Document 6wkLn7k97eqZXMLLqJoDk3e04

liovenber 19, 1953 ROT ILL" r/'^AUlT The Saranac Laboratory Ho. F-53-590 The deta rad the r'tor,o'i T>ort = lning to th* m<> of one P.oville Dun"pult were brought to The S^renra Laboratory by Dr. Fa.ul Cartier of the Thefcford Industrie! Clinic on July 31*. 1953 and consisted of the fo!loving: 1. Abstract of claim case history. Tile Bo. 576. Thetford Irv'oAtrlnl Clinic, Tbetford Minos ,9uebec; ?. 4 Ho. 576; i"Tcr.t,*v*ric idr 0 Pu UJf 3- Autopsy specimens. Claim ca history: (Tr^nacript) Are: i'-6 years. Haight: 5*/f:M. "ei/^t: 157 lbs. Deceased: July 29, 1953- Autoosied: July 25, 1953- Sections etudied: I>r. Guy rad Dr. A. Vcrveld. Occupational hjetory: Bell ringer Grizslynnn Yardmen Bagger Dryer Hillright Foreman in Crude Hill Maintenance Hill 1919 - 1939 19?9 - 1925 1925 19?5 - 130 1930 - 1992 jcb2 . ic/:Q 1-*19 - 1952 1950 - Jea./53 Consolidated Mine N ------- II " Johnson's Co. ltd. ns v SR ft * It * H In summery, this emoloyee hra worked ?3 7Pflrs in the asbestos Industry, 16 years in a heavy concentration, 5 ye*rs in a noderate concentration, end 1? years In er. unsignifleant ex posure. Medical history: Apparently this employee was in perfect health until Oct. 19^9 whan very suddenly *t work he presented his first acute and severe cardiac episode, retro sternal rain, dyspnea, cyanosis. Three weeks after the scute, the reentgenogre-a was still showing a market cnlarrment of the cardiac, silhouette. He returned to vork doing light work only ?id living quite normally when in Doc. 1952 he felt for the second time in heart failure, he did not recover fren that crisis and h-*s remained in a chronic stage of heart failure to become rautely ill on July 25, 1953 with pulmonary oedenc, anuria, ejctrr-. eyancsls.and dyspnea. | : PLAINTIFF'S 1 . EXHIBIT 00034 ?-53-590 Cl alia case history (c3::t'd): (IT. - - crrirt) Per* Iclor!'.":! rcncrt: The first 3 chest r-d.ic.~- -;3 t '.er. in 19h6, lv*'7 slid 19^3 are es-crtiiilly nnrrvrl. The- cr.r i ' r.n Hovcrlcr P, l?1?? ic shoving a norhcl dil^t-t?. n* t'e '} If. ;-vt. 2!'.C chcot filr9 of ?<-?reh 195"- and ~el=rv. ry 1931 indie".1? the return the heart within n-r-l liui'.iu The filn o f Sec. 2;, 1932 reveals again o'ae.rkcd hypertrophy or dilate.* Ion cf the lie-rt sd moreover Vindicates soft infiltration ?t t?*r level of the second Mid. third Miterior cne.cc. Chore ic r.ot on -r.y cf ter fil e cf 1:1? errier *^?y radiologi cal sifrnB sf cul.'-'en^rv fibres??. Chest aocntgTno/Tnrs: ChF sr-rirs cf ehrr.t roent-'i*r.o^r-::n a-ini ttfcd here 120011 read and interpreted by Leonard J. Sri-tcl, H. P. , Hestl cf the Lrprrtsent of Undiology of thr Trudrsu 7-*und?ition. I concur ''*th the r,.r;c'.lnz~ . ,.1 w w >- laiC11 X3 * 3 Z *1JL i CV' ?5 The chest roant^eso^r*** tenr th* idcrvttflcHticn? Industrial Clinic, Thetford Tilnrs, 'yuehec, 576, dated S-2-H, 9-27-^7. g-pb-h?, ll-B-l:?, 3-22-50. 2-27-51. 2-5-52. 12-23-32. Boent.eenols.- lcr-1 cxaninF-tion cf the rbavr described aeries of chest files denonrtr:?to3 prag^er^tica of the peribrcnchial narkin.Ts fro.-a the cutset. forever, at the series progresses t^err in sern a slight hut definite <l*velo;cnt of fine nettling throughout hath lung field3 cjost pronounced in the b?ses end niddlo thirds. Ty i.'ccpr*ber 1952 t'-ere Is 3one irregularity of thr right cardiac herder. This matter finding is ucdcuhtFdly dup to a plo'crr'l periccrdlel invclvenent. On the earliest filn a. calcified plaque in seen vithia th<e left porlcardiua. This hv.s not checgrd during the six-ye^r period. Peginning in Kerch 195^ thr ? !r n; ill-drflnrd area of lrw creesed density eernencinr rt the uerlphrrsl portion of the right third anterior Interspace. ?y Irceal.er 1952 this has progressed to becone nlnost honoger.ecus in density end shout 3 cn in its videst ctfcras sect ` -n-.*.! dienetrr. Also, there has "been a progressive increase in the tr*nsverso diameter of t,he cardiac silhouette until it hrs become cuch greater than 50^ of the tre nererse diameter of thr thoracic cage. 2- 00034^ P-3':-59C 3onntrrnr-T/v-o: (r.'T.t'-) -.in* ns? Asl'crrt1 c 1. r>? r.r^.: cf irrr'--Fc-d d<?nsltv in the cui*r -'crtisn of tvr riht U'"'i,r con Id r<! renfiit n rnlnoc^ry in- fcsitinu?. rr -rrss* *:trh /in pilncnery tukor- cniloMs, nt 11 5.s ?.l?o r''nc'i,rn.'ble t'--.i it is t>' rrs'ilt of - T:FOT7l"stie Trccsss. Ironnrd J. Bristol, !'.2. , *i . 000350 1 ilovillr Dussault r-5>5 90 Antonsv scccIrens! w'irriprr.s fixed \r> ^r-')!n e *t r the thoracic org^nn, in-, eluding the hr->rt tvr lungs ".nt1 :*lro the liver, the npleen.and the kidneys. Gross ncthclarv: nmrt; The orr^n i vodcrc-t.;: ml vccil, involving bctli ventricles. ?''*> chamber contains lrg* am: firm cont-ncrtpsa clots of fcrnnlin f!r*-d c-locd. The right -trirjs r_r.d ventricle arc greatly dilated. Th*- v-lve orifices an;* cuccs avc-mr normal. The coronary orifices ?rc v>?.tcnt Irut ~rc surv vjr.d-d by small tMn matches cf atheroma.. Discretion of thr c^nnr/ 7esrel la difficult because fixation nrlcer. It difficult to th.rir course. All zrc patent but the intinc! lining exhibits *n occ?ionnl sccll path of atheroma. The ryoc-'rrliun io ""le nnd firm, apprxrritly cue to fixation. Cross Tritnippiu orifice Mitral orifice Aortic orifice Pul.-.on-ry artery orifice Myocardial 'ti.11, right rrMrirlo J'yocrrdi *1 veil, left Tf-ntrlei e 15 C1 in circumference 1^.5 ca in 7 cn in * M 7*5 cn in " 2 to nn in thickness 3 to 12 H " m Tr~rh?g- *nd rv)n bronchi! The tr-rhe. and min bronchi are filled vith e turbid fluid. The passgeo are widely patent. The mean", in polo r-r.d everywhere smooth. Tr-cheohronchiol lyn-ih r.ndcr: The n-des are only moderately en larged find mildly pipr.ented, being grey-black in color. They "m only slightly firmer than no reel and this is interpreted an due to fixation. Tibrosis la not discovered. iunrs: The lungs ere voluminous end firm. hving been fired by introtreeheel Injection of formalin.. The pleura exhibits scattered s-nll foci of blnck pignrnt which are generally soft and raised but are little, if cny, shove the surface. These foci fail to show a perceptible fibrosis. hlaevhere, but particularly over the lover lobes laterally, thare nr 1-rgc res of white thickened, pleura. A calcified pleural plecuc is noted cn the mesial surface of the left uaper lobe abutting the pcricrrdial sac. Section of the lung reveals focal and diffuse d*ropits of birch pigment. Such deposits occur often in areen of thr. lung vhieh arc norc resistant to palpation than are areas elsewhere. In addition, the pulmonary architecture in these firmer areos in senovhrt distorted. These findings suggest tha preoenco of some diffuse fibrosis, but the presence of that fibrosis Is not visualised vith certaint; in the gross. The lower third of - li - 00035 Jtoville Eu.3sa.ult P-52-590 the right urrirr lobe cent.'.inr. a tv---]! IE ~ m thin--''ailed cavity sit'tetp.d in the lateral jnrtisn Fnt'-rJ nrly. This cavity contains a sr'.-'ll amount of purulent materiel. It rcmrinieatF.s with a snail bronchiole. 7'>rre in 'r.r-t'rr sio'.l r but ?-*vller cavity, 3 s ^ Bse it the later-'! portion of th* right r.i-.'die lobe ftnteriorly. Both cavities avvear to be lironuM<*ct*'tic. in type r't'^.r tbi*n tuberculous. In nudities, the right nvy*>r lobe canteens a derr*--eed puckered scar beneath vidch there is a 1-rre mildly pi^-wented irre/.'ular lesion conr.istin^ cf fins --ni; ru.lc tissue. This leeicr. is Intcrrrr-ted r~ the one ncr-cunting for the shadow seen roentf.enoirr^pbl c-'-I ly in `thr er.r:ui e;.-: third anterior spacas1' en th- right. Tussive eon/'esti on 1 ? noted, p*rticul?rly of hoth lower lobes, posteriorly vher- thxre is en occasional crp of increased firnness sm^estive of eerlj hypostatic bronchopneumonia. Ijcohrrv.si Tsr.t--ncrtoSS charge. Liver: Pcrt-r.orton change. 5-^1 a an! Test--r*nrter Jlidney s: ?ost-nort*'n change. Adrcnelst 3'ost-r.crtor. chance. 1*1 croscovic ?-tholc-y: Lung! Sections of the Inn* rrhiliit four defined types cf pathology, namely, s. diffuse pigmented fibrosis, en epithelial proliferation vith focal r.ali.'Tjrnt t.r'nsfor^.-t.ien, n fec-.-l rente pneunonitis, and a focal necrotizing nrceess with envi t.-tion. The diffuse nirnented fibrosi** is vicvslired often as focal cellars about thr rer.nirrtory 'bronchioles *ith irrernl e.r ertrrsiens into the surrounding tiosuo. Elsewhere thr fibre*'!- 1- core renerallred thrcngr.aat large sr?*s of tkp lung. This is e-pecinlly the c^se in sections of the right lung where all lobes are involved, n^rtlculerly the lower lebes on both sides. The fibres!a distorts the respiratory bronchioles and pul monary p=re.chyn.. Connequently, war.y of the alreolar vails are greatly thickened pc*' the alveolar space* ere compressed, or the architecture of the lung is completely obliterated. In a few areas the alveolar vails are thin and ruptured with resultant enlcrgemcnt of the formed alveolar sr.-nces. This feature, however, is not prominent; thus, anatomical em physema is not as pronounced in thin case as in other cases studied from the sere industry. The interlobular septa and the pleura are often thickened with fibrous tissue. All sections disclose widely scattered particles of brown-black pigment. In addition, there are scatt^red^/ficdf?*'JSf various shapes and sizes. These bodies are gnldorwbrown or black-brown in color. Some occur as sphericnl bodies vheree* others are well developed, being long, often clubbed or dumbbell in shape, end sometimes segmented. Both particles and bodies occur within large macrophages which are free within the alveolar suacea or v- ich are embedded In the fibrcua tissue* -5- 00035 Seville Duasault r-5>590 The epithelial proliferation Is visualized in nsny of the bronchioles enc in the Burroun<Hn;: nlve'V-r r'*cpi, especially in sections from both lover lobes where fibrosis constitutes a prominent feat-ore. The epithelium of these brocohl\i7e is usually colutsnr.r, often extremely tall end in rosy i m<=t->r.oe fills t^e corresponding bronchiolor lumen. In the 'lTcol^r sparer tfc-e eoithrli'v exist r* low crbolr'Al type vhich fores e. r<-rt! 1 or oo->let* lnvrstres.t of the spaces. The rrlt'i elll rrolifsr' tl re pr~rrr.r 1r most prczcvncii In tecticna of the lesion ?t the site cf t'-- deprosr.rd racherrd nleurr.l sesr observed groetly ir. thr urper IdV; or. the rlgM aide. At that site there is an irreg-.ler lerge foc^l lesion consir.tine; of e more or less central Bess of diffuse fibrous tl>-.'c lrr?reratftd vith scattered particulate pigment nr.d -j\ -oorit ester. body. Thrcrighcut that nasa there are numerous rrell cl-ost`,rs cf epithelial cellr. These ce7.1s ere arrm^sd cither 'bout snail eentrol r.pHcee, thus Giving rise tc an ...Oj .u. l .*.W .w..w. fwc *!.....w.. . w --- - 1.w--- I- .* --- * . ^ww. s vJ infiltrate th.-? f!V.r~'r tia^is. In the sulmenery prcrc''yn* r.bcnt the central fibrctln mass the s.lveolor r.r".biiotnrE is preserved. Most cf the j-.lvrcl'.r npscee, however, ore lined vith a sisals or a multiple layer cf low cuboids] *-ithrl ics. Close lnsr-octicn of the epithelial cllfl c'mrriMnr the proli* *rM ve process disclor.es often en ap- prrclrble ua.-vol.'tic vith. nom-rous 1::r.:.d hype.-chroamilc cells, nany lr. the -^r^r"'r cf sitorls nd mny inflltr.'-tinv. the supporting frnrsrwnr1: of fibrous ti*;=u. Thi* process is intercruted es an early enrein--?, epidermoid 7r.it often with aa adenomatoid pattern and conforming in com rre'e to the no-celled alveolar carcinoma. It is pertinent to note herr th--.t another sertion from the right ur...ar lobe, but = ovr.cv.i-.t removed from the c-rcinoriatoua process, discloses a fev small focal mr = c-a of epidermoid cells embedded in a dense zone of fibrous tissue. The acute pneumonic process consists of /c*l. cress in which the contained bronchioles *nd surrounding alveolar snaces rare filled vith purulent exudate c^recterlr.tie rf foc-l bronchconeu-aonia. The necrotlr.ing "roeesa occurs in tvo sections from the upper lobe and in cae section from-the riddle lobe of the right lung. The lesions are discrete and are op.c.v-'eulated with a thick wall of fibyruB tissue. The is scui-cosecu In type; otherwise there is notlsln-* tc an ;vot n specific etiology, 'fhs lesions are probably th result of = foe*! tuherrulocn infection. If bo, th.it infection is a psrsntly quiescent. The snail cavities noted in the gross right lung aro lined by -7. thin layer of necrotic tissue with scattered leucocytes, end n ocrnvlenal lirewn asbestos body and tone diaperaed black uigiwnt. The necrotic tisue is largely co- agulativs in type r?.th.r thru ceeon. The outer wall of each cnvlty consist* of a ccnpr-s^ed but loose matrix of fibrous tissue with scattered 'ycphocyten r.d lorge nononuclear cells and an o- ccsionrl arbeeto body. Hero rnd thor throughout the wall are snail isolated clusters of epithelial cello and one of the cavities neighboring n bronchiole is lined in pnrt by a thin layer of cells which tend to !*> regularly 'rraned and which suggest epithelium of the low cubcicUl type. Thene findings suggest that the cavities are swill purulent saccule of teminal bronchioles. There is nothing clout the cavities to indicate a tuberculous etiology. 00035i. Boville Dassault ?-5>590 The necrotic ''roceae toiuir. to hr correlative In type. Epithelioid cells and multi nucleited <=;i~nt cells do not participate in the form't!. on nf the cavities. Acid--fret becllli are not discovered. Heart' "he pyoc.-rdi.*! fib *>*- are er. 1 end the respnetive nuclei vrr fre'ivw'.fy huge "r.c; deeply stained. In addition, then: iu r.i .'Rvcini.l? nr*r:r.t -f lrf.ernt? t.! fihrosis, often con- teinlss.; c:""ll ds"rT''tt1^ sc~'"'t!i of nucule fibers tout otherwise cos--.-li.io2y r*-ul-'Cir.,: lh* fiber. TV'* coronary veceela contained in the eeciioiK- sh-.i-..- little >r >jo st'-*Tocclero3ls. Sections iron the va.ll of the rlfht ventricle rvMblt pome ntstirn and degener ation. These c:^n;;er. r.re cr-p-' t Jhl * vith eerdic hypertrophy and dllr.trtion, tcyet'-rr vl t* ocr'rdi*1 fibrosis. 1 iv*"!** r-v>-vl eos1 or; ts1;- -r`-r.crd prreive congestion with f.t of t'-.e -1 ot - ! -nr. de-ener*' tion of the. liver ,er.lr-1 vslrs. " r- crprv-lp of the liver is thin. Sol eon? See 11 on ^ mr'-LMt --y -r t r o-", "e c 11 m cr.ci lyporplr.si*'. whirl. obliterates many of the lynnh follicles. Ti-e,* is hi aw s'-ne 'oab-nov* -n ch:a,-e. Sidney t The nr-R.il v.occ.ul =:* ch- r.: dr in 1 he ne^uHstr substance ere oftsin distr.r.d-.:<! *-'th blood, "'he t'ihi)i.o- epithelium, par ticularly in the cortical cult**2icp, is often extremely vacuolated. In one son* the csllul -r d-t-il is *bront beca.vre of dennsltlcn of a homogenous substance whir"', h'p -n affinity for the hematoxylin. This is aunarently z. degenerative r,j-rcs'"s, probably due to amyloid. The glomeruli ahnv no eign? flc*-nf. ->r.',rr:ality. There is-little or no ' evidence of nephrosclerosis. (ir.oiv5T The case of Hr. "cville 'v.rsr-Tlt cvhiMi* -n rrly moderately advanced asbestoais charact.-rired -by r dlffue flbrotic nrocean which involves pri marily the pleura, the lntrrlcbvl-r sa-tc, -;id the pulmonary parenchyma, especially about the riR-lr-t-iry bronchioles. The fibrosis is accompanied by widely-scattered blccfc-bror-a Ti~*vnt, hy rnirnles. and by asbestos bodies, the letter In various stupor; nf development end of various sizes and shapes. These findings ere c-.anjfttlblc viu, tlv occuustlcn-l history, to vit, 33 years in the asbestos Indus try of which 16 ye?.-a were > pent in a haavy concantretien and 5 ye*re in a moderate cencer.tr-tion of asbestos dust. Although mrry of the alvesl.-r vallr are thickened vith diffuse fibrosis, the decree of anatomic--1 c~pb.y*en* present in the liras of this ease is not as pronounced as in cth^r esbentetie c-ser vMeh hrve come to us for study. It vould *j*fie*r, hot-ever, tbrt the diffure vulvonery involvement, together with the omnounced epithelial nrcl i^er-'tJvF proeecp obstructing the lumen of many resviretery brrr.cbi eles, v-e of mfflcicrt intensity to have oc casioned tha r*apirr:tcr7 dlffin-Hi rd f'T.r*-rpr1 rrherresnsent of cardiac function. T*>*uh the- h>-^rt, inc'-vlin^; the rJf'it ntriva end ventricle, became - 7- 00035u F.avllle Dusseult r,-5>590 enlarged cr.l hyprrtre-in -' `-ff-rt to c"-- mc"te. Tiltissafccly the camr-ur'llar. fs.ilrd, thue Kirin.; rii* to '',>*lvc cangeaticn ootrd in the lire? rmd Tun.-p::. ' Itirvtrly, the oonfvntica In the Inn.*: favored " nrorn*'1*''!'^ hy c-i- lie >.r 'iiriwwfaaicls. noted .bs a ternl n *1 >rrr it cl! r. \ <* il1 ; ~ ad "r"rr -1 la I* e -c'rt-acrtcn tissue. In*.Frcctire but '1,1 `turMn." f~-:t';r- i cf tV C'-.r-c 'crisin to the flrni:TOr'-<1 o-iit1'*. 11 th- tr^r-chi el .-r nn ri>-' 1 m. vVu?h irrrr.lT*ti :any of o w triers, n>l tc the oerly enneer Incr-ll red *r. -..-'1 -,V '*. -i 1 ;'.v.,r. r;f .vj'uestatie fibrosis present in the- nnrrr late of t.r ri^ht lunj<. C-meer of the lu hoe h*en diseoT'ors'd in v-`t :..* ; .. '..ItV- :'./*'> vln, hut t :-* ri'li.qs.uicjr in tb.ee e<<>>* w* >'rr,srr:t tt-.-j:: t fv t-.v-v 11 y ett 'oll-<iefin*-d end ed-reneed lffftic.ni' M eh rrr*v i :;aJrr.: -1 ! . -u:rr.. Che ense of hr. Thisasalt VT^f-r^c 7* # es ***** t f \fi C ~ **! tV * :rrclireretloo with focel el iff- nnnt i.rr> w'-'f?-. i* <r : lic/Vd by erilrrlSal proliferation ahov-- inf" n< 13 ?Tint correct ri st `c,: with tV dm*Torment of nnrly cencer. Pviti-eVel rrrl ifcr*ti on v-" Wen noted heretofore *. <s frequent hut f:n*TFl):; ~r c. nils ramlzr: ti:;. >i ?.:> licr'-sir.r imeRws oj tne iun Inclrdi.r,* tvV*rr**.l'*', ' r-r ?H-r* <=!, err* r.lainc pneunctile, end cilicoris. The proliferation V Wen all-'-ily mars rrcn-vonced in ease eases vith * ", ''H career r.f t-r lour Vo lern i5i-carprejj ia * fnw of those ce?PB, Per-tafcre, -r, t'- emc.-r in toaso f c*s* Ws oeea fc-njo an r. v*ll-d'*^ii;-*<! -ui xm-JOiiirole Vuror C"oa, n. relotirely lete nts-'p of dcrclornuit. In cantr : t. ihr c-e cf Pr. Porille Thwrcult pr*entn s. pranrrnu*t-d *;.** i>:n. proli fer*tion and n enucer In an rrr'7 tis.e nf di-,T< \ii !'. lacr.li-. t'en of the proliferative rroccoa ;.*''.!*. t!'c --ir-'*. ; It r.rV -le v'T-rn oa^'Potctic flhraris h<t ita inrrrt*.an f n-i tv<* irc,.r'T-"re cf tii- rnr*r lr. end about n. fecal leelon of *riT)rrt ori o * r~ inpor'.'-:-.t f~r o--eai>J r:-1'on. 7hertj findln^e nu.reE5t tii't la ive cs.."e of t'r. }> *.#.!t* r.l- Irani, t>:e ecbeetctic fibrosis was a frctvr vl.ich rime or In corbIr- tian. j'ith other as 7et undisclcnec f-'ctcr* oi.-r rated t-' the cone' r prrerjit In his lunc. Vhathrr tht f= ctcr Fl mr or that factor in corl.ir.'!tlcn with other factors /i ff *cv.ae ts tie etlrlory of c'^ccr dircoTered in other T.sbertaMtc c?*v VVled h.rr-tofore rewlep ta be detrmined. - 0- 00035 ?.trrill* T^xs steal t r-53-590 It Is --J orinl^R that i';.r c**n cf '-'r. "grille Punanult zLlfcits: 1. Moderately .'dvr.RCFd Atbeetcsls. *'iicsprcr.d 5'c=! <-:'!thrl iv.I prolifero Men vith { etc .-.tarn t of s'lyrolT tU'scra,. 3. 7orl leslcc cf - Ecstatic fVbrsBla vith epitheUr.1 proliff ration ,--nd vith tm.11{=anat tro- nsfornate on predacia-; an estrly c-nccr. k. Purulent breach! ti*- "r.~ IrrcchioIIiia vith f c-"l neat.? ;.Rtjuarciti8. 5. Card!ac hypertrophy and dllAtatica. AI 7:13? Arthur J. 7orv2d, ?t.5. -9- 00035