Document K6nmdRMEMbRyxogGj2rw8J01o

:>`4'a ^Du'Font 'C a s e s T HON H N24431 K&- 0020849 Clj_l_o__b__c_f_lt ^ Tc rnlckc mc h h ia t i. "TUFTEAR" FOLDER T O RE-ORDER SPECIFY No. 2VA FOLDER MADE INO/ S.A. 4R2 Mr. Mathias H. Heck 815 U. B. Building Dayton, Ohio Dear Mr. Heck: As the resul interview on the afternoon of July 1st, I herewith a statement on the case of so far as the f a c t s a g ^ n o w n to me .^S^^ have not seen Mr. several year no direct knowledg^ofhis present condit the results of Dr. Fischbein's examinatio adequate to establish the facts in that r therefore I have no hesitation in express I trust that will cover your requirements. Very RAK:is Rober 0020830 the relationship of his present condition to entirely clear, end it appears that a statem beneficial in clarifying certain aspects of much as I, as plant physician, was responsib care of Mr. during his employment and of his illness Sr. was employed by Ethyl Gasol in its Dayton, Ohio,plant for blending Ethyl 1 y2I4. At this time the hazards in the handl had been explored in at least a preliminary and safeguards had been devised for the purp workmen to avoid serious lead exposure. As not anticipated that cases of lead poisoning in fact nothing more serious than minor or d noted in workmen during this period. Mr. Si ployed during a previous period when conditi been inadequately controlled and there was n that he had ever been seriously exposed to l he became ill and was seen by me on March 11 appeared to me to be a typical case of influ occurring with somewhat les3 than epidemic p him home (after an examination) to be cared physician, with no apprehension as to any to lead. 0020851 him in the afternoon and from the clinical p and from my belief that his lead exposure ha enough to produce lead encephalopathy, I con dealing with a post-influenzal encephalitis. other physicians, who since have discarded c relationship of influenza to^^jjjjj^cerebr had the benefit of seeing the onset and char nor do they know anything about the plant co worked. They make the unwarrante had a serious and obviously dangerous on that basis arrive at a conclusion by much of reasoning.) Despite my tentative opinion the case, I considered it wise to hospitaliz him tinder observation, and to Instigate trea that his condition was due to the absorption Facilities for making a prompt differential available then as now, and, in my opinion, t on the theory that If lead were a factor^ fai patient mighi result fatally. Accordingly treatment in a private hospital, where he re so noisy and uncontrollable as to necessitat Dayton State Hospital, at which time he went that his conditions would not be understood might not be carried out, I followed him to K 0020852 by the admission diagnosis of tetraethyl le less of such confirmation as their subseque have provided. The patient's subsequent course Is a and requires no additional information from The experience of the past fifteen years, potential dangers in the handling of tetrae the course and sequellae of tetraethyl lead light on this case, and should be of value of the present status of By re it now seems much more assured than it was acute illness was the result of ab lead and certain of its decomposition produ contribute to that opinion, which, unfortun to proof. First, despite the fact that no other among which Mr. worked became ill as EE 0020853 absorption, (all other cases reported from earlier period when the conditions were adm knows that certain opportunities for exposu potentially which would be considered^dangerous now. T have had greater exposure than I believed a illness. Second, the time of the onset of the Third, two cases of a schizophrenic t tetraethyl lead intoxication, in associatio of behavior tendencies in this direction, ha ability of this intoxication to intensify s least temporarily. Recovery occurred in bo indeed it may be said that no permanent seq seen in relation to tetraethyl lead intoxica hand air. Sibole had definite stigmata of me my acquaintance with him, and the developme might be regarded as the sequel of an acute cation, emphasized by the shock of commitme Institution for the insane as well as subse from family, friends and acquaintances. Thi compensation neurosis but for the fact that continued some time ago, and the further fa mental condition of mental deterioration, a of the recent (May 2 7 19^0) examination of would appear to be too serious to fit in th There is, of course, some doubt as to of tetraethyl lead absorption in this case, that the present mantel status of Mr. Sibole on some other stimulus, or perhaps without Be this as it may, his present condition de 0020854 with the results of Dr. Fischbein*s examina Mr.j j d U ^ d i s a b i l l ty is permanent and th regarded a3 the result of the acute intoxic suffered in 1925 not In the sense that tha organic disease of the brain with permanent the intoxication was the stimulus which bro mental state and contributed to its establi havior pattern. Rob H 0020855 poration since December, 1924. History taken closed no significant previous illness. His showed no indications of any absorption of le substances. Physical examination showed only Tonsils are large, rough and anteri Small amount of liquid puss could be expresse Teeth showed a moderate pyorrhea with some re purulent pockets. Chest rather poorly develo could be found in either the lungs or the hear there were no abnormalities found on examinat urine. During the time of his employment n occurred. In February he developed a common about two weeks leaving him in a somewhat sub time his temperature and blood pressure were morning hours but no other signs of illness w off from work for several days and returned i On March 17th he reported with a very severe and a temperature of 99-4/5. He complained ness and intense weakness. He was sent home under the care of other physicians. His cond improving until Saturday, March 28th when it . he was delirious. when seen by me Saturday afternoon follows; He was lying in bed apparently in a He was unable to recognize anyone but his wif irrationally at times, and refused all medica dition at this time resembled rather striking encephalitis but the description of his previ family and the physician together with afebri condition suggested tetraethyl lead intoxicat that he had been delirious, apparently fearfu disturbing dreams and otherwise running amuck, had felt it necessary the night before- to qui tered morphine, 1/2 grain in one dose. This hypnotics had failed entirely to quiet him at appear that his later stuporous condition was the morphine. With presumable diagnosis of a secon superimposed upon a convalescent acute infect instituted for the clearing up of the mental nation of lead. Inasmuch as no medication co a solution of sodium carbonate and sodium chl Solution) was instilled per rectum. This was About two hours later the patient became rati fused state developed into an acute mania at a morning. He was restrained and about 800 c.c. administered intravenously, The administratio hour and a quarter at the end of which time he and for brief intervals of time appeared ratio a somewhat confused state. After a few hours again developed into an extremely noisy, talka condition. He appeared to be on the point of and 2% magnesium sulphate was administered int quieted at once and broke into a profuse persp condition he was moved to the Dayton State Hos In view of the experience which has cases up to the present, it seems worth while things which have been observed. In the first of acute mania of this type only one has survi died of exhaustion in the course of acute mana the common hypnotics have been used and have p disadvantage rather than and advantage. xhey the manaical symptoms and in fact they appear This with one notable exception. One case was with apomorphine; whether by accident or not t sleep which lasted for 17 hours from which he mental state, a week later he developed anoth which was controlled in the same fashion. ^ I have been fearful of the use of hy that it seems to me that by their very nature the severity of a condition brought about by as lead. It has been experimentally shown in in the fatal cases that an edema of the brain It has seemed advisable to me to make an attem and thus if possible to bring back the normal addition to that magnesium sulphate is known t nervous system aepressent and I have used it f its strong dehydrating powers. The success wi has been met in the case of this man would app use. In our milder cases I have found it q salts and alkalies by mouth. We have demonstr that by this means the excretion of lead from increased. In bringing about this result I ha mixture: sodium bicarbonate - 4 parts, magnesi and calcium carbonate - one part. This is adm about 20 grams daily. The quantity being dete necessary to obtain and maintain a slight alka KK 0020857 This course of treatment has been so satisfac worth while to make note of it. The above suggestions as to the the as a presumption but merely as a statement of which you may or may not be interested in purs (Signed) Robt Robert Medical ETHYL GA K 0020858 DIAGNOSIS: 12* Psychosis ?iith other infections (influenza poisoning may have be ADMITTED: March 1, 1925* First Admi MEDICAL CERTIFICATE: "Use of foul end profane language medicine or remain in bed without rest is a bird or pet animal; again a giant seed; asks to be allowed to gat out o soar and sing. Struggles, spits and c FAMILY HISTORY: Father and mother are both livin age end getting feeble. Mother has pa and father has a rupture; is about SO maiden name was Boyer; is of Scotch a in Ohio, Father was b o m in Feat Virgi thers and four sisters. One sister, five years ago at the age of 45 years, health* One brother, Phil, was also Corporation and the patient *s wife st trouble as the pitient and had to give absent-mindedness and delusions of kn hearing voices. This brother is 34 y brothers, are in pod health, . -` LO PERSONAL HISTORY:. CO o Commitment papers.give the patie C\i o o the patient declares that he was born Ho states he was never In very good h rheumatism from the age of 10 upward. age of 7 years and continued until 17 6th grade. He claims that he did not ill on account of Inability to l e a m but and attended Irregularly, Puberty at He was married In 1918 end went stove factory then came to Springfiel the farm for about two years, going f and Mills concern running a press and lie states that he has always been tro always had to talas something, usually PRBS3HT ILLHSSS: 03 started to 'Borir at the Ethyl G Christmas time and in February he as vtitli a severe headache,temporal. Be s him that he had the influenza with the lie was out of his head and that his en He soys that his wife and two of his c ions time, his mother-in-lan taking co taking tliair temperature one time and ;n*r ocitixnlfXfTTiC?, On admission the patient talked a He sold his food was poisoned and comp gled, spot and cursed so that it was n 113 was disoriented in all spheres but C- at this time, however he is inclined t sive, morose and melancholy. Memory for past end present event poor. General grasp is poor. PHYSICAL SAMIHATIOK: General Appearances Patient is a tall slender moderately stooped; sligh fine, fairly oily. Supra Eyes brows are heavyr eye Eyesi Set slightly obliquej^bs?ow spotE on the skin under t Fares Regular, normal in size an fine scar on ear drum. B e Scar of left mastoid opera Rose: Regular; tip slightly thic ened, deviatedto the left. side enlarged. Subacute r Heck: Shows uniform enlargement Teeth: In good condition; slight Tonsils: S2ioll, apparently negat Throat: Negative. . Chest: Shoulders stooped. Pract thin, soft and fairly oily hollow anteriorly. Atroph over antei*ior ppper portio notches obliterated. Veno anterior portion of chest. H 0020860 PHYSICAL HXAMIXiATIOR: (Continued) loft trapezius markedly inc increased* Right sLadder s than left* Right scapula m slightly ringed* Superfici noted on hack* Rhomboid mu Lungs: Vocal fremitus increased on to the 4th dorsal# Heart: formal in size and position ated. Ho murmurs hoard. ,'bdomen: rWalls flaccid; fairly we touch. Liver normal in siz G. U.: History of gonorrhea with s ' 25 years. Extremities: negative. UROLOGICAL EXAMBiATIOK* Upper reflexes normal. Pupils react to light end accommoda Ankle clonus negative, Bcbinski and Oppenheim negative, lines kicks equal, exaggerated. DIAGNOSIS: 12. Psychosis with other so infectious (influenza) Posi pcSsonging say have been a fa BflOLOSf: Influenza; possibly tetra Eth PROGNOSIS: Good for partial recovery. TREATMENT: Refei&Sto Dr* Marfchens and D McClellan* . BOTES: March SO, 1925. gr. Luminol; Forced to drink milk and water. Dr. Mar March 30, 1925, Given morphine sulphate sulphate, saturated solution 1 gram ever April 1, 1925. Patient given sodium hyp venously twice daily; sodium hypophospha water three times daily; tincture digital daily* K S 0020861 *XHt"vVi?.rJTUV-*w Wr *.-i*i.lT'iTvTUT^^4rUs* April 7, 1925* Sodium hypophosnhite int April 9, 1925# Syrup iodide of iron one meel. April 15, 1925* Discontinued digitalis* April 15, 1925. Boric irrigation three five drops of iodised glycerine to eye* April 13, 1925. Discontinued Spsoa salt Regular diet. Permit-patient to get up. /< 0 0 2 0 8 6 2 BI/.3iI0SXSi 12 Psychosis with other soma feslons (influenza) Possibly meg have been a factor* FIIiST EF^SSETASLOS* June 23, 1925. , COir/jSRSATIOH* Dr. KBeggs and P a t ie n t . q. Hello*J&rold, how are you today? iAd* Pretty good. You have got this fi room* isaren*t you'? . a. Yes* si* "bald you like to go to A Eq , I tel like if I could get hom Are you worried again or yeti r Yet. 3* Hob loag have you been in the hosp I don*t remember now* I c a n H tel head altogether. But y osfare in. fair condition n o m Yes* ci* bhat mskss you think soi A* I Snow that X am doing now. "" r\ that else do you "ant to do? A* thinl that if I could go home I 3* Are yes: sleeping well now* A* Sleep ne. How abaat those dreams r f- They d m ft bother me very much. Q. Bo you hear voices yeti A. Once ia a while* ^ Q* Gan yes. make out That they say?- ' A. Ko. : .. Q* Do you recognize the voices? A. Ko* I san't say that I do but they voice sometimes. Q. Bo you think you have enemies? A. Ho* I cannot think that I have but alL tin time. ^ Q. Fhat you afraid of? A. Seems that X am. afraid that somebo Q. Yst yea think that you can go home realize now that no one is trying just par imagination? Or do you A. Yell* It might be. A In other-"-'words* you are open to c that smebody might want to kill A. Yes* 'ten. I am out in the open aw fusion it is not like that. There C GI-AfI2BSAT1021 COSTIIiUHDi there that I can not kap&my mind s would he better. Just the little t seemed to help me* I think that i he a whole lot better off. q. How old are you? A. Thirty-one. Q.' What year were you b o m ? A* *94. ' q. Have you lied a birthday lately? A. March last. q.. Are you right sure of that? A. nether I had a birthday? q. Ho whether you were born in 194? born iri *95. A. Well, I have a record at home, q* Do you remember what year you were A, Eo, I don't, I cannot remember tha q, How old is your oldest boy? A .- About school age. q. Don't you really know hor; old he i A. X can not tell you. X hav3 forgot have been sick. It seems like ii I heve been sick, longer than it r things are mixed up so much. 0.= Don't you feel that you ought to g tened out before you go home? A. X don't believe that I ever will g Q.- Don't you even remember what year- A* My wife can remember that* Lots o q. X think it would be vise for you t A. That is up to you people. I can't m s 'here#. , " --v q. If wo keep you'here it will only b necessary. . A* I am sure I would be 100% better i . How will I get away from here? Wi or something? Will somebody have Q. Your wife can take you out of here A. Whet if they don't want me out? q. The Dayton State Hospital are the anything to say about whether you q. There is such a eonglsmeration abo Q. There is nothing wrong about your , or are being paid. , A. That is what beats me* It seems I stock on every hard. XF 0020864  Q CJ SjOWERSATIOU C OliTIiiUEDs Q. You have really improved wonderful lbs* Yea# I feel better but I feel tha for something, some interest, X w a. Well, you leave that entirely up out as soon as you are able. That do you think about me going vo* X think it might be all right* Y d i d n H you? Yes, sir. Tell, thank you very much, we wil Do you think I can go home Sunday? Yes, on a visit, & S2y wife seemed to think I night g days and if I proved satisfactory Well you wait until t*3 see here a know* You are getting along fine k, BEGGrSt Suggest that the diagnosis be history of influenza and also a history thyl gas. Treatment as above outlined w to elimination. Also suggest referring t man for nasal condition* Suggest complet 24 hour specimen* if urine contains album urinalysis at intervals of at least every K 0020865 OKVSRS \?10?; C CRT IK03D Q# Do you rsmember when you came to this h A. So. Q. How are you now in comparison with a mo A, I can not 3av as to that. Dr. ?Teno.t c a hit. If I could get home I think I w Q. How many children do you have? A. Three. Q* Eo y o u have any periods when you are at you are or what you are doing? A. I was rood all day. Q. What do you dream about? A. I think someth is going to kill no all day long. Can't I go homo now? My wif still there, Q. he will see about it. -?e want you to g not too quick. A. I would like to get my reItemse written me to death to stay here. Q. Are you hearing anv voices at night? A. Sell, when I can't sleep very well I do Q. Can you hear what they say? A. No. 0. Do you recognize the voiaes? A. Hell, raw brothefs seems to be the most has his voice. I hear the voices of wo straightened out or whether my meals ar a fool out of me up there. My wife does way I have it doped out. Q. 'tell things will be all taken care of. DR. -MCCLELLAN: Suggest that a complete history together with physical findings b'presented One in so far as this case was treated as a secondar medical consultant of the Ethyl Gas Corporation Hospital and that in sofar as we have had numero tion oecuriing in this particular corporation th sideration in arriving at a diagnois as to the bearing such diagnosis vrill have on the conpcnsi t?ais olaim, and in all fairness to the patient w believe that care should be given to ascertain a doas ntrb come under 12. Psychosis with other s Ethyl Gas autointoxication IMPRESSION:2* 15; Manic Dspresslvfe Psycho FIRST PRESENTA.ns June 16, 1925. COHVESSATICM: Sr. McClellan and Patient. Q. Hello, Harold sit right down. How are yo the hospital now? A. I ,iust don't know* v C. Tell me abeat how long? A. I cane here in March. Q. Why did yoai.some here? A. I don't knew, I was out of ray head. Q. Ever have m attack: like that before? -V. EQ. Q. Have you srer been in a hospital before? A. Springfield Hospital* Q. What were gou in. there Bor? .A. Mastoid. Q. IIow long aso? A. I don't knas Q. About how old 7/ere ySu? A, I cannot Jast remember how old. About 13 Q. How old are veu now? A. Thirty. Q. Have you fed a birthday since 7/ou came int A. Marsh 4th. I don't know how long I have b ray head* % mind wanders in oeriods but I outside* 1 went out to see my folks and 1 will tell you that. Q. What do yoa think is the cause of you gett A. Well.I dcsi't know. Ethyl gas|is all that Q. Did it ever bother you before? A. I never worked with it before. Q. How long fed you worked at the. general Moto A. I could not say. It is no use for me to m can tell y better than X can. About thr Q. Vihat is yarn? bosses name? A. Arthur S.-- ----- -- 0 . Did you first become sick while working at home ? . A. They sent we home. ' Q. You must has beoome siokat the plant then the plant? A. Dr. Keyhole. Q. Do you remember going to Dr. Hatcher's hos ft* Ho, I don't remember that.