Document gbOv3ge2zMXMbkV8o9pJ6Q12L

FILE NAME: Contract Unit Workers Comp Claims (WCC) DATE: 1963 DOC#: WCC036 DOCUMENT DESCRIPTION: Workers Comp File - Meyer, Edward Contains all documents found in the Claimant's file, with one blank page between each separate document - .-At A* H. FEL3CF, R f t m July 8 1463 VI. JUL10ISS3 PLATT HPBBER & ASBESTOS WORKS, et al, and CTOTSTKIAL IPIgKPITY CO., at al Clai* No. SF W - i A l ln,1: Aabaatoala REPORT OR REFEREE OF ORDE9 APPROVING COMPROMISE AND RELEASE_______ Asbestoe worker, born April 1*, 1015 claims asbestosia at the reeult of expoaureto asbestos fibers In tha eouraa of his work for varlou employers In California extending over the period^ 1437-61. It la proposed to aattla tha claim by tha payment of $20,000.00, nothing having been paid heretofore. ' : pllp^tha course*of an exploratorythoracotory performed* P* on Aprils11, 162, It vae- aaeartalnad that appllcant waa suffering froaearelnoea of tha long. Biopsies of lurgtissue also dlacloaad aabaatoala. Tha radlcal record indicates that the carcinoma law i * Inoperable-and thatappllcant la ^permanently dlaabledfor- any employment, the prognoals being extremely poor. Hla claim for has been'accepted on the baaia of total vr* K-atsa&e *ut the-record atabllahaa^thafcappllcant lu:iroffered--sri s?iS trprlor to tha filing of application - ware inter preted as strongly suggestive of pulmonary occupational disease* Thera is therefore reasonable support for one of tha asserted ' ^ reasons for settlement, namely, doubt whether tha natter la not barred by* limitations of tine. "* * / - 1 The lnduetrlal character of the carcinoma as a complication of aabaatoala finds support in the nodical, reports,,although it la not conclusively estsblished. Dr. Leon Lewis has given us a partic ularly fist* dissertation on the subjeet-iof^the possible causal- connection, reviewing the literstur e ^ ^"|heK^etiofe The doctor- statesr A V, . "....It can still be said that absolute proof causal relationship between aabaatoala and lung cancer has not been established. Detailed epidemiological work, such aa that reported by Braun and Truan, suggests the possibility that autopsy data may be misleading. The increasing frequency of lung cancer among both aexes, and the apparent correlation with use of tobacco and in halation of smog, undoubtedly confuse the issue". Applicant was a regular smoker for many years, smoking a package of cigarettes a dav. Some of the applicant's paat employment In asbestos Installation was In connection with new ship construction on board vessels lvlrg in the navigable waters. The recently decided case of Calbeek r. Travelers Ina. Co. 370 TJ.S. 114 raises a substantial question of whether the State any longer retains Jurisdiction in such cases. In still other employments applicant worked entirely with fibreglass, or with both fibreglass and asbestos materials for varying periods. At times in his aabeatoa wo-k he worked in situations where considerable dust was generated; at other times under conditions of good ventilation. The determination of which - till - - P vivivi-- EXHIBIT C fitA t i f M / l - M E S E R t .2 employment or employments could properly be held liable for the harmful exposure la not an easy one* On the record as a whole I would conclude that the settlement is fair and adequate and should be approved. Department of Deployment has filed its claim of lien for U.C.D. benefits paid to the applicant during the period Kerch 22, 1062 to Sept. 1, 162 in the total amount of $1820. ITo allocation is proposed by the parties to the satisfaction of the lien claim upon the ground that the injury caused no temporary disability, all of the disability being permanent. While I think it is evident on the record that the applicant is now totally permanently disabled, I am unable to conclude that none of the past disability was temporary in nature. It la reasonable to conclude that a condition of permanency was attained upon the discharge of the applicant from the hospital on April 21, 162, following radical determination that the lung lesion was Inoperable and Irreversible. Department of employment la therefore entitled to a lien based on the formula sanctioned by the Supreme Court In the Baird case. 28 C.C.C. Adv. * p. 77. So computed, it Is entitled to a lien of 8114.63. v *: =* \ fir**.; . .. - - nrsposincRt-:- . --.i ........... . _ '.BiP - ''fr*', ; c--.:"5 ? - ; ' at. .*. .. c. "-* ^ ^ _ Order- Approving?Compromise -and Release, sublect to H e n of $114.63 tobe, deducted andtpaldtoDepsrtrect of Employment, Ltoabe3peid,,out*ef!that ;portion of Order dlsmlaslng Wundet Cork Corp. and dba Drelsbach Box fc Lumber Co. w. Drelsbach I I I I 1 I 1 I * II II II II I * 1 1 II* < - / k t i k u m , m .i. UOKllfIJ.M.. siiuoiMiicti.M.B. * ; H i i w m u M t u t r ,* n m V C u.n o m i l-TNI April 23, 1963 * INTtanAl Hanna end trophy 15^0 Sen Pablo Avenue Oakland 12, California Attention; Mr. Ivan A. Schwab Ra: MEYER, Mr. Edward v* Plant Rubber and Asbestos Works, at al IAC Claim Number; SF I99IM___________ Cant lemon; Mr. Meyer was .examined today at your request at the San Leandro Memorial Kospltbl, Ha It a *B year old male, carried, with two adult children. EMPLOYMENT HISTORY: Plant Rubber and Asbestos Works, asbestos Insulation worker, five or six years to March 1962. During 21 years he worked for nine different employers, always performing the see type.of work, covering pipes and boilers with asbestos molds. The material used was c a n e d tsyj magnesium pipe covering.* ' PHYSICIANS; R. M. Adams, M. D.; C. Stephens., M. D.{ K. Hardy, M. D.| C. M. ChrIstlansen, M. D. (radiology therapy). HOSPITAL!2ATI0H; Doctors* Hospital, Sen Leandro, March 22, 1962, for ? days; April 10 - 21, 1962. San Leandro Memorial Hospital, April 19, I963, to the present, fAH ILY HISTORYl Father died at 66 of a "stroke'*. Mother died at 60 of cancer of the liver. One brother died at 39 of a "stroke"; another living brother has back trouble. Two sisters ere w<oll. Mr*. Meyer's wife has chronic pancreatic Insufficiency. His two adult children are well. There are no other Instances of cancer In the family other than his mother. There Is no family history of diabetes or tuberculosis. PERSONAL HISTORY hr. Meyer was born April 8, I9IS. In How Haven, Connecticut, His family moved to the Bay Area during his childhood, and he has llvod hero aver since. He e< 1KUI CCMM.M.I. OK ICVtS. N.I. SKflPOK MiRCtl. w # Re: MEYER, Hr. tdward April 23. 1963 ; N g i 2. e % completed the first year of M j h school* There was no military service. He limited the use of tobacco to about ore package of cigarettes dally for many years. Alcohol was used In moderatIon. hr. Meyer has been certified for Social Security benefits on the basis of disability. PAST MEDICAL HSTOAT! He recalls no significant past Illnesses. In 1952 there was a head Injury with skull fracture while he was Installing InsulatIon In fche bottom of a ship and a ballast weight dropped on his head. In 1957 craniotomy was performed for removal of subdural hematoma due to the Injury five years previously. (V, 8, Allen* M. 0.) During the Interval between head Injury and craniotomy he developed post-traumatic epilepsy, and Dilantin therapy was Instituted. Ha has cpnl Inued" the use of this drug to date, although he has had no recurrence Since operation. Dn occasions he sees Dr. L. Lawrence for fo1lowup of his cerebral Injury. Appendectomy was performed (date not recalled). He developed a postappendectomy fistula and required secondary repair. He was once thought to have ulcerative colitis/ In I958 or 1959 he was hospitalized at Providence Hospital with the diagnosis of pneumonia. SYSTEMIC REVICV: . Mr, Meyer Is too distressed to Interrogate In detail. He has suffered fro* constipation recently, possibly resulting from medication. KIs principal symptoms are Indicated by the Chief Complaints. CHIEP COMPLAIWTSt 1. Persistent chronic cough, productive of whitish expectoration, of several years' duration. 2. Increasingly severe cough Since March 1962. 3. Progressive shortness of breath. 4. Acute episode of shortness of reath four days ago, HISTORY nr THE PRESEWT ItlHtSS: On April 19. I9n3, Hr. Meyer entered San Leandro Memorial Hospital on the advice of Dr. Robert Adams, because of acute dyspnea, cough and fever. On .April lb he w a s chilled when he wes caught In the rain. He developed an acute respiratory Infection, and became very dyspnelc the following day. Pr. Hardy suggested that he use e steam tent at home, but his cough became worse, more productive, end the temporeture rose to 103* f. On April 19 his chest became quite painful, and ha was ordered to the hospttel. ~ ..... ' D i ii i I I i :i i i i i i i i ; i i i i i i * i i ill (CHI. K.|. MOIUVIS.M.I. SMlliOK MlldX. K.I. Re: HEYER, Hr. Edward April 13, 96) M* ) i # ' V * For appro*lmotely three years prior to a thoracotomy In April 1962, Hr. Heyer had noted progressive shortness of breath. This became very much worse before hts hospitalization a year ago. In April 1902 Dr. K . Hardy performed a thoracotomy for biopsy of the lung. Hr. heyer says that "they got a tumor on my chest". Hr. Hcycr ascrlbos the shortness of breath to a tumor and damage to the lung duo to Inhalation of asbestos. During the 21 years he has worked with asbestos Insulation, he has worked without respiratory protective devices - at times In situations where considerable dust was gerfcrated, and at times where ventilation prevented dust accumulatIon. He states that none of the workers with whom he has been associated have worn masks or othar protective devices. Since surgery In 1962 Hr. Heyer has been totally disabled. Ha has been unable to walk more than a very short distance without having very marked shortness of breath. He has spent the time at home. He received a series of radioactive cobalt treatments, under the supervision of Or. Christiansen. This did not prove helpful. He has remained under the supervision of Ors. Hardy and Adams. PHYSICAL CXAHIKATIQH; Estimated weight. 170 pounds (or less). Estimated height 68 Inches. Blood pressure Ib6/9C (recorded blood pressure values on the hospltel chart are all In normal range). Hr. Heyer Is a moderately uncomfortable, obviously dyspnelc white mala, of mesomorphic constitution, well muscled and without apparent deformity. Thera are bilateral scars of the frontal area and one of the left temporal area; there It a right thoracotomy scar, and a right abdominal Incision. . Aside from the scars and slight depressions In the areas, the crenlun Is negative. *Eycs, cars, nose and throat are clear. Thera are fissures In the angles of-the mouth. The tongue Is smooth and pink. The palate and pharynx are clear. The mouth Is ederftVtou*. well compensated. The neck Is free of palpable lymph nodes, and there are none In the axillae. The thyroid gland Is not enlarged. Carotid artery pulses are normal. The thorax Is asymmetrical. The right hemlthorax Is smatlar than the left. There Is generalized Impairment of resonanca and dullness at the right base. Breath sounds are distent, etmosi absent at the right base, and are broncho* vesicular to bronchial .In character throughout. Thera-re many loud Inspiratory rales of both lung bases, re marked on the right than the left, Tht erea of on i i ;i ii Ait IK C6XK, K.l. Q UOKUfIS. K.l. SHtlSOK Him*. K.l. ) Ra: HCttR. Hr. tdward ' April 2), 196) Page 1. *J cardiac dullness cannot be made out. Heart rate and rhythm are normal. The aortic second sound 1 somewhat accentuated. There are no murmurs. The abdomen Is soft. There are no palpabla 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. There Is no clubbing of the fingers or toes. . neurological examination; Hr. Hcyer Is a well oriented. Intelligent and cooperative man, who seems to bear his exTreme disability with remarkable equanimity.' His manner It friendly, and his mood Is not remarkably depressed. As tested In bed, there er# no apparent abnormal It les of the ncryous system. Cranial nerve examination Is negative. Sensory and motor function arc Intact. Reflexes are physiological. RCVICV Of HEP I CAL REPORTS! An early radiograph of February 10, 1962, Is reported by J. 0, Coatc, M. 0., as showing: a soft tissue shadow protruding from the right side of the mediastinum at the level of the aortic arch and "bilateral thickening of the bronchovasculer shadows In both lower lobes, as described on previous examine!Ion April 22, 1961". Or. Coat# thought the changes In the lower lobes suggested pulmonary occupational disease. Biopsy specimens fro thoracotomy on April II, 1962, consisted of two pieces . of lung, one of sdslch consisted mostly of tumor showing the microscopic character of oat call bronchogenic carcinoma. This section, as well as the one without tumor, showed a few asbestos bodies end variable fibrosis. Although there ere no report* on / lie directly from Dr. K. Hardy, tha thoracic surgeon who performed thoracotomy, there Is e report from Dr. R , H . Adams which Indicates that he considered Hr. Heyer permanently disabled, "mainly because of his Inoperable carcinoma of the lung . . which he thought "directly connected with the esbestosls which he developed as e result of hts employment". , This view Is supported by Or, R. C. Clckenmen, pathologist, In a report of November 27, t9t-2. He reviewed the biopsy materiel end listed four references dealing with pulmonary esbestosls and carcinoma. Tha articles referred to were published between 1939 and 1 9 ^ . . i _ I I . I- l . I I I 1 II II .1 1 II II II I I IN~ f'n *** * f ** rm iiM i1 - ^ < r r w iiinK**--- *-1 * 1KL1M CSHX, N.l. 1(01 If VIS, N.l. SHIIOQX MilCiX, M.t. O * ft; HttCA. Hr. Cd*ard April tj, 19*3 Page 5* .: ' . . : I 1* , ` .. . * v . * ** ' . ANNOTATED BICUOCRAPHV: * Three of the art I d e a referred to by Or. Dlckcnman were submitted for review by Hr. James J. Vonk of the State Compensation Insurance Fund. I. Cureton, ft. J. A., "Squamous Cell Carcinoma Occurring in Asbestosls of the Lung", British j. Cancer, 2**919^8. The author reports a case of e 37 year old woman who worked In a factory making asbestos pipe covers for seven years between ages IS and 22. She developed severe respiratory symptoms, terminally a pleurtl effusion, and clinical signs suggesting neoplasm. At autopsy a bronchogenic carcinoma was found In the left lower lobe. On histologic examination, this was considered to be a non* kerallnlrlng quamous cell carclncma. There was also Sub-pleural fibrosis, thought due to asbestosls. Typical giant cells and asbestos bodies were observed. The author refers to prior observations 1n >3 cases of neoplasm associated with asbestosls up to I9**3 end states that the question of relationship between the twodlsorders could not at that time be specified. 2. Komburger, F., "The Coincidence of frlmery Carcinoma of the lungs and Pulmonary Asbestosls: Analysts of Literature end Report of Three Cases'1, American J, Path., 2:737 September tjl*3. % Homburger reports "at least 13 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 a tabular summary of the reported cases, It Is Interesting to note that the duration of exposure varied from 13 months to 25 years, that there ware Intervale of freedom from exposure before death for as long as 1$ years, that almost alt of the tumors were squamous or oat celt type, and that all but four of tha carcinomas ara Indicated as having occurred in either the right or left lower I b e . 3. Hueper, V. C., "environmental and Occupational Cancer", V. S.-Aubllc'Health Service, Supp. 209, I9**9. Hueper reports 23 cases of "asbestos cancer of the lung" In the American, English and German literature since 193S Among 92 autopsies on asbestos workers reported by a Carman observer (Vedler), there were Ik cases of lung cancer, k In females. Hueper states that histological character of the cancers and hlstoganetlc derivation "support a specific causation of thesa reactions by Inhaled esbestos dust".- . , 1 STL*.: ' 7- ; ;< : I ** * 4 4. , i it. . i < i . ; i i i i <> i J-- ' -**- *---- I W i T - H H H i.. | III --- Mill '.aiucoxx. m .i. o ^ if OK UWIJ, M.l. , SHiltOK MiKfK, M .l.' Re: KCYEA Hr. Edward ; April 23, 19^3 Peg -6. The following additional summaries are submitted, as selected from a large number of articles reviewed: I*. Bonser, C. K., Fautds, J. S., and Stewart, M.*J., ''Occupational Cancer; of the Urinary Bladder In Dyestuff Operatives and of the Lung In Asbestos Textile Workers and Iron-Ore Miners", A. H. J. Clin. Path.. 2:l2i, February I95S. This study from the University of Leeds, Carlisle, England, states that In 1928 one of the authors (MJS) began to collect data from workers In two factories and eventually had a series of 80 autopsies IKong workers exposed to asbestos. In the lungs of 8 persons autopsled, there were small numbers of asbestos bodies, but no pulmonary asbestosls. A total of 72 subjects -- L6 male .and % female -* had asbestosls, and among these 12 mates and 3 females had developed tubrculos Is, and 12 males and 2 females had developed lung cancer. In other words, among the males 26.11 developed cancer, and among the females 8.71 developed cancer. The average ago at-death was $6. The authors point out that "no adequate comparable post mortem material from persons working under factory conditions and not exposed to asbestos dust Is available with which to compare the Incidence of lung cancer In asbestos workers. The Incidence here cited It very high, and Ip comparison v with the Incidence tn Iron-ore miners must be highly significant. The occurrence of occupational lung cancer In the exposed female Is noteworthy." The authors state that, following Introduction of regulations for the control of asbestos dust, the occurrence of both asbestosls and associated cancar showed a definite decline. 5. Doll, A., "Mortality from Lung Cancer In Asbestos Vorkers", Brit. J. of Indust. Med.. 12:81. April 1955. Doll reports the cause of death as determined at autopsies for 105 persons employed fl one asbestos works. Lung cancer was found In 18 Instances, 15 times In association with asbestosls. - * The following Interesting commont occurs In the summary: " 1 13 men who had worked for at least 20 years In places where they were (table to ba exposed to asbestos dust were followed up, and the mortality among them compared to that which would have been expected on the basts of the mortality experience of the whole mate population. 39 deaths occurred In the group; 15.*< were expected. The excess was entirely due to excess deaths from lung cancer ( H against O.b expected) and Irom other respIratory and cardiovascular diseases (22 against 7.6 expected). All the cases ol lung canccT were confirmed histologically, and all were associated with the presence of asbestosls.*' (Note: Underscoring by l.L.) Cw "* * * 1 73 'A, ii i i I I I AMIN COM. M.. ... UOKltlU. N.I. SKUNK H1*6U.K.. fte: MEYER, Hr. Edward April U . 1963 ** 7. i. Lynch, K. M., Hcfver, f. A., Cain, J. ft.. "Pulmonary Tumor In Mice Exposed to Asbestos Oust," A. H. A. Arch. Indust. Health.. J: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: ACX of the dusted mice and )tX of the controls. Hu!tiple pulmonary timers were demonstrated In I0X of the dusted and 8X of the controls. The authors were unable to establish proof of malignancy. They state they were "unable to demonstrate eny proof of the earclnogenlclty of asbestos under the conditions of this experiment^ but the Increased Incidence of multiple lung tumors In dusted enlmals must be regarded as a possible accentual! by tha Inhalation of asbestos dust of an existing tendency to develop lung tisnors". They disclaim any significant contribution of'thls study to solution of tha problem of reletlonshlp between asbeitosls and cancer In men. . 7. braun, b. C.. Truan. T. D., "An Epidemiological Study of lung Cancer In Asbestos Miners", A. M. A. Arch, of Indust. Health, June 1958. This comprehensive article reviews the evidence for and against the assocla* tlon of lung cancer with asbestos exposure and asbeitosls. The authors point out.that there has been a serious defect In most of tha studies namely, that they were concerned only with tha dead and not with tha living workers In the asbestos Industries. In order to remedy this defect, they studied causes of death among a large segment of population In Quebec, and attempted to relata cancer of tha lung to dust exposure, duration of employment, and smoking habits. In th# end they compared the death rates from cancer of the lung for asbestos workers to that of other population groups In Quebec, according to accepted statistical methods. They state: `T h e mortality rate for lung cancer as computed on tha basis of 9 'proved* deaths among the cohort (t. a., asbestos exposed. 1. t.) was 25J per 100,000. Vhen the 3 smalt 'suspocted* cases were added, the total 'rata' for the cohort'we$33.8." According to their findings, these authors thought the mortality rate from lung cancer did not appear to Increase with length or degree of exposure -- facts which they considered strong evidence against the carcinogenicity of asbestos. Although there were s^ll variations In rate among various population groups studied, tho authors state: "On the basis of what are believed to be complete and rel labia data, It seems fair to conclude that the asbestos miners In the Province of Quebec do not have a significantly higher death rata from lung th. J cv*p*r*hla segments of tha general population." This article does not give an account of tha mineralogy of asbestos In Quebec. The stody was made possible through a grant from tha Quebec Asbestos Mining Association,. a * r * i*U(6KK. M.l. . OXUfIS, M.l. SHUtOK HlCfK, M.l. Ao: hCYtR. Mr. Edward April 23. 1963 Faga 8. Broun and Truen quote Goldblett and Gofdbtett, who contributed section edited by . A. A. hcrcwclher, the head of official Industrial hygiene for Great Britain, entitled: "Industrial Carcinognes Is end Toxicology". The Goldblatts said, with reference to asbestos, "there Is no reliable criterion by which one can anticipate carcinogenicity and, at Is yell known, relatively minute changes In the structure of a chemical carcinogen are sufficient to diminish or eliminate carclnogenetlc action. . . . . . If asbestos Is Indeed to be regarded as a carcinogen, the need Is felt to demonstrate seme property which can be regarded as something more than Inertness". They thought that until evidence of direct carcinogenesis was established, asbestos might be considered as a "co-cdpcInogen". 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 ws to be a fruitful approach to further Investigation. 8. Anderson, J., Cempegna, F. A., "AsbestosIs and Carcinoma of the Lung: Case Report and Review of the Literature", Arch, of environmental Health. h 2 7 , July I960. * This Is another single case report of a $2 year old man who worked for 30 years as an ebestos Insulator, both Inside and outsldo. In new and eld buildings. He wore no protective 9ear at any tima. In addition to asbestos, he was exposed to flberglas. He 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 typtcal asbestos bodies, alveolar septal thickening, and thickened pleura. There was a large t m o r mass of the right htlar area switch, on microscopic examination, revealed bronchogenic carcinoma. This casd* report Illustrates the difficulty of distinguishing the cerclno* genetic affect of other pulmonary Irritants from that of tobacco. ' r . - 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 conditions must be satisfied: "(I) that the IncIdence-rete In the occupation undor review should exceed that In the general populatloa to a significant extent and (2) that In the occupation !concerned there should b sufficient association of a worker with a substance 1___I I___l \___I 1__ I \___I I -- I l J I * ' ` 4 1 4 11 -< i n ' . i- . '.. '<** n-w , -- 1. : .^.i- i ~ - i ' ' _ _ J.ANIIN Cm.HJ. ' * SHC190K MiltUJI. Re: HCYCR, Mr. Cd-ard April 2). 1963 P a g e -9. provod experimentally to have carclnogenetlc proper!ies/ ' At that time the author said, "These two postulates cannot yet be regarded as having been fulfilled In the case of the asbestos Industry, but there Is sufficient evidence to warrant careful observation fn the future/' In I9r3, 25 years after these remarks were written, ft can still be said that absolute proof of causal relationship between asbestos and lung cancer has not been established. Detailed epidemiologies I work, such as that reported by * reun end Truan, suggests the possibility that autopsy data may be mil leading. The Increasing freq uen cy of lung cancer amomg both sexes, and the apparent correlation with use of tobacco and Inhalation of smog, undoubtedly confuse the Issue. ^ Despite the absence of certain proof, ho ov er , there are several suggestive Indications of relat lonshlp between asbestos Inhalation and lung cancer. These -ere: 1. The unusually high percentage of cancer deaths among Individuals with proved asbestosls. 2. The relatively high frequency of lung cancer In wcrwsn asbestos workers * data observed before the frequency of lung cancer In the feme! began to rise In the general population. . 3. The,high prevalence of carcinoma of tha lower lobe, es contrasted with a more random distribution and ralatlvaly high Incidence of upper lobe carcinoma In general. ft. The frequent occurrence of squamous and oat cell carcinoma In association with asbestosls. $. The decline In the frequency of asbestosls and of lung cancar among British operatives after tha Institution of dust control measures. On the basts of the established diagnosis In this case and tha admittedly dlsputable.but generally pcsJtIve evidence of correlation between esbestotls and lung cancer, It Is Our opinion.hat hr. Edward heyer Is suffering from a disease which has as part of Its etiology occupational exposure- to asbestos fibers. DIACHOSIS: - . 1. Pnaianocon toils: Asbestosls. 2. Oat call carclr*M of th lung,-. I * ntix (oki.m .i 9 KOI u ru . K.l. SKfLDSI HlHil, M.l, Re: K Y C R . Hr. Cd**rd April 2), ISO f*g* -10. i JL l m imt* -* II II II I c 3. History of po*t-treumatlc epllepiy *nd late tvrglal treatment of Subdural hcjr\4torn*, Sincerely your. ll: Ik } > ' . t Mtfywp -pmv&TTn NAME |_CODE 4 p T S T MED HOSP f* s1 ^^ !___2_ 7 ! r1 1 i! X -R A Y OTHER E X P L A N A T IO N /-- - /-/ >, / / /o - , /-?,_. CK NO FROM THRU AM T. ,,2,,0 G. ~ w4r\^r^O O TOTAL RESERVE ' 1,000. ?/ < J - Le/f / ((0 L tc/a / ty/?c & CLOSED JJAi.il* r<-- p-ff _ <-J -0/ W -/<?9 - / / / )icZ/P j7J)M .-c^-P P / A `, C*J -$ /99/V/ */( t- -H-*" (aM.vh / '. V / , a : i'l n s i- d /o j t V/- c c *< 4 *L- K ,^ &' '1 ^ .jS, :.i..- ;Ki J! a-ir . -., jli. , ^ " * ' StfJV* . 4 ys * ,  ? . '-A