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RECEIVED APR 30 1924 April 29, 1924. Mr. H. B. Viedt, United States Radium Corporation, 422 Alden Street, Orange, N. J. UNITED STATES RAGIUM DORP: My dear Mr. Viedt: I have been able to obtain an impartial opinion on Dr. Barry's abilities and training and find them excellent. We may, therefore, give his opinions as to the cases a good deal of credence. From material which we have been able to dig out of the literature here and piece together with your experiences in Newark it would seem that radium is the probable cause of the trouble. We have not been able to find any direct cases of bone necrosis from exposure to radium, but we have, curiously enough, discovered several instances of bone necrosis due to X-ray. You will remember that Dr. Barry thought he showed us changes in the bone of the jaws of Miss Smith and of Miss Schaub, individuals who had not had teeth pulled. I am fortunate in being able to get here most excellent opinions upon the X-rays of these cases which Dr. Barry has sent me. It seems to us that if radium affects the bones of the jaw in individuals whose teeth have not been pulled it should affect other bones in the body -- at least to some degree -- and the most likely area in the case of all your workers is the hands. I have communicated with Dr. H. L. Alexander, 1019 Broad Street, Newark, who is an extraordinarily able and reliable person with whom I have been -2- APR 30 1924 associated during the past year in work for the New Jersey Zinc Company, and have asked him to make X-rays of the hands of the individuals you bring to him. I enclose a copy of my note. I recognize, of course, the need to move cautiously in the matter, UNITED STATES but it would be a great help to us if you could have X-ray RADIUM CORP. photographs made of the hands of your chemist and his assistant, of your forelady, Miss Smith, and of any of the other girls at the work whom you can trust and whom you can induce to make the trip. If we can have three or four others it will be a boon to our needs. Also, I should like it very much if you would induce Dr. Lehman to go. If you telephone to Dr. Alexander he will be ready to make appointments at your convenience. There seem to be two possibilities in regard to the radium: first, that the rays are causing the damage; and, secondly, that radium itself, absorbed in minute quantities through the skin over long periods of time, is deposited in the bones. Since it apparently behaves like calcium this point of deposition seems highly probable to us. Once deposited in the bones, my associates who have been working with radium feel that it might exist for a good while and continue to slowly exert harm. You will recollect that I felt that in the case of the jaw necrosis cases what had occurred was that something had interfered with the nutrition of the jaw bones, cutting off the blood supply and leaving a devitalized tissue. Dr. Barry's X-rays show areas of rarefication which would occur if bone died and was slowly absorbed. When, in the case of the jaw, such devitalized bone is exposed to the action of the mouth bacteria -3- MEOPIVED APR 30 1924 it is non-resistent -- simply rots away. Lacking this exposure it would probably exist for years as a somewhat porous and weskened structure but not necessarily the cause of any trouble. UNITED STATES Should such an idea be correct you will see at once that changes RADIUM CORP. of the sort shown in Dr. Barry's X-rays should appear in the bones of the hands. I trust that this explanation will suffice to show the importance of getting the X-rays we desire. You will recollect that the Life Extension Institute found nothing in their examinations which indicated the possibility of industrial poisoning. There is a certain amount of indication that this opinion was given without a proper appreciation of the possibilities. We find, in reports published from England, that radium workers show an increase in the lymphocytic cells of the blood 88 an early symptom of generalized damage from radium. It is a curious fact that this finding in the blood was reported in several of your girls by the Life Extension Institute and that the possible cause of it was not understood. Indeed, the Institute simply indicated that the findings should be watched further. When we join forces with you next week we shall wish to take blood specimens (this will simply be a minute drop of blood from the skin) from as many of the people who are working in your plant as we can get hold of, including those who are directly exposed to Undark and those who are not. We shall then chase down this finding with particular care. We shall want to see Miss Carlo again, and if it is possible for you to obtain X-ray plates of her hands they will be of the greatest value to us. Since the taking of an X-ray photograph is but the matter of a MEOPIVED APR 30 1924 moment I should think you would have no difficulty in arranging this. We will arrive at the Robert Treat Hotel late Tuesday evening next, and will wait there until we hear from you UNITED STATES Wednesday morning. Our program for the next couple days will RADIUM CORP. follow out whatever arrangements you have made -- that is, we know that we must chase down Mrs. Kuser, we shall want to get our blood specimens, we shall want to see Dr. Alexander's X-rays, and we shall want to go again to the plant. Under separate cover I am sending you some dental X-ray films. I wish that you would place these here and there in the room where the girls are doing the painting. It is desirable to find out whether they fog. I should suggest doing this during three or four days before we come and leaving the films in place until we get there. I am sending a copy of this letter to Mr. Roeder and hope any you will write me at once if there is part of it which is not clear. Very sincerely yours, Cecil K. Drinker, M.D.

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    "ocrText": "RECEIVED APR 30 1924\nApril 29, 1924.\nMr. H. B. Viedt,\nUnited States Radium Corporation,\n422 Alden Street, Orange, N. J.\nUNITED STATES\nRAGIUM DORP:\nMy dear Mr. Viedt:\nI have been able to obtain an impartial opinion on Dr. Barry's\nabilities and training and find them excellent. We may, therefore,\ngive his opinions as to the cases a good deal of credence.\nFrom material which we have been able to dig out of the\nliterature here and piece together with your experiences in\nNewark it would seem that radium is the probable cause of the\ntrouble. We have not been able to find any direct cases of\nbone necrosis from exposure to radium, but we have, curiously\nenough, discovered several instances of bone necrosis due to\nX-ray. You will remember that Dr. Barry thought he showed us\nchanges in the bone of the jaws of Miss Smith and of Miss Schaub,\nindividuals who had not had teeth pulled. I am fortunate in\nbeing able to get here most excellent opinions upon the X-rays\nof these cases which Dr. Barry has sent me. It seems to us that\nif radium affects the bones of the jaw in individuals whose teeth\nhave not been pulled it should affect other bones in the body --\nat least to some degree -- and the most likely area in the case of\nall your workers is the hands. I have communicated with\nDr. H. L. Alexander, 1019 Broad Street, Newark, who is an\nextraordinarily able and reliable person with whom I have been\n-2-\nAPR 30 1924\nassociated during the past year in work for the New Jersey Zinc\nCompany, and have asked him to make X-rays of the hands of the\nindividuals you bring to him. I enclose a copy of my note. I\nrecognize, of course, the need to move cautiously in the matter, UNITED STATES\nbut it would be a great help to us if you could have X-ray\nRADIUM CORP.\nphotographs made of the hands of your chemist and his assistant,\nof your forelady, Miss Smith, and of any of the other girls at\nthe work whom you can trust and whom you can induce to make the\ntrip. If we can have three or four others it will be a boon\nto our needs. Also, I should like it very much if you would\ninduce Dr. Lehman to go. If you telephone to Dr. Alexander he\nwill be ready to make appointments at your convenience.\nThere seem to be two possibilities in regard to the\nradium: first, that the rays are causing the damage; and,\nsecondly, that radium itself, absorbed in minute quantities\nthrough the skin over long periods of time, is deposited in\nthe bones. Since it apparently behaves like calcium this point\nof deposition seems highly probable to us. Once deposited in\nthe bones, my associates who have been working with radium feel\nthat it might exist for a good while and continue to slowly\nexert harm. You will recollect that I felt that in the case of\nthe jaw necrosis cases what had occurred was that something had\ninterfered with the nutrition of the jaw bones, cutting off the\nblood supply and leaving a devitalized tissue. Dr. Barry's\nX-rays show areas of rarefication which would occur if bone died\nand was slowly absorbed. When, in the case of the jaw, such\ndevitalized bone is exposed to the action of the mouth bacteria\n-3-\nMEOPIVED\nAPR 30 1924\nit is non-resistent -- simply rots away. Lacking this exposure\nit would probably exist for years as a somewhat porous and\nweskened structure but not necessarily the cause of any trouble.\nUNITED STATES\nShould such an idea be correct you will see at once that changes RADIUM CORP.\nof the sort shown in Dr. Barry's X-rays should appear in the\nbones of the hands. I trust that this explanation will suffice\nto show the importance of getting the X-rays we desire.\nYou will recollect that the Life Extension Institute found\nnothing in their examinations which indicated the possibility\nof industrial poisoning. There is a certain amount of indication\nthat this opinion was given without a proper appreciation of the\npossibilities. We find, in reports published from England, that\nradium workers show an increase in the lymphocytic cells of the\nblood 88 an early symptom of generalized damage from radium. It\nis a curious fact that this finding in the blood was reported in\nseveral of your girls by the Life Extension Institute and that\nthe possible cause of it was not understood. Indeed, the Institute\nsimply indicated that the findings should be watched further.\nWhen we join forces with you next week we shall wish to take\nblood specimens (this will simply be a minute drop of blood from\nthe skin) from as many of the people who are working in your\nplant as we can get hold of, including those who are directly\nexposed to Undark and those who are not. We shall then chase\ndown this finding with particular care. We shall want to see\nMiss Carlo again, and if it is possible for you to obtain X-ray\nplates of her hands they will be of the greatest value to us.\nSince the taking of an X-ray photograph is but the matter of a\nMEOPIVED APR 30 1924\nmoment I should think you would have no difficulty in arranging\nthis.\nWe will arrive at the Robert Treat Hotel late Tuesday\nevening next, and will wait there until we hear from you\nUNITED STATES\nWednesday morning. Our program for the next couple days will\nRADIUM CORP.\nfollow out whatever arrangements you have made -- that is, we\nknow that we must chase down Mrs. Kuser, we shall want to get\nour blood specimens, we shall want to see Dr. Alexander's\nX-rays, and we shall want to go again to the plant.\nUnder separate cover I am sending you some dental X-ray\nfilms. I wish that you would place these here and there in\nthe room where the girls are doing the painting. It is desirable\nto find out whether they fog. I should suggest doing this\nduring three or four days before we come and leaving the films\nin place until we get there.\nI am sending a copy of this letter to Mr. Roeder and hope\nany\nyou will write me at once if there is part of it which is not\nclear.\nVery sincerely yours,\nCecil K. Drinker, M.D."
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