Document gbyxRVJMn6KmyzyLg8zkpQa0G

E t h y l G a s o l in e C o r p o r a t io n Lead Exposure ...,Y ~ ................................................................. .... illnesses (Injuries and Operations)........ Suggestive History o f Syphilis, Tuberculosis, H eart Disease, Nephritis, Malaria, Alcoholism, Epilepsy. Insanity, & ` _____ / J ? / ? . ................. it fa m j^ ii^ p ry J N e rv o u s conditions and insanity)........ . . . . . . .L .:_ ................................. ' f m General Health .................................................. . .............. Usual W e igh t.... H abits o f Sleep A p p e t i f e ^ ^ t ? C ^ . . r r . .................. C onstipation...'^6{3^?............................. i/ Indigestion . ....... Periodic Headache----- O ther symptoms now present........................................*........ ........................ Sexual H is to ry , O ther information and remarks... . . p ./? - } E t h y l G a s o l in e C o r p o r a t io n , PHYSICAL EXAMINATION % Case No.,__ _________ Name H eight..... . 3 . 3 . ................... W eight [stripped) Date.. .................................... Temperature__ .................... General Appearance .../3^S.A Nutrition Skin , t/ Development . Posture ^Vision ............. Nose E., Mouth /n .<2 4 a ; ........ *7 " Sense o f Smell.... o cP "P ? Throat '' ` Lymph Glands Chest-- Respiration.........../ f " ................... . Pulse....... 3 3 . . . . . . ......... Blood Pressure /.3 .3 3 3 - ~ - . : A ^5 ' ? C ' ^ Chest Measurements at Nipple Line....... ................................................. H eart Measurements A- "E &( s 'O Abdomen C - 3" I i ,, X iP t^ e3 iZ( c ir -p y ___ c *>--' Pelvis Extrem tiies^A ^Q . __{ P /3 a ^ L . P A P A p^tA pA *-......................... .................. ................... ......... Central Nervous System-- [Reflexes, signs, tremors, sensation) ,.../rP p ^ p A .3 p p :...A P ^ 0 ^ P ^ P ^ ? ..... 7 3 3 x ...,, :.. ......PA PA .^ 3 3 3 p 3 ....^ .___ ____________________________________________________________________ _ Muscular Strength-- Right Hand r# Left H a n d ____ ` I HEREBY ACKNOWLEDGE THAT I HAVE BEEN ADVISED BY.---------- ......._________ _________________________ ... . .. . REPRESENTING THE ETHYL GASOLINE CORPORATION. THAT ETHYL FLUID IS A POISON AND FURTHER THAT I HAVE RECEIVED FROM H IM INSTRUCTIONS AND INFORMATION RELATIVE TO THE DANGERS AND RISKS ASSOCIATED W ITH THE H A NDLING OF SAID FLUID. 'll # 8. Witness: Employee. P'- ik v&- ____/ % L y y y z ^ < - .(33^ S y^ & .._ ^ ^ .'^ .=^ ^ ^ ^ ^ cl...^ ^ !i^ ??.....'^ fe.___________~__ 7^ a P ____ 0 Y> t d s L ~ -? < 2~ -Yf ~ ^ i$ ... L & k ^ .... ^ .~ 1 / 2 - <s j % JLL-<^> , /f/^ / / o o r ,A ooo 9 k -T ................ o . _r. / ; -- M ^l rJt .-- . .. y. " '' ' - ;' -;: ' : u .. . , ;'. .. . ..... : y . y V- y y yy. . .. * , .y '-.y - y. .: .'. y-' . y-y .. v ...':.-.'.y- ','v-'.r' . ` V .,*w*~' - V r . . '- '-r'T- / ..; : y;S!y y:.y- ' '---Vr--.' ` .-y . \ -; ;y' ". . .. ' . .yi - - . ' 1-< ' y ' ...' ' - :V' y- V . : : U . ... .r ' - -y .-- &: */ -y y y . - ; ' ' " V, - . , . ' . . . y. . ' . ; ' --y-y" : .y . . -y ' . ^y-i i-.y-yy ' ' '' .- . ' ' -"*. -, . ' . :"V : : ;. . ., - . .