Document mqmajpKazE0GZ6NOebmZERkZ4

E. I. d u Po n t d e Ne m o u r s & Co mp a n y INC0RJ*OAA' Ol d Hic k o r y Pl a n t Da v id s o n Co u n t y , Te n n . RAYON DEPARTMENT RAYON DIVISION Old Hickory, Tennessee February 13, 1947 Dr. Robert Keho % Kettering Laboratories University of Cincinnati Cincinnati, Ohio Dear Dr. Keho: At the suggestion of Dr. Tarrant, of our Medical Section in Wilmington, Delaware, I would like to submit a problem of lead intoxication to you for your sugge stions and advice. Admittedly, our experience with lead intoxi cation hefe has been very meager, which is also the case in this entire section, as lead poisoning in Nashville and vicinity is rare. s I am enclosing a cohy ofy a letter I recently wrote to Our Dr. Gehrmann, wnich I believe will cover briefly the important points in the individual's his tory. Also, enclosed are copies of examinations we had made by a very good internist in Nashville, and tabulations of lead analyses done in our local labor atory here. After reviewing this case, I would ap preciate your advising me as to the proper steps to take with this individual and also, in a general man ner, the best procedure to follow in any subsequent cases we may run into. As this is an acute problem, I would- appreci ate an answer at your earliest possible convenience. Very truly yours. RPM:FMF Att. MEDICAL DEPARTMENT Old Hickory, Tennessee January 29,1947 "AIR MAI L" DR. G. H. GEHRMANN DIRECTOR MEDICAL DIVISION SERVICE DEPARTMENT WILMINGTON Subject: ROY GREENER - AGE 54 : . The Above employee has been employed by us as a leadburner off and on sintfe 1933. The date of his first recorded examination is September 5,! 1933. His adjusted service date Is November 24, 1943. He has ajlvays been given regular periodic leadburner examina tions and up until the present Illness he has had no objective or subjective symptoms of leading. His R.B.C. count is usually be tween 4,000,000 and 4,5^0,000; Hg. between 80 and 90. In July, 1945) Mr. Greener, on routine monthly leadburner examination, complained of some rather vague symptoms of gastric distress, malaise with easy tiring and some diarrhea. A spot check of his urine for lead showed .055 mg. per 100 cc.; Hg., 90; R.B.C., 4,700,000; analysis, negative; BP, 106/62. A recheck later in July showed lead, 0.120 mg. per 1000 cc. His general condition somewhat improved subjectively. Hg., 9; R.B.C., 4,350,000; no stipple ^eellsy; analysis, negative; BP, 104/62. / During August, Mr. Greener seemed about the same but his urine lead increased, and about the first of September he was re moved from all Exposure to lead and calcium therapy begun. Exami nation at this time showed BP, 124/80; Hg., 90; R.B.C., 4,350,000; three stipple cplls (the only ones ever found). He continued to improve. The weakness and colic gradually became less, although did not entirely disappear until about June, 1946. After about six or eight weeks Of calcium he was deleaded slowly with ammonium chloride. His iirine lead was reduced to within normal limits and he was put back; to doing lead work in the Shops the last of July or first of August, 1946. Mr. Greener seemed to be doing nicely for awhile but be gan to complain!more of subjective symptoms in October - BP, 104/70; Hg. , 80; R.B.C. l, 3,500,000. November examination - complaints about the same; BP, 130/74; Hg., 76; R.B.C., 3*^50,000. At this time it seemed that his symptoms were influenced by the nature and place he was asked to work rather than by the concentration of lead fumes. However, in order to be as fair and as thorough as possible, we requested Dr. Wi R. Cate to re-examine the employee (See his re port of March, 1946). A copy of his examination is enclosed. However, a subsequent check of Mr. Greener's urine shows him to be passing an abnormal amount of lead. (All specimens of urine ex cept the first spot check were 24 hour specimens.) r4 QO N 24976.01 A , /O DR. G. H. GEHtRMANN 2 January 29, 194? We are taking this man out of all exposure to lead and will follow up on his condition to determine his urinary lead out put. As our experience with lead poisoning has been practical ly nil at this plant, please advise us as to what the routine pro cedure is at other plantain such cases. It appears to us that this man recovered from his initial attack but has developed a sus ceptibility to lead. Would it be advisable to prohibit his handl ing lead in the future on this plant? We would appreciate your suggestions and opinions on this case at your earliest convenience. RPMj PMF Enel. /s/ R. P. MILLER, M.D. MEDICAL SUPERVISOR i 01 Q 9 Q 2 X-ray Reports: The esophagus, stomach and duodenum are negative. The small bowel is negative. There are marked hypertrophic changes between the second and third lumbar vertebrae. There is a large amount of gas over the left kidney. However, there are no gross abnormalities seen in the urinary tract. Both kidneys are normal in size. There is no evidence of calcification. There is prompt excretion of the media. There are no gross abnormal changes seen except for a kink in the ureter at the ureteropelvic junction. There is no dilata- s,-- tion above or below this kink. The bladder shadow is nprmal. The entire colon is negative,, ^ . Sincerely, /s/ William R. Cate, M.D. . ` rv / v. 01 930 N 24976.02 0 WILLIAM R. CATE, M.D. Doctors Building Nashville 3> Tennessee March 22, 1946 Dr. R. P. Miller DuPont Rayon Old Hickory, Term. Dear Doctor;Miller: Mr. Roy Greener was in today and I am sure that there is very little iwe can add to your knowledge of his case. He gives a very clear cut history of lead colic, in August, 1945. This was verified by the urine studies made at intervals at the plant. At this time he complains of progressive insomnia nervousness, tremu lousness, dizziness with swaying while walking, difficulty in thinking clearly, vague headaches with jerking of the muscles of the eyelids.; For the past two weeks he has noticed progressive weakness in both wrists with paresthesia in the left forearm. Thp general physical examination was negative. Blood pressure 124/82. All superficial and deep reflexes are bilateral ly equal* and active. Repeated testing by two observers Indicated some weakness in the extensor muscles in both wrists without the typical wrist drop. No changes were noted in the ankles. Laboratory reports enclosed. It Is my opinion that Mr. Greener still shows signs of chronic lead poisoning, the lead being fixed and not available for elimination by the kidneys. It would be best "at this time to mobilize the lead by using either amonium chloride or potassium iodide in order to check any further extension of the wrist drop. His general condition is much improved over last summer and Mr. Greener himself states that he is slowly but gradually getting better. It may be that he will recover completely without further medication. On the other hand the wrist weakness has developed in the past few weeks and may progress further unless checked by appropriate treatment at this time. Sincerely, /s/ WILLIAM R. CATE, M.D. 01931 N 24976.03 LABORATORY REPORTS Greener, Roy March 22, 1946 Hb: 84$ (14.28) R.B .0. 4,720,000 W. 3 .C. 8,800 Sraer: no stippling fouhd.. Hematocrit: McVbl: 112 McHb: 30 McHbC. 25 Sed Rate: 6 mm q Ihr, Blood Sugar: 99 mg. SIT*amber Acid-1.022 Albumin-ft.trace Sugar-ftest.trace Occ.Blood-neg 7-8 RBC pfhp Occ.pus clump Polys 61$ Lymphs 28$ Large Lymphs 8 Eosinophils 3 (100 cells counted) Gastric Analysis Time Free HCL Total HCL Fasting 15 Min. 30 Min. 3 12 23 26 18 28 y n'11* yo v7} -> N 24976.04 OLD HICKORY LABORATORY REPORTS Date February 10, 1947 February 3, 19 47 January 27, 19 47 June 24, 1946 May 20, 1946 April 22, 19461 December 17, 1945 November 19 , 1945 October 29, 1945 October 8, 194 5 August 27, 19^ 5 July 30, 1945 July 24, 1945 Total Volume Total Lead Lead per 1000 cc 1025 ml. 1030 it 0.06 mg Pb 0.11 " 0.06' iDg. 0.11 11 1100 n CM OJ O 0.20 ![ 1265 ri 0.05 0.04 M 785 940 u ri 0.067 " 0.09 " 0.085 f! 0.10 11 1290 M 0.084 " 0.065 It 1581 rr 0.055-0.047 O.O35-O. 030 960 M 0.084 " 0.088 It 1270 ft O.15 0.12 It 1580 ri / ^1120 it 0.28 " 0.134-0.134 0.18 It 0.120-0. 120 mg. Pb per 100 ml. O.O55