Document 08MqwpgreeZNpBE9mzOB6Vdb
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C . M. A VES. M. D. M E D IC A L DIRECTO R
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i&y 7 , 1951.
PLEASE ADDRESS YOUR REPLY TO P O S T -O F F IC E D R A W E R *'D 1 _ H O U S T O N , T E X A S
D r.B o b t. A. Kehoe, U niversity of C incinnati, C in c in n ati, Ohio.
Dear Doctor;
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I am a tta c h in g a copy o f an ex am in atio n o f our l a t e s t c la im a n t, from c o n ta c t w ith t e t r a e t h y l le a d . The ex am in atio n was made "by D r. 5 V B . Lummis o f H ouston, who i s a prom inent I n t e r n e s t , and has made a d ia g n o sis o f in f e c te d t o n s i l s and ad en o id s w ith an old tu b e rc u lo s is , p o ssib ly newly a c tiv e .
D r. Lummis makes a c o n s id e ra b le number o f e x am in atio n s fo r us of th is n atu re and I b elie v e i t would be advantageous to us i f you c o u ld g iv e b o th Dr. Lummis and m y self r e p r i n t s o r re fe re n c e s to such work on th is s u b je c t th a t might be of h elp to us in h an d lin g these cases.
Yours v ery s in c e re ly ,
I, / \
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P a tie n t's Account of P resent Conditions
About th re e months ago p a tie n t began to f e e l i l l and th is has g radually increased in se v e rity u n til a t th is tim e he has had to stop work. P rev io u sly w e ll, he began to have headaches, to n o tic e he was nervous and weak and th a t he d id n o t c a re to e a t . The tem per a tu re was about 98 .6 in th e m orning, 100.2 in th e a fte rn o o n . In th e l a s t two weeks he has n o t been ab le to s le e p w e ll, he f e l t worse end co u ld h a r d ly make th e day a lth o u g h h is work i s n o t h eav y . . He a t t r i b u te s th is c o n d itio n to th e f a c t th a t he works in a la b o ra to ry and t h a t p a r t o f h i s d u tie s i s to t e s t t e t r a e t h y l le a d g a s o lin e . He s t a t e s th a t up to two months a g o , hoods were u s e d b u t s in c e th e n he h as been unprotected and te s ts have been run in th e open. There are perhaps seven o th e r w orkers in th e same room.
PAST HISTORY:
Born in B orth Texas, liv e d th e re u n til 14 y rs old a id had m easles o n ly . S ince has liv e d in Goose Creek* Had in flu e n z e in 1928 and was i l l two w eeks. He s t a t e s .th a t he has n o t had th e fo llo w in g : s c a r le t, d ip h th e ria , rheum atic fe v e r, ty p h o id , m a la ria , pneumonia, u r t i c a r i a , a r t h r o s i s . He d e n ie s v e n e re a l d is e a s e . He has been mar rie d 4 y e a rs, has one c h ild liv in g and w ell and h is w ife has had not m iscarriages.
Present Illness*
The a p p e tite i s n o t good and about two hours a f t e r e a tin g f e e ls weak in th e stomack sad every th re e or fo u r days he vom its, p er haps now s i x tim e s i n a l l , - Bowels a re s l i ^ i t l y c o n s tip a te d and two weeks ago he h ad seme p i l e s w ith b lo o d f o r one day . There I s a s l i g h t cough w ith considerable th ic k ex p ecto ratio n in th e m ornings, w ith a bad ta s te , w ithout blood. , This in s p ite of the fa c t th a t he has very few c o ld s. About noon each day has a headaches lunch r e lie v e s th is but about . S x E K . m i d d l e o f the forehead, i t increases in in te n s ity u n t i l he goes to bed b u t i t does not keep him from going to s le e p . In th e morning i t i s gone. Sleep is d istru b e d ; wakes up f e e l
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ing nervous ( i n th e n ig h t) f e e l s h u ngry and. h o t* No n o c tu r ia . There i s
no tr o u b le w ith sig tra o r h e a rin g * Smokes 15 c i g a r e t t e s d a i l y , one to
two cups o r c o ffe e , fvery' l i t t l e alco h o l*
.
F am ily H is to ry : -jV. '
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Not rem arkable e x c e p t t h a t h i s m o th er, whom he does n o t rem ember, dies of p e lla g ra .
Physical Examination:
130 lb s (u s u a l 142 to 144* 5 f t . 9jj\ i n . T em perature 9 7 .4 , 98, 9 8 .3
pulse 72, 84. B esp iratio n 16. Bloddpressure 120-78.
Pupils, d ila te d : react s lig h tly to lig h t: react to convergence.
No i c t e r u s , no l i d l a g , nonystagm us, no p a ls y o f th e e x te r n a l o c u la r ,
f a c i a l o r p h ary n g e al m u sc le s. No p t o s i s .
F a re s open. A n tra do n o t tr a n s m it l i g h t w e ll (s e e l a t e r )
pharynx reddened s lig h tly . T onsils la rg e , c ry p tic , in fected .
T e e th : e x c e l l e n t . S lig h t p y o rrh o ea o f low er i n c i s o r s . No le a d
l i n e . Tongue co ated l i g h t l y , p ro tru d ed in th e m id lin e w ithout trem or.
H e a rt: P o in t o f maximum i n t e n s i t y 5 th in te r s p a c e , 7& cm. L e ft
b o rd e r 9^- cm. E ig h t b o rd e r s u b s te r n a l. No d u lln e s s above th e t h i r d r i b .
No t h r i l l . Thythm r e g u l a r . No murmurs.
Trachea in m id lin e. Thyroid not enlarged. C ervical glands not
in c re a s e d in s i z e o r number. No m asto id te n d e r n e s s . Neck movements f r e e .
The m uscles above and below th e c la v ic le s a re a tro p h ie d or un
developed. Bight a n te rio r ch est lags a l i t t l e . Ih isp ered and spoken voice
n e g a tiv e . No r a l e s h e a rd . P e rc u s s io n n e g a tiv e .
No o p e ra tiv e s c a r s on abdomen. S p le e n , l i v e r and k id n ey s n o t
e n la rg e d . Abdominal r e f l e x p r e s e n t. No ad en o p ath y . No te n d e r n e s s , no
r ig id ity , no m asses.
No edema. No Oppenheim, no Gordon, No C raddock, No B a b in sk i.
P a te lla rs p resent and a c tiv e . C oordination and s ta tio n good.
B ectal: P ro sta te n eg ativ e. There is s lig h t hypertrophy of the
p a p illa e and some i r r i t a t i o n .
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Laboratory and C onsultations
U rine: 1024, a c id , no album in, no sugar. O ccasional pus c e ll, 3ome mucus, one g r a n u la r c a s t s e e n . No re d b lo o d c e l l s s e e n .
Blood:
Hemoglobin-
^ 80 (S ah li)
Bed Blood c e lls
4 150 000
N h ite blood c e l l s , t 7 650
' , Polynuclears
71
S . lymphs
25
; y ;:; . l . * . '
1'
m Eosinophiles
3
No s t i p p l i n g , ho p o ly c h ro m e sia . No a l t e r a t i o n
, in size o r shape o f the red c e lls
B asal M etabolism : minus 1. T racing very s a tis f a c to r y .
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.... Wassermann; Y ery w eakly p o s i t i v e , ( p o s itiv e 1) M einicke
. ,'** r e a c t i o n n e g a tiv e
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D r. J . M .fio b is o n ; "My e x am in atio n o f Mr.
reveals a
normal c o n d itio n of th e a r s , nose and th ro a t w ith th e exception o f hypertrophied to n sils and an hypertrophied adenoid. T ransillum ination o f the sin u se s is n e g ativ e and sin c e th e re is no s e c re tio n found in h is nose I do not b e lie v e an x -ra y o f h is p aran asal sin u s is n ecessary a t th is tim e. I would suggest removal o f to n s ils and adenoids. I f e e l th is
would r e f l e c t fav o rab ly on h is e a r , nose ana th ro a t condition* His nose and th r o a t show a chronic co n g estio n which is probably due to th e ex
cessiv e smoking o f c i g a r e t t e s ,
--
f .
D r. W. G. McDeed; "C h est; The bony framework o f th o ra d i s
normal in ap p earan ce. The h e a r t shadow is norm al in shape and s i z e . The
domes o f diaphragm a re r e g u la r in o u t l i n e . Lungs; There i s a s l i g h t
m o ttlin g i n th e l e f t a p e x . B oth h ilu s e s a re s l i g h t l y a c c e n tu a te d . The
parenchymae o f lungs a re c le a r . C onclusion; The m o ttlin g in l e f t apex
is probably the re su lt of an old arre sted tu b e rc u lo sis."
Diagnosis;
1. Infected to n s ils and adenoids 2 . T u b e rc u lo s is , o ld . New a c t i v i t y l i k e l y .
D iscussion;
The p ic tu r e o f t h i s p a t i e n t is t h a t o f a c h ro n ic in f e c tio n . There can be no doubt as to th e c o n d itio n o f th e t o n s i l s and he was ad v ised to have th ese removed. Although th e X-ray speaks of healed tub e rc u lo s is and alth o u g h two sputum t e s t s were n e g a tiv e , w ith th e fe v e r and th e amount o f e x p e c to ra tio n , which was c o n s id e ra b le , i t is li k e l y t h a t t h e r e ^ i s a r e l i g h t i n g up to some degree o f th e o ld p ro c e s s . He should be tr e a te d from th is p o in t of view u n t i l he im proves.
As to th e p o s s i b i l i t y o f le a d p o is o n in g from th e t e t r a e t h y l s o u rc e ; From th e h i s t o r y a s g iv e n me he seems to have been d e f i n i t e l y exposed (B o ilin g th e t e t r a gas in th e open room over a c o n sid e ra b le tim e ) . He v e ry d e f i n i t e l y is n o t s u f f e r in g from th e a c u te form o f p o is o n in g . The nervous symptoms have been s l i g h t , o n ly r e s t l e s s n e s s , anorexia, e tc . There is not evident f a l l in b lo o d p ressu re, tem perature, pulse e t c . The c h ro n ic form o f te n resem b les a c h ro n ic in f e c t i o n . There wa3 no change in th e blood no le a d lin e on th e gums, so i t c a n be s ta te d th a t no evidence o f le a d was d isc o v e re d by e x am in atio n . Lead i n th e u rin e and fe c e s was n o t lo o k ed f o r . I t i s l i k e l y , in any ev en t* t h a t , were he p o iso n ed by te tr a e th y l le a d , a f t e r removal from c o n ta c t, he would reco v er in s ix to te n weeks.
S incerely yours