Document Qgr9ywdZamD40jqp313o8Ga0R

Ap ril 25 1925 Dr R B H* Grndwohl Gradwohl La b o r a to r i e s 551I4. Lu cas IAvenue 3t . Lo u isM isso uri Ds ar Dr* Gradw o hlf At lo n g l a s t I h a ve come to th e p o in t o f r e p ly in g to yo u r q u e s tio n s w ith re gard to my o p in io n on methods o f e s tim a tin g the c l i n i c a l s i g n i fi c a n c e o f b a s o p h ilic s tip p lin g o f th e e ryth ro cyte s Perhaps I can b s s t ariswer yo ur q u e s tio n by qu o tin g from an a r t i c l e w h ich I r e c e n t l y p re p a re d f o r th e Ci n c i n n a t i Academy o f Medicin e and then b y augm en tin g my rem arks w ith a l i t t l e in tro d u cto ry statem en t o f $ y p o in t o f view about m ethods* I do n o t b d li e v e th a t an y method i s q u ite s a t i s f a c t o r y which does not give a reaso n ably accu rate q u a n tita tive s ta te m e n t o f th e number o f s t i p p l e d c e l l s . My p e r s o n a l e x p e r i e n c e do e s n o t le a d me to b e l i e v e th a t th e t h i c k s l i d e method pe rm its o f q u a n tita tiv e tre atm e n t A ft e r g i v i n g some! c o n s i d e r a t i o n to th e v a r i o u s m etho ds w h ich have be en d e s cribe d I d e cid e d some ye a rs ago to b e fin the s tu d y o f th in smears w ith uniform d is tr ib u tio n o f efcythro cyteb which would e n a tle us to examine e ach e r y th r o c y te ! w ith a h i g h d e g r e e o f d e f i n i t e n e s s We s e le c te d a method o f s ta i n i n g w hich gave ve ry l i t t l e d i f f i c u l t y from th e p o in t o f view o f u n ifo r m ity , and we p ro ce e d e d to s y a t e a A b i Ca l ly exam ine th e b lo o d o f norm al a n d abnorm al i n d i v i d u a ls by co u n tin g th e number o f s tip p le d ! c e lls in f i f t y f i e l d s , the average of which came v e r y c l o s e t o 250 c e l l s . We a r e th us a b l e to s e t - down o u r r e s u l t s in f i g u r e s w h ich r e f e r to 12,500 e ryth ro cyte s which enables us only a sm all e rro r to e x p re s s them s u b s e q u e n tly in terras o f a m i ll i o n e r yth r o c y t e s , w h ich I b e l i e v e la th e m ost commonly a c c e p te d means o f e x p r e s s i o n . I do n o t b e l i e v e th a t i t i a e t&y s o much a question of ease of seein g s tip p le d c e lls as i t is a questio n o f reaso n able accu racy in the e s tim atio n o f th e ir num ber. Prom o u r f i n d i n g s a lo n e w h ich have be e n c o r r o b o r a te d b y other i n v e s t i g a t i o n , I th in k I t i s q u i t e s a f e to s ay t h a t the mere pre s e n ce o f s ti p p le d c e l l s has no d ia g n o s tic s i g n i f i c a n c e Co n s e q u e n tly I l i k e t o know as a c c u r a t e l y as p o s s ib le fo r c li n i c a l purposes the approxim ate order o f the number o f a t i p p le d c e l l s w h ich o ccu r* ! X have fo llo w e d a c o n s id e r a b le number o f men i n one i n d u s t r y f o r a number o f y e a r s , and we h ave made random o b s e r v a tio n s on a number o f o th e rs from tim e N24617 3 D r, R B, H, Oradpo h l to t i m e . Wa a re now in th e p ro o e a s o f s t u d y i n g th e s e d a ta and I ho pe s h o r t l y we h a ll be a M e to p u b li s h tho e n t i r e s tu d y >? h ave o b ta in e d a v a r i e t y o f a n a l y t i c a l d a ta on th e m agn itude o f th e expo sure and th e e x te n t o f th e l e a d a b s o r p t i o n on th e men i n v o l v e d , and I t h i n k , t h e r e f o r e , we h ave somewhat more e x a c t b a s e s f o r th e i n t e r p r e t a t i o n o f o u r f i n d i n g s th an a re g e n e r a l l y a v a i l a b l e * 17 h a ve d e l i b e r a t e l y a v o i d e d p u b l i s h i n g a n yth i n g on th e s u b je c t be cau s e o f th e somewhat c o n tr o v e r s ia l n atu re o f the s u b je c t in c u r r e n t l i t e r a t u r e . We h ave now re a c h e d a p o i n t where c e r ta i n co n clu s io n s have bee n amply ju s t i f i e d and f o r t h a t re a s o n we a re r e a d y to make a t l e a s t a o o n s e r v a t l v e s ta te m e n t as to th e m eaning o f what we have found The appe n de d carbo n co py o f th e as y e t u n p u b lis h e d a r t i o l e o f w h ich I s po ke a b o ve , w i l l c o n ve y my p r e s e n t p o i n t o f vie w a d e q u a t e ly I h o p e . I t o c c u rs to me on second thought th a t you m ight be in te re s te d in what I have to s a y about the whole m atte r o f d ia gn o s tic m ethods, and I am s e n d in g th e e n t i r e carbo n in s p i t e o f th e f a c t th a t i t lapks re fe re n ce s and is not q u ite in the proper s ta te fo r publication Co rd ially yours, RAK"la ; ' j Ro b e rt A KeKoe,' M.feu 00378