Document DvK3GaQjG9ej2QKgLzwbDoDVd

May 7 1932 M r, K. W. G ilm o re Humble O il Company Hons tori , T exas . My d e a r M r. G ilm o re : ; I havn d elay ed somewhat in r e p ly in g t o y m j j a f c t e p in w hich you en clo sed a b r ie f o f the H case. A fter having gone over th e m a tte r, i t seem s q u i t e c l e a r t o me t h a t fro m a m e d ic a l p o i n t o f view th e case has no m e rit, n e v e rth e le s s I reco g n iz e th a t such cases a re n o t alw ays s e ttle d on th e ir m erit. . Such te stim o n y s s I would be d i s posed to p re s e n t would be b ased on c e r ta in p rim ary c o n s id e ra tio n s 1 The d i a g n o s is o f a c u te n e p h r i t i s was an e n t i r e l y ju s tif ia b le d iag n o sis* The type o f n e p h ritis p re se n t was in no nay c h a r a c te r is tic o f the k id n ey c o n d itin s , which a re o c c a s io n a lly seen In a s s o c ia tio n w ith lo ad in to x icatio n . In a d d itio n to th e evidence o l^ jh e ir ^ ^ ^ ^ rs 1cl a n s , wy a s s i s t a n t h r . R c h ra d in saw __ 'and. d ld ^ iia s M t h e c a s e w i t h h i s p h y s i c i a n s and e s ta b lis h e d th e fo llo w in g p o in ts which are of im p o rtan ce. O nset began w ith headache and abdom inal cram ps, sw e llin g o f th e f e e t and s h o rtn e s s o f b r e a th . Very e a r ly in th e co u rse o f h is I l ln e s s , h is u rin e was d is c o lo re d , o f a b r i c k d u s t c o l b r . He h a d f e v e r an d h e d e s c r i b e d a s o r e th r o a t a day o r two p re v io u s to th e o n s e t. (Im m ediately a f t e r h a v in g made t h i s s ta te m e n t, ho r e t r a c t e d i t and adm itted on q u estio n in g th a t he had had sore th ro a t.) Furtherm ore, D r. Tucker s ta te d th a t he had had tro u b le w ith h is th r o a t fo r y e a rs and had ad v ised a to n sllo cto m y r e p e a t e d l y . I t th u s seem s q u i t e c l e a r to me t h a t t h i s was a case o f a c u te in fe c tio u s n e p h r itis . Thus one need n o t look fo r shy unusual circum stance as th e background fo r th is illn e ss. N8109 2# The c h a r a c te r o f w ork was n o t of the ty p e w hich I s a sso c l^ L te d w ^ n s i g n i f i can t lea d exposure#- There i s a hugh background o f e x p e rim e n ta l e v id e n c e to show t h a t th e h a n d lin g o f E thyl gaso lin e does n o t b rin g about an appreciable a b so rp tio n o f lead through th e akin* F u rth e rm o r^ ^ ^ -- in _the c o u rs e o f d i s t i l l a t i o n o f th e ty p e M r .^ P H H H r c a rrie d o u t, th e re is no occasion w hatever fo r :he~inha 1a tio n o f lead # The d i s t i l l a t e i s -q u a n titiv e ly re c la im e d so t h a t even very sm all amounts o f low er b o ilin g p o in t petroleum products are lo s t . T herefore, I t is obvious th a t no m easureable q u a n tity of high b o i l i n g p o i n t i 'e t r a + e t h y l l e a d e s c a p e s i n t o th e a i r # The background of experim ent and ex p erien ce h ere is so good and so com plete th a t X have n o t reg ard ed i t as necessary to see to i t th a t d is tilla tio n ? of th is tyoe are c a rrie d out in a hood. The s p e c i f i c in s ta n c e o f ex p o su re w hich h as been s tre s s e d a p p a re n tly , h as to do w ith a f i r e w ith w hich some Jith y l g a s o lin e ^ b u rn e d in th e la b o r a to r y . Under t h e s e c i r c u m s t a n c e s 0, - a n y T a t r a - S t h y l l e a d p r e s e n t i n th e g a s o lin e was bu rn ed away In th e same g e n e ra l m anner as i t would have been burned in a m o to r, p ro d u cin g a c e rta in amount of f in e ly d iv id ed le a d in the form of le a d brom ide and le a d o x id e . From th e am ount o f g a s o lin e a c tu a lly b u rn ed , one co u ld r e a d ily compute th e amount of such le a d compounds w hich vrere form ed# U ndoubtedly th e am ounts were o f no consequence b u t when one c o n s id e rs th e f a c t th a t such le a d compounds a re d isc h a rg e d in th e exhaust gases of autom obiles w ith o u t in ju ry and w ithout m e a su re a b le le a d a b s o r p tio n on th e p a r t o f p e rs o n s who a re w orking w ith m o tors, th is exposure d e sc rib e d fo r Mr. C a s tle b e r r y becomes q u ite I n s i g n i f i c a n t , The d ia g n o sis o f le a d p o iso n in g and le a d a b so rp tio n can be made only on th e b a s is o f th e e s ta b lis h m e n t o f th e ex isten ce of s ig n ific a n t exposure as w ell as c h a r a c t e r i s t i c symptoms and s ig n s . In t h i s in s t;n c e , i t i s q u ite c le a r t h a t n e i t h e r o f th e s e two n e c e s s a ry elem ents are p resen t as a b a s is fo r d ia g n o sis. T hat i s to say , th e re is no evidence o f h is having had s ig n if ic a n t exposure to lead and th e re is no evidence t h a t h e h ad any c h a r a c t e r i s t i c symptoms o r s ig n s o f l e a d i n t o x i c a t i o n # On t h e o t h e r h a n d , h e d i d h a v e a h e p h r itis of a n o t u n u su al type w hich i s s u f f ic ie n t i n i t s e l f to e x p la in one o r a l l o f h i s symptoms and h is eventual d eath . I do n o t b e liev e th a t th e re should be any g r e a t d if f ic u lty in e sta b lish in g the soundness of th is p o sitio n . From b o th c l i n i c a l and e x p e rim e n ta l p o in t o f view th e case is a very clean cu t one. I s h a ll be p rep ared to t e s t i f y a s I h a v e i n d i c a t e d a s t o my o p in io n and I s h o u ld be a b le to su p p o rt m y 'opinion w ith s a tis f a c to r y c li n i c a l evidence and a la rg e amount of ex p erim en tal in fo rm atio n which, i s a v a i la b le in m e d ic a l l i t e r a t u r e . Very tr u ly yours $ HA K : I S