Document zoz15dbgZvRdKvR7Jjbo3qda3

; WORKMEN'S COMPENSATION T h e 3 In d u s t r ia l C o m m is s io n o f O h io 0.3 . 12&6 SPECIALIST'S REPORT Add-es .11 2&_g 93rd S tr e e t - C levela n d . Ohio Date of Examination! ____________ coo :0w Mr-j.r ;:u 'c.v,.us ....... N O T E :... Submit report under follow ing h eadings: (1) H istory. (2) Complaints. , (3) EMminm '|j | _ ` including X^ray and laboratory work. (4) Discussion. (5) Opinion. M ail T H R E E c o p i ^ f l H l H l * to the M E D IC A L S E C T IO N --R etain one fo r your file< . .r: - l||l||llH p S;- H ISTO RY `' '< ' ' - ' J - "' ' '* |h | r# C ._ ... \ ..... ........ HP. v- 1, On .Aujpstjg; 1935 vhlleuorMng at' Ferro Enamel Company Vab seised vltk sSW.1J; Mi- attacks of" Yositing and severe colicky diarrhea,. Occasional attacha* a t jljlfl abdoainal' pain in intervals between diarrhea though most of pain wee ' H N | S i L t 1? to haslet* and fessoci&tedwitk diarrhea. locale l | l| a o w d 5-6 titles dally and malting was frequent oyer 3 weeks *1*" n l H I Sjpteiaoer 30,1335 weight had fallen fron S s to 112. Seen bvphysic w* ootirnjed ftua Auiist 6 till jomiabes X* 1935 and was discharged to return to work* On S o v e ^ c r li b N I 1935 heg^n work out was unable to continue after first dav u p * -r- nJlPifli *?? I f-fi^irJimS Ses.s o f b reath w hich began in September 3^ 0 caSMh. i| | |s tinned s lu e s * Most n o tic ea b le, dn a r is in g in a .M* ' l a s t s w H-iii ' ' - -JiflilililMlill feels cask and dyspnoea prevents exertion* Attacks"? '*"lllllll " 2f v tin* of day - not related to effort or rrJ J H | 2*^hile sitting or eating - occasionally while walking -un stcfSiS ; itPalpitation, preeordlsl or sheet pain with attacks* " ^ '111 ???? vhen moused treatment by physician 1 1 1 S 1936 ~ remained at home without medlcr.l racerolel d l M I93S when was hospitalised for 6 day period under r*->rr--1`*-1-1 glirjs^ioatlon and low Ga diet. Discharged - r m ? inor'p i i*u]Hi if* ^flPltaXIoed agdin for Sweeks period or ?* t hotae since. mil Mc y * 1935 till present has had alternating diarrhea 1 IP'1 ^ ^ s s s j r a s i ^ s m ' | p for 2 years till illness tn 19 35. ypefl I-j r * - u. i-.-t .;r. ^XXX 1"33 * eiuu^l worker . '. 4 -- ^ s s m g - * * - - -, -- ' " to the M ED IC L SE C T IO N --R etain one for your file. _ . ; - HISTORY - ' * '. ;C.C. 'Ladr: Poisoning* ........ ,.... _. , 'P.X,~0n Augustrt*; 1^35 hl'e arising' at Ferro Enamel Company was seised -with attac'ks of vomi`t`i`ng and` ~` ' - - Occasionai attacca of tsa grip Bowels .perl,&*'% On , by physician ana M' 'eb. 6* : Yatioit - dl ' tWMtf^vidrs $ by physician * medici supervision under observation* :; - rena'ned`at bon, .period of obser-- * . - .. ' In all of time frets liev. 1$35 till present has had alternating diarrhea '.'Z-i`'C- . and constipation, weakness with atlecke o f slid paroxysmal! dyspnoea, .. w i g h t has remained between 112 and 120 lbs, eince, In'spring 1939 wei^at I: was IJO lbs, for short -period -- has never returned to original wel$it. Bo - 'other systems-.r-ei^^tiol^dk-i-^;.. > ' . 3 `- .. A "'i' - ' Occupational : ^ / 'y 1'}' - .r'" : - -. -c - * School till 8 - f&ra till 10 -- bakery W T & e r till iS^ashlolst apprentice ` A- till 17# machinist till 22 -- auto' sokani till 1933 -*Xken enamel worker , for-2 years till- illness in 1935* :--r; ' lead Exposure - -* -A .- - * Worked, bn driers -"sorting said leaning enamel powder - then bagging. Was 1 very* dusty operation w ere 'resplmtor which was not efficient - did not^ A V, .taste, dust but grit would aceusulate in mouth* (Does not know if fellow A * 1orteen had piwmhlsm as labor turnover was very high.}, 2b p o s a r e was 5 minimal while auto mechanic * no soldering orbattery repair* ;. ,` Family. History* - Father died 33,. accidental,;-Mother f^vllving --and-well, due- -- A I- - ibltsg'livlng at well - 3 siblings-: died,- 2 'in childhood 1 aceideatal* f- Wife living and well -- no children, ' ' ":- - :- ' ---A-- Prev. Jhai^.SlatBiT -- Childhood.diseases. :^,3n^u^a,5S0#. no other known. - * Spheral health good- till P.* C.R. $rnreecglaitniivnegtainlld P.I. - Paroxysmal is relieved by 1; pr- since -- does not 0m e on when down -- no hemoptysis, cou^i or best pain. 8.X. ~Appetite- fair to- poor-:-`inaili; breakfast -- .Bowels irregular -- attacks of diarrhoea about twice per month lasting 2 days with |H> movements daily then regular for.weak or- two when .Will beeose constipated Beaor-holds Hy for past 3D years - "` ' r V- (Sigutiinof ' (CONTINUE REPORT ON REVERSE OF SH EET-N O TE INSTRUCTIONS) CHI :legative (CONTINUE REPORT D O W N FROM HERE) **-~e*rxoCKi Qy. oa iiHE'Si-'-ft:;r: Diet Sata well-balanced diet except f o r seal which is ta k en at most 1 x day. 7 ;^-Brinks at least 1 qt. allk daily - Little coffee - 3-h x week, ' Habits *. Averages & toara sleep -- Occasional insomnia and restless sleep - Has " W as alcohol past year, lever used alcohol excessively- moderate ., smoker, v - ^ .. ; Height -- Usual volgati $M Bast Height: X52 ** 1919 Lowest weight 112 - 1935, >.''? y;-- 7 Alert, cooperative - does, act appear cither weak or ill fairly well * nourished,, muscular, development.and tone good ** is active said well * coordinated - Color slightly pale - fcies and dilated nasal venules suggest B-:; . alcoholic indulgence - no dyspnoea, ) ` . K, tempi $ l t '-Bulei 73 'Hi 2& R Height X23Jlbs Crip. Ht: 70 ' Lft: 60 'Blood Jreesure-Bti 10 5/&U ^ ^ . ' . -- ; Lffc 10 0 / 62 ' Head; Hair sparse * anterior-baldness -- tortuous and sclerotic temporal vein? EarnI Brume-clear'-- reflex good - canals normal-- several lines of Injection superior anterior quadrant left, drum, . . . 7r ..HeHRR1' Bvess .Pupils myotic -- react well'.to'light and toco^oilationi'margins..irreg, Early cataract opacity lenses " * ak. '"v- ' . . Hoses sjily 'dilated venules -- m,EU";1reddeed:--- dry '-. discfoar^V. 'Mouth: Uenersl gingivitis. *Sfeadly Carious- teeth *others with small, 3,' -3- cavities - 'poor occlusion * several marginal deposits which are seemingly related to the gingivitis -- the deposit at the lower left first molar, is punctate, pale bluish and resembles & lead deposit^ fonsils ssdll -- Scarred soft palate distorted by sehr*-,anterior pillar reddened - phaiTns iijeeted* 3k: negative - , .* v'--- -3' ' 3 \ '"H- . " r, . v hi R.S,D, 7,0 R,C,B..,,2,5'jJ',.G^.Apex....rate? 30 -,25 tops.110 ..-'2.min* 90 jest clear -- Itokrt tones eleh3-- .regular - reaction good, - . . Abdomen: 'muscular - no masses or tender areas - .: ' :: 'felviei negative * ` " - ;3 : "Extremities: negative ;; ... Iftiflexee: Suuerflslal reifernes not elicited - tendon reflexes hyperactive no clonus -- so ataxia, ^ v; ' . Musculature: fairly well developed *, symmetrical -- no tremor - muscular . strength fairly good ... ; - ' . . ...: ~3 Mentals talkative - cooperative -- given to reminiscences and wordy detailV- some confabulations appear in statements of daily activities, r - - - * * . : - Laboratory Urine: sugr -- negative -- Alb, negative - . - "W- - ' .3 ,-r . ' Bale, clear, Sp*^. l,Cil .: - Kicrosespleal: negative*'' * .' ' Blacetic -- negative Indican - negative ketone * negative ' ' - ' _ " Lead Concentration: (small sample &-15-1939) 0.6^ sgs./llt-^r - (La^e * 8-28-1939) 0*^9 gs./liter Blood: WB 50 HSU %*010000 v;i.Holy, 50 ,5 Band, 2,0,Lymph ^0,0 sasr Hb m sti`pp-ling: 9 ^ ^f^Baso, 1.0' .^.s.in.-2,5 Mono, *i-0 Lead com e m m W g n i :.?[: -, , :r5j.037 :i0#05 Weight -- Baud vweight: 1% 'Best Heists 152 - 1919 lowest wel$xt 112-1935. 8 .A* Alert* cooperative - does not appear either weak or ill - fairly w e n nourish!, stusctOar. development and tone good - is aotive end well '" coordinated -- Color slightly pale -- facies and dilated nasal venules suggest alcoholic indulgence -- no dyspnoea*. - 4 * - ~.. j Tspi.'9i*i Pulse? 7? . Bx 2&- Weight 123-lbs*..trlp...**i .'TO *.U* ' Lit; foD Blodd pressure K* 10 5/So ,. i . Lftl 100/ 62 ' ' '-' ' ' _ ' \..v 'JF~sL"C-*??,vt -n-y Heads Hair sparse - anterior baldness -- tortuous and sclerotic temporal veins Earn t Drums clear -- reflex: good - amale norgial -- sevri, lines of injection superior anterior quadrant left drum. - . ; 1- -' Bvest Pupils myotic -- react well `to light and accommodation; margins irreg. l5arly'cataract opacity lenses -- E,0*K, ok. - - ~~ Hoses Harife51y"dil6ted venules -- b *is,, reddened -~ dry '- no discharge, Mouths `Ceneri gingivitis --sSadly-qe^ioua teeth--- 'Othors'-^th^lli. cavi'txi'** po'r.ocduslon -- several.marginal deposits which are seemingly;!;;!! related t o the gingivitis -- the deposit at-the lower left first isolar'is punctate, pale bluish and resembles a lead deposit^ Tonsils small - scarred - soft.iip^late distorted by scar - anterior- pillar. reMened-^;;-pliaryak"l|et^l;i- Heoki mefpetXVi- ` - - !.!;J' ` v0-- ; . '!' ^ - dheat; -7*-0 .I?*C*B*,, . . . . 25 im p s.'110 .1 ''2 !rnhi* chest! d e a r -- heart tones clear - .regulsr -- reaction good* - ,/ Abdomen; 'snxscular - ho masses -or -tender a r e a s ,. . v' M 5 ai negative * iiKxttrreemmilties x negwative . .' ' . 1 '' ; -. ' . ' . . . . .. . , ... WSpfifi'Sximxi"' jS^unerflcilali relfge::not elicited -- tendonreflexes hypsrsetve/; ' WT OWT^anoo clonus --- 'nnoo aattaaxxiia,* -' "" ,- .- ' :; -. .; ' ' Musculature; fairly well developed -- symmet'rical - no tremor ' muscular!' strength fairly geodi ~' - '-^ - -v ' . .. .. . 1 Mental; talkative - cooperative -- given to reminiscences ami wordy detail;-. some confabulations appear is .statements of daily activities. v Ori*ne'; sug' a. r*-- negavt.iv-e. : -- A,,ljbai&snexgsa&taivL- Pale, dear, Sp.Sr. X.Q1 Microsoopteals negative*-'- Placetio -- negative indican - negative Acetone -- negative iUr : Lead Concentrations (snail sample S-15-I939) 0 .6 k gs./liter - . : ." i C'-Cld*^# 8 ~ 2 ^ 1 9 3 $ \ .0-^-^s*/liter' Bloodi WB a*, 350 BBS h,010,QOO : ,Poly. 50*'S Band, 2.0.Lymph %5*0 Hb Stippling; .9 Baso. .0 osi`n, 2',5" Mono, ^,0 ' Lead concelfelIan;.. "' "" ' ' .v-s.'r-Vv- i ; ; s 4.g k 7 . : ' 1*.- 'A TX -'' V- ^ -,\pIo6;msg*e*. /100 gras S-15-1939 _. .. i f * i 7x L :-m^\rqqz.cz& (DO NOT WRITE BELOW THIS LINE) ? (continued) Fcccaj Lead Cantont o f S@ispl 0 .3 ^ g. ' _ -L a d Concentration ~ 0 .2 0 a j/g M g o f a ib fUe quantities of lead, found In the blood and urine.- K.ro wholly inconsistent with the occupational history fend more -artiooinrly with the fact that there has been no ocetipsttonal lead exaofjur-e since August of 1^35* Such levels of lend ooneen-> tr-wian r.ro found only in Imedlate tine relationship to severe lead exmaure* and in our 023*0rlehoe are. never -seen f o r longer than a ', few weeks after the cessation o f such exposure. Indeed the urinary lead concentration as determined twice wan found to bo unusually ' M r h even under conditions of very savors load erasure. I our i opinion the rac'd,ta o f these doterninationo hour no relationship y to the occupational lead Oimosureef tuc y are before* but have arisen,^ fro'i n >no different and nnrVstruined. enure of .lend nbeorpt ion which V- t o o l pi-'-co during th e p~t fe u weshs or days 1 fh e deport it- bn th e rnm tisa n e * a secondary aitsiaia* . 1 m d a r e la t iv e lym phocytosis are capntXblri w ith the occurrence of 3.or:.o recent load exposure* while the 'bnonee of 3.nrge masters . of ntipuTsoorythro^ftos in the one saser ev&riinecl is n ot necessarily ; aI'yi floruit* there.being no definite relationship between nuiahors of o tip u led eryth rocytes *_rl the iio<p*oo o f len d absorption itt Individual Oats. * ' V-Y f h o r o in no adequate evidence of clinical illness --1; .- or.ilea' >1lit7 which is in hoopingwith the Mph analyticai results* - In fact there in little or no evidence-of ivncs os* disability or of cl^ronlo 'disease except that certain ctlgRnta of clireaio- alcoholism are visible* In our opinion there is no disability of oootipational origin* '. p-ecoppendationa. . - fhe source of the lead closure which has been. ' ' demonstrated by the analyss is,purely cn^cetarai* and. since- such > results- were not. anticipated, from the. clinical findings* no ;further.--- study was- carried oat. to determine the- scarce*. It Is -believed ,,that :'' a byftot hospitalisation of this- nan# with suitablootuclies -of his lead-, metabolism (under controlled, conditions of lead lotah} .would answer, the etion now presented*. ` It la strongly reoca^ended .that such : p ato^s .be taken to determine .whether or nfrt this is on -erectional. Cash of. lead retfutlouC-we are confident that it ta not) or whether ' so# inadvertent.,or.p&siwpa- intentional lead absorption has occurred.-- 0 0 1 6 8 8? 7^2-v Hebert A. Kehoe* ,M,D. Kettering laboratory SSISSa f HgHglno