Document evXQGnjQnE9OyYJg6XbpvJ1Y4

F1ML RSFORf m CkSBS GT gATfk Ck&lM AT SftMOCT. 'Mim 1950* CCBCTaglTOU MS3IC&L ASP50IS* An interim report was submitted on tbs 29th September, 1950* In this report, ratification, itinerary, tcash history, certain items on tank electing, and the medical Metory of the Individuals concerned were-' given# Ttesrc were a xsatabor of discyejeneiea in this report, especially in respect of the duration of m%ome of ecm of the individuals concerned# non involved in the incident toe been kept tsador react observation, and certain biological samples, and samples of locr-i-bearing mfceri&l fraa ' the tanks have been analysed, ... ' "$ :K | S Iha nodical attendants of the ssa involved wars fully informed of the clinical santfestaUsns of totrosthyl lead poisoning and its taroafesent, end wore gives* a mto&sy of oar clinical findings in each case oa the 29th September, 1950* Official notification of these cases. :f tetraethyl lead pcisoniufj to H*H* Chief Inspector of factories wea consoqumtly not mde by ns*. 2h incident was- la?osght to light through Ur* 0# Bairn, Physician, Pudlcy Bond Hospital, Biraiagim, who dicgjioesd correctly a case of tetraethyl lead poisoning that had been admitted to bis ward on the 20th Septegfcer* Bep'oseatatives of the Associated Et^l-Cosapaay Limited visits the iWF.R.P# at. Bed Stone, sear Stourport on the;/' 26th September, to investigate the incident and to act is m advisory Capacity* - . - - * .- maalfig* ' the tank concerned is the incident is a cylindrical rlvottod tank, 102 feet in d&uaetor,' 25 feet high, 4000 tons capacity, with a fired roof, sereury coaled, and'has two mnhol&e, each epprosSmtoly 30 inches in diewter, ose at the bottom of the teak, cm placed eccentrically oa the roof# ' '.Iae'.'j0f/'iC'"the tank is at er^mlmtoly gre-uai level. Tfcor is a ditch ai^rosdnatcly sir feet Seep, end three feet wide, in concrete, currousdisg the tajf<* Prc% the ditch the esbeaitesat surrounding tli tank elopes steeply away to the ground level* b r; ' :'|N N 24569 It was stated that Hards Ifo* 3 was first put into ccmniealcn in 1937, and used for lose spirit* Jfiroa 1941 to early 194? it had contained loaded gasoline, com of which contained 5#5 c*c* T.s.L* par gallon. In late 194? the tank was filled with water to a depth of approsinatoly 20 foet^ It wa 'oat ofix-^ 1950, rtsaovod, to &bout <jaa foot fropi the Tbs.Sfcot ,m>m Hdbad-'fce^n removed prior to'the pushing operatic-n* The bottom ana lid w&g removed on the 8th August# The ventilation of the tank, was that by natural wind though ikn interim rapport was submitted m ths 2$th September, 1950* la this resort, notification, Itinerary, teak bd-story, certain iteraa on cloning, and the asdics! history of the individuals concerned were given. User were a number of dlseropencdsa in. this report, especially in respect of the duration of ensure of sscmst the individuals concerned. The sms involved in the incident b&ve been kept ursdor reaoto observation, sod certain bic-logical saiapleo, and saaplcs of loaa-bearixss r.*.terial from tbs tanks hove been enalyscd* The eedical attendants of the non involved ware fully informed of the clinical aexdfostatlonG of totae&etbyl lead poisoning cm its trsataent, end wars given a ensmry of our clinical findings ir* each case on the 29th September, 1950. Official notification of theae cases of tetraethyl lead poisoning to H*K* Chief Inspector of factories v&# consequently not ends by us# the incident was brought to light through Dr# Hearn, Physician, Dudley Bood Hospital, Biratogbaa, who disclosed correctly a case of tetraethyl land poisoning that had been admitted to hie ward on the 20th Soptorber. Eopmsontativoo of the Associated Bthyl. Company Lisitsa vialted the A.F.H.D. at Bod Stone, near Stourport on the > 24th September, to investigate the incident and to act in an advisory 5snk History. iho tank concemod in the Incident is a cylindrical rivotted tank, 102 feet in dleaetcr* '-25 feet high, 4000 tons capacity, with a fixed roof, mercury sealed, and has two raanh-olos, each apprciaataly 30 inches in dianotor, one at the bottom of the tank, and one placed eccentrically oa-tbe roof. Use roof of :the tank is at epproximtoly ground level* Thar is a ditch apps?osiaate2y eh" feet deop, aid three feet v.ddo, in concrete, surrounding- the tank* ;Frea the ditch the oabankasat surrounding Use tank elopes steeply mm$ to the ground level. ' It was stated that itenk Uo 3 was first put late cohesion in 193?, and used for bass spirit# ttrcsi 1941 to early 194? it had contained leaded gasoline, eoa of which contained 5*5 c.c* T.S.L, per gallon# In lots 194? the tssk was filled with water - to a depth of approximately 20 feet* -It . to .-i, . l*ior to the punplng operation# Tho bottom aen lid was removed on tho 8th August# Tho ventilation of tho tank was that by natural wind through too two nan lids# The tank had not peevlously been doaned# There were two other tanks in this location, of similar pattern and history,.referred to as Nos. 1 and 2. Tank Cleaning Centrestore* Tho extractors for too tank cleaning were cM:.3ons, 204 Fitcford Street, Birninghan is. 'esars# 1* Whelan H? 00213 6,-n. D Cloeninrp Tha following notes ere tmp^ecantary aad eo^losjsatary to thesis in the interim report* It t j s s noted in the previous report that a oasli of organic Imd . vus detectable when tho tank woo syprcoched on tbs afternoon of the 26th Sepfeaafeer# fhls Is the first occasion m which, in our aparlenee, an organic load odour has been detectable in sludge* It is therefore.' not surprising that the analysis of the sludge resulted in extraordinarily high figures, far behead nay of those imperiously analysed in this country# Ibis is partly due to iaprervod aaethodS of analysis, as it is vary difficult to analyse sludge- saeploa without sosae lees of volatile organic load* This loss has iwv boon vary considerably reduced, but it is possible that the results shorn below ray otill be on the lev side for organic load* It will be observed, fros a consideration of those, that although the tools frtsa which the samples were, taken wore all of the o&ne e abstraction, wore cut into coauissica at tfe sene tine, and, d o far as is known, WvI'O clJ<e-d for tha storage of similar loaded gasoline, and had a oiailor period of disuse, there is a considerable variation in the load contents of the sludge of the three tanks* 51 analysis has been reposted ca several occasions', with aisdlar results in each* this mriatioa in lead content of tank sludge is sorely cosfii-satory to wist m& previously known, that Is to say that sludge is net bopogoaseus is its lead content, and that it is impossible to predict from the task construction and history whether or not the mteriol in* it contains organic lead in each concentration as to present a hasaycl to health* The tank concerned In.the incident, So# 3, had an iateraodiat organic lead content compared with the other two. &mricm ejrperieaco led to the con clusion that exposure of unprotected individuals to the vapour arising: from sludge which contained appxmdsxitaly 0#1;C organic load, calculated on tlse : / dry weight of sludge, ms likely to result in serious illness and-death, if/ the espo'^jrs.was of so short & period es..fifteen'minutes# ;. It is aurprieirig, therefore, that bo ss individuals concerned in this Incident wore not store / seriously ill' than they were, m the^ooure. to the: Vapour fraa "sludge which contained at least .016S tetraethyl reapimtor^jg-otocticn was at least'several' hears in' the csss of fptfHHi end flflHK It is also noteworthy t!mt the completion of the closning of those tanks. was carried r p. out by the sens extractors, end oo^lot^d early in Deooaber, .. without mishap, although one;, tank sludge contained 0*42$ volatile organic, land* Constant and eMllci.rai^^ provided for this by the Esgent - Oil Coapacgr*--.- It' i:ffflrtjui^tc :that'lte& Ho* '3.sjd' : not Tank ?'o# 1 ms tbs one ` involved in the SntoKimtion % Pb due tot .:. tetraethyl Load* .:''.v^rM^iviripnd,. .. . -/r . I&hk : Ko* 1* Usak Ifeak / So* 2* 3d* 3* 0*420 0.0340 ' 0*162 . * * - - v .-OiOOl^i' It s noted in the previous report that a oaeli of organic lead . ms detectable vhm the tank was approached on the afternoon of the 26th September. Ibis is the first occasion on which# in oar osparicnee, an organic lead odour has beau detectable in s&aSge, It is therefor, not surprising that the analysis of the sludge resulted in oxbxterdlaerlly high figures, far beyond any of those previously analysed In this country. This is portly* da to improved methods of analysis, as it is very difficult to analyse sludge samples without soae loss of 'Volatile organic lead* This loss has now been vary considerably reduced# but it is possible that the results shewn below say still be on the low Bide for organic lead* It will be observed# fron a consideration of those, that although the tanks fro which the samples wore, fedcea were all of the son ecnctraction, were sut into conxdcsicn at the sane time# and, so ter as is known, were used for the storage of similar loaded gasoline, and had a similar period of disuse, there is a considerable variation in the lead contents of the sludge of the three tanks. Tm analysis Isas been reposted on. several occasions, with similar results in each, this variation in lead content of tank sludge is norely confirsatory to what was previously known, that is to say that sludge is not koKOgoaccua in its lead content# and that it is impossible to predict from the task construction and history whether or not the material in it contains organic lead in such concentration as to present a basayd to haalth, Tbs tank concerned in the incident# Bo, 3, bad an intermediate organic lead content compared with the other two, tearless eitpcricaco lod to the con- elusion that exposure of unprotected individuals to the vapour arising from sludge which contained epproslaately 0*1% organic lead, calculated on the dry weight of sludge, was likely to result in serious illness and death, if the exposure was of ae short a period as fifteen sdmtes# ' It la surprising, therefore, that some individuals concerned in this Incident wore not aoro seriously ill than they were, as ths&Epesura to the vapour froa sludge which contained at least 0.16k tetreathyl l^^vitbmt roopimto^protectirn was at least several heurs in the case of c tHHIB ^ a~zo noteworthy that the completion of the clemun^oF thecarried out by the caste contractors# and that It was completed early in Doocabor, without tsisbap# although. one tank sludg contalaad 0*42$ volatile organic load. Constant end skilled supervision wea provided for this by the Eagont Oil Cecsp&ny, It is fortunate that Tank Bo, 3 and not Hank bo. 1 ms the cno* involved in the intccdostion of five individuals* % Pb due tot tetraethyl lead, Trlathyl Lead* Z&e&hgrl lead. Halides, Methyl* $6ad* (ORyi'S^Caar^ Totol wgfiSiO n} Inorganic Pb, iv'eter from sludge Fb in P,pn, Organic. Inorganic. Ilank Ik>. 1. 0.420 0.023 O.CCL7 0.465 2,630 "Dank 2*o. 2* 2hak` Bo. 3. ' ` 0.0340 0.0045 0,0031 ::'i;^,Cg70 ,;. i 0.0486 0,162 0.039 0,023 o.eos 0,233 1,5750 2,240 mi* 0.7 o oot 2,32 5.03 k . 0021368 V - 3- * The eoncantr&tic:i of organic lead in s2ad.ce water in tank Ho. 3, 4*e,, 2.3d!', is, in our opinion, .boat saturation -point under the conditions o:d.sting at tis&t tiro* t:.i. j iiorHcsi History of Individuals^ The fivo individuals concerned in this ineiaant were the. sees contractors Whelan end cod conto. ^v , intonicatica, Is in the cose histories 1&'illustrate aie point. Aged 34, narriod, three children* Sbginesr* This sms is considered first, as he bad Leon longest on the Job of cleaning three tanks at Stourport. tie had been previously engage! in cleaning tanka at Had Milo, in Nottingham, la August, 1950, in which the safety prccauticns vre> not observed* He did net suffer ary ill-effects fro this Msdeaeaacur* Bato^^v^^ie Job of cleaning Ho* 3 Sink at Stcurpcrt fro bio brother,the 13th September, 1950. H was Gsauined first on the SbttHaepkSoor, and Egsain on tbs list tocoKber* .,- 8s\vao of tbs opinion that his brother had given Irrtoo se&ily/s&di on the lest asssieinatioai still'to 'work off the eyjsptcas, -. When he first took over fro hi brotter, be irora protective clothing, scEeticsjc over his ordinary street clothing, end a positive pressure full. 0021369 fee air liaomsk ost of the tiso when inihe tank, but took it off whan it beceia cunbersemr to fthefirai day he vac in the tank, the 13th topteaber, he developed ebscsaiml diGceafort end pein, and was sleepless, that night, The following day, Ms vision, norsally defective became wore, and ho caw dmfcio &t timee*.: He felt vwok, and tired easily. His appetite t-ccasse poor* :,Ho felt mmwt.all the.tins, bat was.unable to voalt. g Ba 'tried' to.-f^e:Mself^to^at*-i:h&^ faaadacb developed, !u sad;he.noticed; that' ha .had become pale*1 . t&arrtced asuei, and,;,became severe* : to the 15th f&ptaabsr,- All .the 'systems beesae wears, and about x" tils tine atelephone bells3 seesaed to be ringing continuously in Mo ears* to; Saturday,: 16th September,' he reaainod, in- bed* . A very severe pain had., dinreloped in pit of his stosech,a end ho spent aoct of the day tossing about tfco boi with psdn#'' Be wasLpersjdJ&ng 'wwy.-.ffcesJy about -this, tins* Ths diarrhoea continued in a severe fom.Bctc*^^ ilk that evening, cad'shortly'(MNar'tj^^ soreness, but . tha:pcraplrutiito lru^ssoi,'_- Bieguaa. wore - sore,: eld he. had..,. very., bad taste. of ; *:_ ? r! Tbs five iadMdua^^QMjnnMA in thisJgs&Igj; re t_h_e___t'o cf the contractors,' Kasr|BB^pndSonc^^BBBfc5:a.v; Vu * > and employees dEWlM? flHHHHP contractor, ^ uhil presenting no syspto&a car signs of intoxication, is the ease histories to illustrate one point* Aged 34, carried, three children. ISaginoor* This r.cri is considered first, as he had teen longest on the $eb of cleaning three tanka at Stourport* fie had been previeusly or^aged in Steurncrt frosi hies Mother, KJ Whelan, on the 13th i^ptarsbor, 1$$Q . was easaalnad first on tho 36th September, and again on the 1st Jaeomber* Be vae of the opinion that his brother bad given in too easily, and on tho lest OTp-ninstion still thought it was posai&lo to work off tho sywptons. When he first took over froa his brother, he wore jxrotectivs clothing, scasetiass over hi3 ordinary street clothing, end a positive psoosur-' fall face air line msk soost of the tine uiisa in the tank, tut took it off whan it beoaso cumbersome. On the aftorncon of the first clay he yea in tho tank, tho 13th Soptsabsr, he developed ablcs&nal diocaafort end pain, and vus sleepless that night. Tho foHouins day, Ms vision, nonaally defective beesus worse, end hs saw double et time# H felt weak, and tired easily. His appetite became poor* Ho felt nauseated,all the Use, tut was unable to vomit. Be tried to force himself .to at. d dull frontal headache developed, and he noticed that he had fceccass pale* llnrrkooa ensued, and became severe* On the 15th foptaabssr, ail tho oyaptesae toecane worse, and about tills tine Htelephone belia*1 seae& to be ringing continuously in Mo oars. On Saturday, 16th September, be renairod in bed* . A very sever pain had developed in the "pit of Mo stomach,41 and he pent noat of the day tossing about the bod with pain. He was perspiring very freely about this time. The diarrhoea continued in a severe fores* He took cone hot nilk that venire, and shortly after tho sever abdominal pain eased, louring a soreness, but the pereplmMenl^ gusswere sore, and he had a very bad taste ia Ma south* Sever muscular twitchines. which he could not control,_were present. &% thlo tle, ana he bed oe^itefeing of the bMis , perticulerly "on the face and hands. He forced himself to return to work cn tha ISonday, but vith the other aec, Coateo and Gascoigne, fCiind work cuteid tho tank, and when material fro tho tank wax handled, full safety measures were observed* Cn the 25th and 26th September, he entered tho tank again. He did not admit azsgr terrifying dreams, but sta ted cn tho 1st keeesber that he had not slept since he started tank cleaning on 15 th Seot^ber* Ott escMnation on the 26th Soptesbar, after ho hod one out of la Kc 0.021370 3 " r*\'r '4" K F 0021371 pressure 11C^70* Tosperuture 9?*2 Puls r&te oQ. Stippled >-*** cello - ail. Diced fl2a ~ nonal* Apart fres eaagges&ted .euperfieial and doop roflasea, aid a slight, but net coarsa, tracer of ids tends, no ebnorsali^ was found. The urine was S*ee froa alteam md sugar, the haaooglofeln (fsfcli) 106*. (ICO 14.3 grasses Subsequent tc this esaainatie-n, ha reaaisad at work, hut kept away froa tank cleaning for two- weeks, after which ho returned to superriec other employee who bad reoomencod the cleaning, fie told the Begaat Cil Cerspaay supervisor that he was perfectly all right* bat as a result of persistent leading questions, be finally admitted to no on the 1st Benesh!* that h had not been sjaptoei-free, and, aoreever, ted ted mm further exposure fros tin to tise, although mostly in the open* Ca this occasion, he was still pale, visibly thinner, and still ted a marked loss of appetite. The bad taste in the *aouth was persistent, and he was constantly eating or chewing minis to counteract it. Ho wea still looping badly, end vas very irritable* Fee fzonb&I headache hsd persisted, the guas were still jjore, and he still ted serere iir/oltmt&ry twitchingo end felt persistently cold. Thera had been loss- of libido since the onset* He did not admit to feellr.y tired, but cm laoreed subsequently that when the tank cleaning finished on about the 14th Jocessber, he went to bod for a week's rest. The i-aadlcel attendant of this mn hud been inforaed by ua of his condition oa tte 29th September, and ha ted hmn glvm plioaolarhitcm, which he took intern!ttently fro th 29th September* Apart fron this,, curl a copious intake oi* fluid, ha ted no other trmteoat. Ca tbs 1st Oeessater, tears wore no abnorsaol dialcal findings, blood pressure 1X0/70# fesjspcrature 97,6. Pulse sat 66, H.C.Ci, norssol* flood filss, 103 stippled culls pot cdllioa .R.B.C,, teeseglobin 10f , (sebll). The lead concentrations in txrim m% blood are given below. Date. Vol. of Ssusplo. (sis.) 26. 9*50. Zii 9.50. Xrf2*20*5c# 11.10.30. 10.11.50. 1.12.50. 115 275 45 91 370 .185 Urine. Mesa. Pb. Sastpl. Per litre# 093 *151' .126 ,456 . liicod* 3.Q. at i Standar- `t. gEi. Mg. Fb. 20C* vliood. Sample* IJg./litre. 1*014. i.ea? 1.022 .443 .292 *&. Fb* 100 gs. ! : i *036 *042 .SCO .**62 1.019 1.0U .56*9 462- .062 .168 1.009 ,261 .051 .276 1.009 ,430 *2.41 0.021 0#093 --- ------ -* **W *# * * -^gCnt 0n Company supervisor that ho was perfectly ell right* tat <xo a result of pcrsistcst leading questions, bs finally admitted to no on tbs 1st Booesabor that h@ hod not boss sswtoonr**i end, groover, bad had ecae further espomare fres tiso to bias, although Easily in the open* On this occasion, he was still polo* visibly thinner* and still bad a marked loss of appetite* The bad taste in the mouth ms persistent* and he vsao constantly eating or chewing ainta to ccamtereet it* K me. still sleeping badly, and was very irritable* The frontal headache had persisted, the peas were still sore* and be still bad severe Involuntary twltchings &vd felt persistently cold* ' Tsere had bean lose of libido since the onset* Be did. not admit to feeling tired, but one learned subsequently fch&t vl&n the ton*: cleaning fltdshad on about the 14th Ooceobor* ho insodiatoly went to hed for a week's rest* Ibo medical attendant of this mn bad boon laferaad by us of his condition oa the 29th. Septe&ber* and he bad been given phenotarbitcim* which be took intermittently from the 29th SS^tosaber* Apert froa this, end a copious intake of fluid* he bad no ether treatment.. CM the 1st SMcsaaiber* there were m abnorissl clinical findings* Bleed pressure 110/70. fesporaturo 97*6. Pulse rate 66* S.C.G* normal* Blood films, 105 stippled calls per million K.B.G.* haeEMglcbln 105'- (3ahli;. She lead concentrations in urine an " blood arc given below. Bate. r' Brine. i ip O.L# Cl i. __hga. Fi> > Sample, | SOSplO. ?er litre* i (mis*) . i>#0* cfe j btandar2CW0. diaod. ! Kg./litre. 1*014. Blood. 1'.j m j -ig Fa < -H*. * & . Sample. 100 ga, 1 26. 9.50. Zfl 9.56. 115 275 ,c;9i .126 .351 .453 1.C27 1.C22 .443 .*92 12.10.5C. 13.1C.56. 10.11*50* 45 91 370 *036 .042 C62 3t0 .462 *i6a 1.019 1.014 l.C9 . 5 / 39? <i6l !1 1*12.50. 135 .051 276 1.009 .430 ai.a 0.021 0.C93 ,, ^ will be seen that in this end subsequent oases described* . aiacneais was node on clinical grounds* `end,eonfinacd by the finding of a persistent increase in .the ia the urine*rad in som mses dn increased load contest In th#y S&co&* v It say also be mm that ta Cilagrx>s,,s was mde on tho general clinical picture presented* end not on any particular eyaptoa cr finding, It Will be soon tj&t the blood pressure, usspersturs^ pulse rata eM stippled coll counts wore of no veil-a in these cases* , ., .. . ^ particular case* it would have booh possible for the iadivlaual* end in fact at one stage it was possible for his.-to mislead tao layman as to the tree condition of his health. This mn ms dolibaroteXy 0021372 for tie own ado, bat his knowledge of the condition wan not sufficient tc prevent a diagnosis being aed* cm purely clinical grcjunde. It is not possible to gauge the actual tine this ma was ssspoaad to the toxic vapours, tot is ell.it mo at least scnrotl hours, A certain similarity between his sraptosa and reactions 1 tetraethyl load e.nd those of his sibling, my be seen, but at no stage was mspbalopaihy encountered* Isis exposure was not so intense, but acre nrolongoA, end wan repeated before he was flQflefafr&M* end before the /-$) urinary oneroticn of lead wee consistently within noroal lis&te* lb severity of teo alisontcry sytsptoss is noteworthy* The excessive persgdrctioa tea been occDsionally r.counterecl in dailcr cases in the pest, but has not always boea preseat* The itching of tee skin was described by Eehee la the original noa-fatal eases reported by Ma* It has not teen prosiaent in reports of cases of intoxicaticn since* 2n this and in the subsequent cases, every possible precaution was taken to prevent conteMnaticn of Use spocisena of biological materiel obtained for analysis, and we feel that tee seaplos reported upon wore not ccmtas&mted, as saspios token from blenders in siasUar conditions, and at the same tine, gave noraal findings. She lead excretion in the case of this will be observes to bo. very variable, and the first four csucpleo, token between the 26te September sad 13th Catcher inclusive vero at & level rarely encountered, and indeed tee higher ones ore usually associated with a cuds sore severe illness than presented by thin individual* It will be seen, frees ccnsidcrati.cn. of tea load excretion figures of this individual, and of the other sen in this series, that excretion of Iced in urino is a very indifferent guide as to the severity of the clinical manifestations* One of the others had a lower rate of load excretion, and yst had isore severe sysptoso. It is desirable also to point cut jth\t even at the lower rates of xerotic, such as cm the ICth Hcvesbef end tee 1st December, this sen presetted tec sysptaas of tetraethyl lead poisoning. We hove previously expressed tee pinion that no great weight should bo give to tee result ef & single setctpl of urine, end that tee result cf a series is desirable before any opinion is given. There is ossple confirmatory evidence of this statement in tee analytical results recorded in this report. Further eonsMersticn of the 'lowest cosucn cloaonijsstof' of safety in lead accretion in urine will be given later in this report* Aged 33* ifexxled* Ossa child* Engineer* obtained He bad bom engaged m tank cleaning at nod I'ilo in fJottinghan, and did not teke any precautions, He did not suffer any ar-roront dotrinoat to health ao a result. Bo bod apparently boon present on tee site at Stourport In tea week prior to which the actual tank deeming operation cammed, and probably between the 6th and ate- September. "The tank cleans w* ootMAKMMMS B. Cartw -the afternoon of ttu 11th September* It le possible that he otertei off wearing a respirator, bat quickly discarded it, os the sight glasses oteamed up. The carburettor jet in the puara fcocac blocked, and it ms replaced by the om in compressor. ** <i*'*ve^batbwp^|^|bate^6r cheats hie ta^srgarnent^l^i^^^^vtha *itcy betwe^en h is sya p to staesyfubue earn, but a._t no stage V3& oecepha,,ap&'&ry p--ro. lMonagttseir-be*dlis*nisg2,ui*sjo(jnfty|twfts$ssjja^j, jsbiwaeufoeCre?xAp^hoVoUsMuvrcev swnwsaaswysn--teomt- s-ofreinet,e- nesiiei ,bbeufotresotrhee urimry cs*cr--etii^df 1o g & v&ecnokn*saisitsenntolytewwoitrhthiny*ao2mbtl Jesicoiotase.ive iphocrs^tica ^ SSS SS * **= ia reports <*f cacao of latas&c&tlcn since. Eehofe jvTosinont 3& thlo end in the cniV-equeat eases, every possible precaution tj^8 .piir<m to protont ccnt&Einaticji of tba spocissena os biological fi&terial obtained for analysis, and wo feel that the eeepl** reported upon were not contaminated, aa carets tehen from blondes* in aiailar conditions, and et the caso tiae, gave o o t bs I findings. 3 lead escrotioo in th case of this aan,^flHBHHL will bo observed to bo very variable, and the first four em^les^^Siff^twoon the 26th Sepfcesber and 13th October inclusive vero et a level rarely oncotmtar^d, and indeed the higher ones or usually associated with a ssach sere several illness than presented by this individual* It will be seen, from conoidexation. of the lead excretion figures of this individual, and of the other assn in this series, that excretion of lead in urine is a very indifferent guide as to the severity of the clinical Esemifosteticos, One of the ether;-;- bad a lower rate of lead excretion, and yet Usd laere severe cysptons* It is desirable also to point cat jtivxt even at the lower rates of excretion, such as m the 10th IlovssbOf and til 1st Docossber, this son presented the syaptoas of tetraethyl lead poisoning* Ke have pawiously srsproaeed the opinion that no great weight bo given to the result of a single sample of urine, and that the result ce a fff*os is desirable before any opinion is given. There is cawle confirmatory evidmee of this Btateraont la the analytical results recorded in this reoorfc* turuisr consiueretion of the'lowest oeuon donoadteatof' of safety in !*;'* escration in urine will be given later in this report* ' v Aged 33. Married* Qm> child. Bngineer* ------- The history of this aa ban bom pertly obtained frera observer's* . E bad hem engaged on task cleaning at Bod Hile la itottiagjboa, and did not tebs any precautions. Be did not suffer any apparent detrl&ant to health as a result. Be bad apparently boon present on the sit at Stourport la tho weelc prior to which the actual tanJs cleaning operation - copgaeneed, end probably between the 6th aadSth Soptosber. -'- Tho tank cleaning 'oowawooed^vJfctte ^a^,tl*:;-re<nccivr'''iM*o ait^' ecptMaea^bsJ^*`' v It is possible that he starte^lx wearing e respirator, but quickly discarded it, .as ..the. sight glasses atehsisd up#:...... 2ho carburettor jet in tho puap beeaae blcdrei, end it was roplacol ty the o j s s in the air-lino concroscor* Be did not bother to bath or change his undergas^mto at the end of the working period en the 11th Scptetebor. ' He stated that he noticed a heavy oonnowlol rikningth*e tank when he entered, o ik ! although it s ho carried The first synptesa ho noticed was etdraaiml disomfort, wliich progressed to pain, end was quickly follow! by intenao ond t^raistojut cHarrhomt which necoseitatod hi* leaving tho tanlx for considerable periods. K t 0021374 In the asset words of an observer* ,3Ho had the diarrhoea sc- bad that he was stuck to the seat*8 Ho vaaiton a m Uses, sad was uaafclo to eat. He slept badly that night. lb following day ho entered 'then tank again, bat fait so ill at jaidday that he stopped work m tank denning, and too not returned to it since, nor does he seen to have enycbMre to return to thin t 00 of work. On tide day, the 12th Soptaribar, in addition to the syoptono dsscribed above, and which hod fceecoa acre severe, be bed e dull pain behind his airs, piss and needlee* in toe face and bands, which had' persisted until our last esanitoticn on the let December. H became vary irritabl and confused. Giddiness was severe, especially m aenranant, sM it also .bad ;.._, uersioted to the date of the last ecasniaetica* He rtaainsd off work after ; * odaseday, 12th September, and spent soet of his tim in bed* Tho diarrhoea persisted, end continued to b cover. &M1 mibiag at his doctor's . surgery on too 16tb September, h had a violent 'Shivering and shaking" attack* and was sdsittod to hospital the cane evening, where he remised for four weeks* ; On sdsissic to hospital, he was confused, and was provisionally diagnosed as psychosis of unknown origin* Apart fresa a few lucid intervals, ns resins assaestic for & period, of two weeks,of. his stay in hospital. On adaission, Blood pressure 14G/60. f^erature 93. Pulse r&to 30. CnadMesion, ho was fv-wod to be mrkodly mentally disorientate;), excitoi, restless, ansdous and apprehensive, Thor was a s&rked tremor of too hands, tongue and face. He was given 5 c.e. of paraldehyde inlaremstsularly, end other slid barbiturates by isooth, with no effect. He had really very little intensive treatment in hospital. Ho kept ell the pttiento in the ward awake for a few nights, and would have been referred to a mental hospital had not his condition been subject to very raorkod day-to-day variations* Shortly after ckkiiosicn, ho aborted cub* 8 1 have got tetraethyl load poisoning. 1 s b dying* Four other have died.51 the following day iso said,' "Ton had hotter got too other-four sea in bora, as yourtrratssent is mking we better.1* later, apparently, ho got out of bad, and ran up and down too word without Ms jyjasia.trousers on* ,., He also throw food over ....... a nurse, end aedb attoapts to threw water over too ward sister* On another occasion, he sad a dash for too ward corridor, clouting that he was going to stop too children crying outside. ISio seen on to 1st Beeesber, he had a recollection of those aberrations of beimvieur, and tried to Justify Ms actions by easing tiu.t ho "had to atop those nurses running % and down all too tim,a and that the children were crying in an (^y&oent childsm1 ward* K E 0021375 When Ms f&tb&r visited Ms on too 24to Septoaber, he told bin to go away, then to lift too bed, m& when Mo pillows were consequently eeljus todS;*'M he was very abusive, and repeated his desire to have to ontira bed lifted. *' His fstoor was very distressed t his condition, and felt ttot his sen was insane. He was, moreover, eonf Arsed in this belief when toe ward sister enquired of his whether or not there was mental trouble in too family. k*hen examined on the 27th September, l&chael Whelan was fairly lucid, but hsd could not stsaeHofoc^in esory, especially of recent nor was he t ell clear of events. He the chronological 'y'S-iT ordor of tank ..<aleaIi* ;,,, Ho did not uoderstsna w&y ho ehculd require to veer respiratory protection when there ws a an hole open at to bottom cf the tank end another at the top, with the wind bloving through. After all, he had to get too Job dose if h were going to sake &jjy money, and it was - to yoxk with protection. Bo to study stiona. on tank Meanine. to M in __ **jutk* . OSC pora^tsted Until our 2&c-t easuiaatie** oa the Let December* Ho became vary irritable and confused. Giddiness was severe, especially m aovessnt, and it ala bad persist! to 'the date of the last eoMnctica. He remiaad off wrk after we&sosday* 13tb Ceptocbor, and spent met of bis time in bod* Him diarrhoea persist!, end continued to be severe* While waiting at Me doctor's surgery on the IBto Septeabsr, bo has! a violent 'bMvering cud shaking3 attack, and was sdsltted to hospital the ease veMng# where he remained for four weeks* On admission to hospital, hs was confused* sad ms proviaiotolly diagnosed as psychosis of unknown orlgiru Apart frcaa a few lucid intervals, be resains asnostic for period of two weeks,, of Me stay la hospital. Ck admission, Blood pressure 140/60, ?i*pesafcure 93. False rut SO* Caa&nission, he ms f und to bo mrkodly mntally 'disorientated, estcltod, restless, carious end apprehensive. Ikor me a marked tremor of the hands, tongas and face* He ms given 5 c.c. of paraldehyde intrasnustailarly, end other slid barMtore.ies by nouth, with no effect* Be had really very little intensive treatment la hospital* Ho kept all the patients in the ward awake for a few nighto# end would have boon referred to a Dental hospital had not Ms condition bean subjeei to very mrtsed dsy-to-day variations* Shortly after daissicn, he shouted out, 8 t have got tetraethyl lead poisoning. I aa dying* Four other mn have died. She following day ho said, **You tod bettor get toe other four taea in bora, as yourtreatment is siaking sse bettor*** Later# apparently# he got out of bed# and ran up end down too ward without Ms pyjasa trs users oa. Be also throw food over . a nurse, and aade attaspto to threw water over the ward sister. On another occasion, he ssde a dash for the ward corridor, touting tint fee ms going to stop too children crying outside. When aeon on too 1st Secadbor, he tod a recollection of these aberrations of behaviour, and tried to Justify Ms actions by myinQ that he had to stop those curses running up and down all too tim,tt and that the children vers crying; in an adjacent children's ward. When Ms father visited Ms on too 24th September, ho told Ms to go away, then to lift tie bod, and when his pillows were consequently adjusted, h vns vein- abusive, md ropoatod Ms desire to have the entire bed lifted* Bis father ms very distressed at: Ms condition, and felt that Ms on me insane. _ Bo was, Moreover, eonfimod in this belief when the word cistor enquired of hits whether or not there was cer.tol trouble in the fanily. When eaaMned on the 27th September, Mchael Whelan ms fairly lucid, but had ease defect in eoaozy, especially of recent evento. Bo could not fesssl^. Cart n&&e*hnr 'ma: hast all-'clear of the chronological order .of,,teak.-eleattlngutoB* did, ..not w>dratapcl ofacsOa >jFoqot - "wear res&txatc^ teas a nan bole open et too bottom of the task cad another at too top, with the wind blowing through. After all, he had to get the job done if he wore going to cake any acmy, and it wee sore difficult to work with-protection. BO was endeavouring to study the Company's regulations, on tank cleaning, which had bedn sent to his in hospital* Hospital Xsivostlmtionc. 20.9*50* ffsesuoglotein 1G4* V*f*C* .,200* B.baii, Id Beticulocytos IS. to stippled cells. 1-rey cheat. ^Calcified focus is the right lower acne, no sign of active disease.3 23.9*50. C*S*F* 3 colls# ., Frotoin 20 r^sa. h%R#; nog. Lange# nag* 0021376 2*4* J On the 1st December* he ms re-esassinad by n He locked well, although thinner than when pswlcasly seen* He explained of intemittsmt nausea,, atnorcsl taste which ma not defined, dull pain, in th head, and oplas and needles3 in the fingers and fees* He was sleeping better* bat still had unpleasant dreams about twice a week* Be fait giddy ceeasicnally* Eis chief complaints were irritability end inability to concentrate. Ko had a slight cough, for which no cause was found* On mninatien, Hood pressure was 12C/S0, temperature 97*3* pulse rate 70. There ms a positive Chvostek sign cm the left side cf the face, and the deep reflexes vara exaggerated J There war no ataacmil signs otherwise* The teenoglebin (r&hli} us a 90/S* Stippled colls 160 per million. B.C.G. ?:orasl The load excretion in urine end bleed is shown below. Sate end tint, 4.10*50* 1330 i.lG-,50* 1730 4.10.50* 2150 5.10.50. 0030 5.1C.50. 1400 5.10.50. 2445 5.10.50. 1530 26.10.50. 31.1C.50. 15.11.50, 1.12.50* Urine. insxrsr. --FMTT5,- - - - - - - - - - - - - - - - - - - daaple. Sessple* Litre. (nls.) Bleed. a.ii. at tWWraWSSCaBi wt. gsu 20P* diced* %,/litre nmt* ' ICO go. Semple. 1,014. 330 360 395 54? 390 ! 400 340 320 114 24*? 333 0.076 0.034 0*103 0*143 0,062 0.062 0,046 0.132 0.013 0,079 0,034 0.230 1 0,233 ! 0.276 j i.on i,co9 1.011 0*426 i 2.014 0,1S3 1.0C6 0,155 1.C03 1 0,135 1.' 5 *3 0.413 2,020 0.15S 1.007 0.320 i#02j> 0.090 1.009 .293 ,363 .351 .426 ,459 .722 *632 `W* .316 .195 ,127 1 i I || il ! 1 3.46 i j ! *oc ^ f\* Oesgtont. Shis mn had probably bed the most intense exposure of the five con involved* lie definitely had developed fretnk symptoms of lead esce^ial.opatl^, bit oven when ha ms actually ill, the lead excretion in Ms urine in early October ms at a level not usually 'associated wife any narked aysptoss, although on two subsequent cccaoiono, namely the 5th and 26th October, lead excretion in urine was at a very high level. On tbs 1st December, 80 dey after reaovHfroa exposure it will be noted that this san till bad symptoms, and although} the xcroties of lead in urine was within noraal lis&ts, his blood lead content was epproximtely aouKle?what is here accepted as the acxlmra under normal conditions. A little con sideration will indicate how important it is that asaples of urine and t"* CO *~t blood should be taken at the sane tine. Cue sample of urine taken in the case of this rasa might lead cue to conclude that the symptoms wore being feigned, but the abnormal quantity of lead found in the blood, although only CM cm aaplc ms taken,~ia sufficient ecnfir^tcuy evidence,. in view of the --0'- past .nit<M9,^te'MalBe^liis;.tccx>'eccgptabXe - o- S", ^ ,' ,, i5> *** PO^ts of note la this case are that the diagnosis of tetraethyl lead poisoning ma not made until the attention of the Hospital laedical authorities was drawn to it, no regal'd having boon paid to his st&tcneat that he ms suffering fros lead poisoning* and the very severe diarrhoea frm which bo suffered ia the initial stages* In tills case also, the f* pulse raws asoeesin** ''^S^BSSJSk K iT Married* Four children. Hpo-fittar* This man was esaaiaad in hospital on the 2?th September, 1950* His condition had been properly diagnosed by the pbysic&an In charge. .Through hln to incident waa brought to the attention of the Company, andIlls rxitoaquent coroperaticn made the records of this case reasessably ecnntoto^^Tkia mn bad probably approsAsataly the earn exposure as little 1ess, but csrtadaly he was exposed to a ccncsntraticn of lend. vapour traa the sludge with a- load content in eiceosa of G,l% of organic lead, based on the dry might* without respiratory protection, for several tours. fart of the history given by him when first scon in hospital was subsequently found to bo incorrect. Froa what on could loom, he had boon engaged in tank cleaning et the location in nottinghaa with the Whelans, and had not suffered any ill-effocts fron non-observance of the essential precautions* Ke did not wear respiratory protection at any tine in the tank cleaning at Stourpoorfc* It is probable that ho was present there, and was in and cut of the tank, vdth Hichael Chelan between the 6th and 3th September, and ho entered the tank with Kieh&el Whelan on the sftoxnoon of the 11th September* !! \m slightly indignant at the Suggestion55 of the advisability of wearing a respirator end ether protection, end ho stated that respirators always teamed up, end made hits foal unooraf`ortoblo Hs ads&tted that the odour 5m the tank sad hia feel sick and giddy after a short time* He has no recollection of how ho felt on to 11th Soptestor, last the following day he felt very weak at midday, tod no inellnatlott for food, slept badly that night, but tod no dreams as fur as he could reaesjfccr* Vomiting end diarrhoea ensued about this time. . Ha saw his own doctor, who told him ho had and gave him sleeping tablets* He tod a fooling of stiffness in his legs, end occasionally ever pain* His, vision become blurred, and a frontal headache developed* later, he bad rasafcaoss and tingling in the bands and feet* A.dry cough, which is still present, developed, and was associated with pair.'across the shoulders* ` He rotumod. to work about the 13th, bat the sacll of too patrol caused nausea and vomiting* Ho developed severe abdofaitol pain, and was edrdttod to hospital on to 20th September for this. Sysuria (difficulty in tossing uric) was sorbed at this tie, and. morphia was required for it#" relief. . At this time, ho'also had violent "starts end twitchicgs", and his bands wore very sto!qr* 3c hospital, he passed blood in hi,riae#:;::;:.;!:'; -:;r' Cte aaasimticn os' the 27th September, to- looked tale, was very depressed, ssd slightly <!ioorlentoted Blood pressure 130/90* T^eporatur 97*3. hula rata 32* H complained of difficulty in passing water* Kia memory for recant vents was poor. Share wore no abnormal findings in emainatien. Hospital Investingtlcna* 21. 9*50* 1. Haemoglobin 116$, rod blood cells 5,360,CCO, white blood colls 10,500. Koraal differential count. a* Ce^bJWp-epdLaiil. fluid -- cle*>i* colourless fluid* tolls lee ^^ttori V ca,* rrotoia - 30 rngtss.^ ^ Ima^contet^- oil. H e 0021378 iis iiffilp---* co^pot^tion cade the records of thi case roaeenauly v frnlBr VhZo '&** hod probably apprccteteOy tbe ssao oacpoeurc as possibly a Uttl less, but csri&inly ho was exposed. to a ^5HH!5^3ils of load vapour frm tb sludge with a lead content in assess mTi% d'orgenia lead, .baaed on the dr? weight, without respiratory ;^Kte0tion for sermal hours* fart of the history give by !lin wh*a "Wjftxet soon in hospital me sabsoqusotly found to be Incorrect. ITo a ^ W what case cca34 1ear, be bed been engaged in tank cleaning at the location ik nottinghaa liith tko Whelans, and bad not suffered any ill-offsets fron non-observance of the essential precautions* He did not \cm? respiratory oretaet&8& at any tin in the tank cleaning, at Stcwrport* It la probable that be was oresat there, end was in and out of the tank, with Michael .. Whelan between the 6th and 8th September, end he entered the tank with -' jfiicb&sl yhelan on the afternoon of the 11th September* He was eligibly isidigneni at the "suggestion* of the advisability of wearing respirator end oilier protection, end ho stated that respirators alleys steeled up, and cade his feel unoeasfortable* lie adaltted that the cdour in the tank cad hia fealelQk and giddy after a short time* He has no recollection of how ho felt oa tbs 21th Soptosbor, but the following day he felt very weak at oidday, bad no inclination for food, slept badly that night, but had no dreess as far as he could reassaber* Vomiting end diarrhoea ensued about this tisss. H saw his own doctor, who told hi ho hod "nerves", and gov him sleeping tablets. Ho bad a fooling of stiffness in his legs, and occasionally c-ver pain. ills vision became Hunrod, and a frontal headache developed* later, he had nmtenm& end tingling in the hands and foot* A-dry cough, which Is still present, developed, end was associated with peIn-across the shoulders. Re returned to ver!: about the 18th, but the saeil of the patrol caused muse, and vomiting. Ho developed severe abdcsainal pain, and was admitted to hospital on the 20th Septeabor for this lycuria (difficulty la passing urine) was sarked at this tine, and. rorpbia m required fear it#', relief* At this time, he also bad violent "starts end twitch&iga8, and his hands wore vezy nsba!^r*" In hospital, he passed blood in his urine* On e^assimtioa on tho 27th fioptomber, he looked 'calo, was very depressed, and slightly disorientated. Blood pressure 130/90* Tesperaturs 97*8. Puls rate 62. Ho <^lained of difficulty in pausing water. = Sis nsraoxy for recent events wu poor. Thais were no abnormal findings in emas&naticn. p$2A^_Tmmhimtima. 21. 9*50* 1. I&caoglobin 116%, rod blood cells 5,360,CCO, white blood cells 10,5C 0. IJonaal differential count. .vww^p::.,2 Oas^BPO^ixlaal-fluid -- deer eolourloss fluid. Celle Imsb titan 3/ euwas* Protein * 30 ngsas.jS. Lead content -- Ml. 23*9*50* Blood Croa -- 30 agms* %* 26*9*50* Urine - il.A.p* 27*9.50* 1, Urine - rod. blood cells and occasional lyalino casts. 2* Blood threa'2 '33-0e^* %* ! 3* Urea clearance - 120b of mrei, 7.21.50. I'ee^glotdn 97;,, red blood colls 4.9 million. m/ n.P, 14Q/7C. Urine -- normal* 0021379K f Mi Ko eause tor the teenaturia (blood in vceim) w&s found, and apparedrily hlo rt?nal function is norsssl. ^ t&sa re-esassiaed on the 1st Seeesafcer, he mu still cinfused ca l&at bad occurred* Ha eosplaiasd of poor appetite, slight nausea, frontal iJieadacps, decreased visual acuity, p&ins across hip lad: and shoulders # sod 'a cough, no.had lost one cud a half stones in weight in hospital* but led regained ess stone. He was sleeping better, but sot .neraally. He tired: easily, although ho had sot returned to WSt. He admitted that, he tod ted pneumonia a few years ago. She XNTay of this nan, seen in hospital* and not recorded ia the findings, did not show any evidence & disease* Be looted paler earl thinner than when ev*m in hospital* Bleed pressure 140/80, i'ospeiatrre 97,8, false ttrba 76* . Kaeeglobin 97$ (Sahll). Ifc stippled cells. S.G.G. aorsal, Bo abnormal signs were detected on oucrdri&ticn. Fas concentration of lead in urine, f&ecoa and blood is shown below. vox. or cenple. (els.) 27. 9.50. 2115 176 27, 9.50. 2240 276 47* 9.50, 4400 350 27/43.9.50. 27/43,9.50. #x2-n'*i 27/23.9.5C. 403 27/23,9* 50.,,. 330 27/23*9.50. 350 27/23,9.50* 47/20*9*50* 375 270 28. 9.5C. 0435 299 1.10*>0* , 23,10,50*1017 292 23.10,50, 1143 305 23.10.50, 1253 350 23.10.50* 1700 31S 23.10.50. 1715 325 23.10.50. 2245 24.10,50. 0630 16.11.50* 1.12,50, 375 265 233 170 : brine. 'FaP 7 Staple* Litre. o.U. ct 20. I Icod. wt. ipn* Ised. 3aaple. Mg./Xiire. ICO ga. O4t50 0.230 0,170 0.330 0,450 0*210 0.150 0.170 0*240 0*130 0*300 0,037 0*023 0*034 0.042 0*091 0*079 0*085 0*047 O.C20 145 0 0j>3 0*436 1.759 1.973 0.514 0,454 0.641 0*666 0,127 0,075 0.097 0.132 0,270 0.211 0*321.; ' 0*202 0,1X0. 1*013 1*006 1,004 1,03.4 1*016 1*004 1*002 1.005 1,004 1.C05 1*010 1.064 1*002 1.003 1*003 1,409 1*006 1*03 4 1,03 1.590 1.456 1*700 1.759 1.730 1.795 3.160 1*360 2*240 1.360 1*466 8*13 0*443 0.526 .0.;453' ' 0.696 0*436 0*493 0*345': 0*217 : - 0,127 19.74 0*0063 C.C775 i 1 0.07 0.086 , ; Faecea* Data* Z8. 9*50* 1*10*50* XSh. tft, Mg, Pb* Mg. 1%, ga* Sasple* 1 gra. ash 0*34 * 1*81 0*230 0,680 0.675 0*375 Kz 0021380 iAfbvsr, out not ncrsaaUy* m tiredeasily* although be bad not returned to work. Ho admitted -that, ho had bad paeuaoaia a few years ago. The X^ray of this mm, mm la hospital* and not recorded la the finding, did not show any evidence of- disease. He looked paler end thinner than when sen in hospital* Blood preocuro 140/S0, Toapomture 97.S, false rate 76* .Haemoglobin <$Tjk (Saibli). !!c rtippled cells* B.G.G* normal* fto'atoeiml signs were detected on eusudr&tion. The concentration of loud in urino, faeces and blood is shows bolov. VOX# ox SonjxLe. (els.) UrSa, r~.Tffd* >6. 1 iisplo. litre. Ow ww 2CP* l iced. amnaurci- ttt, {JS. Kfe, IV* Ised* 100 gsa. Kg./liir, 27. 9.50* 2115 27. 9.50. 2240 27. 9.50. 24C0 127/23.9.50. 27/23.9.50. 87/23.9*50. 27/28.9.50., 27/2S.9.5C. 27/23.9*50. 27A3.9.50. 23, 9.50. 0435 1.10.50. ' 23.lC.50.ld7 23.10.50. 1143 23.10.50. 1253 23.10.50. 170:, 23.10.50. 1715 23.10,50. 2245 24.10.50. 0630 16.11.50. 1.12.50, 176 2f?6 350 216 .623 403 330 350 375 270 299 292 305 350 316 325 375 265 233 170 0*260 0.230 0,170 0.330 0,450 0.210 0.150 0,170 0*240 0.100 0*300 0*037 0.-23 0.034 0.042 0*091 0.079 0,065 0,047 0*020 1.46 0*353 0*486 1.759 1.973 0.524 0.454 0*436 0.642 0*666 1,000 0.127 0.C75 0*097 0*232 0,270 0.211 0,321 0.202 0.113 2,013 2,008 2,004 2* 24 1*016 1.004 1*002 2*005 2*004 1.005 1*020 1.C04 1.002 1*003 1*003 I.-09 1*006 2*013 2.C13 1,013 2.590 2.456 1.700 2*759 2.730 1.795 3.160 1*360 *4 % 1*360 1*4C0 0.443 0,526 c. '.53 0,696 0.436 0.493 0,345 0.227 0,127 i W* Xn^r 0#4A:63 0.C775 } } 1 ; \ 19.74 0*027 0.066 faeces. Data* Ash. wt* 35g. Pb* Mg. Fb. gsa* Sample* 1 gas. ash. 9*50.szi- C.: 0*342'-fey7 0,230 0 ' 0.675 4 1.10*50* p 1*81 ' 0*680 0.375 OO ro (ksament. <rH <M Tills saaa* Idas had an Intense <wposuro# and whose concontration of o lead in urine was at tinea at a very high level, in fact ease of the higher o concentrations have only very rarely been encountered* by ,r* Kehoe, did not at any ttee exhibit synpioas of frank lead e^faalopet'ry* Ons' syatpiesj l* in tails case which roquiroa nets la the presence of Hood in the urine* A similar condition was described by Xnder Singh in tank cleaning In Z-dia Id in 1945* Tie cause of this is obscure, and it certainly does not sees to have left any permanent disability* It should be noted also that taje symptom for which this mn v&a edaitted to hospital was severe aidouiaal pain* -3U> *g&ln an uncossson. imi of the finical picture of tetraethyl load poisoning. It will be noticed in this case also ttet the blood lead was in &m&88 of norml on the list Decesiber, while the concentration In ur.ina was wall within the maximum of the nersaal range detoredaed here* Aged 31* rarrlad. ito Children* Pipe fitter. The history given by this ma, although very lucid, was found subsequently to bav discrepancies* R was apparently a recent employe of J. Hhd&c end Seme, but had bsea engaged on tbs tank leaning at Nottingham in aid August, although ho tel sot had a great deal of exposure there. He joined ^ BjjjjMn tbe 11th teptesbor, end v&a in end out of the ianE^j^MUa protection, Mteeugh he wore protective closing of sorts over his ordisery working elotheo* This son stated that he felt wall on tee Monday and Tuesday, th 11th and 12th September, but on Wednesday, 13th ^tester, he felt giddy, and baud cold 13spoilsi!, specially in the shoulders. Ho was aloeplese, end had bad dre&aa* ' Although ho -did not admit vomiting to sas, two independent observers stated that they had seen fcte outside the tank lying on the bank, retching and vomiting on one or other of tees days* He ms also rc-tching end voedting in tee tank on Wednesday, and this condition was th subject of soa slrfch who had sterted the job os that day* Ca the 13th also ho had % test like a penny in Ms south*5' Cn the 14th he did set go to Stcu^port. Hie syasptotss remained the ease* His aloeplassfictcE becas sr severe* Cn tee 15th ho wont to css his own doctor, who,-ho aid, told hdsst that ho was % bundles of nerves* and that there ms ' nothing wrong with hi.* Ho stays! away from work on the 16th and 17th, th* symptoms reminiag or or leas tea eajaa at this tins* Ha vomited on ted aftoraren of th 17th, following retelling throughout tee day* Ha ted a very vivid drs&a that evening, but not particularly terrifying. In tee few short intervals of sleep test he ted, be apparently shouted out. He returned to work at Etourpcrt on tea Mte, altecugh ha had been unable to at his breakfast that morning* He worked my from the tank, shovelling arte on tee pit that ted been exc&mtad for sludge. . Th smell from this caused nausea, and he returned home* On tee 19th, he worked as a fitter la Birmingham, bat felt very'weak and'tired easily* Bis eras sad legs felt heavy, and he felt cold and aching all over, particularly In th logs and thighs, which were also stiff* Be felt and saw twitching in hie muscles at tele 'titae* Boa of thee caused quite violent Kstarta*8 He was apparently at Hfcourport again cm the 2Cth and 21st, bat no exposure on these days is .known. Ho suffered fre j-dpltetions of tit heart at this tiao, the other syaptoas remaining at aor or loss the earn level. H had so appetite at the weekend, 23rd to 24th September, and on tec latter day he start! to have diarrhoea, which was still present on tee 26th September. He went to th cinema on th 23rd,.and ted difficulty in cooing ths picture. He ted the feeling all the time .test he was very far tech in th theatre. Ho slept badly on the 25th and 26th* His appetite vemimA poor# On tho latter day h stated teat he feed a violent pain in the front of th `'tesaaoh** froa th tiis/.he got up, end teat It was still present. It appeared to be K B 0021382 It will b noticed la this case also ttot the blood lead was if- assess of y^y^uxi q j j the 1st De<sw&P* v!;lle toe concentration In urine was vox- vxb.*in to naxiousa of toe norwal range determined bore* Aged 31, Married* ??o Children. Up fitter. The history given fey tola ism, although very lucid, was found subsequently to have diaerepemciee. Ho was apparently a recent employe of J, yhdan srd Sens, feat bad been engaged on tbs tsn& cleaning at l&ttingfcas in aid August, although ho had not lw& & groat deal of exposure there. he joined feHSBH* the 11th H^ptsgber, and was in end cut of the tarf^^Wkd co^S^Wspirsitory protection, although be wore protectivo clothing of sorts over his ordinery waking clothes. Ibis smn stated that ho felt well cm toe Monday and fuasdny, the 11th and 22th September, but cm Wednesday, 13th Stopteeaber, bo felt giddy, and had cold aErp21ail socially in the shoulders. He was sleepless, and had bad <iroa.ua. ' Although ho did not adeit veslfcing to as, two latapendcmt observers stated that they tod seen his outside the tank lying on too bank, retching and vesting on one or other of toes days* Ho vss also retching and vosdting in toe tank cm Vednssdsy, and this condition was the subject of soeso jsirth to who tod started the job on that day, Cn too 13th also ho bad % s Hf SIHSs s a ponry in bia iaemth* Or the 24th ha did not go to Stouyport, Ills oysptoas resslnsd the mm* His sleeplessness because cars sever* da the 15th ho went to see hie own doctor, who," ho mMf told 1*1 that ho was % bundle- of nerves1* and toot there was nothing wrong with hi* He stayed away fros work m too X6th and 17th, tbs syaptoas romining ore or less too mm at this tins* H vonited cn toe aftom-cm of the 17th, following retching throughout the day* Ke had a very vivid <?ma that vsning, but not perticiiiarly terrifying, In too few short intervals of sloop that ha tod, he apparently shouted cut. He returned to work at Btourport os too Id to, although ha had. boon -unable to sat his brsskfast that corning* He worked away- frm the tank, shovelling earth on too pit that had been excavated for sludge* Use sail frosa this caused nausea, and he returned hose, On the 19to bs worked as a fitter in Biraingbas, but felt very weal-: and tired easily. His eras and legs felt heavy, and hs felt cold and aching all over, particularly in the logs and thighs, which were also stiff* He felt and saw twitohings in his ausclea at this tics, Boas of these caused quits violent etarte. He was apparently-at Stourport again on the 20th and 21st, bat no exposure cm these days is .known. He suffered fro pc&piteticas -of toe heart at this tiao, the other eynptcsjs remaining at nore or less the mm level* He had no appetite ai toe weekend, 23rd to 24th September, and on too latter day he started to have diarrhoea, which was still present on the 26th September. He vent to toe dmm cm toe 23rd, and had difficulty in soaing the picture. He tod the feeling all too tins tost he was very for back in toe theatre* He dept badly m toe 25th and 26th* His appetite roaaiaed poor. On the lattr <fety h stated that ho todavi2ent poia into front of too uatotaachSi from too tifflo ho got up, end that it was still present, it appeared to fce in too msclos, and not internal. Intermittently, he hod soon double* Ho had tod a rash on hio left log before starting the tank cleaning, and lm stated that since the sludge got cm to it, it had boon very irritable, ond ha bad had violent polm in hio toss on toot side, which caused his to seroeua oat at tisos with their intensity. Fma hio own sfcatoaant, ho was apparently very ignorant of toe nature of toe baaard in tank cleaning, and although h knew that tilings were not light, fee could not sake up his just vhat'WS at Ifeult. He wa; rossining oa the job on!'with Vholsair only, until: 'the. ^dtoefc.i<m iwa - , >/ - - 0021383 V -11- ,vJf ;-'roa his story; little attention had been paid to bathing, and b had retained hia Soiled works clothes, which ho mid ssciled of the sludge, at his hose* ,, A'' Go emsaisatien, ha was found to be a sea of smll physique, pais, bed an anxious look, and was toss end apprehensive, Blood la.'ossm-o JU2G/9G* Taaporatitra 97*2* Biles mt 60# Blood fllst narnol* Stippled colls - nil* V^aesoglobin (Sahli) 93$* Thero was a mrked coarse trecicr of the left band, end twitching of the face, specially cround the south# Sh tenguo vas heavily furred and tresalcus* A omll ersa of deraatitto was present on the left 'lag, which appealed to be healing* 7h control suscles of the otdoson, specially below the navel, wars rtrasely tender, and he winced and aqulireei even -on light, touch* Ho other pi^aioal signs wore 'found* Tbs -reflexes were j k mw s u ,. IMS asn left the nploysoni of the contractor soon aftemirda, end had no further experience in lank eloooing* Ho ma stated to bs at work leewhers, and to have sad a ccaplets recovery on enquiry on the 1st December, 1950, hut this statosant has not horn eonfira^!, Ssaplos of urine obtained fro bin on two occasions war analysed with the following results* Sat* t 9*5S* 13*10*50* Vcl* Ms* 122 42 v:- 3%pa* Ph/daj^* %* Pc/iitre vl#G'# O.V 2C0. Standar dised* 1%/litro 1*014* 0*126 0,013 1*030 0*429 1.029 X#'22 0*500 0*273 Conssant* ,, , , . ' ,Avs -- : Ov.-Uv*--: -;.;.T,.'-- . --'- 'iV sm gave & very dear history in chronological order,. without prccsyfciiig,:-M.ibo bpiS^'-^v &.-Sw leading questions, yet som of 'his. story was subecqu^^^^ be incoirot*. . A@Edn, althmsgh the two snnplen of urine show <Kcntations: of load ata very high-level, no sigh of lsd musej^olc^thy were dtectd,ner, ihew our preaent knowledge, did they- develop: eubseqsmtly#. ' As. ffer as can fee seoertcinea, his exposure was not of the ease order c.s tbot;of tkotuo tikeXans- end Cart# tne*o inprosoion is that the melton his' log easy have boon-irritated by the eludgo costing into contact with it# Tb 'abdooUnl pain of which h explained on th 26th Sqptcaber did appear to bo mecular, and was, in cur opinion, .very' severe*.', Thorn is'nothing elec - -unusual - tic in this ' . story* :, . &;; ` f'ri fi*>- i f 0021384 '$t jflaaination# ho ma found to be a san of ssssll physique, as anxious lock, and was tones and apprehensive* Elood pressure Tataporeture 97*2* Puls sat 60* Elood fltonoraal# ___cells - ail. Haemoglobin (Sahli) 93$. there vaa a marked oo^o tare^r of the left hand, sad twitching of the face, especially around the south* ' Iho tonga ma heavily furred and tmaslous* A &m of dermatitis was present ea left leg, which appeared to be healing. She contrsi modes of the ebdoaeu, specially below the navel, ver srfcra&cly tender, sad ho winced and squirmed even on light , touch* Bo othor pl^rsleal signs were 'found# a refleseea wa novasi. this son left the esploysmt of the contractor scon, afterwords, and had no further experience in taask cleaning, He ms stated to bo at work elsewhere* and to haws rad a collets recovery <m enquiry on the 1st Dec-scsber, 1950* but this statement has not bom aonfimad. Samples cf urine obtained free fela a two eco&slofi were analysed vlth the fcHovdng results* Date* * 26. 9.50* 13.10*50. Voi* ins* 122 42 H02l . nvssmpio. Kg* WS.tr S*G* at 200* Staxsdar* diced. ?%/litre 1*014* 0*126 0,010 ......... 1*030 0.429 1*029 1*<22 0*500 0.273 Ccrzmnt. this caaa gars a vary dear history in chronological order* without prompting, and required very few lading questions, yet sea of hie story 'was subsequently feuad to bo incorrect. Again, although the two samples of urine show cencentmtiono of load at a very liigh lovd, no signs of lead encapholcpat&y were detected, nor, from our present knowledge, did they develop sub^qcocstly. Aa far as can be ascertained, his exposure uns net of the seme order cts that of the two Whelans end Cart* Cue's impression is that the rash cn Me leg my hove bom irritated by the sludge coring into contact with It* Ihe abdosdnal pain of which he ccsaplsined on the 2oth September did appear to bo aoecular, and was, in our opinion, very severe* Thar is nothing else imu3ual': . j in story* - I'afa - - Aged 23. Single* litter* r \ this aa had only been employed by the contractor for three weeks at the time of the exaain&tion* B had not boon present at the tank cleaning in Sottingbam, und he started tank cleaning et Stourport about tho 14th September, when ho was nainly engaged in pusping outside the tank* Ca the 15th, ho ms inside* after most of the sludge ted toon renew;?, cainly scraping up sludge that was adhering to the botton. h stated that he wore a full face air line respirator* He hod protective clothing of sorts* Ac far g o caagbe ascertained, he wore cotton du^jruea, which jjh& process of cleaning* Accci^ng;^ - HE- 0021385: ;^f i drank a lot of beer o r the evening of the 15th Scptes&er* and* contrary ' to his usual custou after such a debauch* h slept badly that sight* On th 17th, he ms restless all day* had little inclination for food* end that night did not deep* Oa the liith and 19th hs did not go to work, iiis appetite regained peer* but ho slept at night* and Mi a drees* ., .' On the 20th he returned to Stourport. Be does not mmefee* how ho felt - that day, but hs had still little inclination for food* cn the 21st* he ms not at Stcurport* but that night bad a dreaa which ha remubors ' vividly, end in which ha had to oat saggota* Cn the *2iad ho s&w double, and that evening ho bad a dreau is. which h ms in a long* dark tunnel, -and J as he walked down tide tunnel ho toenn smaller m& saaller. On the 25th ha returned to Stourport ea the teak clearing* this day ho fait twitching - in his modes* Be dept better that night than he had done for the-past V week, and his appetite be4 eligntly iaprwed. . .. \*"i v On anaainattco on the 26th September* he ms of ncrcal appasrence* Bipod trossure 130/95* Tespomtare 96*8. Pulse rat 77* naaaoglobta (Sahli) 102,?* Blood film mxml* Ifo etippled cells found, lEs pupils waSre unequsl, the left being smaller than th right, but no other abnormal signs were found* ;f Subsequently* ho resainad at work away frea tank cleaning for a fortnight, but returned to tank cleaning after this time* sysptoa-fr and under shilled suporvleioiu On the 1st Decssbor* no symptoms were adaittod, and he stated that ho felt veil* He was of sen-sal appearance* Blood pressure 120/00,'- ftmjratur 93*2* Puls rate 70* ' Basoglobin {Sohli} 97, Blood fils ansel* So stippled cells found* 7b excretion of lead in urine in this sen is shown below* 'p: ;-'5 , '1 *t '-p'':, ; 'xDate* . Vol* <2le.) -- Bttsi* Saaapl* Fb. Per litre* ; S.G. at 20. A -36.`9*50* 320 12*. 10.50* 27 13.10.50. 282 10*21.50. 330 1.12.50. 46 *060 *212 cao *389 066 . '*234 .050 / ' ' *176 - .013 298 '- ..... 1.0X2 1.022 1.020 . 1.016 . 1*027 Standardised* %.Pb/litre* 1.014. 0.24S 0.247 0,164 0*154 0,155 ':; f' -V/Vi :fe` 22221. Again* the diagnosis, lied to be nade on clinical grounds, but was confiraM later by the^e&ftlysle of samples of urine* Again blood pressure, ^jffipenaturo and.pulse mi. as' d&4fce other case, wore, of little ` valttf* 3od excretion An urine* on the five occasions on which sai^los t^re obtained* axe seen to be in all cases above ners&l. In feet ?a *** let Deecebor, uiion the individual was sysptoja-free* the excretion o'* wfB et tt Mrhar lwo1 than when the eyeptorae were present on* tfao 26th **pta&er* It ia possible that this individual, vivo hod subsequent exposure in tc:\k cleaning* ted absorbed further significant amounts of load* and therefore no cosset on the continued sxcrotbn of load-. -- than nornal is warranted, Aged 55* Married* Three children* Centrector. This nsao assisted in ths tank classing of the tanks at gotiingbaawith the sss disregard for the essential precauticns as Ms employees, and ha did not cuffor any lU-effeets so a r colt* Ha did not. edait to any syaptcas or signs whan esaalnod on the 26th Sapiesber. It is unlikely that he had any exposure at Stourport* lie admitted that he .bad had high blood pressure for soae years* Qa ffiasination he was seen to fee very well-preserved for his years, and of norml appearance* Stood pressure 125/95 f^aperature '97*3, Pales rat 68* t&escglebln (Sahli) 1Q6&* flood fils nexml. Ho stippled colie seen* The lead secretion in urine is shown below. De.to* Tel. Mgm. Fb. a,G* at 20. [oX&) Bg&ple* Per litre* Standardised. %./pb litre. 1.014 27. 9*50* 255 12.10.56. 44 10,11.50. 68 .029 *004 *006 .114 .107 ,097 1*022 1.023 .072 .065 .(62. "V Co&aent* It will, be seen that is tbs three instances on which e&aplea of urine were obtain! fros this tarn, the concentration of lead, although within nottaal Units, is at the upper Halt of nomal on each occasion, . which is as unusual finding in ear essriai*cs, and it.is fait that this ' is on indiesties that he had s q g aignifioent absorption of load at . Eottinghaa, which caused the' excrotien of lead at a higher level than nonaal, but which was sot sufficient tegive rise to syaptessa*. , One feds that the other i^vMu^; ^ in teak' cleaning,at iottinghaa clco absorbed eignificant mounts .cl0ft&':to operations' " there#- >' ,' v - : iai&^ii6afev'-ai>w ':^a 0021387 r.- :: fhroe tan1 o of ciailer construction ana service, which had contained leaded gasoline, are shown to have contained &v&g& with great variability in the organic load eesb&nt, and the cleaning of ms of these, which bad & tetraethyl lead content of 0*16, remalted in the intosdeaticn of five individuals, through e of tbs regulations governing tank cleaning* Coe case of imceihalopathy developed dboat ene wads after the lest atposure. 8s$mnr in nil canon m& at leant for several hoars. M odour of organic load was easily detectable in the elnige fmss tho tech concerned* In the five oases of intesdeation, the clinics! snifstationswore in direct proportion to the Intensity and degree of erposure* Iho lead esGrotion in the individuals concerned cannot be directly related to the intensity of exposure and clinical iBnifstations* This my not be clear iron the clinical pictures recorded, but our clinical depression is tabulated below. HE" 0021388 Koao* Intensity of 2ssposare* i 1 & 3 4 ,_ : ~ .. `v-t '*- .-- xy Clinical l^nifstations. lead Sxcretien* 14 21 33 42 ?. . A live meidosl eyaptons cannot bo related to the itess tabulated above,"as two of the individuals "concern! bad probably auheogaoat ospoguro, tis# at such an intense d^ee ee in .tho eases of the one "ease' in: iasoa^ialc^athy. ' of load was; a poor lAtti&tioa - Of; tfe acvarity ef :,tb*.:y41 condition, * the individual with the highest .lead eolation in tirine bad.v*;: ';.; isost mrlcsd.aiBptoffia raferred to the urinary tract, and notto the central nervous 'system*'' y > . the clinical pictures described era sis&lor to those jadsliebodV . in tho litersturo, n*mely eloep dlstarbances, loss of appetite, cjuscular pain end tvltchings, diairHeea, aai vBrio^ abnormal sensations of taste and on USh^'' scries ere tho severity and poreictanco of abdoeinal ie^'pcmplmtion in one esse, . and tho,pmenoe:of:; Itoeaatoria' .in `another#.. ,51*0 tesperntwo, pules ret a^a#3Bdia^flftrc'rew<li^ dossing* KJOSS SOUK? JA vu--r~ -- - _ -------------- ------ last expoeur. Ssposure in nil cases ms at least far several hours. da cdotar of crgsatc load mo easily detectable in the sludge froa fee tank . concerned* ..- / . Sa the five eases of fehsxieetioa, fee clinical neaifestatd^a'^ii ware in direct proportion to tie intensity and decree of aqsrare, The loud ` scrotio in fee individuals concerned cannot be directly related to fee intensity of exposure end clinical nentfestafclans* Ibis say not be clear froa fe clinical pictures recorded, but our clinical digression is tetelatel: below* ------- --------------- ............... ..-- teas* Intensity of dsqpoawre* --------- -- Clinical l^nifostaticss. lead Itseeretien# iW 1 2 3 4 5 14 Z1 33 44 55 The residual sysptcsas cannot be related to fee item tabulated above, a two of fee Irdividunle concerned ted probably suteoepont osposuro, brat at no tdse at such art internee degree ae in fee cases of K*J* Mhslaa and B* Cart* Is tbs oca case in which frank encephalopathy developed, the urinary ssrstios of lead was a poor indication of fee sorority of the condition* *ho individual wife the highest lead ascrotic in urine ted Boat mrisod eysptoaa referred to fee urinary tract, and notto the c antral nervous syetas# __ fhe clinical pictures described re similar to tfjcse published is fea literature, neasly loop dieturtenc#, loss f appetite, auecular pel and twitchingc, diarrhoea, and various abnoroal sensetions of taste and on fee body* ibrticular in this series ere the severity and persistence of steoainal pain and diarrhoea, fee intensity of perspiration In one case, ate the presence of teeaaturia in another* The tes^oraturo, pule rate and blood i^egetu^ readings ww of.-little 'mlue','and were net depressed, &elebiraa^^ Sesa' eynpteao* war- still - present in son cases more titan two oaths after rexscval fro exposure, sleep distmimees, loss of appetite, aberrations of taste, hoadacho and giddiness being fee aost persistent epsptesja* The objective signs were, in all cases, vary few or none* y It is notewortJiy feat none of these esses had intensive treatment* Tb two hoopitslised cases were given a high fluid Intake, with very snail doses of sedatives* Tho lowest comma doncsttimtor15 for zsosn. lead excretion in the urine, if usac! ao an indicator of fee degree of lead absorption, should probably bo less than 0*2 ngn* per litre, if s^ias of lead intoxication are to be . avoided* X` 0021389 -is~ Mbea cosipetont and independent supervision was provldM, tankt cleaning on too Stourpori site ms completed without'fcishap, although one of the tanks concerned. contained 'tor than double the percentage of volatile lead than to tank which gave 'rim to the intoJdoaties. It should to leer that it is impossible to predict, froa toe history of tar&s Which contained leaded gasoline, whether or sot tho'eludg of these in liked/ to be toxic, as toe concentration of organic load, in too sludge of these is very variable, and thcarofore' it is essential tost toe regulations to toaxvod in all cases, until such tijseS as asspert pinion and oquipaeat are *ailable to estimate too degree of toasrd* fhic, in an/ case, can only apply to sssall tanks, and, as far as T?*E# is concerned, toe regulations should to observed for all tanka, and took cleaning carried cut only under competent and Independent supervision Hag.* Sis concentrations of load in urine referred to in too above report or-s toe concentrations of s&IXigra par litre, end not the standardised figures* A centered normal mm in U*K, is 0*03 ago* par litre,'with concentrations stove 0*01 j^p* per litre unccmon, and under norsai conditions never in. ercoes of 0*12 ips. par litre* The isoen lead concentration In blood is about 0*027 ago* per 100 gsasssa of whole blood, with too upper Unit below O.07*npu per 100 grasssas* Any concentration above 0*055 saga* is sucpiciovn* S* Sevison# todicsl toportEKKst* 19th January, 1951* Kfc 0021390