Document jg1Rzpv4k3G2qbOjJX6832ryp

M ay 15 1954 L j) D r . D u ran d Ben jam in 7430 V irgin ia Avenue St. Lo u is I I , M isso u r i . D e ar D octor Ben jam in : I fe e l it w ise , ev en n e c e ssa r y , to co m m e n t on y o u r le t t e r to D o ct or Sm ith , a copy of w h ich you w er e good en ough to sen d to m e. The poin t I w ish to m ak e is so im p o r tan t in r e lat io n to c lin ic a l an d in d u st r ial m ed icin e a s to req u irk e m p h asis, an d t h e r e fo r e I do n ot w ish to le av e an y qu estion in you r m in d a s to m y p u r p o se in com m en tin g. I r e fe r on ly to you r statem en t, p er h ap s in ad ver ten t, th at th e le v e ls of le ad con cen tration in the blood of tw o of y ou r m en , a s r e p o r t e d by th e D ep ar tm en t o f H ealth of th e City of St. L o u is, w e r e w ell ab o v e n o r m a l, "an d t h e se in d iv id u als sh ou ld h av e sh ow n so m e si g n s o f le a d p o iso n in g . 11 T h is st a t e m e n t i s so u t t e r ly i n c o r r e c t a s to b e a r e d flag b e fo r e m y e y e s. W hen th e con cen tr ation of le ad in th e blood is 0 .0 8 m g. o r m or e p e r 100 g r a m s, th e in dividu al con cern ed m ay develop sy m p tom s. The situ ation , th e r e fo r e , in volves d an ger, an d the in dividual sh ou ld n ot be p e r m it t e d to b e su b je ct e d to fu r t h e r occu p ation al exp o su r e to lead le st he becom e ill. Th e h igh er th e figu r e above th is cr it ical lev el, the gr e at e r the dan ger of the on set of illn e ss an d the m ore sev e r e the illn e ss is lik ely to be if it d evelop s. H ow ever, th ere is no im plication of the actu al e xist e n ce of illn e ss in an y an aly t ic al fin d in g, r e g a r d le ss of le v e l, w h eth er in u r in e, blood or the t issu e s of th e body. Th e an aly tical fin din gs a r e n ever d iagn ostic of illn e ss, but a r e on ly m e asu r em en ts of th e poten tial sign ifican ce o f th e exp o su r e to w h ich th e in d ivid u al h as b een su b ject ed , if th en th e clin ical fin d in gs poin t to th e d ia g n o sis o f p lu m b ism , th e a n a ly t ic a l fin d in gs w ill sh ow w h eth er o r not su ch a d iagn o sis is ten ab le. One m u st alw ays m ake the d iagn osis by ap p r o p r iate clin ical m e an s, sin ce oth erw ise m uqh ip or e se r io u s types of illn e ss m ay be m isse d an d the con sequ en ces m ay be t r agic. You m ay th in k I am sp littin g h a ir s, bu t su ch is n ot,th e c a se , sin ce n ot on ly the m eth ods of clin ical d iagn osis but also the validity of the m edical m easu r es o f p r ev en t iv e m ed icin e a r e b a se d fu n d am en tally on th ese fa c t s. T h is i s, th erefore, one of the m ost im portan t asp e ct s of the en tire problem of occu p ation al m ed icin e in th e le ad t r a d e s, in th at we can r e co gn ise th e existen ce o f d an ge r arid d e t e r m in e it s d e g r e e b e fo r e an y ac t u al illn e ss o c c u r s. It is p r e c ise ly fo r th is r e aso n th at I go to g r e a t dead of trou ble to in ter p r et all of ou r an aly tical iin d in gs w ith gr e a t c a r e , on th e backgrou n d o f ou r v ast e xp e r i en ce withi the p r o b le m o f in d u st r ia l le a d p o iso n in g. U n le ss th e m ean in g of th e an aly t ical d ata co m e s to be in co r p o r at e d in to in d u st r ial m ed ical p r ac t ic e , 0019837 B e ,, D u r an d Be n ja m in - (2) - M ay 15, 1954 th ere is no v alid m e an s, m e d ically , of p reven tin g occu p ation al lead poison in g On th e oth er h an d, if the p rin cip le is u n d erstood an d ap p lied , occu pation al lead poison in g can be elim in ated com p letely . Sin cerely your a , RAK ef Robert A. Kehce, M. D. K 0019838