Document aB1m4JvwnX4mNGa4E9k298JQa

Dermatitis. ' November and December 193$, had a large hive right cheek with soreness^ ass. burning and itching followed by extension of swelling to hands with small discrete vesicles, later coalescing and spreading up arms and ' neck - with few patches on chest. . Off work 21 months till January 1932 - Free till July 1932 -when eruption' reappeared as wheal-- vesicles on hand - spreading over entire body withirh 4 days - increased in severity for 1 month then gradually improved to . date. Only remaining area is. on calves. Has had epldermophytosiisf'eet repeatedly. Never spread - no other dermiti^r*s Filling Station Attendant since April 1930. ' Hs rS fast KJasv, H>S L e f t ' Tare-arias Etkvl 3 Wke*l .A.r. Syw. faWS i k r s - h'i 0.1 o V. * 1* --tyi kr M 0.X- Tvit-e'xstl'y ^ tVlAK o fteupwH -iv e y ik r.' VotS-Y forearm placed in contact with cleaned mouth of 2 os bottles - vapor exposure only - began at 4:12 P.h. Erythema over Ethyl at i|:27 spreading abort 2 cm. beyond lip. At 4:52 erythema had spread about 2-3 cm.beyond lip. Complained of smarting 10 mintues after exposure began (fro;.; Ethyl)' Discontinued all at 4:52 - 40 minute exp'sure- X70 and Renown are negative - skin normal v/hite-reddened- indented - . -ii reddened rings from neck pressure only, . Ethyl zone is exquisitely tender "burns as if on fire" - and shows a high red color. 77ithin the neck indentation, that is,exposed'area, a v/heal is forming. (bottle neck l-l/4 inches inside diameter). Total erythema area 3" in diameter with some graduated thickening from ring area. 1 5:30 ?.!,, Erythema greatly lessened - wheal small 2 inches, across - others' normal. tenderness lessened. 6:00 P.1,1. Receded further - color now pink. 11:0 0 A.h, . (1) Ethyl area slightly enlarged - indurated - marked sub cut.edema elevatc-d - deep red - numerous small vesicles - some, confluent- - typical dorm. .. ;. _. _ (2 ) X,70' - .slightly reddened - discrete vesicles over exposed a r e a ^ o . ^ with slightlytinflamed- skin-.between - very, slight, thickening.- o (3) Re-noim - thickened - reddened - elevated less than (1) but definite - vesicles ::icst pronounced - .entire area conf luent mass - topical dermatitis. Vesicular reaction 'most marked on this elevation- inflammatory and sub cut. edema' - most marked in Ethyl(1 ) 1- 10 voricios have appeared this A .i.i on 1 st and 2nd fingers right hand in inter-digital space. 2-3 in thenar eminence. (Photo 2rc) I0-i0-o2 All three areas increased somewhat in size - and symptoms Increased - itching particularly marked. 24 hoars - no relief till Llonday 10-17-52 about noon 60 hours when they began to subside. ' )-13-02 Itching practically disappeared this day - s w e l l i n g almost gone vesicles broke - and began to dry. O Ux*. fo-tek 24- 3kr5 o%i.clf Uu.d<Y~`to-\t- No aV X-' / oo ky 5. Mo\2>.f To 0-0 c.c. amounts clear paraffin oil were added il) aloha nap. :thol (.1 on per 4000 c.c.) Ethy llene dibromide (i 0 on oer a000 c-;) and one solution containing both. in aoovc c m conurc hi on. Presort samples Sonic Ethyl are 50% cracked' gasoline - Z.7G is lOOy craci'ed - Renown. (3rd grade) is natural gasoline. doth thyl and E70 contain alpha naphthol as inhibitor! a-kot/e. <?# 10 -10 -; 12:00 Boon - Ethyl area hasj central scaly si. thickened area with ring of dried desquamating skin - tender cn manipulation - no fresh lesion or -weeping -islargest by 1/4 inch. (2 ) k-70 shows branny desq. with pigmentation - some '.light thickening - no fresh vesicles or weeping. scaling at eduos ~ -b # (o) Renown area is smallest of three out is completely covered with :'A b. desquamating skin - area Iq indurated - pigmented - no fresh vesicles or weeping - 2 pseudopod like entons`ons of yesterday marked by :. e s - quanatxng and pigmented skin. Ibis area is y.-.ov; the most tender :OP' - 'hsr-e sas been no react* on for any of the path tests thou :n there are .ob numerous small papulo vesicles in ft cubital fossa result oi the hglb adhesive tape and rubbing associated with its removal. The interdigitalb x O o .L.` __ remain the same - 4-5 small papules have appeared on left 1st- finger dorsum - today - (Photo 2:c) ' 10 -2:-52 Improved. itching. -. Vesicles gene - scaling, thickening still, present - 4 . .' '. ' 10-21-52 .' - _ fried - crusty <- induration Ithyi and 270 disappeared though skin i s ' - . stiff from scales, .Renown area is still indurated and presents `the heaviest crusting. The 270 urea is practically ley-led. A few scattered pspules and vesicles have appeared today on tine left, forearm on its lateral aspect, and there are a feu minor elevations' of.-.skin on cheeks and rock - a- v/eeping desquamated 'area las appeared behind" left ear - no ether fresh lesion - but -it -.vonId appear. :that local application lias Initiated a mild general condition, dxp.l with 2 onown hract.'on done at _:30 - 4:45 ' .2 . '* lor-own area, still remains scnev/Lat indurated - all arc nettling - healing well - no fre s h lesion - Photo, ithyl arc 270 areas practically healed. lonov/n still sli/ttly bosquanatln: wna u ckened. J.C : axently healed. 5till covered with fine layer- wo separating skinnc recrudescence resell treatment wo date. T .U / i-acY/ OK e . p c :h\ / .~ / - o - 73 X . x - Z - 73- 77 hhdlXihjhd 3 - 3 . 77- //f 2- 3 V 5' I f a. y - -- / / - 0 3 6 - 5 _ /33 - & - (a - / 5 8 - S I S ' 7 - 7 - / 7 5 - O s, r - ' h / j ' o / a P . 9 o to /e /f-e-uouiii go a fractionated sample'of 1 h.of Renovm gasoline (50210} received in - seven bottles each containing 140 c.c. constituting fractions of the above Booling point ranges. 3 serological tubes taken and 1/2 filled ' ith. each fraction + control and arranged as in above diagram, and that of control in separate set. S u b l et (H.M.} forearm xias allovred to rest firmly on lips of cleaned . tubes- contact bein e made in volar aspect initiated at 4:30 P.2. - no sensation ether than those of pressure v/cre noted during who 15 minute i om-'cs'T e at 4:45 P.i.i. f.o.t Terminahorw . uhjcctsT forearm and hh that h f control were nog. except for -rings of reddening caused by pressur. on mouth of tubes. 5:00 P.M. no reactions - pressure marks subsiding, Ko reaction in '24 hours - either in k.M. or control. Pressure narks all rone in 3-4- 'hours. ; , ii-no ko reactions -"V-w*" kc reactions renc r. adjacent area - started 11:30. irflL / s <x. 3 H 6 6 t F ? to.... O".U it ion tube G - whole r;g and burn ing whole O Z fOQ '-,;5th Co r:trol // o k 0 ./? C / -t - 2j. y i - (> - 0- - 0 ? - F6 " Zfa - / O f /O f - /3 / ( i / -- '9 b 4-7 / fa f if - /? &ouj*t 0 6 0 fa ? - (Bon y r v / -- /fes/ane. / O - & fiz -J / ( 0 / e 1 1 fractionated liter of SoHIO Ethyl gandl..c - 7 cure sac-- 1-15 o.c. aoove B.P. ranges - Ten tubes taken - arranged as atove - created as Exp,I for 15 minutes - began at .11;48 - ended 12:03 - no immediate react.' \r.2 . i; ko reactions . 0repeated for 30 minutes exposure- 11:05 k.:.!. - c: .plained of burn!: Ethyl Tube 20 minutes - no reaction at end of Exp, xukcg. in 24 hours .(both) except tube 10 (Ethyl -whole) which has a fen- tiny vesicle.3 and some inflammation - minimal positive reaction. 10-26-52 area of tube 10 flared up considerably during treatment with. Ethyl i;i Exp.Ill _ as did other areas except those of original exposures - no. vesicles have formed.- erythema - infiltration only. K 0011340 tz.% /o.]E - /% y /c & Y s - -- "ry~tiie.yu.i3L n't 6ud- [*4 ' *- /: I- wk oleS^I i 0 \ .....4. - St-0 C.v.'fTM/ 0-- X i 3. S'fv.+LJ-^ 1 o --- U ,-- 1{. iVacfiovts 1- (s ~Lv-cli<stlf . G v/. I 5-- pi : 0 / - - - 'i ( -' 5 fl _ *- q K _ V-o*i---- 1 -- T - *< <- 3 0---- *- " 1- X. fi . o - - i... q - " 1 - / 6 -2. & - 3 JI 3*/ /"-Y1tf h /- a - ^ JC X - *7 -r<5 k 3- S& - /0 f n y .jo?- 5/ tt it-/?//e 6 - / i - ' I a 7 _ /7- jfniiine. /ft- /re.ru i/a ixr r mo. c 30 minutes - 4:5 o :23 - t--pl no: burn in/_: in I -ni 5 end of 10 ox 'o n - sea are- . 'nuli:- ecu eld hthyl ax-ea of 12-24-32 flared up aor on;g treat:4 4 'its n::r;; lo.king at termination. Old guest; .:ab le arca dole ax-;;i x-O'o. ryifuenata ap- eared in both popliteal spa cos -- 0o stent eruption - no flare up acted yeste r-duy v 'I O' :roat..:ent otter than hthyl gasclh.es - 10 ;.r:.nc' af tei to m i n u s h sore - behind right oar began to veep rberr m: st t:t.:e Jj : atter o r m s u r c area 1 shows several nal/. ...j-- 3aero - '-b. evened by a large bleb - result eonfluen ce sever al oral: ex' X.J i\ O 5.1O tivitv to date bn- oart of original three are .irons 1 and 3 ocsitive - induration - redness and blocs ~ urea 4 - weakly positive . Area 5 questionably so - Area 10 of preceding'-' experiment receded. Renown areas negative -left a m clear - legs angryv:-:;eping numerous vesicles and new areas on thighs ax.d ankles. lax- still veering - all. old lesions activated by treatment - It would appear that either all cuts are necessary for reaction, or that sore lighter fractions, are necessary to carry the heavier irritating fraction into the skin, h and that a general reaction can be induced in distant areas skin within 10-30-mlr.utes of treatment- by what mechanism (no m o r in air)-will rests 21- hours - try heavy cut's with carrier lighter fraction of 1 - EtOH etc..- ho si :is 1 and 3 still red infiltrated 4' elevated - " 5 nog. Iron 10 preceding enp. receded - Renown areas neg. old lesion on legs are continuing to spread - arc painful and swollen, and there is -r-ednes and infiltration scrotal area. Area behind ear is spreading and wet. .- Grip inal 3 are normal. Shadow rings of 2. old areas Ift.arm have appeared (in location of old 4 -5 Renown Lxp. of 10-25-32) r. Phot o right .arm Exp.Ill end 48 hours. .. X K ;. 0.01194 1 *o 10-31-32 ' ' Lesions have not, advanced but have Increased In severity - left leg weeping copiously - ear same - scrotal and scattered lesions remain papular. The reaction to treatment was general and in that sense a milcy^apulo and papo.lo-vesicu.lar eruption discrete and scattered but there were focal recrudescence at the old lesions of considerable severity with considerable general reaction- malaise etc. . '"3 f li-i-32 _ . . 7 :pO P.M. had an attack characterised by palpitation- headache - hot sensation - flushing and reddening 'of skin - Ailitation veins - and inspiratory dyspnoea - lasted 1 -1/ 2 hours - tapered off after first half hour - followed by headache and lower abdominal pain - no history of previous attacks - except that there was some dyspnoea at times during orevious at-tacks. , II-:-- ~2 ' ' - 11:00 A.Ivl, feels well this A.II. Attack of last night not unlike a histamine shock or a mild anaphylactic attack. Further treatments post poned. Areas healing nicely - general lesions have improved since Ivionday - Wet dressings 2/ HaCI and Fa Citrate applied. ' 11- 3- 3 2 . Lesions on legs and ear have increased in severity - and extent and there is low grade pyogenic infection of vesicles on calves - o'oenea - Burrows "Sii.hl6.Tiae dressings. . 11-3-32 ;, Small1- superficial Infections have cleared up but the dermatitis flared up alarmingly/ this P.k. The lesions on the calves wept coviously and the spread of the secretion was marked by the appearance of new areas on the calves -.feet and lower thighs. ' ll_c_ 32 Lesions on legs slowly spreading upward on lower 1/ 3 thick and have advanced over entire dorsum foot. Swelling of calves and legs Is marked and there is considerable malaise. . 11-10 - 32 _ This A.M. - I 3 -days after last treatment the dermatitis spread to the . dorsum of the -hands and entire lower forearms - lesions being confluent.,., on dorsum hands -but tapering off to discrete papulo-vesicles on.the. . g forearms. There has been no unusual hand contact with discharge from ,/h the legs nor has there been any new gasoline exposure. Some heightened sensitivity of the skin has apparently supervened as there has appeared a well marked vesicular dermatitis on an area of the cubital fossa, which . was briefly iodinized prior to venipuncture yesterhny. H - I l -32 . f Hands now involved- on both surfaces though there has been no spread . -; further up the forearms - the legs and thighs remain about the .same - T 3f -with a slight advance on the feet - presumably due. to wetting of fresh-,fg, surfaces with serum from lesions above - treatment to date has consisted!:: of. cleansing and covering with calomine lotion ^ 1% Phenol - changed to 2',c kesorcin ointment. .. .. 11-12 -3 2 '' ' Little change - no spread - Tested today with P. D. and Co. antigens in groups. Rt.Arm - 2k, 2.6,27, 1,2,5 ,6 , and 7 . . Left Ann - 8,9*10,11, ll;.,15 ,16 ,17,18. There was. a. well marked wheal at each site 10 minutes after application antigen to scarified areas but this subsided in If hours - all clear in 12 -2k hours. 11-17-52 ' Legs are drying and scaling in original areas on calves but periphery of lesions is still, angry and active with occasional small vesicles - weeping except at edge has stopped. Hands are not changed. '. ` . 11-19-52 .' .Legs better - hands weeping - forearm areas drying wi.th.ou t ranch des- . quaraation - ear improving. - -; 'Tv 11- 21-5 2 - - ' Calves practically free - except for 1 or 2 small weeping areas on each -= dorsum hands clear - few active areas palms and interdigital areas - _. - -~ ear clear except in sulcus. The course of this recrudescence has been very instructive. This dates directly from the last period of treatment in Exp.Ill on 10-26-32 during^-immediately after which there occurred reaction in distant parts which .progressed, though t reatrnent was dis- ^ continued, and eventually became general. It is interesting to note that when the reaction did assume general proportions the initial general response was first observed in those areas that had been worst affected . and slowest to heal during previous attacks. ' . ' The lesions on the hand began to spread 15 days after the last exposure - \ without any re-exposure of unusual contact, with discharge from other- lesions, and are running a two weeks course being fairly well resolved at this time. These delayed heightened reactions'suggest various possi bilities: 1 . delayed absorption - .. 2. That the absorbed irritant molecule ' 3 self perpetuating . as a virus might be. 3 . That the changes initiated in the skin at the exposed . ' area were in themselves progressive and led to a heightened sensitivity of the skin generally - either directly or by virtue of products^cast off by the affecte-. skin area - of. nature of nReagins!i ' : If* The absorbed irritant ma;y not be destroyed or excreted but continue to circulate in sufficient concentration ^ ' to Induce 'reactions In areas as they are sensitised by f!reagins " elaborated from the original source. 1. The first possibility cannot be. excluded but is not suggested by the course of the general reaction-which does not describe a regular curve In intensity but rises after 2 definite lag or negative periods. ; 2. Cannot be excluded - but as yet neither serum from skin areas nor . j patient'.s blood serum causes any similar reaction In Rabbits or monkeys.I I 5* The third and fourth possibilities remain the most likely from. theyyu| course of the condition as well as from the results of passive transfer experiments below which suggest the occurrence of either sensitizing bodies (Heagin3) or a. virus like substance in the patient's circulating blood. .' Experiment lV Ethyl Cuts - /S'Mr# /a :s o ntf.-oQ 4/. / f - T' X 0 Passive transfer areas Le-fl irtftrm. .-O-v.;-- ;. 1 0/ ^ Pos/liofi. ^_5ke*r5. iXi.5 -Xw'fi/tri.fff - \ d-:* -;- S rCZL/J in, JL. *'*-<! H O3 0 O.: X 0 -- 1 0-- -- A u-b& s 1 Pier Be u ^ o ! 0 S 0f 1 ( t ) j ^ C u Y / O) / : i f 5 H 5 q q ) licXy/e'Mc. ! : q 3 Whole tj j X C u t 5 ef 9 CO tic B e r t i c i t ; i f .) i 6 ) d/fiwe y A X jlene a -lo n e Vo Li-v Fraction w 7 of Ethyl gasoline fractions in Vacuo - manometer 29+ inches F rucSf/o x J i/ o / x <?C _ ^ ^.5"<2C _ 3 - 3oec jf a".? _ _ y -- m fLoce TC ' iLtf-33 _ 33- 3 ^ _ 3f.<r- 3f-7 if.7- tf - -AT -- * -- (at? s o a.P. 16 7 -+ He-cut into 9 entire time - Oil bath. TG for fractions inaccurate as monometer was too low to be read, but distillation was maintained at constant rate between cuts and samples represent progressive fractions - all are clear - good, white except 5 which of course contains dye and in addition became clouny within a few hours exposure to diffuse light. Tubes prepared in the above fashion and. arrangement were used for exposure of passively sensitized areas on arm of normal individual. The areas were sensitized by intradermal injection of Q.Op c.c. of patient's serum (preserved with 1. 10,000 Merthiolate) into each of six areas (Nos. 1-6) on forearm - 6 hours being al 1owed to elapse following., injection for the sensitization reaction to take place. At the end of mouths, of 7/ 8 -full serological test tubes was carried out. Five minutes after experiment started there was marked pain and smarting in the area oC tube tl6!- which increased in intensity during the 15 minute exposure at the end of which the burning could barely be. tolerated. There was noted a red areola - tender to touch in an oval abea from tube - k-to tube Area #6 was markedly affected - the sensitised area was glazed- rsddened and swollen and there was elevation and infiltration for 1. 5 cm, (diameter) around the injection site. This m s w ell marked in k-S hours and tapered off for 2l hours but is still bronzed and noticeable 10 days after treatment. - :' Six salt solution and Merthiolate'(1:10,000)' injection of 0.03 cc were used as controls and a If minute exposure of uhtreatd skin areas in the same fashion with identical tubes was done on the other arm immediately following the original exposure. ho observable effect vas noted on the control sites either at the end of the exposure or 2br hours later. It was noted that the sens:tizing serum was irritating when acted ?,,nd croduced a s eable wheal for 1 - 2 hours after inject 1 showing 2 small pseudopods. Thi na_y have been due to some irritating_ substance present in the serum - other than the sensitizing agent or may br-.ye b een due to reactions with minute amounts of the antigen present the skin of the forearm, as the result of previous exposures to gasoline '; use as control. . I1-25-32. The injection of 0.03 oc of Mr. Miller's serum intradernally to another (C.V.) normal Individual failed to give the same type of wheal, as was noted on prior Injections Into (W.M.) another normal skin. Either due to difference in skins or to presence of antigen In skin first control i 1 ) Dressed right leg with 10/s Thionex in Lanolin on 11-21-32* Five hours later leg began to swell and weep - by 8:00 P.IvI. vas painful and dis charging copiously. Following morning (11-22-32) left leg began to weep anc swelled slightly. Ears wept and several new papular areas appeared In hands and old iodinlzed area - the latter subsequently vesicalated and oozed serum for 1 day. There has been Improvement during past three days. It seems as though there has been a typical sensitivity reaction to the Thionex which was employed several times during the first attack 1 month ago. Malaise, vertigo, full feeling in head with staggering gait noted, on several occasions past 2 days - worse at nights - attacks last 1- 3 minutes and simulate drunkenness hut pass off rabidly,-. II-28 -32 Both legs In about same cond-* tion as they wore 1 week ago - except for Improvement In the appearance of such epithelialized areas as escaped; durihgx thisr.last recrudescence, 2 $ Resorcin Ointment continued on legs - Hands which have improved considerably are to be dressed with Calamine lotion. 11- 30 -32 Noticeable improvement - in old areas especially hands - but a large area Involving l/ 2 right chest has appeared in last 12 hours with two 15 x 15 cm patches over scapulae. These are hard papular scaly eruptions - no vesicles or serum - and although are only few hours old look like, chronic lesions - Their appearance ta not related to any exposur nor was there possibility of contamination.by discharges from active areas. On 11-12-32 an attempt was made to secure passive transfer onto shin of rabbit; without successr either by patch tests or vapor exposure - , intradermal injection of 0.01 cc into the sensitized and. control sites resulted'in a marked acute inflammatory local reaction in epntrol as well as serum treated areas. The cut 5 of 7 Is evidently very irritating but in the case of a rabbit at least this irritating quality is nob fenhanced by application.to areas which have been treated with sensitive human serum. / Attempts.at passive transfer into the skin of a young - (2 yr.old) monkey $ were equally unsuccessful on treatment Tilth vapor and by patch method - intradermal injection of 0.01 cc as in case of rabbit resulted in a marked / .inflammatory reaction leading bo necrosis of the treated skin areas - both / control and serum treated - healed in 6 days. 12-1-32 Lesions chest - legs - hands and face sdme - all weeping at time3especially legs. I2-I4.-32 Seen by Dr. Zwick who recommended camomile tea for wash - a lotior. and dusting powder. 12-7-32 Above treatment aggravated condition legs and patient discontinued application after 36 hours. 12-8-52 The new lesions on chest and back look more and more like a drug rash - compound Resorcin ointment discontinued ~ due to tar in same. 12 -10 -32 Ghest and back lesions practically gone since discontinuance of Comp. Resorcin ointment and use of 10$$ Boric ointment. 12-11-32 Sent to Deaconess hospital - Elimination diet - rice - olives - lettuce, peaches, lamb and bacon - 2700 cals. *-- -- 12-13-32 Very much improved - hands almost clear -- considerable epithelial ization legs - had 1-5 Sr aspirin tablet last night - resulted in edema tongue and lower lips - last few hours. 12-lip-32 Legs improved - chicken, peas, and pears added bo diet - 2500 cal 12 -15 - 3 2 .Hot milk a n d ^ a l t i n e given by error last night - legs and hands worse this A.M. to'return bo original'diet. Back and sides are now enbirel clear - legs under cradle without dressing most of day. Second set of ... passive transfer experiments done. . / 12-17-32 Condition same. 10 Pos .-8-lp8 hrs. , 1 Miller serum 2 0) 2 Salt sol Merth control 3 0 ) neg lp8 hours 0 3 . Serum and immune serum h 0 )'"V 3 hr Serum and normal Rab. serum 3 #1 pain and burning in 15 minutes - edema - redness and subq. infiltration ( 8--I4.8 hours with bronzing subsequently. On 12-18-32 areas 3 and ]p swelled /' markedly and showed-subcutaneous soft edema for Ip x Ip cm area around them - \ and old rabbit serum areas situated 6 cm away showed same reaction - began <p about 5 P.M. on 12 -l8-p2 the older injected areas of 12-9-32 reacted .somewhat less than the more recent, ones - "both reached height morning 12 -19 -32 coincident with onset attack of influenza - tapered off in q. days - gone 12 -2Jf-32 from 12-18 -32 to 12 -25-32 itching was very marked and there were numerous papules both on the surface and adjacent to the lesions - These did not vesiculate and receded with the principal leaion. Areas 1 and 2 of 12-9 and 12-17 were not influenced during those changes in areas 3 and Ip. The reaction seemed to depend on the presence in the skin of rabbit serum - both the normal and immune reacting to the same pitch,. Prom 12-17 to 12-2^. Patient's legs improved tremendously and he was : allowed ,to go hone on 12-2k-32. Put 6n full diet with instructions to take all foods at meal times. - no liquor or foods between meals, 12-27-32 Legs dry - skin normal on calves - nearly healed at ankles - lesio at right angle mandible better - no weeping - almost well. Beef, potatoes,., canned peas (with small amount milk ana flour) white bread - butter beans, 12-29-32 Drove for 1 hour - Bork chops for dinner - beginning about 8 P.M, legs itched and burned - swelled slightly, 12-30-32 Swellings legs increased - weeping began - lesion on right side face lighted up - ate salmon, potatoes, pound cake. Bed rest. 12-31-32 Increased pain, swelling, weeping. 1-3-33 Weeping diminished - legs improved today though swelling is still marked. Applying boric ointment past 3 days. - 1-5-3 3 Seen with Dr. DuCasse - recommended Calomel gr 1/8 tid 15 rifnutes A.C. - Anaesthesia ointment 10 p in Lanolin and Bile salts gr V tid - restricted diet continued - no tobacco for 2 days. 001:11, ;v. \ Samples of Urine and Faeces from employee' Standard Oil Company (Ohio) Patient is a filling station attendant in Cincinnati. Diagnosis: Gasoline dermatitis. / Urine - 10-15-32 Pb found Pb/Liter - 0.05 mg. - 0.02+ mg. Faeces Pb found Pb/lOO ms faeces Pb/gm. Ash - 10-15-32 - 0.73 mg - 1.52 mgs. - 0.11+ mg. Reported: 11-4-32 KE 0011948