Document B5E64ZvmDBDaj32BOxBqzYx5o

W ALTER K . HARTUNC, M . D. Dir e c t o r c f He a l t h .'A M E S E . BAUMAN ASSISTANT DIRECTOR subject : De pa r t m e n t o f He a l t h COLUM BUS June 29, 1935 Ad d r e s s a l l o f f ic ia l Co r r e s po n d e n c e TO THE DIRECTOR OF HEALTH OFFICES! De p a r t m e n t s o f s t a t e b u i l o i n o LABORATORIES: Oh io St a t e Un iv e r s it y Ca m pu s Dr. Robert A. Kehoe, . Laboratory of Applied Physiology, College of Medicine, University of Cincinnati, Cincinnati, Ohio, Dear Dr. Kehoe: May I please ask of you again the favor of critically examining the enclosed form entitled ''Supplementary Evidence in the Diagnosis of Lead Poisoning". We have used this form for the past year in all cases (about 140) where franked lead poi soning was claimed as per the diagnosis made by the patient's physician and reported originally on the regular printed form (also enclosed). This greatly enhanced the evaluating of diagnoses claimed. ' Chiefly, I aminterested in whether you think the time is at hand to modify the last paragraph on the second page which refers to analytical findings of lead in the blood, urine and feces. I have discussed this matter with Mr. Leo F. Ey, Chief of our Division of Laboratories, with the idea of perhaps accepting such reports of lead analyses from certain laboratories in the State. Mr. Ey informs me that his Division has a list of some twenty-five laboratories in the State whose findings are approved, so far as ordinary clinical laboratory reports are concerned, but that certainly a number of these would not be equipped to make the lead determinations required herewith. There is also a group of recognized clinical laboratories in the State, but again their qualifications for work of this character would have to be looked into. It is perfectly obvious that wb cannot accept reports of quantitative or even qualitative: lead findings from unknown labora tory sources, yet it is advisable to encourage such analytical findings wherever they can be trusted. Tie have also to bear in mind that too much importance must not be attached to laboratory findings alone as is, of course, the case with clinical medicine in general, and so it will probably be 'well to Include a cautionary statement embodying this idea. Your reply will be greatly appreciated. We intend to make up our revamped form for cases reported after July 1st. M^rs sincerely, N 5980 Emery Ci Hayhurst ,^G.D., Chief, Division of Hygiene, OHIO DEPARTMENT OF HEALTH D ivision of Hygiene Bureau of Occupational Diseases Columbus, Ohio Supplementary Evidence in the Diagnosis of Lead Poisoning Patient*s Nam Physician' s, Hame Address Address Has t h is patient had previous attacks of load poisoning? date(s). What wero tho onset symptoms in the present attack? Give approximate Was d is a b ility such that work was stopped? I f so , when? Chock or Comment on the Following Items I . Objective Findings ( l . e . , tho physician*s observations) Pallor (esp ecia lly circumoral) Blue lin e in gum(s)* Stippling* (basophilia of rod c o lls ) Polychromatophilia R oticu locytosis* Mononucleosis R.B.C. count(s) W.B.C. count(s) Hemoglobin % Recent rotrograde blood changes? Blood prossuro findings Pulse (at rost) Tooth, gums (condition of) Hand-gripping powor (condition o f): R, L. Wrist extonsors (any aotual w rist drop?): R. Tremor Incoordination L. Ataxia Reflexes: Patellar Ocular Vision: R. L. Recent disturbances Hoaring:R. L. Recent disturbances Mental disturbances M alnutrition Emaciation Promature agoing Gouty signs Evidonco of nephritis Skin (aono, e t c .) Woight variations Othor objoctive findings of note N 5980.01 *nBluo lin o in gum(s)", "stippling" and nr eticu lo cy to si3 n occur in Load Absorption, but, with or without these-, I t roquiros sig n ific a n t abnormalities in various ones o f tho othor Ob.iootivo and Subjective findings lis t e d to sustain a diagnosis of 2 I I . u^ec^ive^Pi_nding (i^e^_,_the_paLtj1en tts .complaints) Morning anorexia Motallic (or sweot) taste Nausea or vomiting D istress in abdomon Obstinate constipation Abdominal c o lio attacks ; Headache Insomnia Weakness (hand g r ip s; use of w rists le g s , f e e t , e t c .) Genorol weakness Syncopal attacks Rheumatic pains Muscle cramps Disturbed v isio n : R. L. Dizzinoss Doafnoss: R. ' L. Woight: Normal At present Mental depression Any furthor commont: ' Physician's Signature Date Tho diagnosis of Lead Poisoning involves evidence o f (1) oxposuro to load or i t s compoundsj (2) objective signs o f blood changos, o f norvous involvements and usually n u trition al disturbances ; and (3) tho prosonco of a number of the sub- jo ctiv e phenomena above lis t o d . To be occupational, in d u strial exposure must bo established. . Stip plin g (a lso r o tic u lo cy to sis and polychromatophilia) indicate that lead absorption is going on at tho tim e. Tho number o f stippled c o lls found increasos as absorption progresses and is a rough measure of the amount of exposure. Hence workers showing stip p lin g without other evidences should have blood examinations mado frequently. Stip plin g w ith other evidencos (see above l i s t of objective and subjoctivo findings) constitutes acute lead poisoning, but acute lead poisoning occasionally e x is ts without stip p lin g (here r o ticu lo cy to sis is invariably prominent and the rod c e lls should always bo examined for this' con d ition ). When the con d itio n bocomos chronic, stip p lin g usually dim inishes, but i s rarely absent as long os exposure continues or acute c lin ic a l signs p rev a il, while anemia is invariably present, usually also with polychromatophilia. Reports o f a n alytical findings of load in the blood, urine and feces are of doubtful value since accuracy of te stin g methods, metabolic disturbing factors at the times of t e s t s (whioh must be made over days and preferably weeks)* and u l t i mate sign ifican ce of t e s t s in view of the findings of ''normal" lead in perhaps equivalent amounts, a ll confuse the p ictu re. OHIOJDEPARTMENT OF HEALTH CERTIFICATE OF INDUSTRIAL OR OCCUPATIONAL DISEASE N A M E O F P A T I E N T ....................................................................................................... ........................ 0HQO SB OS H< Uo H W OPO O 'Sn b u, o < W sU s3 Oh w< M HH Xftf cf/l3) aWMH Ji. h o am 1 Ma a Eh SOgw>*JwOdS-* la 3s>aMa< <a uo ga<o 23QM Soa 4aV-* w Oh a ca, .I0 EMh SU >> ti S t> M m a A D D R E S S : S tre e t and N o...................................................... ........... .......C ity or V illage............................................. PERSONAL AND STA TISTICA L PARTICULARS Sex Age Color Country of Birth M EDICAL C ER TIFIC A TE OF DISEASE D iagnosis ................... .................... S ingle, divor cme da r r(iwe dri,tewthideowwoerdd) o r O C C U P A T IO N C hief sym ptom s and conditions.. (a) T rade, occupation or work (in which disease was ac quired).............. :................... ........................................... -............ Particular kind of work in such trade, etc...................................... D ate first symptoms appeared.......................................... C om plicating D iseases (sucii as alcoholism, syphil Date of entering this occupation............................... Employer's name.......................................................... Address..,.................................................................... Employer's business (goods made or work done). culosis, etc.)...................................................................... W hat substance(s) or condition(s) in your opinion ca affliction?.......................................................................... (b) Previous occupations: Name of occupations Entered (year) Left (year) D uration (actual, estimated). (Check which) A dditional fac ts....................... Date of diagnosis..................................................... ........... ( S ig n e d ) ................................................................................ ......................... . 193...... (Address)..................................... Ind. H y . 3-- 15M-- 11-34. Mail to STA T E D IR E C T O R O F H E A L T H , Columbus. For In See O OHIO DEPARTMENT OF HEALTH COLUMBUS INSTRUCTIONS FOR FILLIN G OUT CER TIFIC A TE P resen t O ccupation. Precise statement of occupation is very important so that the relative healthiulness oi various pursuits may be known. It (for example, branch of the tirspardnienectee(ras)ssarhayanndtodakclnosoomwptohbseiottohpragoretrinceluirnlaaolrtytrpkaeidneodpoeorrfaotocwrc.uo)prkatioonr Date of entering this occupation is important to determine how long the worker may have been exposed to the hazard before contract ing the disease. . Employees name, address and business are necessary to as certain distribution of occupational diseases by industries, many trades (e. g., machinists) being common to different industries. P rev io u s O ccupations need to be known, if possible, because present illness may be due to a former rather than present occu pation. Give simply the name of each distinct occupation which the patient may have followed, with the year he entered he left. Pre present vious I disease, llne or sse to sa. nyThoitsherrefedrisseaesiet,hedr ueto tporevoicoc that is required is the name of each such disease or ill year in which it occurred. M edical Certificate. Only two of the items spec require any explanation. In making these reports it to as consider the possible causes of the disease. influence For this orfeafsaocntoarsnyotchoemr pltihcaa should be noted, such, for example, as alcoholism or sy nection with arteriosclerosis in cases of lead or other ing. The possible effect of other factors, such as poor hy tions in the home, or and when discoverable oshthoeurldpebresonnoatledcounndditeironasd, dmitiuosntalb AN ACT--To Require the Reporting of Occupational Diseases--(As amended February 4, Beit enactedby the General Assembly of the State of Ohio: R eport of Se c t io n ^1243-1, Every physician in this state attending on or called in to visit a patient whom he believes to occupational diseases by physicians from poisoning from lead, phosphorus, arsenic, brass, wood alcohol, mercury or their compounds, or from anth compressed air illness and such other occupational diseases and ailments as the state department of health shall require to shall within forty-eight hours front the time of first attending such patient send to the state commissioner of health a re W hen and to whom to be made (a) Name, address and occupation, of patient. (b) Name, address and business of employer. (c) Nature of disease. (d) Such other information as may be reasonably required by the state department o . The reports herein required shall be made on, or in conformity with, the standard schedule blanks hereinafter The mailing of the report, within the time required, in a stamped envelope addressed to the office of the state commission shall be a compliance with this section. B lanks fo r re p o rt Se c t io n 1243-2. The state department of health shall prepare and furnish, free of cost, to the physicians inc preceding section, standard schedule blanks for the reports required under this act. The form and contents of such bl determined by the state department of health, Such reports n o t evidence _ .Se c t io n 1243-3. Reports made under this act shall not be evidence of the facts therein stated in any action arisin disease therein reported. Copy of re p o rt to be transm itted to proper official P e n a lty Se c t io n 1243-4. It shall furthermore be the duty of the state department of health to transmit a copy of all su occupational disease to the proper official having charge of . factory inspection. Se c t io n 1243-5. Whoever being a physician, practicing in the state of Ohio,, neglects or refuses to make and transm commissioner of health any report provided for in section 1243-1 of the General Code shall be fined not to exceed one hu or imprisoned for not to exceed ninety days, or both, but no person shall be imprisoned under this section for a first of prosecution shall always be as and for a first offense unless the affidavit upon which the prosecution is instituted contains that the offense is a second or repeated offense. N O TE--In addition to the diseases or disabilities provided for in Section 1243-1 of the above law, the regulations Public Health Council result of the nature of on the February person's e2m7p, lo19y2m0e, nptr,oivnicdleudiinngRtehgeulfaotilloonw2ingfodristehaesersepoorrtdiinsgaboilfiti"easnaynddisneoatseexocrluddiisnagbiolitthyercso: Anilin poisoning Benzine (gasoline) poisoning Benzol poisoning Bisulphide of carbon poisoning Carbon monoxide poisoning Dinilrobenzene poisoning Naptha poisoning Natural gas poiso Turpentine poisonin N O TE--A schedule of occupational diseases compensable in Ohio, will be sent upon request to the State Directo Columbus, Ohio.