Document bDreM3D766X0mv43Gvb2mNk6

DC*MATOCOOT AMO OTWMtLOLOOT Aoolrm B.Loveman.M.D. Maurice T. Flieoclman.M.O. James F. Molloy. M. D. '*> ^M*I YVILUC HOAD LOUIVILLCfKCNTUeKT *0*07 2 October 1964 Dr. John Creech, Medical Director, B. P. GSodrich Company, Bells Lane, Louisville, Kentucky. Re: Dear Dr. Creech: First of all, I should like to preface this letter by stating that this report is based in its entirety on an original report done by my associate Dr. James F. Molloy. In my opinion, he has done a superb job of investigation, and not only has he examined the original patient whom you referred to us, but has examined three other of your employees, and in addition has made a personal trip to the B. F. Goodrich plant, in order that he could better under stand the exact type of work which these men had been doing. Incidentally, I also have examined these men and we have discussed the case together in great detail. I am enclosing a summary of our information to date obtained on this patient. This includes a re-reading by Dr. A. J. Miller of the original biopsy done in 1959, as well as some preliminary patchtesting carried out during the last week. In addition, I might add that the recent biopsies that we took were definitely compatible with a diagnosis of scleroderma. This is not only our opinion, but is also the opinion of Dr. A. J. Miller our pathologist. It is needless to repeat the history in detail here, inasmuch as it was exactly the same as that obtained by Dr. Dyer, as well as the staff at the V. A. Hospital. ( XEo' COT BFG67750 Page 2 Essentially, the hlatory of thia patient ia that he vaa firat employed by the B. F. Goodrich Company in Jane 1955 aa a chemical helper. The firat aymptoma mere of tender handa, and thia waa firat noted in Jnne 1956. He waa laid off in 1958 for nine montha and apparently improved during thia period of time. He atatea he waa unemployed for a while during thia period. He worked for the American Radiator and Standard Sanitary for three montha aa a atockworker and at International Harveater for aix weeka aa an aaaembly worker. He returned to the B. F. Goodrich Company in September 1958, approximately, and worked in the high car department for two montha. In November 1958, he returned to work aa a chemical helper. Several montha later hia handa became worae. During the period of 1959 when he waa in the V. A. Hospital hia handa again appeared to improve, but upon returning to work aa a chemical helper he again noticed an exacerbation of hia aymptoma. Laat May, or thereabouts, he waa again taken off work and apparently had definite improvement in that the pain aymptoma 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 atatea: "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 I am wondering if thia could be a scleroderma, since the dermia region is composed of such huge, dense, collagenous fibrils. There waa no history given at the time of the original biopay, and I apparently disregarded the dermia entirely, but believe I should not have overlooked it. The inflammatory reaction ia practically nil." Ve have taken another biopsy from which waa again submitted to Dr. Miller for exaaiination with additional requests far calcium stain, mucin stain and elastic tissue stains. To date, none of the special ataina have been done but the H.E. stains reveal a picture definitely compatible with scleroderma. It may be several weeka before we get to see these special alidea. TlceSoi i roy BFG67751 Page 3 We have carried oat on patchteating to the erode unmodified materiala which were aent into oar office. For convenience, we have merely labeled theae A, B, C, and D. Theae were placed -on the right arm along with a control. Inasmuch aa theae were dry patchteata, they were left on for five daya in the oaoal manner. Recipe A, C and the control were negative. Recipe D waa a ploa minoa reaction and of no significance. Recipe B gave a one ploa positive reaction. This ia of some interest to aa, inasmuch as we expected all of theae 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 t< , the strongest reaction occurring to Recipe B. Incidentally, theae samples were coded at the time of the patchteating so aa 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 aa an allergic reaction. It may be a primary irritant reaction. Our expectation waa that all of the testa would be negative and that we would probably have to go no further along this line. With positive reactions at four sites in three patienta, 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 auch, aa a diagnosis, aa well aa Raynaad *s .disease. Page 4 Raynaud's phenomenon of industrial origin ia well known. It occnri anywhere from one to twentyfonr months after the sae of vibratory tools. It occurs in a variety of age groups. It is a vascular phenomenon which ia unaccompanied by scleroderma like skin lesions and ia likewise unaccompanied by osseous changes. and the other patients do not fit this group by any stretch of the imagination because these bony changes which yon have discovered, occurred early and the cutaneous fibrosis which we see in these 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. This is a disease with a female to male sex ratio of 3:1. Raynaud's phenomenon is-present in 94% of the case. The sedimentation rate is almost uniformly elevated. The serum gamma globulins are elarated. 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. This akin calcification and bone absorption in classical scleroderma occurs on an average of eleven years after the onset of the disease. In case, we have an erythrocite sedimentation rate of 4 mma., a normal serum electrophoreses 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 pst 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 yon and the B. F. Goodrich Company, additional investigative procedures. cc. Tn. re* v--<*.s<w ABL:cl Very sincerely yours Q. S' A. B. Loveman, M.D. /xeSo BFG6775&