Document 5kgJgekdmvOJzdz2xGVOE83wz

FILE NAME PC PC PC DATE DOC PC DOCUMENT DESCRIPTION L D IN THE CIRCUIT COURT FOR ANNE ARUNDEL COUNTY STATE OF MARYLAND, Plaintiff Plaintif Plaintiff Plaintif PlaintiffPlaintif Plaintif Plaintif Ye | KEENE CORPORATION et al.y Defendants , 43 Civil Action No. 1109600 33 s IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF SOUTH CAROLINA IN RE w Asbestosis Cases : Shipworker : Insulator ACE REPORTING INC 216 9th St / Barrister House / 6th Floor CINCINNATI OHIO 45202 TELEPHONE AREA CODE 513 241-3200 IN THE CIRCUIT COURT STATE OF SOUTH CAROLINA COUNTY OF RICHLAND 3 4 UNIVERSITUNIVEYRSITY OF SOUTH 5 CAROLINA, 5 Plaintiff ey W.R. GRACE AND COMPANY oF et et al al . S Civil Action No. CP 40-3769 40-3769 E Defendants. 10 ] 12 CIRCUIT COURT 13 OF COOK COUNTY ILLINOIS 14 15 ys Lavin Lavin al Lavin v Flintkote, et al Pauly Flintkote 161166 v Flintkote et al Pyne v Flintkote et al Greaney Flintkote al Flintkote Flintkote et al i v et 17 17 Grant v Flintkote et al Healy v Flintkote et al 18 20 1 ^ SHULK LLLL | 22 23 24 ACE REPORTING INC CINCINNATI OHIO IN IN THE UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF ILLINOIS N EASTERN DIVISION re fl CHARLES E. LYNCH and 5 ELIZABETH LYNCH S t Plaintiffs 6 J wep So KEENE CORPORATION et al.v Defendants WY et No. 8071 IN THE DISTRICT COURT OF THE STATE OF DELAWARE IN AND FOR NEW CASTLE COUNTY 13 13 14 | 15 15 i 16 16 In Re Asbestos Litigation 17 17 18 1919 20 20 21 21 fl H WALL a a ~ . Master File No. Misc 85-100 Limited y to , C.A. No. 85-03 Morean 3 C.A. C.A. No. 84-541 Overkamp 43 C.A.C.A. No. No. 85-61 85-62 BYown ( Grady C.A O'Neal 7 C.A. C.A. No. 82-79 ( O'Neal : C.A. C.A. No. 84-251 Fogleman C.A. C.A. No. 85-550 Williams JJB os W ~ HAV a } a ~ " fl E ~ 1 1 ACE REPORTING INC CINCINNATI CINCINNATI ONIO IN IN THE SUPERIOR COURT OF THE STATE OF DELAWARE 2 3 In Re Asbestos Litigation C.A. C.A. C.A. C.A. C.A. C.A. C.A. C.A. C.A. C.A. C.A. C.A. C.A. C.A. C.A. C.A. C.A. C.A. C.A. C.A. C.A. C.A. C.A. No. No. No. No. No. No. No. No. No. No. No. No. No. No. No. No. No. No. No. No. No. No. No. 125 Lee 81C Blissick 81C MergenthaleMergrenthaler ) 104 Pannell 82C MR George 82C Conway 82C Shewbrooks 82C Murphy N0-7N0 0-70 Muzzi 82C Mancari 82C Clark 82C Sheppard 82C Korecki 82C McCarty 105 DeHart 102 Logan 140 Stagg 108 Millard 83C Waseilewski 83C Hunter 119 Lloyd 84C Cale 84C Tull C.A. C.A. C.A. C.A. C.A. C.A. C.A. C.A. C.A. C.A. No. No. No. No. No. 84C 72 Huber 83C McDaniel) 84C Davis 145 Bradley 84C C.A. C.A. No. 84C C.A. C.A. C.A. C.A. C.A. C.A. No. No. 84C SE34 JA 85C 85C 85C - JA - 42 42 C.A. C.A. C.A. C.A. C.A. C.A. C.A. No. No. 85C52 85C C.A. C.A. C.A. C.A. C.A. C.AC.A.. No. No. No. 121 121 85C Farrall 85C Bell C.A. C.AC.A.. No. No. 85C 85C Lipscomb) Oliphant C.AC.A.. No. 115 Woodler C.A. No. 85C Bjorson | C.A. No. 85C C.A. No. 85C McGuObierrlee | C.A. No. 85C Summers : C.A. No. 85C Hanson C.A. No. 85C Graham C.A. No. 135 Jensen ) C.A. C.A. C.A. C.A. C.A. No. No. No. No. No. 120 Hessler 85C ( 145 ( ( 85C 86C ( Deposition of ROBERT J. RITTERHOFF M.D. a wie- ness herein taken by the plaintiffs as upon direct examination pursuant to all applicable rules of civil procedureprocedure and and and pursuant ACE REPORTING INC CINCINNATI OHIO Deposition Avenue Cincinnati Ohio at 9:00 a.m. On January 30 1986 before Betty J. Schwab a notary public within and for the State of Ohio Co 21 24 ACE REPORTING REPORTING CINCINNATI OHIO OHIO the the Plaintiff State Evelyn O. Assistant Assistant Assistant Office of Cannon, Attorney the Attorney Calvert and and 5 Baltimore J. Brickman Brickman Esq Blatt & Fales Fales Suite 100 100 East Bay Executive Center Charleston Charleston Charleston South Carolina 29402 29402 29402 29402 29402 On behalf of thethe Plaintiffs in the State of in various jurisdictions Lawrence Madeksho Esq Slenderbolic Bldg 8320 Gulf Freeway Suite Houston Texas 77087 218 On behalf of the various Plaintiffs Plaintiffs Plaintiffs District Court Court Chicagoanad ndand Cook County Chicago in the Federal of Court of M. Johnson Jackson Blvd. Esq Illinois 60604 On behalf Cincin ati the the Plaintiff Cincinnati Board of of Education 20 Michael M. Hollingsworth Esq Esq Blessing Blessing Hollingsworth & Sunderland Sunderland SSunduerlnandderland Suite 902 902 125 East Court Street Cincinnati Ohio 45202 22 ACE REPORTING ING | CINCINNATI CINCINNATI OHIO APPEARANCES CONTINUED: 2 OnOn behalf of the Defendants Defendants Celotex Corporation and Carey Canada James James James Bloom J. Montgomery & Greene Esq 2000 Central Trust Center Cincinnati Ohio 45202 On 1200 Gwynne Cincinnati & McCaslin Building Ohio 45202 On behalf of the Keene Corporation Defendants Willington in South South Carolina Group and James A. Atkins Robert H. Hood & Esq Associates 155 King Street Charleston South Carolina 29402 On behalf of the Defendants W.R. Grace in South Carolina and EmpireEmpire Ace Insulation Insulation Manufacturing Manufacturing Corporation Ruth Ruth Ruth 1340 1340 1340 1340 Thiedke Pickens Porter Street Esq P.O. Box 7788 Columbia South Carolina 29202 29202 On behalf of the Defendant Fiberboard Ted T. Martin Esq Paxton & Seasongood 1700 Central Trust Tower 1 West Fourth Street Cincinnati Ohio 45202 23 ACE REPORTING REPORTING REPORTING CINCINNATI ONIO APPEARANCES APPEARANCES CONTINUED CONTINUED ) On behalf of the Defendant GAF Corporation John Baker Baker Burtch Esq Hostetler Capitol Capitol CapitolCapitol Capitol Capitol CapitolCapitol 65 East East Square State Street Columbus Columbus Ohio 43215 of the Defendant U.S. School District case Gypsum in Esq Warren & Rubenstein Center Columbus Ohio 43215 Enginering On behalf of the Defendant Combustion Engineering EngineeringEngineering Geoffrey Stern Esq Knepper White Arter & Hadden 180 East Broad Street Fourth Floor Columbus Ohio 43215 On behalf of the Defendant Raymark Industries Roy E. Leonard Green & Green Esq 1324 Wayne Avenue Dayton Ohio 45410 of On behalf of the Defendant Nicolet Gary F. Franke Esq Lindhorst & Dreidame 1700 Central Trust Center Fifth and Main Streets Cincinnati Ohio 45202-4116 On behalf of the the Defendant Astor Insulation Jerome J. Haskell & Duchowicz Perrin Esq 11 South LaSalle Street Chicago Illinois 60603 REPORTING CINCINNATI CINCINNATI ONIO M.D. EXHIBITS EXHIBITS EXHIBITS PLAINTIFFS RITTERHOFF RITTERHOFF RITTERHOFF EXHIBIT EXHIBIT dated , a letter letter letter dated dateddated November 1 1944 No. No. , a letter dated November 10 1944 No. No. No. No. a letter dated December 23 1941944 4 letter , a letter dated December 1944 report dated November 20 1944194 1944 , a copy of The American Journal of Pathology IDENTIFIED IDENTIFIED IDENTIFIED IDENTIFED IDENTIIDENFTIFIIED ED ACE ACE REPORTING INC CINCINNATI CINCINNATI , OHIO ROBERT J. RITTERHOFF M.D. 2 of lawful age a witness herein being first duly sworn as 3 hereinafter certified was examined and deposed as follows 4 DIRECT EXAMINATIEXAO MINANTION 7 ih Dr. Ritterhoff would you state your name and | address 03 ; ad i 10 I 11 MR MONTGOMERY Before we begin the deposition can you get the representation of people on the record so we know who is doing what with whom or who we have here 12 Ok 13 13 MS CANNON Assistant Attorney General for for the State Maryland of Maryland In 4 MR MONTGOMERY And you're appearing in 1g which case MS CANNON State of Maryland vs. Keere | Corporation et al It's in the Circuit Court ' i 19 1 for Anne Arundel County Maryland MR MONTGOMERY: I just want names and 20 cases basically That's good enough to start 21 22 | with MR BRICKMAN My name is Mike Brickman 23 I'm appearing here on behalf of the law firm of 24 Blatt & Fales We have plaintiffs in a number of of jurisdictjions urisdictions in which this has been noticed including but I'm not sure it's limited to the South Carolina the United States District Court for the Northern District of Illinois Eastern Division and I'm not sure that's all but I know it's at least in those cases and if there therethere there there there On others I'll be sure that the court reporter gets those others MR MONTGOMERY Can you get us the names of those cases the ones that you know of for now that have been noticed MR BRICKMAN In the District Court For the District of South Carolina this deposition has been noticed for all the asbestosis cases They have a caption there of In Re Asbestosis Cases and also it has been noticed in the State Court South South South South South Carolina Carolina Carolina Carolina Carolina Carolina Carolina Carolina in in in in The University of South Carolina case case case vs. W.R. Grace et al and in the Northern District of Illinois it hashas been bbeeneen specifically noticed in the case of Charles Charles Charles E. E. Lynch and Elizabeth Lynch vs. Keene Corporation MR MONTGOMERY Thank you ACE REPORTING INC CINCINNATI CINCINNATI Onto MR MADEKSHO My name is Larry Madeksho I'm I'm here here here here on on behalf behalf behalf behalf behalf behalf of of the the plaintifs plaintif s plaintiffs plaintiffs plaintiffs plaintif s plaintifs plaintifs plaintiffs plaintiffs inin in regardregard regard regard regard regard MR MONTGOMERY Has there been a notice MR MADEKSHO No. I just became aware of the deposition I think Monday MR MONTGOMERY So there is no pending notice of deposition deposition in this case MR MADEKSHO That is correct MR BRICKMAN Before we go on I also have with me notices of depositions of Dr. Ritterhoff in the Superior Court of the State of Delaware in and for New Castle County In Re Asbestos Litigation and in the District Court of the State of Delaware In Re Asbestos Litigation MR MONTGOMERY Would it be possible for counsel for the plaintiffs to give the court reporter copies of all of the notices in which this deposition is proceeding MR BRICKMAN That will be fine I'm not Sure these are all the cases in which it has been noticed We will give her those to make a part part of the recorrecod rd if you like and we will provide ACE REPORTING INC CINCINNATI CINCINNATI CINCINNATI OHIO OHIO with her with copies of any other notices that were sent out MR MONTGOMERY My name is James J. Montgomery from the firm of Bloom & Greene In Cincinati Cincinnati Ohio I'm here in property damage cases in which there is a legitimate notice issued for the Celotex Corporation and Carey Canada with the exception of the Selah School District case in Washington which I'm only here here here here here Phillip Carey In the personal injury cases in which there has been a legitimate legitimate notice issued I'm here on behalf of the Wellington Group of defendants except insofar as there are other counsel here that are specifically appearing for the Wellington Group Group in specifically noticed personal injury cases cases would also like to specifically this deposition in any casecase case case casecase in in which which which which there there there there there is is not not a valid valid valid valid valid notice notice notice notice notice notice that that that that has has hhas as 20 20 Carey is involved in the property damage aspects or the members of the Wellington Group are involved in a personal injury aspect ACE ACE REPORTING CINCINNATE CINCINNATE OHIO Does that cover it MR DEMICHELIS I think so On behalf behalf of the Corning Fiberglas I would speak to the same objections which Mr. Montgomery has made Could you identify MR DEMICHELIS: My name is Clement J. DeMichelis MS CANNON : Michaels MR DEMICHELIS : DeMichelis I join Montgomery in objecting to use of this in any proceeding in which it has not and timely noticed MR ATKINS I'm Jim Atkins with Hood & Associates in Charleston and I behalf of the Wellington Group as well as the property damage cases properly noticed for Keene tion MS PORTER My name is Ruth Porter I'm here on behalf of W.R. Grace in South Carolina and Empire Ace We would adopt Mr. Montgomery's ACE REPORTING INC objection in its entirety MR MARTIN Ted Martin Martin with Paxton & Seasongood in Cincinnati here on behalf of Fiberboard Fiberboard Fiberboard in the property damagdaemage cases cases cacsaesess , and I join in Mr. Montgomery'sMontgomery's objections. MR BURTCH My name is John H. Burtch I represent GAF Corporation and would join join in Mr. Montgomery's MR FRYE FRYE Richard Frye Frye Columbus ~e = TIL here in the Selah School District United States Gypsum pursuant to notice and in the objection objection to the use of the depo- sition in any other case in which it's it's not noticed Geoff Stern reprrepreessenetinngting representing Combustion Engineering in the Selah School Same objection MR LEONARD Roy Leonard Green & Green Green Green Green We're representing Raymark Industries Industries in the two cases that have been noticed United States District Court for the District of South Carolina South South Carolina Carolina Carolina Carolina Carolina , etc. vs. W.R. Grace Company and in the United States District Court Northern District District of Illinois Eastern District Charles Lynch and 2 Elizabeth Lynch vs. Keene Corporation et al 3 MR HOLLHIOLNLGISNGWSOWRORTH HOLLINGSWORTH I'm Michael HHolingsworth ollingHolingsworthsworth 4 representing the Cincinnati Board of Education 5 here observing DIRECT EXAMINATION CONTINUED Dr. Ritterhoff would you state your name and Cincinnati Robert John Ritterhoff 123 Hosea a, is Dr. Ritterhoff is that your home address ? Not today Are you retired right now Partially And you also do 19 A I'm I'm working five 20 Where that right right right right right ? At Deaconess Hospital Straight Street Straight Avenue Avenue Avenue Avenue Cincinnati to medical school ACE REPORTING INC CINCINNATI CINCINNATI CINCINNATI OHIO After you graduated did you do a residency residency Au I interned first Q Where - A U.S. Marine Hospital Stapelton Stater Island New New YorkYork York York , then then then then returned returnedreturned returned returned returned returned here hhereere to the department of pathology Cr University of Cincinnati I guess that was '37 138. I don't remember which And there I remained until 1973 o oO oh& a Meaning that you remained in the department of Cincin ati pathology at the University of Cincinnati until 19737 X Yes in various capacities capacities capacities 0 Did Did you do your internship in pathology Au No. I did that L it was a general internship Q Doctor are you licensed to practice in Ohio A Right Q In any other state A I had reciprocity with Kentucky but whether that is valid today I don't know 0 Doctor are you Board certified Q Doctor you said that beginning in approximately 1937 you have been associated with the University of Cincinnati 22 22 in various capacities 23 23 A All right I was sent from the department of pathology to the Hamilton County Tuberculosis Hospital on a part- ACE REPORTING INC CINCINNATI OHIO time basis I guess in '38 and I was to continue my affiliation with the department of pathology That continued until '47 In '47 '47 I became childish as I learned that the electrician at the hospital was making more than I was and quit Dunham went to 4 St. ElizEabethlizabeth Elizabeth Hospital Hospital HospitalHospital Hospital Hospital Hospital Covington Kentucky full time continued 5 on a part basis in the department of pathology Os After 23 years at St. Elizabeth I was was fired fired fired fired fired and and and andand then I returned I guess in '70 on a temporary appointment to the department of pathology while they were looking for a new departmental head remained there until '73 In '73 the new departmental head decided he didn't need my services I then went to the Hamilton County Coroner's Office an andd remainerdemained remained remained remained remainedremained there there thertehere thertehere there there until '79 being retired A month later I began work at Deaconess Hospital part time Q Doctor I would like to back up and ask you a couple of questions You said that when you began at the Hamilton County Tuberculosis Hospital that you continued on a time basis in the department of pathology at the University of Cincinnati Au .. Cincinnati Right . And what were you doing at the University of A Teaching 0 What were you teaching ACE REPORTING INC CINCINNATI ONIO Were you full time at Hamilton Hospital HospiitatlalHoHspoistaplitaHolspital Hospital ? Aa Eventually I became full time standing that was to continue continue at the medical On remember approximately approximatelyapproximately Tuberculosis the under- HospitalHospital Hospital Hospital Hospital Hospital Hospital Hospital Hospital And what were your duties ran the laboratory Were Were you you the Originally it was Dr. Dunham by Dr. Skavlem John WhatWhat What What year year year year was was it that Dr. Skavlem immediate immediate supervisor supervisor ? followed Do you know what his title was was your immediate supervisor Well he would have been the The medical director director of the Hamilton County Tuberculosis 24 was appointed by the University University University of Cincinnati ACE REPORTING INC CINCINNATI CINCINNATI CINCINNATI OHIO Q When you ran the laboratory at the Hamilton County ch Tuberculosis Hospital did you also supervise students from the 4 de They came out there yes hum 11 And worked in your laboratory 6 A. NO They came out for demonstrations and lectures Q Lectures by you A By the various members of the staff Q Exactly what were your duties in running A. Well one would have been the autopsy service They were running around 100 autopsies a year Usually I had 12 13 the help of a resident on that And then the other problems 14 were teaching medical students and then supervising the depart- 15 ments of chemistry and microbiology hematology P You were supervising those departments at the 17 A Yes a You said that part of your duties included con- ducting about 100 autopsies a year A Right Q How did you determine which bodies you were going to autopsy A That was determined for me by the doctor who ACE ACE ACE i REPORTING INC | CINCINNATI CINCINNATI CINCINNATI OHIO requested the autopsy Q WereWere Were there any ILL what doctors requested the autopsies for you Would this have been across the whole city Cincinnati of Cincinati Cincinnati Cincinnati CincinnatCiincinnati Cincinnati Cincinnati Cincin ati Cincinati ? A No just the patients at Dunham Hospital or the the the Hamilton County Tuberculosis HospiHosptital al 6 0 Doctor Dunham Hospital is a different hospital from the Hamilton County Tuberculosis Hospital fl No The name was changed to Dunham I don remember the year Q Did you aautopsy utopsy all patients who died in the Dunham Hospital 12 13 No You autopsied only those patients on whom you had a permit 14 a When you left Dunham Hospital in 1947 to go to St. St. Elizabeth Elizabeth Elizabeth Elizabeth Elizabeth Elizabeth Elizabeth Elizabeth Elizabeth Hospital Hospital Hospital Hospital Hospital Hospital Hospital Hospital fl 16 17 A ~. what was your title at St. Elizabeth A Director of the laboratory Q. Is St. Elizabeth Hospital still around A. Yes ( When you went there in 1947 was it a specialized specialized A It was a general hospital ACE REPORTING INC CINCINNATI OHIO OHIO Did it remain a 19707 a) Hospital Hospital the the goddamn Yes when you left And what were at at St. St. St. Elizabeth Elizabeth Elizabeth Elizabeth Elizabeth Elizabeth Elizabeth Elizabeth Elizabeth The same as I gave you for Dunham Hospital Fun year 1414 Autopsies Approximately how many autopsies did you dodo a Elizabeth BY ''555 5 I think we were up to around had resident help and then it declined autopsies has been 19 19 you became full time ment of pathology University of Cincinnati right right right right right ? Yes on a temporary appointment ACE REPORTING INC INC CINCINNATI OHIO QQ Q Before we get to that from 1947 to 1970 while you were full time at St. Elizabeth Hospital you continued in 3 your parttime capacity at the University of Cincinnati 4 Q And that would have been teaching 6 A Teaching A No. 2 What was your position AU Associate professor Q And did you have any dutiesduties other than teaching teachingteaching teachintegachingteaching ? A No. a What was your title from beginning when you in joined the Hamilton County Coroner's office in 737 ,,, Then I became known as a deputy coroner fy, Who was the coroner in 19737 A Dr. Frank Cleveland 18 0 Did you remain deputy coroner until you retired Q Do you have a title right now in your time position at Deaconess Hospital A No.No. Q You began began there in 1979 in your your time ACE REPORTING INC CINCINNATI OHIO A Right @ And what are your duties therethere there there there or or what were your dutiedutsidesuties duties there there when when when you began part time description description A. My duties there are primarily to do with the description of material removed from patients at surgery (onl out of the specimen to start the processing of microslidemicrosslides microslidemsicroslides microslides io Doctor you know we can take a break at any time when you want to Just let me know A have yes Yes but I don't have a list of them with me H o Approximately how many A Oh maybe 15 Q Are you currently a member of any professional organizations organizations organizations organizations organizations organizations organizations organizations organizations organizations organizations organizations organizations organizations ? A I'm a retired member of the Academy of Medicine of| Cincinnati the State of Ohio the AMA the American Society of and Bacteriologists and a retired member of the Academy of Forensic Scientists O Were you an active member of each of those organizations before you retired REPORTING ING CINCINNATI CINCINNATI CINCINNATI CINCINNATI OHIO any other organizations that you were 3 that you are not presently a retired member what 5 Q Well any other organizations A You mean professional iy Yes professional organizations other you you you have already named A The only other one is the honorary medical Alpha Omega Alpha. th. Doctor Doctor are you familiar with asbestosis Au I became became familiar with asbestosis with this tthihs is case case case of Mr. Scobie in 1944. 1944. Prior to this time my knowledge was With studying the to resort resort to tthhee literature Q Doctor Doctor before we gegett to Mr. Scobie I you When first time that you heard of A. Oh, hell I don't know That medical school It could have been after medical school ask ask ask ask ask don't know Q. Was it well before 1944 when you said had Mr. Scobie's case case A would would say that I was dimly aware of it hadn ACE REPORTING CINCINNATI ORIO ORIO seen seen seen seen it it oh that right A 10 Q Ch A A before < You had read about it though before then is MR FRYE Objection Not particularly Doctor -- You didn't let me Finish Sorry My question was Had you heard about it R Mr. Scobie And I'm telling you that my knowledge came with if I'm going to ask you about Mr. Scobie Doctor MR MONTGOMERY I'm sorry This witness has an absolute right to finish any answer he thinks MS CANNON I think he is finished Thank you MR MONTGOMERY Doctor if you want to Finish you have that right right right right right . A No I'm not finished P Doctor okay A Just a minute oO Excuse me Wait I don't think there's a question pending My question was whether or not you had had ACE REPORTING INC CINCINNATI OHIO any knowledge beforbeforee 1944 1944 11944944 and and and and II believe believe believe believe your your answer answer answer answer answer was was was ththat at that that that | your knowledge before 1944 was fragmentary and at that point in time you were fixing to tell me about Mr. Scobie I have not asked you about Mr. Scobie MR MONTGOMERY I'm sorry Counselor he The witness has indicated that he is not finished with his answer which you interrupted , and I believe we owe him the courtesy of allowing him to finish any answer that hehe feels feels feels he hahsahsas incompletely answered MR DEMICHELIS CounselorCounselor , thisthis this this is is is your your your witness I don't think you have the right to cross cross cross cross examine examine examine ee exaxmianmeixne amine this witness or direct direct the wit- ness ness ness ness . MS CANNON I'm not examining the MR DEMICHELIS You're sure making a pretty 18 good effort at it right now MS CANNON There is no question pending MR BRICKMAN Let's Let's Let's Let's go off the record MR DEMICHELIS If you want to give an anan explanation to the doctor let's do it on the the the MR BRICKMAN Let me explain to you there are certain procedures that go on in court where you have to ask a certain question and it has has to bebe answered answered in a certain way and you have to lay a predicate or a foundation Sometimes it's very technical but if you 5 answer giving additional information other than what was asked some of the attorneys may move to strike that testimony and we would have to reask it That is why she needs just to get sometimes an answer to the question and she'll follow it up Or if you want to explain explain it further further furtherfurther you of course have that right but sometimes she needs just just the yes or no and then the explanation with it just for procedural point MR : DEMICHELIS I'm wondering who appointed you judge THE WITNESS Would you read back the question question question quesqut estion qi uesto ionn 18 MR BRICKMAN Did you have an objectionobjectiooonbbjjeectcitoinoobjnectioobjnection objection ? 19 19 MR DEMICHELIS I object to your instruct- ing this witness on anything sir He's a being questioned on direct examination Plain- 22 tiffs counsel in this case had a fair amount of 23 time before this deposition started to confer | ACE REPORTING INC CINCINNATI CINCINNATI ONIO the witness None of the defense counsel did did I hadn't hadn't hadn'thadn't hadn't seen seen seen seen him before I walked into this this room if Now if you haven't got him prepared to give whatever testimony he's going to give on direct we'll just have to go with what we have got MS CANNON We'll clarify one thing that perhaps Mr. + the person speaking speaking I don't You say your name is Mr. Montgomery MR DEMICHELIS NO My name is DeMichelis That's a little more difficult MS CANNON Mr. DeMichelis has not spoken to the doctor before we began but there are other defense counsel that have spoken to him MR DEMICHELIS: I'm not worried about them MS CANNON I want that on the the record record record record record record we spoke with the doctor we left the room Defense Defense Defense Defense Defense Defense Defense Defense counsel conferred and we did not come back back back backback in in until until we were told that that that the the defense defense defense counsel had finished their conferring with the THE WITNESS Well let's get on with the 22 22 23 23 damn damn damn 24 MR MONTGOMERY Doctor I think you have ACE REPORTING REPORTING INC | CINCINNATI CINCINNATI ONIO the right to finish an explanation if you feel 2 MS CANNON There is no pending question MR DEMICHELIS Doctor you don't have to do anything unless the judge tells you MR MONTGOMERY He has has the right and Counsel I think you're being unfair in trying to suggest to him he doesn't have the right MS CANNON Mr. Montgomery U MR MONTGOMERY Please can I finish If he is not comfortable with an answer that he has given and feels that it requires additional explanation this witness has that absolute right in every jurisdiction in this country and I don't think your suggestion to to 15 him to the contrary is anything other than unfair MS CANNON Okay Mr. Montgomye ou'lr l yy ou'll have an an opportunity to ask him questions Let's go ahead and go on to the next area DIRECT EXAMINATION CONTINUED 22 22 Q Doctor before 1944 had you heard of asbestos 23 23 in connection with cancer A ----, am not sure that I had heard of that ACE REPORTING INC INC CINCINNATI CINCINNATI CINCINNATI MRMR MR . DEMICHELIS DEMICHELIS for forfor the record here I want to make a point MR BRICKMAN Is this an objection f MR DEMICHELIS It's not an objection because I don't know what the situation is in all these cases I want to make the point that if this last question suggests that this witness 8 8 might be being called by plaintiffs as witness and that the plaintiffs intend to use this deposition on trial to give expert testi- mony to the extent that in any of these cases this witness has not been previously noticed or identified as an expert witness I'm going to make an objection to any testimony in that area MR MADEKSHO I think those objections are are are MR DEMICHELIS I'm not aware That happened today this morning sir MR MADEKSHO That is correct MR DEMICHELIS I havenhaven't't seen that objec- 23 23 making is not with respect to notices that we 24 24 ACE REPORTING CINCINNATI CINCINNATI OHIO OHIO utilization of this witness witness as an expert witness witnesswitnes ae to the extent that not with respect to whether whether we received received notice of the taking of of his deposi tion tion , but with respect to whether he had previously been identified identified as an expert witness and defend- opportunity opportunity to discover discover discover his testi- mony by way of an earlier deposition deposition before meeting to get his testimony at a testimoniatestimlonial deposition to read in court I hope that is clear gentlemen gentlemen gentlemen gentlemen BY MS CANNON DIRECT EXAMINATION CONTINUED Ch a Herbert C. Dr. Ritterhoff Ritterhoff Ritterhoff did you perform an autopsy on 16 Q 17 | autopsy autopsy This was in about 1944 that you performed 18 A Yes | 19 Do you remember who the referring physician was 20 Au Dr. John Skavlemt 21 0 And this would have been while you were at 22 Hamilton Tuberculosis Hospital | 23 A Right 24 Did Dr. Skavlem give you any information when he ACE REPORTING INC CINCINNATI ONIO referred referred refer ed referred referred referred referred referred , -- to you his it was hishis his f f as as I case of asbestosis asbestosis asbestosis asbestosis asbestosis asbestosisasbestosis died he and that he had had had dieddied dieddied interested in seeing the findings Q After you conducted the autopsy did you send ~ some of your findings to Dr. Gardner I didid d And referring to Dr. Leroy Gardner come to H fay had had had corespondence corespondence corespondence corespondence corespondence corespondence corespondence correspondence correspondencecor espondencecorespondence corespondence corespondence corespondence with Gardner in regard to a case of acute silicosis had of in an employee of Gamble and I knew that Dr. Gardner Bridge in the Gaulley Bridge tunnel workers And so on the basis of that knowledge I sent slides of the case to you referring referring AL To the acute silicosis case Yes Okay Now and then in 1944 with Mr. Scobie some information to Dr. Gardner is that right Right MR MONTGOMERYs I object to leading ACE REPORTING CINCINNATI CINCINNATI CINCINNATI ONIO the witness. $ 2 a Did you have any contact with Dr. Gardner in the time that you sent him the information on the case and the information on Mr. Scobie 5 A. There was a personal contact and Dr. Gardner Cr Dunham Hospital or the Hamilton County TubercuTulberculosis oTuberculosissTuberculosisiTubersculosis and I think Dr. Dunham who was then the medical 8 director brought Gardner to town and he spent the afternoon 8 lung disease and it may be at that time -- I have forgotten ~~ that I had told him that I was unfamiliar with with the asbestos body and he subsequently subsequently subsequently sent me a couple slides show- ing me with th Dr. Ritterhoff when you said you were unfamiliar asbaessbetsotsos asbestosasbestos asbestos body that means you hadn't seen it on slides Au I hadn't seen it it no MS CANNON Could we have this marked Exhibit No. ? Plaintiffs Ritterhoff Exhibit No. 1 a letter dated November 1 1944 was marked for identifica- tion MR MONTGOMERY Excuse me Could you this give us just a second to look at this AGE REPORTING INC CINCINNATI OHIO cael la 2 MR BRICKMAN Have you all had an adequate opportunity to examine it MR MADERSHO It would be a good idea to exhibits have the entire series of of exhibits exhibitsexhibits marked and ask the doctor if he is familiar with them 0- Plaintiffs Exhibit No. , a leter H dated November 10 1944 was marked for identification MR MADEKSHO Doctor we want to make Y Cc Tfl E f E there's there's there's there's there's there's a series of four documents that we want you to have the opportunity to look at this morning instead of perhaps passing passing passing passing passing passing ppasasisngsing them on down the table to other 14 counsel If they need some additional time to review these other copies we will give them all the time that they need if they so desire MR MONTGOMERY Pardon me Mr. Madeksho Since you were not here MS CANNON Excuse me for just a second second M SOFIY Could we go off ofofff thethe record record record discussion 23 MR MONTGOMERY I was in the process of 23 24 making an objection Mr. Madeksho I hope I ACE REPORTING INC CINCINNATI ONIO have your name right WR MADEKSHO Madeksho pronunciation MRMR MR MR . MONTGOMERY MONTGOMERY Please don't take this personally but you have indicated that you are not here in any case in which there is a S notice pending so I don't think it's proper for you to make any objections or speak on the record since there is no case you are noticed 00 MR MADERSHO I'm here representing otherother other other plaintiffs in the cases in Texas and the Eastern District and the Southern District of TexasTexas and we can make objections on the record as we MR MONTGOMERY But you did concede ard tell us at the beginning that you are aware of no notices in which any of those cases are here MR MADEKSHO I'm also here as counsel in regard to MR BRICKMAN Certain cases in South Carolina he is also supposed to be here MR MONTGOMERY That sounds to me like an lib right after you whispered in his Car and Counsel I think that's a little bit of a ACE REPORTING INC CINCINNACINCIT NATI CI INCINNATI OHIO strap Let's be realistic about it N MR BRICKMAN That is not correct and this was a boot strap wouldn't that wouldn't make a difference. MS CANNON I want to go off the record on for for minute so I can finish marking these documents. 8 American Journal of Pathology were marked for | identification DIRECT EXAMINATION CONTINUED Dr. Ritterhoff I'm giving you a copy of what has Ritterhoff Exhibit No. 1 Have you ever seen Q recognize must have but I don't remember this Down at the bottom there is a signature Do you signature That's mine That's your signature Yes CINCINNATI CINCINNATI CHIO Q Okay Okay Okay Okay . And And AnAdnd whatwwhaht at is is RitterhofRiterhof fRiterhof Pyhibit No. 1P MR MONTGOMERY Note my objection He said he doesn't recognize it Anything else beyond that it would be inadmissiibnadmisiblle e inadmisible . II think it would sspeak peak for itself as to what it is is Q Dr. Ritterhoff A. It speaks for itself yes I must have written yale 0 Okay I understand that Now what is it A Well it's a letter MR MONTGOMERY Same objection A letter to Dr. Gardner Q Um hum A And I'm asking for help C What's the date on the letter H A. November 1 1944 Let me show you Ritterhoff Exhibit No. 2 | Leroy This A from This is a response from Dr. Gardner | Gardner to me : received or written November 10 1944 QQ OkOkaayy And Ritterhoff Exhibit No. 3 on the second page of Ritterhoff Exhibit No. 3 there's therethere''s s a signature Do you recognize that signature A That's my signature | Q. And what is Ritterhoff No. 37 ACE REPORTING INC | | CINCINNATI CINCINNATI CINCINNATI OHIO | i i Well it's a letter that I wrote to Dr. Gardner 3 And what's the date on the letter Q Thank you I ask you to look at Ritterhoff Exhibit No. 4 What is that 5 A It's a letter from Dr. Leroy Gardner sent December 27 1944 Q To who A TO me I show you Ritterhoff Exhibit No. 5 Have you ever seen Ritterhoff Exhibit No. 5 before A Yes I think that was in material you sent to me originally 0 A Q Did you ever see it before I sent it to you I don't know I don't know that Doctor let me show you Ritterhoff Exhibit 6 What is that A Well this is a reprint of the article I wrote wrote concerning the findings in Mr. Scobie The American Journal of Pathology. Q. Now Doctor going back to Ritterhoff Exhibit 5 I'm going to ask you to turn to -~ and you have the reprint I guess that you got at was published of Exhibit No. 6 is that ACE REPORTING CINCINNATI ONIO right Would you turn to page 496 of that article A Right 0 Down at at the bottom is a paragraph More frequently A There's 00 part in that a th that at that that that reads reads reads reads reads , who also studied this case, stated stated stated stated stated stated that that that that these these these bodies bodies bodies bodies stained stained stained then and then there's a quote Would you read A TheseThese These bodies stained red with f fuchsinuc fuchsin h fucs fuhchsinsi fiuchnsin n of of van Weigert instead of black like elastic tissue and *" von Kossa's Kossa's calcium stain is is negative a Thank ThanTkhank you very much Now , Doctor Doctor, I'm I'm going to ask you also now to look back again at Exhibit Exhibit Exhibit Exhibit 55 16 A Exhibit 5 all right Now Now where are we 1944 194 It . Exhibit 5 is dated November 20 1944 It 18 18 and it has HerbertHerbert Scobie on top 19 graph -- Now would you read fl - I' 'm in the sentence Would you read that sentence MR MONTGOMERY Note my objection reading from from the document, which has not been para- para- ACE REPORTING INC CINCINNAT CINCI INNATI OHIO identified identified identified think that's a highly irregular procedure procedure 3 I'm aware of 4 MR MADEKSHO I believe we are in the 5 process of getting it identified 8 Q Doctor would would you read that MR DEMICHELIS DEMICHELIS DEMICHELIS You mean into or or f for or himself ? MS CANNON: No. out loud want him to read it it MR DEMICHELIS DEMICHELIS Then I object H These stain stain black with hematoxylin red with the 12 fuchsin of van Gieson Weigert instead of black like elastic Von Kossa's calciumcalcium stain is is negative 15 Q Thank you Doctor Do you know know where you got the article , which has been marked as Exhibit 6 you just read MR : MONTGOMERMYONTGOMERY MR DEMICHELIS DEMICHELIS I think this procedure MR ATKINS For For For the the the record record record record record record instead instead instead instead instead instead instead of of each each each eacheach defense counsel counsel making an objection at this this thisthis this point any defense counsels objections will will be be anticipated anticipated anticipated anticipated unless unless unless thtere th here ethere rthere e i is s s some ome other other other other other ACE REPORTINR G EPORTING INC CINCINNATI , OHIO MR DEMICHELIS I want to add a reason reason MR BRICKMAN You do not agree with that MR DEMICHELIS Certainly I think I said . BRICKMAN I'm sorry I just misunder- 13 yes yes MR DEMICHELIS You're batting 500. You You You right once and wrong once Well obviously if I may speak -- Yes I want to know where you got the quote I must have had this because there are CYOSS- Okay When you say you must must have have have have hadhad had this this this you must have had Ritterhoff Exhibit No. 57 Yes Yes I must havehave had had it sometime sometime sometime Sometime before you wrote the article which Possibly hum MR MONTGOMERY Move to strikestrike strike a all lall lall reference to Exhibit 5 MS CANNON Denied ACE REPORTING CINCIN ATI CINCINNATI CINCINNATI MR MONTGOMERY I appreciate your prompt ruling ruling th Dr. Ritterhoff did you ever speak to anyone at Phillip Carey concerning the Herbert Scobie case AL I spoke with one man 3 When was that in relationship to when your article was written Exhibit 6 if you know A would say that it was after everything was written up a After everything was written up meaning after what things were written up ALL The paper whether it was after publication or before publication I don't don't dodno'n'tt know know know know Q Where did you speak with this -- you said you Q spoke with someone from Phillip Carey How do you know knowknow it was was waswas a Phillip Carey person A I went to the Phillip Carey office office was out at the plant Q Where was the plant located A Well it's out in what is Lockland or whatever it isis . Q. In Cincinnati Cincinnati A Yes. Q Why did you you go there a Q Q Phillip Phillip Phillip Phillip Carey CareyCarey Car Caree y Cy arey I don't remember name but I don't remember it Where in the plant dididd you speakspeak to the In his office | name | Was there anyone else in the office No. And how long did the conversation last Fifteen twenty minutes And what did you tell him I told him that Mr. Scobie died of What did this person look like asbestosis asbestosis asbestosis . asbestosis He He was a kindly kindly kindly kindly kindly kindly gentleman gentleman haired That's That'sThat's That's That'sThat's That's MS CANNON record would like to take a minute A recesrecess recess was taken 21 BY M MS S , : CANNON DIRECT EXAMINATION CONTINUED Q Dr. Ritterhoff where did Mr. A A Where did Mr. Scobie work MR MONTGOMERY the record only Objection That's for " Well according to information that I receiverdeceived , he worked at Phillip Carey At what plant or where at Phillip Carey? 7 MR MONTGOMERY Same objection Hearsay " That I don't know All I know is he waa s ft employes of Phillip Carey a) Were you given any information concerning a compensation claim filed by Mr. Scobie's widow ; A No. MR MONTGOMERY MONTGOMERY : Objection a Did you discuss any compensation from Phillip ,ii Carey to Mr. Scobie's widow with anyone MR MONTGOMERY: Objection A Do I answer or not Q YeYess sir MR BRICKMAN Yes sir you go ahead and 20 A The only information I received was from Dr. | 21 Skavlem and he told me that the widow had been privately privately privately and adequately compensated 23 MR MONTGOMERY Move to strike on the basis of hearsay evidence and not responsive ACE REPORTIN REPORTIN REPORTIN CINCINNAT CINCINNAT _ a .: Ch Dr. Ritterhoff the article that you wrote that we 40 : | referred to earlier as Exhibit 6 .. th Yes h -- this article discussed the Scobie case is that Q 7 And did you do research in preparation for writing 4 : | writing | | read A What do you mean research Q Did you go to the library and get any articles to | A Yes | article Q And I see you're turning right now y' ou're opening up the read A Yes And these would be some of the things that I Some 29 articles were quoted from th And when you say these you're referring to what's the list of references on page 504 and 505 of the article Q Now where did you get these articles A Well I suppose =~ well I did spend time in the medical library os Would you look at the third article A. Yes ACE REPORTING REPORTING INC CINCINATI CINCINNATI CINCINNATI OHIO may h What's the name of that article the the the name name name of of the magazine I'm sorry - 3 i] dha It's Deutsche med Wchnschr volkenschrift volkenschrift Q Where did you locate that article or that magazine : A It was cited I have it cited by Egbert and Egbert isis number five pulmonary asbestosis Report of a case with necropsy findings American Review Tuberculosis A th journals Did you have any access yourself to any foreign Ay Certainly the British ones are over at the medical school library eh Would you look at reference number one ( Where did you locate that article Au Gloyne's article was in the American Journal of Public Health so that's a national journal here Q If you needed to get a foreign medical journal what would you do f Bu would merely tell the librarian and she would would 20 get it if they didn't have it Q Were there some that were already in the library A don't remember asking her to do that Most of 23 these were ~~ well these are available in the library 2 So here on four there's a reference to a BrBritish itish medical journal ? A Yes That's over there That'Thsat's over there, yes| And you say that's over there It would have | meaning in the medical library time the article was written Right For publication in 19467 Right yes I'm almost done Doctor Dr. Ritterhoff let's go back to Exhibits 1 and 3. Exhibits and 3 are these letters that you sent to Dr. Gardney concerning Scobie I 71 oy Right C a And 2 and 4 are letters that you received from in reply to those A Y Yes es . Now did you rely upon thethe information inin letters in writing your article Exhibit 67 _ | A In part I'm sure I don't know = A i pending pending Doctor I don't think there is any question MR MONTGOMERY If you want to explain a prior answer Doctor please do You have the right to explain anything you feel is ACE REPORTING REPORTING CINCINNATE CINCINNATE NS CANNON Just a minute . I I think we can go back and read what the question is THE WITNESS No. have to keep quiet You'reYou're just going tto o MS, CANNON Excuse me Doctor me THE WITNESS You're going to have toto excuse excuse excuseexcuse excuse excuse MS CANNON pending. Doctor there is no question question MR DEMICHELIS The doctor apparently wants to complete his ans answer wer . . CANNON Mr. Montgomery is going to to have an opportunity to be able to ask you some additional questions MR DEMICHELIS Wait a minute If you're going to instruct the witness not to say some- thing we're going to have to ask that this deposition be recessed until we get a ruling from a coure on this I don't think any counsel has the right to tell a witness to shut up at any time I know of no rule in any jurisdiction that permits that procedure MS MS CANNON Actually there is a rule in Maryland that permits that procedure REPORTING REPORTING REPORTING INC CINCINNATI CINCINNATI CINCINNATI ONIO MR DEMICHELIS: hhis ihis s expleaxplan na aexplana explana tion is necessary 3 whether the court wants to strike it and you'll you'll just have to listen to it Doctor you say what you want to say THE WITNESS All right I merely w wa an n wantt t want to to was very fortunate in having having available a man such as Dr. Leroy Gardner who served as of consultant for me who really went out I don't know where I would find a man like that today That's all I wanted to MR MADEKSHO Thank you Doctor MS CANNON Thank you Doctor, That's That's That's very helpful Nothing further MR BRICKMAN Excuse me HoldHold on a second DIRECT EXAMINATION CONTINUED CONTINUED Q Now when you went to the Phillip Carey plant Doctor you said you went sometime around the time that your article was being published A. NO I don't know the exact time I would say it was when everything was worked up Whether or not it was before or after don't know Q Was it within six months of the publication REPORTING CINCINNA CINCN INNAN CINCINNAN NO either one ssidie de side or the other 0 Pha ea Le was I don'tdon't know Was it within a year of the publication publication ? I don't don't know Do you know how close to the autopsy of of Mr. Mr. Scobie Scobie Scobie Scobie " a autopsy would say it was fairly close And fairly close meaning within six months of of A I would guess. Now , saisd aid when you went to the Phillip Carey Phillip plant and you spoke with this individual, whose name you don't don't remember you spoke about Mr. Scobie A Right 0 And that was the person fl you told the Phillip asbestosis Carey person that Mr. Scobie had asbestosis asbestosis asbestosis ? A Right MONTGOMERY MONTGOMERY MONTGOMERY : Note my objection leading leading nature of the question Move to Okay. When you went to the plant and talked to the Phillip Carey person what did you talk about about . MONTGOMERY MONTGOMERY : Objection Objection Objection . Asked Asked Asked Asked and MR MADEKSHO Doctor You can answer the question A The purpose of the visit was to tell someone at Phillip Carey that their employee Mr. Scobie died of asbestosis MS CANNON Thank you very much I have no further questions MR BRICKMAN time I have no questions at this this MR MONTGOMERY Could we have a few moments Could we break forfor a second A recess was taken MR MONTGOMERY Dr. Ritterhoff I thank you for for coming I have no questions Other defense counsel stated that they had no questions) ROBERT J. RITTERHOFF M.D. DEPOSITION DEPOSITION CONCLUDED AT 10:30 A.M. ACE REPORTING CINCINATI CINCINNATI CINCINNATI CINCINNATI OHIO CERT TE STATE OF OHIO r COUNTY OF HAMILTON aS I Betty J. Schwab the undersigned a duly qualified and commissioned commissioned notary public within and for the State of Ohio do hereby certify certify that before the giving givinggiving giving giving giving of of his hishis his sition ROBERT J. RITTERHOFF M.D. was by me first duly sworn to depose the truth the whole truth and nothingnothing but the truth that the foregoing foregoing foregoing is the deposition given at said and place by the said ROBERT J. RITTERHOFF M.D that sition was taken in all respects pursuant to Notice to Take thatthat that that that that said said deposition deposition was taken by me in stenotype and transcribed into typewriting under my supervision supervision transcribed deposition was submitted to the witness for his | examination and signature that I am neither a relative of nor attorney for any of the parties to this cause nor relative of nor employee of any of their counsel and have no interest what- ever in the result of the action IN WITNESS WHEREOF I hereunto set my hand seal of office at Cincinnati Ohio this day of official : MY COMMISSCOMISION ICOMOMISSNION EXPIRES EXPIRES EXPIRES : JanuaryJanuary 29 1991 Betty J. Schwab Notary Public - State of Ohio CINCINNATI CINCINNATI OHIO OF PATHOLOGY Official Publication of The American Association Asociation of Pathologists and Bacteriologists BOARD OF EDITORS CARL V. WELLER EDITOR MALCOLM H. SOULE ASSISTANT EDITOR J. HAROLD AUSTIN . TRACY B. MALLORY PAUL R. CANNON SHIELDS WARREN HOWARD T. KARSNER HARRY M. ZIMMERMAN VOLUME XXII May January MarchMarch and May ) 1946 : (thei , ete. lyoentH Viet siTtagemie OTN 6 PLAINTIFF'S EXHIBIT 6 Ritterhoff Ritterhoff COEXISTENT COEXISTENT PULMONARY PULMONARYPULMONARY ASBESTOSIS JOHN H. SHAVCEM M.D. and Rosent From the Percy Shields Laboratory =. al; was le Falir * described a case in 1914 awakened until the case of Cooke Since that time there have appeared in the available 1937. 150 necropsies on cases of pulmobary reports upon approximately with bose asbetosi.5-12 comparison wth asbestosis.5-12 The paucity of proved cases in te of silicusis is not due wholly to failure to report such cases for in series asbestosis is apparently of infrequent occur- large necropsy of asbestos prod- rence Further despite the widespread usage there are comparatively few people engaged in the asbestos ucis As of October 1944 Only 19,700 people were employed in industry 1 this industry in the United States roentgenologic and Much has been written about the clinical of sarcoidosis However because of the infrequency biopsic aspects of this disease there are only isolated and relatively benign character have literature there have detailed necropsy reports From the available been found ouly 53 reports of necropsies on cases of sarcoidosis Most of these were summarized by Dinner These two diseases present many dinical and roentgenographic similarities and also their more frequent fatal complications are tuberculosis and cardiopulmonary insuficeny insufficiency alike pulmonary complication of pulmonaLy Bronchogenic carcinoma a frequent described described as associated with sar- has not however been Likewise there has not been a previous description of with coexistent sarcoidosis It is the purpose of this report only example of the findings in sudiju asbestosis or sarcoidosi ww www wwwwww w ce oe omen se ky iS The ET rea aT gataert mn ee pe cap : fe ^' ES Ra Ay TS a: se ampers toe ee rer nee wea symptoms there was a weight loss of 22 pounds from December 1943 to March 1944 at which time he presented himself for medical care a The patient had worked in an asbestos plant for 25 years the last ro years having been in a supervisory position During this entire time he had worked in pipe one department in which asbestos pipe was made There was a slight slight but appreciable dust hazard associated with the sawing and splitting of the dried asbestos despite precautionary exhaust ventilation The total time the patient had spent upon this final operation sawing was unknown nor was it learned whether be had been negligent in using the provided respirators To the company's this was their first case of asbestosis company's knowledge Physical examination revealed the following findings Temperature 37 .; minute arterial pressure 105/70 Hg respiration 22 per 170 cm weight 67 Lg mm height blood The chest was of increased interoposterior diameter Respiratory excursions were equal but decreased The percussion note was resonant and auscultation revealed fine riles over the bases of the lungs posteriorly There were no evidences of cardiac enlargement irregularity or decompensation Cyanosis - and clubbing of the fingers were absent The liver wwas as barely palpable the Report on the roentgenogram of the chest Fig Fig ) was as follows " The bony framework is normal The trachea in the midline The hilum shadows arc moderately enlarged bilaterally One small calcified area is present in each hilum There densities scattered lung fields densities scastcateredred numerous are nunumemroues rous smaslmall l nnodular odulanodular r scaterd throuthgrohugohouutt bbootth h fields especially throughout the lower lobes There is some confluence of these densities in the left lower lobe Emphysema is present Examination of the blood showed erythrocytes 5.5 million leukocytes 6.6 thousand 73 per cent neutrocytes 21 per cent lymphocytes 5 per cent monocytes I per cent eosinophils sedimentation rate 26 mm No abnormality was found in the urine The vital capacffy 2200 cc was 51 per cent of normal Tuberculin tests were not done was his only complaint after increasingly patient regular and The seen at intervals severe exertional dyspnea A roentgenogram of the chest 4 months after the initial chest film revealed no new findings Although the patient greatly limited bis activities dyspnea became progressively more severe so that eventually even at bed rest there was extreme air hunger At no time were there evidences of cardiac failure He died approximately 1 months after the onset of symptoms apparently from respiratory failure Autopsy Findings The necropsy was performed 5 hours after death Superficially there was considerable decrease in the subcutaneous tissues and the body musculature There was no clubbing clubing of the nailbeds or dependent edema mediastinum was in midline Each lung completely filled its hemithorax and anterior mediastinal at the level of : . - : 7 3 a oe : CO - ; ore TTTfi iM 7 2 = = . ~~ tee The frontal section of the left lung Fig 3 revealed coarse lacy tannish brown hypercrepitant tissue throughout both lobes Innumerable slightly elevated grayish green irregular firm nodules I to 2 mm in diameter were present throughout the lung Thin radiating fibrous bands surrounded and connected these nodules Also slightly thickened pleural septa extended into the lung substance for variable depths In the lung tissue about the bronchi of the second and third Interspaces Generally these nodules moderate numbers Interspaces these nodules were somewhat confluent and and a similar similar change was noted in the subpleural tissues for a depth of 3 to 5 mm similar lung by present in rated bbyy wide zones of of drydry emphysematous emphysematous emphysematous were sepa- tis ue tissue studded a^'merousminute grayish tubercles Dissection of the bronchi of the they moderately dilated cylindrically lower lobe disclosed that lined saccularly saccularly and by saccularly sacularly sacularly and by and saccularly and lined glistening In the right lung the same were glistenig glistening glistening changes mucosa white white mucosa mucosa mucosa were observed as were throughout the left However the grayish grayish green irregular present nodules tended to be more numerous larger and more confluent This This was particularly true of the anterior portions of the lower and middle lobes Also the nodules were connected by thicker grayish black and grayish white interlacing bands of fibrous tissue Extending deeply into the lung substance thickened pleural septa communicated with the fibrous tissue in and about the clusters of tubercles tubercles Except for more pronounced dilatation and thinning of the mucosa the bronchi right right lung were left of the were ssiimmilialr ar to tthhoossee of tthe he left The tracheobronchial lymph nodes were moderately enlarged and and - on section consisted of dense rubbery anthracotic centers and thin rims of yellowish white tissue Calcification was not grossly de- monstrable ; The embalmed heart weighed 280 gm and had the following measurements tricuspid valve 120 mm pulmonary valve 80 mm mitral valv~ 89 mm aortic valve 65 mm right ventricle wall to 8 mm left ventricle wall is mm The greatest transverse cardiac diameter was 13.5 cm is basis The estimated normal heart weight on the minus 40. The tricus- aortic valve and pulmonic valve ratios were 1.84 and 1.73 respectively The right ventricle was muscles bs ; ! ody re [ oo vo woods a Zz i if te : : ; = a {ES 4 = L= t = . s seu NSMti vob: cueytnfene Mow : ooPNT of ATLA STE, Aerts at. rath ae MT?IN ro taf on tnt Sans, a TMTa samen cemkTn purplish substance was firm and live red with normal markings No The tubercles were seen The live measured 22 by 16 10 cm The remaining organs showed passive hyperemia and moderate generalized and that von Kossa's calcium stain is negative study of appropriately stained sections revealed as pointed out by Gardner that the Schaumann bodies did stain red however a moderate number also arteriosclerosis Microscopic Findings contained calcium in variable degrees as demonstrated by von Kossa's stain An occasional giant cell contained one or more clefts suggestive | Throughout the lung there was a conspicuous linear interlacing of cholesterol crystals More frequently however doubly refractile peribronchial and septal pulmonary fibrosis Fig ) This was par- irregular spicules plaques and conchoidal masses were observed in ticularly prominent in the subpleural tissues The intervening lunglung giant cells These doubly refractile masses were about or in tissue was moderately emphysematous Innumerable tubercles were present in the linear and peribronchial fibrotic areas and were present to a lesser extent in the walls of the respiratory bronchioles and the the Schaumann bodies particularly the smaller and partially calcified oon forms The foreign body tubercles were indefinitely demarcated and con- adjacent alveolar walls Generally these tubercles were of two types sisted of rather closely packed indefinitely arranged large monocytes sarcoidal and foreign body granulomas The former predominated by and one or more foreign body giant cells These tubercles for the intimately approximately ten to one Tubercles of these types were as- sociated and in addition many intermediate types were presented The sarcoidal tubercles Fig 4 were free of casention contained most part were within the dense zones of fibrosis Some however were present in alveoli and respiratory bronchioles Golden yellow discoid verruciform and incompletely segmented asbestos bodies no demonstrable organisms and were for the most part in the same + many of which were in giant cells were observed in and about the presented i stage of development however a minimal number some j Seman i peripheral fibrosis and there was an occasional coarse collagenous t nodules Fig 8 Asbestos bodies singly or in clusters and in muderate numbers were present also in the dense Abrotic areas Fig 9 ball Generally the tubercles were sharply demarcated surrounded by delicate reticulum and did not present peripheral rims of lympho- MpReatse and occasionally within alveoli Fig 10 Rare laminated calcified \ masses enclosing apparent asbestos bodies Fig 1 and other bodies cytes They consisted peripherally arranged epithelioid cells sur- rounding central loosely arranged epithelioid and monocytic cells Giant cells were for the most part centrally located and often com- P which appeared to be of the Schaumann variety were present in the a linear fibrotic bands Asbestos bodies were also encountered in and about the sarcoidal tubercles and in the associated sarcoidal giant cells prised over half of the bulk of the nodule The giant cells appeared to be of two types Langhans cells and foreign body giant cells with predominating the former In many of the Langhans cells there were numerous small vacuoles each containing a pink round body Other those Langhans cells contained large clear vacuoles and rarely in present asteroid cells containing one large vacuole there was present an asteroid containing body an intensely eosinophilic stellate mass 15 to 20 in diameter of both varieties but more frequently in those of foreign body type Tron preparations clearly demonstrated the bizarre forms of the as- bestos bodies In many areas it was difficult to distinguish between the two types of lesions was particularly true throughout the subpleural re- gion where both the lesions and asbestos bodies were more numerous clustered and embedded in a dense matrix of collagen masses of Fig 5 More frequently the Langhans cells cels contamed round oval U suggestively sugestively budding intracytoplasmic bodies of Schaumann sugestively Rarely these bodies , appeared to lie outside of giant some enclosed regular yellowish material ( stained blue with hematoxylin and in ferrocyanide strongly positvepositive for iron Dr. Leroy coarse elastic fibers and fine reticulum The larger bronchi bronchi were remarkable remarkable only for mation The bronchioles and respiratory bronchioles collagen and surrounded by tubercles were slight chronic infam, embedded in moderately dilated moderate moderate In the subpleural regions where granulomatous reaction were case bodies ty| many contained asbestos and the associated granulomatous reaction Within the peribronchial fibrous tissue there was a moderate amount of hemosiderin in lincarly disposed granules and fine lipoid droplets The small pulmonary arteries and arterioles presented presented slight intimal thickening and those in the subpleural zone were surrounded by thick collars of elastic fibers The intervening alveolf were moderately dilated the capillaries were monocytes congested and there was a slight increase in collagen in the alveolar walls bordering the tained lipoid lipoid brousmasses Focally clusters of alveoli con- macrophages Heart infrequent tained lipoid macrophages lesion " Heart lesion cells were infrequent Sections of the pleura revealed dense laminated and oval fenestrated bundles of collagen Focally there were indefinitely demarcated nodules which consisted of circularly disposed lamellac of collagen Superficially the pleura presented slight fibroblastic activity and an occasional perivascular accumulation of lymphocytes and some of the latter occasionally containing beniosiderin beniosiderin No asbestos bodies were observed The pleura over the left lower lobe in addition bore organizing fibrinous exudate on its visceral aspect Sections of the tracheobronchial lymph nodes presented a repetitious pattern of sarcoidal tubercles with almost complete replacement of the lymphoid tissue Throughout the nodes there were minimal diffuse fibrosis and several nodular masses of coarse collagen The tubercles lung were similar to those in the as to structure and stage of develop- ment Inclusions of Schaumann were not observed and only a rare asteroid was present Asbestos bodies were not identified A mod- erate number of hemosiderin macrophages were present in the remaining lymphoid tissue Similar sarcoidal tubercles were present to a slight degree in the spleen and liver and to a lesser extent in the kidneys diaphragmatic muscle and the right and left ventricular myocardium These sarcoidal tubercles however were not as compactly arranged as those in the lung and tracheobronchial lymph nodes and were surrounded by and permeated by lymphocytes Asteroid bodies and Schautumn Schautumn bolles were not present in the giant bodies were found associated Fe AND SABCOMPOSTS SABCOMPOSTS * - 490 arterioles arteries and in the lungs nodular marked obliterative pleural fibrosis pleural fibrosis focal organizing fibrinous marked nodular pleural fibrosis organizng organizing fibrinous obliterative focal organizing coidosi coidosis of pleuritis minimal liver ; sar- coidosis of the beart liver spleen sar- cardiac kidneys right right passive dilatation hyperemia hyperemia and of relative viscera and ventricularventricular ventricular - passive hypearretmeiriaosclerosis hypertrophy generalized of the viscera slsliight ght cicirhosi rrhosis of the liveracustaelciugthte minimal focal intcehrsrtointiiacl apdrroesntaaltiittiiss and nephritis chronic posterior urethritis and TEELE I and Approximately Spectroretic Spectroetic Moist Analyds of Ask Dry Tue - ChCehemmiiccaall and SpectSperctroetoic retic At ozidee cept Cly f Spectroretic Analyds Analyds Ask Ask 40 of Dry Tiss A if As elemente . . Checcel encyk H Chemical tusteets Spectrogranic . suclysis Bi Ee) | Por certcert i , Bi | 0.15 Na Per Led Arbitrary relative red ; Cd SiO 36.7 2.76 & None 36.7 found 10-0 Fe OF BcO | 8.03 Re None found E | ==" | None found af C. 80 EnO | 0.39 te 8.0 75 si | 2.18 2.3 200 | i None found tty 0.02 75 None found Bf None found , = Cr OF NIO COO aoe ; - None aBe 0.05found AE $ 18.42 5.44 None :i 0.00.0 E ; None found 25 | Present Za i 0.3 25 l Pt | i __ i | 10 0 DISCUSSION SES significant history of exposure to asbestos to asbestos was never entertained In dyspnea sented in 1 right heart or cardiac failure concomitant concomitant concomitant is ese7 ade et TATSHon fi . i Ee = f= it = | ; Teste ... ... ; aie ny ie . yv Ee . yv A NJEL EN = NJELLEN TAHPJELAIL THAHiPgJEiLeAInL | YH f TAL .../ TAL .../ i LFEPAJND LFEPAJAND ! LFEPAJND i fe a i 34 re: P i i 500 HITTAENDRHHITOTERFHOFFF existing sarcoid lesions and the discovery of asbestos fibers in the strate to asbestos fibers and with a history of adequate exposure sputum evidences of diffuse pulmonary fibrosis Asbestosis roentgenographiocbserved alone should not have caused death and of the degree Reisner sarcoidosis has generally been regarded as a benign process the basis of his observations on cases of pulmonary sar- however on in assuming too confident an coidosis stated that one is not justified attitude regarding the ultimate outcome This statement is particu- larly true when as in this case sarcoidosis complicates ; pulmonary disease heart strain in that Pathologically there were evidences of right marked dilatation of the right heart evidenced by increased there was valve ratios and slight passive hyperemia pulmonic tricuspid and the basis of body of the viscera The total heart weight however on normal As determined by the ratio of the left and right length was that there may be considerable ventricular weights it has been shown increase in the total relative right ventricular hypertrophy without an However relative right ventricular cardiac hypertrophy heart weight " usually accompanied by evidences of right in Higgins series was not dilatation of the right ventricular failure In view of the significant side of the heart and the slight sclerosis of the pulmonary arterioles there was in all probability some degree of puilncmroenaasreyinhytpoetratlenhseiaornt in this case However in the absence of an of and in the absence evidences of chronic passive hyperemia wofeitghhet viscera there was probably no, or insignificant exaggeration of air hunger due to heart failure is due to It has been suggested that dyspnea in the pneumoconioses arterial blockage by the fibrotic process This in all capillary and with severe is true to a variable degree in those persons probability with attendant extreme chronic fibrosis of the conglomerate type not cyplain the severe emphysema This hypothesis however diffuse miliary studding of seen in occasional cases of framework of the lung by silicotic tuberculous sarcoidal or tubercles It may be that the mechanism due to irritation of the COEXISTENT ASBESTOSIS AND ARCOIDOSIS 502 spiratory alkalosis Tissue changes suggestive of alkalosis such as calcification of the renal tubules were not found Microscopically there was some difficulty in differentiating the two of tubercles since there were many sarcoidal tubercles which types contained asbestos fibers and tubercles of indeterminate type not containing fibers or inclusion bodies were sometimes seen It was difficult to determine how much of the fibrosis was due to asbestosis Morphologically since the majority by far of the sarcoidal tubercles were without evidences of fibrosis and apparently of the same age it is suggested that this process was engrafted upon an established as26 bestosis Further on the basis of Gardner and Cumming experi bronchiolar epithelium the with mental studies on asbestosis marked peribronchiolar fibrosis sequestrated asbestos bodies the marked pleural fibrosis and pleural septal fibrosis and the metaplasia of the in- dicate that the asbestosis was well established and over 700 to 800 days old Dr. Leroy U. Gardner who kindly examined the material stated In comparison with our other material the pigmented foci in your case seem to show more fibrosis and less localized emphysema Histologically this can probably be explained by the presence of sarcoid nodules within the asbestotic zones of reaction I would infer that in your case the two conditions developed more or less simul- taneously but that probably the asbestosis was present to some degree before the sarcoid appeared This opinion is based upon the occur- rence of asbestos fibers and other containing particles in the interior of the tubercle nodules and in some cases within the giant cells themselves The number of asbestos bodies is smaller than seen in many cases Inclusions of the Schaumann variety found only in the lung oc- curred in 4 per cent of the giant cells Some of these enclosed goldenyellow irregular bodies suggesting asbestos bodies but similar to or- ganic material previously described within such bodies Yet there by were dennite dennite asbestos b^"dies unclosed similar dark blue material Schaumann inclusions have been described in only 4 per cent of the reported necropsies on sarcoidosis as summarized by Rubin and Pin" who did not regard these inclusions impressed by the by their frequency unequivocal tuberculous presence of calcified in- feet ee DehKHUFEKHUFE sarcoidosis ** Gardner pointed out that in his sarcoid material bodies regarded by many to consist of calcium or alcified remnants of elastica do not by the von Kossa method contain calcium but by the ferrocyanide method give a strong reaction for iron Only a moderate number of Schaumann bodies observed in the present . staining noncalcified case were either wholly or partially calcified yet all gave a strong reaction for iron Studies on sarcoid lesions of lymph nodes and spleen from another case revealed only a few . Schaumann bodies The presence of doubly refractile noulipoid sub- stance in giant cells and frequently in close relation to Schaumann bodies has not been emphasized in the literature on sarcoidosis It has been noted however that colorless and yellowish tinged refrac ile material is often enclosed by the Schaumann body The fact that these masses are frequently doubly refractile has not been stressed It has been suggested that these enclosed masses represent disintegrat- ing elastica however van Welgert stains do not confirm this suggestion The origin of this refractile and doubly refractile material is not known Being in and about many of the small partially calcified bodies this doubly refraculle material appears to be associated with bodice the development of the Schaumann body The larger and more densely stained were not as frequently associated with with visible doubly refractile substance : However fractured and fragmented apparently old Schaumann bodies as seen in control sarcoid material from lymph node and spleen usually contained moderate amounts of doubly re- fractile substance Apparently then the Schaumann body which stains . blue with hematoxylin and red with acid fuchsin formed in response * - to doubly refractile nonlipoid substance and initially is impregnated by iron and later in amounts demonstrable by von Kossa's stain by Wolbach in 1911 JadasohnJadasohnJadassohn in 1919 and have described a peculiar peculiarpeculiar intracellular generaly generally generally lies lies lies intensely with basophilic Wolbach cent of the COEXISTENT ASBESTOSIS AND SARCOIDOSISSARCOIDOSIS ' 503 503 503 material and decided that they were not similar to times seen in cases sarcoma Friedman characteristic regarded these bodies bodies as intracytoplasmic associatsitoanges intravacuolat nonspecific but highly characteristic of sarcoid lesions Friedman posed that these bodies be called pro- asteroids but perhaps it would be hetter eponymically to call them Wolbach's asteroids They have been described in 7 cases of sarcoidosis and never in the Schaumann calcified inclusion with were in body In the present case asteroids present approximately 1 per cent of the giant celle in the lungs and tracheobronchial lymph nodes Definite transition of asteroid formation were suggested by the presence of spicules on the - pink coccoid particularly those giant cells in which the bodies in small vacuoles were clustered and dis- integrating In addition an occasional Wolbach's lying in a large clear vacuole was surrounded by aagsmtienroaitdedinrsutpetaudreodf vacuoles In view of the presence of similar pink coccoid intra- vacuolar bodies similar asteroids and the same suggestive stages of asteroid formation in the giant cells of talcum observed in powder granuloma as one case in this laboratory these giant cell cytoplasmic changes must be regarded as Wolbach originally suggested nonspecific biochemical cytoplasmic alterations In addition such an depicted in the giant cells of leprous lesions asteroid is ' them spiculated bodies No by Mallory who called transition stages between Wolbach's asteroids and Schaumann's inclusions were even The pathogenetic relationships of asbestosis remotely and suggested dependent upon the chronologic development of the sarcoidosis are nature of the causative lesions and the- agents Historically and histologically in this case it is most likely that asbestosis preceded the coidosis The predominant localization development of sar- of the sarcoidal tubercles with- in asbestotic zones of fibrosis withattendant of both lesions as evidenced by asbestos mboordpiheoslowgiitchimondification modification indeterminate type would suggest an analogy between tuberculosis and though that even in framework of go4 > . SKAVLEM AND RITTERHOFF REFERENCES 1. Gloyne S. R. and Merewether R. SuppSuplementlement International Labour Office Suplemnt and DreeDsrseeenssWe.n C. AsbAesbsetstoossiiss . 205-714 205-714 205-714 Bosp Murray Murray M. CiCtiteedd byby Egbert Egbert " ChaCrhairningg CCrroossss Bosp 2. Murray for Industrial Diseas Departmental Committee on Compensation of Evidence Appendices and Index 1907. CJ 3496 p Cd 3495 p 14. 3. Fahr T. and Feigel Kristallbildung in der Lunge Deutsche med Wohnschr 1914 40 1548-1949 Cited by Egbert 1548-1949 4. Cooke W. Pulmonary asbestosis Brit M. J. 1937 2 1014 1015 Mcasbestosiasbestsosi Ibid 1927 2 1025 1026 pulmonary Donald S. Histology of Cited by Egbert of case with necropsy findings 5. Egbert D. S. Pulmonary asbestosis Report a Am Rep Tuberc 1935 31 25-34 6. Shull J. R. Asbestosis A roentgenological review of 71 1936 27 279-292 Lanza A. J. Asbestosis J. A. M. A. 8. Lynch K. M. Pulmonary asbestosis body and similar objects in the lung J. A. Mo.f cu,ri1o9u3s7 b1o0di9es1974-19i78n the lungs of South African 9. Williams E. The presence goldminers J. Path & Buct 1939 48 475-47710. Sutherland C. L. Tuberculosis in the silica industrie industries Lancet 1940 1 883-896 . asbestosis accompanied by pulmonary II Hannesson H. A case of pulmonary pulmonary tuberculosiFs. TTubheercilnec1i9d4e1nc2e2 o4f0--p4r4imary carcinoma of the lungs and Am 12. Homburger asbestosis Analysis of literature and report of three cases : J. Puth 1943 19 797-807 of the pneumoconiosis Quart Bull Sea View 13. 13. Auerbach O. The pathology Hosp 1936-37 2 3-2U.7S. Department of Labor Bureau of Labor Statistics 14. Monthly Labor Review 1946 62 pNon1c5a3setaatbileng2tuberculosis An analysis of the literature Am 15. Pinner f Rev. Tuberc 1938 16. Horton R. Lincoln N. Noncaseating uberculosis Am Ret 17. Rubin review of autopsied COEXISTECOEXNISTENEE COEXISTEN ASH2SAUDES ASH2SAUDES its Steet tee : 5 U. Personal communication 24. LG. . K. The effect of pulmonary tubtuberculosi erculosis upon the weight of the 25. Cumings experimental heart Am Rev. Tuberc 1944 49 755-275 Studies 26. Gardner Gardner Cum ings L. L. U. U. and Cummings D. D. E. E. , Studies on Studies experimeexnpertimenatall ppnneuemounmo-ono- 26. konikoonisosiis s VI InhalatiCounmomfinasgbsestos dust its effect upon primary tuberculous Byg 1931 infection J. Indust Byg & Toxicol, 1931 223 3 656-58-811 infection The Byg Pathogenesis & of Tuberculosis C. C. Thomas Springfield & 27. Rich A. R. The Pathogenesis Tuberculosi Springfield 1919 Baltimore 1944 722 28. Jadassohn Zur Frage der Sarcoide des Lupus pernio und des Lupus miliaris in Kombination mit Acnitis Cor.-Bl. f schweiz schweiz ActateActate 49 455- 45- 29. Mallory F. B. The Principles of Pathologic Histology W. B. Saunders Co., Philadelphia & London 1918 p 207 [ Illustrations follows ) a sy su Uy ia Haya {UU oe MUU au sed us yok 1) f Yk Ul i pe ye LL Be i . cae. maa ot E il| i | PINON IETS eee rem UAL Ut A showing an ee t ee ed beBe anata ree Fic Lu Lu se athe nt tuberclebosdy eddie ; ) Rete asbestur in alveolus MMM Gy" MNO a ma) ae wa aNAUaon ' CountyCounty HHaamilmtonilton CCoouunnttyy County County Hamilton County County County County CCoouunnttyy oHfamilton of of of Hamilton Hamilton Hamilton Hamilton Hamilton HamiltoHnamilton Hamilton Hamilton W eau ' , < Fe ZITTEN ZITTEN ZITTENJ COD COD DONY DONY DONY ill tReeasey A LUKEELitbill, daih, dite to, ' 17 THE TUOSSZULOSIS TUOSSZULOSIS TUOSSZULOSIS HOSPITAL PRICE TUOSSZULOSIS CINCINNATI O. esysicy QUILL TTT MEWw ore Www w Www UMS L GA CSS " HC se ENT CENTAUA R CEU NTAUR CR ENTAUR Hovebo , Ight Slits ENE ITTIN UL ChulaweMUN Eh " " ILGULLIFY doy WINEHUAWINEHUA Iseter Leroy O. Cards Latyto Director of Baterie SapaSapawap wYaakp e . New York York Heay Teeter dardsort dardsort que I as writing writing to you for anopinion this time in regard regard a se to appreciate greagtlryeatly thought to be one of estoutocio Dr. Evi 4 I could apreciate apreciate apreciate it if you could find time FoVICO LES 200 The grecs findings aro I believe consistent with published sports However Fleroscopically ous active and regradivo takarsular Laatona cvo encountered in the Lango end the trackso brenchiel Iymph node and a rara taberelo is found in the uplce Liver yerdiamd Eldnayo The character and distribation of these casouting taborelos in onerective of caresidooto Tot is the lang nabustos bodies aro procontofthin sono of the locios 4th 4th 4th PoroPoroigi a bgoday glent collo Y nadition -1 -1n ibrosis with inteet asbestos bodies thors APA arcis ys passeitpassyeity of asbestos bedies co compared with coctions way prone kindly sent to wo several years ago the absence of A more ling fibrosis in the lungs And the tuberculos lociosc is the need dos. Bad several of the orgrno have lod so to believe that the Lostou are nixed being one predominantly of carcoidosis and minimally owe of anbosatnbosotosiasainbostaosia Th10 18. my ooledge the first necropsiyn which secto bodlobowdlow have boos demostrated in our sorico or that of thefinest Coneral Esupital In view of this mad to me the peculiaritoyf the legiono it woulbde extremoly doo1rmblo to have your expert opinion opinion ooparuto the I am sending ander necropsy report and cover stained and unstained alldes clinical abstract The limited occupational occupational histortyo all we have at the precont precont time Vory tra y youru ... Peterhoff Peterhoff ... Peterhoff H. J. Hittorhoff H B Ritterhoff DIRECTOR OF LABORATORLIABORAHTORIH Rit erhof PLAINTIFFI PLAINTIFI PLAINTIFFI PLAINTIFFI PLAINTIFI EXHIBIT | Ritterhoff Ritterhoff Ritterhoff Riterhof I2quaAm OI 776 D^reetorof Lebseiterloo 4D 30 DOSTIGTH DOSTIGTH DOSTIGTH The Tuberculosio Noepitel Noepitel 9952 LIM TAPOUTAHTO A OTHO Dear Dr 2330310117 233031011723031017 CQ TABITOP I an host prsteful to nol 101 ZUTMOTIZUTMOOTIO 08 03 STUD 000 000 30 de * CAO 4 BUQT3000 DO IDO^ the longs I 00138 3843 OTE3 TO OT 100 OT 2TDA 393 TABITTOABIPTOP and carccid of AQUI AQUI and 3542 O 941 19001 00 777 OF ran'o to publish your findingfs indifnindigngss-- 943 7190880 t~ suo0ORI LHFUTDOPA16 LHFUTDOPA16 FTPROTAGO LATUTO 177077 TO pathologieal aduago PUY AI OT ping 21032 07 23 OT O7 MOTATPPD DINA ABID MOT 42 20 thio to O where 243 QZQT3 QZQT3 T extensive 177 01993229 La due to the inhaled due However ST15309000030097 ST15309000030097 0972 * ** 0300 pue 243 IOQUDU IO ST15309000030097 ST15309000030097 to asbestos asbestos You Dany cas68 Or would infer that the ran'o ozposure history cays nothing although the occupational fibes had been limited 30oq 943 7 10 OT7 QIQA I Idea Idea may e pod es dong ABoya SAPTIA DA they are really vory boautiful boautiful boautiful to have a shosical analysis of the It night holp Wo have a fairly 09 QUTEIQ2PP 047 Su of En quosced acbootodio ray 000013 on the findings findings in acbootodio acbootodio asgneelua hydrated asgneelua extensive corico of figureo is of no help as to quantity of hydrated asgneelua . diffraction however oven in advanced ondes allieate It is too call to regiator will can If we be of any cervico in this regard regard w7e 7 I TU DOf JOE QUIMCITP 77 03 be very glad to dooporate TY SEJ NOTAOT 041 T9110107 T9110107 the Sinoeroly yoursy LOG Leroy U. Gardner H. D. DireDirecctortDiorecrtor PLAINTIFF'S PLAINTIF'S PLAINTIFF'S EXHIBIT +2 +2 +2 +2 Ritterhoff Ritterhoff Hamilton County of HaHamilton milton u ecw) cap PSR TA TA aA IDS U SUE ' WAL " TTI KARET I SASAT aye mm THE THE TUBERCULOSIS TUBERCULOSI HOSPIT HOSPITAL AL PRICE HILL CINCINNATI CINCINNATI CINCINNATI CINATI S. OHOIHIOO 14 HL COB -- --,-- -- --,-- -- --,-- Desembe2r3 1944 CEU UA au ULL EE des UL, AVILL AWWW a? J, UAL Dr. LoreyU. Gardner The Saverne Laboratory Laboratory Laboratory Barence Yalce New Yo Baar Dr. CarnCaornott Carnot I am very grateful to you for roviccise roviccise roviccise of carecidamin P87 +91900100427 Eccdless to say your confition confition confition of the dingesnou, oven thoughI was wrong as to the degree of aubostocic procent and oven 40 very happy produced a few chuckles Your saggestion au to publication will be followed I could like permission to quote you and include your findings in that report Tiecue Tiecue to being seat for chemical chemical anois Would it ales ba advisable advisable to have ray diffraction studies for illet Unfortunately, I am able to give you supplemental data in regard to bio occupational history have not as the local permitted no factory concerned concerned he bon uncooperative to visit the plant nos have they given in Phuy detail his occupatocupaitional ooccnupatiaonall history history I have several questions I would like your opinions opinions concerning phases of this caco abeat which | occasionally occasionally within Pirot in Pitroofo there soms of the giant cells and occasionally are rolet rolet crusted crusted subected tedio of arces Rave thee9 been previously described described Sueand would you care to comment apon the poquible poquible poquible otiologie and latter chronologie relationships of theco two diseadey I note in your that pathologically it is hard to be sure how much of the fibrocia is tha to inhaled Aust Is it probable that caresidosis antedated antedated antedated and Planarly predisposed predisposed to cobostesis or conversely oof On the thece of Planarly tubercoulo infection infection and your beling beling that residocio is a modified modified tubercul PLAINTIF'S PLAINTIFF'S 3 #3 Countg Countg Countg Countg Hamilton Hamilton Countg ^ DEAR MALE CHAMANAU VHLISLES WH HOTELKONNE HOTELKONNE , IL D. HARITY L OLDINU sult fps ew THE TUBERCULOSIS HOSPITAL ' CINCINNATI 5 WIL B. BICY BICY a TOTENETTETT Yau G2. " " ' ' PLANTIPLANTI PLANTI NL COMFY ARTIRALA DOUBL DOUBL ropert produced taborealosis that in Jour of Indant Hygiene Vol 13 March 1931. on oxporimontally in Bebeetos Sacted cavice I favorthe boltof this ea it is likelythat acbootocio predisposetdo residosis I will greatly appreciate your help in regard to chemical anyone and your . comments if time permite to the above qeutqeutiican cqeuaticnan Yours traly Precis huff , R.f. E. J. Hitterhoff H. D. DIRECTOR OF LABORATORILABEORATOSRIES EJB b Becember 25 1944 B. ( 11717 ( 11717 Ritte Ritte Ritte Ritte DirectDirector orDirector of LLaboraatobriesoratorieLasboratories Laboratories The Cuberculosis HospHospiital tHoaspiltal Ta TITRAM CincinnatCinciin ati 8 Ohio you po po you Yh /> / /RRititetrhteerRit/herhee RiRttierthe/terhe RitRittterheeRirttehrhee PLAINTIFS PLAPINTIFS LAINTIFFPSLAINTIFS ESKHIBIT ESKHIBIT . Ritterhoff Rit erhof Ritterhoff ches oHP ef Riterhof Riterhof RiterhofRiterhof Ritterhoff Ritterhoff Ritterhoff Ritterhoff Ritterhoff Ritterhoff Ritterhoff a very pleased indocd that you could let us uch BUTO uch a generoua oample of tissue for chemical analysis of your Pedolnating Pedolnating Pedolnating sese of caroold and asbesto610 QA ILLA DATA AT QH1 won in ordetro ascertain what are prosoat The otory will inelio Cas only ohonleal and tay diffraction anelyood but I shell cord it off for a spectrographie analycia I ca doing thie Boause I am Boohing fox control material to a series of carsold or sarcoid cacoc fre the fluoroacent Acry industry I en doing everything that I cry to determino whether theso pay to an industrial environmentel environmentelenvironmentel factor involved in the otlology Shua Paz we actually new vory 11ttle 11ttle : Chose people nako fuarcsccnt and other typed of leap radio blbs In a very olcan factory Doryille to andor caspicicbaat in apito af scivo ately the saposure to any particular outstando esde Vory 2141801 Experimental work open many of the ohchicelo Lavalved hes ce yet prodused no decisive resulte It ta my can fooling that casid is probably due to Come infeet to excel excel --"--, at--t,, he process ties Portapc it G5 Q TO I can't recobello the Flotolegial plotero cith barcalecio as Pires dose o cacily Fay Choc it com ilkoly that the dicendo id Quo to Lozza Bacilli or othoz asid organion E boliore that if P eatino g Po cally eating eating IIts tItss aabaab. ,, as a tant is consorned friezer noshanice itc role to all punct to the ciras fine 09rpro- pro- de viatovor to da would Is your caco the presence of asbestosic deem deem to no probably sorely coincidental at least this is the Pirot ties thio oombinatiohans boon reported I have studies on approxiestely approxiestely rift cases of acbostosio and I vo never been one complicated by carsold I would infer that in your caed the two conditions conditions developed ^oreor sobestools to is based to scae probably leso sincitareously but that before the tho This This ap eared degrus before the perooid appeared This sobestools opinion opinion opinion particien the odourenco of asbestos fibros and other iron containing containing prosent was is basebdased based particieon n particien prosent on on in 4ses within the later latel rloroorf the tuberclo nodules and in some the encrusted inclusions the glant gallo themselv69 The calcium encrusted in that elagsiatnit c sarocide colla are tod10d very frequent in all of the polmonary I do not know what they are but they look like bite of elastic H. J. Alttech Altech Alttech 20 Decontes 37 1946 1946 Close that have attractedattracted no : otbord an oyster chell calto have of goations appearance whose origio is hardto imagine oc la the those your caso a few of those dooply stained bodico chich are a footer of Jolleviah piicated portiona Bobcatos 4 carsold and in addition I noted 23 you bentioned corbain of fibre that have a which oad depocta may be Thoda of course are not sono in und piicated bestoc On tho other hand some of the acbestosid tedios in proparations have acced Coat bigarro appearanbod. At the rich of being stonou about the occustical occustical I orposure would appreciate it if you would tell me what sort of a plant the Philip Macufacturing Capely operated whewhet ther h whee ther r cos CareyMacufacturing have any idee of nature of their their E an intcocted of thethe producto the but courio not only exposure to abbestod in the rodelbility rodelbility courio able of an exposure to florecent subotne0 Wo shall probably be to detorcine detorcine detorcidnetoercine detorcine detorcine detorcine the presence or absence of the latter by would opectrographic anelyoid but it bo holpful to know what pocolbilities are involved Passonally I would besitate to commit aclf on the question of causal relationship between acbestcolo asd sarcold Bech rolationship Gay fist but from the ovidence before do I would find it airplcait to deside which o2G 05060 and which was effcot Tr ROTA 50 the fact that the two conditions oestr po raroly in the caso lure I would rather entertain the opinion that chenso bac roogonsible for their cicultaneous occurence in your 6880 After we got ore various choical and ather actical Cata Cata together I would be very glad to 6470 you my further corcents to De ased in your 0070 report if you co dooiro my villc villc that after inspecting the groca catorial I ca coro proceed with the extent asbestosio In comparison comparison with ocz other caterial the pigmented food you as deen to show Boro Abroels Abroels and Ices Localised emphy Logically thia UDO probably be oxplained by the prosence of carcoid nodulce within the debostotio conos of roactio3 Again nay I express by eppssolation for being allowed to study this unusually unusually interesting interesting caco Sincerely yours, LOG P Leroy Leroy U. Jardner H. D. DireDirecctor tDiroectror = E : = hg= : == = 354 = 2 =. a = SC 7; EC Ed S052 = Ee2 = SLATORY SLATORSYLATORYSLATORY SLATORY SLATORY 3 FS SLATORY 2 2 S2AS <a y Sy E Sea ve te 2=C. = 33 = . = 32 =e DPANDDAPTAENDATE DPANDATE MOVE Z DPANDATE Bee xte =} CeSea Se 2 = E 23=2et 2 = 'o Nn > - 237 2 aS Ser Of 8 3s= = s = SS = = > 32 Se: SES23 _ -fe =e= Sve: = 7 2= =. 2. Fe Cr S3SS = S Eel BTSSa a= = a edSs SS 2 or > : ' Sgeegtsegeeeee SS : SS == < 3 Sr AS"? = 2 : "ao , =aa== z= > 2 o3 2 ~ E SS en 2 e- es es 3 2 = 43 = ; >Ts St _ CS ; (>a > ee = (=f = 2017 eee 2 == a <= = ote eek el =| = = = CotacS Cee eo easa [=G6 ASS im oecrec sO 2 =e = == SS = = =4 es 3 FS = = Sa = aeeSoEg _ {===SF 2 ArseS75 ee =SSFSS = Sigs1. _ = Sasre ZS SSSS =ore 8 = > = = =Fes3=sa5 = et Eat 2 2 7 z 23 3 ?= 273 = Eres3~ ieHe z= 3 2 =e4 = > = 2 = =+ > Medspace Medspace Medspace Medspace Medspace Medspace Medspac Medspace 5 Ea = 2 fretustesfretustes fretustesfretustes for fretusfor LoveLoveLoveforLove ]E