Document 2RyLxX7rDJOv2LRnErbxK9rg

SB INCORPORATED EXECUTIVE OFFICES (FORMERLY THE ELECTRIC STORAGE BATTERY COMPANY) 2 PENN CENTER PLAZA, PHILADELPHIA, PENNSYLVANIA September 2 7 , 1 9 & 8 (215) l o c u s t 4-4030 MAIL: P.O. BOX 8109. PHILADELPHIA, PA. 19101 CABLE ADDRESS: ESBCO PHILADELPHIA R. A. Kehpe, M.D. Kettering Laboratory College of Medicine Cincinnati, Ohio 45219 Dear Dr. Kehoe: / I t^hink it has been a number of years since you were in any way associated with The Electric Storage Battery Company. In these years we have changed the name of the company as you can see, but one of our major problems is still lead exposure. We no longer see any of the symptoms which were considered almost inevitable in the old days, but we do continue to get an occasional claim. We have made a few compromise settlements, but we find now that the time has come to make a stand and, also, to ask you to work with us again. Please lep: us know whether you are doing consulting work of this type and if you wold consider testifying in a workmen's compensation hearing in Allentown, Pa. The time of the hearing would probably be no earlier than November of this year. . I am enclosing some information on the claimant to assist your in making a decision. We feel that the claim is a weak one and that the possibility of lead being the cause of this man's health problems is remote. We would be pleased to go into all aspects of the case and the plant's lead control procedures with you in detail. Sincerely, WMP/sm enc. i W. M. Pallies Health and Safety Manager N 6152 /; l J Sx=i i v j . . / FSANCiS S. KLECiCN'E?., M .D . 582 NORTH EIGHTH ST?iE7 ' ALLENTOWN, ?EN.NSYLVAN;a 61C2 Area Code 215 Telephone -C2-5501 M arch 22; 1963 \ Admission: 2 /1 2 /6 3 Discharge: y2/6o Admission diagnosis: ?Abdom inal p a ir., unknown e tio lo g y Discharge diagnosis: Plum'd ism Choi astatic hepatitis, unknown etiology Surgical proceec'ures: Liver biopsy (noodle) 2 /2 2 /6S end 2 /2 9 /6 3 This 35 yc<ir old w h ite mole bad been adm itted to the A lle n to w n Hospital in January 1968 tor recurrent cbdom inai pain end laparotom y w h ich revealed no abnormal fin d in g and was discharged on January 11, 1983 w ith the diagnosis o f suspected pylorospcsm and underlying, g a s tritis . F o llo w upp ccrc- was by T rexlc* M edico! G roup and w ith recurrence o f his abdominal pain , the p a tie n t was scheduled fo r G . i . consultation c t rr.y o ffic e . O rt.2 /1 2 /6 3 the p a tie n t had a severe onset of the seme type o f upper abdominal pain w hich had become progressively worse over tho previous three weeks . The pai sv had been nocturnal v/cs not re lie ve d by food or a n ta cid , was not a lte re d by position , i t , in fact v/as not co ntro lle d on c blond d ie t , c n tia c ld s , anticholenergies therapy. The pain v/as quite severe causing anorexia and nausea but no v o m itin g . There were no signs o f hcmaiay.esls , meler.a or .The patient denies the presence of jaundice, brown urine, or grey colored stools, . The past history o f this p a tie n t is most s ig n ific a n t that ho v/as adm itted to the A lle n to w n Hospital in 950 for abdominal pain sim ilar in nature.and c t this tim e the red blood cells were found to be stippled end a diagnosis o f lead poisoning was made by the attending-physican . However in review of the ch.arr on m ic ro film , no other lab e valua tio n o f sig n ifican ce to this diagnosis were present. Tho p atie n t had been employed in 1950 by the C a lo ric Company in Top to n , Pg . and had worked for them to r 3 months however to his memory he v/as told th a t the y were not using lead based p a in t. For the past 12 years the p a tie n t has been employed a t various positions by the W illa rd Battery C o . o f A lle n to w n , ? a . and to his memory has hed elevated urine levels ( probably measurements o f coproporphyrins) end in fa c t , because o f these oveveted le ve ls was moved to a lo w from a high lead levels area about one year ago by the company. I hcc asked D r. G ernord to forward to me the p a tie n t's blood and urine levels re fle c tin g lead absorption but to this date , the infprcnction Has not been re c e iv e d , D r. G ernard is tho company physican, There is no fa m ily history o f metal poisoning e ithe r in the patients present fa m ily , his parents o r grand parents. N e ith e r is there a history o f liv e r disease, blood disease , or kid n e y disease. Father died a t ` ege 49 o f TS, mother ege 60 is a liv e having sustained a heart a tta c k . N 6152.01 AAAOA6 Q ...d . A.iOO : OCJ3X u : <.t.V 1O-ri . c o n i. Physical exam revealed a v/elI TnourishecI, w e ll -dec/oSopec* , w h ite male w eighing 145 lbs, height 5 *7 ", 5? 130 / 7 8 , pulse 8 0'end a fe b rile . S ig nifica n t abnorm alities were tender rig h t upper quadrant o f the.abdomen w ith norma! bowel sbunds , question o f rebound tenderness in the rig h t aebdomen , rig h t fla n k tenderness, .. Thors was no deseernchlc hepatomegaly and splenomegaly was absent cs were other masses in the abdomen. Recta! exam reveal be! brown stooi and tested in the dispensary it was guaiac n e g a tive . In itio ! impression v/as plumdism vs. pancreatitis vs porphyria vs u lc e r. ~' L c b 'if Evaluation: Pro admission 2 /9 /6 8 Hemoglobin 1 5 .S', hem atocrit 4 6, W3C 6800, 54 sags , 44 lymphs, 2 eooin, serum cmclyse o f 65 u nits. C n the day o f cdreisslcn 2 /1 2 /6 8 urinalysis SG 1 .0 1 0, PH .6.5 , negative fo r p ro te in end t u g c / normal m icroscopic. Scrum erniyse 65 u nits, hem oglobin 1 6 .2 , hem atocrit 43, W3C 8000, 55 segs, 43 lymphs, 2 eosir.s. 2 /1 .3 /6 8 blood lead le ve l .079 mg ms % or 79 meg % , the normal being 2 0 rr.cg % , urine cooroporphyrin s,lightly e le vate d, uroporphyrin norm al. 4 hour urine cmclyse 334 units in 295 cc o f u rin e, serum b iliru b in tote! 1 .3 mgrr.s%, d ire c t 0 .4 , RDC m orphology was negative for s tip p lin g , serum protein electrophoretic pattern on blood drev/n 2 /1 3 /6 3 revealed a normal pattern to ta l p ro te in o f 7 .6 g rr , % , clbum in' o f 4 .2 7 gms % on 2 /1 5 /6 8 amino cefussion o f the g lo b lin revealed 1GG 1000 norma! S CO to 1500, oou norma! 60 to *vG9, i 140 norma. P0 to 1 i 0 , c i > in mgrns the intcrPupiotion therefore was norm al. C n 2 /1 3 /6 3 the BUN 11, u ric a cid 5 .7 , cre a tin in e 0 .8 , F3S 76, serum e le ctrolyte s were sodium : 143, 1< 4 .7 , CL 112, C)2 26 m e c /iito r, a lk a lin e phosphatase 5 .6 BU. O n 2 /1 5 /6 8 the u rin e efepreporphyrin v/as moderately elovetod , the uroporphyrin was norm al. The porphsbi 11nogen was n e g a tive . U rinalysis: SG i .015, PH 5 .5 , negative for p rotein and sugar, normal m icroscopic and when 1 tested tha urine the urine contained b ile . Serum b iliru b in v/as 4 .2 mgms% to ta l w ith i .2 d ire c t. O n 2 /1 6 /6 8 ROC indocins M C V V0, jV.CHV 8 9 .5 , M C H C 3 3 .5 , hemoglobin 1 6 .6 , hem atocrit 50, RSC 5 .5 m illio n , ieo h ite 6 minutes, ?7 time 100%, -Bo? 26 % retention at 45 minutes , re tic u lo c y te count 0 .4 % . This day the urine for porphrobilinogon was negative end stools 2X wore negative fo r o u c ic c . O n 2 /1 6 /6 8 SCO T 150, SG?T ISO, 24 hour urine ' contain 3 .5 e riic units , normal 1 -1 5, 24 hour urine from 2 /1 3 /6 8 to 2 /1 9 /6 3 of 1930 cc contained corphyrir.s, 4 /0 mgms , norma! 00160, uroporphyrin 72 megms normal 0 -2 6 . 2 /1 9 /6 8 the c ik c lin e phospotes* was 1 1.9 DU, hemoglobin 1 4 .2 , hem atocrit 43% , to ta l serum b iliru b in 1 .4 mgms % , w ith d ire c t o f 0 .4 , SGGT 200, S G d l 290. 2 /2 1 /6 3 a lk a lin e phosphatase 12.8 DU, calcium 10.4 , phosphorous 3 .5 , to ta l b iliru b in 1.6 mgms, d ire c t 0 .7 , SGGT 174, SGP7 120, calcium versenato therapy was started on 2 /2 3 /6 8 . O n 2 6 /6 3 hemobiobir. 1 5 .6 , hem atocrit 44?/ WDC 4500, segs 4 9 , lymphs 4 7 , mono 3 , cosin 1, calcium. 10, phosphorous 4 .2 mgms, a lk a lin e phosphatase 1 7 .4 , normal serum cl octroi yes, v o ita l b iliru b in 1 .6 rr.gms % , SCOT 142,, mono tost n e g a tive . 2 /2 7 /6 8 U rinalysis : SG 1 .0 0 6 , ?H 7 , negative for p rotein and sugar, norma! m icroscopic, negative for b ile in the u rin e , 2 /2 9 /6 3 h e m o g io lr.T 3 .3 , hem otocrit 4 1 , blood lead le ve l 47 megms S3, 3 /1 /6 3 urine cororophyrins 214 megms, uroporphyrins 47 megms , in a volume o f 2000 c c , these studios done 7by bio-S cirsnco Labs. 3 /2 /6 8 a lk a lin e phosphatse 8 .6 DU, SGOT 4 4 , SGPT 104, to ta l b iliru b in 1 .3 , d ire c t 0 .5 mgms % , hemofeiobin 1 5 .2 , hem atocrit 4 4, W3C 5400, n o rm a !a h 'iie re n fia l. G astric analysis done 2 /1 5 /6 : revealed basal c o lle c tio n 6 lc c 0 .0 5 mec o f a c id , however the presence o f blood Inva lide d this v a lu e , histalog stim ulation!one hour c o lle c tio n o f loOcc contained 18.2 meq o f a cid . Inr.pression:hypor$ecrotory a b ility . Special hem atology a id a ht,ytog!obin , olectophoresis w ith a value o f 135 mgms SO - n o rm a l. X-Rays (C 320I9) 2./1 3 /6 3 abdomen and chest x -rc y s , no abnormal fin d in g s. Upper G , I . series , no abnormal findings but the emcam was in co m p le te . Upper G . j . series 2 /1 6 /6 8 D r. ^untgr impression was that there was an u!le e r 4 mm In diam eter a t the base of the duodenal b u lb , the ju n c tio n between the pyiorous end the dufcodenum. Personal impression is that this is not cn u lce r defect but rather the entrance I rr'- OciiX; :XdQO O U 3X :.l o f the p y lo ric chcnno! in fo the duodenal bul , end i p o in t out tha t there is no ir r it a b ilit y o f the duodena! b u ib o r the pylorus , neither are there classical signs o f ra d iatio n folds coming from this u lc e r1' . Personal impression: this is c roormal duodenal bulb and that no e c tiv e u lce r is present. 2 /2 0 /6 8 barium enema norm al, 2 /2 4 /6 8 cholocytograrn 3 successive attempts to p o c ify the g a ll bladder have boon unsuccessful,, the same visual Irsaticn is seen. 2 /2 6 /6 8 th e /o u rth day o f exam fo llo w in g injesrion o f O ro g rc fin does not reveal any storx> nor does it reveal any concentration o f dye w ith in the g o ii b le e d e r.' 2 /2 6 /6 3 liv e r scan n orm al. Pathology *' 68-1040 2 liv e r biopsies revealed normal liv o r histology . Consultations: Hem atology consultation D r. David Prcgcr obtained on 2 /2 3 /6 8 his impression was Seed in to x ic a tio n , possible hepatitis due to v ira l infectious mononuclealous, hepatitis or to x ic h epatitis, ho recommended mono test end liv e r scar, i f necessary , did not d ete ct any evidnee o f lead in to x ic a tio n re la tiv e to th red blood ce lls as c account fo r the h y p o rb illru b e m ia . H ospital course: the hospital course was h ig h lig h te d by recurrence o f abdominal p ain re lie ve d by Demerol in je ctio n s . O n 2 /1 5 /6 3 w h ile the patient was having a gastric analysis wo co ll acted c urine w h ich was brown (dark) in co lo r, tested it end found b ile present one in addition found coprophyrin present by the fluorescent m ethod. Thus we considered the abdominal pain os related to e ithe r to . p crp h yric or iced poisoning. W ith the fin d in g o f ' porphrobl 1inogon absent on 2 occasions, w ith elevated ccproporphyrin and blood lead le ve l and w ith cord in a c tio n o f the p a tie n t' s abdominal pc in having re lie f o n ly w ith demerol there seemed to be lit t le question this man did not have porphyria and did not have ulce r disease.' Ho was started on a course o f ca lciu m verscnaic therapy 500 rr.grr.s every 12 hours fo r 5 days and from that tim e forward was asymptomatic . Two liv e r biopsies were norma! and the ch olesta tic ja u n d ice the p a tie n t had remitted*." ' The p a tie n t \va,$ discharged 3 / 2 /O/ vc rrc-c,, o* ... w eighing 139 bjy . He w ill bo fo llo w e d by the Trexlertow n M e d ic a l G ^oup and myself CC A llentow n Hospital Trox! errov,vn M e d ica l Group Union Rspresentative Froncis S. K ieckner, M .D . V. r I A V ritn ;' --vu;- Date 11-17-63 01-20-64 08-12-64 11-10-64 12-18-64 0 7- 07-165 08-03-165 09-01-i65 10-06-65 10-21-65 11-02-65 12-02-165 12-16-65 12-30-65 0 1- 0 7-66 01-25-66 02-07-66 02-08-66 02-15-66 02-28-66 `0 3 -0 7 -6 6 05-05-66 06-03-66 06-23-66 07-05-66 08-02-66 08-05-66 08-11-66 08-23-66 09-06-66 10-03-66 10-18-66 11-01-66 12-06-66 02-03-67 03-03-67 05-05-67 06-09-67 07-07-67 08-04-67 09-08-67 10-06-67 11-10-67 12-07-67 0 1- 09-68 03-26-68 04-05-68 04-16-68 05-03-68 09-13-68 _____________ Urine________ :____ ____________Blood_______ Specific Gravity Mg Pb'/liter Mg Pb/IOO qm blood 1.020 1.025 1.022 1.023 1.018 1 .018 1.011 1.016 1 .0 1 7 1.020 1-015 1.024 ' 1.020 1.020 1 .024 1.032 1.025 1 .0 1 8 1.001 1 .0 1 6 1.014 1 .020 1.024 1.021 1.018 1.021 1.025 1 .0 1 5 1 .0 0 8 1..0I1 1 .0 1 0 . 1.003 1.005 1 .0 1 6 1 .0 1 2 0 .1 8 0 .1 5 0 .1 5 0 .1 6 0 .1 8 0 .0 8 0.11 0 .2 6 0.21 0 .3 9 0 .0 7 0 .1 8 0 .26 0 .1 5 0 .2 6 0 .2 6 0 .1 3 0 .1 0 0 .0 5 0 .1 4 0 .1 7 0 .0 8 0 .1 2 0 .0 9 0 .0 8 0 .1 5 0 .0 5 0 .1 2 0 .0 5 0.11 0 .1 2 0.01 0 .0 6 0.11 0 .0 6 0.063 .. 0.105 0.062 0 .0 92 0 .0 9 7 0.063 0.085 0.059 0.061 O.O93. 0 .0 7 7 0.088 0.045 0 .0 4 0 0 .0 76 0.055 0 .0 4 6