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' c/2 <3 d G d o a* d 'd aC>O a rQ o v G rj to } GO s: r-i CJ o o cu >> co 2 dv. `C t* do S ___ u 5 a. o^ S "C3 w CL> ^ s- ^CO 53 <D T3 E2 cu W e- o A) (JVt*.-7/6&) XT xi j< Z '< `X > UJ I Q i? < UJ w xTry UJ t *"V u . cl ^ >, ^ C= ^ UCOJ ,' sVri~ >-: cc ! O; ' vn < oc i O! CO ; < 0 . cr> co cr> cl --* eu U-l oo X- Ji < K) / -*J. w 'rI i\2 .j o; ?! --9 V:-. <3- , o, ; < zb *5 *J ^2 i >o \J o ^5 vl -/ Q _j 5 X *T3 u -t l i- 3 CE O . o. UJ cc 2 QJ c o O --3 yo 5 -2 ^ ,05 it ,2 *5> s > <2 i < c> 2o 52 x V) OD a < X rs >C o J</l3 'Tc35 _) *t3 -- J2 to & c V- f cN co cu 38 t-o- V* *- p z- 2o "5 v, Vr- CJ -<dy ^ ... , V. Tc fi. sC ir 3 co to c od S CO c3. CO <3 J3 <0 ss Zd~J * v*-, uO 2 > to .>-- Cd du *u to 3O oC ^.- C3 Z ~z PZ * fc2; UJ z o tCN. \Q (-* < iV z < aN x UJ a < LjJ V*.. ':'</> -J uu <"4^* - (-0 5 >* cc .} \ ^; c j-'.. - J <5_. CO 'S. :. 5 5 <c V b> p i 0 7. i oo _J Ox <o .cc O X UJ x >- *-v p r-- c: O -o ^ . ri>t oC 0/ 0u 'd00 3 bp <* 0 > Va5 Cu3 to 3O A >d -C* *TC33 ta, o c V. A rp 021 i / So3 S3 C c. 3 UJ eJ 0c ta -- =5 ? V. _Z 3 d w, -J .- -CC "^33 =o' s^d .Wco:5 >4 r3 TJ /j c P0-J a u u0 >i> cC/3u >J O cu to 3 C 2 S. to uo ap >3 r3 V -a W b y. Vlx*r4 Joaata, pT.P.H., * f )* in ; )> ! |l - *.! 3 i: CITY OF-ST. LOUIS -DIVISION OF HEALTH BLOOD AND URINE . PUBLIC HEALTH LABORATORYSERVICES LEAD EXAMINATIONS ___ Ai'-i-V]YEVD 1--At ~CH 1X?,S<. si. / . ... .... % /-W/ 1 ito 1M J-, t<a& NswLue ,ILz E$}, SEP 2 - 1863 This ii yur return atMreee: Dr--------------- P-A-VLW_____ K. DIRECTIONS P^JcJiLbL__Cc'C H ./AAV \f A- . Mt >S T> (TV? i. S ~.tCitY-. I.DU 1^ MoSt.lt lip Code (fteaae Print) I. Fill tube uitK blood *2. Submit at least 100 ], of urine. LABORATORY REPORT Ml Specimen of blood shows the following concentration of lead: ----------------mg. lead in 100 grains of blood. Specimen of urine showed the following concentration of leadm _P. 1S-P.----- mg. lead per liter of urine. NOTE: Heavy metal on urine specimens are based upon an adjusted specific gravity of 1.024. 8 H U t-j L i C I i L A L i is l A... C;A i u :\V bi_i\ ViC E S l L / \ D !_ X t < ! i . /. i ! O i. b A : t. C> \ ^ Ah\. b\ V'E'-v'J .X-iXAlAL .i___i h i A j AUn/A I35S u TVii# yet.r return aidr***; M--frl .JiAq-'.d.dlA iA nrsiKmoAs y_L..A-^- -b\o.s II tube * i t h blood City _S:ib. Jo^iirL' ._S______Si (n*3< "3 . 5 ii i i t. At ) * k i c0,u ^ 'S't OCj 100 ni. of urine, LABORATORY REPORT Specimen,of blood sho Yt-i i>Ho following concentration of lead: t -fcLP--JJj-- mg. lead in 100 grains of blood. | ^ ^t/Vu-v-cJ Specimen of urine showed the following concentration of lead: .-------------------- mg. lead per liter of urine. NOTE: Heavy ijietal on urine specimens are based upon an adjusted specific gravity of 1.024. a.D.I. 40/13 (r.-T.-7/od) Vajjtard Jonn*on 0r-P.H-, Director of L*bortorit ...... ... . ' . u I This ip the first; JC VAH admission for this ^0 year old Negro male i?ho is a laborer at National, Lead in Granite City and comes in with a chief complaint of progressive weakness,Malaise, drowsiness, and slow speech of long duration. The patient vas vei; unti3, five years prior to admission at which time he noticed an onset of malaise, weakness especially in the legs, and feelings of drowsiness. About 2 to 3 years prio: to admission he noticed intermittent loss of his voice, slowing of his speech and slurring, and difficulty expressing himself with some memory loss. Ke has also had tremors and difficulty in performing work of 5 to 6 years duration. Two years prior to admisslon he was seen by a doctor in Granite City and hospitalized for lead intoxi cation. Ke was treated with blood transfusions and multiple vitamins. He was told to change jobs, and employer placed! him in a different job. Lately, he has been a sweev due to several accidents associated with momentary loss of vision, One year prinr to admission . Ke has been seen here in the clinic in the last weeks prior to admission and found to have a hematocrit of 27.6 and hemoglobin of 8.2 with a lead level of 0.01 with cell indices indicating a microcytic, hypochromic anemia. Iron studies were norms He vas admitted for evaluation of his anemia. Physical Examination revealed a well developed, poorly nourished-looking Negro male in no acute distress who walks with a slow, shuffling gait, and speaks slowly. He is oriented x 3 tut with slow mentation, and has a mild recent memory loss. Blood pressure 130/90, pulse 6b, temperature 93.2, respirations 16. Pupils were equal and reactive sluggishly to light and accomodation. There vas leadline along the gingiva'. Neurologic examination revealed a generalized decrease in strength, decrease in position sense in the lower extremities, a decrease in sensation, to pinprick and totich in both extremities. Laboratory Data: CBG reverie a white count of 10,300, red count of 3,650,000, hemoglobin 9*3, hematocrit 2S.3, NCV 77, KCH 2o, KCKC 33, reticulocytes count 1.0. Skin tests were negative. Cells in periphery showed no basophilic stipling. 2-hour postprandial blood sugar 128, TOLL nonreactive. CO2 26.5, chloride 102, sodium 139, potassium ^-3, amylase lOo units, Qi STh APtCE CAT 8-26-69 IO-31-69 10-1000 TYr; OF OtSCHAGOE tNPATl .S 7 DAYS AEO OAYS MH3(FKC) P*CrtS- TlOi.sdSti. SWT'OLLCKOFC"UV`MND. <____ NO. $.Gn A7u *E o f Ph y s ic ian 6 s MICHAEL T. FSTEK30N, ML. P /"> C P ! T A a nil 20 . 1 nr: l ]9> rui ',L<~ . f i;. i.-. a i .: ;> Hum c-.i ' i;-<- 1-'.. C trc..!.*r A -J.' U S COVCRMl'Cwf uriKS or> ice m i o--js CLINICAL RECORD Heport on or Continuation o? S. f-'. 10 - 1000 (Strike out one hne) (Specify typo of examination or dot a) (Sign find date) Urinalysis vas yellow and clear vith an acid reaction and a specific gravity of 1.020. It vas negative for albumin and sugar. There vas 2+ bacteria. Serum iron 78 mcg., serum iron-binding capacity 285 meg.$j. P/3 uptake vas 35*3/^ vith a normal of 29.1 -i- or - 5* Serum T/iv vas 11.1 meg. 9 vith a normal of 5*3 to 13 meg 4-hour urines vere porphyobilinogen vere negative. Serum creatinine 1.6. Pearl kinetic studies revealed a half-time of iron clearance of 110 minutes. A Lead determination of the urine shoved a concentration of O.789 mg. per liter vith a normal being less than O.15. Direct and indirect Coomb's test vere negative. Red Cell fragility vas decreased negative. Urinary 17-ketosteroids vere 13 mg. pe 24 hours, hydroxy corticoids vere 2.8 mg. per 24 hours. Serum creatinine vas 1.54 per 24 horn's. These vere considered to be vithin normal limits. Calcium 9*6, inorganic phosphate 3*6, glucose 110, BUTT 26, uric acid 6.9, cholesterol 200, tota protein 7*7* albumin 4.8, total bilirubin 0.3, alkaline phosphtase 25y'LDH 125, SCOT 30. X-Rays of the chest vere vithin normal limits as vas x-rays of the abdoic Barium enema vas negative, and skull films vere also negative. Upper GI Series revealed a deformed duodenal bulb vith no active ulcer demonstrated. Gallbladder series shoved normal gallbladder. An IVP vas also negative. A bone marrow examine' tion shoved a markedly decreased stainable iron. Serum protein electrophoresis va; essentially within normal limits. Hospital Course: ^The patient vas placed upon iron, multiple vitamins, and vas given four- courses of Penicillinamine Therapy, which consisted of 1 gram of Penicillinamine per day' over a 3-day period. The pa tient has shown a good response^vith hematocrit of 33-5 and hemoglobin of 11.1 on discharge. Urine lead levels remained elevated, vith the last volume.on 10-2l- being 0.4ll mg. of lead per liter. The patient vas discharged after obtaining more urine and blood for lead studies, and will be brought back to the clinic for possible repeat of his Penicillinamine Therapy if the urine levels remain elevated. The patient vas diecharged on Iron Therapy and Multiple Vitamins. He has a recall date to Unit II Medicine Clinic on 11-19-69. His condition on discharge was fair, although he still shows a quite decreased strength, slow mentation, vith very slow speech and a shuffling gait. It is believed at this time that the patient is capab of restricted work, which is not demanding. He should not return to work in the Lead Company. \ PATIENT'S IDuNT1 r iCATION (For typed or written tsr\trt>'s ivc: A`j me ---la st, first, middle: grade; dfit*. hospital or nntdicol facility) LATCHISOU, Andrew J. nZG\STZR NO. I 439-40-25-67 WVM/\R*L0 NO. 6S VAH ST. LOUIS, MO. 63106 REPORT 0`! . Of COJiTIH'JATtQH OF 10-1000' KtuuUunt Form .v>7 ^ l 2.1 -- 0-- 6^ J07-10+ -t: 11-10-69 | 0k.j /9_ 1t /9 11 St j :v J - r \! K.ri.i 51J K. t' v .A ' ,i s r ! [ !kirt .1 u ' iJ.t ; C i f v ;!, i; A - t CLINICAL RECORD TO: ^ REASON COK fiEOUE iio y/o (J^'rJC fj/# FROM: y v covt , C ' > C t . M t 0 - 1 ` J J CONSULTATION SHiiE'ir' <Tf\J -- <-/\ <9 - REQUEST -.c.-c.4. tnr.Vcf u:!V.y) DATE or tlKQfjZST __u^u-rr FC?f.L/!CS/l_6sr- x 7& cLx f-fx % PROVISIONAL DIAGNOSIS DDOCTT^QR;fi SS SC IGNATURE o^-~^ JT /\x t v a t ^JZcruo <ro^~JL S ^ --L<M? ,4s^% APPROVED L>2c^X PLACE OF CONSULTATION El5qStD QOH CALL CONSULTATION REPORT A-EE-^-c J/ QU ^e^t^nccfIsein c y JJJ^pobTiN>ete r 4" L<\ 'O^v N'Aa ^pY L*e-jy o 27 ^ Ua&cA If Y lv/vy*r j6y-( -f<rr -pa^-r ; AsMp '^A/'OxUS^.ltJ'S -> ,T~ `Va.nC'^X' -W-evLAsv's trA" [houi <7^? i i"3 (Y0A2- o 4 *, <^cTyC\CX % \ $>_ I^JZ^O^U u Jj Ck x Ss ^- L^-CXa s plA^> 4r\VAX> f l^uioX- \ SIGNATURE AND TITLE -- ( <YUcU J :p>y4cow, *S-- ^oe^>^j' > {Continuea(oXn ^re_ve^rse side). h v IDENTIFICATION NO. ' ORGANIZATION PATIENT'S IOENTI PI CAT ION (For ty ptd or written entries (jive: */a/ne---Iastt first, middle; grade; date; hospital or medical facility) L A T C li I SO M A M 0 k E J 439 AO 25 57 2 ' 7 13 c PL28 U2 REGISTER NO. WARD NO. CONSULTATION SHEET StaruJarJ Form 513 313-104 0 91gc<S r\ r) H /.. jL .! J ---------------- - 0 \y:JA s 19 fc'rU-j1 dhsxy<2^e_<$, i . ^y-hua?JX ' Cy o , \'we^ u-esi-Ve, - 1- tuiWsy -- - "O V. 'iw U<2x/_05 -epjp' y^aS'yiuz^ r>r S s ' 9 4 z. -t-i-r~` i+2. h^ -9/ -ou- & tx.h1' 1-2, '9 ----J99 2-^ .,wa Ji....;; 92>v t i/j z _ Cs5W le^W'cG-i! -nM^ C--x ^K -- ti OU-\ , <?u-f`-t%- C^a^)3 - <Pa X{. J>J?" ^(JK.-Otca^Wi^ic- IPOM^ 99 9/ ^ Uy o" ;^? 2D d^aDUo. ,':9ds&)--aSY td/i 90 cA<2_ L-zg-iP. --\ rcou^ ^,-Li. -^. SkcW 9=. P& ' llAS 'f . : ' :' , 0 0p9 : " - 1 ./ 0 pt p nO Zo. i192-2V.J y t'.ro.a - u s toynHvur rcix'icc c * * i. c mu CLINICAL RECORD CONSULTATION S'iLLT TO: REASON ror: RECT-UiST (Comp/eiiifj and finding!) REQUEST FTvO?*: (.r.tqur.!,:-.; iroN, tir.it, cr oc(;:"X'[.) C-- LL _ \j w :X-*~ d a t u or r^Qur i-n-c Hb Yfv tJj^ 2-9 LT LJ- CAzcy ; 7(jj+iJL |7 Uc.-^>. .< fa ,, r/r~L- PROVISIONAL DIAGNOSIS ^-e--Tjv 9- ^ \. d o c t o Vs siciN/Crum: /N.. / j APPROVEcO Atzum. C_Q^-Jl * / | PLACE OF CONSULTATION I- Qb s d s io e o n c al l ?** /. ^Zzr/ CONSULTATION REPORT r^/ -C j/u a Q EMERGENCY O ROUTINE A/'^x >u / ./ . <^ - *2. ^ y^-T l Z^Z x. Z/L , ^ J* ,' LLUll^ SfsUjt^'/y G^G / c^G G~.. C /MTi Au Av ^ _s_ SIG NATJJ rtE/A IS t5 TITUf.'* A-v^, /&.* 0 v (Continued on reverse side) DAT6- IDENTIFICATION NO. ^LLLlZZORGANIZATION /I ,7 PATIENT'S I DENT IF-' t CAT) ON (For typed or writ ten entries five: 'ij^na--/j jf, ^rj/, rrudd/e; ^rade; daf-e; /jospifa/ or medico//aci//r/) REGISTER NO. (3/WARD NO. LATCH ISOM A'iD'^C J A 38 4 0 2S ST 2 17 C Pi. 2 8 U 2 13 CONSULTATION SHEET SfjnJjrd Form 5 1 > 3 I 3-10 I Kfe nU oZ 1i 0^IX Form SLC Rev. Jon. J T*7 prof rHi \ c } Dy Ourc.JU of Til - LuOfc-t Ctrcd-'r A-3? CLINICAL RECORD CPCCiHLiN tiuuun t l :) d v CM-CiMEN 0cryy-JS- cx/t'^uo-v^o \1 TISSUE EXAMINATION OA1L ODTAiNTO , 7/ ^ /<T? -C_- J ii GROSS DESCRIPTION: (DR. H. K03II ANO'/S KY: gek} The specimen consists of several small fragments of "blood clot measuring altogether 1 cm., completely embedded. MICROSCOPIC DESCRIPTION: (DR. K^KCSmilOVSIO/nh:gofc) Serial cectiono through the bone narrow show very moderate hypercellular narrow. Megakaryocytes are normal in number and morphology. Myeloid sere is are veil represented and erythrold scries are moderately increased. Ko basophilic stippling vas found in the red cello. DIAGNOSIS: k. C PL25 U2 CliKICAl RCCO'ID ifi.'Vr.s >:,M ' rtt:V.'i//. c a n d t im OAT Wf\l T T L!N | DOCTORS ORDERS / i r.cl'j't: toj siuUiUn j o-vV rs . /AXr c/;/ /Avu* /or tXtC< f uA: y im./ .:; > /.,,,t/i7. :i:,.,- .*//y oc/ujv.-ii'if,: }>Tod'j>jt, }r!-:ntic:>l in <Jos:n]c form f (.` A fv/y k` ` 'c.'f/ni.s.'i.-rt. '/t'.' Z, A55 cArcXet/J ^ ^U.A SC'S s ig m/.t u k : 7^17/4?: Id--y_k'-'~c'v'~`-<,.. )" uAXcTf iTVw.p-'t '-uC- ."A -(D-__--------------------------i_ _(2?)livik^VVV, I VyXr?*-.A- Ac''-^ - . .ft. ...... --------------- -- <Va-r. i'V .t U> <g)___Qlzt- r.G.-rvA JLS23L&nMzL ..A- <V>C.' (A A lv ^ r--vUr <'PA^ At?v/U JVVp rrpvALiy^/TD'A ;VAAV* iU^v^-.vwv-<-^;.._ , PPbb ,WArw--te-cA-V ss(iPfl6&0s' /] . -- SVuiA ^ V C-.Q v~ A yA--Cy^- fc\) 1- :r4sA J Aik jytv A-V-"a /h >^y 1 - -.-,, "--1" -.-r~?^gg?=- --T'-vg^ugrsrrrr - .P0'C ~r"p- v cA A v\ \ " iSV/V/A^Vv^ Vo AM/^ "" `T'iCVLe <ic\_v_ ip.w? vAxx sc 2.'ov ovvX .] _ X u(9 ' ` vAA&v A0;" ` F 'A *X''-'cO . Q^xroxSL AUxcA < Ax cV Prf1 v '; - ,:\m i/ m @-k'i-.. V^wCL-M..--------$kLc7^^g>piV-^_C--,, " _(iL--Acv>c_o--jLa ~A----cr--Vi&ik!=v---------- A?ALxL -. __ S.CPj 3v a .l Av _1s ___> _<3jdL^^ .(2)_______/ ^ x p *- a x -'y |gG i 021 26 X IpkA 1 il'v f(t/, J 1 ' i. I';' 7 ' t'r .1t r Dy Ourcnu o` U>c iiu .ict, C>rc.utsr AO? CLINICAL RECORD pff.(.imi n/jy*fih'11 y f' 11 v __ {x (___ !~~uA-j iOw TISSUE EXAM!MAT!ON O A. t T. V'UMUI 1 7 /l7tf 9 0* '3~v~d. / X fcJlIEf CLINICAL HIOTORY {/r.c/ecte durci/oo o/ Je-iioi crnd tcjNdiJj- of yrcvrcJiTii a r.oopTuIai] Ho'do Oa s -L. F=~ -2-T .-6, G C^--d /x C.'-Vyyj PrtEOPU: AT J V Z ' L> IA C;*N OGI8 <P^. jC/'' , OPERATIVE KI NDf NCO POSTOPERATIVE DlAGNOC-tG SIGNATURE AND^TITLE J. NAMEOFLADOnATOnY /Gro-xJ daciiiitioa.. hlsiotoaic examination and dlaanoses) PATHOLOGICAL REPORT ACCESSION NO{C), B 69 ~/i65 --- '/ &6?//d- GROSS DESCRIPTION: (DR. J.A.GDHDE3 :gek) The specimen consists Of approximately c of reddish-brown, shiny clotted blood. The specimen is ^submitted in its entirety, KCCRCSCOPXC DESCRXFTXC1I: (DR.J.AoC-SKDES :50k) Microscopic sections reveals nur.erov minute fragments of marrow. .There is a suggestion of slight decrease in cellular and also a slight decrease in'erythroid components. The iron-stain gives the impression of i^di-dd having adequate iron in this preparation. Megakaryocytes are numerous. DIAGNOSIS: No diagnosis made. DAT? Of RETORTi \ D & T: 9-22-69 \ VAH, St. .LoGSS^VO^jS^S^MtDJCAU fAC.Urt) SIGN ATUr.ci /S,vri/y loeoli^n / /rt,{>jr,j{yry if not p.i'l tf r/^u^ttinn }i Stondurd Form 5I9A .Re*. Av Pi cm w ly <* cJ V ^ 9 y/ ^ l it c 2 Circvlnr A - 3? iKc*.} r a d io g r a p h ic r e p o ; . * * *lrtT I r\ A \fjTK: or-ter.i CUBICAL KCCOED DOCTOll'S ORDcl'iS si;/nti''.:re r;iu>t accompany eucA entry inrlvtUnj .Ua:,:!ihy vr.fcr.s. t)utc c.v/ time (of in^titutiny cut t.7.vv*t:- .... ' rccordd. CLINICAL <JC' / OOCrO'T5 Kcv. A svf u.c >' i Ba.'uu r>: it-.c {>.>.'>:s( Cifv u fj r A -- ) CLINICAL RECORD t'(T r 41*. mi c cor :sul y a t ion $:;;o -;y ^ * Q - Si.) PROVISIONAL DIAGNOSIS DOCTOR'S SIGNATURE v k J APPROVED orPLACE CONSULTATION Qe e o s ig e 0o n CALL 0 EMERGENCY Q ROUTINE CONSULTATION REPORT o ^/--Yr -(Lo as Yb.C yp-`^j -fc'-y /AA'i-lj cc in 0 #a -<jAu (/-O^/GiOjl.<. C-La-c ^", i/C?1 ' /) (y-j J?' #ejj-4w u a 0. -<? 'UujUi^J . V_.o>>v C V. %, A.r\cJ JC@c& pf^YT-Jv.Avvtt^ S) , C7sfj /V (7 g7 2 r^ ALYY, - /^f SK(^Z} jf/f -- 70>.ASfl /KA'/" ^.cy ~" 0/\ AflXA --- '7iAY--'7A'o ^ y ' <<>&-/So ZptiT-ch:^ s:n/ f 0_____ } ~<C_- ^1 /Lt--A-^' SIGNAxzjrfz. AMS TITLE (Continued on reverse side) DATE IDENTIFICATION NO. o r g an izat io n *<&4? PATIENT'S IDENTIFICATION (Fvr typrd or written entries give: ^.inis--last, first, r middle; grade; date; hospital or medical facility) REGISTER NO. ^T-o ~ xrz7 y/j. CONSULTATION SHEET ScandarJ Form Mi Mi-104 1s nu o7 -11 75 nU V ** 1 i. ^ . V >. ' . * V ' . (!) u. ' . O u . % *s V.)' 4*' n vM .> 11 w a ii* . J > H Cl cC *v: . * irj .2* V * . 1 c V r, ;, G * i: *' i 4 Jl . i5 , .jr 4 -, o . ! X. * u a ;- .5 C v. * j n . > 'k ;>.* tn t; - ,v; .0' ? j t *'-i : i Vo o o --t M O # i i o ri 4 M *' { ,1 c J-t Cl .3 6 .i ! Cl o; t3 ^7 < 1 M --i -i ;i -{ n >% ' Vi : rl i ' , * * ,.*i ' 1 r> M ;* . o O l) O * '.* r !> f * rH <ii w a 11 ;i * i c j -:i . "I "O G O* O a> (0 ;. i* ` * * . rl * *- * ' f-t M o o cu . * d o \ ! < 2 f2 . -j c; C<< n ' 4a *- , * w C m. *-* fM ! 1 > '* ; * o -j * J* O o -<. .1 7l n } *. 0 4. 4 }i *.* ^ > ;s ** C: i i .7 ri n <7; -* c> /-j .1 *< M Ci 3" n "N 'v^ <n IT*' vJ Cl c* <1 1 O CO C! .d A% *; n **. fi V) i7 '* M ua vi H C via -< M ,5 `V u **; 01 ; .i'i "1 M * .? ?,. a *4 > S on '-i -3 >' n * 4 *2 ,*~k w ' ri :~i 1? *' * -.1 O O t* t *2J .a n .ci r: *r; `I .' o .. i *.Q .VI O :3 *1 C 11 .'l *.' V>! w-; n : t .1 * -i a .1 03 < a M tM O B "7 a ii fl kVl ^-4 !i s. q *! n H <-: (S 4J <a *< ,'r ; a tl -< j TJ >' vj *c vi \2 4 rj rfS M t - 01 n v k* *M *! 11; 4J (.*1 *. i 44 O * , ti --I i . * m *1 * * --1 .a (.- ii (.1 a> r-- :i M 60 *o `n : 5>i !. as G .-,1 CO a c* Js^ 1)i }i 3 .v v> i*J `r; *> &*.. . -i n o5 A % e to H a) 1 Q* ' i .3 1 r ;i n -.*i vi \1 :t ?i U **, | 3 w H . t < ' * -n **5 i-i ?5 > M fj 5 vt v) V1 '1 C 4 C -- 4 :i .j *c o Cl nM in vS .-> ,i * ** *.4 :-i o vi . , (j 4# 1W cs . *v *) aa H -I1 2 , it o rj :1 v ' *r\ a tfj ,,'4 .> M r* ,i n *4 -* ti fi i* C2 ^ t: *C1 n .r o2 -4 U - -4 o ri :Z a r r; 4 * 1 Cl :-> J fk J * ; rl os U 1 it# Oil i 1 O ** r' : , *.0 . | 1-. a f V. < '-5 , | , . ^ v v* \4 m ': ... vi 8? *w ** l H , ; u Ago-*wAaJ ,l uO gA'vCJJJ-eo C`rJj [f K TKiT <;? J u <H -<f : -oKaa -fly VU-i *<Ju!|-5; fii A*' n(; ' ai r3-j -cHl-4i-'~ao<- <'< o, ...i;6 M W i-> pj v.i cii o u u * T-rt MH M 4J W 3 ,Q * r-t$43ji ;'$<f,-< `a cj idOmb a w q tocaoj : '] H ,% . f H U G llitH N O A I.tM S L * i l t*AM -- U iR S I N A M 6 -K lO O L li i ,, /; ' /y^ t<:/' C ^ ^) ^ ^ /w <-y'Xi ucOxy"VY""' f''' Cv / f V. - --'/ V < t-h // (Above $;ace tor mcchaui'co! l! uzndj Trfn`iTi\T;T`cir7T^L 1^s'r^uT^"<^CaXlT6"rs7''5Vr"iTcAu rt.-.ji.-ios. /n o iMcas:v .a l o.Ao-.waS EEOUESTSO tr GUST: Ftcauinatron of tae cnest in. posrerror-au-eerror ana lateral projection: fails to reveal evidence of infiltration, or consolidation in the visualised iuns fields. There is a pleural thickening bilaterally, particularly on the : Tiiere is no evidence of pleural effusion. The cordis c and other mediastinal silhouettes ere normal. DIAGNOSIS: 1. No active lung discaso.;_no cardio:.iy;aly Examination of the abdomen in supine projection reveal's the psoas shaders to l veil delineated and normal as is the gas pattern. There is no evidence of ope foreign body vrithin the gut. DIAGNOSIS: 1 Nesati%Te__aMo:nen. DATE Of EEPOr.T; , a U _________ __________________________________ ilGNATUf.Et iSff.-'ly iJf.-'ln. '! I'cr.i^ry %! nit fart ,y rrijutitii' ! (n a m E, or not'il At Oa Onfta mc o ic ai f a Cu ir) d & t: 8-l-69e: $laodo( J Form 5 I 9A i^c*. At P f 0"'i/lgo I f-J by curtuu ol llo 2 Cifc^'of A -- 3 2 v.} RADIOGRAPHIC fcbfr'O; 021 33 ai?>:c7