Document 5LEnBDjd69GDQOyQzYkrpMjBe

May 20, 1955 Dr. Francis F . Schwentker Pediatrician-in-Chief The Johns Hopkins Hospital Baltimore 5, Maryland ; Dear Doctor Schwentker: i <v. I must apologize abjectively for my failure to reply earlier to your letter of April 21 concerning the youngster who is your patient. Unfortunately I have been out of my office almost continuously since April 19. Having had only a day or two in which to deal with current matters which seemed urgent, and X have been compelled to let my correspondence accumulate. ^ The answer to your question can be given quite categorically on the basis of our experience with tetraethyl lead, and actually with situations comparable to those which you have described. The type of illness indicated could not reasonably be attributed to the absorption of tetraethyl lead, even if there had been a significant amount of absorption. The symptoms of tetraethyl lead poisoning are always those of an acute cere bral intoxication, without other localizing symptoms or signs, and without fever, except, as an occasional terminal phenomenon. Persons who have been poisoned have died or recovered without sequelae. Under |the condition which you have described, tetraethyl lead poisoning is hardly possible. We have seen gasoline intoxica tion as the result of the use of water contaminated with leaded gasoline , but even then the lead absorption was negli gible i(the low concentration of the lead compound in gasoline makes lit virtually impossible to absorb enough lead to he of any importance before being seriously or even fatally poisoned by the gasoline). I judge from the analytical data cited, that in this instance, as in those which we have investigated, the lead content of the water was usually negligible (potable water, accepted as safe for human consumption, may contain up to 0.10 parts of lead per million, i.e. 0.1 mg. per liter). The symptoms following the ingestion of any gasoline over a period, are severe abdominal cramping pains, diarrhoea, which is often bloody, vomiting (often of blood stained material), N6316 V , .......................................... Dp. Francia P. Schwentker - (2) - May 20, 1953 ! . dizziness, tremors and other evidences of central nervous sys tem irritation, loss of weight and great weakness. Slightly or moderately contaminated water (with gasoline) will cause this picture , hut usually, the water is so unpleasant to taste that people will not use it. Unless there is such a significant degree of contamination with gasolinev contamination with lead (from the gasoline) to any significant extent is quite impossible. Usually most of the lead, with the color (dyed gasoline) , is filtered out of the contaminated water as it ieaches through the soil, and thus we have never seen any significant contamination of water with lead from this source. I 'm afraid I cannot help you in the interpretation of your clinical problem. However, I think I can assure you that, this child is not suffering from the residual effects of the absorption of tetraethyl lead. . Sincerely yours, i RAK ef . Dictated but not read. Robert A.' Kehbe , M. "D. THE JOHNS HOPKINS HOSPITAL BALTIMORE 5. MARYLAND RUSSELL H. MORGAN. M. D. RADIOLOGIST-IN-CHIEF ARNOLD R. RICH. M. D. P A T H O L O G IS T -IN -C H IE F FRANCIS F. SCHWENTKER, M. D. R E D1 A T R IC IA N -IN -C H IE F RUSSELL A. NELSON. M. D.. DIRECTOR RICHARD W. TELINOE. M. D. GYNECOLOGIST-IN -CHIEF JOHN C. WHITEHORN. M. D. PSYCH IATRIST-IN-CHIKF ALAN C. WOODS. M. D. OPHTHALM OLOGIST-IN-CHIEF April 21, 1953 Dr. Robert A. Kehoe, Director Kettering Laboratory of Applied Physiology Univerisity of Cincinnati Cincinnati, Ohio . Dear Dr. Kehoej Could I solicit your advice concerning a case which has come to my attention? This is a lad of five years who lives just outside of Baltimore. In April, 1952 he had some pains in his left leg, severe stomach cramps and vomiting. He was suspected of having Rheumatic Fever hut all laboratory tests were normal. Since that time he has had intermittent low grade fever, especially in the evening, and at times has joint pains. He has been examined thoroughly and we are convinced that there is no evidence,of Rheumatic Fever. Physicial examination is normal. Tonsillectomy has had no effect on the fever. In November, 1952 the father decided to check the spring water from which his farm is supplied. The Baltimore County Health Department collected specimens which were reported to be negative bacteriologically; however, the collector mistook some flacking plaster in the spring and did an analysis for lead which was reported .08 parts per million of lead. The father then remembered that in April, 1952 the proprietor of a neighborhood store had dug up a gasoline tank which was approximately 400 yards from their spring. On inquiring he found that the tank had had a leak and was losing 45 gallons of gas per week. The tank was replaced at that time. The father has had a number of analysis done on the water supply which he reports varies from traces to 1.6 parts per million. The patient's blood-lead is 0.030 mg. per 100 e.c. His urinary lead concentration is 0.0445 mgm. per liter. X-ray of the extremities show no lead line. In these circumstances I think it is safe to assume that the child has no lead poisoning. The question is whether tetra-ethyl lead would produce permanent toxic symptoms such as recurrent fever, I have had no experience with tetra-ethyl lead and am therefore seeking your help. Thanking you in advance, I am, Very sincerely yours FFS:rac Francis F. Schwentker, M.D. Pediatrician-in-Chief N6316.01