Document QkqOG8qd0wvEz8Gjbopa73Rjv

FILE NAM E: Plant Insulation Com pany (PIC) DATE: 1959 DOC#: PIC003 DOCUM ENT DESCRIPTION: W orker's Com pensation Claim % 'S m .t iiV iii'a * BEFORE THE: \ STRI;X .ACCIDEKT-CO! S S tJl f i OF TRT: W S T A nO F -C ;.L IF C R K liL Ca io . Ho* 5 6 - LA_176-66U, ERTETI0 . MVCARKETJ. Vii Appi L o u t : ARMSTRONG XORKTCOMPnUT; e t t b l . b n d a FLAM? "RUBBER- AKD3. SBESTOS WORKS J -FIBREBOf.RD tt.TSSC PRODUCTS".COTTOttL- - T io s ; K JiirrtE H O inE E nH O tiiiii'S O P P tai: COMPENTI OWEKS-CORNINQ.OI/.SS-COH-- r/.KY ; L A in y C A R I T d o ln g - b u iln e a a .o a : IC S /-Brry.R-K A tiicrT -R r-m am A .m M iT O E\DINESQNGrC0KPT.KY7 PARAFFINI t o r n i r ; incorporated; j . t : thorpe: rnacRFo^TED: johns-manvilleisaiesCORPO'J.'ITOTI ; PACIFIC'EKPLCTEHS : INSURANCEICOKPANr, o -eorproratlen; pac i f i c iHDEpanTr coMPj.wr; o . e e r - p o r o t l o n ; STANDTlDIACCItEKT'INSOTTi.- AKCEICOKPANT; o - c o r p o r a t i o n ; FIRE' KAN'S FUND INSURERCEICOMP/.EY bcor-pora-tlon : effo n d en te : ORDHT j o i hi to : p a r t i e s : DEZESDUin icosTiaiJttBoo cctw raan U l i l l V I M i JU'- 2 . 1D59> < _ W ILLIAM S A FU tN IMI. M t t n u i - GOOD! CUTE'-APPEAH IT O ' TJEREFCT., IT"IS -'HERr z r - CRDEREDThat : PLANT- RUBBET AND:ASBESTOS :VORKSFTBREBOARD- FAI ET PROnJCTS". CORPORATION K/.ni KE-QUjlNZETBTG:AND S07ILY- CCKTANY LrJV'nt CATuV do i ng -buiIne l i a i LOS-/JiCUSS-HMlKETTlSCTICmATIDS: ANT>" ENGINEERING COKTi.NTPARAFFIKE" COM!ANY, INCORPORATED: j . t ; THoaFETiNConrcr.ATEir JOHNS-M/.NVI LLE-E/.LES C0r.FCn7.TI0K FACIFTC EKILCTEIS- INSURANCE-COKFAKY, o - c o r p o r a t i o n : PACIFIC 1ND31KITY COMPANY, a- c o r p o r a t i orr- STAITARD'ACCI DDiT"I K5CR7.KC COMPANY, n- corpo r e t to r e FTTBLAN'S FUND' IHSU-IK CEICOKTANY* a- carpo r e t l i n e OWENS-CORNIKO- GLASS- COMPANY-' bo Joined e i - p a r t i c i defendant i n t h e obovn e n t i t l e d : souao,- / ' / f - (r / A * . ...: ' V VTIXTAK FRPCAK f loforoo- IKDOSTRTAL- ACCH O T COMMSSION Para lea- aorvtd- ab per' attachod- H i t : do tod- 7-2*59. Copy o f appl-1o a-ti-oii- dot o d 12--H a o r v o d * p o r t t o a 7 - 2 --59 ay 0. 4V.eC*M'*U*.2G43,_ . __________ .6331 JsXVyxood > l * a . , > 1 f p i.lr $ n | ;TK - T i' ifcorj ?. n . i . ^ Jt. fojys*iriy Jwa>*\ > 7- . , | m i , ` .t* >^i>r ,* .A.i>*iio-to.'v *' i v*Pi*nt ?vub>*p -A>ibaa.to.Wrk. 537 fttoivon : 3 l ., <n-7 /.#PlbrbftttPd fjopor tfrjgluata ,Q<wp.. .IrTS jBr.cnaan -S*.. , -s.-P. 19 ^Jfcrlna .nglporln|.% ,ttpplX JCo. &V . il i t .3 11, ^ * . 8 4 --"<*** ;J<t *0Hdft*-CariUn :Co.. :$933 T*l<*dph .n. ^u" v, u . aL-M-r-y a rr 0a J.J, tt&afaat xaf rJec.Uon A#p. :Co. a ijniir .i i ^ t f - a f n * -o. J n e . t L75iBc.cnc:St., :a4f . 1 ^ J i T . tThorpo-Jtoo.. U8;E. ; S i . , J J , 2 \ *Johna-tjanrlUa ;St.,lc :Qor? ,, .jfi ;3. :CiV<UAac;&t.f J A *J_Qbna.&UwlAlc Jor_p,, .-fio* -9067 #;L;8 JO !?rchalara Jo * . :Cq 510 .tf. :6;&t., JA J/O&orty *ttut. t ina. :Co. -uii ;5.?HU1 : 4 t . , J. / i?i,lU J orI . Un* J o . .1033:S. -Hopo;St., JA --------- ' i - - r rn wr r v -- ir ^-- *aS\Jt<lopdAacld. J u i j t i iStfi iS< ! U f i | i l t y At> J 'PJrasonSa un<J lio*. Sta.. ./tttni:RJ>. J h a op . _31ti*0VllaMreiBiad. .U ? oa `Horjlhy A-RotUhr, J J 2 .V. -.6;&t., J.*. *ftey. j. ucuiVik, a a i o . w . j t t a t . . j ..*. Brabcck, rtblqfar (AiE*relR, J l l i a t t o r : a t . ,;StU \ A t`:.pb ^ ^ 'r W l , ' n Jaj T ^ M 'r .f o a y - a j f.J& tLLS / / ' A in# v y +<Z7' /'i.* r i *! i ; !.i )ri y ar t * `I > ACOINAtO-M * | MAMT.'U 4) ` JO ICPM -r ID T U .M O. JOHN K IHIMCY. M -O : ( v m i fc** ! rafcromvy-21, 1937 T b f T r i Y i t i n ` I n f o r c a c i `C o n c i ; * 510 V e it S ix th S t r e e t U i^ o |ik ci 1 4 ^ rvillfornli* i c t i i t i n ; Joseph lilc b ik i I c ^ i c c R t m v t - Ic f B 1219902Armstrong-Cork-Cowp*y~ f: l . 0. K cC im ll36 LL-176-6B4- C lltlaK ir K -: X eC irrH l v ie 'r e f e r r c d 't o our o f f i c i by Dr: I r a n lc o t t for* u x s i u t l o o : oa D c c a b e r ' 7 , 1936. V* ' o b t a i n e d ' t b - f o l low ing- h i i t o r y f r o 0 = t b c - p * t litre ; t e i l d c n c e l f c i i t e r v l T h t ' p a t l e n t , i g c d 5 3 , v i i borri" K ir eh: 3, 1903-, io= Denton, l e s i t i v n tr i b e 'l l v i d f o r'1 6 y t i n ; Then-he-vowed-to^Loi1In g rle ia i nd K i i ^ r e i l B t d h e r e " v e f ~ i i n e t "v i t b : t b 7u u p t l o & : ef* tvd* n i g h t * i p i r l r P o r te r v ille , C l i f f o r d * , 11^1946; C c c v p itlo E * l_ h l tO T 9 l~ KrZ K c C a r r i l 1 w orked i f - - c ook' end- nnf r r io= fcoteli ir.fi r c i t i u r i e c i i o d - i l i o : l o - h l i ow n*place' o f b u t l n e t t * e n t i 1-196(7. r r o e ' l f W t o 1943 he "v i i* p l o y e d by* t h ` ? l i o t - l u b b e r " icV- A i b n t o r V erie r t i r Lo Axgt l e i ' v h t n ' b i " d i d n e i x ^ p l p t " tod- b o i l e r 7 l m u l a t l o o 'w o rk - in' th a t hi e H i " i t * t e d `th a t- h e 'v r k c d : i n 'c o o f lo r d - p o r c i1 lu e h " ai> e n g lo v m d p CS w h ich v e r t *001 v e n t i l i t r e a n d - t h a t b > v n ' e s p o t e t f t o 1 c o o il d c T ib l e * d u e t- a n * f t ; p i r t I c u l i r l y i b e i t e * i n d e i j o e i l a - . H e ' d i d - doc v m ' m b o r m p l r c ^ * tor o e'th is Job. ..... S in c e " 1943 the* p a tie n t hai* b e e tf em ployed by theVA rrfT rdnf Cork C oepiny In to e * A r f t l e ". He M i w o rk ed i n v i r l o u ' b u l l d l r g i , h o t e l * , r t I t l u r i n t i t e i a 2 p l i n c i , e t c . , th r o u g h o u t- Lot* A n gel* C o u n ty , d o in g i n u t p i p ? l n m l * * I l i t ion* In b o il e r * r e o r V . He* l i o w o rk ed w i t h " d l e t r i c k b l o c k " ( f i b e r g l i i i ) nd d id r e f r l g e t i t o r i n i u l i t io n v o rV (e $ j^ tr'ic f- l n t t i 1l i t lofO . H? h e r w orked w ith i t l ^ t l o s 1" 0 * 3 ^ 3 1 P i g n e e t i ) r T o r k ,< ^ K o y ^ o ( i l l l e * ) a n d f o i g U l l , b u t I docc* n o t b e lie v e * he e v e r v ie d d i i t o o r e i f c u r e i r t h . T h r p a t i e n t M a te d t h e f ? i w i i ' i Iw iyi* c o m l d e r e b l e d u c t m d - 1u&e` f r c ^ F t h ? i b o v ? n i t e r t i l e , t h r d e g r e e v a r y i n g In the* d i f f e r e n t area* h ? w o rk e d . Ko w i k o r r n i n t r i c o r w ee w orn i t t h l i Jo b n d the* p e r l e n t h i d b e e n o f f w o rk iln c e * D ecem ber 4r, 1 9 5 * . fl ! X <1 ifl l* r m h m m r n u * 4 %* 1- u i l x m 2 Z 23 . F4 Xu4 -^ m4> Z22 2 * l i *C UT M u ', &X w m n Si i l X fr2 > i 6 * Vf JI V. . i L w r*l I I ; .. -- ;s X Xk 2 M # il.i --U M S: ; *4 u. r ct sC f * U ? X l Z 4 M tM -- g-- ^ V fl * * b; i t& So o* u 2 UX M X ' j i F s u e e o HM r m** %. VO u u4J o5O;J1 i V11W M M Uf JB &J M^ * Si : u i u u X j i CUC J O U rUsi3 X n e st t s X . (tj! ) I t i S i 5 * C u - 1 H m C h .. V M b t* T V s*i f_ 4 ___ 6 u i* " > - u * U S S .1 .. * c u L> .. d. P M .. c -o . . . n M I i l X V 0 * u a a x . m .. t o w; u I -3-4 . -- m b U X -X U X O u wU r O i o C a u c U M r m *4 fc. ., J i 4 A u X ti r * u MX I L2V2H I- D t I . o u u , u h p4 u i* u uc i . u 9 X H b u U,, OX ?u W S Il I, & 41 * u u X . UX * u U s || C U M W p6 UU ** M .. H K 4 M HM x . > U a. X O U r* X U P ^ a m t smm w %s i aa H U * I. # X p '_ eu uVe c s s t a t t b i J c s b - X ----M---uu oQuu a c u o X M X u**1*; 9S itm T js M 9 9 U ti O 6 ?: f? SI t aHS? n a i x b x X M V W M . b ^ > v w u A m VT) v u e U N 9 W b 4 u U O * I. u i 5 X 5 b X M \ p X SS .r 3 r m u X X va sr u 2? 4 2 : H X *4 *4 h X J . K T. X U > N Oia :a 2 *2C SS..* wc : U: H Hb ..CVS U t ? ,o t !f i{ O M X bO > mH b i tO . M> ,V* P P s s- s f* 3 a a 4 . > 4 4 O p -- 44 u P -i X H U oc. u u u a O o .. H u . u m m* -- M a> C S h ft. u U 44 > a M 4 P4 . p p m o a ft. X C A4 P > 22 - I A s *r * X c te r-- 2 a *c y - iU l'ClP I tv |l : h f 3 2 : u*. s t a a . : - u . w %* c, , O k X 70 X MH C. X X . fl P ^ u ! f4 ) U -- C C . P PP --s Tl Ig 44 >. o o :c . *- Il fl ft L :v;i * * *4 0-, ft. CL C M O OM C X 3P m >. w P ts b h m m MC. b o b OM X X UP 4. O Mc b P PX > U X . ? u > O JC /r / . . \*. . I l. h ,.. . . . .. .T 1 . I c l HY P V I H < H 4 a ^ u -O > II , X. Jfl < Niki 44n11 rs^l k4*a"i>-4at>i U>bO*V'OPi P<nKMroiHtt ' O I h M 4 M l l f l M 0 0 0 4. H I H h K p t. w o Ji m a j a c w V I k t m < * r* " C" I*kW* ` C C WMP IQ 4 #r % S O 9 ri wH > * I . t S . V oVc p E s . * *5 . ,. I Z t m *s* ! ` 1 5 ri Ca i--' ! o u S 5 2- A 0-- tt . > C 7- o tt j. . ri f!m* . *D < r"i 4. v V. 4 V O4 0 X a* K H y X IItI ? il . H i i u *&4 y " i: ; - 5 il c i t : tt -- O tt H U tL tOt ryi,C Ap *94 ,, i 25 ? . La ttO* h r.i C ua JS < U Ott 4i *4 4 X 3 ,.* O 4. O w ri tt L w b yi fl ^ -o >a birioa u- tt ! % O CA** 9- w 44 V. rCi O 0. ZO Co 1 S* ( 4 4 ri lt ri ri U Ai ri V A & t .V 2 x $ Ji " **> I M M k a i< y UH rm i f.l, ,j 6- . 4ri Aa H IS o 4 ON tt M a ) , # C' Cri IriOri ,. Ari H 44 o tK* LyS I t V 9 A4 , ri I 1 " M- J3J *UO s*4 .iV wririOWrii AJC ,fl J4C J* ri a- ri a ri t . JC A.* ---y C4 a ri O fl .h i tt f r r i ri ,tt r i M . m u . . . O tt tt o 44 4- H C fl 4 4 flO . X f 44 >ri (I 4 fl r i 5v ori u, aU C 3 H H M i U U r i i l K a o ri m . c ri* ;A " " 44 41 C Ai -4-4 ---O---w---m- ",9 ,<w 4* 3 4 0 4 3 . OC 1 I MM tt A h ri fl VA>ltttt X,44 ,y o m JoC . ,ri V g a. uc 5 >M3 k- Ho o fl ! tt a roi y -ri &. m ,e fi i XKXlc V--. fai % rmi n i, r A A* nt-t a - -r; ,p. ., r* trti * 3 .0 ri ri I ri C 3 ritta*. 5 t; f,fUll A" ri* O n p4 4c1 ri i l * a ri 4b4 tt ri - i -- ri m -r- - o o ) O - fl rr* ir 4 nrorvr i i of: c o-; i:* " ,V ".,iw > r.U .!!},' l l S 't J i , ! . r e . tt>Y* `* L; nv< d i >* k k r4 > J w a ir ti <*i'/4 v . 'i k f l '< * . a v x U t * i o f J tfc r C r i 1 *<' - o r e p o r t e d : * ^ t 1 s ! , ,,n ia j ; i e re , s* * t i ' *y 11, '<! ,> . . . ,, - * .. J j. .. j - f t o tir . ..* v ^ rv lo a r tt# t. - teroid .o.' , ' ; t ' * S r r M B j \ V ( f * o r m i , t - j * c a p<f l i ` V .l-tM b n iU 4 J Jr** r t d * * f .cl-.n: t r o l d . i u t ,*; i * * J- 0 -c . 1i ;i r-r u 'j .! > 1i-ls *.. , 1 . J-.*. \ . : *-U: ItftH TOVOOs i C t f c c i - . J d --------- ' J .t..: . v.xcvce. *. *." .- N** ' * ' M'-** f f ' * i 'p ' ^ i * h * r * p > ` . s s i . : l r : - , # t t T t C : ip?c lay* d ?vx <ee*e*Vv if-v-f, i,,r -*.i' ;i lri ' " .f c h r * P ' '** i - a : f i pf rT.-aaooodJMjr^yr -*Ci-* -- * . 1 and ** ` iVV ''**'t ' - C 'CJitr,. '<.-:raTp* 'L*ai>*. > >' ?" * > >' * * ;`l ^ jU *<' M ita c m s + d **- * nv . . . t l . U c * f l r ^ d r a i r $ e v . . 6 i t ^ r t j i ^ * V ' ? r ,i . < 2 p t a r t h e # t i t V t F v / : h : # - % ' r k - . .:<J-t*V C 5^.*-`*>^-.>^ioR-.jcrlM a,a.4l<jSaC. d t f T N u c w a v ^ H K ^ i r f ; qui . H -V.-' l A fc u ji. e e v i.ic i-e n * s r 1 a - t-s* j o c * f a y ; c - e l - i s - i e . j - f e u M i efe* . t * r . /ir r itic i < ,V n * ';A * ? a tw U ;-t K fe ib a u b i : ji-vniC - > i ozi -w *\ e :> o - e**ca<,,'*i *** *-* .?i v arns is o llOJ . ir tit' ' i*- ii r. w ti I f t .? *ii . i :* -rf.-p * , j v f j i c r t i t r e d r ' l c s o t avr*...:- *.1 . . ' : . . i . : . ______ -L .. hcfexe donai onescen h *vt ;. . e.v f c t i ''. *).* . * v-1'- - co!' ;. i j .;* . i t -i'. r:r -rf- " **- . . >w . '- - -r- . ,j - S/ > -v :t f 1 r n - S K U . EXAMINATION ( c o n t i n u e d ) Kaaul: By.asi h'ttftei H'wdoc tirrct&te TTi*'tlc Ax.nsi a e n - illj j reac.t*. to ; 11-fii1*** en : aCfi3&dS i lo n*. KlXdb eetrrgestlon*. No: a c s r s i Uacatiy Obod;hygiene* ttisst*. LUn-gai Hi amt*. PeaturBtiaipoorFewTralaa:after-cough, a t - rlg h t* base* Negative* to :e u p ariic ia l- exsalnatlon*. Peripheral! Ar.teriaiAbdosenn Qeniiallai cphsnodaai Bbneas&.Jointas EStraaiiiaai S kin: Reflexes: Net-ecleroeed; F i s t ) i*ell_ cuacled) noicaBeea* e l l . d e v e l o p e d ) p r o s t a t e * n o r s a l - c o n f i g --. u ration*. None*enlarged; Negative* N6: edaaa-i Yery-dryPreaent*. and; eoual- L1EDR1TCRIT Urinalysis: Bl ood: cous*- i i ri'eetrocardiogran: Chest* X-ray* Tlthln: norsal.U nits: H e n o g l o b i n ' . 90i . or.* 1 3 * 6 : g a s : RBC: A j 8 7 " " BC:9,600: I n d e x * .921 C e l l - v o l u s e -46* P o ly a ; 55 (S ta b - 5 , S e g '5 0 ) L y n p h a O l , Lionoa*5, E o a i n s - 8 , Bobob- I . S e d l s e n t a t i o n - r a t e 35 a s ; ( n o r s a l - 0 -- 9) N o rsal.tracin g s Done - a t ' E o a p l t e l * ' cf t he O o o d - S a s a r l t e s : " P o a t e r l o r - A r . t e r i o r ' a ns- L a t e r a l - Chest flic s - sh o v th e transverse* d la s e te r ' of the : h e n rt* shadow* t o le - 1 5 . 5 e s a .. co reared t o : 3 3 . 5 c c a ; f o r ' t h e - t r a n s v e r s e - d i a =e*.er* of th e chest". The l e f t h e n r t ' border* la: r e l a t i v e l y p re rIn e rt. There* la- Increased. s o t t l e o - c e n a l . l v t h r o u g h o u t " t h e - n i c - ar.dl o r e r ' l* -ft` l u n - f i e l d . There* la* =ober"afe; d l f f u e e - no t i l e d - d e n s i t y ' nt" the- baaevof* t h e - r l - ' h t lung f i e l d s The a p ices * are* c l e a r ' b i l a t e r a l l y . There* l e no: e v id e nc e* of pleural-fluid" . t pulsonary'Function f tu d le a ' 13-26-36 These* w e re'p e rfo rce d a t tho Cr.r'dio -- R e p p l r a t o r y L a b o r a t o r y o'* t r . c L n l v e r " s i t'y Of Soutl-.ern" C t l i f o i n l o a t t h e - Ho s j v i t nl- o f r r - /I - a...Ni icor.tinueuj the- QiroiL t x s u & t m u ^ r - t h e , w ^ rv A JiU : Ctr br*. m u * * u o c t i ^ / .. " ^ S ^ J S L L fcfrj* g ttg ^ tu i Jr" fHTTf ia l ttlZ l a c oe ehnttraLLltx.- trresisarrfc lue the* * & & i r o p: I jr th. t s a c c i r a rtaarludl bdloxat ftxy.gstt. arturra-- ****frrr rfiii t-rr aTUJTfcil,Tn* rfT hllP&tb thTHh*. fiWN- v.wnZetoesi: m u s mtq: tiriie* occn-ait-iitutT! Ai n t h a o r awrdiDiiai t i z a n ^ * 1lJfc r' ecaaETtP > -- ------ " Tjrtii jx a ^ iftt* . % t e n t b y et on-: KTAobAr-1 0 ; . 1 9 i ^ i fer.- aa E M a m i l p hyt r a i l e i c a n l n a t i e n - . . I t : t h a t : t l c e . Xi-ray a: of.* t l * ! urtT? aada* by-Dht . K l l h i O : . Xarchner.-s The s t e r e o : r o e n t^ - g e n o ^ n c s; re v e a le d : a tnorcal_ thorax; . d la p h ra g a ; heart* and: r e e a e i l a n a d o r a * . T h e , l u n g - f i e l d a , r e r c l e a r r a n d : t h e r e * were* no I n f i l t r a t i o n s ^ . no: d i s p l a c e m e n t s : end:, n o : p l e u r a l . a h a d o r a s The pictures ra s 2th a t: of.'aihealthy.*ad u lti c h e a t!. >' S i n c e * t h a t - . t l n e t l l r s L ' c C i r r e l l l h a s s b e e n - e s p l o y e d t l n T l r a u l a t i n g f o r r a i t i a * u a i n 5 : a a b e a t o 8 i a : i d : o f .`l a t e y e a r a : f i b r r g l l --------- ^ r- -l c C i n r e l l l r a a s r a f arred: to :D ri -R e g in a ld : Sr a r t - cheat: apecii a l i a t i f o r r f u r t h e r : * s t u d y - e n d : e v a l u a t i o n : . i Ui R0- d o u vj- have* recelved:his:report:ln*this: case*. DIlCFOSISi- 'V .*v.*>w 'joxWv i- v w tt"'W1v\s\T v . i \ V i i -v & \ u . t i - ! . - 1 "-- J t b r o V i s ^ o f ' b o t h : l o w t r . - l u B - f i e l d s : r l t h . c a r t e rf ri,, e r t e r 5-- lT B T cU o x y g e n : s a t u r a t i o n : on*, e x e r c i a e - , * - - - r o p : i n . RECOMHETPlTIOrSi< ? - * T h la i p a t i e n t : e h o u l d : nof-ralfc: up: atepa-* or* un-v* n* i .* a v o i d : l i v i n g : a t : a l t i t u d e a? o t h e r - then*- sea-, l e v e l ^ a ' - on *"ifJ :: not* do: heevy* *-t 1c: b e c a u s e ; t h i s crep* i n* ea t u j - * He* a h o u l - - m i l k : e x e r c i s e c o n s t i t u t e s : a c u t e h y p o x i a . * hl c f ct i o n * n o t e d ' ** . ; i a l - p r e s s u r e * a nd: f u r t h e r * i n c r e a s e s t h e - **.,, , ' e i e v a t e a : a r t e r ~ * h e a rt* .. * l o ^d- on* t h e ; tH*- ccysissisw- PAUL A. CUAWTANCITM 0, M C L Iff wntMiif wcii>r| u u o 'w s JOCf W lllM Itt lOU UV UD LOlAN&dlll CA1HOINU < 0JM 47ff Ji.in * P 7- 22, 1957- Th"a ^ i v t l i r s ' I m u r i o e i ^Co. 510 V n t S ix th S t . Lob Angelea 1U,- Cxi I f o r a l A ttn t M r? J o a a p h tB lle h a k -. D aar-K rr B llch ak r- Rat Yeur.-eaaa.#-B-29902: E.C. KeCarrell- la p : Ar=itror.r. Ccrk-Co*. 55 IX 1 75-564C ata: Aoout A u :., 1955 K rr .0 M c C a r r a l l , 12255 K a r t ' S t * , No. Hollywood,C a l i f .', c a r r i e d -white n a la aged 53 y e a r s ; o e e u o a t l e n * u o m o s : worker; was-examined-by me-at ny o ffle a -a t your*recueit cn 1/15/57* Report' of flndlnga, conclusions-and -reeossendatlcns-f allowing- rati nation and - r e v i e w - o f t o e e e d l e e l - r e p o r t f o r ward ad - by* y o u r - 'c f f l e a ? l a - r e s p e c t fully submitted.- OCCUPATIONAL- HI STORY: The p a t l a n t v i s a c o o k o r "a r e s t a u r a n t - n a n a g e r ' a l l . h i a U f a p r s 7 l o y s to 19Ur- F r o a ' 1 9 U l - t o Lae* Ur 1 9 5 5 an a s t a s t o t - w o r k a r * a n d / o r r c o n - ^ s tr u c tI o n 'forem an.- "I a p p l y a s b e s t o s - l c t h e *f l a i d . - T h e * c s t e r i a l - w e * use* we-: put around-s tea.*'pi pea; I t cones i n s e c t i o n s and-we pry" i t apart: endp u t i t around t o e p i p e s . At t a e J o i n t s y e take* tfte*powdered- f o f ^ of. asoeatoa? nix I t Into-a-crud-and Bold 1 t around-the- Jolnts*,- "Vhan' I h a v e - n o r a - t h a n 3 n*rrr- v n l c h isrr*-t verj^ often* I J u s t work a s - a f o r e m a n , - he r e s t c f t n e t i n e - I work- a l o n e - v i t b - the* cen.- *About 75^ o r` c o r a * o f ur` work i s indoors*,-* in boiler* rooms h e a t e r ' rooms; ate* We'work 6 hours a d a y , LO ho urs' a week.I h a v e n ' t acne any work s i n c e I 2 / u / > 5 . I h av en ^t been* doing anything but s it t in g around. kS o a e ' o f t h e p l a c e s we w o r k e d I n were* ver y* c u st y* and- lo n s'v sn ' not." HISTORY O f PRESENT'COMPLAINTS: " I n a b o u t A u e . , 1955 c o u c h i n r starT-d and 1 r o t t i r e d - t o o e a s i l y . I- c o u l d n ' t ellitb'ladders* w ithouttopplnx to r e s t tic iu se of shortness- of breath. 7ne co u c h w a s n ' t a d e e p couch and I ha d I t o n l y wnen l would- e x eT t iffy-* s e l f and b re a th e ' deeo. 'net's wnen I would s t a r t to couch. Tnerar wesn*t much p h i era'.- I t ' s more' o f a w a t e r w n l t e ' . When I d i d n e v w i p u t u r f t e x 'tff b e fo re ' eno d u r i n g the h o l i d a y s m e re * was ab o u t an ounce* o r s o o f w a t e r y s t u f f - no lumps t h a t 2 could a te over' a 3 3*y p e r i o d , i t h a s n 't chanced any In amount. "I went t o Dr. K e n n e e o t t o n l ? / u / 5 6 . He s e n t n e t o Dr. Mo t l e y and Dr* o m a r t . `i n e y h i d a - r i y a t *hs Samaritan Hospital and a l s o by Dr. s m a r t , to o . Dr. M o tl e y d i d p r e s s u r e t e s t s In th e h o s p i t a l - - Kent me t h e r e a l l d a y . I h a v e n ' t r.ad any t r e a t m e n t * "As l o n g as I'm not d o i n g a n y t h i n g I f e e l as well- *1 1 ;s a a a ^ j g r g Q ^ - k . --rrrj.-^f.''.S/-.* 4 - * *--*" *** < - *Sw~ -v> rt* -- j j^ :a 11 d -- 7 I Fig*'2: (<* R* i> 1 . 0 . . K c C t r r a l l . 1/22/57' t 4 ----- *? r fr*vh m a any-when-I breathe* I ' V fh a d a . l i t t l e a o r t n a u undor-ny-brfast boner I n *the * o r n i n g i i v h e n -1 c o u g h - q u i t *a b i t , . T h a t ' i w h e n - t h a t - v a t e r y ' * tu 2 S : e o a n up* * PRESNT~C0HPU12NTSt S h o r t n a e a - o f - b r e a t h . o n* e xe r t i on ,* . a l i g h t : rut* t e r n a l . p a i n or d i s c o m f o r t o n ' e x e r t i o n ; c o u g h m o s t l y l m t h e ^mor nl nga- vl th ' a c a n t y -wa t e r y ~ p h l e g T I n c - ab out A u g , , 1 9 5 6 , . On * v o m l * i n g - a p e l i - o c c u r d - on - l l / l U / S o - FUNCTIONAL-IN^UIRY BY SYSTZKSi G e n e r a l - - No f e v e r ? c h i l l s - o r "s w e a t s . K o lo ii of welght,- O a e t r o - i n t t l n a l i A p p e t i t e - g o o d , - Bcwele nov e -racu_burl j eve ry-day: No l n t a t i n a l - c o m p l a i n t , C a r d i o - r e a p l r a t o r y i No - t a c h y e a r d i a * o r * p l p l t t i r . o r - s w e l l i n g - o f the? f t o r ' a n k l e a ; No n o - b l o d a . o r n a s a l . d i s c h a r g e . G n i t o - u r i n a r y r Day f r e q u e n c y ' 2 0 0 - 3 t l a a a - w l t h no n o c t u r i a o r ' otbor* ayaptoas,- Spool a l - s e n s s Nearing,' v i s i o n ; t a s t o and - s m ell, art* normal. Gla*oi a r e - v o r i r f o r 'r e a d l n g . No b u r n i n g - o r *I t c h i n g , o f t he *yea* Kiseulo-oneoua t Negative; C en tral-nervou s ayston? Ho-lopa w e l l - a n d - b a a - n o rarvouaneat* or* i r r i tability," FAST"KISTORYs >* r e c a l l s m e a s l e s , m a t and c h l e k e n p o x : I n ehl l dhood: i id has bad ccas i o n a l - c o l d s a_nd- sore* t h r o a t s but -n i Te r* p n e u m o n i a , b r o n c h i t i s or asthma. In 19U6 ho h ad - a l a f t ` i n g u i n a l - h e r n i o t o a y a n d - i n ' 1953 . a hoKorrboldortoiy. Ho d en i e s * v e n e r e a l - d i s e a s e " a n d - b a a - b a d - n o a e r l o u e ^ i n j u r l e s v F.O'JLY-HISTORY: Hia n o t h e r ' d le d a t LI- y ear s * o f an-unJrnovrr c a u e v Hlsf a t h e r i s l i v i n g and w e l l . One- brother* and- L- a ls-tor'SF r e ~ l i v l n g - a n d - v e l l , - T h e *p a t i e n t Icnows o f no ast hma, hayfeveT* or* othrr* a l l e r g i c d i s e a s e or t u b e r c u l o s U i n any o f t n # - R e s b e r v of- b U: f kt fl l-yv KnRITAI^-HISTORY: His w i f e , i t a r r i o d i n 1 9 3 2 , i s i n good health',- Thenr h ave*b een no c h i l d r e n . - f -HABITS: He'uses* n e ith e r * tobacco n o r ' a l c o h o l , fHYSlCAXr EC1KIKATI0K: Ge ne r a l - The p a t i e n t I s a r b bu s t * larce* whl to msle of 53 y e a r s a p p a r e n t l y no tT V ie lg h t 73"; w e i g h t 198 l b s . , s t r i p p e d ; t e m p e r a t u r e 9 3 . 8 a t 10: 15 a.mY; pu-lor 102 w ith v a r i a b l e volume; r e s p i r a t i o n s 22, q u i e t and rhythmical;- blood- % p r e s s u r e * l e f t arm" 100/ 72, r i g h t a r W 9 S / 6 8 . n ee d? r t a l r I s g r a v i n g , i t e r ' drums r r nor.Mil-, a watch i s ' h e a r d a t 6"*. S c l e r a s are' c l e a r . Ocular movements e r r n o r r f t j . P u p i l s and fundi . a p p e e r n o r n a K Nasal p a i e nc y on t ho' l e f t i s p o o r , on the* r i c h t * i s good.- The septum i s d e v i a t e d - t o the* l o f t and there- i s s l i g h t i n j e c t i o n and mucus b i l a t e r a l l y . Fnaryrix l a g r a n u l a r b ut n o t % e s p e c i a l l y i n j e c t e d , m e l e f t t o n s i l i s medium* s i t e d , t h e r i g h t r -B l a amell end no d e b r l s l s e x p r e s s e d from' e i t h e r , l n v l o m u i Is l i g h t l y coated a t I t s base but is s te a d y end does not d e v ia te . There* ire* s e v e r a l molar* and b i c u s p i d t e e t h a r * a b s e n t . InVre la much r i o i l i * . To- . I * -L - ?*gt*3. M i K .O .K sC arrall. 1/22/57" Keckt P r e se n ts.n o .a p a a s; ra a tr ieta d .m o tIo n -o r-p a lp a b le-ela n d s* . C r o a t s j T n a i r l e i l , s i l e n t l y b a r r a l ah apad-tout e x p a n s i o n * 1 a *e q u a l , a n d - f a i r . - On d a a p : l n s p l r i t l o n - ~ c n a a t g l r t a ' l a . o 2 j " ; o n~ . f n i l - a s piration 3 Lung: S lig h t ly fcypar-reaonant at-th a b ia a i^ a n d .n o rm a lly -reso n a n t? la iw n ir ; E resth aounaa. a r i- a - lit t le - d is t a n t * .N o - r a le a*are*beard: o n 'deep b r e a th in g or-cough ing-an d-cou an*le u nproduct1vat Anxsro* p o s t e r io r ccr.ora a a Ion o f th e -c n e a t e l i c i t s a lig h t co m p la in t:In : tha lower*ta r n a l-r a r lc r .; L a c a ra l.co n p ra a a lo n -c f t h a ? c n i a u a l l e l t i no p a in cornrialn t .Xo r a t r a c t l e n of th a I n t a r c o a t a l.s p a c e s ; o r - a e t i i t y f a c c a s a o r y - r s a p i r a t o r y s u a e l a s i 1 a . o o a a r v a d . . T h e r e - a r a - n o - p u la a tlo n a . In tha-nacx. H e a r t : Tha l o f t f c o r d i r 'cr, p a r c u a a l o n l a J u a t I n I d a - t h a - n l p p l a * l i n e * T h a - r i g h t l a - u n d e r *tr.a t a r n u a ^ - lo n a a a r a - c l e a r ; r e g u l a r - - but: s l l g o t i y v a r ia o la -lr . voluma; Abdonan | hounded, n o n -te n a a r a n d - a o f t . L lv a r ~ d u lln a a a e x te n d s : fro*? tha-right o tn -rib t o -tha-subcostal-m artin. Splanlc d u lln ess:Is: horns 1. Chare la an o o llq u s l a f t ( h ern iotom y) sc a r ; T n a - la f t ex-- tem al-acdonlnal-rlr.g tha fin g e rtip snugly, th a-righ t ea st! w h a r fs allgr.t lspulaa la - f a i t cn' cougnlng, G a n lta lla : Normal- a x t s r r a lly . r . ae t umr * d i g i t a l - a n d sj yoi codI c e x a m i n a t i o n s : i r r n e g a t i v e ; Te* p r o s t a t a * eland is norm 1 - to p a lp a tio n .- R u a c u lo -c s s a o u s j Tna t r u u c - i s s y m m e tr ic a l- w ith a s lig h t ly 'r o u n d e d '- upper d o r s a l - k y p h o s i s . There*! no t e n d e r n e s s , spasms o r ' r e s t r i c t ! In c o tlc n . Tppar "a x t r a n l t l a a : There* la a l i g h t c l u b b l n r - c f t h e - f l n g e r i * w i t h : c e p t l O i # c y a n o s i s c f t h e m i l s , Tne p ains: a re a o f t ' a n d - c l e a n . . -nara Is no p a lp a b le sdar.epethy o r 'n e r t e t e n a e n e t i ; - L o w ar'axtren itlaa: There* are' cry~callu *es* In both Uifr*pat#ll.ai<* rauicr; n o e l a r t - c r ` c y a n o s i s c f t h e l a g s . K o t i o n O f . t h e - t h i g h s * on* p a e s i r e - fla x lo n is c a r r ie d tc c? decrees with th e-la ra straight*wlthout^ p a i n c o m p l a i n t , r . o t a t i c n a t tfca h i p s la- s i I g b t l - y * s u b n o r r x i- .- S k l n : T n a r e ' a r a s c a t t e r e d p a p u l e s e v a r t h e ' fcacJc b u t none - ont t h e ' haivds- c r ' f o r e a r r j . T h er e Is r.c a c n o r r t l p i g m e n t a t i o n ' . - Te reeri #?: a r e * e e u a l - and s l i g h t l y h y p r o t o n l e . Kb p a r i e 's t h e ' s l a s ' are r a t a l, C FLUOROSCOPY k X - R A Y S: F l '. c r c s c o p y c f t h e - c h e s t r e v e a l s o n > i n c r ' p s s r i n s 1 2 and d e n s i t y f t h e h i l a r and- l o w e r ' trUr/rf- s h a d o w s . Tr.a' c u t l l r . e s c f m e p e r l c a r d l u r s : a r e s h e r r y * . T n r r f l a s ome- l r ~ - c r e a s e In l i n e a r n r k i n r a , e s p e c i a l l y In tr.a rid- and lower* l i * f f l e l s e where* m e r e l i a r a t h e r d iff u s e * has 1r.eas e x te r .a in o a lm o s t t o the- baseTM. Che l a t t e r a r e ' e l S c n i l y a r t h y s e n a t o u a D l aoh r' e raT e x c u r s i o n Is* ab ou t - 1-" and the c o n t o u r o f t h e b e n i c 1aphracr.s* I s rounded.- Vnerer l a n o e v i d e n c e o f f l u i d i n t h e c e s t c p h r e r l c a r . r l e s . The a p i c e s are* cl ea r*, i h r htfart-- g n a t - v e s s e l s i l h o u e t t e * I s r.ornfal- I n s i t e , i h p e e n d p o s i t i o n *2hr mediastinum la c le a r . ^ A - r e y 2 2 3 2 # 1 / 1 6 / 5 7 F * u l A.- t u a i n t i n e a , K . D . , i r e In te r p r e te d as f e l l o w s : - b te r C 9 c o p ic p o a t a r o - a n t e r l o r film s* o f t h a c h e s t r e v e a l m o d e r a te I n c r e a s e i n s i t e ar.d d e n s i t y o f th e r . l l a r s h a d o w s w i t h s e v e r a l m in u te c a l c i f i c a t i o n s o n e i t h e r a id e . There* la c o n s i d e r a b l e w id e n in g c f t1hue .l o-w e r t r u n k s r . e c o w s e x t e r d l n r a l m o s t t o t h * ~-* -*** I // i i m 9 rt&ii.l T f - g l M t o i l Ml 'S fe Rftl Z 0 . . H o C a r r e l l . * > 1/ 22/ 57- i o : o n * t h i l e f t vhe re** t ha y - r e a c h - a l m o s t t o - t h a p e r i p h e r y --l a t a r a l i y j \ Thara-Ii . a l i g h t -early m o d u la tio n -In -the ic e n tr a l- p o r tio n - o f- 't h e * le f t t l o w e r - l o b a r t h a n o d u l i * i h a i l n p . a . f u s s y o u t l i n e / l h a p a - 1 1 i *s u p e r i m p o s e d ^ a lig h t haslnaa a -over-tha-up p ar-ana :m*dd1 p o rtlo n a io f. th e v lo w a r ~ lo b e a i. Jha i p l e a a a r a - c l e a r . - Tha u p p r ~ l o b a * i a p p a i r ~t o - baa a 11 g h t l y a mphya a a u t o u a ^ a a - d o - t h a - a x trame**b a a a a s . T h a - c a r d la c g r e a t t a aal .ou tlin a-ila - ahaggy-but: not" I n e r i i aad; I n *a i t a - o r - a l t a r a d - I n p o B l t l o n o r ' a h e o a . Tha - t r a e h a a d e v i a t e s * a l i c h t l y * to tha-right at th e * lsv e l.o f. th a ? fIra i intarcoata l.a p a caand.aeconcUrlb.Tha -hamidiaphragms : a r a -dona *ahapad-and*rea t a t . tha l a v a l e o f 't h a l O t h 'r l b o n - t h a - r i g h t , a t - t h a la v a i-o f- th a ? 1 0 t h ^ I n t a r c o a t a L . apaca on*tha--laft.- A l a t e r a l - f i l m _o f t h e ae h e a t r a v a a l s - m o d e r a t e earphyaama* in* t h a ' i n t e r i o r "p o r t i ona of* t h a b a a e e * o f t h a u p p e r l o o a a -and- a l i g h t * ar.phy^aami-at t b a 'p o s t e r i o r 'b a t e s of tha " le v e r`looaa*. R o a n t g e n o l o g l c a l l y , * t h e f i n d i n e * *e r a * e o n * l a t a c t - v i t h - a #* f lb ro a la -o f th e -a a b e a toa -type ; ehronlc bronchltla end-emphysema., cron-chlaetaala:vould-have-to-be-considered aa- pcaalblllty; ELECTADCARDI OGRAM! 1/1B/57 QRS-Complex#a: S - T 'S i r a i n t a s T Waves: Conclusion: "Sinus -rhythm? ?.a t e ' a b o u t 6 5 . FR i n t e r v a l ; 2 a a c s . QRS- I n t e r v a l s Snail- In lead-2. .OU-eca*. Mainly downward i n ' l e a d - 3*- V ar y l e w - i n a m p l i t u d e - I n AV7`, Thera are*n waves: In' the- c h e * t ' leader* T i n y c waves* a r sean* l o '- AVL*. S v a v e a a r a ' a e e n t h r o u g h " V5-* ^ m. Ko s i g n i f i c a n t c e v i a t l c n ; - K o r s t l l y I n v e r t e d * I t * ATO. U p r i g h t I n a l l - o t h e r ' l a i d a*,* Seiti-horiiontal- alactrleal- posltiorr.. T h e r e I t no gr fc phi c ' e v i d e n t e - o f con*-* ducticn defect- or' oyocardlal- iichaU>," (Signad: J a n e a 'F. Anderson, H ;D .) REVIEW C? FI LE: D o c t o r * # F i r s t R e p o r t o f Work- I n l u r j T d a t e d - l / l i i / 5 7 * s i g n e d R o b e r t K. K e n r . l c c t t i n d i c a t e s da ta * o f f i r > t - e x a m i n s t l o n as 1 1 / 2 0 / 5 6 . H i s t o r y l a t h a t " p a t i e n t s t a t e s t h a t afeout' one* y e a r aco ha be ga n to c ou ch : no h l a t o r y c f r e s p i r a t o r y i n f e c t i o n ; couch* n o s t narked In A.M.; has high s u b a t c r r . a l tlr .h tn e s a on t a k l n c desm' breath.- L a t e r on ha b e g a n t o c o uc h u p a c l e a r Trueu s w i t h l i t t l e * flr?6* p a r t l c l - e a , " Fhyslcal- examinetlon v u r.eratlve "except fo r' i- few r i l e s a f t e r couch a t r i g h t b a s e . " r a y s were* r e p o r t e d t o show " r e l a t i v e * prorfl-* nence of the l e f t h e a r t border , and- increased ir.ottled- density* throuchou-t t h e itid and* l o w e r ' l e f t l u n g f i e l d . Tnere* I s n o d e r a t e d i f f u s e m o t t l e d - density at the' base of the r lc h t lunr f ie ld ," "A marked e l e v a t i o n o f the* s e d i m e n t a t i o n r a t e * t o 35' la reported together*w lth an eosinophil# of 8>. Dr. Hurley L. H o l l e y 's r e p o r t of pulmonary f u n c t i o n a t u d l e r la p a r t i a l l y q u o te d , "The s i g n i f i c a n t a onorr,#\ity p r e s e n t la thw marked drop In the exercise* a r t e r i a l blood oxycen s a tu r a tio n due' to ehuntlrig o f bl ood t n r o u c h n o n - v e n t 11 a t e d a r e a s i r . l t h i s c o n s t i t u t e s m r a t h e r s e r i o u s chance i n f u n c t i o n . *inls roan sr.ould n o t walk up s t e p s ' oK h l T l a . He* a h o u l o a v o i d l i v i n g a t a l t i t u d e s o t h e r t h a n s e a l e v a l - hw ka. . w hlM aw a L ------------ " f*.I rrr . M |#5 Ki i (X 0 C M o C a r r e l l . a .. 1/22/57" Drw K e n n l c o t t a l a o - r e p o r t e - t h a t - o n - l l / 1 0 / l i b - D r i H o l l a * C. K a r a h n a r - i n t e r p r e t e d : * t a r o * - r o a n t g a n o R r a m r . o f t h e *l un gs a bowing* *a normal .thorax,- diaphragms} heart* and .vassal.shadovs* ihaaapieaa* and - l u n c - f l a I da - v a r e * c l * a r * a n d i t h e r e * v e r e ^ n o - i n f i l t r a t i o n s *. n o - a l a placaaenta^ajid.plaural.ahadowa," * Drr K annicott's *d la a ro a is s la 4"fibrosla.both*lower-lungr f l a l d s jwlth a rxad-drop :i n - a r t e r i a l . blood oxygen- i i t u r it lo & '.e n ' .u ir c t t a i? LABORATORY DATA1 . U r i n a l y s i s , 1 / 1 6 / 5 7 - -A.K; a p e e i t e n : v o i d e d , a t . o f f I c e . Claar*atraw-acid-urlna^withapacific gravity 1.013: n o x a t l v e ^ f o r - a l b u o l n ; sugar.***-; M i c r o s c o p ie s Ftv-amorphousj pnoaphacaa,. Tha C l i n i c a l . Laboratory*- o f . D r a . K a c u c k 4 . Kaner~raporta-* ae-fellowei -- Coepleta-blood-count; 1/19/57" rythreeytsa:5#500,000; hemoelobin*15.2 gits;/lC0ec.; leucocytes-. 1 1 , 6 0 0 . D i f f e r e n t i a l * ^ K e u t r o p h l l o s 5u i j a o a l n o p n l l a a ? 35; lympho c y t e s *-375: mcnoey? as *65. S t a l n a d amaar: T h e - re d - bl o od c a l l s are* n o r m a l . i n s i t e ; r e g u l a r " l n - i h a p e - a n d - t a k e *t h e *s t a i n e v e n l y ; Ko n u c l e a t e d -r e d - b l o o d - c e l l s r o u n d . . ? l a t e l e t a-appear- n o r m a l . i n numbar; Blood-sedimentation r e t a -(Wintroba ) On e "h our r e a d i n g - 16 r a r ; v o l u e - o f p a c k e d - r e d - c a l l s L65; c o r r e c t e d - r a t a 16 c n i - (normal: 0 - '9 M l ) Ilcod-aerology" Co IT331 a m e n t f i x a t i o n * t e a t , K o l m a r : N e g a t i v e ; Standard Kline*test: Negative; Vit&l-Capacity teat Kajcjjnum-=ratdingI 2 , 6 0 0 c c . - A v e r a r e o f 5 r e a d i n g s : 2 , 3 2 0 c e . - Kormll: U,100 cc . Vital-C apacity: ;$( of norrU.. c (Sign ed : L .J. Tragermen,. K .D .) slood-cbamlatry; 1/21/57 S u g a r : ' 95 m-gai p e r 100 c c . o f b l o o d . - (Specimen o b t a in e d , at 9:1*5-a , n ; ) Skin testa- 0,1* cc, - intermediate-strength- Furlfled- Protein' Derivative* of Tuberculin given lntracutenaoualy, right fcrear;- F.esults t Karalive. 0.1 cc. Coccldloldln. 1:1000 d ilu tio n , given intricutaneouely, l e f t forearr.l Results: Negative, c F r e s h sputum: jlan I n s t i o n f o r A s b e s t o s l s B o di e s Upon e x a m i n a t i o n o f m u l t i p l e p r e p a r a t i o n s , no a s b e s t o s l a b o d i e s were* f o u n d . ( S i c n e d : G.D, Kaner*, K. D. ) / 72 hour" aputum: Cul t u r e - fo r' T u o e r c l e b a c i l l i - , 1 / 2 2 / 5 7 Preliminary" report A p p r o x i m a t e l y 25 c c . o f p a l e ereemy-yrray", opaque*, mucoid f l u i d . S pe ci men was d i g e s t e d and amear and- c u l t ur e* made from the* c e n t r l - * fugallted sediment. S t a i n f o r t u b e r c l e b a c i l l i : None fo u n d , ^ C ul tu re " f o r t u o e r c l e b a c i l l i w i l l - be r e p o r t e d on or about March 1 ? , 1 9 5 7 . ( S i g n e d : G.D. Miner", M.D.) . ...v * .r-* w U |T I 6 San -- - . 1 ' 1* U r 1* <* * *' n K - 0 , . K e t a r r . l l . --* 1/P2/57 * :__* BtY3W.-OF. ADDITIONAL-FILE:- Tha - r e p o r t - o f f u n c t i o n a l . s t u d i e s b y - D r ; K.otley a n d . m a i l c a l . r e p o r t of h a g i n a l d . Smart; K.D., received 3/2/57 ' la in conformity with the*abovei recorded .fIn d ln g s-of ray-examination. In reviewing tha jpulaonary f a c t i o n 's t u d l e e I t la n o ted ith at r e s i d u a l a i r ' c a p a c i t y o f t h e *l u n g l a I n e x c e e a * o f n o r m a l - v M c h l a consistent with emphysema-and-that a v ita l capacity of 905 of normal, wee r e c o r d e d on'Kovemoer 3 1936. T h is l a c o n a l d e r a o l y b e t t e r * t h a n - was.recorded.by th e - C lin ic a l la b o ra to ry on 1/19/57 I t la noted, a la o - th a t while oxygen uptake la -no rm al.at r e s t , I t la m odarataljr reduced a f t e r s te p up e x e r c i s e ; In d ic a tin g Impairment -in the-function* o f-a ir-g as exchange In the-pulconary-alr c e lls . Tne p h y s i c a l - f i n d i n g s rec o rd e d by h r ; Smart* on" December*?_1956: a r e - e e e e n t l a l l y t h e n i e - i s t h o s e f o u n d - b y me - o n - J a n u a r y * 1 6 , 1957 Dr.* S m a r t ' s i n t a r p r e t a t i o n o f X - r a y a c f t h a c h e a t on 1 2 / 1 0 / 5 6 i n d i c a t a s - f i n d l n g s i d e n t i c a l . w i t h t h o s e i n r.y own f i l m s - l / l B / 5 7 ' e x c e p t t h a t he makes n o m e n t i o n o f t h e s h a g g y a p p e a r a n c e *o f t h e c a r d i a c o u t l i n e - I n o t e d - i n my f i l m s . } DI5CU55I0K: Nature o f o r i g i n a l - c c n d l t i c n : O c c u p a t io n a l.p u lm o n a r y ' f i b r o s is In a l l - p r o b a b i l i t y due -p r im a r ily to the* i n h a l e t l o n ~ o f a a b e a t o a d u s t w i t h se me c c g r e e - o f . c o m p e n s a t o r y ' p u l m o n a r y -" eriphyseroa. A l t h o u g h f c r cn c h o rr e jc s - h a v e r. ct b e T i T l i a a e , a h a - i n my ' o p i n i o n , are n o t i n d i c a t e d , the p o s s i b i l i t y o f some d e g r e e - o f b r o n c h i e c t a s i s Is p r e s e n t.- There Is no evidence c f nodular s i l i c o s i s . p r e s e n t s t a t u e : - At t b e t i r e e o f r y e x a m i n a t i o n , 1 /1 6 /5 7 ' , the- p a tie n t coraplelned prim arily of shortness of breath o n 'e x e rtio n vlt) s l i g h t s u b s t e r n a l - p a i n o r d i s c o m f o r t end,- m o r n i n g c ou gh w i t h a- scanty watery' phlegm'since August, 1956. The p h y s i c a l - e x a r a i n e t i o n r e v e a l e d - a r a p i d p u l s e , l o w blood* pressure; clubbing and-cytnosls of the fin g e rs , s granular*pharynx, a b a r r e l shaped-chest w ith h jrp e r-re so n a n ce 'o v e r the b a sa l-a re as- o f tne-lunet end-heart dullness within the lim its - o f norniU- Fluoroscopy and-X-rays of the*cheat revealed old c a lc ific a tio n in the l e f t h ilu a , moderate increase in h ilar* an d -lo w er' trunk shadow and in a d d itio n a f u iiy m o ttlin g In the low er lobes w ith evidence* of e a r l y n o d u l a t i c n I n t h e ' l e f t l o w e r l o b e a n d a- s h a c c y a p p e a ra n ce * o f t h e p e r l c a r d i a l - o u t l i n e . , - h e d l a p h r a r r : i s s l i g h t l y e l e v a t e d - on' Doth s id e s , .he h e a r t outline* Is not increased-. An e l e c t r o c a r d i o g r a m on 1 / 1 6 / 5 7 shows n o g r a p h i c e v id en c e* o f conduction defect or myocardial- Ischemia. Pulmonary f u n c t i o n s t u d i e s in December*, 1956 i n d i c a t e d - an i n c r e a s e d r e s i d u a l - a i r c a n i c l t y a l t h o u c h v i t a l - c a p a c i t y was only a l l c h t l y below normal. Vital- cap acity now (1/18/57) 1* moderaaely subnormal. wxvren s a t u r a t i o n of the blood- is reduced- after* exercise*.* Although l a b o r a t o r y uxaml n a t i o n of t h e urine* rrv eele tf- r two p lu s s u r e r ' c o n t e n t , a blood s u r e r was norm al. A t u b e r c u l i n l e s t on l / l 8 / p 7 Is r e p o r t e d as n e g a tiv e whereas Drv bmart o o ta in e d a p o s i t i v e t u e e r e u l i n t e a t . jne s k i n t e s t for* hi s lu-- p l a s i r o s l s and c o c c i d i o d o m y c o * l s b o t h a r e n v c i t l v e . *Jha a l i e h t l y ln cro ased blood s e d lm u n to tH n r a t e i n d i c a t e s t h a t some d e c r e e of i n f e c t i o n is p r e s e n t b u t i t does n o t sp.ie ur t o oe s p e c i f i c . *' t \ \ farrji>Aii u E S S B B S , . r O W J : . - w '-t i* u * '7 Ns d J<ei (}..K c C a r r e l l C 9 9 f / 1/22/57* >* T n l s .p a t i e n t * a e *t h e - r s a u l t o f t o n a - f i f t e e n - y e a r s - x p o i u r a - to a s b e s t o s i d u s t , h a i i d e v e l c p e d /rr Be a tosi~J : and .mroa -comp an a a t o r y p u I c o n s r r emphysemaivith'a slig h t anount-of superimposed .non-specific In fectio n ;. Sonje?early bron ch leeC at 1a iioay b e p r e a e n t . > * Tha ^pa tl en t haa a l a a b l l l t y f o r - t h e t y p o o f work a t which ho haa been ~erutared . but . 2 - b e i l a v a - c o u l d . e a r r j o n : i n d a f i n i t e l y w i t h a* sedentary-occupation; A l t h o u g h .two e x a m i n a t i o n s - o f t h e . p a t i e n t *e . a putu&* h a v e " f a i l e d , t o - s h o w . t h e - p r e s e n c e o f . a a b e a t o e ; b o d i e s , I t may b e - a s s u m e d , t h a t c a n y , o f thea -a r a -p ra a e n t l n ~ h l a - l u n g . t l i a u e a a n d . t h a t hla pulmonary f l b r o a l a w i l l - p r o c r a a a . g r a d u a l l y f o r ' an I n d e f i n i t e - p e r i o d * . That p o ssib ility of cor-pulmonaleand-eventual-right heart failure-w ill, dapend-upon-the-rate-of -progression of h l a -pulmonary f ib r o s is . > I.do-not b e lie v e th a t-the -progression' of h la -pulmonary*fibroslsi v i l l - o s i a f f e c t e d - i n t h e - l e a s t by any form -of. treatm ent ava ila b le t o d a y . I b e l i e v e - s o m a ? t r t n s l e n t t e m p o r a r y - r e l i e f o f h l a - ayrcptom- of dysphoea reirht r e s u lt from*lnterrci t t e n t p o sitiv e -p r e ss u r e -breathlng-i however,' t h s ? p t t l e n t e t presen t has no dyspnoea - at ` r e s t and-aoes not experience-It u r tll-h e has engaged-in moderate exercise.. I believe-the sputum'should be-cultured for*organisms-and-sen- s i t l v l t y ' t a s t s carried out to determine whether or not an tlb lotle therapy might control the a lig h t degree o f infection"present In'his bronchial-tree; i n a n k you v e r y much f o r t h e p r i v i l e g e o f h a v i n g e x a m i n e d - t h i s patient. Yours very truly. ADDENDUM: Kareh 12, the herewith. iC J C -- h u l A. Kua-ntance*, K. D. Z \e r e p o r t on c u l t u r e o f the* sputum* for* tub ercle* ba c l I l l w i l l be forwarded as a su p p le m e n ta l r e p o r t on or' about1957. la b o r a t o r y * r e p o r t s and your f i l e are being' enclosed- 3/ 1 U/ 5 7" The* C l i n i c a l - L a b o r a t o r y * r e p o r t on* c u l - t u r r o f the* 72- hour" specimen o f sputurn-for' tub ercle* b a c i l l i s t a r t e d - o n 1/2-1/ 5 7 \ r e c e i v e d - t h i s morning# I s n e g a t i v e ' for* t u b o r 'd tea e l 111 T h i s would* t end- t o c o n f i r m " the* d i a g n o s i s r e c o r de d - In' n y r e p o r t d a t e d - 1 / 2 2 / 5 7 a n d - w o u l d - s u p p o r t the* r e c o m m e n d a t i o n mide then: t h a t t h r s puturn1be" c u l t u r e d and s e n s i t i v i t y ' t e a t s r u n t o determine* t o which: a n t l b i o t i c s : t h e ' o r g a n ism- r e s p o n s i b l e f o r " the" i n f e c t i o n - I n the" p a t i e n t 1r r e s p i r a t o r y " t r a c t I s s e n s i t i v e * . I f I t i s y o u r ' wish- t h a t - t h i s be* d o n r kindly advise*. PAQ tA tI > 9 9 JOHN M UHAICC.M O -- 'I H l M k -- , .... I i H M 4lllS I. m t M 12 O c to b e r 1959 Th T raveler Insurance Com pany, S10 W eet S ixth S treet Los A ngeles 14, C alifo rn ia. He: Me CARRELL, E R V E T O ., 56 LA 176-684 A r m s tr o n g C o rk C o. It J o h n s M anville C orporation, B 8289902 k 1789244 G entlem en: W r , E v e ry O . M c C a r r e ll c a m e to m y o ffic e o a S e p te m b e r 4 1959 f o r an exam ination and an evaluation of his p re s e n t pulm onary condition. A t the tim e of his v is it the follow ing m edical h isto ry and physical exam ination w ere obtained. A g e : 56; O ccu p a tin s : A s be toe w o rk e rs M a r ita l S ta tu s: M a r rie d ; B irth p la c e : T ex as, M a rc h 3 , 1903; la C a lifo rn ia since 1922, f a m ily H isto ry : F a th e r: A ge 84, living an d w ell: M other: D eceased a t the age of 41, cau se unknown; B ro th e rs: T h re e , living and w ell; S is te rs : T h ree, living and w ell; C hildren: None. P re s e n t U lneae: The p atien t stated that he was in apparently good h ealth ' un til the la tte r p a rt of 1956. A t that tim e w hile a t w ork at the Valley Steam P la n t he had an episode of stran g lin g alleg ed ly due to the inhalation of d u st in his w orking environm ent. He subsequently developed a sev ere cough and w as seen by D r. R obert K ennicntt of Lee A n geles. He was exam ined and had a e h e s t x -ra y taken. B ecau se of the n a tu re of the findings be w as re fe rre d to D r. R eginald S m art who a t the p re se n t tim e is s till h it attending physician. He w as advised to atop h is w ork im m ed iately . His cough continued and has been p re se n t ever since. It has how ever slightly dim inished since he is not exposed to irrita n ts . He has a slight hu rtin g in h it chest in the su b tle m a l a r e a . He Is sh o rt of b re a th with slight e x e rtio n . As p a rt of the study he was r e f e rre d to the la b o ra to ry of D r. H. M otley-w here ex ercise te s ts w ere p e rfo rm e d . He stated th a t the d iagnosis o f his c a se la p a r t w as based on D r. M otley's re p o rt. Sputum studies w ere also perform ed but no definite diagnosis w as m ade fro m the study, a t le a s t if any diagnosis was m ade, he w as not told anything about it. F o r som e tim e now he has been seeing D r. S m art a t in terv als of every six to eig h t w eeks and D r. M otley at in terv als of about every six m onths. Rai Ervay 0 . ,, .J ia rrs L l # 2 ft ft A t the p re s e n t d m h i a U tid that h i haa a h u rtin g in H it c h e a t and tha ao d i of hi* iin g a ra and to a a b eco m e s o r t . H e la n o t p a r tic u la r ly a w a re of th a a e u n le ss ha e x e r c is e s . Hi a p rio c lp a l co m p lain t at tid e tim e la hla cough w hich ha a u te d waa v e ry em haraaalng and w hich m ake a him v ery nervous and shaky, Ha ha a been re c e iv in g cold ahota to keep fro m gettin g c o ld s. P reviously he a ta te d th a t h e h a d only m ild colda b u t te e m e d to c a tc h th e m e a s ily . Hi* th ro a t at thla tim e aecm a to be Ir rita te d a ll of the tim e He ha* had no naaal stu ffiness and he ia not a m outh b re a th e r. Ha w aara glaaaea fo r raading only. Ha h a t had no headachaa o r aym ptom a ra la d v e to hia e a r s . Ha ha* had no night aw eata o r fs v tr Ha h a t had no o rth o p n ea, n o ctu rn al dyspnea o r ankle e d em a . Hie d lg a a tio n ia good. Hia bow el m o v e m e n ts a ro r e g u la r . He denied any nausea vom iting d iarrh ea .co n stip atio n Jaundice re c ta l bleeding aouxiag o r gas F o r n tim e aom * p u la th a t w o re p ro a c rlb e d tended to upaet hia atom aeh but he la now receiving an o th er p ill to com bat th is . He stated that he has had no re c e n t bleeding from h e m o rrh o id s. Ha denied any sym ptom s re la tiv e to the g en i to u rin a ry a y a te m . He s ta te d th a t hie en erg y w aa p o o r. He lacked am b itio n and d riv e . He w as m o d erately tire d a t tha end of the day. He slep t w ell and felt fa irly re ste d a fte r a n ig h t's sleep . If he exerted him self he tire d v ery e a sily but he adm itted th at he re c u p e ra te d v e ry easily aa he could re la x easily . He also etated that if he e x e rte d h im self in any way he becam e b re a th le ss m o re easily aa he did n o t acem to have the " re s p ira to ry re s e rv e " . A t th e o n s e t o f h ia i l l n e s s he w e ig h e d a b o u t 135 l b s . He n o w w e ig h s a b o u t 196 lb s. On hia fo re a rm s he has had in te rm itte n t episode* of em ail cap illary hem orrhages. H a b its : He d e n ie d u sin g to b a c c o an d a lc o h o l. He d rin k * a b o u t th r e e to fo u r crape of coffee a d ay. P a s t M edical H isto ry : He denied any p rev io u s serio u s illn e s s . He has had slig h t attack s of to n sillitis in the p a s t but h e has n o t had hia to n sils rem o v ed . He had a le ft h ern io rrap h y in 1947. He had a hem orrhoidectom y ia 1954. O ccupational H isto ry : He stated th at he sta rte d to w ork w ith asbestos m a te ria ls about 1939. F o r about fiv a y e a rs he sta te d he w o rk ed w ith the P lan t R ubber and A sb esto s w orks doing m a rin e in su la tio n w ork. F o r about ten y e a rs he w o rk ed fo r the A rm s tro n g C ork C om pany Insulating ste a m pipes and b o ile rs. He w orked in the field a t b o iler houses and steam p lan ts. He stated that this w as m o derately dusty w ork m o st of the tim e . No m asks w ere w orn ia th is type of w o rk , la addition to the above occupations fo r se v e ra l y e a rs he dro v e a lu n ch wagon and did v a rio u s type of w ork In d iffe re n t r e s ta u ra n ts . P h y sical exam ination rev ealed a w ell developed w ell nourished adult w hite m ale who did not ap p e ar acu te ly o r c h ro n ic a lly ill. The skin of his face had a ruddy com plexion and hie lip s w ere of a slig h tly dusky c o lo r. He had an Interm ittent dry unproductive cough. T e m p e ra tu re : 9 7 .6 ; P u ls e : 72, r e g u la r; Blood P r e s s u r e : 106/72; W eight: 200 lb s . fUl E rv ey O, 2 ^ ~ a r r U . I 9 H u d la d Hack: E yes: T u c d o n a and m ar*m ail a norm al. E a r : m o d e ra te am o u n t o1 s o il wax in both c a n a ls , d ru m s g ro s sly n o rm a l. N ose: m u co u s m a m b ra n u m o ist, slig h tly sw o llen , p a ssa g e s ample M outh: o ra l hygiene ialr D entition: m o d erate num ber of m o lars ex tra c te d , m o d erate num ber of tillin g , re m a in in g te e th elighU y tarnished P harynx: m ucosa diffusely reddened. T o n sils: m o d e ra te a lia , sm ooth. K eck: no adenopathy, stiffn ess or abnorm al pulsations C h e st: s y m m e tric a l, slig h t in c re a s e in the a - p d iam eter L ungs: b re a th sounds slig h tly dim inishad b ila te ra lly , sc a tte re d fine m o ist r a le s in b o th lo w e r lo b e s , a t the b a se s p o s te rio rly and la te ra lly . H eart: re g u la r rhythm , no m u rm u rs. A bdom en: no m a sse s o r te n d e rn e s s , w ell h ealed le ft h e m io rra p h y s c a r. G enitalia: n o rm al. R ectu m : em ail ex tern al tag s present E x tr e m itie s : fin g er n a il b ed s w ere dusky in c o lo r, the n a ils w ere w idened and s lig h tly c u rv e d and s lig h t clubbing of the f in g e r s w as p r e s e n t. The to es w e re e s s e n tia lly the s a m e . F lu o ro s c o p ic ex am in atio n of the c h e s t show ed an accen tu atio n of the ra a rld n g s of a fine lin e a r c h a ra c te r lo calized p rin c ip a lly to the low er halves of each lung fie ld . The c a rd ia c silh o u ette was not sig n ifican tly en larg ed . The d iap h rag m s w e re round and sm ooth and m oved about th re e c e n tim e te rs w ith re s p ira tio n . A la rg e a e rie s of ch est film s taken a t the o ffice of D r. S m a rt as w ell as a e v e ra l film s tak en a t the H o sp ita l of the Good S a m a rita n X -ra y D e p a rtm e n t as w ell a s a few tak en by D r. P a u l Q uaintance w e re av a ila b le fo r re v ie w . m The e a r lie s t film s w ere thoae taken a t the H o sp ital of the Good S am aritan and w ere d ated 11*20-56. T hese film s show ed a sc a tte re d fin e b a s ila r in filtra tio n in the lo w er h alv es of b o th lung fie ld s . The m in o r in te rlo b a r fis s u r e on the r ig h t a p p e a re d to he slig h tly d e p r e s s e d . A d h esio n s w e re p r e s e n t to the d o m es of boLh d iap h rag m s m o re on the le ft than the rig h t and so m e ad h esio n s w ere also p re s e n t a t the h e a rt b o rd e r on the le ft. The ap ice s and the co sto p h ren ic a n g le s ap p eared to be re la tiv e ly c le a r. J Rsi Ervay 0. ) ^ t r r U I 4 ?H u r i r / i i i m . i i ------------------------ -- 9 T h t film s taken a t tha office of D r. S m a rt t a f i a w ith a group taken oa 12-10-56. In th is g roup so m a of tha o v e rsh o t film s show a fins in filtra tiv e p ro c e ss la tha lo w e r lung fie ld s ti la ta r a lly te lo v th a le v e ls of tha second in te rs p a c e s , F ilm s taken on 27*57 show ao e ss e a tia l ch an g e. The film s taken oa 12-9*17 a re a ls o slig h tly overshot and show ao sig n ifican t change. The 2-5-58 and 4 -4 -5 8 film s show ao change, A Bucky film tak en oa 7-30-51 shows the in filtra tio n to a p p e a r to he slig h tly m o re d is c re te but this m ight be due to rad io lo g ic technique. Subsequent film s a re dated 8-27-51, 10-10-58, 12-19-58, 1-27-59, 5-18-59, 5-14-59, 7-18-59 show no addifeaal significant ch an g e, A Bucky film taken o a the la tte r d ate show s the fins d is e rs ts in filtratio n to be in extent and in the a re a s noted in the original film of 11-20-56, I b s r o w ero 35 film s in this se rio s , la five of theso film s the dates w ere not discernible. Six film s fro m the office of D r, P aul Q uaiatance w ere also available fo r rev iew . T h ese w ere dated 1-18-57 and 12-5-58, They were of ra th e r p oor quality and g ro ssly did not show any changes fro m the film s taken above. T h e r e i s n o q u e s tio n a b o u t th e a p p e a r a n c e o f th is p a tie n t1! lung fie ld s w h ich s u g g e s t the p resen ce of a diffuse p u lm o n ary fib ro sis, which h is to ric a lly w as n o t p re s e n t in film s tak en by D r. R o lls C , K arehner in N ovem ber 1944. O n th e b a s i s o f th is p a tie n t1 o c c u p a tio n a d ia g n o s is of an o c c u p a tio n a l pneu m o co n io sis has b e ta m ade by se v e ra l of his attending pby- ciaa s. A lthough th e x -r a y ap p earan ce of the c h e st is com patible with such a d iag n o sis su c h an x - r a y ap p earan ce could be sim u la te d by o th e r conditions. In th is in sta n c e the diagnosis of an asb esto eie a n d /o r an occupational pneum oconiosis h a s n o t b een co n firm ed w ith ab so lu te c e rta in ty fro m the his to -p ath o lo g ical study of a lung niopsy. F ro m the re v ie w of the film s i t is m y im p re s s io n th at no sig n ifican t change h a s o c c u rr e d in the ap p earan ce of the a b n o rm a l m arkings net the o rig in a l film of D e c e m b e r 1956. It n u i t be re m e m b e re d th at with changes in ra d io lo g ic te ch n iq u e a lig h t d iffe re n c e s in the a p p e a ra n c e of the lung field s o c c u r and su ch changes can n o t alw ays be a ttrib u te d to a c tu a l pathological changes, la D r . S m a r t's r e p o r t of A u g u st 2 6 , 1959 h e s p e a k s of changes due to a su b a c u te b ro n c h itis . I w onder if these changes a r e not due to x -ra y technique ra th e r th an to c h a n g es in the u nderlying p u lm o n ary pathology. Som e em p h asis is placed on this p a tie n t's in c re a se d su sceptibility to c o ld s. No d efin ite reaso n is given for this except that it is contented that im m u n izatio n s w ith cold and flu vaccin es w ill confer an im m unity. This co ntention is baaed in p a rt on the fact th a t this patient had allegedly freed o m fro m eo ld a the p rev io u s w in ter when he had rec e iv e d the above v ac c in e s. If su ch w e re tru e the tre a tm e n t of colds w ould be a relativ ely sim ple m a tte r. irrnTTTT' Hat Ervey O. C arrel! , ii Q 0 With this a slan t of-pulm onary aabestoals or pneumoconiosis 1 would u p a c t consid erab ly g re a te r d a g ra a oI pulm onary iuncnoa im p airm an t. C e rtain ly tha pulm onary function aru d iai dona on F eb ru a ry 10, 19S9 do not lodicata a dlaabliag dagraa ol pulm onary function ceoaldcrlng tha estonsiva pulm onary m arklnga In both lung fla ld a . Hia p ra a a a t phyaician Intlm ataa that his a p p a ra n t p ra a a a t im provam ant la on tha baaia of bla ataro ld and 1PPB tre a tm e n ts. 1 do not know of any rafaranca in tha U ttra tu ra la which It ha a b aaa d am o n atratad that tha uaa of ste ro id .' ha a a lta re d or im provad a tru e p a ren ch y m al ilb ro a la . A s re g a rd s tha uaa of 1PPB tra a tm a n ta this doaa lm prova pulm onary vsntilatlon but in this ina ace if ona accepts D r. M otley's finding a this ha a not bean a particular problem during tha period of observation. Thank you for tha privilege of being perm itted to aaa M r. M cC arrall. Very truly yours, L<___ ^ io A a H . U rabec, M . D.