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UNITED STATES ARMED FORCES MEDICAL JOURNAL 2300 E STREET, N. W. WASHINGTON 25. D. C. 8 August I960 Robert y. Kehoe, M.D. " Department of Preventive Medicine & Industrial Health The Kettering Laboratory University of Cincinnati College of Medicine Cincinnati 19, Ohio Dear D r. Kehoe: Thank you for your letter of 3 August 1960 appraising the article,' "Outbreak of Lead Poisoning Caused by Tetraethyl Lead," by Captain Serlang, which had been submitted for publication in the U. S. Armed Forces Medical Journal. On behalf of the editors, I wish to express my appreciation for your assistance in reviewing this manuscript. Sincerely, , /> - . f} MAY HERMAN, M.D Associate Editor /mg N 6310 r: A ugust 3, I960 xxxxxxxx Avon 1-2568 May Sherm an, M .D , E ditorial O ffice United States A rm ed F o r c e s M edical Journal 230d E S treet, N ,W . W ashington 25, D. C. - - D ear D octor Sherman: I regret that I have been so long in getting to the exam ination of Captain Schlang's paper on T etraethyl Lead P oisoning. Unfortunately, the T hirteenth International C on gress on Industrial Health in New York carn on the h eels of m y return from a m issio n abroad, and there has , been) no tim e until now to look th e paper over. T his paper m ay w ell be published, I b eliev e, in order to acquaint oth ers with the sig n ifica n ce of the exposure to leaded gasolin e which g a v e th e r e s u lts d escrib ed in th is p ap er. It should be m o d ified , h o w ev er, In m y op in ion , to do ju s t th is . A s a r ep o rt of c a s e s it is s a tis fa c to r y and p sefu l. A s a d iscu ssion of the problem or se r ie s of problem s a sso c ia te d with the gen eral d istribu tion and u se of gasolin e containing tetraethyl lead, it lea v es v ery much to be d esired . M oreover, the handling of the diagnostic a sp ects of tetraethyl lead poisoning is not clea r b ecau se the author confuses a num ber of the facts and issu es of th esb c a s e s with th ose a sso c ia te d with poisoning induced by the inorganic com pounds of lead. He in itia te s th is at the ou tset by h is title which should be "An Outbreak of T etraethyl Lead Poisoning. " T here are c er ta in things in com m on in the two se ts of con d ition s, but the im portant point is really that tetraethyl lead poisoning d iffers significan tly from in o rg a n ic lead poison in g at a lm o st e v er y im p ortant point* b e c a u se of the nature of the distribution and ultim ate fa te of tetraethyl lead in the body. Captain Schlang eith er does not know th is, or he does not r ea lize its im portance in diagnosi s, prognosis and therapy. I needi not go into the d eta ils a t th is poin t, but rath er illu str a te m y points by sp ecific exam ples: 1. D r. Schlang should not have attem pted to d isc u ss the hazards a s s o c ia te d w ith the u s e of te tr a e th y l lead (page 1) without sep aratin g them (Completely fro m occupational lead poisoning in g en era l. It is true that the tetraeth yl lead industry has con trolled the exp osu re to this compound, but the im plication that exposure to lead in industry generally Sherm an, M .D . - (?) - A ugust 3, I960 heen con trolled , is very far from being tru e, Lead poisoning is I til m o s t fr e q u e n t p is e a se . in A m e r ic a n in d u s tr y . . * ' /' . ' The general d iscu ssio n of tetraethyl lead poisoning has been done ;tter e lse w h e r e. Captain Schlang should d escrib e has own c a se s, hich do not co v er the en tire field , and let it go at that, instead of s sum ing to co v er the subject, 3. The d iscu ssio n of the diagnosis is not sa tisfa cto ry , esp ecia lly on / page 11, in which m any irrelev a n t statem en ts a re m ade. The effect of ib is d iscu ssio n is confusing, and v irtu a lly a ll of page 11 should be j d eleted . Since the le v e l of lead concentration in the blood does not in crea se in any relation to the absorption of tetraeth yl lead (as it does so n ic e ly in a sso cia tio n with the absorption of inorganic lead ), the statem ents about the lead in the blood a re confusing. /' l i k e w i s e th e s ta t e m e n t s a b o u t !* stip p lin g ,, w h ich n e v e r o c c u r s in resp on se to the absorption of tetraeth yl lead , a s w ell as m uch of the rem ain d er of th e d isc u ssio n on page 12 does not contribute to cla rity . A gain Captain Schlang does not r e a liz e th e d ifferen ce betw een tetraeth yl lead poisoning and inorganic lead poisoning, from the physiologic and diagnostic view points. So m uch fo r m jy c r itic ism , at th is tim e* X repeat that this a rtic le should b e published a fter it has been lim ited to the sim p le function of c a se reporting*. I tru st that x x iy c r itic ism s w ill not seem to be unduly h arsh . I do not m ean them tp be so . Captain Schlang is to be congratulated on h is effort to p u b licize th is situ ation . It is only in evitab le that he would fa il to v is u a liz e th is en tire p rob lem which has b een under exam in ation fo r th irty odd Wears w ithout b ein g fu lly rep o rted . He should not a ttem p t the im p o ssib le, but should sim p ly report h is ob servation s. / Sincerely yours. RAK ef / Enc / R obert A , X ehoe, M .D . / July 5, I960' Dr. May Sherman . , U- S* Armed Forces Medical Journal 300 e Street, K-W. . Washington 25, D.C. Bear Doctor Sherman* /Your request for criticism of Captain Benry A. Schlang1!s arti.. c of Lead ' by Dr, Robert A. om the country. *4* fcsiicm. v .... ttention when he returns on July 14th. Very truly yours, "W'i i - -W Wn Vs i ' / ( / :/;i - W g 9;: A;#/*'/;! N 6310.02 /; UNITED STATES ARMED FORCES MEDICAL JOURNAL 2300 E STREET, N, W. WASHINGTON 25, D. C. 29 June 1960 Robert A. Kehoe, M.Dw Department of Preventive Medicine & Industrial Health The Kettering Laboratory University of Cincinnati College of Medicine Cincinnati 19, Ohio Dear Dr. Kehoe: Because of your contributions to the medical services of the Depar tment of Defense and your special knowledge in the field involved, an praisal of the suitability of the following article which has been subraitted for possible publication in the U.S. Armed Forces Medical Jourlial will be appreciated: "Outbreak of Lead Poisoning Caused by Tetraethyl Lead" by Captain Henry A. Schlang. Your frank criticism is invited to include reasons why you iconsider that the article is suitable for publication after routine editing, is unsu itable in whole or in part, or might be acceptable after proper re visib:in. It would be of particular interest to know your opiniorj as to the ignificance and timeliness of the subject and the technical accuracy of the article. Please do not fold, edit, or make marginal notes on the manuscript, Your name will not be used in any correspondence with the author. A self-addressed envelope, requiring no postage, is enclosed for your convenience. Thank you for your continued interest in our publication. Sincerely, 2 Ends 1. Manuscript 2. Return Envelope /h j THE EDITORS N 6310.03