Document 2JMRoJv7e7XB38zrG4V2opR6g

June 19* 1937 Dr, John K, T rain 1107 B ull S treet: Savannah Georgia ' . o-yo:.U;o " Dear Doctor T rain : ' . ! <v ^': D r, K i t a m l l l e r h a s c a l l e d my a t t e n t i o n to your l e t t e r o f June 8 th in whloh. you des c r i b e th e Illn ess of your patient There are s e v e r a l th in g s I n t h i s p i c c u r H a i c o W me f e e l v e ry c e r ta in th a t th e c o n d itio n was n o t due to le a d ab so rp tio n * At l e a s t i t seems r a t h e r c l e a r t o me t h a t t h i s c l i n i c a l p a tte rn could not have been produced by lead exposure - o ccasl oned by the h a n d lin g of lo a d ed g a s o lin e and th e re p a ir of autom obiles* In the f i r s t place lead poisoning of th e s e v e r i t y a s s o c ia te d w ith c e r e b r a l symptoms in v o lv e s m assive exposure and .co n sid erab le le a d a b so rp tio n . Over a number o f y e a rs in which we have b een s tu d y in g th e lead exposure in c id e n t to the handling and use of leaded g a s o lin e we have b een u n a b le to f in d m e asu rea b le e v id e n c e s of le ad a b s o rp tio n . Thus oven i f i t were ad m itted th a t some a b s o r p tio n ta k e s p lace i t would seem p r a c t i c a l l y im p o ssib le t o acco u n t f o r more th a n th e m ild e s t symptoms of a d is tin c tly chronic type. I t is u tte r ly Impossible in my o p in io n to o b ta in a s u f f i c i e n t amount o f le a d absorption through any kind of exposure to leaded gasoline to produce th e ty p e o f a c u te c e r e b r a l symptoms th a t a r e ; seen in m assive exposure e ith e r to organic or inorganic le a d compounds* Thus I f e e l q u ite c e r ta in t h a t th e . J exposure a t tr i b u te d to th is p a tie n t was not adequate to :, " produce th e c lin ic a l co n d itio n which you- have described* From a p u re ly c l i n i c a l p o in t o f view I have never seen an involvem ent of the low er ex trem ities as a sig n ific a n t p art of the c lin ic a l p ic tu re of lead poisoning In an a d u lt* This sometimes occurs in c h ild re n but* In my opinion* th e involvem ent o f th e low er e x tre m itie s is alm ost s u ffic ie n t in i t s e l f to exclude lead as the toxic a g e n t. D e sp ite th e above e x p r e s s io n o f my opinion I should be very happy to send you co n tain ers fo r the c o lle c tio n of a sm all sample of blood and a sm all spot sam ple o f u rin e on t h i s p a tie n t i f you would l ik e to have le a d a n a ly s e s m ade. We w i l l be v e ry g la d to make th e analyses and re p o rt our fin d in g s to you as evidence f o r or ag ain st there having been sig n ific a n t lead ab so rp tio n . - 2- la fact?* in these eases in which any question of lead has a r is e n * X am alw ays v e ry g la d to h av e th e a n a l y t i c a l d a t a . However I aw ait you? wishes In th e m a tte r b e fo re sending containers fo r the co lleetIo n of thesam ples* The claim o f le a d exposure from washing autom obile p a rts w ith Ethyl G asoline is n o t e n tire ly a new one* Over a p e rio d G f y e a rs we have s e e n a number o f cases of d erm atitis asso ciated w ith the continual use o f g aso lin e f o r th is purpose* and in se v e ra l in stan ce s th e d e rm a titis has te en Blamed onto th e le a d c o n te n t of th e gasoline* Moreover i t is not unusual to fin d h ig h -te s t g aso lin e being used fo r th is purpose* I t freq u en tly :w happens t h a t men o b ta in g a s o lin e fro m th e n e a r e s t so u rc e : fo r such clean in g purposes* and i f th is source happens to have leaded g aso lin e av ailab le* the garage mechanics w ill tak e i t f o r th is purpose w ithout any objection* Thus to our knowledge th e re has been a f a i r us of lead ed g a s o lin e f o r t h i s p u rpose and yet* so f a r a s we have b ee n able to discover* th e re have been no cases of anything- resem bling lead in to x ica tio n during the e n tire period of y e a rs o ver w hich we have made o b s e rv a tio n s * I n q u i t e a number o f c a se s o f co m p lain t* we have made prompt a n a l y t i c a l s tu d i e s and In no in s ta n c e have w been a b le to d em o n strate the presence of abnormal q u a n titie s of lead in the blood or e x c re ta * Thus you w i l l s e e why. I am d o u b tf u l of th e sig n ifican ce of the type of lead exposure here described. I should a p p r e c ia te i t v ery muqh i f you would l e t me know o f any f u r t h e r developm ents I n t h i s case and I should a ls o be very g r a t e f u l to you i f you would r e p ly prom ptly* t e l l i n g me w h e th e r or' n o t you w ish me to send sample c o n ta in e rs . Obviously th is t e s t should be mad a s soon a s p o s s i b le , i f i t i s to be u s e f u l* . I t a ls o o cc u rs to m to a s k w h eth er or n o t any exam inations have been made o f t h i s p a tie n t* s blood* l am th in k in g p a r t i c u l a r l y o f w h e th e r o r n o t th e r e was a n y Ta n e a la and w h eth er o r h o t t h e r e w ere any m ic ro sc o p ic b lood changes i n afiy way s u g g e s tiv e o f le a d I n to x ic a t io n . C ordially yours* RAKsis R obert A* Kehoa* M.D* -