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FIVE CASES FROM THE FLUORESCENT LAMP INDUSTRY Treatment of Chronic Beryllium Poisoning with ACTH and Cortisone EDWARD M. KLINE, M.D. SCOTT R. INKLEY, M.D. AND WALTER H. PRITCHARD, M.D. CLEVELAND AT THE 1950 meeting of the American College of Physicians in Boston, Dr. l George W. Thorne, in a general discussion of the therapeutic use of the pituitary adrenocorticotropic hormone (ACTH; corticotropin), mentioned'briefly a case of chronic beryllium poisoning in which the patient, although in the early stages of treatment, had already shown some improvement. This news was greeted with great hope and enthusiasm. To us who had seen our patients gradually deteriorate, anything remotely promising seemed justified. The able advice of Dr. Harriet Hardy was immediately sought and graciously given. Dr. Hardy was cautious but encouraging. Through her office a contact was made with Dr. Robert JV Hasterlik of Chicago, who had under ACTH treatment a young physicist, who was then showing remarkable improvement. This acquaintance proved very help ful, particularly in regard to the dosage which should be employed. Shortly before we began treatment of our first patient, the favorable report on the single patient treated by Kennedy, Pare, Pump and Stanford appeared.1* Since May 1950 we have had an opportunity to study and treat with ACTH five patients who had been proved to have beryllium poisoning. Three of the cases have been reported in a preliminary manner.2 The purpose of this paper is to report in greater detail the response of these patients and two additional ones to this treatment as determined by (1) clinical assessment of improvement in symptoms, (2) evaluation of lung changes shown by roentgenograms and (3) appraisal of changes in pulmonary function shown by standard functional tests. METHODS All patients were hospitalized during the period of study. Within the first few days before ACTH therapy was begun control studies were made. Daily weight, caloric intake and a clinical From the Department of Medicine, Western Reserve University, and the University Hospitals. Read at a meeting sponsored by the Occupational Medical Clinic at the Massachusetts General Hospital, Boston, Dec. 13, 1950. 1. Kennedy, B. J.; Pare, J. A. P.; Pump, K. K., and Stanford, R. L.: The Effect of Adreno corticotropic Hormone (ACTH) on Beryllium Granulomatosis, Canad. M. A. J. 62:426 (May) 1950. ' s/ 2. Inkley, S. R.; Kline, E. M., and Pritchard, W. H.: Improvement of Pulmonary Function Following tfie Administration of Adrenocorticotrophic Hormone (ACTH) in Chronic Beryl lium Poisoning, J. Lab. & Clin. Med. 36:840 (Nov.) 1950. 549 Ui- r* i- i r it & f,-; I " l|; * -i