Document 1wr50jvvm2nVy8rBvo0y808a

it- W O R K M E N 'S C O M PE N SA T IO N THE INDUSTRIAL COMMISSION OF OHIO Claim No~..Q .-4 5 9 3 -. Claimaiv SPECIALIST'S REPORT Address -103MiWB*d--Sfcw-0&aelnnati, 0* Date o f Examination.-Febrg&Ey-- 2 2 n d - 1 9 3 8 ---,-.-.-...,......................Age. M . . . NO TE: Submit report under following headings: ' ( 1) H istory>: (2) Complaints, (3) Examination.', HISTORY C creolaln t.-- Loss o f a p p e tite p a in in e p ig a striu m o c c a sio n a l^ v o m itin g ". ,,iVi a f t e r sie als p a rs i s t e a t c o n s tip a tio n weakness ana f a t i g u e * ; weakness"'! '; * ' ,{3e@ previous report dated April *j20~1937 fc**_ onset sa d ^ - - eaujpb1o r fliri'e s s * fa m ily M sloffy p e rs o n a l h is to r y # ) %' I* , ' P re se n t I l l n e s s * S in ce l a s t seen h as been u n ab le iso work* Has t i l e d ? ' r 1To"work on s e v e ra l o ccasio n s f o r a l o c a l c o a l company b a t h a s been., u n a b le 'to com plete a dayf a work* Abdominal dlseom fO rt (d u ll ache) ^ -with!, acme .d is te n s io n jatj tli^es* h a s co n tin u e d w ith o u t r e l i e f ^ f * -J . ^ ;-ifl e l f ' ^ i i s * ::ttb h ; jn p ^ f la p :1s rl^|r in "!i * ^ % & hW i S ; lightly - ' : , 1 r|.@y.pns-fe. 'Of : X ccnplsined of# has been g rad u ally disappearing according to p atien t* . .B g iljll^ | p :l i h f i f ; :| p !T o w e r ^ :; e:da%|iljf,cfe,|B*. o r t o h e a r t orr1lu tg a * Baa 'n o t ta d he-ada'ches*-^ ' ` - r **' Denies any exposure to le a d s in c e c e s s a tio n o f employment in Feb* ` < - 19 17* : : ; S f e # i 1 i C S t f j ;;?>&*J ' m rsiG m . > r` Present; c o n d itio n much same a s 'p r e v io u s ly d e sc rib e d * ..Temperature 98 Pulse 68 * Besp* 2 2 . Blood P re ssu re 130-60# . Byes, ea rs nose and ' t h r o a t n o t 'rem arkable# T here i s a p ig m en tatio n o f th e b u c c a l:maooea and tho gums# b u t t h e r e ' I s no c e r t a in le a d lin e * . Seme o f th e p ig - , m en tatio n along th e u p p er l e f t m o la rs may be le a d l i n e b u t 1 ques--. -jmqy -me v ~ k * ~ a u ' ; -*i - A;-i- ;:.U^ --. - ilr^f' - ` ` - - * , ~r ' * ' > "IT 'T.^ ^V^ There are no demons ferable a b n o n sa litie o o f h ea rt .or lu n g s . . Thors i s - ' tenderness in epigastrium and upper.; abdomen* There i s no muscle V - spasm# the abdominal muscle b ein g rela x ed # The l i v e r and sp lee n are . . not palpable^ ; ^ ^ _ ! ' : ' 4 T` . .. - .- A- -- A /A. 'i ' 6 x-~ f .V ^ .' The low er e str e m ltie s- are not rsm arksble and there are no p a in fu l The l e f t arm appears to be soaeEhafc weak h ut w ithout obvious atrophy th degree o f weakness may be q u estion ed 1 & apparently la r g e ly - su b je c tiv e , ih e sensory disttncbqnce p reviously described ta le s s ........ - d e f i n i t e . lab o ra t cry O bservations ' r-row; N19355 i-ioy auu tdLiuiiuuiy wuus.' ^'t/wiBcussi.on. -(a) upm ion. .lVi.a.U J.tlKJit copies^ j to the M EDICAL SECTION--Retain one ftor your file. 'v - , z '' " l"' r hh i s t o r y . i _ , - T A ' * fc * * st o _ ..................... . 1 ' f r .. . . * i. > y / * & * ^ * 7 * ^, . . ttta g '-. . 1! T!^ '; .(S ee p lu v io u s *egerfc dftted AgrilJSff* I f I f f o f o n se t faa v 7 cans 7f Illn e s s # . fa m ily h is t o r y # personetl !&1sto ry * } ' " ? '.. US' '* - -"5v^v-f * - -'V**.*** *~S s&/" - <** " {fa'* -> " P r e s e n t 'i l l n e s s - ' 'Sine `l a s t r s e e n lit t e a u n a b le to . w ork. Has t i l e d * t e beaste.'a' s e v e r a l c s s loan f o r l o c a l i c e s ! e sp say feat lia s been? npa|3l:'si:t& ; & a^lbt'' d ay f s Steak* ; Abdominal d i s e a a f o r t ( d a l l s c h e i 7. f life $spt ,d |stasto fi a t .to e s # h a i continued w ithout r e lie f . 1 * 7 y ^ * G iM l^ e t' t- vom it a f t e r s e a ls # j e i t h m M@e~alf a n y tlit in v o m ita s * , Has n o t liad t a r r y o r ^offtMHproanS s t o o l s * 1*'Has l e s s feting l i g h t l y # *-, to ilers tin g , K i l l f e t t e n t h s Io th e r foods* ; rXa nfefc# spending m ost o f t ime a t ;ito#aI n .had* 7lis jwaifcnsss ' o f tb s ' I s f tr a m * p re v io u s ly J - r ' . e e s p ls ln e d f# has b e e n :g ra d u a lly d is a p p e a rin g cording t o p a t i e n t . H as' had a Symptoms r e f e r a b l e t o g e n ifto -u rln a ry ' t r a c t # -^or ;.te -Ic w s r a . J e x tre m itie s * o r to h e a r t or- ittag s* , w m o t had headache#*'^,:', _ . . * -z - ^ - - . : _ , . . -. - ... . . . . . v ; *? - , ;:xi:.-.<... , .. .,- ,_ .w v ,- v ..^ '- - > . :.: D enies any exposure t o le a d s in c e c e s s a tio n o f employment.,In Peh* .V '** ^:V^&2 ' 153?*; . y ,, * r ''S - 0; PHYSICAL Sm iH A IO H -.s ,u : *\ $&' P r-r^ 7: W tm ^ /-`v* P re s e n t c o n d itio n much same a s 'p re v io u s ly .'d e s c r ib e d * Tem perature 98 P ulse 68' - 8esp.f22 .:.:.B10od P r is s u r e 138^48* 7.:Syes# '.ears# n o se and .`7' ,--. t h r o a t `.hot ^remttabie- - lib e r e i s a p ig o e n ta tio n o f th e b u c c a l sswimUi # irad th e gums* b u t t h e r e ; i s no c e r ta in le a d lin e # .Sene o f .t h e p i g - . m entation along th e u ^ i l e f t m olars may be le a d lin e b u t I s ques*# i tio n a h le . , 7:,7 ' fV , V ^ .'. * . . -, c., , J ':tv:f -1 v ,,'* - - - , * - . ' . - '->.. T - - '". , , - - - . : . .. -' > s-, - . --V v - '.r * '- -. y . .' Thex a re no d ^ a o n s tra h le V ahnorm allties o f h e a r t ,or lu n g s* ^.Tm re i s t e n d e r n e s s i n e p g a s tr B S and upi^r.-.'^sdeoieii^'"' f h e r e . i s n o 'imJacle.' - v spasm # th e a b d o m in a l m u s c le ..being r e l a x e d * '. he' l i v e r 4 o d .> p lic; a ra i1, n o t p a l p a b l e * . -,w , v'.r.'.i.2.>.;;', "' ' ' ' ' ' ................... . ' J - f ' - - --- ` --r- The low er ex trem ities^ a re n o t rcm ark sb ie end th e re .a re no ,p a in fu l joints* - ' - " ! ` ;' -'-7, The l e f t arm ap p ears to be somewhat oeak# b u t w ith o u t obvious a tro p h y the degree of weakness say be questioned i*e* apparently la rg e ly s u b je c ti v e . Th se n so ry dlsfeurbenoe p re v io u s ly d e s c rib e d i s l e s s d e f ---- -- __ ............. ..... " . ^ . .v.'-. -777-v Laboratory O bservations Blood 2- 21-38 7 7 r b c T-'W7 y ^ 7 s K -5 7 7 7 3 * 2 2 0 * 0 0 0 Eh (Dare) ~ -` TO - ' Stippling (50 field s) WBO ` - * . , ^ Polymorphs# ` Band forms - . ' h' $ r t Lymphocyt;*s - "'-r' MononuclLeei ar . -17. S3aossoinpohpflhesile^s , - .* 1% 2-X5-38 2 , 980*000 6 5 % > ^ 4l*,6oQ0 C0 2 .*.Q^ y ?~tr' ' IjX . 0 ^>v V : M. D. (CONTINUE REPORT ON REVERSE OF SHEET--NOTE INSTRUCTIONS) . U i'-i-V .: . ' (CONTINUE REPORT UOTVS FROM HERE) " ~ . . . v -^ t IcoM xixn^. -oehO'KX ' Lead tt 's&llgraB w lO O grsm s 1 blood - . _ V < f m '- i 4 , -~f s.saast) . .. ' ' 2-21-1938 Q22 tcs prd' i th 9*955 y* g) s - 5- 3 5 .-1 9 3 8 0*16 - - , > _ > -- ip le e A lk alin e to m ethyl r e d ' Albumin m su g ar n eg a tiv e M icroscopic - co n sid erab le d b ris m & fw pas' c e lls * Lead in a lllg re m e p r l i t e r , in o rin e , r 2-21-38 , *08rCoped eith (0 * * "^. 3- 15-38 _*/ ..0. 35: ( '-V. . . - 10.18 Foar r c- *- > le a d a n a ly s is on f e c e s .o b ta in e d 31-15-1938 n OB li-2 8 -1 _ ' C ' H- n en tire - sample .P er g ra s, of sh w- s. ! : i S : H*. j, -?. . ~ . . .. . f- 5& |; S D iscuss ion and Opinion - '-Ob,April 2 2 , 193?'' la rg e sample- of,,,..,, u rin e and. a -a oe ^ e!,lo f ' feesr' s o rs b ro u g h t t o th e la b o r a to r y by "'"A' t h i s pattenfe*. 'th e s e h av in g been c o l le c te d b y hiss a t home oa o u r , I n s tr u c tio n s * ... The u r in e sam ple on a n a ly s is y ie ld e d 17*35 m i l lig r s a a f/'lsa d * r 10*7 i l l l g w w i :p e r l i t e r * " . Th, f c a l: seapl'" y ie ld e d 195 'm i l l i g r s a s by a c tu a l w eig h ty .. respond ta g to l6*2t m illig ra m s: p e r .r si gram o f ash*. T h ese, f in d la g s are" Im possib le and-: fa n fe a stlo mm""--'.' "* e x p re ssio n of le a d e x c r e tio n * One o f thasa s i g h t have been contam inat by a c c id e n t, but th e cabined r e s u lts suggested th a t th e samples had b een tss^pered w ith b y th e p a tie n t: r: by soesaesti. e ls e * . I n s u f f i c i e n t mcmledg a s ..to., th e p rh p e r h a title s ,f :le a d to ..a d d , '.la"' o rd e r to*a^ s im u la te ' plisifclfBi*' b ad d e fe a te d : tfce p urpose. '--#* a o t , and '.ear V-**** a t te n tic ' was c a lle d ,..to 'th e lik e lih o o d t h a t e i t h e r th e p a t i e n t was ,,a m a lin g e r ''fe e in g ' a s s is feed':b y "semecne, o r f e a t 'someone was f o o lin g , b o th hi and m is * Those a n a l y t i c a l r e s u l t s became a v a ila b le o n ly affee a y i n i t i a l r e p o r t had been s e n t in * A f e e d ay s '.l a t e r .Mr c l l d-'l.n rf '" ' fcalk:*^bufe' s in c e 't h i s " felfc'"'yieXde"s' i n f o r ^ t i b a ,- . ' : and s in c e I t was b e lie v e d t h a t th e b io . d and u r in e , sam ples ta k en , in th e la b o r a tory on A p ril-2 0 th had g iv en r e s u lts d e f in ite ly p o in tin g tc & s i g n i f i c a n t o c c u p a tio n a l le a d e x p o su re , no su p p lem entary r e p o r t we made t o th e I n d u s t r i a l Commiesion* On June 25* th e p a t i e n t re tu rn e d v o l u n t a r i l y t th e la b o ra to ry * a t uhlebf.tim e a d d i tio n a l blood an d r^ . urine analyses sere, carried oat as follow s: . . / .. ! "~1 r U rine 0*13 mgs*19 ad p e r l i t e r / - ' , % T* * ' ,,* v'f/*'.:: *;^ B lood. 10 0 "g r sis* :' ' "-r\ ': ' V : - \ . A t .th is . tlaa^/th ^patient-^hbdi,tbl asm .co m p lain ts aa th o se p re v io u sly . described* This faefe/and bead'-;.onee n t r t io n 'had,;: f u r th e r fa c t. th a t, the blood and u rin a r; ;:S:h f ,qu i t s u n u su al . However f^fir-. tp e b tib u in g ^ e lic it^ 'llfe ilc ^ n fo ^ s tio tfh S ''to 'the p a tie n t's ..- a c t i v i t i e s * and no ev id en ce o f any f u r t h e r o p p o r tu n itie s f o r le a d exposure s in c e th e c e s s a tio n of h is ^aploym ent was obtained* ' ^ H E* w ith M r*m H H ^X & test re tu rn fo r exam ination 4hd^study*.It nos becomes a l l too ap p aren t th a t the le a d co n ten t o f M s b lo o d , u rin e and -fe e e s have been m a in ta in ed a t an. in o r d in a te ly h ig h l e v e l frrougb hldh. basano r e la tio n to -h ls' c e u p s tlo n of^^ye^'agev'- i .h^ !tbib^k@ a,-''and::'.there i s n o 'd o u b t'".'fi,t h e i r 0 0 1 6 5 5 l " ," r !?t,r>tihc^* fcherfr ie uo-doubfc^ t h a t th e y - indicata.-: th e recefe- --^ -- In fsntir# sa ig > l# ;'q ,:l\ S*95 a g * V 1 s r a ^ ^ a r ? ^ ' ; ; r. ,. . ., i- ,, O'1, * * - ir * *. * ; `* ^?. .. .v -i ^ 1, *'3 *~JS V * *.*i H ***** ' -rx- D isease ton and O pinion * -On A p ril 22. 193? 'a saaple of urine' and a sample'1'o fe e # ere" b ro u g h t t o f e e la b o r a to r y b y ' t h i s p a t i e n t * t h e s e b a y in g : be b ;< sb lteb fe :d hy-,.bl# M % h ,'*** 'ar - -v I n s t r p e b l o u a * _ The u r i n e s a n p l e on a n a l y s i s y i e l d e d X ?*35+ I l l i g r s m e ' o f le a d s 1 0 * ? m i l l i g r a m . p e r l i t e r . fee* f e c a l a m p le / y ie ld e d 19 3 m ill! g r o s s by a c tu a l" w e ig h t* e c ^ m rn o a r! inr. t o 'liJ x ' l i l l i g r r 'W p e r M ' rreTi c f ash* These first in g s arc- ?n;jr**"&r.~<!* ?u5 fen t r e b l e as r r rrnrcsrSpd/tiOff le a d e x c re tio n One off tk r ji r i g h t b eer been on t f nictate* by a c c id e n t b u t th e com bined.result** a u r y e r te i feVrfc th e camples bad be tfiffipsrI dt a i..^..l..l.f..e../..'.i.b..lA, . _ ..... , o r by sooietme. e ls e * \ Insuffff ieicpfe i ta xled^i;jfib;.fei off le a d t o add 1" o r d e r t,. "ir-kl.vte plusbliEa* b ad d e f e a te d th e p-j^posr. *)f tV- a c t and ou r ahtem ilfeill^ f e a t e t tfcer fe e ' p a t t e s t e r e .* z rr 1 inf'orer b ein g a s s is t e d by ateiec^e* nr fee** o r : cur rrr f o o lin g both b ln anti u s# lose a n a l y t i c a l r t s u i t e booerto iv r .I I r t 2e o n ly a f t e r my i n i t i a l r e p o r t `b id bad agall Ih* A far* u o y s l * t c r 5Tr, OastJiWpk^ c c ll? fi in f o r 'a ta lk * "b u t sine t h i s telJr y le lr ' v* no I n f c m r tio a fr.r: ft'.tics i t as b e lie v e d t h a t fe fclo c nun u r ic ? roicuXor token, in fee la b o ra to ry on A pril 2 0 th bad pivots M r - i] ? t> f in" te ly p o in tin g to r i g n i f i e e p t o c c u p a tio n a l le a d erp o ru r , r,<* ru ^ p ic ric u te ry r e p o r t as ide 'to =f e e lsd u stM al' . ift'lif:gfl3bi* On Ju s *< p s t i c a t r e f e r r e d v c lu u 't& r lly t o f e e l a b o r a t o r y * a t *"aieh t i r o c d d lh lc 'V ' i po o . r o d u r in e M aalyse0..er !jcsfh*teC :M%>^s .... . Brin y - v ,;*i3^iaMM " " ` - Blood '- 0*085 *"''' ."""'^..1 ' ......... i t f e t e ' tip - fed.': p e |ic b f e i Sescribed* *T ill 1ffa$fc:lfted; |t blood and i t Adi; c o n c e n t r a t i o n 1t s d |i b i s i 3 ____ Ecntever- fu rfe e r questioning ' licit ^ ..ac t^ iti % 'a d .. 'ey id e ii ^ 'l.... ,_, $& fbehre line fe 'ces at|cii: off h i s ' ' ' .-l*eti\nHT ' : M^k l B i i -- 2 l a t e s t : r e t u m ' f or. I t no b e e v e s ; ': a l l ' tova p p a r e n t f e a f e f e e ':il e a d ; o f M s blood* u rin e l|s d J::^e^ee1isav'-'bbi#mi|intatefed..^t...S^ 'l:'" leveli-.ferough h ic b -M s -no. r e l a t i o n to h i s ro p e n p e tib b o f m y e a r ago*.VTbe _ - r e s u l t s jp s ^ e 'b e iir b t e :^ d |'l i i |d ' 'f b j e ^ i# i|^ b id o ite t'::of:" f e e i r *> A ccurscyif-'Pi^feer^feere^l#-' no- d sfe t- fe a t ^ ey ^ & efrte^ fe* ~ s* o ^ ife~ ^ ' I n t a k e o f r a t h e r - la|pM''--^Pbfr^ivfo f '::'l i a d ^ c lin ic a l.. ; - . --- c a n d itio o f i f ; f a f i :,:'h;a:y:|iio f e r lab oratory .- - eridfeoe of - .'. : t m pr m Bissm b o v e r V p e r i o d o ff:& ' y e a r* b a t i n - f a c t h a v e >p r o g r e s s e d * '- ( C o n t i n u e d on s e p a r a t e s h e e t ) ____________ ______________ ___________________ _. - ............ . - -- . .. ........(DO NOT.WRITE BELOWTHXS LINE) .... . ....... . .. . O\-ZT^TJ.J?'K-C<-k'.7'W$.*.~7iPiT1iOv'?? ~CJLYi(?7^rr2if;^T.,{ X .-- O ' * u H-'J!0 3 !O v1- C L O H I O v oh . (O N S SIHX MOHS ONIdAX SX1NIXNOO X O N OC) ( c o n t i n u e d tm m y e l l o a s h e e t ) I t i s ooaeel^atlo th a t the p re s e n t le a d exposure is duo to sane- eeeidetjfcal fa c to r in the p a t i e n t *3 anviroraaent Ib is la -M g h lf Improbable hu t I t w ill he in v e stig a te d as a n a tte r o f s a i s a t l f l e in to r e h ;. There is- no re a s o n , however* to a s c rib e th ia patient* prosat. c o n d itio n to th e e f f e c ts of h is employasail'tp p io r to February o f 1937# a nd therefor your e x a a in e r has concluding th a t th e re Is no J u s tific a tio n fo r . .compensation of this: elaiiaan t* I t ' may even be dou ted i f Vbm o r ig in a l hlrh len d c o n c e n tra tio n s in blood and u r in e , which 'vereitsfcen as or idones of s lg n ifle a n t occupational lead absorption m rq ld tte to ' o ccu p atio n al ifaptors*, a l b seas p ro b ab le (froa- the: ' , , y ta u ltt. obtrir.od op the la rg e 3oploa of u rin e and foccs as noted above) that, even a t t h i s tim e some tam pering ttith the p a tie n t* o ' lead intake had occurred* " . . ' ' 0016553