Document RJRVqQJE6jkrmY6oXj8DzGq4z

June 1, 1955 D r. R. H. Thompson 11318 M ites Avenue C leveland 5, Ohio D ear D octor Thompson: My le tte r of M ay 14, which was a com bination of a form le tte r which didn't quite fit the situation (it war designed to fit m ost of our enqu iries and to lim it the flood of corresp on d en ce which has sw am ped m e a t tim es and has cau sed undue d ela y in rep lying), and an additional le tte r to m ake up the d eficien cy . I'm afraid the com bination failed to convey m y intention. W hile I do not wish, to in te r fe r e in a3iy way w ith you r effo r t to obtain th is p r o fe s sional serv ice elsew h ere, it seem s only a cou rtesy to explain m y purpose m ore fully, and it is som ething of a duty to clarify the function of this in vestigative and educational institution. I undertook to point out an apparent fault in the approach to the situ ation . The an alyses of sam p les of urine of sm all volum e obtained occa sio n a lly from a scatterin g of workm en w ill not portray the hazard of an industry, on the one hand, or the hygienic status of the individual m en on the other. The variab ility of the excretion of lead in the urine is such that one m ust have a se r ie s of sa m p les fro m any one m an, in o rd er to e sta b lish th e general or a v era g e le v e l of his excretion of lea d . This can be done, but it is troub lesom e and expen s iv e . The altern ative is to obtain and an alyse a sam p le of blood, eith er with or without a sam ple of u rin e. The concen tration in the blood is not su b ject to wide v a ria tio n s, but rather it clea r ly in d icates the m an's g en eral le v el of lead absorption at the tim e of the sam pling. This fact is not g en erally understood, and th erefore m any people, including physicians, do not obtain the inform ation th ey need to do the job th ey a re attem p tin g. If one knows the le v e l of lead concentration in the blood, one knows certain ly, w hether the m an is in a safe statu s. No other an alytical r e su lt w ill give that kind of inform ation. Leaving the individual m an out of consideration for the m om ent, the conditions in a plant, w ith r e sp e c t to the v a rio u s sp e c ific jobs , can be le a rn ed by obtaining and analysing a rep resen tative num ber of sam ples of the urine of the m en engaged in the individual jo b s. The /f ria b ility of the individual resu lts w ill tend to n eutralize each other, and the average of the resu lts w hich apply to a sp e c ific job w ill rev ea l the extent of the ab sorp tion of lead a sso c ia te d w ith the job. This can be done effectiv ely , by the co llectio n of a sufficien t num ber of sam p les, but it too ie expensive, sin ce one has to have a sufficient num ber of r e su lts to be sta tistic a lly valid . The altern a tiv e is to com bine the two p ro ce du res in dealing with a r ela tiv e ly sm a ll num ber of m en w hose exp osu re is in question, and to obtain both sa m p les of blood and urine from such a lim ited num ber of m en. Each set of resu lts villi then reveal the status of that individual D r . R . II. T hom pson - (2) - June 1, 1955 m an, and the com bination of th ese w ill show , a s nothing e ls e w ill, the condi tions of the plant insofar as they a re rep resen ted by the m en under exam ination. T his technique of approach to the problem is one which we have developed ste p -w ise out of wide exp erien ce, and I have sought to dem onstrate its effec tiv e n e ss and to explain its ra tio n a le, to th o se who have com e to us fo r ad vice and h elp . It is fa r fr o m b ein g th e s im p le r u le of thum b p r o c ed u r e w h ich m an y have tried to m ake it. . The other a sp ect of m y le tte r related to our functions as a u n iv ersity lab oratory, w hich com bine education, im provem ent in hygienic standards in the lead trades, and g a th e r in g in fo r m a tio n fo r o u r s e l v e s . "We a r e p r e p a r e d to c a r r y on a n a ly tic a l m e a s u r e a o f co*xc3?Gi i.*~ sibVicXuiori-i xn w-iio-i know w hat w e a r e d o in g , and from which we can ob serve the status of various lead tra d es. We cannot engage in a n a ly tic a l s e r v ic e s fo r f e e s , out of w hich w e ga in nothing of in fo rm a tio n and into w hich w e put nothing of sound a d v ice and gu id ance. In sh ort, we conduct a consultation p ra ctice in this field for our own educational b en efit and that of n d u stry. We m ain tain it a s long a s the r ela tio n sh ip is m u tu ally b e n e fic ia l, but a s so o n a s w e ca n do s o , w e a tte m p t to a id in d u s tr ia l o r g a n is a tio n s in th e knowledge of their problem s and in th eir own solution of the m ed ical and en gin eerin g m ea su res of co n tro l. The an a ly tica l end of it, w hile it in volves sk ill and p recisio n of a high d eg ree, is m e r ely the m eans to the end of adapting p h y sio lo g ica l know ledge to the in terp retation and control of an in d u stria l hazard. I have gone to -some trouble to point out th ese m a tter s, la r g e ly b eca u se I was som ew h at n eg lig en t p r e v io u sly through being p r e ss e d for tim e . It is im portant th at th e s e m a tte r s be u n d e r sto o d , f o r a n u m b er c f p h y s ic ia n s who do not understand the problem have d iscard ed the an alytical m eans of control as being in e ffe c tu a l. So th ey a r e , u n le s s one know s what to do and w hat the r e s u lts m ea n . Sincerely yours, Robert A. Kahoe, M. D. Ki? A n o '} a VU i 4 I / ROBERT H. TH OM PSON , M. D. 11318 M iles Avenue Cleveland 5, Ohio Phone DI. I - 7755 ay 2 7 , 1 9 5 5 Dr. R. A. Kehoe Kettering Laboratory C i n c i n n a t i, Ohio Dear Doctor Kehoe: I assumed, from your l e t t e r o f May 1 4 , 1 9 5 5 , t h a t your l a b o r a t o r y wou I d no t b e i n t e r e s t e d i n r e p e a t i n g l e a d e x a m i n a t i o n s on our employees, once you have e s ta b lis h e d whether a hazard i s or i s net present. S i n c e we are i n t e r e s t e d i n p e r i o d i c c h e c k s on t h e s e men, I have s o llie ite d the services of another laboratory, I a p p r e c ia te your w i l l i n g n e s s to get us s t a r t e d on our program, and hope that^ i f any h e a l t h problem s a r i s e , I may c e a o i e t o ask your advise. Sincerely yours R. H. Thompson, k . b May 14, 1955 D r. R. H. Thompson 2910 Harvard Avenue C levelan d , Ohio D ear Doctor Thompson: I en c lo se with th is note a form le tte r , w hich g iv es som e n e c e ssa r y in fo r m a tio n . I a m c o m p e lle d to r e s o r t to th is p r o c e d u r e b e c a u s e o tiie tim e req uired oth erw ise in corresp on d en ce on th ese m a tters. The letter, how ever, does not cover the situation posed by your request. You do not m ake clea r what your purpose is in connection with th ese a n a ly s e s . If you w ish to a p p r a is e the s ig n ific a n c e o th e er-cpcsure t.o,and absorption o f lead on the part of this sm all group of m en, th is is not the way to do it. I think, th erefo re, you had b etter acquaint m e with your situation and your purpose, and I can ad vise you how b est to proceed. The resu lts of the an alysis of sm all sam p les of the urine of this sm all group of m en w ill not te ll you what you need to know. It w ill be n e c e s s a r y eith er to obtain sam p les of blood along with the urine sa m les, or you w ill h a v e to o b ta in a s e r i e s o f s a m p le s o f th e u r in e o f e a c h m a n . Vrnall sam p les of urine from a sm all group of m en w ill yield resu lts toe variable to be depended upon. We do not do a n a ly ses fo r fe e s , sin c e th is is in no se n se cf the w ord a se r v ic e or diagn ostic lab oratory. H ow ever, I w ill h elp you with your problem if you w ill tell m e what it is, and provide m e with a ll of the inform ation needed to give you good advice. P erhaps I need not point out to you that, as a physician, the inform ation y o u g iv e m e w ill b e h e ld in. c o n fid e n c e , but s in c e th e s e m a t te r s a r e d e a lt w ith so lo o s e l y ir. t h e s e d a y s , it s e e m s w is e to in d ic a te th at th is is a m edical function. A s a m atter of p ro fessio n a l p olicy and duty, we often deal with in d u stries through th eir appropriate o fficia ls and p h y sicia n s, a s our p a tien ts. We cannot s e r v e th em u n le s s w e ha,ve the in fo rm a tio n that enables us to understand th eir trouble, and to p r e scrib e for it p rop erly. B u t fo r c u r a c c e p ta n c e of th is p r o f e s s io n a l duty, b e c a u s e ox th e n a tu re o f our fa c ilitie s , we would not allow o u r selv e s or our regu lar work to be disturbed and interrupted by ser v ic es of this type. In o r d e r not to a e la y you in w hat m ay be a s e r io u s m a tte r , I s u g g e s t that N 7916.02 D r. R . H. Thom pson - (2) - M ay 14, 1955 you obtain sa m p les of blood and urine from each one of th ese m en in contain ers w hich I sh a ll supply, w ith d etailed in stru ctio n s. If you w ish to do th is, send m e word by return m ail or telegram or telephone, and they w ill be sent at once. Then w hile w e are getting th ese sam p les and analyzing them , you can inform m e on the d eta ils of the problem with w hich you are con cern ed . If th ese m en a r e ill, I sh a ll want fu ll inform ation about th em . If they a re under investigation a s rep resen ta tiv es of a certa in type of lead exposure, I sh all need the sto ry of th eir em ploym ent and th eir sp ecific h a z a r d . In a n y c a s e , I sh o u ld lik e a s fu ll in fo r m a tio n on th e ir o c c u p a tio n a l and clin ica l status a s is n e c e ssa r y to provide you with an adequate in ter pretation of the an alytical r esu lts in. relation to the situation w ith w hich you are presented. . C ordially yours. RAK ef Enc. Robert A. Kehoe, M. D. 000'f>iB4