Document aJR4m1eoQ153ZMx2QBnxdx0ZY

FILE NAME: Contract Unit Workers Comp Claims (WCC) DATE: 1957 DOC#: WCC053 DOCUMENT DESCRIPTION: Workers Comp File - Riley, James File Name Contract Unit Claim File: James Riley Scanned ? yes Source JMA: NS-JM Start Year 1957 Stop Year 1961 Contents claim, letter Notes DIPLOMAT* AMERICAN 6 0 AA0 OF INTERNAI MEDICINE Ea t o n M. M a c K ay, M. D. S anta A na C linic 3 0 W EST EIGHTH ST R E E T SANTA ANA, CALIFORNIA KlMMCftkV 2 * 1 ( 6 6 F e b ru a ry 24, I960 Industrial Indem nity Company Box 2252 Term inal Annex Los Angeles 54, C alif R e: C laim No. 57-03-11487 C laim ant: Jam es W. Riley Em p: Lynch A sbestos Co D a te of In j: A p ril 7, 1947 A ttn : D. W* B ro w n C laim s D epartm ent Gentlem en: In m y last rep o rt concerning the above m entioned patient 1 indicated that he had been hospitalized in the P alm H arbor G eneral H ospital, G arden G rove, C alif, on Decembe 27, I960. He was h ospitalized because it w as no longer p o ssib le to keep him re a so n ably free from the intense rad icu lar pain at hom e. This nerve root pain was caused from v e rte b ra collapse. His co u rse in the hospital was rapidly downhill although it p ro v e d p o s s ib le to k e e p h im f a ir ly c o m fo rtab le* He e x p ire d on J a n u a ry 24, 1961 at 7:25 AM* T he im m e d ia te c a u s e of d e a th w as p u lm o n a ry in s u ffic ie n c y o r r e s p ir a to r y fa ilu re . FINA L DIAGNOSIS CODE 350-3971 350-814G 360-1231 360-438.6 370-1X4 362-600.6 360-100.2 435-535.6 861-9X1 640-951 651-951 221-403 2231-403 DISEASE A sbestosis E piderm oid carcinom a (U ndifferentiated squam ous cell type) bronchu (C h ro m o g e n ic a c id fa s t in fectio n ) M in im a l a c tiv e tubercul8f>is.un' Secondary C om plications F ib ro sis pulm onary, due to foreign body (asbestos and A dhesions of p leura due to infection (p leu ral fibrosis) Em physem a (severe) com pensatory. M ultiple a b sc e sses of lung Right h e art hypertrophy and dilatation. A drenal cortex atrophy. A ctive and healed peptic ulcerations of the stom ach. A ctive and healed peptic ulceration of duodenum . F ractu re, com pression, of body of T-7 and T -8. F ractu re, com pression, of body of L-L carcinom a) $ Ca t o n M. Ma c K ay, M, D. - 2- c Re: Jam es W. R iley R. G. R ichards, M. D. the Pathologist of the Palm H arbor H ospital perform ed a post m o rtem exam ination on Mr R iley and a copy of h is re p o rt is enclosed I would ap p reciate it v ery m uch if you could have a copy of the post m o rtem exam inatioi r e p o r t m ad e and send to D r. J . K* S h ire y who i s in te r e s te d along w ith Dr B r e w e r in th is case* A lso if it is not too m uch trouble perhaps you would be w illing to send D r. Shirey copies of the e a rlie r re p o rts I have m ade to you. He has a keen m edical in te re st in this case. * A copy of the C ertificate of D eath is also enclosed. This was m ade before the m icro sco re p o rt of the autopsy m a te ria l had com e in , but I would not have changed m y g e n e ra l coi elusion. If th e re is any m ore inform ation I may be able to give you I w ill try to do so. Sincerely Y ours, v hTu zrfir- Eaton M. M acKay, M. D. EM M :mm e < DIPLOMATE AMERICAN BOARO O ' INTERNAI. MEOICINC ( E a t o n M. M a c K ay, M. D. S anta A na C linic 3 0 WEST EIGHTH STR EE T SANTA ANA, CALIFORNIA KIM9CRLY 2 * 1 1 0 0 J a n u a ry 21, 1961 Industrial Indem nity Company Box 2252 Term inal Annex L o8 A ngeles 5, C alif Re: C laim No. 57-03-11487 C la im a n t: J a m e s "W. R ile y Em p: Lynch. A sb esto s Co D ate of In j: A p ril 7, 1947 Attn: D. W. Brown C laim s Supervisor Gentlem en: T h is is to c o v e r the p e rio d of O c to b e r 31 to d a te on the above m en tio n ed p a tie n t. He has gone gradually downhill and the problem has been to keep him free of pain o r at least reasonably so. I have had to o rd er oxygen for him and had a tractio n bed rented which has provided som e re lie f. On D ecem ber 27, his condition becam e so bad I found it n e c e ssa ry to h o sp italize him . He was placed in P alm H arbor H ospital in G arden Grove because it w as the institution n earest his fam ily. He has continued his dow nhill p ro g ress and I now co n sid er the situation to be term in al. Very truly yours, EM M ;mm Eaton M. MacKay, M. D $ y >-i . " - 'S " '. ' - P( HARBOR GENERAL HOSPITAL^ 12860 Palm S treet Garden Grove, California PATHOLOGICAL REPORT *VV 'si'r .. . V?- NameDoctor. RILEY, JAMES W. Tktc. MCKAY _Hosp. N o._C fi2Z 3_____ D ate. ---------------------------Path. N o___ - * .l/24/fc sT' -wua Specimen. AUTOPSY. Preoperative Diagnosis. ' f-** * 'x V. . y. 'X %* i; PIN A L PATHOLOGIC DIAGNOSESt - "*'1& y t a `**x?si -t -.v^r5 ? i I. PULMONARY INSUFFICIENCY. XI. PULMONARY FIBROSIS, EMPHYSEMA, SEVERE. 362-600.6 III. PULMONARY ABSCESSES. 36^-100.2 IV. BRONCHOGENIC CARCINOMA, RIGHT LUNG. 350-814G V. PLEURAL FIBROSIS. 370-1x4 VI. RIGHT HEART DILATATION AND HYPERTROPHY. 435-535.6 VII. ADRENAL ATROPHY. 861-9x1. VIII .ACTIVE AND HEALED PEPTIC ULCERATIONS OP STOMACH AND DUODENUM. 640-951,1 ', 651-951^ Pa lm h a r bo r g e n e r a l h o spita l 12860 Palm Stret Garden Grove, California PATHOLOGICAL REPORT n -r V-4 -,^"'A'r A Name_________________ RILEY JAMBS W.u______________ Hosp. N o ._ C 6 I 2 3 _____ D ate, Doctor---- MCKAY_________________________________ Path. No___ Specimen______________ftHTSffiSX_______________________________________________________ ShJL 5*-, "t'~ *.z SCviT* H'l Preoperative Diagnosis--___________________________ _____________________________________ GROSS DESCRIPTIONi An autopsy is dona 1/24/61 at 6s p.m. at Backs Troutman and Kaulbara. Mortoarj with Garald Brown as witness on the previously embalmed body of an elderly \ white male, measuring 67% in. in length and weighing approximately 97 lbs. . ; *"he hair is gray. The body appears extremely emaciated and cachetic. - Therd -9 a 24 cm. healed incision about the 9th rib on the right chest w&ll.'t There is a tattoo on the dorsal aspect of the i:lgfc forearm of a horseshoe with the inscription "Good Luck". On the volar aspect of the left forearm is a dagger surrounded by a snake. On the left deltoiu is a woman's head. .~7 ^ - : | PRIMARY INCISION: " i: " The "Y M incision shows a virtually non-existent panniculua and a thin pale musculature. There is no excessive fluid. The entire right pleural space is obliterated by dense fibrous adhesions. There are dense fibrous adhesions over the posterior left pleural aspect. The organs are removed en bloc for further dissection. - ___ ORGAN D E SC R IPT IO N : - V , r. Heart: The heart shows a marked hypertrophy and dilatation of the right ventricle. It weighs 380 gins.. It appears enlarged; the musculature appears pale and flabby . The coronaries are widely patent. The myocardium r 3 homogenous. The great vessels show no alteration. The valvular measure-- ments are within normal limits. There is a slight increase in the amount of fluid in the pericardial sac approximately 40 cc. of clear straw-colored / * fluid -;r:,,V %>jc Lunas: The tracheo-bronchial tree shows a gray-white.uniform mucosa The right main stem bronchus is obliterated by a granular gray-white tumor tissue, appearing desmoplastic. The tumor radiates peripherally from the hilum. The cortical or pleural area appears fibrotlc and scarified. There is a dense fibrosis of the parenchyma bilaterally. The fibrosis of the left lung is predominantly in a subpleural position# occupying the 2 cm. of lung directly beneath the pleura. There are numerous small dilated cystic-appearin alveolar spaces present. Distal to the tumor on the right or in. the right lu (continued) _________________ - : ' PALM HARBOR GENERAL HOSPITAL 12860 Palm Street Garden Grove. California PATHOLOGICAL REPORT Name- RILEY- JANES -W. DoctorSpecimen. KAY, Preoperative Diagnosia. -Hosp. No- -Path. N o. }* w aa: nPGAW -nWPGflTPTKVN (eon frirw ued)- i is a dense fibrosis and an inflammatory processes representing Multiple" ' ' abscesses, dilated bronchi and one area of a relatively wall healed fibro- caseous granuloma of the lung; otherwise the material does not appear: acid.: fast in origin but an acute inflammatory processes secondary to obstruction from the tumor itself. The right lung weighs 600 gins.. The left weighs . 700 gas.. .rCi'Ssi Livert The liver weighs 1200 gas.; it is red-brown, slightly pale. The capsule is thin; the cut surface has a characteristic nutgegglng. The biliary tree and gallbladder are not remarkable. Pancreas The usual pale-tan lobular architecture is present through out. The pancreatic duct id patent. Spleen The spleen weighs 500 gas. and shows a wrinkled, red-purple copula with vascular congestion on section. The lymph nodes and bone marrow are not remarkable. G-I System: The esophageal mucosa is gray-white; the stomach mucosa shows a flattened, atrophic appearing mucosa. The small and large bowel are not remarkable. There are areas just beyond the pylorus in the firsts portion of the duodenum that appear symmetrical. One represents a tenting * of the mucosa and muscularis due to previous scarification and on sectionf shows a fibrosis of the mucosa and muscular coat, on the opposite aspect > is the same tenting defect with the same submucosal fibrosis incident to a previous ulceration. There is a 1 cm. penetrating active peptic ulceration on the lesser curvature of the prepyloric region of the stomach. The small and large bowel sure not remarkable. Endocrine crlands The adrenals are small, light yellow and atrophic. The pitiutary is not examined. s G-U System The kidneys are equal in size and shape. The capsules strip with ease. There is a finely granular cortex; there is a good cortlco-medull demarcation. The pelves, ureters and urinary bladder are not remarkable'/ {C ontinued} R n JiishsrrA* M D P n th n ^ L 'l- * . rPALM C HARBOR GENERAL HOSPITAL 12860 Palm Str*t Garden Grove. California PATHOLOGICAL REPORT ? i- -fei - i'i'S&vfe - "-,,'S%!''"j: > e a , * r ! ^ . . * a. .. ;Z'ssf ' Name. Doctor__ Specimen- RlIgT,- JAMES W^- JM c -- MflKAY Preoperative Diagnosis____ nwn&w nvgppTPTTnKT -Hosp. N o-- C 6 7 7 3 ____D ate, .Path. No.. 4 / 3 4 / 6 k-t*v^fi -WL-a. 'vuz * A.1 -V / 3?> The prostate is i m and well circumscribed* Central Nervous system; Not examined. MICROSCOPIC EXAMINATION; ' " 'TS^SSSr':* Lung; The sections o lung show a dense fibrosis and a homogenous^ escar over the plerual surface. There is an emphysema and passive congest! of the lung. There are portions containing undifferentiated squamous careIn oma with central zones of necrosis. Adrenal; There is a depletion of lipochrome and a peri-adrenal fibres Heart; There is an interstitial edema. The nuclei vary in size and shape and staining quality. There is a prominent interticulated disc. Spleent There is a fibrovascular congestion. Pancreas; a dilatation Lung ; tion of lung The usual lobular architecture is well maintained. of the ductal structures. There is a marked abscess formation with extensive parenchyma. There is - \ -r- daatrue- ; Kidneys tubules. Liver: a submucosal There is a congestion and fibrosis about the collecting There is a central lobular congestion, fibrosis involving the muscular coat. Duodenums .. ' There 5 '< ***** is Lund; There is a fibro--granulomatous process represented with - characteristic asbestos fragments present in the center. The acid fast control shows characteristic acid fast organisms while the -;.t acid fast stains of lung tissue show characteristic acid fast organism i n ^ v addition to the asbeatosis previously described. / M HARBOR GENERAL HOSPITA 12860 Palm Street Garden Grove, California PATHOLOGICAL REPORT Name- -RTTgV, -JAMES Doctor. Specimen. igtXKi, - XS---- 4 ---- ST Preoperative Diagnosi. Hosp. No.. r- RRils cr^. Iichordr; M .D ., PQthologi3& DIPLOMATE AMERICAN BOARO O f IN TE R N A I M COlClNE E a t o n M. M a c K ay, M. D. S anta A na C linic 3 0 9 WEST EIGHTH STREET SANTA ANA CALIFORNIA K m b e r l y 2 -116 6 M a rc h 11, 1961 Industrial Indem nity Company Box 2252 Term inal Annex Los A ngeles 54, Calif Re: C laim No. 57-03-11487 Claim ant :^ai^es_W Riley Emp: Lynch. A sbestos Co D ate of In j: A p r il 7, 1947 Attn: D. W. Brown C laim s D epartm ent Gentlem en: In m y re p o rt of F e b ru a ry 24, in ad v erten tly dated I960 and w hich of c o u rse should have b een 1961, I n e g le c te d to a n sw e r th e q u e stio n p o sed in y o u r le t t e r of F e b r u a r y 15, 1961 c o n c e rn in g the above m en tio n ed c a s e . You w ish ed m e to give a n a p p ro x im a te date that M r. R iley 's disability becam e perm anent. It was my opinion that his status should have been changed from tem p o rary to tal disability to perm anent to tal disability on about A ugust 15, I960. It w as a t th is tim e th a t he s ta r te d to have r a th e r s e v e r e r a d icu lar pain. He went at that tim e to see D r. J . K. Shirey when the change in h is con d itio n b e c a m e ev id en t. I f i r s t saw h im on S e p te m b e r 16, I960 and h is s ta tu s th e n w as certainly PTD. Very truly yours EM M :m m / C C fc lF IC A iE OF C-&A T H u. *(v>nuTX)i ( f ' 'C> Oi O l- AMCftia ( ( E a t o n M. M a c K ay , M. D . S anta A na C linic 3 0 W EST IOMTH S T R E E T SANTA ANA. CALIFORNIA KlMtCHkV 2*1106 October 31, 1960 Industrial Indemnity Company Box 2252 Terminal Annex Los Angeles 54, California Attention of Mr. Martin Dahl Gentlemen:* Re: Claim No. 57-03-11487 Claimant: James W . Riley Empi: LyndTAbLieaios C u. D /I: April 7, 1947 In my report of October 15, 1960 on the above-mentioned patient, I noted that he had been hospitalized on October 3. He had no further bleeding from his lungs after adm ission, and the cough with which he entered d is appeared in a couple of d ay s. His radicular pain became increasingly more severe during his hospital stay and it was impossible to control it with narcotics. Since he received considerable relief by hyperextending his back ewer a pillow, I had him fitted with a Taylor brace for some hyperextension. He has obtained excellent relief from this d ev ice. The sedimentation rate of his blood increased steadily throughout his hospital stay, and has reached a high level. In the absence of any active inflamma tion in his lungs or elsew here, this finding does not augur w ell for his future. In my report of 15 October, 1960 I suggested that you might wish a biopsy of one of the vertebrae which had undergone compression fracture. You indicated by telephone that this was desired. I discussed the question of a biopsy with the patient, and he said unless I could honestly te ll him that it would contribute to his getting w ell, he pre ferred to not have the operation carried out. I acceded to his w ishes. This patient w ill be seen in the office once or twice a w eek, and I will keep you informed in regard to his progress. Verv truly yours, EMM emc ( di plomate AMERICAN VOARO O f INTERNAI MEDICINE c E a t o n M. M a c K ay, M. D. S a nta A na C linic 3 0 9 WEST EIONTH STR EE T SANTA ANA, CALIFORNIA KImscnuT 2-116 Industrial Indemnity C o. Box 2252, Terminal Annex Los Angeles. 54, California Attention of D. W . Brown, Claims Supervisor Gentlemen: Re: Claim # 57-03-11487 James W . Riley Empi: Lynch Asbestos Co. D /I: April 7, 1947 I examined the above-mentioned patient on 16 September 1960. I w ill not review at this time his history of pulmonary asbestosis and a pneumoconiosis presumably due to diatomaceous earth inhalation and the removal of the lower lobe of his right lung about 14 months ago because of the presence of a broncho genic carcinoma. When I examined Mr. Riley on September 16, he was complaining of excruciating pain of a radicular nature commencing in the middle of the dorsal spine and ' following around the expected distribution of the T7 nerve root. For a tim e, the pain was felt mostly on the right, following both sides of the incision scar usee to carry out the lobectomy. When I saw him, he had about the same amount of pain on both sid es. The pain is worse when he lies down at night, and he often has to get up and walk around. There is no relation of his pain to respiratory movements. He has no cough, and consequently, there is no sputum. A change in his narcotic medication controlled the pain somewhat, but this was only for a short time. On September 19, the nerve root on the right side was injected with local anesthetic with some degree of su c ce ss, but this block lasted only about fifteen hours. His recent X-rays showed compression fractures of T7 and T8 vertebrae. It seems certain that this is the origin of the pain, which he is hardly able to tolerate. Examination of his blood showed him to be moderately anem ic, and to have a marked increase in his sedimentation rate. The white blood count was not unusual. By shifting he medication he got along fairly well although he was by no means com fortable, until October 3, when he suddenly commenced to cough up blood. This was of such a serious nature that I immediately hospitalized him in Santa Ana Doctors Hospital. * During the p ast ten d ay s, his condition has remained e sse n tia lly stationary. Sed im entation rate of his blood has gradually increased to a very high lev el. N arcotics now give only p a rtia l control of his p a in , and an effort w as made to give him re lie f with traction in the upper thorax. This was quite su cc e ssfu l, but irritated his lean , lightly covered thoracic w all too much. For the p ast four days he has been spend ing some hours each day with hyperextension of the d orsal sp in e, and this is ap p aren tly giving him d e fin ite r e lie f . I am looking in to a s u ita b le brace to co n tin u e th is for him . Ea t o n " M. Ma c K ay, M. D. ( Industrial Indemnity Co. #2. Re: Claim 57-03-11487 James W . Riley From a medical-point of view, it is rather academic as to the cause of the collapse of the two dorsal vertebrae which have compression fractures. In no instance would surgery be indicated. It is my opinion as of now, that th ese vertebrae have been invaded by a recurrence of his bronchogenic carcinoma or by another cancer from elsew here. From an industrial point of view , th is ^ differentiation might be im portant, and I w ill have a biopsy of one of the ver tebrae carried out, if you so desire. This patient has been on a down-hill course for at least two years p a st, which has been enhanced in recent m onths, and is certainly not slowed up at the present tim e. There is very little curative for scientific medicine to offer him. The most to be expected is better relief of his extreme pain. EMM cmc } 1 { ( -' > / ? '/ : Wkndlll A. Monct.vx. M.D. 2965WIUSNIRE BOULEVARD Los A n g eles S ,C a lif. DUNKIRK 3-4I2S June 12, 1957 American Motorists Insurance Company 2969 Wiltshire Boulevard Los Angeles 5, California Attention: Mr. Carlgnan Re: James Riley J. T. Thorpe Inc. Inj: 1/2/57 8l CM 6885kXOD Gentlemen: Mr. Riley vas examined in this office on June 6, 1957 The patient has, a history of having a gradual onset of increasingly severe cough in the past two to three years and in recent months of losing ten pounds in weight. He also is troubled with chronic weakness and fatigue. The cough has been productive of clear mucoid sputum. Ihe patient has been working as an insulator for thirty seven years. The patient consulted Dr. Schiff and has not worked since May 20, 1957. Dr. Schiff took x-rays and apparently felt that the findings suggested that the patient's condition was the result of inhaling dust from the insulating material at his work. According to the patient, sputum samples were taken and these are now being tested by culture and guinea pig inoculation for possible tuberculosis. The p a tie n t i s a w hite male; 57 y e a rs; m arried; a d d ress: Mf7 W. tend S tr e e t, Los Angeles 37, C a lif. T ele: Ad. 2 ^5^2. Occupation: in s u la to r . EXAMINATION Examination reveals a chronically ill-appearing 57 year old white male who appears to have lost considerable weight. The chest was resonant to percussion. A few fine scattered inspiratory rales were present over the right base. The p a tie n t was re fe rre d to Drs. Crossan and Goin where an x -ra y o f th e chest vas taken. This was re p o rte d as showing fin d in g s com patible w ith an infectious process of a tuberculous nature with cavity form ation. The p a tie n t vas re fe rre d to Dr. Dean S c o fie ld f o r exam ination and for h is opinion. Tt wo.il.-i seem th a t i f th e c o n d itio n i s tu b e rc u lo s is , i t i s no t r e la te d to t t -2- Re: James R iley 81 CM 6885UXOD June 12, 1957 any in d u s tr ia l a ccid en t o r d is e a s e . The presence o f a c a v ity would suggest t h a t i t probably i s tu b e rc u lo s is . The d iag n o sis would be confirmed i f p o sitiv e cu ltu res are obtained. ^ Very tru ly yours, JAMtCSH John. A. Morgan, M. D. 6 1 ( I Lovell S.Coin.M b. John Crojsci. M. D. ( t L>r5.Cro55an & Goin 658 South W estlake L oj A ngeles 57 June 6 , 1957 .... : *1c ' r\ ^ ' s# 0. f HroldP. M.D Henry C.Croiiar, M.b. John A. Morgan, M. D. 2965 K ils h ire boulevard Los Angelas 57, C a lifo rn ia ~ American M o to r ists Insurance Company Xe: m T , Mr. J e m s bop: J. T. Thorpe, Inc. In ji 5-20-37 ?11a <13154 Osar D octor Morgan: / Itoanigcnologlcal exam ination c f tha c h s s t shows an in c re a se in danarty of the r ig h t lung in die sabclaviculux region which i s o i non-hooogGnoua p a tte r n . These a re strand-Li' shadows, extend ing downward and inward to the r ig h t h i l a r r a tio n . These i a a n o d erata iy ia rg a rin g -sh ap ed shadow w ith sm all a re a s o f r e la tiv e traaslu csn cy invoiviny tfcv r ig h t ju b c lu v ic u la r re g io n . COliCV JS 103: F ro t a ro en tg en o lo g ical stan d p o in t th e fin d in g s a re com patible with an in fe c tio u s process o f a tubareulcua n a tu re which is euo-scute or chronic in character w ith cavity form ation. We a rc sending th e o r ig in a l roentgenograms and a copy o f th is re p o rt to S ecto r Dean S cofield as you re q u ested . Very truly yours d o c t H ' FIRST R E P O R T O F ifyri - W & .H - ' INJURY ;r Failure to le a report with the Division is a misdemeanor. (Labor Code, Sections 6407-6413.) Im m ediately after first examination mail one copy directly to the Division of Labor Statistics and Research, P.O. Box 963, San Francisco. / and tw o comae to *- Answer all questions fully. AMERICAN MOTORISTS INSURANCE COMPANY J a m bs s . Ke m p e r , chairman aeSB W1LSHIRE BOULEVARD LOS ANSELES S. CALIFORNIA &LCM6S54 XOD HOMI o m e t HUtlOAM AT LAWRKNCK ^ CHICAOO 40 - 1. EMPLOYER............................. .................................. --------..----- -------------------- 2. Address 'v c itjj'------------------------------------------- ------- ------------- ----------------- 2j. _ CUSinCS<> ( M a m t u a u rnenagdmcbiotca,tnb'u*i tdini eoa* ciotta, ................................. ~.............................. Im tUMtWvMill#e 4. EMPLOYEE .....IAMES.-.V/.....RILEI____ _______________________ 5. Address $ c i )' ---------------------------------------------------------------------------------------------------------- 7. Date injured. - . --.5.7------------- -- ........Hour--......... -- -M Date last worked____ ______ 8. Injured at ^ c!^ ) ____________ .________ _____ ___ ___________ _______ .County.______ L 9. Date of your 6rst examination.------------------- Hour..-............ i i Who engaged your services?__ 10, Name other doctors who treated employee for this injury...................................... ................................. ..Sex.. t l . A C C ID EN T OR EXPOSURE: Did employee notify employer of this injury?., of cause of injury or illness: ..Employee's sucement 12. N A TU R E A N D E X TEN T OF IN JU R Y OR DISEASE (Include all objective finding subjective complaints, f dia. no. If occupational diseaie state date of onset, occupational history, and exposure*.) ^ its/t v t t s ---^j<j`-rvvl_sv iftl`cs^ern] ^ 13. X-rays: By whom taken? (Sttc unon).. (v)<n& kJ-/' p( Treatment: r-t-o f b K -- J t- A er*J u ^ u S 6 Kind of case _______________________ ffhospitalize^ date....................... -- Estimated say.-------------- Name and address of hospital_________ __ __________ ______________ _______ ___ ,------------------------------------ Further treatment (E3"StiJ),u" CT----------------- --------------------------------------------------------------------------------------------- Estimated period of disability for: Regular w ork/?.._.!^.i|...^A i^!rr!^....irlodified work.____ __________________ Desaibe any permanent disability or disEgurement expiected (Sum non.) ------ ---------------------------- ----- --- - ............ If death ensued, give dace________________________________________________________________________________ 2 0 . R E M A R K S (Note any pre-existing injuries or diseases, need for pedal examination or laboratory tests, other pertinent nforsuaoj^.) A _ < i / i t f-f-j-r? ' fn-j ^ s ; ^ 4 L^-> *L ^ f & Z Z s a t- .i I C^i a - i r - f t r ^ Name. AL'Z<2i !,.....L lu ..E .......- .... Degre?v..'^ .iA ....f S S S & ..... ,o (Type or print) t! 1L oa> doctor r . Date ofreporti'iV.'^-`].'/..'/..l...Address F M * ) 7 n Q 1 A t=i-IA C. O O h A \so Ci^ScuL*^ r- BEFORE THE INDUSTRIAL ACCIDENT COMMISSION OF THE STS OF CALIFORNIA CASE NO. 57-LA 182-835 GRACE RILEY, by her Guardian ad Litern and Trustee, James C. Riley, Applicant, vs ORDER APPOINTING JOHNS-MANVILLE, INCORPORATED, a corporation; SOUTHERN ASBESTOS & MAGNESIA CORPORATION, a corpora tion; ASBESTOS COMPANY OF CALIFORNIA; PLANT RUBBER & ASBESTOS WORS (COMPANY); LOS ANGELES RUBBER COMPANY; MARINE ENGINEERING COM?ANY, a corporation; FIBERGLASS ENGINEERING & SUPPLY COMPANY, a corporation; ROBERT 0. LYNCH, an individual, doing business as Lynch Asbestos Company and Lynch Asbestos Company, a corporation; PLANT INSULATION COMPANY, a corpora tion; COAST INSULATION PRODUCTS, a corporation; ARMSTRONG CORK COMPANY, a corporation; J. T. THORPE, INC., a corporation; WARREN AND BAILEY; TOTMAN-MORGAN COMPANY; OWENS-CORNING FIBERGLASS COMPANY, PACIFIC COAST DIVISION; PLANT INSULATION AND THORPE COMPANY; WESTON ASBESTOS COMPANY; M. R. CARPENTER; PLANT RUBBER AND ASBESTOS WORKS; EARL 0. STICE COMPANY; UNITED CORK COMPANY; CORK INSULATION COMPANY; MUNDT CORK COMPANY; METAL CLAD INSULATION COMPANY; OIL FIELD CONSTRUCTION; E. J. BARTELLS COMPANY; ISOTHERM COMPANY; JAMAR & OLNEH COMPANY; ASBESTOS PRODUCTS COMPANY; UNITED REFRACTORY CONSTRUCTION COMPANY; PHILIP CAREY MANUFACTURING COMPANY; REESE INSULATION COMPANY; LOS ANGELES CORK COMPANY; MOUNTAIN STATE CONSTRUC T I O N COMPANY; FIBREBOARD PAPER PRODUCTS CORPORATION; PARRIFINE COMPANY, IN CORPORATED; C. R. DUTTON, C. A. LEIGHTON, WESTON FIBRE GLASS SUPPLY, LTD TRUSTEE, FINDINGS AND AWARD, AND ORDER FOR CONTRIBUTION LOS AN3SLES OFFICE INDUSTRIAL ACCIDENT CQBESSieff STATE Or C.-.L!fC; FILED M G 3 1361 % % WILLI A W /VS, SECRETA.-;'/ ( a corporation; AMERICAN MOTORISTS INSURANCE COMPANY, a corporation; ZURICH INSURANCE COMPANY, a cor poration; PACIFIC EMPLOYERS INSUR ANCE COMPANY, a corporation; STATE COMPENSATION INSURANCE FUND; THE UNITED PACIFIC INSURANCE COMPANY, a corporation; STANDARD ACCIDENT INSURANCE COMPANY; a corporation; GENERAL ACCIDENT, FIRE & LIFE INSURANCE CORPORATION, a corporation; NATIONAL AUTOMOBILE AND CASUALTY COMPANY, a corporation; LIBERTY MUTUAL INSURANCE COMPANY, a corporation, Defendants. Hays, McLaughlin and Evans, by John F. McLaughlin, applicant's attorneys Spray, Gould and Bowers, by David B. Allen, attorneys for Guarantee Insurance Co. Herlihy and Herlihy, by George Thompson, attorneys for Industrial Indemnity Co., Fireman's Fund Insurance Company, Argonaut Insurance Company, and Employers Liability. Assurance Corp. of London, England Clopton and Penny, by Robert M. Penny, attorneys for Pacific En&oyers Insurance co. Weingand, Tipton, Kendig and Stockwell, by Claude weingand, attorneys for United Pacific Insurance Company, General Accident Insurance Corporation and Associated Indemnity Co. Brobeck, Phelger and Harrison, by Rinaldi Sclaroni, Jr., attorneys for Plant Rubber & Asbestos Works, self-insured, and Fibreboard Paper Products Corporation, formerly known as The Parrifine Company, Inc., also formerly known as Pabco Products, Inc., self-insured Jo sep h B ilc h a k , re p re s e n tin g The T ra v e le rs In s u ra n c e Company Ray Cusick, attorney for Standard. Accident Insurance Company F. E. Carignan, representing American Motorists Insurance Company McCaskey and Licker, by Robert Licker, attorneys for National Automobile and Casualty Co. George R. Haswell, by George C. Shelton. Jr.. ( IT IS ORDERED that James C. Riley be and he is hereby appointed Trustee for Grace Riley, to serve without bond. An Application for the statutory death benefit having been filed herein and the defendants under prior Findings and Award having filed their Request for the Joinder of additional employers and insurance carriers, together with Petition for V apportionment and Contribution, and the matters having been regularly heard and submitted for decision, GEORGE A. MARTINELLI, Referee, makes his Findings and Award for the statutory death benefit and Order for Contribution as follows: FINDINGS OF FACT 1. James Whitcomb Riley, bora October 23 1899, while employed as an insulator by various employers in the State of California, commencing in the month of January, 1920 and continuing through May 19# 1957* sustained injury arising out of and occurring in the course of his employment as follows: In the performance of his occupational duties, the employee oas exposed during each and every day of his employment to deleterious dusts which caused a pneumoconiosis with superimposed tuberculosis, rendering the employee totally disabled on May 19, 1957* 2. Findings and Award issued in the employee's favor on November 27> 1959 imposing liability for said disability unon ~^ ( 4. Said employee died January 24, 19 6 1. Said death was proximately the result of the industrial injury herein. 5. Deceased left surviving him, totally dependent, Grace Riley, his widow, who is entitled to the statutory death benefit in the sum of $10,000,00, payable at the rate of $40.00 per week beginning January 25* 1961; together with the burial expense in the sum of $400.00, " 6 . -It is-to. the best interests--of-the- applicant : ~ herein that the death benefit be commuted and paid in a lump sum. 7* The total value of the claim herein is the sum of $25*720.07, comprised of the following items: a) For temporary total disability indemnity, $ 7,680.00; b) For medical treatment, $4,592.76; c) The commuted value of the death benefit, $9,326.76; d) Reimbursement for burial expense, $400.00; e) Reimbursement for self-procured medical treatment, $233.00; f) Lien claim of Veterans Administration for medical treatment, $3*487.55. 8 . Industrial Indemnity Company, a corporation, one of the defendants held liable under the original Findings and Award is liable for the payment of the entire Award herein. 9 . Indemnity for all periods of temporary dis ability has been paid and all medical treatment furnished by Industrial Indemnity Company, a corporation, except as hereinafter noted; 12, The Travelers Insurance Company, a c is entitled to a lien against unpaid compensation in the sum of $200. 0 0 . 13. Veterans Administration is entitled in the sum of $3,487.55 payable by Industrial indemnity Company, a corporation. 14. The industrial injury and death herein were the result of exposure to deleterious dusts over a continuous period of time and proximately caused by employments other than that for which Industrial Indemnity Company, a corporation, was the carrier. The liability of those known employers and insurance carriers based upon periods of exposure is as follows: Plant Rubber and Asbestos $ Works (Company) Associated Indemnity Co. United Pacific Insurance Co. General Accident, Fire & Life Insurance Co. National Automobile & Casualty Co. American Motorists Insurance Co. Guarantee Insurance Co. Liberty Mutual Insurance Co. Standard Accident Insurance Co. State Compensation Insurance Fund Argonaut Insurance Co, The Travelers Insurance Co, Employers Liability Assurance Corporation, Ltd. of London, England Aetna Casualty & Surety Co, Fireman's Fund Indemnity Co. (Industrial Indemnity Co, Pacific Employers Insurance Co. 6 ,0 6 1 .8 1 81.85 842.05 51.26 84.47 1,473.37 651.77 441.09 219.31 1,085.58 733.59 1,324.91 1,481.54 1,530.59 2,374.97 2,7 0 5 .28) T o t a l ................... $ 25,720.07 whose 15. There are employers and insurance carriers ** --*---J1-- J f Riley, Trustee, the sum of $13,447.31, payable forthwith, together with interest as provided by lavj; less $750.00 payable to Kays, McLaughlin and Evans, as attorneys' fees; less $200.00 payable to The Travelers Insurance Company, a corporation, and less the sum of $3,487.55 payable directly to Veterans Administration. ORDER FOR CONTRIBUTION IT IS ORDERED that the employers or carriers listed below pay to Industrial Indemnity Company, a corporation, the following amounts forthwith: Plant Rubber and Asbestos works (Company) Associated Indemnity Co. $ 6,06l.8l 81.85 United Pacific Insurance Co. General Accident, Fire & Life Insurance Co. 842.05 51.26 National Automobile & Casualty Co. 84.47 American Motorists Insurance Co. Guarantee insurance Co. 1,473.37 6 5 1 .7 7 Liberty Mutual Insurance Co. 441,09 Standard Accident Insurance Co. 219.31 State Compensation Insurance Fund 1,085.58 Argonaut Insurance Co, 733.59 The Travelers Insurance Co. Employers Liability Assurance Corporation, Ltd. of London, England 1,324.91 1,481.54 PARTIES SERVED: 8-3-61 nn; Grace R'iley, 1596 West Juno Avenue,, Apartment 1, Anaheim, Calif, James C. Riley, 1596 West .Juno A.venue, Apartment 1, Anaheim, Cjlif. Veterans Administration, 5701 Bellflower Blvd, Long Beach Veterans Administration, 5901 East 7th Street, Long Beach Attn: A. P. Willis, Registrar Hays, McLaughlin and Evans, 6331 Hollywood Blvd, Los Angeles 28 Spray, Gould and Bowers, 1671 Wilshire Blvd., L.A. Herlihy and Herlihy, 412 W. 6th Street, L.A. 14 Clopton and Penny, 639 S. Spring St., L. A. 14 Weingand, Tipton, Kendig and Stockwell, 6ll S.Catalina, L.A. Brobeck, Phelger and Harrison, 111 Sutter St., San Francisco Joseph Bilchak, The Travelers Insurance Co. 510 W. 6 th St, L.A. Ray Cusick,. Standard Accident Ins. Co-. 548 S..Kingsley, L.A. F. E. Carignan, American Motorists Ins. Co."3545* Wilshire, L'.A'r-McCaskey and Licker, National Auto. & Cas. Co. 639 S, Spring, L.A. George Ha swell, Liberty Mutual Ins. Co. 714 S. Hill St., L.A. Petersen, wills,& Hiestand, Employers Mutual Liability Insurance Co. of Wisconsin, 3540 Wilshire Blvd, L.A. Arthur Hershenson, State Compensation Ins. Fund, Box 2134, L.A.54 Associated Indemnity Co. Box 2133* L.A. 54 Guarantee Insurance Co. 1671 Wilshire Blvd., L.A. Industrial Indemnity Co. Box 2252, L.A. 54 Fireman's Fund Insurance Co. 3440 wilshire, L.A. Argonaut Insurance Co. 1001 Wilshire Blvd, L.A. Employers Liability Assur. Corp. of London, England, 639 S. New Hampshire, L.A. Pacific Employers Insurance Co. 1033 S. Hope St., L.A. United Pacific Insurance Co. 616 S. Shatto Place, L.A. General Accident, Fire and Life Ins. Co. 3535 W. 6th St.,L.A. Plant Rubber and Asbestos Co., c/o Plant Insulation Co. 2741.S. Yates Ave., Los Angeles Fibreboard Paper Products Corp. 475 Brannon St., San Francisco 19 Phoenix Indemnity Co. 3750 W. 6 th St., L.A. Aetna Casualty & Surety Co. 810 S. Spring St., L.A. 14 Zurich Insurance Co. 4465 Wilshire, L.A. McCartney, Hall and Ryan, 639 S. Spring St., L.A. Arnold Smith, Sacramento Division of Labor Statistics, San Francisco Johns-Manville, Inc. P.O.Box 9067, Long Beach lOp Attn: Bert Gilbertson \ t i R E G I N A L D H S M A R T . M D. J O S E P H F. B O Y L E . M D. J O H N K S H 1 R E Y , M. D. M E D IC A L O f f ' C C B U IL D IN G tu w tS T S ixt h s t r e e t L O S A N G E L E S 17 M A O iS O S 5 ' 7 6 9 7 S e p te m b e r 19 1957 M r. W illiam T. Hays Attorney at Law 6331 Hollywood B oulevard Los Angeles 28, C alifornia Dear M r. Hays: RL: Jam es W hitcomb Riley The following re p o rt is sen t to you a t the re q u e st of M r. Jam e s W. R iley whom we f ir s t exam ined on June 27, 1957 w ith re g a rd to his pulm o nary condition. The following histo ry and findings w ere obtained: R esidence h is to ry : M r. R iley w as b o rn ir. Joplin, M isso u ri on O cto b er 23, 1899* He h a s liv e d in the L os A ngeles a r e a sin c e 1903 w ith the following exceptions: In 1918 he w as b rie fly in Quantico, V irginia. F ro m 1936 to 1942 he liv e d in San F r a n c is c o . In 1947 he w as in F re s n o , C alifo rn ia fo r two m onths. In 1952 he w orked in D aina, Indiana fo r six m onths. In 1955 he was in Santa M aria, C alifornia fo r fo u r m onths and in L as V egas, N evada for fo u r m onths. In 1956 his w ork re q u ire d a seven m onth stay in San Diego, C alifornia. O ccupational h isto ry : Since 1919 M r. R iley h as b een em ployed in the heat insulation industry, his work req u irin g the application of insulating m a te ria ls to b o ile rs, steam pipes and o th er stru c tu re s requiring insulation. The insulating m a te ria ls which he has w orked with include asb esto s, block, D etrick block, Kalo, rockw ool, fib er g la ss, cork and Mono block. He believes he m ay also have w orked with diatom aceous e arth occasionally as a loose pow der to be applied ag ain st b o ile rs to provide a porous m a te ria l which will allow for expansion and contraction of the b o iler due to tem p eratu re changes. The other m a te ria ls m entioned above a re supplied in various form s such as blocks, cored cylinders, sheets, and blankets. Very often it w as n e c e s sa ry to cut the blocks o r sh eets using a hand saw . It w as also n e c e ssa ry to h am m er nails through this m a te ria l to se c u re it in its proper lo catio n . Since this work was often done in confined sp aces such as boiler room s, a high dust concentration was frequently attained in poorly M r. W illiam T. Kays Re: Jam es W hitcomb Riley S eptem ber 19, 1957 ventilated a re a s . O ccasionally M r. Riley w ore a m ask when the dust concen tration becam e uncom fortable. O nset and course of p resen t illn e ss: M r. R iley considered h im self to be in good health until 3 1/2 y ears ago when he firs t becam e aw are of sh o rt ness of b re a th upon ex ertion which has slow ly p ro g re sse d . At p resen t he feels sh o rt of b reath when walking rapidly on the lev el o r when walking up an incline. A pproxim ately th ree y e ars ago, he becam e aw are of cough which has p e rsiste d to the p re sen t and is productive of 2 to 3 teaspoons of m ucoid sputum daily. There has not been hem optysis, edem a, orthopnea or paroxysm al nocturnal dyspnea. He has not been aw are of fe v e r. F o r the past sev eral m onths, he has noticed m inim al in term itten t left low er an terio r ch est pain which is not re la te d to e x e rc ise , r e s t, m eals o r position. It usually d isap p e a rs spontaneously 1 to 2 h o u rs a fte r o n set. W eight lo s s of a p p ro x im a te ly 20 pounds h as o c c u r re d d u rin g the p a s t 12 m o n th s. M r. R iley firs t becam e aw are of a definite pulm onary abnorm ality when he was recalled by the Los Angeles C ity H ealth D epartm ent a fte r having had a routine chest film in May, 1957. F u rth er exam inations w ere m ade including x -ra y and sputum te sts. A le tte r fro m J r , M o rris J. Schiff dated July 15, 1957 in d icates that sputum exam inations on 6-10-57 and 6-21-57 rev ealed a c id -fa st b acilli in the sm ea r of the concentrated sp ec i m en. The tuberculin skin test reaction was positive. The diagnosis was indicated to be far advanced, pulm onary tu b ercu lo sis, active. It was thought that pulm onary asb esto sis m ight be p re sen t. M r. Riley was next exam ined by D r. Dean S. Scofield of Los A ngeles w hose conclusion on h is r e p o rt of July 17, 1957 w as th at M r, R iley had p ulm onary tu b e rc u lo sis, rig h t, m oderate, with cavitation. Chi ef c o m p la in ts: 1) S h o rtn e ss of b re a th w ith e x e rtio n , p ro g r e s s iv e sin ce o n se t 3 1 /2 y e a r s ago. 2) P e r s is te n t cough fo r 3 y e a r s , p ro d u ctiv e of 2 to 3 te a sp o o n s of m u co id sp u tu m d a ily . 3) W eight lo s s of a p p ro x im a te ly 20 pounds during the p a st y e a r. Inve n to ry of s y ste m s : No o th e r sym ptom s w e re e lic ite d by s y ste m a tic questioxiing. P ast m edical h istory: during childhood M r. Riley had had m easles, m u m p s, c h ick e n pox, whooping cough and s c a r l e t f e v e r . None of th e se w e re severe and there w ere no com plications. A varicocele was rem oved in 1919. ( - 3- M r. W illiam T. Hays Re: Jam es W hitcomb Riley S eptem ber 19, 1957 Fam ily history: M r. R iley's m other died a t age 74 of unknown cause. His fa th e r died a t age 73 of a h e a rt a tta ck . He h as one b ro th e r and two s is te r s who a re living and w ell. His wife and th re e child ren a re living and in good health. T here is no fam ilial history of tuberculosis, diabetes, cancer or hypertension. H abits: M r. Riley sm okes one package of cig arettes daily and uses alcoholic bev erag es to a m o d erate extent but takes no re g u la r m edications. P hysical exam ination: M r. R iley was seen to be a thin w ell-developed w hite m a le who a p p e a re d c h ro n ic a lly il l . H is h e ig h t w as 69 1 /4 in c h e s; w eight, 119 pounds; te m p e ra tu re , 9 3 .6 d e g re e s; p u lse, 80 p e r m inute; re s p ira tio n s , 20 p e r m inu te; and blood p r e s s u r e , 1 2 2 /7 0 . E x am in a tio n of the chest revealed m oderate in crease in the a n tero -p o sterio r diam eter of the chest. Both pulm onary b ases lagged with deep in sp iratio n . T here w as in c re ased m uscle tension over the rig h t upper p o sterio r c h est. The lungs w ere h y p e rre so n a n t to p e rc u ssio n over the upper lobes and th e re was dim inished resonance at both b ases. B reath sounds w ere bronchovesicular over the upper tw o -th ird s and b ronchial over the b a se s. Fine crep itan t and crackling rales w ere present at all bases, anteriorly, p o steriorly and laterally . The point of m axim um cardiac im pulse was ju s t to the left of the xiphoid p r o c e s s . No th r ill w as p a lp a b le . A sin u s m e c h a n is m p re v a ile d and the h eart tones w ere distinct at the apex and distant a t the b ase. No m u rm u rs w ere h eard and the pulm onic second sound was slightly louder than the ao rtic second sound. T here was erythem a and induration of approxim ately 2 cm . d iam eter on the rig h t fo re a rm which M r. R iley stated w as the re sid u al of a recently ad m inistered skin te st. The rem ain d er of physical findings w ere all within the range of n o rm al. F lu o ro sco p ic exam ination of the ch est: An in filtra tio n w ith p o ssib le cavitation was noted in the right apex and subapex. L inear fib ro sis was p re sent in the low er half of both lungs. The diaphragm s m oved approxim ately 3 to 4 cm . and equally. In the la te ra l p ro jectio n they w ere noted to be fla t. Although the h e a rt was not totally enlarged, the rig h t v en tricle appeared prom inent in the left a n terio r oblique projection. L aboratory evaluation: 6 -2 7 -5 7 - B lood count: Kgb. 927o o r 1 3 .5 g m s . WBC 9 ,5 0 0 . P la te le ts average. D ifferential - Eo. 4. Pm n. 54, Seg. 50. Lymph. 39. Mono. 7. M orphology n o rm a l. H em ato c rit 46 m m . in one h o u r. S edim entation ra te (W introbe) 31 m m . in one h o u r. C o rre c te d 29 m m . in one h o u r. M r. W illiam T, Hays Re: Jam es W hitcomb Riley S ep tem b er 19, 1957 6-27-57 - U rinalysis: M orning, straw , clear, specific gravity, 1.011. N egative for album in and su g ar. M icroscopic - 0 to 1 w hite blood cell per high power field. Sm all am ount m ucus. R are epithelial. Few b a c te ria . 6- 27-57 - Intraderm al skin tests: Coccidioidin - negative. H isto- plasm in - negative, 7- 2-57 - (C linical L aboratory ofC. R ichard Smith, M. D .) - Sputum specim en, 3 cc. m ucoid m aterial: W etmount fo r asb esto s bodies: N egative. There is one larg e m ass of elastic tissu e showing alveolar form ation. There a re hyaline - glassy - straig h t fib res 3-5 m icrons in diam eter and 1/8 - 1/2 of an oil im m ersio n field in length. They r e s is t the action of acid. F lo tatio n -co n cen tratio n fo r a c id -fa st b acilli: N egative. GRAM STAIN shows larg e num bers of g ram positive cocci in c lu sters and in chains; gram positive diplococci and large gram positive ro d s. There are de- g en erated pus cells and a few ep ith elial c e lls. A cid -fast stain on the elastic tissu e revealed no a c id -fa st bacilli although som e of the m a te ria l was lost in tran sfer. 7-2-57 - Sputum specim en 3 cc. m ucoid m aterial (C linical L aboratory of C. R ic h a rd Sm ith, M. D .): S u p p lem en tary re p o rt on stu d ies fo r a sb e sto sis bodies. The rem aining sodium hydroxide sedim ent was tre a ted with chlorox and centrifuged at high speed. The resu ltan t sedim ent and wetmount revealed three com pletely ch aracteristic asbestosis bodies. These bodies give the P ru ssio n blue stain reactio n . 7 -2 -5 7 - 3 day sputum and g a s tr ic contents 40 cc. cloudy flu id co n taining ap p ro x im ately 20 cc. m ucop u ru len t (C linical L a b o ra to ry of C. \ R ich ard Sm ith, M. D .): C u ltu re fo r M, tu b e rc u lo sis - s e v e ra l hundred 'sphotochrom ogenic colonies of a c id -fa s t b a c illi (We do not b elieve th ese a re M. tu b e rc u lo sis. They a re s im ila r to a m y co -b acteriu m capable of causing hum an d ise a se . The guinea pig re s u lts w ill help to c la rify the identificatio n . M eanwhile o th er te sts w ill be c a rrie d out. Guinea pig inoculation fo r M. tu b ercu lo sis: N egative. (See attached le tte r) 7-2-57 - C ulture from g astric-sp u tu m specim en: Screening J S e n sitiv ity te s t: S tre p to m y c in - 99 8/10'7o of th e o rg a n is m s a r e s e n s itiv e (Z/10 /o a r e r e s is ta n t) to 10 m e g . of s tre p to m y c in p e r m l. P a r a - a m in o s a lic y lic acid: 100 p e r c en t of the o rg a n is m s a r e r e s i s t a n t to 10 m eg . of p a ra -a m in o sa lic y lic acid p er m l. Isoniazid: 95 p er cen t of the o rg anism s are se n sitiv e (5 per cent arc r e s is ta n t) to 2 m eg . of is o n ia z id p e r m l. ( - 5 - M r. W illiam T. Kays Re: Jam es W hitcomb Riley S eptem ber 19, 1957 7-10-57 - (C linical L aboratory of C. R ichard Sm ith, M. D .) 72 h r. sputum sp ecim en 25 cc. se ro -m u c o p u ru le n t: F lo ta tio n -c o n c e n tra tio n fo r a c id -fa s t b a cilli: 2 plus positive (20 to slid e). C u ltu re fo r M. tu b e rc u lo sis; Several hundred colonies of photochrom ogenic acid -fast b acilli. These a re not M. tu b ercu lo sis but they a re c h a ra c te ris tic of a m y co -b acteriu m capable of causing human disease. iti D ia g n o sis: 1) P u lm o n a ry f ib r o s is ex hibiting th e p rin c ip a l fe a tu r e s of asb esto sis although contributing effects from the inhalation of silica, m agnesium , fib erg lass, foam glass, rockwool, and possibly diatom aceous e a r th m u s t be c o n s id e re d . 2) P u lm o n a ry e m p h y se m a of m ild to m o d e ra te s e v e rity and s e c o n d a ry to p u lm o n ary f ib r o s is . 3) P u lm o n a ry in fla m m a to ry disease involving the apex and subapex of the rig h t lung. P relim in ary studies indicate that this process is due to a non-tuberculous photochrom o genic a cid -fast bacillus which m ay produce a disease quite sim ila r to tu b e r culosis in its clinical m anifestations and chronicity. D egree of d isab ility : M r. R iley is p erm an en tly and to ta lly d isab led fo r the type of w ork which he has done since 1919. At p resen t he is totally disabled fo r any type of physical activity pending control of the pulm onary inflam m atory disease. P rognosis: Pulm onary fib ro sis of this type tends to be p ro g ressiv e while dust exposure continues, as the s e ria l chest x -ra y s have d em o n strated in this c a se . P ro g re ssio n is also apt to occur in the p resen ce of su p e r im p o sed chro n ic pulm onary in flam m a to ry d is e a s e . A dequate tre a tm e n t of the infectious p ro cess with m odern drugs m ay m odify the fib ro tic reactio n , but the n a tu re and deg ree of this influence is not p red ic tab le owing to the relativ ely sh o rt period that this fo rm of treatm en t has been u sed in the presence of com bined pulm onary d isease. Recom m endations for treatm ent: M r. Riley req u ires sanatorium care with b ed re st and appropriate chem otherapy. P relim in ary studies by D r. C. R ichard Sm ith's lab o rato ry indicate that Streptom ycin and Isoniazid a re the m ost effective of the drugs te ste d fo r the tre a tm e n t of the in flam m atory disease. Physical exam ination and x -ra y study of the chest at $ periodic in te rv a ls w ill be n e c e ssa ry to evaluate the resp o n se of the in fla m m a to ry d isea se and to d etect any p ro g re s sio n of fib r o s is . C om plete pulm onary function studies should be repeated in approxim ately one year. In the event p ro g ressio n of fib ro sis is d em onstrated, co n sid eratio n of m ore ( ( . 6- M r. W illiam T. Kays Re: Jam es W hitcomb R iley S ep tem b er 19, 1957 agressive therapy such as interm ittent positive p ressu re breathing and stero id m edication m ay be n ecessary provided the inflam m atory disease is under sufficient co n tro l to p e rm it such th erap y . R elationship of p atien t's condition to em ploym ent: M r. R iley 's occupation fo r the la s t 35 y e a rs has been confined to the application of heat insulation m a te ria ls. There has been no other source of in dustrial dust exposure. The x -ra y film s show pulm onary fib ro sis of a p attern which is m ore suggestive of asb esto sis than any other single entity. A sbestos bodies have been reco v ered from the sputum . T here is no clin ical evidence of b ro n c h ie c ta sis no r of chronic p assiv e congestion of the lungs due to left v e n tric u la r fa ilu re . In m y opinion, M r. R iley has pulm onary fib ro sis of occupational o rig in . The p re se n c e of pulm onary fib ro sis m ay have been a significant factor in the developm ent of pulm onary inflam m atory disease and its subsequent course. If I m ay am plify o r c la rify any of the preced in g s ta te m e n ts , it w ill be m y p riv ile g e to do so. Yours very truly, JK S:ark Enc s. *