Document LKej1m502GxM11X7XaZLmwm83

August 20* 19+2 Lch Co Street 0scLui examination made at the request of Dr. D. B. owe* -aicai director, The B. F. Goodrich Co., Akron, Ohio. age 39 naie, white, married, employed in manufacturing, grinding and mixing plant (Mill 3), B. F. uoodrich Co. Presenting Complaint Muscle pains, pains in feet and legs, tires easily, anemic. Previously felt well until about February 1, 191+2. At tliis time he was transferred from his usual work of tire stacking to water washing synthetic rubber. After doing this work for about two weeks, he seemed drowsy and sleepy although he slept soundly at night and about February 21st noticed some unsteadiness on feet, a wobbly nervous sensation, noted especially on :;etting up after sitting or lying down. Dj^ not seem to have control of muccles of legs although control was better and almost normal after walking for a few minutes. There were no muscle or joint pains at this time. He felt fairly well otherwise although the appetite was somewhat diminished and a disagreeable taste was noted. Ahere was approximately ten pounas weight loss. A physician, Mr , q . W, Hamilton, of Akron was consulted on March lyth, the chief complaint being los3 of appetite, loss of weight, unsteady gait. Dr. Hamilton consulted Dr. AOVie, Medical director of the B. F. Goodrich Co,, about a possible work hazard and was advised that there was a benzol hazard and that if. had not been feeling well, he should be hospitalized for observation and determination of the cause of illness. Accordingly he entered the City Hospital, Akron, March 15th for observation and remained five days until March 20th, Specialists' examinations incluued eye, ear, nose an^lHagoah, neurologic, and laboratory tests. According to tatereent, all tests were reported as negative. Arte^^ been away from work for about six weeks until April pOth, he returned and on advice of the Medical Department was transferred from wasiiing to packing dry rubber. He was feeling much better but still not as strong as usual. xhe appetite was better and he had gained four pounds. The taste was more normal. backache was noted presumed to have resulted from the spinal tap. a 0 continued at this job of packing rubber for two or three weeks until about May 15th or 20th. xhen he was transferred to the Manufacturing Department compounding lead silicate. He worked in this department until August 5th during which time he gradually lost pep, began to notice pains in the febt which he attributed to arch trouble -2 ,UOu u. July 15th tae pains continued and centered into the 4 i./i ''-oc3, iooer part of stomach 'ana small of the hack. --here ' "sioght pain in the wrist. -Kirin;; tills period, there was Jj.- u lcion in motion ana 1:0 rotaole r-tUccle weakness, -hie '. J ;c0 ..fort was described as generalized auarp cons tarn; pain and . > ,-juacle soreness in the feet and legs. there seemed also -o oe some --.uscular pain oi rath- .r vague character in the lower :>ax't of the abdomen and the back. During this period these oains were tore or less constant and at times prevented sloop. V,ey became so disturbing that on August 2nd a physician, Dr. Dickson of Akron, was called because of their increasing severity. Kiev were not greatly relieved by medication and continued until August 3th. At this time Mr. Morgan was advised by i)-,. Dickson . to -,o to the.Cleveland ^linic for general e x a .in .tior.. Strangely enough the .snarp pains disappeared August cjth^ft^rgii the null, deep-seated, muscular- pain persisted. ilr.^HHHHva-.-nt to the Cleveland '-dinic "ugust 3th as an out-patieBfy^ returned again on August 10th at which time his examination -was- complete and the diagnosis '`lead poisoning was made. A review of -^r. J B ^ B H ^ o c c u p a t i o i i a l history revealed that .he had been e::aploye^Dytne B. P. Goodrich Co. in I929 for six to eight months, from 1933 until I938, and f r o m^1939 until the px-esent time, August 19i+2. From 1935 until 1956 he worked in tne reclaimed rubber d e p a r t m e n t a refining process having no special work hazards. From 195 until 1953 and 1939 ana also in 1942 he worked, in the tire division curing tires, tnere being no obvious hazard in this work. In February 19Ip2L ox'gan was transferred to the synthetic rubber department, Mill 3, employed in water was-'inn syntiaetic rubber. This work was carried out in a rather poorly ventilated room. in the manufacture of syntactic ruober benzene was used a na benzol fumes dame from the wet xoibber during the asuing process, bur ng the early phases of this operation, there 'was no control established to eliminate these fumes. they were noted as strong, unpleasant, irri tating odors fina at times caused congestion of the eyes, ibis work was carried out six hours daily, seven uays a week for six 'weeks igltnoneday off in this entire work period, about arch lipth tor.f l H H B b o m p l u l n e d of sleepiness and staggering gait as noted in tS^pffisenting illness, be consulted his physician as noted above. ue ,as away fr.m work from March ll+th until April 23rd. upon his return to work in May 191+2 he was transferred to the lead silicate plant here his work consisted of weighing $0 lb. of lead silicate taken from a drum into a screen box on scales. he drum, box and scales were inside of a ventilatea booth in . -Uich any dust is drawn to the back of the hood away from the opei'ator. he v'/ore coveralls and leather gloves, the coveralls being changed once a week and took a daily shower after work. For- more -complete details of tills lead silicate operation consult the attached report from the Office of the Safety n0iner of the B. F. Ooo'drieh Go. After one .month of this work leau silicate manufacture was discontinued and was received, from another plant. It was ground in a mill with on 027 screen to fine pow-aer. Approximately 1000 lb. of this material was ground dally. Further operations consisted in filling six or seven Kf 0016734 ~3' 200-lb. fiber paper druns with the compound and also in mixing about 6j0 lb. of the ground powder with oil. This work was carried out during the month of July. xt was done in a third floor room ap roximately I4.O x 20 x 25 feet with windows an all 3ides usually o>en on three sides. The grinding mill and scales were placed under a hood with forced ventilation, regulations required the wearing of a dust respirator mask at all times. "hrgan states that ha always wore the mask when weighing and grinning the lead silicate but frequently removed it when away from the hood, ue also noted that fine dust settled on the flooi* and various objects in the room ana chat mask was used when the room was swept aaily. ue was careful to wash his hands oefore eating and did not eat in the shop. General Review and Systems ... health very good prior to February 1942. Usual weight l80, best weight I8I4. (Feb. 5 1942), least weight 168 (1936-dosestic worry), present weight about 170 to 172 (August 15, 1942). Head: Headache every month or 30 with sour stomach, some dizziness with flash of darkness on changing position quickly. . Eyes: Wears glasses for reading or driving, "far sighted". heasles us baby when less than a year old} settled in. eyes producing muscle weakness of left eye. Ears: '%aring slightly impaired, no discharge, no history of earache, o3e; Broken In 1922 - no disturbance in sense of smell. hoes not take cold easily, "slight catarrhal condition", frequent nose bleed as boy (17-19 yr.) C.R. No chest pain, no chronic cough, no hemoptysis, no sputum, dyspnea, ankle edema, palpitation or asthma. G.I. -appetite no foods disagree. Upset stomach a t times from eating too much rich food, nausea, vomting, head ache} attacks usually relieved by vomiting and improvement, follows after two or three hours. Bowels sluggish, takes agaro^ and occasional Ex-lax tablet. Usually takes a laxative about once a week. No cramping or colicky pain. Acute indigestion for two or three hours in 1918. No jaundice. Nothing unusual about the stool. Drinks 4-6 glasses water daily. Seldom takes a soft drink* uas an occasional glass of beer. Seldom drinks whiskey. G. U. Urinates three or four times daily l/2 to 1 pt. Nocturia last we e k or so, got3 up about four o 'clock, voids about a pint. Attack of dysurla every two or three onths thought to have been caused by drinking alcohol, lasted a day or so and gradually disappeared. <0 noted bio .d, pus ,or gravel. No history of venereal disease. Back, extremities and joints: Dull pains in wrist3 and muscles of legs and feet and back as noted in P.I. No previous difficulty. Kfc 0016735 Habi ts dorks six :ours daily, seven days a week. Aver a .os 3 hours sleep, -'lept .veil until present illness, has not been sleeping as wel for oast two weeks because of Irreguiar hours, infrequent dreams. -<i htnai*:- about lead poi son inn buiViu^ ni gnt august Ibfch. 3yokes one p&cx of cigarettes a 'week, Occasional pipe anu cipar during winter. Seldom, drinks, usual ly has bad hangover. harltal History . harried twice 1935"3& .and 1 ^ 1 . Ho children or miscarriages. Present wife in pood health. Personal history Born August 3, 1903 Calhoun County, rfesfc Virginia. hived in >'*est Virginia until 1929. Xn Ohio since. Completed high school 19^7 "ived on a farm until l3 years o ape. Boustabout work in oil fielas during summers and after school hours. Post office clerk during the winter. Columbia ^hemical Company in the boiler .-ooi.i in 1929 for three months. 'hth B. F. Goodrich for eight months in 1929 ana since as noted, under occupational history. wdu Jobs in the intervals. ?hy sical Sxa. :inat 1on General - A well developed, fairly well nourished w Ate male 39 years of age, /Q-l/2 inches tall, weighing lb3 lb . (stripped)'. ell oriented, alert and cooperative. Temperature 93.8, pulse 3d, respiration 23. Clean shaven, dark beard, slight facial pallor, slight inf raorbi tai shadow.. Skin: Of the body and hands essentially normal. uood color, elastic. Perspires reaaily from axillae. Pew scattered inflamed hair follicles over* the back. xnterdigital fungous infection both little toes. Slight scaliness over the dorsum of the left foot. Generous black , hairy growth over body, normal masculine distribution. Slight clubbing of fingers. head: Scalp clean. uormal .growth fine black hair. %es : Pupils equal and regular. -Heact normally to light and accommodation.. Slight nystagmus left eye with close vision and upon looking upward, quic?c phase-, internal internal convergence left eye Ocular tension K f 0016-736 "5 y ,,..-rsu ose : outil: Neck: Chest: Heart : abuoraen: approximately normal.- ^eft disc not seen well because of inability to control eye movement. Klgnt fundus m t u e r pale, no hemorrhage or exudate. Veins moderately full, R-rterios very fine, rhysiolo ic cupping of dises, pulo yellowish surface rith fairly well defined clear margins. Drums appear normal and all fatly retracted, bearing sll :htly airini shed right ear. Slight deviation'-pf the septum to the left. 0 marked obstruction-right inferior turbinate; euematous and slightly congested. Nasal membranes pale and pink covered with some serous discharge and few crusts. , 15 upper, 12 lower teeth. 1 and 5 ri:,ht lower, 2 right upper, 1 and 3 loft lower, and 3 left upper molars .-nssing. Gold cap of right upper central incisor. Silver amalgam and gold fillings. roor dental hygiene. Much sordes. Uums firm ana pale. Purplish line noted along margin of right lower lateral incisor on the buccal surface, all about the remaining lowbr molar on right ana also along the margin of tee upper central incisor on the buccal surface, `here is some diffused purplish discoloration of the gum about the capped tooth. ionsils small and imbedded. i?'ood particles In the upper pole of the right tonsil. No exprssable exuaate. Pharynx not remarkable.. Gag reflex active. Tongue ot coated - protrudes in mid-line without tremor or fibrillary twitching. - . Thyroid not enlarged. Trachea in mid-line. io abnormal pulsations or fulxness of the veins. 53-1/2 inches, [pO-l/2 inches expanded, symmetrical. Fremitus normal. Respiratory movements free and equal. Pressure note equal and resonant tnroughout. KI and iaphragmatic excursion within normal limits. Breath sounds vesicular. N0 rales. Ho abnormal pulsation or thrill. FMI in fifth interspace. BCD Ip x 11. BSD 5* a ~art sounds clear, regular. No murmurs. date 31+, after 50 hops 112, 2 minutes after 100. lood pressure 118/76 lying - down left aim, 103/70 lying down right arm. Radial pulses equal, normal volume and tension. Small pannicuius adiposis, ?.oderately muscular, symmetrical, relaxed. 0 organs .or masses palpable. very slight colonic tenderness, more marked on the left side. External inguinal rings intact. K H 0016737 e-nltali a: normal externally. Aectal: Small external hemorx'faolds. -hlght a -ai.neter. Prostate gland small, sgmmetrical, 'at tenaer. Lympilques: Superficial groups not unduly enlarged. Extremities:! -Qrmal form ana -function, drip 115 right, 90 left. iieurolu ;lc: Cranial nerves. 1-not tested; 2-see. notation under aye, gross tests visual fields' normal. vision not tested. 3, ip and 6 - Reaction and nystagmus as noted. Paresis left external rectus (history of measles -,,turing infancy with eye sequellae). 5 " Coi-neai reflex equal and active, no sensory or motor disturbance. 7 " no facial weakness, u - ^earing slightly diminished right ear (not tested with tuning fork). 9 and 10 - Palace in raid-line. So dysarthria. II and 12 - normal. otor System: tipper extresxities - posture well maintained, . .usclc- power good, coordination normal, muscular movements normal, muscle tone good, no obvious . atrophy or fibrillation. Lower extremities - power go a, coordination normal, muscle tone good. Reflexes1 . bleeps, triceps, wrist jerk and knee jerk active and equal. formal plantar flexion ripht ana left. Abdominals equal and hyperactive. Cremasterics equal and hyperactive. ensauions: night touch and pain normal. Vibration and temperature not costed. Stereognosis normal, -ait.normal, able to stand on either foot singly. Lf.B0;vriiCRy DATA Urinalysis Clear amber, specific gravity 1.Q15, -alkali-ne to methyl red, pH 7*0 *"iugar, acetone, albumin and blood negative, microscopic - few white blood and epithelial cells, no casts. flood examination d-13 Specific gravity whole blood 1.0522, specific gravity plasma 1.0251, total plasma protein 6.19 grams per 100 cc. estimated red blood count 4# 4.00,000, estimated hemoglobin 34/4 estimated packed cell volume 24, pipette count done on oxylated blood <.,100,00, hemoglobin Dare 02>t (l6 grams per 100 cc regarded as normal), hemoglobin Leitz oxyhemoglobin method 12.1 grams, ear blood count (pipette) red blood count 4 390#000, hemoglobin dare 02p, wnite faioed count 5,7pO, differential - Poly. 60, band. 5.5, lymph, 27.5 mono* 4*5 oosin. l.p, base. 1.0, stippled rea cells :)0 per 50 fields, sediment-* tion time (w ntrobe *s vnooi<od) la, 7. / ~ ~ icterus ..~dex approximately normal, hematocrit packed cell volume ij.0.0 . 3-*19 pacific- gravity a?hole blood -1.0520, estimated reti bl-ood cell count l,ifGQ,000, hemoglobin estl tiea rea blood count pipette oxyl--.ted blood ir, 50,000 hemoglobin a.re 8l^, stippled cod calls pd per pO field, average red call count from above ijscimat. ons .r.3 million, average hemoglobin J2/c-. For the roilo.ving rea cell determinations the following value-- were used -- ne;.:o lcoln 12.1 grams, red blcoa count if.3 million, jacked cell volume 4J cc. per 100 cc., l.CV 83 cu.m. (norv.al 32-p2}, LCil 26 micro micro crams (nor .al 7-31), CHC 50ji (30)8 normal). ' ' . , blood V/assermanr. and Kahn tests negative. 8-20 Hemoglobin 78k, WBC 6,850 (10:45 A.M,)-, ABC 6,300 ^2:00 2.M. ), ABC If,3^0,000, uliff-rential -- poly, .55 band. 15.5* lymph. 2O.5, :-ono.. 0.5, eosin. 1, base. 1.5 reticulocytes 156, stip led red cells ip. Icterus index approximately 3, M n r u m h 2.5 milligrams' per 100 cc, red cell fragility normal, beginning hemolysis Q.if4 oer cent, complete 0.30 per cent, Atieuloeytes 156 (per 50 field). Blood chemistry - Sugar 91 urea nifcro ;en lip milligrams per cent. Mff .%affllngtlon Reveals normal sinus rhythm., rate ciij_, PR 0.2, -,,HS 0.06., upright complexes In all leads except 5. L3 shows- low voltage dtS, splintered, depressed S3. . These findings are interpreted as normal. -Quantitative Lead Analyses 8-1-3-12 Spot sample urine G .17 milligrams per liter. Blood O .075 milligrams per 100 grams. Large urine sample, 0.19 milligrams per liter. Feces 0.12 milligrams per gram of ash. Summary of Significant Finalnx~s History of bensol exposure and intoxication in February 1912 with apparent recovery and return to work in good physical condition in May 19l2. -Employed in grinding lead silicate during July and until August 2, 19l2 with significant lead dust exposure. Chief complaints - fcugust 2, loss of pep; muscle aches and pains in the feet and legs, lower abdomen ana back. ' ' Significant Physical Findings Hystagmus, paresis.6th nerve left eye (measles sequellae), blue lino .gums, moderate cardiac hypertrophy with normal BKG tracing, mild myocardial weakness. k g ' 0016739 / / Laboratory examinations reveal a mild noraocytic anemia and lsau 1indin.,s in tiie urine ana bloot* which may be ..interpreted as indicatin g probable si .nidicant exposure. Probable -.Quorate loan absorption with relatively mild intoxication ij.tn the possibility of residual benzol effects as cor.^riDrrttn" to tiie clinical picture ei thor directly or Indirectly by incrc-asin.y susceptibility to lean intoxication. K. V. nitsmiller, id.P. K K 0016740