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FILE NAME: DDd DATE: DOC#: Dd OCUMENT DESCRIPTION:tZZ&Z:D File Name Contract Unit Claim File: James Riley Scanned? yes Source JMA: NS-JM Start Year 1957 Stop Year 1961 Contents claim, letter Notes f.. \ '1/ \ J DIPLOMATE AMEAICAH 80....0 or INTERNAL MEDICINE (' ( EATON M. MACKAY, M. D. SANTA ANA CLINIC 30g WEST E:IGMTM 5TRE:E:T SAN!Y'A ANA, CAL.IFORNIA KI".I:ALY 2lIee February 24, 1960 Industrial Indemnity Company Box 2252 Terminal Annex Los Angeles 54, Calif Re: Claim No. 57-03-11487 Claimant: Jam~s W. Riley Emp: Lynch Asbestos Co Date of Inj: April 7, 1947 Attn: D. W. Brown Claims Department Gentlemen: In my last report concerning the above mentioned patient 1 indicated that he had been hospitalized in the Palm Harbor General Hospital, Garden Grove, Calif. on Decembe 27. 1960. He was hospitalized because it was no longer possible to keep him reasonably free from the intense radicular pain at home. This nerve root pain was caused from vertebra collapse. His course in the hospital was rapidly downhill although it proved possible to keep him fairly comfortable. He expired on January 24, 1961 at 7:25 AM. The immediate cause of death was pulmonary insufficiency or respiratory failure. FINAL DIAGNOSIS CODE 350-3971 350-814G 360-1231 360-438.6 370-1X4 362-600.6 360-100.2 435-535.6 861-9Xl 640-951 651-951 221-403 2231-403 DISEASE Asbestosis Epidermoid carcinoma (Undifferentiated squamous cell/~Eel r,ro~chu (Chromogenic acid fast infection) Minimal active tuber~ui~ilS.ung Secondary Complications Fibrosis pulmonary, due to foreign body (asbestos and Adhesions of pleura due to infection (pleural fibrosis) Emphysema (severe) compensatory. Multiple abscesses of lung Right heart hypertrophy and dilatation. Adrenal cortex atrophy. Active and healed peptic ulcerations of the stomach. Active and healed peptic ulceration of duodenum. Fracture, compression, of body of T-7 and T-8. Fracture, compression, of body of L-l. carcinoma) 6 EATON M. MACKAY, M. D. { -2- ( Re: James W. Riley R. G. Richards, M. D. the Pathologist of the Palm Harbor Hospital performed a post mortem examination on Mr. Riley and a copy of his report is enclosed. I would appreciate it very much if you could have a copy of the post mortem examinatioI report made and send to Dr. J. K. Shirey who is interested along with Dr. Brewer in this case. Also if it is not too much trouble perhaps you would be willing to send Dr. Shirey copies of the earlier reports I have made to you. He has a keen medical interest in this case. A copy of the Certificate of Death is also enclosed. This was made before the microsco: report of the autopsy material had come in, but 1 would not have changed my general COl clusion. If there is any more information I may be able to give you I will try to do so. .. Sincerely Yours, EMM:mm ( DIPlONAfE ANEIUCAN 80ARO 0' INTER"'.... "[OICIN[ (' EATON M. MACKAY, M. D. SANTA ANA CLINIC 30U We:ST f:IGHTH !lT~e:ET SANTA ANA, CAL.IFORNIA KI".O:"LY Z'186 January 21, 1961 Industrial Indemnhy Company Box 2252 Te rminal Annex Los Angeles 5, Calif Re: Claim No. 57-03-11487 Claimant: James W. Riley Emp: Lynch Asbestos Co Date of lnj: April 7. 1947 Attn: D. W. Brown Claims Supervisor Gentlemen: This is to cover the period of October 31 to date On the above mentioned pati~nt. He has gone gradually downhill and the problem has been to keep him free of pain or at least reasonably so. 1 have had to orde r oxygen for him and had a traction bed rented which has provided some relief. On December 27, his condition became 60 bad I found it necessary to hospitalize him. He was placed in Palm Harbor Hospital in Garden Grove because it was the institution nearest his family. He has continued his downhill progress and 1 now consider the situation to be terminal. Very truly yours, ,~&~!ftde~r Eaton M. MacKay, M. D. EMM:mm . - . . H:.'\,-:': .- p(" { HARBOR GENERAL HOSPITALC-'- , . 12860 Palm Street ~,' Garden Grove, Califomia PATHOLOGICAL REPORT Doctor Specimen_ _ _ _...:A=tJ'.l'O=,=SY=-:..-- - - - - - - - - ----- ---- Preoperative Diagnosis,_ _ _ _ _ _ _ __ FINAL PA'l'HOLOGIC DIAGNOSES t I. PULMOBARY INSUPl'ICIBNCY. II. PtJLt)NARY FIBROSIS, EMPlnSEMA, SBVERE. III. PULMONARY ABSCESSES. IV. BRONCHOGENIC CARCINOMA, RIGHT LUNG. v. PLEURAL FIBROSIS. VI. RIGH'l' BEAR'!' DILATATION AND HYPERTROPHY. VII. ADRENAL ATROPHY. VIII.ACTIVE Mm HEALED PEPTIC ULCERATIONS OF AND DUODENUM. 362-600.6 .: 361-100.2 350-S14G !.~ ,'" 370-l.x4 435-535.6.;: ...'.,.. -,. . \,-. ~ - -i : . 1.' \ ( . ( P"AL.M HARBOR GENERAL HOSPITAL 12860 Palm Street Garden Grove. California PATHOLOGICAL REPORT _ _ . _ . _ - - - Specimen'---_ _ _~AU'1'.QUY_ __ .. .~N.~~~~ .---=... Preoperative Diagn08'_8~_ _ _ _"_ _ _ . __._ ._ "_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ :.;,;""::.::...;:~~~:~~-?-.* ~..." ,J :~'II "'~!".~ ~.~...,.f:r;..,."~ G~ RO~ SS ~ DB~ SC~ RXP~ TIO=lfa==================~.,;;.~" .~ ,...- ;,-",:~ , .,; t~?~~,:~ An autopsy is done 1/24/61 at 6: p.m. at Backs Troutman and ltaulbm:a.. Mortuax" with Gerald Brown as witness on the previously embalmed body of an elderly white male, measuring 67Js in. in length and weJ.ghiD9 apprOXimately 97 lba.;..! ""he hair is gray. The body appears extremely emaciated and cachet1c .: ~. _s a 24 em. healed incision about the 9th rib on the right chest wall./~ 'aerf is a tattoo on the dorsal aspect of the .L.:left foreaJ:m of a borseshoe with thI inscription "Good Luck". On the volar aspect of the left forearm is a daggeJ: surrounded by a snake. PRI~ INCISI05: On the left deltol.u. is a woman' s bead. '"...;:,.... : -: __ ~. "ti~ "':' r._. -.. t The ~u incision shows a vi~tually non-existent panniculus and a thin pale musculature. There is no excessive fluid. The entire right pleural. spaee 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. .1 ___ _ '-." -!:.. . ORGAN DESCRXPTION: . - -:. --:.:.- ~::~'1_ Heart: The heart sho\~s a m~lt:ed hypertrophy cmd dilatation of the right ventricle. It \,;eighG 380 gIna.. It appears enaarged; the muscula.ture 1\ppears pale and flabbz The coronaries are widely patent. 'lbe myocard1wa ; 3 homogenous. The great vessels show no alteration. The valwlu meas~e-" .:,'<- 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. " i'" "." :}.f.~~::~~~ ~~',...:,:. "":'~: Lungs: 'l'be tracheo-bronchial tree shotols a gray-\thite. uniform IIILlcoaa The right main stem bronchus is obliterated by a granular gray-white tumor tissue, appearing desmoplastic. The tumor radiates peripherally from the hilum. The corti.cal or pleural area appears fibrotic and scarified. There is a dense fiDrosis of the parenchyma bilaterally. The f1brosis of the left lung is predominantly in a subpleural position, occupying the 2 c:m. of lung - directly beneath the pleura. There are numerous smal.l. dilated cystic:-appearin~ alveolar spaces present. Distal to the tumor on the rlghe or ~ the righ~~~ (continued) -- - __________________'_._"~.~..~""-':~.-~~:~~~:~~~.~~ _.. .. _... - ~. - ""_.... ," ........j ~ ( " ' '~"f::" ...... ... ... ., .. I.... ~'.'''!! .;...~ ~;. """-.. ....... ~ ' .';' : ,; ..,.,.., 7: ~." "0. !.. ~ " , ' . _ .,; .. , ... .:! .' , ' - '-:. ,- .,;' ,Y' . - . - ... , . -::_':;. ",... ..... . . . . ..... '.-( PALM HARBOR GENERAL HOSPITAL' . . ~ .~:.. .li.1. . '~.1<: ~.W . . . ~ ,:, ~ ~~.=-;. - 12860 Palm Street .:- .' ......~ -.. '. Garden Grove. Califomia ... : '~"'.Z ' \ PATHOLOGICAL REPORT ,.;~Il Namel-------=lCR~I.L..a. '~T",--JA~MlIlUl;;S~Wff..,....._-_--Hosp. NO.~6++_3_-Date:--,l)qfJ/24161-=::~ ~ Doctor'______~-.j..J;IU.A~".r . - - - - Specimenl-------l==--,2io--==-------,--------Preoperative DiagnOS'lDis'-_ _ _ _ _ __ - ,... .... -----.!~~~.:. ~ -'::T~ -~ ___-"Path. NO'_ _-;o.PA- .. , :":-, : ,;~.::: ~5- ~ '; .... ~JL:;': i ~ manN OESCRIP_IOB (eoa1d:It"8d) .~!..~.~~~~: :~ r'*'" (.;.,:"'-.IL... is a dense fibrosis and an inflammatory processes represent1ng' uult1pla'", !.: ,.... abscesses, dilated bronchi and one area of a relatively \I,-ell healed f1Dro..:' caseous fast in granuloma of the lung, otherwise or1gin but an acute infl~mnatory pthroe cmesasteesrisaelcodonedsarnyottoapOpbeasrt,r-u'.acct1ioan,": from the tumor itself. The right lULlg weighs 600 gms.. '1'he left waigh. " 700 ;ms.. Livert ..;:::.:! ":.:L .;_ .-!....... ',"'> .$:1:' '. ; _:L~ !_ The liver weighs 1200 gms.: 1t is,red-brown, slightly pale. The capsule is thin: the cut surface has a characteristic nuqegg1ng.. !'he bi11ary tree and gallbladder are not remarkable. Pancreas: The usual pale-tan lobular architecture is present through- out. The pancreatic duct i;;; patent. .' . ' ..,........ Spleen: The 3pleen \'ieiyll~ 500 9Tas. allc4 sho\'lS a \'lrinkled, red-purple ccp3ulG \-lith vascular congestion on section. The lympa nodes and b~ne marrow' are not remarkable. G-I System: The esophageal mucosa is gray-whitei the stomach mucosa ShOW3 a flattened, atrophic appearing mucosa. The small and large bowel . are not remarkable. There are areas just beyond the pylorus in the first:_ \ ~ortlon of the duodenum that appear symmetrical. One represents a tentJ.n9~ ~ of the mucosa and muscular1s due to previous scarification and on section~ shows a fibrosis of the mucosa and musculilX' coat. On the opposite aspect. ~ is the same tenting defect with the same submucosal fibrosis incident to a previous ulceration. There is a 1 em. penetrating active peptic ulceration on the lesser curvature of the prepyloric region of the stomach. The small and large bowel are not remarkable. Endocrine glands: The adrenals are small, l1ght yellow and atrophic. The pitiutary is not examined. , .. ," . G-U system: The kidneys are equal in size and shape. The capsules strip with ease. There is a finely granular corteXJ there is a 900d eo~eo-medull1. demarcatiQP. The pelves, ureters and urinary bladder are Dot. remarkablA;.' " {contl.nUeC11 " R. n RirJuuoJ!t. M.n. P,.,thr,[""i..t,.' (- ' t, ,'.. ~'". PALM HARBOR GENERAL HOSPITAL,' 12860 Palm Street Garden Grove. California PATHOLOGICAL REPORT '-, :~~',;-'i::~~-:t~ -..~ '"! ...--: ~~~~~~-v~~'rJ"''''''-'' ,.". , ., ......'. ~_."'q&ooQDIoA.IY----- N~~e------------~R~I~~~B~.r-~~_RMI~S~Wr~.__---------H~p.Nu.-~D+~---L'B~'____~,~~~~ Doctor'_ _ _ _ _ _ S~en~---____~-~-3~~p~---- ~Q~v~G~'~B~PM'~5BC_R~TwPcTT~Q~Naa'==================================~======~==='=~==~-=;={;=~=~~=~='~~=~=,~=~,i Preoperative Diagnosll&l1$'--_______ '!'he prostate is firm and well circumscr1J:)ed. . .. ':,A'i~.''~t"~"~!J.:i!Jl , .... ~. :: ~ .~-.-.'."- ..~...~ - .. ...~.-' ':U~'ii]! l ";"'j "':;:~70 Caagal Nervous Systema Not examined. ~ "t .. :- =*l;~:_:;~.f7!.~ : .. /,.;~"'-:-:t ...... ; ";:":'~.~I~..'~-~$'.~,,:;,.t'..,;~".:~,'~; MICROSCOPIC ~NATXONI .... '.r <110111[ _ . r:. ...... : .. '~,~~~~' ;j}: 'II .~ til ..... ..;. .. ,_ ............ T:, ; ...... .- ...":..~ ..... ...~ ~'". ""=-~ ""; ~: The sections of lung show a dense fibrosis and a baIogenoaa .. .. ..- ..I!' .........-.~ escaX' over the plerual surtaee. There is an emphysema and passive congest1, of the lung. 'l'here are portions containing undifferentiated squamou,s c:ucin' oma with central zones of necrosis. ", ' Adrenal, Heart, There is a depletion of lipochrome and a peri-adx'enal fibros, There is an interstitial edema. 'l'De nuclei vary 'in size' and shape and sta1ning quality. There is a prominent tnterticulated disc. . - ':; '..:;,"--:' Spleent There is a fibrovascular congestion. Pancreas: '!'he usual lobular a::chitecture is well maintained. .' _.- ,r'. ;_ 'l'here i. a dilatat10n of the ductal structures. -~: '?3 .~., . . :~#~:: L'-lng: There is a marked abscess forraation with extensive destru~ ':' tion of lung parenchyma. ", .::':,,~~'__~, :i~~ Kidney: tubules. There is a congestion and fibrosis about the' collecting '~ .. - . ' . "j.~ ~~:!~~. "~' ,~, ,T , , "":' ,;';':~ Liver: There is a central lobular congestion. a su~mucosal fibrosis involving the muscular coat. Duodenum:' There" 1a' , , ~ , ~ ''',f_:,,.,..-~1J' '. ~-=.:.~i.: .;i~;. ..~ .. A .. Lun;.; There is a fibro-granuloma~ous process raprasani:eCl with " characteristic asbestos fragments present in the center. ,. , . ~- - ~ ~ ::'~.-- :;:':'f:[~~ aTcheidafcaidstfastsatincsonotfrollunshgowtissscuhearsahcowtercihsatircacatceirdisftaicst-aocrigda' nfaisamt'sowZ'hgainle' mtahe1n'':~',_1~: addition to the asbestosis previc.usly described. .- ~ '~:,~, -,' -'~;,~:::~-,~7~~m '" ' __I ~. '.f/t~~,' .... ..-....~: .., ~. -............ .:.ttt.~1~ 1 _ _ _ _ JII. ..I '" . '. ~.\i. .,'~ ,"r. ( HARBOR GENERAL HOSPITA( . 12860 Palm Streec Garden GI"OY., California . ..... ,., . .~ -~ PATHOLOGICAL REPORT n. Name'------.lR~IIo.II.. ..,-1oIJA"'-.N -. lIIi;--------Hosp. No. C6113 Doctor_____)kl~y-JM."""IICiIiIiIla~~MM'r":.,~Di-:-.f!.ar::-- ___________..P. ath. N~.~'=-=';:.:.~.:~~:~~~~ Specimen IiiI 4 = P;;;;~tive DiagnosilJos_ _ _ _ _ _ _ _ _ _ __ D1aillosis: LUIl9 - chromic flb,"osis l asbestosis, fast organism. _'_ :~~ .:1". 1 ,:. I & ' . .'~J>. -!,:,,'" : ..... - : . --.. ~ . - ~-- RR:ls , ,t-_-:' -.p .. - I ' ... Ii.. .! .. ~:- :.~ ~ ~ ,f~~ 1 '," q ~ - "!.~. OIPlOMAT[ At.4[AICAN BOAJ:tO 0' INr[RNAl MtOICIN( ( ( EATON M. MACKAY, M. D. SANTA AtJA eLi N Ie 309 WEST EIGHTH STREET SANTA ANA. CALIFORNIA KI ... e~RL.Y Z-IU56 March 11, 1961 Industrial Indemnity Company Box 2252 Terminal Annex Los Angeles 54, Calif .' Re: Claim No. 57-03-11487 Claimant':...r~L..W._gil~y'_ Emp: Lynch Asbestos Co Date of Inj: April 7, 1947 Attn: D. W. Brown Claims Department Gentlemen: In my report of February 24, inadvertently dated 1960 and which of course should have been 1961, I neglected to answer the question posed in your letter of February 15, 1961 concerning the above mentioned case. You wished me to give an approximate date that Mr. Riley's disability became permanent. It was my opinion that his status should have been changed from temporary total disability to permanent total disability on about August 15, 1960. It was at this time that he started to have rather severe ra dicu1ar pain. He went at that time to see Dr. J. K. Shirey when the change in his can dition became evident. I first saw him on September 16, 1960 and his status then was certainly PTD. Very truly yours, r (~Zf; -jp. 1!:r1(1~, Eaton M. MacKay, M.D. EMM:mm -- ,. . " ( .. ~:C, tl.VrEv'I,C.~lf _ \. '.O ' "Y ! - ~ j ~ ~ _'.'" '- rt ( . : :',- .. :~ ANGlo' EATON M. MACKAY, M. Do SANTA ANA CL.I N IC 30A Wr:ST e::lOHTH 5TRe::ET SANT...... N .... C ...L.I FOFlN I... October 31, 1960 .~, 9 59 .,. ... rl_ .. -- __:- 'v"li,Si I_CASER.ENf EORE'E- 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 Empl: LynCH ASbestos Co. 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 admission, and the cough with which he entered disappeared in a couple of days, His radicular pain became increa Singly more severe during his hospital stay and it was impossible to control it with narcotics. Since he received conSiderable relief by hyperextending his back aler a pillow, r had him fitted with a Taylor brace for some hyperextension. He has obtained excellent relief from this device, The sedimentation rate of his blood increased steadily throughout his hospital stay, and has reached a high level. In the absence of any active inflammation in his lungs or elsewhere, this finding does not augur well 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 tell him that it would contribute to his getting well, he preferred to not have the operation carried out. I acceded to his wishes. This patient will be seen in the office once or twice a week, and I will keep you informed in regard to his progress, EMM erne ( D"LO"AT[ ANt~ICA" 10""0 0' I"TU"AL M(OICIN[ EATON M. MACKAY, M. D. SANTA ANA CLINIC 30S> W~ST e;IOHTM ST"EET SANTA ANA, CAL.II"ORNIA KI".C"~Y zlIee c. Industrial Indemnity CO. Box 2252, Terminal Annex Los Angeles. 54, qalifornia Attention of D. W. Brown, Claims Supervisor Gentlemen: * Re: Claim 57-03-11487 J~mes W. Riley Empl: Lynch Asbestos Co. 011: April 7, 1947 I examined the above-mentioned patient on 16 September 1960. I will 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 time, the pain was felt mostly on the right, following both sides of the incision scar usec to carry out the lobectomy. When I saw him, he had about the same amount of pain on both sides. 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 I 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 success, 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 anemic I 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 I 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 past ten days, his condition has remained essentially stationary. Sedimentation rate of his blood has gradually increased to a very high level. Narcotics now give only partial control of his pain I and an effort was mada to give him relief with traction ln the upper thorax. This was quite successful, but irritated his lean, lightly covered thoracic wall too much. For the past four days he has been spending some hours each day with hyperextension of the dorsal spine, and this is apparently giving him definite relief. I am looking into a suitable brace to continue this for him. EATON" M. MACKAY, 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 I collapse of the two dorsal vertebrae which have compression fractures. In no- _ instance would surgery be indicated. It is my opinion as of now f that these A -1. ; vertebrae have been invaded by a recurrence of his bronchogenic carcinoma or by another cancer from elsewhere. From an industrial pOint of view, this " f..)JJ#-"'~-l differentiation might be important, and I will have a biopsy of one of thever- JO 7'1 tebrae carried out, if you so desire. ~ This patient has been on a down-hill course for at least two years past, which has been enhanced in recent months, and is certainly not slowed up at the present time. There is very little curative for scientific medicine to offer him. The most to be expected is better relief of his extreme pain. ~ Il ,1I{fla~~ Very truly yours, Eaton M. MacKay, M. D. r , EMM erne , t ( ( '\"J';~l)ELL .\. ~I01H~.\",. ~l.D. Z9e;~ WILSHIRE BO'-LEI,IA"O Los ANGE:L.ES S.CAL.II'. OUN.WItIit 3'.,128 June 12, 1957 American Motorists Insurance Company 2969 Wilahire Boulevard Los Angeles 5, California Attention: Mr. Carignan Re: James Riley J. T. Thorpe Inc. InJ: 1/2/57 81 (l( 68854xOD Gentlemen: Mr. Riley was examined in this office on June 6, 1951. ']he 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 losine; ten poums in lle1ght. lie also is troubled. with chronic 'weakness and :''ltigue. The cough has been productive of clear mucoid sputum. The patient has been working as an insulator for "';hirty seven years. The patient consulted Dr. Schiff and has not work~d since May 20, 1951. 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 nou being teoted by culture and guinaa pig inoculation for possible tuberculosis. The patient is a wite malej 57 yearSj married; address: 441 w. 42ncl street, Los Angeles 37, Calif. Tele: Ad. 2 4562. Occupation: insulator. E:XAl-Ull.A!rION Examination reveals a chronically ill~appearing 57 year old wite male who appears to have lost considerable w1sht. The chest 'WaS resonant to percussion. A few fine scattered inspiratory rales were present over the right base. The patient was referr~d to Drs. Crossan and. Goin Where en x~ray of the chest lms taken. This was reported as showing finclings comp~tible with an infectious proces~ of a tuberculous nature with cavity formation. Toe p~ticnt lres referred to Dr. Dean Scofield for examination and for his opinion. 1t 1,,).11,1 s~em that if the conlition is tuberculosis, it is not related. to .. , . , ( -2- Re: James Riley 81. CN 68854XoD June 12, 1957 any industrial accident or disease. The presence of a cavity would suggest that it probably is tuberculosis. ~e diagnosis would. be confirmed if positive cultures are obtained. :.. Very truly ]OursI JAM:CSR Joh~ A. Morgan, M. D. I \ \ \ t ( Lovell S. COIn. M. D. John ~'. Cro"u. M. D. ( \ Drs. Crossan &Goin 658 South \\estlake L05 An&ele.5 57 Jw. 6, 1957 "Cj';7 ,... , 1,.;/ \. ', 5 ", . Harold p, Tolft~\i. M.D. HenD' C. Croli,,?, M.D. " '() .: .... l"'\""I"f" ~ -_-_ . . " .. -'-._.....'J. '---" . - ~ . John A. Mort;.:ul. H. D. 2965 ~1~hire h~ulev3rd Lo. klaal.ca. 57. California .N:aari~ Motoriata lDaaranca C~ Re: lll.ltI~ l:. J .... &:1p: J. T. '1'bo~. IDe. lx&j: 5..20...57 l'1laaa HSUt. ~~::~-:'c:lOlo~1cal ~in;ltion cf tila cU::St ,.~ oIUl iA;:r..... in d3n3l.t] of til; ri;ht. liJ:l,5 iil ;:i~e stlbcla"ic.ul..o.r regiaa ~ i.e of. 1l06l-homo.'lUllWUS patt:=~. 'rhcrG ar~ Gl:r=4U~ siMdorM, extaulU.3 l!QwlIiml Ol:lG 1nwar\1 to the d.;ht hilar r.':lC;iOll. 'there i.e a ~4er4taly larso r~g-ShJ?cd ~~~~ vl~ Gmdll a~eaa of relAtive l.:r.l!131__":~j' i;:o;ol-.'itl:.; ;.:t."-I 1"1:::);;.:;' ,J!J!.:cl~v.!.;;ul84 :-'!:;iO'D. Co:tcVJS!ON: !'rl)':. a xoent~olOSic&l s~~a?Oi:1; t.~'l findines 61.'8 CQIIPai:1blo with ~ in1oct;ious proces, of tl c~barculcala n~t.u;~ 'N:llcl1 $.a 8ui>o-acuto or. chronic ill chara:::tar with C4v1ty t~r:n.l:;ion. w~ .11."0 s~41nc; tilQ ori.;inal :ro~~~~::,.;:ma mul t1 cop)' of thb report to Do~i;Ol' Dean ScoUtlld, as :;ou requuted. Very truly lour~, -1 /'1.,./; n.1/.''.I~'i11_"-~/" ~~I -~ ' /Jonn 'J. C::oau:n. H. D. DOcr1t, '. FIRST REPPRT OF wL~~\ I eIN~1f~!6 ~y~._J';'!-.1i._~ I' /:;]/ . Failure to file a report with tbe Division is a misdemeanor. (Labor Code, ScaioQ! 6407-6413.) . Immeel~teJ" after fint examination mail one copy directly to the Division of Labor Statistics and Research, P.O. Box 965. Sac Francisco. I 8 ---:~.. AND 1WO CO", TO ..,.........- Answer all questions fuUy. f AMERICAN MOTORISTS INSURANCE COMPANY JAM. . S. KEM"It". CHAII...AN a WILSH'ftl: aCULKYARO LOS ANGELES S. CALIFORNIA SlCM6sS54 XOD HO... OI'?lC:S .NaID4N 4T U.WIIUlCIf ~ CHICAGO.o ' 1. E~LOYER.__._...._.._._.._.........._...............................................- ...- .......__.._ _ _._._____._ _ __ =-_. . -------t Ad~ess 1~C,.-lL.;;;:;d;;.:-t,;;.idj~-;;;- 2. ......-....-....---.......--..- ....--------.. 3. BUSiness "rua.OII. reta.hn __', cl~. ctc.) ....- ................... .........- ........................................- ..............._ .........._ .._ ...._ __ ... EMPLOYEE (~:U~ _J.A!~._l'l._..B.ILEY..........._..._.___._.._..._____.._.._ _ _' ----I S. Addres.1 ':Ei:t .......- ...-...-.._.........._.........-....-..._......- ...-...._.--..--_..________1 6. Occupation.....- ....__ ..__...._...._.__...._ ....._ .......___...._..._ .......__-Age....__..._ .....__..5er.._ __ 7. Date injured........~._5i.._...._..._.._.........Hour._.........._.....M Date last workecL-.___._.____:_-'__I 8 InJUleel at (.N. o0.,II).: .....- ..- ..- ....- ...- - -- . - . -..- ..- ...- ....- ....- ..........----.r..".."."..,.,.._,. . ____ 9. Dar~ of your first examination...._ ..._ ..._ .........Hour..................M Who engaged your semces?_. .._ _ to. N2m~ other doctors who treated em 1 ee for this jQ' ......... _ ...... _ ................ u .....__ .._ ..... _ _ .. _ . . . . ._ _ _ _ _ _ _ _ 0: ......... Ia l1li. t 1. ACCIDENT OR EXPOSURE: Did employee nOtify employer of this injury? ._ _ _._____.Employee's statement of cause of injuzy or illDess: 14. Treatment: . cd''U ~_Il"( f -, 0" ~ ~ ,. O--p-tJ~~ ~~~rr--V-' ~ ~ . I'- ~i,.- . .... ~~~~~~:=~::~~~=.!~~~~:=~~;1; _.~ L~ ~ 1). "la..-.4:-. .-. - . ---.-.-- ....-.........-...:.. ..... .. oJ. Further treatment (;::~=Tey ,~ r:p:i'ct.:.::t:...fI~ ~ . r 17. Estimated period of disability for: Regular workl........~~.~I..._..L..:~:~:_t Mbdiied work.........- ...-.-..- ...-----. ~~ _ _ - . _ - - - - - - - - _ - 18. Describe any permanent disability or disfigurement expected (ShU If DOM) ...._ ...................._ ........._. ..........................................._........................ ....... ........................_.....-......_..............._................. ....._.... ..... r - -~ - - F ..- \ ---",t--- 19. If death ensued, give dace 20. REMARKS (Note :In, pre-nistJOII iQjuries or dise-.ues. need for .pedal e,,:unio.tioQ or 13boratoty tests, othet perUlletir infocmatio~) 1 1'1 ~.'-j~_'._ C-=--.c(i ..,y;-~ It ,hS!a-i~. '~Z'.o. ", ~~'-4- ~-c-c~ ~ ~~ J...rL~A""'~-::"""''''GJ\'''''''' c .Jh>h H'~:.J.- c........ "<.. c .-.. I~~~ ...... .-:-4-------}-z.-. .t.L.~::.c:.!..~ :::::.:~! ~ ~...-.-~~ l ... .. 4'1 , - - Name.. 'J .....:/......J.(./.f./..E......_.....Deg'rec(:)...th.:.../).....IJf l- ~iL .... .=..;-~. c. . Dolce of repo~~~ (Type or praM) ]-.:.L--:.1..r!..fj ... Addre'l.S ~~.;';)" ~~?~~.....S;~$~ ::.~ ,.-P_r ( BEFORE THE INDUSTRIAL ACCIDENT cor;;USSION OF THE STIlE OF CALIFOR.~IA CASE NO. 57-LA 182-835 GRACE RILEY, by her Guardian 'ad Litem and Trustee, James C. Riley, Applicant, VB ORDER APPOINTING JOHNS-MANVILLE, INCORPORATED, a corporation; SOUTHERN ASBESTOS & p~GNESIA CORPORATION, a oorpora- tion'; ASBESTOS CONPANY OF CALIFORNIA; PLANT RUBBER & ASBESTOS WO~S (COl-tPANY) ; LOS ANGELES RUBBER COMPANY; MARINE TRUSTEE, FINDINGS AND A\OIARD, AND ORDER FOR CONTRIBUTION ENGINEERmG COM'ANY, a corporation; FIBERGLASS ENGINEERING & SUPPLY . CO~~ANY, a oorporation; ROBERT O. LOS AN::~LES C~FiCE LYNCH, an 1ndividual, doing business as Lynoh Asbestos Company and Lynoh Asbestos Company, a corporation; PLANT INSULATION COMPANY, a corporat1on; COAST INSULATION PRODUCTS, a FILES STATAUG"~;:i~~; itt.F- \N i LLL; ~\~ :.(,~ ?L.L.!'.: corporation; ARlt1STRONG CORK COMPANY, a corporation; J. T. THORPE, INC., i'l:i~r, SECRETA.\'.' a corpora t1on; \'lARREN AND BAILEY j TOT!1AN-MORGAN COMPANY; o\'iENS-CORNING FIBERGLASS COIJIPANY, PACIFIC COAST DIVISION; PLANT INSULATION AND THORPE COMPANY; WESTON ASBESTOS COMPANYj I~. R. CARPENTER; PLANT RUBBER AND ASBESTOS WORKS; EARL O. STICE COMPANY; UNITED CORK COMPANY; CORK INSULATION COMPANY; MUNDT CORK COlv1PANY; ~mTAL CLAD INSULATION CONPANYj OIL FIELD CONSTRUCTION; E. J. BARTELLS COMPANY; ISOTHllU4 COMPANY; JAI~ & OLNEH C COMPANY; ASBESTOS F~ODUCTS COMPANY; UNITED REFRACTORY CONSTRUCTION COMPANYj FHILIF CAREY I\!ANUFACTURING COMPANY; REESE INSULATION COVLPANY; LOS ANGELES CORK COMPANY; MOUNTAIN STATE CONSTRUC- TION COMPANY; FIBREBOARD PAPER PRODUCTS CORPORATION; PARRIFINE COI4PANY, IN- CORPORATED; C. R. DUTTON, C. A. LEIGHTON I v!ESTON FIBRE GLASS SUPPLY; LTD. i \ .I , ( ( I a corporation; Af.iERICAN NOTORISTS INSURANCE COMPANY, a corporation; ZU!UCH INSURANCE COi!?ANY, a corporation; PACIFIC E~~LOYERS INSURANCE Cor1PANYI a corporation; STATE COHPENSATION INSURANCE FUND; THE UNITED PACIFIC INSURANCE COMPANY, a corporat1on; STANDARD ACCIDENT INSURANCE CONPANY; a corporation; GENERAL ACCIDENT, FIRE & LIFE INSURANCE CORPORATION, a corporationj . NATIONAL AUTOMOBILE AND CASUALTY - cor-1PANY, a corporat1onj LIBERTY MUTUAL IiSURANCE cor~ANY, a corporation, -----------------D--e-f-e-n-d-a-n-t-s-. --------- Hays, 1lcLaughlin and Evans, applicant's attorneys by John F. McLaugh11n, Spray, Gould and Bowers, by David B. Allen, attorneys for Guarantee Insurance Co. Her11hy and Herlihy, by George Thompson, attoIneys for Industrial Indemnity Co., Fireman's Fund Insurance Company, Argonaut Insurance Company, and Employers Liab1lity. Assurance Corp. of London, England Clopton and Penny, by Robert M. Penny, attorneys for pacifio ~oyers Insurance co. Weingand, Tipton, Kend1g and Stockwell, by Claude Heingand, attorneys for United Pacific Insurance Company, General Aocident Insurance Corporation and Associated Indemnity Co. Brobeck, Phelger Jr., attorneys and for Harrison, by Plant Rubber Rinaldi Sc1aroni, & Asbestos Works, self-insured, and Fibreboard Paper Products Corporation, fo~crly known as The Company, Inc., also formerly known Parr1f1ne as pabco ProdUcts, Inc., selr-~nsured Joseph Bllchak, representing Insurance Company The Travelers Ray Cusick, attorney for Standard Aco1dent Insurance Company F. E. Carignan, representing American Motor1sts Insurance Company 1.1cCaskey and Licker, by Robert Lioker, for National Automobile and Casualty attorneys Co. George R. Haswell, by George C. Shelton . ( ( IT IS ORDERED that James, C. Riley be and he 1s hereby apPointed Trustee for Grace RileYI to serve without bond. An APplication for the statutory death benefit having been filed herein and the defendants under prior Find1ngs and AW2rd having filed their Request for the joinder of addit10nal ... :,.~ empl.oyers and insurance carriers l together \'1ith Petition for ". apportionment and Contribution~ and the matters having been regularly heard and submitted for decision, GEORGE A. MARTINELLI, Rereree~ makes his Find1ngs and Award for the statutory death benefit and Order for Contr1bution as follows: FINDINGS OF FACT 1. James Whitcomb Riley, born October 23, 1899, while employed as an insulator by various employers 1n the State of California~ commencing 1n the month of January, 1920 and continu1ng through May 19, 1957, susta1ned injury ar1sing out of and occurring in the course of his employment as follows: In the performance of his occupational duties, the employee eas exposed during each and every day of h1s employment to deleterious dusts wh1ch caused a pneumocon1osis W1th 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 'liab1lity for said disability J. ---. I ( ( 4. Said employee died January 24, 1961. Said death was proximately the result ot the industrial injury herein. 5. Deceased left surviving him, totally dependent, Grace Riley, his \,lidow, \'lho is entitled to the statutory death be~ef1t 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 be-st interest's--of-the- applicant herein that the death benefit be corrmuted 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 disabi11ty 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) Re1mbursement for self-procured medical treatment, $233.00; f) Lien claim of veterans Administrat10n 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 d1s- ab1lity has been pa1d and all med1cal treatment furnished by Industrial Indemnity Company, a corporation, except as hereinafter noted~ ,t! ( 12. The Travelers Insurance CornpanYI a corporation, is entitled to a lien against unpaid compensation in the sum of $200.00. 13. veterans Administration is entitled to a lien in the sum of $3,487.55 payable bJ' Industrial Indemnit~' Cor.:pany" 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 \'lhich Industrial Indemnity compa~y, a corporation, was the carrier. The liability of those known employers and insurance carriers based upon periods of exposure is as follows: who~p , i . . Plant Rubber and Asbestos $ \'!orks (Company) Associated Indemnity Co. United Pacific Insurance Co. General Accident, F1re & Life Insurance Co. National Automobile & Casualty Co. American Motorists Insurance Co. Guarantee Insurance Co. Liberty Mutual Insurance Co. Standard Accident Insurance Co. State Compensat10n 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 Indemn1ty Co. Pacific Employers Insurance Co. Total $ 6,061.81 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 2,705.28) 4,603.63 25,720.07 15. There are emPloyers and insurance carr1ers ( " , J Riley, Trustee, the sum of $13,447.31, payable forthwith, togethe~ with interest as provided by law; less $750.00 payable to Hays, 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 Admin1stration. ORDER FOR CONTRIBUTION IT IS ORDERED that the- . employers listed below pay to Industrial Indemn1ty Company, the following amounts forthwith: or carriers a corporation, Plant Rubber and Asbestos Works (Company) Associated Indemn1ty Co. United Pacific Insurance Co. General Accident, Fire & Life Insurance Co. $ 6,061.81; 81.85; 842.05; 51.26; National Automobile & Casualty Co. American Motorists Insurance Co. Guarantee Insurance Co. Liberty Mutual Insurance Co. Standard Acc1dent Insurance Co. State Compensation Insurance Fund Argonaut Insurance Co. The Travelers Insurance Co. Employers Liability Assurance Corporation, Ltd. of London, England -84.47; 1,473.37; 651.77; 441.09; 219.31; 1,085.58; 733.59; 1,324.91; 1,481.54; . PARTIES SERVED: 8-3-61 nn: Grace Riley, 1596 \'lest Juno Avenue, Apartment I, Anaheim, Cal1f. James C. Riley, 1596 west.Juno Ayenue, Apartment I, Anaheim, C~lif. Veterans Administration, 5701 Bellflower Blvd, Long Beach Veterans Administration, 5901 East 7th Street, Long Beach Attn: A. P. Willis, Registrar Hays, f1cLaughlin and Evans, 6331 HollY~'lood Blvd, Los Angeles 28 Spray, Gould and Bowers, 1671 ~'iilshire Blvd., L.A. Herlihy and Her11hy, 412 W. 6th Street, L.A. 14 Clopton and Penny, 639 S. Spring St., L. A. 14 \'/eingand, Tipton, Kendig and Stockwell, 611 S.Cata1ina, L.A. Brobeck, Phe1ger and Harrison; 111 sutter st., San Francisco Joseph BI1chak, The Travelers Insurance Co. 510 W. 6th st, L.A. Ray Cusick,. Standard Accident Ins. Co.. 548 S. Kings.ley, L.A.. _. _.. F. E. Carignan, American Motorists Ins. Co'--3545- Wilshire,L-.A";-- McCaskey and Licker, National Auto. & Cas. Co. 639 S. Spring, L.A. George Haswell, Liberty Mutual Ins. Co. ~ 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 Indemn1ty 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 \oJi1sh1re, L.A. Argonaut Insumnce Co. 1001 v!ilshire Blvd, L.A. Employers L1abi1ity Assur. Corp .of London, England, 639 S. New Hampshire, L.A. Pacific Employers Insurance Co. 1033 S. Hope st., L.A. t- United Pacific Insurance Co. 616 S. Shatto Place, L.A. I General Accident, Fire and Llfe 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. 6th 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. S~ring st., L.A. Arnold Smith, Sacramento Division of Labor Statistics, San FranciSCO Johns-Manville, Inc. P.O.Box 9067, Long Beach lOp Attn: Bert G1lbertson '.\ -- f REGINALD H SMART. M D . ..JOSEPH F. BOYLE:. M D . ..JOHN K SHIREY. M. D. 11.]6 W[ST SIXTH STFt[.[T LOS ANGE:LE:S 17 MAClsc .... 57697 September 19, 1957 .I f . 1..~: ,,~ f i Mr. William T. Hays Attorney at Law 6331 Hollywood Boulevard Los A..'1ge'les 28, California RE: James Whitcomb Riley Dear Mr. Hays: The following rep:>rt is sent to you at t~e request of Mr. James W. Riley whom we first examined on June 27, 1957 with regard to his pulmonary condition. The following history and fin~ngs were obtained: Resic.e..~c :-.istorv: ~'h". ?..iley was born ir: Joplin, Missouri on October 23-,--1-8-9-9--. --H-e--h~a-s- lived in the Los Angeles area since 1903 with the following exceptions: In 1918 he was briefly in Quantico, Virginia. :?rom 1136 to 1942 he lived ill San ?rancisco. In 1947 he was in Fresno, California for two months. In 1952 he worked in Daina, Indiana for six months. In 1955 he was in Santa Maria, California for four months and in Las Vegas. Nevada for four months. In 1956 his work required a seven month stay in San Diego, California. Occupational history: Since 1919 Mr. Riley has been employed in the heat insulation industry, his \York requiring the application of insulating materials to boilers, steam pipes and other structures requiring insulation. The insulatin6 materials which he has worked with include asbestos, block, Detrick block, Kalo. rockwool. fiber glass, cork and Mono block. He believes he may also have worked with diatomaceous earth occasionally as a loose powder to b~ applied against boilers to provide a porous material which will allow for expansion and contraction of the boiler due to tem- perature chan.;es. The other materials mentioned above are supplied in ~ various forms such as bloc!~s, cored cylinders, sheets. and blankets. Very often it was necessary to cut the blocks or sheets using a hand saw. It was also necessary to hamm::r nails through this material to secure it in its plopl~r location. Since this work was often done in confined spaces such as boilpr rooms, a ;.igh dust cO''1centration was frequently attained in poorly ( ( -2- Mr. William T. Hays Re: James Whitcomb Riley September 19, 1951 ventilated areas. Occasionally Mr. Riley wore a mask when the dust concentration became uncomfortable. Onset and course of present illness: Mr. Riley considered himself to be in good health until 3 1/2 years ago when he first became awa.re of shortness of brea.th upon exertion which has slowly progressed. At present he feels short of breath when walking rapidly on the level or when willing up an incline. Approximately three years ago, he became aware of cough which has persisted to the present and is productive of 2 to 3 teaspoons' of mucoid sputum daily. There has not been hemoptysis, edema, orthopnea or paroxysmal nocturnal dyspnea. He has not been aware of fever. For the past several months, he has noticed minimal btermittent left lower anterior chest pain which is not related to exercise, rest, meals or position. It usually disappears spontaneously 1 to 2 hours after onset. Weight loss of approximately 20 pounds has occurred during the past 12 months. Mr. Riley first became aware of a definite pulmonary abnormality when he was recalled by the Los Angeles City nealth Department after having had a routine chest film in May, 1957. Further examinations were made including x-ray and sputum tests. A letter from .Jr. Morris J. Schill dated July 15, 1957 indicates that sputum examinations on 6-10-57 and 6-21-57 revealed acid~fast bacilli in the smear of the concentrated specimen. The tuberculin skin test reaction was positive. The diagnosis was indicated to be far advanced, pulmonary tuberculosis, active. It was thoaght that pulmonary asbestosis might be present. Mr. Riley was next examined by Dr. Dean S. Scofield of Los Angeles whose conclusion on his report 0. July 17, 1957 was that Mr. :a.iley had pulmo!lary tuberculosis, right, moderate, with cavitation. C~!..ef comelain~s:_ 1) Shortness of breath with exertio!l, progressive since onset 3 1/2 years ago. 2) Persistent cough for 3 years, productive of 2 to 3 teaspoons of mucoid sputum daily. 3) Weight loss of approximately 20 pounds durin3 the past year. In~entory 0. systems: No other symptoms were elicited by systematic que s tiouin:;. f Past medical his.!ory: _..Juring childhood Mr. Riley had had measles, mump3, chicken pox, who.::>pi1l6 COUlh and scarlet fever. None of these were s CVere and there were no complications. A varicocele was removed in 1919. ( - 3Mr. William T. Hays Re: James Whitcomb Riley ( September 19, 1957 Family history: Mr. Riley's mother died at age 74 of unknown cause. His father died at age 73 of a heart attack. He has one brother and two sisters who are living and well. His wife and three children are living and in good health. There is no familial history of tuberculosis, diabetes, cancer or hypertension. Habits: Mr. Riley smo!tes one package of cigarettes daily and uses alcoholic beverages to a moderate extent but takes no regular medic,adons. Phxsical examination: Mr. Riley was seen to be a thin well-developed white male who appeared chronically ill. His height was 69 1/4 inches; weight, 119 pounds; temperature, 98.6 degrees; pulse, 80 per minute; respirations, 20 per minute; and blood pressure, 122/70. Examination of the chest revealed moderate increase in the antero-posterior diameter of the chest. Both pulmonary bases lagged with deep inspiration. There was increased muscle tension over the right upper posterior chest. The lungs were hyperresonant to percussion ov:!r the utl?er lobes and there was diminished reSO:lance at both bases. Breath sounds were bronchovesicular over the upper two-thirds and bronchial over the bases. Fine crepitant and crackling rales were present at all bases, anteriorly, po steriorly and laterally. Th~ point oi maximum cardiac impulse was just to the left of the xiphoid pt'ocess. No thrill was palpable. A .:;inus mechanism prevailed and the heart tones were distinct at the apex and distant at the base. No murmurs were heard and the pulmonic second sound was slightly louder than the aortic second sound. There was erythema and induratio!l. of a?proximately 2 cm. diameter on the right forearm which Mr. Riley stated was the residual of a recently administered skin test. The remainder of physical findings were all within the range of normal. Flu~roscopic examination of the chest: An infiltration with possible cavitation was noted in the right apex and subapex. Linear fibrosis was present in the lower half of both lungs. The diaphragms moved approximately 3 to 4 cm. and equally. In the lateral projection they were noted to be flat. Although the heart was not totally enlarged, the right ventricle appeared prominent in the left anterior oblique prOjection. -, " 6-27 -57 - Blood count: Egb. 92% or 13.5 6m3. WBe 9,500. Platelets average. Di.ffercntial - Eo. 4. Prone 54. Seg. 50. Lymph. 39. Mono. 7. Morpl101o~y normal. hematocrit 46 mm. in one hour. Sedimentation rate (Wintrobe) 31 m~. in on~ hour. Corrected 29 nun. in one hour. ( ( - 4- Mr. William T. Hays Re: James Whitcomb Riley September 19, 1957 6-27-57 - Urinalysis: Morning, straw, clear, specific gravity~ 1.011. Negative for albumin and sugar. Microscopic - 0 to I white blood cell per high power field. Small amount mucus. Rare epithelial. Few bacteria. 6-27-57 - Intradermal skin tests: Coccidioidin - negative. Histoplasmin - negative. ., 7-2-57 - (Clinical Laboratory otC. Richard Smith, M.D.) - Sputum specimen, 3 ce. mucoid material: Wetmount for asbE-stos bodies: Negative. There is one large mass of elastic tissue showing alveolar formation. There are hyaline - glassy - straight fibres 3-5 microns in diameter and 1/8 1/2 of an oil immersion field in length. They resist the action of acid. Flotation-concentration for acid-fast bacilli: Negative. GRAM STAIN shows large numbers of gram positive cocci in clusters and in chains; gram positive diplococci and large gram positive rods. There are degenerated pus cells and a few epithelial cells. Add-fast stain on the elastic tissue revealed no acid-fast bacilli altho'lgh some o.f the material was lost in transfer. 7-2-57 - SrlUtum bpecimen 3 cc. mu.coid material (Clinical Laboratory of C. Ri.chard Smith, M. D.): Sup?lemcntary report on studies for asbestosis bodies. The remaining sodium hydroxide sediment was treated with ehlorox and centrifuged at high speed. The resultant sediment and wetmount revealed three completely characteristic asbestosis bodies. These bodies give the P ... ussio~ blue stain reaction. 7-2-57 - 3 day sputum and gastric contents 40 cc. cloudy fluid CO!ltaining approximately 20 cc. mucopurulent (Clinical Laboratory of C. \ Richard Smith, M. D.): Clliture for M. tuberculosis - several hundred ~hotochromogenic colonies of acid-fast bacilli (We do not believe these are M. tuberculosis. They are similar to a myco-bacterium capable of cau3ing human disease. The guinea pig results will help to clarify the identification. Meanwhile other tests will be carried out. Guinea pig inoculation for M. tuberculosis: Negative. (See attached letter) 7-2-57 - Culture from gastric-sputum specimen: Screening ~ Sensitivity test: Streptomycin - 99 8/1010 of the organisms are sensitive (2/10lo are resistant) to 10 meg. of strepto:nycin per mI. Para-amino- salicylic acid: 100 per cent of the Qxganisms are resistant to 10 meg. of para-aminosalicylic acid per ml. Isoniaz;id: 95 per cent of the organisms are scn;;itivc (5 per cent il.rc resistant) to l meg. of isoniazid per mI. I . ( ( - 5- Mr. Wiiliarn T. Hays Re: James Whitcomb Riley September 19, 1957 7-10-57 - (Clinical Laboratory of C. Richard Smith, M. D.) 72 hr. sputum specimen 25 cc. sero-mucopurulent: Flotation-concentration for acid-fast bacilli: 2 plus positive (20 to slide). Culture for M. tuberculosis: Several hundred colonies of photochromogenic acid-fast bacilli. These are not M. tuberculosis but they are characteristic of a myco-bacterium capable of causing human disease. Diagnosis: 1) Pulmonary fibrosis exhibiting the prinCipal ~a.tures of asbestosis although contributing effects from the inhalation of silica, magnesium, fiberglass, foam6 lass, rockwool, and possibly diatomaceous earth must be considered. 2) Pnlmo:lary emphysema of mild to moderate severity and secondary to pulmo!lary fibrosis. 3) Pulmo:lary inflammatory disease involving the apex and subapex of the right luns. Preliminary studies indicate that this process is due to a non-tuberculous photochromo- .. genic acid-fast bacillus which may produce a clisease quite similar to tuber- culosis in its clinical maniiestations and chronicHy. Degree of disability: Mr. Riley is permanently and totally disabled for the type of wo,k whic:t he has done since 1919. At present he is totally disabled for any type of physical activity pending control of the p'.llmo!lary inflammatory disease. Progno:;is: Pulmonary fibrosis of this type tends to be progressive while dust exposure continues, as the serial chest x-rays have demonstrated in this case. Prozression is also apt: to occur in the presence of superimposed chronic pulmonary inflamm~tory disease. Adequate treatment of the infectious process with modern drugs may modify the fibrotic reaction~ b'.lt the nature and degree of this influence is not predictable owing to the relatively short period that this form of treatment has been used in the prese::lce of combined pulmonary disease. Reco:nmendations for treatment: Mr. Riley requires sanatorium care with bedrest and ap?ropriate chemotherapy. Preliminary studies by Dr. C. Richard Smith1s laboratory indicate that Streptomycin and Isoniazid arc the most effective of the drugs tested for the treatment of the inflammatory disease. Physical examination and x-ray study of the chest at ~ periodic intervals will be necessary to evaluate the response of the inflammatory disease and to detect any progression of fibrosis. Complete pulm.:onary function studies should ~e repeated in a.pproxim.atllly O!'l.ll yea.r. In the event pro:;ression of fibrosis is demonstrated, consideration of more ( ( - 6- Mr. William T. Hays Rc: James Whltcomb Riley September 19, 1957 agressive therapy such as intermittent positive pressure breathing and steroid medication may be necessary provided the inflammatory disease is under sufficient control to permit such therapy. Relationship of patient's condition to employment: Mr. Riley's occupation for the last 35 years has been confined to the application of heat insulation materials. There has been no other source of industrial d'\st exposure. The x-ray films show pulmonary fibrosis of a pattern which is more suggestive of asbestosis than any other single entity. Asbes'tos bodies have been recovered from the sp'~tum. There is no clinical evidence of bronchiectasis nor of chronic passive congestion of the lungs due to left ventricular failure. In my opinion, Mr. Riley has pulmonary fibrosis of occupational origin. The presence 01 pulmonary fibrosis may have been a significant factor in the development of pulmo::J.ary inflammatory disease and its subsequent course. If I may amplify or clarify any of the preceding statements, it will be my privilege to do so. JKS:ark EllCS.