Document GmDaRdVvGennZgEjZXG8pO51V

,1 ./ / 2 3 f ,M s; }5 V;r <i t 1-6 $! y :, 7 8 *r. i"7 CLAIM NO. 51339 , ----AVoa. GAJ!roroU, -7 v.a ^socxate-d oi . \ .) . j; . 'X atwXoyor-. o.u* ae locate Wv tnoar^d unner vs. . v,m . %&Z' t?crton' a vOitpesn&tiwT ^JSV^SCRIPT OF TESTIMONY^ ED T)TT. COMPANY, * 1 V' * . ;a-xmc ei'Vq' ua*.t,ioOnr; _I'Lin*-*dep.'s: ,*f-,,{*t,V.y- '..tl. n-a..>^as*,>i ;' (*,' f't 1**J* paid to applicant^ ` ' * Defendant. . . % ) ,-. 11 -t; * r> -i uor:\ O'l ! "' -- ^ - -i-'-H. ----*--i--i-,--v-----'*w-- -'-4*-`--- ! . r- '; i.. ; 9 10 -0 . J"""t C00"18810^ at 8" Francisco, CaUforaU -1 11 <&ft.8nd day of 3opter:bor, 1936, aos.oruerod transcribed = on-< `` [ 12 January-'Sl, l^SeiV'"' ..... ' .'I 13 1 14 n.. Jr 15 .... ....... , /j :lu, ooure ..ox*, hie- '^SS^,Tr^ ivt^SEN5# l*eu*b* 14 v>,. ths Oil ii?ei E, Drew, Reporter. , -: n^. ' l.i t ... .. -- --^ r> V-t' A ., n4tur0; oip'* f-v.'- ' --lv ' j:' n ?ul v l' jig `tAppricant present and represented by Frank J. Comaioh, 16 4 .-*,? * J. \ - , Attorney at I^iw. ,. 17 ,,Attorney foradefendaht?01. -m,.;i F, , $^^Kiessig. 5 ;;vi^ ' ^ .. 'll. ' 18 ,,cftcs tbe; p^-essn't; i , * f Sr, t rtiii proj':v> ..,sicotwxOi>^ji 1a - . . I/ITN5SS2S ... 19 L .i^AvVi.V *ir ! '.I1! -IJ *' ... . ., .. vA,V .-. '. ... -V.- ' *n * --- -,--,1 -PAGES 20 ` Michael Iejep.pevi^^ture--^nd T f. j.--t: _ issolcel. . 3-36. 77-79 21 1-rii S;a;5.a 3;^t.o .applicant,.' KIesn-I,ij. raises the 36-48'- 22 . ^::-Hrt?rHsQanD9f^^lrif.^.i>n5^S(4i-fW-aFr3i '-^r-*wr mv-u,si^j yU""'v"? .r' Oi 7'"sn' J'Ce'44*>' 'f 880-Cv>--U_o55Bvtm44a4j . pensation act, 23 iPl5 ?4i-62r`1;'' ' 24 | 25 Robert,A. Kehoe, M.D. J* F* F0Gtti* e .d . ,;. ^ 62-74 75.7? 26 \ \ - i` The;;Rarties.Btlpw.J.at> first. iuly worx 1 -X*:-j^f.v.aPl-oyed as an oil tester 2 m, December 14, 1935, at Avon, California, by the associated Oil 3/ Jompany. stave .v-yur -name fs?r the - record,. please ' 4 A l8'*chA-.|b; eaj^py^-f. eaid date was self insured under tfcji 5 >rovis iona^of? tforkments,jCpmpen^atiqa. Ant.y 6 3^ t No coxapensation indemnity has been paid to applicant 7 m account of, hie claim ofy an industrials injiury.-^h^ 8 : u Applicant was bom September 19, 1889. 9 , .23ie -wases^at the,1timQ-.,of,iinjuryy.were -1.32*00-a.^month 10 l SSUNSj - ,...jwyia'is-i Oil Co^0.my<: 11 . yivlvy i VAaethoJk Q1*'.apt.-,s^id:?;i4ichael P. Telepnev sustained 12 in rin jury, arising' out Hpf- and ..opfwrringr'iu^he^ cpitP|Sa.,of, ,hi& pc^loir 13 :ent withfvthje ^Associated Oilf .CQmpjany^on or a)5out, :J5ec,ember -M, 193 > 14 ailyf ,.80*, nature,^.pd extent of disability resulting 15 .herefrom,.}'-* lon-g were you engegud as 16 looorerv to Ifcq^dei/endan^^^ Oil Company, affirmativel; 17 >leads thatv thp ipr.eaJiatt dAa.lt ^.%43?pra^ ^^.^tion, 11;(p%5,the^.tor 18 forkmen# 19 $ u cmvan?9 A ' -1 <A JuiAe #<*#*1? pf..,iaedical:, treatment n 20 `umishe^iby ithp^ile/endant to applicant,. Mr. Kiessig raises the 21 [uest ion {whether t .^tirsuant to the Workmen's Compensation Act, 22 iedical t^jaigaent hes been furnished to applicant. 23 24 AP, AIKSSlGt I to rot know wbnt the purpose Is; you v-mt 3. 25 A-uployaent rooord, I iv'.ll furnish - It to the .: 26 . CGyAIGIll ' I will get to 0022045 -2- _5. q;.u s T 3X y 7"Tyo.je.iv J-.J3 orljoycr os on ,'t j ro-as:->u .o j -j o /a b : REFEREE ;',T'r io .'Us s f . MICHAEL*?/ TEL3PNEV 1 / applicant, beingfirstdUly- swoJfifl by the 'Rafefeei testified, as follower? -c.rk2 i K- J. V'" ^ 2 REFEREE* olG; 1 oc that rovor, ly li*.-' *TV J. L'N^ 4'. . t/ 3 q 4 estate you? name fdr the record^ piesiee^? a question and. try to raako your 5 Z 6 ua-Yott a^eJ-the applicant lh' theieratter? A * - Yes , 7 . . RSFERSS: 1?i 11 "yofu -examiney "please, ;.Mr.' `CtMaloh? 8 MR. COMAICHr''-9 Ji-rar, :-.v.u; toe, rf?, j rt-Lvls: ?? Vs our,-.zory% of " f;Ndw,'~KP?wrereoyou first* employed ifey-ttbed. 10 Associated Oil Company? - ' auu ft tout ;;t. tie r n- 11 MR. KI3S3IG t I 'can 'give '-you -that f 12 MR* COMAICH* *; i am Merely-Asking that as- ah opening -question^ 13 A 14 -July 8th;' 1924j ;1 started work at the Associated Oil y Comp any -as a laborer. 15 Q"* -'How-long were you engaged as a laborer? 16 A 17 Up tdJunS i0fch,1926/yl ;-u h ?c llry '* tiers r^-t? q 18 19 " tNow, after that time, were.you assigned to the laboratory i-.o^of ithb ':>Asso01!a,ted:i40'il vC6iapAiiy?`C} o *->!> r . testers alar thers A" 20 21 Q 22 A 23 \cfi0ii ;July,JLOth I was sent to the laboratory to work as an Aadoii'st-ste*<?o teato** -testing .Ethyl gasoline? .TesOf what year? X>ialtf26. after you were appointedto tlr,t position? MR. KIRSSIG: I do not know what the purpose is; if you want his 24 25 ?/or4Bi^l6yiaentyrdO"3fd, 11^furnish^It^tO' the Cctomissianji MR. GQMAICII * a a >1 twill s&et `--to -it; Ay 1 gasoline? 26 0022046 -3-' Pi%* r* j 1 a 'itellV'if there has"been sttficient tntoxieStion from: lead 2 "that' Isl""If lead tae tebh present" in "the * syst em in :spf- : 3 ficient tbShtitieb'that'It' lias produced definite degenera 4 tive chahgeB. `^''Nerve tissue itself "regenerates rslowly, 5 if at all, and' it !?is possible that, under those circum 6 stances^' 'the residual' defects';iifght'''persist att^jr the dis 7 appearance of the lead. However, it wouid not be pro 8 gressive, something which we considered In Mr.Telepnev's 9 case, that is, JuSt' as we' consider any disease,1 ^contribu 10 tory'causes jtnd wS "found nbi the evidence thereof; h '' 11 ::V ` - -'^'wiraiss:;'i5zctJSEDfl ' r 12 Dri "Rdbert Ai tehde,'1 being called on behalf bif the defendahttf|| 13 and duly`sworn by "the Referee j testified," as follows; m 14 REFEREE: ! 15 r* State your name please.a.'.v 16 tr; Robert A.; Xehoe. 17 Tfliere do you live? ';v; -- ' l -V ' :--'..-v ... m < t -r i\w vfjf' m 'U 18 A 19 Q Cincinnati, Ohio,' 5; You are a 'doctor of medicine? `' *'; M 20 A Yes, a graduate of the University-Of Cincinnati, 1920, 21 Practicing Since then? ' J.O- \-m 22 'Hot';piOctice,lvbut tor ' thS most part, engaged in er?eriment|il $< ! m 23 'work, particUlariy^in reiatibn tb industrial 'work,; inthidl HI 24 ' I specialize 'also "as a practicing physician. 25 mr . kiEs&iQiilc"* ^ r--:- 26 0, Ui. Kehoe^ `I feel we are'very foatunate to have you here V'*.i> j && \i KG' 002204' -62- m 1 2 3 4 5 6 7 8^ and- aYallable^tq. ieatil'y. aa an expert in saatterajutiicn coxae within your knowledge* You have heard the testimony of the .preceding .witnesses,, and .1. .believe^ .that you have .examined, this case -in .the, file.j^ all;:of fthe finding3, clinical and .otherwise^, and.are.famillar .with the claim of not hr, Telepney,,, whom yon have,..gPa,p.on^L-ly;...waamJjied*..is. .that ; .correct? Correct * .cd cd T.h-: r, inr v. tvi; 7'^i.r. - ? 5`tv ;.v- i. 9Q 10 11 Now,.,Di;*...Kehoe^ -froBi,-an- examination ,,of this,, f ile, and. from your, knowledge....oil .the facts as recited by the applicant ,anc by, hr * Middleman, e^d,-from the, clinical ,f;Lndings, and the :. 12 diagnostical conclusions of . Brs,*., Towne andr^Johnsont. will t13 you. give,,us, your opinion as, an expert , as to ,the poseibili- 14 ties of lead exposure by the.applicant, and whether, or not. 15 his syriptomatology is consonant .with. a true,..active.,case 16 of lead-poisoning* , In other words, haying first^eliminatejd 17 the possibilities of, exposure, to lead poisoning, -or even wifthl / 18 that possibilityxexistent,,what are the. typical symptoms 19 which, are,present in an active true lead poisoning case; 20 and, in this. connection,- may 1 ask,you.if, you -have person 21 ally examined and.had under your care or supervision or 22 examination true , lead poisoning cases-, and, if so, how many? 23 MH. CpBAICH: , Just, a minute, please; that question is compound, 24 RSFEHEE,i Vr phQUestipnably,, it;is, compound; there is no question 25 about -that.. ,hr* Kiessig is presenting it that-way,to ex- 26 pedite. time.,..,. If .you care to. object, it will be. sustained. K 0022048 m -65- ftrr-,v 2 ox. -Tpo' bnecegyrrS Mj-^iressea* t p j Ya .pir^r lorr j j a Or* coii-'o mt j pj /t t / a o /ix jcnoAJjeg* on p ?a s peex-V poapjTJOXA -r i cn?P c;A;-rTjgpjG po pespuJ.. a a try exhei.* t it Barrens *p t c ~ -%>' - * * r -- % VK, COKAlwJH. -.< 'DI>* K>BBB V V.KSH0E DR.' ROT33KT A. KSHOS. 1 HP. CCHAICH? ^ ^^r^st^ eufricl^t^ li^iamtlon: >411 be given 2 3A on "each1 point ^ *&* rowasenu sc d?lre* In reply1 to" the last' -pbr'tloh' Of-the question first, as to 4 Aether5 or5hot I* have? seeri"* cases offloadpoisoning.' X 5 have seen in fill probabilities several- hundred; I cound't shy 6 the exact number,1 bases? of . varying degrees of lead poisonin 3 p 7 over a period of the past ten years,- during which time I.-.t 8 have been engaged in consultation work in industrial hygienje N 9 and engaged specifically in experimental work and experi 10 mental study of the general subject of lead poisoning, and 11 have, as a matter of fact,"been engaged specifically in the 12 study- Of the toxicology public health' aspects of tetra EthyfL 13 lead in relation to that gas, ?r However, ;during that period 14 of time, I have had some degree of supervision of the manu 15 facture and mixing operations, in which the concentrated 16 ethyl fluid ''is handled, and have been'investigating and 17 reporting to the United States Public Health Service of 18 cases of Complained or alleged injury On the part of public m 19 20 1 , garage mechanics, filling station employees engaged in con- taot with lead iin gasolinev - expedite matters, I would gj jf4 21 like to say that the information I am going to testify to m 22 with regard to lead in gasoline-ls all a matter of record i 1 23 medical literature, and is therefore available for detailed Jm !sf 24 study on thedata as published. ' ^a s.^ m 25 KH. KIl^SKJ* ': At this' point %-willmake a-proffer to submit'- 26 reprints thereof to Counsel and to Mr*ltownsendv as^ Refeiree *w KB 0022049 -64- "L w<* as,`  T ivu yj pef QQ FORM 269 48977 6-S7 40M CALIFORNIA STATE PS INTI NS OFFICE w^^^^erfiyailabl,; If; tii6 c^rCoEaaiasion:andyMjr* ItowaeendLeOidasiiir?s%:aio;.:. A ^.aa&erquestion:/ofglee&'.A&Qj^ixsr la rela t|a. tp ,.lead in ^ ,i .:j gasoline.hasc obviously;been. an. Important*public .health v:.iiuproble*sfand i^audftEyrflhgociates^v engaged ,in th;. study ti^.that^probleia;since f^>abb^Ji^t!?^tb^i.data.ythat;f,; t i^is ? available,t the nelsLsions- thetcbhyeibe.enin^Pxi.ye^? at fcy ubts^alh of.i.the^agenelee.-ii&f^'inYeatieatipn, including myself euf r nd?3cy,,.asspciates,;] in;; tb:,3Cet^hinSv lab<>ratory,in the, *.- : University of Cincinnati*': representatives of the United c vv . States .Public health;^env.id;e,v.representatives .of-the .. .: British;Ministry of Health ' - all. those, various groups, have all. been essentially: the; seme. ; Ho evidences of f , ; lead, poisoning. ^ ; C;.'. MR. KOSSIGf . *.VM ; . : y -> / sK-r . Q, .May I interrupt? ; /ere those, independently aade? A Independent investigations.at different periods of ten or eleven years during which this material has been on -the market A:; ,;\c v-'-.-v,-?.. t `ixx- .: i-.- ... MR >COMAICHs :.If I may, interrupt Just; a; moment ,, don t,;ypu think ; we should confine ourselves to, the doctor ' s own exper- i;;u ienoe In .respect to. hie experiments?,,; . ; ,> REFEREStv. vl'think'o ..` I.!:*- vt. ;.;_r - : - A ; ;^y .2h&;rBSults../pf::our observations;have been as follows: . ' . $hat. no oaes of poisoning and no [cases of lead absorption as. a .cons equence of contaat with gaeo line containing ,tet3 *a UE 0022050 -65- ~WLr *_ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Fo r m 269 48377 -37 40M CALIFORNIA STATE A * J NTIM 6 OFFICE ethyl, lead .have been (Ueooveped, Moreover,, la oar*fully carried out studies in which individuals, filling station employees and. garage mechanics*.`have been introduced Into this employment and > followed pver. a period- of time with con tinuous, exposure .to the product, no evidences of lead absorp tion have been;,found. Animal experimentation has shown two things, Jirst, that; although tetra ethyl lead itself is absorbed through the: skinjwhen this tetra ethyl lend is sufficiently diluted in gasoline,' skin absorption no longer takes place in measurable amount, so at the dilution at whldj tetra ethyl lead ooours, in gasoline, there is now substan tially and generally accepted; evidence to the effect that lead is noti,absorbed through the.akin, on skin contact. The other-item which has also been shown is that the boiling, point or the araporisations of.tetra ethyl lead as compared to ordinary commercial gasolines is so widely separated that usually forty or fifty per cent, of the total gasoline can be evaporated over until no measurable quantities of lead is;to be found in the vapors, iThis means that the vapors given off .by gasoline containing lead,}froia open containers, does not contain ;!& Ihe experimental work and the clin ical .experimentation^ therefore, are in essential agreement to the fact tbat the handling of gasoline containing tetra ethyl lead in commercial ratio(does not represent an occupa tional exposure tq jlead .*compounds and in tha period in which some hundreds tof thousands of-men in the United States over 0022051 1 0' uperiodbr!924 jliaY0 et>eQQ Qngag^d 4n;dispeasiug;,gaso2 v5 line ?f*om filling? statIons ?and ^repairing ^automobiles r!rno 3 r -authentic ca6el:of- lead poisoningimmeasurable load, absorp- 4 tiontbasebae^ foundilj *:/putslfthis:;.occupa%, 6 t'^tibn outsid^ithe igroup^offlea4c;trades^jwith,demonstrable ... 6 I lead exposurdly 'phiftlte7'' 'jpiftasjpt' In ?lt * on ??*!>' -,r c.or? 7 q it Drlsgshoe|vhatisl,the t^ioal^syppIb^atoi'^p^t^^^-POi3011- 8 iiiag>t^nstttellaus^tbat?.'Vrist drop* ;/T 'per 8o.ut;lI ;: have 9 A noLetsm sa^ first ^?^l,o$batl1^0;vbai-aqteylf^ic picture 10 :lu in tetra ethyl* intoxication# rT?biob;b#s; bee^3dn in the IX manufacturing, end ofr.thi&j industry:* has:A^tX#Tent%xpa.&, from 12 th the, gasoline: distribufcingcend>J.st43a7} n?r^w^^<>?:-ally fleP" 13 - arateproblems. x\ That tetra ethyl lead poisoning, as a 14 ` clinical entity, is slightly different from the customary 15 ' > plcture of: chronic; lea4 poisoning. It does, however, have 16 " certain things, in common, in that there is an acute 11117 ': ness, acute or chronio ,illness*..there are -certain changes 18 is thedilood.eventually, : with:the production of anemia and 19 ?- the appearance in/the blood-cells of -abnormalities of shap< i 20 o rand basophylic stippling.rj iln the typical ^lead case.there 21 * iare ia, ntmb ef1 of ocha rac terist io cmanifastat ions, * of .which f >,, 22 ir;the commonest :andi:theieaf*liest are the so blood changes, ... 23 ho^withlthe development; of anemia; i8eeond,the, development of 24 -s, 'gastrointestinal disturbance* ; in which themost common,. . 25 5- ^and'the most significantithing?is a griping colic^Gr Ae fai 26 V. v as the nervodn system lesions.-* axe.;- concerned, and* they^dofi,. FORM 269 46377 (-37 40M CALIFORNIA STATS f R INT^KC Of FiCS ~$7- KJ= 0022052 ri;i\_KI222ie Qi: zzn r-c_ _,, ryj f-/^t j 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25! 26J Fo r m 269 4S377 -7 40M CALIFORNIA STATE FEfMTI^fiOffJCE occur In "both types of ' po'isohing.v They 'may be' 'cerebral' v/ith nental "ai'sturbances of a variety at':tifeies ^'iip'to the * most acute, which resamble acute0 alcoholism, 'but the more characteristic,"commonly 'of "the''nervous system, 'is peripheral paralysis^'' T&f neurtie'"'of1'lieaa' poisoning, 'vhich`results ii. palsy, 1s' usually painless,''prompt' in "its onset',' and in adultjs, it'almost "never 'involves tiie'"iower '`extremities', the most': characteristic lesion Is a wrist drop. X personally have not seen a`case of {pneuy.piogicalA foot 'drop' in'lead poisoning v *< '.TV;, ' ./ ''-T;*: '.V >: I'-'"' * : in my entire experience without associated lesions of the wrist j'" so that "wrist drop 'is" a "common 'phenomena. ""''That, I think,'"covers the "more'characteristic clinical ''picture with which, in my opinion,`'this'case of l'r. Tele.pnevTs is not in harmony.^ Whatsis the normal'lend ingestion of a person? Every person takes "in some'lead?..... Yes, the average'American, ah"a"result of rather'mixed and varied diet a quarter of a milogram'of lead a "day. This re sults in a'lead'ihtoxication'ori an average'of .04 to .08 milograms of lead per liter of urine and in the feces daily, which is,"'to all intents' and "purposes equivalent to that take: in, 'na'meiy"'6ne''quarter''miibgraia',a<!aay' 4 Thisrepresents the normal lead metabolism and' is' the inevitable consequences of j having eaten'"food that !cotitain%-ery minute''quantities of lead J Then, in''atrue lead poisoning case,' what is the percentage? ! Well,, it is^difficult,to.describe precisely the limits of lead -ea- KE 0022053 occnx- 7it por>T rXbce 04 OT8OXI<0S JJK.X mwi pe c6S.opJ.oj L HU!. .v is j s x o - rvyr, .^A,gyT/T J -_ excretion which nay be associated with lead intoxication; 1 ;it may be high, or daw, ..but oneithing one may be sure of 2 that is !.an active case 'of lead* r.;.v-'The level of' lead excre tion a^d.cthe dead tcontent cof .the/.tissues will be }aeasurablo|; i higher,than that./found in oionaal.'individuals* ?.rdn serious, .severe oases. ,of intoxication; rthe levels of lead excretion .may be from four ,to.cten-timed /that seen in the normal in dividual, I think that covers :it In brief. Just to sum it up and relate it to the particular case here, From the evidence you have heard, there being no indication; i of exposure, to lead in significant quantities, there being j no clinical findings of lead, either by Dr,, Fierce or other:, and so. admitted by Dr, Harvey, would you say that this presented a picture of lead poisoning or not, giving your ; I opinion as an expert? -j FORM 269 4SS7T -R7 40M CALIFORNIA STATt FIlNTlNOOrriCt ! would_ say that this does not correspond to me idea of a clinical picture of lead poisoning, ?, If I may explain rry point of view, I should say that for thiB reason. In a leal: trade, - with a known exposure and with a known existence of ' pesos,; one might accept the diagnosis of lead poisoning, even with bi^rre symptoms and elinieal; evidences. In ar. occupation,-.however,; in which there is xlo.recbrdfed incident of dead poisoning; in which there is no experimental or olinioal evidence of absorption;aC a consequence of the normal-operation,:! should have to see a typical picture c: j j i j lead ,intoxication and lead excretion before I could accept a diagnosis of lead poisoning as a legitimate diagnosis/ __ j 0022054 g z c x .6^t o x 7 japTCjr moa pe SBOOG./ir/poq Mxptr j'esq j'^oxj-csr^yoir; liK. *, VjnSSK3T<\ . *;.. f TTrxttJ#. ' .,. ... Cross Examination ................... MR. COMAICH..-* 1 Q, If a man is exposed to the fumes Of tetra ethyl for eighth 2 hours a day, he is: inclined to'inhale';lead'from the fumes? 3 A That depends' upon the source of the fumes entirely, 4 Q, 5 6 7 8 9 A If there' are fumes' from' the testing of this ' tetra.. ethyl; and.-, he is standing over this testing machine, watching- the thex- mometer, and the fumes'from this machine are hitting him, .or o are around him all the time,; he is inclined to inhale them, isn't he?...... ............... . No, I think not. ` 10 Q, 11 A 12 13 Q, 14 A 15 16 17 18 19 Q 20 A 21 22 23 24 Q 25 A 26 t1 -t .. .. : . - Doesn't it vaporize? -r v;. It does not vaporize tinder the particular conditions that prevail in his circumstances, What do you mean? i-'- ; - . .... I mean this. If you put" in this room an open container of gasoline' containing tetra ethyl lead, put it over a flame or over a hot plate, you can distill off something more than forty to fifty per cent, depending upon the quality of the gasoline. ' 'C:' ' ' - :' v Of what? ''' ^ ,, - Of the total *volume of the gasoline in the vessel, before any measurable quantity of lead comes off. ; Iftat is the boiling point of tetra ethyl lead is very high and the boiling point of gasoline is relatively low.; iy yv What about the mther fifty or sixty per cent.? The other fifty or sixty per cent, or whatever it may be, re FORM 269 *5377 -*7 *OM CJU-IFOBMIA STATE FIUNTIIC* OFFICE K 0022055 rnmmmmsmm. - f- y%? m'...........- -* -ww fc. ' poira.8 o gsJ. i/p ?a rncjTiTeq ro >^70 J1 txow- t#*9** T.I. S JtfJT. IS GXhOKGCT fO -TUG ^/Ii;rQS Cl "31,G -PP*AJ X,M*' r-.\ r re- v \./ J . k .J h. - - rxoea rxei/'Tuarj o - naming In the beaker will have all the lead still in it 1 If yon then boil off %he res%. of -that* you .will-boil intc 2 the room the vapors of the lead, along with the gasoline 3 That's just what .1 want.._ . ^ f j, . i\ i. V A< V* ^ 4 Let rp.e say this; your question requires it; under the con 5 ditions whiqh prevail, in. the distillation when condensing 6 , the ir... gasolivne by.me-ans oo.'^fooa-r-c- ondenser7, k*.ya ou -,* collect over in 7 the receiver practically,all,of the gasoline with a very 8 minute loss and all of the;lead iW within ;the limits of, , , . "y" ! f 9 t analytical!^ air. ,( , ....... 10 Q 11 Then it is possible you inhale lead and that goes into the system? .......... .. 12 .a Not under the circumstances you have mentioned. 13 Speaking of this other fifty or. sixty per cent,, you said 14 the lead would be vaporized? 15 A If you boil it off into the open room. That is not what 16 17 r%> 18 A you do when testing. , . . . (. I am just asking --- (interruption) I an not going to allow you to5.,cloud the issue, . Let me 19 just say this. I have to go further because I personally 20 am responsible for the .issuance of instructions and pre 21 cautions in relation not only to .the .handling of .ethyl flui 22 but to the handling of gasoline ,as well, I should hold f 23 myself responsible, if I permitted a suspicion of danger to 24 exist. , . , . v , . 25 26 FORM 269 41277 e-37 A07A CAUFOF.KIA STATr Did you write an article in the American, Medical Journal in 1925? v. / * J i-'ov''~ ^ ............. _____________ ________ -^.,-71-.....r=...!.................. " ........... ....... K 0022056 2 S i re toon ?s AcThcre 0_4;, p^_p,er Tro6,^T- rrTO^X rtr ye ScfsOJX^9 * J: II `.o p PPCu j ^t ; rpc 7.0 r ox *orr -'TIT pojj 7" T~ r-j r. r(3Sj]CGL. JJ f: Jj ' ': irr.ro SPTTT Ty 7** * r-nasi? v A Yes, 0 Oi.VC 1 Q You ,,wrpt$.an article ,f or, that journal.or publication5. it is 2 a matter otrpublic record cnowt isn't it?., 3 A I have .written a. number^0^,articles,. *;; =.a ,-.'.. 4 Q Can you i.tellinie.t-*7;;that ,.in,1925?v 5 A The first J .bc^ieye was, in 1925 ... . ,, ............. 6 Q Quite,a number of other doctors Joined you ..in that essay? 7 A My.associates ..in,the vinvestigatingwork, 8 Q, Can you ...tell me ..about bow .many, deaths took place by reason o 9 exposure to tetra ethyl lead from, 1924.to 1925, according to 10 your experience? , ..., 11 A I would hare.,to .refer, to the figures, which by the way, I 12 have....Therp;..have been, so far ..as my recollection goes, somfe 13 78 cases of adult of mild or serious tetra ..ethyl lead poison 14 ing* in connection with .the manufacturing operations of tetru 15 ethyl lead. I have it right,here.,, This.is.a compilation 16 of a series of.my own publications at,our investigating lab 17 oratory. This,is a work cn.this particular subject which 18 have been put. together for convenience. You ask me up to 19 1926? ..iX" :b . r s .. 20 Q Ho, 1925, if you have the record.... . 21 A Incidents, in...lead,poisoning, 1925 to 1950, in the manufactur 22 ing operations 61 cases; 1930 to 1935, four, all mild. Therr 22 have been two cases, of accidental ingestion*, There have be 24 eleven cases in connection with, a. type, of .work that is reallj 2E as$oelated with^the. manufacturing end, the vlining.of tanks, 2f 0022057 ~=^=' 2 XU-,T,*p6T7 3 OI, G jo 0 * S 05. h/ipj/c noGoigJ iro^ **+- * r *1* t,' X 1 &'&* v.a.pycjc, 5,o:;:. purr/? prp-r'-c;! K T which' havb^ rather'cbncentrated fluid in them*: and: In some 1 instancW,7 tanks that nave had gasoline stored in than 2 ' ovef^a lon^ period '"of' time. ' 'They have Issued precau- v x 3 tibns'ira 'thfetr^'tbld,; in the total industry, 4 We have the records of 'some 78 cases. " 5 ; . -Hi Q, One more question. Mr. Telepnev would take these test 6 "tubes, after testing;Ethyl gasoline, or flasks, and he 7 would be required to wash them out, that is carry the flas 8 a certain distance across the floor. He is exposed to thfc 9 hot flask that is just opened and the fumes coming out; 10 that, of course would contain them, - and he would be inhal 11 ing that, wouldn't he? 12 MR. "KIESSlGri 13 That is assuming something not in evidence. MR. COKAICH. 14 That is his testimony. - Eis testimony is. that after testing tetra ethyl he would take these tubes and 15 he would wash them out and he would be exposed to the 16 fumes at that time; that's just what we want to show here, 17 by being exposed to those fumes. 18 A 19 You mean distillation flasks? ' ` "a: ax . MR. Jf.IESSIG:(QjAfter emtylng all fluid, after distillation is 20 completed, he takes the exhausted flasks into which he 21 first put the fluid for testing, and takes it over and 22 washes It. 22 A 24 I don't think there would beany signifioant^exposure by inhalation of lead under those eireumistances. .22 MR,. COMAICH;. ........ X* u 2 Q, , But, as I understand' you,' In respect ' to that other fifty aI KE 0022058 P+ cp"J ' 2 jouE ;o /,g l o r* ex, t o o 4JJ3JO* ''>< * ^ ,0ni taeoBO- _ o TnnjMJircGs:* .w x j j c s y.vm ^JS,OTrlfa 8-1toxsg in in T -VfCp j.'vAG I.vrt'f'i, T# ,,,,-I c":TiJT!J1 T* U SO'AG sixty per cent., there would be an exposure; that is,what X he has referred to? lea on 'JT & -.; ;.r 2 A As I understand it, you have already distilled qver.into th$ t. . ' r V- r-.i-) * v -;V *' ' % T'^' W 3- ri'.jS. *-* -j-y ^ - n *+ '* " y. ^ 3 receiver, without measurable loss, contents of the flask 4 and you could not leave any more than traces of tetra ethyl 5 lead there. 6 Q There would be traces of tetra ethyl lead in the flask? 7 Pesttil: A Traces. 8 n And then, if hot, there are fumes? 9 Trac es. And then inhaling that, it would be in the system? The amount under those circumstances would be absolutely insignificant. K Nevertheless, he is inhaling the fumes, according to his testimony? That is rather a hypothetical situation, don't you think? XIany hypothetical questions have been asked of you. HR . KISSSIG: Q Asstime for a minute. Dr. Xehoe, he inhales whatever comes off there, in your opinion, would the amount inhaled, if he in haled all the residue left in the flask, be a significant amount or quantity? No, it could not be. It is not within the limits of the experimental analysis of the material that comes over; more over, in this instance, we do not have to assume; it is a. question of whether or not lead was excreted in abnormal quantities, and it was not. KE 002205 -74-~ r.GCc]A0:-` w-nr. " r rru-'.'sr-c r-'7 T-r * *. i..* ro. .4 & 6A0t THf W , ^etTTJ6'1 #* t 2 t* ,* cuC 48 1 WITNESS EXCUSED. 2 YicFEATTIEj 'called? on behalf of.:- .the,;applicant,; under 3 2050 C.C.PV, being* first duly?sworn by.the ..Referee,,, testified 4 is follows:' 5 REFEREEf: 6 1 State your name/-please .-3 1 ,.u 7 k J. F. Peattie. H 6-: xxxT,;i iv.X Lxy , 8 Q, You are' e doctor of medicine? 9 k I am . - 10 Receiving your medical education .when and .where? 11 k University of'Illinois/ 1912. , do-' . 12 5 Do you specialize? 13 k I do not. 0:' p- u:- t.r-Zv V;..'. Vo ; y. u- ;; 14 2 General praotiee? c-' o.r.'. t..- 15 k I am.not In general practiceici v,;: v 16 5 What sort of practice are you in, Dr.Peattie? t. 17 k Medical Director of the Associated Oil Company. 18 REFEREE: Proceed, Fr.Comaich. r. .. :,r y.,-,-;-.,-, 19 m, c o ma ic h : "*v. 20 Dr. Peattie,'the Associated Oil Company has plant doctors, 21 that is, stationed right there on the grounds? 22 A. There is a visiting doctor four or five daye a week, yes 23 Q. Whb is that5'doctor? r,,,, ? * 24 k Dr .'Coates. 25 Q, You also have an Infirmary there, or first aid station, with 26 a nurse irt1 charge? ' `-r v Kf 0022060 -75- ' \ f. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 IQ 17 18 19 20 21 22 23 24 25 26 I 'will file the letter of l)r. Chabanoff of 1 Jebroary 4, 1938, citing authorities of the jierican. 2 3 Medical journal concerning -which she --e stifled at a fomer 4 hearing. I believe you acknowledged reeefot of the sane, 5 hr. Hone. 6 L&. IlOnS: fo copy was sent to ue, and the first knowledge I had 7 of it being filed vms on February 26th, Saturday, at .Rich 8 time I telephoned to the formicsi on here ana someone in 9 the Commission read it .to 12s over the telephone the letter 10 r oferred to. 11 R-hhlRBB: hill that be sufficient or Gouivo.Icnt of service? 12 IB: i mi ss no point that no >py naa Peon nerved, ??:':& 1 13 n 11 boko a copy of it i:i lo baud fron the omission's 14 L'ilS. 15 IhifSEhS; Report of Dr.Chabanoff of Bebruary 4, 1938, received 16 in evidence as Applicants Exhibit 1, yobruary 23, 1938. 17 .All right, we will go ahead. 18 IlR.DSfHLbIFSIlIt I wish to make a statement.he filed this petition 19 about six months ago, and since the last hearing -when you 20 21 informed the attorneysfor the Associated Oil Company that i 22 you- would have one-half hour more on. cro ss-exam nation 23 and at the end o f the half hour, you vxnxld cut -off the 01*0 s e 24 examination., I received a call iron hr* Burke, the. secre 25 tary of the admission that they felt that further cross- 26 examinations of Br.Chabanoff would be proper at this tin ^ 4 Xg 0022062 riM 1 KR.aSTBtLSFSSI-Tt jf 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 OHM 269 177 6-S7 40M .1F0RHJA STATt - I NT! NG OFFICE in tills case, ana I did not nay " 'ran* or ' no", but at his request I have brought Dr.Ciiabanoff here today, but in the past six months at the various bearings and going over the notes I have na.de in the case., I find that out of every sixty minutes we have had,fifty minutes has been taken up at cross-examination of our witnesses. This 3 n u Smia n'ii is made for the ir pose of saying that there UUSt be an. end to ail thi: s, ana I would suggest that J O me referee and the btorney for the Associated oil my curb the ccro ssss--eax=xanliistlon. he all know from our experience in a case of this character when you pp into the roaln of "isn't it possible, doctor'' you can continue on for six months, and I would suggest that the counsel for the associated Oil Company got right down to \7Jiat no vv'ants in the way of c ross-examinat ion, rather than say iTisn't it possible", because a doctor can say it is possible, and it would continue on forever, and I know it,., is the policy of this Comri.iss.ion to expedite hearings and we have tried to expedite this one. X say this in fair criticism that we can determine the thing today, and I have Dr.Ciiabanoff here today, arid I an not going to ob ject to tmy questions, llr. lleferee, if you want to object, that is all right. Dr.Ciiabanoff is here and she is well thought of in the profession, but I would like to 'nave the matter determined, nix months is a long period of tine. K 0022063 O. :-4R.DsmErs3aT;- and in checking over ny notes I think it Is a fair satirist 1 2 that; fifty minutes out? of sixty minutes have been on cross- 3 n, a:.!.aIU? X. 4u- *j*. rO2 i:x the .iuserest ,, VJ iX.> , .: ay cl lent CO 4 XT'lJ. _ t' .v w Ci.. 5 v.l~ _ti>i --* * rW* yJh*'-*vT* c nn V y edite it as nucJi as the v:/? w iXz. \* of 6 z :ie c a. i 111 pomi4* * nil rig^at. 7 > wit ness will cooperate with us. UY*. CIX-t sure v:e 8 .its the c ros.s-exanina tion. i. 0,0 not noan :-y 9 J. v'Vi;.nt to ;V> reclose the vatuOSS givii:ig all the 10 >ns sh.e lii.y4!.1; ni-j want -aid , itenyx to .iTs /"} rUv'0T* X` r i e 11 find eupla x n everyth! "O* 12 fix trout le is you h *o P7 -,r> n mi i. -ll u you did not ra 13 c/i ii.> vtrers y on YfCSht od. 14 ~r:-]. n'Hia tire a' of thi 3 >V -? y% ^ a*f / vi j *-> w *W -U v.i Ul O x. tj wr1Iyp.4.rvy\ YX0 il3 L#J.O Ii3 017- 15 -7 on.Vr't. ^-X*4X*4/> w^../ } xX/SZJ' - J i- naroi`ii. . -T ^oned /h e> -1f* "vf** vvT-OJl will 16 - of ft "ye wr" f or :fnoT? answer. ilild for iohat r enson 17 it is difficult for nil the parties at least, that has seen 18 ciy observation in the past hearings we have had, and 1 19 20 expect we will get along this morning along these linos* 21 IK.HOPS: `The hearing will continue this afternoon as v;ell as 22 this rooming* 23 RSFSRSE: Tes, I suppose so* 1 have no other case this after 24 noon. 25 Lj I.HG-S: If, for airy reason it could not to concluded, can ire 26 Fo r m 269 45377 tf-37 0M CALIFORNIA STATE RfctHTINOOFFlCE go on in the morning? K 0022064 Yes,. 33 far as I an concerned. 1 But I do not thirds it vi?J necessary. 2 3 4 5 -.Jit 6 7 8 9 10 DR. IL1Z 'Ibid OTB.BAdOFB. vritns recalled for oross-t ^ r. } nn or the ^ olio or; , now, doctor and also hr. Referee, dr.Rehoe v/ho .has been -rioted a umber of tines in this cnee is present sod will da available as a vritneso. ^ --TU. ~ X. Z ri hM 11 12 Dr. Jliabanuovli''-? .a rerara to /% , s:\ i.* usjj. .-. 1 ! on which 13 UU referred to today dated Yobruary 4. 1033, that 14 ^ .Cv *&"*'ay * {"> ; i ^ ,i.O \> y L5-t, v J vr? > ;* -t * "Y * i? ih e;T a " r!. x *.} -- '-v- -d v-i O M(w.J,v fO'C^r: YO 10 il 15 m referred in vour tostitio ny on -rovxoas 16 ics4 car. 17 and it is true, is it not, that a substentini part of the 18 literature v/hicli pou have read in. the nodical books on 19 this subject consisted of articles prepared and presented 20 by Dr.Reiioe? 21 Yes. Dr.lCehoe wrote lots of articles, a great may 22 articles about lead poisoning, 23 pud you recognize Dr.Keh.0e as an authority on lead poison 24 ing? 25 Yes, br.heiioo has done a lot of work on lead poisoning, 28 <viri T aPnl' P't.ny-'f'')t'i r>?i of 7 rl 1. r: othOX' tb illfTS, 5. H 0022065 X 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 \ 1 hhat : ; --t ? 2 1320, :.r. 1 c-.r.i not sure whether Iras licensed in Cali 3 fornia 4 Are yot npocializing in any branch of medicine or do you 5 specialize? 6 Yes, I lave been in investigating mid teaching work and 7 experimental medicine, in one field or another of experi 8 mental -edicihe since 1921, and since 1934 ay experimental 9 end clinic work lias been in the field of industrial hy 10 giene vlth particular reference to metallic poisoning. 11 'BRISK: 11 right, go ahead, hr. Hone. 12 ant. 13 hat professional position do you hold now, doctor? 14 A I an the .ssistant Professor of Physiology in the he&ical 15 College of the university of Cincinnati, and Director of 18 the nattering Laboratory of vpplied Physiology in the 17 University of Cincinnati. 18 19 And what previous positions,if any, have you held at 20 hospitals? 21 fell, I was the Resident Pathologist at the Cincinnati I 22 General Hospital for the year 1920 and 1321, and Patliologis' 23 at the Jewish Hospital in Cincinnati some time in 1931 unti 24 1924, and i have been either assistant or assistant pro 2E fessor of Physiology in the lledienl cchool of the Universalt 2 of Cincinnati 3inco 1921. SgiSSSsSfefe K*- 0022067 .ri* tiTl-vA1 nfT-Ts1 t* C DR. P.OKSRT b. KEHOK: 1 Hare you ny special experience or capacity v/ith relation 2 to tetraethyl 50soline? . 3 'ell, I or ny associates conduct* n large proportion of nil 4 experimental and clinical work associated with : ublic 5 health and industrial health studios of that problem, and 6 also I have been in an advisory capacity with relation to 7 the manufacture of tetraethyl lead, r u;i the use end dis 8 tribution of tetraethyl lead gasoline. 9 \n& in connection with those studios have you had very 10 much connection with the Public Health, ferrice of the 11 United ctates? 12 ' * I hove no professional connection with the United states 13 Public Health service, only a friendly professional re 14 lationship, but I have, however, a relation v/ith the 15 Ethyl Gasoline Corporation in which I have been the 16 Chief Uedieal hdvisor since the formation of the company 17 in 1925. 18 19 Have you specialised in industrial hygiene for the past 20 several years? 21 Yes, actually since the founding of the lettering Labora 22 tory in 1951. yy professional end clinical work has been 23 confined to working in industrial hygiene*# 24 25 2< L . .-jS and in connection with any particular branch of it? I'y work has been almost entirely with metallic poisoning, and especially lead poisoning. tiIt 0022.068 118 " "O * .lit :o r?** .yi-rre> >r sVw' > j -.uit x "rMn ;:** 1 ire you ?. member o.f various sc he l snociationa re 2 lated to this field? 3 i25, I mi o follow of tlie \uer iean . odical ssooration; 4 a fellow in. the Ynerican Public to nlth , .scoelation and 5 Chairman of its committee on lead poisoning, and a number 6 of other :3.`. .fic edical issoc lotions. 7 Have vou v/ritten a number of medical s on the 8 subject of lead poisoiling? 9 Pea, I have published a series of articles on the subject 10 ojl . load ,`0so , .;-ia.-Ocvi-i.xcally .o * a the subject 11 of poisoning fron tetraethyl lead said load absorbtion end 12 lead excretion over o period since 1925, i:n gor.cral 13 scientific journals. 14 nid it vms from those publications of yours that medical 15 references were given by Dr.Ohabanoff in this morning*s 16 testimony, is that correct? 17 Yes, it constitutes almost all of the references given by 18 19 ; r.Ohabanoff. I night say that I and my associates have 20 had some part in practically all experimental iTorh that 21 ivas being done- in that field with the exception of those " 22 done by the Government of the United States and the 23 British Ministry of Health and other governmental agenciei 24 with which I have no special connection. 25 You are personally familiar with the entire record in 26 this Solepnov case, are you not, or you nve read the i%3, KH 0022069 lift. r~i - '/-i v ran - y ---------------------------------------v. JH. ciT & N 1 2 3 4 5 6 7 8 9 10 11 12 13 1 14 15 16 17 18 19 20 21 22 23 24 5 26 L ii medical resorts and laboratory 'reports and all of vho testimony, and Lave heard this ..:.oriiing`s testimony, vhich other totimony includes testimony in the case of 1 `iciiael Teiepnev and today in this present ease, you have read nil of that? Tes, I have gore carefully over tise entire record. > based upon your hnowledge of this ease end pour general hnov/ledgo of load poisoning and particularly of tetraethyl lead poisoning, nave you reached a conclusion as to whether or not llichael Teiepnev suffered from lead poisoning in this case and died as a result thereof! I have inched such a conclusion. ,d i, . .'Iia o is your cone lusion? hy cone Ifini ofi is want j ...c a,id uo t save lead poisoning, end it is my opinion that he did not die of lead poisoning. "ill you state the basis for that opinion? './ell, that involves a rather long discussion, I am afraid, hill you proceed, doctor? Yes. The diagnosis of lead poisoning as I would approach,.,; it in this or any other case is based first on a history of significant exposure to load; second, on the presence of a group of symptoms and physical signs, which when com bined together present the characteristic picture of lead intoxication and upon certain laboratory evidences ift K 0022070 . .. -W 4 ( bh.KGdSii? a . such, are available as to the extent to which the exposure 1 presumed to have .-.eon present vmn in effect a significant 2 exposure. I would like to take each of these phases and 3 analyze, so far as I can see its relation to this pnrticula: 4 problem. The occupational lead exposure of !Ar. Telepnev 5 is one which I cannot regard as in any way significant for 6 7 the following reasons: hxperinental and clinical observetioj 8 i;i a large group of non who have keen occupied with the 9 sane type of work have failed to, show any evidence that 10 there is any unavoidable or actual lend exposure associated 11 with tlxo work. -hat is to say there is none thousands 12 men who wave bean engaged over a ;;eriod of years in 13 typo Gi aoi'tc. evd v have studied rein fcive group 14 of these nen with the idea of determining v/hether or 15 not their occupation does involve lead exposure. These 16 observations have been based upon clinical study of men, 17 .-nd also the study of their lead excretion at different 18 tines over periods of years. This type of observation has 19 failed to show any evidence in the fora of a heightened 20 lead excretion, that the occupation involves actual 21 measurable exposure to lead compounds, moreover, so far as 22 my knowledge goes, I know of no case of lead poisoning, 23 acute or chronic, which has occurred amongst men engaged ir 24 this occupation during the entire period of tine since - ! 25 1924. It is therefore an. occupation which has no known 26 K 0022071 q .ROBERT KEKOE: \ 1 or recorded instances of lead poisoning, and it cannot be 2 regarded therefore as a hazardous occupation, In the sense 3 of a known record of having produced cases of lead poison 4 ing* 5 The second phase of the natter is the question of 6 the signs and symptoms presented by Hrduring 7 his illness. The general picture presented by his illness 8 is one, which in ay mind is typical either in its onset, 9 its clinical picture, in its progress or in its final 10 >i. termination characteristic or even nore than midly sug li gestive of lead intoxication. By that I do not mean to 12 say there are any bizaare and atypical cases of lead 13 poisoning, but tills case could not be regarded as typical o 14 15 lead poisoning in the sense that the symptoms and signs in 16 and of themselves justify a diagnosis of lead poisoning in 17 the absence of non-significant lead exposure. In the ab 18 sence of such lead exposure of of a history of lead ex 19 posure, and in the absence of a typical clinical picture oj 20 lead intoxication, one would require laboratory evidence o j 21 unqualified accuracy and significance in order to justify* 22 the diagnosis. I mean, by this to say, that an occupation 23 without any recorded instance of lead poisoning cannot be 24 regarded as in itself likely to produce lead poisoning, an 25 one vjould therefore have to have unasailable evidence in 26 the form of farther laboratory findings in order to confor K& 0022072 T'rr-t-"T<' -h. ; -.V.*- -'a *? *-, r Df'pi'on ' r.' 'tjr-NT? 7i!. , a# to the clinical diagnosis. In this case in my opinion the 1 laboratory evidence obtained during the patient1s illness 2 3 does not permit a. doubt, the failure to find significant 4 and abnormal quantities of lead in the excreta of the man I 5 during his lifetime and during the height of Ms illness, 6 and can only bo explained, I believe, either by the tests 7 themselves having been inaccurate arid uncertain or. that no 8 abnormal quantity of lead v?as being excreted by the .man, 9 which in ny belief and experience ratoons that there were no LO abnormal quantities of lead in his tissues, To return to LI the clinical symptoms I should require in order to xaak L2 a diagnosis in the absence of a history, aid in the ebsenct 13 of adequate laboratory evidence, I should require an ab 14 solute clinical picture, yet in a nervous case for example 15 trie charactertistic type of nervous system damage, which i 16 either a paralysis involving the am,producing wrist drop, 17 with an involvement of the muscles specifically supplied b; IS the muscular spiro nerve, or I should require character IS istic encephalitis, an involvement -;f the brain. These in 2C my opinion should be associated with blood changes, and 21 particularly evidence of stippling of tho erythrocytes in 2S order to be confirmed. That is all y need to say on that. 22 Doctor, there is a difference is there not, between lead, 24 tetraethyl lead and ;;asoline containing tetraethyl lead? 21 2 0022073 IS 3. -s4 * 'si .norm*. A DR. EOBLRT a . IQiHOE: 1 Yes, t .ere is a wide difference between tetraethyl lead 2 itself and gasoline contninlag tetraethyl lead. 3 lad will you explain tint difference? 4 Tetraethyl lead is a single chemical compound with a 5 consistent set of physical properties. It is a v/hite 6 oily liquid of very heavy specific gravity and with a low 7 volatility. The specific gravity is about 1.65, and the 8 boiling point Is about 200 centigram.,which I believe is 9 about 530 Fahrenheit. This material is a poisonous sub 10 stance which is absorbed through the skin and it gives 11 off enough vapor so that its vapor can produce acute 12 13 poisoning, and i;oisoning therefore can occur as a conse 14 quence of skin absorptions, inhalations or a combination 15 of both of these methods of exposure. The type of poison 16 ing which occurs, or which has been seen and described is 17 that of an acute fulminating central nervous system in-' 18 toxication which more than anything else resembles al 19 coholism. such cases of poisoning have been seen in manu 20 facturing operations which recuire the handling of the 21 'I concentrated product under conditions that did not properlj 22 prevent exposure. Gasoline ocjnt&ining tetraethyl lead has 23 on the other hand the essential properties of any ordinary 24 gasoline. Its boiling point is not materially changed froi 25 that of gasoline, It3 behavior is in no wise measurably 26 different from that of gasoline, and, its toxic properties iSri ate*,- KB 0022074 12 . .JTilXXS: have not esn round to ho measurably increased above that 1 of ordinary gasoline, that in in this dilution, -boro that 2 3 of ordinary gr.ooiire. Lkus, in tills dilution in - olino in 4 which tetraethyl lend occurs commercially, it is found that 5 absorbtion through the skin of the product in prevented to 6 such an extent that there is no 'possible sbsorbtion through 7 the skin, fhio has be or. studied in the case of experimental *8 animals nod has eon dully confirmed in the case of human 9 beings, co that in .uy opinion on the available evidence LO it must be accepted that tetraethyl lead is not absorbed LI through the skin out of the o-.-ohi 00 in which such lead L2 occurs in the commercial concentration. Likevd.ee, the 13 oint of gasoline arc the boiling point nr betra14 sthyi lend are co far apart that no measurable aiontity o: 15 1 fO / *1 r liven off in the vapors of uwoline as they are 16 allowed to escape from open containers. In fact, from 40 to 17 50 ?r cent of gasoline can be.boiled off before signifi 16 cant and measurable ouaritity of lead ; ogius to come over IS in the distillate, thus, in handling gasoline in open 2C containers as long as they are incompletely evaporated 21 2J involves no measurable exposure to the gasolino.. \ It is 2i these properties of the gasoline ns differentiated from 2< tetraethyl lead that constitute the safety factors in the 25 use and distribution of leaded gasoline, and it in believed 2< that the handling of gasoline containing lend in the oon- n 0022075 125. -ip POTv^pf? * f -A 1 aercial concentration is puite qithout danger from the 2 point of view of the development of load poisoning in 3 persons engucea in occupations in v/hicli such gasoline has 4 to he handled. fills opinion arising fron experimental ob 5 servation has in my opinion been amply confirmed by the 6 experience of one past thirteen years, during which no coses 7 of lead poisoning have toon seen, oithor by rie or - reported 8 in medical literature as arising iron the use and; distri 9 bution or handling of gasoline coctwining tetraethyl load, 10 to far us worker s in the fields and public .-.onlth officials 11 are concerned, the occupations involved in : andling leaded 12 gaeolino are -mite without any instance of lend poisoning 13 amongst the workers, and ore frost the point of view, or 14 15 lack of proof regarded ns non-hazardous occupations from the 16 point of view of load exposure, it is this point of view 17 which justifies the United litotes Public health Service - 18 in permitting and continuing; distribution and use of leaded IS gasoline as a commercial product, that I have said with 2C relation to the handling of gasoline in filling stations, 21 garages, refineries and so forth is equally true in the 22 laboratory handling of the gasoline, and sharply differenti 22 ated fron the handling of tetraethyl lead ns a concentrated 24 product in any way, either around laboratories, manufacture, 2E distribution ml nixing operations in which tetraethyl is 2 nixed with gasoline. Iphliiii'y^rp7/U : K 0022076 1 9fi JH.riOMS: 1 ROSISKT '-mTA'-i'! IP..HCI3B: -t Dh. liOBKR? A. h.YIOT: 1 Q, 2 3 4 Are any instructions issued at ttis tine tint you know at to the effect. that ergons hancili. ; rw'oiire containing tetraethyl load should exorcise cure in such hnndl .ng, and should wash their hands after handling the sane? 5A in laboratories, no. There is however a sign displayed 6 7 8 9 10 11 12 13 14 15 0 16 17 18 A 19 Q, 20 21 22 A 23 on every pump and every container thirough which, this product is distributed, pointing out the fact that, it con tains tetraethyl lead and asking that its use be limited for aie purpose for which it is intended, nmoly, as motor fuc 14 Those signs arc present as the result of r- gentle man's agreement between u.u -hyl An so line Corporation and the United htatos 1 ubli o health vorvice, without legal compulsion that motorists must and should be Informed if and when, they re pir chasing gasoline containing lead. Originally instructions were issued back in 132S, that such signs te placed in testing laboratories such-as the one in this case, isn't that true? would you state that over again? Tetraethyl gasoline was brought to the Pacific Coast the first time about ."overiber, 1C2-S? I believe so. and at that time and for some short tine thereafter it was the practice to recommend signs of than 24 25 26 A general nature be placed in laboratories similar to the testing laboratory in this case? Yes, I think it was fairly general practice in 1926 and 128. M KE 0022078 ' -n v 'A* Uw 1 * -f Dn.BOBSRT A. EnKQE: 1927, probably as? late as 1028. 1 And that practice \ms thereafter discontinued? 2 A In general it has been discontinued, yes. 3 A And the reason for that is ' ecauee the increased informa tic 4 that has i-en developed since that tin would, indicate 5 6 that there was no further reason for handling tetraethyl 7 Carolina in laboratories any differs from handling 8 ordinary. gasoline not containing load? 9 jeliove the real reason for it lie O --AA V-..L5J fact that 10 on or about 192 v3 ^ X 7, or 1928, 1 discontinued in our 11 regulations any mention of handling loaded gasoline in 12 laboratories on the basis of our experimental work, and 13 our experience that such regulations were unnecessary, but 14 for sot tine afterwards none of the oil distributing 15 companies continued to use such signs, but in the main 16 they disappeared through the laboratories at abo\it that 17 tine. 18 Assuming, doctor, that the videnee in this case showed 19 that during the tine Mr. relepuev was handling leaded 20 gasoline for the associated Oil bonpany, he spilled sub- 21 stantial quantities of such leaded gasoline on his hands, 22 what, if any earing, would that have on your opinion as 23 to whether as a result of that experience over a long 24 period of tine, say six or eight years ir. :clepuev absorbs 25 any lead from that source? 26 d kE 002207 y 12 9 'ifil'Q'-: ' iOlJ] DR.ROBHtT A. K/IHOE? 1A That fact.iwould not lead me to believe that me has absorbed 2 any appreciable muautity of lend* 3 F;rn?.S!2rJl: I take it you limit that to absorption through the 4 skin? 5A /^bsorbtion. though the skin. 6 v TTmf". 7 t. to as to cover any additional portion or thought which the 8 9 10 11 12 13 14 15 16 17 18 19 20 n 21 22 23 referee nay have in mind, or ho my not' have addition al thought, assuming the so.no test with subst antial spillage, would that fact lead you to from your experience to believe that any significant amount of lead entered the body, or the tissues, or circulation of ;,.r. clepnsv from that source? !:* I would not regard the normal and usual or even un usual spillage of gasoline as the basis for the belief that lead had been absorbed, either through the skin or m by inhalation. That would be totally against my actual experience and experimental observe tioiis* Having in mind that if any gasoline were spilled on the hands of hr. and assuming that even it was spilled, ond that it could be spilled, was a substantial amount, having in mind that gasoline so spilled would be 24 the gasoline coning from the containers as the gasoline 25 was brought into the laboratories and prior to its being 26 heated, and that therefore it vould 2ia.be the room tempera-- -7$r KC 0022080 13D U'j. i-A 1 ture proximately, would there be any lead vapors coning 2 :fron such spilled gasoline? 3 The yjiar.tity of lead under those conditions would -'o no 4 snail as to bo of - no theoretical irroortance. It . order to 5 inhale any mensurable significant u.antities of lead ns 6 the result of spillage of gasoline, one would have to in 7 hale very high concentration of gasoline, and tr: at ob 8 viously is impossible, because o o cannot endure exposure 9 to gasoline in concentration i A G XC O A 3 of one end one-half 10 per cent in the atmosphere without drunkenness end \m- 11 ooascionsne ss. 12 30 that irrespective of the source of vie gasoline and 13 irrespective of its temperature and irrespective of whether 14 they spilled gasoline, or vapors coming out of the open 15 16 containers, what is your opinion as to ah ether or not, 17 -r. inhaled any significant quantity of gasoline 18 during his vork for the Associated Oil Company, any sig- 19 i.ii xcant quantity of lead or lead vapors during his em 20 ployment with the Associated Oil Company? 21 It is my very certain opinion that ouch spillage does not 22 involve significant expo sure to lead, and it is also ny 23 opinion that this type of occupationwhich involves the 24 handling of yisoline and some spillage by no stretch of 25 the imagination. can he regarded as hazardous, and my ex 26 perience of thirteen years is entirely opposed to any such 0022081 131, OPIR? A. hhHGl: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 19 20 21 22 23 24 2% 2i L y-jjg assumption. : oreover, the experimental v.ork on non vdio - have ' :en. exposed under such conditions by ski a contacts v/ith . asollne or iniir.lation. of vapors over period of years lias failed to show any evidence of lead absorption in sufficient amounts to increase the lend excretion in ins urine and the feces, arid it is ny opinion that those occupations are not in any sense of lie word hazardous load trades, utherwire, I should issue cautious and de tailed instructions for tin; avoidance of exposure, dorr, with respect to none of too literature ora edical references referred to by r.fn.nbanoff, there anything in any of that literature, \lich contains either statisti- cuilyor otherwise, my rofcran.ee to established cases of lead poisoning resulting iron, the milling of leaded | gasoline? There is not. Specifically with reference to the ttnndard Oil Company and the evidence presented in this c >se of a large number of persons affected with gasoline poisoning as the result of handling tetraethyl lead, and the further reference to the fact that large settlements in such cases have been made, trill you explain whether or not these circumstances o that particular natter are familiar to you? ?' cn < thev are< K'JT 0022082 Vi;*-Ayfl't 'f'<& fUh, .HOE - 1) -4-Vv* - iti * 1 And 1 will ask 70U whether or not that involved the ..onciiin 2 of tetraethyl gasoline in vesting laboratories or -.xvthing 3 sinilar thereto? 4 It had nothing to do v- :'.th rr.ditions associated with the 5 handling of gasoline in laboratories or elsewhere. 6 Ill 70u explain why the mployiaent in which hr. 7 folepnev v;as engaged, ns :L;xl ion ted by the evidence ?.n this 8 case, was substantially different from the cnrloyncnt of 9 tlie persons involved in t: .v tan&srd Oil ton pa ay canes 10 referred to? 11 Tea. PSr. 12 field, --r. 13 employment s in. a wholly different was, I race at, v;n.s in ny o -inlon en gaged in an entirely non-hazar&ous trade in so fat as the 14 15 dangers of load poisoning are concerned. Hie ties. referred 16 to in the \rticle < ruote& were engaged in manufacturing 17 operations associated with the manufacture of tetraethyl, 18 lead during an early period of the r.iniiufacture, in which 19 the methods of control were not satisfactory and ware not 20 put' into e ffeot, and this group of non were acutely po ison ed and ss x remember amongst the group there were five deaths in the manufacturing plant.f?hose cases occurred in experimental work in a manufacturing plant in the Bay ay* hew Jersey refinery of the standard Oil Ucnpany of hew jersey, during a period in vhich they wore attempting to develop a ev; pefeliod for the laanufnature of tetraethyl f o r ** 269 477 6-3* SrutHti5S5SEg3Sfr RE- 0022083 n x<* r i i. 1 2 3 4 5 6 'GKTINUATI0H OF EKARI2JG 7 part 2 8 liarcli 1, 1938 (9:30 9 10 11 12 iges 1 to 60 inclusive 13 [IP CD: Dr. Pekoe 14 15 16 17 18 19 20 21 22 23 24 25 26 0022085 & N 24413.02 1 Continued hearing - March 1, 1938 - 9:o0 a*xa. 2 UR. D-JTHLSFSKJi: I would suggest in '.'ha interest of tine here 3 that the doctor go on with his recitation of facts, 4 theories, and opinion from the beginning and then if ??e 5 want to clear up any point, questions can he asked. I pre 6 sume that the matter has been f To x x q Ini o between Counsel and 7 the doctor and the doctor is well able to give this to us 8 it i J.ai rup uhu proper order, probably cave a great deal of time and 9 my cross-examination of the doctor will be very limited, 10 laird: That rests with the Counsel for the defendant aa to 11 the method ho desires to follow. 12 UR. HOI-TE: 7/ell, I will do the best i can 13 last question? 14 (Question read.) Will you read the 15 HR. HONE: 1'ill you answer the last question which has been 16 read to you? 17 A Yes, a typical case of tetraethyl lead poisoning. In a 18 typical case of tetraethyl lead poisoning, the onset of 19 illness is rather abrupt and bears an immediate relationship 20 to a significant exposure. In such a case, the first 21 symptoms seen are those of brain intoxication with insomnia, 22 extreme nervousness, anxiety, tjremor, hyperactive z^flo^es, 23 extreme irritation in the sense1 that noise or ordinary >4 stimuli excite an exaggerated response, which is usually one of fear. The metal symptoms are the striking part of the picture. These in favorable cases diminish with the 'v ft-** 0022086 SIVi-4ft^UailS8 IIP., liOKE DR. 1 cessatio: -,f exposure and such, cases unless they proceed to 2 a fatal corae, hare been seen to recover fairly rapidly 3 and withem residual symptoms and without residual injury. 4 In this * -ge of poison, no case of paralysis has ever been 5 aeon* 2d oho manufacturing operation paid, -andop conditions 6 of exposure, recognised to be significant and hazardous In 7 i fatal c i.ms , the excitable nervous condition rrogresses with 8 one dev >. .unaent of hallucinations followed b~- convulsions o 1/ ending \ state reserablioig strikingly acute alcoholic 10 dollr-iu - . .-ith death from o.uhaiastion in every instance thus ; ii: i! describe-, vnd I believe within a period of 15 days from 12! the onsu -f symptoms. M r conditions of less 'severe.ex 13 posure, ^ symptoms are those of a central nervous system 14 irritation .-ridoh subside leaving a state which sometimes re 15 sembles that of ordinary chronic lead poisoning in that the 16 individual is fatigued, losses weight,, and shows every evide: 17 of lack of energy and lack of strength, lithin a period of 18 two or i.oree months following cessation of exposure, such 19 cases have improved and have proceeded to recovery -without 20 residual evidence of central nervous system injury, in this 21 period of delayed symptoms, v/Ifch progressive recovery, one 22 finds blood changes to a somewhat less degree than thoae 23 seen in organic blood poisoning but of the came general type 24 with slight anemia and with stippling of the red blood cells 25 Chronic cases of lead poisoning as the result of prolonged 26 exposure to small doses have not been 3een. That is, no -'/'A vMSMISt#''4 0022087-2- frrcra ?R,_ Z( 1 cases cr anemia v/th persistent prostration and persistent 2 disabili'-r when paralysis have been seen wore described. 3 This picture differs from that of ardinary chronic lead 4 poisoning in the above respects, in that in the ordinary 5 type of chronic lead poisoning, the most common symptoms 6 are those of gastro intestinal discomfort ana in which in 7 the more severe and more typical cases, develop into a franl; 8 colic with persistent abdominal pain. In a certain per 9 centage of oases, a serious exposure over considerable 10 periods of time, muscular disorders and a peripheral nerve 11 irritation followed by paralysis are seen occasionally. 12 Paralysis, however, is not experienced as the result of ex 13 posure to rather large quantities of lead distributed in the 14 atmosphere. In these stages, one always finds changes in 15 the blood with some degree of anemia and always during the 16 period of active symptoms, one finds microscopic blood 17 changes in the form of basophilic stippling. The above 18 symptoms are accompanied by loss of weight, loss of strength 19 loss of appetite, general muscular weakness and a variable 20 degree of prostration, the whole picture, clinical picture, 21 depending for its severity and its persistence on the 22 severity of exposure and the duration of exposure. In 23 general, the shorter the exposure, the greater Is the 24 tendency to complete recovery and prompt recovery. Certain, 25 types of injuries, particularly injury to the nervous 28 system, la likely to persist for an indefinite period of t'lCc VflwSU KB 0022088-*- 1 time. "hit Is to say, paralysis nay recover or they nay 2 remain vritrout any considerable improver!ent throughout the 3 rest of the patient's life regardless of the discontinuance 4 of exposure, -ovy, the bearing on this clinical picture of 5 Hr case in in some measure dependent upon whether 6 one regards his Initial injury as an acute tyoo due to large 7 exposure or as to whether one regards it as an essentially 8 ronic injury cue t o 9 .ously stated. chroni' 10 1 lor grade exposure to tetraethyl lead and this is not en- 11 rely capable of be in.tg explained although it may be 12 partially explained by the fact that tetraethyl lead is ex 13 creted from the body somewhat more rapidly than in lead ab 14 sorbed in the form of inorganic lead, thus the dosage which 15 is capable to producing poison is somewhat larger than that 16 of ordinary compound of lead and It has been observed that 17 where the conditions of exposure bo inhalation are not 18 greater than 2 milligrams per 10 centimeters of air, cases 19 of poisoning do not occur even under conditions of prolonged 20 exposure over a period of years and I refer here to the ex- 21 posure seen in the manufacturing enterprises. Kow, the i 22 clinical picture seen in ITr. Telepnev's case as I surv? rize 23 it, is that of progressive muscular weakness with the final 24 development of a paralysis in the lower extremetles. 25 Inasmuch as case.s of paralysis have not been seen in tetra- 26 atypical lesio ethyl lead exposure, this lesion must be regarded" as an/ln -.Wt K& 0022089 -4- n*> ~7 DR. KJ{ 1 tetraethyl exposure. Furthermore, the common paralysis 2 in lead poisoning in any type in adults is that of paralysis 3 in the upper extremities, this being own cl&als&ft&lf'y as 4 wrist drop. In Mr. ^^^^P^case, there is no record that 5 stippling of the erythrocytes was found at any time. 6 REFEREE: Doctor, I must call your attention to the fact that 7 you -are in error, in that a stippled cell 8 A stippled cell. 9 MR. I1CKS: Yes, the record shows that in some number of fields 10 examined, I have forgotten the number, the stippled cell 11 was found and I am sure I am reporting it accurately with 12 regard to stippling; that there was no evidence of stippling 13 with the exception of the finding of a stippled cell in a 14 15 A 16 number of fields. I will qualify that by saying that there is no record that a significant amount of stippling was found at any time 17 during the period of intoxication. By significant amounts, 18 I mean that stippling of the erythrocytes is not uncommon 19 .and is in fact a substantial regular phenomena in the blood 20 in normal persons in numbers not greater usually than 10 21 per 50 fields. 22 MR. HOPE: Yen what? 23 A fen stippled cells per 50 fields. To be significant, there 24 for, stippling must be found in excess of this figure to 25 be beyond the normal range of values. One other very 26 \ significant thought with relation to the diagnosis has to - 00220S0 c IK. HONE /\ nr? 1 do with tlie progress of Illness. Desoite 2 the cessation of exposure and despite various types of 3 treatment prescribed by physicians. Hr. 4H0I condi 4 tion did not abate but progressed steadily with increasing 5 disability until death finally occurred. In lead poisoning 6 of fatal type, death does not occur as a delayed phenomena 7 hut occurs promptly and. during the height of the acute 8 clinical manifestations. Moreover, lead poisoning in all 9 tut the most acute forms, tends to subside spontaneously 10 with the cessation of exposure and regularly progresses in 11 improvement and to recovery except inhere there have been 12 destructive lesions. These destructive lesions particularly 13 of the nervous system does not necessarily improve hat in 14 and of themselves do not result in death; death resulting 15 in all fatal cases in my experience as a consequence of 16 envolveaent of the central nervous system from what is known 17 as encephalitis. In. this instance, the steady progress of IS the disease must be regarded as an important factor in the IS exclusion of lead as the etiological basis of his illness* 2C X think that is sufficient for that. 21 REFEREE: AH right, Mr. Hone. 2J HR. K)HEt What, if any, specific significance attaches to an 22 interval as e^-isbed ^n case of in excess of 18 months v from the cessation of exposure and death. .Mr did no further work in the refinery, in the testing laboratc or with gasoline, on November 9, 1935, and died on July 28, >69 .37 401 ""fJS -KH 002209 i-s- ' ` ,.\s j i J.J "T # 1 2 l It is precisely to that point that; I referred, in saying that 3 the progressive character of the disease following the 4 cessation of exposure is enough in and of itself to cast 5 grave doubt upon, the diagnosis of lead poisoning. If Mr. 6 resulted from lead absorption during his 7 occupation, it could confidently be expected that his 8 symptoms would subside and that he would improve either with 9 or without medical treatment following the cessation of ex 10 posure. The failure so to improve strongly suggests that 11 load in his occupation was not the factor in his illness. 12 IZF'ulIff: hell, wouldn!t you want to limit that, doctor, by 13 saying that whether or not he so quickly recovered after ex 14 posure, depended upon the amount of damage that had been 15 done to the body by the lead previously ingested? 16 I 17 18 19 That is a fair question. In replying to that I would say thl developed a paralysis as a consequenoe of his occupational exposure, it might be expected that the paralysi would not improve and would not disappear for that Is the 20 history of such lesion that resiufcs from the actual destructi 22 of tissue. However, it is not tb be expected that his 22 paralysis would progress beyond that point, nor is it to be e 22 pectod that his other symptoms of general intoxication would 2-S gross and would result in his death, for with the cessation o 21 exposure, granted there v/aa exposure, the toxic substances wo 2t not only be eliminated from the body progressively but would . ~S 0022092 -7- i!fifeSSSteer '- REFEREE L DR. 1 also be so distributed in his body aa to provide for the 2 diminution of circulating lead and therefore the diminution 3 of toxic substances. This in ray experience is an Inevitable 4 consequence of the cessation of lead exposure unless that 5 exposure has been of 3uch magnitude that death results with 6 in a short time following the cessation of exposure as the 7 result of overwhelming amounts of lead in the body. 8 p Through what organ is the lead excreted? 9 .1 Lead is excreted steadily by way of the alimentary tract 10 through the agency of the liver and by way of genitourinary 11 tract through the medium of the kidneys, the rate of ex 12 cretion being dependent on the magnitude of lead absorbed 13 in the tissues of the body. 14 Q. Is or is not nephritis a concomitant symptom of lead poisoni 15 A Chronic nephritis, in my experience, is not a frequent con 16 comitant of lead poisoning. In cases of active lead in 17 toxication, one frequently finds albumin in the urine as an 18 expression of kidney irritation. 19 Q And what has caused that kidney damage? 20 A The irritation to the kidney substance is undoubtedly an ' 21 of lead expression of high concentration/in the circulating blood 22 and in the kidney itself. 23 REFEREE: I just wanted to get these points. I did not mean to 24 take over the examination. 25 r>R. HONE: That is fine. 26 A____Ohnonl n 1 nharst-.l frl.fll .rLephnAi-m g of. tho -typo seen at nooropoy m iSSs*B<s' Kg 00220&3 :j r . no r e f. 1 in Hr. ease is believed by many people to be an 2 expression in some instances of residual effect of prolonged 3 lead intoxication with damage to the Sidney. However, I 4 think it is fair to say that recent investigation and 5 clinical observations cast grave doubt upon that as the re 6 sult of lead intoxication and suggests more strongly that 7 it is an accompaniment rather than a cause and effect re 8 lationship. Hy own opinion is that chronic interstitial 9 nephritis is not frequently and not even demonstrably proven 10 in any case to be the result of prolonged lead absorption 11 in that .1'admit it is my opinion and not universally aocepte< 12 by medical experts. 13 REFEREE: Assuming one had some condition operating like a foci 14 of infection that may be working toward an interstitial 15 nephritis. That would be a cause that if continued at the 16 same rate or perhaps the amount of toxin by reason of the fo< 17 of infection present was increased, damaged the kidney, then 18 if the individual in addition 'were secreting any amount of 19 lead, would it help the condition or make it worse? 20 Well, hypothetically, at least. 21 PhPHBEEt Yes, hypothetical, that is hypothetical. 22 A Well,, it would probably augment the damage, i'll say hypo 23 thetically not to exclude the question with reference to this 24 case but rather because the medical evidence in the things ` ')5 is not such as would permit one to make a categorical, reply 2 to that question. The presence of any poisonous substance SMI - KE" 0022094 - ; REPh REE \ HR. 1 might be presumed to augment tile damage already existent 2 3 All dil Go ahead Mr. Hone. 4 HR. BONE: In. your opinion, was tho condition of chronic 5 interstitial nephritis .found on necropsy entirely explainable 6 and completely independent of lead exposure? 7A Oh, quite. One sees this type of kidney with chronic 8 interstitial nephritis with a snail red contracted kidney 9 as an expression of chronic nephritis over a neriod of 10 years quite apart from load poisoning and quir.e apart from 11 any known toxic agent. In other words, chronic interstitial 12 nephritis Is a disease entity and a pathological picture 13 which has long been known to have no necessary association 14 with lead poisoning, being more frequently an expression 15 of chronic progressive blood vessel disease with spotty 16 damage of the kidney over a period of years. Hkia is one of 17 the commonest pathological.pictures in kidney disease. 18 MR. HONE: Is there anything unusual or extraordinary in the fac' 19 that the patient involved, Mr. kad the symptoms 20 which are indicated by the record in this case and that 21 a number of doctors differed as to the etiology or origin 22 of them or were unable to definitely determine their 23 24 A 25 26 etiology? Ho, that isn't remarkable. Unfortunately there are stilliy quite a number of human ills, the cause of which is unknown of which Bright's disease Is a shining example* "Hie actual *&&& HE 0022995 H01IB m. iit 1 b&ckgrounc -<f blood vessel disease and of Bright * s disease 2 3 4 5Q 6 7 or chronic interstitial nephritis is not known and there fore one ~*nds to ascribe hypothetical causes insofar as these present themselves, as even vague plausible solutions. .'/hat, therefore, doctor, la the significance, if any, with the type of symptoms involved in this case that some of tho doctors handling the case suspected the lead? 8A It would a perfectly normal procedure in "ho case of a 9 nan with a peripheral nephritis or muscular weakness to 10 inquire Into the occupation and if lead was suspected as 11 a possible hazard to examine into its possible relationship 12 v:ith tho condition. This would bo a normal procedure in 13 an effort w, determine the causal background of tho illness 14 and in any said case one would properly regard load.as a 15 possible facuor in the illness. 16 Q, The symptoms complained of by Mr were symptoms 17 falling into that group of. things Then I take it, doctor* 18 the diagnosis or cause of the original disease is a some 19 what difficult thing? 20 A Yes, quite. There are a variety of nervous injuries which... 21 fall into the category of atypical clinical pictures. 22 MR. HONE; The use of the word !fatypical" is to denote the 23 opposite of the word "typical". I was somewhat confused. 24 A 25 There are several nervous system pictures which are -w. sufficiently typical as to be in and of themselves susceptib: 26 of diagnosis without unusual labatory procedure. Mr. is KE 0 0 2 2 0 9,(i mmLmmrn,- 4. 1 2 3 4 5 6 7 (53) 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 FORM 269 45377 8-37 40M CALIFORNIA S7ATC PRINTINOOFFiCK illness was not of that type. It was not characteristic of any Imovm disease entity nor did. it coxae within the category of disease '.'Util an obvious and well known causal agent. Therefore somewhat more than the usual amount of speculation had to indulged in in setting up the possible disease entity for a diagnosis by a process of exclusion, IR. JIOHZt 'hat, then, in connection with this same line of reasoning, doctor, would be '-our cossnent with respect, to the following conjecture, namely, having in mind that Mr. Telepnov complained of the symptoms which are part of the record, having in mind that these symptoms fall into a group where it -would be difficult to ascribe any Particular cause or origin to them, and having in mind that the symptoms, here suggest that there was nothing extraordinary of such symptoms arising and of their being a difference of opinion amongst the doctors examining him as to the possible cause, and the further fact that none of the group of doctors which included,, I think, 23 or 30 who examined him during his lifetime were able to definitely fix the origin and having further in mind the employment:-,of hr, Telepnev as outlined in the evidence in this case, and furth in mind that during that employment he tested gasoline in cluding gasoline containing tetraethyl lead in the manner and to the extent developed by the testimony in tills case, and having in mind that some of the doctors who examined his Kfi 0022097.. T>P i,? ft*.*- 1 suspect-^', lead and were of the oninion that the cause of 2 :he s^rit- c.-ns night be lead poisonars.c, -'/hat is your reason 3 tnd explanation for your conclusion that Mr.! was 4 not suffering from lead poisoning in this case and did not 5 die a3 the result thereof? 6 The first point in my conclusion that ho did not die of lead 7 poisoning contracted in his occupation is that in ny opinion 8 the lead exposure associated with his occupation even under 9 the worst possible conditions was nor, sufficient as to be 10 capable of resulting in the absorption of abnormal quantities 11 of lead. This opinion is based on extensive clinical ob 12 servation and more importantly on '-3naive study of the rate 12 of blood excretion of nen under conditions of exposure in 14 similar occupations,the results of which lava been to convince IE me that there is no measurable lead exposure associated with 1( work of the character performed by Mr, r :/ere you through, doctor? Oh, excuse me. 1! (Being continued) The next most important point, in my 1' opinion, resides in the fact that the clinical picture 2 definitely progressed over a period of one and one half year 2 after the complete cessation of occupational exposure. This $ tends to exclude lead as a casual factor in his illness, r fbe third point resides in the fact,that the actual clinical i picture of his illness was not one sufficiently characte^ist of lead to be in any way diagnostic without more convincing evidence wither of the significance of the exposure nr nf tb ... .... 3M aev? 002209fc1:s_ iceTfo -TF? z' A t.TJ_'-T.V7t VK V Ff 'T* 1 2 3 4 5 6 7 8 9 10 11 ,,! 13 14 15 16 17 18 19 r\ 20 21 22 23 24 25 26 actual absorption of abnormal quantities of lead into the body. 'That would be your opinion with respect to the theory that misfrb bo advanced on behalf of applicant in this case that inasmuch as hr^mHEls shown to have been v;orking with leaded gasoline and inasmuch as the symptoms of such have led some of the doctors to suspect lead and inasmuch as neither during his lifetime nor subsequent thereto was there found any other cause, that therefore the conclusion should reached that his disability was due to the lead poisoning? X should consider- such a conclusion illogical for two X* 0 **. 3 Oii3 --j J. X 3p -auso the clinical picture in lead poisoning io a fairly definite entity, capable of recogni tion, whereas there are numerous nervous system injuries tha.' do not lend themselves to accurate diagnosis* hne would not logically, therefore, choose a readily recognisable entity in preference to a series of diseases of admittedly in definite etiological background. To clarify what might be some confusion resulting from your testimony, doctor, would those answers which you have given imply criticism on your part of the other physicians who examined Mr or who testified in this case, particularly for their failure to immediately mile out lead poisoning as a factor in Hr. Telepnev*a case? Hot the slightest in my mind. It has boon the history in this industry nine it a founding that there has been a great KT 0022099-14- ... y^'v.v--* . 'i.V&hgtV:?* s ' :.K0B3 \\ 1 confusion in the nind3 of many people, including medical 2 men as to the differentiation, of the serious and dangerous 3 exposure associated with the handling and use of the con 4 centrated product tetraethyl and the commercial fora in 5 which 3-eaded gasoline is put on the market The former 6 of these exposures has been well -mown to produce cases of 7 serious poisoning and it has therefore been assumed that the 8 second, namely, the handling of leaded gasoline constitutes 9 a lesser degree of the 3ame thing, whereas this has not been 10 the case. 11 HR. KOITE: And will you state at this point for the record what 12 do you mean when you say "thia has not been the case"? 13 14 15 16 17 18 19 20 21 22 23 4 i k j ,, moan th at the exposure associated vrith the handling of leaded gasoline in any and all ways in which it is commercial handled can never be shown to result even in the absorption of lead, la fact all experimental evidence indicates that lead is never absorped in measurable quantities an the re sult of contact to any extent with gasoline containing tetraethyl lead* Moreover, there have been no cases of recognizable and confirmed lead poisoning amongst some hundreds of thousands of persons whose daily occupation involves exposure both by akin contact and by inhalation to gasoline containing tetraethyl lead, in fact, there is at the moment no experimental or clinical evidence that y?y;:; leaded gasoline is more dangerous than is ordinary gasoline from the point of view of load absorption*____________ _____________ aOM *3$ K: 0022xOG,*_ sjf.Ngjjjp- I)R r 1 And is there any danger of lead poisonin' i'on ordinary 2 gasoline, ''hat is, gasoline not oontainir tetraethyl 3 lead? 4 50 6 l!o, there is not* Year statementa regarding the absence of any evidence of absorption of lead from absorption of gasoline containing 7 tetraethyl lead on the skin would apply, would if doctor, 8 irrespective of the condition of the skin or would the 9 fact that the skin was broken have any further hearing on 10 bhat statement ? 11 who condition of the akin cannot be regarded as an important 12 13 14 15 16 17 18 19 20 21 W, 22 23 '4 factor in the absorption of leaded gasoline for the reason that absorption of tetraethyl lead even raider ideal con ditions occurs more rapidly in the case of a normal intake and healthy skin than in the case of damaged, cracked, scratched or broken skin. I refer under absorption of tetraethyl lead, however, to the undiluted material as applied to experimental animals, there being no evidence whatever that lead in gasoline is a commercial concentration capable of absorption through the skin in measurable amounts And therefore there ia no evidence of the absorption of leac by contact of gasoline containing tetraethyl lead through the flesh or whatever the medical term is of that which underlies the skin? A ho, the important factor there is almost certain that the lead is more easily held by he gasoline than it is by the . cf.* Kf 0022101- !1H. FOrTE 1 skin or tie flesh and the bod" and that nay be shown, by the 2 following experiment fhe pure tetraethyl applied to the 3 skin is absorbed with fair speed and as a consequence of the 4 application of two centimeters on the skin of an animal, 5 one will find by analysis from 30 to 40 milligrams of lead 6 in the carcass of the animal as the result of some two hours 7 of such exposure* If this tetraethyl lead be diluted with 8 gasoline to one part in ten, absorption still occurs hut 9 with diminished speed with the result that the quantity of 10 lead found in the carcase of the animal after such a period 11 of exposure is very much less. If the lead be further 12 diluted to one part in one hundred, animals nay ho treated 13 over a period of weeks and months with this mixture without 14 absorbing quantities greater than 1/3 or 1/4 of that found 15 as the result of a single application of concentrated 16 material. If the lead be still dilute*! to one part per 17 1,000 which is still in excess of the commercial concentra 18 tion of gasoline, the animals may be exposed for months 19 daily at the end of which time all animals show no measurabli 20 increase in their lead content of their tissues. One con 21 cludes from this that In concentration of les3 than one part 22 per one thousand, skin absorption does not occur and these 23 observations are further verified by prolonged studies on 24 human subjects. 25 REFEREE: It is 3.2 o'clock and we will, resume at 1:30. 26 ^ ll 0022102 * (35) 1 Hearing of Karen 1, 1938, 1:30 session* 2 m, HOPE: Shall I r rocaed? 3 RSFhREH: Yes. 4 ?;R. HONE: The fact that ~v. xwt hile working with leaded 5 gasoline had sores on bis hands, that the skin was brokenj 6 would not increase any probability of his absorbing lead 7 had any gasoline been spilled on his hands, would it. 8 doctor? 9 bo. not in ny opinion. 10 11 12 13 | I 14 ! 15 i 16 17 18 19 20 21 22 23 24 25 26 Fo r m 269 48377 6-37 40M CAUPOSN/A STATE PR ] MTJNC OFFICE In fact, with the concentrated, tetraethyl lead the danger of absorption would be less or greater than when the skin was broken? Less danger to the skin. that is your reason for saying that there is the possibility of his having inhaled any significant quantity of load vapor particularly with respect to gasoline vapor? Two i*easons, and one is my general knowledge of the manner in which inhalation tests are carried out and the other my knowledge of the properties of gasoline on the one hand and tetraethyl lead on the other. Such knowledge convinces-- me that there is no measurable escape of tetraethyl lead Into the atmosphere of workrooms and as a consequence of that situation there is no exposure to lead hi work in volving distillation tests. ; /ould any considerable quantity of gasoline fumes first have to be absorbed or have to be inhaled rather, in gamming 0022103 -1188<- HR. HOKB _{x j.;n. 1 2 3A 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 A 20 Q, 21 22 23 24 25 26 that there wore vapors from loaded gasoline and if so, to what extent? Yes, in order to inhale any significant quantity of lead as a consequence of the distillation or evaporation of gasoline, toxic quantities of gasoline itsolf would have to be inhaled and inasmuch as the toxicity of gasoline itself manifests itself very dramatically in dizziness and druhkness find unconsciousness in concentrations of 1 to 1-1/2 per cent in the air and above, it is quite safe in concluding no significant quantity of lead could be absorbed under conditions which such symptoms did not pre sent themselves. Assuming in this case vapor from leaded gasoline escaped into the atmosphere in the presence of hr. would you ordinarily expeet 'nisi to Inhale sufficient of these vapors to get an inhalation of a significant quantity of lead, that lie would first have to lose consciousness from the gasoline vapor? Yes, I think that is a fair conclusion. And. when you base your answer upon the generalnemner in which these tests are conducted^ would you say having read and heard the testimony in this case as to the manner in which the tests were actually conducted that your answer just given could be based upon the manner in which these tests were conducted by Hr.4flHHHand his associates and actually were conducted other than on general tests? lipM&mm' Kh 0022104 '19` raswasswa :R. ROHE ( T/ 1 2 3 ."i 4 5 6 7 8 9 10 11 12 A 13 14 3 15 16 iU 17 18 19 20 21 22 23 24 25 26 That would be ay opinion based on testimony as to the actual methods of distillation carried out. In this case, you mean? In this case, which, are in conformity with standard methods of gasoline testing. 7as hr. case se far as ou can judge from the records in this case, a chronic or an acute case irrespective of what caused it? ould have to he classified as a chronic case if at all* And I understand that neither In the literature or from your own personal exoerienee -- (Interrupting) It would be the first in uy experience, if it were so regarded* could yoxi discuss particularly with reference to the issues involved in this case the subject of deleading? Reloading and dolsading treatment refers to a type of treat ment in which one attempts to liberate lead which is supposed to be in Inert form stored in the skeleton* The purpose of de leading by any of the methods that have been advised or suggested by various physicians is to bring such lead out of, its deposits chiefly of the skeleton, to out it into circula tion and to maintain it in circulation over sufficient period of time as will permit a considerable Increase in the rate of excretion and in the gross elimination of lead from .. the body. That is the purpose of such treatment, I might say '.vhether or not such treatment is actually effective 0022105 -?n_ ;TT? TT/VSTC* Uit iiv/isill 1 and of value in the treatment of land poisoning is c on2 troy ersal. 3 Is there any particular pattern in v/hich lead in the body 4 is deposited? 5 Yes. -lien lead is first introduced into the body it la 6 found in relatively high concentration in the blood and in 7 the soft tissues, more particularly the liver* As time 8 elapses, the lead distributes itself in the tissues in 9 accordance with a typical pattern being found in highest 10 concentration in the skeleton* \a the next highest con 11 centration in the liver and in the nc-t highest in the 12 kidneys and in relatively low concentration in the central 13 nervous system, in the muscles and in the other glandular 14 tissues of the body, with relatively high concentration 15 in the suprarenal gland in a sufficient number of instances 16 to be note worthy and this is the pattern of the distribution 17 more or less regardless of the gross quantity present. 18 I may also say that load is always found in some measurable 19 concentration in the circulating blood both in persons with 20 abnormal lead content and also in the case of all normal ' 21 an persons so that lead is to be regarded as/entirely normal 22 constituent of all the tissues of the body including the 23 circulating blood and practically all states of disease and 24 health. 25 You are familiar with the record indicating the urinalysis 26 made by the Western Laboratories In 1935 during the lifetime 002210' 1 and of the fact that a three day output 2 of urine was collected and the lead content after analysis 3 for lead content and that the patient at the time was put 4 on a definite calcium pure diet and given large doses of 5 ammonium chloride, would you say that was a proper method 6 for making a test for lead and also what the effect of 7 ammonium chloride is? 8 1 'ell, I have every reason to believe that the methods em 9 ployed in analysing that urine were sound and satisfactory 10 methods which I have described in the literature here used, 11 in the urins.lysis* 12 REFEREE: Let me understand* You say you have every reason to 13 believe* Do you know anything at all about the methods 14 that were used? 15 ft I do. 16 Q In this particular case? 17 A. X do* 18 1 '.That vas your source of information? 19 ft I conferred with Dr. Moor as to the details of her work and 20 to the siae and samples employed and the method she em 21 ployed in her analysis* 22 REFEREE; That is all right. 23 *1R, HO HE: Have you finished your answer, doctor? 24 ft 2 2i As to the effect which might be expected from the adrain! stra<| tion of ammonium chloride, one knows that ammonium chloride increases the urine excretion in volume durins? the period of m. ( \' 1 Ii the administration ami also that ammonium chloride is the 2; commonest drug or chemical to be employed, for increasing i 3 the excretion of lead by bringing it out of the depots of 4 deposit and causing them to circulate in higher concentra 5 tion and therefore to appear in higher concentration in the 6 urine. This is supposed to be one of the most effective 7 means of deleading these leaded patients. 8 YR. HOHE: So that the method of conducting thi3 test would, if 9 anything, increase rathor than decrease the concentration 10 of lead in the system? 11 1 Yes, it would increase tho lead, if anything, in the ex 12 cretion? 13 Q. How, with respect to the literature which has been referred 14 to and relied upon by Dr* Chabanoff, one of the articles 15 referred to is the one appearing in Volume Id of the 16 Journal of Industrial Hygienej that was written and published 17 by you, was it not in corroboration with two other men? 18 A Yes, that was published by me and my associates. 19 Q By the way, doctor, while I think of it, you have had the 20 21 22 23 A 24 25 26 Q. knowledge during your experience In this field of load 1- poisoning with a large number of established cases of lead poisoning? Yes, I have studied quite a large number of cases of lead ( t poisoning over a period of the past thirteen years or fourteel years* Yould yon be able to sav about how many? siisM&ttW'- ET 002210  ' otTv 1 ~7 1 A. X uuld raaka a guses* lb in no >:n who hundreds* 2 X In. addition to that, would you .my you havo examined alto-* 3 gsfcbor some few thousands of both ctahllsnod find suspected 4 oases or lead poisoning? 5 w I would not put it quite r.uat vm?. I would say -say assaotater 6 and I have studied, a largo numbs?* :nt;o the thousands of 7 oases oi* worsens in the load trades -under various conditions 8 Oi load oruiosure, 'mmrdous ana uon-i.-j&2ardo;is lead trades 9 nifch tbo idea of determining the relationship of exposure. 10 ryDpfcomcology and lead alteration, 11 there has boon some differences batwo-wi hio various ffitnesseii 12 wo to ^hothur spilled an.;; wa,?,<>Xin on Ills hands 13 ana '..waethwr ho oplilod fssislX quant ir. to;; or whether ha spilled 14 15 16 * large quantities hut the opinion which : ...boon wiven in t5.ilr c3o varies dependent upon which. of those facta was oarroot 7 Py opinion would not for the reason tmfc X could not regard 17 the quantity of spillage as a factor in she exposure* 18 li 19 20 21 22 23 24 21 26 b /aid in a like jmnn$r3 there' jUas beett soma differenoes la the testimony of various witnesses as to the nmaher of asaploff of leaded gasoline handled Irj Hr# !?ould your opinion the s&ra irrespective of Aether 'we ;iandl<*& one s&rapl of loaded gasoline a day or throe or four samples of loaded gasoline or a srabstantici^- larger number? " can say very frankly that I do not regard t!mt as a significant point In the Issue * **>-" . "n to Wait your opinion would ho the some iri'oopcativo of the 4m k 002210&4- KR. KOHS ( >> *>,"4 1 number of samples handled? 2A 3Q Quite. In a like manner, there has been some difference in the 4 testimony as to whether or not there mere any vapors of 5 tetraethyl in the laboratory in which dift worked 6 Irrespective of what portion or portions of this testimony 7 mould be established or regarded as the most accurate* 8 mould your opinion be the same? 9 A In this case, no, for the simple reason that I cannot see 10 any possibility of the quantity of vapor of tetraethyl lead 11 in those workrooms ever reaching a significant level. If 12 on the other hand you mean the question of whether I regard 13 the quantity of vapor as being important in any hypothetical 14 case as to whether poisoning might or might not develop, 15 I can tell you vary frankly that I regard that as the 16 17 18 19 Q. limiting .factor, 'the question is, ,.ow much wag the exposure and in this Inst anco in my opinion, die exposure was en- tirsly insignificant. Insignificant, Is that what you state? 20 A Yes. 21 Q Mow, referring to the article in Industrial Hygiene, Volume 22 16, which is one of the references referred to and relied 23 upon by Dr. Chabanoff and particularly with reference to 24 page 101 of that article, you refer in this article first*o 25 problems dealing with and arising out of the manufacture of 26 tetraethyl lead and the various blending processes and then 00221a 0 _2R. 1 you 3tats as follows; 2 '!?li3 serious dangers of these manufacturing processes 3 have no relation to the problem with which we are concerned 4 in the present discussion. However, the initial confusion 5 of the actual hazard of the manufacture with the 6 problematical dangers arising from the use of the finished 7 fuel has ^resisted. Th<3isfore, distinction between them 8 must be made clear." 9 ,ould you explain exactly what you mean by that, particularity 10 with relation to this case? 11 fes, there was a great deal of general . nhfety as to the 12 dangers of tetraethyl lead anti gasoline containing tetraethyl 13 which aroso out of publicity associated with d:e 'oisona 14 rule:: occurred in the .anufacturo of tetraethyl load 15 particularly in 1925. hewspapor articles on this line were 16 very lurid in their description of the oases and the various 17 mysterious poisonings and they made no distinction between 18 the gasoline and the concentrated material# The manufacture 19 of tetraethyl lead has always been, and is now a very 20 hazardous occupation around which the most detailed wreeau- ' 'Of *i 21 tions must be thrown and maintained. On the other hand, 22 the dangers associated with the handling and the distribution 23 and use of gasoline containing the commercial concentration 24 has always been purely hypothetical and this problem has ^,g,-, . 25 been investigated by ourselves and by various government 26 agencies in this and other countries with the idea of de- I 0022111 -- HR. HOKE vermining whether the danger to filing station employees, 1 garage mechanics and the traveling public as well as any 2 3 and all other persona whose work involves the work of 4 handling gasoline constituted, any significant and measurable 5 exposure to lead symptoms and there lias never been any other 6 opinion about them then that it might be possible that as 7 the result of very minute exposure over a long period of 8 time, cases of chronic lead poisoning night conceivably de velop and. the whole pastime of jyablic health study has S 10 been to establish whether or not that is the fact or whether 11 it is not the fact* The conclusions of all the experimental 12 workers in this field are unanimous in believing that no 13 evidence of any measurable lead exposure has been obtained 14 by any of the investigative work in the field and that there 15 3,3 XIO x* Gci son to believe that this constitutes a hazard eithe^ 16 to the public health or to the health of persons involved in 17 these industries and that is the current point of view and r 18 there is no evidence which indicates that that is not an 19 entirely correct point of view. I may say that the attitude 20 of the health authorities has been that if any evidence were 21 found that this were a danger to the public health or to the 22 health of persons employed as I have indicated, that the 23 distribution of 3uch gasoline shoiald be forbidden and that 24 the product should be withdrawn from the market entirely and. 25 I share in this point of view. 26 Referring to tho same periodical, page 102 as follows: -27H I002211 . VC* 1 2 3 4 5 6 7 8 9 10 11 12 A 13 14 15 16 17 18 0 19 20 21 22 A 23 24 0 P5 2*. "Tho hazards associated with the handling and use of the finished gasoline differ both in.- quantity and quality from those which occur in its preparation. Nothing could demonstrate the difference in the magnitude- of potential lead exposure and two sets of conditions in a more prognastic manner than the failure on the part of such gasoline to produce the substantiated, case of lead in toxication up to the present (November, 1935) after more than 10 years of continuous use in certain parts of the United States and for almost 8 years throughout the entire United States.i'liafe is your opinion, is it doctor? Yes, I would only add that since that was written there have been approximately 3 -years of additional experience during wnioh leaded gasoline has been distributed into practically all parts of the civilized world, during which it haa been investigated in a very critical manner by the government health authorities in additional coxm.tries And your statement of their being no substantiated case of lead intoxication as outline in the article up to the date therein, November, 1933, would you now make the same state ment bringing the time up to the present time? I would makeprecisely the same jstateraent with regard to the causes of the poisoning. Pointing to the same article at' page 102, I quote: "The difference between the volatility of tetraethyl lead and various gasoline bases with which it is mixed is 0022113 110 IIS DR. Ik 1 so great that approximately one-half of the gasoline nay be 2 evaporated before lead could be found in the vapor. . It 3 follows from nils fact that the vapors rising from tanks 4 containing leaded gasoline do not contain an appreciable 5 amount of lead.5'1 Ana that is your ore sent opinion, ia it 6 doctor? 7 Yes, it is. 8 I point further to oho same artiole, pages 103 and 109, with 9 reference to conclusions you reached in connection.with a 10 group of men working in a plant under conditions where 11 leaded gasoline was obtained in hoses and resulted in daily 12 drenching of theaevmen with the leaded gasoline and I will 13 ask you to briefly summarise- that case and your conclusion 14 from it. 15 These observations I regard a.s rather crucial with relation 16 to the problem of lead exposure in the handling of leaded 17 gasoline in any and all ways. The observations were made'5 18 in the gasoline refinery of a rather older and perhaps less 19 well equipped refinery in which gasoline was being Intro 20 duced into barrels by an open hose system with a trip valve# 21 The concentrated gasoline vapor in the room was so great 22 that enormous volumes of forced ventilation was required to 23 maintain it below the Immediate toxic concentration and the 24 men were being bathed actually over a considerable area of. 25 their skin by it for hours during the working day. This 26 particular refinery had planned to undertake the distributio: Ke 0022113 HONE DR. :ZX 1 of leaded gasoline by corresponding methods and this there 2 fore provided a very good opportunity for the study of lead 3 absorption of men before- and after exposure of that type to 4 leaded gasoline, Te studied thi3 group of men by complete 5 physical examination and by analysis of their urinary and 6 fecal excretion before they engaged in this work, using 7 leaded gasoline, and then after they had worked steadily at 8 thi3 work over a period of six months, me repeated the 9 observations in the same group of men. The significant 10 results from the point of view of lead exposure were 11 that in no instance was the lead excretion of these men 12 increased and the main lead excretion of the group before ancj 13 Lxi- Lr V/ were the same within the limit of statistical methods 14 of comparison. Quite clearly these men did not absorb lead 15 out of the gasoline as a consequence of this massive ex 16 posure which I regarded as the highest exposure to gasoline 17 that I have ever encountered in my experience in refinery 18 practice. 19 Q Your discussion of this case, then is with the following 20 statement, page 112j f,]lo case of lead intoxication was found! 21 amongst the subjects," And that is correct, is it not? 22 A That is correct. 23 MR. BETIILEPSEN: Doctor, is there anything you have written in 24 these articles relied upon by Dr. Chabanoff that you would!, 25 change in any degree at the present time? 26 MR. HONE: (Interrupting) Reserve that for your cross-examlnatio -4'..0 A fc 0022115 HOBE t :- / 1 will you, to keep the record clear, 2 IB. DHTHLWSEH: I thought I would save time by it* 3 lEFdREE: i'fnile Counsel is looking there in the book, I will 4 ask you a question or two about the men working in such a 5 quantity of gasoline. 7aa there any history taken or an 6 accurate record wade or ascertained as to what the condition 7 was, say, one year after these investigations? 8 Yes. Ye made no further analysis actually of the sen be 9 cause I regarded six months as sufficient evidence to pro 10 duce a change in the lead excretion if such change could 11 occur, in the other hand, ce did make periodic inquiry as 12 to the outcome of the situation and I may say also ;}ust to 13 be frank, that I advised the discontinuance of that type of 14 exposure not because of any fear of lead poisoning, but be 15 cause I regarded that method of handling gasoline as dis 16 tinctly obsolete and highly undesirable from the point of 17 view of the frequency of occurrence of skin dermatitis. MY5Tl\' hat IS type of exposure would be forbidden outright in most re IS 2C Q. 2] 2< 2c fineries. 77as any sufficient record made or trace kept of any of the men involved in that case that would enable you to say what h the condition of any of these men were three years after thi; time? 2< A Yes. I ara not willing to say too much about that in detail. 2S I think the record will show but I think it is quite safe 2( say that a number of the men were maintained in the employra* A9.M w 0022116 31 REFUSE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 s 17 18 19 A 20 21 22 Q 23 A 24 25 26 of the refinery and I suspect we could find sane statement at the present time if we should look for it* However, they were not specifically followed from time to tine to see xmetiler there were any further developments and I personally regai'd our observation showing complete failure of lead ex cretion over that period of time as absolutely certain evidence that no neasttra'ole quantity of lead was being ab sorbed for the reason that vr& have followed over a period of now more than 10 years a group, several groups of men in the manufacturing occupations, in which one can say definitely, the effect of lead exposure on the average of lead excretion, and they now know definitely what quantity of lead exposure is required over a oeriod of time, 6 months. 03 O months or 3 months, to permit a measurable average in the lead excretion of exposed non. Isn't a fact, doctor, that if one be storing small quantities of lead that you don't get an increase until the storage capacity is exhausted? Ho, that isn't true* Lead excretion bears a direct and easily measured relation to the magnitude of the lead ex posure. At all times? In any group of men in industry that you study, you can m measure the magnitude of the lead exposure in terms of the magnitude of lead excretion to such an extent that the study of lead excretion in the feces and urine is the best and by K 002211 32. r? 77TJ1 p.vpi pi'vr- 1 far the most accurate '.my of measuring the lead exposure 2 itself. 3 Then how do you account for the fact, doctor, that so 4 frequently careful medical non fall to find any load in the 5 excretion during the time the man Is exhibiting symptoms and 6 remove him from the environment and treat him, and yet they 7 are unable to find lead in the urine and subsequent examina 8 tions prove ha was suffering from lead poisoning? 9 I can understand your attitude in ashing that question be 10 cause that is a very significant point. The answer to that 11 is this* That only in the past ten years have the methods 12 of analysis used in these cases been adequate for the detect dje 13 of small quantities of load in the urine, and only in the 14 past 5 years have these methods been sufficiently sensitive 15 and accurate to enable one to show with accuracy the lead ex 16 cretion of normal persons and lead excretion of persons whose 17 excretion differs only slightly from the normal* The reasons 18 for that and for the discrepancy in laboratory matter lie in 19 the extreme difficulty for the accurate determination of smaljl 20 quantities of lead in the excretion* Prior to 1926 it waw 21 unfortunately believed that lead never occurred in tissue and 22 in the excreta of entirely normal persons. It is now known 23 and fully acoepted by all of the experienced authorities in 24 this and other countries that lead is a normal constituent,; 25 of the human body and it Is found always and without exceptions 26 in the blood, urine, in the feces and in the tissues in- rsisaaesw 0032U8 -33- 1 eluding those of new-born children and -unborn fetuses, and 2 that is without exception and without any reservation the 3 failure to previously observe and take into account these 4 facts, is the result of the previous inadequacy and in 5 sensitivity of the analytical methods. bithin the past 6 five years it has become possible to work with 100 cubic 7 centimeters of urine, 13 cubic centimeters of spinal fluid 8 end with a few grara3 of tissue with an accuracy that pre 9 viously was not obtainable even with entire organs and with 10 actual quantities of excretion, how, this is a technical 11 development of the past few roars and that is the reason for 12 file discrepancy found in medical literature and it is the 13 reason also for the uncertainties that existed in the minds 14 of medical men without actual experience as to the significani 15 of this or that other statement in the literature* 16 -That method is used in this delicate matter? I do not mean 17 the details. Do they use a spectroscope? 18 There are at the present time three accepted methods* One 19 of them is a chemical method using orthodox chemical 20 technique which is quite satisfactory but which requires 21 largo samples of urine or feces br tissue. There are two 22 relatively recent methods one of kvliich was developed in our 23 laboratory and the other of which has been developed by a 24 series of individuals with slight variations. The first 21 of these is known as a spectrographic method by means of 2( ' which one can deal .vifch quantities of lead in the magnitude $ 'if ^ R 119 m^FSREE d r , :-:y 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 A 26 of the third or fourth decimal place of millegraas. The other is known as dithison which has recently cone into fairly general use by the people in the world which in al most as sensitive as the spectrograph method and which with in a very low range is ouite accurate* I nay 3ay further, however, that the great difficulty in the use of all of the so nethods lies in the fact lead is found so widely distributed in nature end is found in 30 many things and in relatively large quantities, method and agents and even laboratory equipment must be handled with the most scrupu lous care otherwise gross contamination results. In our own laboratory, for example, we have to work in air con ditioned space which excludes conturinated air for the City of Oincin&tti is just full of soot. ho you know chat method Dr. Lloore used in her examination? Yes. .That was it? Dr. Lloore used a chemical method which we described in the Journal of Industrial Hygiene, volume; 15, September, 1933* A good chemical separatory method which, however, we have since largely abandoned because it requires fairly large samples for its accurate use. Would you say that Dr. Moore did the samples both before death and after death? 'V/ y . She did, yes. She did samples of urine on more than one occasion and she also analysed certain samples of the tissue. ' * '. v,Htf -350022120 (45) '.TREE >v Then would you say that the rel tively large quantity hat 1 she had furnished her by the au' posy surgeon, the resu 2 would be expectedly more accurate than ?rith the relatively 3 small quantities she had to operate with during the life of 4 ;he man? 5 I would not actually because there are several factors in 6 7 t. uis tnav nad not been mentioned that had to be discussed 8 a little in order to arrive at a conclusion* 9 Go on. 10 If the camples she had had been large, the conclusion would 11 be correct but the samples she used actually were quite 12 small. 13 You are speaking of samples from the coroner? 14 ii Yes, on autopsy. I will be glad to discuss that in cone 15 detail. 16 All right. 17 A fell, I will do it now if you wish. 18 fell, yes. Yhat quantity was she furnished after death? 19 A She had fourteen grams. 20 Q That would be about ono-half ounce? 21 A A little less than one-half ounce, yes, and a rib. 22 Q, 23 Approximately 30 grams to the oupce? Yes, 32* Two hundred thirty-eight grama of mixed tissue 24 consisting of liver, spleen, kidney, heart and bone of 25 which she used 117 grams of mixed material for her an.al7.r3is, Fo r m 269 4S377 6-37 40M CALIFORNIA STATE 26 U one--half of it vras used for her analysis* 00221213- *-,,-t4it*i* TRE3 1 A little five omcfts? Mind :;ou, aero is no reference in this to the precise 2 3 weight of the individual organs in question. 4 That would be approximately five ounces? 5 6 How many iraa it? 7 One hundred and seventeen. That : bout five. little less than 5 ounces. 8 little la3a than i O rUlC93? 9 little less than 4 ounces. 10 HHEREi: ill right. 11 12 How, one ioes not know and hr Moore does not know the 13 proportions represented in this mixture of the different 14 organs anc. it ian* t fair to make any assumption because there IE isn't any ilea of that at all. How, the quantity of lead 16 found in that mixture of soft tissue if it had been all liver 17 or mostly liver, would not be significant. If, however, itr J1 1 was all brain or mostly brain, then one would have to admit 1< it was of some significance. In the absence of any informa 2( tion as to the relative proportions it becomes purely guess 2] work. Moreover, these tissxxes were supplied in this form 25 in a Mason jar with a metal top on it and the jar was 2: supplied without having been previously chemically cleaned, 2. and it is the rule rather than the exception that tissues 2 supplied in that fashion for a chemical study should be 2 contaminated to some degree with lead from extraneous sources vsj 002212 *37- :f ..p e s 11 Therefore, one la left entirely without any conclusion ag 2 to the actual quantity of lead found in these tissues That 3 is sad but it is definitely true. 7ith respect to the piece 4 of bone, the sane criticism must be nade with the additional 5 statement that this is not an adequate quantity of bone to 6 be representative of the skeleton of the body and in I I 7 arriving at the figure arrived at, any error of anaylsia or j 8 any error occasioned by the contamination of the tissue from 9 extraneous sources lias been multiplied at least by seven in 10 the process of calculating milligrams per one hundred grams 11 of tissue. Therefore, I cannot personally regard these findin] 12 as making one iota of contribution toward a conclusion in the 13 case, 14 And your reason for that is because you don*t know the pro 15 portion of mixture of the organs and the fact you don*t know 16 how much lead might have contaminated it from the top of this 17 jar? 18 Yes, and from other sources, I may say that in our laboratory 19 we do not and are utterly unwilling to make an analysis of 2C tissue supplied in that fashion because we believe the re 2] sults are ranch more likely to be misleading than to be useful. 22 ' Veil, of course, Dr. Moore did not have any quantity whatso 22 ever of any bon or brain or liver or spleen from this man to 2 examine before he died? 2 That is quite right. She had excreta only. 2 And excreta was the urine? 4 -* e* :s c> -38- He 00221..; RKF'-.RE3 1A 2 3 4 5 6q 7 8 9A 10 11 12 13 Q 14 A 15 16 17 18 19 2C 2] 2J 21 2i. 21 \ M ... r* ? Yes. the did however have theasrine during the period in which the clinical picture was at its height so that at that time whatever quantity of lead -.ms in the excreta should have been at its maximum in its tins relation to the lead exposure if there had been lead exposure* Would the fact that no lead was found in the urine, would that be conclusive that no lead '.ms lodged in the vital organs examined after death or in the bone? 'To. The fact that lead was not found ir. significant quantity in the excreta during the period in close relation to the ex posure strongly indicates that at that further time there was no abnormal quantity of lead in the tissue of Mr* Yelepnev. Yould it be conclusive in "our opinion? In ny opinion if I could be certain that the analysis were carried out with every proper precaution, that would be utterly conclusive. I have never seen a case of lead poisoning with active symptoms without a sufficiently elevated lead excretion in the urine. There is here an ad ditional factor with relation to the findings in the skeleton and that is the period of something like eighteen months elapsing between the cessation of exposure and the man's deat! Granting there had been a significant exposure in the course of this man's work, the time interval between the cessation of exposure and those examinations is of such an order of, magnitude, that no abnormal quantity of lead should have been found in those tissues and I am therefore fully convinced as REFEREE 1 Dr. Moore is that these results were the efffect of con 2 tamination and not a true representation of the facts so 3 far as the lead contents of this man's tissues. 4 Is 'Dr. Moore taking that portion? 5 Dr. Moore has so expressed herself to me personally and 6 has authorized me to say that that is her opinion. I 7 recognize that that lias no standing hat that is her opinion 8 expressed to me in conversation, 9 he11, I take it then that the chemist's findings ns to the 10 existence or nonexistence of lead up until very recently, 11 three to five years ago, and even now, is dependent very 12 much on the technique employed and extraneous circumstances 13 of possible contamination, and in other words it isn't- very 14 much to be relied upon, is it, doctor? 15 To he relied upon only in those instances in which the 16 technique employed has been checked and double checked and 17 followed carefully over a period of years and in which the 18 tissues or excreta are obtained under conditions which ! 19 c ertainly exclude the possibility of contamination. May I 20 point out this that in obtaining samples for examination free 21 a hospital by the routine method of collection it is im 25 possible to obtain significant 4nd useful results. One musi i 22 use special methods for the collection of samples. One must 24 use known chemically clean containers and in obtaining blood 25 samples, it is necessary even to use si special type of hypo^ 26 dermic needle for the reason that the ordinary neddle has 0022125 '40' 1 lead or brass hook which of itself would contaminate the 2 sample# In general this is all true that there are a number 3 of industrial coamissions in the country that flatly refuse 4 to regard analytical evidence as in any way significant 5 unless they know precisely the laboratory from which the 6 information came. 7 Veil, how do you account for the fact that no lead was ever 8 found at all and many clinical examinations and clinical re 9 search that was done during the time Hr. f0lepnev was alive 10 notwithstanding the great possibility of concentration, 11 how do you account for the fact that there was no trace of 12 lead ever found? 13 I believe traces of Isacl were found in one examination and I 14 believe that the result will show that in one examination of 15 the feces containing 2 milligrams of lead was found# More 16 over, Dr. boors has informed me that in her observations 17 she found traces of lead in every Instance but that she re 18 ported them as insignificant because they were within the 19 sons of normal results and she therefore reported them as 20 negative following the clinical pathologist's practice of 21 reporting the results to the clinician for the reason that 22 in general in these matters the clinicians are not able to 23 determine them themselves. H (r e c e s s ) 2S Hr. Referee, I think I should say out of courtesy to Dr. 26 Moore that the samples of urine which Dr. Moore obtained for >' 0022126 -41 IbFkBEE ---- V -- 1 analysis wero obtained in accordance with her precise in 2 structions, that the samples of tissue, on the contrary, 3 were merely given to her without any kray-lodge on her part 4 in the manner in which they 'wore collected or of the treat 5 ment which they had received up to the time they reached her 6 laboratory and it was her feeling because of her negative 7 results during the period of the nan's exposure that the re 8 sults obtained on necropsy tissues could hardly be explained 9 in any other logical v/ay than as the result of some con 10 tamination in their collection and delivery to her* 11 She then found no trace of lead in any of the urine? 12 Yes, she found, email quantities of lead well within the liaitjs 13 of normal lead excretion. 14 Tould the fact that the man had a nephritis effect the amount 15 of lead that v/as being excreted even although he had it in 16 his body and blood that even if the kidneys were normal, you 17 would expect larger amounts in the urine? 18 The evidence is that so long as water la adequately excreted, 19 lead in the blood is also adequately excreted* On might 20 presume that there woxild be some interference with the lead , 21 excretion as a consequence of the nephritic dt'ate but the 22 facts that have thus far been observed are not in harmony 23 vrith that opinion. 24 And it ig your opinion that a nephritic kidney would be as 25 fully a good kidney as a healthy kidney? 2 Yes, substantially* ',v/ii 0022127 -42- REF JR EE i D---R--.---S---R-vf --H 1 Yould It be as an effective Instrument In excreting urea? 2A 3n Rot the nitrogenous bodies In the circulating blood* Hould it be as an effective Instrument in excreting all othejr 4 5 ifti 6 poisons with the exception of lead? In general the excretion of certain mineral material, more particularly chloride, tends to be Interferred with in the 7 case'bf a nephritic kidney, but dissolved substances In 8 general, with the exception of nitrogenous bodies, are not 9 very seriously interferred with by the type of kidney that 10 Is seen in chronic interstitial nephritis where the water 11 excretion is satisfactory except in the terminal stages* 12 r e f DREE: All right. Hr. Hone. 13 r.rp LIOHE: Are you satisfied, doctor, that as the result amongst 14 other things of the examination and laboratory analysis made 15 by Dr. Moore of the urine of Mrduring his life 16 time and of finding therein only such quantities of lead as 17 18 19 A 20 rs 21 22 23 24 25 2 is well within normal limits, that there was at that time no abnormal quantity of lead In Mr* Telepnev*s body? Yes, I would arrive at that conclusion. And while you have testified that the positive findings of..,, abnormal quantities of lead In an uncontrolled examination of tissue such as followed Mr*4|HflHHfe death, are you satisfied, however, that the negative finding of only a nominal quantity of lead or the failure to find an abnormal quantity of lead .during his lifetime is a reliable finding? Yes, I am. I an fairly well satisfied that the actual 0022128.aru. MR HOME 1 2 3Q 4A 5 6 0, 7 8 9 10 11 12 13 A 14 Q 15 16 A 17 18 19 20 Q 21 22 23 24 25 26 analytical method of the material examined as employed by Dr. Moore were substantially accurate. 7ith reference to the urinalysis? i ; i j Both the urinalysis and the tissue analysis, the tissue with which she was supplied. The reason you do not place any significance on the positive findings of abnormal lead in the tissue examined on neoropsy is because of the contamination, including errors resulting from the small amount of tissue examined, but with regard to the analysis made during his lifetime, where there was not ! found very abnormal quantity of lead, the same criticism wou| not apply? Bo far as the contamination is concerned, you mean? Or anything else that would effect your opinion that the analysis showed it was not an abnormal quantity? llo, I regard the analysis of urine as carried out by Dr. Mooi substantial evidence of the fact so far as the lead excretloi of Mr. was concerned during his lifetime. I have no good reason to think otherwise. How, with respect to Dr. Reeves1 report which is the result., of the autopsy surgeon, mad in connection with Mr* Talepnev' death and which report shows as a cause of death uremia secondary to interstitial nephritis which is probably secondary to lead poisoning, does that report affect your-w.; opinion that his death was primarily or secondarily caused by lead poisoning? 0022129 -<14-. oim X. X 1A 2 30 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Veil, I would like to answer that quest!-on somewhat differently than the question implies. That is all right. By saying that the reference to lead poisoning in the coroner's diagnosis leaves me entirely unconvinced and leaver me to "believe that the statement that it was probably secondary to lead poisoning Is entirely without adequate evidence in support of it. I do not take seriously in any way these statements 3Probably secondard to lead poisoning" for a variety of reasons. Will you give the reasons? First "of all the necropsy report even as It Is shown here 1 briefly demonstrates an adequate cause of death, in that thi$ j man had uremia and had interstitial nephritis, a condition which in and of itself is frequently responsible for death and which requires no further explanation inasmuch a s we are not fully aware of all of the conditions which produce chronv i interstitial nephritis. Moreover, the report itself does nol say frankly that this was secondary to cb.ron.ib -interstitial nephritis but says ^probably secondary to lead poisoning",. ^ which involves a definite suspended ^ttdgnent on the part of the pathologist and it was the pathologist's opinion as transmitted to me personally that the only ground for this explanatory statement of the probability lies in his icnowledg of the analytical finding and that lie had no other reason whatever for inquiring into the cause of death* He 0022130 * (48) zIOI'IE ( DR. 1 And he so stated, doctor? 2 And he so stated to me. 3 And did he authorise you to make -feds statement? (49) 4 5 He authorized me to say that that represented his opinion* He said in fact that had the question of lead poisoning 6 not been introduced into the case prior to the necropsy, 7 f that he would have been entirely content to hive as the causa 8 of death uremia secondary to chronic interstitial nephritis. 9 RAFERSh: And he gave you the opinion that he sufficiently re 10 lied on the chemist1s finding to make it the basis of that 11 speculation or that statement of probability? 12 A 13 14 15 16 17 18 19 20 21 22 23 24 i S 26 Fo r m 269 45377 6-37 40M CALIFORNIA STAT1 PR l NT I NO OFFICE ** Yes, he further said that in his official opinion when the question of death has been introduced into his mind by any previous information, that it -/as his duty to make further inquiry beyond the mere necropsy finding and that, he merely carried out what he regarded as the normal routine in sub mitting the tissue for analysis. I should say that as to the type of material which should have been submitted and as to the manner in which it should have been protected against cont.oia.ination, it is scarcely to be expected that Dr. Reeves would be in possession of all the information necessary to enable him to do that with the preciseness that is required to make a post mortem diagnosis of lead poisoninj since his duties cover every type of tiling, every type of possible accidental or toxological cause of death and he can not be presumed to be an expert in every one of these phases w ! a*K* 0 0 2 2 1 31 -46- RDPEREI DR. IhllO/K 1 2 3 4 5 '"1 6 7k 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 A 26 L of his dtiiy woorrkk. HOHF.: 1- discussion with. hr. Reevos, did you F,ive the statement of Dr. Moore to which you hare testified regarding oontnmirncion? I did. And Dr. eeves was in agreement with your views likewise? Yes, Dr. beeves was in agreement that there mirlxt have been ample cr.ortunity for the contamination of the oouipraent'tha he was eouoelled to use for the oarpose of collecting samples - -inch equipment as had actually been supp239d_ to Mm for that purpose and that included an ordinary Mason jar nurchased on the market and -without facili ios for proper cleansing or proper selection, so us to avoid the metal top* And he expressed his views to you that his preference was for a different type of procedure for handling such tissues, did he not? He expressed himself as believing in all probability some better technique should be vised in collecting samples for this type of purpose particularly in the case of lead analysis where it is notorious that the possibility for contamination is substantially ubiquitous. " And he advised you, did he not, that his report including reference to the possibility of lead poisoning was written after examination by him of Dr. Moore*s laboratory report? That is correct. May I say further for the benefit of the Referee that in order to make the diagnosis of lead poisonin -470 0 22132 T' 1 at post mortem, it is necessary to obtain representative 2 samples of practically all of the tissues of the body, to 3 collect them \7ith great cars against coifuetmination, and to 4 analysise thorn separately and individually so that on the 5 basic of their precise weight, one may calculate the lead 6 ; content of the body with reasonable precision and only in 7 this way is one justified in arriving at the conclusion 8 as to the gross lead content of the body and gross load 9 content of the body is the only factor which remits one to 10 express a sound opinion as to the significance and presence 11 of lead in the body. 12 HEPl-RSE. lid you ever hear in --our own experience since your 13 graduation from medical college in--jjy*'s ingle case in 14 which that method had heon followed at autopsy? 15 A Yes, I have, 16 q. How many? 17 A I have my complete record of some 25 or 30 cases in which 18 the analysis was made in that precise fashion, and I have in 19 my own writing described the technique which is necessary 20 for medical, legal purposes to enable one to arrive at a con 21 clusion on lead analysis alone. Hay I say In addition that 22 even in the presence of large quantities of lead in th 23 tissue, it does not necessarily follow that the patient 24 either had or died of lead poisoning and it is well known 25 that persons engaged in the lead traderdia of other causes 26 and that they have had or may have had in their tissues for il5l3 0022] 3 3 REFERS 1 -sx ( 1 2 5 4Q 5 6 7 8 9 10 11 12 13 14 15 16 17 Q, 18 19 20 21 A 22 23 24 25 2< I a period of years quantifies substantially over the normal quantity without at any tine having had a single symptom or 3ign of load intoxication. Do you believe that in the meantime while carrying that excess of lead around, it was militating against the progress of any disease that might ha%Te or perhaps assisted the disease? Actually there is very little evidence either way. Some -gears ago Bell and his coworkers came to the conclusion that lead compounds were valuable in treating and preventing cancer, because they thought they found a significant de crease in the instances of cancer amongst lead workers < I do not believe any one seriously believes it is true but I mention that because it was the background for the extensive use of lead compounds in the treatment of cancer on the part of Bell and his coworkers ;Ln England* Coming back to these 25 cases in which you mention this methe or taking samples of every part of the body to ascertain the entire lead content of the entire body, were any of those found ingested dying of lead? Yes, I have reported two or three fatal cases of lead poisoning and since the report of these cases I have ob tained the analytical data on a series of additional cases in which there was no question about the diagnosis prior to death and in which the necropsy findings, that is to say the analytical findings, fully verified the clinical diagnosis. 0022134 -* EPSREE >rv V 4. I # Z( 1 .That amount of lead in the entire body would be the approxi 2 mate amount found in the case of vital lead poisoning? 3 That depends in some degree upon the nature of the case as 4 to whether it was the central nervous system intoxication or 5 generalized intoxication, hat the largest quantities within my 6 experinece that have actually been found are approximately 7 one thousand milligrams in the adult and approximately 400, 8 I believe, in the severest cases of fatal poisoning in 9 childhood that I have seen, tills corresponds in the skeleton 10 to concexitration manning from 10 milligrams to 30 milligrams 11 per 100 grams of weight in the skeleton as compared to 12 figures of 1 to 4 milligrams in various parts of the skeleton 13 of normal persons* 14 LHP IS 222: All right. 15 [R. HOSE; Have you had extensive experience at post norteas of 16 suspected lead cases? 17 Yes, I have done a series of post morterns myself and have IE analysed the tissue from a series of cost mortems as carried IS out by other pathologists. 2( As concerns the others in the United States, what would you,-, 2] say you experience was in that regard? 22 'Jell, I think there is no question we have done more analytics 22 work in this field than any one else in the United States. 2! Ruling out for the moment the possibility or probability of < contamination, you made some mention of the pnobability of error inasmuch as seven times - I did not quite understand iOM Tvrt flC* '-'i -50^ 002213i lTR. nous ITSVA?t i KElf 1 your reference to that in connection with.this necropsy? 2 A Jell, that was baaed, on this fact. Fourteen grains of tissue 3 /ere used for the analysis of hone. Any quantity of lead 4 which was found in those 14 grama, may have had some error 5 as the result of contamination or as the result of analytical 6 error. Whatever error there was from these combined sources 7 was multiplied approximately by 7 in arriving at the figure 8 per 100 grams of tissue. 9 0 And the same would apply with regard to the analysis of 10 soIf tissue? 11 A Ho, because there were 117 grams used. 12 0 Oh, yes. 13 A And the figure was set on the basis of 100grams. 14 0, And will you explain why the finding by Dr. Moore of a 15 specified amount of lead in the mixed tissue x?ould not in 16 dicate even in the absence of contamination that that vras 17 an abnormal quantity. X mean basing this particular dis 18 cussion upon the fact that mixed tissue was used. 19 A well, my reply to that is based in some degree upon assumptioi 20 21 22 22 Q 24 22 A 2? 0. but if this tissue had been all or predominately liver, the result obtained is not far enough from the normal figure to be in and of itself significant in relation to the diagnosis* In other -words, the quantity you have testified, the quantity1 of one to four milligrams of lead per 100 grams? In the bone. As being found in the bone of the normal person? Kg 0022I36tS1 EOKE 1 A Yes 2 0 And similarly, there are figures fox' the amount to be found 3 in the normal person for the various types of tissue, the 4 brain, the liver and etc. and the quantity in a normal 5 person is greater per 100 grams or other unit of measure and 6 would differ from the quantity to be foxmd in the brain or 7 spleen or other tissue, isn't that right? 8 A Quite right* 9 Q. So that to get a true picture as to whether the quantity 10 of lead in the tissue ia abnormal or normal, you vrould 11 have to have the results for each of these tissues separately 12 A Yes, that is right* Incidentally, what I 3aid with regard 13 to the necessity for calculation of the total quantity14 present is standard practice in the case of arsenic. 15 REFEREE: Yell, that method isn't usually followed by autopsy 16 surgeons throughout the country, is it? 17 A No but when it is not, the evidence will not stand in Court 18 in the face of competent expert advice. 19 Q In other words it is pretty hard to convict hr. Lead? 20 A I would not say so. It is hard, however, to ascertain the . 21 facts with certainty unless one'exhausts the proper methods 22 of procedure. 23 Q, This is precisely the reason that this whole qxiestion in 24 present medical legal problems is controversal. 25 MR. HONE: Doctor, the Referee asked you a question as to 26 whether you attach significance to the fact that one of the 1H. IIOiTE PR, YJf 1 doctors that examined Mr* {^^mQ^recommended that ho "bo 2 removed to some employment where he was not working with 3 leaded gasoline. Row, having in mind the fact that this 4 physician was a general practitioner and not specializing in 5 lead poisoning cases, or any other factswhich may suggest 6 themselves to you, do you attach any particular significance 7 to that recommendation? 8 I do not attach any significance to that largely for the 9 reason that under the same circumstances I would not want 10 to give any such advice. 11 Row, Dr. Chabanoff in her testimony, at which time you were 12 present, referred to report of the Ht. Sion Hospital showing 13 a finding of 2 milligrams of lead in a 24 hour specimen of 14 feces and stating substantially that that proved to her that 15 'na<i absorbed an abnormal quantity of lead. Do 16 vou reach the same conclusion noon that report? 17 18 ihy not? 19 The diagnosis of abnormal lead excretion cannot be arrived 20 at from the study of the lead content of the sample of feces 21 alone, chiefly for the reason that it is so easily possible 22 for one to ingest any quantity of lead up to o or 4 milligram 23 in the course of a day because of the varying lead content 24 of food and drink. Lead found in the feces is largely lead 2E which was put into the alimentary tract by swallowing in the 26 period of 24 or 48 hours immediately preceding the collection fi 002213 S'53' m. HOHE 1 2 3 4 5 6 7 3 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 A 24 25 Q 26 of the sample. Such lead may have come in part from the body by excretion into the alimentary tract but it can be readily demonstrated and has been demonstrated that the greater portion of the chemical lead excretion is the re sult of lead content of food* That such lead was not ab sorbed into the body bat transverse! the alimentary tract without absorption and appeared unabsorbed in the fecal specimen* The daily content of our food under ordinary normal conditions varies from one-tenth of a milligram up to as high as four milligrams with the average quantity of approximately one-fourth of a milligram* Does tLe appearance of lead in the feces necessarily in dicate that lead had boon in the tissues? Ho, and for that reason one does not study the fecal lead in order to determine the rate of lead excretion* One Imows that that is not the case and that therefore it is not the material which should be chosen In this type of study* One should either study either the blood or urine or both. I voider stand then that the appearance of lead in the feces has very little if anything to do with lead which was ab sorbed through the skin or inhaled by inhalation of lead vapors? It has no relationship and in most instances is purely residual. '.VouId you say that the quantity of 2 milligrams in a 24 hour specimen of feces was beyond the range of what might be foun< 0022139-54- y TTn vn 1 2 3 4 5 6 7 xi 8 9 r%\ 10 11 12 13 14 15 A 16 17 18 19 20 21 22 23 24 2* A 2( L In normal individuals on a normal diet? Such values are not found frequently in a normal individual but does occur from time to tine in all normal individuals* In vie?? of this particular test being one test as against several others, would you say it was particularly significant or significant at all? It is not a finding which I would consider as a factor in the diagnosis in this case in any way# Magnesium sulphate is one of the things mentioned, I think, by Dr. Ghabanoff as being given to the patient suspected to be suffering from lead poisoning and I am not sure whethejr she said it had been given to Mr.| assuming he had been given magnesium sulphate would that have any effect upon this particular anal-psis of the fecal matter? That would merely tend to confirm belief that lead was swallowed rather than excreted from the t is sites because magnesium sulphate In the ordinary does contain usually . several milligrams of lead# However, in all fairness it is to be said that Dr. Chabanoff definitely stated she did not administer magnesium sulphate during this period. Therefore) that is not a factor in my judgment* : In connection with the examination of bone made for lead determination, was the examination of a rib in your judgment sufficient? Ho, it is not. One should examine both flat bone and loftg bone for it has been shown that the lead concentration in -?V 1 K 0022140' III. ROUE r 1 2 3 Qt 4 5 6 7 8 9A 0. 10 11 12 A 13 14 15 16 17 18 19 20 21 0, 22 22 24 25 26 A the various parts of the skeleton is quite varied and the extent of the variation is not fully known. Row, with respect to Pr. Chabanoff1 s testimony, Ir* Ckabuioff testified that the necropsy result, the post mortem result, proved that her opinion, that Mr.C^SBB^ was suffering from lead poisoning was correct* In. view of what was said, particularly this afternoon, I assume you are In. disagreement with the effect of the necropsy result? Absolutely so. Rent, hr. Chabanoff stated that the medical literature showed cases of lead poisoning after exposure had ceased for months and even years. Are you in agreement with that? ho, I am not. I have not been able to find any substantiatet. cases of latent lead intoxication in which symptoms came on within a period of six months to one and one-half years after the cessation of exposure. In my experience the symptoms do not recur except ^within a period of a few months under-wf the longest condition following the cessation of exposure and even their recurrence following the cessation of exposure Is extremely rare* Dr. Chabanoff quoted you as saving, and purporting to have said, that basoohiH0 or lead cells occur only occasionally in lead poisoning cases and the medical literature shows that such basophilic stippling of red cells occurs in only 12 per cent of the cases* Is that correct? Ho, it is not correct* My reference to the failure of `a -56^ 0022141 R. SOHE in. .( 1 stippling bo occur in certain acute cases of lead poisoning 2 had to due with the acute fulminating type of tetraethyl 3 lead intoxication in which, the onset of symptoms of an acute 4 type is so rapid, the blood changes do not take place 5 during the most acute symptoms# I pointed out, however, that 6 blood changes occurred subsequently in those instances# Ih 7 my experience stippling is a consistent finding during the 8 period of manifestation of acute symptoms in every instance 9 except those of acute fulminating tetraethyl intoxication 10 [R. DSFHLEFSER: Dr. Chabanoff, I might say, was quoting Dr# 11 Alice Hamilton# 12 HOIOSs (Interrupting) She was quoting Dr* Hehoe# 13 I think I can explain that discrepancy. Ihe "uestion of 14 whether stippling is found is largely a question of when 15 you look. During the period of exposure and during the 16 period of active symptomatology, stippling is almost always 17 present and I pointed the absence of it out in those acute 18 cases of tetraethyl lead intoxication as an important 19 variation from the normal and usual picture. However, 2C following the cessation of exposure and following the 23 diminution of symptoms, stippling does disappear rapidly 2; from the blood and it disappears long 'before the rate of lea< 2: excretion ha3 reached the normal lovel# In my experinece 2` it is always present during the active period of intoxica 2 ting symptoms except as I havo indicated in tho acute very 2 rapidly developing cases of tetraethyl exposure where the 1* c Hi 0022142 MI?. HONE jJPi. a 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 A 22 23 24 2S 2 exposure La massive and accidental and occurs In a fey/ Hours or naybe in a few minutes. Dr. Chabanoff testified that in only 46 per cent of lead cases may lead be demonstrated in the urine, i3 that correct? 'That is distinctly not correct* It is the result of the sort of contradictions in the literature of which the Referee spoke a short time ago. whether or not one .finds lead in the trine in abnormal amounts depends on the seneitlvityj and the accuracy of analogical methods employed in the scare] for lead and because methods have been quite variable in their sensitivity and in accuracy and because of the quantity of the samples used has been quite variable. 0no finds all sorts of results in the literature all the way from entirely negative to large quantities. Now, you will recall Dr. Chabanofff s testimony that she treated accordance with DrFlynn*n in- 3tructlons and particularly Dr. Chub moff * 3 testimony that failed to improve as a result. Is there any significance in that? Probably not. It is somewhat suggestive, however, that when: one uses a treatment that is supposed to produce benefit and it does not result in improvement one might per raps conclude that the treatment was ineffective because the hypothesis upon which it was given was incorrect and that possibly the diagnosis was Incorrect. As a matter of fact. l *ags -58- Sfesass&r*- 0022143 MR. HOSE DR. KSf 1 one expect3 lead poisoning to improve even without treat 2 ment after exposure is discontinued and when it fails to 3 do so, one is justified in being extremely skeptical of 4 bis diagnosis. 5Q 6 Dr* Chabanoff referred to a case she treated of a v/oman casing to her with complaints in a cleaning and dyeing 7 establishment using gasoline for that purpose. Is there 8 any significance in that case as relatesd to this case? 9 A ITo, I see no significance except that this was a group of 10 symptoms derived rather obviously from a situation in which 11 there was no lead exposure and presumably the symptoms were 12 due to either gasoline intoxication or quite probably to 13 carbon tetrachloride intoxication since it is used in a 14 cleaning and dyeing establishment. 15 Q Leaded gasoline is not used in a cleaning and dyeing ex- 16 t ablishment ? 17 A It is not because it is colored and not a suitable cleaning ' 18 medium* 19 REPrKEB: Is that the only reason? 20 A It has been used for almost everything else under the sun, 21 for cleaning tools and equipment in garages and other 22 places despite the warnings that it probably should not be 23 used for that purpose but it is actually and regularly used 24 for that purpose* 25 \VLR, HONE: The higher cost of leaded gasoline might have been 26 another reason? i HE 0022144-39* (53) MR. HOME a DR. 1 .OH A It would have been race but probably not now. 2 Dr. Chabanoff referred to a second case which, refers to 3 lead in printer's ini:. Tills patient was a printer. Is 4 there any lead in printer'3 ink? 5 l-!o, printer's ink is a carbon* The lead, if any como3 6 Iron the type along with bismuth* 7 MR, BHTELEFSI3J: (Interrupting) It is 5 minutes to four, 8 RE' `EKES: All right. Case continued 10 o'clock tomorrow 9 morning, March 2, 1933*. 10 11 12 13 14 15 IS 17 18 19 20 21 22 23 24 25 26 FORM 269 ,'5377 5-37 40M CALIFORNIA STATfc HE 0022145 i (----------------- i------------------- c 1 2 3 4 5 6 7 CONTINUATION OF- HEARING 8 Part 3 9 ICarcii 2, 1938 10 Pages 1 to 105 inclusive 11 WITNESS: Or. Kehoe 12 13 14 15 16 17 18 19 ;T- .. Jf 20 21 22 23 24 25 26 0022146 N 24413.03 __ / Tft -K 1 Bright's Bisea.se portion of it could scarcely be contributed 2 to Vitamin 3 deficiency, but the symptom complex seen in 3 life is not strikingly different from the picture often 4 described in Vitamin 3 deficiency, and particularly the 5 peripheral neuritis, which is an a ccompaniment of such food 6 deficiency quite frequently. 7 .dad would approximately the sane answer be given to, we will 8 say, nalnutrition? S do she extent that Vitamin B deficiency is a malnutrition; 10 it is a specific type of malnutrition. 11 Is it not true that the picture in this case is one 'which, 12 renders it not at all improbable that assuming upon death 13 lolepnev had an abnormal quantity of lead in his system 'C-iU the nreaence of lead would be in itself ingestion 15 or absorption through food, liquids, medicines or other 16 sources subsequent to the termination of lit*, Telepnev1 s 17 employment In the laboratory in November 1935? 18 Veil, X do not consider it probable that Itr. Telepnev did 19 absorb any large quantity of lead following tho cessation 20 of exposure, but if you ask me if it is possible that is a 21 somewhat different matter, and I can only reply to that by 22 saying If at the time of his death Mr. Telepnev did have 23 an abnormal quantity of load in hi3 tissue, which I doubt, 24 it came from some source which was active during the period 25 following the cessation of his employment, ana for the reasoj 26 that in my experience, which is fairly extensive, I have nev 'Ai-3'-i1 k * 002214 -2- m. HONE: {54) -( 1 2 3 4 5 6 7 8 9j 10 111 12 13 14 15 16 17 18 19 20 21 22 A 23 24 25 26 % seen yet a case in which excessive quantities of lead were round in the tissues as long as eighteen months had elapsed between the cessation of exposure and the death of the patient and analysis of his tissue. 2ke evidence quite clearly, the evidence both of the rate of lead excretion and the quantity of lead found in the tissue at necropsy indicate that abnormal quantities of lead do not remain in the tissues for indefinite periods of time following the cessa tion of exposure, and in no instance have I known them to rer,tain abnormal over a period, longer than eighteen months. hving in mind that Hr ceaaed his contact with leaded gasoline at the Associated Hefinery in Hovember 1935. and having in mind Ur. Chabanoff's testimony that each time she saw him he was worse and that lie was worse in 1936 than lie was in January 1935, and that he was worse at the end of 1936 than he was prior, and that he was worse in 1937 than he had been in 1936, would those facts add to your opinion that his condition was not attributable to any possibility of lead contact during his employment terminating in November 1935? Yes, I have already stated that in my opinion the progress of his illness with increasing disability is enough in and of itself to strongly argue against lead poisoning as the : cause of his disability during his period of employment. In my experience this progressive progress following the -3- B. HOM: (Sp* 33. ICSBOS:, 1 cessation of employment is not to be expected; rather the 2 reverse is to be orpected, that is progressive Improvementto; 3 that I do not mean that 1 would necessarily have expscted 4 the paralyses either to disappear or improve, tout that the 5 general constitutional symptoms ana evidence of intoxica 6 tion should have disappeared progressively following the 7 discontinuance of the exposure. 8 Dr. Chabaaoff testified in this case that in the literature 9 she remembered you mentioning that the testing of gasollna 10 was the most dangerous procedure- of the whole business, is 11 th&t correct? 12 lie, that isn't correct, I have made no such statement, 13 what ore the facts in that regard? I think it is almost certain that Dr. Chabanoff misinter preted the type of cases I was discussing nilon I referred in one of my articles to blindness of laboratory workers. This reference had to do with the activity of workmen in the manufacturing plants in which tetraethyl lead is manu factured and prepared for use in gasoline, nothing that I have ever said with regard to the instances of lead poisoning or the dangers, actual dangers, has ever had any reference to persons working with gasoline. In your opinion, is there any danger whatever in handling ana testing gasoline containing tetraethyl lead? I have never seen any evidence of any. such danger and it is my firm conclusion, that there are no such dangers in m'xe 0022149-*- -SlSISiaii mr . mmi___L( l {____ 1 connection with the normal testing operations and activities 2 Q, And the operations cdT Mr. Telepnev in this case would be 3 normal testing activities of leaded gasoline? 4 A They were, from all the information I have been able to 5 obtain. 6 Q, And that information is based upon your knowledge of all 7 the evidence in this case? 8 A Yes, it is, and from further questioning carried on on my 9 own. 10 MR. HONE: That is all. 11 MR. D3THLEFSEN: 12 Q, Doctor, what is your full name? 13 A Robert A. Kehoe. 14 Q, And where were you born? 15 A 16 Q The State of Ohio, very near to Cincinnati. the And I presume you want through/el ament ary schools in that 17 vicinity? 18 A Yes,Georgetown. 19 A And the high school at Georgetown? A. Yos. 20 Q, 21 And after you graduated from high school, then what college .. did you attend? 22 A 23 24 The Ohio State University for one year, and then because of my desire to study medical I wont to the University of Cincinnati. 25 Q. 26 A And what year was it you left the Ohio State? 1914. ,j4Si -5. 0022150 MR, DSTHIAA3I (55) DTi ZmOE: 1Q 2A 3 Then you took a pre-medical course? A pre-medical course at the University of Cincinnati and continued on in medicine at the university of Cincinnati. 4 >oj How many years pre-medical course did you take at the 5 University of Cincinnati? 6 A One year at the Ohio State and tire second year at Cincinnati, 7 and then went on with the combined medical course so as to 8 include a batchelor of science curd a hatehelor of medicine 9 degree 10 -4 And how many terms did that take? 11 A Siz years. 12 Q, And that made then seven years? 13 A It made six, because of one year at Ohio, three included 14 in the pre-medical years at that time. It is now three* 15 Q. And what year did you graduate? 16 A 1920. 17 Q, And after your graduation*did you interne? 18 A No, I did not; my interest had been definitely in the 19 direction of investigative work, and I had been working in 20 the pathological department of the university for a pariod 21 of two years, and I continued as the resident pathologist 22 in the General Hospital, which was regarded officially as 23 24 A 25 26 A the equivalent of an internehip* And when you refer to the General Hospital, do you mean the . General Hospital of the City of Cincinnati? The Cincinnati Gemral Hospital, which is part of the n Save****- ' K 0022151 `8 1 2 3 4 5 6 Q: 7A 8 9 10 a 11 12 13 14 A 15 i) 16 17 18 A 19 20 21 22 23 A 24 A 25 26 Ha&lcal School. 5or/ many years die you spend in that Jiospital? pathological department as a student and resident pathologis for a period of two and a half years* .ind what year did you leave there? I left that work in the latter part of 1921* Up to that time had you established yourself in an office for the general practice of modi cine end nursery? 1 have never been established in an office; my work has always been at the University. And you hare no office at the present time for the general practice of medicine and surgery? 1 have not. When you left the Cincinnati General Hospital, then did you go as an employee of this oil company that you are now the medical director of? Ho, I went into the Department of Physiology as Assistant Professor of Physiology and carried on outside work as the director of the clinical pathological laboratory of the Jewish Hospital, which is one of the largest hospitals in Cincinnati* How long did you continue in that work? Until 1924, but my major werk vras in the University, where I was in the capacity of a full-time member of the faculty and have been since that time* * -7 0022152 ^n DATELAL' [l K^Klj KliHOS 1 q, And still are at the present time? 2 A. w 3 Q. lion in 1924 then, what did you do? 4 A In 1924 ay specific work with this problem began in that I 5 was',! spent the summer of 1524 studying end advising as 6 to some difficulties that had arisen in the manufacturing 7 activities of tetraethyl lead in bayton, Ohio. 8Y 9A 10 c 11 12 A 13 14 15 16 Q 17 18 A You vent to bayton, Ohio? I worked at bayton, Ohio, through the summer And were you working there for some oil corporation at that time? the people in the no, I was working at the request of the/General Kotor3 Research Corporation, who developed this product experiment ally and who ran into difficulties in one phase of their war] when they got along to the semi-production scale. dna you say you v/ere up there studying the problems of the manufacture of tetraethyl lead? Yes. 19 Q, 20 A 21 22 23 24 25 26 bhat were those problem? This was a small manufacturing plant which was the outgrowth of an experimental discovery, and `when relatively unskilled workmen were introduced into this shop, which had previously been a chemistry shop, the conditions of exposure which had previously not been recognized to exist resulted in the poisoning of a number of men, and it was simply a question as to whether the plant should bo carried on and v?hat could -8- :'e 0022153 * n >111. biffiElAl'3/ 15Si DR. rCSKOS 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 l 32 2; 2 5 l:TcIHrgSIiI be done to protect the workmen am what could "be done to make the manufacturing process safe, and my job was to talc care of the men that were ill at that time and to study the plant and to try and do vise safeguards which would per mit this work to go on,if possible,under safe conditions* ere you associated in other details with the care of these asn? I was asked to do it because of ay experimental work tor several years, which had boon concerned with the heavy aetal poisonings, and that fact being known I was asked to come in and investigate the problem and do what I could* And in investigating this problem, how many men did you treat suffering from tetraethyl load poisoning? at thuds time I went tSrrough the plant , and ?/hat/ o ooasioned my coning was the serious illness of a group of 5 car 30 men, and there had been two deaths which were pretty certain^* attributable to their occupational exposure, and that threw enough fright into the whole project, and there was a ques tion as to \ibother it should be abandoned or whether they should go ahead and do something further with it* Vlas that the Athyl Corporation? h'o, it was prior to the formation of the ethyl Corporation, it was tMra-l-ihtle chemical company organised as a conse quence of this discovery,7hii eh came* out of . the research laboratory as the consequence of about ten years of techni cal experimental work. 0022154 -9- ssutr* 03"* 5R. DBTHLS: (55) 1^ 2A 3 4 5 6 rt7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 And how long did you stay in that posi tion? Only through the summer, "because I was; due to teach,at the University of Cincinnati and I could not spend any longer time there* And at the end of that summer,then, where were you employed.? I did continue in an advisory capacity, however, going back and forth between t)ayton and Cincinnati from time to tine and supervising certain changes in tin plant, and certain experimental studies that were being carried on under my general cli rect ion* '..'ell, then, after that cummer and your position of Assistant Professor at the University of Cincinnati, did you engage in any other practice or advisory work? Yes. Uhe general salaries of tho University of Cincinnati are not very large and it is not uncommon amongst the University -- the University of Cincinnati is not a wealthy university, as a consequenoe of which it was the general practice there to permit their full-time members of the faculty to engage in consultation work and general medicine or in any other field in which their interests or professions training allowed them to go, \Sj consultation in that field has been that of advisor to the Industries that have been concerned in the manufacture and handling and distribution of leaded gasoline, largely as a matter of chance. I was for a time the only person who had had any experience and had any direct knowledge of this subject, and when 0022155 iiiilli DHTHLEI? (56) ALHOE: 1 2 3 4 5 Q, 6A 7 Q, 8A 91 10 vi 11 12 A 13 A 14 15 A 16 17 18 19 20 21 22 23 24 25 26 I the Ethyl Gasoline Corporation was famed, fortunately for me, they mors or less naturally came to me for advice and assistance, and 1 have continued in that capacity up to the ; present time. Even at the tine of this hearing? i | Yes, at the present;time* Are you in their employment at the present time? To the extent that a physician is in the employ of anybody, that is a rather theoretical question* How, the corporation that you are the medical director of at the present time is called what? The Ethyl Gasoline Corporation* The Ethyl Gasoline Corporation? n. Yes. And you have your laboratory in tho City of Cincinnati? *11, 1 think you must understand my laboratory -- our laboratory -- is a laboratory for the study of occupational diseases in the University of Cincinnati, and I am the director of that laboratory and in a full-time capacity, with my primary responsibility to the University of Cincinnal under the Dean of the Medical Eohool and under the Board of Trustees of the University, with the necessity of having their full knowledge and consent in all of the experimental activities I carry on in that laboratory. But your salary comes from the Ethyl Corporation? Ho, my salary comes in part from the University of Cincinnati and I rather obviously draw a retainer fee from 11- 0022156 (57) 1 2 3C 4 5 6A 7 8 Q. 9 10 11 12 13 A 14 Q, 15 16 17 18 A 19 20 21 22 23 24 25 26 '4 the Ethyl Gasoline Corporation for such advice and assistance as I give them* And as such you testify in the various cases that arise out of the uso of the ethyl gasoline and in various parts of the country, do you? Hot necessarily, I do if I choose and if the circumstances are that I can testify out of my own knowledge and experience How I presume you are here being paid by the defendants. Associated fide Water Oil Company? I have no understanding whatever with the Associated Oil Company. Jiy expenses are being paid by the Ethyl Gasoline Corporation, if you want to know. By that you refer to the Ethyl Corporation? ... Yes. Isn't your laboratory a sort of central distributing point, you might say, where occupational diseases arising out of gasoline or tetraethyl lead or leaded gasoline are all con centrated in your laboratory? That amongst other things. b!y laboratory has been concerned with the study of lead poisoning more than any other problem, and that has involved studies in relation to public health * yi problems that arise from lead, such as the front spray rV y problem, and such as lead exposure in quite large plants, artd / the storage battery plants. Because of the nature of my work I was permitted by thef/university of Cincinnati to undertake the study of this problem as a pub-l-i-e problem in public health and industry along with the problems on which we were -12 0022157 MB. DEEHUSFS^: (57) DR. mSHOE': 1 2 3 4 5 6 7 8 9 10 1! 12 13 14 15 16 17 0. 18 19 A 20 21 v 22 23 24 25 26 working. {then was '.be problem of this your attention? o-ise first called to l&y first knowledge, I believe,/! will have to state from my V memory because | haven*t my correspondence with mey was in -*5~*ksleve in the spring or early summer before the hearing in this city, the summer before last. It was in Hr. lifetime? Yes, it was in his lifetime, but I cannot just recall, tfho first called this case to you, it was the Ethyl Corporate Ho, my first attention was called to it by one of my own associates who was asked about the ease by Mr. Hugo, I believe, who was the refinery superintendent in the refinery in which Hr. worked. That is the one here in California of the Associated? Yes. that come in the form of a letter or just reporting . the case to you? He mentioned the case at the time and gave same brief descrip tion of it. ell do you recall the description of the case he gave you at! that time? * * hot in detail, because actually it ?;as reported in more or less layman's language to one of my associates, who in return reported it to me verbally, and I had no corros- 1 pondence on it until some time later, 1 having written Mr. -13 0022158 MU 32rHL2g3S^ (57) D?,. YEHOE: -t 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 A 18 0, 19 A 20 21 22 23 24 25 26 Hugo on receiving this information and haring asked for further in formation about the case. In your position, receiving a retainer from the Ethyl Corporation, Isn't it one of your duties to advise all the various oil companies using lead gasoline? Yes, I have been responsible for laying down the regulations or setting up the detailed precautionary measures in relatioi to the proposition of leaded gasoline in these various refineries where the fluid is mixed with gasoline and in prescribing precautionary measures from all of the situations which in my knowledge are in any way hazardous with relation to this entire industry, from the top to the bottom, hell, now you say you have not made any arrangements regard ing your fee schedule here; isn't your regular fee y350 per day and expenses from the time you leave Cincinnati and return? I have never collected such a fee. . You never have? No; actually ay standard fee where the people involved can afford it,- and X make no charge if they cannot afford it, is $100 a day and my traveling expenses, and any fees which" I collect in expert testimony go into our laboratory research fund end do not accrue to me personally, because when I testify as an expert witness I testify on information de- .NY-'"1' rived from laboratory studios and my general philosophy, of that is that I testify on the best information which has 14- ':vj 0022159 MR. DSTHLEF3fi (58) DR. ICSHOE: 1 come out of the laboratory and any benefit, which cones from 2 such testimony is only properly due to the source of infor 3 mation* That is the general arrangement at the laboratory. 4 I wasn*t going to ask you this, but as to turning your fees 5 over to the University, you are under a general retainer 6 from the isthyl Corporation? 7 Yes. 8 What is that retainer a year? 9 HOYS: I object to that; it has absolutely no bearing on 10 this case and. I think it is *ol3nL ILul IJj G rtinent question* 11 RSFSRSiS: The very general rule is that the very widest latitude 12 is allowed in examining an expert for the purpose of test 13 ing his credibility by showing interest in l^ho natter, and 14 under that general rule I am not going to be very strict, 15 so I will overrule the objection. 16 HR. HOHI: I will advise the doctor it is a matter cf his own 17 personal desire. 18 RISFJRliSi Well, I shall hold him for contempt if he does not 19 answer. 20 I do not mind answering. My salary from the Hthyl Gasoline 21 Corporation has been an annual fee which has gone up from 22 year to year more or less, naturally, and it is now $14,000 23 a year. 24 MR. DSTHIHFSHK: 14,000 a year? .v, 25 Yes, which, of course, is a .great deal more than I could ever 26 hope to receive from the University nf Cincinnati as a salary 15 sem^Kg 0022160 MR, .DBTHLSF3.f""- (58) ____________________Q N DR. .ASHOS:( 1 % And are you not subject to call and direction of those that 2 retain you with this annual fee for the purpose of testify 3 ing, in addition to other duties? 4 A I aa distinctly not. I aa a doctor of nedicins and I testif; 5 when I choose and at no one's call, 6 Q, How, how nany cases would you say you have testified to re 7 garding lead poisoning in the last three years? 8 A Lead poisoning or tetraethyl poisoning? 9 Q, Both. 10 A Oh, probably fifteen before the Ohio Industrial Commission 11 as their consultant* 12 And any ether states other than California and Ohio? 13 HONE: (Interrupting) Have 3'ou finished your answer, Doctor? 14 I was. Probably some ton r twelve others, s. few of which 15 have been concerned with the problem of tetraethyl lead, but 16 more of which have been concerned with the occurstional 17 lead poisoning in other industries. 18 HR. DETHL2F5EK: Q,. Have you ever testified in behalf of any 19 patis nt suffering from lead poisoning? 20 A 21 Q, 22 A 23 24 25 Q, N A ? Yes. i V/hen was that? ' * | The case befcrrS which I appeared! before the Ohio Industrial Commission and in one or two occasions on behalf of the claimants and not of the defendants. Has that with reference to tetraethyl lead poisoning? No, I believe only one instance on behalf of the patient, ' K 0022161 >16 **> HR. DJ2THIEE3Afi (58} x' DR. ihVTT/i XT' * 1 whose reputed poisoning -was tetraethyl lead. The 2 was an employee of the General Uotors Chemical Company 3 prior to the founding of the Dthyl 'Gasoline Corporation, in 4 which I appeared at- the request of the Comission to give 5 advice with relation to this case. 6 Call, in your opinion, then, Doctor, testing, making tetra 7 ethyl load tests, constitutes no hazard to the person aakiSjg; 8 them, irrespective of the amount of vapor coming from them 9 or the amount of absorption to the hands or any other 10 source? U I I must ask you to say whether you mean tetraethyl lead or 12 tetraethyl lead gasoline. 13 Yea, the tetraethyl gasoline, ouch as being made by hr. 14 in this case? 15 It is ay opinion that that involves no danger to lead poison 16 ing. 17 And one could not take lead poisoning from engaging in an : 18 occupation of that kind? 19 ii. In fact it is my opinion that it is impossible to acquire 20 lead poisoning in that occupation. 21 At the -second point regarding in which you 22 stated you did not feel he obtained this in the course of 23 employment with the Associated Oil Company, was that the 24 25 26 ll clinical picture progressing ono and ona-half years until ........ the termination of exposure? That is one point- in my opinion, yes* Mmm k e 0022162"17" m {SQL ICIAIOS: And you feel from your experience, do you, that the lead 2 would be excreted or thrown out of the body in a period of 3 six or eight months following the period a? termination of 4 exposure? 5 A In a period within some eighteen months, yes. 3 d Do you know of any ease where there lias been load poisoning 7 that has developed after the termination of exposure to 8 lead poisoning? 9 MR. HOKE: Are you speaking of lead generally? 10 MR. DISTHI3F3 lead generally. 11 A iTithin what limitation of time? 12 DMTHXSF3AII: A'ithin any limitation of ti. e? 13 I know of no cose in which lead poisoning has developed 14 following the cessation of exposure within a period longer 15 than a few weeks. 16 *1 Well, is it a known fact, Doctor, that lead may he deposited 17 in the dust in the garage that uses ethyl gasoline? 18 A It is a known fact that there is some dust in garages that 19 use ethyl gasoline, and it is also a known fact that there 20 is dust in all garages, regardless of whether they use 21 tetraethyl gasoline or any other gasolinejlead compounds 22 are used in garages in the form of solder and in the form 23 of storage batteries, naturally, and it is well known that 24 lead is found within the dust on tho floor of such garages*:.- - 25 There lias not, however, been cases of lead poisoning with 26 any measureable degree of frequency amongst garage mechanics. VJ ifM^t ^g 0022163 -18- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 of exposure to lead compounds* That I may say is the 19 universal experience* tfe are all exposed to load compounds 20 and we all absorb lead and we all have lead in our tissues 21 and excreta, and the quantities of lead required to produce 22 lead poisoning even over any period of time, six months, 23 two years, twenty years, is a definite thing* The small 24 quantities we normally are exposed to do not produce lead 25 poisoning in the general population, 26 How, -doctor, other than the summer in which you had charge -19 ;si3 1rp.TT *r (59) m. :?.? 4 >1 * 1 of these sen that were suspected or had lead poisoning, have 2 you actually treated any case? 3 Yes, quite a number* There had been a series of cases 4 of tetraethyl lead poisoning in the manufacturing end of the 5 trade up to and including the year 1925, and since that tine 6 there have boon a few cases of tetraethyl lead poisoning, 7 several from accidental ingestion, one with suicidal motive, 8 something life twelve, I believe, associated with the 9 cleaning of tanks that had contained lead compounds, and 10 in all since 1925 there have boon, I believe, about ~ 11 vrell I will say in round numbers about twenty cases, I may 12 be wrong in my figures -- excuse me a second--------- 13 (hr. Hone giving the doctor a book}. 14 A (Continuing) ------- -- about twenty-one cases (referring to table 15 in book) since 1925. 16 HPi. ChT'HLfPolN: y That have been called to your attention? 17 A That I have either myself seen and treated and diagnosed, 18 19 20 3, 21 A 22 23 A 24 0, or that one of my immediate associates have seen and treated, and with which I have been in actual contact. Tould they report to you findings on examination? Yos. And how many out of that 25 cases, did you see? About 21, I believe, since 1925. How many have you personally examined of that 21? i,,-H X A^ X believe about six. s ^-bout six? A. Yes. -20- 3-*'**s&:^' r j 1 And that lias been since what year? 2 nines 1925. 3 1325? 4 Ins difficulties occured in this industry prior to the period 5 of 1925* 6 Aden did the difficulties start in? 7 Ids first difficulties occurred late in 1923, and extended 8 j through into 1925 during the period in which there were not 9 | ?ealiy adequate precautionary measures taken in the manu 10 facturing industries. 11 fell, Doctor , isn't it true in one of your articles you 12 stated that the lead content of dust in garag'es is increased \ 13 by the use of leaded gasoline? 14 Ho, X don't think so. I don't think so. I chink what I said 15 was that one would expect such an increase, hut I don't 16 think our figures permitted us to say definitely that there 17 was any striding increase or any definitely recognisable 18 increase as a consequence of the use of leaded gasoline* 19 You have your book there with your article; can you turn 20 to that particular portion regarding the lead content of dust| 21 in garages that use leaded gasoline? 22 Ho, because it isn't published,r<or have; our figures on the 23 lead content of dust in garages been published in detail, 24 since a rather large series of such observations were -25 \ ported by the United States Public Health Service and by the British Ministry of Health, their figures being more 13. DHTEXrFw : ((6600)) --------------------------- s -------------- V' DR. XEHOR: 1 comprehensive than ours; I never published ours at all. If 2 Dr. Chabanoff knows any reference to such a statement I 3 v;ouli be glsd to have it. 4 -.IS. HONE: I think it is only fair. 5 1 It will save me time. 6 1.3. HONE: I think it is only fair as a matter of fact. I 7 understand v/e are not subject to strict rules of evidence, 8 but if reference is made to written articles that Hiey should 9 bo produced and shown to the witness; otherwise, tho refereno which 10 should not be made because it carries implications / would 11 bo difficult for the witness to disprove. 12 3. DHH;.iHFSHlf: 'fell, he is an authority and he should remem 13 ber what he has written. 14 IlCIi'H: I think he has done remarkably, 15 ' i. DiSTHUJi3EXT; I will not try to confuse you. Journal of 16 Medical Hygiene, Volume 16, fage 101. It is in that 17 journal or it.is in the Journal of Medicine* 18 ni. H0HE: You don't mean that* 19 1 Journal of Industrial Hygiene, 1934. 20 I Volume 15, Page 101. KJE 0022167 21 IR. D2THIEF3HK: Oh, it is in the Journal of Industrial Hygiene, 22 Volume 15 at Page 306, one or the} other. 23 1ITERSE: Pell, let us see. 24 HR. IIOiTE: Both of the publications just referred to are present 25 in the courtroom, are they not? 26 I believe so. FORM 269 45377 6-S7 40M CALIFORNIA STATK *BI WTIHSflPeiri -22- m -, KEKQ3 : 1 All right, I will ash you to refer to each of those. 2 All right, with reference to the articles last mentioned, 3 the article which appears in the Journal of Industrial Hygieij 4 Volume 15, Page 306, there is-'no reference in this artiole 5 from beginning to end to dust in garages. This article is 6 concerned nt th the study of a series of nan-hazardous lead 7 trades in manufacturing of white lead and the manufacture 8 of lead storage batteries and the manufacture of tetraethyl 9 lead in the manufacturing plants, which are now in existence 10 and which hare been under study for a period of years# 11 DhTIIHSFoh'iT: how the other article; is share anything 12 in that? 13 .'no other article nas to no -with 'ournai of Industrial 14 Hygiene, Volume 16, 1934, which is a report of a comprehen 15 sive study of the hazards associated with distribution and 16 out use of gasoline containing tetraethyl lead, as carried/by zas 17 and ay associates in the laboratory. This problem begins 18 with the discussion of all of the hypotlietical hazards which 19 are either known or Imagined in connection with the distri 20 bution and use of leaded gasoline, end it is probable at thal? 21 point that some reference has boon made to the fact that lead| 22 i in.the exhaust gas of automobiles may be expected to be found; 23 in the ai;nosphere at those points and they also may be ex- j 24 pected to be deposited in some degree on the floor of garages! 25 along with the lead. It is a rather long article with a 26 good deal of tabular data in it, and I may say for the benefil I -23- (60) DR. HHHOS: 1 of the referee that that article reviews and cites the 2 availsc-1% literature on the subject up to the tine It v.-as 3 written, in case one is interested in the references. 4 7ell, rut say in here that the sale of gasoline to-the con 5 sumer laces it into the province c the general public 6 sic where v. >orae degree In contact and vapors may occur. 7 HB. HOM'D: What page? 8 Hit. BD2EIA1. ;i: Page 103, the second paragraph at the top. 9 vi What do ;-.u ;nean by that, Doctor, that the sale to the 10 general ..relic and handling of it? 11 Involves exposure to gasoline and oxhaust vises 12 13 14 15 16 17 18 19 20 Q, 21 A 22 <1 23 24 25 W, 26 from the eensunption of gasoline in vutomobiles on the part of ourselves, you find me and - erybodv else that uses an -automobile and that walks in the streets, etc. hauldnf t he exposure be greatly increased in the case Of Mr aking these experiments which ho made of tetra ethyl load gasoline? As compared with the fill in station attendant and parage mechanic? Yes. Ihe answer is distinctly "no." And do you know Dr. Logan Glendennire; do you read about hie in tl newspapers? I do not know him personally; I know his writings. From where was he graduated? s,;. . I as sorry, I cannot answer that. 24- IliH? AA J-UJJ (si;- d: 1 2 3 4A 5 64 7 8 .1 9 10 11 12 13 14 15 A 16 4 17 18 A Universlty of lov/a .iSTHI T; It? la i3 more or 1-' in authority on xhe general practice of medicine, isn't he? ./ell, be writes syndicated articles in tbs newspapers, if thatviaakes him an authority. It would indicate him as being an expert on. the articles he writ es? It would indicate he had time to write syndi ca I* .*2 u.-OU articles and would indicate hej hasn't very much tie te; do research work. So you know that it is only within the last three days he r.ecoisraended -wearing a certain type of glove for the employees of oil stations wearing gloves or handling tetra ethyl? i/ell if he did, it is very bad advice. You don't know of this article appearing three days ago, do you? Ho, I havo never seen it, 19 -At. ECUS; (Interrupting) Bo you, Counsel? 20 MR. DETHLES'Sm: Yea, I saw it. 21 MR. HONE: Hell, I think it ought to be produced. i 22 A May I say this, gy , 23 REFEREE: It would be better to produce it. 24 E in explanation of my statement that If he is advising the us< ?5 of a certain type of gloves as a protection against lead 2 absorption, it is bad advice. if he has some other know- ledge"of the necessity of protecting men against skin , l -S.wj (51) -( ~)i. i # ) 1 contacts with soma thing or other, perhaps I arc being a bit 2 hard to say it is bad advice. 3 ' 7> pliELirdjai: Q. hell, wasn't this laboratory, that littering 4 laboratory, really established for the purpose of attempting 5 to prove to all users of tetraethyl gasoline and those en 6 gaged in the manufacture and testing and use of it that it 7 was not harmful to the system? 8 IJo t ? , do you think that is a fair question to ask me, a rV\ university man, if a laboratory was established in his 10 university to prove that this particular product was not 11 raus? 12 . U .2 15 ;.ouldn*t it be fairer to say that this laboratory was to 14 find out whether it was dangerous* 15 You are testifying in those cases to prove that it isn* t , 16 that this is a non-hazardous occupation. I did not mean 17 anything than the most courteous cuestion to you. I am 18 not saying such is the fact. 19 !EFiR2E: The answer is worthy of the question, that equalizes 20 it. 21 IS. QETHIEIfSEN: bo Q, Quoting from your work of larch 1934 in your/ 22 on Page 103, "Garages in general are poorly ventilated, few 22 of them indeed are equipped to maintain adequate dilution 24 of exhaust gases under the most favorable conditions, and :m, 22 when door3 and window's are closed in cold weather ventilation 26 is often neglibible, and for this reason through the winter -26- DSTHIEfS/ (61) -f JL KnHQS! 1 months laany mechanics develop late afternoon headaches from 2 the absorption of carbon monoxide* The exposure to load i 3: in the exhaust gas of automobiles burning: leaded gasoline 4 is greater therefore than that of any group of persons 5 in the community." had continuing down about fifteen linesJ 6 "The spillage and evaporation of gasoline leave behind a 7 large volatile tetraethyl lead, to be slowly volatilised at 8 a later time mo. to be decomposed, and by so doing then aftei 9 the lead dust in the -garage in the dismantling of motors 10 and carbon products of tetraethyl lead nay be encountered 11 by the mechanic , and although these cannot be absorbed 12 through the skin they may be a means of contaminating his 13 hands, his clothing and his surroundings* e must regard 14 these factors,as well as the deposits of load of exhaust 15 gases as contributing to the- accumulation of load dust 16 within the garage, although the aaounts of lead involved are 17 probably; not so great as that originally from the electric'' 18 storage batteries and U3e of paint and solder in the repair 19 of automobile3**' That is the particular portion you refer 20 to? 21 Yes, and at that point I was reciting the whole list of 22 hypothetical dangers regardless of whatever they might be, 23 and regardless of whether or not they were actually measur 24 able, I tried to recite every factor that could complete 25 the lead exposure of garage mechanics in association with 26 those performing such work:. *27- DETEI^F3.y*: (62) DR. AbHQi 1 2 3 4 5 6 7 Q, 8 9A 10 11 A 12 13 ~s. 14 15 '.Ye1 X j XS danger then of inhaling, you might say, this dust in garages such as 1 have just read? It is a hypothetical danger and our purpose has been to study that danger carefully, ana'the results of which study haye been to conclude that the dangers are not of any actual or consequential value* Now you are basing your opinion upon the entire file* What file do you refer to? The records d_.il ii\. C 3.3 e, which are available here in the room, I believe. And have you read the record of the industrial Accident Commission? Wall I have gone over rather carefully, r believe, all of the testimony that has been offered in any of the hearings before the Commission insofar a3 they have been made avail 16 able to me, and I believe tint is practically the entire 17 record, and incidentally it is a duty on ay part to investi-* 18 gate these cases on my own bslmlf and to make adequate report 19 on them to tie United states Public Health Service for their 20 Information* 21 REFSREH: Q,* 3y virtue of what connection? 22 A By virtue of a gentlemen's agreement with the Service. I 23 have no legal or professional responsibility to do so. 24 AR. DSIHLSF3ISS: Q. Well, lead dust from gasoline has been 25 26 A actually measured, hasn't it? Yes, in the exhaust gas* ' M la. BKFHLSF^II: -----------------------------\ (S3 1 But what percentage does it contain of lead? 2 7/hat oercentage does the exhaust gas contain of load? 3 4 I can't tell you the range of values offhand, because I do 5 not remember them. They are quite variable, depending on t&c 6 actual time in which the observations are made both in 7 relation to the operation of the car ana with relation to 8 tr IX/ of the car; that is these deposits are found along 9 the whole exhaust system of the automobile,and they tend to 10 deposit fairly rapidip' on u new car so that the whole thing 11 becomes covered with the deposit, and the proportion that is 12 actually thrown into the atmosphere increases to some, degree 13 and the result is uidoly variable and I don't remember# 14 Do you recall the report of investigation made by gr, Sayre? 15 Yes, I have know of Dr. Sayre's work since the beginning, 16 and I was partially responsible for the turning over of this 17 end of the problem for careful study to the United States 18 Bureau of !{ines for the reason l'had facilities for studying sy ' 19 _a4 which did not have in the laboratory, end for the 20 further racoon that they occupied a position of trust in 21 relation to the United States Government, which I myself 22 did not occupy, and in this period of 1925 and 1924 x was 23 a substantially unknown person and anything I might have 24 said on the subject would have been taken with a "grain of.-;?; 25 salt,'1 where sc their observations would bo and have been 26 taken as totally disinterested# Sit -29-  vu-fc ------------------- 1 (62) . rudi0 li: 1 ^re you able to recall now the percent age of lead dust as 2 the result of this investigation? 3 They did not work on dust in garage floors or the particular 4 amount of lead in the exhaust gas of motors, nutting exhaust 5 gas into a chamber oa which they studied with animals, and' 6 I don't remember their figures because there aro actually 7 re a: as 'k r*2 \) of data one.would have to go over and remember. 8 It was greater than ten per cent, wasn't it? 9 You mean ten er cent lead in the exhaust pigs gus? 10 11 Uil* 11U. that is an absurd figure. There actually is only 12 re r cent of carbon monoxide and that i; largest 13 single constituent of dangerous material in the exhaust 14 gas. Incidentally, my conclusion and those of the Bureau 15 of liines are in precise harmony in these matters. 16 You said something about printer's ink, what was that, on 17 your direct examination? 18 I believe Ur. Hons asked me if printer's ink had lead in. it, 19 and I said it does not; I do not remember the connection 20 otherwise* 21 Shl'HH.wS: Yes, that was the question end answer* 22 H. HOiS: Yes, that is it. 23 lFJiuEE: You said it was composed of carbon* 24 YU DHTHLEFSHN: Do you know who .^li ce Hamilton is? 25 Yes, I know iBLico Hamilton, quite well personally and. pro 26 fessionally. 30' 1 2 31 4 5 6 7 8 9 10 11 12 13 14 the concentration of load in the skeleton of young children 15 varies only slightly from the concentration found in the 16 skeletons of old men. There is no satisfactory evidence 17 of a progressive accumulation of lead increasing concentre* 18 tlon with the years of advancing life. 19 I suppose it is not known ana could not; be ascertained ^U3t 20 the maximum amount of it, more correctly, the minimum amount, 21 no the maximum amount, the maximum amount that an individual 22 might take, an average individual might ingest through a 23 period of ten years and yet not be the victim of any ingestioi 24 of lead intoxication? 25 L2 It is not known in precise terms, and within practical limits . It hut within certain limits is rather well 3mown, for -31- hs ~r -C , "hnHOn 1 candle. 3inat tine or Jir Thomas legge and Kenneth ' C. 2 Goodby ,y *Jtudic3 la ---Ireland, it lias been believed by indus 3 trial'hygienists who have he d udo widest experience with this 4 problem that if the.lead duet in the atmosphere is not in 5 excess of five milligrams per ten oefc4met*iirs of air through 6 the working day that cases of lead poisoning will not occur 7 at all or may be of ouch mild clinical character us not to 8 give serious injury, bines that tine both direct and indire< 9 observation lias stated the figure at a slightly lower level, 10 so that it is now believed by a number of persons whom I 11 regard as the most ccapetent authorities that if the lead 12 concentration in the atmosphere is less than two milligrams vy \ * 13 per tan cetttimeters of air cases of lead poisoning will 14 not develop, even after years of daily exposure. The reason 15 for believing that this a fair expression of facts has came 16 first of all from years of clinical observation in which 17 under those conditions cases of poisoning have not been seen 18 and has been in tie latter days explained rather adequately 19 by the fact that at that level of exposure the lead excretion 20 in the feces and In the urine has been elevated in the 21 population group to such an extent as to lead one to believe 22 that intal.ee and output are equivalent so that storage dees 23 not occur beyond a oertain. point in which the quantity of 24 lead within the tissues of the body is in equilibrium with 25 whole in ana outflow of lead, so that it is now believed, 26 and I think very well substantiated, that there is a I -32- -------------------V `. XEHG2 1 dynamic equilibrium v/itliin certain limits of lead intake 2 v/ith a slight elevation in the lead output, which is main 3 tained at the equivalent ~;ith load intake, and I personally 4 believe that lead poisoning occurs at levels of laad exposure 5 in unich that equilibrium cannot be maintained because of 6 the inadequacy above the certain level of exploratory mecha 7 nism, and we have shown fairly wood evidence of the range 8 of load exposure within which those conditions come to pass, 9 'Jerald those calculations in any wise be affected by any 10 pathological process or disease process that might be acti 11 vated within the body of one who had taken in small quantities 12 of lead over a long period of time? 13 They might be, and in fact one would suspect that they would 14 be, but as a matter of fact no evidence lias actually been IE obtained that that is the case. 16 And isnTt it the case that none could be obtained? 17 No, I don't think so, because in the study of plant population 163 under conditions of exposure, which is where types of work IS have to be done, one St j ^sSTH; findlmen 1^6 definitely under par 2( physically,with blood vessel disease, and with chronic 2: kidney disease and with chronic infections of a variety of 2: sorts, and our general attitude in relation to these men is 2: that if the conditions of work are safe within the limits 2 which I have described, there is no necessity nor is there ^ 2! any advisability in removing these other men from their 2 occupations. That no Hey has nnt ^llnr^ri by -------------- -33- disastrous results amongst these men or by any results that 1 would le&d one to believe that they do not handle lead 2 vithin those limits loss well in a practical sense than 3 4 recent studies have been made of men with general blood 5 vessel disease in r/hioh stangely enough it has actually been 6 found that the rate of load excretions seem to be somewhat 7 higher than that of parsons vrithout blood vessel disease, 8 9 I question these results, but -they are available in the 10 literature. 11 Jinx*o o*T, Mr. Bethiefsen. 12 V**D TYi.XTO'T :*V`7r-t t # 13 Q, Doctor, is it not true that acid base equilibrium influences 14 the deposit of load as regards conditions which tend to depos 15 it calcium in bones could also tend to deposit lead from 16 circulation into bones, and that under such conditions the 17 actual quantity of lead circulating could not be measured,- , 18 quantitatively? 19 A You ask me if that is a fact? 20 1 Yes, 21 A That is a hypotheses, it is not a fact. 22 1 Not a fact? 3 be* As a matter of fact, one never finds in any normal per 2 son or any sick person a time when there is not lead in the j r circuiative blood, if you will look by sufficiontly sen3itlv| 4 I methods. That is true even of a primitive population living b si i*gga 34 m. DATHn2F3.^r: (65) f 1 under conditions in which there is no lead exposure except 2 the natural exposure with the intake of food absorption# 3 Isn't it true that intake by the lungs and digestive tract is 4 in same manner? 5 * They are distributed in the tissue in essentially the sane 6 manner. nt , And you are familiar with the work, I presume, of Dr, 8 d. Heinbnor and 1, Dchuller concerning the action of certain 9 cells toward heavy metal? 10 I am not familiar with that particular article, hut I am 11 familiar v/ith Heinbner and most of his work; I know him 12 personally. 13 Is lead a metal in your opinion? 14 Of course it is a metal. 15 And do you agree that the? concentration with the concentration 16 of metal in the cells may be 1000 times greater than the 17 surrounding media? 18 I should say that is a very,, very fine technical ooint that 19 ought not to be discussed in this very crude manner. The 20 whole method of arriving at the conclusion ns to the lead 21 content of a cell as differentiated from the lead content lit 22 of the mass of tissue is a very exotic ; zone of scientific 23 work. It tapes in methods that I do not think could be 24 possibly discussed amongst lay people, 25 7rs> yT>v ? . *-JA UU KJ-IAJ 4 26 boll, how do you account that the eminent authorities attempt .:V -sSj -35- l! to discuss it la the scientific works that wore put put j 2 for the uneducated public yearning for knowledge on the 3 subject? 4 A I do not believe Dr. Heinbner bus discussed such a subject 5 with relation to the practical problems and diagnosis, lead 6 poisoning or actually the interpretation of lead poisoning*. 7 I an not familiar with the article and I aci not speaking 8 for Dr. Heinbner, but I know him find I doubt if he has 9 connected this -"ith the diagnosis of lead poisoning, 10 ih. DUTHLSFShSf: a . I would say from your answer, then, that 11 you do not agree with the works of Dr. Heinbner and Shuller 12 concerning the action of cells toward heavy metals. dould 13 you say you do not agree that -he concentration of metal 14 inside the cells may be a thousand tines greater than the 15 surrounding media? 16 hit. HONS: Objected to as incompetent, irrelevant and immaterial 17 and lends nothing of value, and if we are going to go into 18 the question as to ?;hother the doctor agrees with seme other 19 doctor then if it is material I shall certainly vrant to go 20 into the subject thoroughly. 21 RIDFSR1E: Doll, I don* t think it is very greatly material, except 22 it cannot be said it is so immaterial or irrelevant that 23 nothing should be heard about it, but I do not think it is 24 of very much important to pursue very much further about that,. 25 although this who3s case is composed of very difficult 26 scientific questions and issues and theories, and is* iwwsmress 36 ..vJji! jffi.-J.-i, J ( O p- * ------------------------------C DR. iCHQS: investigations. 1 UR, HONS: deli, I sulmit tlia specific question can*! "be an swore 2 If the '.7hole context is read we can answer it and we will 3 4 get the reference and go into it from top to bottom* 1. DHTHIHF3HN: I cannot stay here later than august 1st. 5 6 HR. 210213: Nell, it is your fault if you are starting into a 7 thing which is so technical and so far from the issues in 8 this case. It is your fault and not mine. 9 R'HFHREH: The question seems to have some relevancy to this 10 matter as to the amount of concentration in the cells with 11 relation to the amount existing. 12 a (Interrupting) May I answer the question. I think I can 13 briefly dispose of it. 14 RHFERSIS: Yes, that might be the best way. 15 a On this question of where the lead actually is in a tissue, 16 whether it is within the ceils of an organ, or whether it 17 is within the cellular fluid that is within the organ but- . 18 on the outside of the cells, certainly very precis methods 19 of experimental procedure would have to be engaged in. 20 BEFER32: I would think so. 21 i/e know for example that chloride is found within certain 'if 22 cells and that in certain other instances it is outside of 23 the cell. Now the question of whether lead is in liver, 24 whether it is actually within the cell or outside the cell 25 and gets within the organ is of interest in connection with 26 the mechanism of the action of lead within that organ. It 37- HEFI2R32 .303 11 is of no importance 'sith relation to the problem as to I 2 trlie tiier lo ad is there in abnormal or normal amounts, 3 <4 4 Might not it be important in this respect. Doctor, if it war locked in the cell - it would affect the individual vastly 5 differently than if it were in the surrounding tissue or 6 fluid? 7 A'J. 8 That would seem to be entirely possible, but whether it is the case- depends fundamentally upon what is the mo c loan ism 9 10 11 12 13 14 15 16 17 A 18 19 20 21 22 23 24 25 26 of the poisoning, and that is, I assume, what ileinbner and his associates are trying to get. And might it not also be vastly material and important in determining the question of the amount of lead to be ascer tained from tests of the excreta and the blood, whether it were looked in the cells in higher proportions than whether it was circulating in the surrounding tissues and blood; that might/not be of importance in that respect? It might well be. However, ohe knows that with a few excep tions these metals are not actually locked in a cell. The proportions might be very different on one side or the other but this proportion fundamentally would depend upon ,.H<* the total quantity available for distribution within the organ, not in cellular material, and also not in fluid mater ial, whereas for a practical purpose in relation tothe problem of poisoning we must further pursue, be more inter-? vO a osted in the question of what is the load content of. the organ itself andnot what is the lead content of the inside H H2F3RSE: (87> C "T5 , srSFT-TfY*? * * . j.'i V/-*J * 1 of the cell as compared with the outside, for in the latter 2 situation we are dealing with a hypothetical controversial V**- ) <V-- v 3 and even in same, sbe cula t ip>n . o f toxological mechanism$, t\ " A 4 Kight it not also very materially affect the circumstances 5 of whether one Who; had ceased his exposure to lead would hav< 6 symptoms long thereafter defending on v/hethef the lead were 7 locked in the cell in a higher concentration or whether it 8 was circulating in the organisms,not locked within the cell \ 9 Hell, I don#t want to argue the point, but I 'boll eve in all 10 good conscience that we are dealing here with a purely 11 speculative matter* 12 Yes, but that is the way I mane my living, and therefore it 13 seems that this question counsel has asked might be of some 14 importance as to whether or not you agree with that authority 15 that load is one of those substances that may be locked up 16 17 18 19 20 21 't in a cell in a concentrate vastly higher than it could be found in the surrounding tissue? * -:> bell, I may say that I am not familiar voith the details of these articles, and I cannot say therefore whether I am in agreement with him or disagreement. As a pathologist and physiologist, is it one of the attributes 22 of lead that it is susceptible of being locked up in some 23 chemical combination or mixture, or as it is within the cells 24 of the living body or any of hits organs, so that it does vjpgp i 25 not circulate in the surrounding mediums and would not be 26 discoverable in the urine? -'.'Tft SSHR-SISSS 39 'mi {67j Oil* s--'*iiQij a 1 The answer to chat distinctly is i,no,H that load is not 2 deposited in inert form in oho tissues of the body, It is 3 deposited in the tissues of the body and there is an 4 equilibriuia relationship whereby lead is be in/; continually 5 moved in and moved out of the orgms in accordance with 6 the characteristics of the particular organ; that is, the 7 pattern of lead distribution is substantially she same 8 whether the lead content is 1000 milligrams or 100 milligram/ 9 which means that as lead is lost from the bocty it is stead 10 ily lost from all the tissues in which it is found, includ- 11 ing the skeleton, horoovor, it also means thh-- m a a lead is 12 being distributed through tho body it ic discributod into 13 all :;he tissues of the body in proportion to their ability 14 to talc it up and combine vrith it, so that tho picture of 15 the distribution of lead in the body as a very definite 16 pattern. Now if one gives lead to an experimental animal 17 or human being it distributes itself into the tissue, 18 nt this point,as metallic lead? 19 Perhaps some organic compound. When the administration of 20 lead, whether accidental or deli bora to, is discontinued 21 lead is excreted from the tissues of the body at a rate 22 which becomes progressively smaller with the lapse of time. 23 That is,during the period in which the lead content of the 24 body is higher, the excretion rate is relatively higher. 25 the lead is lest its excretory rate progressively 26 diminishes until it reaches a level corresponding to the '*! th .*.... w -- I L.-i.' -- (67) )R. 1 normal picture, and at that tine the lead content of the 2 body is substantially within normal limits. In our exper 3 ience in conditions of severe exposure from one year to one 4 and a half years is required before this lead, is excreted 5 from the tissue down to the normal level, and it is for thl3 6 reason that I said that the lapse of a period of not less 7 than eighteen months is adequate, in my opinion, to get the 8 lead content of the tissue down to a wholly normal level, 9 vrithout exception, in my experience. 10 Do you know of any case in your experience or in the litera 11 ture in 'which one had been exposed to lead for a sufficient 12 length of time to exhibit symptoms of its poisonous effects 13 who had then been absented free! lead environment for a 14 sufficient length of time for Din to have recovered his 15 former state of health with the absence of symptoms of lead 16 intoxication, subsequent to which for some reason or other 17 he had died* and there' had been an autopsy and investigation* 18 to determine whether he was free from lead-' 19 A Yes, there are a series of such cases reported here in my 20 articles; there are only a few to be sure and there have who have - 'hy- 21 been several/'h&d the opportunity to make tills type of ob 22 23 24 25 26 L jv&jg servation, and one takes the opportunity when he gets it. Ye-s. It has taken me something like ten years to get half a dozen such cases (at this point witness going through books), I cite you the Journal of Industrial Hygiene, Volume 15, -41- ^ (S8)f i.V4.'riQE: 1 .-'"G ' ** 1. v.jJL C! series of eases which at the tine of this 2 publication represented all the data I had on this question. 3 ItSPLELE: hell, that is illuminative. 4 Ifov I may say here, and I would like to say for Dr. 5 Chabanoff's benefit, that I recognise what I am saying at 6 this point is unorthodox in terms of literature of nor than 7 five years ago. The contradictions in the literature prior 8 to that tine are in most part due to the fact that there 9 have not boon analytical methods on each process available 10 and in general use to enable one to clinically study cases 11 of this type ana to determine the facts in the case, and 12 in my opinion is still, and I am quite sure, the general 13 accepted opinion in this field, for during the years of our 14 work in this field we nave had the privilege and pleasure 15 of distinctly upsetting some current hypotheses in relation 16 to the behavior of lead in the animal organism. These 17 points of view are new becoming generally accepted because 18 of the unass amiability of the data and proof of the statement 19 I have made. 20 ill. DETH13F322J: d. Is it not true, Doctor, that most author!-*,v, 21 ties agree that lead injected is immediately in most cases 22 excreted by the liver, but that lead inhaled enters into 23 the general circulation? 24 k You did not read it correctly, it is ingested. ;i. 25 g Yes, it is. 26 1H2PKRL3S: Lead ingested. _>1 o_ . n t -r'.?**** f\AOAuAj ------------------------v --------------- -DIM K1H0E: Is it not true. Doctor, that most author ities agree that 1 lead ingested Is Immediately for the moot part excreted 2 by the liver, and that lead inhaled enters Into the general 3 circulation? 4 That is not true. 5 6 That is not true? !Jo, load which is ingested is in a large part unabsorbed 7 and passes through the alimentary tract and is excreted 8 9 in the feces and a smaHl portion is absorbed and most of 10 that is absorbed goes fairly directly to the liver where it is for a time stored and subsequently distributed through 11 tissue of the body in accordance with the general pattern 12 which lead assumes because of its characteristics, load 13 14 which is absorbed by nay of the lungs enters the general circulation .aid, because it enters the general circulation , 15 16 only a portion of it is found in the liver, and under 17 those conditions the tissues of txie bony in general have 18 an opportunity to come in contact with this lead, and under 19 those conditions lead is more readily absorbed by the brain 20 and by the muscles and by other organisms than it 13 in 21 those cases in which it is ingested, and because of the 22 mechanism of lead absorption it ijiust go through the liver 23 until it is distributed in the general circulation. 24 {At this point the case was continued to 1;30 of the 25 same datefc, 26 (Afternoon session or March 2, 1938, beginning at 1;30 ?.M.) ;1 8WaW38f'2S0EK`: -43- DSTHLHFSEH: {69} Ul \ , '._U4 A.*.V/Jli 1 *11 right. 2 ?. J1TH1EF.3HN; Bactor, da you knovif the article., Volume 4, 3 as1 1928, Uniied states Veterans . bureau of Medical Bulletin 4 at -ares 147-148 entitled "Neuropsychiatric Disease", sith 5 history of onset following exposure to tetraethyl lead, 6 written by Dr, Paul S, Reynolds, United States Veterans* 7 Hospital. Perry Point, Maryland* Are you fmiliar with 8 that? 9 Ho, I am not. 10 toid I note at the end the references are "Tetraethyl lead 11 Poisoning"by Robert n. Kehoe, Journal A. II. n., July 11, 12 1925, and Public Health -Bulletin, No. 158, United Jtctes 13 Public Health Cervice. Have you ever road this article? 14 Ho, I have never seen or heard of this article until you 15 called lay attention to it c few moment's ago. 16 In view of the- fact that I want to read it info the record, 17 I believe there would be no objection; will you read a 18 portion of it and I will then take it up. 19 SFERSS I will undertake to read it. Counsel wants it all 20 in, however. Maybe we had better lake turns reading it. 21 U hSIELUFSHDJ: I can read the whole thing. 22 I, H021I: Let the doctor read it and leave it here so the reporte: 23 can copy it. 2< ,'FJSEE: Off the record. 2! D-ETHILFSSN: Let r:e read it,' Doctor. a -44- DO'Oj A-uiori: 4 "2SURCP5YCEIATBIO 41301,33 - (With Bis tory of onset 1 following exposure to Tetraethyl lead)* 2 "Paul Heynolt A, United States Veterans1 Hospital Perry Point, Uaryland. 3 Load lias been for many years one of the most important 4 occupational poisons*. Less than three 'rears ago the attention of the profession was directed toward tetra 5 ethyl lead. Tetraethyl lead about this tine was being added to gasoline and widely sold as a motor fuel under 6 various trade names. 7 "Tetraethyl lead is a heavy liquid (specific gravity 1.62) clear, with a sweetish edor. It is volatile at ordinary 8 temperatures and it decomposes in the sunlight with the formation of triethyl arid. 9 "The increased toxicity of tetraethyl load over the other 10 forms of lead is probably due to its physical properties, which permit rapid absorption through the shin and the 11 respirator;/" mucosa* Acute and even fat al results may occur from exposure to a high concentration of the vapor 12 for several working days, or from covering a large skin surface with 'the liquid. 'rod-acts of the oxidation of 13 tetraethyl lead, i/hich frequently are found in tetraethyl lead containers, nay be absorbed as dust ano are equally 14 toxic.' ~rPTTT 'Ald'Q [ 15 The carts I have rend is from Dr. ..oboe's writings in the 16 a * 1,1.A. Journal of July 11, 1925, that is right? 17 -" r A It is almost a verbatim quotation, and that is the reason 18 I have recognized it. 19 LR. DATHLLFDLK: (Continuing with his reading). 20 "The following case is of special interest because of its,, 21 resemblance to post-influenzal enceohalitie, another such case having been reported. 22 23 24 25 26 "C., a young 'white male, was admitted to United Utates Veterans' Hospital at ferry point, i.'d., on July 11,1926. Family history is negative, pre-war history unimportant save that he secured a degree of batchelor of science at Johns Hopkins in 1918, at the age of 21 years. Enlisted Kay 5, 1918; served overseas. He had a mild attack of influenza, and while serving with the Field Artillery injured his knee. Discharged ,-ugust 5, 1919. K fc 0022190 FORM 269 45377 -S7 *oM CALIFORNIA^*VAiB&r'' **- A *'*"0",a8^s6Ea6fi6; -45-  ih c s 1 "Onset: In November, 1924, ha v,--a3 working as a super visor in the experimental laboratory of a company en- 2 gaged in the manufacture of tetraethyl lead. He had been wording with tetraethyl lead for about three weeks 3 and during this time had boon exposed to the vapor of the liquid ana to the dust from the products of decom 4 position resulting from spilling of tetraethyl load on the floor. 5 ''Onset was with persistent frontal headache, vertigo, 6 and diplopia, almost complete insomnia was present, wiih sleep replaced by dreamlike states in which horrible 7 situations arose ms was sent to a hospital in the city where he was employed and remained there for two 'weeks. 8 :<hen he left the hospital ho .was quite 'weak and 3;ad shown no improvement except that the headache no longer troubled 9 him. The diplopia and insomnia continued in the name degree for two months and the insomnia did not entirely 10 disappear for five months, .Several months later he noticed that his movements hau become much slower .nd in 11 one year a definite slowing end change in his facial expression, but this came on so gradually he does not know 12 when it began, After the acute symptoms had. abated he had no deairs to attempt anything, lost all initiative 13 and desire for association with otters. He folt "too tired to want to fool with anyone," gave up his forrer 14 position, and spent his time at hone by reading and fishin until coming to this hospital. 15 ftPhysical examination is negative except for a deformity 16 of left hand (an- industrial injury) and a postoperative scar oil right knee. Blood fasoermann and cytology nagativ 17 Urinalysis negative. 18 "Neurological: There are no pupillary changes. Triceps, bleeps, tem&oachilles, abdominal, and cremasteric reflaxe5, 19 are present and respond within usual limits. Knee Jerks show a marked bilateral exaggerated response. Romberg, 20 Babinski, and ankle clonus not elicited, racial expressed is masklik and efforts to wrinkle forehead or frown 21 give rise to muscular twitching of face, smiling and whistling movements present, but not well controlled. All 22 movements are performed slowly. Speech is slow, decreasec 22 in quantity, and lips nr not mcloyed to the usual extent, speech is rather flat and lacks emphasis. Carriage is erect, but gait is slowed and body does not sway nor do j 24 the arms swing to the usual extent in walking. When he: | 21 looks from side to side he does no whenever possible without turning his head. No atrophies or marked muscular 2 weakness are present and no areas of anesthesia. * ** DATE (69) mi 1 'Mental examination: Thi3 man has lost Ms initiative and even Ms former desire to accomplish things. He 2 has a feeling of Ms responsibility to provide for Ms family, and worries because he feels he can ao nothing. 3 Ho keeps 'putting things off* and they are never rone, and he has made no plans for the future" 4 5 '-l 6 7 A 8 h 9 10 11 12 13 ,, 14 15 16 17 18 19 A 20 4 21 22 23 t 24 * 25 26 That is the first time you have heard of this particular article? Yes, probably. Do you know of your own knowledge now whether or not this particular case from Perry Point, Maryland, wao ever brought to your attention? I cannot be sure that it was, but it probably was, be sure because the name i3 not M'ced, i cannot Doctor, is it not true that the dilution of tetraethyl lead gasoline also largely diminishes the danger of lead inhalatio: the difference between the volatility of tetraethyl lead and various gasoline bases with which it is mixed are so great that approxixaately one-half the gasoline may be evaporated before lead can be found in the vapor? That is quite correct. What is the maximum part of a milligram of lead which may be-f present per 100 grams of canned food as contamination allowed for sale in the United States by the Federal Government? I am afraid I do not understand the question. 'What is the maximum part of a milligram that may bo present per 100 grams of canned food as contamination allowed for i -47 Hi. DJ2T31MF8&P' (69) ' .............. . ' ...... ,.... A. ------ -- - , , DDRR. 1 sale in the United States by tbs Federal Government? 2 A That is .256 milligrams per 100 Grains. 3 4, yell, Doctor, isn't it true that the Federal Government 4 permits foods to be sold and :nicked in A'ason jars in the 5 United States? 6 A Right. 7 4 Of the type you say tho specimens were given to Dr. Gertrude 8 floor? 9 a. aignt. 10 Is it true that a man may be poisoned as a result of inhala 11 tion of the vapor of tetraethyl lead and also as a result 12 of shin absorption? 13 A Gf tetraethyl lead? 14 15 A Quite. I have described a series of cases in which poison 16 ing resulted from that exposure to concentrated tetraethyl 17 load-?-----18 4 Tour answer is ----------19 A' Tea. 20 Q. Is it true that if a small portion of a rabbit shin was .ex 21 posed for 30 minutes to tetraethyl, 100 milligrams was 22 23 A found 30 days later in the carcass of the rabbit? That seems quite plausible. 24 0, In some of your experiments? 25 A 2 Did I cite such on experiment? Yes, we have the citation. --48 I'.'ii DYTHIS It (70) DR. DIHOE: 1 A Rail, il* I did, that is true. 2 q, That was cited in the American Journal of Hygiene, Tolune 13, 3 issue of 1931, in the vicinity of Page 478. 4 A Under ray name ? 5 f Yes. 6 a 'fall, yes, undoubtedly it is true. 7 i Is it true that in your experience when the rabbit was ex 8 posed fix four hours to tetraethyl load you found 30 days 9 later 9.27 milligrams of leal in iho animal1s carcass? 10 A That sounds up it plausible. 11 1 Is it true, Doctor, in one of your experiments you exposed 12 a rabbit shin to tetraethyl load for four hours and found 13 load in the excreta and the carcass for over a period of 14 thirty days? 15 A- That is true. 16 1 is it also true that the initial distribution of lead in 17 tissue in rapid tetraethyl lead absorption occurs and indi 18 cates same portion of tetraethyl is absarbed and circulates 19 as such? 20 A Yes, when it is applied to the skin that happens. ; Yf* 21 C, The nerves and brain ax*e largely composed of fatty substances" 22 A Yea, and as a consequence of that lead goes into the central 23 nervous system, which is the initial,distribution of tetra 24 ethyl lead poisoning v/here there is contact with either tliiw " 25 liquid or the vapor or concentrated metal. 26 HR, 0STHI,iSF3A&i_____--Iftys, ..when., tatreothyi--Lead--la,, diluted with-- (70) *TO. * `j-t- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 r\ 21 22 23 24 25 26 `.<u m gasoline, there is absorption through the skin? It is delayed or merely prevented, depending on the concen tration. la there a hazard of tetraethyl lead intoxication if proper precautions are not used in blending gasoline with tetra ethyl lead solution? -juite, because that involves the handlin,. of the concentrates material and cho precautions in connection with that occu pation are quite vigorous ana quite elaborate in their application and in their performance, lor instance, still operators are exposed to the possibilitie of tetraethyl intoxication? 'there? In the operation of the 3till, I presume* In a refinery? Yes. Ie never handle any tetraethyl in a refinery in the still and never have. You are speaking of. the article in which I refer----------- . (Interrupting) Yoluae 15, rage 306. I know what it is. fill you point that out and read it. referring to my discussion on the hazards of the manufacture of lead amongst men who are handling the still from whioh tetraethyl is distilled -- that is in oho manufacture of lead which is never done in -50- refinery. :-'jR r1 ~ iiiifBajtjirv.--K, 1 Then those ul 11 operators are subjected to the intoxication 2 of tetraethyl: 3 ~ii persona sfco are engaged in lha handling of tetraethyl 4 load la its concentrated form are exposed to hazards v;hlch 5 are very carefully hoot under surveillance# The purpose 6 of my study of tetraethyl lead -- of the concentrated mater 7 iel ,-- was to determine the extent of the hazards and to 8 .m tormina the precautions necessary to provide safety* I 9 util find the reference for you { fitness loohs dirough bo ole) 10 It Is in "Is Journal of Industrial hygiene in foliaae 15, 11 beginning on Tags 510* headed "The Lead ,;:crotioii of 12 v fotraothyl Load hixnufacturing Plant ; you 13 i c m\ " 14 No. No* f-:- 15 Till a human being excrete load in the urine if he or she 16 were never exposed to lead? 17 / V., I presume he would not, but I have never mown a si tost ion 18 ia which that was possible# V/o have boen attempting under 19 laboratory conditions to obtain a situation in which parsons 20 had no exposure whatever to lead, in order to see whether we.| 21 could ever see a situation in which load would not bo excrete# 22 and I have never found such a situation* 23 la one of your articles you have reported for a five-year '*4 observation you found that 22$ of still operators, 29*49 - 0 of blenders and 3'g of laboratory orlcers wore excreting be5 L tween 0.12 and 0#15 milligrams of lead per litre of urinet t4#&: j&e4fei' Ou.** SKt-3i1B5>5,i^H5gSfi5Si HR. OXTHlfFO lit (71) DR. XJJHOS: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 A 25 26 that is Volume 15, in the vicinity of _ age 311 or 312, is it; not, lector, .lags 309 I think it l a* 2 think your <iuotut,ioa or your statement is incorrect, do you mind roaring it again -- you *1*. >1^ \0 ething about 3^, there ;?as never any such thing as that* Twenty tvm per cent of still operators in the table at 309; do you wind if she points it out, hooter? (Referring to Jr. Chabanoif) This table to which you refer has to do with. the distribution of tho findings on fro urine of all tho ;semens studied over live years in i,ho raanufacruring plant and they 3 s if is d in percentages on the basis of their rate cf jscrction, the number nor cent which excreted lead vs ithii certain limits, is set down hare and the tot;. 1 list of values adds up to 100;j . That is distribution of various types of findings with: axxU X may nod oho t diG obsorva t i ons ma de on uk workers demonstrated that their load excretion was within the limits of normal persons not working in lead trades, whereas for every other group there was a definite elevation in the lead excretion above the normal levels, Jhat is the percentage you have there of laboratory workers, I said 3$, but I understand it is 8;?? fight per cent of what? Of the laboratory workers were excreting between 0,12 and 0.15 of lead for a litre of urine? Kvdpft* SHfSJ DATHLEYf :: (71) .OE: 1 Yes, that 8$ was one person, however. 2 Just one oerson? 3 4 5 ix 6 7 8 9 here there 5$ with 29$? There were twelve 8% and approximately one of 12. Does tetraethyl lead decompose so that only a small portion found later is in the form. of tetraethyl lead? Yes, most all lead is decomposed fairly promptly into some non--volatile compound,so that within a short time after the 10 absorption tetraethyl as such cannot be found in the circu 11 lating blood or tissue. 12 Ci It is true that tetraethyl lead poisoning is not different 13 from lead poisoning occasioned by other load compounds? 14 It is different in its initial manifestation in that it is 15 without exception an acute central nervous system intoxi 16 17 18 19 20 21 22 23 24 21 2 h cation with the decomposition of the lead compounds in the body, and with its subsequent redistribution into the tissues in a manner resembling that of ordinary lead poisoning, and the clinical picture becomes that of chronic lead poisoning, but the initial picture is so different from that of ordinary lead poisoning that it probably would not be identified as lead poisoning in the hands of any other than a person experienced in the handling of such cases. Is that what you set forth in your article, Volume 13, wage 478? A. Yes. nnd would you say there was no difference between it. DSTHLSPr"; (71) ds. 1 tetraethyl poisoning and or ciinary poisoning? 2 Ho, 1 would not say any such thin:;. 3 Could you pick out Toluiae 13, Page 478? 4 This is just a collection of reprints and that is the reason 5 it has no apparent order to it (witness going through hook). 6 Yes, what do you rant? 7 HCMH: (Interrupting) Doctor, doesn't it upset you or make 8 you nervous seatsu next to attorney Dethiefsen is Dr. 9 Cnabanoir, "ho during your cross-examination is making 10 motions and passing him a large and substantial number of 11 notes ant that a large majority of questions are in written 12 font during your cross-examination and are being made by 13 I>r. Chabanoff and handed to Hr, ho thiefsen? 14 * hJiTHH.YYEH: (Interrupting) Yhcy were written before com 15 ing here. 16 U IIONH: I have seen Dr. Chabanoff making a great many notes 17 and I would lime to know if it makes Dr. i'ehoa nervous? 18 It does not disturb me and I am very pleased to have Dr. 19 Chabanoff here. 20 'll. 2IS!HIr3M: Cell, Doctor, while I an waiting bore on 72) 21 that ono question, I will proceed to come other, you were 25 here, I believe, you testified in dan Francisco during the 22 lifetime of Hr.l 2< Yes, I believ-e in the summer of 1936. 2i Ana you testified at the previous hearing, did you? 2< Tec, i testified. ''VX%i -54- m. EOiO: 'r^-) DR. iQIHOE: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Q. 20 A 21 22 23 24 25 26 FORM 269 45377 -S7 <C'M CALIFORNIA STATS r>rr?*-r At a previous hearing? Yes, in die summer oi` 1936, during his lifetime. dAHLAJEiai: Q,. I am referring to that time. Yes. And prior to giving your testimony, did. you make a physical examination of Hr. IIo, 1 did not*, I never made a physical examination of him at any time. uhsn, or course, no physical findings of your own examinetion were mad by him at that time; you did not examine him? Ho, I only had my observations of him here in <;he room. You testified at t-li at time that I.lr.hid not suffer from toxic neuritis without examining him, and even though you had the opportunity to examine hire, didn't you? I think if you will look at the record, I think that you will see that I testified it was an opinion based upon the clinical findings as reported in the medical testimony, and ' I expressed an opinion on those. 1`rom the testimony as given by other doctors? Yes. Bather than on personal examination and observation of the patient? | Yes, rather on personal observation. How many cases have you treated suffering from chronic tetraethyl Intoxication? I have never treated or seen a patient with chronic tetraethvl lead poisoning. There have been no auoh cases to treat -55- 0022200 (72) '3-i# Oh.... j.iT* 1 So far as you knew? 2 X--S , C-J-* US u. -uiO^ 3 .bud this ease, if it were such, would to the first ease in 4 history? 5 Yes, a nodical curiosity. 6 .hid then it should be reported in the nodical literature? 7 ,.itk reservations. One dees not report tied!cal cases ordi 8 narily unless vie can report unassailable clinical and scien 9 tific evidence in proof of the diagnosis otherwise there 10 is no point in it. I nay say this, however, that if I 11 found a case of poisoning as the consequence of handling or 12 distribution of anyone using tetraethyl gasoline, I would 13 be the first to publish it in medical literature as a scien 14 tific curiosity, because that is precisely what I have been 15 looking for in the past fifteen years unsuccessfully. 16 '..'all, in this article I referred to, Volume 15, page 493, 17 you summarized the conclusions, first, that these experiments 18 show that tetraethyl load is absorbed through the skin; 19 second, the initial distribution of load in the tissues in 20 rapid tetraethyl lead absorption corresponds to an oily 21 soluble material and indicates thereafter that scene portion 22 of tetraethyl is absorbed and circulates as such; three, 23 however, tetraethyl is rapidly decomposed by the tissues, 24 including the skin, so that only f.i sms 11 portion is round 25 later in the blood, which is in the form of tetraethyl lead; 26 four, as a net rnyinlt. nft.ar_^ n-c *-KT.nr. n.,n------- -bo-- a. DBTSLEi'/'" :: (7S) OK. fino. 1 days of lead on animal tissue is distributed in a manner 2 characteristic of water soluble lead compounds; five, 3 in small dosages, the factors of rapid decomposition and 4 lower concentration in the blood so interfere with the dis 5 tribution of tetraethyl lead as such as to prevent Its 6 preliminary absorption by the nervous system; six, even 7 when absorbed as tetraethyl compounds, the excretion shows 8 a quantity of water soluble lead compound ; seven, totraethyj 9 lead poisoning is therefore not different from loud poisoning 10 occasioned by other lead compounds -- that is number 7 which 11 I have referred to? 12 Tea, X call your -attnation to the fact, however, that that 13 does not say that the clinical picture of tetraethyl load 14 poisoning .is not different from the clinical picture in 15 ordinary lead poisoning* fliat I have said there is that 16 tetraethyl load poisoning in principle is not different from 17 ordinary lead poisoning in that the active intoxication in 18 this instance as well as in the case of the inorganic portion 19 of the. load and not z'a& load compounds as a whole, and what 20 I have said there is just as true now as it was ./hen it was.,,, 21 written. Hay I cill your attention to one further conclusion 22 which wasn't stressed in reading. It happens to be ratter 23 an important matter with relation to gasoline exposure, if 24 there was such a thing* 25 1 quit with Paragraph 7 because I reached ay 26 point in Paragraph 6. If there is something there that_____ -57- ! 4^JtiSSis>SK i (72) DR. iOi \ 1 should be In the record I wish you could please read. it. 2 ho, that -,;as not my point. I simply asked to call the 3 referee's attention specifically to paragraph 5, which 4 happens to be an important point scientifically* "In 5 small dosages the factors oi` rapid decomposition and low 6 concentration in tile blood so . interferes with the distri 7 bution of tetraethyl as such as bo 02*0vent its preliminary 8 absorption by the nervous system. That is different from 9 the absorption of large uoses. 10 11 y. Doctor, is it true that in early stages in the use of gasolin 12 containing tetraethyl lead it ^ecu-ic apparent thus manu 13 facture of tetraethyl lead and -he elanding of &h<- oucen- 14 trated fluid for use in gasoline was a hazardous occupation 15 and a unique opportunity for the rapid development of lead 16 intoxication? 17 A You are again quoting me and that is correct. 18 Q, hould you find the article for me, American liedical ^ssooiati 19 Journal, Yolume 85, Page 108? 20 A That is the Journal of Industrial Hygiene and not the 21 However, I remember that statement. It occurred somev?here 22 in something I have written; that must have been the 23 American Journal of Hygiene. 24 II?. Dh'TIILuFJSN: fell, that is oil right. 25 A .Veil, let me see'it. It is somewhere (referring to cook). 26 ,Yhat was tha s<>ntsnnft ag&ln?-------------------------------------------------------------------------- 56--  SR. HCJIS: J^3) DP. UHHOS; I have tried not to interrupt the cross-examination , Vat is 1 far afield and I would like to point out that the ques 2 tions asked are dealing with the type of employment in 3 which hr. Telepnev wa3 not engaged arid dealing '.vith a sub 4 stance known as tetraethyl lead which Mr. Telepnev at no 5 time handled, and I have not wanted to object because it 6 has a certain indirect bearing on the mattar, but I think 7 Counsel is going far afield to inquire into tetraethyl lead, 8 which was not handled in any way by hr. Tolepnov. 9 IHFiiRHH: I have that in mind, but due to the fact that he did 10 handle gasoline containing this substance it would be a 11 little difficult for me to say it v;s sufficiently irrele 12 vant to refuse to hear it. 13 14 --1. HO.HS: I am simply saying that I think there should be some 15 limit going into the manufacture of this. 16 I 17 I did not seem to be able to find it (still referring to book); my answer is that it has never been denied by anyone, 16 and least of all by me, that the handling of concentrated IS tetraethyl lead in any and all places in which it is found 2( is a serious danger, and I have been equally emphatic in 2! saying in my experience and in all the experiments that 2: have been done by me, by the United Btatos Public Health 2: Service and the British Minister of Health, there is not the 2* slightest evidence that the handling of leaded gasoline has 21 the slightest hazard, rt has been investigated for f if teon 2 years with negative results. That is the whole story. I -59- W T.?r>*T r KAHOE: 1 2 3 4 5 6i may say chat not only is the evidence negative completely with regard to cases of lead poisoning but the evidence is entirely negative with regard to the absorption of lead under conditions of exposure to gasoline in any and all ways in which it la handled. I will '.rote you again to see whether you agree with, this 7 point: Zr it true that when the product of tetraethyl lead 8 emerges iron the laboratory scale into a recipient stage, c-. 9 cases of load poisoning occurred? 10 A Yes, I hove recited that many times. 11 w hell, I 1st you go on the direct examination. 12 A hell, l ron't -cant to be irritable. 13 0, But you are here as an expert for the Ethyl Corporation of 14 America? 15 MR. mm : ;?e object to that on the ground that the testimony 16 implies he is not here in such capacity. 17 BSFIiRlh: He is here as an expert. 18 MR. HOi;3: I will agree to that. - 19 A I do not want to be irritable; I am just getting tired of 20 the repetition. 21 MR. DETHLSFoAM: Yes, i know, and so is Dr* Chabanoff, and 22 nothing could be more lengthy than the cross-examination of 23 opposing counsel, but I want everything in the record. >.'e 24 25 A 26 believe one way and you believe another. i/hat I have written in this matter is precisely the same now as it was when I wrote it and there is no point at which t-Jt;" -60- ST EL2T32H| : (7-3) JJrl , *n.TAT.' 1 i have contradicted myself. 2 Gan printersr ink he contaminated by lead from the load 3 used in the printing process? 4 Yes, measurably. The load type disintegrates due to the 5 continual passage of ink over it and some of the particles, 6 particularly the oxide, gets into the ink. It is quite 7 definite that printing is a hazardous occupation because 8 it involves the handling of molten lead in rooms in which 9 a large number of linotvpo machines are in operation. This 10 is a hazard of such magnitude that special ventilation is 11 required. 12 SRMi g. in those linotype rooms where the lead is molten 13 to a certain extent, does the lead evaporate or volatilize 14 so that it may be inhaled by in individual? 15 Yes, the boiling point of lead is in the neighborhood of 16 900 degrees centigrade and the vapor present is appreciable 17 at any temperature in excess of 5Q0> a^s a consequence of and 18 v?hich when lead is inhaled in a melting pot/there is vapor 19 arising frem it in a variable amount,depending on the temperfi 20 ture at which it is kept, and for workers over such molten 21 pots in lead industries in this day a special ventilation 22 equipment is required to carry jho fumes over the -urface. 23 The amount of vapor depends on the temperature which is 24 maintained. LIB. HCIli: I take it that question was not asked as to this case 2? L but as a matter of information that you as referee in hnndli; -61- TTOVT?T JLi . ..CHIOS: cases ii ffor exit types.of lead cases 1 RSFSHSiS: I was merely 'sponging" a li ttle scientific explana 2 tion. 3 UR. .DSTHLSFSi-21: y. Jo you agree with. she statement contained 4 in the works of a xa&n named MeHeilly, -no states if a person 5 is once loaded he is always leaded? 6 a 7 I know i'r.hclfeilly quite well and I no very definitely dis agree ..-ith him. 8 -i 9 10 11 >Vho is Ilr, AcNeilly, by the way? A toxicologist at the University of Chicago, And' a nan wi th ability? 12 A man with considerable ability and for whom l have consider 13 able respect, but he has not had she experience in lead intoxication. 1 XL 15 Then you do not agree with the statement that I have just 16 stated that once leaded is always leaded? 17 I do not. 18 You know ho has made that statement? IS I Yes, I do; I have read his book. 2C Do you know the name of the book? 22 i Yes. 22 What is it? 22 i Industrial Toxicology; it is a new book, 24 ; When was it published? 21 i. The book I have in mind came out in November of this year, 2i IE, E0H2: November, 1937, you mean, last year? -62 Mil. HONiu: {JA) DR. OHG3: 1 2 3 4 5 6 7 8 9 10 11 12 Q 13 14 A 15 A 16 A 17 18 19 20 21 22 23 24 25 Q 26 Ye's, .ITU can place the late because it came in the course of a trial in Cincinnati, a murder trial in which I happened to be on one side and UcNoiily on the other. Da THLa Sa EN: c. Do you have disagreed with Mm before? Yes, publicly and privately. Mid you are familiar with Alice Hamilton's works? Quite. Do you recall she reports cases of lead poisoning that have occurred seventeen years after exposure? She cites literature to that effect, Vo c- C A. w O "V*/.b O And do you recall offhand vhat the name of the booh is which that is cited? lib, I can't, I am sorry to say. It is a fact she has made that statement? Yes. Dr. Haailton, for whean I have the greatest respect, has not been for a long time engaged in experimental work, but she has made very excellent reviews of the literature on this subject and of the literature in the whole field of industrial toxicology, and she recites the literature in some instances,drawing conclusions from it, and in some instances merely citing and pointing out what has been said. I have no way of knowing what Dp. Hamilton's opinion i3 on the subject. Are you familiar with any of the reports from Australia -33- USEBWCf'T: {74} DO! il s ii< 1 inhere a number or children were affected by 1 cad? 2 Yen, I know that very well. 3 i.nd that they all died from the results of nephritis? 4 Ho, I would not a av that. I would say that Gibs cat has worker 5 in that field and reported a series of cases of chronic 6 nephritis in children in which they demonstrated to their 7 own satisfaction that the occurrence of chronic nephritis 8 in children with a previous history of lead exposure, lead 9 absorption and lead poisoning was unusually high, and they 10 arrived at that conclusion, therefore, that chronic nephritis 11 was in part at least due to the previous history and previous 12 poisoning of these children, a conclusion which is contro 13 versial in the sense that though, they have cited, much, evidenc 14 in favor of it there has been corresponding evidence cited 15 by men who disagree with the point of view, who believe that 16 the conclusions have been unjustified. In this controversy 17 I must say I occupied a neutral position without being able 18 to arrive at a definite conclusion, I suspected, however, i 19 that the point is well taken, and that is the reason that 20 21 22 Q, 23 24 25 i 2( v lead poisoning in children Is a particularly pernicious disease of much too frequent occurrence. dell, Doctor, isn't it true that patients died from Vitamin B deficiency due to cardiac muscle degeneration and tlrt this organ is greatly enlarged? It is not necessarily enlarged; its function is interfered with but it is not necessarily enlarged; there may be a small DSTHUSITr (75) DH. ZTf\X? * 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1 15 A 16 17 0, 18 19 A 20 4 21 22 23 24 A 23 t 26 atrophic artery, well, t/ere are some doctors that are not, who disagree wit! your writings, your statement that a tester in a laboratory testing tetraethyl gasoline, that he is in a ron-kasardoua o ecu pat ion? If there is anyone who disagrees with me on this, I do not knowvwho it is, I think it is universally accepted at the present time' that this is not a hazardous occupation frost the ooint of view of lead# Three of them disagree with you in this case. not I am/speaking of doctors engaged in the regular practice of medicine, an spea king of doctors and investigators who have had th opportunity to study this problem and that in volves no criticism. To err is human, I understand that, doctor? Or having any contempt of my medical colleagues who spend their time practicing medicine. Do you know the four typical groups of paralyses from lead poisoning, due to lead poisoning? Bg pardon, has Alice Hamilton / classified a3 stating there are four typica groups of paralyses from lead poisoning, do you recull that in her works? I am sorry I do not and that does not make sense to me, fell, I will consult Dr. Chabanoff here and see if I can get it in more medical terms (Hr. 3ethiefsen speaking to Dr. 65 <** UR, DSTHiiuF3^'7* (75) nn .r:rrrfi^ . AJ\\ * Chabanoff out of die record). 1 EOHii: Q. ..'ell, isn't it rather unusual to ask a witness 2 on the other side to help you find, your medical references, 3 hr. Dethlefson, and if you want to aak a doctor to compare 4 his views with someone else, 1 think the ordinary procedure 5 would be to present the reference to the doctor, to give 6 hiis comments. I do this in the interests of saving time? 7 Hay I say in response to that that one could classify the 8 paralyses in nervous lesions in lead poisoning in a variety 9 of ways I nave no doubt whatever cJa ssif ication hr# 10 Hamilton made is a reasonable and plausible one, and I have 11 no essential disagreement v 1th hr. .-lice Hamilton. 12 13 'V:-.' t V -/ -.. j, nl J i,* Jr f How, getting down to j-ir. Arriving 14 at your conclusion, did you take into consideration that he in 1935 Had a pain, in the right leg ana right foot and 15 back pain and pain in the tip of his big toe? 16 17 HR. IlOlif: (Interrupting) Is there any such testimony? 18 HR. D27THL.3F3.SH: Yes, it is in the record. 19 HR. HOBS: I do not think it is an exact statement. 20 RSFEBSS: I am sure I don't remember exactly what it was and 21 if comparison shows it is an error I will militate against 22 it to that extent. 23 HR* DiSTHLlSFSBHr wall, I have it right here* Did. you take into 24 consideration when you were reviewing the entire file in 25 this case that when Hr* started to work for the 26 company, according to their own records, he was in perfect health? -66- A R.. DSTEIZKIN: (75) 'V'-? 4 * a it , -A-b.1.4W-U ft 1J 1 took Into account the record showing ho was accepted for 2 employment, unu I assumed lie was in a fairly good, state of 3 health. 4 The record shows ho was in a perfect state of health, doesn't 5 it? 6 1 would not be interested in what the record said in that 7 connection, because I do not believe it is usual to find a 8 man in & state of perfect health. I accept the fact that 9 he passed the examination. 10 Acceptable to the company? 11- And that makes Mia a reasonably lisalthy nan. 12 That while he was working with lead, doing from four to 13 eight distillations of tetraethyl gasoline for a period of 14 two years, e noticed he had pain in his ri:-;ht leg, his right 15 foot and back pain, and a pain in the tip of the big toe, 16 and he went to the company doctor -- you remember that, do | 17 you? 18 Yes, I remember the record fairly noil. 19 At that time wouldn't that give consideration to you that 20 there should be some consideration given to the fact that he % 21 might be subject to lead poisoning? 22- No, for the following reasons: That the conditions of 23 exposure under which Nr. Talepnev was working have never in 24 my experience produced a case of poisoning. Moreover, my j 2t observations have demonstrated to me beyond any doubt that 2C men working under these conditions with customary methods 67 sm- ilU QlSTHI^Fa^.': (75) DK. X3H03i and care ; > not -absorb lead as a c o d s queue of their expos 1 ure. I -tfcaii not, therefore, go against my years of exper 2 ience ana assume that this man had developed lead poisoning 3 as a consequence.of an exposure, which 1 know did not exist. 4 Moreover, la an adult the development of neuritis in the 5 lower extremities is totally unknown In relationuto tetra 6 ethyl load absorption and is . real in adults as strictly 7 differentiatod iron children in whon paralyses of the lower 8 extremities is not infrequent* 9 II. DdrHLUdhN; hud that he then continued working in the 10 laboratory doing the same type of tetraethyl testing up to 11 June. 1935, when lie had a foot drop: ;;oalunTt you take, to 12 gether with the history of pain in the right leg ana right 13 foot and the back pain, together with ths objective finding 14 of foot drop, plus the statement to you by Mr* Telepner that 13 he had constipation, ins crania and headaches, wouldn* t that 16 cause you to believe there might be same indication he was., 17 suffering from lead poisoning, or do you adhere to the prin 18 ciple that in your opinion upon making such tests it is 19 impossible to get lead poisoning and that you would rule out 20 everything, including the lead findings and symptoms as 21 given to you? 22 No. 23 3. HCllh: (Interrupting) I want t,o object to tho question, but 24 I think the doctor can answer it. 25 I know what he means. 26 58 MR. HOHEt (76) DR. KMHCE: la othur words, I would like for tlie record to show you 1 are not .pinq io answer the q_uo-.ition hut answer what Mr. 2 Dethlofsen believes lie has in mind in putting the question* 3 REFERS!.: Maybe you had better re frame the question. 4 a 5 I can answer it quite satisfactorily, I think. REFSRSS: All right, answer. 6 A I would feel quite certain that the lesion which you have 7 described under those conditions was not due to lead, ubsorp-- 8 tion. I would suspect, for reasons whioh I have r.oniioned, 9 that it was soars other condition, and in this instance I 10 would think particularly of arsenic poisoning since arsenic 11 io the ccKsaonest metallic agent which produces paralysis of 12 the lower extremities without evinenee of arsenic exposure, 13 however, and without permitting mysolf to a doctrinary 14 point of view, I would investigate such a case to determine 15 'whether or not lead was being excreted in abnormal quantities! 16 and. X would study every factor I could find to help in a * 17 diagnosis, which diagnoses in these cases are often difficult 18 I would exclude every possibility I ooulc think of that 19 would produce such a lesion; perhaps successfully. 20 21 c 4 This has been an interesting case, would you have corse in at^ 22 23 A H outsat? I have been very glad to have studied this man and tried to see what I bould do Mr him. 2 Is it not true that in arsenic nouritis, both sensory and L2 motor nerves arc affected? -39-  T> '.*< * n riT7T W - '.J. :ij xXi.eX..L . - - { (76) 'YP m^t-Tnir * - J / # .'.liiivl vij s suite commonly, and. that is the situation in this case. This T man had both sensory and motor disturbances, 2 had paralyses also o o d c s from lead ooisoiiing, from nrw* 3 exposed to lead poisoning* 4 Paralysis, particularly of the upper extremities, in adults, 5 and particularly of the arms. 6 3. D THLErSSi?; v,. Do you agree with the four classifications 7 as set forth in Industrial Poisons in the United states,by 8 Alice Hamilton, at Page 62, Chapter 5? 9 sf5'ive varieties are generally recognized, following the 10 classification introduced by 23ae.' Dejorino-Klumpke (2), 11 12 13 14 15 16 17 18 19 20 21 22 0, 22 A "first is the antibrachial type which involves the exten sors of the wrist and fingers;, with the supinator escaping. Second is the brachial type which involves the deltoid, biceps, braehialis anticus, and the long supinator; and tills is sometimes called the scapulo-huiaeral form and nay be primary or may follow the antibrachial. Third is the aran-Duchenne type of amyotrophy. i e., a more or less rapid atrophy of the small muscles of the hand which begins in the thenar eminence, then involves the interos seous and hypothenar muscles with flattening of the hand, the thaain de singe,r and then, as atrophy progresses and the middle and nail fingers flex, the *main en griffe* a a > results. The fourth type is the peroneal, which, accor ding to Tanqueral, is the type seen in IS cases to 100 cases of type one. This type of palsy attacks the exten sors of the toes, the peroneal muscles, and sometimes the tibialis anticus; moreover it is also bilateral, symmet rical, and is attended with loss of tendinous reflexes. The fifth is the very rare laryngeal type described by 3eiffert in 1884 and later by Korell Mackenzie, btieglitz, deDchweinitz, and others," Do you agree with that? j I. think it is a fair statement of the types of paralyses 2< 2 21 that are seen. In my own. experience paralysis of the . > lower extremities is not as frequent as Dr. Hamilton has indicated, but 1 call your attention to the fact that she ll ,r i ,yj --70-- a. 'il!w' *u\ 1 states c,i paralyses are bilateral involving both -;.ecis > 2 that md ar often associated with paralysis ..i* the 3 upper :r.; comities, very large and overwhelming propor 4 tion or ..j. cases of paralyses in adults, that is in lead. 5 poisonin.% involves the upper extremities, as nr, noiailtoil 6 indicate!, nu in children the rovers is true, in that 7 palsies the lower extremities aro quite frequent 8 ^THi^r:. : D.Z you Icnow a text boon written by -r. ..olomon? 9 I know t is such a book, but X ;n not very familiar with 10 it, 11 ./ho is he? 12 Pharmocolt^ist, believe, in Ct. Louis or Cleveland, I 13 am. not sure that :: know of Ilia, 14 x)o you agree with, him whsn he states in kis book, 72$ 15 cases of lead poisoning ropes?t oonsti oexionv 16 It seams l&usible. 17 and 5o> backache? 18 It seems plausible. 19 Ain 5($ joint pains? 20 A That seems a bit high, but it is plausible, 21 iifhat would be your expression on that? 22 bell, arthralgia occurs sometimes in a fairly large number 23 of cases; it is possible. 24 Colic 5Ip/; 2E Yes, perhaps jjtlOX G frequently than that. 26 _ Headaches in the frontal region 46>c? ___________ ____ m -71- R. DSTHUSFSS*: (77) ( D3i 101 1 I doubt it. 2 what would be your expression? 3 dell, I have not considered that symptom very important* 4 actually I have not referred to the frequency cf its 5 occurrence. Let me see vhat I have said on the subject. 6 (Witness at thi3 point referring to book). I have headache 7 in tetraethyl poisoning in 3;i of the cases* 8 -aid bon about lead in the urine? Q K* It is universally and uniformly present in all cases of lead 10 poisoning during the active stages of intoxication and in 11 all -nor::.::.! persons * 12 Ana high-blood pressure 39, do you agree with that? 13 No, that is not an important symptom in lead poisoning; that 14 is the evidence of blood vessel disease and occurs with the 15 frequency with which blood vessel disease is found amongst 16 persona with lead t>oisoning. 17 What is your expression? 18 In tetraethyl lead intoxication, low blood-pressure is 19 always a constant finding during tha active period of intoxi- 20 cation, almost constant, and is one of the more frequent 21 findings. 22 Pain in the chest 35&, do you agree with Dr. -oloiaan? 23 I do not think it is important* 2! 2 ill* Diii Ji kL>.r* -V. (77) /* DR. K2H02: bitter taste ana a nasty taste, out only by leading question^ 11 I can \?e get them to admit it is a net a Hie taste* 2 4 And the blue line in the gums in 14> of cases? 3 That 7,-ould depend entirely on the stage of the case. Load 4 line is found ?/ith a high degree of frequency in cases of 5 ordinary lead poisoning and during the period of exposure 6 and during the period of active symptomatology, but it tends 7 to disappear with come rapidity; that is to say usually over 8 a period of a few weeks to two or three months until the 9 cessation of exposure. 10 -*nd stippling in the blood cells 12^ ? 11 In my experience stippling during the active phase of the 12 symptomatology is a substantial consistent finding except 13 in oases of acuta fulminating tetraethyl lead poisoning 14 15 where the symptoms corn? on so rapidly as a result of nervous 16 system absorption that the distribution of lead in the tissue 17 or blood generally has not had time to occur. 18 I offer In evidence at this time a textbook of medicine by 19 Russell L. Cecil, Assistant Professor of Clinical Medicine 20 in Cornell University and Assistant Visiting physician to 21 Bellevue Hospital, Hew York City, 2nd Edition, and the 22 article entitled "Lead Poisoning," starting at Page 536 and 23 ending at the bottom of Page 541, together with the reference^ 24 therein appended* 21 BHFSRISS: Do you want to put me in physical possession of that 2 book? -73- iSR. DSTHLSF&SN: (78) DR. KEHCE: r ; 1 ' iuiii ' 1 I thought it could be copied in the record* 2 RSFhRAE: Yes* Will you be satisfied with, having that copied 3 in the record? 4 ICR. DETHLSFSSSj ` x:v ; " ' r ,:1 ;* ';X OO! -'.'.Vi % j 3^-S'I V, /-O :^` ` 5 REFEREE:. All'right* it i is 80 understood andr ordered that the 6 reporter will copy the cited, pages frcarthe cited book into 7 the record* - 8 "A TS23JBOOK OF MEDICINE BY AMRRICAN ...UTEORS, Edited by Russell 1. Cecil, A*. B*H* -D.So. D* Assistant Professor 9 of Clinical Medicine in Cornell-University; Assistant ' Visiting Fhysioiaa. tO i^Bellevua Sospital, New York City, 10 "LEAD POISOHING: Ever since lead has been used in industry 11 and the. arts.lead poisoning has been a well-known occu pational disease, ihysiolans of the Middle Ages associated 12 colic and, anemia with the poison, but to Tanquerel des Planches. 11831) belongs tha credit of first correlating all 13 the jBaanifestations. of the-Intcucication* It is now known that the *.blood,r striated and/smooth muscle, and the nervous 14 system are,.;most . strikingly, affected* and that the disease is usually associated with inhalation of the dust of lead 15 or of its, compounds, , and; with; the ingestion of contaminated foods, and Mttlids* ' a a;. n.? --.olid 16 , ul' o. .' -r/'-i , ::.a oj.5;>.>:' "Incidences Although lead-poisoning is still the most im 17 portant of all industrial> diseases, the relative frequency of occurrence is far lower thah it was fifteen years ago* 1 18 ThArecent iworkiOf ? Oliver? andriegge in England and of "-tui Alice Hamilton in'America hasiproved that prevention is 19 possible | andiassapresuit >o^the< legislation and factory ^ improvement iacitedvby;,?l!heirfinvestigations the number of 20 cases in industryois rapidly deollhing. About one hundred and fifty industries involve some exposure to lead. The 21 dusty trades are the most hazardous and include the manu facture of white and red;leadv*of' storags batteries,' and of pottery* as well as painting^printing; and the mixing of rubber* Ua- Mm- , :.r : ? "Etiology: Outside of industry lead poisoning is infrequent. Recently the preparation by amateurs of wines and ll$&fn/, which contain lead alloys-has caused soma plumbism in the'-* United States* Many, years ago this was such a common cause of poisoning in the elder district: of Devonshire that Devonshire colic* became a well-known disease*_________________ KS om-z^iri) RkFSRDH: {7P/* -v DR, r. v j -7V-w7j7L ov , -V la the sixteenth century T0olica Pictonma* was epidemic 1 in Prance near Poiters, and later this was found to be caused by the lead added to wine to prevent souring. On 2 standing, wine thus treated, could not turn to vinegar 3 because the lead reacted to form lead acetate* 4 "Other less frequent causes of plumbism are the drinking of rather acid water in which lead pipe has been immersed; the 5 use of hair dyes or cosmeticsj the sucking of painted toys; and the ingestion of lead salts vjith suicidal intent or 6 to cause abortion. The amount of lead which enters the organism need not be large to prodtice/f$f$(ons, as in a 7 case of poisoning recently reported after the ingestion of 1.33 gca. of lead"acetate (less than 750 agnu of metallic 8 lead)* 9 "It is now known that lead nay bo absorbed from the gastro intestinal tract, from the respiratory tract, ana even 10 from die mucous membranes of the no so and mouth* The respiratory tract is the more dangerous path of entry, 11 because, while a majority of -he lead absorbed from the gastro-intestinal tract is caught by the liver and excreted 12 that absorbed by the respiratory tract enters at once into the circulation and is distributed throughout the organism* 13 dubcutanecus or intramuscular deposits of lead enter the blood-stream so very slowly that intoxication from bullets, 14 if it occurs at all, is very rare* Absorption of inorganic lead salts from the skin is probably negligible* 15 "Lead is a cumulative poison because it is stored in rela tively large amounts in the solid portion of the bones. lint: 16 it is liberated from the skeleton this deposit does no harm. 17 During absorption, the blood-stream carries lead to all : the organs, especially to the bones, liver, kidneys, and 18 intestines. After active absorption has ceased almost all the lead in the body (mere than 95 per cent) is to be found ^in the bones, from which it is excreted extremely slowly. 19 Symptoms of lead poisoning appear when lead is circulating 20 throughout the organism as a result either of absorption froi outside sources or of liberation from the deposit in the - op 21 bones. 22 "There are three possible paths for the excretion of lead from the body - the gastro-intestinal tract, the kidneys, 23 and perhaps the skin. The larger part of lead eliminated is in the feces, but the fact ;must beckept in mind that 24 during active absorption of lead the feces also contain sons which has been ingested but has never been absorbed.'' 25 The amounts of lead excreted in urine are usually very small but even after exposure to load has ceased this slow 26 elimination (usually a fraction of a milligram per day) may bp\ERIB: (78l DB Epplfcfc. .a w 1 continue slcin isyet'-prows^^ $%& .* '; * " > -'-vsi xa- we*** ;sfcv,.-v - '.. >._4- 2 Morbid' thb,t ak 'kyauoewX&M&kl inei--~ . 3 dene o^^w]Loii-ldiwi^iv:^Mr^0\ intersti^i^a^. Aopiiritis, gastPie/uloei!>,:''-%aid:''%iTt4osis:''bf- thfe liver*-ars ff^imd in lead 4 wartfomiv- Tfc* ieie*-#h&tis: *r;e? $aid $o* degenerate u^alsy usually follows*^^neratiy^^g~ ancl^ 5 ______^___ __. ,, _______ __ ~,r-irJr tatty, 6 and 'the rouscl':'!'tlW#4irir,|ti^4^''l9 `gfadually ^replaced by, fibrous material* 'There*ife^ndaother ` dOfini ta 'pathologic. changes* ;.. - ,.; ,, -.i,-,are*iore,, -'* ' " 7 ioa r3ymx?tcm8: ;-Acute'Poiseding* - True acute poisoning Is to be. 8 seen'only after the suddfn ingestion of larga-dcaes of lead* In animals the synipttstS 'are yOHiiting 'and collapse,, and: * .l;x\ 9 there may be;; a* peripheral. dbel&tiaii Ion 'gif large,^uaatitieshbf red blood-cells acfcsxKapsnied' hy'i'.abute anemia nn^isometiaiea 10 by hemoglobinuria* i;:'`^hV:toarke'4^Q4Q3re-i weakaes^-''JLoss ofhas appetite * diarrhea, 'and tiay resul%<4ii death :ox 11 in a-more chronic type of'i^iabpiii^* In very, susoeptibiatm.individuals the `onset pay "he id, and intense after only a 12 slight exposure! Thisj: 'isf sal lad acue leadtar poisoning, although the eymptotas., are those cf b.the,Sire ;,& i 13 chronio* lype*> Lead' colio pay develop after exposure of only a few days, and pay be as3hoiathi^with, constipation or r 14 sometimes^ id th diarrhea* * Sayers^, aaesaia may* o ocur:*ix t -2 and very*rarely| -;miid nervous,, di^ttnrhe^oeis*'./, 15 "Chronic Poisoning'?- ' In chronic pltunbiam the patient usually 16 suffers from great weakness and .lassitude, obstinate cpnetf-j pation, and often from intense 401101 peculiar.jpaety^ 17 appearance'of th^^^kln" is' quit 4ihhari'c^4:*?!3tic^ ol:" the- conditioen*/;v' iT&hee>"-WWee^^errdbl' f'feeaattuurrees -peculiaLr\t}6to l"er~ad*ifh4 toxiri? * 18 ; cation 'will:'lier#*hk^yebfcsdae'r*^ < ,- feiV.: - -v> *.< --* ' 19 w (a) Changes la the- ^Lopd* - ' ' v&d*,of,, "Me .e arli&at ..videnees of and* 'jamh^r.vjwil^. 20 redi;helli^-'ih. %he^.^iyetS&Jfras ''hl.bo dl'' :Aa1`iS^ei4; destruction ;Of a erythrocytes^in'the'psripheralclrculailoiida"^ 1:: 21 by ihhreas^^'ycoddot'ic^'it>f'&$ . *",. 'Th^^'ounterlwJ^dinaLL of the"loas;-of*^ph>' iaarrbsr> . 22 activiiy*paihthi^#he;*eel3r'i^tny abbv^:^*j^l>y 4-minion f .' cell:''pef' 'cubic i^-piai'ier'thht ,aneniiar'rM UfueJ^y^^nbt^as 23 severe: as^ the^pall^ri; ofthhr-p'jMlbntVwa;ddtlhl4^^^ Beeent.; n investigations * of' i|!a pap,hanis|dl, ofj destru^tioa;,of:SbXaod^^ 24 have shoim that- leadviraaets with, the inorganiO' phosphateto t fora insoluble lead^ynosidiate' and: acid on, the , surface 25 of the cells*; 'Thia^flpders the., cells iLnolasti<Hand^*,.K brittle^ so : that theyi^#' probably broken mbrereaeily'than ;c, 26 normal celiy by the trduaia suffered in circulation* . 9 /9v> i1 -76- ; i:--v r.RSFEBS3: (7 DP. KEEOE: -v,------------------------ '*The nost characteristic change in the blood is the appear 1 ance of * stippling*, a punctate basophilia granulation in the cells which is best demonstrated by dilute Unnas 2 alkaline methylene-blue stain. This appears during absorption and may continue for many months after absorp-v 3 tion of lead has ceased. Stippled cells are probably degenerating young reticulated cells. Their presence 4 in the blood is not absolutely pathognomonic of lead poisoning, as a few may be found in cases of pernicious 5 anemia, leukemia, and sometimes even in normal blood, but such lerge numbers as 100 per million red cells do 6 not appear in adult3 in any disease except lead Intoxication, stippling is, therefore, one of the reliable criteria for 7 establishing the diagnosis of lead absorption. 8 (b) The *Lead Line.* - The *lead line* on the gums is a second important sign of plumbism, and is very valuable in 9 making a diagnosis. It is due to a deposit of lead sulphide about the blood-vessels in the tips of the papillae, and 10 therefore appears most plainly about pyorrheic gums, ./hen examined with a lens it has a punctate appearance and is 11 seen to lie a little below the margin of the gum. A piece of paper inserted between the gum and tooth distinguishea 12 stippling from staining of the tooth root. The peculiar localization distinguishes this from the other pigmentations 13 of the mouth which are more diffuse. The lead line is practically pathognomonic of load absorption, but not of poisoning. It may persist for many months after exposure to lead has ceased. It must be distinguished only from the line produced by bismuth. " (c) Colic. - Abdominal colic is also a common early mani- , fest&tlon of lead intoxication, and occasionally occurs in susceptible people after only a slight exposure. It is usually preceded by constipation and indefinite abdominal pain, 'while the character of this colic in individual cases varies greatly, it is usually very intense and pro longed. The pain which is generally felt below the umbilicus is often relieved by pressure,* During attacks the abdomen is scaphoid in shape, not tender to pressure, and while resistant, shows no evidences of true abdominal muscle spasm. Probably paroxysms of pain occur when peri staltic waves approach areas of marked tonic spasm in"the intestines. This lead colic is often Yery difficult to differentiate from an acute abdominal inflammation; but diagnosis is aided usually by other signs of lead poisoning* It should also be remembered that in lead poisoning the white count is only slightly increased , if at all, that ther is a relative lymphocytosis , and usually no fever. The intense pain in most cases stops within about a week after absorption of lead has ceased, but may be remittent far some time thereafter. " 77. *mS:: {? DH *i KEHOfi: * {d) * falsyi Saifl&toft* * 24$&oIjtiU, ^bixtr'bt tfia'5^ 1 ay&btom wof; In 1834 5anquerel- ides PJihehei jreported'" 1 tr bciurfed inv 10* v. 2 par cent of the1; li$0'iOSSss> he fckilrSkaaineft: it "'Us' aoir;f ,' relatively fare; beoSiS*'-ef ijE^rovaaaaati^ia- In&khtMal:K;f^ 3 proe^ssea^A^eSai^t^aateess^iaA^tfeiK^tSTal^ preeedjlf'** tho ` ae tuhionseir of:jrslyeis.. v $hlsHremprf~ whl cht Is sa? 4 Bbgy f:ely#U- ftnhdai-nrgasi'ahd^hbt iiilyf; shsrvean&?dtoihmj^.*k*> it&o#Hf^I-hli?g1bdermIPonfsfthraet'e"'d^^ w 5 paralysl*#whlch'kiay*Jiiielr*'iS simll&rMfb* firipber^neuritis ahd':l:';,dsualLil7':irlioid:1lai-; onsit iiiriir'-pbfalbir^'^Onbft&jfits, Yery 6 strikift^eharseteristlijr^l^its aest,"!dsbd:!tB&sble?dt*^<;1ib^ithb",b0aldi%:J-ofi?;^e;- vtisw^^ 7 and1-fingerSH* the-hia^liiandHre first-?aitaeicedsln:- a: ***& ' startlingly specific manner producing the characteristic 8 fipger-and-wrist-drop. Paralysis may. also appear in the- . peroneal ' muscles of-ytie-' lege'4 and * produce"1 a' s.teppa^r-:'jgait'|" ja 9 and - oOeasionall^^ife4 tie" hack end yob : Optic neuritis1 la known to1 occurAfter'' absorption of-1 eetd; st bps i^ftmetion 10 may; be - reecm^ed witMh- several" weeks*4 but usually; there is-'gradual', improyei^i*; for. many "months i^^tt'erposu'sa tb1-' 11 the pots cat- continuesvparalysis-may 'be- permanent and progressive, and may simulate a progressive muscular 12 atrophyi^;-;:j'-.? vv't-c; -ft v.-i y:'^.L-':`'\!y>i., -tpos^."i4 tut - * ...'j L.t .!.-' ~.i v-'.S' c.fives'-tt'jrj,)" 13 e| ``SftyOhbii'is^ A in'aahy;; case#'ofleak'^^isoning'1 there is mild hental; depression^ while occasionally transient ir<! i5i;! 14 delirium'^and- cohvulelilhs. o# j^teqpicd^'jbt^eekiff'-ob^r/T'ISd^: cases'- she#-severer eeaifepal* i#rolvemeht - charaoteriked1 by" -: 15 aaTIwd^deiftslOi&^bui^Sttj^e^eddin^ to-'1 convulsion1 and^dbraS in This liaaiUtbH^^ ip? i'tS^ 16 clinlc-ffl^'feanlfesbat;iteb|_ thobjSli the-'-WUsaeimaim' reautioxfls'...- no# positlvei^-1^ - e*ty*&e **. f y an*-* oai * +*!& rb^;, .XSftpij|5CSr;- *sx - 4 -i- -&$k. li^X* t^uu^i-y'ySpbrtb^ii?5^ a .<.. -says. v.* -..c\ $&&. *,* m tips$1**1*,.. lablli tyv ,sf- '.JttV ikbridW iahi-^bsiatl'^Qs or*ie&r^ifibfepifp^ by-- th',ContihudJ^Oti^ilfi-.,thsi;'leadJatrOUEfi^is1'' s'aid;tox-1sb'>^el hypertrophy of the heart, . -f*iry^>sf.sj cun.tsatEulivn;.xc'>d nQiq^iofflff'lt`,^hffr;biagnCMs1t lead?^lifei54Siglr'iif`^oft-i difficult because evidence of aliOrptiott-without sighs of abtukl"^ M222?*i REFERE KEHOE: intoxication may frequently be observed. Usually, unless 1 at least two symptoms characteristic of the poisoning appear, a definite diagnosis of plumb ism should not be 2 made. The best evidence of intoxication is narked stlplling of the red cells; but lead line, colic, constipation, 3 anemia, muscle weakness, and wrist-drop are also important. The excretion of lead in the urine and feces is also very 4 significant* A. majority of the lead excreted is to be found in the feces, but its presence is of little diagnostic 5 value unless all possibility of swallowing lead has been removed, lead in the urine, however, always denotes 6 that absorption has occurred. Excretion may continue long after exposure has ceased; it merely proves that lead has 7 been absorbed by the organism, and is riot in itself a proof of intoxication. 8 'Final diagnosis depends upon all of these consii orations, bu 9 usually requires at least two of the described features, although in some cases both the lead line and slight 10 stippling appear in workers without other evidences of poisoning, marked anemia, colic, or nervous lesions are 11 usually deciding factors in diagnosis. 12 rc JvLive^ ad poisoning often appears after prolonged exposure, but sometimes even after exposure has ceased. This tardy develo 13 meat of symptoms is probably caused by liberation of the load deposit in the D OH G V/ 11 X- oh occurs during severe illness 14 or alcoholic debauches. It has also been reported, rarely, after taking potassium iodide. Thus if lead is held harm 15 lessly within the body some change in the general metabolism may precipitate an attack of poisoning. The disease should 16 alv'/ays be thought of in acute abdominal crises, as it Is not infrequently the cause of unnecessary surgery. > i- 17 "Prognosis: The prognosis depends upon the type of synptoms. 18 Colic usually disappears within a few days with suitable treatment, while anemia, constipation, and general debility IS hang on for many weeks. Palsy disappears very slowly, and in some cases iappermanent Severe psychoses are often fataJ 2C but they may become chronic, and in rate cases they disappear promptly and completely. The mild depression, which is so 23 common a symptom, is lost.as other acute symptoms subside. 2S "Prophylaxis; Dust and the contamination of food and tobacco are the most common sources of poisoning at the present time, 2c If proper precautions are taken by workmen and employers to>^ avoid all dust hazards by suitable ventilation, aided by 2-? the use of respirators, intoxication may be very largely ... j prevented. The incidence of poisoning among painters may be 21 greatly reduced by the xise of sand-paper whioh can be moistened. Clean hands and clean places to eat must be 2i 79- aSFkRES: i?P rDR. KHiOS 1 insisted upon. The toxicity of lead varies so much 'with individuals that no definite prediction may be made as to 2 the amount which will cause syapterns of poisoning to appear, although Leggs states that a continued absorption of more 3 than 2 mga. per day may produce intoxication. 4 "Treatiaant: Relief of the severe colic of lead poisoning often demands much medical ingenuity. Amyl nitrite or nitro> 5 glycerin frequently brings prompt relief, also atropine in large doses, or intravenous calcium chloride. A hot-water 6 bottle may be comforting. If diagnosis is certain, a saline cathartic or an enema is also desirable. Uorphina is rarely 7 necessary to relieve the pain. 8 "After the subsidence of acute symptoms the purpose of the treatment is to gradually eliminate lead from the body. 9 Bines it was first recommended by Melsens in 1840, potassium iodidehas been employed to increase the excretion of lead. 10 Because it is said to precipitate occasionally acute symptoms, the initial doses should not exceed 1 ga. per day, 11 and the amount should then gradually be increased. 12 "Recently, a nexv method of treatment has been developed which| is dependent upon the parallel metabolism of load unci calciun 13 (Aub and Minot). When patients are sufferin'-'; from lead colic a prompt relief may be obtained by the slow injection of 14 sterile calcium chloride solution. Ten to fifteen cc. of a 5 per cent solution is injected intravenously over a period 15 of five minutes. After the pain has been relieved by this method a strenuous cathartic is given. In acute cases a. 16 diet containing much calcium should be given* This con sists of 2 quarts of milk and 3 gm. cf calcium lactate v 17 daily, and tends to reduce the excretion of lead. After disappearance of acute symptoms such a diet should be 18 replaced by one containing as little calcium as possible. With this, large doses of phosporic acid or of ammonium 19 chloride should be given to produce a negative calcium balance and thus tend to liberate lead from the bones. 2C "Saline cathartics have long been recommended to relieve 23 constipation. They probably do not increase the excretion of lead. Treatment for the anemia of lead poisoning should 2S be like that for any secondary anemia. Palsy best responds to galvanic current and massage and should be treated like 22 a peripheral neuritis. Disappearance of the acute symotoms 2l of pluabism does not signify that the disease is cured^. Treatment to stimulate elimination of lead and to regulate A-' the bowels should be continued for a long tine after the 2i more distressing symptoms have been alleviated. 2! >80 : ifZi*.1 ViK ajsrsaiE;~(? 1 "It is always desirable for a patient suffering from say qf,. 1 ther< *yaptojaarttcleatopoisoning id afdS*ther mp&svrf. to lead. J03RPH C., AUB." 2 cru'cacr -t-i-hyl .i S > MR. D53?HLE?33H: And thi3 article is signed "Joseph C. hub," 3 -vr ~ ,.r. -:.;r :OOi;bi;aax ia*. c l v v.:V 4 A & 6 A 7 t/ho is he, a doctor? :: re split `rp- 1'is.to its' ^v: cogent- >'ar\s : Z>r. Aub is in the physiology Department of Harvard universit+i Martafili^ l&ad'tmd': raA^-suv- > . And he has written some books on lead poisoning? .. 4 '-a.' 1% hsraT.4? ,:. Yes,- quite considerable, ,;oc- it -. V:\-. r-o.v/, no, .-I' In. 'p^'-o aitloaro wie 0. And he is an authority on the subject? . 8 I c-d ailed cvsp'L?' .?*atur.c * 'cc G.*seri,S?,Ku- i.o cu >**** 9 A Yes,^ X think on opposes, Dr.^Mb is yer^ fin^^ , MR. DRTKLSJoIH: That is all,.. . 10 i <;. o-iibirifs VXtk :.;c .?,> V'?.i<.;'. Ri , . , .. . rac..j ;>* *- vccj +, . vu 11 A Dr. .*ub and I are in definite disagreement recorded, in v-'"'xY 12 laedical literaturp on certain phases of these subjects, par- 13 $rqatmqji$ of. lead..poisoningrj^lth, reepeftt .tqt*i 14 ffe. PR ft!?**** 15 I? Wl??ftiSn*aS.R?vfa;lRj-1PP.:8Sf?.:*R.oiaiers' ! 16 iliSFARiSA; I. have a few questions, ,, .. . ,. , V7 4 f 18 19 20 l| '! 21 I Hon. I*r. Kehoe, as I understand, it, tetraethyl lead is a * ra.tt.or fox-^fiftoasiy u?on - ho 'tc.tt 2h=5ivraial chooeimp.i,cat*l'osaja.ult,its"ancootm/ bination, of the lead and the ethyl radi- cal;-, is that right? . ,. 11-=`sonars cait^-5 lr&Wb3,fr: that- . r. i.isurs is,. j ic :; Yea, it is a liquid, lead compound, 4but could perhaps bast. . a^-iinito ana ora^ny manner^ ...a-.; c.ufk . ?mai 22 23 l[i Ancdiowthiefy taerteraecthaeym.iically, McomibjKin^eedf.?bed, or o^.ew:ar 24 ^ i ?,fa sp 25 26 .. j radicals and lead are? ! c-cevt .' *;: `fi-i'.od ag -3-. K E" 0022225U DR. _^H03 [ 1 Four ef-tSyl radical to one lead, hence the na_ie ''tetraethyl," 2 which means four ethyl lead, . 3 Now if the chemical salts or combination of tetraethyl lead 4 is decomposed or split up into its component parts are ! 5 metallic lead and the ethyl radical , will fine .-metallic ! 6 lead be liberated? 7 Not in the body, no. It is quite probable, although the 8 detailed chemical steps cannot be described accurately, 9 that the ethyl radicals will oxidize, leaving ionic lead 10 to combine with free radicals which may be available in the 11 body. 12 Forming some variety4--------- 13 (Interrupting) Forming 3ome compound of lead with the materia, 14 available in the body, whether salts or protein or what, IS would be at this time essentially speculative. 1 And what particular combinations might be formed would depend S.; 17 rather fortuitously upon the physiology of that individial 16 body, would it not? IS It seems quite probable that the decomposition occurs in a 2( definite and orderly manner, but the precise nature of the 2: chemical steps simply cannot be Stated at this time, because 2! of technical difficulties of settling that information. 2: How if tetraethyl lead is ingested or otherwise taken into 2 the living human body in small quantities over a long period ' 2 of time, will free metallic lead be liberated in that living 2 body? t 4 -82- RAiThREE: ( { ..0. -r * . # 1 ho, I think it is practically certain that free :.r.otallie 2 load in not even found in the 11 Tints body, except then 3 there are ballets or shot in the tissue, 4 and in conformity with your belief, your opinion would be 5 it is liberated in soma fora of ionic lean, v/hich combines 6 with none or the other radicals composing part of tho body 7 tissue? 8 Yos, some evidence has been obtained that it occurs in cm- 9 lunation rich phosphorus. The organic compounds of phosphor^ 10 in the tissue is not cults clear, 11 ire all forms of lead cumulative poison. 12 The queotior. as to whether lead is cumulative or not depends 13 in largo .vasure upon. the quantities actually taken into 14 the body. That is to say whether the body oat .handle and 15 eliminate load depends on tho amount actually absorbed into 16 the tissue. That is to noroe degree a theory.* 17 Yes. 18 But that point of view is : in kamony with the facts. 19 And what is the General belief or definition of a cumulativ 20 poison? 21 A poison which accumulates in the tissues and tends to in 22 crease in amount as the consequences of failure in sane way 23 of the eliminative prooes3* 24 3o individuals vary in their capacity to ingest lead in sm 25 quantities over a long period of time without manifesting 26 toxic symptoms? M -83- 1SFSHSS: (79) c TB, .IEH0I 1 fhat again depends on the quantity, the quantity which is 2 toxic dor one individual nay not bo toxic dor another 3 individual and vice versa. On tie 01..v.r land, it lias been 4 amply shown that if the quantities bo small enough no toxic 5 effect is produced in any individual either in good health 6 or diseased, fhat la to 3 ay it is 11.0 quite generally 7 accepted the.t load is absorbed by all persons of all ages 8 tain that lead is excreted by sill persons; obviously, then, 9 one must regard lead as a normal element to which we are 10 exposed in our environments, ana yet load poisoning does 11 not occur in the general population except as a result of 12 wha t may be called , for lack of a better qualitative infor 13 al, in abnormal amounts* 14 oOIilO OX m illise questions chX* G X* 0.0 i i iJ1 uOiig f buu I think you 15 can follow them. Is it not a fact that *is' ix. G mymptoms of 16 disease or the symptoms manifested by a slow cumulative 17 poisoning vary almost as widely as do individuals vary 18 in the various ways they do vary and almost as much as the 19 possible variations of the physiological processes within 2C the living body, according to age, the condition of health,j 2] or disease of the various organs of the living body, the 2J face, the temperament, heredity, personal and hereditary 2: antecedents of the individual, the tolerance or idiosyncrasy 2< to a drug or poison, the physical reserves.. end psychiat ric state of the individual during the time ho is subjected 2 to the disease or drug? 1 '< WSg (7f IB S'ZEDS: I think 1 tm quite clear on whot you ask in substance and 1 xttmH-! 5 - t* u-Tf sail up there is unfortunately all true, but 2 within certain very definite Units. The question of 3 susceptibility to load as the result of the variances 4 postulated your question has been regarded for a long lime 5 as a very great, factor, not only in the ooccurrence of poiaon4 6 lug hut in the nature of the clinical picture which develops 7 when poisoning occurs. Only within roe-nt years have we 8 be coins quite certain that lead poisoning does not occur 9 below certain ranges of actual lend intake, and our Industrie 10 hygiene experience and practice has proven, I believe, 11 beyond all doubt that if the lead exposure is within certain 12 Units oases of poisoning will not occur even in the more 13 14 susceptible persons* i lore over, since re have boon able 15 to ohow by chenical naans the distribution of load in the 16 tissues and in the excreta of persons abnormally exposed to 17 lead the precise clinical pattern of lead poisoning has 18 lent itself to soma considerable classification, and there 19 isn't as much variation in the picture as we had previously 20 believed, and this classification n&s cone out of the fact 21 that it is non possible to determine whether a nan has in 22 his body abnormal quentites of lead, whereas previously 22 because of lack of adequate r.tsthod3 one had to assume that 24 when there us3 exposure of whatever hypothetical magnitude 25 2( L I it might be that anything which arose out of that exposure might be due to the exposure and to the absorption itself* -85- 7>SV X K3H0E: A 1 That is to say we s?ere compelled because of the lack of adequate scientific facilities to assume that if an illness 2 3 occurred during a hypothetical exposure, that it occurred 4 as a consequence of that exposure when as a. natter of fact 5 that argument is obviously without the merit of accuracy. 6 This problem, I may say, will not be entirely classified 7 7/ithout a great deal more experimental work. 8 In gasoline,'it is a central nervous system poisoning? 9 Yes, it is. Gasoline in. the atmosphere, in concentration 10 of one end one-half par cent is an immediate intoxicant and 11 anesthetic, and at such concentration people become drunk 12 and quickly uneonsoious. Joncentration as low as one-half 13 in the atmosphere, definite symptoms of vertigo and headache 14 and drunkenness, not wholly unlike- that of alcoholism, are 15 seen. 16 Do the symptoms produced by the ingestion of load or other 17 wise taking into the living body of lead in such quantities ;*> 18 that if the period of exposure was loss than two or three 19 years, you would say that there was no danger to the man 20 exposed thereto, but an exposure to an amount of ingestion 21 or otherwise taken in, if continued over a period of ten 22 years, would expose the man so exposed to the dangers of lea< 23 intoxication, vary from the symptoms produced by the exposure 2.4 to such an amount of ingestion or load otherwise taking in , '-h 4 25 of lead as to produce symptoms of lead intoxication in 2i a period of six months to one year? -as- ( PA \ ^r P. 222102: / 1__________ ;______________ That, Mr. Referee, is a controversial point whether -ha 1 exposure which is capable of producing lead poisoning in sir 2 months or two years or three years can produce ouch a poison 3 if extended on to eight or ten or twelve years is definitely 4 controversial. So much is that the case that with reference 5 to exposure to leaded gasoline on the part of the public, 6 experimental observations are still under way, despite tie 7 negative evidence of almost fifteen years in the cne of 8 ren who have been, in my opinion, the- most heavily exposed 9 persons, that is to say, garage mechanics, filling station 10 attendants, tank-wagon distributors of gasoline* ..e are 11 just now engaged in some further studies of men under these 12 conditions of exposure, who to our knowledge and under our 13 supervision hare been carrying on worn involving this type 14 of exposure since 1923* As yet not only have we been unable 15 to find any evidence of lead intoxication in such persons, 16 but we have been quite unable to find any elevation in their 17 lead excretions. Now in order to settle that problem with 18 a finality which could be scarcely questioned, even by the 19 most skeptical, we confidently anticipate making analyses 20 21 of tissues of such persons as may die within our own lifetime, if wo are able to maintain circumstances under which those 22 tissues can be obtained; the opportunity has not ye'k presented 22 24 itself in the case of persons exposed longer than four or "" 25 five years, particularly because of the labor turnover in 26 these fields of activity, but we do have a group of men now _I7_ j) .-JUt wi (S^> m, IthllOS: under observat ion who have ho an steadily in this work since 1 the first introduction of leaded gasoline in ccnmeroial use, 2 and fortunately for us that occurred in Cincinnati, in 3 Dayton and Cincinnati, and its environments, no thr-t there 4 are non in our immediate vicinity the most exposed and longesp 5 exposed persons in connection with this public health hazard* 6 Is tier any data that would enable you to say 7 how long symptoms of lead intoxication would be deferred uherja 8 the ingestion, or otherwise taking in is in such small quanti* 9 ties as not to produce symptoms within a period of five 10 years? 11 I am sorry, but I will have to ask you to read that over* 12 (question fead) 13 '-.'all, some of my own observations cc the lead trades, which 14 is fairly extensive, I urn extremely skeptical of the develop 15 ment of symptoms in men who have continued without illness * 16 17 and without obvious evidence of abnormal lead absorption evert 18 & period of five years, and X may say that latent lead poisoning in the sense of symptoms and signs and illness and | 1[ 2( injury developing following the cessation of exposure, that y is entirely after the exposure has been ended and after as -1 2! long as three months thoreaft* in my experience such cases do not occur, I have not seen a! single one in an experience of fifteen years, and that involves some thousands of persons in continuous hazardous lead exposure. I mean in the regular lead trades. tlFiil; <er as. Is it a fact, Doctor, that toxicologists generally agree 1 that there are some individuals so susceptible tc .erne poiso* 2 that they would be seriously Injured or even killed by a dos$ 3 so saaall that it would not adversely affect the orail::.ary 4 individual at all? 5 6 That point of view is held, I am quits confident, by many 7 men ana perhaps even particularly with relation to load 8 compounds. On the other buna, that point of view with 9 reference to those very minute quantities such as ora normal 10 to our diet mid are normal to our environment,exclusive of 11 the occupational factors, is definitely no longer tenable, 12 since it has been shown quite clearly that not only do we no* 13 take in daily measurable quantities of lead, but that we have 14 done so since cur birth in our normal food and in the variety 15 of other minute contaminations of our food with loud com 16 pounds from a very large number of sources* I think one can 17 say confidently that lead poisoning does not occur in the 18 general population amongst the healthy or amongst -ha ill, IS except as a consequence of exposure Lhat is measurably large! 2C than that to which we are normally exposed. 2] Tell, since we are all involved in taking in a certain amount 2' if on individual had an idiosyncrasy to lead and the normal 2: amount he took in by his food cud other means were augmented additional small quantities, would he be in danger?, additional quantity were of sufficient agnitude he Ly point of view, however, is that that ' .onid have t< 3 S*t*3TMs .R9- rMiv,:ixM  be of suck a magnitude as to go entirely outside the 1 experience of the most unfortunately situated person in the 2 modern community, i'iio safety factor in lead absorption is, 3 in my opinion, certainly larger than :;e have previously 4 believed,and that conclusion has been forced upon me by 5 6 years of experience in which I have been able to show with accuracy what has gone into the body and what has come out* 7 8 In other words, susceptibility, in my opinion, is not any thing like the important factor we believe it to be, that I 9 10 myself believed it to be ten years ago* 11 0, Do individual metabolic and dietetic factors influence the 12 length of time during which lead intoxication as the result 13 of hie ingestion or otherwise taking in of such minute | 14 quantities over such a long period of time, -..oulu symptoms j i 15 be delayed far more than fire years or longer delayed? 2) ; 16 `They probably do. Dietary factors almost certainly influence 17 the rate at which lead is excreted from the body. Incldetttf-'*' 18 ally they also influence very strikingly.the rate at which 19 lead is taken into the body,for on a selected diet one could 20 double or treble the lead content of his noimal diet, in 21 my opinion any lead exposure to be regarded as significant 22 from the point of view of intoxication must be sufficiently 23 above the range of normal experience to give a demonstrably 24 elevated urinary lead excretion and a demonstrably elevated 25 lead concentration in the blood. I say that because over 26 the period of years in which I have been studying lead -90 xKJ \ poisoning I have not found a case with active symptomology 1 without a definite elevation of the lead in the body, as 2 3 shown by the lead content of che blood and of the urine* You have no doubt, I suppose, that if a nan died of uremia--- 4 A {Interrupting) I am only entitled to one doubt on that 5 score, and I don't Know to what extent to give that weight* 6 7 The necropsy as reported makes mention of a yellow atrophy of the liver. Now yellow atrophy of the liver is not a 8 9 very frequent finding and I presume it means that there was a fatty degeneration, of the liver. Inch degenerative cases 10 are seen, in ay experience, only in a relatively few disease 11 processes,in which the most important is phosphorus poisoning 12 13 and the next most important is arsenic poisoning, and the next most important are a group of organic sulphates, in- j 14 15 eluding chloroform, carbontetrachloride, and I don't know 16 what to make of that finding in the record, but I suspect it 17 is merely a prolonged degenerative process related in some 18 way to the terminal serious illness, with circulatory dis 19 turbance, and so forth, but I don't know quite what to 20 make of that -- it puzzles me somewhat. 21 And you are not all certain as to what the cause of death wa* 22 I think it is logical to conclude, because of Dr. Reeves' 22 extensive experience, that death was from uremia, secondary . 24 chronic nephritis, and Dr.-Reeves himself had regarded this j 21 finding as rather unimportant and merely evidence of the 2 presence of a chronic degenerative disease. I think this is 91 2RE3: (.32) / DR. TTinv 1 by large the most logical conclusion. Incidentally, the 2 fatty degeneration of the liver and yellow atrophy has never 3 been described in relationship with lead poisoning, either. 4 tetraethyl or ordinary lead. 5 1 Sould it be your opinion that it is within the'realm of 6 possibilities that four doses of bismuth injection aaiainis- 7 tered by a physician for the treatment of a syphillitic 8 infection could have caused secondarily the uremia? 9 A I thins not,because of the long time factor intervening. It 10 Is certainly highly improbable. It is nox impossible, 11 ho?/ever. 12 I Do you think it could have caused the liver condition observ 13 A I doubt that also, for the same reason. I would expect an 14 overwhelming portion of the bismuth to have been eliminated 15 from the body during that time interval, 16 d, Isn't it a fact that recent chemical processes have made it Ml'' 17 possible to entirely eliminate the arsenic from bismuth 18 and that arsenic that was formerly the cause of toxic effect; 19 that were attributed to bismuth? 20 A No, I would not say that; I have seen a rather large series < 21 cases treated with bismuth, more in one person than another, 22 and although arsenic very definitely produces more bad 23 reactions and more evidence of intoxication than does bis 24 muth, bismuth, through bismuth injections,has produced > 25 rather striking symptoms when the dosage has been high. In 26 this country the general practice is to use much lower & 92 K E 0022238 vj B, HONS s DR. \~'r'p7>~ %\ A Yesr i have. 1 And the chrase *tetraethyl lead" refers to the concentrated 2 fluid? 3 n Yes, to the chemical compound, to tetraethyl in its un 4 diluted form. 5 And gasoline containing lead or containing tetraethyl lead 6 refers to a fluid in which .gasoline and tetraethyl load 7 are mixed? 8 In concentrations, yes, not in excess of the commercial con 9 centrations. 10 And these commercial concentrations go up as high as one 11 part of lead in 75 parts of gasoline, as testified to by LET* 12 Llittleman, that is correct? 13 . It is not within my knowledge to say whether it is correct 14 or not; I can say quite definitely that the concentrations 15 do not exceed one part in 1260, because no such concentretic 16 have ever been available commercial ly. 17 g, Summarising your answers to a great many questions, you fee 18 that there are no hazards or dangers or significant exposure 19 20 or danger of the absorption into the body or tissues of 21 significant cuantites of lead, or any other harmful conse- 22 quences from the handling of leaded gasoline? 23 MR. DDTHUiJDDN: Objected to as not being proper on the testla< 24 MR. HOMS j I am trying to put 50 questions into one. . 25 J.1A. DETEIZFSKN: Dq will withdraw the objection. i 26 A .It is my very definite opinion with the handling of leaded a liiitP* d: . DETHLEFS3N: DR. r;rv;? 1 gasoline in any and all the ways in which it may "be handled 2 is without danger to persons: so engaged; that, X nay say, 3 has been the burden of sane fifteen years of experimental 4 study, critically examined by experts in this country and 5 abroad in an effort to determine whether there is any actual 6 danger either to the public or to persons employed in the 7 occupations which require exposure to leaded gasoline, and 8 ny answer is very definitely "no." If my answer wore to 9 the contrary I would convict myself of an entire willingness 10 to see a large portion of the population, including myself, 11 seriously disabled by lead poisoning, for this is a public 12 health problem that involves millions of people in the world 13 I'r. Telepnev did not handle concentrated fluid of tetraethyl 14 osTKlImSEHt (Interrupting) How docs he know* 15 K0!$S: 86 far as the record of this case discloses; he has 16 read the entire record of the case. 17 ;KmX: I don't think the record shows he ever handled any 18 19 A pure tetraethyl. You can answer it. From my understanding of the record, or from any other infor 20 mation that I may have, I have no reason to believe that Mr 21 KHMflHMfc ever handled the concentrated fluid. 22 m. KOHE: Q. With regard to your experience and the medical 23 literature on the subject of leaded gasoline, so far as you 24 know all the medical literature confirms the opinions you-: ; 25 have given in this case? 26 I believe that is the case. There vier& some opinions * -95- .. HONE: f^) DR. K3E0.S: 1 2 3 4 5 6 7 8 *i 9A 10 11 expressed to the contrary in the earlier and more contro versial period of the discussion on this public health subject, but the opinions of all of the investigators in this field, whether governmental or otherwise, are in agree ment in saying they have failed to find evidence of danger of lead absorption from the handling and use of leaded gasoline in the commercial concentrations. hhat, if ay, is your interest in this case? I have no interest except that of a person who has been engaged in this field of work for many years in saying what I believe ;.o be true in this record. 12 You have given as your opinion that hr. did not 13 suffer from lead poisoning and aid not die therefrom; going further., is it your opinion that hr, UHlV work and 14 15 employment,as described in this case and as shown by the 16 record, contributed in any way to any of his disability or 17 to his death? 18 a Insofar as lead exposure is concerned, i am entirely con 19 vinced that his occupation in no way contributed to his 20 illness or to his death, for the reason that in my opinion 21 he did not absorb lead as a consequence of his occupation* 22 A The referee has asked you a number of questions, asking you 23 to take into account a number of different speculations and 24 circumstances, including the time clement and the quantity, 25 absorbed over a large number of years and variations in 26 individuals, etc. I am asking again a moot question; in m *96 1^1 i R. KSHOJS: 1 2 3 4 5 6 7 8A 9 10 11 12 13 14 reaching your opinion which you have given in this case, did you take into consideration those various factors; in other v;ord3, prior to giving your opinions in this case, had you taken into consideration these various factors mentioned by the referee, and then,notwithatandi ng these factors, you still gave your opinion that Hr. (BflNB uid no^ suffer from lead poisoning? iS3, quite. I have taken those factors into account in arriving at ray judgment in this instance, do that if ail the questions which were asked you in this case regarding the nature of his exposure aria whether or not there was any danger to him from his work, and if I woul specifically name each and all of those various circumstance referred to by the referee, your answers and opinions would 15 have been the same? 16 A Precisely. 17 C; I am doing this to avoid going through it again. ` ;1 18 HR. DAfHLEFSSH: It is all right. 19 B27fi53: It is all right. 20 JfR. HOE!: Q, You gave a number of answers .involving qualifi- 21 cations that such results would not show unless 22 had been exposed to significant amounts of lead; is it your 23 opinion that Hr. not exposed as the result of 24 25 A his employment to significant amounts of lead? i. It is my very definite opinion. I probably used the ^orgai 26 "'exposed" quite frequently in the general sense of hypotheti ---------------------------------=3T=--------- ---------------- :--------------------------------- ii! (8) /pH. K1H02: 1 exposure, but when I speak of significant exposure si tin 2 *a reran cc iase I meant in raj' opinion there 3 vms no measurable exposure to lead in M3 occupation. 4 In your opinion, i3 there anything in this record which would 5 indicate to you th &* Hxl? * absorbed in any manner 6 quantities of lead which became cumulative and accumulated 7 in Ms body over a period of time? 8 Ho, there is no evidence which I can accept as competent to 9 demonstrate that Hr. at *dny time accumulated lead 10 in his body as a consequence of his repeated small exposures 11 In connection with the book by Mice Hamilton referred to on 12 cross-examination, is there any mention in that book of tetra 13 ethyl lead or leaded gasoline? 14 I believe there is, either in this edition or in the second. 15 With respect to Alice Hamilton's reference to cases of lead 16 poisoning seventeen years after exposure, would you let me 17 have your comments, I wasn't quite clear on that. In other 18 wards, you have given seme testimony here in which the perioc 19 of eighteen months wa3 given as a significant period? 20 I think one could probably find in the literature references, 21 to what is known as "latent lead poisoning," in which certei i 22 symptoms suggestive of lead poisoning occur many years after 23 the cessation of exposure; obviously, in those case the ques* 24 tion of diagnosis is in issue, and in many instances has .be 25 a very controversial issue. In citing the literature, one 2t would naturally refer to such cases, citing the reference m -88- jjgfe&v '/*} 1 2 3 4 5 6 7 8 9 10 11 12 13 14 A for what It is worth, perhaps recognizing that In many instances the diagnosis was not substantiated as it would be required in these days with sore accurate i ethods of observation. The whole question, therefore, r latent lead poisoning in the sense of regarding such cases as evidence, is not much hotter than speculative. You have- testified on croas-exanin ation t hat tetraethel may bo absorbed through the skin, and in that connection you referred to the concentrated fluid, is th at correct? -ia. Is there any chance, in your opinion, th where lead in gasoline is spilled or otherwise cones i outact with the skin that lead nay not be absorbed us ah result of that? There has been no change in my opinion us the result of 15 further study of this problem, 16 w ho far us you know, is there any conflict between the 17 18 19 A opinion you have given in this case and all of th literal ture and writings which you have written and published? There is no 3uch conflict. 20 h In regard to the testimony given on crosa-esamination relating 21 to the parsons handling tetraethyl lead, all of those exper 22 iences occurred in connection with the handling of concen 21 trated fluid? To g , that is true. 2 \ *nd the statistics which wore given were in connection with 5 1 \lead poisoning -nd workers with tetraethyl lead were all at; ~:t X S, E0itd: (5 ) DR. KEHCE: 1 places where oho concen'crated lead was handled, ana :ot the 2 leaded gasoline? 3 d Tea, that is correct, 4 nd that was in the manufacturl ng process? 5 6 U.3 the reference to a laboratory worker was with reference 7 GO laboratory worker handling concentrated tetraethyl lead? 8 IC3 actually engaged in the operations incident to the manu 9 facture of cho product. 10 i -tad your reports and findings in connection vith the examina 11 tion of still operators and laboratory -vor era,after five 12 years operations,were with those working v, th the concentrated 13 fluid? 14 That i3 right. 15 I &&& with them even you found no case of lead poisoning and 16 nothing above some concentrated lead excretions? 17 * >; were able to set up conditions of control for eliminating 18 cases of lead poisoning from that occupation, IS with reference to experiments on rabbits, that involved the 2C concentrated fluid, is that not true? 2] i Dome of them. * 2S <- ones referred to in the cross-jexamination? 21 t The ones referred to were all referred to experiments with 24 the concentrated tetraethyl. 21 , And that is not gasoline containing tetraethyl lead? 2i . That is not, but there were in the saas articlesreferences to EONS: {^' f w j Li experimental work which demonstrated in my own mind clearly lj tliat lead was not involved when animals were subjected to 2; gasoline containing commercial concentrations of tetraethyl 3 lead. 4 In your opinion, v?as there any lead in significant quantities 5 in the air in the laboratory in which. 6 worked? No, obviously not; that is ray opinion, 7 8 ERNE: I think I asked you, did you ever visit this labor4 tory? 9 10 I did not visit that particular laboratory, no, I did not, 11 I know the methods generally used from general knowledge, 5R< HONE: 12 is your opinion that the death of Mr. xs com pletely explainable independent of lead? 13 Yes, adequately so. 14 15 It is your opinion that there was no significant contact or exposure of hlr.jmm^to lead? 16 17 Yes, in the course of his occupation. 18 It is your opinion that Mr. couJ-(i &ot and did not 19 inhale sufficient, if any, lead vapors to cause any of hi3 20 symptoms or any disability? 21 That is my opinion, yes. 22 Or to contribute thereto? 22 Yes, that is my opinion. 24 Or to aggravate or exacerbate any disability he may other-*;, - 2E wise have had? 2< That is my opinion. :p --101-- HOME: ( b e ^. OR. ASHQaSx. 1 It is your opinion that the picture of Mr, case 2 is the opposite or at least differs in many material res 3 pects from the typical picture of lead poisoning? 4 It is my opinion that the condition suffered by Mr. lelepnev 5 was distinctly atypical, that is to say not typical of lead 6 intoxication. 7 In a typical case of established lead intoxication, where 8 on proper urinalysis as far as loan is foynd, what quantity 9 10 11 12 13 14 15 Q, 16 17 18 A 19 q 20 21 22 23 A 24 v.roulci. you expect to find, what quantity of load would you expect zo find in the urine under the 'worst conditions? The quantity found under conditions of abnormal exposure vary with the severitj/ of the exposure from one-tenth of a milligram per litre of urine. It poos as high as *6 or rarely .7 milligrams per litre. And what is the highest you could possibly account for as presenting a true picture of load content without contami nation? I esa afraid I do not understand the question. The last figure which you gave of .6 milligrams per litre as high as you could reasonably expect to find as a true : ; a picture of excess of lead vrithout contamination of the sample examined? Yes, in my experience that reaches a high concentration, as high a concentration that would be expected under the most 26 h severe conditions of lead exposure. And anything higher than that ould indicate what to you? ssSS -102- 1a 2 3 4 5t 6 7 8 9i 10 : 11 12 Anything grossly above that level roui-d strongly suggest aonteaaination from. the sample to me to such an extent that I would want to check the result - before drawing a con clusion from it. The fact that you find as a cause of death uremia secondary to interstitial nephritis, without any further finding as to the cause either of the uremia, if it is interstitial nephritis, there is nothing unusual in that? That is not an uncommon necropsy finding ana diagnosis# And would there be any reason, in your mind based upon the fact that the causes of these disabilities are not definite ly ascertained to ascribe such cause to lead poisoning be- 13 14 15 16 17 18 19 2C I 23 for a number of years in the laboratory under the conditions present in this case? Obviously not. I have definitely concluded his occupation had nothing to do with the development of this disease process, and this disease process in conditions in which there was no possible ocoupat ional exposure. And finally, Doctor, taking into consideration now everything you know about this case, including various hypotheses and 2< speculations and circumstances which either might have been 2: present or were supposed to be present,, or merely presumed 2' to be present, including those which Ur. he thiefsen has v-^yj 2 suggested and the referee has suggested and I have suggested, 2 \ is it your final opinion that Hr. did not absorb :^ -v' LB. HONS: (36) l DE. IGSHOJE: -v- 1 2 3 4 5 ii 6 7 8 9 either in small quantities daily or otherwise quantities of lead oyer a period of several years such as to produoe a case of lead poisoning, or such as to cause his disabilities or any of them, or as to cause his death? I say without any reservation that I do not believe 35Sr# IPHSPHFsuffered any disability or injury frcei lead as a consequence of his occupation either as a primary, secondary or contributary factor in his illness and death. That is all. 10 RhjrLRLi: I believe you testified a little while ago that some 11 authorities of some eminence held the theory that nephritis 12 was one of the common concomitants of the result of lead 13 poisoning, didn't you? 14 A .Yes, I quoted Lockhart Gibson as believing that in children 15 chronic nephritis could come and, in his opinion, did come 16 from a previous existing lead intoxication* Authorities 17 disagree with him on that point, but that is his opinion. *- / 18 IS?. HONE: Q, But in this case you do not believe it aid? 19 A It did not, definitely. 20 $ In fact, that is your opinion, it did not. 21 Ah. DATEILl'didi: That, has been gone into a hundred and eighty-feu 22 time s. 23 A It is my opinion it did not, because in my opinion he did 24 not absorb lead as a consequence of his occupation* ^ tVv;;. 25 i.'.ti, D^fl'BLEFSM: it And that Is the basis of your opinion, that 26 lead cannot be ubsorbed? ... <; 104' (86) --------^--------------------------------------------------- r DB iviuHOS; 1 A It Is not vlie whole 'oasis of my conclusions, 'out is an 2 3' important factor in my cone lus ion$ J HONE: I would like it understood', that our offering of 4 testimony in this case is not a waiver of, hut if anything 5 is In support of all the defenses which we have raised, and 6 in that connection I call particular attention to the de 7 fense raised In our answer that this whole matter is 8 res adjudicatehat this Commission has already passed 9 upon -whether or not the disability of Hr. arose 10 out of or in the course of hi3 employment and decided that 11 they did not, and that there is only one cause of action and I 12 that, therefore, the Commission 'would be without authority 13 to find that the disability complained of arose out of or 14 in the course of the employment, and therefore that the 15 death resulting from the disability was compensable under 16 the Act* fh] 17 \EFE31SE: Mr* Klessig raised the lack of Jurisdiction to this . *1 18 death claim on account of the other claim being re&sadjudoatej 19 cE, KCNE: I imagine you would have Jurisdiction to hear the 2C claim, but I do not think an award contrary to the previoui'f 21 award would be proper. 2 hiF;;REE: If I were in your place I would probably regard it 25 that way, too. 2< f1 :? rr-c t m't 2i 2( -105-