Document 109XEyyXGG1nwpBgo4xkBZzGK

FILE NAME: Norfolk & Southern - WC Case - Ancel Wheeler (NS) DATE: 1951 Nov 3 DOC#: NS040 DOCUMENT DESCRIPTION: Physician Report ELi'ER R. V.AURES, U.D. Suite 827 Union Contral Bldg. Cincinnati 2, Ohio November 3, 1951 Harrison l. Puerst Attorney-at-Law 543 Society for Savings Bldg. Cleveland 14. Ohio Dear Kr. Fuerst ei Ancel Wheeler Wheelersburg, Ohio Vr. Ancel V.'heelar was seen in consultation in my office on October 25, 1951. This 39 year old, white male patient 7.as in good health until October 1, 1950, at which tive he first experienced pain over the right chest and a hacking cough which eventually became ohronio. The cough las never been productive of pus or blood. luring the ensuing year, the patient has developed .dyspnea and the cough has persisted. The pain over the right chest is intermittent, but persistent. According to the history obtained from the patient, he has been employed as a laborer for the Borolk and Wastern Railroad since June, 1944. The patient's particular work involved the operation of a grinder v.hich pulverized asbestos removed from boilers. The patient v.as engaged in this work reputedly without any protective device* Curing the past several months, the patient has developed some wheezing and the dyspnea is more severe on exertion. Physical Examination* Temperature 98.6. Blood pressure 125/70 in the left arm, with the patient upright, hr. Wheeler is very markedly obese, weighing an estimate 224 lbs. The only significant findings are limited to the chest. There is im paired percussion note with distant breath sounds and numerous coarse to fine crackling rales over the lower lobe, right lung, posterior and lateral. Ahe heart was not remarkable to percussion and the sounds were clear and of good quality, no murmurs or arrhythmias being noted. The remainder of the physical examination was not remarkable. X-Rays| A review of the roentgenograms of the chest, PA and lateral projections made on April 16, 1951, in the offices of Drs. hahrer, Krause it Lutert, in Clevplar reveal a diffuse mottling throughout both lower lobes. The rediastinal structures appear to be normal and the upper one-half of each lung field appears to be clear. The mottling or infiltrate is rost severe in the right lower lobe. The patient v.ai not fluoroscoped in this office, but it is my understanding that there was some limitation of motion of the right diaphragmatic leaf. Impression! It is my opinion that 1'r. V'heeler is suffering from, moderately severe pneumoconiosis (asbestosis) involving both lower lobes of lungs, most severe on the right side. This diagnosis is suggested by the classical history of exposure to fine asbestos dust and the focalization of the physical findings Gnd infiltrate in the lev.er lobes of the lung, particularly severe on the right sire. The lirited excursion of the right diaphragm would also suggest this diagnosis when the above x-ray findings are encountered. I would estimate that Kr. V'heeler1s disability wil most probably be a total and permanent one. The sputum sample obtained from L'r. Wheeler has beer, sent on to Dr. Robert Rittorho a pathologist in this city, to sea if any acid-fast organisms or asbestos particles can be identified in the sputum. Tubarculosi *3 in -* --- --- '* -- Harrison 1! Puerst Uovecbor 3, 1951 Ret Ancal '"heeler on to you ieirediately. Wa will nail the x-rays to the officas of Dra. Kahrer, Krause & Lubert. Thank you very euch for asking me to examine Kr. V.'healar for you. Sincerely yours. FRHssd Elr.ar R. 1'auror, -*D. f ANCIL WHEELER N & W Railroad Shop Employee Referred by Dr. Ralph Carothera HISTORY Mr. Ancil' Wheeler stated that he was employed at the N & W Shop and was running a grinder which was used to pulverize asbestos for insulation of boilers. He further stated that he had been an employee in the shop for seven years on the same Job and had asked for a respirator but none was supplied him; that he inhaled quantities of dust with the result that his right upper che3t became sore and painful, producing cough and right anterior chest pain and shortness of breath. He did not have hemoptysis. His past history is not especially remarkable. He had never been seriously ill and had had no operations. The Physical Examination reveals a rather obese adult - age 39 years weighing 2^0 pounds. The pupils were equal and reacted to light and accommodation. Ophthalmoscopic examination revealed no evidence of exudate or hemorrhage. The remaining teeth were In fair condition; no evidence of marked alveolar Infection was noted. The tonsils were large and soft but no pus was expressed. The trachea was in the midline. Thyroid not irregularly enlarged. There was no evidence of cervical adenopathy. The Chest wa3 broad and deep and expanded equally and well. The percussion note was resonant over the backs; the diaphragms were high in position but descended equally; a few ronchl heard at the bases; no moisture over the apice3. The percussion note was resonant anteriorly. The heart was of normal size and configura tion; sounds clear; no murmurs present; P.I1.I. not palpable; no abnormal thrills nor pulsations noted over the precordial area; A 2 slightly louder than P 2; rhythm regular; rate not increased. The Dlood Pressure was 1^0 systolic; 100 diastolic. The perpheral vessel were not unduly thickened. The abdomen was Just above the level of tie costal border; no masses were noted within the abdomen; no areas of tenderne3B; liver and spleen not palpable. The extremities oemonstrated normal neurological findings; no gross joint involvement; no oedema. The Dorsalis pedis were of equal and moderate pulsation. LABORATORY WORK BLOOD CHEMISTRY Moderately Increased URINALYSIS BLOOD COUNT - Essentially negative Hemoglobin Red blood cells White blood cells 4^ 20,000 9 ,0 0 0 ELECTROCARDIOGRAM Rate 88 per minute ?.R. Interval 0.16 seconds Rhythm sinus P waves normal O.R.S, - preponderant S 3 T waves Inverted in lead 3 .Interpretation Normal Electreeardiogran. No change from Electrocardiogram taken 6/20/51 STEREOSCOPIC AND LATERAL VIRUS OP CHEST - Also Buc\VJ Films Of Chest - AP ana lateral Projections - The ribs reveal no destruction or production. The trachea and mediastinal structures are in midline. The heart is not enlarged. No areas of recent infiltration, consolidation or effusion noted. No evidence of pneumonoconiosis. There is again noted slight thickening of the pleura over the right lung. Impression -- Slight thickening of the pleura over the right lung