Document rejOjxQ5VkgQzR2VXpxk9jVXE

FILE NAME: Philip Carey (PC) DATE: 1944 DOC#: PC006 DOCUMENT DESCRIPTION: Letters between Dr. Ritterhoff and Dr. Gardner with Cover Letter LAWRENCE MADEKSHO ATTORNEY & COUNSELLOR AT LAW 8320 GULF FREEWAY SUITE 218 HOUSTON, TEXAS 77087 January 24, 1986 (713) 841-0251 Dr. David Sheehan Attorney General's Office 7 North Calvert Street 2nd Floor Baltimore, Maryland 21202 Dear Dr. Sheehan: Please find enclosed herewith copy of correspondence between Dr. Ritterhoff and Dr. Leroy Gardner which I had previously indicated I would forward on to you. I apologize for the delay in getting this to you, but it took me a while to find it. I will be getting in touch with you prior to the Ritterhoff deposition for further discussion. If there is any additional information which you feel you may need, please do not hesitate to let me know. Your cooperation and assistance in regard to this matter has been greatly appreciated. I remain, Very truly yours, Lawrence Madeksho L M :mkd Enclosures cc: Dr. Barry Castleman 1722 Linden Avenue Baltimore, Maryland 21217 (With Enclosures) Eeara e7 Tccsrcca t m o M i p , aoESSAM ti TO. UOHLEBna u. o. QAK5V > <B22i O- THE TUBERCULOSIS HOSPITAL price mill. CINCINNATI'S. OHIO v n z d . e k e s e g c s , t o. maaasnestcsTT l.c.crmiBYd rspgnm a****?^ Hoveabor 1, I9I1U C B. CAJbCFBSU, VSOD J. UOiUi HOSABT A. V/EHEZNO Bacter Leroy U. Gnrdnor Director of Saranac Laboratory Saranac Lake, Uou Yosk Bear Doctor. Oardaort Again, I cm critics you for an opinion, this tioo in regard to a ease thought to bo ono of caboGtooio. Dr. ghavlcm end I could greatly appreeiato it if you could find tioo W*1YV5W5/J'tflb caoo. *" The grooo findings aro, 1 "boliovo, conoistoat with publiohod reports. Howover, microscopically, numerous cctivo end rogrcooivo tubercular losiono aro cneountorod in tho lunge end tho tracheo bronchial lymph no dec end a rare tuborclo io found in tha sploca, livor, rsyocardiua cad Iddneyc. Sho character and diotrihuticn of tbaoo non-caseating tuboreleo io cuggeotivo of carcoidooic. Yot, in tho lung aobostoo bodioo aro prooent within oono of tho looioao. and within foreign body giant colla. In addition, thoro aro areas of linear fibrosis with intact aobootpo bodioo fha paucity of aobostoo bodioo, co compared with ooetiono you kindly sent to d o several yoaro ego, tho absonco of a mere pronounced fibrecio in tho lungs, end tho tubercular looioao in tho lungo, nodos, cad covered, of tho or^ao, have led mo to bolievo that tho looions aro mined, being ono predominantly of carcoidooic, and minimally ono of osbostocis. 5 M g io, to my knowledge, tho first nosropey in which aobcstooio bodioo havo boon demonstrated in our oorioo or that of tho Cincinnati -i Sonoral Hospital. In view of this and, to mo, tho peculiarity of tho looions it would bo extremely dooirablo to have your export opinion. I am oending under eeparato cover, otalned end unstained olidoa, tho necropsy report, end clinical abstract. She limited occupations! hio'tozy is all vo have at tho present tine. Very truly yours R. J. Ritterhoff, II. D. DIRECTOR OT LABORATORIES mfr^~ fy'u ^ CCz. H s - 1 ^ it*ASu^ . i JL ncvenber 20 2L943 a?0 S. <?. Rittorftoff Director f Laboratories bounty of Hamilton She i'ubos'oul002,0 Eoepltal Prieo Hill Ginoiniiati 0, Ohio Boar Dr. Hittorhoffs 2 on DOS'S graceful to you for allowing so to ooo the sections on four unusually Interesting meo of asbesiosis and sarcoid of the longs. 2 agroo that this combination 1 ot a tho record ao fas* as I know and thst It would bo coot desirable to publish your findings. Obviously the o&rooid constitutes tho predominant pathologies! hang and there Is In addition a oiniaal oount of asbestosto. 2S la hard to be euro osaotly bow m c h of tho flbroclo Is duo to tho inhaled duet. However this is ns where extensive ao you wrote and the number of asbestoelo bodies is smaller than seen In cany oases. Oao would infer that tho tmn8o xposuro to asbestos fibre bad boon limited although tho occupational history oayo nothing about the nature of his work. 2 hope 2 tmy bo prodttod to heap those slides as they arc really very beautiful. It Bight help to have a hernias! analysis of tho' tissue to determine the amount of H&gnoalua present. Vo have a fairly xtoneivo series of figures on tho findings in asboctooio. 2-ray diffraction boweDor is of no holp as to quantity of hydrated magnesium silioate. 2t 1 too small to register oven in advanced oases. If vq an bo of any oervico in thio regard us uill b vory glad to operate. gala cay 2 thank you for allowing os to revlou tho material. Sinoorely yours i LUOiRS Leroy V. Gardner, ft. 0 Director 61P*~ D0AE3 07 tt& U A tt P. BOEtm &H C3IAZn21A$V w it u o m sc n a m. d. HAS3V I 0&DSN O THE TUBERCULOSES HOSPITAL P R IC E HILE. CINCINNATI* O. OHIO Wt& D. E3CXER3CIJ. IA D. l. c. nrmsrster Boccabor 2 3 * 19Ub HOSAST A. m o m io Br. Loroy . Gardner Tho Saranac Laboratory Saranac LeI:o 9 Bow Yorh Boa? B?. Gardners I cm vory grateful to you fo? roviowing et oaao of eareoldoala and agbootoaio. loedlooo to cay. your eonfirantlea of the diagnoaeo, ovon though I caa wrong go to tho degroo of aebestooio praaont, made mo very happy-- ovoa produced a fot? "chaekloo.0 Tour suggestion at to publication dll ho followed; 2 would lite peralocen to quote you and Ineludo your findingo in that report. Tieouo ic being sent for choralcal cnolyoio. could It. Also, be advicabio to have s-my diffraction otudioo for oillca? Unfortunately* I am unable to give you eupplomontal data in regard to his occupational Motory. ao the local factory concerned hao been uncooperative. They have not permittod mo to vlolt tho plant, nor have they given in detail hie occupational Motory. I havo ooveral quoctlono concerning phases of tMo caco about which vZ would Hire your opinion; Tirol, in oomo of tho giant eolio end occasionally within aroaa of fibrosis thoro are raro calcium encruotod aobeotoo bodies. Have these been previouoly fiooeribcdJ Socond. would you coro to comment upon tho pooolblo otiologic and chronologic relationships of thoco two diseases. I note in your letter, that pathologically it io hard to bo euro how much of the fibrooie io duo to inhaled duct.0 Io it probable that careoidooio antedated and prodiepoood to aoboetooio. or eonvoreoly 00? On tho bacon of Pinner*o belief that sarcoidosis io a modified tuberculous infection and your Boas o?iteraran WU. MUHLBRRO, EC. . H A RR Y ~ OLDBN THE TU BERCU LO U S HOSPITAL PRICE HILi. CINCINNATI. S. OHIO W B . D . H IC EER SO Ef. EX. . L. C. Z U TT tjB Y E R -ga. n o C R. CAHDPBXLL J . MORR HO BA RT A. WXiQONO report, Jour, of Indust. Hygiene 7ol 1 3 , March 1931 on experimentally produced tuberculosis in asbestos dusted cavie0. 1 favor tbs belief that in this case it le likely that Gaboatoaia predisposed to earcoldosle. I ill greatly approdato your help in regard to chemical analyooa, and your comments if time permits, to the above questions. Tours truly. RJR/bmr R. J. Ritterhoff, M. 9. DIRECTOR OF LABORATORIES / / Br* &, Rittoshof irootof* of Laboratories ^ho tuberculosis Hospital Prioo Hill iooinnnti @9 Ohio Seal? a?. RIttorhofs 1 m very plo&acd indeed that you ootild 1st os feavo ouch a generouo camplo f tiesu fop chejaieal analysis of your fascinating as of oarooid and astoeatosio. Uo will give it tho wor&a la order to ascertain what are prosat. 9ho otory trill includo sot only hemioal ad -ray diffraction analyses hut X shell seed it off for a opeotrographi analysis- 2 as doing this because 1 am Hoohlng for control Baterial to a serieo of oarcoid or saroold-lifc ocso fros th fluorescent Imp industry. 2 00 doing everything that 2 as to determine whether there cay ho an ia&uotrial eaviroranental factor involved la 8ho etiology, fhua far uo actually know very littlo; these poopl oak fluorescent and other types of laspoand radio bulbo &a a very loan factory* Boryllluu io under mopicion hut in opito of intensive study th cspocur to any particular oubotanoo seeaa very limited, Experimental wortc tapqa oany of tho hooioala involved has aa yet produced no dooisiv resulta. It &o oy own foellng that oarooid io probably due to cooo infection whoo sue io unknown at the present tis. Perhaps it &b a virus. 2 can01 reconcile the hiotolcgiool ploturo with tuberoulooio g q Pinner does e@ eaoily eor do00 it coon u k o l y that tho disease io duo to lopra bacilli or other acid-fast organises, 2 believe. thr.t if cny n-cpoclfie irritant la omsrncd9 its rolo east he a cglihor. onoe pro* bahly noting cs a Jfrigger Eochanieo to allow the virus da* whatever to do its not* TM 2a your cnoo tho presence of asbestosie would ooea to so probably B e n d y coincidental0 at least this is tho first time t M s , c-sabInstion has boon noportd. 1 havo studioo on approximately flfttJ oases of asbestosia and 1 have never soon one plicated by earooid. 2 would infer that in your caeo the two conditions developed aor or loos iemltaneously but that probably th asbestosla was present to os degree boforo the oorooid appeared, This opinion io based on the ooourenoo of asbeotoo fibros and other iron-oontal&Uig particles in thC' interior of the tubercle-like noduloa and in cone- oases vithin the giant oelle thenselves. fhe calcium encrusted inclusions in the giant ello ore very frequent in all of the pulnon&ry sarcoids that X have studied, X do not know what they are but they look like bits of elastic .S' n p - M f c Er. R. J. Ritterfccfff - 0- oooabor 2?, 194d tioouo that havo attracted M a o caltog thorn have an yoter oholl appearance whose origin io hard to imagino. 2 caw in the sections of your can a few of thee deeply stained bo&loo which. ore a featuro of sarcoid and In addition, I noted, ao you Dontioncd0 certain portions of fibre that have & yellowish ast which ao ouopooto oay he asbestoo. Sheas, of course, are not unooaaoa in uncomplioatod cobootoslo. On tho other hand, some of the asbestosio feodloo in preparation have aaeunod coot biaarr appearo m o o . At the risk of being monotonouc about the occupational exposure 2 would appreel&to it if you would tell ao what sort of a plant the Philip Corey Manufacturing Company peratoo and whether you havo any idea of the nature of their products, 2 am interested, of owe, not only in the exposure to asbestos but in the possibility of an exposure to fluorescent substances. Vo shall probably be able to determine the presence or absence of the latter by poctrographic analysis but it would b helpful to fenov what possibilities aro involved. Personally I would hesitate to commit myself cn the question of causal relationship between asbestcoio and sarcoid. Ouch relationship cay exist but from the evidence before uo 2 would find it difficult to decide which was oauso and which was offset. 2 view of tho fact that the two conditions occur eo rarely in tho came lung 2 would rather entertain the opinion that chanco was responsible for their simultaneous ooourenoe In your aoo. After we get cur various chemical and other analytical data together t would be very glad to give you ay furthor commont to be used in your case report, if you oo desire. Z will admit that ofter inspecting the gross satorial l m sore ispreooed with the extent of tho asbeotosis. Zn comparison with our other oaterial the pigmented fool in your case seem to show ooro fibrosis and lees localised emphysema. Eiotologically this can probably be explained by the presence of caroold nodules within the aebeetotio nones of roaotin. Again say 1 express ay appreciation for being allowed to study this unusually interesting case. Sincerely yours. 100: RH Leroy U. Gardner, H. D Director 6iB^