Document BmOK1Bo4JR2DJLjRDdq5p6xj

October 1, 1936 TO WHOM IT MAY CONCERN* T M s is to state that on or about 7 :3 0 PM, July 3 1, 19 3 6 , Dr. Thomas 13. Lowe, Houston, Texas, c m e into my office, which is located in the Park View Hospital, 7444 Harrisburg Boulevard, Houston, Texas, and introduced himself to me. During the conversa tion, he seemed very much worried over the condition of a Mr. rfio. was o.XO`-tX 40a7fch'JL "?L4* `Sard 206, of the Park View Hospital. He said that he would like for me to examine the patient. EXAMINATION MADS Of OH JULY 31, 1936? HEAD AMD i'SGK; Pupils react slowly to light and were constricted (probably due to morphine -- no v,m merman war;! token). MOUTH5 Dry. TOMGUHs .Extremely dry nu coated, end there was an exfoliation of dernir several days old (there was no lead line nor evidence of clue gun upon deposit of lead beneath the; nsueouss membrane). UAHS? Tympanic membrane normfi. UUwUs Hushsl rigidity of muscles present. THYROID: Normal. iCALPs No evidence of scars; from old. or new scalp injuries was found upon`examination of scalp, that is, no trauma to skull or eranUm. CARDIO--VASCULAR: Heart: Ho murmurs; sounds distant and weak. BLOOD PRESSURE: 135/XQ3 (Taken by Dr. Lowe). ABDCMLii's No abdocxnfil iympuniteo. Tho abdomen was flat, scaphoid. ana more of a starvation type, in contra-distinction to the abdomen seen in plurablsm; that is, in plumoien, you have a distinct tender, colicky type of abdomen, with severe cramping. On palpating the abdomen deeply, of this semi-conscious patient, there was no facial expression of pain. " K 0003599 I*'#?***}., October 1, 1936 Page 2 GENITO-URINAHX : This patient passed only four ounces of urin< during hie twenty hours in the hospital (see Laboratory report). J SKIN, BONES, AND JOINTS: Skin was extremely dry and rough. All the muscles seemed to be in a state of spasticity. I saw no more evidence of wrist drop or ankle drop, th&n would ordinarily be expected in any unconscious patient in such a morbid state. (Both the nurse and Dr. Lowe said that prevlous to my seeing the patient, he had been very nervous and irrational, but sedatives they had given him had apparently overcome this). PATELLA REFLEXES: Normal. PELVIS j Normal. SUMMARY: A very sick patient; in fact, he was approaching death. The following is given with m attempt to draw a clear picture of the patient ac 1 saw him:' (1) Pupils constricted and reacted slowly to light, due either to dehydrated brain or morphine (no taeserman having been taken). (P)Tongue coated, exfoliated, dry, shoring a state of almost complete dehydration which is not found in plumbicm. C3) No evidence of trauma to skull and cranium. (4) Breath fetid, *sweetish" as in acidosis. (5) No lead line on gum. (6) Skin dry, rough, cold, and clammy, as in dehydration. (7) Nuchal rigidity; neck muscles spastic; pseudo-meningitis due to acidosis toxemia. ' (8) No evidence of arterio-sclerosis (as usually seen in chronic plumbism) Blood pressure 135/105 (Taken by Dr. Lowe.). (9) Ho abdominal tympanites (starvation scaphoid abdomen, flat, etc., not distended, cramping, colicky, as in plumbism). (10) Anuria. Only four ounces of 'urine passed during twenty hours in the hospital which is seen in extreme dehydra tion. (in plumbism there is blood in the urine and not such a severe anuria). \.;.W Page 3 `v- (11) Ko stippling of r.ed blood cells. No anemia. Blood count was not above normal as seen in acute plumbism; nor below normal as seen in chronic plumbism; but was .... . perfectly normal. ., : A -. (12) Ho wrist drop, nor article drop. No degeneration of peripheral nerves as in chronic plumbism. (Of course, when all patients become unconscious, there is a relaxa- tlon of most terminal extensor muscles, and & spasticity of their opponents, the flexor group, thereby simulating 8&rop*). .; : . . . ... . (13) A delirium, or psychosis, which Is associated v/ith .. many diseases .as the. finis approaches, -.and which can be explained by the fact that the function of nervous tissues are the first to go in a sever dehydration and starvation of this character. TREATMENT AMD CONCLUSION; I have no criticism of the case, in fact, soma of the treatment was suggested by me in the firm belief that it was a true, tragic, extreme upset of this man3s metabolism, especially his blood chemistry. A catabolism of his tissues, a burning up that, by heroic measures of Sr. Lowe, intravenous Ringer* solu tion and saline to replace fluids, and Glucose to replace foods, failed to atop. Burins the summer months of any year is an extremely warm time of year, and many people are subj ect to a loss of body fluid by perspiration, and also we have noted many case of food poieoning, so-called *summer diarrhea'* at this time of year. An_ acute lead poisoning is more likely to happen in the colder sea sons of the year when there is less likely cause of perspiration of laborers who work in closed rooms. His history reveals that he was not ill in the past ten year, with the exception of a mild case of influenza' three years ago 'HZ' 0003631 ROTH, A C -*r' October 1, 1936 Page 4 ' It has been our experience with lead poisoning that the victims have frequent gastro-intestinal upsets, severe cramping in the abdomen, etc., with a gradual accumulation of a lead line on the gum. '' ' : ' : '' '-" ' It also seems, that If we had conscientiously had the least inclination that this man m s actually suffering from lead poisoning, some antidote such as calcium intravenously or potass ium lodld would have been instigated; but we honestly believed that on July 31, 1936, with e man's life hanging in balance, it to be a severe dehydration of the blood chemistry, and his re serve buffera of his blood were completely exhausted to such an extent that the power of intravenouses could not bring him out of the physical ''hole" into which he had descended. These summarized points point implicitly to a blood chemistry, metabolism upset, with resulting starvation to the vital centers, especially the nervous system, with a resulting death, even though heroic measures were resorted to by Dr. Lowe, and were rendered faithfully all night. In ray candid opinion, I believe the instigating, initial producing etiological factor of this vicious cycle was `'food poisoning. * SIGiSD __ V Sc Tssnr "W m s imo He 0003632