Document 8VyYqnQykvnbzDkLDxgOJ4rjk

FILE NAME: Plant Insulation Company (PIC) DATE: 1957 Apr 19 DOC#: PIC001 DOCUMENT DESCRIPTION: Independent Medical Examiner's Report 1 T ( ( H a r o l d G u y o n T r i m 9LC. M D J Lloyd Caton. M D G e r a l d L C r e n s h a w . M. D J ames Kieran. m D R o b e r t B S t o n e . M D. Wm B Le t t w ic m . M D. 2930 S ummit S treet Oakland B California Jj April 19.ri957/' Re: Mr. John C . Pteretti San Francisco 19, C a lifo rn ia ltta n tio n i Mr. D . Hanson Manager Employee Insurance Department G entlem ent This man vas examined in our o ffic e on A p ril 8 , 1957, and subsequently. I reviewed w ith him h is personal h isto ry , h is occupational h is to ry , did a general p h y sical exam ination, includ ing flu oroscopic x -r a y , x -ra y film s o f \ h is c h e s t, electrocardiogram s, pulmonary v e n tila to ry fu n ction t e s t s , and c e r j ta in other laboratory te s ts h erein after d e ta ile d . I a lso reviewed: 1) Copy o f report dated December 20, 1956, unsigned, presumably a copy - o f a record o f D r. R . P . Adams, o f San Lorenzo. C a lifo r n ia . 2) P h o to static copy o f rep o rt dated March 25, 1957, signed by A . D . Sien nas, M .D ., o f Hayward, C a lifo r n ia . I subsequently reviewed a le t te r dated A p ril 12, .1957, signed by A . D . B ieunas, H J ) ., regarding the p ath o logical fin d in g s o f a lung biopsy performed on March 7 , 1957. I a lso reviewed ce rta in m in ifilm s obtained ft-om the Alameda County Tuberculosis and H ealth A sso cia tio n , and subsequently returned to them, as fo llow s: 10- 6-52 11- 6-53 1 2 - 2 9 -5 4 #629 #433 #825 The fo llo w in g chest x -ra y film s were also reviewed: 12-20-56 .1 -1 0 -5 7 2 - 9-57 2-11-57 4 - 4-57 4 - 8-57 #318 #321 #327 #327 #338 R . Paul Adams, M.D. R . Paul Adams, M.D. R . Paul Adams, 2I.D. R . Iteul Adams, M.D. R . Paul Adams, M.D. Our O ffic e (1 film ) (2 film s) (1 film ) (2 film s) (1 film ) (3 film s) % f fti.re 2 - Fibreboard i r Products Corp, A p ril 19, 1957 Re: f *. J Dhn C. Peretti At examination on A pril 8 , 1957, the p atien t's complaints were shortness-of breath on exertio n , some cough a t n igh t, he raises a l i t t l e sputum, and has some postnasal discharge. Hia occupational history is as follow s: 1915-1919 1919-1934 1934-1957 1934-1935 1935 March 1935 1935-1941 1941-1957 Bom January 6 , 1915, in It a ly , near V enice, Lived on the East Coast o f the United S ta te s , Pennsylvania. Came to th is country a t the age o f 5 years. Has liv ed on the West Coast o f the United S ta te s , C a lifo rn ia . F ir s t worked in Oakland, C a lifo rn ia , in fu rn iture fa cto ry , about 7 months. Worked with wood - three to-fcux weeks in foundry as coreboy. Redwood C ity , C a lifo rn ia . Vorked\ih s a lt ponds, barvesting s a lt , fa r S ta u ffe r ft C o ., tinder ju risd ictio n o f Plant Rubber Company (Fabco), nou/Fibreboerd Company. In F a ll o f 1935 started worMng inside o f Fabco P la n t, around Billing m achines, trim jn g and feeding in to machines pipe coverings o f asb esto s," Then worked in Bold room. Transferred to Em eryville Plant o f Faboo. Was sold f i ll e r for 6 months; then f i lt e r operator fo r 4 years, assembling ingre d ien ts: magnesium hydroxide, and asbestos fib e rs from A frica and Canada. Has been Foreman in same plant from 1945 to present tim e. j H is past b isto ry is rather un even tful. He bad t o n s illit is a t the age o f 10 to ' 13 y ears, w ith draining e a rs, occasional a tta ck s. In 1943 be had a piece o f fib e r in h is rig h t eye b a ll. This was removed by Doctor Cooper in Palo A lto , who to ld him he had some nasal d iffic u ltie s (probably polyps) but they were never treated . He states th a t fo r the la s t four years he has had some trouble sleeping a t nights - he wakes up and coughs and sp its up some th ick yellow bucus. He also gets some m aterial ft*cm his nose. He has had a morning cough fo r many years, maybe fift e e n , but he noticed no shortness o f breath then. In October, 1955 he vent deer hunting fo r the fir s t tin e end then noticed he was shorter o f breath than the other men. end a fte r th is exertion be coughed more. He was hunting a t an a ltitu d e o f 6000 to 7000 fe e t . Follow ing th is , he had some ad d itio n al coughing, but noticed no shortness o f b reath. Then in October, 1956, be went deer hunting again . He had much more shortness o f breath than the year b efore, although he was in the sane area (Lassen and Shasta Counties), He had core cough and more sputum, and th is persisted when bo cane home, Ife therefore reported to the p lant curse and doctor about November 1 , 1956. The nurse gave him some ta b le ts fo r h is cough. Doctor Adamson, a t the Oakland Fibreboard P la n t, referred the p atien t to h is own fam ily doctor p rivately without ex amination or a d v ice . About December 2 0, 1956, he saw D r. B . Paid. Adens in San Lorenzo, and about January 17, 1957, be saw D r. A . D . Bicunas, Hayward, C a lifo rn ia , fo r the purpose o f having a lung biopsy. About th is tin e , he saw Doctor Stephens in Oakland for _^<a sin gle v i s i t , fo r pulmonary fu nction te s ts . The re su lts o f these te sts are f Page 3 - Fibrcboard Far, Products Coro. A pril 19, 1957 Re John C. Peretti not kncwn to me. Be ban had no previous chest x -ra y s, except those taken on the m inifilm surveys as noted above. These m inifilm s have been read as n egative. The patient was h o sp italized a t the Eden H ospital by Doctor Bicunas fo r exploratory thoracotomy on March 7 , 1957. M aterial was obtained fo r a lung biopsy. A report from Doctor Bicunas, on A p ril 12, 1957, states th at the lung biopsy done on March 7 , 1957 revealed asbestosls o f the lun g. General physical examination, done on A p ril 8 , 1957, showed a w ell developed, v e il nourished man in no d s tr e s s . His nose shows evidence o f chronic ir r it a t io n , w ith some postnasal d rip and enlargement o f the tu rb in ate. . His teeth are a ll. gone - they were removed in 1955 because o f pyorrhea, not fo r any systemic d ise a se . There Is a scar on h is l e f t lever chest from the recent thoracotomy. Heart is normal in s iz e , shape, and p o sitio n . Blood pressure 128/82. E lectro cardiogram tracings are w ithin normal lim its . H is fin g ers shear d efin ite dub b in g . R eflexes are normal. Abdomen is negative. Chest flu oroscopic x-ray shows Increase in the basal markings and thlckenclng o f the pleura a t the le f t base, follow ing h is recent surgery. Movement o f the diaphragms is w ithin normal lim its , except same lim ita tio n on the l e f t . Pulmonary ven tilato ry function te s ts show decrease in the pulmonary volumes, and some decrease in a b ility to use them; w ith no expiratory resistan ce. \ W hile the mini f 31ns taken o f h is chest on October 6 , 1952, November 6 , 1953, J and December 29, 1954 were read by the survey readers as negative, in fa c t they are n o t. These film s having been read separately and as survey film s could have been considered w ithin normal lim its , but a ctu a lly when the three film s are put together they show a d e fin ite and continued increase o f the b asal markings, as noted. The film o f November 6 , 1953 is not o f good q u a lity , but i t does show an increase over 1952, and the film taken in 1954 sh&rs a very d e fin ite and increas in g ra d io p a city , more corked a t the le f t base. Cheat x -ra y film s from December 20, 1956 to A p ril 8 , 1957 show: the bones are normal; the heart and arch are e sse n tia lly negative; the dlaphragas are essen t i a l l y n egative; but there is increase in the basal markings on both sid e s, a l i t t l e mare marked on the l e f t ; there is some general increase in the normal markings throughout both lu n g s. There was Increase in these markings on January 10, 1957, more marked on the l e f t , with clearin g by February 31, 1957. On A p ril 8 , 1957, there was increased thickening o f the pleura a t the le ft base, fo llow in g h is lung biopsy. On t ills inform ation, I would suggest that i t night be w ell to have the section o f the lung removed a t biopsy studied by another p ath o logist to confirm the diag n o sis o f a sb e sto sls. I have not received the d etailed report o f that examination only the d iagn o sis, and the sections themselves have not been available to me. The other fin d in gs on physical examination end by x -ra y , however, are in accord w ith such a d iagnosis. Laboratory te s ts o f A p ril 8 , 1957 shew: U rin alysis: Albumin - n egative. Sugar - n egativ e. Occasional WBC por high dry fie ld . l Fibreboard JfejW Products Corp, A pril 19, 1957 r Re; h .. John C. Feretti Blood count: Hb, 16.8 ga. (108%) VBC 7,900 R3C ,680,000 Neutro 86% Mono 9% Eosin 5% Sedimentation: 2U cm. in one hour (C utler). Intradenoal tuberculin te s t with 0.1 mg. 0T: Positive in 8 hours. Coccldloidln skin te s t: Negative. Eistoplasm in skin te s t: Negative. 1 note from h is blood study th at he has a mild polycythemia, acme Increase in h is red c e lls , some increase in h is hemoglobin, and a s lig h t increase in his hem atocrit. The sedimentation rate o f 2 mm. would be expected follow ing recent surgery. While the pathological findings on the lung biopsy should be confirmed, the other findings a t th is time would be consistent with a diagnosis o f asbestoeis . The man la not disabled a t the present tim e. While he would notice some short ness o f breath upon severe exertion, fo r a ll ordinary purposes, Including that of his usual work, he has no d is a b ility . 'n As fa r as the persistence o f h is symptoms o f cough during the night is concerned, J th is should respond to adequate medical treatment designed to improve his bronchial drainage. There Is no evidence a t th is time that he has any impairment o f his lesser c ircu la tio n , though a therapeutic te st fo r th is purpose might be h e lp fu l. Sincerely yours, HGT:lh Earold G. Trim ble, M.D. H a r o l d G u y o n T h i m b l e . M Tj J Lloyd Laton M.D G erald L Crenshaw M D J a m e s KiERAN. M D R o b e r t F< S t o n e M D W m B L e e t w i c m M. D 2 9 3 0 S u m m i t STREET O a kl an d 9 C alifornia June 21, 1957 . l ^- ' 1. . Fibreboard Paper Products Corporation 1*75 Brannan Street San F ran cisco 19, C a lifo rn ia >iS/ A tte n tio n : D . Hanson, Manager Employee Insu rance Department Gentlem en: Re: Mr. John C . Per e t t i I saw M r. P e r e t t i y e ste rd a y , Ju n e 2 0, 1957, and a t th a t tim e review ed some o f h is h is to r y w ith h in , e s p e c ia lly in regard to h is w orking c o n d itio n s, too k a ste re o and la t e r a l x -ra y s o f the c h e s t, did a com plete blood co u n t, sed im en tatio n in d e x , and h e m a to c rit. A C o llin 's pulmonary fu n c tio n t e s t was re p e a te d . K r . P e r e t t i has not been w orking sin ce h is lun g b io p sy su rg e ry , and has gain ed some S i l b s . He i s now m oderately o verw eigh t. P h y s ic a l exam ination shows a man in good p h y s ic a l co n d itio n and in no obvious d is t r e s s . l!o ad d itio n a l* fin d in g s were p rese n t th a t were n o t rep o rted on A p r il 19, 1957, in th e re p o rt to y o u , so I w ill n o t go in to any fu r th e r d e t a ils . H is blood count now i s e n t ir e ly w ith in norm al lim it s , h is hem atocrit is norm al, and h is sed im en tation r a te i s a lso norm al. I-r a y s o f the ch est show a v e ry d e fin it e improvement in th e p o st-o p e ra tiv e p le u r a l re a c tio n a t h is l e f t b a s e . O th erw ise, th e re has been no change. The C o llin 's r e s p ir a to r y fu n c tio n t e s t shows a m ild im pairm ent o f p u l monary fu n c tio n , o f th e r e s t r ic t iv e ty p e , w ith no sig n s o f emphysema. In o th e r w ords, th e co n clu sio n s rem ain e x a c tly the same as rep o rted to you by D o ctor H .G . Trim ble on A p r il 1 9 , 1957. D is c u s s io n : M r. P e r e tti has a proven nnlnnnary a s b e s to s is . T his is a perm anent d is a b ili t y , w hich nay g ra d u a lly worsen d uring the y e a r s , u n til he has a com plete d is a b ili t y . However a t th e p resen t tim e h is d is a b ilit y i s d e fin it e ly p a r t ia l o n ly , and does not in c o n p a cita te him from liv in g a norm al l i f e o r doin g o rd in a ry w ork. On strenuous e x e r c is e , a t high a l t i tu d e s , e t c ., he may n o tic e some sh o rtn ess o f b re a th . ,Jth e r u is e , a t the present tim e, h is d is a b ility is a t a s u b -c lin ic a l le v e l. I th in k th a t M r. P e r e tti should be follow ed a t re g u la r in t e r v a ls , say a t le a s t ev ery one to th ree m onths. In these cases one must watch fo r th e developm ent c f c a rd ia c f a ilu r e , and fo r pulmonary tu b e rc u lo s is and other pulm onary in fe c tio n s . 1th each in s p ir a to r y in fe c t io n , Mr. P e re tti must have vigorou s a n tib io tic therapy im m ediately. 1 b e lie v e th a t M r. r e r e t t i h a s , a t the p resen t t i r e , an e s s e n t ia lly normal w orking e ffic ie n c y , except fo r jo b s o f a d e fin it e ly strenuous ty p e . I see no reason why he should r.ot contin ue h is p a st work w ith a s o e s to s , provided th a t he has adequate p ro tectio n from the d u s t. C e r ta in ly , however, he should not have any added subsequent exposure to a sb e sto s d u s t, and i f the p ro te ctio n from such exposure in your p la n t i s not e n t ir e ly ad equate, I then b e lie v e th a t M r. P e r e t t i should continue a t some o th er type o f work where there i s no asbestos dust hazard. j II ! j y i I i 1 , J JL E tn b i J \ - < Sidney j s h ip m a n . m d ROBERT W CLARKE. M D ELIZABETH H GALBRAITH. M D "\ ilia P O S T STUCLT 9 AN c b a n C ' S C C l Ju ly 25, 1957 Fibreboard Paper Products Corporation A tten tio n ! D . Hanson, Manager Employee Insurance Department U75 Brannan S tre e t San Francisco 19, C a lifo rn ia Re: John C . P e re tti Gentlm en: The fo llow in g is xy report on Mr* John C . P e ru tti who reported fo r examination a t your request on Ju ly 19, 1957: General H istory: le t * li3 . Born January 6 , 1915 in I t a ly . Has liv e d ! in the U .S . 3^ years ; in C a lifo rn ia 23 years; in San Lorenzo 7 y e ars. i M arried; fo u r ch ild re n . Occupation - leaderman fo r Fibreboard Corp o ra tio n , E o e ry v illo , C a lifo r n ia . Home address - lli862 Tulane Avenue, ii San Lorenzo, C a lifo rn ia . C h ief Com plaint: Shortness o f breath on exertion sin ce October 1956. fcven before th is the p atien t noticed restlessn ess a t n ig h t. The Problem: The nature o f the pulmonary disease and it s re la tio n to p rior occupation. Fam ily H isto ry: Father k ille d in war. Mother liv in g and w e ll, a e t. 62. One s is te r died a t age o f three in New Tork. Ko b roth ers. fam ily. Ho tu b e rcu lo sis, can cer, diabetes or a lle rg y in the ! M a rita l H istory: W ife a e t. 38, liv in g and v e il. Four children in good ! h ealth . P ast H istory: Operations - See Present Illn e s s . A ccid en t?"- Hone. Childhood diseases - Usual with good recovery. Adult diseases - " t o n s illit is and b ila te r a l o t it is a t aet. 10. Habits - Smokes about a h a lf package o f cig a re tte s d a ily . P rio r to present illn e s s he smoked a package d a lly . Alcohol - uses vine w ith d in n er. C o ffee - ten cups a day. Tea - seldom. A ppetite is good. D igestio n O .E . Bowels re g u la r. Sleeps v e il. N ycturia o cca sio n ally . Weight - B est 192 pounds - re cen tly ; average 186 pounds. Occupational H istory: The p a tie n t has liv e d on both the east and v e st coast sin ce coming to the United S ta te s . In 193U end 1935 he worked in a fu rn itu re fa cto ry and then fo r a few weeks in a foundry. He then worked in s a lt ponds fo r a tim e. Late in 1935 he started working in sid e the Pabco V * .*/- ( Page 2 . Fibreboard Paper Products Corporation ( Re: John C. r e r e tt i p la n t v lth m illin g m achines, e t c . He was trimrdng and feed ing the machines pipe coverings o f asb e sto s. During th is work he wore a f i lt e r type mask. From 19U1 to 1957 he worked in the Em eryville P la n t o f the Pabco Corporation where he was a a mold f i l l e r and f i lt e r operator and la te r on a forem an. A ll o f these occupations involved exposure to asbestos d u st. Present I lln e s s : The p a tie n t sta te s th a t fo r over fo u r years he has noted cough and expectoration a t n ig h t and as a r e s u lt some disturbance in h is sleep * A fte r a 'd e e r hunting expedition in October 1955 he be* came somewhat sh ort o f b reath , although th is occurred a t an a ltitu d e o f s ix or seven thousand fa e t in the m ountains. When he returned h is dyspnea was r e lie v e d . A year la t e r in the same area he n o ticed in cre a sin g shortness o f b reath again and upon h ie retu rn reported to the p la n t d octor who re fe rre d the p a tie n t to h is own fa m ily p h y sicia n . In Jan uary 1957 he was advised to have a pulmonary biopsy which was done, and pulmonary fu n ctio n stu d ies were a lso undertaken. The biopsy spec imen i s sa id to have shown the presence o f asbestos b o d ie s. He was then sent to Dr* Trim ble in O akland. D r. Trim ble had pulmonary fu n ction stu d ie s done which shoved some Impairment o f fu n ction and the p atien t was again to ld th a t he had a s b e s to s ls . A t present he fe e ls f a ir ly w ell but does have some cough and expectoration* P h y sica l Exam ination: tripped to the w aist. 2E Ears- Rose Houth fclandular system V ascu lar system H eart Chest Temperature 96.8* Height 69 inches* W eight 188, Pulse 8b- R espirations 16. - Pu pils equal and re g u la r, re a ctin g norm ally to lig h t and in accommodation; e x tra -o cu la r move ments norm al. - P a r tia lly occluded by cerumen. R ig h t drum scarred ; la rg e calcium d eposit in tympanic membrane. L e ft fa ir ly norm al. - Septum deviated to the l e f t . - Teeth are f a l s e . Pharynx n e g a tiv e . - Thyroid palpable but not enlarged ; no adeno pathy. - R ad ial pulses equal and synchronous; fa ir volume and ten sion ; v essel w alls not thickened fo r a. man o f th is age. Blood pressure 110/70. - R il not seen or f e l t ; no enlargem ent to per cu ssio n , although r ig h t border ie n ot w ell made o u t. - Expansion poor throughout. R igh t lung - note f a i r . B reathing normal ex cep t th a t a t the base p o ste rio rly th ere are numerous rhonchi over the rig h t low er lo b e . . Vocal resonance increased over th is area; no other r a le s . L e ft lung - there is a thoracotomy sca r extend in g over the 7th rib on the l e f t , w e ll healed, non-tender. Expansion poor over th is area. Breath sounds dim inished; otherw ise note good; b reath in g and vocal resonance apparently normal. s f P*r 3. Fibreboard Paper Products Corporation ( Re: John C. Peretti Abdomen E xtrem ities R eflexes V ita l cap acity Fluoroscopy X -ra y s ) Laboratory work: - S o ft and tym panitic throughtout; no masses or tender areas f e l t . L iver is palpable 1 f .b . below the co sta l margin on deep in sp ira tio n . - No clubbing. No cyanosis. No evidence of p h le b itis. - Knee je rk s equal and a ctiv e ; none pathological made o ut. - 1 second - 1800 c c . T otal 2600 c c . - Diaphragm elevated and adherent with thickened pleura along the la te r a l chest w all .on the l e f t . Increased lin e a r markings throughout. Part o f the 8th rib on the l e f t has been removed. Nodulation a t both b ases. - 12/20/56 - Increased root shadows; Increased lin e a r markings throughout, p a rtic u la rly a t bases* l/l0/57 - Same. 211/57 - Same. h/h/57 - A rib resectio n has been dors on the le f t and there is flu id in the l e f t pleural cav ity in ad d ition to the above mentioned changes. Increased flu id on the l e f t a id e . - it/9/57. 6/20/57 - Some o f the flu id has cleared . 7/19/57 - Increased lin e a r markings throughout, e sp e cia lly a t the b ases. Both root shadows accentuated. Costophrenic angle o b literated on the l e f t . P art o f the 8th rib is missing on the le ft. 7/19/57 - U rin aly sis - S lig h tly cloudy; straw c o lo r, sp . g r . l.O li* . A d d re a ctio n . Negative fo r albumin and su gar. Rare squamous e p ith e lia l c e lls . Many u ra te s. - Blood count - Hgb. 86$; lh .6 gm. RBC It, 820,000. Color index .8 9 . WBC 10,250. Neut ro p h ils 73$ o f which' 65$ were mature and 8$ stab c e lls . Lymphocytes 26$; eosinophils 1$. - Wassermann - Kolmer n egative. VDRL n e g a tiv e . (H ertert Laboratory) Opinion: Examination o f M r. P e re tti reveals fib r o s is o f the lungs which i s consis te n t wi d ia gnosis o f a sb e stcs is. This diagnosis is fu rth e r supported by^ the h isto ry o f exposure and the p o sitiv e resu lts o f a pulmonary b iopsy. There is moderate impairment o f pulmonary function as shown by the fu nction studies done in D r. Eaton's o ffic e as w ell as by v it a l cap acity te s ts done in th is o ffic e . We did not do furth er pul monary fu n ctio n stu d ies sin ce these had been done so re c e n tly . I have examined the f i l e , including D r. T rim ble's report dated A pril 19, 1957, th e le t t e r o f D r. M ichael dated June 18, 1957, D r. J . Lloyd Eaton's report dated June 21, 1957, and the p h o tostatic copies o f out-patient Page U. Fibreboard Paper Products Corporatio n Re: John C. P eretti exam inations, together w ith sim ila r copies o f Eduard E . Fong's pathol o gical reports. A t the present time H r. P e re tti w ill be b e tte r o ff working than id le , although h is work should not be so strenuous that i t produces shortness o f b re a th . I f he works in the presence o f asbestos dust or any other dust he should be protected by a mask or otherwise so th at the dust does not reach h is lo n g s. I f d u st-fre e work can be given the p a tie n t i t w ill probably be the b e s t. M edical observation a t monthly in te rv a ls w ill be o f advantage in estim a tin g an in crease in d is a b ility i f i t occu rs. The prognosis In such cases is guarded. Oradusl d e terio ra tio n in pulmonary fu n ction and an In crease in fib r o s is u su a lly take p la ce , although how rap id ly o r slow ly th is w ill occur i t is im possible to say a t the present tim e. Very tru ly yours, S JS th g Sidney J . Shipnan, M .D.