Document zYY5gDyDERO1DK0povJMJ2Z0
September 27, 19}-9
Dr, Charles E. Whipps Carlisle, Indiana
Dear Doctor Whippss
1 am enclosing a cop} of the report of our
examination of Mr.
Ko findings were elicited suggestive of lead poisoning of any type, nor did the results of the chemical examination of the samples of blood and urine indicate unusual absorption of lead compounds, these being well within the normal range.
?ir. Weir requested that I send thi3 report to
TOU.
Please write to us if we can be of any further assistance.
Sincerely yours,
KVKsvr Enel.
Rari V'. ~Kizmllor^ "7
8 - 17-igi.Q Fame
MEDICAL RECORD Race W h i t e
Se x Ma le Age 5Q' ( It - 1 8 -9 9
H O H CO
Rome Address Carlisle, Indiana
P.O. Box 67
Telephone No.
"
3& <T*
Employed Bys S t a n d a r d O i l C o m p a n y or I n d i a n a
INDUSTRIAL HISTORY
'
Present Occupation {Exact description with dates of this and previous employment
at same job.) in charge of bulk operations of St. Oil Company in Carlisle, Ind
ank truck deliveries - gasoline, kerosene, power fuel, heater oil {all grades) Red
rovvn 60^ regular - White .Crown LlO% Premium-with Standard Oil Company for 2ij. yrs.
Previous Occupations {Approximate dates and length of employment)
ridian.Oil Oorr.pany - 10 mo. {1922-23) truck driver
tuart and Davis Oil Company - less than 1 year (1923) truck driver - farm work
prior to 1922. Used ''Ethyl meter" for 6 mo. (I923-2I4.) for adding Ethyl Fluid to
tank (truck) - wore rubber gloves - avoided inhalation.
Lead Hazards (Dates and duration) X Painting (including work at home)
Plumbing
Automobile and Car Body hork Type Casting Smelting
Gasoline Treating (Refinery) Storage BatteryLead Burning
Use of Discarded Battery Boxes as Fuel
kHunting- Trap Shooting, Target Practice (Indoor Range)
Soldering Enameling Paint Manufacture
Ihite Lead Pottery Glass Rubber Garage Refinery Filling Station kBulk Station
)X.Gasoline Truck
Automobile Owner Yes Kind of Gasoline Ethyl and reg,,own Repair Tiork Occasionally
Other Industrial Hazards
not In past years (19)4.3 )
Fills and delivers truck orders - 1,000 to 6000 gallons of gasoline weekly. In .
addition to bulk handling also fills auto tanks and truck tanks and cars - hands
more or less constantly wet with gasoline (canvas gloves) - loading and
operating valves - fumes from supply line in loading and unloading gasoline, (over
- PAST MEDICAL HISTORY
Childhood Diseases Rubeola x
lumps X Rubella k
Scarlet Fever
Chorea
Variola
Varicella k Pertussis ?
Acute Infectious Diseases-! Rheumatic Fever Pneumonia Pleurisy Arthritis Malaria
Influenza X Tonsillitis Tuberculosis Syphilis Gonorrhea Poliomyelitis
Other Diseases Rone
- Appendicitis - appendectomy (October 19^8)
Bilaterial hernia 1931
Allergy? Rone
/
Injuries, Accidents, Operations* /
REVIEW 0F~SYSTEMS Fairly good
10 lb. -
State of Health / Wt.
Best 192lJsual l80 Present 1 77 Recent Gain
Loss si. p a s t
Vision - Normal Failing
Bifocals (2 years;
Diplopia O Inflammatory Disease o Cataract o O m e
Ears* Hearing - Normal
Loss
Earache O Discharge O Tinnitus O
Nose* Smell - Normal Golds
Loss or Perversion O Sinus Disease
Discharge O
Epistaxis 0c cas, Obstruction o
Mouth * Soreness o
Ulcers O
Salivation slight Dysphagia O
Taste Normal Unpleasant
Loss
Metallic o
Tongue Sore
Burning Sensation si. w i t h dr y f e e l i n g
Tf-isth- Devitalization O
Pain
Caries o Bridgework o
Bleeding
o
Recession
o
ak '_Pharynx; Angina O TonsillitisO Hoarseness O DysphoniaO Aphonia Rot remarkable
O
CARPIO-PESPIRs.TORY Not r e m a r k a b l e
Ccv'-rl- Sputum Fever Night Sweats Pain in Chest Dyspnea Orthopnea
O UY
VO 00
Frequently necessary to unload gasoline in covered shed with poor ventilation, particularly on hot days with little air movement*
/< 0016090
_ * 0 - I 7 - 9I4.9
Appetite Fair
Food
, Habits Regular
3
tiroes
daily
water - 1/2 gal.
Thirst large quantity /
Food Idiosyncrasy Tomatoes
Allergy
Frequent Use of Catharti^^ ^
(Flordex seeds)
Anorexia Nausea Vomiting ColicS__l Abdominal PainS 1_Constip_ation Diarrhea Abnormal Stools (Mucus, Pus, Blood, Parasites, ''Tarry" orHClay-Goiored")
Hemorrhoids Eructation Epigastric Fulness Flatulence Hematemesis Jaundice
Nausea frequently a f t e r e a t i n g 1-1/2 to 2 hours (over)
GENITOURINARY
-2^3 times
#
SI Dysuria Pain Nycturia/Hematuria Polyuria Edema of Face Retention Urgency Slight
Frequency xincontinenceSLEnuresis Urethritis Libido Impotence Gonorrhea
Syphilis (Nature and duration of treatment) N o
USURP?SYCKIATRIC
Some
Characteristic Behavior Pattern* Emotional Instability / Euphoria Depression Occas,
Compulsive Disorders Neurotic Traits Phobias Anxiety Memory
Occas insomnia Nervousness X Excessive Dreaming SomertigoSl. Readache Tremors
Convulsions Paralysis
Parethesias Anesthesia
Visual Disturbance Some
Dysphagia
Ataxia S1 Lassitude
.. Stupor
Coma
SKELETAL
.
Musclest Atrophy ?
Aches X
Pains x
Jointst Stiffness x - Knees, ankles Pain x
Bones
. in arms
Sp. at night - legs - less so/
Cramps X
Weakness S o m e
Limitation of Motion x
At times - right arm
PERSONAL HISTORY
Maritalt Duration A Y 1* Health of Partner
Miscarriages 1
P2H txc,,Situationt Well a d j u s t e d
21
G o o d Children 3 Sex Male Age 2i
Duration of Pregnancy p p r o x
29
2 mo. - Spontaneous
of Birth and Residence? S u l l i v a n C o u n t y , I n d i a n a
Sch(?ols.and Education; Completed 1 year h i g h school
Pipeful 2-3 x
Addictions[ Tea0ccasCoffee2-3/ Alcohol
Drugs
Medicines
Tobacco 2-3
Social Interests Reading X
cups daily Games
Amusements
cigars
Sports basketball -
Hobbies Fishing, hunting Vacation 3 vrfcs. last)daily
Spectator
seldom has time
year) with occas.
FAMILY HISTORY
only vacation lapses of
"Nervous Breakdown"
Mental Disease
1-2 weeks
Familial or Hereditary Disease
Other Diseases
State of Health Father Mother
Siblings 1 s i s t e r 66 1. a n d w, 1 bro. T B C ?
Age
78
Ik
63
Cause of Death
"old age"
"01d age"
PRESENT COMPLAINTS (Include duration, preViprfa^/ng & M t s pknch a s ^ n j u r y ldney
or unusual industrial hazard, progression, and previous
She t rouble ,,s - fel t W Y f 'X l L 0nS8!! K ?" ! 1, 1S U f e - l O O - did n o t k n o w what
eu
, 8 tms lelt run down, weak, noticed loss of weight esoeciallv Hnxfn
1oecame od izzy anad Tf ainted while attending church (Mlarch ? q 1l6)
day (Eh W M p p s >
Indiana) (se^attached ille
o h w ^ l L 1 aesa as reeorded by Dr. Whipps). Doctor did not find any
physical abnormality to account for trouble. Patient disturbed bv fact that
several S.O. agents had died suddenly in recent months and thought that something
(over)
G.S.. Indigestion characterized by symptoms as noted - also light
headed and nervous - "headache 2>/\ time"
Examined by doctor in St. Louis (in 19l]-6) as request of Dr.
Whipps - never received report.
.
in gas might be poisoning them. Dr. Whipps thought this a
possibility worth investigating so sent sample of urine in fruit
jar with metal cap to nearby Sherman Hospital, Sullivan - report
"lots of lead".
Samples then sent to Kettering Laboratory.
tfg'"001602
,,AME
GENERAL APPEARANCE
Ht. 69
wt. 168
SKIN
LYMPH NODES - Spitrochlear
DATSE 8 - I 7 -I9 I19
PHYSICAL EXAMINATION
3 a '- R
T. 9 8 . 2 R 20
P. 72
B.P. (Position)
o Axillary o Cervical o Inguinal o Femoral o
HEAD - Skull Hot r e m a r k a b l e
Hair S c a n t
' Scalp N e g a t i v e
LI8/78
Eyes - Pupils SizeSmall Equality E q u a l Contour o
Reaction to L. and A. n o r m a l
En- O Ex-ophthalmos
O
Nystagmus
Strabismus o
Conjunctivae
O
Sclerae o
Corneas o
Vision* Acuity B i f o c a l s
Failing
Test Chart; Rt. 20/
Lt. 20/
Corrected* Rt. 20/ 20 It. 2 0 / 2 0 G l a s s e
Ophthalmoscopic: Fundi Neg.
Discs
Keg.
Vessels Neg.
Ears - Hearing: Ingersoll Tfatch Rt. b.0/40
Lt. i|.o/40
Tuning Fork (256) - Air Conduction /Rt.
Lt. Bone Conduction Rt. Lt*
Otoscopicj N e g a t i v e
Normal
Nose - Septum; Deviation No
Perforation o
SI*
Mucus Membrane: Normal
Edema o
Pallor o
Congestion L e f t
Discharge (serous, mucus, purulent)
Turbinates; Normal
Enlarged
Obstruction
Mouth - Oral Hygiene`$"atTsLips Tremor O Pallor O Ulceration Buccal Mucosa o
Tongue; Pale
Beefy
Clean Coated
Smooth
Atrophic s l i g h t
Fissured
Deviation"*" '
Tremor
Twitching....
Teeth* X Missing; / Non-restorable Carious Tooth; 0 Restorable Carious Tooth;
Py Pyorrhea; D Dead Tooth; B Bridge; P Plate; C Crown; F Filling.
Sums ; Color / Consistency /Recassion O Inf lamination O Pyorrhea OBleeding o
Lead Line (Exact Description and Location)
Lone
Throat* Pharynx
Lymphoid Tissue o
Post Nasal Discharge o
Tonsils Size Small, r e
Crypts o
Exudate o
NECK N e g a t i v e
tracted
Scars Tumors Cysts Vessels - Stasis Engorgement Pulsation Thrill Bruit
Trachea - Midline X
Deviation Thyroid Gland N o t e n l a r g e d
CHEST Size
LUNGS
-orraal
Normal
Shape
Normai
Expansion Normal
Respiratory Movement /
Fremitusg Tactile Normal
Vocal Normal
Resonance normal
Breath Sounds Vesicular Adventitious Sounds
HEART
3.5 cm. <).$ cm.
STze
R.S.D,/ R.C..D. / Rate? Before Exercise 722 Min* After 50 Hops
OUC-
_PMMII; Location 3 I .S .precordial Thrill O
^hock. O Friction Rub O
'Soouunndds Rhythm R e g u l a r
Intensity N o r m a l
Murmurs
o
ABDOMEN Contour tolair
Symmetrical
Scars M i s t . uot palpable
Panniculus x
Masses
o
Tenderness Q
Free, equal
Movement
Superficial Veins o
Spasm
0
/ITALIA Normal
/Discharge
Scrotum
Testicles
Normal
; * JL.V o
Scar
"o
Phimosis O
ANUS AND RECTUM Hemorrhoidsi External O
Internal 0
Ulcer
Fissure
P '10STATE GLAND
Small symmetrical - not tender
EXTREMITIES
Normal
Deformity Atrophy Movements Edema Cyanosis Scars Varicose Veins Ulcers
JOINTS
Normal
'
Clubbed Fingers
Toes Hallux Valgus Flat Foot
Epidermophytosis
SPINE
Normal
Deformity Sacroiliacs Limitation of Motion Tenderness Muscle Spasm
NEUROLOGICAL EXAMINATION
CRANIAL NERVES Not r e m a r k a b l e
'
I. II. Vision Ophthalmoscopic III# IV.
V. VII. VIII. IX. X. (Carotid Sinus)
VI. (Pupil - EQM) XI. XII.
SENSORY FUNCTION Superficial; Tactile NormalPain N o r m a l
Temperature
. Vibratory (128) H o r m a l
REFLEXES; Indicate response; 0, not elicited? 1, sluggish; 2, active; 3, exaggerated.
Deep Biceps Triceps Radial Wrist
Rt.
1 1
!
2!
2! 1
Lt.
1 1 2` 2
Ulnar Patellar Achilles
Rt.
1 2 2
Lt, j! Superficial 1 J! Upper Lat. Abdomen 2 j Lower Lat. Abdomen 2 j! Cremasteric Plantar !{ Corneal
Rt.
1
C1O1L
1
Lt.
21
i
1
MOTOR FUNCTION A d e q u a t e
^
Muscle Strength
Tone + Myoedema Gait-1*02** Extensor Weakness o Wrists o
Ankles
o
Paralysis O
Fibrillary Twitching o
Clonus o
Position Sense* Ataxia Romberg Heel-Knee Finger-Nose Past Pointing Astereogncsis
'
o Neg*
Normal
Normal
No
No
MENTAL STATE
^
Attitude Loop. General Behavior ^ o n s a l Cooperation +
Insight +
Judgment S a t i s f a c t o r y
Intelligence
+
Attention +
Personality Type.; Average Normal NaUZ2ii. Hysterical Hypochondriacal Rigid Paranoid Extraverted Introverted Constitutional Psychopathic Epileptic
Emotional Reaction^ Well Adjusted Irritable Depressed Defensive Agitated si* Indifferent Oversensitive Suspicious Compulsive Elated (Euphoric)
Disturbed Consciousness; Disorientation
Stupor
Convulsions
Delusions Delirium
Memory Defect Coma
SPECIAL TESTS AND EXAMINATIONS! S a m p l e s of b l o o d a n d u r i n e f o r quan. lead
SUMMARY AND INTERPRETATION is, A n x i e t y n e u r o s i s .
`
DIAGNOSTIC IMPRESSION .
A n x i e t y n e u r o s i s wi-th g a s t r i c an if e stat ons
S. V . K i t z m i l l e r M.D. Signature of Examiner
LABORATORY EXAMINATION
HDM33R
name
BASE 8-17-19^9
BLOOD
Hemoglobin. (Spencer Kb Meter) ...... lit..
gm./lOO ml.
Hemoglobin (Oxyhemoglobin)
..........
gm./lOO ml
Red Blood Gells 10s/mm.3
.^,3li.O,OjQ
Sedimentation Rate
...... ....
mm. - 1 hr.
Plasma Protein
...........
gm.
Hematocrit White 31ood Cells 103/mo.3
..6*XQ0
mm.
Differential Count Polys Stabs Lymphocytes Monocytes Eosinophiles Basophiles
,a.
ao.p.
1
. o.
t
%
i
f,
Stippled Cells
/50 Pields
RIHS
Color: ,i'V'A-iF..... . Rea.ction: p H ..... ........ Sp. Or. ,
Albumin ... .Q........ S u g a r ..... Q
B l o o d ..... Q
Microscopic: Few BBC, occaa* opith., 1 clump WBC, rar RBC
SEROLOGY: .
Wassermann Kahn Kline Eagle
Positive
Negative
Signature of Examiner
H 00160-95
To.
Name
MEDICAL RECORD Race
Sex ft
Age
Home Address
.O.^ ulJhone No. / 9'''-
Employed 3y*
^
IID'ISTRIAL HISTORY
Present Occupation (Exact description with dates of this and, previous employment,
U yL-
tj St-.
ZuS^yk
( im, t
Previous Occupations (Approximate dates and length of employment)
/ % ^ > I f 9 2 i - 2 s ) ^7/
-
(^-/*9qj
(?
v>^
%> /9 7 ,-u
Lead Hazards (Dates ana duration)
2/
'/painting (including work at home) Use of Discarded Battery
ftt^-^P f& t&a,t^ '
White $Leeaad$r ,
^
Plumbing Automobile and Car Body Work
Boxes as Fuel ^ Hunting. Trap Shooting,
PPootttteerryy
Ap~n
Type Casting
Target Practice
Rubber
-
Smelting
(Indoor Range)
Garage
Gasoline Treating (Refinery)
Soldering
Refinery
/u. - ^ ^
Storage Battery
Enameling
Filling Station"',r,"v
Lead Burning
Paint Manufacture
l/3ulk Station
t/Gasoline Truck
Automobile Owner ^j^> Kind of Gasoline <f
X i . Own Repair Work
_... ,Other Industrial Hazards
. r %Ai
z^pt Jt J .
SASfeSA ySZL
*(*< <)
(0-r*h>)
PAST MEDICAL HISTORY
Childhood Diseases^ Rubeola
~~ '
Chorea ^
1 ilumps Variola3
Rubella ^ , Scarlet Fever a Varicella ^ Pertussis \
Acute Infectious Diseases a Rheumatic Fever Pneumonia Pleurisy Arthritis Malaria
Influenza*-'' Tonsillitis Tuberculosis Syphilis Gonorrhea Poliomyelitis
B s . r . a . . . ... ^
(triwfy
Injuries, Accidents, Operations;
REVIEW OF SYSTEMS
~
***"'
'*v
State of Health '''(J
' Best/^b/Hsual/^p Present/~J~1Recent Gain
,AiC
Loss
,
Eyesj Vision - Normal ^Failing '/Diplopia n Inflammatory Disease r> Cataract
Ears Hearing - Normal 1/ Loss
Earache o Discharge fi Tinnitus
Vose; Smell - Normal
Colds Q
Loss or Perversion Sinus Disease q
Discharge o
Ep istaxis Obstruction
O
Moutht Soreness
Ulcers &
Salivation
O
Dysphagia
TastejNormal
Loss
Metallic^ (P
Tongue Sore O
Burning Sensation g-
Teeth; Devitalization O Gurrs;- Bleeding V
Pain 0
Caries o
,, Recession 0
Bridgework '>
Throat arid Pharynx Angina 0 Tonsillitis Hoarseness - Dysphonia i5 Aphonia
........ ' - & * -
iardio-respiratory
r
Cough Sputum Fever Night Sweats Pain in Chest Dyspnea Orthopnea
Edema Cyanosis Weakness Hemoptysis Palpitation Precordial Distress
c/, / rJt
. T L?(i ^yo'
/
609100
3>
^, y y ^ y j - ^ r d J ^ y ^ y y tf /L-<v
v
^ ^ y W ^ V
0~r?
5ir ^ n l
Y/~y5^
**y ^ y ^
t ? rf^np /'~'TV$(f*7* 's/^yl fw*.A iY ^ L y^2>
e^ f 3>
j yyj^cf^L^^
y^
y u>
( ^yr^2/^^
V- 0 / 4
Io ^
'
^ v *s~*6sp - ^yyi m )
*1^ < ^ ! r - ^ r p j - 2 ^ y ^ y y s n s ^ p
ASTROEHTERIC , Appetite
Food Habits
a
A AUAf
j
Thirst W
lf y ,vUt/u ___
cL '^ t.< ..U
Food Idiosyncrasy -/-&& */?_& '
' ~ Frequent Use of Cathartics q
Allergy o
j
Anorexia ^ N a u s e a Vomiting o Colic ^ 'Abdominal Pain 'Constipation Diarrhea
Abnormal Stools(?(Mucus, Pys, Blood, Parasites^ "Tarry" oj-i-'Clay-Colored" )
. CFV%)Hemorrhoids#,Eructation^HSpigastric Fulness'-'Flatulence 'Hemat eme sis Jaundice o
GENITOURINARY V ^ ^
Oo
tf
/f
l D^suria Pa:m Nycturia Hematuria Polyuria Edema of Face Retention Urgency (2^
i^fdriequency jti^nicfo-nctoinnumeennccee Eanuresis# Uurreetwhrnitt^is oo Lliibiiddioo/w Imp_otence Gonorrhea
Syphilis (`Nature and duration of treatment)` 9 '
<2J
5UR0PSYCHIATRIC
<w ^
Characteristic Behavior Pattern Emotional Instability Euphoria Depression
Compulsive Disorders Neurotic Traits Phohias Anxiety O Memory O
Insomnia41^ * Nervousness >' Excessive Dreairfi^f1^ Vertigo^/ Headache' Tremors <2?
Convulsions50 Paralysis p Parethesiasj/^ Anesthesia,^ visual Disturbance
Dysphagia^) A t a x i a L a s s i t u d e y
Stupor
Coma *
SKELETAL
?
Muscles > Atrophy
Joints Stiffness v//j
coness
Aches
_. /
Pams .
Pain /
Cramps1'
Weakness
Limitation of Motion
A/A-, - A __
PERSONAL HISTORY
Marital% Duration
Health of Partner
Miscarriages ' /
Domestic Situation
'
a i*
Children y Sex $ Duration of Pregnancy
A
UfeyC ^ h o *
l
Af
^ S S^i. Sin * W O a3id.nce,
y -y,
.
4'k
Addictionst Tea^Ji? Coffee^-/ > Alcohol^
Drugs O Medicines O Tobacco
Social Interestst Reading yy Afa>
Games
Amusements
S p o r t 7 7 % T ^ 7 hjJ?- P i J~ ^-Hobbies? ,. ^ '
/? V a c a t i n g
FAMILY HISTORY
' '' "
"Nervous Breakdown" 0
& { c l a ar AAu ~ f' fA AA rA./f - i a * Mental Disease ? P -- J, "ATcH ,, ^
Familial or Hereditary Disease p
Other Diseases
Father Mother
State of Health ?
Age
7%, 7 cr
6$
Cause of Death
PRESENT COMPLAINTS (Include duration, precipitating factors such as injury, or unusual industrial hazard, progression, and previous therapy.)
&>AjA ~ Y- y AyiA
f a J.
-rivt f4?
AA
^
-Ayy A-A
Crj A p
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6609100 -3ff
^
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. ^ ^ r - y - y y p y^^-y-
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y ^ ^ m y y y y&, y
Tf 'yy- ^
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y.^
iy > .'?^ 7 ^ , y ~ ^ v
f y ? ff
y s\
^
A
^O i*.
A
7
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J
A j?
A a " A A A ^ A 2 ^ >^ 2 >
^-yj
^
DAT:s $ il
%^
-<
PHYSICAL EXAMINATION
GENERAL APPEARANCE
Ht (jr>4
/ 9 T.
V R. 2-0
P. -7 0-
B.P. (Position) //j?- y g _
SKIN
1
LYMPH NODES - Epi trochlear 3 Axillary*^ Cervical <D Inguinal <5 Femoral &
HEAD - Skull
Hair S'GU-i^C -
Scalp
Eyes - Pupils; Sic
Equality --
En- q Ix-ophtha Irvos (p
Conjunctivas >
,
Contour O
Nystagmus & Sclerae &
Reaction to L. and A.
Strabismus 0 Corneas O
Vision; Acuity
Test Chart Rt. 20/ ' Lt. 20/
Failing Corrected: Rt. 20/ ^
Lt. 20/ rz0
Ophthalmoscopic: Fundi
/Discs
V Vessels
Ears - Hearing: Ingersoll TTatch Rt, W' 4'0
Lt. Tt>/0
Tuning Fork (256) r Air Conduction Rt.
Lt. Bone Conduction Rt. Lt.
' Otoscopic; 7 V&f/ Nose - Septum: Deviation ~]pQ
O
. Perforation
Mucus Membrane; Normal
Edema 0
Pallor P
Congestion
' Discharge (serous, mucus, purulent)
Turbinates; Normal t"'
Enlarged &
Obstruction
Mouth - Oral Hygiene;
Lips; Tremor pallor 5 Ulcerationz?Buccal Mucosa
Tongue; Pale ^ : Beefy
Clean Coated t/
Smooth
Atrophic
Fissured &
Deviation O
Tremor
Twitching <p
Teetht X Missing; / Non-restorable Carious Tooth; 0 Restorable Carious Tooth;
Py Pyorrhea; D Dead Tooth; B Bridge; P Plate; C Crown; F Filling.
*
LIGHT
89 i
LEFT
32
12 31
13
,,
2* 3 #
1 WQpr
" - p y Uppei
5 - 14 15
RIGHT
Gums; Color Consistency Recession Inflammation Pyorrhea Bleeding Lead Line (Exact Description and Location)
Throat; Pharynx 2
y # Lymphoid Tissue 0 Post Nasal Discharge
Tonsils;^Size NECK
'/h Crypts >
Exudate r
Scarrs Tvumioorrs Cysts Vessels - Stasis Engorgement Pulsation Thrill Bruit
Trachea - Midline
Deviation Thyroid Gland Q
a
CHSEiSzTe LUNGS
Respiratory Movement 2 ^
Resonance 'istf1/
Shape
Fremitus; Tactile in Breath Sounds 'ytyns^
Expansion >u<n
Vocal <Zt^rG Adventitious Sounds 5
HEART
q ^ (Lus
Sizis;
R.S.^JU7* R.C.,Dd,.7!>* Ratee; Before ExerciseI'l^2 Min. After 50 Hops &
h* /Precordial Thrill & Shock Q
Sounds; Rhythm
ilMj/
Intensity
0
ABDOMEN
Friction Rub
Murmurs o
Contour
Hernia Organs
J Fanniculus Masses
iVy.
Tenderness ^
Movement Superficial Veins Spasm
P
(P /
T
/ITALIA Discharge
Scrotum testicles
5 t
e?
C?
Chancre
ANUS AND RECTUM
Hemorrhoidst External Q
_ Internal 0
Scar O
Ulcer, O #
Phimosis 6 Fissure 3
Deformity Atr o p h y Movements^Edema^?Cyanosis^ 1Scars Varicose Veins'^Ulcers Z?
JOINTS
Clubbed Fingersrp Toes 3 Hallux Valgus & Flat Foot 2 Epidermophytosis 3
SPINS Deformity p Sacroiliacs
Limitation of Motion ^Tenderness ? Muscle Spasm ^
NEUROLOGICAL. EXAMINATION
CRANIAL NERVES
'`
I. II, Vision Ophthalmoscopic III. IV.
V. ^ VII, ^ VIII. 1 / IX. / X.
(Carotid Sinus)
^
Vl^^Pupdl ^jSOM) XI. XII.
SENSORY FUNCTION
.
Superficial; Tactile
-j Pain
Temperature
Vibratory (128)
REFLEXES ; Indicate response; 0, not elicited; 1, sluggish; 2, active; 3, exaggerated.
Deep
Rt. Lt.
3iceps Triceps Radial Wrist
(
r
/
!f y
i
! Ulnar
Patellar 1 Achilles 11 i
Rt. /
V"
Lt. Superficial
Rt.
1 JUpper Lat. Abdomen
"> j Lower Lat. Abdomen i Cremasteric
/ /
Plantar
/
j Corneal
/
Lt /
(
/ (
MOTOR FUNCTION
~
Muscle Strength Wfone -f~ Myoedema p Gait ^^utpxtensor Weakness O Wrists ^
Ankles 2
Paralysis 5
Fibrillary Twitching O
Clonus < 3
Position Sense; Ataxia?Romberg9Heel-Knee Finger-Nose Past Pointing Astereognosis
MENTAL STATE Attitude Judgment
'General Behavior^i'^i2'C< Cooperation
Intelligence --yL
,
Insight -f--
Attention 4--'
Personality Type; Average Normal Neurotic Hysterical Hypochondriacal Rigid Paranoid Extraverted Introverted Constitutional Psychopathic Epileptic
Emotional Reaction; Well Adjusted Irritable Depressed Defensive Agitated Indifferent Oversensitive Suspicious Compulsive Elated (Euphoric)
Disturbed Consciousness; Disorientation p
Stupor
Q
Convulsions
SPECIAL TESTS AND EXAMINATIONS > 4^ ^
SUMMARY AND INTERPRETATION
Delusions 0 Delirium
-- f~2>P Y
Memory Defect 6 tC/oUmiuaa q
-- vA '~^~~7
DIAGNOSTIC IMPRESSION
M,D, Signature oJ7 Staminer