Document peGJXM4DnLwwG6Zx9MZQ25Obj

February ll*., l^Ul Dr. R. H. Kurten 810 Main Street Racine, Wisconsin Dear Doctor Kurten: I h a v ^ j o u r letter of February 5 th. concerning Mr. who is under your case. I think it would be advisable, if I were to explain my point of view concerning the significance of further observations on I may be mistaken, but I am disposed to believe that Mr. Kitto does not fully understand the precise purpose of the recommendation which I made for the investigation of any hazards associated with the operation of the plant in which Mr. ^ B l a n d others are employed. First let me say that I quite approve of making air analyses for the purpose of determining the lead exposure in the atmosphere of the plant. However, our experience in this kind of work has shown that such analyses have to be made with very great care in the selection of the proper site of exposure, and they have to be repeated rather frequently under different operating conditions in order to enable one to determine the cross sectional magnitude of the exposure. For this reason, in connection with jobs of the type that are involved hero, we are quite sure that the study of the lead excretion of representative workmen is more informative and in the long run is actually cheaper to carry out. The reasons for this will be quite clear, I believe, to a medical man. After all, air analyses can only give a general idea of the degree of respiratory exposure associated with various plant operations. They do not tell one exactly what the exposure of the average man is, and unless they are made repeatedly, they do not portray the variability of conditions from hour to hour, or from day to day. Moreover they tell one nothing about the extent of the exposure from swallowing lead as the result of dirty hands, etc. On the other hand, a man who is working every day experience such exposure as is provided during his working hours, and the general magnitude of his exposure is portrayed quite 3- - I shall be able to provide some information which ia actually useful, whereas up to the present, I feel that what I have done on this problem is largely wasted, I realize fully that the question of expenditure on this kind of a problem is an important one, but I always feel badly about questions that are left up in the air because of inadequate information, and in this case I would much prefer to make a number of observations at no additional expense to the management, than to leave this matter in 1 ts present state. Indeed I shall feel that I am amply paid for the additional trouble that we may take In being able to settle the question of the exposure of these slen to my own satisfaction. It Is quite certain that If all or several of these men are absorbing lead in the same degree that Mr. then there is a hazard in the plant which 3houldb^guarded against, and '<*fcich Is very likely to produce trouble. On the other hand, if there Is some unusual factor in Mr. 4 f l M f l H P ^ aae, the facts should be investigated and the nature of the factor should bo established. . .- ____ With specific reference to Mr. and the treatment which he is under going at present, I wish to record my opinion, based on an extensive experimentation with human subjects, that the various methods of attempting to promote increased lead excretion are largely valueless. Moreover, in the interpretation of the magnitude of individual lead exposure, it is desirable to obtain samples of the blood or urine, or both, from an individual over a period of time in which he is conducting himself in a normal physiological manner, that is, on a normal diet and normal activities, with no medication of any kind. If it is possible to modify the rate of lead excretion by means of ammonium chloride, potassium iodide, Vitamin C or various dietary regimes (and I know of no evidence that proves that this is true), then the use of euch medication during the period of Study will be dis advantageous, since all of our data on the interpretation of lead excretion In relation to the magnitude of lead absorption, are based on normal values rather than those obtained under therapeutic measures. Accordingly I would suggest that Mr. he restored to a normal regime for at least a week before the collection of any samples of any kind. In conclusion, I should like to suggest, if you are willing, that you obtain & series of samples of blood and spot samples of urine on a number of these men, and send them along to us for analysis, and He 0005430 k- for an Interpretation of the data. At the same time I should like to have information concerning tne age, the length of employment, the general physical status, and any other Items of useful information concerning the medical history and condition of these men. If these items of information can not be obtained, I would at least like to have the duration of their occupation and presumable lead exposure, plus information as to whether the work has been continuous up to the time of the collection of the samples, ^hat la to say, I should not want more than a few days at least to intervene between the last working day and the day of the collection of the samples. If you are agreeable to this, I shall send you the necessary containers for the collection of the samples, together with detai led instructions for the mamier of collection. Ho doubt you will wish to discuss this whole matter with Mr. Kit to* If it can not be done, I would at least suggest,in connection with Mr. Putney, that we obtain a sample of blood and a sample of urine In accordance with my Instructions. If you will let me know what you can do In this matter, I will be very glad to cooperate with you promptly. Moreover I would be glad If you would assure Mr. Kitto that the question of expense In connection with this work is not an important Item, since, as I have Indicated, I feel that we have left this question in an unsatisfactory state, and I am very anxious to clarify it. Very truly yours, RASE:is Robert A. Kehoe, M.D* H E 0005431 RUSSELL M. KURTEN, M. D. F. A. C. S. SIO MAIN STREET RACINE,WISCONSIN Feb. 5, 1941 Dr. B. A. Kehoe 345 Eesor Ave. Cincinnati, Ohio Dear Doctor Kehoe Li r . Sta fc^and I have been discussing the status of M r . who has been on a deleting regimen for the last three or four weeks. You are acquainted with the findings in this case. Examinations of five other men (two of whom do exactly the same work as Mr. Putney and the other three from the immediate vicinity) reveal no evidence of lead absorption. *7e have attempted to ascertain the absorption of lead from other sources but find none. tfe are having air samples done to find the concentration of lead in the atmosphere. It was suggested that we have you run thru a blood, urine and feces, taken simultaneously or as you might suggest. If you think this would draw any ad ditional light on his status, we will be happy in carrying out your instructions and forwarding such specimens to you For your information, he is on a regimen of high vitamin c intake, acid-base diet and ammonium chloride to increase the acid balance, and periods of high calcium intake. Thank you for your cooperation. SMM* CH tfE O O P 54.>2 B. M. KUBIEI7, M. D