Document jgjKRwBONBVvoK5D832rGrqdO

June 26, 1937 Dr* F r e d e r i c k L. Hoffman Cancer Research Laboratory 133 S o u t h 3 6 t h S t r e e t P h i l a d e l p h i a , Pa* Dear D octor Hoffman* Thanks f o r your fu r t h e r l e t t e r of June 17th* I th in k you are quite r ig h t in b e lie v in g th a t pressure ought to be brought to bear on t h e managements o f l e a d p l a n t s w i t h s e r i o u s l o a d h a z a r d s . However the type o f p r e s s u r e which might be e x p e c t e d t o y i e l d r e s u l t s i s t o 3cme d e g r e e some thing o f a m a t t e r o f c o n j e c t u r e . I n c i d e n t a l l y I am no t speaking of small plants belonging to email producers. R a t h e r t h e p l a n t s which I have in mind are p l a n t s owned and managed b y r a t h e r l a r g e o r g a n i z a t i o n s * I t would be somewhat d i f f i c u l t f o r me t o i n i t i a t e any m e a s u r e s f o r compelling changes in c e r t a in of the plants which I have s e e n * Over a p e r i o d o f s e v e r a l y e a r s , we h a ve made changes i n a number of l e a d p l a n t s and I have d e l i b e r a t e l y s e l e c t e d w h a t I t h o u g h t w o ul d b e among th e w o r s t l e a d hazards to be found because I wanted to see the maximal lim i t s of lead exposure, and the evidence of such exposure on l G a d e x c r e t i o n and on c l i n i c a l symp tom at ol ogy * My e n t r e e i n t o t h e s e p l a n t s was p ro v id e d through an under s t a n d i n g t h a t I s h o u l d b e p e r m i t t e d t o make o b s e r v a t i o n s f o r s c i e n t i f i c purposes, and not f o r p u b lic a tio n in which u s e was made o f names of o r g a n i s a t i o n s * I f you w i l l r e f e r t o cue o f my a r t i c l e s wh ic h a p p e a r e d i n t h e September 1933 number o f th e J o u r n a l of I n d u s t r i a l H ygiene, you w i l l f i n d r e f e r e n c e to an unnamed w h ite l e a d p l a n t and to an oth e r unnamed s t o r a g e b a t t e r y p l a n t . I f you r e f e r to i t , you w i l l see th a t oases of poisoning were d e f i n i t e l y rep o rted t o h a ve o o c u r r e d among the p l a n t p o p u l a t i o n in wh ic h most o f t h e men we re e x c r e t i n g e x c e e d i n g l y h i g h q u a n t i t i e s o f l e a d . The l e a d c o n t e n t o f the t w e n t y - f o u r hour f e c a l sample was as high as 0.21 m illig ra m s in c e r t a i n i n s t a n c e s , w i t h a number o f r e s u l t s o v e r 10 m i l l i g r a m s . Such r e s u l t s , in our experience, oorrespond to atmospheric pollutions with l e a d d u s t o f the o r d e r o f m a g n i t u d e o f 10 t o 4O m i l l i g r a m s p e r 10 c u b i c m e t e r s o f a i r . One o f the j o b s in t h i s p l a n t in volves exposure to dusts even greater than those which I h a v e i n d i c a t e d . The men on t h i s j o b wear r e s p i r a t o r s , w h i l e th e y a r e b e i n g watohed) b u t even so I saw s e v e r a l o a s e s o f p o i s o n i n g fr om i t in the c our 3 8 o f a y e a r * a tim e * T h e r e i s a somewhat s i m i l a r p l a n t a l s o , o f which I have only i n d i r e c t I 00482 2 know ledge, having seen more than one case of p o iso n in g in th e co u rse of s e v e ra l y e a rs , and I have autopsy d ata on two f a t a l eases f r o a th e se p la n ts * I have in a y re c o rd s a n a l y t i c a l d a ta on one or two c a se s of en c ep h alo p ath y which were brought to ay a tte n tio n * (W ithout r e f e r r in g c a re fu lly to ay re o o rd s, I can not be su re of the p re c ise number of cases in the d iffe re n t e a ta ^ o rie a , b u t I have oooaalon to s e e and o b ta in In fo rm atio n on a f a i r p ro p o rtio n of a l l of the cases of laad poisoning th a t ooour in th is g en sral seotlon of the country, X have a lso sesn a f a i r a m b e r of p lan ts a t considerable d istan ces from C in cin n a ti, Xv g e n e ra l im p ressio n is t h a t where com pensation laws a re s t r i c t and are a sso c ia te d w ith adequate in sp ectio n of p la n ts , tha hygienic conditions are s trik in g ly b e tte r than in those s e c tio n s of th e country in which n e ith e r com pensation lawa nor s ta te inspections are ca rrie d out in an e ffe c tiv e manner. In any case there is no q u estion b u t th a t a larg e percentage of th e I n d u s t r i a l e a se s a re p re v e n ta b le * What i s needed to produce good hygienlo co n d itio n s is a p re c is e knowledge on th e p a r t of th e managements of what can be done and what has been done in o th e r s im ila r p la n ts . Obviously the advice of com petent m ed ical men would be o f th e g r e a t e s t u s e fu ln e s s in working out the d if f ic u ltie s in these plants* U nfortunately In some o f then the p la n t d o c to r i s incom petent and p o o rly in fo rm ed . In a d d itio n to t h a t , in some such p l a n t s , th e d o cto rs connive w ith th e management in avoiding th e w orst consequences of bad p la n t c o n d itio n s , I know o f one In s ta n c e in which men a re examined from tim e to tim e and th o se who show th e moat obvious ev id en ce of le a d a b s o rp tio n a re l a i d o f f in on e f f o r t to f o r e s t a l l com pensation c la im s . From. one p la n t alo n e I have seen some e ig h t or te n men In the co u rse of th e p a s t two y e a rs who had a c tiv e le a d i n to x i c a tio n a t th e tim e th e y were l a i d o ff# Most o f th e se men re c o v e r w ithout permanent d is a b ility fo r, in g en eral, oases of lead poisoning w ithout c e n tra l or peripheral nerve involve ment do re c o v e r sp o n tan eo u sly . I t i s th is very f a c t which j u s t i f i e s th e procedure f o r h an d lin g th e men in the minds o f the management of c e rta in of these p la n ts . Prom tim e to tim e , a* th e o p p o rtu n ity has affo rd ed i t s e l f , I have done what I oould do to s tr e s s the dangers e x is tin g in o e rta in o f the p lan ts which I have seen, I have been very cau tio u s not to appear as an e x p e rt w itn e ss on the s id e of p la n t managements in connection w ith such p la n ts, I have in s is te n tly pointed o u t, whenever I have been c o n s u lte d , th a t th e r e is no defense ag ain st claim s a risin g in such p la n ts, e ith e r re a l or f i c ti tio u s , I have t r i e d to make i t c le a r th a t th e managements o f such p la n ts are Jeopardising th e ir p o sitio n b efore in d u s tria l ooaaaislons or b e fo re comnon law c o u r ts , and th a t they w i l l e v e n tu a lly have la b o r d i f f i c u l t i e s as w ell as being a t the mercy of every le g a l ste p taken a g a in st them. However I must confess th a t in the main these co n d itio n s are ev e n tu ally elim in ated only te I 00483 " 3* en t . p u b lic and when th e group r e p r e s e n tin g la b o r oome w a f f l e i e n t l y Inform ed t make I t h ard f o r such employers* There la an occasional f a r sighted manager who ou t o f h i s own decency and human u n d ersta n d in g p ro v id es p ro p e r c o n d itio n s f o r th e workmen* There le an o c c a s io n a l a d d i t i o n a l manager who se e s th e h an d w ritin g on the w a ll and a tte m p ts to p u t h is house in o rd e r b efo re he la com pelled to do so* In a d d itio n to th a t* in su ran c e companies have p ro v id ed a very co n sid erab le amount of b o th p re s s u re and in fo rm atio n * In my opinion t h e i r p re a a u re has been more s e rv ic e a b le th an th e ir inform ation f o r th e one w ith o u t the o th e r la lik e ly to be o f l i t t l e v a lu e . In genera^ a f t e r some y e a rs of experience* I am fo rc e d to kthe c o n c lu sio n t h a t a v ery c o n s id e ra b le p ro p o rtio n of managements make o nly th o se m o d ific a tio n s to w hich th ey are d riv e n . U ndoubtedly th is is due to the fa o t th a t In part new h y g ie n ic m easures a r e expensive* They etoter in to ^ the c o s t o f th e commodity and* th e re fo re * a c t as a h in d ra n c e in c o m p e titiv e f ie ld s * Obviously h e re I am speakin g n o t only of le a d p o iso n in g b u t of a g re a t many o th e r I n d u s t r i a l h az ard s* 'Ahen we become s u f f i c i e n t l y c iv iliz e d * 1 th in k we s h a l l re g a rd i t as a n e c e s s ity to provide working co n d itio n s which are free a t le a s t of in s id io u s h e a lth h azard s* We a r e making some p ro g re ss in th a t d i r e c t i o n . However* as an observer in th e f i e l d r e a l p ro g re s s seems to me to oome v ery slowly* I agree w ith you th a t d e f in ite s e p a r a tio n should be made betw een o c c u p a tio n a l o ases of lead poiso n in g and those which occur in the general p o p u la tio n . In f a c t th e re are many people who would f in d i t d i f f i c u l t to b e lie v e t h a t th$r a re many c a se s o f n o n -o o cu p atlo n al le a d poisoning. I t would be very u s e fu l not only to have th is s e p a ra tio n made* b u t to have su ch In fo rm atio n a v a ila b le as would perm it one to e s ta b lis h the cau sativ e f a c to r In r e la tio n to illn e s s or death from lead poisoning. R ecently I have been try in g to o b ta in seme in fo rm atio n on the o ccu rren ce of lead o r a r s e n ic p o iso n in g from sp ray r e s id u e s . My ex p erie n ce* and t h a t of my o o lle a g e s a t Harvard* le a d s me to b e lie v e th a t moat oases of le ad poisoning In in fa n te and c h ild r e n oesne from chewing o b je ct* coated w ith m e ta lli* le a d and le a d pigm ent*. I am n o t q u ite sure* b u t I b e lie v e th a t every oaae* exoept one* in our l i s t of c h ild re n has had such a c a u s a tiv e f a o t o r . I f we were ab le to put o u r f i n g e r oo the m ost s i g n i f i c a n t f a c t* which cause le a d p o iso n in g o u ts id e o f in d u stry * we would c e r t a i n l y know a g re a t deal more about th e dangers to the p u b lic in th is c o n n e ctio n than we now know. ) There a r e many o th e r th in g s which I could say about th e se problem* and you w ill note th a t the paragraph* above are ra th e r inadequate In th e ir dl*cuB*ion of th ese problem s. This w ill only serv s to show you what you p ro b ab ly a lre a d y know* namely th a t I am iC F rfl r A A O A s o t very o e rta in aa to hom theaa d if f ic u ltie s can b a st ba so lv e d . I have B arely been observing in d iv id u a l fa c ts and c a se s a s c a r e f u lly as p o s s ib le o v er a p e rio d o f soma y ears in order to understand as such as p o ssib le about th e oecurrenoe and the sig n ific a n c e of lea d in to x ic a tio n * I h a re n e t been unm indful of th e s o c ia l problem o r o f the in d iv id u a l problem as Z have gone a lo n g , b u t I m ust con f e s s th a t Z have n o t seen any c le a r - c u t means o f s e t t l i n g i t . With k in d e s t p e rs o n a l r e g a r d s . , 7 C o r d i a l l y y o u r s , RAX j i s R o b ert A. K ehoe,