Document wJjra3GVE5o4RV1rpKkQDG7E

November IT, 1942. Dr* P. M. Andre,. Supervisor, 'Medical Section, Industrial Commission Of Ohio, Columbus* Ohio.- Vi ' v; S V! \ . 1 -A \\ ' \* ^iv i\ \ V' Bear i>r. Andre* |.. I am glad to reply as veil as X can to your letter of, November 6. Unfortunately the problem is not simple. In f'&et, it'was vith great dismay that I received word of the Resolution of the Commission,requiring quantitative analyses on\urine in substantiation of the diagnosis of lead poisonings There is no question of the usefulness of having accurate Ihfonaation on the blood or urine, or both. On the other hand'. It is equally certain that the facilities for providing huch accu rate information throughout the state are not available and that they can not be made available merely by asking for this information. The result will certainly be that you kill re ceive less useful Information than you have been obtaining in the past, simply because you will probably confuse fairly good clinical Information vith hopelessly Inaccurate analyti cal data. You will probably think I am painting an unneces sarily dark picture. Quite on the contrary, I can tell you that there are probably not a dozen places in the United States as a whole from which accurate analytical data of this type can be obtained. The analysis of blood and urine for lead content Is probably the most difficult diagnostic labora tory procedure that could be mentioned. Special equipment Is required, special laboratory facilities which are not contami nated with dusts and other materials from other chemical pro cesses , must be available, and a degree of analytical skill veil beyond that required of laboratory technicians in general. Is Imperative. Moreover, the samples must be obtained under specified and very carefully controlled conditions, since the contamination of samples will occur regularly under anything than the most rigid conditions of care. A 24-hour sample of urine,collected in a hospital by the usual methods should never be analysed,for the results obtained from its analysis are almost certain to be grossly jfilsleading <. lOnly the utmost precision and chemical cleanliness will provide samples worthy of analysis. This is not a routine analytical procedure>:there fore, to be carried out in a clinical., diagnostic laboratory, and only the greatest confusion can be expected to result from the attempt to introduce this measure into hospital and clini cal laboratories. It simply cannot be done, since neither the personnel or the equipment will be available. Therefore, if Dr. R. M. Andre - (2) - Jfoveaber IT* 1942. the Commission intends to adhere to its Resolution, it will be necessary for it to see that certain places are set up which will be available for carrying out this type of work* We have already had a number of requests to do work of this sort. Unfortunately* this is not a diagnostic laboratory* and I can not permit it to degenerate into that type of laboratory. We shall be glad to give every possible assistance to persons interested in setting up good laboratory facilities. We shall be quite glad to give any such persons all the information we have as I am to send it to you. However, it must not be thought that thi3 will solve the problem* for this is not just a question of a method of analysis. Under separate cover I shall send you a complete and adequate description of the dree' methods which ve employ, in the labora tory. 1 should not wish you to refer to them in your instruc- t ions as the "ehoen method, since I think that would tend to make me rather ridiculous. Actually these methods have been worked out carefully over a period of years by my associates here in the Laboratory* and as you will see* all of them are available in published articles. There are other modifications of the so called dithizone method,which have given excellent re sults , and which in the hands of the well trained chemist will. work satisfactorily. We believe that the dithlzone method pro perly carried out, is the method of choice for clinical work. On the other hand* various persons are making use of the poiaro- graph for ie&d determinations and when this is done properly, it gives excellent results. However* w do not believe that any laboratory can do sound work in this field irregularly and inter mittently. Use of the methods requires great precision* continu al checking of reagents * and the greatest care in the `mainten ance of the utmost cleanliness in the immediate environment of the analysis. I am sure* therefore* that where only occasional analyses are to be made by a laboratory technician who is routinely engaged in a large number of laboratory procedure* the results obtained will be unsatisfactory and grossly misleading. From the point of view of the Commission* I feel certain that this will result badly, sin.ce I think there will be more cases to compensate than there would be under other conditions. The regular thing is for the results to turn out abnormally high, as the result of contamination in the process of collection and analysis. - *" I regret very much that I hav to take this position* since khere is nothing I would like better than to see wide spread use of\ analytical procedures in persona suspected of lead poisoning. However, over a period of years in which Xhave been working in this field, i have consistently advised all tho doctors I have c ome in contact With,not to resort to analytical procedures, un less they find it possible to obtain results with absolute cer tainty of high accuracy. It is infinitely better to rely upon KE 001S775 / / / MATERIAL SEHT TOPER SEPARATE COVES "Quantitative Spectrographlc Determination of Lead in Biological Material" Jacob Cholak "Spectrographic Analysis of Biological Material HI. Lead, Tin, Aluminum, Copper, and Silver" - Jacob Cholak and Robert V, Story These articles are to be taken together for the spectrographic method, since the latter one refers to the former# ^termination ofLoad. in Biological Material" * Jacob Cholak and Karl Bambach Electrolytic Deposition of Lead from Biological Material " - Karl Bambach and Jacob Cholak These articles to be taken together for the polarographie method. "Determination of Lead by Pithizone" - Karl Bambach 'feeteminatiicm of Lead" + Donald M. Hubbard These two articles to be taken together for the dithizone method. A complete version in one article will appear in the Industrial and Engineering Chemistry Journal - Analytical Edition in a few weeks i 1: K% 0013776 / Dr. R. M. Andre - (5) - November 17, 1942. pur clinical Judgment than to have the misleading factor of inaccurate analytical data. Despite all I have said above# you can count on my assistance in any vay in vhich ve can effectively help out. Cordially yours, i-'. Robert A. iJehoe , M. D. RAK ef Fnc. K 0019777