Document 0JE3zxOVry380JMjQ4YEmn5Vx

A .a. October 4, 1955 D r, L eslie Joseph 4337 W est Fort Street D etroit, M ichigan .. A ttention: D r, Glanz D ear D octor Glanz: . ,, - We have sen t containers for the co llectio n of duplicate sam p les of blood and two sep arate voidings of u rin e, togeth er w ith the in stru ctions for collecting th ese sam ples from your p a t i e n t , T h e containers w ill probably arrive before this letter, but sin ce the instructions in the package are fa irly com plete, that should make little difference. I w rite p rim arily to em phasize a point made in our telephone conversation, to the e ffect that if this man should have had any significan t exposure to tetraethyl lead vapor in the course of his work, the clin ical evidence of this, would be found in the form of an acute cereb ra l intoxication. This form of lead intoxication w as d escrib ed by m e in 1925 and la ter by my a s so c ia te 'Willard M ach le, who brought the inform ation about it up to date as of the tim e of his a r tic le . There have been sev era l a r tic les sin ce, m ostly in foreign m edical jou rn als. I send a reprint of M achle's a rticle which I b elieve w ill be of in terest to you. The d isea se ow es its character to the fact that tetraethyl lead, an oily liquid with an appreciable vapor p ressu re at ordinary tem p eratures, is read ily absorbed (through the skin and the resp ira to ry apparatus), and is distributed in the body in itially after the m anner of a fat soluble compound. H en ce it a tta ck s the c en tr a l n erv o u s s y s te m , and. c a u s e s an acu te c e r e b r a l intoxication * The com pound is p a r tia lly d e c o m p o se d in. the b o d y / and is e x c r e te d fa ir ly rapidly in the urine (and to som e extent via the alim en tary tract.) A n alysis of the u rin e (and to a le s s e r extent* th e blood) g iv e s evidence of the e x c e s siv e absorption and show s the r ela tiv e sev erity of the exposure. From what you have told m e about M r. I doubt that he has had any v ery se v e r e exp osu re, but the a n a ly ses w ill te ll the sto r y , It is d ifficu lt to convince so m e of th ese m en (and th eir b o s s e s , the con tractors) that they should u se adequate resp ira to rs at their work, and if we can find evidence of exposure, we can, I think, do som ething in that direction in this instan ce. The reason I doubt that M r. su ffered se v e r e exposure to lead is that h is sy m p to m s se e m e d not to he m o re than m ild ly s u g g e s tiv e . In v e r y s e v e r e D r. L eslie Joseph - (2) - O ctober 4, 1955 c a se s the onset com es in a few hours to two or th ree days after the exposure, gath erin g s e v e r it y a s it d e v e lo p s . In m ild c a s e s th e sy m p to m s m ay be delayed or retarded in th eir developm ent, reaching the le v el of e a sy recognition only after eight or even ten d a y s. If nothing happens fo r a w eek after a period of suspected or alleged exposure, one can be sure that the exposure was of m inor consequence. 1 should say that M r. Atkins w ill need to be reassu red that he w ill suffer' no sign ifican t dam age, but he a lso needs warning that he should be protected by a satisfactory air lin e m ask in the continuation of his w ork. There is , I b eliev e, no reason why he should not return to it, if he is prepared to take suitable precautions. I should point out that m en who enter gasolin e tanks m ay be intoxicated by gasolin e vapor. Som etim es this is m istakenly thought to be tetraethyl lead intoxication, sines the excitation due to gasolin e, lik e that associated with the ea rly stages of a n a esth esia , m ay resem b le tetraethyl lead intoxication to som e slight extent. The rule-of-thum b difference lie s in the fact that the cereb ra l sym ptom s in gasolin e poisoning c lea r u n fa ir ly quickly, w hile those o f te tr a e th y l lead p oison in g p e r s is t and tend to in c r e a s e in. s e v e r ity . I shall report our analytical findings to you as soon as they are available and I should app reciate any inform ation concerning M r. Atkins* p r o g r ess that you m ay p ass on to m e. C ordially yours, RAK of Ene. Robert A . Kehoe, M. D. P .S . I find that a ll of the reprints of M achie's a rticle; on T etraethyl Lead P o iso n in g have b een u se d up. *`T h e -r e fe r e n c e is a s fo llo w s: M ach ie, W illard F . , J .A .M .A . 105:578, 1935