Document 2MYzorn36Vv806rvEOb1OeOR

FILE NAME: Metalclad (METC) DATE: 1957 DOC#: METC009 DOCUMENT DESCRIPTION: WC Comp Claim - Riley [From J-M Archive] File Name C o n tr a c t U n it C la im F ile : J a m e s R ile y Scanned ? yes Source JM A : N S -J M Start Year 1957 Stop Year 1961 Contents c la im , le tte r Notes DIPLOMAT* AMERICAN BOARO O r INTERNAL MEDICINE ( ( E a to n M. Ma c K ay, M. D. S anta Ana C lin ic 3 0 0 W EST EIGHTH ST R E E T SANTA ANA, CALIFORNIA KImmcnlv 2*1166 F e b ru a ry 24, I960 Industrial Indem nity Company Box 2252 T erm inal Annex Los A ngeles 54, C alif G entlem en: A ttn : D. W* B ro w n Claim s D epartm ent R e: C laim No. 57-03-11487 C laim ant: Jam es W. Riley Em p: Lynch A sbestos Co D a te of In j: A p ril 7, 1947 In m y last rep o rt concerning the above m entioned patient I indicated that he had been hospitalized in the P alm H arbor G eneral H ospital, G arden G rove, C alif, on Decembe 27, I960. He was hospitalized because it was no longer p o ssib le to keep him reaso n ably free from the intense rad icu lar pain at hom e. This nerve root pain was caused from v e rte b ra collapse. His co u rse in the hospital was rapidly downhill although it p ro v e d p o s s ib le to k e e p h im f a ir ly c o m fo rta b le . He e x p ire d on J a n u a ry 24, 1961 at 7:25 AM. The im m ediate cause of death w as pulm onary insufficiency o r re sp ira to ry failure* CODE 350-3971 350-814G 360-1231 360-438.6 370-1X4 362-600.6 360-100.2 435-535.6 861-9X1 640-951 651-951 221-403 2231-403 FINA L DIAGNOSIS DISEASE A sbestosis E piderm oid carcinom a (U ndifferentiated squam ous cell type) bronchu (Chrom ogenic acid fast infection) M inim al active tuber Secondary C om plications F ib ro sis pulm onary, due to foreign body (asbestos and A dhesions of pleura due to infection (p leu ral fibrosis) Em physem a (severe) com pensatory. M ultiple a b sc e sses of lung Right h e art hypertrophy and dilatation. A drenal cortex atrophy. A ctive and healed peptic ulcerations of the stom ach. A ctive and healed peptic ulceration of duodenum . F ractu re, com pression, of body of T -7 and T -8. F ractu re, com pression, of body of L-L carcinom a) g Caton M. Ma c Kay, M. D. -2 - C Re: Jam es W. R iley R. G. R ichards, M. D, the Pathologist of the Palm H arbor H ospital perform ed a post m ortem exam ination on M r, R iley and a copy of his report is enclosed. I would ap p reciate it v ery m uch if you could have a copy of the post m o rtem exam inatioi rep o rt m ade and send to D r, J , K . Shirey who is in terested along w ith D r. B rew er in th is c a se . A lso if it is not too m uch trouble perh ap s you would be w illing to send D r, Shirey copies of the e a rlie r re p o rts I have m ade to you. He has a keen m edical in terest in th is c a s e , lb A copy of the C ertificate of D eath is also enclosed. This was m ade before the m icrosco re p o rt of the au to p sy m a te ria l had com e in, but I would not have changed m y g e n e ra l coi elusion. If th e re is any m ore inform ation I may be able to give you I w ill try to do so. : Sincerely Yours EM M :mm * < DIPLOMATE AMERICAN BOARO O ' INTERNAI. NCOlCINC ( E a to n M. Ma c K ay, M. D. S anta Ana C lin ic 3 0 WEST EIGHTH STR EE T SANTA ANA, CALIFORNIA K I m o c n l y 2-lie J a n u a ry 21, 1961 Industrial Indem nity Company Box 2252 Term inal Annex L o8 A n g eles 5, C alif Re: C laim No. 57-03-11487 C la im a n t: J a m e s "W. R ile y Em p: Lynch. A sb esto s Co D ate of In j: A p ril 7, 1947 Gentlem en: Attn: D. W. Brown C laim s Supervisor T h is is to c o v e r the p e rio d of O c to b e r 31 to d a te on the above m en tio n ed p a tie n t. He has gone gradually downhill and the problem has been to keep him free of pain o r at least reasonably so. I have had to o rd er oxygen for him and had a tractio n bed rented which has provided som e relie f. On D ecem ber 27, his condition becam e so bad I found it n ecessary to ho sp italize him . He was placed in P alm H arbor H ospital in G arden G rove because it was the institution n e arest his fam ily. He has continued his downhill p ro g ress and I now co n sid er the situation to be term in al. Very truly yours, Eaton M. MacKay, M. D $ EM M :mm I >-I p ( i HARBOR GENERAL HOSPITAL^ 12860 Palm S treet V- Garden Grove, California r *- ** - PATHOLOGICAL REPORT . .'S-I .- V **.<.: * rX Name. Doctor. Specimen. . RILEY. JA M E S W. The MCKAY AUTOPSY. _Hosp. N o ._ C 6 2 2 i_ _ D a te _ ------------------------- P a th . No.__ -1/24/6f -p a -8-- Preoperative Diagnosis. V ' i v ' tV -- 4 PINAL PATHOLOGIC D IA G N O S E S --4.J* W \ . v t 'Ce _ **i-.*- i. li I. PULMONARY INSUFFICIENCY. II. PULMONARY FIBROSIS, EMPHYSEMA, SEVERE. -`Si'W-ii 362-600.6 III. PULMONARY ABSCESSES. 360-100.2 IV. BRONCHOGENIC CARCINOMA, RIGHT LUNG. V. PLEURAL FIBROSIS. 350-814G 370-1x4 VI. RIGHT HEART DILATATION AND HYPERTROPHY. 435-535.61 VII. ADRENAL ATROPHY. 861-9x1 .; VIII .ACTIVE AND HEALED PEPTIC ULCERATIONS OF STOMACH "Sr AND DUODENUM. 640-95l . 65^ ? S i l . :Y<r4tfR; <z.z~ nn . 1 R. G.Richards, MJD., Patwlogit \ ( FaLM h a r b o r g e n e r a l h o s p it a l ' 12860 Palm Stret Garden Grove, California PATHOLOGICAL REPORT -.'-A . K-rcs Name_ Doctor. R.TUEV f "f e e . MCKAY -TaMTgq W,, Specimen- . jb g p s x : Preoperative Diagnosis. GROSS DESCRIPTION1 ---------------- Hosp. N o._C 6223--------P a t*-Path. No.. . 1 /2 A /S 1 " ^ ^ >4 -PAJ8. - * ,v .',^'.y>i ^ ^-r ^ An autopsy is done 1/24/61 at 6: p.m. at Backs Troutman and Kaulbara. Mortuary with Gerald Brown as witness on the previously embalmed body of an elderlv ` white male, measuring 67% in. in length and weighing approximately 97 lbs.. * "he hair is gray. The body appears extremely emaciated and cachetic. Thor ;s a 24 cm. healed incision about the 9th rib on the right chest wall/!: T h e n is a tattoo on the dorsal aspect of the rlgit forearm of a horseshoe with tht inscription -Good Luck". On the volar aspect of the left forearm is a daggex surrounded by a snake. On the left deltoiu is a woman's head. "7 J: / PRIMARY INCISION: - 3^ I The **YM incision shows a virtually non-existent panniculua and a thin pale musculature. There is no excessive fluid. The entire right pleural space is obliterated by dense fibrous adhesions. There are dense fibrous adhesions over the posterior left pleural aspect. The organs are removed en bloc for further dissection. ` ORGAN DESCRIPTION: ... - 3 : Heart: The heart shows a marked hypertrophy and dilatation of the * right ventricle, it weighs 380 gms.. it appears enlarged; the musculature appears pale and flabby . The coronaries are widely patent. The myocardium - 3 homogenous. The great vessels show no alteration. The valvular measure ments are within normal limits. There is a slight increase in the amount of : fluid in the pericardial sac approximately 40 cc. of clear straw-colored ^: fluid. ^.an9 S i ; .- :: ' The tracheo-bronchial tree shows a gray^/hite. uniform mucosa The right main stem bronchus is obliterated by a granular gray-white tissue, appearing desmoplastic. The tumor radiates peripherally from the hilum. The cortical or pleural area appears fibrotic and scarified. There is a dense fibrosis of the parenchyma bilaterally. The fibrosis of the left lung is predominantly in a subpleural position, occupying the 2 cm. of lung directly beneath the pleura. There are numerous small dilated cystic-appearin alveolar spaces present. Distal to the tumor on the right or in the right lixi (continued) ... ... r T PALM HARBOR GENERAL HOSPITAL 12860 Palm Street \ Garden Grove. California PATHOLOGICAL REPORT Name- -RXUBYy- JAMES W. Doctor. KAY, Specimen. -2--- *- Preoperative Diagnosia- ffflflAN nfffiffRTPTIOliT (Continued) -Hosp. No-- C W 3 3 ___ Date ------------------------- Path. No___ . ./"' r*** - i' \ -.j- 4/24^61^ -PAr-&- -r.iw-^ is a dense fibrosis and an inflammatory processes representing nultipleT ^ ' abscesses, dilated bronchi and one area of a relatively wall healed fibro- caseous granuloma of the lung; otherwise the material does not appear" acid.: fast in origin but an acute inflammatory processes secondary to obstruction from the tumor itself. The right lung weighs 600 gms.. The left weighs 700 gms.. Liven The liver weighs 1200 gms.; it is red-brown, slightly pale. The capsule is thin; the cut surface has a characteristic nutgegglng. The biliary tree and gallbladder are not remarkable. Pancreas: The usual pale-tan lobular architecture is present through out. The pancreatic duct is patent. Spleent The spleen weighs 500 gins, and shows a wrinkled, red-purple copula with vascular congestion on section. The lymph nodes and bone marrow are not remarkable. fir,?. S.ystara The esophageal mucosa is gray-white; the stomach mucosa shows a flattened, atrophic appearing mucosa. The small and large bowel are not remarkable. There are areas just beyond the pylorus in the first.^ portion of the duodenum that appear symmetrical. One represents a tenting of the mucosa and muscularis due to previous scarification and on section shows a fibrosis of the mucosa and muscular coat, on the opposite aspect ' is the same tenting defect with the same submucosal fibrosis incident to a previous ulceration. There is a 1 cm. penetrating active peptic ulceration on the lesser curvature of the prepyloric region of the stomach. The small and large bowel jure not remarkable. Endocrine glands; The adrenals are small, light yellow and atrophic. The pitiutary is not examined. G-U system: The kidneys are equal in size and shape. The capsules strip with ease. There is a finely granular cortex; there is a good eortico-medulla flonlfnueSf * ThB Plves' ureters and urinary bladder ara not murtaMi,?..1 R.{?- M T) Pnthrktnoiit-*,' r ( PALM HARBOR GENERAL HOSPITAL 12860 Palm StrM t Garden Grove, California PATHOLOGICAL REPORT - iwvTSrfi: -* ' >;v-"iiK - ........ , '- * -i . - "Vr.r'.' Name. Doctor. Specimen. -- RTTJTY, JAMBS W^7U c -- MggAY__________ -g- ..3. Preoperative Diagnosis. JIo sp . No.-- C 6 7 7 3 ----- Date______3 / 2 4 / 6 ^ 1 Bf2i ----------- ------------- Path. No__: p j^ a --c *-*** -* Ognaw n^rPT Pm rniB . The prostate a firm and well circumscribed* Central Nervous system, Not examined. ' ^- " * k fit i F'- r.-.ijti-y <.V ^ -r : ' MICROSCOPIC EXAMINATION a ncf - - The sections of lung show a dense fibrosis and a * * * V . *. * .- - ^ S . T r thL Plerual " * - - n*1*?.?nng. There are portions containing undifferentiated squamous 2 r c i n oma with central zones of necrosis. * carcon Agsaal, miere is a depletion of Upochro.se and a peri-adrenal fibres There is an interstitial edema. The nuclei vary in size and shape and staining quality. There is a prominent interticulated disc. Spleent There is a fibrovascular congestion. PSSSS The usual lobular architecture is well maintained. There is a dilatation of the ductal structures. . - iHSa* There is a marked abscess formation with extensive destruc tion of lung parenchyma. j There is a congestion and fibrosis about the collecting Liver t There is a central lobular congestion. a submucosal fibr\Vr*oAsOi1se i4 nvol1v*iJ ng it.'!h. e --m_u_s__c_u<lt_a_r_ coat. ' ' ;**.;"&pr.TJ Duodenum T h e r e i s ' ` ' - . - * p. Lung.; There is a fibro-granulomatous process represented with characteristic asbestos fragments present in the center. - = "*' . r'-^' The acid fast control shows characteristic acid fast organisms while the ac^7x fast stains of lung tissue show characteristic acid fast organism i n -- ' addition to the asbeatosis previously described -- -- ***-: HARBOR GENERAL HOSPlTAlf* 12860 Palm S tn e t ^ Garden Grove, California PATHOLOGICAL REPORT Name. Doctor. Specimer -BTfcgY, JAJffiS y u x ts --If l KAY, M .D . Preoperative Diagnosia -Hosp. No-- C 6 7 W ----- Date. -Path. No.i \: 0 ^ ; "'^K ^S ' "^ V24At * --'it'*ji Diagnosis * f I r g S C flbrO S iS ' f " 1" fo rb id v! v' . ' - / * * > T-**5j-s - .-;d3 ...riA fM tk v . . " ' ';- ; ? -- - RR; is r-rM t* `...... ;*. **' **, ; - j i b i*# nf :R .G . Richard*; M.D., DIPLOMATE AMERICAN BOARO Of INTERNAI MCOlClNE Eaton H. Ma c K ay, M. D. S anta A na C lin ic 3 0 9 WEST EIGHTH STREET SANTA ANA, CALIFORNIA K Im bc rly 2-1166 M a rc h 11, 1961 Industrial Indem nity Company Box 2252 Term inal Annex Los A ngeles 54, Calif Gentlem en: Re: C laim No. 57-03-11487 Claim ant :^7ai^s_W r_Riley Emp: Lynch A sbestos Co D ate of In j: A p r il 7, 1947 Attn: D. W. Brown C laim s D epartm ent In m y r e p o r t of F e b ru a ry 24, in a d v e rte n tly d a ted 19o0 and w hich of c o u rs e should have b e en 1961, I n e g le c te d to a n sw e r the q u e stio n p o sed in y o u r l e t t e r of F e b r u a r y 16, 1961 c o n c e rn in g the above m en tio n ed c a s e . You w ish ed m e to give a n a p p ro x im a te date that M r. R iley 's disability becam e perm anent. It was my opinion that his status should have been changed from tem p o rary to tal disability to perm anent total disability on about A ugust 15, I960. It w as a t th is tim e th a t he s ta r te d to have r a th e r s e v e r e r a d ic u la r pain. He went at th at tim e to see Dr* J . K. S hirey when the change in h is con d itio n b e c a m e ev id en t. I f i r s t saw h im on S e p te m b e r 16, I960 and h is s ta tu s th e n w as certainly PTD. Very truly yours, (l Eaton M. MacKay, M. D. E M M :m m I / CH!VE ( V ( SU', ir. ;iDN ANGL.. E a t o n M. Ma c K ay, M. D. S anta A na C lin ic 3 0 WEST ElOHTM S T R E E T SANTA ANA, CALIFORNIA kih*cmly 2`iiee October 31, I960 ' ' JUN Q 59 iXli.BiT___CASE NO.- __________ ___ REr C.REE Industrial Indemnity Company Box 2252 Term inal Annex Los Angeles 54, California Attention of M r. M artin Dahl Gentlemen:* Re: Claim No. 57-03-11487 C laim ant: James W . Riley Empi: Lyngrncrtoeatoa C o . D /I: Aprii 7, 1947 In my report of O ctober 15, 1960 on th e a b o v e-m en tio n ed p a tie n t, I n o ted that he had been hospitalized on October 3. He had no further bleeding from his lungs after ad m issio n , and the cough w ith w hich he entered d is appeared in a couple of d a y s . His radicular pain became increasingly more severe during his h ospital stay and it was im possible to control it with n arco tics. Since he received c o n sid e ra b le re lie f by hyperextending h is back ewer a p illo w , I had him fitted with a Taylor brace for some hyperextension. He has obtained ex cellen t re lie f from th is d e v ic e . The sedim entation rate of his blood increased stead ily throughout his hospital stay , and has reached a high lev el. In the absence of any active inflamma tion m his lungs or elsew here, this finding does not augur w ell for his future. In my report of 15 O cto b er, 1960 I su g g e ste d th a t you might w ish a b iopsy of one of th e v e rte b ra e w hich had undergone c o m p ressio n fra c tu re . You indicated by telephone that this was d esired . I d iscussed the question of a biopsy with the p atien t, and he said unless I could honestly te ll him th a t it would contribute to h is getting w e ll, he pre ferred to not have the operation carried out. I acceded to his w ish es. This patient w ill be seen in the office once or tw ice a w eek, and I w ill keep you informed in regard to his progress. EMM em c ( DIPLOMATE AMERICAN VOAftO O f INTERNAL MEDICINE c E a to n M. Ma c K ay, M. D. S anta A na C lin ic 3 0 9 WEST EIOHTH STR EE T SANTA ANA, CALIFORNIA KIm s c n l y 2 - M 6 6 Industrial Indemnity C o . Box 2252, Term inal Annex Los Angeles 54, California A ttention of D. W . Brown, C laim s Supervisor G entlem en: Re: Claim # 57-03-11487 James W . Riley Empi: Lynch A sbestos C o. D /I: April 7, 1947 I exam ined th e a b o v e-m en tio n ed p a tie n t on 16 Septem ber I9 6 0 . T w in certain m at m is is tne origin of the pain, which he is hardly able to to lerate. Exam ination of h is blood showed him to be m oderately an em ic, and to have a m arked sec^ ment a t l n r a te . The w h ite blood co u n t w as not u n u s u a l. By shifting he m edication he got along fairly w ell although he w as by no means com fo rtab le, until October 3, when he suddenly commenced to cough up blood. This w as of such a serio u s nature th at I im m ediately h o sp ita liz e d him in Santa Ana Doctors H ospital. During the past ten d ay s, his condition has rem ained e sse n tially stationary. Sed im entation rate of his blood has gradually increased to a very high lev el. N arcotic' now give only p a rtia l control of his p a in , and an effort w as made to give him r e l i e f ' u i\ilitraC ti n ^ i upper th o ra ** This w as quite s u c c e s s f u l, but irrita te d h is le a n , lightly covered thoracic w all too much. For the p ast four days he has been spend ing some hours each day with hyperextension of the d orsal sp in e, and this is a p p aren tly giving him d e fin ite r e lie f . I am looking in to a s u ita b le brace to co n tin u e th is lor him . EIaton" M. Ma c K ay, M. D. ( Industrial Indemnity C o. #2. Re: Claim 57-03-11487 James W . Riley From a m edical.point of view , it is rath er academ ic a s to th e c a u se of th e collapse of the two dorsal vertebrae which have com pression fractu res. In no in sta n ce would surgery be in d ic a te d . It is my opinion a s of now , th a t th e s e vertebrae have been invaded by a recurrence of his bronchogenic carcinom a or by another can cer from e lse w h e re . From an in d u stria l point of v iew , th is ^ differentiation might be im portant, and I w ill have a biopsy of one of the ver tebrae carried out, if you so d esire. This patient has been on a dow n-hill course for at le a st two years p a st, which has been enhanced in recent m onths, and is certainly not slowed up at the present tim e. There is very little curative for scien tific m edicine to offer him . The most to be expected is better relief of his extrem e pain. /l Very truly y o u rs, Eaton M . M acKay, M . D. /j EMM cmc r r V k x d k l l A. Mowr.a x . M.D. 2965W IU S N IB E BObLEVARO Los A n g e l e s S , C alif. OUNMift* 3-4126 June 12, 1957 American M o to rists Insurance Company 2969 Wiltshire Boulevard Los Angeles 5, C a lifo rn ia A tte n tio n : Mr. Carlgnan Re: James R iley J . T. Thorpe Inc. In j: 1/2/57 8 l CM 6885kXOD Gentlemen: Mr. R iley vas examined in t h i s o ff ic e on June 6, 1957. The p a tie n t h a s .a h is to r y o f having a gradual o nset o f in c re a s in g ly severe cough in th e p a s t two to th re e years and in re c e n t months o f lo s in g te n pounds in w eight. He a ls o i s tro u b le d w ith chronic weakness and f a tig u e . The cough has been productive o f c le a r mucoid sputum. Ihe p a tie n t has been working as an in s u la to r fo r th ir ty seven years. The p a tie n t consulted Dr. S c h iff and has not worked sin ce May 20, 1957. Dr. S chiff took x-rays and apparently f e l t th a t the findings suggested th a t the p a t i e n t 's con d itio n was th e r e s u l t of in h a lin g d u st iro n th e in s u la tin g m a te ria l a t h is work. According to th e p a tie n t, sputum samples were taken and th ese a re now being te s te d by c u ltu re and guinea p ig in o c u la tio n f o r possible tuberculosis. The p a tie n t i s a w hite male; 57 y e a rs; m arried; a d d re ss: te-7 W. tend S tr e e t, Los Angeles 37; C a lif. T ele: Ad. 2 b562. Occupation: in s u la to r . EXAMINATION Examination re v e a ls a c h ro n ic a lly ill- a p p e a r in g 57 y ear o ld white male who appears to have lo s t considerable weight. The c h est was reso n an t to p e rc u ssio n . A few fin e s c a tte re d in s p ira to ry ra le s were p re se n t over th e r ig h t b ase. The p a tie n t was re fe rre d to Drs. Crossan and Goin where an x -ra y o f th e chest vas taken. This was re p o rte d as showing fin d in g s com patible w ith an in fectio u s process of a tuberculous nature with cavity form ation. The patient vas re fe rre d to Dr. Dean S c o fie ld f o r exam ination and f o r h is opinion. ' Tt \.o.up seem th a t i f the condition is tu b e rc u lo sis, i t i s not re la te d to t { -2- Re: James R iley &L CM 6885UXOD K/ c a > June 12, 1957 any in d u s tr ia l a ccid en t o r d is e a s e . The presence o f a c a v ity would suggest t h a t i t probably i s tu b e rc u lo s is . The d iag n o sis would be confirmed i f p o sitiv e cu ltu res are obtained. u Very tru ly yours, JAM:CSB / JCto' A' H * * * - M- " t ( Lovell S.Coin.M.D. John W Crojjtn. M. D. ( H)r5.Cro55an & Goin 658 South Westlake L05 A n geles 57 June 6, 1957 ;:~r - w IV n *357 J"" ... Htrold P.tomiSijJk. M.D. Henry C .C roiier, M.D. John A. Morgan, M. 0. 2965 Kilshire boulevard Los Aagalea 57, California Osar Toe tor Iforson: u . itaaricaa Motoriate Insurance Ccaoa&v Re: m 2 I , K r. Jam s *pv Eap: J. X. Thorps, Inc. Inji 5-20-37 Fllas 13154 lioani-caolo^lcal examination cf -ha ch33t ebows an ^ ^ danaity of the right Ians in die sabclaviculax region which is of noa-hoaosoaoua pattern. Thera are atrand-li^e shadows, extead- *5 downward and inward to tha right hilar ration. Thera ia a noderataly large ring-shaped shadow with small arena of relative ironslucency involving the ri^ht jubclaviouiar rollon. CCOCLUSXOBi Frir; a roentgenological standpoint the findings are coapacibl* with an infectious process of a tuberculous nature which is eui>~acute or chronic ia character with cavity formation. Uc are sending tha original roentgenograms and a copy of this report to Doctor Dean Scofield, as you requested. Very truly yours, ''John U. Crosean, H. D. *< *&/*-w&H- D O C t '' FIRST R E P O R T O F w , ' INJURY -i' tC* ' * V 1 f *>C'-w27 . Failure to file a report with the Division is a misdemeanor. (Labor Code, Sections 6407-6413.) Immediately after first examination mail one copy directly to the Division of Labor Statistics and Research, P.O. Box 965, San Francisco. / > A N D T W O C O P I M T O < . r '. . . Answer all questions fully. I AMERICAN MOTORISTS INSURANCE COMPANY J a m e s S . K e m p e r , c h a irm a n 29S 9 W1LSHIRC BOULEVARD LOS ANGELES S. CAUJFORNIA dlCM6d54 1. EMPLOYER............................ ......... ....................... ................... ......................... 2. Address 'vcitjj'-------------------------------- ------ -------- --- -------------- --------- a n . , ( M a i u r f a c n i n n * hots. buildJns con- ' ? D U 5inC >>_ am'* c lo r a i, c t c .) ....~ ................................................... ,, ................................... .......... *0D home o m a MEJIIOAM AT LAWRENCE ^ CHICAOO 40 l3 . TSI*M*ttvpn--ie 4. EMPLOYEE .......lALIES-.V/.-- R I L E I 5. Address ^vcin) --__________________________________ 6. Occupation___________________ - _________________ _ --------------------Age____ 7. Date injured......-- Jtf.------------------------- -Hour.,,.......... -- M Date last worked-. 8. Injured at Ifcitj)" ___ ______ ________ ___ ____,,.... -------- -----------County- 9. Date of your first examination.________ ____ Hour.--........... -M Who engaged your services?__ 10. Name other doctors who treated employee for this injury........ -Set. t l . ACCIDENT OR EXPOSURE: Did employee notify employer of this injury?.of cause of injury or illness: ---------Employee's sucement 1 2 . N A T U R E A N D E X T E N T O F I N J U R Y O R D IS E A S E (include a11 objective findings, subjective m mplijnty noae*t. Iirf occupational disease state date ofi onset, occupational history, and exposure.) h * * , / , r- /a*. - s / t VTTS . - - t . w - ^ ^ *4( C^U-Cl J~ & > ''7 " k **7^ - -t- ,f r jV " kL f P' ^3 ^rV C .. __ -- c / A - , >^-r- rfc. >yl P t J ^ t . 14. Treatment /I A cTKJ `-frup f e r ' . f i * * * X ' w (r'ti c~c*^-c, /r - / l ( T *-*-*-- a -* 15. Kind of case ------------------- ------------tf hospitalize^ date.......................-- Estimated stay._________ /r"*" N_ am.e and address ofPfadhmoMspdift<a#l j . Further treatment (S5fS5i),M,oef---------------- ________________________________________________________ I 17. Estimated period of disability for: Regular w o r k l U M i f H work.____ _________________ 18. Desaibe any permanent disability or disfigurement expected (Sumunon) _____________________ -- ___ 19- If death ensued, give dace 2 0 . R E M A R K S (Note any pre-existing injuries or diseases, need for special examination or laboratory rests, other pertinent informatiojj.) A' A . _d ( ^1 ~> C Z^e> / - / , a f M a t-, !/j/ &, c., --. - . Us - . a_ A_ a* - s a . a a a C y ' / ^ - X Name..---- .... .Ss.U .L ,IaI,, (Type or ^print) - Date of r e p o r t s .r ./..r .m l-A d d r e s s ^ v F- M T O Q I A et o riti* \so .... ^ ____________ _ 2 - ' a?- ^ 1 BEFORE THE INDUSTRIAL ACCIDENT COMMISSION OF THE STAE OF CALIFORNIA . CASE NO. 57-LA 182-835 GRACE RILEY, by her Guardian ad Litem and Trustee, James C. Riley, A pplicant, ORDER APPOINTING JOHNS-MANVILLE, INCORPORATED, a corporation; SOUTHERN ASBESTOS TRUSTEE, FINDINGS AND & MAGNESIA CORPORATION, a corpora tion; ASBESTOS COMPANY OF CALIFORNIA; AWARD, AND ORDER FOR PLANT RUBBER & ASBESTOS WORKS (COMPANY); LOS ANGELES RUBBER COMPANY; MARINE CONTRIBUTION ENGINEERING COMPANY, a corporation; FIBERGLASS ENGINEERING & SUPPLY ' COMPANY, a corporation; ROBERT 0. LOS AN3SLES OFFICE LYNCH, an individual, doing business as Lynch Asbestos Company and Lynch Asbestos Company, a corporation; PLANT INSULATION COMPANY, a corpora INDUS ACCIDENTCOSSSSCff state O.- FILED AUG 3 1981 tion; COAST INSULATION PRODUCTS, a corporation; ARMSTRONG CORK COMPANY, a corporation; J. T. THORPE, INC., WILLIAM XA ' /VS, SECRETA.-;'/ a corporation; WARREN AND BAILEY; TOTMAN-MORGAN COMPANY; OWENS-CORNING FIBERGLASS COMPANY, PACIFIC COAST DIVISION; PLANT INSULATION AND THORPE COMPANY; WESTON ASBESTOS COMPANY; M. R. CARPENTER; PLANT RUBBER AND ASBESTOS WORKS; EARL 0. STICE COMPANY; UNITED CORK COMPANY; CORK INSULATION COMPANY; MUNDT CORK COMPANY; METAL CLAD INSULATION COMPANY; OIL FIELD CONSTRUCTION; E. J. BARTELLS COMPANY; ISOTHERM COMPANY; JAMAR & OLNEH C COMPANY; ASBESTOS PRODUCTS COMPANY; UNITED REFRACTORY CONSTRUCTION COMPANY; PHILIP CAREY MANUFACTURING COMPANY; REESE INSULATION COMPANY; LOS ANGELES CORK COMPANY; MOUNTAIN STATE CONSTRUC T I O N COMPANY; FIBREBOARD PAPER PRODUCTS CORPORATION; PARRIFINE COMPANY, IN CORPORATED; C. R. DUTTON, C. A. LEIGHTON, WESTON FIBRE GLASS SUPPLY, LTD.; T?MDT O T T TiTT rmtT * ri r* t,T^po?atlon> AMERICAN MOTORISTS INSURANCE COMPANY, a corporation; ZURICH INSURANCE COMPANY, a corc a t i o n ; PACIFIC EMPLOYERS INSUR ANCE COMPANY, a corporation; STATE COMPENSATION INSURANCE FUND; THE UNITED PACIFIC INSURANCE COMPANY, a corporation; STANDARD ACCIDENT INSURANCE COMPANY; a corporation; GENERAL ACCIDENT, FIRE & LIFE CORPORATION, a corporation; NATIONAL AUTOMOBILE AND CASUALTY COMPANY, a corporation; LIBERTY MUTUAL INSURANCE COMPANY, a corporation, Defendants. Hays, McLaughlin and Evans, y John F. McLaughlin applicant's attorneys Spray, Gould and Bowers, by David B. Allen, attorneys for Guarantee Insurance Co. Herlihy and Herlihy, by George Thompson, attorneys for Industrial Indemnity Co., Fireman s Fund Insurance Company, Argonaut Insurance Company, and Employers Liability Assurance Corp. of London, England ' Clopton and Penny, by Robert M. Penny, Paci^ic EngLoyers Insurance Co. Weingand, xipton, Kendig and Stockwell, by Claude Weingand, attorneys for United Pacific Insurance Company, General Accident Insurance Corporation and Associated Indemnity Co. Brobeck, Phelger and Harrison, by Rinaldi Sciaror Jr., attorneys for Plant Rubber & Asbestos worl self-insured, and Fibreboard Paper Products Corporation, formerly known as The Parrifine Company, Inc., also formerly known as Pabco Products, Inc., self-insured Joseph Bilchak, representing The Travelers Insurance Company Ray Cusick, attorney for Standard Accident Insurance Company F. E. Carignan, representing American Motorists Insurance Company . McCaskey and Dicker, by Robert Licker, attorneys for National Automobile and Casualty Co. George R. Haswell, by George C. Shelton. J r . . ( ( . IT IS ORDERED that James C. Riley be and he is hereby appointed Trustee for (race Riley, to serve without bond An Application for the statutory death benefit having been filed herein and the defendants under prior Findings and Award having filed their Request for the Joinder of additional . . employers and insurance carriers, together with Petition for v apportionment and Contribution, and the matters having been regularly heard and submitted for decision,,GEORGE A. MARTIME1LI, Referee, makes his Findings and Award for the statutory death benefit and Order for Contribution as follows: FINDINGS OF FACT 1. James Whitcomb Riley, bora October 23, 1899, while employed as an Insulator by various employers in the State of California, commencing in the month of January, 1920 and continuing through May 19, 1957, sustained injury arising out of and occurring in the course of his employment as follows: In the performance of his occupational duties, the employee sas exposed during each and every day of his employment to deleterious dusts which caused a pneumoconiosis with superimposed tuberculosis, rendering the employee totally disabled on May 1 9 , 19 5 7 . 2. Findings and Award issued in the employee's favor on November 27, 1959 imposing liability for said disability UDQn t.VlO riafBnftan*- 1 ( ( 4 - Said mployee died January 24, 1961. Sald death was proxlmately the result of the industrial injury herein. 5. Deceased left surviving him, totally dependent Grace Riley, his widow, who Is entitled to the statutory death benefit in the sum of $10,000.00, payable at the rate of $40.00 per week beginning January 25, 1961; together with the burial expense in the sum of $400.00. . ' " 6 ' -it-'i's-to.the best Interests e f the applicant herein that the death benefit be commuted and paid In a lump sum. 7. The total value of the claim herein Is the sum of $25,720.07, comprised of the following items: a) For temporary total disability Indemnity, $ 7,680.00; b) For medical treatment, $4,592.76; c) The commuted value of the death benefit, $9,326.76; d) Reimbursement for burial expense, $400.00; e) Reimbursement for self-procured medical treatment, $233.00; f) treatment*^ $1 ,487?55? S Ad"'lnlstra " fr medical 8 . Industrial Indemnity Company, a corporation, one of the defendants held liable under the original Findings and Award is liable for the payment of the entire Award herein. 9. Indemnity for all periods of temporary dis ability has been paid and all medical treatment furnished by Industrial Indemnity Company, a corporation, except as hereinafter noted; ( 12. The Travelers Insurance Company, a is entitled to a lien against unpaid compensation m $ 2 0 0 ,0 0 . . the sum or 13. Veterans Administration is entitled to a lien m the sum of $3,h87.55 payable by Industrial Indemnity Company, a corporation. 14. The Industrial Injury and death he the result of exposure to deleterious dusts over a continuous period of time and proxlmately caused by employments other than that for which industrial Indemnity company, a corporation, was the carrier. The liability of those known employers and Insurance carriers based upon periods of exposure is as follows: WhORP Plant Rubber and Asbestos <fc Works (Company) * Associated Indemnity Co. United Pacific Insurance Co. General Accident, Fire & Life Insurance Co. National Automobile & Casualty Co. American Motorists Insurance Co. Guarantee Insurance Co. Liberty Mutual Insurance Co. Standard Accident Insurance Co. State Compensation Insurance Fund Argonaut Insurance Co. The Travelers Insurance Co, Employers Liability Assurance Corporation, Ltd. of London, England Aetna Casualty & Surety Co, Fireman'5 Fund Indemnity C o . (Industrial Indemnity Co, Pacific Employers Insurance Co. 6 ,0 6 1 .8 1 81.85 842.05 51.26 84.47 M73.37 6 5 1 .7 7 441.09 219.31 lyO8 5 .58 733.59 1,324.91 1,481.54 1,530.59 2,374.97 2,705.28) 4 ,6 0 3 .6 3 Total $ 25,720.07 15. There are employers and insurance carriers 4**r 1..J-1 _ f Riley, Trustee, the sun of $13*447.31* payable forthwith, together with interest as provided by law; less $750.00 payable to Hays, McLaughlin and Evans, as attorneys' fees; less $200.00 payable to The Travelers Insurance Company, a corporation, and less the sun of $3*487.55 payable directly to Veterans Administration. ORDER FOR CONTRIBUTION IT IS ORDERED that the employers or carriers listed below pay to Industrial Indemnity Company, a corporation, the following amounts forthwith: Plant Rubber and Asbestos works (Company) $ 6,06l.8l; Associated Indemnity Co. 81.85; United Pacific Insurance Co. General Accident, Fire & Life Insurance Co. 842.05; 5 1 .26* * * National Automobile & Casualty Co. 84.47; American Motorists Insurance Co. Guarantee Insurance Co. 1*473.37; 6 5 1 .7 7 ; Liberty Mutual Insurance Co. 441.09; Standard Accident Insurance Co. 219.31; State Compensation Insurance Fund 1 ,085.58; Argonaut Insurance Co. 733.59; The Travelers Insurance Co. 1*324.91; Employers Liability Assurance Corporation, Ltd. of London, England 1,481.54; f PARTIES SERVED: 8-3-61 nn; ' Grace R'iley, 1596 West Juno Avenue,, Apartment 1, Anaheim, Calif, James C. Riley, 1596 West .Juno Avenue, Apartment 1, Anaheim, C-rlif. Veterans Administration, 5701 Bellflower Blvd, Long Beach ' Veterans Administration, 5901 East 7th Street, Long Beach Attn: A. P. Willis, Registrar Hays, McLaughlin and Evans, 6331 Hollywood Blvd, Los Angeles 28 Spray, Gould and Bowers, 1671 Wilshire Blvd., L.A. Herlihy and Herlihy, 412 W. 6th Street, L.A. 14 Clopton and Penny, 639 S. Spring St., L. A. 14 Weingand, Tipton, Kendig and Stockwell, 6ll S.Catalina, L.A. Brobeck, Phelger and Harrison, 111 Sutter St., San Francisco Joseph Bilchak, The Travelers Insurance Co. 510 W. 6 th St, L.A. Ray Cuslck,. Standard Accident Ins. Co^ 548 S._Kingsley, L.A. F. E. Carignan, American Motorists Ins. Co._3545-Wilshire, L.A-- ~ McCaskey and Licker, National Auto. & Cas. Co. 639 S. Spring, L.A. George Ha swell, Liberty Mutual Ins. Co. 714 S. Hill St., L.A. Petersen, Wills,& Hlestand, Employers Mutual Liability Insurance Co. of Wisconsin, 3540 Wilshire Blvd, L.A. Arthur Hershenson, State Compensation Ins. Fund, Box 2134, L.A.54 Associated Indemnity Co. Box 2133, L.A. 54 Guarantee Insurance Co. 1671 wilshire Blvd., L.A. Industrial Indemnity Co. Box 2252, L.A. 54 Fireman's Fund Insurance Co. 3440 Wilshire, L.A. Argonaut Insurance Co. 1001 Wilshire Blvd, L.A. Employers Liability Assur. Corp. of London, England, 639 s. New Hampshire, L.A. Pacific Employers Insurance Co. 1033 S. Hope St., L.A. United Pacific Insurance Co. 616 S. Shatto Place, L.A. General Accident, Fire and Life Ins. Co. 3535 w. 6th St.,L.A. Plant Rubber and Asbestos Co., c/o Plant Insulation Co. 2741.S. Yates Ave., Los Angeles Fibreboard Paper Products Corp. 475 Brannon St., San Francisco 19 Phoenix Indemnity Co. 3750 W. 6 th St., L.A. Aetna Casualty & Surety Co. 810 S. Spring St., L.A. 14 Zurich Insurance Co. 4465 Wilshire, L.A. McCartney, Hall and Ryan, 639 S. Spring St., L.A. Arnold Smith, Sacramento Division of Labor Statistics, San Francisco . Johns-Manville, Inc. P.O.Box 9067, Long Beach lOp Attn: Bert Gilbertson R E G I N A L D H S M A R T . M D. J O S E P H F. B O Y L E . M D. J O H N K S H I R E Y . M. D. MEDICAL O ff'C E BUILDING 136 w tS T S ix t h STREET LOS ANG ELES l7 MAOis on 5 - 7 6 9 7 S e p te m b e r 19 1957 M r. W illiam T. Hay s A ttorney at Law 6331 Hollywood B oulevard Los Ange'les 28, C alifo rn ia Dear M r. Hays: RH: Jam es W hitcomb Riley The following re p o rt is sen t to you a t the re q u e st of M r. Jam e s W. R iley whom we f ir s t exam ined on June 27, 1957 w ith re g a rd to his pulm o nary condition. The following histo ry and findings w ere obtained: R esidence h is to ry: M r, R iley was b o rn ir. Joplin, M isso u ri on O ctober 23, 1899. He has lived in the Los A ngeles a re a since 1903 with the following exceptions: In 1918 he w as b rie fly in Q uantico, V irginia. F ro m 1936 to 1942 he liv e d in San F r a n c is c o . In 1947 he w as in F re s n o , C alifo rn ia fo r two m onths. In 1952 he w orked in D aina, Indiana fo r six m onths. In 1955 he was in Santa M aria, C alifornia fo r fo u r m onths and in L as V egas, N evada for fo u r m onths. In 1956 h is w ork re q u ire d a seven m onth stay in San Diego, C alifornia. Occu pational h isto ry : Since 1919 M r. R iley has been em ployed in the heat insulation industry, his work req u irin g the application of insulating m a te ria ls to b o ile rs, steam pipes and o th er stru c tu re s requiring insulation. The insulating m a te ria ls which he has w orked w ith include asb esto s, block, D etrick block, Kalo, rockw ool, fib er g la ss, cork and Mono block. He believes he m ay also have w orked with diatom aceous e arth occasionally as a loose pow der to be applied ag ain st b o ile rs to provide a porous m a te ria l which will allow for expansion and contraction of the b o iler due to tem p eratu re changes. The other m a te ria ls m entioned above a re supplied in various form s such as blocks, cored cylinders, sheets, and blankets. Very often it w as n e c e s sa ry to cut the blocks o r sh eets using a hand saw . It w as also n e c e ssa ry to h am m er nails through this m a te ria l to se c u re it in its proper location. Since this w ork w a s often done in c o n fin e d sp aces su c h as boiler room s, a high dust concentration was frequently attained in poorly ( -Z M r. W illiam T, Kays Re: Jam es W hitcomb Riley ( S eptem ber 19, 1957 " le y W r e * " aSk * * concen- " e in " " * - I f to ness of b reath upon exertion which ha i i lrS t becam e aw are of sh o rt- feeU short oi breath " a T ta g r a pi < S an incline. Approxim ately th re e y e a rs c h iL C * " " * ta r when "P has p e rsiste d to the p resen t and is productive o f I t T l t l ^ a sputum daily. There has not been hem optysis e d e L 7 t h T 8" WMch m " C id pas. several m onths, h e ^ 's u C t i c e d f . ch est pam which is not related to e x ercise . . . . . lo w er " `a 110' usually d isap p e a rs spontaneously 1 to I t o i r , 7 1 ^ ' t " " ap p ro x im a te ly 20 pounds has o c c u rre d during the p . " m l & T * when h e ^ c ^ y ^ ^ ^ ^ ^ had a ro u tin e ch est film in May, 1957 . ^ v in g including x - r a v and Snu ^ p * a ,* ` a r th e r e x am in atio n s w e re m ad e d a ted duly ,5 1 ,5 7 i n d i ". ^ .p u C ^ T n ^ n ^ tl* ^ i h o 7 h t 7 h l t be/ a ' adva" Ced> Pui m n a r y tu b e rc u lo s is , a c tiv e ."8* i a s " " 3 e x a m ta e d b y 7 tm ; 7 a 7 s . S ^ o i i S 7 f ` 7 P reS eM ' " * -- ext p o rt o i J u ly 1 7 . 1957 w as th a t M r R il S t, w h o se ' "" elusion on his r e m o d e ra te , yw ith cav itaK o n ' * lle y had P" 1" ^ tuberculosis, right, 5 - i e- L E i l i i ! R s : 1) S h o r tn e s s of b r e a th w ith e x e r t i r m sin ce on set 3 1 /2 v e a r s nan ?\ d . . , cn e x e rtio n , p ro g r e s s iv e 2^ lto d3 tteeaassnpoonorn,s oJ f m u co id! sp u2tu) mP de ar silivs te n t cough fo ri 3 y e acr s , vp ro d u ctiv e OoIf 20 pounds during the p a st y e a r. *' ' 1<>SS f a PPro x i^ e l y q u e s t i o ^ -- ^ s ? s te m s :. N " th e r sym ptom s w ere e lic ited by sy ste m a tic r r f S f S l a S z s s t s x s s s t s . ' n comP^lcationS. A varicocele was removed in 1919. - 3- M r. W illiam T. Hays Re: Jam es W hitcomb Riley ( Septem ber 19, 1957 hxstory; M r- R aley's m o th er died a t age 74 of unknown cause. His fa th e r died a t age 73 of a h e a rt a tta ck . He h as one b ro th e r and two s is te r s who a re living and w ell. His wife and th ree ch ild ren a re living and in good health. T here is no fam ilial history of tuberculosis, diabetes, cancer or hypertension. Habits^ M r. R iley sm okes one package of c ig a re tte s daily and uses alcoholic b ev erag es to a m o d erate extent but tak es no re g u la r m ed icatio n s. -- E?lc al exam ination: M r. R iley was seen to be a thin w ell-developed w hite m ale who a p p e a re d c h ro n ic a lly ill. H is h eig h t w as 69 1 /4 inches* w eight, 119 pounds; te m p e ra tu re , 9 3 .6 d e g re e s; p u lse, 80 p e r m in u te ;' re s p ira tio n s , 20 p e r m in u te; and blood p r e s s u r e , 1 2 2 /7 0 . E x am in atio n of the chest revealed m oderate in crease in the a n te ro -p o ste rio r diam eter of the chest. Both pulm onary bases lagged with deep in sp iratio n . There w as in c re ased m uscle tension over the rig h t upper p o sterio r c h est. The lun^s w ere h y p e rre so n a n t to p e rc u ssio n over the upper lobes and th e re w as dim inished resonance at both b ases. B reath sounds w ere bronchovesicular over the upper tw o -th ird s and bronchial over the b a se s. Fine crep itan t and crackling rales were present at all bases, anteriorly, posteriorly and laterally , th e point of m axim um cardiac im pulse was ju st to the left of the xiphoid p r o c e s s . No th r ill w as p a lp a b le . A sin u s m e c h a n is m p re v a ile d and the h eart tones w ere distinct at the apex and distant at the b ase. No m u rm u rs w ere h eard and the pulm onic second sound was slightly louder than the ao rtic second sound. T here was erythem a and induration of approxim ately 2 cm . d iam eter on the rig h t fo re a rm which M r. R iley stated w as the re sid u al of a recently adm inistered skin te st. The rem ainder of physical findings w ere all within the range of n o rm al. g y roscopic exam ination of the chest: An in filtra tio n with possible cavitation was noted in the rig h t apex and subapex. L in ear fib ro sis was p re sent in the low er half of both lungs. The diaphragm s m oved approxim ately 3 to 4 cm . and equally. In the la te ra l p ro jectio n they w ere noted to be fla t. Although the h e a rt was not totally enlarged, the rig h t v en tricle appeared prom inent in the left a n terio r oblique projection. Laboratory evaluation: 6 -2 7 -5 7 - B lood count: Kgb. 927o o r 1 3 .5 g m s . WBC 9 ,5 0 0 . P la te le ts average. D ifferential - Eo. 4. Pm n. 54. Seg. 50. Lymph. 39. Mono. 7. M orphology n o rm a l. H e m ato crit 46 m m . in one h o u r. S edim entation ra te ( W in tr o b e ) 31 m m . in o n e h o u r . C o r r e c t e d 29 m m . in one h o u r . M r. W illiam T, Hays Re: Jam es W hitcomb Riley S e p te m b e r 19, 1957 6-27-57 - U rinalysis: M orning, straw , c lea r, specific gravity, 1.011. N egative fo r album in and su g ar. M icroscopic - 0 to 1 w hite blood cell per high power field. Sm all am ount m ucus. R are epithelial. Few b a c te ria . * 6 - 27-57 - Intrader m al skin tests: Coccidioidin - negative. H isto- plasm in - negative, * 7- 2-57 - (C linical L aboratory ofC. R ichard Smith, M. D .) - Sputum specim en, 3 cc. m ucoid m aterial: W etmount fo r asbestos bodies: N egative. T h e re is one la rg e m a s s of e la s tic tis s u e show ing a lv e o la r fo rm a tio n . There* a re hyaline - glassy - straig h t fib res 3-5 m icrons in diam eter and 1/8 - 1/2 of an oil im m ersio n field in length. They r e s is t the action of acid. F lo tatio n -co n cen tratio n fo r a c id -fa st b acilli: N egative. GRAM STAIN shows larg e num bers of gram positive cocci in clu sters and in chains; gram positive diplococci and large gram positive ro d s. There are de- g en erated pus cells and a few ep ith elial c e lls. A cid -fast stain on the elastic tissu e rev ealed no a c id -fa st b acilli although som e of the m a te ria l was lost in tran sfer. 7-2-57 - Sputum specim en 3 cc. m ucoid m aterial (C linical L aboratory of C. R ic h a rd S m ith, M. D .): S u p p le m e n ta ry r e p o r t on s tu d ie s fo r a s b e s to sis bodies. The rem aining sodium hydroxide sedim ent was tre a ted with chlorox and centrifuged at high speed. The resu ltan t sedim ent and wetmount revealed three com pletely ch aracteristic asb esto sis bodies. These bodies give the P ru ssio n blue stain reactio n . 7 -2 -5 7 - 3 day sputum and g a s tr ic con ten ts 40 cc. cloudy flu id co n taining a p p ro x im a te ly 20 c c. m u c o p u ru le n t (C lin ical L a b o ra to ry of C. \ R ic h a rd Sm ith, M. D .): C u ltu re fo r M, tu b e rc u lo sis - s e v e ra l hundred N photochrom ogenic colonies of a c id -fa s t b a c illi (We do not believe th ese a re M. tu b e rc u lo sis. They a re s im ila r to a m y co -b acteriu m capable of causing hum an d ise a se . The guinea pig re s u lts w ill help to c la rify the identificatio n . M eanw hile o th er te sts w ill be c a rrie d out. Guinea pig inoculation fo r M. tu b ercu lo sis: N egative. (See attached le tte r) * 7-2-57 - C ulture from g astric-sp u tu m specim en: Screening $ S e n sitiv ity te s t: S tre p to m y c in - 99 8/10% of the o rg a n is m s a r e s e n s itiv e (2 / 10 % a r e r e s is ta n t) to 10 m eg . of s tre p to m y c in p e r m l. P a r a - a m in o s a lic y lic acid: 100 p e r c en t of the o rg a n is m s a r e r e s i s t a n t to 10 m eg . of p a ra -a m in o sa lic y lic acid p er m l. Isoniazid: 95 p er cen t of the o rg an ism s a re s e n s itiv e (5 p e r c en t a re r e s is ta n t) to 2 m e g . of is o n ia z id p e r m l. M r. W illiam T. Kays Re: Jam es W hitcomb Riley S eptem ber 19, 1957 7-10-57 - (C linical L aboratory of C. R ichard Sm ith, M. D .) 72 h r. sputum sp ecim en 25 cc. se ro -m u c o p u ru le n t: F lo ta tio n -c o n c e n tra tio n fo r a c id -fa s t b a cilli: 2 plus positive (20 to slid e). C u ltu re fo r M. tu b e rc u lo sis: Several hundred colonies of photochrom ogenic acid -fast h arilK ' These a re not M. tu b ercu lo sis but they a re c h a ra c te ris tic of a m y co -b acteriu m capable of causing human disease. D ia g n o sis: 1) P u lm o n a ry f ib r o s is ex h ib itin g th e p rin c ip a l fe a tu r e s of asb esto sis although contributing effects from the inhalation of silica, m agnesium , fib erg lass, foam glass, rockwool, and possibly diatom aceous e a r th m u s t be c o n s id e re d . 2) P u lm o n a ry e m p h y se m a of m ild to m o d e ra te s e v e rity and se c o n d a ry to p u lm o n ary f ib r o s is . 3) P u lm o n ary in fla m m a to ry disease involving the apex and subapex of the rig h t lung. P relim in ary studies indicate that this process is due to a non-tuberculous photochrom o genic a cid -fast bacillus which m ay produce a disease quite sim ila r to tu b e r culosis in its clinical m anifestations and chronicity. D egree of d isab ility : M r. R iley is p erm an en tly and to ta lly d isab led fo r the type of w ork which he has done since 1919. At p resen t he is totally disabled for any type of physical activity pending control of the pulm onary inflam m atory disease. P rognosis: Pulm onary fib ro sis of this type tends to be p ro g ressiv e w hile dust exposure continues, as the s e ria l ch est x -ra y s have d em onstrated in this c a se . P ro g re ssio n is also apt to occur in the p resen ce of su p e r im p o sed chronic pulm onary in flam m a to ry d is e a s e . A dequate tre a tm e n t of the infectious p ro cess with m odern drugs m ay m odify the fib ro tic reactio n , but the n a tu re and degree of this influence is not p red ictab le owing to the relativ ely sh o rt period that this fo rm of tre a tm e n t has been u sed in the presence of combined pulm onary disease. Recom m endations for treatm ent: M r. Riley req u ires sanatorium care with b ed re st and appropriate chem otherapy. P relim in ary studies by D r. C. R ichard Sm ith's lab o rato ry indicate that Streptom ycin and Isoniazid a re the m ost effective of the drugs te ste d fo r the tre a tm e n t of the in flam m atory disease. Physical exam ination and x -ra y study of the chest at periodic in te rv a ls w ill be n e c e s sa ry to evaluate the re sp o n se of the in fla m m a to ry d isea se and to d etect any p ro g re s s io n of f ib r o s is . C om plete pulm onary function studies should be repeated in approxim ately one y ear. In the event p ro g ressio n of fib ro sis is d em o n strated , co n sid eratio n of m o re ! ( ( - 6- M r. W illiam T. Kays Re: Jam es W hitcomb R iley S ep tem b er 19, 1957 agressive therapy such as interm ittent positive p ressu re breathing and stero id m edication m ay be n ece ssa ry provided the inflam m atory disease is u n d er sufficient co n tro l to p e rm it such th erap y . g-glationship of p atien t's condition to em ploym ent: M r. R iley 's occupation fo r the la s t 35 y e a rs has been confined to the application of heat insulation m a te ria ls. There has been no other source of industrial dust exposure. The x -ra y film s show pulm onary fib ro sis of a p attern which is m ore suggestive of asb esto sis than any o ther single entity. A sbestos bodies have been reco v ered from the sputum . T here is no clin ical evidence of b ronchiectasis nor of chronic passive congestion of the lungs due to left v e n tric u la r fa ilu re . In m y opinion, M r. R iley has pulm onary fib ro sis of occupational origin. The p resen ce of pulm onary fib ro sis m ay have been a significant facto r in the developm ent of pulm onary inflam m atory disease and its subsequent course. . If I m ay am plify o r clarify any of the preceding sta te m e n ts, it w ill be m y p riv ile g e to do so. Yours very truly, JK S:ark Enc s . t