Document NeGpD0jbLB7Ler1oJbN5p8NGQ

I 5 December 1962 Mr. Fred C, Francis Industrial Indemnity Company 1406 dixth Avenue San Diego 1, California re : 31 34 Valley, San Diego Former employee of Vfimdorlich Corporation 1467 State street$ San Diego 1, California ? ear - .r* Francis* vac 'siiod to evaluate st the request of Dr. o. . arbaugh lie c r u s of of chronic lead in~ toxicstion due to exposure to istrsatliyl lend during this nan* s employment with the vhmdorlieh Corporation* X first sew the patient in my office on Hcve&ber 105 1X62* ::3SIUVi t.r iHHiEHf aHHlHJKXb* 1) ihs rat-isrl first consulted his L.Ii.h*i Hr* Pedro vllos.nu&Vd eff 1612 ocyth Hv&ns street* Pan i-ioso 13* in January* 1 962 villa sj `d,och of tinnitus in both s?s and fronts! headaches (It she aid, h nets! that the patient Is n poor ulstoriea and w ore not Asvaetly certain aj to the validity of too dotes named)* Phis vas/not associated with hearing loss# He states that this vas Intc/nclttcnt until Parch* 1962 trues, it boesne almost ccatirmous# lih has si so complained ef dinainoss iators&ttfttttly over this sabs period of time* he believes that bo feoctce rest dissy with mo sost tinnitus and chills and fawr only tfolXe verging in ifh north heading la tho ' fmslerlich tunnel project* He states U'M his H.HUD* gave him a bitter .medloins to tshe in the wniagy for his headachea commencing about Hoy* 1962 which hoipm Ohm considerably# no state* that the chilis sM fever vhici/ haw bean present for approxis&tely the last five neaths ockirred almost only when he *?mk vorking In. the tuniiol and t o k relieved almost IsasdxatoXy by placing a fan In his face* / ' fho patient also claims to haw had/in.scsania since July* Immediately after the possibility d? load. Intoxication was wad immm to himself and tb other vorlprs* feo consulted his LMD who- it.nl iod that tiio patient sight/feave load intend cation in July* 196S* '/ Xho-patient has also complained or his head fooling stopped up especially in the loft nostril, loxlllory end supraorMtol areas 9 December 1962 Mr# Frsd C* Francis lags aw g since October 26, 1962# Ho states that this Is bettor since he has been given pills by Dr# Harbaufdu fh r-aticat ..states that he was last alloyed on tbs 29th of October* 1962 whoa ho-was dismissed trim worm because of absenteeis. Ho claims that his absenteeism was am to Ms seelag his family doctor? Or* Viloanueva for the rtasel congestion from which he was suffering* other p&vtimnt information arc that the patient has had swats since ksreh* 1962 and cramping of his hands on exertion without a fooling of pins or needles* feeing present# for approximately the sms period of tise* ha ha 3 hsd Intermittent episodes of proccroial pain with radiation into his left arm lasting a few minutes# HEVIEM reveille no history of significant weight loss or bin in the past year* ho pntisnt denies headaches prior to 1962 otthheeyr twhia?uni aj una ou ucuc^a&siou ink saj l. h!iiasnag|Bovveir'# D;--ou aS5lsj.aou dteeenaitess c<.o;yu;<ggha* wheeling* dyspnea and orthopnea* He has had belching sine approximately I; archs 1o 62 but no diarrheaf creeping or molonp slid no y'ot history cf /jaundice* ho denies dysuriiif. frequency or nocturia# ....e,. de_n_ies weakness? nervousness or vertigo prior to the present illness*, flier is no history of heat intolerance * disorders of the .joist or of the shin* PAHf HldlCHf reveals so significant childhood diseases and no history of rhtranatie fever* typhoid fever* tuberculosis* pnoumooia or venera&t disease* bast history Includes an appendectomy sn-i removal of all Ms teeth In 1y5f because of pyorrhea# FAKiLf KldlOiQt revealed that his father died at 32 of old age end his ;'.other 'died at gn uskaewa g of $L4 age* fhe patient lias 17 siblings* four dead of tmtoown causes* mu, the patient is unaware of any family history of diabetes* hdart trouble* allergies, hypertension* mental disease-or gout/ PhEiciiAL nxsxctnr reveals the patient ?3 living VnI il h ? <*. -- A# ccmon-lav wife and fens two children by a foriger sarringe whom he In. part supports as well as Ms eomoa-lgw/wif* s tea children* Ho does not snofee ^nd'admits to drinking i^proxiiaately one plat of whiskey a week but states that he feos mvjt boon intoxicated in his life* He drinks no coffee and says ha sleeps approximately four hours a day? welch is his normal saseimt of sleep* KB 0012576 5 December 1962 Ur* fred c* Franei# PHI r ->-i ^imb ia x x c s u s t -d 1 Jk ntooby* imsctilsr colored stale in no distress# The patient see&ed $osmte&$ agitated and hostile towards inquiries sad 'did not sees to comprehend tl*e type of information we were trying to elicit r-any tism*- Height- 9 feet 9 laches* weight 212 pounds* te^erature 9B*S? pul 00 90 md regular* blood pressure a&a 160/104. Skin negative# Uo' lesions soon* gyesi ;-nplis round* react veil to light md aeceonodetlan* Fundi grade teo arteriosclerotic simdc3 only* 2a? as /oraal' canals sM fsesbrjuaes. lose aagativo* Ibrcats artificial tentares* llol^ions aeon* *ouguc and fuss negative* Secii* thyroid not t&srged 02* ncidulsr# as carotid bruits* dodos 1 bone significantly palpable in nock* aupracl&vieular* cdcillory'or inguinal areas* Thorn:-: noKai shape* lungs clear to percussion and auscultation Hearts ,:1 soft* grade two epical systolic sunsm.' which ends 'before gif 12 distinct* 12 of Mgbr raid sharpMsr quality than f2 without sol it 0iSg * thrills or extra sounds- being noted. tfiX not noted mdf&pex beat mt p&lprfhla* Heart . not enlarged to percussion but in view of the patient* s thick thorax* this is not surprising* Spinei 2o deformity or tenderness* Abdonans loft* sm^csltr* bo palpable orgsmg* q.7*ss@3 or hemic* G-enitolia normal* ectai foft prom stool*' Prostate slldly en larged without aimornai rjasBOs* bo tenderness* SxtroMiiies* Dorsalis polls pulse is palpable end strong bilaterally. bo edema* varices or discoloration* 'ilmxroiogles cranial nerves* sensory* actor &nd eere~ beHsr systems-ell grossly intact* Degreased perception in left "ear by .the Binae tost with equivocal decreased per- captive .loss. by the Veter tost* Sttbseeusafc studios vers obtained upon the patient's admission to fharp ..ospltel* The patient was very loathe to go and stayed only one day* XipproxisBately on week, prior to going to the hospital* a lev report was obtained assn outpatient and X was verbally told by rn* Harry Moss that the patient appeared belligerent ami In toxicated to him* nevertheless* the patient was sdaitted*- ihe physical findings on remission were essentially the same.as those obtained in my office and a persistant hypertension cf $pproxisuttoly 160 to 170 over 110 was noted* K 0012577 5 Dacensor 1962 Hr. 'rod c Francis mi Pago ~ur UftCu&XC&f VA2 "B3 Indumed the following:: XM UP was yi* .-erology "9M1 voohiy reactive 1:1 dilution* negative at 1 *2 dilution, MaLuor negative 1:2 dilution# B?F negative. . u'rl&e* specific gra vity 1.913? negativa for albumin, sugar ar.4 negativ itodtaent# Hemoglobin'osx 11-23-62, 12*6 with hematocrit 37? arid heurtaorlt on 11-24-42 of V-3# MBC f,iO consisting' of 61 segs, 5 hands, 3 sosiaophiles, 29 lyasphocyfces, arul 2 monocles* Hatslet ..r.crrholcgy norncl# ileticuXoeyi count 1*3$* Morphology of md calls cud other olmmnts- rionasl* l searched these slides carefully for evidence of bsscwhilic stippling end vas imshlo tc find any# el rate 22 corrected to 1? icintrohe unite# Chest- "-ray shoved ccuo tortuosity of th descending acuta vhieh would ho consistent with left auUyli^iar Lyoeriuuphy hot vus othervio# negative# 2CS war-el alms luwayeardla, first degree heart bio-eh end left ventricular. hypertrophy* .unbar puncturav&s psrfowsed oa 11-23-62, the opening ftseerro being |3- eng* of vate* utd the closing pressure 219 osh# -:-f winter* Ip prexisaatoly 15 oe *:,; of faintly op ale scent fluid vras obtained# lie cell count on this .fluid /consisted, of 67 rod mils .nod 1 -data cell* -Its protein wap V.1 wv,;2j the VDhh non-react.tre ud ddo load content 19 aeg.d, the patient felt rol.laved c-f his headache for several hours ofter V-m L? ym performed* Xhs blood lead level of 11-12-62 w ee? 3D neg.A the norurd vein Icing up to 59 neg.u* *, repeat semua.l#ad level of vast 10 acg.3? nomrl Icing up to 30 ncg#h* A 24 hmT cpectuon for quantitative lead -flowed' a total volune of 2700 ai# with a total dnuatity of 130 ucv# or 30 xicgAiter, the noxn&X values being up to 80 ncg#/liter* A cephalin flocculation tost w,s negative at 24 hours. ton hill recall that in v-y 1 otter to you f July 18, 1962 1 noted that at that tisse hr* jKikoon's urinary load level was 50*2 "'.eg. par 100 sA# at of July 3 and that s repeat lead level obtained on July 13 for Mr* Mason vaa 39*3 ncg./tOO irl ilioco tests wore apparently doaa in a different fashion than the tests obtained in Joverabar and hones th# normal values era aIfforont# Xt should^ hcyevoT*, M noted that In none of these cases did Mr. Jason* 3 blood or urinary levels exceed the upper Unit of neraal values# My final IMPBSMSICMS are: t) Hypertensive card1ov-scalar disease cansing tieodaches and tinnitus** 2) Chronic exposure fco tntra- Kg- 0017578 ethyl li.-w c-Uid '- -.,,c rot foci is significant in areath$ naiieni1 c present Cwiplc ints* 'ihe pc-tlert is to receive tJrmpy Ivis Cfptrtenslon. \thlch I vri.Il ait&art to &?v&ngG vis. trio :;a?cy^nc&JLttp& Clinic* idriitlsn^I copies of tala letter uiH j:mxi to the ?cs aoer-lc; ohc received copies of o;r iVDort of Joly 19* 19-2 for iciom'-ticn :oM cowed eves* .:on?^Ci:f':ll7 submit ted} jorool i'5 ; . e'eud; "XX-iS-Si'it riGi . a:.i>drt .* , >v ; ij .:. - * :- * Cellar.inf: .1 : c Coivt Cory !C,vei':C or \. .. i.J.-iiciiilliO -i ielonatj. '* ; .,. -:0>; ' . .-, .,, ', ' an-Uii'X:;cii -oapnaaCion. 1469 '. tuto ' frent u:a Ciepo 1 5 Californio COCiO -r* frank irinel* foaicol .Clrocior .ethyl C<f5rr.oa?atlon ^:iivez*ziiy of Cincinnati Collado oi Cincinnati 1is Criio odieins fr* John l* xfmoQ$ district Cafaty wpinrsp California Division of ridus trial fo.foiy 145* 4th .evonna -an Mego 1 * California 0012373 August 26, 1963 Donald L. Schmidt, M.D. 233 A Street, Suite 911 San Diego 1, California Dear Doctor Schmidt: I have reviewed all of the information which you transmitted to me in your letter of August 15th, concerning a former employee of the Wunderlich Company of San Diego, CaliforSuiTanc^I have also gone through the other information available to me in relation to the difficulties experienced by employees of this Company during the period under discussion. In specific reply to your question concerning the significance of com plaints registered by Mr.4MMkin May of 1963, I am constrained to say that I cannot associate thdsecomplaints with any toxic effects of the absorption of tetraethyllead which may have been sustained by this employee in 1962. This opinion flows naturally out of a very considerable experience with persons certainly intoxicated (and in many instances severely intoxicated) by tetraethyllead. The characteristic course of this disease, as seen over and over again, is that,primarily, of a self-limited and completely reversible functional disturbance of the central nervous system. In mild cases the symptomatology may disappear in a few days, or may persist for several weeks. In more severe cases, there may be some persistent evidence of intoxication for as long as eight to ten weeks. It is obvious that apprehension and introspection are likely to follow upon a toxic episode, and that certain individuals will have difficulty in shaking off their con cern for minor and common deviations from well-being. It is a fact, however, that no chronic form of this disease has been seen, and that no residual disease5or sequelae have been found^even in association with the more severe types of intoxication which barely permitted survival, it is simply impossible, therefore, to give serious credence to any persistent relationship between tetraethyllead intoxication, as complained of by Mr in 1962, and the symptoms of which he complained of in May of 1963. weis only one complaint among those cited as having existed in May of 1963 - namely, insomnia - which has suggestive implications, and it is all too well known that insomnia in varying degree is a not uncommon complaint of human kind under a variety of conditions, not the least important of which is hypertensive vascular disease. The other present complaints do not fit into the pattern of tetraethyllead poisoning in any stage. I shall not submit a bill for the opinion and service rendered in this manner. I and ray associates have written and advised on this subject previously, and I do not object to giving such advice on this occasion. N13182.01 Donald L. Schmidt, M.D. - (2) - August 26, 1963 Moreover, I trust that I shall not be asked to give a deposition or otherwise to enter formally into the consideration of this case, although I should not refuse to do so under appropriate conditions. Sincerely yours. RAK:vr Robert A. Kehoe, M.D. KE 0012581 DONALD L. SCHMIDT, M.D. INTERNAL MEDICINE AND HEMATOLOGY 233 A STREET, SUITE 911 SAN DIEGD 1, CALIFORNIA BELMONT 2-6181 August 15, 1963 Robert A. Kehoe, M. D. Kettering Laboratory Department of Preventive Medicine and Industrial Health College of Medicine University of Cincinnati Cincinnati, Ohio Dear Doctor Kehoe: This is a letter to follow uo our telephone conversation of August 14, 1963. Mr. formerly an employe of the Wunderlich Company of San Diego. California, was allegedly exposed to tetraethyl lead between the period of March 26 and October 26, 1962. At that time he was discharged for failure to reoort for work. Symptoms which the patient claimed to have during the period of exposure included ringing in the ears, headaches, insomnia, vomiting without abdominal pain, constipation, night sweats, intermittent dizziness, swelling of the lower lip and dryness of the mouth. Six months later, on May 16, 1963. after no further knowexposure to tetraethyl lead, Mrcontinued to complain of poor memory, left-sided nasal stuffiness^ieadaches, insomnia, night sweats and constipation, and numb feelings which migrated over his body. A urinary lead determination of November 25, 196j, was 50 micrograms per liter, the normal range by the method used being 0 to SO micrograms per liter. Mr. has severe hypertensive cardiovascular disease which antedateatos employment by the Wunderlich Company. I am interested to know whether you believe that the symptoms of which Mr. ^^B^complained in May, 1963. are attributable to his exposure to lead between March and October, 1962. Your fee for your comments may be submitted to Arthur W. Jones, Attorney at Law, c/o Higgs, Fletcher and Mack, 2250 Third Avenue, San Diego 1, California. Your comment will be greatly appreciated in this case. KB 0012582 N13182.02 DLS:awh Very sincerely yours. Donald L. Schmidt, M. D. July 24, 1962 John R. Kiser, M.D. 2290 Sixth Avenue San Diego 1, California Dear Doctor Kiser; I acknowledge with thanks your letter of July 9, to which I would have replied at once had it appeared to be necessary. Being pressed for time, I delayed writing until 1 had put some other matters behind me. A letter from Dr. Schmidt, of which you have a copy, came this morning, and I think it advantageous to make a few comments on the situation involved in this correspondence, while it is fresh in the mind of all concerned. Lest my words should appear to have a cricital aspect, let me say that this situation was dealt with in a very satisfactory manner. My comments refer to certain characteristics of poisoning with tetraethyl lead which seem not to be reckoned with in an entirely clear manner. It is not strange that this is the case, considering the negligible opportunity (fortunately) that has been afforded to physicians to observe this form of lead intoxication. Nevertheless, it is of some importance that there be physicians who have some knowledge of peculiarities of tetraethyl lead poisoning, for certain diagnostic procedures should be followed out at the proper time. Aside from the acute nervous manifestations of tetraethyl lead poisoning which are its outstanding characteristic, there is little or nothing (except, of course, the history of exposure, when fully elicited) to suggest intoxication by lead. The encephalopathy bears little resemblance, symptomatically, to that induced by the absorption of large quantities of inorganic lead, and is not to be thought of in the same category. There are, moreover, no cases of peripheral neuropathy on record. It is also true that no chronic form of tetraethyl lead poisoning exists, the symptoms, whether occurring in response to a brief, severe exposure, being essentially the same when induced by prolonged, mild but significant, exposure. The most striking peculiarity, however, from both the physiological and the clinical viewpoints, lies in the fact that there is practically no hematological evidence, micro scopically or chemically, of the presence or effect of lead in the blood. The usual microscopic findings (increase in reticu&ocytes and "stippled" erythrocytes) in inorganic lead 0 U I (' 0 c N13182.03 John R Kiser Page Two July 24, 1962 poisoning ax*e completely and, in addition, there is no change in the porphyrin metabolism. There is also a slight to moderate, often negligible, increase in the lead content of the blood (the conversion of tetraethyl lead in the body to inorganic lead is slow and slight, while the intermediate degradation products of tetraethyl lead are not taken up by the erythrocytes as is lead in inorganic form). on this account, the determination of the lead in the blood provides no indication of the extent of the absorption of tetraethyl lead, and is, therefore, of no use, by itself, in the diagnosis of tetraethyl lead poisoning. The rate of the excretion of lead in the urine, on the other hand, following the absorption of tetraethyl lead, is clearly indicative of the relative extent of the absorption- (This is not to say that the blood should not be examined, for, in fact, the low concentration of lead in the blood, in association with a very high level of concentration of lead in the urine, is a typical finding in tetraethyl lead intoxication). You will recognise from these facts, that the only useful medical measures in the supervision of men who may bo subjected to exposure to tetraethyl lead, are (1) the observation of the men for the appearance of the first symptoms of intoxication, and (2) the analyses of the which insures the chemical conversion of any organic lead in the urine to inorganic). Obviously, the monitoring of the atmospheric lead is important, but the surveillance of the men is imperative unless the lead in the air is of negligible proportions. 1 believe this information will be of interest to you, end while I trust you will not encounter situations that requi: its use, t may be that you will do so. Cordially yours. RAK:wp cc: Dr. .Schmidt Dr. Doty Robert A. Kehoe, M.D. K& 0012584 JAMES F. CHURCHILL, M. D. L.H. REOEUNGS, M.D. JOHN C. SCHLAPPt, M.D. OONALO G. LAN DALE, M. O. JOHN R. KISER, M.O. 9 July 1962 2290 SIXTH AVENUE SAN DIEGO I, CALIFORNIA Robert A. Kehoe, M. D. The Kettering LaboratoryCollege of Medicine - Eden Avenue Cincinnati 19 Ohio Dear Doctor Kehoe: Thank you very much for your kind letter and for forwarding twelve blood kits to me. I have delayed answering you until our situation here became more clarified and I could give you some detailed information. I contacted you initially at the suggestion of Doctor Earl W, Doty, the Southern California Medical Consultant for the Ethyl Corporation. Doctor Doty was in San Diego at the request of the Ethyl Corporation and left some urine containers for urine analysis for lead and suggested that we obtain also some blood sample containers in the event they were necessary. Doctor Doty, I presume, was called to San Diego at the request of the Wunderlich Construction Company through the Ethyl Corporation who was consulting on this problem. I became interested at the request of the Wunderlich Company as a medical consultant for their company although I am a private practitioner in the specialty of Internal Medicine in San Diego. Our problem was that the Wunderlich Company is building a tunnel to house a large underground sewer line. In the course of their mining the workmen went through a strata of earth which apparently had collected a high con centration of gasoline containing tetra-ethyllead. Random samples of this tunnel atmosphere were shown to contain 15 micrograms per cubic foot of tetra-ethyl lead where I understand a tolerance of 4 micrograms is allowed. Approximately thirty men were exposed to this concentration over a period of more than 50 hours. The job was shut down promptly upon finding this hazard and arrangements were made to clear the tunnel of the noxious vapors. In the event any of the men presented with symptoms of organic lead poison ing it was necessary to have some check of their lead excretion and blood concentration. Arrangements were made at the large general hospital locally for urine lead determination on the thirty exposed men. It was felt essential that some method of accurately checking our laboratory results was necessary so that Doctor Doty suggested that we submit urine samples to your laboratory as well as blood samples. For this reason the blood kits were requested. N13182.04 JAMES F. CHURCHILL, M. D. L. H. REDELINGS, M.D. JOHN C. SCHLAPPl, M. O. DONALD G. LAN DALE, M. D. JOHN R. KISER, M.D. 9 July 1962 2290 SIXTH AVENUE SAN OIEGO I, CALIFORNIA Robert A. Kehoe, M. D. The Kettering Laboratory Page Two Fortunately, none of the men exposed revealed any abnormal level of lead in their urine as tested by our local laboratory. Only one individual had any subjective complaints and careful examination re vealed these not to be related to his industrial exposure. For the present, our problem has been resolved. The tunnel is almost completed and the men are avoiding exposure by working with closed oxygen breathing apparatus which they will use until completion of this section of the tunnel. I would like to retain the blood kits for the next several weeks until any possibility of late symptomatology has passed and the studies at our local laboratory have proven accurate and ade quate. Thank you very much again for your kind cooperation and interest in our problem. Yours sincerely. ohn R. Kiser, M.D, JRK:jbl cc to Doctor Donald Schmidt K ooU J A 0 6 O July 2, 1962 John R. Kiser, M.D. 2290, 6th Avenue San Diego California 1 Dear Doctor Kiser: Your telegram came too late on Saturday to enable us to respond to your request for containers for the collection of samples of blood for analysis for lead. The containers are now on their way and you should receive them shortly after, if not before, you receive this letter. 1 write to let you know that we do not, as a rule, accept samples of anything for analysis without knowing exactly what we are doing and why we are doing it. This is in no sense a service laboratory; we have certain specialized facilities for research, and since we are concerned with medical problems, including diagnostic procedures, we make ourselves and our facilities available to our colleagues in medicine under suitable conditions. However, since our funds are earmarked for research, we undertake to be reimbursed for what it costs us to do these things, so long as the charge is not burdensome to the patient. In the latter instance, on the word of the physician, no charge is made. The service, however, is not an analytical, but rather a medical (consultation) service. Accordingly we expect to be advised of the situation which calls for diagnostic services (or those of industrial hygiene) so as to suit the service to the needs and to interpret the findings in that relationship. We do not analyse any material until we have the information which Justifies such analysis (or analyses). Since Z do not know your problem, I should like for you to let me know by return mail just what we are to be concerned with in conducting these analyses. If you are dealing with persons who are being subjected to exposure to lead in their occupation or otherwise, let me know the nature of the work, the nature and severity of the presumed exposure, the duration of employment in such exposure, and the last day (or time) of exposure prior to the collection of the samples. If the patients are ill let me have the account of their illness. N13182.05 Cordially yours, KH 0012 5 8 V RAK:b s _______________ Robert A. Kehoe, M.D. -- 13 July 19^2 >*6ftderlleh Company 1467 state street San Diego 1 California Gentlemen* ihls is to report to yea the results of my investigation of the exposure of your msa to dangerous levels of Xetraethyl load between the period of June 28 end July 16, 19&2* Aw marly as 1 can evaluate , there is now m danger of overexposure to either I'etraethyl lead or gasoline fumes in the central area tunnel of the Metropolitan sewer System*. I shall, however* continue to maintain liaison, both with your ootyp&ny and State of California Division of Industrie! Safety* MSTcrn OF flESSIf mmmt Qn June 28 9 1962* a mmdmm air reading of mlercgsma pm cubic foot of air was noted within the shaft of the sewer tunnel by Mr* M Hatson of the Ethyl Corporation* Shi* concentration of lead Is sufficiently high that the Ethyl people do not allow workers to work at storage tanks for longer than two hours with this concentration of load* ALL work was halted mi a meeting; of myself* Charles Cooks, and Csc&? Chaff for th Mmnderlleh Company! Carl Johnson, John Dupre, aofeert Hurray*.. 1*4* field* J* fiecre*- A*a *.A*- Mhmtt of the Division of Xadasbrlol Safetyj- Mwerd'Watson. of the Ethyl Cor poration and 1*. 'Stodging sad &* Cota of Caterers local So* 89* was held at. the Industrial Safety division Offices at 1*521 4th Avenue, Ean Siege* on Monday, July 2* 1962* At this meeting it was detortalngft mat all workers who had been working in the tunnel would proceed . to Sharp Hospital for urinary coproporphyria and aua&titative urinary loads before consideration for return to work would hi' .given* later that day* officials of the Wunitrlleh Corporation and the Industrial' S&fety Mstika visited the. scone of the construction end It was decided by. the Wunderlich Corporation, that they would wear oxygon naskg M. tanks itt* the construction until such time m the mxsSmm of lead .in the air would, emit them to return to breathe the air being piped into the tunnel*' It should'be noted that in. the week,prior to discovery of this concentration of lead in the-air* three, men had complained of fooling giddy from gasoline fumes and had visited local physicians* HE 00J2583 N13182.06 is July 1962 Vlmderlieh Ccspany Fags tm Hoad of those sea complained of isiscnnla* ai^rehensien* anxiety, nightmares, headache, or difficulty with vision which are the ostial sardfstations of inhalation of load fames- which usually cams encephalopathy before other Banffstations a** noted. Similarllyj there mas no history to suggest gastrointestinal cramping or diarrheas hemolysis or peripheral neuropathy. Work ms resumed with respirator equipment on July 5$ 1962. On July 9* 1 was phoned by Bob Murray of the Industrial Safety Division* who reportedavermg readings of 6 nlerograas per cubic foot with maximm readings of 8 microgrsaas per cubic foot in the tunnel. In accordance with Sthyl Corporation regulations, I advised hr* Murray that, the mm could not work without their respirator equipment for more than four hours in any one shift. By July 13, 1962 the readings throughout the entire tunnel mm less than h - microgrsms per cubic foot except for n reading of 8 microgrems in m small pocket in which the men were not working* /it that time* I advised Mr* Murray that the men could cease using respirator shipment but that subsequent readings would have to he made to determine whether they could continue to function without it* fens of the sea hovo to y know-lodge . had any symptoms suggestive of either load cr hydrocarbon intoxi cation since work has been resumed* Th three men vhe consulted a Sr* B* M* Breuor of 502 8th street* " '* ~ "" ` being stopped on June 23, were and^MiBNRBm* X phe-ned Vfctt's only -complaint was mild vertigo- end that Sr. Brener in examining him felt that there was no need for laboratory studies# Mr* HcFzMm complained of nausea* weakness* idlest pain* vewtigo* and a feeling of Intoxica tion* A chest x-ray and complete blood count mm obtained by Sr*. Bremer and reported to me m being normal* 2m copier, of my history and physical-of 7*66& on Hr* MB. are enclosed* He seemed to be most symptomatic of the three. Suffice It to say that his cea$&&las when he consulted 3?r* Bremer did not suggest lead ncejih&lop&thy' although they did suggest a certain amount of gasoline intoxication. A' chest x-ray- obtained on 7-3-62 at the ralomar Hospital showed no evidence of active disease#. fhe patient*s hemoglobin was slightly decreased for a man of his ago* 12*6 gms* with a hematocrit of 3 and the white ecuat was at the borderline of upper normal at 10*000 with a differential of 60 sags*, b bands* 2 eosinophil* 29 lymphocytes* 5 monocytes. Ho stippling was observed and the red cell morphology was essentially normal, these findings do not suggest lead intoxication but they do not rule it oat# Hhen I saw Mr. he was essentially k JET 00 1 Z 3 9 J * -\st. -1 '-rii' ..aii-wJ ^ p;--A 18 Jtily 1952 ^hlhderllch Company Peg Store ' asymptomatic and physical examination ws entirely within. normal limits accept for mild hypertension of 160/88* fhis I muld not attribute to load intoxication* laboratory values disclosed ' a hemoglobin .of 13 gms** rod count 4*25 million, hematocrit 4o giving m HOT of 58*5, and M0H0 of .32*5* 2h \m im& 10,850 consisting of $7 sags*, 3 bands, 22 lymphocytes, and 2 monocytes. fhr was minimal toxic granulation of the neutrophilss and m basophilic stippling of the red colls noted* It was my im pression that there was no evidence of lead or gasoline intoxica tion at the time 1 saw this patient* How long Isa had shorn this low level of hemoglobin (low normal), it is impossible to state as to the last tins he feed a blood count vms when h& wm &!$** charged from the Kavy la 1958 and the records of that discharge are presently in St. Louis* iha eepropc^phyrin:"test was used as a screening test to allow the men to return to work if negative and. wan negative in eachcase* She quantitative load determinations tools several additional days to be run* tpumi Copropopphyrins were dsteasglnsd by the method of Sdionsson, . lUsdngtoft, and -Bonds, Scandinavian Journal of Clinical and Laboratory Investigation, Telusis I, Pag- 2* timuBtitativ urinary leads were don by the modification of the method.of K&oofit, ??, Biochemical Journal* Volume 34, Page 1234* dasulta of qtu&ittttlve coproporphyria determinations ware 11 done ime&Iately after collection.' of urine trm the patients, ell specimens- being obtained m Jttly 2 8* dll coproporphyria determinations. wore negative. Hett&ts of quantitative urinary lead tests- obtained between duly 2 and July 3, -1962 -showed the following values $ miMi (aicroi^ams/100 milI*)M3MUaE..liM^ KE 0012500 .v Sf r v ic e SYMBOLS > fast message ,-s deferred char* $ indicated by che ,.<r symbol. W. P. MARSHALL. Pr e s id e n t \01 (4-60) DL"Day Letter NLNight Letter j^^lnternational - Letter Telegram The filing time shown in the dare line on domestic telegrams is LOCAL TIME at point of origin. Time of receipt is LOCAL TIME at point of destination I237A EST JUN 50 62 CTB024 OB588 0 SDC530 NL PD SAN DIEGO CALIF 2? j .......': " DRCOBERT A KE0H0E KETTERING LABS COLLEGE OF MEDICINE' EDEN & BETHESDA AVE CIN-- SHIP 12 LEAD FREE BLOOD SAMPLE CONTAINERS WITH COLLECTION INSTRUCTIONS FOR LEAD ANALYSIS JOHN R KISER MD 22?0 6lH AVE SA DIEGO CALIF 1 ! // 13 July 1962 vun&erlleh Compmy Pago Four 19*5 19* 5 19*5 16. a 1**>6 1*^6 13.0 13.0 13.0 13.0 13.9 1 j* u 3.1 3*1 3* 1 o*l * t i.. Oxi July 13 sdditioiialrGM^igs were tmmx on the three highest values, n.sr:iGlj I t rhuvlu Is Mentioned that tile normal rang by this quantitative method is 0 to 60 mlcrogsraui par 100 milliliters* Gmsples were collected on the noon lunch hour for each of tixesa three mm on a Friday so that they had had a chance to aceurmmlat load throughout the week and for at least four hours at work* fhey had toon breathing air Trtthout the aid of a respirator for at laast four hours the day of the determination* The readings for these uen were as relieves and On tlia basis of these last deterain&tions * 1 fool the workers rjp in all probability out of danger to- load, erasure* hut as I have stated*' previously* we will continue to follow them and to obtain lead air samples periodically* fhsnk you for referring this interesting problem, to me* A copy of my history-and physical examination on Mraggj|^bing sent to me* la addition to myself* throe copies of this report are feeing sent to yoti one to Hr* John a* itapre of the State Industrial Safety Division} one copy to lofeert a * Kehoe, H.D* of the Kettering laboratory of the University of Cincinnati College of Medicine $ and an additional copy to Sr. Prank Prlncl of the Kettering laboratory, the Medical birector of the Ethyl Corporation* KE 0 012 5 fl 2 10 July 1962 isvnd&rlioh Cmpany Page fivei vl I i/ish to else express my deep gratitude to Dr John H* &ise* of this city who ms obtaining mx&h. of the instvmental background in clarifying the situation information* offering aony * valuable suggestions* and referring this problem to me. '-Tours very truly* / S' " V~(f .r /O'; l',:J. i ; ft ClJlTr-XClt * lupUp vLii i ark 0Ct Robert A* Kehoe* !U9* Kottaring Laboratory University of Cincinnati College of kc-dlain Cincinnati 19* Ohio Dr, Frank Urinei, helical Director .sthyl Coloration University of Cincinnati College of kacllolno Cincinnati 19* Ohio Ur* John. u Dupre* District Safety Knglneer California Division of Industrial safety 1t|-5t kth street fan Diego 1 * California Johrr H* Kiser* H*i>* 2290 6th Avenue* Suite 103 Bm Diego 1 * California KE 0012593