Document emaJo4pG0Y5jrkBGpE0obR7O4

C O L U S P. HUNTINGTON MEMORIAL HOSPITAL HARVARD MEDICAL SCHOOL BOSTON September l6 , 1940. / / ia -u u ..,, s:X'C6t^ .,J ^ / H r. P o b e r t A. Xehoe, U niversity of Cincinnati, C incirjnati, Ohio. !'y dear Hr. Sehoe: F i r s t o f a l l , l e t rr.e c o n g r a t u l a t e you on t h i s p a p e r . Inasm uch a s m ost o f i t i s y o u r ovm v o r k , I t h i n k i t r e p r e s e n t s an e.cc o r p i i s hr;,exit o f x h i c h you n a y v ;e ll b e p r o u d . u h i l e I do n o t have a d e q u a te p e r s o n a l e x p e r i e n c e t o e v a l u a t e some o f i t , I f e e l s u r e o f i t s v a l u e and, t h e r e f o r e , a p p ro v e o f t h e re p o rt, os a ' h o l e . As you h av e a s k e d , I an g o in g t o voice some s u g g e s t i o n s f o r c h a n g e s , th o u g h t h e y a r e n o t v e r y g r e a t . I n o t i c e ' on p ag e 3 and L, here you t a l k about t r e a t m e n t , t h a t you sp eak o f th e in a d e q u a te v;ay i t i s t r e a te d , and I uonder w hether you thought the paper I gave you as i n a d e q u a t e . I f you v d l l t e l l me v h a t you t h i n k , I r i l l be g l a d t o go o v e r my c a r b o n copy and t r y t o c o r r e c t i t . A f t e r a l l , t h i s r e p o r t . rill be u sed f r e q u e n t l y i n l i t i g a t i o n and I t h i n k i t s h o u ld be gone o v e r x i t h t h i s i d e a i n mind so t h a t no d i f f i c u l t i e s 'Till o c c u r by our la c k of s p e c i f i c i t y in s ta te m e n t. For in s ta n c e , note, th e p la c e I have marked on page 5 and 6. There arc a Iso others* in th e re p o rt - h ic h I have no t m arked. I have a l s o made a n o te on page 1$. On page? 01 and 22, I mould add t h a t s t i p p l i n g and b a s o p h i l i c a g g r e g a t i o n are not as good a q u a n tita tiv e value as j u s t i f i e d by the f ig u re s , fo r they very during the day and vary con sid erab ly from day to day though t h e c a u s e o f t h i s v a r i a t i o n i s n o t k n oun. On p ag e 2L I o b j e c t t o t h e e x a m in a t io n o f s i n g l e f e c a l e v a c u a t i o n s . '"hx-t i s meant i s f e c a l e v a c u a t i o n p er day, or t o t a l e x c re tio n per day, fo r a ra n s ig h t v e il have more th an one bomel movement p e r d a y . T h i s i s m e n tio n e d on page 25 a l s o . On page 2?, a t th e to p , I should l i k e to s u g g e s t, though I do not th in k you m i ll approve of i t , th a t e ith e r tv:enty-four-hour or eight-hour samples should be c o l l e c t e d . The l i t e r c o n te n t may have e r r o r s . I a l s o th ird : t h i s paragraph i s not v ery c l e a r l y s ta t e d . Page. 28 -- a sm all change. Paige 29 -- t o p p a r a g r a p h . -- s h o u ld t h e r e n o t be a s u g g e s t i o n h e r e a s t o That c o n s t i t u t e s a c o n c e n t r a t i o n o f p o s s i b l e l e a d p o i s o n i n g ? P a g e s 29 and 30, o f c o u r s e , r e f e r t o a b s o r p t i o n i n i n d u s t r y , and I t h i n k t h e r e sh o u ld be a s t a t e m e n t t h a t t h e a n a l y s e s must be cone soon a f t e r '"ork s t o p s , b e c a u s e of n rap id drop; a ls o , th a t th e analyses must he done by experienced a n a ly s ts , th a t th e methods are t r i c k y , and th a t poor d e t s m in a t io n s give an e n tire ly erroneous im pression, as the fig u res are such th a t they give t h e i m p r e s s i o n o f a c c u r a c y ! I t i s my e x p e r i e n c e t h a t Then a rg u m e n ts o c c u r s to v.-hetber a p erson has le ad poisoning o r n o t, i t is v ery d i f f i c u l t to co n tro v ert a u rin e a n a ly sis fin d in g even though one is sure th a t the a n a ly sis i s a t " s u i t . A ch em ist cannot do one o r tx o le a d a e t e r r ! n a t i o n s a y e a r and depend upon h is accuracy. This I th in k should be brought out v ery s p e c if i c a l ly . KE 00091SO COULIS P. HUNTINGTON MEMORIAL HOSPITAL HARVARD MEDICAL SCHOOL BOSTON 2- - On t h e to p o f p ag e 2, t h e r e p o r t s e e r s r o t t e r v e r b o s e and u n n e c e ssa rily com plicated. The l a s t sentence o f th e f i r s t paragraph c o n t a i n s t h e meat o f t h e i d e a . On t h e b o tto m o f page 43 I s h o u ld l i k e t o add some such th i n g a s t h i s : "In a high calcium and high phosphorus d ie t, as obtained t;ith m ilk, the bones are kept v e il supplied v ith calcium, so th a t an a c tiv e d e p o sitio n of s a l t s is not so ( l i k e l y " . As you v e i l k n o r, t h e r e i s a l s o r e c e n t e v id e n c e f o r t h i s . and f o r th e f a c t th a t i n t e s t i n a l a b s o rp tio n o f lead seems to be r e - , duced r i t h a high calcium d ie t. - T h ere i s one fu n d am en tal t h i n g ab o u t t h e r e p o r t v.'hicli T th in k you coirlo improve I t d eals la r g e ly v i t h a te c h n ic fo r avoiding l e a d p o i s o n i n g v.iiich r i l l be s u i t e nev: t o many i n d u s t r i a l p h y s i c i a ns i y et in i t you have no s p e c i f i c su g g e stio n s o f ,iiat sh o u ld be done m o r d e r t o p u t i t th r o u g h e f f e c t i v e l y . I n o t h e r v o r d s , I t h i n k i t is an ex cellen t th e o re tic a l d iscu ssio n of the problem of avoiding lead p o i s o n i n g , b u t i s n o t s u f f i c i e n t l y p r a c t i c a l i n i t s d e s c r i p t i o n o f hov: th e method should be se t up and used. In t h i s d isc u ssio n I a lso th in k s t r e s s should ag ain "aid on th e n e c e s s ity f o r accu racy of th e de term in atio n s and th a t i t should be s ta te d s p e c if ic a lly th a t th e value o f th e method i s e n t ir e ly dependent upon t h i s . /-g ain l e t me c o n g r a t u l a t e you on i t . I r e a l l y t h i n k i t i s a " s v e l i " jo b . I f you have an e x t r a copy o f i t , I sh o u ld l i k e v e r y much to have one. Very sin c e re ly yours, JCA:EA 0003121