Document DMyRZRppQBv5BJwOax9Ow88jQ

COPY w as a P a 't i e r r t a t t h e Mayo C l i n i c O c t o b e r t e n t h t o fo u ^ e e ^ n ^ o P N o v e m b e r 1932, August t w e n t y - fir st to O ctober t w e l f t h , 1 9 3 3 , Ja n u a r y se c o n d t o A p r i l t w e l f t h , 1 9 3 4 , May 7 t h t o A u gu st t h i r t i e t h , 1934, Ju n e n in t h and t e n t h , 1935. The, d i a g n o s i s i n h i s c a s e w as p r o l i f e r a t i v e , o c c l u s i v e i n t i m i t i s o f the'; sm a ll a r t e r i e s and v e i n s, and t h e sa ph en ou s v e in s o f b o t h l e g s , r e cu r r e n t n e c r o t ic u lc e r s, and e xt e n siv e d egen er at ion of the n erves o f b o t h l e g s , an d l i v e d o r e t i c u l a r i s o f a l l f o u r e x t r e m i t i e s and t h e low er abdomen. He gav e a h i s t o r y o f h av in g h ad , i n 1 9 2 8 , a c u t e l e a d p o i so n i n g w it h a l e f t drop fo o t . At th e time of h is exam in ation a t the C lin ic , t h e r e was no evid en ce o f t u b e r c u l o si s o r s y p h i l i s , 3 a so p h il i c 3 t i p p l i n g o f t h e e r y t h r o c y t e s was n o t e d on two o c c a s i o n s . U r i n a n a l y s i s was n e g a t i v e f o r l e a d . Mr . r e c e i v e d a l a r g e amoun t o f t r e a t m e n t , i n c l u d i n g bi.laTeTSTTTn Sb ar sy m p a t h e t i c ga n glio n e c t o m y , and b i l a t e r a l c e r v i c o t h o fa c ic sym pat h et ic gan glion ect om y and ge n e r al m ed ical and lo c a l treatm en t. On Ju n e t w e n t y - e i g h t h , 1 9 3 4 , i t w as n e c e s s a r y t o a m p u t a t e t h e l e f t leg, below the knee because of ext en sive, p a in fu l, n on -h ealin g u lce r s. P a t h o lo gic a l st u d ie s of t h is le g r ev ealed a marked degree of degen era t io n o f the n er ves an d p at ch y o c c lu sio n o f th e sm all a r t e r i e s and v e in s by in t im al p r o l ife r a t io n . The cau se of t h e se l e sio n s was n ev er determ in ed a b so lu t e ly , bu t i t i s qu ite p o ssib le t h at they were due to lead poison in g. At th e time of Mr. l a s t e xa m in a t io n , Ju n e n in t h t o t e n t h , 1935, th ere m ^ u T u p I T T l f o e r 3 of th e r igh t le g with severe p ain . Becau se Mr. was t o t a l l y d isa b le d and the t en den cy of t h e u l c e r s to r e c u ^ m ^ s p i t e o f t r e at m e n t , an am p u t at ion o f t h i s l e g was ad v ise d . iv.HK Sign ed N. W. P a r k e r , M.D. K 0016883