Document 2q2zyZDqMX2MyJ0BXpeg57BQL

FILE NAME: Philip Carey (PC) DATE: 1944 Nov 20 DOC#: PC022 DOCUMENT DESCRIPTION: Medical Records of Herbert Scobie P-44-326 or. 20, 1944 (Received) Herbert C. Scobie Age 42 P.N. Hr*. 5 Reoelved from Dr. R. J. Ritterhoff of Hamilton County Yubereuloale Sanatorium of Cincinnati, Ohio, eeren sections of lung and one eaoh of heart, spleen, llrer and with a green connective tleeue mixture plue seven unstained sections. On December 26 he sent a generous gross sample of lung and hilar lymph node tissue for chemical, petrographicand speotrographio analysis. Ris diagnosis was asbestosls and sarcoid OCCUPATIONAL HISTORY - employed for 25 years in the pipe depart ment of the Phillip Carey Company of Cincinnati, Ohio; for the last fl or 6 years as foreman. Product, "Air Cell Paper Asbestos Pipes" - * using starch, sodium sllloate glue and asbestos. Prooese, wet exceptfor cutting and squaring ends of finished material. Some dust in spite of exhaust. The hazard in the plant it probably not great as the labor turn-over is low and many employees have worked from S to 30 years. Ko record that flcoble had been exposed to beryllium or fluorssoent substanoes here or in any other employment. For Prose Description! see appended protoool. Note that the size--, -and frequency of the large flbroue grey pigmented fool aeena mors pro- , minent on grose than on nlcroscoplo examination. The lesions aa in oases of uncomplicated aebeatosie, occur toward the centre of lobules * whloh are separated from one another by thick non-pigmented eepta. How- /' ever, there eeema to be more flbroue replacement and leea emphysema accompanying the grey pigment than in most oaeee of uncomplicated - asbeatoele. The minute oolorleea sarcoid nodules are readily discernible throughout the parenchyma and In plaoea tome project above the surface of the thickened pleura. The hilar lymph nodes are larger than la simple asbestosls. HEART - floss Interstitial fibrosis with a small sarcoid nodule aur- roundsi by connective tissue in a papillary muscle. s. \} * * LUMOfl - The diagnosis of asbestosls and aarcold la conflrssd. The asbeatoele aeema. to be moderate in extent but old while the aarooid consists largely of young proliferative nodules without conglomeration or hyaline ohangee. Both inclusion bodies of saroold and asbestosls bodies art present. Xndloatlv# of asbestoala are the thick flbroue pleura and inter lobular septa and the elongated stringy 'areas of fibrosis extending V along trunk often more or lees perpendicular .to the pleura. The latter lesions are composed of fairly heavy diaorete collagenous fibres and ^ oontala considerable amounts of dust and sons asbestosls bodies. These masses have contracted to produce more or leas stellate borders with . radical strands extending Into the surrounding alveolar walls. Extending into these mssefls are terminal bronohkles whose lumina are largely oloeed. Of course, the associated branches of the pulmonary artery.also enter ths 'mas* but there has been so much oontraotion of ths soar tlosms thst the h n P-44-326 Pag# Tiro characteristic peribronchiolar relationships are no longer reoognixable. The saroold lesione are email fibrous or more rarely oellular nodules containing one or more giant cells. As In uncomplicated oases . they oocur In interstitial tissue, the sheaths of bronchi and blood vessels and the alveolar and Interlobular septs. In addition, nodules are found at the margins of areas of the dust fibrosis.Vhere the dust reaction is heaviest, especially beneath the pleura, the nodules are definitely within the aabeetotio fibrous tissue. The giant and eplthelold cells of the sarcoid show no evidence of degeneration as evidenced by fat stainable with Soharlach R. They are surrounded by a delicate reticulum (black with Foot-Blelsohowskl) and at the periphery of the nodule are concentric bands of heavy non-hyalins collagen. The elastic tissue is probably pushed aside in the formation of nodules. Inclusion bodlee in the giant oells of the earoold granulomas are fairly numerous; those that oocur are largely of the round or oval orenated ooncholdal type. These stain black with hematoxylin, red with the aold fuehsln of Van Qleson-Velgert instead of black like elastic tissue. Von Kossa's oaloium stain is negative. They give a strong Prusslon Blue reaction for iron. On testing other cases of sarcoid It is found that in them also the i n d u e ions contain iron and not elastic or oalclum. Occasionally typical asbeetosls bodies are found within the sarcoid nodules. The asbestoele bodies in the pneumoooniotlo tissue reveal marked and unusual modification In ferrooyanlde preparations. Many of the bodies have one or several very large swellings either ^terminal or in the middle of the fibre. Bitarre forma develop about the partially separated bundles of asbestos. The oonoholdal rounded masses are much more abundat here than within the earoold nodules. Muoh of the grannulmr' dust in the lesions is apparently iron. The blood vessels and bronchial tree show nothing unusual except for / the sarcoid nodules in their sheaths. There le no evidence of Inflammatory reaction or pneumonic exudate. LYKFH N0DE9 - Largely replaced by aarooid nodulee varying from oellular to fibrous in oharaoter. No necrosis. All show giant celia vacuolated but no Inclusion bodies. Varying numbers of lymphocytes in most of the lesions. flPTrgffi - A few small sarcoid nodulea with giant oella but no inclusion bodies. LIVER - Bams as spleen. EIDNETB - 0 earoold; small fool of schleroeie with arteriolar sclero sis.