o r y d is e a s e a r e , in my o p in io n , p a r t ic u la r ly d isa d va n ta geo u s, n ot on ly b eca u se th ey in flu e n ce s u s c e p t ib ilit y , b u t a ls o b eca u se th ey r e s u lt in d is a b ilit y wh ich may be in e x t r ic a b ly co n fu sed w it h plum bism . Ch r on ic s e p s is , e s p e cia lly of d en ta l o r igin is a lso a d isa d va n ta ge, and i t is my p r a c t ic e t o r e fu s e t o a cce p t men wh ose c o n d it io n i s e s p e c i a lly b ad , u n less X can a rr a n ge fo r th e co r r e ct io n o f th e o r a l p a th o lo gy. K T 0013561 N 17479 2 Dr* Alfr ed , von F r is c h Men h e a v i l y a d d ic t e d t o a l c o h o l a r e u n d e s i r a b l e , n o t o n ly because of th e ir gen er a lly bad p h ysica l con d itio n , t h e ir pre d is p o s itio n to ca r e le ssn e ss and u n r e lia b ilit y , bu t a ls o because a c u t e a lc o h o lis m Can o n ly w it h d i f f i c u l t y b e d i f f e r e n t i a t e d fr o m a cu te t e t r a e t h yl le a d p oison in g* M oreover, X a d vise th e s e le c t io n o f men between th e a ge s o f 2 1 an d 50* , As t o le a d e xp o s u r e i t i s p e r t i n e n t t o p o in t o u t t h a t some p e t r o le u m r e f i n e r i e s u s e l i t h a r g e and a l k a l i t o t r e a t s u lp h u r c o n t a in in g p r o d u c t s , t h e r e b y g i v i n g some l e a d e x p o s u r e ...... t o workm en s o em p loyed * I t i s n e c e s s a r y bo s e e t h a t Buch men a re n ot en gaged in h a n d lin g E th yl F lu id * M ed ical exam in ation s in our hands e o n s la t o f a th orou gh p h ys ica l exa m in a tion , b loo d exam in ation (always a d e te r m in a tion o f th e h em oglobin , and a cou n t o f b a s o p h ilic s t ip p le d e r y t h r o c y t e s ; a r e d anci w h it e c e l l co u n t a r e m ade I f s u g g e s t e d b y an y s u s p icio u s fin d in g s ) , an a n a ly s is o f th e u r in e fo r albu m in , s u ga r , s p e c ific g r a v it y and a c id it y , and in s p e c ific ca s e s wh ich i n d i c a t e t h e n e c e s s i t y o t h e r t e s t s a r e m ad e. (We m ake i t a p o in t to exam in e b lo o d sm ears fo r s t ip p lin g o f th e e r y t h r o c y t e s on every subsequen t exam in ation , u sin g a m ethod th a t is e s s e n t ia lly q u a n t it a t iv e ) I n ca s e s o f i l l n e s s o f an y t yp e in men u n d e r ou r c a r e we make u s e o f w h a t e v e r m ean s i s r e q u ir e d t o a r r i v e a t a d ia gn o s is , in th e b e lie f th a t n oth in g sh o r t o f th e b e st f a c i l i t i e s s h o u ld b e made us o f in t h e c a r e o f t h e s e men* We h a ve n o t h ad an y ca s e s o f plum bism in t h is o ccu p a t io n and I b e lie v e t h e r e is no r e a s o n t o s u s p e c t t h a t we s h a l l h a ve s u ch c a s e s , b u t i f t h e y w e r e t o o c c u r we s h o u ld s p a r e n o e xp e n s e t o g iv e th em t h e m ost ad equ ate m ed ical ca re* 'With r e g a r d t o le a d a n a ly s e s wh er e in d ic a t e d fo r d ia g n o s t ic p u r p o s e s , X h ave b een d e ve lo p in g a means wh oreby r e li a b le r e s u lt s can be o b t a in e d b y any o f our Eu rop ean co n s u lt a n t s The f a c i l i t i e s a r e nob y e t a v a ila b le , b u t w ill soon be and I s h a ll com m un icate w it h you l a t e r in t h a t r e g a r d . H owever, you w i ll s c a r c e ly n eed a id o f su ch t y p e , a t l e a s t , fo r some t im e . I t is im p or ta n t in my op in ion to e xp la in th e d a n ger s a s s o c ia t e d w it h th e work t o th e men, a s a means o f in fo r m in g th em an d w a r n in g them a g a i n s t c a r e l e s s n e s s . On t h e o t h e r hand i t is a ls o im p or ta n t to show them t h a t th ey a r e co m p le t e ly p r o t e ct e d a g a in s t d an ger i f th e equipm en t i s p r o p e r ly m a in ta in ed an d i f t h e y fo l l o w i n s t r u c t i o n s * I r e p e a t t h a t we h a ve n e v e r h ad a c a s e o f p o is o n in g in t h i s w o r k , a n d we s h o u ld n e v e r h a v e . At th e s t a r t , a t le a s t , exam in ation s sh ou ld be .r ep ea ted a t q u a r t e r ly in t e r v a ls . Th is may b e ch a n ged , i f t h e r e a r e no le g a l r e g u la t io n s to th e c o n t r a r y, a s co n d it io n s an d th e judgm en t o f th e p h ys icia n s d ic t a t e . I t must be r eco gn ised , h owever, th a t the v is it s o f the d octor a re an in su ran ce a ga in st r e la xa t io n of ca r e as no oth er m easure o f c o n t r o l i s . T h e r e fo r e th e p h ys icia n sh ou ld lo o k in t o t h e q u e s t io n o f t h e car an d q u a li t y and c le a n lin e s s o f e q u ip m en t , and in q u ir e a s t o th e o b se r va n ce o f t h e r e g u la t io n s on e ve r y v i s i t * I s h a ll n ot go in to the q u estion of the sign s o f le a d a b s o r p t io n , b u t I do w is h t o make on e p o in t . B r ie f e x - - Dr ./ A lfr e d von F r is c h posura to h igh con cen tra tion s o f t e t r a e t h yl lo a d va p or, or m assive skin a b so r p tio n , as w ell as b r ie f exp osu re to c r y s t a llin e tr ie b h yX le a d s a l t s su sp en d ed in th e a i r (su ch a s may o ccu r i f a sto r a ge tan k u sed fo r lea d ed ga s o lin e is clean ed in a d ry s t a t e with ou t p r o te ctio n a ga in st in h a la tio n ) s ay r e s u lt in th e sudden o n s e t o f a c u t e sym p tom s, s u ch a s a r e d e s c r ib e d in on o f t h e a r t i c l e s s e n t t o yo u b y Mr* Beva n o f Lo n d o n , - sym ptom s w h ich b e a r l i t t l e o r no r esem b la n ce, and wh ich g ive none o f the u s u a l c lin ic a l s ig n s o f p lu m b ism * On t h e o t h e r h a n d , p r o lo n g e d e x p o s u r e t o s m a lle r am ounts o f th ese o r ga n ic com pounds, g iv e s th e u s u a l p ic t u r e o f ch r o n ic le a d a b s o r p t io n , a lth o u gh le a d Is e xcr e t e d somewhat more r a p i d l y u n d er t h e s e c o n d i t i o n s , t h a n i t i s when t h e m ore common le a d com pounds a r e a b s o r b e d . I n a d d i t i o n t o t h e c a r e o f men who d o t h e wor k o f m ixin g, you may b e c a lle d upon t o exam in e in d iv id u a ls wh o, fo r one r ea son or a n o t h e r , b e lie v e th ey h ave been p oison ed b y ga so lin e con ta in in g t e t r a e t h yl le a d . H ere, a ga in , i t is out p u rp ose to exh a u st a l l th e lo g ic a l means a v a ila b le fo r d ia g n o s t ic p u r p o s e s , i n o r d e r t o a s c e r t a i n t h e t r u e f a c t s . Ho c a s e s o f p o is o n in g h a ve been seen o r d em o n str a ted t o h ave o ccu r r e d from t h is ca u s e , and th e e vid e n ce i s , I b e lie v e , quit a d eq u a te to in d ic a t e t h a t no su ch ca s e s w i ll o ccu r . H owever, I and my a s s o c ia t e s h ave m a in t a in e d an u n b ia s e d an d open ju d gm en t on t h is p o i n t , an d v? a p p r o a ch e v e r y s u s p e c t e d o r a l l e g e d c a s e a s t h o u gh i t v^ ere t h e f i r s t . On m u st n o t f o r g e t , in t h i s c o n n e c t io n , h owever, th a t th ere h ave been more th an ten yea r s of exp er ien ce in t h is cou n tr y, w ith ou t a s in g le case o f lea d p oison in g or demons t r e b le le a d a b s o r p t io n aa a co n s e q u e n ce o f t h e h a n d lin g an d u se o f le a d e d g a s o lin e . The h is t o r y o f exp o su r e t o le a d e d g a s o lin e , t h e r e fo r e , can n ot b e regard ed as a s ig n ific a n t item in a d ia gn o s is . R a t h e r t h e d ia g n o s is m u st b e e s t a b l i s h e d , i f a t a l l , on sou n d c lin ic a l evid en ce, and supported by s p e c ific evid en ce th at le a d has a ct u a lly been absorbed in abnorm al am ounts. F o r yo u r g e n e r a l i n t e r e s t an d in fo r m a t io n , I am sen d in g to yo u , u n d er s e p a r a t e co ve r , a s e r ie s o f a r t ic le s wh ich r e p r e s e n t th e r e s u lt s o f ou r s t u d ie s o f th e g e n e r a l p roblem o f le a d a b s o r p t io n o ve r a p e r io d o f y e a r s . Some o f them r e l a t e t o te tr a &h yl le a d , b u t fo r the m ost p a r t th ey a r e o f im p ortan ce to th e la r ge ? p roblem o f le a d p o iso n in g in g e n e r a l, I s h o u ld b e g la d bo h e a r from you fr om tim e to tim e, and i f an y s p e c ia l d i f f i c u lt i e s a r is e X sh ou ld lik e to be in form ed p r o m p t ly. M oreover, i f I can be o f an y s e r v ic e to you in m a tters o f s p e c ific or gen er a l in fo r m a tio n , I s h a ll b e p lea sed to do so. Co r d ia lly you rs, RAK I S 001,3363 R o b er t A,.Keh oe, M.D. 5 Dr* Alfred von Frisch P .3, , The su p p ly o f my r e p r in t s o f on e o f ou r a r t i c l e s on t e t r a e t h y l le a d I s e x h a u s t e d . I am s o r r y b e c a u s e i t i s t h e m ost I n t e r e s t i n g a r t i c l e w h ich wo h a ve p u b lis h e d on th e s u b je c t . I t can b e fou n d In th e Am er ican J o u r n a l o f H yg ie n e , V o l . 13 , p . 14.78 ,1931* an d I s e n t i t l e d "Th e B e h a v io r o f Le a d I n t h e An im al Or ga n ism I I T e t r a e t h y l Le a d "by Keh oe an d Tham ann. I am w r i t i n g a n a r t i c l e now on a v e r y d e t a i l e d s t u d y of the le a d ab sorp tion of f i l l i n g s t a tio n atten d an ts and ga ra ge m ech a n ics, wh ich has ju s t boon com p leted , I w i l l sen d you a cop y o f I t when I t h as been p u b lis h e d , HAK K& 0013364