Document nkYoNpYRVk98zvZVkDQB7VMBR

.'.''o' SLAW f.AMt-HHSt KAMt- MJOOLCMAM \ ATCH! s o il A*;0R l J / >39 40 2 S H-- C PL28 02 r> 2-i i U G l SU H NO. Ho M {Cheek one) 0 Sl-tICMttn c o s i o r . K ilt f V C M A If t , UAMINAliON HiOUtiltO ONil O JI__|jePcAoll(NF J[ 7V\fSAM^ m rT^ liovc rpcrc? l o t m e c h a n i c a l i m p r i n t i n g , 1 u s e d ) . )*.iNfcKT C u - V C A ^ N l S i O H r , OPLflANONS. fHirSCAL FINDINGS, ANO i'ftOViSlONAi. DIAGNOSIS w- . V- ' 'A 'crv ^ c. . H?"** uOOCy-^Cx i^ V v ^ v v ,^ s ... V;- -- > M NO. uOt*<Ai*iiCNi?CHr ^ ILLOa Tc OF BCQUE REQUESTED 6Y x a rd n a tlc n o f th e s k u l l in p o s t e r i o r - a n t e r i o r , b o th l a t e r a l s and Towne view s .'c-veais th e c a l v a r i a t o b e i n t a c t an d s y m m e tric a l. T he s e l l a t u r c i c a i s n o r a a l . The ? in e a l Gland i s n o t c a l c i f i e d . The p e tro u s r id g e s and sp h en o id w ings a p p e ar norm al* DIAGNOSIS: N e g a tiv e s k u l l . 1 ^HAMfcOFHOSPITALOH OTHCAHCOiCALFACUlTr) O ro Z00 01 01 o u. <____> 0M DONALD MITCHELL; M.D. .9 - 2 - 6 9 SIGN ATURE* iSfifcify location of laboratory if riot part (f rriju/rtiac f*fili(yl Stondord form 519A ;Re*. Aug. IVS4} ^romvIgotcJ by Bureau oi the adgl Cir cu l ar A --32 RAOIOGKAPHIC REPORT F H .W OFST. LOUIS-DIVISIONOFHEALTH BLOOD ANDURINE 1CHEALTHLABORATORYSERViCES LEAD EXAMINATIONS ^ .'w - i 0 \ /' W / f'iyxJ Ape Sci n.c-, -> > . J \* _r^ L _ A' Month J L j[& _ Lb Fuber Thi* yewr r e t u r n d d r i : DEC i - 3S3 ^ j S `. I i" l\ - \ f ! / ( `P i I S f it M A Vr*Cc ,\'y//.^ 1i/1c + IA ( / / fcr 'tii'li/ /J / Z fiL ou /- ^ j s c Zip Cd*_--... _ -- (Pica Print) DIBECTIO.SS 1* F i U l u b e v i t b b l o o d : 2* S u b m it t i c a a t 100 m i, m( rio o * o ro LABORATORY, REPORT __A Specimen of blood shows the following concentration of lead: __________mg. lead in 100 grams of blood. Specimen of.(urine showed the following;corncentration of lead: D 'A / my lead per liter of urine. NOXE-- Heavy metal on urine specimens are based upon an .'-s . , adjusted specific gravity^of 1.024. / /. : . ;i / f y > 0 /'^<Zo^ i'J Js-zjZ4.Ki^. ; CITYOFST. LOUIS-DIVISIONOFHEALTH BLOOD ANDURINE PUBLICHEALTHLABORATORYSERVICES LEAD EXAMINATIONS PLEASE COMPLETE THE PAT EMIS NAME AMD ADDR JaKw C V W ' h U r d '- ........................... * ^ / J ~ s / , C~ t City. S T I c u n . ' s^ . L i, Cod, l, s . u . i .1 1... 100 Ml / 1 I M , (Pie** Print) LABORATORY REPORT I Snecimen^of blood shows the following concentration of lead: mg. lead in 100 grams of blood. Specimen of urine showed the following concentration of lead: ______ ;_____mg. lead per liter of urine. NOTE: Heavy metal on urine specimens are based upon an adjusted specific gravity of 1.024. H.D.L. 40/3 (ifet. 7/60) V j|trd Jonaaon, O r.P J i., D irector of Laboratori i I / OFST. LOUIS-DIVISIONOFHEALTH BLOOD ANDURINE ..1CHEALTHLA30RAT0RYSERVICES LEAD EXAMINATIONS > ! ' ." L A. i p/Monlb / * D*y Year .* * V c ';C " S ; S S (j?AJ *6 Sax Race > -* -T' /// (JJ)L b N - ,, Ybia ) your retu rn addrcaa: i DIRECTIONS 1. F ill tub* lb blood 2* S v b o i t o t l u l 100 1. o t o r io o . O (i'ic * j * Print) LABORATORY REPORT Specimen of blood shows the following concentration of lead: __________mg. lead in 100 grams of blood. Specimen of urine showed the following concentration of lead: 0 r *~f / .A- mg. lead per liter of urine. NOTE: Heavy metal on urine specimens are based upon an adjusted specific gravity of 1.024. w /43 (fWa. 7/68) V*li(*fd Jonaaon, D r.P .H ., O trccto r o f la b o r# to r' PLEASE COMPLETE THE PATICHiS UW/c Ai'iD ADDRESS CITYQFST. LOUIS-DIVISIOMOFHEALTH BLOOD ANDURINE PUBLICHEALTHLABORATORYSERVIC.ES LEAD EXAMINATIONS L t \ ` (a/ ' I V ' ' :, ' . . / / / ,, n i-i>d i ( 1^ 1f i t / V l l l - . . S *.... -i'll/ ( //c h Vc , , er: L < y^ ` Monili C*y Yrx ' 7 / _ /Ajt*t^ S<* ! fUt A* / /. b ftu-t-cr v.Thi# i your return (aa? / V DINECTJONS 'J- A VV T< VR 11; l ; / c s: H i <r T T c ^ a ^ c a V d ______ l . F i l l vL* i t t i l | * 4 3 . S u lia i t t t 1 ** t City C A 1~c h / A i d Zip Code . 100 n i . of r io * . (P|i*e Print) wov 1 3 1S03 LABORATORY REPORT Soecimfin of blood .shows the following concentration of lead: -A--OAA_nig. lead in 100 grams of blood. Specimen of urine showed the following concentration of lead: ______ :_____mg. lead per liter of urine. NOTE: Heavy metal on urine specimens are based upon an adjusted specific gravity of 1.024. : ! i B .O .l. 60/U (Ite.. 7/68) Vnlfttrd JonitA i, D r.P.H ., D*ctor of l*kor*ur> OFST. LOUIS-DIVISIONOFHEALTH BLOOD ANDURINE . L1CHEALTHLABORATORYSERVICES LEAD EXAMINATIONS . . : ts-\/ C t ........... **-- Month D*y / y ~ [ it) 4 ! 6 9 Ag< Sr i Race ft' \ Lab N`uLr That i* your return nddre: OCT % 2 fteD C tV n. f A I cJ\ C\X\ T ( Yi t^ DIRECTIONS I c V-OA '/ i f\. )U Z tp X G fr Citr. r o / . i t / ; -' / s * ' MO . S t n t n ____ t l 2 i p Cod. (Plea P rist) ~ I F i n tub itfe Wood 2 S u b m it s t I r a i t 100 ml* o f u r i a o o LABORATORY REPORT HO --^ L*J Specimen of blood shows the following concentration of lead: d j . O 3.. t-'m.mg. lead in 100 grams of blood. -I Specimen of urine showed the following concentration of lead: ______ 1-- ___mg. lead per liter of urine. NOTE: Heavy metal on urine specimens are based upon an adjusted specific gravity of 1.024. /,? V tO /U (Ik*. 7/M ) Vnlgnrd Jonaaoa, D r.P.H ., D irecto r of Loboratoriea \ CITYOFST. LOUiS-DIVISIONOFHEALTH BLOOD ANDURINE PUBLICHEALTHLABORATORYSERVICES LEAD EXAMINATIONS PALTIENoT. 'Sh r4fAlI.`.fEl o h /. 'fh lt f/ d fs J PA1iEilT'S AODaLSS -c 1 2 <6S' s< . (-c\ [>f Y<r C- / ASJ LabNurl'i y- > ^ oo THia ia yowr retu rn LU oO ' - OCT 2 2 1S60 W C&- // o interi o n s l. rn tab* -itb biMi o J jt. /, r- ^ Yi" //LTLl(. /.xTi'cC. 2 S b i t a t l * a t X, 100 a l t o f a r i a a . U J City.: ^ Zip Cod*_ (Pi*a Print} C/ > LABORATORY REPORT Q, UJ U J Specimen of blood shows the following concentration of lead: ____ ______ mg. lead in 100 grams of blood. \4 OO Specimen of urine showed the following concentration of lead: UJ CO _mg. lead per liter of urine. UJ O - NOTE: Heavy metal on urine specimens are based upon an adjusted specific gravity of 1.024. H .D.t. / (B ...-7 /6 8 ) V l|*rd Js m is a , Dr.P.H. D ire c to r o f Labortoria OFSTAEQUIS' DIVISIONOFHEALTH BLOOD ANDURINE LICHEALTHLABORATORYSERVICES LEAD EXAMINATIONS 021 LABORATORY REPORT \\ Specimen of blood shows the following concentration of lead: .(1:. Q Si: fc... mg. lead in 100 grams of blood. Specimen of urine showed the following concentration of lead: ______ :____ mg. lead per liter of urine. i NOTE: Heavy metal on urine specimens are based upon an adjusted specific gravity of 1.024. (/ 1' U)/4) (ft. 7/ U ) V aljird Jcnti, Dr.P.H ., D irector of LbrU riti li ii i J< CITYOFSt LOUIS-DIVISIONOFHEALTH BLOOD ANDURINE PUBLICHEALfhj LA80RAT0RYSERVICES LEAD EXAMINATIONS LABORATORY REPORT i Specimen of blood shows the following concentration of lead; --------------- mg. lead in 100 grams of blood. p. tW -' Specimen of urine showed the following concentration of lead: A d h S l ._mg. lead per liter of urine. NOTE: Heavy metal on urine specimens are based upon an adjusted specific gravity of 1.024. i I B.D .U 40/43 <Re* t/6 8 ) Vejgerd JofiM ti, D r.P.H ., D irector of Lokoretor OFST. LOUIS-DIVISIONOFHEALTH BLOOD ANDURINE _ICHEALTHLABORATORYSERVICES LEAD q.XAMINAl IONS frA ic -ii. A S q _A_ .... j j A four r e tu r n Odre* g ___ __ V ? / - - } __ AA,,**ee 55e** Ij FFrce<:t .. 'Iq Am A I L ._ OCT 2 - 1963 1 I t- , i } \y ' Lab Kugibcr \ J J i 'J ! . !; \ -ZtAT H . J^Ll cK j a j SA- Ut V--C q-OT\PJkAl__ y . A .. rCbgLjgL City. _ S i* t / - / q Zip Cod* _ (Pleat* Priat) DIRECTIONS . f i l i tub* *tb blood *2. Subatit at Icaat 100 I of ria * . - ............... ' - LABORATORY REPORT - . --i - Zfil0 fix ^ I^FIO LL --* o nSpecimen of blood shows the followi.ng concentration of lead:0 __________mg. lead in 100 grams of blood. Specimen of urine showed the following concentration of lead: .O ' -*l> -L ) mg . lead per liter of urine. NOTE: Heavy metal on urine specimens are based upon an adjusted specific gravity of 1.024. t: l. i; it . ' t! j / i i (iwv. ? / a ) Valgard Jooaaaa, D r.P.H ., D iractor *f Laboratori* J! CITYOFST. LOUIS-DIVISIONOFHEALTH BLOOD ANDURINE PUBLICHEALTHLABORATORYSERVICES LEAD EXAMINATIONS . _^ _L Ac*- y liMt H 3 ! L I o - A F -- C X J j / g U / - \-tJ- v . . ' OCT 5 - I960 Ub ,U a 7 2 3 Thit i i your-rcturn addrcaa; Dr _D a v q t ~- K . . /^* . , . \/ A _U_P.Na\A_Lo c R g A y l/F r. if A /fo r City. L o u _l 5___ (Pica Print) Zip Coda. DI1IECTIONS 1. f i l l tub itb bli 2. Submit i t l i n t 100 a i . / a ri * . LABORATORY REPORT 3 a \3 p/vy o/^ 0 1' Lt h ^ w y Specimen of blood shows the following concentration of lead: __________ mg. lead in 100 grams of blood. i Specimen of urine showed the following concentration of lead: --r^ l-S -O __ mg. lead per liter of urine. NOTE: Heavy metal on urine specimens are based upon an adjusted specific gravity of 1.024. i j | a .D .L. A 3 (IWr. 7/48> Vilfird Jam ioa, Or.P.il.. Director / Libai OFST. LOUIS-DIVISIONOFHEALTH BLOOD ANDURINE JCHEALTHLABORATORYSERVICES BEAD EXAMINATIONS j T L lilL !' _ _ _ _ \Jl q \ j S J 3 . SEP 2 9 1269 ^ w u r j / JK^ L, Tht* t< your re tu rn dire; J A m .CL X a ik jl v b A . 01 RECTIONS 1. F ili tub itH blood JEC TLU__ (Tq c ^ a a .n) Vj/V U-c^ d ., .JhCity. 5 -r Loui ^ c s..i Zip Cod . *2. S u b m it I J e i t l 100 1. of uriA *. (PJc*e Print) O l-o LABORATORY REPORT ( J 'A l / ^ C E . ,H S~ f Specimen o i blood shows the following concentra/ion of L a d : __________mg. lead in 100 grams of blood. I 5 i Specimen of urine showed the following concentration of lead: dL: p mg, lead per liter of urine. jO.i^ NOTE: Heavy metal on urine specimens are based upon an adjusted specific gravity of 1.024. 1/ rv 1 (!Wir. 7/M) V)frd Jen*oo, Dr.P.R. Director o f Lobortri :s CITYOFST. LOUIS-DIVISIONOFHEALTH BLOOD ANDURINE PUBLICHEALTHLABORATORYSERVICES LEAD EXAMINATIONS IcA -pC M -iK S o^ j 0A tL J & g jr f ___ A/ J y jm LI *#:< ] 5>-* I ru* JA/C_ .A SE P 2 9 'iS69 w w SL TKi* ) your re t u r n ddrcte; n r ------------ 1 ) A ' i J . - l D - ________ L -- (L U vuL ^_ xTal^.V C oC iiA AM \l f \ H-z>j c u , _ J r J L a u l l S__ - st.t<M2_zip {Picaae Ptim l) DinccTio.Ns ; 1 F i l l t u b * * t b b l o o d ' *2, S u b m i t i l l c * t 100 ! o f uru LABORATORY REPORT l~ A D I L( ai 1 ^ -p i ' Spccimenjif blood shows the following concentration of lead: i' / t Q - : .mg. lead in 100 grams of blood. . Specimen of urine showed the following concentration of lead: ___________ mg. lead per liter of urine. * xNOTE: Heavy metal on urine specimens are based upon an adjusted specific gravity of 1.024. I B.0 .1 . <0/43 (fie*. 7 /M ) V *)i*rd J o n ttM , D fiP .B ., Dr*<tr m( U Imi >-* -~S- w. KS t UC HEALTH LABORATORY SERVICES' LEA D EX A M IN A TIO N S - - ^ ^ ^ ^ i^ L ilL A B O R A T O R Y SERVICES LEA ^E X A M IN A T IO N r r J ^ H W S c \L .A ^ -v* -'-.E.*, , h; -a ? i w Y ! ? ^ :,j : ! 1) . . i% r imu mi SEP I U> ls> I I . . P a -Vi O K 'a K c u V 'i mum ions T o n * C o c H M v . \J.A. ` ffo5 p . `E" " " u ' > 2 T 4 L o u . 1 ^ ___ S . M r M O f . , . r . J . __ ________ 1*mm) I 'l l ) *1 . u( u t m r , - ^ J^cd# !iy ia/-^c/Z . . ./ | a 7 " I 3*- ] i. |rvr * d .|,, ,4 . .1. K.i.. lJ- j `j ! SEP IP. 1909 V. . 7 I 'O _ K cl ^ l a </| ummiov. . \ ! A f *i o r i|) * *-- * ** M 3 So !* t l i | | -5t - L o t uIs-E. .M...).r_M_________________ *" ........... (i'ir* i rtM ) ro __^ -' L A B O R A T O R Y R E P O R T ' ' -~-- __^ . ." t ' i i V Oaj ' - `j Specimen of bh,od shows Lh<* fol lowing concentrili ion of lead: -- ------ --. mg. load a 100 grams of blood. T I; ; iLi LABORATORY REPORT 0AV A blood shows the following concentration of lead: :-- ni- lead in 100 grums of blood. `V 'r ; n *" Ul ine showed the following concentration of lead:- J J cx O-- m-. lead per liler of urine. ' . . NO IE: Heavy metal on urine specimens are based upon an adjust -d specific gravity of 1.024. .. I ., ^ Specimen of urine showed the following concentration of leadi ' A . ------------mg. lead per liter of urine. NOTE,. Heavy metal on urine specimens nre based upon an \ adjusted specific gravity of 1.024. ' M i l 0 4 . , ; Mil '* V .l # l .l ,1^ , . . , . , I W .I '.I I . | i , r i l ,, r ,,1 l . l i ' l . U.J ... 40'43 I I ..: 7/ 1,1 j! J _ ___ VIm 4 J n i i h , Dr.P.H., U w < i t *f CITYOF-ST. LOUIS-DIVISIONOFHEALTH BLOOD ANDURINE . PUBLICHEALTHLABORATORYSERVICES LEAD EXAMINATIONS V.o^th . . A tT n r.IC .V J .. . U a - T c'-H l - v . S o . N l _ _ _A__ _ _ S*_ _ _P.-y __ '' 7 ". _ $0 ^L_ , .** / ^ J . L-ab N.c.sL,,e j l S Z L ' f S E P a - 1S 53 This i i your return addreaa: Dr-------------- A - V l O -- J f G / U t C u s a l - E J c U /v _ Cc'C _ _ X/ A - . City^ -S i r . - L P -A A -L S ______State L 2 . Z i p Code ` (ft** Print) . 0 1 PECTIONS I 1. F it) tube itb blood *2. S u b i t a t l e a s t ' 100*1, o fu rin a. LABORATORY REPORT Ml Specimen of blood shows the following concentration of lead: __________ mg. lead in 100 grams of blood. Specimen of urine showed the following concentration of leadm 0 1 $ ? __mg. lead per liter of urine, -j'- NOTE: Heavy metal on urine specimens are based upon an adjusted specific gravity of 1.024. _ "x j ft W VC__M_i.-VA.Y'.'Y--- f"1 V-x- A _h\q.S v>_0{- R lfv DMiKCTIO.-iS J . / . oC. Aj 0 . ( c f C k lu!'' *" >- ki=J ( T lc :< Piji.t) "2 * -S<i l i t. at J * t 100 *>J, o f u n At , l a bo r a t o r y r e po r t Spcdn,9n f blood show, the- following concentration of leadload in 100 grams of blood. > . , $ , Specimen of urine showed the following concentration of lead --- ------------- mg. lead per liter of urine. NOT E. Hcu\y jjir,tal on urine specimens are based upon an adjusted specific gravity of 1.024. a.D.i. 0/43<r,,T.-7/so) v . l a<-d J o a, o ,,, Dr. PUI ., D ir ec to r of L . l o r . t o r i . . *' - ... .. U T h i s i p t h e f i r s t JC VAH a d m i s s i o n f o r t h i s ^ 0 y e a r o l d N e g r o m a le who i s a l a b o r e r a t N atio n al, Lead in G ra n ite C ity and comes in w ith a c h ie f co m p lain t o f p ro g re s s iv e w e a k n e s s ,M a la is e , d ro w s in e s s , and slow sp eech o f lo n g d u r a tio n . The p a tie n t v a s v el.' unti3 , f iv e y e a rs p r io r to ad m issio n a t w hich tim e he n o tic e d an o n se t o f m a la ise , w eakness e s p e c ia lly in th e id g s, and fe e lin g s of d ro w sin ess. About 2 to 3 y ears p rio : to ad m issio n he n o tic e d in te r m itte n t lo s s o f h is v o ic e , slow ing o f h is speech and s l u r r i n g , and d i f f i c u l t y e x p r e s s in g h im s e lf w ith some memory l o s s . He h a s a ls o h ad t r e m o r s a n d d i f f i c u l t y i n p e r f o r m in g w o rk o f 5 t o 6 y e a r s d u r a t i o n . Two y e a r s p r i o r t o adm issi. on he was se e n b y a d o c to r in G ra n ite C ity and h o s p ita liz e d f o r le a d i n t o x i c a t i o n . Ke w as t r e a t e d w i t h b lo o d t r a n s f u s i o n s a n d m u l t i p l e v i t a m i n s . He w as t o l d t o change j o b s , and em p lo y er placepfd him in a d i f f e r e n t jo b . L a te ly , he h as b e e n a sweev due t o s e v e r a l a c c i d e n ts a s s o c i a t e d w ith m om entary l o s s o f v i s i o n , One y e a r p r i o r t o a d m issio n . Ke lias b een se e n h e re in th e c l i n i c in th e l a s t w eeks p r i o r to a d m issio n a n d f o u n d t o h a v e a h e m a t o c r i t o f 27.6 a n d h e m o g lo b in o f 8 . 2 w i t h a l e a d l e v e l o f 0 .0 1 w ith c e l l in d ic e s in d ic a tin g a m ic r o c y tic , hypochrom ic an e m ia. I r o n s tu d ie s w ere norms He v a s a d m i tt e d f o r e v a l u a t i o n o f h i s a n e m ia . P h y s i c a l E x a m in a tio n r e v e a l e d a w e l l d e v e lo p e d , p o o r ly n o v iris h e d -lo o k in g N egro m ale i n no a c u te d i s t r e s s who w alk s w ith a s lo w , s h u f f l i n g g a i t , and s p e a k s s lo w ly . He i s o r i e n t e d x 3 b u t w ith slow m e n ta tio n and h as a m ild r e c e n t memory l o s s . B lo o d p r e s s u r e 1 3 0 /9 0 , p u ls e 6 k , te m p e ra tu re $ 3 . 2 , r e s p i r a t i o n s 16 . P u p i l s w e r e e q u a l a n d r e a c t i v e s l u g g i s h l y t o l i g h t a n d a c c o m o d a ti o n . T here v a s le a d lin e a lo n g th e g in g iv a '. N e u ro lo g ic e x a m in atio n re v e a le d a g e n e ra liz e d d e c re a se in s tre n g th , d e c re a se in p o s itio n sense in th e low er e x tre m itie s , a d e crease i n s e n s a t i o n , t o p i n p r i c k a n d t o ii c h i n b o t h e x t r e m i t i e s . L a b o r a t o r y D a t a : C3C r e v e r i e a w h i t e c o u n t o f 10 , 300, r e d c o u n t o f 3, 650, 000, h e m o g lo b in 9*3> h e m a t o c r i t 2S . 3, KCV 7 7 , KCH 2 o , KCHC 3 3 , r e t i c u l o c y t e s c o u n t 1 . 0 . S k i n t e s t s w e r e n e g a t i v e . C e l l s i n p e r i p h e r y show ed no b a s o p h i l i c s t i p l i n g . 2 - h o u r p o s t p r a n d i a l b lo o d s u g a r 1 2 8 , VPLL n o n r e a c t i v e . CO2 2 6 . 5 , c h l o r i d e 1 0 2 , s o d iu m 1 3 9 j p o t a s s i u m ^ . 3, a m y la s e lO o u n i t s . / AG.v i O Q n o a t s 8 - 26 -6 9 Dii e h AftcE c a t s : 10- 31-69 T i r "c- t o o t T Y r i OF OliCMAHOE iNPATi E s 7 Da y s AEO OAYS K 3 ( p : c ) 6 . 6_ _ _____ EX rsTiiid STOCK C " 'M P C 5: Odd. W*. LI- OF. U*:" 0 . tC- tCJO, NO. S.CnATU^E of Physician 6 s LEOHASL T. FETST-SON, M D . p ^ O IT a * >'. f-, ^ V . U rin a ly s is v as yellow and c le a r v ith an acid re a c tio n and a s p e c ific g ra v ity o f 1 .0 2 0 . I t v a s n e g a tiv e f o r album in and s u g a r. T here v as 2+ b a c te r ia . Serum iro n 78 m c g . , sc ru m i r o n - b i n d i n g c a p a c i t y 285 m e g .9 P / 3 u p ta k e v a s 35, 3$ v i t h a n o r m a l o f 29.1 -i- o r - 5* S e ru m T /4 v a s 1 1 .1 m eg . 9 v i t h a n o r m a l o f 5*3 t o 13 meg ij--h o u r u r i n e s v e r e p o r p h y o b i l i n o g e n v o r e n e g a t i v e . S eru m c r e a t i n i n e 1 . 6 . P e a r l k i n e t i c s tu d ie s re v e a le d a h a lf - tim e o f ir o n c le a ra n c e o f 110 m i.nu.tes. A Lead . d e t e r m i n a t i o n o f t h e u r i n e s h o v e d a c o n c e n t r a t i o n o f O.789 m g. p e r l i t e r v i t h a n o r m a l b e i n g l e s s t h a n O .15. D i r e c t a n d i n d i r e c t Coom b' s t e s t v e r e n e g a t i v e . R ed C e l l f r a g i l i t y v a s d e c r e a s e d n e g a t i v e . U r i n a r y 1 7 - k e t o s t e r o i d s v e r e 13 m g. p e 2k h o u r s , h y d ro x y c o r t i c o i d s v e re 2 .8 mg. p e r 2k h o u r s . Serum, c r e a t i n i n e v a s 1 .5 4 p e r 2k h o u rs . Tiiese v e re c o n s id e re d t o b e v i th i n norm al l i m i t s . C alcium 9>6, i n o r g a n i c p h o s p h a t e 3 . 6 , g l u c o s e 1 1 0 , BUT! 2 6 , u r i c a c i d 6. 9, c h o l e s t e r o l 2 0 0 , t o t a p r o t e i n 7*7* a lb u m in 4 . 8 , t o t a l b i l i r u b i n 0 . 3 , a l k a l i n e p h o s p h t a s e 2 5 y"LDH IP.5, , SCOT 3 0 . X -R a y s o f t h e c h e s t v e r e v i t h i n n o r m a l l i m i t s a s v a s x - r a y s o f t h e abdom B arium enema v a s n e g a tiv e , and s k u ll film s v e re a ls o n e g a tiv e . U pper GI S e rie s re v e a le d a deform ed duodenal b u lb v ith no a c tiv e u lc e r d em o n strated . G a llb la d d e r s e r i e s shoved n o rm a l g a l l b l a d d e r . An IVP v a s a l s o n e g a ti v e . A bone m arrow examine.' tio n shoved a m arkedly d e c re a se d s ta in a b le ir o n . Serum p r o te in e le c tr o p h o r e s is va; e s s e n t i a l l y v i th i n norm al l i m i t s . H o s p ita l C o u rse : ^The p a ti e n t v a s p la c e d upon iro n , m u ltip le v ita m in s, and v as giv en fo u r co u rses o f P e n icillin am in e T herapy, w hich c o n s is te d o f 1 gram o f P e n ic illin a m in e p e r d a y 'o v e r a 3 -d ay p e rio d . The p a t i e n t h a s shown a good r e s p o n s e ^ v ith h e m a to c rit o f 33-5 cad hem oglobin o f 1 1 .1 on d is c h a r g e . U rin e le a d le v e ls rem ain ed e le v a te d , w ith th e l a s t volum e on 1 0 -2 1 -i b e in g 0 .4 l l mg. o f le a d p e r l i t e r . The p a tie n t v a s d isc h a rg e d a f t e r o b ta in in g m ore u r in e and b lo o d f o r le a d s tu d ie s , and w i l l b e b ro u g h t b a c k t o th e c l i n i c f o r p o s s ib le re p e a t o f h is P e n ic illin a m in e T herapy i f th e u rin e le v e ls rem ain e le v a te d . The p a t i e n t w as d is c h a r g e d on I r o n T h e ra p y and M u ltip le V ita m in s . Ke h a s a r e c a l l d a t e t o U n i t I I M e d ic in e C l i n i c o n i l - 19- 69. H i s c o n d i t i o n on d i s c h a r g e w as f a i r , a lth o u g h he s t i l l shows a q u ite d e c re a s e d s tr e n g th , slow m e n ta tio n , v i t h v e ry slow speech and a s h u fflin g g a it . I t i s b e lie v e d a t t h i s tim e th a t th e p a tie n t i s capab o f r e s t r i c t e d w o r k , w h ic h i s n o t d e m a n d in g . Pie s h o u l d n o t r e t u r n t o w o rk i n t h e Lead Company. , \ P A T i t N T 'S I O C N T 1f I C A T l O ' J ( f o r t y p e d or w r i t t e n e n t r i e s x'/ V f : A h m ? -- first, _ m iddle; grade; date, hosptt.il or medico! facility) LATCHISOU, A ndrew J . I 'R'E_1_G__I_STE_ R UO_ . ^ r- /frr ! 439-40-2-5-67 6 sWVMAKRLO N O . VAH S T . LO UIS, MO. 6 3 1 0 6 REPORT OM ___or CONTINUATION OF KCmiUurtl F a r m '0 7 d l 307-104 t: 1 0 -1^0 0 0 ' 1i i1- --604--6^ o9 11-10-69 0O 29 1 9Li1 l!0 '//o ',/ / A %f - lx <=4> PROVISIONAL DIAGNOSIS Y o X /Z DD OOC TCQK; i 'SS CS l N / T U n Z , Z c /w ; o^-~^ J T /\ATVA ^ / \ ^ j 2 Cx^o-<z / ^3-^cruo <r -- ^ ,4 s^% L>2c^X C ZZ^.-iTZ APPROVED PLACE OF CONSULTATION E iieq sto s Q oh ca l l QU EX^ttR'^CciENi CY r JJJ^POTIN>tee CONSULTATION REPORT 4" L<\ 'U U '^ y V K x V o K /tU C- 2 7 U a& < 9. M? Z v v ly/ v y r 6 - ( ; -f< rr pL & r `S c p / i 2 ? C C 'C -C -',_ '^ A / ' O x u s ^ . l t J 'S `A ' .w M .tA i? - 2 ^ A r r H E -> r j - * {j-Q jJ P 'ly n ^ ^ < 7 ^ p <I .i1--33 c 4" 9 ^ 0* O ^" ^ 4?^ ^ L T (A <t 4 , Sl u d C ix S s^ - L ^ -C j W S t~ V v - p C t Cs j J c 4 r\V A X > - c> 6 u ^ 'g v ^ -- ( t u c U 1P\J i l s d SIGNATURE AND TITLE 3 f te > y 4 C O W , *S-- - ^ o e ^ > ^ j ' > { C o n t i n u ^e a (oXn rie_v e^r s e --s-i d.e ) . h v IDENTIFICATION NO. ' ORGANIZATION P A T I E N T ' S I O E N T I PI C A T I O N ( F o r t y p t d o r w r i t i n n e n t r i e s ( j i v e : * / n / n e --- ! a 3 t t f i r s t , m i d d l e ; rode; d o te ; h o s p ita l or m e d ic o ! facility) L ATCli I SO M AM0 k J 439 AO 25 57 2 ' 7 13 c PL2 8 U2 REGISTER NO. WARD NO. CONSULTATION SHEET StanciaMrJi-1F0o4rm 513  S + t h ^ '-[U - J 5 V . i)~ o A ' 5 `1 / 9 1 '- '- v V - JcO - ' C h 'A lo . , (.j.-- / 'iw U o o ^ r> r s 9 -4 2. -t-T-i~! l+2. -A^ vjU - 9/' A IT 1*2, 'i ? ----- & J9 9 2 - / * _ u a J L . . . Z ______ -- Ca < 5V / 7 -j y 5>v le e ^ s J ! -fa T t^ a , L . H M 'in i .c jK M P " ~ ' n ? w- f l "'U - v - ^ C g t - < p Kj J [ i y o m ^ c 2 < 9 P# / ! ^ U,K of" ^ ^ S ( j ^ rv\v\-- , ^-zW. &-SY t / i 9 r e o ^ c o z /^ Sk iW <W a 'Z ^ L<* p . d r . : ` c, 0 0 p 9 : " - L./', p t fe t^ p nO oZ. i i 9- ^'- > y I jJ r jJ L P ? . fa ) PROVISIONAL DIAGNOSIS \ 7 T n Xt u r e 7 0 - a -^Gb APPROVER u L ^ Z r - J l id Z Z -tsy s j \a * / j PLACE OF CONSULTATION |. d sdsio e Q on ca l l CONSULTATION REPORT Z 9-47. Q EMERGENCY Q POUTINE ? c 4/ . ,, . S e t A o A / y j d , A J ^ .Z jj, t u l i X / ' / u c . X O yCAst?'-1 oA-L/Aft . *7j - 2 7* i 0 y { ^ G ^7 * / s -- 7 7 7 7 7 7 ~ ^ t y r {C o n tin u ed on reverse side) S I G N - A 1 > j n s ^ A l s d T I T L F . ' -* / y< .A .^ j <.-0 1 OJSTE IDENTIFICATION NO. > O R G A N IZ A T IO N / ) ;] a Yh; "I 4 P A T IE N T 'S ID E N T IF IC A T IO N (/'o r t y p e d o r w rit t e n e n t r i e s i'rve: -- last, firit, m id d le ; rade; date; h o s p ita l or m e d ic a l facility) REGISTER NO. V / A R O ' N O . .* (e / \ | LA TC H I SO 'I Af! O'-' L ^ (J39 O 2S 67 2 17 18 r PI.2 8 U2 CONSULTATION SHEET S f j n J j r d F o rm 515 5 I 5-10 I ^ 1 02124 B n t c r C L I N I C A L HfCf'OrV {/nc.'ud durciioa o( hzioo credzapidit-/ of <jro'i7U^fai7^fc^i) \I IiI GROSS DESCRIPTION: (DR. M. KG31R/N07SKY: g e k ) T he s p e c im e n c o n s i s t s o f s e v e r a l s m a l l frag m en ts o f b lo o d c lo t m easuring a lto g e th e r 1 cm ., c o m p letely em bedded. MICROSCOPIC DESCRIPTION: (DR. LKCSX / O VSIv/nh; g o k ) S e r i a l s e c t i o n s t h r o u g h t h e b o n e n a rro w show v e ry m o d era te h y p e r c e ll u l a r m arrow . M eg ak ary o cy tes a r e nox-mal i n num ber and m orphology/. M yeloid s e r a i s a re v e i l r e p r e s e n te d an d e ry th ro ic l s e r i e s a r e m o d e ra te ly i n c r e a s e d . Ko b a s o p h i l i e s t i p p l i n g v a s fo u n d i n t h e r e d c e l l s . DIAGNOSIS : ii\oA'\Ci,iJ f C P123 U2 Un w oyf t-j<f' . Gs ^-^L. Topio-T*- 7 P n E O r C R A T J V C 'D iA U N O G lS 'i~yc> /7 ( e^Aryv-iU , Cf / (^_____________________________________________ OPERATIYC FIND1NC0 POCTOP;:AT1VLC DtAO[,'OU0 OIQNATURE ANO^TITLE NAME O F LABORATORY A PATHO LO G ICAL R E P O R T ' A CCESSIO N N O (C ). B 6 9 '3 .6 5 .. . . A #-,* / & ( ,? //& GROSS DESCRIPTION:(DR. J.A.GEKDB3: g e k ) T he s p e c im e n c o n s i s t s ^ o f a p p r o x i m a t e l y t o f re d d is h -b rc u n , s h in y c lo tte d "blood. The specim en i s -su b m itted in i t s e n ti r e t y , KCCRCSCOFTC DFJSCRXFTTOIi: (DR, J . A . GERDES: g e k ) M i c r o s c o p i c s e c t i o n s r e v e a l s n u r .e r c i m in u t e f r a g m e n t s o f i c a n 'o v , .T h e r e i s a s u g g e s t i o n o f s l i g h t d e c r e a s e i n c e l l u l a r and a ls o a s li g h t d e c re a se i n e r y t h r o i d com ponents. The ir o n - s ta in g iv e s th e im p re ssio n o f ^;(}ig h a v in g ad eq u ate iro n in t h i s p r e p a r a tio n . M egakaryocytes, a re num erous. DIAGNOSIS: Ko d i a g n o s i s m ade. 021 9. 7/ ^ Jl X `\ v - o -A. r xV TilsrFrU. OtOCK APf'(u6C:1C Ef'Oi?: SCOUT 7?`DATE O f S5.CUL5T FILM) No c a l c ific a tio n trt ECU CSU D A A -, .ZL s a rc seen overxyxr. AT e x tn e r rxcirey or ~~~N b o u r s e o f e i t h e r u r e t e r , A` "f't e r i`n t`r a-v--e--n o uu cs i*r g*e c t x o n ox c o~n t' r a s t r a t e r i a l , the i - - - v i s u a l i z a t i o n o f the c a ly c e s and r e n a l p e lv e s b i l a t e r a l l y . Fee k id n e y s a r e nerv C Ji z e j chaoe ana p o s itio n . The c a ly c e s a re w e ll clipped. The in fu n d ib u la w ith in z l i m i t s . Ho e v id e n c e o f o b s t r u c t i o n i s see n on e i t h e r s i d e . The r i g h t u r e t e r : th ro u g h o u t i t s co u rse i s n o t d is p la c e d . The u r e te r on th e le x t i s n o t adequate, s e e n ." The b la d d e r docs n o t f i l l v e i l enough w ith c o n t r a s t m a t e r i a l t o ran.?- corn possible. | BtPRESSIOH: N e g a tiv e IVP D A T? O f RETORTi \ D & T: 9 - 2 2 - 6 9 :: /; VAH, S t . L c t i l f n'P '.r.".'^3^ * MCD,C`) ' C":'n, . HAKCY L . CtRUI'I, M, D. , 9- 22- 69- l j SIGN ATURE / S.Vi i / y / cr?i*, / in in 'iit-jry if n it p.t'l t{ i St o n d u r d Fo r m 5 1 9 A .Re. Av PiCfn wlyo*cJ Vf 3 ttx>j vf itc S Circvtnr A - 27 iKc*.} r a d io g r a ph ic r e po : CLINICAL S ' D O C TO T 5 pr o v is io n a l d ia g n o s is DOCTOR'S SIGNATURE ^APPROVED C\ ~(Ls0-M o fU < 7 -7<M j ~ PLACE O P CONSULTATION Q e SOSIDS 0ONCALL CQfiSUlTAT'Oii REPORT 0 EMERGENCY 0 POUTINE c - $ U X crtX ^lO / 3 a :d b . :S X ' `X & c >n 1 0 * X <c.c^ % y j^ y T u X -T o ^ ou 'A h , ^ C c ^ ^2^LcT-ivv_/ 0 cr X - V --; N^<3C^U ^ X r T ^ O ' X y 7 >/ f - ' 7 C2.SL&/ /^ X c - b ivpv <^<r / y & u . \j'~ -- / ^ c 0 > /\ ^ 7<^ X X c ^ -''/i`Z c^ c r, v %. z >c X o l ^ -C^'cX, X xx> , y/ . t * / . /* ,1 s f /J x x <<72 0 to < .c < ^ x X /' 6 a x i 3 x S I G N A - t r / s ANCV T I T L E ' DATE IDENTIFICATION NO. o r g a n iz a t io n uxJ 7 l U ^'> X ~ ~ l : ^ C' - PA TIEN T'S IDENTIFICATION (ror t y p e d or written ani*.-//Ve.* Mini9~/ aj/ , fi rs t , r middle; grade; date; hospital or medicai facility) R EG ISTER NO. wy p y CONSULTATION SHEET Se.md.trJ Form 513 513-104 I 02130 \. N. . , ^ * \ : this time, ove. ' 2. Delayed emptying o f the stomach, poeatbly secondary to the &` * |T y d ji ! -y + '-l ---t t.`o :> X \o _ rn ,;ij'.t v; i 'X 'i .1--.-.r c c o ;r; - . _, * *._.........j.-r-.ia frsj_-- ..j /3o33;;23.i:3oa a iso ./o v : . , , ;/>-** JE ; .U jihon/C ii.;^ jr.-rich h;-:~ ; . o rn vi c a o n a n y d ' -' v r / * j r-? .... ... -- - ^ j . -;i; v - ax j fttftaaxva iis * r a i.U i h;;s X m :b in b tti sria :, 7 D ; - . . r v-. -. . -. V. r... ... , ........ ' " ,' , / i V i U , u a n a 'i7 :c J & a o k * " * `u * .c-a ~ ^ . J. -' i-- .' 3c/ L- i u - - . - ... .. ... ^ ). ^ v `J . . r.t\y A.* , L - Iv :! \ .1 I "a0'G:SS : Exair,svfci o n o f t h e c h e s t 'in p o s t e r i o r - a n t e r i o r e n d l a t e r a l p r o j e c t i o n : f a i l s to re v e a l evidence o f in f i lt r a t io n , or c o n so lid a tio n in th e v is u a lis e d lu n g f i e l d s . T here i s a p le u ra l thiccening b ila to -rc -lly , p a r t i cal.ar.ly on th e : T here i s no ev id en ce o f p le u r a l e ffu s io n . The c a rd ia c and o th e r m e d ia s tin a l s ilh o u e tte s e re norm al. ' DIAGNOSIS: 1 . No a cj'J.y e l u n g d is c a s e .;_ n p c a rd ^ m c g a l y . ^_ E x a m in a tio n o f t h e abdom en i n s u p in e p r o j e c t i o n r e v e a l s t h e p s o a s shcd.o-.rr. t o X v e i l d e lin e a te d and norm al as is th e gas p a tte rn . T here is no evidence o f op: r, f o r e i g n b o d y v r i t h i n t h e g u t . ' DIAGNOSIS : 1 N e g a t_ iv e _ a b d o :r^ n . a hi DATE O f RE?0?.T; : o r h o s ? ii a l 0 o o t i m l o ic au t a u i j t ) SiGK.M'U" v'Er i S f t e t l y ua'i d & t : 8 - 1 - 6 9 cc / 7 /l *.<Qr ,t ! <i r y % n i t f r .r l rtijutllin Sl o o d o ( J Fo r m S1 9 A |Rc* . A>Pf o"' ylyn 1-J by ( u f t n u ol lHq C C<cu*af A - 3 2 iAy .} RA D I O G RA P H I C Ri l ^ O : . . . . ( t o 1A PATlLM S LAa Ss Tt u w j . - pi ; / a m - m i o o l e ^ a m e t LATCH I ON : u J 439 4 0 2 5 6 7 2 1 7 1 0 C PL28 U2 / R L C i S f LM WO. / lOhccx one; j n t o s i o t . wwCtiCWAia. ^ XI_----J-l^o*cfolCKT LH U\* ( A b o v e i p a c e / o r m e c b c n > c o / imprinting, il usee.') ^ XtFCiTins,p e k t i n c n t Cl i n i c a l h i s t o r p k t s i c a l ' m h u i >;o s . a .n q "p r o v fs. o s a C o o n o sT$ O Xt/\'S\yV\JL/(L^J _________________________r* q *~q c fc T Z s & ts ^ BA'o%5:arainn-bion o f th e la r g e i n t e s t i n e ' means o f a barium cinema f a i l s t o r< o b s t r u c t io n t o th e r e tr o g r a d e flo w o f h " ~'' T h e r e i s n o c o n s t a n t c o n s t r i c t ! '^ j L n t r a l u m i n a l f i l l i n g d e f e c t , a l t h o u g h a b l i g h t a m o u n t o f r e t a i n e d s t o o l i s se> . V cecu at f i l l s v e il and re flu x is noted in to th e appendix. \ c /S - ^DT iI/At >G. TNh fO' TSOIS; >.NT>*e*g. aA.t.?i-v- -ev Vbr iavrt -i'u m . eVni me arig . dat e o f Srozr VAH S T . I.O -JIS, MO, 63I O 6 d S; T Q -2 - 6 Q--eokr hOS/iial 0*OlImcoiCau/aCu.iJi) DONALD IDCTCHr'LL, M*D. } 9 ^ 2 -6 9 3IGSATU i n . ' i : : / tSor.Nory / *c.,` cf fi<\ St o n d u r J For f rt 3 I 9 A r f t Qt n ylyultfti kc Li IC/n Cr(ulo^A"32 RA D IO GRA PH IC 31?.:07 V ^ -S 02133