Document KGgEXbRbo6zY4yJKO70E915Qx

I UNITED STATES PUBLIC HEALTH SEE.VICE \ ___________________ ' PUBLIC HEALTH BULLETIN No. 163 JUKE, 1926 THE USE OF TETRAETHYL LEAD GASOLINE IN IT S RELATION TO PUBLIC HEALTH PREPARED BY DIRECTION OF THE SURGEON GENERAL WASHINGTON GOVERNMENT PRINTING OFFICE 1926 U N ITED STA TES PU BLIC HJSALTJ SERVICE- PUBLIC HEALTH BULLETIN No. 163 JUNE, 1326 THE USE OF TETRAETHYL LEAD GASOLINE IN IT S RELATION TO PUBLIC HEALTH PREPARED BY DIRECTION OF THE SURGEON GENERAL WASHINGTON GOVERNMENT PRINTING OFFICE 1926 1 " " ' r " " TM ................ " 1 " I M ' . ' I I ... .MM... ,, , , , REPORT OF COMMITTEE OF SEVEN RECOGNIZED AUTHORITIES APPOINTED BY -THE SURGEON GENERAL OF THE UNITED STATES PUBLIC HEALTH SERVICE TO PRESENT A STATEMENT AS TO THE HEALTH HAZARD INVOLVED IN THE RETAIL DISTRIBUTION AND GENERAL USE OF TETRAETHYL LEAD GASOLINE MOTOR FUEL By W. H. H o w sl l, A, J. C h e s m t , D aved L. E hsall, H ex H u n t , W. S. L e a t h e r s , J ttlitjs St ie g l it z , C.-E. A. W in slo w J anuaby 17, 1926. Surg. Gen. H. S. Cumming, United States Public Health Service, Washington, D. 0. .Dear Sib : The committee appointed by you .at the request of th conference held in Washington May 20, 1925, was directed; to present to you, "if possible by January 1 next, a statement as to the health hazards involved in the retail distribution and general use of tetra ethyl lead gasoline motor fuel." As soon as practicable after its appointment the committee met in your office for organization and for discussion of the procedure to be followed in carrying out its in structions. The members of the committee familiarized themselves, as far as possible, by conferences and by reading, with the existing data bear ing upon the subject and upon lead poisoning in general. They had access to the stenographic report (see Public Health Bulletin No. 158) of the addresses and discussions which took place at the conference of May 20, and subsequently they made a personal examination of the plant at Deepwater, N. J., for the manufacture of tetraethyl lead, and of one of the stations at which the ethyl fluid is mixed with gaso line. Ethyl gasoline was first placed on sale February 1,1923, and its sale was voluntarily discontinued May 5, 1925, about 300,000,000 gallons of ethyl gasoline being distributed during this period. Serious cases of poisoning occurred among men handling lead tetraethyl and ethyl fluid in the States of New Jersey and Ohio. As far as the committee is aware these accidents had all occurred in connection with the manu facture and blending of concentrated tetraethyl lead, and threw no direct light upon the problem specifically laid before us--that of the 103 u --- U UJUtlrlf- iii - uLcre are at present no good grounds for prohibiting the use of ethyl gasoline of the composition specified as a motor fuel* provided that its distribution and use are controlled by proper regu lations. The committee feels that the formulation of specific regu lations. in regard to the manufacture, distribution, and use of tetra ethyl lead, ethyl fluid, and ethyl gasoline for adoption and enforce ment by the several States belongs properly to the office of the Sur geon General of the Public Health Service. In an appendix to this report attention is called to.certain suggestions which have been made in the course of the discussions of "this committee and which it is believed should be taken into consideration in making such regu lations. In conclusion we beg to say that we are conscious of the fact that the conclusions to which we have come in this report, although based upon most careful and conscientious investigations, are sub ject to the criticism that they have been derived from the study of a relatively small number of individuals who were exposed to the effects of ethyl gasoline for a period of time comparatively brief when we consider the possibilities in connection with lead poisoning. A more extensive study was not possible on account of the limited time. I t remains possible that, if the use of leaded gasolines becomes widespread, conditions may arise very different from those studied by us which would render its use more of a hazard than would appear to be the case from this investigation. Longer experience may show th at even such slight storage of lead as was observed in these studies may lead eventually in susceptible individuals to recognizable lead poisoning or to chronic degenerative diseases of a less obvious char acter. In view of such possibilities the committee feels that the investigation begun under their direction must not he allowed to lapse. The respective States would be dependent upon the findings of such investigations for changes in their regulations. With the experience obtained and the exact methods now available, it should he possible to follow closely the outcome of a more extended use of this fuel and to determine whether or not it may constitute a menace to the health of the general public after prolonged use or under con ditions not now foreseen. Outside the question of ethyl gasoline it would seem from this investigation that wherever automobiles are housed together there is an accumulation of lead dust which may prove to be a source of danger to the workers involved, in addition to the hazards arising from the production of carbon monoxide gas. The vast increase in the number of automobiles throughout the country makes the study )f all such questions a matter of real importance from the stand- able appropriation be requUOU *-jfc - w of these investigations under the supervision of the Surgeon Uenerai of the Public Health Service, and for a study of related problems connected with the use of motor fuels. W. H. H owell, Chairman. A. J. Cheslby. David L. E dsall. R eid H unt. W , S. L e a th ees. J ulius Stjeglitz. C.-E. A. Winslow. TREASURY DEPARTMENT UNITED STATES PUBLIC HEALTH SERVICE PUBLIC HEALTH BULLETIN No. 158 AUGUST, 1935 PROCEEDINGS OF A CONFERENCE TO DETERMINE WHETHER OR NOT THERE IS A PUBLIC HEALTH QUESTION IN THE MANU FACTURE, DISTRIBUTION, OR USE OF TETRAETHYL LEAD GASOLINE PREPARED BY DIRECTION OF THE SURGEON GENERAL WASHINGTON GOVERNMENT PRINTING OFFICE 1935 Suggestions by members, of.th e ..conference : Dr. M. Nieoll, j r __ ___________________________________________ ..Dr. Francis D. Patterson___ _______ ___________ ------------------------Mrs,, Grace M. B urnham ______________ _______ _______________ Dr. D. E. Howe____ ____ _____________________________110 Dr. Tandell Henderson____________ .__________._____ ____ i l l Dr. Henry I<\ Vaughan_____ ____ ____ _____ --_L_________ 113 Mr. E, W. W ebb-__ .____ _________________ ,,,,i________ -111 Besolution--- .-- ----- :___ : 1 -- ___ _________________1________ Itemarks by Surg. Gen. H, S. Gumming__________________ ______ __ __ Page 109 109 110 116 116 LIST OF ORGANIZATIONS, INDUSTRIAL AGENCIES, AND GOVERNMENT BUREAUS REPRESENTED A T'TH E CON FERENCE, WITH THE NAMES OF THEIR REPRESENTA TIVES' American Federation of Labor: * A. L. Berres. Mrs. Grace M. Burnham, Director Warleers' Health Bureau. Miss H arriet Silverman. American Institute, of Chemical Engineers: Dr. D. E. Howe. American Oil Co.: : John M. Klein. Lee Sonnebom. American Petroleum Institute: Robert Welch. F. B. Dow. American Public Health Association: Dr. Henry F. Vaughan. J, A. Tobey. Anglo-American Oil Co. : H. S. Tegner. Baltimore City Department of H ealth: Dr. J. H. Shrader. Barrett Co.: S. R. Church. Brown University: Prof. C. A. Kraus. Bureau of Chemistry: Dr. C. A. Browne, Chief. Dr. W. W. Skinner, Assistant Chief. E. W. Schwartze. Bureau of Labor Statistics: Miss Whitney. Bureau of Mines: - Dr. H. Foster Bain, Director. Surg. R. R. Sayers (detailed from the V. S. Public Health Service). C. A Taylor. Dr. W. X McConnell. William Vant. Bureau of Standards: Dr. H. C. Dickinson; -- Doctor Thompson. Carnegie Steel Co.: B. M. Livezey. (V) Chemical W arfare Service: Lieut. Col. Edward B. Vedder, M. C. Cincinnati College of Medicine: Dr. Robert A. Kehoe. Colnmbia University: Dr. Haven Emerson. Dr. Frederick B. Elian. Department of- the Interior : Hon. Hnbert Work, Secretary. Deppe Motors Co.: . N. P. Deppe. E. I. du Pont de Nemours & Co. : Irenee du Pont. W. F, Harrington. Charles K. Weston. . Charles L, Beese (President American Institute of Chemical Engi neering. Dr. A. K. Smith. Ethyl Gasoline Corporation: W. Gilman Thompson (Medical Consultant Standard Oil Co. of Neto Jersey). ' C. F. Kettering. Thomas Midgley, jr. Dr. Graham Edgar. E. W. Webb. A. W. Maxwell. Federal Oil Board: C. W. Waterman, Manager. General Motors Corporation: C. F. Kettering,(also w ith.E thyl Gasoline- Corporation). Geological Survey: Dr. George Otis Smith, Director'. Gulf Refining Co.: Dr. W. A. Gruse (of Mellon Institute). Harvard University: Dr. Joseph C. Aub. Dr. Cecil Drinker. Dr. David Edsall. Dr. Alice Hamilton. Prof. Reid Hunt. Johns Hopkins University: Dr. W. H. Howell. ' Dr. K. K. Marshall. National Research Council: Dr. Ludwig Hektoen. Dr. E. W. Washburn. National Safety Council: , Paul Frederick Strieker. Navy Department, Bureau of Aeronautics: Lieut. S. B. McMurrain. New York Academy of--Medicine-: Dr. E. H. L. Corwin. Dr. J. A. Shears. New York State Department of Health ; Dr. M, Nicoll, jr., Commissioner of Health, Dr. Augustus Wadsworth. New York, Reconstruction Hospital: M. DeM. Touart, Medical Director, Ohio State Department of H ealth: Dr, 13, R. Hayhurst. Pennsylvania State Department of Labor and Industry: D r. Francis D. Patterson, Chief of the Division of Hygiene and Bngmering. Philadelphia City Department of Health: Dr. W illianr C. Robinson, Standard Oil Co. of Indiana: Dr, F, R. Morton, Medical Director. Standard Oil Co. of New Jersey: Dr. C. C. Johns. E. M. Clark. R. A. Van Eaton. F. A. Howard. State and Provincial Health Authorities: Abel Wolman, of the Maryland State Health Department (repre senting Dr. Johns S. Fulton, State Health Officer.) Steel Products Co., Cleveland, Ohio : C. E. Thompson. Studebaker Corporation; A. J. Chanter. E. J. Miles. University of Pennsylvania : Dr, H. F. Smith.' United States Tariff Commission: Frank Talbot,-of the Chemical Staff. The Texas Co. : Sherman Ford. Yale University : Dr. W. H. Haggard. Dr. Yandell Henderson. United States. Public Health Service: Surg. Gen. H. S. Cumming, Chairman of Conference. Asst. Surg. Gen. A. M. Stimson. Asst. Surg. Gen. J. D. Long. Surg. L, R. Thompson. Surg. G. W. McCoy. Prof. William Mansfield Clark.Prof. Carl Voegtlin. Dr. H. D. Gibbs, Senior Chemist. In April the animals concerned in the above experiments were moved into different quarters, which allow of no opportunity of exposure to lead 'in any way other than under controlled experimental conditions. Treatments are being continued to determine if symptoms and signs of poisoning eaa .be pro duced by the experimental methods previously outlined. The C h a irm a n , I believe, if I can. read your faces aright, this is the time to. adjourn for lunch. We will meet again at 2 o'clock and complete the discussion, (Thereupon, at 1 o'clock p. m., a recess was taken until 2 o'clock: P- m-) Afternoon Session The C h a ir m a n . In accordance with the program, I suggest that we now take up the discussion of the experimental data which were reported this morning, aiid I am going to ask Doctor Henderson, of Yale, if he will open the discussion. BE. YANDELL HENDERSON Professor of Applied Physiology, Yale University Mr. Chairman and gentlemen, I have no general paper to present, such as we have listened to this morning. There are, however, one or two quite general points that have occurred to me as this confer ence has gone on that I would like with your permission to mention before I touch on more specific matters. One point is that which Secretary Work spoke of, that we might be here for a number of days. I think I oiight to say, on behalf of myself and my col leagues, that we can scarcely stay beyond to-day. We are down here on our own expense, neglecting work which we ought to do, and I hope this conference will finish this evening if possible. I think we ought to do so, and to set an example I am going to be very brief and merely try, as the chairman has suggested, to open this discussion. There is one other point of a general character that I want to call to your attention. The Surgeon General, in opening this meeting, spoke of the lack of laws applying to such a matter as this, and, to my mind, there he touched on a matter which is more important by far than the specific question before ns. As I understand it, the Surgeon General has neither authority to say that ethyl gas may be made or may not be made, or even to direct an investigation in volving the expenditure of Government money without special act of Congress. I should like to point out that if gasoline were a food this situation would not exist. We have full legal protection and legal definition of foods and of their qualities, and it seems to ,me that this is one thing that we all can agree on. Perhaps the two sides here present will not be able to agree with regard to the par- ticular question of whether ethyl gasoline shall be used or not, but it seems to me that we can all agree that such a situation as has arisen regarding leaded gasoline should not arise again; that there should be legislation to give the necessary power to th e :Health Service. Then, when other questions of this sort come up., as they certainly will, the Surgeon General would have full authority, just as the Bureau of Chemistry in the Department of Agriculture now has full authority over foods. The Surgeon General should have full authority to investigate and supervise and to advise the public, the State boards of health, -and city boards of health in all such i matters. I have handed to the Surgeon General a resolution cover ing this idea. I do not think we are at a point in the discussion as ; yet where we can present specific resolutions, but I hope before this meeting adjourns that we can all agree that it would be advisable, highly advisable, that Congress should be asked to vest in some ; branch of the Government the authority to investigate and. to advise, at least, regarding substances other than foods entering into inter state commerce. I think we ought to be able to agree on that. I have been assigned to open the discussion, and, as I said, Tam going to be brief. In fact, I do not catch points presented ver bally very readily; but there were three which I caught this morn ing which stick in my mind. They stand out like mountain peaks. One of them was reported by Doctor Sayers. He reported that there was 10 per cent of lead in the dust of his experimental cham ber. Exhaust gases had been going through there for some months. Exhaust gases go through garages for a very much longer time than that. We may therefore take that observation as an indica tion of what the dust in a garage is going to consist of, namely,[ 10 per cent of lead. : Another point which struck me. profoundly was that presented by Doctor Kehoe, that his controls were poisoned. I should not I have said poisoned, I should say his controls became leaded, and I . I think he implied that this was due to the lead from the lead | ethyl which he had around there being in some manner.released, | getting loose, going into dust, or vapor, or in some way getting | into his control animals. That, I think, is a very fair illustration | of what the sanitary experts expect with regard to conditions | where you have a material of the high toxicity of tetraethyl lead-, | or of lead in any form lying about. | Then a third point, which I shall want to come back to, was I- ' made by Doctor Elinn, that tetraethyl lead, used even in small i amounts, is absorbed through the skin, so that if you get it on your I hands, it gets into the body in some way, either through the skin I or through the respiratory tract. I t is certainly a very striking | fact that even the experimenters, even the investigators, who cer- tainly would handle the product carefully, .who, are exposed very, very little, show that they have absorbed an appreciable amount of lead. We have in this room, I find, two diametrically opposed con ceptions. The mien engaged in industry,:chemists, and engineers,, take it as a matter of course that a little thing like industrial poison- ^mg~sou!d^m^,B,ajjdwTcl to stand in' tHeTwayGfflT^reat industrial -han3T~the^sanitary~experts- take T t~ as.T' inattejy of_j;ourse.that the first consideration is the health of ;'t'he~" jigagle^ Now lead--as many sa.pif.fl.ry expert ted ypy vastly better than I can--lead is the commonest industrial poison, or^as^lmtlT^&e production of"the automobile^ Recently carbon monoxide has displaced it. But it seems probable on the basis of the. evidence that we have heard this morning that lead will soon recover its leadership, and that if leaded gasoline comes into use, lead will, again take not only first place, but by far the first place as the greatest industrial problem. I have talked with many chemists and engineers, and I do not think they have any appreciation of the place that lead occupies. Lead poisoning to-day is, in the eyes of industrial physicians, com parable to typhoid fever. I t is almost comparable to tuberculosis in its character as a disease. It is a form of poisoning of a peculiar type. It is cumulative. I t is airead}^ fairly common. We do not know what percentage of the population, how many tens of thou sands of people in America, are carrying a greater or less quantity of lead in their bodies now. We have every reason to believe that it is a very considerable number. . I can well understand that the Ethyl Gasoline Corporation may say, " W ears not responsible for the lead in the bodies of typesetters, printers, and house painters," but the sanitarian has to look at the matter from another side. He knows that if a painter or a typesetter has in him already such a quantity of lead that he can just keep it -down--he can just keep it in his bones or just keep it excreted at the rate he takes it in--then the addition of a little more is going to increase enormously the number of cases of lead poisoning in the community. We have to look at the thing from that side. Bo while we want to be as considerate as we can in regard to the industrial standpoint, we must also ask that our standpoint should be understood and considered. There is a matter upon which I touch with hesitation, because I am afraid that I may cause offense, and yet I have to. This is not the first poisonous substance that has been developed. In modern * industry more and more frequently we have poisonous chemicals of one sort or another developed. This was particularly the case during the war. There I can speak from personal experience. When the war started I was assigned to the physiological or medical side of the development of war gases. I got. a very capable man and put him in charge of the sanitary supervision of production. Very con siderable amounts of phosgene and mustard gas were produced in America, during the war;, and we did not poison the people who made it.: Such substances can be handled so that you do not kill people. On the other side we have a list, according to different counts, of between 11, and 15 men killed by tetraethyl lead. They died in a terrible- form of insanity. Furthermore, somewhere between 50 and 100 other men have been poisoned more or less severely. It is prob able that not all the cases have been reported. I was surprised this morning not to hear the Whiting plant in Indiana mentioned, because I have a letter here from a man whose son was severely poisoned in the laboratory, at Whiting, Ind. This, indicates that we have not heard of. all the cases. Chemists and >engineers surely have no desire to kill people; and if that is the case,, then there.is something about the manufacture of tetraethyl lead,, something about its lack of odor, something about its other qualities, which renders it peculiarly liable to result in severe poisoning, v That is a very important point. Chlorine, although a very irritating substance, seldom causes death. Hydrogen sulphide, although as toxic as cyanide, seldom kills a laboratory worker. The reason is that chlorine is so irritating and hydrogen sulphide smells so bad that a man gets out of the way. I am going to read one dr- two communications showing how people are poisoned by tetraethyl lead. Before I do so Xwant to say that I am not combating what was said this morning about the "'special merits of lead for automobiles. I am simply trying to show that there is another side. I have asked some of the chemists, my colleagues in Yale University, and I have found that lead is not by any means the only substance which, on theoretical grounds, or even on the basis of experiments, can be used as an antiknock medium. I find from the engineers in the mechanical engineering laboratory of Yale University, where they work quite largely on automobiles, that they have a feeling that even with the present fuel it will be possible to develop engines that will make use of the rapid form of explosion, which is called detonating. I do not offer an opinion on that matter, I simply quote it as showing that men who are competent to have an opinion believe that there are other chemical and engineering possibilities. The subject of masks was mentioned. I had a good deal to do with the developing of the gas mask during the war. I t has now been developed into the Burrell mask, now used in industry. I think it is very doubtful whether you can permanently protect men i ,p" " i -- - -|, , | | M, -- - ** ........ | ................ i f , in ,, by means on-masks .jmderUh'dustriaX conditions. A m a n w iu p u c on a mask and go into ammonia," but you can not depend on masks to protect men under constant working conditions. I t is not known, I believe, whether the masks will stop tetraethyl lead. I had occasion this morning to mention in connection with Doctor Sayers's remarks that his use of the standard of four parts of carbon monoxide is not well founded. In the streets of New York it is true that the concentration of carbon monoxide runs from 1 to a little more than 1 part of that gas in 10,000 parts of a ir; but in garages the concentration of carbon monoxide runs up to 10 or 12 or more parts of carbon monoxide. So we would have to multiply Doctor Sayers's figures by 3 or 4 in order to estimate what the effects will be in garages. I have already talked longer than I meant to, but I want to men tion one or two cases I have collected to show how careless people become, and also to show the really terrible responsibility--I am sorry to have to say this--which rests upon the gentlemen who have developed this substance in not having warned more effectively the people who have used it. I received this letter only a day or two ago, dated May 8, from West Virginia. In tae early stages, of the sale of ethyl fluid, they were not able to furnish ethylizers and we filled thousands of l-ounee bottles with the fluid. In serv ing the customer we would pour the contents of the bottle in his tank and run the gasoline in on top of it. In filling these bottles the w riter took an active part, and I have had my hands and arms up to my elbows covered with the fluid. This not only happened once, but a number of times, before we knew there was any danger. . At least we should have some guaranty that in future, people will be adequately warned. I have here, also a quotation from a report of Doctor Shrader, in Baltimore, describing the mixing of the ethyl fluid to make ethyl gasoline. I believe this mixing is now done at the works, so I will leave out the first part of the report in which the men he interviewed mention having had the .liquid often splashed over their faces and arms. This passage, however, applies. He says: One service man reports that he gets it all over his hands and coat sleeves, and that the company issues instructions that in all such cases I was to wash it off with gasoline and tincture of green soap; hut we do not bother with that any more, we ju st wipe it off. This service operator had it splashed upon his: face and reported that " it smarted some," and another that it splashed up his nostrils and that u he nearly sneezed his head off." In this connection I. should like to mention one other point. I have spent my summers for some years motor boating, and I find it the regular practice of the men on motor boats when the gaso line pipe plugs up to first blow into it to blow it clear; and if they can not blow it clear, to suck until they suck it clear. I have seen men time, after time squire muuwuuw to___.... have to keep such conditions in mind. I think it is sufficiently well known to everybody that gasoline is spilled around garages, and I would merely instance one or two collateral points. Methyl alcohol is .much less poisonous than tetraethyl lead, wet cases have been reported of men .poisoned by inhaling the fumes. from the radiators of cars using alcohol in winter. This shows that con siderable amounts of fumes are inhaled, by men, particularly those driving trucks, and that men have been seriously affected, even by the present fumes. There are also cases on record where the at mosphere in a closed car has become so charged with carbon mon oxide as to cause death. I quote this fact to illustrate the point that exhaust, gas is sometimes discharged inside of cars. The main calculation which I want to contribute to this discussion is. th is: Doctor Haggard, my associate here, and I have published ex tensive work on automobile gases in the streets. We know the amounts of carbon monoxide in garages; we know that the figures run to 1 or 2 parts in the streets and 8 to 10 or 12 parts in garages, and more than that in repair shops'. Kow, taking the data obtained by Mr. A. 0. Fieldner, of the Bureau of-Mines, and combining them with other data we have, it appears that in an automobile every kilo of gasoline burned involves 12 kilos of air. In the exhaust gas there would then be about 1 milligram of lead for each 0.8 liter of carbon monoxide produced, or 1.4 milligrams of lead per liter of carbon monoxide. , From this we can calculate the amount of lead in a 1 to 10,000 mixture of carbon monoxide, or the amount of lead in. a 10 to 10,000 mixture. If, then, a man breathes four to five thou sand liters of air in 10 hours, and the air contains 1 part of carbon monoxide in 10,000, as in the streets, he would inhale in the course of 10 hours one-half milligram of lead. That, of co'urse, sounds to a chemist like an exceedingly small figure. To the man interested in industrial diseases the daily inhalation of half a milligram of lead is a serious matter. In a garage, where often there are 10 parts of carbon monoxide, the worker would inhale daily 2y2 milli grams of lead. Of course, this would be reduced in proportion as the lead sticks in the muffler. We come up to the high figure in pro portion as all of the lead is discharged. As processes improve, more will probably be discharged. It seems to me that the Surgeon Gen eral, or some officer of the Government, should have general super vision, so that in future the regulations can be, adjusted to actual conditions. Even now we often have' 200 cars per block in Fifth Avenue, and if they each bum 2 gallons of gasoline per hour it runs up to about 200 pounds of lead- in Fifth Avenue between Twentythird Street and Central Park. Even one-fifth of that amount as volatilized lead is a very large amount. These figures are based on 60130--25----- 6 , we nave tound it in streets and garages* Carbon monoxide is a true gas; it diffuses rapidly. Lead does not act as gas; it bangs in the air so`that one wofild expect a very considerable concentration of lead dust as compared with the rapid escape of the carbon monoxide. Thus it seems to me. on the basis of all the data that we have at the present time, that the or dinary conditions in thoroughfares in heavy traffic would afford about one-half of a milligram of lead a day for a man to absorb. Kobert estimates that the amount of lead, day in and day out, which would almost certainly result in distinct lead poisoning is i milligram. Garage workers and repairers would absorb very much more. Now, I put it to the gentlemen on the industrial side of this con ference that they, no more than any sanitarian, would approve of having a milligram of lead in every gallon of the city's water supply. Yet if the city's water supply contained 1 milligram per gallon we would take daily from it just about the amount of lead which, as nearly as we can figure it on the basis of such facte as we now have, the people of New York, especially in the denser parte, would be expected to inhale. I have here somewhere--I will not read it now--a paper by X>r. Alice Hamilton in the last Journal of the American Medical Asso ciation. She is here and will speak for herself. In that article Doctor Hamilton expresses the matter as fully and as clearly as anyone possibly can. In the last sentence of her paper she sets up this very simple proposition that this substance, this new industrial hazard, should not be put into general use, or its use should not be extended until we have adequate and full information assuring us that we are not introducing another health hazard into our daily lives. The C h a ir m a n . I am going to ask Doctor Thompson i f he will follow. Doctor T hom pson. There are others here very much more com petent to discuss this subject than I, and I should like to yield my place to Doctor.Edgar. Will you call on him? The C h a ir m a n . Doctor Edgar. Doctor E dgar. W ith Doctor Thompson's permission, X also, not being a physiological chemist or even a physician, would like to have Doctor Kehoe answer the questions, not myself. The C h a ir m a n . Doctor Kehoe, DR. ROBERT A. KEIIOE College of Medicine, Cincinnati, Ohio Mr, Chairman and gentlemen, there are one or two items of Doctor Henderson's talk that I should like to speak of first, be ginning particularly -with that one which refers to the experimentswhich were conducted by myself, in that the controls in our animal experimentation showed that they had absorbed lead. I should like to point out the manner in which those animals were exposed to lead. The condition was such as does not and could not conceivably occur in the industrial handling of gasoline. Now, to make that, point clear I should like to recite the exact conditions to which these animals were exposed. At the time when it was decided, on the ini tiative of the Ethyl Gasoline Corporation, to remove completely from the industry that hazard which was regarded by the medical committee as a most important one, namely, the handling by garage men and filling station employes of concentrated fluid, all of the material which was then out on the market was returned to the Ethyl. Gasoline Corporation. This came in in varying quantities and at different times over a period of a number of weeks, and it came in in such quantities that the immediate disposal of it was a matter of some difficulty. Various storage rooms in and about the,build ings used for the blending and distribution of this material were filled for a time with the cases containing these small cans that had been returned, and it was only in that situation that the over flow took place into the room in which we were experimenting. Under these conditions an exposure on the part of these animals was had, not to the dust of dilute gasoline, which appears on the public market, but to the dust which arose from the decomposition . of concentrated tetraethyl lead, a situation which presented oppor tunity for absorption of an enormously greater quantity than could occur under other conditions. I t was under these conditions that our animals absorbed lead--conditions which, let me emphasize, have no relationship to the hazards existing from the handling and distribution of diluted tetraethyl lead in gasoline. - There is one other point that I should like to make with regard to the poisoning of certain persons who were experimenting with tetraethyl lead, whose specimens of feces and stools, or feces and urine, later showed lead. Anyone who experiments in any way at all with concentrated tetraethyl lead is bound to absorb a certain amount of vapor of tetraethyl lead into his body. I see no possible escape from that condition. One may work with a very good hood, but in the very business of treating the animal with concentrated tetraethyl lead and staying in the same room with it there would, be a certain absorption of lead. I t seems to me that the absorption _____iiw u muon as oemg interested in opinions: as being interested in facts, and if it can be shown--if it is shown as the result of this discussion--that an actual hazard exists in the handling of ethyl gasoline, that an actual hazard exists from, exhaust gases from motors, that an actual danger to the public is had as a result of the treatment of the gasoline with lead, the distribution of gasoline with lead in it will be discontinued from that moment. , Of th at there is no question. I make no plea for industrial progress, because in my nwn opinion industrial progress is not synonymous with human progress at.all; but I must say, from the standpoint- of industry, that when a mate rial is found to be of this importance for the conservation, .of fuel and for increasing the efficiency of the automobile it is not a thing which may be thrown, into the discard on the basis of -opinions. I t is a thing which, should be treated solely on the basis of facts. That has been our attitude from the beginning, and that will con tinue to be our attitude. The Chairman. We have this discussion divided somewhat arbi trarily, I fear; but are there any remarks by anyone on the.experi mental phase of this? Doctor Mortgx. I would like to answer Doctor Henderson about the letter he has in regard to a case of lead poisoning. This young man he refers to is the son of the dean of the law department of the University of Kentucky. He was working in the experimental laboratories at Whiting, Ind. A few days after the papers were full of the New Jersey accident, where a number of men died as a result of lead poisoning, this young man took sick. He is a grad uate of the University of Chicago, and he was treated by one of the medical staff ,of the University of Chicago, who did not make a diagnosis of lead poisoning but said that Ms trouble was nervous ness. I saw him, examined him, and had Dr. Kalph Webster, head of the Chicago laboratory, examine the urine for lead. I also had the blood examined. Everything was negative, so that my diagnosis was neurasthenia or nervousness. He went home to Kentucky, His father had three men at Louisville, I believe, take care of him for two or three weeks. We afterwards received a letter from one of the men at Louisville which said that no signs of lead poisoning had been found and that the diagnosis was nervousness, or a neu. rotic case. Doctor H ehdersox. This letter states he had been assigned for several months to investigations on the method of developing tetra ethyl lead. The doctor denied, that. Doctor Mortok. He was experimenting. He was using tetra ethyl. He was not -making it. Doctor H enderson. Had he not been working with ethyl.gaso line? Doctor M orton. N o. Doctor F o m . I object to the insinuation just -expressed by Doctor Kehoe that quantites of 0.7 and .0.8 milligram of lead are common findings in the normal stool. In an examination of 28 stools of men supposedly poisoned .at the Standard. Oil plant in Bayway we were able to detect lead in only 18 or 19 cases, and the stools of these men were examined more than once in most instances. Doctor Touart can correct me if my statement is incor rect. As I said this morning, the records of over 500 men showed that lead was present in the urine only in 20 per cent. These men were exposed to lead in their work.- I think most medical men will agree that lead is not a common finding in the feces and urine of the normal man. ' Doctor. Atm. I should like fo-.say a few words about the experi mental side. Two or three things struck me this morning quite clearly, which I think men who have not been working in the investigative side would hardly appreciate. First of all, the dif ferent types of animals vary tremendously in susceptibility to lead intoxication. Guinea pigs, pigeons, rabbits, and cats are fairly susceptible, . Some animals I have not.worked with, so Lean not say definitely whether goats or monkeys are susceptible or not, but dogs, chickens, pigeons, and rats are only fairly so. The same thing is true of the blood picture. Some of the blood pictures given this morning might tend to give a false impression, because many animals will not show blood changes, as, for instance, anemia during lead poisoning, and when it is slight stippling does' not-appear-in many-animals, such as cats, hens, and pigeons. As one looks over the experimental data one has to be careful to realize that different types of animals give you different results. Secondly, about the discussion of lead analyses. Lead analyses are particularly difficult when analyzing the bones. When one re ports a tremendous variation, as, for instance, a high content of lead iii acutely poisoned animals, and then a low content weeks later when there was found to be only an elimination at most of 10 milligrams in the feces and urine, the question arises whether per haps the discrepancy lies in the difficult analyses. I t took us several months to learn how to recover all of the lead present in bone, for it is a very difficult analysis. The analyses which have been reported as found -in normals I can not corroborate. We have done many determinations in normal individuals in the last three years, and so far as can be made out normal individuals do not have lead in their stools and urine. Nor- mal lead was reported many years ago by several investigators* Their methods were not very accurate. With modern methods* even as recently as five years ago, manganese has been mixed- in lead determinations and has given the-picture of positive lead, determina tions- With the present methods--we use -Fair-bell's method--the stools from normal individuals contain no lead and. the average in dividual in iSfew England does not have normal lead in his body. We analyzed the bones of 26 individuals, who for one reason;or an other had to have an amputation. Of these 26 cases, 19 of them had no lead in their bones, and practically all the lead which is stored in. the body is to be found in the bones. Seven of them did have some lead storage, and most of these were later found to have had an exposure to lead of some sort previously, in their life. There are one or two other things to speak about. We studied one man 'who had some symptoms from tetraethyl lead exposure. His excreta showed lead in the urine and feces just as it appears' in the usual chronic cases, and it responded fairly well to medication, which suggests that the chronic effect of tetraethyl lead will be similar to that from the absorption of nonorganic lead. . Another point, and that is, in practically all the observations reported on exposure to tetraethyl, although many of them showed no sjnmptoms, practically all showed ^absorption of lead, and to my mind that is very important because lead is an accumulative poison, and whether they showed signs of poisoning or not is not important in acute experimente, but it is important that these individuals have absorbed lead and retained it. That means in more chronic ex posure the -amount present will become increased. Besides, the amounts .which were found in the experiments reported to-day are not small ;as one looks -at the figures, at least compared to the ani mals. which we have studied; the amounts found in organs .are rela tively large quantites. There is one more thing. I do not think, as the problem occurs to me, that the question of the. toxicity of tetraethyl lead itself or.even the distribution of the product is the problem involved. By far the greater problem is the question of whether, distributing lead over communities from- the exhaust gas:will-cause any toxic symptoms.in individuals who can not -protect. themselves. -- I. am n o t.perfectly certain in mv calculations, but from what Mr. Kettering said, 15,000,000,000 gallons of gasoline will be,used, and i f we-used tetra-, ethyl lead in all of this it would mean 50,000 tons of: lead dis tributed over the--United States in a year. If that is correct, and I think it is, I am not certain,.that this would cause poisoning, but. whether it would cause poisoning is a -very serious .`question. One must give that considerable thought, and it seems to me that it must first be proved .that it. is not poisonous-, because of thetremendously ifiusersults that this amount of lead scattered in fine powder over a long period might' cause. It seems to me that this should be very thoroughly investigated before tetraethyl lead is again put on the market. Doctor E dg-as. With reference to the question of the analysis of lead, as the doctor pointed out, as ter small quantities of lead' in ani mal tissue, it is difficult to get strictly accurate data. I do not know what method has been used by the Bureau of Mines. Our own method has been ashing animal tissue at low temperature, 500- 600 C., the lead being precipitated by hydrogen sulphide, reprecipi tated and dissolved and reprecipitated the third time as sulphide to-get rid of various impurities that accumulate, and finally repre cipitated as-chromate,: and estimated colorimetrically by treatment of chromate with diphenyl-carbozide. The details of our own method were worked out in the period of a month or so arid have- been conducted with extreme care. With the addition of khown quantities of lead and materials giving blank quantities of lead we have obtained very satisfactory results, and I think we have reasonable certainty of accuracy in our own method-- we have worked that over quite thoroughly,:because it is an ex tremely difficult problem. The average person with inexperience in lead analysis can not get accurate data with small quantities of lead without considerable care. Doctor Ejehoe. Whether or not lead is found in normal stools brings up the question of the manner in which these controls we used were obtained. We looked about for controls who could- n o t' in any conceivable way have been exposed to ethyl gasoline.- . A community in which -ethyl gasoline has never been sold or dis tributed was selected--Columbiis, Ohio. We went to Columbus, Ohio, and originally had the idea of .going to a commercial, garage of some sort which employed men and .subjected them to physical examination and collecting specimens for analysis. This did not appear to be feasible, so that the procedure which was adopted is as follows: We went to an employment agency, and the men. were sent to us from the employment agency just- as they came in. Careful histories- were taken--I have these histories with me--to obtain in formation as to'whether or not these.-men had ever had any. exposure to lead of which they knew. In order to obtain- that information' leading questions were asked as to their -occupations over a period of years.-. - ' . ; Specific questions were asked as to whether or not they had worked in an automobile factory, a tire factory, whether there was known exposure to lead, whether they had worked in battery factories -or -- ,,.woij wyi&s oi any Kind, and so on through the industries which we know -presented leaWHazaroC' Histories were tahen'IJy"on| naan and physical examination was done by another without any knowledge of the history, and specimens were turned oyer to the laboratory without either history or physical examination, simply with the names and numbers, and those- specimens, both, of urine and feees, were Examined. The amount of lead which was found uni formly in these specimens was as much a surprise to me a s :to anyt body in this room. This report was presented to. me yesterday. X hare no reason to doubt its accuracy,:and there: it is. Take it for what it is. The result is not complete, because we. have only data on 10 men out of 30 who had exposure and 10 men .out of 64 who. had no exposure. The data on this particular matter will be completed and: published later, but it just happens that 10 men. on whose specimens I have reports were taken, at random by the laboratory, group, they having no knowledge of the number of controls or. the number of exposed men, and it simply turned out the way I presented it.. , Doctor H aggard. Doctor Kehoe's report certainly shows a serious hazard. People do not have lead in their excreta unless there has been an exposure to lead. In the past lead, has been, found only in the excreta of typesetters, painters, and the like. But now Doctor Kehoe finds lead in the excreta of all persons tested. I t would appear that such a general exposure could only come from one source, and that is the leaded gasoline which was widely used in the city when he made his study. Doctor Kehoe's work offers an expert ' mental demonstration of what sanatarians had assumed on theoretical grounds. The C h a ir m a n . I s there any further discussion oh. the experi mental results ? I f not, I will ask Doctor Edsall, of Harvard, to open the discussion on this subject from the clinical standpoint. DR. DAVID EDSALL Dean' School of Public Health, H arvard University I suppose I am asked to . speak about the clinical side because I have had some experience in the general question of lead poison ing. I would say that I have not had clinical experience with tetraethyl lead poisoning. I have not seen cases, I have seen the 'conditions under which it is produced and handled, but my know!-, edge in the matter is really-confined chiefly to the general question of lead poisoning and experience in that for a good many years. The Ch a ir m a n . We want to bring o u t everything we can. Doctor E dsald. I speak then from the standpoint of a clinician somewhat experienced in lead poisoning and in industrial conditions. In the first place, as regards the manuraeture ox - am personally prepared to believe that while it is an extremely hazardous thing, it can be made reasonably safe as. compared with the .manufacture of other very dangerous substances. I would de plore, some of the .things that were.said this morning as regards careless handling of it for a long time without any dangerous symp toms, because the impression: might readily get about that that is a safe thing to. do. I think the escape from dangerous symptoms in these circumstances was, unquestionably a pure piece of luck. There can be no doubt that in the. handling and in the.manufacture, in the first place, all. the. mechanical precautions that can be taken should be taken, and in addition to that there should be extremely careful observation of the plant all the time. I have also very little doubt that the transportation and gross distribution of it can be reasonably safely handled if done very carefully. I was impressed, however, by the numbers that Doctor Kehoe mentioned this morning as showing symptoms. Out of 100 men since last August, 18 had showed symptoms that could be inter preted as being some degree of mild poisoning. That means, it seems to me, that the methods .of handling were as yet far from perfect. I t is a high incidence of lead poisoning in any kind of occupation where there is exposure to lead to have in that time 18 per cent of workers show symptoms of lead poisoning. Nevertheless, I think the manufacture and gross handling of it could be made, reasonably safe as compared with many other things that are done and must be done. But that means that everything must be done with constant care and watchfulness, because disturb ances may occur at any time which, might lead to serious results; and under the best circumstances I feel sure there would be occasion ally serious cases.of poisoning. That, however, is unfortunately necessarily true in the handling of all dangerous chemicals, and it is generally recognized that that does not make the manufacture of them a thing- to be necessarily limited or forbidden. On the other, hand, I have been in much doubt about the question of the use of the product in garages and sales stations and in regard to the question of the effect of the. exhaust. I have been very much impressed by an examination of the results reported here to-day. The only evidence that I have heard that would indicate that it may be safe is the evidence that Doctor Kehoe mentioned in the group he .studied of people exposed to it about .garages where it was used. In spite of what Doctor Kehoe has just said, I think that his work will, have to be neglected, for the reason that the finding of lead in such a large proportion of control people -means that however care fully these observations were made there was something wrong technically. Very careful and prolonged work by our group and other groups has shown that lead in the excretions of apparently normal persons is:very unusual and can be traced generally to some previous exposure. Therefore one must feel that with the people that were taken as controls something has been overlooked or there were technical errors, and therefore the results can not he accepted. On the other hand, I am impressed by Doctor Sayers's report of a large amount of lead in the dust of the chamber in which animals were exposed and in which an extremely high degree of ventilation was being carried out. Of course larger amounts of tetraethyl fluid were used than are used commercially, but, on the other hand, Doctor Henderson is technically correct in saying that the standard dilution of carbon monoxide in the experiments to l in 10,000 is not correct, for the conditions in garages often provide a higher proportion of carbon monoxide. - Those two things will probably balance each other, so I think we can take Doctor Sayers's results as indicative'of what may occur in garages, not necessarily as what will occur but as the only evi- deuce we have as to what may occur. We are dealing here-not with tetraethyl lead but with lead, so that the observations in regard to lead that have been made for many years are observations that can`he directly transferred to this ques- tion. For 100 years and more observations have been made as to the effect of having a noteworthy amount of lead dust around in any occupation. We know what happens to some of the people exposed to it. I t is not a question, then,, whether there is or is not a hazard. There, is a hazard, if these observations of Doctor Sayers and the observations of Professor Flinn are correct. ' The question is, how great is the hazard? Judging from other conditions in industries in which lead dust occurs, I am disposed to believe that the hazard is a noteworthy one. Hdw severe I am not prepared to say. The only way in which one can determine how serious it is would be through a very large number of extremely1carefully carried out ob servations as to what the effects are upon a large number of human beings with ethyl gasoline in general use'in the neighborhood in which these people live. : - I t has to be remembered, and this can be repeated in occupation after occupation, that even where there is a noteworthy hazard only a limited number of people show clinical symptoms of lead poison ing that are clearly recognizable. A very much larger number, if you examine carefully, will show signs of ill health of an indefinite character, and these are the things that are very likely to be over looked. They show chronic disease, as of the gastrointestinal tract, anemia, and vague chronic disorders of health much more frequently than they show the commonly recognized effects, namely, lead colic or paralysis or mental symptoms of lead poisoning. I accept with j -j J \ j ) | j \ ;| | h j | f I f | | | | t I | 1 I | ^ | the greatest skepticism, general statements as to lead hazards, such as reports th at " nobody, has been sick" or " nobody has shown any symptoms of lead, poisoning." That kind of testimony is negligible.-; The only kind of testimony that would show;whether there was lead poisoning or not would be based on extremely careful .and.highly experienced observation, in cluding carefully carried out examinations of the excreta and in cluding also the recent methods that Doctor Aub's group have been carrying out of producing artificial acidosis and determining whether this leads to lead excretion in exposed people who. have been carrying lead quietly in their systems without having symp toms and without excreting any of it under ordinary conditions. That is one of the .most striking things in regard to this whole, question, that persons may- be absorbing lead and keeping in their systems a large portion, and-yet have no obvious symptoms. Then these persons may develop symptoms or show excretion, owing simply to alterations in their diet, or to other simple circumstances. Under ordinary conditions you may say that besides those people who show definite lead poisoning in consequence of exposure to lead there are a much larger number that are carrying lead and are therefore potentially liable to symptoms of poisoning. The only conclusion that Xcan draw from the data presented here to-day is that in the question of the exhaust and to a certain extent in the question of the effects of the ethyl gasoline mixture, we are dealing with a matter that has to be judged by the accumulated experience of many years now as to lead poisoning in whatever cir cumstances or occupation it occurs. And I can not escape feeling that a hazard is,,.perfectly clearly shown thus'T aT ^T^hat has been" reported here to-day^jh a t it appears t o b e a hazard' oUconsiderable moment, and that the only way thatTX could'be 'saicTthat it is a safe., be after' very~careiuTand proIongedandAevoted studv~as to' how great the jia zarclUs. ' Hfe~occupations in which there a fe iM d U ia H rd sh has been the increasing viewpoint not only of public health men but of industries themselves and of governments, for many years now, that a hazard having been discovered must be relentlessly struggled against and essentially eliminated before the conditions are passed as being ap proved. When we are dealing with industry, with a manufactur ing process, that is nearly always a feasible thing, and it has been done in some of the lead processes that at first looked as though they were perfectly impossible to control. But there you have a group of workers entirely controllable as a- group. Kegulations which can be put upon them can be carried out with care and the whole matter is within the control of the individuals who are responsible for it. We liaYe one occupation, however, that is an outstanding ex ception and that is comparable to this situation, namely, the occu pation of painting. There are some others that are comparable also, but that is the outstanding one. There you have this situation: The individuals carrying out instructions are individual human beings working.separately, they are subject to no control, and you have all the errors of the human individual to deal with, as contrasted with a group that work under control and under conditions that can be made very definite. Painting has been widely studied by students of hygiene, by the employers themselves and increasingly by governments. In that occupation regulation and instruction are really very disappoint ing and oftentimes entirely fruitless. Hence governments are in creasingly acting toward the elimination of lead from paints to a more or less considerable degree, because they know no other method of controlling the situation. In the use of tetraethyl lead by the public we have to take into consideration the fact that we are in a position where we must de pend upon the individual in garages, both public and private, and in other uses as to the care with which the Substance is employed, or special precautions used. That makes a very difficult situation, it seems to me. You may make all the regulations you wish andyou may give all the warnings that you will, but we know from ex perience in other conditions that are quite comparable that those warnings will very commonly be neglected and that most individuals will be utterly careless in the way that they use the dangerous sub stance. Furthermore, I^Jjnd. it very difficult to conceive how a garage,'Tr"'example,'"could be kept hygienically safe, if_ therewere amounts of dust in it comparable even to those that Doctor Sayers found in His room. I t is very difficult to see how they could feemade safe, with the floor, the rafters, and everything covered with' fine dust such as this. Conditions in a garage are not such that it can be kept clean, as most factories can be kept clean. I should suppose that there wo'uld be necessarily always a considerable amount of lead-containing dust if this substance were used in garages. Granting that, I think we can scarcely deny that there is a definite hazard. I repeat, the only way that I can conceive of that we could de termine how serious, how extensive that hazard is, would be by mak ing very extensive and very elaborate and very careful studies over a long time. The C h a irm a n , Doctor Touart, have you something to say in regard to hospital education? DR. M. DE M. TOUART Medical Director, Reconstruction Hospital, New York City Mr.: Chairman, ladies, and gentlemen, I doubt if I have anything to say that would be of' very great help to this conference, but X speak from the observation and treatment of. 49 individuals who were suspected of being poisoned by tetraethyl lead. Thirty-nine of these patients presented clinical evidence that might be charged to the poisoning. The other 10 we may disregard, I am impressed by the fact that this substance, in concentrated form, produces a train of symptoms, that, in some cases results in a severe and fatal illness. Among the cases, that did not die, several were ill, with great suffering-, for a long period of time. I can not help but feel, under these circumstances, that if the hazard is going to be extended to the general population the matter should be carefully considered before doing so, I might say that of these 39 patients, 28 had stool examinations for lead, and, as Professor Flinn said, 18 of these showed positive lead findings. The other 10 did . not show' positive, lead findings in the stool. At the same time, however, there was.definite clinical evidence of tetraethyl lead poisoning, and f feel we have had suffi cient experience with the condition to be able to recognize it clin ically where well* developed. I would also say, however, that some.of these individuals gave no physical evidence and no symptoms or any evidence that could be found by a physical examination that would indicate they were ill, but at the same time showed lead in the stools. This suggested to me that perhaps a man may be poisoned from the tetraethyl lead without showing clinical evidence, and that therefore there may be a considerable number of individuals so poisoned who have not come under observation. I t would not be of any interest to this meeting to hear anything about the clinical signs that are found in this condition. I t has been said to-day that industry was willing or is willing, if it is shown conclusively that the use of leaded gasoline is a hazard to the general population, to cease the distribution of the same. I t seems to me that perhaps the attitude should be taken that this ethyl gasoline is under suspicion and therefore should be withheld from public consumption until it is conclusively shown that it is not poisonous. The C h a irm a n . Any discussion of this clinical question? Dr. J oseph C. A nn.'Mr. Chairman, may I just say a word- in re gard to this question ? . ' The C h a ir m a n . Yes. DR. JOSEPH C. AUB . Medical School, H arvard University I would like to say that I think that some who have to diagnose industrial1hazards feel that the finding of -lead in the stools con stitutes lead poisoning^ but anybody who is exposed to lead mayhave lead in the stools. That may mean only absorption,- and it may mean poisoning; but it does-not necessarily mean that dead found in the stools had been absorbed or that one can base a diagnosis of lead intoxication upon this finding alone. I f that were so, every body exposed to lead dusts would have lead poisoning, and many of them show no signs whatever of it. The Ch a ir m a n . I s there any further discussion on this aspect? DR. ROBERT A. KEHOE College of Medicine, Cincinnati, Ohio Mr. Chairman, I have just one more word to say and then I have finished. I beg your indulgence in that matter. One thing ,that has been seen in tetraethyl lead poisoning--and we have had occasion, to observe it in every form in which it has occurred--is that in those cases, in which absorption is present over a long period of time the symptoms do not differ, strikingly from the symptoms in chronic lead poisoning except that up to the pres ent the paralytic conditions have not been seen in any considerable number. However, it must be said that the lead line, stippling of the blood, that sort of effect, which is considered very good evi dence of chronic lead poisoning in the human beings, appears in the tetraethyl lead poisoning. Such evidence has been found in the blood also in cases of more rapid poisoning, but in the case of slow poisoning--for example, in cases in which we have had any reason whatsoever to suspect that lead poisoning was occurring, or in which there have been any suggestive symptoms, or in the case of exposure over a considerable portion of time to minute quantities of lead--in all these cases we have been able to find stippling and in some few of them we have been able to find the lead line. It would appear that the presence of a lead line in teeth is con ditioned by a certain amount of inflammatory reaction in the gum margin. In a person of perfectly normal dental condition the lead line in the gums is not likely to appear, but stippling of the blood is much more likely to be present. In .the case of the men examined we have made very careful blood examinations. The blood ex aminations have been made by myself, personally, and I can there-. fore say from my own observation that in the cases which have been examined which have had exposure to ethylized gasoline no evidence even of this type has been found of poisoning in these cases. '.' * The examinations made of men who have been exposed to any of these possible hazards must be made not on a basis of symptoms of tetraethyl lead poisoning but mtist be made on' the basis of those symptoms, any one or all of which have ever been seen, which have been considered indicative of lead poisoning. Only by such a .method of examination which we have made, or attempted to make, is it possible to determine whether any symptoms or any clinical signs have arisen. May I say just one other word? I do not regard the data which we Have presented on men examined up to the present as conclusive in any way. I should not like to be understood to say the examina tions which have been made up to the present---the analytic work which has been done up to the present--are adequate. I t only pre- T .sents suggestive evidence which, in my opinion, should be carried 1 further to a conclusive result. The Ch a ir m a x . I s there.any further discussion of the clinical I symptoms? j MR. PRANK A. HOWARD y Standard Oil Go. of New Jersey j I f I may comment just a moment on Doctor Sayers's report here I on page b, section 9--" The guinea- pigs exposed to motor benzol and 1 a motor-gasoline blend died." My reason for commenting on that is that in the oil industry we know only of one situation, one commercial situation, that has any parallel to the one we are now discussing; that, is, the use of benzol blends marketed as motor fuel. | In the city of Baltimore our own company's statistics show that in | 1923, 70 per cent of the motor-gasoline consumption of that city was | benzol blends. That was largely 40 to 50 per cent benzol blend, i which is the type that Doctor Sayers was working with. correct? Is that A V oice. Fifty-fifty. % Mr. H oward. There was a statement also made in regard to benzol 'poisoning this morning that very much surprised me. Doctor Flinn, i I thought, said that benzol vapor was poisonous but that the poisonI : ing was not cumulative. I do not think he meant to say that. I I think what he meant to say was that the benzol itself was not acumu| l a t e d , because the poisoning certainly is cumulative. I think it | ; produces a very dangerous condition of anemia. This has been | : recognized in the State of Massachusetts, and legislation has been i i enacted 'prohibiting'its use in factories. Our problem is not one of detecting acutely fatal conditions caused by exposure to the concentrated tetraethyl lead, but to distinguish between health and something a little less than good health- The notorious indifference of people to anything less than a striking dis abling symptom is one of the problems of modem health adminis trators* People wait until they suffer an obvious illness or disability before they complain. I t is the business of the health officer to see that people through medical observation become much more acutely sensitive to the slightest deteriorations in their health which are constantly being caused by a multitude of harmful conditions of environment among which lead in industry is a common cause of disability. Up -to the present time those who have reported upon the toxic results, of tetraethyl lead have laid considerable emphasis on the occurrence of a number of deaths. I think health officers would agree, and certainly students of industrial hygiene would, that the number of deaths is not necessarily an index of the extent of the in dustrial hazard- We should like very much in this conference to know the number of days lost on account of disabilities which have been created among those who did not die- We should like to know whether those who have been subjected to acute poisoning by tetra ethyl lead have ever resumed their former perfect physical fitness. In this our information is very incomplete. We have reason from other examples of lead poisoning to suspect that there is a consider able duration of deterioration in physique and in capacity for work and attention and self-control which follows any form of serious lead poisoning. Unless we know the relation between the number of man-days of exposure and the duration of days of handicap from minor illnesses resulting from nonfatal poisoning, we shall not be in a position to measure the true importance of the hazard- Certainly the death rate is a very poor and incomplete indication, although a serious one, of the degree of any industrial hazard. I presume that it is the inclination of every health officer to urge a continuance of the cessation of the use or sale of th ethyl gaso line which has been voluntarily determined upon by the company. I should like to suggest and request--and this I say with due respect for'the undoubted determination of the industries here rep resented to act as humane and considerate men--that in the future animal experimentation will precede and not follow human experi mentation. Up to the present time we have almost invariably got our first inkling of a new industrial chemical hazard by some human catas trophe. The technique of approaching any problem of possible toxic effect of a new substance is so well known to medical schools, experimental laboratories, and government laboratories of various departments that it seems rather pitiable in a country of, such wealth in means and knowledge that we had to wait for a series of human catastrophes to develop the demand for a series of animal experi ments.. , Certainly in the future we could properly expect, either by common consent or by some form, of governmental suggestion or direction^ that no possibly dangerous new chemical substance should be put into retail use until' .proof of its harmlessness had been shown beyond doubt. Such suggested control need not, amply .governmental interference with the liberty of process and discovery of chemical materials, but it seems inevitable th a t:in some way or other there should be a clearing house for hazards, preferably at the expense of the Gov ernment, but if not at the expense :of the Government, certainly by mutual agreement among the chemical industries generally, before retail distribution of a new product is carried- out, I believe that the Surgeon General would find it greatly to the advantage of his colleagues in State and municipal health work throughout the country to have as a result of such a conference as this the basis for recommendations following such a series of clinical studies as has already-been suggested. The Chairm an". Dr, Henry Vaughan. DR. HENRY F. VAUGHAN President of the American Public Health Association Mr. Chairman, as a health officer and as one of the few health administrators whom I see here in attendance to-day, I have been trying to assimilate and trying to arrive at some decision as to how a health commissioner might logically proceed in drawing some con clusions from the discussions which have taken place to-day, and my feeling is that the whole thing is more or less in a state of flux. I find myself wobbling in one direction at one time and in another direction the next moment- ; As health administrators it is our prime function and duty to try to keep our respective communities as healthy as possible. In the city of Detroit, where I happen to be engaged as a health adminis trator, I am sorry to say that we have on an average one death each day from automobile accidents, approximately 800 to 850 each year, and yet there has been no legislation so far to do away with the automobiles. Furthermore, we annually have a few people who close themselves up in the winter months'in their garages, and in spite of the pub licity, which we have given .to this subject insist upon choking them selves to death with carbon monoxide, and still we have not legislated against the construction of garages; nor have we said that such, people can hot drive automobiles. I t seems to be almost impossible to safeguard against all foolhardy accidents. There are other things which have contributed to. the lead hazard in large cities. With us we have had quite a hazard in the painting , of automobile bodies which fortunately has been eliminated^ and. there has been a marked decrease in the incidence of lead poisoning in our city.- I judge that this is true also in other automobile centers^: This question of whether there should- be a prolonged discontinua,-. tion of the use of ethyl gasoline is not a matter That can be settled in any degree by the1administrative healthofficer and one for which he wouhTnot assume- prime responsibility :at this time. I t is rather a function of the physiologist and the physiological chemist to tell, us from this mass of information which has been brought together to-day whether we may. expect an accumulative health hazard. Oer-.: tainly in a study of the statistics in our large cities there is noth-; ing which- would warrant a health commissioner'"in saying thaTyM could nQ^ e lle tn v T .gasolme W ' " : --* . Nowpyou take our "own city, for example: We have made a little, survey there on ethyl gasoline. Ethyl- gasoline has been sold in: Detroit for approximately a year and a half, and the amount which, has been consumed has averaged from 60,000 to .1,250,000 gallons a month. I t was first used in October, 1923, and discontinued in May, 1925, and we have personally interviewed 170 individuals who have handled ethyl fluid and ethyl gasoline'both, and who have averaged over 11 months of service in the handling of this fluid; men .at the filling stations who have not only handled the complete, mixture, the. ethyl gasoline, but also the ethyl fluid, , . , In 139 instances the men handled the fluid and in 169 instances the. ethyl gasoline. You can see, therefore, that- most of the men had .had experience with each type. . During the period, of 11 months there were 9 out of the 170 who were sick at some time, and only i individual claimed as the cause of sickness the ethyl gasoline, and in further questioning concerning any ill effects from ethyl gasoline his reply was in the negative. So apparently his sickness was not connected- at all with the use of ethyl gasoline. flow, of these 170 individuals 137 had:spilled ethyl fluid or ethyl , gasoline on their clothingor on their bodies, or had .had some of the material squirted into their faces or into their eyes. They had had, the. warning, they had been told that they must remove the ethyl fluid with gasoline and use a soap,, but this .warning had not been, followed, and in practically all instances the material had simply been wiped off the clothing or off the skin. Out of the 137 claim ing to have been exposed in this fashion only 16"felt any slight ill effects ;a,t, all--temporary burning and skin blotches,' but nothing more serious. ,` ': I. Now, that is the situation as we found i t in'interviewing.those- J who had handled ethyl''fluid and also-ethyl gasoline, and the results ! are entirely negative. As health administrators, you will readily see that in a report like that you would not be justified in stating that it is logical to discontinue the use of ethyl gasoline on those ;results alone. We must be guided entirely by the- findings-and the result and the dictum of those who can foresee whether, there is i toxic material or lead poisoning which may make itself felt in the future; but so far as the present situation is concerned, as a health administrator I feel that it is- entirely negative. I would certainly urge, as Doctor Emerson has, the continuation ; of these experiments, and I would also like to urge that the- Surgeon | General -ultimately arrive at some: decision which may act. as, a 1: guide-to the-health commissioners and. health officers throughout the | 'country. 1 . Now, Mr. Chairman, the American Public Health Association has- . seen fit to appoint a committee to represent the association at this J . conference, and Doctor Hayhurst, of Columbus, who is an active member of our section on industrial hygiene, is here, and I hope, that you will permit Doctor Hayhurst. to continue this discussion on behalf of the health administrators. The C h a ir m a n . Doctor Hayhurst. - BE. e ; r. hayhurst College-of Medicine, Ohio State University, Coinmtrus, Ohio I have also been delegated by the State Department of. Ohio to state Our: experiences- with ethyl gasoline^ The., substance of the whole situation is summed up very much in this, that we have been undecided what to do because of the animal experimentations on the one side, in this place and that, and in the result of the reports of our health officers.. We have had to get out, as the late President Burton, .of Michigan, said in a story and root for our selves. President Burton said.that a man who decided to raise pigs, scientifically put one in a pen on a balanced diet and it gained a hundred pounds in six months.. Another one he put in a pen on a balanced diet and all the alfalfa it could eat and it gained 200 pounds in six months. Another he .put in a similar pen, but he left a hole in the end of the pen. - I t got. out in the yard and rooted for itself and gained 300 pounds- in six months. r. I am only going to talk about the rooting part of the investiga.-, tions. .. Last August when we were called to Dayton, Ohio, we made re ports on conditions which had been investigated by the State de- Mj% J M evidence that could, be obtained at that time, forbade the use of the concentrated'preparation, but did not prohibit the use of the diluted form under certain definite restrictions as to sale and dis tribution. The city of New York, over which I have not jurisdiction, pro hibited the use of any form of ethyl lead. In other words, a man filling his gas tank at Buffalo or Syracuse with this preparation and going down to New York City would be amenable to the rules of the Board of Health of the City of New York and be punishable by the city authorities. Many city and State boards of health are in a quandary as to what action, if any, to take in. this matter, or are in doubt as to the wis dom of action already taken. For this reason, whether you as Sur geon General of the Public Health Service have legal authority or not, I am very certain that your opinion, arrived at after careful investigation of all the facts, will be accepted by the majority of health officials. Finally may I suggest that this matter be brought up at the com ing conference between the United States Public Health Service and the State boards of health. The C h a ir m a n . Doctor Nicoll spoke as nicely as though he were giving me a bos of candy. Is there any further discussion ? 1 MRS. GRACE M. BURNHAM Director Workers' Health. Bureau Mr. Chairman, I have looked over the program, and I do not exactly see where the Workers' Health Bureau comes in--either .entirely under the heading of " Industrial aspects " or entirely under " Public health aspects -so I have chosen to wait until the Public. Health speakers have spoken. The C h a ir m a n . I t comes under the second heading. Mrs. B urnham. The Workers' Health Bureau is interested in studying occupational diseases as they affect various groups of indus trial workers and in working out programs of health control for those groups. We are interested in the problem of tetraethyl lead and tetraethyl lead gasoline in its different stages. In the first place, we are interested in the factory productionJ stages. In looking over the material which has been made public on the subject during the past six months we were interested in findingthat there is no authoritative list of actual deaths and occupationaldisease records which anyone can have recourse to. That is, no governmental agency has compiled from the data which have ap~ peared in individual reports or in the newspapers any authoritative lists of deaths or disease, - : ; In cooperating in preparing the article on tetraethyl lead which appeared in the Medical Journal May 16 we had some doubt about the 60 cases of poisoning and 11 deaths which, we .enumerated. Yet this morning,, after having heard the speakers from the various plants, I have added up 149 cases of poisoning; 43 at Bayway--or 48, as one gentleman says, including 5 deaths--28 at the du Font plant up to May 16, 1924, after which we have no record,* and 78 at the General Motor Co. plant up to .date. That makes a total of 149 that we know of already. - Now, it seems that one of: the immediate .things to ask would be for the United States Public Health Service to get the medical records of these men that have been examined and compile them. We have, heard, reports here that men have been given medical examinations and have shown no symptoms, and then we have heard other reports stating that they did show certain symptoms. I f we knew the symptoms that the men did show, we could go oyer the number of eases and .arrive at certain definite conclusions that would be authoritative. My suggestion is that the United States. Public Health Service have made available to them imme diately the medical records of all the men examined in all the plants where tetraethyl lead has been either manufactured or compounded or handled, and that from those records a .statement be made as to the actual number of deaths and poisonings, showing also how long the men have been employed before they died or were poisoned. I agree with the suggestion already made here that we also find out what happened to the men after they had been poisoned, and what happened to them after they had been laid off or discharged, whether they were reemployed in other industries, or whether they were permanently injured as a result 'of what occurred. I was very much interested in looking over Commissioner Mc Bride's report last fall, after the Bayway tragedy, to notice the seriousness with which the men who were responsible for the poison ings from tetraethyl lead regarded the situation. Commissioner McBride said that there were certain precautions which had been taken to protect the workers. Commissioner McBride made the statement that at the Standard Oil Co. plant " in many instances a medical examination was required twice a day " and. that in the du Pont plant " a man would forfeit a. full day's pay if he did not bathe every day." I t seems to me that wheraxi material handledjs so poisonous that as a precaution a medical examination of~Ihe~lnen employed is required as often .as twice a day, we are faceTwith a very seriouslutuatioiU Somebody has suggested--I think it was Doctor Edsall--that in manufacturing poisonous material we can rely;on control, and that if the risk or danger in tetraethyl lead applied only to its manu facture, it might not require prohibition. We have reports from England that after I f men died from the use of tetrachlorethahe in airplane dopes the use of tetrachlorethane dopes was prohibited. Representing the workers who must work, and who must take such conditions in their work as are offered to them, and considering that 11 men engaged in the manufacture of tetraethyl lead have already died in spite of medical examinations twice a day, we are confronted with a serious hazard in the manufacturing processes alone which calls for drastic action. The next question which, came up in the discussion to-day was the question about handlers, of either ethyl fluid or ethyl gasoline. I t has been, reported by the concerns in question that 20,000 filling stations are using ethyl gasoline, and have used it for a period of two, years. And yet I, have heard a report of only 30 medical exami nations out of all the men in the country handling tetraethyl gaso line. I doubt whether the report of 30 examinations out o f a total of 30,000 or probably 50,000 men using this material is significant. 1 also want to call attention to the remarks that Doctor Eehoe made when he said that wthe recognition of early symptoms is by no, means easy " ; and that the workers only occasionally show early signs of poisoning. We who are working in industry know that the average worker is not an industrial diagnostician. We do not want the worker to be a diagnostician, because if he is he may diagnose his case wrongfully. We also know, we workers, that the average physician is not familiar; with the signs of occupational diseases. He has to be educated to that. He does not know the group of symptoms which make up tetraethyl lead poisoning. You take constipation, or you take de creased red corpuscles, or you take pallor, or you take a low blood pressure--you take all those things and put them together; and an expert in occupational diseases may recognize them as an incipient occupational disease; but Hie ordinary medical practitioner and the ordinary worker would not recognize such a condition as an occupa- tiofiai a i s e k s i '^ ^ you "would call him pathm logical. The point I want to bring out is this: That you can not rely on neg ative evidence in a hazard which goes the length and breadth of the country, and which may affect, in industry alone, almost a million workers. I have figures from the United States Census Bureau for 1920, which show that there are 280,000 chauffeurs; 31,000 garage laborers;. 411,000 draymen and expressmen; and, taking the Ethyl Gasoline Corporation's figures, at least. 40,000 service-station operators, which totals up to about 767,000 workers who would be directly affected-- not counting those engaged in the manufacture of tetraethyl lead. Now, I believe that we should separate out from the public health hazard the hazard to teamsters and chauffeurs and traffic ucops," if you will, all those who work for 8 hours a day or IS hours a day in an occupation which exposes them constantly to exhaust gases in sta tions and on crowded thoroughfares and traffic jams, so that they will get more than their proportion of any poisonous materials which come out in exhaust gases. j And I agree with Doctor Edsall that, until a thorough examination has been made of a representative group of workers exposed to the exhaust gases contained in tetraethyl lead gasoline, over a period of time sufficient for them to absorb this material, with the necessary tests of feces and urine, to determine whether there has been any lead absorption--until such examinations as those have been made, we are not justified in saying that there has been no poisoning just because the workers themselves have not reported symptoms of mild poison ing. . And finally, we have the case of the public--the public health haz ard, which has been discussed in a very satisfactory manner by Doc tor Henderson and Doctor Edsall and Doetor Emerson, who stated that, in addition to the risks which so many of our workers in indus try (who are also part of the public) already have to undergo from lead, you are adding daily the possibility of a tetraethyl lead risk which will ultimately bring the lead beyond the stage where it can be resisted. I believe that the Public Health Service is the agency through which a thorough scientific investigation of this entire matter should be carried out. I believe that this investigation should be made en tirely out of public funds; and I think that the United States should be self-respecting enough to realize that, when there is a public health hazard involved which -affects the entire population, that hazard ought to be investigated 'out of public funds and by a responsible pub lic agency. I believe that after such an investigation is made, another confer ence should be called, which should be a public conference, and at which labor should be represented, to which this report should be made. And I believe that until that time, and until the manufac ture, distribution, and use of tetraethyl lead has been proved conclu sively to be safe, its use should be discontinued. The C h a irm a n , I think you are estimating th e chauffeurs very low, I think there are about 50,000 of us who do our own driving here in "Washington. : .'Mrs* B urnham. Well, we always believe in underexaggerating. The C ha irm a n . I will ask Mr. Berres, secretary of the metal trades department of the American Federation of Labor,; to address the conference. ME. A. L. BEEBES Secretary, Metal Trades Department, American Federation of Labor. Mr. Chairman, I want to express to you the appreciation of the American Federation of Labor for the invitation to be present,: This discussion here has been very interesting to me, because there have been'so many things said that I did not understand. I do want to say, however, without having had -an opportunity to look into this m atter.carefully, that there has been enough said here to-day to warrant those having authority to do something at least in the shape of vaccinating this patient now under suspicion. I feel that, as has been stated here by some of the previous speak ers, until such time as it can be definitely determined that there is no hazard in the manufacture, and handling of this gas, its use ought: to be prohibited. I appreciate what it means to take the " knock" out of a motor. But we are more concerned.about taking and keeping the knock out of the human being than we.are in taking the knock out of motors,. From that point of view, Mr. Chairman, the American Federation of Labor would attack the use of this gas. We feel that where, the health, and general welfare of humanity is concerned, we ought to step slowly, I want to take advantage of -this time to say that, notwithstanding that we are often charged with being against progress and efficiency, that is not true. We are against any progress and efficiency that carries with it serious injury to the human family. If we can get progress--and we can, because I have no doubt that some of the gentlemen here are thoroughly capable of finding a method by which this gas can be used, without injury to those han dling it--we welcome progress if it does not mean injury to the human being. With those thoughts in mind, I wish to express the hope (and I believe I voice the sentiment of many of those who are here) that this gas will not be used until a thorough and comprehensive inves tigation and study is made as to just what does happen to those directly engaged in the manufacture and handling of tetraethyl lead and tetraethyl-lead gasoline, and in fact to the general public, I have often found myself in traffic jams--and while I do not know anything about chemical action, I have felt that something would have to be done in. order to do away with the .bad effect of monoxide gas in the public automobile jams. . Th only thing, we wish to say-at this, time, Mr. Chairman, not having had opportunity to study this subject, is to.urge that, until ;a comprehesive study can be made to determine whether or not this gas in injurious, its use be prohibited. I would like to suggest to .those present at this meeting that, inas much as certain gentlemen have, I believe, on a former occasion agreed not to use this gas pending a study of it, that we jointly request them not to use this .gas until- we can determine "whether or not it is injurious to those who must, come`in contact with it. - The Ch a ir m a n , I s there any further discussion? BR. YANDELL HENDERSON Professor of Physiology, Yale University There is a technical point on which I think I can throw a little light, hy analogy. Doctor Hayhurst referred to a number of reports from practicing physicians regarding the health conditions in Ohio. Now, I feel fairly sure of what T am going to say, and that is this: That not one good practicing physician in a thousand would recognize a slight degree of tetraethyl lead poisoning when the lead is inhaled. I f he had a good medical education and if he knew the man had a stomach ache and certain other symtoms of lead poisoning, Jae. could, size it up as lead poisoning. But if tjie material is inhaled-- a n d .its symfcomology is altered when it is inhaled, because of its wider distribution in the body--it is extremely likely that nine hundred and ninety-nine ordinary physicians out of a thousand would fail to recognize the condition as lead poisoning. I base that assertion upon observations which I have made in the town of Danbury, Conn. Probably everybody has heard of the u Dan bury Hatters," and the cases of mercury poisoning there. That is a fairly close analogy. That has been going on for a long time. Some o f us have been trying to find out some way of improving the .situation. The difficulty has been that, even when a man's condition was so bad, and his hands were, shaking so terribly that he could not reach out and take a glass of water and put it to his mouth, the ordinary physician could not recognize that as mercury poisoning. And what we have had to do was to get physicians who can diagnose it and recognize it; and now that they have physicians who can recognize it and know that it is mercury poisoning, and who will so testify before them&mnensation commissioner^ the compensation commissigner can award compensation ; andlhe insurance company-has to pay .the money; and.it comes back on the manufacturer, and con- ditions are improving, So we believe that we are cleaning up that situation. But the first thing we had'to do was to realize that the general run of physicians did not recognize that form of poisoning when they saw it. And so I think it is fairly clear that we can not expect the ordinary practicing physician-to recognize the symptoms of tetra ethyl7lead poisoning at this time. For that reason, it is very important that the medical data with regard to these occupational diseases should be collected, and that the medical profession should be educated, through the United StatesPublic Health Service, so that the medical profession can diagnose lead poisoning in all its forms and manifestations. I would suggest, Mr. Chairman, that you ask Doctor Hamilton to address the conference upon this subject. The C h a ir m a n . Doctor Hamilton and I have had conferences,, both here and abroad, and I know that she always has something worth while to say; and in regard to this particular subject of tetrao ethyl lead poisoning I think she can tell us something about her observations. I wish she would say something to help us on- this-, problem. DR. ALICE HAMILTON Professor of Industrial Medicine, Harvard University Mr. Chairman, I do not think I have anything at ail of vale that Xcan add to what has been said. I would only like to emphasize oneor two points that have been brought out. One is the fact that lead is a slow and cumulative poison and that it does not usually produce striking symptoms that are easily' recognized. The other is that if (as does seem to have been shown) this is a probable danger, shall we not say that it is going to he an extremely widespread one, an extraordinarily widespread one? Now, as Doctor Edsall has said, you may control conditions within a factory. But how are you going to control the wholecountry % Speaking for myself, I do not know of any lead trade which (although it has been improved under modern methods and scru pulous care) has been made entirely safe. There may be one. I donot know of any, however. There is always some lead poisoning in connection with every lead trade, even when it is done in a factory under medical supervision and with a very conscientious employer. I f we were to assume that all of the precautions .would be taken with this new form of lead that could be taken, it would mean eternal vigilance--and we all know the American temperament too well to believe that that eternal vigilance will be kept up all oyer the country. r I would like jo make a plea to the chemists to find something else and T am u tte rh ^ ^ that the' only subitanee which can bg. used to taketh^m ock of a gasoline engine" is tetraethyl^ lead. ""May I draw a comparison by showing what happened in England when they faced a very much more.serious emergency than we are facing here? We all know that in 1916, England had every, reason to ignore minor dangers in her effort to produce fighting planes. Well she was covering her fighting planes with a tetrachlorethane dope. ISfow, that poison caused a toxic jaundice, and sometimes a fatal form, among the dopers. But how many eases were there % Only about 92; and only 12 of them died. And yet every time there was a death, a question was asked in Parliament, and "the ministry of mimitions had to answer that they had put their chemists to work; and that they hoped very soon that they -could announce that they had found a substitute for tetrachlorethane; and in 191?, when England was frightfully hard pressed for fighting planes, they made the announcement, after only 12 deaths had occurred, that they had found a substitute ; and that from that, time on no tetrachlorethane solvent would be used in connection with any fighting plane in England. Kow, we can not say that we in the United States are up against any emergency like that. And yet we have already equalled th at death rate. If the English Government could consider such sickness and death as serious even in war times and if the British chemists could find a substitute, I think it is not unreasonable to. ask that our chemists set about it to do away with tetraethyl lead, by finding something else that will do th same work. The C h a irm a n . I notice a gentleman here who has been an industrial officer of a great State for a good many years. I will ask Doctor Patterson to address the meeting. DR. FRANCIS P. PATTERSON Philadelphia, Pa. Mr. Chairman, for a period of 18 years--first of all, as an indus trial physician and then as the head of the department of industrial hygiene for the State of Pennsylvania--I have come very inti mately in touch with the problem of lead. And when we strip the various chemical terms that we have used here of their verbiage and analyze them, we find after all that this tetraethyl lead is just a question of lead itself. mucn interested m trie statements made here. I am- sure some of them were only due to misinformation on the part of certain speakers who did not appreciate how seriously the chemists as a whole viewed the situation, and what very serious effort has been made from the start to find1other things; or how completely the whole hazard has been reviewed by them and the responsibilities consid ered; or the extent of cooperation to which chemists are quite pre pared to go to get out anything that is better. Some reference has been made to an experience during the' war at one of the arsenals that I do not think was quite the kind of experi ence that it was said to be; but I do not think it is proper to enter into that kind of discussion at the present time. I am sure the American Chemical -Society and the American So ciety of Chemical Engineers will be very glad to assist in any way in meeting the problems growing out of the use of tetraethyl lead. The C h a irm a n . Doctor Thompson represents the Bureau . of Standards. Would you care, to say anything, Doctor Thompson? Doctor T hompson. I do not believe I have anything special to say. There is just one thought, however, that I would like- to submit. I think the idea of the commissioner for the State of Pennsylvania ought to be emphasized, and that is that in looking at the question of the adoption or nonadoption of any additional lead industrial risks we should look at the problem in the large, rather than be swayed by prejudice. I t is often much easier to see the concrete immediate dangers than to evaluate the perhaps more important industrial advantages. We do not like to match the life of a man against the life of a Nation. Nevertheless, there are things to be considered on both sides; and I believe there should be a thorough investigation of the whole subject by the United States Public Health Service, which should bring out both sides of the question. The C h a ir m a n . I s Doctor Gruse, of Pittsburgh, here? We want to get all the light on this subject we can. Doctor G rttse. I am here simply as an observer. I have nothing to say. The C h a ir m a n . Is Miss Whitney, of the Bureau of Labor Statis tics here? Miss W h it n e y . I do not have anything to say, Mr. Chairman. The C h a ir m a n . I s Doctor Corbin, of the New York Academy of Medicine, here ? Doctor Oorbin. Mr. Chairman, I-have nothing to contribute to this discussion. The public health committee of the New York Academy of Medi cine has been very much interested in this subject,- which we have studied purely from a chemical point of view. I can only add that. if an investigation is made on a somewhat larger scale, X am sure the public health committee of the Hew York Academy of Medicine will be very glad to contribute its share to the scientific investigation of this product. The C h a irm a n .Thank you very much. Doctor Marshall, haveyou anything to suggest to the conference? Doctor M arshall. I have nothing particular to add to the discus sion. I have had no experience at all with the subject. I t seems to me that the impression I have got from listening to the evidence pre sented is that there would be certain hazards from the use of this substance which would seem to involve the garage workers; that there is-an amount, of dust whichis deposited in the chamber through which the air is rapidly circulating; and assuming that the same pro portionate amount would be caused in the garage, it seems to me th at in the garage there is a very distinct hazard attached to it. As to the other aspects of the question, it seems to me that Doctor Edsall has very well summed them u p : There is a hazard there, but how great a hazard we do not know yet. . The Ch a ir m a n . Thank you, Doctor. I see the National Safety Council is represented. Doctor Cam eron, have you anything to suggest? Doctor Cameron. No; I am-just here representing them. The C h a irm a n . I s there anybody else now before we close the hearing? Mr. Howard, of the Ethyl Gasoline Corporation. MR. FRANK A. HOWARD Representing Ethyl Gasoline Corporation My associates of the Ethyl Gasoline Corporation, which includes the General. Motors Corporation and the Standard Oil Co. (N. d.),. and, in ah indirect way, the du Pont Co., have asked me to. make a- brief statement.concerning the position of our company regard ing this meeting and the problem which you have to attack here. I think Doctor Henderson -correctly stated,that we have a real responsibility. How great that is I do:not think any of you gentle men will ever be able to appreciate, because it has been so manysided. Relatively speaking, the responsibility of Doctor Henderson, and of you gentlemen of the Public Health Service, is rather simple ; that is, you have but one problem, and that is, Is this a public-health hazard? Unfortunately, our problem is not that siiu p b iW e" can not quite act on a remote probability. We are engaged in the General Motors Corporation in the manufacture of automobiles, and in the Standard Oil Co. inkhe manufacture and refining of oil. On these things our present industrial civilization is supposed to depend- 106 I might refer to the comment made at the end of the war--that the Allies floated to victory on a sea of oil--which is probably true. Our contijiugddeYelQpnient of motor .fuels is essential in our civiliza tion^ And our dependence upon a continuing supply'of petroleum has been a subject which interests everyone who has the interest of his country at heart. The President has gone so far in the past few months as to appoint a special committee, presided over by Doctor Work, to see if they could not exhaust all the possibilities of con serving petroleum in every direction. Now, as a result of some 10 years' research on the part of the Gen eral Motors Corporation and 5 years' research by the Standard Oil Co., or a little bit more, we .have this apparent gift of God--of S cubic centimeters of tetraethyl lead--which can be produced at a low figure, an inconsequential figure ultimately, and which will permit that gallon of gasoline, which we have recovered from the earth all over the world, because we import much of our supply and hope that we will import more in the future so that we will use less of our own supply, to go perhaps 50 per cent further, and, if our opti mistic engineering friends are correct will make it go 100 per cent further in the long run. Now, there is that situation. We are presented with that gift ojLGod which enables us to do that. ^But there are problems con nected vGtlTItfflhe engineering problem must be worked out, and the production, of cars must be worked out. And we are presented with this question at the start concerning the use of tetraethyl lead, the questipmof the health hazard. What is our duty under the; circumstances ? Should we throw this thing aside? Should we.say, " No; we will not use it," in spite of the efforts .of the Government and the General Motors Corporation and the Standard Oil Co. toward developing this very thing! which is a certain means 'of saving petroleum? Because some animals die and some do not die in some experiments, shall we give this thing up entirely? -. Frankly, it is a-problem that we do not know how to meet. We can not justify ourselves in our consciences if we abandon the thing. I think it would be an unheard-of blunder if we should abandon a thing of this kind merely because of our fears. We could not justify an attitude of-that kind; I do not think anybody.could. Possibilities can not be allowed to'influence us to such an extent as that in this matter. I t must be not fears but facts that we must be guided by. I do not think we are justified in trying to reach a final conclusion in this matter on fears at all; nor are we justified in saying that we will cease this development because of fears we entertain. This develoment must be stopped, if it is stopped; at all, by proofs of the facte. Now, on that point, think this conferenec has had a wonderful effect. We have had presentations of facts on both sides. But X must say---perhaps I am a little biased--that most of the facts presented have been in favor of the use of the tetraethyl lead product. Perhaps some of those present will object to this statement; but I am referring now to the experience in the use of the commodity. So far as the record of the use of the commodity for its intended purposes is concerned, think we have had a 100 per cent record. As against that, of course, there are many cases of experimental evidence indicating a possible hazard. All of those facts that we have available must be sifted an<| weighed. Unfortunately, to-day many errors have crept into pur discussions. One' quite ap parent error that came up was in the statement that manufacturers of this commodity have to have their employees medically examined twice' a day. Of course, this gathering is not competent to weigh all those facts and statements. But somebody must be found who is able to go into th questions of fact involved and to weigh the facts and determine whether there is anything serious in this hazard prob lem with which we are confronted now. And I do not think there is any better suggestion that could be made than to have the Surgeon General of the United States Public Health Service assume the responsibility, if he will do so. I appre ciate that it is a very serious and difficult undertaking; but if he will assume the responsibility of trying to get together and weigh all those facts, that will be the only way out of what seems a hopeless dilemma to us at this time, because we do not know what our duty under the circumstances is.. And I think, Mr. Surgeon General, that you would afford to us the best hope we have of a solution of the problem by helping us to determine what our duty in the premises is; and on behalf of the Standard Oil Co., the General Motors Corporation, and the du Pont Co., I.assure you that every resource we have for supplying information will be placed at your full disposal in making such an investigation. Mrs. B torxham, Mr. Chairman, in regard to the remarks of the gentleman who spoke for the General Motors Co., my statement that the examination of employees working on tetraethyl lead products was made twice a day was a public statement made by Commissioner McBride, of the State of New Jersey, after visiting the plant of the Standard Oil Co. and getting the information from the Standard Oil Co.'s physicians. I would like to read this statement: Before men were employed in the ethyl plant they were subjected to a very careful medical examination. In no instance was any man employed at this work without first undergoing this examination. After the men had 108 started to work in this department examinations were made weeMj In some cases, where i t was deemed necessary, men were examined as often as once or twice a day. These examinations were very thorough and included blood pressure, examinations of the lungs and heart, and having the teeth; examined. While I am on my feet, I want to make the statement that this " gift of God," to which the gentleman referred, was not a gift of find when those 11 men were kmed or those 149 were poisoned. And I think the statement of my brother delegate, Mr. Berres,.; to the effect that the thing that we are interested in in the long run is not mechanics or machinery, but men, is a thing that we have to bear very carefully in mind in this age of speed and rush and effi ciency and mechanics. After all, if the human beings that are left are not able to enjoy all of this efficiency and speed, there is no use in having it. Our experience during the war with the draft ought to prove to us that the physical stamina of this country is going down. At that time one-third of the young men of the country in the best days of their youth were found physically unfit to be drafted to serve in the Army. And when a condition such as that is 'brought out, then it is time for us to take notice and decide in what direction we are going. Doctor H enderson. Mr, Chairman, I would like to say one other word in regard to the statement of the gentleman representing the du Pont Co., the General Motors Co., and the Standard Oil Co. He spoke as if the matter had just come up, and as if it was too much to ask that they stop the manufacture and sale of tetraethyl lead. Now, that is not quite an ingenuous statement, because I have in my hands correspondence in which the first date is March 13, 1922. That is a little over three years ago. In that correspondence they asked me if T 'would investigate this matter. I believe that every other man pres:nt who works in the field of industrial physiology and toxicology received a similar request. We all, I .think, indicated that we would be willing to make an investigation, provided we could do it freely, without any dictation, and simply to find the facts. In practically every case the person addressed intimated--as 1 did very strongly--that we looked at the matter as one that should be investigated from the standpoint of public safety. Then the Ethyl Gasoline Corporation dropped the matter. They did not have the investigations made. We can not turn back the hands of the clock; we can not go back to conditions as they were three years ago. But we can at least ask that, in view of the fact that the Ethyl Gasoline Corporation neglected to have an investigation then which we were perfectly 109 willing to carry out, they should stop now until we have an oppor tunity to make it. The C h a irm a n . Is there any further discussion? Miss S ilverman. Mr. Chairman, on behalf of the Workers' Health Bureau, may I read the report of Commissioner McBride, of New Jersey, which covers one of the .statements made by the repre sentative of- the Standard Oil Co. % In the report with regard to the Standard Oil Co.'s plant, it is said--this is in regard to one of the men employed in this plant: This man had been employed in the production building as a general clean-up man. We were advised th at he was uncleanly and would not wash as he should and as a consequence became affected and died. Every man now engaged a t this work is compelled to wash frequently and bathe daily. If this order is disobeyed, they are made to forfeit any pay due them on any day the rale is disregarded. I ask you gentlemen to consider the fact that you are asked to allow a man to be subjected to contact with a poison which is con sidered hazardous by the leading scientists of the country. And when you expose them to that poison out of which the manufacturers are making profits, the manufacturers penalize those men by making j them forfeit a day's wage. The Ch airm an. Are there any further remarks % R esolution Doctor hiicono. In order to crystallize what I have tried to sug gest,! offer the following resolution, prepared by Dr. Haven Emer son and myself: I t is the sense of this conference th at the Surg'eou General of the United States Public Health Service appoint a committee of recognized authorities in clinical medicine, physiology, and industrial hygiene to present to him, if possible, by January 1 next, a statement as to the health hazards involved in the retail distribution and general use of tetraethyl lead gasoline motor fluid, and th at until such tim e distribution of this substance be discontinued. Doctor P atterson. Mr. Chairman, arising to second the resolution which has just been offered, I first .of all believe, and respectfully suggest, that that committee be rather limited in numbers, because I think that every one who has had experience in working with large committees has found that such committees are at best unwieldy. And I therefore offer an amendment to this resolution, that the com mittee be limited to seven members, . 1 furthermore suggest for your consideration that while this com mittee is at work the opportunity should be given to have practical experience placed before the committee as to what is the effect of the distribution of ethyl gas.