Document NGR6VvR2vjnpKm9gbv735zjRw

September 19, 1945 C'/*/ 1 Dr. Joseph J. Hoto Baton Rouge Louisiana: Boar Doctor-lotos- This is my report who I saw at- the Baton Rouge Oeaaral Hospital at your request on September 16, 1945. This patient formerly had been employed by the DuPont Company and while working became ill with a number of other workmen, ostensibly from organic lead poison ing. He was admitted to the Baton Rouge General Hospital on February 3, 1945, and during which time he has bean under your ears. I understand that at the tins of his admission he had .58 and .66 milligrams of organic lead in his urine* la.addition., be had .05 and .035 milligrams of organic lead in his blood. These two tests were made over approximately throe weeks period of time;,v and the point is that ho gave evidence of lead poisoning from these respec tive tests. At the time of his admission he had a two plus spinal Wasseraann, but it was deemed inadvisable to give him treatment for his loss with the likelihood of crowding him with heavy metals and thus producing- an added factor. At the time he cams in the hospital he was walking, but there'was insecurity in his gait and it was obvious that this incoordination had a rather dramatic onset. His condition became such tint, after a series of psychotic episodes, it wee nec essary that he be given special care, a nurse, and two attendants to prevent him from running psray. Over this period of time his behavior picture has continued to remain psychotic. I sew him oh- -September'.16, 1945, and found him lying in. bed rather quiet, smoking rather incessantly. He obviously-was- somewhat suspicious, on .guard, and it was not easy for hi to reveal tos:ae the content of his thoughts. However, I was satisfied that at times ho had auditory hallucinations and that in the past he rad had visual hallucinations He had certain ideas that he was charged with electricity which came from under theb hospital bed| that people wore talking about him on the outsidej and that he was in communication with th Lord, with a tendency toward believing in "special missions." The history was that be became belligerent at times,d with these open outbursts of hostility it was necessary to restrain him physically and sedate hi. I did not find any delusions to the point of fearing death, but that "people were talking about hi," and that "he cannot leave the hospital, because if he did there would be no charges of electricity to keep him alive." His sensoriua, surprisingly, "was clear, with the exception of the day of the month. Jackson, Roosevelt Pag* 2 which h missed by about four days* His judgment was poor and. his insight path-' ologie&l. On neurological examination one found a rather well developed, well nourished man* His pupils responded to light, the left one being smaller seemingly than the right, ..f but of moderate sis. His fundi were negative* There was a weakness of the right eya which looked like a transient third weakness but could be an eld squint (I could not ascertain from the family what it was}* All cother cranial' nerves were negative* His tongue was not particularly tremulous and neither were his lips,-but he bungled up badly the test phrases that we give to paretics* There was no impairment in his vision. His upper extremities moved freely with good strength and the muscles were in good condition* The use of his fingers in delicate movements was normal. His abdominal reflexes were present and there was no tenderness any place over the abdomen* inadvertently I touched his right patella, at which he screamed out in pain and began to cry, and thereafter he would not let ire touch or test this knee. Neither would hs let ms test the left patella reflex, but I am inclined to believe on assumption alone that it is present but reduced. The ankle ^arfcs are present but reduced* There was rather olear-cut evidence of atrophy la the legs in the posterior group of muscles, and somewhat in the anterior group* Again, he would not permit me to test his reflexes. The patient would not walk at the request of any of us, but from the history and nurses' records he is able to get up and walk with a reduced security. After ob serving and studying the patient, I interrogated each of his attendants, the nurse, his aunt, end his wife. The delusion that he was being druggedfths belief that if he left the hospital and went home he would diej his seeing small men, 1illiputians, on the pipes, was recounted by me attendant* They all agreed that he is peyohotio. His wife says that hs was taking shots in order to be-drafted when he was first told that he had syphilis* Be probably took treatment somewhere between eight nd twelve months, and evidently took arsenio&ls and bismuth because he received 'hra and hip shots." - 'V.'. - A 'A Reviewing his nurse's notes, it became obvious to me that his.sedation, particularly ths neurosine, contained a considerable amount of-..bromides*:, Inasmuch as it is pos sible that a bromide factor might be considered in this case, I suggested that a bromide determination be made, I do not believe this boy is neuroticf neither do I believe he is a malingerer. Rather, I believe this man had syphilis, and with the lead poisoning the syphilis was lighted up and produced an added factor which continued after the lead levels dropped. My suggestions therefore-are as follows* 1) that he be given arsenical f. K 0017524 Jackson, P.cosevelt Pag' 3 in small to increasing doses (mapharssn)j and 2) that vary.careful repeated blood, and urine determination for bromides bs carried out, as ..veil as a general urine analysis and a blood chemistry,, so as 3ro to guided intelligently hew frsouent to give the iirsenicals and in what increasing dosage. His only opportunity for recovary, which likely will leave scr.c limitations, lies in the natter of taking ear of his tertiary syphilis, which now is meningovascular syphilis with parotic im plications. In one week to ton days we should compare notes and study his progress* He deserves several months therapeutic trial, but likely will respond with reasonable speed, and likely the psychotic components will drop out and attendants will not be necessary* His vitamin balance should be a positive one and his blood count kept up (liver, etc*) durin: treatment* His urine (aside from lead) should be watched* I hope these facts cover his c-as sufficiently for the prosecution of adequate treatment, and X believe the boy has a good chance of improving his behavior picture if the 'treatment program is handled with care* Stats hospitalization now, I believe, vould be inadvisable, but certainly it can bs considered if, after a reasonable period of tire, he does not -respond to the treatment regime* Sincerely yours. 7. A* Hatters, M.D. cc*. Br. 3* L. Hankin Modical Department The DuPont Company. Hopth Baton HCuge, La* TAW.s . KE 0017525