Document yk2gB79r8yLyyEk6Z73RGBbX3

April 8, 1944 ii Dr.* E. G. Funsch# 4101 Laclede Avenue# St. Louis, Missouri. Dear Dr * Funsch s Before sending you containers for the collection of "blood samples# in accordance with the request in your letter of March 29# it seems desirable to acquaint you -vith our general procedure for dealing vith work of this type. This is not a clinical diagnostic laboratory#.and it is not in accord vith our policy as a University laboratory engaged in investigation to do work of this sort generally for fees. Our primary interest is in the collection of information on the general subject of occupational exposures vhich bring about lead absorption in abnormal quantities. On the other hand# I realize the difficulties associated vith obtaining reliable results for a diagnosis of lead poisoning and for the car of patients# and therefore ve have been not only willing but glad to cooperate vith our medical colleagues in carrying out analyses in cases on which ve can obtain full clinical information concerning the nature of the lead exposure# its duration# and the details of the clinical picture produced thereby. For this service ve charge the actual cost of carrying out the analyses# this approximating |50d per sample analyzed. Considering th fact that the measurement of lead absorp tion Is not always easy and that samples are subject to variation as veil as to frequent contamination# it is our practice to supply equipment for the collection of samples as veil as detailed instructions In general# I do not consider a single blood sample to be satisfactory for the purposes of interpreting the degree of lead absorption. "We advise the collection of two samples of blood at the same time# the one serving as a check on the other from the point of view of possible contamination. In addition we advise the collection of the spot sample of urine at the same time# since the lead concentration in the urine is a better measure of the lead absorption Under most conditions 0015734 Dr, E, C , Funs ch - (2) - April 3, 1944 for a number of reasons. In any case, the interpretation of . t'-e 'esuits obtained on the two sets of samples is much simpler and much more certain, bTe do not charge extra for the additional sample of blood, in spite of the greater expense of dealing with it, for the reason that it is our means of assuring ourselves that the samples have been properly collected I am attaching hereto instructions for the collection of spot. samples of urine on both men and women, as well.as instructions for the collection of blood samples* It is necessary that these instructions be followed with the most minute .care,since otherwise contamination of the sample occurs almost with regularity. This is a problem which very few people can appreelate, since few recognize how widely disseminated lead dusts are, and since still fewer fail to appreciate the smallness of the quantities of lead involved in samples of this type. The interpretation of the analytical information cannot be made in such a way as to indicate the presence .of lead intoxi cation, There is no value for the lead concentration In the blood, urine or tissues that can be regarded as diagnostic of lead intoxication. The analytical data can be used only to estimate the order of magnitude of fhe lead absorption. It is true, of course, that the wider deviatiors from the normal are associated with a higher incidence of intoxication, but in the individual case the analytical results have no implica tion in relation to illness * The diagnosis must always be made on purely clinical grounds. For this reason it is our practice to interpret all analytical data when reporting them, the interpretation being based on the findings and on the information supplied. It is obviously necessary, therefore, to have the clinical data. If after considering the matter further you are willing to comply with our requirements, we should be glad to give you such assistance as we can* Very truly yours, RAK ef Enc. . Rooert' A. eiioe, M* D. K 0015735