Ask the Scholar

{
    "localId": "75729502",
    "label": "Letters Received, September 27, 1937",
    "core": "doc",
    "dtoType": "document",
    "citationUrl": "https://catalog.archives.gov/id/75729502"
}

{
    "id": "75729502",
    "sourceUrl": "https://catalog.archives.gov/id/75729502",
    "contentType": "document",
    "title": "Letters Received, September 27, 1937",
    "citationUrl": "https://catalog.archives.gov/id/75729502",
    "collections": [
        "Safety Light Collection",
        "Records Related to Radium Dial Painters"
    ],
    "iiifBase": "https://s3.amazonaws.com/NARAprodstorage/lz/electronic-records/SLC/Radium/SLC_0003375_Page_1.jpg",
    "thumbnailUrl": "https://s3.amazonaws.com/NARAprodstorage/lz/electronic-records/SLC/Radium/SLC_0003375_Page_1.jpg",
    "largeImageUrl": "https://s3.amazonaws.com/NARAprodstorage/lz/electronic-records/SLC/Radium/SLC_0003375_Page_1.jpg",
    "imageCount": 6,
    "hasImages": true,
    "source": "import",
    "hasTranscription": false
}

{
    "url": "https://catalog.archives.gov/id/75729502",
    "naId": 75729502,
    "levelOfDescription": "fileUnit",
    "recordType": "description",
    "ocrSource": "nara-archive"
}

{
    "seq": 3,
    "pageIndex": 0,
    "type": "photo",
    "url": "https://s3.amazonaws.com/NARAprodstorage/lz/electronic-records/SLC/Radium/SLC_0003375_Page_3.jpg",
    "mediaId": "ef559eb072b316ee",
    "ocrText": "laboratory tests periodically-almost ad infinitum-in the\nMilk Therapy\nvain hope that perhaps a definite laboratory report, one\nAnother procedure which is far safer and which, in addi-\nway or the other, will ultimately be obtained, and the\ntion to having real therapeutic value, is capable of giving a\ndiagnosis then made in accordance therewith. Actually, in\ncertain amount of information as to the probable part played\nthese cases, conclusive laboratory tests are not often ob-\nby lead in the patient's clinical picture, is that of giving him\ntained; the patient becomes the despair of everyone; and\na guart of milk a day, and keeping him under constant\nthe result is that no proper investigation is ever made to\nobservation to see that he conscientiously obeys orders. This\ndetermine what really is the matter with him.\ninsures the continued storage of lead in an inert state, and\nWhile an occasional stippled cell may be found in the\nis thus effective in clearing up such symptoms as are due\nblood of a perfectly normal individual, in a person with\na\nto the actual circulation in the blood, at the time, of toxic\nknown history of lead poisoning this must be given weight.\namounts of lead. If persisted in, such therapy would also\nBut the finding of a rare stippled cell cannot be regarded,\ntend to prevent mobilization of stored lead at some future\nper se, as a determining factor either for, or against, a\ntime, and thus prevent recurrence of symptoms due to such\ndiagnosis of lead poisoning. In such cases, instead of mak-\nmobilization. Even in such a patient, however, lead sequelae\ning repeated blood and urine tests for lead, and taking a\nmay continue, because they are not the result of an immedia**\ndefeatist attitude toward interpreting the clinical syndrome\nlead intoxication, but of cell injury which occurred at\nbecause of the absence of laboratory confirmation of lead\nsome previous time, and which has not yet been completely\npoisoning, it might be well, perhaps, to attempt an entirely\nrepaired or compensated for. This would be apt to occur\nnew appraisal of the patient's condition from the ground\nespecially where there has been injury to the nervous system\nup. Has he developed a recent gall bladder infection?\nIs\nwhere cell regeneration tends to be particularly slow, or may\nthe pain in his back, or his abdomen, due to the develop-\neven be non-existent.\nment of renal calculus, and so forth?\nThere is, at the present time, a great need for the applica-\nThere is an understandable, but unfortunate tendency to\ntion of good clinical medicine not only to lead poisoning, but\ngrow stale in these long-drawn-out cases and frequently, no\nto the diagnosis of rccupational diseases as a whole. One is\nconstantly surprised to hear doctors in discussing lead\nmatter how long a time has elapsed since the original illness,\npoisoning ask for a few specific criteria upon which they\nno attempt is made to go over the patient again with the\nmay make a positive diagnosis of this disease. It is self-\nsame detachment that one would employ in working up a\nevident of course that no such criteria exist for the diagnosis\nnew case which had never been seen before. Not only that,\nof any disease-and, the diagnosis of industrial disease is\nthere is a tendency to grow weary of the case, and without\nessentially no different from the diagnosis of diseases in any\nsufficient investigation, rather arbitrarily decide that the cur-\nother category.\nrent clinical picture cannot, after so long a time, still be due\nNo Short Cuts\nto the original lead poisoning. Indeed, the question is often\nIndustrial diseases differ from other diseases in one im-\nraised in these cases as to how long after an attack of lead\nportant particular only, and that is that in the case of the\npoisoning a clinical syndrome, however characteristic of\nformer, the doctor is called upon to prove his diagnosis in\nthe disease, may properly be regarded as still due to the\ncourt, whereas in the latter his diagnosis is for his own use\noriginal poisoning. Obviously there can be no categorical\nin the treatment of his patient, and may be changed at any\nanswer to this question. It is well known that there is no\ntime if he desires.\nclinical syndrome so characteristic of lead poisoning, or its\nIt is this necessity of proving that one's diagnosis\nsequelae, as to be regarded as pathognomic. On the other\nis correct in cases of industrial disease which tends to\nhand, if a clinical picture is to be interpreted as due to\nmake physicians rather uneasy, and tends to force them to\ncauses other than lead, appropriate diagnostic procedures\nseek short cuts such as they would never look for otherwise.\nare required to ascertain these causes. And yet, a compre-\nHowever, such short cuts will never be found, and the\nhensive diagnostic work-up such as would immediately be\ndiagnosis of disease will always remain an art. It is very\ninitiated in any other type of case, is frequently not even\nrare in medicine to find a patient who presents a classical\nconsidered, in cases of suspected lead poisoning. Instead,\npicture of any disease. Good diagnosis is necessarily a\nan unjustifiable amount of time and money is expended in\nsynthesis on the part of the examining physician of many\nmaking repeated laboratory tests, and instituting all sorts\nfindings all interpreted in the light of his experience. It is\nof therapeutic measures for the storage or elimination of\ndependent not only on his knowledge and experience with the\nparticular disease in question, but on his knowledge of the\nlead-whereas the actual cause of the patient's symptoms may\nwhole gamut of diseases, because every diagnosis is in the\nbe elsewhere.\nlast analysis a differential diagnosis.\nDe-Leading Procedure\nIn lead cases there appears to be a tendency somehow to\nSuch patients are frequently de-leaded; and this for two\nstart out with definite pre-conceptions and a lack of proper\nprincipal reasons : (1) Therapeutic-to remove as much\ndetachment, which seriously interfere with sound medical\nof the stored lead as possible from the body in the hope\njudgment. One is impressed, for example, with the fact that\nthat there will be no further mobilization in the future; and\ncases suspected of lead poisoning who complain of backache\nso subsequent acute attacks will be prevented, and the present\nor abdominal cramps, and show a considerable number of\npus cells and red blood cells in their urine are rarely given\nsymptoms incidentally cleared up; (2) Diagnostic-to deter-\na proper urological work-up. Because backache and ab-\nmine whether or not there is any easily mobilizable lead\ndominal cramps are among the many symptoms associated\nstored in the body-the theory being that if there is, it may\nwith lead poisoning, attention is unduly focused upon whether\nbe responsible for the present clinical picture, and if not,\nor not there is sufficient laboratory data obtainable to make\nlead probably is not a factor in the case.\na diagnosis of lead poisoning. No attempt is made to deter-\nProperly interpreted, one may get valuable information\nmine the cause of the abdominal urinary findings or to in-\nas to the existing lead status of the patient from such a\nvestigate thoroughly the many causes for backache and\nprocedure. On the other hand, de-leading is by no means\nabdominal cramps, other than lead poisoning.\nan innocuous procedure, and should be carried out in a\nCertainly in all cases of suspected lead poisoning where\nhospital under carefully controlled conditions and by\nthere is any doubt as to the interpretation of the svmoto\nphysicians thoroughly conversant with the method. An\ncomplex presented, a thorough-going and comprehensive\nacidosis is established which can be carried only so far, and\nmedical investigation is indicated. The patient should be\nno further with safety. Moreover, in order to measure\nexamined not only for the possibility of lead poisoning, but\nadequately the total lead excretion obtained, one must have\nfrom every possible angle which may be expected to throw\nlight upon any etiological factors which may be involved.\nlaboratory facilities for accurately measuring lead excretion\nWhere the laboratory findings for lead do not conclusively\nquantitatively not only in the urine but in the feces as well.\nclinch a diagnosis of lead poisoning, the final determination\nProperly carried out by properly qualified persons, this pro-\nas to the part which lead plays in the situation must be\ncedure has its place both in the treatment of lead poisoning\nbased upon a careful clinical appraisal of the whole medical\nand as an aid to diagnosis.\npicture."
}