Document zo0bm08X9vJpbp60577xmNKaa

'^ A T M g ? J T o r OltQAMFC L jU 3 |T T B A g T H V L ) INTOXICATION ' y m i c a l c iu m im o d m u v m s s m .it; ( S T H Y -t;;?;^ t ^ M l^ X S Y I lA A C & T iC A C ID ) (S O T A ) jy ............................. ......................... _.. --.arl V. : ".lis r n ille r , M* D , , J a e b Cfeolifck, C h. a. Hob*Pt v. *\eh<>e, .a . T h s h b n efieial Ifeete tnsdeip&ted., < k ^ p m i)r **U*a<t to acm e e x te n t fr o m =he a d m in is tr a tio n ut CDTA (e th y le n e d t e m ia e t e t r a c c e t ie a c id } in in^rpanic lead poisoning prompted it * u s e is* 111 treatm ent d th ree c&sec oi y re s o le le a d o o iso n jn g e*n re c e n tly m '.^ana-ma. . . m a n y y e a r s p e te o n in g c* fchlp ty p e h a s b e e n c o n fin e d a l m o s t mi* r o ly to .rk m e n in th e :faU' -4ev.m in d u a d ry e n g a g e d i a c lo a n in g s to r a g e 'b a i .nave co n tain ed le a d e d g neaU n*. T he hamrd of o rg a n ic le a d p o iso n in g m th is o c cu p a tio n re sid e p r im a r ily in th e sia d g e w hich fo rm s -&noaili th e w a te r b o tto m u n d e rly in g th e g a s o lin e its a s to r a g e ta n k , in a e d itio n to va ^-/tag /{m o u n ts o f gasc-line* o u c h s lu d g e c o n ta in m a il o u a n titia ' I d e c o m p o s itio n p ro d u ct of t e t r a e t h y l lo a d , -and m a y c o n ta in t e t r a e t h y l le a d Ituolf in coacencrati*>s.s which o c ca sio n a lly , reach c t sv a ex ce e d 0 .1 per cen t. T h is Judge m ay he the so u r ce o f d an gerou s c -seat ration# of lea d in t.he a tm o s p h e r e w ith in th a tan k u n d e r o r d in a r y co n d itio n o f te m p e r a tu r e If w o rk m e n a r e e x p o s e d to- s u c h c o n ta m in a te d a t m o s p h e r e w ith o u t s u i t a b l e p ro se c tio n &r s u ffic ie n t p erio d # o f t im e a c u te i l l n e s s w ill r e s u lt . '`h e le n g th of t i m e r e q u i r e d f o r s u c h e x p o s u r e to g iv e r i s e to s e r i o u s lo a d p o is o n in g w ill v a r y w ith th e c o n c e n tr a tio n o te tr a e t h y l le a d v a p o r in th e u ir h a t it i* p o s s i b l e to b r e a t h e in a n d a b s o r b a le t h a l d o s e o>f t e t r a e t h y l le a d In h a lf a n h o u r. U n d er le a s s e v e r e c o n d itio n s , a few hour of e x p o s u r e on one Aay v r n a n u m b er > .^ u c fe a a iv e day; m a y ind uce a s e r io u s o r fa ta l illn e a * . f rom the K etterin g L a b o ra to ry tn th e .D epartm ent of P re v e n tiv e M edicine and Industrial H ealth, C ollege of M edicine, U niversity of C incinnati, C incinnati ih e rap id ity and sev erity of th e o n set of o rg an ic lead intoxication ire d i r e c t l y .re la te d to th e i n t e n s ity a n d d u r a tio n ;>l th e e x p o s u r e , in th e e a r l y stage o f s e v e r e c a s e s , a n d a t a l l t i m e s in th o s e i a w h ic h th e e x p o s u r e h a a '.~'Csn .m inim al, the sy m p to m s m ay be ill-d efin ed , hut they 300a develop into a re m a rk a b ly c h a ra c te ris tic p a tte rn in the s a v e r# case. Th# interval of tim e w hich e la p s e s between e x p o su re and th e onset of illn e s s m ay v a ry fro m s e v e ra l h o u r s t<> a p e r i o d o f s e v e r a l, d a y s la th e se v e r e c a s e s , th e s e v e r i t y o f the e x p o su re am i the rM .titan* Illn e s s ten d in g to be in v e rs e ly re la te d to th e ra p id ity o i iM jsei. 'h s n th e e x p o s e r e h a s c o n tin u e d i n t e r m i t t e n t l y f o r s o m e tim e a t a low level of intenetiy, recognisable sym ptom s m ay he delayed fo r a p erio d of z'xct wr t h r e e w e ek s 'hen th e e x p o s u r e h a s a w n s lig h t a n d of s h o r t d u r a t i o n , a tru e clin ic al p ic tu re m ay n et develop, o r m ay be d ifficu lt to d e te c t o r to d Lfferoe stiate fro m an an x iety s ta te , p a rtic u la rly in m en w hose e x p o su re can p ro p erly be re g a rd ed to have been negligible but yet ha been had under conditions w hich th e w orkm an h im se lf cannot d iffe re n tia te fro m th o se w hich have cau sed s e rio u s o r p o ssib ly fa ta l illn e s s, la m ild c a s e s th a t re s u lt fro m $ singla or b rie f p e rio d of e x p o su re , the sy m p to m s u su ally r e g r e s s ra p id ly , and re c o v e ry la c o m p le te w ithin a week, o r a .. In th e m o re s e r io u s c a s e s th e illn e s s p ro g re s s e s ra p id ly tow ard a. s ta te o f a cu te m en ta l d istru n a n c e , c h a r a c te ris e d by d e liriu m , m a n ia , co n v u lsiv e se ta u re s an d c o m a. Visual and a u d ito ry h a llu c in a tio n s a r e u s u a lly p r e s e n t in th e s e s e v e r e case:, ,,acid perio d s m ay p re c ed e o r follow th e se bout* of m ania and d e liriu m , and a t th is tim e th e patient is u sually d e p re ssed and a p ath etic. Tielapses a re com m only o b se rv e d , nUhottgh sig n s pointing to ev en tu al re c o v e ry a r e u su ally a p p a re n t w ithin a w eek o r 0 afte r the o n set of the a cu te illn e s s. P ro g n o sis a s to life ir -ihcrtild *>e g u a r d e d d u r in g be e a r l y stag s m th o s e c a s e s e sd ii'to tin g s e v e r e m e n ta l d e r a n g e m e n t. ''h a .?re|!soi i r r e c o v e r y i s e x c e l l e n t e a c * th e c r i t i c a l s ta g e h a s b e e n p a s s e d , a n d c o m p le te r * to r a t i o n *.f p h y s ic a l a n d m e n ia l a c u itie s occurs u su ally w sthln tb s p eriod of fo u r to ten week. bay a tte m p t to c la s s if y th e U ln e a s in o n e c a te g o r y o r &aothr. o r to attem pt to r e l a t e th e effectiv en ess of an y sp ecial m ed icatio n o r th e ra p e u tic p ro c e d u re , with re s p e c t to th e s e s y m p to m s c o n trib u te l i t t l e to ma u n d e r s ta n d in g o f th e c l i n i c a l a y ad rot?* s i n c e t h e s e p a tie n t a t s o m e t i m e d u r in g t h e i r i l l n e s s e x h ib it th e azures ill rouueatiy p ass jm one he o th er o r even fro m elatxvoly n o r m a l m e n ta l i.ia tu to o?te o f g r o s s d is tu r b a n c e w ith a m a s ia g r* o ld iiy . 2'io m e n ta l diitoar.p&nce m a y s u b s id e a t a n y tim e , w ith o r w ith ou t treatm ent. .-..a tank c l e a n u p o p e r a t i o n s th a t, ?e$ttlfcd in th e a c u t e p o is o n in g o f a n u m b e r' .s rlo n e a In to in a m a e x te n d e d o v e r a p e r io d o f tw o w e e k s . >ith ugh a e v a r a i o f th e w o r k m e n c o m p la in e d o f in s o m n ia b a d d r e a m s , re sties-se&s a n d lo s s o f a p p e tite a f te r th e th ir d d a y of w o rk in th e tanks* a ll c o n tin u e d t o s ta y -o i to o jc:>u u n til to c le a n in g o p e r a t i o n s w e r e d is c o n tin u e d whan 3 m en failed to re p o rt to r w ork. One of th o se m en w as adm itted to the h o sp ita l too follow ing day end d ied two days la te r, b p o th er of th e se w o rk m en , who had been su b jected to to e g re a te s t s e v e rity of exposure w as se e n by a p h y s ic ia n on th e d a y th e ta n k c le a n in g w o rk w as s t oppeyi&ad w as a d m itte d to a lo cal h o sp ital fo r observ& tion and tre a tm e n t. At th at tim e h e seem ed to be co n fu sed and s e n ^ ita o & to a * end c o m p la in e d o f n a u s e a , a b d o m in a l paint a n d zonaltin g . .,&ter h e b e c a m e r# # tle * a a n d w a s tm a b ie to s le e p . lie w a s d iso rien ted and highly ag itated , and a t tim e s fe a rfu l and d e p re sse d , .ie v o m ite d s e v e r a l tim a &n c o m p la in e d s> ps-n in th e r ig h t n g u tn a i x-egiwu. T h e r e wa.e as? d isstu rs& n ce in Ispwel mcti<m a d th e a p p e ti te w a s g o o d . ''h y a i c a i e x a m io a tto f t t th is t i m a ..H sclo sad no iig n i f c a n t fin d in g w ith che e<iceptk>n. -d. a r t e r i a l h y p o te n s io n . T h e b o d y t e m p e r a t u r e # **8.<*. th e p u l s e -i-0, th e -.lo a d p r e s s u r e ^ /5 3 , th e reepiratic* 24 and reg alar? th e re w ere no pulm onary ralee no a d o ra ita a i to n d a m e # , a p ea tn . o r rig id ity %r* no s ig n if ic a n t a l t e r a t i o n - .?ei l e x e s . Ti fo llo w in g d a y th e b lo o d p r e t s u r e oOfhQ* ;nU 7 8 , ye?sr,uon6 >15. th is pnfcienf w a s r e s tv r .jn c d in h e i w ith a n k le -*rrap a n d w r i a t b a n d s . . n "o n iia a a i to bb and a g ita te d , te.lking irra tio a a ily and m o ro w tosa c .;yi:n;.i-;>a.siy. lsftxao .i! ri-sdb'stb -n, '-.vas in g m -ai teas* of b e in g Misionad y i l l t d a n d oras h ig h ly su.pieiisu* > aH d o c t o r s a n d n u r s e s , "he co n d itio n td th is m a n o s m o s t c r itic a l f o r th e en su in g a v a ra l d b y a . h e v $ irrat.vb.nai arci th e v ic tim <sf h a l l u c i n a t i o n s . f ie c r i e d o u t -tc n-s *icm ally* s tr u g g le d coatim joutly a g ain st the re stra in in g trap , m o v ed hin h e a d an d e y e s c o n sta n tly a n d a s c a m v io le n t a n d a b u siv e w ithout a p p a re n t p rev o catio n . fe cam ple *ed re p e a te d ly of th e ta s te of g a so lin e an d o the ^ asatio n of httm i d isc o m fo rt in h is th ro a t. " o r th e f i r s t t i m e , <? th e tw e lfth d $y a f t e r h is a d m is s io n t o th e hospital., he be an to have fleetin g p erio d o lu c id ity d u rin g which he recognise-, hi m o th e r s a d b r o th e r . T o w e v e r, Ha b e c a m e a g ita te d re a d ily , ta lk e d lo u d ly end irra tio n a lly and w as alw ay s in f e a r of being k ille d . A tew day# la te r he Hejja in e x h ib it lo n g e r p e rio d s c{ ra tio n a l b e h a v io r, w hen h e w ould a n s w e r 'rv-tions r e a d i l y ;v .d s e n s ib ly , .jnci fo llo w th e i n s t r u c t i o n s of th e n u r s e a n d o rd e rly . F * e m th l# ' ti m <.?a, A sid e f r o m s h o r t p e r i o d s o f .gitatv-ss a n d ap p reh ea& itm , big d a ily Jm p rd v m etit w as a p p a re n t to v ry o n . T o vma .llovred to ?i6 i s s c h a ir , arid a ll p h y s ic a l r e s tr a in t v m a ,'om ovod. T-. nival sc dm: u?CM*led w ith o u t h iter r u p tiim , Vat c o n sta n t a tten d a n c e ay a m a ie r.urae -m continued in o rd e r to a v e rt any act# ai violence o r irra tio n a lity w hich m ight 4 ev eto 9 out of re la p s . Vieil re la p se s com m only o c c u r in su ch c a s e s and must, a lw a y s h e g u a r d e d %>qAinAt. l a b o r a t o r y Va ta v-dn aacftiftwlsn) /' fiaigras - ATC 6, i3 0 , dOO. H u ' . , .. (..a iiii), W 3C - , T .d ..Viffererstia i : "Uy m o r pdo-mi c le a r i-:eutr>phili .-.ym phocytes ..'o'icytes Y dsm ophiles 3 -, abnorm ality of eryth rocytes, no punctate ' o.sophiua. C o n g u iv tio n iim a 4 m in u te s , 33 saa-tmd ^ r o th r o m h ia C on ten t tOOf* '; fragility T e s t Iie m o ly s i b eg in s a t 0.-*4 4, c o m p le te a t 0 . 34 :- Aloud Chemiefcsry tTyea f-fttregaa C lucese C alc fvtm Tnorg&mc Phosphate Aig. 'er 00 m l. ; -s ~ .0 0 > 4 riaalyois ' pecimen d e e r , a ra u tr, cp. gr* . . 0 2 3 , 5 . 5 , a l b u m n n e g a tiv e , s u g a r n e g a tiv e , M ic r o s c o p ic : JTo r e d c e ll a , no c a s ts , few leu co cy tes and ep ith elial c e lls. I^um roti8 te s ts w e re c a r r ie d n u t in th is c a s e a s w ell a* in a ll therm o t th e gro u p and &ll of th e r e s u lt s w e r e w ith in th e n o r m a l r a n g e . . fh e a s e a s d e s c r ib e d wa on a t s e v e r a i w hssh v a r ie d m ; u t d * n nnd in d eg ree am ong th em selv es. The e a rly fatal outcom e of one man*s illn e ss had s e r v e d to d e s s e a s t r s t e th e grav i? c r & c te r --n ih a e r ^ o s u r . a n d e v e r y r e a s o n p r e s e n te d i t s e l f f o r ?&kls$ u s e -if a n y th e r a p y w h ich o ffe re d h o p e of b e n e iit. bithiopropehol th e ra p y had b een em ployed in a few seat*, p re v io u sly , ad had T een w*U t o l e r a t e d , '.vhile c a lc iu m <U*c<H;mt v e r s o a a t e h a d o e e n u s e d w ith s e e ra m g ly b e n e fic ia l ofte c ta by o th e r s in -cas-es o f i*argatuc le a d p o iso n in g . The la t t e r w a s m a d e available' In- lim ite d m o u n t, and ao w a s e m p lo y e d to {.hat e x te n t, w h ile th e f o r m e r , ala , w&ss g lv e a m ft fe w in s ta n c e . Thru Iraxn .a g r o u p o f aisc c r i t i c a l l y ill p& iidniij 't c ; o s,e le c te d i o r . is -o a tm e a l >?iUi c a lc iu m a l o d i u m v o rsessA tu . C -o m p ro h u m u v s 4 ;.n e < u la k e r a i d r y i o a a {rot* u o d v tk ite c e i l a n d d i f f e r e n t i a l c o a ia ta , K b , h e m a t o c r i t , b le e d in g , v lo itm g a n u p r o th r a m b in tim e , u rx a a ly ri* {l.-.cladi'ng u ro b ilin o g e n ), .serum calcurn, y & a a s h o re s , to ta l s e r u m y r c L n n , ; / 0 r a t i o , g lu c o s e , u r e e N, i -t s p ro te in nU rcgen, b iliru b in ) ^vere c u rrie d a a i p ri r to , d u rin g end a fte r tr e a tm e a t xn e a c h c a s e , I n c r e s u l t * <?C tixms te c t o w * ra w ith in n o r m a l r a n g e m e v e r y in s ta n c e . C z lc h itn A*Ss o d iu m vTjciii?iv*ue. w a s giver in d a ily in tr a v e n o u s dofees of g ra m p e r th ir ty pounds of body w eig h t. T he a d m in is tra tio n of the e m p o u n d g a v e r ; e to a> d e m o n s t r i f l e n tu w * ri adxecta a t *,y t i m e . ;.-a m p le cd T-vx b lo o d a n d u r i n e u a l l o f th e p a tie n ts w e r e o b ta in e d fo r a n a ly s is f o r le a d ., d iffic u ltie s w e re e n c o u n te re d 'in c a r ry in g out a p ro g ra m of sam p lin g , b e c a u se of th e d is ta n c e fro m the s o u rc e of -supply in th e l a b o r a t o r y xn C in c in n a ti, .m d w h ile th e s e a n d e t h e r d if f ic u ltie s in tr o d u c e d d is c re p a n c ie s into th e p k a o rv a tio n a, co n sid ers, hi n u m b e rs os d a ta w e re b ra in e d u l t i m a t e l y , a n d a r e iiiu at r a t e d ;-lvw by Ud iv id u a l r a e . * -.-.sipp lied f o r c lin ic h i t r i a l > y T f k e r L a b r a le .p u s , .,,.c. , L o s A n g e le s , 'C a l i i o m &TM &NT O F -A C tIT g TSTJkV C T H Y L .LOOT IN T O JC A rIO N C ase - Age intense in term itten t exposure, eve re paiseriing. ' 'ieea by p h y sician n ite r a p erio d of about 3 w eeks pent w orking in and aro u n d tan k a. In s e m i s tu p o r , c o m p la in in g o n a u s e a a n d v o m itin g . D ate 1953 Tim e 3 loo4 Aig . P b T e r 500 G ra m bpectregrapfaic -d th iso n e i rmo: V-g. ~h /-'e y t ; i i a r S -S th r o u g h -3 >3 - T r e a tm e n t w ith D itb io p ro p a n u l (B A L ) * ;3* j 2 :0t5Q TC. ivl* 0.K> 0. 075 S-it 3 : 00 A , Me ^ 3*1 3 0:00 J% Vi. 0 .0 7 0.0'> T r e a tm e n t w ith DitM rjprorsanol D isco n tin u ed 3 - i-4 th r o u g h 8-2* - T r e a t m e n t -with C a lc iu m C ie o d iu ra ;/ e r s e n a te (;CD I. 3 - 4 :j) .->- "Vsi* - 0 .0 7 8---1`v 5:00 V*0C 5 3- i 4 ;A':, t . c l . 3~ 9 -: T A. C . -0 h- :0 2i?3 P . M. 7. 0 >" Oj . :00 A . T , 5. 07 0.0 5- V ; : .0 -0, -v-u #` 8 id P . M, 0. 03 3- t9 3-20 .- !t9Q f-r. . A5, :. i r `* '->* ;V;v.t 0. QB O.O-J 0.. 99 8-21 5:30 A . -'vi* 0. ,0 T r e a t m e n t v 4 ih C-v-lclU* ..adiam v e ra e n & w tT C T A ) D is c o n tin u e d 8-22 :00 / , M . . 0. 50 3-23 3-27 hm a.al 0:0 0 A . hi, 0. i3 0. .30 9-J2 o .as 0 .0 b 0. 02 9-2 o. 3* 9-3 0. 32 9 -H 9-5 4 0. 00 O.OO 9. 29 9-19 0, :r. 9-20 9. 03 9-20 9. 05 9-22 -.">i- 05 10-30 0 .0 b o .o s 07 ii- i 1 0 .0 4 9 .0 0 0. 09 "L ; 3 ^ C o n ta in e r s f o r sh e c o lle c tio n a i s p e c im e n s <;f M ood a n d u r i n e w e re : n u t a v a ila b le a t th e tim e t r e a t m e n t w ith B A i. v** in s t i t u t e d . A Ti ir\ o .* r> y*.] U u liU iO / 7 3 RATS* ENT O F AC U TS: T g T ft A S T B YL. tN TO X IC A ; 1Q?< Cat - Aga 24 e n g a g e d in t a s k c le a n in g r a tio n f a r tw e l? * lay9 flig h t to m o d erate in term itten t ex p o su re, J4sM p o ia o n ia g . 0M3Bi by s& y sic ia n on fifth d a y a f t e r s to p p in g *?rk. C hief com plaint, insom nia. 'Cate : A2 Tim e Blood M f.. "F% P e r J.98 Gram s p,;.1 et ro g rap h ic Pit& issene . Crine M g. Pa Per 8- i2 s- a ;.J:50 p , h i. .<:00 P. M . 0 .0 3 :!. 9 0. 03 C i 4 through 3- 3 - TreAim et * with Ao iciu m Piaodium Vor senate ( CP U* i -:i ' r" 0 -0 i- i f \.tm & L: .. 3-A 3- i6 3 la 3-17 3-13 3 8 8 - 18 3-18 . :: 1 Y , 1:09 a . Y . 4:00 A, 14. v:99 A. M . : 0. . . ,4. A . :.A P. A , :0:9Q a . Pi. :29 P , t e . 1: A! P. M , Y :4 0 A * M . 4:21 A . M . i j :80 A . M . i: S P. M . M. A 0* W W' 0,QU ' f * Y 2-' 0 .9 4 0 . 9 9. Y 0. ii 0 .4a 9. 32 0 . 28 0 . 08 0 .0 7 0 . 12 l/ T reatsnent mlib. Calciu m .oisodium Varsum atc ^ a cm iia u a d S- if 3-if 3-30 3-21 3-22 8-23 9-U 9*i2 9*13 ;0 :3 9 A . M . 3:00 P. H . 13:20 P . M . 4:09 A . M . 3:09 A. M . 1;44 A . JM. H :0 0 A . M . 9.06 0.08 0.03 0.06 3 .2 2 0.09 0.08 9.99 0 . 95 0.09 0 . 07 / i f 0006188 T5?S A T M 2 N '7 O F AC U T S T E T R A T F Y . LAMA INT VCATIOM O cft r? -1^L5 S5 ?>* Age % i'm k C le a n in g * . - r s in te r m it te n t -cpeeur f o r tw o w ek a. avare pe farm ing. A dm itted to hospital on fourth day a ita r topping work. Agitated, garru lous, confused, visual and auditory hallucinations. D ftis '. 9 ?:* Tim Tlvod , ?4&* Ph P e r 90 C r a m # -pp e tro g ra p h ic .J U hi o* ' Icvfto M g. I-b P f Lv a - a '; :30 3 T i , J. 49 $-2 ; 3 i ,} A . Ai. 9 .0 3 !> Oft a - a : A . b. 0. 3D 0 -si ;h ro u g h B-T - T r e a tm e n t w ith C a lc iu m u i o d iu m 'Mr s e n a te (:h>TA ) ' :->3 .-.. T ;. 0 .0 4 a . 01 S- fti -- t V-J ' .Vi* O.CM 0.0ft U , A H- ft :A0 \ ;=;. ; ::- A. TT 0 75 ft, r? I - T ;:2Q ?. IT. 2 TO 8- i 4 I 3 A. Al. vv 8-.j 3*3-7 A ;A A *'*!--i'i ..=! ":'.-;i.. r i a A 13- ft ft''. o. o.- - . 00 5 33 A :7 : i i. .* A. TI. 0. 24 3 -i7 3 -iS s -ia 3 -1 9 ': 10 t . TA : 0 A , AL 355 A. M. i* b A, M. ft.Oft 0 .0 b ?. '3;.fl 0. 45 0, 59 $~Q Tr ament a -zi a.*,, <?*>* 3-23 3- 4 H -27 - 5 7 :3 0 ft. 14. w ith C<dciu m ' ;.30 A . : !. TOO f t . Ti. v:3 . IT. -Is30 A-. U . T:30 / . . M. .-.ftftftTium v'r$(macr 9 . 0> co n tin u eft 0 .0 5 3.2 0. 22 \ 7 .2 4 ' ft. 24 -.. A. ZB ' \ T ,M \ l , 9*-U J 9-15 9 - i? 9-19 9-23 9-22 ID- 33 0.0ft o.dft 9 .0 4 ft,. 04 >. m :j . g & . T 0$ >.05' , 3.29 ` ft. 0B 0. 04 0 03 . 9 .9 5 0 . *4 l"?^ Oil 0. 07 0. T SLEA T U EM T O F 4 C U T S T S T R A S T H Y I . i.-EA 3> I N T O X I C A T I O N iw Ong*gs<i i s ta sk claau'ung, ."- eve?* in te r m ftic a t e x p o s u r e io r two *'ek. lever poisoning. A d m itte d t* h a s p its ! l o r t ><h .* rv a tw n y.n fo u x tb clay a f te r - to p p in g 'w ork, a g i t a t e d , confused, iUsorianted. AudOen o n e e t o f ctsn v u ieiv e e is u r a and d e lir iu m . D ate ,7i>l Tim e F lo o d Fig. '''/ A p r 100 O r a m s pectroggs-^ uc Dlt hia- one T rine AT Tiic i i e r T- ;,i Ahroagh &-Z i f r ea tm en t w ith T H t h i o p f T A L > o- 3 3 -U d-**i ./-vi ' =. 3*i-v d-?S 3-18 d - v8 5 -i9 S- i 9 S-ZO 3 -Z l S~ZZ -23 : 1 <* 1 F . : :3 ; >., 35. ; . " . ..V > * 3 ;. \ ; ;. .:4 4 A . 31. AJi,vv/ , -. L-'_* :_ ) A - -A. -:-:o . , . A . - D a a .;a . .. :03 .i,.;.-:. V'1 '.1 -'-^. ilcOO He on ; 1:0c A . At. ,::^C a . a . ? :99 a . ,3. ItA0 ; \. ,.v5. 3 .0 ? D oh V^. ."tA 0 .0 3 0 .0 3 >.0? A, o s V *i*V.'f 0 .0 4 0 .0 4 :) n 4* 3 4. 54 . '> 3. 30 i -72 . . US '. FJ <. 14 T rea tm en t *&b -T ith ionrepaaoi D isco n tin u ed 3~ i i 9 - 13 9-i3 AUt VTV~Sjt 0.0' - o .m 0 .0 4 ;& A i r * A T M 8 N T o r A C H T A T a T K A T T I T . L S A 9 i ? C A K A TU.A `2*2z JS S B ? * Tank cleaning. S e v e re iAies-mAas; w*|ar l a r tw o w e e k s , s e v s r a v&^onsvtg. .Araitted to h o s ^ a i a fourth y # ft r work. lOxete*!, c^ai->^i, m u c illa tw itc h in g i a c e , ; i m * ( a n d le g e ; a u d i t o r y am ! visual haucirasiucrsa. Oase , ?>. T im a B lo o d &tg* P h .-ec i 0 0 o r n t n ? p-3C->vaai6 liiiiatvrjo '.. 'rso V* A s r ;'uppj> rtlv a : A. ...svi&tA'O r r & tm w it u i y 3- .2 3 --.2 :?- 6 d * - ***,. " , 3- ? a* ; : i; 3 i 7 3 - i? J-S7 -7 :- 7 o - 7 S -l y 3-1* S -i? -2Q 8-21 3-22 3-25 9 - 0-i 9 -ii .; r ; ; .> A . Ti. *>*- *.-i * i V'V* 's- . .* ' ;;)) ! lo e n S : T J J ;. .:.sao ' :ii. '*V' - .'-* : > : 'isa ) . JJ, . ' :3' A . ;o :.. .- .6. . A . I j -J .-. i-.i. v*Ts. ... i.-,i * ' **?V"t'.' -.S'. * i i'. : ; :..-} <f. J i' i J o A . 'J:-- M . 7:00 l. i 3:20 A . s. . : .-(i A . id . 3:00 A. id. .;AC. *' A%?-e 5 : 0 0 -v, AS. 0.0? ` o .o ii 0. 0? - - 0 .0 6 A. 04 v.O u a. os 0 .0 i :;.0s o, os 0 .0 8 0 .0 6 , ... 0 .: . J o . .: - . v s). j ;'), Jt 0 .2 3 . 26 ' 0.2? 5 . As 22 0. ; i o. 2 1 >. i ? 0 . ,,4 ;. i 6 j, 20 A 08 KE" 0006191 VI' S A T M S N t o r A CU T O T S 7 B *U CTH YL LKAi ) i N TO X I CATI CN 'Z ^ sJK tB S K tL . * ~~ 'I'ngaged in ts&Jc c le a n in g Lr o n e '.v-eefe, 'interm ittent bri-ei ssje^sttare. No c lin ic a l a 'gtt# o f poiaosisig* . P c s u i t s os r e p e a te d a is s ly s e c <> earn ed u f 'blood a n d u r i n e w ith in th e f o r m a l ra n g e M an y s u b je c tiv e c o m b i* `.nt *v Tc.-.intiiiig d is s ia e * * w akna& , a a ii s e a , ia a o m a i* Isss <>f a p p e tite . .' 5te !; '.;N. * Tl^od ^ : . ' L P o f iOO G ra m a .-p e t r o g r a p h i c liiihi-sono , -2 ' 3 'L T a r .L ite r "i'* Tff iiafcm ! i.- v a n * No / ixiin it icap t 'aqjKJSttre t o T e t r a e t h y l i -iS-1 r>^ 'i -- : Ir - -:J-,': ' -i3 i; "v* '', ?- > ' 0 - .; 5 .?- 8: 9" It WO 9 ~Z\ 1 -i ' '-.*'--, * ;* n-.t^*.rz.* - > .-.*-.., ." :. J ' . . . L oo : * :.;TY'e 04 O .K J . -.1 < 0. j l 0 ,0 4 0 .0 4 Cl. 04 0 .0 4 V04 0 .0 4 ; , o ? ;. o s r os :, ) a' oa i , .i 0 r oo 4 04 o . so j . 03 ). 03 X r 0006182 ''-'he a n a l y t i c a l d a ta o b la m e d in tw o ..uhr c a a e s o f t e t r a e t h y l le a d poisoning a re p re se n te d fo r c o m p ariso n w ith th e jronp th at w as tre a te d w ith a i c i a m d siu id lu rn v e rs e n & te . d e p e& ted d o sura of dituic\:>rar,i&rspi L| w are a d m i n i s t e r e d by i n t r a m u a c u t a r in jo c tk fn to o n e o i th e s e y & tian t . "dhe o t h e r receiv ed only sup& etfive and sy m ptom atic th erap y . , c a s e o i a n x ie ty e u r o a t* t h a t bev-eK-ped a a m e m b e r .4 sh e /' ro u p viho had sglistible estposmr is in clu d ed h e r e to d e m o n s tr a te th e n o rm a l h rc o is oi the analyt ical re su lt s. `.^ w ith s ta n d in g th e a c t ?.ha c o m p le te r e c o v e r y o il u d io w > c .a . a i s r - ty o i r s s e s or t a r r a e m y i lo a d i n t o x i c a t i o n "-.v<:h p r o m p t .r i r .u a .. n :M iaith fu l m a in te n a n c e iu s|ooh n u rs in g c a r s , a d e q u a te p h y s ic a l rastv& vnt a 4 s y m p to m a tic s e d a tiv e a n d s u p p o m y e th e r a p y , th e i l l n e s s is -.it a p i i e , .,,up ,t la n d s to o e ris io t %.itii n p y ja ra n t rmissir-ana p etal m u c h o i th e o r w.i h a a l-*a A lunU iatedl f r o m h a .vody. c a y 4 g e a t th a t w ill r e d u c e -ho :e-eiuty .Kid . haaften th e c o u r s e o i th e llla q a a v?msl-d h e u s e i u l . d he o a s i s f o r th e t h e r a p e u t i c co o c f c i i c i u i j i ;.U iui'n ' ojonotv li.js bt ik e : .in o iic c il e f f e c ts d u t m a y fo lio - - the iP m s a iio a o i a c h e r m c a ily in e r t c o m p le x m th e s o ft t i s s u e s os th e dody an d is th e i n c r e a s e d ex c rati&rt. n lo a d w h ic h fo llo w s . T h a t th e l a t t e r o c c u r s follow ing th e ab so rp tio n of te tra e th y l lead , a w ell a a inorganic com pounds of le a d is g ra tify in g * a n d o ile r * h o p e th a t a. b e n e f ic ia l e f f e c t c a a be a c h i e v e s y this m eans. ' b ile is la o b v io u s th a t n o a lld c o n c lu s io n * c a n c d ra w n a s to th e u s e fu l th e ra p e u tic e ffe c ts e i c a lc iu m ch so d iu m v e rs e r* se fro m a re v ie w of itie a e c a s e s , it m a y no s a id th a t th e d r a g w a s -11 t o l e r a t e d . io h a r m f u l v ifects vi any kind veer p b se rv a d , bo sig n ific a n ce m ay bo a tta c h e d to tra n s ie n t p e rio d s of U akA l im p ro v em o a t in .ociatio w ith in c ro a a in th e iiU m iaasfoa o i le a d , s in c e atach e p iso d e * feave he observ-ed ir s q u e a tly in CR.6-a iii w M c h rso s p e e if io th e r a p e u t i c a g e n t h a 4 o e e a A tim in iste re e s. viay 2 ?, K 0006194