Document pzEeLnJjZL6zM1gVDRRwa3bE

BOSTONCIIT HOSPITAL TO Hast 4th St., S. 3. Age 32, marie - white Occupation - Chauffeur Admitted Bee. 17, 1928 Discharged Bee. 24, 1928 Medical 1 - #575264 Under care of Br. Caplan Biagnosis . Acute Ivlonocyti Leukemia Oral Sepsis , Chief Complaint - Loss of pep, marked dyspnea, weakness. present Illness - On Oct. 18, 1928 patient went to the doctor be cause he felt weak, had anorexia, got out of breath quickly, patient first experiencedthese symtoms about Oct. 1, .1928. His friends called his attention continually to his pallor, his loss of appetite and lack of pep. On Oct. 18, 1928 local II. C._pres cribed dr. S S sweet spirits of nitre. Br1 UaH^o3 tine a day. I?'igita4is drops twice a day. Patient kept up this treatment for 7-8 weeks. He was also taking an ir tonic prescribed by his doctor. Patient went to local E. B. two weeks ago for his "piles" which he says were not bleeding but caused him discomfort. On .Sunday, December 16, 1928 patient called local I. D. who took his temperature and found it to be 102. He advised patient at once to come to the hospital, patient quit work since October 15, 1928. Since onset of his present illness, patient has had a _very poor appetite; he has not slept well end he ha3 lost con siderable weight. He vomited occasionally during the mornings, the vomitus being yellow. The only pain he has had in the last 8 weeks has been in th upper* gums. The symtoms have been be coming progressively worse, his appetite has been becoming poorer his dysp^HSf-is becoming worse, his pallor has- been increasing. Family History - Father died of Pneumonia, mother died a long time ago from tuberculosis. Ho history of diabetes, insanity, gout or cancer. , -: Marital History - Ihrried 12 years* One child living and well. One child died at age of one month. T/ife never had any mis carriages.. Habits - Never ate or slept regularly. Boes not drink alcoholic beverages. Used to chew a bit. Used aspirin for his sore gums. Coffee; no tea. One cup a day. 0011717 i: -.if Social History - Has "been, a chauffeur for 15 .years and has always worked hard for a living'. Has been associated with the Gasoline Industry for a long while and says he is made sick by the odor frequently. . The gasoline, contains the least tetraethyl. He is the sole means of support for his wife and child. Occupation: Has been a chauffeur for last 15 years and gasoline handler. Past History - yas born in Boston and has lived here since. Has never had any operation or been in a hospital. Does not remember childhood diseases. Typhoid fever 10-11 years ago. Head - Hot many headaches. Byes - Sees well. Ears - Hears well. Ho running ears. How sore right ear. Hose O.E. month - sore upper right gum Teeth Usually in good condition. IIo sore tongue. Sore throats once in a while. G-astro - intestinal: Appetite prior to present illness has been excellent. Ho vomiting or pain after eating. Bowels irregular. Salts used. Piles for 2 years; bleed occasionally. Fresh blood in stools. Ho jaundice. Cardio liespiratory; Ho pain in chest, no dyspnoea before present illness. Ho swelling of ankles, no cyanosis, no cough or night sweats previous to present illness. Heuro - muscular} Ho joint or muscle pains. Ho twitcnings or convulsions. Ho anaesthesia or hyperesthesia, ilways been a strong muscular, vigorous active man. GeYrUe-to - Urinary - Ho uysuria, no hematuria, no pyuria. Day: Urine 2-5. ^octuria - Since he has had fever. Denies veneral infection. Ho burning oi\ passing water. Best weight last summer. 165 lbs. Present weight 150 lbs. Patient is a white male 52 years of age, married and has one child.' States that he has always been well until 10 weeks ago when his wife noticed that he was getting quite pale and advised him to see a physician. He did and was advised to quit work, he is a chauffeur for the Jenney Gasoline Company, having been with that Company for six years and having been in contact -with Ethyl gas for the last two years. He has been up about at home taking various tonics. About one week ago began to have some chills and perspired very freely at night. Has lost some weight but does not know how much. Three days ago had bridge removed from tipper right jaw and his jaw has been swollen since. Denies''rheumatic fever and veneral disease and denies alcholism. KE 0011718 \. i - 5 - J? Physical -Sasun - Awell developed ^dd nourished anemic white man 52 years of age, lying in bed, national and cooperative. Head scalp slightly bald. Ears and-'nose - negative to external ex amination.: 'Eyes pupils equal''ana regular, react to light and accomodation. Gonjuncxivfit-i Mucous, membranes pale, Mouth teeth in poor condition. Swelling of right, upper jaw with some slough, Tenderness especially on pressure. ,Face-while right side of face swollen and tender. Heck swelling at right angle of jaw, also a few suwti posterior cervical glands. Heart not enlarged, sounds of good quality, rapid, regular. Blood pressure 120/75. False, rapid and of fair quality. Lungs, essentially negative. Abdone;KLiver slightly .enlargea and slightly tender. Splendor enlargement ana tenderness. Extremities. Iio edeig&A. Knee jerks present. Skin Anemic*.Glands: Few in neck ana g#rin - snail. Impression I Anemi a? Etiology? Type 2? Leukemia 3? Chemical Intorication 4. Alveolar Infection (Sight upper jaw).. II. 0. Belson. .' Bee. 18. On admission yesterday this patient who has worked with Ethyl gasoline for 2 years, and has always been well until 2 months ago, when his wife noticed he was not looking well ana was pale, was treated by local 11. D. with tonics. About one week ago per spired freely at night and had chills. 3 days previous xo admis sion had teeth bridge removed and jaw has been swollen ana tenaer since. physical exam. - Showed an anemic male, with tenaer ana palpaole liver and., spleen. Pew glands in neck, ana pea size .lands in groin. Eight side of face swollen - gums. of right upper jaw swollen and tender with sloughing area where bridge was removed and some edema at angle of the jaw. Before any olooa examination was done we considered leukemia, anem^ia? type, chemical in toxication due to Ethyl gas giving an anem^ia. The aly'igolar swelling and infection, I believe, is merely coincidental be ing duts to removal of bridge. . Blood examination showed 71,100 while blood cells. Bed blood cells, 1,610,000. Smear showed many large monocytes (?ranjyelocytes) Eed blood shows evidence or regeneration - each form being seen. This patient has a 1eukeijt&ia? Type - Urine shows slightest pos sible trace albumen - occasional hyaline and granular casts. I2/ 2O- Patient is running a temperature, jaw is sore and throat is also sore. Patient cannot open mouth fully on this account, B. S. 113 mg. /lQO cc. Mon--protein nitrogen 37 mg./lOO ce. Uric Acid 6-4 mg./lOO dd. Patient to be seen by Dr. Larrabee in blood consxdtation. KB Qu.-.1l 9 :i i _ 4- liov. 20 ~ X-Ray reports: Dense right antrun Sabi* negative. Arms and legs negative. Chest - slight mottling of upper left lung not enough for tuberculosis. Throat culture reports streptecoceus hernolyticus and staphycoccus afewsaf. Discharge note - Ayoung pale man, gasoline handler comes in com plaining of shortness of "breath since October 1, 1928. months previous to admission his wife noticed that he looked quite pale, this with a temperature and. anore^iz - plus had teeth sent him into the hospital. On entrance he was by inspection alone a blood case. His white blood count 17,000 rose to 96.600 in b days. Differential showed a peculiar large mononuclear cells - rather granular. Dr. Larrabee thought it possibly a myelogenous type. He did not show any improvement and gradually gained in white blood cells ana lost in hej$Sfcgib.in. He finally passed away after becoming very dysb&S&k*- F. Y. Palfrey 0011720