Document 3O5ReBqGJnEK1LXOX1LmejVJ

March 19,1956 Dr. W. E. Obetz ' The Industrial Ccmlssion Columbus Ohio Dear Dr. Obetz* I am enclosing herewith a series of reports and extracts of reports of examinations made on James Hamblin, who has been tinder mgr observation for a period of several months. The illness of has been an unusual one and it is not easy to determine its precise nature* By reason of my interest in the problem presented, and also because I have wished to clarify the diagnosis and to do something for this man, I have recommended hospitalizajtion and consultation advice. But for his having been sent to me, the case would certainly have been diagnosed finally, as lead poisoning, and he would have been compensated on that basis. Accordingly I have considerable hesitancy in an pinin which may have the effect of depriving compensation# I may also point out that the hospTtaTand medical expense would have been borne by the CoEjmissIon if it had been incurred after their acceptance of'the case as one of lead intoxication. Since this would have occurred but for my intervention, so to spe&h, it is my feeling that this man should be given the benefit of any doubt which may exist in the minds of the Comission. Moreover* It vjould appear that the hospital bill and the consultation fees constitute an equitable charge for services rendered to the Commission, if they can be allowed legally. In suggesting the allowance of such awards, I must disclaim any interest in compensation either for myself or for the services rendered by this laboratory, since what we have done has been in the line of our investigative Interests. The hospital expense, on the other hand, which was incurred on my recommendation, and which was necessary in arriving at a conclusion from the point of view of lead absorption, is a matter of some diffi culty. Very truly yours, RAKjis Robert A. Kehoe, h.D. 0 166-00 Harsh 19#193^ Dr, !?, B* Obsfcs ^bs Industrial Commission Columbus Ohio bear ter* Qbefca* I am nslosing herewith a series of reports and extracts of reports of examinations sad on TM-- who has been under tts$ obs0rvatlon for a period of several months#. The illness of M r v H j j ^ H H w has been an unusual one and it ia not easy to "S^iffixn its precise nature* By reason of my interest in the. problem presented* and also because I have niched to clarify the diagnosis and to do something for this man* I have recommended hospitalisation and consultation advice* But for his having- been sent to me* the can would certainly have been diagnosed finally as lead poisoning* and lie would have been compensated on that basis* Accordingly t have'considerable-hesitancy in arriving: at. an opinion which say .have the effect of depriving Hr* Hamblin of compensation* 1 may also point out that the hospital and medical expense would have been borne by the Comission if it had been incurred after their acceptance :Of.th cate as one Of lead Intoxication* Sine this would have occurred but for ray intervention* so to speak* it is ray feeling that this sac should be given the benefit of any doubt which may exist in the minds of tine Cemission* Moreover* it would appear that the hospital bill and the consultation fees constitute an equitable charge for services rendered to the Go-mission* if they can be allowed legally* In suggesting the allowance of such awards * I m e t disclaim any interest in compensation either for myself or for the services rendered by this laboratory* since what have don has been In the line of our investigative interests* -fhe hospital expense* on the other hand* *?hlch was iticurred on my recommend 11on* and which was necessary in arriving at a conclusion from the point of view of lead absorption* is a matter of some diffi culty* Very truly yours* HAKtis Robert A* kehbb* 'h*D* 0 0 1 6 6 *"*1 Date of this Reports Kerch 19, 1936 O.D* 12,907 ilg? 27 Pattout became ill on October 21st,1935, and-was-sent to ' hospital October 22nd, at night* remaining there until October 25th, v%a seen at Kettering- .Laboratory November Ifth at -which time the examination sis described in the appended sheets was made* He m s aeon again on November 15th, at which time the clinical picture was essentially unchanged* Some improvement began to take place shortly after this, and he was seen frequently In varying states of slow improvement over a period of weeks until h was sent to th Good Samaritan Hospital for further study on December 28th, 1935* During this ambulatory period and during th subsequent stay in the hospital, the lead excretion was watched, both under normal conditions and under various types of therapy designed to promote lead excretion* In all 31 urine samples and 16 fecal samples .re examined* At no time wore, abnormal quantities of lead found in the excreta or blood* Various consultants have rendered opinions and have prescribed treatment, as noted on the appended reports* In order to"fossa a judgment as to th potential magnitude of the lead exposure experienced by th patient, the plant in which h was working at the onset of his illness was visited and subjected to detailed examination* Among the pertinent facts established by the examination, the following arc of greatest Importance* {1} Th mea engaged In th some work as Hamblin, had boon employed as long or longer than he, and had 'experienced no symptoms, and gave no clinical evidence of significant lead absorption* {2} An air line mask ventilating system used by this group of men was in good working order and was so designed as to prevent the possibility of significant contamination of the air supply with lead dusts# (3) The general hygienic conditions of the plant m ? such as to safeguard th men against th more severe types of load exposure. (J4.) Routine blood examinations on the,men, checked in this laboratory, fulled to Indicate the existence of significant lead exposure*' Discussion of -Gas , The ayinpboriatology at the onset, and the physical findings at the initial examination were not convincing evidence of lead intoxication* In th absence of blood changes, end with the acute onset and the nouro- logical findings, it was necessary to postulate the absorption of considerable quantities of..lead,. If -th latter were th causative factor* Th lack-of evidence of significant exposure, and the failure to find an abnormal load excretion, disprove th occurrence of any considerable lead absorption* (Attention is called to the fact that th blood and urinary load were analysed on Tioverabcf Iffch only 2 weeks after the onset of Illness and th cessation of the. exposure* In Our experience the blood and urine levels remain elevated for weeks or months after the cessation of severe xpoaur5 * 2, 5-3,9-19^ i On the other hand the patient maintained an elevated tenperatare over* a period of reeks and gave they evident of an Infectlime prosso In the upper Jtte&lrstQ)?? % rbct* ,fh existence of an efchmoidltls (Sc report of consultant) during the last ported In the hospital, fits into this pattern* The present absence of organic neurolo leal Involvement (see report of consultant) provide little aid In differential diagnosis, sine an acute intoxication however, I believe the Illness Is best explained as an infectious wi^i'iSn ndcnhalliiiai ofJ,bacterial brikln* this nrpe^ss ........"" " :::i' ! : Robert A* Kehoe* M*B* HE 0016603