Document r5DL9mX3GqLMDOO0a4y3E5bq

D R. F. CU R TIS DO H AN 2 2 1 M ALO NEY C LIN IC B U IL D IN G HOSPITAL O F THE UNIVERSITY QF PENNSYLVANIA 3 6 th AN D , S P R U C E S T R E E T S PHILADELPHIA 4 Juno 26, 1962 Dr. Robert A. Kehoe Kettering Laboratory College of Medicine University of Cincinnati Eden Avenue Cincinnati 19, Ohio Dear Dr. Kehoe: Thank you for your letter of June 4-th about the "possible case of tetraethyllead poisoning". I have enclosed copies of the three discharge summaries of the case. The patient ~was first adm itted to the Hospital of the Univer sity of Pennsylvania on June 30, i960 and twice thereafter. On th first admission he showed signs and symptoms which were interpreted as Infectious Hepatitis. Because of stippling of his red blood cell the blood lead concentration was determined. Post-discharge this was reported as three times the top "normal value" for our laboratory, so he was readmitted for treatment with EDTA. I would be grateful, if after reviewing the information supplied, you would hazard an opinion concerning the possibility that the hepatitis was related to his lead poisoning. At that time when I was "Ward Chief", we were unable to find in the literature available to us, any reference to hepatitis resulting from lead poisoning. However, we had heard rumors of some evidence to this affect that was accruing in Boston. The work situation was investigated by the Occupational Health Section of the Department of -Health of the City of Philadelphia. It was their opinion and that of the Ward staff and others who saw him, that the history of swallowing leaded gasoline when starting a siphoning procedure for gasoline was the source of the lead. He stated he had practiced this type of siphoning for the past year or two before admission to the hospital. K 0015324 -2 The welding operation and paint were ruled out. The paint did not contain lead. He worked for only three months in the "shop" which was said,by the experienced investigator from the Department of Health,to be quite ventilated. know. If you have any questions, please let me Sincerely, FCD:m end. F. Curtis Dohan, M.D. 0015325 August 6f i96 0 mm h e* A ^ itte d -6/ 30/ 60 |3 is c lia r ^ -7 /a 2/iSo. pjseafflgg. DIMIDSES; In fe ctio u s h e p a t i t i s . ' lead 2as poisoning. OMs lias the 1s t IFJP adm ission fox* t h i s ho ye ar o M Ifegro s a l e who e n te re d w ith a c h ie f com plaint o f ,jau n dice , dis co m fo rt | a th e aMoiaea mid abnormal u rin e . gave a h is to r y on adm ission o f in te rm itte n t e pis o de s o f s e llin g midabdoralnal gain th a t would l a s t u s u a lly a p e rio d o f s e ve ra l hours Abut o c c a s io n a lly would he pro longed to a period o f 2 -3 days. 2hese pains would e ase on on th e average o f 2-3 tim es a month* I5e had had th e f i r s t e pis o de about January o f i9 6 0 . About one month be fo re adm ission he had begun to n o tic e a gradu al lo s s o f ap p e tite Kins days be fo re ad mission r i g h t upper quadrant and l e f t upper quadrant fe e li n g . O f annoyance but n o t pain la d developed* On 6/ 2.6/60 he f i r s t n o tice d ye llo w in g o f M s mat s c la ra e and a ls o thought M s s to o ls had Men rath e r l i g h t re c e n tly. had re ce ive d no in - ac tio n s in th e pre vio u s s i x months, and. had been exposed t o no known to x in s * l a the p as t m edical h is to r y i t was noted th a t he had develo ped h ive s a f t e r an unknown in je c tio n 2-3 ye ars p re vio u s ly, ha was on s o cu rre n t m e dicatio n . He works a s a tru ck r.ratal shop body nan and lias done t h i s work, fo r th e l a s t 15 ye a r s . Ife lias cooked v j o packs o f c ig a r e tte s p e r week fo r s e ve ra l ye ars bu t in re ce n t weeks has deve lo pe d d i s t a s te fo r c ig a r e tte s * He denied any e xce s s a lc o h o l in take * l a th e system review i t was rioted th a t he had developed a 12 pound w e igh t lo s s in th e pre vio us th re e weeks and th e r e s t o f th e system review was e n t i r e l y n e ga tive . On p h ys ic a l exam ination h is blood pre s s ure was 130 / 9 0 , p u ls e 72 , re s p ira tio n s 20 and . te m pe rature . Ito was no te d to be a 46 ye ar o ld co lo re d male in no acu te d i s tr e s s whose s c le ra s appeared m oderately i c t e r i c , lie had c h a tty p o s te rio r c e r v i c a l and i n - gu in ai nodes. ;ife was te n d e r t o palpatio *! in th e r i g h t upper- quadrant o f th e abdomen bu t th e l i v e r raid s ple e n were n o t p alp a b le . Zfe uralo glcal exam was e n ti r e ly n e ga tive * He was f e l t : to / Ip re l^iatiti@i'l^bd was p u t on in fe c tio u s p re cau tio n s . On adm ission h is hemoglobin was 1 1 .4 w ith C$ r e tic u lo c y te s , HBC-17, 900, n e utro pMla k$$ 2ya^M^tC| S;.2g^# 'AGO 77, b i lir u b in 1 . 1 d i r e c t and- 2 .6 t o t a l * Serum c h o le s te r o l 254, albumin 4 . 1 , glo b u lin 3 .3 . a lk a lin e phosphatase 23, a c id phos phatase 0 . 8 , 1131? 25, and glu co s e 80. Over th e .n e xt few days b i li r u b i n ro s e to 3 .2 d i r e c t and 6 .2 t o t a l and h is symptoms seemed t o g e t d wo rse. M s a lk a lin e phos phatase was the n noted to be 13 . Over th e n e xt two weeks h is s ygpto as grad u ally d i minished e xce p t f o r o cca s io n al bo uts o f vague e p i g a s tr i c r e i n . On 7/ 2Q/o he Was noted to have b a s o p h ilic s ti p p li n g o f hi re d c e l l s in th e pe riph e ra l smear and blo od was drawn f o r a scrum le a d de te rm in atio n . On '7/ 22/ 60 i t was f e l t th a t he was w a ll enough to be disch arge d bu t tlia t th e re were s t i l l s e ve ra l unanswered qu e s tio n s . Ha was the n discharge d to be fo llo w e d in Hematology Clin ic * A few days l a t e r th e blo od le ad de te rm in atio n was re po rte d as 180 fcja.$ which i s markedly e le va te d . Arrenigemcnts were than arade fo r re -adm iss io n fo r 'treatm ent o f chro nic le a d poisoning. FRiea STans. 8 /8 ISsg ebs F . Kayaond, M. D KE 00153 'A pisaiftixis. m m m Qa&mto&t? 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Lave cctta cte d t*sa Envim qm ental Hca&fch S tv i s t o e <sp ta Pulslto Ssal&h Sapt* o? .-iiilao aMo la A EioM, vaewej? fea lir^ aii^ ts &d t i wafctog coq&it&osas, mt& w isa -a a a i ttosfc tb e s e e s e m v &sxtl <st*er a s e o aa ve o xias a tb e o s e toesfctoa t s ap ato .JS3Q- becsa cas^osed t o to ad . - asta r i p i a s t o o btato b is a d as& fn e epeelaBa 'fs e a tb s Sor * stgp*u ' "Se s e to taas s h S^ ai* t b i c sasato SfipKtifcto t a b i s 2s@& p as s o a iag i a a t i l l paec&tosatlstL ts to c a ti r e l y t/ oestoto trsafc tk to ssesoeeatB s cas a s*f tossto t^ps&tfcis ftoctsa&sy * load,* ::a t i o ta s * isuad i t qcsr se *k *t a v&ss. p e * *to pssvS&ed s a f f i s t o e t cbtoallas Sa brin g o a la te a*. to ad potooang* Lis luo o gie fe iii o m &m m s^oa t i s o e p ttal tase to *2 fteess c a d fe l bs e a gto e a / r^r-yp s y o o i a ^ r t e t iis ^ to to ^ fe J iM * ASSiJa ^ 'l i a s e . 9-35-60 oes tr* A. Xs vis ! l * . , Za?. a , 'ZsxmiX ~ E*J*P* Dr. Georg UMm%% * iUU.Z, s * a fin a d , -s i'&atoesafc a i-Mto to e ' K f 0015331