Document jBBmrowkVoj6eQ1DeNYRLGovN

FILE NAME: Philip Carey (PC) DATE: 1944 Nov 20 DOC#: PC007 DOCUMENT DESCRIPTION: Medical Record P-44-325 Hov. 20, 1944 (Received) Herbert C. 3cobi Age 42 P.H. Hr*. 5 Reoeived fron Dr. It. J. Ritterhoff of Hamilton County fuberouloais '` Sanatorium of Clnolnnatl, Ohio, seven sections of lung and one eaoh of heart, epleen, liver and with a green connective tleaue mixture plot ,, - even unetalned eectlone. On December 26 he eent a generoue groee ^ eample of lung and hilar lymph node tleaue for chemical, petrographio and apeotrographlo analysis. His diagnosis was asbestosle and saroold* OCCUPATIONAL HISTORY - Employed for 25 years In the pipe depart ment of the Phillip Carey Company of Cincinnati, Ohio; for the last 5 or 6 years aa foreman. Froduot, "Air Cell Paper Asbestos Pipes* using starch, sodium silicate glue and asbestos. Prooess, vet except* ./ for cutting and squaring ends of finished material. Some dust la spite v of exhaust. The hazard In the plant is probably not great as the labor turn-over is lov and many employees have worked from 8 to 30 years* Ho record that fleoble had been exposed to beryllium or fluoresoent t eubetanoes here or in any other esployment* for Cross Description: see appended protocol. Rote that the sixa--\ ' *an4 frequency of the large flbroue grey pigmented fool seems mors pro- , mlnent on groee than on microscopic examination* The lesions as in oases of uncomplicated asbestosIs, occur toward the centre of lobules * which are separated from one another by thick non-pigmented septa* How- - ever, there seems to be more fibrous replacement and lees emphysema accompanying the grey pigment than In most oases of uncomplicated - mebeetosle* The minute colorless sarcoid nodules arm readily dleceralbls throughout the parenchyma and In plaoee some proJsot above the surface of the thickened pleura. The hilar lymph nodes are larger than la simple asbestosls. HEART - Homs Interstitial fibrosis with a small saroold nodulo sur-; rounded by connective tissue In a papillary mueole. LPKQ6 - The diagnosis of asbestosls and sarcoid le confirmed. Tha asbestosls seems to bo moderate In extent but old while the saroold consists largely of young proliferative nodulee without conglomeration or hyaline ohanges. Both Inclusion bodies of saroold and asbestosls bodies are present. Indicative of aebeetaaie are the thick flbroue pleura and inter lobular aepta and the elsmgated stringy areas of flbroeie extending along trunks often more or lees perpendloular .to the pleura. The lattar . leilons are ooapoeed of fairly heavy discrete oollagenoue fibres and f ^ contai considerable amounta of dust and mone asbestoele bodlea. These maaeee have contracted to produce more or lees stellata border with radical strands extending into the surrounding alveolar walls. Xxtendlng into these nasata art tsrmlnal bronofatt.es whose lumina are largely closed. Of courts, the associated branohts of tha pulmonary artery also enter tha 'mas* but thare has been to much contraction of the aoar tieeve that tha  - 44-326 Page Two characteristic peribronchiolar relationships are no longer reoognixable. The sarcoid lesions are small fibrous or more rarely oellular nodules containing one or more giant oells. As in uncomplicated oases they occur In Interstitial tissue, the sheaths of bronchi and blood vessels and the alveolar and Interlobular septa. In addition, nodules are found at the margins of areas of the dust fibrosis.Where the dust reaction Is heaviest, especially beneath the pleura, the nodules are definitely within the asbeetotio fibrous tissue. The giant and epltheloid cells of the sarcoid show no evidence of degeneration as evidenced by fat stalnable with Scharlach R. They are surrounded by a delicate retloulum (black with Foot-Blelsohowskl) and at the periphery of the nodule are conoentrlc bands of heavy non-hyaline collagen. The elaatlo t1 issue is probably pushed aside in the formation of nodules. Inclusion bodies in the giant oells of the saroold granulomas are fairly numerous; those that oocur are largely of the round or oval orenated oonchoidal type. These stain black with hematoxylin, red with the a d d fueheln of Van Qleson-Velgert Instead of black like elastic tissue. Von Xossa's oalolum stain le negative. They give a strong Praseion Blue reaction for Iron. On testing other cases of sarooia it le found that in them also the i n d u e lone contain iron and not elaatlo or { o a l d u a . Occasionally typical asbestosls bodies are found within the saroold nodules. The asbestoele bodies In the pneumooonlotlo tissue reveal marked and unusual modification in ferrooyanlde preparations. Many of the bodies have one or eeveral very large swellings either 'terminal or in the middle of the fibre. Bitarre forma develop about the partially separated bundles of asbestos. The oonchoidal rounded masses are auoh more abundat here than within the earoold nodules. Muoh of the grannular' duet in the lesions is apparently iron. The blood vessels and bronchial tree show nothing unusual exoept for the sarcoid nodules In their sheaths. There le no evidence of inflammatory reaotlon or pneumonic exudate. LYMPH NODES - Largely replaced by sarcoid nodules varying froa oellular to fibrous In character. No necrosis. All show giant oells vacuolated but no lncluslom bodies. Varying numbers of lymphocytes in most of the lesions. flPL-gffi - a few small saroold nodules with giant oella but no inclusion bodies. LIVER - Same as spleen. n KIDNETB - 0 saroold; small fool of schlsrosls with arteriolar eoleroels.