Document 995MyrxbwzDM7dXD4bN8yY5j3
IIJTERPEETATIOH
The lead concentration in these tissues Is veil above normal levels, as would be expected from the history of exposure. The concentration In the brain is about four times the upper normal level. These findings, however, In themselves, do not justify the diagnosis of lead encephalopathy, since such re sults have been obtained repeatedly without relation to de monstrable clinical plumblsm. On the other hand we have found lead concentrations of these magnitudes in association with veil defined lead intoxication. The diagnosis, therefor, must be made on clinical grounds, the analytical results merely tending to demonstrate the absence or the occurrence of signi ficant lead exposure. In the absence of evidence of signifi cant lead exposure, the diagnosis of lead poisoning is untenable} when present, the evidence can only confirm a conclusion arrived at on clinical information.
Heb ert A . lie h o e , M. D . I should; be interested in having the clinical record.
H t T 0016810
INFORMATION REQUIRED ON CASES PROM WHICH TISSUES ARE OBTAINED AT NECROPSY FOR KETTERING LABORATORY OF f. APPLIED PHYSIOLOGY
Ne cro p s Y number / S P ^
U Date o f Ne cropsy
2
i A' JL
H o s p i t a l mirnber / V - V 3 - V f
Date o f De ath / - i ^ ^ 3L
Age ^f&Se x 0 ^ N u tritio n
Le n g t h o f Bo d yf/ <o , S o . .
Clin ic a l Diagno sis
Ap p ro xim ate D u r a tio n o f Il l n e s s 2 o / I f f .
S '/ y ' ^ 'C T T fA fJs i/ e c > n r
c 7 >y- y -/ T x Ss y / T c y < & } > jli * e r / a's f 4 c 2& *?*/ } *'
~Tf*:s'.I
C e~^ T~~
C~e>Jsjie..
-WW'
An ato m ical D ia gn o s is .
'
f- /- s-
0 / / j 1*7-
sfr'f e e s e s * s c *- / w o w / V
t'G ' ? o ft i y / t .
'C- v? *t y r *r Ji> / fs r cr r y <r/ vyt/ tssg-s s*
S' V'J/vyv^vC'vi
A <!r' ^ Z t S 'cevC rtreA r W v ? A / o i fi -- / o ^ s .
S o jC r^ti^A i .
'
Previous Me dical His to ry in B rie f
Occu p atio n al His to ry lA jvK & e* Fo*. 9 / ySr/ ^ 'ty c / H f S / - a r * e :>cAb S r j/ s if ?
c & ^ 2>.
^ > ro
H i s t o r y o r Ev id e n c e o f Ex p o s u re to Le a d , A r s e n i c , Me rcu ry
/A/*o c c , sif. fc. a/ P e r t i n e n t Re m arks
e*"
3 / yr-s\
&s= c-eEsq,
ns/ #** .
TISSUES DESIRED
(Ple as e o b tain such o f the se as circum stance s w ill p e rm it, g i v i n g w e igh ts o f e n t ir e o rgan s when a v a i l a b l e . -ve ight o f sample p ro vid e d w i l l be de te rm in e d in Ke tte rin g La b o r a to r y .}
Or g a n
To tal / ie ight.o f
W e igh t Sam ple
- ~^
; S/r~
4V i Lu n g s r / _
y He a r t '--!:_____
Y?o ss~
u Li v e r -- /<^T-S
4f. Sp l e e n - -- t ? o
/ Kid n e ys -- 2 7 0
. Su p r a r e n a ls Sto m a ch an d
(>)
In te s tin e s
Prostate
3i^ W 5.
Th yr oid
fqtfcfZgA S
Or g a n ________
To ta l Weight of .h e ig h t Sam ple
Brain
\2 3 o
S p i n a l Co rd
S t r i a t e d Muscle
Ad ipo s e t is s u e
Lo n g Bone
Rib
Te sticle
Sk in
"
Z8 9 I0 0 3 h
jjT r~*
. ) % } ! f e f f j i-
V "
/ :i/'
^
0'7x ^1 .
/ y j-
p#
/y*7&n
!/
V .
z ?r J ^ T f ? ~ o
Y$ i 4- >f*>? '~Y7.J>-j ! /- /
h-
~in <t. ;
. ''" V ^ r/ - -#- /
':p p y ~ '*'^ y^9 2 ?'#r2?>o 1^!' <^7 s*pL^f / y f j f***} I
.V.>.* ^*Z ^ ^
i ft (/
y *^?
4L
j/_
\\ X
^* r ^ i/ ?
--- i w.; i r h e - T'' <T'9^ J ) \ \
' ^TZpf^T?,/ /,-
c^Wv-; ? tpfr
-- L- y' J
/ Jy N` ^
- 1-4 8 ~43 Cl i n i c a l Summary
1 -1 9 *4 3 . On 1 -8 -4 3 , p a t ie n t b e ca m e .d iz z y a n d v/ as see n t o s t q g g e r . Sin c e t h e n t h e p a t ie n t h a s had s e v e r e o c c i p i t a l h e a d a ch e s . Se v e r a l h o u r s a ft e r t h e on set o f di z z in e s s , he b e ga n t o v o m it . Vo m it in g c o n t in u e d fo r a p p r o xim a t e ly t h r e e d a y s . P a t ie n t co m p la in e d o f s l i g h t sfc-dominal p a i n , and o f d ou bl e v i s i o n . P a - t ie n t r e n a ln e d i n b e d u n t i l t h e t im e o f a d m is s io n . One' weep a ft e r t h e o n s e t o f h i s i lln e . s s 1, he began t o be i r r a t i o n a l ,, an d r e q u ir e d p h y s ic a l r e s t r a i n t . -nlso s u ffe r e d h a llu c illa t io n s and d e lu s io n s ., Pood in t a k e had beer n o r r n l u n t i l t h r e e d ays b e fo r e a e t e is s io n . P a t ie n t bad been a known h yp e r t e n s ive fo r o ve r on e y e a r . At t h i s t im e , b e ca u s e o f v o m it in g and b i l a t e r a l a b d o m in a l p a in , a cco n p e n ie d w it h a b d o m in a l s w e lli n g , he 'ras s t u d ie d i n t h e c l i n i c and num er ous x - r a y s w er e t a k e n a t that tim e . P a tie n t was not h o s p it a lize d , however.
.
P a t ie n t h a d . j r eum onia in 1 9 2 7 . Re vie w c f symptom s r e v e a le d t h a t t h e n a t ie n t liad worn gla s s e s fo r : th e la s t s ix or seven months b ecau se o f d im in u tion o f a cu it y o f v i s i o n . N o c t u r ia 1 x . Oec u e s t io n a ! h is t o r y r e v e a le d t h a t he had w or ked e t t h e P a g le P it c h e r Le a d Co . fo r a p p r o xim a t e ly 30 y e a r s .
. -/. Vh
e xa m in a t io n r e v e a le d a w e ll d e v e lo p e d , w e ll n o u r is h e d , p o o r ly , o r ie n t e d , 50 vrwir o ld w h it
m a le 7 .1 th some b lu r r in g : o f h i s s p e e ch . P u p ils -were s m a ll end r e a c t e d u o o r ly . E.O.Lh
n or m an . The r e t i n a l fu n d i -were r o t 'w e ll e xa m in e d , b e ca u s e o f ja c k o f c o o p e r a t io n .
How e ver , i t was t h o u gh t t h a t t h e r e vres some edema o f t h e l e f t r o r v e xr it h g r a y in g o f t h e
fu n d i an* some A .Y. n ic k in g . Ther e was a co a r se h o r iz o n t a l n ystagm u s. B .P . 195/ 110.
No le a d l i n e on gum s. N e u r o lo g ic a l e xa m in a t io n n e g a t iv e e x c e p t fo r b i l a t e r a l n la n t a r -
r e v e r s a ls .
" ""
La b o r a t o r y Yo r k :
-
'
Ur s a N, 65 bncm. / , Wassem ar . n and fo ld cu r ve n e g a t i v e .
2 ..U.N . 16 r gm .J.
'"
Ro u t in e In b o r n t o r y s + u d ie s r e ve s le d no a n a -Lu and no s t i r u lin g o f r ^n c e l l s . Ur in e
co n t a in e d album en and num er ous UP C. lu m b ar p u n ct u r e y e id e d ^ c1 e a r , s l i g h t l v --e n o w . U -iid u n d e r i n i t i a l p r e s s u r e o f 140. w it h t t t t P e n d y , P M2C and p r o t e in o f 95 n g. f3.
On 1 -2 1 -4 3 p e t le n t d e ve lo p e d u r in a r y r e t e n t io n and a r e t e n t io n c a t h e t e r w as in s e r t e d .
Ne had b e e n r u n n in g a d a i l y t e m p e r a t u r e e le v a t io n Ve t ween 100 and 1 0 2 , s in c e 1 -2 0 -4 3 .
X-r a y s o f s k u ll on 1 -2 3 -4 3 showed a fe w at-as o f h y p e r o s t o s is in fr o n t a l r e gio n , b u t
wore oth erw ise n e g a t iv e .
'*
P a t ie n t vras t r a n s fe r r e d t o s u r y o iy fo llo w in g n e g a t iv e e x p lo r a t o r y b i - o c c i n i t a l and b i-s u b t e m p o r a l b u r r h o le s u n d e r l o c a l a n e s t h e s ia , B .P . on d a y f o i l owing"-.was 1 4 0 / 9 0 ,
1 -8 6 -4 3 . P a t ie n t n o t e d t o be much w o r s e , d y s p n e ic , v/ it h s l i g h t c y a n o s is , . He r .a a l e s s
d ys p n e io t h a n p r e vi o u s ly w it h s l i g h t s p a s t ic t w it c h in g . T . 1 0 3 .3 * ( r e c t a l ) , u u ls e 132
L'.P . 1 2 0 / 7 0 . lie r o u s e d t o m u t t e r u n i n t e l l i g i b l y when d is t u r b e d .
' **
1 -2 7 -4 3 . P a t i e n t ' s c o n d it io n w as p r o g r e s s iv e ly d o w n h ill and he e xp ir e d a t 3 :3 5 p . 1.
K 0 0 16 8 1a
/ '{/
- fjt'-'fi ."VC- '' it ; 'r -lil
UNIVERSITY O F CINCINNATI
To Doctor Robert Kahoe Ke tte rin g Laboratory
Co lle ge o f -Medisine.
_.r '
From Oocbor Charle s 0 Arin g'
Ile urology Offi c e s
.ru: .
Oir.c in n a ti General H f i l i a l
D ate ' February 36, 1943
Dear Bob,
,
Slid e s o n ^ ^ P have not come through y e t. . 1*11 send a copy o f our
record as soon as i t i s complete , probably i n about a week.
As e ve r,
~ :r;
..a.
H t 0016814
i>i. .
:S>
Hype rife n s i ve e nc e ph a1 opa th y P o s s i b le le a d e n ce p a p h o lo p a th y
3I - :v e a r xo o s ure t o le ad . - Ea g l e
Le a d Company - /ft* * * -
Te o r o p s y 1- 28- 1l5 - - ^ r s . Gib b s , Ev a n s , an d R i t t e r h o f f
An alysis Humbe r
Tis s u e
-
We igh t Gram s
r ;
Mg. Pb Pound
Mg. Pb/ lOQ
It5 A-2 ii5
ii3 A-2li6
Lu n g He art
3 0 .7 : 2 H.3
: :
0.03
o .o o ii
0 .0 9 8 0 .0 17
r00--
Il 3 a -2!<_7 t 'HA-Zk S 7 HA-2 1 l9
lip A- 250
Ji3 A-2 Sl
/l SA-252
Kid n e y Sple e n Liv e r Hrain P e c to r a l Muscle Pan cre as
, ;
;
2 3 .5 32.6 2 7.O
a . 3
28.0
3k*o
; i :
j
0 0
- lM
0 .130 0 .32 0 .20
0.03 '
b
0 .170
O.itOO
1.18 0 .48 0 .25 0.088
J.3 A-2 5 3 ll3 A-2 5 ii
[13A-255
Cla v ic le Rib
; 7 .5 i 75 |
1 . 1^ 1.2 2
; Su p rare n als
3*8 '
O.OOljL
.....
.......... ' . ........... ,v ^_J____________ ____________
15.20
16.25 0 .105
_ _____ ....
K<i 0016815
Sa m p le s Re c e iv e d * l-2 8 -i| _3 Sam ple s Re p o rte d : 2 -2 -l| 3