Document L2YBBdN9Bq0Dgn0KxwzEvK2d

April 2, 1935 Doctor Alfred von Frisch I. Heifers fcorfera trass ij. Vienna* Austria My dear Doctor von Frisch: 7 I ara pleased to have the opportunity to write you with regard to the consultation work which you have agreed bo carry out in the medical supervision of workmen who are to be engaged in mixing Ethyl Fluid with gasoline in Austria* Hungary and Czechoslovakia* I shall try to outline for you the general problem associated with this work as I see it, and acquaint you with my point of view, and with the information which has accumulated over a period of years* It has been my purpose to so provide against the dangers of this type of work that no cases of lead poisoning I'jould occur anywhere* The first problem has been bo provide equipment for mixing that would limit the exposure bo negligible proportions and to set up such specifications and regulations as would give assurance that the equipment was being used in the proper manner and maintained in an effective condition* This has been accomplished in a generally satisfactory manner* The next raeasure has to do with the selection of reliable men who could be trusted bo understand and follow the prescribed technique* and whose general health was good at the start* thus making lb possible to avoid* to a large extent* difficulties due to hon-occupational diseases which might be confused with lead intoxication* Moreover* I hoped to bo atle to eliminate largely, the unusual susceptibility to load which might be associated with the existence of organic diseases of the cir culatory system and of the digestive system* particularly the liver. Accordingly I have advised the selection of workmen who are free of definite organic disease, and who have no history of previous exposure to lead compounds in Industry* Liver* kidney, and circulatory disease are* in my opinion* particularly disadvantageous* nob only because they influence susceptibility* but also because they result in disability which may be Inextricably confused with plumbism. Chronic sepsis, especially of dental origin is also a disadvantage, and it is my practice to refuse bo accept men whose condition is especially bad*, unless X can arrange for the correction of the oral pathology 2- Dr. Alfred von Frisch Men heavily addicted to alcohol are undesirable, not only because of their generally bad physical condition, their pre disposition to carelessness and unreliability* but also because acute alcoholism Can only with difficulty be differentiated from acute tetraethyl lead poisoning. Moreover, I advise the selection of men between the ages of 21 and 50 As to lead exposure it is pertinent to point out that some petroleum refineries use litharge and alkali to treat sulphur containing products, thereby giving some lead exposure to workmen so employed. It is necessary to see that such men are not engaged in handling Ethyl Fluid. Medical examinations in our hands conslat of a thorough physical examination, blood examination (always a deter mination of the hemoglobin, and a count of basophilic stippled erythrocytes; a red and white cell count are made If suggested by any suspicious findings), an analysis of the urine for albumin, sugar, specific gravity and acidity, and in specific cases which indicate the necessity other tests are made. (We make It a point to examine blood smears for stippling of the erythrocytes on every subsequent examination, using a method that is essentially quantitative.) in cases of Illness of any type in men under our care w make use of whatever means is required to arrive at a diagnosis. In the belief that nothing short of the best facilities should be made us of in the care of these men* We have not had any cases of plumbism in this occupation and I believe there la no reason to suspect that we shall have such cases, but if they were to occur we should spare no expense to give them the most adequate medical care. With regard to lead analyses where indicated for diagnostic purposes, I have been developing a means whereby reliable results can be obtained by any of our European consultants. The facilities ar not yet available, but will soon be and I shall communicate with you later in that regard. However, you will scarcely need aid of such type, at least, for some time. It is important in my opinion to explain the dangers associated with the work to the men, as a means of in forming them and warning them against carelessness. On the other hand it is also important to show them that they are completely protected against danger if the equipment is properly maintained and if they follow instructions. I repeat that we have never had a case of poisoning in this work, and we should never have. At the start, at least, examinations should be .repeated at quarterly intervals. This may be changed, if there are no legal regulations to the contrary, as conditions and the judgment of the physicians dictate. It must be recognised, however, that the visits of the doctor are an insurance against relaxation of care as no other measure of control is. Therefore the physician should look into the question of the care and quality and cleanliness of equipment, and inquire as to the observance of the regulations on every visit. I shall not go into the question of the signs of lead absorption, but I do wish to make one point. Brief ex- K* 0013362 Dr ./Alfred von Frisch posure to high concentrations of tetraethyl lead vapor, or massive skin absorption, as well as brief exposure to crystalline trlebhyl lead salts suspended in the air (such as may occur if a storage tank used for leaded gasoline is cleaned in a dry state without protection against inhalation) may result in the sudden onset of acute symptoms, such as are described in one of the articles sent to you by Mr* Bevan of London, - symptoms which bear little or no resemblance, and which give none of the usual clinical signs of plumbism* On the other hand, prolonged exposure to smaller amounts of these organic compounds, gives the usual picture of chronic lead absorption, although lead is excreted somewhat more rapidly under these conditions, than it is when the more common lead compounds are absorbed. In addition to the care of men who do the work of mixing, you may b called upon to examine individuals who, for one reason or another, believe they have been poisoned by gasoline containing tetraethyl lead* Here, again, it Is out purpose to exhaust all the logical means available for diagnostic purposes, in order to ascertain the true facts. Ho cases of poisoning have been seen or demonstrated to have occurred from this cause, and the evidence i3, I believe, quit adequate to indicate that no such cases will occur. However, I and my associates have maintained an unbiased and open judgment on this point, and we approach every suspected or alleged case as though it were the first. On must not forget, in this connection, however, that there have been mors than ten years of experience in this country, without a single case of lead poisoning or demons treble lead absorption as a consequence of the handling and use of leaded gasoline, The history of exposure to leaded gasoline, therefore, cannot be regarded as a significant item in a diagnosis. Rather the diagnosis must be established, if at all, on sound clinical evidence, and supported by specific evidence that lead has actually been absorbed in abnormal amounts. For your general interest and information, I am sending to you, under separate cover, a series of articles which represent the results of our studies of the general problem of lead absorption over a period of years, Some of them relate to belra&hyl lead, but for the most part they are of importance to the large? problem of lead poisoning in general, I should be glad to hear from you from time to time, and if any special difficulties arise I should like to be informed promptly. Moreover, if I can be of any service to you in matters of specific or general information, I shall be pleased to do so. Cordially yours. RAKsIS 0013363 Robert' A, K'ehde,' "feVl>, (see next page) 5 Dr* Alfred von Frisch P.3* Th supply of ray reprints of on of our articles on tetraethyl lead Is exhausted* I am sorry because It la the most interesting article which we have published on the subject. It can be found in the American Journal of Hygiene, Vol. 13, p. 1+78,1931# and Is entitled "The Behavior of Lead in the Animal Organism II Tetraethyl Lead"by Kehoe and Thamann* I am writing an article now on a very detailed study of the lead absorption of filling station attendants and garage mechanics, which has just boon completed, I will send you a cony of it when It has been published. HAK KF 0013564