Document wr4XNa9a9QDOmJo9D9yvy2aJ

^OHIO DEPARTMENT OP HEALTH Bureau of Occupational Diseases Columbus, Ohio April 3, 1933 C > f Supplementary Evidence in the Diagnosis of Lead Poisoning (items are arranged for checking or comment on the given oase) 1 - \ *--i. P a t ie n t *s N a m e A d d r e s s P h y sic ia n ' s Name D r . Edward F.Ko t e r s h a l l ^ .d d r ess 3771 W. 150t h S t * Clevelan d 0 * 2841 Yf. 25t h S t . , " O b je ct iv e i . e . , th e p h y sic ian 's fin din gs^ - 1 . P allor (e sp e cially eircum oral) 2 , Blu e l i n e * in gu m (s) 3* Stip p lin g* (basoph ilia of red c e lls) 4 . R e t i c u l o c y t o si s* y^iMe^ZtZZ S,S&O, O o 0 5 . Red cell count(s) ^ .A o o, P oly ch r o m at op h ilia s^^Zzfz/L ,- /Ojooo White cell count(s) / Dj0>c> Mononucleosis 6. Hemoglobin percentage W, How determined 7. Evidence of recent blood changes of retrograde character a* s . 8. Blood pressure finding6s rf S% 9. Condition of teeth, gums, mouth 2 10. Condition of hand gripping power ,0--- / / / Qz ^ JLc [ J ^ y J. 2 ^ sC yc^ fcd , 11. Condition of wrist extensors (any actual wrist drop) Jp t . 12. Tremor JU ^ Z a s v 13. Patellar reflexes ,n \ yisC^' Incoordination y jLj^ Z Z Z C ^ Ataxia 14. Ocular palsies ^ A j^ e Z Z Z tZ '^ ^ ^ p ^ . 15. Malnutrition or emaciation 16. Acne or dermatitis 17. Evidence of nephritis 18. Gouty s igns 19. Mental disturbance yd/- ^M-jzzz^-^y 20. Other objective signs^ noted; ZtZZt- t^ ^ cJL^ f(z tz . N8249 Blue line in gum(s)", "stippling" and "roticulocytDsis" occur in Load Absorption, but, with or without those, it requires significant abnormalities in various ones of the other Objootivo and Subjoctivo findings listed to sustain a diagnosis of 2 Subjective, i.e., the patient's complaints 1. Morning anorexia Metallic (or sweet) taste 2. Hausea or vomiting 'B 3. Acute attacks of abdominal colic Dyspepsia 4. Obstinate constipation Diarrhea at onset 5. Headache Insomnia 6. Weakness (hand grips; use of wrists, legs, feet, etc.) 7. General weakness C L c ^ p t _ 8. Rheumatic pains ^ L.-ue^ e^ z : f {7 t . 9. Disturbed vision Syncopal attacks 10. Weight: Normal- ^ At present. /> 11. Other symptoms Slit zf 12. Any further coinaent: Physician's g i g n a t u r e ^ g f ^ j f a Eate J 4 ^ 6 . ^ . / ? . 3 3.;. .A .... The diagnosis of Lead Poisoning involves evidence of (1) exposure to lead or its compounds; (2) objective signs of blood changes, of nervous' involvements and usually nutritional"disturbances; and (3) the presence of a number of the subjective phenomena above listed. . . Stippling (also reticulocytosis and polychromatophilia) indicate that lead absorption is going on at the time.-;. The number of stippled cells found increases as absorption progresses and is a rough measure of the amount of exposure. Hence workers showing;stippling without other evidences should have blood examinations made frequently.'1' StipplingHirith other evidences (see above list of objective and subjective findings) constitutes acute load poisoning, but acute lead poisoning oc casionally oxists without stippling (horo roticulocytosis is invariably prominont and the red colls should always be examined for this condition). When the con- ; dition bocomos chronic, stippling usually diminishes, but is rarely absent as long as exposure continues or other clinical signs prevail, whale anemia is invariably present, usually also with polychromatophilia. : Inasmuch as the accuracy of analytical findings of lead in tho urine and feces is a matter of groat doubt, tho value of tosts for same in establishing (diagnosis 1 is questionable. . `. .