Document nkQ1qBb0KeyrOMeqz6gb4QwEG

the following*statement is made in answer to a reguest by Mr. Clifford 3. Axtell for'an opinion in the case fiheroopoTlS^^'l^-'i. my understanding that Mr. fl U H p * haS fc5e" o o S e ^ n i R I ^ that ^fe diagnosis of optic atrophy has been ad and that has ad claim through his attorney that thejoptic atrophy was produced by the action of lead which was absorbed fro leaded gasoline* which was used in small quantities (several gallons per month) for the purpose of operating a start ing motor and also for wiping engine parts. . ..ir. V* -J - My name is, Lester W. Sanders. I was graduated with the degree of Bachelor of Arts fro Miami University in 1322, the degree of Bachelor of Medicine from the University of Cincinnati in 1927 and the degree of Doctor of Medicin from the University of Oiaciim&tl -in; 192s 1 am a member of the American Medical Association, the Ohio State Medical Association* the Academy of Medicine of Cincinnati* Ohio* and the Association of Industrial Physicians and Surgeons. I am an Instructor in.Physiology and an Instructor in Applied Physiology at the College of Medicine of the University of Cincinnati. I am a member of the medical staff of the Ithyl Corporation. The Laboratory of Applied Physiology* with which 1 am associated, engaged itself in the investigation of the toxicity of tetra ethyl lead in 1925 and has continued this study throughout the past 2k years. Every effort has been made to have knowledge of and Investigate every case of alleged or actual tetraethyl lead intoxication which occurs In the United States (and aleo in other countries) and these cases are reported by us to the Surgeon Ceneral's Office in Washington. If optic atrophy is produced by the action of lead, a general ised lendiriatoxic&tion m s t first exist. In order to establish a oertaln or even reasonable diagnosis of lead intoxication, the following;requirements must be satisfied? 1. A reasonable number of the characteristic signs . and symptoms of lead Intoxication5must exist. . There is:no single clinical sign or symptom which could possibly establish the diagnosis a. A reasonable source of lead for absorbtion must be proved or ^ v / b. An amount of lead must be found in the excreta and;blood which is sufficiently high to account V for an intoxication and to prove an absorption of lead greater than that which occurs In the average population. The mean level of lead \ X 0016;i4i N18656 in the urines of specifically unexposed in~ r l t l a > line*dividuals (those having no known exposure to Snir-:lea^|''ls;ti.02:-iailligraiis;per liter* The in-*r3 0Jj6 dividbal level not infrecently is found to be 0*07' milligram per liter. . -ih`>-4ay?intention that a lead intoxication in the case of Mr. 'lan^ehaw-wak"never.-proved and that there is no reason whatsoever to,believe that it ever existed. ' Fi v--l- -'. .' ' '' fo the best.of ay knowledge, the signs and symptoms presented by Kr. were not characteristic of lead intoxication at any time during his illness. This opinion is supported by the fact that out of a reported hs physicians who were consulted, only one (or one group of physicians) suggested the possibility of .a lead. intoxication-;^;,^;;;-yp : ... head was reported to have been found in the urine, but no quanti tative amount was stated. The source of the lead allegedly absorbed was stated to have been the gasoline used as previously described, ho intelligent eval uation was made of the amount of lead which could possibly have been absorbedunder the existing circumstances. the reasons why a quantity of lead sufficient to produce any intoxication or pathologic change could not have been absorbed from the source stated is established in the scientific literature During the years of about l$2h and 192$, this specifio problem of the possibility of the absorption of lead through the skin frost leaded gasoline applied to the skin was investigated by the department described before as the Department of Applied Physiology^at athe Bnivereity of Cinoinnati. Gasoline contain- 7 ing the^saiEikum allowable amount of tetraethyl lead was applied daily to ithaskinso f ^laboratory animals.,. Bo appreciable amount .of lead.was ever found to have been absorbed from the applied g a s o l i n e ' ' ~ :- ;.a -: Furthermore', in.investigations made independently by the United StatesvPublicrHealth Service, and by the group with which I am associated;, of a cross;eection of-workers having the greatest-"-*' exposi#e|tb; leaded gasolines, -it %ae-demonstratedby-' both groups of investigators that,no elgnificantsmaunts of lead were absorbed fro leaded gasoline,A;either by skin contact or inhalation. - This was demonstrated by;Individual analyses of the faeces and urine of the-ken e x a m i n e d . ' . - ' . -.r _ ; f," i .j.'S- v , - ' ` " - `.' . . . : . . - '_ . .. ', *. ` * < . "" , ' leaded gasoline is handled at least four times from its menu- f a c t u m to.;its ultimate consumption. It is loaded at the refinery into tank cars, .trucks OrAbargee as an open process through large. " * ......................... " -' ' - ^'-v- :/ YT".`m-V'"':  -3- swing lineafOl&ch are operated by men on an eight hour or longer shift. It is unloaded and later redispensed at bulk stations by similar methods. It i then put into tanks at service station and redispensed by the service station operators. All o f these workers* during their working hours* handle continually from hundreds to thousands of gallons of leaded ..gasolines per day. 411 of these men are frequently wetted by these gasolines and are exposed in various degrees to the vapors of these gasolines. In 19^6 there were 5Sg ' points where leaded gasoline was blended and subsequently loaded. It is a conservative estimate that from eight to ten thousand aien were engaged full time in loading this gasoline. There were many'more involved in the same kind of work-at bulk -".-''pianta* and there were at least a million filling station attendants in some 230CM30 stations handling leaded gasoline throughout their days work. In the State of:Wyoming alone, eighty three million' gallons o f l e a d e d g a s o l i n e w e r e sold, in ld6, and necessarily handled by the before mentioned groups. In the entire United States, one billion eight hundred thousand gallons of leaded gasoline were handled in the ease fashion. ~r.A . Ho one authenticated case of lead intoxication has ever been reported or seen by us in any of these groups of workers 'ho have the maximum exposure to leaded gasolines. An additional group of men who are intermittently in contact with leaded gasoline is composed of garage mechanics. Ho authenticated case of lead intoxication has ever been reported or seen by us in this group. There have been case of tetraethyl lead intoxication seen by us from time to time, as a result of exposure to the concentrated lead compound, which is added to gasoline. 1 none of these cases have ve seen blindness and/or optic atrophy or other, forms of peripheral neuritis. ' ..... " The ssaximim allowable limit of lead added to automobile gasoline is three cubic centimeters per gallon, but this limit is in- frequently-.reached and it I& estimated that in the area concerned the gasoline lead content would rarely exceed two cubic cent!- meters, and usually, considerably less.. This would mean a usual concentration of from Q .0125 to 0 .025'^ lead in the gasoline in Question, v. - .' . 'i** i***,',r* " ' '' ,St. The d l c ^ :''hlstory'-dfr^r. * 0 * illness; its- cnoh a r a c t e r - ' lstic of51end#ntoziontlon'*;^;.Ttie.;:'isidixet'rlal. history of Mr. hangehau-shows:,tbatibis^exposure;to leaded gasoline was infinitely small "compared with workers whose essential full time job i that of handling; leaded gasoline and it has been shown that lead intoxication has -i^t beoured in these groups where millions of men have been: ,,involved. ^ There is not a-sufficient difference in susceptibilityto lead intoxication to account for this case as one isolated.case out of millions of similar, but very much -greater exposures. ' ' Kr ---i. J ...-w T - ester js. anciers, M.p. ;