Robert Kehoe and the Kettering Laboratory FROM THE DARKNESS it can be difficult to determine the source of a shadow. Dr. Robert Arthur Kehoe of the Kettering Laboratory cast such a shadow over us all, one of the darkest of the modern era. For more than sixty years Americans breathed hundreds of thousands of tons of raw poison wafted into the atmosphere from leaded gasoline. This toxic air contributed to a medical toll of some 5,000 annual deaths from lead-related heart disease and an almost incalculable toll of tragedy in the neurological injuries and learning difficulties imposed on children. One estimate, based on government data, suggests that from 1927 to 1987, 68 million young children in the United States were exposed to toxic amounts of lead from gasoline, until the additive was finally phased out in the United States.' For this in good measure we can thank Dr. Kehoe. Dark-haired and dark-eyed, Kehoe described himself as a "black Irishman" and claimed to be descended from Spaniards who had been shipwrecked on the Irish coast during Elizabethan times. The scientist possessed boundless energy, and a keen mind, and he could also tell "one hell of a dirty joke," colleagues remembered. Others who confronted him professionally, however, remembered Kehoe as arrogant and aloof. 2 For almost fifty years Kehoe occupied some of the commanding heights of the nations medical establishment. He was at various points president of the American Academy of Occupational Medi- 102 CHAPTER EIGHT cine and president of the American Industrial Hygiene Association; he served as a consultant to the Public Health Service, the International Labor Organization, and the Atomic Energy Commission.' Kehoe also exercised a powerful influence on the publication of medical reports, since he sat on the editorial boards of leading scientific publications.' He preached the gospel of leaded gasolines safety from his pulpit at the Kettering Laboratory for the duration of his entire scientific career.' Kehoe did much the same for fluoride, with health consequences of a potentially similar magnitude. The Fluorine Lawyers and the " Infectious Idea of Easy Pickings" SPOOKED CORPORATIONS STAMPEDED Kehoe's laboratory following World War II. 6 The great factories that had throbbed and roared for the long years of national emergency had spewed unprecedented volumes of poisonous gas and smoke into the skies over numerous American cities and manufacturing areas. There were aluminum plants on the Columbia River and at Niagara Falls; uranium plants in New Jersey, Cleveland, and Tennessee; steel mills in Pittsburgh; gasoline refineries in Los Angeles; and phosphate plants in Florida. These were just some of the industrial operations that had won the war for the United States, but from which a steady rain of fluoride and other pollutants now fell, endangering the health of workers in factories and people living nearby. Patriotic U.S. citizens tolerated the smoke of war. When peace arrived, they turned to the courts. Perhaps the first to file suit were the injured peach farmers from the Garden State, downwind from DuPonts Chamber Works. They were quickly followed by numerous additional lawsuits alleging fluoride damage to crops, farm animals, and citizens.' Soon we had claims and lawsuits around aluminum smelters from coast to coast," recalled Alcoa's leading fluoride litigator, Frank Seamans. "Once this sleeping giant was awakened, claims and lawsuits were brought against all types of plants involving fluoride emissions — steel plants, fertilizer plants, oil refineries, and the like," he added.' ROBERT KEHOE AND THE KETTERING LABORATORY 103 To battle this awakened giant, Seamans and attorneys for other beleaguered corporations organized themselves into a self-described Fluorine Lawyers Committee, which met regularly through the cold war years.' The Committee would eventually include attorneys representing several of Americas top corporations, including Aluminum Company of Canada, U.S. Steel, Kaiser Aluminum and Steel, Reynolds Metals Company, Monsanto Chemical, the Tennessee River Valley Authority ( TV A), Tennessee Corporation and subsidiaries, Victor Chemical, and Food Machinery and Chemical Corporation. Those corporations, guided by the needs of the Fluorine Lawyers, and directed by a Medical Advisory Committee of doctors from the corporations, funded the fluoride research at the Kettering Laboratory. 10 The gathering storm clouds were surveyed after the war at a confidential conference at the Mellon Institute on April 30,1946. Among the guests filing through the ornately decorated aluminum doorways of the bunkerlike structure on Pittsburgh's Fifth Avenue were representatives from several of the companies facing fluoride lawsuits and complaints, including Alcoa, Pennsylvania Salt, and Harshaw Chemical." Robert Kehoe dispatched a loyal young Kettering lieutenant to the conference. Although Edward Largents only degree was a BA obtained in 1935 from Westminster College in Fulton, Missouri, his willingness to sacrifice his own body and the bodies of others on behalf of the Kettering Laboratory's corporate clients, had already propelled him to the front line of industry's defense against fluoride litigation.' Starting in 1939, the giant Pennsylvania Salt Company and the Mead Johnson food company paid for a special experimental diet for the Kettering researcher. Pennsylvania Salt manufactured numerous fluoride products, including a cryolite pesticide spray, while Mead Johnson made a children's food, called Pablum, containing animal bone meal. (Bone meal can contain high amounts of fluoride.) Largent converted to a human guinea pig for the Kettering sponsors, eating, drinking, and breathing large quantities of fluoride for several years." Under the direction of a Kettering toxicologist, Francis Heyroth, the eager young researcher consumed fluoride in various forms: as cryolite, calcium fluoride, hydrogen fluoride, sodium fluoride, and sodium fluoroborate. As ,04 CHAPTER EIGHT with similar experiments, in which human volunteers breathed lead fumes in a Kettering Laboratory gas chamber, the data were subsequently used to promote industry s position that moderate levels of fluoride — or lead — in the body were in "equilibrium with the environment and, if kept below certain thresholds, were both natural and safe. Such a hypothesis was immensely practical, of course. Following Largents wartime experiments eating cryolite, for example, the Department of Agriculture raised the amount of cryolite pesticide residue permitted on agricultural produce, an obvious windfall for the Pennsylvania Salt Company.' Now, in April 1946, Largent was one of those sitting in the audience at the Mellon Institute as the grand old man of prewar fluoride science, Alcoa's director of research, Francis Frary, took the stage. Frary explained to the Mellon audience some of industry's worries: how fluoride accumulated in the human skeleton and how coal had recently been identified as an "important" new source of airborne fluoride.' Largent was well aware of the legal risks that fluoride posed to corporations. He had been battling farmers who had launched court cases against several big chemical companies in New Jersey and Pennsylvania, alleging damage to crops and herds in a postwar barrage of litigation in the Philadelphia and Delaware Valley area. Largent described these as almost epidemic." 6 Industry confronted a potentially devastating cold war domino effect — that Americas industrial workers would follow the farmers into court. Largent had been monitoring the fluoride exposure inside the Pennsylvania Salt Company s two big plants in Natrona and Easton, Pennsylvania. The X-rays showed "bone changes" in workers skeletons and pointed to a clear and present danger, he stated. "These X-ray data could easily be misused by dishonest people to conduct a probably successful attempt to obtain compensation, Largent told a colleague from the Harshaw Chemical Company in an April 1946 letter that discussed the importance of the pending Mellon conference. The infectious idea of easy pickings may spread to include damage claims regarding occupational injuries," he added.' The Mellon Institute audience was captivated by the bold new medical theory of a second speaker. According to the roentgen-ologist (X-ray expert) Paul G. Bovard, much of the bone damage ROBERT KEHOE AND THE KETTERING LABORATORY 105 seen on workers X-rays was probably not caused by fluoride, and the Danish scientist Kaj Roholm had been a needless worrywart.' x Dr. Bovards fresh perspective was terrific news, Largent reminded the Pennsylvania Salt Company. Several of [your] employees show bone changes which might be successfully, even if it were dishonestly, made to appear like fluorine intoxication. The possibility of a roentgenologist being led by a dishonest lawyer to make such an error is not too far-fetched; it shows with great emphasis how fortunate we are to have the help and interest of a man with Dr. Bovard's capabilities." 19 Bovard's fresh thinking would prove "invaluable assets to the defense against dishonest claims for compensation," Largent concluded. 20 Largent passed on more good news. Following the Mellon conference, other U.S. companies had also expressed "intense interest" in the fluoride problem. Alcoa's Francis Frary had told Largent that the aluminum company might support an expanded research program at Kettering. Other companies soon contacted Robert Kehoe directly. The DuPont medical director, Dr. G. H. Gehrmann, told Kehoe that DuPont, too, might be interested in joining the fluoride research at Kettering!' Such collaboration became a reality that summer and fall. On July 26, 1946, industry representatives met again, this time in the Philadelphia headquarters of the Pennsylvania Salt Company. And by the end of the year DuPont, Universal Oil Products, Reynolds Metals, and Alcoa had all agreed to pay for expanded fluoride studies at Kettering. Of special interest to sponsors: the willingness of the Kettering team to procure additional humans for experimentation. "This program should allow for new human subjects and should materially contribute to this subject," noted Pennsylvania Salts S. C. Ogburn Jr., in a November 1946 letter to Edward Largent. More Human Experiments, and a Suspicious Scientific Study THE EXPANDED RESEARCH program quickly bore fruit, both in fresh human experiments and in an influential scientific paper attacking Kaj Roholm. In January 1947, as industry checks for the fluoride research started to arrive in the Kettering Laboratory 106 CHAPTER EIGHT mailroom, Edward Largent looked around for more human subjects. He did not have to look far. Largent sometimes ate in the Ketter-ing lunchroom with members of a local African American family, the Blackstones, several of whom worked for the University of Cincinnati as laboratory assistants and animal handlers. A group of black boys — a wonderful family, Elmo and Peanut and Gentry," remembered Edward Largent years later. 22 The Blackstone brothers had helped Dr. Robert Kehoe in his lead experiments. In 1947 a new item appeared on the Blackstones menu — extra-dietary fluoride. In May of that year, forty-one-year-old Elmo Blackstone began eating fluoride and carefully collecting his urine and excreta. The industrial experiments would continue for three and a half years, during which time he would consume a startling 12,047 mg of fluoride in the form of sodium fluoride and sodium fluoroborate, considerably more fluoride than even Lar-gent had ingested. In one experiment, begun in June 1948, Elmo was given 84 mg of sodium fluoride each week in his food for 130 weeks.' There is no surviving record of whether Elmo Blackstone experienced injury as a result of these experiments, but the historians Gerald Markowitz and David Rosner describe similar Kettering human experiments with lead as particularly pernicious because their objective was not the discovery of a therapy for those with lead poisoning but was to gather evidence that could be used by industry to prove that lead in the blood was normal and not indicative of poisoning by industry. 25 In 1951 Edward Largent mounted a major assault on the research of Kaj Roholm, describing health effects of fluoride exposure in American workers that were much less severe than those reported by the Danish scientist. 26 His paper laid a medical keystone for Americas cold war industrial enterprise. 27 The war had hugely increased U.S. industrial dependence on fluoride, a hunger that grew voraciously as the American economy began its spectacular cold war expansion, with entire new enterprises, such as fluorocarbon plastics, aerosols, refrigerants, uranium enrichment, rocket fuels, and agricultural chemicals, all requiring that employees breathe and absorb fluoride. 28 By 1975 the government estimated that 350,000 men and women in 92 different occupations were exposed to fluoride in the workplace. 29 Yet the consequences of that chemical exposure BERT KEHOE AND THE KETTERING LABORATORY 107 would be largely overlooked, in part because of Largents 1951 paper, published in the influential American Journal of Roentgenology. Roholm had reported that fluoride produced a host of medical symptoms in factory workers. Most distinctly, fluoride could visibly disfigure a worker's bones, disabling them with a painful thickening and fusing of spinal vertebrae, a condition Roholm called crippling skeletal fluorosis. Largent now contradicted the Dane, reporting that no disabilities had been caused by fluoride in the U.S. workers he had studied. Instead, he argued that fluoride "deposition only highlighted a preexisting condition, making it more "apparent" to X-rays. "One wonders if Roholm may not have overemphasized the part that fluorides may play in causing limitation of mobility of the spine," Largent wrote. Perhaps the crippled spinal columns of the Danish workers were mostly the result of "hard labor," he suggested. 30 Largents 1951 paper was influential among those for whom it was meant to be influential, so that in 1965, for example, the nations leading fluoride expert, Harold Hodge, could state that crippling fluorosis has never been seen in the United States. 31 But Largents paper also appears to have been a grim scientific hoax. At the end of his paper the Kettering researcher had ostentatiously posed a question: why did fluoride appear to affect American and European workers differently? "Just why disability has not been recorded in American workers remains unanswered, Largent wrote. The answer is simple. The facts were hidden by a Kettering cover-up that misled a generation of medical researchers about the consequences of industrial fluoride exposure and sentenced many thousands of U.S. workers to undiagnosed fluoride injury. Just three years earlier Kettering's Robert Kehoe had privately told Alcoa that 120 workers at its Massena aluminum smelting plant had "bone fluorosis" and that 33 were "severe" cases that showed evidences of disability ranging in estimated degree up to loo per-cent. 32 Similarly, while Largent publicly reported no fluoride dis- ability, privately three doctors had told him that workers' X-rays showed evidence of fluoride-linked medical injury, according to his personal correspondence and long-concealed records. Largents 1951 paper was based on X-rays of workers at the Pennsylvania Salt Company. Fluoride was burrowing inside the 1 o 8 CHAPTER EIGHT employees bodies, deforming and crippling their bones, according to a radiologist, Dr. Thomas Smyth. Ira Templeton, one worker from the company s plant in Easton, Pennsylvania, showed marked increase in the density of the pelvis, upper portion of the femur, vertebrae, ribs, clavicle, scapula and forearm. Dr. Smyth considered these [effects] to be indicative of marked fluorine intox ication," Largent told management. At another Pennsylvania Salt plant at Natrona, Pennsylvania, X-ray images of a worker, Elmer Lammay, revealed that "bone growths on some of the vertebrae were extensive enough to indicate that some of the bones of the spine were becoming solidly fused together," Largent reported to management. 33 A second Natrona worker, Ross Mills, also revealed a "clear-cut increase in the density of the lower ribs and the lower thoracic and lumbar spine, typical of fluorine absorption," according to radiologist Paul Bovard, who classified Mills a "probable case of fluorosis." 34 Although the Kettering researchers hid the incriminating X-ray pictures from the workers, on January 31, 1947, a mix-up occurred and Ira Templeton's results were sent directly to the Easton plant. " All of the films show osteosclerosis previously described and considered to be as a result of fluoride poisoning. . . . Very truly yours, Russell Davey, M.D.," read the mailed analysis." Pennsylvania Salt's management was furious at the misdirected letter. Its workforce might learn of the danger from fluoride exposure, the company worried. "You can appreciate the seriousness of this situation to us," wrote a senior official, S. C. Ogburn Jr., to Dr. Robert Kehoe, Largent's boss at the Kettering Laboratory. "Doubtless, this letter has been widely discussed at our Plant and is evidence of extremely poor tact, to say the least, on the part of Drs. Pillmore and Davey," Ogburn added. 36 Kehoe asked the offending radiologist, Dr. Davey, to send future X-rays directly to the Kettering Laboratory and thereby "absolve the management of the Easton plant of any responsibility." He added, "We wish to avoid any situations that would result in undue suspicions or anxiety on the part of any of these men." And Kehoe swiftly reassured Pennsylvania Salts management that any apprehension or concern by workers about their health was the result of a semantic misunderstanding. In Europe the terms "fluorine gOBERT KEHOE AND THE KETTERING LABORATORY 109 poisoning and fluorine intoxication might suggest disability and even worker compensation. In the United States, however, Edward Largent and the radiologist Dr. Paul Bovard were using these terms differently, infusing medical language with new meaning, Kehoe insisted. Poisoning was merely an unfortunate choice of verbal expression," he added. 37 Dr. Kehoe and Edward Largent now delivered their sponsors some good news. Dr. Bovard had reversed the earlier diagnoses of fluoride poisoning by Drs. Smyth and Davey. He now claimed that, "with the exception of spinous ligament changes seen in films of Ira Templeton, the bone changes were so commonly seen in laborers as to have no necessary or likely relation to fluorine deposition. Pennsylvania Salt should therefore "differentiate between the terms, fluorine intoxication, which carries with it the implication of illness and disability, or impending disability, and "fluorine deposition, which signifies demonstrable change but without implying, necessarily, that illness or disease has occurred or is imminent, suggested Largent. 38 The Kettering researchers published verdict of no disability was manifestly suspicious. All three radiologists had diagnosed some degree of fluoride-induced spinal thickening, ligament changes, or fluorosis in the Pennsylvania Salt workers. A careful reader of Largent's published paper might also note an important distinction between the way Largent had arrived at his medical conclusions and how Kaj Roholm had investigated the same problem. The Dane had listened closely to the health complaints of the Copenhagen employees. He had concluded that fluoride poisoning was insidious and hydra-headed and that several groups of symptoms — including stomach, bone, lung, skin, and nervous problems — often presented themselves at different times in different people, making fluoride injury both serious and sometimes difficult to diagnose. 39 Largent's 1951 published finding of "no disability" in the Pennsylvania Salt workers, however, was made without ever talking to the employees themselves. Nor had the Kettering team performed any medical examinations beyond studying bone X-rays in a distant office. Detailed clinical examination of the workmen in these plants could not be carried out and therefore no other data are available for consideration, Largent wrote." 110 CHAPTER EIGHT Sins of the Father EDWARD LA RGENTS WILLINGNESS tO perform human experiments was remarkable. In the haste of World War II, he had helped the Manhattan Project fix fluoride inhalation safety standards at 6 parts per million for U.S. war workers who breathed in fluoride in factories." Following the war Largent even turned to his own family to obtain additional scientific data. 42 He couldnt get experimental subjects, explained his son Edward Largent Jr., who today is a classical composer and professor emeritus at the Dana School of Music at Youngstown State University in Ohio. A lot of people were just antifluoride for whatever reasons, he added. His son, then a high school student, was selected by his father because he "was available and he was willing," his father told the medical writer Joel Griffiths. "Willing human subjects are not that easy to find," he explained. Largent told his son that he needed more data for whatever research he was doing, Largent, Jr. remembered. "It was really sort of a cursory knowledge. I wouldn't have understood a lot of what he was talking about because I was only a sophomore in high school. The Manhattan Project's Rochester division had already reported earlier experiments with hydrogen fluoride gas on dogs. At concentrations of approximately 8.8 parts per million of hydrogen fluoride, the lungs of one out of five dogs hemorrhaged. 43 Largent, Sr., had read the study but appeared skeptical about the results. " When I read it I wasn't impressed with what it meant in terms of potential human exposure, he told Griffiths. There was no review commit-tee for the Kettering inhalation experiment and no formal consent forms. "I was the review committee," he said. He did not anticipate health problems in the experimental subjects. "As far as we were concerned, there were no such risks," he added. In order to perform these new experiments, Largent had to have a gas chamber built. The process was a challenge. HF gas is corrosive, and the acid attacked the metal cylinders and valves. " It was found to be very difficult to maintain a specific concentration of HF in air inside the inhalation chamber, he reported. Once the gas chamber was built, Largent reserved the greatest amount of fluoride for one of the Kettering laboratory s African ROBERT KEHOE AND THE KETTERING LABORATORY 111 American laboratory assistants, forty-six-year-old male Gentry Blackstone. For fifty days in the early spring of 1953 Blackstone sat in the Kettering gas chamber six hours a day, breathing an average dose of 4.2 parts per million of hydrogen fluoride acid. But Largent did not experiment on Gentry Blackstone alone. Largent also exposed his own wife, Kathleen, to a lower dose of 2.7 parts per million. And although Gentry Blackstone received the largest amount of fluoride over the longest period of time, the single highest exposure values were given to Largent's son. On June 22, 1953, Edward Largent Jr., aged seventeen, entered a Kettering gas chamber for the first time. Cold cosmetic cream was applied to his face. The experiment would continue for twenty-eight days, six hours at a time, with weekends off. "I had to sit in this cage," the son remembered. A small fan was placed in front of the boy to improve the gas circulation. Outside, his father operated the controls and watched. The walls of the chamber were made from transparent plastic sheeting. The gas whispered in. At first, it caught the teenagers lungs and burned his nostrils, he said. His skin reddened and flaked. He read fiction to relieve the tedium, eyes stinging and smarting. The average dose for the six weeks that Edward Largent Jr. sat in the chamber was 6.7 parts per million — almost two and a half times what his mother received. For one remarkable week in early July 1953, however, with a break for Independence Day, the scientist gassed his son with doses of hydrogen fluoride that averaged 9.1 parts per million and climbed as high as 1 1 .9, almost four times the maximum allowable concentration then set by federal authorities and twice what the father had tolerated himself. The son's urine levels spiked at 40 parts of fluoride per million. The highest doses given to his son were accidental, the father said in retrospect; "It was our inability to keep it from going higher than we wanted it to." Largent's experiments rang alarm bells for industry. At a 1953 Symposium on Fluorides at the Kettering Laboratory, he described his inhalation studies and spelled out the potential dangers they had revealed.." The gathered officials — including the head of the Fluorine Lawyers Committee, Alcoa s Frank Seamans — knew that American workers were regularly exposed to 3 parts per million of fluoride in their factories and workplaces. They also knew that when fluoride urine levels rose above 8 milligrams per liter, there was real danger 1 12 CHAPTER EIGHT that fluoride was building up in the skeleton and might soon become visible to X-rays. Largent delivered the bad news. Fluoride levels in his experimental subjects had spiked sharply immediately after their gas chamber exposures, even at lower acceptable exposure levels. Urinary concentrations averaged about io mg. per liter, he told the industry men, "although the atmospheric concentrations of HF were near to 3 ppm, which is generally accepted as satisfactory for prolonged occupational exposure. 95 In public Largent continued to maintain that fluoride was safe in low doses. 96 Privately he told the industry representatives at the 1953 Symposium, One wonders (whether) . . . prolonged exposure to HF at such a level may not give rise to medico-legal controversies."" Despite his private warnings to industry, Largent s experiments on his family and on the Blackstones are now considered a scientific foundation for today's official safety standard for the tens of thousands of workers who each day breathe the gas in their factories. The other source for safety assurances? Experiments done in 1909 on rats. 98 Even though the family experiments seem shocking, Edward Largent Jr. refuses to judge his father for placing him in a hydrogen fluoride gas chamber. Although the music professor has experienced knee problems in recent years, he blames a youthful passion for soccer; he doubts that it had anything to do with his summer spent breathing fluoride in the basement of the Kettering Laboratory, where he remembers only moderate discomfort. Mostly, he told me, "It stank and it was very boring. Be careful about criticizing," he warned, referring to the 19505 experiments. "Those were different times. The criteria and the sensitivities to such things were very different." He added, "It is like trying to judge a Beethoven symphony today. You have to look at the circumstances, the instruments he was writing for, the audience situations." After the experiments Edward Largent Jr., abruptly changed his career plans. He had passed his entrance exams for medical school at Ohio State, but suddenly plumped for music. Science no longer seemed so appealing. "I just decided I didn't want to do that, he said. His father would be haunted in later life by his own service as a human laboratory animal. Painful osteofluorosis led to a knee ROBERT KEHOE AND THE KETTERING LABORATORY 113 replacement and a reliance on medication for relief, the former Kettering researcher told medical writer Joel Griffiths in a taped interview in the mid-1990s. Both knees were hurting, Largent explained, because of the deposition of fluoride. Ironically, he seemed to have wound up suffering from the very type of skeletal disability his industry-funded scientific studies said did not exist. (In a second interview, however, Largent reversed himself and denied to Griffiths that he had ever suffered osteofluorosis.) 49 Edward Largent Sr. died in December 1998, five days after an operation for a broken hip, suffered after a nighttime fall: gripped by Alzheimer's dementia, Largent had forgotten to use his walker to get to the bathroom. At the end of his life, his son recalled, Edward Largent "was angry and frustrated and very frightened because he knew there was something that wasn't right and that he couldn't fig ure out how to deal with it. The son wondered whether his father's bone pain in later life was because of his fluoride experiments. Edward Largent Jr.'s mother also suffered from ill health in her final years. Kathleen Largent had a leaking heart valve and a nerve disorder known as myasthenia gravis. (Arthritis, increased risk of hip fracture, Alzheimer's, and other central-nervous-system disorders have all been linked by scientists to fluoride exposure.) 50 In recent years Edward Largent Jr. has spent hours reading about the Manhattan Project, wondering if his father was involved. An elder brother said their father had worked at Oak Ridge. And as a boy, Edward Largent Jr. remembers his father arriving from Tennessee at their Cincinnati home on a Friday night during the 1940s, driving a black car with government plates. "The car would go in the garage and I would say "Let's go for a ride,' and Dad would say No, no we can't use that car.' And then he would leave Sunday after-noon in the government car." 9 Donora: A Rich Man's Hocus Pocus
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