Document M45N1e9zMKBOGDELaYQwQek2k

Juno 9 *19 3 6 Dr. A, W* Hammond I DO Front Street Beaver Bam, Wisconsin Bear Dr* Hamtondt 1 have Been late in replying to your letter of Hay 20th because of the pressure of other work. However I am entirely willing to express m y point of view upon the question which you have raised* !iy personal feeling about blood examinations of all types is that they are not entirely adequate* We have studied for a number of years the relationship between stippling of the erythrocytes as well as determinations of the haemoglobin and complete red blood cell counts to lead absorption* In general it is true, in a y experience,, .that under conditions of severe exposure to lead compounds there is a distinct tendency to an increase in the number of stippled cells* This is equally true of the retieuloeytes* in our ex* perlones the method of McCord la not mor useful than any other method* We prefer a much simpler method of staining and counting stlppld cells and have found high .stippled cells to be as good an indieat!oh as any other blood chance* However, in chronic lead exposure the stippled count 13 not entirely adequate* Moreover cases of rather acute plumbism may occur without a prodromal elevation of the stippling count* Thus In the individual cas one may miss the mark by depending upon the blood changed*; I prefer to depend upon a complete Careful clinical examination of the patient from head to foot, for the actual presence of prodromal symptoms Is the most important warning of impending serious plumbism* As to the lead analyses of the urine, the value of these is dependent upon the accuracy with which they are done* The range of normal values &y sensitive methods is now well established* The mere detection of lead in the urine is of no value* One must have accurate quantitative determinations. The usefulness of such determinations is that they show the extent of the lead exposure and absorption of an individual* One now knows feat if fee lead excretion of a groupf of men is above a certain level, cases of lead poisoning are likely to occur* The higher fee lead level, the greater the frequency of Occurrence of cases* Quantitative 2 Dr. A# W# Hammond urinary analyses are useful in the estimation of the significano of occupational exposure# They do not* however* make a diagnosis nor do they predict a clinical outcome# I am sending you herewith a reprint of an article in which I ha' expressed myself in some detail on the significance of the blood and urinary findings# Very truly yours* RAKiis ftoBerij' A* Ketaoe* Ii#D#