Document wDbGp0QG8n8XQKnJGbN0LOR1D

DR. F. CU RTIS DO HAN 221 MALONEY CLINIC BUILDING HOSPITAL OF THE UNIVERSITY QF PENNSYLVANIA 36t h AND, SPRUCE STREETS PHILADELPHIA 4 Juno 26, 1962 Dr. Robert A. Kehoe Kettering Laboratory College of Medicine University of Cincinnati Eden Avenue Cincinnati 19, Olio Dear Dr. Kehoe: Thank you for your letter of June 4th about the "possible case of tetraethyllead poisoning". I have enclosed copies of the three discharge summaries of the case. The patient-was first admitted to the Hospital of the Univer sity of Pennsylvania on June 30, i960 and twice thereafter. On the 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. 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, C. Mi ___ F. Curtis Dohan, M.D. FCD:m end. 0015325 August 6f i960 mm he* A&^ttea4/30/60|l>tsclwssi-7/22/a5. pjseamgg. d imid s b s ; Infectious hepatitis, lead 2as poisoning. 02iis was the 1st IFJP admission for this 46 year oM Ifegro sale who entered with a Chief complaint of jaundice# diseosafort |a the aMoiaea said abnormal urine. gave a history on admission of Intorsaittent episodes of aching MdaMomimi gain that would last usually a period::of:;several hours,hut occasionally would he pro- . longed to a period of 2-3 days. 2hese -pains would ease on on the average of 2-3 times c; month. I5e had had the first episode about January of i960. About one month before admission he had begun to notice a gradual loss of appetite. Kins days before ad mission right upper quadrant and left upper quadrant feeling.Of annoyance but not pain lad developed. On 6/26/60 he first noticed - yellowing of Ms mat sclaaae and also thought Ms stools had Men rather light recently. -had received no in jections in the previous six months, and. had boon exposed to no known toxins. In the past medical history it was noted that he had developed hives after an unknown injection 2-3 years previously. 3a was on so current medication* He works as a truck r.ratal shop body nan and lias done this work, for the last 15 years. Ha. lias cooked v j o packs of cigarettes per week for several years but in recent weeks has developed distaste for cigarettes. He denied say excess alcohol intake* In tiie system review it was rioted that he had developed a 12 pound weight loss in the previous three weeks and the rest of the system review was entirely negative. On physical examination his blood pressure was 130/90# pulse 72, respirations 20 and temperature 53,4W. 36 was noted to be a 46 year old colored male in no acute distress whose scleras appeared moderately icteric, lie had chatty posterior cervical and in guinal nodes* ;'ite ms tender to palpation in the right upper quadrant of the abdomen but the liver and spleen were not palpable. Z&urological exam was entirely negative. He was felt: ta:lpv@ ms put on infectious precautions. On admisoioa his hsmglahln ms 11.4 with 6# reticulocytes# HB0-X7#9OO# neutrophils 64$, iimocyte^'XO^ 2ya5?M^t6S:.2g^# 'AGO 77# bilirubin 1*1 direct and, 2.6 total. Serum cholesterol 254, albumin 4.1, globulin 3*3. alkaline;phosphatase 23, acid phos phatase 0.8# WB 25, and glucose 80. Over the next few days bilirubin rose to 3.2 direct and 6.2 total and his symptoms seemed to get & worse. His alkaline phos phatase was then noted to be 13. Over the next two weeks his sysgitoms gradually di minished except for occasional bouts of vague epigastric pain. On 7/2O/60 he Was noted to have basophilic stippling of hi red cells in the peripheral smear and blood was drawn for a scrum lead determination. On '7/22/60 it was felt that he was wall enough to be discJmrged but that there were still several unanswered questions, Be was then discharged to be followed in Hematology Clinic. A few days later the Mood lead determination was reported as ISO which is markedly elevated. Arrangements were then made for re-adaission for treatment of chronic lead poisoning. FRiea STans. 8/8 KE 0015327 ISs g ebs F. Raymond# M. D ) DJSCSAHS SUfiHOQT psmmBt 0/5/So mommsmi 3/20/60 Mscharcc di^gnm.iss. <^rotiic lead poisoning Xaaa mphritis, suspected Shiis 47 year old negro m2e was admitted to the IJ^versity Hospital for the second tins on #/5/60 and discharged on 8/20/60* His first asfe&asicsi had heea in toe, i960 because of' an /Mil first edsissloa he w noted to be aaeaic with basophilic stippling of the red blood cells* A lead 2efei was dram at that tins but vas not reported until after the discharge of the patient* She blood lead vus 130 game percent, with, a top nonaa! is this hospital of 60 gasaa. percent* Because of this be was madnitted for therapy* History reveals tbs presence of creepy i^-^osinal pain occurring 2-3 t-Sssss per issoath since January, I960* . 5fi|#c. episd|isd',:c4 'last, fr 3 hrs* to 3 days* 2beee hate gradually $gpqae>qoBtt mvose.aad assess Snegraft*. Ja the few weeks prior to this abtogic&'.hi8 -had abdopi^.ps^ g^S following* each mal* . Share . has:been no history of any actaXXie taste is tbs 3a# a? any pedicular ro^cular tea-sseas of the eras or leg, ansi no IstfUn personality changes* Sfeysicsl easEtfnobim on admission rsvesOed the ps?eseac of a definite- lead lias 00 the lingual surface of the guraav/* i03&inder of the- o:\Eoinafcioa including the murolcfjic'. evaluation ms perfectly rostaal* & had' several episodes ofekWxMavdnaX pain during the- first few days in the iijpspit&lj those waste reX&sved alnoefc iamdiatelyhj iiitrevenous injection of ealciqn {^accsmte. Lt&oratory vorl-s oa this adxsSssion revealed the followingt- Hcpoat bleed lisad ms 125 GSBiaa percent 5 SVhour urine collecttoo for losd revealed an emnetion of 550 gam, with a too normal ia this hospital of XpQ gatm per ft fens* Hgb* T5$t 10.2 $a*, isgbc with Eioderato basophilic sti$pllag* Stef wens 7*42 percent s^ticulocjtee, lC and differential 'iere iiorsaaX, as wane Has platelets, Repeat liver funetioa t sts on this a^aaicaa revealed on SGOSj? of 44 waits, normal S0PS?, bilirubin *5 sg* direct with 2 sag* total* fotal protein Ai*Q ratio and aUsaliae phosjaistase were aorsaX* Si^.'sol turbidity end alas turbidity were within noncal Siaits. Oriaalysis was within. nonaal liwits onoept fee the: presence of saner white co.Hs per bpf m well as X-iv bbo #s per bpf* A tarae of protean was present* A mwolagie consultant found no evidence of peripheral saeurepsthy car eacephalopafeby. Spinal tap revealed nozml smeostries eM narnal pwtaia cells .and glucose. Creatinine usd ISM were within sosaal limits. Bom narrow exanimtioa revealed a mderate I'^sreollalarity wiHi increase ia reel mil acciwity. Satis of the mre chsraeteristie ehaagps ia lead poisoning wars} presest ia the Ixm m&zrcn?. A differ ential Cocx&'s teat to he t^ical cf lead poiaonlsg. After settling tte cells la tbs siroematairf top layer of cello of cells was positiv ,vtoteaa the hottsa layer was mgative. v* With a ficnly established dissssasia ef.lead poisoolns with fairly acute sya^osaedwtlogy la tte wy cf cdjdgaiSDl pain, it was daieded to give this patient a course of Tersentte* m received 1 .gasTdaily for a days. Daring this period his tarinsssr lead esxmetian increased aar&edly varying frees SX%$. 11.5 .jag* cn the 1st day of treataaont to 6 ag* ca tte 'das? of treafeasut*. A repeat blood lead, at the end of the first course mm KE 0015328 N20383.02 55 p x e percent which Is tritlsto our nossaal Itoits* Following the 2nd day of tresteent Ills pbdoatoal pain disappeared and has sat returned since that tiae* Hhs investigation of possible sources of lead to this ipsttosm revealed tbs following too possibilities: Cl) lie works at the Byder aak Rental Co* and lias been siphoning considerable quantities of gesoMn for tbs past sear or too* He frequently -ssllo88 cosnsitorabls asaounfcs of gasoline vMhe, of course, contains tetraetbyl lead; (2) fsm Bocedber until early Ifereb be pointed trucks to an ua ventilated rood, at the saoe ttoe there tiers peepto vetoing to this rooa. Itois, of course, night cause ecnstoertible amounts of toad to be present to the air with tie possibility that be night bare beccos totetoated by this route* Qs envtocmental health toporocat cf tbe IMtotfelpMa Pdblic Tfealth Service is investigating this .job situation cad tJiH report to us as ssem as they have acre definite informaticai* In the neantim to is not to return to work. Repeat liver fuaetioa studies at tbe end of Ms hospital course revealed coraplete return to aoassal to all those studies which. were abnortaal on atoisoion* Ms. Sgb* on dischtoge %m& 9*5 h*, however,' there vas evidence that toiaolyBis had stopped to view of the sonaal sOraB bilirdbia* I& had a 2^ hr* urtos ccOtoetioa and a csspl repeat blood toad drawn .test before discharge ond this will be checked to one be is soon to the Hcaatology 0H3 As far os Ms urtos to eoaoeraca fcllauias tie course of toix-esat, tto nuc&ier of BBC's to Ms urine increased to 13 - 20 with no change to. the tfgC'c or protein. fho possibility that this uigfrfc teprcccxrt a toad nephritic secondary to S&rge tsassfes cf toad being excreted thrombi tbe sLdmys on Vcrsenate therapy oust be considered* Culture of his urine oa one occasion cli-oued no growfeit tod' -on ffee beker ^ few coloaxteg of aon-heobilytie. stapi oursas* He was discharged c<3eaete3y asp^temtie and win he seen to the 0H> of Ilemtclogjr to one week. Arnold S* Bo 1g &4> H3* aosMent to todieine ASH sea Dictated 8/22/60 KB" 0015329 3223Ca*C2 SKUS OegiMdjer 13#. .lotted! o~3i-~& 2feeimnpi|. S^io-go ^igciiarae test Toismxlxm a fas*sy-olK stss? sM liesro al% uses admitted to ttar bSSmaslt? Sespital. bias on :& 1mA first hewn Gdaitbed 6-30 to fsa-&> trith a Rictus consistent with aeufco loptsbifeis* At, theft bios a-hisfeoey ff istsmtbteafc -jsas^y alxIaB&aal pals for the yrsvious sswa ta ci^fc smtlas was f&fcaiaed* SSsls teas saaoociaSod -*.18h .JodfitRsfee -.amtipatioeu Martas this sdndssio be ms found. to tom a Urxjjglefoia of l>*3 3b with ixaso^Mlia stippMss. a blood lead at dam# ixst the j&fclsafc *es discharged prior :U bels*; reported. T ms later reported to be S3* jptx ^ca? cent, She top iiae&al 5i esar lafcamfccry seisug^- gaaaa per eeefc. Became :C this .45 *f*ss rc-mdaitted ** wet eeeorad tine on 35-<5j eM di&i&arged m 0-52-0*. .^*adalo0iae^ ms ff;*? ebitSy and tamtamt of load v^isming. A history gfyg^^g s m safe veil i d^ste&, bast tbtso *x k s jseverai 1. iss IsaE*^ fair- Iff Z&xy? *!uas^jce off ipeoldao during the iro^isus cevsM ycere raisins the poas'tbiH- *;/ aff fcetreap,?! isod veitacias* 2* in 'Ooesabat V}?i earl? i$m$k i$G ha iw& aiated sat tsnascii is a poss*!^ vspftil&fcea rjoa ia tfsieb voMSag ms also desae* 2$a .aided the possibility off ajswoeas.'o to load ferns# bis armt blood lead ms 125 ggsasa _or eaarfe. A u^V-four hosr tsdhary collection <.`hr lead ms *33 0mm per ta)SQt?-ffar oers, A-s sop ttes&X in ^Kratjr? t&lag 1ms bias 3U, ^aaasu Hi# arises? eop^opor- /..yris. *7C jr/el m i-AL arm r*s? ima^^icwr haunt* t$e top aopl being loss Aj &s 1.^ urm. ;.e v b -'ivta si *x3o off mleita slisoci'^a 3 ursea iatro* venoiAsi;/ rfeii;/ ,,-.:.r ffaar vz^/c* Zviss la a Laama&s in ths ts'tar/ iced ,u*al 07 trm st*c-,vT2ii^' oiio -^tiesfc ;ad asyaftesae^ie. A rsrsost bl-sod I,-ad at ::ffo and *i;is .^mrs off ttsistamit -*as Z} sax rjsr asaa -.ffciali tisa i/ithin .o5T wjtal ursl0bia duriag t- saex^i &feiesiqa wartoil i^esa ff.y to :tff.2 viuli T --IS ij SS" coat rotioaloo^teB# eM a bi!4rw&n off S tsa^* l S tbls 1.3 sag* ttss irs&iseet. TJacsse ffjbdlag tiore ossocidMoa ooociatjsafe -aitu a bomlgtle eiaissb *0 his srienia. ?o >11j mZz q m. be sSM aeli fee* Meal saps M tlss etdooiml gala Ziis ms axaca^i; lestlag tliirfey to siiy tsusstos# aad oeeussrias a^swt ose ialff hosus* afftwwp mods* MiM ecsstiimtl eoatsaaed* ca he ms ssea ia the I^saatolas? lutpatSsaat ^erfeaetift, A blood lead ewid v^ixmf lead had. beea coi- Soctod .^sst tssi prior to dlsehdrso rswsled the ffol3arStS She blood leed had risen to I-'A rpaaia per es*# the larot?foar wtoasiT lend' vm 33S gmm* * Became of tls retasn off o;aapt!atol%^ end i^sc&r^tsd blood leml. osff lead he ms m^adaitted far' ffarah^r- txrmtxnt. Hwsitsol evmSmtixXi at this tliat as oolsr 3 that a load lias \sae vdsibl j o ti43 lirs(3ual siin^oe of tl*s sm bat aot tb l^Sd s^ssfhoe# id thor \*tm iblrl? rosdsrato liiaosal cod CKstjusswtiml. pallar. Srlor to beglnaStts a second ccas off thera* blood assd asdaa load aa dswss* a blood as 73 os*;i# aad tbs tsm^-four urinary Imd cpeaoa per epeeiasstt. ,3e ^at gSsnes a JRswr da? esssrse off cslsiisa dlsodUm \'i%'&smt-&\ 2 r?m& r<a? tbs? laSatef^soml? cww a six hsir period. At tls eM off this g c o t s o a ^peat blood lsd vas 0?ff ag4 aad the *** laatient *s a^ia sn^&oaafeie. Ht 0015330 N20383.03 sspusfter 13* 2S&* result of the sobwar Xaad output dsg&ut tt ccursa of t*6*aea& are mb ysfc svt3^s1s to m* rSrne&m tee egad -of stay 9 iSara* biopsy na p@af*&. 3sSs rcvaolcd ertflaba* of ire#3B*afcl< of i*$*ia wsms^mX mUs thaufgst fcy tl Smifaoiofiist to t c^istoat with ttw sees**? pfsaea of vN$ Zx#m9- it oss not entire possible to raM oat a toscte l^stitis oa tails basis* as t*a Xiscbargsdi on >le-& essentially sSynptaaKttte* to isnm/oceftasted tte .Eavlxoqiaental 3oa2&t} Divisiosi of ti PtMio Hsj&Xth &$ of :-liil^isiiia a fioM vaster bats iavastigsted tl sm&lisg mmM&immt wa& am hem found tbst taws * sevesi <si*ea? as oa& veoixias a tUe ossaa 3aeatSan tso my also i-sm been osmosed to 2esdU -* ar hoping to obtain ti&etft and ariaa pe&Siaaa Sna ebss for irr^o&tiftjatitru "Sb relriionahip of ibis esn's Asiffitltls to Isis 2ss& poisoning is still ps^Scsstls^U .rt is entirely possible tfe& this represents mm of t^sisitsepsfcitis eecooaary to load* ::a its other hand it sesr be tftst a 'fissl. hepatitis :^rifis4 saffis lest sfefatMiiia to bring ait a latest lead possessing.- :iis isnagtafeixi m diseSMtwi frcs1 tbs Isospltsl *sas 1$*2 fieesss, end fe las been given a follsr^ip sytoiaaasm to tfce .iSEsJa ?raasc. 9-35-60 ess 3r* A lewis - H.SJ.I*. 3r* a , Tfceucil. ~ iut?*P* Dr. Georgs- iii&rig * E*!/*.?* AtsH S* aotod* :?3idQat as i&dleias K 0015331