Document peBdeOR5oO29ErGNJbmgMxxJE

E TH YE C O R P O R A T IO N Ma n u f a c t u r i n g a n d Tr a f f i c De p a r t m e n t September 13, 1944 PL EA SE A D D R ESS REPLY T O C H R Y S L E R BUILDING 4 0 5 L E X IN G T O N A V E .,N E W Y O R K 17, N.Y. D r. R. A. Eehoe C ollege o f Medicine U niversity of C incinnati Eden & Bethesda Avenues C in c in n a ti 19, Ohio Dear Dr. Kehoe: A ttached hereto fo r your inform ation and f ile s i s th e ''Lead Hygiene and S a fe ty B u lle tin Ho. 37" is s u e d by the Lead In d u s trie s A sso c ia tio n . Yours very tru ly J . H. S chaefer 1-1 K f 0014648 LEAD I N D USTRI ES ASSOCI ATI ON August 30, 1944 LEAD HYGIENE AMD SAFETY BUI,LETIff HO. 37 SUBJECT; A STUDY OF CCCUPATlOylii;L "ISAD POISONING AT PERTH iuSOYj 'NL J* To Members o f th e Lead I n d u s tr ie s A s s o c ia tio n : One of our members, th e N a tio n a l Lead Company, has given much s tu d y to th e c o n tr o l o f le a d p o is o n in g a t i t s P e rth Amboyj N .J . p l a n t , and th e m ed ical o f f i c e r in c h a rg e , D r. W illia m C. W ile n tz , has p re p a red a p a p e r, as a tta c h e d , on "O ccu p atio n al Lead Poisoning" based upon h is own e x p e rie n c e and o b s e r v a tio n w hich I b e lie v e th e e n tire lead industry w ill find of in te re s t. I t i s my hope t h a t i t w i l l s tim u la te th e p r e p a r a tio n and exchange of sim ila r data by o th er companies in th e A sso ciatio n or the u ltim ate com pilation o f inform ation which w ill be o f help to the industry a t larg e. I s h a l l d e e p ly a p p r e c ia te , and I know D r. Y iilentz w i l l lik e w is e , an y comment and d a ta you may c a re to subm it a f t e r re a d in g his a rtic le . Very tr u ly your.s, S e c re ta ry . KE 0014849 LEAD HYGIENE. AND SAFETY BULLET'lN No. 37 CONFIDENTIAL NOT FOR PUBLICATION OCCUPATIONAL LEAD POISONING BY . . ' Wm. C. W ile n tz , M.D. A STUDY OF CASES OF LEAD ABSORPTION AND LEAD INTOXI CATION OBSERVED BY TEE AUTHOR AT THE NATIONAL LEAD COMPANY, ATLANTIC BRANCH, PERTH AMBOY, N. J . AND AT THE PERTH AMBOY GENERAL HOSPITAL '" 0014050 I t i s n o t my i n t e n t i o n i n t h i s r e p o r t t o p re s e n t a n y th in g new o r s ta r tlin g on th is su b je c t, since y ears of study and in v e stig a tio n by pro m inent members o f th e m e d ic al, chem ical-and e n g in eerin g p ro fe s s io n , have provided our lib ra rie s w ith a m ultitude of s c ie n tific m aterial* I t is ny d e sire however, to p resen t c e rta in phases o f th is su b ject along w ith my own i n t e r p r e t a t i o n , t o th o s e p erso n s who a re i n t e r e s t e d i n th e e f f e c t s of lead as i t confronts us daily in industry* .. Jly re a so n f o r s t a t i n g i t t h a t way i s th e obvious f a c t, t h a t th e le a d in d u s trie s have been on the defense f a r too lo n g ;-' and, w ith th e aid o f in fo rm a tio n o b ta in e d by a survey o f s tu d ie s a t o u r p l a n t , we hope t o a s s is t in n e u tra liz in g th is a ttitu d e . This u n fa ir and in sid io u s propaganda has been perm itted to permeate throughout the e n tire f ie ld of in d u stry , government c ir c le s , co u rts of ju s tic e and h a s, th e re fo re , placed us a l l in a v e ry u n fa v o ra b le p o s itio n * .,...... . .. . I can w e ll r e c a ll th a t when I f i r s t undertook th e re s p o n s ib ility over th e h e a lth and w e lfa re o f th e employees a t t h is p la n t, I had g re a t f e a r o f what was to come, what to ex p ect, what d re a d fu l com plications w ere su re t o a r i s e , w hat meager th e r a p e u tic a g e n ts we had a t o u r d is p o s a l and such poor prognoses to expect. These fe a rs had th e ir o rig in in the t a l k and g o ssip amongst th e people o f t h i s community where "everyone was f a m i l i a r w ith a l l t h e bad e f f e c t s from le a d p o is o n in g ." As a m a tte r o f f a c t , t h e m ed ical and le g a l f r a t e r n i t i e s h e ld th e same im p re s s io n s , so t h a t i t i s not s u r p r is in g t o le a r n t h a t laymen f e l t th e same way about th in g s . , These f e a r s and im p ressio n s may have b een j u s t i f i e d some y e a r s ago, but such cannot be th e tru e condition today w ith in d u stry spending huge amounts o f c a p ita l to i n s t a l l th e most modern p ro te c tiv e equipm ent, 'as w e ll as providing modem m edical d isp en sa rie s to d eal w ith anything t h a t may a r i s e i n th e co u rse o f employment* Cases o f lead absorption and in to x ic a tio n should recover w ithout any re s u ltin g d is a b ility . This statem ent is p redicated on th e b e lie f and knowledge, th a t i f sound m edical o b servation and treatm ent are provided in co n ju n ctio n w ith p resen t-d ay co o p eratio n from management, e x c e lle n t re s u lts must be obtained. I w ill say , however, th a t w ith o u t t h is co o p eratio n anything could happen, w ill most c e rta in ly happen even today* L et no one m isu n d e rstan d iry th o u g h ts ab o u t t h e t o x i c i t y o f le a d . I am thoroughly acquainted w ith th e p o s s ib ilitie s and p ro b a b ilitie s -o f -th is to x ic chem ical, but I an p e rfe ctly s a tis fie d to s ta te frankly th a t I an no more f r ig h te n e d by i t s e f f e c t s th a n I am ab o u t any o th e r to x ic sub stance* L e t's not continue to consider lead absorption and in to x ic a tio n as &n in c u ra b le d is e a s e ." Lot.'s p u t an end t o t h i s ty p e o f lo o se t a l k . We have f a c t s t o s t a t e and n o th in g t o conceal- L o t' s do t h a t and g r e a t ben efits w ill result* Exposures p re v a le n t i n o u r p la n t were from le a d fumes and le ad dust in combination w ith oxides, s u lfa te s , hydroxides and antim ony, th e most p rev alen t exposure being from lead d u st and prim ary manner of ab sorption being through the re sp ira to ry tr a c t v ia in h alatio n of the du st. 001465 TABLE 2 AVERAGE AC-E OF INTOXICATION CASES AVERAGE EXPOSURE OF INTOXICATION CASES AVERAGE TIME LOST FROM WORK AVERAGE ii.' (y e a rs ) 32 0 33 32 36 - 33 (weeks) ' 1 0 ' 0 7 14 11 M 11 (d ay s) 30 0 46 22 31 32 AGE OF YOUNGEST INTOXICATION CASE AGE OF OLDEST INTOXICATION CASE (yearns) 29 0 23 23 24 N 25 (y e a rs) 35 0 46 45 47 m 43 LENGTH OF EXPOSURE OF YOUNGEST CASE LENGTH OF EXPOSURE OF OLDEST CASE LENGTH OF SHORTEST EXPOSURE CASE LENGTH OF LONGEST EXPOSURE CASE (weeks) (weeks) (days) (days) 8 0 3 16 4 .8 6 0 12 12 8 ** 10 37 0 29 45 11 ** . 30 42 0 9 12 IS - 20 Age Groups S tu d ie d : 7 C ases `betw een 23 t o 29 y r s . 9 C ases betw een 30 to 39 y r s . 4 Cases between 43 to 47 y r s . T ab le 2 d is c lo s e s th e w ide range o f age groups t h a t may became a f f e c t e d , as w e l l , a s , showing c le a r ly a w e ll known f a c t , v iz . ,- t h a t th e young and middle* agpl men a r e p r im a r ily in v o lv e d and m ost .s u sc e p tib le , to th e e f f e c t s of lead exposure. ` ' '' ,,^ . . T h a t.is th e re a s o n why i t i s im p o rta n t t h a t th e s e younger men be given most c a re fu l pire-emplqyment exam inations. - . ' ' The m ost s e r io u s c ase s e n co u n te re d w ere, two men who w ere em ployed in th e cap a c ity o f d ism an tlin g an old b u ild in g - one was 35 y r s . o f age w ith a 16 week exposure .w hile th e o th e r was 39 y r s .. of. ago w ith a 7 week exposure - both were o f Spanish .descent. ' D ism antling has always been considered one.of th e most serio u s exposures. ' ' - . t ;' I t seems t o me t h a t av erag e l o s t tim e from work o f 32 days should compare fa v o ra b ly w ith o th e r' p la n t f i g u r e s . We have n e v er made i t a p o lic y o f i n s i s t i n g upon q u ick re tu r n to w ork, b u t a t th e same tim e s as soon a s th e s u b je c tiv e symptoms su b sid e o r d is a p p e a r , a rran g em en ts a r e made i n p ro v id in g o th e r ty p e s o f w ork. The b lo o d p ic tu r e g u id es u s i n t h i s r e s p e c t, b u t only as an aid in estim ating the e n tire p ictu re. HE 0014352 FURTHER INTOXICATION CASK ` STUDIES TOTAL NO. CASES FROM 1939-1945 (5 y r s . ) 20 Cases H o sp italized Cases not H o sp italized - TOTAL - 14 6 20 HOSPITAL CASES STATISTICS (14 c a s e s ) S h o rtest H ospital Stay - Longest H ospital Stay Average S tay - A verage Age o f P a t i e n t * Average Length o f Exposure' ** Average Loss o f Time o f Case - 5 days 34 days 14 days . 36 y e a rs (23 to 45) 8 weeks 42 days NON-HOSPim CASE STATISTICS (6 c a s e s ) Average Age of P a tie n t - Average Length of Exposure - Average Loss of Time of Case - 34 y e a rs (23 to 47) 14 weeks 16 days T ab le 3 d is c lo s e s some i n t e r e s t i n g f a c t s r e l a t i n g t o th e h o s p i t a l i zatio n and am bulatory handling of th ese cases. I t must be c le a rly under s to o d t h a t wo w ere d e a lin g w ith d i f f e r e n t d e g re es o f in t o x i c a t i o n , th e most pronounced and s e rio u sly i l l being h o sp ita lize d w hile th e m ild type cases were tre a te d as am bulatory. .. I t i s a ls o w o rth n o tin g t h a t th e s e s tu d ie s c l e a r l y show t h a t th o average exposure fo r th e m ost serio u s cases (h o s p ita l case) was 6 weeks s h o rte r th an th e am bulatory case , in d ic a tin g a more a c u te , fu lm in atin g , in te n se in to x ic a tio n w ith in a s h o rte r p erio d of time* E a rly h o s p ita liz a tio n pays div id en d s - do n o t h e s it a te or d e la y - p a tie n ts, w ill be g ra te fu l. - funds w ill be saved - r e s u lts w ill be ex c e lle n t* ', K* ' 00 4SS3 ffiE-^ MPL0yi.5El-]T STIPPLING STto'fES TOTAL HO. IRE-EMPLOYMENT EXAM (1959-1943) , t o t a l ,l!n o . s h o w in g s 't 'i p p Lin g eM M ^ent AVERAGE AGE OF STIPPLINU CASES' ' NO*/ `GkOUPS STUDIES ('FROM 16 y r s . - 55 y r s . ) AGE GROUPS SHOWING LARGEST NUMBER OF STIPPLING: ' 21 y r s . - ' - 7 20 y rs . -. 5 27 y r s . - 5- . 31 y rs* `- 4- 1262 62 -(5%) 32 ` 28 PRE-EMPLOYHEN? PCCOPAT1015 OF STIPPLING GASES: 1 STUDENT ' .2 TRUCK DRIVERS ' 1 TELEPHONE OPERATOR " ' 1 ARMY DIS CHARGE ' - 2 TILE MANUFACTURERS " ' ' 1 SILK MANUFACTURER. ' 1 RAILROAD WORKER . . , 1 FERTILIZER .. . ' 1 JEWELER 1 IRON WORKER (UNDERWEIGHT) 1 CERAMIC WORKER 1 CARBORUNDUM (AND PYELITIS) 2 PLUSH MILL WORKERS ' 1 COAL MINER .. 2 BRICK WORKERS (AND PYELITIS) ( l ) ' 2 STEELWORKERS (ONE SYFHILLITIC) ' '1 4 CABLE WORKERS ' 7 COPPER WORKERS (ONE WITH PYELITIS) (ONE WITH NEPHRITIS) 2 A.' S. & R. WORKERS4*SMELTERS (ONE WITH NEPHRITIS) 1 `DETINNING WORKER WITH TERRA COTTA BESIDES 1 PAINTER ' : ' 12 LEAD'WORKERS AND BRICK WORKERS ( l ) COPPER ( l ) iYELHIS (l) . TERRACOTTA (2) A .S.R . - ' SMELTERS (3) 7 NONE'AS- TO OCCUPATIONS, b u t FOLLOWING DISEASES WERE . `FOUND ON PRE-EMPLQYlffiNT EXAMIHWiONS l l AUDITiSti T0 THE ABOVE* .' 3 SYPHILLIS 1 NEPHRITIS AND UNDEESVEIGHT 1 PITUITARY DISFUNCTION 1 UNDERNOURISHMENT K 0014854 - 6- Table 4 confirm s w hat has always been known as a f a c t , namely t h a t th e r e a re many c o n d itio n s , o th e r th a n le a d e x p o s u re , t h a t m ust be c o n sid e re d whenever th is subject is discussed. This tru th is s t i l l not clear to the gnral m edical and le g a l p rofessions. I t i s i n t e r e s t i n g t o observe t h a t no man employed (who had shown pre-employment s tip p lin g ) has up to th e p re s e n t tim e shown a ry in c lin a tio n towards absorption o r in to x ic a tio n . This fa c t has great3y a ssiste d us in our d e s p e ra te employment problem w hich i s common t o a l l in d u s try to d a y , due to conditions beyond our co n tro l. TREATMENT We do n o t employ a n y th in g u n u su al i n o u r tre a tm e n t* We have n o th in g new t o o f f e r . We f e e l , how ever, t h a t i n view o f th e f a c t t h a t d u rin g th e p a st fiv e y e a r s , we have had to t r e a t tw enty lead in to x ic a tio n s and th a t in no case so f a r has th e re re s u lte d any d is a b ility , our procedure in handling such c a se s m ust have some 'm e r it. For t h a t re a so n and only f o r t h a t re a s o n , do I even m ention t h a t fa c t* Does n o t t h i s fh c t prove t h a t th e se cases a re c u ra b le ? I f we can g e t such r e s u l t s so can anyone else* Aiyone who w ish es th e b e s t in fo rm a tio n on tre a tm e n t should c o n s u lt th a t most e x c e lle n t pamphlet re c e n tly p u b lish ed by th e American Public H ealth A sso ciatio n , e n title d "O ccupational Lead Exposure and Lead Poison ing. " This pamphlet can be u tiliz e d as a guide to th e f u lle s t ex ten t and maximum b e n e f i t to a l l concerned. I ag ree w ith a l l t h e i r s u g g e s tio n s , s in c e I have u t i l i z e d them g e n e r a lly i n a l l my c a s e s . I do f e e l i h a t tre a tm e n t i n order to be s a tis fa c to ry must be adm inistered in a d e fin ite s p e c ific manner, o th erw ise i t makes v ery l i t t l e d iff e r e n c e what you employ as th e ra p e u tic agents. . Our g e n eral ro u tin e i s as fo llo w s; DURING ACUTE PHASE;. . 1. HOSPITALIZE . 2 . BED REST (OR AMBULATORY, DEPENDING ON SEVERITY OF PAIN) 3 . ONE OUNCE MAGNESIUM SULFATE EVERY HORNING ON ARISING 4 . TEASPOONFUL TINCTURE BELLADOMA*FHENOBARBITAL MIXTURE Q.4.H.- FOR PAIN - 5.- NARCOTICS SELDOM UTILIZED 6. 10 co.- 20% NEOCAlfiLUCONATE - INTRAVENOUSLY Q .4.H . (3LCWLY) ' 7. 15 GR. NEOCALG-LUCONATE WAFERS OR BONE PHOSPHATE WAFERS ORALLY Q .4.H . 8. WARM WATER BAG OR ELECTRIC PAD FOR ABDOMINAL PAIN 9. DIET HIGH IN CALCIUM AND LOW IN PHOSPHATES 10. COMPLETE,BLOOD'COUNT AND. STIPPLING FOLLOWED BY RED BLOOD COUNT HEMOGLOBIN AND STIPPLING COUNTS EVERY OTHER DAY 11. ESTIMATION OF LEAD IN URINE AND URINALYSIS, FOLLOWED BY OCCASIONAL URINALYSES H 00 OD 5 - 7- TREATMENT (Contd) DURING CONVALESCENT PEASE: ' 1. REGULAR DIET PERMITTED ' 2 , HELD LAXATIVES RECOMMENDED " 3*- CALCIUIi OR BONE FHOSHIATE WAFERS IROVIDED ` -4. IRON AND VITAMIN B COMPLEX TABLETS IROVIDED FOR ANEMIA ' ' ' AND AS TONIC . ' ' ' 5. WARN AGAINST OVERINDULGENCE"0 F ALCOHOLICS, EXPOSURE TO COLDS, ETC. 6. BIIIONTHLY RED BLOOD COUNTS, HEMOGLOBIN, AND STIPPLING COUNTS 7. RETURN TO SOME WORK AS SOON AS FEASIBLE FOR PSYCHOLOGICAL REASONS 8. MAKE SURE COMPENSATION PAYMENTS ARE MADE ON TIME FOR SAME REASON 9 . NO FURTHER EXPOSURE PERMITTED . REMARKS : 1. GLUC.OITAIE INTRAVENOUSLY MUST BE CONTINUED FOP, AT LEAST SEVERAL DAYS AFTER ALL SYMPTOMS OF COLIC SUBSIDE AS SAFETY MEASURE, OTHERWISE PAINS WILL RECUR AND YOU WILL HAVE TO`~START ALL OVER AGAIN. 2 . GLUCONATE ORAL YiAFERS DEFENDING. ON' CONVALESCENCE. 3 . NO IRON PREPARATIONS DURING HOSPITAL STAY-WILL NOT BE UTILIZED. 4 . VITAMINS, MILK AND SPECIAL DIETS ARE QUESTIONABLE AS TO TRUE ' VALUE BUT CAN BE USED WITHOUT ANY ILL-EFFECTS IF ONE SO DESIRES. 5. DELEADING NOT ADVOCATE.D. ' '' " SUMMARY ' 1. DO NOT u n d e re stim a te e f f e c t s o f le a d ex posure t u t f r a n k a t t i t u d e tow ard th e e n tir e problem on th e p a rt o f management and m edical departm ent minimizes th e hazard. 2. P h y sician -in -ch arg e Eiust examine a l l blood counts as completed w ith in 24 h r s . - d e la y may be s e r io u s - th o ro u g h s tu d y m ust be made i n each case and th e fo llo w in g method i s recommended: A. When a b lo o d c o u n t, o r c l i n i c a l s ig n s .,o r b o th s ig n if y a " S u s p ic io u s 11 o r "A b so rp tio n C a se ", a w r i t t e n o rd e r i s im m ediately sent in trip lic a te to general superintendent, departm ent head, and forem an, w ith d e s ig n a tio n 'o f "Watbh C ase", meaning ju s t what i t s ta te s . . . '. ... *. .. ' t B. The same p ro ced u re i s fo llo w e d when a n "Impending" o r tr u e "In to x icatio n Case" is p re s e n t, b u t here we designate our o rd e r a s "Keep-Out C ase", meaning keep Out o f a l l exposure. ` An im m ediate te le p h o n e c a l l t o d ep artm en t h e ad 'a lw ay s p re cedes a r r i v a l o f w r i t t e n o rd e r on same day. ' C. These o rd e rs a re a g a in rep eated in a M onthly M dical Roport t o same members o f management, whoso d u ty i t i s to s e e - to i t t h a t a l l m e d ic al o rd e rs a r e c a r r ie d o u t w ith o u t d e la y . Whero d isc u ssio n of th e case i s requostod by th e management, a con ference i s always arranged b u t th e o rig in a l m edical o rd er s ta n d s u n le s s th e r e i s unanimous a p p ro v a l o f some o th e r p ro cedure* I would lik e to s ta t e a t t h i s p o in t th a t compromise does n o t f i t in to t h i s -type o f w ork and th e m edical d e p a rt ment should adopt a f a i r b u t s te m at titu d e due to th e g re a t 8< SUMMARY (C o n t'd ) re s p o n sib ilitie s involved. D. As soon a s th o c o n d itio n o f th e employee changes t o a s a t i s f a c t o r y l e v e l , t h e LfedEtcal D epartm ent is s u e s a n o th e r o r der to th at effoct. 3. A ll cases must be in absolute control of p lan t physician or surgoon as tho tre a tin g o f those cases req u ires exporionce p e cu liar t o t h i s typo o f exposure. B est r e s u lts w i l l otherw ise n o t bo ob ta in e d . 4. Early h o sp ita lisa tio n im portant. 5. D oleading n o t recommended. 6. Monthly red blood co u n ts, hemoglobin and s tip p lin g e stim a te s. Monthly p h y sica l exam inations. Q uarterly urinalyses. 7. Ho re -e x p o su re p e rm itte d w ith o u t co n sen t o f m ed ical d ep artm en t. 8. Employees must be im pressed w ith im portance of re p o rtin g a l l i l l nesses im m ediately to M edical D epartm ent, so th a t re la tio n sh ip to exposure be a s c e r ta in e d q u ic k ly . I f th e company has no a rra n g e ment to provide m edical caro to th e ir employeos, other than those . co n d itio n s a r is in g out of t h o i r employment, th e n I suggest th a t th o p la n t p h y s ic ia n v i s i t home o f th e s ic k employee f o r th o p u r pose of determ ining th is re la tio n sh ip . I f th is policy is not adopted, i t is easy to soo what dangers arc inherent. 9. Employeos m ust bo educated to t h i s h azard by i n t e l l i g e n t means. 10. Employees must be educated in th e value o f h y g ien ic m easures, such as clean lin ess of hands and body, d en tal c are, frequent change o f working c lo th e s, in g estio n o f s u ffic ie n t and proper foods, s u f f i c i e n t s le e p and r e s t , a s w e ll -as reaso n ab le a b stin en c e from a lc o h o lic s. 11. C entral e atin g places should be e sta b lish e d . Suggest providing employees w ith an e x tra te n m inutes p rio r to e a tin g tin e f o r pur pose o f ^ g e ttin g c le a n e d up*" Suggest a ls o t h a t everyone be com p e lle d to eat in th is c e n tra l c a fe te ria even i f sono a re perm itted t o b r in g t h e i r own fo o d s t o p la n t f o r any s p e c ia l re a so n . : CONCLUSIONS .... - . . . 1. Lead a b so rp tio n and in to x ic a tio n cases should recover w ith no re sulting d isa b ility . . ' 2. No j u s t i f i c a t i o n o f "p o iso n -fe a r-c o m p le x " i n le a d in d u s tr y . 3 . I s in c e r e ly hope t h a t no one w i l l m isu n d e rstan d itry rem arks a s t o th e dangers involved in d ealin g w ith t h i s to x ic m etal, b u t I do ' b e lie v e th a t i t i s about tim e th a t th e le a d in d u stry do som ething, . about th e charges and im plications th a t lead absorption and in to x icatio n are " incurable d isea ses." . 4. I am n o t d e s ir o u s o f u n d e re s tim a tin g i t s p re v a le n c e o r e f f e c ts * b u t on th e o th o r hand, I am m ost an x io u s t o c l e a r away many no tio n s which arc ab so lu tely erroneous and fa ls e . *, K T 001465- 7 - 9- . CONCLUSIONS (C o a t'd) ' . . 5. However, t h i s change, i n thought w i l l only occur i f and when u n i v e rs a l good r e s u lts are ob tain ed in tr e a tin g th e se oases* X would lik e to su g g est th a t th e Lead In d u s trie s .A ssociation check on re s u lts o f t h e i r member companies and where a s s is ta n c e i s needed, arrangem ents be made t o p ro v id e t h i s h e lp w ith a study, by com p e te n t m e d ic al te c h n i c a l c o n s u lta n ts . I sun f a m i l i a r w ith th e f a c t th a t frequent b u lle tin s are published fo r the dissem ination of in fo r m a tio n , b u t i n my o p in io n , t h i s pro ced u re f a l l s s h o rt o f th e . goal to be achieved. 6. I Trould a ls o lik e to su g g est th a t th o se who are c o n sta n tly engaged in the m anufacture of lead and i t s by-products, as w ell as those t h a t a re e n tr u s te d w ith tie d u ty o f p re s e rv in g th e h e a lt h o f em ployees so engaged, make a concerted e f f o r t to p re se n t our views to a l l groups, lay and m edical, so th a t th is propaganda d irected ag ain st th is in d u stry be su ccessfu lly re s is te d on a l l fro n ts a t every opportunity. 7. The p u b lic i s e n t i t l e d t o know o u r view s and i t i s ..pur re s pons I b i l i t y to thorn, a s w e ll as to th e e n tir e w orld, to see th a t they have access to th ese opinions. DR. m , C. YfI LENTZ K 0014658