Document zmXaBzOQpKmz99jVqBwQmB23

r 'I-' F O R M 191 S m m b b i ,C m m PLEASE BEFER TO FILE1NO. March 24th,1944 JJH -- Re: James A.Williams, Birmingham,Ala. Plant -- Dr. Robert A. Kehoe, University of Cincinnati, College of Medicine, Eden Avenue, Cincinnati 19, Ohio. Dear Dr. Kehoe: I thank you very much for your letter of March 21st, 1944 enclosing report of your examination of James A. Williams, and am glad to know that you found no evidence of lead poisoning. Very truly yours JJB:CM KF 0016284 FORM 1SI INCORPORATED IN KENTU CKY T l o t c u ^ v c r r r j j pXjT Fv ST r , March 20th, 1944 PLEASE REFER TO FILE NO. 3M13 -- RE: Birmingham,Ala. Plant -- Dr. Robert A. Kehoe, University of Cincinnati, College of Medicine, Eden Avenue, Cincinnati 19, Ohio. Dear Dr. Kehoe: We haven't heard anything further from f l H ^ W a n d I am just wondering if he has presented himself to you for further examination or if you have heard anything further from Dr. H. P. Hart. Awaiting to hear from you, I am Very truly yours, JJ H :CM J. Jos. Hettinger K F 0016285 ) 'zXi-tSL&'".PKiSK-<t" \f>r u ''iarch 21 l^Ml Mr. J. Joseph Hettinger Standard Oil Company (Kentucky) Louisville, Kentucky Dear Mr. Hettinger: In re Birmingham Plant I regret very m u c h the delays associated with the r e port on the man refer r e d to, but at long last, we have obtained the necessary samples from Doctor Hart, and have completed the job. I a m g lad we waited to check the original analytical results, for by this means we have eliminated any question that might otherwise have remained in doubt. I enclose h e r ewith the complete report, together 'with a summary of the case made by ray associate, Doctor H e n r y Ryder. This, summary is wholly adequate and after reviewing all the available facts I am in full agree m ent viith it. I trust that we shall have given you the information you required for the proper disposition of this matter. Very truly yours, RAKsKK Enc. R o b e r t A. "Kehoe D. K k 0016286 February 5, I9I44. HHNMHfc negro male, 50* married 22 Penn ive., So., Massillon, Ohio; telephone - sister, 8039, Massillon Family physician - M. B. Stilwell, 612 First Bat1! Bank Bldg., now in A.U.S. " Referred by J. J. Hettinger, Standard Oil Co* of Iy., Louisville, Ky, Employer - Standard Oil of Ky.; Birmingham, Ala, plant* Current Complaint Generalised aches, and weakness, 1J months. Occupational History . Worked for 21*. years for Standard Oil of Kentucky, In Birmingham plant. He states that when gasoline was first colored., he did the blending of the color (red or blue) In the gas. He aid this for a year or longer. Following this he did tae loading, unloading, compounding and mixing. He says he has inadvertently swallowed gasoline, when he was taking the cap off the tank cars, and gasoline has spouted into his eyes, face, nose and mouth, This nauseated him each time, but he bad no other effects. His most severe nausea followed the episode where he got stuck in the manhole trying to rescue a fellow worker. He states he was unconscious some period of time, and when he "found himself" he was vomiting. In 19lj.l-2 (the exact time escapes him), he was working one day when ha got a ketch In his neck. He continued working, and that night after he got home he was seised with a sudden pain, he localizes to the apex of his heart, which was an Oppressive sensation, This pain Was very severe, and was associated with shortness of breath* He could not lie down because it made the pain worse. He could not take a deep breath, because that would make the pain worse; there was no apparent orthophoea. He went to Dr, W. R, Ward, who X-rayed his heart, told him It was "too snail,'! and "something was pressing on his heart.'1 He was told to stop wojk# and patient returned to work after I4.-5 days, before he got doctor's permission. This pain nearly disappeared, although he still occasionally gets a cramping pain in this area, which comes only when he does some exertion. Stopping the exertion relieves the cramping, but it takes hours for it; to go away completely. This pain does not always come with. a given amount of exertion, and for periods of months he may be free from it despite exertion. He does not consider this episode part of his present Illness, which he states began in the spring of 19^2, with the principal complaint of stiffness In his joints, and inability to raxse his arms and legs, not from weakness but from pain. In November of 1942 he was off work for 7 days because of an acute attack of this pain. N 0016287 * a f^ sr weeliary~>f He went from one doctor to another, trying to get relief, h 3 went to two doctors for the original attack in 1941-42 and from time to time as he felt worse and worse he went from on doctor to another. ' In January 1943 he *30t ao nervous he eouidnlt keep himself together.n At times he would be working, and get iind of jittery, feel weak, and breathless, The pain in his joints was also bothering him; sometimes he would even have to have help to get his clothes on. When ha quit work on the advice of Dr* C. H. Wattersoh he was; sene to the'government hospital, They requested lumbar puncture, which the patient refused* He says they did him no good at all. Then his brother in-Massilion sent for him to try to help him, and he das been there since. In Massillon he has been under the care of Drs. Hart, Stillwell, and Mallory. They have not helped him either* Dr. Mallory gave him no opinion as to the nature of his illness. Dn. Hart said he found ^definite evidence of lead poisoning in his blood.1' He was the first doctor who suggested this* Several of the other doctors said it could have been lead poisoning but never did say that It was. The patient got no opinion from 2-, Stillwell. He has noted constipation ever since he first got sick. This consists of feeling like he wanted to move his bowels, but passing only gas unless he takes a cathartic. He originally, had considerable distress in his belly, such that he couldn't keep ills belt buttoned, and having to unbutton his pants when he sat down. This has gone away. Se still has to take varied catharsis In order to move his bowels* His incapacitation now consists of pain and stiffness in his joints, and ''nervousness." Pas^JIlstpry ' Born in Florida. Lived one-half of life in Alabama, the other half in the South, Sever ill in travels before the present Illness. Does not recall childhood disease?, infectious diseases or metabolic diseases. Haceived vaccination and inoculation in World Itfar. . Was in Government Hospital at fuskege in 1933* In War saw no active service. (He was shipped back to this country by mistake with a group of sick men.) Teeth out this last year, since June, without relief. Ho injuries or accidents. Family History Father died at 72, ? cause. Mother died at 60+, ? cause. One brother and two sisters now living and well, except some infants, and one sister who died of pneumonia, and one brother killed in accident. p- February5*l^Wl- fe infectious* metabolic, allergic or nervous familial diseases* ' 1 - Mari.ta3JMorz. ` Duration 15 years. Wife I4.5, living and well, and working. Nine children} 6 living and well; one died at childbirth, one "scared death by :a cat", and one "died with a. fever." Habits - Smokes 20 cigarets per week. So alcohol. Drugs cathartics only, now; has taken much on doctor's advice. Systemic History General-Usual weight was 22J lb. before illness. Has "fallen off badly" to l80 lb. Strength poor, endurance gone. Never had chills and fever. Has had anorexia since start of illness. Skin - negative Head - Headaches occasionally, entire, not often now. Had a severe headache for 5 uays, January 19i0. Waving of environment when he is tired; change in position relieves it. So syncope. Eyes - Occasional burning. Poor vision, with present illness. Ears - Hearing Ok. No discharge. Nose - negative Mouth - No lesions of tongue or mucous membrane. Teeth out on doctor's request. Speaks of dentist finding extra amounts of bone in his jaws on removal of his teeth. Throat -No soreness* Neck - No swelling or tenderness. . C.R. - No cough. Shortness of breath with exertion. Pain - see, present illness. G.X. - Appetite poor. Can't eat well without teeth. No food intolerance. N0 pain in stomach. Bowels move with catharsis. No piles or hernia, G.U. - Rare nocturia. No frequency or aysuria. Venereal disasse - serology repeatedly negative. Extremities - No numbness or tingling. Arthralgias - present illness. . 'Physical E xamlnation A worried, moderately obese negro not acutely ill, complaining about his joints, who is correctly oriented, and anxious. Height 5 13 - 3 A "# weight 191-3Ai- lb., temperature cj6,Q, pulse 78# respirations 21, blood pressure U 4J4./9O (HAS), grip right 55, left 35 right handed. Skin - No lesions or excoriations. k 0016289 February 5, 1944 Head - Mo masses or tenderness* . Eyes - Pupils, J mm, equal and round, slightly irregular, .^qpd./:r(Sactioni:po light'.and; aeqe^fod^tiio,^# directly and consensually. Sclera negative. Conjunctiva slightly injected. Normal extrinsic ocular movement. No nystagmus. Eye grounds - vascular - slight arteriola narrowing; discs good color, flat; retina - no lesions seen. Ears - Both right and loft - Hinne positive, Schwahach negative, drums normal, Weber not laterallzed. Nose - Mucous membrane normal. No deviation or obstruction* Mouth - Lip normal. Mucous membrane normal. Gums - On lateral aspects alveolar processes both maxilla are hard irregular rougheninga, a pp&rently attached to bone* The skin over them is tender. Sums are well healed. The spotchy negroid pigmentation is present over lingual and buccal surfaces of gums. Throat -Tonsils and pharynx slightly injected. Adenopathy - negative Thyroid -no Chest - Symmetrical, somewhat barrel-shaped. Lungs clear anteriorly and posteriorly to percussion and auscultation, Bre&sts-negatiVe Heart - Sinus rhythm. Sounds normal, A s * Ps not accentuated*' PMI not felt. Heart not enlarged to percussion. Bruits soft (grade 1} systolic over left sternal border.' No gallops, thrills or rubs, Abdomen-Mild aortic tenderness. No masses felt. Liver is of normal sis. Spleen not felt* Kidneys negative. No hernia. Genitalia - No scars. Normal. Rectal -Some prostatic tenderness; prostate is slightly boggy and enlarged. No rectal masses. Extremities - No atrophies or deformities. He voluntarily restricts circumduction of shoulders, and head or neck, referring pain to entire shoulder joint, and spine of C7. There is no local tenderness to palpation or percussion. There is some crepitus of both knees, and slight pain or pressure over metatarsals. Neurological- Muscle power is somewhat weakened; apparently he is cautious because of pain. Sensation normal to pin prick and cotton wool throughout. No tremor. No ataxia. Finger to nose, and Romberg negative. Reflexes - BJ TJ WJ HP Hoff. s ++ ++ ++ 0 k ++ ++ ++ 0 Abd. U. L, Crem. KJ AJ Plantar H 0 0 + ++ 4 k 0 0 + ++ l' Lab Work Urine - Yellow, clear, specific gravity 1.028, albumin negative, sugar negative, centrifuged sediment - much mucous; rare white blood cells and red blood cells per low power field. 4 5- February 5 l^Mi- Blood - Hemoglobin lit-.6 gms ($0$), WBC 3*?00 BBC h>?20,000 Stiflpling 0, differential - 'Poly*. 3^* Band. 3, ijympii*. 5*4-# 'Mbn* 3# Eosn*. 2*5i Babb...-1*.5 ` ' >' Henry W. Ryder.,. M.B., J=&2Lgss$isfi&L2a (27-i4). . Examination of the chest shows the greatest cardiac width to be II4. cm. and the thoracic width 30*5 cm. The aorta is elongated but not dilated. The lungs and pleura are essentially negative. The thoracic skeleton is negative. Examination of both shoulders shows roughening in the acromi oelavibular joints which Is probably a manifestation of arthritis. The shoulder joints themselves are negative. The surrounding soft parts appear normal. Examination of the cervical spine shows no gross abnormalities. The presence of arthritis or cervical rib is not shown. Examination of the upper molar areas shows multiple small root fragments in these areas* Identification of the areas will need to be done more accurately if and when removal of these fragments is done. Lead Analyses 2- 5-I4J4. Brine 0.02 mg. Pb/Liter ' Blood 0.12 (spectrograph!c), 0*10 (dithizone) mg. Pb/100 grams 3- 13-141- Urine 0. Olp mg. Pb/Liter Blood 0.035 (spectrographic), 0.03 (dithizone) mg. Pb/lQO grams Electrocardiogr am (2-5-44-) Normal sinus rhythm, rate 66. P waves upright all leads. PR interval O.Oo sec. Left axis deviation. T 1,3,4 upright, T3 inverted. No ST segment deviation. Serology (2-15-44- Holmes) Reported negative. Summary of findings on Oil Company of Kentucky emP^7e oi> Standard information on the patient was obtained from the patient, and from company records which Mr* Hettinger considered his complete file on the patient* He apparently has been employed by the Standard Oil Company of Kentucky for 2i^ years. His principal occupation appears to have been the operation of pumps used in the transfer of gasoline from tank cars and trucks to storage tanks, curing this he has had repeated exposure to gasoline and has been nauseated from this exposure on repeated occasions. Once 8 years ago he was acutely narcotized from"overexposure. E had no symptoms following this overexposure suggestive of acute tetraethyl lead intoxication. He was asymptomatic until 2 or J years ago when he began to suffer from pain localized to the apex of his heart which has continued to the present: time. This pain is not related to exertion. In the spring of l$k2. he began to suffer from an Illness characterized by pain and stiffness in M s shoulders and hips, nervousness, anorexia.., weakness and breathlessness. He had no satisfactory relief from these symptoms despite the care of a numbsr of physicians. Because of these symptoms he was considex*ed completely disabled In January of aiK* since that time has done no work, receiving payments from the company on their disability plan. He was referred to us for examination because of bhe opinion expressed by one of his medical advisors that there was some evidence of lead poisoning. A review of his systems revealed in addition to the above symptoms that he has lost lj.Q pounds In weight. He had no significant cerebral symptoms. His teeth had been removed on hia physician's advice. He had no angina or breathlessness. He had not suffered from abdominal pain. He was habituated to the use of cathartics to move his bowels, H@ had had no dysaesthesias, muscular pain or palsies suggestive of sensory or motor neuritis. On physical examination he appeared anxious and concerned. He was $0 pounds overweight, H had slight diastolic hypertension, and his eye grounds showed some arteriola narrowing. The alveolar margin of his upper jaw showed excess rough bone, over which the gums ware tender* His heart and lungs were normal. His abdomen was' not remarkable. H had some prostatic enlargement, softness and tenderness. He voluntarily restricted the motion of his shoulders and upper spine, although he had no local tenderness. His muscles appeared to be somewhat weak uniformly, but there was no evidence of muscular atrophy. There were no abnormal neurological signs, except for absent abdominal reflexes. He 0016292 * Laboratory exasdnatlons showed no urinary abnormalities, He had no anemia or stippling of his red cells. The serology was negative. The urine lead levels were within normal limits on two separate occasions. The blood lead was elevated on the first examination, but was within the li.-J.ta of normal on a repeated examination. The ij. lead electrocardiogram was normal. The heart and lungs were normal to X-ray examination. He had minimal evidence of arthritis of the acromio-cl&vicular joints to X-ray examination, 'her were multiple small root ^fragments in his upper molar areas by X-ray examination. * Comment This man has had evidence of repeated xalld gasoline intoxication, with recovery on each occasion without residua. H has had no apparent overexposure to tetraethyl lead, and no symptoms or signs of illness that would have resulted if he had had overexposure, Ih Illness that has led to his disability appears to have been a mild case of hypertrophic arteritis* accentuated by anxious concern. There is no evidence he la suffering from an organic disease of his central nervoup system. He has had no symptoms or signs that we would interpret as being due to lead intoxication, and no evidence of overexposure to lean in any form. His anorexia and constipation appear to be due to tender gums because of retained root fragments, and to haoitual catharsis. His blood lead was apparently elevated on a single examination. A repeat examination 6 weeks later was normal. This elevated level is considered to be a sampling error and therefore an artefact for tee following reasons (1) the urine lead was not elevated at the same time; (2) he had no history of abnormal leaa exposure; (5) he had no .symptoms of signs of lead intoxication; (ij.) if he had lead exposure during his job, the blood lead levels would soon be normal after a year,s absence from his job, no matter the extent of his exposure; (5j) he is suffering from a. non-febrlle disorder not related to lead intoxication and which has no known effect on the metabolism of lead, and. (6) the repeat blood lead examination was normal. Diagnosis- Psychoneurosis, anxiety hysteria Hypertrophic arthritis, mild retained root fragments with soreness of gums and anorexia Cathartic colitis Essential hypertension, mild, asymptomatic . No evidence of lead poisoning Henry if. iiyder, K.D.