Document 8VpZnr6o2vdwbyLprNyeqb6bZ

Thanks very much for your letter of August 28 and your description of yo*ur patient* From your description of Mr. experience I can not avoid the conclusion that his ex* posur^vo lead was insignificant. You are aware, of course, that the quantity of ETHYL fluid which is in Ethyl Gasoline is small, and that the only lead which would be left behind after the emptying of the gasoline tank and after washing, would be small amounts of unchanged and decomposed tetraethyl lead which might remain in the encrustations on the sides of the tank and _ to some degree on the bottom. The decomposition materials are to a very large extent soluble in water, and consequently would be removed more or less in the process of washing. This materlal dissolved in water Is almost Incapable of being absorbed through the skin. As a consquence of these facts I think you will see that the exposure of Mr* ^ t o the absorption of lead com pounds wUs very minute, anc^ffln; unless he were so exposed over a long period of time it would not be possible for him to ab sorb a sufficient amount of lead to produce Illness* After a considerable amount of experimentation with tetraethyl lead and the products of decomposition, and after several years of observations of conditions similar to these in the industry, I think I can say with a certain assurance that the exposure to lead under these circumstances was negligible. On the other hand, the tanks, even after such xtashing, contain a considerable amount of gasoline vapor, and the ab sorption of such gasoline vapor produces very definite symptoms in all people, and may produce even alarming symptoms in the case of somewhat more than usually susceptible persons. The gastro-intestinal upset as well as the insomnia, are not re markably unusual occurrences following gasoline intoxication, and In an occasional person the symptoms persist for some period of time and have a tendency to recur on the slightest provocation*, for example, an occasional individual is made very ill by merely smelling gasoline after having been overcome by it. , .. ' , However* I do not wish to dismiss your suspicion that this man absorbed lead, without giving it the consideration that it deserves* Furthermore, your coiirtesy in writing me about it calls for something more than a merely ex-cathedra statement. Therefore If you and your patient are agreeable should like=to collect samples of his excreta for the purpose . |f " ;f: I of analysis in order to determine t o o u r mutual satisfaction the amount of lead which he absorbed*in his experience I am sending, you a package containing ^ jug, in which I should like his urine collected and a mason jar for his faeces X would appreciate it if you would hate him collect a sample of his excreta representing a singlelarge evacuation* This sample should he collected directly. Into the mason jar and not in any intermediate container, in order that we may he certain there is no external contamination* I should like . him also to urinate directly into the gallon jug until he has collected at least half the jug full* The length of time involved is of no great consequence since we estimate the lead in terms of the amount per liter* He should keep these containers at his home and should use the greatest care against introducing any dust from any source into them* They should therefore both he kept tightly covered, except at the time that they are being used* I should he very glad also if you would make one or two smears of his blood and send them to us for microscopic examination* It will not he necessary to use any fixative, merely make the smears and send them on to us for examination by our somewhat special ised method* . The treatment which you used is one which I believe is very good for either gasoline intoxication or for metallic poisoning* I believe that you could have added with benefit the administration of glucose. In serious cases of Intoxica tion due to anaesthetic-like compounds, 1 believe that the intravenous administration of glucose has proven the most effective measure* 2 personally use a mixture of alkaline salts sufficient to maintain the urine either neutral or slightly alkaline* The use of sodium thiosulphate has un doubtedly been beneficial in some cases of metallic intoxica tion* I personally do not use it in lead intoxications* though I have seen benefits from its use In the hands of others. In lead intoxications I have been very much opposed to the use of morphine* in the few cases of acute intoxica tion in *feieh X have seen it used, it has produced distress rather than beneficial results* I am inclined to believe that you will find this patient0 recovery from what I regard as gasoline intoxication, to be somewhat prolonged. My ex perience with these gasoline intoxications leads me to believe that they are more serious than they 'are ordinarily given ered It for being* I should continue the use of alkaline salts as much as needed, and I should get this man on a normal diet as quickly as possible* They usually recover fairly rapidly when they are able to eat in a normal way* However, such cases as X have seen show a considerable amount of nervous system irrit ability for-some time to come, X should also caution him strongly against any considerable exposure to gasoline fumes for some time after his return to work*