Document 2JvgEk66ZyeODbExgLQVpDO2r
April 25, 1925
Dr, R, E, H* Gradwohl Gradwohl Laboratories 5514 Lucas i Avenue 3t. Louis, Missouri
Dear Dr* Qradwohlf
At long last I have come to the point
of replying to your questions with regard to my opinion
on methods of estimating the clinical significance of
basophilic stippling of the erythrocytes* Perhaps I
can best ariswer your question by quoting from an article
which I recently prepared for the Cincinnati Academy of
Medicine, and then by augmenting ay remarks with a little
introductory statement of 9y point of view about methods,
1 do not bdlleve that any aefchod is quite satisfactory
which does hot give a reasonably accurate quantitative
statement of the number of stippled cells. My personal
experience does not lead ae to believe that the thick
slide method permits of quantitative treatment. After
giving aomej consideration to the various methods which
have been described, I decided some years ago to be|ln
the study of thin smears with uniform distribution of
efcythrocyteb which would ena^le us to examine each
erythrocyte; with a high degree of definiteness. We
selected a method of staining which gave very little
difficulty from the point of view of uniformity, and
we proceeded to systematically examine the blood of
normal and abnormal Individuals ty counting the number
of stippled; cells In fifty fields, the average of which
came very close to 250 cells. We are thus able to set~
down our results in figures which refer to 12,500
erythrocytes which enables ua wiffc only a small error to
express that subsequently in terras of a million erythro
cytes, which I believe is the mo3t commonly accepted means
of expression, I do not believe that it is
so much
a question of ease of seeing stippled cells as it is a
question of reasonable accuracy in the estimation of their
number. Proa our findings alone which have been corroborated
by other investigation, I think it is quite safe fco say that
the mere presence of stippled cells has no diagnostic
significance. Consequently I like to know as accurately
as possible for clinical purposes the approximate order
of the number of stippled ceils which occur.
I have followed a consideratle number of men in one industry for a number of years, and we have
N 2461
Dr, R# B. H. Qradirohi
3
to time.
aw now In the process of studying these
date and t hope shortly we shall be able to publish the
entire study. '?o have obtained a variety of analytical
data on the magnitude of the exposure and the extent
of the lead absorption on the men Involved, and I think*
therefore* we have somewhat more exact bases for the
Interpretation of our findings than are generally available*
Y*e have deliberately avoided publishing anything on the
subject because of the somewhat controversial nature of the
subject In current literature. We have now reached a point
where certain conclusions have been amply justified and
for that reason we are ready to make at least a conservative
statement as to the meaning of what we have found.
The appended carbon copy of the as yet unpublished article of which I spoke above, will convey my present point of view adequately I hope. It occurs to me on second thought that you might be interested in what I have to say about the whole matter of diagnostic methods* and I am sending the entire carbon In spite of the fact that It lapks references and la not quite in the proper state for puMlcatlon.
Cordially yours*
RAK"ls
/
Robert A. Kehoe, &.B.
00378