Document M8No6GaZzvqwMM48GBNGKr4V
Naxno
No- . 27530
Intarpratation of Single
takas os
2/16/72
Sfi-tlT
Plant: Millington# N.J
Bonding Data
2/29/72
roantganogram oi ebaat
The bilateral thickened pleura# large heart
and small irregular densities that obscure the vascular
markings are again noted. These findings suggest the
presence of a pneumoconiosis. More medical data is required in order to establish the meaning of these
shadows.
GEORGS W. WRIGHT, M. D. Saint Lots'* Hospital 11311 Shakar Boulaaazd Ciavalaad, Ohio 44104
V/
Nam*
No. 27530
Interpretation of single
taken on
10-28-70
Plant: Millington, N.J.
Rudiag D..
11,23_70
roentgenogram of cheat
Comparison of the current to that of 1968 and earlier shows further evidence of thickening of the pleura on both sides plus intrapulmonary fibrosis, on the left especially. The
heart has not increased further in size. The appearance of the film series would be consistent with asbestosis.
GEORGE W. WRIGHT. U. D. Saint Lake'* Hospital 11311 Sbakar Boolavard Claaaland, Ohio 44104
Nasi*
No. 27530
latazpratatioa of
single
Plant:
Millington, N.J.
Roadia? Data 10/21/68
roontgaaograsi of chaat
V.
takaa ob 10/4/68
Direct comparison of this film to previous ones shows that the
haziness at the left base extending out from the cardiac
shadow is larger and more prominent. At the extreme right
base is a similar shadow. The heart shadow, which in previous
films is abnormaly large, is still larger now as compared to
the last film in 1966.
It is most likely that he has some sort of intrinsic
heart disease and the lung shadows may be secondary to this.
Nevertheless, the lung shadows may be caused by disease of the
pleura and related to his occupation.
A complete occupational history and medical information
regarding his cardiac status are needed for adequate evalu
ation of these films.
OXORGX W. W&IGHT, U. D.
Salat Loka'a KoapiUl
FURNISH COKPIZTE OCCUPATIONAL HISTORY TO DR. WRIGHT, COPY TO THIS OFFICwEl .
11311 Skaka* Bealavud QavaUad, Okla 44104
F. H. ZIMMERMAN 10/23/68
Nam*
No* 27530
Interpretation ei
single
taken on 9-22
Plant: Millington, N.J. Reading Data 10-12-^6
roentgenogram of chest
No chance seen when compared to the film of 19f4. Previous comments regarding the heart, etc*, are still germane and pertinent.
GEORGS W. WRIGHT. M. D. Salat Lake's Hospital 11311 Shaker Boulevard Clovalaad, Ohio 44104
tr *'
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Name No. Interpretation.of
Plant:
Millington, N.J.
2 7530 single
Reading Date 6/8/64 roentgenogram of chest
5/13/64
This film again shows an abnormaly large heart
with haziness at left base. The previous comments
apply -- see previous report.
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\
GEORGE W. WRIGHT, M. D. Saint Laka'a Hospital 11311 Shaker Boulevard Cleveland 4, Ohio
*
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Plant:
Millington, H.J.
No. 5762
Reading Date : 6/2T/62
Interpretation of j_r}]_e
roentgenogram of chest
compared with
taken on
A comparison to files of *53, *55, *57, and *60 rhow the cardiac silhouette has become slightly larger and now is definitely pathologically large. There is a haziness at the base of the left lung and the right, cardiophrenic angle, the nature of which is not clear. He is a large and probably obese person which may explain in part these findings. A thorough medical study is needed to evaluate his current cardio-pulmonary status.
JUA*. *.
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GEORGE W. WRIGHT, M. 0. Saint Luka's Hospital 11311 Skakar Boulavard Clavela&d *, Ohio
#*
**
sfc
x-
NGC
Name
Pleat: Millington, New Jersey
No. 56-60
Reading Date : 4/15/60
Interpretation of single
roentgenogram o! chest
taken on 4/1/60
compared with
taken on
No abnormality seen in the lung proper. Attention is again called to the enlarged heart shadow.
.................................... .... >/'
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GEORGE W. WRIGHT, M. D. Stmt Luke'* Hospital 11311 Shaker Boulevard Cleveland 4, Ohio
,> ;
., Name: No.
1-57-B
Interpretation of
taken on 9-11-57
Single
Plant:
Millington, N
Reading Date:
10-1-57
J. (NGC)
roentgenogram of chest
compared with
taken on
Compared to film of 12-8-55, no change. previous report regarding heart.
*^
See
GEORGE W. WRIGHT. M. D. Saint Lake's Hospital 11311 Shaker Boulevard Cleveland 4, Ohio
t. hr: --V
George W. Wright, M. D.
DEPARTMENT OF Experimental medicine
January 16, 1956
*T. LUKE'S HOSPITAL nan shaker slvo. CLEVELAND 4, OHIO
No. 55-83-B Name
National Gypsum Co. Interpretation of single roentgenogram
Millington, N. J.
of chest taken on 12-8-55.
compared with
taken on 9-15-53
No change. The cardiac shadow still appears to be enlarged.
W. M.D.George
Wright,
6
Department op Experimental medicine
SAINT LUKE'S HOSPITAL 11311 SHAKER BLVD. CLEVELAND 4, OHIO
No. 58 Name
Natl. Gypsum Co. Millington, N.J.
'Interpretation of single roentgenogram
of chest taken on
9-15-53
compared with
taken on
The cardiac silhouette is unusually vide in relationship to the thorax. ? cardiac enlargement.
No abnormality of an occupational nature is seen.
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.ate 4/F/61 Aee 47
Color
Arthritis Operations V eo ereal Diseases
NATIONAL GYPSUM COMPANY
Sales District
Office
Dept.
Address
Plant Mixiington* Cbeck No. 8
M D*
Children
PHYSICAL RECORD
CTO BE COMPLETED BY PERSONNEL DEPARTMENT)
Epilepsy
___
Hernia "
List os reverae aid* soy koepital admiesioaa is past 5 yosr*.
Tuberculosis
Liquor
Tobacco
Drugs
Otber Illnesses
Injuries -- description,location, % disability
Compensation Received
Hare you history of ailieoaia or sat other dust disease?
Oo you bore s workaea'e cospeaaaboa eaae peadiag far either iajurr or illacee?
Base yoo ever bees is militarr eerviee?
Here any of your paresis or brothers or sisters had Tuberculosis, Caacer, Diabetes, Epilepsy or Insanity?
Last previous employment
1 certify that the above answers are true, correctly recorded, sad that I is is good health, sad that I here never suffered from Silicosis, except (history)
Signature of Applicant
Witness
* U divorced, give date and place
.. .right
s'i'A"
PHYSICAL EXAMINATION (TO BE COMPLETED BY DOCTOR)
Weight ZL / 6*______________
Eyes: Right
Left
Corrected: Right
Pupils
i/
Coru<
Longs
Shortness of Bresth
Heart
Blood Pressure
Over Weight Nonsal Weight Under Weight
Left Si.
Binocular Visioo
T Chest X-Rav
Poise
4
Ears Throat and Tonsils
&
Nose Hearing: Right ^
Teeth Left TM/U
Abdomen
Hernia
Spine
Hemorrhoids *
Extremities ^
Scars Skin
Refle:
Blood Tent
(Not# a of defecta if asy exist)
(Bead and seek only -- give lacaciea)
Glands
Mentality
Urinalysis
Musculature Genitals L
ti'fi tJz V W /
*T ?+
u, ^ r
General Condition: Good
Fair
^o you recommend applicant foe week? /(
Remarks
Poor
Nttition: Good ^ Type of Work? U
Fair Poor tH *.zrA7
APPROVE)
FOREMAN
SAELTY SUPERVISOR PLANT
Examined hr
A f//7
D"e V /f-
CW^M
TRK nfP!i)YETS CONDmON IS KNOWN BY BIS SUPERVISOR. YES 1 1 NO
NATIONAL GYPS I'M COMPANY PHYSICAL EXAMINATION RECORD
DATE OF BIRTH 7/16/13 L AST EMPLOYNENT
(AGE 52
PLANT, OFFICE, SALES DISTRICT** v * _ DATE ? -- "t-V
PRE-EMPLOYMENT ;__ REINSTATEMENT i PERIODIC HKALTH
ADDRESS |
w
[SINGLE [^^ARRIED OTHER
HEIGHT // DISFIGUREMENT - FACE. HEAD OR NECK
|j VISION-DISTANT | /MUSI***'
VISION-NEAR
Vasserman
h&:
WEIGHT 2,<rO HEART
)u--C-*E- 20
20/
* At+ZZUii'
NJ CHEST
| U.L.E. 20 `bO> HERNIA
20/
CONFICURATlOS CHEST EXPANSION
LUNGS
0
BLOOD PRESSURE
//
INGUINAL RINGS ^
R
OPERATIVE SCARS
L
URINALYSIS
sugarJw#. albumin )u^s
ABDOMEN /)L.M.P.
/
-----
. /NQRV V^>
_ -
etuThced RELAXED
BACK AND EXTREMITIES --EDEMA, .AMPUTATIONS, FUNCTIONAL DEFECTS, DEFORMITIES
HC FINDINGS - NEUROLOGICAL
SKiN ERUPTION
W-
SUNWARD OF PERMANENT DEFECTS. IMPAIRMENT; EXAMINEE HAS BEEN ADMSED OF MGMHCVsT K!NDIV,> >NO
EMOTIONAL STABILITY
--
APPLICANT'S SIGNATURE
JOB ASSIGNMENT
COMPANY APPROVALS PERSONNEL BUFFALO
DATE
DISTRICT
SA' ' M' ER
'LA NT JANAGER
SAFETY SUPER.
-
Aeeepi Conan. Accept
PHYSICIAN'S Sf^ATi'R^^
PREVIOUS MEDICAL
>jy ^
PART EXAMINED
FILM NO.
Kt 4rj: \S
M.D. Nf, ;!> R
i
Name ate
Age
1l9
Color
Arthritis *** Operations Venereal'Diseases.
NATIONAL GYPSUM COMPANY
Sales District
1 Addresa
--------
Office
PlMt Itminrton. n.J.
DepL
Check No. g
S M W D*
Children
PHYSICAL RECORD
(TO BE COMPLETED BY PLANT OR OFFICE)
Epilepsy
Hernia-
List os reverse side err hospital admissions is past S years.
Tuberculosis
Liquor
Tobacco
Drags
Other IHnesses
Injuries -- description, location, % disability
Compensation Received Have you a history of ailieoeia or ear other dust disease?
Do you have a workaen'e compensation case pending lor either injury or illness? Hsve you ever bees in military service?
Have ear ol four parent* or brother* or titter* bed Tubtrcuioaia, Cancer, Diabetes. Epilepsy or Insanity?
Last previous employment_____________________________________
I certify that the above answer* are true, eorreetlr recorded, and that I as is good health, gad that 1 have never suffered hoc Silicosis. except (hiatorr)
Signature of Applicant
Witness
* If divorced, give date and place
..uht- 6 `ifr
Eves: Riht
*
Loft
PHYSICAL EXAMINATION
(TO BE COMPLETED BY DOCTOR)
Weight
J2
&U
Corrected: Riht/vd
Pupil:
Cornea
Lungs & Heart &
Shortness of Breath Blood Pressure tfth
Over Veigbt Normal Vet|ht . Under Weight
Lch
Chest X-Rav Pulse 2-
Ears Throat and Tonsils V
Nose Hearing: Right
Teeth Left
Abdomen
Hernia
Spine
Hemorrhoids ^
Extremities Scars Skin Reflexes Blood Test
(Note % of delects if ear coat)
GUnd. y(Head asd seek only -- live loceooa)
.Musculature y Genitals &
Mentalitv
Unnalvsia 1/-1& A Ln~4s rr, / v -*
---
General Condition: Good
Fair
Do you recommend applicant for work? *
Remarks
Poor
Nutrition: Good Fair Poor
-----T--y--p-e---o-f--W--o--r-k-?---------------------------- IClC*
APPROVED
FOREMAN
SAFETY SUPERVISOR PLANT__
^ 4 jo
D*te
Examined by 1 JM/115
U,
THIS EMPLOYEE'S^Tforh&N is KNOWN BY HIS SUPERVISOR.
X YES
NO ___
NATIONAL GYPSUM COMPANY PHYSICAL EXAMINATION RECORD
Millington __ SALARIED PLANT, OFFICE. SALES DISTRICT
HOURLY DATE.
PRE-.EMPLOYMENT d REINSTATEMENT _r PERIODIC HEALTH
ADDRESS
DATE OF BIRTH 7/7 A/H
(AGE^t- >
d SINGLE [x MARRIED OTHER
LAST EMPLOYAENT
PREVIOUS MEDICAL
HEIGHT
DISFIGUREMENT - FACE. HEAD OR NECK
WEIGHT /f</
CHEST
?U-r 7^^cavFK1RAT,m
VISION * DISTANT jj VIblON- NEAR WASHERMAN with.* , ogi (la*ke | "ilh.w 'out {le*e
Ho:
R.E. 20/
L.E. 20/ COLOR VISION:
R.E. 20/ L.E. 20/
URINALYSIS SUGAR ^^Jh'MIN
HERNIA
_
^ /!c 0/jd
LUNGS
C^Jl
^
FEMALE APPLICANTS - dateof last mensthal period
INGUINAL RINGS /?.
R '
OPERATIVE SCARS
'
L _ P-LS-fr'.
^ // */'
NORMAL ENLARGED RELAXED
BACK AND EXTREMITIES - edema, ampliations, functional defects, deformities
_____
y ng S. C FINDINGS - ADDITION AL
a
NECROLOGICAL
SKIN ERUPTION
*
GENERAL CONDmOV-StTToD Q FAIR POOR: EXAMINEE HAS BEEN .ADVISED OF SIGNIFICANT F ENDINGS Y E> I 1 no SUMMARY OF PERMANENT DEFECTS. IMPAIRMENTS:
APPLICANT'S SIGNATURE HERE AND ON REVERSE SIDE
| ENIOTlOVAL^SrABIUTY
INTELLIGENT*
JOB ASSIGNMENT
Accept, Coniiitionai Aec epiene^ Reeeon* Reject PHYJ>ftfl
S
COMPANY .APPROVALS
PERSONNEL MANAGER BUFFALO
DATE
P.AHT EXAMINED
VR.A^ REPORT - RADIOGRAPHIC FINDINGS
f
FILM NO.
D* 'CT ACER
LA NT MANAGER
KK t2r,50
SAFETY SUPER.
M.I).
sj i RE'- - .
/
NATIONAL GYPSUM COMPANY
Sales District /
Name ate
Age
Anril 17* 19^9 Color y
Arthritis _ Operations Venereal. Di&eases Liquor
Addresi
Office Plant Hil.
Dept,
Check No.
S M W D*
Children
PHYSICAL RECORD
(TO BE COMPLETED BY PERSONNEL DEPARTMENT)
Epilepsy
Hernia_
List os reverse side any hospital admissions is past 5 years.
Tuberculosis
Tobacco
Drugs
Other Illnesses
Injuries -- description, location, % disability
Compensation Received
Have row a hiatory of aUiceaia or any other dust diaeeee?
Do you have a workmen'a eompeoaatioB case
peediac for either injury or illaeaa?
Hava you ever bees is military aemee?
Have aov of your pareota or brothers or sisters had Tuberculoeie. Caacer. Diabetes, Epilepsy or I&esaity?
Last previous employment
I certify that tbe above aoawero are true, correctly recorded, and that I as is rood health, and that 1 have sever auffered from Siiicoeie. except (history)
Signature of Applicant
Witness
If divorced, give date and place
.eight
PHYSICAL EXAMINATION (TO BE COMPLETED BY DOCTOR)
Weight
Eyes: i^fat
Loft
Corrected: Rbt
Over Weight
Normal Weight
Under Weight
Loft
Binocular Vietoa
Pupils y Lungs y > Heart
Cornea
Shortness of Breath Blood Pressure
i10
Chest X-Ray Pulse
Ears
Nose i/
Teeth
Throat and Tonsils- a
Hearing: Right
Left
.
Abdomen V Spine ^
Hernia Hemorrhoids y
Extremities ^ Scars V Skin ^ Reflexes * ' Blood Test. ^
General Condition: Good
(Note % of defeca if nay emat)
(Head and nock only -- give locaUoa)
Glands *
Musculature * Genitals y
Mentality j/
Urinalysis MJA*
/y%-______________________________
Fair
Poor
Nutrition: Good \J
Fair
Poor
'o you recommend applicant for work? /t Remarks
Type of Work?
KK
APPROVED
|
FOREMAN
SAFETY SUPERVISOR PLANT uturro
j 1 \
/ Date
Examiaed by
/.
THIS EMPLOYEE'S CONDITION I^KNOffc BY HIS SUPERVISOR. YES,__
NO,__
i-.'9 ,4v
f v
Area Cess 201
telephone e:.2t22
RES. NO. 24018
M. SHAFI. &.D.. P.A.
**
153 PARK AVENUE
SOUTH PLAINFIELD. N. J. 07080
NAME.
AOORESS
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Connecticut General Life Insurance Company
* SUPPLEMENTARY CLAIM
GROUP ACCIDENT AND SICKNESS OR HOSPITAL EXPENSE BENEFITS
This part to be completed by the Employer
Name of Employee Date of Accident or Beginning of Sickness ....
3..................................Sex. r\......... .D..a..t.e...o..f........./f/Y I
Period ofadiitional disability covered by this statement.
........................... .. .From....#................... f.Thru7.*.Ji^ m t&w jcxtu-
If the employee has returned to work, on what date did he return?.. MrS yV47!.. ..dT7^w<G>
A.M. ..P.M.
yV/^77%M9c
6Y/T4AC C* *
A'w o/ Employer
...a%*!>....
Dttuton
Date. . <?-*, i-?t_
ATTENDING PHYSICIAN'S SUPPLEMENTARY STATEMENT
(To bt furnished witkeul expense U the insurance company)
Patient's name .1
.........................................................................
Age.. S'.]?
Nature of sickness or injury (Describe complications, if any)...............................................................................
- . ttxfr. ^
.......5 ^
Date of first treatment____fcr V......................................19 .
Date of most recent treatment
.....................19...7.VT....
Frequency of treatments.. *?
........................................
The patient has been continuously disabled (unable to work, from t -
If still disabled, when &h<xUd patient be able to return to work?...
19 through
-stvu e.
?- tf*
19 ^ v
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THE ORTHOPEDIC GROUP, P.A.
c-' MAPLi- A\T
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1969 1713
5tSC-* **s
OFD CCK3,
15- 00
; ,, so{ >> p*. s:
15 r
D/A: 2/7/69 Attending Physician: Dr* Chrobak
Diag; Avulsion fx. distal phslsnT digit l5/rt* hand* Mallet finger deformity. '
^7 /
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Surgeon's Report
To.
Complete and fend immediately *;w ;
Ct^-' .
File: ...... Employer: Carrier: ..
The patient
1. Name of Injured p,
n2. Address: No. and St--
3. Name and ^<Mre__g^_gmgi(ggr^j|ftfciAFlS-X--GhrpSt3tt
4. Date .of acddent or onset of diwe: ..X.Q.T.?5."..Hour...........--JL Date disability began...B.O...fc.-iRXJ...l.fiSt
The '* 6."" State in patient's.own words where and bow accident occurred or occupational disease was caused Accident
..........
The
Injury
6. Give tearste description of nature and extent of Injury or disease and state year objective findings:
...JS.ar.Q..liXa.0....f.traln..f________________
eeeeeeee sees aeeees--ess tsteeeeeeee
7. Will the Injury result In (a) Permanent defect?--.Q^----.-It eo, what?.
(h) Facial or head disfigurement? .....Aft.
(Perrosofot disability tucb a* loit of whole or pane of Aagsra. facial or bead disfigurement, etc., sail be accurately marked oe Chart oo rererac aide of tb` la report).
8. Is injury above referred to the only cause of patient's condition ?-7*.... ...If not. state contrlbutlnc causes:.
9. Is patient suffering from any disease of the heart, lungs, brain, kidneys, blood, secular system or any other dis abling condition not due to this eeeldent?---Aft--Give particulars:--............................................................. ........
10. Is there any history or evidence present of previous accident or dieease*.Aft
Give particulars:..................
11. Has normal recovery been delayed for any reeaon?-.AO.........Glva particular*:-.............................................................
Treat*
went
12. Date of your first treatment:...XQ?f2.*2..----..Who engaged your services?...........JUAUP.ftd,.........
13. Describe treatment given by youAp^ly...pftA...XQ..,ll<lftt
.frftnd&gft____
.... *pr..Uft4....^....^^
.......................... ....................... ...........................................
14. Were X-Rays takenTAO.....By whom?...----..............--.................................................................... When?............. (Nib* sad address)
15. X-Ray diagnosis:................ ............................
16. Was patient treated by anyone also?..AO. .......By whom-.................................................... When' (Nsas sad addms)
17. Was patient hospitalised?--Aft......Name and addrees of hospital:.-.....................................................
18. Date of admission to hospital:.................... -.............--...... --Date of discharge:....................................... 19.__ Is further treatment needed?.-AO................................. For how long?......................................................
120. Patient
be able to muse regular work on:..--......--
.....................
Disability |j 2]' patient Jg? be able to resume light work
.....-............................... --...............................
22. If death ensued five date:............................................. . REMARKS: (Give any information of valua not included above) --.
1 am a duly licensed physician in the State ot -- I was graduated from......... latt).*._____________________ Medical SebooUn--ftftR.t.QA....................... TeejlSftM
Date of this report:----- ........................................... -(Bipod) This report must be signed personally by physician. Addr
Telephones
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