Document gDpOwLNjOz5oxKZ3JawDnme3a

"Cases of TEL poisoning French Manufacturing Plant-Paimboeuf -- - ui n Tf Tf (N KE 0020933 ) l?saaa: Em ployer; Eth yl-Ku h lm an n , laimboeuf, Hr* Nantes Lo ir e Xn ferieu r e, FRANCS. Apre; 33 ye a r s * Date rnd P la ce o f ?;jr t h : 9t h A p r i l , I 9 15 a t B r e s t * M a rital Sta te; Sin gle* F a n ily H istory; N ot known* P a r e n t s p r o b a b ly a l i v e . H istory o f p a st I lln e s s e s : Not known. H a b ita and En viron m en t; A well-kn own h eavy d r in k e r o f lo c a l win e. He r e s id e d in lo d gin gs in r a it a b o eu f. P r e vio u s Em ploym en t; Worked in t h e a r s e n a l a t r e s t . D u r a t io n and t yp e o f em ploym en t n o t kn own * Em ploym ent w it h Etn yl-Puhlroan n * P a isib oeu f 1 2 7 t h Au gu st - 6t h Sep t em b er , 1947 He commenced work on t h e 27t h Au gu s t , I 9 4 7 and was p assed ns m e d ica lly f i t fo r em ploym en t in th e T e t r a e t h y l Lead P la n t on 9 t h Se p t e m b e r ,19^ 7 He worked a s r p r ocess o p e r a t o r on th e ground flo o r o f th e T .S .L . b u ild in g , t r a n s p o r t in g h op p er s t o and from t h e a llo y b u ild in g. 0020934 Sep t em b er , 19^ 7 He WRs on s t r i k e w it h o t h e r e m p lo ye e s . 3r d O ct o b e r - 8t h December, 1947. A secon d o p er a to r on the top flo o r o f th e T .e .L . b u ild in g engaged in ch a r gin g a u t o cla ve s and c o n t r o llin g t h e r e a c t io n . Oi X 8t h Decem ber, I 9 4 7 " 6t h M ar ch , I 9 4 8 . He worked ea a b la ck s m it h on t h e ammonia p la n t on t h e same s i t e b u t n o t in th e T.B.L. se ctio n . 6t h March - 13 t h N o ve n t e r , I948 (see excep tion s He was en gaged on g e n e r a l m a in t en a n ce Marital State: Family History: History of Past Illnesses: Habits and Environment: Previous Employaient: Employment with Ethyl-Kuhlraann. iaimboouf : 27th August - 6th September, 1947 September, 19^7 3rd October - 8th Deoember, 19^ 7 8th December, 19^7 6th March, 1948 6th March - 13th November, I948 (see exceptions below) 2(;th-29th July, 1^48 ) llth-13th October, ipie) Single. Not known. Parents probably alive. Not known. A well-known heavy drinker of local wine. ile resided in lodgings in Baimboeuf. 'Worked in the arsenal at Brest. Duration and type of employment not known. He commenced work on the 27th August, I947 and was passed as medically fit for employment in the Tetraethyl Lead Plant on 9th September,19^7 He worked as a process operator on 'he ground floor of the T.h.u. building, transporting hoppers to and from the alloy building. He was on strike with other employees. A second operator on the top floor of the T.h.L. building engaged in charging autoclaves and controlling the reaction. He worked ea a blacksmith on the ammonia plant on the same site but not in the T.L.L. section. He was engaged on general maintenance on T.j..ii. plant. His work was not supervised. The detail of all work carried out by him during the last three week* of employment is not definitely known. Ho had changed -valves on alloy pots, greased reduction on stills^ installed compressed air lines and forged chisels end picks for the lead reoovery building. He was the second operator on the top floor of the T*K.L. building. 0020936 15th November - 1st December, 1948 1st December, 1948. Treatment Nurse/health Visitor, who found him agitated. The Works' Medical Officer was informed and visited him later in the day when he found him in a condition closely simulating Delirium Tremens* He was excited, confused and perspiring profusely. He was suffering from hallucinations* On examination the pulse rate was 100 beats per minute, temperature 99*8P. (37*7C.) and blood pressure l^O/lOQrnm.Hg. There were no localising signs* He was removed to the hospital at the Ethyl-Kuhlaann llant, paimboeuf and kept under observation for several hours. His condition did not improve and he was transferred, the same evening, by ambulance to St* Jacques Hospital, Nantes* In hospital he was under the care of Dr* Gorman, a rhyaieian, who considered him to bo a typical case of Delirium Tremens, although Dr Gorman knew of the possibility of tetraethyl lead intoxication* Delirium Tremens is a common condition in the area. He did not respond to treatment in the usual raanner. Hia condition progressively deteriorated? agitation being the most prominent sign* During the few days prior to death hie condition simulated aeningo-encophalitia. There was a marked generalised rigidity, dysphonia and dysphagia* Kernig's sign was positive* Brudinski'8 sign not known* Blood pressure, lumbar puncture and biochemical examinations were not possible owing to the locomotor activity. There were no abdominal symptoms. Myoclonus and convulsions were not noted. The temperature was elevated during the last few days of illness* Death. ,He was treated as a case of Delirium Tremens. Morphia, hyoaolne And barbiturates 15th November - 1st December, 1948* 1st December, 1948. lthyl-Kuhlannn Plant, laimboeuf and kept under observation for several hours. His condition did not improve and he was transferred, the same evening, by a.ntbulanoe to St. Jacques hospital, Nantes. In hospital he was under the care of Dr. Gorman, a Physician, who considered him to be a typical case of Delirium irentons, although Dr. Gorman knew of the possibility of tetraethyl lead intoxication. Delirium 'remans i* a common condition in the area. He did not respond to treatment in the usual manner. Hia condition progressively deteriorated; agitation being the most prominent sign. During the few days prior to death his condition simulated meningo-enoephalitis. There was a marked generalised rigidity, dysphonia and dysphagia. Kernig*s sign was positive. nrudinski's sign not known. Dlood pressure, lumbar puncture and biochemical examinations were not possible owing to the locomotor activity. There were no abdominal symptoms. Myoclonus and convulsions were not noted. The temperature m e elevated during the last few days of illness. Death. Treatment He was treated as a case of Delirium Tremens. Morphia, hyoaoine and barbiturates were not given. Hia treatment consisted of a hypodermic injection of 1J mg. strychnine sulphate per day for eight days* Post Mortem - 2nd December, l948i There was subcutaneous eochymosla of scalp and right iliac region* K 0020937 Lungs: Liver : Kidneys: The superficial veins were congested. There were some haemorrhagic areas on its surface. The brain stem and cerebellum exhibited a similar appearance to the cerebrum. On section of the brain numerous pinpoint haemorrhages were noted. These were congested without consolidation. Sections floated in water. Normal in size. It felt more orepitant than normal when out with a knife. These were lilao in colour. Analysis of Biopsy Material. The samples provided were forwarded to the Courtauld Institute of Biochemistry, Middlesex Hospital, Medical School, London, ft`,1., where they were analysed under arrangements made with Professor E.C. Dodds. The samples had been forwarded in bottles prepared by Professor Dodds, which were broken in transit. Each sample was weighed after adhering pieces of straw had been removed, then washed under the tap and finally washed with distilled water. The results are as follows QQ20938 Sample. Brain Liver Lung Kidney * 0CM Weight. 63 gm. 29 " 63 Mg. Pb. found. Mg./Pb./lOO gm. tissue. O .36 0 .15 0.097 0.40 O .57 O .52 0.48 0.64 not adequately supervised and details of his duties during the three weeks prior to his fatal illness are not known. The degree of the significant exposure cannot be ascertained. The olinioal picture exhibited during his fatal illness is common to tetraethyl lead poisoning and Delirium Tremens. It was known that ho was addicted to aloohol. Consequently, there will always remain a oertain element of doubt in this case. It is bad practice to assume two causes for any pathological process, but in this instance both poisons may be accepted as having played a part. It may remain e matter of opinion as to which was the actual cause of death. The mortality rates in tetraethyl load intoxication and Delirium Tremens are approximately the same. The biochemical and analytical procedures, which may have been of assistance in ascertaining the ianin cause of the illness, were ujxr'ortunately not carried out. Th meningeal irritation and rigidity exhibited in this case are not to be expected in tetraethyl load intoxication, which, as a rul<s, does not present any localising cigna. The post mortem findings in tetraethyl lead intoxication are not specific and arc common to those resulting from many toxic processes. The picture of congestion, oedema and petechial haemorrhages, ouch os founa in this case, is similar to that found in tetraethyl lead poisoning and chronic alcoholism. There was considerable delay in the receipt of the pathological specimens for analysis through the post. There is some possibility of the tissues having been contaminated when tho Lotties containing them were broken. Ah reasonable steps were taken to remove such possible contamination, it is considered that the results of analysis should be coopted as correct. The following table shows a comparison of these results with the maximum normal standards determined by Dr. E.A. Kehoei Standard. iiaximum normal ]% Pb. per 100 gas* of fresh or forasalin-fixed tissue. Brain Liver Lung Kidney 0.09 0.28 0.06 0 .16 Tissues of deoeased O.57 O .52 0.48 0.64 illness, were unfortunately not carried out. The meningeal irritation and rigidity exhibited to I M S case are not to be expected to tetraethyl lead totoxioation, which, as a rule, does not present any localising signs* The post mortem findings to tetraethyl lead intoxication are not specific and are common to those resulting from many toxic processes* The pioture of congestion, oedema and petechial haemorrhages, such os found to this case, is similar to that found in tetraethyl lead poisoning and ohronic alcoholism* There was considerable delay to the receipt of the pathological specimens for analysis through the post* There is some possibility of tlie tissues having been contaminated when tho bottle# containing them were broken. A# reasonable steps were taken to remove such possible contamination, it is considered that the results of analysis should be acoopted as correct. The following table shows a comparison of these results with the awxiuuta normal standards determined by Dr. K.A. Kehoe: Standard* Maximum normal Mg* Pb. per 100 gas* of fresh or formalin-fixed tissue* Brain Liver Lung Kidney 0.09 0.28 0 .0 6 0 .16 Tissues of deceased 0.57 0 .52 0.461 0.64 The concentration of lead in the formalin to which the tissues were fixed was O.OoJ mg. per litre* A sample of potable water from the area contained 0*55 mg. of lead per litre* The concentration of lend in the four tissue samples analysed are obviously very auoh to excess of normal. This high lead content oould not have resulted fro contamination of the formalin. The moderately high lead content of the potable water, by British standards and the very high rate by American standards, is not a likely cause * HE 0020940 umm Albert Nicolas, an employee of Masera* Sthy1-Ku'nlmann, Paiaboeuf, who died on the 1st December, 1948 following an illness simulating tetraethyl lead intoxication, was a known chronic alcohollo. For this reason he should not have been employed in the manufacture of tetraethyl lead, and, further, he should not have been permitted to commence work without a pre-employment medical examination. Ho had significant lead exposure from his occupation. He was not supervised in work which involved an occupational load hazard. The clinical picture, post mortem findings and results of the analysis of four tissues are strongly suggestive of tetraethyl lead poisoning. There is a possibility of another o*use, namely. Delirium Tremens from chronic alcoholism. In view of all the findings it is considered that it is fair and reasonable to conclude that the moat likely cause of death in this oase was tetraethyl lead poisoning. 7.4.49. 8*6leal Department* The As*oel*l*4 ifc/i K. Dftvison. (.Senior Uodioal Officer) 4tnifc*4 K E" 0020941