Document Eq9XawDmN5vOa0BmGa9NGna1j
THE INDUSTRIAL COMMISSION OF OHIO
Claim, NO....0B-14593--
Claimant
SPECIALIST'S REPORT
Address --0* Date of Examination..F-bruay...22od*--1938---.---;- ....................Age.... .....................................................
.1.
NOTE:
Submit report under following headings: '(1) History.^(2) Complaints. (3) Examination.'.
including X-ray and laboratory work. (4) 'Discussion.(5) Opinion. Mail THREE copies -'
to the MEDICAL SECTION--Retain one for your file. " ^
ftp P&.'S%a
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..~......................mm
HISTORY
Oe e ^Infc - Loss of appetite* pain in epigaatoim, oocasibn^t^vcaaitliig;'
ter seals* parsis teat constipation* weakness and fatigue* .weakness gs
. .. Of {pUpfN|^h i' | 'C'^Lsciga^i^L^ifi: #S
J
^ 1 .{See previous repdrb Sated April *j20*" 1937 for.onset and^ -
- eadsb1 or illWsss* family history* personal history*$ - % '
-
Present^ Illness * Since last seen has been unable to cork* Has tiled
to work on several occasions for a local coal company but has been..
uofhl^rff0fc
;tAhdaiiibl;` ';d3pde^faj?i.; ..{-dull ache) -- .
0Oi!b|l||pb!i:jpeSi:taiib
l^fth; jbbtflop
in ^ 'vosltua'*
J|atthg!;'lightly#1-' toi^stingi, m'illk betted*' |thab ? ot3|er redds*: Is peak* spending most of .'
|iaejia^hdae-tn bed* the weakness' of f the left arm* previously
complained of* has been gradually disappearing according to patient*
. HstsSi|iM||
lb': :ienf
;::tji! :lbier
, ,.
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- '4T1i^K^*' r* *'
Denies any exposure to lead since cessation of employment ,ln Feb* `
nm :!::;.;
*&
& w ';
PEIBICAI,, mMlHATIOM ' '
` . 'i], SW^
e^;;/
Present condition much same as previously described* .Temperature 98
Pulse 68 * Besp* 22* Blood Pressure 130-60* 2 Eyes* ears*, nose and '
throat not 'remarkable* There is a pigmentation of the buccal muses.,
and the gums* but there1 is no certain lead line* . Some of the pig-., V
mt*-i'*oe,n;n.f..cor'al:b--til1 oe., ni*iii
av. lon>'g- /* thj,e.v-v*upper ,v. r ^.v^.
lefterm.\r,olars may be lead lin,.. e y;iv.y l .-; ;:.r
b, ut
Is :qu@s**;,;
There are no demonstrable abnormalities of heart .or lungs* . There is
tenderness in epigastrium and upper abdomen* There is no muscle V *
spasm* the abdominal muscle being relaxed* The liver and spleen arS-,y
nptl'ps i:pr,ayov ie^.
yy&yi.su *
-rfO;; 'S,-p.?y,* '-j A .y.y. sy.?-1y' :yy.i*^-s,Kf *~st -.4
The loser extremities-are not remarkable and there are no painful
Joints# '
' *
"
V--
' >uv.. .: -V';,^.
The left arm appears to be someateit weak* but without obvious atrophy
fch degree of weakness may be questioned i *e* apparently largely
^
subjective. The sensory disturbance previously described la less
definite*--' -- -----i---1> y,,...."
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N19355
xxxv&uui-ug
aim idutjj.<i.uuy wui n. ^t^.yiJiscubsibn, Ka) opinion. mail 'J.fiKJi;K copies
to the MEDICAL SECTION~-Retain one for your file.
jrswiJav.'e#
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HISTORYy sepsis*-* 1 Complaint.- Losa
$,y\ ]/xW&s br aaDett^I feln riti
eptiap?<sa^ lafliaJsu.'JrJ8-xo.**-s^e=jf o"Vs^^tl'oWi-q1.',P''il^s/4t%"XM-- *vi^g- -a
-meals# '- rareis tentoocatipatlon* weekassslfind fatigue* 7sleekness ~
Of ..left
1 ytT'V.
.f(iSnee` %i p-j- -rj^"enviop---u- *s-r *wyfeXpXWweXr=t*t,bA-aMy"d *a-J^t^efd''* r**A.#*.*p, *ri-*l*-'ditL&y-'*'0W#* VffMJ*'T^^ f,o^. r.:..
ofr n*- rs>' e-^ ,t.-*fA^-uM">*.d-'Av?
-'
" '^-
. -3?r-i
cause of illness* v family history*. gersewtl history!} ' * *--
; * -i .' .. ,''*S''* .f.-> "3v,
** '* - M.-V..*** - ~?if t~/-% -
~ ' ~lS
Preseat Illness -"'Sine lastseen lies been unable to, stork* ."Has tiled *
t1 work. -a several occasions for alocalveeal cosipeijy bub has'b!
enable'to complete a day**wo*fc*j;;AMbwl#il discomfort (dell eehel! f
mllte some distension at .toes# hen eutatia^eS wlHioiit'nelief# 1 * >4^ tonfeliii^iia fc vceslb after meals* jsith a# bloo& &ii my tfam in Yoaitaar Has not bad bfpny^or toffbewg^oaad stools*-1 'Em less bating lightly^* .
toilers ting. i3i$t betts^lt^aalottoer f<xds; rJm
spendirg most of
mm at; base; lb. bed* . Xbe ~m@ikmm' ef tbs' left am* presioasly j - ^
complained of* baa been:gradually disappearing accord lug .to patient*: ^
S^ .b^rno Sfap^ms'^frsbla to geuitoitirinas^r ^ traefc* - or: to ^ lower^ 4 @Mt3S^at`tidS'* or;to bearfe;r tangs*, Bss,,mot--faad,headaches*Z $2*
r.
*"
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m --- *
*
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* . -- -
j^v *
X*J,- v.
-Srt*" ' -* - Jlf
'*
^D0eXn7ie.s; ' a n---y- .ev xposure
t\o
lead
.,
since
.
-
cessation
of
enplo*me. *n>t':' inz Pe' b* '* *
** *? I - -.
- '1' 4 ;yJ.,-n' -
-., - ' : *':* *%
^T^-i - '^.^.fi--*r 'x- T. .
c e- i.OruK-':` -
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2,7. 't ... 4-.-*: * ^ -w< J''..9 -XS'-
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PHYSICAL B3CMIHATI0S
,,r * 0- ;js*iaE;:`V.'':: 'r. "i-5 r-f,:?.
Present condition much sas as'previously.described*. ,Temperature 98
Poise 68' - Hesp..^2* Blood Pr#Sttr 130-*6g **7:Syes`j .'.ears^/uos'and..i '*1-,,.
toroat'not Jr^arkal^La*'^therh ls.;a"pigEienttltm...c^;. t^ Isiccai'asaaiaMi#:
eoad the gams* but there is no eerfcain lead-.line*' . ..Sc k bfith pig-,,...
mentation ding the upper left molar, may be lead line but Is ques* .
fcionable*., -,., .;,
........ ......
, ^. ....,.
llier aro no demons fcrableabtaormalifcies of heart .or lunge*. There la
tenderness in epigastric and upper.:^otae9ii`'' There.is nb 'jmisele' \ '* v
spasm* the abdominal muscle ..being relaxed*:'. The' 11mr .aod. -spleen- a*H.
not palpable* . y
- : - -'
The lower eartremities are not remark&b.le and there .are no painful
joints*-
' v'"-^ - .-' !
;'--/>Hyyy
. -:x"r
The left arm appears to be somewhat weak* but without Obvious atrophy
the degree of weakness say be questioned i*e* epoarently largely
subjeotlvo* Th sensory dlsturbence previously described is less
deflolto*-'"--'--"-"-'-^-----------____..........0^:..,..
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Labrafcm*y Observations
Blood
y7
Eb (Dare) -
Stippling (50 Fields}
w bo
Polymorphs*
Band forms - . 1
Lymphoeyt<;es -:;;
---
MononueLleeiar
Sosinophlles Jasophfles -
2*21-3B
3*220*000
- * TO - '
, 25
frM
3*15-38
- -v;'
*" - -
.
2,980*000:
74
LftbOO
50*M 2,0^ >-p
tiUQf t-
5.05 1.0^ 1.0^
.M. D.
(CONTINUE REPORT ON REVERSE OF SHEET--NOTE INSTRUCTIONS)
KE. 0016550
'
'
r
(CONTINUE REPORT DOWN FROM HERE)
-
bead in milligram* per 100 grams 1b blood
4_ \ - 1 > r
. i Jr-H,
2-21*1938
Q.22 (compared with $*055 one year ag)
- 5-15-195
0.16 - --.J> " ' - ; i-o.
"i '1 'fe
brine Alkaline bo methyl re&;f- Albumin and sugar negative
Mibroscopie * considerable debris and a few pas* ells*
lead in milligrams pfer liber. 1b xtrtn&
. - 2-21-58
0*08; (Compared wlth(Q*26 a jt-20-1
3-15-58 _* /, ..MS?
U*
Fee##:
'lead analysis on feces obtained 3-15*1938
;2jwps>3ts ' o '"- *t-
Xn entire sample l Per gram, of. .aster:
/ >-
* ... #
95 I4 eg*
* c.
V
Plseasslon and Opinion - Oo April 22* 1937 * 3-srge sample- pf,,y.,,,
urine' and a sample- 0? feces mere brought to the laboratory by * s
this patient* these having been collected by bis at heme m our . . *
Ins tractions* ...'Tbs. wine; sample -era analysis yielded 17*35 milligrams
of "leads. or 10*7 milligrams: per, liter* '; The., fecal, sample yielded y*
` milligrams by ac tual weight* ; corresponding to lb*4 milligram:' .per tAy :
gram of ash* These, findlugs 'ere" impossible and'fantastic asaav
expression of lead excretion* One- of thasa sight have bean contaminate
by accident* but the cabined results suggested that th@ samples. hsd
been tampered with by the patient: or: by someone, else* Insufficient
knowledge as to the proper Quantitles of lead to add* inorder
.
siiauXats plujsblgm*'had defeated:the purpose,of"-&*aotand our
'-
attentic' was called to the likelihood 'that, either-' the patient sas^.a
malingerer being assisted by someone* or that someone was fooling
both him and us* Those analytical results became available only aft:
my Initial report had been sent In* A few days la ter Mr * Gas b was...
called In for a talk* but since this talk yielded so infenaation*
and since it was believed that the .blo^d and urine, samples takes, in
the laboratory on April-20fch had given results definitely pointing to
a significant occupational lead exposure* no supplementary report was
made to the Industrial Commission* On Juae 23* the patient returned
voluntarily tp the laboratory* at which"', time additional blood an&T;,.
urine analyses sere, carried oat: as follows:
.
':
-.1:.;:. brine ...... 0,13 mgs*lpad per liter ` \ r*,
Blood .,~\;0*085 wgS2"Iead per 1QQ grams* * '
At this time the patient had the 'same complaints as those previously,
described* ' This fact'and the, further fact. that, the blood and urinar;
lead concentration had '#malnd.e.o high* mm quite, unusual# However
further questioning, elicited little information as to the patient9
activities* and no evidence of nay further opportunities for lead
exposure sine the cessation of his employment as obtained*
u -* '
with Mr* flHMFl&test return for examination and study* it no
becomes all too apparent that the lead content of his blood* urine
and feees have been maintained.at an. inordinately high-level throngs
--^.ieoBe^jsieai*1 which" has: no relation to his .occupation of^a year age* 3
analytical results have been checked and there Is no doubt of their
". .
i ^ aether*- there: Is no -doubt- fch&fc they-Indie.to the
001.6551
---------- **------ fto* clinical
la pal&tt-aaaffi#.
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Ms ease ton and Opinion'
Xiii^yis#l.,,f^r.?t: yyy
urine''and a sa^ia;,'ot' li`ft#8fi" were brought tetha laboratory bjr *'"''" '-p.,^
tails pstteab# these baying boon collected by bis at boss on cur v^;
inn true.Ions* _ ib idrtoe1 sample p analyst yielded, Xf#2%mllltgpmifc
of lead* or 10*7 mtnigrm* per liter, the* ffeeaT stsaple; yielded 1$5
slttigrliab .Ijigr
to 16*4. ailligreaBS jjef^p;
gram cur1
":
ana fantastic m s b '^-T
trcrcsripn f lead excretion. One of ttrs right tevc been o entryInal
by* fiteldwbflr by|;..
so.gges&ed that the sasples;|3||Ml
been tslgblbir
or`by mateone. else. \ InmxCf IclfSlfey-;.
rslinrorer,,belag assisted by 'aoniee^e, nr the*; rfoee-ir rrr feeling **'
both bta anti us. These analytical results bc-oese s'*r.Ilst3c nly after
jr.y initial report ted been seat in* P for* doyr Iptcr Mr* Gcet was. . ,...
cdl?d in for'a talk,'Xmt'since this talk yield*d no IM errartion,
t.nr: r. '.nee It was believed that bhr bio c
urin scooler token, in
tbs 3 - .:bsro tory on April 20th bad 'given rotvO tr i>f iurtcly feinting to
r. significant occupational lead -erporare9 n. ruppl cctntsry report was
r;eic bo the Industrial CcooRisslon. On ifur *-y. ti * patient rotiraed ;
voluntarily to the laboratory, at ^Mch t-i^t cddlhiwnrl blond rad ,,.
vr&eifcMtyjses were, carried' out. as" follows};.'. J, i\\\ .X * ' ;; # *r " *
brio -,. 0.13 sgs^f^S pop titer,.
felted
0*085 gftfX4ed pp^* %Qfp~gF&s&n
'\-
St tbie tine-"the :'te^iept'ted|t^e 'Stesfr}^^Miataf ps" teo#brew:l;oh&ly.
described. This fact and bbp*ibrtb4?! fbfeftbhat the blood and urinary
lead concentration ted. fem&ined.ao hflte, 44? teit. unusual* However
further 'quostloning 'elicit#!! little Iwtes^t^pb^ ''te tbs' patient*
activities, and no evidence"bf any
fpr.Iead"-
sposure since the cesaatfte of Ms espic^ra^tifc was obtained. '* * ' H'.
With Mr.^MiMIII#latest return for esaalnatlon and study. It now becomes all too' apparent that" tterlesd content of Ms blood, urine and - feees tev been aintalnea at an, inordinately high, level; .tocjugb
,sicBia;rjfi@iw white'bte tto ^el^tite'to hlsroetepatle|i9 of-;a.iyea^;ago*i: The
anMytlcai results have"been cheeked'and there lir no-doubt of teelr - accuracy*" Further^- -tbe-re"-4s- no-dotet - that -they-lnd-ica-fce- the-.-receit--^ .lb,take, f latter large quantities of lead^ Moreover the clinical condition f Wm patient, as to:'-syaptc*ss and as, tb other leborefcory eviabnce of leed- ebserptioe ''i'anmia and stippllbbl'haVe-sbown to- . . -r.-n-p: improveaaht over h period trip:a'year, bat in- faetlhav' professed* (Continued on separate sheet)-- ----------- --------------------
.(DO NOT. WRITE. BELOW Tms LINE)
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C:CH-?.:-'I!.03!Ov1- Ck OHIO
COv!33/l3ViiOM
(ONS SIHX WOHX ONIdAX SX1NIXNOO XON OQ)
{continued tmm yellow sheet) It is ooneelvablo that the present lead exposure is due to sons- aoeidcnfcal factor la the pat lent* a environment this is-Mghly improbable hut it will be investigated ns a matter of - sciaatlfl intere-t, There'is no reason, however* to ascribe thia patient's present condition to the effects of bis employ, asat'tppior to February of 1937# ad therefor your -examiner has ;:iap:-h#xittl.on--.ln concluding that there la no justification, for . th#"farther .compensation Of this: claimant* It' may even be dou ted If the original hl-h lend concentrations in blood and urine, which 'were taken as evidence of slgnifleant occupational lead absorption* "iii^'due to' occupattonal fuutora*, --.-It aeema probable ,`Cfroa the Msulti, o'otrir.ed on the large samples of urine and foecs as noted above) that wen at this time some tampering with the patient*a laid intake had occurred*
0016553