Document mpVrqrmv9OzjrNo0R2Lz1Mewg

June 14, 1954 D ,'. 13. J o h n t a u e r M edical D irecto r Jones and Laugh!in. S teel C o rp o ratio n T h ird A venue arid B o sa S tre e t P ittsb u rg h 30, Pennslyvania I r e t u r n to y o u , s o m e w h a t t a r d i l y , I f e a r , y o u r p a p e r on " C lin ic a l 7_,ead Intoxication. " As I told you o v er the telephone, th is is a good p a p er, and I sh all he glad to see it in p rin t, I am m aking a few c o m m en ts, fo r such u se as they m ay be to you, since I sh all co n sid er it u n n e c e ssa ry to com m ent on the points co n cern ed in m y d isc u ssio n s, dotations have been, m ade in the m arg in of the text. P a g e s 8, 9 a n d 10 - T he L e a d L in e . T he f i r s t s ta t e m e n t (p ag e 8) s h o u ld h e m odified b ecau se of m edico-legal co n sid eratio n s to som ething lik e the follow ing: "T he lead. lin e is the m o o t c o n sis te n t sig n of th e o c c u rre n c e of p o te n tia lly h a z a rd o u s a b s o r p tio n of le a d , on th e p a r t o f th e i n d u s t r i a l w o r k e r . " C o m m e n t s (1} It is not a sign of p lu m b ism , and should not be said to be, sin ce th e te rm p lu m b ism is ta k e n g e n e ra lly , fo r m e d ic o -le g a l p u rp o s e s , to m e a n in to x ic a tio n . (2) It is r a r e l y s e e n in th e c h ild (b e c a u s e ox th e c o m m o n la c k o f g in g iv itis in th e c h ild .) The second sta te m e n t (page 3) should be m odified a cc o rd in g ly , sin ce th is is not a lesio n of "lead p o iso n in g ." I should sim ply delate the second sen ten ce. It is not s tric tly c o rre c t, sin ce the d isc A eratio n of the re c ta l m ucosa is also a sig n of m e ta llic ab so rp tio n , and since th e so called lead line is not n e c e s s a rily due to lead , but to any m e ta l th at fo rm s a b lack sulfide. T h e t h i r d s ta t e m e n t (page 9} s h o u ld m a k e th e e x c e p tio n of c h ild r e n , a n d of p a r s o n s who have u n u su ally sound and h ealth y gu m s, so a s to lin k th is le sio n to g in g iv itis. The lin e d oes not o c cu r u n le ss th e re Is som e g in g iv itis. My fo u rth c o m m e n t r e la te s to th e o m issio n , on p ag e 10 of the m o s t d iffic u lt fe a tu re of the d iffe re n tia tio n of le a d lin e , in th a t the n a tu ra l p ig m en tatio n of n e g ro e s and c e rta in o th er p erso n s w ith heavy pigm entation involves the buccal m ucosa and the buccal side of the gum s, and o c ca ssio n a lly (very ra re ly in m y ex p erien ce) the lingual side of the gingival m ucosa. P a g e 10 - M u s c u la r W e a k n e s s , T h e " e v a lu a tio n " of m u s c u l a r w e a k n e s s is n o t a lw a y s d if f ic u lt. S o m e tim e s it is v e r y e a s y . B: d e p e n d s u p o n th e d u r a tio n a n d sev e rity of the w eakness. E x ten so r w eakness of the fo re a rm s can som etim es., be observed to be g ro ss. The ex ten so r m uscl not only show th e ir w eakness b efo re the fle x o rs, but - m e re N13940 D r . D. John L a u er ~ (Z) - June 14, 1954 freq u en tly than not a re the only points cf w eakness. I h a v e n e v e r s e e n fo o t d r o p in le a d p o is o n in g in th e a d u lt. It is e x t r e m e l y r a r e , in. contradistinction from a rsen ic poisoning. ' On page 14, I have w ritten in c e rta in suggestions fo r e d ito ria l changes w hich seem to m e to he n e c e s s a ry o r ad v an tag eo u s. On page 15, I have questioned your f ir s t statem en t, not only b ecau se I do not believe it is tru e in g en eral, but also b ecau se som e stippling is , as we have shown, an en tirely norm al phenom enon. It is, usually, I believe, a juvenile form of e ry th ro c y te , w h ic h is p r e s e n t in i n c r e a s e d n u m b e r w hen th e b o n e m a r r o w -is s tim u la te d in any one of a v a rie ty of w ays. I would c e rta in ly not m ake so fla t a sta te m e n t a s th is. This e n tire p a ra g rap h is open to serio u s o bjection. In y o u r second p a ra g ra p h you say it is "a good m e a n s of studying e x c e ssiv e le ad a b s o r p tio n . ,f A c tu a lly i t is a c o m m o n ly u s e d a n d v e r y p o o r m e a n s to th is e n d . If one has no o th er m e an s, it w ill have to se rv e , but it is not "good. " I would c e rta in ly not encourage re lia n c e upon th is phenom enon.- You need not condem n it, if you d o n 't feel lik e doing so, but you should net com m ead it, except a s an a c c e ss o ry clin ical p ro c e d u re , w ithout d is c u s s in g in c o n s id e ra b le d e ta il its u s e fu ln e s s a n d its s h o r t com ings. Your lim itation of it to the study of groups gives you a reaso n ab le out, but this w ill not be understood by m ost of your audience. M oreover, as I have indicated, it is n ev er seen in te tra eth y l lead poisoning, and so your statem en t of its "constancy" is not c o rre c t. S everal of the points I have co v ered a ro th o se that com e up co n stan tly in m ed ico leg al c o n tro v e rsie s, and if you put y o u rse lf on re c o rd in p a rtia l e r r o r , you m ake g re a t tro u b le fo r y o u rself and fo r your co lleag u es. It is n e c e ssa ry , in d iscu ssin g the su b ject to be v e ry m eticu lo u s in y o u r sp ee c h , and not to re ly upon the u n d e r standing of y o u r co lleag u es. If, th e re fo re , I a m m o re c ritic a l than I would be o rd in a rily , it io b e c a u s e it is im p o rta n t n o t to s a y an y th in g th a t is n o t s t r i c t ly tr u e . I rep eat that the p ap er is good. H ow ever, 1 know the problem of p rep arin g such p a p e rs in b re v ity and h a ste , and I have no h e sita tio n in c ritic is in g as w ell a s in praising it. . Sincerely yours, RA K e Enc. Kt 0012198 R obert A. Kehoe, M. 0 .