Document MG6zDBDxq4dq3Q5a67Zo6v0Rk

MEaOKAH.XIM ON A CA;>E OF IPSBIi&B LEAP..IilTOXLGAl.Mf--Ai.lliS BXhYL-AUHLiAAKM TT.'i'HAI/iKYL L~.AU jrUICt^ -tAlMUd LuIHB IT^KRXBU&B,. .8AH(3L- CASE SUi.Et. Ms me: Employer: Ethyl-Kuhlmann, Paimboauf, Hr* Mantes, Loire Xnferieure, FSAHCS. A {?e{ 33 years. Date rnd Place of Hirth: 9th April, 1915 ftt Brest. Marital State: Family History: Single. Hot known. Parents probably r-live. History of last Illnesses; Hot known. Habits and T'nvironraent: A well-known heavy drinker of local wine. He resided in lodgings in paimboeuf Previous mployaent: Employment with Hthyl-fuhlraann. iftimbooufa 27th August - 6th Heptoaber, 19*7 Worked in the arsenal at Brest. Duration and type of employment not known. lie comaenoed work on the 27th August, I947 and was passed as medically fit for employment in the Tetraethyl Lead Plant on 9th September,1947* He worked as a process operator on the ground floor of the T.S.L. building, transporting hoppers to and from the alloy building. September, 19^7* 3rd October - 8th December, 19^7* He was on strike with other employees. A second operator on the top floor of the T.P.L. building engaged in charging autoclaves and controlling the reaction. 8th December, 19^7 " 6th March, 1948* He worked ea a blacksmith on the ammonia plant on the same site but not in the T.E.L. section. 6th March - 13th Moventor, I34Q (see exceptions below) He was engaged on general maintenance on Y.L.U. plant. His work was not supervised. The detail of all wwHr 0020934^ OASK SlibhT Name: Employert Ethyl-Kuhlmann, Paiuboeuf, Nr. Nantes, Loire Inferinurw, PNANCS. Aget Date r-nd Place of Mirths Marital State: Family Hiatory: History of Fast Illne.-iaea: Habits and Environment! Previous :mcloyent: Employment with Ethyl-Kuhlraann. Pa taboouf i 27th August - 6th Deptewabar, 19^7* September, 1947. 3rd October - 8th Dooember, 19^7 8th December, 1947 6th March, 1948. 6th March - 13th November, 1948 (see exceptions below) 2(;th-29th July, 1^48 ) llth-13th October, I948) 33 yw* 9th April, 1915 at Brest# Single. Not known. Parent* probably alive. Not known. A well-known heavy drinker of local wine. He resided in lodgings in paiaboeuf. 'Worked in the arsenal at Brest. Duration and type of employment not known. He commenced work on the 27th August, 19^7 and was passed as medically fit for employment in the Tetraethyl Lead Plant on 9th September,19^7* He worked as a process operator on she ground floor of the T.A.u. building, transporting hoppers to and from the alloy building. Ho was on strike with other employees. A second operator on the top floor of the T.A.L. building engaged in charging autoclaves and controlling the reaction. Ho worked aa a blacksmith on the ammonia plant on the same site but not in the T.L.L. section. Ho was engaged on general maintenance on T.L.ii. plant. His work was not supervised. The detail of all work carried out by him during the last throe weeks of employment is not definitely known. Ho had changed valves on alloy pots, <;ronaed reduction gears on stills, installed compressed air linos and forged ohisola end picks for the lead reoovery building. He was the second operator on the top floor of the building. K 0020935 f History of Illnesst Saturday, 13th November, 1948. Monday, l^th November, 1948. 15th November - 1st December, 1948* 1st December, 1948. 2- He complained of chill end attended the forks' Surgery for treatment. He was absent from work and was visited at hia lodgings in Taimboeuf by the Hurae/iiealth Visitor, who found hia agitated. The Works' tiedionl Officer was informed and visited hia later in the day when he found hia in a condition closely simulating Delirium Tremens. He was excited, confused end perspiring profusely. He was suffering from hallucinations. On examination the pulse rate was 100 beats per minute, temperature (37*7C.) and blood pressure l^O/lOOram.Hg. There were no localising signs. He was removed to the hospital at the Ethyl-Kuhlaann llant, laimboeuf and kept under observation for several hours. His condition did not improve and he was transferred, the seta evening, by ambulance to St. Jacques Hospital, Nantes. In hospital he was under the care of Ur* Norman, ft Physician, who considered him to bo a typical case of Delirium Tremens, although Dr. Gorman knew of the possibility of tetraethyl lead intoxication. Delirium Tremens is ft common condition in the area* He did not respond to treatment in the usual manner. Hia condition progressively deteriorated? agitation being the most prominent sign. During the few days prior to death his condition simulated meningo-oncophalitis. There was a marked generalised rigidity, dysphonia and dysphagia* Kernig's sign was positive. Brudinaki'a sign not known, blood pressure, lumbar puncture and biochemical examinations were not possible owing to the locomotor activity. There were no abdominal symptoms. Myoclonus end convulsions were not noted. The temperature was elevated during the last few days of illness. Death. 0020936 Treatment! , He was treated as a case of Delirium Tremens. Morphia, hyoaoine and barbiturates were not given* M nf a Vvrjdrmio taouasy. 1948. 15th November - 1st December, 1948* 1st December, 1948. ..a ..f.o c w w s j .i. U'US) nurn, K(U Waa VliUl(l at hia lodgings in laimboeuf by the Nurae/Health Visitor, who found him agitated* The Works* Medical Officer was informed and visited him later in the day when he found him in a condition closely simulating Delirium Tremens. Me was excited, confused and perspiring profusely. he wea suffering from halluoina tiona. On examination the pulse rate was 100 beats per minute, temperature 99.8?. (37.7C.) and blood pressure 150/100ram.Hg. There were no localising signs, ile was removed to the hospital at the ithyl-Kuhloonn Plant, laimboeuf and kept under observation for several hours. His condition did not improve and he was transferred, the same evening, by arjbulanoe to St. Jacques hospital, Nantes. In hospital he was under the care of Dr. Ooriasn, a rhysician, who considered him to be a typical case of Delirium Tremens, although Dr. Corraan knew of the possibility of tetraethyl lead intoxication* Delirium Tremens is a common condition in the area. He did not respond to treatment in the usual manner. Hia condition progressively deteriorated; agitation being the most prominent sign. During the few days prior to death his condition simulated meningo-enoephalitis. Thera was a marked generalised rigidity, dygphonia and dysphagia. Kernig*a sign was positive. orudinski's sign not known, lilood pressure, lumbar puncture and biochemical examinations were not possible owing to the locomotor activity. There were no abdominal symptoms. Myoclonus and convulsions were not noted. The temperature was elevated during the last few days of illness. Death. Treatment* He was treated as a ctese of Delirium Tremens. Morphia, hyoacine and barbiturates were not given. His treatment consisted of a hypodermic injection of 1J mg. strychnine sulphate per day for eight days. Post Mortem - 2nd December, 1948: There was subcutaneous eoohymoaia of scalp 'ml right iliac region. K& 0020937 \- ' X Post Mortem (Contd.) Brain: Lungs: Liver: Kidneys: 3- - Th dura raster was normal. The subarachnoid space contained aanguinous fluid. The brain was shrunken in appearance, appeared compressed and had a lilac hue. The superficial veins were congested. There were some haemorrhagic areas on its surface. The brain stem and cerebellum exhibited a similar appearance to the cerebrum. On section of the brain numerous pinpoint haemorrhages were noted. These were congested without consolidation. Sections floated in water. Normal in size. It felt more orepitant than normal when out with a knife. These were lilac in colour. Analysis .of... Biopsy . Material*. The samples provided were forwarded to the Courtauld Institute of Biochemistry, Middlesex Hospital, Medical School, London, ft`,1., where they were analysed under arrangements made with Professor E.C. Dodds. The samples had been forwarded in bottles prepared by Professor Dodds, which were broken in transit. Each sample was weighed after adhering pieces of straw had been removed, then washed under the tap and finally washed with distilled water. The results are as follows:- 0020938 Sample. Brain Liver Lung Kidney Weight. 63 gm. 29 " 20 * 63 Mg. Pb. found. Mg./Pb./lOO gm. tissue. O.36 0.15 0.097 0.40 O.57 O.52 0.48 0.64 cummin The deceaeed, froa existing knowledge of the occupational tmviionaiont^wa^eusgootod to significant exposure to organic- load compounds in the course of his employment. Hia work wee not adequately supervised and details of his duties during the three weeks prior to his fatal illness are not known. The degree of the significant exposure cannot be ascertained. The olinioal picture exhibited during his fatal illness is common to tetraethyl lead poisoning and Delirium Tremens. It was known that ho was addicted to alcohol. Consequently* there will always remain a oertain element of doubt in this case. It is bad practice to assume two causes for any pathological process* but in this instance both poisons stay be accepted as having played a part. It may remain e setter of opinion as to which was the actual cause of death. Inc mortality rates in tetraethyl lead intoxication and Delirium Tremens are approximately the some. The biochemical and analytical procedures, which may have been of assistance in ascertaining the main cause of the illness, were unfortunately not carried out. The meningeal irritation s-.nd rigidity exhibited in this case are not to be expected in tetraethyl lead intoxication, which, as n rul<s, does not present any localising signs. The post mortem findings in tetraethyl lead intoxication ere not specific and arc common to those resulting from many toxic processes. The picture of congestion, oedema and petechial haemorrhages, such os founa in this ease, is similar to that found in tetraethyl lead poisoning and chronic alcoholism. There was considerable delay in the receipt of the pathological specimens for analysis through the post. There la some possibility of the tissues having been contaminated when tho Lotties containing them were broken. As reasonable steps were taken to remove such possible contamination, it is considered that the results of analysis should be eccoptod as correct. The following table shows a comparison of these results with the maximum normal standards determined by Dr. K.A. Kehoe; Standard. Maximum normal ]% Pb. per 100 gas. of fresh or formalin-fixed tissue. Brain Liver Lung Kidney 0.09 0.28 0.06 0.16 Tissues of deceased O.57 O.52 0.48 0.U4 not adequately supervised and detaila of hia duties during the three week* prior to hie fatal illness are not known* Tim degree of the significant exposure cannot to ascertained. Tho ollnioal picture exhibited during hit fa tal illness is common to tetraethyl load poisoning and Delirium Tremens. It was known that ho was addioted to alcohol* Consequently# there will always reraain a aortaIn element of doubt in this case* It is bad praotios to assuias two causes for any pathological process# but in this instanoe both poiaons may be accepted as having played a part* It may remain a stter of opinion as to which was the actual cause of death. The mortality rates in tetraethyl load intoxication and Delirium Tremens are approximately the same. The biochemical and analytic*! procedures, which may have been of assistance to ascertaining the main cause of tho illness, were unfortunately not carried out* The meningeal irritation and rigidity exhibited to tMa ease are not to be expected in tetraethyl lead totoxioation# which, as a rule# does not present any localising signs* The post mortem findings in tetraethyl lead intoxication are not specific and arc common to those resulting from many toxic processes. The pioture of congestion# oedema and petechial haemorrhages, such os found to this ease, is similar to that found in tetraethyl lead poisoning and chronic alcoholism* There was considerable delay to the receipt of the pathological specimens for analysis thresh the post* There is some possibility of the tissues having been contaminated when tho bottles containing them were broken. As reasonable steps were taken to remove such possible contamination# it is considered that the results of analysis should be acoopted as correct. The following table shows a comparison of these results with the awxiuuta normal standards determined by Dr. R.A. Kehoe: Standard. Maximum normal Mg* Pb. par 100 gae. of fresh or formalin-fixed tissue* Broto Liver Lung Kidney 0.09 0.28 0.06 0.16 Tissues of deceased 0*57 0.52 0.40 0.64 The concentration of lead in the formalin to which the tissues were fixed was O.OoJ flg* per litre* A sample of potable water from the area contained 0*55 mg. of lead per litre* The concentration of lend in the four tissue* samples analysed are obviously very auoh to exeesa of normal. This high lead content oould not have resulted free contamination of the formalin. The moderately high lead content of the potable water, by British standards and the very high rate by American standards, is not a likely cause * 0020940 of the high concentration of lead in the tissues. There are no other records from the if-icboettf area with which thane results may bo cospcred. The load content of th local wino is also unknown* umm Albert Nicolas, an employee of Messrs. Ethy1-Ku'nimann, Paiaboeuf, who died on the 1st December, 1948 following an illness simulating tetraethyl lead intoxication, was a known chronic alcoholic For this reason he should not have been employed in the manufacture of tetraethyl lead, and, further, he should not have been permitted to commence work without a pre-employment medical examination* Ho had significant lead exposure from his occupation. He was not supervised in work which involved an occupational lead hazard. The clinical picture, post mortem findings and results of the analysis of four tissues are strongly suggestive of tetraethyl lead poisoning. There is a possibility of another cause, namely. Delirium fretsen^ from chronic alcoholism. In view of all the findings it is considered that it is fair and reasonable to conclude that the moat likely cause of death in this oase was tetraethyl lead poisoning. K. Davison. (.Senior Uedioal Officer) 7.4.49. lied Leal pepsrUatat, The As*ol*l*4 ifc/i Ctae%*MKjr fcUiU4, ICS. KE' 0020941