Document g6BR6Q6ypRm5gKEQ1oMKwzdq

FILE NAME: Fibreboard (FIB) DATE: 1963 Apr 23 DOC#: FIB001 DOCUMENT DESCRIPTION: Medical Exam Report ii ii ii ir ii ii ii ii i * i i ii' i / ' mf*~r ~* in' ' * U W U; iflM COM, M.l. UOK ICYIS. M .t. sauxei'Niuti.N.i. y m i i v < c u f m c r ,' ` ' * " i m u < r y cm o M n ' ' TU|*4 t-THI rt**r4l HIOfClNC April 23, 15$) Hanna and Brophy I5**0 San Pablo Avenue Oakland 12, Callfornta Attention; Mr. Ivan A. Schwab Ae: MEYCA, Mr. fdward vi Plant Rubber and Asbestos Vorks, at 1 * IAC Claim Humber; Sf l9q . H l ________ . Gentlemen; !K!oZsipotnt!b?lr. WiH!ai*I?ti,ra ,*L58rfyear old mayl?ew,r mraerrwie*dt, witthhet*woaUdualntd rcohilMdermeonri.al `- CHPICYHChT HI STCAY: Plant *`'bb r *"* Asbestos Verks, asbestos Insulation worker, five or tlx y e a n to March 1962. During 21 y e a n he worked for nine different employers. aL a v s molds th* M m e tyP*-#f **>% covering pipes end boilers with asbestos * t molds. The material used was c a n e d &>* magnesium pipe covering.* PHYSICIANS: * . . ' , , i : !: M-1,! * K- e- " HQSPITALI2ATIQM: * * . . sSa!nn\Lerain!d^r!o *Me,mto*r1i!al?*uHoslpTitadlr,e 'Ap*r*irlch15", 19,6936,2*tofortheT pdr*eys*eintA.pril 16 . 21, I9$2. fAHILY HISTflltri i U i 60 of <*n r f t * liver. One' s nii;. ill I35 ! r.V llffke |#*ftolheP " * ' " 5 brother has back trouble. Two . I1 a wV?!1, M r * Hc*r * ,f chronic pancreatic Insufficiency. His *7? * d"I* children are **lf. There are no other Instances of cancer In the family other than hit mother. There Is no family history of diabetes or tuberculosis. PCASOHAL HISTORY . . i o 'th^ilv**! J?!5, Kow K,veft* Connecticut, Hit family moved to the Bay Area durlnS M s childhood, and he has lived here ever since. He a* m t,. .. IXU IH M .M . MON tCIIS. N.I. mtoox MIX. M . t At: MCYCA, Hr. tdward ( April 23. 1963 : Xi j i 2. * % ` completed the M r i t year of high school. There was no military service. He limited the use of tobacco to about one package of cigarettes dally for many years. Alcohol was used In moderation. Hr. Heyer has been certified for Social Security benefits on the basts of disability. PAST HCDICAl HISTORY; He recalls no significant past Illnesses. In 1952 there was a head Injury with shuII fracture while he was Installing Insulation In Ibhe bottom of a ship and a ballast weight dropped on M s head. In 195? craniotomy was performed for removal of subdural hematoma due to the Injury five years previously. (V, I. Allen, H. 6.) During the Interval between head Injury and craniotomy ha ' developed post-traumatfc epilepsy, and Oltantln therapy was Instituted. Ha has cpntInuetf"the use of this drug to data, although he has had no recurrence slnca operation. On occasions he sees Dr. 1. Lawrence for follow-up of his cerebral Injury. Appendectomy was performed (data not recalled). Ha developed a post-appendectomy fistula and required secondary repair. He was once thought to have ulcerative colitis/ In 1958 or 1959 he was hospitalised at Providence Hospital with the diagnosis of pneumonia. . SYSTCHIC KCVICVS ' ' - . Hr. Heyer 1s too distressed to Interrogate In detail. Ha has suffered from constipation recently, possibly resulting from medication. His principal symptoms are Indicated by the Chief Complaints. CHICf CQHPIAIHTS: ' 1. Persistent chronic cough, productive of whitish expectoratIon, of several years' duration, 2. Increasingly severe cough since Harch 1962. * 3. Progressive shortness af breath. b, Acute episode of shortness of breath four days ago. - HISTORY Of THE PftESCHT IlltfSS: . On April 19. 19^3. Hr. Heyer entered San Leandro Homorla! Hospital on the advice of Dr. Robert Adams, because of acuta dyspnea, cough and fever. On April lb he w.u chiliad when ha was caught In the rain. Me developed an acuta respiratory Infection, and became very dyspnele the following day. Or. Hardy Suggested that he use a steam tent at home, but his cough became worse, more productive, end the temporeture rose to 103* f. On April 19 hi* chest became quite painful, and ha was ordered to the hospital, Sf ~ > UOUtfli. M.l. : SKCIIOK KiH(CK. M.i. Ae: KCYCR. Mr. Cdwerd April 13, 1963 9. . for approximately three year* prior to thoracotcrny In April 1962. Mr. Heyer had noted progrettlve thortneti of breeth. This became very much vorte before hit hospitalIxatlon a year ago. In April 1962 Or. K. Hardy performed a thoracotomy for blopty of the lung. Hr. Heyer tayt that "they got * *wmor on . Hr Hcver atcrlbot the thortnes* of breath to a tumor and damage to the lung duo to^lnhalatlon of atbettot. During the 21 year* he hat worked "Ith ibettot Inflation, he hat worked without respiratory protective * ~ * at timet In tltuatlont where contlderable dutt wet gerfcrated, and at timet where ventilation prevented dutt accumulation. He tales worker* with whom he hat been aisoclated have worn metkt or other protectl device!. * Since surgeryln I9.'2 Mr. Meyer hat been totally dltabled. He hat been ...bt. w i k -or. th.i. . n r *'< <' * < * r ^ " * thortnett of breath. He hat spent the time at Me"* He T jirlellansan of radioactive cobalt treatments, under the tupervltlon of 0 r J f**1*}1!" * * This did not prove helpful. He has remained ur,6t.T the supervision of Drs. Hardy and Adams.' . ' ' PHYSICAL CXAKIKATION: . estimated weight. 170 poundt (or lest). Cttlmated height 68 pressure 1UG/96 (recorded blood pretture valuet on the hotpltal chart are a In normal range). , Hr Hever It a moderately unccvnfortable, obvloutly dytpnele white mala, of meiwoiphlc comtltutlon. well muscled and without f!^ori irel* are bilateral scars of the frontal area and one of the e f t * there It a right thoracotomy scar, and a right abdominal Incision. . Aside from th. scars and slight deprei*Ions In the are.*, 1 tS. negative, "lyes, ears, note and throat a a 1*r. There are f ssuret ^ angles of-the mouth. The tongue It smooth and pink. The palate P 7 are clear. The puth It edentulous, well compentated. . . The neck It free of palpable lymph nodot, and there are none In the aalllee. Th! thyroid gland It^not enlarged. Carotid artery pulse* are normal. Th. th.r*. I. Th. rt,h. h l . h . r . . I. . I . ; There It generallxed Impairment of resonance ''*** * ' . ^ ,, . V r o n t h e - Breath toundt are dlttant, almost absent at t a * 1 joud inspiratory vesicular to bronchial .In har.cter throvghout. * h* " ' * ' f . J the area f rales of both lung bate*, w r a marked on the right than the left. The area o Ii tI inw i n .i.iiI, i ---` mu ia r--- ---- * * m il* tOUK, K .l. 0 ltO IU YIS.M .I. : SNtlOOR K1M6CN. N .B. . * Re: M U C H . Hr. tdward April 2), 196) Page b, . ` \* ' . .) ' erdl*c dullness cannot be mede out. Heart rate end rhythm are normal. The aortic second sound It somewhat accentuated. There are no murmurs. The abdomen Is soft. There era no palpable masses. The liver Is not enlarged. The genitalia appear normal. The extremities show slight cyanosis of the fingernails. The toenails are all somewhat abnormal. Several are markedly horny and thick. Thera Is no clubbing of the fingers or toes. . . % . Hcurolootcal examination; Hr, Heyer Is a well oriented. Intelligent and cooperative man, who seems to bear his e*T>eme disability with remarkable equanimity.' HIs mannar If .. friendly, and his mood Is not remarkably deprassad. ' As tested In bed, there er# no apparent abnormalities of the nervous system. Cranial nerve exwnlnatlon Is negative. Sensory and motor function are Intact. Reflexes are physiological. . . arvirv or h c p i c a l RtrCRTS: An early radiograph of February 10, 1962. Is reported by J. D. Coate, H. 0., as showing: a soft tissue shadow protruding from the right side of the mediastinum at the level of the aortic ereh end "bilateral thickening of th# bronchoveseular shadows In both fo-er lobes, es described on previous examination April 22, 1961". Dr. Coate thought the changes In the lo-er lobes suggested pulmonary occupational disease. Biopsy specimen! from thoracotomy on April II, 962, consisted of t** places of lung, one of which consisted mostly of timer showing the microscopic character of oat cell bronchogenic carcinoma. This section, as wall as the one without tumor, showed a few asbestos bodies and variable fibrosis. AI though'the re are no reporU on /lie dlreetly from br. K. 1K*rfr- 'thoracic surgeon who performed thoracotomy, there Is a report from which Indicates that he considered Hr. Heyer permanently disabled, mainly because of his Inoperable carcinoma of tha lung . . ." which ha thought "directly connected with the esbestosll which ha developed at a result of hit employment". This view Is supported by Or. R. C. Olckenman, pathologist. In a report of Novonber 27. 191-2. Ha reviewed tha biopsy material and llstad four references dealing with pulmonary sbestotls and carcinoma. Tha articles referred so . *ere published between 1939 and 19^8 . , ; .r-- , *>* _ t I I . k I I I I I I I I . I ill! II'' m ix COKI. H.l. 0 KON UVfS.N.I. SHLDCX HmfX.K.I. , Re; m t t R . Hr. Cdward April *3. 9*3 P9 S. . e - k ------ > - - - - 11, ANNOTATED UtllOCRAPHY; * . Three of the artIclcs. referred to by Dr. Olckenman were submitted for review by Hr. James J. Vonk of the State Compensation Insurance Fund. I. Cureton, R. J. R., "Squamous Cell Carcinoma Occurring In Asbestosls of the Lung**, Drltlsh J. Cancer, ;2**9'19*^8 The author reports a cese of s 37 year old woman who worked In a factory making esbestoi pipe covers for seven years between ages 15 and 22. Sh# developed severe respiratory symptom, terminally a pleural effusion, and clinical signs suggesting neoplasm. At autopsy a bronchogenic carcinoma was found In the left lower Jobe. On histologic examination, this was considered to be a non keratinizing squamous cell carcinoma. There was also subpleurel fibrosis, thought due to asbestosls. Typical giant cells and asbestos bodies were observed. The author refers to prior observations In IJ cases of neoplasm associated with asbestosls up to I9**3. nd states that the question of relationship between the two disorders could not at that time be specified. 2. Hcmburger, f., ,fThe Coincidence of Primary Carcinoma of the lungs end Pulmonary Asbestosls: Analysis of Literature and Report of Three Cases', American J. Path.. 225797, September I9I*3 * Hcmburger reports 'at least 19 known cases" , Including the three he reported, of asbestosls associated with pulmonary carcinoma. In his laboratory there were four Instances of carcinoma In eight cases of asbestosls examined. In e tabular summary of the reported ceses, It Is Interesting to note that the duration of exposure varied from 19 months to 25 years, that there were Intervals of freedom from exposure before death for as long as 15 y*r* almost a n of the tumors were squamous or oat eell type, and that all but four of the carclncmas are Indicated as having occurred In either the right or left lower lobe. * - * " 3. Hueper, V. C., "environmental and Occupational Cancer4', U. S.-Aublle'' Health Service, Supp. 209, 19l*9. lueper reports 23 cases of ''asbestos cancer of the lung" In the American, English m d German literature since 1935. Among 92 autopsies on asbestos w r k e r s eperted by c Carman observer (Vedler), there were Ik cases of lung cancer, * In females. . _ ' Hueper states that histological character of the cancers od hlt09omtIc derivation ''support a specific causation of these reactions by Inhaled asbestos dun*. . . . * S il\..v 4 ' * y  i ___COMK. K.. .0 . 1E0M ItflJ, M.l. SKtKOK Hllit*, M.t. ' ' . ' Ae: CYEA, Hr. Edward ; April 3), 196) Pi ji 4. The following additional summaries art submitted. * elected from a U r g e number of articles reviewed: L c H . feuld. J. S., end Stewert. H . J . . "Occupational Center: ` of the'url'nery bladder In Dyestuff Operative end of the Long In MVetto* Tcictlle Workers end Iron-Ore Inert", A. . J- Clin, ^eth., 2.I2E, febrwery 1955. Thlt tudy fre* the University of Leeds, Carlisle. England, states that In 1928 one of the author* (MJS) began to c o l l e d data fror* worker In two factorle and eventually had a terlet of 80 autoplet r n g worker* **P**J to asbestos. In the lungs of 8 persons eutopsted, there were mall number of asbestos bodle. but no pulmonary asbesto!. A J**1,!f hi male and 26 female -- had esbettosl*. and among these * ** \ " 3 .. i, d developed twberculo* 1. and 12 male* end 2 female* had developed lung cancer. In other word*, a ^ g the male* 26.IX ' among the female* 8 .71 developed cancer. The average age at death we* 5b. The authors point out that "no adequate comparable post worl;m "a**f]*J fr<** persons working under factory condition* and not exposed to du*t I* available with which to compare the Incidence of lung of asbetto* dutt. the occurrence of both atbestotl* and atsoclated cancer showed a definite decline. 5. Doll, A., "Mortality fro Lung Cancer In Aibetto* Vorker*", .Bf,tv J,~ -- Indust. Hed., J^;8I, April 1955 . Coll report, th. ..... .f * . * .. <.Ur.lr.< .t employed o". *.W.to. orkl. 1."! e r ... time* In association with asbettosls. {; ' I ' <. '* . workkeid: ' t\o7rr'e:t\ !icers* .*w: ! K r .* . r . tW.ii.y amon-g them compared to to a*bclos dutt were followed up, end the morte! ty * ., e,pef|ence 122 against 7.6 expecicdTi a h sn "S eaneeT were coni i men ^ hlstotoglcelly, end all were associated with the presence of esbestosls. (Note: Underscoring by l.L.) c. . . - * auHcoxx. k .i. IfOM ItVIS. M.l. SHCUON HMH., M.l. Re: METER, H r. Cdwird April U . 190 Rage ? ..... . . -- -- i , Lynch, K. H., hdver, f . A., Cain, J. A. "Pulmonary Tumor* In Mica Exposed to Asbestos Oust," A. H. A. Arch. Indust. Health.. Ji:207, . . March 1957. . Tnese workers at the Harvard School of Public Health exposed mica to dusty atmosphere containing asbestos fibers. 127 animals, killed after 17 months' exposure, were compared to 222 controlled animals. Primary lung tumors were found In both groups: kCX of the dusted mice and }tZ of the controls. Multiple pulmonary timers were demonstrated In IOX of the dusted and 8X of tho controls. The authors were unable to establish proof of malignancy. They state they were "unable to demonstrate any proof of the carcinogenicity of asbestos under the conditions of this experiment but the Increased Incidence of multiple lung tumors In dusted animals must be regarded as a possible accentuation by the Inhalation of asbustos dust of an existing tendency to develop lung tumors". They disclaim any significant contribution of'this study to solution of the problem of relationship between asbestotls and cancer In ran. . - 7. Iraun, . C., Trean, T. 0., "An Epidemiological Study of Lung Cancer In Asbestos Miners", A. H. A. Arch, of Indust. Health, June 1958. This comprehensive article reviews the evidence for and against the associa tion of lung cancer with asbestos exposure and asbestosls. The author* polni out.that there has been a serious defect In most of the studies -* namely, that they were concerned only with the dead and not with the living workers In the esbestes Industries. In order to remedy this defect, they studied ceuses of deeth among a large segment of population In Quebec, end ettempted to relete cancer of the lung to dust exposure, duration of employment, and smoking habits. In the end they compared the death rates frew cancer of the lung for asbestos workers to that of other population group* In Quebec, according to accepted statistical methods. They stete: "The mortality rate for lung cancer as computed on the basis of 9 'pfovtd' deaths among the cohort fl. e., asbestos exposed. L. t.) was 25J per 100,000. When the 3 small 'suspoctcd' cases were added, the total 'rata' for the cohort w a s J 3 . 8." According to their findings, these authors thought the mortality rate from lung cancer did not appear to Increise with length or degree of exposure -* facts which they considered strong evidence against the carcinogenicity of asbestos. . Although there were smell variations In rate among various population groups studied, the authors state: "On the basis of what are believed to ba tompiate and reliable data, It seems fair to conclude that the m o t t o miners In the Province of Quebec do not heve a slgnHIcently higher death ^ rate from lung cancer than do comparable segment* of the general population. i ' This article does not give an account of the mineralogy of asbestos In Quebec. I The study was made possible through e grant from the Quebec Asbestos Mining . Association.. . ... a JUJL ARUM COKM. M.t. . / tfO>lfVlS.N.t. 5HU&0X HHC[X, H.l. . Re: MCTCA. Mr. Cdward April 23. 1963 Mega 8. r % - r 1. . L m - ^ . . . a .. ... - Broun ond Truon quote Coldblett nd Coldblott, who contributed section edited by t. A. A. Herewelher, the head of official Industrial hygiene for Great Britain, entitled: "Industrial CareInogenesIs and Toxicology". The Goldblatts said, with reference to asbestos, "there Is no reliable criterion by which one can anticipate carcinogenicity and, at Is well known, . relatively minute changes In the structure of a chemical carcinogen are sufficient to diminish or eliminate carclnogenct lc action...........If asbestos Is Indeed to be regarded as a carcinogen, the need Is felt to demonstrate some property vdilch can be regarded as something more than Inertness". They thought that until evidence of direct careInogenesIs was established, asbestos might be considered as a "co-carcinogen". This point Is, In our opinion, very Important, since It Is possible that known chemical carcinogens, such as those In tobacco tars, may actually be concentrated by absorption on asbestos dust and fibers. The possibility that carcinogenesis may ba abetted by asbestos seems to us to ba a fruitful approach to further i Investigation. # .. 8. Anderson, J., Campagna, f. A . , "AsbestosIs and Carcinoma of the Lung: Case Report and Review of the Literature", Arch, of environmental, * Health. h2,7, July I960. This Is another single case report of a $2 year old man who worked for 30 years as an abestos Insulator, both Inside and outsldo, In new and old buildings. He wore no protective gear at any time. In addition to asbestos, he was exposed to flbergtas. Me was a heavy smoker until five years prior to his death, having smoked "three packages of cigarettes dally for many years". The autopsy findings revealed diffuse asbestosls with typical asbestos bodies, alveolar septal thickening, and thickened pleura. There was a large tuor mass of the right hilar area which, on microscopic examination, revealed bronchogenic carcinoma, . This cesd" report Illustrates the difficulty of distinguishing the cerclnogenetic effect of other pulmonary Irritants from that of tobacco. ^ . Discussion: In an early article on asbestos hazards published by the International labor Office In 1938, criteria were proposed for the establishment of Industrial origin of cancer. It was said the following two condjtlons must be satisfied: "(I) that the Incidence-rate In the occupation under review should exceed that In the general population to significant extent and (2) that In the occupation ;concerned there Should be sufficient association of a worker with a substance e Amu cern, m.i. 0 itox UVIS. M.I. s m i n i m u c h .n .i .' Re: HCYCR, Hr. Edward April 2), W ) P#9# J . proved capertmcntel1y to hove cerclnogenotle proper!le*/' At the! time the euttior eld, ,rrheie two pottulete* cannot yet be regarded as having been fulfilled In the case of the asbestos Induitry, but there I* lufflclent evidence to warrant careful observation In the future.** In 19''), absolute not been by Braun leading. apparent 25 year* after these remark* were written. It can still be aid that proof of causal relationship between asbestos and lung cancer has established. Detailed epidemiological work, *uch a* that reported and Truan, suggests the possibility that autopsy data may be all The Increasing frequency of lung cancer among both se*es, and the correlation with use of tobacco and Inhalation of *mg, undoubtedly confuse the Issue. ^ Oesplte the absence of certain proof, however, there are several suggestiva Indications of relationship between asbestos Inhalation and lung cancer. These are: 1. The unusually high percentage of cancer deaths *ong Individuals with " proved asbestos!*. . . 2. The relatively high frequency of lung cancer In *<en asbestos worker data observed before the frequency of lung cancer In the female began to rise In the general population. * 3. The high prevalence of carcinoma of tha l o ^ r Jote, as contrasted with a mre random distribution and relatively high Incidence of upper lobe carcinoma In general. . U. The frequent occurrence of squamous and eat cell carcinoma In association with avbastosls. 5. The decline In the frequency of asbestos Is and of lung cancer among British operatives after tha Institution of dust control measures. On the belle of the established diagnosis In this case and tha admittedly disputable but generally positive evidence of correlation between esbettesi and lung cancer, It I our opinion .that Mr. Edward Meyer Is Suffering fro a disease which has as part of Its atlology occupation! eaposure- to asbestos fibers. DIAGNOSIS: - I . Pneinocontosls: Asbestos!*. . *, 2 . Oat call cercine** of the lung,-. * i . *0 II - - 1*11* (OHI. M.l. 0 * -ife* in n , m.i . 5HUDC* xmr*, m. i. . A: K T U , Kr. ( < W t f fAipgril-102*3 1563 I t Stncerely yours. i u*rk I I1 II II I -4 . I % *' 1 * * I \