Document Ne8mraLmXqwgJwZxBYqv633DD
INTERPRETATION
The lead concentration in these tissues is veil above normal levels 3 as would be expected from the history of exposure. The concentration In the brain Is about four times tb. upper normal level. These findings, however, In themselves, do not justify the diagnosis of lead encephalopathy, since such re sults have been obtained repeatedly without relation to de monstrable clinical plusibism. On the other hand we have found lead concentrations of these magnitudes in association with veil defined lead intoxication. The diagnosis, therefor, must be made on clinical grounds, the analytical results merely tending to demonstrate the absence or the occurrence of signi ficant lead exposure. In the absence of evidence of signifi cant lead exposure, the diagnosis of lead poisoning Is untenable! when present, the evidence can only confirm a conclusion arrived at on clinical information.
Robert A * Ifehoe, M. D. I should; be interested in having the clinical- record.
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INFORMATION REQUIRED ON CASES FROM WHICH TISSUES ARE
OBTAINED AT NECROPSY FOR KETTERING LABORATORY OF
APPLIED PHYSIOLOGY
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Necropsy number ^
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Hospital number rt-ys-vf
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Ag eif Sex ^ Nutrition ^<*1
Date of Death /- S. T- y j|_
Length of Body^yQ^.
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Clinical Diagnosis
Approximate Duration of Illness 2o 2/t/f,
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Anatomical Diagnosis .
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Previous Medical History in Brief
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Occupational History J/ Yeryt'CS c /h 7s /.
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History or Evidence of Exposure to Lead, Arsenic, Mercury
/VO C C * /V. Pertinent Remarks
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TISSUES DESIRED
(Please obtain such of these as circumstances will permit, giving weights of entire organs when available. height of sample provided will be determined in Kettering Laboratory.)
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Organ
Total /height. of Weight Sample
\/j Lungs <* > -- S/F~
v' j Heart
-- 2'9Xo~
`/ Liver -- /<,*->
% Spleen --- /?o
/ Kidneys -- 270
.Suprarenals H *~s f)
Stomach and
Intestines Prostate Thyroid
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Organ ____ _
Total Weight of ielght Sample
Brain
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Spinal Cord
Striated Muscle
Adipose tissue
Long Bone
Rib
Testicle
Skin
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Autop^r -1*98_45 Clinical Summary
1-19*43. On 1-8-43, patient became.dizzy and v/as seen to stagger. Since then the patient has had severe occipital headaches. Several hours after the onset of dizziness, he began to vomit. Vomiting continued for approximately three days. Patient complained of slight sb dorainal pain, andof dcubl e vision. Pa- tient remained in bed until the time of admission. One' weep, after the onset of his illness', he began to be irrational,., and required physical restraint. -ulso suffered hallucinations and delusions., Pood intake hadbeer normal until three days before adbiission. Patient bad been a known hypertensive for over one year. % this time,' because of vomiting and bilateral abdominal pain, aocornpe nied with abdominal swelling, he was studied in the clinic and numerous x-rays were taken at that time. Patient was not hospitalized, however.
Patient had jreumonia in 1927. Review cf symptoms revealed that the patient liad worn gl sses for: the last six or seven months because of diminution of acuity of vision. Kocturifi 1 x. Occupational history revealed that he had worked e t the Eagle Pitcher Lead Co. for approximately 30 years.
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Examination revealed a well developed, well nouri shed, poorly, oriented, 50 year old whit male 7/ith. some blurring of his speech. Pupils -were small end reacted poorly. E.O.U, . normal. The retinal fundi were rot -well examined, because of jack of cooperation, ilovrever, it was thought that there vies some edema of the left nerve Jith graying of the fundi and some A.V. nicking-. There was a coarse horizontal nystagmus. B.P. 195/110. Eo lead i ire on gums. Iveurological examination negative except for bilateral -niantar ' reversals.
La b o Tu to ry V!o rk:
Urea K. Gohngm. /, massemar.n and Cold curve negative.
.l.U.ir. 16 rym./.
Routine labeir tory s+udies revealed no are-La and no sti poling of
cells. Urine
contained albumen arid numerous UBC. Lumbar pv.ncture y&elded clear, slightlv yellow.
Thud under initial pressure of 140. with v+tt Pend}'-, 2 Y;2C and protein of 95 ny, f>.
On 1-21-43 patient developed urinary retention and a retention catheter was inserted. He had been running a daily temperature elevation between 100 and 102, since 1-20-43. X-rays of skull on 1-23-43 shoved a few areas of hyperostosis in frontal region, but ware otherwise negative.
Patient was transferred to surgoiy following negative exploratory bi-occipital and bi-subtemporal burr holes under local anesthesia, B.P. on day following was 140/90,
1-26-43. Patient noted to be much worse, dyspneic, v/ith slight cyanosis, . He was less dyspneio than previ ously with slight spastic twitching. T. 103.3 (rectal), pulse 132, E.P. 120/70. lie roused to mutter unintelligibly' when disturbed.
1-37-43. Patient's condition was progressively downhill and he expired at 3:35 p, 11.
HE 0016811
N19510.02
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UNIVERSITY OF CINCINNATI
[in t e r d e p a r t me n t a l c o r r e s p o n d e n c e s h e e t ]
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To Doctor Robert Kehoa
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Kettering Laboratory
College of Medicine.
From doctor Charles D Aring-
Heurolpgy Offices '
Cincinnati C-enorcl Hospital
Date ' February 36, 1943
Dear Bob,
.. .
rid'
Slides
have not come through yet. . 1*11 send a copy of our
record as soon as it is complete, probably in about a week.
As ever,
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N19510.03
Hyperifensi^ve enc enhalopa thy JX-year exposure to lead -
Possible lead encepapholopafchy
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Eagle ,j3r#ftd Lead Gompany - />*****
necropsy 1-28-1l 3 -- ^rs. Gibbs, Evans, and Ritterhoff
Analysis Humber
Tissue
It5A-2lt5
Lung
ii3A-2li6
Heart
Ii3A-2!l 7
Hidney
t'HA-ZkS
Spleen
k3A-2k9
Liver
k3A--250
Train
Ii3A-2bl
Pectoral Muscle
k'SA-252
Pancreas
k3A-2p3
Clavicle
k3A-25k
Rib
U3A-255 ; Suprarenals
.....
..........
Weight Grams
;
Mg. Pb Pound
Mg. Pb/lOO
30.7
0.03
O.O98
2P.5 :
0.00k
0.017
?-3 * 5 32,6
;
o.oko 0.130
0.170 O.kOO
27.O :
0.32
1.18
kl * 3
0.20
o.k8
28.0 ;
0.07
0.25
3k *0 1
0.03
0.088
7.5 i
1.1k
7*5 1
1.22
3*8 '
0.00k
. ... ...... . .. ..... . ____ __________________ __.
15.20
16.25 0.105
_______ _ ___....
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Samples Received* l-28-k3 Samples Reported: 2-2-k3
N19510.04