Document 6wxwOZb6V9dv1K3ZeXqVDqgb6

History Sheet Sample copy of an analytical report (with explanatory note from Dr. Kehoe) August 9, 1963 Mr. J. P. Warner, Medical Supervisor Nassau Smelting and Refining Company Tottenville, Staten Island 7 New York, New Y^rk Dear Mr. Warner: I address you according to your letter, not knowing the nature of your relationship to the medical personnel or affairs of your Company. The matter is of some importance, and so I refer to it at the outset, since the matter of which you speak is strictly medical in character and should be handled by us with a physician. The reason for this is a very practical one, as I am sure you will appreciate. I am not being "stuffy" or officious. First of all, in your Company's line of work, the hazard of lead absorption is actual, rather than potential,, in most instances. This means either that there will be cases of lead poisoning to be dealt with, or that this possibility exists and has to be avoided by the means at your disposal. One of such means, in the type of regimen which I would advise, in connection with analyses of the blood of Workmen, is that of removing men from further exposure when they have reached a certain level of absorption as indicated by the concentration of lead itt the blood (the urine can also be used in this manner, but not with comparable precision). This requires handling by a physician. The records of the analyses should also be in the custody of a physician, and should not be available to others, since otherwise these findings tend to become too widely known and become the subject of dis cussion, speculation and concern. I speak of these matters in advance, because we have had ample experience with the mishandling and misuse of information of this type. This is a medical research laboratory, primarily, although we provide advice and assistance to industry in consultation in matters of occupational medicine and hygiene. We do not carry out analyses, as such, as a technical service for any one. Rather we use them as part of our consultation service in industrial hygiene, all of which is done at the actual cost of the services rendered, in terms of the time of the personnel so involved, the cost of materials used, and a general overhead charge to cover miscellaneous costs (heat, light, power, maintenance services, etc.). This, in the ease of lead analyses comestho #12.50 per sample (we require duplicate samples of blood, for which we make the single charge of #12.50 as though it were one sample), and we prefer to have both blood and urine from each man, so that the total charge^, under these circumstances is 025.00 per person. Under suitable circumstances we are willing to deal with samples of blood alone. We provide containers for the samples, including equipment for drawing the blood, and we provide instructions for the collection of the Mr J, P Warner - (2) - August 9, 1963 samples, which must be followed meticulously. We also require information about the men, their job within the plant, the duration of their employ ment in the same job, and other pertinent items of occupational history, especially as to the last day of work in relation to the time of collecting samples. In connection with illness of any type, we also require adequate clinieal information as to the nature of the illness, its onset and course, any therapy that may have been instituted, and any other relevant matters. On the basis of such information, we interpret the analytical findings, and give such advice as appears to be indicated. Unless such information is made available, we do not continue the service, for our concern is not to carry out' services for fees, but to provide the service that is needed, and to gain information for ourselves in the process. Through this channel, we have certain fairly extensive and varied relationships with industry, and we are able to keep ourselves informed as to the hygienic status of the lead-using industries. I enclose, herewith a simulation of a fairly typical report, a-copy of the instructions which we issue, and the form on which the name of "the employee and the pertinent information is transmitted to us. The periodicity of the sampling should be determined by the environmental conditions in your plant (with respect tp the degree of hazard). This can be determined after the first series of results have been obtained. The extent of the sampling, i.e. the numbers and types of personnel so involved, is also a matter of judgment, since any group which may be selected to represent the various types of employees (if that is desired), must be truly representative. In order that I may make some suggestion about this, I should know what your problem'^) is (are) and What you are attempting to learn. The procedures in this matter should be carefully tailored to the need, for they are too expensive to be applied incautiously, and yet if your people*are actually subjected to hazard, these procedures are too useful to be without. I believe you will recognize frdm what I have said that this is some thing which should be handled by a physician. Medical judgment has to be employed, instead of a rule of thumb. I hope, therefore, that your Company has a responsible physician, with some knowledge of the requirements of industrial hygiene, with whom I can deal in establishing a satisfactory arrangement, in case you decide that this should be done. You will pardon me, I am cure, if I question your Coppany's policy in this matter. I have no way of knowing the facts in advance, and it is not at all uncommon to find that some of the companies engaged in older, conventional types of operation^ in the production and use of lead, are somewhat lacking in medical talent. We shall be glad to assist you in handling your problem, if we can develop a satisfactory means 6S so doing. Incidentally, it might be wise and helpful in developing a realistic program, if I were to visit your plant at some mutually convenient time, and talk with your key people. I am in New York from time to time, and could do this without undue inconvenience. Kf 0018744 Very truly yours, RAK:vr Robert A. Kehoe, M.D