Document oeMqaRKEXea0oNGp3KLm6j9bD

January 4, 1963 372-5717 Lester H. Hergesheimer, U . D. Plant Physician National Lead Company 2007 Last Cumberland St. Philadelphia 25, Pennsylvania ; . Dear Doctor Hergesheimer: I regret my delay in replying to your letter of November 22, and will undertake to make amends. I was out of the country (in Santiago, Chile) on a special mission for the Pan American Health Organisation, for three months and returned only a short time ago. Some of my correspondence, including your letter, arrived while I was on my way home (by ship), so that it had to wait for my return and while I undertook to attend to several seemingly urgent matters, I think you should know that I am no longer the Director of this Laboratory and the Department of the Iledical College of which it is a part. I retired in July of 1935, and have been succeeded by Edward P. Radford, M .D., formerly of the Harvard School of Public Health. I expect to remain here for a time, however, in order to complete some work that has been in progress for some time under my direct guidance, and to find an "understudy" to take it over. I can be addressed here, therefore, for some time to come. The answer to your question, with respect to our publications or my opinion, depends very much upon your meaning of "lead absorption without symptoms",, There are those who speak of "lead absorption" s some kind of a physical state which is almost but not quite that of a frank in toxication, and when you speak of "evidence of lead absorption", I wonder what you mean. Just in order oo be quite explicit on this matter, and yet not pedantic (for the language in this matter has become too confused to pass for communication), let me emphasize what you already know, I am sure, namely - that all of us at all times absorb lead. When you speak of this phenomenon in any relationship to disease ox* illness, you must, therefore, deal in the quantitative aspect. Do you mean a dangerous degree of absorption, as defined in present, precise terms, as a grossly abnormal "body burden" of leau , or as a dangerously elevated concentration of lead in blood or urine? Or do you mean a gingival "lead line", or an alteration in the histology or chemistry (porphyrin or amino acid content) of the blood, (the former is not, necessarily associated with intoxication by lead, whilh an excess of porphyrins in blood or urine may be a sign of such intoxication, if other factors can be excluded). , ,Dr ergesheimer, Janua r> 1 1 9 6 6 page O Now if I may assume that 'our use of the term "absorption" in its simple, physiological sense, the ere absorption of lead, within what are now accepted as safe limits, evolves no risk and requires no treatment. In the case of persons **' are employed in the lead-using industries, there are sound means os. etermining whether or not they are in danger, and when they approach :>.*' border line between safety and danger, their further exposure to lea,. . "s an occupational hazard, should be terminated or reduced to an appronrt 'to level. At this point, they are not ill and they neither rectui. o nor Mould be subjected to treatment. (The use of chelating agents tor the "moval of lead from the body of a well man is c aedical measure fraught " ith grave ethical questions that need thorough exploration befo "o being undertaken. There may be situations that justify such therayp nit the^e are indeed rare, and are generally dubious.) Given time ana freedom potentially dangerous exposure to lead, the excess burden will 'n- 'xcretecl, and the man can return to his former work (which, by this .tim.* should have been made safe). This means, of course, that the man can >'vk during the entire period of his restoration 'or he is not ill, ..or v=. he any more iikeiy than 'any other workman to become ill. '..hat, is re-.'n'vo d , therefore, ia a plant in which there are operations with lead tha : u'e difficult to control, is a regimen of supervision that will de .>'ot risk among the men, and transfer them to other operations that a w tree of lead hazards. By such means the danger can be dealt with 'a time, and any and all cases of intoxication can be prevented. This , i,!' and should be done in all of the lead trades. (If jobs are not availatv'. *' for such transfers, the only alternative is to reduce the lizard to e.> <irely negligible proportions in all operations. ) It is possible, of course to surround modern technical operations in the lead trades, with ap**u'priate safeguards, so that the conditions reader which men work are ' id continue to be safe. The role of the industrial physician is .*' make sure that these safeguards are adequate, and that they are mainta . 'ed adeouately, through his superviston of the workmen. If these are ' . it is his duty to make the facts known and to insist on executive a.' 'ion until the appropriate measures of safety are taken. There is no .'nnixed activity (except war) in this country, that can justify its exit, '"nee at the cost of human health and life, and it is the function o ; physicians in industry to vaake sure that this principle is fully unclers M o d by industrial management and acted upon. Verhaps you will understa ' ' i and accept my words concerning the role of the industrial physician 'n the spirit in which they are given, if you reflect on the fact that he means of eliminatin'* 'ead poisoning from industry have been avalla M o for many years; that this is the richest country in the world and M many respects, the most advanced; and yet the incidence the prevent cble disease - lead poisoning; 9 in this country is still high'and probabi ' the highest of any occupational disease. This is, indeed a shameful faa ' . 'which exists because our people in industry, including, unfortunately, any of our industrial physicians, are not familiar with what is kno i, and that the policies of many grohps in industrial management, i -. his respect, are not realistic. I've been Dr. Hergesheimer, January 4, 1366, page 3 at this a long time, in practically all segments of large and small American industry, and I know w h e r e o f I speak. I feel called upon, therefore, particularly within our own (medical) circles, to speak of it again and again. We, as physicians, should engage actively in in fluencing the policies of industry in matters of industrial health and hygiene. As these matters have stood for a long time, many, if not m o s t , of the physicians in the lead-using industries have been concerning themselves with the treatment of lead poisoning, and not with its preven tion by means of the removal of the threat. The proper design of plant and operating equipment and the control of the dissemination of lead through the work areas are, of course, matters of satisfactory engineeringThe physician, as a rule, cannot attend to these matters. 4He can, how ever, demonstrate the extent of the adequacy or inadequacy^these measures of control and he can provide the impetus that will bring them and keep them up to standard, (for the maintenance of operating and hygienic eouipmeut and the good qualify of the housekeeping are stern necessities if success is to be 'achieved). I am sending you, under separate cover some publications that will be of interest to you. 2f these (or other matters) raise questions in your mind that you would like to put to me, do not hesitate to do so. It may turn out that you would like to pay a visit to this Laboratory and find out for yourself what has been and is being done here in this field of industrial health. If so, I would be pleased to arrange with you a mutually convenient time during which we could discuss the various aspects of the matter at sufficient length. Sincerely yours, PAX: abb ivobert A . Kehoe, M. D. mt i o n a l Lea d Co mpa n y Philadelphia Branch M a n u f a c t u r e r s o f " DUTCH BOY" PRODUCTS TELEPHONE. G A R F I E L D 6 - 0 6 0 0 T. M. GILMORE GENERAL SUPT. 2 6 0 7 EA S T C U M B ER LA N D ST. Phil adel phia 25 November 22, 1965 Dr. R. A. Kehoe Kettering LaboratoryUniversity of Cincinnati Cincinnati, Ohio Dear Dr. Kehoe: It was recently my privilege to be employed as director of the Medical Department of the Philadelphia Branch of the . National Lead Company. In refreshing myself concerning the medical aspects of lead .toxicology, I am impressed by the extensive literature on safe standards and lead intoxication, but find very little on the handling of patients who give evidence of lead ab sorption without symptoms. Does your laboratory have any available reprints on this subject? If so, I would appreciate any help or suggestions you might give. Sincerely yours, ster H. Hergesheimer, M. D. Plant Physician l h h /m g