Document 3Nx4ybjkEVeEEB7ndYrYNveGD

April 1, 1935 Mr* J* G* Gtavensou Legal Dpartaient General Kptors Detroit, Dlchigfljnt Dear Mr. Stevenson* premised to send you a nemorandma rpr~ seating ay point of view in the ease at the oldsmotoil Factory* Flrs^^^t me repeat that consider it advisable to pot i^r* through & rigid physical examination in order to determine whether he has any disability at present, and to establish, if possible, fch nature of hie illness and disability* .. As I see it from the available data, there are four tentative diagnoses which e re possible. S*fa first of these - lead poisoning should b completely eliminated on the ground that there is no evidence of a suggestive exposure to lead compounds, there is no evidence that lead absorption ocourod and moreover, the cl'nical findings wore not in any way characteristic of lead poisoning* The only suggestive evidence of lead absorption consists in the fact that on of the physicians stated that he observed a lead line on the gums* This lead line was apparently fleeting and it occurred at a time when on Sould have expec ted some degree of congestion of the g ^ margin* It is my experience that the bluish appearance of the gums is often present and that sometimes it is quit difficult through the us of ordinary technique, to differentiate the blueness of congestion ahd the blueness of 'lad Xihe* In fact, unless one compresses the gum and looks with a hand lens and establishes the fact that the blue* ness is punctate in character, one is not certain whether or not a lead line actually exists* It has been said that a lead analysis of the urine at the tira of the symptoms , failed to demonstrate the presence of lend* Such evidence I an sorry to say is of little consequence sinoe the volume to find amounts of lead which arc normally present in the urine indicates that the technique of the examination was faulty, or that the quantity of the sample examined was . inadequate* Nevertheless, in view of the clinical and experimental .evidence...which is available, I think we shall have to conclude that lead poisoning is the most unlikely interpretation of this man*a Illness* i:. : . J v . ' 0011025 ? -v V n, J* Qm abevenson 2 The second possibility for diagnosis arises froa the fact that the man gave a definite history of increasing weakness swelling of the extremities* and vaulting of coffee ground like material som time in toy, Subsequent examination in Hovember at the University Hospital disclosed that he had an Inactive and apparently partially healed gastric ulcer* It is entirely possible that the entire illness was the result of a recognized gastrio ulcer with persistent haemorrhage and with the development of a train of symptom and blood findings which were the result of persistent haemorrhage over a pariod of time* If this had been the explanation of the man's illness* his prompt recovery With the partial healing of the ulcer and with the customary treatment of anon!3 would have been expected. There was one point which militates against the correctness of this diagnosis but does not completely eliminate It. There was a disproportionate drop In the white cell count of the blood as compared to the rod* and there was also a disproportionate relationship between the polynuclear leukocytes and the lymphocytes* This might have occurred without any specific explanation for it Is fairly common to find industrial workers* and in feet other persons* who have a low white count and a relatively high lymphocyte couht* Haemorrhage in such an individual might result In the; picture which is descriied in this case. It is* of course* impossible to determine whether or not this occurred for there, were no counts prior to the man*3 Illness, Thor is no adequato basis for a correct diagnosis in the records of examination which have been furnished me. Perhaps Dr. BsuCr or Dr. Henry night be able to throw some light on thl| -questioni 1 " ' ''* . " The third possibility and on which I consider quit likely that this man was exposed to sono quantity of benzol in the course of his work* and that being somewhat unuiually susceptible he developed the type of anemia which is oharao torts tic of moderate exposure to benzol vapors. The blood picture seen is quit like that which is found in early benzol poisoning and the train of symptom which developed were such as to fit in with an anemia of this fcypf On the other hand* the prompt recovery under treat Hient casts some doubt upon this diagnosis though not as muo t doubt as would exist if there was reason to believe tha the exposure to benzol had been prolonged. With the hlspory of short exposure and with the rather prompt de velopaent of illness* the entire course of the man's illness la compatible with the diagnosis of moderate exposure to benzol 7 . ., The fourth possibility is that this man has on Infectious agranulocytosis. He gives a definite history of i perais tont sore throat* of general weakness and pros Fr* J . 0 # Stevenson feretIon and a blood picture whloh is compatible with this dtiagnoele# I f it sere to b e shown that this blood condition hii a tendency to re-occur) and i f he wore to show now some evidence of such blood findings, I would regard this as the most likely diagnosis# The fact which militates against it scat is the fact that his recovery under treatment was apparently prompt, whereas the outlook for recovery and particularly for rapid recovery in these cases Is not very goent# In fact most of the cases about which I know anything have resulted fatally, since there has been a definite tendency for the occurrence of re-occurrences and remissions In the disease# Under the circumstances I am somewhat at a loss in giving advice as to what might best be done In this case# If another examination fails to disclose any present evidence of disability, or any basis for present diagnosis, I should feel that it would be wise In all likelihood to soifcle the case on as fair a basis as la possible# The a1mattor of the Oldsraobit Company is not the best stupe In the purchase of gasoline containing either benzol or lead, it was not exercising the precautionary measures which are of right to be expected In the selection of a cleaning material# Moreover, the company did not take the steps which were necessary bo arrive at a definite diagnosis on a sick employee at a tin when the diagnosis could beat be made* They are, therefore, lacking in evidence whereby they might he able to clear themselves of any ree- pon libtlifcy for the origin of the man*a illness in occupa tional conditions# fflth the absence of a definite diagnosis, it would seem that they would be unable to defend themselves and they would in all likelihood, therefore, ho required to make seme settlement to compensate for either temporary disability or for both temporary and present disability if the latter can bo shown to exist, or if it can not be dls- ^proven# . . - .' X should be very glad to have copies of the available clinical information which appears in the plant dispensary record and of the record of examination at the University Hospital* X should like also to have a copy of any [further record of examination which might be obtained# It A y be possible that further examination will provide some basis for -a'conclusion which is not apparent at the proA n t time# . Very truly yours, nm% Rotort!'A# KcHbe, ` 0011027