Document RjeweX9k09GDo1zDmoEnVqM0E

Ju ly 9, 1957 D r. D. W. C aldw ell, M edical D ire c to r E sso R e se a rc h and .Engineering C om pany P. Q. Box 45 L in d en , Mew J e r s e y ' ' D ear D octor C aldw ell: D o cto r K a rl V . K ltsm ille r h a s c a lle d m y a tte n tio n to y o u r som ew hat sh a rp le tte r of June 25 c o n cern in g th e e x am in atio n of a film o f th e blood of one of your C om pany's em ployees* M r, Floyd B u tle r. I had occasio n a lso , y e s te r d a y , w hen I w as in N ew Y o rk , to s e e D r. E m il C . B e y e r , with, w hom D r. T hom as R . M aloney is a sso c ia te d in h is w ork fo r E thyl C o rp o ratio n . S ince th e re s e e m s to be so m e m isu n d e rsta n d in g in y o u r mind, and th a t of y o u r a s s o c i a t e . D r . V*. H a u s h e e r , w ith r e s p e c t to b o th o u r e x a m in in g p r o ced u res and o u r read in ess to supply in fo rm atio n fro m th at so u rce, I have thought it w ise to w rite to you. My re sp o n sib ility in fee m a tte r is a d ire c t one, and m y acquaintance w ith you suggests th at we should not be a t odds w ith e a c h o th e r in a m a tte r of th is type* F ir s t le t m e say th a t m em b ers o f.o u r staff m ake ev ery effo rt to co o p erate w ife the p hysicians in y o u r C om pany and o th e r o il -com panies, out of p rim a ry in te re st in the w elfare of the m en exam ined a s w ell as in the p ro fessio n al am enities. So fa r a s blood exam inations a re concerned* how ever, th ese c o n sist of only tw o p ro c e d u re s in field ex am in atio n s, n am ely , th e d e te rm in a tio n of th e hem o globin content of fee blood and fee exam ination of a stain ed film by a w ells t a n d a r d i s e d , s e m i - q u a n t i t a t i v e m e th o d f o r b a s o p h il ic '`s tip p lin g " o f th e ery th ro cy tes. A differential leucocyte count is not c a rrie d out on such a film because of the specific m ethod o f staining, and also b ecau se, in m oat in s ta n c e s, th is is not believed to be e sse n tia l fo r o u r p u rp o se s. The film s a re not kept, but fee re su lt of the count is reco rd ed on the ch art of the patient. F o r the sak e of u n ifo rm ity , the counts a re a ll done by one w ell tra in e d p e rso n in th is L a b o ra to ry , and re p o rte d to the p h y sician who sen t in th e film s. T hat is why D r. K itzm ilier did not have the re s u lt. If it is believed th at fu rth e r hem atological (or o th er) exam inatb n3 a re indicated, the p e rso n concerned is re fe rre d to the re fin e ry p h y sician o r to h is p e rso n al p h y s ic i a n . - -> I should point out to you, fo r your own info rm atio n , th a t the d eterm in atio n of He 0020302 Af Q Dr D . W. C aldw ell - (2) - Ju ly 9, 195? th e ''stip p lin g " is done p a rtly in d e fe ren c e to the high b u t undue re g a rd in which th is te s t is h eld (with re s p e c t to lead ab so rp tio n ) in m ed ical and m e d ic o -le g a l c irc le s . O ur fa ilu re to do th is w ould re s u lt in se rio u s c r iti cism a t tim e s , and m o re o v e r, if som eone e lse w ere to m ake such o b serv a tio n s (this h as o c c u rre d fro m tim e to tim e) and w ere to m is in te rp re t them , ws w ould find o u rse lv es a t a d isad v an tag e. The fa c t is th a t th e re a re no m ic ro sco p ic changes of any kind in the blood in resp o n se to th e ab so rp tio n of tetraeth y l lead, but this fact is not gen erally known to physicians, and we have to e sta b lish the fa c ts w ith re s p e c t to stip p lin g am ong the m ixing plant p e rso n n e l in o rd e r to av o id am biguous s itu a tio n s . We do n e t a tte m p t to e sta b lish th e e n tire blood p ic tu re , h o w ev er, b ecau se of the p ra c tic a l diffi cu ltie s w hich p re s e n t th e m selv e s to o u r p e rip a te tic p h y sician s. It could be arg u ed th a t th is should be dene, but it is fa ir to say th at th e reg im en of the ex am in atio n s e sta b lish e d y e a rs ago h a s b een fra u g h t with v e ry few s e rio u s d iffic u ltie s. . I s h o u ld , p e r h a p s , m a k e a fe w a d d itio n a l c o m m e n ts . O u r p u rp o s e , in. c a r r y i n g o u t t h e e x a m in a tio n s -of m ix in g p la n t p e r s o n n e l i s to m a in ta in a r e g i m e n o f preventive m edicine in relatio n to a specific h a z a rd . We have n ev er had a case of te tra e th y l lead in to x icatio n am ong th e m ixing p e rso n n el in th is country* In d e e d , s e v e r a l s y s t e m a t i c in v e s t ig a ti o n s o f t h e 'm i x i n g p e r s o n n e l,m a d e s o m e * v/hat a t ran d o m , have d e m o n stra te d th a t the a b so rp tio n of te tra e th y l le ad am ong th ese m en is negligible. Tills is as it should be, if the precautions advised and in d o c trin a te d into th e m en a re follow ed. O ur p rin c ip a l p u rp o se is to m a in ta in Zhia in d o c trin a tio n . In addition* h o w e v e r, by a p r o c e s s o f a p p ro p ria te selection,, we un d ertak e to avoid th e likelihood of the o c c u rre n c e of d isea se th at sim u la tes te tra e th y l le a d poisoning. In th is we have been g e n erally su ccessfu l, and it m ay in te re st you to know feat th e re h as been only one claim m ade in th e U nited S tates of te tra e th y l lead poisoning am ong the p e r sonnel of m ixing p lan ts. This one w as obviously fa lse and w as the re s u lt of & grudge* w hich a ro se when the fo rem an of a m ixing plant fo rcib ly ejected one of the m e m b e rs of the m ixing p erso n n el. The claim was denied by the re fe re e in th e c o m p e n sa tio n -case- th a t a r o s e o u t o f th is a lte rc a tio n . , We do, of co u rse, p ic k u p cases of illn e ss th at req u ire attention, provided e ith e r through the physicians of the oil com panies, o r when np such in te rm e d ia ry is av ailab le {as w as the case fa irly g en erally in 1926 when th is regim en of m ed ical su p erv isio n w as in itiated ), by p riv a te p h y sician s in th e com m unity. O ur exam ination a re , obviously, lim ited in scope because of the n ecessity of c a rry in g th e a rm a m e a ta ria n of th e e x am in atio n s a ro u n d fro m p lace to p la ce . Thi3, how ever, has not been an insurm ountable o b stacle to the p erfo rm an ce of a reaso n ab ly good p h y sical exam ination. T h ere a re lim itatio n s fro m the asp ect of the la b o ra to ry p ro ced u res, but I do not feel that we need apologias fo r the qu ality of the exam inations th at have been m ade. I do not h e sita te to KET,0020303 D r . 0 , W. C a ld w e ll - (2) - J u ly 9* 19S? say , how ever, th at o u r p rim a ry co n cern has been to do a good job of p reven tiv e m edicine* to keep aliv e in the m en an a w a re n e ss of th e h a za rd s of the job, and to keep them a le r t in th e ir own p ro tectio n , in the com plete a ssu ra n c e that if th ey abide by the detailed in stru ctio n provided fo r th e ir guidance, they w ill be sec u re from the specific d a n g ers. I u n d erstan d fro m m y co n v ersatio n w ith D r. B ey er y e ste rd a y , th at M r. B u tler is the victim of som e blood d y sc ra sia , p resu m ab ly a fo rm of leu k em ia. T his u n fo rtu n a te ly would not be picked up o r even su sp e c te d , e a r ly in its d ev elo p m en t, on the b a sis of o u r type of blood .exam ination. It m ight w ell be su sp ected in its la te r m an ifestatio n s, although it m ight be m issed com pletely. T his, of c o u rse, is the typo of p ro b lem w hich p re s e n ts its e lf in th e c o u rse of any type of ex am in atio n w hich is n o t u tte rly co m p reh en siv e. We have recognized th is o v e r th e y e a r s , as do a ll co n sc ie n tio u s p h y sician s who c a r r y out ex am in atio n s of a routine o r p re sc rib e d type fo r sp ecific p u rp o se s. .There is , I fe a r, no an sw er to th is p ro b lem . Qua has to d esig n a p ro c e d u re of ex am in atio n in re la tio n e ith e r to a specific p ro b lem , o r on som e g en eral schem e based upon the p ro b a b i l i t i e s . U n u s u a l d i s e a s e s , <?r d i s e a s e s w h ic h p r e s e n t th e m s e lv e s in u n u s u a l p a tte rn s, a re alw ays lik ely tc be m isse d in a g en eral su rv ey . T his is one of the d ifficu lties of a ll p e rio d ic ex am in atio n s, and one w hich; I d a re say , has given a ll of a s in the field of o ccu p atio n al m ed icin e gome, se v e re tw inges fro m tim e to tirn e. If there is a n y th in g w hich we can. do to be o f a s s is ta n c e to you o r to M r. B u tle r, I tr u s t th at you w ill le t m e know. A t the m o m en t th e re does not seem to be such a possibility. Sincerely yours, R A K e D ictated but not read. C .C . : D r, K. V. K itsm iller D r. E m il C. B eyer Rofaei-fc A . K e h o e , h i. D . E 0020304