Document LJ44X2vBg0dD3R4bXom2Da1D5

M EZ \ Kk 0006575 N 7557 'r Vh - *4' ' , S S r , -^"lesCAM n v a r i o a s f o r m s h^'S^^TeW'' r ec o g h i sad a s one"'of ' __ :;^;, V^'J ^ , N. " .v'f v ' *" $] r *1 /vihe ' i m p o r t a n t o c c u p e t i o n a l p o i s d n s v' f o r a l o r g t i me'.' * i !he z e a l o u s ^ *s '' H . ' - -: .v .. : *. .. Vuy* 'siW-'te? :" : : ' ' . . t ^- ., ~. s t u d y a n d t h e i n s i s t e n t p r e s e n t a t i o n of t h e c h a r a c t e r i s t i o s of t h e AW j ^ . ` :n? - - . -. -. -.< . . ,. - ; -... ' ' .-'.^ ,' . . . ' ' . ._. --i ="' , -:-,; . . * ';., .-is c o n d i t i o n have, out l i n e d a c l i n i c a l p i c t u r e .-,vfcich i s a m a tte r o f 'g e n e r a l ? <helm edical i n s t r u c t i o n and knowledge, i n s p i t e of t h e c o n t r o v e r s i a l \ r\ w 'n a t u r e o f c e r t a i n d i a g n o s t i c d e t a i l s , ihe* m a n u f a c t u r e ' a M ' h a n d l i n g ' o f '^ te tra -e th y i lead, r e s u lta n t uoon i ts ' rec en t development for important i n d u s t r i a l purposes, has brought about th e appearance of a type of lead ^ 1 %c y;1' p o i s o n i n g , vh Ich b e c a u s e o f i t s u n i q u e c h a r a c t e r ' , i s made t h e ' '. . . ... ; . : . ' ' ." . of the present paper. . .. . subjebt .. . - '' o . ; [V .. - , . . xetra-eth;/! lead is a c le a r, heavy (sp. g. about 1.62 j o ily ^ l i q u i d u i th a p e c u l i a r s w e e t i s h .odor,- stoich i s somewhat v o l a t i ^ T o rdinary te m p e ra tu re . I t is insoluble i n e ith e r h o t or cold water ,a s 1- ' ' .' . ' S '\ c o h o l and. a c e to n e , and m is c ib le i n a l 1 p r onorti ons ' w ith f a ts , and o ils .. ' I t i s n o tt^. c o rrrroo s i v e , b u t when a p p l i e d to >l i v i n g t i s s u e f o r some tim e b r i n g s a b o u t n e c r o s i s . i a l l owed t o b e i n oo n t a c t :.vit h t h e : s k i n - f o r - - . h a l f , a n .h our' or m o r e l i t t l e or ix>. s e n s a t i o n i s . p r o d u c e d b u t .d e s q u a m a t i o n o c c u r s ' a f t e r a day or two l e a v i n g w h i t e and g l i s t e n i n g p a t c h e s . However, i f removed from the sk in ( b e s t done with" fe r o s e n e ) w ithin, a P s h o r t tim e a f t e r i t s a p p l i c a t i on ,no h a r m f u l e f f e c t on t h e s k i n i s p r o - ow d, u ce ,d , t'O * O. J j t-- '* r I t '*'would be a s s u m e d t h a t ' si ah. aTc ompound of l e a d i s a g e n e r a l . protoplasm ic poison and in f a c t dierais^s f in g e n e ra l have regarded it Jas k. s u c h . O b s e r v a t i o n and e x u e r i m e n f c a t i o n i h a v ^ & o n f i rms d t h e t r u t h o f t h i s %" ,, Kl ,> / , ' a ssu m p tio n , and have shown the e x t e n t o f t o x i c i t y , th e avenues of ad-> m i s s i o n i n t o the bo-dy,. and t h e c l i n i c a l :fe a t^ ire s which d e v e lo p i n t h e ,, . - r " "" ' ' > ' x' S&1. ' > Hage Tv d : e s o f : f t h e p o i s o n i n g a r e . . v e r y str ik in g ,- '* -much " so y tfca t t h e go nil i t i o n j i j e a r s l i t t l e r e s e m b la n c e t o a n y o f th e 'c L ini. c a l t y p e s ox l e a d p o i s o n i n g *.- ?: -r". . - ' .. ' - - - ^ '. e x c e p t t h e i n f r e q u e n t l e a d e n c e p h a l i t i s * - . . - - .; v-V-- - ; He v e r t h e l e s s . i t ' c a n n o t h e :mW0iVr y v ^ ^ - v .- ' -," _v -y .. y^y'doubted t h a t the lead i s th e e s s e n t ia l tox;ie agent in the compound. . *$3* * ^ * > - ,,^ 4/ ^ ' ' ' ' * * 'Jrh-' > ^ ^ 4 1 'he p e c u l i a r symptoms a n d s i g n s p r o d u c e d ^ r e d u e , i n a l l l i k e l i f r o o d , t h e P h y s i c a l a n d c h e m i c a l p r o p e r t i e s - o f - t h e compound.-wh i c h p e r m i t of - - ' ' ' "h- , P 7 ? ' T / " " - a more ra p id a b so rp tio n through J h e 's M n and lungs than possible in the v vi ' ` j * * '' '' - t l 'f '" ' 'V'jc a s e of d ie more common lead* compounds, "m ore i m p o r t a n t , i t s d i s t r i b u - I f ! * io n i n t h e t i s s u e s may be donfidentlly expected t o d i f f e r from t h a t o f - - - . . 4 , 4 h . -. . . . . , . . . ' . . , 'the u s u a l lead compounds in t h a t is s o l u b i l i t y in fats, p red isp o ses i t s . - :: -j-' y 'y ' y ' ' : y - .' - .. ' ; *r` ' ' '. ' h . l o c a l i . x a t i o n d>ni; r e l a t i v e l y h i g h c o in e n t r a t i on i n t i s s u e s o f h i g h f a t c o n te n t, such a s adipose t i s s u e , c e n t r a l n e r v a is system a ra l i v e r . ' , - ' ' ' ; Modes of E n t r a n c e . I t h a s b e e n shorn e x p e r im e n ta lly f e - . A^emiagggtB t h a t t e t r a - e t h y l ' l e a d i s c a p a b l e of p r o d u c in g i l l n e s s and dea t h . : : .. . ' . iJiUirvQ . ''When i n h a l e d a s a - . v a n o r , when &%> '>l i e d - t o t h e dr i n , when a d m i n i s t e r e d -'-* s oy ~ (iv- immorally s a d rrhk-a- r rileCLSi i n t r a v e n o u s l y . Under a n y one o f t h e s e & i h c o n d i t i o n s d e a t h may be b r o u g h t a b o u t i n t h e c o u r s e of t h r e e to s i x h o u r s , t h o u g h m i n i m a l l e t hL d o s e s do n o t M i l u n d e r t w e n t y - f o u r h o u r s a k o rd in a rily . xhe in tra v e n o u s i n j e c t i o n does n o t produce immediate death, ViV.; .. . ...... ; :/ . , ... . , . ...................... . ' : : ' ^ s u n le s s i n j e c t e d i n su ch quant i ti es and a t such a r a t e as to produce p^.mechanical 'blocking of the blood vessels . . ydy y-my .. ; / .. / - l y y ( l ) U n p u b l i s h e d e x p e r i m e n t s f r o m tie He s e a r c h L a b o r a t o r y of t h e E t h y l pS?y;yN-..;, v' . . . ... Sg'G'asoline Oorporationj. Dayton, Ohio. ; . ... .. , . . .-. ...v.;; . " yuV-yn r',n'---',.y;-:"yy4^y'4.--''dy'.-yy. ' v-';' ' ?:...4:'-:vV4:;--y l %y.--, 4 , .'y ,.yy4^y y/ - , v.;.-s' -yyyy-yy:-y ..:^y;-wyy#y;;f:y:-y-- -i.-- ? vc * ** <\ " , * ,v " ,, * . ' ? ' 'K a ' } 000657' ' - - '> a g e T h r e e -- , - - . . ;( T hi s f h r Nf e e r e a s o n t h a t no c o a g u l a t ie n , is- p r o d u c e d i n t h e "blood by t h e '[ p r e s e n c e o f t e t r a - e t h y l l e a d , w h i c h i s i m m i s c ib l e , w i t h b l o o d . ) Lien, ...ifco), h a v e b e e n s e e n t o become i l l a s a r e s u l t of i n h a l a t i o n o f v a p o r of " H ^ - t e t r a - e t h y l l e a d ; and a l s o a s a r e s u l t of a b s o r b i n g t h e f l u i d t h r o u g h -X..-.-.tbe ' a k' i n . inQg o f r r 't*r-n.t...I..g........h...o..w....e..v."e rZ, '. i l' l ?n e?s"s ' .f'i `n men' is s b e e n oec ode g e i ' ' by t h e ` combi r a t i on .of f e e s e c o n d it i o n s . over a eo Bid er able p e r i o d of, `time . 5, ?' ` ' / ' '"'' Symptoms and S ig n s . Under coni it io n s which permit of in h a l- :Jr\ a t i o n . o f , c o n c e n t r t ed v a p o r ,< t , e t r a ~ e t h y l l e a d , ; or i d n c o n t a c t w i t h u n d i l u t e d t e t r a - e t h y l l e a d , ac b o t h , f o r s u f f i c i e n t p e r i o d s of tim e . a n i l l n e s s d e v e l o p s i n which some o r a l l c t h e f o l l o w i n g s u b j e c t i v e sym- -ptoms a p p e a r; in so m n ia , n a u s e a , v e r t i g o , , a n o re x ia , headache and m uscular weakness. A sickening ta s te which is not described as m etallic, is frequent. Itch in g or burning of the skin occasionally is complained of. These a r e u n v a r y i n g l y a c c o m p a n i e d by t h e ob j e c t i v e s i g n s of p a l l o r , lo w blood pr essure,^ subnormal tem perature, and los of weight . xhere is u s u a lly a slo w iig o f the p u ls e . A w e ll d e fin e d and r a t h e r co arse t r e m o r i s an a l m o s t co n s t a n t f i n d i n g , a n d t h e r e f l e x e s a r e f r e q u e n t l y e x a g g e r a t e d . The m u s c l e s them s e l v e s a r e hype r - i r r i t a b l e , r e s p o n d ! ng 0 t r e a s i l y t o . me c h a n i c a l s t im ula t i o n . g a s t r i c c r a m p s , a l t h o u g h o c c a s i o m l l y $>; p r e s e n t , a r e n o t s e v e r e , a nd a r e alm cs t never; a m a t t e r c f . c o m p l a i n t on the p a r t of th e p a t i e n t , . n e it h e r c o n s t i p a t i o n nor d i a r r h o e a is ex-- p e r i e n c e d . a l e a d l i n e h a s "been s e e n by f e e . w r i t e r ' in b u t ' t w o c a s e s and v-4-if1'"- i* , H'.Y'here a s e v e r e p y o r r h o e a l e n t some doubt, as. to t h e n a t u r e o f t h e b l u e 7' d i s c o l o r e r b i o n . , ly " \*Kr W mm ? t * ` V. ^ * 4 ,, 'l A f - X * t- $ %"J *^ 9 i5? *. fc . ^ w ^ -i- i -4 ,, * '% *+* * ^ ^ ' Page Pour Esaminati ai of the b lo o d shows no co ast a n t s ig n if ic a r li f i n d i n g s . A s l i g h t anemia sometimes, develops b u t th e changes c h a ra c te ris tic ' .- (Jr*tosdr of o r d i n a r y - l e a d p o i s o n i n g a r e us m l l y Otfreg i -ot-eu-a -o -x-- fcfcrcrir : s fing a- i n . o n l y "sas o u t o f >f o r t y o a s e s h a s s t i p p l i n g of t h e -tio> erythrocytes appeared,-and in 'th e se only owed e n o u g h c h a n g e to h e found :except by th e most p a tie n t, search lag , Urinary finding s a r e m e a g e r . T here is. an h y p e r a c i d i t y of -the ur in e i n a l l s e v e r e c a s e s > "the u r i n e r e m a i n i n g a o i d t o M e t h y l Ked d u r i n g t h e e n t i r e twenty-four hours, . A n a l y s i s of Symptoms a n i S i g n s . The i n s o m n i a i s a i e o f t h e e a r l i e s t a n i m o s t pe r s i e t e n t symptom, i t i s so s e v e r e a s t o , be a com plete i n a b i l i t y t o sleep f o r - d a y s a t a tim e , and as i t .b e c o m e s l e s s p r o n o u n c e d i t f r e Cjuehfc l y o c c u r s e v e r y second n i g h t . i t i s n o t o r d i n a r i l y f o l l o w e d Tqv any t i t e a s e f a t i g u e even i n p e r s o n s who a r e doing h e a v y manual l a b o r d u r i n g t h e d a y . .any s l e e p which i s o b t a i n e d b y t h e a f f e c t e d p e rs o n is l i k e l y t o be f i t f u l and d i s t u r b e d wd. t h t w i t c h i n g o f t h e b o d y , f r e q u e n t , mover nt s , a n d c r y i n g o u t . The com plaint i s fre q u e n tly made by the p a t i e n t t h a t his mind i s t o o a c t i v e t o a l l o w s l e ^ p , and t h a t i t e n a s l e a or awake he i s i n a dream or d r e a m lik e s t a t e i n w hich a l l k in d s of g r o t e s q u e and un u s u a l s i t u a t i o n s a r i s e . The n a u s e a , v o m it i n g , l a c k o f a p p e t i t e and v e r t i g o a r e a 11 esp eeia l l y p ro n ou nced i n th e . e a r l y p a r t of th e day. a n d u s u a l l y w e a r o f f d u r i n g t h e c o u r s e of t h e d a y . An i n d i v i d u a l in th is s itu a tio n often goes w ithout b re a k fa st, the very thought Vor s i g i t o f .which n a u s e a t e s h i m , b u t e a t s h e a r t i l y an d w i t h r e l i s h . > * %' i n t h e - e v e n i n g . However, an a t t a c k ,c n a u s e a a n d v o m i t i n g m a y . b e , ^ i m m e d i a t e l y p r e c i p i t a t e d l y . t l s ocl o r ..ofith e t e t r a - e t h y l ' l e a d . xhe v e rtig o i s not pronounced except in very severe c a s e s , and is u su a lly -g an i n d e f i n i t e / f e e i i n g ' o f d u l l n e s s , h a l f d i z z i n e s s a n d h a l f h e a d a c h e , d. I he bLood p r e s s u r e changes'; a i e s e e n - e a r l y a n d a re t h e - ' most r e l i a b l e e a r l y f i n d i rgs,..-"i'he s y s t o l i c pr e s s u r e m y 'go as low j 'a s e i g h t y m i l l i m e t e r s o f E er.cm 'y , h u t i s t s u a l l y b e t w e ea n i n e t y a n d one , ' h u n d r e d i n p e r s o n s w^iose p r e s s u r e w a s p r e v i o u s l y horns. 1 xhe d i a s t o l i c ' '`t 1p r e s s u r e i s r e l a t i v e l y l o w e r i n ' a l m o s t e v e r y c a s e , t h e p u l s e p r e s s u r e _ " "being f i f t y to s i x t y m i l l i m e t e r s ,. ' The t e mpe r a t u r e i s e x t r e m e l y low i n t h e e a r l y morning " h o u r s , o f t e n b e i n g a s low a s n i n e t y - s i x , r a r e l y "being a ho re n i n e t y - s e v e n i n an a f f e c t e d p e r s o n . I t a s c e n d s d u r in g t h e da y h u t o r d i n a r i l y is subnormal through th e e n tire tw enty-four hours. - i L o ss cf w e i g h t i s a oo n s t a n t f i n d i rg v a r y i n g from s l i g h t t o g r e a t d e c r e a s e s s u c h a s f i f t e e n p o u n d s i n two cr t h r e e weeks . a ." \ x` ' ' ' xhe s e v e r i t y o f ' t h e t r e m o r is q u i t e. v a r i a b l e , b u t some i v ' k ..degree of i t i s a l m o s t c o r e t a n t . i n some c a s e s i t is t h e m ee t s t r i k i n g " symptom, and t h e .one m o s t co m p lain e d o f . . i n t h e more s e v e r e c a s e s , J'. " s u d d e n t w i t c h i n g s o f an a r m or l e g , u s u a l l y t h e f o r m e r , o c c u r t o s u c h p' ' b a n e x t e n t a s t o a r o u s e th e s u b j e c t from s l e e p or c a u s e him t o d r o p a n " o b j e c t h e l d i i the: hand. : ` '. ; xhas e symptoms and s ig n s t o g e t h e r w ith the somewhat ex- ' 's ^g erated r e f l e x e s , p r e s e n t a p i c t u r e a? a d e g r e e o f c e n t r a l n e r v o u s ^ s y s t e m i n v o l v e m e n t *h i c h / i s no t , ;se:en i n - a n y but. t h e most a c u t e c a s e s of f. >* t Mivufs#*'l.exd p o i s o n i n g , i n d e e d t h e y s u g g e s t ' a d e g r e e of s e l e c t i v e l o c a l i s a t i o n ,,v ' ' ' 't ' hv- ' i n no r v e u s t i s s u e , w h i c h m i g h t b e a i t i c i r a t ed f r o m . a c o n s i d e r a t i o n o f 'a - 1 d -> < " ------ -----------------; ------- -- ----- ,,* z&f&-z /KgTM**?*' # r 7 J ' sfFT Xl$Cy''V ^ i* J ^L M f ' v iage Six ^3* ^ 'y,r *^ \ - .,'% ' . , 't # C lin ic a l Types In m ild cases^ -where' exposure has "been ^ slig h t/'" in so m n ia and a n o rex ia , w ith a s l i g h t drop in blood p ressu re in **' 4 .'?' * ^ : . ; r * >:<. r-. - "v- ~y-;-.*. v * y - .-*..* V i-i.'V .* . t j# .c . ' . r r v ..*: - - ; .: \ . ' . ...................... /which the most pronounced drop .is 'in t he,,diastolic.,,pr essure, are fr e - ih-isiirY , 73 " / _ *Yw '"i f ,ri// f'',i\, ` ' (p ien ti;/the only*^inding s . indeed'1he'"insomnia is sometimes replaced /* Cfti " - * 5** " Or- ^ r * r t> 1* > , 5ir ,"by & d istu rh ed J & p ep i n w hich f r i g h t f u l dreams a r e ' go ns n i cuou s ly f r e - ~ f-* * % ` % '* P*^ . * ^ ^* *K V`1ji^j*^ H ^ ^ -**7 ^y * ^ v f^ ueirt In'.t;he` course -of -_a~,few d a y ^ th e/o o ^ n d itio 'd isa p p p a rs_ alm ost / " * * ti - , e n t ir e ly ,-t h o u g h fr e q u e n tly le a v in g th e hlood p ressu re low ered for from , -; i ?,* / ' , - S* r j- J 1J vetrone--, .t o^three..-weeks* x ln mare's e v e r e `c a s e s-J h e symptoms a re mcr e .numerous t'f and ;pronouncedrj ^^ uMfFVrpni prrt lilamflaiin--irrml-xr-- ''t: '' - . * - -. - . insomnia arfl a n o r e x i a . . are o r ^ y .Qn mnntrTr' "^hrr iir m T lit . ,: ' , . . . . : . ' ^ '. . ,,\ V - 7 . i.'0 ' W* V- - '' . e s p e c i a l l y p r o n o u n c e d 4- now e v e r , when t h e ': in somnia disappears improvement, cones su re ly and w ith th e re tu rn of the a p o e t i t e t h e s u b j e c t i v e sym ptoms u s u a l l y di s a p p e a r a l m o s t c o m p l e t e l y . 'Yeakness on e x e r t i o n , l a s s i t u d e -and t h e <s u h n o r m a l b l o o d pr e s s u r e , o c c a s i o n "ally p e r s i s t f o r long p e r i o d s cf .time , a n d by t h e i r p s r s i s t e i c e s u g g e s t the f a t i g u e of c h ro n ic i n f e c t i ousr di s e a s e s . i n v e ry se v e re c a s e s the n e r v o u s s y s t e m in v o lv e m e nb i s s e e n a t o n c e to be t h e e s s e n t i a l c h a r a c t e r i s t i c of t h e c o n d it i o n , r h e p a t i e n t is i r r i t a b l e , " n e r v o u s " , and i s in a c o n s t a n t s t a t e o f e x c i t e m e n t v h i c h na y pr q g r e s s t o s u c h an e x t e n t a s .. w t o r e n d e r him m a n i a c a l , ^ The na n i a r e s e m b l e s an a l c o h o l i c d e l i r i u m ver y s t r i k i n g l y . ' m i t -the-vie tim t a l k s constantly, and is u su a lly in - c o n s t a n t fear.- c , a n i m a l s .gnd p e r s o n s wh o .are* on t h e poinfc^,o:-.a.t tackin g.-. . him. His s tr u g g l in g to escape o r to d e fe n d him self i s s , a n d , u n l e s s r e s t r a i n e d or q u i e t e d in. some , o t h e r .zfeshioa h e i s ~ '/ S ** if**'** J.' t ' <3s:ely -to ' jump o u t of t h e window or i n j u r e h i m s e l f i n so me ,,ot h e r f a s h i o n . jlM -fu * . j i^igto . .. ..... ......... ' ' ~ i a g n o s i s . j.he d i a g n c ^ i s T of t e t r a - e t h y l l e a d p o i s o n ! ng i s * . W x - - d * * -* he made f r o m - a cor e f u l c o n s i d e r a t i o n ,of t h e. /symptoms a nd- si .ns t o - ^ ^ ^ b t h e r 'rcCthha h i s t o r y of e x p o s u r e . yHoafeverj none of t h e i t e m s ^ h i e h go nzTie tip t h e c l i n i c - 1! 's p e e t cf t h I s ,,eo n d i i i o n i s c h a r a c t e r i d i e o f i t *- %n:^alone. a c a r e f u l d i f f e r e n t i a l d ia g n o s is must le made from t u b e r c u l o s i s , ^ $ ffs yoyi l i s e h r o n i e 'myoe *r di t i s and o t h e r ^chro n i c i n f e c t i o n s t i l t h `J X A - ; ^\ s y s t e i n i c i n t o x i c a t i o n . x r e - t m e n t . xhe t r e a t m e n t ;h i c h h t s "been employe. P Vi h-K V i ffsfcshesM h e r e i n / ' d i s c u s s e d h a s h e e n ..ha s e d .on s e v e r a l c o n s i d e r a t i o n s . It e. ^i;0eem:3:i l i h e d y i t h a t ' . t e t r a - e . t h y l l e a d , i s - o o nver t e d i n t h e t i s s u e s t o i n - V s- ' o r g a n i c l e a d compounds c a p a b l e o f r e a d ' n g aLth p r o ^ e i n n i n t h e -:ry :if%that h e a v y m e t a l .rsaIt s a r e g e n e r a l l y lono.^n t o ; .do . H s & s iiiv ; ' ' . - . ' . _ . i . . " .v vfc ^ c -rv-: ... ' : . " . : . ' . . . '. ' - Ssexpevrlmentsd..'evidenc e t h a t - t h i s . . i s .the.!, n : a . j \iher e is sone .. . . X,?** r Fran th is i t wcuId appear that the v a ria tio n s t h e symptomatology o f t e t r a - e t h y l lead p o is o n in g as opposed to o rd in - f e i;a'y l e a d p o i s o n i n g , a i f f e - H n ^ a f t . ' * ' -7 -- f r o m ordi, t i i t ; Ip -fT--00^^50-44* 57. ` F v a r i s e e i t h e r f r oin a u n i q u e d i s t r i h u t i ca *of l e a d i n t h e or from '1 >4 , * t g r e o t d i f f e r e n c e i n t h e /Nq i e n t i t y p r e s e n t i n t h e , A s a i m i n g '' .. h" c o r r e c t n e s s o f ' t h e s e c d n c l u s i cqfs ' ^ e ^ t r e a t m e n t of t e t r a - e t h y l l e a d j t < -* , h . t '-^ ? v w I;t* *^r~Wa* *I - ''%"' jj^wh iQ^ ^ f g d e m o n s t r a t e d i t s s-v ! V -*- f ,, rv > Page' B ig h t ; '` `' ~%' rh*;sr e f f i c a c y i -nr&ev er a 1~Jt y p e s , * / *S. . i 5 - .' x of heavy metal p o i s o n i n g , i 'h e ,e x p e r i ne n t a l h a s l s - c f * t h i s m e t h o d a n d t h e . c l i n i c a l e v i d - Sfw i ' (3 ) ^?.^^-nces,,ste33Ch3q530xi-o f i t s . v a i n e . p p e a r f e l s e T h e r e . r. Tie p r i n c i p l e s h.' ^ - 4>* ' - 'V ' n n d e r l y i n g i t - f h r e a s ?fo H o w s : \ r ' ^ ^V t Jc/iS ii -, '5' ,<*f H e a v y m e t a l s c . o m U h % i th a*ncL p r o d u c e coo a g u l a t i o n o f :-** . ^ : - > l i V i rg `t i s s u e \ v .V ir ^ lP g P '' - ~ r : ? - - - ... ' 'v ( 2 } i f i h i s oombinot i c n cf ^ h e a v y me t a l a n d t i s s u e c a n h e l o t h pre-* ~ \ ' f - v e n t e d a n d b r o k e n b y th ^ - p r e s e n c e o f s u f f i c i e n t co ncen tza. ons o f s a l t s \ f.^t ~' * ,,'V \ , 'Y J \ .*'1 . ",* V Y>'1 V + *. V* i> * ' ,sK?^k?z. o f t h e lig h t m etals,in-such ?>*. P a way a s to restore the tissue to normal m * * 'i < ' *' , -%*^ p h y s i c a l s t a t e end f r e e i h e ~ i*t ( S ) The sympt oms o f ' he a v y me t a l ' i n aci d intoxicati soluble form fbr ,and cn^edema, with excretion. con se r u e n t ^i. r e t a r d e d e x c r e t i o n , a s s o c i a t e d w i t h h e a vy - ne t a l p o i s o n i n g , e s p e c i a l l y of the a c u t e t y p e , b e y be c o m b a tte d e f f e c t i v e l y b y t h e same m e a n s. I n g e n e r a l i h e t r e a t m e n t , co i n s i s t e d of a d m i n i s t e r i n g m i x t u r e s q f -sodium b i c a r b o n a t e , oe d i u m c i t r a t e , . .cs. l c i u m c a r b o n a t e a n d m agnesium o x i d e i n q u a n t i t i s s u f f i c i e n t to make and ma i n t a i n n e u t r a l i t y of t h .... . ................................................ u r i n e . I n t h e more s e v e r e c a s e s magnesium s u l p h a t e was added t o th e -<#0 above l i s t , given in -sm all doses throughout t ie dajT in order to m aintain '-.free d iu re s is , /.i ' - ^V- . - a d m i n i s t e r e d . la r g e q u a n tit i es o f "water and c i t r u s f r u i t j u ic e s were WrnX v s f j ;v . *4 V.V.V-' o jBfo n a r c o t i c s were u s e d i n o r o d u c i r g s l e e p . ( I t can n o t b e . ' ^ m p h a s is e d t o o much t h a t t h e u s e of opium compounds and c h l o r a l h y d r a t e - -In t h i s a n d s i m i l a r t y p e s o f -in so m n iz i s a n e x tr e m e l y d a n g e r o u s p r o c e e d u r e ) g / j r i t was f o u n d t h a t a f t e r a th or ougn. a l k a l i n a . j a t i on t n e i n s o m n i a de i<k'creased in sever: - 'r ; : 1 ;^ftl^#turned `-almost ' It! ^ fBMSnp se ve r a i e a s e s genn e r a l ,weakoess.-er'vous`. I r r i t a b i l i t y , a s 'evidenced* by" S# ` fc V -PI PSrV^.tn-e-et'hPT1'-. I m'i^3fa`d;n'ii!,fid Ss-'iS^ft.'SS&^bi %feyo^W^ie re was'no in c r e a s e in -th e ` s e v e r it y of th e _ ^rmptoms and no i^^j;ape^nto p r e v io u sly `i sever * e r.-..s ympto>m- cs i n . , 7 -*1 a >s in g * ' le;c ' a s e . ** i t is possible MX-SSpSSs?'.-- ' ' T o a t of d o o r e x e r c is e 'and r a n re a tio n ^ 'fR e s t i a ibiecL-' was 'im p ossib le J:f o r m o st 'Tttfyuy ,7 * a w - * * * - ? ^pgif these cases, t h e y w e r e :permitf*t&d' t o . a m a s s i he ms e l v e s ;sndttoB: SSfjigSSjMmSf&sf'e' j) o c c u p i e d .BO'#'- ' 'u>ai# *Ufa0i%V*>&$F *" 1 ' - ,, > -i `>> , * i n f l i g h t o u t a f - do a r T r e c r e a t i am ' ':< .*&*. , - . Ufi*?TM/ **4}/ w i t h o u t ; , A z& V ^ ^ i g n i f i a a n c e ^ v m t h e o i h e r ` l a n d / ,.tha%'%&i1^ o f / 1tiie d e l a y e d a f f e c t s of e i t h e r y*j5r*^ ^ , r *. ^ ,, t * * J" vs^* / '* ^ -/ % ^or&ixs^ y ' l e a d p o i s o n i n g or o f - t h i s p a r t i c u l a r i y P e of lead: p o i s o n i n g n ^ y IKSf isaasd i n an y: o f -the s e c a s e s . Kxper ir n t a l e v i d e m c e o b t a i n e d i n : S d C M iV .ai*"'' .* ^ t h e s t u d y o f t h e s e ' o a t i e n t s is ' to be '-made t h e s u b j e c t o f a l a t e r o u b l i e - ^ L *ffc. z/her)'*HznT$ a x on**/"- C ^ a t i o n , inasm uch a s fcff Fvi/ipur* p c o m p l e t e a t t h i s t i m e , .out on fi'.'c l i n i c a l 'e v i dene e a lo n e the w r i t e r f e e l s j u s t i f i e d i n p r e s e n t i n g t h e ". .'.. ' ' .v . . .,-.f. . ' . : ; . ' - ? ' '. W . - - ' v / ! =-. \ . .- " '. ', ' ' . . ' .: - - r -u . ,. :_ . ' : f .. . ` a b o v e m e th o d of t r e a t m e n t a s th e m o s t s a t i s f a c t o r y method which c a n 'J?-* " '^inowbe o f f e r e d . `I t s e f f i c a c y i n the a c u t e m an iac al ty p e s of t e t r a - e t h y l f s ^ l e a d p o i s o n i n g h a s not b e e n - d e t e r m i n e d I t i s -^ . . h a s a j s c ^ g e s t i , h o w e v e r , .. " . ' ..-' : -V ;th a t" i n a n a a i t e case o f in o rg a n ic l e a d p o iso n in g , ri th pronounced j c e re b ra l symptofts, such a treatm ent vigorously carried cut re s u lte d in 7, a n a l m o s t ' imned i a t e a n d c o m p l e t e r e c o v e r y . W`tv ' wM-r A s` >l-?'*'*Viti: - > \ * X ': i V^ fi * *r * *1, \<t-\ r i* w