Document JBMdXBML6E9njBddM6Qpdey6

July 10, 1964 Sir Theodore Fox, M.A., M.D., F.R.C.P. Editor, The Lancet 7 Adam Street, Adelphi London W.C. 2, England , Dear Sir: My attention has been called to a preliminary communication by Doctors Olga Gutniak, Haliva Koziolowa, and Edward Kowalski (May 23), in which certain statements are made which are so out of accord with the experience of many years in the experimental and clinical consideration of intoxication by tetraethyllead as to be truly remarkable. In the title of the communication the reference to "Chronic Tetra-ethyl Lead Poisoning" takes for granted the existence of such a syndrome, which is strange, since in forty years of experience, neither I nor any of my associates 'tatS's seen any but an acute form of tetraethyllead intoxication. This, however, is only a minor and perhaps a semantic deviation^ in view of the strikingly casual statement that 11 patients (presumably suffering from "chronic"tetraethyllead poisoning) were "drivers (of cars) or workers in car workshops, and had been exposed to the fumes of tetraethyllead petrol for more than eight years." Repetitive and detailed investigations of the handlers of "tetraethyllead petrol," in the United States, from time to time over the period since 1923, when leaded gasoline was first introduced upon the market, have failed to locate a single individual, among the thousands of persons in these occupations, who had developed symptoms of tetraethyllead intoxication, or who, for that matter, had absorbed demonstrable quantities of lead. And yet the authors report the finding of lead in the blood of the patients who were suffering from "chronid' tetraethyllead poisoning, in quantities ranging from 62 to 155 micrograms per 100 milliliters. No such quantity of lead has been found in the blood in acute, fatal tetraethyllead intoxication. Indeed, it has been mare that the concentration has exceeded 50 micrograms of lead per 100 grams of whole blood. This is an important distinguishing feature in the differential diagnosis of tetraethyllead intoxication. There is no obvious reason to quarrel with the observations made by these investigators in the pursuit of their objective of investigating certain hematological phenomena in human blood. There is something obviously faulty, however, in relating their findings^in this respect, to the absorption of tetraethyllead. KET 0006348 Sir Theodore Fox, M.A., M.D., F.R.C.P. - (2) - July 10, 1964 The fact that the findings in this group of patients were negative, while not unexpected under the circumstances, is beside the point. RAK:vr Robert A. Kehoe, M.D Kettering Laboratory Department of Preventive Medicine and Industrial Health College of Medicine University of Cincinnati t 1iu' KE" 0006340