Document yk48jGJmj9x65ee1yxqvVDr5X

December 28 , 1935 III*. E. R. Aldon . Soeony-Vacuum Oil Company Claim Department 26 Broadway Hew York Res Louis DeBernard Dear Mr* Aldens Your situation in the matter of Louis D e B a m a r d is obviously not an easy one* I have looked over our record and have discussed the matter with Dr. Machle who saw him on several occasions and who corresponded with Dr# St.John* Dr. Machle*s view is that is a psychopathic inferior type and that his record prior to his acute illness demonstrates that this was the case before he received any occupational injury. It is our understanding that Dr* St. John is of the name opinion and that he is prepared to state from his previous experience with the patient that his mental condition as described by him in his last letter was in no wise different from his condition prior to his illness. (In this connection it seems probable that DeBernard*s army record might be available since, according to Dr. Machle, there is every reason to believe that it would substantiate the point of view expressed above.) Dr. Machle*s opinion is that this man will take advantage of any kindness that is shown him and that if he succeeds in receiving undue consideration, he will become more and more of a liability# It Is his feeling that the case should be allowed to take its regular course through the Compensation Court since that would seem to be the only means by which the matter can he settled. Obviously there may be legal or other reasons for avoiding this course* but that Is our best reaction to the problem with which you are faced# Our previous experience does not lead us to expect residual injury from the type of poisoning from which DeBernard .suffered, and in his case there is apparently every reason for believing from clifiical.evidence ffi&fc1SgdhIS0?iti581Sai'!if7o8a1,?aitut l M S W mHhat It tapered off to a normal level substantially in a characteristic manner. With the subsidence of hia acute symptoms he finally returned to what was for him a normal state. Dr* Sheehan*s report indicates that he Is not suffering from lead encephalopathy. In this situation lead analyses come to have only an academic value* The .. Mr. E. R. Alden ) - 2- presence of lead in the tissues of the body does not necessarily mean illness. The illness must be established by clinical examination. It is, therefore, faulty reason ing to regard a lead analysis as a factor In the diagnosis. It has been established in this man*s case that he did have cerebral symptoms as a result of lead absorption. It would not be surprising, therefore, If lead were to be found In his tissues. That is precisely what would be expected from one*a knowledge of the case. On the other hand the finding of lead in the skin by methods which are not too precise, (I am quite familiar with Dr, Gaults work) is almost wholly without sigrifloanee* In the first place we know little about the behavior of the skin as regards lead compounds, V/e do know that its behavior Is somewhat erratic. In the present state of our Information it Is not possible to draw useful conclusions from lead analyses made on the skin by the current methods. If one suspected, that load were an active factor in this nan*s present condition, it vould need to be demonstrated that there was an unusual amount of lead In the 'circulatory blood and in hie excreta. Prom our observations oh this man and frem the period of time which has elapsed since his exposure, I cm quite certain that 310 such finding could bo obtained. Lut as I have pointed out in all m y publications, ever, the finding of load In unusual amounts dobs not, establish a diagnosis. Lead may exist In fairly high, concbiitrations ,ln the body without producing symptoms. Therefbre the1physical findings and the symptoms constitute important items in the inter pretation of a ,patient*s disability. 2here is one other point In connection with this man and with patients of this type, which is a matter 0 1 some interest, -.'e have established that fact that when organic compounds of lead are absorbed Into the nervous system, they tend to remain there in relatively high con centration for indefinite periods of time after all symptoms have disappeared. There is little doubt, therefore, that If one had the means of examining this man *3 central nervous system, abnormal quantities of lead would be found. As an example of this, we had occasion to examine the brain of a man who had had a lead exposure similar in general type to that of DeBernard, and from'which he recovered completely. I knew him and saw him,frequently over a period of eight years, and took care of him In hit final illness which was the result of an acute infection. During this entire period there was not the slightest suggestion of any re currence of his cerebral intoxication, and yet when he died we found a concentration of lead In the brain which was very high. This medns, of course, that lead compounds remain in the braih in an Inactive form and in an essentially Insoluble form, and without producing any Injury for a long tine. You may see from' this how silly it Is to attempt to interpret symptoms on the base's of the lead concentration of a tissue. How It may be that the' skin behaves In some ~P- Hrv:';E* R. Alden manner like the brain in retaining lead for long periods of time. I do not believe this is the case for our experimental results on animals do not give us any reason for believing that the skin behaves in this manner* In fact the only tissue in the body which we have found capable of retaining lead for long periods of time is the central nervous system* However it is possible to imagine circumstances in which the skin might retain moderate quantities of lead for a considerable period after the cessation of exposure* If this should be the case, I can only ask what of it and what relation does it have to the infcerprd&tion of a disability. I have gone to some lengths to explain m y point of view in order to make m y attitude quite . clear. I can only repeat that from the information available in this case, and from our considerable experience with similar cases, I do not believe this man has any disability as a consequence of his acute illness of some years ago. If this case were presented to the Ohio Indus trial. Commission, I should merely state essentially what I have said to you and leave the responsibility for camponsation in their hands. Hot knowing the details of the procedure in your state, I am, of course, unable to give an opinion on the advisability of this same procedure in Connecticut* Very truly yours, RAKfis Robert A. Kehoe, M.D. 0017211