Document XRvYO33enMLdM8BkGGEVzrabd

r A .* 'i V I January 31, 1940 COPY Urs. Dominie Bertagliat Keewatln, Ulnnesota Dear lira. Bertagliat: Both Doctor Johnsmo and rysalf vere very unhappy about the outoome of the lllneaa of Ur. Bertegliat. During the short tins that we knew him in the hospital, he was moat courageous in spite of the extreme severity of his illness. On admission to the hospital, the history was obtained that he had worked for many years in a plant that used powdered silicon and asbestos. Uost of this time he worked as a foreran, but wue periodically exposed to the dust in the main factory. About four or five year# ago ho began to have trouble with a cough and diffi culty in getting his breath in and out of his chest. Be consulted numerous doctors but the condition gradually became so severe that on the ISth of November, 1947, it wae necessary that he leave his position and seek other employment. About two or three weeks prior to his admission to the hospital, he noted some swelling of his ankles for the first time in his life. On admission to the hospital, Ur. Bertalgiat wee dyspneic on both inspiration and expiration, orthopneie, and had some tachypnea. There were many expiratory rales and wheetes over both bases. The heart tones were normal exeept for some accentuation of the P2 aound. The liver teemed enlarged and.extended three centime ters below the right costal margin. There was pitting edema of both ankles. Blood pressure was 116/74. An x-ray of his chest, tiken at six-foot distanoe, showed a TT34.5 cm) UR S.O, IS.7,7 total 12.7. The bronehovesicular were markedly accentuated is both lung fields. In both bases therefore lineal areas of increased density. The diaphragms were low and there appeared to be some decrease in the density of the lungs. Fluoroscopy of the heart revealed the heart shadow to move in a normal manner. There was very little movement of the diaphragm. An SCO showed a right axis deviation with a flat T1 and 2. PRVii ) r * r 2 It. Bertagli&t wt* treated with adrenalin, digitoxin, aaincphylin, penicillin, salt-free diet and salyrgea. He died quite suddenly on the fourth hospital day. Autopsy by Dr. George Berdez of Duluth revealed the lungs to be eaphyseaatic. The bronchial ttree was dilated throughout the lungs without containing a large amount of purulent exudate. There were no areas that appeared to be typical of bronchiectasis. The heart weighed 450 ga and showed a very definite hypertrophy of the right ventricle. The liver ahowed a fine coduling which was due to dark areas in the center ef the lobules. Diagnosis: 1. Chronic bronchitis with eaphysena; 2. Right heart failure secondary to No. 1. It is sqr opinion that Sir. Bertagliat developed a sensitivity to one of the substances in the duat to which he was exposed during his work. From this he developed a chronic bronchitis which finally led to hia death from frailure of the right side of his heart. Ke were unable during his brief hospitalization to test hia for skin sensitivities. The microscopic sections have not as yet been reported. TJhen they are available, I will write you concerning them. *incerely. Randall S, Derifield, k. D. V