Document 9L9LBDaxvyjv5avbmpNwxBrV

JOHN G. WELLS. M. 0. 4i jrrc*soN sTweir NIWNAN. OeO(*GI* T*L***< *L- 3.ct I 28 July 1964 Mr. >*. Roscoe Lowery, Chairman State Board of Workmen*s Compensation 494 Labor Building . 2S4 Washington Street, S.W. Atlanta 3, Georgia . Re: Mrs. Lois Kurtt Dear Mr* Lowery: Mrs. Lois Murtt, a 53 year old white woman, has worked in the Asbestcn Mill of the United States Rubber Company at Hogansville for approximately 17 years. ' During this time, she has been exposed to an accumulated Asbestos dust exposure of 87.2 million particles per cubic foot year* This figure, is arrived at by multiplying the measured dust count3 in patient*s work area, averaged out over a year's time by tha number of years exposure* Mrs. Kurtt was first examined in May of 1957, at which time her examination was essentially negative* She denied all res piratory symptoms, and was found to be completely healthy except for moderate obesity (weight 222)* The-heart and lung examination was normal. The laboratory work was normal* Chest x-rays showed mild left ventricular prominence and clear lung fields.* The latter have alva/3 been difficult to visualize because of patient*s obesity and heavy overlving breasts shadows. She was examined each year thereafter; and as late as May of 1362, stated that she felt her strength, energy and endurance were quite adequate* On this occasion, she also stated that breathing seemed adequate for all normal activities. She denied all 3'nsptems suggestive of upper, middle or lower respiratory tract disease* hvsical examination, in 1932, revealed a blood pressure of 123/71 rind a weight of 132* She was well developed, well nourished, alert and co-operative and moderately obese* There was no cough or cyanosis There was no clubbing. Slight limitation of bases to percussion was observed. As before* patient was quite obese. The lungs were clear to auscultation. The heart examination was normal except for the appearance of a grade 1/6 aortic systolic rumur which was well localized to the aortic area. . .. ~ Chest examination on this occasion revealed distinct vascular markings; slight irregularity of the ventricular border had appeared. It was felt that these changes were suggestive of, but not diagnostic of asbestos disease. As previously noted, patient's obesitv and heavy overlying breasts shadows`have presented a chronic problem in inteepe- taticn of her chest x-rays. '' In September of 1962, patient undem/ent numerous studies of her pulmonary function. , On this occasion vital capacity was recorded at 66,4 % of normal. Her maximal breathing capacity was 33.2 ^ of normal. Her tined vital capacity was 40,7 ^ at 1 second; 38.6 ^ at 2 seconds and 93.4 * at 3 seconds. The capacity ratio..was 40,0 liters per minute and air velocity index was 1.3. These data tended to show a restrictive defect, and gave no indications whatsoever of obstructive ventilator*/ insufficiency. Her arterial oxygen saturation wk* a figure which is normal for this laboratory which is located at a 1,0 00 foot elevation. The arterial partial pressure of carbon oxide was 42 mm. of mercury. *' The ?H was 7,38. `the pulmonary nitrogen emotying rate at seven minutes was 2.2--a figure well within normal limits, and suggesting a normal ciistriubtion of inspired gas. The diffusing canacity for oxygen, usinc the two stage oxycen method of Tiley was 8.23 cc of oxygen per minute per millimeter of rercum This figure suggested a mild diffusing defect for oxypan. In June of 1963, patient was again examined and stated that she had had a good year* and insisted that her strength, energy and endurance were quite adequate. She stated that her wind was normal for all exertion, and that she had had no chest pain, cough, wheezing..pr awareness of cardiac irregularity. ' Physical examination showed a blood pressure of 129/78 and a weight of 203. ` She appeared quite well. There was no clubbing. . The lungs were entirely clear to auscultation. The heart was normal in all respects. A2 was greater than -2. The previously described soft aortic systolic murmur had disappeare Her red count was 5.23 million per cubic millimeter; the hemoglobin 11.7 and the hematocrit 39 volumes-^. Her chest x-ray was unchanged from previous reports. She was last examined on the 27th of April 1964* at which tire she noted that there had been a mild diminution in her general strength and stamina over the previous year* Additionally, she stated that her wind seemed adequate for all normal exertion; but that she became mildly dyspneic if she exerted excessively. She continued to deny chest tain, chronic cough, wheezing and awareness of her heartbeat. Physical examination on this occasion revealed a blood pressure of 140/80, and otherwise normal vital sipns. the apoeared quite well, alert and co-operative, and was *ble to lie quietly on her back. There was.no cough, cyanosis cr jaundice. There was no dubbing. ( "urtt -4. Respiratory excursion and descant of bases to percussion vare slightly decreased* Breath sounds were norral over the bases oostariorlv, but anteriorly there was a "peeling off*' sound at end inspiration* The cardiac examination was normal except for the re-arpearance cf a grade 1/6 basal systolic murmur which seemed slightly louder over the aortic area* A2 remained greater than P2. The red blood count was 3.315 the hemoglobin 11.7 and the hematocrit 40 volumes *. . Che3t x-ray showed no change from the examination of 1963, which continued to show a. slight thickening of tho left ventricular border and the appearance of slight background haziness in the lower lunji fields---changes very suspicious of aarly asbastosis. stand up ventilometry showed a vital capacity of 1*9 liters cr 35*3 of Predicted normal* Maximal voluntary ventilation (Free) was 3S.0 liters per rinuti or 92 ^ of predicted normal. The capacity ratio was 44,5 and the alveolar ventilation lnda;< (AVI) was 1.4. Tier *orced expiratory volume at 0.5 seconds was 79.2 % of her forced vital capacity; and her forced expiratory volume at one szcond w*as 34.S * o f her forced vital capacity--figures again indicatin the absence of an obstructive ventilatory defect. It was felt that the combination of historical data, clinical findings, x-ray changes and pulmonary physiological findings satisfied the criteria for a diagnosis of early pulmonary a3be3tosis. Accordingly, patient was seen on the 23th of February 1364, in the presence of Mr. John Alexander, in charge of Industrial delations at the Hogansville lant and Mrs. Grace ?!ipp, the -lant Murse, and told that she did have early asbestos disease. She accented this information with good grace, and was transferred to Reid -fill on the following Monday. She was told that we were intensely interested in her fortune and wall being, and that we honed to be able to follow her through the years to core and offer such continuing advice as mirht ha helpful for the continuing? of her good health. f Yurt -o- *, jV ont - ?atient, as noted, was 'transferred to ?*id :till where she difficulty in adiustinj* to the demands oF her new iob. "he found - she apparently was not able to cone with these remands, and decide aonly for her disability, t>i , rw> tt is my feelinc? that Mrs. Lois Wurtt has a permanent disabili relates to the type of work for which she has been trained and which has performed over the past several decades. y nl O ci *H I would judne that the pulmonary asbastosis is responsible about one-half of her disability; and that ane* arteriosclerotic rt disease* obesitv and various other factors relating to her life usticn are responsible for the other one-half of her disability. with all best wishes, Yours; very truly. John ft. `Jells* M.D