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Of the 52 persons in all of the above groups who reported nasal allergy, 43 or 83 percent attributed eye irritation to air pollution under at least some circumstances.

Mr. Winn. Not being a doctor I cannot get the tie between cancer and checking people's eyes. Why were you asking people in a cancer clinic about eyes? Just a place to poll people?

Dr. KAILIN. A place to ask people working in a downtown area and because one of my colleagues works there. My own office staff and people dropping in the office, people without allergies, just people coming in-we found again 45% of these people had eye irritation in a general area and about 66% complained about eye irritation when it included heavy spot exposure such as behind a bus.

Mr. WINN. Are you an eye doctor?

Dr. KAILAN. No I am an allergist. We did a telephone survey. We just picked names out of the D.C. telephone directory and we reached 89 people. 63 Percent of those people had symptoms under the whole spectrum of possible circumstances.

Mr. Winn. What question did you ask them on the telephone? How did you pose the question? ?

Dr. KAILIN. The D.C. Medical Society would like to know whether people feel that air pollution in the Washington metropolitan area at times have an irritating effect on their eyes. Are you willing to answer four questions? First, have you felt such irritation in the last 12 months, not at all, one, two, three occasions, four or more occasions? And then, if you noticed such irritation did you associate it with a special location such as being behind a bus or in a parking garage; being almost any place in downtown Washington on a smoggy day; being in the suburbs of Washington on a smoggy day?

Mr. Winn. Was there a difference between downtown Washington and the suburbs in your percentages? Did pollution or irritants seem higher downtown.

Dr. KAILIN. I couldn't answer that question. I will know more when I go over the data again. But many of these people never went into the suburbs. If we went back over our data and searched a little deeper I had one person who said she had trouble in Washington once but she almost never goes into Washington. The one day she went in she had trouble.

Mr. Winn. Anything further you can give us on that will be appreciated.

Dr. KAILIN. On our telephone survey we also found half the people complained of eye irritation from the general air. Among allergic persons it runs much higher, If we select the persons who told us they had an allergy in their nose, 83 percent of them have some symptoms under some circumstances.

Mr. Winn. These are people who had known allergies?
Dr. KAILIN. Yes. Thirty of them are my own patient.
Mr. Winn. These are nose and throat types of allergies?

Dr. KAILIN. Yes. I did not include persons who got hives after a bee sting, for instance.

Mr. Winn. These people were more aware of air pollution than a person that does not have an allergy?

Dr. KAILIN. Yes.
Mr. Winn. What percentage of the general public have allergies?
Dr. Kailin. I think it is going to run around 20%.
Mr. Winn. Twenty percent of all of us have some type of allergy?

Dr. KAILIN. Yes. Pretty close to it. There have been a number of surveys. This is going to hit pretty close to that.

Mr. Winn. Thank you very much.

Mr. Gude. You said one part of your survey was just a random selection out of the telephone book. Then it was not confined just to persons with allergies.

Dr. Kailin. This was a random selection of telephone numbers from the telephone book.

Mr. GUDE. What were the results of your random poll?

Dr. KAILIN. Of that group 51.7 percent felt that the general downtown area was irritating to their eyes and 63 percent felt both the general area and special circumstanes, like being in a high pollution area behind a bus or in a parking garage, was irritating.

Mr. GUDE. Now as to specific data. You stated on line 7, "aggravation of asthma attacks have been reported by some research workers at about the same low does level. Other researchers report asthma attacks at the level associated with eye irritation, or 9.15 parts per million of .15 parts per million. A value of .15 parts per million was exceeded on ten days in 1965.” So these are specific figures that you researched ?

Dr. Kailin. Yes. Those are people's surveys, not made in Washington.

Mr. GUDE. But the .15 apart from being a sulfur dioxide
Dr. KAILIN. That was oxidants.

Mr. GUDE. Whether it occurred in Washington or any other area, this would hold true for an asthmatic regardless of which city he lived in ?

Dr. KAILIN. That is right. Mr. GUDE. This is a constant. Dr. KAILIN. It is a constant for a particular site. I think that Mr. Wynn has already indicated that a measuring device only measures the air where that device is. This is correct.

I have a person over in Bethesda. Is it .15 where he is or does it happen to be much more? This is one of the difficulties of doing research in this field.

Mr. GUDE. But you do know that when .15 is present, asthma patients will have more difficulty than they will in areas where there is less than .15?

Dr. Kailin. That is what the survey indicates so far.

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Mr. GUDE. So if we detect .15 in any particular area in Washington, then in that particular area asthma patients would have more difficulty.

Dr. KAILIN. We would expect that.
Mr. GUDE. Is this a scientific method that you are describing?
Dr. KAILIN. Yes.

Mr. GUDE. In the second paragraph of your statement you appear to discuss the fact that certain irritant gases cause the lung air passages to close down and as a result of that carbon monoxide begins to

Dr. KAILIN. No. There are two thoughts there Mr. Gude. A person who is barely getting enough oxygen to his tissues because he does not have enough red cells to carry it or because his heart is not working well, needs to be able to breathe freely in the first place to absorb it. Therefore, his air tubes have to be opened. Or the person with anemia or heart disease, if part of his red cells are plugged up with carbon monoxide, as an alternative mechanism he also does not have the ability to get as much oxygen to his tissues.

Carbon Monoxide is something he gets out of auto exhaust from the air. These are two completely separate ways of diminishing the oxygen available to the man's tissues.

He will get carbon monoxide too if he smokes, you know.

Mr. GUDE. If you have an irritating gas in the atmosphere, the patient cannot take in as much oxygen.

Dr. KAILIN. That is because his air tubes clamp down. If independently of this he is also breathing some carbon monoxide, maybe he is driving in his automobile in heavy traffic and his blood carbon monoxide levels go up, and this has been measured on a number of occasions, again his blood cells are not available to take such oxygen as his lungs pick up.

Mr. GUDE. Isn't there somewhat of a snowballing effect that goes on here? First you have the irritation through the lungs, which then are less able to function. At the same time, while the pollutant is going up in the air the carbon monoxide is also building up. So what the person is breathing is supplying him with more carbon monoxide than he would get if the air was cleaner.

Dr. KAILIN. There is likely to be more than one oxygen interfering agent in the air at one time; yes. One is bad, another may not be bad. But usually it is.

Mr. Gude. In other words, having a variety of pollutants in the air can cause a greater effect than just one pollutant by itself.

Dr. KAILIN. That is correct.

Mr. GUDE. In other words, when we are talking about polluted air we are describing a very complex mixture.

Dr. Kailin. And there are many more pollutants than we are able to measure.

Mr. GUDE. I wonder if you could provide for us the source of the figures that you quoted in the first paragraph, so we could have them for the record.

Dr. KAILIN. Yes.
Mr. GUDE. We would then have a scientific source.

Mr. MULTER. When we receive them we will make them part of the record.

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the person.

Mr. WINN. I would like to ask an unusual question but I have a thought behind it. Other than the 20% of us who are allergic, what part of the anatomy of the remaining non-allergic 80% would be first affected by air pollution? Let us say, downtown in the District. The eyes, the nose, the throat, the lungs?

Dr. KAILIN. Probably the eye would be first to be appreciated by
Mr. Winn. You mean watering of the eyes or irritation?
Dr. Kailin. Burning and irritation.

Mr. Winn. Do you think this would have anything to do with accidents?

Dr. Kailin. It might, but I haven't seen any figures that nail the point down. There has been a question of interference with vision. I have seen this reported and the question has been raised whether interference of vision increased the driving safety. Interfering with vision can be a physical thing. You get the haze in the atmosphere. What happens to the

person, his eyes water and tear. Mr. Winn. Would you do an additional study for us? Would you interview a few more people that live in the outskirts of town and come into the District to work? That category of people you don't seem to be covered in your survey.

Dr. KAILIN. I might be able to get that. Mr. Winn. I am referring to people who live in Maryland and Virginia, away from the downtown.

Dr. KAILIN. I can tell you this. I asked Dr. Eugene Higgins, who is a nose and throat specialist who happened to call in yesterday when we were in the middle of doing all this-I asked him to check the patients coming into his office. He interviewed twelve, most of whom live in the suburbs and work in the District. All twelve felt that the pollution irritated their eyes and their noses.

Mr. WINN. Downtown?

Dr. Kailin. Yes, and reported that in most instances when they have most discomfort other people in their offices also complained. Half of them said that when they have difficulty, their families out in the suburbs had difficulty with their eyes.

Mr. Winn. I'm trying to find out if there is any relief when they go home away from downtown.

Dr. KAILIN. I don't have that for you. I have the strong impression this is the case, particularly some persons who are trying to get away from air pollution.

Mr. Winn. Thank you.

Mr. MULTER. I suggest it might be well if we asked HEW to make a survey of a number of employees in Government in various departments in the District and ask them to indicate whether they live in the District or out of the District and ask this same question.

Mr. Winn. A very good idea. I would appreciate it.

Mr. MULTER. It would seem to me that the D.C. Medical Society can render a real service here if they would make a survey or send a questionnaire to some of its members who specialize in eye, nose, throat and lung diseases. I know all physicians are interested in not only treating the patients but also trying to determine what causes the illness. I think we might get some valuable information from that. Would you undertake that for us? Or ask the Society to do it?

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Dr. Kailin. I can. My experience with conducting surveys of this type, however, is that if you can reach the affected individual you get a far higher degree of replies and you know a little better what you are doing. Working through a busy physician who is doing this as ancillary to other things you are likely to lose a lot of information.

Mr. MULTER. It would seem to me in making a survey questioning individuals who are not physicians and who are likely patients you would get subjective opinions rather than objective.

Dr. KAiLin. How is one going to get an objective measurement on a subjective person. It is nearly impossible to do. Burning of the eyes is not something you can put under a microscope. Short of a laboratory experiment where you can put a gas of known concentration past a person's eyes and switch it from one gas to another, which gives you a laboratory answer, I do not see how you are going to do it on a citywide basis.

Mr. MULTER. We are dealing here with an area where the politically motivated person is going to say, why should we intefere with private enterprise and tell people what to do unless there is some good reason to do it. This is going to be the reaction of some of our colleagues when we bring legislation of this kind before them. They are going to say where is the proof you need this. We may feel this because our eyes are irriated and we have gotten some complaints. We will be asked let's see the evidence that requires that we step in and do these things.

Dr. Kailin. Yes, you do need objective things but you don't want to use eye irritation which is such a nebulous thing for this kind of a study. I am currently doing another study using an objective technique in which Dr. Platt who works at that cancer committee-Dr. Platt and I are looking at the nuclei of cells scraped from the inside of the cheek in people who are most severely affected by air pollution. We count to see how many of these cells show a particular characteristic in their nuclei. It is one of the chromosomes we are looking at. We find in the severely affected people as oxidant levels in the air go up, the thing we are looking at in the cell changes. This is not true of people who are not affected by air pollution to a severe extent. It is only true of the person who has such severe symptoms that they become confused and stagger and have muscle weakness and forgetful and this kind of thing when they come into the downtown area. This bunch of people worries the daylights out of me because more than ten percent of them have developed cancers in various parts of the body. We think it is important. These are in the Washington area. These are people where the oxidant level seems to matter. This is the sort of thing that makes us feel need, not just the irritation of the eyes.

Mr. MULTER. Do not a considerable part of the people in the medical profession contend a large part of smoke contamination results in cancer and others say you get the same result in breathing the air around us.

Dr. KAILIN. When you are getting known cancer-producing agents from smoke and in addition you are getting known cancer-producing agents in the air benzo pyrene in both groups you are getting a double dose.

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