Document 5D1k6RZV6Vw5gp0MOZ7VRw6X5

the followingis made in answer to a request by My. 01 ifford 5. Axtell for an opinion la the case fherropolfSt) It is my understanding that Mr. has be- ooiF''CTIRrr'that a diagnosis of optic atrophy ha been made and that has made claim through his attorney that theoptic atrophy was produced by the action of lead which was absorbed from leaded gasoline* which was used in small quantities (several gallons per month) for the purpose of operating a start ing motor and also for wiping engine parts. ..?: ** : ; v > . ' - My name is, Lester W. Sanders. I was graduated with the degree of Bachelor of Arts from Miami University in IS22, the degree of Bachelor of Medicine from the University of Cincinnati in 1927 and the degree of Doctor of Medicine fro the University of Oinciimatl in, 1926. ; 1 am a member of the American Medical Association, the Ohio State Medical Association* the Academy of Medicine of Cincinnati* Ohio, and the Association of Industrial Physicians and Surgeons. 1 am an Instructor in.Physiology and an Instructor in Applied Physiology at the College of Medicine of the University of Cincinnati. I am a member of the medical staff of the Ethyl Corporation. The Laboratory of Applied Physiology, with which 1 am associated, engaged itself in the investigation of the toxicity of tetra ethyl lead in l$5J and has continued this study throughout the past 24 years. Every effort has been made to have knowledge of and Investigate every case of alleged or actual tetraethyl lead intoxication which occurs in the United States (and also in other countries) and these cases are reported by us to the Surgeon General's Office in Washington. If optic atrophy is produced by the action of lead, a general ized lead intoxication must first exist. In order to establish a .certain- or even reasonable diagnosis of lead intoxication, the following requirements must be satisfied.* '1. A reasonable number of the characteristic signs and symptoms of lead intoxication must exist. There is:no single clinical sign or symptom which could possibly establish the diagnosis. 2. Either.* a. A reasonable source of lead for absorbtion must be proved or ^ b. An amount of lead must be found in the excreta and;blood which is sufficiently high to account for an intoxication and to prove an absorption of lead greater than that which occurs in the average population. The mean level of lead \X 0016.141 i - '. -a- In the urines of specifically unexposed in- ^ividpals (those having no Isom exposure to ' onge? aij|isO.oamilligramsper liter* The in- ^ dividuallevel not infre gently is found to he `s-rwic* as 6*07' illigra8 per liter. -p^rat; ,t?v '/ 'x ^ l v' nycontentlon - that a lead intoxication in the case of Mr. haneha,w-'Was"'never.-proved and that there is no reason whatsoever ;to,believe that it ever existed. ?, ' ' vx:}.' - V- ' .V,. ` ' To the best of my knowledge, the signs and symptoms presented by Kr. were not characteristic of lead intoxication at any time during his illness. This opinion is supported by the fact that but "of a-reported physicians who were consulted, only one Cor one group of physicians) suggested the possibility of a lead intoxloation lead was reported to have been found in the urine, but no quanti tative amount was stated. The source of the lead allegedly absorbed was stated to have been the gasoline used as previously described. Ho intelligent eval uation was made of the amount of lead which could possibly have been absorbed under the existing circumstances. The reasons why a quantity of lead sufficient to produce any intoxication or pathologic change could not have been absorbed from the source stated is established in the scientific literature During the years of about l$2b and 1925 this specifio problem of the possibility of the absorption of lead through the skin fro leaded gasoline applied to the skin was investigated by the department deeoribed before as the Department of Applied Phyeiology^at^theDniversity of Cincinnati. Gasoline contain ing the maximum allowable aasount of tetraethyl lead was applied daily to the skin of laboratory, animals.,. Ho appreciable amount of lead.was ever found to have been absorbed from the applied gasoline. * , .. 1 r--' ' - ' f Furthermore'* in. investigations made; independently by the United staiesiPublic!Health Service, and by the group with which I a associated;: offa cross;section of-workers .having, the greatest exposure, to;leaded gasolines, it was demonstrated by both groups of investigators that so significant amounts of lead were absorbed fro leaded gasolinereither .by-skin" contact or inhalation. - This was demonstrated.;^; individual analyses of the faeces and urine of the men 'examined.!:-';, ! Leaded gasoline is handled at least four times from its manu facture* to~its ultimate consumption. It io loaded at the refinery into tank cars, trucks or bargee as an open process through large 001.6& 4 , -3- i are operated by men on an eight hour or r la unloaded and later redispensed at bulk stations by similar methods. It i then put Into tanks at service station and redispeneed by the service station operators. All of these workers* during their working hours* handle continually from hundreds to thousands of gallons of leaded gasolines per day. dll of these men are frequently wetted by these gasolines and are exposed in various degrees to the vapors of these gasolines. In -19*M> there were points; where, leaded.gasoline was blended and subsequently loaded* It Is a conservative estimate that fro eight to ten thousand men were engaged full time in loading this.gasoline. There were any ore involved in the same kind of work - at. bulk plants* and there were at least a million filling station attendants in some 230>000,. stations handling leaded gasoline throughout their days work*, In the State of':Wyoming alone, 'eighty three million gallons of leaded gasoline were sold in 19*6, and necessarily handled by the before mentioned groups. In the entire United States, one billion eight hundred thousand gallons of, leaded gasoline were handled in the ease fashion. A - ; " ' * " Ho one authenticated case of lead intoxication has ever been reported or seen by us in any of these groups of workers who have the maximum exposure to leaded gasolines. An additional group of sen who are intermittently in contact with leaded gasoline is composed of garage mechanics. Ho authenticated case of lead intoxication has ever been reported or seen by us in this group. There have been cases of tetraethyl lead intoxication seen by us from time to time* as a result of exposure to the concentrated lead compound which is added to gasoline. In none of these cases have we seen blindness and/or optic atrophy or other, forms of peripheral -neuritis.. A-~>"A The maximum allowable limit of lead added to automobile gasoline is three cubic centimeters per gallon, but this limit is in frequently reached and it i& estimated that la the area concerned the gasoline lead content would;rarely.exceed two cubic centi meters* and usually, considerably less. This would mean a usual concentration of from 0.0125 to 0.025^ lead in the gasoline in question, v. ` ' . -Xf?..; r, , ' - j."- fhe'asdicalAistory^b^'^t. illness; is- not character- ' lstio oflead: intoxioatioa. , The industrial history of Mr. Langehaw'-shows that; his exposure? to leaded gasoline was infinitely seall'compared- with workers whose essential full time job is. that of handling:leaded gasoline and it has been shown that lead intoxication has not ocoured in these groups where millions of. sen have been'involved, ^ There is not a-sufficient difference in sueoeptability to lead intoxicatioa to account for this case as one. isolated.case out of millions of similar, but very much greater exposures. , Kr v- -- - ,, -i`5 V; .v '. `'i ' f,~ .. .-v * - - Ti-ester W., Senders, M.D*