Document B5ErMyMmoE1Q4E9bbpQQ270w8

/? S H E LLY O IL COM PAN Y IN SU R A N C E DEPARTM ENT C . L. SW IM P-10530. TULSA,OKLAHOMA DECEMBER SEVENTH, 1 9 3 8. - D r. R obert A. Kehoe K e tte rin g L aboratory Eden & B etheada S tr e e ts C in c in n a ti, Ohio Dear D r Kehoe: ; The claim o f has been se t fo r hearing ' : h e re in T u lsa fo r December 14, 1938, by th e S ta te I n d u s tr ia l Commission of Oklahoma. T here has been c o n s id e ra b le d e la y in o b t a i n i n g t h e c o m p le te p h y s i c a l e x a m in a tio n on t h i s man su b seq u en t to th e tim e D r. S ch rad in was in T u lsa b u t th a t has f i n a l l y b e e n c o m p le te d an d I now h a n d you co p y o f a r e p o r t u n d e r d a te o f th e 5 th I n s t , made by D r. J . C. B rogden o f t h i s c i t y . D r. B rogden i s one o f th o se D r. S c h rad in met when he was h e re . T his re p o rt by D r. Brogden in th e th ir d paragraph re fe rs to th e exam ination of th is p a tie n t by th is doctor in Ju n e , 1936 when was s e n t to him to a s c e r ta in w hether or n o t he was in ^ c h p h ^ 3 ic a l c o n d itio n as would j u s t i f y us in l e t t i n g him r e tu r n ' to work fo llo w in g an a tta c k o f f l u a t th a t tim e o r a t l e a s t some In v o lv e m e n t o f h i s c h e s t . D r. B ro g d e n 's r e p o r t a l s o r e c i t e s t h e r e p o r t s o f D r . W. S . L a ra b e e o f T u ls a made in F e b ru a ry and March ,1 9 3 ^ ^ n d t h i s same d o c to r 's r e p o r t on an x - r a y e x a m in a tio n o f ^ m ^ c h e s t on" J u l y 2 7 , 1 9 3 8 . D r. 3 r o g d e n ' s r e p o r t a l s o i n c l u c f e ^ ^ e p o r t o f D r , M. B . L h e v in e w ith r e s p e c t to x -ra y s tak en by him on November 2 , 1938, to g e th e r w ith th is d o c to r's in te r p r e ta tio n ' of th e x-rajrs taken by D r, L arabee in M arch, 1936 and J u ly , 1938 and a com parison o f th o se p re v io u s x -ra y s w ith th e ones tak e n by him t h i s p a s t November. D r. B rogden's r e p o r t a ls o In c lu d e s a r e p o r t as made by D r. N elson as to h is l a b o r a to r y f in d in g s arid y o u r r e p o r t to D r. N elson w ith re s p e c t to th e an aly ses o f the blood and u rin e . ^ T h e re i s a l s o e n c lo s e d copy o f a r e p o r t b y D r . R . M. S h ep ard o f T u ls a who s p e c i a l i z e s in d is e a s e s o f th e lu n g s and a ll of th ese are s e lf explanatory. ' - U nder our p r a c t i c e in w orkm en's com pensation cases h e r e i n O klahom a we go i n t o t h e c a s e i n t h e f i r s t i n s t a n c e w i t h - #2 . D r . R o b e r t A* Kehoe 12-7-58 o u t h a v in g a v e ry a d e q u a te id e a o f j u s t w h at th e c la im a n t may a s s e r t . We d o n o t h a v e o c c u p a t i o n a l d i s e a s e c o v e r a g e i n t h i s s t a t e so t h a t "before th e b e n e f its o f th e w orkm en's com pensation law a re a v a ila b le i t i s n e c e ssa ry f o r a claim an t to prove an a c c id e n ta l in ju r y . U n fo rtu n a te ly , how ever, our superme c o u rt h a s ap p ro v ed f i n d in g of a c c i d e n t a l i n j u r y in some r a t h e r f a r fetch ed s itu a tio n s . In th is connection you w ill note th e h i s t o r y o f t h i s man a s g iv en by D r . B ro g d e n , from v/hich i t a p p e a rs t h a t he may c la im t h a t he r e c e iv e d a w h if f o f th e s e g a so lin e fumes from tim e to tim e d u rin g th e day and th a t he n o tic e d some u n p le a s a n t e f f e c t s such as h ead ach e o r n a u sea or som ething e ls e ; th a t he f a in te d th a t evening in th e w arehouse o f f i c e a n d h e may c la im t o h av e b e e n n a u s e a t e d a t home t h a t e v e n in g to g e th e r w ith th e s ta te m e n ts he h a s made to th e d o c to r as s e t o u t i n h i s r e p o r t . I a n t i c i p a t e now t h a t le a d may n o t come i n t o t h e c a s e a t a l l b u t a g a in t h a t i s o n ly a s u r m is e and we s h a ll need to aw ait the a c tu a l testim ony from th e w itn ess sta n d b e f o r e we can b e c e r t a i n on t h a t a n g l e . . I t is our p re se n t th o u g h t to l e t th e p l a i n t i f f and h is m edical w itn e ss develop th e ir case a t th e h e a rin g on th e 14th i n s t . and then o b ta in ,a co n tin u an ce f o r th e in tro d u c tio n o f our d e fe n s e t e s tim o n y . The d o c to r s who h a v e exam ined t h i s man t e l l me t h a t h e d o e s n o t a t a l l h a v e t h e a p p e a r a n c e o f a d i s a b l e d man and t h e y do n o t t h i n k t h a t he i s in f a c t d i s a b l e d . I do n o t b e lie v e th e c a se would be v ery dangerous e x ce p t f o r th e r a t h e r pronounced l i b e r a l i t y o f the I n d u s t r i a l Commission o f th is s t a t e , fre q u e n tly w ith o u t much re g a rd to th e w eig h t of th e e v id e n c e . . ".. I a n t i c i p a t e c la im a n t w i l l e n d e a v o r t o p i t c h h i s c a s e r a t h e r h e a v ily on th e p r o p o s itio n t h a t th e b r e a th in g o f g a s o lin e fum es by one who h a s im p a ire d o r d is e a s e d lu n g s w i l l r e s u l t in an a g g ra v a tio n of th a t lu n g c o n d itio n . The l i t e r a t u r e i s q u ite m eagre w ith r e s p e c t to th e e f f e c t of g a s o lin e on th e human body and p a r t i c u l a r l y t h e i n h a l a t i o n o f i t s v a p o r s an d i t seem s t o me t h a t in a d d itio n to th e work done by th e B ureau o f M ines in 1927 and th e f a c t t h a t much of your w ork h a s in v o lv e d g a s o lin e b o th lead ed and u n lead ed , i t m ight b e h e lp fu l fo r us to o ffe r as w i t n e s s e s i n d i v i d u a l s who h a v e b e e n e n t i r e l y overcom e b y g a s o l in e v a p o rs i n soiae o f o u r a d j a c e n t r e f i n e r i e s and ta n k c a r s and who can te s tif y th a t they have n ot su sta in e d any perm anent a f te r e ff e c ts . I t is s ig n ific a n t th a t a ll o f th e lite r a tu r e is w holly s i l e n t w i t h r e s p e c t t o a f t e r e f f e c t w h ic h l e a d s me t o assum e t h a t th e r e is no su c h . I f you can fin d tim e I should be very g lad to h ear from y o u g i v i n g me t h e b e n e f i t o f a n y i n f o r m a t i o n o r o b s e r v a t i o n s th a t you care to make. - CLS:K D R. J . C . BROGDEN y-' 4 1 4 -4 1 5 Me d ic a l Ar ts Bld g* T u ls a , Oklahoma . December 5 , 1938- ; : - S k e lly O il Company S k elly B uilding T u ls a , Oklahoma A t t e n t i o n M r. Swim: I h a v e -c o m p le te d my e x a m in a tio n o f t h e a b o v e p a t i e n t * He i s a v e ry w e ll n o u rish e d m ale, 52 y e a rs o f a g e , m a rrie d , o c c u p a tio n ,/ tru c k d r iv e r f o r S k e lly O il Company. F am ily H is to ry : F a th e r d ie d a t 40, a c c id e n t. M other liv in g and w e ll, fo u r s i s t e r s and one b ro th e r liv in g and w e ll, none dead. M a rita l H isto ry : M arried 29 y e a rs, w ife liv in g and w e ll, fo u r c h ild re n liv in g and 'w e ll and one c h ild d ie d in in fa n c y . P rev io u s d is e a s e s : Pneum onia, 1916: F lu , 1918: M a la ria , 35 y e ars ago: Form er O p e ra tio n s: Appendectomy, 1921 and o p e ra tio n f o r f i s t u l a in ano, 5 y e ars ago. ( I f i r s t saw t h i s p a t i e n t in June 1936. At t h a t tim e he was s e n t up t o me f o r a w o rk e x a m in a tio n and h e gav e me a h i s t o r y o f i n F e b r u a r y 1 9 3 6 , h e h a d f l u . He h a d c o u g h , n i g h t s w e a ts and f e v e r . T his co n tin u ed f o r some w eeks. X -ray showed e x te n siv e p e r i b ro n c h ia l th ic k e n in g w ith an a re a in th e l e f t m id d le lu n g w hich was s u s p ic io u s o f TB o r a b c e s s . R e p e a te d sp u tu m t e s t s w e re n e g a t i v e f o r TB b a c i l l i . He h ad b e e n o f f w ork s i n c e F e b r u a r y . He w ould s p i t up a g r a y i s h p u s w i t h b ad o d o r . T h is h a d b e e n g r a d u a l l y d e c r e a s i n g and. f o r t h e p a s t m onth t h e r e h a d b e e n v e ry l i t t l e . He s a i d he h a d g a in e d 15 poun d s i n w e ig h t and f e l t g o o d . He was v e r y a n x io u s t o go b a c k t o w o rk . I in s p e c te d th e x - r a y s p i c t u r e s , ta k e n by D r. H e a s le y , w h ich showed some p e rib ro n c h ia l th ic k e n in g in b o th lu n g s w ith i n f i l t r a t i o n in m iddle le f t lo b e.) . E x a m in a tio n : B egan Novem ber 2 , 1 9 3 8 . He g i v e s th e f o l lo w in g h i s t o r y : S ay s h i s t r o u b l e f i r s t s t a r t e d ,,two" y e a r s ago i n F e b r u a r y w hile w orking in th e d u st out a t th e S k e lly W arehouse fo r a couple o f d a y s . He b e g a n s p i t t i n g u p - b lo o d , c h i l l i n g , c o u g h in g and s p i t t i n g up p u s and e v e r y t h i n g e l s e . He w e n t t o b e d f o r e le v e n w eeks and was o f f work f o r fo u r m o n th s.-H ie w a s -tre a te d :b y D r. B ra n le y and as he w a s n 't g e t t i n g a n y b e t t e r h e to o k c h i r o p r a c t i c t r e a t m e n t s . He c o n tin u e d t o im p ro v e and w as e x am in e d b y me on Ju n e 2 0 , 1 9 3 6 . He w e n t b a c k t o w o rk f o r S k e lly O il Company f o r a b o u t one and o n e -h a lf y e a r s , d r iv in g a ta n k w agon. About th re e months a f t e r going back to work began s p i t t i n g up b lo o d and y e llo w p u s b u t d i d n ' t q u i t w o rk . He was w o rk in g a l l t h e tim e b re a th in g gas fumes in lo a d in g and u n lo a d in g ta n k w agons. He d id n o t work in s id e any of th e tanks and on Ja n u ary 22, 1938, w h ile lo a d in g tan k wagon and g e n e ra l ro u tin e o f w ork, no s p e c if ic a c c id e n t o c cu rred , b u t about 4 :3 0 in th e a fte rn o o n , he had q u it work and w ent to th e w arehouse o f f ic e and w h ile ch ecking in c a sh , he f a in te d f o r a few s e c o n d s . He came to and w e n t home to b e d , c o u g h in g , s p i t t i n g up b lo o d and p u s, could h a rd ly g e t h is b re a th and he h as n o t been back to work s in c e t h a t tim e* He was in bed f o r e le v e n weeks and tr e a te d by D r. H e a s le y , g r a d u a l ly im proved b u t now coughs c o n tin u o u s ly , w orse a t n i g h t , and now and th e n sp u tu m h a s b lo o d s t r e a k s , h a s b r e a k i n g .o u t ; over body and arms and h a n d s, o c c a s io n a l c h i l l and he th in k s- he runs a l i t t l e tem perature* E x a m in a tio n a t t h i s tim e show s a man f a i r l y w e l l n o u r i s h e d , p re s e n t w eig h t 164 pou n d s. T here was p r a c t ic a l l y no cough observed and no sputum d u rin g th e th re e exam inations w hich la s te d about 30 o r 40 m inutes . . ............ ' .: Eyes: R eact to l ig h t and accom m odation. There i s a pterygium , in n er canthus o f l e f t eye. T eeth: Some a b s e n t and s l i g h t p y o r r h e a , no le a d l i n e o r sto m atitis. T o n sils: Sm all, not s e p tic . Mucous Membran^xGood c o lo r , no anem ia Lungs: B re a th sounds O.K. E x p an sio n o f b o th s id e s o f th e c h e s t g o o d , No m o is t r a l e s h e a r d o v e r an y p a r t o f t h e lu n g . Abdomen: N egative. :-v G en italia: N egative . There is a s lig h t enlargem ent of th e l e f t in g u in a l r in g . There is in te n siv e s c a rrin g of the e x te rn a l sp h in c te r from an old o p e ra tio n . There is a sm all p a p u la r e ru p tio n around th e w ris ts and stom ach. Blood P re ssu re 120/70 P ulse 80 Tem perature 98 Copy o f th e L a b o ra to ry work done by th e M edical A rts L abor a t o r i e s , D r. W. S . L a r a b e e , F e b r u a r y 2 4 , 1936 ''F l u o r o s c o p i c e x a m in a tio n o f c h e s t : The a p ic e s l i g h t up w e ll u n d er cough, bo th a n te r io r ly and p o s te r io r ly . The p o s t-b ro n c h ia l space is c le a r and lig h ts up w e ll u n d er cough. The d iap h ra g m a tic e x c u rsio n s a re norm al,, th e an g les c l e a r . The r i g h t dome i s a l i t t l e u n e v e n .. We do n o t s e e a n y e v id e n c e of lung a b sc e ss. _- '' R ight lung: M arch 9 , 1936u\; Apex c lo u d y , some f i b r o s i s th ro u g h o u t th e e n t i r e lu n g w h ich does not reach th e p erip h ery except a t th e b ase. The sev en th and e ig h th r i b s are drawn .inw ard su g g e stiv e of an o ld p leu risy . .. CM ' L eft Lung: Apex i s h a z y w ith some f a n sh a p ed f i b r o s i s e x te n d in g upw ard from the h i l u s . The c e n tr a l th ir d of th e lung i s f i l l e d w ith a dense f ib r o s is w hich rea ch e s to th e p e rip h e ry . Diaphragm f r e e , an g le c le a r . C o n c lu sio n s: R ig h t lu n g i s p ro b a b ly n e g a tiv e f o r tu b e r c u lo s is . The apex and c e n tra l p o rtio n of th e l e f t lung a re stro n g ly su g g e stiv e of tu b ercu lo sis. .: ' .. . . / .. Sputum : T h e sp ecim en i s m u c o p u ru le n t and som ew hat t e n a c e o u s . No T . B . were found on d i r e c t sm ear o r a f t e r d ig e s tio n . March 12, 1936 March 13, 1936 Specim en as above T .B . n o t fo u n d . R epeated ex am in atio n o f sputum shows no evidence o f T.B. Ju ly 27, 1938 . Stereogram of the c h e st: R ig h t L ung: The apex shows c o n s id e ra b le f i b r o s i s , w ith some th ic k e n in g about th e h ilu s and marked f i b r o s i s from the h ilu s to th e b a se , w ith in c re a se d b ro n c h ia l th ic k e n in g . The 7 th r i b is drawn inw ard, su g g estin g an old p le u ris y . . L e f t L ung: T h ere i s some f a n sh ap ed f i b r o s i s e x te n d in g upw ard from t h e h i l u s , w ith some th ic k e n in g and some c a l c i f i c a t i o n s deep in th e t i s s u e . M oderate amount o f f i b r o s i s in th e r e s t o f th e lu n g . The diaphragm is fre e , the angles c le a r. Im p re ss io n : B i l a t e r a l f i b r o s i s , more m arked in th e low er r i g h t . '' I am a l s o s u b m i t t i n g a c o p y o f t h e r e p o r t o f t h e x - r a y ta k e n b y D r . M. 3 . L h e v in e , on Novem ber 2 , 1 9 3 8 , and a l s o h i s i n t e r p r e t a t i o n o f t h e film s tak en by the M edical A rts L a b o ra to rie s in Ju ly 1938. "XRAY EXAMINATION OP THE CREST. X -ray exam ination of th e ch est of H r. subm itted fo r exam ination and taken by W alter 3 . L a rra D e e ^ ru s s e rie s o f x -ray s u n d e r th e No. A1906, ta k e n on M arch 9 , 1936, p r e s e n ts e v id e n c e o f con s id e ra b le lack of tran sp aren cy in the rig h t apex and to a le s s e r degree in th e l e f t . There was a ls o v is u a liz e d a c o n sid e ra b le a re a o f d e n s ity in th e c e n t r a l p a r t o f th e l e f t lu n g e x te n d in g l a t e r a l l y . The r i g h t pulm onary f i e l d i s f a i r l y c le a r . Both c o sto p h re n lc a n g le s ap p ear to be c le a r . The d e n s itie s in th e a p ic e s a p p a re n tly are due to an o ld f i b r o t i c le s io n , p ro b ab ly o f s p e c if ic n a tu re . The d e n s ity in th e cen t r a l p a rt o f th e l e f t lung is p ro b ab ly an a c u te'in flam m ato ry p ro cess as found in a d iffu s e b ro n c h ie c ta s is . The s e c o n d f i l m u n d e r t h e NO. A 4759, ta k e n on J u l y 2 7 , 1938 r e v e a l s a c o n sid e ra b le im provem ent in th e c o n d itio n o f b o th a p ic es as compared w ith th e x -ra y of p re v io u s d a te , in as much as th e d e n s i ti e s a re c le a r c u t and th e r e i s e v id e n c e o f some in c r e a s e d f i b r o s i s . The a r e a o f d e n s ity in th e c e n t r a l p a r t o f th e l e f t lu n g i s much l e s s as com pared w ith th e p re v io u s x -ra y o f March 9 , 1936. The a re a is much s m a lle r and th e re a re o nly a few dense lin e a r m arkings rem a in in g . The x -ra y o f November 2 , 1938 as compared w ith th e p re v io u s two x -ra y s r e v e a ls th e d e n s itie s in b o th a p ic e s to be d e f i n i t e l y c i r c u m s c rib e d w i t h no e v id e n c e o f a n y a c t i v e p r o c e s s in th e m . As f a r as the d e n sity In the c e n tra l p a rt o f the le f t lung, th e re is a t p re s e n t no e v id e n ce of any a b n o rm a lity . The o ld In flam m atory a re a b e in g com pletely a b se n t. ,, . TULSA X RAY AND PATHOLOGICAL LABORATORIES (S igned) M orris B. L hevine, M . D . , F . A . C . R - I am a l s o s e n d in g a c o p y o f t h e r e p o r t s u b m i t t e d by D r . N e ls o n , o f blood and u rin e . ,^ v- "P atien t ______ _ _ _ _ 11-2-38 R oute #6, Box 196 - E xam ination: B lood C ount, B lood Vasserman, U rine. R .3.C . Hgb. W . B . C. ' 4 ,7 0 0 ,0 0 0 13.9 grams or 80^ S a h li 11,800 D iffere n tia l - P o ly Lymph Mono Eos Bas 60 6 1 0 S taff 22 S3 Segm ented 38 A rneth-C ooke Index 1 .8 0 S tippled r .b .c . V /asserm an Edmer Kahn K line One N egative N egative N egative trin e Sp F r . 1 .0 3 1 R eaction' pH 5 .5 A lbum in S lig h t trace -Sugar N egative A cetone N egative D ia c e tic acid N egative M icros co p ic 3 to 5 pus c e lls per hig h power f ie ld , O ccasio n al squamous e q it h e l i a l c e ll.- 3 h y a lin e c a s ts p e r 100 low power f i e l d . O ccult blood N egative I .A .N e l s o n , M. D. P ath o lo g ist." I a lso subm it a copy of th e r e p o r t se n t by D r. R obert A. Kehoe, of b e tte r in g L ab o rato ry of A pplied P hysiology, U n iv e rsity of C in cin n ati o f th e r e s u l t s o b ta in e d on th e b lo o d and u r in e o f Mr. A. F . D uncan. "U rine Volume A n a ly sis No. 38A-4625 A 100.0 mY. ...B ____ 100.0 m l. Page 5 12-5-38 B lo o d Mgs P b / L i t e r 0 .0 4 5 #'fh 1 , 0 .0 3 5 f\. a A n a ly sis No 38A-4626 Grama Mgs Pb/lO O Grams S pectrographic 1 9 .4 0 .0 2 D ithizone 1 9 .4 0 .0 2 5 " C o n c lu s io n s : T h is man i n my o p i n io n h a d an o ld p u lm o n a ry a b s c e s s on th e l e f t s id e . T h is has c le a re d up alm ost co m p letely a t th e p re s e n t tim e , and I do n o t see any d i s a b i l i t y p r e s e n t. I do n o t th in k th e re has been any d i s a b i l i t y caused b y b re a th in g in of gas fumes w hatso e v e r. I am e n c l o s i n g a co p y o f D r . S h e p a r d ' s r e p o r t , ' R esp ectfu lly subm itted, ( S ig n e d ) J . C . B ro g d e n , M. D . j cb/gs enc J . C . B ro g d e n , M. D . - 0010996