Document x5915ZOwBLQQbyK90GzdL2gBb

"N o r w o o d " BRAN D 7 0 DUPLICATE ,THIS FOLDER ORDER NO. 91-1/3 M A D E IN U. 5 . A. CO oo tet N19307 K ettering Laboratory, College of M edicine Eden Avenue, C in cin n ati 19, Ohio. POSTING DATE INVOICE DATE JV 16 54 NOV/ 0 REF. NO. OR AMOUNT OF INVOICE DISCOUNT AND ALLOWANCES 2 5 .0 0 NET PAYMENT 2 5 .0 0 Reimbursement o f th e K e tte rin g L ab o rato ry fo:T s e r v ic e s o f Robe:r t A. Kehoe, i.D . i n th e cai,se o f vs N a tio n a l Lead Co* it w ith *h a sequel ble m e e is me, as ie n an >n th e e ith e r upon rhage as re su lt of i effects :ts .) i d eter io ra tin g e disease lat both STHlOGHAPH. INC. CHICAGO A T T A C H E D C H E C K IS IN S E T T L E M E N T O F ITE MS L I S T E D IF N O T C O R R E C T . RETU RN AT O N C E . 1, o f th e Issum e, tw enty lad the ria l whicl issu m e th r vital ux of the cal basis I O ther- \ KiT 0016431 National Lead Company900 W. 18th S treet * Chicago, Illinois -j ' V * - r-.-I'.f; . .... . ^ - ' * D ear M r, -W ickem eyer: I have gone over the inform ation on which you sent with your le tte r of N ovem ber 8, and I b elieve that you are dealing with a case w hich.aim oat certain ly, w ill be regarded as a com pensable sequel of lead absorption.. I do not have the inform ation that w ould enable m e to be e n tir e ly c e r ta in cf th e c o r r e c tn e s s o f th is op in ion , but th e r e is nothing in the m a teria l which you have sen t m e that would enable m e, as your m edical ad visor, to te ll you how to com bat the opinion of the ophthalm ologist that this m an's optic atrophy m ay w ell have been an exp ression of the toxic effects of lead . This opinion is founded on the fact that a sufficient absorption of lead m ay cause optic atrophy, either by d irect action on the nervous tissu e or through indirect effects upon the r eg io n a l blood v e s s e l s . {I h ave se e n b ila te r a l r e tin a l h em orrh age a s the principal lesio n in lead poisoning, and although the eventual resu lt of such hem orrhage d iffers in detail from that described h ere, such effects on other lo ca l blood v e s s e ls can bring about m uch the sam e e ffe c t s .) . F o r this rea so n , in com batting a cla im of this type, or rather in d eter m ining the facts in the c se , one is put to the n e c e ssity of dem onstrating either that th ere w as no significant absorption of lead , or that the d isea se was caused by som e other definitely dem onstrable d isea se, p r that both of these facts w ere true. A s to the fir s t of th ese p o ssib ilities, I know nothing,at fir st hand, of the f s e v e r it y o f th is m an *se x p o su r e to le a d in h is w ork, but I m u st a s s u m e , >- from som e fam iliarity with the lead trades,- that during the p ast tw enty ; y ea rs in w hich he is sa id to have been working at a fu rn ace, he had the opportunity to absorb a considerable am ount of lead . (The m aterial which you have sen t m e does not go into this properly, and one would a ssu m e th a t none of the physicians has any definitive inform ation on this very vital m a tte r . 1 cam o n ly a s k w hy tills i s not s e e n b y th em to be th e c ru x o f the c a se . It d oes not appear that you r Company had any sound m ed ical b a sis fo r th e a p p r a is a l o f t h e - s e v e r it y o f th e e x p o s u r e w ith in th e plant; - Other- , 2 fi '.j -iOi' . . ? I . - . . . 0016432 ;llj^ l; le a d ; ^ ,:ahnlytiehJ.;'m e ^ n s, :; A p p a ren tly both t h e ; u r in e and the blood w e r e a n a ly s e d , th e la tt e r o n Ju ly .14 {day,of rep o rtin g ). I know nothing of the an alyst o r the m ethods of a n a ly sis, .The resu lts , obtained, how ever, if taken at their fa ce value, show that Mr. Brooks had absorbed dangerous quantities of lead. Of particular im portance is the result on the blood. The concentration of 0 .1 0 m g. per 100 gram s (given as 0 . 1Q0 m g m . %-in D r . Sym m es* r ep o rt), if c o r r e c t, i s su ch a s to ju s tify the diagnosis of lead poisoning in the p resen ce of a lesio n or lesio n s which a re com patible with the effects of lead absorption. (The norm al range is 0 .0 1 to 0 . 06-f, and anything above 0 .0 8 is p oten tially dan gerous.) It is sim ply not p o ssib le, under th ese circu m stan ces, to sa y that lead had nothing to do with the optic atrophy. - 1 su sp ect that it did not, but th ere is nothing by w ay o f ev id en ce.to support th is opinion in this c a s e . In su m m ary, then, with resp ect to the sev erity of the exposure to lead, the facts are not en tirely adequate, but from the inform ation which has been developed, it is n ecessa ry for m e to conclude that M r. 4H H R M w as exposed to lead in h is work, and that he absorbed lead to an extent that was potentially hazardous. If you have any evid en ce to ind icate that th is .was not the c a se , you should bring it out. I should ad vise you, at this point, that if the data on the m en in this resp ect a re the findings on the stippling of the red blood corp u scles, you .may ju st a s w e ll fo r g e t about th eir e x iste n c e . A s an an sw er to th is question, or to any other im portant aspect o f the effective m odern m edical control of the hygienic situation in the'hazardous lead trad es, this procedure is ob solete, and in any m odern m edico~legal hearing in this country such reports are not worth paper on which they a re w ritten. This brings us to the consideration o f the nature of M r.M jH H J | illn e s s . The origin al report of D r. A lv is says ca teg o rica lly that tfi^ d isea se of the .eyes was not ind ustrial, and it is evident that D r. A lv is b elieved , a s did D r. H aggard (who is sa id by D r., H arger, in h is sum m ary,' to be the plant physician), that i t was syphilitic in origin . Subsequently, D r. A lvis (letter - , - of Hall Cochrane, N ovem ber 3, 1954) is said to have adm itted that the optic . ; atrophy could have been due to lea d absorption. ,{Just why this factor was not considered by both D rs. Haggard and A lv is at the tim e the lesio n s of : optic atrophy w ere fir s t discovered, is incom prehensible to m e. This was the tim e to determ ine th e.extent of the em p loyee's absorption of lead. This . was a lso the tim e to institute treatm ent to p reserv e as m uch,of the patient's vision as p o ssib le, and if the therapy for syphilis had turned out to be KS 0016433 optic atrophy is not due to the syp h ilis, and thus we are left with chronic lead poisoning a s the cau se. This conclusion m ay or m ay not be true, but it is plau sible, it cannot be disproved, and, in m y opinion, you are inescapably stuck with it. , Cordially yours. RAK ef C. C. : M r. E. G. Kestenbaum Enc. Robert A .. Kehoe, M. D. . -iKi K 0016434 humane reaction to a tragic situation, is that this man was perm itted to work in a job involving hazardous absorption of lead until he w as alm o st lite r a lly blind with optic atrophy. If th is is preventive m edicine in . i ndustry, it barks back to the dark a g e s . Such a thing m ight happen, perhaps, a s the resu lt of som e failu re to recogn ise the existen ce of a serio u s exposure to lead in the m id st of a m anufacturing activity in which lead v/as on ly a m in or en gred ien t. It m igh t happen in a o n e -h o r se plant in which inexp erien ced o r ir resp o n sib le and ignorant people w ere operating in disregard of a potential hazard. But that it should happen to an em ployee of a large and w ell known Company, lik e National Lead, is a lm o s t in c r e d ib le . It.is then an e v id e n c e o f g r o s s in co m p eten ce on the pari: of so m e r e s p o n sib le p e r so n o r p e r s o n s . I am not saying this because I b elieve, n ecessa rily , that the optic atrophy resulted from lead absorption. I suspect from tie description of the eyes that it was the resu lt of d ise a se of the blood v e ss e ls of the eye. But no m an w hose vision is failin g in this m anner should be subjected to the risk of dangerous absorption of lead, whether the risk is that of the man as to h is v isio n and health., or w hether if is that of your Company a s to its lia b ility . M ed ical s u p e r v isio n o f a p o te n tia lly h azard ou s le a d plant in v o lv e s -r the n e c e s s ity , as a m atter o f p ro fessio n a l duty and com petence, to know the extent of the haaard of lead absorption of the people in the plant, to know the. , p recise extent to which each job involves the likelihood of lead absorption, . - and to know the ph ysical status of the individuals, in relation to the .- character and the w ear and tear, as w ell a s the hazards, of their job. ,4j_, N othing l e s s than th is typ e o f m e d ic a l su p e r v isio n w ill p r o te c t y o u r p eo p le *' ' t and p rotect your Com pany's position, and it is quite clear that the tim e is -, near when your Company w ill not be able to accept the financial risk . a sso cia ted with le s s than effective m edical and hygienic supervisiez!. I take advantage of this rather critica l situation to point this out, sin ce th ese a r e the only opportunities that present th em selves to industry to learn from , th e ir m is ta k e s w hat not to d o . If that s e e m s to he u n fa ir, I a s k y o u to r em in d ' '? y o u r s e lf , if n e c e s s a r y , {and I h a r d ly think it is n e c e s s a r y ) that m y c o n c e r n ", with this m atter has com e out of long and som etim es painful experience, and that it a r ise s out of a profound in terest in the w ell being of A m erican indus tr y and a ju stifiab le pride in its accom p lish m en ts, because of which I am a ll the mor^ sen sitive to its faults. KF 0016435 To: N ational Lead Com pany 900 W. 18th .Street C hicago, Illinois A ttention: M r. C. W ic& em eyer G eneral Superintendent >or: R eim bursem ent of the K ettering L aboratory for Se: ' :t A . K ehoe, M . D. in th e c a s e of vs N ational Lead. Com pany S 2 5 .Q 0 KE 0016437