Document dQRMO5bm7gLYVgnw687r1k3db

April 24, 1942 Dr. Jack B. Brains, 5 0 6 E. 12th Street, Kansas City# Missouri. Dear Dr. Brainsi I have your letter of April 22, concerning "which I shall give you my hast advice. 1. Concerning the analyses made one year after the patient loft the trass foundry. I think it is fair tc say that these results vere obviously in error. The figure of O . 5 4 5 mgs. of lead per liter of urine might have teen valid, if it had teen obtained immediately after the cessation of exposure or during its occurrence. Even so, it is an unusually high figure. It is quite an impossible result twelve months after the discontinuance of exposure, and must have been ob tained by some incorrect method, either in handling the sam ple or in carrying out the analysis . Gn the basis of this opinion, it is apparent that you have no analytical data which justify any conclusion concerning the severity of this man's exposure. Therefore, this severity would have to be interpreted on the basis of definite and specific knowledge of the conditions in the plant involved. From what you have told me about the metal handled in the plant, I have a very definite question in my mind concerning the severity of the exposure. It is possible, of course, to have significant lead exposure when molten metals containing only 5p of lead are handled. On the other hand, it would be a bit unusual, and, therefore, I should want to know much more than is indisated in your letter concerning this exposure before ac cepting it as valid. 2. If It has now been two years since the discontinuance of this exposure, very little useful Information can he obtained by any of the analyses mentioned in your letter. It is tc be presumed on reliable evidence that the concentration of lead in the blood and urine of this man will be within ap proximately normal limits. It is quite certain that the microscopic blood changes will have disappeared and that examination for stippling or the basophilic aggregation test will show nothing which relates to this man's original lead exposure. KE 0020029 Dr. JacfcB . B3?ams - (2) - April 24, 1942. r\ 3. This leaves one in the position of having to make a diagnosis from the history of the case. The diagnosis of lead encephalopathy is difficult to make under these cir cumstances , and I think, can he made only through the ex clusion of other types of cerebral disease , plus definite, evidence of lead exposure of serious proportions. Lead encephalopathy does not occur under conditions of slight to moderate lead exposure, hut is always an expression of kes,,vy lead exposure. 4. Coming now to the specific answer to your request, if you still wish it, I will send you tubes and a needle for the collection, cf blood camples and a container for the collection, of a spot sancle of urine. It will not be necessary to have a 24*hour urine sample, and it will he quite unnecessary to determine the partition of lead between the erythrocytes and the plasma. The analysis of fecal samples is never of value except under conditions of con tinued exposure, and, therefore, such samples are not re quired. As I indicated above, it is predictable that all of the results will be essentially normal* nevertheless, if you want them, wire me, and I shall 3end containers at once, with suitable instructions. For our records and information, I should like you to send ms a complete clinical resume of this case* since we are concerned primarily with the collection of information rather than with clinical diagnostic procedures. I shall be glad to give you my opinion on the case, if you will send me the necessary information. . Cordially yours. Robert K. j^hoe, M. D. RAE ef ' P . S . Our charges will cover tho actual cost cf the analyses, which will approximate $5.00 per sample analysed. ITo charge is'made, except on the basis of the patient*e ability to pay. tfET 0020030