Document 2JErVb2L8MDpD48RgMZBrV33b

Ml l*NllMT ADOLPH B.IOVCMAM.M.D. HAumec T. Fucoclman.M.D. JAMKS W. MOLkOV. M-0. kOuiiviui.KiMTveRr 40io? 2 October 1964 Dr* John Creech, Medicel Director, B. F. Gdodrich Company, Bella Lane, Loniavllle, Kentacky. Re: Dear Dr. Creech: Firat of'all, I ahoald like to preface thia letter by atating that thia report la baaed In ita entirety on ah original report done by my aaaociate Dr. Jamea F. Molloy. In'my opinion, he has done a aaperb job of inveatigation, and not only haa he examined the original patient whom yoo referred to aa, bat haa examined three other of yonr employeea, and in addition haa made a pertonal trip to the B. F. Goodrich plant, in order that he coaid better andera tend tbe exact type of work which theae men had been doing. Incidentally, I alao have examined theae men and we have dlacuaaed the caae together in great detail. I am encloaing a aommary of oar information to date obtained on thia patient. Thia indsdea a re-reading by Dr. A. J. Miller of the original biopay done in 1959, aa well aa aome preliminary patchteating carried oat daring the laat week. In addition, I might add that the recent biopalea that we took were definitely compatible with a diagnoala of acleroderma. Thia ia not only onr opinion, bat ia alao the opinion of Dr. A. J. Miller oar pethologiat. It ia needleaa to repeat the hiatory in detail here, inaamnch aa it waa exactly the Benue aa that obtained by Dr. Dyer, aa well aa the ataff at the V. A. Hoapital. BFG67750 Page 2. REDACTED Essentially, the history of this patient la that he was first employed by the B. F. Goodrich Company in June 1955 as a chemical helper. The first symptoms were of tender hands, and this was first noted in Jane 1955. He was laid off in 1958 for nine months and apparently improved dnring this period of time. He states be was unemployed for a while daring this period. He worked for the American Radiator and Standard Sanitary for three months as a atockworker and at International Harvester for six weeks as an assembly worker. He reformed to the B. F. Goodrich Company in September 1958, approximately, and worked in the high car department for two months. Zn November 1958, he returned to work as a chemical helper. Several months later his hands became worse. Coring the period of 1959 when he was in the V. A. Hospital his hands again appeared to improve, bat upon returning to work as a chemical helper he again noticed an exacerbation of his symptoms. Last May, or. thereabouts, he was again taken off work and apparently had definite improvement in that the pain symptoms have practically disappeared. Apparently, since then the radiographic studies have also shown a tendency to some bone regeneration. The original biopsy taken by Dr. Mapother has been re-examined by Dr. A. J. Miller, who states: **I have re-examined the sections labelled D-6451, taken from patient ~ which yon requested. According to the report, I did not see much at the time, and looking at them now Z am wondering if this could be a scleroderma, since the dermis region is composed of such huge, dense, collagenous fibrils. There was no history given at the time of the original biopsy, and Z apparently disregarded the dermis entirely, but believe Z should not have overlooked it. The inflammatory reaction is practically nil." We have taken another biopsy from : which was again submitted to Dr. Miller for examination with additional requests for calcium stain, mucin stain and elastic tissue stains. To date, none of the special stains have been done but the H.E. stains reveal a picture definitely compatible with scleroderma. It may be several weeks before we get to see these special slides. BFG67751 ED Page 3 We here carried oot on patchtesting to the erode unmodified materials which were sent into our office. For convenience, we have merely labeled these A, B, Cv and D. These were placed -on the right arm along with a control. Inasmuch as these were dry patchteats, they were left on for five days in the aaoal manner. Recipe A, C and the control were negative. Recipe D was a ploa mines reaction and of no significance. Recipe B gave a one ploa positive reaction. This ia of some interest to as, inasmuch as we expected all of these routine patchteata to be negative. Furthermore* patchteata were carried out on two other men. One had completely negative results. The other had positive patchteata to Recipes B and D, similar tc , the strongest reaction occurring to Recipe B. Incidentally,- these samples were coded at the time of the patchtesting so as not to prejudice any readings. They have recently been decoded, and this code is listed at the end of this letter. Very frankly, at the present time we cannot interpret this as an allergic reaction. It may be a primary irritant reaction. Our expectation was that all of the tests would be negative and that we would probably have to go no further along this line. With positive reactions at four sites in three patients, we will probably have to proceed further by (1) reducing the particle size of the material to a standard, and (2) by calibrating the parts per million in a concentration to be applied in the patchtests, and (3) by doing dilutions of 1:10 and 1:100 and 1:1000. These further procedures will indicate to us whether we are dealing with a primary irritant or an allergic reaction. At this point, it is felt that we can definitely rule out scleroderma as such, as a diagnosis, as well as Raynaud*s^disease. BFG67752 Page 4 Raynaud's phenomenon of induetrial origin if veil known. It occora anywhere from one to twentyfoar month* after the aae of vibratory tool*. It occur* in a variety of age groups. It is a vaecnlar phenomenon which ia unaccompanied by acleroderma like akin leaiona and ia likewiae unaccompanied by oaaeooa changes. and the other patienta do not fit this group by any atretch of the imagination becaoae theae bony changes which you have discovered, occurred early etui the cntaneoua fibroaia which we aee in theae people, to our knowledge and search of the literature, has never been reported in Raynaud's phenomenon of industrial origin. Scleroderma itself, was also considered. Thia is a disease with a female to male sex ratio of 3:1. Raynaud's phenomenon ia present in 94% of the case. The sedimentation rate la almost uniformly elevated. The aerum gamma globulins are derated. The esophageal changes are noted in 70% of the cases and bone absorption of the distal phalanges are noted in association with actual calcification of the sub cutaneous tisane as an extremely late manifestation in 62% of the cases. Thia skin calcification and bone absorption in classical acleroderma occurs on an average of eleven years after the onset of the disease. In case, we have an erythrocite sedimentation rate of 4 suns , a normal aerum electrophoresis and no evidence of esophageal changes. This has led ns to the conclusion that we are dealing with a slightly different entity which we are calling, for the.lack of a better name, "Epidemic Scleroderma". In conclusion, our findings lead ns to conclude that the present. dermatological and vascular condition, is in all probability to a major degree, dependent upon the patient's industrial exposures. I am enclosing, along with this letter, the material put together by Dr. James F. Molloy, and this includes epidemiological data; working, summary of cases of "Epidemic Scleroderma", and a brief summary. Please be assured of my appreciation for the privilege of seeing these most interesting cases, and I trust that we shall be able to carry out for you and the B. F. Goodrich Company, additional investigative procedures. c. "pn. fle* ABL:cl Very sincerely yours Q. A. B. Loveman, M.D. 1 BFG67753