Document qa3qKOyEjkx9kkv251L35nKLj

E. I. du Pont N 3de emour s INCORPORA' &Company Ol d Hickor y Pl a nt Da vidson Coun TY, TENN. RAYON DEPARTMENT RAYON DIVISION Old Hickory, Tennessee February 13, 1947 Dr. Robert Keho % Ketter g Laboratories University of Cincinnati Cincinnat i, Ohio Dear D r . Keho At the suggestion of Dr. Tarrant, of our Medical Se ction 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 hepe has been very meager, which is also the case in this entire section, as lead poisoning in Nashville and vicinity is rare. ' I am enclosing a cony of) a letter I recently wrote to Our Dr. Gehrmann, wnlch I believe will cover briefly the1 important points in the individual1s history. Als o, enclosed are copies of examinations we had made by a very good internist in Nashville, and tabulation s of lead analyses done in our local labor atory here After reviewing this case, I would app r e d a t e your advising me as to the proper steps to take with this individual and also, in a general mann e r , 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. R. P. MILLER, M.D. MEDICAL DEPARTMENT i 01 Q 9 7 c0 P Y i. Old Hickory, Tennessee January 29,1947 ! "A I R M A I L " DR. G. H. G EHRMANN .' DIRECTOR . 1- MEDICAL DIVISION - SERVICE DEPARTMENT ' : WILMINGTON ! Subject: ROY GREENER - AGE 54 : . The above employee has been employed by us as a leadburner off and on sine e 1933. The date of his first recorded examination is September 5* 1933. His adjusted service date is November 24, 1943. He has always 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 4,500,000; Hg. between 80 and 90. In Ju ly, 1945* Mr. Greener, on routine monthly leadburner examination, co mplained of some rather vague symptoms of gastric distress, malai se with easy tiring and some diarrhea. A spot check of his urine fo r lead showed .0 55 mg. per 100 cc.; H g . , 90; R.B.C., 4,700,000; anal ysis, negative; BP, 106/62. A recheck later in July showed lead, 0 .120 mg. per 1000 cc. His general condition somewhat improved subjec tively. Hg., 90; R.B.C., 4,350*000; no stipple ^cellsy; 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; H g . , 90; R.B.C., 4,350,000; three stipple cells (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 urine 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. I, 3*500,000. November examination - complaints about the same; BP, 130/74; Hg., 76 ; R.B.C., 3,450,000. At this time it seemed that hisisymptoms 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 hi m to be passing an abnormal amount of lead. (All specimens of urine ex cept the first spot check were 24 hour specimens.) DR. G. H. GEHRMANN 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 tb lead. Would it be advisable to prohibit his handl ing lead in the future on this plant? We would appreciate your suggestions apd opinions on this case at your earliest convenience R P M jPMF Enel. /s/ R. P. MILLER, M.D. , MEDICAL SUPERVISOR 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 promj&t 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. i. ) , *ri .\ WILLIAM R. CATE, M.D. Doctors Building Nashville 3, Tennessee March 22, 1946 Dr. R. P. Miller DuPont Rayon Old Hickory, Tenn. Dear Doc tor ;Miller : Mr. Roy Greener was in today and I am sure that there is very little we 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 hej 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. Thje general physical examination was negative. Blood pressure 12^/82. All superficial and deep reflexes are bilateral ly equa^ andjactive. 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 amonlum chloride or potassium iodide in order to check any further extension of the wrist drop. His general condition is much impro|ved 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. 0 'io \ 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 fouiid.. Hematocrit: McVbl: 112 McHb: 30 M c H b C . 25 S e d iRate: 6 mm q Ihr. Blood Sugar: 99 mg. SIT*amber Acid-1.022 A l b u m i n - f t .trace Sugar-ftest.trace Occ.Blood-neg 7-8 RBC pfhp Occ.pus clump ' Polys 61$ Lymphs 28$ Large Lymphs 8 Eosinophils 3 (10 0 cells counted) Gastric Analysis Tim Free HCL Fasting 15 Min. 30 Min. 3 12 23 Total HCL 26 18 28 I OLD HICKORY LABORATORY REPORTS Date February 10, l47 February 3, 1947 January 27 1947 June 24, 1946 May 20, 1946 April 22, 1946 December 17, 1945 November 19 1945 October 29, 1945 October 8 , 194 5 August 27 194 5 July 3 0 , 1945 July 24, 1945 Total Volume Total Lead Lead per 1000 cc 1025 ml. 0.06 mg Pb 0.06 m g . IO3 O rt 0 .11 " 0 .11 " CVi OJ 0 110 0 rt 0.20 " 1265 ri 0.05 " 0.04 " it 785 0.067 " 0.085 " 940 n O.O9 " 0 .10 " I29O M 0.084 " O.O65 " I58 I ft O.O55- O .0 47 O.O35-O.O3O 960 ft 0.084 " 0.088 " I2 7O ft O .15 " 0 .12 " I 58 O ri 0.28 " 0.18 " 0 yil20 it O.134 -O.I34 0 .120 - 0 .12 0 mg. Pb per 100 ml. O.O55 c -VUr~" ..VS; , .-i y;- . ' n 2e - ^ V ... ....! .I.....* .S ,7 / r ' :i: : 7 :^'