Document L20DrKd4rrNk52Ep2bKERrpz

September 19, 1945 Dr. Joseph J . Hoto B aton Rouge L o u isia n a -/'.' Dear D octor-lo to ?. '. T his i s my r e p o r t on whom I saw at- th e E ato n Rouge O en aral H o sp ital a t your re q u e s t on September 18, 1945. T his p a t i e n t fo rm e rly had been employed b y th e DuPont Company and w h ile w orking became i l l w ith a number o f o th e r workmen, o s te n s ib ly from o rg an ic lead poison in g . He was a d m itte d t o th e B aton Rouge General H o s p ita l on F e b ru a ry 3, 1345, and d u rin g w h ich tim e he h as bean u n d er your e a r s . I understand th a t a t the tim e o f h is adm ission he had .58 and .63 m illig ram s o f o rg an ic lead i n h is u rin e* I n .a d d itio n , be had .0 5 and .065 m illig ram s o f o rg an ic le a d in h is b lo o d . These two t e s t s w are made over a p p ro x im a te ly th re e weeks p e rio d o f tim e ,; and th e p o in t i s t h a t ha- gave e v id e n c e o f lo a d p o is o n in g from th e s e r e s p e c t i v e t e s t s . A t th e tim e o f h is ad m issio n he had a two p lu s s p in a l-W a s se ra a n n , b u t i t was deemed in a d v is a b le to g iv e h i s tre a tm e n t f o r h is loos w ith th e lik e lih o o d of crow ding h i s w ith heavy m e tals and th u s producing an added f a c t o r . A t th e tim e he c a s e in th e h o s p i t a l he was w a lk in g , b u t th e r e 'was i n s e c u r i t y i n h is g a it and i t was obvious th a t th is in c o o rd in a tio n had a ra th e r dram atis o n set. His c o n d itio n became such t h a t , a f t e r a s e r ie s of p sy ch o tic e p iso d e s, i t was nec e s s a r y t h a t he be g iv en s p e c ia l c a r e , a n u rs e , and two a tte n d a n ts to p re v e n t him from ru n n in g gway* Over t h i s p e rio d o f tim e h is b e h a v io r M a tu r e has co n tin u e d to remain p sy ch o tic. . I saw him oh-Septem ber 16, 1945, and found him ly in g in bed r a th e r q u ie t, smoking r a t h e r i ncessant l y* Ho o b v io u s ly was somewhat s u s p i c io u s , cti g u a rd , and it- was n o t easy fo r him to re v e a l t > t h e o o n ten t o f h is thoughts* However, I was s a tis f ie d t hat a t tim es ho had a u d ito r y h a l lu c in a tio n s and t h a t i n th e p a s t he rad had v i s u a l h a llu c in a tio n s * He had c e r t a i n id e a s t h a t he was ch arg ed -w ith e l e c t r i c i t y w hich cam from under th e - h o s p i ta l b a d | t h a t people wore ta lk in g a b o u t him on th e o u ts id e j and t h a t he was i n com m unication w ith th e L o rd , w ith a te n d e n c y tow ard b s H a v in g in " s p e c i a l .missions**' The h i s t o r y was t h a t bo became b e l l i g e r e n t a t tim e s , aid w ith th e se open o u tb u rs ts o f h o s t i l i t y i t was n e c e ss a ry t o r e s t r a i n him p h y s ic a lly and ' sedate him. 1 did n o t fin d any d elu sio n s to th e p o in t of fe a rin g d eath , but th a t "people wars ta lk in g about him ," and th a t "he cannot leave th e h o s p ita l, because i f he d id th e re would be no ch arg es of. e l e c t r i c i t y to keep him a l i v e ." H is s e n s e r in a , s u r p r i s i n g l y , "was c l e a r , w ith th e e x c e p tio n o f th e day o f th e month. Jacksok, H eoeevelt Pag* -, . - ~ . 'v' w hich hs m issed by about fo u r days His ju d g se n t was poor and, h is in s ig h t p a th -' ologie& l. '. : On n e u r o lo g ic a l e x a m in a tio n one found a r a t h e r w e ll d e v e lo p e d , w e ll n o u ris h e d man* His p u p ils responded t o l i g h t , th e l e f t one b e in g s m a lle r seem ingly th a n th e r i g h t , . b u t of m oderate size* His fundi were negative* There was a weakness of the r ig h t eya which looked lik e a tr a n s ie n t th ir d weakness b u t could be an old sq u in t ( I could n o t a s c e r t a i n from th e fa m ily w h at i t was} A ll cother, c r a n i a l' n e rv e s w ere n e g a tiv e h is tongue was n o t p a r tic u la r ly trem ulous and n e ith e r were h is l i p s , -but he bungled up b a d ly th e t e s t p h ra s e s t h a t we g iv e t o p a r e t ic s * There was no im p airm ent i a h i s v is io n . His upper e x tr e m itie s moved f r e e l y w ith good s tr e n g th and th e m uscles ware in good condition* . The u se o f h is f in g e r s in d e l i c a t e movements was n o rm a l. Hie abdom inal r e f le x e s w ere p re s e n t and th e re was no te n d e rn e s s any p la ce over th e abdomen* in a d v e r te n tly I touched h is r ig h t p a te lla , a t which he screamed o u t in pain, and began to c ry , and t h e r e a f t e r he w ould n o t 1 s t i t s to u c h o r t e s t t h i s k n e e , n e i t h e r w ould he l e t me t e s t th e l e f t p a t H a r e f l e x , b u t I am in c lin e d t o b e lie v e on assu m p tio n a lo n e t h a t i t i s p r e s e n t b u t re d u c e d . The a n k le a rk s a re p r e s e n t b u t re d u c e d . There was r a th e r o le a r-c u t evidence o f atro p h y in th e leg s in the p o s te rio r group o f m u s c le s , and somewhat i n th e a n t e r i o r g ro u p . A g ain , he w ould n o t p e rm it me t o te s t his reflex es. . The p a t i e n t would n o t w alk a t th e r e q u e s t o f an y o f u s , b u t from th e h ip to r y and n u rse s' reco rd s he is ab le to get up and w alk w ith a reduced s e c u r ity . A fte r ob serv in g and studying th e p a tie n t, I in te rro g a te d each of h is a tte n d a n ts, the n u rse, h is a u n t, end h is w if e . The d e lu s io n t h a t he was b e in g druggedj.--the b e l i e f t h a t i f he l e f t th e h o s p i t a l and w en t home he w ould d i e j h i s s e e in g s m a ll men, l i l l i p u t i a n s , on th e p ip e s , was reco u n ted by m e a tte n d a n t. They a l l ag ree d t h a t he i s p s y c h o tic . His w ife says t h a t he was ta k in g sh o ts in o rd er to b e -d ra fte d when he was f i r s t to ld t h a t he had s y p h ilis * He p ro b a b ly :to o k tr e a tm e n t somewhere betw een e i g h t and tw elv e m onths, and e v id e n tly to o k arsen io & ls and bism uth because he re c e iv e d 'krai and h ip s h o ts ." - ' - ' - ' . .. , ; ` - R eview ing h i s n u r s e ' s n o t e s , i t beoam obvious t o me t h a t h i s . s e d a t i o n , p a r t i c u l a r l y th e n e u ro sin e , con tain ed a co n sid e ra b le amount o f .bromides , Inasmuch as i t is lp o s ,, s ib le th a t a bromide fa c to r might be considered in th is c a se , I suggested th a t a * bromide d eterm in atio n be made. ' : -v ': ' . ` ' r"* *// .. . . . . ' ' -V.''' ' ' ' .'"A-- ' >* . V"'" ' - r 'v-s- I do not b e lie v e th is boy is n e u ro tic t n e ith e r do I b eliev e he i s a m a lin g ere r. R a th e r , b e l ie v e t h i s man had s y p h i l i s , and w ith th e le a d p o is o n in g th e s y p h i l i s was lig h te d up and produced an added f a c to r w hich continued a f t e r the lead le v e ls d ro p p ed . My s u g g e s tio n s th e r e f o r e a r e a s fo llo w s* 1) t h a t he. be g iv en a r s e n io a l's :- * -5 " Jackson, P.cosevelt Pag' 3 in small to in c re a sin g doees (mapharssa)$ and 2) th a t v ary 'c a re fu l repeated blood, and uri.no d e te rm in a tio n f o r brom ides bs c a r r ie d o u t, as -.veil as a g e n e ra l u rin e a n a l y s i s and a b lo o d ch e m istry ,, so as ^o ho g uided i n t e l l i g e n t l y hew frs q u e n t to give th e n rs e n ic a ls and in w hat in c re a s in g dosage. His only o p p o rtu n ity fo r r e c o v e ry , vrhich l i k e l y i l l le av e some 1i n i t a t i o n s , l i e s in th e m a tte r o f ta k in g ear of h ie t e r t i a r y s y p h ilis , which now i s noningov& scular s y p h i l i s w ith p a r e t ic im p lic a tio n s. In one w eek t o te n days we sh o u ld compare n o te s and s tu d y h i s p r o g r e s s . He d e s e rv e s sev eral months th e ra p e u tic t r i a l , but lik e ly w ill respond w ith reasonable speed, and lik e ly th e onyohotic components w ill drop out and a tte n d a n ts w i l l no t be n ece ssary . His vitamin b alan ce should be a p o s itiv e one and h is blood count k ept up ( l i v e r , e to .) c u rin : tre a tm e n t. His u rin e (asid e from lead) should be watched* I hops these fa c ts cover h is case s u ffic ie n tly fo r the prosecution of adequate tre a tm e n t, and X b e lie v e th e boy has a good chance o f improving h is b eh av io r p ic tu re i f tho 'tr e a tm e n t program i s handled w ith care* S t a t s h o s p i t a l i z a t i o n now, I b e lie v e , would be in a d v is a b le , b u t c e r ta in ly I t can bs con sid ered i f , a f t e r a reaso n ab le period o f t i r o , he does not -respond to th e ireatm erat regim e. Sincerely yours, 7 . A* H a tte r s , M.D. ocj Br. 3* L. Hankin Medical Department The DuPont Company. North Baton Hduge, La TAW.s :yirVv t" * w : ,^ >-V "