Document v63x3w5x09BXYpLxZgV6Gm2nY

\ Boston, Hassachnsotts February 5th, 19-42 Dr. 2, 2* Evans, Medic?.! Dept., 2. I. Dupont Honours & Co., Perms Grove, H. J. Dear Bob*- I talked with Howard Gehra&nn and Joe Stchar about the proposed changes in record card for tha lead Examination, and the possibility of carrying a running record on tha entire group. Howard had some ideas on the scheme and wanted to consult with Foulger about it before the plan was finally put into effect. I think it will be a very good idea to have the plan gone over by as many people as possible, even though Joe is anxious to go ahead with it soon. Tha changes in the examination record that seem desirable to me have been indicated ou the attached record. After you have made any changes that seen desirable to you, you can advise Howard and he can then proceed to make his and Foulger*s contributions. It seems quite unimportant to me which method we use for following these man as long as we express our results in quantitative tanas. Howard suggested the possibility of developing son type of scoring arrangement similar . to that used for E. G. B* workers which may ox* m y not offer any advantages* The important thing is to have some means whereby we can measure change in quantitative data from month to month, since in the last analysis your opinion of the clinical status of the men will have to be the guide for the management in their handling of the employees. I rather think that both you and Howard should stress the careful follow-up of clinical condition of the questionable nan that you are now carrying out ana point out to the management that, with thi3 type of careful clinical supervision of border line cases, there is little to be gained by furnishing tha management with more tixan a bare outline or summary of the over-all picture in the lead area. Anything more than that would . -put the in tha extremely awkward position of having to sake decisions is a highly technical field, for which they have had no training, and I as quite sure they would wish to avoid this Notes on tha card changes are itemised below, and are marked on- the attached card* First of all, it would seem desirable to simplify the card and eliminate meaningless headings and repetition. There also should be an in struction sheet for the physicians which would determine the criteria by which they judge the finding* Item 1 If would be a good idea in view of the variabilities in blood pressure, following week ends, picnics and holidays, to note the day of tha week, or day after holiday in addition to the date and time as is now done. Item 2. The general headings for statements sueh as digestive, muscular, etc., can be omitted. They seem to serve no good purpose, and if the medical officer does not know to which system the findings refer, i%,needs to be worked on* February 5th, 1942 To ar pv&P5. __ Itata 3, Paliar eaa regain, hut the criteria should be set. Iten 4 'kept. Anemia and emaciation can be omitted since the record of the eight is Item 5. Colic or abdominal pain. - Few people can differentiate between the two, and they can b considered together, particularly since it is extremely un likely tint we will encounter any genuine cases of clear-cut saturnine colic* Ita 6. Breakfast anorexia, can remain, and should cover the loss of appetite* Item 7. Vomiting is so non--specific and unusual that it seems to me can be omitted. The case is true for convulsions arid tinnitus* Itea 8* meowing. Arteriosclerosis can be omittad for reasons we discussed'during our Item 9. A separate heading night be made for laboratory findings under which uantitativs data and plus or minus findings -- such as albumen, sugar and urinary acidity - can be noted* One might consider whether or not it is desirable to in clude a volume index record on these man* If too much work is not involved, it would be profitable to include this study on the seven men in the blonder group that wa will be following this year, since this will give us an idea of. the value of this* Item IQ, As discussed in our meeting for coding purposes, one might include a few columns for reference to findings in the various systems* I believe the shortened fora, particularly when rearranged in order, will have definite advantages, fro your point of view, as well as for statistical purposes, and moreover will probably leave enough room at the bottom of the card 'or notes on the particular examinations that the physician nay wish to isake, I would appreciate getting,your reaction to the foregoing suggestions* With best regards, 2 a Vary truly yours, d/M Sue* K ff A U <' O'U ( ri 0