Document mp6Mp1Lbk979Q0vm3KQ08wEKk

Fe b ru a ry 2 1 , 19^7 F r . ? M ille r , Me d ica l Dep artm en t, y . I . cu Fo n t lue Nem our s and Co . Old H ick o r y P la n t , David son Co u n ty, ie n n . nee: M ille r I have your le t t e r or Feb r u ar y ljj w ith it s attach m en ts in r e la t io n to the ca se o f 1 oy Gr e e n e r . Be fo r e g iv in g jc a r e fu l c o n s id e r a t io n to th e d e t a ils c f th e ca se I s h o u ld l i k e !t o r a i s e t h e q u e s t io n o f t h e a d e q u a cy and a c c u r a c y c-1' t h e : e s u lt a o r le a d a n a ly s e s on t h e u r in e th is man. I ob ser ved t h a t a s e r ie s o f a n a ly s e s h ave been made and th a t the r e s u lt s as ta b u la te d a r e r e a so n a b ly co n s is t e n t m gn va lu e s a r e r e co r d e d fr om tim e t o t im e , h o w e ve r , and somewhat i r r e g u l a r ly . t h e s e w ould seem to in d ic a t e t h a t th e le a d e xp o s u r e was r a t h e r v a r ia b le fr om tim e to t im e . Ot h e r w is e i t w ould mean t h a t th e a n a l y t i c a l r e s u l t s a r e s u b je c t t o m or e v v r d &r io n Lkan t h e y s h o u ld b e . I p o in t t h is o u t ,b e c a u s e I muse b e q u it e fr a n k n s a y in g t h a t I am v e r y s k e p t ic a l a b o u t a n a l y t i c a l r e s u l t s c .l t i n i c in a n in d u s t r ia l la b o r a t o r y . These in s u lt s may be h ig h ly a c c u r a t e , but co n s id e r in g the d i ffi c u lt i e s n ot on ly o f the a n a ly t ic a l p r o ce d u r e s b u t o f t h e m e t h od s e m p loye d in t h e c o l l e c t i o n o f s a m p le s , I beg; le a ve to be s k e p t ic a l. In our e xp e r ie n ce i t has n ot been p o s s ib le to o b t a in s a t is fa c t o r y a n a ly t ic a l r e s u lt s on b io lo g ic a l m a t e r ia ls fr om p la n t la b o r a t o r ie s . I f th e s e r e s u lt s a r e ' t r u s t w o r t h y , I can a s s u r e you t h a t t h e y o r e q u it e t h e e x c e p t io n t o common e x p e r ie n c e . Ac c o r d in g ly I r a is e th e q u e s t io n c f t h e m ethods em ployed by you r m e d ica l p e r s o n n e l in c o lle c t in g the sam p les and by your a n a ly s t s in m a k in g t h e d e t e r m in a t io n . I f you w i l l g iv e me t h e in fo r m a t io n on t h e s e m a t t e r s , I s h a ll then be p r e p a r e d t o a c c e p t one a n a ly t ic a l r e s u lt s o r to d is ca r d them as the ca se may b e , on r e a s o n a b ly ad e q u a te in fo r m a t io n . For the p r e se n t I must take the p o s it io n , on th e b a s is o f my own e x p e r ie n c e , t h a t t h e s e r e s u l t s ca n n o t be t r u s t e e , and t h a t I s h a l l h a ve to dr aw my c o n c lu s io n s fr o m t h e o i l fiic u x d a t a a lo n e . Th is p o s it io n is based on th e fa c t t h a t such a n a ly t ic a l e vid e n ce m ust be e e r r e d t beyond any p e r a d ve n tu r e , or e ls e i t is w h o lly d e ce iv in g. I sh ou ld lik e a ls o to p o in t ou t t h a t ou r s y s t e m a t ic e xp e r im e n t a l an d c l i n i c a l c b s e r v a t io n s o v e r a p e r io d o f y e a r s h a ve s a t i s f i e d us co m p le te ly the t the d e m o b ilis a t io n o f le a d by means o f ca lciu m t h e r a p y , an d 1 Is m o b i li z a t i o n by m eans o f ammonium c h l o r i d e , a r e co m p le t e impos s i b i l l t i e s . The d e p o s it io n o f le a d in t h e s k e le t o n D r . R. P . M i l l e r - (2J - Fe brua ry 2 1 , 19^7 is n ot m a t e r ia lly in flu e n ce d in the r e a so n a b ly norm al in d iv id u a l by th e a d m in is t r a t io n o f ca lciu m , n or is i t in flu e n ce d a p p r e cia b ly fo r more than the b r ie fe s t p e r io d o f tim e by th e a d m in is t r a t io n o f ammonium c h lo r i d e o r by a n y o f t h e o t h e r a g e n t s t h a t h a ve b e e n p r op osed fo r t h is p u r p o s e . I do n o t e xp r e s s th e s e p o in t s o f view in o r d e r to be! c r i t i c a l o f v h a t h a s been d on e, b u t m er ely to s t a t e the p o s it io n en vh ich I proceed v it h the co n sid e r a tio n o f th is case I t w ould a p p e a r fr om th e a c c e p t a b le fa c t s p r e s e n t e d in yo u r d e s c r ip t io n o f the ca s e t h a t t h is em p loyee h a s had s i g n i fic a n t le a d e xp o s u r e , t h is c o in c id e s co m p le t e ly v it h cut' e xp e r ie n ce in th e m a t t e r o f le a d Mour ner a , e s p e c i a l l y when t h e l a t t e r w or k r a t h e r s t e a d ily a t t h e ir job o f le a d b u r n in g . I t a p p e a r s a ls o t h a t t h is man h ac seme o e gr e e o f c l i n i c a l le a d in t o x ic a t io n , t h is c o n c lu s io n b e in g u t t i f ! by t h e s ym p t o m a t ic p i c t u r e . "Che a b s e n ce o f c h a r a c t e r i s t i c g v id e h e c o f m ic r o s c o p ic b lo o d ch a n ge s *va t ip p le d e r y t h r o c y t e makes t h is in t e r p r e t a t io n q u e s t io n a b le , b u t a ga in in is is a q u e s tio n o f m ethod o f ejxaruinu s i on and s e n s i t i v i t y o f t h e s p e c i f i c p r o ce d u r e e m p lo ye d . Ac c e p t in g t h e s e t h in g s a s f a c t s , fo r che s a k e o f t h e a r g u m e n t , I w ou ld t.ake t h e p o in t o f v ie v t h a t t h i .3 man h a s h a d I n t e r m i t t e n t e xp o s u r e t o le a d e v e r some c o n s id e r s .bit? pc r io d o f t im e and t h a t he hob a ccu m u lated le a d in h is b o d y. I t h in k you can h k e i t a s c e r t a i n t h a t h e h a s n e v e r h a d a m p le Lme a t. a n y t im e to e x e r e b -t h e le a d thus a ccu m u la te d , ana t h e r e fo r e i t takes, 1 ^ * - . . . r .f W O and i eioi^ a 1 le a d e xp o s u r e t o p r o d u ce s i g n i f i c a n t lo a d a b s o r p t i o n , th a n won id be t h e c a s e in a p_ r e v io u s ly_ u n e xp o s e d new e m p lo y e e , r d i n y l y when ^ r ~ . i V_, L *' h e i s e xp o s e d t o le a d a g a i n , h e d e v e lo p s symptom, moi e r a n i d i y t h a n w ou ld be a n t i c i p a t e d in a p r e v io u s ly u n e xp o s e d p `i c o n P h is i c t h e b a s is o f h is ''b u s c e p t ib iii t y ," i f he can be s a id ic ~ e m ors s u s c e p t i b l e t h a n a n o t h e r i n d i v i d u a l . I f t h is man: v e r e g iv e n : im e to e lim in a t e h is r e t a in e d le a d , h e w ould th en be no m ere s is c e p t r o ie th an my o t h e r .in d iv id u a l, assu m in g t h a t he is o t h e r w is e r e a s o n a o ly norm el and h e a lt h y . I w ou ld s a y t h a i v h a t i s n e c e s s a r y i n t h i s c a s e i s t o iCCo. . on m s p r e s e n t s t a t u s r th r e fe r e n c e t o le a d a b s o r p t io n . I f h e Iras a b s o r b e a p p r e c ia b le qui .Lie s o f l e a d , a b o ve n o r m a l l e v e l s , he w i l l show an e le v a t io n o f th e le a d co n t e n t o f h is b lo o d and u r in e . Ilor eovex-, i f he is kep bu t o f lead e xp o s u r e , th e co n ce n t r a t io n of le a d in t h e b lo o d on e u r in e w i l l d e c r e a s e t o t h e n o r m a l l e v e l s , f i l l s muv r e q u ir e months! or perhap s even y e a r s , dependent upon the le n g t h and s e v e r i t y o f h i s p r e v io u s e x p o s u r e . He s h o u ld n o t b e p e r m it t e d to resum e h is le a d e xp o s u r e , assu m in g t h a t he h a s had s ig n ific a n t e x p o s u r e , u n t i l s u ch a- t im e a s h e shows s u b s t a n t i a l l y n o r m a l v a lu e s in b o th th e b lood and u r in e . way o f e s t a b lis h in g t h e fa c t s a t t h is t im e , I w ould s u g g e s t t h a t i o b t a in s a m p le s o f b lo o d and u r in e f o r us n our* c o n t a in e r s , D r . I.. ? . M i l l e r - (pj - Fe b ru a ry 1 , 1^47 fo llo w in g ou r i n s t r u c t i o n s . On t h e b a s is o f t h is in fo r m a t io n I can b e t t e r a d v is e i'ou a3 to what sh ou ld be d o n e . I f , a t th e same t im e , you sh ou ld w ish to ch e ck the a ccu r a cy o f th e a n a ly t ic a l r e s u lt s o b t a in a b le in y o u r own l a b o r a t o r y , you m igh t o b t a in s a m p le s a t a b o u t th e same tim e t o r t h e ir a n a ly s is , so t h a t th e r e s u lt s o f th e two la b o r a t o r ie s cap be com p ar ed . I sh ou ld warn you t h a t sam p les ou gh t n o t t o be d iv id e d s c b e t w e e n t h e two laDorac o n e s , s in c e .h e h -n d l n g in c id e n t t o t h i s d i v i s i o n i s much t o o l i k e l y t o r e s u lt in co n ta m in a tio n . ! I f ve ca n h e lp :ycu in t h e m anner in d ic a t e d a b o v e , ve s h o u ld be gla d to do s o , and m oreover, i f what I have sa id r a is e s fu r t h e r q u e stio n s in yo u r m in e , | s h o u ld b e g la d t o a n s w e r them t o t h e c e s t o f my a b ilit y i f you w ill propose them . j Co r d ia lly yo u r s, IAK e f j | ! o b e r t A . Ke h o e , M. D .