Document gLENENY0gmXQ3V3KEy7XKMK9

Cas of t&ployee of Joseph Forciez*, Gravelbourg,.-Saskatchewan, Canada. In ep tambor of 1929 bogan to fool ill, with a headache, insomnia, abdominal- cramps diarrhoea, vomiting, and. weakness* The condition progressed until he finally was forced to quit v;OT*lC o.nci later v,'as taken to a liespi tal for observation an d treat e jdie fol low:ing is tl T csumo of hi s oc cupational v!story, nc the on'set and course of'his illnes;g up to the present, cember "J ? wrj-*. cfb*., o il - Inmarried la S1 :1f-tO' V - begat iv -CCUp:'ifcio" -ii. ;;Ory - tarted to ;O*k ii 0013 b 1920 in butcher shop '.hare for one year. 'hcnancr chop four years. :a moeriiulst in stone . .* U v `> . " --1 u ' im p "' @ !' V i " - i-y v -jh i 'j ' 1 - y . i r_* p . v - . r \ r \ ^ h^lped tinsmith about two years ago for about three months, did no roldextiug. dith present -company for'one and one half or two years ho unov.'n load exposure* First. started handling X'thyl Gasoline .Juno 27, 1029. fork consisted of pumping gas from tank car to barrels and then from barrels into truck and subsequently delivering gas to filling sta- tlons* On June 27, 1929 (first shipment} 1G4S gallons wore handled In a period of, four to five hours* On August 19, 1019 a shipment of 1638 gallons, and on September Go, 1929 one of 1657 gallons was received and handled in r.pproximatoly the same time as the first shipment. This mail estates that he worked very rapidly using no precautions to avoid c o n m e t - w i t h the.gasoline, and ee a result.was v thoroughly soaked with the gas from above the waist to his feet* His hands during this period were constantly wot with the gas The clothing after being wet was not changed and was worn every day up until his entrance to 'hospital. The nan at this time had a habit of biting his nails and probably had his fingers in hi-s mouth a great deal after filling his truck. The barrels were filled in a c o m e r of a closed structure where two small doors offered the only ventilation - On the second occasion of.barrel filling, o becam disr.y while at work and went outside for fresh air oturned and finished job lie vomited on the next morning and bit not feel i':-` well for days, having a headache which usually b'-'gan .1 worning on arrival at work and lasted through the day and sometimes in the night 'Ho slept poorly and f e l t tired He had no frightful dreams, but was restless. ' After the third experience of barrel filling hia symptoms became worse,^hether after this or before {subject is not sure) Tie developed abdominal cramps of a dull, aching character, a diarrhoea, with two or three loose stools per day The pain -was not relieved by defecation, nor was it localized, but was moat severe on tho sides low down, and radiated to the back at times, sometimes up toward throat* llausea and vomiting occurred daily with' or without meals, but began only after arriving at work where exposure to gasoline was resumed. The vomiting was followed by a bad taste (not adequately described - "everything tasted same". Later described as ''coppery" .) The appetite was very bad, but he forced himself to eat. He slept badly, and was "jumpy" , his. rooaanat complaining of M s grinding Ms- teeth and moving about# He wakened tired# felt weak, had double vision and ''spots in front of eyes" , had weakness of knees, vertigo, pains in arsis and legs, and abdominal pain# At this time he consulted a doctor who made a diag nosis of lead poisoning (without knowledge of his occupation) T he next day saw another doctor who made the same diagnosis (without knowledge of other doctor<s diagnosis or of occupation)# V.as now too ill to continue work and went into hospital on advice of doctors# At this time ho seems to have had a lapse of memory for he got, a haircut, about which he had no knowledge until his;: barber later told him about his peculiar behavior while in the shop* be now developed considerable pain in arms and legs - (having had weakness of legs and knees before) On lifting the arm he had pain In the right deltoid muscle and in wrist* ..iter a day or two.: ho developed a right wrist d r o p ,which lasted one day* ' His hospital record is largely valueless# It indi cates that on admission his temperature was normal, his urine showed a trace of albumen# Pain over the right parotid gland developed which lasted four days# (Nausea without vomiting per sisted at first while in hospital. Examination notes at hospital show that there was a generalized tenderness over abdomen, flanks J-' and baekj A punctate pigmentation of the lower gums some distance from the teeth. Patient says that while in hospital he noted prickly sensation- over entire body. He describes a peculiar ''old coin" taste in mouth when back was rubbed with an ointment of menthol, methyl salycllate, and chloral hydrate, romo muscular incoordination of hands was noted in that it was ''hard to do things with handsri* T he condition gradually improved and the symptoms abated after about two weeks in the hospital Did not return to work for about a month .and in this time gained back the weight he had lost (about 12 lbs.). "as seen by Dr. Lester V?' Sanders of the Ethyl Gasoline Staff at this time (Dr Sanders* findings appear in records of examination) Dr* Handers investigated various possibilities of lead absorption, obtaining samples of thp subjoct*s blood, excreta, drinking water from two sources# Eg also obtained the subject*s unlaundered clothing for o ctudyf-.of its load content (See appended data.) lie returned to work' about November 15th, wording at light work with no appreciable gasoline exposure, a. wo tut later began work in earnest and handled gasoline, filling turn; wagon and hauling on way home in evening cramps began to beco. :o severe again, increasing in severity until ho was scarcely able to walk has very weak and had continuous pain on both sides low in abdomen. Did not return to work, but improved sufficiently to come.to Cincinnati on December 2nd at -request of Dr hehoe. Entered Holmes Hospital December 2nd for observation# It this time his symptoms were confined to discomfort in the abdo men, some muscular soreness in the back, and inconstant headache, bn the way to Cincinnati he had noted weakness of the legs, es pecially the right, and an ache In the right arm. Physical examination disclosed the following facts. (Composite findings of Dr. Handers, Dr. Hehoe, and Dr. Foshay.) Hie general appearance was that of a healthy strong young man* of ruddy complexion and stout build* His abnormal findings were* . .. (!) ':y~aertrophy and edema of tho left inferior turbinate, with impingement on th septum and a partial obstruct ion of the left nos trillsome, opacity to transillumiiiation of left ethmoid or sphenoid, region* and some tendernessj congestion and edema of mucous membranes of nose and posterior pharynx .ith a post nasal discharge* osterior cervical lympr. glands or. ,,oft soi to palpation, Tonsi. edematous and containing liquid pus in deep crypts. Loft U:-OU inusitis involving etiaaoid region verified by X-ray examination. . (2) Abdominal tenderness over caecum, vnd sigmoid especially but involving entire largo bowel. Distension of caecum and ascending colon. (3) Paresis (somewhat variable from day to clay, and apparently absent at times) Of the hands and forearms, equal on the two sides* more pronounced in the extensors than the flexors* and more pronounced in the hands than in the forearms. Reflexes were present in all, and there was no'demonstrable atrophy* There was tenderness along the musculo-spiral nerve Ho sensory disturb ances were present. -X. if: (4) l!o lead line was present at any point. A'F' 0011310 0T i; L-tiv-u . , Aoi-nf TT ;rplAGA Mood Gasserman negative Kod 5 lood. Count (2 counts) 1 ,1500,000 hi te Mood Count o ,e 0 differential: 'olymorp} lonuelear neutrophiles 75:- Lymphocytes , Dosinophlies -22.5 f. 3>f iasophilos 0 .5 ;' ; tippling per L0 fields: hovoubor 21, 1929 Fecsnber 2, 1929 December 9, 1229 10 6 1o acuc, lobin - 20 . -.0 lysis of blood for lead - three aamplias of oCec each Ml rinulysis - relative on three occasions tool - cist, unforeod, v;ifch excessive mucous and no Mood* ho intestinal parasites found bacteriological culture chons oresene9 of an haemolytic streptococcus M o stool .1s such as is seen in a low grade colitis. ;:-*:ay examination of (Metro Intestinal Tract - Negative except foi spastic condition of colon. .nalysis of Excreta for Lead. hates 11/11/29 12/1/C9 1.2/2/29 12 /0 / 2 9 Urine - ilgs/titer 0.05 0.04 0.02 0.03 Faeces - Dgs/gra ash 0.17 0.13 0.13 0.13 Analysis of Prinking hator. (1) From garage in Gravolbourg (2) ~rom' residence in Gravelbourg. vg 0011311 0.02 mgs. per liter 0.0G mgs. por liter Analysis of Trousers used, in work. ' . Front of trousers Back of trousers - 7950 grams of cloth contain 420 mg Fb - 101*75 grams of cloth contain 7.50 m g Pb Discussion:- . . The history of this natient strongly suggests to. me a primary intoxication from gasoline.inhalation. T he alimentary- symptoms the nausea and vomiting (on exposure only), and especially the quick recurrence on a single exposure after apparent recovery, point so strongly in this direction that it is difficult to avoid the conclu sion that gasoline was the nrimary cause of his illness. . .';`v On the other hand there is the opinion of two physicians.who saw him at the time of his severest illness, who attributed his symptoms to lead, and -.ho say that a "lead line" was seen at this gimo, In my experience lead lines do not disappear in from.four to si;: weeks, but one cannot arbitrarily say that no such load line existed. . The. important physical findings are limited to a slight-degree of muscular weakness involving the extensor and pronato2i* muscles of tli forearm and hand. I cannot say with any certainty that this condition occurs as a result of severe gasoline intoxication, while it is well known to be a characteristic feature of lead intoxication. An experienced and capable internist (without direct experience of gasoline intoxications) Dr. Lee Foshay of Cincinnati, who was called in consultation, believes the condition to be the result of lead intoxication. The alimentary symptoms are due to a spastic colitis and in ay opinion bear no relationship to lead intoxication. Their onset 0G; .! G.: T : sat fssa at the time of1 severest exposure corresponds to one*s expectations of gasoline intoxication. ' The stippling,is not of a magnitude which would be considered significant of- lead poisoning* 2he lead excretion is distinctly within the normal range, giving no evidence of a signi ficant and recent lead exposure. It is true that the analytical results have been obtained after two months discontinuance of ex posure, but experience leads me to expect to find evidence of significant exposure months after discontinuance* . The diagnosis, therefore, hinges upon whether, or: not. one is willing to accept the statement that a lead line origi nally existed, and whether one regards the neuro-aaus eular signs as specific for lead intoxication. Tho.simplest and easiest conclu- . cion would be that of a suddon mild load Intoxication. ..-uch a diagnosis, hoviever, nvust rest upon a history of significant expo sure , or in the absence of such, history, laboratory evidence of significant exposure such as significant excretion of lead, lead line, and stippling of a degree associated with lead absorption - .... one or the other of these, together with characteristic physical signs. In this case, the history, in terms of wide experience, is very doubtful, the evidences of lead absorption are not present, and the physical findings are meager, and in ray opinion, non-specific; for lead* I would regard the diagnosis of gasoline intoxication as a practical certainty if it can be found that a peripheral ascending neuritis of a mild type is a sequel of such an Intoxicabl on. ** 0011313 Investigations now under way will probably determine this point* Meantime one must make a fallible choice as to which causative * -- factor to assign to this case. Kobfc. A. Xohoo, M. T>. December 26,1929 Kf' 0011314