Document 15ZQy0Q5218xbK6K8NkXy40oa

Y4'A:,v April 16* 1936 yy Dr* It* M* Fan Sandt Wewoka H ospital Weisoka, Oklahoma Dear Dr* Van Sandt* ' I am very glad th at you wrote to me about your patien t who had swallowed gasolin e and I h asten t o r eply n ot only because i t i s easy to be mistaken about cases 0f t h is so r t * but also because I t is n ecessary not to do the wrong th in g byw ay of therapy * The illn e ss of your pat ien t i s ...... prim arily due to the e ffe c t s of gasolin e* Because of the fa c t th at gasolin e i s n ot swallowed frequ en tly, i t " . is not gen erally appreciated th at I t is a very ir r it at in g Y m aterial and th at i t does exten sive damage t o the g a st r o - ' in t e st in al m u cosa.Even small quant i t tea of gasolin e such as may In adverten tly be mixed with drin kin g water produce a gast r o in t e st in al disturban ce which r e su lt s in var iab le amouhts of damage to the mucosa more or lose in proportion to the quan tity in gested* The mucosa may be badly eroded and as in your in stan ce th ere may be con siderable hemorrhage# ( I t is p ossib le * of cou rse* t h at your p at ien t may have had a ga st r ic or duodenal u lce r to begin with* but I t Is not n ecessary to have such a lesion in order to have in t e st in al' hemorrhage)* . Usu ally, however* th ere I r a n au sea/vom itin g, r at h er in ten sive diarrh ea* weakness and p r ost r at ion * and sometimes nervous system symptoms sim ilar to th ose seen when gasolin e i s Inhaled in r e lat iv e ly h igh ,con cen tration s. _ As to the In fluen ce of lead in t h is pictu r e* you may dism iss i t e n t ir e ly from yfcrar mind* Hot on ly i s JSthyl Flu id le e s ir r it a t in g in I t s ffeote than i s gasolin e* but also the quan tity involved In t h is type of ' case i s n egligible** A simple calcu lat ion w ill show you ,, Y ,, -- t h at t h is I s a fact or o f no consequence* Let u s suppose th at t h is man swallowed as much as 100 cc, of gasolin e, ~' I t i s en t ir ely u n likely t h at he swallowed t h is much but Y th at I s almost cer t ain ly th e maximal quan tity which h e - / - could have swallowed* Tetraeth yl lead 1$ presen t in gasolin e Y in qu an t it ies n ot in excess o f 3 cc. per gallon and-in most-Y ` in stan ces the quan tity i s con siderably le ss than t h is* b e in g/. - on the average something under 2 cc* per gallon end In the . second grade gasolin es bein g about one or le ss c c * per `. i gallon *. At the minimal con cen tration the In gestion of 100 0 0 # of leaded gasolin e would r e su lt in the in gestion of over 1 grain * Z * SSag ' -T- ,t * V` T:" (act u ally about 80 mgs.) o f t et r aet h y l lead . Granting th at the en t ir e quan tity was absorbed I t la not to be expected th at any symptoms would r e su lt sin ce the toxic dose of t et r aet h y l lead even fo r small experimental animals I s gr eat er than t h is when admin istered o r ally . " ~ " 1- 1 - ' ik' i 1 should Imagine th at what happened is th at your p at ien t developed an erosion of the mucosa of th e stomach, and perhaps of the duodenum. This re su ited ,in a cer t ain amount o f oozing o f blood from a fa ir ly con siderable su rface of the ga st r o in t e st in a l mucosa, This would account fo r the bloody st o o ls, the r ath er con siderable anemia and the gen eral symptomatology. Barrin g fu r t h er hemorrhage, I should expect him to make an uneventful recovery, I should t r e at such patien t with a very bland d ie t en t ir ely fr e e of r u ffage u n t il the gastro-in fcestin al symptoms have e n t ir e ly subsided. I f any fu r t h er tran sfu sion s are in dicated, t h is i s undoubtedly the b est way of r est or in g h is blood to I t s normal pictu r e, but u n less th ere i s fu rth er hemorrhage, I should not con sider tran sfu sion s as n ecessary* . . I should appreciate i t very much i f you w ill l e t me know a l i t t l e la t e r any fu rth er d e t ails in the course of t h is man*a I lln e ss. Vie have been very much in terested in cases of gasolin e in toxication because for some queer reason not many of them have been described in the lit e r a t u r e , and such experimental observation s as have been made have been con fin ed almost exclu sively to the e ffe ct s of the in h alation of gasolin e* Sin cerely yours, RAKtie - .. , oberfc A . &eboe, M.D.