Document 3NzznrnJwa8Xb9gpe4pO1d900

November all- 1957 : F*'Al, Wentworth*f *'?4 ^ $ % ty Farmington Avenuev 'rHayt f ord# Conne eticut.f.^ ~#3i& c - 4 - 0 3 i{^ : * '^ * 1 `iv. Pear Doct or , Wenfewor t ht j * ., ^tojs - S? i i -vrh , -y- bave c a r e fu lly examined ' iaforipM^fer: g lv e n ^ in y o u r le t t e r o f November l?th* T h S f y o u * d e e c r I b e la- not one . Whichla,:.-0^ y in c ln g . In r e la tio n to a diagnosis of lead r . whi ch- you describe .vi*:bf, yeryi ^auaual magnitude in connection with lead , rend#ln ^ ^ ||^ w e a c # --:o fi suefcian anemia,, i t would con fid en tly be - expected* that there'wouldfbe a great deal of stip p lin g unless Indiedt one were dealing with a genuine a p la stic type of anemia. The la r g e s t numbers of stip p led c e ll s which one eyer se e s are: found In anemias of th is sev e rity in association with sucb blood dyscrasla as the leuceralas. The. same#-,Of course#: a p p lles. to the basophlT^Aggregsation Test which Is .only, a m odiiieation^ofJthe t e s t for stip p lin g . From the se v e r lty o fth e a n e m ia , I should suspect the existence' of some type o f blOod d isea se or, a lte r n a tiv e ly , a rather severe infectious process. . .- ' :? > >* v -'V -- A v- * analyses reported on the urine and fe c e s are npt su ch ,as to Inspire confidence In th e ir accuracy# i In the ca se-cf a sick man who has been out o f exposure for. some: ^ayfj;or weeks, q u a n tities of the order of..ma^ltderof-'tifb% illigrams in the feces are unusual*^ Moreover: a concentration of .67 milligram s 4 o f i-lead^per-lltesi'^ f b rln e-tls||sost unusual even in the .sev e rest types o f lead -in toxication . Therefore, unless you were able^ to show th at .there had been a seriou s and s ig n ific a n t exposure to lead my f i r s t suspicion would be J.thaJtttbcs^ sa|^l^bSlSesnlti?'C*,.;'grossly In erro r. I t '\-U^-!C^oou^n^hQbl^i#i^^y$:tO'conclude -that th is is the / ease :but4cnltbe'*^tb^hbbd^1f'know nothing of the methods of a n a ly sis a t the* A gricultu ral Experiment S ta tio n , nor do I know whab theiriSxperiebC e has been In handling such quant i t i esxof . .l e a d t h e excreta of human b ein g s. Unless they are quite.experienced in th is f ie ld , th eir r e s u lts are more lik e ly to-b e m isleading than to be u se fu l in.a dlagnoais#;::foi^in^^nerai^Chemists who have been handling th e r a th e r large q u an tltles o f le a d which are found In many ` material which-Varefito^be4iC:ted# are not e n tir e ly competent t o d e a lw it h le a d ln h a m a n e x c r e t a , Moreover the manner of c o lle c tln g samples f o r a n a ly sis must be checked with the utmost caution fo r under, ordinary h o sp ita l conditions urine and feca l,sa m p les a r e 'lik e ly to be g ro ssly contaminated with 0.01 le a d from u r in a ls and o th er co n ta in e rs* You s i l l u n d erstan d , t h e r e f o r e , th a t I am n o t a t a l l Im pressed by the sign ifican ce o f these an alytical resu lts* When I t comes to th e q u e stio n o f exposure to le a d , there Is nothing In your d escrip tio n of th is man's occupation th a t su g g ests th a t he had any occupational lead exposure* Regardless of the type of g a s o lin e which he may have been handling* and r e g a r d le s s of h is manner o f h an d lin g I t , th ere i s n oth in g in t h is exposure which can be regarded as hazardous* There has n ever been more than an h y p o th e tic a l exposure in con n ection w ith lead ed g a so lin e * No o a ses o f lea d p o iso n in g have ev e r been s e e n , and a l l o f the ex p erim en ta l evid en ce In d icates th at even in the most seriou s con d ition s of sk in con tact and in h a la tio n , the le a d ab sorp tion from t h is source i s too. sm all to be measured* I t is thus u tte r ly im possible that such exposure oould have resu lted in lead absorption to the exten t in dicated by the analyses which you have rep orted . As t o th e le a d c o n ten t of b e e r , i t seems Improbable th a t t h is was a fa c to r * I cannot but wonder whether t h is man had some exposure to b en zo l in h is occup ation and whether he had a le u c o p e n ia alon g w ith h is anemia* I should be v ery much in t e r e s t e d in any fu r th e r in form ation which you may o b ta in about th is p a tien t* Moreover i f you should have any fu rth er opportunity to obtain samples of blood or urine for analysis of th eir lead con ten t, I should be pleased t o send you s u it a b le c o n ta in e rs and to r e p o r t the r e s u lt s o f our an alyses to you* Cordially yours. RAKiIs ; Robert . Kehoe, M.D* K& OG12086