Document ZJreKkbn1O8QE4d8OQnggn4NJ

/ OOy-> CD foc> CO CD f3lj 4O cr t-j UVt--O11 A CONFIDENTIAL RSPOFT ON CASES CF TETRAETHYL LEAD INTOXICATION ARISING CUT OF THE CLEANING OF AVIATIC.N GASOLINE STORAGE TANKS AT KCLB, DORSET, J- .NUAFtY - MARCH, 1951. I By DR. PHILIP BOYD. CHIEF MEDICAL OFFICER* 0020871 C 0 S TEH? 3, Page 1 Pago 2. Page 3. Pag 4 -6* / *r-i Sunsairy and conclusion* Racossaendatlcna Personnel end site involved* Chronological narrative* Appendix Medical report dated February 12# 1931# by )**f # OsHop# H*H*C*d*, on or?o o* Ippendix *B* -* Medical certificate relating to Page 9 -- *uf * r&ga XO Paga ++JL Pago mm *i&+ Rage f * Appendix *C* Appendix *1)' Appendix s* Appendix IF5 Apnsndix *0* 'fedleal report on Medical report on Statements relating1 Statscsent on Medical report on HP 0020872 The cleaning of four uadarjjprousd tanks (MW) at th installation of Shell Hex & B,P* Limited at Pool, Dorset, was th subject of e contract with Messrs* flaaona and Hawker limited, of IS Bolingbrok Grove, London S*H*11# The teaks had been la constant us by th Air Ministry for th storage cf aviation gasoline containing high concentration of T.iS.L. between 194$ and 1945* Si 1945 they were nptiad and had regained so since* Tank cleaning began on January 19, 1951? and in all seven sssplcyeos of Sisrons and Hawker Limited wore involved in the operation, until cospleticn on March 3, 1951* It appears that the Foressan-in-chargs was fully fusilier with the potential hasard of intoxication from tetraethyl lead arising in the course of tank cleaning operations and of the rocorsasnded precautions to ba taken to avoid exposure* ITevcrthaloss, admissions wore sad that scm or all of the men entered the tanks without respirators* Between February 9 and March 9, four man complained of fooling unwell, one of who was admitted to hospital and one died* Another on of th four was subsequently admitted to th Middlesex Koopitel for investigation* Cf th reaaindar, non sals any complaint sand mibeoejaent. easmaSjriat&eia stowed no sig&SXictirvi absorption$ it is possible that one vac not exposed to the hazard* CCHCLtTSZOS. Frcm th evidence available and from aginations mdo subsequently, there is li btl doubt that three imn suffered fro tetraethyl load intoxication in varviiv? r?m&vn*+ - vrit(*n /Ha ot K/T 0020873 >JcC drove, louden F*F.X1* rtja tanks had been in constant use by the Air Ministry ttlC storage cf aviation gasoline containing high concentration { r,J,L. between 194C and 1945* 2a 1945 they were onptiod and bad reraised so since* Tank cleaning began on January 19, 1951, an:? in all seven osplcyees cf Simmons and Hawker Molted wore involved in the operation, until completion on March 3, 1951* It appears that the Foresan-in-charge was fully familiar with the potential ha sard of intoxication from tetraethyl lead arising in the course of tank cleaning operations and of the recosasended precautions to be taken to a void exposure* Nevertheless, admissions were sad that seme cr all cf the men entered the tanka without respirators* Between February 9 civ! March 9, four sen complained of feeling unwell, one of whoa was adaitted to hospital and one died* An- tfcer one of the four vns subsequently admitted to the Mid<l.lesax Vcapital for investigation* Of the reminder, none sad any coupleint aril subsequent cssasimticn. showed no significant absorption5 it is possible that one was not exposed to the hazard* lAl '.%Vri ft From tho ovidence available and from examinations made subsequently, there is little doubt that three an suffered from tetraethyl load intoxication in varying degree* The writer did not hevo the opportunity to oxonino one of thee wjho died, and although there is no ovidenco to show whether he was sin.iln.rly affected, in view oS Ids known exposure, the probability of absorption of tetraethyl lead boinf' either thr> ssaia or a contributory regarded* KE 0020874 u g o of death cannot be dis The fact that son vore exposed to the hazard of tetraethyl lead absorption is attributable to the lack of enforcement of the rocosaonded precautions by the supervisor responsible* r3G0^iaHDa?ICNS^ ' '' Sine the potential hazard of tetraethyl load Intoxication arising out of the cleaning of gasoline storage tanks is veil known* it ia recooaonded that strenuous efforts be End to ensure that the cleaning of such tanks is conducted under the strict and continuous supervision of a responsible person well versed in the recesoonded precautions and who boa the authority and character to enforce comT lance with the recemefid&tlono# (Philip Boyd). Chief Medical Officer. \lt 0020875 ,.wv Messrs. ^oll-Moa: a3 B.P. Halted, at Poole* /,/: ; Tank Cleaning Centraetors. f: Messrs. Slsaons end !5evksr Limited, / 18 Bolingbroka C-reve, l g h d c b , s.y* n. Tank OloaalRsr Hteployaee Concerned. Details of Tank. Pour underground tasks wore involved in the incident. They were each of 4OO0 tens capacity, 180 feet la diaaeter, and 20 feet high. The tanks k o t o in cons'bant us by the Air Ministry between 1940 and 1945 as A.P.E.D* storage for aviation gasoline containing high concentrations of tetraethyl load. Si 1945 the tanks wara emptied, leaving cpproidmtely 3 inches of sludge c-n the bottom. In June 1950 the manhole covers were removed and wind sails erected. The tanks wore lort opera until cleaning cosaaescod in January 1951. H 0030876 4~ H* CHIXlft-LOSICAt S&RPATXVS. Dotoj The following details were elicited subsequent to March 12, 1951* upon which .-.late the incident was first brought to the notice of the Company* January 19* 1951 > The following son comenced to work at tank cleaning at the abcvG**5sontioned sites- cna February fhc last was foreman of the gang* Shell-Ilex and B.P* Halted reported to Messrs* Sissons and :&uker that the tank elasnar^^^^^as feeling unwell, and that it was thought that he was suffering frost iafluenaa. On the same day Mr. Howland, tank cleaning supervisor of Messrs* wrote to the foreman, at the site, ami requested that ^JJ^hould be sent to London, with instructions to report to tbs Contracts Office* Instructions were also given for each somber cf the gang, including to be a31cally saainod by a local doctor, in accordance with ncrsaal routine, February 12* "r* Gallop, of X Farkstoae Hoad, Poole, who issued a report* (Appendix lA)* At this time ^jjj fooling unwell, li&d returned to London, was complaining of sleeplessness and weakness, ccsplnining of sleeplessness and gonerttl nervousness, end I no coapiaiats. A3L3. avie were reported by Dr. (lollop ua chewing no evidanee or signs of absorption of tetraethyl load, jllbyuary li, g-~n visited Dr* Gallop, complaining of a core t:u*oat* tn the sane day, Joined the Pool gong to replace K 00208? / Ilgisr, The following details wore elicited subsequent to March 12, 1951, ttpon which. date the incident h o b first brought to the notice of the Cosgauyv January 19. I9fil. The following son comenced to work at tank cleaning cboyc~:-:Gnt.i;;'Bd-d site:** UXI Iho last was foreman of the. gang* February % SheOl-^ex and .P. Waited reported to Messrs. Simons and 5hawker that the task cleaner VHB Mtta ^liRg unW8lI an,i thafe ifc ^ thought that ho was suffering frees iafluenaa* On the scuae day Mr. Howland, Lnnd cleaning eupervisor of Messrs wrote to the foresan, at the site, and requested that Perry should be sent to London, with instructions to report to the Contracts 0 flee. Instructions wore also given for each rseabar of the gang, Including to h n3ically essoined by a local doctor, in accordance with acraal routine* February 32* *"*to Dr* ll,?" Gallop, of 1 Farkston head, Poole, who issued a report. (/gpendlx A*)* At this tin foaling unwell, had rturned to London, Capgur s complaining of sleeplessness 'and weakness, cosspltiiniag of elooplossnose and general nervousness, and no ccmpl^lnto* All four wene-a reportocl by Dr. Collop as showing no avidenco or signs of absorption of tetraethyl lead* Capsur again visited Dr. Gallop, cosplsiidng of a sore throat* Cn the suss day, joined the Pool gang to replace Karon 2.* feeling unwell, loft th cite of work and returned to London to see hie own doctor. HHP t!ls foremn, in view of the fact that the tank loaning was partly conpletod, loft instructions for the coaling of the tanks, and for th tracing of a los^ reported by the Sholl-eSox: engineers, and he hinself loft on weekend leave for London, K E" 0020878 **5* March 3. 1fcnk cleaning and sealing were coaploted, and all that remained to bo dona appears to have been to check the verb. ^turned to Poole# as seen by his own doctor and certified as suffering from neurosis> an& unable to follow his occupation# {Appendix *B*)* March 6* requests! leave of absence for domestic reasons* ?&reh 7* fBV^a ^isittod to St# John's Hospital, Battersea, in a confused sad agitated mental state* Ca the sas day, ^JJPP^-splained of sleeplessness, and reported to a local medical officer* On this day ho took the whole contents of a bottle of sleeping draught, together with & number of aspirins* Harc-h o* admitted to Poole General Hospital, end labor 'transferred to Dorchester Mental Hospital* .`arch 9* Wm at ft* John's Hospital, unknown to the rest of the team. sported to Poolo for the first time as replaceroent for March 10, ^^Bpreturnod to Poole, &net heard for thu first time of admission to hospital* On the same day and, learned of death* March 11* instructed to leave with his gang for Holyhead on _ March ID, end in proceeding to do. this, hoard for the first time of Capsur*s death* On the same day, Mr* Howland was independently informed that C&pertxi* woo tJuTforing rroa nourools. March 12, 'Mr* Howland vo inforsed that had died and that Pearce was missing* HossViU A routine yest-raortea was performed m the body of ~ xnasadeatod with the a result of K 002087 r-a newrosis, and unable to follow hi occupation. (Appendix *B). Ksrcfa 6. leave of absence for domestic reasons. ?farch 7. admitted to St. John's Hospital, Battersea, In a confused and agitated mental state. Cm the earn day* ^jJpsotBplained of sleeplessness, and reported to a local medical officer. Cn this day he took the whole contents of & bottle of sleeping draught, together with a number of aspirins. Hereh 8. IHP10 admitted to Pcolo General Hospital, and later transferred to Dorchester Mental !k*epital# Kerch 0. m/Rdied at St. John's Hospital, tthknown to the rest of the team. ^U^roported to Pools for the first time as raplacomant for jspaur. March 10. ^m^roturnod to Poole, and kwsrd for tho first time of Hogan's admission to hospital# Cm tho case day HHV an?i learned March 11. instructed to leave with hie gang for Holyhead on March 12, end in proceeding to do 'this, hoard for the first time of Capsur's death* On the saia day, Mr. Howland was independently inforracd that tmft&sriMQ rro neurosis. March 12. Mr* Howland was infesaod that Capour iasd .iod and c.hat was missing. A routine postmortem was performed on the body of Kassrs* f||^m^||B^oosmsmilcated with the Company, no a result of which, a mooting vas called for the following day. l-fcrch..,33T Sic coroner's pathologist reported that ^J^dled from meningitis following influenza, Kossrs* and 3&b*vi8Wd Poarca. an.d ^^J|pro00odod to Holyhead. A mooting took place at which X*. Hoble and Kr. Biggs of-thj* Company, Dr. Boyd, and Dr* Cassells of I.t'.I* were present* JJecislpna were t^len with a view to establishing the facts underlying the preliminary report by Messrs, ana! K 0020850 March 14 Arrangements vere Bade for to bo admitted to the I-dddlesex Hospital for iarosttgatioa and treatment* and for am Fsreh 16* be seat to !*orthvich for emsiaatiloa by Dr. Bennett. end Dr. fl^^Leited the Dorchester i&ntsl Hospital, to confirm arrangMjnte for the investigation and treatasst of this man* The subsequent development of events is Included in the detailed accounts and appendices on the wen involved* K & 0020881 DR* %i'ni C7i.? GALLOP AND DR. JT*S. ASTBBRY* 1 Parkstone Bead* Poola* Dorset* 12th Potrusry, 1951* fesgrs. and Lake het&te Site, Hsworihy* --*>*****w>**i*iw*Wn 1 have today essoined 4 of your employees who are verking em tank cleaning at the above address* Coiapd&inad of sleeplessness and general nervousness* I can find no evidence of absorption of tetraethyl lead* Complained of sleeplessness and weakness* I can find no abmra&lities or signs of absorption of totaraotliyl lead. Chaplains of no symptoms# Hething abnormal found cn culmination* K 0020882 a '/^VL BE. H*F* GALLOP JUS JE. J.S. a S20RY* 1 Psrfeeton Bond*. Pools* Dorset. 22th February, 1951. Messrs,, Hissons and Hawker* Lake Estate Site* Jfesworthy. 1 have to-day examined 4 of year employees whe are \forking on tank cleaning at the above address. Complained cf sleaplosonosa and general nervousness# X can find so evidence cf absorption of tetraethyl lead. Complained of sleeplessness and weakness*^ I can rind no abnormalities ox* signs of absorption ox fcetraatbyl load* Complains of no symptoms* nothing abnormal found ;n xeatisstion# Complains of no symptoms# Nothing abnormal found on esussinatlen* KH* 0020883 G&IXCP, M.P.C.S* 4ppt. Factory Durgeon. 62 F&lcoa Bead, Claphas Junction* s.wn* Sliis is to certify that T-asiding at 71 Grant road* 2.W.12* is unable to follow his occupation. ttift HrvQTCS sm>. HT 0020884 Js4*. `-.A: ASgEKDSX C, 184 SteckweXl Hoad? louden. S.*9- Aged 26* SSile# !%rrisd* Two children* Foroasa. This mis started cleaning storage teaks with Messrs* Sissons and Hawker in December 1949, and was prcsssied to cltergehand la tey 1950* On January 26,. 1951, he was pit in charge of teak cleaning operations at Fools* Although aware of the recossaended precautions for the pre vention of exposure to tetraethyl load iatcsdlcaticn, he admitted ften&ly that both ho and tilts men under him, to his ova knowledge, ffcequesUy emitted to wear their respirators* They seldom wore the smareatsrs provided, tut always wore thsdr wuterpro'-f'suits, overalls, rubber boots and rubber gloves* The sludge arc the tank had been known, to splash his face* As pert of his duties he sad sura that the overalls and and underclothes wore changed ones weekly, that the non*a boots; were washed at the end of the day, and that their hands were washed before eels* On March 7> 1951, he began to he worried about hia vfe*o health, and. took her to BrMlingtoa to visit her .peraats* On March 8 lie returned to London, and, fooling d up,8 decided to take two days off# Ga March ic he returned to Poole, and learned that one of his workaen, had boon admitted to a mental hospital* He was vary worried, and ton Ills own Inlfttiv* Ho e*yw tli* flira* o ls*y vith hie nj e, pefiswig9]r8t to London* On March 11, he spout the night at FUrtes* near Swindon, on route to Holyhead, having received orders for his gang to an assignment of tank cleaning there. The mm night ho overheard the wm d&srcoa&ing ' the fact that another workmate ted died,- allegedly froa a brain twaour. He became very worried, had a few drinks and wont to bod, but he could not sleep* He ted tfca h wished which,for 184 Stocfcwsll Food, London, 3*W9* -aged 26 Male* Married# Two children. Foresaw. T?v$ <s ras>.ft started cleaning storage tanks with Measrs* Massons sd Hawker in Decenber 1949, sad was promoted to ehargehend In 1;&y 1950* On January 26, 1951, he was put in charge of tank cleaning operations at Boole* Although aware of the roeamsndad precautions for the pre vention of exposure to tetraethyl lead iatoxication, he admitted frankly that both he end the noa under hia* to his own knowledge, frequently oaitted to veer their respirators. They soldo were the souwesters provided, tut always wore their waterpro-f suits, overalls, rubber boots and rubber gloves* The sludge fress the tank bad been known to splash his face* As pert of Ms duties ho tied sure that the overalls and and underclothes were changed once woekly, that the non*a bo--ts were washed at the end of the cloy, as*l that thoir hands were tiamsed before meals* On March. 7, 1951, ho began to ba worried about bis vifats health, and took her to Bridlington to visit bar pcrents* On March 3 he returned to London, end, feeling "fed up,B decided to telco two days off* On Kerch 10 fee returned to Poole, and - loomed that one of Ms workmen, had been admitted to a cental hospital* Ha was* vary worried, and on his trwn inlativ# ho drtrv the tlrats lorty, -d.th his jsanfj cs posssagaaro, to London* On March 11, he spent the night at Purton, near Swindon, on route to Holyhead, having received orders for his gang, to an aasigmsent of tank cleaning there* The ease night he overheard the tson discussing the feet that another workmto had died,- allegedly froa a bruin tuaour. He becaaa very worried, ted a few drinks' and vent to bed, but he could not sleep* He load the feeling that he wished to go to church, which, for Mas, was very unusual, but instead ho visited a doctor* Ho was dis charged with no trostaant ether than reassurance* He returned to his lodging, loft e. note fo. ais sen, and, at 1*30 a**, stf^Pted to walk in a 0020886 |\ w. * .v rf -lev- direction which ho hoped would bring his to Bridlington* Ho received a lift to Swindon, and proceeded to walk is pouring rain to within a few niles of Heading*. Her ho was picked up, tirad end with blistered foot, and voc taken to Chiswick by lorry* 'His recollections of the? journey ware vague, but ho reasdbered taking a nuzsbor f bases until ha reached his father*0 house in London at 7*45 a*a# He was lot in to the house by a neighbour, and issediately ho telegraphed his wife* Ho than lit a fir* end crouched a the floor in front of it* At no.' n he telephoned his fin office* His wife returned frea Bridlington, and, because of her anxiety, took him to St* Holier Hospital at 11 p*n* He was reassured, and return to hia father*8 house, where he slept well. On March 13 he visited his firsts office, where he was questioned concerning the recent events. Hit doctor's assistant, whoa he saw later, proscribed phsnofcerbiione Following the discussion on the night of Ksrch 13, between the officials of Th Associated Bfchyl Ck>npany Halted, Dr. Boyd and Dr* Gosao] it was decided that this patient should b kept under observation, and arrangements were x&& with the i-HsMlesese Hospital, to which ho was adssittod ca March 15, 1951* On Adalaaion*, 15.3*51. . Coanlednts 1. Horry* ; 2* (a) Twitching of the nose* (fc) A sense of something stuck in his throat* (c> A ertseping sonem-tien starting aberce tha rljjht ear and radiating backwards sad downwards to fcha right shoulder, aggravated by telephoning or wearing ear-phones. (d) Transient Ices of focussing power of the eyes* () Transient fooling of what i known as deja vu* ,v: The above symjtoraa had boon isrosont in increasing quantity for a period of two weeks* In addition he ei mplainod ofj 3* a panicky feeling of iastaJ^IJif^^l^h,. -.occurred for *" ***1B't tima oa - '!w4- 4S -- * 002088? mjreetion which ho hoped would bring him to Bridlington* He received a lift to Swindon, and proceeded to walk in pouring rain to within a few alias of Reading* Hera h was picked up, tired and with blistered foot, and was taken to Chiswick by lorry* Kis rocollcctions of tha journey were vagus, but ho reaessbcred taking a mribor of buses until he reached his father's house in London at 7*45 a*a* He was lot in to the house by a neighbour, and iasedlately ho telorraphod his wife* Ha then lit a fir, r,cd crouched on tha floor in frost of it* At noon he telephoned his fir1a office. His wife returned from Bridlington, and, because of her anscisty, took him to St* Heller Hospital at 11 p.s* He wan reassured, and returned to his father's house, where he slept well*. Cn Merab 13 he visited his firm's office, where he questioned concerning the recent events* His doctor's assistant, whoa he saw later, prescribed phenoberbitone* Following the discussion on th night of Ksrch 13, between the officials of 2ha Associated Kthyl Goapoay Limited, 3r* Boyd and Hr. d?.c3oll8, it was decided that this patient should be kept under observation, and armngenente were made with the ^liMleaes: Hospital, to which he was admitted cn March 15, 1951* OcKmlaints* 1. Kerry. 2* ft? Twitching of the nor:*. A sons of scaothlng' stuck la Ms throat* (c) A cropng eontmtion storting; above *ha right, ear and radiating backwards and downwards to .the right shoulder, aggravated by telephoning er wearing ear-phones* a) Transient loos of focussing power of the eyes* () Transient feeling of what is known as deja vu. ilia above symptoms had been present in increasing quantity for a period of two weeks* In addition he c. nplainoi of? 3* A panicky, feeling of instability, which occurred for the first tiia on ads&osion that day. This lasted a very abort tins, and was unaeoosapaniod by other sytsptc.- 4. Sore tlirw-t and coH during the last two days* Kf 0020888 / -11- (a) t H*. parent felt that he was ro3ponr4'ols for tbs death of one of tbs gang, ami the taental dtataa&anoe of another, by failing to insist o k the precautions h knew that were necessary* Ho adaittocl fully that he had known of deaths occurring in similar work os previous occasions * and further thst on of tbs reasons for his laxity ms the ambition to bo tsad a foreman, and to. increase his chances of this by speeding tha work of his gang* This ms to bo achieved by dispensing with ncc*afortabl masks* (b) His wife was now suspected* after four weeks of incomplete recovery frcia pneunicnia, of pulmonary tuberculosis* and me being investigated at fit* Thomas *s Hospital* (c) He bad unfortunately, with a view to increasing his popularity, got* into debt by buying his gang boor* General 'Kiogtioning* Headaches very occasionally* 'lo fits cr faints* Insoamia present for three weeks, relieved by hypnotics* Eedueod powers of concantrsticn for two days* normal sons of smell and bearing, diminished esnee of tests, Met&lllo tact in the mouth for one week. A eligbt noea bl*d otto wo*k ago, Ro dysphagia* Coed appetite. During the last week he had had a strong desire for spicy foods*Highest known weight 13 st* 7 lbs., whilst in the array. Average weight 12 st* 10 lbs* Present weight 11 st* XG lbs* Jo chest pain, dyspnoea or palpitations* HE 0020889 on tha precautions he knew that were neeessasy* He admitted fully \at he had known of deaths occurring in sSs&lar wife on previous occasions. and further that one of the reasons for bis laxity was the. aafcition to he md& a foreman, and to. increase his chancos of this by speeding the work of his gang* this was to ba achieved by dispensing with uneeiaivu-table masks* (b) His wife 8 now suspected, after four weeks of Incomplete recovery from pneumonia, of puloomry tuberculosis, ami was being investigated at St* Thomas*s Hospital* (c) He had unfortunately, with a view to increasing his popularity, got into debt by buying his gang boor* r-incral (Aiestioning* Headaches very occasionally* Ho fits or faints* Xascsosia present for three weeks, relieved by hypnotics* Esdacod powers of concentration for two days* normal sense of smell and hearing, diminished sense of taste* Metallic tact in the south for one wook* A slight rsosa bleed one week ego* Ho dysphagia* Good appetite* During the lust week he ted had a strong desire for spicy foods* Highest known weight 13 st* 7 lbs*, whilst in the army* Average Weight 1Z et* 1G lbs* Present weight 11 st* 10 lbs. Ho chest pain, dyspnoea or palpitations* Decent unproductive cough* Occasional attacks of heartburn after food during recent years, Micturition normal* Bowels open rsguI' .rly* Hover ted hemlae* haoruorrhcido, or varicose veins* Ho aches or pains la the limbs, or weakness of arms or tends* . K F 0020800 12 Hast Kedieal history* llo&slcs end chicken pox as a child* Three years ago wee impatient at the National Heart Hospital for treataent f sudden attacks of palpitation (Ibrcsysasl taer^-c&rdia)* Has given digitalis and jfcsmberkiton, for nine ssenths* Since then* no recurrence of sys^toas* Never had rheumtic fever, chorea, pleurisy, paouaonla, joundic3 or renal disease* excision of aole frost left posterior axillary- wheat aged nine or ten years* Crushed loft hand in 1947* H& was seat by Dr* Gallop of Poole on February lk 1951, whose report stated that there were no signs of lead absorption* Pergonal History* Shy, slightly built, average at school, enjoyed gasses, fond of Ms father, bat at loggerheads with his tiother. Work* 1* Office boy on leaving school* 2, Building* 3* E*S*H*S* (on ih Continent)* 4* Htmbing end general contra c.ting, 5* Present occupation* Sj^y^ttira -- 2.5 to 20 n any foa? Um poterb tluroo woolio. previously to 40 a day. Beer* bp to iu pints a day until one j&onth previously* iJiM-i'jMfn .Abroad* -- Brsasoe and Cenaany* Is carried, with a wife end two children, who live in Battersea. vsmmm 0020891 for treatment of suddan attacks cf palpitation (Rarc?ag?S2il tachycardia)* yes given digitalis and phenoterMton ? for nine acutha* Since thesis no recurrence of sysptosas* Haver had rfeetaaatie fever, chorea, pleurisy, pneumonia, jaundice or roa&l disease* decision of tsole trm left posterior axillary when aged nine or ton years* Crushed left hand in 1947* He was seen by Br* Gallop of Pool on February 12, 1951, whose report stated that there ware no signs of lead absorption# 5* Present occupation* Q.jgsro.t^gs. * 3.5 *o ISO a day for -Wia past throo woolra previously X to 4C c day* 222s> ** Up to 10 pints & day until cao month Alive and trail * KE 0020802 ,--_***. ;iX . . A A . j . 1*03- On <33saminatifgt A pleasant, co-operative, uelX-feult> yo'sig j t skj i* Tssferatiara 97*4 ? Cardiovascular 'Ysten# Poise 68, regular* Bleed Pressure 105/45* Baest sounds I and IX in 11 areas* Apes teat impalpable* radial arteries thickened, slight Iccoiaotor brcehialio. phenomenon* J*T.P. - 1?#A#D. .'.'c acral or ankle oedema* Pesniretery "vstosu Chest expansion' 2fa* ' 'cmsent syaastrical*. fradtm central* frsetfls fresitus - K .A*D* . Percussion -- K*A*D* Erastii sounds normal# So adventitious sounds* Co cyanosis or clubbing* ^line&tarv Pvsten* i-buih: I-aicosae noisi ant! clean* Kc halitosis* !te- lead lias. Slight staining of teeth. Abclcsm H*A.D*. Central Porvcus Astern* \ - asasMklaisa*^ X * $*& *0 >' II aM SI - pupils equal, central, react, to light and Dccossaodation* III, If and ?I -- external ocular noveaents normal* -- Peter, senary and reflex functlono normal* 11 - Ssfching ebnorml* 111 Air conduction hotter titan fcono conduction, !!> Hand IS - Nothing abnormal* Tendon rafleaoes present and ayaraetricolly equal* Plantar reflexes both flexor* Power, tens,, light touch and tsesterior cc-iunn ponsaticn and co-ordination normal in links* 2i*i K f 0020893 Teoporaiuro 974 ? Cardiovascular ?-?vctea Pulue 68, regular# Blood Pressure 105/45* Heart sounds I and ''! in areas ^ pou beat impalpable pil. arteries thickened, all|jht lecosotor. brecaiolis. pheneaenca* J*V*?* ~ 15*A*J>. be sacral or ankle codesaa* rosulratcrv rystesa* Chest expansion.'2!5* -tovcsont sywaetrieal* Trachea central* Tractile frosttus -* K.A*D* . Percussion - M/u0* Breath sounds noraal* do adventitious sounds* :;:o cyanosis or clubbing. isontarv Sroiou I-huth I-Sicooae soist and clean* lie halitosis* Ko load lino. Slight staining of tooth* Abaorvsn ' i- *> * Central Reryens gystais* Cyenial Uoareea. X - U.A.D* II and XII -- puplle equal, control, react to ii^ht aril aecossnodation* XIX, IV and VI * external ocular luovsssents tarsal* ? - Motor, sensory and reflex functions normal VIZ * 1c thing chnoiml. ' Wit - Air -conduction better them bone conduction* IX, XI end XXI- nothing' abnorasl* Tondcn reflexes -present end symmetrically equal.* Plantar reflexes both flexor* Power, tons,, .light touch and posterior column const tion co-ordination cormsl in liofc* listeraal genitalia - Horoal* Urines fi*C* 1010 ,mil" "'u",`. Ho c<. ;-uloble protein cr reducing cub. !-C$3*3 0020894 '&! m * :< ' '/ xn. "X4" tv Gears loft posterior axillary fold and palm of left hand* Hands wars sad moist* Bocent blister on plantar surface of left bin too. Lymph glands and tigroid - f.A*D* g-oleton* Bilateral fourth and fifth hammer toes* Investsrationst The following investigations wore porforaadt flood. Hoeaoglcbin 92$ (13.3 grasss)* E.B.Ce r?,CCOCO. Colour Index 0*93 s.*C. 7,400. Differential Count Ceutrcphils Lymphocytes 2 xuocptes Eosinophils Keticuloeytes m 44:5 65, 15 Cerefcrc? Spinal Fluid*. This ss perforsed in the fourth to fifth lumber interspace* Crystal clear fluid at 105 millimetres pressure, rising to 135 ailliaetre on jugular venous compression, falling again to 115 idlliaetres* Protein - 30 milligrams per ICO mis* Bandy *s t rst negative* . - dugar ** 61 milligrams per al* LTJ Chloride -- 692 milligrams per ml* Cells * 1 Ijraphoeyto per cubic lailiinatro, WTa*nBg* --- n10egxat0iv.e* ,i KZ~ 002089 liver Function Tests* Colloidal gold - negative* Thymol turbidity - 3 units* Serum biluribin -0*3 milligrams per ICO sals*. Alkaline phosphatase * 4*7 units* CholOitrcl - 174 KilUgraas per 100- sals* <'jl i>0 * vbll^S (al). a' -*\ro? j.i. y-+^ Xdtro* ;' ft Cteindardie'! i>./litro X*CXL4- Seearfes* *1 tc `2 s# ^*a w# Control 0.243 0.736 1*029 o *UOOQ 0.017 0.356 (3.65 mis. formalin). 21.3.51. 10.4.51. 5J i\ *`x. **'V> fc -:n u *<* */-* x'1-- 1 I? 340 0.165 0*169 1.C07 0.393 565 0.076 0*135 1*003 135 0*094 0.507 1.023 5G3 0.164 0.232 XA^23^4* 0.236 0.310 G.272 450 0.120 0.266 1.013 ~66 0.036 0.3o4 1.021 532 C.0B2 0.1.42 0.237 0.216 0.165 435 ~s r^t i u $ ^.QX 1.C10 0.143 430 C.037 0.162 1.009 0.250 460 0.160 C.331 1.034 i Wfi if!i>**'*^,- Before X-ray of abdomen 4 hours after X-ray* 13 hours after X-ray. Before %-ray of abdosen. Before X-ray of aldose. Before X-ray of abdoraon. 2 hours after .X-ray. 4 hours after X-ray. 17 hours after X-ray. ientrol ~ 320 1. diotillo:] xmt&v, 10 sis. fonx$15.n* *.} ,:!S*QUCt82*! jj ? tftfc o cco ....... t, r., :_i; i***- J, ibjjfeipm if:};; 2 i-i*irljj\i-iV- 1' f# ;ci n j.1- iHijiiiliiiijiiii --arc ~rf thi' ~}i jiff H3:inzr:. fiipi 4, v'T iliijiS i4i-*H*jtCtetlJtt.}mlirtjia'jifaij-af CD CVi .j o CD \i r-WO---1 '2HcwO0l j1 -; . : ....... ........... '.'r.t*::'-- -v~-X-.: ttf:*-C<U3 X2i7:c-.l4r_.42j .--20 %t *1. *i3c 2_1*2H-4z_Iiict:_iH:4Lu.liilli.si:,"::TUx::j::--:: :: March. ** r\VA *0. . 41 vcsv-ro* 34G 10.4.51. ?} il - f ir** 505 135 5S3 450 .--66 532 - *> X* u U 435 ~30 420 i.-/ eV..*Wij$| 0.105 0.076 0.094 0.164 0.120 0.086 0.032 0.044 C.037 0.160 U.OL7 0.169 0.135 0*507 0*282 0.266 0*324 0,142 o.ioi 0.162 0.381 1.CG7 1.008 1.023 X.C14 1.013 1.021 1.012 x.cao l.coo 1.024 0.393 0.236 0.310 0.272 0.287 0.216 0.165 0.343 0.250 0*22.,. Before X-ray of aMctssa 4 hours after 35-ray* 13 beura after X-ray. Before X-ray of ahdcaaen. Before X-ray of atdooea. Before X-ray of abdoraon. 2 hours after X-ray* 4 hours after X-ray. ` 17 hours after X-ray. it Control 390 ls* distilled usiar* 10 isls. formlin* 4vlc<x1 't'TQBtVX*}* S y s to lic Elood Pressure. D ia s to lic plood Pressure o r r*f^.1 <? / * pressure was often .t w r<oterraiao X 0020897 1 -16- 21ectrocmo(%halosygsm 2,4,51* This was reported on by Ur. G, Parsons Smith as follows*- "There ma a slow alpha rhythm of 8 per second, and It was : isturbod in all areas by runs of low voltage 5 to 6 per second uavas, which were most obvious in the central part of the right temporal lobe# Hyperventilation caused the appearance of high voltage paroxysms of 2 per second waves in both frontal regions* and some random 3 per second ' activity over the rest of the cortex# Although this record could be part of a constitutional abnormality* it seoss most probable that because of the aesyastry, the abnormality is an acquired one*11 23*4*51* Second E#S#G# reported on by Dr. G# Arsons ffcith# "The 3.*E#G# record on had changed considerably S -c-nce 2*4*51, The dominant frequency varied between 7 and 9 per second* Its voltage had doubled fToa 16 p. to 3'- ja* In the first record tho readings for the parietal regions wore comparatively flat and featureless, whereas in this record tho 7 por second frequencies were predominant* In the temporal lobe ids assyaetry described previously is reproduced end ns elsewhere had a higher voltage than before# Tho response to hyperventilation was also different* within go Ot CO half a minute, low voltage 2 par second waves appeared in both occipital o c\? regions* High voltage generalised 3 to 4 per second waves first appeared o o tUaates appecirod pax-osyeiaailjr i'or -the rest of* tho xoroioa and for 20 seconds after it* They had not appeared in the previous record, J-U until 2 Disrates 20 seconds, and on that occasion wore not nearly so narked* It could be that the oarvical activity was cuppressod in the first record end that it is now reappearing# The record is still an abnormal ana, aad it a ,, po,,iuo to aacaaa thaaa too sco*ia areas by runs of low voltage 5 to 6 par second waves* which were most obvious In th central pert of the right temporal lobe* Hyperventilation mused the appearance of high voltage paroxysm of 2 " fr'*k | per second waves in both frontal regions* sad some random 3 par second activity over the rest of the cortex* Although this record could be pari of a constitutional abnormality* it serno most probable that because of the assyttoiry, the abnormality is an acquired one*** 23*4*51# Second E.E.G. reported on by Dr* 0* Persons Saith* i!Tha S.S.G* record on changed considerably S'-lnco 2,4*51* the dominant frequency varied between 7 and 9 pr second* Its voltage >iad doubled from 16 jn to 32 u* In the first record the readings for the parietal regions ware cooperatively flat and featureless* whereas in this record the 7 per second frequencies vers predominant* In the temporal lobe the assysetry described previously is reproduced and as elsewhere bad a higher voltage than before* The response to hyperventilation waa also different* within half a minute* low voltage 2 par second waves appeared in bet}', occipital regions* High voltage generalised 3 to 4 per second taavec first appeared at li- ciinutoa ea3 sppoarod porowaflBtaolljr Oox* tho raet of the exoroico and for ~C seconds after it* They had not appeared in the previous record* untxl 2 minutes 20 seconds* and on that cession wore net nearly so marked* It could, be that the cervical activity was suppressed, in the first record and that It is now reappearing* Thai record is still an. abnormal one* and it will sot bo possible to assess these two records until we have found a baseline.** Chest "-ray. K.A.D* i3,U,G* 11 A *D * Kt 0020899 -17- Plain X-ray of Abdomen* Tills X-ray m&s taken and compared with a plain X-ray of the abdosen of another young mn of similar age and physique who ted net suffered exposure to T.E.L* An undoubted increase In the density of the lives? of the affected san was noticeable* Progress* During the period of progress as an in-patient, the following significant notes were made* 1. Recurrent headaches, 'sometimes frontal, sometimes basicranial, occurred. Dull continuous pain appeared at-any time of the day, and lasted from half an hour to several hours* It ms not affected by posture and was umcecapaaisd by nausea or visual changes* ... As progress occurred* those heedach.es improved* 2* lastly in tho early stereos, he suffered from sudden attacks of depersomlisation, usually occurring while talking to people, and often in visiting hours* They lasted for about half an hour, and disappeared with his general improvement* 3, A rather persistent sensation of something creeping over .? his akin on tho right aide of the head'and nock occurred in the early stages of his disease, lasting for hours, and was probably his commonest complaint* He left hospital still complaining slightly of this symptom* 4* Bio temperature varied irregularly during admits cion, generally boing between 96T* end 9f*6F*usually on the low cido. Tils pulse during his admission- varied between 56 end 94, usually boing Ground a figure of 60 or 70 por minute* Apart from those symptoms, ho showed otherwise no abnormaliti-a, and on April 14, he was considered recovered sufficiently for convalescence* Ontnion* 0020300 * suffer^ exposure to T.E.L* An undoubted increase in the density ofthe li-.W of tfco effect;-! nan wen noticeable. &agSgfa. During the period of progress as an in-patient, the following significant notes were csadSe# 1* Recurrent headaches, soraetimes frontal, sometimes haaicranial, occurred. Dull continuous pain appeared at any tine of tho day, and lasted from half an hour to several hours. It was not affected by posture and ms unaeecapanied hr nausea or visual changes* As progress occurred, these headaches improved. 2* lastly in the early stages, he suffered from sudden attacks of depersoraHaatien, usually occurring while talking to people, and often in visiting hours* They lasted for about half an hour, and disappeared with his general fosprovstsent* 3. k rather persistent sensation of something creeping over his skin on the right side of the head and nock occurred in the early stages of his disease, looting for hours, and was probably his cosmsonest complaint* He left hospital still complaining slightly of this symptom* 4* His temperature varied irregularly during admission, generally being between 96F. and 91*6F. . usually on tho low side* nis pulse during his admission varied between 56 and 94, usually being around a figure of 60 or 70 'per minute* Apart from these symptoms, ho showed otherwise no abnormalities, snd on April 14, he ms considered recovered sufficiently for convalescence. Opinion* :S A case of intoxication of moderate severity, showing certain clinical signs, and symptoms and'confirmed by pathological investigations * HE" 0020901 ` - V--: "&" mmmJk' Aged 20* Halo. Single* Sank Cleaner. For the pest fir oontha this Mm had been employed by Koccrs# Sissons aid flawkor in various occupations, and during tho previous five weeks was employed In tank cleaning at Poolo* Ho isad been fully warned concerning tho hazards involved and instructed in the precautions to bo observed to avoid exposure to tetraethyl lead, but admitted to working for intern&ttont periods without his air line mask and gloves*- (A copy of the police statement of his mveaents prior to his admission to hospital io attached in Appendix *S,) On Parch 9f, 3$51, tfcio patient was admitted, under certificate to the Kcrrisca Hospital, Harrison, Dorchester* Kis past history, ftaily history, habits, ate., wore not available, owing to his mental state at the time of admission* Cm evaluation, he was found to-be confused, and aurally hallucinated# Es was deluded (og* he believed he had contraetd venereal diseas by robbing against a pole in the park at Bournemouth) His condition mentally was obviously very serious, but his physical state was found to bo satisfactory. General Aore&sncs* A thin, unshaven, dogsiscaute-lookiag individual, confused zsU -uoc>--oip<ai-a-til.vo Paia, bufc no apparent anac-oia* Tosnperatiare 97*6F* Cardiovascular System* Pulse ?6 per minute, regular* Blood Pressure 1C6/S0* Heart sounds I and II in all areas, no added sounds* Apex beset was indefinoble* Egapiratory System* K K 0020902 Kasars* fiiaaoias and Hawker in various occupations, and during the previous five weoke was eapicyod ia tank cloning at Poole* Ho had been fully warned concerning the haserds involved and instructed in the precautions to b observed to avoid tstposuro to tetraethyl load* but admitted to working for intermittent periods without his sir lino mask and gloves* (A copy of the police staiasaeat of hie Eoveaents prior to his admission to hospital Is attached in appendix **) Oq ''arch 9, 1951, this patient was adnitted, under certificate, to the Kerrisoa Hospital, Kcrrlson, tore!jester* . His past history, family history, habits, etc*, were not available, owing to his mental state at the time of admission* Ca oraoinailcn, he was found to be confused, end aurally hallucinated* He was deluded (*g* he believed ha had contractd venereal disease by rubbing against a pole in the park tit Bournemouth)* His condition isontally was obviously very serious, but his physical state was found to be satisfactory. Genera1 /nn>oaranee> A thin, unshaven, degonersto-toolclng individual, confused asxl Tineo--opei-aliive Pale, but iso apparent anaeoia* Temperature 97*6F* Cordievascular ^ystoa. Pulse 76 par salnuto, regular* Blood Pressure 106/80. Heart ccande 1 and XI in all areas, no added oounds# Apoc beat ma indefinable. Respiratory gyetea* Respiratory rate 20* Hcvement symmetrical. Trachea central* Tractile fremitus - normal* Percussion > ncrml* Respiratory sounds -- normal* ailmentcry System* Mouth clear. Abdomen - . *A*Q, Kf 0020903 >19-* Central Nervous System# Gimni&l nerves normal# All reflexes normal* ELantars 4* 1 The progress of this case was vary slow, and it was only by June 25 that he could be stated to be almost symp-tcia-free, with occasional night Imllacinatlosss which worried hi little* Ly this time he was able to develop insight into his condition, and he was finally discharged from hospital in September 1951* Five days following his admission, Ms blood pressure reae to 126/90, and subsequently remained fairly constantly at this level* He was retained in bed continuously until Ifey 24, after which time he was allowed up at snail intervals. During the whole period his pulse rata varied fro 10$ to 50, being most frequently around the lower figure* Throughout his stay in hospital his temperature was persistently snb-norsal. His treatment consisted of rest and fluids in large quantities. During the slow progress of his mental condition, a gradual improvement was noted, and as time passed his visual and aural hallucinations diminished# The first to disa.pear completely were his visual hallucinations# The following laboratory .investigations were carried outs 19.3.51# Haemoglobin 1024$ . E.B.C* 5,500,000 prcu*Bn# Colour. Index 0.92 ` Leucocytes 9,300 cousin 13outrophlla T?% Cosophils *yf- Metasyolc cyt eo 1#0 Turk calls 0*5% Monocytes lymphocytes 6*5% 14.5:3 Reticulocytes --leoe then Icterus Index ~ less than 2 units. Moan Corpuscular voluaas - 02 e.n. Backed coll volume - 47 cum# Mo basophilic stippling* Platelets abundant# Fragility - normal* h( g 0020904 June 25 that he could be stated to bo almost syj3ptaa-froe, with occasional night hallucinations which worried his little* By this tia ho was abla to develop insight into his condition, and he was finally discharged from hospital in September 1951* fire days following his admission, his blood pressure rose to 126/90, and aubsegusntly remained fairly constantly at this level* He was retained In bed continuously until hay 24, after which time ho was allowed up at small intervals* During the whole period his pulse rate varied from 106 to 50, being most frequently around the lower figure* throughout hie stay in hospital his temperature was persistently sub-normal* His treatment consisted of rest and fluids in large quantities# During the slew progress of his :mental condition, a gradual isprovoserit was noted, and as time passod his visual and aural hallucinations diminished. Tha first to dloa.poa? completely were his visual hallucinations. he following laboratory Iu v o e sticns wore cams; 3,9.3*51* r.*it <- Kccmvlobin 10X2 * E.B.C. 5,500,COO per CU.5S3* Colour.lades 0*92 Loucocytes 9,300 Differential count -- neutrophils Basophils 77% Puatasyelc- eyt es 1. Of* Turk calls 0.55 bcriocyies 6.52 lymphocytes 14*5:2 Reticulocytes-less tten 1% Icterus Index - loss than 2-units* Mean Corpuscular volume -82 e.e* lacked cell volume -- 47 m.m# he basophilic stippling. Platelets abundant. Fragility - normal. 16* 3.51* Steins* S#G# Insufficient sample* Reaction -- neutral# albumen - Positive + Blood - Positive Ro reducing substances# Kc R.B.C., ,-j ss or casta# K? 0020905 *20 The blood vaa examined for the following substances: Blood Brae Differential Protein Cholesterol Brie Acid Colloidal gold Ammonium sulphide AUcslins phosphatase thyraol turbidity i,i t5 42 ags* per 100 sis* 7.55 grass per 100 sis* 0*166 milligrams per 10D mis. 4*1 Ega* per 100 c*c* 0 units* 2 units* 9 units par 100 c*c* units negative* Urinalysis* Sate* FolUSG (sal). m/ Sample* Litre* S.Q. Standardised ag./litro 1.014 19.3.51. '-1*3*51* 2.5.51* n 4530 1520 1090 1.5 0.703 0.102 0.048 0.331 0.155 0,067 0.044 1.CC9 Xa 0i,-4 1.004 0,515 0.5U 0,234 0,30a Faeces. |3Xooc3^ Date, 18*3.51. tl i Ash lit. <&.> 13.23 8.65 _______ ite Sample* 1 gsa, Ash* 4.4 3.04 0.330 0.350 Date* 18*3.51. 2.5.51. Wt. Cm. 6.95 4*27 l%su. Fb/ Sample, lC0.:.gBUw.. 0.004? 0.068 0.0053 0.126 | Opinion. V-. [<{ , 0 0 2 0 0 6 Cholesterol Colloidfe1 gold Arswmitca sulfide Aiksline phosphatase Shyaol turbidity W.K. Prim lysis * 0*166 ailllgjnsaa par ICO ssls* 4*1 sgs# per 100 e.e. C unite* 2 unite* 9 units per 200 c.e. 2 units negative* Sate* Volusss ...... MR9.l Ffe/ ..... (al). Sample* litre. S.G. Standardised ag./litre 1,014 19*3*51# 21*3*51* 2*5.51* is 4530 4630 1520 1090 1.5 0.703 0*102 0*048 0.331 0.155 0.067 0.044 1*009 1.004 1.0C4 1*002 0.515 ' 0.541 0.234 0.3G3 iS OCQS * Date. 18.3*51* M Ash Wt* Ge *i 13.-3 S, 65 Vm*~w Sample. 1 ga* Ash. 4*4 3*04 0.330 0.350 piooa. Bate* Wt. Cm*- Hgta,. TV Sample* 10<l.gEl*C.; 18.3*51*' 2.5.51* 6*95 4*27 0.0047 0.0053 0.068 0.126 Opinion* i .I A ease of T.S.t* intoxication of grout severity# presenting a full pasture of an encephalopathy of prolonged duration# confirmed by lithological Investigations* HE 002090? APP&IPH / -2X* ifmdlady gave tho following sto*yi "On the 12th of February, :951s caas to sy house end uas given aecotsaodaticn. He was vory reserve;! and did sot cosplain of anything* About 5 bus* on Wednesday, 7th March 1991, he knocked at aybedreota deer end opened it sayings Thiels wants yeu#8 (Shioia is ray daughter)# I ashed his what was the Batter and he said, i!2 don't foel ell, I*va had no sleep.w I gave bia sea ratchoe and told Hiss to go ownstsirs and sake himself a hot drink* He cstae back about 5 p.s* that sane date end said the doctor had given hin son sleeping tablets and he went to bed about 9 p.m* in a single rocn. About 1.30 c u ew on Siursday, 3th Parch 1951, I heard a banging noise* and on going out on to the landing X saw Ills two sates go Into th roc# . I wont to liis rcca and saw standing cut of bo! only In his shirt* He was. shivering* When asked what uas the ratter, he said he had had one of his bad turns# I left and got a hot drink which he drank, it was cocoa, ' I spoke to kin about his behaviour and he sat on the bod end cried* Before leaving for work later he said ho felt vary ill and was shivering# He eta his breakfast after scste persuasion. Ho said he was vdliing to go to the doctor# J telephoned the local doctor of Pool and m "* t*houX3 ctxXX at tlaa evare&ry whaa ho would give Jxija fjoao- thlag to aake Ills sleep. It 5 p#ta# tho caas dato arrived back and loft after tea with his twwoe mates for the doctor's surgery and arrived beck about 3 p.a. hewed v. a medicine bottle filled tilth, a brown coloured liquid# I read out the directions on tho label - cn-d iuablsspocjtful to oa taken before going to bed. He then loft tho recta* About *i n one of February, / 5 51* cams to my bouse cud was given accociaodaticn. He was very roservod and did not complain of anything* About 5 a*n* on Wednesday, 7th March 195l he knocked at my bedroom door and opened it saying, HShiele wants you*8 (Shicla is tay daughter)* I asked his what was the Batter and he said, BI don't feel veil, I've ted no sleep*M I gave hia cone matches and told him to go downstairs and sake himself a hot drink* Within a few minutes 1 followed and tm his in the kitchen asking himself a cup of cocoa* Ha was dressed in his trousers, shirt and socks and ho was shivering* He had his drink end said he had taken fives aspirins* 1 warned him agptinat taking sol's than two and lie so,id ho had taken then to sake him sleep* Soon after ho went to bed end I did not hear anything of his again. About 6*~5 e*s. on Wednesday, 7th March 1951* he case into the kitchen and appeared all right and said he was very sorry what had happened .* X advised his to go to the doctor and I understand ha went to a local doctor in Foole* Just after 8 q *s u he left for work* He esse back about 5 p.s, that ss.se date and said the doctor had given him soma sleeping tablets and he went to bed about 9 p.m* in s single rooffi* About 1*30 &*m* on Thursday, 8th March 1951, I heard a banging nciso, and on going out on to the landing .2 caw his two sates go Into the rco. 1 wont to his rocs and saw HCGAH standing cut of bed only in his shirt* Ho was shivering* When asked what was the matter* he said ho had had one of his bad turns* I loft and got a hot drink which he drank, it was cocoa* 1 spoke to his about his behaviour and ho sst on the bod end cried* Before leaving for work later he said ho felt very ill and waa shivering* lie ate hia breakfast after scrao persuasion. He said he was willing to gc^fcc^tho doctor* I telephoned tho local doctor of Pool and h told rao flMpPPmould call at th& surgery when ho would give his son-* thing to mke hia sloop* At 5 p*ra* the earns date Arrived back and left after tea with his two rates for the doctoru^ntrgery and arrived back about 8 p.a* SB"showed me a nodieina bottle filled with, a brown coloured liquid* a read out the directions on the label - cue tablespoonful to be taken before going to bod* He then loft the room. About five minutes after he returned to the room where 2 was and said, ''Phene the police, I must get away, X can't stop hero, I'm a sick s e h , X rang up tho doctor's surgery ant? it was arranged that ha would call after surgery hours* I also telephoned the police and ! ambulance* HCQAH put his wallet and papers on the table and left* The next time I saw hia ho was in the hall with his t"o friends* Tho police and amhulanco arrived and soon after tho doctor arrived * Acid told n that he ted ted a serious attack of influenza during thne^^^Hdxeeaaiiiict at Liverpool and also that ho ted pneumonia and did not know anybody. Ho has never tliroatoned to do himself an injury in my presenco*" . 0020909 ~22~ 8th Kareh, 1951* story* One of his colleagues* who was with his, gave the following I have known {HBHIliPfor about a month no he is also staying at the ease lodging* and working with as cn a tank cleaner* slept in a roc with several others and about Sunday* 4th Kerch 1951* he kept walking shout in the bedrocs and slamming doors, and on Wednesday* 7th-Kerch 1951, he was given a room on his own* About 1 a*a* on Thursday, 8th Kerch 1951* 1 wont to his rooa vith another sate, who was sleeping in ay room* The reason we wont to Kogan's roc was because the latter was mumbling to himself and asking & noise. X saw him sitting on the floor with the bed clothes scattered around him. We tried to help bin up but ha was contrary and would not do anything ho was told. Soon after ho cone up to our rocs and slept in the next bod. X kept his under observation during the night. He did rot sleep but appeared delirious. About 8.10 a.s* that ease date X loft his with sy other sate at the lodgings end I went to work and seemed all right than. I saw his again about 10.30 tun* that morning* Ho did toll se that his sistor was getting carried and that hie other in Ireland had written to his asking his to go homo# He said that he had not enough c&vocl up to go homo. H had his dinner with us and appeared normal. The three of us arrived at the lodgings from work about 5 p that day* the 8th Kerch 1951* Bo. had tea and then went to a local doctor's surgery in Poole* as ^flj^Hhad decided to see a doctor. The doctor gave his a proscription and he took it to Timothy White's* the chemists. High Street* Poole*.and soon after was given a bottle of brown coloured liquid. He did ask the assistant if there wore any tablets and she replied, ttIT*w He did not know what the aedicine .contained* .... Xibcut 8-p.ru wo arrived at our lodgings and flBfeand I started to play cards but a few minutes after he said he was going upstairs* and loft. X got up and said to my mate, "Bill's gene outside. I wont cut of the dining room and saw H00&8 going out through tfco min doorway leading to the street, 1 ran after him and caught hold of him by the arm a few yards trow, thelodgings* towards tho Quay* Ha said "Don't stop no* Bill* ask ^ S -tit* fcotfclo and X think I will drown EKraolf*' He tried to break away from ne but ay a&te arrived and helped me to taka his back to the lodgings whore we locked the door. The landlady called tho police. Ho kept saying "I'm no good for this world, God ought to punish s@, and kept uunblisg to himself. Goon after the police and ombulancs arrived* an.; the doctor arrived soon after this, resulting from which KOGAB was taken to the Poole General Hospital. On the way he did not say anything 1 could understand* . ___ _>Jorke-.i with us cleaning petrol tanka internally and m&ks ' /A are worn In which orme tho fusses have no 11.1 *n it Wm *6^.. > X * 0020910 --V MHp slept is a loos with several others and about Sunday, 4th Karoh 1951, ha kept walking about la the bedroca and elaming doors, end on Wednesday, 7th inarch 1913., ho was given a room cn his own. About 1 a.m. on Stepsday, 8th March 1951, I went to his room vitb another cate, who was sleeping in my room* The reason we wont to Hogan* c room was because the latter was samfcllng to himself and tasking a noise. I saw him sitting on the floor with tits bed clothes scattered around hi. We tried to help him up but ho was contrary and would not do anything ho was told. Soon after ho came up to our rocs and slept in the next bed. I kept him under observation during the night. He did not sleep but appeared delirious. About 8*10 a*, that same d&taj^eft hi with ay other mate at the lodgings and I went to work and tt0/}ceemod all right then. i saw him again about 10*30 a*, that morning# Ke did tell m that his sister was getting married and that his mother in Ireland had written to him asking him to go homo. He said that he had not enough caved up to go hose. He had his dinner with us and appeared normal* The three of ua arrived at the lodgings from work about 5 p.su that day, tho 8th March 1951* l^had tea and then wont tc a local doctor's surgery in Poole, ss||^hsd decided to see & doctor. The doctor gave him a prescription and he took it to Timothy 'White *s, the chemists. High Street, Poole, and coon after was given a lottls of brown coloured liquid. He did ask the assistant if there wore ary tablets and she replied, "He.11 He did net knew what the raodicine contained. About 8 p.ia. we arrived at our lodgings and KCGAh ami I started to play cards but, a few minutes after he said ho was going upstairs, and left. I got up and s-aid to sy mate, "Bill's gone outside." I vent out of tho dining room and saw flHIpgcing out through tho main doorway loading to the street* I ran aftsSHnsTand caught hold of hi by tbs arm a few yards from tho lodgings, towards the Quay* He said "Don't stop me, Bill, I've &rWak all that*a in the bottle and I think I will drown myself*" He tried to break away from me but ssy mate arrived and helped me to take him back to the lodgings whore we locked the door* Tho landlady called the police. He kept saying "I'm no good for this world, God ought to punish s,i! and kept mabliug to himself. Boon after the police and cbulatm^prived, and the doctor arrived soon after this, resulting from which ^ Pwsa taken to the Poole General Hospital. On the way he did not say anything I could understand. ^worked with us cleaning petrol tanks internally and masks are worn in which case the fumes have no ill effects on a person working there. During convcrsatioaBJ^r told me that ho had the influenza during the severe epidemic at Liverpool and was very delirious. He know that the medicine prescribed by the doctor was to mke hi sleep. Ho has always appeared worried about something." /< 00209.11  i! -i y I colleague made the following staiosontt I have been staying at the lodgings for the past five weeks# whilst X have beer, working at Haim^rthy* I have two other sates at the same address# who work with so. foe'has bean with no all the tiae at the lodgings# and WILLIAM HCGiiJI, an Irishman# lias been there about a fortnight* Whan he came to Fool, ho said ho had oorae from Liverpool, he than had two" mates with him who li ter wont o r to Portsmouth* Our work is to clean out the slush and gas fumes in the petrol tanks# for which u vmr special masks and boiler suits which we change very day* tfe finish the tanks by washing the surface at the bottom of the tank. W have done thro tanks* Until about last Sunday, March the 4th 1951#. the Irishman# has been quite normal* When h cam to us he said that h3 had boon in the *flu epidemic at Liverpool, and that h had boon put nout" for two days not knowing what ho was doing# tho nurse had told him 00. Cn Sunday S-ferch the 4th, he was walking about into other rooms during the night, I did not so him* The following Kenday, Tuesday and Wednesday nights ho was walking about tha house and sitting on tho floor crying* He cam to work on those days and seemed all right, tho trouble occurred at night* Ga Tluu'sday, the 3th Ibrch 1951# I was going to take him to the doctor's in the morning but tho landlady said, ;f!!o#i3,and phoned the doctor sad made an appointment to see the local doctor the same night* II went to work in the day and sew a doctor tho same afSomc-on through the Shell Ilex, people* That evening we all three mates wont to the doctor's in Xtoole who gave a proscription for medicine, which w obtained at Timothy White's* 7ns doctor advised Hogan to go boa to Ireland* VI vent tockt^tha lodgings and son of us wore playing cards at about S p.m. when up and said ho was going upstairs. The next miaut^ttjogirX Sbiela, the daughter of the landlady, cams running in and saMwHThad run down tho read to the Quay* My mate and as went after brought him back. He said ho was going to sling hisBCelf in the water* After we got him back he was wandering in hie speech about being a beast and ne^i^t live. I wont to ray room end found tho'bottle cn the bod which fUPhad got from the cheeict that night. It was empty end the cork was missing. Wo later contacted the colic and tended them tho empty bottle. I went in the ambulance with HCGAH to the hosoital and he was fluttering all the way.*' 0020312 um ss ooen wont op WU. the time at the lodgings, and UIllIuM KCGail, as irishman, has been there about a fortnight* Whan ha case to Pool, he aid ho had come tire Tdvorpocl, ha than had t .`o mates with his who 1st? went on to rastsmouth* Our;w*t.1 to deen out the slush and gas fames in the patrol tanks, for which we wear special masks and boiler suits which w change every day* We finish the tanks by washing the surface at the bottom of the tank* We have done throe tanks* Until about last Sunday, March the 4th 195! /___ the Irishman, has been quite normal* When he earn to us he said that he had boon in the "flu epidemic at Liverpool, and that he had been put "out'* for two days not knowing what he was doing, the nurse had told him so* On Sunday March the 4th, he was walking about into other rooms during the night, 2 did not see him* Hie following Monday, Tuesday arid Wednesday nights he was walking about the house and sitting on the floor crying* He came to work on those days and seemed all rights the trouble occurred at night* Oa Thursday, th Bih March 1951, 2 was going to take him to the doctor's is th norning but the landlady said, "J!o,!Sand phoned the doctor end made an appointment to s g o the local doctor the same night* He went to work in the day and saw a doctor the sas efSornc-cn through the Shell Hex people* That evening we all three mates west to th doctor's in r-ool who gave a proscription for medicine, which wo obtained at Timothy White's. The doctor advised Hogan to go homo to Ireland* VI vent back to .the lodgings and eon of us were playing cards at about S p*a* when^pj^got up and said ha was going upstate* Th next minut^tha girl Shiala, the daughter of the landlady, came running in and said had ru down the road to the Quay, My note and me went after lii^aM brought him back. Ha said ho was going to sling hisasalf in the water* After we got hia bock ho was wandering in hie speech about being a boast and no^fit to live. I wont to my room and found the bottle cn the bed vhich^B bad got from the ehecsist that night* It was empty and the cork was missing* Wo later contacted the police and handed* thorn tha empty bottle. I went in the ambulance' with KGGAH to the hospital and ho was muttering all the vay . (In view of the fact that the above reports are included for the purpose of medical interest, all noses and identities other than that of the patient have bee deleted)* K 0020913 -24- \SSWUTt ~ -..- Sergeant made the following reports 8th Llarek, 1951, Sir, I - Ko Fixed Abode . Atl^mptad Suicide* 2 Iseg to report tliat at 3*10 p*a* on Thursday 8th torch 1951, a telephone message was received at the Police Station, Pool, Press the landlady of some lodgings in Poole to the effect that a rasa there was-attempting suicide, . irrived there at 3*20 p*ss* the sane date where I saw | a native of Eire In the hall of the building being restraina by two men who were also losing there* He was mumbling also saying he wanted to get cut of it* The Inspector arrived soon after* I had contacted a doctor of Poole, who hod attended this rsan recently for a nervous complaint* Tho doctor when told by sa that he bad refused to go tc hospital by ambulance which had arrived told roe that to use force any have serious consaqaences and tho he would come at once* He arrived aeon after and taken to hospital, X instructed a policeman to go also and droop nin under observation* This can was detained and another policeman was detailed for observation during the night, another policeman was detailed to relieve him at 6 am* on tho 9th last* ponding arrangasaents being mad for civilian observation* was born on the 3rd April 1931, in County Wexford, Eire, . ad Is employed by lasers* Sissons and K&wker of toMsvorth Common, London, as a Petrol Tank Cleaner at Shell 1-Sax, lake Estate rite, Eamworthy* He has b&on unable to sleep aid had an attack of influoaaa during tho serious epidemic at Liverpool* On Thursday, 3th Inst*, ha had obtained a bottle of sloeping draught on the prescription given by tho local doctor and cn his return to his lodgings ha drank tho contents and attempted to drown himself* Statements have been taken from the two men with whom he has been working, also tho landlady, e no doubt ho will have to be charged with attempted suicide, there being m person in the country who will accept any responsibility, - It does not appear likely that he will die, and this prtlioinary report is submitted for your information pending the submission of the file, when he is charged* I am. Sir, Your obedient servant. 'K 0020914 bOrgt* ' ;Q >*,** * throughout the period of tank cleaning at Boole# Dorset. Ga February 12# together with other sobers of the gang# he reported to Dr* Gallop in Poole# on the instructions of his firm. At this time he was conplalniag of sleeplessness and general ueolmoas. Sr. Gallop# however# signed a certificate to state that he could not find any atnormllty r signs of absorption of tetraethyl load. (Appendix *i On February 13 complained of a sore throat# and visited Dr* Gallop again. He was given a tcalc and discharged* Cn Jtorch 2 still felt unwell# and returned to London for a few days* rest* He then reported to his own doctor. Ha woe certified officially as unable to follow his occupation due to neurosis* On 'torch 7 ho was admitted as an emergency to ft* John's Hospital, Battersea# S.W.ll, suffering from acute agitation and delirium* On Esaalnation* The only abnormality discovered clinically was a radorning of the fauces and tonsils* 0020915 Ha showed severe laeatal agitation# and undue concern about his threat* On Kerch 9* 1951# ho became even acre agitated# eaaA retrtlesn, end suXXojrad S^roa hallucinations, and at 5.30 a*um on the sasa day ha collapsed# following a seizure with convulsions# and died* A routine coroner*s inquest van held# md a death certificate by the coroner's pathologist was issued stating that death was due to meningitis following influenza* Ho analysis was made, either before or subsequent to the .'death of this patient* to establish ^ tu *-* *--1' **  if-Sflii \ Opinion* In view of ths opportunity for exposure to intoxication and the history of this case, together with the clinical sjrsptoaatologj^sadi despite the diagnosis arrived at by the coroner*s pathologist and the lack of evidence of lead absorption, a diagnosis of !2.L. poisoning would aeon to be justified in this case* K 0020917 wV-v'- \V APygSDIX G> and started work at Tool, tank cleaning* in January* 1951* On February 9* 1951* J* Perry reported sick, probably , suffering frca influsnaa, and Pearce was instructed to send him back to London* On February 12, 1951* together with* reported to Dr* Gallop, of Pool, on instructions from Sissons and Ksvker, They complained of no systems* and nothing abnormal was found on examinetics* (Appendix *A*)* On March 9 B*^Ufc.'eported to Pool as a replacement for Gapsur* On March 13* ^m^end ^B^rocecdod to Holyhead - for their nest job, as tank, cleaning t Tool had been completed on Parch 1C* On Parch 15* and reported to Dr* Bennett* part-time medical officer of Associated Ethyl* and they were eraainod at Horthwich* ho clinical signs or symptoms of tetraethyl load poisoning were found* At no time had these assn complained of ary symptom suggestive of iniorsication with tetraethyl load, although it was noted that on the whole their urine levels for lead.were above the average* tlrimlvalo* Date* 15.3*51. If n 23.3.51. If 9*4.51* hamo* vHIV Volume (ml)* 166 102 126 70 172 33 172 I'm* PIa/ ...-... Sample litre* S.Q* Standardised Mg./litre 1.014 0*028 0.169 1.011 0.0X31 0.177 1.021 0.0055 0.044 1.C09 0.022 C' 3X4 1*015 O.OG83 0.051 2.<*01*4 0.214 0.115 0.063 0.293 0.051 0.CC75 0.197 1*017 0.046 o.!& 0*162 8160200 in *7/i* VU * Us.*A^p / j -' - V ^ . suffria^ fiptes. influenaa? sad flpas Instructed to send him "back to London-? * ;f 0a February 12, 1951* flBM f^BPtogothor with ard^(B| reported to Dr. Gallop, of Poole, on instructions from Sissons and Hawker, They complained of no eyaptons, and nothing abnormal was found on examination, (Appendix A*-)* On Fareh 9 (m^reported to Poolo as a replacement for On Parch' 13, t0 Holyhead for their next Job, as tank cleaning at Fool bad been completed on Parch 1C* On March 15,^0jH^jH an^ ((^reported Bennett, part-tizse medical officer of Associated Ethyl, and they were examined at i'orthwieh. Ho clinical signs or symptoms of tetraethyl load poisoning were found. At no time had these mn complained of any symptoms suggestive of intoxication with tetraethyl load, although it was noted that on the whole their urine levels for load were above the average. tTrimlygle. Volume (ml). 166 102 126 70 172 38 172 202 175 200 77 Kh b, PI i <2 f* Semple | Litre. L* Standardised Mg./litre 1.CQL4 , 1 0,028 0*0181 0.0055 0.169 0,177 0*044 1.011 1.021 1.009 | 0.214 0.115 0.063 0,022 0.3141 1.015 0,0083 0.051 X. 014 0.293 0.051 0.CQ75 0,197 1.017 0.162 0.04-6 0,263 1.018 0.203 0,020 0.012 0,099 1.013 !o ,C77 1.018 0.106 0.060 0,017 0.085 1.015 0,0112 0.156 1.022 0.079 0.100 K 0020919 \ Sk Pptnicn bur eases of sub-olisical intoxication by T. . ;*L. suggested i:y the eircusstsncos oi` their exposure and supported hy patholcgica!' invest!on tlcns. \{E 0020920