Document RxK5r0EL6k0wQay6nO00mrbE

March $ , 1 9 ^1 D r. It. U. X u rte n olD Main a t r e e t ``a o i n s , Wi s c o n s i n Dear Doctor Kurten: ' I have had th e r e s u l t s of the a n a l y s e s made on sa m p le s o f u r i n e and b l o o d o b t a i n e d from fo u r men, f o r some d a y s, I have been w a itin g t o o b ta in th e o th e r sam ples and t o com plete th e a n a ly s e s b efo re re p o rtin g the r e s u lts to you. However, s in ce t h e y h ave n o t been r e c e i v e d 3 . y e t , and s i n c e we w i l l be delayed f o r a s h o rt time in our a n a l y ti c a l program while the la b o rato ry is being painted throughout, I t seems w ise to re p o rt the r e s u lts to you. A ccordingly I am s e n d i n g you h e r e w i t h t h e a n a l y t i c a l r e s u l t s , A few words of i n t e r p r e t a t i o n a re I n d ic a te d in c o n n e ctio n with these r e s u l t s . Three of the blood analyses have given r e s u lts w h ic h a r o d e f ^a i te ly above the normal l e v e l s . The o th e r w ithin normal lim its . I t would be i n t e r e s t i n g t o know t h e d e t a i l e d h i s t o r y o f e x p o s u r e o f t h e s e men in r o l a t l o n t o t h e a n a l y t i c a l f i n d i n g s , and I sh o u ld b e g l a d t o hav e t h i s in f o r m a t i o n a t y o u r e a r l y c o n v e n i e n c e . On t h e o t h e r h a n d , i f wo may assume t h a t th e se samples were taken w ith th e utm ost p r e c a u t i o n a g a i n s t c o n t a m i n a t i o n , we may a c c e p t t h e f a c t t h a t t h r e e o f t h e s e men h a v e had some r e c e n t e x p o s u r e t o le a d compounds. The b lood l e v e l s a re n o t n e c e s s a r i l y d a n g e r o u s l y h i g h , and y e t we h a v e s e e n symptoms o f i n t o x i c a t i o n o c c a s i o n a l l y in c o n n e c t i o n w i t h b lo o d l e v e l s o f th e o rd e r o f m egnitude of 0 7 m illig ra m s per 10 gram s. ' The blood Is only s l i g h t l y v a r i a b l e from hour to hour and from day to day under s u b s ta n tia lly uniform con d ition s of e x p o s u r e . T h e r e f 01 e we may e x p e c t t h a t t h e s e t h r e e men have had lead exposure o f th e same o rd e r o f m agnitude. On t h e o t h e r h a n d , t h e l e a d c o n c e n t r a t i o n in t h e b l o o d does n o t change as prom ptly o r t o th e same d eg ree as t h a t In th e u r i n e , s o t h a t m in o r d i f f e r e n c e s in m ag n itu d e o f exposure are not as w ell demonstrated by the blood as by the u rin e . A ccord ingly i t is w oll to examine c a r e f u l ly th e r e s u l t s o b ta in e d on th e u r i n e . * The v a r i a b i l i t y of the a n a l y t i c a l r e s u lts on th e u rin e is f a i r l y co n sid erab le from hour to hour d u rin g t h e day*, and from day t o d a y , v a r y i n g c h i e f l y w ith th e u n it output of w a te r. For th is re a so n , sm all spot samples are - 2- -` r not ss u sefu l as- la rg e ones, unless they a re taken under p recise conditions 1th re sp e ct to time of day, water i n t a k e * e t c * F o r t h e s e r e a s o n s we m u s t r e g a r d th e r e l a t i v e l y h ig h r e s u l t o b t a i n e d on as ln" conclusive with re sp e ct to I ts e v ld e n c e o ^ie a d exposure. In o t h e r wor d s , t h i s r e s u l t , t o g e t h e r w ith th e r e s u l t s obtained co ju st a t the upper range of normal values or th e low er range of abnormal v alu es, c h e v e r way one c h o o s e s t o l o o k a t i t * The l a t t e r two r e s u l t s are q u ite in keep ing w ith th e r e s u l t s o b ta in e d ou t h e b l o o d , and th e r e l a t i o n s h i p which o b t a i n s h e r e b etw een t h e b l o o d and t h e u r i n e a r e t h o s e w h ich we u s u a l l y f i n d , I t h i n k , t h e r e f o r e , we can a c c e p t th e f a c t t h a t b o t h o f t h e s e men h a v e had aora9 r e c e n t l e a d e x p o s u r e w hich is probably n o t o f an e s s e n t i a l l y dangerous ord er of tu d e * 'Ye may a l s o a c c e p t on e a n a l y t i c a l e v i d e n c e on as i n d i c a t i n g t h a t h e h a s had no r e c e n t s i g n i f i c a n t e x p o s u r e s i n c e , alth ou gh the d isc re p a n c y between h is blood and u rin e v a l u e s i s c o n s i d e r a b l e , i t i s n o c beyond t h e r a n g e of common e x p e r i e n c e , and we may p r o b a b l y assume f c h a u r i n e sample was a co m p a ra ftv e ly c o n c e n t r a t e d on e. Th Is b r i rags us t o th e c o n s i d e r a t i o n o f t h e u i u B o b b u 3.0 e d on These are d is tin c tly unusual in th at thei e is a v e r ^ T a e d iscrep an cy between the r e s u lts o b t a i n e d on t h e b l o o d and t h a t o b t a i n e d on the u r i n e . I sh .-u ld f e e l r e a s o n a b l y c e r t a i n t h a t t h e h i g h r e s u i t fen th e u r i n e v;as i' n p a r t th e r e s u l t o f c o n t a m i n a t i o n , e x c e p t f o r f a c t t h a t we h a v e had a s e r i e s o f pro v? ous h ig h r e s u l t s iha t tend to i n d i c a t e t h a t t h i s i s h i s u s u a l b e - rr&vior W7.th r e s p e c t t o l e a d e x c r e t i o n . The o n l y s i t u a t i o n in w h ich we have f o u n d r e s u l t s o f t h i s t y p e w itn an y d e g r e e o f c o n s i s t e n c y i s when i n d i v i d u a l s have h:.;d a r a t h e r l a r g e exposure fo r a sh o rt period o f tim e, under tnsse conditions the lead I s least from the body ra p id ly during th e i n i t i a l phase of the ab so rp tio n , with the r e s u l t th at the blood does not develop a high c o n c e n tra tio n o f l e a d , b u t the urine shows a d isp ro op rtlon ately high co n cen tratio n . I su sp ect, th e re fo re , t h a t H H f e & u s t have had a r a t h e r s e rio u s exposure w ithin a ' p erio d o f tw e n ty -fo u r hour-s or so o f th e tim e in which th e s e samples were taken* You w i ll be a b le to judge t h a t b e t t e r txan I , b u t th is i s an i n t e r e s t i n g phenomenon, and I f e e l th a t fo r the sake of your b e t t e r in form ation , i t ought to be fu rth e r in v e s tig a te d . A cco rd in g ly, i f you a re ag reeab le , I should l i k ^ j o su ggest the c o lle c tio n of a s e rie s of urin e sam p les on b e fo re , during, and sh o rtly a f t e r h is d ay 's work. I f tills meets w ith yo u r a p p ro v a l, I w ill send you the necessary con tain ers# I r e a l i s e , of c o u rs e , th a t th is may n o t be p o s s i b l e f o r many r e a s o n s , And. i f i t i s i m p o s s i b l e , the inform ation concerning d a y 's work w ill enable you to see w ith re a so n a b le c e r t a i n t y w hether o r n o t th e in te rp re ta tio n which X have given of the r e s u lts obtained on them i s p l a u s i b l e and p r o b a b l y c o r r e c t . 3 I f t h e I n t e r p r e t a t i o n in t h e e a s e oi* Putney Is c o r r e c t, then I t la q u ite c le a r th at the lead exposure occasion ed by c e r t a i n phases o f h is fcork i s c e n s id e r e .b le and s i g n i f i c a n t , and i n t h a t ca se s te p s should be taken to p r o te c t him a g a in s t tia's exp osu re. . I s h a ll look forw ard with a g reat d e a l of i n t e r e s t t o any I n f o r m a t i o n <hleh you su p p ly r;v- a s t o t h e d e t a i l s of th e p o t e n t i a l e x p o s u r e o f t h e s e s e v e r a l men in a s s o c i a t i o n w i t h t h e i r d a y *e Very truly y o u rs. K a 00054 :9 -