Document JJB40aDgG7mRXxRVey3egM44Z

Februar? 29, 1932 Mr. Joe V. Williams, Jr., V;llliams and Williams, Hamilton National Bank Bldg., Chattanooga, Tenn. Dear Mr. Williams; Your letter concerning the differential diagnosis of ''Jake" paralysis and lead poisoning very nearly contains its own answer. From your description of the case I would consider it almost certain that the man whom you discuss is suffering from ''Jake" poisoning rather than lead poisoning. The cases of "Jake" paralysis have uni formly shown a greater involvement of the lower extrem ities than of the upper, and for this very reason have simulated arsenic poisoning rather than lead, it is commonly known that, except in the case of children, paralysis of the lower extremities is rare in lead poi soning. There is an overwhelmingly greater frequency of involvement of the arms, the particular lesion which occurs most frequently being wrist drop which is a par alysis of the muscles which extend the hand. 'The best proof in the elimination of the factor of lead would be to have data on the blood findings at the time of the paralysis, and to have analytical data on the excretion of lead in the urine and faeces in a period near the time of exposure. I take it from your letter that there is no such informa tion, and unfortunately it v/ill be impossible to obtain data at this date,which is practically a year later. Thus the evidence would have to rest upon clinical in formation, which should be of two types. First, one should attempt to show that the lesions present are more easily explained on the basis of Jamaica ginger than on the basis of lead absorption. This can be done by referring to clinical descriptions of the two condi tions. A very satisfactory clinical description of lead poisoning can be found by referring to "Lead Ab sorption and Lead Poisoning", by Legge and Goadby, or, by referring to the work of Osier, ''Principles and Prac tice of Medicine", 8th edition, published by D. Appleton and Company, New York, 1918. There are numerous other sources, but this I believe should be satisfactory for your purpose. Any good work on occupational diseases K Z v/iby will also give you adequate descriptions of lead p lng. Your next point should be the establishment the facts as regard exposure. If the patient in q tion has symptoms which are more readily explained the basis of his use of Jamaica ginger* you should able to say, first, that he has actually consu Jamaica ginger, second, that the lead exposures to he was subjected were not a sort which produce lea soning with any degree of frequency. Knowing noth the plant In question, I do not know that this la fact, but if it is true that cases of lead poison have not developed In the foundry, considerable p should he made of this fact for a diagnosis of le soning depends upon establishing at least two of ble three facts. One must be able to demonstrate existence of significant exposure, This can be d strated only by analytical methods or by statisti methods. Thus, if a given occupation has been as with cases of lead poisoning, it may be assumed t nificant exposure is possible. If, now, the symp illness are such as can be explained as the resul lead absorption, the diagnosis may reasonably be U|iless.one has evidence of significant exposure a St1is not possible to arrive at a diagn I trust this will give you some a ance. If there is any further information which give you I shall be glad to do so. Very truly yours, HAKjEJT He o (' U vH ojC Q