Document 8Ry9kLLwz64qKB0jjoQ11pX5Z

C ABLEORAMS: THYLPORT. LO NOON. t el eg r a ms : ETHYLFORT, CHURTON. \ Telephone: VICTORIA 55 20 ETH YL EXPORT CORPORATION ln c6' -porated in <he Stat e o f D e l a w a r e . U . S . A . w i t h l im ite d liability. abfordLOhNoDuOsNe,S,.vWi.clt oria HeadOffice: l 3 S E A S T A 2 "-0 S T R E E T N EW Y O R K , U .S. A 20th Llay, 1935. jr. H. A. Kshoe. Dear Jr . i.enoe, I am enclosing herewith copy of a letter we have received from the Italo-Americana, together with an exhaustive memorandum prepared by Pro3 Dauta, with reference to a workman named< The :story as I got it is as follows, labourer engineer employed at the H a l o ' s depot at Monopoli. IrTAugust of last year during a mixing operation the pump on the plant apparently stopped functioning, and the foreman in charge of the mixing operations very foolishly called in Llichele, who happened to be passing, to carry out repairs to the pump. This work, apparently, occupied him for about one hour, after which he went about his normal duties in the depot. About half an hour later he was taking some readings on a tank and complained of feeling faint, and was then sent home. The :nan was apparently sick for sometime, and finally his local Doctor reported that he had Lead poisoning, this matter was not brought to our attention by the Italo until about February of this year, at which time the man was still in baa health. We suggested that he be sent up immediately to see Prof. Datta ana kept under his observation, since in my opinion it was then too late to send anyone from this country to examine him. It appears that Prof. Datta kept him under observation for some ten days and prepared the enclosed report, but as you will see from the Italo's letter, since returning to his home town he has again become sick. Personally I should doubt very much whether this man has contracted Lead poisoning,Isince his total exposure to Lead occurred while examining the pump, and he would, therefore, not come in direct contact with concentrated Fluid. The mistake of course was made by the foreman in charge of the mixing plant, who had no right whatsoever to call in an outside man to examine the plant; however, this he did and we have now got to try and find out what exactly is the matter with this man Michele. I do not know whether you can assist us in any way from the report prepared by Prof. Datta, but should be extremely glad to have your remarks by return of post, since the natter, as you will appreciate, is quite an important one. I have not had an opportunity DATE 20- 5 -3 5 of having the encxosea Italian memorandum translated, but I presume you wi have no difficulty in getting this done yourself. On this matter being reported to us I took it up very strongly with the Italo, since they should have let us know last August and not the beginning of this year. Kindest personal regards, 0021564 GENOVA Via Assarotti, 40. M*r 15th, 1935. R. F. Hawkins. Ethyl Export Corp. Abford House, Victoria, London. = Labourer Lear Sirs, Following up the correspondence exchanged in respect to the above we are attaching herewith an exaustive memorandum prepared by Professor Lodovico Datta together with supporting analysis. I7e very much regret handing you this memo in the original language but as the matter involves medical terms and phraseology we are not inclined to make a free translation of same as this might involve a misinterpretation of such pertinent facts which may prove of importance to the person who might study the matter. It is suggested therefore that no attempt of translation be made on this side and the same should be passed on to your Doctor Kehoe. No doubt Doctor Kehoe would be able to confer with someone of the staff of the University of Cincinnati who has some knowledge of Italian. We might add that since was placed under observation by Prof. Datta upon returning to his home town he has again shown symptoms of a blue ridga over his gums together with a general run down condition. It would seem that the local medico who was treating him is at a loss to explain this set back and he has inquired to be allowed to consult with Prof. Datta so that he might have the benefits of Prof, Datta's experienc and study of Vescia during the time that he was held under observation at the Savona Hospital. In view of the lack of experience which our local medicos have had in treating this type case it will prove very interesting all around to ;secure Dr. Kehoers opinion which we trust will not be forthcoming at too late a date. : Yours very truly, (Signed R. F. Hawkins) 1CEK0RAIJDUM OH REDICAD REPORT OP PROFESSOR DATTO ; Case of' In the absence of details of Doctor Manghlsi's obser- rations an interpretation of the initial illness is difficult. I* The history of exposure Is not adequate* One cannot be certain that the patient was actually exposed to tetraethyl lead* It is assumed by the physicians apparently that the chief ex* poaure to lead occurred through inhalation* Inasmuch as the Ethyl Fluid in the pump was diluted with gasoline one cannot be certain that actual Inhalation of tetraethyl lead occurred* It was pro bably slight and perhaps negligible since apparently only fifteen minutes elapsed during the repair* The questions of skin contact with the material in the pump is not definitely settled* Such contactif it occurred was probably more significant than the inhalation, although if the mechanio washed up properly afterward very little absorption occurred* If the dilution was as much as 1 part of Fluid to 100 parts of gasoline the absorption was al most certainly negligible* The statements of Drs* Manghisl and Datto as to the exposure without detached reference to these points are therefore Inadequate and essentially valueless* 2* The description of symptoms and signs as quoted by Dr* Datto from Dr* Fanghlslts report are not in accord with the clinical picture of tetraethyl lead intoxication* One cannot be certain as to the initial and subsequent symptomatology for they are not adequately differentiated in the report. It is quite certain however that did not have a lead line on the gums within a few hours or days as a result of this exposure for lead line does not ooour under such circumstances* The statements 2 as to the temperature without reference to the Banner of talcing it* - that the pulse as lowered, without giving the figure, and that the blood pressure as more or less normal, are all without point. The urine is said to have shown load by qualitative test. This is wholly without significance, and Dr. Datto is in gross error in interpreting it as a contributory evidence of Intoxica tion. The later examination of the patient by Dr* Datto is of value only in demonstrating the apparent absence of evidence of lead intoxication. It should he recognized, however, that by that time it would confidently be expected that all sequelae of tetraethyl lead poisoning would have vanished* !lo case of acuto tetraethyl lead poisoning has been seen to persist with active symptoms or evidences of abnormal lead excretion through such a period. 5* The lead examinations reported by Dr. Datto are quite meaningless. Dither the samples were contaminated with lead in their collection or the analytical methods were grossly inaccurate. The quantities of lend reported (0.19 to 0.21 mg. per liter of urine, and 0.78 mg. per grata of ashed feces) are impossibly high In relation to the'time of exposure, 7 months prior. Rather than being within the normal limits, these figures correspond to those obtained on persons during active abnormal lead absorption. If they were correct they would indicate greater absorption than any we have ever seen, if the interval after exposure were taken into account. However, they can be disregarded, for such results never occur after such an interval. It is equally valueless to attempt the Interpretation of a lead line in relation to a single exposure to lead which --J -- occurred seven months previous* Whether or not there as a line of pigmentation due to lead Is a matter of Interest but Is probably unrelated to the single exposure In question* The dubious charac ter of the conclusion from the test leaves this matter without eight* it* The interpretation of the case made by Dr* bat to falls to take into account the questionable character of the exposure, the possibili ty of gasoline intoxication, (which might account for all the initial symptom ) and the Important time factor* The symptoms of an intes tinal disorder, (diarrhea and cramps) are not in accord 1th the clinical picture of tetradthyl lead absorption* Colic has never been seen In tetraethyl lead intoxication* In this connection she hypothesis that tetraethyl lead vapors may condense on the respiratory mucosa and be swallowed subsequently, as advanced by Dr* Datto, is theoretically unsound by reason of the volatility of tetraethyl lead, and la not in accord with the facts as observed in a scries of actual oases in which adequate chemical data are available* Summary * The available data of the report do not Justify the making of a diagnosis at this time, and it is doubtful if a diagnosis of the initial condition can now bo made* I question the existence of lead intoxication in this man at any time, not only because of the questionable dharacter of his exposure but also because of the ap parently atypical symptomatology* Robert A* Kehos, M #D* 002156