Document vDB02nNr44kabL6nr5LgnrpE

1; AMERICAN LEAD PLANT Teleph on e: Imperial 4447 - 4448 Chicago Branch Manuf act urers of D U T C H B O Y P R O D U C T S R. W . M cKITTRICK, Plant M anager November 8, 19$h 1400 East 21st Street Indianapolis 18, Indiana Dr. Robert A, Kehoe Kettering Laboratories Eden & Bethesda Ave., Cincinnati, Ohio . Dear Dr. Kehoei . Tie attach medical correspondence involved in Indiana Compensation Case ho. O.C. 977 regarding alleged loss of eyesight due to lead intoxication, of our employee We also attach letter from Mr. Hall Cochrane, Attorney, who has been retained to pursue the matter before the Indiana Industrial Commission. As explained to you by phone this morning, we wish to have authoritative opinion and testimony in this matter and therefore, have come to you. Later this morning we received a call from Mr. Kesteribaum, of our Insurance Department, who stated that he had been in communication with a specialist cn internal medicine who pointed out that should penicillin have been ad ministered prior to spinal fluid analysis, there could be no evidence of syphilis in the fluid. Therefore, if penicillin were administered the timing of the injection 7dth relation to syphilis test of spinal fluid referred to in A. T. Symrnes letter of November 2 may have a very important bearing on this case. Should you determine that we have a basis for fighting this claim, and we wish to do so if Tie have any case at all, perhaps it would be indicated for you to send someone to Indianapolis to discuss the matter with the medical people involved. I can be available in Indianapolis whenever you should wish me to be here. Please send copies of correspondence to Mr. E. G. Kesteribaum, Hamlin & Co., 2 Broadway, New York U, New York. Very truly yours NATIONAL LEAD COMPANY EHIC/iGO BRANCH C .Wi ckemeyer/r cc: E. & Kesteribaum P. <J. Pater R. li. McKittrick Hall Cochrane (Office) General Superintendent National Lead Company 900 . 18th St., Chicago, 111. 4^ . ;ff' ROBERT WM. HARGER, M. D. 80U Hume Mansur Building -Indianapolis U, Indiana ' Melrose 1-3112 jftr. 4. L. Payne 129 3 Market St., Indianapolis, Ind. ' tear Mr. Payne: The following summary of medical facts should be pertinent in the case of MR. ?-T. 8, lU09 Columbia Avenue MS 69617, and employee of National Lead, of this city. He has suffered gradual loss of vision until the right eye has become completely blind, and the left eye has only 3$ vision or less. He has bilateraloptic atrophy and retinal arteritis characterized by yellow (gliosis) scarring of the optic nerves and. very advanced narrowing of the vessels of the retina associated with sheathing termed perivascnlities 'This has been a slow and relentless pro cess and has been dismissed by the medical advisors of National Lead as due to tertiary syphilis involving the optic nerves and retinal vessels. Dr. E. B. Haggard, 806 Beard of Trade Building, ME 3d733, is the plant physician, and his eye consultant was Dr. E. 0. Alvis, 320 Hume Mansur Building ME U'i339. The basis for their diagnosis has been stippled red cell counts, ranging between 300 and 3320, and positive serologic blood tests for syphilis. Cecil's Medicine Text quotes stippled cell counts of over 1000 in chronic lead poisoning, and repeated consultations recorded in his hospital chart at IGH do not confirm the diagnosis of the type of shyphilis that could cause this con dition. He has most certainly had lues, but apparently not of the brain and nervous system<> Because of the general medical symptoms in addition to the eye findings, one of our bright young internists was called in consultation and Mr. Brooks was hospitalized last summer for study. Dr. Alfred T. Symmes, 633 E. 38th, HI 86U9, will send in a summary of his findings and review of the IGH record. From my follow-up in the matter, it went something like this; for fear of CNS lues, we gave a round of penicillin therapy during which the remaining vision in the left eye was lost. This subsequently has'returned to only less than 3$ of his vision. His studies failed to substantiate the diagnosis of CNS lues, but did reveal a marked deficiency in kidney function, wasting of sleletal muscle and abnormal neurological findings of peripheral nerves. His blood lead was not done, but the urinary excretion findings were in the very upper limits of normal or lower limits of chronic lead poisoning. This urinary lead determination was done in July and his last exposure must have been in early May when he last worked 'with the furnaces. He actually stopped work altogether on 2i;th June this year. . In order to clarify his ocular situation, I had my findings compared with those of Dr. Fred M. Wilson, Chairman of the Dept, of Opthamology at the Medical Center, and Dr. Paul D. Thompson, UOU Hume Mansur. Both of these consultants feels that iir. Brooks has optic atrophy secondary to optic neuritis which cannot be dissociated from the Industrial hazard of his 20 years of molten lead exposure. Especially significant of course is the fact that his findings do not Indicate central nervous system syphilis. - I personally feel that this man has had both syphilis and lead poisoning, that hxs secondary optic atrophy is not due to the syphilis, and thus xre are left with chronic lead poisoning as the cause: 2-1 is lo StliiftEr: lst almost all his vision and has other signs in cluding, gr^plytp^dijced>hidney'' function which, we feel:, is fue to. chronic lead pOisoping/'foKdwihg 20 years of eiEpospre to' molten lead at the National Lead Iferks of':this city. With kindest personal regards^ Robert Harger, M.D. E 0016440 iy py) E. 0. A.lvis, M. D. 320 Hume Mansur Building Indianapolis, Ind. May 3, 19f>U National Lead Co. 1OC-H, 21st St., Indianapolis, ind Re Ave . Gentlemen : The above named was examined for .you at the request of Dr. E. B. Haggard. Mr. Brooks aged i;8 informed me that his distant vision was alright but that he could not see to read. He has never worn corrective lenses but does wear goggles at work. He has done the same type of work for twenty two years and looks in on hot slag every day. He has noticed baa vision for over a year. About two and one half years ago his right eye was injured when.struck by a milk bottle. Examination revealed his eye lids to be normal. There was no congestion, tears or secretions about either eye. His pupils were moderately dilated and hardly re sponded at all to light stimulation. Finger tension was normal in each eye. Distant vision in the right eye was confined to hand motion and the perception of light. Distant vision in the left eye was 20/200 which is only 20% normal. Efforts to im prove vision in each eye with lenses were not successful. Slit-lamp microscopical examination of the anterior segments of each eye did not show any pathological changes. There were no corneal scars or microscopical evidences of injury. Inspection of the interior of each eye through the already moderately dilated pupils showed bilateral optic atrophy. Some of the smaller arteries were silver streaks meaning that some time in the past he has had an arteritis. The retina as well as the macular area, of each retina were normal. If his eyes had been damaged by the glare of hot slag then there would have been found changes in the macular areas of each retina. No changes were found. The refracting media including the vitreous, lens and aqueous were normal ana free from exudates. The cause of this visual failure is systemic in origin. It is not industrial. He informed me that he has taken some "shots" at the General hospital and that his eyes were examined there last December. He also answered saying that he has a Uplus blood and that Dr. Alexander is giving his shots to "build him up." Yoursvery truly, EOA:ja E. 0. Alvis, M.P. KG' 0016.441 (COPY) E. B. HAGGARD, M. D. 806 Board of Trade Bldg., Indpls., h ) Ind* June 28, 19%k ,onal Lead Go. 0 E. 21st St., .ty. Re s Gentlemen: On 6 / 2 k / 5 k , I was notified by you that the above had gone to Indianapolis General Hospital and that, the hospital had told you that the admission diagnosis was lead poisoning. Our medical records on the above show: He was ill with pneumonia and in the hospital in Feb. and March, 196k * His stippled cell count has been negative and very low, his highest count ever was 3,000c Not long ago, I examined his eyes and found his eyesight to be 20/200 in each eye. Further examination by an eye specialist shows that he has Argyll-- Robertson pupils and some optic atrophy, both due to syphilis, in the optnion of the eye specialist. The eyesight is not correctible, in the opinion of the specialist. A blood test, taken by me, showed a h plus Kline and Mazzini with Mazzini qualitative 16 units. After this eye examination by the specialist, his job was changed to one demanding less accurate eyesight. He has been working steadily for about 3 months. He left his job about noon on 6 / 2 k / 5 k to go to the hospital. I last had seen him on 6/23/5U for his weekly interview, and he made no complaints to me on that date. Apparently he made no complaints of any kind to management on 6/2ii/31i, the day he went to the hospital. I saw him at the hospital on 6/23/5U and he said he was In the hospital because of his eyes and because of the lead. His doctor is: A. T. Symmes, M.D., 605 E. 38th St,, City, an internal medicine specialist. On 6/23/5U I gave to Dr. Dyke, Medical Director of the Indianapolis General Hospital a note, detailing Brooks blood counts together with the information on his eyes, and in the note I asked that the hospital to be sure to check on the accuracy of any diagnosis Dr. Symmes might make, and to record accurately whether or not his condition was in any way due to lead, and particularly to note whether or not he had any real disability from work (as distinguished from the impairmentnet disability- from his eye condition). In my opinion was not disabled from working on 6 / 2 k / $ k or 6/23/3U* He has an impairment of his eyesight but he is just as able to work as he has been since his job was changed after the eye examination. I reported all the foregoing to Mr. 'Tickemeyer over the phone on 6/23/ p U and told him I would write two copies of this report so that he could have one. I intend to talk to Dr. Symmes, but have not yet been able to get ahold of him. K e 0016442 National Lead Co. Re 6/28/^U SUMMARY: Max Brooks has some lead absorption, but does not have lead poisoning. His lead absorption has not been disabling from 15 -March 19$h (the date I began to work at the plant) to date., and will not become disabling-- certainly not as long as he is away from work. He has permanent impairment of his eyesight, due in my opinion to syphilis. This impairment is not due to his work and has not disabled him from work. Yours, E. B. Haggard, M.D. 0016443 (COPI) E. 3. Haggard, M, D. 806 Board of Trade Indpls., ii, Ind. It May, 19$h National Lead Co. 1600 E. 21st St., Indpls., Ind. Gentlemen: The above was sent to Dr. E. 0. Alvis, an eye specialist, after my examination showed Max to have very poor vision. I found that the sight in his right eye was worse than 20/200 and the left eye was 20/200, both with and without glasses. The examination by Dr. Alvis shows that his trouble with vision is due to optic atrophy, an affection of both optic nerves. I took a blood test which shows I4.plus, with a quantitative of 16 units. This blood test, together with the optic atrophy and the failure of both pupils to react to light make me say that all these are due to his having had syphilis. The quantitative indicates that treatment is probably NOT needed at the present time. Glasses will not correct the condition. VJe have here a man who has no useful vision in his right eye and very poor vision in his left eye. He cannot do any work requiring accurate eyesight, and his poor eyesight will make him clumsy in try ing to do many things. If you keep him at work, he should be put on work not requiring accurate eyesight and also where he runs the least chance of being injured because of his poor eyesight. For.instanceI believe he would be very poor at tapping the furnace because he would miss his target when thrusting with the ramming rod or tapping rod. Yours., E. B. Haggard, M.D. (Signed) 0036444 (COPI) HALL COCHRANE,ATTORNEY 2063 N. Meridian St. (Address Correspondence) Indianapolis, Ind. November 3, 19$k Mr. C. Yickemeyer, General Supt. National Lead Company P. 0. Box 70Q0A Chicago 80, 111. P.e: Occupational Diseaseufanjn No. O.C. 977 Our File No. Mc-l-(7) Gentlemen: Since my last correspondence to you I have received from Dr. E. 0. Alvis, M.D, of this city a copy of his medical report addressed to you under date of May li, 19?Uj and a copy of same has in accordance with Industrial Board rules been forwarded to the claimant. I have further received a letter from E. B. Haggard, who is apparently undergoing operations for eye cataracts and m i l be away from his office for the next two or three weeks, and who suggests that we are going to need expert testimony on lead poisoning and further recommends that I contact you in this regard. I received a second communication from Dr. A.lvis, who now admits that the loss of eyesight might be due to absorption of lead but that it would take an examination b y a toxicologist to determine these facts. I have contacted the Indianapolis Industrial Clinic for reference to a toxicologist and they have informed me that they are in a position to perform the services which we seem now to require and that as an alternative or secondary source of information have given the name of Dr. Spolyar, as also being competent to assist us. They pointed out that these examinations are extensive and are rather expensive, however, I. feel that we hardly dare face an Industrial Board hearing on this claim with our medical evidence being in its present condition, for as things now stand we are faced with what I believe will result in an absolute case of liability. Prill you therefore please review this mater at once and favor me with your directions and authority to carry them out. Yours very truly, cc: Hamlin & Co. Eugene Mclniire Adjustment Co. HALL COCHRANE, ATTT. -  '4i' 'V f/ ALFRED T. SYMMES, M, D. 625 East Maple Road w : Indianapolis 5, Indiana November 2, 1954 gsil.Vt ' 1 '**vv '** ?? '? _ Arthur^L'V Payne"'''*' ' ** 129 East' Market Street Indianapolis V Indiana . .>-r *v| ';* !l|.ear . g.~ **r;^`*A>- . . . This 'iVVr&usraary of the pertinent facts on Mr. Avenue, Indianapolis, Indiana. 1409 Columbia As DrT'Robert Harger has already written, Mr. main complaint, when fdrst seen by me, June 26, 1954, was burning of the eyes for one and - one-half years. At the time of the first examination, he had difficulty seeing, but was able to get around with his remaining vision. Other than this, Mr.M M A gave no other complaints. " -f The past pertinent history Included a head injury in 1953 for which he was hospitalised at Indianapolis General Hospital for a period of ap proximately three weeks. Apparently there were no lasting effects from his injury. He was again hospitalized in December, 1953 in Indianapolis General Hospital due to: 1) bronchial pneumonia, 2) hypertensive cardio-vascular disease and 3 ) infarction of the myocardium due to arter iosclerotic coronary thrombosis. The family history Is non-informing* The physical examination revealed the following: General appearance - The patient appears weak and is thin. His speech is Somewhat slurred* (This may have always been so.). He walks with .hesitation. . Hair - Black Head - Normal Contour Ears - Normal Eyes - Pupils do not react to light and accommodation. (Medication?) He had bilaterally small, pale discs of optic atrophy. Vessels are : scarce and reveal two plus construction. ,1* Nose - Negative Mouth - Upper compensated edentulism. Very poor lower teeth and gums. Darkening at edge of gum conceivably due to lead. Neck - Negative ' Chest - Negative except for poor aIration right lower to auscultation and percussion. Abdomen - Negative G.U * - Bilateral cystocele with small remaining testes, otherwise negate Rectal - Normal prostate and normal fecal material on rectal finger. Vascular System - Good peripheral pulsations throughout, ' 7 Glandular - Large inguinal and femoral lyraph nodes bilaterally which are non-tender. ' ::. ;. Neurological - Right ' M7.' Left' Biceps 2-Plus : 7 . 7 . 2-Plus Triceps Radial-Periosteal Hoffman Abdominals 2-Plus" 2-Plus .': '. -2-:PluS '7 7 . . : 2-Plus' 777 . 0 7 7 , - , ' Upper 2-PIUS 7 - 2-Plus- Lower 2-PLUS ~ 7 . 2-Plus Cremasteric 2-PlUE ^ ,7 2-Plus '- . ' . Patellar 2-Plus 5 . . : 3-Plus to 4-Plus (Contra)* Achilles 2-Plus-.J, .' : 3 - PIUS' with sustained Vibratory - Normal . r 7 . ' 7 ; .. ' .. .. clonus ' ' ' < . '' Rhomberg - Negative '7- '# 7'.' 7. ' - ~ / - Multiple scars on both, legs. There is one plus leg edema left. Legs had trophic changes with .thickened skin. ; 7 '7''7- Laboratory Reports: Blood Work -7 'M ;r-;7 . ... . . ' '. : '/ '',. 12-30,-53;.to 2-2-34 . ' Hb, - 8 gas to 10,2 gms. : -WBC' -- 12,700 to 15,600 .... .. / ' 7 ,7/ ' -. .12-30-53 .: . ;;Np: Stippling seen '' ,, . . ' .12-30-53 '' Kolmer -44441 - . V.D.R.L; - 4-.P1US.. . Kahn - -Plus , .' -' ,. . 1-20-54 ' ' ' .7"'`7 Bilirubin - 0.332 - ,;T.P.-. 7.?0, alb. 4113, glob. 3.57 y Cholesterol - ,1797 resters 92 Ceph. Floe ., 24 hr , ;-i 9,. 46 hr. - l~?lus ; / :7;Aik* phosphatase - 3.6 , '* ' ' 1 . -1 . 6-25-54 ' . Kahn - 4-Plus '> V.D.R.L.- - 4-Plus ` ' ` ' Kolmer - 4-Plus , : - BUM- 35 ttfigS . , ' 7 . -7:-77' ' 'XV..'; 'i ';;V '77.7 - ,7 7 7 # 77;#f ::,';7'7:7,V7 7 CSKf 7 77 # 7 >-U*7 7.77717 - V":i.i,v. >f . . 77!77f: .7-'. 7 7 - -A-7 " -V' " ; - V;-!f r 7 ,,7.7':-*-.-7 7.7777 '' 7-7777 777777' :6-26-5*:- Hb. - 12 gms. ' Hemat - 30 Mm Sed Rate - 30..Hr. (corrected) WBC -.6,550 Differential Polys - 18$ Lunjphs - 10# -- Eos in - IQ$> Mono - 2# Test for sickle cell - Negative RBC - Normal Platelets i* Infrequently seen 7-8-5* BUN - 80# 7-1*-5* ' i!b.-9* 92 to IO.96 as. Hemat. - 35 mm WBC - 5 5GOO Differential - Polys - 6l # Eosin - 1 Bp $Lymphs - 19# Mono - 2 RBC 3.2* to 3.5 Urines ' 1-6-54 to 1-11-5* Sp. gr. - 1.010 to 1.015 alb. - 2-Plus WBC - 30-*0 RBC - 100-200-Plus Cssts-several ' -' . 6-26-5* ' sp.gr. -1.022 ph-* sugar -0 albumin - plus 1 6-27-5* 2* hr. Lead Excretion 0.18 mg/1000 c.c. No Arsenic . 7- 1*-5* 2* hr. Lead Excretion - 0.11* mg/1000 c.c. Blood lead level - 0.100 mgm # 7-1*-5* Urine - Alb-tracej Occasional finely granular cast PSP test - 15 min-0#j Total hour - 22# Urea Clearance tests - Test I - 6#j Test II - 18$ -i Page 3 1-25-54 w WBC-O, RBC-Oj, sugar 70 mg % Chlorides - 126.5 meq. Culture - no growth Wass. - no report Gold curve - 1112210000 6-25-54 Lump-2 WBC-2 BBC-30 Sugar-05 Chlorides - 123.1 rneq. Protein - 21 mg. Kolmer - negative Gold curbe - 0112100000 Chest Plates 1-25-54 Reveals clearing of the lung fields Heart prominent transversely 2-2-54 Cardiomegaiy - most left ventricle. There is continued clearing of the lung fields. 6-28-54 Heart enlarged TCD 15*5 cm. (TTB 28.5 cm.). Lung fields are clear 7-9-54 "iiPr lateral, and Town views of the skull again reveal multiple metallc shots scattered overlying the scalp, face, and cervical region. There is no change since the previous examination." EKG Findings M M n M M in aM M W aa M a u t 12-30-53 " : ' " ,. . . . Reveals rate of 114/min* There is elevation at the R-S-T seg- r - ments in II, III, avf. Low voltage ' "impressions i - 1) Sinus tachycardia ... 2) Ischemia of posterior wall 12-31-53 . Elevated S-T in II, III, avf, q in III, avr. Inverted T in avl. Suggestive of posterior wall Infarction 1-15-54 There is slight elevation of the S-T segment in I, II, avf slight q V6 . P-R interval 0.22 see. ^RS 0.06 see. Some Pag 4 I VM M SI depression of S-T In Vf5 and V6. Inverted T-V5 and V6. I Impression: Hon specific St-T changes consistent with digitalis effect and/or myocardial damage. - f/ J.iiO , ,/ '' I Two EKG were done on the last hospitalisation - revealed '7C non-specific myocardial damage. The.'foll^ig is a cop^ of'a letter, from Dr, E. B. Haggard that I .received: ''Dear doctors ' . '. '1 . "hi Here is the Information on the above that I promised to send you i| Stippled Cell Counts Dec. 1953 Apr. 8, 1954 23, May 6, 1954 June 10. 1954 10, 1954 3320 3000 Neg. 3000 Neg. 500 2000 (Indlana polis Lab.) (Chicago Lab.) Serology - 5/1/54 - Kline and Mazzini both 4-plus. Mazzini quantitative 16 units. Dr. Alvis saw this man in May 1953 and reported: Eyesight - right-hand movement and light perception only. left - 20/200. Eyesight not correctible tilth glasses. Pupils dilated and very slight - almost no reaction * to light. Optic atrophy and retinal arteritis," I nave asked Dr. Alvls to forward you a complete copy of his findings Yours, . /s/ . B. Haggard, MD,f .';.r'ig Henderson, (Archives of Internal Medicine, Vol. 89, 1052) states that urine lead up to 0.075 tng. per liter is within normal limits and that blood lead levels above 0.0a mg* per 100 c.c. is elevated. He reports a case of lead poisoning In which there was great fluctuation in the urine from normal values to moderately high values. Dr. Robert A. Kchoe, Lead Absorption and Lead Poisoning, (Medical Clinics in North America, July, l9^)> states that.TrTTead poisoning,.stippled red cells per million red cells are 720 to 16,000| lead in blood is 0.07 to 0.35 rag. per 100 gras. Lead in urine (in small sample) is 0.07 to 0.35 mg', per liter. Lead in urine (in large sample) 0.02 to 0.33 mg. per liter. Dr. Ciannattasis et si, Lead Poisoning, (American Journal of Diseases " Mof Children) Vol. 84, 1952, state that in their fourteen cases, the urinary excretion of lead revealed a value of 0.1 rag. per liter or more excepting in one case where the value was 0.08 rag. per liter. This latter patient had repeated convulsions, was in coma, tut survived to be \u, ooks* lead levels certainly Were in the toxic range. The fact ; he has another organic disease, namely syphilis, would seem to be _ ide the p o i n t T o summarize, Mr. Brooks has certainly had: 1') expo^#td?e to lead; 2) changing neurologic findings es reported above; & r 3} elevated basophilic stippling as reported by Dr. Haggard; M) the ' reported urinary lead excretion which is elevated; and 5) a lead level which is in the upper limits of normal. The diagnoses are as follows : 1) Optic atrophy; 2) Lead poisoning; 3* undiagnosed site; 4} Hypertensive cardiovascular disease; 5 ufficiency; and 6) azotemia. Very truly yours, /s/ Alfred T. Syraraes, M. D. i 0016451 Claim Ho. O.D. 17057 KEr 0016452