Document ym073oE8EddDQE5mbn5nnYgO4

WILLARD MACH LE, M. D. 61 PARK A V E N U E NEW YORK 2 1, N. Y. 7 February 1946. SUBJECT: Memorandum on Meeting at Lead Industries Association llOQhrs 7 Feb 45. TO: Dr. Bobert A. Kehoe 1. Present:- Mr. F. F. Colcord Vice-?res ident Mr. Drew Fletcher Yice-President Dr. William C. Silentz Ur. Felix Yiormser Dr. Joseph Aub Dr. Willard Machie Dr. A. J. Lanza Dr. Carl Peterson Mr. Phillip Drinker Mr. Clinton Crane President Mr. Earl W. Webb President U. S. Smelting and Befining Company St. Joseph Lead Company National Lead Company Lead Industries Association Harvard Medical School Ethyl Corporation Metropolitan Life Insurance Company American Medical Association Harvard. School of Public Health St. Joseph Lead Company (Luncheon) Ethyl Corporation (Luncheon) 2, Wormser elaborated on misinformation existing with respect to lead intoxic ation and hazards, pointing'out frequent general lack of medical knowledge on the subject:--- volume of Cantarow and Trumper being cited as an example. 3. After much discussion, mainly by medical contingent, it was decided that a systematic program of education through professional channels was indicated. Peterson stated that the Council is interisted in any such teaching program and suggested that it begin with a Symposium at the next Congress on Industrial Health, vihich, it is hoped, can be held in Boston in October, but may have to he moved to Atlantic City because of space requirements (anticipated attendance 1000 to 1500). 4. It was suggested that the Symposium deal with all heavy metals, lead being used as prototype and example. It was finally agreed that the general program would consist of a series of authoritative papers dealing with aspects of the diagnosis of plumbism, and a concluding paper summarizing diagnosis and management of eases. 5. The entire meeting was marked by a considerable lack of realism, and an evidence of a certain lack of comprehension of what one did to educate doctors. Ho consideration was given to the very essential role of research in providing the facts for an educational program or for validation and clarification of the material that is to be taught. It is the observer's opinion that Lead Industries Association suffers from lack of good medical advice to assist them in defining their problems, carrying out a research program, and translation of results into practices and information for dissemination. Copy to Mr. John C. Schafer KE 0014530 2 He said that the Lead Industries Association m s prepared to cooperate fully in any joint program and could supply background information which would educate the doctors to a broad view of where lead is used with public exposure rmd where it would not be found, and so save doctors the embarrassment at times of making diagnosis of lead poisoning when obviously lead was not in volved. He said that, after all, the Lead Industries Association would have to take its cue from the American Medical Association in cooperating in the symposium and that he suggested Dr. Peterson take the chair and preside over the meeting so that the entire problem could be explored by those present. Dr. Peterson then took the chair and said he felt that the discussion witii the Lead Industries Association had convinced him there was a fine oppor tunity for the American Medical Association and the Lead Industries Association to perform an educational service for the doctors which would be useful to the profession and to the public. Ho felt that the symposium should bo undor the joint sponsorship of the two organizations. He invited suggestions of the group as to what would be the best scope of a program and the best procedure to follow. Dr. Machle felt it was desirable to crystalize the nature of the prob lem before we could attempt to solve it. He ventured the thought that it was desirable to inject fresh information in the symposium rather than to rehash existing material and that perhaps a distinction should be made between the question of occupational exposure and public exposure to lead. Mr. Fletcher was reminded of St. Joseph Lead Company's experience at Josephtown, Pa. where prospective employees shunned employment because they understood it was operated by the St. Joseph Lead Company and assumed it was lead whereas theoperation was entirely zinc oxide production. Dr. Wilentz said he had discovered a difference of opinion among doc tors who had read a paper he had submitted recently for publication in a medi cal journal, which emphasized the need of some clarification oi viewpoint. Mr* Drinker recalled the days of Alice Hamilton who had found no hazard in the handling of lead sulphide in the mining of lead ores whereas the U. S* Public Health Service standards today establish a universal tolerance for lead that was difficult to meet particularly in mining. He said that industry could supply a lot of data on the handling of lead concentrates that might be interesting to a symposium and perhaps lead to a change in Government view point on lead tolerances. Mr. Fletcher said it was important to develop the thought that trhere the lead hazard occur it could be controlled and also that lead poisoning was readily curable. Dr. Aub felt that currently it was of the greatest importance for doc tors to understand: (a) how to make a diagnosis for load poisoning, and (b) how to treat lead poisoning. 3- He said it was extremely important to make an early diagnosis of the disease otherwise a determination months later was purely guess work. It was import ant to develop the amount of exposure and to obtain quantitative data accurate ly on the urine and blood. Dr. Peterson said that the enrollment at the Annual Congress on Indus trial Health would likely reach 800 to 1,000 persons, but not all of these would be physicians, and he hardly expected that all of them would attend a lead symposium. Dr. Peterson conferred with Mr. Drinker as to the possibility of holding it in Boston in cooperation with the School of Public Health. Mr. Drinker thought this was an excellent idea and felt sure that the Harvard authorities would be pleased to cooperate. Dr. Aub thought it would be desirable not to place the emphasis alto gether on lead at the symposium but merely to use lead as a 'prototype of all metal poisoning inasmuch as all heavy metals acted closely alike in their toxic effects. Mr. Drinker felt it was desirable to consider some means of educating community medical centers to disseminate whatever information is obtained by word of mouth through appearances before medical groups in industrial areas, particularly where knowledge of lead was fragmentary at the best* Mr. Colcord brought up the question of the unethical doctor and admitted that he was difficult to control. ' Dr. Aub thought more trouble arises from inaccurate analyses of lead in the urine and blood than from any other single source of diagnosis. He said he himself did not realize until recently that the American public Health Association had/a companion volume of its Committee report on Occupational Lead Exposure and Lead Poisoning, outlining, "Methods for Determining Lead in Air and in Biological Materials." He also thought it might be wise to consider ultimately stimulating the establishment of centers for accurate analytical work on metals throughout the United States. Mr. Wormser called attention to the inaccurate analyses he had re cently observed in an investigation of alleged lead poisoning in infants in Boston, whore the work had been done by Massachusetts Institute of Technology and found to' bo faulty. . Dr. Aub recalled a similar experience in a recent murder case where a local diagnosis had proven to be unsubstantiated when submitted to the U.S. Public Health Service for dotormination. Dr. Machlo agreed that tho emphasis on tho proposod symposium might woll start with a consideration of an accurate diagnosis. Dr. Petorson thought the symposium should not bo confined to occupa tional exposures but should go into the question of public exposure as well. Dr. Wilontz described Mr. Wormser*s roccnt appearance before a group of medical men at the New Rocholle Hospital, which ho considered enlightening. -4 Mr. 'stormser said that this experience had indicated to him that in a repre sentative high class community such as New Rochelle the need, of education among the doctors was quite apparent and that he hoped that the work of this symposium, if spread around the country, would help to prevent inaccurate diagnosis of lead poisoning among children and others. He said that his ex perience with some of the articles which had appeared in the Journal of the A.M.Ai, particularly that of Dr. Yfilliams on Chronic Lead Poisoning, and Dr* Rathmell of Norristown, Pa* on an acute attack of lead poisonirg in a child from squeezing orange juice into an aluminum cup, had shown that one doctor was prone to build on the faulty premise of another, without careful investi gation of his premises. Dr* Machle thought it was important in a symposium not to make them too long drawn out, that the average doctor was too pressed for time to read any encyclopedical observation, that whatever was presented should be summa rized so as to be of greatest use to the profession at large. Dr. Peterson thought that a start might be made by having the Lead Industries Association prepare a paper on the general subject of the occur rence of lead in the United States so as to give the doctors a background on the subject and express industry's viewpoint. Mr. Wormser agreed to under take this task. Dr. Peterson thought the symposium might treat of: (1) The occurrence of lead poisoning, (2) The diagnosis of lead poisoning, and , (3) Management of lead poisoning cases. Dr. Aub questioned whether diagnosis could be covered satisfactorily in one session, that It was important to get specialists on each element in the problem for example, one man on blood, etc., and that it might be desira ble to have a series of papers on the subject. Dr, .Machle thought it might be well to have a series of authorities on the subject. Dr. Aub said that lead was not very toxic. Apparently every metal with an insoluble phosphate had some toxic properties. He again emphasised his feeling that the key note of the symposium should be that lead was merely a prototype and that the entire approach might well be expanded to cover all the heavy metals * Dr* Machle thought that in lead poisoning it was essential (1) to have a history of the exposure, (2) accurate diagnosis,, and ' (3) confirmatory laboratory findings* - 5- He summarized, his views as follows: 1 That an educational program must be backed up by a systematic research program closely related to it* 2. Plans for such program should emerge from deliberations- of people with knowledge of the lead industry, research, and the medical profession; the direction the research takes not being determined entirely by those who will prosecute it. Mr. Drinker echoed Dr. Aub's comments about lead and felt that the metal had been kicked around unnecessarily and that it was a good time to correct this situation. -- Mr. Wormser suggested that the . S. Public Health Service be called in to play a prominent part in the symposium as it possesses a vast amount of experience on both occupational problems involved and also on the question of measuring the public hazard of metal poisoning. Dr. Peterson summarized the meeting by stating: (1) It was the understanding of the group that a series of symposiums on metal poisoning, with initial attention to lead as a prototype for metal poisoning, was highly desirable. (2) The original meeting would be the joint effort of the American Medical Association, Lead Industries Association, U.S. Public Health Service, and the American Public Health Association as cooperating agencies. (3) That a full day might be devoted to aspects of the lead problem as outlined at the meeting, particularly the diagnosis and the management of lead cases. (4) The Lead Industries Association would be called upon to present the industry's side of the problem with background information. (5) Some papers might be submitted on occupational experiences. (6) A series of papers on diagnosis and clinical management should be prepared* Dr. Peterson inquired as to the suitability of creating a heavy metals committee which would act as consultants to the Council on Industrial Health in this field and which would call upon existing committees such as that on lead poisoning of the American Public Health'Association to define the total problem. Dr. Peterson said he would investigate the possibility of holding the meeting in Boston, and if not an effort would be made to go to Atlantic City, and finally that he would work with the Secretary of the Lead Industries Association in outlining a program which could be submitted to this samo group for disoussion and comment.