Document bBamVaoV8qN24G7DeZGZ0bpB1

ebv t o or mcom Am p?am Claim ho. 0. B* 30323 Dec*u- August 19* 13*3v s _ Th# undersigned reviewer took part in a, olinical-imtbologl- cal chnferenoa with'staff physicians at th Cincinnati General Kohpitsl and the staff of the laboratory' of neuropathology of that Institution in early March;13%3. At that time* the entire history of the case, the-;' clinical record, th# necropsy findings* the analytical data* and the'-. report, on.the gross sad aleroacopic study of the brain vers considered 1 ( \\ in detail. The .microscopic slides v examined carefully fey the;. dr re viewyAna a amber of questions ver raised for discussion. The. '* reviewer was not convinced that the raiercseopic evidence presented ves sufficient to establish the diagnosis of load encephalopathy beyond cavil, however* It was not possible* to set up- another diagnosis that could be substantiated* and the concensus of opinion of the conference* with which the reviewer concurred, was that the diagnosis of lead encephalopathy was justified for both clinical and medico-legal purposes. A review of the record as submitted has given no reason for altering this conclusion. It cannot be said that the diagnosis of lead encephalopathy has hem established without question . It is possible - that the primary clinical condition was hypertensive encephalopathy, and that death resulted from the hemorrhage. However* the hemorrhage is regarded by the neurologists aad the neuropathologists as incidental In this case* and that conclusion cannot be proved erroneous. Against the diagnosis of lead encephalopathy is the opinion of Dr. tiatuska who regarded the condition aa primarily hypertensive. 0016802 sad considered that tills employe had never had. s|gabions or sign , suggestive of plm&tm* Sphere is also the pinion of the Anoistsai 'OsniCSfii: ftesagar ..off: the Eagie*PIehr LmA 0aapmj to the effect t** the deceased bad. not been serieuely exposed.to lead in Ms worlc* %e latter opinion, however honestly' held* is not to be taken seriously in view of the analytical findings on the tissues of the deceased* these analyses demonstrate 'that the lead espeimt had been of signifi east pro^rtions* and- the. load w#Wiej in the liver, spleen and s b 8ele prove that the exposure had continued to fee significant up to a time shortly* before death. The skeleton obtained fifteen to sixteen .ties* the concentration.of load found in the hones -of uhsxpoeed persons* la fact, vhiX the lead concentrations demonstrated la these tissues do not prove the existence of Illness dee to lead# nor do they reveal the cause of death* they do* nevertheless* fit Sato the range of concentra tions found--.in unquestioned -fatal cases of lead poisoning end... they definitely establish the baserdoas character of the occupational lead exposure* Tim clinical infosmtioa in the record, with respect to hematological - abnormalities is inadequate* and the existence of other clinical symptoms of pliasbism emmet fee established Tim latter la often the esse when the cerebral stssifstations are as severe as they were in this case* She. clinical' course of the disease was- compatible, with the diagnosis of diffuse encephalopathy from any cause. Considering all the available iafotwattoa* the .differential diagnosis ilea between hypertensive encephalopathy and lead encephalopathy. Either of those my have bran the. primary cause of the- fatal Illness. $be cceibination of the analytical result on the brain* which is in the range seaoclated with the occurrence of lead eacephalepathy* together with the micro* KX 0016803 3 sefopie pathology of tfo' bmiSj vhicit t&e neuropathologist regards as, epical of the. effects of lead absorption * tip tins malm la favor of lead meei&BAepatisjf. TO foxoidcie th diagnosis of - load e&cepa&iapathx ass would have to prove that h:rperte3iv@ easephalcp&fchy vm the cause of death* !ThX&, In the opinion of lit reviewer, cannot rcNaseamfoly foe done ia the faeo of the evident#* Therefore, the benefit of such doubt as esaf atlll assist ahouli foe. given- to tfo oX&sxs&st in this case*. signed . . ACfoert A * . iOiioc , i * ij H 0016304