Document M1aDpjnRq9j2Qzm57mz2eE5M

Octo be r 2 6 ,-193>6 A ir Mail a *. D. Kerr Gr an t 231 Macquarie St r e e t Sydney, Au s t r a lia Dear Doctor Grant* I fin d t o my dismay t h a t a le t t e r which you wrote me alm ost a year ago fou n d i t s way in t o the c o lle c t io n o f th in gs t h a t ar e alw ays w a itin g on my desk fo r me to fin d some fr e e tim e to d eal w ith them# These ar e m ostly th in gs to be r ead and pondered on r a t h e r than th in gs th a t r e q u ir e r eason ab ly prompt action # Un fo r tu n a te ly I have been hard p r essed fo r tim e d u r in g the p a s t ye a r , and on ly r e ce n t ly have I been a b le to con sid er the p o s s ib ilit y o f catch in g u p . I r e gr o t the unr easonable d ela y in r e p ly in g to you# Ce r t a in ly t h is was n ot w il fu l n e gle ct or d isco u r te sy. You are q u ite r ig h t t h a t the most u s e fu l d ia gn o s t ic procedure in the case o f sm a ll ch ild r e n su sp ected of having absorbed s ig n ific a n t q u a n t it ie s o f le a d i s th a t o f a n a lyzin g the b lo o d . For a number o f ver y p r a c t ica l r ea son s, such as the very gr e a t lik e lih o o d o f the con tam in ation o f th e u r in e in the p r ocess o f i t s c o lle c t io n , on the one hand, and the wide ran ge in the e xcr e to r y r a t e , on ^ th e o t h e r , the r e s u lt s ob tain ed on th e u r in e o f ch ild r e n , are open to m isin t e r p r e t a tio n ve r y fr e q u e n t ly. In co n tr a st is the ca s? of in te r p r e ta t io n o f th e r e s u lt s o f the an alyses o f p r o p e r ly co lle ct e d samples o f blood in most in s t a n ce s . We undertake t o ob tain d u p lica te samples o f the b lood , co lle ct e d in t o co n ta in e r s which we p r o vid e , 'ey methods and w ith equipment w h ich , a ls o , we p r e s cr ib e . We ar e r a r e ly in doubt con cer n in g the s ign ifica n ce o f the r e s u lt s , and when we ar e in d ou b t, we can u s u a lly r e s o lve the doubt by ca r e fu l a t t e n t io n to the nature o f the illn e s s pr esen ted by the ch ild wheee blood co n ta in s lead in amounts th at are of b or d e r lin e s ig n ifica n ce . 's I t is true t h a t r eason ab ly s a t is fa c t o r y r e s u lt s can be obtain ed by the a n a lyse s o f s u it a b le samples o f u r in e . Vie r e lie d upon such r e s u lt s b efor e we had s a t is fa c t o r y methods fo r a n a lyzin g the b lo o d . At p r e s e n t , however, I in s is t upon h avin g samples o f blood fo r a n a lys is in a l l ca se s o f childhood le a d p o iso n in g, and in a l l cases of le a d p oison in g in the a d u lt , e xce p t those r a r e cases of t e t r a e t h y l le a d p oison in g which occu r under h igh ly unusual or a ccid e n t a l c ir cum stances (when t e t r a e t h y l lead is absor bed , the b lood le v e l in cr e a se s l i t t l e or none, ap p a r e n tly because the in ter m ed iate compounds r e s u lt a n t upon th e d e - ' com position o f the m olecule in the t is s u e s ar e n ot capable o f combining w ith the component o f the or ytltr ocyte th a t i s in vo lve d when in or ga n ic le a d compounds are absorbed). The a n a ly t ic a l procedures which we use fo r the -urine ar e n ot d iffe r e n t , essen t i a l l y , from th ose which ap p ly to the b lo o d . The problem throughout is th e use o f methods o f high s e n s it iv it y and p r e cis io n and the avoidance o f equ ip ment, r e a ge n ts, and procedures t h a t in tr od u ce le a d . This r e q u ir e s proper and c a r e fu lly d esign ed la b o r a to r y fa c ilit i e s and s k ille d p er son n el. This is no jo b fo r an or d in ar y la b o r a to r y te ch n icia n and in deed oneshould n ot-attem p t su ch N22324 Dr . D. Kerr Gr an t 2 Octobe r 2 6 , 1956 a n a lyse s u n le ss he is a w e ll tr a in e d a n a ly t ic a l ch em ist who understands ever y ste p o f the pr oced u r e. Moreover, one should n o t attem p t t o ca r r y o u t o cca s io n a l an a lyse s o f t h is type* I t i s b e t t e r to depend e n t ir e ly on one*e c lin i,c a l ju d g m ent, than t o have th e m islead in g in for m ation obtain ed from an in ad equ ate a n a lysis* There i s no good r e a so n , however, why th er e sh ould n o t be a t le a s t one s a t is fa ct o r y la b o r a to r y fo r work o f t h is type in ever y la r ge urban cen ter t h a t is equipped w ith oth er "ca ca i fa c ilit ie s * The fr equ en cy w ith which cases o f le a d p o ison in g ar e se e n , or a lt e r n a t iv e ly the frequency w ith which the d isease is su sp e cte d , in any such urban cen ter in w iiich th er e is in d u s t r y, i s such ac to ju s t ify such a fa c i l i t y . I f you have n ot succeeded in fin d in g such a lab or a t o r y in your gen er al a r e a , you should see what can be done to b r in g ab ou t i t s estab lish m en t* I f we can help you le t me know* We have been in str u m e n ta l in s e t t in g up a number o f such la b o r a t o r ie s in va r io u s p a r ts o f t h is and ce r t a in other co u n tr ie s (En glan d , Fr a n ce , Germany, Dominion o f Canada)* I am sen d in g you a b o okle t on methods r e ce n t ly issu e d by th e APHA, which was prepared fo r the ap p r op r iate com m ittee, by Mr . Cbolak o f our s t a ff, w ith By a s s is t a n ce , on the sam pling problem . I t may be o f h elp to you . m ' - Sin ce r e ly you r s, /) RAKjbd Rober t A. Kehoe, K.D* Dir ector SVP6X Me t h o d s fo r D e t e r m i n i n g D e a d in A i r a n d i n B i o l o g i c a l M a t e r i a l s - A P H A , se nt unde r s e parate co v e r. ,